[The influence of preoperative preparation on changes in haemodynamics in patients with pheochromocytoma].

The parameters of haemodynamics in 64 pheochromocytoma patients were studied by the "Centaur" technology using the methods of echocardiographic examinations, daily monitoring of arterial pressure and bioimpedance rheography. A comparative analysis of the character of hemodynamic derangements in pheochromocytoma patients at various stages of treatment depending on the quality of preoperative preparation was made. A reliable positive influence of selective alfa-adrenoblocks of the parameters of blood circulation in pheochromocytoma patients in the preoperative and intraoperative periods was revealed. Efficiency of the application of noninvasive methods of estimation of hemodynamics for specification qualities of preoperative preparation has been proved.

[Radiation and nonradiation factors in thyroid pathology development for Chernobyl cleanup workers--residents of Mayak PA affected zone].

Thyroid state study was been carried out for Chernobyl NPP accident liquidators living in Ozyorsk, the city, located in the nuclear facility affected zone (Mayak PA). In total 531 individuals were examined. Thyroid assessment was made basing on physical examination, on ultrasound study and on hormones measurement of thyroid stimulating hormone, free thyroxine and thyroid peroxidase antibody. Screening revealed thyroid pathology for 27% of clean-up workers. As a result of the study carried the following conclusions were made: thyroid disease prevalence among the Ozyorsk residents participated in the breakdown elimination after Chernobyl accident was not differ from the individuals who didn't take part in this work; the prevalence of thyroid disease in liquidators was significantly connected with non radiation risk factors: with gender (for women compared to men), RR = 4.0, 95% CI 2.9-5.5; with age (over 60 years old vs under 60 years old), RR for women was 1.7; 95% CI 1.0-3.0 and for men -1.9; 95% CI 1.1-3.2; with hereditary predisposition, RR for autoimmune thyroiditis was 3.3, 95% CI 1.4-7.9.

[On the choice of the material in surgical treatment of rectocele].

An investigation of the physical (capillaries, elasticity, strength, traumaticity) and implantation properties of modem synthetic absorbable suture material "Maxon 1", "Polysorb 1", "Vicryl 1" has shown considerable advantages of the monofilic thread "Maxon 1". For surgical treatment of anterior rectocele of the III degree (anterior levatoroplasty) this thread was used in 114 patients with good direct, nearest and long-term results.

[Surgical management of acute cholecystitis in elderly and old age patients]. / Khirurgicheskaia taktika pri ostrom kholetsistite u bol'nykh pozhilogo i starcheskogo vozrasta.

Results of treatment of 233 old and elderly patients with acute cholecystitis were analysed. In 206 from them percutaneous transhepatic drainage of the gallbladder (PTDGB) was carried out under US control with creation of temporary microcholecystostoma for elimination of acute attack of cholecystitis by decompression of the biliary system, in 2 patients laparoscopic cholecystostomy was performed, and in 27 patients with choledocholithiasis and jaundice early endoscopic papillosphincterotomy was carried out. Elimination of acute attack of cholecystitis in early terms contributed much to improvement of the patients condition, to carrying out further examination and correction of concomitant diseases. After adequate premedication 189 patients were operated on early after admission (on day 2-4). The operation of choice was cholecystectomy, in 49 patients being combined with various interventions on the choledochus. Postoperative mortality rate made up 4.2%. 44 patients were not operated because of elimination of the attack by PTDGB (17) and endoscopic papillosphincterotomy (27).

[Stimulation of medical personnel work in operating rooms]. / Stimulirovanie truda meditsinskogo personala v operatsionnoi.

Preliminary results of experimental trial on stimulation of medical staff's labour in the operation unit, held in medical institutions of Chelyabinsk, has been analysed. As a basis for calculation of the payments for the work, the labour expenditures of each member of surgical team (surgeon, assistant, anesthesiologist, surgical nurse, anesthesist, litter bearer nurse) and the cost of 1 hour work were assessed, the degree of the difficulty of each operation, as well as the total cost of the procedure was determined. Registration of the work of all members of the surgical team and its payment, according to the quantity and the quality of the performed operations, demonstrates the stage of transition to the system of payment for the labour, i.e.--for the concrete work, done by somebody of the staff (for the treatment of some patient, etc.). The evaluation of the work according to the number of treated patients (operations being done) and to the quality of the treatment provides the conditions for personal financial incentive of surgical staff to intensification of their work and contributes to the achievements of favourable final results and in the same time--it provides decrease of the terms for patients' stay in the hospital, saving money and material resources.

[Percutaneous laser-induced thermotherapy of nodular goiter]. / Chreskozhnaia lazerindutsirovannaia termoterapiia uzlovogo zoba.

