[Prevention and correction of cognitive dysfunction after general anesthesia]. / Profilaktika i korrektsiia kognitivnykh narushenii posle obshchei anestezii.

AIM: To evaluate clinical efficacy of intraoperative use of cytoflavin in the prevention and correction of cognitive functions in surgical patients with no history of neurological and psychosomatic disorders. MATERIAL AND METHODS: The study included 60 female patients who underwent surgery on the thyroid gland. Patients were stratified into two equal groups matched for main indices. Patients of the main group received infusions of cytoflavin (20 ml in 200 ml of 5% glucose solution). Patients underwent thyroidectomy with general inhalation anesthesia using desflurane. Cognitive testing was performed one day before operation and 6, 24 and 48 h after. Waking time after stopping desflurane administration and time prior tracheal extubation were recorded. RESULTS AND CONCLUSION: The use of cytoflavin promoted the early post anesthesia adaptation and more rapid recovery of initial cognitive status of the patients.

[Treatment of paracolostomic hernias using polypropylene mesh].

It was analyzed the results of treatment of 23 patients with large paracolostomic hernias. Twenty patients underwent colostomy suturing and hernial ring Onlay-plasty with polypropylene mesh without tension. Onlay-plasty of hernial ring with own tissues and polypropylene mesh and colostomy reconstruction outside of implant were performed in 3 patients. Onlay-alloplasty with polypropylene mesh "PROLENE" is effective method of treatment of postoperative paracolostomic ventral hernias with colostomy closing as well as with its reconstruction outside of implant.

[Features of behavioral reactions of chronically irradiated mice in the raised crosswise labyrinth with various genetically determined radiosensitivity and possibilities of their modification by the fungal biopolymer complex].

Structural elements of the central nervous system--neurons, along with the higher neuroendocrine structures and the hypothalamus centres, show high sensitivity to a chronic action of low doses of ionizing radiation (IR) in view of their extreme enrichment by phospholipids and intensive supply by oxygen, creating favorable conditions for the development of oxidizing stress. Stressful influences cause negative emotions in the behaviour of animals manifested as fear or uneasiness. The study represents the results of comparative research into the behavioral reactions characterized by uneasiness in the Balb/c and C57bl/6 mice exposed to a chronic irradiation at low doses. The chitin-melanin-glucan complex from fungi Fomes fomentarius (ChMG) was approved as an adaptive agent. It has been shown that under identical conditions, deposition levels of radionuclides 137Cs and 90Sr are raised in mice with IR hypersensitivity--line Balb/c, in comparison with less radio sensitive mice--line C57bl/6. Simultaneously, Balb/c mice were observed to exhibit the signs of a more anxious behaviour in the new environment. Chronic external and internal radiation exposure to rare ionizing radiation at low doses promotes strengthening of anxiety and phobic reactions in mice with IR hypersensitivity. The use of ChMG in animals neutralized the increase in anxiety and phobic reactions after a prolonged irradiation, thus indicating the presence in ChMG of the anxiolitic activity along with the above mentioned powerful radiosorbent, antioxidant, gene protective and immunomodulatory properties.

[Remote signaling of radiation damage to the extracellular space in mice with various levels of genetically determined radio sensitivity].

The search results of "bystander" signals are presented at different model of influence of IR on Balb/c and C57bl/6 mice, characterized by different levels of genetically determined sensitivity to IR influence. We used the following models of IR influence: 1) external gamma-quanta influence from small samples of nuclear fuel from the CNPP 4th power unit modified in the course of the accident in 1986, which are 99% connected with 137Cs, with the total dose of irradiation of about 5.0 Gy for 16 hours and accumulated dose of 0.290 Gy for 231 day of exposure, 2) internal intake of 137Cs with water for 40 days. It is shown that cells of different types (splenocytes, hepatocytes, bone marrow and astroglia cells) irrespective of a model of IR influence produce the factors, which failed to be identified in this research, raising the SSF levels in the DNA of non-irradiated cells. Under conditions of a single exposure to gamma-field external irradiation at a dose of about 5.0 Gy, the intensity of production of "bystander" signals is higher in the mice with the raised level of genetically determined sensitivity to RI (Balb/c). Under the same conditions of gamma-field exposure, induction of additional levels of SSF in the DNA of non-irradiated cells is detected for at least one month after IR exposure. Intraperitoneal injection of melanin in the melanin-glucan complex from fungus F. fomentarius before irradiation exposure promotes an essential decrease in the production of "bystander" signals, testifying in favor of the free radical nature of their certain part.

[Carotid endarterectomy and endovascular angioplasty with stenting in patients with atherosclerotic stenoses and occlusions of the internal carotid artery].

