Pub Date : 2024-03-18DOI: 10.17816/clinpract627504
Dilya A. Mustafina, Aisylu N. Bagautdinova, Milyausha M. Zinatullina, Diana I. Bukharmetova, NIkita A. Gorbunov, Elvina T. Zainetdinova, Daniil Yu. Leonov, Aibike G. Pirmagomedova, Anna E. Chernyshova, Maria P. Markhanos, Anna G. Abgaryan, Arina S. Arustamyan, Konstantin S. Chavro, Farzonakhon Mirzojonova
The incidence and prevalence of oncological diseases, which are in second place in terms of the frequency of causes of death, is steadily increasing among the population of the Russian Federation. Advances in translational medicine, including immunotherapy, have revolutionized cancer treatment strategies. A special breakthrough has been achieved in two areas of immunotherapy that have modernized cancer treatment: chimeric T-cell receptors and antibodies known as immune checkpoint inhibitors (ICTs) blocking cytotoxic T-lymphocyte-associated protein 4 (CTLA-4), programmed cell death protein-1 (PD-1) and ligand programmed cell death receptor (PD-L1). ICTs enhance the adaptive immune response of the tumor and can cause adverse effects as a result of hyperactivation of T cells, which often leads to the emergence of an opportunistic infection. In addition, immunosuppressive drugs, which are often prescribed to mitigate the side effects associated with ICT, are also a risk factor for infection. The purpose of the review is to analyze the literature on possible relationships between ICT inhibitors and the risk of infection, as well as to consider the possible benefits of ICT inhibitors as a treatment for various types of infections, including viral, parasitic and fungal, as well as sepsis. Although ICT inhibitors have demonstrated the ability to significantly prolong the life expectancy of patients with advanced cancer, they often lead to adverse events, which often requires treatment with immunosuppressive drugs, including corticosteroids, anti-TNF and other biological agents. The overall effect of ICT inhibitors on human infections remains poorly understood. Further research is needed to understand the basic mechanisms of the immunological effects of ICT inhibitors on various types of infections, which in some cases may be beneficial.
在俄罗斯联邦人口中，肿瘤疾病的发病率和流行率正在稳步上升，在死亡原因中占第二位。转化医学（包括免疫疗法）的进步彻底改变了癌症治疗策略。免疫疗法的两个领域取得了特殊突破，使癌症治疗实现了现代化：嵌合 T 细胞受体和抗体，即免疫检查点抑制剂（ICTs），可阻断细胞毒性 T 淋巴细胞相关蛋白 4（CTLA-4）、程序性细胞死亡蛋白-1（PD-1）和配体程序性细胞死亡受体（PD-L1）。信息和通信技术可增强肿瘤的适应性免疫反应，并可能因T细胞过度激活而产生不良反应，这往往会导致机会性感染的出现。此外，为减轻 ICT 的副作用而经常使用的免疫抑制剂也是感染的风险因素之一。本综述旨在分析 ICT 抑制剂与感染风险之间可能存在关系的文献，并考虑 ICT 抑制剂作为治疗病毒、寄生虫和真菌等各类感染以及败血症的药物可能带来的益处。尽管 ICT 抑制剂已证明能够显著延长晚期癌症患者的预期寿命，但它们往往会导致不良反应，这通常需要使用免疫抑制剂治疗，包括皮质类固醇、抗肿瘤坏死因子和其他生物制剂。人们对 ICT 抑制剂对人类感染的总体影响仍然知之甚少。需要进一步研究，以了解 ICT 抑制剂对各种类型感染的免疫效应的基本机制，在某些情况下，这种效应可能是有益的。
{"title":"The role of immune checkpoint inhibitors in the development and treatment of infectious processes","authors":"Dilya A. Mustafina, Aisylu N. Bagautdinova, Milyausha M. Zinatullina, Diana I. Bukharmetova, NIkita A. Gorbunov, Elvina T. Zainetdinova, Daniil Yu. Leonov, Aibike G. Pirmagomedova, Anna E. Chernyshova, Maria P. Markhanos, Anna G. Abgaryan, Arina S. Arustamyan, Konstantin S. Chavro, Farzonakhon Mirzojonova","doi":"10.17816/clinpract627504","DOIUrl":"https://doi.org/10.17816/clinpract627504","url":null,"abstract":"The incidence and prevalence of oncological diseases, which are in second place in terms of the frequency of causes of death, is steadily increasing among the population of the Russian Federation. Advances in translational medicine, including immunotherapy, have revolutionized cancer treatment strategies. A special breakthrough has been achieved in two areas of immunotherapy that have modernized cancer treatment: chimeric T-cell receptors and antibodies known as