Bulletin of the Medical Institute "REAVIZ" (REHABILITATION, DOCTOR AND HEALTH)
Peer-reviewed journal "Bulletin of the Medical Institute "REAVIZ" (REHABILITATION, DOCTOR AND HEALTH)"
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Rehabilitation of patients who have suffered a hemorrhagic stroke
Objective: to study the features of rehabilitation measures in patients who have suffered hemorrhagic stroke, analyze the main stages of rehabilitation and substantiate the importance of various restorative treatment methods. Materials and methods. A literature review on rehabilitation of patients after hemorrhagic stroke was conducted. The main directions of restorative treatment were reviewed: therapeutic exercise, massage, physiotherapy, speech rehabilitation and social-psychological support. The results of clinical studies on the effectiveness of various rehabilitation methods at specialized medical institutions were studied. Results. Hemorrhagic stroke is characterized by high mortality (more than 50% of cases) and development of serious complications in surviving patients. Comprehensive rehabilitation includes early initiation of measures, individual approach, complexity and continuity of treatment. Therapeutic exercise showed effectiveness in restoring motor functions in 77.3–83.3% of patients. Physiotherapeutic methods (magnetic therapy, transcranial direct current stimulation, laser therapy) increase rehabilitation effectiveness up to 82%. Speech rehabilitation for various types of aphasia provides improvement of indicators by 20–40%. Socialpsychological support facilitates patient adaptation to new living conditions. Conclusion. A comprehensive approach to rehabilitation after hemorrhagic stroke, including medical technologies, physical activity and psychological support, significantly increases chances for successful recovery. Early initiation of rehabilitation measures, individualized programs and family participation in the recovery process are key factors for successful rehabilitation.
Assessment of the quality of life of patients with cholelithiasis before and after laparoscopic cholecystectomy
Relevance. Cholelithiasis remains one of the most pressing issues in modern gastroenterology and surgery. Epidemiological studies indicate a significant increase in incidence in Russia—from 14.4% in 1956–1985 to 28.3% in 2021 — with a pronounced predominance among women (ratio up to 5:1). Despite the high efficacy of laparoscopic cholecystectomy, postoperative impairments in quality of life persist in 10–30% of patients, necessitating an in-depth study of postoperative outcomes. Purpose of our study was to identify clinically significant differences in symptom dynamics before and after cholecystectomy and to evaluate the efficacy of laparoscopic cholecystectomy in pain relief and quality of life improvement. Materials and methods. A prospective analysis was conducted on 120 medical records of patients who underwent elective laparoscopic cholecystectomy between August 2023 and October 2024 at the Surgical Department of City Clinical Hospital No. 18 in Kazan. Inclusion criteria were: age 18–75 years, confirmed diagnosis of cholelithiasis, and absence of acute inflammatory processes. Outcomes were assessed 6–12 months postoperatively using: (1) a visual analog scale (VAS) for pain, (2) a specially designed quality-of-life questionnaire, and (3) standard statistical analysis methods. Results and their discussion. The mean patient age was 54.5±10.2 years, with a predominance of women (58%). Statistically significant improvements (p<0.001) were observed: reduction in mean pain score (VAS) from 6.2±1.8 to 2.1±1.3; decrease in dyspeptic symptoms by 2–3 times; improved psychological status (life satisfaction increased from 35.8% to 72.5%).The most pronounced effect was noted in patients with symptomatic cholelithiasis (87.4% improvement vs. 72.1% in the asymptomatic group, p<0.05). Patients with comorbidities (obesity, type 2 diabetes) exhibited a higher need for enzyme therapy (32.5% vs. 15.2%, p<0.01). Conclusion. Laparoscopic cholecystectomy demonstrated high efficacy in treating cholelithiasis, significantly reducing pain (from 6.2 to 2.1 on the VAS) and improving quality of life. The greatest efficacy was observed in patients with symptomatic disease (87.4% improvement). The findings justify the need for: individualized postoperative management, development of differentiated rehabilitation programs, and implementation of long-term monitoring systems. This study confirms the appropriateness of laparoscopic cholecystectomy as the treatment of choice for cholelithiasis and identifies directions for optimizing postoperative patient care.
Multidisciplinary approach in the treatment of patients with articular manifestations of ankylosing spondyloarthritis
Objective: to substantiate the necessity of applying a multidisciplinary approach in treating patients with articular manifestations of ankylosing spondyloarthritis and to determine optimal methods of postoperative rehabilitation. Materials and methods. A literature review was conducted on the problems of diagnosis, treatment, and rehabilitation of patients with ankylosing spondylitis. Modern approaches to surgical treatment of large joint involvement in this disease, including hip and knee joint replacement, were reviewed. The principles of organizing a multidisciplinary team and methods of postoperative rehabilitation were studied. Results. Ankylosing spondylitis affects 0.5-2% of the population, predominantly men aged 15–30 years, leading to significant functional limitations and disability. The multidisciplinary approach includes participation of rheumatologists, orthopedic surgeons, rehabilitation specialists, and other professionals for comprehensive patient care. Rheumatologists ensure disease activity control and prevention of postoperative complications. Orthopedic surgeons specialize in surgical interventions, including arthroplasty for large joint involvement. Rehabilitation specialists develop individualized recovery programs including early mobilization, physiotherapy, therapeutic exercise, and patient education. Conclusion. The multidisciplinary approach is an integral part of successful treatment of ankylosing spondyloarthritis, especially in surgical interventions on large joints. Comprehensive postoperative rehabilitation, including early mobilization, physiotherapy, and patient education, contributes to improved functional outcomes and quality of life for patients.
