Treatment Tactics Research Articles

PET/CT with <sup>18</sup>F-FDG for TENIS Syndrome in a Patient with Bone Metastasis of Hurthle Cell Thyroid Cancer: a Clinical Case Report

A significant role in improving the prognosis of differentiated thyroid cancer (DTC) in the presence of bone metastases is determined by early diagnosis of metastases, timely and correctly selected treatment tactics for the patient. During dynamic follow-up of patients with DTC after combined treatment (thyroidectomy with radioiodine therapy) are determination of the level of oncomarkers (serum thyroglobulin and antibodies to thyroglobulin) and ultrasound diagnostic of the neck, scanning with radioactive iodine (if clinically indicated). In some cases, patients have TENIS-syndrome (Thyroglobulin Elevated Negative Iodine Scintigraphy, hereinafter TENIS-syndrome), characterized by high serum thyroglobulin level in blood and absence of radioactive iodine accumulation on post therapeutic scintigraphy. According to the research studies, PET/CT with 18F-FDG has high sensitivity and specificity (89 % and 72 %, respectively) in visualization of metastatic radioiodine refractory foci in TENIS-syndrome.This article presents a clinical case of a patient, a 52-year-old woman with Gurtle cell thyroid cancer (pT3aN0M0, stage I) with established TENIS syndrome. Thyroidectomy was performed in September 2019 and radioiodine therapy was performed in January 2022 due to suspected disease progression given high thyroglobulin levels. Given the absence of pathologic accumulation of 131I according to post-therapy radioiodine scanning, PET/CT with 18F-FDG was performed, which revealed a solitary metastasis in the left iliac bone (41×35×42 mm with SUVmax 17.25). In November 2022, radical treatment of the solitary bone metastasis was performed in the scope of resection of the left iliac bone with reconstructive-plastic component. According to the data of control examinations in June 2023, the patient has a complete biochemical and radiologic remission of the disease.

Metachronous Multiple Primary Inoperable Squamous Cancer of the Esophagus: Case Report

The incidence of primary multiple malignant neoplasms (PMMN) in Russia is steadily increasing due to the increasing frequency of detection of metachronous tumors. A similar trend is observed in esophageal cancer (EC). Advances in the diagnosis and treatment of cancer have led to an increase in the life expectancy of patients after a cured primary tumor and, in turn, to an increase in the detection rate of a second tumor. The longer life expectancy of patients with cancer, the higher the likelihood of developing a second tumor. PMMN of the esophagus is one of the least studied problems in modern oncology, which complicates the choice of treatment tactics, since there are no standards for the management of such patients. This article reflects a multidisciplinary and individual approach to the treatment of a patient with primary multiple metachronous inoperable squamous cell carcinoma of the middle and lower thoracic esophagus. The patient underwent chemoradiotherapy (CRT) with full effect, with no post-radiation damage and improved quality of life.

Prediction and decision-making based on nonlinear risks model in stomach cancer treatment

Objectives. The goals are to develop a nonlinear risk model and examine its prediction applicability for clinical use.Methods. Methods of survival analysis and regression statistical models were used.Results. A practical approach to assessing nonlinear risks of adverse events using the example of gastric cancer treatment is proposed. A model for predicting the metachronous peritoneal dissemination in patients undergoing radical surgery for gastric cancer was proposed and studied. Assessment of risks for various periods of observation was performed, and the clinical suitability of developed approach was assessed.Conclusion. In clinical oncological practice, not only timely treatment plays an important role, but also the prevention of adverse outcomes after treatment. Individualization of patient monitoring after treatment reduces the risks of fatal outcomes and the costs of additional research and treatment in the event of cancer progression. Based on the results of this study, we propose solutions that should lead to more effective and high-quality treatment tactics and follow-up after treatment for gastric cancer, also to the selection of optimal approaches and to obtaining clinically favorable outcomes of the disease. The proposed risk prediction method will ultimately lead to individualized patient management based on the results of personal data.

