[Experience in treatment of combined osteovascular limb injuries in children].

The article is dedicated to one of the currently important problems of present-day traumatology and angiosurgery, i. e. possibility of performing primary reconstructive operations in children with complete and incomplete amputations, open and closed bone fractures in the conditions of circulatory impairment. The authors share their experience in treatment of 92 patients presenting with such injuries, describing the main indications for carrying out repair operations, and drawing appropriate conclusions. The main stages of reconstructions are demonstrated by a series of clinical examples.

[Radical breast resection with skin-muscular latissimus dorsi flap grafting].

The oncological breast surgeries with single-stage replacement of the lost volume by means of autogeneous tissue using distant flaps grafting (particularly by skin--muscular flaps of the latissimus dorsi) allow obtaining satisfactory and stable aesthetic results without the decrease of indices of relapse-free and general survival. The early results of the application of the skin-muscular flaps of the latissimus dorsi for single-stage breast reconstruction after radical breast resection are presented in this work in 3 patients with breast cancer. The technique allows performance of the extensive radical resection with single-stage grafting in patients with breast cancer and obtaining an objective clinical response against the background of neoadjuvant therapy with subsequent applying radiation therapy and systemic treatment.

[The single-stage and delayed reconstructive plasty in breast cancer patients].

An absence of breast is the irreversible cosmetic and physical defect, which reduces the self-assessment and psyco-emotional status of women. Nowadays the necessity of reconstruction after mastectomy will gain more popularity and plays a fundamental role in psychological and social rehabilitation of breast cancer patients. The article analyzes the experience of reconstructive plasty of 26 patients with I-III stages of breast cancer.

[Stages of diagnosis and surgical treatment for combined bladder injuries].

62 case histories of patients with bladder injuries who were admitted in the Department of Urology and Emergency Surgery of the Republican Scientific Center of Emergency Medicine (RRCEM) from 2001 to 2010 were retrospectively analyzed. 15 (24.2%) patients with hematuria or urethremorrhagia were admitted in the emergency room within an hour after the injury onset. Three (4.8%) patients were hospitalized in the period 1-3 h since injury onset, 12 (19.3%) patients since 3-6 hours, 5 (8.1%) - since 6 to 12 h, 16 (25 8%) patients - since 12 to 24 hours, and 11 (17.7%) patients - after 24 hours. Concomitant injury of the bladder with fractures of the pelvic occurred in 21 (33.8%) cases. At the time of admission in the emergency room, I-II degree traumatic shock was diagnosed in 37 (60%) of patients, III-IV degree traumatic shock - in 11 (17,7%). All 62 patients had a complete rupture of the bladder, 37 (59.6%) of patients had intraperitoneal rupture, 23 (37.1%) - extraperitoneal rupture, and only 2 (3.3%) - mixed rupture. Strict adherence to the RRCEM algorithm of diagnosis and treatment of patients with bladder injuries have substantially improved the efficiency of complex of medical and diagnostic measures and improved the outcomes of this group of patients - mortality was 12.9%.

[Experience with the treatment of combined open injuries to the upper extremities with affected main arteries].

The paper deals with the principles of management of combined mechanical injuries to the upper extremities with special reference to amputation of their segments based on the 3-year experience with the treatment of 1488 patients including 405 ones with traumatic amputations. Replantation of large and small segments was undertaken in 24 and 76% of the cases respectively. 43% of the patients underwent one-step traumatic amputation of two and more segments. Skin and soft tissue defects occurred in 111 patients including 27 with extensive lesions. 82.4% of the surgical interventions had the desired outcome. An example of successful replantation is described. The results are compared with the literature data.

[Successful brachial replantation in a child after a traction-type traumatic amputation].

The article deals with certain aspects of managing patients presenting with extremital bone-and-vascular injuries known for utter severity and a high incidence rate of postoperative complications. Suggested herein, as the authors believe, is an optimal for both the patient and surgeon policy of emergency reconstruction. Emphasis is placed on the necessity to follow a certain sequence while restoring the anatomical structures destroyed. The conclusions drawn include compulsorily considering a possibility to spare the damaged segment, followed by restoring adequate blood circulation and prevention of wound infection, carrying out osteosynthesis with obligatory shortening of the bones, and postponing orthopaedic measures for the remote postoperative period. Also presented in the article is a photograph-illustrated clinical case report of a successful brachial replantation.

