Today, our country has created a modern system of medical support for the Armed Forces of the Russian Federation. Measures to improve the medical support system are being consistently implemented, and the quality of care provided to soldiers, members of their families and veterans of military service is improving. The capacities of the air ambulance evacuation system are being expanded, military medical organisations are being supplied with high-tech medical equipment, advanced and unique treatment methods are being introduced.

I warmly congratulate you on the Day of Military Medical Workers! You are the hope for those who find themselves in trouble, thanks to your knowledge and experience many lives have been saved and people have been able to return to normal life after severe injuries. I wish you good health, good luck in your work and personal life, happiness and prosperity!

Best regards, Chief Editor, Director of the Medical Institute of Continuing Education of the Russian Biotechnological University (ROSBIOTECH), Academician of the Russian Academy of Medical and Technological Sciences, Member of the European Academy of Dermatology and Venereology, Honored Doctor of the Russian Federation,
V.V. Gladko

¹ Medical Institute of Continuing Education of the Russian Biotechnological University (ROSBIOTECH), Moscow, Russia
² Research Center for Immunology and Allergology, Moscow, Russia
³ Scientific and Educational Center "Maruga", Moscow, Russia

Abstract

Background. The analysis of traditional, primarily Chinese, medicine is the subject of close attention of modern medicinal substances developers. One of the important, frequently used plant substrates is Tripterygium Wilfordii, which is used as an antiinflammatory agent, including for the treatment of skin diseases. However, the mechanisms of action of this agent, particularly in such a widespread disease as atopic dermatitis, still need to be investigated.
Aim. To study of the effect of Tripterygium Wilfordii extract on in vitro cytokine production in normal and atopic dermatitis patients.
Materials and Methods. In a culture of the effect of Tripterygium Wilfordii extract on spontaneous and phytohemagglutinininduced synthesis of IL-2, IL-4, IL-6, IL-10, IL-17, TNFα, IFNγ was evaluated in mononuclear cells culture obtained from healthy donors and patients with atopic dermatitis using enzyme immunoassay test systems Cloud-Clone Corp. (CCC, Wuhan)
Results. It was found that the level of spontaneous cytokine synthesis in patients with atopic dermatitis was significantly increased, while the response to the mitogenic stimulus was sharply reduced, absent or inverted. Tripterygium Wilfordii extract in all samples, except for intact cells of healthy donors, showed a pronounced inhibitory effect.
Conclusions. Under in vitro conditions, cultured mononuclear cells of patients with atopic dermatitis produce a greater amount of IL-2, IL-4, IL-6, IL-10, IL-17, TNFα, IFNγ, which indicates the activation of the cytokine function. Tripterygium Wilfordii extract has a pronounced inhibitory effect, especially on activated cells. The use of Tripterygium Wilfordii extracts seems reasonable for promising pharmaceutical substances.

Key words: atopic dermatitis, cytokines, Tripterygium Wilfordii extract.

For citations: Volchek I. A., Teryaev A. S., Gladko O. V., Rebrova O. M., Michurina A. P., Makarova A. G. Tripterygium Wilfordii extract as a regulator of spontaneous and in vitro stimulated cytokine production with atopic dermatitis. Bulletin of the Medical Institute of Continuing Education. — 2023. — V. 3, № 3. — P. 8–13. — DOI 10.36107/2782-1714_2023-3-3-8-13.

Literature

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9. Волчек И.А., Теряев А.С. Влияние экстрактов дудника амурского (Angelica amurensis) на синтез цитокинов in vitro // Вестник медицинского института непрерывного образования. — 2023 — T. 3. — № 2. — С. 8–3. — EDN AKJOTJ. DOI: 10.36107/2782-1714_2023-3-2-8-13

¹ Department of Plastic Surgery Bedford Hospital, Bedford, UK
² Department of Skin and Venereal Diseases with Cosmetology course Medical Institute of Continuing Education, Russian Biotechnological University (ROSBIOTECH), Moscow, Russia
³ Dermatology Department Bedford Hospital, Bedford, UK

Abstract

Background. Rhinophyma is a chronic and progressive condition, considered a form of severe rosacea, which classically affects the tip of the nose. Some people have rhinophyma without having rosacea. The disease also carries a risk of 3-10% of malignant transformation. Different therapeutic methods have been described over time, with different grades of efficiency, and each of them with its associated risks. At present, the gold standard treatment for the "established" rhinophyma is the ablative laser
Aim. To propose a new therapeutic protocol, combining ablative and non-ablative lasers, with an early approach, that results in a better cosmetic outcome and a longer free disease interval.
Materials and Methods. The four stages of the new proposed protocol involve early treatment of rosacea with vascular lasers (PDL, NdYAG), then the use of an ablative laser (CO2) and further revision of the post-ablative result (CO2, ErYAG, PDL/NdYAG).
Results. The results of the treatment are presented with "before" and "after" photos of the patients.
Conclusions. The proposed approach, combining ablative and non-ablative lasers, leads to a better cosmetic result and a longer remission.

Key words: rhinophyma, rosacea, non-surgical treatment, surgical treatment, vascular laser, ablative laser.

For citations: Chiru R. Rhinophyma — from the genetics of the disease to a new therapeutic protocol / Chiru Roxana, Margaj Vishrabdha, Maheshwari Kavish, V.V. Gladko, S.A. Masyukova, I.V. Ilyina, E.P. Burova // Bulletin of the Medical Institute of Continuing Education. — 2023. — V. 3, No. 3. — P. 14–20. — DOI 10.36107/2782-1714_2023-3-3-14-20.

Literature

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2. Laun J., Gopman J., Elston J.B., Harrington M.A. Rhinophyma. Eplasty. 2015 May 1;15:ic25. PMID: 25987948; PMCID: PMC4426765.
3. Fink C., Lackey J., Grande D.J. Rhinophyma: A Treatment Review. Dermatol Surg. 2018 Feb;44(2):275-282. doi: 10.1097/DSS.0000000000001406. PMID: 29140869.
4. H. Sadick, B. Goepel, C. Bersch, U. Goessler, K. Hoermann, and F. Riedel, "Rhinophyma: diagnosis and treatment options for a disfiguring tumor of the nose," Annals of Plastic Surgery, vol. 61, no. 1, pp. 114-120, 2008
5. Pandrangi, V., Z. Johnson, C. & A. Krane, N. Rhinophyma: Taking Care of the "WC Fields" Nose. Curr Otorhinolaryngol Rep 10, 262-270 (2022). https://doi.org/10.1007/s40136-022-00409-2
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10. Payne G., Ko F., Anspaugh S., Wheeler C.K., Wright T.E., Robson M.C. Down-regulating causes of fibrosis with tamoxifen: a possible cellular/molecular approach to treat rhinophyma. Ann Plast Surg. 2006;56(3):301-305. doi:10.1097/01. sap.0000199155.73000.2f16508362
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13. Tuzun Y., Wolf R., Kutlubay Z., Karakus O., Engin B. Rosacea and rhinophyma. Clin Dermatol. 2014;32(1):35-46. doi:10.1016/j. clindermatol.2013.05.02424314376
14. ReboraA. The management of rosacea.Am J Clin Dermatol. 2002;3(7):489–496. doi:10.2165/00128071-200203070-0000512180896
15. Stefania Tenna, Pierluigi Gigliofiorito, Marika Langella, Carlo Carusi, Paolo Persichetti, Treatment of rhinophyma with ultrasonic scalpel: case report, Journal of Plastic, Reconstructive & Aesthetic Surgery, Volume 62, Issue 6, 2009, Pages e164-e165, ISSN 1748- 6815, https://doi.org/10.1016/j.bjps.2008.11.006.
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Medical Institute of Continuing Education of the Russian Biotechnological University (ROSBIOTECH), Moscow, Russia

Abstract

Background. Lichen Planopilaris (LPP) is a variant of primary cicatricial alopecia with a lymphocytic inflammatory infiltrate that occurs at the level of the hair follicle funnel and destroys stem cells of the bulge zone. Timely diagnosis and determination of the correct treatment tactics allows to achieve stabilization of the process and minimize irreversible hair loss. The article presents clinical cases of Lichen Planopilaris in men, initially accompanied by misdiagnoses and lack of adequate therapy, which led to significant irreversible hair loss.

