Russian Medical Academy Research Articles

Chronicles of A.I. Pospelov Moscow Society of Dermatovenerologists and Cosmetologists (MSDС was founded on October 4, 1891) Bulletin of the MSDС № 1156

On February 20th we held our last meeting of A.I. Pospelov Moscow Society of Dermatologists and Cosmetologists in person. There were 115 participants and 3 applicants. Our agenda included four reports. The first speaker reported a clinical case of cytostatic therapy ineffectiveness in a patient with pustular psoriasis (State Scientific Center of Dermatovenereology and Cosmetology); the second case was about the adverse dermatological reactions in patients receiving pembrolizumab and nivolumab for hepatocellular cancer (Sechenov University). Two reports were presented in the scientific part of the meeting: the first report was about the clinical features of perianal dermatoses (Russian Medical Academy of Continuous Professional Education), the second one was based on the diagnosis of erythroderma (Sechenov University).

Genetic features of a patient may influence the efficacy and safety profile of a medicinal product

Identification of the genetic features that determine a patient’s individual response to a medicinal product and provision of this information to a doctor helps to predict the effectiveness of therapy and the risk of adverse drug reactions. Dmitry A. Sychev — Academician of the Russian Academy of Sciences, Doctor of Medical Sciences, Full Professor, Rector of the Russian Medical Academy of Continuous Professional Education — talks about the importance of a personalised approach to selecting medicinal products and methods for their efficacy and safety control.

Research of Russian physicians' opinions on tuberculosis pharmacogenetics.

There is currently no widespread implementation of pharmacogenetic testing (PGx) methods in the practice of phthisiology service. The aim of this study is to determine how informed and prepared phthisiologists, residents, and postgraduate students of the Russian Medical Academy of Continuing Professional Education (RMACPE, Moscow) use PGx techniques in their work to improve treatment safety, predict the occurrence of adverse reactions (ADRs), and personalize therapy. A survey was conducted among phthisiologists (n =314) living in different regions of the Russian Federation and studying at RMACPE, such as residents and post-graduate students (n =185). The survey was developed on the Testograf.ru web platform and had 25 questions for physicians and 22 for residents and post-graduate students. More than 50% of respondents are ready to use PGx in clinical practice and thus are aware of the method's possibilities. At the same time only a small part of participants were aware of the pharmgkb.org resource. The absence of PGx in clinical guidelines and treatment standards, according to 50.95% of phthisiologists and 55.13% of students of RMACPE, the absence of large-scale randomized clinical trials, according to 37.26% of phthisiologists and 43.33% of students, and the lack of physician knowledge on PGx, according to 41.08% of phthisiologists and 57.83% of students, are all factors that prevent the implementation of PGx in Russia. According to the survey, the overwhelming majority of participants recognize the importance of PGx and are willing to use the method in practice. However, there is a low level of awareness among all respondents about the possibilities of PGx and the pharmgkb.org resource. The implementation of this service could significantly increase patient compliance, lower ADRs, and enhance anti-tuberculosis (TB) therapy quality.

Analysis of the work of the Immunohistochemical Quality Control Center of the Russian Medical Academy of Continuous Professional Education of the Ministry of Health of Russia in 2023

The article demonstrates a detailed analysis of the results of the rounds of quality control of immunohistochemical studies conducted by the Central Committee of the Immunohistochemical Quality Control Center of the Russian Medical Academy of Continuous Professional Education of the Ministry of Health of Russia in 2023. Typical shortcomings and errors in the immunohistochemical examination of various tumors have been identified and ways to eliminate them are given. Particular attention is paid to defining a panel of standard breast cancer markers and eliminating the shortcomings of immunohistochemical examination of markers of accompanying diagnosis.

Comorbid patient with osteoporosis at doctor's appointment. What factors should be considered in selection of therapy

Relevance. Osteoporosis is a systemic disease of the skeleton, which is characterized by a decrease in bone mass per unit volume and a violation of the microarchitectonics of bone tissue, which leads to an increase in bone fragility and an increased risk of fractures.Target. The problems of comorbidity of osteoporosis and polypharmacy in the treatment of this disease are considered.Materials and methods. On the basis of the Center for Osteoporosis of the Penza Institute for Postgraduate Medical Education, a branch of the Russian Medical Academy of Continuing Postgraduate Education of Russia, we conducted an open, prospective, randomized study of the comorbid status of age-related patients with osteoporosis in order to improve the diagnosis and pathogenetic therapy of the disease. More than 1400 women took part in the study.The results of a study of the comorbid status of age-related patients with osteoporosis are presented. The expediency of antiresorptive therapy in comorbid patients with osteoporosis is discussed.Conclusions. The characteristics of osteoprotectors of a new generation based on the bioactive component of gonadotropic action are given, and the prospects of these agents in the implementation of a personalized approach in the treatment of osteoporosis, taking into account comorbidity and polypharmacy, are evaluated. Particular attention is paid to the problem of osteosarcopenia and its solution with the help of these osteoprotectors.

