Tactics Of Patients Research Articles

Median arcuate ligament syndrome with predominantly respiratory manifestatios

Introduction. One of the causes of respiratory disorders in young people may be visceral circulation chronic vio-lation in median arcuate ligament syndrome (MALS). The aim of the study was to assess the clinical significance of respiratory disorders in establishing the MALS diagnosis in order to determine the necessary management tactics for patients with this pathology. Materials and methods.49 MALS patients were examined, the main symptoms being respiratory disorders, such as shortness of breath, difficult inhaling and/or exhaling, and others. The medi-an age was 24.7±0.9 years, females predominated (60%). The diagnosis of MALS was confirmed by clinical data, the results of transabdominal ultrasound duplex scanning of the abdominal aorta and its visceral branches using re-spiratory and orthostatic tests. Subsequent comparative analysis of the characteristic respiratory symptoms’ seve-rity before and after surgery (decompression of the celiac trunk) was performed. Research results. 10 main symp-toms of respiratory disorders were identified in patients under study, the frequency of each ranged from 31% to 50%, in most patients they were combined. Spirometry in these patients did not reveal any changes in both static lung volumes or airway patency. Bronchodilation revers-ibility tests were negative. Chest X-ray and/or computed tomography did not reveal any visible changes. During examination, hemodynamically significant compres-sion stenosis of the celiac trunk (CT) was observed in all patients. For all patients, auscultation of the abdominal cavity and detection of systolic murmur were performed. Confirmation of the diagnosis was based on ultrasound of the unpaired visceral arteries with color mapping, im-aging of the severity of CT stenosis, nature and speed of blood flow. An ultrasound study of the diaphragm func-tion revealed a direct statistically significant relationship between the diameter of the orifice of the CT and the am-plitude of the respiratory displacement of the diaphragm dome during quiet breathing (r=0.58), the amplitude of the respiratory displacement of the diaphragm dome during forced breathing (r=0.64), and the thickening frac-tion of the muscular part of the diaphragm, with quiet breathing (r=0.61) and thickening fraction of the muscu-lar part of the diaphragm during forced breathing (r=0.46, not significant, trend). The given correlation coefficients were estimated as a medium-strength relationship, i.e., the narrower the CT mouth, the worse the diaphragm ki-netics. In most patients, after surgical treatment, decom-pression of the celiac trunk, the clinical manifestations of respiratory disorders resolved, which may indicate their connection with diaphragmatic compression stenosis of the CT. Conclusion. The clinical manifestations of respi-ratory disorders in MALS, in most cases, are similar to the symptoms of bronchial asthma, which often led to the establishment of an erroneous diagnosis and ineffective-ness of the prescribed therapy. This theoretically and clin-ically important circumstance must be taken into account in the differential diagnosis of celiac trunk compression syndrome in combination with respiratory disorders. In the presence of hemodynamically significant compres-sion stenosis of the CT and respiratory disorders, it is ad-visable to perform surgical intervention

OPTITMIZATION OF MANAGEMENT TACTICS FOR PATIENTS WITH HEADACHE CAUSED BY ESTROGEN WITHDRAWAL

Abstract. The clinical case of a patient who applied for an appointment regarding the selection of a method of contraception after a medical abortion was studied. Anamnetically, the patient had symptoms caused by the withdrawal of estrogens when taking combined oral contraceptives (COCs) and also with a physiological decrease in the level of estrogens during the menstrual cycle without the use of combined oral contraceptives. After consulting a neurologist, a migraine-like disorder was diagnosed as a "Headache caused by the withdrawal of estrogens", and a gynecologist's consultation was recommended to choose a method of contraception that does not give this complication. The study of this clinical case demonstrated the possibility of optimizing the management tactics of patients with headache caused by the withdrawal of estroneens by using the drug claira for contraception. This drug has a dynamic dosing regimen, which provides for a gradual decrease in the estrogenic component in combination with a gradual increase in the dosage of progestin and a subsequent short hormone-free interval (BGI), lasting only two days. An additional advantage is that a short BGI helps to maintain a stable level of estradiol and inhibits the development of follicles. This drug, having high contraceptive reliability, has also demonstrated high effectiveness in the occurrence of headaches caused by estrogen deficiency. Keywords. Headache, estrogen deficiency, clair, combined oral contraceptives.

