Biomedical subjects
Publications and source records attributed to G S Iumashev.
The cervical vertebrae were replaced by carbon implants in 60 patients; carbon synthetic foam was used in 19 of them and composite material based on carbon (ostec) in 41. The biological and mechanical properties of the implants ensured firm stabilization of the spine and excluded the danger of postoperative kyphosis and destruction of the vertebral bodies by the implant.
Experimental data on 116 adult mongrel dogs and clinical findings of 121 patients with complicated spinal injury who had been operated on at Moscow Clinical Hospital No. 67 which is a basis of the Clinic of Traumatology, Orthopedics and Military Surgery, I.M. Sechenov Moscow Medical Academy, underlay the authors' research material. Experimental studies of the impact of local cooling of the intact spinal marrow indicated that there were the least changes in the temperature range of +9 to +11 degrees C with a session lasting 2-3 hours. Experimental histological studies of nerve tissue with hemisection demonstrated that two-hour local hypothermal sessions at 2- or 3-hour intervals proved to be optimal within the first 2 postoperative days. Clinically, the intraoperative regional spinal cooling at the last stage showed a 1.5-2-fold reduction in blood loss and exerted a profound hemostatic effect. Its postoperative local cooling produced analgetic and spasmolytic effects and improved cerebral blood flow. The application of local spinal hypothermia by the procedure developed by the authors is within reach at any medical institution.
Enzyme immunoassay (ELISA) was used to study the levels of serum rheumatoid factors (RF) of classes IgM and IgG in patients with spinal injuries and osteochondrosis. The findings show that at the late stages of the disease, the patients with spinal injury show 46% seropositiveness for IgG-RF and 40% for IgM-RF. Patients with fresh central nervous system (CNS) injuries were 12 and 14% seropositive, respectively. Patients with osteochondrosis exhibited 33% seropositiveness for IgG-RF. Determination of serum RF enables the authors to identify systemic body lesions at the late stages of spinal injuries as rheumatic disease. These data support the conclusion that RF determination is a reliable serological indicator of the severity of a patient's traumatic disease.
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Enzyme immunoassay was used in the research of the levels of rheumatoid factor (RF) of IgM and IgG in the blood serum of patients with the injury of the spinal cord and osteochondroses. Analysis of the results obtained demonstrated a 46% RF IgG seropositivity and 40% RF IgM seropositivity in the patients with the injury of the spinal cord in the late period of the disease. The patients with freshly injured CNS demonstrated 12 and 14% seropositivity, respectively. Osteochondrosis patients demonstrated a 33% RF IgG seropositivity. The detection of the blood serum RF enabled one to qualify the systemic lesions at the injury of the spine cord in the late period of the disease as a rheumatoid condition. On the basis of the data obtained a conclusion could be made of fact that the detection of RF was a reliable serological test for the assessment of the severity of the condition associated with the injury sustained.
A group of "Intost" materials based on carbon were developed by the I. M. Sechenov Moscow Medical Academy jointly with the Research Institute of Graphite. After experimental studies the materials were authorized for use in clinical practice for implantation. A concept of the design of endoprostheses of the joints from "Intost" was developed, on the basis of which unipolar combined endoprostheses of the hip joint (127 cases), metatarsophalangeal articulation (27 cases), humeral and metacarpophalangeal articulations (two cases each), and condyles of the tibia (5 cases) were made and applied in clinical practice. A detailed analysis is given of ten years of experience gained with the use of the combined unipolar endoprosthesis of the hip joint manufactured from "Intost-1" and "Intost-3". Long-term beneficial results were obtained in 95% of patients. Endoprosthesis is recommended for the treatment of fractures and false joints of the neck of the femur in elderly and senile patients.
Serum levels of circulating immune complexes (CIC) and those in the liquor were studied in patients with spinal trauma using enzyme immunoassay. CIC and clinical--laboratory findings characterizing the activity of the inflammation were consistent. Assessment of CIC factor in spinal trauma seems clinically valuable as it is involved in inflammation and tissue damage suggesting a prognosis of CIC-related pathology.
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The article presents an analysis of reconstructive operations on the spinal cord in 176 patients with traumas of the thoracic and lumbar parts of the vertebral column. The operative treatment in acute period consisted in end-to-end anastomosis of the horse's tail roots, in late period of trauma disease of the spinal cord--in reconstruction of the spinal cord defects with intercostal nerves by the type of "collateral anastomosis" or free transplants from the peripheral nerve. The operations performed resulted in an improvement of sensitivity, movement, functions of pelvic organs in part of the patients.
The authors have used grafts for stabilization of the spine in 16 patients including 12 patients after anterior decompression of the spinal cord and in 4 patients with spondylodesis. The grafts were used in combination with osteoplasty with autografts taken after resection of the vertebral bodies. The osseous block took place on the average 4 weeks earlier as compared with auto--and allobone owing to the autografts. Biodestruction and substitution of the allograft by bone tissue went on without kyphosis formation on the operation level.
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