[Combined surgeries for secondary chest wall lesions]. / Kombinirovannye operatsii pri vtorichnom porazhenii grudnoi stenki.

The authors present treatment of rhabdomyosarcoma of the gluteal region with secondary lesion of the lung and chest wall. Features of chest wall defect closure are analyzed.

[Chest wall repair after extensive resections]. / Rezul'taty vosstanovleniya karkasa grudnoi stenki posle obshirnykh rezektsii.

OBJECTIVE: To analyze the outcomes after different methods of post-resection chest wall defect reconstruction. MATERIAL AND METHODS: The study included 41 patients aged 22-73 years who underwent chest wall repair with local tissues and synthetic materials. Twelve (29.3±7.1%) patients had sarcoma, 9 (21.9±5.9%) - non-small cell lung cancer (NSCLC) with invasion of the chest, 9 (21.9±5.9%) - metastatic lesions, 8 (19.5±6.2%) - benign tumors, 2 (4.8±3.4%) - breast cancer with invasion of the chest wall, 1 (2.4±2.4%) - desmoid tumor. Seven patients were diagnosed with T3N0M0, 1 - T3N2M0, 1 - T2N0M1b (oss). Among patients with NSCLC with invasion into the chest wall, squamous cell cancer was verified in 4 (44.4±16.6%) patients, adenocarcinoma - in 4 (44.4±16.6%), neuroendocrine tumor - in 1 (11.2±10.5%) patient. Stages of surgeries are presented. RESULTS: We analyzed treatment outcomes in 41 patients. Five (12.2%) patients had seroma, hemothorax, thoracopleural fistula, subcutaneous emphysema and fatal asystole. There were no postoperative complications associated with paradoxical breathing. CONCLUSION: Accurate morphological verification prior to treatment is valuable to determine the stages of combined treatment of chest wall tumors. Chest wall defect closure with own tissues and synthetic materials is necessary after extensive resections. A multidisciplinary approach involving thoracic and plastic surgeons is needed.

TRANSFORMATION OF UKRAINIAN HEALTHCARE TO THE NEW CONDITIONS OF DEVELOPMENT: RISKS, SOLUTIONS, MODERNISATION OPTIONS.

This article analyses the transformation of Ukrainian healthcare in the context of the new digital healthcare. The study highlights the risks faced by Ukraine's healthcare system and proposes solutions and modernization options to improve the situation.The article conducts a narrative synthesis of related literature with a cross-sectional analysis to analyse the development of Ukrainian telemedicine and its current state in European countries. Risks, such as insufficient financial support, lack of personnel, corruption, and inaccessibility of medical services to the population, are considered.The article goes on to propose solutions to overcome these risks, including attracting additional investment in the healthcare system, improving working conditions for healthcare professionals, and reducing corruption. The article also discusses options for modernization, including the introduction of electronic medical records, the development of telemedicine, and ensuring access to quality healthcare services for all segments of the population. The paper also describes the mechanisms associated with new information and communication technologies, of which telemedicine is a part, to illustrate the potential of this new technology to transform traditional organizational forms of medicine. A brief overview of the role of telemedicine in the Ukrainian healthcare system is presented. An analytical approach is proposed along with a description of five different aspects for the effective use of telemedicine. The conclusion of the article is that the transformation of Ukrainian medicine to the new conditions of digital development requires a comprehensive approach and joint efforts of the government, medical professionals, and the public. Through risks and challenges, there is an opportunity to improve the medical system and provide quality healthcare services to all citizens of Ukraine, especially in regions with active hostilities.

[Post-traumatic thoracic splenosis]. / Klinicheskii sluchai posttravmaticheskogo grudnogo splenoza.

Splenosis is a rare disease and defined as spleen tissue autotransplantation following spleen rupture and subsequent splenectomy in most cases. The authors report ectopic splenic tissue in pleural cavity diagnosed in 31 years after blunt thoracoabdominal trauma.

EAACI Position paper on the standardization of nasal allergen challenges.

