[Fast-track recovery for perforated duodenal ulcer]. / Metod uskorennogo vyzdorovleniya pri perforativnoi yazve dvenadtsatiperstnoi kishki.

OBJECTIVE: To study the outcomes of fast-track recovery in patients with perforated duodenal ulcer (PDU). MATERIAL AND METHODS: There were 138 patients with PDU who underwent surgical treatment for the period from January 1, 2015 to December 31, 2019. Patients were divided into 3 groups: main group, control group 1 (CG-1) and control group 2 (CG-2). The main group (fast-track group, FT-group) included 51 patients who underwent laparoscopic suturing of PDU followed by enhanced recovery (fast-track). CG-1 comprised 44 patients who underwent open suturing of PDU and conventional perioperative treatment. CG-2 consisted of 43 patients who underwent laparoscopic suturing and conventional perioperative treatment. Complications were assessed using Clavien-Dindo grading system. RESULTS: In the FT group, postoperative complications were observed in 2 patients (3.92%). Anemia of mixed genesis (Clavien-Dindo grade II) was diagnosed in 1 patient and left-sided lower lobe pneumonia in another one (grade II). There were no deaths. Mean length of hospital-stay was 3.86 days. In the 1st control group, the largest number of complications was observed (n=12, 27.27%) including 9 extra-abdominal complications (pulmonary disorders (II) - 7 patients (15.9%); sepsis (IVB) - 1 (2.27%), delirium (IVA) - 1 patient (2.27%), postoperative wound seroma (IIIA) - 1 (2.27%) patient). Intra-abdominal complications consisted of compensated pyloroduodenal stenosis (II) in 1 (2.27%) case, recurrent bleeding from acute gastric and duodenal ulcers (IIIB) in 1 (2.27%) patient. Mortality rate was 4.54% (n=2) in this group (progressive multiple organ failure). Mean length of hospital-stay was 7.56 days. In the 2nd control group, postoperative complications included extra-abdominal (pulmonary disorders (II) - pneumonia in 4 (9.3%) cases, spontaneous pneumothorax (IIIA) in 1 (2.32%) case) and intra-abdominal events (duodenitis (II) in 1 (2.32%) patient and compensated pyloroduodenal stenosis (II) in another 1 (2.32%) patient). There were no lethal outcomes in this group. Mean length of hospital-stay was 6.7 days. CONCLUSION: Treatment outcomes in patients with perforated duodenal ulcer confirmed an effectiveness of laparoscopic suturing and complete abdominal sanitation. These measures create the prerequisites for fast track recovery in urgent surgical practice. FT-protocol of inpatient management is followed by reduced hospital-stay and less incidence of postoperative complications. Moreover, this approach promotes early and safe discharge of patients.

[Comparative evaluation of effectiveness and safety of the local hemostatic agents in the experiment].

Comparative evaluation of effectivennes and safety of the local hemostatic agents in the experiment. On the model side damage the femoral artery of pigs we performed a comperative test of modern local hemostatic agents (LHA): bandages on the basis of chitosan <> (TG), eGemofleks Combat> (GC), (GB) bandages on kaolin-based <> (CG), and the usual bandage 10 cm x 3 m (control group). 25 animals were divided equally into 5 groups. After 45 seconds of bleeding from 6-mm side wound of femoral artery was used LHA with a three-minute external compression and wound edges approximation. In the case of the continuation-bleeding wounds performed re-tamponade with the second package of the LHA. Hemostasis after applying the first packet never recorded in the CG group, occurred in I out of 5 animals in the groups TG and GC, 2 of 5 animals in the group GB and the control group (p>0,05). Application of two packages LHA in the TG group, GB and the control group was effective in 3 of 5 animals and in groups CG and GC - in 2 of 5 animals (p>0,05). Mortality did not differ significantly between the groups. Thus, the conventional bandage wound with ordinary tamponade in this model is not less effective than current LHA.

Acoustic interactions between inversion symmetric and asymmetric two-level systems.

Amorphous solids, as well as many disordered lattices, display remarkable universality in their low temperature acoustic properties. This universality is attributed to the attenuation of phonons by tunneling two-level systems (TLSs), facilitated by the interaction of the TLSs with the phonon field. TLS-phonon interaction also mediates effective TLS-TLS interactions, which dictates the existence of a glassy phase and its low energy properties. Here we consider KBr:CN, the archetypal disordered lattice showing universality. We calculate numerically, using conjugate gradients method, the effective TLS-TLS interactions for inversion symmetric (CN flips) and asymmetric (CN rotations) TLSs, in the absence and presence of disorder, in two and three dimensions. The observed dependence of the magnitude and spatial power law of the interaction on TLS symmetry, and its change with disorder, characterizes TLS-TLS interactions in disordered lattices in both extreme and moderate dilutions. Our results are in good agreement with the two-TLS model, recently introduced to explain long-standing questions regarding the quantitative universality of phonon attenuation and the energy scale of ≈ 1-3 K below which universality is observed.

