[The mechanical properties of the bone tissue from the middle facial region].

The objective of the present work was to study age-related features of the reaction of the maxillary sinus cavity walls to a variety of impacts associated with the surgical interventions. To this effect, a variety of stress-strain conditions were simulated that are known to arise in the maxillary sinus cavity walls under the action of different force vectors taking into consideration the age-specific peculiarities of the mechanical structure of the bone tissue. The 3D model of the maxillary sinus cavity was built up based on the results of spiral computed tomography with the use of the Solid Works 2012 software package (USA). The finite element method (FEM) was employed to construct the grid. Three variants of force application were simulated, one to the canine fossa region, another to the upper portion of the alveolar process at the border between the upper and lower walls of the sinus, and the third to the anterior part of the inferior nasal passage. The study has demonstrated that the bone wall of the maxillary sinus differently responds to the impacts of similar magnitude depending on the application point and age-related physical and mechanical properties of the bone tissue. This finding should be taken into account in the choice of the optimal surgical approach to the maxillary sinus. It was calculated that endonasal interventions should be preferred for the treatment of patients above 60 years of age as the minimally injurious ones to the bone tissue. Moreover, special caution is needed when the intervention is performed beneath the canine fossa, where the bone is extremely fragile and the risk of injury extension to the floor of the maxillary sinus is especially high.

[Variations of clinical and functional characteristics of nasal cavity mucosa in the patients of different age groups presenting with acute rhinosinusitis].

The objective of the present study was to evaluate changes in the functional properties of nasal cavity mucosa during the treatment of the patients of different age groups presenting with acute rhinosinusitis. The following methods were used for the purpose: daily measurement of pH, body temperature, pain sensitivity threshold in the intranasal mucous membrane, mucociliary transport (MCT) time; in addition, joulemetry was performed to examine the patients suffering from acute rhinosinusitis. The study has demonstrated marked differences in the functional conditions of nasal cavity mucosa associated with the treatment. The aged and elderly patients were characterized by lowered mucosal temperature at all stages of therapy, elevated pain sensitivity threshold, and long duration of the recovery of ciliary epithelium activity that reflected non-responsiveness inherent in the patients of this age group. The direct joulemetry technique made possible the most detailed evaluation of dynamics of these pathological changes in nasal cavity mucosa and its age-specific features. It is concluded that the clinical manifestations of acute rhinosinusitis are characterized by well apparent age-specific features that should be taken into consideration in diagnostics and treatment of this condition. The comprehensive evaluation of the parameters of the functional state of nasal cavity mucosa associated with this pathology allows the severity of inflammation and the effectiveness of its treatment to be estimated; moreover, it permits to correcte in due time the scope of the prescribed therapy.

[The combined application of thermography and local thermometry for diagnostics, prognostication, modeling, and evaluation of the effectiveness of the treatment of acute sinusitis].

The objective of the present work was to study the possibilities of the combined application of thermography and local thermometry for diagnostics of acute sinusitis, characteristic of dynamics of the clinical course of this pathology, and evaluation of the effectiveness of its treatment. The study included 23 patients presenting with acute rhinosinusitis and 21 ones free from pathology of paranasal sinuses. Contact thermometry was performed with the use of the electronic thermometer applied to the anterior surface of the inferior turbinated bone. An infrared thermovision camera was employed to carry out thermographic measurements. The study demonstrated variations in endonasal and surface temperature under effect of the treatment. Positive dynamics of the patients' conditions was manifested as a drop of endonasal temperature and relatively constant surface temperature. A rise in the surface temperature was associated with the pathological process. In the patients showing slightly positive dynamics of the disease, the surface temperature on the side of the pathological process was lower than on the unaffected side. This difference was interpreted as an indication of the reduced microcirculatory activity in this region. It was hypothesized that dynamics of the inflammatory process is to a large extent determined by the character of blood circulation in the affected region. The authors conclude that the combined application of thermometry and thermography not only improves the quality of diagnostics of acute rhinosinusitis but also facilitates the evaluation of its dynamics and the effectiveness of the treatment.

