A new method of surgical treatment of vasculogenic impotence

The authors describe a method of surgical management of vasculogenic impotence consisting in the formation of an anastomosis of an autovenous shunt with the dorsal artery of the penis. To prevent revascularization of the cavernous bodies of the penis with the restoration of erection, the dorsal artery of the penis is divided transversely at the root of the penis, the distal end of the autovenous shunt is given the shape of a trapezium with the upper side sutured, after which the autovenous shunt is anastomosed end to end with both the distal and proximal segments of the dorsal artery of the penis at the lateral sides of the trapezium where the angles were not sutured. The method allows incompetence and thrombosis of the vascular anastomosis to be prevented, raises the efficacy of revascularization of the cavernous bodies of the penis by creating favourable hemodynamic conditions through separation of the blood flow into the distal and proximal segments of the dorsal artery of the penis, which provides retrograde supply of blood into the deep artery of the penis sufficient for adequate revascularization of the cavernous bodies.     

Clinical and morphological substantiation of the surgical treatment of post-traumatic neurogenic deformations of the limbs in children

The authors have analysed and determined the role of such clinical factors as the age of the patients, the level of the nerve lesion, the period of time since the moment of the injury, the lesions of the arterial vessels and the individual regenerative capacity of various nerves with the aim of defining the optimal period of time for surgical correction of neurogenic deformations of the extremities in children in cases of the peripheral nerve lesions. Morphological investigation of the paralysed muscles of 56 patients with lesions of the peripheral nerves was carried out. Characteristic structural and functional changes in the denervated muscles were established and the terms of appearance of irreversible changes were determined.A conclusion about the necessity of surgical treatment within the period of 1 year and more since the time of the nerve injury has been made on the basis of the investigation. Positive results of the treatment of 180 patients confirmed the correctness of the authors' conclusions.     

The operative cure of hallux valgus and bunions

The main basic factors in the etiology of hallux valgus and bunions are the adduction of the metatarsal bone of the big toe and the obliquity of its tarsometatarsal joint.The conspicuous and obvious causes of the discomfort and disability are the valgus of the big toe, bony overgrowth at the base of the big toe and the overlying bursa or bunion.The author's operation aims to correct all of the pathological changes without disturbing the function of the big toe joint or the weight bearing surface of the head of the first metatarsal.The adduction of the first metatarsal bone is corrected by the removal of a double wedge from the tarsometatarsal joint, the mobilization of the metatarsal bone and the manual approximation of the first and the second metatarsal.The overgrowth of bone on the head of the metatarsal and the bunion are excised through a separate incision.The correction of the valgus of the big toe is assured by securing to the metatarsal bone a tongue of strong tissue, consisting of bursal wall and capsule, which is attached to the base of the phalanx.Care is exercised not to remove or in any way disturb the articulating portion of the head of the metatarsal bone. This accomplishes two results, namely, the support of the forefoot is not altered and the mobility of the big toe is not diminished.By bringing the big toe into line with the inner border of the foot, the sesamoid bones are returned to their normal relation to the head of the metatarsal, and the dorsal and plantar tendons of the big toe are brought into a normal or nearly normal position, where they can function properly.     

Changes in the synovial medium in deforming gonarthrosis

The authors have determined the changes in the synovial medium of the joint characteristic of various stages of severity of the disease in 248 patients with deforming gonarthrosis on the basis of arthroscopic and thermographic studies and investigation of the permeability of the synovial membrane in the complex with clinical and roentgenologic examinations. At the initial stages the signs of local reactive inflammation of the synovial membrane near the foci of degeneration of the articular cartilage prevail. For the late stages a trend to spreading of the reactive inflammation of the synovial membrane with the development of sclerotic changes in the previously affected areas is characteristic. A comparison of the results of arthroscopy, infra-red thermography and the permeability of the synovial membrane point at parallel changes in the synovial medium and in the microcirculatory and regional circulation of the knee joint. These findings may be used for working out the rational tactics of treatment of the patients with deforming gonarthrosis.     

