[Surgical tactics at acute colonic bleedings].

The analysis of complex clinical examination of 134 patients with acute colonic bleeding treated at Medical Centre "St. Grigor Lusavorich" in Yerevan during last 12 years is presented. It was found that causes of acute colonic bleeding are very diverse. The main ones are: cancer, colorectal cancer (28,4%), diverticulosis of the colon (14,9%), hemorrhagic erosive and erosive-ulcerative lesions of the colon (13,5%), colon polyps (11,9%). Technique of emergency colonoscopy with intubation of the colon is proposed and an increase in 18,2% sensitivity and 17,5% accuracy was observed. In cases of conservative hemostasis without application of endoscopic methods and a surgical intervention positive results were obtained in 26,5% cases of acute colic bleedings. Application of modern methods of endoscopic haemostasis reduced the number of emergency operations in 1,7 times; the recurrence rate of bleeding in 2,6 times. The differentiated surgical treatment of patients with acute colonic bleeding increases the number of simultaneous radical surgery on the colon by 23,9%, reduces postoperative complications by 26,3%, lethality - by 11,6%.

[Pathogenesis of enteral insufficiency in patients with postoperative peritonitis].

Enteral insufficiency is considered to trigger the syndrome of endogenous intoxication and, further, multiple organ failure. Enteral insufficiency often accompanies postoperative septic complications, such as peritonitis. Morphologic changes of the intestinal wall by septic peritonitis consisted of edema, fibrinous degradation of muscular layer and dystrophy of local nervous pathways. Microbiologic analysis of intestinal and gastric contents, peritoneal fluid and blood samples demonstrated a broad spectrum of pathogenic flora. Besides, enterotoxin allocated from blood and intestinal contents coincided in all cases. Adequate algorithm of detoxication, including extracorporal methods, had been worked out.

[Development of navigation technologies for ambulatory surgery]. / Proektirovanie navigatsionnykh tekhnologii dlia ambulatornoi khirurgii.

The article considers the main directions in the development of navigation surgical technologies allowing to decrease traumatic effects of certain operative interventions and to fulfill them in "one day" hospitals. The historical aspects of navigation surgery are given as well as a classification of the navigation interventions and examples of the newest of them used at the present time in the Medical Center of Bank of Russia.

Fat augmentation for glottic insufficiency.

OBJECTIVES: Fat lipoinjection augmentation for glottic insufficiency has been used in patients with vocal fold paralysis. Relatively little information is available on the effectiveness of fat injection in patients with vocal atrophy, intubation trauma, and post-hemilaryngectomy defects. STUDY DESIGN: This paper retrospectively compares the efficiency of fat injection in patients with vocal cord paralysis (n = 9), vocal scar (n = 13), and vocal atrophy (n = 11). METHODS: The perceptual acoustic, phonatory function, and videolaryngostroboscopic data were evaluated before and after fat augmentation in 33 patients. RESULTS: Mean follow-up time was 9.7 months. Nineteen patients had excellent results. Three patients had no change. Five patients had late failure. Six patients were lost to follow-up. Phonatory function showed significant improvement in jitter, shimmer, noise-to-harmonic ratio, maximal phonation time, grade, asthenia, and breathiness (P < .05). Videolaryngostroboscopic rating showed significant improvement in right linearity of the vocal fold edge, amplitude of vocal fold vibration, excursion of the mucosal wave, vibratory behavior, and phase symmetry (P < .05). Anterior defects did better than posterior defects. Small vocal fold defects did better than large defects. CONCLUSIONS: Fat injection is a good autogenous implant and may be considered as an option in management of patients with vocal fold scar, defect, or atrophy. Reabsorption of fat is a problem, but the procedure may be repeated.

Familial Mediterranean fever: effects of genotype and ethnicity on inflammatory attacks and amyloidosis.

