[Reconstructive operations for scarry contractures of the shoulder joint after burns].

The article presents two methods of formation of the axilla cupola with saved skin from the area of hair growth, and when there are scarry changes. The first method allows exclusion of displacement of the axilla skin into not proper places. The second method gives better engraftment and better outcomes of operation. A method of two-stage treatment was worked out for severe contractures of the shoulder joint in order to avoid a transection of the tendons and muscles and overdistention of the vascular-nervous bundles. During the preoperative period a gradual liberation of the shoulder is to be fulfilled by means of a dosated distraction of the scars, contracted tendons and muscles. The dosated distraction is performed using a specially developed splint with a turnbuckle mechanism. Using the splint the full volume of movements was restored in 73.9% of the patients. In the rest of the cases operative treatment was used, and the distracted scarry tissues can be used as plasty material.

[Rehabilitation of patients with upper extremities burns at the stage of skin restoration].

Results of surgical treatment of 479 patients with deep burns of the upper extremities on the area from 0.5 to 60% of body surface with the lesion of shoulder (398), elbow (407), radiocarpal (371) joints and hand (423) area. Early or delayed necrectomy (28.6%) with following skin grafting was performed at hospitalization of patients in early period. At IV-degree burns plastic reconstruction with skin-subcutaneous flaps was used: local (22), combined (16), pedicle flap and Filatov's graft (29), flaps with axial circulation (8) and on microsurgical anastomoses. Active surgical policy resulted in recovery of the function of the shoulder joints in 73.7%, elbow joints--in 75.15%, radiocarpal joints--in 83.4% and of hand in 50.2% cases.

[Cavernous vegetative innervation and hemodynamics in patients with fibroplastic induration of the penis and erectile dysfunction].

Different versions on pathogenesis of Peirony's disease (PD) and erectile dysfunction in this disease made us to investigate cavernous innervation and hemodynamics in patients with fibroplastic induration of the penis. We have detected characteristic changes of cavernous electric activity and histochemical picture in biopsies of all our patients with PD. Of them, 61% had cavernous hemodynamic disorders. Our findings suggest that early affection of cavernous innervation may trigger PD pathogenesis and erectile dysfunction in this disease.

[Clinical efficacy of the drug enerion in the treatment of patients with psychogenic (functional) erectile dysfunction].

Twenty patients with psychogenic erectile dysfunction received the drug enerion (Hungary). After a 30-day course of enerion erectile function improved in 16 of the above patients. A mean value of the international index of erectile function (IIEF) increased in them from 17.5 to 24.8 points. Improvement of cavernous arterial blood flow after the treatment was seen in 3 of 6 patients with arterial disorders. As shown by electromyographic examinations, cavernous electric activity normalized in 8 patients. Thus, psychogenic erectile dysfunction can be effectively treated with enerion.

[A new approach to raising the efficiency of drug therapy for erectile dysfunction]. / Novyi podkhod k povysheniiu éffektivnosti farmakoterapii érektil'noi disfunktsii.

AIM: To try combined treatment of erectile dysfunction with viagra and alprostadil in case of failure of their monotherapy; to compare effectiveness of viagra in dynamics of treatment, in various doses and dose adjustment. MATERIAL AND METHODS: 82 patients with ED of different genesis received a course of intracavernous injections of alprostadil followed by a course of viagra; 25 patients received combined treatment with alprostadil and viagra. Each course lasted for 3 months. Viagra efficiency was also assessed in long-term use (12 months) and different initial doses (50 or 100 mg). RESULTS: Monotherapy with alprostadil or viagra was effective in 73.2 and 75.6% patients, respectively. Their combination was more beneficial--88.0%. When used for a long time, viagra lost efficiency in psychogenic ED by 17.7%, in organic ED--by 16.9%. In an initial viagra dose 50 mg efficiency reached 70.3%, 100 mg--80.0%. CONCLUSION: Combined treatment of ED is a method of choice in monotherapy failure and in severe ED. Lowering of viagra efficiency in long-term administration may be explained by disappearance of placebo effect.

