Pronounced Pain Syndrome Research Articles

Quality of life in patients with temporomandibular joint arthrosis and orthopedic treatment of missing teeth depending on the severity of arthrosis and implant volume

Temporomandibular (TMJ) arthrosis severely impacts everyday activity and has substantial negative consequences for the general health state, especially when local manifestations are orchestrated by pronounced pain syndrome. That justifies the necessity of investigating the quality of life (QL) of patients with TMJ arthrosis who are undergoing orthopedic treatment. The research aimed to investigate the QL of patients with unilateral and bilateral TMJ arthrosis before and 6-8 months after occlusion correction, which was achieved by placing a different number of implants. In total, 127 patients (75 women and 52 men) were observed in the study of quality of life indicators, which were divided into four groups: bilateral TMJ arthrosis with the implantation of 3-6 implants (36 patients); bilateral TMJ arthrosis with the implantation of 1-2 implants (30 patients); unilateral TMJ arthrosis with the implantation of 3-6 implants (29 patients); unilateral TMJ arthrosis with the implantation of 1-2 implants (32 patients). Each group was comparable in age, gender, duration, and manifestations of arthrosis. QL was measured using questionnaire SF-36. In patients who were diagnosed with bilateral TMJ arthrosis and underwent implantation of 3-6 implants in the postponed period, only pain (P) and SRF scales significantly exceeded initial values – by two times and by 23.2% correspondently (P<0.05). In patients with bilateral TMJ arthrosis and implantation of 1-2 implants showed significant increase on all scales except PF and MH. Thus, the implantation of a significant number of implants (3-6) in the setting of unilateral manifestations of TMJ arthrosis showed an improvement in the quality of life of patients compared to the baseline level on five scales - PF, P, Vit, SRF and RLEH (P<0.05). In patients with unilateral TMJ arthrosis and a small number (1-2) of implant insertions, initial QL was relatively better when compared with other groups, and posttreatment improvement was seen in all scales (P<0.05). The results indicated the effectiveness of improving the quality of life by correcting the occlusion using permanent implants in patients with manifestations of TMJ arthrosis. The severity of the therapeutic effect has an inversely proportional relationship with the severity of the manifestations of arthrosis and the amount of orthopedic care provided. The obtained results indicate the effectiveness of the SF-36 questionnaire in orthopedic patients with TMJ arthrosis and general distinct health disorders.

Pathomorphological Features of The Cornea in Secondary Posttraumatic Dystrophy (Clinical Case)

Secondary corneal dystrophy is a group of diseases characterized by an inflammatory–dystrophic process in the cornea of the eye. This pathology is accompanied by a pronounced pain syndrome and leads to an irreversible decrease in vision, up to complete blindness. To date, many aspects of pathomorphological changes of the cornea in secondary dystrophies remain insufficiently studied due to the impossibility of conducting an intravital study of the cornea tissue. The article presents a case of morphological analysis of a tissue fragment of a pathologically altered cornea in secondary posttraumatic corneal dystrophy. Destructive changes in corneal tissue revealed during light microscopy indicate the presence of signs of fibrinoid swelling in the shell stroma with gross disorganization of the base substance and neovascularization. The study made it possible to correlate the data of pathomorphological changes and the clinical picture, as well as to evaluate the effectiveness of the chosen method of treatment of this pathology (intrastromal injection of a suspension of autologous mononuclear leukocytes of blood into the stroma of the damaged cornea).