immune checkpoint inhibitors (ICTs) blocking cytotoxic T-lymphocyte-associated protein 4 (CTLA-4), programmed cell death protein-1 (PD-1) and ligand programmed cell death receptor (PD-L1). ICTs enhance the adaptive immune response of the tumor and can cause adverse effects as a result of hyperactivation of T cells, which often leads to the emergence of an opportunistic infection. In addition, immunosuppressive drugs, which are often prescribed to mitigate the side effects associated with ICT, are also a risk factor for infection. The purpose of the review is to analyze the literature on possible relationships between ICT inhibitors and the risk of infection, as well as to consider the possible benefits of ICT inhibitors as a treatment for various types of infections, including viral, parasitic and fungal, as well as sepsis. Although ICT inhibitors have demonstrated the ability to significantly prolong the life expectancy of patients with advanced cancer, they often lead to adverse events, which often requires treatment with immunosuppressive drugs, including corticosteroids, anti-TNF and other biological agents. The overall effect of ICT inhibitors on human infections remains poorly understood. Further research is needed to understand the basic mechanisms of the immunological effects of ICT inhibitors on various types of infections, which in some cases may be beneficial.","PeriodicalId":508133,"journal":{"name":"Journal of Clinical Practice","volume":"227 17","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140233436","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 : 2024-01-28DOI: 10.17816/clinpract568027
Denis L. Davidovich, Pavel А. Filisteev, A. V. Smirnov, Andrey K. Burovskiy, A. Y. Solomka, Andrey M. Tariverdiev, German S. Tomashevskiy, D. V. Razbirin, Maksim S. Loshchenov
Background: To date, there is no single standard for conducting HAL-RAR operations. The constant discussion raises the question of the number of terminal branches of the superior rectal artery, which must be ligated in the submucosal layer of the rectum in order to provide the adequate dearterialization of hemorrhoids. Aim: To study the anatomy of the branches of the superior rectal artery and to develop recommendations for the optimal ligation of the terminal branches of the superior rectal artery. Methods: 150 protocols of the previous operations have been studied. In order to further objectify our results, the results of radiation diagnostics (CT and MRI) were revised for 100 patients without pathological changes of the rectum and anal canal to study the variant anatomy of the superior rectal artery and its terminal branches in the rectal wall. Results: In 148 patients, 6 terminal branches were identified, in 2 (1.333%) patients, 5 branches were found. 100 cases without pathological changes were also analyzed (60 MRI and 40 CT scans). In all the cases, 6 terminal branches of the superior rectal artery were determined, located at 1, 3, 5, 7, 9 and 11 o'clock positions of the conventional dial. At the same time, a large number of identified anatomical options for the branching of the VPA and the method for reaching the rectal wall should be noted, which we used as a basis to propose a classification. Conclusion: In the vast majority of cases, there are 6 terminal branches of the superior rectal artery, located in the lower ampulla of the rectum at approximately 1, 3, 5, 7, 9 and 11 hours of the conventional dial. A number of variants of the vascular anatomy of the proximal branches are possible, but 6 distal branches are involved in the direct blood supply of the hemorrhoids. When performing selective Doppler-controlled dearterialization of hemorrhoids, it is expedient to ligate 6 arterial vessels.
