Research and Practical Medicine Journal
ISSN / EISSN : 2409-2231 / 2410-1893
Current Publisher: QUASAR, LLC (10.17709)
Total articles ≅ 387
Latest articles in this journal
Research and Practical Medicine Journal, Volume 7, pp 155-163; doi:10.17709/2409-2231-2020-7-4-12
The occurrence of tracheal fistulas of ischemic genesis combined with the failure of esophagogastroanastomosis and the communication between them is a rare and formidable complication after esophagectomy with mediastinal lymphadenectomy due to its anatomical position and extensiveness. However, it is insufficiently documented in the literature, both in terms of treatment and in terms of its causes. This observation aims to demonstrate the rare cause of this complication and the atypical successful treatment. In this case, a patient with squamous cell carcinoma G2 of the middle third of the esophagus and TNM stage cT3NxM0. On the McKeown thoracoscopic-laparotomy esophagectomy intraoperatively a short arterial vessel with a diameter of about 3 mm, which passed through the paracancerous infiltration and supplied blood to the esophagus and trachea revealed. The vessel was not isolated from the infiltrate, but was clipped and crossed between the aorta and infiltrate to maintain surgery ablastic. On the 7th day after the operation the insolvency of esophagogastroanastomosis, the fistula of the trachea with mediastinum and the communication between the leak of esophagogastroanastomosis and the fistula of the trachea were diagnosed. We consider this combination as a special case of esophagogastroanastomosis fistula, complicated by the communication between the right pleural cavity and pneumothorax. According to our experience, partial leak of esophagogastroanastomosis successfully heals by secondary tension within 10–15 days against the background of cervicotomic wound drainage and feeding through a nasointestinal tube. In this case there was a leak of saliva in the mediastinum and its penetration into the lumen of the trachea and the right pleural cavity. Surgical diversion of the fistula and stenting of the trachea were considered, but not applied, as the fistula in our opinion was controlled, but the aggressive content of the gastric conduit prevented healing. The patient was on assisted lung ventilation with minimal pressure support and inflow increased oxygen fractio. For this reason, we considered the best stenting of the esophagogastroanastomosis leak area to be covered with a stent in order to stop the aggressive content of the gastric stem from entering the fistula, which led to the successful treatment of the developed severe complication. It should be noted that this method of treatment may be ineffective in patients who need pressure support during ventilation.
Research and Practical Medicine Journal, Volume 7, pp 27-35; doi:10.17709/2409-2231-2020-7-4-3
Purpose of the study. Analyzing the dynamics of VEGF-А, TGF-β and their receptors in the lung tissues in rats with antitumor effect of 1,3-diethylbenzimidazolium triiodide (Stellanin).Material and methods. The study included white outbred rats weighing 180–220 g. The main group included males (n=27) and females (n=27) with sarcoma 45 (s45) inoculated into the subclavian vein but not developed in the lungs (2×106 cells in 0.5 ml of saline) due to the subsequent intragastric administration of Stellanin (0.4 mg/kg once a day) according to an intermittent scheme: administration for 5 days and a break for 2 days. The control group included males (n=14) and females (n=14) without treatment with growing s45 in the lungs. Intact groups included 5 males and 5 females. After 4, 5 and 8 weeks of the experiment animals were decapitated, and levels of VEGF-A, sVEGF-R1, sVEGF-R2, TGF-β and sTGFβR2 were measured in 10% lung homogenates by ELISA (CUSABIO BIOTECH Co., Ltd., China).Results. Lung tissues of intact females showed 1.4 times (pConclusions. Stellanin prevents the development of malignant process in the lungs by inhibiting neoangiogenesis (deficiency of VEGF-A and excess of sVEGF-R1) and suppressing the proliferation of malignant cells (TGF-β growth).
