Clinical Medicine (Russian Journal)最新文献

{"title":"Comprehensive assessment of the relationship between indicators of systemic intoxication and intra-abdominal pressure at the patients operated for peritonitis","authors":"S. Perekhodov, Y. P. Popov, V. V. Evdokimov, P. A. Popov, K. I. Dubovitsky","doi":"10.30629/0023-2149-2023-101-6-275-278","DOIUrl":"https://doi.org/10.30629/0023-2149-2023-101-6-275-278","url":null,"abstract":"According  to the latest  statistical  data,  22% of patients  with emergency  abdominal  surgical  pathology  are  admitted  to medical institutions with signs of peritonitis. Despite modern methods of treatment and diagnosis, the mortality rate for this pathology remains at the same level and is approximately 18–29%, and in advanced forms can reach 75–90%. Recent studies show that in an unfavorable outcome of this pathological process, a leading role is given to a progressive increase in intraabdominal pressure (IAP). The relationship between the degree of endogenous intoxication and IAP values makes it possible to quickly assess the severity of the patient’s condition and the state of central hemodynamics without additional laboratory and instrumental studies. The aim of the study was to evaluate the indicators of systemic endogenous intoxication and intraabdominal  pressure and their relationship  in patients  with peritonitis in the pre- and postoperative  period. Material and methods. This work is based on a retrospective analysis of 74 patients operated on at the clinical bases of the Department of Hospital Surgery of the Moscow State Medical University named after A.I. Evdokimov for peritonitis from January to October 2022. The main causes of acute peritonitis were perforated ulcer of the stomach or duodenum, acute intestinal obstruction, thrombosis  of  mesenteric  vessels,  acute  pancreonecrosis,  complicated  colon  cancer.  The  average  age  of  patients  was 49 ± 2.5 years (34-75 years), 47 women, 27 men. The severity of peritonitis was assessed based on the degree of endotoxemia according to clinical and laboratory data. To monitor intra-abdominal  hypertension, IAP was measured. IAP measurement was performed on the operating table before surgery and in the early postoperative period. At the same time, compartment syndrome of the first degree was found in 51 (68%) patients, the second degree in 14 (19%) patients, and the third-fourth degree in 9 (13%) patients. For a comprehensive assessment of the patient’s condition and the effectiveness of the measures taken, the central hemodynamics was assessed and its relationship with the indicators of intra-abdominal pressure was evaluated. Comparative  analysis of central hemodynamics  manometry showed that with an increase in compartment  syndrome, there is a clear decrease in the performance of cardiac activity indicators, requiring urgent correction. The relationship between indicators of intra-abdominal  pressure and the duration of preoperative preparation was also evaluated. Conclusions. The relationship between the degree of endogenous intoxication and the degree of intra-abdominal pressure has been proven. With an increase in IAP values, the values of endogenous intoxication increase, which subsequently leads to the development of multiple organ failure. Even with the first degree of endogenous intoxication, a decrease in myocardial contractile ability is noted, which leads to the ","PeriodicalId":10439,"journal":{"name":"Clinical Medicine (Russian Journal)","volume":"18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83050429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Russian military doctors during the Yihetuan (\"Boxing\") Uprising in China","authors":"V. Simonenko, V. G. Abashin, I. A. Ivashova, P. Dulin","doi":"10.30629/0023-2149-2023-101-6-334-343","DOIUrl":"https://doi.org/10.30629/0023-2149-2023-101-6-334-343","url":null,"abstract":"The article presents information about the participation of doctors of the Russian imperial army and navy during the events of the Yihetuan Movement in China in 1900–1901. A brief summary of the course of the battles in Pechelii Bay and Manchuria is presented. Biographical information about the doctors of the army land units and the ships of the Pacific squadron is given.","PeriodicalId":10439,"journal":{"name":"Clinical Medicine (Russian Journal)","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80399119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adenocarcinoma of the small intestine in a patient with Peutz-Jeghers syndrome","authors":"A. T. Kortieva, V. S. Krushelnitskiy, S. A. Gabriel’, V. Dynko, A. Y. Guchetl, V. M. Durleshter, V. V. Ignatenko","doi":"10.30629/0023-2149-2023-101-6-315-318","DOIUrl":"https://doi.org/10.30629/0023-2149-2023-101-6-315-318","url":null,"abstract":"Peutz-Jeghers syndrome is a genetic disorder inherited in an autosomal dominant pattern and characterized by a mutation in the STK11 gene. According to domestic literature, the risk of inheriting this pathology from a parent to a child is 50%. According to WHO data, in 2018, more than 74,000 new cases of colorectal tumors were detected in the Russian Federation, with 5–10% of cases being hereditary syndromes, of which 1% is Peutz-Jeghers syndrome. The frequency of occurrence is approximately 1/29,000–1/120,000.  