Key words: cicatricial alopecia, Lichen Planopilaris, primary lymphocytic alopecia, treatment.

For citations: Safonova L. A. Features of the course of Lichen Planopilaris in men. // Bulletin of the Medical Institute of Continuing Education. — 2023. — V. 3, No. 3. — P. 21–26. — DOI 10.36107/2782-1714_2023-3-3-21-26.

Literature

1. Summary of North American Hair Research Society (NAHRS) — Sponsored workshop on cicatricial alopecia, Duke University Medical Center, February 10 and 11, 2001. Journal of the American Academy of Dermatology, 48(1), 103-110. https://doi. org/10.1067/mjd.2003.68
2. Chantal B., Leonard C. Sperling and Jerry Shapiro Lymphocytic primary cicatricial alopecias, including chronic cutaneous lupus erythematosus, lichen planopilaris, frontal fibrosing alopecia, and Graham-Little syndrome. J. Am. Acad. Dermatol 2016;75:1081- 99. http://dx.doi.org/10.1016/j.jaad.2014.09.058
3. Errichetti E, Figini M, Croatto M, Stinco G. Therapeutic management of classic lichen planopilaris: a systematic review. Clin Cosmet Investig Dermatol. 2018;11:91-102. Published 2018 Feb 27. doi:10.2147/CCID.S137870
4. Lepe K, Nassereddin A., Salazar F. J. Lichen Planopilaris https://www.ncbi.nlm.nih.gov/books/NBK470325/
5. Babahosseini H., Tavakolpour S., Mahmoudi H., Balighi K., Teimourpour A., Ghodsi S.Z., Abedini R., Ghandi N., Lajevardi V., Kiani A., Kamyab K., Mohammadi M., Daneshpazhooh M.J. Lichen planopilaris: retrospective study on the characteristics and treatment of 291 patients. Dermatolog Treat. 2019 Sep;30(6):598-604. doi: 10.1080/09546634.2018.1542480. Epub 2019 Jan 4.PMID: 30411987
6. Rosalynn R Z Conic, Melissa Piliang, Wilma Bergfeld, Natasha Atanaskova-Mesinkovska Association of Lichen Planopilaris With Dyslipidemia DOI: 10.1001/jamadermatol.2018.1749
7. Kenia Lepe, Nassereddin Ali, Francisco J. Salazar Lichen Planopilaris StatPearls Publishing; 2022 Jan; https://www.ncbi.nlm.nih.gov/books/NBK470325/
8. Lyakhovitsky A. Amichai B., C Sizopoulou, A Barzilai A case series of 46 patients with lichen planopilaris: Demographics, clinical evaluation, and treatment experience J. Dermatolog treat; 2015 Jun;26(3):275-9. doi: 10.3109/09546634.2014.933165. Epub 2014 Jul 1.
9. Errichetti E., Figini M., Croatto M., Stinco G. Therapeutic management of classic lichen planopilaris: a systematic review. Clin Cosmet Investig Dermatol. 2018;11:91-102. Published 2018 Feb 27. doi:10.2147/CCID.S137870
10. Carolina Oliveira Costa Fechine, Neusa Yuriko Sakai Valente, Ricardo Romiti Lichen planopilaris and frontal fibrosing alopecia: review and update of diagnostic and therapeutic feature; Anais Brasileiros de Dermatologia Volume 97, Issue 3, May–June 2022, Pages 348-357
11. Yang C.C., Khanna T., Sallee B., Christiano A.M, Bordone L.A. Tofacitinib for the treatment of lichen planopilaris: A case series.. Dermatol Ther. 2018 Nov;31(6):e12656. doi: 10.1111/dth.12656. Epub 2018 Sep 27.
12. Errichetti E., Figini M., Croatto M., Stinco G. Therapeutic management of classic lichen planopilaris: a systematic review. Clin Cosmet Investig Dermatol. 2018;11:91-102. Published 2018 Feb 27. doi:10.2147/CCID.S137870
13. Charles Chiang, Deborah Sah, Bryan K. Cho, Blanca E. Ochoa, Vera H. Price Hydroxychloroquine and lichen planopilaris: Efficacy and introduction of Lichen Planopilaris Activity Index scoring system; Journal of the American Academy of Dermatology Volume Лечение волос и кожи головы: практ руководство / под ред. А.Тости, Д.Аз-Сигала, Р. Пирмеза; пер. с англ. под ред. А.Г. Гаджигороевой // М. — Геотар-Медиа. — 2021. 176 с. doi:10.33029/9704-5873-0-HST-2021-1-408

¹ Department of Dermatology, SUNY Downstate Health Sciences University, Brooklyn, NY
² Medical Institute of Continuing Education of Russian Biotechnological University (ROSBIOTECH), Moscow, Russia

Abstract

Mohs micrographic surgery (MMS) utilizes intra-operative histological assessment to maximize clearance of cutaneous malignancy while minimizing surgical defect size. [1–4] On cosmetically sensitive areas, most notably the face, transposition, advancement, and interpolation flaps and occasionally skin grafts are often utilized as repair techniques, despite potential for post-operative complications including bleeding, infection, impaired wound healing, and graft/flap loss.[1–5] Here we present a case of a large (6.5 cm by 3.5 cm) surgical defect on the cheek following MMS for the management of a morpheaform basal cell carcinoma and briefly review considerations regarding closure repairs, emphasizing linear closure as a reliable and successful option.

Key words: Mohs micrographic surgery; morpheaform basal cell carcinoma; surgical repair; linear closure

For citations: Marson, Justin W. Linear Closure: a straightforward approach to large defects on the nasolabial cheek following Mohs micrographic surgery for morpheaform basal cell carcinoma./Justin W. Marson, Rebecca M. Chen, Michelle Schwartz, V.V. Gladko, I.V. Ilyina and Daniel M. Siegel, // Bulletin of the Medical Institute of Continuous Education. — 2023. — V. 3, No. 3. — P. 27–30. — DOI 10.36107/2782-1714_2023-3-3-27-30.

