Vol 32, No 10 (2021)

The number of medical specialties using additive technologies for the diagnosis and treatment of patients is increasing every year. There is the most active growth in the number of scientific publications, designed therapeutic procedures, and cured patients in traumatology, orthopedics, and neurosurgery. The number of clinics and surgeons using 3D-printed models for preoperative planning is growing every year. Owing to additive technologies, there is a possibility of personalized medicine products and comprehensive visualization of the area of surgical interest. Practicing surgical approaches and techniques allows one to shorten the time of surgery and the duration of anesthesia, to reduce tissue injury and blood loss. 3D printing implants can significantly improve the results of surgical treatment in traumatic, orthopedic, and neurosurgical patients. New materials and equipment open up new opportunities in the development of this innovative area in medicine.

Crohn’s disease and ulcerative colitis are chronic recurrent inflammatory diseases of the gastrointestinal tract, according to modern concepts, environmental aspects, intestinal microflora, genetic predisposition and impaired immune response to intestinal microbiota play an important role in the pathogenesis of these diseases. In addition to clinical manifestations from the gastrointestinal tract, inflammatory bowel disease can manifest itself with extraintestinal symptoms, among which one of the most common are lesions of the oral cavity. This review examines the specific and nonspecific manifestations of inflammatory bowel diseases in the oral cavity, as well as lesions of the oral cavity that develop as a result of malabsorption syndrome and during drug intake. Oral lesions, which can both precede intestinal manifestations and occur after the manifestation of inflammatory bowel diseases, require special attention from gastroenterologists and dental specialists

Objective: to investigate the impact of renal pelvic and ureteral mucosal infection on the severity of hematuria and inflammation in patients with nephrolithiasis (NLT), to establish risk factors (RFs), and to develop an adequate model for predicting urinary tract infection (UTI). Subjects and methods. The clinical, instrumental, and laboratory data were analyzed in 196 patients with NLT. Methods for pair correlation analysis and for construction of multivariate linear regression models using the EZR v package 1.35 (Saitama Medical Center, Jichi Medical University, Saitama, Japan) were applied to predict the risk of UTI in NLT. The adequacy of the regression model was assessed using the adjusted coefficient of determination (adjusted R-squared value (R2 adjusted)). Results. In the presence of UTI, the age of patients was established to have a significant impact on the severity of microhematuria in NLT. In patients with comorbidity of NLT and type 2 diabetes mellitus, UTI was found more frequently (p=0.027), the count of red blood cells in urine increased by 66.3% (p=0.014), and gross hematuria was more common (p=0.034). There was evidence that the size and localization of calculi in the renal pelvis and ureter were RFs for UTI in patients with NLT. The occurrence of UTI in the presence of renal pelvic (>50- mm) and ureteral (>10-mm) calculi was accompanied by the increasing severity of microhematuria. The diagnostic model based on the studied factorial signs demonstrated the high effectiveness of UTI prediction in NLT: the area under the receiver operating characteristic (ROC) curve (AUC) was 0.892 (95% confidence interval (CI), 0.768-0.963); the sensitivity was 88.9% (95% CI, 65.3-98.6), and the specificity was 90.0% (95% CI, 73.5-97.9).

Objective. To study the results of endoscopic transpapillary interventions in the treatment of choledocholithiasis. Subjects and methods. In 2016-2020, the Endoscopy Unit, V.D. Seredavin Samara Regional Clinical Hospital, performed interventions into the major duodenal papilla in 354 patients (249 women and 105 men; the patients’ mean age, 65 years; and patients aged over 60 years (78%)) with obstructive jaundice caused by choledocholithiasis. Results. After various endoscopic interventions, it could be possible to extract concretions into the intestinal lumen and to restore choledocheal patency in 306 (86.3%) patients with single and multiple common bile duct stones of relatively small diameter (0.8-1.4 cm). Nasal biliary drainage was installed in 69 patients, which made it possible to reduce the manifestations of obstructive jaundice and to stop cholangitis. Large concretions measuring >1.5 cm were detected in 32 patients. The sizes of common bile duct concretions were <1.0 cm in 4 patients. To prepare patients for more radical endoscopic intervention, mechanical lithotripsy was attempted to extract bile duct concretions in 36 patients having the latter; nasal biliary drainage was installed in 11 patients of this group after papillotomy, and duodenal biliary endoprosthesis was performed in 10 patients. Before endoscopic lithotripsy, 16 patients underwent balloon dilation to facilitate subsequent extraction of concretion fragments. Conclusion. Endoscopic transpapillary interventions are a highly effective and less traumatic treatment for patients with choledocholithiasis. Papillotomy greatly facilitates the subsequent extraction of common bile duct concretions. Nasal biliary drainage and choledochal endoprosthesis can improve the health of patients and prepare them for more radical endoscopic and surgical treatments.