The aim of the work is to share the experience of diagnosing and treating a patient with Peutz-Jeghers syndrome. Today, we have the ability to timely diagnose pathological changes in the mucous membrane of the small intestine, perform minimally invasive treatment, reducing rehabilitation time due to a decrease in surgical trauma.","PeriodicalId":10439,"journal":{"name":"Clinical Medicine (Russian Journal)","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84815021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Infosphere interaction of clinicians, pharmacists and patients in management of hypertension. Improvement options","authors":"V. Yakusevich, O. Zheltkevich","doi":"10.30629/0023-2149-2023-101-6-319-326","DOIUrl":"https://doi.org/10.30629/0023-2149-2023-101-6-319-326","url":null,"abstract":"Arterial hypertension remains a leading risk factor for cardiovascular disease and mortality. Adequate antihypertensive therapy requires not only the development of new drugs and drug combinations, but also close professional interaction between specialists at all levels of healthcare, with mandatory patient involvement in this process. The aim of this study was to investigate information requests, ways of satisfying them, and interaction in the information field of internists, pharmaceutical workers, and patients in the treatment of arterial hypertension, and to propose ways to improve professional interaction. Material and methods included surveying doctors (n = 99), pharmaceutical workers (n = 220), and patients with arterial hypertension (n = 382), analyzing their medical documentation, organizing joint educational events during the qualification improvement of specialists at different levels of healthcare, and developing a special computer program for the automated workplace of a doctor and pharmacist as a means of improving the level of professional interaction. Results presented the profile of the main information requirements of specialists and patients in the treatment of arterial hypertension and its pharmaceutical support. The need for constant interaction in the triad doctor—pharmacist—patient was substantiated. A concept of an automated workplace for doctors and pharmacists was developed, and its functional computer program was provided. The automated workplace was tested in Yaroslavl pharmacies. Conclusion. Close professional interaction between healthcare specialists with patient involvement is an important aspect of rational pharmacotherapy. Unifi cation of the information environment of medical and pharmacy institutions allows eliminating discrepancies in medical and pharmaceutical consultations and ultimately contributes to clinical success.","PeriodicalId":10439,"journal":{"name":"Clinical Medicine (Russian Journal)","volume":"36 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82716719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In memory of A.L. Grebenev (to the 90th anniversary of his birth)","authors":"A. Sheptulin","doi":"10.30629/0023-2149-2023-101-6-332-333","DOIUrl":"https://doi.org/10.30629/0023-2149-2023-101-6-332-333","url":null,"abstract":"3 июня 2023 г. исполнилось бы 90 лет со дня рождения видного советского и российского ученого, клинициста и педагога, члена-корреспондента РАМН Андрея Леонидовича Гребенева.","PeriodicalId":10439,"journal":{"name":"Clinical Medicine (Russian Journal)","volume":"65 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78081093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Heart rate variability and quality of life ın patients with breast cancer metastasis","authors":"O. S. Mekhraliev, A. Agayev","doi":"10.30629/0023-2149-2023-101-6-279-285","DOIUrl":"https://doi.org/10.30629/0023-2149-2023-101-6-279-285","url":null,"abstract":"The implementation  of Holter monitoring  (HMECG)  and quality of life questionnaires  in clinical practice allows  for the assessment of the risk of developing dangerous heart rhythm disorders and the most important parameters related to the daily activities of patients with breast cancer. The aim of the study was to evaluate the physical and psychological health, taking into account the variability of heart rate in patients with breast cancer complicated by metastatic lymph node involvement. Material and methods. The study used data from questionnaires  completed by 115 breast cancer patients with metastatic lymph node involvement  who were receiving treatment at the Republican  Oncological  Hospital, divided into two groups: a main group of 45 patients with metastatic breast cancer and lymph node involvement, and a control group of 70 patients without lymph node involvement. The average age of the patients was between 30 and 60 years old. Complaints associated with heart