Pub Date : 2018-03-29DOI: 10.17709/2409-2231-2018-5-1-7
В. А. Державин, В. Ю. Карпенко, А. В. Бухаров, М. В. Иванова
Inter-ileal abdominal dissection (IIAD) is one of the most traumatic maiming operations, which implies removal of the lower limb with a single block with an adjacent half of the pelvic ring. Taking into account the low overall incidence of locally advanced bony and soft tissue sarcomas localized in the projection of the pelvic bone and hip joints, and a small number of clinics with sufficient experience in performing such operations, modern specialized literature has a limited number of publications on the IIAD. Purpose. Presentation of the experience in the implementation of the IIAD in patients with locally advanced sarcomas of bones and soft tissues. Patients and methods . The analysis of results of treatment of 26 patients with locally advanced sarcomas of bones and soft tissues is presented. There were 14 men (54%), women 12 (46%). Patients with primary malignant tumors of bones 23 (88%) prevailed among patients. Depending on the morphological structure, 16 (61%) had chondrosarcoma, 4 (15%) had osteosarcoma and 3 (11%) had a malignant fibrous histiocytoma. Three (11%) patients had locally advanced softtissue sarcomas. In 2 (7.5%) synovial sarcoma and in one (3.5%) malignant tumor from the shells of peripheral nerves. The primary tumor process was in 21 (81%) patients. The clinical stage was established as IIb in 14 (54%), Ib in 3 (11%), IVa 1 (3.5%) and IVb in 3 (11%) patients, respectively. Results. The average duration of the operation was 4.1 hours (2.7–6 hours). The volume of intraoperative blood loss is 3400 ml (500–9000 ml). The margin of resection was evaluated as positive in 4 (15%) patients. The recurrence of the tumor after the IIAD performed by us was in 4 (15%) patients with a negative edge of R0 resection. Conclusions. Postoperative complications were noted in 5 (19%) patients. Four (80%) had wound purulent-septic com-plications: partial flap necrosis — 2, total necrosis of the flap — 1, edge necrosis of the wound — 1 patient. The overall 5-year survival rate of patients treated in the clinic by the treatment was 40%. The results of the functional status of patients after the operation were 45% on the MSTS scale, which correlates with the data of other authors.
回肠间腹腔剥离术(IIAD)是最具创伤性的致残手术之一，它意味着切除下肢与邻近的一半骨盆环。考虑到局限于骨盆骨和髋关节突出部位的局部晚期骨和软组织肉瘤的总体发病率较低，以及有足够经验进行此类手术的诊所数量较少，现代专业文献中关于IIAD的出版物数量有限。目的。介绍在局部晚期骨和软组织肉瘤患者中实施IIAD的经验。患者和方法。本文对26例局部晚期骨软组织肉瘤的治疗结果进行了分析。男性14人(54%)，女性12人(46%)。原发性骨恶性肿瘤患者23例(88%)。根据形态学结构，16例(61%)为软骨肉瘤，4例(15%)为骨肉瘤，3例(11%)为恶性纤维组织细胞瘤。3例(11%)患者有局部晚期软组织肉瘤。2例(7.5%)滑膜肉瘤，1例(3.5%)周围神经外壳恶性肿瘤。21例(81%)患者发生原发肿瘤。临床分期分别为IIb 14例(54%)、Ib 3例(11%)、IVa 1例(3.5%)和IVb 3例(11%)。结果。手术时间平均4.1小时(2.7 ~ 6小时)。术中出血量3400 ml (500-9000 ml)。4例(15%)患者的切除边缘评估为阳性。我们所做的IIAD术后肿瘤复发率为4(15%)例R0切除阴性边缘患者。结论。5例(19%)患者出现术后并发症。4例(80%)有伤口脓毒性并发症:皮瓣部分坏死2例，皮瓣全坏死1例，伤口边缘坏死1例。经临床治疗的患者5年总生存率为40%。术后患者的功能状态在MSTS量表上的评分为45%，与其他作者的数据相关。
{"title":"МЕЖПОДВЗДОШНО-БРЮШНОЕ ВЫЧЛЕНЕНИЕ В ЛЕЧЕНИИ БОЛЬНЫХ С МЕСТНОРАСПРОСТРАНЕННЫМИ САРКОМАМИ КОСТЕЙ И МЯГКИХ ТКАНЕЙ","authors":"В. А. Державин, В. Ю. Карпенко, А. В. Бухаров, М. В. Иванова","doi":"10.17709/2409-2231-2018-5-1-7","DOIUrl":"https://doi.org/10.17709/2409-2231-2018-5-1-7","url":null,"abstract":"Inter-ileal abdominal dissection (IIAD) is one of the most traumatic maiming operations, which implies removal of the lower limb with a single block with an adjacent half of the pelvic ring. Taking into account the low overall incidence of locally advanced bony and soft tissue sarcomas localized in the projection of the pelvic bone and hip joints, and a small number of clinics with sufficient experience in performing such operations, modern specialized literature has a limited number of publications on the IIAD. Purpose. Presentation of the experience in the implementation of the IIAD in patients with locally advanced sarcomas of bones and soft tissues. Patients and methods . The analysis of results of treatment of 26 patients with locally advanced sarcomas of bones and soft tissues is presented. There were 14 men (54%), women 12 (46%). Patients with primary malignant tumors of bones 23 (88%) prevailed among patients. Depending on the morphological structure, 16 (61%) had chondrosarcoma, 4 (15%) had osteosarcoma and 3 (11%) had a malignant fibrous histiocytoma. Three (11%) patients had locally advanced softtissue sarcomas. In 2 (7.5%) synovial sarcoma and in one (3.5%) malignant tumor from the shells of peripheral nerves. The primary tumor process was in 21 (81%) patients. The clinical stage was established as IIb in 14 (54%), Ib in 3 (11%), IVa 1 (3.5%) and IVb in 3 (11%) patients, respectively. Results. The average duration of the operation was 4.1 hours (2.7–6 hours). The volume of intraoperative blood loss is 3400 ml (500–9000 ml). The margin of resection was evaluated as positive in 4 (15%) patients. The recurrence of the tumor after the IIAD performed by us was in 4 (15%) patients with a negative edge of R0 resection. Conclusions. Postoperative complications were noted in 5 (19%) patients. Four (80%) had wound purulent-septic com-plications: partial flap necrosis — 2, total necrosis of the flap — 1, edge necrosis of the wound — 1 patient. The overall 5-year survival rate of patients treated in the clinic by the treatment was 40%. The results of the functional status of patients after the operation were 45% on the MSTS scale, which correlates with the data of other authors.","PeriodicalId":119961,"journal":{"name":"Research'n Practical Medicine Journal","volume":"20 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":"114697472","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: 10.17709/2409-2231-2018-5-1-11
