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Comprehensive assessment of the relationship between indicators of systemic intoxication and intra-abdominal pressure at the patients operated for peritonitis 腹膜炎手术患者全身性中毒指标与腹内压关系的综合评价
Pub Date : 2023-07-21 DOI: 10.30629/0023-2149-2023-101-6-275-278
S. Perekhodov, Y. P. Popov, V. V. Evdokimov, P. A. Popov, K. I. Dubovitsky
According  to the latest  statistical  data,  22% of patients  with emergency  abdominal  surgical  pathology  are  admitted  to medical institutions with signs of peritonitis. Despite modern methods of treatment and diagnosis, the mortality rate for this pathology remains at the same level and is approximately 18–29%, and in advanced forms can reach 75–90%. Recent studies show that in an unfavorable outcome of this pathological process, a leading role is given to a progressive increase in intraabdominal pressure (IAP). The relationship between the degree of endogenous intoxication and IAP values makes it possible to quickly assess the severity of the patient’s condition and the state of central hemodynamics without additional laboratory and instrumental studies. The aim of the study was to evaluate the indicators of systemic endogenous intoxication and intraabdominal  pressure and their relationship  in patients  with peritonitis in the pre- and postoperative  period. Material and methods. This work is based on a retrospective analysis of 74 patients operated on at the clinical bases of the Department of Hospital Surgery of the Moscow State Medical University named after A.I. Evdokimov for peritonitis from January to October 2022. The main causes of acute peritonitis were perforated ulcer of the stomach or duodenum, acute intestinal obstruction, thrombosis  of  mesenteric  vessels,  acute  pancreonecrosis,  complicated  colon  cancer.  The  average  age  of  patients  was 49 ± 2.5 years (34-75 years), 47 women, 27 men. The severity of peritonitis was assessed based on the degree of endotoxemia according to clinical and laboratory data. To monitor intra-abdominal  hypertension, IAP was measured. IAP measurement was performed on the operating table before surgery and in the early postoperative period. At the same time, compartment syndrome of the first degree was found in 51 (68%) patients, the second degree in 14 (19%) patients, and the third-fourth degree in 9 (13%) patients. For a comprehensive assessment of the patient’s condition and the effectiveness of the measures taken, the central hemodynamics was assessed and its relationship with the indicators of intra-abdominal pressure was evaluated. Comparative  analysis of central hemodynamics  manometry showed that with an increase in compartment  syndrome, there is a clear decrease in the performance of cardiac activity indicators, requiring urgent correction. The relationship between indicators of intra-abdominal  pressure and the duration of preoperative preparation was also evaluated. Conclusions. The relationship between the degree of endogenous intoxication and the degree of intra-abdominal pressure has been proven. With an increase in IAP values, the values of endogenous intoxication increase, which subsequently leads to the development of multiple organ failure. Even with the first degree of endogenous intoxication, a decrease in myocardial contractile ability is noted, which leads to the
据最新统计数据显示,22%的急诊腹部外科病理患者因腹膜炎体征而入院医疗机构。尽管采用了现代治疗和诊断方法,但这种病理的死亡率仍保持在同一水平,约为18-29%,晚期可达75-90%。最近的研究表明,在这一病理过程的不利结果中,腹内压(IAP)的进行性增加起主导作用。内源性中毒程度与IAP值之间的关系使得快速评估患者病情的严重程度和中央血流动力学状态成为可能,而无需额外的实验室和仪器研究。本研究的目的是评价腹膜炎患者术前和术后全身性内源性中毒和腹内压的指标及其关系。材料和方法。这项工作基于对2022年1月至10月在莫斯科国立医科大学以A.I. Evdokimov命名的医院外科临床基地手术的74例腹膜炎患者的回顾性分析。急性腹膜炎的主要病因为胃或十二指肠穿孔性溃疡、急性肠梗阻、肠系膜血管血栓形成、急性胰脏坏死、合并结肠癌。患者平均年龄49±2.5岁(34-75岁),女性47例,男性27例。根据临床和实验室数据,根据内毒素血症的程度来评估腹膜炎的严重程度。为了监测腹腔内高血压,测量IAP。术前和术后早期在手术台上测量IAP。同时,1度室室综合征51例(68%),2度室室综合征14例(19%),3 - 4度室室综合征9例(13%)。为了全面评估患者的病情和所采取措施的有效性,评估中心血流动力学及其与腹内压指标的关系。中央血流动力学测压对比分析显示,随着室室综合征的增加,心脏活动指标的表现明显下降,需要紧急纠正。评估腹内压指标与术前准备时间的关系。结论。内源性中毒程度与腹内压程度之间的关系已得到证实。随着IAP值的增加,内源性中毒值增加,随后导致多器官功能衰竭的发展。即使是一级内源性中毒,心肌收缩能力也会下降,这导致心血管衰竭的发展,这取决于病理过程的严重程度。IAP综合征的诊断对于术前术后及时发现病理和综合治疗具有重要的实用价值。
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引用次数: 0
Russian military doctors during the Yihetuan ("Boxing") Uprising in China 义和团起义时期的俄国军医
Pub Date : 2023-07-20 DOI: 10.30629/0023-2149-2023-101-6-334-343
V. Simonenko, V. G. Abashin, I. A. Ivashova, P. Dulin
The article presents information about the participation of doctors of the Russian imperial army and navy during the events of the Yihetuan Movement in China in 1900–1901. A brief summary of the course of the battles in Pechelii Bay and Manchuria is presented. Biographical information about the doctors of the army land units and the ships of the Pacific squadron is given.
