2022, volume 18

Objective: to conduct a comparative pathomorphological analysis of wounds of various origins requiring full-thickness skin autoplasty. Material and methods. Histomorphological comparison of the wound bottom before plastic surgery with full-layer skin autografts was performed in those groups of patients: 1 — for excision of scar tissue in elective surgery; 2 — traumatic detachment of the skin perform plastic surgery by Krasovitov; 3 —when excising granulation tissue to the fibrous layer. The object of research is biopsies of patients from three study groups. Results. The histologi-cal picture of wounds after scar removal is characterized by well-developed dense fibrous-cellular connective tissue, has signs of chronic inflammation. Unlike a cicatricial wound, acute lesions were characterized by granulation and mature dense fibrous connective tissue, with pronounced inflammatory changes, each of which had its own characteristics. Conclusion. The results of a comparative analysis revealed the features of the morphological picture of wounds depending on the type of injury. In the group of acute injuries, traumatic and burn wounds, the most pronounced tissue injuries were revealed. Given the data obtained, it should be assumed that full-thickness autodermoplasty will have the best result in the group of patients after planned excision of scar tissue.

Objective: to determine the main factors determining the occurrence of professional deformities of the lower extremities in ballet dancers based on the analysis of literature data. The analysis of 33 scientific publications presented in the databases and web resources of MEDLINE, PubMed, Google Scholar, Cyberleninka, the electronic library eLibrary and published in the period from 2011 to 2020 was carried out. The most frequent professional deformities of the lower extremities in ballet dancers are valgus deformity of the foot, talus partitus, hypertrophy of the posterolateral process of the talus bone (formation of the Steida process), flattening of the butt joints and excessive acetabular retroversion. Based on the analysis of studies, the order of occurrence of professional changes in the lower extremities of ballet dancers (foot — ankle joint — hip joint — knee joint) was determined. The systematization of the factors that cause the professional deformity of the lower extremities, and the association into groups based on their genesis (exo- and endogenous) is carried out. The nature of the influence of a number of exo- and endogenous factors on the features of the development of pathological morpho-functional changes of the lower extremities in ballet dancers is determined

Objective: to analyze the satisfaction of doctors (in the social role of patients) suffering from chronic diseases with medical care in rural health care. Material and methods. 188 doctors with chronic diseases from medical organizations of the Saratov region took part in the survey. The questionnaire developed by Academician of the Russian Academy of Sciences A. V. Reshetnikov (Moscow) was used. Results. The respondents attributed the lack of necessary specialists (67.1%), queues (9.6%), inability to get an appointment at a convenient time (8.5%), inattentive attitude of employees (8.5% of responses) to negative phenomena in the activities of medical organizations in which they received medical care. The respondents attributed insufficient technical equipment of medical organizations (67%), high cost of medicines (60.0%), long queues for doctor's appointments (27.1%) to the problems that arise in patients in a situation of chronic disease. Conclusion. Despite the limited availability of medical care, when assessing satisfaction with medical care in rural medical organizations in the region, the majority of respondents positively assessed the quality and availability of medical care in different conditions of provision and indicated high and medium estimates of the social responsiveness of rural healthcare. An explanation of the results obtained is possible in the perspective of what was described by Academician of the Russian Academy of Sciences A. V. Reshetnikov of the phenomenon of "paradoxical" medicine that arose in Russian healthcare at the end of the 20th century.

Objective: to analyze changes in the opinions of young people about measures to prevent and treat sexually transmitted infections (STIs) against the backdrop of the coronavirus pandemic compared to the pre-pandemic period. Material and methods. The research program is based on a comparison of data from a sociological survey of 400 respondents aged 16-21 in 2021 and an analysis of 838 questionnaires from participants in a similar study in 2017 of the same age. Research method — sociological (questionnaire). The author's questionnaire was used, consisting of 46 questions, combined into five blocks: self-assessment of the relevance of the STI problem, the likelihood of infection risk, readiness to undergo preventive screening examinations, preferred directions for seeking help if STI symptoms occur, consent to examination and treatment together with a sexual partner. By gender, the distribution was as follows: in2017 — women — 51%(n=427) men — 49%(n=411); in2021 — 52%(n=208)and 48%(n=192). In processing and presenting the data, extensive indicators were used, compared with the assessment of the significance of differences according to Student's t-test. Results. In 2021 an increase in the interest of young people in undergoing screening examinations (79.5% versus 63% in 2017, p=0.006) and seeking medical help (93.5% versus 89.5%, p=0.007) was noted. However, the number of cases of concealing the state of health from a partner increased significantly (from 8.3 to 32.2%, p=0.003). Conclusion. The study revealed a change in the opinions of respondents regarding STIs during the pandemic, which consists in an increase in understanding of the need for regular examinations, seeking medical help when symptoms of the disease appear, but at the same time, a decrease in the sense of responsibility for the health of their partner.

