Репозиторий Университета

© 2018, Media Sphera Publishing Group. All rights reserved. Arterial aneurysms of the A2 segment are very rare (<1%) peripheral aneurysms of the anterior cerebral artery (ACA) territory. Usually, these are saccular aneurysms; there are single reports of fusiform aneurysms of this location. Surgical treatment of these aneurysms involves both microsurgical and endovascular interventions. In the presented case, we used deconstructive surgery (proximal clipping of the aneurysm) with intraoperative awakening of the patient, which verified sufficient collateral blood flow. In the case of focal deficit development, we planned to simultaneously perform an interarterial anastomosis between the A3 segments of the right and left ACAs.

© 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 Media Sphera Publishing Group. All rights reserved. The review analyzes the main etiological and pathogenetic mechanisms of the development of NSAID-enteropathy. Particular attention is paid to the role of intestinal microbiota in the manifestation and progression of NSAID-enteropathy. The special role of probiotics in the prevention and treatment of NSAIDs enteropathy is considered.

© 2018 Izdatel'stvo Meditsina. All rights reserved. The main reason of surgical treatment failure in cases of chronic dacryocystitis concurrent with nasolacrimal duct obliteration is scarring of the newly created ostium. This outcome is caused by the continued activity of myofibroblasts that leads to the formation of a rough scar. Mitomycin C is currently considered to be the most preferred anti-fibrotic drug. Nonetheless, contradictory evidence of the drug efficiency stimulates further research for finding alternative anti-fibro-tic therapeutics. Recently, several advances were made in developing new anti-fibrotic drugs, including monoclonal antibodies, small RNA molecules, and other gene therapy formulations, nanoparticles and small-molecule therapeutics. This review article aims to provide up-to-date information on the efficacy of mentioned agents and on prospects of their use in dacryology.

© 2018 Journal of Pharmaceutical Negative Results. Objective: The objective was to compare the complex formation of flavones (luteolin, apigenin), flavonols (morin, quercetin, and rutin), flavanones (naringenin), flavanonols (dihydroquercetin), caffeic, and ferulic acids with aluminum ion using two spectrophotometric methods and the application of these methods to estimate the flavonoid content in the angionorm herbal product. Materials and Methods: Method 1 included direct complex formation with aluminum chloride, and Method 2 involved preliminary nitrozation and subsequent complex formation of nitroso-derivatives with aluminum chloride. 2,4-dinitrophenylhydrazine method was also tested. Results: The conjugation system increase in the chromophore structure of nitroso derivatives is reflected by the hyperchromic effect of all substances (from 1.4 to 4-fold). The largest bathochromic shift of nitroso derivatives was seen for rutin, luteolin, and dihydroquercetin (to 510-530 nm). The total flavonoids estimation in the extract of the four herbs mixture, which constitute angionorm preparation active ingredient, depends on the chosen reference substance (3.49% calculated as luteolin when measured by Method 1 or 8.71% by Method 2; 7.97% calculated as dihydroquercetin when measured by Method 1 and 4.14% by Method 2. Conclusion: The complex formation according to Methods 1 and 2 does not allow the identification of the selective spectral regions typical for the certain flavonoids subgroups and hydroxycinnamic acids. Neither method of complex formation is suitable for the assay of total flavonoids in unknown samples or for the flavonoid content comparison in the different herbal material.

© 2018 Izdatel'stvo Meditsina. All rights reserved. This review article considers the modern notions about glucocorticoid hormones. Particular attention is paid to their molecular mechanisms of action, with emphasis on the importance of studying new compounds of the group of selective modulators of glucocorticoid receptors.

