Diagnostic Tactics Research Articles

Modern principles of Crohn's disease diagnosis in children

The aim of our work is to review and analyze scientific literature to highlight the world experience in diagnosing Crohn’s disease (CD) in children, given the need to maintain a unified strategy in diagnostic tactics for this pathology.CD is an autoimmune disease with a chronic progressive transmural inflammatory process of unknown etiology, which can affect the entire gastrointestinal tract from the oral cavity to the anal canal in patients of any age. Approximately 20–25 % of CD cases manifest in patients under the age of 18 years. The pathogenesis of CD is a multifocal process in which genetic mutations of more than 50 genes take place. Morphological changes are diverse and not fully understood. CD is characterized by systemic, local manifestations and the presence of surgical complications. The main diagnostic methods are endoscopic, radiological, morphological and MRI. Differential diagnosis of CD should include ulcerative colitis, inflammatory and autoimmune intestinal diseases in children, congenital malformations of the gastrointestinal tract. Today, the diagnosis of CD in children remains debatable.Conclusions. In the lack of a clear idea of the etiological factors, pathogenesis of CD in children and its consequences, finding diagnostic tactics for this pathology determines the urgency of the issue in pediatrics and pediatric surgery. Diagnostic search in children with CD is a lengthy and materially expensive, requiring powerful facilities and equipment as well as fundamental competencies of a physician. The cascade approach to the diagnosis of CD proposed by the World Gastroenterology Organization (WGO) is the best option for determining the optimal targeted diagnostic algorithm for each patient, taking into account the existing logistic support at a hospital and the financial capacity of a patient.

The impact of Toll-like receptors on the immune system functioning and on the immunopathogenesis of chronic hepatitis C: a modern view (literature review)

There exists a considerable body of literature on immunopathogenesis of chronic hepatitis C. Although results appear consistent with prior research in the area mentioned above, they appear inconsistent with the issues in the area of diagnosis, prognosis and treatment effectiveness. In this context the study addresses the research to receptors of the innate immune system – Toll-like receptors.The aim of the research is to analyze the data of current professional literature regarding the role of individual Toll-like receptors in the immunopathogenesis of chronic hepatitis C.Materials and methods. The method of reviewing and systematizing as well as the method of content analysis were used to overview the scientific literature as for the role of Toll-like receptors. For this purpose, we employ survey data collected from the world professional literature and analyzed the results of current researches.Conclusions. The innate immune system plays a prominent role in the primary protection of the body against pathogens which recognition depends on the Toll-like receptors family wheres the genetic analysis is considered as a promising method of preventive and personalized medicine. The advantage of genetic markers regardless of age and other factors contain information about the susceptibility to multifactorial diseases which can be used to create a «genetic passport» of a person. Perceptions about the impact of the Asp299Gly polymorphism of the Toll-like receptor 4 gene and Gln11Leu of the Toll-like receptor 7 gene on the immunopathogenesis of chronic hepatitis C are ambiguous and this research provides a good starting point for discussion and further study which will allow optimizing the therapeutic and diagnostic tactics for this disease based on the complex evaluation of immunity which are defined by the determined polymorphisms.

INFLUENCE OF DIDACTIC CONDITIONS ON EFFECTIVENESS OF FORMATION AT YOUNGER SCHOOL STUDENTS OF INFORMATIVE UNIVERSAL EDUCATIONAL ACTIONS OF STATEMENT AND A SOLUTION

The article presents methodological, diagnostic and technological (procedural) components of the formation in younger schoolchildren of cognitive universal educational actions (PAP) of the setting and solution of the problem. The methodology of forming the components of «problem setting» and «problem solving» is disclosed in the article from the perspective of the system approach. The diagnostic component presents the diagnostic tactics (criteria, indicators, model of formation levels) of the PDS «problem setting» and «problem solving» in younger schoolchildren; There is provided didactic-methodical instrumentation for determining possible levels of UDM formation, problem setting and problem solution at the control stage of the experiment (qualitative and quantitative analysis of the execution of complex diagnostic tasks by junior students). The procedural component shows that compliance in the educational activity of the primary school with the principles of technology of intellectual and developing education, provision of visualization of problem situations, implementation of speech control of the process of setting and solving the problem through the development of speech logic in children increases the efficiency of the process of formation of education of students of the primary school in the younger schoolchildren in the ability to formulate and solve problems.The study carried out and the analysis of its results make it possible to draw a conclusion on the expediency of implementing in the educational activity of the primary school a designated didactic strategy, which helps the teacher to master the universal didactic tools of teaching younger schoolchildren to solve the educational problem and solve it.

