Репозиторий Университета

© 2018 Media Sphera Publishing Group.All Rights Reserved. The goal is to present the possibilities of diagnosis verification, the features of the clinical picture of tuberculous pericarditis in the therapeutic clinic and the results of its treatment. Materials and methods. The paper presents clinical observation and a general analysis of 10 cases of tuberculous pericarditis in patients aged 31-79 (mean age 58.0 ± 15.1 years), 6 women and 4 men. Diagnostic puncture pericardium was performed on two patients, pleural puncture - on three Thoracoscopic biopsy of hilar lymph nodes and lung (n=1), pleura (n=1), supraclavicular lymph node biopsy (n=1). Dyskin test was carried out, as well as sputum examination, multispiral computed tomography, oncological search. Results. A 31-year-old patient with a massive effusion in the pericardial cavity, pleural lesion, arthritis of the left knee joint, whose results of the pericardial effusion and sputum were not diagnosed, tuberculosis was detected only with thoracoscopic biopsy of the lung and intrathoracic lymph nodes; the treatment via prednisolone and subtotal pericardectomy was performed. Among 10 patients with MSCT of the lung, changes were noted in general, but in only one case they were highly specific. Diaskin test is positive in 70%. In the study of punctata, bronchoalveolar flushing, Koch bacteria were not detected; at sputum in microscopy and biological sample BC was detected in two patients. The lymphocytic character of effusion in the pericardium / pleura is noted in 4 out of 5 cases. At a biopsy of lymphonoduses and a lung at 2 patients the picture of a granulomatous inflammation with a caseous necrosis. Pericarditis was predominantly large (from 2 cm and more) effusion, signs of constriction were noted in 50% of patients. Conclusion. Tuberculosis is one of the frequent causes of pericarditis in the Moscow therapeutic clinic. The most lymphocytic effusion with fibrin and the development of constriction. The negative results of all laboratory tests for tuberculosis do not exclude a diagnosis, It is necessary to use invasive morphological diagnostics, including thoracoscopic biopsy.

© 2018 Media Sphera Publishing Group. All rights reserved. Cardiovascular diseases (CVD) are the main cause of death worldwide. A broad study of the pathogenetic mechanisms of the CVD onset and progression has led to understanding of the importance of endothelial dysfunction (ED) in these processes. During recent years intensive work has been conducted in the direction of searching for markers of ED. Metabolomics is an intensively advancing approach to early diagnostics of diseases. Metabolomic analysis based on mass spectrometry allows to study complete metabolic profiles and their deviations resulting from changes in expression of genes and RNA, protein activity, or environmental factors. Metabolomic analysis has already demonstrated significant results in the solving of different scientific and clinical problems. It appears to be a promising method for detecting early biomarkers of CVD. Various aspects of application of metabolomic profiling in the field of cardiovascular diseases are discussed in this article.

© Bionika Media Ltd. The author has carried out a systems analysis of the data available in the current literature on the participation of vitamin D in the physiology of bone metabolism, the pathogenesis of osteoporosis, and the possibilities of osteoporosis therapy with active vitamin D metabolites. The paper describes the mechanisms of vitamin D participation in the processes of bone metabolism and calcium homeostasis. It presents the effects of vitamin D on connective and muscle tissues. Its deficiency is shown to play a role in the pathogenesis of osteoporosis and in the increased risk of low-trauma fractures. There are clinical trial findings that confirm the possibility of using active vitamin D metabolites for the therapy of osteoporosis and for the prevention of low-trauma fractures. Active vitamin D metabolites used alone or in combination with antiresorptive therapy for osteoporosis is an effective measure to prevent low-trauma fractures and can be prescribed for menopausal osteoporosis.

