Vestnik medicinskogo instituta "REAVIZ": reabilitaciâ, vrač i zdorovʹe最新文献

{"title":"Methods of early diagnosis and pharmacological prevention of pancreatitis after endoscopic papillosphincterotomy","authors":"T. R. Spiridonov, E. D. Novikova, T. O. El'cov","doi":"10.20340/vmi-rvz.2023.5.clin.6","DOIUrl":"https://doi.org/10.20340/vmi-rvz.2023.5.clin.6","url":null,"abstract":"Introduction . The most frequent complication of endoscopic papillosphincterotomy (EPST) is acute pancreatitis. This complication is supposed to be based on mechanical, chemical, hydrostatic, enzymatic and thermal impact on pancreatic ducts and parenchyma. According to different literature data, the incidence of post-EPST pancreatitis (PEP) varies from 30 to 40 %, and the mortality rate is 2–10 %. The aim of the investigation was to expand information about peculiarities of early diagnostics and prevention of post-EST pancreatitis at the present stage. Materials and methods . To reach the set goal we analyzed 559 case histories of patients with diagnosed cholelithiasis, 319 of them underwent EPST. Results . During the study it was found out, that elevated neutrophils/lymphocytes ratio over 4,96 (p = 0,001), high LDH level over 250 IU/ml (p = 0,01), as well as Creactive to albumin index over 0,180 (p = 0,001) are reliable markers of early diagnosis. Also, indirect diagnostic markers of PEEP are biochemical signs of cholestasis and cytolysis of hepatocytes, as well as hyperglycemia combined with glucosuria. We consider the inclusion of intraoperative injections of papillotomy wound margins with Epinephrine in combination with subsequent Somatostatin administration in combination with rectal Diclofenac and intravenous hydration with Reamberin to be the most effective strategy for PEP prevention. Conclusions . Thus, we can conclude that despite the ongoing research and the search for effective algorithms for the prevention and early diagnosis of PEP, their data often contradict each other or simply do not confirm their effectiveness. The problem of prevention and diagnosis of PEP remains complex and requires further study. There are discrepancies, sometimes significant ones, in the current literature, which provides grounds for the development and research of new methods of early diagnosis and prevention.","PeriodicalId":481396,"journal":{"name":"Vestnik medicinskogo instituta \"REAVIZ\": reabilitaciâ, vrač i zdorovʹe","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135286719","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":"Possibilities of transition of the strategy from glucosecentricity to organoprotection when prescribing antidiabetic drugs in patients with type 2 diabetes mellitus in the perimenapause","authors":"V. V. Smirnov, Yu. B. Semenova, A. B. Shapovalova, N. N. Matveeva, V. A. Zubarev","doi":"10.20340/vmi-rvz.2023.5.clin.5","DOIUrl":"https://doi.org/10.20340/vmi-rvz.2023.5.clin.5","url":null,"abstract":"Obesity, type 2 diabetes mellitus and cardiovascular diseases associated with these conditions remain one of the largest global health problems. According to statistics, at least 90 % of patients with type 2 diabetes mellitus are obese or at least overweight (BMI > 25). Very often, the cause of death in this cohort of patients is the development of a cardiovascular catastrophe. Currently, there is a gradual rejection of the exclusively glucose-centric concept of type 2 diabetes mellitus therapy in favor of an organoprotective one. In this article, we examined the possibility of using various groups of incretinomimetics (DPP-4 inhibitors and GLP-1 agonists) in the primary prevention of cardiovascular diseases in patients with type 2 diabetes mellitus in perimenopause, and comparing their effects with traditional metformin therapy. The aim of the study was to evaluate the effect of non – insulin antidiabetic drugs from the class of incretinomimetics on risk factors for the development of cardiovascular diseases in patients with type 2 diabetes mellitus in perimenopause. Object and methods . A dynamic examination of three groups of patients was carried out. The first group (n = 22) received therapy with the GLP-1 agonist semaglutide, the second group (n = 30) metformin therapy and the third (n = 19) with the DPP-4 inhibitor linagliptin. All patients, in addition to general clinical examination, assessment of the dynamics of weight loss and insulin resistance, underwent a dynamic study of triglyceride levels, low – density lipoprotein cholesterol, as well as markers of general inflammation – C-reactive protein and interleukin-6. Results . The results of the study showed that semaglutide and metformin were equally effective in reducing body weight, but metformin and linagliptin did not significantly affect the level of atherogenic fractions of the lipidogram, unlike semaglutide. Nevertheless, both semaglutide, linagliptin, and metformin reduced the level of markers of general inflammation. Conclusions . The results of the study allow us to discern a certain cardioprotective potential not only in agonists of GLP-1, but also in representatives of the class of DPP-4 inhibitors, which requires further research.","PeriodicalId":481396,"journal":{"name":"Vestnik