Репозиторий Университета

© 2018 Russian Electronic Journal of Radiology.All Rights Reserved. The incidence of hip osteoarthritis and degenerative lumbar spine stenosis increases with the lifespan. The combination of these two conditions is not rare and is known as “hip-spine syndrome” in literature. Due to the similarity of symptoms the main problem is to determine the primary pain generator. Solving this diagnostic problem can lead to proper treatment, surgical or other. Purpose. To provide the literature review of the hip-spine syndrome. Materials and methods. We analyzed articles published on https://www.ncbi.nlm.nih.gov/pubmed during 2004-2018 searching for keywords: «radiographic and clinical hip osteoarthritis» - 1141 results, «lumbar spine stenosis and MRI canal» - 521 results and «hip-spine syndrome» - 35 results, 54 items were chosen due to the objective. Results. Primary source of pain for patients with hip-spine syndrome often remains unclear. The existing diagnostic algorithms are imperfect, about 25% of patients do not feel relief of pain after spine surgery or total hip arthroplasty. Mandatory x-ray examination in case of unknown source of pain is important and can show changes in hip and lumbar spine. That can help to change the way of search for pain generator Conclusion. It is necessary to create new diagnostic algorithms that will be harmless for patients and will be with maximum value for surgeons.

© 2018 Russian Electronic Journal of Radiology.All Rights Reserved. Purpose. To improve diagnostics and effectiveness of treatment in patients with unresectable cholangiocarcinoma complicated by obstructive jaundice. Materials and methods. A total of 28 patients (100%) with unresectable or functionally inoperable cholangiocarcinomas complicated by obstructive jaundice were diagnosed and treated. All patients underwent percutaneous drainage of the ducts under the ultrasound control and fluoroscopy. After reduction of jaundice video fluorescent diagnostic was performed. There was used a special module for that, by means of which a video fluorescent image of the bile ducts tumor was obtained and the degree of photosensitizer accumulation in the tissues was determined. Following photosensitizers were used: Photosens, Radachlorin (Russia) and Photolon (Belorussia). After the videofluorescence diagnostics photodynamic therapy of tumor stricture was conducted. Photodynamic therapy was performed using a fiber-optic system, if necessary, a controllable balloon catheter on the distal segment was used allowing to conduct therapy throughout the stricture more evenly. For the restoration of biliary evacuation nitinol stents were used. Results. In all patients a videofluorescent image of the bile duct tumor was obtained and a high degree of photosensitizer accumulation was determined. At the same time 23 patients (82%) had a malignant lesion confirmed morphologically. The effectiveness of combined treatment in unresectable cholangiocarcinoma was evaluated by life expectancy, the highest was 29 months (mean 14±5 months), but some of patients were under dynamic control for a period of 6 to 17 months. Conclusions. Usage of interventional treatment methods for patients with cholangiocarcinoma complicated by obstructive jaundice improves liver function and decreases jaundice. The combined use of minimally invasive technologies with fluorescent diagnostics and photodynamic therapy allows to increase the median life expectancy and improve the quality of patient’s life.

© 2018 Russian Electronic Journal of Radiology. All Rights Reserved. Purpose. To present abilities and limitations of Whole body MRI and FDG-PET/CT in the setting of sarcoid reaction and to stress the importance of use of broader differential diagnosis during interpreting its results. Materials and methods. The observation is introduced from clinical practice, examination was performed on 1.5 Tesla MRI scanner with the acquisition of four regions of interest: head and neck, thorax, abdomen, pelvis and upper thigh. Scanning protocol included diffusion-weighted imaging sequence. Results. The examination has let us exclude the presence of the active tumor tissue in breast cancer patient after systemic neoadjuvant treatment and drew our attention to false positive PET/CT result, which in turn led to change of further treatment strategy. Conclusions. Interpretation of FDG-PET/CT should be done in a complex manner with clinical, laboratory and radiological data correlation.

