Pub Date : 2017-12-13DOI: 10.17709/2409-2231-2017-4-4-7
Виктор Анатольевич Лазаренко, Андрей Евгеньевич Антонов
Purpose. To develop an artificial neural network for diagnosing and predicting the development of cholecystitis based on an analysis of data on risk factors, and to explore the possibilities of its application in real clinical practice. Materials and methods. The collection of materials was held in at the hospitals of the city of Kursk and included a survey of 488 patients with hepatopancreatoduodenal diseases. 203 patients were suffering from cholecystitis, in 285 patients the diagnosis of cholecystitis was excluded. Analysis of risk factors’ data (such as sex, age, bad habits, profession, family relationships, etc.) was carried out using an internally developed artificial neural network (multilayer perceptron with hyperbolic tangent as the activation function). The computer program “System of Intellectual Analysis and Diagnosis of Diseases” was registered in accordance with established procedure (Certificate No. 2017613090). Results. The use of neural network analysis of data on risk factors in comparison with the processing of information that forms a clinical picture allows the diagnosis of a potential disease with cholecystitis before the onset of symptoms. The training of the artificial neural network with a quantitative output coding the age of probable hospitalization made it possible to generate an array of values, signifficantly (α ≤ 0.001) not differing from the empirical data. The difference between the mean calculated and mean empirical values was 0.45 for the training set and 1.75 for the clinical approbation group. The mean absolute error was within the range of 1.87–2.07 years. Conclusion. 1. The proposed new approach to the diagnosis and prognosis of cholecystitis has demonstrated its effectiveness, which is confirmed in clinical approbation by the levels of sensitivity (94.44%, m = 2.26) and specificity (80.6%, m = 3.9). 2. The error in predicting the age of probable hospitalization of patients with cholecystitis did not exceed 2.29 and 2.38 years for p = 0.95 and p = 0.99, respectively.
{"title":"Диагностика и прогнозирование вероятности возникновения холецистита на основе нейросетевого анализа факторов риска","authors":"Виктор Анатольевич Лазаренко, Андрей Евгеньевич Антонов","doi":"10.17709/2409-2231-2017-4-4-7","DOIUrl":"https://doi.org/10.17709/2409-2231-2017-4-4-7","url":null,"abstract":"Purpose. To develop an artificial neural network for diagnosing and predicting the development of cholecystitis based on an analysis of data on risk factors, and to explore the possibilities of its application in real clinical practice. Materials and methods. The collection of materials was held in at the hospitals of the city of Kursk and included a survey of 488 patients with hepatopancreatoduodenal diseases. 203 patients were suffering from cholecystitis, in 285 patients the diagnosis of cholecystitis was excluded. Analysis of risk factors’ data (such as sex, age, bad habits, profession, family relationships, etc.) was carried out using an internally developed artificial neural network (multilayer perceptron with hyperbolic tangent as the activation function). The computer program “System of Intellectual Analysis and Diagnosis of Diseases” was registered in accordance with established procedure (Certificate No. 2017613090). Results. The use of neural network analysis of data on risk factors in comparison with the processing of information that forms a clinical picture allows the diagnosis of a potential disease with cholecystitis before the onset of symptoms. The training of the artificial neural network with a quantitative output coding the age of probable hospitalization made it possible to generate an array of values, signifficantly (α ≤ 0.001) not differing from the empirical data. The difference between the mean calculated and mean empirical values was 0.45 for the training set and 1.75 for the clinical approbation group. The mean absolute error was within the range of 1.87–2.07 years. Conclusion. 1. The proposed new approach to the diagnosis and prognosis of cholecystitis has demonstrated its effectiveness, which is confirmed in clinical approbation by the levels of sensitivity (94.44%, m = 2.26) and specificity (80.6%, m = 3.9). 2. The error in predicting the age of probable hospitalization of patients with cholecystitis did not exceed 2.29 and 2.38 years for p = 0.95 and p = 0.99, respectively.","PeriodicalId":119961,"journal":{"name":"Research'n Practical Medicine Journal","volume":"8 5 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":"123733162","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: 10.17709/2409-2231-2017-4-4-14
А. Т. Асратов, А. С. Калпинский, И. А. Тараки, Ю. В. Самсонов, А. А. Костин
This article describes a rare clinical case of prostate cancer with a high baseline PSA level of 1407 hg/ml. In the course of diagnosis, hormonal and surgical treatment there was a successive dynamics of PSA decline: 07.08.2015–1407 ng/ ml, 14.09.2015–43,61ng/ml; 17.11.2015–0,326 ng/ml; 13.02.2016 (end of hormone therapy) — 0,084 ng/ml. After the operation of radical prostatectomy with enlarged lymphadenectomy, on 20.04.2016 (with prolonged hormone therapy up to 9 monthes) gradual decrease of PSA level continued: 05.05.2016–0,008 ng/ml; 17.06.2016–0,008 ng/ml; 08.09.2016–0,039 ng/ml; 30.11.2016–0,002 ng/ml; 07.09.2017 (total PSA) — 0,008 ng/ml. In parallel, there was a consistent improvement in the clinical picture, up to the MRI data of 19.10.2017, when there were no significant neoplastic changes at the level of the study (in the projection of the prostatic bed).
