Tactics Of Patients Research Articles

«Masks» of alcoholic polyneuropathy

The paper considers the aspects of clinical manifestations, diagnosis, and therapeutic approaches in alcoholic polyneuropathy (PNP). It gives the data available in the literature on the prevalence of this disease in different countries and on the frequency of alcohol drinking in men and women. The author describes main risk factors for alcoholic PNP, such as malnutrition, thiamine deficiency, direct alcohol toxicity, and a familial history of alcoholism. She characterizes the most important pathogenetic mechanisms in the development of PNP. Particular attention is paid to the clinical presentations and diagnosis of main types of PNP, such as toxic alcoholic (due to directly toxic effects of alcohol metabolites) and alcohol-related thiamine-deficient ones. The paper presents the management tactics in patients with various types of alcoholic PNP, which include combination treatment and ensure the impact (alcohol refusal; balanced nutrition with the addition of various medications) on the etiological factor of the disease. Taking into account the available evidence base, it is necessary to prescribe B-group vitamins to these patients. Alpha-lipoic acid preparations that have an effect on the peripheral and central nervous systems occupy a separate place in the treatment.

New approaches to managing patients with hypertensive crisis (sudden increase in blood pressure)

The article discusses management tactics for patients with hypertensive crisis – a sudden increase in blood pressure, which is based on the assessment of end-organ damage. In the presence of acute end-organ damage, condition is defined as hypertensive crisis and requires immediate intensive care. In this case, intravenous administration of drug is necessary, the choice of which depends on the type of end-organ damage. Gradual decrease in blood pressure and selection of long-term antihypertensive therapy on an outpatient basis is recommended for patients with hypertensive crisis without acute end-organ damage.

The surgical treatment of destructive pulmonary tuberculosis in petients with diabetes

The purpose of the study was to improve quality of surgical treatable of destructive pulmonary tuberculosis in patients with diabetes.Materials and methods. D.B. Giller and employees of the Department of Phthisiopulmonology and Thoracic Surgery of the First Moscow State Medical University M.I. Sechenov performed operations on 200 patients with diabetes due to tuberculosis. Group 1 was mustered from 78 patients from 2004 to 2009. Group 2 was mustered from 122 patients from 2011 to 2017.Results. An analysis of the results showed that after 31 operations, 27 (13.5%) patients from both groups developed 33 complications. The second group (6,6 %) had fewer complications after surgery than the first group (24,4%) 3.7 times. The first group had more vulnerary and bronchopleural complications than the second group. 12 patients (15,4%) of the first group and 6 patients (4,9%) of the second group had bronchopleural complications (empyema, residual cavity, delayed expansion of the lung and intrapleural bleeding). 2 patients died in the hospital (30-day mortality was 0.66%) after 303 surgical intervention in both groups. 1 patient (0.9%) died after 106 surgical intervention in the first group. 1 patient (0.5%) died after 197 surgical intervention in the second group. The full effect was achieved in 75 (96.2%) patients in the first group and 114 (93.4%) in the second group. The survival value of patients of the second group was 100% after 1 year, 98% after 2 years, 98.8% after 3 years, 96.9% after 4 years, 95.2% after 5 years. The surgical treatable affected the occupational rehabilitation of patients from group 2. 61.5% of patients from group 2 became able to work after 1 year. 64.5% of patients from group 2 became able to work after 5 years.Conclusion. If doctors will use our tactics in patients with destructive pulmonary tuberculosis and diabetes, the risk of complications after surgery dropped and reactivation of tuberculosis will not occur.