Literature

1. Alam M., Ibrahim O., Nodzenski M., et al. Adverse Events Associated With Mohs Micrographic Surgery. JAMA Dermatology. 2013-12-01 2013;149(12):1378. doi:10.1001/jamadermatol.2013.6255
2. Johnson A.R., Egeler S.A., Wu W.W., Bucknor A., Ibrahim A.M.S., Lin S.J. Facial Reconstruction After Mohs Surgery: A Critical Review of Defects Involving the Cheek, Forehead, and Perioral Region. J Craniofac Surg. 2019;30(2):400-407. doi:10.1097/SCS.0000000000005074
3. Brandão C.M., Weimann E.T.S., Terzian L.R., Machado Filho C.D.S., Paschoal F.M., Criado PR. Keep it simple. A ten-year experience in reconstructions after Mohs micrographic surgery. An Bras Dermatol. 2020;95(6):714-720. doi:10.1016/j.abd.2020.05.004
4. Soliman S., Hatef D.A., Hollier L.H., Thornton JF. The rationale for direct linear closure of facial Mohs' defects. Plast Reconstr Surg. Jan 2011;127(1):142-149. doi:10.1097/PRS.0b013e3181f95978
5. Cook J.L., Perone J.B. A prospective evaluation of the incidence of complications associated with Mohs micrographic surgery. Arch Dermatol. Feb 2003;139(2):143-52. doi:10.1001/archderm.139.2.143
6. Kimyai-Asadi A., Goldberg L.H., Peterson S.R., Silapint S., Jih M.H. The incidence of major complications from Mohs micrographic surgery performed in office-based and hospital-based settings. J Am Acad Dermatol. Oct 2005;53(4):628-34. doi:10.1016/j.jaad.2005.03.023

¹ Main Clinical Hospital of the Ministry of Internal Affairs of the Russian Federation, Moscow, Russia
² Medical Institute of Continuing Education of the Federal State Budgetary Educational Institution of Higher Education "Russian Biotechnological University (ROSBIOTECH)". Moscow, Russia
³ Institute of Oncology, Radiology and Nuclear Medicine, Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology of the Ministry of Health of the Russian Federation, Moscow, Russia

Abstract

Purpose. To carry out a comparative analysis of the results of endoscopic tympanoplasty with auricle cartilage and microscopic tympanoplasty with temporal autofascia in the surgical treatment of total and subtotal perforations of the tympanic membrane.
Materials and Methods. 56 patients were devided into 2 groups, the first group had 28 patients after endoscopic type I tympanoplasty with auricle cartilage; the second group had 28 patients after type I tympanoplasty with temporal autofascia. The patients were examined after the surgery in 2, 3, 6, 12 months, anatomical and functional results were assessed, audiometry, and the number of recurrences of tympanic membrane perforations were extimated.
Results. The average operation time in the first group (60.2±11.5 min) was significantly less than in the second group (88.3±15.2min; p<0.5). Complete closure of the tympanic membrane perforation and graft engraftment was observed in group 1 in 92.8 %, in group 2 in 89.3 %. The average preoperative air conduction according to audiometry data in group 1 was 42.1±15.4 dB, in group 2 it was 38.2±12.4 dB. The differences of bone-air conduction before the surgery were 18.8±11.6 dB and 19.6±13.3 dB respectively. The bone-air interval before the surgery was 23.3±6.4 dB in group 1, — it was 19.2±7.8 dB in group 2. After the surgery in 1-year follow-up, the average improvement in air conduction in group 1 was 18.1±7.7 dB, in group 2 it was 19.5±7.5 dB. Postoperative bone conduction was 17.8±10.7 dB and 18.8±14.9 dB respectively. The bone-air interval 1 year after the surgery was 10.1±4.6 dB in group 1and 11.5±8.4 dB. There was no statistically significant difference between the two groups.

Key words: tympanoplasty, endoscopic tympanoplasty, chronic suppurative otitis media.

For citations: Morozov I.I., Gorbunova N.V., Grachev N.S. Results of tympanoplasty in total and subtotal tympanic membrane defects // Bulletin of the Medical Institute of Continuing Education. — 2023. — V. 3, No. 3. — S. 31–35. — DOI 10.36107/2782-1714_2023-3-3-31-35.

Literature

1. Singh S.P., Nagi R.S., Singh J. To compare short and longterm graft uptake and hearing outcome of type I cartilage tympanoplasty between small, medium and large perforations using reinforced sliced conchal cartilage // Indian J Otolaryngol Head Neck Surg 71:550–556. https:// doi. org/ 10. 1007/ s12070- 019- 01727-6
2. Atchariyasathian V., Suwannajak R., Plodpai Y., Pitathawatchai. A comparison of endoscopic transtympanic myringoplasty and endoscopic type I tympanoplasty for repairing medium- to large-sized tympanic membrane perforation: a randomized clinical trial // Eur Arch Otorhinolaryngol 277:2199-2207. https:// doi. org/10. 1007/ s00405- 020- 05955-3
3. Горбунова Н.В., Морозов И.И. Современные тенденции в эндоскопической отохирургии // Вестник медицинского института непрерывного образования. — 2023. — T. 3, № 2. — С. 33-38. — EDN BGCHJI [Gorbunova N.V., Morozov I.I. Modern trends in endoscopic otosurgery // Bulletin of the Medical Institute of Continuing Education. — 2023. — V. 3, № 2. — P. 33–38. — EDN BGCHJI (In Russ.)]
4. Hu Y., Teh B.M., Hurtado G., Yao X., Huang J., Shen Y. Can endoscopic ear surgery replace microscopic surgery in the treatment of acquired cholesteatoma? A contemporary review // Int J Pediatr Otorhinolaryngol. 2020 Apr;131:109872. doi: 10.1016/j. ijporl.2020.109872.
5. Choi N., Noh Y., Park W. et al. Comparison of endoscopic tympanoplasty to microscopic tympanoplasty. Clin Exp Otorhinolaryngol 10:44-49. https:// doi. org/ 10. 21053/ ceo. 2016. 000806.
6. Li B., Zhou L., Wang M., Wang Y., Zou J. Endoscopic versus microscopic surgery for treatment of middle ear cholesteatoma: A systematic review and meta-analysis // Am J Otolaryngol. 2021 Mar-Apr;42(2):102451. doi: 10.1016/j.amjoto.2020.102451.
7. Горбунова Н.В., Морозов И.И., Грачев Н.С. Мастоидопластика при хирургическом лечении хронического гнойного среднего отита. методики и результаты // Вестник медицинского института непрерывного образования. — 2023. — T. 3, № 2. — С. 24–29. — EDN AZGTTC [Gorbunova N.V., Morozov I.I., Grachev N.S. Mastoidoplasty in the surgical treatment of chronic suppurative otitis media. Methods and results // Bulletin of the Medical Institute of Continuing Education. — 2023. — V. 3, № 2. — P. 24–29. — EDN AZGTTC (In Russ.) ]
8. Ryan P., Wuesthoff C., Patel N. Getting started in endoscopic ear surgery // J Otol. 2020 Mar;15(1):6-16. doi: 10.1016/j. joto.2018.10.002.
9. Manna S., Kaul V.F., Gray M.L., Wanna G.B. Endoscopic versus microscopic middle ear surgery: a meta-analysis of outcomes following tympanoplasty and stapes surgery // Otol Neurotol. 2019;40:983-993.
10. Грачев Н.С., Полев Г.А., Морозов И.И., Самарин А.Е., Ворожцов И.Н., Щербаков Д.А. Опыт применения эндоскопической техники в отохирургии у детей // Вестник оториноларингологии. — 2020. — Т. 85. — № 1. — С. 59–63. https://doi.org/10.17116/otorino20208501159 [Grachev NS, Polev GA, Morozov II, Samarin AE, Vorozhtsov IN, Shcherbakov DA. Our first experience with endoscopic ear surgery // Vestnik otorinolaringologii. 2020;85(1):59-63. (In Russ.) https://doi.org/10.17116/otorino20208501159]
11. Bayram A., Muluk N.B., Cingi C., Bafaqeeh S.A. Success rates for various graft materials in tympanoplasty-a review // J Otol 15:107-111. https://doi.org/ 10. 1016/j. joto. 2020. 01. 001
12. Shakya D., Nepal A. Long-term results of type I tympanoplasty with perichondrium reinforced cartilage palisade vs temporalis fascia for large perforations: a retrospective study // J Otol16:12-17. https:// doi. org/ 10. 1016/j. joto. 2020. 07. 004 13. Guo L., Su Y., Cai Z., Yang Y. Outcomes of transcanal endoscopic middle ear surgery for congenital cholesteatoma // Acta Otolaryngol. 2023 Feb;143(2):141-146. doi:10.1080/00016489.2023.2176544.
13. Srinivasan V., Toynton S.C., Mangat K.S. Transtympanic myringoplasty in children // Int J Pediatr Otorhinolaryngol 39:199-204. https://doi.org/10.1016/ S0165- 5876(96) 01477-2
14. Alzoubi F.Q., Tarifi A.A., Khader Y., de Carpentier J. Comparison between transtympanic and elevation of tympanomeatal flap approaches in tympanoplasty // Otol Neurotol 31:773-775. https://doi.org/10.1097/MAO.0b013 e3181 e40a41