Clinical analysis of the cases of thrоmboembolism of small branches of the pulmonary artery in the pulmonological departments of the center of pulmonary diseases during 2017-2018

Pulmonary embolism is recognized by WHO as one of the most common cardiovascular diseases and is diagnosed in about 0.15–0.20% of the population. It is the third most common cause of sudden death after coronary heart disease and stroke. Traditionally, this disease is spoken in the circle of vascular surgeons, cardiac surgeons, resuscitators. These are usually severe patients with massive thromboembolism and high risk for life. In this case, the diagnostic and subsequent tactics are obvious. At the same time, a huge contingent of patients with sub-massive pulmonary embolism and thromboembolism of small branches of the pulmonary artery are difficult to diagnose due to the variety of clinical manifestations. The purpose of the work was to conduct a clinical analysis of cases of the thromboembolism of small branches of the pulmonary artery. Material and methods. Twenty-four case histories of patients with the thromboembolism of small branches of the pulmonary artery who were treated at the departments of Pulmonology № 1 and № 2 of the Ivano-Frankivsk Center of Pulmonary Diseases in 2017 and 2018, were analyzed clinically and statistically. Among the examined patients were 17 (70.8%) men and 7 (29.2%) women. Patients' age ranged from 18 to 80 years and averaged 49.12 ± 2.75 years. The average length of hospital stay was 22.27 ± 1.77 days. Results. On admission, all patients complained of coughing. Most of them (79.1%) reported shortness of breath in combination with chest pain (75%), hemoptysis (45.8%) and hyperthermia (41.6%). One third of the patients had episodes of dizziness. From the anamnesis of patients' lives it is known that 5 (20.8%) of them were treated for recurrent pneumonia in the last year, 3 (12.5%) — for recurrent pleurisy, and 2 (8.3%) had recurrent hemoptysis. In 17 (70.8%) patients the diagnosis was verified by spiral computered tomography with contrast. Classical radiographic signs of the thromboembolism of small branches of the pulmonary artery and myocardial pneumonia occurred in only 3 (12.5%) patients. In most (58.3%) cases, changes in the chest X-ray were regarded as pneumonia. Two (8.3%) patients showed only signs of chronic bronchitis and emphysema. Ultrasound was informative, revealing signs of exudative pleurisy were in 11 (45.8%) patients. ECG and/or echocardioscope-signs of pulmonary heart were detected in 14 (58.3%) patients. D-dimer levels were determined in 18 (75%) patients. In all patients, this indicator was significantly higher than normal and averaged 5334.81 ± 9.75 ng FEU/ml. Based on a comprehensive examination of the causes of the thromboembolism of small branches of the pulmonary artery in this cohort of patients, the following were recognized: cardiac arrhythmias — in 6 (25%) patients, deep vein pathology — in 5 (20.8%) patients, hereditary thrombophilia — in 3 (12.5%)) patients, surgery — 2 (8.3%), tumors — 2 (8.3%). Unfortunately, in 25% of patients the causes of weight loss are not established. Conclusions. Despite the introduction of state-of-the-art high-information technologies into diagnosis, the thromboembolism of small branches of the pulmonary artery recognition remains a challenge for physicians. Diagnostic difficulties are due to the fact that the clinical picture of the thromboembolism of small branches of the pulmonary artery is characterized by non-specificity of symptoms and runs under the mask of various cardiac and respiratory diseases. Particularly important are alertness to the weight of physicians of different specialties, knowledge of the features of its multifaceted clinical picture and mahagement of such patients.