[Sildenafil and alprostadil in the combined drug therapy of erectile dysfunction]. / Sildenafil i al'prostadil v kombinirovannoi farmakoterapii érektil'noi disfunktsii.

Forty-four patients with erectile dysfunction (ED) aged 21-72 years aged 21-72 years (mean age 61 years) were examined and treated with sildenafil and alprostadil monotherapy or combined therapy. ED was psychogenic in 9(20.5%), arterial in 12(27.2%), vein occlusive in 9(20.5%) and neurogenic in 14(31.8%) patients. Monotherapy was most effective in psychogenic ED (alprostadil--100%, sildenafil--88.9%), least effective in vein occlusive ED (alprostadil--33.3%, sildenafil--22.2%). Alprostadil was more effective in arterial and neurogenic ED (83.3 vs 66.7 and 78.6 vs 57.1%, respectively). Combination of the two drugs produced much high response: 100, 85.7 and 55.5% in arterial, neurogenic and vein occlusive ED, respectively. Thus, combined treatment with sildenafil and alprostadil is a method of choice in the treatment of ED in failure of monotherapy with these drugs or in vein occlusive ED. In the combined treatment dose of the drugs, number of side effects and cost of therapy are lower.

[MRI of penis and pelvic floor in examination of erectile dysfunction pathogenesis in patients after perineal blunt injury and choice of treatment policy]. / IaMR-tomografiia polovogo chlena i tazovogo dna v patogeneze i vybore taktiki lecheniia érektil'noi disfunktsii u bol'nykh posle tupoi travmy promezhnosti.

Since 1995 we have treated 18 patients (age 17-52 years) after blunt perineal injury. 14 of them suffered from erectile dysfunction (ED). All the patients underwent examination which consisted of the standard tests and modern techniques: pharmacological dopplerography, electromyography of the penis with pharmacological loading, NMR-tomography of the perineum and the penis. NMR-tomography helped in identification of anatomic structures of the penis and pelvic fundus, pathological tissue processes (hematomas, damaged tissues, fibrous scars) after blunt injury of the perineum responsible for ED. The latter resulted from arterial (100%), venous (33.3%) and neurogenic (11.1%) lesions. Basing on the formulated pathogenetic conception it was possible to design diagnostic algorithm and policy of combined treatment of patients with ED following perineal blunt injury allowing for the time of the trauma and characteristics of the injury.

[Dose correcting factors in the treatment of erectile dysfunction with viagra]. / Faktory, vliiaiushchie na dozy preparata Viagry pri lechenii érektil'noi disfunktsii.

28 patients with erectile dysfunction of different origin received viagra (25, 50 or 100 mg depending on the effect and tolerance). The examination on the treatment week 4, 8 and 12 stated a 85% response. It was found that patients with body mass more than 90 kg benefited most in the dose 100 mg. Maximal single dose 100 mg is recommended for patients over 65 years of age. A 100% response was observed in patients with psychogenic and arteriogenic erectile dysfunction. Low effectiveness of viagra in patients with neurogenic erectile dysfunction can be explained by damaged parasympathetic nerve fibers. Thus, in the decision on viagra dose it is advisable to consider the patient's body mass, age and etiology of erectile dysfunction.

[Electromyography of the penis in the diagnosis of erectile dysfunction after radical operations on the organs of the lesser pelvis]. / Elektromiografiia polovogo chlena v diagnostike érektil'noi disfunktsii posle radikal'nykh operatsii na organakh malogo taza.

The paper presents the technique and results of electromyography of the penis (EMP) for 68 males divided into 3 groups: 21 volunteers with erectile disorders, 20 patients with nonvasculogenic erectile dysfunction and no history of pelvic operations, 27 patients with erectile abnormalities as a result of pelvic operations (after cystectomy -11, cystoprostatectomy -1, rectal resection -7, rectal extirpation -8 patients, groups 1, 2, 3 and 4, respectively). Autonomic innervation of the penis is primarily characterized by such EMP parameters as amplitude, synchronism and frequency of potentials. Neurogenic penile disorder was identified in 3 patients of group 2 (1 patient with intervertebral disk hernia, 2 patients with lumbosacral osteochondrosis), in all patients of group 3 (electric silence was recorded in 22 patients). EMP should be included in the algorithm of examination of patients with erectile dysfunction as providing a reliable assessment of autonomic penile innervation.

