2016, volume 12

Aim: to study the peculiar features of clinical course of acute varicothrombophlebitis and surgical approach to patients with undifferentiated dysplasia of connective tissue. Material and Methods. The features of undifferentiated dysplasia of connective tissue, character of clinical course of acute varicothrombophlebitis, remote results for 94 patients, who had had Troyanov — Trendelenburg's operation, were studied. Results. 70 patients (74,5%) with acute varicothrombophlebitis demonstrated more than four phenotypic characters which showed the presence of undifferentiated dysplasia of connective tissue. 22 patients (31,4%) with acute varicothrombophlebitis with undifferentiated dysplasia of connective tissue were proved to have the discrepancy between localization of acute varicothrombophlebitis clinical evidences and level of proximal part of thrombus in the lumen of great saphenous vein. During the remote observation period, 66 patients (94,3%) with acute varicothrombophlebitis with undifferentiated dysplasia of connective tissue had pheblectomy, as there was vertical and horizontal pathological venous reflux. Out of 24 patients (25,5%) with acute varicothrombophlebitis without undifferentiated dysplasia of connective tissue, only four patients (16,7%) needed thesecond stage of surgical treatment, because 20 patients (83,3%), in 6 months after Troyanov — Trendelenburg's operation, demonstrated the restoration of functional consistency of valves of great saphenous and perforating veins. Conclusion. When determining the indications for urgent disconnection of saphenofemoral junction for patients with acute varicothrombophlebitis and also when choosing surgical treatment approach during remote observation period, it is reasonable to examine the phenotypic characters of undifferentiated dysplasia of connective tissue.

The article describes a clinical case of spontaneous esophageal rupture. Raising awareness of physicians about this syndrome will facilitate its timely diagnostics.

Tftea/m of the study is to determine the relationship of clinical surgical treatment options of degradation of retroperi-tonealfat. Material and Methods. We have analyzed the results of treatment of 1177 patients with necrotizing pancreatitis, taking into account the severity and characteristics of parapancreatitis. Statistical data processing was carried out by the program Statistica for Windows 6.0. using the Student's criterion. Results. The variety of clinical forms of pancreatic necrosis due to a combination of options lesions of the pancreas and retroperitoneal fat. The outcome of pancreatic necrosis is determined not only by the degree of destruction of the pancreas, but also features parapancreatitis. The allocation of limited and common prevalence of parapancreatitis was substantiated and specified. Conclusion. The effectiveness of the treatment of pancreatic necrosis is dependent on the development options of parapancreatitis which present the predictive and tactical value.

Purpose: improvement of differential diagnostics of benign and malignant renal tumors basing on complex estimation of the results of MRTand the level of such biomarkers as vascular endothelial growth factor, monocyte chemotactic protein-1 and matrix metalloproteinase-9 in blood serum and urine. Material and Methods. A total of 106 patients including the main group of 60 patients with renal cancer (RC), the group of comparison of 16 patients with benign renal tumors and the control group of 30 practically healthy persons were examined. ELISA was employed for detection of the biomarkers in blood serum and urine. The tumors were diagnosed by MRT Results. The increase of the level of the biomarkers in blood serum and urine was registered independently of the character of neoplastic process; more significant increase was observed in patients with RC, especially at the early stages of the disease. Some peculiarities of changing of the level of the biomarkers depending on the dimensions of malignant tumors were found. Conclusion. At the early stages of RC complex detection of the abovementioned biomarkers in blood serum and urine can serve an additional clinical diagnostic and prognostic criterion.

The purpose of the clinical observation is to study the early symptoms of multiple heart rhabdomiomas of a newborn; to draw the attention of specialists on one of the rarely occurred problems in the neonatal practice.

