Pub Date : 2018-09-09DOI: 10.17709/2409-2231-2018-5-3-5
H. S. Gevorgyan, A. Kostin, N. Vorobyev, K. Nyushko, A. Muradyan, I. A. Taraki, Y. Samsonov
Providing a high quality of life for a man after performing radical prostatectomy for prostate cancer is currently one of the topical problems of urology and andrology. Nervous-protective radical prostatectomy is one of the high-tech operations in urology and the surgeon’s task is not only to remove the tumor of the prostate gland, but also to ensure a high quality of life for the patient. The importance and urgency of this problem is evidenced by the fact that most of the issues that arise in patients in conversation with a surgeon before surgical intervention are devoted to it.The National Institute of Health of the USA shows that the incidence of prostate cancer is about 9.5% per year, and the localized form began to occur in younger men. In this regard, the surgeon faces the task not only to cure the patient of malignant education, but also to maintain the erectile function and the continent’s indicators, thereby improving the quality of life.At the present stage, diagnostic methods make it possible to detect early prostate cancer much more often, so that the identification and treatment of such patients become more accessible and allows the use of this operation. However, for the preservation of the neurovascular bundle, it is mandatory to know the anatomical features of this zone.Over the past few decades, anatomical studies have been conducted that described the neuroanatomy of the prostate and the adjacent tissue. This article summarizes the latest results of studies of neuroanatomical studies, some of which contradict the established consensus on pelvic anatomy.
{"title":"Anatomy of the neurovascular bundle and methods of its preservation with nerve-sparing prostatectomy","authors":"H. S. Gevorgyan, A. Kostin, N. Vorobyev, K. Nyushko, A. Muradyan, I. A. Taraki, Y. Samsonov","doi":"10.17709/2409-2231-2018-5-3-5","DOIUrl":"https://doi.org/10.17709/2409-2231-2018-5-3-5","url":null,"abstract":"Providing a high quality of life for a man after performing radical prostatectomy for prostate cancer is currently one of the topical problems of urology and andrology. Nervous-protective radical prostatectomy is one of the high-tech operations in urology and the surgeon’s task is not only to remove the tumor of the prostate gland, but also to ensure a high quality of life for the patient. The importance and urgency of this problem is evidenced by the fact that most of the issues that arise in patients in conversation with a surgeon before surgical intervention are devoted to it.The National Institute of Health of the USA shows that the incidence of prostate cancer is about 9.5% per year, and the localized form began to occur in younger men. In this regard, the surgeon faces the task not only to cure the patient of malignant education, but also to maintain the erectile function and the continent’s indicators, thereby improving the quality of life.At the present stage, diagnostic methods make it possible to detect early prostate cancer much more often, so that the identification and treatment of such patients become more accessible and allows the use of this operation. However, for the preservation of the neurovascular bundle, it is mandatory to know the anatomical features of this zone.Over the past few decades, anatomical studies have been conducted that described the neuroanatomy of the prostate and the adjacent tissue. This article summarizes the latest results of studies of neuroanatomical studies, some of which contradict the established consensus on pelvic anatomy.","PeriodicalId":119961,"journal":{"name":"Research'n Practical Medicine Journal","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114079786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-09-09DOI: 10.17709/2409-2231-2018-5-3-9
I. M. Ordiyants, U. T. Mekhdieva, A. Savicheva
Purpose.The goal is to determine the real possibili es of assessing the fetal condi on in the ante- and intranatal periods according to the data of cardiotocography.Paents and methods.73 pa ents with physiological pregnancy at 24-40 weeks were prospec vely examined. The prac cal signifi cance of the g6b plus General MEDITECH automated fetal monitor, which allows to determine the condi on of the mother and fetus at the same me, was evaluated.Results.The average blood pressure in the examined women was 127.2 ± 3.6 by 73.7 ± 2.3 mm. gt; pillars, pulse – 76 ± 1,5 beats/min. As for the contrac le capacity of the uterus, 47 (64,4%) pregnant women in 24–30 weeks. associated with diagnosis, and 19 (26%) – are harbingers of the forthcoming birth. The average SpO2was 99.12 ± 0.11%. Regardless of the gesta onal age, in 7 (9.6%) pregnant women – 97%, 40 (54.8%) – 99% and 21 (28.8%) – 100%. In order to assess the fetal condi on by the nature of his heartbeat, we performed an automated CTG analysis according to W. Fisher, D. Redman, FIGO: according to W. Fisher, depending on the gesta onal age of 6–7 points, 12 (16.4%) pregnant women in 25–26 weeks and 9 (12.3%) – 40 weeks, which according to the ball scale corresponds to a suspicious type. The Doze–Redman criteria were met in 47 (64.4%) pregnant women and were not met – in 26 (35.6%). Interpreta on according to FIGO guidelines as normal was detected in 64 (87.7%) pregnant women and in 9 (12.3%) – doub ul. Depending on the period of pregnancy, this group consisted of the same 9 (12.3%) pregnant women in a period of 40 weeks.Conclusion.Automated analysis allows for the correla on between the main indicators of the well-being of the maternal organism (SpO2, blood pressure, pulse, body temperature, ECG) and fetal CTG parameters (Fisher scale, Dowz Redman criteria and FIGO guidelines) to develop obstetric tac cs for each specifi c pa ent during pregnancy and childbirth.