Endomyocardial Biopsy of Heart Tumors under Cone-Beam Computed Tomography Control

Tumors of the heart are rare entities characterized by the absence of specific signs and symptoms. A biopsy is necessary for verify the diagnosis and determine the most correct treatment tactics. Endomyocardial biopsy (EMB) is a modern and relatively safe approach for biopsy of cardiac tumors. Usually this procedure performs under the control of fluoroscopy and echocardiography (intracardiac, transthoracic, transesophageal). However, this procedure is rarely used in patients with suspected cardiac malignancy.We present two clinical cases of endomyocardial biopsy of cardiac tumors by the endovascular approach under the control of cone-beam computed tomography (CBCT). The biopsy was successful in both cases and pathological diagnosis was established.

Symptomatic and aggressive vertebral hemangiomas in children: features of modern interpretation and treatment tactics

Objective. To analyze the features of clinical-radiological manifestations of symptomatic vertebral hemangiomas in children and the possibility of algorithmizing their treatment.Material and Methods. As part of a monocenter cohort, 24 children aged 4 to 17 years received treatment for symptomatic vertebral hemangiomas. The clinical-radiological manifestations of the tumor and the effectiveness of various methods of invasive treatment were evaluated.Results. Symptomatic uncomplicated and complicated vertebral hemangiomas, corresponding to stages S2 and S3 of the Enneking classification for benign tumors, occur in children with almost equal frequency. For tumors without extravertebral spread, a closed percutaneous vertebroplasty provides stable relief of complaints. For aggressive hemangiomas with extravertebral, including epidural, spread, various treatment methods are used. An algorithm for choosing therapeutic tactics is proposed.Conclusion. Surgical treatment of symptomatic vertebral hemangiomas should be carried out using a tactical algorithm that takes into account the stage of the tumor (S2 or S3) and the possibility of performing closed or open vertebroplasty, selective arterial embolization and decompression and stabilization operations on the spine.

Діти з дефектами генів - група ризику щодо розвитку аномалій серцево-судинної системи

To date, the prevalence of congenital heart defects (CHD), the level of disability and mortality from them in children remains an unsolved problem in pediatrics, despite the improvement of preventive measures, diagnostics and treatment in pediatric cardiology. There are a number of genetic diseases that are manifested by congenital anomalies of the cardiovascular system. Purpose - to analyze the abnormalities of the cardiovascular system in children with gene defects for the early diagnosis of genetic diseases in patients and the detection of congenital pathology of the heart and blood vessels in them, followed by their treatment tactics. This article describes a number of genetic syndromes in children, in which congenital anomalies of the heart and blood vessels are the most common. The characteristics of each of the syndromes include its definition, clinical symptoms with an emphasis on the external signs of the patient, the study of abnormalities of the cardiovascular system in this genetic disease, the examination plan for the patient and genetic testing used for the accuracy of the diagnosis. Conclusions. Based on the results of our analysis, we can conclude that there is a certain regularity between genetic diseases in children and the development of CHD in them, according to which certain CHD are formed with certain gene defects. Knowledge of the main clinical symptoms, especially external dysmorphism, in such patients helps in faster diagnosis and treatment of a genetic disease, in particular CHD. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Pheochromocytoma in combination with severe aortic insufficiency: clinical case

Pheochromocytoma is a rare neuroendocrine tumor of the adrenal medulla with widespread cardiac complications. Dilation of the heart chambers can cause valve defects. At the same time, severe cardiac comorbid conditions that complicate the choice of treatment tactics for patients are not sufficiently described in the literature. A clinical case of pheochromocytoma in combination with severe aortic insufficiency in a man admitted to the endocrinology department is presented. In conditions of aortic insufficiency, the risk of surgical intervention is extremely high. After a thorough analysis of clinical and laboratory-instrumental data, the patient was recommended to have a right-sided laparoscopic adrenalectomy.