本文描述了一例罕见的前列腺癌临床病例，其PSA基线水平高达1407 hg/ml。在诊断、激素治疗和手术治疗过程中，PSA呈连续下降趋势:07.08.2015-1407 ng/ml, 14.09.2015-43,61ng/ml;17.11.2015-0,326 ng / ml;2016年2月13日(激素治疗结束)- 0.084 ng/ml。前列腺根治性淋巴结肿大切除术后，2016年4月20日(延长激素治疗至9个月)PSA水平继续逐渐下降:05.05.2016-0,008 ng/ml;17.06.2016-0,008 ng / ml;08.09.2016-0,039 ng / ml;30.11.2016-0,002 ng / ml;07.09.2017(总PSA) - 0,008 ng/ml。与此同时，截至2017年10月19日的MRI数据，临床表现也有持续改善，当时在研究水平(前列腺床投影)没有明显的肿瘤改变。
{"title":"Рак предстательной железы с высоким исходным уровнем простатспецифического антигена после комбинированного лечения","authors":"А. Т. Асратов, А. С. Калпинский, И. А. Тараки, Ю. В. Самсонов, А. А. Костин","doi":"10.17709/2409-2231-2017-4-4-14","DOIUrl":"https://doi.org/10.17709/2409-2231-2017-4-4-14","url":null,"abstract":"This article describes a rare clinical case of prostate cancer with a high baseline PSA level of 1407 hg/ml. In the course of diagnosis, hormonal and surgical treatment there was a successive dynamics of PSA decline: 07.08.2015–1407 ng/ ml, 14.09.2015–43,61ng/ml; 17.11.2015–0,326 ng/ml; 13.02.2016 (end of hormone therapy) — 0,084 ng/ml. After the operation of radical prostatectomy with enlarged lymphadenectomy, on 20.04.2016 (with prolonged hormone therapy up to 9 monthes) gradual decrease of PSA level continued: 05.05.2016–0,008 ng/ml; 17.06.2016–0,008 ng/ml; 08.09.2016–0,039 ng/ml; 30.11.2016–0,002 ng/ml; 07.09.2017 (total PSA) — 0,008 ng/ml. In parallel, there was a consistent improvement in the clinical picture, up to the MRI data of 19.10.2017, when there were no significant neoplastic changes at the level of the study (in the projection of the prostatic bed).","PeriodicalId":119961,"journal":{"name":"Research'n Practical Medicine Journal","volume":"236 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":"133902249","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: 10.17709/2409-2231-2017-4-4-15
Д. В. Сидоров, М. В. Ложкин, Л. О. Петров, А. Г. Исаева
A gold standard for the treatment of metastases of colorectal cancer in the liver is combined treatment with postoperative or perioperative chemotherapy. Despite the improvement of antitumor drugs, the main condition for the successful treatment of patients with metastatic colorectal cancer is the operation in a radical volume, implying a macroscopic and microscopic absence of a residual tumor. The main contraindications to anatomic resections of the liver include a marked decrease in liver function, insufficient volume of the remaining parenchyma of the liver, and for a long time, bilobar liver damage was considered, which excludes the possibility of simultaneous removal of all foci. The traditional variant of the surgical solution of the problem of bilobar metastatic liver injury is the implementation of two-stage anatomical resections. It has been proved that the reduction of liver and FLR functional reserves of less than 20% at normal and 40% in the case of compromised liver parenchyma, the implementation of surgical interventions is associated with a high risk of hepatic insufficiency. One of the promising ways to overcome this obstacle is to perform various modifications of ALPPS liver resections. In the present work, we present a clinical case of performing a two-stage liver resection according to the type of ALPPS in a patient with metastatic colorectal liver cancer who had previously undergone PVL with unrealized vicar hypertrophy. The described observation testifies to the justification of performing repeated liver resections in patients with metastatic colorectal cancer and demonstrates the possibilities of ALPPS technique.
