Security and reliability of CUSTOMBONE cranioplasties: A prospective multicentric study.

BACKGROUND: Repairing bone defects generated by craniectomy is a major therapeutic challenge in terms of bone consolidation as well as functional and cognitive recovery. Furthermore, these surgical procedures are often grafted with complications such as infections, breaches, displacements and rejections leading to failure and thus explantation of the prosthesis. OBJECTIVE: To evaluate cumulative explantation and infection rates following the implantation of a tailored cranioplasty CUSTOMBONE prosthesis made of porous hydroxyapatite. One hundred and ten consecutive patients requiring cranial reconstruction for a bone defect were prospectively included in a multicenter study constituted of 21 centres between December 2012 and July 2014. Follow-up lasted 2 years. RESULTS: Mean age of patients included in the study was 42±15 years old (y.o), composed mainly by men (57.27%). Explantations of the CUSTOMBONE prosthesis were performed in 13/110 (11.8%) patients, significantly due to infections: 9/13 (69.2%) (p<0.0001), with 2 (15.4%) implant fracture, 1 (7.7%) skin defect and 1 (7.7%) following the mobilization of the implant. Cumulative explantation rates were successively 4.6% (SD 2.0), 7.4% (SD 2.5), 9.4% (SD 2.8) and 11.8% (SD 2.9%) at 2, 6, 12 and 24 months. Infections were identified in 16/110 (14.5%): 8/16 (50%) superficial and 8/16 (50%) deep. None of the following elements, whether demographic characteristics, indications, size, location of the implant, redo surgery, co-morbidities or medical history, were statistically identified as risk factors for prosthesis explantation or infection. CONCLUSION: Our study provides relevant clinical evidence on the performance and safety of CUSTOMBONE prosthesis in cranial procedures. Complications that are difficulty incompressible mainly occur during the first 6 months, but can appear at a later stage (>1 year). Thus assiduous, regular and long-term surveillances are necessary.

[Psycho-physiological peculiarities of stomatologists aged 50-65 with essential hypertension].

The article presents the results of studying of psycho-physiological peculiarities in stomatologists in the age before 65, that is actual in modern medicine. Certain specificity of psycho-physiological indices in stomatologists with essential hypertension is shown. The proposition is justified that alexithimia and susceptibility to illnesses of psychosomatic origin (particularly, essential hypertension) in stomatologists are essentially influenced by withdrawal, absence of inclination to partnership, cooperation, compromise at solution of problems and in conflict situations, and irresponsible attitude to other people, reduced empathy and sympathy to other people.

[Peculiarities of professional burnout of anaesthetists-experts in resuscitation in various age periods].

The article is devoted to consideration of the problem of professional burnout with anaesthetists-experts in resuscitation in various age periods that is very actual in modern medicine. It is shown that peculiarity of the doctors' activity provokes formation of professional burnout in them. Psycho-emotional tension born by the sense of responsibility before the patients determines formation of responsible attitude of the doctors towards therapy, but it also has negative consequences in concern with disorder of homeostatic balance and unreasonable energetic expenditure. It is proved that formation of professional burnout in anaesthetists-experts in resuscitation has age specificity. At the age of 30-55 it develops according to two subfactors: motivational-adjusting (reduction of professional achievements) and depersonalizational-derealizational one. Doctors at the age of 56-68 expose asthenic symptomatology of professional burnout.

[Intermittent prolonged fever triggered by efforts]. / Fièvre prolongée intermittente survenant à l'effort.

INTRODUCTION: Fever of unknown origin is a common reason for care in internal medicine. The wide variety of possible etiologies makes it difficult to standardize the diagnostic work-up that has to be primarily guided by the interview and physical examination. CASE REPORT: We report a case of prolonged fever having as main characteristics to be intermittent and triggered by efforts. The diagnosis of cerebrospinal fluid shunt infection with Propionibacterium acnes was finally made. In reaching this conclusion, many tests were needed, including renal explorations with biopsy showing an aspect of shunt nephritis. CONCLUSION: Prolonged fever of unknown origin in a patient having prosthetic material should raise the suspicion of prosthesis infection (especially if the fever is associated with efforts).

