[In-hospital outcomes of endarterectomy and coronary artery bypass grafting in multiple diffuse lesions of coronary arteries]. / Gospital'nye rezul'taty éndarteréktomii i koronarnogo shuntirovaniia pri mnozhestvennom diffuznom porazhenii koronarnykh arterii.

BACKGROUND: According to a series of studies, performing coronary endarterectomy in direct myocardial revascularization increases the risk of myocardial infarction and in-hospital mortality. There are no commonly accepted indications for carrying out endarterectomy, and in clinical practice this technique is used in severe diffuse lesions of coronary arteries. AIM: The study was aimed at assessing in-hospital clinical outcomes of coronary artery bypass grafting (CABG) with the use of endarterectomy in patients with severe multiple diffuse lesions of coronary arteries. PATIENTS AND METHODS: This was a single-centre retrospective study enrolling a total of 205 patients presenting with multiple diffuse lesions and subjected to CABG procedures. Of these, after excluding those with severe concomitant pathology (n=28), 177 were enrolled and divided into 2 groups: 76 patients during formation of a coronary anastomosis were subjected to forced endarterectomy from the native channel (Group 1, n=76) and the remaining patients to prolonged anastomosis and/or bypass grafting of distal branches of the diffusely damaged artery (Group 2, n=101). In-hospital outcomes were analysed in both groups. RESULTS: The demographic and clinical characteristics were comparable by all parameters except for age: Group 1 patients were older (66.3±8.4 vs 63.0±8.5, p<0.05). The groups were comparable by severity of coronary lesions by both the SYNTAX Score and diffuse lesion index. The incidence of perioperative myocardial infarction during coronary endarterectomy (Group 1) amounted to 9.2% (7/71) and in the group without endarterectomy (Group 2) to 0. There were no cases of in-hospital mortality in either group. CONCLUSION: In severe diffuse coronary lesions, endarterectomy combined with CABG makes it possible to perform adequate myocardial revascularization. Performing endarterectomy from coronary arteries is associated with an increased risk for the development of myocardial infarction, but its use is justified if it is impossible to create an anastomosis by means of other techniques.

[Molecular mechanisms of neuroretinoprotection in primary open-angle glaucoma]. / Molekuliarnye mekhanizmy neiroretinoprotektsii pri pervichnoi otkrytougol'noi glaukome.

PURPOSE: To evaluate the effectiveness of neuroprotective therapy in patients with primary open-angle glaucoma based on specific biochemical markers of neurotrophy and neurodegeneration. MATERIAL AND METHODS: In the course of the study, lacrimal fluid (LF) of 23 patients (46 eyes) with stage I-II primary open angle glaucoma (POAG) aged 66.3±10.8 was examined. The control group consisted of healthy individuals (12 control LF samples). Local antihypertensive therapy was complimented with 10 intramuscular injections of retinalamin (GEROPHARM LLC, St. Petersburg) - a complex of peptides isolated from cattle retinas, administered 5 mg once a day. Enzyme immunoassay (ELISA) method was used to test LF for concentrations of brain-derived neurotrophic factor (BDNF) and neuron specific enolase (NSE) before and after the treatment. RESULTS: In healthy subjects, the content of BDNF was 0.83±0.06 ng/mL, NSE - 0.51±0.06 ng/mL. In patients with POAG, the indices were higher: BDNF was 1.39±0.85 ng/mL (p>0.05), NSE - 4.31±2.02 ng/mL (p<0.05). The patients with stage II-III POAG had a significant increase of BDNF concentration (1.37±0.41 ng/mL and 1.52±0.40 ng/mL respectively in stages II and III) indicating compensatory capabilities at these stages of the disease. The NSE marker was also high in these stages (4.16±2.44 ng/mL and 5.78±2.80 ng/mL, p<0.05), which indicates the degeneration of retinal ganglion cells. After Retinalamin® therapy, patients with stage II POAG had control group levels of marker proteins, while in stage III patients NSE content remained high. CONCLUSION: There is a compensatory increase of BDNF level and a pathological increase of NSE content in LF of POAG patients. The change in the content of neurotrophins in the LF was determined to depend on the stage of POAG. Thus, in stages II and III POAG there is a marked increase of NSE and a compensatory increase of BDNF. After the complex therapy including retinalamin in patients with stage II POAG, a decrease in initially high concentrations of BDNF and NSE in LF down to the control group values was noted. In stage III patients, signs of neurodegeneration persist in the form of high NSE values. Taking into account the positive dynamics of the neuronal marker content in LF in the complex therapy of POAG with Retinalamin®, timely neuroretinoprotection is recommended.

