[Efficiency of the multimodal approach to analgesia in total knee arthroplasty]. / Éffektivnost' mul'timodal'nogo podkhoda k analgezii pri total'noi artroplastike kolennogo sustava.

MATERIAL AND METHODS: The study included 160 patients with end stage knee osteoarthritis hospitalized for primary uncomplicated TKA. There were 142 women and 18 men (mean age 66.5 and 65.4 years respectively). In the control group (n=100) standard protocol of perioperative pain management was applied, in the main group (n=60) - original multimodal approach including patient's education in order to increase his awareness and to reduce anxiety on the preoperative stage, modified surgical technique (optimization of incision length, 'sliding window' principle, tourniquet during the whole procedure until applying of compressive dressing, no drains and local infiltration analgesia) and double-level postoperative analgesia. Different factors of pain syndrome were assessed before surgery by using of specialized tests, while the dynamics of early postoperative pain characteristics were evaluated by individual diaries. RESULTS: Despite decrease of pain syndrome in both groups within 3 days after TKA in the main group these changes were significantly better (p<0.05). On the first postoperative day 42 (70%) patients in the main group had not pain at rest, while in the control group such cases were absent (р<0.001). There was 2-fold increase of hours of moderate/severe pain per day in the control group compared with the main group (р<0.001). No specific complications were identified in both groups during follow-up. CONCLUSION: Original multimodal perioperative approach to analgesia proved its efficiency in patients undergoing primary TKA compared with conventional one and may be safely used in clinical practice.

[Bidirectional knotless barbed sutures during primary total knee arthroplasty: effective solution or new problem?] / Primenenie dvunapravlennykh nitei s nasechkami dlia nepreryvnogo bezuzlovogo shva v pervichnoi artroplastike kolennogo sustava.

THE HYPOTHESIS OF THE STUDY: The use of bidirectional knotless barbed sutures for closure of capsule and subcutaneous fat tissue in primary total knee arthroplasty (TKA) is safe and time-saving. MATERIAL AND METHODS: 302 patients with end-stage osteoarthritis scheduled for primary non-complex TKA were randomly divided into two prospective groups: in group I (N=102) the capsule of the knee joint and subcutaneous fat tissues were closed by continuous braided suture while in group II (N=200) by bidirectional knotless barbed sutures. The skin in both groups was closed by non-absorbable monofilament polycaproamide uninterrupted suture. RESULTS: The time of the surgery was significantly shorter in group II (65,25±11,9 min) than in group I (72,5±14,7 min) (p<0.05). The volume of hidden blood loss was similar in both groups. The number of patients with superficial infection during the first two week after surgery did not differ significantly (1,9% (I) and 1% (II)): they all healed successfully after skin debridement and additional closure. There were no cases of deep periprosthetic infection (PPI). At 3-month follow-up no difference found regarding pain level and knee function (Knee Society Score). CONCLUSION: The use of bidirectional knotless barbed sutures in TKA reduces the time of surgery, does not affect the volume of hidden blood loss or PPI occurrence.

[A paradigm of early gonarthrosis: a review of the current diagnostic and treatment options (Part 1)]. / Paradigma rannego gonartroza: obzor sovremennykh vozmozhnostei diagnostiki i lecheniia (Chast' 1).

The prevalence of chronic joint diseases, among which osteoarthritis (OA) prevails, continues to grow worldwide. So far, many OA patients starting to get any kind of treatment only at the stage of organ failure, when the progression of the pathological process cannot be considerably delayed. The long-felt need for a change in thinking how to effectively diagnose and treat OA patients at early stage induced to prepare this review. Its first part is devoted to discussion of the limitations of traditional approaches and to analysis of the current diagnostic capabilities, particularly the clinical features of early OA, its morphological characteristics based on the magnetic resonance imaging and arthroscopic criteria, as well as the perspectives of biochemical and genetic markers implementation.

All-diamond optical assemblies for a beam-multiplexing X-ray monochromator at the Linac Coherent Light Source.

A double-crystal diamond (111) monochromator recently implemented at the Linac Coherent Light Source (LCLS) enables splitting of the primary X-ray beam into a pink (transmitted) and a monochromatic (reflected) branch. The first monochromator crystal, with a thickness of ∼100 µm, provides sufficient X-ray transmittance to enable simultaneous operation of two beamlines. This article reports the design, fabrication and X-ray characterization of the first and second (300 µm-thick) crystals utilized in the monochromator and the optical assemblies holding these crystals. Each crystal plate has a region of about 5 × 2 mm with low defect concentration, sufficient for use in X-ray optics at the LCLS. The optical assemblies holding the crystals were designed to provide mounting on a rigid substrate and to minimize mounting-induced crystal strain. The induced strain was evaluated using double-crystal X-ray topography and was found to be small over the 5 × 2 mm working regions of the crystals.

