Репозиторий Университета

© 2018 Stolichnaya Izdatelskaya Kompaniya. В последние годы наблюдается очевидная тенденция увеличения в популяции числа пожилых больных. Эти пациенты в большинстве случаев страдают несколькими коморбидными заболеваниями, что значительно утяжеляет прогноз и усложняет тактику ведения. Представлен клинический случай пожилой пациентки, длительное время страдающей сахарным диабетом 2 типа, получающей инсулинотерапию, нахо- дящейся на программном гемодиализе из-за терминальной хронической почечной недостаточности, а также имеющей постоянную форму фибрилляции предсердий. Пациентка была госпитализирована в ГКБ №1 им Н.И. Пирогова по поводу острого повторного инфаркта миокарда. Проведено экстренное чрескожное коронарное вмешательство, стентирование инфаркт-зависимой артерии стентом с лекарст- венным покрытием. Послеоперационный период осложнился развитием острой кровопотери на фоне кровотечения из верхних отделов желудочно-кишечного тракта, тяжелой анемии сочетанного генеза (постгеморрагической, нефрогенной), что потребовало от врачей принятия нестандартных решений по выбору антитромботической терапии. Данный клинический случай иллюстрирует сложности ведения пожилых полиморбидных пациентов в реальной клинической практике, и спорные вопросы, возникающие при назначении им антитромботической терапии, особенно, после развившегося кровотечения. Рекомендательные документы не могут дать ответ на все вопросы, которые ставит перед врачом повседневная практика. В каждом конкретном случае возобновление антитромботической терапии и ее оптимальный выбор для пожилого полиморбидного пациента с развившимся кровотечением является предметом дискуссии, и представляет для лечащего врача настоящий вызов.

© 2018, Media Sphera Publishing Group. All rights reserved. Aim — the study purpose was to analyze the efficacy of intra-arterial administration of verapamil (IAV) in the treatment of angiospasm in SAH patients and to determine optimal parameters of the procedure. A number of studies demonstrated the efficacy of intra-arterial administration of vasodilators, in particular verapamil, in the treatment of angiospasm after aneurysmal SAH, which served the basis for inclusion of this method in the recommended protocol for treatment of SAH patients [1―7]. Material and methods. We analyzed the efficacy of IAV in 35 patients in the acute period of SAH, with 77.2% of the patients having a Hunt-Hess score of III―V. The inclusion criteria were as follows: IAV within two weeks after SAH; excluded aneurysm; verapamil dose per administration of at least 15 mg; follow-up for at least three months. Efficacy endpoints were as follows: changes in spasm according to angiography and transcranial dopplerography (TCDG); development of ischemic lesions; clinical outcome according to the modified Rankin scale. Results. A total of 76 IAV procedures were performed. The verapamil dose per procedure was 36.7±9.7 mg, on average; the number of procedures varied from 1 to 5. One arterial territory was treated in 12 cases, two arterial territories were treated in 48 cases, and three arterial territories were treated in 15 cases. Typical adverse reactions included decreased blood pressure, a reduced heart rate, and elevated ICP. In all cases, TCDG revealed signs of reduced angiospasm ― a 20―40% decrease in the LBFV in the M1 MCA. Four (11.4%) patients died; of these, only one died due to angiospasm progression. On examination at 3 months or more after discharge, favorable outcomes were observed in 74.3% of cases. Conclusion. IAV is associated with a low risk of significant complications. IAV should be performed under control of systemic hemodynamics and ICP. The indications for IAV include signs of moderate worsening or severe angiospasm according to TCDG and/or angiography. The IAV procedure may be performed every day. Further clarification of the IAV procedure and evaluation of clinical outcomes under prospective study conditions are required.

© 2018 Russian Electronic Journal of Radiology. All rights reserved. Purpose. Purpose of the study is to have a detailed examination and investigation of the patient with all the required parameters. Material and methods. Revision knee replacement prosthesis making a difference in treatment outcome. Results. The result after the sleeve operation was uneventful and the patient had no complaints or pain even after a year of surgery. Conclusion. Long term complications are comparatively less when a proper prosthesis is selected for the particular patient operation.

