[Computed tomography in determining the differentiation of ductal adenocarcinoma of pancreatic head]. / Vozmozhnosti komp'yuternoi tomografii v opredelenii stepeni differentsirovki protokovoi adenokartsinomy golovki podzheludochnoi zhelezy.

OBJECTIVE: To evaluate the features of «hypervascular rim¼, tumor dimensions and density as prognostic factors of differentiation of pancreatic head adenocarcinoma. MATERIAL AND METHODS: Pancreatoduodenectomy was performed in 311 patients with pancreatic head adenocarcinoma for the period 2013-2019. A retrospective study included 81 patients who met the following criteria: available data of morphological and immunohistological examination indicating tumor grade from Grade 1 to Grade 3, as well as available preoperative CT images in four phases (native, arterial, portal and delayed). Tumor dimensions, density of the pancreas, adenocarcinoma and abdominal aorta by the phases of contrast enhancement were analyzed in all patients. Moreover, we estimated coefficient of relative enhancement change. Perifocal hypervascular enhancement was assessed in arterial and portal phases. Contrast-enhanced MRI was performed in 15 out of 81 patients. MR images were analyzed regarding a hypervascular rim, and the last one was compared with CT images. RESULTS: There was no significant difference in density values between different tumor grades. Coefficient of relative enhancement change >1 was observed in 63.64% of highly-differentiated tumors. REC ≤1 was found in 85.11% of tumors grade 2 and 82.6% of tumors grade 3 (p=0.005). According to Chi-square test, there was a correlation between tumor differentiation and hypervascular rim (p=0.03). Moderate and low differentiation was observed in 96.42% of tumors with perifocal enhancement. Hypervascular rim was absent in 81.82% of tumors grade 1. Adenocarcinoma grade 2 was found in 85.71% of cases with unclear perifocal enhancement. CONCLUSION: Preoperative contrast-enhanced CT is valuable to assume the tumor grade in patients with pancreatic head adenocarcinoma due to assessment of hypervascular rim and REC.

[Central hemodynamics during conduction anesthesia in patients with pyonecrotic forms of the diabetic foot].

Conduction anesthesia-induced central hemodynamic changes were studied in 20 patients with pyonecrotic forms of the diabetic foot and coronary heart disease (CHD). There was a 19% reduction in cardiac output and a 25% increase in total peripheral vascular resistance, as compared with the baseline values, the level of blood pressure being unchanged. The authors proposed to include droperidole into premedication and intraoperative perlinganite infusion for postload reduction, which stabilized central hemodynamics during conduction anesthesia in patients with diabetes mellitus and CHD.

[Regional anesthesia and timely treatment for neuropathy in patients with pyonecrotic forms of the diabetic foot].

Regional anesthesia was studied for its impact on the functional status of a peripheral nerve in 20 patients with purulent diseases of the lower extremities in the presence of diabetes mellitus. The impact of conservative therapy on the peripheral nerve was also studied in these patients. There was no negative impact of regional methods of anesthesia on the function of the nerve, its improvement due to treatment with alpha-lipoic acid and serotonin adipinate.

[Evaluation of the clinical status of patients with surgical infection]. / Otsenka tiazhesti sostoianiia bol'nykh s khirurgicheskoi infektsiei.

The possibility of objectively evaluating the severity of the clinical status of patients with surgical infection is discussed. A retrospective and prospective analysis of clinical laboratory values is carried out in 196 patients with surgical sepsis. SAPS score indicated a statistically significant difference in the state of two groups of patients (survivors and dead). Analysis of clinical laboratory data offers additional criteria, specific of surgical infection, which improved the accuracy of scoring evaluation.

[Current methods of morphological and hemostasiological analysis of reparative process in wounds making use of information programs]. / Sovremennye metody morfologicheskogo i gemostaziologicheskogo analiza reparativnogo protsessa v rane s ispol'zovaniem informatsionno-programmnogo obespecheniia.