Laparoscopy in the treatment of retro-cervical endometriosis

Original approaches to the endometriosis complex treatment by authors are presented in this article. The experience of laparoscopic intrusions in 232 patients is united. The authors prove the necessity of active surgical (conservative or radical) tactics in patients with widespread endometriosis forms. The use of agonists Gn-RG is recommended for preparation before the intrusion and as anti-recidive treatment, especially in patients with combination of genital endometriosis and uterus myoma.

Molecular-genetic testing in preoperative diagnosis and choice of surgical tactics in patients with thyroid neoplasms

The high frequency of the detection of follicular thyroid tumors requires the development of the most effective new methods for their differential diagnosis to early verification of well-differentiated cancer, reduce the number of unjustified surgical interventions, select their rational volume, and improve the treatment results. The use of molecular genetic research methods in preoperative diagnostics and the choice of surgical tactics in patients with the thyroid neoplasms was substantiated. To optimize the algorithm of diagnosis and treatment, a retrospective analysis of the results of examination and surgical treatment of 100 patients with the thyroid neoplasms was carried out, the diagnosis of which was supplemented by the determination of molecular genetic markers in the cellular material of the puncture fine-needle biopsy using a flow fluor-cytometry and polymerase chain reaction. The diagnostic significance of the preoperative determination of the tumor marker Galectin-3, the V600E mutation of the BRAF gene in the puncture material in the detection of thyroid cancer and the choice of the rational surgical tactics was assessed. The prognostic value of the sodium iodide symporter in the development of a thyroid cancer resistance to postoperative radioactive iodine therapy has been established, which makes it possible to substantiate the need to expand the scope of the surgical intervention. The use of an optimized diagnostic and treatment algorithm, considering a new molecular genetic research methods in this category of the patients, contributes to the choice of individualized surgical tactics, depending on the nature of the pathological process.

Hospital and mid-term results of simultaneous correction of coronary and carotid arteries

Study objective: to present the immediate and mid-term results of onestage surgical treatment of patients in the volume of CEE and CABG based on a differentiated approach to patient selection.Materials and methods: in FCCVS n.a. S.G. Suhanov, Perm developed an algorithm for choosing treatment tactics in patients with combined atherosclerotic lesions of the coronary and brachiocephalic arteries. According to this algorithm, for the period from 01.07.2014-01.01.2021, one-stage correction of CABG + CEE was performed in 104 patients. The primary endpoints were all-cause death, acute myocardial infarction (MI), transient ischemic attack (TIA), and stroke. Hospital and midterm results were analyzed. The average follow-up time in the study of mid-long-term results was 40.3 ± 20.4 months.Results: in the study of hospital outcomes, the mortality rate was 0%. There were recorded 3 (2.9%) cases of perioperative stroke and 1 (0.9%) case of myocardial infarction. There were no cases of TIA. The combined endpoint (death, acute MI, stroke, TIA) reached 4 (3.8%) patients. In the study of mid-term results, we were able to contact 96 patients out of 104 operated on (92.3%). The survival rate was 94.8%. 5 (5.2%) people died. There were 2 (2.1%) cases of myocardial infarction, 4 (4.1%) cases of stroke.Conclusions: simultaneous revascularization of the carotid and coronary regions of CABG + CEE is safe and allows adequate elimination of the lesion in both regions.

