[Maxillary sinusitis as a complication of dental implants placement: a case report]. / Verkhnechelyustnoi sinusit kak oslozhnenie dental'noi implantatsii: sluchai iz praktiki.

The article presents a case of chronic odontogenic maxillary sinusitis and the results of its surgical treatment. The cause of the sinusitis, confirmed by the results of X-ray and pathohistological studies, was an inflammatory process affecting the bone tissue around the implant, installed in the place of the upper first molar which was accompanied by the development of an oroantral fistula. During the surgical intervention, the communication between the oral cavity and the maxillary sinus was eliminated, and the implant with the abutment, which was entirely in its cavity, was also removed.

[Endoscopic biopsy of a frontal lobe tumor infiltrating the lateral ventricle using intraoperative navigation]. / Endoskopicheskaya biopsiya opukholi lobnoi doli golovnogo mozga, prorastayushchei v bokovoi zheludochek, s ispol'zovaniem intraoperatsionnoi navigatsii.

The authors describe the clinical observation of a patient with a paraventricular tumor of the left frontal lobe and demonstrate the effectiveness of endoscopic biopsy of a volumetric mass of such localization through the lateral ventricle using intraoperative navigation. The disease manifested with convulsive seizures two years before the patient was admitted to the hospital. During this period of time, he was repeatedly examined. The dimensions of the volumetric formation remained unchanged. Based on the data obtained, it was not possible to accurately verify the type of tumor. Anticonvulsant therapy was ineffective. The patient underwent surgery - endoscopic partial removal of the tumor (biopsy) and opening of the tumor cyst through the left lateral ventricle using intraoperative navigation. Clinical improvement in the patient's condition was achieved. After the operation, the headaches and the seizures stopped.

MANAGEMENT OF EMOTIONAL DISORDERS IN ELDERLY PATIENTS UNDERGOING SURGICAL TREATMENT OF PROXIMAL FEMORAL FRACTURES.

The goal of our research was to study the to identify key aspects of the management of emotional disorders in the practice of operative treatment of proximal femoral fractures in elderly patients. The study was conducted with 24 patients who needed surgical treatment of proximal femoral fracture and were at risk for the development of psycho-emotional disorders due to the presence of emotional disorders of an anxiety-depressive nature were examined. The presence of such disorders was recorded at the time of admission, before and after surgical treatment using specialized psychodiagnostic techniques. Mini Mental State Examination, modified Hachinski ischemic scale, Frontal assessment battery, Spielberg-Khanin Scale of Reactive and Trait Anxiety, The Zung Self-Rating Depression Scale were used. Results of the clinical study of the Most patients at risk had a high level of reactive anxiety - 14 (58.33%) patients (equally in subgroups I and II - 7 (29.17%) patients in each) compared with moderate levels (10 (41.67%) patients) - equally I and II subgroups (5 (20.83%) patients in each). In the subgroups I and II with moderate and high levels of reactive anxiety, a predominance of female patients was noted: subgroup I - female patients with a moderate level - 3 (12.50%), and with a high level -5 (20.83%); subgroup II - 3 (12.50%) and 4 (16.67%) female patients respectively. As a result of determining the key aspects of the management of emotional disorders in the practice of operative treatment of proximal femoral fractures in elderly patients:the presence of moderate (41.67%) and high (58.33%) levels of reactive and trait anxiety in elderly patients with proximal femoral fractures and emotional disorders is noted. The presence of a depressive state of varying severity was recorded: a subdepressive state (75.00%) and mild depression (25.00%). The general levels of reactive and trait anxiety and depressive disorders showed the presence of limit levels between moderate, high (reactive and trait anxiety) and mild depression and sub-depressive state (depressive disorders): reactive anxiety (42.52±0.05), trait anxiety (42.23±0.07) and depressive disorders (51.41±0.07). It is proved that the treatment of emotional disturbances of the anxiety-depressive spectrum lead to a significant levelling in existing psychological changes.The deterioration of the existing emotional disorders of the anxiety-depressive spectrum among patients at risk in the absence of drug treatment has been established.

Deep brain stimulation as a possible treatment of hyperthermia in patients with serotonin syndrome.