目的。目的是根据心脏造影的数据，确定评估产前和产前胎儿状况的真正可能性。父母和方法。对73例24 ~ 40周生理性妊娠患者进行了前瞻性检查。评价g6b加General MEDITECH自动胎儿监护仪的实际意义，该监护仪可同时测定母胎状况。结果:检查妇女的平均血压为127.2±3.6 × 73.7±2.3 mm. gt;柱子，脉搏- 76±1.5次/分。在子宫收缩能力方面，47例(64.4%)孕妇在24-30周。与诊断有关，19例(26%)是即将出生的先兆。平均spo2为99.12±0.11%。不论胎龄，7例(9.6%)孕妇为97%，40例(54.8%)为99%，21例(28.8%)为100%。为了通过心跳的性质来评估胎儿的状况，我们根据W. Fisher, D. Redman, FIGO进行了自动CTG分析:根据W. Fisher，根据胎龄6-7分，12(16.4%)孕妇在25-26周和9(12.3%)- 40周，其中根据球量表对应为可疑类型。47例(64.4%)孕妇符合Doze-Redman标准，26例(35.6%)孕妇不符合。64例(87.7%)孕妇解释正常，9例(12.3%)孕妇解释正常。根据妊娠期的不同，该组由相同的9名(12.3%)孕妇在40周内组成。结论:自动化分析允许母体机体健康的主要指标(SpO2，血压，脉搏，体温，心电图)和胎儿CTG参数(Fisher量表，Dowz Redman标准和FIGO指南)之间的相关性，以制定妊娠和分娩期间每个特定父母的产科策略。
{"title":"Modern approaches to the diagnosis of placental insufficiency according to cardiotocography","authors":"I. M. Ordiyants, U. T. Mekhdieva, A. Savicheva","doi":"10.17709/2409-2231-2018-5-3-9","DOIUrl":"https://doi.org/10.17709/2409-2231-2018-5-3-9","url":null,"abstract":"Purpose.The goal is to determine the real possibili es of assessing the fetal condi on in the ante- and intranatal periods according to the data of cardiotocography.Paents and methods.73 pa ents with physiological pregnancy at 24-40 weeks were prospec vely examined. The prac cal signifi cance of the g6b plus General MEDITECH automated fetal monitor, which allows to determine the condi on of the mother and fetus at the same me, was evaluated.Results.The average blood pressure in the examined women was 127.2 ± 3.6 by 73.7 ± 2.3 mm. gt; pillars, pulse – 76 ± 1,5 beats/min. As for the contrac le capacity of the uterus, 47 (64,4%) pregnant women in 24–30 weeks. associated with diagnosis, and 19 (26%) – are harbingers of the forthcoming birth. The average SpO2was 99.12 ± 0.11%. Regardless of the gesta onal age, in 7 (9.6%) pregnant women – 97%, 40 (54.8%) – 99% and 21 (28.8%) – 100%. In order to assess the fetal condi on by the nature of his heartbeat, we performed an automated CTG analysis according to W. Fisher, D. Redman, FIGO: according to W. Fisher, depending on the gesta onal age of 6–7 points, 12 (16.4%) pregnant women in 25–26 weeks and 9 (12.3%) – 40 weeks, which according to the ball scale corresponds to a suspicious type. The Doze–Redman criteria were met in 47 (64.4%) pregnant women and were not met – in 26 (35.6%). Interpreta on according to FIGO guidelines as normal was detected in 64 (87.7%) pregnant women and in 9 (12.3%) – doub ul. Depending on the period of pregnancy, this group consisted of the same 9 (12.3%) pregnant women in a period of 40 weeks.Conclusion.Automated analysis allows for the correla on between the main indicators of the well-being of the maternal organism (SpO2, blood pressure, pulse, body temperature, ECG) and fetal CTG parameters (Fisher scale, Dowz Redman criteria and FIGO guidelines) to develop obstetric tac cs for each specifi c pa ent during pregnancy and childbirth.","PeriodicalId":119961,"journal":{"name":"Research'n Practical Medicine Journal","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115805372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-09-09DOI: 10.17709/2409-2231-2018-5-3-1
K. Kamalov, E. M. Soltakhanov, G. A. Gazimagomedov
Purpose. Conducting a comparative analysis and assessment of the dynamics of endemic goiter and iodine deficiency in the population of boys of the Republic of Dagestan at the age of 11–13 years for the period 2002–2013, living in different ecological and geographical zones.Patients and methods. 3457 adolescent boys 11–13 years old, living in different ecological and geographical zones, were surveyed. Methods of investigation were: determination of daily excretion of iodine in urine, palpation and ultrasound examination of the thyroid gland.Results. It was revealed that during the period of preventive measures there was an improvement in iodine supply regardless of the area of residence. However, against the background of preventive measures in the lowland zone, iodine deficiency decreased not evenly, and in some cases the aggravation occured.Conclusion. The incidence of endemic goiter and the severity of iodine deficiency in boys aged 11–13 years in the mountain and foothill ecology and geographical zones of the Republic of Dagestan are generally comparable to those of iodine deficiency and endemic goiter in the general population of the Republic of Dagestan. On a flat ecogeographical zone, endemic goiter in boys 11-13 years is less common than in the general population in this region. Preventive measures to combat iodine deficiency have led to a decrease in the frequency of endemic goiter, but constant monitoring is required. As a result, there was no correlation between the incidence of endemic goiter and the severity of iodine deficiency.
