2018, volume 14

Objective: an analysis of the conditions and nature of the work of public health workers in the city of Samara, according to their own research and the results of a special assessment of working conditions for the development of preventive measures. Material and Methods. The study analyzed the results of assessing the factors of the production environment, such as microclimate and illumination in 70 rooms of two large medical institutions of the city of Samara. An estimation of the qualitative and quantitative microbial composition of the air medium in the analyzed rooms was carried out. The analysis of registration cards for a special assessment of the working conditions of workplaces in the same organizations was carried out between 2012 and 2017. Results. In analyzing the conditions and nature of the work of medical workers, it was revealed that the final class of working conditions for doctors and nurses of surgical departments was 3.3, therapeutic 3.2 as a result of biological factors. At the same time, the air in the working area of the study rooms of the surgical and therapeutic sections differed significantly in the structure of the conditionally pathogenic microflora. Physical and chemical factors did not exceed the level of class 3.1-3.2. Conclusion. An analysis of the results of the studies showed the need to optimize ventilation in the residents and nurses, as well as the need to improve the quality of natural and artificial lighting. The expediency of standardization of the conditionally pathogenic microflora of the air environment in class «B» premises is shown.

Objective: to assess the possibility of using markers of renal injury and carcinogenesis as additional criteria for the choice of the method of surgical treatment of RCC and to minimize the risk of development and progression of kidney injury. Material and Methods. 60 patients with morphologically confirmed RCC T1-3M0N0 operated on in the volume of open nephrectomy or laparoscopic nephrectomy or laparoscopic resection and the kidney were examined. Patients were divided into 3 groups: group 1: patients after nephrectomy performed for kidney cancer using traditional surgical technique, group 2: patients after laparoscopic nephrectomy and group 3: after laparoscopic resection of kidney tumor. Before surgical operation, on the 5-7 day and after 1 month, all patients were examined by concentrations of urinary excreted lipocalin 2 (NGAL), and serum concentrations of IL-18, MMP-9 and IGF-1. Renal function was estimated using the calculated GFR equation (CKD-EPI 2009) based on serum creatinine level. Immunohistochemical study of histological preparations of distant tumors on proliferation antibodies (Ki-67, PCNA), apoptosis (BAX, Bcl-2) was performed. Differences in clinical data and clinical variables were compared using Spearman rank correlations and t-test. Results. The studied indices of renal damage of IL-18, NGAL, MMP-9 and IGF-1 both in the early (5-7 days) and later (1 month) postoperative period showed a correlation between the surgical intervention method and the degree of tumor cell differentiation. Conclusion. The levels of biomolecular markers of renal damage (IL-18, NGAL, MMP-9 and IGF-1) correlate with the degree of differentiation in thetumoral cells and functional activity of the remaining renal parenchyma in the postoperative period, but also depend on the individual characteristics of the patient's body. A certain level of expression of MMP-9 and IL-18 with a small tumor size can be a guide to determine the indications for the choice of organ-preserving surgery in patients.

The article presents a clinical case of systemic lupus erythematosus with severe thrombocytopenia in a 55 year old patient. The standard therapy of usage of high doses of glucocorticoids, cyclophosphamide and intravenous im-munoglobulin was not effective. Application of Rituximab improved the course of disease, decreased the severity of thrombocytopenia, led to disappearance of leucopenia and anemia.

The article highlights debatable questions concerning the effectiveness of surgical treatment of osteoporotic vertebral fractures. The reasons of unsuccessful outcomes of vertebroplasty are analyzed. A combined method of surgical treatment is proposed, including vertebroplasty and full-endoscopic foraminotomy with a combination of local and ra-dicular pain syndrome caused by stenosis of the intervertebral foramen. A clinical example is given.

The aim of the work is to assess the quality of life before and after multistage and one-stage operations, palliative interventions performed with malignant neoplasms of the esophagus. Material and Methods. The quality of life was evaluated in 565 patients with esophageal cancer at various stages of surgical treatment by means of questionnaires for assessing the quality of life of GIQLI, GSRS, MOS SF-36 questionnaire. Results. When performing multi-stage operations before the end of treatment, the quality of life changes insignificantly, and is comparable with the quality of life after palliative operations. The study of the quality of life after the end of treatment with the use of endoscopic minimally invasive technologies in these questionnaires convincingly showed the advantage of this category of surgical interventions due to less trauma, better cosmetic effect, quick activation and rehabilitation in the postoperative period. Conclusion. Taking into account the results of the research, preference is given to one-stage operations with the use of minimally invasive endoscopic techniques, which in a short time can save the patient from cancer and significantly improve the quality of life.