Research and Practical Medicine Journal, Volume 7, pp 19-26; doi:10.17709/2409-2231-2020-7-4-2
Цель исследования. Изучить результаты одномоментной препекторальной реконструкции молочной железы (ОППРМЖ) после подкожной мастэктомии по поводу рака с дополнительным укрытием эндопротеза полипропеленовым сетчатым имплантатом.Пациенты и методы. Серия последовательных наблюдений из 6 больных раком молочной железы T1–2N0M0 в возрасте от 34 до 47 лет. Всем выполнена операция подкожной мастэктомии, 2 — с сохранением сосковоареолярного комлекса («nipple- sparing») с ОППРМЖ силиконовым имплантом с покрытием из вспененного полиуретана (Polytech, Германия). Для профилактики миграции импланта его переднюю поверхность укрывали полипропиленовой сеткой (Ethicon/Johnson& Johnson, США) с фиксацией последней к большой грудной мышце.Результаты. В одном наблюдении имел место успешно излеченный незначительный некроз кожи в области края разреза. Других осложнений операций и рецидивов опухоли за весь истекший период наблюдения не было. Эстетический результат (симметрия субмаммарных складок, сосково- ареолярного комплекса (после nipple- sparing мастэктомии), формы и объема протезированной и контрлатеральной молочной железы) объективно и субъективно расценен как хороший, во всех наблюдениях. У всех больных развитие перипротезной соединительной ткани было минимальным (Бэйкер- I).Заключение. Первые результаты применения простого сетчатого полипропиленового имплантата при ОППРМЖ после подкожной мастэктомии по поводу рака для профилактики миграции импланта являются обнадеживающими. Степень развития перипротезной рубцовой контрактуры минимальная.
Research and Practical Medicine Journal, Volume 7, pp 94-104; doi:10.17709/2409-2231-2020-7-4-8
Purpose of the study. To improve the results of treatment of benign prostatic hyperplasia with symptoms of the lower urinary tract in the presence of concomitant metabolic syndrome.Materials and methods. The investigation included 103 patients aged 42 to 75 years with a reliable diagnosis of BPH and signs of MS, according to the criteria of GFCF (2009). Patients were randomized into two comparable groups: Group 1 included 52 men who were prescribed tamsulosin in combination with targeted correction of metabolic disorders; Group 2 consisted of 51 men who were prescribed tamsulosin monotherapy. After 6 and 12 months of the study, the dynamics of metabolic parameters, prostate volume, residual urine volume, maximum urine flow rate, and total IPSS and QoL score were evaluated in each group of patients.Results. A direct correlation was established between the severity of metabolic disorders and the progression of BPH /LUTS in the main assessed indicators. The use of combination therapy with metformin, ACE inhibitors / ARA and statins in combination with tamsulosin showed efficacy after 6 and 12 months of the study compared with tamsulosin monotherapy. The treatment is based on the rinciple of T2T ("Treat to Target"): maintaining target levels of blood pressure, glucose, blood lipid parameters, and body weight correction.Conclusion. Overweight, arterial hypertension, the atherogenic profile of dyslipidemia and hyperglycemia are risk factors for more pronounced progression of BPH / LUTS and a deterioration in the quality of life of patients. The investigation IMSYPA showed the effectiveness of pathogenetically based complex therapy aimed at eliminating metabolic imbalance.
Research and Practical Medicine Journal, Volume 7, pp 105-117; doi:10.17709/2409-2231-2020-7-4-9
Internal stenting of the upper urinary tract is a widespread urological surgery. Its frequency in modern practice is high and continues to grow due to the widespread use of endourological, percutaneous, and laparoscopic interventions. The presence of a stent in the patient's body often leads to a decrease in the quality of life due to the occurrence of stent-dependent symptoms, which often requires urgent hospitalization. According to various data, they are registered in at least 80% of patients. The most common stent-dependent symptoms are frequent and / or painful urination, urge to mix (up to imperative), nocturia, pain in the lumbar region, macrohematuria. According to existing data, a fair share of responsibility for the development of these symptoms lies with the distal (vesicular) curl of the internal stent, especially if the technology of its installation is not followed or the length of the drainage is incorrectly selected. The review describes methods for correct installation of internal ureteral stents by transurethral retrograde, antegrade, and laparoscopic approaches, as well as a method for installing and removing mono-pigtail drains. The internal drainage procedure is standard, so the focus is on the nuances and details of this widespread manipulation. The given cohort of patients and the range of surgical interventions indicate a significant experience of the authors in this issue. All illustrations are author's own and taken from the daily workflow. It should be noted that the modern understanding of the process and technological equipment ensure correct stenting when performing any interventions with any access. An adequate choice of installation method and correct positioning of the stent, knowledge of simple details and "secrets" allow not only to restore urodynamics, but also to effectively prevent the development of stent-dependent symptoms, thereby preserving patients quality of life.