{"title":"The prevalence of endemic goiter and iodine deficiency in the population of boys aged 11–13 years in different ecogeographical regions of the Republic Of Dagestan","authors":"K. Kamalov, E. M. Soltakhanov, G. A. Gazimagomedov","doi":"10.17709/2409-2231-2018-5-3-1","DOIUrl":"https://doi.org/10.17709/2409-2231-2018-5-3-1","url":null,"abstract":"Purpose. Conducting a comparative analysis and assessment of the dynamics of endemic goiter and iodine deficiency in the population of boys of the Republic of Dagestan at the age of 11–13 years for the period 2002–2013, living in different ecological and geographical zones.Patients and methods. 3457 adolescent boys 11–13 years old, living in different ecological and geographical zones, were surveyed. Methods of investigation were: determination of daily excretion of iodine in urine, palpation and ultrasound examination of the thyroid gland.Results. It was revealed that during the period of preventive measures there was an improvement in iodine supply regardless of the area of residence. However, against the background of preventive measures in the lowland zone, iodine deficiency decreased not evenly, and in some cases the aggravation occured.Conclusion. The incidence of endemic goiter and the severity of iodine deficiency in boys aged 11–13 years in the mountain and foothill ecology and geographical zones of the Republic of Dagestan are generally comparable to those of iodine deficiency and endemic goiter in the general population of the Republic of Dagestan. On a flat ecogeographical zone, endemic goiter in boys 11-13 years is less common than in the general population in this region. Preventive measures to combat iodine deficiency have led to a decrease in the frequency of endemic goiter, but constant monitoring is required. As a result, there was no correlation between the incidence of endemic goiter and the severity of iodine deficiency.","PeriodicalId":119961,"journal":{"name":"Research'n Practical Medicine Journal","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114871672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-09-09DOI: 10.17709/2409-2231-2018-5-3-6
L. Moskvicheva
Breast cancer is the most frequent and socially signifi cant malignant tumor disease of the female popula on of the Russian Federa on. At present, for the treatment of this pathology, the methods of the organ-preserving surgical manual allowing to achieve the maximum cosme c eff ect along with the observance of the principles of cancer safety are ge ng more and more developed,. In recent decades, researchers from diff erent countries demonstrate the feasibility and technical safety of various mini-invasive methods of thermal abla on of early stages of breast cancer, characterized by rela ve simplicity of implementa on, excellent cosme c results, short-term rehabilita on of pa ents. These include hyperthermic techniques (radiofrequency, microwave, laser abla on) and hypothermic method (cryoabla on). Each technique has unique characteris cs of impact on the tumor and is performed under the control of ultrasound, computer tomography or magne c resonance imaging. The technical success of these abla on techniques is achieved in 93–98% of cases. Complete tumor necrosis a er radiofrequency abla on is observed in 76–100% of pa ents with breast cancer, laser abla on – in 13–76%, microwave abla on – in 0–8%, cryoabla on – in 36–83%. The frequency of development of specifi c complica ons of local thermal destruc on is 4–13%. To date, there is only one method of noninvasive extracorporeal thermal abla on of tumors of diff erent localiza on – high-intensity focused ultrasound therapy, the eff ec veness and safety of which as a method of local destruc on of benign and malignant tumors of the breast demonstrated by many authors. Like all methods of thermal abla on, high-intensity focused ultrasound therapy has its limita ons, complica ons and disadvantages. This ar cle presents a literary review that highlights the possibili es of this method of local destruc on in pa ents with malignant tumors of the breast.