The possibilities of using combined oral contraceptives and antiandrogens in the treatment of polycystic ovary syndrome in women of late reproductive age
Polycystic ovary syndrome is one of the most common endocrine disorders in women of reproductive age and is accompanied by menstrual irregularities, hyperandrogenism, and insulin resistance. Combined oral contraceptives or antiandrogenic drugs are usually used to correct androgenia. The aim of the study was to compare the efficacy and safety of antiandrogens and combined oral contraceptives in the treatment of androgen syndrome in polycystic ovary syndrome in the late reproductive period. Object and methods. 44 women with polycystic ovary syndrome aged 35–45 years were examined. The first group consisted of 25 patients who received ethinyl estradiol therapy in combination with drospirenone. The second group consisted of 19 patients receiving ciproterone therapy. All patients underwent general clinical studies (general blood analysis, general urinalysis, biochemical blood test, assessment of psychological state on the Beck depression scale, echocardiography, daily monitoring of blood pressure, determination of the level of androgens, dihydrotestosterone, testosterone, D–dimer, homocysteine, markers of bone resorption and resynthesis in the blood. Results. The results of the study showed that androgen levels in patients treated with combined oral contraceptives and antiandrogens were comparable in both groups. Patients taking combined oral contraceptives had higher levels of depression on the Beck scale, hypertension was more common, and higher levels of D–dimer were noted, while lower levels of atherogenic lipidogram fractions and homocysteine were noted. Patients taking antiandrogens had higher levels of hepatic transaminases. Conclusions. Combined oral contraceptives and antiandrogens have demonstrated comparable efficacy in correcting laboratory manifestations of androgenism. Combined oral contraceptives contribute to reducing cardiovascular risk by reducing the level of atherogenic lipidogram fractions and homocysteine, but they can provoke the development of hypertension. Combined oral contraceptive therapy is associated with a higher risk of developing depressive states, therefore, it is advisable to test patients on the Beck depression scale before initiating therapy. Antiandrogen therapy leads to a higher risk of hepatotoxicity, which is accompanied by an increase in the level of hepatic transaminases and requires regular laboratory monitoring of these parameters.
Optimization of postoperative management for pain relief in the event of knee joint diseases in overweight patients
The number of overweight people in the world is steadily increasing. This leads to an increase in the population suffering from osteoarthritis, which is one of the main causes of poor quality of life and disability among elderly patients. The disease is characterized by long-term pain syndrome, which reduces life satisfaction and significantly increases the level of discomfort. As a result, the demand for surgical interventions for lower limb joint replacement increases. Since excess weight and obesity create additional stress on the joints, which also increases the risk of developing the disease. Objective: To evaluate and compare pain relief efficacy following primary total knee arthroplasty between obese/overweight patients (BMI≥25) and normal-weight individuals at 3-, 6-, and 12-month postoperative intervals. Materials and methods. A prospective cohort study analyzed 120 cases stratified by BMI. Pain intensity was assessed using the Visual Analog Scale (VAS) in two patient groups with distinct weight-height profiles. Results. Both cohorts demonstrated significant postoperative pain reduction, with complete pain resolution achieved in all participants regardless of BMI status. Conclusion. In patients with gonarthrosis, regardless of the various factors leading to its occurrence, a favorable effect was noted regarding the exclusion of pain syndrome after total knee arthroplasty.
Acute intestinal tumor obstruction: contradictions of tactics and ways to improve results
Objective. To identify ways to improve the treatment outcomes of patients with acute obstructive intestinal tumor obstruction in an on-call surgical hospital. Materials and methods. By design, the study is a non-randomized, retrospective multicenter analysis. The object of the study was 1,571 patients who underwent emergency surgery in surgical departments of the Samara region for acute intestinal obstruction of tumor origin with tumor localization in the left half of the colon. The analysis of the immediate and long-term treatment results was carried out. Results. It is necessary to change the principles of the organization of oncological care in terms of reducing the time of preoperative examination, the fastest examination at the stage of treatment at the oncological dispensary. On the other hand, a possible solution to this problem may be primary resection based on the oncological principle with the removal of a single-barrel colostomy in an urgent surgical hospital. This will allow the patient, even in case of a delay in admission to the oncological dispensary, to get a time reserve and reduce the frequency of complications from intestinal stoma. Conclusions. Proximal double-barrelled colostomy remains the leading intervention aimed at resolving intestinal obstruction in patients with tumors of the descending colon and sigmoid colon, even in the patient's operability. The principles of organizing oncological care for patients discharged with colostomy from an on-call surgical hospital and referred for radical surgery need to be reviewed in terms of speeding up hospitalization and continuity of specialized care.
Clinical and pathogenetic features, quality of life, diagnostics and prognosis in occupational chronic obstructive pulmonary diseas
Evaluation of functional characteristics and immunopathogenesis of occupational chronic obstructive pulmonary disease in its isolated and comorbid course opens up new possibilities in assessing the development, predicting the course features and personalized approach to pharmacotherapy of the studied bronchopulmonary pathology, as well as in developing an individual strategy for its primary and secondary prevention. The aim of the study is to determine the functional characteristics and immunological markers of the risk of developing occupational chronic obstructive pulmonary disease in its isolated course and in combination with arterial hypertension under conditions of exposure to industrial aerosols of chemical and fibrogenic nature. Object and methods. The study involved 175 patients and 60 control group individuals. Determination of the levels of cytokines IL-4, IL-6, IL-8, IL-10, MCP-1, FGF 2, TGF-b, vascular endothelial growth factor (VEGF) in the blood serum was carried out by the method of solid-phase enzyme immunoassay. All patients were tested using the SF-36 questionnaire ("SF-36 Health Status Survey"). For statistical processing of the data, one-way analysis of variance with intergroup comparisons according to Dunnett's criterion in the form of mean and standard deviation (M±SD), as well as comparison of the groups as a whole (ANOVA) were used. Results. For the first time, the features of functional and immunological manifestations of occupational chronic obstructive pulmonary disease were established in its isolated course depending on the severity and in its combined course with arterial hypertension. Conclusion. The revealed functional and immunological features of occupational chronic obstructive pulmonary disease in its isolated course depending on the severity and its combined comorbid course with arterial hypertension can optimize the approach to early diagnosis, prognosis, prevention and pharmacotherapy of the pathology under study.
