2014, volume 10

Aim: to specify operative and anesthetic risk during urgent and preventive operations for patients with ulcerative gastroduodenal bleedings, develop algorithm for prognosis of unfavorable outcomes after operations and point out possible ways to control risks in given pathology. Material and Methods. To specify factors of operative and anesthetic risk during urgent and preventive operations a comparative analysis of two groups of patients suffering from gastroduodenal bleedings, who were treated in the surgery department of "Saratov city clinical hospital Nr.6" was done. The first group consisted of 39 patients, who died after the surgery, the second group of 274 patients with a favorable outcome after the operation. The statistical analysis was done by use of the program Statistica 6.0. Results. The operative and anesthetic risk factors where determined with the help of parametric and non-parametric methods of statistical analysis. An algorithm of evaluation operative and anesthetic risk factors by a tree classification was devised through the use of multidimensional analysis. With the help of this one can predict the outcome of urgent and preventive operations and highlight the risk group with an expected lethality of about 40%. Conclusion. The division of patients according to degree of risk of bleeding relapses as a whole with complex evaluation of patient's condition severity and operative and anesthetic risk allows choosing the right treatment plan and by this as a result increases the chance for a favorable treatment outcome.

Aim: to establish the structure of the relationship between the change in regulations of fluorographic regimen and frequency of occurrence of bacillary excretion (MBT+), destructive forms of the disease in patients with newly diagnosed tuberculosis. Materials and Methods. 1,428 cases with newly diagnosed tuberculosis — a form №089u-tub, as well as other types of reports of the Saratov region have been analyzed. Statistical analysis has been performed by computer software «Microsoft Excel» and «Statistica-6.0». Analysis of the data by the test of Kolmogorov — Spirin has showed normality of their distribution. Confidence index was assessed by Student's. Differences were assessed as valid if the probability was 95% (P

The purpose of this study was to identify risk factors for recurrence of prostate adenocarcinoma after HIFU therapy. Material and methods: Material for the study was obtained from patients diagnosed with adenocarcinoma before and after HIFU treatment. Morphological study was conducted using a standard staining, and immunohistochemical markers: PCNA, Amacr, E-cadherin, Bel2, Andr, Estr, VEGF, P53, PCNA. Results: After treatment in 89% of patients with initial prostate volume greater than 50 cc the signs of recurrence of adenocarcinoma were showed. At low risk for D'Amico after treatment the expression of proliferation markers, VEGF, Amacr significantly decreased. With a high degree of risk — increased expression of Bel2. After treatment the expression of the following markers: PCNA, Amacr, VEGF significantly increased in the group of patients with the presence of invasion. Conclusion: Patients with initial prostate volume less than 50 cc, low risk to D'Amico, the lack of perineural and perivascular invasion have a low risk of recurrence after HIFU therapy; patients at high risk for D'Amico, the presence of perineural and perivascular invasion initial and prostate volume greater than 50 cc, low-grade cribriform form of adenocarcinoma have a high risk of recurrence of adenocarcinoma. Recurrence of adenocarcinoma develops independently of the period after HIFU therapy.

Objective: to improve the treatment results of patients with benign prostatic hyperplasia (stage l-ll) accompanied with chronic abacterial prostatitis (category III A) by the use of terahertz therapy at frequencies of molecular spectrum of emission and absorption of nitric oxide 150,176-150,664 GHz. Material and methods. Atotal number of 75 patients met the inclusion criteria and were available for analysis. They were divided into three groups: 1st core group — 25 patients with BPH (stage l-ll) accompanied with chronic abacterial prostatitis (category III), which received standard medical therapy in combination with THZ-therapy; second group — 25 patients with BPH (stage l-ll) accompanied with CAP, which received standard medical therapy; third control group — 25 healthy men. Results. The combination of THZ — therapy with standard medical treatment allowed us to achieve marked improvements in the IPSS and QoL system, rapid anesthetic effect, more significant volume reduction of the prostate tissue in the 1st core group. Also THZ-therapy in 1st core group revealed a statistically significant increase of the maximum speed of blood vessels in the prostate tissue, improved a prostate secretion and rheological properties of blood. Conclusion. THZ-therapy as a complementary treatment has a beneficial effect on the clinical course of BPH (stage l-ll) accompanied with CAP (category III).

Diaphyseal fractures of the femur are rather common. In the treatment of fractures of the femur various methods of osteosynthesis can be used: intramedullary, of plate, transosseus. In our country external fixation using external fixation devices has traditionally been popular. Objective. The analysis of the frequency of use of transosseous osteosynthesis in the treatment of fractures of the femur and the identification of the most common indications for the use of the method in the present practice. Materials and Methods. The analysis of the structure of external fixation in fractures of the femur, on the experience of treatment of 126 patients with diaphyseal fractures of the femur. Results. The results of the study revealed that the structure of the osteosynthesis of fractures of the femur transosseous osteosynthesis with the use of external fixation devices is not considered to be common and is used as an alternative method of treatment. Conclusion. The treatment of fractures of the femur using transosseous osteosynthesis is currently used mostly for open, comminuted fractures and revision osteosynthesis, as well as a high risk of infectious complications in the zone of fracture, due to complexity of the method, the lowest strength of fixation and a relatively high percentage of non-specific complications.

