2022, volume 18

The article provides a clinical observation of a patient with manifestations of panniculitis in the lower extremities. This clinical case demonstrates the difficulties in establishing a diagnosis, which were due to a long and progressive course of the disease, a progressive change in the clinical picture, so the patient was given various diagnoses. The formation of the lower leg as an inverted bottle occurs several years after the onset of the disease and is an important diagnostic criterion. The correct diagnosis of lipodermatosclerosis was made to the patient 10 years later. The connection of the disease with the pathology of the endocrine system was noted.

Objective: evaluation of the effectiveness of onychomycosis diagnostics using the culture method and the etiological structure of pathogens isolated from patients in the Saratov region. Material and methods. Samples of the nail plate obtained from 1075 patients with suspected onychomycosis were studied using microscopic and cultural methods. Identification of pathogens isolated in the course of mycological examination was carried out, and dominant species were determined. Results. In 22% of patients with suspected onychomycosis, a negative result of direct microscopy and mycological examination was obtained. A comparative analysis of the effectiveness of the methods used showed that during mycological examination, the frequency of indication of pathogens of onychomycosis is higher, since with negative results of microscopy in 24% of cases their growth was observed on Sabouraud dextrose agar. It was revealed that dermatophytes prevailed in the etiological structure of pathogens (61 %) among which representatives of the genus Trichophyton dominated, yeast-like fungi were isolated in 21 %, and molds — 18%. Conclusion. The use of the cultural method makes it possible to increase the efficiency of diagnosing onychomycosis, as well as not only to detect micromycetes in the pathological material, but also to identify it, which will allow the dermatologist to prescribe an effective antifungal therapy to the patient, taking into account the sensitivity of the pathogen.

Objective: to characterize the methods for determining the activity of foci of localized scleroderma and conduct their comparative analysis. Material and methods. Using two female patients as examples, we compared three instrumental methods of determining localized scleroderma activity: radio-wave diagnostics (active radiometry or trans-resonance functional topography), ultrasound (ultrasound) of the skin and infrared thermal scanning (IR thermogra-phy), as a method for assessing the activity of the pathological process in juvenile localized scleroderma. Results. The thermal imager allows obtaining a visual display that clarifies the clinical picture of the disease from the entire studied area, however, changes on the skin may be lower than the diagnostic accuracy of the device. Ultrasound of the skin requires special training, a separate module and software for determining the speed of blood flow, which will allow an assessment of both morphological damage and functional disorders. At the same time, the speed of blood flow may not reflect metabolic processes in damaged tissues. Some places are difficult to explore. Radio-wave diagnostics, despite the long time and the presence of hard-to-reach places, give a more accurate result, which can be expressed by numerical indicators that remain stable for the duration of the inflammatory reaction, even after visual resolution. Conclusion. All three methods have the potential to determine the presence and activity of a localized scleroderma lesion in the areas of skin under study.

The article presents a case of cutis verticis gyrata in 32-years-old patient. Information is given on the etiology, pathogenesis, clinical presentation and treatment principles based on literature data. This clinical case draws attention practical specialists to feature of clinical presentation and diagnosis due to the rarity of the pathology.

Acrodermatitis of Hallopeau is a pustular skin lesion of unclear etiology and pathogenesis, characterized by the severity of pathological processes in the extremities. The article presents cases of the development of acrodermatitis of Hallopeau in a patient with onychomycosis. The characteristics of anamnestic, observed, laboratory data in a patient are given. The scheme of treatment is given, which includes: hyposensitizing therapy, detoxification, cytostatic, external therapy and physiotherapeutic method of treatment.

Abstract. The article follows the career of Emil E. Melamud, MD, DSc, one of the leading scientists of Saratov school of neurosurgeons. His contribution to Russian neurosurgical science is the development of technologies for jugulating complications of spinal cord injuries, treating children with spinal injuries, analgesic and antispastic electrical neurostimulation of the nervous structures of the central and peripheral nervous systems.