AIM: To determine the safest and the most effective surgical treatment of patients with cicatricle stenosis of tracheolaryngeal segment via analysis of different approaches.MATERIAL AND METHODS: For the period 1963-2015 at Petrovsky Russian Research Center for Surgery and Sechenov First Moscow State Medical University 1128 patients with cicatricle tracheal stenosis have been treated. There were 683 men and 445 women. 684 (60.6%) patients were young and the most employable (21-50 years). All patients were divided into 2 groups depending on time of treatment: the first one included 297 patients between 1963 and 2000, the second group - 831 patients between 2001 and 2015. In group 1 tracheolaryngeal anastomosis was made in 10 (16.9%) out of 59 patients who underwent tracheal resection. Previously indication for this surgery was cicatricle stenosis of cervical trachea and larynx with upper borderline of cicatricle changes at least 2 cm from vocal folds. In group 2 these procedures were more frequent. 94 (28.5%) out of 330 patients underwent tracheolaryngeal resection. Cranial borderline of lesion was within 0.5 cm from the vocal folds (only if posterior laryngeal wall at the level of cricoid cartilage was intact). Difficult patients are those who need for double-level or redo repair and procedures with tracheostomy.RESULTS: In the second group overall morbidity after tracheal resections followed by anastomosis was 5.6%. These complications were more common after tracheolaryngeal anastomosis (17%). There were no lethal outcomes after 94 tracheolaryngeal resections. Good long-term results were observed in 89.8% of patients after circular resection. Their quality of life was similar to that of healthy people. Preserved cicatricle tracheal segments during tracheal repair with T-shaped airway tube adversely affects quality of life in these patients in long-term period.

© 2018, © 2018 Informa UK Limited, trading as Taylor  &  Francis Group. Background: Mesenchymal dysplasias or inherited connective tissue diseases are the group of diseases with deficiency of various components of connective tissue. Connective tissue disorders can affect different organs: skeleton, sight organ, skin, lungs, heart. But the most dangerous is vascular wall insufficiency leading to high risk of hemorrhage, especially during pregnancy and delivery due to hemodynamic and hormonal effects on the walls of the modified vessels. Aim: To evaluate the risk of complications during the pregnancy and delivery in patients with mesenchymal dysplasias. Study design: Fifty-six pregnancies in patients with mesenchymal dysplasias, including subclinical forms of diseases: 23 with Marfan syndrome (I group), 22 with Ehlers–Danlos syndrome (II group), and 11 with Osler–Weber–Rendu syndrome (hereditary hemorrhagic telangiectasia) (III group) of the age from 18 to 36. The study included retrospective analysis (for the period from 1993 to 2005) and prospective study. Results of study showed high risk of life-threatening complications during pregnancy and delivery, especially the risk of hemorrhage and cardiovascular complications. In all the patients, we observed the progression of bleeding or development of bleeding in new localizations (epistaxis in 27 patients, easy brushing in 22, skin and mucosa telangiectasia in 20, gastrointestinal bleedings in 4, hemoptysis in 4, hematomas for minor traumas in 14, conjunctivas hemorrhages in 5). Conclusion: The pathogenesis of bleeding in such patients has mixed pattern: besides vascular wall pathology coagulation deficiency plays some role. The preferred delivery method for such patients is caesarean section. Deep vaginal ruptures and serious hemorrhage accompany vaginal delivery.

© 2018 Izdatel'stvo Meditsina. All rights reserved. The review discusses the issue of reflux nephropathy for specialists of the system of higher medical education: the article provides the definition, characterizes the epidemiology, risk factors for disease development in children with vesicoureteral reflux, causes and molecular mechanisms of renal fibrosis formation and progression in reflux nephropathy, markers for diagnosing and predicting the disease course.

© 2018 Izdatel'stvo Meditsina. All rights reserved. I.M.Sechenov First Moscow State Medical University, Moscow, 119991, Russian Federation There was executed the study including the examination of 833 students of 2-6 courses of the medical University concerning their subjective rating of the stress level on exams, its causes and the measures they used to reduce stress. 26.7% of students noted the high level of stress on examination, there was significantly increased the number of students with low-stress levels in students оf 3-4 courses, boys, and students with good and excellent grades note significantly less a high level of examination stress. The most common manifestations of stress are changes in the cardiovascular system (62% of the students) and autonomic nervous systems (48.6%), these manifestations were significantly less noted in students with good and excellent grades. In the course of training, there was discovered the increase in complaints of the frequent urination, loose stools and discomfort or pain in the abdomen. The main causes of stress at exams, according to students, there are a large amount and difficulty of exam material and the insufficient addressing of examination tasks in the classroom. In the dynamics of training, there is a significant reduction in the number of students who believe early acquaintance with the exam questions to be important, the sufficiency of the time devoted to self-education and an increase in the number of students recognizing it is necessary to reduce the waiting time of the call to the exam. Most popular methods of the reducing examination stress on younger courses are the use of rites, superstitions, and drugs, in the senior years. A growing number of individuals using the techniques of autogenic training was discovered. 49.9% of students do not fight with stress. 63.9% of students consider the introduction of elective subjects of “Prevention and correction of examination stress in students” to be necessary.