© 2018 Dynasty Publishing House. All rights reserved. The objective: To establish the character of haemodynamic disorders in the fetoplacental complex taking into account blood rheological properties, severity of systemic inflammatory response syndrome and to offer a pathogenetic rationale for terms that would be optimal for treatment of placental dysfunction in pregnant women with influenza. Patients and methods: 114 pregnant women with influenza were examined, of them 35 with moderate, 79 with severe flu. In order to rule out the variability of parameters reflecting the state of the fetoplacental complex all women were at comparable terms of gestation (20-30 wks). Results: We have found a relation between the severity of influenza, increased blood viscosity and the development of haemodynamic disorders in the fetoplacental complex. In moderate flu, fetoplacental blood circulation practically does not suffer. Resistivity index (RI), pulsatility index (PI) and systolic/diastolic (S/D) ratio remain within control values. In severe influenza, blood viscosity significantly increases and uteroplacental blood flow exhibits significant impairment. Against the background of increased blood viscosity on the average by 15-20%, taking into account the shear rate, RI, PI and S/D ratio values increase by 25-30%, which is indicative of the signs of impaired blood circulation. In increased blood viscosity at low shear rates it is uteroplacental blood flow that suffers predominantly, without involving fetoplacental one. Conclusion: In severe influenza, the contingency of placental hemodynamics on the maternal and fetal sides is impaired, and increased blood viscosity is to a great extent the cause of these disorders.

© 2018 Dynasty Publishing House. All rights reserved. The objective: The purpose of the study is to establish the role of infection with herpes simplex viruses type I and II in the pathogenesis of urogenital infection in pregnant women. Patients and methods: 89 patients of I, II trimester gestation, aged 18 to 35 years (average age of 27.5 ± 5.6 years) were examined. The design of the research and the methodology of verification of the UGI pathogens of pregnant women are presented in previously published materials. The establishment of character of pregnancy course (urgent delivery, premature birth, termination of pregnancy and mis-carriage), the presence or absence of infection and/or clinical manifestations of infectious and inflam-matory diseases, as well as evaluating the gene expression of TLR-2, TLR-3, TLR-4, TLR-8 (in relative units - RU) was conducted according to manuals. Results: It is established, that in UGI in pregnant combined viral-bacterial infection is registered. Viral component of UGI pathogens in pregnant women is presented by the association of viruses from the Herpesviridae family - herpes simplex viruses, Cytomega-lovirus, Epstein-Bar virus. Against the background of polyfactorial mechanisms of the pathogenesis of abortion, extra maximum activation of gene expression of TLR (22-23 RU or more) additional external factors, for example, infections can be an aggravating pathogenetic factor of miscarriage. Reduced expression of genes of TLR2, TLR4, TLR3 and TLR8 in the mucous membrane of the cervical canal in UGI of pregnant women in infection with herpes simplex virus due to the oppressive effect of pregnancy on the reaction of TLR, combined with the immunodepressive effect of the virus itself. With the violation of cellular part of immuno-logical reactivity of the body under the influence of adverse endogenous and exogenous factors on the process of pregnancy is activated the infectious process caused by the bacte-rial-viral pathogens association, which is accompanied by hyper reaction and increased reaction from the expression of genes of TLR, determines the pathological development of pregnancy. It is established that in the UGI of pregnant gene expression levels of TLR2-21.2 and above, TLR4-23.0 and above, TLR8 - 26.0 and above (the level of gene expression of TLR8 above 28 is the predictor of the onset of abortion and miscarriage) testify to the acute infectious process with the clinical manifestations of the UGI, and also indicates the possible interruption of pregnancy and miscarriage; levels of gene expression of TLR2 below 21.2, TLR4 below 23.0, TLR8 below 26.0, in-dicated a decrease in the severity of the infectious process and its chronicity, as well as the possibility of direct microbial damage to the tissues of UGT, placenta, and fetus. Conclusion: Verified in preg-nant women in 61% of cases clinical manifestations of the infectious process are necessarily associated with the verification of the association of herpes simplex viruses I and II type - triggers of infectious process deterioration, determining the prognosis and outcome of the development of the UGI in preg-nant.

