Treatment Tactics Research Articles

The choice of classification to determine the optimal tactics for treatment of the thoracolumbar junction traumatic injuries.

Aim: To evaluate the influence of the degree of detail of the nature of the pathomorphological changes in the osteoligamentous structures on the tactics of treating the patients with the traumatic damage to the thoracolumbar junction. Materials and Methods: A retrospective analysis of the treatment tactics was carried out in 96 patients with a traumatic injury of the thoracolumbar junction, both those who underwent a surgical treatment and those who underwent a conservative therapy. The lesions were classified using F. Magerl and AOSpine classifications; the neurological status was assessed according to the ASIA scale, the nature of the damage was specified using the McCormack criteria. The statistical data processing was performed using the Random Forest machine learning algorithm. Results: The nature of the injury makes it possible to unambiguously determine the optimal method of therapy when using the F. Magerl classification with a probability of 58.33%, while in relation to the AOSpine classification this figure is 55.21%. When building the models that include the nature of the damage, the level of the neurological disorders and the McCormack criteria, it was found that the use of the F. Magerl classification demonstrates an error in unambiguously determining the most effective treatment method at the level of 26.04%, while the use of AOSpine this figure was 21.88%. Conclusions: The application of the AOSpine classification is more promising for the development of a multifactorial algorithm for the treatment of the traumatic injuries of the thoracolumbar junction.

THE DRIVING FORCE OF EXOGENOUS AND ENDOGENOUS STRESS AS AN IMPORTANT FACTOR OF METASTATIC PROGRESSION OF BREAST CANCER. THE ROLE OF GELATINASES IN IMPLEMENTATION OF INVASIVE AND MIGRATION PROCESSES

Summary. The review of the literature draws attention to the fact that, from the modern point of view, oncogenesis is a multistage process in which, along with numerous factors of various origins, stress occupies a prominent place. It has been established that stress triggers mechanisms that lead to the activation of programs such as proliferation, invasion, migration of tumor cells at various stages of neoplasm formation, and due to the integration of these actions, the spread of malignantly transformed cells in the body occurs, namely the recurrence of removed tumors and metastasis. In addition, it has recently been shown that as a result of chronic stress, the polarization of tumor cells towards a more mesenchymal phenotype and the release of proteases, in particular the gelatinases MMP-2 and MMP-9, which carry out the destruction and remodeling of the extracellular matrix, and this promotes the metastasis of malignantly transformed cells. Objective indicators of changes under the influence of stress are given, which, after checking their significance, can be used as prognostic criteria and targets for personalized treatment tactics for patients with breast cancer.

ПРИМЕНЕНИЕ МАЗИ ТРАУМЕЛЬ® С В КОМПЛЕКСНОЙ ТЕРАПИИ ПОСТТРАВМАТИЧЕСКОГО СОСТОЯНИЯ В ПРАКТИКЕ ОТОРИНОЛАРИНГОЛОГА

A clinical case describes the treatment of facial and nasal trauma in a child complicated by rhinosinusitis. The choice of optimal treatment tactics allows you to eliminate the adverse cosmetic and pathophysiological consequences of the injury.

Management of patients with insomnia and polymorbidity. A draft of the clinical guidelines

Insomnia is a serious and widespread public health problem, but is often undetected and patients do not receive needed treatment. Insomnia is often comorbid with other diseases and conditions, such as arterial hypertension, type 2 diabetes mellitus, pain syndromes, anxiety and depressive disorders, etc. A separate problem is drug-induced insomnia, when patients develop symptoms due to other diseases treatments. Insomnia has a negative effect on the prognosis of comorbid diseases, including an increased risk of death, more severe disease, and decreased quality of life. The presence of sleep disorders makes it difficult to effectively treat the underlying disease, so clinical guidelines draft for the evaluation and treatment of insomnia in multimorbid patients is proposed. Diagnostic methods are reviewed and recommendations are given for the treatment of acute and chronic insomnia and features of the treatment of insomnia in multimorbid patients. A clinical algorithm has been proposed to determine treatment tactics in multimorbid patients.

