THE USE OF THORACOPLASTY IN THE TREATMENT OF DESTRUCTIVE PULMONARY TUBERCULOSIS

Despite a decrease in the incidence of pulmonary tuberculosis in the Russian Federation in recent years, among the newly diagnosed patients there remains a significant proportion of patients with bacterial excretion and destructive pulmonary tuberculosis. In patients with destructive pulmonary tuberculosis, surgical treatment is often the only possible method for saving lives. We studied the results of extrapleural posterosuperior thoracoplasty in 42 patients with destructive pulmonary tuberculosis. The comparison group consisted of 30 patients who received medicamentous therapy. The mortality rate for 3 years of follow-up in the conservative treatment group was 36.7%, in the surgical treatment group it was 23.8%, p = 0.237. Among patients with more than 2 years of disease experience, mortality was 45% in the main group, 88% in the comparison group, p = 0.070. In the absence of drug resistance, mortality in the main group was 4%, that in the comparison group – 14.2%, p = 0.283. Mortality in individuals with normal body weight was lower in the group of patients who underwent thoracoplasty than in the comparison group: 17.6% vs. 33.3% (p = 0.202). Among those who did not achieve sputum negative reaction, mortality was lower, and passing to the 3rd group of dispensary care was more common in the surgical treatment group – 41.7% vs. 71.4% (p = 0.077) and 33.3% vs. 21.4% (p = 0.426). Among patients with drug resistance or low body weight or unachieved sputum negative reaction, mortality rates were comparable in both groups. Thus, thoracoplasty, in comparison with conservative therapy, makes it possible to improve treatment results in patients regardless of the length of the disease in groups with Mycobacterium tuberculosis sensitive process, with normal body weight, with preservation of elimination of bacilli. The effectiveness of thoracoplasty decreases in patients with an increase in the disease duration.

INFORMATIVE VALUE OF SONOELASTOGRAPHY IN THE DIFFERENTIAL DIAGNOSIS OF FOLLICULAR THYROID CANCER

In recent years, the opportunities of radiation diagnostic methods have stepped far ahead and today they play a leading role at the stage of preoperative diagnosis of thyroid diseases. The most promising of them is multiparametric ultrasound examination, as well as sonoelastography associated with it. Strain elastography and shear wave elastography make it possible to determine the boundaries of pathological formation and quantitative characteristics of nodular stiffness, which is important when determining the boundaries of invasive tumor growth, primarily thyroid cancer, when planning an upcoming surgical intervention. The article describes a clinical case of radiation diagnosis made for follicular thyroid cancer; it shows the importance of multiparametric ultrasound, including sonoelastography, in the early detection of thyroid cancer. A timely diagnosis and a correct chosen tactics for treating follicular thyroid cancer resulted in a favorable disease outcome.

EFFECTIVENESS OF A COMPREHENSIVE GERIATRIC ASSESSMENT TO IMPROVE THE LIFE QUALITY OF THE ELDERLY AND TO EASE THE CAREGIVERS BURDEN

In the modern world, the number of elderly people with various diseases is growing, they need an appropriate care. Care implementation requires special knowledge, mental and economic expenditures. Ensuring a decent old age for the elderly is one of the problems of modern society. Comprehensive geriatric assessment is a multidimensional interdisciplinary diagnostic process for assessing the physical, psychological, functional and socio-economic problems of elderly people in order to develop a comprehensive individual plan for their treatment and rehabilitation. Comprehensive geriatric assessment benefits the elderly population, but the effectiveness of comprehensive geriatric assessment to improve the life quality of the elderly remains unclear. The article provides an overview of studies devoted to studying the effectiveness of using comprehensive geriatric assessment. The article discusses the influence of a comprehensive geriatric assessment on determining the life quality of the elderly, the duration of their stay in the hospital, and relieving the caregivers' burden. In addition, the influence of a comprehensive geriatric assessment on the ability to determine life expectancy, to conduct early diagnosis of major geriatric syndromes, the risk of morbidity and mortality in elderly patients is being considered. It is important that on the basis of a comprehensive geriatric assessment, appropriate rehabilitation programs can be drawn up, and technologies for rehabilitation can be determined.