© 2018 The Royal Society of Chemistry. Enhancing the output performance of nanogenerators using composite films consisting of a piezoelectric material embedded into polymers has gained much attention over the last few years. Such composite films can provide a high surface charge density and dielectric permittivity, which can further efficiently enhance the performance of nanogenerators. We, for the first time, employed aluminum (Al)-doped barium titanate (BaTiO3; ABTO) particles to enhance the performance of nanogenerators. These ABTO particles were synthesized via a solid-state technique, and the effect of Al dopant concentration on their crystallinity and ferroelectric properties was systematically investigated. However, the BTO particles with 2% Al dopant concentration exhibited a high remnant polarization and piezoelectric coefficient, and they were further employed to efficiently enhance the output performance of the hybrid piezo/triboelectric nanogenerators. For this, these ABTO particles were first mixed with polydimethylsiloxane (PDMS) to prepare a composite film. Next, the ABTO/PDMS composite film was employed as a piezoelectric material and triboelectric material of the hybrid nanogenerator (HNG) and exhibited a high output performance owing to their synergetic effects. In addition, the influence of the surface roughness of the composite film on the performance of the HNG was also investigated and optimized. Consequently, the HNG device with the rough surface ABTO/PDMS composite film exhibited maximal open-circuit voltage, short-circuit current, and power density values of ∼945 V, ∼59.8 μA, and ∼42.4 W m-2, respectively. For practical device application, the stable and high electrical power generated from the HNG device was employed to light several light-emitting diodes and power portable electronic devices.

© 2018 Blackwell Publishing Ltd. All rights reserved. AIMS: On the basis of echocardiography to evaluate the thickness of epicardial fat (TEF) in patients with metabolic syndrome (MS) and to establish a connection with the main indicators of laboratory and instrumental methods of research. MATERIALS AND METHODS: The study included 76 patients, 43 patients with MS and 33 without MS.The average age of patients in the MS group at the time of inclusion in the study was 62.7±10.3 years in the control group (without MS) - 60±14.7 years. All patients underwent a comprehensive examination that included the collection of complaints, study of history, physical examination, anthropometric measurements, laboratory (including the study of the levels of caspase - 8, leptin in blood plasma enzyme-linked immunosorbent assay using kits «Platinum ELISA») and instrumental examination (echocardiography, ultrasound examination of organs of small pelvis). TEF was determined using transthoracic echocardiography on the machine Acuson Sequoia 512. RESULTS: According transthoracic echocardiography was significantly higher in the group of patients with MS and was 4.67±1.7 mm, as compared to 2.66+1.15 mm in the control group (p<0.001). Identified moderate and strong correlation between TEF and weight of the patients, waist circumference, ratio of waist circumference to hip circumference, body mass index, glucose levels in the blood plasma, the presence of diabetes mellitus type 2, ultrasonic signs of steatosis of the liver and pancreas, increased aminotransferases, the level of caspase-8 concentration in plasma leptin. Patients the MS group with increased TEF increases the risk of developing hypertension, ischemic heart disease, left ventricular hypertrophy, diastolic dysfunction of the left ventricle type 2, level of caspase-8 and concentration in plasma leptin. CONCLUSION: Based on the obtained data, the measurement of TEF is justified in patients with MS in everyday clinical practice. The correlations between theTEF and the clinical and metabolic parameters of the CVD and MS make it possible to consider the TEF as a new marker of the risk of developing MS and cardiovascular diseases.

© 2018 Publishing House of the Union of Pediatricians. All rights reserved. A calcium deficiency is detected in more than 80% of children. This is the result of inadequate consumption of milk and dairy products which are the main food sources of calcium. There is a correlation between deficiency of calcium intake with food in childhood and the risk of osteopenia and osteoporosis in subsequent life periods. With insufficient exogenous intake of calcium, its concentration in the blood decreases which stimulates bone resorption. The factors that further limit the consumption of dairy products are lactase deficiency and cow's milk protein allergy. In order to ensure the intake of the necessary amount of calcium, it is advisable to use vitaminmineral complexes in children that contain not only a sufficient amount of calcium and Vitamin D but also other micronutrients required for bone formation.

