Vol 30, No 6 (2019)

The paper considers the diagnosis and classification of postgastrectomy syndromes, their causes, treatment, and prevention. Based on the analysis of Russian and foreign researchers’ publications on the treatment of postgastrectomy complications, the authors demonstrate different unsolved aspects and a need to further develop optimal methods for primary and reconstructive surgical correction in patients with complicated peptic ulcer disease.

The article describes the application of cell cronoblocker in multimodal programmes for the prevention of early aging. Many studies confirm that the development of a number of diseases, such as hypertension, diabetes mellitus type II, osteoarthritis and others in middle-aged people is a direct consequence of the processes of premature aging. It is important to use measures to prevent premature aging. The particular interest for the preparation of preventive programs are present the cell chronoblockers, which capable of preventing premature aging by normalizing the internal potential and functioning of the cell, such as organic sulfur, beta-alanine, succinic acid, ubiquinone, dimethylaminoethanol and others. The importance of distinguishing the preparations of cellular chronobiology and study its properties as an effective complementary preventive components of the geriatric programs is promising.

Currently, despite the extensive experience of countries and health professionals in vaccination fields, there are many unresolved issues. This is especially true of vaccination in elderly people. Today there is a need to develop clear vaccination programs at all levels, especially at the state level, taking into account all the features of the elderly population. The author also presents specific issues of vaccination, such as vaccination for influenza and Herpes Zoster prevention, pneumococcal vaccination and others. The question of optimization of vaccination taking into account its positive impact on the prognosis, quality and life expectancy is discussed. Vaccination coverage, unfortunately, remains low, as does the degree to which the population as a whole is convinced of the need for vaccination.

The paper analyzes the current possibilities of diagnosing a form of urinary incontinence using uroflowmetry, a noninvasive urodynamic study. The main possibilities of preventing acute and chronic urinary retention according to uroflowmetric results and those of estimating the residual urine volume are detailed. The results of treatment for urinary incontinence and the possibilities of choosing individual combined therapy with the preliminary screening urodynamic diagnostic technique uroflowmetry and without the latter have been compared.

The paper analyzes the clinical features of gastroesophageal reflux disease (GERD) in the age aspect. It proposes a modified approach to diagnosing and treating GERD in elderly patients according to age, somatic status, and potential risk factors.

As patients age, their bone tissue in the presence of gross morphological changes associated with the progression of osteoporosis shows alterations at the level of microelements, which manifest as a gradual decrease in C, N, O, Na, Mg, P, and Ca levels in the areas with necrotic tissue.

The original procedure for endoscopic harvest (EH) of the great saphenous vein (GSV) in the flap with the surrounding tissues has contributed to a significant reduction in the frequency of wound complications. However, harvesting in the flap is very traumatic for the lower extremities, although a direct quantitative assessment of wound complications has previously been carried out. Of interest was also the impact of the new procedure for GSV EH on lymphatic outflow, since such publications are not sufficient and the results are ambiguous. Objective: to comparatively assess lymphatic drainage function and to quantify the volume and extent of soft- tissue injury of the lower extremities after GSV EH. For this, before and after coronary bypass surgery, the patients underwent radionuclide lymphoscintigraphy of the lower limb (in 16 patients in the open harvest (OH) group and in 14 after EH) and magnetic resonance imaging of the lower limbs (in 21 patients in the OH group and in 23 in the EH group). Instrumental examination was complemented by measurements of changes in the lower limb circumference in order to verify lymphostatic edema. The scintigraphic signs of impaired lymphatic outflow were observed in 62.5% of cases in OH and in 42.86% in the use of the original endoscopic procedure. Lymphatic edema occurred in 12.17% of cases after EH and in 45.28% after traditional harvest (p<0.0001). In addition, the EH group demonstrated the lesser extent of the injury zone (8.96±2.87 and 11.2±3.1 cm, respectively; p<0.05) and the smaller volume of edematous tissue (1.50±0.95 and 5.8±2.6 cm3; p<0.05).

The increase in the prevalence of cognitive impairment (CI) and depression, which are closely associated with senile asthenia (SA), is a pressing problem of geriatrics. The relationship of this pathology to the presence or absence of SA was studied using the comprehensive geriatric assessment (CGA) technique in 300 patients divided into 3 equal age groups: elderly patients, senile patients, and long-livers. After analysis of case histories and outpatient records in all the groups, the patients with presumptive SA were selected according to the “Age is No Hindrance" screening scale (a total score of >3). The MiniCog test (a 3-word recall test and a clock drawing test) was used to evaluate cognitive functions; the geriatric depression scale (>5 positive answers to 15 questions) was employed to diagnose depression. It has been shown that the incidence of SA increases with age, with women predominating among the patients. Depression is detected at the age of 65-74 years in every three patients, and by the age of 85-90 years in more than 50% of those making their outpatient visit. The presence of SA substantially affects the prevalence of depression. It is more expedient to use the clock drawing test as a screening study to identify mild CI; the word recall test can detect CI associated with impaired memory function. Hypertension is widespread in all groups regardless of the presence of SA, and the prevalence of diabetes mellitus decreases with age.

Electron scanning microscopy and enzyme immunoassay were used to conduct a comprehensive study of blood characteristics in elderly patients with prostate cancer (PC). A total of 110 people divided into groups and subgroups, differing in age and nature of the extent of a tumor process, were examined. In apparently healthy elderly patients, the percentage of prehemolytic forms of erythrocytes were shown to be higher than that in middle-aged people. The elderly, also those with prostate pathologyy, versus the control group of the same age had lower content of discocytes, higher frequency of transitional forms of red blood cells, and their decreased average diameter. Tendencies toward changes in the concentration of biomarkers (TuM2Pk, interleukin-12, FGF, VEGF, tumor necrosis factor-а, and total prostate-specific antigen l) were also determined in elderly people with varying tumor extents in PC.

A specific feature of hemophilia, unlike many other hemorrhagic diathesis, is the defeat of the musculoskeletal system due to repeated bleedings. First described clinical case of the effective application of recombinant coagulation factor VIII (Octofactor, moroctocog alpha, JSC «GENERIUM») in a patient with hemophilia A during performing a series of sequential prosthetics of major joints. The use of moroctocog alpha in the required doses provides adequate hemostasis during surgery, as well as contributes to the favorable course of the postoperative period and timely discharge of the patient.