Медико-социальная значимость заболеваний периферической нервной системы на примере карпального туннельного синдрома.

Peripheral nerve diseases are one of the socially significant problems in the healthcare system of the Russian Federation. Effective care for patients suffering from these diseases is an important task for healthcare, as so as they are accompanied by prolonged disability. However, at present we do not have data that could fully demonstrate the medico-social and medico-economic aspects of carpal tunnel syndrome (CTS) and other peripheral nerve diseases in the Russian Federation. The aim of the study is to improve the quality of medical care for patients with carpal tunnel syndrome based on the analysis of statistical data of patients operated on for this pathology in the S. P. Botkin City Clinical Hospital. Material and methods. The patients in the study were all adult men and women who underwent surgical treatment of CTS at S. P. Botkin City Clinical Hospital in the period from 2016 to 2022. The sources of information about the treated patients were the information of medical information systems used in the hospital in different years. Statistical and visualization tools of the Microsoft® Excel® spreadsheet were used to obtain descriptive statistics and present data graphically. Results. In the S. P. Botkin City Clinical Hospital, which is the clinical base of the Department of neurosurgery of the Russian Medical Academy of Continuous Professional Education, in the period from 2016 to 2022, 692 surgical interventions were performed for patients with CTS. The analysis of statistical data has shown results comparable with the available literature data, however, a distinctive feature is an extremely long history of the disease before surgical treatment. Conclusions. Currently, in our country, there is an underestimation of the importance of peripheral nerve diseases, therefore, their separate statistical accounting in the structure of neurological morbidity is extremely important. Another important task is a multidisciplinary approach that provides high-quality medical care to patients with this pathology.

Comparative Assessment of Actual Nutrition of Preschoolers Given Uniform Approaches to Its Organization

Background: A healthy balanced diet is the basis for maintaining health at any age. Identification of causes of violations in organization of nutrition of preschoolers remains relevant, since the breach of fundamental principles of healthy eating aggravates negative trends in children’s health. Objective: To compare actual feeding of children attending two preschools using a single menu. Materials and methods: In spring–summer 2022, we carried out a comparative analysis of the diet of 99 children aged 3 to 6 years attending two kindergartens using methods of estimation and portion weighing. In total, we examined 20,700 portions and took 41,580 weight measurements. Food intake was then estimated both per child and per preschool. To establish the quality of meals served, we conducted a questionnaire-based survey of parents; the questionnaire was approved by the Local Ethics Committee of the Novokuznetsk State Institute of Advanced Medical Training – Branch of the Russian Medical Academy of Continuous Professional Education (protocol No. 1 of January 14, 2020). Results: Weighing of the food set showed that actual consumption of food products differed from that specified in the menu. The diet was imbalanced. Natural food standards were met in both preschools only for cereals and legumes (95–100 %), juices and fruits (100 %). Deficit of bread ranged from 8 to 28 % of the recommended consumption rate, and that of potatoes and vegetables was 14 %. Significant differences between the weights of food products actually consumed and listed on the menu were found for vegetables, potatoes, by-products, fish, cheese, and cottage cheese. The total caloric value of the rations was 6–12 % lower while the protein content was 8 to 18 %, fat content – 7 to 16 %, and that of carbohydrates – 5 to 11 % lower than declared. Conclusions: Weighing provides more accurate data on children’s nutrient intake in preschools. Nutrition information given in the menus is overestimated by 6 to 15 % on the average. The parent survey showed that children did not eat some of the dishes from the preschool menu at home, so it was more difficult to adapt them to the proposed diet.

