[Minimally invasive method of treatment of severe organic dysphagia].

Dysphagia occurs in the clinical picture of stenosing esophageal diseases as a first symptom, but shows an extensive-stage disease. The aim of the study was to examine the experiences of esophageal stents incurable patients and the formulation of indications and contraindications to their use. The study was conducted on 68 patients treated at the Department of General Surgery of the Kirov Medical Academy during 2007-2011 for cancer of the esophagus and gastric cardia, and 2 patients with benign esophageal strictures. The success of self-expanding stents esophageal stenting was 100% (that is technically able to put a stent in all patients). Thus, the self-expanding esophageal stent wire stents--is the most effective method used to maintain patency of malignant esophageal narrowing in inoperable esophageal cancer patients in stage IV, and is the primary treatment of choice for patients with esophageal fistulas malignant.

[The comparative effectiveness of high-intensity dynamic training with the use of exercise machines and therapeutic gymnastics for the joints in the patients presenting with early rheumatoid arthritis].

The objective of the present work was to compare the effectiveness of two therapeutic exercise programs for the patients presenting with early rheumatoid arthritis (RA). The study included 51 patients. Fifteen of them (group 1) were given conventional medicamental therapy in combination with high-intensity dynamic physical exercises with the use of the Enraf-Nonius training devices (45-60 min). Eighteen patients of group 2 were offered 10 sessions of remedial gymnastics for the joints (45 min each) under the guidance of an instructor that were continued under the domestic conditions (45 min each session thrice weekly for 3 months). Eighteen patients of group 3 were given medicamental therapy alone (control). The parameters estimated in the study included the mean strength of knee joint extension and ankle joint flexion measured with the use of En-TreeM devices, articular pain (100 mm BAHI), DAS28, HAQ, and RAPID3 indices. It was shown that both programs of therapeutic exercises reduced the severity of the disease, improved the functional and motor activity of the patients and their quality of life. The majority of these characteristics were significantly different from those documented in the control group (p<0.05). The clinical effectiveness of high-intensity training with the use of exercise machines was higher than without them (articular pain was reduced by 57.9% (p<0.01), DAS28 by 24.7% (p<0.05), HAQ by 60.7% (p<0.01). RAPID3 by 47.5% (p<0.01), mean strength of extension of the weak and strong knee joints increased by 87.9% (p<0.01) and 70.5% (p<0.01) respectively, the strength of flexion of the severely and less severely affected ankle joints increased by 84.6 (p<0.01) and 68.8% (p<0.01) respectively. Compliance with regular performance of therapeutic joint exercises during 3 months was higher (83.3%) than with high-intensity dynamic training with the use of exercise machines (60%). It is concluded that the latter modality should be recommended to the younger patients with RA (below 40 years), a short history of the disease, and its low activity.

[Combined step-by-step rehabilitation of the patients presenting with early-onset rheumatoid arthritis].

The objective of the present study was to develop the program for combined step-by-step rehabilitation of the patients presenting with early-onset rheumatoid arthritis (RA); the secondary objective was to estimate the effectiveness of this program. A total of 34 patients were recruited for the participation in the study. They received medicamental therapy in combination with the rehabilitative treatment during 6 months. The hospital-based treatment included therapeutic exercises for large joints under the supervision of a specialist (45 min), occupational therapy (45 min), local aerial cryotherapy of wrist, knee, and ankle joints (10 sessions 15 min each at a temperature of -60 degrees C), ortheses, and the educational program (4 daily studies 90 min each). The outpatient and home-based treatment included therapeutic exercises for large joints (45 min), wrist exercises (45 min) three times every week, ortheses. 26 patients received only medicamental therapy (control group). The following characteristics were measured: the average power of extension of knee joints and of flexion of ankle joints (by means of En-TreeM analysis of movements), wrist grip strength, articular pain (100 mm VAS, DAS28, HAQ, RAPID3 indices). The rehabilitative program ensured excellent compliance with basal therapy, reduced requirements for symptomatic medicines, and improved adherence to the methods for the formation of the correct movement patterns, orthesis wearing, and regular therapeutic exercises. The rehabilitative treatment resulted in the relief of articular pain by 70.4% (p < 0.01), decrease of DAS28 by 31.9% (p < 0.05), HAQ by 75.8% (p < 0.01), and RAPID3 by 60.1% (p < 0.01). The grip strength of the more seriously injured wrist increased by 44.9% (p < 0.05) and that of the less damaged one by 31.3% (p < 0.05). The average extension power of the weaker knee joint increased by 88.7% (p < 0.01) and that of the stronger joint by 67.7% (p < 0.01). The average flexion power of the more seriously injured ankle joint increased by 81.6% (p < 0.01) and that of the less damaged one by 70.2% (p < 0.01). The two groups were significantly different in terms of the majority of characteristics evaluated. It is concluded that the combined rehabilitative treatment helps to control the activity of the disease, enhances the functional abilities, improves the locomotor activity and quality of life of the patients with early-onset rheumatoid arthritis.

