[Neural network model of treatment policy decision in patients with ulcer disease]. / Neirosetevaia model' opredeleniia lechebnoi taktiki u bol'nykh iazvennoi bolezn'iu.

Based on neuronetwork computer technologies expert neuronetwork complex Axon was developed providing individual prognosis of ulcer disease and recommendations. The base of this expert system is information data base consisting of two blocks. The first block consists of detailed information about 634 patients with gastric ulcers (GU), the second block - about 417 patients with duodenal ulcers (DU). Control evaluation of the system demonstrated that the coefficient of sensitivity in patients with GU was 0,706 - 0,724, coefficient of specificity - 0,701-0,790. Coefficient of sensitivity in patients with DU was 0,765-0,817, coefficient of specificity - 1,000-0,877. The best neuronetwork evaluation was carried out in 57 new hospitalized patients. In 7 of 10 operated patients indications for surgery were based on combination of prognostic and clinical data. Only 2 (4,3%) of 47 patients demonstrated disagreement of prognostic and clinical data. In comparison of results of complications prognosis with real clinical results in surgical group 7 (70,0%) of 10 patients demonstrated agreement of these data. In 32 (74,4%) of 43 patients treated conservatively prognosis of complications corresponded to real clinical data.

The ALTEA/ALTEINO projects: studying functional effects of microgravity and cosmic radiation.

The ALTEA project investigates the risks of functional brain damage induced by particle radiation in space. A modular facility (the ALTEA facility) is being implemented and will be operated in the International Space Station (ISS) to record electrophysiological and behavioral descriptors of brain function and to monitor their time dynamics and correlation with particles and space environment. The focus of the program will be on abnormal visual perceptions (often reported as "light flashes" by astronauts) and the impact on retinal and brain visual structures of particle in microgravity conditions. The facility will be made available to the international scientific community for human neurophysiological, electrophysiological and psychophysics experiments, studies on particle fluxes, and dosimetry. A precursor of ALTEA (the 'Alteino' project) helps set the experimental baseline for the ALTEA experiments, while providing novel information on the radiation environment onboard the ISS and on the brain electrophysiology of the astronauts during orbital flights. Alteino was flown to the ISS on the Soyuz TM34 as part of mission Marco Polo. Controlled ground experiments using mice and accelerator beams complete the experimental strategy of ALTEA. We present here the status of progress of the ALTEA project and preliminary results of the Alteino study on brain dynamics, particle fluxes and abnormal visual perceptions.

[The state and development of colon proctological care at the Vishnevsky Central Military Clinical Hospital]. / Sostoianie i razvitie koloproktologicheskoi pomoshchi v TsVKG im. A. A. Vishnevskogo.

The work is devoted to the assessment of gastric carcinoma spread using the method of spiral CT. It is established that CT is highly effective at carcinoma advanced stages (II-IV), that's why this method should be the main one in determining the disease spread. Besides the CT possibilities in determining the depth of tumor invasion into gastric wall are not unequivocal. The method is more informative at the advanced tumor (pT2-pT4). Without contrast amplification the CT doesn't allow to conduct differentiation according to T1-T2 invasion degree. At the same time the method gives great opportunities in revealing the tumor spread to gastric serous membrane, i.e. in detection of T3 invasion degree that is of great significance for disease prediction. The use of bolus contrast amplification widens the CT possibilities in detection of tumor invasion into gastric wall and in some cases it permits to differentiate T1 and T2 degrees.

ALTEA: anomalous long term effects in astronauts. A probe on the influence of cosmic radiation and microgravity on the central nervous system during long flights.

The ALTEA project participates to the quest for increasing the safety of manned space flights. It addresses the problems related to possible functional damage to neural cells and circuits due to particle radiation in space environment. Specifically it aims at studying the functionality of the astronauts' Central Nervous Systems (CNS) during long space flights and relating it to the peculiar environments in space, with a particular focus on the particle flux impinging in the head. The project is a large international and multidisciplinary collaboration. Competences in particle physics, neurophysiology, psychophysiology, electronics, space environment, data analyses will work together to construct the fully integrated vision electrophysiology and particle analyser system which is the core device of the project: an helmet-shaped multi-sensor device that will measure concurrently the dynamics of the functional status of the visual system and passage of each particle through the brain within a pre-determined energy window. ALTEA is scheduled to fly in the International Space Station in late 2002. One part of the multi-sensor device, one of the advanced silicon telescopes, will be launched in the ISS in early 2002 and serve as test for the final device and as discriminating dosimeter for the particle fluences within the ISS.

