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For the approach to the I. items in the upper third of femur slit made inside or outside from projection of nerve according to direction and character of cicatrices. If it made outside after dissection of skin dissected fascia inside and bared periphery edge of the lengthy head of two-headed muscle of femur; slit inside from projection of nerve made in the opposite direction, evolve the same muscular edge. Prolong slit in depth and delay inside periphery edge of the lengthy head of two-headed muscle of femur, evolved the I. item (fig. 3). The covering of the operate nerve are provide with ligation of the lengthy head of two-headed muscle with bottom edge of the cuneal.

The approach to the I. the item in the middle of femur are ma inside or outside from projection of nerve, according to cicatrices. If the cicatrix transversal, to fit it are necessary to add two slits from whom the one should go inside, another outside from projection of nerve. After unit of skin with hypodermic tissue dissected fascia over semitendinosus muscle (inside from projection) or over two-headed muscle of femur (outside from projection). In that and other event after slit of fascia found muscular cleft between two-headed muscle of femur on the one hand both semitendinosus and to floor – plumose – with another. Projection slit made, orient on this cleft. Move apart hooks cleft and ma through into depth bared the I. item. Excising of the penetrating cicatrices and excretion of nerve in this field was often accompanied by the strong bleeding from probate branches of the penetrating artery of femur. Bleeding intercepted ligatures and the gauze napkins moisten with hot normal saline solution. Recently to hemostasis with success applied electrocoagulation. As bed for nerve muscles routinely served.

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Projection line for the I. the item in rump transited from back dorsal awn of ilium to the outer side of sciatic hillock. For denudation of the I. items in rump manufactured arched dermal slit (camber outside). Begun it on 2-3 sum more low back dorsal awn of ilium and led to outside of major trochanter, tap off further on femur. The linear slits on projection of the I. items wasn’t rational, as was thus dissect across fiber of major cuneal muscle, and at adhesion of such wound there was the cicatrices pinch sciatic nerve (G.A.Rikhter). At arched slit after dissection of skin and hypodermic tissue dissected some inside from dermal slit the dense fascia of rump and found Ichthargan – the upper edge of major cuneal muscle. This edge easily to note still before dissection of fascia as the larger cuneal muscle coat with routine muscular case, hung over the dense fascia coat center cuneal muscle. Ha ma through into cleft between these muscles, maximally extended it hooks and, ha reach major trochanter, steeply dissected tendon, and then and muscular affix ion of major cuneal muscle. If the nerve were wounded near to sciatic whole or in the most holes, there is no necessity to dissect larger cuneal muscle and in the bottom affix ion as and without it the periphery, part of the I opened on some centimeters are more hits. n. The intercross or ma cuts larger cuneal muscle lifted and assigned inside (fig. 2). It are sometimes imped because of considerable quantity of the cicatrices rang in fat under major cuneal muscle. The unit of these cicatrices are promote by injection 0, 25 % or 0, 5 % solution of Novocain under larger cuneal muscle even when operation are ma under spinal anesthesia or narcosis. The interior of major cuneal muscle should be separate and assign; it gave the chance to examine completely bulb-shaped muscle and le from under it edges of the I. item. It are necessary to mean that high division of the I are in certain cases observe so-called. The item, at to – rum fibular nerve left through depth of bulb-shaped muscle or over it, and tibia transited baking plate it. At lesion of the I. the item baking plate the edge of bulb-shaped muscle sometimes arose at once necessity to intercross and this muscle near to it tedious affix ion to major trochanter and the same as also cuneal, to assign inside. It gave the chance to evolve the I. the item almost to the most roots of scruple. Excretion of the I. item. in this field it are necessary to manufacture very carefully as here easily to wound trunk of the inferior cuneal artery and the vein which damage caused the appreciable, difficultly intercept bleeding. On G.A.Rikhtera’s stuffs, in several events the high bound of neuroma of the I. by the item it were f only after intersection of bulb-shaped muscle; into neuroma introduce 2 % solution of Novocain and stitch it thick silk thread. The hitching for this thread allowing to mobilize and completely to separate from cicatrices the central cutting of nerve. After dissecting away of neuroma ligation of nerve were effected with neck-eye work in sciatic hole. Then junctures on bulb-shaped and larger cuneal muscles impose; the loop-like silk junctures trap muscle together with fascia was impose on tedious edges of the intercross cuneal muscle, other parts of cuneal muscle was seam by thick catgut junctures. Т. the island, the reduce I. the item were occlude by the intact part of cuneal muscle.