Maintaining a body temperature within a narrow range is vital for the survival of all mammals, including humans. With the help of optogenetics, a better understanding of the thermoregulatory organs and pathways is achieved. Optogenetic activation of the GABAergic neurons in the ventral part of the lateral preoptic nucleus (VLPO) leads to decrease in the body temperature. On the other hand, number of drugs could alter the thermoregulatory balance, leading to a hyperthermic state, such as serotonin syndrome (SS). SS is a potentially life-threatening clinical condition that occurs as a result of a drug-induced increase in the intrasynaptic serotonin (5-hydroxytryptamine, 5-HT) levels due to overdose of a single drug or due to interaction between two or more drugs with serotonergic mechanism of action. In this hypothesis, we propose a novel method for the treatment of hyperthermia, a core clinical sign of serotonin syndrome, through deep brain stimulation (DBS). An electrode is stereotactically placed in the VLPO, which may lead to reduction of the core body temperature. If proven effective, this technique should be left as a salvage method for reduction of hyperthermia, where the drug treatment is insufficient or ineffective. This technique could be used for the treatment of other syndromes, where hyperthermia takes a central place, including malignant hyperthermia, neuroleptic malignant syndrome, etc. DBS, on the other hand, could be used alone to induce hyperthermia in patients with malignant diseases. Hyperthermia improves the immune response, improves the drug penetration and stop the repair of already damaged tumor cells after chemotherapy or radiotherapy.

A possible novel technique for intraoperative imaging of the vertebral artery during arthrodesis of the upper cervical spine.

In elderly, the fractures in C1-C2 are a common entity. Poor bone quality and wide range of motion hamper the natural bone fusion, thus making surgery often the only possible way to deal with the underlying pathology. The proximity to important neurovascular structures represents the stabilization in this segment a challenge to the surgical team. There are two major techniques, which are used to achieve a dorsal fusion in the C1-C2 Segment: Goel/Harms and Magerl techniques. The reported risk for damaging the vertebral artery in both techniques lies between 8% and 9,5% using a C-Arm. In Goel/Harms technique lateral mass screws in C1 and pedicle screws in C2 are placed. A transarticular screw is placed on both sides C1-C2 in Magerl technique in order to achieve stabilization of the C1-C2 Segment. By using the new navigational methods for a better imaging of the bony structures (O-Arm), this risk could be reduced further down. The risk for injury of the vertebral artery using the O-Arm navigation depends on the pathology, which is operated, ranging from 0, 3% to 2%. A further problem represents the anatomical variations of the vertebral artery, of which the high-riding vertebral artery being the most important one, reported between 10 and 14,5% of the cases according to the literature review. The novel technique for intraoperative imaging of the vertebral artery represents a fusion between an intraoperative O-Arm and intraoperative application of contrast, thus intraoperatively seeing the exact way of the vertebral artery. Also, after the insertion of the screws, a second CT scan with the O-Arm could be performed, yet again with contrast, to see whether the perfusion of both vertebral arteries is preserved. The significance of this method could bring the injuries of the vertebral artery to 0% independently on the technique, which has been used. This method could be used not only for craniocervical stabilization but also for removal of complex tumors in craniocervical junctions, whereas the vertebral artery is encompassed.

Two patterns of cytokine production by placental macrophages.

INTRODUCTION: Macrophages participate in the regulation immune and morphogenetic events in the placenta. However, these roles remain unclear for placental macrophages (Hofbauer cells). The aims of this study were to characterize the consecutive steps of cytokine production (intracellular synthesis and secretion) in placental macrophages in early and late gestation and to compare the secretory profiles of placental macrophages and villous tissue. METHODS: Macrophages and villous tissue were isolated from placentas obtained from normal pregnancies at either 9-12 or 38-40 weeks of gestation. Intracellular cytokines were determined by flow cytometry after staining with monoclonal antibodies. Secreted cytokines were quantified by cytometric bead array and ELISA. RESULTS: Two patterns of cytokine production were revealed in placental macrophages. Cytokines in the first group (IL-1, IL-6, IL-8, IL-10, TNFα) demonstrated low basal production and were stimulated by bacterial endotoxin. Cytokines in the second group (IL-11, IL-17A, IL-17F, TGF-ß, VEGF) were characterized by constitutive production and did not respond to stimulation. Gestational age-dependent changes were observed: basal secretion of TNFα and IL-8 increased whereas IL-11 and IL-17 secretion decreased in third-trimester macrophages compared with the first-trimester cells. Comparison of cytokine production at the cellular and tissue levels suggested the contribution of the placental macrophages both in intraplacental and extraplacental cytokine production. DISCUSSION: It would be safe to assume that the two patterns of cytokine production, revealed in our study, correspond to two regulatory roles of placental macrophages: "immune" and "morphogenetic". The inflammatory phenotype of macrophages is attenuated in early gestation and increases with the progression of pregnancy. The cytokines of the first group supposedly contribute to both local and extraplacental levels, whereas the cytokine effects of the second group are more likely confined to the placental tissue.

[The Effect of Life-Style and Occupational Hazards on Development of Hysteromyoma].

