[Use of 'Korona' cava filter in oncological patients]. / Primenenie kava-fil'tra 'Korona' u onkologicheskikh bol'nykh.

Using the 'Korona' cava filter in a total of 1345 oncological patients revealed regularity of a change in the shape of the inferior vena cava at the level of implantation. This made it feasible to determine one of the causes of long-term complications following implantation of other models of cava filters. The absence of clinically significant complications in the remote period after using this model of cava filter made it possible to implant it for a longer period, which is of special importance in oncological patients.

[The modification of the M.D. Patsiora's operation by portal hypertension].

The direct transcutaneous transhepatic portography was performed in 85 patients with hystologically confirmed liver cirrhosis, portal hypertension and varices of the esophagus and stomach. It was found out, that the left gastric vein partakes the varicous transformation in 100% of cases. The least had an isolated division in 27% of the studied patients. 68% had the significant dilatation of the posterior gastric vein, whereas 19 (22%) patients had the combined posterior, left and short gastric veins dilatation. The study allowed the modification of the M.D. Patsiora's operation (the azygo-portal disintegration), by supplementing it with the gastric devascularization. The new method increased the 2-years survival from 77 to 97%, improved the hemostatic effect from 51 to 89% and decrease the recurrences from 25 to 5%.

[Optimization of surgical strategy in trauma of the chest: correlation of thoracoscopy and thoracotomy].

The authors analyzed an experience with treatment of 4372 patients. Videothoracoscopy allowed the number of usual drainages of the pleural cavity to be reduced in closed trauma from 16.3% to 2.3%, in wounds--from 3.9% to 0.4%. Persistent hemo- and airstasis were obtained by coagulation of the vessels of the thoracic wall and lung, suturing lung wounds. The coagulated hemothorax was removed, diaphragm wounds were sutured, the pericardium wounds were revised, the character of intrathoracic lesions was reliably determined in 98% of cases. Conversion into thoracotomy was fulfilled in 91 (5.5%) patients. Thoracotomy was fulfilled in 344 (8%) patients with indications to operative interventions and severe condition and unstable hemodynamics. The number of thoracotomies and lethality in patients with penetrating wounds of the chest became 1.5-2 times less, was not considerably changed in closed traumas.

[Pathogenesis of esophageal and gastric varicose veins formation in patients with liver cirrhosis].

RESEARCH OBJECTIVE: studying the features of the collateral venous blood flow and the basic ways of the formation of gastroesophageal varices in patients with cirrhosis and portal hypertension. METHODS: The following analysis is based on the interpretation of results from percutaneous transhepatic splenoportography in 85 patients. It has been established that in all 85 patients the left gastric vein plays a key role in the formation of gastroesophageal varices. RESULTS: It is established that a leading collector in 100% of observations participating in formation gastroesophageal varices, is the left gastric vein. In work the attention is focused on an insufficient estimation of a role of a back gastric vein in a pathogenesis of varicose transformation. From 85 observations its presence is taped in 58 (68%) cases, and, at 19 (22%) patients its expansion isn'ted in a combination to expansion left gastric vein, and at 39 (46%) patients - in a combination with left gastric vein and short veins of a stomach. CONCLUSION: The obtained data on the formation mechanism of varicose expanded veins of an esophagus and a stomach defines necessity of changes for algorithm of inspection of patients for the purpose of diagnostics of features of a venous blood flow of a stomach and an esophagus and definition of surgical tactics concerning volume pre- or intraoperational blockade of the basic venous collectors.

[Temporary cardiac pacing in patients with acute myocardial infarction in the conditions of air medical service].

Temporary electrical cardiac pacing in the conditions of air medical service was used in 183 patients with myocardial infarction complicated with life threatening disturbances of cardiac rhythm and conduction. Immediate results of treatment, complications, and causes of lethal outcomes are presented. Two groups of patients were distinguished: in which traditional and improved by authors methods of temporary electrical pacing were employed. It was established that the use in urgent situations of improved techniques of control of endocardial electrode position, transesophageal, cutaneous, and atrial dependent endocardial ventricular electrical pacing allowed to decrease number of complications 2.6 times, and to lower mortality in acute period of myocardial infarction by 12.8%.

[Alpha-fetoprotein immunotherapy as a stage of combined treatment of cancer patients].