[Inhibition of lipase activity by low-molecular-weight chitosan].

Inhibition of enzymatic activity of lipase (EC 3.1.1.3) from the fungus Candida rugosa and wheat (Triticum aestivum L.) germ by low-molecular-weight chitosan with an average molecular weight of 5.7 kDa in reactions of p-nitrophenyl palmitate cleavage was studied. Preincubation of lipases with chitosan, prior to addition of the substrate to solution, showed that equilibrium during the lipase-inhibitor complex formation was reached within 30 min. The inhibition constants for C. rugosa lipase and wheat germ lipase were 1.4 and 0.9 mM, respectively. The contribution of electrostatic interactions to the complex formation between chitosan and lipases is insignificant.

[Structural and energy changes in water and its biological activity].

The authors consider the structural and energy changes occurring in water during its treatment using physical methods and the impact of these conditions on metabolic processes. Emphasis is laid on the necessity of putting the integral indices, considering the magnitude of changes in the structural and energetic conditions of water and its biological activity, into practice.

[Mathematical modeling of laser-induced selective destruction of labyrinthine vestibular receptors].

Basing on mathematical modeling, we tried to investigate in humans the ability of laser energy to suppress the function of the ampullar receptors of the semicircular canels and otolith receptors; to elicit mechanism of action of laser energy on labyrinthine receptors. Modeling has shown that in 1 mm thickness of the canal wall laser impact raises temperature of the liquid to 120 degrees C. Temperature higher than 100 degrees C stands in it up to 120 ms. This induces a distinct hydrodynamic shock which suppresses function of labyrinthine ampullar and otolith receptors. The heat factor of the laser impact causes destruction of the receptor sensory cells lasting for about a year.

[Inhibitors of ribonucleases].

RNases are the most important enzymes of cellular metabolism. They influence gene expression, cell growth and differentiation, participate in cell protection against pathogens and induction of apoptosis. Since intracellular RNases exist mainly in complexes with their inhibitors, the latter are also involved in all above-mentioned processes. The review describes natural protein inhibitors of animal, plant, and bacterial RNases along with synthetic low molecular-weight inhibitors. Special attention is paid to the perspectives of application of RNase inhibitors to therapy of oncological and allergic diseases. Despite wide distribution of RNases and their numerous studies, the number of available natural and synthetic inhibitors of these enzymes remains limited. Creation of highly efficient low-molecular inhibitors of RNase activity of angiogenin and eosinophil-associated RNases, aimed at the therapy of oncological and allergic diseases, still remains quite actual.

[Cerebral cavernomas, epilepsy and seizures. Natural history and therapeutic strategy]. / Cavernomes intracrâniens, épilepsie et crises d'épilepsie. Histoire naturelle et modalités thérapeutiques.

PURPOSE: To review, from a retrospective series of 48 patients presenting with seizures associated with one or more supratentorial cavernoma(s), the natural history of the seizures and outcome according to medical and surgical treatment. METHODS: Patients were divided into two groups: group A included patients presenting with a single seizure or rare seizures (n=21), and group B patients having intractable epilepsy (n=27). All received antiepileptic drugs and 35 were operated on (12 in the group A and 23 in the group B). Stereo-EEG was performed in 8 patients in group B. Surgery included lesionectomy alone (n=16), resection of the cavernoma and perilesional tissue (n=7) or tailored corticectomy including the cavernoma (n=12). RESULTS: The natural history of seizures was different in the two groups: mean age at seizure onset was 25 years in group B and 33 years in group A (p<0.05), seizures were partial in all patients in group B and 8 patients in group A (p<0.05). Seizure frequency and periodicity also varied. Prolonged seizure-free periods were observed. The cavernoma was temporal in 17 patients in group B and 4 patients in group A (p<0.01). In group A, seizure outcome was favorable following surgery or with antiepileptic medication only (7 patients out of 12 operated were seizure-free, as were 5 out of 7 non-operated). In group B, seizure outcome was better after surgery than with medication only (17 patients out of 23 operated were in Engel's Class I, while 3 patients of 4 non-operated patients had persisting seizures despite antiepileptic polytherapy). CONCLUSION: Variations in seizure severity in patients harboring cavernomas suggest different therapeutic approaches. In case of unique or rare seizures, surgical resection of the cavernoma is appropriate, but benefits of surgery over antiepileptic medication in terms of seizure control remains unclear. Intractable epilepsy associated with cavernomas is better controlled after surgery rather than with medication only. In these patients, a detailed preoperative work-up is necessary and should be followed by wide resection associated or not with corticectomy, especially in the temporal lobe. Evaluation of outcome after surgery should consider the surgical strategy, antiepileptic medications and the patient's seizure history.