The prospective observation of women with uterus myoma being on operative treatment in gynecological department of the Tula oblast clinical hospital during 2011-2012 was implemented. The regular female donors of the department of transfusiology of the given medical institution were used as the comparison group. It is established that female contingent with uterus myoma has a complex of such predisposing medical social risk factors as lower motion activity, financial neediness, increased stress load, diet of lower quality and its limitations, increased liquid intake, inobservance of work and rest regime, with passive character of longer day rest, certain occupational hazards. The unfavorable effect of forced body position, electromagnetic radiation and psycho-emotional over-strain on development of uterus myoma is reliably established. According data of component analysis, possible complex prevention of uterus myoma is presented by higher level of intellectual strain during working activities, maintenance of work and rest regime, long-term day rest, regular intake of fruits and cultured milk food, availability of quality preferences in diet, regular exercises, frequent foot walks at clean air. The established characteristics of life-style and occupational hazards in women with uterus myoma testify their pathogenic involvement in development of disease and availability of opportunities of their usage in development of programs of individual prevention.

Coordinated expression of TNFα- and VEGF-mediated signaling components by placental macrophages in early and late pregnancy.

INTRODUCTION: Mononuclear phagocytes are thought to significantly contribute to cytokine regulation at the maternal-foetal interface, but the role of placental macrophages has been poorly investigated. TNFα and VEGF were demonstrated to have regulatory effects on basic structures of the placenta, particularly the trophoblast and blood vessels. The aims of this study were to determine the expression of TNFα, VEGF and related receptors in placental macrophages, and how does the participation of placental macrophages alter with gestational age in TNFα- and VEGF-mediated signaling. METHODS: Macrophages were isolated from placental villous tissue from normal pregnancies at either 9-12 or 38-40 weeks gestation. Cell surface receptors (TNFR1, TNFR2, VEGFR1, and VEGFR2) and intracellular TNFα and VEGF were quantified by flow cytometry after antibody staining. Basal and stimulated secretion of both cytokines and soluble TNF receptors was quantified by cytometric bead arrays. Secreted VEGFR1 was measured by ELISA. RESULTS: The expression of TNFR1 and VEGFR1 was remarkably variable and did not change from first to third trimester. There was minimal basal TNFα production in the placental macrophages, but nearly all cells in the population produced VEGF. TNFα and VEGF secretion increased with gestational age accompanied by decreased secretion of the antagonists sTNFR1 and sVEGFR. Macrophages isolated from early term placentas were less effective in responding to bacterial endotoxin. Lipopolysaccharide induced increases in the secretion of TNFα, TNFR1, TNFR2, and VEGFR1 but did not affect the production of VEGF. In late pregnancy, a significant correlation was observed between TNFR1 and VEGFR1. DISCUSSION: The progression of pregnancy is accompanied by the concerted increase in TNFα and VEGF secretion and decrease in the production of their soluble receptors, but the expression of cell surface receptors does not depend on gestational age. The observed patterns of basal and stimulated expression of TNFα and VEGF may reflect the dual immune and morphogenetic roles of placental macrophages in gestation. Compatible patterns of TNFR1 and VEGFR1 expression suggest common regulatory pathways for these receptors.

Comparative phenotypic characterization of human cord blood monocytes and placental macrophages at term.

The expression of surface molecules in cord blood monocytes and placental macrophages was studied using flow cytometry. When compared with monocytes, macrophages presented a decrease in HLA-DR and LAP/TGF-ß1 levels and increased expression of alternative activation markers, especially CD206. No difference in the production of the apoptotic factors TRAIL and TWEAK was observed, whereas the levels of cytokine receptors in monocytes were significantly higher than in macrophages. Most remarkable was the difference in the expression of IL-17 and TNFα receptors. A strong correlation between VEGF and TNFα receptors was revealed in both cell populations. The results obtained in this study provide antigenic phenotypes for two related cell populations and outline the feasible functional alterations during tissue macrophage differentiation.

In vitro expression of vascular endothelial growth factor and its receptors by placental macrophages.

The expression of VEGF and membrane-bound and soluble forms of the VEGF-R1 receptor in cultured placental macrophages (trimesters I and III of pregnancy) was studied by flow cytometry, cytometric bead array, and ELISA. Nearly all population of placental macrophages (98%) was capable of producing VEGF during the early and late gestational periods. However, the expression of cellular VEGF-R1 varied from 3.4 to 92%. VEGF secretion was relatively low in the first and third trimesters (0.5 and 1.1 pg/10(5) cells, respectively). Cultured placental macrophages produced soluble receptor sVEGF-R1 in the first and third trimesters (86.4 and 36.4 pg/10(5) cells, respectively). Stimulation with LPS was followed by a 4-fold increase in sVEGF-R1 secretion. Our results indicate that placental macrophages are involved in the autocrine and paracrine regulation in chorionic villi. The data suggest that these cells have a physiological and pathogenetic role in gestation.

