[Features of clinical course of primary peritonitis in children].

The article presents an analysis of the features of primary peritonitis in children. Medical reports of 182 patients with primary and appendicular peritonitis were analyzed. It was significant, that the sick girls aged 4-7 years often had the primary peritonitis after acute inflammatory processes, which took place a month earlier. Chronic infection foci were noted in these patients. The age-specific features of maturation of the immune and reproductive systems predisposed the disease.

[Immunological features of children with primary peritonitis].

An immunological research of the patients and control group with primary peritonitis was made. The main indices of immune response were in the range of age rates. However, the immune signs of foci of chronic inflammation were revealed in patients after operation. The consequences of disease (an abdominal cavity effusion) were eliminated during surgical interventions, but not the cause of the inflammation. Children with the primary peritonitis should be examined for detection of infection foci.

[Treatment of erectile dysfunction in cases of venous and corporovenous insufficiency of phallus]. / Lechenie érektil'noi disfunktsii pri venoznoi i korporovenoznoi nedostatochnosti polovogo chlena.

A total of 230 patients of different age with impaired venous drainage of penis cavernous bodies were examined. Test with intracavernous injection of papaverin, dopplerography of the vessels and cavernosometry were employed. To treat venous and corporovenous insufficiency, it is suggested to make a resection of the deep dorsal vein, ligation of the superficial and circular veins with suturing tunica albuginea. In negative result of the surgery viagra in a done 50 (100) mg is recommended or penile implants.

[Current problems in public health reform in Russia]. / Aktual'nye problemy reformirovaniia rossiiskogo zdravookhraneniia.

Transformation of state treatment and prophylaxis institutions into private institutions is analyzed on the basis of collective opinions of the heads of institutions which were expressed during sociological interviews. The rating of the major negative consequences of commercial transformation of public health and of preferences of respondents in the sphere of paid services is determined. Relative significance of factors affecting the price (tariff) of medical services is evaluated.

[Diagnostic and prognostic significance of biochemical indicators in colorectal neoplasms]. / Diagnosticheskoe i prognasticheskoe znachenie riada biochimicheskikh pokazatelei pri kolorektal'nom rake.

Activities of some enzymes and content of medium-weight molecules in patients with colorectal cancer were studied in order to assess the diagnostic value of these parameters for detection of tumors in the large intestine and development of endogenous intoxication after surgery and for prediction of remote results of treatment. Increased activities of creatine phosphokinase and hexokinase is typical of tumor growth, whereas increased activities of alkaline phosphatase and gamma-glutamyl transpeptidase are observed only in metastases to the liver. The role of medium-weight molecules in the diagnosis of endogenous intoxication during the early postoperative period is shown. The content of these molecules in the sera increases 3 days before clinical manifestation of endotoxicosis, when the traditional parameters are virtually normal.

[Breast reconstruction in cancer]. / Rakonstruktsiia molochnoi zhelezy pri rake.

Different procedures of breast reconstruction were employed in the treatment of 223 breast cancer patients (primary reconstruction-97; delayed reconstruction-136). No major complications were recorded, including total necrosis of transverse abdominal island flap. The advantage offered by the latter is due to its resistance to chemoradiotherapy: complications such as boundary necrosis do not destroy cosmetic effect as in the case of expander application.

[Essential measures of an organizational-medical character aimed atdecreasing the incidence of diseases of the circulatory system and mortality caused by them in modern Russia]. / Neobkhodimye meropriiatiia organizatsionno-meditsinskogo kharaktera, napravlennye na umen'shenie zabolevaemosti bolezniami sistemy krovoobrashcheniia i smertnosti ot nikh v sovremennoi Roccii.

Mortality caused by diseases of the circulatory system is analyzed on the basis of files of the Ministry of Health and of the State Statistical Committee of Russia and the results are correlated to the objective parameters reflecting the potentialities of cardiological service in Russia and the actual status of prophylaxis, including regular check-ups. Conclusions are drawn and recommendations offered.

[Left-side varicocele and infertility: diagnosis and treatment]. / Levostoronnee varikotsele i besplodie: diagnostika i lechenie.