{"title":"Anatomy of the terminal branches of the superior rectal artery during selective doppler controlled dearterialization of the hemorrhoidal nodes (HAL-RAR)","authors":"Denis L. Davidovich, Pavel А. Filisteev, A. V. Smirnov, Andrey K. Burovskiy, A. Y. Solomka, Andrey M. Tariverdiev, German S. Tomashevskiy, D. V. Razbirin, Maksim S. Loshchenov","doi":"10.17816/clinpract568027","DOIUrl":"https://doi.org/10.17816/clinpract568027","url":null,"abstract":"Background: To date, there is no single standard for conducting HAL-RAR operations. The constant discussion raises the question of the number of terminal branches of the superior rectal artery, which must be ligated in the submucosal layer of the rectum in order to provide the adequate dearterialization of hemorrhoids. Aim: To study the anatomy of the branches of the superior rectal artery and to develop recommendations for the optimal ligation of the terminal branches of the superior rectal artery. Methods: 150 protocols of the previous operations have been studied. In order to further objectify our results, the results of radiation diagnostics (CT and MRI) were revised for 100 patients without pathological changes of the rectum and anal canal to study the variant anatomy of the superior rectal artery and its terminal branches in the rectal wall. Results: In 148 patients, 6 terminal branches were identified, in 2 (1.333%) patients, 5 branches were found. 100 cases without pathological changes were also analyzed (60 MRI and 40 CT scans). In all the cases, 6 terminal branches of the superior rectal artery were determined, located at 1, 3, 5, 7, 9 and 11 o'clock positions of the conventional dial. At the same time, a large number of identified anatomical options for the branching of the VPA and the method for reaching the rectal wall should be noted, which we used as a basis to propose a classification. Conclusion: In the vast majority of cases, there are 6 terminal branches of the superior rectal artery, located in the lower ampulla of the rectum at approximately 1, 3, 5, 7, 9 and 11 hours of the conventional dial. A number of variants of the vascular anatomy of the proximal branches are possible, but 6 distal branches are involved in the direct blood supply of the hemorrhoids. When performing selective Doppler-controlled dearterialization of hemorrhoids, it is expedient to ligate 6 arterial vessels.","PeriodicalId":508133,"journal":{"name":"Journal of Clinical Practice","volume":"19 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139592176","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 : 2024-01-07DOI: 10.17816/clinpract623044
Madina Alievna Omarova, A. N. Boyko
In recent years, more and more papers have appeared in the literature to study the role of the microbiota in the development of various pathological processes in the central nervous system (CNS), including the development of the pathological process in multiple sclerosis (MS), through the brain-gut axis. In this regard, the question of the effect of administered disease-modifying treatments in MS on the composition of the microbiota is interesting. The purpose of this review article is to summarize the current evidence investigating the effect of administered disease-modifying treatments in MS on the gut microbiome.
{"title":"The effects of administered disease-modifying treatments in MS to the gut microbiome","authors":"Madina Alievna Omarova, A. N. Boyko","doi":"10.17816/clinpract623044","DOIUrl":"https://doi.org/10.17816/clinpract623044","url":null,"abstract":"In recent years, more and more papers have appeared in the literature to study the role of the microbiota in the development of various pathological processes in the central nervous system (CNS), including the development of the pathological process in multiple sclerosis (MS), through the brain-gut axis. In this regard, the question of the effect of administered disease-modifying treatments in MS on the composition of the microbiota is interesting. The purpose of this review article is to summarize the current evidence investigating the effect of administered disease-modifying treatments in MS on the gut microbiome.","PeriodicalId":508133,"journal":{"name":"Journal of Clinical Practice","volume":"4 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139448814","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 : 2024-01-07DOI: 10.17816/clinpract386270
E. Ryabchenko
Sclerosing mucoepidermoid carcinoma of the thyroid gland (SMCTG)is a recently recognized malignant neoplasm of the thyroid gland. For the first time about SMCTG was reported in 1991. This type of tumor may develop in connection with Hashimoto's thyroiditis (TX). There are two variants of mucoepidermoid carcinoma of the thyroid gland: the usual and sclerosing variants. SMCTG has recently been recognized by WHO as a separate disease. The paper presents a clinical case with MCLC in a 51-year-old woman who, according to the data of a fine needle aspiration biopsy (FNA)- follicular tumor on the background of TX. Extrafascial thyroidectomy was performed. The patient remained under observation for 10 months. The aim of the study was to demonstrate a clinical case of a patient after surgical treatment with a diagnosis of sclerosing mucoepidermoid carcinoma of the thyroid gland against the background of autoimmune thyroiditis. Description of the clinical case. We present a clinical case of a 51-year-old woman who was observed for 2 years for autoimmune thyroiditis with node. The patient had no symptoms or signs of compression. The level of thyroidstimulating hormone (TSH) was 15.8 (range 0.4-4.0), antibodies to peroxidase (AT-TPO)-150 Iu/ml. Scintigraphy of the thyroid gland revealed a dominant cold node (1.52 cm) in the right lobe of the gland. During the control ultrasound examination of the neck, negative dynamics was observed, a fine needle aspiration biopsy (FNA) of the thyroid node (thyroid gland) was performed a follicular tumor was obtained against the background of TH, which was the reason for timely treatment.