Objective rapid morphological and hemostasiological methods for evaluating the reparative process in the wound making use of PC software have been developed for identification of stages of reparative process in the wound under conditions of modern surgical service. Cytran consultative software has been developed for evaluation of phases of reparative reaction in the wound. Coagulogram consultative software was used for identification of reparative reaction phases in the wound from hemostasiological changes in tissue factors of granulation tissue in the wound. Cytran and Coagulogram software were used under clinical conditions in 105 patients with open, suppurative, and burn wounds for characterization of the reparative reaction phases.

[Health care standards for surgical patients in clinical hospital]. / O standartakh meditsinskoi pomoshchi khirurgicheskim bol'nym v klinicheskom statsionare.

In Russian Federation the Obligatory Health Insurance Standards are based on the a priori expert assessments but not on statistical analysis of really recorded cases. This leads to the essential standard incompleteness, indistinctness and heterogeneity. In Vishnevsky Institute of surgery the "Automatized system for care registration in hospital" was designed, and data base on more than 10,000 patients treated in 1995 to 1999 was created giving now the starting-point for further efforts for overcoming the above standards insufficiency.

[Clinical and laboratory study of cefodizime (Modivid) in prophylaxis and treatment of surgical patients]. / Kliniko-laboratornaia otsenka tsefodizima (modivida) pri profilakticheskom i lechebnom primenenii v khirurgii.

The results of the clinical and laboratory study of the efficacy of the prophylactic and therapeutic use of cefodizime (modivid) in patients with chronic calculous cholecystitis and burns are presented. Expediency of the preoperative prophylactic use of the drug and its significance in the treatment of infectious complications of the burn disease were verified. The immunological investigation gave evidence of an increase of the phagocytosis functional activity when cefodizime (modivid) was used prophylactically in cholecystectomy.

[Late results of lymphovenous anastomoses in lymphedema of the lower extremities]. / Otdalennye rezul'taty operatsii limfovenoznykh anastomozov pri limfedeme nizhnikh konechnostei.

The authors examined 152 patients with lymphedema of the lower limbs 2-6 years after operation for lymphovenous anastomoses (LVA). They evaluated the dynamics of edema according to Alberton's formula, the changes in the character of the episodes of erysipelas, and the patient's feeling of heaviness in the involved limb. The function of the anastomosis was studied by the radioisotope method. Positive results were recorded in 99 patients. In the remaining patients the LVA did not function and the symptoms of lymphedema did not change or progressed. The effect of LVA was found to be positive in 51 patients in the group of 69 patients with secondary form of lymphedema and in 48 of 83 patients with the primary form of the disease. The last-mentioned was connected with congenital insufficiency of lymph drainage. The condition of the collecting lymphatics is an important factor of LVA efficacy: the effect of LVA was positive in 68 patients in hyperplasia and in 31 patients in hypoplasia of the lymphatics. The results of LVA are improved by regular nonoperative management for the correction of endocrine-immunological and hemostatic factors as well as by stimulation of lymph drainage in the limb and prevention of inflammatory complications.

[Myocardial asynergy of the left ventricle in patients with aortic stenosis]. / Asinergii miokarda levogo zheludochka u bo'lnykh s stenozom us'tia aorty.

Left ventriculograms obtained from 21 patients without any intracardiac hemodynamic abnormalities were analyzed by using the correlation method. The analysis revealed three functional areas of the left ventricle and defined normal values of their systolic and diastolic pulses. Hypo- and hyperkinesia of the functional areas in the left ventricle were quantitatively determined. Left ventricular cinematics was studied in 105 patients with aortic stenosis. Most patients of them were demonstrated regional cinematic abnormalities of various genesis. Local or total hypokinesia was detected in 62 per cent; hyperkinesia of its upper areas was found in a third; 7 per cent had normal dynamics of contraction in all the functional areas. It should be taken into account heterogeneous responses of the left ventricle to systolic overload while performing all investigations and studies or making clinical and prognostic assessments.