A case of varicose necrotic phlegmon of the orbit in a child

AIM: This study aimed to analyze the peculiarities of a clinical case of orbital cellulitis in a child with varicella-zoster virus infection. MATERIAL AND METHODS: In this report of a rare case, necrotizing orbital cellulitis developed on day 6 from the onset of varicella-zoster disease in a 5-year-old child. The child was hospitalized in a serious condition at the intensive care unit of an infectious disease hospital and was subsequently transferred to an ophthalmology department of another hospital. The patient was subjected to comprehensive laboratory examinations and received conservative and surgical treatments. Computed tomography was performed to detect changes in the status of the orbits. RESULTS: The disease manifested with a pronounced pain syndrome in the right orbit, intoxication, and hyperthermia. Exophthalmos, purulent discharge, and necrosis of the conjunctiva of the affected eye were also observed. Computed tomography revealed infiltration of the right orbit without changes in the sinuses. The clinical blood analysis demonstrated leukocytosis, left shift in neutrophils, eosinophilia, and high levels of C-reactive protein and lactate dehydrogenase. The coagulogram demonstrated a proclivity toward hypercoagulation, as evidenced by diminished prothrombin activity according to Quick’s test, increased active partial thromboplastin time, and high D-dimer levels. Urinalysis revealed leukocyturia. Cultures from the conjunctival cavity yielded Streptococcus pyogenes, and a polymerase chain reaction tested positive for S. pyogenes. Antiviral, antibacterial, and symptomatic treatments were initiated. Necrotic masses were obtained during the drainage of the orbital cavity. The child was hospitalized for 21 days. The symptoms were controlled, and the patient’s condition was satisfactory at discharge. Visual functions remained fully preserved. At the examination 1.5 months later, a slight residual exophthalmos was detected. CONCLUSION: Employing a complex multidisciplinary approach, timely prescription of antibacterial and antiviral therapy, and surgical assistance (drainage of the orbit) ensures a successful disease outcome.

A clinical case of an atypical clinical pattern of renal colic in a nonverbal patient

Renal colic is a condition caused by the passage of a concretion from the kidney through the ureter into the bladder, which is accompanied by a pronounced pain syndrome. Patients with renal colic often seek emergency help with complaints of severe pain, nausea, dysuria. However, there is a category of people who, for various reasons, cannot verbally express their feelings. Such patients are called nonverbal. Nonverbal patients are people with severe cognitive impairments or those who are temporarily unable to speak due to surgery or illness, but they can still demonstrate pain using nonverbal signals.In this article, we present an observation of an atypical clinical picture of renal colic in a nonverbal elderly patient. In the observed woman, an acute attack of renal colic lasted 5 days and passed first under the «mask» of acute pancreatitis. Without receiving pathogenetic therapy, the patient developed acute obstructive pyelonephritis, septic shock, which was initially mistaken for an acute violation of cerebral circulation. The performed computed tomography (CT) helped to identify a concretion in the upper third of the ureter on the left, a violation of the outflow of urine from the left kidney. The patient urgently had a stent installed in the pelvis of the left kidney, urine outflow was restored, anti-inflammatory, detoxification, litolytic therapy was prescribed. After that, the patient's condition improved significantly, and after 3 months, a decrease in the size and fragmentation of the concretion was observed during the control CT scan.Conclusion. Nonverbal patients are a special group of patients whose clinical picture may be blurred or atypical. Assessment of pain symptoms in nonverbal patients is difficult, which can lead to an incorrect diagnosis and lengthen the period of diagnosis of the disease. The timely diagnosis of renal colic in nonverbal patients is also affected by the localization of pain, since its irradiating nature can direct the diagnostic search «on the wrong track».

Validation of the Russian version of Spine Oncology Study Group Outcomes Questionnaire

Introduction. Surgical intervention is the only or main component of combination treatment of the majority of malignant tumors of the spine. Pronounced pain syndrome and neurological deficit caused by spinal tumors significantly worsen disease progression, decrease patients’ quality of life.Aim. To develop a Russian-language version of a specialized questionnaire to study the quality of life of patients suffering from tumor lesions of the spine Spine Oncology Study Group Outcomes Questionnaire (SOSG-OQ).Materials and methods. In 82 patients with tumors of various parts of the spine who are treated at the N.N. Blokhin National Medical Research Center of Oncology, psychometric evaluation of the SOSG-OQ questionnaire was performed confirming its convergent validity and reliability–consistency (Cronbach’s α = 0.899).Results. Exploratory factor analysis confirmed adequacy of the questionnaire’s structure and its conformity to the basic factor model. Instruments of the validated Russian version of the SOSG-OQ questionnaire (text and data analysis instructions) for its use in clinical practice are presented. Results obtained using the new SOSG-OQ questionnaire show a significant decrease in quality of life of patients with spinal tumors. Additionally, after surgery patients described their health-related quality of life significantly higher than prior to treatment.Conclusion. Validated Russian version of the SOSG-OQ questionnaire can be recommended for application in oncological clinic for more precise and differentiated evaluation of performance status, emotional condition, experience of patients, evaluation of life circumstances associated with the disease to promote more targeted and personalized psychological care.