{"title":"RARE FORM OF CANCER OF THYROID GLAND ON THE BACKGROUND OF AUTOIMMUNE THYROIDITIS.","authors":"E. Ryabchenko","doi":"10.17816/clinpract386270","DOIUrl":"https://doi.org/10.17816/clinpract386270","url":null,"abstract":"Sclerosing mucoepidermoid carcinoma of the thyroid gland (SMCTG)is a recently recognized malignant neoplasm of the thyroid gland. For the first time about SMCTG was reported in 1991. This type of tumor may develop in connection with Hashimoto's thyroiditis (TX). There are two variants of mucoepidermoid carcinoma of the thyroid gland: the usual and sclerosing variants. SMCTG has recently been recognized by WHO as a separate disease. The paper presents a clinical case with MCLC in a 51-year-old woman who, according to the data of a fine needle aspiration biopsy (FNA)- follicular tumor on the background of TX. Extrafascial thyroidectomy was performed. The patient remained under observation for 10 months. \u0000The aim of the study was to demonstrate a clinical case of a patient after surgical treatment with a diagnosis of sclerosing mucoepidermoid carcinoma of the thyroid gland against the background of autoimmune thyroiditis. \u0000Description of the clinical case. We present a clinical case of a 51-year-old woman who was observed for 2 years for autoimmune thyroiditis with node. The patient had no symptoms or signs of compression. The level of thyroidstimulating hormone (TSH) was 15.8 (range 0.4-4.0), antibodies to peroxidase (AT-TPO)-150 Iu/ml. Scintigraphy of the thyroid gland revealed a dominant cold node (1.52 cm) in the right lobe of the gland. During the control ultrasound examination of the neck, negative dynamics was observed, a fine needle aspiration biopsy (FNA) of the thyroid node (thyroid gland) was performed a follicular tumor was obtained against the background of TH, which was the reason for timely treatment.","PeriodicalId":508133,"journal":{"name":"Journal of Clinical Practice","volume":"26 22","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139448412","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 : 2024-01-07DOI: 10.17816/clinpract567958
Olga Ulyanova, N. A. Ermolenko, I. Banin, Vera V. Belinskaya, T. Dutova, Arkady V. Kulikov, Nadezhda P. Golovina
Among the bacteria that infect the central nervous system (CNS), Listeria monocytogenes (a facultative intracellular bacterium, Lm) is one of the most deadly for humans and animals. Listeriosis affects domestic and agricultural animals (pigs, small and large cattle, horses, rabbits, rarely cats and dogs), as well as domestic and decorative birds (geese, chickens, ducks, turkeys, pigeons, parrots and canaries). Lm can be detected in fish and seafood (shrimp). The source of infection with Lm are animals in which the disease proceeds in the form of manifest, erased and asymptomatic forms with a transition to long-term carriage. This pathogen is found all over the world in food products and in most cases infection occurs when eating contaminated food. Embryos, newborns, elderly people and persons with immunodeficiency states and chronic diseases are especially prone to disease. Lm is capable of causing intracranial hemorrhage, meningitis, meningoencephalitis (ME) and rhombencephalitis. In this work, we present our own clinical observation of the development of severe listeriosis ME in a patient older than 40 years on the background of the novel coronavirus infection (COVID-19).
在感染中枢神经系统（CNS）的细菌中，单核细胞增生李斯特菌（一种细胞内细菌，Lm）是对人类和动物最致命的细菌之一。李斯特菌病主要影响家畜和农畜（猪、小牛和大牛、马、兔子，很少影响猫和狗），以及家禽和装饰用鸟类（鹅、鸡、鸭、火鸡、鸽子、鹦鹉和金丝雀）。在鱼类和海产品（虾）中也能检测到 Lm。Lm 的传染源是动物，在这些动物中，疾病以表现型、消退型和无症状型的形式出现，并过渡到长期携带。这种病原体在世界各地的食品中都有发现，大多数情况下是在食用受污染的食物时感染的。胚胎、新生儿、老年人、免疫缺陷患者和慢性病患者尤其容易患病。Lm 可导致颅内出血、脑膜炎、脑膜脑炎（ME）和菱形脑炎。在这项工作中，我们介绍了自己在新型冠状病毒（COVID-19）感染的背景下，对一名 40 岁以上患者发生严重李斯特菌病 ME 的临床观察结果。
{"title":"LISTERIOZNYY MENINGOENCEPHALIT ON THE PHONE OF THE NEW CORONAVIRUS INFANTRY. CLINICAL CASE","authors":"Olga Ulyanova, N. A. Ermolenko, I. Banin, Vera V. Belinskaya, T. Dutova, Arkady V. Kulikov, Nadezhda P. Golovina","doi":"10.17816/clinpract567958","DOIUrl":"https://doi.org/10.17816/clinpract567958","url":null,"abstract":"Among the bacteria that infect the central nervous system (CNS), Listeria monocytogenes (a facultative intracellular bacterium, Lm) is one of the most deadly for humans and animals. Listeriosis affects domestic and agricultural animals (pigs, small and large cattle, horses, rabbits, rarely cats and dogs), as well as domestic and decorative birds (geese, chickens, ducks, turkeys, pigeons, parrots and canaries). Lm can be detected in fish and seafood (shrimp). The source of infection with Lm are animals in which the disease proceeds in the form of manifest, erased and asymptomatic forms with a transition to long-term carriage. This pathogen is found all over the world in food products and in most cases infection occurs when eating contaminated food. Embryos, newborns, elderly people and persons with immunodeficiency states and chronic diseases are especially prone to disease. Lm is capable of causing intracranial hemorrhage, meningitis, meningoencephalitis (ME) and rhombencephalitis. In this work, we present our own clinical observation of the development of severe listeriosis ME in a patient older than 40 years on the background of the novel coronavirus infection (COVID-19).","PeriodicalId":508133,"journal":{"name":"Journal of Clinical Practice","volume":"3 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139448874","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 : 2024-01-07DOI: 10.17816/clinpract321703
V. Potapov, A. V. Gorbunov, S. Larionov, A. Zhivotenko, O. V. Sklyarenko
The prolonged course of the autoimmune inflammatory process in Bekhterev's disease is accompanied by calcification of the ligaments of the vertebral column, damage to the rib vertebral and arcuate joints, their ankylosing, which ultimately leads to a decrease in the support capacity of the spine, as a result of which even a minor injury can lead to a fracture. Timely diagnosis using MSCT and MRI studies allows us to assess the nature of traumatic changes and choose the most effective type of surgical treatment, if necessary, using stabilizing systems.