Predicting surgical risk in acute cholecystitis

From mathematical treatment of the results of operative treatment of 163 patients with acute cholecystitis on a computer with the use of program complexes on the basis of the mathematical theory of image recognition the authors obtained a decisive rule which allowed calculation of the prognostic index reflecting the severity of the patient's condition and the prognosis of the surgical treatment according to the initial values of total protein, leucocytosis, AlAT, and the patient's age. Besides, the efficacy of the preoperative management can be judged from the dynamics of changes of the index. Development of the tactics of treatment of patients with acute cholecystitis on the basis of the prognostic index improved the results of operative treatment considerably.     

Skin grafts with axial blood supply in correcting post-traumatic defect of the foot

The analysis of the results of the surgical treatment and the orthopaedic provision of 117 patients with extensive wound defects of the feet has allowed the authors to consider the most important factors to be as follows: the determination of the limits of the saving approach to the preservation of the bone matrix, the choice of the optimal method of dermatoplasty (the method of plasty, the type of the graft) and the rational prosthetic and orthopaedic provision. Such approach has allowed to work out the possible versions of the surgical treatment using the grafts with axial blood supply in 6 main types of the injuries of various segments of the foot.     

Gas exchange and metabolic functions of the lungs in endotoxic shock

The experiments were carried out in 27 dogs with endotoxic shock under conditions of the artificial ventilation of the lungs and barbital anesthesia. It was established that under the above conditions the metabolic functions of the lungs were the first to be impaired. The artificial ventilation of the lungs fails to prevent the development of the impairment of the surfactant-synthesizing function of the lungs as well as the serotonin-inactivating function of the lungs. Two stages of the development of the shock lung syndrome were distinguished: the first one is the disturbance of the metabolic functions of the lungs; the second one is the disturbance of the gas exchange function of the lungs.     

The early identification and classification of growth disturbances of the proximal end of the femur

An analysis of the serial radiographs of sixty-eight patients who were treated for congenital dislocation of the hip revealed that a growth disturbance of the proximal end of the femur that was caused by partial or complete physeal closure developed in thirty-three of these patients. The disturbances were related to the character of the metaphyseal growth-disturbance lines and were subsequently classified according to the site and extent of physeal closure. In order to study this problem, we divided the physis of the proximal end of the femur into two contiguous sections: a medial and a lateral portion. Two typical patterns of premature closure were identified: one located at the junction of the medial and lateral portions of the physis and the other located in the area of the medial portion of the physis alone. The pattern of physeal closure, together with the age of the patient at the time of closure, determines the subsequent growth of the proximal end of the femur. The final outcome of growth of the proximal end of the femur can be predicted within six months after the initial treatment. Epiphyseal changes were found to be of no prognostic significance in the absence of physeal closure.     

游离足内侧皮瓣的解剖研究与临床应用

目的 改进和完善以足底内侧动脉深支的内侧支供血的游离足内侧皮瓣的设计和应用技术。方法 基于８只足标本的解剖观测结果,制定独特皮瓣设计方案,应用游离足内侧皮瓣修复手部皮肤缺损４例,改进如下：皮瓣静脉回流选用大隐静脉,缝合皮瓣的隐神经带,利用动脉蒂的伴行静脉与受区动脉吻合,挽救发生动脉危象的皮瓣等。结果 ４例皮瓣均完全存活,效果良好。结论 皮瓣设计例题,将该皮瓣的深静脉动脉化是动脉危象的有效补救措施,     

Clinical picture of anterior instability of the shoulder joint

The authors have studied the clinical picture of 360 patients with primary traumatic dislocations and the long-term results have been observed in 286 patients. The analysis of 50 arthrotomies of the shoulder performed in cases of anterior instability has been made. A direct relationship between the clinical course of instability and the severity of the intra-articular lesions appearing during the first traumatic dislocation has been established. Such lesions include ruptures or avulsions of the anterior portion of the cartilage wall, ruptures of the joint capsule, avulsion of the capsule from the neck of the scapula, fractures of the anterior border of the glenoid cavity, compression fracture of the posterior lateral portion of the head of the humerus, etc, Inadequate treatment of traumatic dislocation leads to instability in the form of frequent dislocations or subluxations in the shoulder joint. The surgical treatment of the instability should be directed at the reconstruction of the injured structures of the shoulder joint.     

