Search

The article presents the results of a study of impact strength of underground cement materials with different water content activated by mixing water with the addition of high range plasticizers, biocidal agents, pigments, ground quartz, silica fume and fine aggregate. Samples for testing are formed in plates of size 150×100×10 mm. Testing was conducted at impact drop-weight method ASTM D7136. The maximum contact force, contact duration and magnitude of the pulse of the drummer were considered as the test parameters. The good results of the studied parameters showed highly filled plasticized compositions of the new generation. The use of iron oxide with yellow and green glauconitic pigments allows obtaining good results. Activation of the mixing water led to a rise in the maximum contact force in the case of the processing mode of E+М (3–3) while reducing the duration of the contact and the magnitude of the impulse. During the test of the biocidal composites with different biocidal preparations, it was established that the best indicators of the impact strength correspond to materials with the addition of «Teflex Antiplesen».

Using the 'Korona' cava filter in a total of 1345 oncological patients revealed regularity of a change in the shape of the inferior vena cava at the level of implantation. This made it feasible to determine one of the causes of long-term complications following implantation of other models of cava filters. The absence of clinically significant complications in the remote period after using this model of cava filter made it possible to implant it for a longer period, which is of special importance in oncological patients.

The direct transcutaneous transhepatic portography was performed in 85 patients with hystologically confirmed liver cirrhosis, portal hypertension and varices of the esophagus and stomach. It was found out, that the left gastric vein partakes the varicous transformation in 100% of cases. The least had an isolated division in 27% of the studied patients. 68% had the significant dilatation of the posterior gastric vein, whereas 19 (22%) patients had the combined posterior, left and short gastric veins dilatation. The study allowed the modification of the M.D. Patsiora's operation (the azygo-portal disintegration), by supplementing it with the gastric devascularization. The new method increased the 2-years survival from 77 to 97%, improved the hemostatic effect from 51 to 89% and decrease the recurrences from 25 to 5%.

Research Objective: studying the features of the collateral venous blood flow and the basic ways of the formation of gastroesophageal varices in patients with cirrhosis and portal hypertension., Methods: The following analysis is based on the interpretation of results from percutaneous transhepatic splenoportography in 85 patients. It has been established that in all 85 patients the left gastric vein plays a key role in the formation of gastroesophageal varices., Results: It is established that a leading collector in 100% of observations participating in formation gastroesophageal varices, is the left gastric vein. In work the attention is focused on an insufficient estimation of a role of a back gastric vein in a pathogenesis of varicose transformation. From 85 observations its presence is taped in 58 (68%) cases, and, at 19 (22%) patients its expansion isn'ted in a combination to expansion left gastric vein, and at 39 (46%) patients - in a combination with left gastric vein and short veins of a stomach., Conclusion: The obtained data on the formation mechanism of varicose expanded veins of an esophagus and a stomach defines necessity of changes for algorithm of inspection of patients for the purpose of diagnostics of features of a venous blood flow of a stomach and an esophagus and definition of surgical tactics concerning volume pre- or intraoperational blockade of the basic venous collectors.

The authors analyzed an experience with treatment of 4372 patients. Videothoracoscopy allowed the number of usual drainages of the pleural cavity to be reduced in closed trauma from 16.3% to 2.3%, in wounds--from 3.9% to 0.4%. Persistent hemo- and airstasis were obtained by coagulation of the vessels of the thoracic wall and lung, suturing lung wounds. The coagulated hemothorax was removed, diaphragm wounds were sutured, the pericardium wounds were revised, the character of intrathoracic lesions was reliably determined in 98% of cases. Conversion into thoracotomy was fulfilled in 91 (5.5%) patients. Thoracotomy was fulfilled in 344 (8%) patients with indications to operative interventions and severe condition and unstable hemodynamics. The number of thoracotomies and lethality in patients with penetrating wounds of the chest became 1.5-2 times less, was not considerably changed in closed traumas.

