Treatment Tactics In Patients Research Articles

Biomechanics cerebral and carotid arteries: aneurysm development and atherosclerotic plaque detachment in the presence of combined pathologies

Today, the main cause of mortality in the world remains cardiovascular diseases. In this case, the combined pathology of the neck and head arteries, in which atherosclerosis affects the carotid arteries and there is a change in blood flow in the vertebral arteries or in the circle of Willis due to aplasia of the communicating artery, significantly increases the risk of aneurysms formation and their subsequent rupture. Assessing the risk of complications in this type of pathological condition may allow the physician to initiate timely preventive measures in specific clinical cases. The paper presents the results of modelling various variants of combined pathologies in the arteries of the neck and head. The segment under consideration includes sections of the common carotid, external and internal carotid arteries, as well as vessels of the circle of Willis and the basilar artery. The main idea of the study was to create a prognostic model to assess the risks of aneurysm formation in the circle of Willis and atherosclerotic plaque rupture in the carotid arteries. Such a system may be useful for physicians in routine practice when planning treatment tactics in patients with combined pathologies of the arterial channel. Based on the literature analysis, a number of pathologies of the cerebral and carotid arteries, most frequently occurring in various combinations, were identified: stenoses of the ICA (30 % and 70 %) and aplasia (absence) of one of the connecting arteries were considered from the point of view of geometrical features. In addition, the character of blood flow in the basilar artery, which can change its direction in steal-syndrome, was taken into account. Based on the analysis of blood flow and wall shear stress, two degrees of risk of aneurysm formation were distinguished. High risk corresponds to cases for which both of these values were statistically significantly different from the norm. Medium risk corresponds to cases for which only one of the values was statistically significantly different from the norm. For models containing atherosclerotic plaques, data on shear and normal stresses on the surfaces of atherosclerotic plaques were tabulated. The risk of plaque rupture on each side was determined for each case by analysing the result sets 11 combinations of pathological conditions with increased risk were indicated.

НЕКРОТИЗИРУЮЩАЯ ИНФЕКЦИЯ МЯГКИХ ТКАНЕЙ. ОБЗОР ЛИТЕРАТУРЫ

Necrotizing soft tissue infection is a potentially dangerous infection often resulting in disability and mortality. Polymorphism of clinical symptoms often makes it difficult to diagnose necrotizing soft tissue infection in the early stages of the disease. The treatment tactics in patients with necrotizing soft tissue infection shall be active and include early surgical intervention and antibiotic therapy. Multidisciplinary approach is a key to successful treatment of the patients with this pathology.

429. BARRETT'S ESOPHAGUS IN CHILDREN

Abstract Background In children, Barrett's esophagus (BE) is much less common than in adults and has its own characteristics. If in adult practice the treatment tactics are quite restrained, then in childhood they are, on the contrary, as radical as possible. Barrett's esophagus is a consequence of pathological gastroesophageal reflux disease, which is considered an obligate precancerous disease, which determines the relevance of research in this direction. Material and research methods 345 children with GERD were examined over 10 years. BE was detected in 52 children, which accounted for 14% of cases. Of these, 20 children had peptic stricture of the esophagus. They were included in the 2nd group of the study. The first group - 32 children without peptic stenosis of the esophagus. The treatment tactics for patients in the first group are fundoplication, after 3 months eradication of BE (electrodestruction or cryodestruction). In the second group - a course of bougienage, fundoplication, with destruction BE, or extirpation of the esophagus for extended peptic strictures of the esophagus. Results Of the 52 children, boys predominated (71%). The average age was 10.2 years In all cases in the first group, antireflux surgery produced a positive result, although it did not affect the regression of metaplasia in the category of patients with an endoscopically negative form. In all patients of the second group, a positive result was obtained, GER was stopped, stenosis and metaplasia of the esophagus were eliminated. Eradication of metaplasia in 45% (9 children) of cases was achieved by extirpation of the esophagus due to extensive peptic stenosis (4-6 cm), and in 55% (11 children) - postoperative endoscopic destruction BE. Conclusions BE detected in childhood is subject to eradication upon its detection, regardless of the absence of signs of high-grade dysplasia, which is more likely to occur in adulthood. Patients with an endoscopically negative form of BE require clinical observation with morphological control once a year. Extirpation of the esophagus with simultaneous coloesophagoplasty is indicated in children with peptic strictures (4-6 cm) that are not amenable to balloon dilatation against the background of fundoplication for 6 months or more.