К. М. Петросян, Наталья Северская, Д. Н. Дербугов, А. А. Курильчик, Н. В. Желонкина, Андрей Викторович Дементьев, Е. И. Куприянова, Г. А. Давыдов, Андрей Дмитриевич Каприн, В. Н. Галкин, Сергей Анатольевич Иванов
Hyperparathyroidism is one of the most common endocrinopathies. This disease leads to a violation of phosphorus-calcium metabolism and the washing out of calcium from bone tissue. Breach of the skeleton’s structure in hyperparathyroidism is often mistaken for metastatic bone damage, which leads to incorrect treatment tactics. In this work we present the clinical observation of a patient with an adenoma of the parathyroid gland and a severe bone form of hyperparathyroidism. Multiple lesions of bones with destruction of the cortical layer and the presence of the softtissue component were initially regarded as metastases in the bone. However, the morphological pattern of bone foci, as well as an elevated level of calcium and parathyroid hormone, made it possible to diagnose the bony form of hyperparathyroidism. The search for the cause of hyperparathyroidism revealed a tumor in the projection of the right lower parathyroid gland. Surgical removal of parathyroid adenoma led to the normalization of the level of calcium and parathyroid hormone. The article presents data of laboratory-instrumental methods of research and the results of surgical treatment of a patient.
{"title":"ТЯЖЕЛАЯ КОСТНАЯ ФОРМА ГИПЕРПАРАТИРЕОЗА У БОЛЬНОЙ С АДЕНОМОЙ ПАРАЩИТОВИДНОЙ ЖЕЛЕЗЫ","authors":"К. М. Петросян, Наталья Северская, Д. Н. Дербугов, А. А. Курильчик, Н. В. Желонкина, Андрей Викторович Дементьев, Е. И. Куприянова, Г. А. Давыдов, Андрей Дмитриевич Каприн, В. Н. Галкин, Сергей Анатольевич Иванов","doi":"10.17709/2409-2231-2018-5-1-11","DOIUrl":"https://doi.org/10.17709/2409-2231-2018-5-1-11","url":null,"abstract":"Hyperparathyroidism is one of the most common endocrinopathies. This disease leads to a violation of phosphorus-calcium metabolism and the washing out of calcium from bone tissue. Breach of the skeleton’s structure in hyperparathyroidism is often mistaken for metastatic bone damage, which leads to incorrect treatment tactics. In this work we present the clinical observation of a patient with an adenoma of the parathyroid gland and a severe bone form of hyperparathyroidism. Multiple lesions of bones with destruction of the cortical layer and the presence of the softtissue component were initially regarded as metastases in the bone. However, the morphological pattern of bone foci, as well as an elevated level of calcium and parathyroid hormone, made it possible to diagnose the bony form of hyperparathyroidism. The search for the cause of hyperparathyroidism revealed a tumor in the projection of the right lower parathyroid gland. Surgical removal of parathyroid adenoma led to the normalization of the level of calcium and parathyroid hormone. The article presents data of laboratory-instrumental methods of research and the results of surgical treatment of a patient.","PeriodicalId":119961,"journal":{"name":"Research'n Practical Medicine Journal","volume":"17 11","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132390266","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: 10.17709/2409-2231-2018-5-1-13
А. А. Клименко, И. П. Костюк, Олег Борисович Карякин, С. А. Мозеров, З. Н. Шавладзе, И. Н. Заборский, В. С. Чайков, Марианна Энверовна Тарасова
This article presents a clinical observation of the treatment of recurrent invasive urothelial cancer of the upper urinary tract using surgical and chemotherapy treatments. During the treatment, surgical treatment and 2 chemotherapy lines were performed. The patient was under strict dynamic control, during which diagnostic procedures were carried out, which allowed time to identify the progression of the underlying disease and prescribe timely treatment of identifi ed relapses. At the first stage, the patient underwent surgical radical treatment to remove the primary tumor focus localized in the lower third of the right ureter. At the control examination a local relapse was revealed. The 1st line of chemotherapy was prescribed and performed, against which the full effect of the treatment was noted. But in the future, the progression of the disease was revealed, which required the 2nd line of chemotherapy with preliminary surgical removal of a local relapse.