© 2018 Russian Electronic Journal of Radiology. All Rights Reserved. Purpose. The purpose of this study was to determine possibilities of functional computed tomography for diagnostics of the knee endoprosthesis loosening. Materials and methods. A total of 12 patients with suspected knee endoprosthesis loosening were observed. We performed dynamic computed tomography on the Toshiba Aquilion One 640. On MIP images in the three planes of the joint in the static position, we marked up to 5 lines. Every line connected the point in prosthesis component with the point in the periprosthetic cortical bone. After that, the computer analysed the functional research reconstruction and showed the length of the same lines at each stage of knee flexion. If the length of at least one of the lines changes by more than 1.1 mm, we can confirm loosening of the endoprosthesis component. Results. According to data of dynamic computed tomography, in 2 patients we identified loosening of the tibial components, 1 patient – the loosening of the femoral component and 1 patient – the loosening of both components. In 8 patients knee implants were stable. In 10 patients we performed total revision knee arthroplasty. Computed tomography data were fully confirmed by intraoperative examinations. 4 patients were operated because of components loosening, 6 patients were operated because of patellofemoral in-congruence. 2 patients were treated conservatively with good results. Conclusion. The dynamic computed tomography of the knee after total arthroplasty showed high efficiency in diagnostics of the knee endoprosthesis loosening.

© 2018 Russian Electronic Journal of Radiology.All Rights Reserved. Purpose. Modern methods of diagnostics and visualization allow timely identifying and sometimes even preventing the development of complications. Our clinical case demonstrates the possibilities and diagnostic algorithm of such serious complication of catheter ablation as pulmonary vein (PV) stenosis. Materials and methods. 61-year old patient after repeated catheter ablations is presented. Results. The use of echocardiography and MSCT allowed determining the stage and characteristics of PVs stenosis. Catheter ablation is one of the most common and effective methods in atrial fibrillation treatment. However, significant increase in number of operations and specialists who perform catheter ablation, leads to appearance of specific complications. Modern methods of visualization and diagnostics allow to timely recognize and sometimes even prevent the development of complications. Conclusion. An echocardiography and MSCT are the main instruments in diagnostics of PVs stenosis.

© 2018 Russian Electronic Journal of Radiology. All Rights Reserved. Urolithiasis (ICD) is one of one the most actual health problem in the world. The significant prevalence of urolithiasis in the population (at least 5% of the population in industrially developed countries) forces us to constantly investigate the etiology and pathogenesis, look for effective prevention mechanisms, improve diagnostic methods and develop new technologies for conservative and operative treatment. The relevance of urolithiasis in connection with global demographic shifts has become especially important in recent years. The constant displacement of the age pyramid of the developed countries society towards the proportion of elderly and senile populations leads to an increase in the ICD frequency. The development of endoscopic equipment, the creation of new contact lithotripotors improving the methods of nephrolithotripsy have made it possible to solve the problem of ICD. Currently, one of the topical issues is the choice of diagnostic method to predict and evaluate the effectiveness of treatment in patients with ICD. Studies have shown that urolithiasis directly affects intracellular hemodynamics. The change in renal blood flow in ICD patients depends on the nature of urodynamic disturbances, localization and size of the calculus, the duration of the disease, the presence of complications and the age of the patient. Therefore, evaluation of perfusion is necessary in studying of kidney function.