[Surgical treatment of chronic pancreatitis, complicated by intracystic bleeding].

Data of 14 patients with chronic cystic pancreatitis, complicated by intracystic bleeding, were analyzed. Early diagnosis of a bleeding episode provides an in-time diagnostic and treatment procedures. Angiographic bleeding vessel occlusion is considered to be a method of choice. When the latter is impossible, a method of temporary intraoperative hemostasis is suggested, which decreases blood loss and permits an adequate surgical aid.

Identification of a shape isomer in 235U.

The shape isomer in 235U has been searched for in a neutron-induced fission experiment on 234U, which was performed at the isomer spectrometer NEPTUNE of the EC-JRC IRMM. A neutron source, with a tunable pulse frequency in the Hz to kHz range and its individually adjustable neutron pulse width in connection with an appropriate detector system turned out to be the ideal instrument to perform an isomer search, when decay half-lives above 100 micros are expected. From the delayed fission events observed for two different NEPTUNE settings and at mean incident neutron energies En=0.95 and 1.27 MeV the isomeric fission half-life could be determined to be T1/2=(3.6+/-1.8) ms. The corresponding cross section was determined to sigmaif=(10+/-8) microb. With these results an experimental confirmation for the existence of a superdeformed shape isomer in odd-uranium isotopes is given for the first time.

Study of local blood flow and pressure in tissues and vessels of hip joint of experimental animals.

Acute experiments on dogs showed that clamping of the femoral artery below origination of its deep branch playing the leading role in blood supply to the hip joint increases local blood flow in femoral head due to redistribution of arterial flow in favor of the deep femoral artery. This fact is essential for the development of surgical methods for the treatment of patients with aseptic necrosis of the femoral head.

[Morphologic and morphometric characteristics of the femoral head in experimental necrosis and after incomplete occlusion of the femoral artery]. / Morfologicheskaia i morfometricheskaia kharakteristika golovki bedrennoi kosti pri ee éksperimental'nom nekroze i nepolnoi okkliuzii bedrennoi arterii.

Partial occlusion (by 70-80%) of the femoral artery (FA) below its bifurcation with the deep femoral one was created in 15 dogs 6 months after modeling of aseptic necrosis of femoral head (FH). The dynamics of local circulation was evaluated using the methods of hydrogen clearance, angiography, flowmetry, polarography and mingography. FA and neighboring vessels as well as FH bone tissue were studied using histological, histochemical and morphometric methods. It was found that partial occlusion of FA below its bifurcation with the deep femoral branch resulted after 180-240 days in a redistribution of blood flow in favor of the latter along with a formation of collateral vessel widening as well as in the change in the circulation vector in the direction of the hip joint. This contributed to FH revascularization after modeling of its traumatic aseptic necrosis. The results of the morphological analysis indicate the activation of osteogenesis and gradual replacement of the necrotic area in FH with a newly formed osseous tissue and are suggestive of possible application of this method for clinical use.

[The limits of fluctuations of the laboratory findings in the preoperative period during uncomplicated revision endoprosthesing of the hip joint]. / Predely kolebanii laboratornykh pokazatelei v predoperatsionnom periode pri neoslozhnennom revizionnom éndoprotezirovanii tazobedrennogo sustava.

The revision endoprosthesis of the hip joint for aseptic loose components was performed in 482 patients (297 women and 185 men). Before operation the assessment of 44 laboratory indices was made which included clinical blood tests, investigation of the coagulating system, protein and mineral exchange, enzymatic activity and other biochemical criteria. The postoperative course was even, without variations. The work shows the limits of deviations of the parameters with respect to normal condition and gender. The authors believe that they can be considered as a variant of the clinically adequate reaction rather than as a criterion of the unfavorable prognosis of the postoperative course.

[Biorhythmical characterization of exacerbations of the degenerative-dystrophic process in patients with the impaired hip joint]. / Bioritmicheskaia kharakteristika obostrenii degenerativno-distroficheskogo protsessa u patsientov s porazheniem tazobedrennogo sustava.