Asymptomatic Cholecystitis Presents a New Challenge for Correcting Treatment Tactics in Patients with Gallstone Disease Rather Than Being an Unsolvable Problem of Biliary Surgery

Gallbladder stones, or cholelithiasis, represent a significant public health concern, particularly in Russia, with an incidence of 5-6 per 1,000 people annually. Western countries report a prevalence of 10%-20%, which has nearly tripled in the last three decades due to advancements in diagnostic techniques. Notably, the condition disproportionately affects women and the elderly, with a marked increase in prevalence after the age of 70. Approximately 80% of cases are asymptomatic, and the clinical manifestations develop in only 1-4% of patients annually. Despite the rising identification of asymptomatic cases through enhanced imaging, management strategies remain unclear, leading to hesitancy among surgeons regarding surgical intervention. Current guidelines from various national and international bodies, including NICE and ESGE, advocate for a watch-and-wait approach for asymptomatic patients, citing spontaneous stone clearance. However, the treatment of asymptomatic choledocholithiasis remains contentious, with some guidelines supporting intervention. This ambiguity is compounded by the recognition that complications can arise from unnecessary cholecystectomy, with 10-40% of patients experiencing ongoing symptoms post-surgery. The article emphasizes the need for a comprehensive understanding of asymptomatic cholecystitis, advocating for a meticulous diagnostic approach that considers the potential underlying causes of gallstone formation. The lack of consensus in current literature regarding management strategies highlights the necessity for further research into the natural history of asymptomatic gallstones and the implications of various treatment options. By addressing these complexities, clinicians can enhance patient outcomes and reduce the incidence of post-cholecystectomy syndrome, ultimately leading to more individualized and effective management strategies for patients with asymptomatic cholecystitis.

Консервативная тактика ведения врожденного и инфантильного нефротического синдрома: опыт одного центра

Treatment tactics for patients with congenital nephrotic syndrome (CNS) varies from aggressive kinds, such as early nephrectomy, to conservative ones that include diuretic and nutritional support. The purpose of this research was to assess the effectiveness of conservative treatment of children with congenital and infantile nephrotic syndromes. Materials and methods used: a single-center retrospective study of 11 pediatric patients who had been manifested with NS within their first year of life and had required diuretic therapy, was conducted. The effectiveness of conservative therapy was assessed as preservation of the renal function according to glomerular filtration and satisfactory weight/height and height alone parameters’ dynamics that ensure the safety of kidney transplantation. Results: despite the molecular genetic study was conducted in all 250 children with NS, the described 11 have had verified pathogenic variants as follows: in the NPHS1 gene in 5 (45.5%, CI 16.8-76.6%), in the NPHS2 gene in another 5 (45.5%, CI 16.8-76.6%) and a single patient with none of a kind. It was revealed that despite the persistence of pronounced NS laboratory activity, the edema gradually disappeared against the background of conservative therapy, which in its turn had made it possible to refrain from early nephrectomy as well as to begin the renal replacement therapy over the age of 3 (4) y/o. 9 (81.8%, CI 48.2-97.7%) had satisfactory weight and height parameters at the age of 3 y/o. Only a single patient had undergone the early nephrectomy at the age of 4 months old, that was then followed by a successful kidney transplant at the age of 1 year and 4 months old, which, however, did not affect the then positive height prognosis. Conclusion: thus, reasonably selected conservative therapy for CNS can be effective against edematous syndrome and contribute to satisfactory weight/height growth parameters without early nephrectomy and, accordingly, the start of dialysis during the first year of life.

Choice of treatment tactics in patients with acute bacterial intestinal infections who have a high risk of developing irritable bowel syndrome

Choice of treatment tactics in patients with acute bacterial intestinal infections who have a high risk of developing irritable bowel syndrome

Diagnostic Efficacy of Trephine Biopsy and Core Biopsy of Bone and Soft Tissue Tumors