{"title":"FEATURES OF DIAGNOSIS AND TREATMENT OF SPINAL FRACTURE IN BEKHTEREV'S DISEASE (CLINICAL CASE)","authors":"V. Potapov, A. V. Gorbunov, S. Larionov, A. Zhivotenko, O. V. Sklyarenko","doi":"10.17816/clinpract321703","DOIUrl":"https://doi.org/10.17816/clinpract321703","url":null,"abstract":"The prolonged course of the autoimmune inflammatory process in Bekhterev's disease is accompanied by calcification of the ligaments of the vertebral column, damage to the rib vertebral and arcuate joints, their ankylosing, which ultimately leads to a decrease in the support capacity of the spine, as a result of which even a minor injury can lead to a fracture. Timely diagnosis using MSCT and MRI studies allows us to assess the nature of traumatic changes and choose the most effective type of surgical treatment, if necessary, using stabilizing systems.","PeriodicalId":508133,"journal":{"name":"Journal of Clinical Practice","volume":"34 21","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139448158","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 : 2024-01-07DOI: 10.17816/clinpract567849
E. Akhtanin
ABSTRACT Background. To analyze the data of modern foreign and domestic literature on intestinal fistulas, including high unformed small intestinal fistulas, their classification, treatment methods, drainage methods, their types and effectiveness. Research methods. The basis of this work includes an analysis of modern literature (domestic and foreign) on the general information of intestinal fistulas, their classification and treatment methods. Research method: analysis of modern domestic and foreign literature on the treatment of high unformed small intestinal fistulas, performed on the database of the scientific library elibrary, CyberLeninka and The National Center of medicine. Results. Intestinal fistulas, often found in surgical practice, are a consequence of a number of reasons (errors in surgical technique and conservative treatment, tactical errors, the presence of severe concomitant diseases, etc.) and a high risk factor for death. Clinically, intestinal fistulas can be different depending on the localization, etiology, morphology, function, complications, etc., causing a number of difficulties in choosing a treatment method and reducing its success. Special attention is paid to high unformed small intestinal fistulas, which are accompanied by a pronounced violation of the body's homeostasis system, on the one hand, and the need for multi-stage treatment, on the other. The treatment regimen for high unformed small intestinal fistulas includes conservative and surgical treatment. The conservative method of treatment includes intensive infusion therapy, control of the source of infectious complications, reduction of irretrievable losses, nutritional therapy, and local treatment, which consists in protecting tissues from aggressive intestinal contents and various methods of adequate drainage of the wound. The drainage methods used for intestinal fistulas are different – depending on the principle of their operation, the material of the drains, the configuration of the wound, the morphology of the fistula, the number of fistulas, etc. Active and vacuum methods seem to be the most used and effective methods in the local treatment of high unformed small intestinal fistulas.