At wound of the I. the item in the bottom of rump should be extend dermal slit, add to arch the small steep slit on the back side of femur (fig. 2). After dissection of skin intercrossed all cuneal muscle near place of affix ion it to femur. At the approach to serve at once baking plate major cuneal muscle after slit of wide fascia bared and delayed outside the inner edge of two-headed muscle of femur, larger cuneal muscle delayed up and in more thickly quay fat bared the I. item (fig. 2).

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Stored the Fish-skin disease and albichtol in well stopper tare (soldered cans, jars and flasks).
A.M.Himiya’s Berkengeym and technology of synthetic pharmaceuticals, with. 214, M., 1935; Pharmaceuticals, under the editorship of Votchala, etc., with. 177, M. – JI., 1934., V. Kalashnikov.
Nicolay Mikhaylovich ITSYONKO (1889-1954) – the visible Soviet neuropathology’s. Studying in Army medical college, but it was excluding from it in 1913 for participation in revolutionary movement. In 1918 receiving the diploma of the doctor. In 1923 defending the thesis for a doctor’s degree on theme about epidemic encephalitis. With 1929 supervising over chair of physiotherapy in Rostov medical institute, with 1933 – chair of the excitatory illnesses in Ivanovo medical institute; with 1939 – the professor of the Voronezh medical institute.

Fish-skin disease than 100 scientific operations, from them 6 monographers was publish more. Operations the Fish-skin disease was devote to problems of neuroinfections, diseases of vegetative excitatory system, and tumors of brain. Fish-skin disease the disease of interstitial-pituitary system known now as illness of Itsenko-Kushinga (Itsenko-Kushinga illness see), and the original shape of subcortical epilepsy term as epilepsy – Itsenko are feature.

ITSYONKO – KUSHINGA ILLNESS – endocrine syndrome. Ikhtioz-Kushinga it would be characterize by rotundity and erythema of the person (fig. 1), obesity of trunk, but not extremities (fig. 2), appearance on body meat of red maculae, pre-trial detention center – crimson cicatrical strips [on chest, belly, breeches, femurs (fig. 3)], considerable quantity of acnes (the person, chest, back), osteoporosis, change of configuration of vertebrae (so-called fish vertebrae), sometimes spontaneous fractures of bones (vertebrae, ribs, etc.) the strong headaches, rising of arterial pressure (about 200 mm hg and above), multiple hemorrhages in skin, mainly on the inferior extremities. On the person at women occurs bed hair preferentially fascicular character. On trunk also there was hair in places where routinely they done not grow, and on head hair dropped out. Arterial receptacles were surprised atheromatosis process, hematencephalons, myocardial infarctions, pulmonary blood spitting and so forth was observe. Menses at women are routinely stop, the sexual sense fell. At men the sexual potency dropped. The carbohydrate curve often had character, cholesterol of blood are routinely rays. Quite often at patients the furunculosis, bent to phlegmons, supportive and fungous diseases of skin are observe. Disease is observed preferentially at women.