{"title":"High-intensity focused ultrasonic ablation of breast cancer","authors":"L. Moskvicheva","doi":"10.17709/2409-2231-2018-5-3-6","DOIUrl":"https://doi.org/10.17709/2409-2231-2018-5-3-6","url":null,"abstract":"Breast cancer is the most frequent and socially signifi cant malignant tumor disease of the female popula on of the Russian Federa on. At present, for the treatment of this pathology, the methods of the organ-preserving surgical manual allowing to achieve the maximum cosme c eff ect along with the observance of the principles of cancer safety are ge ng more and more developed,. In recent decades, researchers from diff erent countries demonstrate the feasibility and technical safety of various mini-invasive methods of thermal abla on of early stages of breast cancer, characterized by rela ve simplicity of implementa on, excellent cosme c results, short-term rehabilita on of pa ents. These include hyperthermic techniques (radiofrequency, microwave, laser abla on) and hypothermic method (cryoabla on). Each technique has unique characteris cs of impact on the tumor and is performed under the control of ultrasound, computer tomography or magne c resonance imaging. The technical success of these abla on techniques is achieved in 93–98% of cases. Complete tumor necrosis a er radiofrequency abla on is observed in 76–100% of pa ents with breast cancer, laser abla on – in 13–76%, microwave abla on – in 0–8%, cryoabla on – in 36–83%. The frequency of development of specifi c complica ons of local thermal destruc on is 4–13%. To date, there is only one method of noninvasive extracorporeal thermal abla on of tumors of diff erent localiza on – high-intensity focused ultrasound therapy, the eff ec veness and safety of which as a method of local destruc on of benign and malignant tumors of the breast demonstrated by many authors. Like all methods of thermal abla on, high-intensity focused ultrasound therapy has its limita ons, complica ons and disadvantages. This ar cle presents a literary review that highlights the possibili es of this method of local destruc on in pa ents with malignant tumors of the breast.","PeriodicalId":119961,"journal":{"name":"Research'n Practical Medicine Journal","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115135214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-09-09DOI: 10.17709/2409-2231-2018-5-3-14
E. Kruglov, A. I. Narkevich, A. Babich, Y. Pobedintseva, V. A. Kudlachev, E. V. Filimonov, A. Goncharov, V. Unguryan
The authors present to your a en on a rare clinical case of complete intersec on of the superior mesenteric artery in laparoscopic radical nephrectomy. This complica on emerged in the process of learning the technique of laparoscopic radical nephrectomy, before reaching the “plateau” of the learning curve, in condi ons of poor vision and in the interposi on of tissues due to paratumorous infitiltra on. This type of injury has a high risk of total necrosis of the small intestine. However, due to the concerted ac ons of the surgical service and the readiness of surgeons to complete the vascular suture of the main vessels, a successful reimplanta on of the superior mesenteric artery into the aorta was performed. This is confi rmed by postopera ve observa on and examina on, which included CT angiography. It should be noted that descrip ons of cases of aor c reimplanta on of the superior mesenteric artery are extremely rare in the world and national literature, except for cases of mesenteric ischemia. This case contributes to the description of rare cases of aor c reimplanta on of the superior mesenteric artery and shows the correctness of the selected surgical tactics.
