Vol 65, No 2 (1984)

Dear members of the Scientific Council, guests! The Soviet health care system, and in particular the state service for the protection of mothers and children, created for the first time in the world, is the most important social achievement of the October Revolution.

The decisions of the XXVI Congress of the CPSU and the decree of the Central Committee of the CPSU and the Council of Ministers of the USSR "On additional measures to improve the health of the population" set new tasks for Soviet health care, the most important of which are improving the quality of obstetric and gynecological care, prevention and early detection of diseases, and improving women's health and children and their dispensary observation.

In the decisions of the XXV and XXVI congresses of the CPSU, in the decree of the party and the government "On measures to further improve public health", the need to improve the quality of medical and preventive care at the polyclinic level was noted. In connection with this, obstetricians-gynecologists of antenatal clinics should pay even more attention to the primary and secondary prevention of complications of pregnancy, childbirth and perinatal pathology. At the same time, early detection and rational treatment of extragenital diseases are of leading importance, among which cardiovascular lesions occupy the first place in the number of patients (0.5 - 7%) and as the cause of maternal mortality. Of these, acquired heart defects account for 90% and congenital - 10%.

Women's consultation plays an important role in the system of maternal and child health care. Pathology leading to stillbirth and death of newborns occurs in 63% of cases in the antenatal period [3]. In this regard, the decrease in the incidence of newborns, the prevention and reduction of child and perinatal mortality depend on the increase in the effectiveness of antenatal protection of the fetus, at present, further improvement of the work of antenatal clinics deserves special attention, strengthening their connection with children's clinics, maternity hospitals and medical and preventive institutions serving women of childbearing age.

The protection of women's health in the USSR is not only a departmental function of the health authorities, it is ensured by a complex of socio-economic measures that have made it possible to reduce obstetric and perinatal pathology. In the field of maternal and child health care, specific preventive measures are being implemented following the decisions of the XXVI Congress of the CPSU and the decisions of the Central Committee. The CPSU and the Council of Ministers of the USSR 'to further improve the protection of public health.

In recent years, there has been a tendency towards an increase in the frequency of functional diseases of the cardiovascular system among young people (20-30 years old). According to V.P. Nikitin (1961) and T.A. Sorokina (1979), the proportion of these diseases among patients who applied for therapeutic 1.4 - 6.7%, for cardiological - 38 - 56% [9, 10 ].

Iron deficiency anemia is one of the most common diseases [2]. Its main cause is blood loss, increased iron consumption during periods of growth, lactation and pregnancy, as well as its nutritional deficiency [4]. Clinical experience and studies by various authors indicate the existence of protracted forms of anemia that are not amenable to conventional therapy with iron preparations. There are isolated reports on the importance of the endocrine system in the formation of resistance to iron preparations in anemia in children [5, 7]. However, the pathogenesis of refractory iron deficiency anemias in adults has not yet been established.

In 63 patients with acute pancreatitis, laparoscopic hypothermic lavage of the omental bursa was performed in complex treatment without prescribing antienzymes and cytostatics. In 42 patients in the control group, omental bursa lavage was not used, but antienzyme and cytostatic drugs were used. The terms of treatment in the main group compared with the control group were reduced by 1.6-2.5 times.

The study involved 52 women with rheumatoid arthritis, aged 18 to 29, including 19 pregnant women. The comparison of the clinical features of the process activity with the content of cortisol in the blood, anti-lymphocytic antibodies and rheumatoid factor was carried out. In women with rheumatoid arthritis, a decrease in the content of cortisol with a tendency to an increase in the titer of anti-lymphocyte antibodies and a significant increase in these indicators during pregnancy was found. Low cortisol levels were observed in the exacerbation phase of the rheumatoid process. The data obtained indicate the effect of the concentration of cortisol in the blood and the titer of anti-lymphocyte antibodies on the pathogenesis of rheumatoid arthritis, as well as the need to develop a tactic for treating women with this pathology.

Childbirth was carried out and studied in 87 women with severe forms of late toxicosis, who were treated during pregnancy according to the generally accepted scheme. In the 2nd stage of labor, the ganglion blocker pentamine was used, which made it possible to reduce the frequency of the operation of applying obstetric forceps by almost 4 times. The condition of mothers and their children after delivery is satisfactory.