Emergency care for patients with various oncopathologies
Relevance. The complexity of systemic treatment of cancer patients, especially in the geriatric population, in conditions of decompensation of the pathological process with the development of emergency conditions, require specialized care. To assess the nature and scope of emergency surgical care for complications of the chest organs in patients with various oncopathologies. Object and methods. The study included 217 patients in 2024, admitted to the institute with various oncopathologies (33 – to the shock room and 184 – to the thoracic department), requiring diagnostics and various emergency care. Results. Manifestations of complications of cancer of various localizations, their diagnosis and treatment are shown. By the nature of the complications, the following are distinguished: secondary complications of the chest organs, esophagus (associated with compression of organs, the presence of metastases, obstruction of the lumen due to the spread of the oncological process), inflammatory complications, hemoptysis, pulmonary hemorrhage and cardiovascular complications. The main method for diagnosing complications is X-ray examination and computed tomography with intravenous bolus contrast enhancement, FBS, esophagoscopy, on the basis of which, and the clinical picture data, the treatment tactics are determined. Emergency care was provided based on the examination results and the use of minimally invasive, endoscopic, videoscopic, open surgical interventions and conservative management for treatment. The indication for angiography and the need for endovascular embolization was bleeding that did not respond to conservative management. Conclusions. Treatment of structural focal changes, inflammatory processes, pulmonary hemorrhages, cardiovascular complications in cancer patients is based on the use of minimally invasive, endoscopic (stenting), videothoracoscopic, angiography and embolization, conservative management and, in only a number of cases, open interventions.
Experience of using fluorescent ICG imaging for monitoring wound edge ischemia in plastic surgery after wide excision of localized skin melanoma of the trunk and extremities
The article presents the experience of using fluorescent ICG imaging for assessment and control of wound edge ischemia during plastic surgery after wide excision of localized skin melanoma of the trunk and extremities. The study demonstrates the effectiveness of intravenous administration of Indocyanine Green (ICG) for intraoperative assessment of tissue blood supply in two methods of defect closure: local flap surgery and wound edge mobilization. The method allows predicting zones of potential necrosis, making it possible to make timely decisions about the need for anticoagulant therapy and prevention of ischemic complications, thereby improving the results of surgical treatment of patients with skin melanoma.
State of microcirculation in patients with hemorrhagic fever with renal syndrome
Topicality. Hemorrhagic fever with renal syndrome is a significant natural focal infection in Russia. A key pathogenetic mechanism is endothelial dysfunction, leading to impaired microcirculation. However, its detailed assessment in patients with varying degrees of disease severity remains an urgent task. The aim of the study was to determine the state of microcirculation depending on the severity and stage of hemorrhagic fever with renal syndrome. Object and methods. An open prospective study included 85 patients. The comparison group consisted of 30 conditionally healthy individuals. Microcirculation parameters were assessed using laser Doppler flowmetry: basal perfusion level, nutritive and shunt blood flow, and coefficient of variation. The examination was conducted during the oliguric and polyuric periods of the disease. Outcomes. In patients with moderate and severe forms of the disease, a type of microcirculation impairment not corresponding to classical patterns was recorded in both periods. While maintaining a normal average perfusion level, a statistically significant increase in nutritive blood flow, a decrease in shunt blood flow, and an increase in the coefficient of variation were detected in the forearms and lower legs compared to the control group. No significant differences in microcirculation parameters were found between the disease periods or between the groups with different severity. Findings. Hemorrhagic fever with renal syndrome is characterized by a specific impairment of microcirculation, manifested by redistribution of blood flow in favor of the nutritive bed and increased tension in regulatory mechanisms. These changes are persistent, remaining in the polyuric period and independent of the initial disease severity, which underscores the prolonged nature of endothelial dysfunction.
Clinical experience with the use of oxygen-helium mixture in rehabilitation and outpatient treatment of patients with acute community-acquired pneumonia with ischemic heart disease
Background. Community-acquired pneumonia in elderly patients with concomitant coronary artery disease is characterized by high risk of cardiovascular complications and mortality due to systemic inflammatory response, endothelial dysfunction, and hypoxemia. Standard therapeutic protocols demonstrate insufficient efficacy, necessitating the search for innovative rehabilitation strategies. Objective. To evaluate the clinical efficacy and safety of heated helium-oxygen mixture (thermoheliox) inhalations in the complex therapy and rehabilitation of patients with moderate-to-severe community-acquired pneumonia with underlying coronary artery disease. Materials and methods. An open-label randomized clinical trial included 320 patients (aged 40-80 years) with CT-verified community-acquired pneumonia and concomitant CAD, discharged from hospital within 5 days. Patients were divided into two groups: the main group (n=160) received standard therapy supplemented with a 10- day course of thermoheliox inhalations (70% helium, 30% oxygen, temperature 50-80°C) in cyclic regimen; the control group (n=160) received standard treatment only. Clinical, laboratory (CRP, leukocytes, ESR), instrumental (spirometry, echocardiography, chest CT, capnometry, pulse oximetry), and psychometric parameters (TOBOL test, 6-minute walk test) were assessed. Results. The thermoheliox therapy group demonstrated significant acceleration of clinical symptom resolution, with CRP normalization on day 10 in 90% vs 75% in controls (p<0.05). The incidence of pulmonary complications (bronchiolitis, atelectasis, emphysematous bullae) at 3 months was 12% vs 37% in the control group. Gas exchange parameters improved faster: PaCO₂ normalization was achieved in 85% vs 69%, SpO₂ ≥95% on day 5 in 100% vs 93-94% in controls. Exercise tolerance by 6-minute walk test increased by 8.1% vs 1.2%. Central hemodynamic parameters showed reduction in total peripheral resistance from 1480±150 to 980±56 dyn/sec/cm⁻⁵ and increase in cardiac output from 3.5±0.6 to 5.3±1.0 L/min. Psychological testing revealed an increase in patients with harmonious attitude toward disease from 52% to 82% vs 54% to 64% in controls. Conclusions. The use of heated heliumoxygen mixture in rehabilitation of patients with community-acquired pneumonia with underlying CAD demonstrates pronounced clinical effect, reduces pulmonary complications by 66%, improves central hemodynamic parameters by 42%, and shows high safety profile. The method is recommended for inclusion in comprehensive treatment programs for this patient category.