[Silentscope - new method of diagnosis and treatment of patients with salivary stone disease. The border need to use]. / Sialoéndoskopiia - novyi metod diagnostiki i lecheniia bol'nykh sliunnokamennoi bolezn'iu. Granitsy neobkhodimosti ispol'zovaniia.

The authors conducted an analysis of the efficiency of the method of suandokmai for diagnosis and treatment of diseases of the salivary glands. The use of calendarscope allows to establish the absence of stone in the case of salivary colic. In rare cases it is possible to remove the stone without surgical intervention at small dimensions of the calculus. 'Price of equipment - the efficiency of diagnosis and treatment' does not allow to recommend the method in clinical practice.

[Long-term results of endoprosthesis of the hip joint with Plus-Endoprosthetic prosthesis].

An experience and results with using endoprosthesis of the hip joint with Plus-Endoprosthetic prosthesis in 937 (1018 operations) patients were analyzed. The period of follow-up observations was 12 years. Distinctive characteristics of the endoprosthesis are described. Specific behavior of this construction in patients with diseases and damages of the hip joint are shown. Results and complications of the endoprosthesis operations are analyzed. In whole, excellent and good results were obtained in 99.42% of cases, satisfactory - in 0.47%, unsatisfactory - in 0.11%.

[Prevalence of main stomatological diseases in workers of silk factory].

Caries and periodontal diseases among the workers of silk factory, where the professional harmfulness were: discomfort of the microclimate, the intensive noise, psychological loads, bound with the monotonic of labor process, enforced working posture, high bacterial dirty of the rooms, were detected of higher levels diseases as contrasted to the data of the people not working in indicated factory. The necessity of implementation of preventive sanitary-hygienic measures for elimination of the professional harmfulness, and also improvement and advancing the dental help to the workers of silk factory were marked.

[Serological markers of viral infections in patients with rheumatoid arthritis].

The authors carried out serologic examination of 202 patients with rheumatoid arthritis (RA) and 200 healthy persons for detecting of specific markers of infections caused with herpes simplex virus (HSV), cytomegalovirus (CMV), Epstein-Barr virus (EBV), hepatitis B and C viruses (HBV and HCV) and human T-cell lymphotropic retroviruses 1 and 2 (HTLV-1/2). It was demonstrated that detecting frequencies of HBsAg and total antibodies to HTLV-1/2, HSV and CMV among RA patients and healthy persons were practical equal--only anti-EBV were detected more often among RA patients than among healthy persons. But in the same time IgM-antibodies to HSV, CMV and EBV were detected more often among RA patients than among healthy persons. Authors concluded that most probable RA etiologically can be connected with chronic reproductive infections caused with HSV and EBV, which at least are able to participate in forming of predisposition to this disease by means of autoimmune reactions promotion.

[Approaches to objective assessment of the individual weight bearing in patients after total endoprosthesis of the hip joint].

An algorithm for the detection of weight bearing on the lower extremity after total endoprosthesis of the hip joint was developed, taking into consideration the parameters of the morphometric structure, type of pathology, method of treatment, the resulting extremity functioning and social and every-day conditions. The individual rehabilitation measures after endoprosthesis were performed in three steps and corrected depending on changes in the parameters in question. The amplitude of movements in the joint after using the method of calculation of the weight bearing on the lower extremity became close to normal in 26 patients after completion of the rehabilitation course and the statistic-dynamic indices of the extremity became stable.

[Rehabilitation of orthopedic patients after hip replacement].

A comparative analysis of the treatment of 120 patients after endoprosthesis for degenerative-destructive diseases of the hip joint was carried on. All the patients were divided into two groups: the main group included 74 patients who underwent a full course of rehabilitation, the control group consisted of 46 patients without rehabilitation. The results of a comparative assessment of the static-dynamic function in the two groups of patients after operation of endoprosthesis have shown the inclusion of an obligatory program of rehabilitation to be expedient for the restorative treatment in addition to the operation of endoprosthesis.

