Vol 70, No 6 (1989)

In accordance with the "Main directions of development of public health protection and reorganization of the USSR health care in the Twelfth Five-Year Plan and for the period till 2000", the psychiatric service undergoes a certain reorganization. The requirements for psychiatry are dictated by the changed structure of the prevalence of mental diseases, especially in the area of borderline mental pathology, the growing share of psychosomatic disorders, and new approaches to treatment and social rehabilitation of the patient.

Clinically and morphologically the cyst is an intermediate stage between acute and chronic pancreatitis. In the early stage of the disease, i.e. in absence of capsule, pancreatic juice leakages in retroperitoneal tissue, small omental pouch, inside pancreatic parenchyma cannot be anatomically considered a cyst, but since they are initial substrate for its formation, they are eligible to be called cysts in unstable stage. According to some authors, in the early stages of cysts should be treated conservatively, while others believe that surgical treatment should be carried out immediately after diagnosis, before a dense capsule develops, which takes 2-4 months to form.

We analyzed the experience of surgical treatment of 2000 patients with peptic ulcer since 1965. The main result of the study can be reduced to two main statements:

1) the problem of surgical treatment of gastroduodenal ulcers cannot be solved by a single unified surgical technique;

2) further progress in surgical treatment of gastroduodenal ulcers should be expected in the way of objectification of indications for early surgery, intensification of preoperative preparation, improvement of methodical approaches to surgical interventions and their technical solution.

Congenital lobar emphysema, or progressive emphysema of newborns, is a malformation associated with incomplete patency of the bronchus and the formation of a valve mechanism in it as a result of cartilage development defects and is caused by segmental or lobar ballooning of the lung parenchyma. The term "congenital localized emphysema" should obviously be recognized as the most rational one, since not only one lobe, but also separate segments and several lobes can be affected by this disease. It occurs relatively rarely in children, so the causes of its occurrence have not been studied enough so far. Due to the rarity of the disease, as well as a small number of publications, diagnostic errors and adverse outcomes are possible.

The development of acute pyelonephritis is a frequent cause of death in patients with bladder cancer. Treatment of this category of patients is very difficult because of their severe condition caused by the combination of purulent and cancerous processes, as well as severe impairment of urine passage in the upper urinary tract, which is associated with a long asymptomatic course of bladder cancer and, therefore, late diagnosis of the disease. In most cases, the development of acute pyelonephritis is caused by ureteral obstruction as a result of tumor infiltrating growth, resulting in intramural blockage and retention changes in the upper urinary tract. The causes of inflammatory complications after surgical intervention for bladder cancer are, as a rule, surgical trauma and defect of ureterocystoanastomosis.

Radical treatment of breast cancer, including combined and complex methods, in a number of cases causes complications, which in 30.2% of patients lead to disability. One of the most frequent late complications is limb edema. It should be emphasized that edema not only changes the proportions of the body, but also causes considerable discomfort, causing pain, a constant feeling of heaviness, considerable difficulty in wearing clothes, and limb dysfunction in 45% and even 100% of patients.

Excessive body weight and hypodynamia, especially typical for the urban population, contribute to the weakening of certain parts of the musculoskeletal system, causing early degenerative-dystrophic changes in them. Chaotic motor activity, accompanied by uncoordinated muscle contraction, leads to subcutaneous "creeping" tendon ruptures, among which injuries of the Achilles tendon are among the most frequent. In addition, the number of open injuries of this tendon in everyday life, in traffic accidents and at work is increasing.

Differential diagnosis of acute inflammatory diseases of the genitals and acute surgical pathology (often acute appendicitis) is still an urgent issue in emergency surgery. According to our data, gynecological diseases occurred in 4.8% of patients admitted to the clinic with suspected acute appendicitis. Any suspicion of gynecological disease requires a thorough examination of the patient and a detailed collection of her gynecological anamnesis. Of course, not every gynecological disease is difficult to diagnose. Sometimes the absence of clear signs of acute genital diseases and acute appendicitis leads to diagnostic errors and unwarranted laparotomies. At the same time, waiting tactics in patients with unclear clinical picture is fraught with disease progression and development of complications. Therefore, accurate and timely diagnostics will allow to exclude unnecessary laparotomies and prevent both pathological process progression and its complications.