Eighty-four patients with left varicocele were subjected to complex examination to identify the causes of disturbed spermatogenesis. It was found that not only the testis but the adrenal also is involved in the pathological process in varicocele caused by venous renal hypertension. Changes of venous hemodynamics in the left adrenal lead to activation of steroidogenesis in its cortex and, consequently, to impairment of spermatogenesis in both testes. As the result of the study a new method for the treatment of sterility in patients with left varicocele was suggested, namely, X-ray-guided endovascular occlusion of the central vein of the left adrenal. Tentative evaluation of the results of the intervention gives hope of its efficacy.

[The efficacy of the combined antibacterial treatment of patients with colonic cancer complicated by perifocal inflammation]. / Effektivnost' kombinirovannogo antibakterial'nogo lecheniia bol'nykh rakom obodochnoi kishki, oslozhnennym perifokal'nym vospaleniem.

In patients with colonic cancer complicated by inflammation since 1989 we have been using irrigations of tumor area with antibacterial drugs (dioxidin, betadin) side by side with conventional antibacterial and detoxicating therapy. The complex antibacterial therapy having been applied in 47 patients eliminated clinical manifestation of inflammatory process. Histological and morphometrical biopsy of tumor tissue and surrounding mucosa gives a reason to conclude that the complex therapy has proved to be effective.

[The surgical treatment of patients with colonic cancer complicated by perifocal inflammation of the tissues]. / Khirurgicheskoe lechenie bol'nykh rakom obodochnoi kishki, oslozhnennym perifokal'nym vospaleniem tkanei.

In the clinic, at preoperative preparation of the patients with cancer of the colon complicated by perifocal inflammation, the irrigation of a tumour area, using antibacterial preparations, is employed. After laparoscopy, a drainage tube with microirrigator for perfusion of the antibacterial solution is introduced to the region of tumour location. Using the method described, 25 patients were prepared for the operation. Their state improved after 7-8 days. One-stage radical operation was performed in 20 patients. Of them in 17, primary intestinal anastomosis was created.

[The pathochemical mechanisms of bronchospasm after physical exertion in bronchial asthma patients]. / Patokhimicheskie mekhanizmy bronkhospazma posle fizicheskogo usliliia u bol'nykh bronkhial'noi astmoi.

As many as 71 bronchial asthma (BA) patients and 12 patients suffering from chronic asthmatic bronchitis were examined in the stage of subsiding exacerbation. Before and 10 minutes after exercise measurements were made of the blood content of histamine (H), PGF2 alpha and PGE, adrenaline (A) and noradrenaline (NA), hydroperoxides (HP), and of the general and non-protein thiol groups. The initial level of H, PGF2 alpha, HP, A and NA was so much higher than the control value and the degree of its increase after exercise was so much more significant the more pronounced bronchospasm of effort (BE). The content of PGE after exercise rose to an approximately equal measure both in patients and in healthy subjects thereby pointing out to the relationship between the PGE increment and muscular work itself. The low level of thiol group in BA patients' blood determined by the pathological process was noticeably reduced after exercise, paralleled by an increase in the content of HP. Thus, muscular work in BA patients demonstrates high responsiveness of the systems that produce bronchoconstricting substances. It is likely that BE and its degree in BA patients may be predicted more significantly on the basis of the blood content of H, PGF2 alpha and HP rather than on the basis of the clinical and functional parameters.

[Loop colostomy in patients with cancer of the colon and rectum]. / Petlevaia kolostoma u bolnykh rakom obodoxhnoi i priamoi kishki.

At the clinic of Scientific Research Institute of Proctology, Ministry of Public Health of Armenia, in 97 patients with complicated cancer of the colon and rectum, a two-barrel loop colostomy was created for the recent 10 years. Use of intraperitoneal method contributed to 3-fold decrease in incidence of postoperative purulent complications. Irrigation of a tumour site with antibacterial preparations in perifocal inflammation of colonic cancer together with carrying out the complex antibacterial therapy permits to perform the radical operations.

[The activities of the renin-angiotensin-aldosterone and sympathetic-adrenal systems during hemodialysis]. / Aktivnost' renin-angiotenzin-al'dosteronovoi i simpato-adrenalovoi sistem vo vremia gemodializa.