© Bionika Media Ltd. Objective. To carry out a systems analysis of the data available in the current literature on the pathogenesis, therapy, and prevention of vaginal infections caused by the pathogens of bacterial vaginosis (BV) and vulvovaginal candidiasis (VVC). Material and methods. The review includes the data of foreign and Russian articles published in the past 10 years and found in Pubmed on this topic. Results. The paper highlights the main pathways of pathogenesis and the causes of recurrent vaginal coinfection. It describes methods for the treatment of women with BV and VVC and presents the optimal therapy and prevention schemes for recurrent vaginal infectious diseases, which have evidence-based effectiveness. Conclusion. The features of a microbial portrait and immune status predispose to recurrent BV and VVC, the presence of which results in coinfection. The cause of the latter is also repeated therapy for recurrent monoinfection. First-line therapy for BV is recognized to include metronidazole and clindamycin; the advantages of the latter are a wider spectrum of activity against the microorganisms that are difficult to identify. To treat coinfection and to prevent VVC in patients with BV, it is advisable to use fluconazole that also remains a first-line treatment option for vaginal infection caused by Candida albicans.

© 2018 Ima-Press Publishing House. All rights reserved. Idiopathic lobular panniculitis (ILP) (synonym: Weber-Christian panniculitis) is the least studied disease in the group of systemic connective tissue lesions and characterized by systemic damage to subcutaneous adipose tissue (SAT). There is no unified concept of the etiology and pathogenesis of ILP now. The literature contains almost no data on the diagnostic value of laboratory studies and therapeutic approaches, which served as the basis for this investigation. Objective: to investigate the relationship between the clinical presentation of ILP and immune inflammatory parameters in patients with this disease. Subjects and methods. Examinations were made in 67 patients (9 men and 58 women) aged 20 to 76 years with a verified diagnosis of ILP (median duration, 78.91 [48; 540] months), who were followed up at the V.A. Nasonova Research Institute of Rheumatology for the period 2007 to 2017. The determination of α1-antitrypsin titer, liver fractions, amylase, lipase, trypsin, ferritin, creatine phosphokinase, leptin, and tumor necrosis factor-α (TNFα), chest computed tomography, and induration morphological examination were done in addition to physical examination. Results and discussion. The disease was found in all age groups, but it accounted for more than half (57%) of cases at the most able-bodied age (45–60 years). Analysis of the clinical manifestations of ILP could identify its four types: nodular (n=30), plaque (n=10), infiltrative (n= 5), and mesenteric (n=12), which were characterized by typical clinical features. The observed group showed a significant increase in erythrocyte sedimentation rate (ESR) (p=0.01) and C-reactive protein (CRP) level (p < 0.0001). ESR correlated with tenderness on the visual analogue scale (VAS) (p<0.05; r=0.29), induration area (p<0.05; r=0.50), and rises in body temperature (p<0.05; r=0.68) and CRP level (p<0.05; r=0.68). The concentration of CRP correlated with tenderness on visual analog scale (p<0.05; r=0.46), induration area (p<0.05; r=0.61), node stage (p<0.05; r=0.41), and TNF-α concentrations (p<0.05; r=0.32). The latter showed a direct correlation with node stage (p<0.05; r=0.41) and leptin levels (p<0.05; r=0.28) and an inverse correlation with the number of nodes (p<0.05; r=-0.24). Leptin levels were increased in 35 (52.23%) patients and displayed a direct correlation with body mass index (p<0.05; r=0.46), induration area (p<0.05; r=0.31), CRP level (p<0.05; r=0.36) and an inverse correlation with the number of nodes (p≤0.05; r=-0.33). Morphological examination of skin and SAT biopsy specimens was performed in 65 (97.01%) patients. Pre- and retroperitoneal adipose tissues were biopsied in three of five patients without skin and SAT lesions; this was not done in the remaining patients because of access difficulties. ILP was verified in all cases. Therapy was performed using the essential drugs adopted in rheumatology practice. Their therapeutic effects were noted in 62.68% of cases; inefficiency and health deterioration were detected in 12 (17.91%) patients, which necessitated an increase in the dose of disease-modifying antirheumatic drugs. Seven patients were given the following biological agents: abatacept (n=2), adalimum-ab (n = 3), etanercept (n=1), and rituximab (n=1). Conclusion. There is an obvious need to expand knowledge about this pathology amongst physicians and to conduct further investigation in order to timely diagnose and search for the most effective treatment options for ILP.