{"title":"«СПАСИТЕЛЬНАЯ» ДВУХЭТАПНАЯ РЕЗЕКЦИЯ ПЕЧЕНИ ПО ТИПУ ALPPS","authors":"Д. В. Сидоров, М. В. Ложкин, Л. О. Петров, А. Г. Исаева","doi":"10.17709/2409-2231-2017-4-4-15","DOIUrl":"https://doi.org/10.17709/2409-2231-2017-4-4-15","url":null,"abstract":"A gold standard for the treatment of metastases of colorectal cancer in the liver is combined treatment with postoperative or perioperative chemotherapy. Despite the improvement of antitumor drugs, the main condition for the successful treatment of patients with metastatic colorectal cancer is the operation in a radical volume, implying a macroscopic and microscopic absence of a residual tumor. The main contraindications to anatomic resections of the liver include a marked decrease in liver function, insufficient volume of the remaining parenchyma of the liver, and for a long time, bilobar liver damage was considered, which excludes the possibility of simultaneous removal of all foci. The traditional variant of the surgical solution of the problem of bilobar metastatic liver injury is the implementation of two-stage anatomical resections. It has been proved that the reduction of liver and FLR functional reserves of less than 20% at normal and 40% in the case of compromised liver parenchyma, the implementation of surgical interventions is associated with a high risk of hepatic insufficiency. One of the promising ways to overcome this obstacle is to perform various modifications of ALPPS liver resections. In the present work, we present a clinical case of performing a two-stage liver resection according to the type of ALPPS in a patient with metastatic colorectal liver cancer who had previously undergone PVL with unrealized vicar hypertrophy. The described observation testifies to the justification of performing repeated liver resections in patients with metastatic colorectal cancer and demonstrates the possibilities of ALPPS technique.","PeriodicalId":119961,"journal":{"name":"Research'n Practical Medicine Journal","volume":"16 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":"129012747","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: 10.17709/2409-2231-2017-4-4-6
Елена Владимировна Филатова, О. А. Булах, Е. В. Полковникова, Н. М. Привалова, Х. М. Малаев
Purpose. A comparative analysis of the efficiency of different procedures of exercise therapy is carried out: hydrokinesitherapy and therapeutic gymnastics with the use of exercise on an unstable support (stabiloplatform) depending on the sex of patients. Materials and methods. Under our observation there were 72 patients undergoing rehabilitation on the basis of SBOH CC No. 201 DHM Zelenograd, an equal number of women and men and 36 people with back pain of vertebrogenic genesis. All patients repeatedly received standard medical therapy, physiotherapy (magnetotherapy, laser therapy) and a massage therapist. At the end of the physiotherapy treatment was assigned a set of physical therapy: group 1 included men and women, 36 — classes on stabiloplatform, a course of 10 treatments; Group 2 consisted of men and women, 36 — hydrokinesitherapy in the pool, a course of 10 treatments. The effectiveness of therapy was assessed: on a scale (VAS, mm), Schober’s test, test Tomiura test Ott summary index of health status (Oswestry questionnaire). Results. The intensity of the pain syndrome according to the VAS score in the compared groups before the rehabilitation did not differ (on average 5.8 in men and 6.15 in women), after the completion of the course of treatment it statistically significantly decreased in both groups. Significantly, the best indicators were determined in the group of men when practicing on the stable platform (1.4 vs. 3.8 in women), and in women with physical therapy in the pool (1.6 vs. 2.9 in men). Effectiveness of changes in the test values of the mobility assessment of different parts of the spine, depending on the method of rehabilitation performed: men were more efficiently restored on the stabiloblatform, women in the pool classes. The indicators of the Tomayer test (inclination forward) significantly changed in both groups: in men on the stabiloplatform from 28.3 ± 0.05 to 13.8 ± 0.1 (p <0.05); for those engaged in the basin from 28.5 ± 0.2 to 16.2 ± 0.5 (p < 0.05). Women in the stable platform — from 28.5 ± 0.05 to 16.2 ± 0.03 (p < 0.05); for those engaged in the basin from 28.5 ± 0.1 to 12.7 ± 0.2 (p < 0.05). Before treatment, the overall health index (according to the results of the Oswestry questionnaire) differed significantly in both groups. After the end of treatment, there was a significant decrease in the indices in all the patients examined. At the same time, in men, the indices were significantly better when exercising on the stabiloplatform (index decrease from 39 ± 0.2 to 12 ± 0.1, p < 0.01), and in women — in the second group with hydrokinetic therapy (index decrease from 36 ± 0.6 to 12 ± 0.2, p < 0.05). Conclusion. The results of the study of the psychoemotional state, the vertebroneurological status and the assessment of the pain of patients with dorsopathies suggest that men and women respond differently to rehabilitation methods, in particular: static and dynamic methods of exercise therapy, which, apparently,
{"title":"ЛФК на нестабильной опоре и гидрокинезотерапия в реабилитации пациентов с болями в спине","authors":"Елена Владимировна Филатова, О. А. Булах, Е. В. Полковникова, Н. М. Привалова, Х. М. Малаев","doi":"10.17709/2409-2231-2017-4-4-6","DOIUrl":"https://doi.org/10.17709/2409-2231-2017-4-4-6","url":null,"abstract":"Purpose. A comparative analysis of the efficiency of different procedures of exercise therapy is carried out: hydrokinesitherapy and therapeutic gymnastics with the use of exercise on an unstable support (stabiloplatform) depending on the sex of patients. Materials and methods. Under our observation there were 72 patients undergoing rehabilitation on the basis of SBOH CC No. 201 DHM Zelenograd, an equal number of women and men and 36 people with back pain of vertebrogenic genesis. All patients repeatedly received standard medical therapy, physiotherapy (magnetotherapy, laser therapy) and a massage therapist. At the end of the physiotherapy treatment was assigned a set of physical therapy: group 1 included men and women, 36 — classes on stabiloplatform, a course of 10 treatments; Group 2 consisted of men and women, 36 — hydrokinesitherapy in the pool, a course of 10 treatments. The effectiveness of therapy was assessed: on a scale (VAS, mm), Schober’s test, test Tomiura test Ott summary index of health status (Oswestry questionnaire). Results. The intensity of the pain syndrome according to the VAS score in the compared groups before the rehabilitation did not differ (on average 5.8 in men and 6.15 in women), after the completion of the course of treatment it statistically significantly decreased in both groups. Significantly, the best indicators were determined in the group of men when practicing on the stable platform (1.4 vs. 