[Clinical results and prospects for the use of phenosanic acid in patients with focal epilepsy]. / Klinicheskie rezul'taty i perspektivy primeneniya fenozanovoi kisloty u vzroslykh patsientov s fokal'noi epilepsiei.

OBJECTIVE: To study the efficacy and safety of using a new original synthetic antioxidant - phenosanic acid as an adjunct therapy in patients with focal epilepsy. MATERIAL AND METHODS: A randomized, double-blind, placebo-controlled, parallel-group study evaluated the efficacy and safety of phenosanic acid as an adjunct therapy to basic antiepileptic drugs in 120 patients with focal epilepsy. Primary purpose: to study the dynamic of seizure frequency. Secondary purposes: to study the dynamic of seizure-free days, the dynamics of bilateral tonic-clonic seizures, the results of questionnaires and scales (General Dynamics Assessment, Visual Analogue Scale (VAS), Quality of Life in Epilepsy (QOLIE-31-P), European Quality of Life Questionnaire (EQ-5D), Hospital Anxiety and Depression Scale (HADS), Frontal Asstssment Battery (FAB), Mini-Mental State Examination (MMSE)). RESULTS: Phenosanic acid (Dibufelon) showed statistically significant benefit over placebo in the primary indicator of efficacy (reduction in the frequency of epileptic seizures by at least 50%) and in the secondary indicators. The drug was safe and well tolerated by the patients. CONCLUSION: The addition of phenosanic acid (Dibufelon) to base antiepileptic drugs seems to be perspective because of its positive effect on reducing the number of epileptic seizures, as well as on comorbid disorders in the emotional and cognitive spheres.

[Use of Detravenol in treatment of chronic venous insufficiency of lower limbs]. / Primenenie preparata Detravenol pri lechenii khronicheskoi venoznoi nedostatochnosti nizhnikh konechnostei.

AIM: The purpose of this study was to prove that Detravenol is not inferior by clinical efficacy to Detralex® in the course administration in patients presenting with chronic venous insufficiency of the lower extremities caused by lower limb varicose veins. PATIENTS AND METHODS: Ours was a prospective randomized open-liable comparative trial aimed at determining efficacy and safety of the two drugs in parallel groups with active control. The trial enrolled a total of 106 patients with chronic venous insufficiency of the lower extremities secondary to lower limb varicose veins. The patients took the drug during 60 days twice daily. The primary outcome measure of efficacy was reduction of the malleolar circumference upon completion of treatment as compared with the baseline values, with the secondary outcome measures being the dynamics of parameters according to the Venous Clinical Severity Score (VCSS), CIVIQ-2 quality of life questionnaire, and the findings of ultrasonographic duplex scanning. RESULTS: The obtained findings demonstrated efficacy of therapy with the use of Detravenol in treatment of patients with chronic venous insufficiency of the lower limbs. The 60-day therapy with the study drug resulted in decreased oedema of the lower extremities: the malleolar circumference reduced averagely by 4%, the composite index of the venous clinical severity score diminished averagely by 50%, and the subjective measure of quality of life increased. Patients taking the study drug demonstrated positive dynamics according to the findings of ultrasonographic duplex scanning, with no serious adverse events during the trial observed. CONCLUSION: By the primary outcome measure of efficacy (reduction of the malleolar circumference) therapy using the investigational drug proved to be not inferior to therapy with the comparator drug. By the secondary outcome measures the compared therapies appeared equally effective. The study drug and the comparator were found to have a similar safety profile.

EXPERIENCE OF APPLICATION OF VOLUME FORMING AGENT «DAM+¼ IN TREATMENT OF ANAL INCONTINENCE ASSOCIATED WITH INCOMPETENCE AND TRAUMA OF ANAL SPHINCTER.

