Vol 69, No 1 (1988)

The diagnosis and treatment of acute conditions occupy a special place in the work of district physicians and emergency physicians, since they are more often faced with the clinical manifestations of diseases requiring emergency care. Despite the fact that in recent years the diagnostic process has become increasingly collaborative, it is the general practitioner who ultimately assesses the correctness of the diagnosis.

Botulism is a severe infectious disease characterized by damage to the central and peripheral nervous system and manifests itself in three main clinical syndromes: gastroenteric, general infectious and paralytic. The paralytic syndrome, the leading one in the clinic of botulism, causes all the main signs of the disease: disorders of vision, the acts of swallowing and breathing, articulation, phonation, etc.

Hemorrhagic fever with renal syndrome (HFRS) is a viral zoonotic natural focal infectious disease of humans and is particularly widespread in the forest areas of the Urals and Middle Volga region. In recent years, methods have been developed and put into practice for indication of infection in rodent hosts of HFRS virus and for serodiagnosis of human HFRS.

In the acute care clinic, the main place in the treatment of patients is occupied by injection methods of drug administration to the upper extremities. This does not take into account the different characteristics of the pathology for which these measures are performed. Thus, in the decompensated stage, they can lead to death or worsen the condition of the patient.

Children's tendency to acetonic states (ketoacidosis) is associated with functional immaturity of the liver, increased tone of sympathetic innervation and labile nervous system. Constitutional abnormalities and dietary disturbances are of great importance in the development of the disease. The increasing frequency of ketoacidosis in children with pronounced clinical manifestations and insufficient familiarity of pediatricians with the diagnosis of this condition prompted us to study the features of ketoacidosis clinic, diagnosis and treatment in children.

The aim of the present study was to investigate the peculiarities of the course of acute traumatic disease with multiple and combined injuries and to develop pathogenetically substantiated corrective therapy. The patients treated in the intensive care unit from 1983 till 1986 were examined. 110 (18,8%) out of 584 patients had multiple and combined injuries. There were 87 men and 23 women.

Symptomatic hypertension is often regarded by doctors as a kidney disease and without proper critical evaluation of the identified changes in urine diagnose chronic pyelonephritis, which delays the establishment of the true nature of the process for a long time. Timely diagnosis is also complicated by the fact that endocrine diseases, such as Conn's syndrome, pheochromocytoma, occur without any external manifestations of endocrinopathy. Such patients are not examined by endocrinologists, so the diagnosis is usually made (not in all patients) by general practitioners, urologists, surgeons. The aim of this work was to determine the frequency and peculiarities of urinary syndrome (proteinuria, microhematuria, leukocyturia), renal dysfunctions in adrenal hypertension before and after surgical treatment of patients.

The aim of the present work was to study intestinal and central hemodynamics in patients with intestinal infarction during laparotomy using angiotensiometric method. The research was carried out in 14 patients (9 men and 5 women) aged from 36 to 85 years old operated for intestinal infarction. The operations were carried out under endotracheal anesthesia with the use of calypsol (in 5 patients), sodium oxybutyrate (in 3 patients), ether (in 3 patients), and sedoxone (in 3 patients). At all stages of surgical treatment the patients received comprehensive intensive care.

We have performed a selective expert evaluation of 111 cases of lethal outcomes of newborns delivered by cesarean section. In the total number of operations performed during the study period, the number of neonates who died by means of this surgical intervention was 5.8%. The incidence of infant deaths after cesarean section in the early neonatal period among all neonatal deaths during the same period reached 24.8%. The high proportion of children delivered by cesarean section in the structure of early neonatal mortality indicates the relevance and practical significance of studying the causes of infant mortality in this group.

In clinical neurology today, there is a revision of the principal positions, which casts doubt on the nosological essence of neuroses. The issues of differential diagnostic criteria of neuroses, boundaries of neuroses and neurotic personality development, accentuation of character traits and decompensation of psychopathies remain rather debatable in psychiatry up to now. Questions of clinical differentiation of psychologically adequate, preclinical, neurotic and psychopathic reactions to frustration are poorly studied. As a consequence, the importance of pathopsychological studies of borderline neuropsychiatric disorders, the study of patients' self-esteem and self-awareness, and the analysis of compensation mechanisms and protective measures that contribute to the prevention of neurosis is growing.

The aim of our studies was to find out whether the position of the eyeball in the orbit was associated with the occurrence of corneal collapse during cataract extraction as well as with the occurrence of vascular detachment in the postoperative period. We followed up 87 patients (35 men and 52 women) aged 44 to 87 with immature, mature, and over-mature age-related cataract. Eyeball elevation was measured using a Hertel mirror exophthalmometer. The patients were divided into three groups according to the position of the eyeball in the orbit. The distance was less than 16 mm for Group 1 patients (29 patients), 16-20 mm for Group 2 (46 patients), more than 20 mm for Group 3 (12 patients).

The microcirculatory bed is an important department of the circulatory system and determines not only the state of peripheral hemodynamics but also the trophic function of the organs. Microcirculatory bed, including arterioles, precapillaries, capillaries, venules, arteriolovenular anastomoses, constitutes 90% of all blood vessels [9, 18J. Arterioles - long meandering vessels 30-40 µ in diameter - are divided into terminal and mesarterioles. Precapillaries are 15-20 µ in diameter and regulate blood flow to true capillaries. Arterioles and precapillaries perform a transport function, delivering nutrients to the organ. Excretion of metabolic products from the organ occurs only in the capillary channel. Blood flow in capillaries depends on the activity of precapillary sphincters. Capillaries are usually straight and their wall lacks muscular elements. The appearance of tortuosity indicates damage to the capillary bed and impaired blood flow in it.

In 154 patients adenomectomy was performed under epidural anesthesia. There were 36 patients aged from 50 to 60 years, from 60 to 70-63, from 70 to 80-50, over 80-8. The oldest patient was 91 years old.

Closed liver injuries are rare and more common in men. Preoperative diagnosis is difficult and mortality is high. Liver injuries are often detected during surgery or at autopsy. Considering the rarity of this pathology and difficulties in diagnosis, we decided to share our observation.

We studied the state of cardiac hemodynamics in patients with chronic pyelonephritis with and without arterial hypertension according to echocardiographic study (EchoCG). We have examined 149 patients with chronic pyelonephritis aged from 17 to 70 years (men-51, women-98). The average age of the patients was 43.9 years.

Fixation of metacarpal bone fractures is usually performed using metal spokes, either intramedullary or transaxially. During transaxial fixation, as a rule, spokes are inserted in transverse or oblique planes in relation to the axes of the metacarpal bones. The disadvantage of these methods is the possibility of migration of spokes, insufficient stability of fractures, especially with simultaneous fractures of three or four metacarpal bones of the hand. Bone defects along the length do not exclude the possibility of bone settling with a decrease in its length, angular and rotational displacements.

Currently, interest in phytotherapy, which has its roots in traditional medicine, has increased among doctors and medical students. This is primarily due to the fact that the world of plants has served humans since ancient times as a reliable source of medicines and at the same time provides unlimited opportunities for the successful search for new therapeutic agents. The increased interest in medicinal plants is also largely determined by the frustrations that befall practitioners who use an increasing number of synthetic drugs, which cause a large number of complications and often fail to live up to the expectations placed on them.