Military Medical Training at the Central Institute for the Advanced Medical Education in the Second Half of the 1930s

The paper describes the initial stage in the organization of military medical training at the Central Institutefor Advanced Medical Education (CIAME), now the Russian Medical Academy for Continuous Professional Educationat the Ministry of Health of the Russian Federation, Moscow. The problem statement in this study is the first of itskind in Russian historiography. The research relied on the documents found in the Russian State Archive of Scientificand Technical Documentation and the Archive of the Russian Medical Academy of Continuous Professional Education.The decision to establish a military medical department at the CIAME was made in 1936. The authors identified the main tasks and challenges the new department had to face, as well as solution methods, areas of theoretical and practical training,and curriculum. The article also describes the role of the CIAME in the Battle of Khalkhin Gol in 1939 and the WinterWar of 1939–1940. In the second half of the 1930s, the CIAME medical staff acquired experience in military medicaltraining and medical care in combat conditions, which proved invaluable during the Great Patriotic War of 1941–1945.

Clinical factors of the risk of hyperplastic endometry processes on tamoxifen therapy with breast cancer: Retrospective population study

Background. One of the main stages of the treatment of breast cancer (BC) is endocrine therapy with tamoxifen or aromatase inhibitors. Five years of adjuvant tamoxifen therapy reduces the risk of disease recurrence by 39%. Tamoxifen was approved by the U.S. Food and Drug Administration in 1977 as a treatment for ER-positive BC. However, sometime after the start of tamoxifen's wide use, reports have been published on its long-term adverse effects. Most common were hot flashes, gynecological symptoms (vaginal dryness, vaginal discharge), depression, forgetfulness, sleep changes, weight gain, and decreased libido. However, more serious adverse events such as venous thromboembolic disease and endometrial hyperplasia or cancer are the most clinically significant. The article presents the results of a retrospective population-based study on assessing hyperplastic processes of the endometrium (HPE) in patients with breast cancer during TAM therapy, conducted in 2017, approved by the Ethics Committee of the Scientific Research of the Russian Medical Academy of Continuing Professional Education. Aim. To identify clinical factors that may increase the risk of HPE during tamoxifen therapy in patients with a history of breast cancer living in the Moscow region. Materials and methods. We retrospectively reviewed 230 case histories of patients with breast cancer. Of these, 120 patients who received TAM therapy had the following HPE risk factors: average age, menopausal status, body mass index, and duration of TAM therapy. Results. It was found that patients with HPE taking TAM were older (p=0.017), more likely to be postmenopausal (p=0.035), overweight (p=0.023), and received TAM for a longer period (p=0.028) than patients without HPE. Conclusion. The data obtained indicate the need for continuous monitoring by gynecologists of patients with breast cancer taking tamoxifen, paying particular attention to women from high-risk groups, namely older postmenopausal women with high body mass index receiving TAM for more than 1.52 years.

Predictive modeling of adverse events of tamoxifen therapy for breast cancer (results of a cohort study)

Relevance. Endocrine therapy is the standard treatment for women with ER-positive breast cancer. The clinical response to Tamoxifen is variable. Approximately 30 % of patients with breast cancer will have a recurrence of the disease within 15 years after treatment, despite ongoing endocrine therapy. This article presents the results of a prospective pharmacogenetic cohort study. The study was conducted in 2018–2019. Aim. To analyze adverse drug reactions to Tamoxifen in the adjuvant regimen in breast cancer patients in relation to the carriage of genetic polymorphisms of genes encoding cytochrome P450 enzymes and drug transporter proteins and to build predictive models based on them. A comparative analysis of the relationship between genetic and non-genetic determinants with adverse events on tamoxifen therapy allowed us to build predictive models of their development. Materials and Methods. The study involved 120 women with pre- and postmenopausal breast cancer who underwent genetic testing for CYP and Pg enzyme gene polymorphisms. Entry criteria: a histologically confirmed diagnosis of breast cancer, taking Tamoxifen at the recommended doses, establishing a diagnosis not earlier than 2007, and obtaining informed voluntary consent to participate in the study. Allelic variants were determined using real-time polymerase chain reaction in the Research Institute for Molecular and Personalized Medicine of the Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of the Russian Federation. Results. An associative analysis showed their association with the development of adverse drug reactions (ADR) to Tamoxifen, indicating the clinical significance of different genetic polymorphisms of CYP2D6, CYP3A5, CYP2C9 and ABCB1. The complex associative analysis performed using mathematical modeling made it possible to build predictive risk models for the development of such ADR, such as hot flashes, dyspepsia, bone pain, and asthenia. The resulting regression models were statistically significant (p < 0,001) and demonstrated high diagnostic efficiency. This allows them to be implemented in clinical practice. Conclusion. Thus, models that include both genetic and non-genetic determinants of response may further improve the prediction of individual response to tamoxifen