rhythm disorders were considered as criteria for indicating HMECG. Quality of life questionnaires were performed using official versions of EORTC QLQ-C30 and QLQ-C30/BR23 questionnaires. Results. According to the results of statistical analysis, it was found that the effective refractory period of the atria (ERP PR) in the main group during atrial fibrillation (AF) was shorter than in the control group (p = 0.001). It was also found that in addition to shortening the ERP PR, an important factor in diagnosing breast cancer is an increase in the recovery time of the sinus node function and its corrected equivalent (CVVFSU) at relatively low average values of daily, nocturnal, and diurnal heart rate frequencies. Worsening overall condition or general fatigue are some of the most common symptoms encountered in breast cancer patients, which should be considered as important parameters significantly affecting the quality of life of patients burdened with metastatic regional lymph node involvement.","PeriodicalId":10439,"journal":{"name":"Clinical Medicine (Russian Journal)","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87420006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Domestic military field surgery at the stages of history","authors":"M. Knopov","doi":"10.30629/0023-2149-2023-101-6-344-347","DOIUrl":"https://doi.org/10.30629/0023-2149-2023-101-6-344-347","url":null,"abstract":"The article briefly presents the main stages of the development of the Russian military field surgery.","PeriodicalId":10439,"journal":{"name":"Clinical Medicine (Russian Journal)","volume":"54 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89099187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The path from cardiac arrest to discharge from the hospital","authors":"A. Chepurnaya, L. H. Bikmeeva, G. K. Dil'muhametova, T. Y. Lekhmus","doi":"10.30629/0023-2149-2023-101-6-327-331","DOIUrl":"https://doi.org/10.30629/0023-2149-2023-101-6-327-331","url":null,"abstract":"The presented clinical case demonstrates the qualified work of medical staff who act not only according to established instructions, but also by vocation. Acute coronary syndrome with ST segment elevation is associated with acute occlusion of the coronary artery and sometimes, despite medical assistance, ends in a fatal outcome. The described clinical case showed the possibility of restoring the functioning of the heart and brain activity, which allowed the patient to be discharged from the hospital in a satisfactory condition. The article also analyzes the patient's condition after discharge: the patient underwent aorto-coronary bypass surgery, plastic surgery of the interventricular septal aneurysm, and mitral valve plastic surgery.","PeriodicalId":10439,"journal":{"name":"Clinical Medicine (Russian Journal)","volume":"58 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84775267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-COVID neurocognitive disorders","authors":"O. A. Sapronenkova, E. A. Shirokov","doi":"10.30629/0023-2149-2023-101-6-265-274","DOIUrl":"https://doi.org/10.30629/0023-2149-2023-101-6-265-274","url":null,"abstract":"The article discusses the causes and mechanisms of cognitive disorders in patients who have recovered from COVID-19. A review of scientific publications in recent years has shown that the impairment of central nervous system function is one of the key features of coronavirus infection. Post-COVID neurological syndrome is observed in most patients. The authors have summarized data on the penetration of viruses into brain structures and studied the leading mechanisms of nervous system damage associated with viral infection. Promising directions for the prevention and treatment of neurocognitive disorders associated with past coronavirus infection are proposed.","PeriodicalId":10439,"journal":{"name":"Clinical Medicine (Russian Journal)","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77903985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A rare case of isolated IBM — HNRNPA2B1associated myopathy with inclusion bodies","authors":"F. I. Isaev, E. Antipenko, M. N. Erokhina, E. Parshina, T. Kozlova","doi":"10.30629/0023-2149-2023-101-4-5-247-251","DOIUrl":"https://doi.org/10.30629/0023-2149-2023-101-4-5-247-251","url":null,"abstract":"Hereditary inclusion body myopathy (IBM) is a variant of multisystem proteinopathy. It is a generalized progressive disease with autosomal recessive or autosomal dominant inheritance, characterized by the development of a degenerative process in muscle fi bers due to the accumulation of rimmed vacuoles and nuclear intermediate fi laments. This article presents a clinical observation of a rare variant of IBM — HNRNPA2B1-associated myopathy with a phenotypically diverse picture in representatives of one family from diff erent generations.","PeriodicalId":10439,"journal":{"name":"Clinical Medicine (Russian Journal)","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75301721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}