[Surgical treatment of the unformed intestinal fistulae].

Treatment results of 5 patients with unformed intestinal fistulae are represented. High unformed intestinal fistulae are acknowledged to be completely unsuitable for conservative treatment and should be operated on. Complex treatment should include complete parenteral feeding, adequate fecal diversion with the use of aspirational drainage. Surgical treatment must be y the increase of fistula discharge or absence of fistula formation. Low intestinal fistulae should better be surgically dissected after their organization, otherwise urgent surgery is to be performed by complications development, such as purulent leakage into the abdominal cavity or severe wound infection.

[Comparative analysis of horizontal venous reflux surgical correction by large trophic lower leg ulcers].

Subfascial perforant veins dissection (SPVD) of the lower leg was performed in patients with chronic venous insufficiency CEAP class 5 and 6. 252 operations were performed in 236 patients. All patients had trophic lesions (skin hyperpigmentation and lipodermatosclerosis) 218 (92,4%) patients had trophic lower leg ulcer to the time of operation. 30 patients had earlier performed phlebectomy. Open SPVD was performed in 122 cases, endoscopic technique was used in 114 patients. Comparative analysis of these two methods was performed. Long-term results were accessed with the use of SF-36 questionnaire. Efficacy, pathogenetic validity and economic expedience of SPVD by large trophic lower leg ulcers are confirmed by the decrease of postoperative complications and recurrence rate. The horizontal venous reflux elimination and trophic ulcer dissection with intraoperative skin plasty allow a significant improvement of treatment results.

[Mental development disorders and attention-deficit syndrome caused by iodine deficiency: a clinical and epidemiological study].

A clinical and epidemiological study including 2,397 children of school age living in the areas with different levels of or without iodine deficiency has been carried out. An increased frequency of cases with IQ not more than 80-85 scores was observed in iodine deficient areas. Iodine deficiency was a cause of clinically diagnosed borderline development delay only in 7% of children. Attention deficit syndrome (without hyperactivity) and anxiety-depressive disorders as well as asthenic symptoms were observed most frequently. Basing on the literature data and own observations, the author suggests a hypothesis on the pathogenetic basis of these disorders.

[Results of epidemiological surveys for iodine-deficiency diseases within the framework of the Thyromobile project].

In the Russian Federation, there are virtually all areas whose population is at risk for iodine-deficiency disorders. During 2003, we made epidemiological studies of iodine-deficiency disorders within the framework of the Thyromobile project supported by the pharmaceutical company "Nycomed"in 12 regions of the Russian Federation. A total of 2673 individuals were examined. According to the WHO recommendations, the study covered prepubescent children aged 8 to 11 years. It involved physical examination, thyroid ultrasound study, blood sampling for ioduria, intelligence test, and sodium chloride iodine assay. The findings indicated that the tension of goiter endemia corresponded to the level of iodine deficiency, which was in the range of mild iodine deficiency, in most regions other than some districts of the Volgograd, Astrakhan, Nizhni Novgorod regions where the median of ioduria in schoolchildren corresponded severe iodine deficiency. The studies indicated that the population's use ofiodinated salt is not up to the recommendations of international expert organizations. Intelligence tests revealed an 11-18% IQ decrease in children from virtually all study areas. According to the strategy of iodine deficiency control in the Russian Federation, it is advisable to use iodinated salt for mass prevention and drugs containing a physicological dose of iodine for group and individual prevention.

[Surgical sepsis-definition of the notion. Problems of terminology]. / Khirurgicheskii sepsis-opredelenie poniatiia. Voprosy terminologii.

The problems of terminology are discussed, as well as classification and definition of sepsis. Comparative analysis of traditional for our country and up-to-date foreign classifications is carried out. The criteria for diagnosis of sepsis are discussed. On the basis of 20-year experience in examination and treatment of patients with sepsis, the authors set forth their own stand, suggesting two varieties of sepsis for consideration: common complication of surgical infection, a rare disease.

[Artificially induced suppurative diseases]. / Iskusstvenno vyzvannye gnoinye zabolevaniia.

128 cases of artificially caused purulent diseases have been analysed. All the cases were masked as chronic septicemia, recurrent abscesses, nonhealing wounds and fever of the unclear origin. The specific features of artificial diseases have been pointed out: social status, occupation, provoking factors, specific clinical signs--multiple hospitalizations, dominating location of postoperative scars and abscesses. Diagnostic principles, including psychological ang psychiatric testing are discussed. The neuro-psychiatric disorders were detected in most cases. Prevention of such diseases is analysed.

[Characteristics of dynamics of influenza epidemics and trends of change]. / Osobennosti dinamiki épidemii grippa i tendentsii ee izmeneniia.

Long-term epidemiological data on 60 reference bases (cities) of the Regional Influenza and Acute Respiratory Disease Center (for the former USSR) are analyzed. Trends in developing an epidemiological process are defined. It is shown that the rate influenza A epidemics has been recently declined, its morbidity is decreasing among adults and increasing among children: influenza A epidemics has recently shown mainly its endogenous spread. Influenza B epidemics have become more intensive, but in the past years influenza B morbidity has been also stable.