[Methodological bases for problem solution of monitoring and estimation of mental health services activity: national and international aspects]. / Metodologicheskie osnovy resheniia problem monitoringa i otsenki deiatel'nosti psikhiatricheskikh sluzhb: natsional'nyi i mezhdunarodnyi aspekty.

General principles and questions, concerning the problem of monitoring and evaluation of psychiatric service's work from the points of systemic and mathematic modeling, are considered. An analysis of the structure and parameters values of national psychiatric service is presented. Suggested, are recommendations on using this information and improvement as well its collection, processing and presentation of the results in the national and international aspects. Taking Russia as an example, a selective correlation analysis of the regional rows of the values of the indices for psychiatric service's work was conducted to reveal their informational excessiveness. It is shown that the sets of the indices existed and being elaborated for solution of the monitoring problem and estimation of psychiatric service's work are excessively informative and can not be used without an additional analysis in corresponding mathematic modeling. In the view of the condition of the discussing questions, a use of hierarchical modeling apparatus seems to be the most natural and adequate for the solution of the problems posited.

[Lighting and technical elements of medical illuminators and the principles of minimal heating of the surgical field]. / Svetotekhnicheskie élementy meditsinskikh svetil'nikov i printsip minimal'nogo nagreva operatsionnogo polia.

Schemes of lighting-and-technical elements of medical illuminators, manufactured by leading companies, are presented in the article. The values of the energy/light correlation are analyzed for different illumination sources; besides, the conditions of a minimal thermal inflow into tissues are described.

[Suicides in the Russian Federation as a sociopsychiatric problem]. / Samoubiistva v Rossiiskoi Federatsii kak sotsiopsikhiatricheskaia problema.

The analysis of suicide situation in Russia in 1989-1993 is presented. Unfavourable trends have been identified: growth of suicides prevalence and younger age of their committing. The differentiation of Russian regions according to suicide rates is also presented. While suicide prevalence was 37.9 per 100,000 among general Russian population it was more than twice as high among mentally ill, in outpatient clinic, that is 78.2. 1738 mentally ill suicide cases have been considered. Most of these suicides have been committed by patients at the age of 30-59 years. Schizophrenic patients prevailed--55.6% of cases. It was found that unlike general population age-sex structure of the population considered was more stable and wasn't changed under the influence of social factors. The changes in the nosological structure of the above population depended on the changes of the psychiatric registration procedure.

[Development and organizing the manufacture of "cold" light medical fixtures: Systematic comprehensive approach]. / Sistemno-kompleksnyi podkhod k razrabotke i organizatsii proizvodstva meditsinskikh svetilnikov "kholodnogo" sveta.

The paper outlines the experience in applying a systemic comprehensive approach to the development of new generation medical luminaires used by the All-Russian Research Institute of Medical Instrument Making. The approach used in the development and introduction of cold-light medical lamps allowed the authors to develop and organize the manufacture of a whole series of different-type models of the luminaires, as soon as practical, making less investments than those during the former practice in the development and production of similar medical articles.

[The main results of the experiment regarding the changes in the principles of follow-up of patients with mental disorders]. / Osnovnye rezul'taty éksperimenta po izmeneniiu printsipov dinamicheskogo nabliudeniia za litsami s psikhicheskimi rasstroistvami.

In 1988--1989 an organizational experiment was carried out in Moscow, Leningrad, in the Latvian SSR, the Altai territory and in the Ivanovo region. Apart from the conventional follow-up of patients with mental diseases, the counselling form of the follow-up was established in the experimental territories. In accordance with this new principle, the treatment and counselling assistance to persons with mental disorders was rendered only after seeing a doctor. The main results of the experiment are as follows: 1) the follow-up group of patients noticeably diminished at the expense of a decrease of the number of persons taken under the follow-up studies as well as at the expense of more rapid removal of the patients from the register including their active transfer to the patients' group given medical advice; 2) in the follow-up group structure, there was an increase in the number of patients with psychotic disorders and mental retardation and a noticeable lowering of the number of patients with non-psychotic disorders; 3) the group of patients to be given medical advice dramatically increased in the experimental territories, while the number of patients suffering from non-psychotic disorders accounted among them for 80-85%. On the whole the experiment provided evidence in favour of the opportuneness and soundness of introduction into psychiatric practice of the two follow-up types: as far as patients with grave mental disorders and deep social decompensation are concerned, they should be followed up over time by means of conventional methods; as to patients with milder mental disorders, the counselling form of the follow-up is quite sufficient, provided they adapt themselves socially or are well protected (in respect to children and retired persons).

