Репозиторий Университета

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

© 2018 Media Sphera Publishing Group. All rights reserved. Ascites and hydrothorax may be the symptoms of congestive heart failure and do not always reflects presense of the decompensated liver cirrhosis. Clinical examination of patient with chronic hepatitis C which cyanosis of the lips, cervival veins pulsation, a triple heart rhythm indicated on pathology of the heart (constrictive pericarditis), which was confirmed by instrumental methods. Congestive heart failure has lead to the congestive liver in a young female patient. Regression of all the symptoms of heart failure occurred after surgical treatment (pericardectomy).

© 2018 Media Sphera Publishing Group. All rights reserved. Purpose of the review to present up-to-date data on the causes, methods of diagnosis and treatment of the refractory form of gastroesophageal reflux disease (GERD). Refractory GERD is the preservation of typical symptoms of the disease and/or incomplete healing of the esophageal mucosa against the background of taking a standard dose of proton pump inhibitors (PPI) once a day for 8 weeks. The reasons for the lack of response to the treatment are divided into related to the patient, related to therapy, and not related to GERD. Diagnostic approaches include x-ray examination of the esophagus and stomach, endoscopy with biopsy, 24-hour Impedance-pH monitoring, esophageal manometry. Depending on the reasons for the lack of response to the therapy, treatment may include lifestyle changes, doubling the dose of PPI, replacing PPI with another, adding H2-receptor antagonists, prokinetics, antacids, alginates and adsorbents. If conservative treatment is ineffective, it is possible to consider alternative methods, such as surgical treatment. Refractory GERD is a serious clinical problem. The absence of an answer to 8-week therapy with PPI requires a thorough differential diagnosis using additional examination methods. The identification of the causes of refractory to the therapy allows to optimize the approaches to its overcoming and to choose the optimal treatment.

© 2018 Media Sphera Publishing Group. All rights reserved. Primary sarcomas of the pericardium are extremely rare malignant tumors of the heart. The incidence of sarcoma increases after radiation therapy in the field of breast. The specific features of this case report are the difficulties in diagnostics of undifferentiated spindle-cell sarcoma of the pericardium and the connection between the disease and the radiation therapy for Hodgkin's lymphoma.

© 2018 Media Sphera Publishing Group. All rights reserved. The article reflects the main positions of the latest Russian and pan-European clinical recommendations on the diagnosis and treatment of chronic pancreatitis (CP), devoted to the pharmacotherapy of this disease. The main objectives of pharmacotherapy for CP are to reduce or arrest pain abdominal syndrome and prevent or compensate for functional pancreatic insufficiency.

© 2018 Media Sphera Publishing Group. All rights reserved. The primary autoimmune liver diseases conventionally include primary biliary cholangitis, primary sclerosing cholangitis and autoimmune hepatitis. Despite of primary autoimmune affection of different parts of the hepatobiliary system, in the recent decades, a lot of data has emerged indicating the presence of extrahepatic manifestations of these diseases, in particular, lung lesions, such as nodular and interstitial changes with possible progression and development of fibrosis and respiratory failure. In case of lungs disease, both pulmonary parenchyma and lung vessels, pleura, and intrathoracic lymph nodes can be involved. The most sensitive and specific procedure to assess the extent of the lung lesions and their evolution is high-resolution computed tomography. Due to the possibility of long-term asymptomatic course of the pulmonary disease with development of irreversible changes in patients with autoimmune liver diseases, it seems reasonable to conduct screening studies aimed at early detection and treatment of lung lesions in this population.