{"title":"Клинический случай лечения инвазивного уротелиального рака верхних мочевыводящих путей. Проблемы комбинированного лечения","authors":"А. А. Клименко, И. П. Костюк, Олег Борисович Карякин, С. А. Мозеров, З. Н. Шавладзе, И. Н. Заборский, В. С. Чайков, Марианна Энверовна Тарасова","doi":"10.17709/2409-2231-2018-5-1-13","DOIUrl":"https://doi.org/10.17709/2409-2231-2018-5-1-13","url":null,"abstract":"This article presents a clinical observation of the treatment of recurrent invasive urothelial cancer of the upper urinary tract using surgical and chemotherapy treatments. During the treatment, surgical treatment and 2 chemotherapy lines were performed. The patient was under strict dynamic control, during which diagnostic procedures were carried out, which allowed time to identify the progression of the underlying disease and prescribe timely treatment of identifi ed relapses. At the first stage, the patient underwent surgical radical treatment to remove the primary tumor focus localized in the lower third of the right ureter. At the control examination a local relapse was revealed. The 1st line of chemotherapy was prescribed and performed, against which the full effect of the treatment was noted. But in the future, the progression of the disease was revealed, which required the 2nd line of chemotherapy with preliminary surgical removal of a local relapse.","PeriodicalId":119961,"journal":{"name":"Research'n Practical Medicine Journal","volume":"12 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":"128647061","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 : 2018-03-28DOI: 10.17709/2409-2231-2018-5-1-9
Р. А. Гафанов, Светлана Гармаш, И. Б. Кравцов, С. В. Фастовец
For a long time, chemotherapy remained the main treatment option for metastatic urothelial carcinoma (mUC). Over the past year, there have been revolutionary changes associated with the approval of five new drugs aimed at blocking the interaction between the surface protein of T-lymphocytes PD-1 and its ligands PD-L1 and PD-L2, resulting in the activation of the immune response. It is noteworthy that the anti-PD-1 antibody pembrolizumab demonstrated an increase in overall survival relative to chemotherapy in a randomized phase III trial in the second line with mUC. Based on this level 1 evidence pembrolizumab was approved by the US Food and Drug Administration (FDA). Nivolumab (antibody PD-1) also demonstrated an increase in overall survival compared to historical control and was approved by FDA. Likewise, antibodies targeting PD-L1, including atezolizumab, durvalumab and avelumab, received accelerated approval from the FDA as the second line of treatment for mUC. Some of these agents are approved in the first line by the results of phase II study (atezolizumab and pembolizumab received accelerated approval for first-line treatment in patients not receiving cisplatin). Despite these many endorsements, clinical development of new biomarkers for selection of patients, who can get maximum advantages of immunotherapy and also for development the optimal therapy sequencing still are biggest and critical question for future investigation. The clinical introduction of biomarkers to determine optimal treatment of patients remains extremely important.
{"title":"СОВРЕМЕННЫЕ ВОЗМОЖНОСТИ ТЕРАПИИ ИНГИБИТОРАМИ КОНТРОЛЬНЫХ ТОЧЕК ПРИ МЕТАСТАТИЧЕСКОМ УРОТЕЛИАЛЬНОМ РАКЕ","authors":"Р. А. Гафанов, Светлана Гармаш, И. Б. Кравцов, С. В. Фастовец","doi":"10.17709/2409-2231-2018-5-1-9","DOIUrl":"https://doi.org/10.17709/2409-2231-2018-5-1-9","url":null,"abstract":"For a long time, chemotherapy remained the main treatment option for metastatic urothelial carcinoma (mUC). Over the past year, there have been revolutionary changes associated with the approval of five new drugs aimed at blocking the interaction between the surface protein of T-lymphocytes PD-1 and its ligands PD-L1 and PD-L2, resulting in the activation of the immune response. It is noteworthy that the anti-PD-1 antibody pembrolizumab demonstrated an increase in overall survival relative to chemotherapy in a randomized phase III trial in the second line with mUC. Based on this level 1 evidence pembrolizumab was approved by the US Food and Drug Administration (FDA). Nivolumab (antibody PD-1) also demonstrated an increase in overall survival compared to historical control and was approved by FDA. Likewise, antibodies targeting PD-L1, including atezolizumab, durvalumab and avelumab, received accelerated approval from the FDA as the second line of treatment for mUC. Some of these agents are approved in the first line by the results of phase II study (atezolizumab and pembolizumab received accelerated approval for first-line treatment in patients not receiving cisplatin). Despite these many endorsements, clinical development of new biomarkers for selection of patients, who can get maximum advantages of immunotherapy and also for development the optimal therapy sequencing still are biggest and critical question for future investigation. The clinical introduction of biomarkers to determine optimal treatment of patients remains extremely important.","PeriodicalId":119961,"journal":{"name":"Research'n Practical Medicine Journal","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121544681","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 : 2018-03-28DOI: 10.17709/2409-2231-2018-5-1-6
Т. Г. Геворкян, И. А. Файнштейн