Drug therapy of bronchial asthma currently remains the most effective and affordable method of treatment. The main medications are sympathomimetics and adrenolin-like substances, intal, steroids and methylxanthines. Methylxanthine derivatives, particularly theophylline, as bronchodilators have been known since 1924. In recent years there has been renewed interest in the clinical pharmacology of the drug. The effectiveness of theophylline is largely due to the use of very high doses of the drug, bordering on toxic. A pronounced therapeutic effect occurs when the concentration of theophylline in the patient's blood reaches 10-12 µg/ml. Severe complications in the form of arrhythmia, respiratory arrest, gastric bleeding occur at a concentration of 15-20 µg/ml.

Clinical manifestations of birth injuries of the central nervous system are polymorphic and depend on the level of damage to the structures of the nervous system. Clinicians often encounter subclinical manifestations of natal injuries, especially of birth injuries of the spinal cord. Subsequently, it is these undetected natal injuries that cause the so-called delayed neurological disorders. Late neurological complications can occur in the weeks and months of a child's life, as well as many years later. Patients of the neurologist are children with headaches due to chronic and cerebral vascular insufficiency, early cervical osteochondrosis, postural disorders, transient disorders of spinal circulation developed as a result of instability of previously injured vertebrae, with cerebral circulation disorders of the ischemic type from mild dyshemia to severe ischemic strokes with all the typical symptoms.

The treatment of burn disease presents significant difficulties. Particularly high mortality (51.7% - 64.4%) occurs during the period of acute burn toxemia, characterized by pronounced intoxication of the body.

According to the toxic theory of burn toxemia pathogenesis, it is determined by the toxicity of blood, lymph, extracts from the skin and internal organs, fluid blisters burned. This theory is recognized by most combustiologists; researchers differ in their opinions only in assessing the nature of the toxin and the place of its formation.

Increasing morbidity and high mortality of patients with cancer of different organs dictate the necessity to search for effective methods of early diagnosis and treatment of malignant neoplasms as well as to study the factors determining the course of the disease and its prognosis. The successful solution of these tasks is impossible without thorough investigation of the functional morphology of the lymph nodes adjacent to the tumor, which play the role of the first barrier in the path of cancer metastasis. Finding out the role of lymph nodes in tumor metastasis is one of the major issues of modern oncology, because presence of metastases in regional lymph nodes worsens prognosis considerably, decreasing 5-year survival period.

Over the last decade the number of children with peptic ulcer disease has increased. The severity of the course and frequent exacerbation of the process, leading to dangerous complications, dictate the need to find new methods of treatment aimed at accelerating the healing of ulcerous defects.

One of the severe complications leading in some cases to the lethal outcome after colorectal resection is purulent complication with development of intestinal anastomosis failure. The following factors influence anastomosis failure: the patient's condition at the time of surgery; measures to prevent infection of the abdominal cavity; technical aspects of the operation both in terms of tactics and in the application of the anastomosis; measures aimed at decompression of the operated intestinal area.

Postpartum atonic bleeding is still a major complication, often leading to death. The main cause of major blood loss is a delayed laparotomy to stop the bleeding.
The method of ligation of the uterine main vessels does not require a high surgical technique and simultaneously preserves menstrual and generative functions.

Abdominal pregnancy is exceptionally rare, accounting for 0.4% of all ectopic pregnancies. The literature describes cases of abdominal pregnancy with the fetus remaining in the abdominal cavity up to 42 weeks.
We describe one such case of abdominal pregnancy.

A combination of risk factors that have a constant effect on the musculoskeletal apparatus of the crew in the northern region (noise, vibration), as well as working conditions on the open deck (cold and moisture) lead to degenerative-dystrophic changes in bone tissue, against which its strength to mechanical influences is reduced.

When repairing skin with extensive skin defects, devices are usually used to obtain mesh grafts from skin flaps with different expansion coefficients. They consist of a cutting element, a supporting roller and a plate. As a cutting element they use special interchangeable knives, a roller with a continuous thread or safety razor blades installed in large numbers (from 50 to 250) perpendicularly to the axis of the rotating roller or to the supporting plate. The main disadvantage of these devices is the difficulty of blanking and changing the cutting elements, which is dangerous and requires not only considerable time, but also a certain qualification of medical personnel.

Over 600 specialists in allergology and pulmonology from 34 countries - England, Austria, Brazil, USA, Israel, Sweden, Japan, Czechoslovakia, GDR, Hungary and others - took part in the regular working meeting of the International Society "INTERRASTMA". Soviet specialists from Moscow, Leningrad, Tbilisi, Baku, Kazan, Belarus, Lithuania and Ukraine also participated in the meeting.