[Comprehensive treatment of indolent trophic ulcers of venous aetiology]. / Kompleksnoe lechenie dlitel'no nezazhivaiushchikh troficheskikh iazv venoznoi étiologii.

AIM: The study was undertaken to evaluate efficacy of comprehensive treatment with the use of erbium laser radiation in patients suffering from venous trophic ulcers of lower limbs. PATIENTS AND METHODS: The study included a total of seventy-six 45-to-80-year-old patients. Of these, there were 43 (56.6%) women and 33 (43.4%) men. The duration of the disease averagely amounted to 10.8±4.8 years. In 38 patients, the bottom of the ulcerative defect was with pronounced periulcerative inflammation and various degree of purulent discharge. All patients were admitted to the surgical department and underwent meticulous examination. Erbium laser irradiation was carried out with consideration for the ulcer size. Laser irradiation was performed at a wavelength of 2940 nm, pulse duration - 0.3 ms, laser beam diameter - 7 mm with radiation power of 2.19 J/cm2. RESULTS: Efficacy of treatment was assessed in dynamics by the degree of pain syndrome, ulcer size upon completion of treatment, as well as the rate of trophic ulcer epithelialisation. In 15 (19.7%) patients with varicose disease the vertical and horizontal reflux was eliminated with performing phlebectomy and echosclerotherapy. The obtained findings demonstrated that 42 (91.3%) patients of the study group had decreased terms of the beginning of purification of the fundus of the ulcer. After 6 months of rehabilitation and follow up, complete ulcer healing was achieved in 18 (64.3%) patients of the control group and in 39 (86.7%) patients of the study group. CONCLUSION: The obtained findings showed that laser radiation proved to be an effective method of treatment in patients presenting with indolent trophic ulcers. Comprehensive treatment made it possible to effectively influence the microflora and the state of regional lymph drainage, to stimulate the processes of reparative regeneration.

[The role of disturbances of lipid metabolism in pathogenesis of allergic rhinitis].

Physiological normal levels of total cholesterol, total lipids, total protein, superoxide dismutase, catalase, malonic dialdehyde, and total antioxidant activity were determined for the first time in nasal secretion of volunteer donors (n = 24). Excessive lipid peroxidation and suppression of antioxidant protection system were documented in 70 patients with round-the-year allergic rhinitis of whom 26 and 44 presented with the mild and moderately forms of the disease, respectively. The clinical efficiency of polyoxidonium (Russia) in the treatment of allergic rhinitis has been demonstrated. This preparation reduces the intensity of lipid peroxidation and strengthens the antioxidant protection of the organism. The results of the study confirm the high efficacy of combined therapy of allergic rhinitis with aerius and polyoxidonium.

[Possibilities of early diagnostics of echinococcosis relapse].

Successful introduction of modern mini-invasive technologies of echinococcosis treatment necessitate problem-solving in early exposure of relapse and diagnosis verification at small cysts. It is ascertained that development rate of recurrent cyst decreases with size enlargement. Median of growth rate had amounted 1.5 mm a month (quartile--1.02 and 2.4 mm/month) till the diameter of the cyst reached 5 cm. Carrying out immune-enzyme analysis allows to forecast treatment results in terms of 3-3.5 years in most observations. Taking this data into account algorithm of early relapse diagnosis was worked out. Long-term results of surgical treatment of echinococcosis of various localization were studied in 652 patients. Regular check-up according to developed algorithm allowed to reveal relapses after 12.4 +/- 7.7 months on average, whereas in the absence of regular check up relapses were diagnosed after 27.9 +/- 15.6 months on average (p=0.0005). Revealed cysts were relatively bigger (3.8 +/- 1.1 and 8.0 +/- 3.7 cm respectively), that at regular check-up according to algorithm.

[Recurrence of echinococcosis: pathogenesis, prophylaxis, early diagnosis and treatment].

