Special Methods Of Examination Research Articles

Determination of Demographic, Systemic, and Radiographic Characteristics of Patients Applied to the Oral and Maxillofacial Radiology Clinic

Objective: Anamnesis, extraoral intraoral examination, radiographic examination, and other special examination methods are used to diagnose diseases in the oral and maxillofacial regions. The aim of this study was to establish the demographic, systemic, and radiographic characteristics of the patients by analyzing the records of patients who were treated at the Oral and Maxillofacial Radiology Clinic of the University Faculty of Dentistry. Methods: The anamnesis and diagnostic records of patients who were treated at the OMR clinic between 01.01.2013 and 31.12.2019 and the radiographic records of the patients referred to the X-ray department were retrospectively analyzed. The number of patients was analyzed according to demographic, systemic, and radiographic classifications, and tables were created according to years and total numbers. Results: The number of females who applied between 2013-2019 was statistically significantly higher than that of males. When the age distribution of all patients who applied to the OMR clinic was analyzed, it was observed that the patients who applied were 15 years of age and older, and 29.3% of these patients were in the 30-44 age group, with the highest proportion. When radiographic data were analyzed, it was observed that the most common radiograph obtained was a panoramic radiograph (90%). Conclusion: Anamnesis records revealed the systemic disease characteristics of the study area, which is helpful for diagnosis and treatment planning. The most requested radiographic types and clinics that requested the most radiographs were determined. This will help improve the functioning within and between departments. By determining the common diagnoses in panoramic radiographs, the issues to be considered in patients of certain age and sex groups have been clarified.

Анализ результатов и осложнений после повторной пластики рецидивных стриктур уретры.

Introduction. Over the past 30 years in reconstructive urology there has been a tendency to reduce the frequency of use of minimally invasive methods of surgical treatment of urethral strictures of various localizations and the predominant use of reconstructive plastic interventions with the expansion of the narrowed area of the urethra using inserts from various tissues. Buccal dilation urethroplasty is currently recognized as the optimal treatment option for urethral strictures of various locations and of varying length. Thus, the issue of choosing the most appropriate method of surgical intervention for recurrent urethral strictures, in the context of a possible increase in the risk of complications, requires additional research. Purpose. To analyze and evaluate the results and complications after plastic surgery of recurrent urethral strictures using a free autograft of the buccal mucosa. Materials and methods. The analysis included data on 51 patients operated on at the Research Institute of Urology and Interventional Radiology named after. N.A. Lopatkina–branch of the Federal State Budgetary Institution National Medical Research Center of Radiology of the Ministry of Health of the Russian Federation for the period from 2014 to 2021 regarding recurrent urethral stricture. The average age of the patients was 36.2±1.6 years (from 18 to 58 years). The diagnosis of recurrent urethral stricture was confirmed by anamnesis, clinical and laboratory examination according to a standard protocol, and special examination methods (uroflowmetry, ultrasound examination of the bladder, retrograde or antegrade cystourethrography, voiding urethrography). According to indications, fibrourethrocystoscopy was performed. According to radiological research methods, the localization and extent of urethral stricture were determined. The functional state of the bladder and the severity of bladder outlet obstruction were determined by the volume of residual urine determined by ultrasound of the bladder, as well as by uroflowmetry data. Results. An analysis of the results and complications after plastic surgery of recurrent urethral strictures using a buccal flap was carried out after repeated operations. As the length of the stricture increases, the risk of its recurrence increases significantly. The most significant factors are the location of the stricture in the penile region and its extent. No other long-term complications (newly developed urinary incontinence/erectile dysfunction) were observed in any case in the analyzed group of patients. Conclusion. Repeated operations for recurrent urethral strictures can eliminate urinary disorders with an effectiveness close to (or equal to) that of primary operations. When choosing a method of surgical treatment of recurrent strictures, both the extent of the stricture and its location should be taken into account. The presence of an extended stricture of the penile urethra may be a risk factor for its recurrence. Complications that develop after repeated operations in the vast majority of cases are not life-threatening. The question of the effectiveness of different types of surgery requires additional research with the accumulation of clinical material.

