[Preventability of perinatal losses by the example of the large industrial cities Chelyabinsk and Novosibirsk]. / Predotvratimost' perinatal'nykh poter' v Cheliabinske i Novosibirske.

Perinatal mortality rate is an indicator that characterizes the quality of medical care, as well as the social and economic situation in the region. OBJECTIVE: to audit perinatal losses in large regional centers of the Russian Federation with a population of over 1 million inhabitants, such as Chelyabinsk and Novosibirsk. MATERIAL AND METHODS: A comprehensive postmortem examination of 309 cases of perinatal losses in 2016 was made, which was supplemented with an assessment of preventability according to the Scandinavian-Baltic classification. RESULTS: The rate of preventable deaths in Chelyabinsk and Novosibirsk amounted to 91 and 81.5% of cases, respectively; the deaths were due to stillbirths at more than 28 weeks' gestation and to dead newborns in almost half of cases. The proportion of intranatal deaths was shown to increase in Chelyabinsk; the number of neonatal deaths at more than 33 weeks' gestation rose in Novosibirsk. CONCLUSION: Supplementing the traditional clinical and postmortem analysis with an assessment of the preventability of perinatal loss makes it possible to ensure a unified approach to evaluating these conditions and the comparability of autopsy results in different subjects of the Russian Federation and to determine regional reserves for reducing perinatal mortality rates.

[Assessment of the predisposing risk factors of the complicated postoperative course after combined operations].

Results of 335 combined operations were analyzed. Men were 89 (27%), women - 246 (73%), the majority of patients were of middle age. 285 (85%) operations included cholecystectomy. 195 (58%) patients had hernioplasty. The third place belonged to vascular operations - 76 (23%). Certain predisposing factors, correlating with the risk of the complicated postoperative course, were marked out. Indications and contraindications to the combined operation were assigned, based on the number of predisposing factors in a patient. Considering the increased risk of intraoperative complications during the combined operation (increased duration, blood loss), participation of highly experienced surgeons and use of modern high-tech equipment seem to be reasonable. The general results of the analysis prove that combined operations are effective, safe and economically beneficial.

[The nosological structure of mortality of low-weight fetuses in Novosibirsk].

The nosological structure of mortality was studied among low-weight fetuses, by analyzing 667 autopsy protocols over 2006-2008. There were 255 cases of spontaneous miscarriage and 412 cases of medically indicated abortion. Spontaneous and artificial abortions most frequently occur in repeated pregnant women at 26-27 weeks gestational age. In the nosological structure of fetal mortality, intrauterine fetal asphyxia was most commonly in spontaneous miscarriage; intrauterine pneumonias and generalized infection ranked second; in artificial abortion, the number of congenital malformations doubled and that of intrauterine fetal asphyxia reduced. In spontaneous and artificial abortions, the incidence of decompensated chronic placental insufficiency increased by twice.

[The nosological structure of congenital fetal malformations in Novosibirsk].

The authors comparatively studied the nosological structure of congenital malformations (CM) in 395 fetuses at 22-27 weeks post-conception age and the efficiency of prenatal diagnosis in Novosibirsk. They analyzed 227 and 168 autopsy protocols of fetuses with CM over the periods from 2000 to 2002 and from 2006 to 2008, respectively. In the nosological structure of mortality among low-weight fetuses, CM ranked third in 2000-2002 and second in 2006-2008. During all the observation periods, the structure of CM showed 4 major systemic CMs: multiple anomalies of development, the central nervous and urogenital systems, heart, and vessels; multiple CMs occupying a prominent place. There was a preponderance of hydrocephalus and spinal hernias among central nervous system CMs, that of hydronephrosis with megaureter among urogenital CMs, and that of ventricular septal defect among CMs of the heart and vessels. The efficiency of prenatal diagnosis in the above observation periods was 46-75%.

Granulomatous inflammation in the lungs of mice with systemic candidiasis receiving a composition of amphotericin B and dialdehyde dextran.

A composition of amphotericin B and dialdehyde dextran was used for the therapy of male C57Bl/6 mice with systemic candidiasis. The composition was more effective than free amphotericin B. A decrease in the number and size of candidal granulomas in the lungs was more significant after therapy with the study composition (compared to free amphotericin B).

Immunomorphological characteristics of animals with different levels of orientation and exploratory behavior.

We revealed some relationships between the level of orientation and exploratory behavior, functional activity of the immune system, and structural and functional organization of the CNS in animals. Significant differences in brain morphology and expression of cytokine IL-1 beta, type I IL-1 receptor, and erythropoietin receptor genes in brain cells were detected in (CBA x C57Bl/6)F1 mice with different initial levels of orientation and exploratory behavior. Immunocompetent cells of mice with high and low levels of exploratory behavior differ by spontaneous and mitogen-induced proliferative activity. The formation of humoral and cellular immune response in these animals causes opposite changes in exploratory behavior and the type of these changes depends on the initial level of this behavioral reaction.

[Bronchopulmonary and laryngeal symptoms of gastroesophageal reflux disease: diagnosis and treatment]. / Bronkhopul'monal'nye i laringeal'nye simptomy gastroézofagealnoi refliuksnoi bolezni: diagnostika i lechenie.