Objective: to evaluate the efficiency of the neuromodulation methods and to determine their role in complex rehabilitation of patients with spastic syndromes after spinal cord injury. Material and methods: Based on the study and treatment of 105 patients with spastic syndromes after injury of the spinal cord, electrical stimulation of the spinal cord, epidural drug therapy in combination with electrical nerve stimulation and local hypothermia spinal cord have been consistently applied for the treatment of spastic syndrome. Results: Consistent use of methods of neuromodulation in patients with spastic syndromes after spinal cord injuries are given in 88,6% of cases to obtain positive results. Conclusion: The obtained results allow to estimate efficiency of neuromodulation methods and to determine their role in complex rehabilitation of patients with spastic syndromes after spinal cord injury

The aim of the research is to identify common patterns of compensatory changes in internal architectonics of the proximal femur with valgus and varus deformity. Material and Methods. The parameters of the proximal femur were determined on the basis of 78 roentgenograms of children with hip dysplasia (1-4 years, 4-7 years, 7-16 years) before and after surgical treatment (after 6 months). Results. The degree of change in internal architectonics of the bone substance has been determined after changing of the femoral neck-shaft angle achieved with the help of correcting osteotomy in different age groups. Conclusion. Maximum recovery of internal architectonics of the bone substance is observed in the groups aged 4-7 years.

Objective. The purpose of the study is to analyze the errors, complications and outcomes of the operative treatment of patients with femoral neck fracture in the 1st group with application of wires bundle and fixation in the llizarov frame (64 cases) and in the 2nd group with application of developed monolateral wire- and half-pin device (23 cases). Material and Methods. The observation of 87 patients with fractures of the femoral neck. Operations performed using spokes kit for transosseous osteosynthesis by GA llizarov and develop devices for the treatment of patients with
fractures of the proximal femur. Two groups of patients were studied: duration of surgery, duration of osteosynthesis, complications, and outcomes (in terms of one year after the dismantling clips) using the modified scale Luboshyce — Mattis — Schwartzberg. Results. Fracture repair was achieved in 40 patients (62,5%) of the 1st group. The following complications were observed in this group: non-union and pseudarthrosis — in 21 (32,8%) case; aseptic necrosis of the femoral head in 3 (4,7%) cases; hip ankyloses — in one (1,6%) case, breakage and migration of wires into the joint cavity and smaller pelvis — 3 (4,7%) patients and cutting out of wires from the femoral head was observed in 3 (4,7%) cases. Totally 61 complication were revealed. In the second group of the patients non-union was found in one patient (64 years old). Complications were observed in 6 patients of this group — pint-tract infection, moderate secondary displacement of the fragments (the patient fell down on the operated limb) and wire breakage. Conclusion. The efficiency of the femoral neck osteosynthesis with application of elaborated monolateral wire- and half-pin fixator made up 95,7% of the positive outcomes (in osteosynthesis using bunch of wires with llizarov frame fixation the same 60,9% of the positive outcomes).

Nursing of very low and extremely low birth weight infants is one of the most difficult problems of modern perinatol-ogy. It is impossible to carry out this task without organization of fee-ding of this group of children. The aim of our research was to study clinical efficiency of breast milk fortifiers administration (human milk fortifier) when preterm infants feeding. Materials and methods. In consequence of this clinical research (with included 60 premature infants born at less than 33 weeks of gestational age with less than 1500g birth weight) the following advantages before other types of feeding were revealed. Results. Mother and child solidarity in the course of breast feeding make deep favorable mutual emotional pressure. It was succeeded to keep all breast feeding advantages and to provide preterm infants special needs in feedstuffs. Human milk fortifiers administration provides higher body weight gain intensity; reduces length of stay in a hospital. It should not go unnoticed high tolerability and lack of complications at its medication usability was noted. Human milk fortifier divorce with small quantity of breast milk and that is especially important for very low and extremely low birth weight infants feeding. Conclusion. All above-mentioned allows recommending human milk fortifiers «PRE NAN FM 85» administration for breast milk in neonatal practice

Research Objective: Evaluate the indicators of mineral metabolism in HIV-infected patients, patients with chronic hepatitis С and co-infection HIV/HCV. Material and Methods: The content of microelements (zinc (Zn), copper (Cu), iron (Fe)) in serum was determined by atomic absorption spectrophotometry. The study involved 99 patients: with chronic hepatitis С — 32 patients, with HIV infection — 34 and co-infection of HIV/HCV — 33 patients. Results: Microelements and metal-dependent proteins metabolic disorders as a reduction of the zinc, haptoglobin contents, and an increase of copper, iron, and ceruloplasmin contents were identified in patients with chronic hepatitis С In HIV-infected patients and patients with co-infection HIV/HCV were identified reducing zinc, copper, iron, haptoglobin, ceruloplasmin. in patients with co-infection HIV/HCV compared HIV-infected patients lower zinc, haptoglobin, ceruloplasmin contents (p