Purpose: The current article describes the initial results after the creation of intervascular connections with use of an exclusively endovascular approach. Connections of two vessels were performed in the thoracic and abdominal areas with use of a kinematic needle without traversing a solid organ. The materials developed specifically for this technique are described., Materials and Methods: The procedure was carried out in 11 animals and consisted of bringing together two vascular structures with use of magnets, performing a puncture from the lumen of one vessel to that of the other, and inserting a prosthesis between the two. The prosthesis has a biconical morphology and is made with a 0.016-inch monofilament of nitinol. Its most outstanding feature is that, when it is dilated with a balloon, it shortens and "rolls up," flattening its ends. This allows good fixation to the vessel wall, avoiding the protrusion of metal into the lumen of the native vessel., Results: On four occasions, the aorta was connected to another nearby vessel: the abdominal aorta to the inferior vena cava (IVC; n = 1), the ascending aorta to the trunk of the pulmonary artery (n = 1), and the descending aorta to the left pulmonary artery (n = 2). On another four occasions, two veins were connected: the portal vein and the IVC. Finally, on three occasions, the right pulmonary artery was connected to the superior vena cava. The connection was safely and accurately performed with passage of a guide wire in all cases. In two experiments, the prosthesis was too short and leakage with massive bleeding was observed after a successful initial deployment of the prosthesis, Conclusion: Intervascular anastomoses created by an endovascular approach are feasible in the authors' experimental model for several different vessel pairings.

Temporary electrical cardiac pacing in the conditions of air medical service was used in 183 patients with myocardial infarction complicated with life threatening disturbances of cardiac rhythm and conduction. Immediate results of treatment, complications, and causes of lethal outcomes are presented. Two groups of patients were distinguished: in which traditional and improved by authors methods of temporary electrical pacing were employed. It was established that the use in urgent situations of improved techniques of control of endocardial electrode position, transesophageal, cutaneous, and atrial dependent endocardial ventricular electrical pacing allowed to decrease number of complications 2.6 times, and to lower mortality in acute period of myocardial infarction by 12.8%.

A new original instrument is proposed for draining the cystic duct into the common bile duct through the stump. The device combines a reliable fixation of the drainage tube in the stump of a narrow (less than 3 mm) or scared altered cystic duct and the not traumatically embedded cannula into the common bile duct.

The paper discusses the preliminary findings on alpha-feto-protein (AFP) treatment of 58 patients with stage III-IV malignancies of different localizations. No influence on neoplastic processes was registered in poorly differentiated cell tumors, nor were any immunological mechanisms of antitumor action triggered on. However, in moderately- and well-differentiated cell tumors, several foci of acute immune inflammation were induced. It is suggested that AFP is responsible for tumor cell apoptosis by freeing antigenic determinants from shielding antibodies via elimination of <> of tumor growth.

Early rehabilitation after open cholecystectomy or cholecystectomy from a mini-approach was performed in 101 patients with cholelithiasis treated surgically at Ust-Kachka health resort. Changes in clinico-laboratory indices reflecting the condition of hepatopancreatobiliary system and central hemodynamics before and after rehabilitation were studied depending on the variant of cholecystectomy. Advantages of early rehabilitation of patients after different variants of cholecystectomy at Ust-Kachka health resort in normalization of general condition of the patients and in prevention of functional disorders progression early after operation are demonstrated.

Results of surgical treatment of 81 patients with recurrent goiter and 79 patients with benign nodular forms of goiter are analyzed. Based on clinical data, results of ultrasonic and histological examinations, it was determined that recurrence of goiter does not depend on volume of surgery. It is seen in patients with subclinical forms of postoperative hypothyreosis and in half of cases with lymphoid infiltration of I - IV degree. Dispensary observation and timely prescription of suppressive therapy, if it is necessary, permit to reduce number of goiter recurrences from 8.2 to 2.5%.

Influence of different methods of external drainage of the biliary tract on dynamics of inflammation in the biliary tracts was evaluated based on the data examination of bioimpedance, specific electric conductivity and general microbial number of bile received during surgery and from drainage of the common bile duct during 9 days after surgery in 197 patients with cholelithiasis complicated by bile outflow disturbances. It is demonstrated that each type of external drainage has own indications depending on the degree of bacterial contamination, macroscopic structure, biophysical parameters of bile, and planned treatment policy after surgery. Right fixation of the drainage tube in the common bile duct improves immediate results of surgical treatment of patients with cholelithiasis.

The authors evaluated influence of Alfetin new Russian biologic preparation on pulmonary surfactant system and phospholipid metabolism in workers at risk of occupational pneumoconiosis, who suffer from infiltrative pulmonary tuberculosis. Considering positive changes in serum phospholipids subunits under alfetin treatment, the authors proved membrane protective effect of the drug. Alfetin was proved to weaken toxic effects of tuberculostatic drugs on lung surfactant.