[The variants and potentials of reconstructive surgery of the penile skin]. / Varianty i vozmozhnosti rekonstruktivnoi khirurgii kozhi polovogo chlena.

The authors have operated 24 patients to repair total and subtotal defects of penile integuments due to oleogranuloma. They have performed a total of 13 transplantations of axial island cellolocutaneous inguinal flaps basing on the external pudendal, superficial epigastric or superficial circumflex iliac arteries; 3 transplantations of free axial inguinal grafts; 2 transplantations of free axial grafts from the forearm on the radial artery. Microvascular anastomoses with the recipient zone vessels were formed. 8 two-stage Reich operations were conducted. Postoperative dynamic monitoring (skin thermometry, oxygen polarography, Doppler ultrasound scanning of the vessels) of the graft has found more favourable vascular reactions in the axial flaps vs. scrotal ones. Effective contralateral grafting was performed in a patient with the transplant necrosis on the superficial epigastric artery.

[The therapeutic and diagnostic potentials of the intra-corpora cavernosa use of alprostadil, Edex, in patients with erectile dysfunction]. / Lechebno-diagnosticheskie vozmozhnosti intrakavernoznogo primeneniia al'prostadila "Edeks" u bol'nykh s érektil'noi disfunktsiei.

The paper presents the results of diagnostic and therapeutic use of intracavernous injections of alprostadil edex (prostaglandin E1) of Schwartz Pharma AG production (Germany) in 14 patients with functional, compensated and subcompensated organic erectile dysfunction. Pharmacological test with alprostadil modelling cavernous body function extends diagnostic efficacy of doppler scanning of the penis and cavernosography. A complete effect (100% sexual rehabilitation) was achieved in 1 and partial in 3 males. Alprostadil edex kits are advocated as safe and convenient.

[The effect of extracorporeal piezoelectric lithotripsy on cardiac activity]. / Vliianie distantsionnoi élektrop'ezolitotripsii na serdechnuiu deiatel'nost'.

To evaluate cardiac effects of shock waves, 40 patients with uroliths (10 subjects with and 30 without arrhythmia) were examined during their exposure to remote electropiezolithotripsy (Piezolith-2300 unit). Arterial pressure and ECG were registered before, during (upon 1500 and 3000 impulses) and after the session. Except a slight deceleration of the heart rate, no cardiac disorders significant clinically were reported.

[Polymer-drug complexes in the treatment of extensive ovarian cancer]. / Polimer-lekarstvennye kompleksy v lechenii rasprostranennogo raka iaichnikov.

The paper presents the results of intracavitary chemotherapy with deposited cytostatics of advanced ovarian cancer as well experimental, morphological, biochemical and pharmacological data. Intraabdominal introduction of microspheres filled with cyclophosphamide, 5-fluorouracil, doxorubicin can be a variant of drug therapy in multimodality treatment of ovarian cancer. Combination of intracavitary chemotherapy with a systemic one has the advantage of local and regional effect which is not inhibited by mediated action of the deposited cytostatics via the systemic blood flow. The method is indicated in residual tumor dissemination after cytoreductive surgery and ovarian cancer with ascites.

[Primary dermatoplasty in open injuries of the hand and fingers in ambulatory conditions]. / Pervichnaia kozhnaia plastika pri otkrytykh povrezhdeniiakh kisti i pal'tsev v ambulatornykh usloviiakh.

An experience with the treatment of 158 patients with open lesions of hands and fingers under conditions of traumatological unit is described. The authors recommend such operations of skin plasty as plasty by means of translocation of local tissues including insular triangle flaps on a vascular pedicle, free skin plasty, plasty on a temporary feeding pedicle from neighbour finger or hand, plasty after Krasovitov, replantation of not completely torn terminal finger phalanges. Skin plasty operations resulted in shorter terms of treatment and better functional and cosmetic results.