Micronutrient correction of emotional-mental state in medical staff from surgical and resuscitation departments of the northern hospital
The professional sphere of medical activity is one of the extremely complex and extremely responsible, which entails a high risk of emotional and mental stress, which is most pronounced in doctors and nurses of emergency medical services. Objective: to study the effectiveness of monthly intake of magnesium, potassium, vitamins B6 and C by health workers from the surgery and intensive care departments of the Khanty-Mansiysk District Clinical Hospital. Objective and methods. The examination included 52 doctors and nurses who had been working in the North in the surgery and intensive care departments. Why have 7-10 night shifts during the month for more than 5 years. Of these, 14 were men and 38 women (mean age 36,7±4,6 years). The content of magnesium and potassium in hair was determined by mass spectrometry, the concentration of vitamins B6 and C in blood serum - by chromatography, the prevalence of anxiety and depression was assessed using the HADS hospital scale. All subjects took 440 mg of potassium, 200 mg of magnesium, 10 mg of vitamin B6 and 100 mg of vitamin C per day for 30 days. Results: after the correction, a reliable increase in the provision with the studied micronutrients was noted (p=0,001–0,004) with normalization of their content in bio substrates in 88.6-100% of the examined individuals. In parallel, a statistically significant decrease by almost 1.5 times in the prevalence of anxiety (p=0,004) and depression (p=0,012) was revealed against the background of improved well-being, quality of sleep, mood; increased performance and stabilization of the emotional and mental state in 67,3–86,5% of doctors and nurses from the surgical and intensive care departments of the northern hospital. Conclusion: timely correction of psycho-emotional stress should become the basis for creating methods of individual prevention of professional stress in order to prevent the development of emotional burnout, premature formation of somatic pathology, improve the quality of life and increase its duration.
Nfluence of exogenous factors on the morphological structure of the liver (literature review and original research)
Objective: to study the influence of exogenous factors on the morphological structure of the liver based on literature analysis and original experimental research. Materials and methods. A literature review was conducted on drug-induced liver injury, alcoholic liver disease, and the effects of ammonia on hepatocytes. An experimental study was performed on male rats with modeling of metabolic disorders by administration of palm oil (30 mg/kg) for 8 weeks and dexamethasone (0.125 mg/kg) for 13 days. The effects of metformin (300 mg/kg) and vildagliptin (8 mg/kg) on morphological liver changes were studied. Results. It was established that drugs cause various morphological liver changes: steatohepatitis, veno-occlusive disease, cholestasis, acute and chronic hepatitis, granulomatous hepatitis. Alcoholic liver disease is characterized by activation of lipogenesis, inhibition of β-oxidation of fatty acids, disruption of NADH/NAD+ redox balance, development of oxidative stress and hepatocyte apoptosis. Ammonia exerts cytotoxic effects by disrupting glutamate metabolism and the Krebs cycle. The experimental study revealed pronounced dystrophic changes with predominant fatty dystrophy in centrilobular zones in the control group. Vildagliptin application showed better results compared to metformin in restoring liver morphological structure. Conclusion. Exogenous factors cause a complex of pathomorphological liver changes at cellular, tissue, and organ levels. Understanding the mechanisms of hepatotoxic action of various agents is necessary for developing effective methods of prevention and treatment of drug-induced liver injury.
Clinical observation of a patient with a papillary tumor of the kidney with reversed nuclear polarity
Papillary renal tumor with reverse nuclear polarity is a rare neoplasm with a favorable prognosis, recently identified separately in the classification of tumors of the urinary tract (2022). Previously, this tumor was considered a subtype of papillary renal cell carcinoma. However, papillary renal tumor with reverse nuclear polarity demonstrates unique morphological, immunohistochemical and genetic features, including frequent KRAS mutations and the absence of chromosomal abnormalities characteristic of papillary renal cell carcinoma. The main diagnostic difficulties are related to histopathological similarities with aggressive renal tumors (eg, papillary renal cell carcinoma) and variability in the expression of some markers. Errors in verification may lead to overtherapy, while papillary renal tumor with reverse nuclear polarity requires a less aggressive approach. The paper presents a clinical observation of a 65-year-old female patient with a papillary tumor of the kidney with reverse nuclear polarity. This case is of interest due to the rarity of this pathology and the complexity of its diagnosis.
Surgical anatomy of the human buccal fat pad (literature review)
Objective: to analyze current data on the surgical anatomy of the human buccal fat pad based on a review of domestic and foreign literature. Materials and methods. An analysis of scientific publications devoted to the study of anatomical structure, topography, functions and clinical application of the buccal fat pad (Bichat's fat pad) was conducted. Data on gross anatomy, histotopographic features, anatomical variations and agerelated changes of this structure were reviewed. Results. It was established that the buccal fat pad represents a specialized mass of adipose tissue consisting of three independent lobes (anterior, intermediate and posterior), each having its own capsule and blood supply. The structure is fixed by six ligaments to various anatomical formations of the facial skull. Contradictory data regarding morphometric parameters, topographic features and functional significance of the buccal fat pad in individuals of different sex and age were revealed. Wide application of this structure in reconstructive and plastic surgery for closure of oral cavity defects, maxillary reconstruction, treatment of temporomandibular joint ankylosis and aesthetic operations was demonstrated. Conclusion. Despite active study of the buccal fat pad, contradictory data on its anatomical structure, morphometric characteristics and functional significance persist in the literature. Further comprehensive studies using modern morphological methods are necessary to obtain a complete understanding of the surgical anatomy of this structure and optimize its clinical application.
Morphological features of autoimmune gastritis
Purpose: description and analysis of characteristic morphological criteria of autoimmune gastritis (AIG). Object and methods. The study included 37 patients diagnosed with AIG who were treated at the clinics of I.M. Sechenov Moscow State Medical University in 2022. During the endoscopic examination, biopsies of the gastric mucosa were taken according to the Sydney protocol. The severity of atrophy was assessed using the OLGA system. Additionally, an immunohistochemical study was performed using antibodies to Chromogranin A (5H7, RU, Leica Biosystems, Germany). Results. The average age was 59±12.78 years. 97% of the patients (36 out of 37) were female and 3% (1 out of 37) were male. In biopsies of the antrum of the stomach, grade 1 gastritis was detected in 89.2% of patients (33 cases), while in the stomach body, grade 2 gastritis was noted in 78.4% of samples (29 cases) (chi-squared 9.21, p=0.01). A predominance of the metaplastic type of atrophy of the gastric mucosa was noted in the stomach body: complete intestinal metaplasia (IM) was noted in 59% of biopsies (22 cases), incomplete in 2.7% (1 case). Differences in the degree and stage of AIG depending on the localization of gastritis have been established – lesions of 2 or more degrees/stages in the body of the stomach are significantly more frequent (chi-squared 9.21, p=0.01). Additional histological findings were: the presence of hyperplastic polyps of the stomach body in 3 patients (8% of cases), as well as a highly differentiated neuroendocrine tumor of the stomach body (G1) in 1 patient (2.7% of cases). Conclusion. Histological examination of the fundal part of the stomach typically shows signs of glandular atrophy, widespread pseudopiloric and/or IM, as well as signs of hyperplasia of enterochromaffin-like cells. Reactive changes in the mucous membrane may also be noted in the antral part of the stomach.