Methods for Diagnosing and Predicting Diaphragm Dysfunction in the Recovery Period of a Stroke: a Narrative Review

INTRODUCTION. Diaphragm is not only the main human respiratory muscle, it also plays an important role in maintaining intra-abdominal pressure, balance, upper limb motor function, swallowing and speech. In patients with cerebral stroke, the function of the diaphragm can be impaired on the side of hemiparesis in more than half of the cases and may negatively affect the entire recovery process. Moderate clinical manifestations of unilateral diaphragm dysfunction require special examination methods for diagnosis and planning of appropriate rehabilitation measures.
 AIM. To analyze the predictors and compare of methods for diagnosing diaphragm dysfunction in patients with hemiparesis during the recovery period of stroke to improve the quality of the rehabilitation diagnosis and the effectiveness of further rehabilitation process.
 DISCUSSION. An analysis of publications over the past five years was done. Anatomical and physiological aspects of the diaphragm are identified, and a comparison of manual and instrumental methods for the diaphragm function evaluation are presented. An assessment of diagnostic methods is given in terms of accuracy, accessibility and possibility of use for dynamic monitoring of patients. The main values of normal indicators of diaphragm function and their level in case of unilateral dysfunction are presented. Predictors of diaphragm dysfunction in patients with hemiparesis as a result of stroke are identified.
 CONCLUSION. Timely diagnosis of diaphragm dysfunction will ensure the appropriate rehabilitation goal setting during the recovery period of a stroke and will help to optimize the interventions and increase the effectiveness of rehabilitation process. The information is addressed primarily to specialists working in rehabilitation. The search was carried out using the Pubmed and RSCI databases.

Chlorin photosensitizer photolysis products for treating hospital-acquired pneumonia

Purpose: to develop a technique for therapeutic application of photoactivated photosensitizer «Radachlorin» to be included into the complextherapy of nosocomial pneumonia.Material and methods. Twelve patients with nosocomial pneumonia were taken in the trial. They were treated with a device having a nebulizer witha ring-shaped irradiator and diodes λ ≈ 660 nm for photoactivation of photosensitizer «Radachlorin» (manufactured by OOO «RADA-PHARMA»,Moscow, registration number LS-001868). The photosensitizer was developed according to the technical tasks provided by OOO «New SurgicalTechnologies» (Moscow, Russia). Radachlorin solution photolysis products were inhaled by the patients twice a day for 3 days in combinationwith the standard therapy when they were in ICU. Patients in the control group (n = 12) did not have any inhalations.Results and discussion. On day 3, the number of colony-forming units (CFU) of various pathogens found in swabs from the throat decreasedby 39.45 ± 3.17 % on average; C-reactive protein decreased by 42.38 ± 4.26 %; procalcitonin decreased by 51.83 ± 3.45 %, if to compareto baseline limits. At the same period in the control group, CFU in swabs increased in average by 17.28 ± 4.21 %; C-reactive protein increasedby 27.76 ± 3.52 %; procalcitonin increased by 30.15 ± 2.24 %. On day 10 in the main group, the number of CFU pathogens decreasedby 35.45 ± 3.32 %; C-reactive protein decreased by 72.15 ± 2.56 %; procalcitonin decreased by 55.56 ± 4.23 %, if to compare to baseline limits. On day 10 in the control group, CFU concentration remained elevated by 31.15 ± 2.56 %; C-reactive protein – by 65.32 ± 4.27; procalcitonin – by 30.21 ± 3.45 %, if to compare to baseline values. These findings indicate that the inflammatory process acquired a progressive form which demands switching to other curative modalities and more careful selection of antibiotics. The probability of random origin in statistical processing is p < 0.05. There were no undesirable side effects during procedures.Conclusion. Justified application of the described technique – inhalations of photolysis products of E 6 chloride derivatives – has an effective therapeutic impact at the course of nosocomial pneumonia. It seems promising to continue investigations on the described technique, namely, to search for the most effective ways of its application, to find out an optimal number and frequency of procedures under the control of general clinical and special methods of examination of the studied patients, since the data which have been obtained by the authors us are preliminary and should be supplemented with new findings.