DIFFERENTIAL APPROACH IN THE COMBINED SURGICAL TREATMENT OF VARICOSE VEINS OF THE LOWER EXTREMITIES ACCORDING TO THE RESULTS OF ULTRASOUND DOPPLER ULTRASOUND

The most common pathology of the lower extremity veins is varicose veins, which is an urgent medical and social problem. The number of patients with trophic disorders is not decreasing, despite the improvement of treatment methods, which leads to a deterioration in the quality of life. Therefore, the topic of introducing new and improving existing minimally invasive treatment methods is relevant and requires further research. According to international studies, the combined laser method of treatment is superior in terms of therapeutic and cosmetic results to all known methods of surgical treatment of varicose veins and can be used in most cases.Aim. To demonstrate the eff ectiveness of individual diff erentiated combined surgical techniques for the treatment of varicose veins of the lower extremities, taking into account the data of ultrasound preoperative and intraoperative navigation.Material and methods. The study included 246 patients with varicose veins of the lower extremities of class C2-C5, who had various variants of varicose veins of the lower extremities – saphenous varicose veins in the system of small and/or large saphenous veins, which in some patients was combined with varicose veins in the basin of non-saphenous veins and reticular varicose veins. Patients were divided into clinical groups due to the diff erence in surgical and tactical treatment approach. All patients underwent preoperative ultrasound Doppler ultrasonography (USG) of the lower extremity veins in horizontal and vertical positions. The patency of deep and saphenous veins, the presence of unable varicose dilated saphenous venous tributaries with an assessment of the aff ected basin (saphenous, non-saphenous varicose veins and combined forms) were assessed. Horizontal and vertical pathological venous refl uxes were detected. All patients underwent combined surgical intervention – EVLC and miniphlebectomy under ultrasound Doppler monitoring, and sclerotherapy as indicated. The observation period lasted 1.5 years for each patient.Research results and discussion. The assessment of the treatment results was based on the presence of patient complaints, analysis of the clinical picture, the presence or absence of complications during the observation period, recurrence of the disease during the observation period, and analysis of the ultrasound assessment of the veins by an ultrasound diagnostician during a dynamic examination. USG was mandatorily performed in patients of all groups before surgical treatment, during surgical correction and as a control within 1-3 days after surgery. Dynamic follow-up was performed in all patients at 1, 3, 6 and 12-18 months after surgical treatment.Conclusions. Most patients have a complete recovery after surgical treatment. Careful history taking in patients of this group and performance of ultrasound Doppler ultrasonography of the veins of the lower extremities allowed to choose an eff ective individual surgical treatment. Specialists’ understanding of the capabilities of ultrasound Doppler ultrasound of the veins of the lower extremities, as well as compliance with the full examination protocol for ultrasound Doppler veins, allows us to provide detailed information to determine the most eff ective treatment tactics and prevent complications of the disease.

Study of the spectrum and antibiotic sensitivity of the respiratory tract microbiota of newborns with infectious complications during long-term mechanical lung ventilation

