Vol 17, No 4 (2011)

The paper analyzes the data of a pilot sociological survey conducted to study public concepts of the profession of an anesthetist-resuscitator. The survey could form a patient opinion about the specific features of the professional activity of an anesthetist-resuscitator and his/her social status and role in the therapeutic process. Analysis of the findings has revealed contradictions between the social significance of this profession for society and the public views of the essence of this medical activity. This leads to the inadequate assessment of the job of an anesthetist-resuscitator and to the depersonalization of this medical profession.

In patients with persistent asthma, tobacco smoking potentiates the worsening of pulmonary ventilation capacity, has an additional negative effect on blood oxygen-transport function, causes adaptive changes in the morphofunctional characteristics of the circulating pool of red blood cells, and enhances autonomic nervous system dysfunctions.

The aim of the study was to define the sensitivity and specificity of the new skin test Diaskintest® (DST) using the complex antigen consisting of recombinant CFP-10/ESAT-6 proteins. Four hundred and twenty-five patients with respiratory tuberculosis, 37 with dubious pulmonary tuberculosis process activity, and 111 with pulmonary nontuberculous diseases were examined. DST showed a high sensitivity in 84.2% of the tuberculosis patients. 84.2% of 247 patients treated for 1 to 29 days had a positive response to DST and only 38 (55.9%) of 68 patient treated for more than 100 days had it. The response was twice found in 72 patients. Three months before treatment, 32 (48.5%) of 66 patients with a baseline positive reaction showed a decreasing trend in the response and its positive to negative conversion; the average sizes of the first and second papules were 18.4 and 10.1 mm, respectively. In the patients with pulmonary nontuberculous diseases, the specificity of DST was 96.4%: 105 of the 111 patients had negative tests; the positive tests in 2 patients were accounted for by Mycobacterium tuberculosis due to their professional contact with tuberculosis patients. None of 29 cases of inactive focal tuberculous changes showed any positive response to DST. The latter may be used to detect tuberculosis, to determine the activity of the process, and to evaluate the efficiency of treatment.

The paper gives the results of prosthetic aortic valve replacement using the comparatively new models of On-X and MedEng-2 prosthetic heart valves. The hemodynamic parameters of the above prosthetic heart valves and the long-term results of their implantation are considered in detail. The findings have led to the conclusion that aortic valve replacement by On-X and MedEng mechanical bivalve prostheses yields good postoperative and long-term results. The On-X and MedEng prostheses provide optimal transposthetic hemodynamics with low pressure gradients. No significant differences found in the results of prosthetic heart valve replacement.

To treat patients with fractures and displacement-fractures of the anterior and middle foot is a topical problem of ambiguous solution. The authors have developed their working classification, an algorithm for treating these patients, and a surgical procedure in accordance of this classification. All damages to the middle and anterior foot were divided into stable and unstable, isolated and multiple. A treatment option was chosen, depending on the functional characteristics of the damaged foot column. To prevent the development of compartment syndrome, if a postoperative wound could not be sutured without tension on its edges, a relaxing incision was made beyond the injury projection for soft tissue decompression; during medical treatment, if elevated interfascial pressures were suspected, dotted incisions were done along the dorsal surface of the foot. The wounds after the relaxing incision were managed openly until the traumatic edema disappeared, and were then sutured. One hundred and forty-two patients with damages to the anterior and middle foot (68 controls and 74 study group patients) were followed up at the Traumatology Departments of City Clinical Hospital Sixty-Four in 2002 to 2008. Assessment of treatment results validly showed an increase in the positive outcomes of treatment and a considerable reduction in complications.

In infants, tuberculosis is frequently accompanied by the development of generalization of a specific process. Analyzing data on the infants examined and treated at Moscow Tuberculosis Clinical Hospital Seven has revealed that generalized tuberculosis develops in infancy in every ten tuberculosis infants. When generalized tuberculosis develops, every ten infants die. An individual treatment approach and intensive and long-term combination therapy are required. The use of antituberculosis agents in higher daily dosages is warranted.

The paper describes the prevalence of secretory otitis media in children with allergic rhinitis. Five hundred and seven subjects with allergic rhinitis were examined; 91 children with secretory otitis media were identified. This group was analyzed and a risk group identified.