[Biomechanical investigations in the assessment of effectiveness of endoprosthesis].

Based on complex biomechanical investigations the authors have brought out clearly that after endoprosthesis in coxarthrosis patients the biomechanical indices concerned with maintenance of posture and kinematics of walking were markedly improved. The remaining light instability, unsteadiness and tension when standing and walking require strict individualization, sequence, loading of the locomotor apparatus.

[Integral evaluation of phenotypic and genotypic variability of morphologic and psychophysiologic human traits]. / Integral'nye otsenki fenotipicheskoi i genotipicheskoi izmenchivosti morfologicheskikh i psikhofiziologicheskikh priznakov cheloveka.

The paper demonstrates the expedience of the developed populational-genetic approach to studying the genetic bases of a complex of quantitative characters pertaining to different levels of human organization: anthropometry, neurodynamics and psychodynamics. The studies were carried out in eight human populations of different degree of isolation and ethnical background. It is shown that correlation phenotypic variability is higher for these characters, as compared to genotypic variability, the number of general genes responsible for this variability being decreased, respectively.

[The comparative analysis of the glycemic effect of certain carbohydrate products on diseases of the biliary system]. / Sravnitel'nyi analiz glikemicheskikh éffektov uglevodsoderzhashchikh produktov pri nekotorykh zabolevaniiakh biliarnoi sistemy.

A comparative analysis of glycemia effect of hydrocarbon foods in patients with dyskenisia of belieferous tract (n = 21), cholelithiasis (n = 20) and postcholecystectomy syndrome (n = 21). The food was given on an empty stomach on the basis of 50 g of carbohydrate per portion. The glucose level was defined in blood on an empty stomach and in 30, 60, 90 and 120 min. intervals after each loading. A significantly smaller increase of postfood glucemia after consumption of boiled rice and lentil was registered as well as accordingly low meanings of their glycemia indices in comparison with those of wheat bread and boiled potatoes.

[Effect of food loadings on postprandial glycemia in patients with fatty hepatosis in combination with obesity]. / Vliianie pishchevykh nagruzok na poslepishchevuiu glikemiiu u bol'nykh zhirovym gepatozom v sochetanii s ozhireniem.

It was investigated the dynamic of postprandial glycaemia in 38 patients with fatty hepatosis and obesity after ingestion of breads, macaroni products, grits and legumes and it was determined its glycaemic index in the present study. These differences in the postprandial glycaemic reaction in observed patients in process of food loading were analyze.

[Optimization of diet therapy in patients with gallstones complicated with obesity and impaired glucose tolerance]. / Ob optimizatsii dietoterapii bol'nykh zhelchnokamennoi bolezn'iu s soputstvuiushchim ozhireniem i narusheniem tolerantnosti k gliukoze.

It was investigated the influence of a diet with lower glycaemic index on clinico-metabolic parameters in obese patients with gallstones and impaired glucose tolerance. The results investigations indicated that the lowering of glycaemic index and the caloric reduction of diet have a beneficial effects on dynamic of parameters of functional status of liver and gallbladder. It was noted the increase of medical effect of diet in correction of obesity and impaired parameters of carbohydrate and lipid metabolism in this patients in process of dietotherapy.

[Bronchoscopy in inhalation burns]. / Bronkhoscopiia pri ozhogakh verkhnikh dykhatel'nykh putei.

The treatment of burns of various depth and location which are combined with thermoinhalation affections of the respiratory organs is a serious problem during the entire course of burn disease. Despite advances in modern treatment of burns, the death rate of pulmonary complications is still high. Pulmonary disorders encountered in inhalation of chemical toxic products of burning, smoke and its finely divided components increase the fatal outcomes by 30-100% in different periods of the burn disease. Until recently, thermoinhalation affections were not often taken into account in analysis of the causes of death of patients with burns, and the diagnosis was based on scanty historical data and late clinical symptoms. In works published from the beginning of the eighties, bronchoscopy was assigned secondary significance. Evaluation of the character of the lesion, the extent and depth of pathological changes in the tracheobronchial tree in thermoinhalation affections is based in most cases on the post-mortem findings. The purpose of this work was to evaluate clinically and by laboratory studies the role and significance of bronchoscopy in establishing the diagnosis in individuals with burns and thermoinhalation damage during life, in the treatment and prevention of the expected complications in the respiratory organs, and to promote wide use of a bronchoscope in this category of seriously ill patients. On the basis of the study, the authors revealed a close correlation between respiratory insufficiency of various degree and extent and the depth of the affection of the tracheobronchial tree. They also substantiated indications for systemic bronchoscopic treatment of thermoinhalation lesions.