Nasal allergen challenge (NAC) is an important tool to diagnose allergic rhinitis. In daily clinical routine, experimentally, or when measuring therapeutic success clinically, nasal allergen challenge is fundamental. It is further one of the key diagnostic tools when initiating specific allergen immunotherapy. So far, national recommendations offered guidance on its execution; however, international divergence left many questions unanswered. These differences in the literature caused EAACI to initiate a task force to answer unmet needs and find a consensus in executing nasal allergen challenge. On the basis of a systematic review containing nasal allergen challenges of the past years, task force members reviewed evidence, discussed open issues, and studied variations of several subjective and objective assessment parameters to propose a standardized way of a nasal allergen challenge procedure in clinical practice. Besides an update on indications, contraindications, and preparations for the test procedure, main recommendations are a bilaterally challenge with standardized allergens, with a spray device offering 0.1 mL per nostril. A systematic catalogue for positivity criteria is given for the variety of established subjective and objective assessment methods as well as a schedule for the challenge procedure. The task force recommends a unified protocol for NAC for daily clinical practice, aiming at eliminating the previous difficulty of comparing NAC results due to unmet needs.

[IMMUNE SYSTEM DATA IN PATIENTS WITH PERSISTENT RECURENT HERPES VIRUS INFECTIONS IN DYNAMICS OF COMPLEX THERAPY].

The positive clinical, serolgical and immunological effects of Glutamyl-Triptophan in patients on persistent herpes virus infections are shown. Treatment resulted in the increase of avidity on HSV 1, HSV 2, CMV, EBV antibody, the levels of CD3+-, ICD8+-, CD16+-, CD3+HLA-DR+- (%, abs) and.CD3+CD25t-cells (%), that indicates the optimization of the immune systemdata. The data received allow to recommend Bestim for patients with persistent herpes virus infections.

[Proinflammatory cytokines in patients with pyelonephritis].

The antiinflammatory cytokines participate in antiinfective immunity, that is why it is advisable to study their peculiarities in determination of the role in immunologic pathogenesis of pyelonephritis. Of the work is to study the levels of pro-inflammatory blood cytokines in the patients with pyelonephritis (PN), to determine the peculiarities in acute and chronic its course in children and adults. The immuno-enzymic method ELISA and the corresponding test-systems were used to study the levels of cytokines in blood. There were studied the levels of pro-inflammatory cytokines (TNF, MCP and IL-23) in blood serum of patients with acute (APN) and chronic (CPN) pyelonephritis. The analysis showed the reliable increase in levels of all studied findings in both forms of PN--both in all 173 patients and in every group--children (87) and adults (86). The MCP-1 levels in APN are reliably higher than in CPN, while in TNF-b and IL-23--do not differ. The levels of all three cytokines in blood of adults were higher than in children in APN, but TNF--in CPN as well. The high level of TNF, MCP-1 and IL-23 in blood of adults and children confirm their important role both in APN and CPN, but MCP-1 can be considered as a predictor of acute/exacerbation of chronic pyelonephritis. By the findings of the studied cytokines, more expressed immune response was noted in the adults.

The Exact Definition of the Boundary between the Rapid and Slow Ejection Phases on ECGs and Accurate Location of the j Point.

The aim of the study was to describe the boundary between the phases of rapid and slow ejection in the cardiac cycle and to define the exact location of the j point on ECGs. MATERIALS AND METHODS: The work is based on the theory of heart cycle phase analysis using mathematical equations of hemodynamics. The balance of phase diastolic and systolic blood volumes depending on the duration of the cardiac cycle phases has been verified by these equations. The interrelation of phase duration and phase blood volumes was employed to exactly define the cardiac cycle boundaries on ECGs. Synchronous recording of the ECG and rheogram was used to determine the precise location of the j point. RESULTS: The exact boundary between the phases of rapid and slow ejection has been defined. A new point L determining the boundary between SL-Lj phases was introduced for its designation. CONCLUSION: The j point was previously considered to be part of an ECG depending on the body temperature and which does not always appear. It had an ambiguous definition: Osborn wave or j wave. At the same time, the precise boundary between the rapid and slow ejection phases, the blood volumes of which in the total amount are equal to the blood stroke volume, has not been identified exactly. The work performed allows for accurate definition of criteria for recording rapid and slow ejection phases and j point location on the ECG.

[Experience with the use of surgical lasers for the treatment of patients with upper respiratory tract and ear diseases].

The objective of this study was to analyse the efficiency and safety of the use of a holmium- YAG laser (wave length 2.09 mcm) and an erbium-activated glass-based fiber laser scalpel (wave length 1.56 mcm) in ENT-surgery. Priority methods for the surgical intervention in the nasal cavity, paranasal sinuses, and middle ear were developed to treat patients with distorted nasal septa, vasomotor rhinitis, polypous rhinosinusitis, Eustachian tube dysfunction, and various forms of chronic suppurative otitis media. Long-term observations demonstrated fairly good stability of beneficial outcomes of the treatment with the above methods in the majority of the patients. It is concluded that surgical technologies with the use of modern medical lasers provide extensive possibilities for a great variety of interventions in patients with upper respiratory tract and ear diseases.

