[Features of an explosive lower extremities injury protected by sapper shoes]. / Osobennosti vzryvnoi travmy nizhnikh konechnostei, zashchishchennykh obuv'yu sapera.

The purpose of the work is to conduct experimental studies that reveal the characteristic features of explosive injuries of the lower extremities using various samples of sapper protective shoes of domestic and foreign production. The subjects of experiment were the amputated by medical reasons lower extremities of a person. The severity of explosive damage during contact blasting and the parameters of shock accelerations acting on the lower extremities, as well as approximate periods of disability and the forecast of possible disability, are determined. The results of the study can serve as initial data when testing safety shoes. In addition, using the proposed modeling technique, it is possible to compare the protective properties of various samples of anti-mine shoes, assess the presence (or absence) of signs of aggravation of damage during an anti-personnel mine detonation, and carry out a forensic medical assessment of an explosive injury.

[Extended endoscopic endonasal posterior (transclival) approach to tumors of the clival region and ventral posterior cranial fossa. Part 1. Topographic and anatomical features of the clivus and adjacent structures]. / Éndoskopicheskii éndonazal'nyi zadnii rasshirennyi (transklival'nyi) dostup k opukholiam oblasti skata i ventral'nykh otdelov zadnei cherepnoi iamki. Chast' 1. Topografo-anatomicheskie osobennosti skata i pogranichnykh s nim obrazovanii.

OBJECTIVE: to describe the main topographic and anatomical features of the clival region and its adjacent structures for improvement and optimization of the extended endoscopic endonasal posterior (transclival) approach for resection of tumors of the clival region and ventral posterior cranial fossa. MATERIAL AND METHODS: We performed a craniometric study of 125 human skulls and a topographic anatomical study of heads of 25 cadavers, the arterial and venous bed of which was stained with colored silicone (the staining technique was developed by the authors) to visualize bed features and individual variability. Currently, we have clinical material from more than 120 surgical patients with various skull base tumors of the clival region and ventral posterior cranial fossa (chordomas, pituitary adenomas, meningiomas, cholesteatomas, etc.) who were operated on using the endoscopic transclival approach. RESULTS: We present the main anatomical landmarks and parameters of some anatomical structures that are required for performing the endoscopic endonasal posterior approach. The anatomical landmarks, such as the intradural openings of the abducens and glossopharyngeal nerves, may be used to arbitrarily divide the clival region into the superior, middle, and inferior thirds. The anatomical landmarks important for the surgeon, which are detected during a topographic anatomical study of the skull base, facilitate identification of the boundaries between the different clival portions and the C1 segments of the internal carotid arteries. The superior, middle, and inferior transclival approaches provide an access to the ventral surface of the upper, middle, and lower neurovascular complexes in the posterior cranial fossa. CONCLUSION: The endoscopic transclival approach may be used to access midline tumors of the posterior cranial fossa. The approach is an alternative to transcranial approaches in surgical treatment of clival region lesions. This approach provides results comparable (and sometimes better) to those of the transcranial and transfacial approaches.

Photodynamic inactivation of enveloped virus in protein plasma preparations by solid-phase fullerene-based photosensitizer.

BACKGROUND: The problem of transfusion-transmitted infections still remains serious and actual for health care despite the detailed testing of donors. Human immunodeficiency virus, hepatitis B and C viruses and human cytomegalovirus are among the most dangerous pathogens that can be transmitted with blood. Previously, a composition consisting of fullerene layer applied on silica gel particles was shown to inactivate influenza virus up to complete loss of infectivity. METHODS: In the present study the unit has been developed with source of irradiation whose spectrum is appropriate for solid-phase fullerene. The ability of the unit to inactivate the enveloped influenza virus in protein fraction of donor blood has been studied. RESULTS: It was shown that at optimized conditions complete inactivation of enveloped virus of extremely high initial titer (7.0-9.5 log 10 EID 50/0.2 mL) in the solution of albumin was achieved after as short time as 30 min of irradiation. This process did not affect the oxidative metabolism of neutrophils and membranes of erythrocytes evaluated by NBT reduction test and morphological analysis of erythrocytes, respectively. CONCLUSION: The data obtained suggests that the method described can be recommended for further development and optimization of the procedure of inactivation of viruses in the preparations of the plasma of donor blood.