External quality control of immunohistochemical studies in pathomorphology: tasks, problems, solutions, development prospects

In 2022, the Quality Control Center for Immunohistochemical Studies of the Russian Medical Academy of Continuing Professional Education conducted 12 rounds of markers for breast, lung, prostate, bladder cancer with the participation of 83 laboratories. For the first time, a round was held to control the method of in situ hybridization in the diagnosis of breast cancer, and a digital round. Typical problems in carrying out immunohistochemical studies in oncomorphology have been identified and the importance of participation of laboratories in external control has been shown.

«Реабилитация. Искусство. Педагогика». III Международная онлайн-школа по физиологии выразительного движения

The article is devoted to a review of the 3rd international online school on the physiology of expressive movement “Rehabilitation. Art. Pedagogy”, which took place on November 16th, 2022. The main topic of the scientific discussion was the phenomenon of expressive movement as a manifestation of the creative and motor abilities of a person, as well as it being one of the possible markers of his inner, spiritual world. Two previous online schools have shown that this topic seems to be very interesting to a wide range of scientific community, which includes representatives of the medical rehabilitation sphere, the performing arts, dance history researchers, physiologists and body-oriented therapists. However, this time the concept of the school was aimed at finding points of contact between the direct experience of theatre pedagogy and practicing psychologists and physiologists. This concept has become not only a characteristic feature of the 3rd online school, but also revealed a special scientific approach, which is the interdisciplinary nature of the discussion. The event was organized by the Russian Medical Academy of Continuing Professional Education of the Ministry of Health of the Russian Federation together with the Russian Institute of Theatre Arts (GITIS) (as a part of the “Priority-2030” Strategic Academic Leadership Program) under the support of the National Association of Physiotherapy and Balneology. Such a scientific union is significant for further research. Since the school is an interdisciplinary one, which makes it unique, the article presents brief summaries of the reports that present a wide range of scientific and practical issues of physiotherapy, rehabilitation, theatre pedagogy, and the history of plastic expressiveness.

Analysis of the complications of endocrine therapy with tamoxifen in breast cancer: clinical and pharmacogenetic aspects. Prospective pharmacogenetic cohort study

Background. Tamoxifen is the drug of choice in ER-positive breast cancer (BC) therapy for perimenopausal women and one of the endocrine therapy options for menopausal patients. The pharmacological effect of tamoxifen can be influenced by the activity of cytochrome P450 (CYP) enzymes and P-glycoprotein transporters (Pg), and the genes encoding them have broad polymorphism, affecting serum concentrations of active metabolites. This article presents the overall results of a prospective population-based study of the clinical significance of genetic polymorphism of tamoxifen metabolic enzymes and transporters in breast cancer patients after radical treatment receiving adjuvant endocrine therapy with tamoxifen in outpatient settings during 2018-2019. The study was approved by the Research Ethics Committee of the Russian Medical Academy of Continuing Professional Education.
 Aim. To analyze the clinical presentation of endocrine therapy with tamoxifen in the adjuvant regimen and to assess the association of polymorphisms of genes encoding cytochrome P450 enzymes and drug transporter proteins with adverse events in BC patients.
 Materials and methods. One hundred and four women with stage I-III luminal breast cancer receiving adjuvant tamoxifen were examined for the presence of CYP2D6, CYP2C, and the following CYP3A gene polymorphisms: CYP2D6*4, CYP3A5*3, CYP2C9*2, CYP2C9*3, CYP2C19*2, CYP2C19*3, as well as the ABCB1 gene polymorphic marker (C3435T) encoding the P-glycoprotein. The allelic variants were identified using the real-time polymerase chain reaction; the test was performed in the Research Center of the Russian Medical Academy of Continuing Professional Education. The study material was buccal epithelium (double sampling) taken after informed consent signing.
 Results. Association analysis showed the association of different genetic polymorphisms of CYP2D6, CYP3A5, CYP2C9, and ABCB1 with tamoxifen adverse drug reactions, indicating the clinical significance of these polymorphisms.
 Conclusion. With the implementation of genetic testing of the studied polymorphisms into the routine clinical practice of oncologists prescribing tamoxifen and gynecologists involved in the follow-up of breast cancer patients receiving endocrine therapy in the adjuvant mode, there will be an opportunity for more effective and safer pharmacotherapy.