[Invaginated esophageal anastomosis]. / Invaginatsionnyi pishchevodnyi anastomoz.

Extirpation of the stomach accounts for 55.5% of all radical surgery for gastric cancer. Five hundred and sixty-two operations with creation of invaginated esophageal-intestinal (gastric) anastomosis were performed. The surgical technique is presented, its positive points are demonstrated. Main advantages of the invaginated anastomosis are physiologic function in postoperative period and a decreased rate of sutures insufficiency. Complications after extirpation and proximal resection of the stomach were seen in 17.6% cases, 5.9% patients died. Insufficiency of anastomosis sutures was in 8 (14%) patients, 4 (0.7%) of them died.

[Colostomies in gunshot wounds of the large intestine]. / Kolostomy pri ognestrel'nykh raneniiakh tolstoi kishki.

The frequency and indications to colostoma formation are shown that were performed during the recent military conflicts in 40-70% of the wounded with large intestinal injuries. The authors state the indications to colostoma formation in the injuries of extra- and intra-abdominal parts of rectum and colon as well as the conditions when colostoma could be avoided. Different methods of colostoma formation and technical details are presented. In field surgery it is reasonable to apply the more simple methods. The operation defects, colostoma complications, measures of their prevention and treatment are discussed in details. The authors distinguish the complications developed in the early postoperative periods and colostoma diseases having independent significance and which become manifestative in 2-3 months after operation.

[Choice of the method of treatment of uncomplicated gastric and duodenal ulcers]. / Vybor metoda lecheniia neoslozhnennoi iazvennoi bolezni zheludka i dvenadtsatiperstnoi kishki.

Three features of ulcer prevalence in Russia and therapeutic policy in ulcer consist of an increase of ulcerous patients number, a decrease of elective operations number for uncomplicated ulcers and an increase of emergency operations rate in complicate ulcer. Decrease of elective operations number leads to increase of emergency operations rate in complicated ulcer. The majority of complicated ulcers has long-term anamnesis, complications develop in chronic ulcers. Expansion of indications to elective operations in uncomplicated gastric and duodenal ulcer is advocated.

[Anastomotic suture incompetence after transperitoneal resection of the rectum]. / Nesostoiathel'nost' shvov anastomoza posle chrezbriushnoi rezektsii priamoi kishki.

Sphincter saving operations were made in 68.1% of 276 radical operations on the rectum, 85.6% of them being transperitoneal resections. The advantages of this operation are: less traumaticity, blood loss and postoperative lethality as well as saved function of the sphincter apparatus. Incompetence of the sigmorectal anastomosis sutures developed in 29 (18.6%) patients. The dependence of frequency of this complication on the sex and age of the patients, on the character of the disease and localization of tumor, on using suturing apparatuses, radiation treatment and unloading colostomy was studied. The distinctions found proved to be unreliable. Direct causes of the development of the complication are thought by the author to be technical defects of the surgery, disturbed blood supply and regenerative abilities of the sutured end of the gut. Recommendations are given how to prevent the development of the complication and of its more severe consequences.

The ALTEA facility on the International Space Station.

The ALTEA project studies the problems related to possible functional damage to the Central Nervous System (CNS) due to particle radiation in space environment. The project is a large international and multi-disciplinary collaboration. The ALTEA instrumentation is an helmet-shaped multi-sensor device that will measure concurrently the dynamics of the functional status of the visual system and the passage of each particle through the brain within a pre-determined energy window. ALTEA is scheduled to fly in the International Space Station in February 2003. One part of the multi-sensor device, one of the advanced silicon telescopes, will be launched in the ISS in early 2002 and serve as test for the final device and as discriminating dosimeter for the particle fluences within the ISS.

[The use of artificial neuronal networks in the treatment of peptic ulcer]. / Primenenie iskusstvennykh neironnykh setei v lechenii iazvennoi bolezni.