OBJECTIVE: The gene causing familial Mediterranean fever (FMF)-an autosomal recessive disease characterized by recurrent short episodes of fever associated most commonly with peritonitis, pleuritis, and arthritis-has recently been found and several mutations identified. The most severe complication of the disease is amyloidosis, which can lead to renal failure. The aim of this study was to investigate the role of genetic versus nongenetic factors on the phenotype as well as on the development of amyloidosis in FMF in a large and heterogeneous group of patients. METHODOLOGY: We studied 382 patients from 4 ethnic origins living in different environments: North African Jews, other Jews, Turks, Armenians living in the United States, and Armenians from Yerevan, Armenia. Information regarding amyloidosis was available for 371 patients. We examined the association between the mutation M694V and the development of amyloidosis, and we also compared the clinical characteristics of the inflammatory attacks in patients from different ethnic origins, while controlling for the type of mutation. RESULTS: A significant association was found between amyloidosis and the most common mutation in exon 10 of the FMF gene (MEFV), M694V (for M694V homozygotes, relative risk = 1.77; 95% CI = 1.16-2.71). Amyloidosis was present in 44 of 171 homozygous FMF patients (25.7%), in 22 of 143 compound heterozygous FMF patients (15.4%), and in 7 of 57 patients carrying other mutations (12.3%). In homozygotes for M694V who had not been treated with colchicine before 20 years of age, the risk of amyloidosis developing before this age was 61.0%. In our series, there were no cases of amyloidosis in 16 patients carrying the common mutation E148Q. We found that the type and severity of the FMF inflammatory symptoms were associated with both the genotype and the country of residence of the patient. CONCLUSIONS: In the light of the high frequency of amyloidosis in homozygotes for the mutation M694V, colchicine treatment should be given to this group irrespective of the severity of the inflammatory attacks to prevent the development of amyloidosis. Our findings also suggest that factors other than genotype, such as environment or genes other than MEFV, play a role in the determination of the severity of the inflammatory attacks in FMF. amyloidosis, specific mutation, phenotype-genotype correlation, ethnicity.

[Technologies of ambulatory surgery]. / Tekhnologii ambulatornoi khirurgii.

The development of the outpatient surgery in Russia is thought by the authors to be very urgent if compared with the experiences of foreign clinics. In 1998 a Center of the outpatient surgery was set up in the Medical center of the Bank of Russia where the planned surgery treatment was performed in the regimen of the one-day hospitalization. The ultrastructure of the unit and problems of the outpatient surgery technologies are discussed. The first experiences with performing 313 ambulatory interventions concerned with surgery, traumatology and cosmetology are analyzed.

Videolaryngostroboscopy following vertical partial laryngectomy.

Phonation after partial laryngeal ablative surgery has not often been examined. Videolaryngostroboscopic recordings made after vertical partial laryngectomy (VPL) were retrospectively reviewed and correlated with patient historical and operative factors. Among VPL patients (n = 42), the most common site of vibration during phonation was the contralateral false vocal fold (17/42 patients or 40.5%), followed by the contralateral arytenoid mucosa (10/42 or 23.8%) and the contralateral true vocal fold (8/42 patients or 19.0%). There was no overall difference in vocal quality judgment with respect to site of vibration (ANOVA, p = .373). Vocal quality scores were similar with use of the pyriform mucosal flap versus other reconstructive methods (Student's t-test, p = .568). This study highlights the fact that reconstruction of a new vibratory source after VPL is important for voice production. Because VPL patients infrequently demonstrated true vocal fold vibration, alternative sites (ie, false vocal fold, arytenoid mucosa) must be considered as new phonatory sources after VPL.

Nutritional implications of dental and swallowing issues in head and neck cancer.

Tumors of the head and neck account for 4% of cancers in the United States. Both the disease process itself and side effects of cancer treatment, such as xerostomia, dysphagia, and malnutrition, compromise oral health, swallowing ability, and nutritional status. Optimal treatment of dental, swallowing, and nutritional problems of head and neck cancer patients requires practical strategies that address these problems. These strategies should include appropriate referrals to the dentist, speech/language pathologist, and registered dietitian to enhance patient comfort, prevent secondary malnutrition and dental disease, and improve treatment outcomes. Since dental, swallowing, and nutritional issues are interrelated, appropriate therapeutic strategies hinge on timely, integrated input from each discipline. A better understanding of the dental and swallowing therapies used in patients with head and neck cancer by health professionals will help promote the comprehensive care of these patients.

