[Evaluation of the effectiveness of anecaine in central segmental blockades in orthopedic-traumatologic interventions]. / Otsenka éffektivnosti anekaina dlia tsentral'nykh segmentarnykh blokad pri ortopedo-travmatologicheskikh vmeshatel'stvakh.

Efficacy of anecaine (A) (bupivacaine, Pliva) and marcaine (M) (bupivacaine, Astra) in central neuroaxial block combined with sedation is compared. In the group with epidural block (n = 167, ASA I-III), 102 patients were given anecaine and 65 marcaine in equivalent doses. In the group with spinal block (n = 82, ASA I-III), anecaine was administered to 52 and marcaine to 30 patients. In the epidural block group a catheter was placed at L2-3 or L3-4 with cranial direction. A test dose of bupivacaine (20 mg) was followed after 5-7 min by the main dose of 2 mg.kg-20 mg. Propofol was given for partial suppression of consciousness at a continuous infusion rate 1.6 mg.kg.hr. In spinal block group, bolus dose of bupivacaine (10-20 mg) was injected through the subarachnoidal approach at L2-3 or L3-4. Diazepam (0.1 mg.kg.hr) was used for sedation. Block onset, duration of sensor and motor block, and of effective analgesia were evaluated in all groups. Hemodynamics and respiratory function were monitored. Moderate hypotension (16-17% decline from basic values) was observed in all patients irrespective of bupivacaine brand. In a comparative non-randomized study anecaine showed a faster onset of block and longer duration of clinical effect than marcaine in epidural and spinal anesthesia for orthopedic surgery on the lower limbs.

[Extracorporeal detoxication in the treatment of peritonitis complicated with multiple organ insufficiency]. / Primenenie ékstrakorporalnoi detoksikatsii pri peritonite v faze poliorgannoi nedostatochnosti.

The article deals with experience in the use of filtration and combined methods of extracorporeal detoxification in 201 patients with peritonitis in the phase of polyorganic insufficiency. The methods were developed in the department of abdominal surgery of the Moscow Regional Scientific Research Clinical Institute. The authors show the indications for and the advantages, the mechanisms of the effect, and the results of bifiltration cascade exchange plasmapheresis, improved hemofiltration method, and selective detoxification of portal blood, and the combination of these methods with continuous membrane blood oxygenation. The mortality reduced from 46.6% in the control group to 26.5% in the main group.

[The importance of a study of the tears in the early diagnosis of infection in penetrating eye injuries]. / Znachenie issledovaniia slezy v rannei diagnostike infitsirovaniia pri pronikaiushchikh travmakh glaza.

Status of tears was studied in patients with penetrating wounds to the eyes using polarization optic microscopy to assess the type of morphological types of crystals, measurements of secretory IgA to assess local immunity status, and screening methods to estimate protein level from the relative coefficient. A total of 122 patients with penetrating corneal and corneoscleral wounds were examined, 48 of these without clinical signs of infection and 74 with clinical manifestations of an infection. For control 88 subjects without somatic diseases or ocular diseases were examined. Crystallography revealed predominance of two morphologic types, Nos. 3 and 5, whose crystal structures were taken as the normal types. Their detection rate was reduced in penetrating wounds to the eye. Secondary morphologic types Nos. 14 and 16 reliably predominated in "pure" injuries and a secondary morphologic type 14 M in patients with developing infection (in 19 patients this type predominated during the preclinical form of infection of the eye). Increased IgA levels were observed in patients with noninfected injuries and reduced ones during infection. An infection was found associated with reduced protein level.

[The prognosis of the outcomes of comatose states in the first 24 hours following craniocerebral trauma]. / Prognozirovanie iskhodov komatoznykh sostoianii v pervye sutki posle cherepno-mozgovoi travmy.

In 58 patients with disorders of consciousness in the first day after the trauma assessed by the Glasgow coma scale both favourable (31%) and fatal outcomes (69%) were observed. Some differences were revealed in the indices of the Moscow scale and Glasgow scale.

[Effects of earplugs on the development of hypoacusis and extra-aural pathology in workers exposed to industrial noise]. / Vliianie primeneniia antifonov na razvitie tugoukhosti i ékstraural'noi patologii u rabotaiushchikh v usloviiakh proizvodstvennogo shuma.

Using an EC computer and Medstat-85 software, statistical multivariate analysis of data accumulated during 20 years of examinations of 210 workers of a textile (twisting) shop was performed. Out of these subjects 70 persons used antiphones (of ear plugs) continuously, 70 workers used them occasionally, and 70 subjects did not use them at all. It was found that hearing impairment and concomitant vascular disorders developed at an earlier stage and in a greater extent in those workers who never used ear plugs. The noise-induced changes proved more expressed than age-related vascular pathology.

[Formalization of the process of differential diagnosis of nevi and initial choroid melanomas with the aid of a diagnostic table]. / Formalizatsiia protsessa differentsial'noi diagnostiki nevusov i nachal'nykh melanom khorioidei s pomoshch'iu diagnosticheskoi tablitsy.

Basing on the results of a multidimensional discriminant computer-aided analysis of clinical findings in 11 patients with nevi and 102 with initial choroidal Stages TIa-TIb melanomas, the authors suggest formalization of the process of differential diagnosis between nevi and initial choroidal melanomas. For this purpose a diagnostic table with the minimal number of signs was developed. The disease can be diagnosed (the share of erroneous diagnoses is under 6 percent) with the use of just common instruments that can be found in any ophthalmology room.