© 2018 Media Sphera Publishing Group. All rights reserved. Objectives: To study efficacy of treat-to-target (T2T) strategy in early peripheral psoriatic arthritis (EPsA) after one year of treatment. Methods: 44 (M/F - 18/26) DMARD-na?ve patients (pts) with active EPsA, according to the CASPAR criteria, mean age 37.5±11.3 years, PsA duration 7 [4; 24] months, psoriasis duration 36 [12; 84] months, disease activity index (DAS) 3.78 [3.18; 4.67], DAS28 4.33 [3.67; 4.8] study were included. At the baseline and every other 3 months for total 12 months of therapy all pts underwent standard clinical examination, tender joint count (TJC), swollen joint count (SJC), patient pain VAS, patient/physiciańs global disease activity VAS, enthesitis by Leeds Enthesial Index (LEI)+Plantar Fascia (PF), dactylitis, Psoriasis Area Severity Index (PASI), body surface area (BSA), Health Assessment Questionnaire (HAQ), DAS, DAS28-C-RP, C-RP (mg/l). The dose of MTX s/c was escalated by 5 mg every 2 weeks from 10 mg/wk to appropriate dose 20-25 mg/wk according to the drug intolerance. If pts does not achieve the lower disease activity (LDA), MDA or remission after 3 months of MTX subcutaneous (s/c) mono-therapy, then combination therapy of MTX+Adalimumab (ADA) by standard regime was continued up to one year. At 12 months of therapy the proportion of pts who attained LDA by DAS/DAS28 or remission by DAS<1.6/DAS28-C-RP<2.6 or MDA, ACR20/50/70, PASI75 and dynamics of HAQ, LEI+PF, dactylitis were calculated. Mean±SD, Me [Q25; Q75], %, Friedman (Fr.) ANOVA, U-test, Wilcoxon test were performed. All p<0.05 were considered to indicate statistical significance. Results: At one year of treatment according to T2T strategy significant improvements disease activity and physical health function related to quality of life was seen. By 12 months of therapy remission by DAS and MDA was reached 61.4%/65.9% of pts accordingly. By 12 months of therapy ACR20/50/70 was seen in 88%/77%/59% of pts. In pts with BSA≥3% (n=16) at baseline psoriasis improvements by PASI75 was seen in 88% of pts. In 55% of active EPsA pts MTX (s/c) mono-therapy was an effective treatment. Conclusions: One-year treatment according to T2T strategy significantly improves all PsA clinical domains - Arthritis, dactylitis, enthesitis, skin psoriasis and quality of life despite of type of treatment. It seems that T2T is a useful strategy in EPsA but additional research concerning its implementation in real practice are needed.

© 2018 Tomsk National Research Medical Center of the Russian Academy of Sciences. All rights reserved. Reconstruction of head and neck defects after surgery for cancer remains challenging. The choice of the reconstruction technique depends on the tumor size and localization, type of the defect, patient’s age, concomitant diseases, and disease prognosis. Surgeons have currently a broad range of material for reconstructive surgery, from free flaps to revascularized flaps. Microsurgical reconstruction has made a revolution in treatment of patients with complex head and neck defects. However, the use of this technique may not be advisable for some patients. The search for new techniques is needed to improve functional and aesthetic results and reduce traumatism without compromising oncologic outcomes. Thirty-six patients underwent surgery with reconstruction using the submental island flap, a new alternative in the reconstruction of various head and neck defects. The graft was taken after making a neck incision for neck lymph node dissection. A few patients develop total and marginal necrosis of the graft. Short- and long-term results showed no worsening of oncologic outcomes in the selected group of patients.

© Russian Journal of Cardiology. Arterial hypertension (AH) remains one of the most prevalent cardiovascular disorder in the world, as one of the main risk factors of myocardial infarction and stroke development. Monotherapy of AH is effective in no more than one half of patients even with moderate increase of blood pressure. Combinational antihypertension treatment does influence pathogenetic mechanisms of AH being an optimal solution. It is worthful to apply a fixed combination of telmisartan and hydrochlorothiazide. Such combination provides additional antihypertensive effect with more significant decrease of blood pressure than for the components separately. Also it is protective for organs and tissues that makes it to prescribe such combination to a broad range of patients.

