[Endoscopic video-surgical treatment of children with cryptorchism]

Technical methods of laparoscopic orchiopexy were designed for patients with the abdominal form of cryptorchism. Results of the operations and substantiation of using the method are described. An evaluation of the effectiveness of the laparoscopic method of descending the testes was compared with that of a traditional operation using the inguinal access on the basis of an analysis of long-term results of the surgical treatment.

[Use of plasmapheresis in the treatment of drug-resistant cardiac arrhythmias]

AIM

To study the therapeutical efficiency of plasmapheresis (PA) in patients with drug-resistant cardiac arrhythmias (CA) and its mechanisms.

MATERIALS AND METHODS

Discrete PA sessions were carried out in 56 patients with drug-resistant CA: paroxysmal atrial arrhythmia (AA), ventricular and supraventricular premature contractions, supraventricular tachycardia of various etiology. Biochemical blood values, coagulographic parameters, lipid peroxidation (LPO), the spectrum of nonesterified fatty acids (NEFA), the level of medium-sized molecules were determined, ECG monitoring, EchoCG, and left ventricular radioisotope computed tomography were performed before and after a PA session.

RESULTS

PA was effective in 50% of cases. The duration of its effect averaged 3.0 (1.25-5.0) months. PA was more beneficial for patients with IHD, AA with normal left atrial dimensions, and hyperlipidemia. The duration of the effect was significantly higher when antiarrhythmic drug therapy was continued after PA. Due to PA, there were significant decreases in the blood concentrations of cholesterol, medium-sized molecules, malonic dialdehyde (MDA) and in the proportion of polyunsaturated NEFA. The antiarrhythmic effect was associated with the decreases in MDA and NEFA, with a tendency for a reduction in the rate of chemiluminescence.

CONCLUSION

PA may be used in the treatment of drug-resistant CA. The most significant mechanism of its antiarrhythmic activity is to recover sensitivity to antiarrhythmics. The intrinsic antiarrhythmic activity may be associated with its effect on NEFA metabolism and LPO; however, its mechanisms await further studies.

[Influence of posttransplantation plasmapheresis on results of transplantation of a cadaveric kidney]

Plasmapheresis was performed with "Haemonetics" (USA), PCS-Ultralite and MCS+ devices. During one procedure 1750-3550 ml of plasma were removed. Results were evaluated by the following parameters: diuresis within 24 hours after surgery, number of hemodialysis sessions after surgery, period of normalization of creatinine in blood. In patients of the study group oligoanuria was seen 4.5 times more rarely than in the control group, they needed less sessions of hemodialysis. Level of creatinine normalized earlier in the study group. Actually survival of patients with potent transplants was higher in the study group than in the controls. It is concluded that plasmapheresis has positive influence on the course of posttransplantation period.

[Chromatographic analysis of low molecular weight fraction of cerebrospinal fluid in children with acute neuroinfections]

Low molecular-weight (oligopeptide) fraction of the cerebrospinal fluid was analyzed by high-performance reversed phase liquid chromatography in 30 children with bacterial and viral neuroinfections. The incidence and height of chromathoraphic peaks in bacterial meningitis depended on the disease etiology, stage, and severity. Qualitative and quantitative composition of low molecular-weight fraction of the liquor varied in patients with viral neuroinfections, depending on the severity of the cerebral parenchyma involvement. Differences in chromatographic profiles in complicated and uneventful course of neuroinfections indicate a possible damaging, protective, or regulatory effect of the liquor peptides. These data focus the attention on the role of oligopeptides in the genesis of neuroinfectious process, significance of search for peptide markers, their further isolation, identification, and development of test systems available for clinical application.

[Diagnostic significance of the cerebrospinal fluid protein spectrum in bacterial and viral meningitis in children]

Protein spectrum of the cerebrospinal fluid (CSF) was studied by polyacrylamide gel disk electrophoresis in 119 children with bacterial and 17 with viral meningitis of different origin over the course of disease. Liquor proteinograms of patients were compared with those of 37 children without meningitis. Protein spectra of the CSF were shifted in the patients. These shifts can serve as differential diagnostic markers: types 1-2 and 2-2 haptoglobins and beta-lipoprotein appears in the blood during the acute period of disease. More pronounced and stubborn changes in the CSF protein spectrum in pneumococcal and hemophilic meningitis correlated with a more severe clinical course and formation of residual neurological consequences. Progress of dysproteinemic shifts in the protein spectrum of the CSF was characterized by a many-fold increase in the concentrations of high-molecular-weight proteins and decreased relative content of liquor-specific fractions, indicating sharp impairment of the blood-brain barrier permeability and formation of brain edema. Disk electrophoresis method is characterized by high resolution, informative value, requires low amounts of CSF for analysis, and is recommended as an accessory diagnostic test for infectious hospitals.