The article deals with diagnosis and treatment of fat embolism concomitant with trauma. A new term is suggested, i.e. liqoroglobulism, which is concomitant with the cerebral form of fat embolism. The results of investigations of patients, who endured fat embolism, are presented. A new method is suggested for the treatment of fat embolism, i.e. a combination of hemosorption and liquosorption. A thesis on that the blood-brain barrier is damaged in the cerebral form of fat embolism is formulated.

The electric conductivity of the hepatic bile received during and 24 hours after surgery from the drainage introduced into the common hepatic duct was studied in 94 patients with cholelithiasis. It is demonstrated that conductivity increases in cholestasis, inflammatory process in the biliary tract and depends on the hepatic morphofunctional status. The specific electric conductivity of intraoperative bile that is more than 192 S/m is considered to be criteria for the diagnosis of cholangitis. The electric conductivity of urine before and in first 4 days after surgery decreases in inflammation of the biliary tract and depends on the degree of concomitant renal dysfunction and electrolyte disturbances. There was a decrease in the conductivity of bile and urine in all studied groups. Detection of biophysical parameters of biological fluids may objectively control the postoperative period and correct treatment policy.

The authors have analyzed results of thoracovideoscopy in 45 patients with the syndrome of pleural exudate, 17 of them had undergone the ultrasonic examination of the pleural cavity before thoracoscopy. The examination has revealed high sensibility of the ultrasonic method in the diagnosis of fragmentations of pleural exudate and pathology of the pleural leaves. The endoscopic and echographic classification of the pleural exudate is given depending on the fragmentation degree. The authors consider that echography of the pleural cavity as a noninvasive and highly informative method should be included in the first rank in making an algorithm of clinico-diagnostic measures for patients with exudative pleuritis.

Criteria of selection of a type of protection against paroxysmal supraventricular tachycardia were studied in 38 patients with permanent dual-chamber cardiac pacing. Three types of protection were distinguished. Criteria for their selection were presence of "pacemaker syndrome", state of chronotropic function of the heart, frequency of attacks of supraventricular tachycardia, results of modeling of pathological atrial activity. During follow-up after programming of optimal type of protection of dual-chamber pacing (mean duration 5.1 years) chronic supraventricular tachycardia developed in 13.5% of patients, survival was 89.2%.

Specific electrical conductance (SEC) of the hepatic bile in 94 patients with cholelithiasis and concomitant pancreatitis was increased (p < 0.001) and depended on the degree of cholestasis and the morpho-functional state of the liver. The value of SEC of the intraoperative bile higher than 193 S/m is taken for a criterion of the diagnostics of biliary pancreatitis. The electrical conductance of urine during the first 4 days of observation decreased in patients with acute pancreatitis (p < 0.05), impaired carbohydrate metabolism and concomitant renal dysfunction. The value of SEC of urine lower than 238 S/m corresponds to acute pancreatitis. The investigation of physico-chemical indices of biological liquids in patients with a pathology of the pancreato-biliary system allows to objectively control the course of the disease and to correct the treatment methods.

The time course of changes in current epidemiological indices and epidemically significant features of the pathomorphism of infiltrative pulmonary tuberculosis in those living in the Perm Region are mainly characterized by negative trends. They lie in the increase or stable maintenance of high rates of morbidity, mortality, and destructive pattern of a lesion accompanied by bacterial isolation. The reason for the established situation is incomplete realization of potentialities of improving actions to detect the disease early, to optimize diagnosis and medical therapy, and to considerably expand an phthisiosurgical aid.

An analysis of surgical treatment of 142 patients with cancer of the colon and rectum included 32 emergency cases and 110 scheduled operations. Standard surgical methods only were used in 94 patients, the lymphotropic immunocorrection with myelopidum in the postoperative period was made in 48 patients. The use of lymphotropic immunocorrection was shown to considerably improve the immunological parameters and to decrease postoperative lethality.

Based on the data available in the literature and their own findings, the authors have established that the pathomorphism of infiltrative pulmonary tuberculosis in the preantibiotic age was characterized by negative features, then underwent phases of positive changes and relative stabilization, thereafter it again acquired obviously marked negative peculiarities. At present, the clinical features of new cases of infiltrative pulmonary tuberculosis in Perm residents are the predominance of acute onset (67.3%), disseminated (55.8%) and destructive (91.6%) pattern of specific lesion accompanied by bacterial isolation (84.6%).