Degenerative and inflammatory hand joint changes in osteoarthritis according to magnetic resonance imaging

Erosive osteoarthritis (EOA) of the hand is an osteoarthritis (OA) phenotype that is characterized by central and marginal erosions of the articular surfaces in the distal and proximal interphalangeal (DIP and PIP) joints and in some cases by a fairly aggressive course with obvious pain syndrome and a high level of functional impairment. Diagnostic criteria and management tactics for EOA patients are still under investigation. Objective: to evaluate the nature of the changes detected by hand joint magnetic resonance imaging (MRI) in patients with EOA and non-erosive OA (NEOA) of the hand. Subjects and methods . Examinations were made in 61 females meeting the American College of Rheumatology (ACR) diagnostic criteria for hand OA; the patients' mean age was 66.34+5.79 years; the median age at disease onset was 50 [45; 56] years; the duration of pain was 15 [11; 20] years. All the patients underwent MRI of the second-fifth DIP, PIP, and metacarpophalangeal (MCP) joints of the right hand. The patients also filled out the AUSCAN questionnaire. EOA and NEOA were detected in 30 and 31 patients, respectively. Results and discussion . The patients with EOA and those with NEOA were matched for gender, age, and disease duration. The DIP joints in patients with EOA were found to have significantly more frequently and a greater number of large osteophytes (OPs), (53 and 16%, respectively), joint space narrowing (JSN) (73 and 35%), degenerative collateral ligament changes (DCLCs) (93 and 55%), subluxations (47 and 13%), and bone marrow edema (BME) (57 and 19%) than in those with NEOA. Synovitides and subchondral cysts occurred with approximately the same frequency in EOA and NEOA. The PIP joints in patients with EOA significantly more frequently showed BME (37%) and DCLCs (97%) than in those with NEOA. Subluxations in the PIP joint of the right hand were encountered exclusively in patients with EOA. Their incidence was 17%. Degenerative symptoms (small, less often moderate sizes of OPs, JSN, and DCLCs) were identified with approximately the same frequency in both groups (p>0.05). The PIP joints in patients with EOA were significantly more often found to have BME (53 and 26%, respectively; (p 0.05). Large OPs in the PIP joint were found relatively rarely. Subluxations in the PIP joints were undetected in both groups. Conclusion. The symptoms of active inflammation are predominant and degenerative changes are more pronounced in patients with EOA unlike those with NEOA. Articular surface defects in the PIP joints in patients with hand OA differ from erosions in those with rheumatoid arthritis. These CDs in EOA are much more common than those in NEOA; however, the nature of their occurrence is unclear; therefore, the patients in whom they have been found need dynamic monitoring.

Cardioesophageal carcinoid: multidisciplinary approach to diagnosis

Cardioesophageal carcinoid is a rare neuroendocrine neoplasm. Diagnosis and treatment are especially difficult in case of proximal localization of the gastric lesion (in the region of cardia) which requires a complex multidisciplinary approach. The clinical presentation of gastric carcinoid is in most cases nonspecific, and the tumor is accidentally detected in endoscopic exa-mination for the pain syndrome, dyspepsia, anemia, etc. Thus, all said above makes tumors of cardioesophageal zone a rather actual problem. In this article, on an example of patient K., of 61 years of age, possibilities of a complex approach to diagnosis and treatment of a complicated case of cardioesophageal carcinoid are shown.
 Conclusion. Diagnosis of carcinoid tumors is difficult and requires a multidisciplinary approach. The algorithm of diagnostic search and treatment tactics should suggest an individual approach in each clinical case which permits to make a correct diagnosis and to successfully reali-ze a required complex of medical measures.

Развитие острого повреждения почек у детей с острыми кишечными инфекциями

Acute intestinal infections are the fourth most common cause of death among children under 5 years of age and the fifth most common cause of lost years of life worldwide. High incidence of se-vere forms and complications, as well as frequent development of critical conditions requiring hospitalization in the intensive care unit necessitate further investigation of pathogenesis and development of diagnostic and treatment methods for this polyetiological group of diseases. This article provides the latest data on the pathogenesis of acute kidney injury (AKI), its incidence among children with intestinal infections, diagnostic tactics, including the use of early markers, features of AKI in patients treated in hospital, and outcomes, including the transition to chronic kidney disease. Doctors of different specialties should be careful about AKI in children with various infectious diseases, particularly those with diarrhea, in order to prevent AKI progression, exclude nephrotoxic drugs, and monitor kidney function in dynamics. Key words: children, acute intestinal infection, acute kidney injury