© 2018 Dynasty Publishing House. All rights reserved. The objective: To optimize a tactics of examination and treatment of patients with a benign cervical pathology associated with papillomavirus infection (PVI) in female patients of reproductive age. Patients and methods: 124 patients aged 22 to 35 years underwent complex examination and treatment. Two groups were singled out: the first (main) group included 72 patients, who in the postoperative period received treatment with an antiviral immunostimulating drug isoprinosine, the second group comprised 52 patients, who did not receive the antiviral medication (control group). Inosine pranobex (isoprinosine) was administered 3 g/day (2 tablets 3 times daily) for 28 days. A carbon dioxide (CO2) laser and argon plasma were used to destroy the affected uterine cervical epithelium. Results: The Pap test found various pathological changes in 112 (90.3%) patients. ASCUS smear results had similar incidence rates in the groups 16 and 18% (p > 0.05). The incidence of LSIL in the groups was 31.9 and 32.6%, respectively (p > 0.05). In the basic group, 60 days afterwards complete elimination of virus was noted in 95.8% of cases; in the control group in 78.8%. The frequency of HPV infection recurrence among patients with complete virus elimination was 2.9% in the basic group, in the control group - 14.6%. Conclusion: The employment of the surgical stage permits to destroy pathological tissue, deactivate virus at the local level and prepare conditions for deactivation of virus in the body. Postoperative antiviral and immunostimulating therapy not only ensures practically complete elimination of virus but also reduces recurrences of PVI.

© 2018 Media Sfera. All rights reserved. Purpose. To study the effects of long-term instillation of 0.18% sodium hyaluronate artificial tears VISMED multi on ocular surface in glaucomatous patients with long-term instillation of preserved anti-glaucoma drops. Material and methods. The study included 79 patients (40 female and 39 male; 79 eyes in total) with primary open-angle glaucoma (POAG) divided into 3 groups according to disease stage: mild or early (stage I) glaucoma - 15 patients (15 eyes), moderate (stage II) glaucoma - 30 patients (30 eyes), advanced or severe (stage III) glaucoma - 34 patients (34 eyes). Conjunctival and corneal changes were assessed with Norn's test, Schirmer I test and corneal fluorescein staining test. All patients completed Ocular Surface Disease Index (OSDI) questionnaire. Corneal compensated intraocular pressure (IOPcc) was measured using Ocular Response Analyzer (ORA) (Reichert Optics Inc., USA). In addition to hypotensive therapy, all patients received instillations of 0.18% sodium hyaluronate (VISMED multi) three times every day. After 14 days, all examinations were repeated. Results. The condition of eye surface in patients with moderate and advanced (stage II and III) glaucoma depends on the degree of IOPcc compensation. As glaucoma increases in severity, the pathological changes in the ocular surface progress. Instillations of 0.18% sodium hyaluronate solution lead to significant improvement of the test results in all groups, and in early glaucoma patients it restores all objective indicators to normal values. Conclusion. Treatment with 0.18% sodium hyaluronate solution (VISMED multi) leads to statistically significant (p<0.05) improvement of ocular surface condition in glaucoma patients with long-term instillation of preserved antiglaucoma eye drops.