determining the structure of leading microbial colonizers of the respiratory tract as potential causative agents of ventilator-associated pneumonia and their sensitivity to antibacterial drugs plays an important role in choosing effective tactics for etiotropic therapy of newborns. According to the data of scientific publications, the etiological structure of infectious complications associated with long-term respiratory support in newborns is known to have certain features. The spectrum of nosocomial microbial pathogens and their sensitivity to antimicrobial drugs are among them. The patients of early age are characterized by a number of peculiarities of anatomical and physiological characteristics and the qualitative and quantitative composition of the microbiota of the respiratory tract. In order to form ideas about the determining causative agents of VAP in newborns, it was advisable to conduct a microbiological study of the species composition of microorganisms associated with this infectious complication, as well as to determine their sensitivity to antibiotics recommended by the management protocols of the corresponding pathology. To study and solve this problem, it is necessary to study the spectrum and antibiotic sensitivity of the causative agents of VAP. A prospective study was conducted in 69 newborns with VAP (2020 - 2023), who were treated in the Neonatal Intensive Care Unit (NICU) of the Vinnytsia Regional Children's Clinical Hospital (VRCCH) and consisted in studying the composition of the microbiota and antibiotic sensitivity. We took into account opportunistic microorganisms that are not characteristic of this biotope of the respiratory tract of newborns who were diagnosed with VAP during long-term mechanical ventilation. As a result of the prospective analysis of the microbiological study of the microbiota of 69 newborns, 82 microorganisms - etiologically significant pathogens of VAP - were isolated and identified. Thus, according to the data of our bacteriological studies, 17 Gram-positive and 65 Gram-negative pathogens of VAP were isolated and identified in NICU VRCCH for 2020-2023. As a result of the study of antibiotic sensitivity of VAP pathogens in newborns, the following trends were observed. Low sensitivity of Acinetobacter baumannii to ceftazidime, aztreonam, imipinem, meropenem, amoxicillin, piperacillin, levofloxacin, ciprofloxacin was established. And sensitive to amikacin, gentamicin and cefoperazone-sulbactam. High rates of resistance of Pseudomonas aeruginosa to ceftazidime, doxycycline, imipinem, meropenem, gentamicin, piperacillin, levofloxacin, ciprofloxacin, ofloxacin were established. The best indicators of sensitivity of P. aeruginosa to amikacin, cefoperazone-sulbactam and tobramycin were found. According to the results of the sensitivity of K. pneumoniae to antibiotics, resistance to all antibiotics was established. The development of resistance of Staphylococcus aureus to azithromycin, norfloxacin, cefotaxime, benzylpenicillin has been established. The indicators of S. aureus sensitivity to amikacin, tetracycline and vancomycin turned out to be the best. We took into account opportunistic microorganisms that are not typical for this biotype of the airways of newborns who were diagnosed with VAP during long-term mechanical ventilation. The results of the study indicate the need to take into account the data of a microbiological study with the mandatory identification of isolated pathogens, their microbial load at the site of infection, determining their antibiotic sensitivity is of crucial importance in the selection of etiotropic treatment tactics for newborns with VAP.

Resorption of lumbar disc herniations: a non-systematic literature review

Objective. To analyze the information on spontaneous resorption of lumbar disc herniation.Material and Methods. A non-systematic review of 37 publications on resorption of disc herniation was conducted. The data on the timing, mechanisms and predictors of regression of lumbar disc herniation were summarized. A clinical case is presented illustrating the resorption of a herniated L4–L5 intervertebral disc over 8 months.Results. The frequency and timing of resorption of lumbar disc herniation vary depending on the number of patients, follow-up period, the type and nature of the hernial bulging, and other characteristics of patients. The results of meta-analyses indicate that the average period of spontaneous resorption of lumbar disc herniation is more than 6 months. The main theories of spontaneous resorption of lumbar disc herniation are the dehydration theory, the mechanical theory, and mechanisms associated with inflammatory processes and neovascularization. Currently, predictors of disc herniation resorption include the type and size of the hernia, follow-up period, Modic changes, etc. Existing data on the timing, mechanisms and predictors of resorption of lumbar disc herniation are insufficient to improve treatment tactics for this category of patients.Conclusion. Herniated lumbar intervertebral discs tend to undergo spontaneous regression which, however, is not observed in all patients. The mechanisms of resorption can be different, and the fact of resorption itself can occur in different types of hernia with different frequencies. An analysis of large data sets is necessary to more accurately determine the timing and predictors of resorption of lumbar disc hernias.