[Cerebral cavernomas followed by epileptic seizures: clinical picture, diagnosis, and treatment]. / Kavernomy golovnogo mozga, protekaiushchie s épilepticheskimi pripadkami: klinika, diagnostika, lechenie.

The clinical features of epilepsy associated with cerebral cavernomas and the results of different types of its surgical treatment: cavernonectomy, extended cavernomectomy, and epileptic focus resection were analyzed. The clinical, radiological, and electrophysiological data were studied in 48 patients with epileptic seizures associated with cerebral cavernomas who had been admitted to the Unit of Neurosurgery, Saint Anna Hospital (Paris, France) in 1982-2001. According to the severity of epileptic manifestations, the patients were divided into 2 groups: 1) 21 patients with single and rare seizures and 2) 27 patients with drug-resistant epilepsy. All the patients received medical antiepileptic therapy. Twelve patients from Group 1 underwent cavernomectomy or "extended" cavernomectomy. In Group 2, 23 patients were operated on and 3 types of operations (cavernomectomy, "extended" cavernomectomy, and corticoectomy) were performed. Statistically significant differences were found in anatomic, clinical, and electrophysiological parameters. Criteria associated with the development of drug-resistant epilepsy were established. These included: the early onset of seizures, temporal cavernoma, and a combination of partial and generalized seizures in one patient. The paper shows it necessary to choose a surgical intervention in relation to the duration of seizures, their frequency, and a response to medical antiepileptic therapy. The advantages of surgical treatment over medical one were not found in single and rare seizures (Group 1), while in drug-resistant epilepsy, surgical treatment yielded much better epileptological results than did medical treatment. The volume of a surgical intervention depends on the sizes of an epileptic focus detected by an in-depth preoperative study and on the site of a cavernoma.

[Modern evaluation of the accuracy of determination of the acid-forming function of the stomach by the method of intragastric pH-metry]. / Sovremennaia otsenka tochnosti opredeleniia kislotoobrazuiushchei funktsii zheludka metodom vnutrizheludochnoi pH-metrii.

Described are the results of research of how the standard location (antral region-stomach body-cardium) of the comparison electrode in the 3-electrode probe affects the clinical evaluation of the acid-forming function of the stomach (AFC) in patients with gastric and duodenal ulcer. It was found that a sufficient accuracy (+/-0.2) in measurements of basal pH of the stomach body and, consequently, in clinical evaluation of AFC for the main standard locations is ensured by pH-probes with the chlorosilver skin comparison electrode.

[Accuracy of acidity changes in the gastrointestinal tract as determined by pH-tubes with the internal and external comparison electrodes]. / O tochnosti izmereniia kislotnosti vnutri zheludochno-kishechnogo trakta posredstvom pH-zondov s vnutrennim i vneshnim élektrodom sravneniia.

It was for the first time that the presence of diffusive potentials on the borders between segments of the gastrointestinal tract (GIT) with differing compositions and pH values were detected in the practice of pH-metry. The diffusive potentials were found to be a cause for a considerably worsening accuracy of pH measurements by the second measuring electrode of the two-electrode pH-tube with the internal comparison electrode. On the contrary, when pH-tube with the external cutaneous comparison electrode is in use, the measuring accuracy does not deteriorate virtually for all electrodes in the latter case.

[New medical pH probes for the examination of the gastrointestinal system]. / Novye meditsinskie pH-zondy dlia obsledovaniia zheludochno-kishechnogo trakta.