The authors analysed the dynamics of the activity of the renin-angiotensin-aldosterone, hypophyseal-adrenal, and sympathoadrenal systems in 46 patients during a hemodialysis session according to the type of hemodynamics. No essential changes were encountered in the hormone concentration in patients with normotension and "controllable" hypertension. In patients with "uncontrollable" hypertension the dialysis dehydration was attended by increased activity of the renin-angiotensin-aldosterone system, the level of cortisol and the adrenocorticotropic hormone increased slightly. Daily catecholamine excretion was 2-3.5 times below the lowest normal value. Noradrenaline clearance of the plasma membrane dialyser was 82.1 ml/min. Increase in the concentration of noradrenaline, and the activity of renin and aldosterone were encountered both in hypotension and in arterial hypertension. It is concluded that disturbed water balance, dyselectrolythemia, anemia, infectious complications, etc. are the trigger factor of decompensation of the system of the hormonal hemodynamic regulation. Substitution adrenomimetic therapy for arresting collaptoid reactions is inexpedient. Systematic use of medicinal agents should be avoided in favour of a search for an optimal dialysis regimen, should this prove ineffective the decision should be made in favour of an operation.

[The x-ray endovascular treatment of renin-dependent arterial hypertension with secondary aldosteronism in patients without vasorenal involvement]. / Rentgenoéndovaskuliarnoe lechenie reninzavisimoi arterial'noi gipertenzii s vtorichnym al'dosteronizmom u bol'nykh bez vazorenal'nogo porazheniia.

In 20% of cases, essential hypertension is of high renin pathogenesis which is indifferent of that of renal lesions. In these patients high blood pressure is closely related to high aldosterone generation due to elevated angiotensin II levels. Adrenal blood portalization is a possible way of abolishing secondary aldosteronism and hyperreninemia in this case. With this, 90-98% aldosterone and 20-30% renin are inactivated, which served as the basis for bilateral electrocoagulation of adrenal central veins in 13 patients with permanent and malignant arterial hypertension. The renin-dependent pattern of essential hypertension was confirmed by a positive BP response to a tested captopril dose (25 mg), the vasorenal one was ruled out on the basis of the peripheral captopril test, captopril pharmacorenography. Bilateral electrocoagulation of adrenal central veins was performed during a phlebographic examination. The manipulation proved to be successful on 11 (85%) left and 9 (70%) right adrenals. Blood pressure became lower in the first day and stable on days 4-5. There was a significant decrease in blood pressure at a year follow-up, in increased aldosterone levels, plasma renin activity with unchanged adrenocorticotropic hormone concentrations. After the manipulation, 2 patients refused to take antihypertensive drugs, 11 patients received lower doses of drugs. The method for abolishing secondary aldosteronism is considered to be promising for further clinical studies. A special attention should be given to patients with diseases concomitant with essential hypertension who have no alternative to surgical treatment.

[The diagnosis and treatment of arterial hypertension in patients on hemodialysis treatment and after a kidney allograft]. / Diagnostika i lechenie arterial'noi gipertenzii u bol'nykh na lechenii gemodializom i posle allotransplantatsii pochki.

Analysis of examination and treatment of 104 patients who were periodically exposed to hemodialysis and 60 persons who sustained the allotransplantation of a cadaveric kidney enabled the authors to reveal the incidence of arterial hypertension before and after the transplantation. Pronounced arterial hypertension (AH) was documented in patients who were treated with hemodialysis sessions for the proper renal diseases developed in angionephrosclerosis (chronic glomerulo- and pyelonephritis). In those who sustained the transplantation, AH was pronounced in case of acute of chronic rejection, transplanted artery stenosis of renal renin hyperproduction. Higher incidence of AH (2.3-fold higher) was observed in posttransplantation patients with the native kidney left. It correlated with higher peripheral plasma renin activity (RRA). The authors suggested that the scheme should be used for the diagnosis of AH manifestation both before and after the transplantation which included the account for the cause of the disease terminal stage, the character of the AH variance in hemodialysis captopril testing, radiocardiographic examination, indirect renal angiography (99-Tc pertechnetate) or selective blood testing for RPA in case bilateral nephrectomy should be made in two stages. For the patients who had sustained the transplantation of the kidney, the diagnostic scheme should include a double pulse Doppler sonography, arteriographic investigation of the transplant and pharmacorenography with a captopril load test. Advisability of captopril stimulation of renin secretion during the selective sampling of the blood was demonstrated. The authors verified the time-course of renin activity, the concentration of aldosterone, cortisol and adrenocorticotrophic hormone in patients with a history of bilateral nephrectomy, defined the indications for bilateral nephrectomy associated with AH and discussed its possible outcomes.(ABSTRACT TRUNCATED AT 250 WORDS)