Purpose. Evaluation of the effectiveness of the method of palliative pancreatoduodenal resection for complications of advanced pancreatic head cancer. Patients and methods. The article analyzes the results of treatment of 32 patients with advanced pancreatic head cancer in the Department of Radiosurgery of the FSBO «N. Blokhin National Medical Research Center of Oncology” of Ministry of Health of Russia. All patients underwent palliative pancreatoduodenal resection. In terms of the prevalence of the process, the patients were distributed as follows: 17 (53.1%) patients with the locally advanced process and 15 (46.9%) patients with distant metastases. Results. The average time of the operative intervention was 5.2 ± 0.3 hours, the average blood loss was 543.1 ± 1.3 ml, the average bed-day was 22.1 ± 0.6 days. In total, in the shortest postoperative period, complications were noted in 5 patients (15.6%). The total postoperative lethality after the PDR was 6.3%. In general, the results were divided into 4 groups: good results were recognized in 16.7% of cases, satisfactory enough — in 26.7%, less satisfactory, but a positive effect — in 50%, non-satisfactory results of treatment were found in 6.6% cases. Quality of life using the MOS-SF-36 questionnaire — if the average indicator on the scale of physical health was 41.2 ± 0.5 before the operation, then after a month of surgery it was significantly higher — 68.1 ± 0.9, according to the scale the average figure increased from 30.6 ± 0.9 to 71.5 ± 0.7. However, the differences between the values before and after surgery are statistically significant (p<0.01). The long-term survival rate for 1 year after the operation was 39.2%, 2 years after the surgery, 7.1%. Conclusions. Palliative pancreatoduodenal resection with a common pancreatic cancer in some cases can be an operation of choice that effectively eliminates the underlying pathological process and its complications in the form of mechanical jaundice, duodenal obstruction and pain syndrome and significantly improve the quality of life of patients.
{"title":"ПАЛЛИАТИВНАЯ ПАНКРЕАТОДУОДЕНАЛЬНАЯ РЕЗЕКЦИЯ ПРИ РАКЕ ГОЛОВКИ ПОДЖЕЛУДОЧНОЙ ЖЕЛЕЗЫ","authors":"Т. Г. Геворкян, И. А. Файнштейн","doi":"10.17709/2409-2231-2018-5-1-6","DOIUrl":"https://doi.org/10.17709/2409-2231-2018-5-1-6","url":null,"abstract":"Purpose. Evaluation of the effectiveness of the method of palliative pancreatoduodenal resection for complications of advanced pancreatic head cancer. Patients and methods. The article analyzes the results of treatment of 32 patients with advanced pancreatic head cancer in the Department of Radiosurgery of the FSBO «N. Blokhin National Medical Research Center of Oncology” of Ministry of Health of Russia. All patients underwent palliative pancreatoduodenal resection. In terms of the prevalence of the process, the patients were distributed as follows: 17 (53.1%) patients with the locally advanced process and 15 (46.9%) patients with distant metastases. Results. The average time of the operative intervention was 5.2 ± 0.3 hours, the average blood loss was 543.1 ± 1.3 ml, the average bed-day was 22.1 ± 0.6 days. In total, in the shortest postoperative period, complications were noted in 5 patients (15.6%). The total postoperative lethality after the PDR was 6.3%. In general, the results were divided into 4 groups: good results were recognized in 16.7% of cases, satisfactory enough — in 26.7%, less satisfactory, but a positive effect — in 50%, non-satisfactory results of treatment were found in 6.6% cases. Quality of life using the MOS-SF-36 questionnaire — if the average indicator on the scale of physical health was 41.2 ± 0.5 before the operation, then after a month of surgery it was significantly higher — 68.1 ± 0.9, according to the scale the average figure increased from 30.6 ± 0.9 to 71.5 ± 0.7. However, the differences between the values before and after surgery are statistically significant (p<0.01). The long-term survival rate for 1 year after the operation was 39.2%, 2 years after the surgery, 7.1%. Conclusions. Palliative pancreatoduodenal resection with a common pancreatic cancer in some cases can be an operation of choice that effectively eliminates the underlying pathological process and its complications in the form of mechanical jaundice, duodenal obstruction and pain syndrome and significantly improve the quality of life of patients.","PeriodicalId":119961,"journal":{"name":"Research'n Practical Medicine Journal","volume":"43 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125155539","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 : 2018-03-28DOI: 10.17709/2409-2231-2018-5-1-8
Елена Владимировна Филатова, Х. М. Малаев
Purpose. Evaluati on of the effectiveness of complex restorati ve treatment with the inclusion of galvanic mud procedures in patients with pain in the lower back. Patients and methods. There were 30 patients (18 men and 12 women) with a diagnosis: lumbulgia or lumboeishalgia under observation. Patients underwent a course of rehabilitation on the basis of the Republican Hospital of Rehabilitation, Makhachkala. Against the background of standard therapy, galvanic mud procedures were included in the therapy. The effectiveness of the treatment was assessed by the control of pain assessment according to the VAS scale, the body mass index, the psychoemoti onal state of the HAM test, the tests of Schober and Thomayer were carried out. Results. After the complex treatment in patients, clinical and functional indices of the state of the neuromuscular apparatus Were noted, varying depending on gender. The results of the study showed that the intensity of the pain syndrome according to the VAS score in the compared groups before the rehabilitation differed significantly (5.4 ± 0.1 points in men and 6.16 ± 0.3 in women, (p <0.05), after completion of the course of treatment, the VAS score decreased statistically in both groups: in men 2.0 ± 0.4 points and in women 1.8 ± 0.1 points (p <0.05), but between groups of significant differences in the quantitative assessment of pain the syndrome was not revealed. In determining the mobility of the lumbar spine, the results of the Schober test with lumbargia as in men, and women were unreliably reduced, after treatment restored within the norm: in men before treatment, 3.46 ± 1.47 cm, after 5.3 ± 0.73 cm (p < 0.05), in women before treatment 3.95 ± 0.5 cm, after 5.35 ± 0.55 cm (p < 0.05).The analysis of the dynamics of the test results of Tomayer revealed unreliably significant differences before treatment in men = 24.8 ± 2.4 cm, in women = 21,6 ± 6,2 cm. After the course of treatment in both groups there was a significant improvement in the indices: in men = 5.23 ± 1.44 cm (p <0.05), in women 1.45 ± 0.87 cm (p < 0,05), but at the same time a reliable difference in the indices (p < 0.01). Conclusion. The conducted research has shown that carrying out galvanic mud procedures in a complex of treatment in patients with lower back pain positively influences the restoration of lumbar vertebral segment motor activity, as well as the psychoemotional state of the patient. In this case, women are more actively reduced pain and increased motor activity, but less significant indicators of the change in the psychological test.