© 2018 Stolichnaya Izdatelskaya Kompaniya. The metabolic syndrome is a highly prevalent condition associated with increased cardiovascular risk in the population. Microvasculature is the terminal part of the cardiovascular system which primarily reacts to the increased secretion of the pro inflammatory adipokines typical for the metabolic syndrome. Microcirculation and blood cell abnormalities are the leading mechanisms of cardiovascular events development in this condition. Prevalence of microcirculation abnormalities and red blood cell dysfunction in metabolic syndrome and their role in the increased blood viscosity and cardiovascular events development are covered by the paper. The microcirculation abnormalities with a special focus on red blood cell dysfunction (impaired aggregation, stiffness) seen in metabolic syndrome and associated conditions are discussed in detail. The impact of abnormal red blood cell deformability (secondary to cholesterol accumulation in the cellular membranes) on the hemorheological abnormalities is revealed. Abnormal red blood cell surface charge due to proinflammatory changes associated with insulin resistance in diabetes mellitus is highlighted. These abnormalities lead to increased red blood cell aggregation and plasma viscosity that are the essential components of cardiovascular events pathogenesis. Their timely diagnosis is crucial for effective cardiovascular prevention.

© 2018, Media Sphera Publishing Group. All rights reserved. Venous surgery prescribed to the patients receiving anticoagulation therapy for the treatment of atrial fibrillation especially with the use of warfarin is considered to constitute a serious challenge due to the increased risk of the development of venous thromboembolism and other hemorrhagic complications in case of withdrawal of the anticoagulant. A clinical case of successful perioperative management of the patient with varicose veins with the use of long-term warfarin therapy for the management of atrial fibrillation is presented. Several surgical clinics refused to treat the patient on a regular basis on the ground of impracticability of any invasive procedures because of the patient’s condition taking into consideration the involuntary intake of the anticoagulation agent and the concomitant cardiac pathology. We performed the primary clinical examination and duplex ultrasound study of the patient who was found to have varicose veins in right lower extremity (С2, 3S, Ер, Аs, p, Pr2,18, LII) with the international normalized ratio (INR) being 3,64. We confirmed the indication for the surgical treatment and offered the patient high ligation, stripping and phlebectomy. Prior to surgery, the patient was switched to a subcutaneous injection of enoxaparin. After reducing INR down to less the 2.0, we performed surgery under spinal anesthesia. The anticoagulation treatment was restarted 12 hours after the operation. No complications was documented within the first weeks after the intervention. The patient was switched back to warfarin therapy.

© 2018 Izdatel'stvo Meditsina. All rights reserved. This article provides a short history of the creation of hypnotics, examines their mechanisms of action, and conducts a comparative analysis of the main groups of hypnotics such as barbiturates, benzodiazepines, "nonbenzodiazepine" benzodiazepine receptor agonists, melatonin receptor agonists, orexin receptor antagonists, histamine H1-receptor antagonists.

© 2018 Dynasty Publishing House. All rights reserved. The lecture deals with treatment of patients with CIN associated with papillomavirus infection (HPVI). The issues of epidemiology, diagnosis and treatment of CIN are discussed. Emphasis is put on a complex approach to treating patients with HPVI-associated CIN. Special attention is paid to studying the mechanisms of dysregulation of immune response during the period of human papillomavirus virus (HPV) persistence, which promotes immune suppression and is considered to be a necessary precondition for progression of HPV-associated cancer. Based on analysis of literature sources, the authors show that high oncogenic risk E6 and E7 HPV types interact with key proteins of interferon signalling pathway, inhibiting its production. This accounts for insufficient effectiveness of preparations of pure interferons and their inductors for treatment of HPV infection. From the pathogenetic positions, the use of inosine pranobex as a medication in complex therapy would be appropriate, since it ensures complete elimination of HPV and reduces the frequency of HPV infection recurrences.

