[Combined regional anesthesia of the lower extremities in children with cerebral paralysis].

The authors share their first experience of combined regional anesthesia during surgical interventions into the lower extremities in children with infantile cerebral paralysis (ICP). A hundred and twenty-five blocks were performed in patients aged 5 to 20 years. Lidocaine, marcaine, naropine, or a mixture of lidocaine and marcaine mixture, were used. The paper describes the specific features of techniques for femoral-sciatic nerve blocks in these patients, shows the adequacy of anesthesia at surgery and the very good course of the postoperative period due to continuous analgesia and the alleviation of muscle spasticity in the operated limb.

[Regional anesthesia of the sciatic nerve with anterior approach in children: new landmarks]. / Regionarnaia anesteziia sedalishchnogo nerva perednim dostupom u detei: novye orientiry.

The purpose of the case study was to evaluate new landmarks for the needle insertion in sciatic nerve block made through the anterior approach. We identified, by X-Ray, new simplified bone landmarks and suggested that the skin should be marked in order to find the puncture site. We made regional anesthesia of lower limbs through femoral and sciatic nerve blocks in 221 children with the classical posterior approach used in 166 patients and with the anterior approach with skin marks used in 55 children. The conclusion is that the new ischial approach is a good alternative to the classical posterior approach. The former ensures the regional anesthesia of the lower limbs in all trauma cases; besides, it cuts the block implementation time. The rate of complications and the duration of postoperative analgesia are not dependent on a selected approach.

[Dystrophin gene expression in patients with Duchenne muscular dystrophy after myoblast transplantation]. / Ekspressiia gena distrofina u bol'nykh miodistrofiei Diushenna posle transplantatsii mioblastov.

Based on originally designed technique of myoblast cultivation and in accordance with the approved by the Russian Ministry of Health "one muscle treatment" protocol of myoblast transplantation to the Duchenne muscular dystrophy patients, the first in Russia clinical trial of this gene correction method was carried out. Immonologically related myoblast cultures (30 to 90 million cells per patient) were injected after all preliminary procedures into tibialis anterior muscles of four boys selected from a group of volunteer recipients (Duchenne muscular dystrophy patients) based on the analysis of a number of surface antigens in donor-recipient pairs. The condition of the patients remained satisfactory during the whole period of post-transplantation follow-up (from 6 months to 1.5 years). Six months after myoblast transplantation the presence of donor DNA or dystrophin synthesis was demonstrated in muscle biopsies of three out of four patients. This result confirms efficacy and safety of the procedure used.

[Primary tumors of heart]. / Pervichnye opukholi serdtsa.

The analysis of 36 years' experience in surgical treatment of 162 patients with benign and malignant primary tumors of the heart, verified by morphological examination, is presented. The possibility of their timely and intra vital revealing is noted in cases of clinical alertness which makes possible to suspect this disease and purposefully examine these patients using preferably echocardiography and computed tomography. The scope of the operations and their success depend on morphological characteristics of the tumors and the extent of neoplastic process. However, by now short- and long-term results of surgical treatment evidence, that predominant part of this category of patients is potentially curable, provided that these neoplasms of the heart were revealed at an initial stage.

[An algorithm for differential diagnosis searching in space-occupying lesions of the liver]. / Algoritm differentsial'no-diagnosticheskogo poiska pri ob''emnykh obrazovaniiakh pecheni.

The experience of examination of 584 patients with volumetric masses of the liver (VML) of various origin is presented. For successful differential diagnosis of VML and definition of rational surgical policy the algorithm of examination was considered with due regard for diagnostic stages, each of them being characterized by definite complex of tests. It is thought necessary to begin examination with noninvasive and highly informative tests. Complex of radioimmunologic evaluation of tumor markers level is advisable to include in diagnostic algorithm of patients with VML. The use of invasive methods of diagnostics is justified in complicated diagnostic situation. For evaluation of regional function of the liver radionuclear examination should be used. Liver puncture are feasible only whenever parasitic nature of cystic masses of the liver is excluded. If it is found to be impossible to determine the character of VML the question of advisability of diagnosis laparotomy should be resolved in its favour. The most efficient use of various methods of examination in 584 patients with VML of various genesis made it possible to increase accuracy of diagnosis of hepatic hemangioma, in nonparasitic cysts--1.7 times and in parasitic cysts--1.2 times.