¹ Main Clinical Hospital of the Ministry of Internal Affairs of the Russian Federation, Moscow, Russia
² Medical Institute of Continuing Education of the Federal State Budgetary Educational Institution of Higher Education "Russian Biotechnological University (ROSBIOTECH)". Moscow, Russia

Abstract

Background. Postoperative nasal septum perforation (PNSP) is one of the complication of the nasal septum (NS) surgery, with an incidence of 1–8 %. Surgical repair of the nasal septum improves the patients' quality of life. The most effective techniques are the ones using two rotation flaps of the nasal mucosa, which are used for the plasty of traumatic and idiopathic perforations. The results of implementing this technique for the closure of PNSP require a comprehensive study
Aim. To evaluate the effectiveness of rotary flaps of the nasal mucosa in postoperative nasal septum perforation repair.
Materials and Methods. 18 patients with postoperative nasal septum perforation were operated on. The number of the patients depending on the area (S) of the PNSP was S <1cm² — 4, S 1-2 cm² — 10, S > 2cm² — 4. The criterion for the technique efficiency was the fact of intraoperative complete closure of the PNSP, and the absence of recurrences of the PNSP within 1 year. We analysed the cause-and-effect relationships between the structural features of the PNSP (6 types were identified) with the technique of execution and long-term results.
Results. Complete intraoperative closure of PNSP in 13 of 18 patients (72 %). In 5 patients, an additional sampling of temporal autofascia was performed with subsequent implantation between the flaps for intraoperative complete closure of the PNSP. In 4 out of 13 patients (30 %) with PNSP S 1-2 cm² the PNSP relapse (type 3, 4) was noted. There was 1 relapse (type 5) with PNSP S > 2cm² in 1 out of 5 patients (20 %), to whom autofascia was additionally used.
Conclusions. The surgery of the PNSP according to the specified technique is effective with the PNSP S <1cm²; at S 1-2 cm² it leads to distant relapses in 30 % of the cases, S > 2 cm² is not effective. The use of a temporal fascia autograft allows to increase the efficiency of the postoperative nasal septum perforation regardless the area of it.

Key words: nasal septum perforation, nasal septum perforation repair, complication or nasal septum surgery.

For citations: Gorbunova N.V., Shirokaya A.V., Sardarov G.G. [and etc]. Using of rotational nasal mucosa flaps in postoperative nasal septal perforation repair. // Bulletin of the Medical Institute of Continuing Education. — 2023. — V. 3, No. 3. — S. 36–41. — DOI 10.36107/2782-1714_2023-3-3-36-41.

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¹ Main Clinical Hospital of the Ministry of the Internal Affairs of the Russian Federation,Moscow, Russia
² Medical Institute of Continuing Education, Russian Biotechnological University (ROSBIOTECH), Moscow, Russia

Abstract

Aim. Evaluation of the effectiveness of platelet-rich plasma use in type 1 tympanoplasty according to the reviewed literature
Materials and Methods. The research studies were included where patients with chronic suppurative otitis media underwent tympanic membrane reconstruction using platelet-rich plasma. Inclusion criteria: the patients with chronic tubotympanic otitis media without signs of exacerbation, type 1 tympanoplasty using platelet-rich plasma together with autografts in the study group and only autografts in the control group, postoperative catamnesis of at least three months.
Results. The frequency of a positive outcome of the operation and complete engraftment was 85.7–100 % in the study groups and 55–92 % in the control groups. The average improvement in hearing after the surgery was 10.3-18.62 dB in the study groups and 7.23-15.64 dB in the control groups. There were no significant complications with the platelet-rich plasma use.
Conclusions. The use of platelet-rich plasma in type 1 tympanoplasty in patients with chronic suppurative otitis media is a safe and technically simple method that allows to improve the efficiency of the operation, reduce the number of recurrences of tympanic membrane perforations and unsatisfactory functional results.

Key words: tympanoplasty, platelet-rich plasma, endoscopic tympanoplasty, chronic suppurative otitis media.

For citations: Gorbunova N.V. Morozov I.I., Sardarov G.G., Bulanov K.V. Platelet-rich plasma use in tympanoplasty // Bulletin of the Medical Institute of Continuing Education. — 2023. — V. 3, No. 3. — S. 42–47. — DOI 10.36107/2782-1714_2023-3-3-42-47.

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¹ 1 Medical Institute of Continuing Education of Russian Biotechnological University (ROSBIOTECH), Moscow, Russia
³ Branch No. 2 “National Medical Research Center for High Medical Technologies named after A.A. Vishnevsky of the Ministry of Defense of the Russian Federation, Moscow, Russia

Abstract

The selection of antithrombotic therapy for patients with coronary heart disease (CHD) and concomitant pathology, despite clinical recommendations and scales defining the risk of thrombosis and bleeding may be difficult in some cases. Each doctor may face a clinical situation that does not fit within the general recommendations. Practical experience and determination of indications for the use of anticoagulants depending on the dosage in each specific case will help in the faultless choice of a combination of antithrombotic therapy. A clinical example of a very high-risk CHD patient with concomitant traumatological pathology requiring the selection of antithrombotic therapy is presented.

Key words: coronary heart disease, prevention of venous thromboembolism, orthopedic surgical interventions, antithrombotic therapy.

For citations: Yudin V.E., Yaroshenko V. P., Klimko V.V., Sarkisova M.K. Peculiarities of antithrombotic therapy in the patients with coronary heart disease with concomitant traumatological pathology. How to keep the balance between thrombosis and bleeding? // Bulletin of the Medical Institute of Continuing Education. — 2023. — V. 3, No. 3. — S. 48–52. — DOI 10.36107/2782-1714_2023-3-3-48-52.