JUSTIFICATION OF THE COMPLEX TREATMENT OF PURULOUS COMPLICATIONS OF FOOT INJURIES IN PATIENTS WITH DIABETES MELLITUS

In recent years, despite the development of modern methods of diagnosis and treatment of foot injuries in patients with diabetes mellitus, there has been an increase in the number of purulent-necrotic complications with a significant percentage of generalization of the infection. Due to potentially "catastrophic" wound healing, uncontrolled, irrational use of antibiotics, lack of regular blood glucose control, implementation of long and complex surgical interventions leads to the development of complications, including infection. The aim of the study. To substantiate the expediency of using a complex treatment scheme for purulent complications of foot bone fractures in patients with diabetes. Materials and methods. The results of treatment of 25 diabetic patients with foot injuries complicated by a purulent process were analyzed. In order to restore homeostasis disorders, patients received a complex of medical measures, including surgical treatment, infusion therapy, immunotherapy, antibiotic therapy. Patients were under the constant control of an endocrinologist. The results. As a result of complex treatment of patients, the inflammatory process was stopped in 21 (84%) patients, however, in 1 (4%) patient with stage 3 diabetic foot syndrome and in 3 (12%) patients with stage 4 according to the F.W.Wagner classification, the inflammatory process spread on the shin, therefore amputation was performed in this patients. The use of the developed treatment tactics, which included drainage of the wound with the removal of destroyed bone fragments, fixators (pins, screws, plates) in the maximum possible volume is the most effective method of surgical treatment of patients with this form of inflammation and allows you to save the foot, avoid the progression of purulent process and repeated surgical intervention.

Features of metabolism in chronic wound remodelling

Background/Aim: The treatment of chronic wounds continues to be a pressing problem throughout the world. Healing occurs through some evolutionarily conserved biochemical pathways. The mechanisms of development of disorders of reparative regeneration are not fully understood. The work aimed to study the dynamics of changes in metabolic parameters during the healing of chronic wounds. Methods: Healthy Wistar rats were divided into two groups. The animals of the first group were intact. Chronic wounds were simulated for the animals of the second group. On days 7, 14 and 28 after wound creation, the animals were euthanised. Biochemical parameters such as glucose, total protein, albumin, cholesterol, urea, creatinine, aspartate aminotransferase (AST), alanine aminotransferase (ALT) and alkaline phosphatase (ALP) were assessed in the blood serum of animals. Results: It was found that the maximum decrease in glucose and total protein levels in the blood serum of animals in the experimental groups compared to intact animals was observed 2 weeks after surgery: the glucose concentration in rats was 1.7 times lower (p < 0.001). The level of albumin in the blood serum of experimental animals compared to intact animals was reduced by 1.5 times after 14 days (p < 0.001) and by 1.2 times after 28 days (p < 0.01). A week after surgery, the concentration of urea in the blood serum of experimental animals was 1.3 times higher (p < 0.01) than in intact rats and by day 28 after surgery, the urea level was 1.4 times higher (p < 0.001). The reduction in cholesterol and creatinine levels was not significant. An increase in AST, AST and ALP levels in the blood serum of experimental animals was shown. An increase in the blood serum of animals 7 days after surgery compared to the indicators of intact animals: ALP concentrations by 2.8 times (p < 0.001) and ALT concentrations by 1.4 times (p < 0.001) was established. The AST level significantly increased 14 days after surgery (p < 0.05). Conclusions: The study of metabolic parameters allows monitoring of the state of the body during the healing process of wounds to correct treatment tactics.

Случай многоочагового асептического некроза костей с вторичным остеоартритом и глюкокортикоидным остеопорозом у взрослой пациентки с ювенильным дебютом системной красной волчанки — факторы риска и современная тактика терапевтического лечения

