Current problems in the diagnosis and surgical treatment of rare developmental defects of the lungs]

The author analyzes questions of diagnosis and surgical treatment of 168 patients with rare malformations of the lungs which made up 5.6% of the general amount of patients with surgical nonspecific diseases of the lungs and 36.1% among all defects of development of the lungs. It was established that diagnostics of rare defects of development of the lungs might be of full value but when using a complex of roentgenological, bronchiological and functional methods of examination. Surgical treatment of rare defects of the lung development is indicated to 86.1% of the patients and must be performed till the progressing of secondary alterations, when disturbances of ventilation and oxygenation are observed, there is blood flow shunt disturbances of hemodynamics of the pulmonary circus of blood circulation.     

Effects of electrets on bone reparation during intramedullary osteosynthesis

With the goal of improvement of intramedullary osteosynthesis efficiency in treatment of composite and associated fractures of long bones by way of improvement of fixatives according to their electrical properties and optimization of reparative electrogenesis conditions in 72 experiments with animals the effect of electro-conductive properties and electrostatic field of intra-bone implanted rods on the osteo-reparation following transverse osteotomy has been studied, the method has been elaborated and on the basis of dynamic analysis of 147 clinical observations has been given comparative evaluation of the results of polytetrafluorethylene intramedullary osteosynthesis. The advantages ethylene-based electrets application in case of intramedullary osteosynthesis. The advantages of electret application for activation of osteo-reparation, improvement of the results of treatment and reduction of terms of rehabilitation of victims with critical traumata have been demonstrated.     

Effects of cholecystokinin-octapeptide and tetragastrin on the contractile activities of the stomach, duodenum and papilla of Vater

Effects of cholecystokinin-octapeptide (CCK-OP) and tetragastrin (TG) on the stomach, duodenum and papilla of Vater were examined using 13 adult dogs. The contractile activities of the stomach and duodenum were examined using the strain gage, and the manometric study of the papilla of Vater was also performed. CCK-OP increased the contractile activities of the stomach and duodenum, but at the same time the pressure of the papilla of Vater was decreased. TG increased the contractile activities of the stomach, but decreased that of the duodenum and the pressure of papilla of Vater. CCK-OP lowered the pressure of the common bile duct, and that fall corresponded with the disappearance of the phasic contraction of the papilla of Vater. We concluded that the contractile activity of the papilla of Vater was independent of the contractile activity of the duodenum, and the most effective drainage of the bile was achieved at the time of the disappearance of the phasic contraction of the papilla of Vater.     

Diagnosis and treatment of obstructive jaundice of non-neoplastic origin]

The results of surgical treatment of 853 patients with obstructive jaundice of non-tumor genesis and initial bilirubin level in the blood of 100 mumol and higher are analysed. Individualization of therapeutic-tactical approach with the use of preoperative diagnosis of the level of obstruction of the bile ducts and severity of the state of a patient, and as well their preoperative decompression with the use of endoscopic methods permit to accomplish a number of measures aimed at reduction of the incidence of purulent-necrotic complications and lethality, improve the long-term results of treatment of the patients with obstructive jaundice.     

Minimally invasive technologies in the treatment of severe forms of acute pancreatitis at various periods of the disease

The choice of the optimum technique of the sanitation procedure in treatment of acute necrotizing pancreatitis (ANP) is now one of the most disputable problems. Clinical estimation of the efficiency of various operative techniques of treatment of ANP at various stages of disease has been made. In the aseptic phase laparoscopic decompression of the pancreas is indicated when the patient has evident hemorrhagic parapancreatitis. In the phase of septic sequestration of ANP the optimum method of minimally invasive surgical intervention is considered to be minilaparotomy which is expedient for abscesses of small volume, lipid abscesses of any volume with the minimal content of necrotizing tissues as the first step of sanitation in critical patient. High quantity of the necrotizing tissues in the zone of the destructive focus requires traditional laparotomy of the abscess under conditions of preventive maintenance of the endotoxic shock.     