© 2018 Russian Electronic Journal of Radiology. All rights reserved. Purpose. Evaluation of the morbidity structure and demonstration CT-semiotics of the main diseases in patients with nontraumatic acute abdomen. Materials and methods. 905 studies of the abdomen performed in 2016 in the State Clinical Hospital named after S.P. Botkin in patients with acute abdomen. The studies were conducted natively, with contrasting per os, with intravenous enhancement, depending on the expected pathology. Results. The most common causes of acute abdomen were: acute intestinal obstruction (27%), pancreatitis (9%), urolithiasis and its complications (8%), oncology directly and its complications (7%), inflammatory changes in the gallbladder and diliary ducts (4%), inflammatory changes in the kidneys (3%). Also significant weight in the structure of morbidity was perforation of the bowel (2.5%), mesenteric thrombosis (2%), extraorganic inflammatory changes (2%). Only 5% of cases failed to reliably detect signs of a pathological process in the presence of a clinical picture. The main characteristics of the risk group for the emergence of acute abdominal pathology, such as the age of 32-67 years, the male sex, are revealed. A more detailed analysis of risk factors within the statistically most significant nosological groups was also carried out. The diagnostic efficiency index of multislice computed tomography (CT) for the above diseases varied from 95% to 97%, the sensitivity and specificity of the method depending on the disease were 95-97.8% and 93.2-97%, respectively, p> 0.05. Conclusions. CT allows to determine the nature of the disease quite accurately in emergency medical care in patients with nontraumatic urgent abdominal pathology. The identification of a risk group in the structure of acute nontraumatic abdominal pathology facilitates early diagnosis and timely treatment.

© 2018 Russian Electronic Journal of Radiology. All rights reserved. Introduction. Instrumental methods of examination may alter the course of treatment and patients' management. Several studies have shown that interobserver variability in values obtained with renal scintigraphy (RS) can be as high as 10%, however, RS remains the standard investigation for the assessment of split renal function. Objective. This paper aims to present how numerical analysis of abdominal MSCT results can be used to evaluate split renal function. Materials and methods. A prospective study was launched in a Research Institute for Uronephrology and Reproductive Health from November, 2015 to May, 2017. 88 patients were enrolled into the study (2 with hydronephrosis, 10 with hypertensive kidney disease, 5 with stone kidney disease, 2 with kidney anomalies, 69 with renal tumors). Comparison made between renal scintigraphy data and 3D MSCT-based models. Results. CT-based methods for the calculation of split renal function with 3D-models showed correlation with renal scintigraphy (p<0.004). Conclusion. A new approach for split kidney function assessment based on contrast-enhanced CT with 3D-models and mathematical analysis allows for both acquiring detailed data on clinical anatomy and evaluation of renal function to promote preoperative decision-making. It showed strong correlation with no significant difference in comparison with RS in terms of glomerular filtration rate, perfusion and plasma flow.

© 2018 Ima-Press Publishing House. All rights reserved. With the development of current neuroimaging techniques, their role in diagnosing epilepsy is becoming more significant and that is not only in identifying the disease that plays a key role in epileptogenesis, but also in assisting a clinician in the subsequent formulation of the diagnosis, in correcting drug therapy, and, in some cases, in addressing the issue of surgical treatment in the patient. The priority technique in this case is magnetic resonance imaging (MRI) that has high sensitivity and specificity in defining the location of minor and more major lesions of the brain structure and that includes a set of current sequences that can obtain important diagnostic information about the functional state of the brain. This article highlights the International League Against Epilepsy guidelines for MRI in patients with suspected epilepsy, assesses the use of and briefly characterizes both structural and functional pulse sequences that are most commonly included in the epileptological protocol. It considers major pathological processes and evaluates anatomical and functional changes in the brain structure, which play an important role in epileptogenesis.