本文介绍了1900-1901年义和团运动期间俄罗斯帝国陆军和海军医生的参与情况。本文简要介绍了在佩切里湾和满洲的战斗过程。介绍了陆军陆战部队的医生和太平洋中队的舰艇的生平资料。
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引用次数: 0
Adenocarcinoma of the small intestine in a patient with Peutz-Jeghers syndrome peutz - jegers综合征患者的小肠腺癌
Pub Date : 2023-07-20 DOI: 10.30629/0023-2149-2023-101-6-315-318
A. T. Kortieva, V. S. Krushelnitskiy, S. A. Gabriel’, V. Dynko, A. Y. Guchetl, V. M. Durleshter, V. V. Ignatenko
Peutz-Jeghers syndrome is a genetic disorder inherited in an autosomal dominant pattern and characterized by a mutation in the STK11 gene. According to domestic literature, the risk of inheriting this pathology from a parent to a child is 50%. According to WHO data, in 2018, more than 74,000 new cases of colorectal tumors were detected in the Russian Federation, with 5–10% of cases being hereditary syndromes, of which 1% is Peutz-Jeghers syndrome. The frequency of occurrence is approximately 1/29,000–1/120,000.  The aim of the work is to share the experience of diagnosing and treating a patient with Peutz-Jeghers syndrome. Today, we have the ability to timely diagnose pathological changes in the mucous membrane of the small intestine, perform minimally invasive treatment, reducing rehabilitation time due to a decrease in surgical trauma.
Peutz-Jeghers综合征是一种常染色体显性遗传的遗传病,以STK11基因突变为特征。根据国内文献,父母将这种病理遗传给孩子的风险为50%。根据世卫组织的数据,2018年,俄罗斯联邦新发现的结直肠肿瘤病例超过7.4万例,其中5-10%为遗传性综合征,其中1%为Peutz-Jeghers综合征。发生的频率大约是1/29,000-1/120,000。这项工作的目的是分享诊断和治疗Peutz-Jeghers综合征患者的经验。今天,我们有能力及时诊断小肠粘膜的病理变化,进行微创治疗,减少手术创伤,缩短康复时间。
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引用次数: 0
Infosphere interaction of clinicians, pharmacists and patients in management of hypertension. Improvement options 临床医生、药剂师和患者在高血压管理中的信息互动。改进的选择
Pub Date : 2023-07-20 DOI: 10.30629/0023-2149-2023-101-6-319-326
V. Yakusevich, O. Zheltkevich
Arterial hypertension remains a leading risk factor for cardiovascular disease and mortality. Adequate antihypertensive therapy requires not only the development of new drugs and drug combinations, but also close professional interaction between specialists at all levels of healthcare, with mandatory patient involvement in this process. The aim of this study was to investigate information requests, ways of satisfying them, and interaction in the information field of internists, pharmaceutical workers, and patients in the treatment of arterial hypertension, and to propose ways to improve professional interaction. Material and methods included surveying doctors (n = 99), pharmaceutical workers (n = 220), and patients with arterial hypertension (n = 382), analyzing their medical documentation, organizing joint educational events during the qualification improvement of specialists at different levels of healthcare, and developing a special computer program for the automated workplace of a doctor and pharmacist as a means of improving the level of professional interaction. Results presented the profile of the main information requirements of specialists and patients in the treatment of arterial hypertension and its pharmaceutical support. The need for constant interaction in the triad doctor—pharmacist—patient was substantiated. A concept of an automated workplace for doctors and pharmacists was developed, and its functional computer program was provided. The automated workplace was tested in Yaroslavl pharmacies. Conclusion. Close professional interaction between healthcare specialists with patient involvement is an important aspect of rational pharmacotherapy. Unifi cation of the information environment of medical and pharmacy institutions allows eliminating discrepancies in medical and pharmaceutical consultations and ultimately contributes to clinical success.