medicinskogo instituta \"REAVIZ\": reabilitaciâ, vrač i zdorovʹe","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135288206","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":"Differential approach to the diagnosis and treatment of appendicular peritonitis in children","authors":"I. Yu. Karpova, D. S. Strizhenok, D. A. Myasnikov, V. V. Parshikov, E. D. Pyatova, T. E. Potemina","doi":"10.20340/vmi-rvz.2023.5.clin.7","DOIUrl":"https://doi.org/10.20340/vmi-rvz.2023.5.clin.7","url":null,"abstract":"The incidence of appendicular peritonitis (AP) is 3-4 % among all acute surgical diseases in children, and the structure of acute appendicitis in recent decades fluctuates within 10-15 %. Timeliness and informativeness of acute abdomen diagnostics remain important tasks of clinical practice. The use of laparoscopy with its possibility of diapeutic approach allows to diagnose and eliminate the cause of the disease. On the basis of the surgical department of the Children's City Clinical Hospital No. 1 in Nizhny Novgorod. In the period from 2018 to 2022, 126 (11.2%) patients with various types of AP were treated in Nizhny Novgorod. All children were examined with assessment of general and local status, laboratory tests were performed using unified methods developed for practical healthcare. In complicated or doubtful cases, ultrasound of the abdominal cavity organs was performed (Vivid-7 of expert class using high-frequency transducers: convex (frequency up to 5 MHz) and linear (frequency up to 10 MHz). Local forms of AP prevailed – 90 %, of which appendicular abscess was found in 35 % of observations. Data of anamnesis, examination of patients, assessment of purulent-inflammatory markers in complicated and controversial situations were resolved by ultrasound of abdominal cavity organs. Instrumental diagnostics allowed them to detect anechogenic contents (effusion), delimited areas of absceding between the intestinal loops, perforation defect of the appendix wall, periappendicular abscess forming. Within the framework of surgical correction the priority was given to laparoscopy (59.5 %), a modern therapeutic and diagnostic method with a diapeutic approach. Open interventions were used in 51 (49.5%) patients, of which: Sprengel's access was performed in 31 (61%) patients, Volkovich-Dyakonov was used in 19 (37%) cases, midline laparotomy was performed in 1 child. Analysis of the results of bacteriological studies allowed us to identify the leading pathological pathogens belonging to Gram-negative or Gram-positive flora. In the postoperative period, therapy corresponding to the treatment of patients with peritonitis was prescribed. Evaluation of bacteriological examination revealed that Enterobacteriaceae (87%), non-fermenting bacteria (72%) were susceptible to all antibiotics. However, the highest susceptibility (73 %) was noted to cephalosporins. All children were discharged home in satisfactory condition, with an average bed-day of 12.32 ± 2.4.","PeriodicalId":481396,"journal":{"name":"Vestnik medicinskogo instituta \"REAVIZ\": reabilitaciâ, vrač i zdorovʹe","volume":"66 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135286721","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":"Atypical location of the thyroid node in the upper section of the neck (clinical observation)","authors":"S. N. Styazhkina, A. I. Rysov, T. V. Fedulova, M. A. Gasanova, M. I. Chakmina, A. A. Tursukova, A. V. Gil'mutdinov","doi":"10.20340/vmi-rvz.2023.5.case.1","DOIUrl":"https://doi.org/10.20340/vmi-rvz.2023.5.case.1","url":null,"abstract":"Currently, there is an increase in the number of patients with nodular formations of the thyroid gland (TG), which requires preoperative diagnostics, which allows to detect in a timely manner follicular neoplasia and highly differentiated forms of cancer, colloid goiter with compression of the neck organs, nodular and diffuse toxic goiter (DUS) [5]. Most often, the nodes are located in the thyroid gland, but there are cases with atypical localization. Ectopia of the thyroid gland, or thyroid ectopia (from the Greek “ektopos”, i.e. “displaced”) is the presence of its atypical tissue in a place that is not characteristic of normal localization. This pathology develops due to a violation of the migration of progenitor cells of the thyroid gland during its embryonic development. The prevalence of thyroid ectopia is 1 per 100,000–300,000 people, 1 case per 4–8 thousand patients with thyroid pathology. Among the sick in 65–80 % of cases are women. According to the studied literature, thyroid ectopia can become a source of malignancy, so timely diagnosis and surgical treatment is necessary to prevent the development of life-threatening conditions. An analysis of a clinical case of atypical location of a thyroid nodule with a suspected oncological neoplasm in case of recurrence after hemithyroidectomy was carried out.","PeriodicalId":481396,"journal":{"name":"Vestnik medicinskogo instituta \"REAVIZ\": reabilitaciâ, vrač i zdorovʹe","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135286722","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":"Rare damage to the tendons