[Circular dichroism spectra of rat liver chromatin upon exposure to hydrocortisone and insulin]. / Spektry krugovogo dikhroizma khromatina pecheni krys pri vozdeistvii gidrokortizona i insulina.

It was shown by the circular dichroism method that hydrocortisone and insulin have a synergetic effect on the structure of chromatin in vivo. The effect of hydrocortisone and insulin on chromatin is mediated and determined by intracellular regulatory mechanisms.

[Therapeutic interventions under ultrasonic control in diseases of the abdominal cavity organs]. / Lechebnye vmeshatel'stva pro kontrolem ul'trazvukovogo issledovaniia pri zabolevaniiakh organov briushnoi polosti.

The results of 212 transcutaneous therapeutical abdominal interventions, performed under the ultrasound control, have been analysed. 190 patients have been treated. The sectorial ultrasound probe was acting at the frequency of 3 MHz. The electronic matrix guided the needle. One-stage percutaneous drainage with an "umbrella" stylet catheter was used in all cases. Percutaneous drainage of the gallbladder was performed in 140 patients; 111 of them had acute cholecystitis with a high surgical risk. The operation of cholecystectomy has been performed in 32 patients after control of the acute stage of the disease. In 47 patients percutaneous drainage was indicated in case of liver cysts and abscesses, intraliver hematomas, liver pseudocysts, liver pseudoabscesses, abdominal abscesses. These types of curative procedures have limited contraindications, can be performed irrespective of the patient's condition, and in certain cases may be an alternative to major surgical interventions.

Integration of United States emergency medicine concepts into emergency services in the New Independent States.

At this writing, a collaborative partnership has been in place for 30 months between the Boston University Medical Center, the University of Massachusetts Medical Center, the Armenian Ministry of Health, and the Emergency Hospital of Yerevan, Armenia, to improve emergency and trauma care in that city. Fifty-five individuals have traveled to and from the Emergency Hospital, the partner hospital. The collaboration has led to the creation of the Emergency Medical Services Institute (EMSI) at Emergency Hospital, an 800-bed facility that serves as a trauma center and as base for the Yerevan ambulance system. A curriculum (text and slides) has been developed and translated into Armenian and Russian. To date, the Armenian EMSI has trained nearly 300 emergency medical personnel: physicians, nurses, drivers, and first responders. The Armenian EMSI faculty have received training in directing instruction of emergency care providers. Plans are in place to begin training in Armenian cities outside of Yerevan and in neighboring republics. An emergency medicine residency program received ministry approval and was begun with six resident physicians in January 1995. To date, 45 nurses have graduated from a 400-hour training program. This partnership program chose an education initiative as the vehicle for interaction between the United States and the formerly Soviet-directed Armenian health care system. Officials of the partner hospital requested assistance in upgrading the skills of its abundant emergency care workforce, citing cardiovascular disease, trauma, and accidents as leading causes of death and disability in Armenia.(ABSTRACT TRUNCATED AT 250 WORDS)

[Polymer materials in laparostomy of peritonitis]. / Lechenie peritonita metodom laparostomii s primeneniem polimernykh materialov.

Cleansing of the abdominal cavity by the open method-laparostomy and the use of polymer materials-was conducted in 85 patients with generalized peritonitis (mainly due to perforation of a malignant tumor of the colon). With the use of this method the incidence of purulent complications reduced from 50% to 35.2% and mortality from 42% to 25.8%.

[The surgical treatment of patients with colonic cancer complicated by perifocal inflammation of the tissues]. / Khirurgicheskoe lechenie bol'nykh rakom obodochnoi kishki, oslozhnennym perifokal'nym vospaleniem tkanei.