The paper deals with pH-probes with mercurius chloride versus silver chloride electrodes for intragastric pH-metry. Present-day oral, transnasal, and endoscopic pH-probes with reusable epicutaneous silver chloride electrode have been designed and introduced into medical practice.

[Changes in clinical-instrumental parameters in patients with mitral stenosis after balloon catheterization valvuloplasty of the mitral valve]. / Izmeneniia kliniko-instrumental'nykh pokazatelei u bol'nykh mitral'nym stenozom posle kateternoi ballonnoi val'vuloplastiki mitral'nogo klapana.

The results of mitral valvuloplasty using a balloon catheter were presented for 104 patients with mitral stenosis. Instrumental measurements and clinical symptoms were evaluated before the operation, 6 and 12 months after it (62 and 42 patients, respectively). The balloon dilatation has increased mitral orifice from 120.5 +/- 5.8 to 333.88 +/- 7.45 mm2, transmitral diastolic pressure gradient decreased from 22 +/- 1 to 7.91 +/- 0.6 mm Hg. All the patients benefited clinically: cough, blood spitting, lower limb edemas, protodiastolic murmur disappeared, dyspnea noticeably reduced. NYHA functional class I-II was established in 85% of the patients. The highest effect was achieved in patients with isolated mitral stenosis.

[The use of an automated teaching system in a therapy department]. / O primenenii avtomatizirovannoi obuchaiushchei sistemy na kafedre terapii.

At the division of general therapy N 1 of the Kirov Military Medical Academy a version of automated training system was elaborated for the IBM AT/386 users of MS DOS operational system. The knowledge text control was carried out during the lessons at the display classroom equipped with Wyse-85 terminals ("Wyse Technology Company"), DEC VT 220 regimen, and connected up to PC IBM AT/386 which works in multiterminal function. Application of text control has shown that the volume of knowledge had increased up to 82-90%, but it was right only for the groups where the methodics of classes with application of the results of text controls was strictly adhered. The progress in other groups was less than 68%.

[Monocyte functional activity and nonspecific antiviral cellular resistance in adaptation to the conditions of eastern Siberia]. / Funktsional'naia aktivnost' monotsitov i nespetsificheskaia protivovirusnaia kletochnaia rezistentnost' pri adaptatsii k usloviiam Vostochnoi Sibiri.

Monocyte functional activity and antiviral cellular resistance were studied in the newcomers to the Baikal region from the European Russia. A total of 105 patients with acute respiratory diseases and 30 normal subjects were examined. 46 healthy residents of St. Petersburg made up the reference group. The process of adaptation was found to be associated with changes in the functional activity of the immunocompetent cells. The authors came to a conclusion on the principal role of viral injury of the monocytes in the development of acute bronchitis or pneumonia.

[Therapeutic effect of intravascular phosphobion during transesophageal electric cardiostimulation in patients with ischemic heart disease]. / Lechebnyi éffect vnutrivennogo vvedeniia fosfobiona pri chrespishchevodnoi élektrokardiostimuliatsii u bolnykh ishemicheskoi bolezníu serdtsa.

The authors propose a new method of treating coronary patients with angina pectoris of effort and at rest. It involves combination of transesophageal pacing with simultaneous intravenous administration of phosphobion. The treatment given to 10 coronary patients produced positive antiischemic and hemodynamic effect against its absence in control subjects treated conventionally with ATP.

[Stage-by-stage diagnosis in conducting the cardiological screening of servicemen using a computer]. / Poétapnaia diagnostika pri provedenii kardiologicheskogo skrininga voennosluzhashchikh s ispol'zovaniem EVM.

A 3-staged algorithm and a device named PKSV-01 were worked out to carry out a pre-doctor screening of servicemen. This method made it possible to define the sound servicemen, as well as patients with cardiovascular diseases including ischemic disease and postinfarctional cardiosclerosis. The specificity came to 91.9-93.9%, and sensitivity up to 81.4-97.8%. The application of lineal discriminative function ensured 93.1% of the right answers.