Limb salvage and functional recovery in infected nonunion of the distal tibia treated with the Ilizarov techniques.

Introduction: Treatment of infected nonunion of the distal juxta-articular tibia is a challenge due to a short distal fragment, deformity, thin soft-tissue envelope, and active infection. There is still no consensus on the approach that is able to maximally salvage the limb and ankle function. Material and methods: Infected juxta-articular nonunion of the distal tibia was managed with two Ilizarov techniques, monofocal compression (MC) used in 12 patients and bifocal compression-distraction (BCD) in 6 patients. The choice of the technique depended on the size of the postresection defect, ≥3 cm or ≤3 cm, respectively. The tactics of functional approach were careful debridement, insertion of wires in the distal fragment so that they do not penetrate the ankle joint, stable fixation, and temporary bridging of the ankle and forefoot. MSCT was used along with regular radiography to assess the union and regeneration. Ankle functions were evaluated with AOFAS ankle-hindfoot score system. Results: Bone consolidation, infection arrest and ankle function improvement were achieved in all patients. External fixation continued 221.7 ± 15.1 days for MC and 235 ± 25.8 days for BCD. Complications were wound divergence, wire-tract infection, premature consolidation of the fibula, and hypoplastic regeneration in one case. The mean functional AOFAS score after treatment was 90.7 ± 2.5 points in MC and 89.7 ± 1.3 in BCD patients. Residual limb discrepancy after MC ranged 0-4 cm. Bone shortening was compensated in BCD patients. Conclusion: Limb-salvage and functional approach to the treatment of infected nonunion of the juxta-articular distal tibia with the Ilizarov techniques achieves good outcomes. It provides bone infection arrest, consolidation, defect compensation and significantly improves the ankle joint function.

[Surgical treatment for gastrointestinal stromal tumors].

The results of treatment of 15 patients with GIST tumors from 2007 to 2010. We describe the clinical manifestations depending on the location and development of complications. Estimated the complexity and accuracy of preoperative diagnosis using different instrumental technigues in accordance with the recommendations of an international agreement in 2005. Accurate diagnosis can be established only by using immunohistochemical study,which is true in all cases the presence of GIST tumors. As an additional method of imaging for suspected tumor site in the small intestine is used angiography of visceral abdominal arteries.

Force spectroscopy of barnase-barstar single molecule interaction.

Results of the single molecule force spectroscopy study of specific interactions between ribonuclease barnase and its inhibitor barstar are presented. Experimental data obtained for the force loading rate ranging 2-70 nN/s are well approximated by a single straight line, from which the dissociation barrier of the width of 0.12 nm and height of 0.75-0.85 × 10(-19)J can be inferred. The measured value of specific interaction does not depend on the NaCl concentration. This apparently contradicts the well-known dependence of the binding energy of this pair on the salt concentration, but such a "contradiction" is explained by the insensitivity of the force spectroscopy data to the relatively long-range electrostatic interaction. The latter essentially contributes to the value of barnase-barstar binding energy revealed by biochemical measurements, and it is exactly this electrostatic interaction which is influenced by the salt concentration.

[Methods of surgical and pharmacotherapeutic influence on the celiac plexus in abdominal surgery].

Literature and own experience in surgical, surgical-pharmacological and contact electro-pharmacological influence on the celiac plexus for correction of dysfunctions in the upper abdominal diseases are analyzed. Original surgical procedures on sympathetic nerves in celiac neuro-ischemic syndrome, chronic duodenal obstruction, duodenal ulcer, and also methods of catheterization and electro-pharmacological impact on celiac plexus in celiac ganglioneuritis and surgical trauma of the stomach are described.

[Potentialities of life quality evaluation for gastroenterological patients]. / Vozmozhnosti otsenki kachestva zhizni bol'nykh v gastroénterologicheskoi praktike.

Quality of life (QL) was studied in 112 patients with gastroenterological diseases: 29 cases of gastric ulcer (GU), 53 cases of duodenal ulcer (DU) and 30 cases of chronic pancreatitis (CP). QL was judged according to the test of the Cardiological Research Center of the RAMS. QL in the above gastroenterological diseases was related to restrictions in the diet, emotional and muscular load, long-term treatment. The integral quantitative indices of QL were worse in CP and GU than in DU, and deteriorated with the disease duration and severity. A close correlation was found between QL and subjective symptoms of the disease, especially pain syndrome. The proposed approach to qualitative and quantitative assessment of gastroenterological patients's quality of life adequately reflects this complex phenomenon and closely correlated with clinical evidence.

[Suppurative-septic complications after surgical treatment of destructive pancreatitis]. / Gnoino-septicheskie oslozhneniia pri khirurgicheskom lechenii destruktivnogo pankreatita.

Complex prophylactics of pyo-septic complications was used in 46 patients with acute destructive pancreatitis. It resulted in 11% less frequency of the complications, postoperative lethality became 28% lower. In 35 patients with the preserved spleen resection of the pancreas was followed by less lethality as compared with similar operations including splenectomy. The immune stimulating therapy in combination with antibiotics ++ is most effective after radical operations on the pancreas.