The authors made a comparative assessment of carotid endarterectomy and endovascular angioplasty with stenting in patients with atherosclerotic lesions of the carotid arteries. The authors consider that indications to stenting and carotid endarterectomy are identical in patients with stenose and occlusions of the carotid arteries. Contraindications to angioplasty of carotid arteries are determined. It was shown that angioplasty and stenting in atherosclerotic lesions of the carotid arteries was an effective method with a less number of complications as compared with carotid endarterectomy and are thought to be an adequate alternative to open surgical method of treatment of patients with stenoses and occlusions of the carotid arteries.

[Effect of herpes simplex virus on spermatogenesis].

To investigate the effect of Herpes Simplex virus (HSV) on spermatogenesis, HSV in ejaculate was detected by a rapid cultural method in 268 infertile males and 47 healthy ones. The number of mobile spermatozoa in HSV infected samples was less than in non-infected samples (21 mln/mlversus 40 mln/ml, p = 0.0001). The relative number of morphologically normal gametes was 13% versus 19% (p = 0.002), respectively. The quantitative karyological test discovered that males with HSV-infected ejaculate have more degenerating sex cells while in high virus contamination (more than 10 virus particles in 1 ml) the number of spermatides and spermatocytes of the 1 order at diploten stage is low. Organic testicular culture was used for more detailed study of pathogenetic mechanisms of HSV impact on spermatogenesis. Testicular explants infection was associated with reduction in the number of spermatogones, spermatocytes and spermatides on culturing week 2. The above findings reveal some pathogenetic mechanisms underling fertility disorders in males with HSV infection: a gametotoxic effect of the virus reducing populations of spermatogones, spermatocytes and spermatide; affected mobility and morphological characteristics of spermatozoa. Detection of the mechanisms of HSV action on spermatogenesis opens a perspective of antivirus drug administration in combined treatment of male infertility.

[Peyronie's disease: comparative results of conservative treatment].

Long-term clinical experience with conservative treatment of Peyronie's disease has demonstrated that clinical efficacy of this therapy comprises maily anesthesia while erectile problems are not solved. Introduction of the drugs into the fibrous plaque is not adequate and hard to perform. Some drugs affect only some components of pathogenesis. For stabilization of the process it is recommended to use transdermal electrophoresis or phonophoresis. The search for new effective drugs and methods continues.

Lung cancer differential diagnosis based on the computer assisted radiology: The state of the art.

The concepts of the modern computer-aided diagnosis (CAD), the methods of pulmonary nodules detection and facts derived from the available literature on the pulmonary nodule differential CAD topic are compiled in one source and described in some details. Several issues of the lung cancer epidemiology and an early diagnosis are discussed. The analysis of the performed research shows an evidence that various CAD systems can be successfully applied for chest radiographs, computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET). These modalities can serve as a useful tool for a practicing medical professional facing the burden of a routine diagnostic job.

[New conception of surgery in Peyronie's disease].

Clinical experience of the authors on patients with Peyronie's disease shows that intraplaque therapy with verapamil and interferon and a malignant course of the disease can result in shortening of the penis (4 and 1 cases were observed, respectively). The length of the penis diminished by 30 to 50%. The patients were treated with graft corporoplasty with endoprosthesis of the penis. Basing on the experience with these cases the following conclusions were made: intraplaque injections are hard to perform and can provoke progression of the disease; long-term conservative treatment for stabilization of the active stage of Peyronie's disease can lead to shortening of the penis; in malignant course of the disease and progressive shortening of the penis surgical policy is justified despite "acute" phase of the disease.

[Long-term results of one-stage urogenital reconstruction in total epispadia and extrophy of the urinary bladder in adults].

Surgical treatment of 34 patients with total epispadia and extrophy of the urinary bladder aged 15-33 years consists in one-stage extending corporoplasty, extending urethroplasty, granuloplasty, spongioplasty and sphincteroplasty. This novel method of one-stage urogenital reconstruction in adult males with total epispadia and extrophy of the urinary bladder provided satisfactory cosmetic results in all the patients and functional results in 68% patients, improved quality of life, social and sexual adaptation in patients with the above serious conditions. Postoperative complications and relevant prophylaxis are described.

[Heterotopic urine derivation in females with urinary bladder extrophy].