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17. Roffi M., Patrono C., Collet J. P., et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: European Heart J. 2016; 37(3): 267-315;Sousa-Uva M., et al 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J. 2019;40(2):87-165.
18. Божкова С.А., Касимова А.Р., Накопия В.Б. и др. Все ли мы знаем о профилактике венозных тромбоэмболических осложнений после больших ортопедических операций? // Травматология и ортопедия России. — 2018. — Т. 24. — №1. — С. 129-143. DOI: 10.21823/2311-2905-2018-24-1-129-143.

¹ Medical Institute of Continuing Education of Russian Biotechnological University (ROSBIOTECH), Moscow, Russia
² Branch No. 2 of "National Medical Research Center for High Medical Technologies, Central Military Clinical Hospital named after A.A. Vishnevsky" of the Ministry of Defense of the Russian Federation, Moscow, Russia

Abstract

Background. The use of the hyperbaric oxygenation therapy (HBO) in the program of medical rehabilitation of the wounded in a timely manner and according to the indications leads to an increase in cardio-respiratory syndrome indicators, improvement of microcirculation in damaged tissues, reduction of the healing time of postoperative scars. An integrated approach to the rehabilitation of the wounded with the use of HBO contributes to the reduction of treatment time for amputee prosthetics
Aim. To optimize the rehabilitation program using the hyperbaric oxygenation method in a rehabilitation center, on the basis of studying the features of the clinical picture and the functional state of the wounded with the consequences of mineexplosive and gunshot wounds.
Materials and Methods. Under the supervision there were 215 patients with amputation defects, aged 20 to 50 years, who were injured during the special military operation between March 2022 and June 2023.
Results. The hyperbaric oxygenation therapy (HBO) resulted in faster healing and epithelialization of wounds, an active growth of granulations, expansion of the zone of viable tissues, and improvement of microcirculation.
Conclusions. As a result of medical rehabilitation using the hyperbaric oxygenation method in the rehabilitation center, the most patients achieved the planned rehabilitation ePect.

Key words: medical rehabilitation, hyperbaric oxygenation, the wounded.

For citations: Yudin V.E., Klimko V.V., Yaroshenko V.P., Budko A.A., Davydova A.A. Optimization of the medical rehabilitation program for the wounded using the hyperbaric oxygen therapy.// Bulletin of the Medical Institute of Continuing Education. — 2023. — V. 3, No. 3. — S. 53–57. — DOI 10.36107/2782-1714_2023-3-3-53-57.

Literature

1. Тришкин Д.В., Серговенцев А.А., Юдин В.Е. и др. Современная система реабилитации и абилитации военнослужащих с ампутацией конечностей // Воен.-мед. журн. — 2023. — Т. 344. — № 2. — С. 4–20.
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7. Отраслевые методические указания ОМУ 42-21-27-88 «Аппараты гипербарической оксигенации. Правила эксплуатации и ремонта». — М., — 1990.

¹ Institute of Osteopathy, Moscow, Russia
² Medical Institute of Continuing Education of Russian Biotechnological University (ROSBIOTECH), Moscow, Russia
³ St. Petersburg Institute for Advanced Training of Medical Examiners, St. Petersburg, Russia
⁴ Clinic "Kivach", Republic of Karelia, Russia
⁵ Branch No. 2 of “National Medical Research Center for High Medical Technologies, Central Military Clinical Hospital named after A.A. Vishnevsky” of the Ministry of Defense of the Russian Federation, Moscow, Russia

Abstract

Background. The relevance of the problem of treating patients with non-alcoholic fatty liver disease dictates the need to find new approaches to such patients' treatment.
Aim. Evaluation of the eZectiveness of the combined use of sanatorium-resort and osteopathic methods of treating patients with non-alcoholic fatty liver disease in sanatorium-resort conditions.

1. To study the dynamics of health complaints patients with non-alcoholic fatty liver disease during the treatment.
2. Investigate the changes in blood biochemical parameters (ALT, AST, GGT) in patients before and after the treatment.
3. To assess the osteopathic status in patients with non-alcoholic fatty liver disease.
4. To evaluate the effectiveness of the patient treatment according to the SF-36 quality-of-life questionnaire.

Materials and Methods. On the basis of St. Petersburg Institute for Advanced Training of Medical Examiners and Clinic "Kivach" (Republic of Karelia), 24 patients of different sexes aged about about 36.4±3.6 years who were undergoing the program "General rehabilitation — 14 days" at the clinic's sanatorium due to non-alcoholic fatty liver disease were examined. Upon arrival at the sanatorium, all patients had their body mass index (BMI) calculated, ultrasound of the abdominal organs and examination for hepatitis B and C markers were performed; the general health condition was assessed, biochemical blood parameters were monitored (liver enzymes: alanine aminotransferase (ALT), aspartate aminotransferase (AST) and γ-glutamyl transpeptidase (GGT) before the treatment, immediately after the treatment in the sanatorium and after 3 months (at the place of residence). The patients' life quality was investigated with the SF-36 questionnaire [1]. The osteopathic examination included an assessment of musculoskeletal, craniosacral and visceral systems according to the generally accepted schemes and was carried out differentially depending on the biomechanical disorders found [2]. The osteopathic treatment of the patients was carried out for 40 minutes 2 times a week.
Results. The high efficiency of the combined use of sanatorium-resort and osteopathic methods of treating patients with nonalcoholic fatty liver disease in sanatorium-resort conditions was identified.
Conclusions. After the course of the combined treatment of the patients in the sanatorium, there is a significant improvement of subjective state indicators (health complaints), normalization of biochemical (liver) blood parameters and osteopathic status. In 3 months after the treatment of the patients, favorable changes in the above-mentioned indicators are more expressed. The effectiveness of the treatment of the patients with non-alcoholic fatty liver disease in sanatorium-resort conditions is confirmed by the positive dynamics of the indicators of physical and psychological components of the health quality of life according to the SF-36 questionnaire.

Key words: osteopathy, sanatorium treatment, non-alcoholic fatty liver disease, quality of life, osteopathic treatment, osteopathic status

For citations: Buchnov A.D., V.V. Matvienko VV, Yudin V.E., Budko A.A. [et al.] The effectiveness of osteopathic treatment of patients with non-alcoholic fatty liver disease in sanatorium and resort conditions. // Bulletin of the Medical Institute of Continuing Education. — 2023. — V. 3, No. 3. — S. 58–62. — DOI 10.36107/2782-1714_2023-3-3-58-62.

Literature

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¹ Medical Institute of Continuing Education, Russian Biotechnological University (ROSBIOTECH), Moscow, Russia
² National Medical and Surgical Center named after N.I. Pirogov, Moscow, Russia
³ Military Medical Academy named after S.M. Kirov, St. Petersburg, Russia

Abstract

This article examines the organization of forensic medical experts of state forensic medical expert institutions with objects contaminated with radioactive substances in emergency situations. The issues of the organization of medical care for radiation damage are covered only in the specialized literature, which is quitereasonable, since it is of exclusively professional interest. However, in the professional literature the topic of the organization of forensic medical examination of objects contaminated with radioactive substances (RS) is practically not discussed. The article proposes the principles of organization of forensic medical examination of objects contaminated with radioactive substances in emergency situations.

