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Needle breakage may be a damaging experience for both medical practitioners and patients. Medical literature provides numerous cases of dental practitioners being confronted with this problem. We have studied the clinical case of the patient L. at the Moscow State University of Medicine and Dentistry involving needle breakage during conductive anesthesia. We propose our medical approach to solving this issue alongside with a desirable course of action, providing additional recommendations and suggesting intraosseous anesthesia as a safer type of pain management.

The authors assessed the effect of carbonization and its influence on the parameters of endovasal laser obliteration (EVLO) depending on wavelength of laser radiation (970 and 1470 nm) using a light guide with radial emission. They also analysed the value of drop of radiation power of the light guide after performing EVLO and visually assessed the degree of damage of the glass tip of the radial fibre by means of ultra-close-up photography. The study comprised a total of 20 patients with varicose disease. A total of ten procedures of EVLO were performed in two modes: mode one - W-laser 1470 nm, mode two - H-laser 970 nm, using fibre with radial emission, an automatic retractor of the light guide. It was determined that the median of power loss after EVLO with W-laser amounted to 0.6 W, and that for H-laser - 3.15 W (p=0.002). Ultra-close-up photography showed pronounced damage of the glass tip of the radial light guide while using H-laser and no damages while using the W-laser. It was proved that using laser radiation with wavelength of 970 nm using the light guide with radial emission leads to pronounced carbonization on the surface of the glass tip of the light guide, its damage, a decrease in radiation power and risk of mechanical destruction of the flask. Using the laser with wavelength of 1470 nm with the use of radial light guide did not result in the development of such negative effects, which increases the service life of laser fibre and makes it possible to use it for obliteration of several segments in one patient.

The article deals with the analysis of factors impacting dosage inaccuracy and input of this inaccuracy into total inaccuracy of analysis. The total dosage inaccuracy includes both the value of inaccuracy mentioned in the technical passport of dosage device and inaccuracy values occurring at all stages of dosage during implementation of technique. The characteristics of dosage devices and their merits and shortcomings are taken into account. The article substantiates the choice of types of dosage devices to be implemented in the laboratory research. The modes of errors elimination and inaccuracy minimization were analyzed against the perfectly calibrated and totally corresponded to passport data device of air transfer dosage.

External hemorrhage of extremities wounds is the leading cause of soldiers' death on the battlefield. In these cases control of massive arterial bleeding require not only prompt and effective measures, but also safety procedure. We assessed on volunteers the effectiveness, application time and pain intensity during the use of construction powerful quick-grip one-handed bar clamp. In results we found that the use of improvised quick-grip clamp for hemorrhage control in axillary and popliteal areas stops arterial blood flow in an extremity in all cases proven by Doppler ultrasound examination. Application time in axillary zone was 15.3 +/- 5.2 sec, in popliteal area--27.3 +/- 8.0 sec. In the groin area, the use of this improvised device was not effective due to technical characteristics (small distance between the main frame and the pressure surfaces). There do appear to be sufficient reasons to design the universal clamp for hemorrhage control from the wounds of junctional zones as well as proximal segments of extremities on Advanced Trauma Management stage and also for civilian prehospital emergency care.

The purpose of the study was to estimate the drift of the zero value of "Codman" intracranial pressure sensors, compared with the duration of monitoring, location of intracranial pressure sensors, and also to assess the relationship of drift to the gauge number. 60 "Codman" intracranial pressure sensors were investigated. The analysis of zero drift were made depending on the length of monitoring and location of the intracranial pressure sensor, as well as on description of the gauge number. Data are presented as median, quartiles, minimum and maximum values. The gauge numbers of 499, 491 and 501, (475 and 513). The drift was 0 mm Hg. -1 And 0 (-2 to 3). In 43% of the ICP measurements of the drift of the zero value was absent. In 40% o the drift was within +/ - 1 mm Hg. The analysis showed no dependence of the drift of the zero value of the duration of monitoring, location of the sensor and gauge numbers. On two patients simultaneous recording of intracranial pressure in the ventricles and brain parenchyma was carried out. The high correlation between the measured values r = 0.94, p < 0.01. In one "in vivo" case the zero drift was detected, which amounted to 2 mm Hg and grew by 5th day of monitoring. The maximum value of the drift of the zero value was 3 mm Hg. The dependence of drift on the duration of monitoring, reference values of the calibration and sensor implant site was absent. This shows the accuracy and reliability of parenchymal ICP measurement.

Paper is devoted to the safety rules by surgical interventions on patients with permanent pacemaker. Data of 123 operated patients with intraoperative pacemaker instability were analyzed, possible premises of this complications were discussed. The use of monopolar electrocoagulation proved to be the most frequent of reason of pacemaker failure. Strong correlation between rhythm failure and duration of the single electrocautery exposure was revealed.