Verification of pathomorphological diagnosis is a key stage in selection of treatment tactics in patients with neoplasms. Understanding of the nature of pathological process is especially important in context of primary tumors of the bones, soft tissues and metastases as despite active development of diagnostic techniques, they do not allow to obtain full information on histological nature of the tissues, differentiation grade, as well as molecular and genetic characteristics of the tumor. These data are associated with selection of optimal treatment tactics at every stage and disease prognosis. The optimal approach to obtaining histological materials in tumor of the bones and soft tissues are radiologically guided (X-ray, computed tomography and magnetic resonance imaging) trephine biopsy or ultra-sound-guided core biopsy.Aim. To determine information value of trephine and core biopsies of neoplasms of the bones and soft tissues of various locations, identify mistakes during manipulation affecting results of morphological diagnosis.Materials and methods. Between 2015 and 2023 at the Russian Scientific Center of Roentgenoradiology, 788 patients aged 18–85 years (380 men, 408 women) underwent 602 trephine biopsies and 248 core biopsies (n = 850) of neo-plasms of the soft tissues and bones of various locations. Absence of informational value of morphological study required repeat trephine biopsies in 19 patients, core biopsies in 2 patients, open biopsies in 13 patients.Results. Informational value of trephine biopsy of the bones was 90.5 % (long bones – 96.8 %, flat bones – 91.6 %, spine bones – 82.1 %), core biopsy of the soft tissues 98.8 %. Sufficient amount of material for immunohistochemical testing was obtained in 89 % biopsies. Interventions in cases of bone neoplasms were performed using CT (computed tomography) navigation; for core biopsies of the soft tissues, ultrasound was used. Absence of informational value in trephine bio psies was caused by insufficient amount of material (48 (7.97 %) cases), retrieval of trephine biopsy from the area of tumor necrosis (4 (0.67 %) cases), incorrect selection of access (4 (0.67 %) cases) and needle type (1 (0.17 %) case).Conclusion. Results of analysis of trephine and core biopsy data of bone and soft tissue neoplasms showed high information value, which is supported by literature data. This allows to consider these methods of histological material retrieval the “golden standard” of bone and soft tissue tumor diagnosis.

Specific Features of Diagnostic and Treatment Tactics in Patients with Crushed Abdominal Hernias Without Resection of a Hollow Organ.

The purpose of the work is to analyze the results of the use of optimized diagnostic and therapeutic tactics in patients with strangulated abdominal hernias without resection of the hollow organ. Materials and methods: The work is based on the analysis of the results of surgical treatment of 665 patients with strangulated abdominal hernias without resection of the hollow organ, who were divided into 2 groups depending on the features of the diagnostic and treatment tactics. Unlike the patients of group 1, the following diagnostic tactics were used in group 2: substantiated laparoscopic diagnosis of abdominal organs; mandatory biochemical assessment of hernia water; mandatory intraoperative instrumental assessment of the state of the strangulated organ; expansion of indications for the use of laparoscopic interventions and components of the comprehensive Fast track program; substantiated complex prevention of malignancy. The clinical diagnostic algorithm included laboratory, instrumental and biochemical research methods. Results: The use of priority diagnostic and therapeutic tactics in the patients of group 2 allowed to increase the number of laparoscopic hernioplasty by 49.34%, the number of allohernioplasty by 18.62%, among which the "Sublay" technique was preferred for strangulated ventral hernias. This was accompanied by a decrease in the pain syndrome on the VAS scale during the four days of observation, both during coughing and at rest, and amounted to only 2.21 ± 0.29 points on the fourth day when at rest. In addition, and after 12 months, the patients of group 2 observed a better recovery according to the SF-36 questionnaire, which amounted to 76.77±6.63 points for the assessment of the general state of health, 70.81±5.86 points for the assessment of physical functioning, 68.88±5.37 points for the assessment of role functioning due to physical condition, 68.03±5.92 points for the assessment of role functioning due to emotional state, and social activity was characterized by 72.82±5.52 points. Conclusions: 1. The proposed diagnostic and treatment tactics in the patients of group 2 with strangulated abdominal hernias without resection of a hollow organ, in contrast to patients in group 1, made it possible to increase the number of laparoscopic operations to 227 (66.37%) in contrast to 55 (17.03%) in the first group, which was accompanied by a decrease in pain syndrome on the VAS scale on the fourth day when coughing from 4.35 ± 0.38 points to 2.97 ± 0.43 points. 2. The expansion of indications for the use of laparoscopic operations in patients of group 2, in contrast to patients of group 1, led to a decrease in the postoperative complications by 10.48% and the postoperative mortality by 2.29% and was characterized by better postoperative rehabilitation according to the assessment of the patients' condition after 12 months according to the SF-36 questionnaire..