Pilonidal disease: comparative analysis of leading professional organizations clinical guidelines

pilonidal disease is an inflammatory disease that is most often localized in the sacrococcygeal area and is characterized by the formation of a cyst or abscess with the possible secondary formation of fistulas. Pilonidal disease is a fairly common disease, according to individual studies, the incidence ranges from 26 cases per 100,000 people (USA) to 48 per 100,000 people (Germany). Men are three times more likely to suffer than women. Most often, the disease manifests itself between the ages of 18 and 30. The risk factors for developing the disease are: excess weight, increased hair growth, chronic trauma to the sacrococcygeal area and anatomical features of the gluteal cleft (its shape, depth, configuration). The occurrence and development of the disease in persons of working age often leads to a sharp decrease in work capacity and quality of life. There is still no single, generally accepted classification of pilonidal disease in the world. Today, there are 3 clinical guidelines created by professional associations (USA, Germany, Italy), based on the principles of evidence-based medicine. The purpose of the study is to perform a comparative analysis of the main points of the clinical guidelines of leading professional organizations (German National Guideline on the management of pilonidal disease, The American Society of Colon and Rectal Surgeons' Clinical Practice Guidelines for the Management of Pilonidal Disease, Consensus statement of the Italian society of colorectal surgery: management and treatment of pilonidal disease) regarding the clinical-diagnostic approach and the choice of optimal treatment tactics for patients with certain forms of pilonidal disease. In the study, a review and comparative analysis of literary sources from the scientific databases of medical literature PubMed Central (U.S. National Institutes of Health's National Library of Medicine), ScienceDirect (Elsevier publishing house), Wiley online library, Springer Link, Cochrane library, materials of the 3rd International Pilonidal Conference ( 2023, Copenhagen, Denmark) and clinical guidelines of specialized organizations of the USA, Germany and Italy. The following issues of diagnosis and treatment of diseases are selected for comparative analysis: choice of prevention method and non-surgical procedures that reduce the risk of disease recurrence; choice of treatment method and assessment of its necessity for asymptomatic pilonidal cysts; the choice of a surgical method of treatment for symptomatic pilonidal cysts; the choice of a method of surgical treatment for a recurrent form of PC. According to the performed analysis, it can be concluded that the diagnostic and therapeutic strategies reflected in the clinical guidelines are based on the evidence base and the analysis of research data conducted in the field of treatment of pilonidal disease, which leads to the existence of an essential correlation between the recommendations related to the choice of a method of prevention and non-surgical procedures that reduce the risk of recurrence of the disease, the method of treatment and assessment of its necessity for the asymptomatic form of the disease, methods of surgical treatment of the recurrent form of the disease. There are differences between clinical guidelines due to varying general consensus structures and main questions chosen to form a list of general provisions.

Hypotensive therapy in obstetric practice

Arterial hypertension remains a leading cause of maternal morbidity and mortality while leading to significant economic costs in health care. Properly selected treatment tactics allow for prolonging pregnancy and levelling out various complications arising from the disease. However, there are still some questions about the effectiveness and safety of prescribed therapy due to possible side effects of the drugs. The aim of this study was to evaluate the efficacy and complications of hypotensive therapy during pregnancy, childbirth and the postpartum period. We analyzed the literature on eLibrary, Scopus, Cochrane Library, PubMed.

Surgical treatment of locally advanced desmoid tumor of the anterior abdominal wall

Desmoid tumor (DO) is a rare monoclonal connective tissue tumor arising from deep soft tissues, characterized by invasive growth and a tendency to local relapses and incapable of metastasis [1].The purpose of presenting this clinical case is to assess the significance of timely diagnosis, the choice of an individually correct treatment method, tactics of further observation, therapy.To achieve this goal, a number of literature sources were studied, a clinical case of surgical treatment of a desmoid tumor of the anterior abdominal wall was presented in our medical institution (Northwestern State Medical University named after I.I.Mechnikov, St. Petersburg).The difficulty of the case was the significant size of the indolent tumor, insensitive to systemic therapy, in a young man, and therefore the decision on surgical treatment tactics was also ambiguous. In each clinical case, it is worth taking an individual approach to treatment tactics. When choosing observational tactics, strict outpatient monitoring and regular follow-up should be performed.