Purpose: To assess effectiveness and safety of excimer laser extraction of chronically implanted transvenous pacing leads using countertraction technique. We operated upon 10 patients (female 2), mean age 56.1+/-11.7 years. Average time of lead placement was 7.7+/-4.2 years. Indications included erosion of device pocket in 4 patients, abscess of pocket in 2 patients, high grade of tricuspid valve insufficiency in 1 patient with 2 ventricular leads, lead related induction of life-threatening ventricular tachycardia in 3 ICD patients. We used xenon-chloride laser with excimer laser sheath SLS n KIT 14-16 Fr and locking stylet LLD KIT (Spectranetics, USA). Endotracheal anesthesia was applied in all cases. Leads removal was a success for 3 atrial and 12 ventricular leads. All endocardial leads were extracted with countertraction after near-the-complete progression of the laser sheath. Postoperative follow-up period was 16.3+/-5.7 months. There were no procedure-related complications., Conclusion: Laser lead extraction is a safe and effective approach to removal of long-term leads including those with active fixation.

The main principles of assessment of reliability and service life of sophisticated medical equipment are described.

Illustrated with case history (patient F), the authors represented diagnosis, prognosis, treatment, long-term consequences of local radiation lesions.

The experience of pacemakers use in 24 children aged 6-15 years in the treatment of arrhythmias and conduction disturbances (CD) were summarized. Surgical intervention is indicated when a medical history of syncope or severe hemodynamic disturbances is present. In order to achieve a high quality of life of the child with arrhythmias and CD it is essential to use up-to-date pacemaker models with 2-chamber stimulation, frequency modulation, telemetry and prolonged expiry term.

The study included 149 patients with implanted cardioverters-defibrillators (CD) at high risk of development of ventricular tachyarrhythmia. It was found that unmotivated malfunction of CD occurs in supraventricular tachycardia, when a short episode of ventricular tachycardia spontaneously ends before CD starts to work, when T-wave is mistaken for ventricular contraction, in defective isolation, electrode dislocation. A method to reduce frequency of CD malfunction is proposed. To prevent unmotivated discharges it is recommended to use attendant drug therapy, upgrading equipment and algorithms of tachyarrhythmia detection, early correction of myocardial ischemia and electrolyte disorders.

Eleven cases with migration (escape) of catheters, inserted into subclavian veins, into the vascular bed, are analyzed by the results of forensic medical evaluations. Expert evaluation of aftereffects of the complications caused by flaws in medical care is made. Suggestions are made on evaluation of the severity of harm inflicted to health in such cases and the criteria of such evaluations are offered.

The paper reports a case of escaping pacemaker syndrome in a female with continuous endocardial ventricular pacing. The syndrome was provoked by defects in the electronic scheme because of weakening of pacemaker's battery.

In 378 patients with artificial pacemaker (AP) 10-year follow-up revealed disturbances of continuous pacing and cardiac arrhythmia. Diagnostically significant were: ECG, Holter ECG monitoring, functional AP control. Cardiac arrhythmias were spontaneous and pacing-induced. Programmed AP corrects complications of cardiac pacing and arrhythmia without surgical intervention. Regular technical control of the stimulation system providing early diagnosis of AP defects is an important component of check-ups of patients with AP.

The X-ray films and ECG records were analysed in 11 cases of dislocation and 20 cases microdislocation of the endocardial lead in patients with monopolar ventricular pacing. In 3 patients lead was dislocated into the right ventricle cavity, in 2 patients--in the another heart cavity, in 6 cases lead dislocation was negligible. In 20 cases of microdislocation the fluctuation all intracardiac parts of the endocardial lead not only his distal end was revealed. Therefore it is better to call this complication of heart pacing "the endocardial lead instability". The X-ray picture of the negligible lead dislocation was identical to microdislocation: a thickening unclear contour of the distal lead end. The ECG picture in cases of dislocation was different from microdislocation: the lack of pacing contrary to pacing preserved in cases of microdislocation. All patients with dislocation and microdislocation had high amplitude spike of pacemaker impulses.

In order to remove the fragment of an instrument, filling material evicrol is applied onto the mouth of the root canal in which the end part of the broken instrument is detectable; the second half of the endodontic instrument is introduced in evicrol substance. After evicrol hardening the two parts of the instrument are reliably connected, and thus the fragment may be removed from the root canal.

Basing on the experience of the surgical treatment of 15 patients with catheteric embolism of the heart and vessels the authors concluded that septic occurrence in given patient category requires urgent operative intervention. In catheteric heart embolism in patients with heart defects surgical interventions may be performed in nonperfusing deep (28-25 degrees C) hypothermal protection, permitting simultaneous removal of heart foreign body and to correlate heart defects not requiring continuous circulation control.