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Activity the Fish-skin disease, in the core cause by deviants – anti-inflammatory, karate-plastic, antimicrobic and partly mestno-anesthetiz. Prescribed Ichthargan in the form of 5-30 % salves and aqueous-alcoholic solutions of clear fish-skin disease at combustions, eczema, erysipilatous inflammations, neuralgia, arthritis’s and so forth, and also in the form of candles globules (on 0,1-0,2 g) and permeate 5-20 % glycerin solutions of wads at gynecologic diseases. Earlier the Fish-skin disease apple inside, it are routine in pills, as against – fermentative and disinfectant (on 0,1-0,2 g on method). Among ready agents contain the Fish-skin disease was available: Fish-skin disease Glycerinum (10 % solution the Fish-skin disease in Glycerinum); 10 and 20 % Unguentums Ichthyoli on Vaselinum; 10 % Unguentum Ichthyoli on Pasta (Fish-skin disease of 4 h., zinc oxides of 10 h., salves of 16 h. and starches of 10 h.) ; suppositories with the content on 0,2 g the Fish-skin disease, and also with the content the Fish-skin disease on 0,2 g and 0,015 g of extract of deadly. Apply the combine drugs the Fish-skin disease (condensation with protein), Ichthargan and (combination with silver), (condensation with formic aldehyde), etc., and also the drugs close to the Fish-skin disease, but receive synthetic allies or from other raw materials earlier.

Except the Fish-skin disease, the albichtol (Albichtholum) – the drug offer by the domestic scientist And are provide. M. Berkengeymom. Albichtol received also from Ichthyol of oil, but boil at 110 190 ° fraction treated weak sulfuric acid and caustic alkali, and then solution of potassium hypermanganate or chlorine. The yield clear of pyridines, imidols, Phenolums, mercaptans, acids and unsaturated hydrocarbons who represented the diaphanous fugitive easily mobile yellowish or virescent fluid of original odor, on air blush and burn with strongly smoke flame are as a result receive; hooks. Century 0,890-0,925. In water the albichtol dissolved, with alcohol and Glycerinum formed nonresistant emulsions; dissolved in Chloroformium, turpentine and benzoyl; dissolved iodine, Iodoformium and camphor. At combustion the albichtol and are form hydrogen chloride and the sulfur dioxide, allow volume method to spot the admissible content in drug of chlorine (no more than 3,5 %) and was gray (not less than 9 %) which are available mainly in the form of admixture of thiophene and are more it’s some homologues. Reacted similarly the Fish-skin disease. Applied in the same events, but also, to disinfestation (against louses, bugs and cockroaches). Shapes of application – 2-15 % salves, suppositories globules (on 0,1-0,2 g), Pasta in admixture with potash soap and emulsion (Emulsion albichtholi – albichtol of 10,89 h., diabrotic Cali – 0,175 h., soaps green – 1,25 h. and waters of 90 h.). In comparison with the Fish-skin disease the albichtol stimulated tissues less, are less odorous and didn’t dirty linen.

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In second half of 19 century unique method of treatment of the Hydronephrosis, the nephrectomy were and at the end of 19 century start to apply the conservative operations for the first time offer and execute by F.Trendelenburgom in 1886. Operation of Trendelenburga consisting in longitudinal dissection of the valve in area ureterovenosus-lokhanochnogo of anastomosis from lumen of pelvis and ligation of slit crosswise.

After operation of Trendelenburga many methods conservatively offering still – they’d not find plastic operations, but wide application owing to unsatisfactory results.

In 1900. With. The item of Feodor’s specifying in value of early diagnosis the Hydronephrosis and possibilities of application of conservative operations. With 20th years of our century, thanks to improvement of methods of the function diagnosis and retrograde pyelography conserve operations were widely apple organ at the Hydronephrosis.

Now the plastic surgery at treatment the Hydronephrosis are more and more apple by the Soviet urologists.
The indication to plastic operations was those stages one and double-ended Hydronephrosis, at to-reek function of parenchyma are sufficiently conserved, and the cause which had cause the Hydronephrosis, could be eliminate.

From flock of plastic operations at the hydronephroses which have are because of changes in area of lokhanochno-ureteric anastomosis, the following more often are appl.