© 2018, SPb RAACI. The aim of this prospective randomized clinical study was to investigate the role of preoperative carbohydrate admnistration in surgery-induced metabolic, immune and inflammatory reactions after thoracoabdominal operations. At the Surgical department I (B.V. Petrovsky National Research Center of Surgery), we investigated a modulatory role of carbohydrate preload upon surgical stress observed after major thoracoabdominal operations (thoracoscopic and open esophagectomy, retrosternal colonic esophagoplasty) followed by the enhanced recovery protocol. The study was performed in 2014-2017, it included 30 patients, divided into 2 groups. Group A patients (n = 16) received carbohydrates preload (12.5% maltodextrin solution per os or enterally). In patients with dysphagia, the 12.5% dextrose solution was used intravenously in equal volumes. Group B patients didn’t receive any additional preload with carbohydrates. The groups were age- and gender-matched, similar for disease and surgery types. Glucose and insulin levels (with HOMA insulin resistance index, HOMA-IR) were measured before surgery and on day +1, interleukin levels (IL-6, IL-10, IL-8) and index IL-8/IL-10 were assessed before surgery, and on days +1 and +5 after surgery. Cell-mediated immunity was investigated before surgery and on day +5. The stress-induced hyperglycemia (> 7.8 mmol/L) was detected more frequently in group B (50%), than in group A (6%), p = 0.012. Insulin resistance measured by HOMA-IR in group B was detected in 71% of patients and in 25% patients of group A only, p = 0.027. Individual analysis of immune response demonstrated that a trend for immune recovery was detected by the day +5 post-op in the group A. Postoperative levels of IL-6 and IL-10 were lower on day +1 and +5 in group A. Morbidity rates and the terms of hospitalization were similar in both groups. Local postsurgical infections in group A were developed in 6% of the patients vs 35.6% in group B (p = 0.072). In conclusion, a complex study of surgical stress, i.e., metabolic, immune and inflammatory reactions after esophageal surgery has shown that the carbohydrate preload decreased the incidence of postoperative insulin resistance and stress-induced hyperglycemia, being accompanied by lower release of proinflammatory cytokines and provides positive effects upon the patient’s immune system.

© 2018 S. Karger AG.All right reserved. Therapeutic plasma exchange (PE) is a procedure of removing and replacing a large volume of plasma with various biologically active substances that have a pathological effect on the patient. Plasma exchange in some diseases is one of the components of pathogenetic therapy (ANCA-associated systemic vasculitis, antiphospholipid syndrome, Goodpasture's syndrome, thrombotic microangiopathy, etc.). PE removes circulating immune complexes damaging tissues and organs and restores the coagulation system. In the practical recommendations of the American Apheresis Society (2016) leading experts in the field of apheresis therapy, based on an analysis of numerous clinical studies, gave clear recommendations to use the apheresis technologies for extracorporeal detoxification. Also 4 categories of indications and contraindications, assessing the benefits of carrying out apheresis procedures for a specific nosology were specified. A number of new diseases have been introduced, such as atopic (neuro) dermatitis (atopic eczema), cardiac neonatal lupus, Hashimoto encephalopathy, HELLP syndrome, in which PE is one of the leading therapeutic approaches as well as cytotoxic and glucocorticosteroid therapy. However, the use of plasma exchange in the treatment of some diseases remains controversial, for example, sepsis. So further research is needed.

© 2018 Nutritec. All Rights Reserved.  The aim of this study was to examine the effect of polyphenol quercetin on morphological changes in nonalcoholic fatty liver disease (NAFLD) in rats fed high-fructose diet. Material and methods. For 20 weeks animals (n=8 in each group) of the 1 st group were given standard diet and water; the 2 nd group - standard diet and 20% fructose solution; the 3 rd group - standard diet with quercetin supplementation (0.1%) and 20% fructose solution. Formalin-fixed and paraffin-embedded liver samples were sectioned, stained (hematoxilin and eosin, Van Gieson's stain), evaluated with the use of the SAF and NAS scales. Results and discussion. Histological assessment did not reveal pathology in the structure of the liver of the 1 st group rats (SOAOFO; NAS - 0, fibrosis - 0). The 2 nd group rat livers disclosed micro-, mid- and macrovesicular steatosis, inflammation without ballooning, pericellular and periportal fibrosis (S2A1F2; NAS - 3, fibrosis - 2). Quercetin-treated rats exhibited in liver significantly less steatosis without significant changes in inflammation and fibrosis features (S1A1F2; NAS - 2, fibrosis - 2) compared with rats of the 2 nd group. Conclusion. The data obtained demonstrate the ability of quercetin to inhibit the development of NAFLD in rats fed a diet with a high content of fructose, by reducing the severity of hepatostatosis.

