Measurements of neutron fluxes from tokamak plasmas using a compact neutron spectrometer.

A compact neutron spectrometer based on the BC-501A liquid organic scintillator was applied to neutron measurements at the TUMAN-3M tokamak. The spectrometer was calibrated using measurements from the ion beam of the cyclotron accelerator. Neutron spectra were measured during discharges using a neutral deuterium beam injection into the TUMAN-3M D-plasma. An energy distribution of the neutrons from the plasma that hit the spectrometer was obtained from the measured BC-501A instrumental spectra by the DeGaSum code using detector response functions obtained in the course of the calibration. This allowed for the estimation of the 2.45 MeV neutron yield and the evaluation of both the time evolution of the DD fusion rate and the characteristic time of the injected deuterium slowing down in discharges with neutral beam injection heating.

[On teaching surgery at the graduation course of a medical college according to a new curriculum]. / O prepodavanii khirurgii v meditsinskom vuze na vypusknom kurse po novomu uchebnomu planu.

Teaching surgery to students of the medical college represents a complex dynamic process based on the achievements and advantages of domestic medical education. The article presents an analysis of historical aspects of teaching surgery formed under the influence of N.I.Pirogov's ideas and shows the necessity of searching for new forms of organization of teaching surgery at the up-to-date stage of reorganization of higher professional school. Special attention is given to a compulsory preservation of traditional principles of the system of teaching surgery verified by almost two centuries of experience of using it.

[The influence of hereditary thrombophilic mechanisms on the degree of permanent intravascular coagulation in patients with artificial heart valves]. / Vliianie nasledstvennykh trombofilicheskikh mekhanizmov na stepen' postoiannogo vnutrisosudistogo svertyvaniia u bol'nykh s iskusstvennymi klapanami serdtsa.

The genotyping of 40 patients with artificial heart valves (AHV) was performed after prosthesis of the mitral and aotic valves with bicuspid AHV (Medinzh-2 and CarboMedics). The patients took phenylin and varfarin. The patients' genotype was estimated by the thrombophylic genes: factor V Leiden (FVL), prothrombin G20210A, methylene tetrahydrofolate reductase C677T, G/A--455FGB, 4G/5G PAI-1, PI A1/A2 GPIIIa. The genes determining the thrombocytic activity or the vascular wall state substantially influence the third degree of the intensity of the permanent intravascular coagulation (PIC-3) independent of the degree of correction of hemostasis of oral anticoagulants. The addition of anti-aggregants to therapy is the only that can normalize functional activity of thrombocytes in patients with AHV having such defects. The laboratory detection of the genetic defects is of great practical importance for the determination of risk groups of formation of PIC-3 and the strategy of antithrombotic protection of patients with AHV.

[Socioeconomic aspects of the increased volume of cardiosurgical treatment of children with congenital heart defects]. / Sotsial'no-ékonomicheskie aspekty uvelicheniia ob"ema kardiokhirurgicheskoi pomoshchi detiam s vrozhdennymi porokami serdtsa.

The authors made an analysis of social-economical conditions limiting the possibilities of rendering cardiosurgical care to children. Possible ways are mapped out allowing to increase the amount of operations on children with congenital heart diseases.

[Turbidimetric express method in the assessment of the hemostasis parameters in patients with prosthetic bileaflet heart valves]. / Turbidimetricheskii ékspress-metod v otsenke parametrov gemostaza u bol'nykh s iskusstvennymi dvustvorchatymi klapanami serdtsa.

Thirty patients of medium (47 +/- 3) years of age with prosthetic bileaflet heart valves without any specific complications of the I-II functional classes and with the postoperative period after mitral (11) and aortal (19) valve replacements during (2.52 +/- 0.48) years were studied. The defects of coagulation and fibrinolytic systems were found in 9 patients with high prothrombin index (93.21 +/- 9.8)% and low INR (0.9-1.7). The activation of fibrinolysis, low platelets, hypofibrinogenemia, D-dimer which are the risk factors of thrombogenic complications were found in these patients. The updated turbo-dynamic express-method which helps to activate fibrinolysis in short terms and to make its correction is proposed.

[Experience in the use and comparative assessment of the effectiveness of crystalloid and blood cardioplegia]. / Opyt primeneniia i sravnitel'naia otsenka éffektivnosti kristalloidnoi i krovianoi kardioplegii.

Due to an increasing attention to questions of adequate protection of the myocardium and widely spread use of the method of blood cardioplegia the authors have made a comparative analysis of effectiveness of using 2 methods of cardioplegia--pharmacocrystalloid and cool blood antegrade cardioplegia: 34 patients were operated upon under conditions of extracorporeal blood circulation for aortic and mitral valve replacement. A comparison was made of 17 patients with intermittent antegrade cool crystalloid cardioplegia (group 1) and 17 patients with intermittent antegrade cold blood cardioplegia (group II). The results have shown that intermittent antegrade cool blood cardioplegia is a safe and effective method for myocardial protection during cardiopulmonary bypass.

[Use of gelofusin in the clinics of the St. Petersburg's I.P. Pavlov State Medical University]. / Primenenie preparata "Gelofuzin" v klinikakh Sankt-Peterburgskogo gosudarstvennogo meditsinskogo universiteta im. akad. I.P. Pavlova.

The authors analyze the results of using blood substitute made on the basis of gelatin and give a comparative characteristic of different colloid blood substitutes on the basis of dextran, gelatin, starch and polyethylene glycol. Advantages of Gelafusin are shown.

[The role of the Cell Saver autologous transfusion method in preventing the pulmonary distress syndrome during open-heart operations on children]. / Rol' autotransfuzionnoi metodiki "Cell Saver" v profilaktike legochnogo distress-sindroma pri operatsiiakh na otkrytom serdtse u detei.

Complex estimation of the state of the lungs at the postperfusion and early postoperative periods based on roentgenological, clinical data, investigations of the parameters of oxygenation and mechanics of respiration was carried out in 32 children with septal defects of the heart, operated upon under conditions of artificial blood circulation with different kinds of the transfusion maintenance including the apparatus "Cell Saver 5" (CS) for the reinfusion of autoerythrocytes. The dynamics of endotoxicosis, hematological parameters during and after operation and requirements in transfusion media were studied. Differences in these indicators were established between the patients operated upon with the use of donor hemocomponents and those who were operated upon with CS. It allowed a conclusion about the role of the method of intraoperative reinfusion of erythrocytes in substantially less frequency and severity of the postperfusional pulmonary complications in this category of patients.

[Aortic valve prosthesis and the plication of a dissecting aneurysm of the ascending aorta in a patient with infectious endocarditis against a background of chronic kidney failure and its management by regular hemodialysis]. / Protezirovanie aortal'nogo klapana i plikatsiia rasslaivaiushchei anevrizmy voskhodiashchei aorty u bol'nogo infektsionnym éndokarditom na fone khronicheskoi pochechnoi nedostatochnosti i provedeniia reguliarnogo gemodializa.

Some literature data are presented on the problem of cardiac surgery in patients with chronic renal insufficiency under regular hemodialysis and on the specificity of performing operations on such patients under conditions of artificial circulation. The authors describe their first experience of a one-step prosthezing of the aortal valve and plication of the dissecting aneurysm of the ascending part of the aorta in the patient receiving the regular hemodialysis during 5 years as well as the positive results of this original operation in dynamics of the first year of observations.