The evolution of views on the complex treatment of esophageal cancer

INTRODUCTION. Currently, the choice of tactics in the treatment of esophageal cancer remains an urgent problem. Important factors are: the stage of the disease, the functional state of the patient, as well as the morphological type of tumor. An integrated approach is today the standard for this pathology. However, after radical treatment, a significant number of complications are observed, in particular, the development of leakage of esophagogastroanastomosis. Today, according to world literature, it is generally accepted that the development of anastomotic leakage is associated with the detection of the disease in late stages, the consequences of radiation during combined chemoradiotherapy, and extensive surgical intervention for esophageal cancer.The OBJECTIVE was to improve the results of treatment of patients with malignant neoplasms of the esophagus and esophagogastric junction, through the use of an integrated approach.METHODS AND MATERIALS. During the period of 1988–2022, treated 2784 patients with cancer of the esophagus and esophagogastric junction were treated at the Republican Clinical Oncology Dispensary named after Prof. M. Z. Sigal. The study group included 1,799 patients who received surgical treatment, combined chemoradiotherapy in combination with surgery, and external beam radiation therapy in combination with surgery.RESULTS. Due to changes in treatment tactics for patients with cancer of the esophagus and esophagogastric junction, postoperative mortality after surgical complications decreased from 24.3 % to 6.2 %, and anastomotic leakage in the postoperative period decreased from 27.0 % to 8.1 %.CONCLUSION. Changes in the treatment of patients with cancer of the esophagus and esophagogastric junction made it possible to reduce the development of postoperative complications and increase life expectancy. The molecular genetic approach allows for effective analysis of screening, early diagnosis, treatment and rehabilitation.

CLINICOMORPHOLOGICAL FEATURES, DIAGNOSTIC AND TREATMENT OF CYSTS OF THE MINOR SALIVARY GLANDS

Small salivary gland cysts occupy a large percentage in the structure of oral cavity diseases in children and adults.
 The aim of the study is to determine the main diagnostic criteria and treatment tactics for patients with small salivary gland cysts.
 Materials and methods. 5 adult patients aged from 21 to 50 years and 2 children aged from 3 and 16 years were examined and surgical removal of small salivary gland cysts was performed. Pathohistologic studies of biopsy material were performed.
 Results obtained. Women (85.7%) prevail among the patients with cysts of the minor salivary gland. The average age of the patients was 27,0±6,1 years. The most frequent localization of small salivary gland cysts was the mucous membrane of the lower lip (85,7%). In 5 patients it was confirmed that the cause of cyst formation was mechanical trauma, namely biting or bruising of the lower lip. Clinically, a cyst of the minor salivary gland was a single oval or rounded mass with a size ranging from 0.4 to 1.1 cm. The average size of the cyst was 0.69±0.08 cm in diameter.
 According to the results of the pathohistological examination, the extravasation type of cyst of the minor salivary gland was determined in 3 patients, the retention cyst was also determined in 3 patients on the lower lip. A superficial extravasation cyst has been diagnosed on a soft palate in a woman aged 50 years old.
 In 3 patients, cystectomy was carried out in a traditional surgical method, in 4 patients with the use of a high-intensity diode laser. Hyaluronic acid gel hyaDENT BG was used to accelerate wound healing after laser ablation.
 Conclusion. Based on literature analysis and own clinical observations, the main etiological factors and clinical-morphological signs of various clinical variants of cysts of the minor salivary glands were determined. It is shown that only the mucous retention cyst is a true cyst, because it histologically has an internal epithelial lining.

Isolated cerebral varices: clinical observations and literature review

The aim of the study is to present rare clinical cases of isolated cerebral varices, summarize scientific literature data on their diagnosis and treatment.The article describes 2 clinical observations of isolated cerebral varix, presents a literature review of this topic, as well as treatment tactics for patients with this pathology.In the first clinical observation, in a male 72‑year-old patient isolated cerebral varix was interpreted as distal saccular aneurysm of the right middle cerebral artery per computed angiography data. Surgical treatment was performed: from subtemporal approach in the area of the floor of the middle cranial fossa, cerebral varix, inflow and outflow veins were visualized. The inflow and outflow veins were clipped, aneurysm was resected and sent to histological examination. The patient was discharged on day 8 after surgery. Histological examination of the cerebral varix wall showed typical components for a venous wall, in particular, individual smooth muscle fibers, absence of elastic membrane.In the second clinical observation, in a female 59‑year-old patient magnetic resonance (MR) imaging, MR angiography and MR venography in the projection of anterior basal parts of the left temporal area showed an aneurysmal malformation transitioning into the superficial middle cerebral vein. Taking into consideration venous pathogenesis of the vascular lesion, dynamic observation of the patient was chosen.Isolated cerebral varix is a rare vascular pathology without a specific clinical and instrumental picture. To avoid erroneous diagnosis and determine further treatment tactics, additional examinations are recommended: MR imaging, MR angiography and MR venography.