The active development of resuscitation and intensive-care treatments allows surgical interventions to be performed in very sick patients with various surgical diseases. Patients with multiple injuries often require long-term mechanical ventilation, which needs to have a tracheostomy. Objective: to describe various cases of tracheostomy complications, as well as preventive measures used for their elimination. Material and methods. The paper describes the experience in treating patients with severe surgical disease, including head and neck tumors, who were treated in the Intensive Care Unit (ICU), V.D. Seredavin Samara Regional Clinical Hospital, and in the Surgical Unit, Railway Clinical Hospital at the Samara Railway Station, in 2009- 2019. A study group included patients who had undergone tracheostomy during their ICU stay. The paper describes clinical cases of tracheostomy complications and methods for their elimination using the authors’ patents: Conclusion. Despite improvements in methods for surgical intervention and postoperative management of patients, the number of complications continues to remain high. To reduce the frequency of complications, it is necessary to use modern diagnostic methods and recent developments in alleviating disease in a patient who has undergone a tracheostomy.

Idiopathic macular rupture (IMR) results in deteriorated central visual acuity. There is currently no drug treatment for macular ruptures because targeted drug delivery to the macula is impossible. Endovitreal surgery remains the generally accepted treatment. The success of surgical treatment depends not only on the method and techniques used by a surgeon, but also largely on the gap diameter and age, concomitant disease, and a patients age. All this requires a differentiated approach to treating patients with macular disease. The paper describes various clinical cases of surgical treatment for IMR, by applying a differentiated approach to choosing therapy.

The characteristic resistance of dorsopathies to conventional therapy explains attention to new technologies that combine several therapeutic components, ozone therapy in particular. According to the rules of biopuncture, by introducing gas into the area of reflexology points, ozone therapy enhances the efficiency of treatment. Objective: To detail the main components and therapeutic characteristics of ozone therapy according to the rules of biopuncture. Subjects and methods. The investigation involved 90 patients less than 55years of age in the phase of a dorsopathy exacerbation with a leading vascular component. The patients were divided into 3 groups: 1) those who received basic medical-and-physical treatment and standard ozone therapy with a preferential choice of algic areas; 2) those who had basic medical-and-physical treatment and ozone therapy according to the rules of biopuncture (exposure to a set of segmental, distant, and vascular points); 3) those who had basic medical-and-physical treatment only. The observed changes were verified by clinical, psychological, and electrophysiological analyses. Results. Both ozone therapy regimens showed a significant efficiency (an improvement was reported by 69 and 73% of the patients, respectively) compared to the control group (49%). The results of the Multiphasic Personality Inventory indicated a decrease in anxiety and the need to control the nature of painful manifestations in patients of the ozone therapy groups, there was also an improvement in the indicators of the Well-Being-Activity-Mood questionnaire. The differences between the ozone therapy groups in achieving a stable effect (2.6 days earlier in Group 2) and in the degree of a reduction in vasoreflex responses, the reversal of which was confirmed by characteristic shifts in electrophysiological parameters (in 50% and 75% in Groups 1 and 2, respectively). A follow-up analysis revealed dorsopathy relapses in 32% of cases of the control group and these were significantly less often in the ozone therapy groups (21% and 18% in Groups 1 and 2, respectively. Moreover, the relapses were milder in Group 2. In addition, the latter group maintained a positive vascular effect confirmed by electrophysiological parameters. Conclusion. Thus, the investigation involving additional control methods, such as clinical, psychological and electrophysiological ones, showed that according to the rules of biopuncture, ozone therapy ensures that the latter achieves a faster and more stable effect.

The article discusses the issues of diagnosis, pathogenesis, clinical picture of osteoporosis, as well as the prevention of osteoporotic fractures of various localization using the drugs Osteomed, Osteomed Forte and Osteo-Vit D3. The effectiveness of these drugs in the complex therapy of osteoporosis, increasing bone mineral density, reducing the likelihood of recurrent injuries, and improving the quality of life has been shown.