[Prevention and treatment of postoperative complications of hepatic echinococcosis]. / Nekotorye osobennosti profilaktiki i lecheniia posleoperatsionnykh oslozhnenii ékhinokokkoza pecheni.

The paper presents the outcomes of surgical treatment in 117 patients with complicated liver echinococciasis in the past 9 years. Hepatic function and immunity, their pre- and postoperative changes in the combined use of essentiale and T-activin were studied. It has been found that the functional status of the liver, its detoxifying function in particular, largely impairs and immunosuppression develops in patients with complicated liver echinococciasis. The postoperative combined use of essentiale and T-activin led to the normalization of hepatic function and immunity. The combined treatment reduced the incidence of postoperative complications from 34.83 to 17.2%, such as acute hepatic failure, suppuration of a wound and a residual cavity, isolated abdominal abscesses, pleurisy, and pneumonia.

[Disorders of the processes of protein biosynthesis and a decrease in the content of cytochromes P-450 and b5 in the microsomal fraction of rat kidney in the dynamics of development of acute pyelonephritis]. / Narushenie protsessov biosinteza belka i snizhenie soderzhaniia tsitokhromov P-450 i b5 v mikrosomal'noi fraktsii pochek krys v dinamike razvitiia ostrogo pielonefrita.

Noticeable decrease in microsomal protein level MOS terminal component--cytochrome P-450 and MOS median link--cytochrome b5 contents in microsomal fraction implicated in renal pathologic process was established in development of acute unilateral pyelonephritis. These findings reduction expression directly depended on severity and pathologic process development degree. One of the main causes led to reduction in cytochromes P-450 and b5 level and inhibition proteins biosynthesis may be influence of toxic products which are generated in substance exchange involved in prevalence of catabolic processes in injured kidney and intensification in endogenous intoxication syndrome on renal structures. Implication of many other factors effecting decrease in microsomal hemoproteins and protein levels in the damaged kidney in above pathology showed necessity to perform further investigations in the field given.

[Ultrasonic diagnosis in the surgical treatment of angiodysplasias of the lower extremities]. / Ul'trazvukovaia diagnostika v khirurgicheskom lechenii angiodisplazii nizhnikh konechnostei.

An experience with examination and surgical treatment of 156 patients with angiodysplasia of lower extremities shows that the ultrasonic location and dopplerography are highly informative methods of diagnosis of this disease. The orthostatic probe (the Valsalva test effect) allows the spread of angiodysplasia (suprafascial or subfascial) to be determined. The adequate strategy and volume of surgery can be chosen correctly. These methods of examination being noninvasive and easy makes them helpful for the objective assessment of the effectiveness of the surgical procedures and control of further treatment.

[The absorptive-excretory function of the liver in patients with mechanical jaundice before and after endobiliary interventions]. / Poglotitel'no-vydelitel'naia funktsiia pecheni u bol'nykh s mekhanicheskoi zheltukhoi do i posle éndobiliarnykh vmeshatel'stv.

The authors analyze the character and degree of disturbances of the absorbing-eliminating function of the liver in 156 patients with mechanical jaundice of different etiology. In patients with mechanical jaundice the absorbing-eliminating function of the liver is disturbed at early stages of the disease and these disturbances progress at longer terms of the disease. The restoration of the absorbing-eliminating function of the liver was noted in the process of percutaneous transhepatic drainage of the bile ducts.

[Characteristics of the blood flow in the vertebral artery before and after the surgical treatment of the proximal segment of the subclavian artery]. / Osobennosti krovotoka v pozvonochnoi arterii do i posle khirurgicheskogo lecheniia proksimal'nogo segmenta podkliuchichnoi arterii.

The features of the blood flow in the vertebral artery were studied by ultrasonic dopplerography with functional test for reactive hyperemia in 52 patients. The authors claim this to be an objective screening method allowing the sequelae of occlusion of the vertebrosubclavian segment to be studied and providing information for establishing the diagnosis and appraising the efficacy of reconstructive operations.

[Transcutaneous endobiliary interventions in mechanical jaundice]. / Chreskozhnye éndobiliarnye vmeshatel'stva pri mekhanicheskoi zheltukhe.