Clinical manifestation of corneal epithelial dystrophy after LASIK

Modern keratorefractive surgery provides high efficiency, safety, predictability, stability of clinical and functional results of correction of various types of ametropia. In the process of preoperative diagnostics, standard and special examination methods are performed to exclude corneal diseases and determine the optimal technology for laser vision correction in each specific case. However, detection of subclinical forms of dystrophies and degenerations of the cornea is not always possible in the course of standard preoperative diagnostics. In this connection, the aim of this work is to present a clinical case of the manifestation of corneal epithelial dystrophy after laser vision correction. The article describes a rare case of clinical manifestation of corneal epithelial dystrophy after excimer laser vision correction, which was compensated by anti-inflammatory and corneoprotective therapy. Diagnostic studies are also separately described, including keratotopographic examination, optical coherence tomography of the anterior segment of the eyes and in vivo confocal microscopy of the cornea, the role of these research methods in the early diagnosis of degenerative processes of the cornea is noted. In vivo laser confocal microscopy is classified as a minimally invasive diagnostic manipulation that allows real-time analysis of all layers of the cornea at a level close to histological. Recently, this method of diagnosing the anterior segment of the eye has found wide application in clinical practice. The management of patients with corneal dystrophies requires increased attention from an ophthalmologist; anti-inflammatory and keratoprotective therapy of the cornea, followed by long-term dynamic monitoring of the eye condition, is topical as a prescribed treatment.

DIFFERENTIAL-DIAGNOSTIC INFORMATIVENESS OF THE MORPHOLOGICAL AND IMMUNOHISTOCHEMICAL STUDY OF PAROTID SALIVARY GLAND CYSTS.

The aim: To conduct a general analysis of the results of the study of the morphological and immunohistochemical structure of cysts of the parotid salivary glands. Materials and methods: Our study is based on the application of generally accepted, additional and special methods of examination, which concerns 21 patients who underwent surgical intervention to remove cystic formations of the parotid salivary gland. Results: It was established that there are 2-3 HLA-DR+ cells per 100 epithelial cells located in the basal and subbasal layers in the form of their continuous ribbon and their moderate infiltration of tissues within the acinar epithelium. In the epithelium, CD3+ cells were also detected in the number of 1 to 7 per 100 epitheliocytes and they were the most numerous, along with HLA-DR+ cells. Instead, the presence of CD4+ and CD20+ cells was not detected in the epithelium, unlike the subepithelial layer, where they occupied significant areas. In turn, the infiltration of CD8+ cells of the epithelial layer was established in the amount from 1 to 7 per 100 epitheliocytes. A moderate number of them was also determined subepithelially, and they were single directly in the cyst wall. Conclusions: Immunohistochemical study of the structural components of cystic formations is this is the direct way to establish the nature of the redistribution of immune cells in it, which is very important when conducting differential diagnosis in difficult and doubtful cases.

SURGICAL ISCHEMIC ASPECTS OF COVID-19: MANAGEMENT OF PATIENTS WITH COVID TOES AND FINGERS.

The aim: Study of clinical manifestations and management of patients with COVID toes and fingers. Materials and methods: 1,841 patients with laboratory-confirmed SARS-CoV-2 infection were hospitalized. All patients were divided into two groups: without surgical pathology - 1,693 (91.96%) and with surgical pathology (patients with COVID toes and fingers and abdominal syndrome) - 148 (8.04%). The diagnosis of COVID-19 was made on the basis of clinical data, laboratory test results (PCR test for SARS-CoV-2) and computed tomography of the chest. On admission, in addition to the general laboratory tests, mandatory special methods of examination included determination of D-dimer, procalcitonin (PCT), C-reactive protein, and interleukin-6 (IL-6). Results: Surgical ischemic manifestations were observed in 8.04% of all patients with COVID-19, of which 86.48% presented with ischemic abdominal syndrome and 13.52% with COVID toes and fingers. C-reactive protein and procalcitonin are the markers that may indicate the development of ischemic surgical problems. A direct statistically significant linear correlation was found between the severity of the underlying disease and the mean D-dimer (r = 0.815; p = 0.01). Conclusions: The confirmed phenomenon of COVID toes and fingers does not require active surgical tactics. It is necessary to conduct pathogenetic treatment of COVID-19 and dynamic monitoring of its clinical course.