[Asymptomatic osteoma of the frontal sinus with intracranial invasion as a cause of post-traumatic pneumocephalus]. / Nemaia osteoma lobnoi pazukhi s vnutricherepnym rasprostraneniem kak prichina posttravmaticheskoi pnevmotsefalii.

A rare case of frontal sinus osteoma growing intracranially in a female of 38 is reported. The disease ran without any otorhinolaryngological or neurological symptoms until the sinus blunt injury followed by headaches resistant to analgetics and other neurological signs. Computed tomography discovered osteoma involving the cerebral cranium and pneumocephalus in the right cranial fossa. Management of patients with paranasal sinuses should account for possible intracranial complications and CT control of the tumor growth is very much desired.

[X-ray study of the stomach after vertical gastroplasty in the treatment of morbid obesity]. / Rentgenologicheskoe issledovanie zheludka posle vertikal'noi gastroplastiki pri lechenii morbidnogo ozhireniia.

The operation vertical gastroplasty is used to treat the so-called morbid obesity. It ends with the formation of a small stomach. Some experience gained with X-ray of the stomach is analyzed in 17 patients undergone vertical gastroplasty. X-ray evaluates the status of the small stomach arranged as a tube in the upper portions in the vicinity of the lesser curvature of the stomach. The shape, sizes, outlet of the small stomach, as well as emptying rates and the state of an internal vertical suture of the stomach are to be studied.

[Computerized tomography of pericardial diseases]. / Komp'iuternaia tomografiia boleznei perikarda.

Computed tomography (CT) was used to examine 114 patients with pericardial diseases. CT symptomatology of pericardial diseases are given in detail. CT defines the thickness and density of the pericardium and its content. To identify constrictive pericarditis, it provides additional information on the status of the vena cava, atria, ventricles and on pleural changes. The minimum pericardial amount of capsulated fluid that can be detected by CT is estimated to be 10 ml. Multipositional CT and functional CT (to breathe in and out) are indicated in the diagnosis of pericardial cysts.

[The characteristics of diagnosing homosexuality in examining a special population contingent]. / Osobennosti diagnostiki gomoseksualizma pri obsledovanii spetskontigenta.

In social terms homosexuality is one of the most dangerous sexual perversions, for it is subject to a strong social disapproval, affects the personality core, leads to social disadaptation, growth of anxiety, development of neurotic and depressive states, suicidal inclination, is conducive to the spread of syphilis and AIDS, forms the basis for numerous crimes (violence, aggression, murder). Homosexuality virtually cannot be corrected and is carefully concealed. In single-sex groups (soldiers, students of military schools, convicts) the prevalence of homosexuality may be as high as 30 to 50%. The proposed complex method for the diagnosis of homosexuality in men has been developed on the basis of methods of sexology, anthropometry, verbal and nonverbal psychodiagnosis, multidimensional mathematical statistics. The method consists of several independent blocks representing different aspects of sexuality. It is conductive to a flexible and rapid solution of numerous practical problems from singling out a risk group in screening examinations to full expert evaluation of the sexual sphere with a resulting differential diagnosis.

[Role of computerized tomography in stenoses and other diseases of the trachea and main bronchi]. / Rol' komp'iuternoi tomografii pri stenozakh i drugikh zabolevaniiakh trakhei i glavnykh bronkhov.

Fifty-one patients with stenosis of the upper portion of the tracheobronchial tree of various origins were examined; the sensitivity of computer-aided tomography (CAT) in the diagnosis of stenoses of the trachea and the main bronchi was found to be 95.83%, specificity 98.31%, and accuracy 93.87%. CAT is superior to other methods of investigation (common tomography, tracheobronchoscopy) in the detection of changes in the tracheobronchial walls and the tissues adjacent to the trachea and the main bronchi. CAT is particularly valuable for the diagnosis of the causes of compression stenosis. The method permits specification and recognition of the type of involvement in traumatic injuries (6 cases), tracheoesophageal fistulae (6 cases), post-tuberculous processes (3 cases). CAT examinations are truly valuable in the diagnosis of osteoplastic tracheobronchopathy (3 cases), some other rare diseases (tracheobronchomegaly--1 case, scleroma--1 case, amyloidosis--2 cases). The authors recommend the optimal algorithm of examinations of patients with diseases of the upper portions of the tracheobronchial tree: roentgenoscopy--roentgenography--CAT--tracheobronchoscopy.