The article presents the case analysis concerning the successful therapeutic treatment of multiple osteonecrosis in an adult female patient with the juvenile form of systemic lupus erythematosus (SLE), including an analysis of the risk factors for their development. A comprehensive approach, including limiting axial load on the hip joints, the use of bisphosphonates, teriparatide, nonsteroidal anti-inflammatory drugs (NSAIDs), and disease-modifying osteoarthritis drugs, resulted in pain reduction, slowing of structural progression of femoral head changes, and improved functional status of the patient. Disease-modifying treatment of osteoarthritis was conducted with alternating injectable and oral medications. The success in treating osteonecrosis in this female patient was also enabled by the adjustment of basic SLE therapy and the reduction of prednisone dosage to 1.25 mg/day. This case serves as a vivid illustration of what is referred to as "complicated comorbidity.» The comprehensive approach allowed for achieving sustained positive outcomes, thus postponing surgical intervention in a physically active young female patient. KEYWORDS: systemic lupus erythematosus, SLE, aseptic necrosis, risk factors, osteoarthritis, osteoporosis, basic therapy of osteoarthritis, DMOAD, bisphosphonates, glucocorticoids. FOR CITATION: Gaydukova I.Z., Musiychuk M.M., Bombina M.V., Aparkina A.V., Petukhova A.A., Filonenko E.P., Inamova O.V., Rebrov A.P. Сase of multi-focal osteonecrosis with secondary osteoarthritis and glucocorticoid-induced osteoporosis in an adult patient with juvenile- onset systemic lupus erythematosus — risk factors and modern treatment tactics. Russian Medical Inquiry. 2024;8(7):406–412 (in Russ.). DOI: 10.32364/2587-6821-2024-8-7-6.

Pharmacotherapy of schizophrenia: clinical and some age-related aspects

The article discusses modern approaches to the rational choice of therapy for schizophrenia in accordance with the principles of personalized medicine. Clinical markers for determining the optimal treatment tactics are considered depending on the syndromic features and stereotype of the course of the disease, and the possibility of justified combination therapy with drugs of different pharmacological classes. The specifics of the treatment of schizophrenia in childhood/adolescence and adult are discussed, including the basic principles of choosing drug classes, daily doses and drug therapy tactics.

ANAEROBIC CAPACITY OF POSTPUBESCENT FEMALESFROM THE LOWLAND AREAS OF ZAKARPATTIA

B a c k g r o u n d . Human physical health depends on the body's ability to adjust (adapt) to the conditions of the external environment, while maintaining normal functional parameters of all physiological systems. The urgent mechanism of such adaptation is carried out by a humoral and reflex way, however, this process is personified by the somatotype of a person. Therefore, determining the component composition of the body and somatotype allows to individualize the ways to prevent certain diseases, to choose effective treatment tactics, as well as to predict the effectiveness of the treatment. The purpose of the study is to establish the ability of females of different somatotypes, who are residents of lowland areas of the Zakarpattia region, to adapt to physical work in the anaerobic mode of energy supply. M e t h o d s . 118 healthy females aged 16 to 20, residents of lowland areas, participated in the study. To assess the ability to perform physical work on a cycle ergometer in anaerobic mode, we using the Wingate anaerobic test described by Yu.M. Furman et al. We also measured the capacity of anaerobic lactic processes according to the method of Shögy A., Cherebetin G. The somatotype was determined by the Heath-Carter method. R e s u l t s . The examined females, residents of lowland areas, were represented by 5 somatotypes: ectomorphic, endomorphic, endomesomorphic, mesoectomorphic, and balanced. The largest number of individuals were of balanced (34.7 %) and endomesomorphic (32.2 %) somatotype, the smallest of ectomorphic (10.2 %) and mesoectomorphic (9.3 %) somatotype. In individuals with an endomesomorphic somatotype, the average value WAnT 10 rel. (40.25±1.23 kgm·min-1·kg-1) significantly exceeds the average value of females only of the endomorphic (37.1±0.65 kgm·min-1·kg-1) somatotype. At the same time, the average value of WAnT 10 rel. in representatives of the balanced (40.5±1.28 kgm·min-1·kg-1) somatotype significantly (р<0.05) exceeds the value of females of the endomorphic somatotype by 9.2 % and those of the ectomorphic somatotype (37.4±0, 76 kgm·min-1·kg-1) by 8.2 %. It is worth noting that the lowest average values of WAnT 30 rel. are observed in representatives of lowland areas of ectomorphic (35.4±0.72 kgm·min-1·kg-1) and endomorphic (35.7±0.96 kgm·min-1·kg-1) somatotypes, which do not differ from each other (p>0.05). The highest average values of WAnT 30 rel. in residents of the lowland areas were found in females of the endomesomorphic (39.0±1.03 kgm·min-1·kg-1) and balanced (39.33±0.89 kgm·min-1·kg-1) somatotypes, which are significantly higher (by 6 %) than the values of the representatives of the mesoectomorphic somatotype, and higher than the values of representatives of the ectomorphic and endomorphic somatotype (by 11 % and 10 %, respectively). C o n c l u s i o n s . Anaerobic productivity of females from Transcarpathia is related to somatotypological features of the body. There are gender differences in the adaptation of young people to physical work of anaerobic orientation depending on the somatotype. Among girls living in lowland areas, endomesomorphs and individuals with a balanced somatotype exhibit the highest capacity of anaerobic alactate and lactate energy supply processes for muscle work, and ectomorphs have the lowest capacity.