Today the use of artificial neuronic nets (ANN) is the most perspective method in the prediction of clinical course and in the choice of correct therapeutic tactics. The experimental complex "Axon" with the software was created in the hospital that permitted to predict the course if gastric and duodenal ulcers. We introduced the data of 909 patients that contained the anamnesis, results of objective examination and late results of the treatment. These data has become the base for training and formation of ANN similar to the structure of human cerebral cortex. Having received the information about a new patient and using the previous experience of therapy of 909 patients mentioned above the trained ANN gives an accurate information concerning this patient. It is presented in the form of protocol of prognosis of ulcer clinical course, the probability of complication development, the results of conservative and surgical treatment. The protocol includes the conclusion with recommendations on the choice of therapeutic tactics.

[Use of neural network computer technology in the determination of therapeutic strategy in patients with stomach and duodenal ulcer]. / Primenenie neirosetevykh komp'iuternykh tekhnologii v opredelenii lechebnoi taktiki u bol'nykh s iazvennoi bolezn'iu zheludka i dvenadtsatisperstnoi kishki.

The authors present the expert neural network programmed complex "Axon" allowing the prognosis of the course of ulcer disease of the stomach and duodenum to be made. On the basis of the prognosis obtained certain medical strategy can be recommended. The neural network in which the data of treatment of 909 patients with ulcer disease of the stomach and duodenum had been introduced was taken as a basis of the complex. The program is registered in the Russian copyright agency for PC programs, data base and topologies of integrated circuits. The authors consider that the approach proposed will allow the correct medical policy to be chosen which can lead to better results of treatment of patients with ulcer disease and thus the 100 years long contradictions between different specialists in determining medical policy for such category of patients will be overcome.

[Therapeutic policy in rectal cancer]. / Lechebnaia taktika pri rake priamoi kishki.

The results of clinical examination and treatment of 751 patients with rectal cancer are presented. A total of 684 (91.0%) patients underwent radical surgery. In 439 (64.2%) from them sphincter saving operations were carried out. The rate of sphincter saving procedures for the last 5 years has increased up to 73.8%, most often of them transbdominal resection was used--284 (64.7%) patients. Sygmoidorectal anastomosis in 158 (55.6%) patients was carried out by the hand sutures, and in 126 (44.4%)--suturing apparatuses were used. The operation was finished by the suture of the pelvic peritoneum by two layers of sutures and the drainage of the area of the anastomosis from the perineum site by two tubes for prevention of the development of peritonitis even in case of insufficiency of the anastomosis was made. All the operated patients underwent preoperative radiotherapy with a total dose 20-25 Gy. The basic stage of the operation was on demand followed by chemohyperthermic perfusion of the abdominal cavity. It was carried out in 30 patients, including 12 patients with rectal cancer. In cancer of the rectum of the II B and III stages the usage of chemotherapy is obligatory. New operations for metastases of cancer of the colon into the liver were made in 4 patients (left and extended right hemihepatectomy). Complications developed in 33.5% of patients, lethality made up 3.8%, including 1.8% for the last 5 years.

[On the problems of sepsis classification]. / K voprosu o klassifikatsii sepsisa.

The article is devoted to classification of sepsis. Two classifications are compared: the Russian one, developed in A.V. Vishnevsky Institute of Surgery (phase I--the initial one or toxemia, phase 2--septicemia; 3--septicopyemia), and the American one, accepted in 1991 in Chicago which singles out three forms of sepsis (sepsis, severe sepsis or sepsis-syndrome, and septic shock). Both classifications are thoroughly analysed and it is stated that there is no principal disagreement in the definition of phases of the course and description of clinical stages of sepsis. The necessity for universal classification of sepsis is emphasized.

[Small intestine intubation for treatment of patients with peritonitis and intestinal obstruction]. / Intubatsiia tonkoi kishki pri lechenii bol'nykh s peritonitom i kishechnoi neprokhodimost'iu.

The analysis of 36 case records of patients with peritonitis (n = 12) and intestinal obstruction (n = 24) is presented. Nasogastrointestinal intubation of the small bowel was used in combined treatment. The aims, indications and contraindications for the intubation are formulated. Bacteriologic and biochemical parameters of bowel content were studied. It was established that the quantity of enterobacteria and unfermenting gram-negative bacteria was increased in intestinal paresis, the alkaline phosphatase, amylase, bilirubin, transaminase, a potassium content were increased as well. For the tube to function from the first hours after its introduction it should be periodically properly washed with sodium hypochlorite in concentration 300 mg/l.