© 2018 Media Sphera Publishing Group. All rights reserved. Contex. Angioimmunoblastic T-cell lymphoma (AITL) is a rare form of non-Hodgkins lymphoma, characterized by generalized lymphadenopathy, hepatosplenomegaly and dysproteinemia. Hypergammaglobulinaemia is revealed in 50-83% pts with AITL. However, the characteristics of immunoglobulinopathies observed in AITL are scarce. Objective: The aim of the study was to characterize quantitative and qualitative immunoglobulinopathies in patients with AITL at the onset of the disease. Patients and methods. 55 patients with newly diagnosed AITL were enrolled in the study, the male/female ratio was 30/25; median age was 61 (29-81) years. Diagnosis was based on standard WHO criteria. Immunochemical studies of blood serum included serum protein electrophoresis/immunofixation, nephelometric quantification of total immunoglobulins, serum free light chain assay. Results. Quantitative and qualitative immunoglobulinopathies were determined in 49 (89,1%) of 55 pts. Quantitative immunoglobulinopathies were revealed in 47 (85.5%) of 55 cases, qualitative - in 14 (25,5%). Combination quantitative and qualitative immunoglobulinopathies was observed in 12 (21,8%) of 55 pts. The detected immunoglobulinopathies were divided into 4 groups: polyclonal hypergammaglobulinaemia, hypogammaglobulinaemia, oligoclonal gammapathy, and monoclonal gammapathy. Polyclonal hypergammaglobulinaemia was marked in 41 (74.5%) of 55 pts, elevated level of IgG was determined in 27 (49,15%) of 55 cases, IgM - in 18 (32,7%) and IgA - in 21 (38.2%). Interestingly, polyclonal IgE hypergammaglobulinaemia was detected in 12 (48,0%) of 25 cases of performed studies. Hypogammaglobulinaemia was detected in 8 (14,5%) of 55 cases. Oligoclonal gammapathy was determined in 4 (7.3%) of 55 pts. Monoclonal gammapathy was revealed in 11 (20,0%) of 55 cases. The amount of monoclonal immunoglobulin varied from 2.6 to 14.1 g/l. Monoclonal immunoglobulin Gk was detected in 5 of 11 pts, Gλ - in 2, Mλ - in 2, Mk - in 2. Monoclonal gammapathy was accompanied by polyclonal hypergammaglobulinaemia in 9 of 11 cases, hypogammaglobulinaemia - in 2. Conclusions. Quantitative and qualitative immunoglobulinopathies are observed in most patients at the onset of AITL. Quantitative abnormalities were determined more often than qualitative. Monoclonal gammapathy can be a manifestation of lymphoproliferation and other concomitant disorders. The prognostic value of immunochemical parameters is still unclear and requires dynamic observation and study.

© 2018 Dynasty Publishing House. All rights reserved. The objective: To give a characteristic of body composition in adolescents with atopic bronchial asthma combined with overweight, and to determine the impact of its disorders on the degree of disease control. Patients and methods: Bioimpedance analysis of the body composition was performed in 168 adolescents aged 12-17 years, including 68 patients with mild bronchial asthma in the remission stage and in combination with overweight, 50 overweight adolescents without asthma and 50 healthy same-age peers. Bioimpedance characteristics were compared with the degree of controlling the symptoms of disease. Results: As has been found, adolescents with atopic bronchial asthma combined with overweight are characterised by significant changes in the body composition, which is manifest by higher fat tissue (on average 156.8 ± 21.3% with respect to the norm), total body water and extracellular fluid (127.0 ± 8.1% and 112.3 ± 5.9%, respectively), lower active cell (to 92.8 ± 10.2%) and skeletal muscle mass (to 96.9 ± 6.2%). The degree of the above disorders of body composition was higher in patients with incomplete asthma control. Conclusion: Disorders of body composition in adolescents with bronchial asthma reflect a decreased physical activity, shifts in water-electrolyte balance and protein deficiency. Worsening of body composition is associated with loss of asthma control.

© COPYRIGHT SPIE. Downloading of the abstract is permitted for personal use only. The development of express method for assessing the state of skin graft by the spectroscopic properties of tissue components involved in the healing of the affected skin or healing of skin grafts was carried out in present work. The proposed method for assessing the state of the skin by the spectroscopic properties of tissue components (using photosensitizers, fluorescent dyes (methylene blue and IcG) and nanophotosensitizers aluminum phthalocyanine nanoparticles (NP-AlPc) applied locally) will evaluate the physiological condition of the skin and assess the degree and rate of engraftment or rejection while also controlling several biochemical and physiological parameters in the entire graft, or the whole area of the skin lesions. Such parameters include the oxygenation of hemoglobin in the tissue microvasculature; the blood supply level; blood flow and lymph flow; assessment of intracellular metabolism; assessment of the cellular respiration type (aerobic/anaerobic).To assess the extent of inflammation the spectrally sensitive to biological environment nanoparticles of aluminum phthalocyanine (NP-AlPc) were also used.