Diagnosis of hypoplasia of the heart ventricles: role of morphometry and morphology in its assessment

The article deals with the results of the study of the quantitative anatomy and morphology of hypoplastic ventricles. The object of study were 28 specimens of the heart: 15 with hypoplasia of the left ventricle and 13 with hypoplasia of the right ventricle. The control group was composed of 10 specimens of normal hearts. Morphometry was conducted in all of the 28 specimens. At the same time angiocardiometry and calculations of the volume characteristics of the ventricles were undertaken in the diagnosis of hypoplasia of the right ventricle. The morphometric criteria of hypoplasia of the heart ventricles and their morphological variants were determined as a result. It was found that the lineal characteristics of the heart yielded sufficient information both for the diagnosis of hypoplasia and for determining its degree. Morphometry showed that constant ratios exist between the diameters of the atrioventricular valves and the lineal sizes of the ventricles in normal and pathological hearts. Knowledge of the aforesaid is of much practical importance because having determined the sizes of the atrioventricular valves during echocardiography one may calculate all linear characteristics of the heart and evaluate the sizes of the ventricles by means of the quantitative criteria. The article gives the method of such calculation, while its results are evidence of the high precision of the suggested constants.     

Use of robotics in the realization of external perosseous osteosynthesis

The authors expound the principles of making up of the algorithm (program) for diagnosis and implementation of the optimal variations of rod insertion in various types of fractures of the extremities and the method of adaptation of the program to a specific fracture according to its biomechanical characteristics. The succession of the realization of the program of insertion of the rods, reposition of the fragments and application of the apparatus with the aid of the robot are described.     

Possibilities of free osteoplasty with distraction osteosynthesis in correction of a defect of the long tubular bone]

A defect of the upper half of the tibial bone was compensated by an increment of the transplant to the cut of the femur, separation of it and graded descending into the defect in experiments in 12 adult dogs. Investigations of osteogenesis, of the fate of freely transplanted bone and of the influence of the transplant displacement on the topography and vascularization of the surrounding soft tissues have shown that use of large bone transplants allows to shorten the time of filling the defect and reduces deformities of soft tissues. Higher vascularization of the extremity and partial demineralization of the transplant observed under conditions of distraction facilitated reestablishment of the arterial network and organotypical reconstruction of the transplanted bone.     

The importance of the compensatory powers of the lungs in determining the indications for surgical treatment of hypoplasia of the lungs

The author studied the compensatory possibilities of pulmonary respiration, gas exchange and hemodynamics of pulmonary circulation to determine the indications for operative treatment of simple hypoplasia of the lungs. The work is based on the results of examination of 58 patients. Forty-five patients underwent an operation. It was established that simple hypoplasia of the lungs is characterized by mild ventilation disorders and deep disorders of gas exchange leading to manifest and latent hypoxia in 94.6% of cases. Deficiently developed pulmonary-arterial channel, the presence of morphological foundations of pathological blood shunting (up to 24-32% of minute pulmonary circulation volume) were the causes of disturbed hemodynamics of pulmonary circulation and the development of pulmonary hypertension in 30.6% of cases. The indications and contraindications for surgical correction of simple hypoplasia of the lungs are discussed on the basis of study of the functional condition of ventilation, gas exchange, and hemodynamics of pulmonary circulation.     

Serum myoglobin as an indicator of endotoxicosis in acute intestinal obstruction

To give objective assessmed of endotoxicosis, the authors for the first time have studied blood myoglobin as a marker of tissue hypoxy in 84 patients with acute obstruction of the small bowel. A strong correlation between serum myoglobin level and clinical manifestations of endotoxicosis was established. It enables the authors to recommend the study of myoglobin values in patients for quick and objective evaluation of endotoxicosis. As a result of comparative analysis of the pronouncement of clinical and roentgenological symptoms as well as changes in laboratory findings and among them--myoglobin level in 427 patients with acute intestinal obstruction, the authors demonstrate 5 stages of clinical course of the disease. Th stage of ischemia was in 48.9% patients. In 22% of them manifestations of obstruction were eliminated by conservative means, 26.9% of patients of this stage were operated. The stage of water-electrolyte balance disturbances was detected in 26.2% of patients. The stage of peritonitis was detected in 15.9% of patients. The stage of multiorganic insufficiency was revealed in 8.9% of patients. All of these patients were operated. The stage of rehabilitation took from 2 months to 3 years after the operation. Conservative symptomatic treatment was used in all these patients. It was established that maximal informativevalue of myoglobin study was achieved in patients at the stages of water-electrolyte balance disturbances, in peritonitis and polyorganic insufficiency. The results of the examinations allows evaluation of the stage of endotoxicosis, prediction of the course of the disease and assessment of the effectiveness of detoxication therapy.     