Osteoporotic Vertebral Compression Fractures: Medical, Social Aspects, Clinical Picture, Treatment and Medical Rehabilitation. A Review

INTRODUCTION. Osteoporosis is one of the most common metabolic skeletal diseases in the world, which is characterized by a decrease in bone tissue strength and an increased risk of fractures with minimal trauma, including pathological vertebral compression fractures (VCFs). VCFs are accompanied by a decrease in the quality of life of patients with osteoporosis due to a pronounced pain syndrome, sleep problems, decreased motor and social activity, a high risk of falls and fractures, the development of pathological spinal deformities, decreased lung capacity and increased number of comorbid diseases. In this regard, timely treatment and medical rehabilitation in patients with osteoporosis and VCFs are of particular importance to restore functionality, reduce the risk of developing new fractures, disability and death.
 MAIN CONTENT OF THE REVIEW. The literature review is the analysis of 7 domestic and 49 foreign literary sources, which was used to describe the prevalence, medical and social significance and clinical picture of osteoporotic VCFs. It provides data on modern methods of drug and non-drug treatment of patients with VCFs. The effectiveness and limitations of the use of physical therapy methods in the rehabilitation of patients with pathological spinal fractures are described in detail.
 CONCLUSION. It is concluded that VCFs pose a significant healthcare burden due to their high prevalence and negative impact on the quality of life of older patients with osteoporosis. Osteoporotic VCFs lead to the development of severe back pain, limited mobility, spinal deformities, loss of height and permanent disability. An effective strategy for the treatment and rehabilitation of patients with osteoporotic VCFs should include the use analgesics, orthotics, correction of nutritional deficiency, elimination of vitamin D and calcium deficiency, modern methods of physical therapy, fall prevention and timely prescription of effective drugs for pathogenetic therapy of osteoporosis to reduce the risk of pathological fractures in the future and ensure a high level of functioning and of the quality of life.

Clinical case of tuberculous otitis media in early childhood

Nowadays, the incidence of tuberculosis remains high all over the world, despite the vaccination, medical support, social policy. The main reasons for this are the high level of migration, the prevalence of bad habits, the prevalence of immunodeficiency conditions, the formation of resistance to antimicrobial drugs, the tendency to refuse vaccination. At the same time, great difficulties arise in the diagnosis of extrapulmonary forms of infection. The purpose of this publication is to remind about the peculiarities of the course and diagnosis of tuberculous otitis media. According to the literature, the main characteristic features of tuberculous of the middle ear are prolonged suppuration without pronounced pain syndrome, inefficiency of standard antibacterial therapy, the anamnestic data about contacts or violation of the vaccination schedule, multiple perforations and a pronounced granulation process during otoscopy, a pronounced destructive process in the temporal bone during X-ray examination. The article presents a clinical case of the development of tuberculous otitis media in a young child with delayed diagnostics and the development of mastoiditis with required emergency surgical treatment. Verification of the etiology of the disease and the specific treatment carried out made it possible to achieve complete relief of ear symptoms, restoration of the tympanic membrane and ventilation of the middle ear.

Long-term postoperative regional analgesia of the lower third of the face in patients with tumors of the oral cavity

Pain has a certain number of physical, psychological and social consequences. Pain is of particular importance in the postoperative period for patients with tumors of the oral cavity and of the oropharynx. The effectiveness of analgesia in the postoperative period is a serious problem in maxillofacial surgery. Postoperative pain is not always removable, sometimes it becomes chronic. Pronounced pain syndrome in the postoperative period is experienced by 40 to 75% of patients, but 50% of patients experience pain of medium and high intensity. The aim of this study was a comparative assessment of the effectiveness of a new alternative method of a long-term postoperative regional analgesia and the use of non-narcotic analgesics in patients with tumors of the oral cavity and oropharynx in the postoperative period. The study was conducted in 48 patients (38 men, 10 women, average age 58,05±12,31 years) with tumors of the oral cavity and oropharynx. Patients were divided into two groups depending on the method of postoperative analgesia. In the main group (22 patients) pain was suppressed by a long-term postoperative regional analgesia. In the control group (26 patients) analgesia was performed with non-narcotic analgesics. To control the effectiveness of analgesia, a visual analog scale was used, the duration of analgesia and the manifestation of dysphagia on the day 1, 3 and 10 after surgical intervention as well as similar effects were assessed. On the day 10 of using a long-term postoperative regional analgesia, a positive trend towards a reduction in pain syndrome was observed (2.0±0.63), in contrast to drugs of general action (p<0.05). Over the course of a long-term postoperative regional analgesia it was noted that analgesic effect increases from blockade to blockade. In 80% of patients of the main group, stage II-IVa the act of swallowing was nearly restored, only in 2 patients 2 degree of dysphagia was observed (p<0.05). The advantage of the proposed method in the adequacy and duration of analgesia was established (p<0.05), as well as a lower frequency of side effects – 9.1% and 23.3%, and restoration of act of swallowing (p<0.05). The technique of long-term postoperative regional analgesia allows reducing the invasiveness of the manipulation.