[Clinico-statistical grouping of patients on the basis of the duration of treatment in psychiatric hospitals]. / KLiniko-statisticheskie gruppy bol'nykh, vydelennykh po dlitel'- nosti ikh lecheniia v psikhiatricheskikh bol'nitsakh.

Nine clinico-statistic groups of patients were distinguished on the basis of the time of inpatient treatment of the non-randomized group of mental patients (n-57328) discharged during one year from the Moscow psychiatric hospitals, bearing in mind the diagnosis, age and the presence of a grave somatic illness. Each of these groups is characterized by the mean period of inpatient treatment, which makes it possible to use them for economic calculations in introduction of the cost accounting into activities of the psychiatric services.

[Ukrainian Psychiatric Consultation Center-- a new organizational form of outpatient psychiatric services for the population]. / Respublikanskii psikhiatricheskii konsu'ltativnyi tsentr-- novaia organizatsionnaia forma vnebo'lnichnoi psikhiatricheskoi pomoshchi naseleniiu.

The paper treats of the experience gained by the Republican Psychiatric Counselling Center set up in the USSR for the first time. The Center is oriented at the improvement of the highly specialized psychiatric services for patients with psychic disturbances. During 1980-1987, the number of patients referred to the Center by the chief psychiatrists of the regions or by the Ministry of Public Health of the Ukrainian SSR and of those who resorted to the Center's services on their own initiative increased 7-fold, namely from 857 to 6,024 persons. The structure and functions of the Center are described as are prospects of the development of this kind of the outpatient psychiatric services in all the Union Republics, territories, regions and large industrial cities of this country.

[Analysis of the activities of psychoneurological dispensaries rendering the services to patients with borderline conditions]. / Analiz deiate'lnosti psikhonevrologicheskikh dispanserov po okazaniiu pomoshchi bo'lnym s pogranichnymi sostoianiiami.

As many as 1,851 disease histories of patients belonging to the group of mental disorders of non-psychotic level (code MKB-9 300-317) were analyzed within the framework of the organizational experiment with a purpose of reorganizing the dispensary assistance. The data obtained indicate that the diagnosis and the treatment recommendations are not based enough in all the cases, with social restricting measures dominating over social and protective ones. For such a group of patients, the dispensary follow up is not justified. That is why the available dispensary services require changes in the principles and concrete patterns of their functioning.

[Prerequisites and new approaches toward improving the outpatient registration of mental patients]. / Predposylki i novye podkhody k sovershenstvovaniiu dispansernogo ucheta psikhicheski bol'nykh.

An increase in the registered numbers of mental outpatients, particularly at the expense of persons with borderline abnormalities, which is attendant by certain social restrictions for the latter group, is fraught with compromising the personality of these on the whole normal persons, which necessitates reorganization of the existing practice of registering patients in psychoneurological institutions. It is proposed that the existing form of registration be applied only to psychotic patients. In accordance with the level criterion patients with mental disorders of the borderline level are not liable to registration, provided their main links and relations in the social environment have remained intact. Registration should be strictly based on such time limits which can be justified on medico-social and clinico-therapeutical grounds.

[New models of endoscopes (EGDB-VO-4, SK-VO-4)]. / Novye modeli éndoskopov (EGDB-VO-4).

Two new flexible endoscopes (EGDB-VO-4, SK-VO-4) designed for examinations and intracavitary interventions in the upper and lower portions of the digestive tract are described. Specifications are given with special references to the design features as compared to the earlier models.

[Study of the movements of flexible endoscopes]. / Issledovanie dvizhenii gibkikh éndoskopov.

Examinations of the intestinal tract by conventional clinical endoscopic methods have shown that in the course of observations colonoscopes are subjected to a greater load than esophagogastroscopes. The load is greater by a factor of 2.2 in a number of translational motions and by a factor of 4.4 in a number of rotatory motions. Control grips are subjected to 2.5 times as much load as esophagogastroscopic controls, and colonoscopic tube bending is 2.8 times greater than that of esophagogastroscope.