Сравнительные характеристики тревожно-депрессивных расстройств и их влияние на качество жизни больных с сердечно-сосудистыми заболеваниями в амбулаторном звене, в зависимости от гендерной принадлежности

Aim. To evaluate the main parameters of indicators of anxiety and depressive disorders depending on gender, as well as its complex impact on the quality of life in outpatient patients with cardiovascular diseases. Materials and methods. The open prospective study included patients who were followed up on an outpatient basis at GAUZ TO “City Polyclinic No. 5” in Tyumen during 2016-2019. Everyone included in the study underwent generally accepted methods of clinical examination, as well as special methods of examination: determination of the N-Terminal fragment of the Brain Natriuretic Propeptide (NT-proBNP), assessment of points on the Hospital Anxiety and Depression Scale (HADS), the Morisky Green Test to determine adherence to treatment, conducting a personality psychotype test (DS-14), calculation of the number of points using a questionnaire to determine the quality of life (SF-36). Data analysis was carried out using statistical packages STATISTICA (version 22.0). For all analysis carried out, differences were considered significant at a two-tailed level of significance p < 0.05. Results. A total of 141 patients (44 men and 97 women, mean age 68.9 ± 8.8 years) were included in the study. When comparing the gender subgroups, it can be noted that women are characterized by higher levels of anxiety (7.0 (5.0-9.0) points vs. 4.0 (2.0-7.0) points in the male group, (p < 0.0001) and depression (7.0 (4.0-9.0) vs. 5.0 (2.75-7.25) points, p < 0.05) and a slightly more frequent occurrence of psychotype D (33% vs. 27.3% in the male group, p = 0.064). In the female group, there were correlations of the scales of anxiety and depression with indicators of quality of life, adherence to therapy. The indicator of the state of the cardiovascular system, estimated by the level of NTproBNP, directly correlated with age (r = 0.289, p = 0.006), the severity of anxiety (r = 0.336, p = 0.001) and depression (r = 0.314, p = 0.002). For the male subgroup, levels of anxiety and depression had no significant effect on quality of life, commitment, and NT-proBNP. In the male group, there was a negative relationship between the state of the cardiovascular system (assessed by the level of NTproBNP) and role functioning (r = –0.312, p = 0.042)., as well as – the emotional state (r = –0.325, p = 0.038). Conclusion. A more unfavorable state of the cardiovascular system, assessed objectively by the level of NT-proBNP, reduces role functioning and emotional state in men, and increases the level of anxiety and depression in women.

Ассоциация психотипа личности Д с уровнем тревоги и депрессии, и его влияние на приверженность к лечению и качество жизни у амбулаторных больных с сердечно-сосудистыми заболеваниями

Aim. To assess the prevalence of personality psychotype D, as well as its complex effect on levels of anxiety and depression, compliance and quality of life in outpatients with CVD. Materials and methods. The open prospective study included patients who were followed up on an outpatient basis at GAUZ TO “City Polyclinic No. 5” in Tyumen during 2016-2019. Everyone included in the study underwent generally accepted methods of clinical examination, as well as special methods of examination: determination of the N-Terminal fragment of the Brain Natriuretic Propeptide (NT-proBNP), assessment of points on the Hospital Anxiety and Depression Scale (HADS), the Morisky Green Test to determine adherence to treatment, conducting a personality psychotype test (DS-14), calculation of the number of points using a questionnaire to determine the quality of life (SF-36). Data analysis was carried out using statistical packages STATISTICA (version 22.0). For all analysis carried out, differences were considered significant at a two-tailed level of significance p < 0.05. Results. In total, the study included 141 patients (44 men and 97 women, mean age 68.9 ± 8.8 years). Personality type D was identified in 31.2% of patients. Individuals with personality psychotype D were characterized by a higher level of anxiety and depression, a lower quality of life on a number of scales by the quality of life questionnaire. Also, for the group with personality psychotype D, there was a multidirectional correlation between quality of life indicators, which was not found in the group without personality psychotype D. More than two thirds of patients with psychotype D were with insufficient adherence or non-adherence to treatment. Psychotype D is also characterized by a higher level of NTproBNP, which indicates a poorer state of the cardiovascular system in these patients, but no correlations were found between the state of the cardiovascular system and the quality of life in patients with personality psychotype D. Conclusion. The selection of patients with personality psychotype D in outpatient practice allows a more rational approach to CVD therapy, including methods of correcting chronic psychological factors, thereby improving the prognosis of patients.

Оптимизация ранней диагностики рака предстательной железы

The prevalence and incidence of prostate cancer is gradually increasing both in our country and in countries near and far abroad. The difficulties in the differential diagnosis of prostate cancer are convincingly evidenced by the fact that the level of diagnostic errors reaches 40%. It should be noted that in assessing the differential diagnostic capabilities of the indicators of the clinical and special examination methods for patients with lower urinary tract symptoms, disagreements were found in 46–77% of the analyzed clinical signs, the changes of which mainly reflect the negative nature of the effect of tumor decay products on the patient’s body. The aim of the study was to improve the early diagnosis of prostate cancer by using the mathematical method of differential diagnosis of prostate pathology, as well as the rationale for the proposed method for early diagnosis of prostate cancer in patients with clinical symptoms. Using our proposed method for early diagnosis of prostate cancer makes the diagnosis not only reliable and accurate, but also independent of the level of qualification of the urologist and his personal experience, allows you to unify, optimize and personify the differential diagnosis of prostatic hypertrophy and prostate cancer.