ДИАГНОСТИКА МИОКАРДИТА В ПРАКТИКЕ КАРДИОЛОГА

Abstract. Introduction. Diseases with EKG-detected infarction-like changes include myocarditis, pericarditis, hypertrophic and non-hypertrophic cardiomyopathy, Takotsubo cardiomyopathy, pulmonary embolism, aortic dissection, stroke, and subarchnoid hemorrhage. It is therefore extremely important to differentiate these diseases from true myocardial infarction, as the approaches to the therapy and management of such patients will differ fundamentally. Aim. To draw the attention of cardiologists and therapists to myocarditis as one of potential causes of erroneous diagnosis / overdiagnosis of acute myocardial infarction. Materials and Methods. This study presents a clinical case of acute myocarditis, probably streptococcal, manifesting as acute coronary syndrome. Clinical, laboratory, and instrumental indicators and medical documents were analyzed. Results and Discussion. Analyzing this clinical case of a young patient and considering a pronounced pain syndrome (acute pressing pains in his heart area) lasting for 30-40 minutes and EKG-detected changes (sinus tachycardia with a heart rate of 93 per minute, ST elevation by 2 mm above the isoline in II, III, aVF, up to 1.5 mm in V5-V6), the physicians initially suspected acute coronary syndrome with ST-elevation. Taking into account his pain syndrome, subfibrility, inflammatory changes detected in laboratory examinations, EKG findings, and no local or global changes in echocardiography, acute myocarditis was suspected and then proven using cardiovisualization, namely magnetic resonance imaging of the heart, which allowed verifying the diagnosis and assess the nature and localization of myocardial damage complying with EKG-detected changes in the patient. After the inpatient treatment, the patient was discharged to the outpatient stage with improvement. Conclusions. The clinical case presented made it possible to suspect acute myocarditis manifesting as acute coronary syndrome with ST-elevation, while advanced cardiovisualization techniques finally proved the diagnosis of myocarditis. We can hope that a wider use of heart MRI will further enhance the diagnostic capabilities of this technique in cardiology.

Тонзилектомія в дітей: терапевтичні можливості в оптимізації результатів хірургічного втручання

Tonsillectomy is one of the most common surgical interventions. The search for effective medical measures to optimize the course of regeneration processes in a postoperative wound is urgent. Purpose - to evaluate the effect of the complex homeopathic preparation Tonsilotren on the reparative processes of the postoperative period in children who underwent tonsillectomy. Materials and methods. The test group of 70 patients with chronic tonsillitis and 30 patients of the control group aged from 6 to 17 years were under observed and compared. All patients in the test group received Tonsilotren 7 days before surgery and for 2 weeks after surgical tonsillectomy. The examination of the ENT doctor was carried out during 5 visits: 1 visit before the operation, 2-5 visits - corresponded to the period from 1 to 14 days of the postoperative period. The results of observation were evaluated according to the following indicators: hyperemia of the mucous membrane of the faucial pillars, swelling of the mucous membrane of the faucial pillars, fibrinous pellicle in the postoperative wound, epithelization of the postoperative wound, bleeding from the postoperative wound, blood clots in the postoperative wound, scarring of the faucial pillars, pain intensity to VAS scale during swallowing and eating solid food, side effects, tolerability of the Tonsilotren medicine, complications of the disease, the need and duration of use of analgesics. Results. Prescribing of the Tonsilotren medicine to patients with chronic tonsillitis during and after surgical treatment (tonsillectomy) significantly increases the effectiveness of the treatment, namely: it helps to reduce the intensity of pain during swallowing and eating solid food, hyperemia and swelling of the mucous membrane of the faucial pillars, acceleration of epithelization of the postoperative wound, reduces scaring of faucial pillars (p<0.05). Epithelization of the postoperative wound with an area of more than 75% of its surface was observed in 24 (34.3%) patients on the 10th day and in 68 (97.1%) patients on the 14th day after the operation in the test group, while this indicator occurred in the control group only in 13 (43.3%) children on the 14th day after surgery. During observation, no side effects of the Tonsilotren medicine and adverse events were detected, which confirms the safety of its use. Conclusions. Course use of the Tonsilotren medicine in children in preparation for tonsillectomy and in the postoperative period demonstrates better effectiveness compared to standard treatment in terms of indicators of postoperative wound healing, rates of epithelization, absence of scarring and blood clots, and less pronounced pain syndrome. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Роль воспаления в патогенезе эндотелиально-эпителиальной дистрофии роговицы