The age-dependent structure of the contingents treated conservatively at the local outpatient clinics (197 women aged 17-82 and 59 men aged 25-85) and patients subjected to operations of total endoprosthesis of the hip joint for coxarthrosis (663 women aged 19-89 and 304 men aged 22-82) was investigated. The structure of the indices under study was found to fluctuate with the average period length 10.7 years (sigma = 2.7 years), 8.2 years (sigma = 3.5 years), 7.3 days (sigma = 3.0 years), 9.5 years (sigma = 2.1 years) respectively. A comparison of the fluctuation curves of the age-dependent structure of the women treated conservatively and operated upon showed the coincidence of the maximums in 35, 43, 60, 65, 69, 74-74 years of age, in men--in 34-35, 41, 75-76. It can be supposed that the revealed age-dependent fluctuations of activity of the inflammatory process and the pain syndrome correspondingly might be considered as an element of the periodic disease in pathogenesis of degenerative-dystrophic lesions of the hip joint.

[Seasonal fluctuations of intraoperative blood loss in hip joint replacement]. / Sezonnye kolebaniia intraoperatsionnoi krovopoteri pri éndoprotezirovanii tazobedrennogo systava.

Under analysis was the level of intraoperative blood loss in total endopropsthesis of the hip joint in 513 patients operated upon for degenerative-dystrophic processes of consequences of trauma in the period from 1996 to 1999. The assessment of seasonal variations of its value was made. It was shown that the volume of blood loss is dependent on two groups of factors: medical and associated with the influence of the environment. The least "chronorisk" of excessive blood loss was noted in the period from July to November, the greatest--from January to June (with the maximum in March and reduction in May).

[Unicompartmental meniscal knee replacement in treatment of patients with knee osteoarthrosis]. / Odnomyshchelkovoe éndoprotezirovaqnie bol'nykh s izolirovannymi proiavleniiami degenerativnykh zabolevanii kolennogo sustava.

One condyle meniscal endoprosthesis is thought to be an adequate method of surgical treatment of patients with isolated symptoms of degenerative diseases of the knee joint when the indications and contraindications are carefully observed. The method includes the substitution of the articulation surfaces of only internal condyles of the femur and tibia for artificial ones leaving intact the external and anterior parts of the joint as well as the crucial and lateral ligaments. It results in elimination of the pain syndrome, rapid restoration of the knee joint function and the supporting ability of the lower extremity.

[Emergency endoprosthesis of the hip joint. Risk of hospital mortality]. / Ekstrennoe éndoprotezirovanie tazobedrennogo sustava. Risk gospital'noi letal'nosti.

An analysis of case histories of 854 patients operated upon for fractures of the proximal part of the femoral bone at the R.R. Vreden Research Institute of Traumatology and Orthopedics for the period from September 1997 to December 2000 was made in order to assess the intrahospital lethality. The maximum season fluctuations were found to take place in October and March, minimum in September, December and April. The trend was characterized by a gradual rise from September to June. The authors associate these fluctuations with the action of external rhythmically changing factors, the growing trend--with the role of the factor of tiredness of the medical personnel. It was also shown that duration of the time interval from operation to the moment of death as well as the diversity of the value of this index was maximum in December-January and December correspondingly.

[Space-time organization of bone tissue remodeling in vertebral bodies after femur osteotomy]. / Struktura prostranstvenno-vremennoi organizatsii remodelirovaniia kostnoi tkani tel pozvonkov posle osteotomii bedrennoi kosti.

Roentgenometric and roentgenodensitometric chronobiological characteristics of space and time remodeling of the bone tissue in tail vertebra XI and XII after osteotomy of the right femur are described. Examination of 179 white non-inbred male rats revealed circadian periodicity of vertebral bone tissue remodeling. Dynamics of asymmetry of this process also has a circadian periodicity.

[Weak stress factors in the prevention of postoperative complications in elective orthopedic surgery]. / Slabye stressogennye faktory--élement profilaktiki posleoperatsionnykh oslozhnenii pri planovoi ortopedichekoi khirurgii.

Based on their personal and literature data the authors propose to use weak stressogenic factors (pyrogenal and interrupting normobaric hypoxia) as an element of preoperative preparation of patients for prevention of postoperative complications. The using of this method made the frequency of postoperative complications in the area of the operation wound twice as rare, outside the wound--three times as rare.

[Reorganization of the mineral matrix of the bone tissue]. / Perestoroika mineral'nogo matriksa kostnoi tkani.

Basing on experimental and clinical chronobiological investigations with an application of three different methods of estimation of osseous tissue mineral density: biochemical (phosphates content in bone tissue mineral matrix), roentgenographic densitometry and dual photon X-ray absorption, it has been shown that 4.5% of mineral matrix mass are in constant interchange with body fluids. It corresponds to the degree of fluctuations of osseous tissue mineral density (in the direction of increase or decrease) both locally and in the skeleton on the whole during the period of time amounting to about one week. This fact should be taken into consideration while evaluating the effect of drug therapy in patients with osteoporosis.