Choice of the method of treatment of unilateral fractures of the femur and bones of the shin

The authors present their experience in the treatment of 74 patients with unilateral fractures of the femur and the bones of the crus. The peculiarities of these injuries which unfavourably affect the results of the treatment are discussed. Four versions of treatment are distinguished, with surgical treatment of fractures of the femur and the bones of the crus being the preferable one. The best results, concerning both the duration of the period of in-patient treatment and the final outcome, were obtained in cases of combined intraosseous osteosynthesis of the femur and perosseous osteosynthesis of the fragments of the tibia with Ilizarov's apparatus.     

Comparative study of electric excitability and metabolism in the assessment of vitality of the ischemized muscles of the amputated limb before replantation

The authors have studied the dynamic changes of metabolic processes and the functional and the structural preservation of the muscles under the influence of heat ischemia (18-21 degrees C) on 29 amputated posterior extremities of 21 adult dogs of the both sexes. It has been shown that direct muscle excitability disappears 5 hours after the influence of heat ischemia, although after 6 hours of observation the values of the metabolic processes in the muscles made 35-40% of the basic level. The character of the changes in the muscle excitability gives an idea of the duration of action of heat ischemia and the preservation of vitality of the amputated extremity only up to the moment of its complete disappearance. The final irreversible ultrastructural lesions of the overwhelming majority of the myocytes appear during the period of 6 to 8 hours of action of heat ischemia.     

Double fractures of the bones of the crus and their treatment

The authors have studied 256 patients with double fractures of the bones of the crus, the basis of the analysis of the causes, the mechanism of the origin and the clinico-roentgenologic picture a classification of the lesions and a number of new methods of treatment have been worked out which provide reposition and fixation of the fragments, prevent the development of early and late complications and contribute to reduction of the terms of treatment and disability. The method of treatment of double fractures of the bones of the crus with permanent skeletal traction has been improved. A method of insertion of metal rods into the tibia in cases of double fractures of the tibia with oblique planes of the fractures has been technically substantiated. A method of intraosseous administration of antibiotics and drugs and a method of subcutaneous fasciotomy (a. c. No. 1113098) with a fasciotome of the author's construction has been proposed. The application of a shock-proof clip of our construction (a. c. No. 310659) and slides in the joints (a device with rollers for a hinged plaster cast) contributed to an early recovery of the support function of the injured extremity. The long-term results of the treatment have been studied in 211 patients with double fractures of the bones of the crus and an analysis of rational use of the proposed methods of treatment has been made. To evaluate the results of the treatment the authors have applied clinical, roentgenologic, electrophysiologic, biomechanical and statistical methods of investigation. The results are positive in most cases.     

Micro-mesoscopic study of fibro-muscular structures of the venous nephro-adrenal transition in humans]

The purpose of this work has been to study the disposition of the fiber and muscular tissues of the wall of the supra-renal left vein, and of its transition to the renal vein. We analysed the disposition of the bundles of muscular, collagenic, elastic and myoelastic fibers, and how they integrate from a morpho-functional point of view. In a general way, we evidence the presence of strong longitudinal musculature in the venous wall, and condensations of the collagenic tissue at the level of the ostium of the mouth which constitutes real pillars of sustain of the bundles of the muscular fibers. In relation to the venous transition we concluded that, the morpho-functional architecture of the region, do not suggest the existence of a morphological sphincter but, in fact of the physiological sphincter.     