© 2018 Izdatel'stvo Meditsina. All rights reserved. The cerebrovascular effects of 5-hydroxyadamantane-2-one (100 mg/kg, i.v.), nimodipine (0.03 mg/kg, i.v.), and S-amlodi- pine nicotinate (0.1 rag/kg, i.v.) were compared and found to differ significantly. While G ABA-ergic 5-hydroxyadaman- tan-2-one and slow calcium channels blocker nimodipine cause a pronounced increase in cerebral blood supply under conditions of global transient ischemia of the brain, their activity in modeling hemorrhagic stroke is significantly lower. At the same time, S-amlodipine nicotinate equally improves cerebral circulation in both hemorrhagic and ischemic brain damage, i.e., the cerebrovascular effect of S-amlodipine nicotinate in the hemorrhagic stroke model is superior to that of nimodipine and 5-hydroxyadamantan-2-one. This is due to a distinguishing feature of the of S-amlodipine nicotinate action, which, in contrast to 5-hydroxyadamantan-2-one and nimodipine, has a binary vasodilating effect on cerebral vessels: (i) blocking slow calcium channels and (ii) stimulating GABAA-receptors.

© Bionika Media Ltd. Objective. To investigate the clinical efficacy of Elgyna in the medical treatment of human papillomavirus (HPV)- associated cervical intraepithelial neoplasias (CIN). Subject and methods. The results of antibacterial therapy prior to destructive treatment were comparatively analyzed in 53 patients with severe dysbiosis in HPV-associated CIN. A study group included 27 patients who took the combined drug Elgyna as one vaginal tablet twice daily (6 administrations); a comparison group of 27 patients received the combined drug Tergynan as one vaginal tablet twice daily (6 administrations). A control group comprised 20 women with the visually unchanged cervix. All the women underwent standard examinations and vaginal microbiocenosis estimation by RT-PCR assay using the Femoflor test. Results. The use of the combined drug Elgyna during medical treatment before destruction was found to normalize molecular biological parameters at the local level and contributes to a significant reduction in the time of epithelialization and a decline in the number of recurrences. Conclusion. HPV-associated cervical neoplasias are accompanied by the development of pronounced dysbiotic processes in the vagina with the predominant involvement of obligate anaerobes. Taking into account the properties of the combined drug Elgyna that provides a normalizing effect on the parameters of biocenosis in accelerating healing and in preventing a recurrence of the process, it is appropriate to prescribe the drug before destructive treatments.

© 2018 All-Russian Public Organization Antihypertensive League. All Rights Reserved. objective. To investigate the serum levels of galectin-3 in patients with metabolic syndrome (MS) and in patients with combination of MS and left ventricular hypertrophy (LVH), as well as to define the role of this marker of fibrosis in MS. design and methods. The study included 43 patients with MS (33 patients had LVH), and 33 patients of comparable age without MS (LVH was diagnosed in 10). The level of serum galectin-3 was determined by enzyme immunoassay kits Platinum ELISA. Results. The average level of galectin-3 in the MS group was significantly higher (1,89 ± 1,71 ng/ml), compared to the group without MS (1,03 ± 0,22 ng/ml, p = 0,006). The study showed a positive correlation between the level of galectin-3 and LVH (r = 0,323, p = 0,004). The mean value of galectin-3 in patients with no evidence of LVH was 1,2 ± 0,76 ng/ml, in patients with LVH — 2,1 ± 2,02 ng/ml. conclusions. In patients with MS the level of galectin-3 was higher than in patients without MS, and in patients with MS and concomitant LVH it was higher than in patients without LVH. In patients with MS and LVH increased galectin-3 levels may indicate the severity of myocardial fibrosis and help for prognosis evaluation.

