Diagnostic algorithm of centrally mediated abdominal pain syndrome — does it need changes? According to the materials of Rome IV Criteria

The article discusses the algorithm for diagnosing of centrally mediated abdominal pain syndrome (CAPS), formerly called functional abdominal pain syndrome, contained in the Rome Criteria of the IV revision (2016). Recommendations for the diagnosis of CAPS, mainly based on the compliance of the signs available in patients with the developed diagnostic criteria with a minimum of additional laboratory tests, are criticized, since such an approach is fraught with possible errors. The author considers the diagnosis of CAPS as a “diagnosis of exclusion”, which can be made only after a thorough examination of patients using laboratory and instrumental research methods (including ultrasound and endoscopic), confi rming the absence of organic diseases in patients.

Teaching anatomy in the fi rst Educational Institutions of Russia (for the 225th Anniversary of the Military Medical Аcademy)

The article presents data on the origin and development of dissecting rooms in the history of hospital schools, medical and surgical schools and academies. The names of the first anatomy professors of Moscow and St. Petersburg are presented; information about the development of the Department of anatomy of the Medical and Surgical Academy is given.

Acute coronary syndrome in patients under 35 years old

Objective. To evaluate the clinical and demographic characteristics of a group of patients under 35 years old admitted with acute coronary syndrome, as well as the features of coronary bed damage and endovascular treatment.Material and methods. A retrospective analysis of the group of patients aged 30 to 35, admitted to the Regional Vascular Center with a diagnosis of acute coronary syndrome in the period from 2019 to June 2021, was carried out. The study included 72 patients with ACS, regardless of the ST segment changes on the electrocardiogram, were admitted to the hospital by the emergency medical service referral. Positive troponins were detected in all the patients by qualitative analysis. Upon admission, they were sent to a catheterization laboratory. An examination was carried out according to the recommendations of medical care, as well as selective coronary angiography and, if indicated, stenting of the coronary arteries was performed.Results. When analyzing the clinical and demographic characteristics of the group, attention has been drawn to the absolute predominance of males — 71 (98.7%), urban residents — 64 (88.9%), low frequency of bad habits: tobacco smoking in 13 (18.1%) and alcohol abuse in 2 (2.8%) patients, the absence of concomitant pathology, a signifi cant time from the onset of symptoms to calling an ambulance (165 [90; 263]). According to the results of angiography, it should be noted the possibility of acute coronary syndrome with intact coronary arteries is 9 (27.3%) among all ACS cases with ST segment elevation and 29 (74.3%) with ACS without ST segment elevation, while in one third of the above episodes (13 (34.2%)) ACS was caused by the presence of a muscle “bridge” in the basin of the anterior descending artery, a concomitant phenomenon of slowed blood fl ow. The attention has been also drawn to the almost equal proportions of acute thrombotic occlusion (19 (55.9%)) and haemodynamically signifi cant hemadostenosis (14 (41.2%)) as the cause of ACS.Conclusion. In patients under 35 years old with a typical clinical. picture, positive troponins, with a qualitative analysis, there is a high probability of pathological changes in the coronary bed, regardless of the ST segment changes, which requires X-ray endovascular methods of diagnosis and treatment. Angiographic features of the coronary artery lesion in young people are the discreteness of the lesion in the proximal or middle sections of the arteries, the high frequency of thrombotic occlusions, the predominant lesion of the anterior descending or right coronary arteries, the low frequency of calcifi cation of the coronary arteries.

Hemocoagulation study in various patients over a period of 50 years. Рart 4

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Moscow neurological school in the history of Russian medicine

The article presents an outline of the research work of outstanding scientists, representatives of the Moscow neurological school.