© 2018 Izdatel'stvo Meditsina. All Rights Reserved. Introduction. Now radio lines of the management of explosions find more and more broad application for the execution of acts of terrorism. The special technical means which are powerful sources of EMP in the range of frequencies of 0.02 – 6.00 GHz by which workers in the course of their production and operation and also the population which has appeared in a radiation zone can be affected, are developed for the suppression of radio-frequency signals of control of explosive devices. Aim of the study. Scientific justification and development of hygienic requirements for the safe use of systems of suppression of radio lines of control of explosive devices (SS RCED). Material and methods. The calculation methods for determining the EMF intensities created by different types of SS RCED (1500 calculations) were used, more than 250 measurements were carried out at different distances from 5 types of SS RCED in the open area and in the offices. Results. Hygienic investigations have allowed to point out 5 categories of the irradiated contingents for which hygienic regulations of EMP on the basis of the analysis of the standard and methodical documents acting in the Russian Federation have been proved. Calculations and natural measurements of the EMP levels from various types of SS RCED in rooms and in the open territory are taken. The technique of forecasting of conditions of radiation taking into account their technical characteristics (range of frequencies, power, etc.), the time of the exposure and distances from sources is offered. The algorithm of carrying out a hygienic assessment of conditions of radiation of personnel and population from SS RCED and a complex of preventive actions are developed. Discussion. Protection of workers by production, service, and operation of SS RCED, has to be carried out by restriction of the time of the impact of EMP taking into account power expositions at different distances from a source, and the population - by determination of safe zones of stay taking into account categories of the irradiated contingents. The technical actions including the organization of remote control of SS RCED and application of means collective (shielding) and/or individual protection are offered. Conclusion. The conducted complex research allowed justifying hygienic requirements for the production and operation of SS RCED and developing the project of SanPiN 2.1.8/2.2.4.xxxx-18 «Sanitary rules and standards of safe use of systems of suppression of radio lines of management of explosive devices of the range of frequencies of 0,02–6,00 GHz».

© 2018, Media Sfera. All rights reserved. Changes in ocular anatomy and topography that occur due to congenital development anomalies are often of complex, composite nature. Such pathologies are accompanied by not only refractive errors, but also changes in eye’s macrostructure. Careful analysis of the changes is necessary to better understand the clinical picture. Purpose - to study the specifics of structural and morphological changes of the eye in certain ocular congenital pathologies and in some orphan diseases using the results of three-dimensional ultrasound analysis and digital acoustic imaging. Material and methods. The study included 60 patients (119 eyes) with congenital ocular changes, some of which are registered as independent orphan diseases, as well as with systemic manifestations including congenital changes in eye membranes, lens and the vitreous body. The examination involved three-dimensional scanning followed by digital processing of the imaging data obtained using general medical ultrasound systems Voluson 730 Pro Kretz and Voluson E8. Results. Digital ultrasound technologies significantly expand the scope of data on eye morphology in various congenital changes obtainable in vivo. Conclusion. The advantage of this investigation method is the possibility to reliably detect congenital spatially complex morphological deformations in the eye tissues, which in some cases are impossible to observe with other methods.