Paraganglioma of the nasal cavity. case report

Paraganglioma is one of the tumors that is rarely found in the practice of an otorhinolaryngologist. Approximately 90% of tumors from nonchromaffin paraganglia occur in the adrenal glands. Nevertheless, 5 – 10 % of paragangliomas have different localization: 85 % - in the abdominal cavity, 12 % - in the chest, 3 % - on the head and neck. Paraganglioma grows slowly, but there is a risk of its degeneration into a malignant neoplasm. Diagnosis of paraganglioma includes CT, MRI; Ultrasound scintigraphy, arteriography, biopsy, histological examination. The main treatment for this education is surgical. As this tumor occurs rather rarely, we present a clinical observation of a paraganglioma of the nasal cavity. Purposes. The purpose of this article is to describe a rare clinical case of paraganglioma of the nasal cavity to determine diagnostic measures and treatment tactics to help a practical doctor. Materials and methods. On 01/18/2019 patient M., 52 years old, with complaints of recurrent nosebleeds, difficulty breathing in the right half of the nose was received at the ENT Center «V. T. Lisovets Dynasty». Bleeding from the nasal cavity has been disturbing the patient twice a week for 6 months, for no apparent reason. An increase in the frequency of bleeding up to 4–5 times a week has been noticed for the last month. On a series of MRI tomograms dated 12.24.2019, in the front sections of the nasal concha, on the right, a volumetric pathological formation with dimensions of about 10 × 12 mm, with tuberous contours, an inhomogeneous MR structure was determined. Bone structures were not affected. The neoplasm narrowed the lumen of the nasal cavity on the right. Conclusion: MR-picture of the pathological volumetric formation (of blastomatous nature) of the nasal cavity on the right. Results. On 01/21/2019 the patient underwent surgical removal of the neoplasm within healthy tissues using a radioknife. An anterior nasal tamponade with a hemostatic preparation was performed. The postoperative period was without complications. A morphological examination of surgical material N 330/2019 yielded the following results: a microscopic examination determined a tumor with the same histological picture in the form of alveolar and solid areas, a branched network of blood vessels of capillary type, fibrous tissue of various thicknesses. Tumor parenchyma was represented by epithelioid morphology cells with pronounced eosinophilic cytoplasm, a large nucleus with granular chromatin. Cells with a weakly expressed eosinophilic cytoplasm, with small monomorphic nuclei were also found. Conclusions. The patient was diagnosed with a rare tumor of neuroectodermal nature, which in most cases has a benign nature, slow growth and develops from nonchromaffin ganglia, which are scattered throughout the body. As the formation grows, the arterial and venous network of vessels develops. The clinical picture of a neoplasm of the nasal cavity is often masked by the symptoms of chronic polypousrhinosinusitis, vasomotor and chronic hypertrophic rhinitis. Based on the foregoing, this clinical cases valuable for the practitioner in terms of the features of localization, diagnosis and these lection of the correct therapy for this category of patients.

THE COMPREHENSIVE EVALUATION OF PATIENTS’ CONDITION IN RECOVERY AND RESIDUAL PERIODS OF ANEURYSMAL SUBARACHNOID HEMORRHAGE

The aim: is to evaluate peculiarities of clinical and neurological characteristics, quality of life, brain morphometry changes and metabolic deviations of patients, who suffered from aneurysmal subarachnoid hemorrhage. Materials and methods: In the period of 2016-2019 we examined 114 patients, who signed the informed consent, taking into account their age, clinical and anatomical form of hemorrhage, disease duration, Hunt-Hess severity grade, complications of acute period. Such parameters were evaluated, as clinical and neurological characteristics, the degree of the Barthel index and the modified Rankin scale, cognitive functioning (MoCA), psycho-emotional sphere and quality of life (HADS, SF-36), morphometric parameters based on brain computed tomography measurements, explored the indicators of apoptosis, mitochondrial dysfunction, intracellular oxidative stress. Results: Сephalgia (90,35 %), pyramidal syndrome (53,50 %), sensibility deficit (36,84 %) were leading among the all neurological syndromes. Slight dependence and disability grade was found during assessment of the Barthel index and the modified Rankin scale. In 85,96 % of patiens we revealed cognitive impairment of different severity grades. The anxiety was manifested in 65,79 %, depression - in 64,91 % of patients. Due to the morphometry data, the process of cerebral atrophy was detected (central - in 26,31 % of patients, cortical - in 16,67% and mixed - in 28,07 %). AnV+ and PI+ - cells level exceeded normal values in 2,88 and 1,96 times while the level of JC-1+ and ROS+-cells - in 2,17 and 2,82 times (p<0,01). Conclusions: Having studied clinical and neurological, neuropsychological, morphometric and metabolic factors, we found their pathogenetic role in the course of late recovery and residual periods of aneurysmal subarachnoid hemorrhage, that would help us to improve the diagnostic tactics and reveal the predictors of unfavorable outcome.