目的。下背部疼痛患者复合修复治疗包括电泥治疗的疗效评价。患者和方法。有30例患者(18男12女)诊断为腰痛或腰痛观察。病人在马哈奇卡拉共和国康复医院接受了一个康复疗程。在标准治疗的背景下，电泥浆程序被纳入治疗。根据VAS评分、体重指数、HAM心理情绪状态测试、Schober和Thomayer测试进行疼痛控制评估治疗效果。结果。在患者的复杂治疗后，注意到神经肌肉装置状态的临床和功能指标，因性别而异。研究结果显示，两组患者康复前疼痛综合征VAS评分强度差异有统计学意义(男性为5.4±0.1分，女性为6.16±0.3分，p <0.05)，疗程结束后，两组患者VAS评分均有统计学意义下降;男性2.0±0.4分，女性1.8±0.1分，差异有统计学意义(p <0.05)，但两组间疼痛综合征定量评价差异无统计学意义。在测定腰椎活动度时，腰痛患者的Schober试验结果与男性和女性相比，在治疗后均不可靠地降低，恢复到正常范围内:男性治疗前为3.46±1.47 cm，治疗后为5.3±0.73 cm (p < 0.05)，女性治疗前为3.95±0.5 cm，治疗后为5.35±0.55 cm (p < 0.05)。对Tomayer测试结果的动态分析显示，治疗前男性= 24.8±2.4 cm，女性= 21,6±6.2 cm，差异不可靠。治疗结束后，两组患者的各项指标均有显著改善:男性= 5.23±1.44 cm (p <0.05)，女性= 1.45±0.87 cm (p <0.05)，但两组患者的各项指标均有可靠差异(p < 0.01)。结论。已开展的研究表明，在下背痛患者的综合治疗中进行电泥浆程序对腰椎节段运动活动的恢复以及患者的心理情绪状态有积极影响。在这种情况下，女性更积极地减少疼痛和增加运动活动，但在心理测试中变化的指标不太显著。
{"title":"Гальваногрязелечение в реабилитации пациентов с болями в нижней части спины","authors":"Елена Владимировна Филатова, Х. М. Малаев","doi":"10.17709/2409-2231-2018-5-1-8","DOIUrl":"https://doi.org/10.17709/2409-2231-2018-5-1-8","url":null,"abstract":"Purpose. Evaluati on of the effectiveness of complex restorati ve treatment with the inclusion of galvanic mud procedures in patients with pain in the lower back. Patients and methods. There were 30 patients (18 men and 12 women) with a diagnosis: lumbulgia or lumboeishalgia under observation. Patients underwent a course of rehabilitation on the basis of the Republican Hospital of Rehabilitation, Makhachkala. Against the background of standard therapy, galvanic mud procedures were included in the therapy. The effectiveness of the treatment was assessed by the control of pain assessment according to the VAS scale, the body mass index, the psychoemoti onal state of the HAM test, the tests of Schober and Thomayer were carried out. Results. After the complex treatment in patients, clinical and functional indices of the state of the neuromuscular apparatus Were noted, varying depending on gender. The results of the study showed that the intensity of the pain syndrome according to the VAS score in the compared groups before the rehabilitation differed significantly (5.4 ± 0.1 points in men and 6.16 ± 0.3 in women, (p <0.05), after completion of the course of treatment, the VAS score decreased statistically in both groups: in men 2.0 ± 0.4 points and in women 1.8 ± 0.1 points (p <0.05), but between groups of significant differences in the quantitative assessment of pain the syndrome was not revealed. In determining the mobility of the lumbar spine, the results of the Schober test with lumbargia as in men, and women were unreliably reduced, after treatment restored within the norm: in men before treatment, 3.46 ± 1.47 cm, after 5.3 ± 0.73 cm (p < 0.05), in women before treatment 3.95 ± 0.5 cm, after 5.35 ± 0.55 cm (p < 0.05).The analysis of the dynamics of the test results of Tomayer revealed unreliably significant differences before treatment in men = 24.8 ± 2.4 cm, in women = 21,6 ± 6,2 cm. After the course of treatment in both groups there was a significant improvement in the indices: in men = 5.23 ± 1.44 cm (p <0.05), in women 1.45 ± 0.87 cm (p < 0,05), but at the same time a reliable difference in the indices (p < 0.01). Conclusion. The conducted research has shown that carrying out galvanic mud procedures in a complex of treatment in patients with lower back pain positively influences the restoration of lumbar vertebral segment motor activity, as well as the psychoemotional state of the patient. In this case, women are more actively reduced pain and increased motor activity, but less significant indicators of the change in the psychological test.","PeriodicalId":119961,"journal":{"name":"Research'n Practical Medicine Journal","volume":"494 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133375968","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 : 2018-03-27DOI: 10.17709/2409-2231-2018-5-1-1
Марина Викторовна Макарова, М. Ю. Вальков
Purpose. To compare of the diagnostic accuracy of ultrasonography (US) with magnetic resonance imaging (MRI) as a reference in the assessment of pathological changes of the soft tissues at the X-ray negative stage of knee joint osteoarthritis (OA). Materials and methods. Nineteen patients with X-ray negative stage of knee OA diagnosed in 2015 underwent US and MRI of the knee joints. We estimated the sensitivity and specificity, positive and negative predictive values for pathological changes in 7 distinct anatomical areas on US comparing to MRI. Results. There were no false positive results. The findings of US and MRI coincided for the presence of an excess amount of free fluid in the joint cavity and suprapatellar bursa synovitis and the presence of Baker’s cyst, 15 (79%) and 4 (21%) patients, respectively. More o en, false-negative results on US have been seen in assessing changes in the lateral meniscus and osteophytes: 