treatment

Elderly people are a high-risk group for developing tuberculosis, with difficulties in diagnosis and treatment with an uncertain prognosis. We present a clinical case of tuberculosis with a favorable outcome in a patient aged 86 with a large numerous comorbid pathologies, including an organic brain disease with intellectual and behavioral disorders. This clinical observation demonstrates an atypical course of tuberculosis in the elderly, a slow reverse dynamics of the process and a cure with large residual changes in the lungs.

The review of the literature data on the peculiarities of the pathogenesis of radicular and myelopathic syndromes of cervical osteochondrosis is presented. The issues of differentiated diagnosis of radiculopathic and myelopathic syndromes are considered. The characteristic of various methods of treatment is given. The efficiency and possibility of using electrostimulation of the spinal cord for the treatment of radicular and myelopathic syndromes of cervical osteochondrosis have been studied.

Purpose: to assess the possibilities of frameless biopsy of brain tumors with deep and hard-to-reach localization and its impact on the treatment strategy. Material and Methods. 56 patients with supratentorial brain tumors of deep and hard-to-reach localization who underwent biopsy using frameless neuronavigation according to accepted standards. Results. In 9 (16.1 %) cases there was a discrepancy between the data of the preliminary MRI examination and the histological conclusion of the punctate after the biopsy, which changed the tactics of treatment. Conclusion. Biopsy of brain tumors of deep and hard-to-reach localization allows you to accurately and least invasive to establish the correct diagnosis. Conducting a frameless biopsy with subsequent immunohistochemical verifcation of the biopsy allows planning adequate further treatment, increasing the duration and quality of life of patients with brain tumors of deep and hard-to-reach localization.

Purpose. To present the own experience in iris cyst treatment. Materials and Methods. In this retrospective study 20 eyes with iris cysts were included. Lesions were managed with intracystic ethanol irrigation with and without subsequent surgical resection of the walls. Results. Complete iris cyst destruction was achieved in 16 cases. In 4 eyes cyst recurrence after ethanol irrigation was revealed and successfully treated by ethanol irrigation without subsequent surgical resection of the walls. No complications were seen within mean follow-up of 26 months. Conclusion. Intracystic ethanol irrigation is an effective treatment modality. Additional surgical resection of the cyst walls helps to improve treatment results with no signs of recurrences and complications.

Purpose: to investigate the epidemiological and clinical features of optic neuritis, evaluate the effectiveness of treatment and underlying diseases. Material and Methods. 58 patients (60 eyes) with optic neuritis (ON) were observed. Among them, 54 adults (26 men, 28 women) aged 19-67 years (mean age 36±11.8 years) and 4 children (1 boy, 3 girls) 14-16 years. Along with the standard ophthalmologic examination, electrophysiological studies, visual evoked potentials and magnetic resonance imaging of the brain and orbit, and a consultation with a neurologist were conducted. The patients were divided into two groups. In the main group of 32 patients (34 eyes), the complex treatment is carried out according to the developed method, which includes daily administration of 1 % nicotinic acid solution in the age dose (from 1 ml to 6 ml per day) with pentoxifylline on the background of basic ON therapy. In the control group of 26 patients (26 eyes), along with basic therapy of 1% nicotinic acid, 1 ml intramuscularly is prescribed a course of 10-15 days. Results. The number of children of young working age (65.5%), including children (6.9%). In the overwhelming number of cases, intrabulbar neuritis was diagnosed (84.5%). In 8 of 9 patients, the precursor of retrobulbar neuritis (PN) was multiple sclerosis (MS). Among other etiological causes of ON viral infection prevailed (37.9%). In patients prolonged by the proposed method, an improvement in visual functions (increased visual acuity, expansion of the general boundaries of the visual field) was achieved in 91% of cases, including high vision (0.5-1.0) in 65% of cases; in patients of the control group, these indicators correspond to 54% and 23%. Conclusion. The use of nicotinic acid intravenously in age dosage with pentoxifyllone in complexes with basic therapy allows the use of methods of treatment of optical neuritis using etiology and can be recommended for widespread use in practical ophthalmology.