Distraction osteogenesis for bone repair in the 21st century: lessons learned

Bone regeneration obtained by distraction osteogenesis is influenced by a series of factors. These include factors that are related to the mechanical stability of the system of distraction (internal or external devices), and to factors directly depending on the biology of the bone tissue, such as the method of bone interruption (osteotomy), the delay and rhythm of distraction, the anatomical site of the osteotomy, and the histological characteristics of the bone requiring reconstruction. The stability of the system of bone fixation depends on the rigidity of the frame, the connexion of the apparatus to the bone (wires, pins) and the intrinsic stability of the segment (length and level of maturation of bone regenerate). The radiological characteristics of bone regeneration (hypo- or hypertrophy) lead to the adaptation of the rhythm of distraction. Following more than 28 years of experience of application of the Ilizarov method for bone reconstruction, the authors describe the technique of frame assembly and the methods of evaluation and treatment of the complications of new bone formation.     

Diagnosis and microsurgical correction of impotence of vascular origin

The authors worked out an original complex of instrumental methods for the diagnosis of impotence of vascular origin, which includes ultrasonic Dopplerography of the genital arteries, radionuclide examination of hemodynamics of the penis, and radiocontrast phalloarteriography with the use of intracavernous pharmacological load. The results of the study make it possible to increase essentially the efficacy of microsurgical correction of impotence of vascular origin through objective indications for operative treatment on the basis of the suggested diagnostic methods, improvement of the techniques of revascularization of the cavernous bodies, and pathogenetically substantiated tactics of postoperative rehabilitation of patients.     

Influence of the temperature regimen of sanitation of the abdominal cavity on the course of the syndrome of post-sanitation intoxication in patients with acute diffuse peritonitis

The aim of the investigation was to work out and study effectiveness of the method of sanitation of the abdominal cavity in patients with acute diffuse peritonitis based on a combination of using the properties of hypo- and hyper-thermal solutions. The complex of experimental investigations has proved the safe clinical use of the proposed method to be possible, discovered main pathogenetic mechanisms of a positive influence of heterothermy when performing sanitation of the abdominal cavity against the background of acute peritonitis. The results of clinical approbation of the method in 86 patients have shown sufficiently high efficiency of using sanitation of the abdominal cavity in heterothermal regimen in a complex of measures for treatment of patients with acute peritonitis that allowed getting reliably lower degree of post-sanitation intoxication, less number of complications and lethal outcomes.     

Late results of combined surgery of the veins and lymphatic vessels in patients with chronic lymphovenous insufficiency of the leg

An analysis of long-term results of treatment of 1258 patients with chronic lymphovenous insufficiency of lower extremities has shown the necessity of differentiated approach to different categories of the patients. A substantial improvement of results of the treatment of patients with complicated forms of varicose disease is observed in combination of operations on the venous and lymphatic systems. The character of these operations (lymphovenous anastomoses, lymphonodovenous anastomoses) must be determined strictly individually on the basis of an analysis of clinical course of the disease, data of lympho- and phlebography.     

Use of arthroscopic arthroplasty in the treatment of patients with degenerative diseases of the knee joint]

An analysis of results of treatment of 38 patients with 40 degenerative injuries of the knee joint by arthroscopic arthroplasty shows clinical effectiveness of this method only in cases with light and medium degrees of gravity of the disease. The absence of clinical effects of the complex conservative treatment of patients with osteochondrosis and persistent painful syndrome, mechanical symptoms of disturbances in the joint, recurring synovitis can be considered as indications for arthroscopic operations. The probability of achievement of positive results of arthroscopic treatment is higher in patients with the I-III degrees of injuries of the cartilage and IV degree--with a full thickness defect of the articulation surface as big as 1 cm in diameter in one part of the knee joint and on one of the joining condyles.     