Fifteen females aged from 17 to 31 years with bladder extrophy (the condition after ureterosygmostomy) have undergone heterotopic urine derivation with creation of a cutaneous urine-retention catheter mechanism. Surgery was indicated in progressive decline of renal function in the presence of renal reflux, total urine incontinence in the failure of pelvic floor muscles and rectal sphyncter apparatus. Creation of cutaneous urine-retention catheter mechanism was made by the following techniques: heterotopic plastic repair from the ileocecal angle by Mainz pouch I (11 patients, 73.4%); heterotopic W ileocystoplasty by Abol-Enein (4 patients, 26.8%). Implantation of both ureters was conducted by Wallace technique in 4 (26.7%) cases. In 7 (46.6%) patients ureteral implantation was performed with antireflux defense by the method of cross dublicate creation. Four (26.7%) patients with small intestinal derivation have undergone extramural implantation of the ureters according to Abol-Enein. The results show that conversion of ureterosygmostomy in heterotopic urine derivation with one-stage genital reconstructive interventions decreases the number of potential complications, improves surgical outcomes and provides much better medico-social rehabilitation. Heterotopic intestinal continent derivation of urine is an operation of choice in women with urinary malformations. In such patients orthotopic urine derivation is impossible.

[Intestinal replacement of the urinary bladder with creation of continent cutaneostomy].

Continent urine derivation with creation of cutaneous urine-retaining catheter mechanism was conducted in 28 patients. Indications for surgery were the following: contracted urinary bladder in combination with long obliteration of the urethra, urinary bladder extrophy (the condition after ureterosygmostomy), urinary bladder cancer, arteriosclerotic urinary bladder. Creation of cutaneous urine-retaining cather mechanism was performed according to the following methods: urine derivation by Minez pouch I (with creation of appendistoma) was made in 14 patients; extending intestinoplasty by Minez pouch (creation of intestinal reservoir from ileocecal angle with catheter appendicostoma) was made in 8 patients; extending ileoplasty with catheter ileostoma by Huder--2 patients; creation of a reservoir of the ileum with catheter ileocutaneostoma by extramural technique of Ald-Enein--2 patients; extending intestinoplasty with catheter ileostoma--2 patients. Implantation of the ureters was made using principles of antireflux defense.

[The method of a complete one-stage urogenital reconstruction in extrophy of the urinary bladder and total epispadia in the adults].

In the context of surgical treatment of bladder extrophy/epispadia in the adults, the authors offer one-stage urogenital reconstruction, i.e. urethro-corporo-glanulo-sphyncteroplasty with penile preparation. Long-term results were analysed in adult patients with total epispadia and urine incontinence. Intact erectile function was observed in all 25 patients. An adequate function of the artificial muscular sphyncter was registered in 20 patients. The length of the penis increased from 2.5 to 5 cm. Sexual adaptation was achieved in 88% cases. Social adaptation occurred in all the cases.

[Congenital penile deviation: an integral diagnostic approach to correction].

A comparative analysis of diagnostic examination of 130 men with isolated congenital erectile penile deviation (EPD) aged 14-22 years (mean age 17 years) has demonstrated that true EPD can be determined objectively only at adequate erection. Therefore, the diagnosis should be based not on subjective opinion of the patient but on the results of artificial pharmacological erection or viagra-test in combination with visual erotic and genital stimulation. Vacuum erection test is not justified. In patients with congenital EPD rigidity depends much on correlation between perfusion volume and functional volume of the penis (cavernous volume). The problem of congenital EPD can be formulated as the problem of "long penis". Measurements of the penis in the group of 54 patients with congenital EPD registered a low penile coefficient in 67% cases while a mean length of the penis in all the examinees was longer than a mean standard one and was about 13 cm in relaxed condition. EPD patients often suffer from asthenodepressive disorders deteriorating the copulative function. Psychotherapy and medication of the depressive syndrome result in stabilization of the psychological condition improving quality of life 1.3 times. Thus, an integrative diagnostic and therapeutic approach, due selection of the patients for operative correction of penile deviation can improve quality of the treatment aimed both at correction of erectile malformation and psychosexual adaptation of the patients.

[Choice of corporoplastic method in Peyronie's disease depending on hemodynamic status of the penis].

We studied 164 patients with Peyronie's disease, 34 of whom have clinical symptoms of erectile dysfunction. Dopplerography has detected alterations of penile hemodynamics in 71.8% cases. Vein occlusive dysfunction prevailed (54.8%). Dopplerographic signs of venoocclusive dysfunction were seen also in patients with minor erectile disorders (55.4%). The analysis of absolute values of the systolic velocity peak allowed us to consider values in the range > 25 but < 35 cm/s as borderline or suboptimal, corresponding to subclinical period of venoocclusive dysfunction. Dynamic cavernosometry results served the basis for criteria of subclinical venoocclusive dysfunction characterized by threshold intracavernous pressure 50 mm Hg, coefficient of 30-s reduction of intracavernous pressure from 1.75 +/- 0.93 to 2.1 +/- 0.8 mm Hg and supporting perfusion velocities under 29.2 +/- 15 ml/min. Characteristics of hemodynamic status and penile geometry help an optimal choice of deviation correction in patients with Peyronie's disease.