of the posterior thigh muscle group. Clinical case","authors":"A. V. Mironov, V. S. Mironov, V. V. Shalin","doi":"10.20340/vmi-rvz.2023.5.case.3","DOIUrl":"https://doi.org/10.20340/vmi-rvz.2023.5.case.3","url":null,"abstract":"Introduction . Hamstring tendon injury is a rare high-energy injury. The aim of the work is to demonstrate a rare clinical case of simultaneous damage to the distal tendon of the semimembranous muscle and the distal tendon of the biceps femoris. Object and methods . The patient is 55 years old, fell on the ice and sat in the \"splits\" position. Immediately after the injury, there was a sharp pain, the absence of active flexion of the right shin. She was treated conservatively. However, the pronounced pain syndrome and the lack of active movements forced the patient to do an MRI and consult a traumatologist. Results and discussion . After performing an MRI and examination by a traumatologist, damage to the distal tendons of the semi-webbed and biceps femoral muscles was diagnosed. Surgical interventions were performed – tendon suture and tenodesis. Immobilization with a sharshnir splint with a bending angle of 80 degrees. After immobilization, a dosed extension of the knee joint with a hinge system with a frequency of 5 degrees per day was performed for 6 weeks. After carrying out a full complex of medical rehabilitation using physiotherapy and the Arthromot apparatus, the volume of movements is 0/0/180. Conclusion . Early surgical treatment and competent rehabilitation measures allow you to fully restore the lost functions. Even with such rare injuries.","PeriodicalId":481396,"journal":{"name":"Vestnik medicinskogo instituta \"REAVIZ\": reabilitaciâ, vrač i zdorovʹe","volume":"133 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135286723","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":"Changes in the hormonal background of medical students in different periods of study, taking into account gender differences","authors":"V. V. Maslyakov, O. N. Pavlova, L. H. Habibrakhmanova, R. R. Gilfanov, E. Y. Nakaeva","doi":"10.20340/vmi-rvz.2023.5.phys.1","DOIUrl":"https://doi.org/10.20340/vmi-rvz.2023.5.phys.1","url":null,"abstract":"The purpose of the study . To conduct a study of hormonal changes in medical students in different periods of study, taking into account gender differences. Object and methods. In order to achieve this goal, a study of the main physiological indicators was conducted in 120 volunteer students aged from up 18 to 24 years. The following criteria were used for inclusion in the studies: the absence of acute or chronic diseases, which is confirmed by the availability of health certificates, the presence of the middle of the menstrual cycle (for women), obtaining consent to conduct the study. Conclusion . Changes in the hormonal background of medical students depend on gender and the course of study, the greatest changes in the hormonal background of students, 1–2 courses, and these changes occur regardless of gender, then, at 3–4 courses, there is some stabilization of the hormonal background, and this is more concerning for female representatives.","PeriodicalId":481396,"journal":{"name":"Vestnik medicinskogo instituta \"REAVIZ\": reabilitaciâ, vrač i zdorovʹe","volume":"441 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135286720","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":"Cranioplasty with autograft and bone grafting material: a clinical case study","authors":"A. A. Ofitserov, N. V. Borovkova, A. E. Talypov, M. S. Makarov, G. P. Titova, N. E. Kudryashova, O. V. Leshchinskaya, R. Sh. Muslimov, I. N. Ponomarev","doi":"10.20340/vmi-rvz.2023.3.clin7","DOIUrl":"https://doi.org/10.20340/vmi-rvz.2023.3.clin7","url":null,"abstract":"A clinical study of the effectiveness of delayed cranioplasty with an autologous bone flap using allogenic bone grafting material was performed. The autograft was preserved, saturated with human collagen type 1, lyophilized and sterilized. Bone-plastic material was used to fill diastases. The patient was followed up in the postoperative period for 24 months. No clinical complications were registered. Radiological and radioisotope analysis showed normal fixation of the autograft after 6, 12 and 24 months. Biopsy analysis after 12 months showed the presence of regenerative processes in the absence of inflammation. The clinical result was assessed as successful.","PeriodicalId":481396,"journal":{"name":"Vestnik medicinskogo instituta \"REAVIZ\": reabilitaciâ, vrač i zdorovʹe","volume":"123 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136345533","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":"Modification of transsternal occlusion of the main bronchus by plastic surgery of the anterior mediastinum with a mesh implant in the surgical treatment of widespread destructive pulmonary tuberculosis","authors":"R. V. Tarasov, S. S. Sadovnikova, E. V. Krasnikova, M. A. Bagirov","doi":"10.20340/vmi-rvz.2023.3.case.4","DOIUrl":"https://doi.org/10.20340/vmi-rvz.2023.3.case.4","url":null,"abstract":"An observation from practice is given – surgical treatment of a patient with widespread destructive pulmonary tuberculosis due