3.8 in women), and in women with physical therapy in the pool (1.6 vs. 2.9 in men). Effectiveness of changes in the test values of the mobility assessment of different parts of the spine, depending on the method of rehabilitation performed: men were more efficiently restored on the stabiloblatform, women in the pool classes. The indicators of the Tomayer test (inclination forward) significantly changed in both groups: in men on the stabiloplatform from 28.3 ± 0.05 to 13.8 ± 0.1 (p <0.05); for those engaged in the basin from 28.5 ± 0.2 to 16.2 ± 0.5 (p < 0.05). Women in the stable platform — from 28.5 ± 0.05 to 16.2 ± 0.03 (p < 0.05); for those engaged in the basin from 28.5 ± 0.1 to 12.7 ± 0.2 (p < 0.05). Before treatment, the overall health index (according to the results of the Oswestry questionnaire) differed significantly in both groups. After the end of treatment, there was a significant decrease in the indices in all the patients examined. At the same time, in men, the indices were significantly better when exercising on the stabiloplatform (index decrease from 39 ± 0.2 to 12 ± 0.1, p < 0.01), and in women — in the second group with hydrokinetic therapy (index decrease from 36 ± 0.6 to 12 ± 0.2, p < 0.05). Conclusion. The results of the study of the psychoemotional state, the vertebroneurological status and the assessment of the pain of patients with dorsopathies suggest that men and women respond differently to rehabilitation methods, in particular: static and dynamic methods of exercise therapy, which, apparently, ","PeriodicalId":119961,"journal":{"name":"Research'n Practical Medicine Journal","volume":"81 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":"128435314","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: 10.17709/2409-2231-2017-4-4-8
С. А. Родин, Дарья Васильевна Мальцева
Extracellular matrix (ECM) proteins are a major component of the tumor stroma. Laminins emerge as one of the main families of ECM proteins with signaling properties. Apart from the structural function, laminins and products of their degradation affect survival and differentiation of cancer cells, motility of cancer and stromal cells, angiogenesis, invasion into distant organs, and other aspects of cancer development. Here, we discus expression of laminins in colorectal cancer (CRC), studying of laminin functions in in vitro and in vivo models of CRC, and using laminins as prognostic markers of CRC. Recently, we have reported a new approach to assessing prognostic power using classifiers constructed from sets of laminin genes. The method allows for accurate prognosis of CRC and provides additional information that may suggest possible molecular mechanisms of laminin function in CRC progression.
{"title":"Ламинины в колоректальном раке: экспрессия, функции, прогностическая значимость и молекулярный механизм действия","authors":"С. А. Родин, Дарья Васильевна Мальцева","doi":"10.17709/2409-2231-2017-4-4-8","DOIUrl":"https://doi.org/10.17709/2409-2231-2017-4-4-8","url":null,"abstract":"Extracellular matrix (ECM) proteins are a major component of the tumor stroma. Laminins emerge as one of the main families of ECM proteins with signaling properties. Apart from the structural function, laminins and products of their degradation affect survival and differentiation of cancer cells, motility of cancer and stromal cells, angiogenesis, invasion into distant organs, and other aspects of cancer development. Here, we discus expression of laminins in colorectal cancer (CRC), studying of laminin functions in in vitro and in vivo models of CRC, and using laminins as prognostic markers of CRC. Recently, we have reported a new approach to assessing prognostic power using classifiers constructed from sets of laminin genes. The method allows for accurate prognosis of CRC and provides additional information that may suggest possible molecular mechanisms of laminin function in CRC progression.","PeriodicalId":119961,"journal":{"name":"Research'n Practical Medicine Journal","volume":"21 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":"125231963","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: 10.17709/2409-2231-2017-4-4-10
А. М. Меджидова, А. Э. Эседова
The problem of infertility in women with internal genital endometriosis is one of the main reasons among the reasons for this infertility problem. The review presents modern literature data of recent years, in which endometriosis is considered as one of the main causes of infertility. Despite the existing methods of diagnosis and treatment of infertility associated with endometriosis, today there is no single algorithm for conducting such a category of patients. The need to define survey tactics is an important component in the effectiveness of treatment. When developing a plan for managing patients with infertility associated with endometriosis, the age of the woman, duration of infertility, the presence of pain and the stage of the disease should be taken into account. Treatment of infertility associated with endometriosis includes surgical methods, hormone treatment and the use of ART. According to some authors, the development of adenomyosis occurs during menstruation against the backdrop of regeneration, healing and re-epithelialization of the uterine mucosa. At this point, the introduction of endometrial cells into the “weakened” transition zone, which has structural and functional differences compared to the rest of the myometrium, can occur. The JZ “transition zone” is the region in the inner layer of the myometrium, which has received many definitions: an intermediate zone, an archiometry, an internal myometrium, a subendometric myometrium. This zone is a basal layer of myometrium and consists of longitudinally placed smooth muscle fibers, usually its thickness in women of reproductive age does not exceed 2–8 mm. Many researchers consider mechanical damage to the transition zone as the key pathogenetic link in adenomyosis. The main method of screening and the “gold standard” of primary instrumental diagnostics in gynecology remains transvaginal ultrasound examination of pelvic organs. Magnetic resonance imaging can also be used, the advantage of which in comparison with ultrasound is the possibility of obtaining an image in any plane and the absence of “invisible” zones, has a high resolution. A systematic review and meta-analysis of data obtained with transvaginal ultrasound and MRI in women with histologically confirmed adenomyosis showed a similarly high level of accuracy of diagnosis, but an important advantage of MRI was the standardization of images. However, not always with the deviations of the transitional zone of the uterus revealed with the help of MRI, histologically confirmed adenomyosis is subsequently diagnosed. There is a significant need to develop a common terminology and classification of violations of the transition zone of the myometrium, as well as systematization of ideas about instrumental criteria for diagnosis of adenomyosis.
