Use of Additive Technologies in Surgical Treatment of Chronic Posterior Dislocations of the Shoulder.

The aim of the study was to evaluate the efficiency of additive technologies in surgical treatment of patients with osteochondral defects of the humeral head articular surface against the background of chronic posterior dislocation of the shoulder by means of comparing clinical and radiological results with the McLaughlin procedure. Materials and Methods: A prospective randomized comparative group clinical study was conducted, which included 20 patients who in 2019-2021 underwent surgical treatment of chronic posterior dislocation of the shoulder in the Traumatological and Orthopedic Department of the Institute of Traumatology and Orthopedics of the Privolzhsky Research Medical University (Nizhny Novgorod, Russia). Depending on the type of surgery, all patients were divided into 2 groups: group 1 (n=10) was subject to McLaughlin procedure, whereas group 2 (n=10) - to reconstruction of the humeral head using a customized implant based on additive technologies (3D printing). To assess postoperative results, 6 months after the surgery all patients underwent the following procedures: X-ray imaging of the shoulder joint in two projections, CT scanning, and angulometry as well as provided their responses in line with the following questionnaires: Visual Analog Scale (VAS), Disabilities of the Arm, Shoulder and Hand (DASH), American Shoulder and Elbow Surgeons Shoulder Score (ASES), Constant Shoulder Score (CSS), Shoulder Rating Questionnaire (SRQ), and the Hospital for Special Surgery Shoulder Surgery Expectations Survey (Survey of patient, SP). Results: Both the McLaughlin procedure and the reconstruction of the humeral head using a customized implant made using additive 3D printing technologies increased the range of motion in the shoulder joint, mitigated the pain syndrome and improved the patients' quality of life. During the postoperative period, there were no infectious complications in both groups. The total bed-day in group 1 was 7 [5; 9] days; in group 2, it was 8 [6; 9] days. There was no recurrence of dislocation or progression of osteoarthritis of the shoulder joint in patients in both groups during 6 months after the surgery. The ASES, SP, SRQ, CSS, DASH, and VAS questionnaires assessment for both groups showed a statistically significant improvement for all indicators in the postoperative period. There were no statistically significant differences found between the groups as to the results of angulometry and answering the questionnaires. Conclusion: Customized implants made using additive technologies can shorten the surgery duration by 1.3 times, whereas the volume of intraoperative blood loss - by at least 1.5 times compared to the McLaughlin procedure.

[Effects of nirmin on central hemodynamics in patients with heart failure in the acute period of myocardial infarct]. / Vliianie nirmina na tsentral'nuiu gemodinamiku u bol'nykh s serdechnoi nedostatochnost'iu v ostrom periode infarkta miokarda.

Nirmin, a novel dosage form of nitroglycerin, was used to treat heart failure in 47 patients on days 1-3 after acute myocardial infarction. The drug was intravenously injected at 12-400 micrograms/min for 3-24 hours. Central hemodynamic changes were evaluated from equilibrium radionuclide ventriculographic data and pulmonary diastolic and central venous pressures. Nirmin improved the clinical status in 89.3% of the patients. Hemodynamic effects of the agent were manifested by reduced myocardial preload and its improved contractility, followed by elevated left ventricular ejection fraction and decreased hypokinesia of the myocardial affected areas.

[Changes in the hormonal profile in patients with ischemic heart disease during physical training]. / Izmenenie gormona'lnogo profilia u bo'lnykh ishemicheskoi bolez'niu serdtsa v protsesse fizicheskikh trenirovok.

Changes in blood insulin, thyroxine, triiodothyronine, thyrotropin, somatotropin, corticotropin, cortisol, and aldosterone were defined in 46 male patients with coronary heart disease during daily graded exercises performed on a bicycle ergometer for 30 days. The exercises led to improvement of health in 44 patients. There was a significant reduction in baseline insulin and aldosterone levels and a tendency to lower corticotropin and triiodothyronine concentrations. The amounts of somatotropin, thyrotropin, thyroxine, and cortisol failed to greatly change during the exercise.

[Functional status of the hepatobiliary system during anti-orthostatic hypodynamia]. / Funktsional'noe sostoianie gepatobiliarnoi sistemy pri antiortostaticheskoi gipodinamii.

In 16 male subjects, the hepatic absorption-excretion function and the gallbladder and biliary ducts were investigated using computer scintigraphy and 99mTs-HIDA. Comparison of the data obtained after 6-hour (-20 degrees) and 3-day (10 degrees) antiorthostatic hypodynamics with the baseline data obtained in the supine position demonstrated deterioration of the absorption-excretion function of the liver. In response to a short-term exposure (6 hour) the changes were seen only in subjects with latent or clinically nonmanifest pathologies of the digestive organs. As the exposure continued, changes in the hepatobiliary function became more manifest and significant. It is recommended to study in greater detail changes in the above function and their involvement in the symptom complex of an acute stage of adaptation to microgravity.

[Structure of functional scintigraphic images during the development of gallbladder bile reflux into the intrahepatic ducts]. / Postroenie funktsional'nykh stsintigraficheskikh izobrazhenii pri vyiavlenii refliuksa puzyrnoi zhelchi vo vnutripechenochnye protoki.

The authors proposed a method of cholescintigraphy with functional imaging reflecting RP distribution within the entire area in the field of vision of a gamma-chamber detector taking account of the type of motor activity of the gall bladder. This method was based on plotting an activity-time curve along the outer contour of a gall bladder image, the determination of moments of change in gall bladder motor activity on this curve, and the calculation of corresponding gradients of RP accumulation and clearance functions represented on an image where the color of each element was determined by a sign of the gradient and its intensity--by its absolute value. The use of this method in 92 patients made it possible to reveal conditions with possible B-bile reflux into the intrahepatic ducts, and to raise its diagnostic accuracy by 7% as compared to a routine analysis of activity-time curves by decreasing the number of false-negative results.