{"title":"DRAINAGE METHODS IN PATIENTS WITH UNFORMED INTESTINAL FISTULAS DURING THE PREPARATION TO THE SURGICAL TREATMENT","authors":"E. Akhtanin","doi":"10.17816/clinpract567849","DOIUrl":"https://doi.org/10.17816/clinpract567849","url":null,"abstract":"ABSTRACT \u0000 \u0000Background. To analyze the data of modern foreign and domestic literature on intestinal fistulas, including high unformed small intestinal fistulas, their classification, treatment methods, drainage methods, their types and effectiveness. \u0000Research methods. The basis of this work includes an analysis of modern literature (domestic and foreign) on the general information of intestinal fistulas, their classification and treatment methods. Research method: analysis of modern domestic and foreign literature on the treatment of high unformed small intestinal fistulas, performed on the database of the scientific library elibrary, CyberLeninka and The National Center of medicine. \u0000Results. Intestinal fistulas, often found in surgical practice, are a consequence of a number of reasons (errors in surgical technique and conservative treatment, tactical errors, the presence of severe concomitant diseases, etc.) and a high risk factor for death. Clinically, intestinal fistulas can be different depending on the localization, etiology, morphology, function, complications, etc., causing a number of difficulties in choosing a treatment method and reducing its success. Special attention is paid to high unformed small intestinal fistulas, which are accompanied by a pronounced violation of the body's homeostasis system, on the one hand, and the need for multi-stage treatment, on the other. The treatment regimen for high unformed small intestinal fistulas includes conservative and surgical treatment. The conservative method of treatment includes intensive infusion therapy, control of the source of infectious complications, reduction of irretrievable losses, nutritional therapy, and local treatment, which consists in protecting tissues from aggressive intestinal contents and various methods of adequate drainage of the wound. The drainage methods used for intestinal fistulas are different – depending on the principle of their operation, the material of the drains, the configuration of the wound, the morphology of the fistula, the number of fistulas, etc. Active and vacuum methods seem to be the most used and effective methods in the local treatment of high unformed small intestinal fistulas.","PeriodicalId":508133,"journal":{"name":"Journal of Clinical Practice","volume":"17 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139448561","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 : 2024-01-07DOI: 10.17816/clinpract417232
A. Vinokurov, Aleksander Kalinkin
Background: Clinical manifestations of Kimmerle anomaly (AK) are detected in 5.5 to 20% of patients. The main reason for the development of symptoms is prolonged compression of the V3 (atlantic) segment of the vertebral artery (VA) in the bone ring formed as a result of exostosis of the atlantooccipital membrane. To date, the final tactics of treating patients with AK has not been determined. The effectiveness of conservative methods of therapy does not exceed 40%. The aim of the study was to evaluate the result of minimally invasive surgical treatment of patients with symptomatic AK using video endoscopic assistance. Methods: In the period from 2020 to 2022, 15 patients were operated on. The indication for surgical treatment was the lack of effect of conservative therapy for 1 year after the onset of the disease, the increase in the symptoms of the disease, the decrease in blood flow through the vertebral artery from the side of the AC when turning the head. In two (13%) patients, VA decompression was performed through a posterior median approach, and in thirteen (87%) patients, through a paravertebral intermuscular approach (4 cm incision in the occipitocervical region in the projection of the AC) using video endoscopy.Results: The outcome of the disease was assessed at discharge from the hospital, as well as 6 and 12 months after the operation. After surgical treatment, all patients showed complete regression of symptoms, restoration of blood flow velocities in VA. There were no complications after the operation. The use of video endoscopy made it possible to reduce the size of the surgical wound from 12 cm to 4 cm, which contributed to a decrease in the intensity of pain in the postoperative period, early activation and a decrease in the duration of inpatient treatment.Conclusion: With proper selection of patients with AV, decompression of the V3 segment of the VA using video endoscopy is a safe and effective method of treatment.