MICRORNA-122 AS A BIOLOGICAL MARKER OF CHRONIC VIRAL HEPATITIS C

New epigenetic markers are being studied in various countries around the world to diagnose, predict, and treat the patients with chronic viral hepatitis C. Epigenetics is currently studying the hereditary changes in gene expression or phenotype that are not related to the changes in DNA sequence. One field of epigenetics is the expression of RNA that does not encode a protein, namely miRNA, which is a molecule 18−22 nucleotides in length that plays a crucial role in regulating gene expression. Circulating miRNAs are a new genetic material that can be isolated from a patient's blood. The expression level of a particular miRNA has different biological and clinical effects. By means of its determination in various miRNAs it is possible to predict development of diseases. In order to study the baseline expression of miRNA−122 in patients with chronic viral hepatitis C with the first HCV genotype, 74 patients were examined. Diagnosis and monitoring of the patients was performed according to the local protocols and bioethical standards. The level of miRNA−122 expression in patients with chronic viral hepatitis C with the first HCV genotype was established by reverse transcription. Studies show that the level of miRNA−122 expression in the patients with HCV and healthy individuals showed significant variability. The obtained data indicate that the expression level of miRNA−122 in patients is 29 times higher than in healthy individuals at p = 0.0001 (U; Z). This can be an additional biomarker as an index of the presence of chronic viral hepatitis C and can be further used in practice. Therefore, the high level of miRNA−122 expression in subjects (≥ 8.771 rel. units (Log10 miR−122 ≥ 0.939 rel. units)) may be the basis for further screening of patients for HCV infection. The prospects of using this index, which will allow to personalize the diagnosis and treatment tactics for patients, that, in turn, will contribute to the implementation of the WHO global strategy for the elimination of viral hepatitis. Key words: chronic viral hepatitis C, miRNA−122, elimination of viral hepatitis, biological marker.

Комплаентность, социально-психологический профиль и удовлетворенность пациентов пожилого и старческого возраста оказанием кардиологической помощи в условиях стационара

Objective. The aim of the study was to investigate the compliance, social and psychological profile and satisfaction of elderly and senile patients with cardiological care in a 24-hour in-patient hospitalization. Materials and methods. 400 elderly and senile patients were hospitalized in the District Hospital of Kostroma District No 1 and randomized in the study. Compliance of patients and social and psychological profiles were evaluated. The types of temperament of patients, valuable orientations and skills to communicate were determined. The individual strategy and tactics of patients’ behavior in a conflict situation and the level of motivation of patients for success in treatment were investigated. Results. Senile patients are more critical than elderly people in assessing the medical care provided and are more likely to have extreme levels of compliance, which can be expressed either in the "blind" implementation of doctors recommendations, or in their partial or complete disregard for and lack of confidence in medical appointments. Social and psychological factors that negatively affect the formation of satisfaction of patients of elderly and senile age with the cardiological care in hospital conditions are melancholic type of temperament, extreme levels of communicability, opposing style of behavior in conflict, suspicious style of interpersonal relations, and high level of motivation for success in treatment. Conclusion. When working with patients, their personal characteristics should be taken into account, stage-by -stage psychological counseling should be carried out with the formation of the psychological portfolio of the patient.

DIFFERENTIATED TREATMENT TACTICS IN PATIENTS WITH RECTAL FOREIGN BODIES

Summary. Patients with rectal foreign body (RFB) are quite rare in the practice of emergency surgeons. There are different techniques for deleting RFB depending on the features of the object being entered. There is still no standardized protocol for the surgical treatment of such patients.
 Aim. To analyze the immediate and long-term results of treatment of patients with RFB. Introduce differentiated therapeutic tactics into the practice of urgent surgeons depending on the characteristics of the foreign body and the presence of complications.
 Materials and research methods. Three patients with RFB were treated in the surgical department of SRCH during 2018-2019. Their average age was (38 ± 3.6) years. The algorithm of the examination consisted of a physical examination, a rectal finger examination, a radiological and a laboratory examination.
 Results and discussion. In two of the patients, the cause of RFB was sexual abuse, and in the third, violent acts. Removed objects: dildo, metal deodorant bottle and glass beaker. RFB in all individuals was diagnosed with a finger rectal examination. In one patient with RFB was removed under local anesthesia, and in two patients used general anesthesia with muscle relaxants. In one case, an attempt to remove RFB was successful, in the other, a laparotomy, colotomy, and preventive sigmostomy were required.
 Conclusions. Patients with RFB need differentiated therapeutic tactics. In most patients, it is possible to remove it in a conservative way, peranally, using local anesthesia or endotracheal narcosis with muscle relaxants. For large, tightly clamped objects that cannot be removed conservatively indicated open laparotomy, colotomy.

