[The increasing of role of paramedical personnel under application of remote ultrasound studies].

The ultrasound studies are highly informative diagnostic methods. The modern ultrasound devices can be applied as component of mobile telemedicine systems that can significantly increase availability of medical care. However, application of ultrasound scanners requires inclusion of ultrasound diagnostics specialist in the medical team that is not always nor possible or appropriate. In the modern regulatory legal base, transfer of certain functions of ultrasound diagnostics specialist to average medical staff is not provided. The article considers issue of genuine development and testing method of implementation of ultrasound examinations by paramedical personnel under remote control of physician. Two organizational models were tested within the framework of organizational experiment. In the first model, physician monitored progress of examination by telemedicine monitor and, if necessary, directed actions of medical nurse. In the second model, the nurse independently obtained images of patients' organs, and physician according received visual information formulated final conclusion. The organizational experiment included patients with pathology of abdominal cavity, retroperitoneal space and lower limb arteries. Results. On the basis on results of 156 examinations, time-consuming analysis was performed, and effectiveness of developed methods was evaluated. The proposals were proposed to include additions into professional standard of ultrasound diagnostics nurse and to substantiate the need of altering the training programs for paramedical personnel.

[Risk factors of fatal outcome in pancreatonecrosis].

The article analyzed risk factors after operations for pancreatonecrosis in order to predict a course of the disease and carefully plan the treatment. It was revealed that the lethality level depended on different factors: the sex, age, a period of admission to the hospital, prevalence of necrotic suppurative process and severity of operative trauma. The authors made a conclusion of radical change to treatment approach. The open operations should be reduced at the expense of introduction of low-invasive methods of treatment in the case of pancreatonecrosis.

[Metabolic therapy and pulmonary disfunction in patients with obstetric sepsis].

The role of reamberin, a succinate-containing infusion preparation in correlation of pulmonary metabolic and respiratory disturbances in patients with obstetric puerperal sepsis was estimated. The prospective randomized study enrolled 43 patients with puerperal obstetric sepsis complicated by polyorganic deficiency (SOFA 8-10). Nineteen patients of the 1st group and 24 patients of the 2nd group were additionally treated with reamberin in a dose of 800 ml/day for 8 days. The venous and arterial difference by glucose, lactate, pyruvate, diene conjugates, malondialdehyde and ceruloplasmin was investigated. The blood gases were determined with the Ciba Corning 45 apparatus. Lower metabolic activity of the lungs with prevalence of the glucose anaerobic metabolism and lower activity of the intrapulmonary antioxidant protection were observed in the patients with obstetric sepsis. The use of reamberin in the complex therapy of obstetric sepsis promoted maintenance of the initial balance and anaeroibic and aerobic pulmonary metabolism, thus providing shorter terms of the decompensation and recovery of the lungs respiratory function.

[Infusion correction of bile outflow and endotoxicosis in patients with mechanical jaundice].

The investigations were performed in 139 patients divided into 3 groups and who were given similar volume of infusion therapy (1600 ml/day). In the first group consisting of 54 patients the solution of infusion therapy included the Ringer solution and 10% of glucose solution in the ratio 1:1. In the second group (37 patients) the infusion therapy was performed with a solution of sterofundin-G-5. In the third group (48 patients) remaksol in dose 800 ml/day was included in infusion therapy. The inclusion of sterofundin-G-5 and remaksol in the infusion therapy increased the rate of bile outflow at the early postoperative period as compared with the solutions of Ringer and 10% of glucose. Remaksol is better for arresting endotoxicosis and bile excreting function of the liver as compared with infusion of sterofundin-G-5.

[Comparative assessment of short-term outcomes of cholecystectomy in minimally-invasive surgical procedures for chronic calculous cholecystitis].

A randomized blind trial was carried out for comparative evaluation of short-term results of surgical treatment of chronic calculous cholecystitis in 100 patients after laparoscopic cholecystectomy and in 100 patients after minimally-invasive cholecystectomy. Both groups contained geterogenous patients (morphology in gall bladder zone, concomitant diseases). Statistically significant (p=0.000001) decrease of hospital stay was revealed after laparoscopic cholecystectomy. It is necessary to keep exact selection criteria for each type of elective surgery in cholelithiasis.

[Clinical-functional and morphological characteristics of patients with one gallstone in the gallbladder]. / Kliniko-funktsional'naia i morfologicheskaia kharakteristika bol'nykh s odinochnym kamnem v zhelchnom puzyre.

Patients suffering from gallstone disease form a non-uniform group. There is variance not only in the number and localization of gallstones, but also in the clinical development of the disease (the presence or absence of typical attacks of liver colic, jaundice in the anamnesis), the condition of the contractile and concentrating functions of the gall bladder, the stone formation activity and the inflammatory component manifestation. Taking into account the anamnesis data, the functional state of the gall bladder and the stone formation activity, it seems possible to make a differentiated selection of treatment methods and techniques for a certain patient suffering from the gall-bladder disease. This approach is most suitable for patients having a single stone in the gall bladder as the approach enabling to perform organ-preserving treatment for them.

[Bile crystallography and viscosimetry in cholelithiasis]. / Kristallografiia i viskozimetriia zhelchi pri zhelchnokamennoi bolezni.

High prevalence of cholelithiasis necessitates development of an easy screening diagnostic method, and therefore structural analysis of a dried drop of biological fluid attracts special attention. A new method, clinical crystallography, has been used for analysis of bile from patients with cholelithiasis. A relationship between the crystal morphology and biological fluid viscosity has been revealed.