Use of nitric oxide producer L-arginine during infusion therapy of experimental hemorrhagic shock.

Experiments on rats showed that infusion of NO precursor L-arginine before bleeding enhanced their tolerance to hemorrhagic shock. When infused after blood loss as a component of saline solution, L-arginine improved efficiency of infusion therapy for hemorrhagic shock and increased survival rate of the animals.

[Features of hemocomponental therapy in oncological patients].

The authors present an analysis of specific features of transfusions of erythrocyte containing media in oncological patients. Special attention was given to necessary selection of donor erythrocytes in performing operations with massive intraoperative blood loss. It considerably contributes to a decreased number of posttransfusional reactions and complications. For the recent five years transfusions of erythrocyte containing media to more than 15 thousand patients with surgical treatment were analyzed. Among them the individual selection of donor blood was fulfilled in 2047 cases. Compatible erythrocytes could not be selected in five cases only. In these patients infusions of Perftoran were used as an oxygen carrier both during operation and at the postoperative period.

[Sonoelastography in differential diagnosis of thyroid nodes].

The study was aimed to assess the diagnostic possibilities of the new method of sonoelastography. 68 patients with different thyroid nodes were studied. Sonoelastography increased the sensitivity of the routine ultrasound investigation from 89 to 94.8%, the specificity from the 83 to 93%, and the accuracy of the method from 76 to 89%. The method assignes the information of the structural changes of the thyroid, unavailable by the routine ultrasound investigation.

[Significance of the determination of B2-glycoprotein-1 antibodies in recognizing the thrombogenicity in antiphospholipid syndrome].

According to the recent data, the determination of the higher titer of antibodies to beta2-glycoprotein-I (beta2-GP-I) that is included in a complex compound with negative phospholipid membranes determinates the thrombogenicity in antiphospholipid syndrome (APS). To specify this regularity, the authors examined 86 patients with primary APS and 20 patients with venous and arterial thrombosis without APS. With increased beta2-GP-I antibody levels, the incidence of thrombotic events was established to w significantly higher than in APS without the increased titer of beta2-GP-I antibodies. In primary APS-associated persistent miscarriage, the increased titer of beta2-GP-I is much more infrequently encountered.

[Effects of indirect electrochemical oxidation of blood on certain indices of homeostasis in surgical patients].

An analysis of certain biochemical hematological and hemostasiological indices of blood of 41 patients has shown that an intravenous injection of sodium hypochlorite with concentration 300 mg/l has a marked detoxicating and hypocoagulating effect.

[The hemostasis system state in patients with ulcerous gastrointestinal bleedings].

In patients with gastrointestinal bleedings there occurs activation of the hemostasis system directed to arrest of bleeding. Short-term hypercoagulation directed to arrest of the bleeding gives place to hypocoagulative changes. Their degree and duration depend on the severity and rate of blood loss. The excessive intravascular activation of blood is accompanied by the formation of fibrin deposits not only in the area of the bleeding source but in other regions of the blood channel. There appears disseminated intravascular coagulation of blood deteriorating the reparative processes in the ulcer, initiating and maintaining generalized plasminemia which promotes the thrombus lysis in the ulcer crater and recurrent bleeding.

[Prophylactics of hemotransfusion complications in surgical practice]. / Profilaktika gemotransfuzionnykh oslozhnenii v khirurgicheskoi praktike.

In the paper the authors are making an analysis of the courses of hemotransfusion complications and recommend a system of measures to prevent them.

[New blood substitutes of polyfunctional action]. / Novye krovezameniteli polifunktsional'nogo deistviia.