ОСНОВНЫЕ ПРИЧИНЫ И ФАКТОРЫ РИСКА РАЗВИТИЯ ОЛЬФАКТОРНОЙ ДИСФУНКЦИИ У ВЗРОСЛЫХ ПАЦИЕНТОВ

Pathology of smell is an interdisciplinary problem. Olfactory disorders are polyetiological and occur in a wide variety of diseases. However, with these complaints, patients first turn to otolaryngologists. The article describes the etiopathogenetic mechanisms of olfactory disorders, identifying the following main causes and risk factors for the development of olfactory dysfunction in adult patients: diseases of the nose and paranasal sinuses; acute respiratory viral diseases; head and nose injuries; consequences of surgical treatment in the nasal cavity and paranasal sinuses, intracranial operations; diseases of the nervous system; diseases of the endocrine system and internal organs; intoxication; taking medications; smoking; alcohol and drug addiction, age over 65 years, metabolic disorders. The mechanism of disturbance of the olfactory function is determined by the level of damage to the olfactory analyzer and is conductive, sensorineural, central and mixed. Chronic diseases of the nose and paranasal sinuses are the most common cause of olfactory dysfunction. Timely detection of olfactory disorders is fundamentally important for early diagnosis of the diseases that cause them. Determining the causes and risk factors of olfactory disorders is an important task, as it helps determine treatment tactics for patients.

Experience of using autologous cornea for deep and penetrating keratoplasty in dogs and cats

This paper presents a generalized experience in the treatment of deep corneal ulcers, descemetoceles and perforated corneal ulcers in which keratoplasty was used using autologous cornea. Deep corneal ulcers are characterized by an acute inflammatory process and the risk of developing many complications leading to loss of vision. Conservative treatment of such pathologies takes a long time and is not always successful. Keratoplasty for corneal transplantation is considered an effective method. The outcome of the operation depends on the transplanted material and postoperative treatment tactics. The work conducted a study on the effectiveness of using autologous cornea in 32 animals with subsequent inclusion of a regenerative drug in the treatment regimen. The authors describe the clinical picture, the surgical technique, and provide the results of dynamic observation of animals. Based on the results of clinical observations, it was established that the use of autologous cornea for deep corneal ulcers can be an effective treatment method. In none of the 32 cases examined, rejection was recorded, while the morphofunctional characteristics of the cornea were preserved. Drug maintenance therapy, including a regenerative drug, showed good results in the postoperative period. The use of a regenerative drug accelerated the healing process and made it possible to maintain the transparency of the cornea and its curvature.

Обоснование и опыт применения витамина В12 в комплексной терапии новой коронавирусной инфекции и постковидного синдрома

Aim. Analysis of vitamin B12 deficiency as a risk factor for severe novel coronavirus infection and its possible use as adjuvant therapy in the management of COVID-19. Key points. The COVID-19 poses the greatest risk to older people and patients with diabetes mellitus type 2. These categories of patients often require long-term hospitalization and intensive care, and the prognosis of the disease and the risk of life-threatening complications are much higher than the average in the population. Determining the risk factors for a severe course of COVID-19 and the mechanisms of their occurrence helps to choose the optimal treatment tactics and significantly improve the prognosis of recovery, reduce the negative consequences of the disease, the so-called post-COVID syndrome, and shorten the rehabilitation period for patients after COVID-19. One of the hypotheses explaining the increased risk of severe COVID-19 in these groups of patients is vitamin B12 deficiency. Perhaps this factor is unifying for the elderly and patients with type 2 diabetes mellitus. Thus, the question arises whether the elimination of B12 deficiency will affect mortality from COVID-19 or recovery rates. In this review, we will analize the latest evidence that shows B12 is involved in many immunological, microbiological and hematological processes that are the target of coronavirus infection. Conclusion. Our review data confirms the hypothesis that B12 deficiency is a potential risk factor for severe COVID-19, and replacement of this deficiency by prescribing vitamin B12 therapy can be considered as adjuvant therapy and prevention of complications for these categories of patients. Keywords: novel coronavirus infection, COVID-19, SARS-CoV-2, vitamin B12, cobalamin, diabetes mellitus type 2, metformin, rehabilitation.