Insulin resistance: Unsolved issues of harm and use

Insulin resistance, diagnosed in more than half of cardiac patients, is considered to be a negative factor contributing to further exacerbation of existing metabolic disorders and the progression of cardiovascular diseases (CVD). However, recently, scarce data emerged suggesting that about a quarter of obese people have a favorable prognosis of CVD. These data allowed us to make an assumption that insulin resistance in high-risk patients may represent some kind of a protective mechanism that prevents damage to the organs and tissues of the cardiovascular system. This review discusses the potential protective mechanisms of insulin resistance and the possibilities of their clinical use in choosing the treatment tactics in patients with obesity, type 2 diabetes mellitus, and poorly controlled glycemia.

Protein CRABP1 as one of the possible prognosis factors in children with high-risk neuroblastoma

Neuroblastoma (NB) is the most common extracranial solid tumor of childhood, accounting for 6—10 % of all malignant neoplasms in children. One of the fundamentally important problems for the clinician is the stratification of the risk group and the definition of treatment tactics for patients with NB. In this work, we studied the dependence of the expression of CRABP1 protein in the primary focus and tumor metastases on the type of genetic disorders (amplification of the MYCN gene, deletion of the 11q23 locus) and the effect of the therapy in patients with NB.

ДИАГНОСТИКА И ВЫБОР ХИРУРГИЧЕСКОЙ ТАКТИКИ ПРИ ШЕЙНО-ЗАГРУДИННОМ ЗОБЕ

Background. The frequency of retrosternal goiter is 10-15% of the total number of surgical thyroid diseases. The main treatment method is surgery. The relevance of the work is determined by the contraventions in algorithm for the preoperative sternotomy risk assessment in this group of patients. Objective: to identify factors that increase the risk of sternotomy in patients with retrosternal goiter. Material and methods. The study was performed in the St. Petersburg City Hospital 26 in 2011–2019. During this period 1156 operations for thyroid diseases were performed. Retrosternal goiter was detected in 227 (19.6%) patients. Results. The clinical picture of the retrosternal goiter was polymorphic and depended on the degree of compression of mediastinal organs and vessels. Long-term compression of the organs of the neck and mediastinum contributes to relative compensation and the asymptomatic course, which was observed in 78 (34.4%) cases. The main diagnostic method for retrosternal goiter was radiological. Computed tomography helped to the mediastinum. The most significant factors in determining the likelihood of sternotomy were: the size of the retrosternal part of the goiter and its relationship with the upper thoracic aperture, localization of the goiter in the anterior or posterior mediastinum, the relations of thyroid tissue with vital organs, large vessels and nerve trunks. Combined cervical access with longitudinal transverse sternotomy was planned in 18 cases, but the real need for it was only in 2 (0.9%) cases. Conclusion. Computed tomography with 3-D reconstruction is the leading method of differential diagnosis and determination of surgical treatment tactics in patients with retrosternal goiter. In most cases, surgery is possible through cervical approach, but it is necessary to foresee the likelihood of sternotomy. Determining only the absolute dimensions of a goiter does not always determine the need for longitudinal-transverse sternotomy. An important role is played by a combination of risk factors.