Thoracoabdominal wounds diagnostic in the secondary medical care during the combined forces operation in the East of Ukraine

The aim — to determine the sequence and scope of diagnostic measures in patients with thoracoabdominal injuries upon admission to the stages of medical evacuation of the II level of medical support, depending on the severity of the injury.Materials and methods. A retrospective analysis of 123 victims with gunshot thoracoabdominal wounds received during the operation of the combined forces (anti‑terrorist operation) in the East of Ukraine was carried out. The victims were divided into two groups: the main (n = 71), in which the diagnostic tactics depended on the severity of the injury according to the anatomical‑functional AdTS scale, and the comparison (n = 52), in which the diagnostic tactics depended on an empirical assessment of the injury severity. Groups on average age and injury severity were comparable. Clinical diagnostic methods and X‑ray imaging for chest, abdomen, spine, pelvis, and damaged limbs, FAST protocol ultrasonography, thoracopuncture/thoracocentesis, laparocentesis with diagnostic peritoneal lavage were used.Results and discussion. The introduction of ultrasonography according to the FAST protocol into the preoperative diagnostic algorithm in patients with thoracoabdominal wounds made it possible to reduce the time of preoperative diagnosis (by 12.2 min), the number of unjustified laparotomy and with high sensitivity to diagnose markers of damage to the organs of the chest (98.4 %) and abdominal (93, 8 %) of the cavity.Conclusions. FAST protocol ultrasonography is a non‑invasive fast (3 — 4 min) method for the diagnosis of thoracic and abdominal components of trauma with a sensitivity of 93.8 and 98.4 %, respectively, for identifying markers of damage to internal organs. The use of the FAST protocol reduced the time of preoperative diagnosis in severe and extremely severe victims with thoracoabdominal wounds by 1.4 times. Differential diagnostic tactics, depending on the severity of the injury, combined with the use of the FAST protocol, reduced the number of diagnostic errors by 19.1 %.

TREATMENT-DIAGNOSTIC MEASURES FOR INJURY OF THE NECK

Summary. The article is devoted to the study of the urgent problem of neck injury and medical diagnostic tactics. Externally, a small wound on the neck can hide serious damage to deep structures and adjacent anatomical areas. In peacetime during neck injuries, it is necessary stick to the basic principles of surgery: all wounds are subject to primary surgical treatment with a thorough revision of the wound canal. The algorithm of therapeutic and diagnostic measures depends on the nature and severity of the damage, clinical symptoms, and related injuries that are life-threatening.

Candida brain damage on the background of HIV-infection

A clinical case of the asymptomatic onset of HIV-infection on the background of clinically significant osteochondrosis and hypertension in the absence of an epidemiological history, and an analysis of the scientific literature on the problem are presented. It is important to note the low level of viral load in the patient, but there are conflicting reports in the literature about the correlation of levels of HIV viral RNA in the cerebrospinal fluid in patients with neurological manifestations. The treatment and diagnostic tactics in diagnostically unclear cases are discussed.

Complications of deep vein thrombosis: pulmonary thromboembolism and venous gangrene of the lower extremities (clinical case)

Venous thrombosis and thromboembolic complications are an important public health problem. According to current recommendations for the diagnosis, treatment and prevention of venous thromboembolic complications, patients are stratified by the risk of pulmonary embolism, by the risk of death in pulmonary embolism, respectively, diagnostic and therapeutic tactics are recommended. Adherence to the recommendations allows to reduce mortality from pulmonary embolism, in the opposite case, mortality from pulmonary embolism remains high due to the problems of rapid diagnosis and risk-adjusted therapy. If pulmonary embolism is a frequent complication of venous thrombosis, then venous gangrene is a rather rare complication, which is also characterized by high mortality. A rare case of a combination of two serious complications of deep vein thrombosis is described: thromboembolism of the pulmonary artery and venous gangrene of both lower extremities. Late diagnosis and late treatment led to amputation of both lower extremities, performed in the presence of a floating thrombus in the inferior vena cava and right heart. The causes of late diagnosis and the complexity of the treatment of simultaneously developed two complications are analyzed.