Key words: forensic medical experts, radiation safety control, emergency situation, maximum permissible radiation dose.

For citations: Alshevsky V.V., Kataev A.S., Nabiullin I.R. Organization of the work of forensic medical experts of state forensic medical institutions with objects contaminated with radioactive substances in emergency situations. // Bulletin of the Medical Institute of Continuing Education. — 2023.— V. 3, No. 3. — P. 63–66. — DOI 10.36107/2782-1714_2023-3-3-63-66.

Literature

1. Linda Hall Library: научная электронная библиотека: сайт: - 5109 Cherry Street Kansas City, Missouri 64110-2498 URL: https://www.lindahall.org/about/news/scientist-of-the-day/harry-daghlian (дата обращения: 07.06.2023). — Режим доступа: свобод- ный. — Текст: электронный.
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5. Постановление Главного государственного санитарного врача РФ от 26 апреля 2010 г. № 40 «Об утверждении СП 2.6.1.2612-10 "Основные санитарные правила обеспечения радиационной безопасности (ОСПОРБ 99/2010)» (с изменениями и дополнениями).

Crimean Republican Center for Disaster Medicine and Emergency Medical Care, Simferopol, Russia

Abstract

Background. In the current environment the civil defense medical service requires a number of corrective and reorganization measures.
Aim. The purpose of the research is to choose the optimal format of the activity of authorized personnel for solving tasks in the field of civil defense in the Territorial Center of Disaster Medicine in the system of the disaster medicine service.
Materials and Methods. The activity of those in charge of civil defence tasks of seven ambulance stations, which are a part of the Territorial Center of Disaster Medicine, has been studied in two forms of activity organization. The first form: civil defense units are directly subordinate to the head of the ambulance station. The second form: the forces and means of civil defense are included directly in the department of the Disaster Medicine Service of the Department of the Territorial Center of Disaster Medicine.
Results. As a result of the conducted trainings on organization of communication and alerting in administration and divisions of the Territorial Center of Disaster Medicine in the conditions of passing civil defense signals, it is shown that where the civil defense units of the Territorial Center of Disaster Medicine are included in the department of the disaster Medicine Service, the teams are brought to the performers 2.8 times faster compared to where the forces and means civil defense is directly subordinate to the head of the ambulance station.
Conclusions. For the first time proposed format of activity, where the forces and means of civil defense and disaster medicine service of the Territorial Center of Disaster Medicine are structured into one unit with a single management vertical, is the most promising form of interaction between services of the same functional purpose to protect the territories and population from emergencies: prevention of emergencies, elimination of medical and sanitary consequences.

Key words: disaster medicine, civil defense, Territorial Center of Disaster Medicine, emergency situation, elimination of medical and sanitary consequences, healthcare organization.

For citations: O.M. Lyulko, A.V. Shvets, V.I. Zolotareva Integration of the disaster medicine service and civil defense units of the Territorial Center of Disaster Medicine on the example of the Republic of Crimea.// Bulletin of the Medical Institute of Continuing Education. — 2023. — V. 3, No. 3. — P. 67–71. — DOI 10.36107/2782-1714_2023-3-3-67-71.

Literature

1. Малека Ю.Н. Медицинская служба гражданской обороны: генезис, проблемы, перспективы развития. Ю.Н. Малека // Научные образовательные проблемы гражданской защиты. — 2015. — №2. — С. 48–52.
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¹ Medical Institute of Continuing Education of Russian Biotechnological University, Moscow, Russia
² Russian Presidential Academy of National Economy and Public Administration, Moscow, Russia
³ Association of Industry Unions of Agriculture and Food, Moscow, Russia
⁴ 4 Research Center No. 2 of the All-Russian Research Institute of the Ministry of Internal Affairs of the Russian Federation, Moscow, Russia

Abstract

Background. Sterilization of medical devices is one of the most important measures of non-specific prophylaxis aimed at preventing infections associated with the provision of medical care. Sterilization of medical devices is one of the main measures to ensure the safe provision of medical care, an important stage in the system of infection control and epidemiological safety, in accordance with the requirements of which the work on the prevention of nosocomial infection is carried out.. There have been numerous cases of nosocomial infections transmitted through medical devices. Strict observance of all norms and rules of sterilization measures, especially in a pediatric emergency medical organization, is of great importance in the nonspecific prevention of infection associated with the provision of medical care. Strict implementation of the rules for organisation of the central sterilization department in a pediatric emergency medical institution plays an important role in the prevention of infections associated with the provision of medical care to children and makes it possible to fully avoid nosocomial infections in both patients and staff of a medical organization. To carry out measures to properly organise the work of the central sterilization department, a number of administrative, organizational and anti-epidemic measures are required in a medical organization.
Aim. To determine the work organisation features of the central sterilization department in a medical institution of the pediatric emergency care proRle.
Materials and Methods. The materials presented in the publication were obtained by analyzing the work of the central sterilization department of the Research Institute of Emergency Pediatric Surgery and Traumatology.
Results. It has been established that the personnel of the central sterilization department of the Research Institute of Emergency Pediatric Surgery and Traumatology, its material resources and technical equipment comply with the requirements of sanitary rules SP 2.1.3678-20 "Sanitary and epidemiological requirements for the operation of premises, buildings, structures, equipment and transport, as well as the conditions of activity of business entities selling goods, performing work or providing services" and other regulatory and legal documents regulating the work of the central sterilization department in a medical organization.
Conclusions. The organization of medical devices sterilization in the central sterilization department of the Research Institute of Emergency Pediatric Surgery and Traumatology allows to perform sanitary and hygienic (prophylactic) and anti-epidemic measures in order to prevent infections associated with the provision of quality medical care a to patients.

Key words: sterilization, asepsis, antisepsis, prevention, central sterilization department (CSD), healthcare-associated infections (HAIs), nosocomial infections, hospital infections, patient safety, Research Institute of Emergency Pediatric Surgery and Traumatology.

For citations: Gladko V.V., Maev E.Z., Vlasenko A.V.,[et al.] Work organization of a central sterilization department in a pediatric emergency medical institution(part 1). // Bulletin of the Medical Institute of Continuing Education. — 2023. — V. 3, No. 3. — P. 72–78. — DOI 10.36107/2782-1714_2023-3-3-72-78.

Literature

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¹ Department of Plastic Surgery, Medical Institute of Continuing Education of the Russian Biotechnological University (ROSBIOTECH), Moscow, Russia
² Revitalife Plastic Surgery Clinic, Moscow, Russia

Abstract

The article discusses the results of clinical observation, the use of the thrombolytic Russian drug Jrombovazim® for oral use in the early postoperative period, after aesthetic extended surgeries of the periorbital area of the upper and lower eyelids, as well as the buccal area. A comparative clinical dynamic evaluation of the results of soK tissue edema correction with and without thrombolytic therapy was carried out. The performed correction indicates the rate of regression of postoperative edema, lymphostasis, hematomas in the area of surgical intervention in patients with drug administration of Jrombovazim®

Key words: pereorbitoplasty, blepharoplasty, Jrombovasim, lymphatic drainage.