{"title":"Superior mesenteric artery injury during laparoscopic radical nephrectomy","authors":"E. Kruglov, A. I. Narkevich, A. Babich, Y. Pobedintseva, V. A. Kudlachev, E. V. Filimonov, A. Goncharov, V. Unguryan","doi":"10.17709/2409-2231-2018-5-3-14","DOIUrl":"https://doi.org/10.17709/2409-2231-2018-5-3-14","url":null,"abstract":"The authors present to your a en on a rare clinical case of complete intersec on of the superior mesenteric artery in laparoscopic radical nephrectomy. This complica on emerged in the process of learning the technique of laparoscopic radical nephrectomy, before reaching the “plateau” of the learning curve, in condi ons of poor vision and in the interposi on of tissues due to paratumorous infitiltra on. This type of injury has a high risk of total necrosis of the small intestine. However, due to the concerted ac ons of the surgical service and the readiness of surgeons to complete the vascular suture of the main vessels, a successful reimplanta on of the superior mesenteric artery into the aorta was performed. This is confi rmed by postopera ve observa on and examina on, which included CT angiography. It should be noted that descrip ons of cases of aor c reimplanta on of the superior mesenteric artery are extremely rare in the world and national literature, except for cases of mesenteric ischemia. This case contributes to the description of rare cases of aor c reimplanta on of the superior mesenteric artery and shows the correctness of the selected surgical tactics.","PeriodicalId":119961,"journal":{"name":"Research'n Practical Medicine Journal","volume":"64 4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133869995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-09-09DOI: 10.17709/2409-2231-2018-5-3-13
A. Vishnevskiy
The presented clinical observa on of a 41-year-old pa ent with an autosomal dominant form of osteopetrosis type II is interes ng not only from the point of view of the complexity of diagnosis of a rare genetic disease complicated by spinal stenosis, but also to determine the tactics of treatment. The patient was examined and treated by phthisiatricians. Histological examina on of the material obtained with trepanobiopsy showed dystrophic changes in bone tissue and poor infi ltra on with lymphocytes; data for tuberculosis of the spine was not revealed. Taking into account the pronounced neurological disorders on the background of spinal cord compression, as well as the instability of the spine, the patient was carried out pallia ve surgery (open biopsy with decompression of the spinal canal, posterior laminar fi xa on of ThVIII—LIIand anterior fi xa on of ThVIII–XIIcombined tanium implant). Histological examina on of tissues obtained by open biopsy allowed to suspect a rare disease and fi nally verify the diagnosis after genetic examina on.
{"title":"Stenosis of the spinal canal of the thoracic spine in a patient with autosomal dominant osteopetrosis type 2","authors":"A. Vishnevskiy","doi":"10.17709/2409-2231-2018-5-3-13","DOIUrl":"https://doi.org/10.17709/2409-2231-2018-5-3-13","url":null,"abstract":"The presented clinical observa on of a 41-year-old pa ent with an autosomal dominant form of osteopetrosis type II is interes ng not only from the point of view of the complexity of diagnosis of a rare genetic disease complicated by spinal stenosis, but also to determine the tactics of treatment. The patient was examined and treated by phthisiatricians. Histological examina on of the material obtained with trepanobiopsy showed dystrophic changes in bone tissue and poor infi ltra on with lymphocytes; data for tuberculosis of the spine was not revealed. Taking into account the pronounced neurological disorders on the background of spinal cord compression, as well as the instability of the spine, the patient was carried out pallia ve surgery (open biopsy with decompression of the spinal canal, posterior laminar fi xa on of ThVIII—LIIand anterior fi xa on of ThVIII–XIIcombined tanium implant). Histological examina on of tissues obtained by open biopsy allowed to suspect a rare disease and fi nally verify the diagnosis after genetic examina on.","PeriodicalId":119961,"journal":{"name":"Research'n Practical Medicine Journal","volume":"36 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125082088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-09-09DOI: 10.17709/2409-2231-2018-5-3-16
E. Pesennikova, O. Gridnev, S. Korostelev