[Embolization of cerebral aneurysms in acute period of hemorrhage complicated by the development of vasospasm].

Results of endovascular treatment of cerebral aneurysms in acute period of hemorrhage complicated by the development of vasospasm in 80 patients were analyzed. The results of treatment of patients with vasospasm were worse. The appearance of vasospasm did not depend of the severity of the patient's state, so all the patients independent on their state need prophylactic measures against this complication. Based on the analysis a strategy of embolization of aneurysms in acute period of hemorrhage complicated by the development of vasospasm was worked out.

[The laser chromoendoscopy eradication of Helicobacter pylori].

35 patients with absence of positive dynamics after course of treatment of diseases associated with Helicobacter pylori infection and without achievement of eradication are surveyed. The original technique of Helicobacter pylori endoscopy eradication with use of the therapeutic laser in length of a wave of 660 nanometers is offered. Carrying out of rate laser chromoendoscopy eradication considerably reduces terms of healing of inflammatory-destructive changes of stomach and duodenum mucous membrane allows achieving of Helicobacter pylori eradication.

[Results of endoscopic inspection of upper digestive tract of IHD patients].

Comparative studying results of esophagogastroduodenoscopy by 150 ischemic heart disease patients and 50 patients who are passing preventive inspection are lead. Performance of endoscopic reveals researches pathognomonic for ischemic heart disease of change of stomach and duodenum mucous membrane, testifying about presence of chronic inflammatory-destructive process.

[Correlation of morphologic and humoral indicators in Helicobacter infections].

50 patients without gastroduodenal and somatic pathology and considering healthy are surveyed. Carrying out of the correlation analysis of results of morphological research of biopsies of stomach and duodenum mucous and laboratory parameters of peripheral blood has revealed that progressing of infection H. pylori leads to strengthening immunoinflammatory to reaction in system blood-groove.

[Effect of aktovegin on dynamics of the oxygen methabolism in tissues].

The analysis of aktovegin impact on methabolism dynamics of oxygen in tissues was performed. Indirect impact of aktovegin on the oxygen cascade dynamics is provided through the mechanism of the erythrocytes saturation by oxygen. The efficacy of aktovegin application as antihypoxic preparation in patients with an acute gastric strees-affection was proved.

[Minimally invasive surgery of patients with hypertensive intracerebral bleedings].

An analysis of results of surgical treatment of 79 patients aged from 41 to 72 years with hypertensive intracerebral hematomas of supratentorial localization has shown that results of surgical treatment depended on the severity of the patients' state, the degree of impairment of consciousness, volume and localization of hematoma, ventricular hemorrhage and in less degree on the terms of operation and the degree of displacement of the median structures of the brain. The endoscopic techniques proved to be preferential in hematomas of the lateral and mixed localizations with the volume not more than 60 cm3. The developed method using a cannula allowed abandon open operations in most patients with the lateral and mixed hematomas. The postoperative lethality became less by 9.9%.

[The tissue oxygen cascade as the marker in different schemes of general anesthesia on dynamics of the hypoxic syndrome in patients, suffering an acute hemorrhage of high operative risk].

An acute hemorrhage of high operative risk coincides with the transport oxygen cascade disorder. There was established the impact of various schemes of general anesthesy on dynamics of the tissue oxygen cascade indices. Application of general anesthesy, based on propofol with fentanyl combination, positively influences on the hemoglobin-oxygen affinity dynamics.

[Effect of different schemes of general anaesthesia on dynamic of intellectual capacity restoration in patients operated for acute hemorrhages with high operative risk].

The analysis of speed of the cognitive functions restoration, depending on the general anesthesia scheme applied was conducted. The impact of various schemes of the intensive therapy applied on the dynamics of index was investigated. Interrelationship between the homeostasis indices and the intelectual capacities patients, operated on for an acute bleeding in high operative risk, was established.

[Anesthesia based on ketamin during performance of a high-risk operations: advantages and misadvantages].

The impact of a general anesthesia scheme, using ketamin, and of various intensive therapy schemes, on hemostasis indices was studied in patients, suffering an acute hemorrhage of a high operative risk. The silent interrelationship between these indices and the common clinical indices dynamics was established.

[Effect of antihypoxant actovegin on dynamics of markers of the oxygen cascade].

The analysis of actovegin impact on the blood indices dynamics was performed. Immediate activation of transport chain of the oxygen cascade in all groups of investigation was noted. Antihypoxic mechanism of actovegin action through normalization of concentration and transport elements of the oxygen cascade was proved.