Abstract. Objective: to analyze current literature data on the role of endothelium in the development of micro- and macroangiopathy in obesity. Adipose tissue (AT) is a highly vascularized endocrine organ. Functional relationship between endotheliocytes and adipocytes is regulated by the paracrine pathway. AT generates adipokines, biologically active substances with pro- and anti-angiogenic activity, cytokines. The imbalance of these factors causes a violation of the angiogenesis process, resulting in the formation of functionally immature vessels and endothelial dysfunction, which underlie a number of diseases. When writing this review, we analyzed 50 scientific papers received in the following databases of the RSIC, CyberLeninka, Scopus, Web of Science, MedLine and PubMed databases from 2013 to 2021 using the following keywords: "angiogenesis", "obesity", "adipocytes", "endotheliocytes", "vascular endothelial growth factor", "pro-and antiangiogenic factors", "endothelial dysfunction". As a result of the analysis, it was shown that endothelial dysfunction plays an important role in the pathogenesis of obesity, causing the development of micro- and macroangiopathies in adipose tissue. A deeper understanding of the molecular mechanisms of interaction between adipocytes and the vascular endothelium in obesity will contribute to the development of new therapeutic approaches that reduce the risk of obesity-associated endothelial dysfunction.

Abstract. Objective: to evaluate the activity of oxidative stress in rats with stepwise incomplete cerebral ischemia (SICI). Material and methods. Experiments were performed on 24 male outbred rats weighing 260±20 g, allocated into 3 subgroups (6 animals in each) based on time of ligation of both common carotid arteries (CCA). The control group comprised of sham-operated rats of the same sex and similar weights (n=6). To identify the pro-oxidant — antioxidant state of the brain based on its homogenates, the activity of lipid peroxidation processes, the content of thiobarbituric acid reactive substances (TBARS), the concentration of reduced glutathione (GSH), total thiol groups (TSH), and the activity of glutathione peroxidase were determined. Results. SICI with ligation interval of both CCAs of 1 day and 3 days led to a significant decrease in the total SH groups of proteins and glutathione by 30% (p=0.038) and 46% (p=0.044), respectively, TBARS concentration by 29% (p=0.038) and 31 % (p=0.043), respectively. SICI with the maximum interval between CCA ligations was manifested by less pronounced changes in the pro-oxidant — antioxidant state of the brain. Conclusion. In SICI with ligation of both CCAs 7 days apart, at which histological changes were the least pronounced, changes in the pro-oxidant — antioxidant balance were insignificant. The most pronounced disorders of the pro-oxidant — antioxidant balance in the brain were observed in the subgroup with the minimum interval between CCA ligations, which implied the highest activity of oxidative stress.

Abstract. Objective: to analyze the data available in the literature on the microscopic structure of the upper and lower respiratory tract after exposure to various chemicals, as well as a possible role in the pathogenesis of chronic obstructive pulmonary disease (COPD). The following databases were used to write the review: PubMed, MEDLINE, Cohrane Library, eLibrary, Scholar.google, Sciencedirect, using keywords in Russian and English: "morphology", "COPD", "experiment", "inhalation", "chemicals", "lower respiratory tract", "chronic inflammation", "pathomorphology", "microscopy", "chemical exposure", "air pollutants", "dust", "endogenous impacts". The search depth is from 2005 to 2022. The number of analyzed sources is 35. This article displays the main pathomorphological features of the structure of the respiratory system in COPD, some differences in micromorphology in the disease caused by prolonged smoking, the features of the course of an acute purulent process in COPD, and also considers the main etiological factors associated with the inhalation of chemicals at work, their impact on healthy lungs.

Abstract. Objective: to reveal anthropometric and craniometric features of patients with posterior fossa tumors. Material and methods. The study group included 115 patients with posterior cranial fossa tumors. The comparison group consisted of 40 healthy women. We used the Rees — Eysenck body index for somatotype diagnosis. We calculated craniometric parameters, cephalic and posterior fossa indices and detected the posterior cranial fossa shapes. Results. There was a tendency to increase a proportion of asthenics and to decrease in picnics. The occipitofrontal diameter (174.0 [170.3; 176.4] и 177.6 [172.3; 181.6] mm)) and the tentorial angle (88.0 [84.2; 92.9] и 90.0 mm [86.0; 98.1]) in the study group are smaller (p<0.001 and p<0.05 respectively). Dolichocrania and acrocrania were registered less frequently in patients than among healthy women, and the percentage of dolichocrania was almost 3 times less. Ortho- (47.8%) and hypsicrania (41.7%) were more often detected in the study group, and hamecrania was 2.5 times less common than in the comparison group (p=0.023). Among the patients, small-wide (21.6%) and deep-narrow (9%) shapes of posterior fossa were recorded significantly more often than in the comparison group. The variability of the posterior cranial fossa types in the comparison group was less, in 95% of cases we detected a fossa of medium depth and width. Conclusion. We revealed definite anthropometric and craniometric features of patients with posterior fossa tumors. Most of the patients were asthenics with ortho- and hypsicrania, having small-wide or deep-narrow shapes of posterior cranial fossa. It is necessary to further study this topic and compare the results obtained with clinical manifestations.