[The effectiveness of BACTEC MGIT 960 system hit analysis of surgery material of patients with tubercular spondylitis].

The article considers the comparison of effectiveness of cultivation of 290 surgery samples from focus of destruction in patients with tubercular spondylitis in liquid medium Middlebrook 7119 with fluorescent detection of growth and two dense egg medium -Levenschtein-Yensen and Finn-II. The sensitivity of methods of inoculation in liquid medium Middlebrook 7H9 and in dense egg mediums has no difference (38.2% and 43.1%, p = 0.271). The duration of growth consisted 2 +/- 2.3 days for liquid mediums and 40.6 +/- 3.2 days for dense mediums. The method of pre-inoculation processing of surgery material. In case of inoculation of 440 samples in liquid mediums contamination consisted 3.9%. In case of inoculation of bone fragments of focus of destruction in liquid medium Middlebrook 7119 the culture was isolated in 43.5% of samples of patients with tubercular spondylitis.

[Use of transpedicular fixation in the surgical treatment of tuberculosis spondylitis and chronic hematogenous osteomyelitis of the vertebral column].

The efficiency of applying various posterior instrumental fixation modes (semirigid constructions and transpedicular fixation (TPF)) was comparatively analyzed in 91 patients with tuberculosis and and osteomyelitis of the spine. TPF was shown to have some advantages in correcting its deformity and preventing the latter's losses, reducing the number of complications in the area of anterior spondylodesis.

[Assessment of methods of placement of polypropylene meshes in alloplasty of ventral hernias].

Alloplasty with polypropylene meshes was fulfilled in 153 patients with ventral hernias. Most frequently the prosthesis was placed in the preperitoneal fatty tissue under the sutured muscular-aponeurotic margins of the hernia hilus (61 patients) or in sheathes of the rectus muscle of the abdomen (48 patients). Best results were obtained after implantation of the mesh in sheathes of the rectus muscle of the abdomen. The greatest number of complications and recurrences was obtained in alloplasty above aponeurosis.

[Combined surgical operations for locally spread cancer of the rectum and female genital organs with ablation of remote metastases].

The article presents data of 148 combined cytoreductive operations (with ablation of remote metastases) in patients with widespread rectal cancer (in 83 patients) and female genital organs (in 65 patients). The immediate and long-term results suggest that such operations are justifiable in multitype hospitals.

[Alloplasty of inguinal hernias with polypropylene gauzes].

An experience with treatment of 61 patients with inguinal hernias on whom 69 alloplastic hemioplasties had been performed was analyzed. For the most part the Lichtenstein method of alloplasty with polypropylene gauzes was used. Good immediate and long-term results were obtained. No recurrences were observed during the three year follow-up. Alloplasty should be used more widely for the treatment of inguinal hernias.

[Use of combined surgery for locally-advanced tumors of the small pelvis].

Two-hundred and six operations were carried out at the Hospital (radical surgery - 184, combined excision of tumor and metastases - 22) (1995-2004). Complication was in 43 patients (20.9%), lethality - 8.7%. Five-year survival after radical surgery was 49.1% (rectal cancer) and 52.6% (cancer of female genitals). Four out of 22 patients survived for 5 years.

[Experience in treatment of locally disseminated and metastasizing tumors of organs of the small pelvis under conditions of surgical department of a city multifield hospital].

Combined, extended and cytoreductive operations for locally disseminated malignancies of the small pelvis organs have been widely used in the recent decade. The surgical method in this situation consists in a maximally possible ablation of all tumor foci, distant metastases included. Good equipment of the medical institution and proper qualification of the surgeons give low postoperative lethality and satisfactory long-term results.

[Recovery of the support capacity of the vertebral column in patients with tuberculous spondylitis].

The paper presents the results of anterior spine fusion in 250 patients with tuberculous spondylitis involving 2 to 8 vertebrae, by using free and non-free autologous bone grafts, carbonaceous implants, and revascularized transplants. Anterior spine fusion added to posterior spinal fixation with a CD-type metal construction. A tuberculous process in the spine was cured in 96.1% of cases; the spinal support capability recovery rate was 95.2% in the early postoperative period and in 93.5% in the late one.

[Clinical classification of extrapulmonary tuberculosis].

The authors propose a clinical classification of extrapulmonary tuberculosis, which is based on the standard reporting signs. They give the definitions of classification criteria established in any locations of tuberculous infection: etiology (tuberculosis, BCG infection, tuberculoallergic lesions), the extent and activity of a process with regard to clinical and morphological stages; bacterial isolation with consideration of the drug resistance of Mycobacteria; the nature of complications and sequels, etc. The characterization of local lesion includes the determination of organ-dependent clinical forms of tuberculosis; the type and form of complication; residual and sequels.