© 2018 Russian Electronic Journal of Radiology. All rights reserved. Purpose. The purpose of this study is to compare the diagnostic performance of coronary computed tomographic angiography (CCTA) and stress test as a first-line examination for the diagnosis of stable coronary artery disease in outpatient settings. Materials and methods. The study prospectively enrolled 74 patients with typical and atypical angina symptoms lasting longer than three weeks, mean age-63,9±10,4 years, 28 (37,8%) women. Exclusion criteria: contraindications to iodine-containing contrast media, statins; GFR <45ml/min/1,73 sq m; inability to perform stress testing. All patients consistently underwent stress testing (standard Bruce protocol and The Modified Bruce protocol) and standard CCTA on a 640-slice CT scanner Toshiba Aquilion ONE. We determined pretest probability of CAD and stratified risks using SCORE and ACC/AHA scales. Statistical processing was performed with SPSS version 11,5 software. Results. Treadmill test results were positive in 51,4% of patients, among them according to CCTA: 19,15% had stenosis = 70%, 35,3% had stenosis 50-69%. CCTA revealed that 28,6% of males and 46,2% of females with typical and 66,7% of males and 50,0% of females with atypical angina symptoms with positive treadmill test had no evidence of atherosclerotic lesions. 4,05% of patients with negative stress testing had evidence of significant arterial lesions (stenosis >70%). According to the SCORE risk estimation, 67,6% of patients with atherosclerotic changes in coronary arteries had high risk, ACC/AHA score-70,6%. The sensitivity and specificity of the SCORE and ACC/AHA scales in revealing coronary atherosclerosis were 83% and 71%, 81% and 88%, respectively (p> 0.05). Conclusion. CCTA can be considered as a method for the primary diagnosis of stable coronary artery disease in outpatient practice.

© 2018 Russian Electronic Journal of Radiology. All rights reserved. Purpose. To demonstrate the effectiveness of volumetric multispiral computer tomography at the planning of focal liver masses treatment. To present visual 3D reconstructions of the liver, its vessels and focal masses. Material and methods. A group of patients included 25 patients with different focal liver masses. The age of the patients was from 29 to 83 years (mean age 62.1 years). Each patient had MSCT of abdomen with intravenous contrast injection. The following diagnoses were made according to the results of the examination, most of which were subsequently confirmed histologically: hemangioma-3 (12%), focal nodular hyperplasia-2 (8%), abscess-1 (4%), hepatocellular carcinoma-2 (8 %), cysts-4 (16%), metastases-13 (52%) cases. Results. Three-dimensional modeling allows effectively and without distortion to combine all the phases of contrasting in a single image, which gives complete information about the anatomical features affected by the pathological process of the liver. Conclusion. Processing DICOM images with the construction of 3D models of the liver helps the surgeon at the planning of surgical treatment, improves the spatial perception of the anatomical relationship of the organ, its vessels and pathological formations. However, three-dimensional modeling requires additional time and its clinical significance remains insufficiently studied.

© 2018 Russian Electronic Journal of Radiology. All rights reserved. The analysis of 523 ultrasound examinations of the face in fetuses in pregnancy 10-14 weeks. Studies performed using 2D/3D/4D equipment transabdominal and transvaginal accesses and different modes (surface, multiplane and multislice). Investigated and presented to the rendering capabilities of individual facial structures at different age of gestation. Presents new and original methods for the visualization of the hard palate. The high informativeness of 3D/4D echography, means and tools, and its advantages in assessing the anatomy of the face in the first trimester of pregnancy are shown.