The paper summarizes the experience on 27 implantations of sensory multiprogrammable pacemakers (two-chamber Synchrony-II and one-chamber Sensolog-III) produced by Siemens-Elema. The implantations were performed in the Moscow Cardiostimulation Center in 1993. Primary pacemaker implantation was performed in 19 patients, 8 patients needed the replacement of one-chamber pacemakers because of the power source exhaustion or circulatory insufficiency. The two-chamber pacemaker was implanted to 14 patients with a complete AV-block and chronotropic sinus node incompetence and to 4 patients with sick sinus syndrome in intact AV-conduction. In 6 patients the one-chamber pacemaker was implanted to stimulate the right ventricle. They had permanent bradysystolic auricular fibrillation and complete AV block with persistent or transitory tachysystolic auricular fibrillation. 3 patients with sick sinus syndrome received one-chamber pacemaker. The authors think their experience with sensory Siemens-Elema pacemakers positive.

In many cases of death from oxygen deficit in an enclosure the development of a pathologic state is adequate to development of high-altitude hypoxia. This fact prompts extrapolation of high-altitude physiology data to such cases and helps calculate the onset of loss of consciousness and death. Methods of such calculations to be used in practical forensic medical expert evaluations are presented.

A total of 105 patients with implantable pacemakers were examined. Whether the pacemaker disconnection test can be used to predict syncopes in failure of permanent cardiac pacing was studied. The spontaneous ventricular activity was evaluated in 62 patients with acquired complete atrioventricular block (CAVB) and in 43 patients with artificial CAVB. The patients with varying pacemaker dependence were grouped. It was ascertained that 7% of patients with artificial CAVB and 19% of those with acquired CAVB were dependent on pacemakers. In possible failure of stimulation or in reimplantation of a pacemaker on its disconnection, 93% of patients with artificial CAVB and 81% with acquired CAVB could develop their own cardiac rhythm. Lowering the frequency of pacing enabled the duration of asystole to be decreased. The usage of isadrin was demonstrated to enhance spontaneous ventricular activity.

The article cites the results of the researching work that analyzes the crew cooperation in the conditions of an aircraft break-downs which were imitated at flight simulator; elaborates psychophysiological recommendations and makes its efficiency estimate. The authors state that psychophysiological recommendations could relieve routine work embarrassing situations, therefore promoting for better professional reliability of flight crews.

180 patients with scoliosis (aged 12-29 years) were subjected to the correction of deformation by means of the Harringtone type distractors and spondylodesis with utilization of osseous transplants. In 24 of them (13,3%) the distractor has been broken in different terms after the operation. The danger of the break increases with the age of the patients and abruptly increases in case of scoliosis of the V degree (in excess of 90 degrees) and in case of necessity to bend the distractor to correct the kyphoscoliosis. The distractor break is associated not with the material structure but with the rod design.

The article presents an experience with the work of a city phlebologic center, confirming the importance of active introduction of modern surgical methods of prevention of embolism of the pulmonary artery in the program of aid to patients with acute embologenic iliofemoral phlebothromboses. Use of the methods of endo- and exovenous cava filtration and cavaplication allowed lethality in this group of patients to be reduced from 15-20% to 1%.

Under analysis were causes of reoperations in bradyarrhythmic forms of disturbances of conductivity of the heart. 565 operations connected with electrocardiostimulation were performed on 276 patients. Reoperations in patients with the myocardial stimulation were made on 63 patients, with the endocardial stimulation--in 226 patients. Causes of reoperations were as follows: depletion of the source of ECS--31.5%; dislocation of the electrode--8.2%; damage of the electrode--15%, suppuration of the bed, decubitus of the stimulator--28.8%; competing rate--7.4%; break of the contact in the connecting system of the electrode and cardiostimulator--9.4%.

In patients with bradyarrhythmia 1105 operations were performed. Among them 528 primary stimulations were fulfilled with 2.4% lethality, 289 changes of the generator, 122 temporary electric cardiac stimulation. Complications were observed in 15.5% of the patients. Medico-technical complications took place in 5.5%, arrhythmias++--in 52.9%, purulent complications in 5.3%. Long-term results were followed-up in 405 patients within the terms from 6 months til 15 years after operation. Five years survival took place in 64.2%, ten years--in 43%, 15 years--in 27.8%. Complications in remote periods were noted in 27.6% of patients. Great attention is given to timely performed operations and dispensary observation of the patients for the improvement of results of electrocardiostimulation.

The results of the operative treatment of 277 patients with atrioventricular block and sick sinus syndrome were analysed. The primary implantation of the electrocardiostimulators (ECS) was performed in 211 (73.5%), the repeated one--in 76 (26.5%) patients. The complications of endocardial electrocardiostimulation developed in 58 (17.3%) patients, of them in 39 (14%), the repeated operative intervention was performed. Most frequently, the complications were conditioned by the quality of electrodes and ECG.

The method to compute friction loss in medical microturbines and tips at the stage of their development is proposed. It is verified when designing friction loss of the following devices: a turbine tip HTC-300-02, a pneumatic micromotor MMP-20, and micromotor tips (NVP-30M) and (NP-30M). The method may be useful in estimated designs of friction loss.