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№3 (19) 2020
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Аннотация ▼
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Ключевые слова: перитонит, открытый живот, лапаростомия, вакуум-ассистированная повязка, вакуум-инстилляционная лапаростома, барботаж.
Improving treatments for complicated forms of peritonitis is one of the key issues of modern surgery. Despite the variety of surgical intervention technologies, as well as the improvement of algorithms and guidelines, lethality in secondary prevalent peritonitis remains at a high level, due to which the search and development of methods of management of patients remains relevant, combining both the technique of surgery and the methods of perioperative management. Peritonitis treatment, implying the use of vacuum therapy at the present stage, is the flagship in the field of abdominal surgery, and therefore the issue of improving this technology is prioritized by both domestic and foreign specialists. One of the innovative ways to modernize the vacuum technology of conducting an open abdomen or laparostomy is the use of the sparging perioperative abdominal sanitation in the perioperative period. In modern literature, references to the management of patients with general purulent peritonitis, implying the use of sparging, are single and fragmentary, which in turn causes the need for more research in this area.
Keywords: peritonitis, open abdomen, laparotomy, vacuum-assisted dressing, vacuum-instillation laparostomy, sparging.
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Ключевые слова: детская урология, обструктивные уропатии, мегауретер, уретероцистонеоанастомоз, мультикистоз, хроническая почечная недостаточность.
Every year, about 250 children are examined and treated for obstructive uropathies in the Altai Regional Clinical Center for Maternity and Child Welfare. Patients with a combination of malformations of the urinary system demand most attention. Children with the afunction of one of the kidneys, recurrent pyelonephritis, gross organic pathology of the second kidney and, as a result, a high risk of development of chronic renal failure require particularly subtle approach to the treatment tactics. Observing the dynamics of preoperative and postoperative periods, good results of treatment of a combination of obstructive megaureter and multicystic disease in a child, the authors saw it necessary to highlight this clinical case in the scientific world.
Keywords: pediatric urology, obstructive uropathies, megaureter, ureterocystoneoanastomosis, multicystosis, chronic renal failure.
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Цель работы: проанализировать и обобщить данные литературных источников и собственного исследования для выявления экофизиологической роли фотопериода в активности репродуктивной системы женского организма в разные периоды онтогенеза. Выявлено, что роль фотопериода в онтогенезе женского организма в репродуктивной системе заключается в выработке фото-зависимого гормона эпифиза – мелатонина, который оказывает влияние на менструальный цикл и способность к зачатию. Показано, что максимум зачатий наблюдается в апреле, а минимум – в феврале, что объясняется сезонностью фотопериодических явлений и выработкой мелатонина, осуществляющего контроль за активностью репродуктивной системы.
Ключевые слова: фотопериод, мелатонин, хронопериодическая система, онтогенез, зачатие, репродуктивная система.
This paper systematizes the data of literary sources and presents the results of own research on the role of photoperiod in the female reproductive system.
Objective: to analyze and summarize the data of literary sources and own research to identify the ecophysiological role of photoperiod in the activity of the reproductive system of the female organism at different periods of ontogenesis. It is revealed that the role of photoperiod in the reproductive system in ontogenesis of the female organism consists in the production of photo-dependent hormone epiphysis: melatonin, which has an effect on the menstrual cycle and the ability to conceive. It is shown that the maximum of conception is observed in April and the minimum in February, which is due to the seasonality of photoperiodical phenomena and the production of melatonin, which controls the activity of the reproductive system.
Keywords: photoperiod, melatonin, chronoperiodic system, ontogenesis, conception, reproductive system.