Objective: to conduct a comprehensive analysis of citizens appeals and complaints to medical organizations (hereinafter — MO) of the Russian subject. Material and methods. Based on the reporting data, an analysis of the with citizens' appeals work in the Chelyabinsk Region MO for the period 2015-2019 was carried out. Results. An increase in the number of referrals in the study period (from 8397 to 15271) was revealed, where issues of quality (30.7%) and accessibility (29.1 %) of medical care prevail in the thematic structure. At the same time, there is a decrease in appeals recognized as justified (from 8.6 to 4.6%) and an increase in appeals considered without determining the topic (from 19.8 to 30.2%). For the third level MO, a correlation (r=0.99, p=0.011) between the number of complaints considered by the medical commission and recognized as substantiated was determined. Conclusions. 1. The citizens' appeals dynamics is characterized by a pronounced growth with a thematic predominance of complaints about the quality and accessibility of medical care. 2. The third level MO medical commission work with citizens' appeals to contributes to increasing the objectivity of their consideration. 3. A significant number of requests classified as "others" at the stage of consideration requires additional tools for their detail. 4. The increase in complaints may be due to both objective reasons and subjective evaluation of patients in the context of increasing information availability, which requires further investigation.

Objective: to present up-to-date scientific information concerning the pathophysiological and clinical features of diabetic encephalopathy (DE) in children with type 1 diabetes mellitus (DM). A total of 44 publications were analyzed, obtained from the Cochrane Library, PubMed, eLibrary.ru and Medscape using the following search queries: "diabetes mellitus in children and adolescents", "diabetic encephalopathy", "pathophysiology of diabetic encephalopathy in childhood" and "clinical manifestations of diabetic encephalopathy in childhood". The analyzed literature was published in the year range of 2008 to 2021. This work provides a general overview and describes the etiology, pathophysiology and clinical manifestations of DE in children and adolescents in the setting of type 1 DM. It comes to a conclusion that an understanding of the mechanisms of development of this complication, coupled with timely diagnosis, will help minimize the progression of central nervous system damage in this category of patients.

Objective: to demonstrate successful experience in the diagnosis and treatment of fibrosarcoma of rare localization (in the axillary region). Timely surgical treatment by a complex surgical team with the involvement of specialists of various specialties, in the form of decompression of the brachial plexus and radical excision of a malignant neoplasm, made it possible to improve the patient's quality of life, prevent complete loss of functions of the left arm, and also prevent tumor metastasis.

Objective: to analyze the features of clinical course of lower extremity varicose vein disease and acute thrombophlebitis of varicose veins for the patients with undifferentiated connective tissue dysplasia after crossectomy. Material and methods. The prospective clinical cohort study covered 132 female patients with varicose disease who underwent crossectomy. 67 patients with dysplasia were included into the main group; patients without dysplasia were included into the control group. Examination of patients and ultrasound scanning of lower extremity veins were made in 3, 6, 12, 36 months. The Cox regression analysis was used to assess the influence of dysplasia on the risk of developing thrombophlebitis of varicose veins. Results. The progress of clinical manifestations of varicose disease after crossec- tomy was found for 57 (85.1 %) female patients with dysplasia and for 14 (21.5%) female patients without dysplasia (p=0.002), which needed making phlebectomy The recurrence of thrombophlebitis of varicose veins was found for 22 (32.8%) female patients with dysplasia and for 5 (7.7%) female patients without dysplasia (p=0.002). The indication of Cox-model Exp(S), which characterizes the predicted change of risks for dysplasia, was 4,216 (95% С11.595-11.147). Conclusion. The clinical course of varicose disease for patients with undifferentiated connective tissue dysplasia is characterized by the progression of clinical manifestations of chronic venous insufficiency of extremity. Undifferentiated connective tissue dysplasia increases the risk of developing the recurrence of thrombophlebitis of varicose veins after crossectomy by more than 4.2 times.

Objective: to describe a malignant synovial sarcoma of rare localization. Synovial sarcoma is a soft tissue tumor originating from connective tissue, mainly from the synovial membrane of the joints. However, there are also rare localizations. This clinical case demonstrates the need for a more detailed diagnosis of neoplasms and demonstrates the need for early initiation of surgical and conservative treatment.

Objective: to evaluate the effectiveness of surgery in children with secondary proximal hip deformity and acetabular dysplasia. Material and methods. The study included 60 children (65 joints) of 9-16 years old (the average age was 12.5 years old). We divided all patients into two age groups: group 1 — children aged 9 to 12 years old (35 joints), group 2 — children aged 13 to 16 years old (30 joints). We used various surgical tactics; the choice depended on the examination methods and results. Long-term results were followed up to 7 years after the intervention. We assessed the treatment outcomes using Tschauner-Hempel equations and McKay scale. Results. Group 1 featured excellent outcomes in 48.6% of cases, good outcome in 42.8%, satisfactory outcome in 8.6% of cases. Group 2 featured two unsatisfactory outcomes, excellent outcomes in 36.6%, good outcomes in 32.3% and satisfactory outcomes in 24.5% of cases. Conclusion. According to the long-term results of radiometric and functional indicators, surgical correction of residual deformations in hip dysplasia in children and adolescents is a highly effective tool for preventing the development of early coxarthrosis. In order to obtain good and satisfactory treatment outcomes, surgery tactics should rely on a thorough analysis of the anatomical-functional state of the hip joint, taking into account the age of the patient. More optimal for surgical prevention of early hip osteoarthritis is 9 to 12 years of age.