[The ways of the development of clinical medicine in the XXI century].

The article raises a question of the passion by many doctors for treating the patients with a great number of medicines. Recommendations on the medicine-free therapy are given which include giving up harmful habits and on healthy mode of life.

[On teaching surgery at the graduation course of a medical college according to a new curriculum]. / O prepodavanii khirurgii v meditsinskom vuze na vypusknom kurse po novomu uchebnomu planu.

Teaching surgery to students of the medical college represents a complex dynamic process based on the achievements and advantages of domestic medical education. The article presents an analysis of historical aspects of teaching surgery formed under the influence of N.I.Pirogov's ideas and shows the necessity of searching for new forms of organization of teaching surgery at the up-to-date stage of reorganization of higher professional school. Special attention is given to a compulsory preservation of traditional principles of the system of teaching surgery verified by almost two centuries of experience of using it.

[Hydrodynamic investigations of the current mechanical artificial heart valves]. / Gidrodinamicheskie issledovaniia sovremennykh mekhanicheskikh iskusstvennykh klapanov serdtsa.

The work presents results of comparative investigations of the integral hydrodynamic characteristics of the best for today domestic mechanical heart valve (MHV) Medinzh-2 (MI-2) and the turn-disk domestic MHV--LIKS-2, EMIKS (E) and foreign MHV--Medtronic-Hall, Bjork-Shiley (BS), Sorin (SO) and bicuspid valves--St. Jude Medical (SJ), Carbomedics in the stationary and in the pulsatile flows. It was found that according to the main hydrodynamic characteristics including the outlet flow structure, MHV MI-2 was substantially superior to MHV E, BS and SO, and by certain characteristics it approximated to the best foreign MHV SJ. Like all mechanical heart valves, the valve MI-2 disturbs the uniformity of the inlet flow and forms a complex non-stationary flow with detached zones, areas of great shear stresses, with vortex structures of different types, and hence the task of hydrodynamic optimization of its construction is thought to become actual. The comparison of clinical parameters of work of the valve MI-2 with its hydrodynamic characteristics confirms its high hemodynamic effectiveness and thrombo-resistance in patients at long-term periods of follow-up, taking into account the adequate correction of disbalance of hemostasis.

[Socioeconomic aspects of the increased volume of cardiosurgical treatment of children with congenital heart defects]. / Sotsial'no-ékonomicheskie aspekty uvelicheniia ob"ema kardiokhirurgicheskoi pomoshchi detiam s vrozhdennymi porokami serdtsa.

The authors made an analysis of social-economical conditions limiting the possibilities of rendering cardiosurgical care to children. Possible ways are mapped out allowing to increase the amount of operations on children with congenital heart diseases.

[Pathophysiological and pathomorphological aspects of pulmonology]. / Patofiziologicheskie i patomorfologicheskie aspekty pul'monologii.

The tendency for the wide use of the term "obstructive" in chronic nonspecific lung diseases, which has contemplated in the literature on pulmonology and practice, is discussed. In the author's opinion, the term is invalid since it corresponds neither to the pathomorphological nor pathophysiological essence of data on the diseases and entails poor treatment results.

[Should the presence of coiled blood flow in the left heart ventricle and aorta be taken into consideration when constructing artificial heart valves?]. / Sleduet li uchityvat' nalichie zakruchennogo potoka krovi v levom zheludochke serdtsa i aorte pri konstruirovanii iskusstvennykh klapanov?

The use of an original device developed by the authors which was introduced in the blood flow in experiments in dogs has confirmed the presence of coiled blood flow in different parts of the aorta. The rate, direction and angle of coiling were calculated. The results obtained suggest that the fact of coiling the blood flow should be taken into account when constructing new models of artificial valves of the heart in order to decrease the energy value of the cardiac output, to prevent injury of the formed elements of blood and thrombogenesis.

[The role of the Cell Saver autologous transfusion method in preventing the pulmonary distress syndrome during open-heart operations on children]. / Rol' autotransfuzionnoi metodiki "Cell Saver" v profilaktike legochnogo distress-sindroma pri operatsiiakh na otkrytom serdtse u detei.

Complex estimation of the state of the lungs at the postperfusion and early postoperative periods based on roentgenological, clinical data, investigations of the parameters of oxygenation and mechanics of respiration was carried out in 32 children with septal defects of the heart, operated upon under conditions of artificial blood circulation with different kinds of the transfusion maintenance including the apparatus "Cell Saver 5" (CS) for the reinfusion of autoerythrocytes. The dynamics of endotoxicosis, hematological parameters during and after operation and requirements in transfusion media were studied. Differences in these indicators were established between the patients operated upon with the use of donor hemocomponents and those who were operated upon with CS. It allowed a conclusion about the role of the method of intraoperative reinfusion of erythrocytes in substantially less frequency and severity of the postperfusional pulmonary complications in this category of patients.

[A method for external painful stimulation in the treatment of arteriosclerosis obliterans of the vessels of the lower extremities]. / Metod vneshnego bolevogo vozdeistviia v lechenii obliteriruiushchego ateroskleroza sosudov niznikh konechnostei.

Under analysis are results of treatment of 21 patients. Positive effects were obtained in 19 of them. This effect was noted in 6 patients during 2 years.

[Aortic valve prosthesis and the plication of a dissecting aneurysm of the ascending aorta in a patient with infectious endocarditis against a background of chronic kidney failure and its management by regular hemodialysis]. / Protezirovanie aortal'nogo klapana i plikatsiia rasslaivaiushchei anevrizmy voskhodiashchei aorty u bol'nogo infektsionnym éndokarditom na fone khronicheskoi pochechnoi nedostatochnosti i provedeniia reguliarnogo gemodializa.

Some literature data are presented on the problem of cardiac surgery in patients with chronic renal insufficiency under regular hemodialysis and on the specificity of performing operations on such patients under conditions of artificial circulation. The authors describe their first experience of a one-step prosthezing of the aortal valve and plication of the dissecting aneurysm of the ascending part of the aorta in the patient receiving the regular hemodialysis during 5 years as well as the positive results of this original operation in dynamics of the first year of observations.

[The basic indices of cellular immunity in surgery for rheumatic heart defects]. / Osnovnye pokazateli kletochnogo immuniteta v khirurgii revmaticheskikh porokov serdtsa.

Distinct changes of basic indicators of cellular immunity were diagnosed in 157 patients with rheumatic heart disease which needed surgical correction. A classification of disturbances of cellular immunity is proposed. A definite correlation between the degree of cellular immunity disturbances and basic clinical parameters of the rheumatic heart disease was followed as well as the influence of the immunological changes on the prognosis of operation results and the outcome of the disease.

[The physiotherapeutic correction of secondary immunodeficiency in the preoperative period in patients with rheumatic heart defects]. / Fizioterapevticheskaia korrektsiia vtorichnogo immunodefitsita v predoperatsionnom periode u bol'nykh s revmatichesmimi porokami serdtsa.

Directed correction of immunity by physiotherapeutic methods was used at the period of preoperative preparing 45 patients who needed the operation for rheumatic valvular disease of the heart. The number of purulent complications during the postoperative period in the group of patients subjected to direct correction of the immune status was found to be less than in the control group.