© 2018 Publishing House of the Union of Pediatricians. All rights reserved. Background. To assign genetically engineered biologic drugs, we need data on the predictors for response to therapy. Prognostic factors for the response to tocilizumab in patients with juvenile idiopathic arthritis (JIA) without systemic symptoms are poorly studied. Objective. Our aim was to reveal early predictors for the response to tocilizumab therapy in patients with JIA without systemic symptoms. Methods. A retrospective cohort study enrolled patients with JIA without systemic symptoms who received tocilizumab therapy between July 2009 and August 2017. We assessed the association between the initial demographic, clinical, and laboratory parameters in patients and the best response (according to the ACR90 criteria) to treatment after a year. Results. The study included 95 (girls 85%) patients; the mean age was 10.3 (6.0; 13.6). During the first year of therapy, 71 (75%), 55 (58%), 38 (40%), and 22 (23%) patients achieved the improvement according to ACR30/50/70/90 criteria, respectively; 22 (23%) patients reached disease inactive stage according to the Wallace criteria. When performing multivariate analysis, the following improvement predictors were revealed based on the ACR90 criteria after a year of treatment: decrease in serum C-reactive protein level during the first month of therapy [odds ratio (OR) 1.024; 95% confidence interval (CI) 1.007-1.051], decrease in disease activity score on the visual analogue scale according to the parent/patient assessment (OR 1.048; 95% CI 1.005-1.105), early onset of the disease (OR 0.38; 95% CI 0.16-0.72), persistent oligoarthritis according to the ILAR (OR 9.9; 95% CI 1.5-109.3). During the first year of tocilizumab administration, neutropenia was registered in one patient, leukopenia - in three cases, and urticaria - in one case. Conclusion. The variant of JIA, the age at the disease onset, and the disease course pattern in the first month of tocilizumab therapy are the predictors of treatment efficacy throughout the year.

© 2018 Stavropol State Medical University. All rights reserved. Based on the indices of the functioning of the diffuse neuroendocrine system (DNES) of the digestive tract, the features of the formation of irritable bowel syndrome with extraintestinal manifestations are studied. We estimated the role of the endocrine cells of the mucous membrane of the sigmoid colon and the antrum of the stomach producing motilin (MT), vasointestinal hormone (VIH) and somatostatin (SS), in the onset and course of irritable bowel syndrome with extraintestinal manifestations. The relationship between the patient's psychological status, his neuroendocrine system and extraintestinal manifestations of the disease is demonstrated.

© 2018 Ima-Press Publishing House. All rights reserved. We have considered it appropriate to publish this case due to the rarity of progressive myoclonus epilepsy; diagnostic difficulties, particularly in the early stages of the disease (the female patient has been long followed up for diagnosed juvenile myoclonic epilepsy); the relative role of a genetic study because it has not brought results in this case, and, finally, a problem with therapy, and a significant contribution to the achievement of certain success of currently available antiepileptic drugs, levetiracetam in particular.

© 2018 Russian Electronic Journal of Radiology. All rights reserved. Purpose. The purpose of this study was to determine ultrasound criteria of normal temporomandibular joint structure and function. Materials and methods. Prospective study was conducted upon normal 16 TMJs of 9 patients (4 male, 5 female with mean age of 22.9 years) without clinical or radiological signs of disc displacement. All the patients underwent high-resolution ultrasound (Samsung SONO ACE R3, 12 MHz linear probe) and MR imaging of TMJs with the mouth closed and during the maximal mandibular range of motion. Both examinations were performed and interpreted independently by blinded expert operators. Results. Mouth opening range varied from 4.4 cm to 5.4 cm, average amount was defined as 4.94 ± 0.39 cm. Also average heights of the front, middle and rear parts of disc were measured (0,42 ± 0,07 cm; 0,35 ± 0,07 cm and 0,41 ± 0,05 cm, respectively). Structure of the TMJ disc can be defined as fine-grained, hypoechoic and homogeneous. The average height of lower joint space was defined as 0,12 ± 0,03 cm. Average amount of maximal parasagittal mandible condyle movement was defined as 14.7 ± 1.38 mm. Conclusion. Obtained results of ultrasound criteria of normal temporomandibular joint structure and function correspond to the provisions of normal human anatomy and the norm values established for the MRI of the TMJ. Thus, ultrasound criteria of normal temporomandibular joint can be used for assessment of TMJ internal degenerative diseases.

