[The head of the medical service must be the person...(To the 70th anniversary of N.G. Ryzhman)].

The article is devoted to contribution of major general (rear Admiral. - navy) of medical service Nikolay Grigoryevich Ryzhman (1944-2005), the chief of the medical service of the Northern fleet (1991-1999), to development of naval medicine, who would have turn 70 years this September. The constant analysis, and experience generalization of the medical services of the fleet connections and associations and aspiration to provide fighting capacity for the fleet crew - were a keynote of Ryzhman's activity concerned development and deployment of the new forms and methods of medical support and searching of ways to increase crew efficiency. The implemented methods and forms of organization of the medical support and scientific development of the medical support are used even now in the practical activities of the medical service of the Northern fleet.

[Risk factors of extraocular spread after local treatment of uveal melanoma].

14 cases of extraocular spread in patients with uveal melanoma after previous eye preserving treatment were analyzed. The time of manifestation and risk factors of extrascleral invasion were determined in patients after different local treatment modalities of uveal melanoma.

[Transpupillary thermotherapy in the treatment of recurrent and residual choroidal melanomas: preliminary results].

Thirty-eight patients (16 males and 22 females) with recurrent and residual choroidal melanomas who had undergone brachytherapy were followed up. The indication for transpupillary thermotherapy (TTT) was an active residual tumor (36 patients) and recurrent melanoma (2 patients). The follow-up interval between brachytherapy and TTT was 10 to 127 months. TTT using a diode laser was performed on a Nidek DC 3300 device at a wavelength of 810 nm. The mean tumor prominence prior to TTT was 1.9 mm (range 1 to 3.5 mm), its mean diameter was 8.6 mm (range 4-14.5 mm). Twenty patients were observed over time. The follow-up time after TTT was 3 to 15 months. After the first session of TTT, a positive effect was observed in 15 patients. In 9 patients, the effect was inadequate, which required additional sessions of TTT. Among the early TTT complications, there were superficial petechial hemorrhages, macular edema, exudative retinal detachment above the tumor. Treatment resulted in no complications in 18 patients. Late metastases were seen in none patients. Our investigations have indicated that TTT is a highly effective treatment for recurrent and residual uveal melanomas, which provides complete tumor resorption in 29% of the patients.

[A risk of metastasis of choroid melanoma after brachytherapy]. / Risk metastazirovaniia melanom khorioidei posle brakhiterapii.

The efficiency of treatment, frequency rate and the time of onset of metastasis were analyzed in 271 patients with uveal melanomas. The follow-up ranged from 4 to 16 years. 193 patients were observed more than 5 years and 77 patients were observed more than 7 years. Modest and medium tumors were registered in 185 patients. A complete resorption of tumors was observed in 167 cases, 78 eye were enucleated due to an insufficient therapeutic effect. Metastases were diagnosed in 9.6% of patients. As for the group of patients observed for more than 5 years, metastases were observed among them in 6% of cases. Metastases set on in 4-5 years after operations in 38% of cases, metastases developed postoperatively in 5 to 10 years in 50% of patients. A total regression of tumor is not a guarantee to a complete recovery, however, the frequency rate of metastases drops to 7% and they appear during a more remote time period (on the average 7.7 years later). At the same time, when the therapeutic effect after brachytherapy is insufficient, the frequency rate of metastases went up virtually to 18%, while the time of their onset reduced to 4 years.

[Prospects for radiotherapy of optic nerve meningioma]. / Vozmozhnosti luchevoi terapii meningiom zritel'nogo nerva.

32 patients with meningioma of the optic nerve, undergone gamma-teletherapy were followed up. The mean total focal dose was 35 Gy. 24 patients were follow-up for 1-8 years. Gamma-, therapy was shown to be the method of choice for treatment of meningiomas in the retrobulbar part of the optic nerve. It permits one to stabilize growth of the tumor, to preserve and, in number of casetelet to elevate the acuity of vision. The decline of acuity of vision was noted only in 3 cases within 6-12 months after the completion of radiotherapy. Even low initial acuity of vision and signs of atrophy of the optic nerve cannot be a ground for pessimistic prediction in relation to the results of treatment.

[The health of the command officer staff doing their service in Polar regions]. / Zdorov'e komandnogo ofitserskogo sostava, prokhodiashchego sluzhu v Zapoloar'e.

Initial referral (not considering dental diseases) for the last 4 years was analyzed in servicemen from the Northern Fleet, group of navy specialists serving in Headquarters was investigated. Anamnesis and central hemodynamic parameters were studied in casual sample (388 senior officers), special questionnaires were used to determine intensity of service activity. According to the data obtained during the last 4 years level of morbidity, hospitalization and disability (without dental diseases) in servicemen constituted 857.01%, in Headquarters senior officers it was 488.77%, hospitalization level was 40.14% and 18.05% respectively; disability level constituted 259.77% and 127.06%. Distribution of persons investigated in the groups according to category of working intensity was the following: the 1st (low working intensity)--0%, the 2nd (middle working intensity)--35.6%, the 3rd (intensive work)--61.3%, the 4th (high working intensity)--3.1%. Good health level was established in the group of senior officer staff. The results obtained allow to conclude that in conditions of Kol'sky Zapolarie morbidity can be decreased approximately in 1.75 times.