Background. Bullous keratopathy is a chronic steadily progressive disease that leads to a significant decrease in vision and is accompanied by the appearance of a pronounced pain syndrome. Currently, the role of cytokines in the pathogenesis of the disease remains insufficiently studied. The aim of the study was to study the level of proinflammatory cytokines of the lacrimal fluid in bullous keratopathy. Results. There was a statistically significant increase of the level of proinflammatory cytokines in the lacrimal fluid of patients with bullous keratopathy: interleukin (IL) 1β by 3.6 times (p< 0.05) compared with the group of conditionally healthy volunteers (comparison group), IL-6 by 3.8 times (p< 0.05), the level of tumor necrosis factor (TNF) α– 2.0 times (p< 0.05). Conclusion. The bullous keratopathy is accompanied by a statistically significant increase in the concentration of proinflammatory cytokines in the lacrimal fluid of the diseased eye. The revealed feature of the local immune response in this pathology opens up prospects for new conceptual constructions of the pathogenesis of the bullous keratopathy with the subsequent development of effective methods of treating the disease. Keywords: bullous keratopathy, lacrimal fluid, proinflammatory cytokines, interleukins, inflammation

До питання про рідкісні захворювання, які маніфестують у дітей лихоманкою і соматичним болем. Клінічний випадок

Neuroblastoma is one of the most common tumor in the pediatric population, with the frequent localization in the retroperitoneal space. In the early stages disease can be asymptomatic and complicates diagnostic. The initial manifestations are not specific and can be considered as symptoms of different diseases. Purpose - to analyze and note some "red flags" of certain rare diseases that allow to suspect these diseases in children with fever and somatic pain. The article presents the data and clinical observation of a child with neuroblastoma with rapid progressive development and rapid metastasis. The features of the course and complications of the primary differential diagnosis of a malignant tumor process are described in a 3-year-old boy. The child was taken to the SI «Institute of Pediatrics, Obstetrics and Gynecology named of academician O.M. Lukyanova NAMS of Ukraine» with complaints of back pain, refusal to walk, weight loss and fever. The child was transferred to the intensive care unit for hemotransfusion due to progressive negative dynamics of the condition (pronounced pain syndrome, intoxication syndrome, oliguria). After demonstration an improvement the boy with the diagnosis of «Retroperitoneal neoplasm (neuroblastoma?), neoplasm of the left hand, neoplasm of the sternum; severe anemia of complex genesis; pathological compression fractures of vertebral bodies Th3, Th10, Th12 and L2; secondary hypoparathyroidism; functional bowel disorder; moderate degree of hypermetropia, strabismus, partial atrophy of the optic nerve» was transferred to the National Cancer Institute in the department of pediatric oncology for further examination and determination of the tactics of further therapy, where MRI of the brain and spinal cord with contrast, SCT of the head, chest, abdomen, pelvis, and bone biopsy were performed. This case will help pediatricians to suspect the presence of a tumor in the early stages and refer them to specialized specialists for the further examination as early as possible. The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Single-incision sleeve gastrectomy in the treatment of patients with type 2 diabetes mellitus associated with obesity