[The motor function of a gastric esophagus transplant according to the data of gastroimpedancemetry]. / Sostoianie motornoi funktsii zheludochnogo ézofagotransplantata po dannym gastroimpedansometrii.

The motor function of the artificial esophagus was studied in 50 patients at different terms after resection of the esophagus for cancer. It was found that the lower and middle parts of the transplant had normal gastric peristalsis, the upper part had hyperkinetic peristalsis with spastic contractions. Impaired peristalsis was observed in the esophagus stump in more than half of the patients.

[The optimization of an early rehabilitation program for cerebral stroke patients: the use of different methods of magneto- and laser therapy]. / Optimizatsiia programmy rannei reabilitatsii bol'nykh tserebral'nym insul'tom: primenenie razlichnykh metodik magnito- i lazerterapii.

Magnetotherapy and laser therapy were used in complex and complex-combined regimens in 75 patients after cerebral ischemic or hemorrhagic stroke starting on the poststroke week 4-5. Clinico-neurologic, neurophysiological and cerebrohemodynamic findings evidence for the highest effectiveness of neurorehabilitation including complex magneto-laser therapy in hemispheric ischemic and hemorrhagic stroke of subcortical location in the absence of marked clinico-tomographic signs of dyscirculatory encephalopathy. Complex-combined magneto-laser therapy is more effective for correction of spastic dystonia. Mutual potentiation of magnetotherapy and laser therapy results in maximal development of collateral circulation and cerebral hemodynamic reserve (84% of the patients). Complex effects manifest in arteriodilating and venotonic effects. Complex magneto-laser therapy is accompanied by reduction of hyperthrombocythemia and hyperfibrinogenemia.

[Gastric motility based on gastric impedance measurement data after truncal and combined vagotomies in duodenal ulcer]. / Sostoianie motoriki zheludka, po dannym gastroimpedansometrii, posle stvolovoi i kombinirovannoi vagotomii pri iazve dvenadtsatiperstnoi kishki.

The motor function of the stomach was investigated by the gastroimpedansometric method in 73 patients: 32 of them with ulcer of the duodenum before operation, 17--after truncal vagotomy and 13 after combined (anterior selective proximal and posterior truncal) vagotomy with Finney's pyloroplasty within the period from 4 to 10 years. Motor activity in the cardial and antral parts and the stomach body was evaluated using the computer medical complex "Gastrolog" by the indicator of local motility and contraction rate. The indicator of local motility was reliably higher in patients with ulcer of the duodenum than in healthy subjects. At later terms after truncal vagotomy a normokinetic type of motor activity was noted in all parts of the stomach, the level of motility of the antral part being reliably higher after combined vagotomy with saved anterior Latarget's nerve (p < 0.01).

[The intraoperative leaving of foreign bodies as a defect in surgical treatment]. / Intraoperatsionnoe ostavlenie inorodnykh tel kak defekt khirurgicheskogo lecheniia.

The work presents literary data and our own study results obtained in the cases of intraoperative leaving of foreign bodies in different categories and types of surgical interventions. Influence of the fact of foreign body leaving on outcome is analysed. The authors describe the causes of intraoperative leaving of foreign bodies and preventative measures of such medical care defect. Recommendations on medical tactics in the case of detection of foreign body left during operation are given.

[The hemodynamic effects of transcerebral electro- and electromagnetotherapy in stroke patients]. / Gemodinamicheskie éffekty transtserebral'noi élektro- i élektromagnitoterapii bol'nykh insul'tom.

The results of a 10-year prospective trial of physiotherapeutic factors in 350 convalescents after cerebral stroke are reviewed. Nonspecific aspects of mechanisms of therapeutic action of transcerebral physiotherapy (development of collateral circulation and cerebral hemodynamic reserve) and specific ones seen primarily in extracranial parts of major head arteries are shown.

[Combined vagotomy in the surgical treatment of patients with duodenal ulcer]. / Kombinirovannaia vagotomiia v khirurgicheskom lechenii bol'nykh s duodenal'noi iazvoi.