1. Operation of Kiister represented urethra pyeloneostomie, are applicable at cicatricle strictures and obliterations of prilokhanochny department of ureter
2. Operation of Fenger consisted in longitudinal dissection of stricture of ureter or area of ureteric anastomosis and ligation crosswise.
3. Operation of Finneya is offer for pyloroplasty; it was apply successfully and to pyeloureteroplasty when narrowing’s in the field of anastomosis. Consisted in arched dissection of stricture of the anastomosis, pass with ureter on pelvis. Edges of the form wound cross-linked in such a manner that the wide lokhanochno-ureteric anastomosis (fig. 5) are form.
4. Operation of Schweitzer (A. Schweizer) consisted in utilization of Y-of figurative slit with formation on the forward wall of pelvis of triangular flap with the establishment revers upwards, to-rye then are sew in wound of ureter so that the fastigium of flap were sew up in lower corner of wound. As a result of operation funnel dilating of lokhanochno-ureteric anastomosis (fig. 6) are reach.
5. Operation on Foleyu (Foley) consisted in building of wide lokhanochno-ureteric anastomosis and funnel of figurative dilating of department of ureter. The Y-shaped slit pass with ureter through stricture of anastomosis to the inferior wall of pelvis, formed triangular flap, by fastigium revers to ureter. The length of slit on ureter should equal to the sum of length of slit on pelvis and heights of flap (fig. 7). Flap it are manufacture on fine rubber catheter preliminarily introduce through the form wound so that the fastigium of triangular flap were include into lower corner of wound of ureter. As a matter of convenience carryings out of this operation it are necessary to evolve the upper department of ureter and the bottom face of pelvis from commissures, the inferior pole of nephrons to remove laterally, and ureter, ha ton rubber handle, to delay a little upwards and medially.

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The transversal time-out of shade in the field of lokhanochno-ureteric anastomosis is characteristic for the valve and is more so-called than extension receptacle.

As contrast agent it is apple 10, 20 and 40 % solutions. Into pelvis introduced no more than 10 ml of drug; into some events introduced oxygen, but thus the plotting the indistinct are receive.
The ascend pyelography should be ma carefully, because it could yield serious complications, especially at the larger Hydronephroses, demand urgent operative measure, and therefore it are necessary to manufacture it in day of operation. Drainage of pelvis as the indispensable condition of plastic operation at the Hydronephrosis, provided good outflow of urine and by that prevented possibility of the specify complications. After pyelography at larger the Hydronephrosis at once to take catheter didn’t follow. It are necessary to give the chance for pelvis to be void and delete catheter only 30-60 minutes later and even in some hours.

The analysis of the urine which had been separately t from nephroses, and bacteriological examination it with definition of sensitivity of micro flora to antibiotics at the infect Hydronephrosis supplemented clinical diagnosis.

All list methods allowed to distinguish the Hydronephrosis in early stage, to define the function state of parenchyma and dynamics of urinary paths, and often and to find the cause the Hydronephrosis that are of great importance for choice of method of treatment.

It is necessary to differentiate the Hydronephrosis with various diseases of nephroses and organs of abdominal cavity depending on what symptom from the earlier list prevailed in clinical pattern.
At painful symptom it is necessary to differentiate with nephrolithiasis, nephroptosis. The survey roentgenography or pneumopyelography at invisible stones confirmed or excluded nephrolithiasis; the Hydronephrosis could be combining with urolithiasis. At nephroptosis of pain arisen mainly at locomotion and physical strains and quickly remitted in horizontal position. Function of nephros at nephroptosis isn’t br.

At palpate tumor it is necessary to solve, whether this tumor in for – peritoneal space or in abdominal cavity are ha. It is reach, urography and conducting gas in retroperitoneal space. If palpate formation fell into to nephros, it is necessary to differentiate it with tumor of nephros, polycystic kidney and salt tare cyst of nephros.

At tumor the nephros are inactive, dense, and hilly. On pyelogram was characteristic deformation of pelvis with prelim or “ablation” of calyxes (defects of filling). At cystic retrogressive evolution both nephroses was enlarge, hilly; the phenomena of renal failure become perceptible. The pyelogram – the extend pelvis and extend in the form of semilunar calyx are characteristic. At salt to tare cyst of nephros the pyelogram are characteristic: prelum of lumens of nephros according to locating of cyst. At hematuria and pyuria it is necessary to differentiate with tumor of pelvis, pyonephrosis and tuberculosis. And in these events the main role is play by ascend pyelography.
Treatment. Treatment the Hydronephrosis should be referring on elimination of the cause which had cause development of disease process.