The purpose was to evaluate the results of arthroscopic reconstruction of the rotator cuff of a shoulder using the single-row anchor fixation method, to evaluate the dependence of the results of treatment on the size of the rupture of the rotator cuff of the shoulder. Material and Methods. This report provides an analysis of results of surgical treatment of 84 patients with the damage of the rotator cuff of a shoulder, who underwent arthroscopic reconstruction of the rotational cuff of a shoulder using single-row anchor fixation. The size of rupture of the rotator cuff of the shoulder was measured with the use of MRI and during surgery itself. All ruptures were subdivided into small (less than 1 cm), medium (1-3 cm) and large (3-5 cm). The exclusion criteria were patients with a massive rupture of the rotator cuff of a shoulder, with retraction of the tendon to the level of the articular process of the scapula or fatty degeneration of the muscles of the short shoulder rotators. The paper presents the features of operative technique and original algorithm for postoperative rehabilitation at different stages of treatment. Evaluation of the results of treatment was performed according to the rating scale of the Constant score, ASES, UCLA. Results. The average age of the patients was 56.0±7.4 (36-71 years). Of these, 22.6% patients had a small degree of rupture of the rotator cuff of a shoulder, 50% middle and 27.4% patients had a large degree of rupture. The nearest results (up to one year) were evaluated in 5 patients, long-term results in 79 patients (more than a year). The average rating score according to the Constant score was 89,8±9,2; the average value according to the ASES scale was 83,7±17,6; the average value according to the UCLA scale was 29.3±5.9. In all other patients complete recovery was observed in the period from 6 months to a year after the operation, there was a decrease in the pain syndrome, an increase in the volume of movements, an improvement in the quality of life. Conclusion. Arthroscopic reconstruction of the rotator cuff of a shoulder using the method of single-row anchor fixation, if necessary, with the help of seams which reapproximate the edges of the rupture, and with the help of the accompanying procedures, provides good results. Reduction in pain, increase in movement and in muscle strength in the arm were noted in all patients, regardless of the size of the damage to the rotator cuff of the shoulder. The rehabilitative protocol used ensures the creation of favorable conditions for engraftment of the restored tendon and, at the same time, provides prevention of the development of the stiffness of the shoulder joint.

Aim: to analyze anatomic and functional changes in children with flatfoot. Material and Methods. We analyzed foot state in 40 children (34 boys and 6 girls, aged 5-14, mean age: 9.6±2.3 yrs), comparison group consisted of 30 healthy children aged 5-14 (mean age 8.5±2.5 yrs) without foot pathology. Patients were diagnosed on the basis of clinical examination: complaints, functional stress tests, QL questionnaire Oxford Ankle Foot, instrumental methods (X-ray, biomechanical investigation). Results. Right from early age (5 yrs) children start experiencing discomfort in feet in the course of various physical exercises, in our experiment 77% of patients have discomfort complaints. Mean indexes of OAFQ were 30.8±12.5. All children had signs of astragalus erection with respect to calcaneum which stipulates disturbance of longitudinal arch of foot joints and of normal function in talocalcaneal coalition. The disturbance of gait time indexes results in its decreased function. Conclusion. At present the problem of flatfoot in children did not get proper attention. The surgeons should focus on the features of pathology development in children 7-14 yrs applying all modern diagnostic methods.

Aim: to analyze anatomic and functional changes in children with flatfoot. Material and Methods. We analyzed foot state in 40 children (34 boys and 6 girls, aged 5-14, mean age: 9.6±2.3 yrs), comparison group consisted of 30 healthy children aged 5-14 (mean age 8.5±2.5 yrs) without foot pathology. Patients were diagnosed on the basis of clinical examination: complaints, functional stress tests, QL questionnaire Oxford Ankle Foot, instrumental methods (X-ray, biomechanical investigation). Results. Right from early age (5 yrs) children start experiencing discomfort in feet in the course of various physical exercises, in our experiment 77% of patients have discomfort complaints. Mean indexes of OAFQ were 30.8±12.5. All children had signs of astragalus erection with respect to calcaneum which stipulates disturbance of longitudinal arch of foot joints and of normal function in talocalcaneal coalition. The disturbance of gait time indexes results in its decreased function. Conclusion. At present the problem of flatfoot in children did not get proper attention. The surgeons should focus on the features of pathology development in children 7-14 yrs applying all modern diagnostic methods.

Longitudinal flatfoot is heterogeneous group of conditions, characterized by a decrease of longitudinal arch height. In mobile flatfoot, this decrease is dynamic, it occurs under vertical load and proceeds asymptomatically. Specialists should pay attention to the "pathological" flatfoot developing with pain syndrome or causing severe gait disturbance. The review analyzes the fundamental and current opinions of local and foreign researchers on the development of flatfoot in children. Literatural data of age dynamics of foot development, epidemiology of flatfoot in childhood, the influence of flatfoot on the foot and gait biomechanics and basic diagnostic methods are presented.

 An accurate assessment of renal function is critical for adequate dosing of medications. The most informative marker reflecting the functional state of the kidneys is glomerular filtration rate (GFR). Determination of inulin clearance is the most accurate way to assess GFR in children and adults. In this case, the method is invasive, cumbersome, younger children require the installation of a urinary catheter. Techniques for radioisotope estimation of GFR can solve this problem, but all widely used radioisotopes have the ability to bind slightly to plasma proteins, which leads to an underestimation of real values.