动脉高血压仍然是心血管疾病和死亡的主要危险因素。充分的降压治疗不仅需要开发新的药物和药物组合,还需要各级医疗保健专家之间的密切专业互动,并强制患者参与这一过程。本研究旨在探讨内科医生、药学工作者与患者在高血压治疗中的信息需求、满足方式及信息领域的互动,并提出改善专业互动的方法。材料和方法包括调查医生(n = 99)、制药工作者(n = 220)和动脉高血压患者(n = 382),分析他们的医疗文件,在不同级别的医疗保健专家资格提高期间组织联合教育活动,并为医生和药剂师的自动化工作场所开发专门的计算机程序,作为提高专业互动水平的手段。结果显示了专家和患者在动脉高血压治疗及其药物支持方面的主要信息需求概况。医生-药剂师-病人三位一体中需要不断的互动得到证实。提出了医生和药剂师自动化工作场所的概念,并提供了其功能计算机程序。自动化工作场所在雅罗斯拉夫尔的药店进行了测试。结论。医疗保健专家与患者之间密切的专业互动是合理药物治疗的一个重要方面。医疗和药学机构信息环境的统一可以消除医疗和药学咨询中的差异,并最终有助于临床成功。
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引用次数: 0
In memory of A.L. Grebenev (to the 90th anniversary of his birth) 纪念A.L. Grebenev(纪念他诞辰90周年)
Pub Date : 2023-07-20 DOI: 10.30629/0023-2149-2023-101-6-332-333
A. Sheptulin
3 июня 2023 г. исполнилось бы 90 лет со дня рождения видного советского и российского ученого, клинициста и педагога, члена-корреспондента РАМН Андрея Леонидовича Гребенева.
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引用次数: 0
Heart rate variability and quality of life ın patients with breast cancer metastasis 心率变异性与生活质量ın乳腺癌转移患者
Pub Date : 2023-07-20 DOI: 10.30629/0023-2149-2023-101-6-279-285
O. S. Mekhraliev, A. Agayev
The implementation  of Holter monitoring  (HMECG)  and quality of life questionnaires  in clinical practice allows  for the assessment of the risk of developing dangerous heart rhythm disorders and the most important parameters related to the daily activities of patients with breast cancer. The aim of the study was to evaluate the physical and psychological health, taking into account the variability of heart rate in patients with breast cancer complicated by metastatic lymph node involvement. Material and methods. The study used data from questionnaires  completed by 115 breast cancer patients with metastatic lymph node involvement  who were receiving treatment at the Republican  Oncological  Hospital, divided into two groups: a main group of 45 patients with metastatic breast cancer and lymph node involvement, and a control group of 70 patients without lymph node involvement. The average age of the patients was between 30 and 60 years old. Complaints associated with heart rhythm disorders were considered as criteria for indicating HMECG. Quality of life questionnaires were performed using official versions of EORTC QLQ-C30 and QLQ-C30/BR23 questionnaires. Results. According to the results of statistical analysis, it was found that the effective refractory period of the atria (ERP PR) in the main group during atrial fibrillation (AF) was shorter than in the control group (p = 0.001). It was also found that in addition to shortening the ERP PR, an important factor in diagnosing breast cancer is an increase in the recovery time of the sinus node function and its corrected equivalent (CVVFSU) at relatively low average values of daily, nocturnal, and diurnal heart rate frequencies. Worsening overall condition or general fatigue are some of the most common symptoms encountered in breast cancer patients, which should be considered as important parameters significantly affecting the quality of life of patients burdened with metastatic regional lymph node involvement.
在临床实践中实施动态心电图监测(HMECG)和生活质量问卷,可以评估乳腺癌患者发生危险心律失常的风险和与日常活动相关的最重要参数。该研究的目的是评估身体和心理健康,考虑到乳腺癌合并转移性淋巴结累及患者的心率变异性。材料和方法。该研究使用了115名在共和肿瘤医院接受治疗的转移性淋巴结浸润乳腺癌患者完成的问卷调查数据,这些患者被分为两组:主要组有45名转移性乳腺癌和淋巴结浸润患者,对照组有70名没有淋巴结浸润的患者。患者的平均年龄在30 - 60岁之间。与心律失常相关的主诉被认为是HMECG的诊断标准。生活质量问卷采用正式版的EORTC QLQ-C30和QLQ-C30/BR23问卷。结果。统计分析结果发现,主组房颤(AF)期间心房有效不应期(ERP PR)短于对照组(p = 0.001)。我们还发现,除了缩短ERP PR外,诊断乳腺癌的一个重要因素是窦结功能及其校正当量(CVVFSU)在相对较低的日、夜、日心率频率平均值下的恢复时间增加。整体病情恶化或全身疲劳是乳腺癌患者最常见的症状,应被视为影响转移性区域淋巴结受累患者生活质量的重要参数。
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引用次数: 0
Domestic military field surgery at the stages of history 国内军事野战外科在历史上的发展阶段
Pub Date : 2023-07-20 DOI: 10.30629/0023-2149-2023-101-6-344-347
M. Knopov
The article briefly presents the main stages of the development of the Russian military field surgery.
