[Complications after reconstructive operations on major arteries of lower limbs and methods of correction thereof].

The present study was aimed at revealing and examining the causes of specific complications after reconstructive vascular operations in the aortic-iliac-femoral zones. The study comprised a total of 155 patients, with the period of postoperative follow up amounting to 3 years. Thirty-nine patients were operated on for various specific complications within the terms from 1 to 3 years. The results of the study showed clear-cut relationship between the development of complications and progression of the underlying disease. Satisfactory results after secondary interventions were obtained in patients with good state of the distal bed and operated on at early terms after complications.

[Methods of diagnosis and treatment of asymptomatic bacteriuria in postmenopausal women suffering from type 2 diabetes mellitus].

We studied prophylactic potential of local use of estriol in respect of urinary infections (UI) in postmenopausal women with asymptomatic bacteriuria (AB) suffering from type 2 diabetes mellitus (DM). A two-stage trial has been conducted. Stage one (a prospective study) was made to detect AB in DM women with AB. Of 414 female examinees AB was detected in 87 women. At stage two these women were randomized into two groups: group 1 received 0.5 mg estriol as vaginal cream, group 2 (control) received no prophylactic treatment. After 9 months of the trial AB was detected in 19.4% women of group 1 and 68.4% of the control group (p<0.001). Clinically significant UI was detected in 8.3 and 18.4% examinees (p<0.001), respectively. No correlation was found between AB development and a HbA1c level. Estriol treatment resulted in a rise of vaginal health index (VHI), appearance of lactobacteria in the vaginal smear, lowering of atrophic vaginitis detection rate. No significant changes were registered in the controls. Thus, local estriol administration effectively prevents and treats UI in postmenopausal females.

[Long-term results of one-stage urogenital reconstruction in total epispadia and extrophy of the urinary bladder in adults].

Surgical treatment of 34 patients with total epispadia and extrophy of the urinary bladder aged 15-33 years consists in one-stage extending corporoplasty, extending urethroplasty, granuloplasty, spongioplasty and sphincteroplasty. This novel method of one-stage urogenital reconstruction in adult males with total epispadia and extrophy of the urinary bladder provided satisfactory cosmetic results in all the patients and functional results in 68% patients, improved quality of life, social and sexual adaptation in patients with the above serious conditions. Postoperative complications and relevant prophylaxis are described.

[The action of low-intensity extremely high-freguency electromagnetic radiation on growth parameters for bacteria Enterococcus hirae].

It has been found that the exposure of Enterococcus hirae ATCC9790, grown under anaerobic conditions for 30 min or 1 h, to low-intensity (flux capacity 0.06 mW/sm2) coherent electromagnetic radiation (EMI) of extremely high-frequency 45 - 53 GHz), or millimeter waves causes a marked prolongation of the lag-growth phase and a decrease in their specific growth rate, the inhibitory effect increasing in the frequency range from 49 to 53 GHz. The effect enhanced as duration of expocure was encreased from 30 min to 1 h; however, further increase in exposure duration to 2 h did not cause an enhancement of the effect. It has been shown that the action of extremely high-frequency EMI on these bacteria does not depend on medium pH (pH 8.0 or pH 6.0). It is proposed that these bacteria have defensive or reparation mechanisms which compensate for the action of radiation; the occurrence of different mechanisms for pH regulation is not ruled out.

[A morphological investigation of supramolecular structural changes in biomembrane models under the influence of medicines].

The supramolecular structure of multicomponent lyotropic systems sodium pentadecylsulfonate-colchicines-water and sodium pentadecylsulfonate-essentiale-water has been studied by polarizing microscopy. The mesomorphism and phase changes depending on the composition and concentration of constituent compounds of the systems were established.

[The problem of surgical intervention classification in HVI-infected patients].

The actuality of HVI-infection problem for civilian health system and for medical service of RF Armed Forces is undoubted. During the period from 1999 to 2004 383 patients with surgical pathology against the background of HVI-infection were hospitalized in Saratov and Ulyanovsk regions. Basing on the experience of their treatment the classifications of invasive diagnostic and surgical interventions in HVI-infected persons were developed. The substantiation of operative treatment standards (urgent and planned) as well as closely connected with them methods of preoperative preparation and postoperative manage of HVI-infected patients could be the purpose of further investigations.

Identification of MEFV-independent modifying genetic factors for familial Mediterranean fever.