[The concept of ophthalmologic oncology development]. / Kontseptsiia razvitiia oftal'moonkologii.

The authors review the research results concerning the diagnosis and treatment of ocular tumors over 25 years of activities of Department of Ophthalmooncology and Radiology and analyze the perspective trends for future studies.

[Metastatic involvement of liver in patients with uveal melanoma]. / Metastaticheskoe porazhenie pecheni u bol'nykh s uveal'noi melanomoi.

The efficacy of enucleation and brachitherapy is assessed in 1150 patients. The incidence of metastases is the highest (up to 2/3) occurs within the first 3 years. Neither enucleation, nor brachitherapy affect this value. However, in general after enucleation the incidence of metastases to the liver (31.7%) is higher than after brachitherapy (5.8%), this indicating that brachitherapy is more effective in minor and medium-sized melanomas of the choroid.

[Criteria for assessing the efficacy of brachytherapy of uveal melanomas, complications of therapy and there prevention]. / Kriterii otsenki éffektivnosti brakhiterapii uveal'nykh melanom, oslozhneniia, ikh profilaktika.

The authors assess the efficacy of brachytherapy of uveal melanomas in 954 patients. Strontium ophthalmoapplicators were used in 652, rutenium ones in 302 patients. As a rule, Sr applicators were sutured in patients with tumors up to 3.5 mm thick and Ru ones in cases with tumors thicker than 3.5 mm. A special program was used for individual approach and improving the accuracy of planning. A total of 74.5% of patients have been followed up for at least 3 years, with check-ups every 3-6 months. The effect of brachytherapy was considered positive in cases with complete resorption or at least 50% decrease of the tumor and a stable clinical picture for 9-12 months. In 60% of patients the tumor regressed completely, in 16% partially, and in 24% there were signs of activation of melanoma growth one year after treatment. The frequency of radiation complications was as follows: retinopaty, 3.15%; neuroretinopathy, 1.1%; hemophthalmia, 0.9%; neovascular glaucoma, 1.1%; cataract, 0.63%. The incidence of radiation complications increases with increase of the applicator power and rigidity of exposure. Computer planning of brachytherapy with due consideration for the size of the tumor and the eye and localization of the neoplasm for each case will help decrease the incidence of complications.

[Clinical, diagnostic and therapeutic aspects of congenital anophthalmos]. / Kliniko-diagnosticheskie i lechebnye aspekty vrozhdennogo anoftal'ma.

This study was aimed at elucidating the diagnostic potentialities of computer-aided tomography (CAT) in congenital micro- and anophthalmia. Twenty-five young patients with various clinical manifestation of this abnormality were examined. Used in complex with the traditional diagnostic methods, CAT played the key role. It permitted imaging the entire complex of changes in the orbit and its contents, which helped choose adequate therapeutic measures. Surgical treatment was proven to be little effective or useless at all in cases with a more than 4 cm3 deficit of the orbital volume on the involved side; contrary to this, early staged fitting with prostheses is effective and creates favorable conditions for subsequent surgical correction in a less than 4 cm3 deficit of the volume.

[Electrophysiological and neuroradiological methods in the diagnosis and prognostication of functional outcome in young children with lesions of the visual tract]. / Elektrofiziologicheskie i neiroradiologicheskie metody v diagnostike i prognozirovanii funktsional'nykh iskhodov u detei rannego vozrasta s porazheniem zritel'nykh putei.

The authors analyze the data of computer-aided tomography, neurosonography, and visual evoked potentials to chess pattern reversal in 14 infants aged 6 to 11 months with partial atrophy of the optic nerve and/or visual cortex involvement before and in various periods after transcutaneous electric stimulation combined with neurotrophic drug therapy. The advantages of comprehensive examinations in neuroophthalmological diagnosis in infants are shown, as is the possibility of using electrophysiological and neuroradiological methods for prediction of functional outcomes in the said patient population.

[Electrophysiological methods in assessing the risk for the development of multiple sclerosis in adolescents with monosymptomatic optic neuritis]. / Elektrofiziologicheskie metody v otsenke riska razvitiia rasseiannogo skleroza u podrostkov s monosimptomnym opticheskim nevritom.

Pattern electroretinograms and visual evoked potentials (VEP) were investigated in response to reversal checker-board patterns with different sizes of checks in 13 adolescents with monosymptomatic optic neuritis in acute period and in the course of convalescence 1-2 and 12-36 months after the disease onset. All the children underwent computer tomography of the orbit and brain. The results allowed identification of high and low multiple sclerosis risk groups. The high risk can be proved by a progressive increase of VEP latency 1-2 months after the disease onset and its significant advance in later period of optic neuritis. Normal VEP latency in late optic neuritis shows a low degree of its development.

[Computer tomography in the diagnosis of intraocular melanomas]. / Komp'iuternaia tomografiia v diagnostike vnutriglaznykh melanom.

Examinations of patients with intraocular melanomas are particularly informative after administration of an x-ray contrast agent. This permits tumor imaging at a thickness of more than 1 mm in 95.4% of cases, helps tentatively locate the necrosis and hemorrhages sites, and detect the growth into the orbit. Computer-aided tomography holds good promise for the choice of treatment strategy in intraocular melanomas.