The aim of the study was to evaluate the incidence of chronic kidney disease (CKD) in patients with chronic back pain and nonsteroidal anti-inflammatory drugs (NSAIDs) intake not less than a year, and to study the interrelation between CKD, peculiarities of pain and its treatment. Material and Methods. 91 patients with axial spondyloarthri-tis — ax-SpA(ankylosing spondylitis and non-radiographic ax-SpA) and 35 patients with degenerative diseases of the spine (DDS) with NSADs intake not less than 1 year were involved in the study. The control group included healthy volunteers who did not took NSAIDs during the last year (n=51). By age, gender, factors of cardiovascular risk, GFR
in patients with ax-SpA, DDS and controls were comparable. The activity of pain was evaluated according to the accepted recommendations. The index of NSAID intake as calculated for the preceding year. Results. GFR in patients with ax-SpAwas 87,0 [77,25; 102,0] ml/min/1,73 m2, 11 (18%) patients showed a reduction in GFR of less than 60 ml/ min/1,73m2. In patients with DDS GFR was 87,5 [65,5; 97,0] ml/min / 1,73 m 2 (p=0,27), decreased GFR of less than 60 ml/min / 1,73 m2 was detected in 3 (15%) patients. The ratio of albumin / creatinine urine in patients with ax-SpA was 35,8 [25,46; 43,4] mg/g, in patients DDS —207,1 [91,66; 244,59] mg/g (p<0,0001), in healthy individuals —25,45 [17,34; 33,65] mg/g. Conclusions. Patients with chronic back pain taking NSAIDs for a long time have revealed GFR, comparable with healthy people, and increased urine albumin. Patients with degenerative diseases of the spine have a greater index of albumin in urine than patients with ax-SpA.

The aim: to identify the frequency and clinical features of delirium in acute myocardial infarction (AMI) in the conditions of the intensive care unit. Material and Methods. The study involved 104 patients (43,3% women and 56,7% men) with AMI during the stay at the intensive care unit. The average age was 68,0 [59,0-76,7] years. Delirium was diagnosed using the criteria questionnaire Moss-ICU. For neurodevelopmental testing we used screening tests and rating scales. Results. The incidence of delirium in patients in this category was 28,8%. Most frequently delirium develops in patients aged 60-89 years: in the age group 60-74 years 25,0%, in the group of 75-89 years 44,7%. Delirium developed in the 1-2 day stay in the intensive care unit and intensive care. The average duration of delirium was 7,7 days. Hypoproductive form of delirium was detected in 64,3% of all cases, hyperproductive form in 21,4% of patients, mixed form in 14,2% of patients. The occurrence of delirium is associated with an increase of the duration of stay at the intensive care unit at 6 times compared with patients without delirium. Conclusion. The presence of delirium greatly increases the probability of death in the reanimation period of acute myocardial infarction. Moss questionnaire and training of doctors to work with rating scales should be accepted in all ICU intensive care units for early diagnosis of delirium and immediate correction of disorders of consciousness in patients in critical condition.

The article presents the review of contemporary concepts of tumor induction mechanisms applicable for neoplastic transformation, promotion and proliferation. The paper also contains an in-depth analysis of results of authors' own observations and study of immunological protection mechanisms of a significant number of patients diagnosed with oncopathologies of mammary and thyroid glands as well as adenocarcinoma of ascending colon. We have established common development patterns of T-cell and B-cell immunodeficiencies that are not influenced by location and proliferation of neoplastic tumors; the progress of such immunodeficincies, however, depends on regional metastasis development. Thus, we can conclude that insufficiency of immunological defense mechanisms leading to disruption of maligned cell elimination process is the primary pathogenic factor for metastatic tumor development.

Objective: the establishment changes in the structure of the causes of violent death in Saratov from 2011 till 2015. Material and Methods. The examination was based on analysis of the results of the forensic medical expert researches of corpses in the Saratov city office of forensic medical examination of corpses in the period from 2011 to 2015. Results. The structure of the causes of violent death was identical in Saratov in the last five years. The mechanical trauma was a leader, in second place — poisonings, then — mechanical asphyxia and external factors. There were two trends in the dynamics of components of each type of violent death: positive and negative. Positive trends were expressed as a decrease in the proportion of deaths from poisoning by ethanol and reducing the number of deaths from alcohol intoxication from other causes. Negative trends were expressed as the increase in the number of forensic medical expert examinations in the last two years, an increasing share of violent death of children in 2015, maintaining the leading position of automotive trauma among deaths from injuries by blunt objects. Conclusion. The number of forensic medical examinations of corpses was increased in Saratov for the studied period, but the proportion of fatal poisoning with ethanol was decreased. In 2015, the share of violent death of children aged under 14 was increased.