Based on the analyses of normative-legislative documents related to medical activities in RF published between 1990 and 2017 the classification of medical facility legal risks has been formed. The usage of the classification enables building systematic approach for legal protection.The right for health protection is ensured also by providing paid medical services according to the Federal Act on Public Health Care. It doesn’t follow from Russian legislation that this right could be exercised only in private medical institutions, which makes public medical institutions legitimate participants of the process. However, in accordance with the Government Resolution No. 1006, there is range of restrictions for public medical institutions in case they provide paid medical services. For instance, they must justify charging by informing consumers about their rights guaranteed by the State guarantees program.The analysis of normative-legislative documents that ensure regulation of public medical services caused the classification of legal risks. The violation of the Consumer Protection Act and of the Civil Code (contractual risks) appeared to become the most common ones.There is no clear notion of “medical error”. That’s why it is almost impossible to make a distinction between patient irresponsibility, staff negligence or low doctor’s professionalism. This is the reason for patients’ rights as well as medical personnel responsibility to be regulated by the state.The analysis that is been made shows that risks and sanctions in the provision of Paid Medical Services by State institutions occur in cases of misconduct while providing Paid Medical Services. The most typical cases of misconduct while providing Paid Medical Services come when: medical services could be provided under the State guarantees program; failure to provide medical care occurs; violation of medical and contractual documents in the provision of Paid Medical Services takes place; violation of patient’s rights to receive complete and reliable information related to medical care takes place.
{"title":"Main legal risks in provision of commercial medical services by state medical institution","authors":"E. Pesennikova, O. Gridnev, S. Korostelev","doi":"10.17709/2409-2231-2018-5-3-16","DOIUrl":"https://doi.org/10.17709/2409-2231-2018-5-3-16","url":null,"abstract":"Based on the analyses of normative-legislative documents related to medical activities in RF published between 1990 and 2017 the classification of medical facility legal risks has been formed. The usage of the classification enables building systematic approach for legal protection.The right for health protection is ensured also by providing paid medical services according to the Federal Act on Public Health Care. It doesn’t follow from Russian legislation that this right could be exercised only in private medical institutions, which makes public medical institutions legitimate participants of the process. However, in accordance with the Government Resolution No. 1006, there is range of restrictions for public medical institutions in case they provide paid medical services. For instance, they must justify charging by informing consumers about their rights guaranteed by the State guarantees program.The analysis of normative-legislative documents that ensure regulation of public medical services caused the classification of legal risks. The violation of the Consumer Protection Act and of the Civil Code (contractual risks) appeared to become the most common ones.There is no clear notion of “medical error”. That’s why it is almost impossible to make a distinction between patient irresponsibility, staff negligence or low doctor’s professionalism. This is the reason for patients’ rights as well as medical personnel responsibility to be regulated by the state.The analysis that is been made shows that risks and sanctions in the provision of Paid Medical Services by State institutions occur in cases of misconduct while providing Paid Medical Services. The most typical cases of misconduct while providing Paid Medical Services come when: medical services could be provided under the State guarantees program; failure to provide medical care occurs; violation of medical and contractual documents in the provision of Paid Medical Services takes place; violation of patient’s rights to receive complete and reliable information related to medical care takes place.","PeriodicalId":119961,"journal":{"name":"Research'n Practical Medicine Journal","volume":"62 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122040955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-09-09DOI: 10.17709/2409-2231-2018-5-3-7
M. Zabelin, A. Kaprin, A. Kostin, E. Gameeva, S. E. Varlamova
This ar cle discusses the use of EGFR inhibitors in the treatment of pa ents with colorectal cancer. The mechanisms of their ac on, specifi c manifesta ons of toxicity are considered. A review of current literature data on the use of both approved for clinical use (cetuximab, panitumumab) and an -EGFR an bodies at the stage of clinical trials is presented. EGFR inhibitors are one of the main groups of targeted drugs used to treat pa ents with colorectal cancer. The correlaon between toxicity and effi cacy of these drugs is discussed separately. The scope of their applica on is limited to the treatment of disseminated forms of the disease, but in the future the number of available an -EGFR an bodies may grow, the possibility of their use in new condi ons, including in the framework of chemoradiotherapy.