Atypical course of incarcerated post-traumatic diaphragmatic hernia

The article focuses on the instrumental imaging methods which greatly enhance the possibilities when arriving at correct and quick diagnosis of acute surgical pathology. Analysis of clinical and anamnestic data of the disease course and the results of instrumental research methods made it possible to arrive at clear clinical diagnosis, determine the indications for surgical treatment in this specific clinical case. The use of modern visualization methods while examining the patients prevents errors in diagnosis and helps to determine the optimal treatment tactics.

Ингаляционное применение ультранизких доз алкилирующих препаратов у пациента с рецидивирующей криптогенной организующейся пневмонией

The treatment tactics for a morphologically confirmed diagnosis of cryptogenic organizing pneumonia (COP) typically involves systemic glucocorticoids (SGCs) as the primary therapeutic agents. These drugs commonly lead to the regression of clinical, radiological, and pathomorphological changes. However, a substantial number of patients experience disease relapse upon dose reduction or discontinuation of SGCs, necessitating an increased dose, prolonged courses, or alternative therapeutic approaches. Alternative treatments may include the adjunct or standalone administration of cytostatic drugs such as azathioprine, cyclophosphamide, or mycophenolate mofetil. In these scenarios, there is no standardized approach for dosing either SGCs or cytostatics, even though treatment duration may extend over several months. It is important to consider that medications from both classes are associated with significant side effects that can limit their use. Consequently, the need for alternative anti-inflammatory treatments with high efficacy and safety profiles remains pressing. One potential approach is the inhalation of ultra-low doses of the alkylating agent melphalan. This article presents a clinical case illustrating the successful application of this novel therapeutic strategy in a patient with recurrent COP. KEYWORDS: cryptogenic organizing pneumonia, cytostatics, alkylating drugs, melphalan, treatment, inhalations. FOR CITATION: Sinitsyn E.A., Larchenko Yu.A., Samsonova M.V., Petrov K.S., Zykov K.A. Inhalation of ultra-low doses of alkylating drugs in a patient with recurrent cryptogenic organizing pneumonia. Russian Medical Inquiry. 2024;8(8):464–469 (in Russ.). DOI: 10.32364/2587- 6821-2024-8-8-4.

Опыт применения органосохраняющего подхода при перекруте придатков матки у девочек-подростков

Uterine appendage torsion (UAT) is always an urgent and dangerous pathology that requires surgical treatment. UAT in childhood and adolescence is more common than in women of reproductive age, which is due to the anatomical characteristics of the puberty period. Female adolescents are a special group that requires maximum focus on preserving reproductive function and ovarian reserve. The choice of the optimal surgical treatment volume for female patients with UAT is currently debatable. If previously the only correct solution in UAT was an adnexectomy, at the moment the treatment tactics began to change towards organ-preserving surgeries. In order to assess the efficacy and safety of performing organ-preserving surgeries for UAT, we retrospectively analyzed the medical histories of 24 female patients from 3 to 18 years old. The clinical cases of three female patients who underwent detorsion are presented. In all cases, the surgery was performed successfully. At the present stage, organ-preserving surgical tactics for UAT in female adolescents are preferable, since it allows preserving the reproductive potential of young generation, which is a priority area of pediatric and adolescent gynecology. KEYWORDS: female adolescents, acute abdomen, uterine appendages, torsion, diagnosis, organ-preserving surgery, detorsion. FOR CITATION: Selikhova M.S., Yakhontova M.A., Zvereva E.S., Kalacheva L.S. Organ-sparing approach for the uterine appendage torsion in female adolescents. Russian Journal of Woman and Child Health. 2024;7(1):45–50 (in Russ.). DOI: 10.32364/2618-8430-2024-7-1-7.

