EDITORIALS
LECTURES
REVIEW
ORIGINAL RESEARCHES
Adequate ventilating maintenance of long operations of liver transplantation is one of conditions of successful realization of this complex, difficult and long operations. Experience of realization 16 related ортотопических transplantations of liver at adult patients in the age of from 16 up to 61 years (compare 29,6±12,5) was analyzed. Average duration of anaesthesia has made 15,4±1,58 hour. Ventilating maintenance was carried out in a mode of traditional artificial ventilation easy with use of a technique minimal-flow. Key parameters of ventilation are determined by stages of operation, i.e. a dynamic condition of cardiovascular system, productivity of heart, blood volume, value of preload and after load and many other parameters. The basic condition of successful realization of similar anaesthesia is the knowledge of features minimal-flow anaesthesia, presence of informative ventilating and gas monitoring. The use of isoflurane in a regime of minimal-flow allows essentially lowering the charge anaesthetic to provide reliable, controlled and safe anesthesia during all operation. Time of postoperative artificial and support ventilation easy has made 4,2±1,1 hour.
METHODS
Low- and minimal-flow anesthesia are modern technologies of inhalation anesthesia for which realization modern anaesthesiological respiratory devices both constant informative ventilating and gas monitoring are necessary. Realization of minimal-flow anesthesia is connected to some physiological features of gas exchange in lungs, having a place at small streams of inhalation gases. Observance of simple rules of realization low-flow anesthesia with modern inhalation anesthetics allows providing reliable, well controlled and practically safe anesthesia at the most difficult and long operations.
Modern chemotherapy is impracticable without due maintenance of oncological patients' life quality. New modes of cytostatic drug introduction allow undergoing almost any courses of medical treatment on an outpatient basis, while long-term chemotherapy and anaesthesia are performed by using specially developed infusion systems. Subcutaneous implantation of ports that are devices for multiple infusions makes for easier introducing of medicinal agents, thus avoiding extravasation and phlebitis. The authors share their own experience in using outpatient infusion pumps and ports.
PRACTICE OBSERVATIONS
The paper presents a follow-up of a defect of interventricular septum arisen from a child's chest blunt injury diagnosed on the basis of auscultatory data, radiography, and ultrasound study. When acute consequences of the injury were suppressed, the child underwent alloplasty of interventricular septum in parallel with artificial circulation and chemical cold cardioplegia. As per control examination made in a year, hemodynamic indices were normal.
The paper provides a follow-up of a child aged thirteen when the authors have diagnosed bilateral renal artery stenosis, most evident on the right. The patient underwent left balloon angioplasty and renal arterial transposition of the right renal artery in four months. The repeated examination showed normal arterial pressure without any correction of antihypertensive drugs. Based on the results, the authors concluded that combination therapy of renal angioplasty in cases of vasorenal hypertension is advisable.
PUBLIC HEALTH ORGANIZATION
The paper provides a report of the chief specialist of the Public Health Department of the Sakhalin Oblast Administration that contains information about regional anesthesiology and reanimation service. The author points out the low level of hospital facilities, provision with narcosis apparatus, follow-up devices, and expendables, as well as highlights the necessity to modernize equipment of resuscitation and intensive care departments, to purchase modern equipment, and to train personnel. In conclusion, the author places emphasis on creation and reinforcement of specialized reanimation centers and equipping of air medical service in order to provide timely transportation of patients from remote districts.
The paper provides analysis of results of invasive prenatal diagnostics (696 cases) performed in Regional Clinical Center of Maternity and Childhood Protection (Vladivostok) over 2001-2003. Chromosomal anomalies were detected at 4.2% of cases. The most frequent pathologies were Down's syndrome and balanced translocations. Based on the findings, the authors pointed out the necessity of wider application of invasive prenatal diagnostics in the region.
Neoplasms are one of the most important medical and social problems. In Primorye 24060 oncological patients have been registered in oncological dispensaries. In 2003 6268 patients were for the first time registered as persons having malignant tumors. In 2003 oncopathology structure comprised tumors of reproductive system (38.5%) and genital organs (18.5%). Breast cancer prevailed, and then followed carcinoma of uterine cervix, uterus and ovaries. Among all malignant tumors resulting in Region's woman mortality the highest death rate was registered, if women suffered from neoplasms of breast, uterine cervix, ovaries, and uterus. Putting the screening system into practice will allow to reduce a portion of advanced tumors of reproductive system and to decrease death rate among Region's women.
HISTORY
The paper provides a profile of P. I. Fedotov who is a head of the department of propedeutics of internal diseases in Vladivostok State Medical University. His course of life includes work in the regional hospitals on graduating from the institute, participation in the military operations during the Great Patriotic War, presentation of two theses for Doctor's degree, guidance for the department for 13 years, establishment of pulmonologists' school in Primorsky Region, and development of a series of basic works on the problems of clinical picture and medical treatment of lungs diseases
PEDAGOGY
Depending on general goals and objectives of postmortem examination, post-graduate training of forensic experts is provided by departments of pathologic anatomy and forensic medicine conjointly. It consists of four stages that include postmortem diagnostics of the most important somatic diseases (stage I), work with macrobiological specimens (stage II), microscopical diagnostics (stage III), and making out of a diagnosis and thanatological conclusion, based on the attainments (stage IV). Four-stage training system shows up an adequacy of this approach to didactic process of forensic pathologists' advanced training.
Some interactive methods have been introduced at the department of human anatomy to develop creative virtues, analytical potentiality and manual skills of students studying there in hours of self-instruction. These methods imply preparation of different systems of human organism and the follow-up analysis of the results, as well as work on term papers.
Specialists working at therapeutic departments of Vladivostok State Medical University are engaged in constant, purposeful and concerted activities to form professional skills of students, as provided by the requirements of State Educational Standard for the year 2000. The main line of students' activity is work at clinic, using state-of-the-art technologies included. A special attention is focused on the students' self-instruction under teacher's control that allows providing training of the future doctors for mastering the profession during post-graduate courses in intership.
INFORMATION
Medicina-DV Publishing House established two years ago in Vladivostok State Medical University specializes in publishing scientific literature and teacher's manuals. Besides, this publishing house is engaged in preparing and issuing "Pacific Medical Journal" being far-famed both in Russia and in Asia-Pacific Region. By inviting well-qualified specialists, in a short space of time it has succeeded in achieving impressive results. At the latest Far-Eastern exhibition "Publishing court2004" this journal and two books issued by "Medicina-DV" were rewarded with certificates of quality for editing and design. From 2005 electronic issues of the "Pacific Medical Journal" are going to be available for Internet users at http://www. elibrary.ru.