Morphological changes in megakaryocytes during hydroxyurea treatment of polycythemia vera and primary myelofibrosis
Introduction. Myeloproliferative diseases are characterized by the disorder of one or more myelopoiesis cell lines in the bone marrow. In true polycythemia, primary myelofibrosis and essential thrombocythemia, hyperplasia of the megakaryocytic lineage occurs with the formation of their atypical forms. In megakaryocytes in these neoplasms, inhibition of apoptosis is observed, which contributes to the preservation of atypical forms. Hydroxyurea is used to treat Ph-negative mycloproliferative diseases. The mechanism of action of this drug is associated with the inhibition of ribonucleotide reductase. The aim of this study was to provide an ultrastructural characteristic of megakaryocytes with the definition of potential therapeutic targets in the treatment of Ph-negative MPN with hydroxyurea. Materials and methods. Four bone marrow samples obtained from patients were examined using the iliac spine trephine biopsy method. The patients were diagnosed with true polycythemia and primary myelofibrosis. All the presented patients, regardless of the nosology, were treated with the drug - hydroxyurea in therapeutic doses. Result. In bone marrow samples, in the cytoplasm of megakaryocytes, "voids" were visualized that looked like optically empty vacuoles. During electron microscopy of megakaryocytes, in bone marrow preparations, in the projections of the optically empty vacuoles described above, cavities from round to irregular in shape, of different sizes were determined. In some of these cavities, layered masses were visualized, the plates of which had a concentric direction - autophagic vacuoles. Layered structures, with concentrically directed plates, resembling the contents of autophagic vacuoles, were also determined outside the cells. Condensation of chromatin in the nuclei of megakaryocytes was not observed. Conclusion. The results obtained in the study suggest that hydroxyurea initiates an autophagic response in megakaryocytes during treatment of Ph-negative myeloproliferative neoplasms. Possibly, as the initiation of autophagic cell death, which could explain its therapeutic effect. However, it is also possible that autophagy has a cytoprotective role. Thus, autophagy is a potential therapeutic target in treatment with hydroxyurea.
Anatomy of the fibro-septal network and ligamentous apparatus of the face: comparative analysis of static and dynamic regions during aging
Objective: To conduct a morphofunctional analysis of the fibro-septal network and ligamentous apparatus in static (temporal, parotidmasseteric) and dynamic (zygomatic, buccal) facial regions with assessment of age-related changes and fixation capabilities. Materials and methods. Dissection of two cadaveric heads with preliminary silicone filling of vessels was performed. Layer-by-layer dissection was conducted with isolation of skin, subcutaneous fat, musculoaponeurotic layer (SMAS), and main retaining ligaments. Methods of loose fibrous tissue endoscopy, biomechanical testing, and photodocumentation were applied. Results. Regional differences in fibro-septal network structure were revealed. The temporal region is characterized by dense connective tissue with pronounced fibro-septal network and temporal adhesion as the main fixation structure. The zygomatic region contains mobile fat compartments and zygomatic ligament, which determines susceptibility to gravitational ptosis. The buccal region is distinguished by high dynamic activity with elastic septa and buccal ligament. The parotid-masseteric region is represented by dense, minimally mobile structures with masseteric ligament. Biomechanical changes during aging: 15–20% decrease in elastic modulus in temporal region, 30–35% reduction in collagen density in zygomatic region, 25–30% increase in ligament extensibility in buccal region. Conclusion. The fibro-septal network and ligamentous apparatus demonstrate regional specificity of structure and function. The greatest age-related changes are observed in dynamic zones. The obtained data substantiate the necessity of a personalized approach to correction of age-related changes considering biomechanical characteristics and local morphological features.
Anatomical and topographic characteristics and cytoarchitectonics of the trigeminal node in an adult
Introduction. In numerous domestic and foreign sources, structure of the trigeminal node of human and animals have been studied from topographic, anatomical, histological, embryological, surgical, neurophysiological and pathoanatomical positions. It is known, the shape of the trigeminal node is variable, most authors believe that it has a semilunar shape. The internal structure is mainly reduced to the characteristics of the cellular component of the node, as well as the nerve fibers passing through it. In the human trigeminal ganglion, the ratio of neurons to glia is 1:100. It is believed that a Gasser node can contain from 20 to 35 thousand neurons. In addition, the node contains fibroblasts, as well as small vessels, mainly blood capillaries. The aim of the study is to clarify the anatomical and topographic characteristics and structural organization, as well as the morphometric features of trigeminal neurons. Materials and methods. The object of the study was 4 trigeminal ganglia with a sensitive root and branches extending from it, with preserved dura mater, taken from corpses of adult men of the second period of adulthood (60-65 years old), without signs of surgical interventions and injuries. Sections were made from the selected material, stained according to the Nissl, Van Gieson methods, as well as with hematoxylin and eosin. Results. In accordance with the peculiarities of the structural organization, the structural and functional zones of the constituent parts of the Gasser node (the trifurcation zone, the intermediate zone of the trigeminal node, the zone of formation of the sensitive root) are isolated. Attention is drawn to the highest density of distribution of neuron bodies oriented in the direction of the maxillary and mandibular branches of the trigeminal nerve, which, as we assume, is explained by the larger area of receptive fields associated with these branches. In the zone of formation of the sensory root are seen mainly large neurons, divided into groups by nerve fibers, forming bundles of orders I, II and III, which merge to form a sensitive root. Conclusions. The trigeminal ganglion is characterized by local features of neurocyto- and myeloarchitectonics, the study of which should be carried out taking into account gender and age characteristics.