Кристаллообразующая активность мочи и методы ее измерения.

ntroduction. Diagnosis and determination of treatment tactics in patients with urolithiasis are based on determining the causes of lithogenesis. At the moment, the standard of examination in patients at high risk of recurrence of urolithiasis is the detection of metabolic disorders based on the results of a biochemical analysis of blood and daily urine, as well as an assessment of the chemical composition of the urinary stone. The violations determined using this approach are a manifestation of the physico-chemical processes of stone formation, the assessment of which is currently practically not performed by urologists, due to the lack of simple diagnostic methods and tools. Materials and methods. The review was conducted on the basis of data published in PubMed databases (https://www.ncbi.nlm.nih.gov/pubmed) and Scientific Electronic Library еLibrary.ru (https://elibrary.ru/), and was limited only to articles in scientific peer-reviewed journals. The search was devoted to the study of the crystal-forming activity of urine, factors affecting the lithogenic properties of urine, as well as methods for assessing the risk of stone formation in the most common metabolic types of urolithiasis. We found 189 sources no older than 10 years (published after 2012) that were relevant to the topic of the review. Conference abstracts, short messages, duplicate publications wereexcluded from them. After that, based on the relevance of the data, reliability of sources, impact factors of journals and the sequence of presentation of the material in the manuscript, 41 articles were selected directly for citation in the review. Also, when writing the review, original articles published before 2012 were used. Results. The analyzed literature sources demonstrated a large number of methods for determining the crystallization properties of urine. However, none of them, in view of the complexity, as well as the ambiguity of the results obtained, have not been widely introduced into clinical practice. In view of this, it is required to develop a simple and informative method for diagnosing the crystal-forming properties of urine, which will increase the percentage of non-reactive urolithiasis. Conclusions. The methods available to doctors for determining the crystal-forming properties of urine are extremely laborious. The development of an easy-to-use and sufficiently accurate real-time determination of the crystallization and anti-crystallization properties of urine, will significantly improve the diagnosis, treatment and metaphylaxis of urolithiasis.

Os odontoideum of C2 vertebra: History and current options to treatment. Literature review. Part 2

The second part of a literature review is presented on a rare pathology of the craniovertebral region, the os odontoideum of the C2 vertebra. This review is non-systematic and was conducted using the databases and search resources: PubMed, Google Scholar, and eLibrary. The second part of this literature review describes historical, including conservative, treatment tactics for patients with os odontoideum, peculiarities of preoperative planning and preparation, as well as modern techniques and options for surgical treatment.

Studying of Thyroid Dysfunction on Patients with Metabolic Syndrome

A retrospective study was conducted several studies aimed at knowing the relationship between the level of thyroid hormone and the metabolic syndrome and according to the results of the study, it is recommended to determine the level of tsh hormone in the pituitary gland in all patients as well as in all patients with risks of developing cardiovascular diseases: in patients who they suffer from obesity, dyslipidemia, arterial hypertension, hyperhomocysteinemia, and tobacco smoking., hereditary factor, diabetes mellitus type 2. No less important is the issue of treatment tactics in patients and in accordance with current recommendations, the appointment of thyroid hormone preparations is indicated for patients with an increase in the level of tsh more than 10 μm / l. The assignment of thyroxine to the boundary level of tsh is still a matter of debate. Most authors consider surgical myocardial revascularization, continuous statin therapy, and correction of subclinical hypothyroidism with small doses of thyroxine to normal tsh values as ideal. The most appropriate is the early detection of subclinical hypothyroidism in patients and correction of disorders identified with thyroid hormone preparations. The study showed that subclinical hypothyroidism is an additional independent risk factor.