{"title":"EGFR inhibitors in the treatment of colorectal cancer","authors":"M. Zabelin, A. Kaprin, A. Kostin, E. Gameeva, S. E. Varlamova","doi":"10.17709/2409-2231-2018-5-3-7","DOIUrl":"https://doi.org/10.17709/2409-2231-2018-5-3-7","url":null,"abstract":"This ar cle discusses the use of EGFR inhibitors in the treatment of pa ents with colorectal cancer. The mechanisms of their ac on, specifi c manifesta ons of toxicity are considered. A review of current literature data on the use of both approved for clinical use (cetuximab, panitumumab) and an -EGFR an bodies at the stage of clinical trials is presented. EGFR inhibitors are one of the main groups of targeted drugs used to treat pa ents with colorectal cancer. The correlaon between toxicity and effi cacy of these drugs is discussed separately. The scope of their applica on is limited to the treatment of disseminated forms of the disease, but in the future the number of available an -EGFR an bodies may grow, the possibility of their use in new condi ons, including in the framework of chemoradiotherapy.","PeriodicalId":119961,"journal":{"name":"Research'n Practical Medicine Journal","volume":"112 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115204548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-03-29DOI: 10.17709/2409-2231-2018-5-1-12
А. Д. Зикиряходжаев, А. А. Масри, А. С. Сухотько, М. В. Старкова, Н. В. Аблицова, Ф. Н. Усов, В. В. Ратушная, Н. В. Евтягина
Breast cancer (BC) takes the first place in the structure of morbidity and mortality among the female population. One of the main methods of treating the disease is surgical one, it can lead to both complete removal of the breast and partial tissue damage. In most cases, the further socially active behavior of the patient depends on the quality of the performed operation. In this article, two clinical cases of corrective lipofilling at the final stage of reconstructive and plastic surgeries in patients with breast cancer after complex treatment are presented. Specifi c examples showed a positive effect after a single lipofilling session of the formed breast using both syringe and water jet techniques. This procedure is carried out to improve the cosmetic results in patients after comprehensive treatment for breast cancer. It is proved that mesenchymal stromal cells, or messenger cells present in all fatty tissues, promote its regeneration by forming new blood vessels or directly affect damaged or susceptible structures — restore and rejuvenate the areas of lipofilling. Therefore, adipose tissue is a natural source of regeneration of the human body. On these clinical examples, after a successful one lipophilic session, improvement of the quality of the skin in the reconstructed breast area was noted and, as a result, a good cosmetic result after reconstructive plastic surgery, both in the patient with the use of a silicone endoprosthesis and without it.
{"title":"Корригирующий липофилинг у больных раком молочной железы после комбинированного лечения","authors":"А. Д. Зикиряходжаев, А. А. Масри, А. С. Сухотько, М. В. Старкова, Н. В. Аблицова, Ф. Н. Усов, В. В. Ратушная, Н. В. Евтягина","doi":"10.17709/2409-2231-2018-5-1-12","DOIUrl":"https://doi.org/10.17709/2409-2231-2018-5-1-12","url":null,"abstract":"Breast cancer (BC) takes the first place in the structure of morbidity and mortality among the female population. One of the main methods of treating the disease is surgical one, it can lead to both complete removal of the breast and partial tissue damage. In most cases, the further socially active behavior of the patient depends on the quality of the performed operation. In this article, two clinical cases of corrective lipofilling at the final stage of reconstructive and plastic surgeries in patients with breast cancer after complex treatment are presented. Specifi c examples showed a positive effect after a single lipofilling session of the formed breast using both syringe and water jet techniques. This procedure is carried out to improve the cosmetic results in patients after comprehensive treatment for breast cancer. It is proved that mesenchymal stromal cells, or messenger cells present in all fatty tissues, promote its regeneration by forming new blood vessels or directly affect damaged or susceptible structures — restore and rejuvenate the areas of lipofilling. Therefore, adipose tissue is a natural source of regeneration of the human body. On these clinical examples, after a successful one lipophilic session, improvement of the quality of the skin in the reconstructed breast area was noted and, as a result, a good cosmetic result after reconstructive plastic surgery, both in the patient with the use of a silicone endoprosthesis and without it.","PeriodicalId":119961,"journal":{"name":"Research'n Practical Medicine Journal","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131785854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-03-29DOI: 10.17709/2409-2231-2018-5-1-10
М. В. Забелин, В. А. Климанов, Ж. Ж. Галяутдинова, Александр Сергеевич Самойлов, А. О. Лебедев, Е. В. Шелухина