2 (11%) diagnosed cases vs 15 (79%) for MRI, respectively. The degenerative changes in the medial meniscus were found in 10 (52.6%) on US compared to 15 (79%) for MRI, respectively. Method of US showed the low sensitivity in the detection of early pathological changes of the knee ligaments: sensitivity and predictive value of negative results accounted for the cruciate were 47% and 18%, for collateral ones only 24% and 13%, respectively. Conclusion. Ultrasound examination is highly effective in the diagnosis of synovitis, free fluid in the joint cavity and suprapatellar bursa and Baker’s cysts in patients with X-ray negative stage of knee OA. It helps to identify the group of patients with the highest risk of progression of OA. The method of ultrasound is significantly inferior to MRI in the diagnosis of early degenerative changes in ligaments, the menisci and cartilage of the joint.
{"title":"СРАВНЕНИЕ ДИАГНОСТИЧЕСКОЙ ТОЧНОСТИ МАГНИТНОРЕЗОНАНСНОЙ ТОМОГРАФИИ И УЛЬТРАЗВУКОВОЙ ДИАГНОСТИКИ ПРИ ИССЛЕДОВАНИИ КОЛЕННЫХ СУСТАВОВ С РЕНТГЕНОЛОГИЧЕСКИ НУЛЕВОЙ СТАДИЕЙ ГОНАРТРИТА","authors":"Марина Викторовна Макарова, М. Ю. Вальков","doi":"10.17709/2409-2231-2018-5-1-1","DOIUrl":"https://doi.org/10.17709/2409-2231-2018-5-1-1","url":null,"abstract":"Purpose. To compare of the diagnostic accuracy of ultrasonography (US) with magnetic resonance imaging (MRI) as a reference in the assessment of pathological changes of the soft tissues at the X-ray negative stage of knee joint osteoarthritis (OA). Materials and methods. Nineteen patients with X-ray negative stage of knee OA diagnosed in 2015 underwent US and MRI of the knee joints. We estimated the sensitivity and specificity, positive and negative predictive values for pathological changes in 7 distinct anatomical areas on US comparing to MRI. Results. There were no false positive results. The findings of US and MRI coincided for the presence of an excess amount of free fluid in the joint cavity and suprapatellar bursa synovitis and the presence of Baker’s cyst, 15 (79%) and 4 (21%) patients, respectively. More o en, false-negative results on US have been seen in assessing changes in the lateral meniscus and osteophytes: 2 (11%) diagnosed cases vs 15 (79%) for MRI, respectively. The degenerative changes in the medial meniscus were found in 10 (52.6%) on US compared to 15 (79%) for MRI, respectively. Method of US showed the low sensitivity in the detection of early pathological changes of the knee ligaments: sensitivity and predictive value of negative results accounted for the cruciate were 47% and 18%, for collateral ones only 24% and 13%, respectively. Conclusion. Ultrasound examination is highly effective in the diagnosis of synovitis, free fluid in the joint cavity and suprapatellar bursa and Baker’s cysts in patients with X-ray negative stage of knee OA. It helps to identify the group of patients with the highest risk of progression of OA. The method of ultrasound is significantly inferior to MRI in the diagnosis of early degenerative changes in ligaments, the menisci and cartilage of the joint.","PeriodicalId":119961,"journal":{"name":"Research'n Practical Medicine Journal","volume":"97 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123747718","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 : 2018-03-27DOI: 10.17709/2409-2231-2018-5-1-2
А. А. Камалов, А. М. Тахирзаде
Purpose . Evaluation of the effectiveness and safety of various pharmacotherapy options in patients with erectile dysfunction (ED) in combination with benign prostatic hyperplasia (BPH). Materials and methods. In 127 men with BPH and ED, pharmacotherapy was performed for 3–12 months. Inclusion criteria: IPSS ≥8 points, IIEF-5 ≤21 points, prostate volume ≤40 cm 3 , prostatic specific antigen (PSA) level <1.5 ng/ml. In patients who are interested in improving erectile function, the following treatment options have been performed: monotherapy with tamsulosin 0.4 mg daily (n = 30), sildenafil monotherapy 25 mg daily (n = 31), tamsulosin 0.4 mg daily and sildenafil 25 mg daily (n = 34). Results. With combined therapy, statistically significant and most pronounced improvement occurred at all time points for all 5 parameters: IPSS, QoL, IIEF-5, maximum urination rate (Q max ), residual urine volume. Monotherapy with α1-adrenoblocker at all times led to a significant improvement in 4 parameters (IPSS, QoL, Q max , residual urine volume), but had no effect on erectile function. Monotherapy with a phosphodiesterase type 5 inhibitor (PDE-5) improved IIEF-5 from the very beginning, and the remaining parameters (IPSS, QoL, Q max , residual urine volume) after 6 months. Conclusions. The combination of α1-adrenoblocker and PDE-5 inhibitor can be considered as an optimal treatment option in patients with LUTS and ED with prostate volume <40 cm 3 and PSA level <1.5 ng/ml.
