[Surgical treatment of osteomyelitis of the frontal bone and the walls of the frontal sinus]. / Khirurgicheskoe lechenie osteomielita lobnoi kosti i stenok lobnoi pazukhi.

Having in view observations made during surgical treatment of 21 patients with frontal bone osteomyelitis of traumatic (18 patients) and rhinogenic (3 patients) origin, three varieties of osteomyelitis can be distinguished, viz. osteomyelitis of frontal squama, osteomyelitis of frontal sinus wall, and mixed osteomyelitis involving nasal bones. Three therapeutic approaches are recommended: closed healing of the wound after dissecting the fistula and removal of osteomyelitic bone lesions, drainage of frontal sinuses via the frontonasal anastomosis, and tamponade of the cavity, that developed after the resection of the pathological focus, with the host muscle tissue. In advanced osteomyelitis of the frontal sinus walls, preference should be given to the neurosurgical approach with a wide revision of the pathological focus, removal of the mucosa, suppurative epidural layers and further formation of an enlarged frontonasal anastomosis and prolonged drainage of the cavity for 24 to 30 days. When treating osteomyelitis of frontal squama with its significant enlargement, the most efficient method is tamponade of the cavity formed by the hard membrane, skin and bone with the host muscle. Small osteomyelitic lesions of the frontal bone can be removed by dissecting the fistula, 3-4 day draining and suturing the wound.

[Neurologic symptoms and their dynamics in contusions of the spinal cord of mild and moderate severity at the level of the 1st and 2d cervical vertebrae]. / Nevrologicheskie simptomy i ikh dinamika pri ushibakh spinnogo mozga legkoi i srednei stepeni tiazhesti na urovne I i II sheinykh pozvonkov.

The results of the study of 154 patients with an acute trauma of the cervical portion of the vertebral column showed that fractures, dislocations and fractures/dislocations of the first-second cervical vertebrae accounted for 10.4% of all the studied cases. In mild contusion of the first-second segments the leading clinical symptoms in the acute period were pareses of the arms and paralyses of hands with retained reflexes and insignificant impairments of sensitivity in fingers, i.e., the level of clinical manifestations did not correspond with the conventional segmento-metameric innervation. In the acute period of contusions of moderate severity tetraplegia is formed, which, however, does not affect the reflexes. Timely elimination of the compression helps to restore motor activity and sensitivity first in the legs and the body and later in the arms. In the long term of the injury motor activity in the arms recovers and the leading clinical symptoms become manifestations of pyramidal deficiency with insignificant sensitivity disorders in the hands and feet, predominantly of a subjective-radicular nature.

[Prevention and treatment of the complications of peridurography]. / Profilaktika i lechenie oslozhnenii pri poiasnichnoi peridurografii.

In lumbar peridurography conducted in 117 patients with discogenic radiculitis complications occurred both in the stage of peridural anesthesia and after introduction of the radiocontrast medium. During anesthesia the dura mater was punctured in 4 patients, in another 2 patients dicaine penetrated into the subarachnoid space and caused spinal anesthesia with a high upper level. Peridural anesthesia with paralysis of the respiratory musculature developed in 1 patient. After the injection of the radiocontrast medium, spasm in the lower extremities and trunk of the type of spinal epilepsy developed in 4 patients. The clinical picture, prevention, and treatment of these complications are discussed.

[Clinical picture of single and multiple rhinogenic brain abscesses]. / Klinika edinichnykh i mnozhestvennykh rinogennykh abstsessov golovnogo mozga

The authors examined 11 patients with rhinogenous abscesses of the brain aged from 2 to 45, 5 of them with multiple abscesses. According to their data the infection penetrated into the cranial cavity by two principal ways, namely, contactual (in 2 patients) and hematogenous via venous passages (in 4 patients). Contactual cerebral abscesses of rhinogenous genesis more frequently appear during frontitis, have a lingering chronic course and localize at the pole of the frontal lobe. Clinically they manifest themselves by focal and total cerebral symptoms including craniographic changes of hypertensive character. In patients with rhinogenous abscesses of phlebitic genesis a subacute course of the disease was noted. In addition to focal and total cerebral symptoms of general intoxication charater the authors noted in such cases symptoms of depression of the superior truncal structures of the brain. Cerebral abcesses of contactual and phlebitic genesis have mostly a benign course after surgical treatment (out of 6 patients there was only 1 lethal case). Hematogenous spreading of the infection along the arteries is often noted to cause multiple cerebral abscesses (in one or in both lobes) and is frequently accompanied by suppurative meningitis, periventriculitis. All cases of mutiple rhinogenous abscesses had a lethal end.