The results of special methods of examination of patients with tubal-peritoneal form of infertility

The results of special methods of examination of patients with tubal-peritoneal form of infertility

REHABILITATION POSSIBILITIES OF SOFT CONTACT CORRECTION IN POST-TRAUMATIC AND CONGENITAL PATHOLOGY OF CHILDREN

Objective. To analyze the results of the use of contact correction in the rehabilitation of children with post-traumatic and congenital abnormalities. Material and methods. 424 patients, aged between 3 months and 17 years, using soft contact lenses using traditional and special methods of examination. Results and discussion. It was established that in the overwhelming number of children who were assigned to wear, the post-traumatic pathology prevailed - 341 (79.1%) patients; congenital abnormality was 83 cases (20.9%). Contact lenses were made individually according to the developed technologies from a hydrogel material by turning using biocompatible paint, which allows combining several color zones of different diameters, while achieving optimal functional and cosmetic results. Proved a significant increase in visual acuity compared with spectacle correction and correction of transparent contact lenses in 86.4% of children. Thus, the use of soft contact lenses, performing corrective, diaphragmatic and cosmetic function is a method of preventing the development of amblyopia, strabismus, contributing to the full development of the visual analyzer in children.

The comparison of a questionnaire survey and special methods of examination in patients with gastroesophageal reflux disease

The comparison of a questionnaire survey and special methods of examination in patients with gastroesophageal reflux disease

Visual impairment in combined pathology: multiple sclerosis and pituitary adenoma

PurposeTo study the changes of visual function in patients with combined pathology: multiple sclerosis and pituitary adenoma.MethodsFour females from 18 to 41 years old were examined.They complained of decrement of visual acuity, pain with eye movement. We identified decrease in visual acuity from 0.01 to 0.1, visual field central defect.To exclude organic pathology, the patient was sent for MRI of the brain, confirmed the diagnosis: MS and pituitary adenoma. For identify the root cause of reduced visual acuity, patients were examined by Cirrus HD‐OCT; Humphrey HFA II‐750i; Microperimetry on MP‐1, MRI of the brain and orbits.Results144 patients were examined in the S. Fyodorov “Eye Microsurgery” Complex, Moscow, 4 of them were diagnosed and confirmed a combined pathology:MS and pituitary adenoma. According ophthalmoscopy in three patients was marked optic disk hyperemia and swelling of the disc margin, one patient – temporal optic disk pallor. According microperimetry we received a decrease in overall photosensitivity from 8.3 to 11 dB. OCT: in 3 patients revealed a slight an increase average retinal nerve fiber layer thickness (A RNFL) from 110 to 113 μm. In 1 patient revealed a decrease A RNFL thickness to 76 μm. To confirm demyelinating cause of optic neuritis was scheduled MRI of orbits. In two patients were found nidus of demyelination in the optic nerve. Hormonal activity of pituitary microadenomas in the blood serum: cortisol from 350 to 400 mME/l, prolactin from 190 to 315 nmol/l.ConclusionsVisual impairment caused by demyelinating process that is confirmed by special methods of examination. Identified pituitary microadenomas is hormone‐inactive tumor, therefore they do not affect the clinical course of MS. Combined pathology requires a change in tactics of patient's management with the participation of the endocrinologist and neurosurgeon.