The attempts of introduction of volume forming agent in submucous layer started at the beginning of 1990th. The aim of these innovations was to rise of basal pressure. This research has been performing since 2007. It included experimental and clinical phases with participation of 41 patients with anal incompetence aged 3­26 years old. The agent «DAM+¼ was introduced in submucous layer of anal сanal in four points. The basal pressure was risen in 2­3 times after implantation and it was at the average more 65% of age standards. The application of volume forming agent «DAM+¼ is effective method of correction of anal incontinence. It'll require the re-introduction procedure in longterm period.

[The ways of improvement of direct results of surgery of patients with rectal cancer].

The data of 1740 patients (during 20 years) with rectal cancer were analyzed. Planned operations were performed in 95.8% of patients. The adenocarcinoma was verified in all patients. Accompanying pathology was detected in 84.9% of patients and the pathology of cardiovascular system was more frequent (76.6%). Complicated course of tumourous process was revealed in 4.5% of patients (cases of bowel obstruction, the perifocal inflammation). The majority of patients had the II, III stage of the oncologic process. All operations were performed by conventional (open) way. The number of anterior resection of the rectum increased and the number of abdominoanal resection with bringing down reduced. The specific weight of sphincter preserving operations, which were completed by forming a colostomy decreased. The quantity of performed abdominoperineal extirpation was constant.

[Interaction between Steinernema carpocapsae with the arthropode fauna and natural populations of entomopathogenic nematodes in orchard biotope].

The introduction of a novel entomopathogenis nematode Steinernema carpocapsae strain "agriotos" (Rhabditida: Steinernematidae) into the soil of an orchard resulted in the reduction (up to 50 %) of total amount of phytophagous insects. No negative effect on the groups of beneficial arthropods, caused by the nematode, has been found. Recommended optimal application rate is 500 thousand invasive nematode larvae per 1 m2 of the soil. Increase or decrease of the application rate resulted in the rise of the abundance of phytophagous insects. This fact proved the existence of regulating factors determining optimal ratios of the amounts of parasites at micro- and macro-levels. Activation of native populations of entomopathogenic nematodes in soil surface layer has been observed after the introduction of the novel parasite species.

[Comparative assessment of the Longo operation and suture ligation of the terminal branches of the upper rectal artery in treatment of chronic hemorrhoids].

The immediate and long-term results of treatment of patients with chronic hemorrhoids were compared in two groups of patients. The A. Longo method of operation was used in one group of patients, suture ligation of the distal branches of the superior rectum artery was used in the other group. The second method was shown to have some advantages over the Longo operation, but the long-term results show greater effectiveness of the Longo method.

[Use of the method of transcanal endoscopic microsurgery in treatment of tumors of the rectum].

The method of transanal endoscopic microsurgery (TEM) is in use now for treatment of benign tumors of the rectum, and in some cases for early forms of cancer of the same localization, equally with traditional surgical methods such as transanal and endoscopic dissection. Immediate and long-term results of treatment of three groups of patients operated on by the methods in question were compared to establish the effectiveness of the methods. It was shown that TEM was more precise, had less number of intra- and postoperative complications and considerably rarer recurrences.

[Use of preventive colostomas in surgery for rectal cancer].

The study included 482 patients with rectal cancer. Colostoma was formed in 179 for prophylaxis of anastomotic leakage complication. Such measures are indicated in sphincter-sparing surgery on rectum. Preference should be given to transversostomy.

[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.

[Potentialities of complex treatment of prolapse of the rectum].

The method of surgical correction of prolapse of the rectum should be chosen with special reference to the patient's age, severe somatic diseases, co-existing pathology of the colon (diverticulosis) and necessity of resection of part of the large intestine as well as marked previous constipations in order to use the most adequate method of surgical treatment. The biofeedback therapy should be used in some patients in the postoperative period due to concomitant insufficiency of the anal sphincter for obtaining better results of the operative treatment.

[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.

[Open hemorrhoidectomy with using the apparatus controlled bipolar electrocoagulation]. / Otkrytaia hemorroidéktomiia s ispol'zovaniem apparatno-kontroliruemoi bipoliarnoi élektrokoaguliatsii.