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The analysis of the course and outcome of pregnancy in 92 women with sporadic reproductive loss according to the type of non-developing pregnancy in history was performed, including 42 patients after pregravid preparation in accordance with the identified nutrient-deficient conditions and the presence of antibodies to xenobiotic benzo[a]pyrene compared to a group of 50 women who did not receive preparation before the onset of pregnancy. Repeated non-developing pregnancy in the group without pregravid preparation was recorded 3 times more often. In children born to women after pregravid preparation in the early neonatal period, posthypoxic CNS lesions were significantly less likely to be recorded (21.9% and 65.2%, p=0.0001) and there were less diseases that required the second stage of treatment (17.1% and 63.0%, p<0.0001). Conclusion: pathogenetically substantiated pregravid preparation of women with the sporadic case of non-developing pregnancy allows to improve the prognosis of gestation and reduce the frequency of perinatal complications.
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Ключевые слова: эклампсия, преэклампсия, биологические маркеры, тканевой фактор.
Eclampsia/preeclampsia continues to be not completely recognized, pathological condition of gestation determining perinatal/maternal morbidity/mortality, occupying the 3rd place in their structure up to the present time. This review examines the major historical steps of evolution in understanding eclampsia/preeclampsia: the “strange” disease of humanity associated with reproduction. The stages of description, definition, and understanding of the “disease of theories” are presented. The focus is on freely available information on the role of biological markers and the balance of modulators of hemostatic reactions specific to this pathology. Determination of the role of biologically active factors in the pathogenesis of the development of preeclampsia can contribute not only to the deepening of knowledge about the pathogenesis of this pathology, but also involves the search for drugs that have the ability to target specific PE markers.
Keywords: eclampsia, preeclampsia, biological markers, tissue factor.
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Материалы и методы. В исследование включены 119 беременных в сроке 24–33 недели гестации: 27 женщин с целым плодным пузырем, у которых впоследствии произошли срочные роды со своевременным излитием околоплодных вод и рождением здоровых доношенных детей; 92 женщины с преждевременным разрывом плодных оболочек в 24–33 недели гестации, родившие недоношенных детей. Статистический анализ проводился с использованием логистической регрессии.
Результаты и обсуждение. В структуре соматических заболеваний основной группы беременных и группы контроля достоверно значимых различий не было, что свидетельствует об отсутствии неблагоприятного воздействия хронических заболеваний на ПРПО. Установлено, что в группе ПРПО статистически значимо выше доля женщин с ИППП в анамнезе (65% против 19%, p<0,001), в частности, с Candida albicans (18% против 0%, p=0,01) и Chlamydia trachomatis (14% против 0%, p=0,01). Анализ детородной функции продемонстрировал следующее: группа контроля и группа ПРПО статистически значимо различаются по паритету беременности (p=0,001), в частности, в группе ПРПО выше доля женщин с третьей беременностью и более (57% против 26%, p=0,005) за счет меньшей доли женщин с первой беременностью (12% против 41%, p=0,001). Также в группе ПРПО статистически значимо выше, чем в контроле, доля женщин с потерями беременности в анамнезе (32% против 0%, p=0,001) и абортами (57% против 19%, p=0,001). При анализе осложнений беременностей в группе контроля и группе ПРПО статистически значимых различий не выявлено, однако у большинства женщин с ПРПО беременность протекала на фоне угрозы преждевременных родов (49%). В группе ПРПО по сравнению с контролем на первые сутки после излития вод отмечался уровень гемоглобина 121(111;129,5) г/л против 129(121–132) (p=0,03) и повышенная концентрация лейкоцитов – 13,7(8,2;17,2)×109 Ед/л против 6,7(6,6–7,6)×109 Ед/л (p<0,001). Заключение. ПРПО в 24–33 недели гестации ассоциирован с повышенным уровнем лейкоцитов (выше 13×109 Ед/л) в сыворотке крови, с паритетом у женщины (первая, третья и более), наличием потерь беременности и абортов в анамнезе, носительством возбудителей инфекций, передаваемых половым путем (ИППП).
Research objective: to study and assess the impact of major clinical factors on premature rupture of fetal membranes at 24–33 weeks of pregnancy.