© 2018, Media Sfera. All rights reserved. Modern public healthcare practices are constantly being improved by the medical community, which involves approval and implementation of professional standards such as including public health activities in the responsibilities of medical specialists. To understand how well such skills can be mastered by the specialists, we have conducted a comparative analysis of ophthalmologist qualifications found in the most often used guidelines and textbooks. With logical, analytical and hypothetical analysis, books and guides published before 2018 were found to have insufficient coverage of the public health responsibilities. Improvement of the public healthcare in terms of professional standards is an important course of development for the medical field. The continued work on Russian Federal State Educational Standard (Higher Education) for Ophthalmology - index number 31.08.59 - should include actualization of educational materials with modern public health notions, development of a universal learning evaluation database for specialist accreditation, as well as evaluation tools for the obtainment and confirmation of their qualification. The professional standards for ophthalmologists should fully account for the job responsibilities they acquire. Training of ophthalmologists in the public healthcare should utilize the following textbooks published in 2018: «Organization of medical aid in the Russian Federation» under the editorship of V.A. Reshetnikova, «Healthcare and public health» under the editorship of G.N. Tsarik, and «Public health and healthcare» by V.A. Medic.

© 2018, Media Sfera. All rights reserved. Condition of the ocular surface greatly depends on functional integrity of corneal nerve fibers. Improving the methods used to study corneal nerve fibers allows their condition to be timely evaluated and adequately interpreted. The article reviews the structure, function, chemical composition of corneal nerve fibers, specifics of their innervation, as well as application of modern methods of their evaluation in diagnostics of various pathological conditions.

© 2018, Media Sfera. All rights reserved.  Surgical treatment of intraocular lens (IOL) with late dislocation remains one of the current problems of ophthalmology. Purpose - to evaluate specific morphofunctional changes in the eye after dislocated IOL exchange with retropupillary-fixated iris-claw IOL. Material and methods. Surgical outcomes of 150 patients (150 eyes) with in-the-bag IOL dislocation (122 eyes) or sulcus-fixated IOL dislocation (28 eyes) were analyzed. The follow-up period was 1-3 years. Results. Increase in visual acuity and stable retropupillary fixation of the IOL was observed in all cases after reimplantation. Mean endothelial cell loss after 3 months was 6.9±1.3% in the group with preoperative density of >1200 cells/mm 2 and 12.3±2.7% in the group with preoperative density of <1200 cells/mm 2 . There was no significant increase in intraocular pressure after IOL reimplantation. The incidence of clinical cystoid macular edema with decreased visual acuity was 4.7%, which is significantly more frequent than in patients after uncomplicated phacoemulsification with in-the-bag IOL implantation. Conclusion. Retropupillary implantation of iris-claw IOL provides stable fixation, good functional outcomes with low complication rates and is suitable for reimplantation in eyes without adequate capsular support.

© 2018, Media Sphera Publishing Group. All rights reserved. Rehabilitation of patients with sensorineural hearing loss is an urgent task of otorhinolaryngology. One of the diseases leading to a pronounced hearing loss is the cochlear form of otosclerosis. The article describes a clinical case of rehabilitation of a patient with this pathology by means of cochlear implantation. The classification of otosclerosis based on the interpretation of computer tomography of temporal bones is presented.

© 2018 Universiteit Gent. All Rights Reserved. Due to the recent introduction of golimumab into paediatric rheumatology practice, an overview of the clinical studies of this tumour necrosis factor alpha inhibitor, most of which were conducted with adult patients with rheumatic diseases, has been presented. Clinical laboratory effects and tolerability of golimumab in the form of subcutaneous injections have been analysed for rheumatoid arthritis, psoriatic arthritis, and spondylitis. Evaluation of the efficacy and tolerability of golimumab in long-term observational studies (up to 5 years) has been discussed.

© 2018, Dynasty Publishing House. All rights reserved. Bronchial obstruction, developing in children of preschool age against the background of acute respiratory infection, is characterised by a high prevalence, heterogeneity of clinical signs, difficulties of differential diagnosis, and a tendency to recurrence. Treatment of an acute episode of bronchial obstruction in acute respiratory infection is pathogenetic, since it is aimed at alleviation of bronchial spasm, oedema and mucus hypersecretion, and also at elimination of respiratory failure and hypoxia, if present. Therapy should be started as soon as possible, at the appearance of the first clinical and physical signs of bronchial obstruction. Drugs of choice for stopping bronchial obstruction are short-acting (4–6 h) β2-agonists: fenoterol, salbutamol.