The article discloses the results of the examination and treatment of patients with gastroesophageal reflux disease, the course of which was complicated with extraesophageal (bronchopulmonary and laryngeal) symptoms. The authors managed to establish the connection between gastric reflux and pulmonary and laryngeal symptoms with a high degree of reliability, based on the results of functional methods of research (24-hour pH-measurement in the esophagus). The obtained results of the treatment testify to the efficiency of active surgical tactics in this group of patients.

[Functional results of laparoscopic antireflux surgery and causes of postoperative dysphagia]. / Funktsional'nye rezul'taty laparoskopicheskikh antirefliuksnykh operatsii i prichiny razvitiia posleoperatsionnoi disfagii.

Results of functional examination of 176 patients with gastroesophageal reflux disease are presented. 94 patients were were followed up from 1 month to 4 years after laparoscopic antireflux operation (82--by Nissen and Nissen--Rossetty, 6--by Dor, 6--by Toupet). After Nissen operation the pressure in the region of lower esophageal sphincter (LES) increased more than after partial fundoplication and remained the same during 4 years of follow-up (p < 0.05). Postoperative dysphagia in the majority of cases was associated with excessive increase of pressure and length of LES region, decrease of it capacity to relaxation during swallowing (p < 0.05). 360 degrees-fundoplication can not be recommended only in complete loss of contractile capacity of the esophagus.

[Ultrastructure of epithelioid cells in the dynamics of forming tubercular granules]. / Ultrastryktura épitelioidnykh kletok v dinamike formirovaniia tuberkuleznoi granulemy.

As shown by ultrastructural findings in epithelioid cells, their number and differentiation degree increase in granulomas of animals with chronic generalized tuberculosis. Isoniazid treatment stimulated differentiation of the monocytes into epithelioid cells and differentiation of the latter. A large number of epithelioid cells with adequate lysosomal apparatus may denote a risk of the destructive process in the affected organs. The efforts in the search for new potent anti-tuberculous drugs should be focused on their lysosomotropy, ability to stay long in the lysosomal apparatus being bactericidal and bacteriostatic, and to stimulate plastic processes in the macrophages.

[Changes in the granuloma in the experimental treatment of tuberculosis with a prolonged form of isoniazid]. / Izmeneniia granulemy pri lechenii tuberkuleza prolongirovannoi formoi izoniazida v éksperimente.

The main difficulties encountered in the treatment of the persistent forms of a chronic tuberculous process are associated with a difficult access to mycobacteria persisting in the vacuolar apparatus of macrophages that form granulomas as well as with a high level of toxic affections of the parenchymatous liver cells. The complex long-acting isoniazid preparation on the dextran basis and the scheme of its application prevented, to a considerable degree, the above complications under the experimental conditions and hence can be considered as promising for clinical use.

[Gallstone obstruction of the small intestine]. / Zhelchnokamennaia neprokhodimost' tonkoi kishki.

Six cases of gallstone obstruction of the small intestine are discussed. They were of interest because the operations were carried out by the same team of surgeons which made it possible to perfect the operative techniques. After intubation of the small intestine and aspiration of its contents, the stone was moved proximally for a distance of 40-50 cm. Enterotomy was conducted above the concrement. The intestine was cut for no more than 2 cm. The concrement was removed by exerting pressure on its lower pole. Although the size of the stone doubled versus the intestinal incision, the latter did not rupture in any of the cases and acquired the initial size. As a result, the intestinal suture was small, accurate, and did not distort the intestinal lumen. The nasointestinal catheter for postoperative decompression of the intestine was advanced to the ileocecal angle. Gallstone intestinal obstruction is characterized by an atypical (obscure) clinical picture which causes diagnostic difficulties and leads to delayed operative treatment. The obstruction is partial, the concrement moves continuously along the intestine, and the level of the obstruction is determined by the duration of the disease.

[Duodenogastric reflux in patients with peptic ulcer]. / Duodenogastral'nyi refliuks u bol'nykh iazvennoi bolezn'iu.

Complex study of the frequency and intensity of the duodenogastric reflux in 468 patients with peptic ulcer is analysed; 372 had duodenal ulcer and 96 had gastric ulcer. The authors give the characteristics of the diagnostic possibilities of X-ray, endoscopic, ionomanometric, and aspiration (radionuclide and biochemical) methods of examination of duodenal regurgitation. They proved the relation of the frequency and intensity of the duodenal regurgitation to the type of the ulcer and the phase of its course (exacerbation or remission), the condition of the pyloric closure function, and disorders of duodenal motor activity. The sequelae of long-term duodenogastric reflux are analysed; it is shown that patients must be examined in the preoperative period in the phase of remission so as to gain the true values of intensity of the reflux for its subsequent correction.

[Healing of experimental wounds under the effect of x-ray irradiation at high altitude]. / Zazhivlenie eksperimental'nykh ran pod vozdeistviem rentgenovskogo oblucheniia v usloviiakh vysokogor'ia.

Experiments were conducted on 969 mature rabbits; combined radiation injury (in general irradiation with 500 r and even more so in local irradiation with 2000 r) inflicated during the first two adaptation phases (particularly the first one) to the high altitide (3379 and 3640 m above the sea level) led to more profound morphological changes in the tissues and to the greater delay in the healing of the penetrating wounds on the pinna than in the valley (820 m above the sea level).