The paper discusses the preliminary findings on alpha-feto-protein (AFP) treatment of 58 patients with stage III-IV malignancies of different localizations. No influence on neoplastic processes was registered in poorly differentiated cell tumors, nor were any immunological mechanisms of antitumor action triggered on. However, in moderately- and well-differentiated cell tumors, several foci of acute immune inflammation were induced. It is suggested that AFP is responsible for tumor cell apoptosis by freeing antigenic determinants from shielding antibodies via elimination of <> of tumor growth.

[A device for performing drainage into common bile duct].

A new original instrument is proposed for draining the cystic duct into the common bile duct through the stump. The device combines a reliable fixation of the drainage tube in the stump of a narrow (less than 3 mm) or scared altered cystic duct and the not traumatically embedded cannula into the common bile duct.

[Effectiveness of external drainage of the common bile duct]. / Otsenka éffektivnosti naruzhnogo drenirovaniia obshchego zhelchnogo protoka.

Influence of different methods of external drainage of the biliary tract on dynamics of inflammation in the biliary tracts was evaluated based on the data examination of bioimpedance, specific electric conductivity and general microbial number of bile received during surgery and from drainage of the common bile duct during 9 days after surgery in 197 patients with cholelithiasis complicated by bile outflow disturbances. It is demonstrated that each type of external drainage has own indications depending on the degree of bacterial contamination, macroscopic structure, biophysical parameters of bile, and planned treatment policy after surgery. Right fixation of the drainage tube in the common bile duct improves immediate results of surgical treatment of patients with cholelithiasis.

[Effect of biological preparation alfetin in infiltrative pulmonary tuberculosis]. / Vliianie biopreparata al'fetina na infil'trativnyi tuberkulez legkikh.

The authors evaluated influence of Alfetin new Russian biologic preparation on pulmonary surfactant system and phospholipid metabolism in workers at risk of occupational pneumoconiosis, who suffer from infiltrative pulmonary tuberculosis. Considering positive changes in serum phospholipids subunits under alfetin treatment, the authors proved membrane protective effect of the drug. Alfetin was proved to weaken toxic effects of tuberculostatic drugs on lung surfactant.

[Diagnosis, treatment and prophylaxis of postoperative recurrent nodular goiter]. / Diagnostika, lechenie i profilaktika posleoperatsionnogo retsidivnogo uzlovogo zoba.

Results of surgical treatment of 81 patients with recurrent goiter and 79 patients with benign nodular forms of goiter are analyzed. Based on clinical data, results of ultrasonic and histological examinations, it was determined that recurrence of goiter does not depend on volume of surgery. It is seen in patients with subclinical forms of postoperative hypothyreosis and in half of cases with lymphoid infiltration of I - IV degree. Dispensary observation and timely prescription of suppressive therapy, if it is necessary, permit to reduce number of goiter recurrences from 8.2 to 2.5%.

[Results of early rehabilitation after various methods of cholecystectomy at Ust'-Kachka resort]. / Rezul'taty rannei reabilitatsii posle razlichnykh variantov kholetsistéktomii na kurorte Ust'-Kachka.

Early rehabilitation after open cholecystectomy or cholecystectomy from a mini-approach was performed in 101 patients with cholelithiasis treated surgically at Ust-Kachka health resort. Changes in clinico-laboratory indices reflecting the condition of hepatopancreatobiliary system and central hemodynamics before and after rehabilitation were studied depending on the variant of cholecystectomy. Advantages of early rehabilitation of patients after different variants of cholecystectomy at Ust-Kachka health resort in normalization of general condition of the patients and in prevention of functional disorders progression early after operation are demonstrated.

[The parameters of physico-chemical properties of bile and urine in the diagnosis of pancreatitis associated with cholelithiasis]. / Pokazateli fiziko-khimicheskikh svoistv zhelchi i mochi v diagnostike pankreatita v sochetanii s kholelitiazom.

Specific electrical conductance (SEC) of the hepatic bile in 94 patients with cholelithiasis and concomitant pancreatitis was increased (p < 0.001) and depended on the degree of cholestasis and the morpho-functional state of the liver. The value of SEC of the intraoperative bile higher than 193 S/m is taken for a criterion of the diagnostics of biliary pancreatitis. The electrical conductance of urine during the first 4 days of observation decreased in patients with acute pancreatitis (p < 0.05), impaired carbohydrate metabolism and concomitant renal dysfunction. The value of SEC of urine lower than 238 S/m corresponds to acute pancreatitis. The investigation of physico-chemical indices of biological liquids in patients with a pathology of the pancreato-biliary system allows to objectively control the course of the disease and to correct the treatment methods.