The authors discuss evaluation of the severity of fatty embolism. Three criteria are taken into consideration: clinical symptoms, presence of fat in the serum or liquor, and presence of fat on the surface of serum or liquor. The broth symptom is defined. The studies indicate that after detection of this symptom microscopy of the serum for detecting fatty globulemia is inefficient.

The article is devoted to the problem of diagnosis and treatment of 28 patients with cranio-cerebral injury with posttraumatic fat embolism. In 15 of them fat liquoroglobulia was diagnosed which is a reliable symptom of the cerebral form of fat embolism. The method of detection of fat liquoroglobulia is described. A new method--liquorosorption--was used in treatment of patients with the cerebral form of fat embolism. A disturbance of the hematoencephalic barrier is thought by the authors to be possible in such embolism.

The immediate outcomes of treatment were studied in 119 patients with caseous pneumonia whose age was 20 to 64 years. In most cases, caseous pneumonia was found to preserve its classic traits by characterizing by acute onset (85.8%), prompt progression, high proportion of fatal outcomes in the early postoperative period (54.1% within 3 early postoperative months). There is an increase in cases of more "benign" course of this form of tuberculosis (subacute onset and prolonged slow progression) at the same time. The use of current methods for combined intensive antibiotic and pathogenetic therapies substantially improves the outcomes in this most severe group of patients, reduces the initiation of a phase of relative stabilization of a specific process and of cessation of bacterial isolation.

The article is devoted to the problem of fat embolism. In 63 patients with combined and isolated traumas the maximum frequency of fat embolism was diagnosed in the investigation of blood serum from the femoral artery. It can be supposed that no isolated injury of the lesser circulation circuit can occur in fat embolism. An investigation of the venous-arterial difference of fat globulemia has shown the main role of the so-called theory of shunting for fat embolism to be doubtful.

Through a period from 1981 to 1996 127 roentgen-endovascular embolization of gastric veins were carried out in 95 patients for portal hypertension complicated by esophagogastric bleeding or in its threatening relapse. Group 1 consisted of 73 patients, to whom endovascular treatment was carried out urgently at the background of continuing hemorrhage, in 52 patients--it was delayed and in 21 patients in the nearest posthemorrhagic period. In 73 patients bleeding resulting from embolization was stopped. In the earliest postembolization period recurrence of hemorrhage developed in 6 patients, thus initial hemostatic effect of embolization made up 91.8%, and survival rate--74% (54 from 73 patients of the 1-st group were discharged from the clinic). Group 2 consisted of 22 patients to whom embolization of gastric veins was carried out as an elective procedure. There were bleedings in the anamnesis in the patients of the latter group, and varicose veins of the esophagus with trophic disturbances in esophageal mucosa manifested real treat of the hemorrhage. The survival rate in this group of patients made up 95.5%. The analysis of the results of elective endovascular embolization of gastric veins revealed more favourable results in the nearest postembolization period, than in urgent procedures. Far off results of embolization of gastric veins were followed up in 61 patients (43 patients of the 1st group and 18 patients of the 2nd group). Index of survival up to 6 months made up 87.8%, up to 12 months--80.5%, up to 3 years--57.5% and up to 6 years--19.6%. Hemostatic effect up to 6 months made up 100%, to 12 months--84.6%, to 3 years--54.9%, to 6 years--15.6%.

The specific features and outcomes of surgical treatment were analyzed in 122 newly detected patients with pulmonary tuberculomas without prior specific therapy. Postoperative complications developed in 4.1% of the patients undergone surgery, recurrent tuberculosis was observed in 1.6%. Early surgical interventions in this group of patients were found to reduce the time of treatment and working rehabilitation. A value of intraoperative rapid cytological verification of diagnosis was shown while choosing the adequate volume of lung resection in difficult diagnostic cases.

An experience with using endovascular venous embolization in 53 patients with bleeding from varices of esophageal veins is presented. Transhepatic, transsplenic and laparotomic accesses were used. Embolization of the gastric veins was fulfilled with nonlysing materials--teflon velour in combination with metallic spirals. The results obtained proved to be better than those known from the literature.

The authors have developed a method for transcutaneous transsplenic catheterization of the portal vein basin and used this method in clinical studies. This method permits a higher quality of spot splenoportography, selective catheterization and embolization of the gastric veins in bleedings from varicose veins of the esophagus in the patients in whom catheterization of the portal vein bain via the transcutaneous transhepatic approach is impossible because of liver tumors of occlusive stenotic deformation of the portal vein.