Complex of measures for prophylaxis of echinococcosis recurrence was developed basing on experimental and clinical studies. Results of surgical treatment of echinococcosis of different location in 983 patients were analyzed. Complex approach to the treatment reduced the rate of recurrences to 0.6% (p=0,0002). Criteria of recovery and algorithm of early diagnosis of echinococcosis recurrence are presented.

[Residual fibrous formations after hydatidectomy and their clinical significance].

After radical hydatidectomies in the organ still remains a fibrous cyst capsule in which the maternal chitinous membrane has signs of destruction (the second phase of vital activity). Germinal elements capable to transform in cyst-satellites can be introduced into the fibrous cyst capsule. Most cyst-satellites while growing break inside the initial cyst. The residual fibrous cyst capsule which is in the second phase should be considered as a risk factor of recurrence and so hydatidectomy must be followed by intraoperative ultrasound scanning of the peri-parasitogenic space for a detection of cyst-satellites as well as by anti-recurrence courses of medication at the postoperative period. In the USI the area of localization of the residual fibrous capsule is visualized as polymorphous focal structures which can be classified as: an unechogenic focus (a residual cavity); heterogeneity of the echo-structure with minimal unechogenic foci; heterogeneity of the echo-structure with prevailing unechogenic foci (a mixed type structure); hyperechogenic focus (focal fibrosis). The optimal strategy of management of the postoperative period can be worked out by using USI in the field of liquidation of the residual cavity and by getting an exact character of its echo-tomoscopic picture.

[Echinococcosis of the heart].

Basic clinical and special methods of diagnosis of cardiac echinococcosis are described. Among 12 patients with cardiac echinococcosis 5 patients have been operated and 7 patients have been not. Five of seven non-operated patients died during 1 year due to disruption of the cysts. All 5 operated patients survived. It is demonstrated that surgical treatment should be performed with artificial extracorporeal circulation, and postoperative anti-recurrent anti-helminth therapy is mandatory. Medication before surgical procedures is contraindicated because it leads to cysts disruption with high risk of lethal outcome.

[Prevalence of obesity in the Republic of Daghestan].

Monitoring of body mass in the dwellers of this or that region is of indisputable value for practical public health. The sample size (n = 1,500) required to study of the prevalence of obesity among the population was calculated in terms of the size of the population of the Republic of Daghestan, by using the well-known formula. The median of age was 27 years, from 14 to 79 years, its mean was 34 years; the standard deviation was 17.4. The distribution of the obtained values of the body mass index did not correspond to the normal values. The median of body mass indices was 23.9 from 13.95 to 50.15 respectively; quartiles (25%:75%) were 21.45:27.56; percentiles (5%:95%) were (18.59 33.98); the mean was 24.87; the standard deviation was 4.83%. Out of the 1,500 examinees, 65 (4.3%) persons had a low body mass; 801 (53.4%) had a normal body mass; and 416 (27.7%) had an excessive one. Obesity was observed in 218 (14.5%) examinees, including first-, second-, and third-degree obesity in 164 (10.9%), 43 (2.9%), and 11 (0.7%) examinees, respectively. There were some differences (statistically insignificant in some cases) in body mass and obesity in relation to the place of residence (a climatic and geographical zone, town-village), gender, and ethnicity.

[Ultrasonic examination in diagnosis of hydatid echinococcosis]. / Ul'trazvukovoe issledovanie v diagnostike gidatidnogo ékhinokokkoza pecheni.

Out of 247 patients operated for suspected echinococcosis of the liver, 21 (8.5%) cases of non-parasitic diseases of the liver and other organs were revealed: non-parasitic cysts (7), hemangioma (4), abscesses (4), malignant tumors (3), hydronephrosis of the right kidney (2), polycystosis of the liver and right kidney (1). Analysis of echotomographic picture of cystic structures showed that combinations of symptoms did not correspond to echinococcus cyst. Interpretation of echotomographic symptoms in diagnosis of hydatid echinococcosis may lead to diagnostic mistake if location, size, form of cyst, pattern of complications and phase of vital activity of parasite were not taken into account. Results of ultrasound investigation (USI) is more important than data of serologic studies. It is necessary to perform poly-positioned USI for prevention of diagnostic mistakes.