Background. Single‑incision laparoscopic sleeve gastrectomy (LSG) allows the most comfortable conditions for patients in the perioperative period and achieve better cosmetic results, providing the same advantages in terms of metabolic effects as in multiport surgery. Its application requires appropriate skills and a specific material and technical base, therefore, currently there is a limited number of publications on the results of treatment of patients using this technique.
 Objective — to evaluate the results of treatment of patients with obesity‑associated type 2 diabetes mellitus (T2DM) after single‑incision LSG in comparison with multiport LSG.
 Materials and methods. This study included 41 patients with prediabetes or T2DM, who were divided into 2 groups: single port (15 patients) and multiport (26 patients). The following assessments have been performed: body weight and body mass index (BMI); surgery duration; volume of intraoperative blood loss; pain syndrome according to VAS scale on postoperative days 0, 1, 2, and 3; postoperative hospital stay; patient satisfaction with the cosmetic results of surgery according to POSAS scale after 1 month, and T2DM remission according to the level of glycated hemoglobin (HbA1c) one, two, three and five years after surgery.
 Results. There was no significant difference in the volume of intraoperative blood loss (p=0.076) and surgery duration (р=0.59) between the groups. In the single‑incision LSG group, less pronounced pain syndrome was observed with a significant difference starting from the 1 postoperative day (p <0.05), however, the severity of the pain syndrome between two groups on postoperative day 0 did not reach a significant difference (p=0.48). Average postoperative hospital stay in the single‑incision LSG group was significantly lower (p=0.035). At the same time, the cosmetic results of the operation were significantly better in the group of single‑incision LSG (p=0.001). The average level of glycated hemoglobin (HbA1c) in the groups was: for single‑incision group — 6.3±0.7%, and for multiport group — 7.4±1.7% (р=0.02). Normalization of carbohydrate metabolism was observed in the majority of patients involved in the study with a follow‑up period up to 5 years (p <0.01), and only 1 patient (3.8%) in the multiport LSG group had a recurrence of type 2 diabetes after 5 years.
 Conclusions. Single‑incision LSG is an effective and safe operation in patients with obesity‑associated type 2 diabetes. Single‑incision LSG is an acceptable alternative to multiport LSG, if provided by a surgeon who has an experience in performing such operation and after careful selection of patients. Performance of a single‑incision LSG allowed implementation of some aspects of international protocol (intraoperative bilateral subcostal interfascial block, absence of abdominal cavity drainages) into clinical practice, which in turn shortened patient’s hospital stay. Single‑incision LSG allows patients to achieve similar results in remission of type 2 diabetes, while significantly reducing pain in the postoperative period and improving cosmetic results of surgical treatment compared to multiport laparoscopy, which in turn can potentially improve the quality of life of patients and the quality of specialized surgical care to population, and to reduce the risks of fatal cardiovascular complications.

Fibrosis as a key link in the morphogenesis of extragenital endometriosis

The clinical of extragenital endometriosis is variable and depends on the localization, while the leading manifestation is a pronounced pain syndrome, which in some cases can simulate various surgical pathologies. Materials and methods: A morphological and IHC study was performed in 82 cases of extragenital endometriosis of various localization. Research results: An IHC study showed positive expression of -SMA in fibrosis foci around and between endometriosis foci. The expression area of TGF-1 was different for the cytogenic stroma and the perifocally located connective tissue. Conclusions: Fibrosis is an integral component of the morphogenesis of endometrioid heterotopias, while the degree of its severity depends on the duration of the existence of endometriosis foci. Severe pain syndrome is probably associated with deformation of organs and tissues, compression of nerve endings due to fibrosis processes.

Rare damage to the tendons of the posterior thigh muscle group. Clinical case

Introduction. Hamstring tendon injury is a rare high-energy injury.The aim of the work is to demonstrate a rare clinical case of simultaneous damage to the distal tendon of the semimembranous muscle and the distal tendon of the biceps femoris.Object and methods. The patient is 55 years old, fell on the ice and sat in the "splits" position. Immediately after the injury, there was a sharp pain, the absence of active flexion of the right shin. She was treated conservatively. However, the pronounced pain syndrome and the lack of active movements forced the patient to do an MRI and consult a traumatologist.Results and discussion. After performing an MRI and examination by a traumatologist, damage to the distal tendons of the semi-webbed and biceps femoral muscles was diagnosed. Surgical interventions were performed – tendon suture and tenodesis. Immobilization with a sharshnir splint with a bending angle of 80 degrees. After immobilization, a dosed extension of the knee joint with a hinge system with a frequency of 5 degrees per day was performed for 6 weeks. After carrying out a full complex of medical rehabilitation using physiotherapy and the Arthromot apparatus, the volume of movements is 0/0/180.Conclusion. Early surgical treatment and competent rehabilitation measures allow you to fully restore the lost functions. Even with such rare injuries.