[Effects of various food products on blood sugar level in patients with diabetes mellitus and obesity]. / Vliianie razlichnykh produktov pitaniia na uroven' sakhara v krovi u bol'nykh sakharnym diabetom i ozhireniem .

The blood sugar level was evaluated in patients with insulin-independent diabetes mellitus and obesity, and in normal volunteers, during 3 h with a 30-min interval before and after food loading containing 50 g of carbohydrates. It has been found that 17 food products studied produce varying effects on the blood glucose level regardless of the content of starch and sugars in them. Pure glucose, boiled rice, potatoe, white bread, boiled bean, pastry, honey and sugar produce the highest glycemic effect. Milk, ice cream, boiled lens and noodles produce a moderate effect on the blood sugar level both in normal subjects and in patients with diabetes mellitus and obesity. The increase of the glucose blood level after intake of food products was significantly higher in patients with diabetes mellitus as compared to those with obesity and normal volunteers. Milk products, lens, macaroni and millet are most promising for patients with diabetes mellitus due to their moderate influence on the blood glucose content.

[Restorative treatment of degenerative-dystrophic diseases of large joints]. / Vosstanovitel'noe lechenie degenerativno-distroficheskikh zabolevanii krupnykh sustavov.

The authors performed courses of treatment with Midocalm in 110 patients according to their original method. It reduced the pain syndrome, increased the volume of movements in the joint and shortened the time of treatment.

[Prolonged epidural analgesia induced by clopheline in combination with lidocaine in obstetric analgesia]. / Dlitel'naia épidural'naia analgeziia klofelinom v sochetanii s lidokainom pri obezbolivanii rodov.

The study was carried out in 178 women without grave obstetrical or extragenital diseases. In group 1 labor pain was relieved by prolonged epidural anesthesia with 2% lidocaine solution (2-2.5 mg/kg), in group 2 prolonged epidural anesthesia with 1% lidocaine solution (1 mg/kg) and 0.01% clofelin (1 microgram/kg) was administered. Central hemodynamics, heart rhythm, external respiration function, uterine contractility, and fetal intrauterine status were assessed. The findings indicate that none of the methods had a negative impact on the vital parameters of women and newborns at any stage of anesthesia. However, a combination of epidural clofelin (1 microgram/kg) with lidocaine permits an appreciable decrease in the doses of both drugs without decreasing the efficacy of anesthesia. This method has a favorable effect on the course of labor: the mouth of the womb opens sooner at a lower uterine activity and there are no negative effects on the fetus and newborn.

[The characteristics of the surgical procedure in isolated gunshot wounds of the leg in peacetime]. / Osobennosti khirurgicheskoi taktiki pri izolirovannykh ognestrel'nykh raneniiakh goleni v usloviikah mirnogo vremeni.

The article presents results of treatment of 20 people with gunshot wounds of the leg for the period from 1994 till 1996. The authors used the methods directed to treatment of the traumatic disease, correction of the regional blood circulation and microcirculation, firm fixation of the fractures, adequate drainage and fasciotomy fulfilled if indicated.

[Structure of causes of mortality of patients with otorhinolaryngologic diseases]. / Struktura prichin letal'nosti bol'nykh otorinolaringologicheskogo profilia.

42 lethal outcomes have been registered for 9 years in the ENT department of the Andizhan regional hospital and in the department of the head and neck tumors of the regional cancer hospital. Among the causes of the patients' death, ENT cancer ranked the first (73.6%) followed by intracranial otogenic complications. The least frequent causes were esophageal and respiratory foreign bodies, acute stenotic laryngotracheitis. The averaged annual lethality was stable (0.25%). A further decrease of lethality depends on fitting out updated medical units and instruments, on perfection of the personal's skill, on earlier hospitalization of priority cases with ENT diseases.