[Determining the prescription of brain injuries based on the changes of the nucleolus organizer in astrocytes]. / Opredelenie davnosti povrezhdenii golovnogo mozga po izmeneniiam iadryshkovogo organizatora v astrotsitakh.

The well apparent signs of the proliferative reaction and activity of the nucleolus organizer in astrocytes within the zone of injury and at its periphery are considered to be the indicators of the participation of these cells in all the phases of the inflammatory and reparative processes associated with the brain injury. The objective of the present study was the evaluation of the changes in the number of the nucleoli in the nuclei of astrocytes during the acute post-traumatic period following the craniocerebral injury. A total of 26 cases of death of the men and women at the age from 36 to 50 years caused by the craniocerebral trauma were available for the examination. The tissue samples were stained with hematoxylin and eosin, based on the use of the Perls' Prussian blue staining protocol or by means of the AgNOR staining technique. The astrocytes in the regions immediately adjacent to the sites of brain injury were shown to undergo areactive necrosis during the first hours after the damage had been inflicted. The evaluation of the changes in the astrocytes required taking into consideration the influence of autolysis on the character of the signs being identified. The increase of the number of points in the astrocytes in which RNA replication occurs within days 2-4 after the injury can be accounted for by the accumulation of the granules containing silver in the cell nuclei. The cross reactions between hemosiderin and RNA await further investigations. It is concluded that the methods employed in this study may be of diagnostic significance for the purposes of forensic medical histology if used in the combination with other specialized techniques for determining the prescription of the craniocerebral injuries. The combination of the morphological and functional studies opens up the promising prospects for the investigations into the necrotic and proliferative processes in astrocytes associated with brain injuries of different origin.

[The diagnostic potential of computed tomography for the purpose of forensic medical examination of a craniocerebral injury]. / Diagnosticheskie vozmozhnosti komp'iuternoi tomografii pri sudebno-meditsinskoi ékspertize cherepno-mozgovoi travmy.

The authors make use of the data borrowed from the special literature and the results of their original investigations to carry out the comparative analysis of the materials of the intravital X-ray studies and post-mortem examinations. Special attention is given to the possibilities available at the present time for making virtopsies in the cases of the craniocerebral injury.

[Anatomic rationale for clinical efficacy of intraosseous mental nerve anesthesia]. / Anatomicheskoe obosnovanie klinicheskoi éffektivnosti provodnikovoi anestezii vnutrikostnoi chasti podborodochnogo nerva.

The aim of the study was to prove the anatomical and clinical effectiveness of the modified anesthesia of mental nerve. The effectiveness of conductive anesthesia near the mental foramen was objectively evaluated using the electric pulp test (EPT) in 100 volunteers of both sexes, aged 35-43 years. Wet anterior mandible preparations obtained from 350 cadavers aged 18-74 years were also studied. EPT value after local mental anesthesia conducted according to Malamed C. using 4% articain solution of local anesthetic with vasoconstrictor concentration of 1:200.000 after 2 minutes was 93±0.82 mA, after 4 minutes - 188±1.26 mA. Yield variability indicators of intraosseous mental nerve anesthesia was slightly higher varying from 94.11 mA to 96.61 mA after 2 minutes and from 197.4 to 199.92 mA after 4 minutes survey. The study showed the efficiency and predictability of intraosseous anesthesia of the mental nerve.

[Optimization of the surgical methods for the treatment of recurrent nasal bleeding (a pathologo-anatomical study)].

The objective of the present work was to study specific features of blood supply to the nasal cavity by staining mandibular and ethmoidal arteries to reveal their size and topographic features under conditions of a pathologo-anatomical department. The secondary objective was to modify the existing and develop new methods for the ligation of these vessels. This pathologo-anatomical study was based on 16 preparations examined with the use of up-to-date optical facilities. The results of investigations of the topographo-anatomical peculiarities of blood supply in the nasal cavity are supplemented by the evaluation of the potential of endoscopic rhinosurgery for the treatment of recurrent nasal hemorrhage. The methods for endoscopic ligation of mandibular and ethmoidal arteries have been developed and optimized.

[Maxillary puncture: endoscopic assessment].

Frequency of the injury of the nasolacrimal duct ostium during maxillary puncture through the lower nasal passage was estimated endoscopically. Changes in the maxillary medial wall during the puncture were also studied. Anatomic features of the ostiomeatal complex which may contribute to development of chronic inflammation were determined. Forty one sinuses of 27 deceased middle-aged patients were examined within 24 hours after death. One third of patients in a random population had chronic maxillary inflammation caused by structural anomalies in the ostiomeatal complex. Half of the punctures were made with severe traumas of the nasolacrimal duct ostium. Natural anastomosis of the sinus did not function in about 20% cases. Accessory anastomosis in the posterior fontanelle was registered in 12.2% cases. The posterior fontanelle broke during sinus lavage in 3 cases. Indications for maxillary puncture in acute and chronic maxillary sinusitis should be considered much more carefully in the presence of stable alterations in the ostiomeatal complex and block of the natural anastomosis.

[Lesions of retroperitoneal fatty tissue in destructive pancreatitis]. / Porazhenie zabriushinnoi kletchatki pri destruktivnom pankreatite.

Experience of examination and treatment of 102 patients with lesion of retroperitoneal space undergone surgery for pancreonecrosis is analyzed. Based of data of ultrasonic examination, computed tomography, surgery and autopsy laws of morphologic transformation and ways of spread of pathologic process into retroperitoneal space in pancreonecrosis were revealed. Developed scheme is important for substantiation of surgical policy.

[Application of viable cryopreserved alloderm transplants in the treatment of wound defects of soft tissues]. / Ispol'zovanie zhiznesposobnykh kriokonservirovannykh allodermotransplantatov v lechenii ranevykh defektov miagkikh tkanei.

An original method is proposed for treatment of long-standing intractable wounds and trophic ulcers using viable cryopreserved allodermotransplants and a distant air-plasma treatment. The main source of the allodermotransplants is the cadaverous skin. It was shown that the cadaverous skin taken during 17 hours after the donor's death was viable. The maximum period for storage of the viable skin when the worked out preservative is used at the temperature regimen -18 degrees C is 10 days, and at -70 degrees C it can be as long as 45 days. The analysis performed included 101 patients with long-standing intractable wounds and trophic ulcers. In 51 of them the new worked out method was used. An analysis of clinical and histomorphological data has proved that the application of the viable cryopreserved allodermotransplants and distant air-plasma treatment favor the better course of reparative processes. By the end of the forth week the wounds were completely closed in 19.7% of patients, the wound areas were considerably less (more than by 50% of the initial size) in 43.1%, less reduction of the wound area (less than 50% of the initial size) in 27.4%, in 9.8% there was no effect. No negative results were noted. It should be noted that closure of the tissue defect can be achieved by stimulation of the physiological regeneration of the patient's tissues. This method of regeneration of the skin is effective in trophic ulcers, long-standing intractable wounds and is also recommended in case of deficit of donor resources or when the severe state of the patient does not allow active surgical treatment.

[Combined trauma and sepsis in forensic medical practice]. / Sochetannaia travma i sepsis v sudebno-meditsinskoi praktike.

The relationship between combined injury and sepsis is an important problem of forensic medicine. A total of 227 cases with combined injuries have been investigated postmortem at Bureau of Forensic Medical Expert Evaluations of Moscow in 1997. Sepsis developed in 9.7% cases. The studies revealed a direct cause-and-effect relationship between mechanical injuries and development of sepsis in the overwhelming majority of cases. Sepsis may develop at any period of the traumatic disease, except the first one, and the infection is prone to generalization in the remote postoperative period.