[The cochlear implantation in patients with syndromic deafness. Clinical examples]. / Osobennosti provedeniya kokhlearnoi implantatsii u patsientov s sindromal'noi glukhotoi.

OBJECTIVE: To describe clinical observations of patients with syndromic deafness. RESULTS: Deaf patients with CHARGE, Crouzon, and Wildervanck syndromes were monitored at the Russian Research Clinical Center for Audiology and Hearing Rehabilitation (Moscow) in different years. All of them were diagnosed having bilateral congenital deafness. After collecting anamnesis, evaluating the results of computed tomography of the temporal bones, and audiological examination, it was decided to conduct the cochlear implantation. CONCLUSION: The only method that allows patients with bilateral congenital deafness to gain hearing is the cochlear implantation. The malformations of the tympanic cavity structures, an abnormal course of the facial nerve canal lead to technical difficulties during the surgical stage of cochlear implantation. The navigation equipment, monitoring of the facial nerve makes it easier to find anatomical structures, as well as to avoid injuries.

[Surgical treatment of lung injuries and diseases in patients with blunt chest trauma]. / Khirurgicheskoe lechenie povrezhdenii i boleznei legkikh u patsientov s zakrytoi travmoi grudi.

OBJECTIVE: To establish the indications for optimal open lung surgery in patients with severe blunt chest injury. MATERIAL AND METHODS: Hematomas, lung wounds and purulent pulmonary complications were studied in four groups of victims. Causes of injuries included road accidents (n=426), falling and beating (n=387), catatrauma (n=217), squeezing the body with a massive weight (n=46). Majority of victims (n=731, 67.9%) were transferred to the hospital within 1-5 hours after injury; 345 (32.1%) patients were transferred from other hospitals to treat combined injuries of head, chest, abdomen and complications within 1-49 days after injury. RESULTS: Lung surgery was applied in 48 patients. Typical resections and pneumonectomies made up 77.1%. Indications for surgery included lung wounds complicated by pulmonary hemorrhage grade IIa and severe hemothorax, intrapulmonary hematoma ≥6 cm with high risk of bleeding and suppuration, gangrene, gangrenous and purulent abscesses of aspiration genesis, lung cancer first diagnosed in victims. Postoperative mortality was 14.6%. Twelve victims with unrecognized deep lung wounds and pulmonary root rupture were not operated. Thus, 5.6% of victims with severe blunt chest trauma need for open lung surgery.

[Surgical technique in patients with chronic pancreatitis]. / Optimizatsiia tekhniki operatsii u bol'nykh khronicheskim pankreatitom.

AIM: To justify ligation of vascular branches of anterior pancreateroduodenal arterial arch or gastroduodenal artery prior to bifurcation. MATERIAL AND METHODS: This method was tested on sufficient clinical material: 147 patients with recurrent chronic pancreatitis. The interventions are presented by Frey, Beger procedures and its Berne variant. RESULTS: Comparative analysis showed reliable advantages of vascular ligation during pancreatectomy.

Production of Brewster angle thin film polarizers using a ZrO2/SiO2 pair of materials.

The production of polarizers for high-intensity applications based on a ZrO2/SiO2 pair of thin film materials is discussed. A special approach to accurate determination of a ZrO2 refractive index and the application of direct broadband optical monitoring enable obtaining good manufacturing results.

Numerical Simulation of Light Propagation and Scattering in Turbid Biological Media.

This article considers the processes of light propagation and scattering in biological tissues. The results obtained made it possible to estimate basic signal parameters and their dependence on various optical parameters with respect to the laser Doppler flowmeter and laser Doppler microscope. We also developed a new method to determine the indicatrix asymmetry of single and multiple light scattering by a suspension of oriented spheroidal particles that simulated erythrocytes in a shear flow. It was found that the angular dependence of the asymmetry index provides information on the shape and orientation of particles. In addition, we obtained single scattering indicatrices, which may improve the accuracy of computer simulation of light scattering by blood.

[Reoperations after cochlear implantation]. / Reoperatsii pri kokhlearnoi implantatsii.