Patient- oriented approach to management of patients with hepatic cirrhosis

Aim of the study: Optimization of medical care to patients with liver cirrhosis (LC) based on using of patient- oriented approach in real clinic practiceMaterials and methods: The reviews of 734 medical histories of patients treated in polyclinics and in-patient facilities of general specialization (surgery, therapy) and died from HL in 2015–2019 years in Krasnodar region were analyzed. The experience of regular medical check-up of 85 patients with LC who underwent mini-invasive surgeries was summarized.Results: The number of mistakes in treatment tactics of patients with LC was revealed. The experience of regular medical check-up and schools for patients with LC was summarized.Conclusion: Regular medical check-up of patients with LC in multi- disciplinary clinic with practice in mini-invasive surgeries and liver transplantation, attendance of schools for patients improves stabilization and in some cases treatment course of disease.

Current aspects of diagnosis and treatment of patients with neuroendocrine tumors

The article presents modern possibilities and existing problematic aspects of the choice of therapeutic and diagnostic tactics in patients with neuroendocrine tumors of the gastrointestinal tract and pancreas are presented. The asymptomatic course of neuroendocrine tumors of the gastrointestinal tract and pancreas was established in 18.5% and 24.6% of cases, respectively. Carcinoid syndrome was detected in 12.9%. The sensitivity rates of chromogranin A and neuron-specific enolase in the diagnosis of tumors were 54% and 13%, respectively. The levels of cancer-embryonic antigen in G-1/G-2 and G-3 tumors were 5 ng/ml and 8.9 ng/ml, respectively (p 0.001). A pathognomonic sign of neuroendocrine tumors of the small intestine is a mesentery tumor conglomerate, and the sensitivity rates of computed tomography and positron emission tomography with 68Ga to detect this sign were 92.3% and 92.9%, respectively (p 0.05). The computed tomographic density of neuroendocrine pancreatic tumors G-1/G-2 in the arterial phase was 112.1 40.2 HU and that of G-3 tumors was 54.0 10.4 HU (p = 0.025). Surgical treatment was performed in 259 (79.7%) patients. Postoperative complications that developed in localized and locally distributed neuroendocrine tumors of the gastrointestinal tract and of the pancreas were found in 3.5% and 8.8%, and in 58.1% and 40% of the cases, respectively, and those of generalized tumors were noted in 20%. The tumor-specific 5-year survival rates of patients with localized neuroendocrine tumors of the gastrointestinal tract and pancreas were 92.5% and 94.4%, those with locally distributed tumors had 66.8% and 77.8%, and those with generalized tumors had 51.8% and 47.1%, respectively. In patients with generalized tumors, the 5-year survival rates after cytoreduction and removal of the primary tumor were 88.2% and 64.6%, respectively (p = 0.097), and the rate after drug therapy was 28.8% (p 0.001). The prognosis of the 5-year survival of patients is determined by the degree of malignancy and tumor localization, treatment method, and patient age. In general, neuroendocrine tumors are a heterogeneous group of neoplasms that require a multidisciplinary approach to diagnosis and choice of therapeutic strategies.

Modern approaches to the choice of treatment tactics in patients with cervical cancer

Currently, approaches to the choice of treatment tactics for cervical cancer have changed significantly. According to the recommendations of ESGO (2018), RUSSCO (2020), the use of a combination of surgical treatment and radiation therapy significantly increases the incidence of complications. Therefore, when planning the treatment of patients with IB1–IIA1, a combination of surgical treatment and radiation therapy should be avoided. The article presents an analysis of modern approaches to the treatment of initial, locally advanced and advanced cervical cancer. Modern approaches to organ-preserving treatment are considered, including the view from the point of view of expanding the indications for trachelectomy as part of combined treatment. The question of the expediency of using hyperthermia and indications for this type of treatment in combination with radiation therapy is considered. The author presents his own view of the problem as a whole and possible ways to solve this problem.