[Efficacy of traditional therapy and chronotherapy using prestarium in elderly patients with polymorbid syndrome].

The aim of the work was to compare efficiency of traditional therapy with prestarium (tert-butylamine salt) and chronotherapy with prestarium A (arginine salt) in elderly patients with polymorbidity syndrome (diabetes mellitus, nephropathy, grade I-II chronic hepatic insufficiency). All patients underwent standard clinical and laboratory examination including measurement of glycemic profile, plasma urea, creatinine, K+ and Na+, AP monitoring, ECG, and echo-CG. The results suggest persistent hypotensive effect of prestarium and prestarium A within 4 days after the onset of therapy. However, in patients with a more severe disease, twice lower doses of prestarium A were needed to achieve positive effect and transform circadian AP rhythm from non-dipper to dipper pattern.

[Use of prestarium (perindopril) in patients with polymorbidity syndrome (AH, DM, nephropathy)].

The study included 20 patients aged 61-86 (mean 73.1 +/- 3.1) years with stage II hypertensive disease, type 2 diabetes and nephropathy with signs of grade I chronic renal insufficiency (CRI). The major parameters measured were AP, HR, laboratory characteristics of carbohydrate metabolism and renal function. Prestarium given at a dose of 4 mg BID had not only antihypertensive but also negative chronotropic effect, decreased energy consumption by myocardium, and normalized daily AP profile (24 hr AP monitoring). Adequate control of diabetes ensured close-to-normal carbohydrate metabolism. Prestarium therapy did not cause further aggravation of renal insufficiency in patients with grade I CRI, nor did it alter creatinine and urea levels.

[The use of monopril in elderly patients with arterial hypertension and coronary heart disease].

We examined 20 patients (mean age 69.4 yr) with stage II AH and CHD. 13 ones suffered CHD with stable FC II and III angina, two others had myocardial infarction. The patients were given monopril, 10 mg BID (08.00 & 20.00). Those with CHD were additionally treated with cardiket (20 mg BID) or monocinque (20 mg BID). If appropriate, hypothiazide or triampur compositum (25 mg each) was given in the morning. Usual clinical examination was supplemented by dynamic studies and evaluation of clinical symptoms on day 21 after therapy including systolic and diastolic AP, pulse and mean dynamic AD, double product, heart rate, ECG, echoCG, AP and ACG monitoring. The above treatment produced marked antihypertensive and antianginal effects in the absence of adverse events.

Distal forearm fractures: the analytical approach for treatment.

Although distal radius fractures are in the centre of orthopedic surgeons' attention, the rate of unsatisfactory treatment results remains very high. This study evaluates the analytical approach to distal radius fracture treatment. We observed 59 patients divided into 4 groups according to a modified Fernandez classification, regarding the patomechanism of injury: 1. bending extraarticular fractures; 2. shearing fractures; 3. comminuted fractures, and 4. malunions. We also took account of patients' compliance and demands. 1st and 2nd group patients underwent ORIF, the 3rd group was subjected to external fixation, and the 4th group underwent radial corrective osteotomy with plating. We obtained 53% good, 40% satisfactory and 7% poor results according to the Mattis score. We consider such analytical approach to distal forearm fracture treatment very promising and well-founded.

[Combined trauma of the abdomen and pelvis]. / Sochetannaia travma zhivota i taza.