[Diagnostic and therapeutic approach in hepatic echinococcosis complicated by mechanical jaundice]. / Diagnosticheskaia i lechebnaia taktika pri ékhinokokkoze pecheni, oslozhnennom mekhanicheskoi zheltukhoi.

The article presents the results of the treatment of 43 patients with echinococcosis of the liver the course of which was complicated by mechanical jaundice (MJ). In 11 patients MJ arose as a result of cystic content break into the bile ducts, in 32 patients, due to cystic compression of the lobular bile ducts. An effective scheme of the patients' examination is proposed which involved present-day ultrasound, X-ray and endoscopic methods. The system of objective evaluation of the patients' condition is outlined as designed for planning surgical policy. In non-severe disease the patients are operated after standard preparation within 24 hours after hospitalization. If the disease is more severe, the patients demand preparation including extracorporeal detoxication and cholangiostomy. In serious conditions the operations are made to remove the cyst content and cholestasis. This differentiated diagnostic and therapeutic policy diminished postoperative lethality from 15.2 to 6.9%.

[Morphogenesis of hydatic cyst of the liver]. / Morfogenez gidatidnoi kisty pecheni.

The morphological features of 138 cysts of different size were studied in 107 patients with Echinococcosis of the liver aged 14-75 years (39 men and 68 women) in order to specify the morphogenesis of Echinococcus cyst. The content of 23 cysts looked like a jelly-like mass, in 10 of them there were scraps of degenerating chitin. In 26 cysts there were solitary daughter cysts, in 11 they were multiple. In 10 cysts there was a relatively large volume of turbid fluid. In 99 cases the content of the cyst was a colorless transparent fluid with the invariable chitin membrane. Enlargement of the fibrous capsule was noted in 17 cysts, in 2 cases the thickness achieved 15 mm. In two cysts the fibrous capsule was completely calcificated, solitary calcificates were noted in 7 cysts. An analysis of the state of different cysts enabled a scheme of morphogenesis of the hydatid cyst to be proposed. According to this scheme the viability of the cysts is divided into two consecutive phases, each of them can have the developed daughter cysts or not (Ia, Ib, IIa, IIb phases).

[Classification of hydatid cysts revealed after surgical treatment]. / Klassifikatsiia ékhinokokkovykh kist, viiavlennykh posle khirurgicheskogo lecheniia.

The proposed classification is designed to make publications more exact. Information about sizes, location of cysts, terms of their detection permits to judge about causes of recurrences. Primary echinococcosis is pathology associated with development of hydatid cysts revealed for the first time before surgical treatment. Primary cysts are all the cysts revealed before and during surgery, including ones which could be potentially detected. They are also called primary after surgery if they have not been removed for some reason (it is possible to use term "residual" cysts because their nature is known).

[Features of the lipid peroxidation process and antioxidant activity of white rats in extreme, multi-stage supercooling]. / Osobennosti protsessov perekisnogo okisleniia i antioksidantnoi aktivnosti lipidov belykh krys pri glubokom mnogokratnom pereokhlazhdenii.

High content of polyenic fatty acids, slight increase in antioxidative activity and decrease in content of malonic dialdehyde (MDA) in rat myocardial tissues were observed in supercooling. The data obtained suggest that intensive oxidation of fatty acids occurred in the tissues, which may be essential for synthesis of biologically active substances involved in development of resistance to supercooling. Multiple supercooling caused an opposite effect in lung tissue: saturation of lipids was increased, antioxidative activity was maintained on the level similar to the control values, while content of MDA was markedly increased apparently due to destruction of metabolic products penetrating from other tissues. The dissimilar impairments of lipid metabolism were detected in liver tissue, where multiple supercooling did not alter the rate of lipid saturation, antioxidative activity was unaltered and content of MDA was as low as in the control animals.