Multi-morbidities of allergic rhinitis in adults: European Academy of Allergy and Clinical Immunology Task Force Report.

This report has been prepared by the European Academy of Allergy and Clinical Immunology Task Force on Allergic Rhinitis (AR) comorbidities. The aim of this multidisciplinary European consensus document is to highlight the role of multimorbidities in the definition, classification, mechanisms, recommendations for diagnosis and treatment of AR, and to define the needs in this neglected area by a literature review. AR is a systemic allergic disease and is generally associated with numerous multi-morbid disorders, including asthma, eczema, food allergies, eosinophilic oesophagitis (EoE), conjunctivitis, chronic middle ear effusions, rhinosinusitis, adenoid hypertrophy, olfaction disorders, obstructive sleep apnea, disordered sleep and consequent behavioural and educational effects. This report provides up-to-date usable information to: (1) improve the knowledge and skills of allergists, so as to ultimately improve the overall quality of patient care; (2) to increase interest in this area; and (3) to present a unique contribution to the field of upper inflammatory disease.

[Clinical experience of usage of neurostimulator in regionar anesthesia].

The elaboration of more reliable and simple methods of transmitted and plexus anestesias has provided a wide clinical usage of regionar anestesia (RA) during the operations on extremities. The creation of devices to identificate (locate) nerval bearer and plexes was also an important factor for increasing quantity of RA. For such identification we use the portable "Innervator 232" neurostimulator manufactured by "Fisher & Paykel Ltd.", New Zealand. Successful conduction of transmitted and plexus anesthesia depends a lot on anesthesiologist's knowledge of anatomy-topography location of nerval bearer and plexes, precise fulfillment of anesthesia, manual capabilities of physician and obtaining a paresthesia or muscular contraction during the identification of nerval bearer with the help of neurostimulator. RA is secure, effective, and provides less risk for a patient. With neurostimulation the amount of successful anesthesias increases up to 98%. The neurostimulator is easy to use, clinically effective in emergency and planned surgeries for identification of nerval bearer and plexes.

Surgical treatment of Wolf-Parkinson-White syndrome during plastic operations in patients with Ebstein's anomaly.

OBJECTIVE: Ebstein's anomaly is the most common pathology associated with the accessory conduction pathways. METHODS: From January 1990 to August 1999 48 patients underwent surgical repair of Ebstein's anomaly by various plastic techniques. The pathways were identified and characterized at preoperative electrophysiologic mapping in 17 (34.5%) patients. There were seven males and ten females. The patients age ranged 6-35 years (mean 12.7+/-2.1 years). Five patients were in NYHA class II and were in 12 in NYHA class III. The cardiothoracic ratio ranged from 0.59 to 0.69 (mean 0.65+/-0.08). Tachycardia was present in 15 patients with Wolf-Parkinson-White (WPW) syndrome. Atrial septal defect was present in 12 patients (70. 6%). Accessory conduction pathways were in the right posterior septal area in seven patients, in right posterior septal area and free wall in seven patients and in right free wall in three. The pathways were successfully ablated in all patients during cardiopulmonary bypass. RESULTS: There were no deaths, no relapses. Follow-up ranged from 4 months to 7 years (mean 4.7+/-1.1 years). There were no late deaths, but one patient required successful tricuspid valve replacement because of severe tricuspid insufficiency. At follow-up 57.8% of patients were in NYHA class I. CONCLUSIONS: Preoperative electrophysiologic study allows to identify the accessory conduction pathways in patients with Ebstein's anomaly. The combined approach of tricuspid valve repair and surgical ablation of accessory atrioventricular connections has been proved safe and effective. This operative procedure allows to improve functional results in patients with Ebstein's malformation and concomitant accessory conduction pathways.

[Biophysical phenomena in the circulatory system in indirect measurement of the arterial pressure and an analysis of the devices for its measurement]. / Biofizicheskie iavleniia v sisteme krovoobrashcheniia pri kosvennom izmerenii arterial'nogo davleniia i analiz priborov dlia ego izmereniia.