[Morphologic and functional aspects in the treatment of patients with intestinal fistulas]. / Morfofunktsionalnye aspekty pri lechenii bolnykh s kishechnymi svishchami.

Combination of severe purulent processes (peritonitis, phlegmons, and extensive wounds of the abdominal wall), eventration, and complete high unformed intestinal fistulas leads to rapid hemostasis disorders and emaciation. In nonoperative treatment lethality reaches 70%. Complete bilateral disconnection of the fistula bearing intestinal loop is the operation of choice in such situations. In this case the length of the disconnected intestinal segments may be two thirds of the length of the jejunum and the greater part of the colon. The results of morphofunctional study of an intestinal segment disconnected for a long period are analysed. The tactics of active surgical treatment is illustrated by clinical cases.

[Blood neutrophilic leukocytes in patients with suppurative-septic diseases]. / O sostoianii neitrofil'nykh leikotsitov krovi bol'nykh gnoino-septicheskimi zabolevaniiami.

Neutrophil leucocytes of patients with sepsis, purulent inflammatory processes clinically close to sepsis and those of healthy persons were studied electron-microscopically. Leucocytes with degranulation due to the release of their content into the circulation were found in purulent-inflammatory diseases. Leucocytes with pronounced degranulation, areas with cytoplasma lysis and extracellular organelles (lipid droplets, primary and secondary granules with clear-cut membrane borders and content of granules without membrane borders) were observed in sepsis.

[Key problems of the pathogenesis of infection]. / Kliuchevye voprosy patogeneza sepsisa.

The authors analyse the results of clinico-immunological studies in 452 patients with various forms of pyogenic surgical infection; 292 of the patients had surgical sepsis. It is proved that the condition of the primary and secondary purulent foci determines the course of the wound process and the occurrence and progress of sepsis. Radical surgical debridement of the wound leads to early optimization of the condition of the immune system and creates conditions for effective immunologic correction and intensive therapy.

[A kit for conducting enteral feeding]. / Pribornyi kompleks dlia provedeniia éntera'lnogo pitaniia.

A new kit for probe feeding permits to provide dosaged and continuous administration of nutritional mixtures with a certain speed and intervals. The complex is supplied with a device that permits to maintain a certain temperature of the mixture (if necessary the range of heating and cooling varies from 10 to 40 degrees C) and an electromixer, that prevents the mixture viscosity increase. The kit is successfully used for enteral (probe) feeding in patients with acute purulent infection and sepsis.

[The epidemic spread of the influenza A and B viruses in the USSR in 1985-1986]. / Epidemicheskoe rasprostranenie virusov A i B v SSSR v 1985-1986 gg.

The data on the spread of influenza A and B in the autumn and winter of 1985-1986 are given. Three epidemics caused by all presently circulating viruses, B, A (H3N2) and A (H1N1), were registered in the USSR. Of these, the greatest one was the epidemic of influenza B; morbidity rate among the adult population during this epidemic was at the level with the morbidity rate characteristic of the epidemics registered at the period of 1962-1972, and morbidity rate among children, especially school children, was even higher.

[Motor evacuatory function of the stomach and the absorptive capacity of the intestines in patients with extensive suppurative wounds receiving tube feeding]. / Motorno-évakuatornaia funktsiia zheludka i vsasyvatel'naia sposobnost' kishechnika u bol'nykh s obshirnymi gnoinymi ranami v usloviiakh zondovogo pitaniia.

Radionuclide gastroscopy conducted in patients with vast purulent wounds and sepsis disclosed reduced motor-evacuatory function of the stomach and the rate of its fractional emptying, that supports the necessity of continuous administration of nutrient mixtures by a drip method. A significant improvement of the motor evacuatory function and the rate of fractionated emptying of the stomach, 9-12 days after the commencement of the enteral (tube) nutrition, has shown the necessity of its use at the early stages of the course of severe purulent infection. The investigation of the absorptive capacity of the intestine with the use of the D-xylose test has revealed that it is insignificantly decreased in 82.6% of patients with severe purulent infection, and tube nutrition in such patients could be successfully conducted. Only in 17.4% of the patients the adsorptive capacity of the intestine was significantly decreased, and in these cases predominantly parenteral nutrition was recommended.

[Effect of a complex system for controlling influenza on a city scale on population mortality]. / Vliianie kompleksnoi sistemy bor'by s grippom v masshtabe goroda na smertnost' naseleniia.

A decrease in mortality among the population, and primarily in mortality caused by the diseases of the respiratory tract, has been achieved in one of the northern cities of the USSR owing to a complex of prophylactic and antiepidemic measures, including the use of live inactivated vaccines, remantadin and other anti-influenza remedies, carried out on a city scale. This fact indicates that such measures have proved to be necessary and effective.