[Diagnosis of tumors of the trachea and main bronchi by computerized tomography]. / Diagnostika opukholei trakhei i glavnykh bronkhov c pomoshch'iu komp'iuternoi tomografii.

A total of 104 patients with tumors of the upper portions of the tracheobronchial tree were examined. The tumors were malignant in 66 cases (53 primary and 13 secondary ones) and benign in 38 cases. The sensitivity of CT in the diagnosis of blastomas of the trachea and the main bronchi made up 96.12%, specificity 86.15%, and accuracy 91.6%. CT permitted the detection of the tumor, specification of its site and size, definition of its contour, imaging of a non-transparent portion and of relationships with the adjacent organs and tissues, assessment of the status of the walls (by detecting dense, thickened, or deformed sites) and regional lymph nodes.

[Cerebral complications in cardiac myxomas]. / Tserebral'nye oslozhneniia pri miksomakh serdtsa.

The authors analyze injuries to the central nervous system in patients with heart myxomas due to tumorous embolism of brain vessels with the development of acute or "delayed" cerebral symptomatology. Stress the difficulty of correct interpretation of acute disorders of cerebral circulation with no other signs of intracavitary heart neoplasm and the possibility of the asymptomatic form of cerebrovascular embolism or its consequences in association with a remarkable clinical picture of heart myxoma. Emphasis is laid on the necessity of carrying out all-round examination of the brain to reveal injuries that may occur under such conditions, to determine the prognosis and treatment policy in the given patients' group, especially in the long-term period after resection of intracavitary heart neoplasm.

[Correction of cellular and humoral defense reactions in the surgical treatment of acute cholecystitis]. / Korrektsiia kletochnykh i gumoral'nykh zashchitnykh reaktsii pri khirurgicheskom lechenii ostrogo kholetsitita.

Complex study of cellular and humoral defense reactions in patients with acute cholecystitis revealed a decrease in their level, decelerated change of the neutrophil phase to the mononuclear phase, and increased metabolic phagocyte activity in the focus of affection. In the postoperative period the indices of cellular and humoral nonspecific reactions of the blood reduced still more, the level of leukocyte viability and the micro- and macrophage functional activity in the focus of affection remained diminished. The use of extracorporeal prognostic immunostimulation in combination with plasmapheresis corrects the immunodepression within a short time but fails to change the local defence reactions. Transposition of the extracorporeally stimulated auto-immunocytes to the inflammatory focus ensures a high level of local defense reactions and promotes readaptation of the immune system as a whole.

[Computerized tomography in the diagnosis of heart neoplasms]. / Vozmozhnosti komp'iuternoi tomografii v raspoznavanii novoobrazovanii serdtsa.

Computed tomography (CT) was used to study 56 and 4 patients with primary and secondary cardiac blastomas, respectively. CT allows differentiation between a racemose and dense endocardial tumor, localization of myxoma pedicle, recording its prolapse into the adjacent chamber, identification of extra-, intracardiac and intramyocardial tumor growth as well as changes in adjacent vessels. CT image of cardiac myxoma is similar to a filling defect of diminished density, that of extra-endocardial tumors display polymorphism. Blastomatous invasion of the heart is characterized by blurring of cardiovascular elements boundaries, pericardial thickening and fluid accumulation. CT is advocated as a new, noninvasive and highly efficient diagnostic modality in cardiac tumors.

[Computerized tomography in evaluating the function of aortocoronary shunts]. / Kom'piuternaia tomografiia v otsenke funktsii aortokoronarnykh shuntov.

An examination was made of 38 patients undergone aortocoronary bypass surgery. Comparing the density of content in the aorta and shunt before and after bolus contrast in computerized tomography makes it possible to evaluate the patency of the aortocoronary shunt. A shunt patency coefficient (SPC) was proposed, which fitted the ratio of density differences in the shunt to those in the lumen of the ascending aorta before and after the injection of a contrast agent. SPC equal to 0.5 or more is indicative of a good patency of the aortocoronary shunt, but that being 0.3 or less suggests no or extremely poor function of the shunt. SPCs that are equal to 0.3-0.5 are transient indicators of its patency.