The use of transillumination as an element of microsurgical technique on the fallopian tubes made it possible to identify the individual characteristics of the blood supply in 22 patients, to differentiate the smallest intraorgan vessels of the fallopian tubes, to perform their precise ligation under a microscope, and to distinguish the border between the adhesive structures and the serous membrane of the fallopian tubes. The proposed

Renal artery occlusions occur in patients with severe aortic atherosclerosis, panarteritis, as well as as a result of previous operations and are severe vascular pathology. It is very difficult to restore renal blood circulation in such patients, since this often affects the areas of bifurcation or trifurcation of the renal arteries. Cases of multiple renal arteries are especially difficult. It is known that surgical treatment for occlusions consists in creating bypass anastomoses, in particular the anastomosis of the superior mesenteric artery with the renal artery using the great saphenous vein [5]. However, the formation of this anastomosis is feasible only when treating a single renal artery, while its multiplicity is observed in 15–38% of cases [1–3].

In the extensive literature on the pathomorphology of diphtheria, we did not find information about the effect of diphtheria toxin on mitosis in the affected tissues. Only in one of the works devoted to the description of the cytotoxic effect of the toxin on tissue culture was the disappearance of mitotic figures in an intoxicated cell culture noted [5].

Over the past two decades, the interest of clinicians in the state of the cardiovascular system in patients with pulmonary tuberculosis has significantly increased, which is associated both with the use of advanced technology, which allows a more in-depth study of hemodynamics, and with the pathomorphosis of tuberculosis. If in the pre-antibacterial era cor pulmonale was detected in phthisiatric patients in 6.6% of cases [36], now it is diagnosed in chronic pulmonary tuberculosis in 40-50%, in cirrhotic form in 75-80% [26]. Pulmonary heart failure in such patients reduces performance and can cause disability [31]. The frequency of deaths in chronic pulmonary tuberculosis due to chronic pulmonary heart disease reaches 58.6% [17], and specific cardiac lesions in deaths from tuberculosis are only 2.5-4% [26]. The state of the cardiovascular system in pulmonary tuberculosis requires study in connection with the development of pulmonary surgery. Pathogenetic correction of hemodynamic changes in phthisiosurgical patients expands the limits of operability in common processes and in old age [2].

A real way to detect breast cancer is dispensary observation using a set of diagnostic measures. To improve the quality of such monitoring and its economic efficiency, it is necessary to distinguish among healthy women who have undergone a preventive examination, a group of increased risk and patients with precancerous diseases.

Based on the feasibility of determining the activity of serum 5'-nucleotidase as an indicator of thromboplastinemia in myocardial infarction and traumatic brain injury, in this work, we studied the content of 5'-nucleotidase in placental tissues as a possible marker of thromboplastin entering the bloodstream during the development of thrombohemorrhagic syndrome during pregnancy and childbirth.

The restoration of the working capacity of patients after acute myocardial infarction is an urgent problem of modern cardiology. In 1979, on the basis of the Vasilievsky sanatorium, a department for the rehabilitation of patients with acute myocardial infarction was organized. Using the questionnaire method, we analyzed the effectiveness of rehabilitation treatment of patients based on long-term results for three years (1979-1981). 800 questionnaires were sent out. The aim of the study was to clarify the patient's condition, the duration of disability during the illness (hospital, sanatorium, polyclinic), current ability to work, as well as questions about whether the patient is a disabled person, whether the treatment continues under conditions of dispensary observation, what is the volume of his physical activity. This study involved 526 (65.7%) people who answered all the questions.

The purpose of this work was to study the incidence of basophilism among schoolchildren and to elucidate its possible causes for the development of ways of prevention. To take into account the influence of geographical and social characteristics, it seemed expedient to examine schoolchildren in different points of the Soviet Union. We examined 6072 schoolchildren aged 10 to 16 years (2977 boys, 3095 girls) 2608 in Perm, 783 in the Perm region and 2681 in the Smolninsky district of Leningrad. At the same time, we paid attention to the physical and sexual development of the condition of the skin (the presence of stretch marks, pigmentation, dryness) and internal organs, the level of blood pressure, the size of the thyroid gland. When basophilism was found, these adolescents were surveyed in detail using a special questionnaire, and their development maps were studied.