Peculiarities of surgical tactics of patients with thymus tumors

The aim of the study: to study retrospective analysis results of the surgical treatment of thymus tumours for predicting long-time results.
 Methods. Study included 35 patients who were treated at the Department of Thoraco-abdominal Surgery from September 2019 to May 2021. The control group included 20 patients with SVCS were treated with conventional techniques, while the experimental group included 15 patients who underwent a novel bypass surgery developed by us.
 Results. The venous bypass was mandatorily complemented with cytoreduction. Complications in the post-operative period were reported from the experimental group and included auriculo-subclavian bypass thrombosis, post-operative complications were reported in the control group including haemorrhage from the sternotomy wound in 1 (3.3 %) case, superior vena cava thrombosis in 2 (6.6 %) cases, pneumonia in 2 (6.6 %). The relative risk of complications and lethal outcome was calculated for patients from both groups. It was found that the risk of complications was twice as high in the control group as in the experimental group (standard error of relative risk equals 0.64).
 Conclusion. The first mandatory step of the radical surgery in patients with thymomas with SVC invasion should be the auriculo-jugular and auriculo-subclavian bypasses, which can reduce the relative risk of post-operative complications by a factor of the risk of lethal by a factor of 3.5

Immunotherapy by anti-GD2 antibodies in patients with primary high-risk neuroblastoma, primary resistant and relapsed disease: Raisa Gorbacheva Memorial Research Institute of Children Oncology, Hematology and Transplantation, First Pavlov State Medical University of St. Petersburg experience

Introduction. The long-term event-free survival of patients with high-risk neuroblastoma (NB) receiving intensive complex therapy according to current russian standard do not exceed 40 %. Also, there is no standard tactics in patients with primary resistant and relapsed disease, most of them die due to disease progression. While, anti-GD2 immunotherapy (IT) proved to be effective in patients with high-risk NB, in Russian Federation this method is not generally available. There are currently two pilot studies ongoing in Raisa Gorbacheva Memorial Institute aimed to evaluate the effectiveness of anti-GD2 antibodies in high-risk NB patients.Aim of the study – describing a single-center experience of anti-GD2 IT in primary high-risk NB patients and patients with primary resistant and relapsed disease.Materials and methods. A total of 20 patients received anti-GD2 antibodies, 16 of them were included into pilot trials. The median age at IT initiation was 5 (3–17) years. In 13 cases the therapy was initiated in patients with high-risk disease after auto-HSCT, in 3 cases – in patients with 1st systemic relapse of primary resistant disease after 2nd-line therapy and haplo-HSCT, in 1 case – in patient with 2nd chemosensitive relapse after haplo-HSCT. Also, 3 patients with progressive chemoresistant disease received anti-GD2 antibodies as monotherapy (n = 1) or in combination with chemotherapy (n = 2) as salvage regimen.Results. Patients receiving anti-GD2 antibodies after auto-HSCT retain response to therapy in 11 of 13 cases with a median follow-up period of 15 (6–27) months, in 2 cases there was disease progression during or immediately after IT cessation. Both patients with disease progression responded well to salvage therapy. Two of 3 haplo-HSCT recipients with prior good response to 2nd-line therapy are currently in remission 16 and 36 months past haplo-HSCT, one patient progressed 55 months after transplantation. A patient with 2nd late relapse after haplo-HSCT currently maintains remission on IT. Both patients with chemorefractory progressive disease did not respond to IT and died due to disease progression. IT was characterized by acceptable toxicity. In most cases it was complicated by Gr 1–2 fever, rash or neuropathic pain effectively controlled by supportive therapy. However, three patients had signs of neurotoxicity requiring therapy termination in one case.Conclusion. Dinutuximab beta IT is characterized by acceptable toxicity. With a median follow-up of 18 (6–59) months the majority (14 of 17) patients receiving anti-GD2 antibodies as maintenance therapy after auto- or allogeneic HSCT retain response. However, we did not observe any response in patients with progressive chemorefractory disease.

