Vol 19, No 1 (2017)

The performance of volunteers-operators of duty shifts, subjected to increased mental and psycho-emotional loads during prolonged operator’s performance using a caffeine-containing complex (chewing gum) has been studied. It has been revealed that in performing their duty shifts under fatigue conditions (a state of monotony), the use of a caffeine-containing complex can lead to a slight improvement in the subjective status against the background of a decrease in the vegetative parameters values of the cardiovascular system (tone of peripheral vessels) (2 tables, bibliography: 8 refs).

Objective. To assess the effectiveness of using the intraoperative neuromonitoring for conventional and minimally invasive surgical interventions on the thyroid gland for the prevention of the laryngeal nerve damage. Material and methods. For achieving this goal it was performed the retrospective analysis of surgical treatment of 310 patients with thyroid gland diseases, and 54 patients were selected, which were divided into 2 groups matched by sex and age, the nature of thyroid pathology and volume of surgical intervention: in the first (main, n = 27) operations were carried out using intraoperative neuromonitoring, in the second (control, n = 27) - visual monitoring of the laryngeal nerves was performed. The survey was performed according to the Russian and international clinical guidelines. Laryngoscopy was performed for all patients before operation and for patients with impaired phonation function - after it. «NIM-Neuro® 3.0» device with special armored endotracheal tubes preloaded with circular (detecting), as well as stimulating electrodes for searching and continuous monitoring of laryngeal nerves was used for intraoperative neuromonitoring during the operation. Results of the study. Traditional interventions were conducted on the 6 patients, minimally invasive nonendoscopic surgical - on 25, video-assisted - on 23. The exterior branch of the superior laryngeal nerve has found in 25 (92.6%) patients of the main group and 8 of the (29.6%) control group. Recurrent laryngeal nerve was identified in 27 (100%) patients of the 1st group and in 26 (96.3%) patients of the 2nd group by visual inspection. In the main group there are no cases of intraoperative fixation of the loss or signal attenuation during the laryngeal nerves monitoring, which is proved by the absence of single- and double-sided paresis of the larynx in the postoperative period. Only in 2 patients there was functional dysphonia on hypotonic type. In the control group the laryngeal dysfunction in the form of functional dysphonia (n = 1), paresis (n = 1) and paralysis (n = 1) has occurred in 3 patients. Conclusion. It has been found out that intraoperative neuromonitoring is an effective additional method of neural structures detecting, and it does not substitute the anatomic visualization of laryngeal nerves. intraoperative neuromonitoring in patients with high risk of complications (repeated operations on the thyroid gland, thyroid cancer with extrathyroidal proliferation and regional metastases) can reduce the incidence of paresis and paralysis of the larynx. All minimally invasive interventions on the thyroid gland should be accompanied by the intraoperative neuromonitoring of laryngeal nerves (8 figs, 1 table, bibliography: 15 refs).

Explore the historical domestic experience of primary health care to the population of major cities, the establishment of this type of medical care as the main and the largest national healthcare system partition stages of the reform of primary health care to date, with a gradual transition to a system of health insurance in order to further increase the availability of and quality of care. Due to the recent modernization of the health system outpatient offices were equipped with modern innovative medical devices for the delivery of primary health care at a high level. In addition, historically proved the effectiveness of medical care at the district territorial principle, which defines and improves access to health care, with subsequent referral to narrow specialists (bibliography: 20 refs).

The results of the experimental evaluation of the effectiveness of wound dressings based on chitosan nanofibres and copolyamide with treatment of full mechanical skin wounds. To develop their own original technique of mechanical reproduction all layers of the skin wounds in the experiment. It was found that application of wound dressings based on aliphatic copolyamide and chitosan can significantly optimize reparative regeneration processes in the area all layers of the skin defect, thus reducing the time stated scab rejection and wound healing, respectively, 7.5 and 11.2 days (p < 0,05). It is shown that the use of coatings based on hyaluronic acid hydrogel is also accompanied by a significant acceleration in the zone histogenesis all layers of the blemishes, shortening the healing period of the final 21% (p < 0,05) (4 figs, 1 table, bibliography: 14 refs).

Ivan Stepanovich Kolesnikov (1901-1985) - Soviet surgeon, Doctor of Medical Sciences, Professor, Academician of the Academy of Medical Sciences of the USSR, Major General of the Medical Service, Honored Scientist of the RSFSR (1964); Hero of Socialist Labor (1976). Laureate of the Lenin Prize and the USSR State Prize. November 4, 1968 at the Department of Hospital Surgery Professor IS Kolesnikov, together with Academician of the Academy of Medical Sciences of the USSR Colonel-General of Medical Service A. A. Vishnevsky performed the first in our country heart transplantation (1 figs, bibliography: 15 refs).