Short-term and long-term results of surgical treatment of 487 patients with duodenal ulcer were studied. In 337 patients (69.2%) truncal vagotomy was performed; in 94 patients (19.3%)--combined vagotomy; in 56 patients (11.5%)--selective vagotomy. With no lethal outcomes, the frequency of general surgical complications was 5.6% which did not depend on the type of vagotomy. According to the Visick criteria long-term excellent and good results were noted after truncal vagotomy in 90.4% of the patients, after combined vagotomy--in 88% and after selective proximal vagotomy--in 70% of the patients. With the same frequency of recurrent ulcers, diarrhea and dumping-syndrome combined vagotomy has some advantages in recovery of the motor evacuating function as compared with truncal vagotomy; yielding in frequency of diarrhea it has better long-term results by the Visick criteria as compared with selective proximal vagotomy and less frequency of recurrent ulcers.

[The acid-forming function of the stomach and its hormonal regulation after truncal and combined vagotomies]. / Sostoianie kislotoobrazuiushchei funktsii zheludka i ee gormonal'noi reguliatsii posle stvolovoi i kombinirovannoi vagotomii.

The acid-producing function of the stomach and the state of its hormonal regulation were assessed on the basis of the immediate and long-term follow-up results obtained after truncal (334 patients) and combined (96 patients) vagotomy for duodenal ulcer. According to the data of aimed endoscopic pH-metry and gastroimpedancemetry the acid level changes in different parts of the stomach and duodenum were the same at the nearest and remote periods as well as the dynamics of the main hormones responsible for the acid production.

[An individual approach to the surgical treatment and medical rehabilitation of duodenal ulcer patients]. / Individual'nyi podkhod k khirurgicheskomu lecheniiu i meditsinskoi reabilitatsii bol'nykh duodenal'noi iazvoi.

Since 1986 403 patients have been treated according to the following programme: successive preparation for surgery, the operative intervention chosen individually for each patient, the purposeful medical rehabilitation. Different types of vagotomy with draining operations were performed in 85.6% of the cases, stomach resection--in 14.4% of the patients. The mortality rate was 0%. The indications for various types of vagotomy, stomach resection and different types of draining operations were determined. Rehabilitation of 55% of the patients after the operative treatment took place at the gastroenterological department, the others--at an outpatient department. The indications for rehabilitation, its volume and time were established. The best remote results in the follow-up periods up to five years were obtained after truncal vagotomy and stomach resection. Ulcer recurrences were noted in 3.5% and 5.2% of the cases respectively. Recurrences of the disease were noted in 7.8% after combined vagotomy and in more than 20% after SPV. Nine patients out of 34 with recurrent ulcers were reoperated with good results, the others were successfully treated by conservative therapy.

[The morphofunctional status of the isoperistaltic gastric transplant for esophagoplasty]. / Morfofunktsional'noe sostoianie izoperistal'ticheskogo zheludochnogo transplantata dlia plastiki pishchevoda.

Thirteen patients with carcinomas of the esophagus underwent one-stage operations--extirpation of the esophagus without thoracotomy with simultaneous esophagoplasty using isoperistaltic gastric tube made of the greater curvature of the stomach, in posterior mediastinum with esophagogastrostomy in the neck. The morphofunctional state of the gastric transplants was investigated at early and late periods (for 8 months) after operations. The reduction of blood in the transplants to 40% of the initial, deterioration of acid production, depression of the motility, ischemic atrophy of mucosa and increased fibrosis in submucosa were revealed. Nevertheless satisfactory results of the isoperistaltic tubular esophagoplasty were obtained in 77% of patients in early periods and in 54% of the patients during the first year after operation.

[The bitemporal use of a UHF electrical field (27.12 MHz) in the early recovery period of acute cerebral circulatory disorders: the viscous-elastic properties and microcirculation of the blood]. / Bitemporal'noe primenenie élektricheskogo polia UVCh (27,12 MGts) v rannem vosstanovitel'nom periode ostrykh narushenii mozgovogo krovoobrashcheniia: viazkostno-élasticheskie svoistva i mikrotsirkuliatsiia krovi.

UHF electric field (27 or 12 MHz) was applied in intermittent regimen and nonthermal dosage by means of bitemporal condensation plates in early terms after cerebrovascular accident in 40 recovering patients. Clinical response was achieved in 60% of patients who had underwent physiotherapy alone and 75% of those who had been exposed to the electric field in combination with therapeutic exercise and massage. Investigations of microcirculation, blood viscosity and elasticity showed positive changes in the above parameters which could underlie beneficial effect of the field. The paper presents discussion on the effect of such physiotherapy on blood rheology.