[Microbiological and molecular genetic characterization of Mycobacterium tuberculosis strains isolated from patients with multiorgan and generalized tuberculosis]. / Mikrobiologicheskaia i molekuliarno-geneticheskaia kharakteristika shtammov Mycobacterium tuberculosis, vydelennykh ot bol'nykh poliorgannym i generalizovannym tuberkulezom.

The paper presents the microbiological and molecular genetic characteristics of Mycobacterium tuberculosis (MBT) isolated from multiple lesion foci in 26 patients with multiorgan and generalized tuberculosis. Cultures of MBT of the family Beijing were isolated from the pathological specimens taken from 17 (65.4%) patients; those with individual genotypes were in 9 (34.6%) patients. The study indicated that cultured MBT from different types of pathological material from 25 of the 26 patients had identical spoligotypes irrespective of their clinical diagnosis. At the same time minor profile IS6110 changes might occur in the Mycobacteria of a patient during persistence. It may be concluded that multiple foci of tuberculous affliction in the patients are of unique origin and have the mechanism of development, associated with endogenous reactivation of infection.

[TNF-alpha in prognosis of a recovery of the spinal marrow function in patients with spinal tuberculosis]. / Faktor nekroza opukholi alfa v prognoze vosstanovleniia funktsii spinnogo mozga pri tuberkuleze pozvonochnika.

The TNF-alpha significance in forecasting a degree of recovering of the spinal marrow functions was studied in complicated courses of tuberculous spondylitis in 37 patients with generalized and multiple tuberculosis. The TNF-alpha level in the cerebrospinal fluid was found to be related with a severity of inflammation and of neurological disorders, as well as with a degree of spinal marrow compression and with a speed of regression of postoperative disorders in the spinal marrow. The initial TNF-alpha concentration of > or = 400 pg/ml was indicative of a possibility to ensure a fast regression of postoperative disorders in the spinal marrow, while no complete recovery of spinal-marrow functions was observed in cases the TNF-alpha was < 400 pg/ml.

[State of local immunity in patients with inflammatory diseases of the spine]. / Sostoianie mestnogo immuniteta u bol'nykh s vospalitel'nymi zabolevaniiami pozvonochnika.

The paper presents the results of examination of spinal fluid in tuberculous spondylitis (n = 83), its sequelae (n = 58), spinal osteomyelitis (n = 25) for the levels of tuberculosis antibodies (TAb) by applying the routine enzyme immunoassay, specially adapted to this biological object, and immunoglobulins. A relationship was found between TAb detection and the rate of the process and the severity of a spinal cord lesion. Forty one patients had severe spinal cord disorders (paraplegia and deep paraparesis). To detect TAb in CF is shown to be of differential diagnostic value. There is new evidence for impaired blood-brain and immunological barriers in active tuberculosis in the spine with spinal cord compression.

[Spinal lesions in generalized and multiple organ forms of tuberculosis]. / Porazhenie pozvonochnika pri generalizovannykh i poliorgannykh formakh tuberkuleza.

The paper presents the results of examination of 152 patients with generalized and multiorgan lesions, mainly involving the vertebral column. The tuberculous process is defined in 64.4% of the patients as a generalized one by virtually simultaneously involving several organs and primarily the spine and respiratory organs and in 35.6% as a multiorgan one when symptoms of tuberculous spondylitis or tuberculosis of other organs rather than the lung appear some period (3 years or more) after organ involvement. Recommendations are given for pre- and postoperative treatment. All the patients with a preserved pathological process in the lung underwent operations on the spine in early periods (1-3 months) after admission to hospital.

[Clinical and radiographic manifestations of tuberculous spondylitis in adults]. / Kliniko-rentgenologicheskie proiavleniia tuberkuleznogo spondilita vzroslykh.

Data on 348 adult patients with tuberculous spondylitis treated in 1994-1999 are analyzed. The radiation manifestations of spondylitis first occurring in maturity, which amount to 82.3% in the clinical setting were studied in 112 patients. In 50% of cases, spondylitis was a manifestation of multiorgan tuberculosis. The proportion of those with onset in youth increased (27.9). Isolated lesions of the corpus vertebrae were more frequently detected. The processes involving 2 vertebrae were predominant (61.2%), but complicated by foci at new levels. There was a drastic increase in the proportion of disseminated and multi-levelled spondylitis involving 3-9 vertebrae (36.9%). The exudative component of the inflammation was much pronounced, abscesses were extensive in all forms of spondylitis. Spinal cord deficit was noted in 68% of cases of thoracic and cervical spondylitis. MRI should be used for early diagnosis and determination of the extent of a process.

[Effectiveness of combined resection and exenteration of the pelvic organs as part of the comprehensive treatment of extensive malignancies of the rectum and female genitals]. / Effektivnost' kombinirovannykh rezektsii i ékzenteratsii organov malogo taza kak étapa kompleksnogo lecheniia rasprostranennykh opukholei priamoi kishki i zhenskikh genitalii.