Principles of diagnosis and choice of treatment tactics for patients with pancreatic-pleural fistulas

Introduction. Pancreatic-pleural fistula is a rare complication of pancreatitis that has no pathognomonic symptoms and unified approaches to the choice of treatment tactics.The aim of the study was to formulate the principles of diagnosis and choice of treatment tactics in patients with pancreatic-pleural fistulas.Materials and methods. Five patients with pancreatic-pleural fistulas were treated from 2012 to 2022. All patients underwent standard clinical-laboratory and instrumental methods of investigation.Results. The diagnosis of pancreatic-pleural fistula was made at 18−65th day from the disease on the basic of amylase activity in the pleural effusion from 29462 to 51328 U/L. Surgical treatment consisted of pleural cavity and pancreatic pseudocyst drainage in two patients, in one patient we performed pleural cavity drainage and Virsung’s duct stenting, one patient underwent pancreatic duct stenting and repeated pleural punctures, one patient had papillosphincterotomy, video-thoracoscopy and pleural cavity drainage. Discussion Diagnosis of pancreatic-pleural fistulas is based on a set of criteria: history of acute attacks or exacerbation of chronic pancreatitis, presence of pancreatic pseudocyst, recurrent hydrothorax, brown pleural effusion, and high amylase activity in it. Surgical treatment tactics can be staged and characterized by the principle “from simple to complex”.Conclusion. The diagnostic algorithm of pancreatic-pleural fistulas is based on the data on acute pancreatitis, recurrent hydrothorax, hemorrhagic nature of the effusion and high level of amylase in it. The choice of surgical treatment tactics implies combination of pleural cavity drainage with Virsung’s duct stenting, as well as external drainage of pancreatic pseudocyst (if any).

Treatment tactics for patients with combined kidney tumor and urolithiasis (clinical cases)

Annotation. Global medical literature shows an ever-increasing number of patients suffering from urolithiasis and malignant kidney tumors. The number of patients suffering from both conditions also seems to be on the rise. Correlation and interdependence, as well as the preferable course of treatment for these diseases, remain uncertain. The present study aims to map out treatment strategies for patients presenting with both urolithiasis and kidney tumor. In 2013- 2021 21 patients with urolithiasis and kidney tumor were examined and treated in the SI “Acad. O.F. Vozianov Institute of Urology NAMS of Ukraine”. In 61.9% of cases a tumor and calculi were located unilaterally, in 14.3% contralaterally, and in other 14.3% tumor was comorbid with bilateral urolithiasis. 4.75% of patients had a tumor combined with a stone in the upper third of the ureter on the same side, and 4.75% – in the lower third of the ureter on the opposite side. Depending on the localization of a tumor and a stone, the stage of the oncological process, the presence of metastases, clinical manifestations, etc, different treatment tactics have been employed. Simultaneous removal of a kidney tumor and a stone in case of their ipsilateral location was performed in 52.4% of patients. We prioritized organ-sparing surgery in all cases. 9.52% of patients underwent PNLT before the tumor removal. In 9.52% of patients ureterolith removal was followed by kidney tumor removal. 71.4% of patients underwent successful laparoscopic resection of a tumorous kidney, but in 28.6% of patients, attempts to save the organ failed. So, types of combinations of urolithiasis and kidney tumor can be different, hence, it is necessary to apply individual treatment tactics in each case. If the functional state of a tumorous kidney and technical capacity allow it, organ-sparing surgery is highly advisable.

Dupilumab in complex therapy for chronic rhinosinusitis with nasal polyps and asthma

Chronic Rhinosinusitis with Nasal Polyps (CRwNP) caused by T2 inflammation has a complex pathogenesis, for which treatment options include medical therapy (topical and systemic glucocorticosteroids, leuktriene inhibitors, etc.) and surgical therapy, often recurs and significantly reduces the quality of life for patients. Chronic rhinosinusitis with nasal polyps is common in patients with asthma and, particularly, severe asthma and an allergic reaction to nonsteroidal anti-inflammatory drugs. These conditions are in most cases associated with a common pathogenesis, including a type II immune response, hyperproduction of interleukins (IL) 4, 5 and 13, activation of eosinophils and tissue remodeling. Biological therapy which block the effect of IL-4, 5, 13 can significantly improve the condition of such patients. Dupilumab is a humanized IgG4 monoclonal antibody that targets the IL-4 receptor alpha chain (IL-4Rα), thereby blocking the action of IL-4 and IL-13. Currently, dupilumab is approved for asthma, CRwNP and atopic dermatitis. Dupilumab can reduce the number of exacerbations, treatment with systemic corticosteroids, improve the condition of the upper and lower respiratory tract and achieve an increase in FEV1 by 0.2–0.3 L, which leads to a significant control of these diseases. One of the topical issues is the choice of tactics choice of treatment tactics in patients with CRwNP, asthma and nasal septum deviation. This article presents a clinical case of a patient with severe asthma, CRwNP and deviated nasal septum receiving dupilumab for 4 months.