ALCOHOL ABUSE AS AN UNDERESTIMATED CAUSE OF NON-TRAUMATIC OSTEONECROSIS OF THE FEMORAL HEAD (DESCRIPTION OF CLINICAL CASES)

Osteonecrosis of the femoral head is a severe degenerative-dystrophic disease, which is characterized by the destruction of the bone substance in the head in the most vulnerable (loaded) parts. Due to a rapid progression in the absence of proper surgical treatment, osteonecrosis of the femoral head, as a rule, results in disability. There is a wide range of causes that cause the development of osteonecrosis. According to the authors, alcohol abuse should be attributed to the underestimated causal factors of this pathology. The article presents two clinical observations which convincingly demonstrate the role of alcohol abuse as a cause of osteonecrosis. In a 44-year-old man prolonged alcohol abuse led to a progressive (within a year) advance of osteonecrosis in the heads of both femurs, and in a 26-year-old woman, along with a short-term intake of glucocorticoids, it contributed to the formation of multifocal non-traumatic osteonecrosis with damage to the pelvic, right knee, shoulder joints. The authors explain underestimated role of alcohol abuse as a causal factor of osteonecrosis as follows. Firstly, patients, as a rule, try not to display their addiction, and therefore, unlike other predictors of developing femoral bone osteonecrosis (injuries, serious somatic diseases, taking glucocorticoids), this fact is not reflected in medical documentation. Secondly, patients with idiopathic forms of osteonecrosis often do not have an "assigned" doctor who could dynamically follow up the patient and, consequently, monitor more carefully his condition and risk factors for osteonecrosis. When consulting such a patient, a subspecialist, as a rule, sets himself the task first of all to exclude "his disease", which makes the patient vulnerable in terms of finding out the causes of osteonecrosis. These clinical cases demonstrate the need to take into account alcohol abuse as a significant causal factor in the development of osteonecrosis.

EVALUATION OF PREDICTIVE CAPABILITIES OF TIRADS, EU-TIRADS, TLA_RU SYSTEMS IN THE ULTRASOUND DIAGNOSIS OF THYROID NODULAR PATHOLOGY

The aim of the study was to evaluate the prognostic capabilities of EU-TIRADS, TIRADS, TLA_RU systems in ultrasound diagnostics of thyroid nodular masses. A retrospective independent continuous blind study of ultrasound examination protocols was conducted in 665 patients, 241 patients had benign non-cancerous thyroid diseases, 86 patients had benign tumors (adenomas), 338 patients had thyroid cancer. During the preoperative examination, all patients underwent a multiparametric ultrasound examination of the neck organs according to the standard procedure, with the registration of identified thyroid nodes, with examining the prognostic capabilities of stratification systems – TIRADS, EU-TIRADS, TLA_RU. It was found that the TIRADS system has a sensitivity of 91.04%, specificity – 91.41%. Focusing on the scale of AUC values reflecting the quality of the diagnostic test, it can be stated that TIRADS is a test with excellent quality (AUC =0.972). Basing on the results of the analyzing the data obtained by the EU-TIRADS system, it was revealed that it is a high-quality test (AUC=0.826), but its predictive capabilities are worse than those of TIRADS. The original TLA_RU model has 87.5% sensitivity and 95.7% specificity. During the ROC analysis, it was found that the AUC is equal to 0.954±0.00894, which suggests that the TLA_RU model is an excellent quality test in the differential diagnosis of thyroid nodular masses. Multivariate statistical comparative analysis of thyroid imaging assessment systems (TIRADS, EU-TIRADS and TLA_RU) from the standpoint of evidence-based medicine has shown that thyroid cancer risk stratification systems based on the assessment of multiparametric ultrasound signs have great diagnostic capabilities.