简要介绍了俄罗斯军事野战外科发展的主要阶段。
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引用次数: 0
The path from cardiac arrest to discharge from the hospital 从心脏骤停到出院的过程
Pub Date : 2023-07-20 DOI: 10.30629/0023-2149-2023-101-6-327-331
A. Chepurnaya, L. H. Bikmeeva, G. K. Dil'muhametova, T. Y. Lekhmus
The presented clinical case demonstrates the qualified work of medical staff who act not only according to established instructions, but also by vocation. Acute coronary syndrome with ST segment elevation is associated with acute occlusion of the coronary artery and sometimes, despite medical assistance, ends in a fatal outcome. The described clinical case showed the possibility of restoring the functioning of the heart and brain activity, which allowed the patient to be discharged from the hospital in a satisfactory condition. The article also analyzes the patient's condition after discharge: the patient underwent aorto-coronary bypass surgery, plastic surgery of the interventricular septal aneurysm, and mitral valve plastic surgery.
本文所提出的临床案例表明,医务人员不仅按照既定的指示行事,而且按照职业要求行事,是合格的。ST段抬高的急性冠状动脉综合征与急性冠状动脉闭塞有关,有时尽管有医疗救助,但最终会导致致命的结果。所描述的临床病例表明,恢复心脏和大脑活动的功能是可能的,这使得患者出院时情况令人满意。本文还分析了患者出院后的情况:患者接受了冠状动脉搭桥手术、室间隔动脉瘤整形手术、二尖瓣整形手术。
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引用次数: 0
Post-COVID neurocognitive disorders covid - 19后神经认知障碍
Pub Date : 2023-07-20 DOI: 10.30629/0023-2149-2023-101-6-265-274
O. A. Sapronenkova, E. A. Shirokov
The article discusses the causes and mechanisms of cognitive disorders in patients who have recovered from COVID-19. A review of scientific publications in recent years has shown that the impairment of central nervous system function is one of the key features of coronavirus infection. Post-COVID neurological syndrome is observed in most patients. The authors have summarized data on the penetration of viruses into brain structures and studied the leading mechanisms of nervous system damage associated with viral infection. Promising directions for the prevention and treatment of neurocognitive disorders associated with past coronavirus infection are proposed.
本文讨论了COVID-19康复患者认知障碍的原因和机制。近年来对科学出版物的回顾表明,中枢神经系统功能损伤是冠状病毒感染的关键特征之一。大多数患者出现新冠肺炎后神经系统综合征。作者总结了病毒侵入大脑结构的数据,并研究了与病毒感染相关的神经系统损伤的主要机制。为预防和治疗与过去冠状病毒感染相关的神经认知障碍提出了有希望的方向。
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引用次数: 0
A rare case of isolated IBM — HNRNPA2B1associated myopathy with inclusion bodies 一例罕见的孤立性IBM - hnrnpa2b1伴包涵体肌病
Pub Date : 2023-06-01 DOI: 10.30629/0023-2149-2023-101-4-5-247-251
F. I. Isaev, E. Antipenko, M. N. Erokhina, E. Parshina, T. Kozlova
Hereditary inclusion body myopathy (IBM) is a variant of multisystem proteinopathy. It is a generalized progressive disease with autosomal recessive or autosomal dominant inheritance, characterized by the development of a degenerative process in muscle fi bers due to the accumulation of rimmed vacuoles and nuclear intermediate fi laments. This article presents a clinical observation of a rare variant of IBM — HNRNPA2B1-associated myopathy with a phenotypically diverse picture in representatives of one family from diff erent generations.
遗传性包涵体肌病(IBM)是多系统蛋白病的一种变体。它是一种常染色体隐性遗传或常染色体显性遗传的全身性进行性疾病,其特征是由于边缘空泡和核中间纤维的积累而导致肌肉纤维发生退行性过程。本文介绍了一种罕见的IBM - hnrnpa2b1相关肌病变体的临床观察,该变体在一个家族不同代的代表中具有表型多样化的图景。
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引用次数: 0
期刊
Clinical Medicine (Russian Journal)
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