Experience in the use of low-temperature plasma in the therapy of radiation reactions.

The use of low-temperature plasma is a modern and developing direction in medicine, including rehabilitation. Low-temperature plasma (LTP) has a high antiseptic, wound-healing activity, and is also a safe method of physical exposure. In the in-patient facility of clinical unit of Federal State Budgetary Educational Institution of Further Professional Education Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of the Russian Federation named after Prof. Yu.N. Kasatkinа, a patient was treated with low-temperature argon plasma after selective right cervical lymph node dissection, resection of the mandible, and tissues of the oral floor with defect plasty with a fibular autograft for cancer of the gingival mucosa of the mandible on the right pT4aN0M0, stage IVa. In the process of EBRT (external beam radiation therapy), the patient developed a complication in the form of a local radiation reaction with the formation of a fistulous opening in the area of the postoperative scar. The fistulous opening and the affected area were treated with a cooled air-plasma flow. During the continued use of LTP, the termination of pyorrhea, a decrease in hyperemia and edema in the area of tissues damaged by ionizing radiation were noted. The patient was promptly continued radiation therapy.
 Thus, the use of this therapeutic factor in the program of medical rehabilitation is an effective way of local impact on the pathological focus, allows you to achieve a quick reparative effect, eliminates and prevents the development of bacterial complications. In addition, the use of an air-plasma flow contributes to the rapid relief of manifestations of radiation reactions, having a beneficial effect on damaged tissues, as well as shortening the rehabilitation period for severe cancer patients in the postoperative period and during the course of EBRT. The results of LTP action have a positive effect on the general condition of patients and improve their quality of life.

A survey of physician opinions in Russia in the field of pharmacogenetics of cardiovascular disease.

Aims: To study the readiness of Russian physicians with experience and younger physicians undergoing clinical residency and postgraduate education to apply pharmacogenetic testing in their clinical practice. Materials & methods: The sociological study involved physicians (n =378) living in different regions of the Russian Federation, as well as residents and graduate students (n =185) of the Russian Medical Academy of Continuing Professional Medical Education. The survey consisted of 35 questions, and 23 were created on the online platform of professional surveys, Testograf.ru. Results: Every second respondent was willing to use pharmacogenetic testing in clinical practice to predict the efficacy and safety of medications in patients with cardiovascular disease (p=0.06). Factors impeding the clinical implementation of pharmacogenetic testing in Russia were identified: physicians' ignorance of pharmacogenetics (p=0.015), a lack of pharmacogenetic testing in clinical guidelines and treatment standards (p=0.175) and a lack of economic justification for using pharmacogenetic testing (p=0.320). Conclusion: Russian physicians have a positive attitude toward pharmacogenetic testing. However, the level of test implementation remains low.

New devices to control fever in children with COVID-19 and other acute respiratory infections

Introduction. When performing thermometry, different measuring instruments can be used: from contact individual to remote. Doubts about the accuracy of the measurements obtained arise in the course of severe infections, impaired general well-being, a feeling of fever, headache.The aim of the study was to evaluate the effectiveness of daily monitoring of body temperature in children with COVID-19 coronavirus infection and other acute respiratory viral infections using a medical thermograph designed to graphically display the dynamics of changes in the child's body temperature during the day to monitor its variability, compared to a halystone thermometer.Materials and methods. The clinical study was performed at two clinical sites of the Academician G.N. Speransky Department of Pediatrics, Russian Medical Academy of Continuing Professional Education: the Khimki Regional Hospital and the Z.A. Bashlyaeva Children's City Clinical Hospital. The study included 120 children aged from 3 months to 3 years, divided into 4 groups. Group 1 and 2 were children with ARI, Group 3 and 4 were children with COVID-19. Body temperature in the 1st and 3rd groups was measured only by a halistane thermometer; in the 2nd and 4th groups - by a new generation intellectual thermograph with halistane thermometer control in the specified time intervals.Results. The study obtained high reliability of indicators of the new thermograph, designed to graphically display the dynamics of changes in body temperature during the day, compared with the halistane thermometer, commonly used in hospitals.Conclusions. The thermograph registers the child's body temperature with high reliability, which makes it possible to react to its changes in time. The use of thermograph makes it possible to set the critical value of body temperature at its rise for each user individually depending on his premorbid background, which is especially important in the group of children with a high risk of febrile convulsions and microcirculatory disorders in terms of prevention of the possible development of adverse events.