In the clinic, at preoperative preparation of the patients with cancer of the colon complicated by perifocal inflammation, the irrigation of a tumour area, using antibacterial preparations, is employed. After laparoscopy, a drainage tube with microirrigator for perfusion of the antibacterial solution is introduced to the region of tumour location. Using the method described, 25 patients were prepared for the operation. Their state improved after 7-8 days. One-stage radical operation was performed in 20 patients. Of them in 17, primary intestinal anastomosis was created.

[Loop colostomy in patients with cancer of the colon and rectum]. / Petlevaia kolostoma u bolnykh rakom obodoxhnoi i priamoi kishki.

At the clinic of Scientific Research Institute of Proctology, Ministry of Public Health of Armenia, in 97 patients with complicated cancer of the colon and rectum, a two-barrel loop colostomy was created for the recent 10 years. Use of intraperitoneal method contributed to 3-fold decrease in incidence of postoperative purulent complications. Irrigation of a tumour site with antibacterial preparations in perifocal inflammation of colonic cancer together with carrying out the complex antibacterial therapy permits to perform the radical operations.

[Microcholecystostomy]. / Mikrokholetsistostomiia.

Treatment efficacy was compared for transcutaneous transhepatic microcholecystostomy controlled by laparoscopy (75 patients) against that controlled by ultrasound scanning (67 patients) principally in acute cholecystitis. Basic indications for microcholecystostomy are a high operative risk in elderly patients and decompression of the bile ducts for obstructive jaundice. Four patients (2.8%) developed postmicrocholecystostomy complications treated by urgent surgery. The manipulation is short-term, simple and is well tolerated even in grave condition. This makes microcholecystostomy an alternative to cholecystostomy.

[Mechanical jaundice in cholangitis]. / Mekhanicheskaia zheltukha pri kholangite.

The peripheral lymph of the leg and venous blood from donor volunteers were compared. The lymph was found to issue at a higher rate in the active period of the day (from 9 a. m. to 9 p. m.) than at night (from 9 p. m. to 9 a. m.) and is equal to 0.45 and 0.22 X 10(-3) litre/hour, respectively. Its cell composition was lower than that of the peripheral blood (lymph, 2.04 X 10(7) cell/litre; blood, 509 X 10(7) cell/litre) with erythrocytes and platelets not taken into account. Lymphocytes (over 90 per cent) and monocytes (9 per cent) prevailed; the cell number varied with the time of the day; at daytime it was 5-6 times greater than at night. The immunological parameters of the lymph were characterized by a lower content of B cells, greater proportion of 0 cells, and a close T-cell proportion, the active lymphocytes being prevalent. This T-cell proportion correlated with higher spontaneous and lower PHA-induced proliferative activities. The lymph immunoglobulin level was 10-27 per cent of the serum immunoglobulin level; a relationship was observed between the plasma and lymph levels in different age groups.

The use of amide local anesthetics in patients susceptible to malignant hyperthermia.

The use of amide local anesthetics in dental patients presumed to be susceptible to malignant hyperthermia (MH) is controversial. A literature review of 17 recent dental publications and their reference citations revealed that the recommendation to avoid local anesthetics of the amide type in dental treatment of MH-susceptible (MHS) patients is based on in vitro muscle investigations, unpublished communications, and a single case report suggestive of MH. Therefore, a survey of members of the Malignant Hyperthermia Association of the United States designed to determine what, if any, MH-like reactions have occurred in patients with MHS receiving dental treatment was conducted. Of a total of 307 MHS respondents, 36 (12%) reported adverse reactions to dental care. Only one respondent, however, reported symptoms suspicious of MH (fever, muscle pain) in which the administration of amide local anesthetics appeared to be closely linked. Fifty-six (18%) of the respondents have had difficulty obtaining routine dental care since being identified as MHS; this includes 27 who have been refused dental treatment or have had to undergo operative procedures without the benefit of local anesthesia. These results support the conclusions that amide local anesthetics may be administered to MHS patients without significant risk and that currently the diagnosis of MH susceptibility can adversely affect the quality of dental care.