Experience in treatment of 164 patients with combined trauma of abdomen and pelvis is analyzed. Mean age of the patients was 40.1+/-17 years, 94 patients were male, 70 -- female. ISS was 28.6+/-11 points. Lethality was 44.5%, during first day -- 61.6%. High lethality may be associated with mistakes in surgical and traumatological policy. Abdominal surgery was performed in 64 (39%) patients, only in 24 (14.6%) of them laparotomy was curative, the rest 40 (85.4%) patients underwent diagnostic laparotomy. It is demonstrated that diagnostic laparotomy has negative influence on prognosis of combined trauma of the abdomen and pelvis. Adequate traumatological policy has also great influence on lethality, particularly during the first day. Overall lethality of patients with rotary-vertical instability of the pelvis was lower in the group with fixation of the pelvis than in conservatively treated patients (41.7 and 56.6%). Lethality during day 1 in patients with fixed pelvis was 0, without fixation of the pelvis -- 82%. It is concluded that verified indications for laparotomy and active traumatological policy improve treatment results in patients with combined trauma of abdomen and pelvis.

[Laparoscopy in diagnosis of abdominal injuries in patients with combined trauma]. / Laparoskopiia v diagnostike povrezhdenii zhivota u patsientov s sochetannoi travmoi.

Importance of laparoscopy (LS) in diagnosis of intraabdominal catastrophe in patients with combined trauma (CT) is determined. Based on analysis of treatment results in 1,118 patients with CT it was revealed that real LS requirement does not exceed 10%, and it may influence negatively trauma outcome. Low diagnostic value of this method was revealed: sensitivity 98.4%, specificity 51%, accuracy 69.2%. It is concluded that LS is not a method of choice in diagnosis of intraabdominal injuries in patients with CT.

[Treatment of purulent-inflammatory complications of polytrauma, diabetes, infected pancreonecrosis]. / Lechenie gnoino-vospalitel'nykh oslozhnenii, soprovazhdaiushchikh politravmu, sakharnyi diabet, infitsirovannyi pankreonekroz.

Results of Antilympholin-K3 use in combined treatment of purulent-inflammatory complications in polytrauma, diabetes, infected pancreonecrosis are analysed. Thirty-nine patients aged from 19 to 74 years were treated. Double injection of Antilympholin-K3 enhanced phagocytic activity of neutrophils, phagocytic index, chemiluminescence of mononuclears and neutrophils, immunoglobulins concentration. Positive dynamics in immunological indices is accompanied by improving clinical status, cleaning of postoperative wounds from pus, improving of epithelisation.

[Assessment of changes in the course of nasal and paranasal inflammation]. / Otsenka dinamiki vospalitel'nogo protsessa v polosti nosa i okolonosovykh pazukhakh.

Direct joulemetry, a method of diagnosis of nasal and paranasal mucosa condition, is based on measurement of electric current work (CW) by electrochemical dissociation of biological fluids on the mucosa of the frontal sinus and its aperture. 27 patients had CW characteristics in three forms of inflammation: purulent, serous-fibrinous, exudative. The effectiveness of the method in follow-up of patients with frontal sinusitis is shown.

[Primary outcome of disability as a result of femur neck fractures]. / O pervichnom vykhode na invalidnost' v rezul'tate perelomov sheiki bedrennoi kosti.

The authors propose the strategy of surgical treatment of patients with fractures of the neck of the femur with due consideration for patient's age, disorders of local circulation, and terms of operation. As a result of this strategy, the share of good outcomes and social rehabilitation improved appreciably. Anatomic physiological classification of disorders of local circulation at the femoral bone neck has been developed, which helps assess the rehabilitation potential of the invalids with consequences of fractures of the neck of the femur.

[Subdural exudate in bacterial meningitis in children]. / Subdural'nyi vypot pri bakterial'nykh meningitakh u detei.

A subdural exudate (SE) complicating bacterial meningitis in 28 children was diagnosed by the findings at diaphanoscopy, subdurography, thermography, CT, EEG, echo-EG, rheo-EG in the evidence of aggravating neurological symptoms. SE drainage was carried out in all the cases, in 20 patients it was bilateral. CNS age-specific anatomicophysiological features responsible for emergence of the exudate primarily in the anterior hemispheric compartments subject to consequent atrophy are considered when assessing mechanisms of the exudate development in infants.