Evaluation and treatment of peripheral nervous system dysfunction in patients with prediabetes

The worldwide prevalence of prediabetes is steadily increasing, with up to a third of patients already showing signs of diabetic neuropathy (DN). Prediabetes includes impaired fasting glucose (IFG), impaired glucose tolerance (IGT), or a combination of both.Recent diagnostic criteria of prediabetes according to Russian, European, and American clinical guidelines are presented. The review covers the most common forms of DN in patients with prediabetes (distal symmetric sensory polyneuropathy, painful DN, cardiovascular autonomic neuropathy) and their prevalence. Recommended methods of DN screening are discussed: diagnostic scales, sensory testing, nerve conduction study, autonomic testing, corneal confocal microscopy. The results of studies evaluating instrumental methods for diagnosing peripheral nervous system (PNS) dysfunction in prediabetes are discussed. Management tactics in patients with prediabetes and PNS dysfunction should include non-pharmacological and pharmacological interventions. Combining a low-calorie diet and regular physical activity can delay the development of diabetes mellitus and reduce the severity of neuropathic pain. In patients with painful DN, the first-line therapy includes pregabalin, gabapentin, and duloxetine. Since there is no current data on the effect of hypoglycemic therapy on the risks of development and/or progression of DN in patients with prediabetes, antioxidants are considered pathogenetic therapy. Alpha-lipoic acid (Berlition®) in the management of patients with prediabetes is discussed.

Возможности выявления латентной ППИ при ревизионном эндопротезировании коленного сустава

Abstract. Introduction The paper presents a comparative analysis of routine screening methods and the EBJIS 2021 algorithm in detection of latent periprosthetic joint infection in patients admitted for revision knee arthroplasty due to aseptic loosening and after spacer implantation. Materials and methods Group 1 included 49 patients who underwent revision knee arthroplasty due to aseptic loosening, group 2 were 47 patients with PJI after spacer implantation. Results and discussion There were no significant differences between patient groups in terms of age, gender, and preoperative ESR and CRP levels. In 62.2 % of all cases, the aspirate was inappropriate for cytological examination; this fact limited its diagnostic value. The most frequently intraoperatively isolated pathogen in both groups was coagulase-negative staphylococci. However, in 70 % of cases these results were not diagnostically significant, and infection was diagnosed only in 8.2 % of cases in group 1 and 12.8 % in group 2. Moreover, the chances of isolating the pathogen from tissue biopsies were 5.6 times higher than from intraoperative aspirate (OR = 5.6, 95 % CI = 1.2-26.4). In case of negative preoperative aspirate, in almost 25 % of cases, pathogens were isolated from intraoperative tissues, 40.9 % of them were diagnostically significant. The chances of its detection increased 4.7 times in combined increase in ESR and CRP blood level (OR = 4.686, 95 % CI = 0.765-28.700). Using EBJIS 2021 criteria, infection was confirmed in more than 10 % of cases in each group, and the diagnostic significance of the criteria exceeded the significance of using routine screening methods. At a follow-up period of more than 2 years, the effectiveness of treatment was 95.3 %, while signs of infection were detected in 4.7 % of cases, regardless of the group. Conclusion EBJIS 2021 criteria are characterized by high diagnostic sensitivity and specificity and enable to identify periprosthetic joint infection in knee revision cases even in its latent form and to correct treatment tactics in patients without a history of PJI.

Результаты применения усовершенствованного витреоретинального вмешательства при пролиферативной диабетической ретинопатии

