[Two treatment approaches for lumbar disc herniation and sequester migration to the second and third McCulloch's windows: transpedicular and translaminar sequestrectomy (ridit analysis)]. / Dve taktiki lecheniya poyasnichnykh gryzh mezhpozvonkovykh diskov s migratsiei v zonu vtorogo i tret'ego okna po Makkalloku: transpedikulyarnaya i translaminarnaya sekvestrektomiya (ridit-analiz).

A ridit analysis of results of transpedicular endoscopic and translaminar microsurgical surgeries for sequester migration to the second and third McCulloch's windows was carried out. The authors assessed pain syndrome, quality of life and neurological impairment. OBJECTIVE: To compare the outcomes of transpedicular and translaminar sequestrectomy for lumbar disc herniation and sequester migration to the second and third McCulloch's windows. MATERIAL AND METHODS: We analyzed treatment outcomes in 51 patients with lumbar disc herniation and severe sequester migration. We assessed lumbar and leg pain syndrome using then visual analogue scale, neurological impairment using the adapted Nurik scale and quality of life using the Oswestry questionnaire and the MacNab scale in early postoperative period, as well as in 2 weeks, 6 and 12 months after surgery. Ridit analysis was used for statistical processing of data. RESULTS: Transpedicular sequestrectomy was performed in 24 patients, translaminar sequestrectomy - in 27 cases. Groups were comparable by gender, size and location of sequestration, somatic and neurological status, as well as pain severity. There was a higher probability of back (0.39) and leg (0.364) pain regression, neurological recovery (0.446) and improvement of quality of life according to the Oswestry questionnaire (0.389) after transpedicular surgery. According to the MacNab scoring system, excellent and good results were obtained in 84.21% and 15.79% of patients in 6 months after transpedicular surgery. In the second group, excellent, good and satisfactory results were obtained in 63%, 25.9% and 11.1% of patients, respectively. CONCLUSION: Herniated intervertebral discs with severe sequester migration should be divided in accordance with localization of the main sequestration. Transpedicular endoscopic approach is advisable for sequester in the third and rarely the second McCulloch's windows. Translaminar microsurgical approach is preferred for sequestration in the second and rarely the third McCulloch's windows. Clinical outcomes after translaminar microsurgical sequestrectomy and transpedicular endoscopic surgeries are similar. However, postoperative back and leg pain regression, neurological recovery and improvement of quality of life according to the Oswestry scoring system are more common after transpedicular surgery.

[Results of application of a new method for the treatment of hallux valgus of the first toe].

Background: The aim of the present article was to report our experience with the treatment of patients with hallux valgus and to perform comparative analysis of the results of the newly proposed and standard methods for its surgical correction. Methods: The data on 70patients (101 feet) with hallux valgus that were operated on between 2011 and 2015 in St. Petersburg Hospital No 2 using the new and standard methods were analysed. The functional assessment (AOFAS score) and X-ray examination were performed preoperatively, 3 and 12 months after the procedure. Comparative analysis between patients undergoing surgical correction by the new and standard methods has been undertaken. Results: We did not find any significant difference between the two groups in mean AOFAS score 12 months after surgery. Nevertheless, the function score of the patients treated by the newly proposed method (79.4±6.5 in 3 months) was significantly better than in those given the standard treatment (72.2±7.6 in 3 months). Mean intermetatarsal angle 12 months after surgery by standard and new methods was 9,7±0,7° and 8,6±0,7° (p<0.05), mean metatarsophalangeal angle 13,6±0,9° and 13,0±1,1° (p<0,05) respectively. Conclusion: According to the data obtained, the original method of hallux valgus surgical correction allows to improve its functional and x-ray results.

[THE USE OF THE METHOD FOR DETERMINING THE "ORTHOPEDIC INDEX" IN THE TREATMENT OF PATIENTS WITH FEMORAL NECK FRACTURE].

The choice of surgical strategy for the treatment of femoral neck fracture is a serious challenge to modern traumatology and orthopedics. Group I of this study was comprised of patients in whom orthopedic age was determined by our original method including assessment of the quality of life based on the SF-36 questionnaire. The somatic state of the patients was evaluated from the Charlson index and bone quality in the surgical area by densitometry. Patients of the control group were treated by the standard methods adopted in this country and abroad. It was shown that the difference between orthopedic and calendar ages results in the increase of the frequency of complications. The clinical and statistical results of the study indicate that the new method permits to reduce the number of revision interventions, decrease postoperative lethality, and improve the patients' quality of life.

[Surgical reconstruction of posttraumatic defects and deformities of the orbit using frameless navigation].

