[Multimodal approach to postoperative analgesia in patients with neuropathic pain].

Chronic neuropathic pain syndrome observed prior to surgery not only influences the intensity of pain, but also reduces the efficiency of selective use of analgesics. The purpose of the investigation was to study the efficiency of various analgesics and their combinations after lumbar microdiskectomy. Seventy-six patients who had undergone lumbar microdiskectomy and who suffered from chronic back pain were examined. According to the mode of postoperative analgesia, the patients were divided into 4 groups: 1) 20 patients received i. m. promedol 20 mg (a control group); 2) 20 had i. v. tramal (patient-controlled anesthesia); 3) 18 were given i. v. xefocam 24 mg/day; 4) 18 i. v. ketamine 0.1 mg/kg/hour + i. v. xefocam 24 mg/day. Their analgesic effect was evaluated using a visual analogue scale 1, 2, 4, 6, and 24 hours after surgery. The use of xefocam in combination with microdose ketamine was ascertained to cause no increase in the frequency of adverse reactions, to upgrade the quality of analgesia, and to minimize the intensity of pain 24 hours following surgery.

[Spinal operations performed in prone position: pulmonary gas exchange, hemodynamics, and possible complications]. / Operatsii na pozvonochnike v polozhenii na zhivote: sostoianie gazoobmena, gemodinamiki i vozmozhnye oslozhneniia.

Invasive and non-invasive studies have been used to study the cardiac and respiratory systems in 93 patients during prolonged prone surgical interventions into the vertebral column. Pronounced hemodynamic changes have been found to be absent at the stage of anesthetic anesthesia and while turning the patient with to the prone position. Gas exchange is determined by the increase in alveolar dead space, PaCO2, and PaO2. The position complications during these interventions are caused by errors while placing the patient on an operating table.

[Prophylaxis of thrombotic complications in microsurgical auto-transplantation of tissue complexes]. / Profilaktika tromboticheskikh oslozhnenii pri mikrokhirurgicheskoi autotransplantatsii tkanevykh kompleksov.

Problems of prophylaxis of intra- and postoperative thrombotic complications are discussed basing on the experience of treatment of more than 1500 patients who underwent microsurgical autotransplantation of tissues. Influence of non-fractionated heparin, acelysin and low-molecular heparin on hemostasis in combination with standard hemodilution after microsurgical autotransplantation was analyzed. Scheme of treatment before, during and after surgery are developed for prophylaxis of thrombotic complications.

[Sleep and sedation: clinical and electrophysiological parallels]. / Son i sedatsiia: kliniko-élektrofiziologicheskie paralleli.

Clinical and electrophysiological studies were performed in 10 volunteers and 45 patients with Classes I and II, as stated by the American Society of Anesthesiologists, to evaluate consciousness during sedation. Prior studies on volunteers showed that there was a clear correlation between N-REM sleep and SEF in 90% of cases. Based on these findings, the authors propose a modified suppressed consciousness scale whose rating was adjusted to the levels of N-REM sleep. Irrespective of the type and technique of sedation (infusion of thiopental and propofol; PCS, midazolam), changes in the levels of drug-depressed consciousness were found to be the same.

[Tests of durability characteristics of osteosynthesis of femoral neck fractures by different fixators under static and dynamic loading]. / Ispytaniia prochnostnykh kharakteristik osteosinteza perelomov sheiki bedra raznymi fiksatorami pri staticheskikh i dinamicheskikh nagruzkakh.

Test bench experiments on the models of femoral neck bone fractures with the use of various kinds of latches has been carried out for evaluation of durability characteristics of the osteosynthesis, using universal test machine "Zwick-1464". 40 preparations of proximal-diaphysis parts of the femoral bone from 28 females and 12 males (mean age 71 years) were used one day after death. The models of basal, transcervical and subcapital fracture were formed with the angle between its planes and horizontal plane (the angle of Pauel's) 30, 40 and 70 degrees. The models of fractures underwent static and dynamic loads, the results being fixed automatically in graphics. The obtained data have confirmed the dependence of the stability of the osteosynthesis by tested fixators on the size of Pauels' angle: the more was this value the less was the firmness of the junction. Dependence of the firmness of fixation of bone fragments on location of the fracture in femoral neck was noted. The differences of durability characteristics of created constructions in basal, and transcervical fractures of types I and II by Pauels are insignificant. The authors think that the least invasive mode for fixation among tested constructions is osteosynthesis with V-shaped bunch of needles, which produced minimal trauma for bone tissue and created resilient tension in the system of bone fixator (latch), which is especially important in osteoporosis.

[The results of treating stomach cancer at a medical center]. / Rezul'taty lecheniia raka zheludka v meditsinskom tsentre.

Results of diagnosis and treatment of gastric cancer according to the program of screening in permanently followed-up population group during 1980-1995 years, developed and introduced into practice of Medical Center of the President of Russia Administration, are analysed. According to the Cancer Register data through this period, total number of cases of this disease comprised 896 patients. Active revealing of cancer of the stomach made up 61%. The causes of advanced disease in patients with stage IV cancer have been thoroughly analysed, their share being high enough--23.5%. Due to achieved level of early diagnosis (I stage) the possibility of only radical surgical treatment rises up to 83.5%, allowing to receive a high percent of corrected 5-year (92-93%) and 10-year (83-88%) survival. Every third patient with cancer of the stomach succumbs due to causes unconnected with the progression of the disease.

[Current status of gastric cancer morbidity]. / Sovremennoe sostoianie zabolevaemosti rakom zheludka.

Gastric cancer is one of the most common diseases in patients over 70 years of age. It makes 14.4% of all malignant tumours, 15.7%--if oncohaematological cases are not included, and 19.8%--if oncohaematological cases and skin basaliomas are not considered. Most frequently the 1st stage of cancer was found in patients over 70 years of age (41.8%). The 4th stage of cancer is most commonly detected in patients of the oldest age group (34.5%). The program for early detection makes it possible to increase significantly timely diagnosis of gastric cancer (up to 80% in stages I and II). The screening program provides the detection of early stages of gastric cancer in 40.6% of the patients with the 1st stage of gastric cancer. 5-year survival is 30.2%, the corrected rate--40.3%. The rates of 5-year survival (both--observed and corrected) are the highest in patients with the 1st stage of the disease. The 5-year survival rate in patients aged 50-59 years is 65.5%; whereas in patients over 70--16.0% and 27.7% (observed and corrected, respectively).

[The current status of the diagnosis of lung cancer under the conditions of the long-term dispensary care of a population group]. / Sovremennoe sostoianie diagnostiki raka legkogo v usloviiakh dlitel'noi dispanserizatsii gruppy naseleniia.

In 1980-1995 the authors observed 739 cases of lung cancer. A special screening program on early diagnosis of lung cancer has been developed. The centralized system of the information collection, storage and processing of all the cancer cases, follow-up of all the registered cases provided observed and corrected 5- and 10-year survival. Efficacy of screening and early treatment is shown.