Purpose. To improve the technology of combined vitreoretinal intervention, including preliminary intravitreal injection of angiogenesis inhibitors followed by vitrectomy and a differentiated approach to internal limiting membrane peeling in patients with proliferative diabetic retinopathy (PDR). Material and methods. The research based on analysis of morpho-functional parameters 134 patient's eyes with PDR during type II diabetes mellitus. The patients were divided into 2 groups. The first group consisted of 30 patients (30 eyes), who were determined optimal period for vitrectomy. That patients underwent fundus photography and optical coherence tomography during 1 month after intravitreal injection of ranibizumab. Vitrectomy was performed within 1-3 months (38.4 ± 5.6 days). The second group consisted of 104 patients (104 eyes) who underwent vitrectomy with a differentiated approach to internal limiting membrane peeling and tamponade of the vitreous cavity. Results. The optimal period for vitrectomy in patients with PDR is 10-14 days after preliminary ranibizumab injection, which is due to the maximal regression of neovascularization and minimal traction on the retina (the risk of developing local traction retinal detachment decreases by 36.6%). Carrying out vitrectomy in optimal period helped to reduce the risk of intraoperative hemorrhagic complications by 4.2 times, the frequency of using perfluorocarbons by 3.7 times. At postoperative period, in patients without internal limiting membrane peeling on the silicone oil tamponade, the risk of epiretinal fibrosis increased 2.7 times compared with the data before treatment, and 1.8 times on air-gas mixture tamponade. Conclusion. The optimal surgical tactic for patients with PDR is preliminary intravitreal injection of angiogenesis inhibitors before vitrectomy, internal limiting membrane peeling at silicone oil tamponade (frequency of epiretinal fibrosis 96%) and individual approach to surgical correction of macular area at gas-air mixture tamponade (frequency of epiretinal fibrosis 36%), which allows to achieve a progressive improvement in morphological and functional results. Key words: proliferative diabetic retinopathy, preliminary anti-VEGF therapy, vitrectomy, internal limiting membrane peeling.

Results of a six-year prospective study of surgical treatment of patients with combined atherosclerosisof coronary and brachiocephalic arteries based on differentiated approach

Objective. To present the results of surgical treatment of patients with multifocal atherosclerosis based on a differential approach of surgical strategy.
 Materials and methods. During the period of 20142021 in the S.G. Sukhanov Federal Center for Cardiovascular Surgery, Perm, we operated 243 patients with combined atherosclerosis of coronary and carotid arteries; 104 (42.8 %) patients underwent a one-stage coronary and carotid artery surgeries, and 139 (57.2 %) patients underwent a staged correction of pathology. Critical lesion of the coronary arteries was revealed in 16 (6.6 %) patients, single-vessel critical lesion in 24 (9.9 %), two-vessel and three-vessel critical lesion was detected in 87 (35.8 %) and 79 (32.5 %) patients, respectively. 145 (59.7 %) patients had a critical lesion of the carotid arteries, and 16 (6.58 %) had a bilateral critical lesion. We have developed an algorithm for choosing treatment tactics in patients with concomitant atherosclerotic lesions of the coronary and carotid arteries. Depending on our differential approach, we selected 104 (42.8 %) patients who underwent a one-stage surgery, and 139 (42.8 %) patients who were subjected to a staged treatment.
 Results. A total hospital mortality was 0 %. In the staged group, 1 case of transitory ischemic attack (TIA) (0.7 %) was recorded, in the group of combined interventions there was no TIA. In the group of combined interventions, there were 3 (2.9 %) cases of the perioperative stroke and 1 (0.9 %) case of myocardial infarction. In the group that underwent staged interventions, there were 2 (1.4 %) cases of perioperative stroke and 2 (1.4 %) cases of myocardial infarction. Both groups had similar combined results (death, acute MI, stroke) 5 (3.6 %) for the staged group and 4 (3.8 %) for the combined one. There was no significant difference in any of the endpoints.
 Conclusions. The proposed approach to the choice of techniques for treatment of combined lesions of the carotid and coronary arteries based on the differential approach is safe and permits to adequately eliminate the lesions.