Aim: to evaluate the effect of the drug Cytoflavin (CFL), containing mitochondrial substrates and co- factors, on tear production in arc welders, gas welders and office workers with dry eye syndrome (DES). Material and Methods. 124 patients (248 eyes) with DES of professional etiology were enrolled in this study. Patients of the experimental group (CFL) took three 25-day courses of cytoflavin separated by 1 month intervals, while the control group received placebo. Results. Reception of CFL over 3-month cycles with intervals of 30 days contributed to an increase in visual acuity (VA) by 29,0-34,0%, Schirmer's test (ST) by 27.0-51.0%, and Norn's test (NT) by 7.5-11.0%, meniscus measurements (MM) by 32.0-37.0% and lower indices of intraocular pressure (IOP) by 3-5% in both occupational groups. Conclusion. The resulting increase in values of parameters characterizing the functional activity of the lacrimal gland under the action of the CFL suggest that pharmacological energy protection contributes to the improvement of tear production and eye hydrodynamics in welders and office workers.

 Objective: determination of comparative antiangiogenic effectiveness and influence of beta-blockers on the level of a vascular endothelial factor of growth in an experiment. Material and Methods. For determination of antiangiogenic effect of beta-blockers, comparative studying of their influence on the level of a vascular endothelial factor of growth in an experiment on 72 nonlinear laboratory rats, by average weight 180±20 g which were conditionally divided into 6 groups is executed: 1st — control, 2nd — negative control (experimental ischemia (El), crossing of femoral vessels), 3rd — positive control (El with bevacizumab introduction), 4th — El with introduction of a timolol, 5th — El with introduction of a betaksolol, 6th — El with introduction of interferon alpha 2b. Results. The VEGF levels were: in 1st group 1.5±0.3 pg/ ml, in 2nd group 20,3±3,2 pg/ml, in 3rd group5,8±0,9 pg/ml, in 4th group 13,8±1,4 pg/ml, in 5th group 192,0±2,3 pg/ml, in 6th group 11,1 ±2,2 pg/ml. Results of microscopy and immunohistochemical research demonstrate lack of activation of processes of neoangiogenesis in 1 st group of animals. At animals of 2nd and 5th groups along with the expressed inflammatory processes the neoangiogenesis phenomena are established. Conclusion: Beta-blockers show the direct or mediated negative impact on synthesis of VEGF and oppression of neoangiogenesis. The activity of selective beta-blocker concerning neoangiogenesis suppression was lower in comparison by activity non-selective that allows to consider the timolol effective antiangiogenic remedy.

The purpose was to analyze the risk factors for the development of perinatal lesions of the central nervous system and to identify cause-effect relationships. Material and Methods. The retrospective analysis of primary documentation: history of childbirth and history of development of newborns is carried out. The work is based on the results of a comprehensive clinical and neurological examination, neurosonographic data and individual laboratory parameters. Results. In 2017 in the clinical perinatal center of the Saratov region 3301 births were conducted, of which the first delivery was performed in 69,4%, repeated in 30,6% and cesarean section in 41,2% of women. Hypoxic-ischemic disorders were observed in 928 newborns (27,7%). Children with low Apgar score had a combined genesis of chronic intrauterine hypoxia and acute asphyxia in childbirth in 3.8% of cases. Intraventricular hemorrhages (IHD) were diagnosed in 4,3% of cases, birth injuries in 3,6%. Congenital malformations of the central nervous system (CNS) were detected in 31 children (24,4%). Conclusion. The pathological course of pregnancy, problematic natural childbirth and emergency cesarean section are the most frequent risk

The review of open access literature on the issues of complex diagnostics and treatment potential of implant-associated infection of the knee joint area was given in the article. We describe clinical signs, the potential of laboratory diagnostics of deep implant-associated infection from the point of view of sensitivity and specificity as well as main methods of surgical treatment of the pathology.

Aim: to develop a personalized approach to diagnostics and treatment of patients outcomes with degenerative and post-injury deformities of cervical spine. Material and Methods. Between January 2009 and January 2016, 520 patients at the age of 15-80 years with degenerative (227) and traumatic (293) lesions of cervical spine were treated in neuro-surgical department. We conducted a comparative analysis of two groups of patients: treated in the period from 2009 to 2012 (group 1: 235 patients) and in the period from 2013 to 2016 (group 2: 285 patients). The developed diagnostic algorithm was used in patients of group 2 when the operation was planned. Results. The frequency of all complications was significantly lower in group 2. In the analysis of complications it was revealed that more often in group 1 there were: dysphagia, dysphonia, severe postoperative pain in the neck and upper limbs; breakdown or malposition of the screw, graft or plate. Conclusion. The comprehensive algorithms for diagnosis and treatment of patients with degenerative and post-injury deformities of cervical spine that take into account their individual morphometric and functional data allow to form an effective personalized program of surgical rehabilitation and reduce the number of perioperative complications from 35 to 9%.