Difficulty in diagnosing tubular-villous tumor of the large intestine. A case report
Relevance. Currently, the problem of diagnosing a villous tumor of the rectum remains urgent. Diagnosis of villous tumors of the rectum can be difficult for the following reasons, they often do not show pronounced symptoms in the early stages, for final diagnosis it is necessary to conduct a histological examination, which takes time and may not always be available, it is necessary to distinguish villous tumors from other types of polyps and tumors, which also complicates the process [6]. Statistically, the following data have been obtained: of all neoplasms of the large intestine, the villous tumor occupies a leading place, the incidence of cases is 10–15%, and therefore it is important to develop diagnostic methods with high accuracy, in particular endosonography.[2]. The aim of the study To demonstrate the use of endosonography in the diagnosis of villous tumors of the rectum. Materials and methods: This clinical case demonstrates the successful use of endosonography in the diagnosis of villous tumors of the rectum. Patient C, a 66-year-old woman, was admitted to the hospital complaining of pain during bowel movements, constipation, episodes of blood impurity in the stool, and bloating. Results. Due to the use of endosonography, the accuracy of the diagnosis of villous tumors of the rectum has increased, as well as the amount of time required to detect this pathology has decreased. Conclusion. The conducted study revealed positive aspects in the use of endosonography as a diagnostic procedure for rectal villous tumor.
Results of revision knee arthroplasty in a patient with malposition of implant components (clinical case)
Endoprosthetics is currently the most effective treatment for terminal stages of knee gonarthritis. However, changes in knee kinematics after surgery sometimes lead to poor clinical outcomes. This article presents the treatment outcomes for patient A., 59, diagnosed with stage 3 right-sided idiopathic gonarthritis, pain syndrome, and varus deformity of the right lower extremity. She underwent right knee arthroplasty. For two years after surgery, the patient experienced pain in the anterior knee joint. She was diagnosed with malposition of the endoprosthesis components. Revision arthroplasty was performed with replacement of the endoprosthesis components and restoration of the joint line. A good functional outcome was achieved. Restoration of the joint line during endoprosthetics is a crucial part of normal knee biomechanics. The correct position of the joint line is determined using the joint line distalization coefficient.
Treatment of pregnant patients with calcular cholecystitis, choledocholithiasis, and obstructive jaundice
The article is devoted to the treatment of patients with various manifestations of cholelithiasis during pregnancy to clarify tactical approaches to the treatment of pregnant women with choledocholithiasis. The patients were treated simultaneously by a surgeon and an obstetrician-gynecologist. The article discusses the treatment of 22 patients with cholelithiasis - 20 with acute calculous cholecystitis and 2 with choledocholithiasis. 5 patients from 20 (25%) were operated on for stool cholecystitis. The rest received conservative treatment One patient with choledocholithiasis was treated conservatively, and the second patient underwent transpapillary intervention. There were no fetal complications in any of the 22 patients. It is concluded, that reasonable minimalism should be adhered to in the treatment of pregnant women admitted urgently to the hospital with various manifestations of cholelithiasis, as well as the safety and necessity of using endoscopic methods for the diagnosis and treatment of choledocholithiasis in pregnant patients.
Asymptomatic course of the tuberculosis process on the background of malignant neoplasms of various localization
The immune response in both tuberculosis and ZNO has similar mechanisms. These diseases have similar clinical and radiological manifestations, which makes timely diagnosis difficult among the population. An observation from practice is presented – surgical verification of pulmonary tuberculosis and two types of tumors in a patient with a recurrent course of myeloma. Patient M., 50 years old, considered himself ill since August 2023, when he noticed pain in the ribs on the left, a CT scan of the chest revealed a few scattered foci in both lungs, large calcification in the upper lobe of the right lung, foci of lytic destruction of bone tissue in all vertebrae, ribs, sternum, shoulder blades and collarbones. He was examined by an oncologist, according to PET/CT data, it is a common osteodestructive process, additional formation in the apical sections S1-S2 of the left lung with an increased level of metabolic activity. He was further examined and diagnosed with Multiple myeloma. 3 courses of chemotherapy (CT) of the 1st line with the effect were performed. On 04/27/24, a stabilizing operation was performed on the spine with anterior access – strengthening of the anterior complex of the Th12 vertebra. On PET/CT: a CT picture of the subpleural compaction area (magnification from 13×8 mm to 16×9 mm) and large calcification of the upper lobe of the left lung without dynamics for 6 months. A sample with recombinant tuberculosis antigen was performed – a 22mm papule with a vesicle. Upon further examination, no data were received for the tuberculosis process. A therapeutic and diagnostic operation was performed in the amount of VATS resection S1, S4-5 of the left lung with lymphodisection L10, L11, L13. According to the results of histological examination: moderately differentiated adenocarcinoma S1 of the left lung with a mixed type of growth (areas of acinar, papillary and solid types of growth). There is a site in S4-5 that is suspicious of a microblast of a highly differentiated neuroendocrine lung tumor (typical lung carcinoid). The structure of the necrosis focus in S4-5 of the left lung and fibrosis foci in L11 are more consistent with post-tuberculosis changes. Microbiologically, MBT DNA was detected in the surgical material by PCR (in S1 and S5), and CM3 was detected by luminescent microscopy in 100p/sp (in S1) and 9 in 100p/sp (in S5). The sensitivity to HRFq was established by the SYNTHOL method. Anti-tuberculosis therapy has been deployed. Given the lack of data for the oncological process in the lymph nodes, the pT1N0M0 stage has been established. The patient was kept under observation, and chemotherapy was not deployed. The patient continued tuberculosis treatment at his place of residence.
Biliary complications after orthotopic liver transplantation
Relevance. Biliary complications take the leading position among all possible complications after liver transplantation, their frequency varies from 10-15% to 30% in case of cadaveric liver transplantation, and up to 40% in case of transplantation from a living donor. They include: strictures and deformations of the anastomosis leading to mechanical jaundice, cholangitis and impaired graft function. The arisen pathology significantly worsens the prognosis, therefore prevention of anastomotic strictures, timely diagnostics and treatment are required. Purpose of the study. To reveal the frequency of biliary complications after orthotopic liver transplantation, to determine the factors contributing to their development. Materials and methods. 264 operations for orthotopic liver transplantation were performed in the conditions of the State Autonomous Establishment of the Republican Clinical Hospital from 2019 to May 2025. Of them 258 – from a cadaveric donor, 6 – from a related donor. A total of 264 patients were retrospectively analyzed, including 77 males and 187 females. For statistical processing of the study results Microsoft Excel program was used to calculate the percentage of evaluation criteria. Research results. The total incidence of biliary complications amounted to 10.6%. It has been established that the occurrence of biliary strictures, deformations and failure of biliobiliary anastomosis depends on the recipient's primary disease, the technique of biliobiliary anastomosis formation, and the method of drainage. Conclusion. On the basis of the obtained data we can conclude that for essential decrease of biliary complications frequency it is necessary to use complex multidisciplinary approach, which includes: improvement of surgical technique, choice of optimal method of reconstruction and drainage of biliary tracts. Special attention should be paid to preventive measures in patients with aggravated biliary anamnesis, which will minimize the risk of biliary complications in the postoperative period.