© 2018 Dynasty Publishing House. All rights reserved. The review deals with specificities of interactions between decidual cells and cells of the maternal immune system. Literature data about involvement of decidual cells in initiation of the immune process are presented. The role of decidual cells in the formation of immunological tolerance due to variously secreted and expressed cytokine molecules that control sequential reproductive events has been shown. In the decidual membrane, complex interaction between decidual cells and cells of the maternal immune system occurs, aimed at ensuring immunological tolerance of the «mother-fetus» system. Impairment of this process leads to the development of gestational complications, including loss of a pregnancy.

© 2018 Dynasty Publishing House. All rights reserved. The article presents a clinical case of severe preeclampsia, HELLP syndrome in a 39-year-old woman, who became pregnant after IVF using donor oocytes. Conclusion: donor egg recipients, irrespective of age, should be viewed as having a higher risk for obstetric complications.

© 2018 Publishing House of the Union of Pediatricians. All rights reserved. The lecture discusses the issue of reflux nephropathy for specialists of the system of higher medical education: the article provides the definition, characterizes the epidemiology, risk factors for disease development in children with vesicoureteral reflux, causes and molecular mechanisms of renal fibrosis formation and progression in reflux nephropathy, and markers for diagnosing and predicting the disease course. In order to control the retention of the lecture material, the text includes case problems and multiple-choice tests.

© 2018 Russian Electronic Journal of Radiology. All rights reserved. Purpose. To present the relevance of cone-beam computed tomography (CBCT) in diagnostics of nasal cavity fungus ball before surgery. Materials and methods. The clinical observation of the patient with nasal cavity fungus ball is provided. Patient's examination included anterior rhinoscopy, forward-viewing endoscopy, and CBCT. Results. After comprehensive clinical examination of the patient including CBCT accurate diagnosis was established: fungus ball in the left half of the nasal cavity. Endoscopic foreign body removal had been carried out with endotracheal anesthesia. It is required to perform histological examination. Conclusion. The presented clinical case demonstrates the importance of CBCT application in pre-admission diagnostics of nasal cavity fungus ball.

© 2018 Stavropol State Medical University. All rights reserved. This lecture concerns fever of unknown origin (FUO), one of the topical interdisciplinary problems of clinical medicine. This lecture reviewed some clinical situations when fever is a single manifestation of diseases. Diagnostic algorithm is proposed to find the causes of long-term fever, as well as patient management tactics. Particular attention is paid to the management of FUO when possible causes hasn't been identified despite a comprehensive examination.

The objective of the research was to elaborate experimental-theoretical and clinic-bacteriological rationale for the application of laser diagnostic for identification of main pathogens of purulent-inflammatory processes in maxillofacial area. For germs identification by giant Raman scattering effect SERS-substrate with nano silver metallic balls, reference strains (Ps. aeruginosa 27853 and S. aureus 25923) and clinical cultures of Staphylococcus, Bacillus and Escherichia coli were used. Using an example of purulent inflammation pathogens we considered that each of bacterial species is characterized by individual spectral lines of Raman scattering, which allows to identify them in short term (1-2 min). Moreover the proposed method is highly sensitive (105-106 CFU/ml). Creation of germs library and device portability makes use of laser diagnostic for express-indication purulent infections possible directly in clinical conditions. Thus, analytical capability, quick result, high sensitivity and peculiarity, economical effectiveness due to lack of necessity to use growth medium and to transport it to microbiological lab gives an opportunity to consider laser diagnostic as a perspective universal express-method of clinical microbiology.

© 2018 Russian Electronic Journal of Radiology. All rights reserved. This clinical observation emphasizes the importance of a clear interaction between radiologists and surgeons within the treatment of primary spontaneous pneumothorax. Materials and methods. Patient A, 15 years old, was admitted to the thoracic department of the Faculty Surgery Clinic of the Sechenov University with complaints of dry cough, constant pain, uncomfortable sensations and edema in the left chest half, dyspnoea within physical exercises. Results. Based on the patient's complaints, the history of the present disease, data of subjective and objective investigation methods, the patient was diagnosed with a spontaneous primary left-sided pneumothorax complicated by the growing intermuscular emphysema. Controled by X-ray, the patient's pleural cavity was drained with subsequent air aspiration. Conclusion. The observation confirms the high information value of radiology diagnostic methods: thoracic X-ray and computed tomography. These methods allowed checking the effectiveness of each treatment stage, to diagnose such complication of primary spontaneous pneumothorax-increasing intermuscular emphysema and timely performing adequate surgical treatment.