ПРИЧИНЫ, ДИАГНОСТИКА И ЛЕЧЕНИЕ ВЕРХНЕЧЕЛЮСТНОГО СИНУСИТА, СОВРЕМЕННОЕ СОСТОЯНИЕ ПРОБЛЕМЫ

Object. Patients with inflammatory diseases of paranasal sinuses make up about 1/3 of the total number of patients admitted to hospitals with diseases of the upper respiratory tract. &#x0D; The aim of the study was to describe the causes and methods of treatment of maxillofacial sinusitis according to the Department of maxillofacial surgery and otorhinolaryngology SB "SOKB № 1" AND compare them for the periods from 2006 to 2007 and from 2015 to 2018 g.&#x0D; Methodology. A retrospective study of nosology according to the annual reports and protocols of operating journals, patient histories of the Department of maxillofacial surgery and otorhinolaryngology SB "SOKB № 1" FOR the periods from 2006 to 2007, and from 2015 to 2018. &#x0D; Results. Over the investigated period, the proportion of hospitalized patients with sinusitis increased 1.9 times. Between 2016 and 2017, 2.7 times more patients with chronic sinusitis and rhinosinusitis were hospitalized than in 2006-2007. The number of hospitalized patients with acute sinusitis decreased significantly (9.5 times). The frequency of chronic inflammation in the maxillary sinus is 3.3-7.4 times higher than in other paranasal sinuses. Women predominate among patients with sinusitis. The age of patients with sinusitis is varied, but middle-aged and young people make up the majority. Analysis of factors of infection of the maxillary sinus showed that the most common cause of inflammation of the maxillary sinus in hospitalized patients were foreign bodies and perforations of the bottom of the sinus when removing the upper teeth. The analysis of surgical treatment methods of chronic maxillary sinusitis in different years showed that in 2006-2007 Caldwell—Luke sinusotomy prevailed, and now – endoscopic sinusotomy.&#x0D; Conclusion. Pathology of maxillary sinuses requires a comprehensive approach of an otorhinolaryngologist, dentist and maxillofacial surgeon in matters of diagnostic and therapeutic tactics.

Diagnostic Tactics in the Absence of Ultrasound Images of the Gallbladder

Objective: determine the optimal checklist of diagnostic procedures, whose application will make it possible to effectively identify and differentiate malformations of the biliary system of the fetus accompanied by the absence of ultrasound imaging of the gallbladder. Material . The fetuses in single-fetal pregnancy in the period of gestation of 16-37 weeks were examined. Results. The study has determined the optimal checklist of the diagnostic procedures, including dynamic sonography, biochemical amniotic fluid test, magnetic resonance imaging, which should be carried out in the absence of ultrasound imaging of the gallbladder during the screening ultrasound examination of pregnant women aimed at the identification of the congenital malformations of the fetus. The cases and conditions of the biochemical amniotic fluid testing have been identified. The standards of the percentile values of the total alkaline phosphatase and gamma-glutamyl transpeptidase concentrations in amniotic fluid have been developed. Conclusion. If the gall bladder of the fetus cannot be visualized by ultrasound, isolated agenesis of the gall bladder, atresia of the biliary tract, cystic fibrosis, aneuploidy, multiple congenital malformations should be suspected. In view of the extremely unfavorable prognosis in case of biliary atresia, the verification ultrasound examination should be repeated dynamically several times over the next week, and if the gallbladder is not detected, then for the differential diagnosis it is necessary to use additional methods such as MRI and biochemical amniotic fluid test in order to determine changes in their concentration of digestive enzymes in comparison with the normative values determined by the authors.