Hemorrhoids are known to be a widely spread disease. The aim of this study was to compare two methods of hemorrhoidectomy. The hemorrhoidectomy was performed on 262 patients with combined III-IV degree hemorrhoids, 130 patients being operated by the conventional method--Milligan-Morgan hemorrhoidectomy, 132 patients undergoing hemorrhoidectomy using a bipolar vessel sealing system. It was noted that the operation time was significantly shorter, postoperative pain and postoperative complications less frequent due to the bipolar device-controlled electrocoagulation.

[Comparative assessment of the results of open carotid endarterectomy and carotid aftery stenting]. / Sravnitel'naia otsenka rezul'tatov otkrytoi karotidnoi éndarteréktomii i stentirovaniia sonnykh arterii.

A comparative study of 48 carotid stent grafting and 23 open carotid endarterectomies was carried out. Patients of both groups were comparable by cerebrovascular insufficiency degree and concomitant diseases. General rate of complications after carotid stent grafting (CSG) was 5.1%. There was a small ischemic stroke with right-sided hemiparesis and aphasia in one patient during CSG. Complete regress of the neurological symptoms was seen on the 5th day. In the nearest postoperative period after CSG there was a big ischemic stroke in the territory of MCA in one patient. Rate of complications after open carotid endarterectomy (OCEAE) was 8.7% Transient ischemic attacks were seen in 2 patients in early postoperative period. Paresis of the IX cranial nerves was in one patient. In long-term postoperative period after CSG 2 patients died due to cardiac causes. One patient died 18 months after OCEAE due to ischemic stroke. In long-term period after OCEAE restenosis of the internal carotid artery was seen in 4.5% cases, while there were no restenosis after CSG. It is concluded that CSG is an effective method of treatment of carotid stenosis with lower lethality and postoperative complications rate compared with OCEAE. Indications for CSG are symptomatic stenosis of ICA (>60%), asymptomatic stenosis of ICA(>70%), two-sided lesions of the carotid arteries, carotid stenosis with lesions of other brachiocephalic arteries, insufficiency of Willis circle.

[The scientific and clinical value of molecular genetic changes in the intercellular gap junctions observed in colon cancer]. / Znachenie molekuliarno-geneticheskikh izmenenii mezhkletochnykh shchelevykh kontaktov pri rake tolstoi kishki.

Colon cancer is one of the most widespread pathologies with high mortality due to recurrence and metastasis. The molecular methods of diagnosis, prognostication and biotherapy in colorectal cancer enjoyed a rapid progress during the recent decades. The hypothesis on the key role of impaired intercellular gap junctions in the onset and progression of malignant tumors is a promising trend in carcinogenesis research. We have recently discovered a variety of tumor-specific mutations of connexin 43 gene in advanced colorectal cancer (Oncogene. -2002.-Vol.21, No.32-pp.4992-4996), which confirms the above hypothesis in malignant tumor progression. We believe that further studies of connexins' mutation changes in tumor growth is a promising trend in research of its etiology and pathogenesis and in designing new methods of diagnostics and treatment of colonic and other gastrointestinal cancers.

[Survival of patients with distant metastases of colon cancer after different extent of surgery]. / Pokazateli vyzhivaemosti bol'nykh rakom obodochnoi kishki s otdalënnymi metastazami posle operatsii razlichnogo ob''ëma.

