[Combined operations for prophylaxis of gastroesophageal bleedings at the patients with portal hypertension].

Results of portocaval bypass (1st group), suture ligation of gastric and esophageal varicose veins (2nd group), and combined operations (3rd group) performed in early postoperative period at 759 patients with liver cirrhosis and extrahepatic portal hypertension are analyzed. Long-term results were studied at 549 patients. Early recurrence of bleeding was occurred at 41 (12.9%) patients of 1st group, at 17 (8.5%) of 2nd, and at 2 (4%) patients of 3rd group. Lethality due to bleeding recurrence at 1st group was 5.1% among the patients with liver cirrhosis and 1.9% among ones with extrahepatic portal hypertension. Recurrence of bleeding at 2nd group was seen at 52.8% patients with liver cirrhosis, and at 36.4% - with extrahepatic portal hypertension. Lethality due to bleeding recurrence in this group was 7%. The best results were achieved in 3rd group: the recurrence of bleeding was diagnosed at 2 (7.7%) cases, there was 1 lethal outcome. It is concluded that combined surgical procedures at the patients with portal hypertension permit to reduce the rate of early recurrences of bleeding in 2.5 times. It allow to perform widely the partial portocaval anastomoses at the patients with liver cirrhosis and the bypass procedures at extrahepatic portal hypertension.

[New Mn-chelates are radioprotectors and antioxidants for cells in vitro]. / Novye khelaty margantsa -- radioprotektory i antioksidanty dlia kletok in vitro.

Earlier we have synthesized new Mn-chelates (Mn-compexes of ethyl ethers of salicyliden-D, L-tyrosine, -gamma-amino butyric acid and -D, L-tryptophan) bearing several free functional groups. The radioprotective and antioxidant activity of these compounds were tested on the secondary cultures of chick embryo cells. To this end the cells in vitro were gamma-irradiated with 60Co at the doses 40 and 60 Gy or treated with H2O2 at the concentration 3 mmol/l, the new Mn-chelates were added into the cultures, and the number of survived cells was determined in 24 hours. It was revealed that all the new Mn-chelates at micromolar concentrations (from 40 to 10 mumol/l) but not their precursors (Mn-acetate and ethyl ethers of salicyliden-aminoacids) effectively protect the cells from lethal effect of both gamma-irradiation and H2O2. Mn-chelates tested are considered as promising potential radioprotectors that effect seems to be reasonable to study in vivo.

Epiretinal membrane removal in diabetic eyes: comparison of viscodissection with conventional methods of membrane peeling.

AIMS: To compare conventional methods of epiretinal membrane peeling with viscodissection. METHODS: 154 eyes with proliferative diabetic retinopathy (PDR) that underwent pars plana vitrectomy with membrane dissection (89 traditional, 65 viscodissection) were studied retrospectively. Incidence of retinal breaks (RBs), length of time under anaesthesia, postoperative intraocular pressure, retinal reattachment rate, and final visual acuity (VA) were measured. RESULTS: To compare cases of similar complexity, a "complexity score" was defined. The average complexity score for cases done with and without viscodissection was 4.7 and 3.2, respectively. The mean frequency of RBs in eyes undergoing viscodissection was 0.43 (SD 0.5) v 0.14 (0.35) RBs/eye without viscodissection. In complex cases, the frequency of posterior/peripheral RBs was 0.31 (0.47)/0.13 (0.34) RBs/eye, respectively, with viscodissection v 0.12 (0.33)/0.23 (0.43) RBs/eye without viscodissection. None of these differences were statistically significant. The average preoperative/postoperative VA (logMAR) in the viscodissection cohort was 1.7/1.3 (range 0.3 to >1.9/0.1 to >1.9) v 1.4/1 (range 0.48 to >1.9/0.1 to >1.9) in the non-viscodissection cohort, among eyes with 6 months of follow up. Anaesthesia duration was significantly shorter for cases done without viscodissection (p=0.03), but cases done with viscodissection were significantly more complex than cases done without viscodissection (p<0.0001). CONCLUSION: Viscodissection appears to be a safe and effective alternative technique in eyes with PDR. Owing to the retrospective nature of the study, additional studies are warranted.