{"title":"АКТУАЛЬНЫЕ ВОПРОСЫ ДИАГНОСТИКИ И ЛЕЧЕНИЯ БЕСПЛОДИЯ У ЖЕНЩИН С ВНУТРЕННИМ ГЕНИТАЛЬНЫМ ЭНДОМЕТРИОЗОМ","authors":"А. М. Меджидова, А. Э. Эседова","doi":"10.17709/2409-2231-2017-4-4-10","DOIUrl":"https://doi.org/10.17709/2409-2231-2017-4-4-10","url":null,"abstract":"The problem of infertility in women with internal genital endometriosis is one of the main reasons among the reasons for this infertility problem. The review presents modern literature data of recent years, in which endometriosis is considered as one of the main causes of infertility. Despite the existing methods of diagnosis and treatment of infertility associated with endometriosis, today there is no single algorithm for conducting such a category of patients. The need to define survey tactics is an important component in the effectiveness of treatment. When developing a plan for managing patients with infertility associated with endometriosis, the age of the woman, duration of infertility, the presence of pain and the stage of the disease should be taken into account. Treatment of infertility associated with endometriosis includes surgical methods, hormone treatment and the use of ART. According to some authors, the development of adenomyosis occurs during menstruation against the backdrop of regeneration, healing and re-epithelialization of the uterine mucosa. At this point, the introduction of endometrial cells into the “weakened” transition zone, which has structural and functional differences compared to the rest of the myometrium, can occur. The JZ “transition zone” is the region in the inner layer of the myometrium, which has received many definitions: an intermediate zone, an archiometry, an internal myometrium, a subendometric myometrium. This zone is a basal layer of myometrium and consists of longitudinally placed smooth muscle fibers, usually its thickness in women of reproductive age does not exceed 2–8 mm. Many researchers consider mechanical damage to the transition zone as the key pathogenetic link in adenomyosis. The main method of screening and the “gold standard” of primary instrumental diagnostics in gynecology remains transvaginal ultrasound examination of pelvic organs. Magnetic resonance imaging can also be used, the advantage of which in comparison with ultrasound is the possibility of obtaining an image in any plane and the absence of “invisible” zones, has a high resolution. A systematic review and meta-analysis of data obtained with transvaginal ultrasound and MRI in women with histologically confirmed adenomyosis showed a similarly high level of accuracy of diagnosis, but an important advantage of MRI was the standardization of images. However, not always with the deviations of the transitional zone of the uterus revealed with the help of MRI, histologically confirmed adenomyosis is subsequently diagnosed. There is a significant need to develop a common terminology and classification of violations of the transition zone of the myometrium, as well as systematization of ideas about instrumental criteria for diagnosis of adenomyosis.","PeriodicalId":119961,"journal":{"name":"Research'n Practical Medicine Journal","volume":"19 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":"125290314","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: 10.17709/2409-2231-2017-4-4-13
Д. Сидоров, С.А. Степанов, М. A. Ложкин, Л. Петров, Л. А. Митина, О. A. Гуц, А. Исаева
For today it is difficult to imagine medical practice without modern visualization methods of instrumental diagnostics. At the same time, according to the estimates of the World Health Organization, two-thirds of the world population is deprived of such opportunities. Ultrasound diagnostics with intravenous contrasting (CEUS), which requires minimal financial costs and technical equipment, has a great potential to remedy this situation. At present, there is a growing interest in the use of echography with contrast enhancement in order to improve the efficiency of detecting focal pathology and the accuracy of differential diagnosis, incl. in surgical hepatology. Difficulties in planning the surgical tactics in patients with metastatic colorectal liver cancer are well known (discrepancy in the data of preoperative methods of radiation diagnosis about the number and segmental location of foci in the liver, the probability of additional foci). The “gold standard” of the diagnostic evaluation, which combines palpation of the liver and the performance of intraoperative ultrasound (IOUS), is now supplemented by the possibility of contrast enhancement during intraoperative echography. In this article, we present a description of the method of ultrasound diagnostics with intravenous (IV) contrasting, illustrating the possibilities of investigation by clinical cases of intraoperative ultrasound diagnostics with contrast enhancement in patients with metastatic liver cancer. Our impressions about the possibilities of ultrasound with intravenous contrast in the intraoperative diagnosis of tumor foci in patients with metastatic liver cancer we build on this little experience.