The article generalizes materials of 148 rethoracotomies. Main complications are described. Grounds are given for the use of perfusion through the xenospleen at the early postoperative period in order to liquidate the coagulated haemothorax mainly after pulmonectomy. An original method of determination of the coefficient of relative viscosity of the exudate on the absorbing base is described. The method allows the objective control of infectivity of the pleural exudate to be performed. The clinical use of different methods of detoxication in the preoperative period is substantiated: UVI of blood, hemocarbosorption and xenohemosorption, which allowed to reduce lethality after rethoracotomies and reoperations on the lungs.

Among the various methods of antibacterial preparation injection for the management of pulmonary tuberculosis the intrapulmonary injection techniques with the help of a needle-stream injector (NSI-1) still remain little studied. The experience of using these techniques for treating more than 200 patients, among whom 23 patients were later operated on, showed that the early use of the method (immediately after the diagnosis was established) helped to stabilize the process in 1-1.5 months. This made it possible to perform operations within 3 months after the diagnosis was made. The method proved effective also in patients who did not present favourable dynamics during 3-6 months of the use of the traditional therapeutic methods. The results obtained allow for the use on a wide scale of needle-stream injections in the preoperative management of destructive tuberculosis patients.

After studying the results of embolization of the hepatic artery in 14 patients with portal hypertension and resistant ascites the authors came to the conclusion that this operation often leads to the development of hepatic insufficiency and a fatal outcome and produces a clinical effect only in a small number of patients. Celiac- and mesenteric angiography and transhepatic portography were carried out for pathogenetic substantiation of the intervention. Pressure in the portal vein, hepatic veins and arteries, and in the inferior vena cava was measured during the examination. The space velocity of the portal and arterial hepatic blood flow was determined. Clinico-angiographic examination of the patients failed to reveal criteria for predicting the efficacy of embolization of the hepatic artery. A positive result may be expected in cases in which embolization leads to a reduction in portal pressure. Embolization of the hepatic artery produced no clinical effect in initial reduction of the blood flow in the liver.

The ventilation function was studied in 103 pulmonary tuberculosis patients of pneumoconiosis-risk occupations in the absence of pneumoconiosis and in 51 patients who were not exposed to dust. Patients of "dust" occupations were found to have a decrease in the parameters of external respiration and bronchoscopic findings more often showed chronic bronchitis. The initial signs of pneumoconiosis were revealed in the histological examination of surgically removed lung segments in 83.4% of the patients.

Operations were performed on 102 patients (93 with tuberculomas, 2 with fibrocavernous tuberculosis, and 7 with infiltrative tuberculosis of the type of caseous pneumonia) without preoperative chemotherapy. Certain difficulties in identification of the nature of the disease in tuberculomas are pointed out. It is shown that only emergency histological study helps to avoid errors. Postoperative complications occurred in 5.9% of patients. Exacerbation of tuberculosis after economical resections in tuberculomas occurred in 2.1% of patients due to a nonradical intervention. The expediency of early interventions which allow the term of treatment to be shortened is shown.

Data are reported on 66 tubercular patients. In 59 of them enterosorption along with traditional treatment were used to control side-effects of antibacterial treatment, correction of liver function, reduction of tubercular intoxication. The obtained results indicate efficiency of enterosorption that removes during a short time period the side-effect allowing to treat efficiently the main disease.

The authors discuss the possibility of a laparotomy approach for endovascular embolization of the gastric veins in patients with portal hypertension and gastroesophageal bleeding. This approach was used in four patients in whom transhepatic catheterization of the portal channel was impossible. After laparotomy, catheterization of the portal vein system was conducted through one of the veins of the small intestine. The effect of embolization in two of three patients who were subjected to the operation consisted in correction of esophagitis and complete cessation of esophageal bleeding. In view of the danger of the development of operative and postoperative complications due to the specific features of the pathological condition, the authors recommend using laparotomy endovascular embolization of the gastric veins only in the presence of strict indications.

Endovascular occlusion of the veins which carry the retrograde outflow of blood from the portal system into the system of the superior caval vein through the varicose dilated esophageal veins is known to be one of the most effective methods to stop profuse bleedings due to a disturbed integrity of the varicose dilated veins of the esophagus. It is thought to be expedient to add injections of thrombin to embolization. When performing embolization of the splenic artery it is necessary to exclude possible development of the resulting collateral blood flow via the spleen.