The authors analyse experience in the treatment of 132 patients with obstructive jaundice which was caused by a neoplastic lesion in 61 and by a benign disease in 71 of them. Bearing in mind the serious condition of this category of patients and the high risk of the operative intervention, two-stage treatment is applied with preliminary decompression of the biliary system and restoration of the main hepatic functions in the first stage. Transcutaneous endo-biliary interventions are carried out when other sparing methods cannot be accomplished or are ineffective. The authors give an integral, finer evaluation of the functional condition of the liver, elimination of the biliary microflora, and in this manner develop the criteria of the indications for the second stage of the intervention (prolonged bile passage in the intestine). In view of the high risk of the operative intervention, the authors suggest wider use of the methods of transcutaneous endo-biliary interventions according to indications. Nine patients died (6.8% mortality) in increasing hepatorenal insufficiency with growth of the oncological process.

[The effect of fluorine and other biogeochemical factors on enamel and dentin microhardness]. / Vliianie ftora i drugikh biogeokhimicheskikh faktorov na mikrotverdost' émali i dentina.

Dental enamel and dentin microhardness were studied in subjects aged 35-44 living in various climatic and geographic zones of Azerbaijan. A total of 172 intact teeth were examined. Dental hard tissue microhardness was found to be related to caries intensity, fluorine content in potable water, and to other biogeochemical factors. Enamel and dentin microhardness were found much higher in the areas with high fluorine levels of potable water than in those with fluorine-deficient water.

[Roentgenologically-guided biliary tract surgery in mechanical jaundice]. / Rentgenéndobiliarnaia khirurgiia pri mekhanicheskoi zheltukhe.

From experience in radiologically-guided endobiliary surgery in 96 patients the authors claim it to be an effective method in the treatment of obstructive jaundice of various etiology, especially when endoscopic methods proved to be poorly effective while surgical operations were linked with a high degree of risk. Analysis of the microflora of the bile is indicated. The expediency of two-stage treatment of patients with obstructive jaundice is pointed out. Thirty one patients were cured by radiologically-guided endobiliary surgery.

[Metabolic function of the liver in middle-aged and elderly patients with peritonitis]. / Metaboliziruiushchaia funktsiia pecheni pri peritonite u bol'nykh pozhilogo i starcheskogo vozrasta..

From analysis of experimental (576 rats) and clinical (104 patients) materials, the authors drew the conclusion that the pharmacological activity of certain drugs metabolized in the liver increased markedly in old rats with experimental peritonitis. The drug-metabolizing function of the liver was inhibited significantly in peritonitis in elderly and senile patients. A method was developed for establishing the stages of peritonitis.

[Clinical and experimental research on the drug-metabolizing function of the liver in peritonitis]. / Kliniko-éksperimental'noe issledovanie farmakometaboliziruiushchei funktsii pecheni pri peritonite.

It was found that in experimental peritonitis the activities of hepatic amidopyrine-N-dimethylase, aniline hydroxylase and NADPN cytochrome-C-reductase as well as the contents of cytochromes P-450 and B5 in the microsomal fraction of the liver significantly decrease and also there is prolongation of the half-life and reduction of the clearance of antipyrine. Similar changes in the drug pharmacokinetic were revealed also in the patients with developed and diffuse peritonitis, their degree being more significant in patients hospitalized in the toxic phase and especially in the terminal phase of the disease.

[Stimulation of egg development in female nematodes by beta-diethylaminoisobutyronitrile]. / Stimulirovanie razvitiia iaits vnutri samok nematod deistviem beta-diétilaminoizobutironitrila.

The biological activity of a new organic compound beta-diethylaminoisobuthironitrile was determined. A new phenomenon for nematodes of open-type larval development (Strongyloid) was found. Alive females of nematodes belonging to the genera Trichostrongylus, Ostertagia, Bunostomum and Haemonchus were treated with 5 volumes-% mixture of the compound with water. The development of eggs of these nematodes in the mother body and output of larvae in female were observed. The larvae lead an active mode of life, feed and are capable of developing. Optimal exposure of females in solution is 4 hours for Haemonchus and Trichostrongylus, 2 hours for Bunostomum, and 3 hours for Ostertagia. Stimulation of egg development in nematodes of semiclose and semi-open types was not observed.