Radical cystectomy: a comparative evaluation of perioperative outcomes in patients with a complicated and uncomplicated postoperative period

The objective: to evaluate the diagnostic capabilities of general clinical and special methods of patient examination in predicting complications after the radical treatment of bladder cancer. Patients and methods. This study is based on retrospective data from 126 patients who underwent open radical cystectomy (RCE), with one in three patients who had complications in postoperative period. All patients were divided into two groups according to the Clavien-Dindo classification to identify the predictors for the development of intra– and postoperative complications. The first group comprised of 82 (65,08%) patients with uncomplicated postoperative period. The second group consisted of 44 (34,92%) patients who developed complications of varying severity and required additional instrumental or surgical correction. Diagnostic possibilities of indicators of general clinical and special methods of examination of patients, available for quantitative registration, in predicting favorable and unfavorable outcomes and perioperative complications of RCE were evaluated. Results. As a result of the comparative statistical analysis, 33 objective quantitative indicators characterizing the history of the disease and the objective status of patients showed no statistically significant differences. The age of the patients in the first group was on average 60,8±12,8 years and 58,2±9,5 years in the second group, р>0,05. This insignificant difference indicates that the elderly age >70 years, in combination with systemic diseases, limit the possibilities and the volume of surgical interventions. As a result the majority of the sampled patients aged 55–60 years. The average period from biopsy and muscle-invasive bladder cancer (MIBC) diagnosis before the RCE was 53,1±42,7 days in the group with uncomplicated postoperative period and 146,9±94,4 days in the group with complications. The indicator in the second group of patients exceeds the limit recommended by the EAU, where this period is limited to 90 days from the time of diagnosis of MIBC and exceeds the terms by 1.6 times. Conclusions. The absence of statistically significant differences between all indicators in both groups indicates the need to create an algorithm to predict the development of postoperative complications for example – mathematical modeling.

Modern possibilities of homeostatic reserves indication in bronchitis in children

Aim. To study the homeostatic reserves indicators in children with bronchitis by assessment of colonization resistance indicators and oxidative stress processes in the oral cavity.Methods. Clinical and instrumental examination of 115 children aged 5 to 14 years admitted to hospital with different variants of bronchitis was performed. The patients (main group) were divided into two subgroups according to the diagnosis: the first subgroup included 70 children with recurrent bronchitis, the second subgroup consisted of 45 children with acute bronchitis. The control group included 33 apparently healthy children of the same age. The examination complex included, in addition to conventional clinical and laboratory methods, special methods of examination - the oral cavity colonization resistance indicators identification (buccal epithelial cells colonization index and saliva anti-adhesive activity). In addition, oxidative stress indicators on oral neutrophils model - spontaneous and induced luminol-dependent chemiluminescence, were measured.Results. It was found that colonization index and saliva anti-adhesive activity was significantly lower in children of the main group than in control group. The lowest rates were characterstic for the first subgroup of patients. In children with acute bronchitis higher values of the induced and the spontaneous luminol-dependent chemiluminescence were registered as compared to control, whereas in recurrent bronchitis, by contrast, they were lower than in control (pConclusion. Patients with recurrent bronchitis extremely «vulnerable» in relation to recurrent bacterial infections (diseases) in connection with the mucosal protection system severe defects; they need to undergo aimed preventive and rehabilitation measures, the effectiveness control of which can be performed using the proposed non-invasive methods.

Assessment of the severity of acute destructive pancreatitis for proper treatment selection

The review covers the most common integrated scales used for the assessment of severity of acute destructive pancreatitis. The use of those scales in the surgical in-patient department is discussed. Different views of Russian and foreign pancreatologists on the use of integrated scales to predict the disease outcome according to various criteria (clinical, laboratory, and special examination methods) are presented. Because of the acute pancreatitis morphological forms variety at admission for urgent surgery, there is a need for a comprehensive assessment of the disease severity in such patients. First stage of assessment is based on clinical data obtained at admission; correlation with systemic organ failure is also taken into account. This approach helps to distinguish mild, moderate and severe clinical course of disease. The use of multiple integral scales used for clinical assessment, with the number of possible options exceeding 20, is widely applied when the patient is admitted. The surgeon’s selection of a scale for assessment of the disease severity depends on the available equipment and the time for evaluation. Currently, the multi-parameter prognostic scales Ranson (1972), APACHE II (Acute Physiology And Chronic Health Evaluation, 1990), Glasgow-Imrie (1984), SAPS (Simplified acute physiology score, 1984), MODS (Multiple Organ Dysfunction Score, 1995), SOFA (Sepsis-related Organ Failure. 1996) are considered to be most objective. The use of these scales allows improving the prediction of outcome and necrotic complications by several times.