ОПТИМИЗАЦИЯ ТЕРАПИИ ТРУБНО-ПЕРИТОНЕАЛЬНОГО БЕСПЛОДИЯ, ОБУСЛОВЛЕННОГО ХРОНИЧЕСКИМ САЛЬПИНГИТОМ

The outpatient stage of therapy is the primary and very responsible link in the introduction of patients with chronic forms of VZOMT, since this pathology has a significant impact on such indicators as perinatal, maternal morbidity and mortality. In addition, VZOMT directly affects the development of infertility, ectopic pregnancy, habitual miscarriage, as well as a decrease in the ovarian reserve after unsuccessful attempts of in vitro fertilization, surgical interventions on the appendages of the uterus. To preserve the reproductive function in patients with VZOMT, an important stage is the implementation of a number of therapeutic and rehabilitation measures. The problems of treatment and rehabilitation of patients with VZOMT undoubtedly remain relevant, since cases of relapses and chronization of inflammatory processes significantly worsen the prognosis for a woman's reproductive function. These problems are both social and economic. Taking into account the wide range of infectious agents of VZOMT, it is recommended to use a complex of antibacterial drugs that cover as many varieties of pathogenic and conditionally pathogenic flora as possible. Moreover, an important aspect of the treatment of inflammatory diseases of the female reproductive system is the use of different forms of drugs and ways of their administration. It is rational to combine oral or parenteral with intravaginal. This combination makes it possible to increase the effectiveness of treatment and contributes to the prevention of relapse of the disease. The inclusion of prednisolone – 21 phosphate in the therapy complex also contributes to increasing the effectiveness of therapy, since it creates favorable conditions for the vital activity of normal microflora and unfavorable conditions for conditionally pathogenic microflora. The results obtained in the study indicate a good clinical effectiveness of complex therapy with the inclusion of Elzhina in the treatment regimen for the treatment of fibrotic processes in the fallopian tubes. The use of a combined drug for intravaginal use containing ornidazole-500 mg, prednisolone-3 mg, econazole-150 mg, neomycin 65000ME (Elzhina drug) allows optimizing the management tactics of patients with tubal – peritoneal infertility caused by chronic salpingitis and increasing the fertility rates in this group of patients.

Determination of procalcitonin content in blood serum, urine, and ejaculate for the diagnosis of urogenital tract pathology

The determination of the concentration of procalcitonin (PCT) in blood serum and other biological fluids is used for the diagnosis and monitoring of the course of sepsis and the syndrome of a systemic inflammatory reaction. This review summarizes the data on the diagnostic value of the definition of procalcitonin in the practice of urologists and andrologists. The content of procalcitonin in such biological fluids as urine, seminal plasma is almost 10 times higher than the level of this protein in blood serum: this phenomenon is manifested in physiological conditions and in pathological processes. The relationship of clinical and laboratory indicators of inflammation with the severity of urosepsis was analyzed. Elevated serum procalcitonin levels are considered as a predictor of septic shock in patients with urolithiasis, and determine the management tactics of patients with urinary tract obstruction. The marker function of this protein was studied in inflammation in the renal parenchyma, in malignant neoplasms of the kidneys, bladder, ureter, prostate and testis; in the diagnosis of testicular torsion and orchiepididymitis. The article describes the regular changes in the level of urinary procalcitonin depending on the severity of vesicoureteral reflux, the severity of the manifestations of the inflammatory reaction. There were significant differences in the concentration of procalcitonin in seminal plasma between the groups of men with reduced and normal ejaculate fertility.

Hepatosplenomegaly in liver cirrhosis is caused by reactive oxygen species formation, an increase in apoptosis and autophagy, and pronounced autoimmune reactions