{"title":"Первый Российский опыт интраоперационной ультразвуковой навигации с контрастным усилением при выполнении резекций печени по поводу злокачественных опухолей","authors":"Д. Сидоров, С.А. Степанов, М. A. Ложкин, Л. Петров, Л. А. Митина, О. A. Гуц, А. Исаева","doi":"10.17709/2409-2231-2017-4-4-13","DOIUrl":"https://doi.org/10.17709/2409-2231-2017-4-4-13","url":null,"abstract":"For today it is difficult to imagine medical practice without modern visualization methods of instrumental diagnostics. At the same time, according to the estimates of the World Health Organization, two-thirds of the world population is deprived of such opportunities. Ultrasound diagnostics with intravenous contrasting (CEUS), which requires minimal financial costs and technical equipment, has a great potential to remedy this situation. At present, there is a growing interest in the use of echography with contrast enhancement in order to improve the efficiency of detecting focal pathology and the accuracy of differential diagnosis, incl. in surgical hepatology. Difficulties in planning the surgical tactics in patients with metastatic colorectal liver cancer are well known (discrepancy in the data of preoperative methods of radiation diagnosis about the number and segmental location of foci in the liver, the probability of additional foci). The “gold standard” of the diagnostic evaluation, which combines palpation of the liver and the performance of intraoperative ultrasound (IOUS), is now supplemented by the possibility of contrast enhancement during intraoperative echography. In this article, we present a description of the method of ultrasound diagnostics with intravenous (IV) contrasting, illustrating the possibilities of investigation by clinical cases of intraoperative ultrasound diagnostics with contrast enhancement in patients with metastatic liver cancer. Our impressions about the possibilities of ultrasound with intravenous contrast in the intraoperative diagnosis of tumor foci in patients with metastatic liver cancer we build on this little experience.","PeriodicalId":119961,"journal":{"name":"Research'n Practical Medicine Journal","volume":"7 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":"126495046","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 : 2017-12-12DOI: 10.17709/2409-2231-2017-4-4-4
И. П. Дуданов, С. В. Ордынец, И. А. Лукинский, Б. С. Абуазаб, В. В. Ахметов, А. А. Шабонов, О. П. Вербицкий
Purpose. We present the experience of treatment of patients with cerebral vascular accident by the ischemic type, the cause of which was non-atherosclerotic lesion of brachiocephalic arteries. Materials and methods. During 2011–2015 years 4118 patients with acute ischemic stroke were observed. Of these, 589 patients (14.3%) were operated in the acute period of stroke in the period from 4–6 hours to 14 days. The cause of the stroke was various types of pathology of the extracranial divisions of the brachiocephalic arteries (EDBA). Of this number, with atherosclerotic carotid artery stenoses, 336 patients (57.1%) were operated on, with non-atherosclerotic pathology of carotid arteries — 253 patients (42.9%). Of these 253 patients, dissection of the intima of the carotid arteries was detected in 10 (3.9%) patients, aneurysms in the extracranial segment of the ECA and ICA were detected in 14 (5.5%), and 229 (90.6%) revealed various types of tortuosity and kinks carotid arteries and fibrous dysplasia. All patients are operated on. Various types of reconstructions of carotid arteries with a good clinical effect have been performed. There were no lethal outcomes. Concusions. The data obtained in the study confirm the opinion that not only atherosclerotic lesions of the ICA are an indication for surgical treatment at an early date. This stage is an important part of the comprehensive rehabilitation of patients with acute ischemic stroke.
{"title":"ЭКСТРАКРАНИАЛЬНАЯ НЕАТЕРОСКЛЕРОТИЧЕСКАЯ ПАТОЛОГИЯ СОННОЙ АРТЕРИИ В ПРИЧИНАХ РАЗВИТИЯ ОСТРОГО ИШЕМИЧЕСКОГО ИНСУЛЬТА","authors":"И. П. Дуданов, С. В. Ордынец, И. А. Лукинский, Б. С. Абуазаб, В. В. Ахметов, А. А. Шабонов, О. П. Вербицкий","doi":"10.17709/2409-2231-2017-4-4-4","DOIUrl":"https://doi.org/10.17709/2409-2231-2017-4-4-4","url":null,"abstract":"Purpose. We present the experience of treatment of patients with cerebral vascular accident by the ischemic type, the cause of which was non-atherosclerotic lesion of brachiocephalic arteries. Materials and methods. During 2011–2015 years 4118 patients with acute ischemic stroke were observed. Of these, 589 patients (14.3%) were operated in the acute period of stroke in the period from 4–6 hours to 14 days. The cause of the stroke was various types of pathology of the extracranial divisions of the brachiocephalic arteries (EDBA). Of this number, with atherosclerotic carotid artery stenoses, 336 patients (57.1%) were operated on, with non-atherosclerotic pathology of carotid arteries — 253 patients (42.9%). Of these 253 patients, dissection of the intima of the carotid arteries was detected in 10 (3.9%) patients, aneurysms in the extracranial segment of the ECA and ICA were detected in 14 (5.5%), and 229 (90.6%) revealed various types of tortuosity and kinks carotid arteries and fibrous dysplasia. All patients are operated on. Various types of reconstructions of carotid arteries with a good clinical effect have been performed. There were no lethal outcomes. Concusions. The data obtained in the study confirm the opinion that not only atherosclerotic lesions of the ICA are an indication for surgical treatment at an early date. This stage is an important part of the comprehensive rehabilitation of patients with acute ischemic stroke.","PeriodicalId":119961,"journal":{"name":"Research'n Practical Medicine Journal","volume":"87 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122953850","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 : 2017-12-12DOI: 10.17709/2409-2231-2017-4-4-5
А Ю Тихомиров, О. В. Миняева, Татьяна Владимировна Тихомирова