Research and Practical Medicine Journal, Volume 7, pp 135-154; doi:10.17709/2409-2231-2020-7-4-11
Вакцины представляют собой успешный пример в современной медицине и отвечают за значительное снижение заболеваемости и смертности во всем мире. Очевидно, что необходимы исследования, позволяющие разработать эффективные вакцины против некоторых сложных патогенов, включая вирус иммунодефицита человека и гепатита C. В обзорной статье рассматриваются современные возможности создания вакцин как нового поколения, так и разработанных с помощью более ранних технологий, проверенных временем: живые аттенуированныйе вакцины, инактивированные, рекомбинантные, синтетические пептидные и субъединичные вакцины на основе вирусоподобных частиц, ДНК- и мРНК-вакцины. Однако многие инфекции все еще не поддаются профилактике с помощью имеющихся в настоящее время вакцин. Они являются основной причиной смертности во всем мире — например, вирус атипичной пневмонии, ближне-восточного респираторного синдрома и коронавирус 2 — SARS-CoV-2, вызывающий тяжелый острый респираторный синдром и коронавирусную болезнь 2019 года — COVID-19. Поскольку сегодня не существует эффективного лечения от COVID-19, актуальным является разработка вакцин для предотвращения инфекции. Целью большинства вакцин- кандидатов является индукция выработки нейтрализующих антител против SARS-CoV-2. В настоящее время разрабатывается несколько платформ, а некоторые потенциальные вакцины- кандидаты прошли клинические испытания I и II фазы. В России клинические испытания проходит вакцина на основе вектора ДНК аденовируса, в которую встроен ген вируса SARS-CoV-2.
Research and Practical Medicine Journal, Volume 7, pp 62-78; doi:10.17709/2409-2231-2020-7-4-6
Purpose of the study. Was to compare the early and long-term results of different variants of the classical KEAE.Materials and methods. In a retrospective study, we collected data on 1.242 patients who trans- ferred KEA from January 2011 to December 2019, using a patch was performed in 239 cases in 1003 — primary suture closure. We used 3 methods of arteriotomy closure with the use of a patch. There were 848 men and 394 women, the average age was 63.16 years, all of them were sympto- matic. Most patients had a transient disorder (49.2%) or ischemic stroke (50.8%). All patients had significant (moderate to severe) carotid stenosis. After the operation 5 (0.4%) patients had ischemic stroke, 1 (0.08%) had n. hypo-glossus damage, 3 (0.24%) had postoperative hematoma. The usual endarterectomy was performed without a shunt in all cases. All arteriotomies were mostly open. Early and late results of this procedure with a period of observation of at least 36 months were ana-lyzed: technical aspects of arteriotomy, features of restoration of the integrity of the vessel, changes in the "geometry" of the vessel, the use of zaplat. We studied the state of hemodynamics and complications in the early (30 days) and late postoperative period, the development of restenosis was compared between groups during the 36 months of observation. Results. When assessing the geometrical changes in the group with the patching, it was noted that the worst results were obtained using the technique with a U-shaped fixation suture on the distal part of the patch and the use of a wide patch. When using a narrow patch geometric changes in the width of the patch are the smallest. The main reason of the frequent geometrical changes in the dis-tal part of the patch was the patch wrapping inside the artery with the formation of a duplicate. The application of the modified technique of patch closure allowed to reduce the number of distortions in the operation area, to avoid the formation of artery stenoses in the place of patch imposition, to prevent changes in the bifurcation geometry of the internal carotid artery. The best results in the application of the primary edge suture were obtained by the method of closing the arteriotomy with the counter edge suture with the precision control of the application. The application of the U-shaped suture along the edges of the arteriotomy allowed avoiding deformations in this place. Con-trol of needle injection by means of straightening and lifting of the wall edge ensured absence of deformations in the suture.Conclusions. The post-CEAE closure technique affects the hemodynamic profile. Sewing patch-ing does not seem to create favorable flow dynamics. Consideration should be given to the elective use of the patch to improve disturbed flows. However, the linear precision suture remains the method of choice for suturing the arteriotomy.