IMPROVEMENT OF THE ALGORITHM FOR DIFFERENTIAL DIAGNOSIS OF INTRACYSTIC BREAST CANCER AND CYSTIC MASTOPATHY

Breast cancer is one of the most important problems of modern oncology. Intracystic cancer in the structure of malignant breast neoplasms belongs to one of the most rare forms and is a variant of intraductal papillary cancer. The issues of early diagnosis of this pathology remain controversial today. The aim of this work was to improve the algorithm of differential diagnosis of intracystic breast cancer and cystic mastopathy. Within the framework of this study, we examined 153 female patients of the prospective group with suspected breast cyst cancer and analyzed the results of examinations carried out for 59 patients of the retrospective group who were examined and treated for intracystic breast cancer in the period from 2010 to 2015 on the basis of Smolensk Regional Oncological Clinical Dispensary. The standard algorithm for examining the patients with suspected intracystic breast cancer in the framework of this study included multiparametric ultrasound (ultrasound in B-mode, ultrasonic Doppler examination, strain elastography, shear wave elastography) and fine needle aspiration puncture biopsy according to our improved technique with subsequent evaluation of the new algorithm's effectiveness. We drew conclusions on low sensitivity and specificity of the traditional algorithm for examining patients with suspected intracystic breast cancer, about a greater effectiveness of the improved algorithm for this diagnosis and advisability to use fine needle aspiration puncture biopsy using the ozone-oxygen mixture to improve the diagnosis of intracystic cancer at the preoperative stage.

PRIMARY AMYLOIDOSIS INVOLVONG THE HEART: CLINICAL OBSERVATION

Primary amyloidosis is a disease with a complex and not fully understood pathogenesis, which is characterized by a wide range of clinical manifestations. Light chain amyloidosis is the most common form of systemic amyloidosis. At this, the heart is the dominant target organ in systemic amyloidosis. Cardiac amyloidosis (amyloid cardiomyopathy) is most often manifested by diastolic heart failure resulting from restrictive cardiomyopathy. Therapy of amyloid cardiopathy includes optimal treatment of heart failure and chemotherapy. To reduce the symptoms of heart failure, diuretics are the main means, since other pathogenetic agents cannot be used due to hypotension and a possible decrease in cardiac output. With the introduction of new medicinal products into clinical practice, such as the proteosome inhibitor Bortezomib, the prognosis for patients has improved. However, amyloidosis remains a difficult disease to diagnose and treat.

DYNAMICS OF IMMUNOLOGICAL AND FUNCTIONAL INDICATORS IN THE COURSE OF TREATING EXACERBATION OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Repeated exacerbations of chronic obstructive pulmonary disease cause progression of this disease and result in its unfavorable outcome. Prevention of the first exacerbation of chronic obstructive pulmonary disease and alleviation of exacerbations are key goals in the treatment of the disease. Due to the fact that immune mechanisms occupy the central place in the pathogenesis of chronic obstructive pulmonary disease, the aim of the study was to study immunological parameters in patients with chronic obstructive pulmonary disease at the beginning of exacerbation and in the period of exacerbation termination, as well as the way how changes in immunological indicators affect the dynamics of pulmonary functional parameters in the process of treating patients with exacerbation of chronic obstructive pulmonary disease. The study included 116 patients hospitalized in the pulmonology department due to the first exacerbation of chronic obstructive pulmonary disease. In addition to the standard set of studies, patients underwent lymphocyte phenotyping using CD3, CD4, CD8, CD20 monoclonal antibodies, evaluation of neutrophils' phagocytic activity in a latex test, determination of immunoglobulins – IgG, IgA, IgM concentrations, circulating immune complexes and cytokines (interleukin (IL)-1β, IL-4, IL-8, interferon-γ (IFN-γ) in the serum. The above-described range of studies was carried out on the 2nd day of inpatient treatment and on the 10th–12th days of treatment. The results of the study showed that COPD exacerbation is associated with quantitative insufficiency of the cellular link in adaptive immunity against the background of activation of its humoral link. The features of the cytokine profile in patients with chronic obstructive pulmonary disease in exacerbation stage testified to the activated production of proinflammatory cytokines (IL-1ß, IL-8) and the main cytokines associated with the activation of humoral (IL-4) and cellular (IFN-γ) components of adaptive immunity. At this, the function of the cellular link was activated to a greater extent, as indicated by an increase in the ratio of IFN-γ/ IL-4. Analysis of indicators of external respiration function enabled us to establish that all speed indicators in patients were lower than in healthy ones. The functional parameters of the lungs, as well as immunological parameters, did not undergo significant changes as a result of treatment, which determines further progression of the disease.