Vitrectomy with silicone oil infusion in severe diabetic retinopathy.

AIMS: To determine the results of pars plana vitrectomy (PPV) and silicone oil infusion (SOI) in severe proliferative diabetic retinopathy (PDR). METHODS: The records of 23 eyes (21 patients: 12 males, nine females) with PDR who had undergone PPV and SOI were reviewed retrospectively. RESULTS: Average follow up was 5.4 months (range 1-25). Surgical indications were tractional retinal detachment (TRD) (17.4%), traction-rhegmatogenous retinal detachment (TRRD) (8.7%), TRD with vitreous haemorrhage (VH) (48%), TRD with neovascular glaucoma (NVG) (8.6%), TRD with fibrinoid syndrome (FS) (17.3%). With one operation, the retinal reattachment rate was 17/23 (74%). Among these 23 eyes, 11 (48%) had previously failed vitrectomy, and the retina was attached in 8/11 (73%) with a single procedure. With additional surgery employing PPV and SOI, the final reattachment rate was 20/23 (87%). The only cases with intraocular pressure <5 mm Hg had retinal detachment. Postoperative visual acuity (VA) improved in 10 eyes (44%), was unchanged in three (12%), and decreased in 10 eyes (44%). CONCLUSION: SO tamponade is useful in severely diseased eyes with PDR, even in the presence of rubeosis iridis (RI) and NVG, FS, or in cases with previously failed vitrectomy, especially in the presence of RI.

Use of viscodissection and silicone oil in vitrectomy for severe diabetic retinopathy.

Improvement in surgical techniques has led to improved anatomic and functional success rates following surgery for severe complications of proliferative diabetic retinopathy (PDR). We compared the anatomic and functional outcomes of surgery in a non-randomized, consecutive case series of patients with severe PDR. We found that viscodissection using Healon provides outcomes comparable to conventional pick and scissors dissection. We also found that adjunctive use of silicone oil can salvage selected cases with particularly severe manifestations of PDR (e.g., the fibrinoid syndrome). With proper selection of patients and techniques, the anatomic success rate can exceed 80% even in the most severe cases. The goal of this paper is to show the applicability of using viscodissection and silicone oil infusion during vitrectomy in eyes with severe PDR.

Neuro-ophthalmic manifestations of sarcoidosis: clinical spectrum, evaluation, and management.

OBJECTIVE: To familiarize the reader with the neuro-ophthalmic manifestations of sarcoidosis. MATERIALS AND METHODS: All patients underwent systemic evaluations (chest radiograph, magnetic resonance imaging and/or computed tomography, serum angiotensin-converting enzyme level, and gallium scan). Histologic confirmation was preferred (11 of 15 patients underwent biopsy, ten of whom [82%] had positive biopsies, and four refused). Otherwise, the diagnosis of clinical sarcoidosis was based on laboratory evaluation. RESULTS: We report our experience with 15 patients who had neuro-ophthalmic manifestations of sarcoidosis other than optic neuropathy or chiasmal disease. Eight of 15 (53%) did not have known sarcoidosis at the time of presentation. Thirteen of 15 (87%) patients demonstrated lesions consistent with sarcoidosis on magnetic resonance imaging of the brain. Treatment with corticosteroids and/or other immunomodulatory agents was necessary in all cases. CONCLUSIONS: Neuro-ophthalmic manifestations of sarcoidosis are rare. They may be the presenting signs of otherwise occult disease. Suspicion and inclusion in the differential are a key to establishing the diagnosis. A strategy for the detection and evaluation of these cases is presented.

Evolution of sarcoid granulomas of the retina.

PURPOSE: To report a case of a young woman with a history of sarcoidosis who developed retinal granulomas. METHODS: Case report. RESULTS: A 33-year old woman with history of sarcoidosis with involvement of the central nervous system, confirmed by skin biopsy, bronchoscopy, and neuroimaging, presented with visual loss and was found to have choroidal and optic nerve granulomas in the left eye, and subsequently developed retinal granulomas in the left eye. CONCLUSION: Retinal granuloma is a rare manifestation of sarcoidosis.