Personificated approach to management tactics for patients with atrophic vulvovaginitis in postmenopause

Personificated approach to management tactics for patients with atrophic vulvovaginitis in postmenopause

PREDICTION OF THE DEVELOPMENT OF INSOLVENCY OF ANASTOMOSES ACCORDING TO THE LEVEL OF CRYOBILK

Abstract. The aim of the study was to create individualized surgical treatment tactics in patients who underwent anastomosing intestinal surgery using the express method for determining cryoglobulins. The study was based on a study of the results of treatment in 96 patients who underwent resection of segments of the small intestine with the formation of inter-intestinal anastomoses, in the SI «ZIGUS NAMSU» during the period from 2015 to 2018 years. Using a high-quality rapid method for the determination of cryoglobulinemia (CGE) during surgery can significantly affect surgical tactics: with a low level of cryobilk in blood serum, it can perform a resection of a segment of the small intestine with the formation of primary small intestinal anastomoses; when the level of cryobilk in blood serum is more than 80 mg / l, which corresponds to a positive rapid test for cryobilk, one should refrain from the formation of primary anastomoses, and use the tactics of the formation of “delayed” anastomoses, in severe general condition of patients (and a high level of CGE – more 600 mg/l) – also the formation of the final small intestinal stoma.

THE STRUCTURE OF THYROID NODULES IN CHILDREN SUBJECTED TO SURGICAL TREATMENT

The article provides the literary information and the results of our own research on the structure of the thyroid nodules in operated children.The clinical significance of nodular neoplasms of the thyroid gland is determined by the relatively high risk of carcinomas. Along with this, the relevance of this research is due to the increasing of surgical interventions and the fact that the features of nodules in children and tactics of management of patients remain debatable.The aim of the work was to study the structure of thyroid nodules in childrenin various age groups. The case histories of 225 operated childrenfrom 4 to 17 years oldfrom 2007 to 2017 were analyzed. Nodular neoplasms of the thyroid in children were more common. Tumor-like diseases - colloid nodes in childhood were rare, only in 2.2% of cases. The high incidence of thyroid cancer (35.6%) under the mask of nodal goiter determines active surgical tactics in patients with nodal neoplasms in childhood.

Сучасні аспекти терапевтичної тактики хворих на акантолітичний пемфігус

Сучасні аспекти терапевтичної тактики хворих на акантолітичний пемфігус

Kazan version of the classification of congenital heart defects of John Kirklin

The article is devoted to the analysis of classifications of congenital heart defects from a practical point of view. The researchers present their classification of congenital heart defects with the substantiation of optimal terms of surgical correction. The proposed classification allows us to predict possible critical hemodynamic conditions in children with heart defects both in the neonatal period and in other age groups. The classification creates the basis for choosing the treatment tactics of patients with congenital heart defects using the known stages of hemodynamic changes, it has been used by the cardiologists and cardiac surgeons in the Republic of Tatarstan for more than 15 years.

Особенности хирургической тактики у пациентов с инвертированной папилломой околоносовых пазух: клинический случай

Особенности хирургической тактики у пациентов с инвертированной папилломой околоносовых пазух: клинический случай

The influence of clinical, pathological and surgical factors on the occurrence of recurrence of borderline ovarian tumors in different age groups

Background. Borderline ovarian tumors (BOT), due to their unclear biological potential, remain a problem for oncogynecologists. On the one hand, frequent recurrences of tumors, and on the other hand, a high survival rate in the diagnosis of patients requires careful weighing of all risk factors when choosing surgical intervention tactics in patients with BOT. A large number of recurrences of BOT in patients of fertile age lead to disability of patients, deterioration of their quality of life and loss of reproductive function.Objective: evaluation of the influence of clinical and morphological factors (the presence of non-invasive implants, bilateral lesion of the ovaries, the presence of psammous bodies and malignization tricks) and surgical factors (damage to the cyst capsule and carrying out fertility preserving operations) on the recurrence of BOT in various age groups.Materials and methods. The material for the study was the protocols of an in vivo pathoanatomical study of a biopsy (surgical) material obtained from patients with a diagnosis of BOT for the period from 2000 to 2017 inclusive, according to the Regional Forensic Medical Bureau of Kursk. A total of 110 protocols for the first occurrence of BOT and 14 protocols for the tumor recurrences were analyzed. The age of patients undergoing an in vivo pathologic examination ranged from 19 to 75 years.Results and conclusions. It has been revealed that psammous bodies, fertility preserving operations and reproductive age are associated with tumor recurrence. Groups of patients with foci of malignancy and bilateral lesions have a lower risk of BOT recurrence due to the radical surgical treatment tactics and possibly the use of chemotherapy in the first case. Non-invasive implants are not associated with the risk of BOT recurrence.