[The advantage of the laparoscopic method of examining patients with nonpalpable testes]

The authors compared the diagnostical value of traditional operations with the inguinal access and a new method using laparoscopy for treatment of patients with testis aplasia. The laparoscopic method of examination was found to be preferable since it allows the correct diagnosis to be made in 96% of children with cryptorchism.

[Unsolved questions of infectious endocarditis prophylaxis in outpatients practice]

AIM

To check practical feasibility of recommendations of prevention of infectious endocarditis (IE) and to provide more accurate figures on the occurrence of valvular lesions in working population.

MATERIALS AND METHODS

Subacute IE manifestations have been analysed in 10 patients of a general outpatient clinic. Echocardiograms of 6209 patients under 60 years of age were studied retrospectively.

RESULTS

In one-third of the patients IE developed in the presence of streptococcal and staphylococcal infection. In all the cases cardiac valve involvement was stated. In 4 cases changes in the valve were not accompanied my impairment of the valvular function. By echocardiography, valvular structure changes without valvular disease were detected 2.3 times more frequently that valvular disease. Difficulties presenting in outpatient IE prophylaxis are outlined.

CONCLUSION

Advances in IE prevention will be achieved if echo-CG becomes a mandatory examination in the program of working population check-up, if early diagnosis of streptococcal ENT infection is made, if physicians of different specialties work as a team.

[Contemporary quality control of inpatient care according to the survey]

A sociologic survey was carried out in one of the large multi-profile hospitals of St. Petersburg. A total of 220 questionnaires were distributed. The questionnaire included twenty signs by which the respondents assessed the quality of medical care and expressed their opinion on how it may be improved.

[Heart transplantation conducted at the All-Union Research Center of Surgery (the first clinical experience)]

The authors analyse experience in the first eight operations for orthotopic transplantation of the heart. Six patients were discharged from the clinic with good immediate results. Comparison of their own data with summarized results gained in other countries allowed the authors to define some specific problems which are of practical interest for clinics embarking on the clinical realization of the problem of heart transplantation.

[Mitral valve dysplasia as a cardiac surgery problem (a clinico-morphological comparison)]

Clinical appearance of mitral incompetence associated with mitral dysplasia (abnormal connective tissue structure in the cusps and chordae, with significant accumulation of acid mucopolysaccharides) is dependent on the extent of regurgitation, its pathogenetic mechanism (sudden or progressive), the presence of the prolapsing cusp syndrome, and attendant complications (endocarditis, chord abruption). Indications for surgery were marked regurgitation in 94% of patients, and septic endocarditis in 6%.

[Treatment of auricular fibrillation after correction of rheumatic heart disease under extracorporeal circulation]

Of 372 patients operated on for rheumatic valvular defects under extracorporeal circulation, 221 patients had chronic atrial fibrillation. In 41 patients, the duration of arrhythmia ranged from a few months to 2 years. Sinus rhythm was recovered in 22 patients, using quinidine and electric-impulse treatment, and 19 patients have maintained it continuously for many years. Factors contributing to stable and lasting sinus rhythm are an adequate correction of the defect, inactive rheumatic process, and the duration of atrial fibrillation not exceeding 1-2 years. The optimum time for sinus rhythm recovery is 2-6 months after surgery. Sinus rhythm recovery prior to surgical correction of the defect is not recommended.

[Role of mitral valve dysfunction in the development of cardiac insufficiency in postinfarct cardiosclerosis]

The clinical suggestion on the dysfunction of the mitral valve in 20 patients with post-infarction cardiosclerosis was confirmed by ventriculography (8 persons) and in autopsy (12 persons). The paper presents a clinical characteristics of the both groups of patients, the indices of the central hemodynamics, the end diastolic pressure in the left ventricle of the heart, coronaroangiography, as well as morphometric data of the examination of the hearts and of the extent of the scar lesions of the myocardium in patients who died of congestive cardiac insufficiency against the background of postinfarction cardiosclerosis combined with the papillary muscle affection.