Vol 34, No 10 (2023)

Vulvar cancer (VC) is a relatively uncommon malignant neoplasm of the female genital system. However, the prevalence of human papillomavirus infection in women of reproductive age has been increasing, elevating the risk of this oncopathology. The treatment of VC, like many other malignant tumors, involves radical approaches that have a profound impact on various aspects of a woman's life. Surgical intervention significantly alters the anatomy of the external genitalia, leading to serious psycho-emotional disorders such as anxiety, depression, and body image dissatisfaction. Additionally, common adverse effects of treatment include lower extremity lymphedema, sexual dysfunction, and social maladjustment, all of which contribute to a reduced overall quality of life (QoL). To address these complications and enhance the QoL for patients following radical surgical treatment of VC, it is essential to timely introduce comprehensive personalized rehabilitation into the management strategy.

Serious skin injuries can lead to the formation of scars, in particular hypertrophic and keloid scars. The prevalence of keloids and hypertrophic scars varies among different populations.

Scar formation is a natural process during wound healing, but when keloid scars form, regeneration is impaired. It is generally accepted that a keloid scar is formed as a result of increased synthesis of collagen and extracellular matrix against the background of reduced degradation of these products. Clinically, keloid and hypertrophic scars have a number of differences. Thus, the formation of a keloid scar takes a longer period; it extends beyond the boundaries of the original wound and is often accompanied by itching, pain, and impairs motor function. Treatment of keloid scars is a very difficult task, and inadequate treatment can aggravate the patient's condition.

Pain in the right hypochondrium is one of the most frequent complaints in patients with diseases of the gallbladder and biliary tract. In recent years, in developed countries, there has been a tendency to increase the frequency of gallbladder diseases. According to statistics, every tenth person experiences unpleasant sensations in the upper abdomen after eating fatty, fried, salted and smoked food, as well as after drinking alcohol or after psychoemotional and physical exertion. The most common diseases of the gallbladder and biliary tract are biliary dyskinesia.

Biliary dyskinesia is a functional disease caused by uncoordinated and untimely contraction of the gallbladder, bile ducts and Oddi sphincter. Pain with dyskinesia is described by the term "biliary pain": localized in the right hypochondrium, lasts about 30 minutes, there are often repeated attacks and even at night, sometimes nausea and vomiting occur, which does not bring relief, there is a feeling of bitterness in the mouth. Traditionally, this pathology of the gallbladder was divided into hypoand hyperkinetic types, which differed in their manifestations.

It should be noted that long-term functional disorders eventually lead to organic lesions. For example, with the hypokinetic type, there is a violation of the properties of bile, its ability to form stones increases, which leads to the development of cholelithiasis.

This article is devoted to the etiology, pathogenesis, clinical picture and treatment of JMP, as well as the use of the drug Hilak Forte in intestinal dysbiosis as a result of biliary tract disorders.

The article identifies the main problems that may arise when organizing a bariatric service in a multidisciplinary hospital. The ways of their solution are proposed. Special attention is paid to the problem of the organization and development of bariatric surgery at the legislative level. The problems of technical equipment of hospitals where bariatric operations are performed are described in detail. An important place is given to the need for special training of surgeons, the role of a multidisciplinary approach to the surgical treatment of obese patients. The treatment of a surgical patient consists of several stages: preoperative examination and preparation for surgery; performing bariatric surgery, performing aesthetic operations, lifelong outpatient observation.

Worldwide, Parkinson's disease (PD; primary Parkinsonism) is ahead of other neurological disorders in terms of the growth rate of disability and mortality. Despite significant progress in the study of the etiopathogenesis of PD, early diagnosis is a difficult clinical task. The long latent phase of the disease and the absence of reliable laboratory markers often cause a delay in diagnostic neuroimaging, which, together with the potential unwillingness of the radiologist to see changes characteristic of the neurodegenerative process, leads to untimely diagnosis and, as a consequence, a delay in the appointment of therapy.

This article provides a literary review of generally recognized visualization patterns of the disease in accordance with modern concepts, and also discusses the issues of differential diagnosis of PD with the most common Parkinsonism-plus syndromes. A clinical case of the diagnosis of Parkinson's disease in a 93-year-old patient by structural magnetic resonance imaging is presented.

Objective. To evaluate the effect of a polypeptide complex isolated from bovine cartilage tissue (PPCC) and its constituent AED peptide on the proliferation of chondrocytes, obtained from young and old rats.

Materials and methods. Chondrocytes primary culture of young (3 months) and old (20 months) rats was used in the work. Cell proliferation on the 4th passage was evaluated by the cell growth curve for 5 days. PPCC and the AED peptide were studied at concentrations of 20; 200 and 2000 ng/ml.

Results. The AED peptide at an effective concentration of 200 ng/ml increased the number of chondrocytes in cultures obtained from young and old animals by 1.4–1.8 and 1.6–2.1 times, respectively, compared with the control. PPCC at an effective concentration of 2000 ng/ml stimulated the proliferation of chondrocytes in cultures obtained from young and old rats, respectively, by 1.7–2.2 and 1.8–2.5 times compared with the control.