{"title":"ФАРМАКОТЕРАПИЯ У ПАЦИЕНТОВ С ЭРЕКТИЛЬНОЙ ДИСФУНКЦИЕЙ И ДОБРОКАЧЕСТВЕННОЙ ГИПЕРПЛАЗИЕЙ ПРЕДСТАТЕЛЬНОЙ ЖЕЛЕЗЫ ПРИ ОТСУТСТВИИ РИСКА ПРОГРЕССИРОВАНИЯ ЗАБОЛЕВАНИЯ","authors":"А. А. Камалов, А. М. Тахирзаде","doi":"10.17709/2409-2231-2018-5-1-2","DOIUrl":"https://doi.org/10.17709/2409-2231-2018-5-1-2","url":null,"abstract":"Purpose . Evaluation of the effectiveness and safety of various pharmacotherapy options in patients with erectile dysfunction (ED) in combination with benign prostatic hyperplasia (BPH). Materials and methods. In 127 men with BPH and ED, pharmacotherapy was performed for 3–12 months. Inclusion criteria: IPSS ≥8 points, IIEF-5 ≤21 points, prostate volume ≤40 cm 3 , prostatic specific antigen (PSA) level <1.5 ng/ml. In patients who are interested in improving erectile function, the following treatment options have been performed: monotherapy with tamsulosin 0.4 mg daily (n = 30), sildenafil monotherapy 25 mg daily (n = 31), tamsulosin 0.4 mg daily and sildenafil 25 mg daily (n = 34). Results. With combined therapy, statistically significant and most pronounced improvement occurred at all time points for all 5 parameters: IPSS, QoL, IIEF-5, maximum urination rate (Q max ), residual urine volume. Monotherapy with α1-adrenoblocker at all times led to a significant improvement in 4 parameters (IPSS, QoL, Q max , residual urine volume), but had no effect on erectile function. Monotherapy with a phosphodiesterase type 5 inhibitor (PDE-5) improved IIEF-5 from the very beginning, and the remaining parameters (IPSS, QoL, Q max , residual urine volume) after 6 months. Conclusions. The combination of α1-adrenoblocker and PDE-5 inhibitor can be considered as an optimal treatment option in patients with LUTS and ED with prostate volume <40 cm 3 and PSA level <1.5 ng/ml.","PeriodicalId":119961,"journal":{"name":"Research'n Practical Medicine Journal","volume":"34 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116178912","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 : 2017-12-14DOI: 10.17709/2409-2231-2017-4-4-17
Е. В. Песенникова, О. В. Гриднев, С. С. Кучиц
Purpose. To consider the relationship between the concepts of “medical service” and “medical care” in the work of public medical institutions, based on the analysis of normative legal documents of the modern period. Materials and methods. In the course of the research, more than 18 legal and regulatory documents that were published during the period from 1990 to 2017 were analyzed, an analysis of judicial practice and related literature sources (periodicals) was carried out. Results. The analysis made it possible to distinguish the stages in the development of the organizational and legal framework for the provision of paid medical services in the Russian Federation and the dynamics of the relationship between the terms “medical care” and “medical service”. It was revealed that the concept of “medical services” appeared much later and was associated with the development of paid medical services and the need to establish legal aspects of health care. The provision of medical assistance is regulated mainly by public law, and the provision of medical services is governed by private law. The term “medical care” is broader than the “medical service” from the standpoint of the social aspect. At the same time, the concept of “medical service” can be considered more widely than medical care in cases when it is not only about measures aimed at treating the patient, but also about providing additional services to the patient in the process of receiving medical care. Conclusion. Thus, we concluded that the categories of medical care and medical services should not be identified, but also not completely different concepts, but rather enter into a partial intersection relationship. The need to distinguish between the concepts of “medical care” and “medical service” is dictated not only by the category relations or opinion of the population and the medical community, but also by the need for legal support for the process of providing paid medical services with state-owned establishments.