Typical metastases, atypical course of the disease and morphology

The process of tumor differentiation is a central aspect of the histopathological classification of solid malignancies and is closely related to the biological behavior of the tumor (poorly differentiated tumors/dedifferentiated tumors are known to be more aggressive than more differentiated tumors). The mechanisms by which tumor cell differentiation is disrupted are poorly understood, but pathologists and molecular tumor biologists have introduced the concept of dedifferentiation to explain the phenotypic changes that occur in solid tumors. In this review, we discuss a case of detection of dedifferentiated cancer, where even with the help of molecular testing of a tumor sample, we were not completely able to unambiguously determine the original source of the process, which entailed difficulties in choosing treatment tactics. And the main question that we asked ourselves during the treatment process: should treatment be based on molecular markers identified in the tumor, or should treatment be carried out according to the recommendations for the treatment of tumors of an undetected primary location with empirically selected chemotherapy?

Современное оперативное лечение пациентов с камнями почек размером до 2 см и сопутствующей ИБС.

Introduction. While providing urological care to patients suffering with nephrolithiasis, prior attention is to be paid to choosing the appropriate surgical approach. Assessment of risk for commorbidities such as coronary artery disease (CAD) should affect the choice of surgical technique. The treatment tactics for such comorbid patients have not been sufficiently developed and are poorly covered in the scientific literature. An appropriate choice of surgical technique is not presented. Aim: to study the effectiveness and safety of high-tech surgical lithotripsy techniques in comorbid patients with CAD, taking into account the functional state of the cardiovascular system. Materials and methods. The study is retrospective, multicenter. Subject of the study: adult patients suffering from nephrolithiasis (single kidney stones 15-20 mm) and concomitant CAD (200 people); control group - similar patients without CAD (190 people). The examined groups were distinguished according to the surgical intervention performed (extracorporeal shock wave nephrolithotripsy, percutaneous nephrolithotripsy, transurethral nephrolithotripsy) and concomitant CAD. Primary endpoint: Stone-free rate, which was determined using ultrasound scanning and Х-ray techniques. The frequency of achieving the endpoint, the number of stages of surgical treatment, and the frequency of complications were also assessed. Results. In terms of the frequency of achieving Stone-free rate, all contact lithotripsy techniques were comparable in effectiveness, which in all groups exceeded 85%. Neither the presence of CAD nor chronic heart failure (CHF) affected the results. With extracorporeal shock wave lithotripsy, the presence of CAD did not in any way affect the likelihood of achieving a stone-free rate, however, with CHF, the percentage of complete sanitation of the urinary tract from stones decreased to 53.8%, which seems unacceptable for clinical work. When using extracorporeal shock wave lithotrypsin against the background of CHF in «mono mode», the average number of stages is significantly higher (2.79) than with contact techniques (<1.05). There is a clear inverse relationship between CHF, the number of stages of surgical treatment on the one hand, and the frequency of achieving stone-free rate on the other hand. Postoperative pyelonephritis more often develops in comorbid patients after contact lithotripsy techniques (up to 26.0%). Postoperative bleeding and cardiac risks occurred sporadically, mainly in the same situation – contact nephrolithotripsy in a patient with CHF. Conclusion. The more severe the patient’s comorbidities are, the more indications he has for immediate surgical treatment of nephrolithiasis. Of course, only if he is compensated for coronary artery disease. Percutaneous nephrolithotripsy is the method of choice. For small (<2 cm) stones, a mini-approach should be preferred, giving a better safety approach.

Комбинированное оперативное вмешательство при врожденных глаукомах у детей с сочетанной патологией хрусталика

In recent years, the percentage of early manifestations of congenital glaucoma in children with anomalies of the anterior segment of the eye has increased. The tactics of surgical treatment of this form of glaucoma, especially with combined pathology of the lens, is an urgent problem in pediatric ophthalmic surgery. Purpose. To determine the optimal tactics and analyze the results of surgical treatment of congenital glaucoma in eyes with anomalies of the anterior segment of the eye, combined with abnormalities of the lens development. Material and methods. For 2018–2023 we operated on 27 people (43 eyes) with congenital glaucoma in eyes with concomitant congenital lens pathology. All children underwent combined surgical interventions (vitreal and anthralaucomatous surgery) in one or more stages. Results. As a result of surgical treatment, a positive effect on IOP compensation was achieved in 88,4 % of cases (38 eyes). Conclusions. In case of pathology of the anterior segment of the eye in combination with pathology of the lens, surgical intervention is necessary in the early stages of identifying Intraocular pressure decompensation. Сombined operations are effective: vitreal surgery (reconstructive surgery on the anterior segment) and antiglaucomatous operations of the fistulizing type. Keywords: congenital glaucoma, congenital lens pathology, combined operations