背景：5.5%至20%的患者会出现基默尔异常（AK）的临床表现。出现症状的主要原因是椎动脉 V3（大西洋）段长期受压于寰枕骨膜外突形成的骨环。迄今为止，治疗 AK 患者的最终策略尚未确定。保守疗法的有效率不超过 40%。本研究旨在评估使用视频内窥镜辅助对有症状的 AK 患者进行微创手术治疗的效果。研究方法在 2020 年至 2022 年期间，15 名患者接受了手术治疗。手术治疗的指征是发病一年后保守治疗效果不佳、疾病症状加重、转头时交流侧椎动脉血流量减少。2例（13%）患者通过后正中入路进行了VA减压术，13例（87%）患者通过椎旁肌间入路（枕颈部AC投影处4厘米切口）使用视频内窥镜进行了VA减压术：出院时、术后 6 个月和 12 个月时对病情进行了评估。手术治疗后，所有患者的症状均完全缓解，VA血流速度恢复正常。术后没有出现并发症。视频内窥镜的使用使手术伤口的大小从 12 厘米缩小到 4 厘米，这有助于减轻术后疼痛的强度、尽早恢复功能和缩短住院治疗时间：结论：在适当选择房室患者的情况下，使用视频内窥镜对VA的V3段进行减压是一种安全有效的治疗方法。
{"title":"Surgical treatment of patients with symptomatic Kimmerle anomaly using video endoscopy","authors":"A. Vinokurov, Aleksander Kalinkin","doi":"10.17816/clinpract417232","DOIUrl":"https://doi.org/10.17816/clinpract417232","url":null,"abstract":"Background: Clinical manifestations of Kimmerle anomaly (AK) are detected in 5.5 to 20% of patients. The main reason for the development of symptoms is prolonged compression of the V3 (atlantic) segment of the vertebral artery (VA) in the bone ring formed as a result of exostosis of the atlantooccipital membrane. To date, the final tactics of treating patients with AK has not been determined. The effectiveness of conservative methods of therapy does not exceed 40%. The aim of the study was to evaluate the result of minimally invasive surgical treatment of patients with symptomatic AK using video endoscopic assistance. Methods: In the period from 2020 to 2022, 15 patients were operated on. The indication for surgical treatment was the lack of effect of conservative therapy for 1 year after the onset of the disease, the increase in the symptoms of the disease, the decrease in blood flow through the vertebral artery from the side of the AC when turning the head. In two (13%) patients, VA decompression was performed through a posterior median approach, and in thirteen (87%) patients, through a paravertebral intermuscular approach (4 cm incision in the occipitocervical region in the projection of the AC) using video endoscopy.Results: The outcome of the disease was assessed at discharge from the hospital, as well as 6 and 12 months after the operation. After surgical treatment, all patients showed complete regression of symptoms, restoration of blood flow velocities in VA. There were no complications after the operation. The use of video endoscopy made it possible to reduce the size of the surgical wound from 12 cm to 4 cm, which contributed to a decrease in the intensity of pain in the postoperative period, early activation and a decrease in the duration of inpatient treatment.Conclusion: With proper selection of patients with AV, decompression of the V3 segment of the VA using video endoscopy is a safe and effective method of treatment.","PeriodicalId":508133,"journal":{"name":"Journal of Clinical Practice","volume":"66 16","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139448962","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 : 2023-12-14DOI: 10.17816/clinpract624157
D. Namestnikova, Daria Borisovna Kovalenko, Irina Alekseevna Pokusaeva, Darya Chudakova, I. Gubskiy, K. Yarygin, VP Baklaushev
Over the past three decades, multiple preclinical studies have been conducted and have shown that transplantation of the mesenchymal stem has a pronounced positive effect in animals with experimental stroke. On the base of the promising results of the preclinical studies several clinical trials with the mesenchymal stem cell transplantation in stroke patients have also been conducted. In this review we presented and analyzed the results of completed clinical trials dedicated to the mesenchymal stem cells transplantation in patients with ischemic stroke. According to obtained results it can be concluded that transplantation of the mesenchymal stem cells is safe and feasible from an economic and medical-biological point of view. For further implementation of this promising approach into the clinical practice randomized, placebo-controlled, multicenter clinical trials on a large sample of patients and with the optimize cell transplantation protocols and patients’ inclusion criteria are needed. In this review we also discuss possible strategies to enhance the effectiveness of cell therapy with the use of the mesenchymal stem cells.
{"title":"Mesenchymal stem cells in the treatment of ischemic stroke","authors":"D. Namestnikova, Daria Borisovna Kovalenko, Irina Alekseevna Pokusaeva, Darya Chudakova, I. Gubskiy, K. Yarygin, VP Baklaushev","doi":"10.17816/clinpract624157","DOIUrl":"https://doi.org/10.17816/clinpract624157","url":null,"abstract":"Over the past three decades, multiple preclinical studies have been conducted and have shown that transplantation of the mesenchymal stem has a pronounced positive effect in animals with experimental stroke. On the base of the promising results of the preclinical studies several clinical trials with the mesenchymal stem cell transplantation in stroke patients have also been conducted. In this review we presented and analyzed the results of completed clinical trials dedicated to the mesenchymal stem cells transplantation in patients with ischemic stroke. According to obtained results it can be concluded that transplantation of the mesenchymal stem cells is safe and feasible from an economic and medical-biological point of view. For further implementation of this promising approach into the clinical practice randomized, placebo-controlled, multicenter clinical trials on a large sample of patients and with the optimize cell transplantation protocols and patients’ inclusion criteria are needed. In this review we also discuss possible strategies to enhance the effectiveness of cell therapy with the use of the mesenchymal stem cells.","PeriodicalId":508133,"journal":{"name":"Journal of Clinical Practice","volume":"73 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139180194","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 : 2023-11-30DOI: 10.17816/clinpract454763
