Vol 32, No 8 (2021)

A comprehensive approach to treating BC patients, which includes highly effective drug treatment options and postoperative radiation therapy, allows surgeons to perform operations of various volumes: from tumorectomies to radical mastectomies with breast reconstruction. Organ-sparing operations (OSO) in the combined/combination treatment of BC lead to equal relapse-free and overall survival rates compared to mastectomies, despite the higher frequency of local relapses. The widespread use of oncoplastic resections over the past decades, which combine the principles of oncological safety and aesthetic surgery, has made it possible to expand indications for organ-sparing treatment in BC. Today, the issues of oncological safety of OSO involving both conventional (tumorectomy, lumpectomy, quadranectomy) and oncoplastic resections do not lose their relevance. In addition, owing to a personalized approach to treating BC, the question of determining the predictors of local relapse after OSO remains interesting. This paper provides a literature review reflecting the oncological results of OSO in BC patients, as well as the factors influencing the frequency of local recurrences.

Erectile dysfunction (ED) serves as an early marker or precursor for cardiovascular diseases. The most important pathogenetic component of hypertension and ED is pathological endothelial changes, insufficient nitric oxide production, chronic inflammation, and androgen deficiency. ED can also develop as a complication of antihypertensive therapy. When treating hypertension in males, it is recommended to evaluate sexual functioning regardless of age and to prescribe antihypertensive therapy individually. The issues of continuing sexual activity and treatment of ED should be discussed with the patient after assessing the risk of a cardiovascular event and stabilizing the condition.

The lecture is devoted to the problem of stress disorders and is addressed to General practitioners and students of medical universities. It describes the epidemiology of stress, its risk factors, the mechanism of its effect on the structures of the central nervous system. The article describes the connection of stress disorders with other noncommunicable diseases, both mental and somatic. Information is presented on the impact of coronavirus infection on the formation of stress disorders in the general population and in medical workers engaged in providing medical care to patients with COVID-19. The syndrome of «burnout» in doctors, its causes are described. Methods of stress prevention are also considered.

Primary hyperparathyroidism is one of the acute medical and social problems due to the low level of diagnosis. The main cause of disease is the hypersecretion of parathyroid hormone by the adenoma of the parathyroid gland, which results in osteoporosis, recurrent stone formation, ulcerative lesions of the gastrointestinal tract and other severe complications. Diagnosis is based on the detection of hypercalcemia and visualization of the paradenoma by ultrasound, the most effective method of treatment is paraadenomectomy. In Western countries, the active study of primary hyperparathyroidism began in the 70s of the last century. The studies carried out made it possible to find out the prevalence of the disease, which was previously considered a rare pathology, and also significantly increase the detection rate of primary hyperparathyroidism at an early stage. In highly developed countries since the 2000s 80% of new cases of the disease are presented in uncomplicated forms. In the Russian Federation, the situation remains extremely unfavorable: the overwhelming number of cases are detected at the stage of severe complications, while uncomplicated forms do not exceed 30%. The clinical observations presented in the article illustrate the complexities of timely diagnosis of primary hyperparathyroidism and indicate the need to take urgent measures. The screening of adults for hypercalcemia will make it possible to find out the prevalence of primary hyperparathyroidism, identify the disease at an early stage, as well as determine the provoking factors for the development of primary hyperparathyroidism and outline ways of prevention.

Due to the presence of comorbid pathology, children with autism spectrum disorders (ASD) require enhanced monitoring by a pediatrician and specialists in other fields of medicine. These conditions include both a number of somatic (frequent respiratory diseases, constipation, diarrhea, and allergic manifestations) and neurological (sleep disorders, attention-deficit/ hyperactivity, and seizures) symptoms. Lack of information about the manifestations of somatic diseases in children with ASD is primarily due to difficulties in examination and diagnosis, poor social interaction as an inability to characterize and localize their own unpleasant sensations and pain symptoms; neurological symptoms are often attributed to the manifestations of the underlying disease. The paper analyzes the scientific literature on the incidence and nature of comorbid pathology in children with ASD.

Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology, Ministry of Health of Russia, Moscow Pericardial effusion may accompany malignant disease or be its first obvious clinical manifestation. The clinical interpretation of the presence and amount of pericardial effusion remains a subject for further study. Objective. To determine the incidence of pericardial diseases and their possible prognostic value in children and adolescents with cancers and hematological cancers. Subjects and methods. A total of 312 patients with cancers and hematological cancers were observed during the active development of the disease. Examinations were additionally made in 114 children and adolescents who had been admitted to the intensive care unit (ICU), including 53 patients (Group 1) with a fatal outcome and 61 patients (Group 2) who had been transferred from ICU to general wards after relief of life-threatening conditions. During the remission period, 253 children were examined at the rehabilitation stage. The diagnosis of a pericardial condition was based on ultrasound. Results. Among the 312 patients outside the ICU with an actively ongoing cancer process, pericardial effusion was detected in 79 (25.3%); out of them, 35 (44.3% of all patients with effusion) were found to have minimal effusion. Fifteen of these 35 patients had effusion in the presence of a systemic infection. Moderate effusion was recorded in 15 patients (19% of all patients with exudative pericarditis). There were no neoplastic cells or infectious agents in the pericardial fluid. Twenty-nine (36.7%) patients had a large effusion with the separation of epi- and pericardial layers in systole and diastole with an echo-free space over the anterior surface of the heart; in 15 of them, it was concurrent with a plural effusion. Small and moderate effusions did not affect the condition of patients. Large, long-lasting, and polyserositis-associated effusions were correlated with an unfavorable outcome. The volume of effusion, which was equal to or greater than that of the left ventricle and often concurrent with polyserositis, is regarded as critical, threatened by cardiac tamponade, was observed only in the group of children with a fatal outcome. At the stages of rehabilitation, pericardial effusion was rarely detected; it was minimal and did not affect prognosis. Conclusion. Effusive pericarditis frequently accompanies cancers. Recurrent large-volume effusions that are concurrent with those into other cavities and life-threatening are unfavorable. They are rarely associated with infection and suggest the underlying disease has a critical course, as well as they can be regarded as paraneoplastic.

The study of ethnic features of the functioning of the central nervous system (CNS) is an urgent problem of modern medicine. Purpose. Study of the features of the functional state of the CNS in schoolchildren of the indigenous and non-indigenous population of Khakassia by the parameters of a simple visual-motor reaction. Material and methods. We examined random samples of schoolchildren 12-17 years old of both sexes, indigenous and non-indigenous population of the city of Abakan. The functional state of the central nervous system was assessed by the method of a simple sensorimotor reaction using the hardware-software complex UPFT-1/30 «Psychophysiologist». We compared the indicators of 2 groups, formed taking into account ethnicity: the indigenous (Khakass) and nonindigenous (Caucasians) population. The functional state of the central nervous system was assessed according to the indicators of the average response time (level of response rate) and its standard deviation (level of stability), by integral parameters reflecting the level of error and the level of sensorimotor reactions (level of central nervous system activation). The indicators were processed in the program «Statistica 12» (USA). Results. Most schoolchildren of the indigenous and non-indigenous population of Khakassia have a satisfactory functional state of the central nervous system. Ethnic differences in the functioning of the central nervous system were revealed in the form of a predominance of inertia and imbalance of nervous processes, a lower concentration and stability of attention in adolescents of the indigenous ethnic group. Conclusion. The revealed tendencies towards the deterioration of a number of indicators of a simple visual-motor reaction in some schoolchildren of the indigenous population of Khakassia (a decrease in concentration and stability of attention, a slowdown in simple visual-motor reactions) indicate the predominance of inhibition processes in the central nervous system, a state of fatigue, a decrease in mental performance and cognitive activity in this contingent of adolescents. The results obtained confirm the urgency of this problem and indicate the need for further research in this direction.

The paper reflects the results of Russian and foreign studies of the impact of. aorto-coronary bypass surgery on quality of life and prognosis in patients with coronary heart disease. The predictors of a poor prognosis after surgery are shown to be old age, female sex, diabetes mellitus, obesity, cerebrovascular diseases, chronic obstructive pulmonary disease, respiratory and renal failure, and smoking.