© 2018, Dynasty Publishing House. All rights resvered. The work specifies the indications and conditions for surgical treatment of patients with uterine leiomyoma. The role and clinical significance of ulipristal acetate (UPA, Esmya) in a complex treatment of patients with uterine leiomyoma of varied localisation of nodules according to the FIGO classification have been determined. Special attention is paid to the problem of drug-induced liver injury (DILI) against the background of intake of Esmya. As has been shown, there no reasons to associate UPA with DILI, since (1) UPA does not pertain to the group of drugs associated with a risk for DILI; (2) no cases of DILI have been recorded in patients receiving UPA in a therapeutic dose (5 mg). Treatment with UPA should be administered with control of transaminases. If ALT or AST activity exceeds 2×upper limit of normal (ULN) either isolatedly or in combination with bilirubin >2 × ULN, the intake of Esmya is contraindicated.

© 2018, Dynasty Publishing House. All rights reserved. The objective. Was to develop echographic and Doppler prognostic markers of lesions of the central nervous system (CNS) in premature newborns. Patients and methods. In accordance with the objective of the study we conducted a complex prospective examination of 196 pregnant women diagnosed with threatened preterm labour. The treatment group consisted of 166 women, whose pregnancy ended with spontaneous births at terms 22–36 wks, and premature newborns later developed various disorders of CNS. Results. We found morphological ultrasound and Doppler ultrasound specificities of fetal CNS against the background of threatened preterm labour depending on the term of gestation at the moment of birth and subsequent neurological disorders in premature infants. The most significant were changes of the ventriculo-cranial index, width of anterior horns of lateral ventricles, thalamo-occipital distance, systolic-diastolic ratio between vertebrobasilar vessels of the brain. Conclusion. Such a detailed prenatal diagnosis contributes to noninvasive prognostication of the severity of neurological lesions of CNS in premature infants. The results showed interrelations between perinatal outcomes and initial blood flow impairment of fetal CNS in 97% of observations.

© 2018, Dynasty Publishing House. All rights reserved. The objective. To evaluate the incidence and prevalence of hepatitis C in Russia and estimate the impact of hepatitis C virus on liver cirrhosis, hepatocellular carcinoma and liver-related mortality before the implementation of the national program for the elimination of viral hepatitis. Materials and methods. We analyzed statistical data on the incidence of hepatitis C in Russia in 2001–2017, the incidence, prevalence and mortality rates from liver cirrhosis and malignant liver tumors in 2011–2015. An analysis of the incidence and prevalence of HCV was carried out in various age-sex groups. The structure of genotypes of the hepatitis C virus was determined in patients at different stages of liver fibrosis and with different levels of viral load. Results. In 2017, 50 798 cases of HCV were registered in Russia (34.6 per 100 thousand of the population). As of January 1, 2017, the total number of patients with chronic hepatitis C under medical observation was 591 830 (405 per 100 thousand population). The incidence rate of fibrosis and cirrhosis in Russia in 2015 was 12.7 per 100000 population (18640 cases), the total number of registered patients – 75.9 per 100 thousand population (110951 people). The incidence rate of malignant liver tumors in 2015 was 5.5 per 100 thousand population (8083 cases), the total number of patients on dispensary observation was 5.0 per 100 thousand population (7360 people). In 2015, the estimated number of deaths from liver cirrhosis and hepatocellular carcinoma in the outcome of chronic hepatitis C was 14 792 and 1635, respectively. Conclusion. Hepatitis C is the main cause of liver cirrhosis (excluding alcoholic etiology), hepatocellular carcinoma and liver-related mortality in Russia. To reduce the prevalence of HCV and mortality from liver cirrhosis and primary liver cancer, it is necessary to provide all patients with HCV with antiviral drugs.