[Selection of protection regimen of dual-chamber cardiac pacing against paroxysmal supraventricular tachycardia]. / Vybor rezhima zashchity dvukhkamernoi élektrostimuliatsii serdtsa ot paroksizmal'nykh nadzheludochkovykh takhikardii.

Criteria of selection of a type of protection against paroxysmal supraventricular tachycardia were studied in 38 patients with permanent dual-chamber cardiac pacing. Three types of protection were distinguished. Criteria for their selection were presence of "pacemaker syndrome", state of chronotropic function of the heart, frequency of attacks of supraventricular tachycardia, results of modeling of pathological atrial activity. During follow-up after programming of optimal type of protection of dual-chamber pacing (mean duration 5.1 years) chronic supraventricular tachycardia developed in 13.5% of patients, survival was 89.2%.

[Diagnostics of traumatic fat embolism]. / O diagnostike travmaticheskoi zhirovoi émbolii.

The article deals with diagnosis and treatment of fat embolism concomitant with trauma. A new term is suggested, i.e. liqoroglobulism, which is concomitant with the cerebral form of fat embolism. The results of investigations of patients, who endured fat embolism, are presented. A new method is suggested for the treatment of fat embolism, i.e. a combination of hemosorption and liquosorption. A thesis on that the blood-brain barrier is damaged in the cerebral form of fat embolism is formulated.

[Biophysical properties of bile and urine in patients with cholelithiasis]. / Biofizicheskie svoistva zhelchi i mochi u bol'nykh kholelitiazom.

The electric conductivity of the hepatic bile received during and 24 hours after surgery from the drainage introduced into the common hepatic duct was studied in 94 patients with cholelithiasis. It is demonstrated that conductivity increases in cholestasis, inflammatory process in the biliary tract and depends on the hepatic morphofunctional status. The specific electric conductivity of intraoperative bile that is more than 192 S/m is considered to be criteria for the diagnosis of cholangitis. The electric conductivity of urine before and in first 4 days after surgery decreases in inflammation of the biliary tract and depends on the degree of concomitant renal dysfunction and electrolyte disturbances. There was a decrease in the conductivity of bile and urine in all studied groups. Detection of biophysical parameters of biological fluids may objectively control the postoperative period and correct treatment policy.

[Possibilities for ultrasonic diagnosis of pleura pathology in patients with pleural exudate]. / Vozmozhosti ultrazvukovoi diagnostiki patologii plevry u bol'nykh s plevral'nym vypotom.

The authors have analyzed results of thoracovideoscopy in 45 patients with the syndrome of pleural exudate, 17 of them had undergone the ultrasonic examination of the pleural cavity before thoracoscopy. The examination has revealed high sensibility of the ultrasonic method in the diagnosis of fragmentations of pleural exudate and pathology of the pleural leaves. The endoscopic and echographic classification of the pleural exudate is given depending on the fragmentation degree. The authors consider that echography of the pleural cavity as a noninvasive and highly informative method should be included in the first rank in making an algorithm of clinico-diagnostic measures for patients with exudative pleuritis.

[Epidemiological features of the pathomorphism of infiltrative pulmonary tuberculosis in the Perm Region]. / Epidemiologicheskie osobennosti patomorfoza infil'trativnogo tuberkuleza legkikh v Permskoi oblasti.

The time course of changes in current epidemiological indices and epidemically significant features of the pathomorphism of infiltrative pulmonary tuberculosis in those living in the Perm Region are mainly characterized by negative trends. They lie in the increase or stable maintenance of high rates of morbidity, mortality, and destructive pattern of a lesion accompanied by bacterial isolation. The reason for the established situation is incomplete realization of potentialities of improving actions to detect the disease early, to optimize diagnosis and medical therapy, and to considerably expand an phthisiosurgical aid.

[Pathomorphosis of infiltrative pulmonary tuberculosis: clinical aspects]. / Klinicheskie aspekty patomorfoza infil'trativnogo tuberkuleza legkikh.

Based on the data available in the literature and their own findings, the authors have established that the pathomorphism of infiltrative pulmonary tuberculosis in the preantibiotic age was characterized by negative features, then underwent phases of positive changes and relative stabilization, thereafter it again acquired obviously marked negative peculiarities. At present, the clinical features of new cases of infiltrative pulmonary tuberculosis in Perm residents are the predominance of acute onset (67.3%), disseminated (55.8%) and destructive (91.6%) pattern of specific lesion accompanied by bacterial isolation (84.6%).