[The informativeness of clinical laboratory indices of the effectiveness of exchange plasmapheresis in patients with peritonitis]. / Issledovanie informativnosti kliniko-laboratornykh pokazatelei éffektivnosti obmennogo plazmafereza u bol'nykh peritonitom.

The results of the application of exchange plasmapheresis in 51 patients with suppurative peritonitis have been processed statistically using "MEDSTAT-85" software. 2-3 exchange plasmapheresis procedures at an up to 2-day interval, with exfusion of 1000-1200 ml plasma and adequate replacement of plasma loss by freshly frozen donor plasma and specific hyperimmune plasma were shown to be an optimum regimen. Blood toxicity, concentration of medium molecular toxins and leukocytic index of intoxication were the most informative criteria of the efficacy of exchange plasmapheresis.

[Methodological aspects of formation of groups at risk for cancer of the stomach and large intestine]. / Metodologicheskie aspekty formirovaniia grupp riska po raku zheludka i tolstoi kishki.

An algorithm for selection of groups at high risk of cancer of the stomach and colon has been developed with the aim of improving the diagnosis of these diseases in mass screening of the population. A multidimensional statistical analysis realized in MEDSTAT-85 programme package was used to identify the most informative risk factors and to formulate the regularity having these factors expressed in percent by weight. The proposed programme of targeted screening allows for rapid and effective selection of risk groups and, in combination with the conventional gastric and colon fluorography techniques, facilitates timely detection of gastric and colonic cancer.

[Determination of groups at risk for laryngeal tumors]. / Opredelenie gruppy riska opukholevykh zabolevanii gortani.

A procedure for development of an adequate screening program for detecting precancer and cancer of the larynx was elaborated on the basis of outpatient charts and regular check-up data. Patients with laryngeal neoplasia were included into the "cancer" group (47), those with hyperplastic laryngitis--"precancer" (189) and disease-free subjects--into the "normal" group (260). Cancer suspects as identified by the procedure should be referred to the otolaryngologist for closer examination.

[Surgical treatment of patients with cranio-cerebral trauma and the role of neurological symptoms in the prognosis of its outcomes]. / Khirurgicheskoe lechenie bo'lnykh s cherepno-mozgovoi travmoi i ro'l nevrologicheskoi simptomatiki dlia prognozirovaniia iskhodov.

Under examination there were 411 patients with cranio-cerebral traumas. A unified method was used at different medical institutions in order to study questions of prognosis of the outcomes. Surgical treatment was used in 117 of them. The investigations have shown that the state of trance-coma both before operation and in the postoperative period is absolutely unfavourable prognostically. The state of trance-coma and the value of 15 scores and less should be taken into consideration as a contraindication for the solution of the question of operation in patients with cranio-cerebral traumas.

[Use of a point-scale assessment of patient status in the surgical treatment of craniocerebral injuries]. / Ispol'zovanie ball'noi otsenki sostoianiia bol'nykh pri khirurgicheskom lechenii cherepno-mozgovoi travmy.

The indications and contraindications for surgical treatment in craniocerebral trauma (CCT) were based on estimation of the patient's condition in marks; the dynamics of changes of the results of the estimation in the pre- and postoperative periods were studied. A total of 375 patients with CCT were examined in different medical institutions according to a unified method. Neurosurgical interventions were carried out on 155 patients. All patients who underwent operation when their condition was rated below 15 marks died on the immediate postoperative days, whatever their age and whatever the time of the operation after the trauma. The probability of a favourable outcome increased to 40% in a condition rated 21-30 marks on the day of the operation and reached 69% when it was above 30 marks.

[Information value of initial clinical signs for the prognosis of outcome in the first 24 hours after craniocerebral injury]. / Informativnost' klinicheskikh priznakov dlia prognozirovaniia iskhodov v 1-e sutki posle cherepno-mozgovoi travmy.

The informativeness of clinical indicators for predicting lethal and favourable outcomes during the first 24 hours after a head trauma has been investigated. A pool of clinical findings about the status of 302 patients examined according to a uniform technique has been analyzed using a packet of the MEDSTAT-85 software. The authors present an optimal set of clinical signs for predicting fatal and favourable outcome within the first 24 hours after the trauma with an 83% probability rate.

[Prediction of the outcome of craniocerebral injuries in the acute period]. / Prognozirovanie iskhodov v ostrom periode cherepno-mozgovoi travmy.

Unified clinical findings in 302 patients were analysed to prognosticate the outcomes of severe craniocerebral trauma in the acute phase. The patients condition in the acute stage was evaluated in points according to four types of outcome: fatal, with coarse and moderate neurological disorders, and with a satisfactory compensation of the condition. In a condition rated 20-30 points the probability of a favourable or a fatal outcome was equal. In a condition rated less than 20 points the probability of a fatal outcome increases, in one-rated above 30 points the probability of a favourable outcome grew.

[Prediction of various categories of recovery in craniocerebral injuries and the informative value of clinical signs]. / Prognozirovanie raznykh kategorii vyzdorovleniia pri cherepno-mozgovoi travme i informativnost' klinicheskikh priznakov.

The authors studied the informative value of clinical signs of craniocerebral trauma (CCT) in relation to the prediction of different categories of recovery. Using a package of applied programmes MEDSTAT-85 a clinical pool of the findings about the status of 302 patients examined by a uniform technique was subjected to clinical analysis. The optimal set of clinical indicators for predicting different categories of recovery in the first 24 hours after the CCT with an average accuracy of 80% is described.