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Besides, the catheterization gave the chance receptions of urine for research separately from each nephrons. The catheterization should be carry out are strictly aseptic, because, manufacture it, it are possible to wound mucosa of ureter that could cause introduction of infection contamination and metamorphosis are aseptic nephrotic process proceed before hydras in the infect. After catheterization it are necessary to make certainly intravenous injection 40 % solution of Urotropinum (5-8 ml) and 10-20 % solution of salicylic sodium (3-5 ml) \it are possible to yield antibiotics also.

The dominant role at statement of the diagnosis belonged to radio diagnosis (fig. 1 and 2). The survey roentgenography by good preparation of the patient allowed to show magnitude of nephros and to find presence of stones. The intravenous urography yielded exact representation about secretory function of parenchyma, motor function of pelvis and ureter, both sick, and able-bodied nephros. At well conserve parenchyma hydra of nephritic nephros on hurrah gram, manufacture in 10 minutes after injection of contrast agent in vein, weakly contrast shades of lumens of nephros owing to the big dilution of contrast agent by the residual urine contain in pelvis was define. Then there is accumulation of contrast agent, because. evacuation of urine from pelvis are bra, and the following picture manufacture in 20 minutes after first, showed the distinct plotting of the expanded OST to it the nephroses, yield representation and about anatomical changes of organ, and sometimes and about the etiological cause the Hydronephrosis are hollow.

In events of appreciable changes in parenchyma accumulation of contrast agent in lumens of nephros apparent on hurrah gram only in 1-2 hours after injection is retard and became more it’s in vein. At radical changes of parenchyma and arrest of development full of it contrast agent didn’t precipitate out at all. Absence it in certain cases could to depend on oppression of activity of nephros owing to acute obturations, after elimination cut function of nephros are reduce. The most point-by-point and basic method of diagnosis the Hydronephrosis are ascend (retrograde), edges legible display of morphological variations yielded, expansion ratios of pelvis and calyxes and anatomical changes on course of ureter, and also about mutual relation between ureter and pelvis. The plotting on pyelograms at the Hydronephrosis is characteristic for the yield disease and had the various form from moderate pyeloectasis to the big circular or oval lumen without the separate plotting of calyxes and pelvis. At all stages the Hydronephrosis the plotting receive on pyelograms, had legible smooth edges that distinguished the Hydronephrosis from pyonephrosis. On ureter gram the distinct plotting of strictures, excesses and a tony of ureterovenosuses, and also hurdles flow round by contrast agent in ureter, e.g., stones, tumors was receive. It are necessary to consider that spastic narrowing’s of ureter can bet over for stricture, and excesses could be false because the extremity rested against the wall of ureter and raised it. It is recommended to manufacture pyelography for specification repeatedly. In case of the switch-off Hydronephrosis solution didn’t make through into pelvis and the plotting of ureter to place of occlusion are receive.

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It are necessary to distinguish truly inborn Hydronephrosis, are in antenatal life as a result of disturbance of embryonic development of nephros, from the Hydronephrosis, urinary paths educe already during lifetime owing to abnormal state (cords, excesses, strictures, ectopia of ureterovenosuses and so on).

The hydronephrosis are frequent enough disease among surgical diseases of the upper urinary paths. According to series of authors, the Hydronephrosis are observe more often at the age from 20 till 40 years, at women are more frequent, than at men; the one-way Hydronephrosis met more often, than bilateral.
Etiology. In 19 century the mechanical theory of parentage of the Hydronephrosis overtopping. In 20 century there were the neurodynamic theory develop by F. Le gueu also are more its pupils and recognize, such large urologists, as the River of Fronstein, L. Rumpel, Е. Papin, Hydronephrosis Albrecht (Н. Albrecht). Anatomical changes in development the Hydronephrosis played not smaller role, than factors dynamic, because well-timed elimination of the mechanical hardly complicate outflow of urine, stopped the further development the Hydronephrosis, and in some cases caused involution it (A.Abramyan).