For citations: Pakhomova R.A., Klimenko K.V. Early medical correction of periorbital edema, after aesthetic priorbitoplasty of the upper and lower eyelids // Bulletin of the Medical Institute of Continuing Education. — 2023. — V. 3. — No. 3. — P. 79–82. — DOI 10.36107/2782-1714_2023-3-3-79-82.

Literature

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¹ Medical Institute of Continuing Education of Russian Biotechnological University (ROSBIOTECH), Moscow, Russia
² National Medical Research Center for High Medical Technologies named after A.A. Vishnevsky of the Ministry of Defense of the Russian Federation,Moscow region, Krasnogorsk, Russia
³ Branch of the Military Medical Academy named after S.M. Kirov of the Ministry of Defense of the Russian Federation, Moscow, Russia
⁴ Peoples' Friendship University of Russia, Moscow, Russia

Abstract

Based on the experience of performing endomyocardial biopsy and the results of its histological diagnosis and treatment, as well as the continuous development of medical technology and diagnosis of non-coronary myocardial diseases in modern realities, myocardial biopsy still remains the "gold standard" of diagnosis. Endomyocardial biopsy is an invasive diagnostic method, therefore, it has periprocedural and postprocedural risks associated with both endovascular access to the heart and biopsy performance. This article describes the history of endomyocardial biopsy and a clinical case complicated by extravasation into the fascial bed of the sternocleidomastoid muscle, as well as strategies and methods that can improve the sensitivity of endomyocardial biopsy using additional instrumental diagnostic methods.

Key words: endomyocardial biopsy, non-coronary myocardial diseases, endovascular biopsy, myocarditis, hematoma, jugular vein puncture.

For citations: Shabaev R.M., Ivanov A.V., Ivanov V.A., Gulyaev N.I., Khatsaeva S.R., Esion G.A. History of endomyocardial biopsy development in endovascular surgery. A clinical case of an endomyocardial biopsy complication. // Bulletin of the Medical Institute of Continuing Education. — 2023. — V. 3, No. 3. — P. 83–90. — DOI 10.36107/2782-1714_2023-3-2-83-90.

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¹ 419 Military Hospital of the Russian Ministry of Defense, Krasnodar, Russia
² Medical University of Continuing Education of the Russian Biotechnological University (ROSBIOTECH), Moscow, Russia
³ State Research and Testing Institute of Aviation and Space Medicine, Moscow, Russia
⁴ Branch №5 of 425 Military Hospital, of the Ministry of Defense of Russia, Aleisk, Russia

Abstract

Background. Nowadays, objective assessment of fitness for flight work is an important component in the prevention of early morbidity and prolongation of professional longevity in pilots. Magnetic resonance imaging of the brain as a method of neuroimaging is mandatory. Studying and analyzing the obtained MRI data of the brain of young pilots in comparison with electroencephalography data provides a functional approach to determining fitness for flight work and prognosis of professional longevity.
Aim. To study the frequency and structure of various forms of brain structure changes using MRI of young pilots to ensure their examination within the framework of medical and flight expertise in comparison with electroencephalography data.
Materials and Methods. A total of 320 pilots diagnosed as healthy were included in the study. The median age characteristics were 19.0 [17.0; 25.0] years. The study design was an empirical, single-moment study. All pilots without identified contraindications (n=320) underwent a contrast-free magnetic resonance study of the brain. An electroencephalograph-analyzer was used to record EEG. The data were recorded under standard conditions in a silent darkened room.
Results. When evaluating the results, it was found that in 307 (88.2 %) cases the EEG data were within the age normal range. In group 1 patients (without any MRI features in the liquor system) 40 (11.5 %) people were found to have changes in the form of decreased total cortical electrogenesis in the form of the presence of alpha rhythm in occipitotemporal and temporal leads, as well as beta rhythm predominantly in the right cerebral hemisphere. In a single case (0.3 %) of a young pilot T. from group 2 (with the presence of dilatations of liquor spaces in various brain localizations) EEG changes showed no clear amplitude accent. At this patient's MRI dilated liquor spaces up to 10 mm in the posterior cerebellar region were visualized.
Conclusions. Based on this study, the advantage of MRI in assessing intracranial changes in determining the degree of young pilots' fitness for military service has been proved. the data obtained indicate that the incidence of intracranial changes differs significantly from the figures presented in the available literature. Electroencephalography in comparison with brain neuroimaging is a functional method in determining the state of health of young pilots, but a significant number of structural features of intracranial formations determined by tomography are variants of normal anatomy and have no abnormalities on electroencephalography.

Key words: neuroimaging of the brain, magnetic resonance imaging of the brain, electroencephalography, cystic cerebral neoplasms, medical and flight committee.

For citations: Kolomiitsev V.G., Gornov S.V., Gornov V.V., Agakhanova M.D. Functional assessment of MRT and EEG results of the brain of young pilots in the interests of medical-flight examination. // Bulletin of the Medical Institute of Continuing Education. — 2023. — V. 3. — No. 3. — P. 91–95. — DOI 10.36107/2782-1714_2023-3-3-91-95.

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¹ Faculty of Advanced Medical Training of the Moscow Regional Research and Clinical Institute namedafter M.F. Vladimirskiy, Moscow, Russia
² Department of Fundumental Medical Disciplines of the State University of Education, Mytishy, Russia
³ National Medical and Surgical Center named after N.I. Pirogov of the Ministry of Health of the Russian Federation, Moscow, Russia
⁴ Russian Biotechnological University (ROSBIOTECH), Moscow, Russia

Abstract

Background. This article is devoted to the prospects of assessing the dating of traumatic haemorrhage formation using biophotonics technologies, in particular hyperspectral imaging. Currently, the most common method of determinatin the age of bruising in forensic medicine is macroscopy, the low objectivity of which does not allow to reliably determine the timing of the occurrence of the injury. In order to improve the accuracy, various instrumental research methods, including physical and biochemical ones, have been introduced into the practice of forensic medical experts. However, those who use the color of the bruise as the main characteristic are advantageous. These include photometry methods. Nevertheless, for all their benefits, these methods are not able to determine the spatial location of chromophores in the bruise. Hyperspectral imaging has a great potential as it eliminates this problem, which increases the prospects for studying this issue.
Aim. Improving the accuracy of determining the age of traumatic hemorrhage formation using hyperspectral imaging.
Materials and Methods. Registration of hyperspectral images of traumatic hemorrhages was carried out using a hyperspectral camera designed in the Biophotonics Laboratory of the Skolkovo Institute of Science and Technology under the lead of Dmitry Gorin.
Results. As a result of digital image processing at each wavelength, a map of tissue oxygenation is obtained, whichcan be used to see the distribution of oxy- and deoxyhemoglobin chromophores in the bruise.
Conclusions. The method of such an actively developing area of biophotonics as hyperspectral imaging is capable of surpassing the research results of other spectral methods.

Key words: photometry, hyperspectral imaging, forensic medicine, age of bruises biophotonics, color, physics.

For citations: Pligin A.V., Maksimov A.V., Kataev S.A. Biophotonics perspectives in determining the age of traumatic haemorrhage formations. // Bulletin of the Medical Institute of Continuing Education. — 2023. — V. 3. — No. 3. — P. 96–99. — DOI 10.36107/2782-1714_2023-3-3-96-99.