Purpose. To study the effectiveness of various schemes of correction of repolarization disorder syndrome, including with the use of beta-blockers, in young athletes of the initial training group. Materials and methods. At the first stage, 410 children involved in sports sections were examined. The average age of the examined was 12.22 ± 3.11 years. At the second stage, the athletes (boys) of the initial training group were selected from the surveyed contingent, engaged in martial arts. The groups were formed: A – people with violation of myocardial repolarization processes (72 patients, the average age 10,50 ± 0,35 years), the control group – people without changes in an electrocardiogram (33 people, the average age 10.36 ± 0, 62 years old). All underwent an electrocardiographic study at rest and after physical activity on the Innomed HS80GL apparatus with analysis of the main indicators. The vegetative status and the state of adaptation were estimated by Kerdo index and adaptive potential by Baevsky. After the examination, the subgroup A1 (40 people) was prescribed metabolic and antioxidant drugs. Additionally, in the subgroup A2 (32 people), a non-selective beta-blocker was included in the treatment regimen. The course of treatment is 10 days. The analysis of indicators was carried out in 10 days and in a month after the initiation treatment. Statistical processing was carried out in the program Statistica. Results. An earlier disappearance of cardialgia was determined in the subgroup A2 (p < 0.05), whereas in the subgroup A1, 5% of patients had complaints not only at the end of the course, but also a month later after the initiation treatment. The more rapid positive dynamics of the electrocardiographic pattern with a more stable result was observed with the prescription of a beta-blocker. Conclusion. It was proved the advisability of prescribing of beta-blockers in the treatment of beginning athletes with violation of myocardial repolarization against sympathicotonia.
{"title":"ОПЫТ ИСПОЛЬЗОВАНИЯ НЕСЕЛЕКТИВНОГО БЕТА-БЛОКАТОРА В КОМПЛЕКСНОЙ ТЕРАПИИ НАРУШЕНИЙ РЕПОЛЯРИЗАЦИИ У ЮНЫХ СПОРТСМЕНОВ","authors":"А Ю Тихомиров, О. В. Миняева, Татьяна Владимировна Тихомирова","doi":"10.17709/2409-2231-2017-4-4-5","DOIUrl":"https://doi.org/10.17709/2409-2231-2017-4-4-5","url":null,"abstract":"Purpose. To study the effectiveness of various schemes of correction of repolarization disorder syndrome, including with the use of beta-blockers, in young athletes of the initial training group. Materials and methods. At the first stage, 410 children involved in sports sections were examined. The average age of the examined was 12.22 ± 3.11 years. At the second stage, the athletes (boys) of the initial training group were selected from the surveyed contingent, engaged in martial arts. The groups were formed: A – people with violation of myocardial repolarization processes (72 patients, the average age 10,50 ± 0,35 years), the control group – people without changes in an electrocardiogram (33 people, the average age 10.36 ± 0, 62 years old). All underwent an electrocardiographic study at rest and after physical activity on the Innomed HS80GL apparatus with analysis of the main indicators. The vegetative status and the state of adaptation were estimated by Kerdo index and adaptive potential by Baevsky. After the examination, the subgroup A1 (40 people) was prescribed metabolic and antioxidant drugs. Additionally, in the subgroup A2 (32 people), a non-selective beta-blocker was included in the treatment regimen. The course of treatment is 10 days. The analysis of indicators was carried out in 10 days and in a month after the initiation treatment. Statistical processing was carried out in the program Statistica. Results. An earlier disappearance of cardialgia was determined in the subgroup A2 (p < 0.05), whereas in the subgroup A1, 5% of patients had complaints not only at the end of the course, but also a month later after the initiation treatment. The more rapid positive dynamics of the electrocardiographic pattern with a more stable result was observed with the prescription of a beta-blocker. Conclusion. It was proved the advisability of prescribing of beta-blockers in the treatment of beginning athletes with violation of myocardial repolarization against sympathicotonia.","PeriodicalId":119961,"journal":{"name":"Research'n Practical Medicine Journal","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126321540","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 : 2017-12-12DOI: 10.17709/2409-2231-2017-4-4-1
Н.В. Поляков, Николай Георгиевич Кешишев, Ш. Ш. Гурбанов, Марина Владимировна Григорьева, Л. Д. Арустамов, А. В. Казаченко, Б. Я. Алексеев
Determination of indications for performing reconstructive and plastic surgical interventions in stricture of UPS is a difficult task. When making an incorrect decision, the treatment can be ineffective. Functional and anatomical preservation of the kidney can significantly affect the outcome of the operation. Purpose. Evaluation of the effectiveness of laparoscopic plastic surgery of stricture of UPS, depending on the anatomical and functional state of the ipsilateral kidney. Material and method. The results of treatment of 134 patients, who underwent for the period from 2012 to 2015 the different types of reconstructive surgical interventions for stricture of the pelvic-ureteral segment (Calp de Virde scrappy plastic surgery, Andersen-Heinz ureteropyelanastomosis, and antineoplastic ureteropyeloanastomosis), were analyzed. To analyze the effectiveness of the treatment, in the preand postoperative period, the following parameters were evaluated: the presence of pain syndrome, the presence of pyeloectasia, the functional state of the renal parenchyma (according to radioisotope renography), and the absence of recurrence of the UPS stricture. Result. The overall efficacy of laparoscopic UPS reconstruction was 94.7%. The results of treatment did not depend on the chosen technique of operative intervention. In this case, the effectiveness of the treatment was dependent on the initial deficiency of kidney function: the best results were seen in patients with kidney function deficiency of less than 25%, and the proportion of ineffective interventions was highest among patients with a deficit of more than 75%. The degree of dilatation of the pelvis in the postoperative period was also associated with preoperative indicators of kidney function deficiency, this may be due to the presence of cup-pelvis-plating system atony. Conclusion . Thus, the results of our work demonstrated the high efficiency of laparoscopic plastics of UPS. The effective- ness of treatment is determined by the timeliness of the intervention. As a basic prognostic criterion for the effective- ness of the forthcoming intervention, the degree of deficiency of the kidney function should be considered.