Headache and epilepsy: prevalence and clinical variants

Headache, which is often present in patients with epilepsy, can occur outside of epileptic seizures as well as have a temporary connection with them – occur immediately before, during or after an attack. Clinical types of headache in epilepsy are considered in the International Classification of Headache, but not in the classification of epileptic seizures and types of epilepsy. Meanwhile, the presence of concomitant headache and its clinical phenotype should be taken into account when choosing treatment tactics in patients with epilepsy. The article presents data on the prevalence of different types of headache in patients with epilepsy and a modern classification of cephalalgia depending on the temporal relationship with an epileptic attack. Diagnostic criteria for four clinical variants of cephalgia are given: interictal, preictal, ictal and postictal. The comorbid relationship between epilepsy and migraine is considered in more detail, including the pathophysiological mechanisms underlying the combination of these paroxysmal conditions.

Prophylaxis of postoperative hypoparathyroidism in thyroid surgery.

There are a number of thyroid gland diseases that require surgical treatment. Therefore, it is important to improve the surgical approaches and treatment tactics in patients that need such surgery. To provide an algorithm to prevent parathyroid gland damage during surgery. This work was based on treatment results of 226 patients with different thyroid diseases. All patients received extrafascial surgical interventions using modern methodological approaches. For prevention of postoperative hypoparathyroidism, we used the "stress-test", 5-aminolevulenic acid, and a method of double visual-instrumental registration of photosensitizer-induced fluorescence of parathyroid glands. Transient hypoparathyroidism was registered in four (1.8%) cases after surgery. Permanent hypocalcemia in patients was not recorded. Autotransplantation of parathyroid gland was required only in one case (0.44%). A deficiency or low level of vitamin D was detected in 35% of the cases, and in the majority of those cases, it was due to secondary hyperparathyroidism. The deficiency was corrected with the administration of vitamin D in all cases. In 10.17% (23 patients) of cases, there was no proper visual glow effect after administration of 5-aminolevulinic acid (5-ALA), which required proceeding to the second part of the proposed method (a helium-neon laser and registration of fluorescence using a laser spectrum analyzer). The proposed methodological approach allows prevention of persistent hypoparathyroidism and reduces the frequency of transient hypoparathyroidism and other complications in surgical treatment of patients with various thyroid gland diseases.

Optimal Surgical Treatment Tactics in Patients with Synchronous Metastatic Colorectal Cancer

Aim: The aim of the study is to choose the optimal tactics of surgical treatment in patients with colorectal cancer (CRC) with synchronous intra-abdominal metastases. Materials and methods: The study included 74 patients with CRC with synchronous intra-abdominal metastases (peritoneal carcinomatosis and/or liver metastases), which were divided into 3 groups: I group (25 patients)-Intestinal stoma + neoadjuvant chemotherapy + Cytoreductive Surgery (CRS) + Adjuvant Chemotherapy (ACT); II group (18 patients)-Colon/rectal resection + ACT + CRS + ACT; III group (31 patients)-CRS + ACT. Results: The best oncological results were obtained in III group (median overall survival 46 months vs 27m. in I group and 31m. in II group). In contrast, a higher incidence of postoperative complications was observed also in this group (29%). There is no significant difference in overall survival (p>0.05 according to Log-Rank test) and the rate of postoperative complications between all groups of patients. The mean length of hospital stay was shorter in III group-9.8 days (p<0.01). Conclusions: All three options could be selected for the treatment of synchronous metastatic CRC. Therefore, the main goal remains the achievement of complete cytoreduction. So, it is necessary to focus on its possibility when choosing the sequence of stages of treatment in such patients. However, if it is possible to achieve complete cytoreduction and in the setting of the oncological center it is recommended cytoreductive surgery as the first step followed by adjuvant chemotherapy as the best treatment tactics for patients with synchronous metastatic CRC.