The objective of the present study: the improvement of the quality and effectiveness of the surgical stage of cochlear implantation on the basis of the comprehensive analysis of performed reoperations. PATIENTS: 84 patients of the 2413 ones who had undergone cochlear implantation were re-examined by revision surgery within various periods after the first intervention. MAIN RESULTS: In certain patients, the correction of the intracochlear electrode array position was performed and in 72 cases the replacement of the implant was done. The most frequent cause of the replacement of the implant was the failure of the device. In the case of the extrusion and inflammation, the two-stage surgical treatment was applied. The exposure of the different parts of the cochlear implant with the duration up to 2 weeks was considered as a complication which could be adequately corrected. The surgical treatment of such patients was carried out in a single stage. The reparation processes at the place of the first intervention were strongly expressed, especially in children. Standardization of the cochlear implantation surgical stage based on the determination of its optimum volume in our Center led to a decrease in the number of reoperations and made the learning process easier to master for young otosurgeons. CONCLUSION: It is can be concluded that the reoperation after primary cochlear implantation is a highly effective technique and, taking into account the listed features, doesn't present difficulties for the qualified otosurgeon.

[The new technologies for the intraoperative registration of the electrically evoked compound action potentials of the acoustical nerve by means of the neural response telemetry method].

The present article reports the results of a clinical study of the new wireless device CR120 designed for the intraoperative registration of electrode resistance and the electrically evoked compound action potential (EAP) of the acoustical nerve by means of neural response telemetry. The study has demonstrated the high effectiveness of the application of the new wireless device in clinical practice. It was shown that the registration of electrically evoked compound action potential with the help of the CR120 Intraoperative Remote Assistant took 22% less time than by the conventional method (p<0.001). Moreover, the trial revealed the strong correlation between the threshold EAP values recorded with the use of the new device and by the classical method.

[Mechanical damage and spontaneous esophageal perforation].

The article presents the results of treatment of 95 patients with iatrogenic damages and perforations caused by other reasons and spontaneous rupture of the esophagus. A defect of the esophagus was formed in thoracic part in 67.4% cases. Combined suppurative complications such as a neck phlegmon, mediastinitis, pleural empyema, pericarditis, pneumonia and lung abscess occurred in prevalent majority of patients. Surgical interventions were performed through cervical, thoracotomical and laparoscopical accesses. Different plastic methods of covering sutures of the esophagus were used in conditions of suppurative inflammation in 33 patients. An inconsistency of sutures was noted in 6 (18.2%) cases. Postoperative lethality consisted of 34.6% in spontaneous rupture of the esophagus and it was 11.9% in case of other damages.

[The state of microcirculation in the middle ear structures at different stages of the treatment of the patients presenting with chronic otitis media].

The present work was designed to study dynamics of blood circulation in the tympanic membrane and tympanic cavity mucosa of 92 patients (105 ears) presenting with otosclerosis, adhesive non-perforative otitis media, and different stages of chronic suppurative otitis media. Normal characteristics of tympanic microcirculation were determined in 22 otologically healthy volunteers (30 ears). Laser Doppler flowmetry with the use of a specially designed probe (the outer diameter: 1.9 mm) was applied. The results of Doppler flowmetry varied in ontologically healthy subjects. The same circulation parameters in the vessels of the microcirculatory bed of the postero-superior quadrant of the tympanic membrane in the patients presenting with chronic suppurative otitis media at the stage of remission, otosclerosis, and adhesive non-perforative otitis media did not significantly differ from those of otologically healthy subjects. The blood flow was shown to increase in the tympanic membrane of the majority of the patients during the postoperative period (within 2nd to 4th weeks after types I-III tympanoplasty); thereafter, it either decreased or returned to the baseline level by weeks 6-8. Four months after the improvement of perfusion parameters of tympanic cavity mucosa and the arrest of exacerbation of mesotympanitis, characteristics of microcirculation in tympanic cavity mucosa were not significantly different from those of the patients with adhesive perforative otitis media. It is concluded that laser Doppler flowmetry may be used as an objective non-invasive technique for the study of microcirculation in the tympanic membrane and tympanic cavity mucosa.

[The evolution of surgical interventions for cochlear implantation at the Russian Research and Practical Centre of Audiology and Hearing Rehabilitation].

The objective of the present study was to estimate and analyse the effectiveness and labour intensity of the methods of surgical intervention for cochlear implantation. The analysis of the surgical stage of cochlear implantation was based on the examination of 2073 children and adults during the period from 1991 to 2013. The age of the patients varied between 6 months to 71 years. The cause of deafness was meningitis and an injury in 11% and 6% of the patients respectively. The cochlear implants from Advanced Bionics were inserted in 495 patients, those from Med-El in 9 ones , and from Neurelec in 20, and Nucleus devices from Cochlear in the remaining patents (n=1549) including 37 double-array electrodes and a Hybrid implant for electroacoustic correction of hearing . The implants with a straight and perimodiolar electrode were placed in a roughly equal number of the patients. The rationale for the performance of selected components of the surgical stage of cochlear implantation was developed along with the technical procedures for the purpose applied at this Centre since 1991. The original methods for the fixation and covering of the receiver-stimulator and also for the choice of the place of the electrode array insertion into the cochlea are described. They allowed to significantly decrease the frequency of complications, duration and extent of the surgical intervention as well as to reduce to a minimum post-operative manipulations.