[Laparoscopic cholecystectomy in choledocholithiasis and stricture of the terminal part of the common bile duct]. / Laparoskopicheskaia kholetsistéktomiia pri kholedokholitiaze i strikture terminal'nogo otdela obshchego zhelchnogo protoka.

The authors offer the treatment and diagnostic algorithm in choledocholithiasis, stricture of a terminal portion of the common hepatic duct and papilla stenosis revealed in laparoscopic cholecystectomy (LCE). With the purpose of intraoperative assessment of bile ducts states during LCE, the diagnostic system including laparoscopic and ultrasonic examinations, cholangiography and choledochoscopy was developed and applied. In intraoperative revealing of choledocholithiasis without bile outflow disorders and wide cystic duct the authors prefer to remove the concrements during choledochoscopy through cystic duct without intervention on Vater's papilla (VP). In combination of choledocholithiasis with bile outflow disorders and also in isolated papilla stenosis and stricture of a terminal portion of the common hepatic duct, one-stage laparoscopic cholecystectomy, intraoperative antegrade papillosphincterotomy and retrograde calculus extraction is optimal. In cases when complete endoscopic calculus extraction is impossible, the drainage of the common hepatic duct by Cholsted's with subsequent delayed endoscopic papillosphincterotomy (EPST) is acceptable. During intraoperative examination in 49 patients (57.6%) the concrements in choledochus, not diagnosed earlier, were revealed, in 21--stricture of terminal choledochus portion and in 19 patients--papilla stenosis. In 12 cases the concrements were removed during choledochoscopy through the cystic duct stump, 4 patients with big concrements required laparoscopic choledocholithotomy. In 16 cases LCE with various variants of choledochus drainage was performed as the first stage, as the second stage--EPST and lithoextraction. Antegrade papillosphincterotomy was performed in 15 patients during LCE. In 12 cases intraoperatively revealed choledocholithiasis combined with papilla stenosis (7) and choledochus stricture (5) was the indications to intraoperative papillosphincterotomy. Papilla stenosis was the indication to antegrade papillosphincterotomy in 3 patients.

[The mechanisms of the neuroprotective action of carbonate mineral baths in ischemic brain lesions]. / Mekhanizmy neiroprotektornogo deistviia uglekislykh mineral'nykh vann pri ishemicheskikh porazheniiakh golovnogo mozga.

Effects of Arzni effervescent mineral baths (EMB) on brain tissue metabolism were studied on white rats (normal controls and those with transitory cerebral ischemia). It was found that EMB prevent ischemia-related disorders of phospholipid and adeninnucleotide pools, promote an increase in vasoactive prostaglandins in brain tissue, shifts in catecholamines concentrations in the hemispheres and hypothalamus, inhibit the activity of monoaminoxidase and absorption of 3H-noradrenaline by brains sections. Mechanisms of neuroprotective action of Arzni EMB in cerebral ischemia are considered.

Cell-cell contacts accelerate cell colony growth in sparse cultures of chick embryo fibroblasts.

There is no cell proliferation in very sparcely plated chick embryo cell cultures. Substituting conditioned medium or adding of ethanol-fixed homologous cells to the cultures accelerates cell colony growth. The mechanism for the mitogenic action of fixed cells is considered to be the contact stimulation of cell proliferation, and addition of extra cells to sparse culture is believed to mimic the cell micro-environment existing in subconfluent cultures. The role of diverse cell-cell contacts in cultured cell growth regulation is discussed. The procedure used (addition of ethanol-fixed cells) may improve normal cell cloning techniques.

[Long-term potentiation of the neuronal activity in the motor cortex induced by simultaneous stimulation of the thalamus and somatosensory cortex in cats]. / Dlitel'noe povysheniie neironal'noi aktivnosti motornoi kory, vyzvannoe sovmestnym razdrazheniem talamusa i somatosensornoi kory mozga u koshek.