Clinical Aspects of Prevention and Management of Primary Inferior Oblique Muscle Overaction

Background. Primary inferior oblique muscle overaction (PIOOA) may occur for various reasons and happens to 72 % patients with infantile esotropia. The criterion for the first surgical step is prevalence of vertical or horizontal deviation. The choice of tactics weakening inferior oblique muscle is ambiguous.Aims: to carry out retrospective analysis of PIOOA frequency in patients with infantile esotropia; to assess influence of esodeviation reduction by a surgical, chemodenervational or prismatic method on the existing PIOOA dynamics; to assess clinical and functional results of PIOOA treatment.Methods and methods. The retrospective analysis of 572 patients’ cases lay in assessment of PIOOA frequency and rate in patients with infantile esotropia that manifested under 9 months, with different treatment tactics. The prospective part of the research included two groups of patients. Group 1 (106 patients, 222 eyes) – studying the influence of surgical treatment of PIOOA. Group 2 (127 patients, 207 eyes) – studying the effectiveness of surgical PIOOA treatment. Conclusion. PIOOA frequency in case of different treatment tactics for patients with infantile esotropia is from 17 to 69 %, and the degree of its clinical manifestation is from 1.2 ± 0.4 to 2.6 ± 0.8. Bilateral weakening of medial rectus muscle reduces its probability up to 17–19 %, and the degree of its manifestation up to 1.2 ± 0.4. In cases of combination of PIOOA with infantile esotropia from 20 to 25° with paretic component, it is reasonable to carry out esodeviation reduction by means of bilateral recession, chemorecession or prismatic correction as the first treatment stage, whereas the rate of existing PIOOA is credibly reduced. In cases of choice of tactics, which is necessary for clinically significant reduction or elimination of PIOOA, it is reasonable to carry out chemorecession, marginal partial myotomy or myectomy depending on the PIOOA manifestation.

Possibilities of Ultrasound Dopplerography in Detecting Instability of Atherosclerotic Plaque of Carotid Arteries

Background. Studying the possibilities of ultrasound diagnosis of atherosclerotic lesions of the carotid arteries to determine the treatment tactics of patients with various types of atherosclerotic plaques.Objective. Assessment of the possibilities of ultrasonic triplex research in identifying signs of instability of atherosclerotic plaques of the carotid arteries.Design and methods. The study included 360 patients aged from 28 to 95 years old who were admitted to the St. Petersburg State Budgetary Health Institution “Mariinskaya Hospital” with diagnoses of transient ischemic attack and acute cerebrovascular accident. All patients underwent an ultrasound visualization of the brachiocephalic arteries. Results. Most patients had atherosclerotic plaques of the carotid arteries with a stenosis of up to 75 % and had signs of instability with varying degrees of severity (according to triplex ultrasound). However, it was not possible to reliably assess the presence of hemorrhage in the plaque using a single imaging method.Conclusion. The data obtained indicate the complexity and ambiguity of the studied question. Further detailed examination of the signs of atherosclerotic plaque instability is required using various diagnostic imaging techniques.