Isaac Solomonovich Zhorov — romantic of the twentieth century

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Immediate results of surgical treatment of high and intermediate risk pulmonary embolism in elderly and senile patients

The aim of the study: is to analyze the immediate results of surgical treatment of high-and intermediate-risk PE in a group of elderly and senile patients. Material and methods. The study included 43 patients operated on for high-and intermediate-risk pulmonary embolism between 2008 and 2019. In the general group of patients, the number of women prevailed and amounted to 67.4%. The average age was 65.4 ± 4.23 years old. The Miller index in the general group was 29.1 ± 1.42. The Geneva Index was 8.4 ± 1.12. The average pressure in the pulmonary artery at the time of operation was 54 ± 1.4 mm Hg, and the peak pressure was 68 ± 3.43 mm Hg. Results. 5 patients died at the hospital stage. Thus, the hospital survival rate of patients was 88.4%. Among nonlethal complications, cardiovascular and respiratory failure prevailed. According to the statement, the calculated pressure gradient in the pulmonary artery was 29.0 ± 3.1 mm Hg. Conclusion. Surgical treatment is a highly eff ective and reliable method of treatment in the group of older patients.

A critical analysis of the ten-year experience of using endoscopic transpapillary interventions in an urgent surgical hospital

The aim of this work was to provide a critical analysis of the ten-year experience of using transpapillary interventions in an urgent surgical hospital with a detailed study of all groups of registered complications.Material and methods. In the period from 2008 to 2018, 1188 retrograde endoscopic transpapillary grafts were performed on the bile ducts with dissection of the major duodenal papilla in a typical and atypical way on the basis of our clinic. The group of observed patients included 1188 patients with endoscopic papillosphincterotomy, including 839 women (70.6%) and 349 men (29.4%). The average age was 63.2 ± 1.25.Results. During the period, 25 complications (2.1%) were revealed when performing transpapillary interventions with dissection of the major duodenal papilla: acute pancreatitis — 10 patients (0.8%); bleeding from the opening of the major duodenal papilla — 4 (0.33%), perforation 12p. intestines — 4 (0.33%), breakage of the basket cable with wedging — 1 (0.08%), cholangitis — 1 (0.08%), overlapping with a stent of the lobar duct — 1 (0.08%). The overall mortality associated with complications is 0.25%. Based on the analyzed material, the iatrogenic index was calculated. It was 0.044. After the analysis of complications, on the basis of the data obtained, we proposed an algorithm of actions when performing transpapillary interventions.Conclusion. Based on the study, we come to the conclusion that it will not be possible to completely level the risk and avoid possible papillotomic-induced complications. In this regard, the early, preferably intraoperative diagnosis of the latter and the prompt implementation of correlating therapeutic measures are of great importance, which will undoubtedly improve the treatment results and have a positive eff ect on the outcome of the disease.

Medical errors — causes and contradictions

Studying and improving the theory of errors of doctors has always been important, and today it has become especially relevant.The article lists the main provisions of the advanced version of the theory of errors of doctors. The main content of the articleis devoted to four important aspects of the problem of physician errors. The article states the main contradiction of the problemof errors in medicine. The structure of general objective and subjective causes of medical errors is shown. The main optionsfor doctors to experience errors that complicate doctors’ mutual understanding in this problem are formulated. For the fi rsttime, the reasons for the denial of errors by doctors are summarized. These aspects and conclusions on them are the result ofan analysis of publications on the problem of errors in medicine, repeated discussions of the problem on professional medicalsites. The content of these aspects was based on its own material on error analysis and observation from practice. The aboveaspects and their conclusions need not so much to be confi rmed by special studies, but rather to refl ect on their role and placein the problem of errors. The general objective and subjective reasons for the occurrence of medical errors are shown inconnection with their possible "guilt". Lack of experience is presented as the most common cause of medical errors. Variousoption for doctors to experience errors are presented as a reason that makes it diffi cult for doctors to understand this problem.

The Hippocratic Oath and deontology in modern medicine

The article deals with the history of the origin of Hippocratic Oath, the main issues of professional medical (medical) ethics (bioethics) from the standpoint of modern trends in the development of medicine: euthanasia, induced abortion, gender relations and transgender transition.