[Features of the intestinal microbiota in the elderly in the development of coronary heart disease.]

The review is devoted to the influence of the microbiota on the development of such an age-dependent disease as coronary heart disease, the formation of which depends on atherogenesis in particular. According to the World Health Organization, cardiovascular disease is the leading cause of death worldwide. Statistical data from the Federal State Statistics Service also confirm that coronary heart disease is the leading cause of death in the Russian Federation today. It is known that the vast majority of cardiovascular diseases are atherosclerosis-associated pathologies. Atherogenesis and the state of the human gut microbiome are dynamically interrelated. The gut microbiota, which consists predominantly of bacteria, plays an important role in maintaining homeostasis. The pathogenesis of atherosclerosis is based on systemic inflammation. Aging is accompanied by a wide variety of clinical manifestations, including a basic pro-inflammatory state (i.e., «inflammation-aging¼), the activity of which is maintained by the microbiota in older individuals and increases their susceptibility to diseases. Intestinal microbiocenosis in elderly and senile people differs from those of young people. In persons of older age groups, there is an increase in microorganisms secreting endotoxins lipopolysaccharide and trimethylamine-n-oxide, initiating and maintaining chronic inflammation. More research is needed to study the mechanisms of action of microbial metabolites and their clinical application in various therapeutic interventions.

[Clinical manifestations of the expiratory tracheal stenosis, and its effects on the progress of bronchopulmonary pathology].

Non-differentiated connective tissue dysplasia (NDCTD) presents a genetic-related anomaly of the mesenchimal matrix leading to the dysfunction of various organs and systems, the degree of which determine the severity of the clinical picture as well as individual prognosis. Despite high prevalence, NDCTD is often neglected by practitioners because the clinical manifestations of this pathology are very polymorphic due to the fact that connective tissue (CT) is spread throughout the organism. Various changes in the skin, locomotor apparatus, and, especially, the internal organs determine the individual prognosis and cannot but influence the course of concomitant diseases. Among visceral NDCTD markers the most well-known ones are mesenchimal cardial dysplasias, such as valvular prolapses, false chords, interventricalar septum and Valsalva sinus aneurisms etc. However, the generalized CT defect in NDCTD implies the presence of polyorganic symptoms thus stimulating search for new visceral markers of CD dysplasia. Various internal manifestations of NDCTD, such as expiratory tracheal stenosis, have their own pathogenetic features, as well as specific clinical and functional manifestations.

[The choice of the method for surgical intervention in the combined treatment of cancer of the oral mucosa in the retromolar space]. / Vybor metoda khirurgicheskogo vmeshatel'stva pri kombinirovannom lechenii raka slizistoi obolochki polosti rta v retromoliarnom prostranstve.

Combined treatment of 30 patients with stage III-IV squamous-cell carcinoma of the retromolar mucosa, including radiotherapy in a dose of 43 Gy at the first stage of treatment, was carried out. The second stage consisted of two types of combined operations. Modified combined intervention suggested by P. G. Bitiutskii et al., the results of which were followed up for 2 years and found satisfactory, is preferable to previously employed operation, for it is conducive to a more rapid functional rehabilitation of patients.

[The use of ultrasonic tomography for assessing the spread of a primary tumor of the mucosa in the retromolar area and for choosing the surgical treatment method]. / Primenenie ul'trazvukovoi tomografii dlia otsenki rasprostranennosti pervichnoi opukholi slizistoi obolochki retromoliarnoi oblasti i vybora metoda khirurgicheskogo lecheniia.

Ultrasonic examination was carried out in 31 patients with stage III-IV squamous-cell carcinoma of the retromolar mucosa. Dissemination of the tumor of the retromolar triangle into the stomach was detected in 14, into the adjacent anatomical structures in 6 patients. Combined operations with inclusion into the block of removed tissues of the involved structures were carried out due to the information obtained. The data of ultrasonic tomography were confirmed by morphologic examinations of removed preparations.

[Function-sparing surgery in the combined therapy of laryngeal cancer]. / Funktsional'no-shchadiashchie operatsii pri kombinirovannom lechenii raka gortani.