确定在UPS狭窄中进行重建和整形手术干预的适应症是一项艰巨的任务。当做出错误的决定时，治疗可能是无效的。肾脏的功能和解剖保存可以显著影响手术的结果。目的。评估腹腔镜下UPS狭窄整形手术的有效性，取决于同侧肾脏的解剖和功能状态。材料和方法。分析2012 - 2015年收治的134例盆腔输尿管段狭窄的不同类型重建手术干预(Calp de Virde scrappy整形术、Andersen-Heinz输尿管吻合术、抗肿瘤输尿管吻合术)的治疗结果。为了分析治疗的有效性，在术前和术后评估以下参数:疼痛综合征的存在，肾盂扩张的存在，肾实质的功能状态(根据放射性同位素肾造影术)，以及UPS狭窄没有复发。结果。腹腔镜下UPS重建的总有效率为94.7%。治疗结果不依赖于手术干预技术的选择。在这种情况下，治疗的有效性取决于最初的肾功能不足:在肾功能不足25%以下的患者中效果最好，而在肾功能不足75%以上的患者中无效干预的比例最高。术后盆腔的扩张程度也与术前肾功能不足的指标相关，这可能是由于盆腔镀杯系统张力的存在。结论。因此，我们的工作结果证明了腹腔镜整形UPS的高效率。治疗的有效性取决于干预的及时性。作为即将到来的干预措施有效性的基本预后标准，应考虑肾功能不足的程度。
{"title":"ЛАПАРОСКОПИЧЕСКАЯ ПЛАСТИКА ПРИ ПЕРВИЧНЫХ СТРИКТУРАХ ЛОХАНОЧНО-МОЧЕТОЧНИКОВОГО СЕГМЕНТА","authors":"Н.В. Поляков, Николай Георгиевич Кешишев, Ш. Ш. Гурбанов, Марина Владимировна Григорьева, Л. Д. Арустамов, А. В. Казаченко, Б. Я. Алексеев","doi":"10.17709/2409-2231-2017-4-4-1","DOIUrl":"https://doi.org/10.17709/2409-2231-2017-4-4-1","url":null,"abstract":"Determination of indications for performing reconstructive and plastic surgical interventions in stricture of UPS is a difficult task. When making an incorrect decision, the treatment can be ineffective. Functional and anatomical preservation of the kidney can significantly affect the outcome of the operation. Purpose. Evaluation of the effectiveness of laparoscopic plastic surgery of stricture of UPS, depending on the anatomical and functional state of the ipsilateral kidney. Material and method. The results of treatment of 134 patients, who underwent for the period from 2012 to 2015 the different types of reconstructive surgical interventions for stricture of the pelvic-ureteral segment (Calp de Virde scrappy plastic surgery, Andersen-Heinz ureteropyelanastomosis, and antineoplastic ureteropyeloanastomosis), were analyzed. To analyze the effectiveness of the treatment, in the preand postoperative period, the following parameters were evaluated: the presence of pain syndrome, the presence of pyeloectasia, the functional state of the renal parenchyma (according to radioisotope renography), and the absence of recurrence of the UPS stricture. Result. The overall efficacy of laparoscopic UPS reconstruction was 94.7%. The results of treatment did not depend on the chosen technique of operative intervention. In this case, the effectiveness of the treatment was dependent on the initial deficiency of kidney function: the best results were seen in patients with kidney function deficiency of less than 25%, and the proportion of ineffective interventions was highest among patients with a deficit of more than 75%. The degree of dilatation of the pelvis in the postoperative period was also associated with preoperative indicators of kidney function deficiency, this may be due to the presence of cup-pelvis-plating system atony. Conclusion . Thus, the results of our work demonstrated the high efficiency of laparoscopic plastics of UPS. The effective- ness of treatment is determined by the timeliness of the intervention. As a basic prognostic criterion for the effective- ness of the forthcoming intervention, the degree of deficiency of the kidney function should be considered.","PeriodicalId":119961,"journal":{"name":"Research'n Practical Medicine Journal","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130791321","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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