PURPOSE: To explore the possibilities of frameless navigation surgery in patients with posttraumatic defects and deformities of the orbit. MATERIAL AND METHODS: In order to develop frameless navigation technique for surgical treatment of posttraumatic defects and deformities of the orbit, examination and surgery were performed on 21 patients of the N.V. Sklifosovsky Research Institute of Emergency Medicine. Multi-slice spiral computed tomography was used for preoperative simulation and intraoperative control. Virtual layer-by-layer reconstruction of missing bone fragments and modeling of anatomical position of dislocated bone fragments in frontal, axial, and sagittal images were performed. Implant position control was done with pointer device of the navigation system. RESULTS: Good functional (disappearance of diplopia in primary position of gaze) and cosmetic results were obtained in all patients. None developed complications in the postoperative period. CONCLUSIONS: The use of frameless navigation in surgical treatment of posttraumatic defects and deformities of the orbit allows to obtain good and stable functional and cosmetic results.

[Odontogenic maxillary sinusitis: peculiarities of diagnostics and treatment].

The objective of the present work was to improve the quality of diagnostics and the choice of optimal therapy for the management of odontogenic maxillary sinusitis associated with the localization of foreign bodies in the lateral parts of the maxillary sinuses. To this effect, multispiral computed tomography was used to enable the exact location of the foreign body inside the sinus and to choose the optimal approach for the surgical intervention. The modified Coldwell-Luc procedure was employed as the most adequate technique in the given clinical condition.

[About the treatment of battlefield injuries of the musculoskeletal system with the help of new "Rod field package"].

Injuries of the musculoskeletal system are at 60% of all battlefield injures and take first place in modern military conflicts. The main antishock measures are: pain management, emergency bleeding control, bone fragment positioning and fracture fixation. Specialist of the centre of traumatology and orthopaedics of the Burdenko General Military Clinical Hospital in cooperation with specialists of department of battlefield surgery of Mandryka Clinical Research and Training Medical Centre analysed the most effective domestic and foreign external fixators and developed Rod field package (RFP). The above mentioned researched had two stages. On the first (analytical) stage specialists formulated requirements for idea rod field external fixator. On the second (experimental) stage tests with the help of plastic models of long bones were carried out. The performed analysis showed, that installation of the external fixator is easy and fast, the external fixator is light and has capabilities for 3D bone fragment positioning and fracture fixation, the external fixator is radiotransparent. Implementation of this package into the clinical practice of delivery of battlefield emergency surgical care may improve results of treatment.

[Traumatic occlusion of posterior cerebral artery with occipital lobe ischemia]. / Travmaticheskaya okklyuziya zadnei mozgovoi arterii s ishemiei zatylochnoi doli.

Traumatic cerebrovascular injury (TCVI) are rare, severe and dangerous complications of traumatic brain injuries. Current data suggests they accompany less then 2% of severe traumatic brain injuries. Most common forms of TCVI are formation of traumatic pseudoaneurysms and dural arteriovenous fistulas, less frequent - traumatic occlusions, intersections and some others. This pathology complicates the course of traumatic brain injury, decreases quality of life and prognosis, and requires complex diagnosis and treatment strategy. The authors describe a rare case of traumatic posterior cerebral artery occlusion in a patient injured in a road traffic accident and provide literature review on modern concepts of TCVI.

[Diseases of proximal femur segment in subjects of working age].

A high-energy injury in subjects under the age of 50 as a rule leads to hip dislocation. This condition requires urgent orthopedic aid to avoid the risk of femur head osteonecrosis. Given a failure of closed reduction of dislocation (to be performed within 6 hours after the injury), immediate open reduction is indicated. The surgical approach depends on the dislocation type. The Kocher-Langenbeck approach is practiced to treat posterior dislocation and the Smith-Petersen or Watson-Jones approach in case of anterior dislocation. The most frequent and dangerous complications are femur head osteonecrosis (in 4-22% of the cases even after timely reduction) and post-traumatic coxarthrosis. Osteonecrosis is managed by a variety of surgical methods, viz. central decompresson, osteoplasty, corrective osteotomy, endoprosthetics. Its late stages, with sclerosis affecting over 30% of the head surface, are treated by resurfacing arthroplasty, hemiarthroplasty, total surface arthroplasty, uni- and bipolar hemiarthroplasty, total endoprosthetics, and administration of expanded stem cells into the subchondrial layer. The use of tissue-engineering technologies for the treatment of osteonecrosis is not confined to the treatment of its precollaptoid stages. They can be employed to promote osteointegration at the metal-bone interface and thereby to improve secondary stability or prolong the hardware lifetime.

[Enucleation in patients with intraocular melanomas].