Enhanced recovery after retrograde intra-renal surgery (RIRS) in comparison with mini-percutaneous nephrolithotomy (Mini-PCNL) for renal stone treatment

The study presents a comparative analysis of the mini-percutaneous nephrolithotripsy (mini-PCNL) and retrograde nephrolithotripsy (RIRS) with a logistic analysis of outcomes and complications. The prospective study included 50 patients diagnosed with urolithiasis from 2018 to 2021 in the urological hospitals in Irkutsk. Patients were divided into two groups: RIRS (group I, n = 23) and Mini-PCNL (group II, n = 27). The comparison groups are statistically homogeneous. Both procedures equally lead to high stone free rates (SFR > 1 mm, 91.3% vs 85.1%; p = 0.867; SFR > 2 mm, 95.6% vs 92.5%; p = 0.936). The intergroup analysis of the total operation time (and lithotripsy) demonstrated similar times (p > 0.05). Postoperative complications of classes II-III (Clavien-Dindo) in the early and late postoperative period developed rarely and were comparable (p > 0.05). Class I complications were predominant in the PCNL group (p = 0.007). Some parameters demonstrated the superiority of RIRS over PCNL: less pronounced pain syndrome (p = 0.002), less drainage time (p < 0.001), no postoperative hematuria (p = 0.002), shorter hospitalization and total treatment period (p < 0.001). The study highlighted the positive effect of the one-day surgery principle on the risk of developing postoperative hematuria, urinary infection, or severe postoperative pain. RIRS and mini-PCNL have similar effectiveness, but RIRS meets the criteria of the enhanced recovery program more than PCNL.

Treatment and rehabilitation of patients with temporomandibular joints pathology

Relevance. According to statistical observations, the pathology of the temporomandibular joints (TMJ) is often found in dental practice, and is accompanied not only by a pronounced pain syndrome, but also by the occurrence of internal disorders in the structure of the joints themselves. The article discusses the causes of diseases of the temporomandibular joints, gives a physiological justification for the principles of treatment of this pathological condition, indicating further principles of rehabilitation. The aim of the study is to develop principles for the treatment and rehabilitation of patients with TMJ. Materials and Methods. The condition of patients was determined on the basis of a comprehensive examination, including functional diagnostic tests, collection of anamnestic data, study of models of biomechanical occlusions, axonography, psycho-emotional state of patients using the SCL-90-R scale, quality of life. Results and Discussion. The pathology of the temporomandibular joint is considered as a disorder of its functioning, both in the absence of morphological changes and in their presence. In the absence of changes, the psychosomatic factor plays a decisive role against the background of stressful conditions (20-27 %). In the presence of pathological changes in the elements of the joint, the violation of occlusion comes first, which leads to a decrease in the elasticity of the articular surfaces, due to a change in the state of the synovial fluid. Conclusion. To prescribe therapeutic measures for the pathology of the temporomandibular joint, a specific triad of clinical manifestations is necessary: severe pain syndrome, limitation of movements of the lower jaw, internal disorders of the joint (detected using MRI). Rehabilitation of patients with TMJ diseases, according to our research, should be carried out in a complex of gnathological, conservative and surgical treatment. As a surgical treatment, we recommend: prosthetic synovial fluid, arthrocentesis, arthrolavage and prosthetics of the head and articular cavity of the condylar process.