The paper deals with two categories of new oxygen-carrying blood substitute solutions (OCBSS), based on a modified hemoglobin (MG) and perfluor-organic carbon emulsion (PCE), and with crystalloid and colloid blood substitutes of the antihypoxic action containing the Crebs' substrate (sodium fumarat). Described are the results of clinical use of Russian OCBSS based on MG (Gelenpol) and on PCE (Perftoran) in 151 patients with hemorrhagic shock and intraoperative blood loss. Both drugs are allowed for medical application in Russia. Gelenpol was administered at 1 to 6 units, perftoran--at 10-15 ml/kg. An improved oxygen status as well as normalization of hemodynamics, microcirculation, rheology, and of blood acid-base balance (ABB) were registered. Gelenpol had a hematosis-stimulating action. The combined use of both drugs or one of them alone in surgery is under discussion. The OCBSS efficiency can be enhanced when they are used jointly with the first Russian infusion antihypoxants containing sodium furmarat, i.e. Mufasol and Polyoxyfumarin. Both of them were shown to normalize the oxidation in tissues, to recover the mitochondrial metabolism in the liver and myocardium and to improve the blood ABB when used in hypovolemic and hypoxic conditions of different etiologies, in substituting for intraoperative blood losses (gastrointestinal hemorrhages), in polytrauma and destructive cholecystitis as well as in preoperative preparations of patients with diffuse peritonitis. The OCBSS preparations and antihypoxants are undoubtedly drugs of choice in emergency infusion-transfusion therapy and in cases of multiple victims from accidents.

[Prognosis of the course of complicated ulcer disease and mortality in aged and senile patients]. / Prognoz techeniia oslozhnennoi iazvennoibolezni i letal'nosti u bol'nykh pozhilogo i starcheskogo vozrasta.

The developed system for forecasting the course of the disease in elderly and senile patients made it possible to distinguish two variants of the ulcer course: favorable and unfavorable. Its application confirmed that it is possible to use the forecast evaluation system in studies of remote results. In case of an unfavorable forecast, this provides the ground for urgent recommendations for surgical treatment in this group of patients without waiting for life-threatening complications to develop.

[Use of an artificial carrier of oxygen on the base of modified hemoglobin in patients with gastroduodenal hemorrhage]. / Primenenie iskusstvennogo perenoschika kisloroda na osnove modifitsirovannogo gemoglobina u bol'nykh s gastroduodenal'nymi krovotecheniiami.

Infusions of Helenpole used in 23 patients allowed for a short time to stabilize hemodynamics and to considerably improve the gas-transporting function of blood. The best curative effect in patients with hemorrhagic shock was obtained by means of intravenous jet infusions of the medicine, after stabilization of the hemodynamic indices with the help of an intravenous dropper (80-90 drops/min). The dose of the 1% solution of the medicine was 25-30 ml/kg of the patient's body weight.

[Effects of methods of freezing and thawing of blood plasma on the activity of procoagulants and antithrombin-III]. / Vliianie metodov zamorazhivaniia i razmorazhivaniia plazmy krovi na aktivnost' prokoaguliantov i antitrombina-III.

The authors investigated the activity of procoagulants and antithrombin-III after freezing and thawing of blood plasma by different methods. It was shown that quick freezing and thawing using special apparatuses best of all preserved the coagulative properties of the plasma. The medical efficiency of quick-frozen plasma was shown to depend on the method of freezing and thawing.

[Biochemical characteristics of liver involvement in patients with antiphospholipid syndrome]. / Biokhimicheskie osobennosti porazheniia pecheni u bol'nykh s antifosfolipidnym sindromom.

The incidence of hepatitis B and C virus and cytomegalovirus infection is high in patients with the antiphospholipid syndrome (APS). The specific features of virus infection in APS patients are determined by the activity of APS. During clinically manifest stage, the activities of aminotransferases, lactate dehydrogenase (LDH), and alkaline phosphatase increase, while during remission only aspartate aminotransferase and LDH levels remain high, for this latter enzyme high activities of isoenzymes LDH5 and LDH4 being recorded. These data indicate that the pathological process in APS involves not only the liver, but the sinusoidal endothelium as well. This seems to account for some other clinical and laboratory manifestations of APS, such as increased level of circulating immune complexes, dysfunction of physiological anticoagulants, etc.