Natalia V. Garanina, Michail B. Dolgushin, L. M. Fadeeva, E. Pogosbekyan, Denis V. Sashin, E. A. Nechipay, Andrey V. Dvoryanchikov
OBJECTIVE. The aim of this study is to improve the quality of differential diagnosis of metastases in the brain of tumors of different primary localization by introducing the diffusion-kurtosis magnetic resonance imaging technique into the MR-scanning protocol. MATERIALS AND METHODS. The study included 60 patients who underwent examination and treatment at the National Research Medical Center of Oncology named by N.N. Blokhin of the Ministry of Health of Russia from October 2019 to March 2022, in which, according to magnetic resonance imaging, metastatic formations in the substance of the brain of different localization of the primary tumor were detected. 20 patients were diagnosed with lung cancer (33.3%), 20 patients with breast cancer (33.3%) and 20 patients with melanomas (33.3%). 3%). We evaluated the tumor size, diffusion and kurtosis parameters, such as mean kurtosis (MK), axial kurtosis (AK), radial kurtosis (RK), kurtosis anisotropy (KA), radial diffusion (RD), fractional anisotropy (FA), relative anisotropy (RA), axial diffusion of the extra-axonal fluid (ADEAF), radial diffusion of the extra-axonal fluid (RDEAF), axonal fluid fraction (AFF), and tortuosity of the diffusion trajectory (TTD). RESULTS. Statistically significant (p0.05) differing parameters of diffusion and kurtosis in the comparative evaluation of indicators were identified in the structure of melanoma and lung cancer parameters - axial diffusion (AD), fractional anisotropy (FA), relative anisotropy (RA), radial kurtosis (RK) and tortuosity of the diffusion trajectory (ТTD) ), as well as in the structure of melanoma and breast cancer - axial diffusion (AD), axonal fluid fraction (FAF), fractional anisotropy (FA), axial diffusion of extra-axonal fluid (ADEAF), mean kurtosis (MK), relative anisotropy (RA), radial kurtosis (RK) and tortuosity of the diffusion trajectory (TTD).
{"title":"DIFFUSION-CURTOSIS MRI OF THE BRAIN IN DIFFERENTIAL DIAGNOSTICS OF METASTASES OF TUMORS OF VARIOUS PRIMARY LOCATION","authors":"Natalia V. Garanina, Michail B. Dolgushin, L. M. Fadeeva, E. Pogosbekyan, Denis V. Sashin, E. A. Nechipay, Andrey V. Dvoryanchikov","doi":"10.17816/clinpract454763","DOIUrl":"https://doi.org/10.17816/clinpract454763","url":null,"abstract":"OBJECTIVE. The aim of this study is to improve the quality of differential diagnosis of metastases in the brain of tumors of different primary localization by introducing the diffusion-kurtosis magnetic resonance imaging technique into the MR-scanning protocol. MATERIALS AND METHODS. The study included 60 patients who underwent examination and treatment at the National Research Medical Center of Oncology named by N.N. Blokhin of the Ministry of Health of Russia from October 2019 to March 2022, in which, according to magnetic resonance imaging, metastatic formations in the substance of the brain of different localization of the primary tumor were detected. 20 patients were diagnosed with lung cancer (33.3%), 20 patients with breast cancer (33.3%) and 20 patients with melanomas (33.3%). 3%). We evaluated the tumor size, diffusion and kurtosis parameters, such as mean kurtosis (MK), axial kurtosis (AK), radial kurtosis (RK), kurtosis anisotropy (KA), radial diffusion (RD), fractional anisotropy (FA), relative anisotropy (RA), axial diffusion of the extra-axonal fluid (ADEAF), radial diffusion of the extra-axonal fluid (RDEAF), axonal fluid fraction (AFF), and tortuosity of the diffusion trajectory (TTD). RESULTS. Statistically significant (p0.05) differing parameters of diffusion and kurtosis in the comparative evaluation of indicators were identified in the structure of melanoma and lung cancer parameters - axial diffusion (AD), fractional anisotropy (FA), relative anisotropy (RA), radial kurtosis (RK) and tortuosity of the diffusion trajectory (ТTD) ), as well as in the structure of melanoma and breast cancer - axial diffusion (AD), axonal fluid fraction (FAF), fractional anisotropy (FA), axial diffusion of extra-axonal fluid (ADEAF), mean kurtosis (MK), relative anisotropy (RA), radial kurtosis (RK) and tortuosity of the diffusion trajectory (TTD).","PeriodicalId":508133,"journal":{"name":"Journal of Clinical Practice","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139200585","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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