to a modified technique of transsternal occlusion of the main bronchus by plastic surgery of the anterior mediastinum with a mesh implant. Patient A., 37 years old, has been suffering from pulmonary tuberculosis for 2 years. She was admitted to the clinic with complaints of shortness of breath during exercise (mrc 3), cough, back pain. On computed tomography of the chest organs: a picture of fibrous-cavernous tuberculosis of the left lung with extensive mediastinal pulmonary hernia. The patient underwent transsternal occlusion of the left main bronchus with plastic surgery of the anterior mediastinum with a polymer mesh implant. The result of the treatment was the stabilization of the process and the clinical cure of the patient.","PeriodicalId":481396,"journal":{"name":"Vestnik medicinskogo instituta \"REAVIZ\": reabilitaciâ, vrač i zdorovʹe","volume":"67 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135421482","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":"Hospital substitute forms of medical assistance during COVID-19","authors":"M. G. Karaylanov, A. V. Mikheev, I. G. Prokin","doi":"10.20340/vmi-rvz.2023.3.covid.1","DOIUrl":"https://doi.org/10.20340/vmi-rvz.2023.3.covid.1","url":null,"abstract":"Primary health care in modern socio-economic conditions is given special attention. This type of medical care makes up a large part of the volume of the entire healthcare system in our country, but the least expensive compared to inpatient care. Practically up to 80 % of all available domestic healthcare resources are annually distributed to provide medical care to citizens in stationary conditions. While in modern conditions it is possible to use the available resources more economically and more efficiently. The introduction of hospital-replacing technologies into the practice of medical organizations, both outpatient and inpatient types, is an undoubted advantage of the development of domestic healthcare. During the COVID-19 pandemic, when most of the hospitals are being converted into infectious diseases hospitals, day hospital treatment has become of paramount importance as the main form of hospital-replacing technologies. At the same time, the day hospital is an intermediate link between the outpatient and inpatient networks. Day hospitals in our country appeared relatively recently, but they have received significant development from the standpoint of the greatest medical, social and economic efficiency of treating patients compared to round-the-clock hospitals under the same conditions. During the pandemic, this circumstance was undeniably proven.","PeriodicalId":481396,"journal":{"name":"Vestnik medicinskogo instituta \"REAVIZ\": reabilitaciâ, vrač i zdorovʹe","volume":"64 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135997493","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":"Effects of low doses of gamma radiation on the human body","authors":"E. V. Shanina, F. Breker, N. A. Lysov, V. Yu. Shanin, Yu. V. Ponomareva, A. A. Supil'nikov","doi":"10.20340/vmi-rvz.2023.1.clin.7","DOIUrl":"https://doi.org/10.20340/vmi-rvz.2023.1.clin.7","url":null,"abstract":"The purpose of this study was to investigate the incidence of additional cases of malignant neoplasms (MN) in a comparative aspect between the settlement living next to a radioactive waste disposal facility (RWDF) and the indicators of an environmentally clean area of the same territorial unit (region). Evaluation of radiation situation on the residential territory adjacent to the RAW disposal facility in settlement 1, and in settlement 2 (comparison settlement), as well as interpretation of the obtained data was performed in strict compliance with the requirements of regulatory documents specifying requirements to the research object. When performing measurements, the methodology described in the regulatory documents establishing these rules was used: MU 2.6.1.2398-08 \"Radiation Monitoring and Sanitary-Epidemiological Assessment of Land Plots for Construction of Residential Buildings, Public and Industrial Buildings with Respect to Radiation Safety\". The residents of the settlement 1 were found to be exposed to 3.7 mSv/year, i.e. 54.2% more than the average whole-year exposure dose received by the residents of the settlement 1 from natural background (2.4 mSv/year), which results in excessive risk of MHC development compared to the ecologically clean region. This indicates that excessive risk of MNS can occur even in conditions of radiation background within the considered safe dose of not more than 5 mSv/year. However, this risk is much lower than that from high doses of radiation. This makes it urgent to search for solutions that would allow implementation of the recommendations of the Chief State Sanitary Doctor of Russia regarding reduction of total radiation dose to 1 mSv per year or to develop measures allowing to neutralize harmful effects of radiation exposure on the human body.","PeriodicalId":481396,"journal":{"name":"Vestnik medicinskogo instituta \"REAVIZ\": reabilitaciâ, vrač i zdorovʹe","volume":"43 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136090937","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}