Прогностические факторы закрытия макулярного разрыва при хирургическом лечении отслойки сетчатки, осложненной макулярным разрывом без проведения мембранопилинга

The desire to preserve the internal limiting membrane poses the challenge for researchers to develop personalized treatment tactics for retinal detachment with macular hole, depending on prognostic factors. The purpose of the study is to evaluate the influence of prognostic factors of anatomical success in patients after surgical treatment of retinal detachment with macular hole without membrane peeling. Material and methods. We studied the data of 20 patients (20 eyes) diagnosed with retinal detachment with macular hole stage C proliferative vitreoretinopathy. All patients were assessed for macular hole indices. Vitrectomy and endotamponade with silicone oil were performed. During the second operation, silicone was removed, the rupture was repaired with an inverted flap, and endotamponade was performed with a C2F6 gas-air mixture. The patients were divided into 2 groups: Group 1 (16 people / 16 eyes) — patients whose macular hole closed on its own; Group 2 (4 people / 4 eyes) — patients who underwent membrane peeling and repair of the gap with an inverted flap to close the hole at the second stage of treatment. Results. A significant difference between the groups was revealed when analyzing the macular hole index: among patients in whom the hole closed on its own, the indicator was 0.79 ± 0.07 and was higher than in patients who required plastic surgery at 1.65; traction index, in patients with a closed gap the indicator was 1.08 ± 0.13 and was 2.08 times higher. Conclusions. The study noted cases of convergence of the edges and complete closure of the macular hole without peeling of the internal limiting membrane during tamponade of the vitreal cavity with silicone oil. Indicators of the macular hole index and traction index of the hole can be used in determining personalized treatment tactics for patients with retinal detachment complicated by a macular hole. Keywords: rhegmatogenous retinal detachment, macular hole, membrane peeling, silicone tamponade, macular hole index

Клинический случай лечения ангиоматоза сетчатки при болезни Гиппеля – Линдау

Purpose. To develop treatment tactics for retinal angiomatosis in Lindau – von Hippel disease, and the possibility of surgical treatment in retinal detachment. Subjects and methods. A patient with Lindau – von Hippel disease underwent intravitreal administration of angiogenesis inhibitors followed by laser coagulation of the angiomatous node. As the disease progressed, endovitreal intervention was performed. Results and discussion. As a result of the treatment, an anatomical result was obtained with preservation of visual functions. Conclusions. Patients with Lindau – von Hippel angiomatosis require dynamic monitoring at least once a year to identify signs of disease progression in time and carry out treatment. Keywords: Lindau – von Hippel disease, retinal angiomatosis, retinal detachment

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.

Cervical Lymph Node Dissection for Head and Neck Cancer (Literature Review)

Metastatic damage to the cervical lymph nodes is one of the urgent and complex problems resulting from the occurrence of squamous cell cancer of the cervix and neck. Most patients die from them when the first tumor is cured. The frequency of metastasis to regional lymph nodes of the neck reaches 60-70%. Surgical treatment remains the determining component in treatment tactics. Various options for cervical lymph node dissection have been developed, each of them has its own indications. Some authors argue about the need for preventive lymph node dissection of the neck, while others, on the contrary, talk about selective operations, others prefer to perform radical surgical interventions, and others prefer to perform elective neck relief. Thus, in the treatment of regional metastases of head and neck cancer, there are issues that deserve serious attention and clarification. The purpose of this article is to review the available data on cervical lymph node dissections.