Substantiation of use of laser radiation Nd:YAG (1064 nm) and diode (805 nm) for destruction of thyroid tissue was the purpose of this study based on experimental research of reparative and adaptive processes in thyroid gland. The influence of high-intensity laser radiation was studied in vivo in thyroid gland of 41 dogs. The optimal modes of laser radiation ensured focal destruction of thyroid gland without damage of surrounding organs were selected. The developed modes were used in the treatment of 18 patients with recurrent nodal and multinodal euthyroid goiter. Exposure was performed by puncture method without denudation of thyroid gland. There were no complications during irradiation and nearest postoperative period. In dynamic ultrasonic examination over 2 years the decrease of nodes sizes was revealed in all the patients.

[Characteristics of thyroid cancer in combination with autoimmune thyroiditis]. / Nekotorye osobennosti raka shchitovidnoi zhelezy v sochetanii s autoimmunnym tireoiditom.

Remote results of the surgical treatment of 413 patients with carcinoma of the thyroid gland without autoimmune changes and 199 patients with thyroid carcinoma associated with an autoimmune component were studied. Remote results of the surgical treatment and indices of survival in the second group of patients were found to be better than those in patients without autoimmune changes in the thyroid gland.

[Oxygen tension in would tissues during healing]. / Napriazhenie kisloroda v tkaniakh rany v protsesse ee zazhivleniia.

Transcutaneous strain of oxygen (TcPO2) was studied in tissues of 111 wounds in 110 patients. The uncomplicated course of the wound process was characterized by rapid normalization of the initially decreased TcPO2 in the wounds closed with sutures or in case of gradual approximation of their margins as well as by a slow elevation when the wounds were healing by second intention. High significance of measuring TcPO2 was shown for diagnosis of acute pyo-inflammatory diseases and wound complications. Great feed-back correlation was found between the degree of disjunction of the wound margins and TcPO2 of its tissues. A hypothesis is put forward on the dependence between the degree of tissue tension and the precapillary sphincter tone allowing an explanation of all the changes in TcPO2 of the wound tissues in the process of its healing.

[The clinical-morphological estimation of the results of laser osteoperforation in treatment of chronic osteomyelitis]. / Kliniko-morfologicheskaia otsenka rezul'tatov lazernoi osteoperforatsii pri lechenii khronicheskogo osteomielita.

The method of laser osteoperforation was approved in 135 patients with chronic osteomyelitis. The diode laser with wave length 970 mm and peak power up to 30 Wt was used. Energy was delivered by the percutaneous contact method with a quartz light guide of 0.4 mm diameter. All the patients had a distinct positive reaction in the nearest days after operation. The fistulas were closed within 4-10 days. Stable remission was noted during 2-5 years by objective indices (X-ray, fluometry, densitometry, morphological data). Our experiences with clinical use of laser osteoperforation show its high efficiency in treatment of chronic osteomyelitis. The method is minimally invasive and allows to considerably shorten the terms of treatment and rehabilitation.

[An experimental model of suppurative osteomyelitis]. / Eksperimental'nyi model' gnoinogo osteomielita.

A new experimental rabbit model of acute purulent osteomyelitis is proposed. The model is reproduced by percutaneous introduction of 4 million St. aureus microorganisms into the medullary channel of the femoral bone after aseptic destruction of the bone marrow by ethyl alcohol and hot saline. The model satisfies the demands of good reproduction, reduces probability of contamination of periosteal tissues during intraosteal inoculation and provides reproduction of local inflammation without its generalization which results in reduced number of fatal outcomes among experimental animals.

[Immunological reactivity and the HLA system antigens in patients with autoimmune thyroiditis and nodular euthyroid goiter]. / Izuchenie immunologicheskoi reaktivnosti i antigenov sistemy HLA u bol'nykh autoimmunnym tireoiditom i uzlovym éutireoidnym zobom.

Factors of nonspecific resistance, cellular and humoral immunity were investigated before operation in 84 patients with nodular euthyroid goiter and in 50 patients with autoimmune thyroiditis, 50 patients were investigated in the long-term postoperative period. Class I HLA antigens were investigated in 205 patients. Humoral changes of immune homeostasis (hyper-production of antithyroid antibodies, an increase in the level of IgM and IgG against a background of the raised number of peripheral blood B-cells, a decrease in the level of lysozyme), disorder of the cellular factor of immunity (specific sensitization of T-lymphocytes to thyroid antigens, a decrease in the number of T-lymphocytes, especially T-suppressors) were detected in autoimmune thyroiditis. Immunological changes in nodular euthyroid goiter were characterized by T-cell sensitization to thyroid extract and microsomal antigen against a decrease in the total number of T-lymphocytes. In most patients with nodular goiter immunity indices after operation returned to normal whereas in patients with autoimmune thyroiditis they showed no tendency to improvement. These data as well as an increase in the frequency of HLA-A11, HLA-A19 and HLA-B8 were indicative of genetically determined primary nature of immune disorders in autoimmune thyroiditis. It was not typical of nodular euthyroid goiter in which an autoimmune process seemed secondary, occurring in response to damage of thyroid tissue by a growing nodule.