Various factors of infectious and toxic genesis can lead to the liver cirrhosis, often accompanied by complications such as recurrent bleeding due to portal hypertension against the background of hepatosplenomegaly. Metabolic changes and disturbances in immunoreactivity occur in the liver and spleen. To substantiate the choice of personalized treatment tactics for patients with hepatosplenomegaly, we investigated individual metabolic predictors and immunopathological processes in patients with: liver cirrhosis and hepatitis B (HBV) and/or hepatitis C (HCV) viruses (I group, n = 52); with herpes viruses CMV (cytomegalovirus) and EBV (Epstein-Barr virus) (II group, n = 48), and with splenomegaly and frequent recurrent bleeding associated with hereditary enzymopathies (III group, n = 15). We used the methods of immunoturbidimetry; enzyme immunoassay; light, fluorescence and confocal microscopy. In group I (HBV/HCV), we revealed a decrease in the C4 component; a significant increase in the phagocytic index and phagocytic number, a reduced number of active phagocytes and the digestion index; a decrease in the IL-1β content and an increase in IL-18 and IL-6. In group II (CMV/EBV), we revealed a high activity of the C3 and a low activity of the C4 component against the background of a high level of ROS in neutrophils; the antineutrophil antibodies (ANCA) formation in 85.7% of patients (71.4% –perinuclear antibodies (pANCA) to myeloperoxidase; 14.3% – cytoplasmic antibodies (CANCA) to proteinase 3). Also, in group II, an increased level of pro-inflammatory cytokines IFN-γ, IL-1β, TNF-α, IL-18 and anti-inflammatory IL-6 was detected. Changes in links of immunity in II group led to the formation of autoimmune reactions in 64.7% of patients, which was expressed in the development of a broad range of antinuclear antibodies ANA (11 specificities, including ANA to chromatin and chromatin-associated proteins, to proteins cytoskeleton, enzymes and enzyme complexes). In group III, we revealed a low absorption capacity of neutrophils, a high frequency of antineutrophil antibodies pANCA occurrence and cANCA (in 67.2% of the examined), and low concentration of TNF-α. The developed model of the stepwise change of immunological markers makes it possible to substantiate the choice of a complex targeted treatment, including antiviral and immunotropic therapy.

The Point-Rating Scale for Determining Treatment Tactics in Patients With Adhesive Small Bowel Obstruction

Relevance. The most practiced method of treating patients with acute intestinal obstruction - urgent surgical intervention - does not guarantee remission, contributing to the progression of morphological changes in the abdominal cavity. From this perspective, a shift in emphasis towards the planned surgical treatment of patients with adhesive disease with the use of the existing anti-adhesive methods after conservative resolution of the intestinal passage disorders looks like a promising direction.Aim of the study. Improving the results of patients with acute adhesive intestinal obstruction treatment by developing a point-rating scale that allows to highlight groups of patients who are prone to conservative resolution of intestinal passage disorders episode, and, thereby, reduces the proportion of urgent interventions.Material and methods. The analysis of the 125 patients treatment results (retrospective group) admitted with symptoms of acute adhesive intestinal obstruction was carried out. On this basis, the point-rating scale was developed including a number of factors that have certain value in terms of predicting the probability of conservative therapy success. Subsequently the developed scale was applied in 170 patients (prospective group) as part of treatment tactics implementation aimed at maximally conservative resolution of adhesive intestinal obstruction without negative effect on the immediate results of patients operated in later periods.Results. The developed point-rating scale made it possible to reduce the frequency of urgent interventions among patients with signs of acute adhesive intestinal obstruction (from 79.2% to 57.6%) due to longer conservative measures — 18.1±17.2 and 11,2±8.7 hours in prospective and retrospective groups, respectively). There was no negative impact on the frequency of resection interventions (12.2 and 16.1% in the prospective and retrospective groups) as well as postoperative complications and overall mortality.Conclusions. The developed point-assessment scale made it possible to stratify patients in accordance with the probability of conservative therapy success and to justify its continuation for more than 12 hours in low-risk patients. The obtained results allow us to recommend the proposed scale for use in clinical practice.

Возможность применения органосберегающей тактики у пациенток с маткой Кувелера

Возможность применения органосберегающей тактики у пациенток с маткой Кувелера

Дифференциальный подход к лечению макулярных кровоизлияний при ретинопатии valsalva

Purpose. Analysis of the diagnosis results and treatment of patients with macular hemorrhages in Valsalva retinopathy. Material and methods. The analysis was included 4 patients (4 eyes) with a diagnosis of Valsalva retinopathy. All patients were underwent a standard ophthalmological examination, as well as optical coherence tomography with angiography function (OCT-A). Results. To evaluate the results obtained in the course of a different approach to the treatment of macular hemorrhages. Conclusion. It is necessary to determine the approach to the choice of treatment tactics for patients with Valsalva retinopathy in a timely and differentiated manner, taking into account the prescription of the pathological process, the localization and volume of hemorrhage. Key words: macular hemorrhage, preretinal hemorrhage, internal limiting membrane (ILM), Valsalva retinopathy.