[Vasopressin content of the blood in ischemic heart disease patients and its interrelation with other hormones]. / Soderzhanie vazopressina v krovi bol'nykh ishemicheskoi bolezn'iu serdtsa i ego vzaimosviaz' s drugimi gormonami.

Blood vasopressin, tri-iodothyronine, total thyroxine, thyrotrophic hormone, cortisol, ACTH and insulin levels were measured in 60 chronic coronary patients aged 35 to 70. Coronary patients showed elevated blood vasopressin, particularly in the presence of frequently recurring anginal attacks. There was no significant difference in vasopressin levels of patients with and without attendant essential hypertension, those with atherosclerotic and postinfarction cardiosclerosis, or in relation to body weight. Insulin, cortisol, adrenocorticotrophic and thyrotrophic hormones were significantly increased, and tri-iodothyronine and total thyroxine, significantly decreased, in coronary patients as compared to the controls.

[Study of the contractile function of the gallbladder using cholescintigraphy]. / Issledovanie sokratitel'noi funktsii zhelchnogo puzyria s pomoshch'iu kholestsintigrafii.

The motor activity of the gall bladder was studied using cholescintigraphy with 99m Tc-HIDA in 57 patients with chronic cholecystitis and chronic hepatitis and in 9 controls. A comparative analysis of the curves activity-time based upon the elements of images of the external contour and the entire zone of the gall bladder, made it possible to reveal differences in the type of reaction of the gall bladder to the use of cholagogic stimulators (cholecystokinin i.v. and cholagogic breakfast). A method of the processing of the results made it possible to determine the number of contraction phases of the gall bladder during its emptying as well as the true latent period and the period of primary reactions of the biliferous apparatus after taking a food stimulus.

[Relation between blood levels of thyroid hormones and insulin and lipid metabolism and the clinical course of chronic forms of ischemic heart disease]. / Vzaimosviaz' mezhdu soderzhaniem v krovi tireoidnykh gormonov, insulina, obmenom lipidov i klinicheskim techeniem khronicheskikh form ishemicheskoi bolezni serdtsa.

Ninety patients aged 41 to 68 years with the chronic patterns of coronary heart disease (CHD) were examined for the content of triiodothyronine (T3), total T4 and free thyroxine (FT4), thyrotropic hormone (TTH), adrenocorticotropic hormone (ACTH), and insulin. At the same time the patients were examined with the aid of the glucose tolerance test, determination of blood concentration of cholesterol, triglyceride, high density lipoprotein cholesterol, fibrinogen and soluble fibrin. The patients with CHD showed a decrease in the basal level of T3, T4, FT4 and elevation of TTH, ACTH and insulin in blood. A correlation was found between the basal of insulin and thyroid hormones and lipid metabolism in CHD patients. It was shown that thyroid hypofunction, unmarked clinically but detectable by the lowering of the content of thyroid hormones and rise of thyrotropic hormone in blood of CHD patients, might promote the development of hyperinsulinemia.

[Relation between concentrations of lipids, carbohydrates, fibrinogen and thyroid hormone and insulin levels in the blood of patients with chronic forms of ischemic heart disease]. / Vzaimootnoshenie mezhdu soderzhaniem lipidov, uglevodov, fibrinogena i urovnem tireoidnykh gormonov i insulina v krovi bol'nykh s khronicheskimi formami ishemicheskoi bolezni serdtsa.

Seventy-five patients with chronic coronary heart disease (CHD), aged 41 to 65 years, were studied for levels of triiodothyronine, total and free thyroxin and immunoreactive insulin. Simultaneously, the glucose tolerance test was carried out and blood concentrations of cholesterol, triglycerides, high density lipoprotein cholesterol, fibrinogen and disoluble fibrin were determined. Patients with CHD displayed decreased basal levels of triiodothyronine, total and free thyroxin and increased concentrations of immunoreactive insulin in the blood which was attended with decreased tolerance to glucose. These hormonal disturbances resulted in an elevation in cholesterol, triglycerides and fibrinogen. CHD patients showed an inverse correlation between cholesterol and free thyroxin levels and a direct relationship between triglycerides and immunoreactive insulin.

[Effect of probucol on lipid metabolism and the clinical course of ischemic heart disease and arteriosclerosis obliterans of the vessels of the lower extremities]. / Vliianie probukola na lipidnyi obmen i klinicheskoe techenie ishemicheskoi bolezni serdtsa i obliteriruiushchego ateroskleroza sosudov nizhnikh konechnostei.

Thirty-eight men with chronic coronary heart disease (CHD) aged 38 to 65 years (ten patients with attendant obliterating atherosclerosis of lower extremity vessels) were treated with the hypolipidemic drug probucol in a dose of 1000 mg/day for three months. Probucol exerted a beneficial effect on the clinical course of CHD and obliterating atherosclerosis of the lower limb vessels. The drug has a marked hypocholesterolemic effect in CHD patients with high cholesterol levels in the blood serum which warrants the advisability of its use in type IIa and IIb hyperlipoproteinemia. The probucol therapy is associated with a decrease in the cholesterol/erythrocyte membrane phospholipids molar ratio which improves the rheological properties of the blood in CHD patients. The drug produces no side effects.