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¹ National Medical Research Center for High Medical Technologies named after A.A. Vishnevsky of the Ministry of Defense of the Russian Federation, Krasnogorsk, Moscow region, Russia
² Department of Urology, Medical Institute of Continuing Education of the Russian Biotechnological University (ROSBIOTECH), Moscow, Russia
³ Department of Urology and Andrology, State Research Center – A.I. Burnazyan Federal Medical Biophysical Center of the Federal Medical-Biological Agency, Moscow, Russia
⁴ Department of Urology, City Clinical Hospital named after D.D. Pletnev, Moscow, Russia
⁵ Lomonosov Moscow State University, Moscow, Russia
⁶ JSC "European Medical Center", Moscow, Russia
⁷ Urological Department of Branch №1 of the N.N. Burdenko FGBI GVKG of the Russian Ministry of Defense. Moscow, Russian

Abstract

Background. A retrospective analysis of surgical treatment of patients with large proximal ureteral stones for the period from January 2018 to December 2022 was carried out. A total of 275 patients were included in the study, 246 (89.4%) men and 29 (10.5 %) women, The average age was 42.7±3.5 years. The inclusion criteria were the stone size ≥10 mm, the average size was 12.7±0.8 cm, the localization of the stone was above the intersection of the ureter with the iliac vessels. The patients were divided into groups according to the performed method of surgical treatment: remote lithotripsy (ESWL-ureterolithotripsy) in 75 patients, percutaneous (antegrade) lithotripsy in 38 patients and transurethral lithotripsy in 128 patients. Simultaneous percutaneous percutaneous nephrolithotripsy (PNLT) and transurethral ureterolithotripsy were performed in 14 patients and percutaneous (antegrade) flexible ureterolithotripsy through previously formed percutaneous accesses was performed in 20 patients. The density of stones subjected to ESWL was significantly lower than in groups with other methods of treatment p≤0.001. Percutaneous methods of treatment were used for larger stones (p<0.05). The SFR index was achieved with ESWL in 60 (80 %) and was maximally expressed with endoscopic and percutaneous methods of treatment. Antegrade flexible ureterolithotripsy was achieved in 19 (95 %) patients in the group. Simultaneous percutaneous and retrograde interventions were successful in 12 (85.7 %) patients, which is comparable to the effectiveness of PLT — 32 (84,2 %) patients. Intraoperative complications were noted in 2 (2.6 %) patients in the ESWL group (subcapsular hematoma) and in 17 (8.5 %) cases in the endoscopic and percutaneous treatment groups. Postoperative complications were associated with exacerbation of pyelonephritis in 18 (6.5 %) patients and were managed by the conservative measures.
Aim. To evaluate the effectiveness of the main methods of treatment for large proximal ureteral stones.
Materials and Methods. The results of the performed surgical treatment of patients with large stones of the proximal ureter in one of the Urological Departments of the Urological Center of the National Medical Research Center for High Medical Technologies named after A.A. Vishnevsky for the period from January 2018 to December 2022 were analyzed. A total of 275 patients were included in the study
Results. The key indicator of the effectiveness of surgical intervention in large stones of the proximal ureter is the stonefree rate (SFR), which was achieved with ESWL-ureterolithotripsy in 60 (80 %) patients and the maximum in the group of antegrade flexible ureterolithotripsy in 19 (95 %) patients.
Conclusions. Percutaneous and transurethral endoscopic methods of treatment demonstrate the greatest effectiveness of removing large stones of the proximal ureter. ESWL-ureterolithotripsy as a first-line method can be considered provided that the kidney function on the side of the stone is preserved and there are no clinical manifestations of obstructive pyelonephritis activity. ESWL-ureterolithotripsy is successful with a stone density of up to 1000-1100 HU.

Key words: proximal ureteral stones, percutaneous ureterolithotripsy, ESWL-ureterolithotripsy, nephrostomy, percutaneous antegrade ureterolithotripsy.

For citations: Kochetov A.G., Martov A.G. , Sidorov, D.V., Pavlov O.V., Dubrovskih S.A., Plechanova O.A., Kasaikin A.V. Treatment tactics of for patients with large proximal ureteral stones. // Bulletin of the Medical Institute of Continuing Education. — 2023. — V. 3. — No. 3. — P. 100–106. — DOI 10.36107/2782-1714_2023-3-3-100-106.

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¹ Russian Scientific Center of Roentgenoradiology, Moscow, Russia
² Pirogov Russian National Research Medical University, Moscow, Russia
³ Research Institute of Urology and Interventional Radiology named after N.A. Lopatkin — Branch of the National Medical Research Radiological Centre, Moscow, Russia

Abstract

Medical advances and general care have improved the life expectancy of spinal cord injury patients over the past decades. Rightfully so, the relevance of age-related diseases such as cancer has been raised. This literature review discusses the published data on the epidemiology, possible causation, and course and follow-up of genitourinary cancer in patients with the neurogenic lower urinary tract dysfunction due to the traumatic spinal cord injury.

Key words: spinal cord injury, neurogenic bladder, neurogenic bladder complications, bladder cancer, prostate cancer

For citations: Salyukov R.V., Kasatonova E.V., Salyukova Yu.R., Pavlov A.Yu. Malignancy due to the neurogenic lower urinary tract dysfunction in patients with the traumatic spinal cord injury. // Bulletin of the Medical Institute of Continuing Education. — 2023. — V. 3, No. 3. — P. 107–114. — DOI 10.36107/2782-1714_2023-3-3-107–114.

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¹ FSBI «National Medical Research of High Medical Technologies» of the Ministry of Defense of the Russian Federation.
² Russian Biotechnological University, Department of Urology Medical Institute of Continuing Education, Moscow, Russia.
³ A.I.Burnazyan MBU INO FMBC of the FMBA of Russia.
⁴ GBU of Moscow «City Clinical Hospital. D.D.Pletnev of the Department of Health of the City of Moscow», Moscow, Russia.
⁵ Medical Scientific and Educational Center of Moscow State University named after M.V. Lomonosov.
⁶ Urologist at «European Medical Center» Moscow, Russia.

Abstract

This research describes in detail the method of endoscopic diagnosis and treatment of interstitial cystitis/bladder pain syndrome. Primary bladder pain syndrome is chronic or recurrent episodic pain localized in the bladder area, which is accompanied by at least one symptom, including increased pain when the bladder is full and increased frequency of urination during the day and/or night. Hydrodistension of the bladder is a therapeutic and diagnostic procedure of tight filling of the bladder with an irrigation solution under a pressure of 80 cm of water, performed under general anesthesia. The paper presents an analysis of the various stages of the hydrodistension procedure, which are of key importance for the correct stratification of patients and achieving a therapeutic effect. A case series demonstrating the variety of diagnostic and therapeutic results of hydrodistension cystoscopy is described as clinical examples.

Key words: interstitial cystitis, bladder pain syndrome, Hunner's lesion, cystoscopy with hydrodistension.

For citations: Plekhanova O.A, Martov A.G., Kochetov A.G., Baykov N.A. Cystoscopy and hydrodistension in patients with interstitial cystitis/bladder pain syndrome. // Bulletin of the Medical Institute of Continuous Education. — 2023. — V. 3, No. 3. — S. 115–120. — DOI 10.36107/2782-1714_2023-3-3-115-120.

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