© 2018, Stolichnaya Izdatelskaya Kompaniya. The aim of the review is presenting the possibilities and perspectives of the third generation of thienopyridine P2Y12 receptor inhibitor prasugrel in the treatment of patients with acute coronary syndrome (ACS). The main pathogenetic stage of ACS is intracoronary thrombosis, which develops on the surface of a damaged atherosclerotic plaque. The use of acetylsalicylic acid with addition of the second antiplatelet agent, so-called dual antiplatelet therapy, is a standard component in the treatment of any type of ACS, regardless of reperfusion and the selected treatment strategy. Due to some limitations in the use of clopidogrel as the second component of dual antiplatelet therapy, the possibility of prasugrel or ticagrelor usage should be considered in patients with ACS with percutaneous coronary intervention (PCI). Prasugrel therapy is associated with better clinical outcomes as compared with clopidogrel therapy in moderate or high-risk patients who undergo PCI. Because of higher bleeding risk and the lack of clinical benefits in special subgroups of patients, prasugrel must not be used in patients with a stroke or transient ischemic attack in the past. If, after a thorough individual benefit-risk assessment a decision is in favor of prescribing prasugrel to the patient older than 75 years or with a small body weight the maintenance dose of prasugrel is to be reduced by half. Real clinical practice data has shown that with following these recommendations prasugrel demonstrates optimal efficacy, safety, and even more significant impact on the prognosis than this in clinical trials. Prasugrel is able to reduce significantly the incidence of cardiovascular events such as cardiovascular death, myocardial infarction and stroke in patients with ACS who undergo PCI.

© 2018 Ima-Press Publishing House. All rights reserved. Many physicians have difficulty managing patients with vertigo. Incorrect routine diagnoses are frequently made in patients with peripheral vestibulopathy, which makes therapy fail. Most cases of vestibular vertigo are caused by peripheral vestibular disorders (otolithiasis, hydrops, neuronitis). Rehabilitation maneuvers are effective in the treatment of benign paroxysmal positional dizziness; salt-free diet, diuretics, and betahistine dihydrochloride are for Mnire's disease (syndrome); vestibular rehabilitation is for vestibular neuronitis. Betahistine dihydrochloride is most effective among all the medicines used in different causes of vestibular vertigo, including that of unclear origin. The paper gives the positive experience with betahistine made in Russia for vestibular vertigo.

© 2018 Ima-Press Publishing House. All rights reserved. Cranial dystonia is a common disease of the extrapyramidal nervous system. The clinical manifestations of dystonia are extremely variable; many of its forms are often undiagnosed. Dystonia is a sensorimotor disorder of the nervous system. Damage affects not only one structure, but also a network of the nodes interacting with each other in the somatosensory cortex and associative sensory and motor fields, which play a role in the integration of various sensory modalities coming from both outside the body and from the receptors within it. Botulinum toxin preparations show the highest efficacy in treating cranial dystonia. If their administration cannot achieve a positive result, oral drugs and surgical treatments should be used.

Surgical treatment of the anal fissure is associated with unreasonably high risks of delayed development of fecal incontinence to gas or liquid stool. Standardized sphincter-preserving therapy, based on the pharmacological reduction of increased internal anal sphincter tone (chemical sphincterotomy) allows to improve significantly the results of the non-surgical approach of treating one of the most common pathology in proctological practice. Our work presents a retrospective analysis of the treatment of 295 patients with anal fissure treated with diltiazem ointment, nifedipine ointment, nitroglycerin ointment and botulinum toxin A. Significant improvement or disappearance of complaints was noted in 84% of patients. The use of botulinum toxin A was successfull in 10 out of 11 patients without the need of surgical intervention. High efficiency (91% of patients) of the sphincter-preserving approach with a significant decrease in the need for aggressive surgical manipulation allows to decrease sphincterotomy rate and reduces the risk of delayed fecal incontinence.

© 2018 Media Sphera Publishing Group. All rights reserved. In this article we present problems of prognostic value of day-by-day blood pressure (BP) variability, its role in development and progression of damage of target organs in arterial hypertension, and impact on risk of cardiovascular, cerebral-vascular complications, and mortality. We also discuss methodological aspects of assessment of day-by-day BP variability. The article contains literature data on effects of antihypertensive therapy on variability of home BP, and consideration of evidence base of possibilities of the fixed amlo-dipine/perindopril combination for lowering day-by-day BP variability.

Etiology, epidemiology and pathophysiology of anal fissure are examined in the article in order to determine the most optimal treatment strategy. The authors concluded that the most effective treatment is combined approach using both minimally invasive surgery and various medicines for anal spasm reduction.