The reports deals with the principle and methods of making a two-stage diagnosis of laryngeal tumor evolved on the basis of the data on two calibrated groups of 250 patients each and a computer-supported procedure of mathematical analysis. Two programs for a MC-52 microcalculator are suggested to select the scope of surgical intervention. Such procedures of preoperative radiation therapy as exposure under hyperbaric oxygenation conditions, cutting down the preoperative radiation dosage and shortening the interval between ir radiation course and surgery have been improved. Five improved procedures of saving therapy for tumors of the supraglottic area and four--for glottic cancer were used in 142 patients. The functional and oncological results of saving surgery were evaluated in 458 patients receiving combined treatment for laryngeal tumors. Said results were found to be beneficial.

[A method of combined horizontal resection of the larynx with removal of the arytenoid cartilage and its primary reconstruction]. / Sposob kombinirovannoi gorizontal'noi rezektsii gortani s udaleniem cherpalovidnogo khriashcha i pervichnogo ego rekonstruktsiei.

A modified technique of combined laryngeal resection in vestibular cancer T3-T4 (involvement of the arytenoid cartilage) was tried in 8 patients. To compensate for laryngeal separative function after the radical surgery, the reconstruction of the posterior laryngeal wall was performed by mobilization of the upper corniculum of the thyroid cartilage. In satisfactory functional results the method did not contribute to the disease aggravation.

[Experience with conducting programmed labor]. / Opyt provedeniia programmirovannykh rodov.

An analysis was made of programmed labours in 128 high-risk females having relative indications for cesarean section. Oxytocin or prostaglandin was used as a uterine-contracting agents. The dosage, rate and duration of drug administration were adjusted by the values of uterine activity and the rate of cervical dilatation. In the latent phase (up to 4-5 cm) the optimal dilatation rate was considered to be 1 cm/h in primiparas, 1.5 cm/h in multiparas; in the active period (over 5 cm), that was 1.5 and 2.0 cm/h, respectively. The optimal labour duration was at least 10-12 hours in primiparas and at least 8 hours in multiparas. One hundred and sixteen (90.6%) females delivered vaginally without any delivery operations. Twelve (9.4%) delivered via cesarean section. All 128 babies were liveborn. It has been concluded that programmed labour is a sparing tool of delivery in high-risk pregnant who have no indications for cesarean section.

PIP: Programmed labor defined as a planned natural delivery was carried out in 128 women. The group included 43 gravida I (average age 24.6 years) and 85 gravida II (average age 29.2 years). Indications for programmed labor included late toxemia (44), prolonged pregnancy (23), ABO and Rhesus isoimmunization (24) fetal hypotrophy (8), and extragenital diseases (29). All patients had relative indications for cesarean section. Planned labor was conducted at gestation age of 36-38 weeks in 24 women, at 39-41 weeks in 81, and at 42-43 weeks in 23. Predelivery management included administration of prostaglandin synthesis inducers, spasmolytics, estrogens (300-500 units/kg, intramuscularly). In the evening prior to labor induction, the patients received intracervical administration of prostaglandin gel. Labor was induced by oxytocin or prostaglandin administration. Oxytocin dose depended upon the body weight and ranged from 5 units (1 ml) for the body weight of 50-69 kg to 7,5 units (1.5 ml) for 70-89 kg, and 10 units (2 ml) for the body weight of over 90 kg. Oxytocin was given by an intravenous drip starting with 8-10 drops/min and gradually increasing to 30-40 drops/min. Prostaglandin (5 mg per 500 ml of solution) was given by an intravenous drip starting with 20 drops/min and gradually increasing to 40 drops/min. Effectiveness of oxytocin or prostaglandin dose was estimated by stability of uterine contractions and by the rate of cervix dilatation. Normal duration of labor was no more than 10-12 hr for gravida I and no more than 8 hr for gravida II. Of 128 women, 116 had normal vaginal delivery and 12 had to undergo emergency cesarean section. Delivery was complicated by cervix rupture in 9 patients. All 128 women gave birth to live babies. Agar score ranged from 8-9 in 108, to 7 in 15, and 6 in 5.