Vol 70, No 4 (1989)

The need for comprehensive studies of public health in connection with environmental pollution is due not only to the possible deterioration of health, but also to the loss of working time and reduced product production as a result of increased morbidity. It is especially important to establish a quantitative relationship between the degree of air pollution and the health of the child population.

All the causes of occupational traumatism can be grouped into three groups: technical, sanitary-hygienic and organizational-personal (subjective).
The study of occupational traumatism at the dairy industry enterprises of the Saratov region in 1967-1976 and in 1977-1986 showed that during the first observation period the organizational-personal (subjective) causes amounted to 48.1%, sanitary-hygienic causes to 17.4%, technical causes to 19.6%, and other causes to 14.9%. In the second observation period, the ratio of causes was different: technical causes accounted for 9.4%, sanitary and hygienic causes for 23.8%, and subjective causes for 66.8%.

Exercise tolerance in patients with coronary heart disease with postinfarction cardiosclerosis is determined by the level of coronary and myocardial reserve. At the same time, the larger the surface of the infarcted area and the number of coronary arteries affected by atherosclerosis, the lower the exercise tolerance. The presence of close correlation between heart size and the degree of coronary insufficiency, the size of postinfarction scar, its localization, the level of end-diastolic pressure in the left ventricle prompted us to check the diagnostic significance of the most informative X-ray cardiometry parameters for postinfarction cardiosclerosis patients in the assessment of the functional state of the circulatory system and the possibility to predict physical performance without ergometric study.

Early diagnosis of arthritis is a challenge for clinicians because clinical signs, biochemical and immunological studies are not specific enough, and radiography reveals changes in bone tissue only in the unfolding clinical picture of the disease. Therefore, radioisotope diagnostics of bone and joint diseases with pyro-monodiphosphonate or methylene diphosphonate labeled with 99Tc is becoming more widespread.

Iron deficiency anemia, which is based on iron deficiency in the blood serum, bone marrow, depot and tissues, is more common than other forms of anemia. The most frequent etiological factors of iron deficiency anemia are known to be various kinds of blood loss: menorrhagia and metrorrhagia (in women), from the gastrointestinal tract (peptic ulcer, erosions, diverticula, hemorrhoids, non-specific ulcerative colitis, etc.), hematuria, nasal and uterine bleeding. The causes of this anemia can be tumors of various localizations, rare diseases (pulmonary hemosiderosis, glomus cysts), worm infestations, chronic infections, enteritis and intestinal resection. Anemia can also occur in women during pregnancy and lactation, when the body's need for iron increases, in adolescents with an insufficient baseline level (if their mothers suffered from iron deficiency anemia), and in donors.

Widespread introduction of antibiotics of aminoglycosides group into clinical practice necessitates adequate dynamic monitoring of functional state of the kidneys in terms of early detection of their possible nephrotoxic effect. According to the literature, the incidence of renal damage during treatment with glycosides ranges from 15 to 35%.

The problem of gastric and duodenal ulcer treatment, in spite of many proposed methods and means, remains far from being solved until now. In the modern concept of ulcerogenesis some researchers in the development of peptic ulcer disease attach great importance to biogenic amines, in particular to histamine, which, affecting the lining cells, stimulates the secretion of gastric juice of high acidity, changes capillary blood circulation and acts on trophic processes in the mucosa of gastroduodenal zone. It has been found that in patients with peptic ulcer disease the content of histamine in the blood is increased, especially during exacerbation of the disease; at the same time in patients the processes of binding and inactivation of histamine are disrupted.

The issues of diagnostics and treatment of acute appendicitis are systematically covered in the periodical press, but insufficient attention is paid to the tactics of non-destructive (catarrhal) form of appendicitis, the causes of rather frequent removal of morphologically unchanged processes in patients with the clinical picture of acute appendicitis and measures to reduce the number of needless appendectomies.

Some authors consider appendectomy mandatory in all cases of pain syndrome in the right iliac region. Thus, according to S.D. Lebedev, appendectomy is performed in 84.4% of patients admitted with suspected appendicitis. The unchanged appendectomies, which, in the author's opinion, contribute to the reduction of appendicitis morbidity.

Despite a significant number of works devoted to malignant lymphomas, early differential diagnosis of these tumors and malignant neoplasms of the mediastinum in general, as well as differentiation of variants in the group of malignant lymphomas itself remain undeveloped. This is especially true for isolated lesions of the mediastinum. Radiological picture of mediastinum and lung lesions in malignant lymphomas is extremely diverse. It depends on the combination of lesions of different groups of mediastinal lymph nodes, their size, localization, as well as on the stage of the disease. Is it possible to distinguish in this polymorphic picture the features peculiar only to lymphogranulematosis, non-lymphogranulematous lymphomas (lymphosarcomas and reticulosarcomas are combined by this term according to WHO classification of 1976) or these diseases cannot be distinguished radiologically from each other? Some authors answer that there is no dependence of the radiological picture on the histological variant of malignant lymphomas, while others point to some differences. Therefore, we would like to dwell on the clinical and radiological data allowing differential diagnosis of non-lymphogranulomatous lymphomas and lymphogranulematosis.

