The aim of study was to optimize evaluation and surgery of cranioorbital injuries in different periods after trauma. Material and methods. We analyzed 374 patients with cranioorbital injuries treated in Burdenko Neurosurgery Institute in different periods after trauma from January 1998 till April 2010. 288 (77%) underwent skull and facial skeleton reconstructive surgery within 24 hours - 7 years after trauma. Clinical and CT examination data were used for preoperative planning and assessment of surgery results. Stereolithographic models (STLM) were applied for preoperative planning in 89 cases. The follow-up period ranged from 4 months up to 10 years. Results. In 254 (88%) of 288 patients reconstruction of anterior skull base, upper and/or midface with restoration of different parts of orbit was performed. Anterior skull base CSF leaks repair, calvarial vault reconstruction, maxillar and mandibular osteosynthesis were done in 34 (12%) cases. 242 (84%) of 288 patients underwent one reconstructive operation, while 46 (16%)--two and more (totally 105 operations). The patients with extended frontoorbital and midface fractures commonly needed more than one operation--in 27 (62.8%) cases. Different plastic materials were used for reconstruction in 233 (80.9%) patients, of those in 147 (51%) cases split calvarial bone grafts were preferred. Good functional and cosmetic results were achieved in 261 (90.6%) of 288 patients while acceptable were observed in 27 (9.4%). Conclusion. Active single-stage surgical management for repair of combined cranioorbital injury in acute period with primary reconstruction optimizes functional and cosmetic outcomes and prevents the problems of delayed or secondary reconstruction. Severe extended anterior skull base, upper and midface injuries when intracranial surgery is needed produced the most challenging difficulties for adequate reconstruction. Randomized trial is required to define the extent and optimal timing of reconstructive surgery in patients with severe traumatic brain injury and craniofacial injury in acute period of trauma.
In animal experiments (albino rats), stimulating and suppressive effects were studied of immunomodulating agents on the processes of chemical mutagenesis. Combination of different immunodepressants hardly ever intensifies cyclophosphamide-induced chromosomal rearrangement in rat bone marrow cells, with heparin exerting an antimutagenic effect, while corticosterone, when being administered at an augmented dose, appeared to enhance cyclophosphamide's mutagenic action. One-stage administration of immunostimulants and cyclophosphamide tended to weaken antimutagenic defence of cell genetic apparatus.
The efficacy of amphotericin B powder of the Soviet production was studied as a therapeutic agent in experimental zoonotic leishmaniosis of the skin form of mice and hamsters. Amphotericin B was administered per os and its action was compared with that of monomycin injected subcutaneously (50 mg/kg). Amphotericin B in a dose of 150 mg/kg administered for 30 days protected 96+/-0.07 and 76.4+/-0.9 per cent of the mice and hamsters respectively from development of the leishmaniosis clinical signs, 68.8+/-0.04 per cent of the animals being cured (in the treatment experiments). The effect of the antibiotic was analogous to that of monomycin administered parenterally. The study of the kinetics of amphotericin B showed that the antibiotic was well absorbed from the digestive tract of the animals into the blood which provided the chemotherapeutic effect.
Morphological manifestations of combined intoxication with ethanol and narcotics are described. Special attention is paid to changes in the liver which were studied both qualitatively and quantitatively. Specific features in the pathological processes concomitant with combined intoxication are described; high incidence and expression of morphological markers of alcoholism in subjects abusing both ethanol and narcotics in comparison with "pure" alcoholics were determined. These features can be used in forensic medical and pathological (autopsy) diagnosis of chronic narcotic intoxication and its combination with alcoholism.
The significance of a combined echocardiographic study of patients who survived myocardial infarction for evaluation of ventricular hemodynamic disturbances was shown. According to the ultrasonic B-scanning data the left ventricular end-diastolic and endsystolic volumes in such patients were increased, and ejection fraction values, delta S and VCF were markedly decreased. The most pronounced left ventricular pump and contractility dysfunctions occurred in transmural and anterior myocardial infarctions. During M-mode echocardiography in patients with posterior wall hypokinesia, the prolongation of isovolumic relaxation and contraction followed by the shortening of rapid filling was observed. A significance correlation between the prolongation of isovolumic relaxation and polygraphic T interval was found. The thinning of the left ventricular hypokinetic posterior wall was observed during the ejection period, and that of hypokinetic ventricular septum was seen within the cardiac cycle. The signs of more marked left ventricular dilatation with its decreased contractility were found in patients with systolic murmur recorded soon after myocardial infarction development. Such a murmur phonocardiographically recorded was a sign of mitral valve insufficiency.
Echocardiography was conducted in patients who had suffered from myocardial infarction (47 were examined in the subacute period of myocardial infarction and 23 in more remote periods) with signs of mitral insufficiency and 31 patients with no signs of mitral insufficiency (they were examined in the subacute period of myocardial infarction). It was found that after myocardial infarction the contractility of the heart muscle is diminished to a greater extent in patients with signs of mitral insufficiency than in the others. In patients with mitral insufficiency symptoms of circulatory insufficiency were revealed more frequently. The mechanisms of the development of mitral insufficiency in patients with myocardial infarction are discussed.
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