Development of the human anterior urethra

To further our understanding of the development of the anterior urethra a series of 38 normal human fetuses ranging from the end of the embryonic period proper to the third trimester of gestation were studied. Tissues prepared as serial histological sections were examined and appropriate specimens were reconstructed. The formation of the bulbar and spongy urethra occurred by proliferation of mesenchyme underlying the epithelium of the urethral folds, causing the creation of a tubular urethra by epithelial fusion in the ventral midline. The tubular urethra becomes invested by mesenchyme, the future corpus spongiosum. This process of fusion of the urethral folds extends to the glans penis. At this period of development the glans contains the urethral plate, a lamina of epithelium lacking a lumen. The mechanism of the subsequent connection of the spongy urethra to the canalized urethral plate has been the point of controversy. Our observations support the idea that 3 processes must act in synchrony to produce successful completion of the anterior urethra: 1) the prepuce forms by overgrowing the glans due to proliferation of the penile skin and subcutaneous tissues, and in so doing it continues the progression of closure of the urethral folds into the glans and forms the frenulum by its fusion on the ventral aspect, 2) the mesenchyme surrounding the prolongation of the urethra fuses with the mesenchyme of the glans, which before this time had existed as a mesenchymal structure distinct from the corpus spongiosum or corpus cavernosum and 3) the epithelium of the urethral plate within the glans, which underlies the epithelial tag, becomes canalized and develops continuity with the lumen of the spongy urethra.     

The highest permissible levels of resection of the esophagus in cancer during surgery with intrathoracic or cervical esophagogastric anastomoses

The levels of esophageal resection for squamous carcinoma were determined in 84 patients by measuring the distance from the incisors to the ring of the esophagogastric anastomosis during esophagoscopy. The radicalism of the operations was evaluated from the difference in the distance between the incisors and the upper border of the tumor and the distance between the incisors and the anastomosis. The mean levels of the highest possible resections of the esophagus were at a distance of 33.5 +/- 2.8, 23.6 +/- 2.0, and 20.4 +/- 2.0 cm from the incisors, respectively, in Garlock's operation, Lewis' operation, and Dobromyslov-Torek's operation with esophagoplasty using an antiperistaltic gastric pedicle. It is suggested that the choice of the method of surgical treatment should be based on comparison of the determined levels of the highest possible resection of the esophagus with the endoscopic assessment of the level of the upper border of the tumor in the esophagus.     

胶原酶在髌骨软骨软化中的作用

２４只新西兰兔，随机分４组。右膝髌骨手术方法造成髌骨倾斜状态为实验侧，左膝实施假手术为对照侧，定期处死动物后进行髌骨软骨面接触压力测量、软骨组织病理观察以及胶原酶免疫组化（ＬＡＢ法）定位。结果：实验膝髌骨倾斜后导致髌内侧面软骨接触压力降低，而髌外侧面软骨接触压力无明显变化；组织病理显示：髌内侧面软骨中层至深层明显变性、软化，髌骨外侧面软骨变性不明显；免疫组化染色显示：髌内侧面软骨中层、深层软骨细胞浆与周围软骨基质胶原酶明显增多，且自软骨下骨长入钙化层或深层的血管内皮细胞以及软骨裂隙边缘处胶原酶强阳性。而髌外侧面软骨胶原酶含量无明显增多。表明：软骨胶原酶增多部位与髌骨软骨软化发生部位及其程度相一致。作者认为，胶原酶对髌骨倾斜导致髌软骨软化过程中软骨基质的破坏起重要作用。     