Design and production of antireflection coating for the 8-10 µm spectral region.

A special design procedure allowing to trap layer thicknesses inside specified limits is applied for designing of antireflection coating (AR) for the infrared spectral band of 8-10 µm. The obtained AR design has no too thick layers that may cause delaminating of the deposited AR coating. A special monitoring procedure taking into account wavelength positions of monitoring signal extrema is applied for coating deposition. The manufactured coating features excellent AR properties in the requested spectral region and possesses high mechanical stability.

[Psychoemotional stress and somatic diseases in veterans of special risk units].

Participants of nuclear-powered submarine accident liquidation and special risk units' veterans participating in surface nuclear weapon tests as well as in liquidation of their consequences have been examined. It has been established that functional state of this category of people is difficult to interpret only in the context of radioactive irradiation effect or injuring stress factor exposure. This state is determined by a complex of psychotraumatic factors tending to become aggravated and characterizing by their individual significance and absolute or relative insolvability. In most representatives of this category the disease is manifested by psychopathologic syndrome of neurotic disorders (low spirits, emotional lability, asthenia, anxiety) and somatic disturbances as dysfunction of the cardiovascular, respiratory, digestive and other systems. The results obtained provide the pathogenetic substantiation of efficient ways and methods for rehabilitation of the special risk units' veterans. The data prove the necessity of appropriate correction of cardiovascular disorders in practically healthy servicemen residing under conditions of psychoemotional tension.

[Stapedoplasty: one technology, two types of protheses].

The article presents postoperative results of stapedoplasty depending on the type of prosthesis (Teflon or titan). The technique of the operation was the same but snapping the prosthesis around a long process of the incus in application of titan prostheses. Thickness of tephlon prostheses was 0.8-1.0 mm, titan - 0.6-0.8 mm, the length of both prostheses was adjusted individually from 3.5 to 4.25 mm. Efficacy of the prostheses was assessed in 0.125-2 kHz and 3-8 kHz tests.

[Efficacy of various epidural analgesia regimens after lung surgery].

A prospective study included 90 adult patients undergoing thoracic surgery. After placing an epidural catheter at the Th4-Th5 level, all the patients were randomized in 3 groups. Twenty-nine patients received controlled epidural analgesia (PCEA) with fentanyl, 2 microg/ml, in 0.2% bupivacaine solution (Group 1). In other groups, these analgesics were given either as bolus infections (Group 2; n = 30) or as a continuous epidural infusion of fentanyl, 2 microg/ml, in 0.2% bupivacane solution (Group 3; n = 27). Pain scores and the incidence of adverse effects were assessed within the first 24 hours after surgery. The data were compared using the Student's t-test and x2 test with Bonferroni correction; p < 0.017 was regarded as statistically significant. The VAS scores in coating were significantly lower in Group 1 than in Groups 2 and 3. The need for epidural opioids for adequate analgesia within the first 24 hours after surgery was significantly less in Group 1 than in Groups 2 and 3. There were no excessive sedation episodes in all the groups. In Group 2, the incidence of nausea was 20%. These adverse reactions were not found during PCEA and continuous infusion (p < 0.017). Opioid-induced pruritus was mostly (23%) observed in Group 2. Thoracic PCEA with fentanyl-bupivacaine solution provided adequate postoperative analgesia after thoracotomy and reduced the need for opioids. In addition, PCEA reduced the incidence of adverse reactions of opioids.

[The influence of some retarding agents NOS of dihydrothiazine-thiazoline rank on postradiational of recovery endogenous CFU-S-8 of mice].

In this work the attempt to estimate a nitric oxide (NO*) role in regulation of the number of pool haemopoietic stem cells at the irradiated mice was made. With this purpose the number of new compounds from dihydrothiazine-thiazoline line was synthesized, their NO-inhibiting activity was investigated in vivo by the method of ESR-spectroscopy of spin trap and their influence on an output endogenous spleen colonies (CFU-S-8) after the total sublethal y-irradiation of mice in a doze of 6 Gy was also investigated. Was shown, that the tested compounds reduced the contents of NO* in a liver tissue of mice which have received an injection of nitric oxide synthesis inductor - lipopolysaccharide, and also increased an output CFU-S-8 forming endogenous colonies in the spleen of the irradiated mice. Received data testify to perceptivity of search radioprotective agents among NO* synthesis inhibitors.