Long-lasting potentiation of the cat motor cortex units induced by tetanic stimulation of the VL + SCx led to an increase of the motor cortex unit discharge rate. The findings suggest that co-activation of cortico-cortical and thalamo-cortical afferents modifies neuronal activity of the motor cortex at the specific site which receives convergent sensory input from the thalamus and the somatosensory cortex.

[Intercellular contacts accelerate the growth of cell colonies in a chick embryo cell culture]. / Mezhkletochnye kontakty uskoriaiut rost kletochnykh kolonii v kul'ture kletok kurinogo émbriona.

In sparsely seeded (1.10(3) cells/sm2) chick embryo cell cultures no cell proliferation commonly occurs. However, such factors as increasing cell density, a conditioned medium, or addition of ethanol fixed homologous cells to the culture may accelerate the cell growth. The mitogenic action of fixed cells serves as a contact stimulation of cell proliferation (Gasparian, Grigorian, 1989, 1990). Distant and contact cell-to cell interactions, that involve soluble and insoluble cell derived mitogens, are supposed to operate during the log phase of culture growth. The addition of an excess of cells to the previously sparse culture may mimic the cell microenvironment commonly existing in subconfluent cultures. The role of diverse cell-to cell contacts in the cell growth regulation is discussed. The addition of ethanol-fixed cells may improve the cell cloning technique.

Motor reactions and vestibular reflexes in cats and monkey in weightlessness.

Close morpho-functional relationships of the cerebellum and vestibular system at all stages of phylogenesis of vertebrates suggest that cerebellum can be regarded as an important center of gravireceptive function. Direct examination of electrical activity of the labyrinth in cats during transient (1-2 sec) state of weightlessness produced by free fall has shown that there was an almost two fold increase in both the rate and amplitude of electrical activity in the vestibular ganglion. It is commonly accepted at present time that the conditions of orbital flight around Earth closely connect with weightlessness that usually manifests itself as undesirable factor of flight. It is known, that vestibular, proprioceptive, visual and other sensory modalities are converted on the cerebellum, which would indicate that this information is used for motor coordination and spatial orientation. Undoubtedly, origin of many vestibulo-motor disturbances during flight and in postflight period to a considerable degree depends on weightlessness. On the whole the visual illusions, motor discoordination, and space sickness, including vomiting are referred to the "space adaptation syndrome." But nature of these disturbances still is not well understood. This investigation was dedicated to study of vestibular and motor reactions of cats and monkey in short-term microgravity.

[Resection of posterior tibial veins with ligation of arteriovenous anastomosis in acute ischemia of the lower extremities]. / Rezektsiia zadnikh bolshebertsovykh ven s pereviazkoi arteriovenoznykh anastomozov pri kriticheskoi ishemii nizhnikh konechnostei.

The paper deals with the pathophysiological validation and assessment of the efficiency of a new low-traumatic operation aimed at decreasing the degree of injured extremity ischemia in patients with atherosclerosis obliterans and decompensation of peripheral circulation. The essence of the operation is to remove arteriovenous shunting into the shin. Eighteen patients were operated on, out of them only 5 underwent a subsequent amputation. It is concluded that this intervention is promising and indications for it are defined in this paper.

[A possible pathway for mitogenic signal transmission during the contact stimulation of the multiplication of cultured cells]. / Vozmozhnyi put' peredachi mitogennogo signala v protsesse kontaktnoi stimuliatsii razmnozheniia kul'tiviruemykh kletok.

Cultured cells of the Japanese quail embryo were labeled with 3H-glucosamine, fixed, suspended and inoculated into built-up cultures of the homologous cells. The transfer of insoluble components of labeled cell surface into the cells of underlaying cell sheet was revealed. A decrease in the cell incubation temperature up to 4 degrees C blocks the process. The exchange of cell surface sites between contacting cells seems to be one of the possible ways of information transmission from one cell into another during contact regulation of cell proliferation.