[Place of multivariate statistics in clinical physiological research]. / O meste mnogomernoi statistiki v kliniko-fiziologicheskikh issledovaniiakh.

On the basis of their own experience of many years in the use of mathematical methods in medicine the authors provide a critical analysis of the results of using computers in making the diagnosis and the main reasons for dissatisfaction with the results. Regarding clinico-physiological studies as a field for the application of modern mathematical statistics, they suggest a logical scheme which they had tested time and again for statistical analysis of the data by multidimensional methods (particularly with the use of the method of principal components, cluster analysis, latent analysis, lambda-moments, etc.) and also some methodological devices which permit keeping the data at hand throughout the entire analysis, resorting time and again to all possibilities for their complete and exhaustive description. The position of the authors in principle consists in the fact that success can only be achieved by constant joint work of the medical specialist and mathematician, beginning with the first stage of formulating both the medical and statistical tasks on condition that the clinico-physiological essence of the problem is comprehended by the mathematician.

[Diagnosis of thrombosis of the left atrium in rheumatic heart defects, using the main components methods]. / Kiagnostika tromboza levogo predserdiia u bol'nykh revmaticheskimi porokami serdtsa s pomoshch'iu metoda glavnykh komponent

A new method of diagnosis of left atrial thrombosis was developed for rheumatic heart disease patients. The mathematic method of the main components was used that permits to detect the thrombosis of the left atrium in 94.3% of the cases. Fourteen most frequently encountered symptoms of this complication were singled out, the probability of the occurrence of these symptoms was calculated for the patients with rheumatic heart diseases and atrial fibrillation with and without thrombosis. A computer was employed to develop the method, while no computer is needed for the diagnosis itself. Symptoms from the list must be identified in the given patient, the digital values of the main components found in the table be summed up with that of the free member, with due regard of the sign, and the presence of the thrombus be determined on the basis of the presented chart.

[The character of the background spike activity of cortical neurons under the influence of psychotropic drugs]. / Kharakter fonovoi impul'satsii korkovykh neironov pri vozdeistvii psikhotropnykh veshchestv

A comparison was made on alert rabbits between the nature of spike activity of normal cortical neurones and of those after a two-week daily administration of neuroleptics, namely chlorpromazine, trifluoperazine and haloperidol in 1 and 5 mg/kg doses. The groups of neurones did not differ in the mean frequency of firing. However, the use of the main components method and of cluster analysis showed considerable differences between neuronal activity following the action of neuroleptics and that in control animals. The most common effect of neuroleptics consisted in a reduction of the number of low frequency neurones with burst discharges and small dispersion of distribution of interspike intervals. Trifluoperazine and especially haloperidol differed from chlorpromazine in that they brought about an appearance of cortical neurones for which the distribution of interspike intervals had an almost symmetrical form and a mode of 80--170 msec. After the action of haloperidol about a third of the neurones had a mode up to 10 msec. An assumption has been made that the major effect of trifluoperazine and haloperidol consists in an increase in the reverberative activity of the brain.

[Classification of cortical neurons according to the character of their background impulse activity]. / Klassifikatsiia korkovykh neironov po kharakteru ikh fonovoi impul'snoi aktivnosti

The method of basic components and cluster analysis was used to classify 75 units in the visual cortex of alert rabbits, proceeding from the empiric form of distribution of interspike intervals (DII), the mean frequency of impulsation and the relative number of intervals up to 500 msec. They were classified into nine groups containing from two to twelve units. Besides the cues, used as a basis for classification, the groups of units also differed in the structure of burst activity, the correlation of adjacent intervals and the ratio between the short (up to 20 to 60 msec) and long intervals. The latter served to make suggestions on the genetic affinity of bimodal DII to those with a bend on the waning after the maximum, and on the nature of formation of high frequency bursts and intervals exceeding 20 to 60 msec.