Results of cross-sectional epidemiologic study on determination of recombinant biological agents requirement for treatment of patients with rheumatoid arthritis in real-life clinical practice. Report 1. Demographic, social, clinicaland laboratory characteristics of Russian patients with rheumatoid arthritis

Objective. To get objective information characterizing demographic, social and clinical status of Russian pts with rheumatoid arthritis in real life clinical practice. Material and methods. Cross-sectional epidemiologic observational study without any intervention in routine clinical practice (including administration of studied therapy and special methods of examination) was performed. It was based on cross-sectional collection of clinical data of pts actively visited the doctor or hospitalized during period from 01.03.2009 to 07.05.2009. 1810 pts with RA were included in 22 cities of Russian Federation during this time. Results. New data about clinical features of RA and therapeutic approaches in real-life clinical practice of rheumatologists were obtained. Modern social and demographic characteristics of population of pts with rheumatoid arthritis were got. RA pts in Russia were shown to have higher activity and severity of the disease than in other countries. Conclusion. Presented data can be used for development of perspective programs on improvement of specialized service for pts with RA.

DETECTION OF LOW INTENSITY EPIDEMICITY: APPLICATION TO CLEFT LIP AND PALATE.

The Encyclopaedia Americana defines an epi demic as a sudden excessive prevalence of a disease in a population. This is a typical definition, and although suddenness is not always considered an essential feature of an epidemic, most would agree that it refers to disease, and that it denotes an in creased prevalence. But there are two serious difficul ties in this concept which limit its usefulness and unless they are recognized they may prove a serious hindrance to the detection of epidemic properties in several classes of disease. The first is found when the occurrences are few in number, sparsely scattered in time, and widely sep arated in relationship to the frequency of any supposed fluctuations. This problem arises with uncommon illnesses such as congenital malformations when an apparent crop of cases poses the question how many cases can make an epidemic. The true difficulty seems to be the breakdown of the concept of prevalence upon which in turn the concept of an epidemic depends. The situation is analogous to the breakdown of the gas laws when very few molecules are involved and the inappropriateness there of the ordinary con cept of pressure; or the breakdown of the theory of wave propagation in the study of low intensity radia tion. Pressure, wave motion, prevalence, and epide micity, are terms appropriate to the study of high concentrations and when we are compelled to deal with low intensities special methods of examination must be devised. The second difficulty arises from the assumption implicit in the above definition, that an epidemic is recognized on a time base. However, it is clear that space must sometimes be taken into account as well as time. A feature of many epidemics is that the geographical region of maximum prevalence moves with change in time, or stated conversely, that the time of maximum prevalence changes with change of place. The result is that a disease which is manifestly epidemic on the time scale in each of a number of small regions, may over a sum of those areas show only equivocal evidence of epidemicity in the terms defined above. Conversely, a disease of which the incidence is geographically uneven during a short period may appear more evenly distributed when a longer period is considered. These difficulties are not serious with a frequently occurring disease; either the time scale or the geo graphical area may be divided into sufficiently small classes to demonstrate variations of prevalence in terms of the other. But with uncommon diseases such as leukaemia or congenital malformations the pro cedure of subdivision leads back into the problems of small numbers. It may be impossible to examine either the space or the time variations in prevalence, without at the same time impairing the applicability of the concept of prevalence. This may not be for lack of large numbers of events for analysis, but because they occur sparsely over a large area and over a long period of time, and accumulation of further data may do little towards solving the problem. For these reasons, no doubt, most of the statements to date of low intensity space-time clustering in particular disea ses have been based upon impressions and anecdotes rather than upon rigorous analysis. A previous attempt (Knox, 1959) has been made to analyse low intensity data on time base alone and the present paper is an attempt to extend this to space and time jointly. The two purposes of the present study are to suggest a method of analysing this class of data in a more discriminating manner than has so far been employed and to employ the technique in the investigation of a particular problem.

Photofluorography in routine x-ray diagnosis.

In our country, as in many others, X-ray diagnosis has made great progress since the end of the last war. All those special examination methods developed together, or as a consequence of the steep rise observed in general surgery and neurosurgery, add up to a considerable portion of the amount of work carried out daily by an up-to-date X-ray department and entail great expense due to high film consumption. Generally speaking, however, the funds available for an X-ray department unfortunately lag far behind the increase in diagnostic methods. Therefore, we have made an attempt to reduce cost of routine examinations, especially of those referring to fractures, by employing the photofluorographic method to such an extent that the funds saved in this way are available for promoting special methods of examination, particularly those of an angiographic nature. With this in mind and co-operating with the Siemens Reiniger Werke we have finally designed a photofluorographic unit the table of which shifts longitudi...