The results of a retrospective non-randomized pair-controlled investigation are discussed. The data on a patient of cytoreductive surgery and another one operated on for symptoms only (control) were compared. Both subjects had to have comparable most important prognostic characteristics, such as gender, age, primary tumor localization and the number and pattern of distant metastases. The study included 34 patients. The surgery group comprised 19 patients (female--13, male--6). Total cytoreductive surgery (5) used standard removal of primary tumor and marginal resection of a segment of the liver (4), or excision of the right lobe (1). Partial surgery (14) involved removal of primary tumor alone. Controls (female--10, male--5) were operated on for symptoms (proctotoreusis--12, shunt--3). No systemic antitumor therapy was given. Concomitant pathology, its absence as well as postoperative complications were excluded from consideration. Median survival in control was 5.2 mo, total or partial surgery--13.5 mo (p = 0.00083). In a longer perspective, it was 27.0 mo for total surgery and 12.6 mo--partial (p = 0.00295), while after partial surgery it was longer than for symptomatic treatment--5.2 mo (p = 0.0029). No correlation was established between survival, on the one hand, and gender, age or primary tumor localization, on the other (p(0.005). However, a relationship was found between survival and extent of excision (p = 0.01737).

[Formation of a colonic reservoir while performing a low anterior resection of the rectum]. / Formirovanie tolstokishechnogo rezervuara pri vypolnenii nizkoi perednei kishki.

The aim of the investigation was to determine the most functionally grounded level of the formation of colonic reservoir from the margin of the anal canal while performing a low anterior resection of the rectum. Sphincter-preserving operations were performed in 113 patient with the formation of colonic reservoir and direct stepler colorectal anastomosis. Questionnaires and apparatus "Colodynamic-3" were used to follow-up 28 patients with the reservoir (main group) and 19 patients with a direct anastomosis on whom the operations had been made more than a year ago. The rate of the development of complications was almost the same in the both groups--28.5% and 26% correspondingly. The reservoir-accumulating function became less in the group of "direct" anastomoses. The best parameters of the reservoir-accumulating and evacuatory ability of the colonic reservoir were found to be in patients with the level of anastomoses 4-6 cm from the anal canal margin. Creation of the reservoir was more difficult in patients with the carneus mesentery and a small width of the sigmoid colon.

[Mycotic aneurysms of the thoraco-abdominal part of the aorta]. / Mikoticheskie anevrizmy torakoabdominal'nogo otdela aorty.

Mycotoc aneurysms (MA)--a rare and extremely dangerous lesion of the aorta. CT, MRA and aortography were used to diagnose MA of the thoracoabdominal areas in 2 men of 64 and 67 years of age. The clinical picture included: fever with shivering with the temperature 38-39 degrees C and increasing pains in the inferiothoracic and lumbar areas of the spine. Hemoculture was positive in 1 patient only. The patients were operated on. Shunting of the aorta from the inferiothoracic to infrarenal segments was performed in one patient with the exclusion of the involved portion and resection of MA. Metalloosteosynthesis of the spine due to destruction of LI-LII and compression of the spine were performed in the second patient followed by analogous shunting of the aorta and visceral arteries with the resection of the aneurysm. To prevent infection of the prostheses the shunts were wrapped up with a piece of the greater omentum. One patient died two months later from recurrent sepsis. The other one is alive, within 28 months the shunts are patent, there are no signs of a reinfection.

[The medical anthropological study of the bone remains from the Yekaterinburg burial]. / Mediko-antropologicheskoe issledovanie kostnykh ostankov iz Ekaterinburgskogo zakhoroneniia.

Results of medical anthropological expert studies of bone remains of Emperor Nicholas II, his family members, and persons in their attendance are presented. Craniological (including computer photoblending), odontological, osteometric, and spectral methods were sued. Numerous photographs, Imperial Family clothes from museums, soil specimens from Tsarskoe Selo and place of burial were used. Expert studies confirmed previous conclusions on personal identification of skeletons as Nicholas II and four Imperial Family members. Additional proofs of identification of skeleton No. 6 as Great Princess Anastasia Nikolaevna are presented. No remains which could be identified as Cesarevich Alexei Nikolaevich and Great Princess Maria Nikolaevna were found. The so-called "adolescent teeth" are upper teeth of a subject aged 17-18. Rare odontoglyphic characteristics of these teeth permit referring them only to skull No. 6 (Great Princess Anastasia Nikolaevna) but not to an adolescent, specifically, to Cesarevich Alexei Nikolaevich.