Materials and methods. The study included 119 pregnant women in the period of 24–33 weeks of gestation: 27 women with a whole fetal bladder, who subsequently had an urgent birth with the timely discharge of amniotic fluid and birth of healthy full-term babies; 92 women with premature rupture of fetal membranes at 24–33 weeks of gestation, giving birth to premature babies. The statistical analysis was carried out using logistic regression.
Results and discussion. There were no significant differences in the structure of somatic diseases of the major group of pregnant women and the control group, which indicates the absence of adverse effects of chronic diseases on the PRFM. It was found that in the PRFM group, there was a statistically significantly higher proportion of women with STD in history (65% vs. 19%, p<0.001), in particular, with Candida albicans (18% vs. 0%, p=0.01) and Chlamydia trachomatis (14% vs. 0%, p=0.01). The analysis of fertility demonstrated the following: the control group and the PRFM group differ statistically significantly in pregnancy parity (p=0.001), in particular, in the PRFM group, there is a higher proportion of women with third pregnancy or more (57% vs. 26%, p=0.005) due to a lower proportion of women with the first pregnancy (12% vs. 41%, p=0.001). The proportion of women with history of pregnancy loss (32% vs. 0%, p=0.001) and abortion (57% vs. 19%, p=0.001) is also statistically significantly higher in the PRFM group than in control. In the analysis of complications of pregnancies in the control group and the PRFM group, there were no statistically significant differences, but in most women with PRFM pregnancy occurred against the background of the threat of premature birth (49%). In the PRFM group compared to the control on the first day after the fluid discharge, the level of hemoglobin 121 (111;129.5) g/L vs. 129(121–132) (p = 0.03) and an increased concentration of leukocytes – 13.7(8.2;17.2)×109 IU/L vs. 6.7(6.6–7.6)×109 IU/L (p<0.001) were noted.
Conclusion. PRFM at 24–33 weeks of gestation is associated with an increased level of leukocytes (above 13×109 IU/L) in the blood serum, the parity in a woman (first, third and more), the presence of pregnancy losses and abortion in history, carrying the pathogens of sexually transmitted diseases (STD).
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Ключевые слова: глаукома, ОКТ.
The increasing incidence of glaucoma worldwide shows objective difficulties in both diagnosis and treatment. The introduction of optical coherent tomography into the algorithm of diagnostic examination of patients with glaucoma allows to objectively assess patterns of structural and hemodynamic changes. The article discusses the opportunities of OCT and OCT-angio for the purpose of early detection of the disease and dynamic observation of patients.
Keywords: glaucoma, OCT.
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Ключевые слова: аквапорины, плод.
The study of aquaporins, molecular water channels, is of interest in understanding the transport of water and dissolved substances both in the body and between the mother and fetus. The review considers modern data on the aquaporin family, their expression in organs in postembryonic ontogenesis, in fetal membranes, kidneys, lungs, fetal skin, their role in the regulation of amniotic fluid volume.
Keywords: aquaporins, fetus.
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Ключевые слова: краниопластика, аддитивные технологии, 3D-печать, дефекты костей черепа, реконструктивная нейрохирургия.
The article gives the historical background of the development of cranioplasty: since the Mesolithic or early Neolitic, when cranial trepanation was ritualistic. Since then, reconstructive neurosurgery has undergone several periods of development. Indications for cranioplasty are currently divided into three groups: therapeutic, cosmetic, and preventive. The article lists the main stages contributing to the development of reconstructive neurosurgery. Modern materials used to close skull defects, their properties, features, pre- and intraoperative modeling are described. Previously, “freely” or “manually” simulated biopolymers were used in cranioplasty. Recently, they have seldom been used for the plastic of extensive defects due to a poor aesthetic result. Currently, 3D printing allows to improve the aesthetic effect of reconstructive neurosurgery. Conducting experiments on stem cells and developing morphogenetic proteins solve the problem of transplant rejection.
Keywords: cranioplasty, additive technologies, 3D printing, skull defects, reconstructive neurosurgery.