Взаимосвязь обеспеченности витамином D и функционального статуса жителей г. Мурманска 60–80 лет, больных остеоартритом

The purpose of this paper was to identify the relationship between the level of vitamin D and the functional state parameters in older patients with osteoarthritis. Materials and Methods. The study involved 100 subjects (85 women and 15 men) aged between 60 and 80 years (mean age 69.03 ± 2.34 years) receiving treatment at outpatient facilities in Murmansk. The following research methods were used: questionnaire, clinical examination, X-Ray, and serum vitamin D testing. The radiographic stage of osteoarthritis and the degree of joint dysfunction were determined. We used the Age Is Not a Barrier Questionnaire, Hospital Anxiety and Depression Scale, Pain Visual Analogue Scale, Mini Nutrition Assessment Questionnaire, and SF-36 Quality of Life Questionnaire. Results. We found that 1/3 of the patients with osteoarthritis aged 60–80 years had vitamin D deficiency, while over 1/2 of them had vitamin D insufficiency. Patients with vitamin D deficiency were more likely to show signs of a risk of malnutrition than those with vitamin D insufficiency, as well as a more pronounced pain syndrome, higher radiographic stages of osteoarthritis and degrees of joint dysfunction, as well as higher rates of anxiety and depression, and lower quality of life. Quality of life was lower in patients with higher levels of anxiety and depression, as well as with a more pronounced radiographic stage of osteoarthritis. The results of this study indicate the advisability of including vitamin D in the combination therapy of osteoarthritis in patients aged 60–80 years.

The use of centrally acting analgesics in the postoperative analgesia in patients with the consequences of a severe mine-explosive injury of the lower extremities

In this article, the authors discuss the place of modern analgesics of central action (nefopam hydrochloride) in the analgesia of patients with explosive injuries of the lower extremities. Currently, there is no information in global practice regarding the use of centrally acting analgesics for analgesia in patients with combat trauma. An example was the analgesia of patients in the p/o period with a severe explosive injury of the lower extremities. Attention is drawn to the need for effective analgesia for patients with a combo injury not only in the acute period. A feature of the treatment of such patients is the need for major restorative and reconstructive surgical interventions, which in turn are accompanied by a pronounced pain syndrome. In our experience, the addition of non-narcotic analgesics of central action (nefopam hydrochloride) to the scheme of multimodal analgesia is appropriate to improve analgesia in this category of patients. The addition of nefopam hydrochloride to a multimodal analgesia regimen at 20 mg IV every 6 hours was effective in the treatment of severe acute postoperative pain.

Эктопические ресницы как фактор риска возникновения язв роговицы у собак. Особенности клинической картины, диагностики и лечения

This paper presents a generalized experience of diagnosis and treatment of dogs with ectopic eyelashes and corneal ulcers caused by them. Ectopic eyelashes are ophthalmopathy, which is most common in dogs and is characterized by the germination of pathological eyelashes or eyelashes through the tarsal plate and conjunctiva of the upper eyelid from hair follicles, and have a damaging traumatic effect on the cornea, causing erosion and then corneal ulcer. The pathology is congenital and has an autosomal dominant type of inheritance. There is also a pedigree predisposition to this disease. The following breeds are most susceptible: Brussels Griffin, Brabanson, Retriever, Pekingese, Shih Tzu, Cavalier King Charles Spaniel, boxer, English Bulldog, English Cocker Spaniel, Poodle, Jack Russell Terrier and Yorkshire Terrier. The main problem of the appearance of ectopic eyelashes is the occurrence of erosions and corneal ulcers in the projection of eyelash growth. Which is accompanied by a pronounced pain syndrome, which manifests itself in the form of photophobia, blepharospasm, lacrimation and / or suppuration, corneal edema and the desire of the animal to constantly scratch the eye. In this work, a study was conducted to determine the risk factors for the occurrence of this pathology (this is a breed predisposition and genetic inheritance), diagnosis and effectiveness of surgical treatment of this pathology on 50 dogs. The authors describe the clinical picture, the technique of the operation, and the results of dynamic observation of animals. According to the results of clinical observations, it was found that there is a characteristic breed predisposition and genetic inheritance of ophthalmopathy. This factor must be taken into account during the clinical examination of the animal. Also, when ectopic eyelashes appear, a fairly characteristic clinical picture of the disease is observed. The surgical method of V-plastic surgery is proposed for treatment. No relapses were recorded in any of the 50 cases examined, while the morphofunctional characteristics of the cornea were preserved. Drug maintenance therapy, including a regenerative drug, showed good results in the postoperative period. The use of a regenerative drug accelerated the healing process, allowed to preserve the transparency of the cornea and its curvature.