© 2018 ABV-Press Publishing House. All rights reserved. Background. Memory and attention deficits are prevalent in the chronic pain population. There are multiple common mechanisms in chronic pain and cognitive impairment. However, the presence, prevalence and clinical burden of such impairment are frequently underestimated. Objective: to evaluate subjective and objective cognitive deficits in patients with chronic migraine (CM). Materials and methods. We recruited 53 subjects with CM and 22 gender- and age-matched controls with low-frequency episodic migraine (a maximum of 4 headache days per month) aged 18-59. All patients filled in the HADS (Hospital Anxiety and Depression Scale) anxiety and depression scale and Pittsburg Sleep Quality Inventory (PSQI). Cognitive function was assessed with Montreal Cognitive Assessment (MoCA), Digital Symbol Substitution Test (DSST), Rey Auditory Verbal Learning Test (RAVLT) and the Perceived Deficits Questionnaire (PDQ-20). Results. 56 % of patients with CM complained of memory problems. Decreased cognitive function was also observed during self-assessment using the PDQ-20 questionnaire. Objectively, we found a significant decrease in 90-second DSST results and RAVLT total recall and learn ing rates. 44 % of subjects with CM scored lower than 26 points on MoCA. Most frequently we found impairments in attention (75 %), memory/delayed recall (50 %), language (50 %) and executive function (37 %). Depression and sleep quality correlated with only several parameters of cognitive tests. Conclusion. Subjective and objective cognitive deficits are prevalent in the CM population. Most often memory and attention are impaired. Cognitive complaints need to be carefully assessed, and treatment of such impairment may improve quality of life and decrease disability in CM.

© 2018 Russian Electronic Journal of Radiology. All rights reserved. Purpose. The aim of the study is an increasing frequency of predicting the results of remote shock wave lithotripsy in patients with nephrolithiasis. Matherials and methods. The study involved 127 patients with diagnosed urolithiasis with the presence of a single renal calculus from 10 to 17 mm in size. All patients underwent a complex of laboratory analyses, multispiral computed tomography. The concrement elimination was carried out by extracorporeal shock-wave lithotripsy. Results. In this study, there were no sufficient relationships between the maximum size and average density of stone and the number of extracorporeal lithotripsy sessions in patients with nephrolithiasis. On the contrary, the parameter of the "homogeneity" of the stone, reflecting its structure, showed a strong reliable relationship with the effectiveness of extracorporeal shock-wave lithotripsy, as well as high sensitivity and specificity. Using this indicator, it was possible to increase the percentage of successful procedures from 56,9% to 75,8%. Conclusion. The maximum size and average density of stone have insufficient diagnostic value in predicting the results of shock-wave lithotripsy in patients with single kidney stones 10-17 mm in size. In this case, an indicator of the "homogeneity" can be used to select the optimal method of treatment.

© 2018 Russian Electronic Journal of Radiology. All rights reserved. Purpose. The literature data and the results of our own research, which demonstrate the possibilities of using radiological research methods for the analysis of the lungs lesions in deceased patients, are presented. It is shown that the postmortem computed tomography (CT) allows to identify abnormalities of the chest bones, as well as to establish the presence, precise localization and volume of gas and air accumulations, including pneumothorax. The literature data on the comparison of postmortem CT lung characteristics, including the density of their tissue, with data of histological examination of lung preparations and causes of death in adult patients, are presented. It is noted that postmortem magnetic resonance imaging (MRI) is more expedient for the detection of the lungs pathology in dead fetuses and deceased newborns. The possibilities of postmortem MRI for the diagnosis of congenital pneumonia, hemorrhages in the lung tissue, pulmonary edema, hydrothorax, as well as for differential diagnosis of stillbirth and the death of a living newborn are shown. Differential diagnostic signs of pulmonary artery thromboembolism and postmortem blood clots are indicated. The possibilities of postmortem CT and MRI for noninvasive determination of the sizes and weight of the lungs, including for assessment of pulmonary hypoplasia in newborns with congenital diaphragmatic hernia, are described. It is concluded that the postmortem radiological methods of investigation can be used to analyze of the lung lesions and determine the causes of death. The combined use of CT and MRI is recommended for a full analysis. It is emphasized that postmortem radiological examination can not be an alternative to pathological and forensic autopsy. Radiological methods should be used as a supplement to the autopsy, including as a kind of "guide" for a better definition of pathological processes during the autopsy.

© 2018 Media Sphera Publishing Group. All rights reserved. This article presents current views on the classification, diagnosis, treatment, and prevention of drug dependence caused by the co-use of several psychoactive substances (PASs). It describes the fundamental regularities of the development and course of the disease, the patterns of consumption, and the issues of laboratory diagnosis. Particular attention is paid to the clinical diagnosis of the most common patterns of use of various PASs. In order to make and propose the reader the most complete basis for evidencebased strategies for the treatment of various variants of polydrug abuse, the authors studied the results of investigations that enrolled patients using more than one PAS at least 1 month before the start of treatment. The section on therapy is presented as clinical recommendations, taking into account the levels of evidence and the grades of recommendations.