Возможности применения препаратов рекомбинантного интерферона α-2b в комплексной терапии кандидозной инфекции слизистых оболочек у пациентов групп риска

Background: despite the availability of various antifungal medications, achieving complete relief of fungal infections can be challenging, particularly in cases where Candida spp. exhibit resistance to antimycotic agents or in patients who are at increased risk of developing candidiasis, such as those with immunosuppression, decompensated diabetes mellitus, or undergoing prolonged antibacterial treatment. The limited success of antifungal monotherapy in treating candida infections highlights the necessity for alternative treatment tactics. Aim: this study aims to assess the impact of recombinant interferon α-2b combined with antioxidants, administered as rectal suppositories, on extending the relapse-free period in high-risk patients following successful antifungal treatment of oral and genital mucosal candidiasis. Patients and Methods: the study comprised 50 patients with different forms of oral and genital mucosal candidiasis, all having insulin- independent diabetes mellitus and suboptimal glycated hemoglobin levels. Initial antifungal treatment involved drugs from the imidazole or triazole groups. Patients were then randomized into two cohorts: one receiving recombinant interferon α-2b with antioxidants (n=17) and the other receiving a placebo (n=18). Clinical outcomes and microbial content of Candida fungi were evaluated pre- and post-treatment. Results: the median age of participants was 55.5 years, with females constituting 56% (28 patients) of the cohort. Vulvovaginal candidiasis was the most prevalent diagnosis, affecting 42% of patients. The initial mean microbial load of Candida was 1.4×105 CFU/ml. Post initial antifungal treatment, 70% (35 patients) exhibited full symptom regression and marked reduction in CFU levels. The group treated with interferon α-2b experienced a mean clinical remission duration of 53.6±7.5 days, with 76.5% (13 patients) maintaining remission throughout the 60-day follow-up and CFU levels dropping below 1×103. In contrast, the placebo group had a mean remission duration of 30.1±9.6 days post- antimycotic therapy. Conclusion: integrating recombinant interferon α-2b with antioxidants into the treatment regimens for oral and genital mucosal candidiasis in high-risk patients significantly extends clinical remission periods. These findings suggest that this combination therapy could be a promising option for rehabilitation and potentially preventive interventions for patients susceptible to candida infections. KEYWORDS: Candida spp., mucosal candidiasis, diabetes mellitus, interferon alpha-2b. FOR CITATION: Zlobin D.E., Gureeva M.A., Molochkov A.V., Misnikova I.V., Polesko I.V., Guseva T.S. Possibilities of recombinant interferon α-2b drugs in the complex therapy of mucosal candidiasis infection in patients at risk. Russian Medical Inquiry. 2024;8(7):433–438 (in Russ.). DOI: 10.32364/2587-6821-2024-8-7-10.

ДИАГНОСТИЧЕСКАЯ ЦЕННОСТЬ МОДЕЛИ ПРОГНОЗИРОВАНИЯ ПРИ ОБСТРУКЦИИ ВЕРХНИХ МОЧЕВЫВОДЯЩИХ ПУТЕЙ

Patients with urological pathology often develop supravesical obstruction (SVO), which affects the renal parenchyma and causes disruption of the normal renal function and various complications, such as chronic renal disease and urosepsis, which can lead to death. Prediction accuracy assessment for this group of patients is challenging, making it difficult to draw firm conclusions Objective: To develop predictive models for choosing rational treatment tactics in SVO. Methods: Data from 655 patients aged 4 to 86 (average age 39.56±17.23 years) admitted to the Republican Specialized Scientific and Practical Medical Center of Urology in 2021-2023 with SVO were analyzed. There were 350 men (53.4%) and 305 women (46.6%) enrolled in the study. Patients were divided into groups according to the primary diagnoses: urolithiasis (UL) – 231 (35.3%), anomalies of the upper urinary tract (UUT) – 332 (50.7%), acquired diseases of the ureter – 92 (14.0%). Results: Critical Z-values (cut-off points) were calculated for each group, determining the complicated course of SVO. In the UL group, the Z-value was 1.910; in the group of patients with anomalies of the UUT, ureteropelvic stricture (UPS) – 1.998, ureteral stricture – 1.239, ureterocele – 1.894; in the group of patients with acquired diseases of the ureter, secondary ureteral strictures – 1.209, ureteral obliteration – 1.713. Conclusion: Discriminant prediction models showed high sensitivity and specificity for choosing the optimal tactical approach in patients with complicated SVO. Keywords: Supravesical obstruction, hydronephrosis, prediction model, management tactics.