Familial Mediterranean fever (FMF) is a recessively inherited disorder predisposing to renal amyloidosis and associated with mutations in MEFV, a gene encoding a protein of unknown function. Differences in clinical expression have been attributed to MEFV-allelic heterogeneity, with the M694V/M694V genotype associated with a high prevalence of renal amyloidosis. However, the variable risk for patients with identical MEFV mutations to develop this severe complication, prevented by lifelong administration of colchicine, strongly suggests a role for other genetic and/or environmental factors. To overcome the well-known difficulties in the identification of modifying genetic factors, we investigated a relatively homogeneous population sample consisting of 137 Armenian patients with FMF from 127 independent families living in Armenia. We selected the SAA1, SAA2, and APOE genes-encoding serum amyloid proteins and apolipoprotein E, respectively-as well as the patients' sex, as candidate modifiers for renal amyloidosis. A stepwise logistic-regression analysis showed that the SAA1alpha/alpha genotype was associated with a sevenfold increased risk for renal amyloidosis, compared with other SAA1 genotypes (odds ratio [OR] 6. 9; 95% confidence interval [CI] 2.5-19.0). This association, which was present whatever the MEFV genotype, was extremely marked in patients homozygous for M694V (11/11). The risk for male patients of developing renal amyloidosis was fourfold higher than that for female patients (OR=4.0; 95% CI=1.5-10.8). This association, particularly marked in patients who were not homozygous for M694V (34.0% vs. 11.6%), was independent of SAA1-allelic variations. Polymorphisms in the SAA2 or APOE gene did not appear to influence susceptibility to renal amyloidosis. Overall, these data, which provide new insights into the pathophysiology of FMF, demonstrate that susceptibility to renal amyloidosis in this Mendelian disorder is influenced by at least two MEFV-independent factors of genetic origin-SAA1 and sex-that act independently of each other.

[The characteristics of the oral health promotion of patients with hematological diseases]. / Osobennosti sanatsii polosti rta u bol'nykh gematologicheskimi zabolevaniiami.

A total of 197 patients were subjected to planned sanitization of the oral cavity in St. Petersburg specialized dental hospital for short-term treatment. Critical values of blood parameters were determined for preventing the complications after planned sanitization. The probability of complications is lower if blood hemoglobin level is at least 100 g/liter, granulocyte count at least (1.5-2.0).10(9)/liter, platelet count at least 60.10(9)/liter, and erythrocyte content in patients with polycythaemia vera no more than (4.5-5.0).10(12)/liter. Preparation of patients to treatment carried out by a dentist together with a hematologist and total analgesia help eliminate stress reactions and effectively and timely correct the complications developing during treatment. This means that oral sanitization in patients with diseases of the blood system should be carried out at dental hospitals for short-term treatment.

[The incidence of pathological microbial colonization and the adaptational characteristics of newborns with intrauterine hypotrophy]. / Chastota patologicheskoi mikrobnoi kolonizatsii i osobennosti adaptatsii novorozhdennykh s vnutriutrobnoi gipotrofiei.

A total of 103 full-term small-for-date newborns were examined, as was a control group of normal full-term babies born to healthy mothers. Bacteriologic studies carried out in 148 newborns revealed most frequently Klebsiella, enterobacteria, Proteus, staphylococci, yeast fungi, and various associations thereof. If such microflora is found in small-for-date newborns, prophylactic antibiotic therapy is advisable to prevent the development of grave infections.

[A surgical method for conization of the cervix uteri]. / Operativen metod za konizatsiia na matochnata shiika.

Uterine neck conisation and the restoration methods applied after it are well-known. On the basis of 48 women admitted to the clinic for cervix uteri conisation on different indications the authors suggest a new method for the spontaneous epithelialization of the defect thus obtained. The operated patients have been under medical supervision and examined in the first and sixth month after the intervention. The results obtained show a complete epithelialization of the excised surface and no change in the anatomical characteristics of the uterine neck.

Telemedicine and international disaster response: medical consultation to Armenia and Russia via a Telemedicine Spacebridge.

UNLABELLED: The Telemedicine Spacebridge, a satellite-mediated, audio-video-fax link between four United States and two Armenian and Russian medical centers, permitted remote American consultants to assist Armenian and Russian physicians in the management of medical problems following the December 1988 earthquake in Armenia and the June 1989 gas explosion near Ufa. METHODS: During 12 weeks of operations, 247 Armenian and Russian and 175 American medical professionals participated in 34 half-day clinical conferences. A total of 209 patients were discussed, requiring expertise in 20 specialty areas. RESULTS: Telemedicine consultations resulted in altered diagnoses for 54, new diagnostic studies for 70, altered diagnostic processes for 47, and modified treatment plans for 47 of 185 Armenian patients presented. Simultaneous participation of several US medical centers was judged beneficial; quality of data transmission was judged excellent. CONCLUSION: These results suggest that interactive consultation by remote specialists can provide valuable assistance to on-site physicians and favorably influence clinical decisions in the aftermath of major disasters.