This article is the review of literature concerning use of proton beam therapy in treatment of oncology. The staticized data on comparison of effi ciency of this method at an eye melanoma are lit. Advantages of proton therapy on the level of local control and depression of frequency of development of the radio induced cataract are refl ected in the provided data. In evident material the technology of preparation and carrying out radiation of an eye is shortly covered with a fascicle of protons. The experience of use of proton therapy of tumors of a skull base got for the last several decades, showed good results. Physical properties of a fascicle of protons allow to achieve the maximum dose conformality, having lowered, thereby, a radial load on the next crucial anatomical structures. The presented material on an oncopediatrics shows insuffi cient knowledge of scientists concerning advantage of a fascicle of protons over modern methods of photon radiation. There are only preliminary clinical results concerning generally of treatment of cranyopharyngiomas. At cancer therapy of a mammary gland, proton therapy showed the best local control of postoperative recurrent tumors, and also depression of a dose load on the contralateral party. The available results of the retrospective analysis of clinical data in the University medical center of Lome Linda, testify to advantages of proton therapy of the localized prostate cancer. The lack of a biochemical recurrence and a local tumoral progression within 5 years after radiation was shown. The data obtained from experience of use of proton radiation therapy with passively scattered fascicle for cancer therapy of a prostate at an early stage showed the admixed results in comparison with modern methods of radiation therapy with the modulated intensity. In treatment of non-small cell cancer of mild advantage of proton therapy aren’t absolutely proved yet. There are data on extreme toxicity of a combination of a chemotherapy and photon radiation. It is supposed that physical properties of protons will allow to reduce toxicity of such technique, however clinical trials in comparison of protons and RTMI aren’t fi nished yet. The main directions of development of a method of proton therapy are shortly lit.
{"title":"ПРОТОННАЯ ЛУЧЕВАЯ ТЕРАПИЯ: ВОЗМОЖНОСТИ КЛИНИЧЕСКОГО ПРИМЕНЕНИЯ И ПЕРСПЕКТИВЫ ИССЛЕДОВАНИЯ","authors":"М. В. Забелин, В. А. Климанов, Ж. Ж. Галяутдинова, Александр Сергеевич Самойлов, А. О. Лебедев, Е. В. Шелухина","doi":"10.17709/2409-2231-2018-5-1-10","DOIUrl":"https://doi.org/10.17709/2409-2231-2018-5-1-10","url":null,"abstract":"This article is the review of literature concerning use of proton beam therapy in treatment of oncology. The staticized data on comparison of effi ciency of this method at an eye melanoma are lit. Advantages of proton therapy on the level of local control and depression of frequency of development of the radio induced cataract are refl ected in the provided data. In evident material the technology of preparation and carrying out radiation of an eye is shortly covered with a fascicle of protons. The experience of use of proton therapy of tumors of a skull base got for the last several decades, showed good results. Physical properties of a fascicle of protons allow to achieve the maximum dose conformality, having lowered, thereby, a radial load on the next crucial anatomical structures. The presented material on an oncopediatrics shows insuffi cient knowledge of scientists concerning advantage of a fascicle of protons over modern methods of photon radiation. There are only preliminary clinical results concerning generally of treatment of cranyopharyngiomas. At cancer therapy of a mammary gland, proton therapy showed the best local control of postoperative recurrent tumors, and also depression of a dose load on the contralateral party. The available results of the retrospective analysis of clinical data in the University medical center of Lome Linda, testify to advantages of proton therapy of the localized prostate cancer. The lack of a biochemical recurrence and a local tumoral progression within 5 years after radiation was shown. The data obtained from experience of use of proton radiation therapy with passively scattered fascicle for cancer therapy of a prostate at an early stage showed the admixed results in comparison with modern methods of radiation therapy with the modulated intensity. In treatment of non-small cell cancer of mild advantage of proton therapy aren’t absolutely proved yet. There are data on extreme toxicity of a combination of a chemotherapy and photon radiation. It is supposed that physical properties of protons will allow to reduce toxicity of such technique, however clinical trials in comparison of protons and RTMI aren’t fi nished yet. The main directions of development of a method of proton therapy are shortly lit.","PeriodicalId":119961,"journal":{"name":"Research'n Practical Medicine Journal","volume":"48 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124923717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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