Pregnancy failure is one of the pressing problems of modern obstetrics. According to the WHO committee of experts, in 10-25% of cases the pregnancy ends in spontaneous termination. A variety of etiological factors that lead to pregnancy termination causes a wide variability of medical, surgical and physical treatment methods. One of the leading pathogenetic mechanisms of pregnancy failure is myometrial hypoxia due to hemodynamic disorders in the uterus. The latter cause a decrease in the excitability threshold of the muscular wall of the uterus and increase its contractility.

The success of any surgery largely depends on a detailed knowledge of anatomy, peculiarities of the relationships of fascias, fascial spaces, and other tissues and organs in the surgical area. Nevertheless, in obstetric practice, the fascial sheets of the lower parts of the anterior abdominal wall and bladder are usually overlooked when performing a cesarean section, while the importance of restoring the fascial formations is emphasized by many authors. Being an extension of the bony skeleton, fasciae not only form a support for muscles and organs, but also limit the spread of infection, preventing the generalization of the process. It is especially important when performing cesarean section with preliminary isolation of peritoneal cavity in women of high risk group for the development of septic-epidemic diseases.

Elevated insulin levels not accompanied by a decrease in blood glucose are found in various non-endocrine pathologies. An increase in basal insulin has been detected in psoriasis, as well as in children with chronic lung disease. In atherosclerosis, hyperinsulinemia is detected both on an empty stomach and during glucose tolerance test (GTT), which, combined with dyslipoproteinemia, increases the risk of coronary heart disease.

Patients with rhinogenic orbital and intracranial complications require urgent care and treatment involving various specialists. On the basis of the clinical material for 35 years including 347 orbital and 33 intracranial complications the modern rational tactics of their emergency therapy at inflammatory diseases of the paranasal sinuses was developed. Treatment of patients with orbital and intracranial rhinogenic complications requires timely wide scale surgical intervention and vigorous medication therapy. Urgent surgical intervention on all affected paranasal sinuses with revision of the orbit or cranial cavity is mandatory. X-ray examination of the paranasal sinuses, puncture of the maxillary sinuses and trepanopuncture of the frontal sinuses, EEG, ECHO-EG, REG data help in determining the volume of surgical intervention. As a rule, it is necessary to open all affected sinuses on one side or even switch to the other side. In rare cases, it is necessary to open all perinasal sinuses on both sides. When performing a radical operation of the frontal sinus, it is necessary to perform mandatory revision of the other sinus through the intercorporal septum.

For many years, researchers have been interested in the question: do bacterial endotoxins penetrate the intestinal barrier intact? Despite the abundance of factual data obtained in clinical and experimental studies, this question still remains open.

Hypertrophic cardiomyopathy is due to a so-called primary myocardial lesion. In typical cases, the interventricular septum is hypertrophied to a greater extent than the free wall of the left ventricle. Another variation of this disease is uniform concentric myocardial hypertrophy with a significant increase in heart mass. Although the etiology of hypertrophic cardiomyopathy is unknown, it is thought to be genetically determined by autosomal dominant transmission with a high degree of penetrance. The burdened heredity and familial nature of the disease occur in almost 60% of these patients, so the examination of their close relatives is of particular interest.

A number of authors have shown the possibility of using reflexotherapy in the complex of means of rehabilitation of patients with traumatological and orthopedic profile.

We analyzed a ten-year experience of using reflexotherapy in the complex of rehabilitation treatment of 196 patients with consequences of limb fractures and 187 patients with osteoarthritis of large joints. Among them there were 56% men and 44% women at the age of 21 to 67 years old.

We observed one patient who developed bone contracture of the lower jaw after 3 years due to contusion of the left parotid chewing area. Here is an excerpt from his medical history.

There are very few articles on the treatment of epithelial coccygeal passages in the periodical literature. Therefore, it is not surprising that these diseases are not recognized in a timely manner, and serious mistakes are made in their treatment. It is believed that in the acute period of the disease there are all conditions for radical surgery, but a number of authors suggest performing radical surgery after signs of acute inflammation subside in a period of 5 days to 6 months.

We analyzed the clinical course of polymorphic salivary gland adenomas, distant results of their treatment, morphological features of the course of tumors and their recurrences.

In August 1989 it will be 60 years since his birthday and 36 years of working activity of honored doctor of TASSR, Head of Endocrinology Department of Kurashov Kazan Red Banner Order of Labor Medical Institute, doctor of medical sciences, Prof. V. Talantov.