This paper analyzes the data available in the literature on the incidence of uveal melanomas. It historically describes enucleation and the specific features of its performance in patients with and without uveal melanoma. The specific features of enucleation in patients with uveal melanoma, indications for locomotor stump formation, and procedures for calculating the parameters of an implant are considered. Analysis of the data available in the literature shows that there is presently no unambiguous opinion as to the most rational enucleation modes and as to the capacities and types of used implants as a whole. This primarily applies to enucleation used in patients with intraocular neoplasms.

[Enucleations in uveal melanoma (analysis of archival records)].

The paper analyzes outpatient cards of 415 patients who underwent enucleation for uveal melanoma (UM) in 1962-2008 and who have been registered in the Moscow City Ophthalmology Center since 1990. The patients' mean age was 58.94 +/-1.29 years. During the follow-up, 56 patients died 5.24 +/- 1.84 years postoperatively. The distribution of UM by the histological types was as follows: spindle cell (n = 275; 66.27%); mixed cell (n = 100; 24.09%), and epithelioid cell (n = 26; 6.27%) UM. Eleven (2.65%) patients were diagnosed as having necrotic melanoma. Poor (preequatorial and juxtapapillary) position was observed in 35.4% of the patients. Mortality in patients with UM after enucleation was 14.44% with a life expectancy of 5.24 +/- 1.84 years. The findings make it possible to recommend that an enucleation procedure should be developed, by concurrently forming a locomotor stump, which promotes the improvement of the results of individual cosmetic prosthetics in patients with UM that is not to undergo organ-saving treatment.

[Possibilities of outpatient surgery].

The main types of hospital-substituting technologies, their material and technical basis and possibilities of outpatient medical help are described in the article. Suggestions concerning further development of hospital-substituting technologies are presented by second congress of Russian outpatient surgeons.

[About perfection of the complex system of the treatment of the wounded with the gunshot fractures of the limb's long bones].

The article deals with clinical study of treatment results of 106 wounded. The study was carried out with the help of different methods of correction of blood flow in the place of shotgun fracture of long bones in terms of application period. Developed system of incipient complex correction post shotgun circulatory injuries improves the results of treatment by 87.3 +/- 1.8% (p < 0.05), decreases the number of wounded with laps of blood flow in tissues by 34.1 +/- 1.1%, that is lower than 20% from normal level, and in 38.2 +/- 1.5% cases helps to avert the development of necrosis and wound abscess.

[Domestic 1.44 mcm Nd:YAG laser in combined treatment of dacryocystitis complicated by abscess formation].

We have treated 12 patients with acute dacryocystitis complicated by abscess formation. All the patients were examined by an ophthalmologist and otolaryngologist. The patients received intravenous antibiotics followed by Nd:YAG laser dacryocystorhinostomy via transcanalicular approach under the endonasal endoscopic control. The treatment resulted in resolution of symptoms and signs of acute dacryocystitis complicated by abscess formation in all the patients. No recurrence of acute dacryocystitis occurred during the median follow-up period of 11 months. Ostium patency defined as the absence of epiphora and observation of irrigated lacrimal fluorescein at the ostium was achieved in 9 patients. Epiphora recurred in 3 cases. Use of Nd:YAG laser reduces the duration of the operation and provides maximal functional and cosmetic results.

Visual evoked potentials in humans during recognition of emotional facial expressions.

Visual evoked potentials were recorded from the occipital, parietal, central, frontal, and posterior temporal areas of the cortex during recognition of emotionally positive, negative and neutral facial expressions and during passive observation in 22 right-handed healthy subjects. These studies showed that in the posterior temporal areas, the latencies of the N90, P150, and N180 waves of potentials evoked by faces with emotionally negative expressions were significantly shorter than those evoked by other types of facial stimuli. Differences were seen both on recognition and during passive observation. Correct recognition involved both hemispheres and was characterized by high levels of interhemisphere temporal correlation of the processes occurring during the development of the P150 wave in the posterior temporal and the N180 wave in the frontal parts of the cortex. The possible relationship of these data to primary subthreshold recognition of facial expressions in the posterior temporal fields of the cortex is discussed, as is the role of the frontal cortex in completing this process and in taking the correct decision about the nature of the image.

[Human visual evoked potentials during the recognition of facial emotional expression]. / Zitel'nye vyzvannye potentsialy cheloveka pri opoznanii litsevoi émotsional'noi ékspressii.

Visual evoked potentials (VEPs) were recorded in 22 right-handed healthy subjects in the occipital, parietal, central, frontal and posterotemporal cortical areas during recognition and passive viewing of positive, negative, and neutral emotional facial expression. Peak latencies of N90, P150, and N180 VEP components appeared to be significantly shorter in response to the negative emotional expression than during administration of other facial stimuli. The differences were observed both during active recognition and passive viewing. Correct recognition was characterized by involvement of both hemispheres and high level of interhemispheric correlation between the peak latencies of P150 in the posterotemporal and of N180 in the frontal areas. It is suggested that the facial expressions are primarily recognized at the subthreshold level with participation of the posterotemporal areas. The role of the frontal areas is discussed in the completion of this process and making the correct decision about the image.