© 2018 Media Sphera Publishing Group.All Rights Reserved. Aim. To study the causes of falciparum malaria deaths in Russian Federation and to optimize therapy for severe forms of the disease. Materials and methods. The analysis of falciparum malaria cases with deaths recorded in Russian Federation from 2013 to 2017 was conducted. The results of optimization of pathogenetic therapy of severe forms of falciparum malaria for the prevention of adverse outcomes in the intensive care unit of the Infectious Clinical Hospital №2 of Moscow in 44 patients with severe course are presented. Treatment, clinical laboratory and instrumental investigations were carried out in accordance with our intensive care protocol, which took into account the current WHO recommendations. Results. From 2013 to 2017 there were nine deaths from falciparum malaria reported in patients from African countries (6) and India (3). In Russia, due to the lack of effective drugs of artemisinin group, quinine with tetracycline or doxycycline is used for etiotropic therapy of patients with complicated form of falciparum malaria. In the management of such patients, the basis for treatment was the prevention of is-chemic, reperfusion injuries of organs and hemorrhagic complications. In the infectious clinical hospital №2 of Moscow, since 2007, the intensive care unit has developed and tested a protocol for intensive therapy in patients with severe and complicated forms of falciparum malaria, including preventive methods of extracorporeal hemocorrection with prolonged veno-venous hemodiafiltration therapy and plasmapheresis, as a result of which the mortality rate decreased from 84 to 6.8% Conclusion. The country's lack of anti-malarial drugs, the insufficient awareness of the population about the risk of infection and measures to prevent malaria, late referral of cases for medical care and errors of clinical diagnosis and treatment annually lead to fatal outcomes. In such situation, the experience of optimizing the treatment of severe falciparum malaria is particularly useful, allowing decreasing the mortality.

© Bionika Media Ltd. Objective. To investigate whether early endometrial cancer can be treated and whether fertility can be preserved in young women, by using a hormonal combination: levonorgestrel intrauterine hormonal system (LNG-IUS; Mirena 52 mg of LH) and gonadotropin-releasing hormone agonists (Zoladex 3.6 mg). Subjects and methods. The investigation covered 79 patients. The case histories of 37 patients with atypical hyperplasia and 42 with stage IA (T1aNxMo) endometrial cancer were analyzed. The patients’ mean age was 33 years. The investigation was conducted at the Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of the Russian Federation. Results. Primary treatment was completed in 67 (84.8%) patients and in 12 (15.2%) during hormonal treatment. After completion of special treatment, 8 (11.9%) of the 67 women had 10 pregnancies that resulted in childbirth and spontaneous miscarriage in 8 and 2 cases, respectively. Recurrences and incurable disease were stated in 3 (4.2%) and 9 (12.8%) cases, respectively. Repeated hormone therapy cycles were not performed because the patients had refused organ-sparing treatment. All the 12 (17.1%) patients were successfully operated on. Conclusion. The proposed treatment regimen is a highly effective medical treatment in patients with precancer and early endometrial cancer. Independent hormone therapy is undoubtedly the best alternative to hysterectomy today in this group of patients who want to preserve reproductive function.

© 2018, Media Sphera Publishing Group. All rights reserved. Non-motor disturbances represented by sensory, affective, obsessive-compulsive disorders, cognitive dysfunction, sleep disturbances are often found in patients with dystonia and have a negative impact on their quality of life. The prevalence of sensory and affective disorders and sleep disturbances is above 50% in patients with cervical dystonia and is 25% in patients with blepharospasm, writing spasm; cognitive dysfunction is found in more than 25% of patients with focal dystonia. The relationship of nonmotor, in particular psychiatric disorders, with the impairment of social and everyday life and worsening of quality of life in whole was shown. Common pathophysiological mechanisms of non-motor disorders as well as approaches to treatment of these disorders are discussed. The authors present the results on the positive effect of botulinum toxin therapy that reduces cognitive dysfunction, sensory disorders and depressive syndrome. Non-medication treatment of non-motor disorders in patients with dystonia is considered.

© 2018, Media Sfera. All rights reserved. Throughout the history of pediatric ophthalmology, pathophysiological state has always played an important role. It’s characterized by reduced central vision, often paired with disruption of binocular vision, which is interpreted as amblyopia. Central vision is necessary for social integration, so its disorders cause great quality of life changes in patients limiting their professional activities and complicating everyday life. Despite large number of proposed methods of treatment, amblyopia still remains a pressing problem and its prevalence has not changed significantly over the years.