ABDOMINOPLASTY IN THE SURGICAL TREATMENT OF PATIENTS WITH COMPLEX ABDOMINAL WALL DEFECTS

Patients with complex abdominal wall defects usually have deformations of the abdomen, which may remain after the operation, and require the solution of a whole ramge of problems. Quite often, abdominal wall defects are combined with a variety of aesthetic deformities that are associated with abnormal postoperative scars, trophic ulcers, and fistulas. Though the restoration or improvement of abdominal wall functionality is the main goal of alloplasty for complex abdominal wall defects, the cosmetic aspects of the operation, sometimes far more important for patients, deserve special attention. The choice of optimal operative access largely depends on lateral surgery, but most surgeons do not pay special attention to it and mainly use framing incisions above the defect or protrusion. By this time, such values ​​as the type, size of the incision, depth, and borders of flaps flaking are reported empirically and often lead to additional deformation of the operative area and the development of complications. Abdominoplasty is one of the most controversial operations in aesthetic and plastic surgery, where complications reach 27.5-30.8%. The concept of "abdominoplasty" provides techniques for the operational correction of abdominal wall deformities presented by excess skin and subcutaneous fat, pathological postoperative scars, as well as defects of the muscular aponeurotic layer in abdominal area. There are several abdominoplasty techniques. The purpose of this work is to determine the efficacy of the modified abdominoplasty in the surgical treatment of complex abdominal wall defects. Materials and methods. The study involved 360 patients with complex abdominal wall defects operated on at the surgical department of the Poltava Municipal Hospital №1 in for the last 10 years. Various deformities of the abdominal wall were detected in 289 patients (80,3%). Localization of the defects can be described as following: M – 306 (85%), L – 31 (8,6%), ML – 23 (6,4%). The size of the defects: W1 – 103 (28,6%), W2 – 188 (52,2%), W3 – 69 (19,2%). Additional diastase rectus muscles were detected in 179 patients (49,7%). The combined surgical diseases were found in 332 patients (92,2%); 18,1% of them were diagnosed to have intra-abdominal pathology. Results and discussion. The following types of dermatolipectomy were used: longitudinal - 77 cases (28,1%), by Babcock - 114 cases (41,6%), by Kelly - 6 cases (2,2%), by Fernandes - 63 cases (22,9%), modified Fernandez - 7 cases (2,5%), by Berson - 3 cases (1,1%), by Torek - 2 cases (0,8%), by Hrazer – 2 cases (0,8%). Simultaneous operations were performed on in 65 patients (18,1%). Types of alloplasty used: «onlay» - 3 cases (0,8%), «sublay» - 289 cases (80,3%), «sublay-inlay» - 38 cases (10,6%), «inlay» - 3 cases (0,8%), Ramirez – 4 cases (1,1%), intra-abdominal - 2 cases (0,6%), combine – 21 (5,8%). Conclusions. The term abdominoplasty has a broader definition than it was considered previously. Differentiated surgical tactics for patients with complex abdominal wall defects improves the abdominoplasty outcomes.

Surgical tactics with acute pancreatitis complicated ascites-peritonitis

Fluid accumulation in the peri-pancreatic region and the distal areas of the abdominal cavity is widespread in the early stage of acute severe pancreatitis. The fluid is mainly hemorrhagic ascites, rich in activated lipolytic and proteolytic enzymes, vasoactive substances and inflammatory cytokines, and is aseptic at the onset of the disease. Evacuation of a fluid rich in potentially toxic mediators from the abdominal cavity is supported in a number of publications as a rational measure to alleviate the burden of disease in critically ill patients.The purpose of the study was to analyze recent publications on surgical tactics for enzymatic peritonitis and its impact on acute severe pancreatitis. A thorough analysis of the literature made it possible to draw the following conclusions related to the state of this problem. To date, randomized clinical trials and publications show controversial data on the efficacy of surgical interventions for acute pancreatitis complicated by ascites-peritonitis. International recommendations have a low level of evidence regarding the effectiveness of drainage, lavage and video-laparoscopic rehabilitation due to inclusion of patients with non-severe pancreatitis into individual studies. Optimization of surgical tactics in patients with ascites-peritonitis in severe pancreatitis may be associated with the definition of: the severity of the condition in patient with ascites-peritonitis, parapancreatitis severity, toxicity level of ascites-peritonitis, indications and optimal drainage / lavage time. To address these issues, there is a need for further prospective studies.