Research and Practical Medicine Journal, Volume 7, pp 118-134; doi:10.17709/2409-2231-2020-7-4-10
Currently, pancreatic cancer remains one of the most unfavorable tumor pathologies, characterized by pronounced difficulties in diagnostics and treatment, a significant impact on the ability to work and quality of life of patients, and low indicators of patient life expectancy. Features of the development of malignant neoplasms of this localization contribute to limiting the possibility of performing radical surgery, and therefore a special role in the treatment of patients with pancreatic cancer is assigned to chemotherapy. Specific systemic drug therapy for this pathology is the most important and, in the majority of cases, mandatory element of treatment. It can be carried out in a neoadjuvant, adjuvant and independent mode, include mono- or multi- component schemes, and be combined with other types of systemic or local antitumor effects. The choice of chemotherapy regimen depends primarily on the General somatic status of the patient and is determined by the potential toxicity of a particular combination of cytostatics. This review of the literature demonstrates the effectiveness of various chemotherapy regimens in patients with stage III–IV pancreatic cancer in the first and second lines, describes the frequency of adverse reactions to treatment and their nature, and mentions ways to reduce the toxicity of multicomponent drug therapy regimens. This review is based on the analysis of scientific sources of the Internet resource "National Center for Biotechnological Information".
Research and Practical Medicine Journal, Volume 7, pp 79-93; doi:10.17709/2409-2231-2020-7-4-7
Purpose of the study. To determine the effectiveness of antiandrogenic therapy — 10-year General and tumor-specific survival (OV, OSV) depending on the type of hormone therapy, the stage of the disease, and the risk of progression.Patients and methods. The study was based on a retrospective analysis of 100 patients with localized, locally advanced, and metastatic prostate cancer over the period 2008–2018. The assessment was conducted in 2019. All patients received antiandrogenic treatment in the form of castration therapy (n=59) and combined (complex) treatment (n=41) in various variants and modes for more than 5 years. Patients had a 100% 5-year survival rate. The control point of the study was General and tumor- specific survival, as well as prognostic factors that determine this survival. Results. By the end of the study, 53 (53%) patients were alive, 8 (8%) died, and 39 (39%) patients were censored. The highest percentage of 10-year overall survival was achieved in localized stages of the disease and was 52% (31 patients) — stage 1, 38% (22 patients) — stage 2. Tumor specific survival rate (1–2 stages) — 62% (33 patients). At stage 3–30% (14 patients) and 51% (21 patients) and at stage 4–18% (1 patient) and 32% (2 patients), respectively. Depending on the risk of progression (Gleason index), high rates of both General and tumor- specific survival were achieved with low Gleason (2–5), and moderate risk of Gleason progression (6–7), and were 85% and 62%, respectively. The most effective method of treatment that determines the 10-year overall survival was combined (hormone radiation) therapy, which allowed to achieve results in 75% of patients. The tumor — specific survival rate was more than 80%.Conclusion. In real clinical practice, the use of antideprivation therapy in various variants and modes allows to obtain a 10-year General and tumor- specific survival rate in 75% and more than 80% of patients. Stratification of patients by risk groups forms a personalized approach to the treatment of each patient. Use of research treatment regimens in the work STAMPEDE, CHAARTED allows to increase the overall survival of patients with metastatic stage of the disease.
Research and Practical Medicine Journal, Volume 7, pp 164-174; doi:10.17709/2409-2231-2020-7-4-13
Cystectomy, as a type of surgical treatment, is performed for various diseases of the bladder. Most often — with malignant tumors, as well as with benign pathological conditions. Complications in the postoperative period in patients undergoing cystectomy are mainly caused by the need to ensure adequate urine derivation. One of the options for solving this problem is the implementation of ileocystoplasty, which, in turn, is associated with the performance of technically difficult and large-scale manipulations during the operation. Successful prevention of severe complications of cystectomy (or their elimination) is probably possible only in those multidisciplinary medical organizations in which the provision of medical care to patients with urological oncology is a daily programmed activity. Outpatient health care specialists play a special role in routing patients with bladder diseases, and not only their formal referral and delivery to multidisciplinary medical and prophylactic institutions in an emergency mode with “on-duty” syndromic diagnoses such as “renal colic or hematuria”. At present, in St. Petersburg, all conditions have been created for the concentration of patients with severe diseases of the bladder in a number of specialized medical organizations, in which a large number of cystectomies with intestinal plastic are routinely performed annually, which makes it possible with a high probability to guarantee a favorable clinical outcome without discrediting method of the rarity of its implementation.