© 2018 Sankt Peterburg. All rights reserved. The purpose of this study was to assess the level of apoptosis in cells of human seminiferous tubules in normal and pathological spermatogenesis by revealing the proportion of immunostaining cells for caspase-9 and -3 and by comparing the expression of pro-apoptotic (BAK and BAX) and anti-apoptotic genes (BCL2 and BCLW). A retrospective study involved men (n = 42) who complained of childlessness in marriage for 2 years with a diagnosis of idiopathic infertility, established after physical, genetic, biochemical (hormones) and cytological (spermogram) analyzis. The biopsies of the testes as well as the autopsy material of men 22—35 (n = 10), 64—75 (n = 10) and 75—90 (n = 10) years were studied using the immunohistochemical method (caspase-9 and -3) and PCR-RT. The marking level for caspase-9 in spermatogonies with normal spermatogenesis is approximately at the same level (the proportion of stained spermatogonies is 39.5 0.33 % in young men, 35.6 0.44 % in the elderly, and 32.2 0.28 % in man of senile age), and increases when the maturation is blocked and in the case of focal variant of Sertoli-cell-only syndrome (64.3 0.39 and 72.0 0.41 %, respectively). When using antibodies to caspase-3, the percentage of immunopositive spermatogonia in normal spermatogenesis was 60.1 0.44 % in young men, 78.2 1.2 % in the elderly, and 87.3 0.9 % in men of senille age, and with idiopathic infertility, a sharp increase in the proportion of labeled spermatogonia was observed (an average of 91.4 1.1 %). In the case of hypospermatogenesis and the blocking of maturation, a significant increase in the relative level of expression of the proapoptotic genes of the internal pathway of apoptosis of BAX and BAK was observed against the background of a decrease in the expression of the anti-apoptotic genes BCL2 and BCLW, compared to men of the same age but with normal spermatogenesis. Based on the results, we can conclude that in the elderly’s testes the receptor-mediated pathway of apoptosis predominates over the mitochondrial (internal) pathway. In the idiopathic form of male infertility the internal pathway of apoptosis is dominant. An increase in the activity of apoptosis markers can be associated with impaired maturation of the germ cells in the meiosis block and with the depletion of the germ cell pool in Sertoli-cell-only syndrome.

It reports the results of primary basal blood flow in partially edentulous bone tissue with atrophy, as well as comparative evaluation of haemomicrocirculation level of the alveolar bone mucosa after bone augmentation via tunneling and conventional methods. The results of the initial state of microcirculation in the mucous membrane of the alveolar process in the partially edentulous area show a 45% decrease of blood flow (M), its intensity (s) by 60%. Microcirculatory shifts in blood flow levels indicators, its intensity, vasomotor activity are more evident when using the conventional method, where revascularization takes more than five months. When using the tunnel method, there is an improvement in haemodynamic mechanisms of tissue blood flow regulation. Microcirculation is restored 4 months after surgery.

© 2018 Russian Electronic Journal of Radiology. All rights reserved. Purpose. To present the possibility of the computed tomography (CT) in determination of a kidney injury for improving the quality of diagnostics and treatment of this group of patients. Materials and methods. Analyzed data comes from 72 T-researches with 50 patients with kidney injury at the closed injury of a stomach who were on treatment in Sklifosovsky Research and Clinical Institute for Emergency Medicine. Data of T was verified with the results of operations and autopsies. For determination of injury severity of a kidney the scale of Organ Injury Scale (OIS) was used. Results and discussion. Kidney injuries of the 1 degree (a contusion of a kidney and a subcapsular hematoma) were found in 12 patients, including the one with pre-existing pathology. Injuries of a kidney of the II degree were revealed in 14 patients: a cortical gap-in 9 cases, a subcapsular hematoma of a kidney with gap signs-in 3 cases; a subcapsular cyst with symptoms of hemorrhage and a gap-in two patients. Kidney injuries of the III degree were diagnosed in 7 patients in the form of a rupture of cortical substance from 12 mm to 18 mm deep. Damages of the IV degree were revealed in cases of 11 patients, including thrombosis of a segmentary branch of a renal artery in 6 patients. Injuries of a kidney of the V degree were revealed in 6 patients mainly in the form of fragmentation of a kidney. For an assessment of efficiency of treatment of 22 patients CT research in dynamics was executed, identification of complications served as the indication for repeated surgical intervention. Conclusions. T is an informative method which is possible to define not only an injury of a kidney, but also the degree of its severity. It allows to choose rational tactics for the treatment and to avoid an unreasonable nephrectomy. Performance of T in dynamics allows to estimate efficiency of treatment and in due time to diagnose complications.