Machine Perfusion of Livers with Moderate Macrosteatosis: Efficacy of HOPE with Controlled Rewarming
Objective. To evaluate the efficacy of machine perfusion using hypothermic oxygenated perfusion (HOPE) with controlled rewarming in reducing ischemia-reperfusion injury of human donor livers with moderate macrosteatosis through comprehensive analysis of regulated cell death mechanisms. Materials and methods. Prospective experimental study of 24 human donor livers with 30-50% macrosteatosis. Organs were randomized into three groups: control (standard cold storage, n=8), HOPE (hypothermic oxygenated perfusion at 10°C, n=8), and HOPE+W (HOPE with controlled rewarming from 10°C to 20°C, n=8). Markers of oxidative stress (MDA, GSH/GSSG), apoptosis (caspase-3, -7, -8, -9 activity, cytochrome c release), mitochondrial function (ATP production, respiratory function), inflammatory response (IL-1β, IL-6, TNF-α), and clinical transplantation outcomes were evaluated. Results. The HOPE+W group achieved significant reduction in oxidative stress markers: MDA level was 2.8±0.4 vs 5.9±0.8 nmol/mg protein in controls (p<0.001), GSH/GSSG ratio was 5.2±0.6 vs 2.1±0.3 (p<0.001). Caspase-3 activity was reduced to 0.9±0.1 vs 2.4±0.3 rel.units in controls (p<0.001). ATP production was maintained at 18.2±2.1 vs 8.4±1.2 nmol/mg/min in controls (p<0.001). IL-6 concentration in perfusate was reduced to 45±7 vs 124±16 pg/ml (p<0.001). Peak ALT levels were 524±89 vs 1248±186 U/L in controls (p<0.001). Hepatic artery thrombosis was absent (0% vs 25% in controls, p=0.034). Graft survival without retransplantation was 100% vs 75% in controls (p=0.045). Conclusion. Hypothermic oxygenated perfusion with controlled rewarming effectively protects livers with moderate macrosteatosis from ischemia-reperfusion injury through suppression of oxidative stress, preservation of mitochondrial function, inhibition of apoptosis, and modulation of inflammatory response, leading to significant improvement in early and medium-term transplantation outcomes.
Clinical protocol for management of potential organ donors with brain death
Objective. To develop a comprehensive clinical protocol for management of potential organ donors with brain death, based on modern evidence-based medicine principles and aimed at maximizing the quantity and quality of transplantable organs. Materials and methods. A systematized approach to donor management is presented, including pathophysiological rationale for therapeutic interventions, standardized donor management goals (DMG), algorithms for hemodynamic and respiratory support, protocols for hormone replacement therapy, correction of electrolyte disorders, and prevention of infectious complications. The protocol is based on the "treat and optimize" philosophy, preferring prolonged optimizing treatment (12–15 hours) over accelerated organ procurement. Results. A comprehensive protocol has been developed, including: detailed tables of mandatory invasive access and monitoring; step-by-step hemodynamic support algorithms with clear indications for vasopressor and inotropic therapy; hormone replacement therapy protocol for refractory instability; hypernatremia correction system as a risk factor for liver transplant dysfunction; rational antibiotic prophylaxis schemes; organ-specific management approaches; laboratory monitoring system with specified frequency and critical values of parameters. Conclusion. The presented protocol implements the concept of transformative intensive care medicine, where donor management is considered as high-tech medical care aimed at saving multiple lives. Strict adherence to the DMG protocol with achievement of target parameters (mean BP 60–70 mmHg, urine output 0.5–1.0 ml/kg/h, PaO2 >100 mmHg, temperature >35°C, sodium<155 mmol/L) significantly increases the quantity and quality of transplantable organs.
Modern possibilities and prospects of mesenchymal stem cells in orthopedic dentistry (literature review)
The review article presents the results of an analysis of modern literature sources dedicated to the isolation and application of mesenchymal stem cells (MSCs) in prosthetic dentistry. The article discusses the main types of dental MSCs — dental pulp stem cells (DPSCs), stem cells from human exfoliated deciduous teeth (SHED), stem cells from the apical papilla (SCAP), and periodontal ligament stem cells (PDLSCs) — focusing on their origin, molecular and biological characteristics, differentiation potential, and possible applications in tissue engineering. The data on the secretory activity of MSCs, their immunomodulatory and regenerative properties are summarized. The high potential of dental MSCs in the reconstruction of hard and soft oral tissues, including in cases of edentulism, is emphasized, highlighting their role as an alternative or adjunct to conventional treatment methods.
Features of lifestyle and health of students of the university medical faculty
Objective: to identify significant factors influencing the health of 1st and 3rd year students of the Faculty of Medicine. Object and methods. A total of 72 students (57 females – 79.2% and 15 males – 20.8%) were selected for the survey. The average values of age, body mass index, and time of study at the university of the respondents were: 20.1±1.3 years, 26.7±0.5 kg/m2 and 1.92±0.4 years, respectively. Results. 37.5% of students were found to be overweight and have stage I obesity, 75% of students rated their health as "good" or "excellent", but 25% reported unsatisfactory health. 34.7% of students have chronic diseases, among which gastrointestinal tract pathologies (56%) and respiratory system (28%) predominate, 47.2% of students smoke regularly, and 27.8% of students drink alcohol. 79.1% of students do not engage in physical activity and do not plan to do so in the near future, while 59.7% of students are aware of the relationship between physical activity and health. Conclusion: A number of significant factors influencing the health of first- and third-year medical students have been identified: problems with body weight, subjective assessment of health by students, the presence of chronic diseases, bad habits (smoking, alcohol), low physical activity and insufficient awareness of the role of physical activity.