METHODS OF DEPROGRAMMING THE MASTICATORY MUSCLES: LITERATURE REVIEW

Deprogramming of masticatory group muscles is an integral step in determining and fixing the centric jaw relation in the diagnosis and treatment of patients with orthopedic and orthodontic pathology of the maxillary system. The review presents the main methods for determining the centric jaw ratio using deprogramming of masticatory muscles, as well as indications for the use of these methods. In complete adentia, the most acceptable are the method of non-forced control of the mandibular movements, the Dawson method, the Schiler method, the method of recording the Gothic angle, transcutaneous electroneurostimulation. The above-listed methods can be used in partial adentia as well, and in the presence of all teeth in the oral cavity. In the pathology of the temporomandibular joint, deprogramming methods using the Lucia jig, a leaf gauge, Sliding Guide, as well as the method of recording the Gothic angle will also perform a diagnostic function. With the help of these methods, it is possible to change the design of long-wearing deprogrammers and medical devices. The most universal of these methods are the method of electronic recording of the Gothic arch and transcutaneous electroneurostimulation.

EXPERIENCE OF USING ENAMEL MATRIX PROTEIN IN COMBINATION WITH A CORONARY ADVANCED FLAP AND A CONNECTIVE TISSUE GRAFT TO ELIMINATE GUM RECESSION

The article presents the experience of complex managing a patient with gum recession in the area of the maxillary premolars. Periodontal treatment of gum recession consisted of initial therapy, including supra- and subgingival scaling, root planing, pharmacotherapeutic support (broad-spectrum antiseptics, drugs that stimulate regeneration), surgical combined method based on the use of enamel matrix protein to stimulate regenerative processes. The clinical material Emdogaine is a combination of an enamel matrix derivative and propylene glycol alginate, which performs the function of a carrier. Biora company has been producing it for more than 20 years (Emdogain, BIORA): now the rights to this material belong to Straumann). This preparation was developed to stimulate regeneration of periodontal tissues. Amelogenin is a specific enamel protein capable of stimulating regeneration of lost periodontal tissues by influencing cell differentiation. Dental cement is an osteoid connective tissue that covers the roots of teeth and serves to attach periodontal fibers. Application of an enamel matrix derivative to the sanitized root surface leads to regeneration of non-cellular cement and to the formation of periodontal tissues, which was observed in our study. Transplantation of free connective tissue grafts to eliminate gum recessions makes it possible to effectively eliminate gum recession in most clinical cases (complete root coverage, an increase in the level of clinical attachment from the keratinized attached gum area). In our clinical case, free grafts were obtained in the donor area of the maxillary tuberosity. Transplantation of free connective tissue grafts provides an aesthetic result and is currently considered a standard technique for eliminating gum recession. According to the clinical study, a combined use of connective tissue grafts and the enamel matrix derivative, an additional use of enamel matrix derivative enabled to obtain a satisfactory result and to improve the appearance of the dentition. Such combined surgeries are indicated in an aesthetically significant area. The described materials, methods and stages of patient's follow up can serve as the basis for the protocol of managing patients with gum recession.