Evaluation of commercially available blood pressure meters is performed. The effect of biophysical processes occurring in blood flow on indirect measurements of blood pressure is analysed. Some conclusions are given.

[Correction of mineral and protein metabolism by anabolic preparations and vitamin D2 in rats with dental caries]. / Korrektsiia mineral'nogo i belkovogo obmena pri kariece zubov u krys anabolicheskimi preparatiami i vitaminom D2.

The effect of nerabol, namacyte and vitamin D2 introduction (separately or in combination) on the animal mineral and protein metabolism has been studied in the experiment on 210 white Wistar rats with reproduced caries. Biochemical and radioisotopic investigations have permitted determining the quantitative content of phosphorus, calcium, 14C-glycine in the saliva, blood serum, teeth, jaw bones and femur. The data obtained evidence for the pronounced caries-static effect of the tested preparations connected with their active influence on the mineral and protein metabolism of experimental animals as well as for the expediency to use the above drugs for complex prophylaxis and treatment of dental caries normalizing processes.

[Metabolic disorders and their correction in schoolchildren with different forms of caries]. / Metabolicheskie narusheniia i ikh korrektsiia u shkol'nikov s razlichnymi formami kariesa.

Biochemical studies of salivary metabolic disorders in 839 schoolchildren with various forms of caries have revealed salivary pH range to vary from 6.23 +/- 0.02 to 6.80 +/- 0.04, with calcium and inorganic phosphorus levels varying from 4.20 +/- 0.07 to 5.12 +/- 0.11 mg% and from 0.117 +/- 0.05 to 1.041 +/- 0.21 micrograms/ml, respectively. Alkaline phosphatase activity range was found to vary from 107.7 +/- 7.65 to 295.0 +/- 32.3, that of acids from 11.7 +/- 1.81 to 52.5 +/- 4.61 nmol/ml. alpha-ketoglutarate, oxalacetate, phosphoenolpyruvate levels were 3.12 +/- 0.03 to 28.8 +/- 3.41 mumol/ml, fructose diphosphatase content from 2.5 +/- 0.35 to 8.71 +/- 0.72 nmol/s/ml. Use of namacit various dosage forms (5 percent aqueous solution, as a toothpaste component--6 percent, or a component of an adhesive coating) elevated salivary pH level to 7.06. Calcium level remained unchanged, that of inorganic phosphorus increased (p less than 0.001), phosphatase activities grew, as did acid levels and fructose diphosphatase activity, that increased irrespective of the dosage form used (p less than 0.001).

[Relation of the course of dental caries in schoolchildren to a series of risk factors]. / Zavisimost' techeniia kariesa zubov u shkol'nikov ot riada faktorov riska.

A total of 839 schoolchildren were investigated in different age groups. In compensated and subcompensated caries forms its intensity varied within the limits of 1.76 +/- 0.07 to 3.13 +/- 0.59 and 5.40 +/- 0.15 to 7.29 +/- 0.17, respectively. In decompensation these values were 10.23 +/- 0.34 to 12.28 +/- 0.42. The highest hygienic index (2.0 +/- 0.25) was found in schoolchildren with decompensated form of caries. Sub- and decompensated forms developed with concomitant gastrointestinal, endocrine disorders and CNS trauma.

[The current views on anesthesiological support for surgical interventions under extreme conditions]. / Sovremennye vzgliady na anesteziologicheskoe obespechenie khirurgichekikh vmeshatel'stv v ékstremal'nykh usloviiakh.

Local wars and major catastrophes of the last years have originated a new approach to a problem of anesthetic management at the various phases of evacuation. In cases of mass casualty admission it must be taken an option between field block anesthesia and general intravenous anesthesia with spontaneous breathing or artificial lung ventilation. In many respects the outcome of surgical intervention will depend on action coordination between surgeon and anesthesiologist.

[The current problems of intensive therapy in military field surgery]. / Sovremennye problemy intensivnoi terapii v voenno-polevoi khirurgii.

The authors discuss actual problems in intensive therapy as practiced in the military medical set-ups, particularly the usage of standardized methods of anti-shock therapy in the high-quality medical aid. The emphasis has been placed on the role of monitoring, i.e. continuous observation and immediate reaction to the changes in a patient's life-support vital functions. It should not be labor-consuming process for medical personnel neither a burden to the patient. The organizational structure of a hospital should provide for an intensive therapy and resuscitation section as a unit.