The results of the surgical treatment of 865 patients with extended malignancies of the rectum and female genitals are presented. Combined resection and exenteration of organs of the small pelvis (both radical and palliative to ensure cytoreduction of tumor) were carried out in 695 cases (palliative surgery for symptoms--170). The number of resections and sphincter-saving operations has increased while the lethality rates have dropped in recent years. Three-year survival after combined radical surgery for rectal cancer was 59.1%; five-year survival--49% (palliation with removal of distant metastases--26.0 and 14.8%; without removal--24.2 and 0%, respectively; palliative surgery for symptoms--2.3 and 0%, respectively). In cases of palliative surgery for cytoreduction of tumor of the female genitals, 3- and 5-year survival after removal of all distant foci was 66.2 and 54.1%; partial cytoreduction--42.2 and 28.8%, and surgery for symptoms--13.8 and 13.8%, respectively. Cytoreduction improved both the chances and efficacy of adjuvant radio- and chemotherapy. It is suggested that surgery be included as a component of complex treatment of malignancies; combined cytoreduction is fully justified even if its effect is merely palliative.

[Efficiency of plastic surgery for osteoarticular tuberculosis by using revascularization of osseous tissue bed and graft]. / Effektivnost' plasticheskikh operatsii pri kostno-sustavnom tuberkuleze s primeneniem revaskuliarizatsii kostnoi tkani lozha i transplantanta.

The paper provides the results of using original procedures for revascularization of the osseous bed and free bony grafts by transplanting osteovascular complexes in patients with tuberculosis of the hip joint and spine. A total of 20 patients with tuberculous coxitis and 14 with spondylitis were operated on. These interventions were found to have advantages over plastic surgery with bony grafts and mobilizing operations without plasty in similar skeletal lesions, appeared as a great scope of movements in the operated joints is achieved, less time for grafts to adhere with the bed and bony block of vertebrae, and enhanced accumulation of a radioopaque agent in the area to be replaced.

[Intestinal obstruction in disseminated malignant tumors of the female genitalia: the surgical procedure and combined operations]. / Kishechnaia neprokhodimost' pri rasprostranennykh zlokachestvennykh opukholiakh zhenskikh polovykh organov: khirurgicheskaia taktika i kombinirovannye operatsii.

Results of surgical treatment of 103 patients are presented who had spread malignant tumors of the female genitalia with the involvement of different segments of the intestine and urinary tract, and damaged intestinal passage. Combined operations were performed on 57 patients (55.3%), palliative--46 patients (44.7%) 54 patients were operated on urgently. For the last 10 years resectability has been increased 8.5 times owing to active surgical policy. Immediate lethality after combined operations was 10.5%. Cumulative indices of 3- and 5-year survival were 66% and 53.3% respectively. Lethality and 5-year survival after palliative operations were 30.4% and 13.8% respectively. Combined operations for cancer of female genitalia (both primary and recurrent ones and metastases) are quite reasonable in order to provide the optimum volume of cytoreduction and perform chemo- and radiation treatment.

[Lymphatic cysts arising after extended surgery for cervical and endometrial tumors]. / Limfaticheskie kisty posle rasshirennykh operatsii po povodu raka sheiki i tela matki.

Retroperitoneal lymphatic cysts account for 10.0-15.0% of complications of extended hysterectomy for tumors of the cervix uteri and endometrium. The data on 1,093 cases treated at the Institute Clinic in 1980-1994 have been analyzed to establish retroperitoneal lymphatic cyst frequency, factors of its development, criteria of diagnosis and procedures of therapy and prevention. Age over 50 years, low differentiation of tumor cells, deep invasion and considerable local extent of tumor have been identified as factors of risk for lymphatic dissemination. Ultrasonic examination proved the most effective diagnostic procedure with a credibility of 85.5%. Depending on cyst size and condition of adjacent organs, treatment of postsurgical lymphatic cysts may be palliative or radical. In the present study, surgery was used in 28.8% of cases. Frequency of complications can be lowered by timely detection of early forms of cancer of the cervix uteri and endometrium which do not require lymphadenectomy.

[Pathogenesis of colorectal cancer after resection of various segments of the large bowel]. / K voprosy o patogeneze kolorektal'nogo raka posle rezektsii razlichnykh otdelov tolstoi kishki.

The data on 120 cases of primary multiple cancer of the large bowel and 91 cases of diffuse polyposis are discussed. The development, duration and morphological features of metachronous and primary cancer arising after resection of the bowel varying in type and extent were studied. The results pointed to a high risk of cancer in such cases. The study also pointed to disturbances in the enterohepatic system and bile acid circulation as a factor of carcinogenesis in the bowel.