Self-directed learning in anatomy: incorporation of case-based studies into a conventional medical curriculum

This paper reports an attempt to develop self-directed learning skills in second-year medical students by introducing case-based projects into the gross anatomy course at a long-established medical school. The programme and students' responses to a questionnaire completed at the end of the year are presented. Information on the various resources used by students to find information is given. The performance of students in the case-based components of the course has been evaluated and also in the more traditional end-of-year written examination. The data confirm that students have recognized that the projects were about obtaining a deeper understanding of the anatomy, and the programme appears to have promoted the use and study of library texts.     

Treatment of equino-excavato-varus deformity of the feet in adults using a hinge-distraction apparatus

The treatment of severe aggravated forms of equino-excavato-varus deformation of the feet of various etiology is rather difficult because the resections performed to eliminate the deformation require the removal of large quantities of the bone tissue and are traumatic, and when accompanied by neurotrophic disturbances they are usually contraindicated. At the Central Institute of Traumatology and Orthopaedics 65 patients with acutely pronounced feet deformations have been treated with Volkov-Organesian-Povarov distraction apparatuses. In 34 patients the deformation was accompanied by various neurotrophic disturbances. The results were good in 61 feet, satisfactory in 18 feet and bad in 4 feet. The experiment has demonstrated the efficacy of apparatus treatment, especially in the cases of aggravated forms of feet deformations, where this method often is the only one available.     

Specific features of osteosynthesis using a pivotal compression-distraction apparatus

The article is devoted to the analysis of 5-year-long application experience of the rod-based apparatus with external fixation. The apparatus have been developed at the institute named after prof. M. I. Sitenko. Certain advantages and indications for rod-fixation in traumatology have been substantiated. In urgent traumatology the apparatus made the best showing in treatment of the open fractures. Possibility of these apparatus application as the treatment-and-transportation immobilization facilities in case of mass entrance of victims has been demonstrated. Rod-based apparatus are widely used for fixation in case of correcting osteotomies, limb stretching (especially of the femoral segment) in children as well as for fixation of the instable spine damages. Complications in case of rod application manifest themselves as suppuration of the soft tissues and osteomyelitis. But their number is lower as compared with the wire apparatus application.     

Hemodynamic evaluation of the effectiveness of preservation of subvalvular structures in mitral valve prosthesis

The article deals with the clinical evaluation of the results of mitral valve prosthetics with preservation of the subvalvular structures in 40 patients and comparative evaluation of the hemodynamic indices after prosthetics with preservation of the subvalvular structures of the posterior cusp and after routine mitral valve prosthetics. The authors show good clinical results in patients after valvar-preserving prosthetics of the mitral valve and essential improvement of left-ventricular contractile activity after such an operation. Comparative analysis showed that the total ejection fraction increased by 10.8 +/- 4.5% in the main group and reduced by 11.4 +/- 2.6% (p less than 0.01) in the control group. Left-ventricular end diastolic pressure did not change in the main group but increased significantly (p less than 0.05) in the control group. A conclusion is drawn that preservation of the subvalvular structures in mitral valve prosthetics is expedient even in patients with an initially grave condition because the method makes it possible to normalize intracardiac hemodynamics more rapidly in the postoperative period and essentially improve the contractility of the left ventricle.     

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.     

Immunoreactivity in suppurative keratitis

Immunologic analysis of blood serum of 40 patients with purulent keratitis has shown disturbances in T- and B-systems of immunity, especially in moderate and severe degrees of the disease. This dictates a necessity of further studies in this direction by using immunocorrective therapy.     

Socioeconomic differences in the use of physician services in Nova Scotia.

OBJECTIVES: Socioeconomic differences in use of physician services in Nova Scotia, Canada were examined. METHODS: The study was based on survey data, containing information on socioeconomic status, linked to physician claims data. Socioeconomic differences in use of physician services were estimated, adjusted for age, sex, and region of residence. RESULTS: Large socioeconomic differences were observed in the use of physician services, with use inversely related to both household income and education. These differences remained after adjustment for age, sex, and region. CONCLUSIONS: Use of physician services is inversely associated with socioeconomic status.