Electrophysiological diagnostics in choosing treatment strategy for neuropathies in children with transcondylar fractures

A common complication of transcondylar fractures (TCF) in children is neuropathy requiring not only therapeutic but also surgical treatment. Despite numerous reports, clear criteria for selecting patients for surgical treatment have not been defined. To clarify the role of clinical and electrophysiological diagnostics in choosing treatment tactics for neuropathies in children with TCF. There were 20 patients with neuropathies after TCF between 2020 and 2022. Of these, 10 ones were selected for surgical treatment according to electrophysiological diagnostic data. Inclusion criteria: age 6-12 years, closed TCF within previous 3-12 months, symptoms of neuropathy confirmed by electroneuromyography (ENMG), no nerve disruption according to ultrasound data. Exclusion criteria: elbow joint contracture and post-traumatic ulnar nerve dislocation. All patients underwent needle myography with functional assessment of motor and sensory fibers, spontaneous activity in muscles, recruitment pattern and motor unit potentials. Intraoperative electrophysiological diagnostics included stimulation of motor fascicles with registration of M-responses from the target muscles. The follow-up period was 3-6 months. The study included 20 patients aged 6-12 years without peripheral nerve disruption. A group of 10 patients who required surgical treatment was identified. The control group consisted of 10 patients who did not require surgical treatment. To choose treatment tactics, we considered ENMG data. Surgical procedure was determined according to intraoperative neuromonitoring (IONM) data. When choosing treatment strategy, surgeons should consider objective ENMG and IONM criteria, as well as fascicular anatomy.

Влияние бариатрических операций на овариальный резерв у пациенток с ожирением и первичным бесплодием

Aim. To describe two clinical cases of obese female patients with primary infertility who underwent sleeve gastrectomy. Key points. The presented clinical cases demonstrate the multidirectional impact of bariatric surgery on ovarian reserve indicators in two patients of reproductive age with primary infertility, comparable in degree of obesity and concomitant diseases. In both patients, 12 months after surgery, body weight was successfully reduced and carbohydrate metabolism levels were normalized. However, in the first patient, the level of anti-Mullerian hormone (AMH) increased slightly, and pregnancy occurred, while in the second patient, on the contrary, the level of AMH decreased compared to the preoperative level, and the desired pregnancy did not occur at the time of writing. Conclusion. Literary data on the impact of bariatric surgery on women's reproductive function are scarce and contradictory. Determining the contribution of metabolic surgical interventions to restoring ovarian reserve, normalizing AMH levels and overcoming infertility will allow individualizing treatment tactics in obese patients. Keywords: obesity, infertility, anti-Mullerian hormone, bariatric surgery, sleeve gastrectomy.

Specifics of imaging in traumatic lesions of the shoulder joint

Background. The shoulder joint is one of the most complex and functionally important joints in the human body. Also, the shoulder joint is one of the most traumatic areas of the human body. Each type of injury of the joint requires a special approach to radiological diagnosis, as it has its own characteristic signs on radiographs that must be recognized and correctly interpreted. Purpose of the study: To consider methods and features of interpretation of radiographs in the context of various types of damage. Material and methods: Systematic analysis of existing scientific publications, studies and clinical observations on this topic. To search for relevant information, online databases of scientific articles were used, including PubMed, eLibrary MEDLINE, Google Scholar and others. In addition, data from meta-analyses and literature reviews, clinical guidelines in radiology and osteopathy were used. Results and discussion. Correct classification helps determine diagnostic and treatment strategies, ensuring effective and timely medical care for injured patients. Computed tomography allows to obtain layer-by-layer images of the joint, which provide a more accurate determination of the nature of the injury, the presence of fractures or soft tissue damage. MRI is often used to further diagnose shoulder injuries. MR-arthrography is commonly used to evaluate clinically unstable patients. Conclusion.Early radiation and magnetic resonance diagnostics make it possible to effectively establish treatment tactics and provide the necessary medical care. It should be emphasized that the use of radiography in combination with other imaging methods makes it possible to increase the accuracy of the diagnosis and determine parameters such as displacement of bone fragments or soft tissue damage