Septic Angina (Alimentary-Toxic Aleukia) in the Kuibyshev Region during the Great Patriotic War (To the 80th anniversary of the Victory)
Relevance. Septic angina (alimentary-toxic aleukia) is a disease that has been in the USSR since the 1930s, during the Great Patriotic War, following the consumption of grain contaminated with Fusarium [1]. However, Fusarium grain is a worldwide disease, affecting the agricultural products and crop quality [2]. This work has historical and scientific interest, as the historical lessons neglect lead to the diseases recurrence and the previously relevant issues resurgence. The aim of the study is to analyze the incidence of alimentary-toxic aleukia in the Kuibyshev region during the Great Patriotic War. Materials and methods. The work was carried out in the SamSMU Department of Infectious Diseases with Epidemiology. The alimentary-toxic aleukia incidence in the Kuibyshev region during the Great Patriotic War was characterized. Results. Cases of human and animal disease after consuming grain infected with Fusarium were reported in the USSR in the 1930s and 1940s in several regions. The disease was known as "septic angina". The incidence of the disease increased during the Great Patriotic War. In the Kuibyshev region, the disease cases were first reported in 1942. In 1944 the situation was particularly severe. The patients had consumed cereals contaminated with Fusar fungi and their toxins. Since 1950 no cases of alimentary-toxic aleukia have been reported in the USSR. Conclusions Septic angina (alimentarytoxic aleukia) was widespread in many regions of our country since the 1930s, especially during the Great Patriotic War. In famine times it was difficult to combat the disease, as it was caused by the consumption of poor-quality bread products from last year's grain. The causative agent was identified after the Great Patriotic War: the patients had consumed grains contaminated with Fusarium fungal toxins. Since 1950 no cases of alimentary-toxic aleukia have been reported in the USSR. However, in the modern world, the problem of Fusarium contamination of grain crops and mycotoxin contamination remains important [3,4,5]. It is necessary to take measures to reduce their harmfulness and prevent potential diseases in humans, taking into account our country's unique experience in the fight of alimentary-toxic aleukia.
Morphometric parameters of the knee joint: completeness and quality of assessment according to radiography
Background. Knee joint radiography remains the primary diagnostic method for gonarthrosis at the outpatient stage. Correct disease staging requires accurate measurement of joint space width, however, the quality of study result descriptions has not been fully investigated. Objective: To evaluate the completeness of joint space width descriptions and the correctness of gonarthrosis staging in knee joint radiography protocols. Materials and methods. 1000 randomly selected knee joint radiography protocols from the UMIAS database of Moscow for the period 2023-2024 were analyzed. The presence of objective data on joint space width measurements and the correctness of staging according to N.S. Kosinskaya classification were assessed. Results. Objective joint space measurement data was contained in only 22.0% of protocols (220 out of 1000). In 78.0% of cases, subjective formulations such as "moderately narrowed", "unevenly narrowed" were used without specific measurements. Nevertheless, specific stages of gonarthrosis were indicated in conclusions: stage I – in 54.1% of defective protocols, stage II – in 31.8%, stage III – in 8.5%. In 5.6% of cases, disease stage was not determined. Conclusion. Unsatisfactory completeness of morphometric parameter descriptions in knee joint radiography was revealed. Implementation of automated joint space width measurement tools is necessary for objectification of gonarthrosis staging and improvement of diagnostic quality.
Application of magnetic resonance morphometry in patients with multiple sclerosis to study disease progression
Background. Multiple sclerosis is a chronic inflammatory neurodegenerative disease that often leads to disability. Modern neuroimaging methods, including magnetic resonance morphometry, allow detection of brain structural changes associated with disease progression and clarification of their relationship with the clinical and functional status of patients. Objective: To evaluate the capabilities of magnetic resonance morphometry in detecting cerebral atrophy in patients with verified multiple sclerosis and establish the relationship between volumetric parameters of brain structures and clinical-functional data in different types of disease course. Materials and methods: A retrospective study of brain MRI data from 38 patients with verified diagnosis of multiple sclerosis aged 22 to 67 years was conducted. MR morphometry was performed on a high-field MR scanner with magnetic field induction strength of 3.0 Tesla. The study protocol consisted of T2-WI, T2 TIRM, T1-MPRAGE pulse sequences with slice thickness of 4.0 mm. Post-processing of MR data was performed using the online volBrain platform designed for automatic assessment of volumetric parameters of brain structures. Data from previously conducted neurological examination and testing using the Expanded Disability Status Scale, Fatigue Impact Scale, cognitive functions according to the Montreal Cognitive Assessment, and functional status using the 9-hole peg test and 25-foot walk test were also evaluated. Statistical analysis was performed using GraphPad Prism 8.00 and Statistica software. Results. Significant intergroup differences were revealed in total brain volume, gray matter volume, cerebellum and occipital lobes volumes. Statistically significant correlations between morphometric parameters and functional scales were established. Conclusions. Magnetic resonance morphometry allows objective detection of cerebral atrophy associated with multiple sclerosis progression and can be used to evaluate treatment efficacy and predict disease course.
Proton magnetic resonance spectroscopy (1h-magnetic resonance spectroscopy) in assessing metabolic changes in the perifocal zone in high-grade gliomas (literature review)
Background. High-grade gliomas are characterized by infiltrative growth with possible presence of tumor cells in the perifocal zone, which creates difficulties in determining the true tumor boundaries when using standard MRI diagnostic methods. Objective: To present a review of current publications on the application of proton magnetic resonance spectroscopy (¹H-MRS) in assessing metabolic changes in the perifocal zone in high-grade gliomas. Materials and methods. A systematic analysis of publications in PubMed, Scopus, eLibrary and Google Scholar databases for the period 2015-2024 was conducted using keywords: "¹H-MRS", "high-grade glioma", "glioblastoma", "peritumoral zone", "metabolic changes". Results. Proton MR spectroscopy allows detection of metabolic disorders in the perifocal zone of gliomas, including increased choline (Cho) levels, decreased N-acetylaspartate (NAA) and appearance of lactate (Lac). The most significant prognostic markers are elevated Cho/NAA ratios >1.99 and Cho/Cr ratios >1.73, which correlate with early tumor recurrence and presence of infiltrating tumor cells in noncontrast enhancing zones. Conclusion. Integration of ¹H-MRS into the clinical protocol for evaluating high-grade gliomas improves diagnostic accuracy, enhances surgical and radiation therapy planning, and allows optimization of personalized treatment approaches for patients