Computed tomography in the determination of transarticular C1-C2 screw length

This study evaluated the significance of computed tomographic (CT) measurements of the upper cervical vertebrae and their clinical implications in transarticular C1-C2 screw placement. In the first part of the study, analysis of axial CT scans of the atlas of 46 patients who had a normal C1-C2 region was performed. Measurements included the vertical distance between the middle of the ventral cortex of the lateral mass and the anterior-most point of the anterior tubercle, and the angle of the anterior ring of C1 relative to the frontal plane. In the second part, axial CT scans of the upper cervical spine were performed in seven cadaveric cervical spines and analyzed using the same criteria. Using the Magerl technique of transarticular C1-C2 screw placement, one screw was placed in each cervical spine. Following each placement, a strict lateral radiograph was taken and the distance between the tip of the screw and the anterior-most point of the anterior tubercle of C1 was measured. Analysis of the cervical cadaveric specimens showed the vertical distance between the middle of the ventral cortex and the anterior-most part of the anterior tubercle when measured on CT scan corresponded to the distance measured on lateral radiographs after placement of the C1-C2 transarticular screw. The study of the 46 patients with normal C1-C2 region had shown the mean values of linear and angular measurements to be greater in males than in females, although no significant difference was found between the two groups (P>.05). The mean distance between the anterior-most point of the anterior tubercle and the middle of the ventral cortex of the lateral mass was 6.5+/-1 mm, and the mean transverse angle of the anterior ring relative to the frontal plane was 22 degrees+/-3.1 degrees. Axial CT evaluation of the individual anatomic relationships of the atlas is simple and may be a useful guide in the determination of the length of the transarticular screw when performed during surgery under lateral fluoroscopic control.     

Test bed for assessment of the kinematical determination of navigation systems for total knee arthroplasty. Does a limited range of motion of the hip joint influence the accuracy of the determination?

OBJECTIVE: To locate the rotational center of the hip joint, CT-less navigation systems for artificial knee-joint replacement use movements of the femur with a rigid body attached. It cannot be assumed that the hip joint provides free mobility at all times. The purpose of the present study was: 1) To build a mechanical model to assess the system's accuracy in locating the rotational center of the hip by simulating a step-wise reduction of the range of motion (ROM) of the hip joint. 2) To determine the system's resolution by assessing a critical distance between two positions of the same femoral rigid body during the process of locating the rotational center of the hip. 3) To determine the sensitivity of the navigation system to the rotation of a femoral rigid body relative to the femoral bone while locating the rotational center of the hip joint. MATERIAL AND METHODS: To assess the impact that a limited ROM of the hip joint has on the accuracy of determination of the hip joint's rotational center, a test bed was built. This enables validation of the algorithm used by a CT-less navigation system. RESULTS: In the first part of the study, it was shown that a reduction of the ROM of the hip joint to 30% of its initial value had no evident influence on the accuracy of locating the rotational center of the joint. In the second part of the study, it was determined that the limit of resolution between two spatial points of the pivoting process is between 4.4 and 8.7 cm. The third part of the study showed that the examined system rejected the determination of the hip center even when the rigid body was only rotated through 22.5 degrees . CONCLUSIONS: The results show that osteoarthritis of the hip with a limited ROM, for example, cannot be taken as a contraindication for the use of the evaluated CT-less navigation system. However, the surgeon should ensure that the pivoting of the femur is performed without hindrance within the free range of motion of the hip joint. In accordance with the vendor's recommendation, a minimum distance of 10 cm should be maintained between two spatial points. To ensure safe and unconstrained operation, the rigid body must be firmly attached to the bone and must not be dislocated.     

Histological and biomechanical observations of the rabbit patellar tendon after removal of its central one-third

Using 35 Japanese white rabbits, a study was made of tissue regeneration and the mechanical properties of the patellar tendon after removal of its central one-third. After removal of the central one-third of the patellar tendon on one side, in experiment I the strength of the entire patellar tendon including the regenerated tissue was compared with that of the patellar tendon on the opposite side with the central one-third removed at the time of killing, and in experiment 2 the strength of only the regenerated tissue was compared with that of the patellar tendon on the opposite side with two-thirds of the medial and lateral sides removed at the time of death. In experiment 1, the maximum load showed no significant difference between the operated side and the control. In one-half of the cases, the strength of the operated side including the regenerated tissue was weak, suggesting weakening of the patellar tendon on the residual bilateral sides. In experiment 2, the maximum load of the regenerated tissue was significantly lower than that of the control, the former being 25% of the latter even at 6 months. Histologically, the characteristics of the cells and collagen fibers gradually approached those of normal tissue, but the crimp pattern of the collagen fibers and fibrils was evidently smaller than that of the control. These results indicate that regenerated tissue was still mechanically weak and immature at 6 months.