[Changes in the cardiac rhythm in response to acoustic stimuli in subjects with a seasonal affective disorder]. / Izmeneniia serdechnogo ritma v otvet na akusticheskie stimuli u lits s sezonnym affektivnym rasstroistvom.

Groups of depressed patients and normal controls were exposed to series of tones of low (75 dB) and high (105 dB) intensity. The initial component (averaged heart rate in 5 s post-stimulus interval) of cardiac reactions to the weak stimuli was decelerative. Depressed patients tended to have more decelerative reactions than controls. In depressed patients there was habituation across trial blocks. The first component of responses to the loud stimuli was predominantly accelerative in both groups. The later phase of the heart rate responses (averaged in the second 5 s post-stimulus interval) was predominantly accelerative in controls and decelerative in patients for both intensities. Characteristic features of orienting and defensive components of the cardiac reactions in winter depressions are discussed.

[Recognition of joy, anger, and fear by face expression in humans]. / Opoznanie chelovekom émotsii radosti, gneva i strakha po litsevoi ékspressii.

Behavioral and neurophysiological characteristics of a visual recognition of emotions of joy, anger, and fear were studied in 9 young healthy men and 10 women. It was shown that these emotions were identified by subjects with different rate and accuracy; significant gender differences in recognition of anger and fear were found. Recording of visual evoked potentials (VEP) from the occipital (O1/2), medial temporal (T3/4), inferior temporal (T5/6), and frontal (F3/4) areas revealed differences (related with the type of emotion) in the latencies of P150, N180, P250, and N350 waves and in the amplitude of VEP components with the latencies longer than 250 ms. These differences were maximally expressed in T3/4 derivation. The subjects could be divided in two groups. The first group was characterized by increased VEP latencies and higher amplitudes of VEP components later than 250 ms in response to anger (in comparison with other types of emotions). These phenomena were observed in all the derivations but were most pronounced in T3/4. In the second group, only late P250 and N350 components had shorter latencies during recognition of fear. VEP amplitude variations related with the type of emotions were insignificant and were recorded in the occipital and frontal areas. The two groups of subjects also differed in psychoemotional personality characteristics. It is suggested that primary recognition of facial expression takes place in the temporal cortical areas. A possible correlation of electrophysiological indices of emotion recognition with personality traits is discussed.

[Hemispheric asymmetry of visual evoked potentials during human recognition of facial emotional expressions]. / Mezhpolusharnaia asimmetriia korkovoi vyzvannoi aktivnosti u cheloveka pri opoznanii émotsii po litsevoi ékspressii.

Visual evoked potentials (VEP) in standard 16 EEG derivations were recorded in 26 young men and 20 women during recognition of facial emotional expressions and geometric figures. The stimuli were presented on a computer screen in the center of the visual field or randomly in the right or left vision hemifields. Peak VEP latency and mean amplitude in 50-ms epochs were measured; spatiotemporal VEP dynamics was analyzed in a series of topographic maps. The right hemisphere was shown to be more important in processing emotional faces. The character of the asymmetry was dynamic: at earlier stages of emotion processing the electrical activity was higher in the right inferior temporal region compared to the left symmetrical site. Later on the activity was higher in the right frontal and central areas. The dynamic mapping of "face-selective" component N180 of VEPs revealed the onset of activation over the right frontal areas that was followed by the fast activation of symmetrical left zones. Notably, this dynamics didn't correlate with the hemifield of stimuli exposition. The degree of asymmetry was lower during presentation of figures, especially in the inferior temporal and frontal regions. The prominent asymmetry of information processes in the inferior temporal and frontal areas was suggested to be specific for recognition of facial expression.

[Prevention of pressor reaction to tracheal intubation in patients with cerebral aneurysms: fentanyl and nitroglycerin combination]. / Profilaktika pressornoi reaktsii na intubatsiiu trakhei u bol'nykh s anevrizmami sosudov mozga: kombinatsiia fentanila i nitroglitserina.

The authors analyze the clinical efficacy of a combined method for the prevention of pressor reaction to laryngoscopy and tracheal intubation, based on the combination of common clinical doses of fentanyl (4 micrograms/kg b. m.) and intravenous infusion of nitroglycerin solution in 26 patients with brain vessel aneurysms. This method effectively prevented the dangerous rise of arterial pressure during laryngoscopy and tracheal intubation.