EVOLUTION OF SURGICAL TACTICS AT THE ACUTE APPENDICITIS

The problem of diagnostics and treatment of an acute appendicitis remains extremely actual and are of spe­cial interest for system of rendering an emergency medical service as it is connected with delivery of health care in the emergency form. The assessment of evolution of surgical tactics at an acute appendicitis was a research objective. The content analysis, legal, historical, analytical, statistical methods are used. Data of the monitor­ing of sharp surgical pathology of abdominal organs in St. Petersburg which is carried out by the St. Petersburg Scientific Research Institute of Emergency Medicine of I. I. Dzhanelidze, normative legal documents, domestic and foreign scientific literature became material for research. Medical and diagnostic tactics at an acute appendi­citis I evolved from conservative to active (quick) which dominates and now. Today it comes back to possibility of conservative treatment of its uncomplicated forms again. The stationary office of an emergency medical service allows to change routing of patients with an acute appendicitis, to provide possibility of inspection and dynamic supervision of patients within the first days from the beginning of a disease from the beginning of starting conser­vative therapy (single introduction of glucocorticoids and antibiotics).

Problem Tuboperitoneal Infertility in Women of Reproductive Age

Family health is an indicator reflecting the health status of the population. According to world statistics around the world about 15% of couples suffer from infertility. The proportion of infertile couples in the Russian Federation varies from 8 to 21%, while more than 55% of cases of infertility are due to impaired reproductive function. Inflammation of the fallopian tubes is one of the main causes of infertility. According to many authors in the Russian Federation, in groups of women up to 38 years old, inflammatory diseases of the pelvic organs occur from 20% to 50%. As a result of the development of damage to the fallopian tubes, the risk of developing tuboperitoneal infertility is high. According to statistics, every fifth woman has chronic inflammations, while 75% of them have adhesions in the small pelvis, in which the fallopian tubes are affected, not even having surgical treatment. All the above facts make the problems of tuboperitoneal infertility extremely low. This article presents the results of a clinical–factor analysis of tuboperitoneal infertility in women of reproductive age. Considered in detail the main factors that ensure the effectiveness and efficiency of the treatment in accordance with the algorithms of therapeutic and diagnostic tactics.

Individual properties of therapeutic and diagnostic tactics applied in patients suffering from erectile dysfunction in combination with «empty sella syndrome”

Individual properties of therapeutic and diagnostic tactics applied in patients suffering from erectile dysfunction in combination with «empty sella syndrome”

ПРОТИВОВОСПАЛИТЕЛЬНАЯ ТЕРАПИЯ ЗАБОЛЕВАНИЙ ГЛОТКИ

Sore throat is one of the most common complaints faced by doctors of various specialties. This symptom accompanies many diseases of the pharynx and larynx, and may be a manifestation of certain diseases that are not associated with the respiratory tract. When choosing therapy, it is necessary by doctors to rationally use the criteria for the appointment of systemic antibiotic therapy. However, local anti-inflammatory therapy as a symptomatic treatment should be selected before accurate confirmation of the etiology of the disease. This provides patients with a quick return to an active life and an improvement in the quality of life in general. The article discusses the etiology and pathogenesis of pain in diseases of the pharynx, modern diagnostic methods and optimal tactics for treating patients. As a symptomatic treatment, to reduce inflammation in the pharynx, the drug Vertum LOR, which belongs to the group of non-steroidal anti-inflammatory drugs of local action, may contain benzidamine as an active substance.

Abdominal bleeding in victims with abdominal-vertebral injury as a result of road accidents

One of the main factors for increasing mortality from injuries and injuries is road traffic injuries. With a combined and isolated abdominal trauma, the operational activity reaches 88%, significantly exceeding that in injuries of the limbs, pelvis, chest and head injuries. The purpose of our work was to reduce the lethality of internal bleeding in victims of abdominal-vertebral trauma as a result of an accident by improving medical diagnostic tactics and provision of emergency surgical care. We analyzed the treatment of 122 victims with abdominal-vertebral trauma as a result of an accident, were hospitalized in the Kiev City Clinical Emergency Hospital for the period from 2013–2017. Abdominal bleeding of different volume in case of concomitant abdominal-vertebral injury as a result of an accident occurs in 37.4% of cases and is shocking in 57.4% of cases. The main source of hemoperitoneum is damage to the parenchymal abdominal organs. A feature of spleen and liver injury is the weak correlation between the mechanism of combined trauma and the degree of damage to the parenchymal abdominal organs.