Telemedicine and international disaster response. Medical consultation to Armenia and Russia via a Telemedicine Spacebridge.

UNLABELLED: The Telemedicine Spacebridge, a satellite-mediated, audio-video-fax link between four United States and two Armenian and Russian medical centers, permitted remote American consultants to assist Armenian and Russian physicians in the management of medical problems following the December 1988 earthquake in Armenia and the June 1989 gas explosion near Ufa. METHODS: During 12 weeks of operations, 247 Armenian and Russian and 175 American medical professionals participated in 34 half-day clinical conferences. A total of 209 patients were discussed, requiring expertise in 20 specialty areas. RESULTS: Telemedicine consultations resulted in altered diagnoses for 54, new diagnostic studies for 70, altered diagnostic processes for 47, and modified treatment plans for 47 of 185 Armenian patients presented. Simultaneous participation of several US medical centers was judged beneficial; quality of data transmission was judged excellent. CONCLUSION: These results suggest that interactive consultation by remote specialists can provide valuable assistance to on-site physicians and favorably influence clinical decisions in the aftermath of major disasters.

[Streptococcal infection and chronic glomerulonephritis in children]. / Streptokokkovaia infekstiia i khronicheskii glomerulonefrit u detei.

Microbiological, immunological and immunohistochemical studies were carried out in 78 children with different clinicomorphological forms of chronic glomerulonephritis (GN). According to the data obtained, the role of streptococcal infection (SI) is inconclusive in certain clinicomorphological forms of chronic GN, suggesting different approaches to the treatment of these patients. The etiological role of SI is most probable in mesangioproliferative and mesangiocapillary GN, manifesting by hematuric and mixed forms of chronic GN. Antibacterial therapy is indicated to patients with a rise of the level of ASL-O and with the clinical signs of acute SI or exacerbation of chronic tonsillitis in the same patients, especially during immunosuppressive therapy.

[Rendering qualified medical services to patients with fractures of long tubular bones]. / Okazanie kvalifitsirovannoi meditsinskoi pomoshchi postradavshim s perelomami dlinnykh trubchatykh kostei.

The conditions for rendering aid to and treatment of the injured in extreme situations require insistantly the development of new methods for skilled medical service. From analysis of treatment of 114 patients with fractures of the long tubular bones the authors conclude that the use of various types of pin apparatuses for this purpose is expedient because they possess advantages over the nail apparatuses. Analysis of treatment of 90 patients showed the expediency of using some auxiliary devices for immobilization of peripheral erimetaphyseal fractures and oblique and spiral diaphyseal fractures.

[Endoprosthesis of the elbow joint in sequelae of gunshot wounds]. / Endoprotezirovanie loktevogo sustava pri posledstviiakh ognestrel'nykh ranenii.

5 patients have been implanted the endoprostheses of Sivash K. M. to restore functions of the upper limb after the gunshot injury in the area of elbow joint with the clinico-roentgenologic bone defect detection. Coarse cicatricial changes in the area of an articulation with presence of foreign bodies are characteristic for those patients. There have been achieved significant improvement of restoration of active movement of elbow joint and upper limb in whole with 4 of them in spite of high danger of possible post-operative inflammation. In one case due to hard physical labour there have been noted break of an endoprosthesis with the subsequent inflammation. The endoprosthesis has been removed. The most stable positive outcomes proved by physiological tests of the neuromuscular system of upper limbs are observed at endoprosthetics of elbow joint with replacement of the soft tissue defect with completely vascularized musculocutaneous autotransplant.

Sonographic screening of mass casualties for abdominal and renal injuries following the 1988 Armenian earthquake.

The value of sonography in acute trauma evaluation is generally underestimated, and the opinions are controversial. Sonography was performed as a primary screening procedure in 400 of 750 mass casualty patients with trauma admitted to a large hospital within the first 72 hours after the 1988 Armenian earthquake. Two real-time sector scanners were used in the reception area of the hospital, and the average time spent on one patient was 4 minutes. More than 130 followup sonographic examinations were required. Trauma-associated pathology of the abdomen and retroperitoneal space was detected in 12.8% of the patients, with 1% false negatives and no false positives. The authors believe that sonographic screening of mass casualties is a quick and effective means for detection of abdominal and retroperitoneal injuries. Sonography should be used for this purpose more routinely to gain experience and maintain preparedness of the sonographers for screening of trauma cases in mass casualty situations.