A study of the quality of knowledge about child autism among doctors of different specialties planning to work in the field of physical and rehabilitation medicine

BACKGROUND: In recent decades, a steady increase in the prevalence of autism spectrum disorders around the world has been reported. It is known that autism spectrum disorders requires early diagnosis and medical intervention. By identifying the risks of autism spectrum disorders, doctors can help the child and family get qualified help as soon as possible. Given the variety of functional disorders in autism spectrum disorders, these patients require special rehabilitation programs and therefore physicians planning work in the field of physical therapy and medical rehabilitation should be oriented in this problem.
 AIMS: To determine the level of awareness of the problem of autism spectrum disorders among doctors of different specialties planning to work in the field of physical and rehabilitation medicine.
 MATERIAL AND METHODS: A survey was conducted on the KCAHW questionnaire of 105 doctors of 8 medical specialties who underwent primary retraining in the cycle "Physical and Rehabilitation Medicine" at the Department of Physical Therapy, Sports Medicine and Medical Rehabilitation of the Russian Medical Academy of Continuous Professional Education.
 RESULTS: According to the results of filling out the KCAHW questionnaire, the median of correct answers was 14 [7; 19] out of 19 possible, which is the average value of the level of knowledge about autism spectrum disorders. Our research shows that there is a lack of knowledge in the relationship between autism and epilepsy and mental retardation, as well as the relationship between the disease and poor nutrition. Among the respondents, there was also a misunderstanding about the age of the child at which the first signs of autism spectrum disorders can be suspected: 60 (57.1%) of the survey participants correctly determined that autism begins in childhood, 35 (33.3%) of the surveyed doctors believed that autism occurs in infancy, and 10 (9.5%) people indicated the neonatal period.
 CONCLUSION: The KCAHW questionnaire is a reliable tool for assessing health care providers' knowledge of childhood autism. The conducted research allows us to conclude that doctors are not sufficiently knowledgeable in the field of knowledge about autism spectrum disorders. The totality of all the respondents' answers indicates the importance of additional information about modern research on the problem of autism spectrum disorders for all doctors planning further work in the field of physical and rehabilitation medicine.

Pages from the history of therapeutic schools of the Central Institute for Improvement of Doctors - Russian Medical Academy of Continuous Professional Education

In the 1930s, therapeutic scientific and pedagogical schools were formed at the Central Institute for Advanced Training of Physicians: Cardiology School of prof. Dmitry D. Pletnev, School of Clinical Hematology and Emergency Care of prof. Alexander N. Kryukov, School of Dietetics and Gastroenterology of prof. Manuel I. Pevzner and School of Hematology of prof. Joseph A. Kassirsky. 2022 marks the 125th anniversary of the birth of an outstanding therapist, academician of the USSR Academy of Medical Sciences, Major General of the Medical Service, prof. Miron S. Vovsi. Along with the fact that M.S. Vovsi belongs to the scientific and pedagogical school of cardiology of prof. D.D. Pletnev, he managed to create his own. M.S. Vovsi is one of the creators of modern military field therapy, expanded the understanding of the pathogenesis of nephritis, pneumonia, coronary heart disease, hypertension, heart failure, he introduced new methods for diagnosing and treating these therapeutic pathologies that have not lost their relevance today.

Clinical tasks

The column is written by Doctor of Medical Sciences, Professor I.N. Kholodova, Department of Pediatrics named after G.N. Speransky, Russian Medical Academy of Continuing Professional Education of the Ministry of Health of Russia

Russian Medical Academy of Postgraduate Education, Moscow

Examination and treatment results of 120 patients with closed injuries of the ankle joint are presented. In 76 patients with various patterns and severity of closed injuries duplex crus veins examination using color Doppler to evaluate the venous blood circulation was performed within the first 24 hours. Mural deep vein thrombus of the crus was diagnosed in 26 (34.2%)) patients. Deep vein occlusion (posterior tibial vein) was detected in type B2 injuries 14 (45.2%) out of 31 examined patients, in type B3 11 (36. 7%)) out of 30 patients and in type C2 1 (9.1%)) out of 11 patients. Elaborated diagnostic curative scheme gave a two times decrease of the ratio of chronic venous circulation disturbance as compared to control and in 34.2%) of patients the development of postthrombophlebitic syndrome was prevented.