下腰椎形态与椎管退行性狭窄的关系及其临床意义

目的:探讨腰椎形态与退行性椎管狭窄的关系。方法:测量男、女各100例体检人员L3/4以下椎间小关节角,椎体冠状径、矢状径,椎管中央和侧隐窝的前后径,了解椎体参数、椎间小关节角与椎管狭窄的相关关系,并进行统计学分析。结果:相关和偏相关分析显示椎间小关节角与椎管前后径为负相关关系,且与中央矢状径负相关程度更大;椎体矢状径、冠状径和椎管前后径均为正相关关系。偏相关分析显示椎体冠状径和侧隐窝正相关系数最大。P值均小于0.05。结论:腰椎小关节角增大会改变应力分布,加重不稳定倾向,加速腰椎退变;椎体矢状径、冠状径的增大有助于减轻退行性椎管狭窄。提示临床手术中应注意腰椎前、后路的重建、固定,特别是椎间小关节角已增大时。     

Changes in the surface and activation of circulating leukocytes after autologous transfusion of UV-irradiated blood

Under study was the dynamics of functional properties of leukocytes of healthy people and patients after UV-irradiation of their blood, mixing the UV-irradiated and non-irradiated blood. It was shown that UV-irradiation and mixing the irradiated and non-irradiated blood facilitated the liberation of bactericidal cation proteins of leukocytes, higher expression of membrane receptors, growth factors, activation of reparation of DNA after its injury by gamma-rays. It proves the role of immediate activation of leukocytes of the circulating blood in trigger mechanisms of effects of autotransfusion of UV-irradiated blood.     

Outcome treatment of pseudoarthrosis of long bones with decortication method depends on osteosynthesis]

Purpose of work was estimation of the results of treatment of pseudoarthrosis of the long bone with the method of decortication, with use of autogenic bone depends on kind of pseudoarthrosis and kind of osteosynthesis. In the years 1995-2005 56 patients were treated because of pseudoarthrosis of long bone in our Clinic. Pseudoarthrosis is classified according to Weber-Cech classification. In the methodology of clinical estimation and subjective estimation of the patient Stewart and Hundley and Anderson classification were used. Union was achieved in 51 cases. Time of bone union achievement was 5 months. The results of treatment are depends on morfology of pseudoartrosis and are independs of kind of osteosynthesis.     

Diagnosis and evaluation of the severity of arterial insufficiency of the legs using ultrasonic Doppler flowmetry in the treadmill test

A method of diagnostics and assessment of the severity of arterial insufficiency of lower extremities was developed on the basis of multistep treadmill-test and measuring time of reestablishment of continuous bloodflow in the popliteal artery by the method of ultrasonic doppler flowmetry. An examination of 40 patients with angiographically detected alterations of the vessels and 18 healthy persons was performed. It was found that the diagnostic and assessment criterion of arterial insufficiency in treadmill-test with high parameters of sensitivity and specificity is longer duration of the period of reestablishment of continuous bloodflow over 180 sec. The arterial insufficiency severity is estimated by the value of exercise by the moment of the appearance of the criterion.     

Clinico-experimental basis for regional and systemic administration of thiopoietins in liver cirrhosis. Report I

The authors present results of studying the effectiveness of a new class of medicines--preparations of the group "Glutoxim" (Molixan, Redoxell, Bikvolit, Liglutin) obtained on the model of experimental cirrhosis of the liver in 76 white rats caused by dimethylnitrosamin, and describe their first experience with using thiopoietins in 24 patients with cirrhosis of the liver in a surgical clinic. It was found that three weeks of treatment with Molixan and Bikvolit gave a significant hepatoprotecting effect (less amount of the connective tissue, reduction of the dystrophic processes in hepatocytes). A positive effect of Redoxell was shown in longer time of treatment. When used in clinic therapy with thiopoietins was followed by correction of the T-cell link of immunity in most patients. One of the most important results of treatment with medicines of the group of thiopoietins was a substantial improvement of the quality of life of the patients.