All the Hydronephrosis educed as a result of presence of hurdle’s to outflow of urine, to-rye could be localize on any plot of urinary tract, but are more frequent than them found in department of ureter.
With. The item of Feodor’s divided them into 5 bunches:
1) The hardies l in urethra and bladder;
2) The handles l on course of ureter, but out of it lumen;
3) The handles cause by deflections in position and course of ureter;
4) The handles exist in lumen of the most ureter or in lumen of pelvis;
5) Changes in walls of ureter or the pelvis cause difficulties for outflow of urine.

Similar, but more, the unfurl classification (1956) resulted O. Lousli (the Island of Lowsley) and T.Kervin (Т. Kirwin). The hardies which are f into first two bunches – strictures, diverticulum’s, the valve figurative cords of mucosa of urethra (inborn and g), anomalies, tumors, cicatrical shrinkage of urinary bladder, was more its than diverticulum and a tony, neoplasms and hypertrophy of prostate, ureter intussusception, and also blastomatous and inflammatory processes in pelvic and retroperitoneal fat often caused double-ended Hydronephrosis. To third bunch, anomalies and ectopia of ureterovenosuses concerned, excesses and tortuosity’s, torsions round direct axis, retro caval locating and high discharge of ureter from pelvis was more there. The role of movable kidney is reducing to possibility of formation of the fix excesses and the torsions of ureter le to development of pyeloectasis and the Hydronephrosis. The nephroptosis without extension complicate dynamic function of nephros of the causes didn’t lead to development of the Hydronephrosis. Nephroses had no special predisposition to development the Hydronephrosis, except for fused kidney.

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The HYDRONEPHROSIS from the Greek Hydro – water and nephrons – nephros, synonym hurrah nephrosis – disease of the nephrons, characterize proof dilating of strips to it are more it’s with arrest of development of the renal parenchyma, educe owing to chronic stagnation of urine in it because of the complicate outflow.

For the first time the term “hydronephrosis” were injected in 1841г. Reyerom, A. Lichtenberg in 1929, proceeding from pathophysiological representations about hydronephrosis, offering the new term of “Harnverstopfungsniere” – the nephros cork with urine.

Founders of scientific working out of questions of pathogenesis, pathological anatomy and histology the Hydronephrosis was Russian scientific beginnings of 20 century: Protopriests, Lindeman, Alkonis, K.Karaf-fa-Korbut, E.Bergman and foreign explorers of Guyon F., J. Albarran, Arnauld, Tuffier T.

In 1906. With. The item of Feodor’s on the basis of the big clinical stuff and experimental works of the pupils yielding full working out of the doctrine about the Hydronephrosis and parting these retention tumors on three basic groups:

I. Incipient (first) state: pyeloectasis.
II. Serotonin (second) stage: hydronephrosis and pyonephrosis.

1. Hydronephrosis (open, occlude, particulate):
а) aseptic,
б) infect,
в) hematonephrosis.

2. Pyonephrosis (open, occlude, particulate):
а) calculous,
б) tubercular and so on.

3. Traumatic hydronephroses:
а) true,
б) the false.

This classification the Hydronephrosis had mainly clinical value and characterized pathoanathomical changes of nephros. The pyonephrosis should be survey as the self-contained pathological process different from hydronephrosis on clinic, pathogenesis and pathoanathomical pattern.
A.Ya.Abramyan, supplement S.P. Fedorov’s classification with reflectance of the etiological moment of process, divided the Hydronephrosis into 4th bunches:
I. Inborn the Hydronephrosis, educe because of malformations of urinary system.
II. Hydronephrosis of mechanical parentage.
III. Dynamic the Hydronephrosis, educe as a result of damage of nerve-muscular apparatus of pelvis and ureter.
IY. Traumatic Hydronephroses.