[The role of a cutaneous cut in safe covering of a receiver-stimulator in cochlear implantation].

The aim of the study was to compare efficacy of cutaneous cuts of various length in placement of a receiver-stimulator behind the ear. Conditions for ligature fixation of the cochlear implant receiver-stimulator as well as the state of soft tissues at the site of the intervention in the postoperative period are analysed. Cochlear implantation was made in 55 patients using implants CI 22M, 24M, Combi 40+. Group 1 included 38 patients (21 children aged 1 year 9 months to 14 years, mean age 7.07 +/- 0.9 years, and 17 adults) operated with an U-cut in the endaural variant, 17 patients (age 1 year 8 months to 15 years, mean age 7.06 +/- 1.2 years) operated with a vertical cut in addition of original subcutaneous flaps entered group 2. The number of complications related to soft tissues and postoperative suture in children of group 1 was significantly higher than in group 2 (p<0.05, t=2.0).

Structure and activity of NO synthase inhibitors specific to the L-arginine binding site.

Synthesis of compounds containing a fragment similar to the guanidine group of L-arginine, which is a substrate of nitric oxide synthase (NOS), is the main direction in creating NOS inhibitors. The inhibitory effect of such compounds is caused not only by their competition with the substrate for the L-arginine-binding site and/or oxidizing center of the enzyme (heme) but also by interaction with peptide motifs of the enzyme that influence its dimerization, affinity for cofactors, and interaction with associated proteins. Structures, activities, and relative in vitro and in vivo specificities of various NOS inhibitors (amino acid and non-amino acid) with linear or cyclic structure and containing guanidine, amidine, or isothiuronium group are considered. These properties are mainly analyzed by comparison with effects of the inhibitors on the inducible NOS.

[Computed tomography in the evaluation of cochlear structural features in cochlear implantation].

Temporal bone computed tomographic scans were studied in 136 deaf patients of different age and sex, including 56 patients (39 children and 17 adults) rehabilitated with cochlear implantation (CI). The mean values of the cochlear parameters that are important for the results of a surgical CI stage, namely: the diameter of the cochlear base (DCB), the diameter of the basal helix, the height of the cochlea, the angle between the cochlear base and the promontorial wall, were calculated. These parameters were compared in different age groups. A correlation was determined for each of the studied parameters and for the depth of intracochlear insertion of electrodes. There was a significant correlation between DCB and the depth of insertion of the electrodes of CI22M and CI24M cochlear implants. DBC at which the active part of the electrode chain of an implant could be significantly more frequently placed in the tympanic scala of the cochlea was estimated.

Effect of NO synthase inhibitor 2-amino-5,6-dihydro-4H-1,3-thiazine on endotoxin-induced changes in hemodynamic parameters and respiration in rats.

We studied the effect of NO synthase inhibitor 2-amino-5,6-dihydro-4H-1,3-thiazine (2-ADT) on the cardiovascular system in rats with endotoxic shock. Blood pressure, heart rate, and respiratory rate were recorded. E. coli lipopolysaccharide decreased blood pressure and heart rate. 2-ADT in a dose of 5 mg/kg normalized these hemodynamic parameters. The normalizing effect of 2-ADT decreased with increasing the dose of this preparation. 2-ADT in high doses (10, 20, and 30 mg/kg) and repeated injections of the preparation caused death of experimental animals.

[Comparative analysis of approaches to surgical cochlear implantation in adults and children]. / Sravnitel'nyi analiz sovremennykh podkhodov k khirurgicheskomu étapu kokhlearnoi implantatsii u vzroslykh i detei.

The aim of a surgical stage of cochlear implantation (CI) is to place the implanted part of the device in the temporal space. Criteria of the decision on the side of the intervention and components of it in CI are outlined. To help selection of an optimal variant of surgical intervention in CI at the initial stage, the techniques of the implanted parts insertion are reviewed. Types of skin cuts, approaches to the cochlea, location of cochleostoma, methods of fixing the stimulator are described. The importance of intraoperative registration of the musculus stapedius reflex and action potential of the acoustic nerve in response to cochlear electrostimulation is emphasized. Basing on the experience of treating 38 deaf patients, the author states that for effective performance of the operation it is desirable to conduct reverse U-cut of the skin, make posterior tympanostoma, cochleostoma in the basic cochlear margin, suturing of the cut with intracutaneous suture.