{"title":"МЕДИЦИНСКИЕ УСЛУГИ ИЛИ МЕДИЦИНСКАЯ ПОМОЩЬ – АКТУАЛЬНЫЙ ВОПРОС ДЛЯ ГОСУДАРСТВЕННЫХ УЧРЕЖДЕНИЙ ЗДРАВООХРАНЕНИЯ","authors":"Е. В. Песенникова, О. В. Гриднев, С. С. Кучиц","doi":"10.17709/2409-2231-2017-4-4-17","DOIUrl":"https://doi.org/10.17709/2409-2231-2017-4-4-17","url":null,"abstract":"Purpose. To consider the relationship between the concepts of “medical service” and “medical care” in the work of public medical institutions, based on the analysis of normative legal documents of the modern period. Materials and methods. In the course of the research, more than 18 legal and regulatory documents that were published during the period from 1990 to 2017 were analyzed, an analysis of judicial practice and related literature sources (periodicals) was carried out. Results. The analysis made it possible to distinguish the stages in the development of the organizational and legal framework for the provision of paid medical services in the Russian Federation and the dynamics of the relationship between the terms “medical care” and “medical service”. It was revealed that the concept of “medical services” appeared much later and was associated with the development of paid medical services and the need to establish legal aspects of health care. The provision of medical assistance is regulated mainly by public law, and the provision of medical services is governed by private law. The term “medical care” is broader than the “medical service” from the standpoint of the social aspect. At the same time, the concept of “medical service” can be considered more widely than medical care in cases when it is not only about measures aimed at treating the patient, but also about providing additional services to the patient in the process of receiving medical care. Conclusion. Thus, we concluded that the categories of medical care and medical services should not be identified, but also not completely different concepts, but rather enter into a partial intersection relationship. The need to distinguish between the concepts of “medical care” and “medical service” is dictated not only by the category relations or opinion of the population and the medical community, but also by the need for legal support for the process of providing paid medical services with state-owned establishments.","PeriodicalId":119961,"journal":{"name":"Research'n Practical Medicine Journal","volume":"41 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132652856","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 : 2017-12-13DOI: 10.17709/2409-2231-2017-4-4-9
Алексей Александрович Костин, А. Г. Мурадян, А. О. Толкачев, С. В. Попов
Patients with castration-refractory prostate cancer (PC) are a complicated group of patients for treatment. At the time of diagnosis, 85% of patients have a localized tumor process, however, in 40% of patients, generalization of the tumor process is observed. The most common localization of prostate cancer metastasis is the skeletal bone, which affects up to 90% of cases. At the same time, taking into account the increase in the morbidity of prostate cancer pathology, it dictates the need to search for new, more effective methods of treatment for this group of patients. Currently, there are six effective methods of treatment of metastatic castration-refractory prostate cancer (mCRPC): effects on androgenic stimulation (abiraterone acetate, enzalutamide); chemotherapy with drugs from the taxane group (docetaxel, cabazitaxel); immunotherapy (Sipuleucel-T), radionuclide therapy with Radium-223 chloride (Ksofigo®). 223Ra is a tropic to bone tissue alpha emitter, which, due to its high linear energy transfer and short transmission distance, provides an enhanced localized antitumor effect due to higher energy delivery. The article presents a literature review highlighting the mechanisms of development of castration refractoriness, the characteristic and efficacy of Radium-223 in the treatment of patients with metastatic castration-refractory prostate cancer.
{"title":"РАДИЙ-223. МЕСТО В ЛЕЧЕНИИ МЕТАСТАТИЧЕСКОГО КАСТРАЦИОННО-РЕФРАКТЕРНОГО РАКА ПРЕДСТАТЕЛЬНОЙ ЖЕЛЕЗЫ","authors":"Алексей Александрович Костин, А. Г. Мурадян, А. О. Толкачев, С. В. Попов","doi":"10.17709/2409-2231-2017-4-4-9","DOIUrl":"https://doi.org/10.17709/2409-2231-2017-4-4-9","url":null,"abstract":"Patients with castration-refractory prostate cancer (PC) are a complicated group of patients for treatment. At the time of diagnosis, 85% of patients have a localized tumor process, however, in 40% of patients, generalization of the tumor process is observed. The most common localization of prostate cancer metastasis is the skeletal bone, which affects up to 90% of cases. At the same time, taking into account the increase in the morbidity of prostate cancer pathology, it dictates the need to search for new, more effective methods of treatment for this group of patients. Currently, there are six effective methods of treatment of metastatic castration-refractory prostate cancer (mCRPC): effects on androgenic stimulation (abiraterone acetate, enzalutamide); chemotherapy with drugs from the taxane group (docetaxel, cabazitaxel); immunotherapy (Sipuleucel-T), radionuclide therapy with Radium-223 chloride (Ksofigo®). 223Ra is a tropic to bone tissue alpha emitter, which, due to its high linear energy transfer and short transmission distance, provides an enhanced localized antitumor effect due to higher energy delivery. The article presents a literature review highlighting the mechanisms of development of castration refractoriness, the characteristic and efficacy of Radium-223 in the treatment of patients with metastatic castration-refractory prostate cancer.","PeriodicalId":119961,"journal":{"name":"Research'n Practical Medicine Journal","volume":"54 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127692148","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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