Conclusion. PPCC and the AED peptide have geroand chondroprotective properties. Both peptides are more effective when acting on chondrocytes obtained from old animals. The obtained data open up prospects for the study of PPCC and the AED peptide as stimulators of regeneration and proliferation of chondrocytes in steoarthrosis models.

Objective. Evaluate the effect of adding pectin + inulin complex (Veris) to standard therapy on electrolyte balance and renal function on patients with ulcerative colitis.

Materials and methods. The study involved 30 patients (mean age – 32.0±7.5 years) with moderately severe course of ulcerative colitis without severe concomitant pathology and signs of reactivation of opportunistic infection. Patients were divided into 2 groups: main (n=15) – patients received drug Veris (pectin + inulin) in addition to standard therapy; control (n=15) – patients received only standard therapy. The following laboratory parameters were evaluated in all patients on the 5th and 10th day after the start of therapy: albumin, creatinine, potassium, sodium, chlorine, calcium, phosphorus.

Results. It was established that the complex of pectin + inulin (Veris) has a favorable effect on renal functions, significantly reducing the level of blood serum creatinine, reducing the loss of albumin by the body, and not causing undesirable side effects and allergic reactions. There was a decrease in the period of hospitalization in the group of patients receiving Veris, which indicates its modifying effect on the ongoing therapy.

Conclusion. Addition of the combined preparation inulin + pectin (Veris) to patients with moderately severe course of ulcerative colitis has a positive effect on renal function and allows to consider its modifying effect as a promising way to optimize the therapy of inflammatory bowel diseases.

The paper presents literature data on oncological results (the features of recurrences and metastases) of subcutaneous or skin-sparing mastectomies with reconstruction for breast cancer (BC). Local recurrences of BC, as well as distant metastases occur in about 75% of cases in the first 5 years after surgery. The risk of recurrences and metastases correlates with the molecular biological type of cancer.

The paper considers the relationship of postoperative radiation therapy after subcutaneous or skin-sparing mastectomies to the risk of a recurrence.

Analyzing the literature data allows conclusions about the low risk of recurrences after skin-sparing/subcutaneous mastectomies with single-stage reconstruction. Local and regional recurrences after these surgical interventions occur if there are poor prognostic factors, including those at Stages IIВ–IIIС of the disease, metastases in the regional lymph nodes, multicentricity, in the absence of radiation therapy, in the presence of HER2 overexpression or triple-negative breast cancer, if the patients are young.

Objective. To study the effectiveness of combined application of zonal drug blockade and pharmacopuncture (drug stimulation of reflexology points) in treatment programs for dorsopathy at the lumbosacral level.

Materials and methods. The study included 90 patients of both sexes under the age of 65 years who were treated for exacerbation of lumbosacral dorsopathy. The dynamics of clinical characteristics were compared with shifts in the results of psychological testing and electrophysiological analysis – zonal thermography, tetrapolar rheovasography and laser Doppler flowmetry. Patients were divided into three randomized groups in which basic (standard) medical-orthopedic treatment was performed. In addition to this, the first two groups used local stimulation, choosing up to 20 loci in the lumbosacral zone and 6–8 distal reflexology points in the lower extremities. Methodically, the anesthetic Lidocaine was injected into the points of the lower back and sacrum, and the drug alflutop (1st group, true pharmacopuncture) or physiological solution (2nd group, to a certain degree of placebo) was injected into the points of reflexology. The course of exposure consisted of 10 procedures performed every other day. In the 3rd group (control) they were limited to basic therapy.

Results. Both variants of local stimulation were significantly superior in effectiveness to standard treatment. However, with the comparability of the rate of reduction of algia in these effective groups, the final level of pain was significantly lower in the 1st group. These data were consistent with a clear tendency to normalize the mental status and characteristics of regional vascular response in these patients.

Conclusion. The advantage of the complex, which includes true pharmacopuncture, is explained by the direction of action and the points of application of medications: rapid anesthesia due to blockade with the anesthetic Lidocaine and the maximum effectiveness provided by pharmacopuncture with the drug alflutop.

The level of vitamin D in human blood plays a significant role in the pathogenesis and treatment of diseases of the musculoskeletal system. In conditions of cholecalciferol deficiency, up to 10–15% of exogenous calcium and up to 60% of phosphorus are absorbed in the body; with an optimal vitamin D content, calcium absorption increases to 30–40%, and phosphorus – up to 80%. To date, new generation osteoprotectors Osteo-Vit D3, Osteomed and Osteomed Forte are presented on the Russian market, which, in addition to the main components, include a preventive dose of vitamin D.

Objective. To study is to summarize the literature data describing the mechanism of action of the main components of new generation osteoprotectors, as well as the results of clinical studies on the use of osteoprotectors with vitamin D3 fortifier in case of damage to the musculoskeletal system.

Materials and methods. For the review, studies for 2009–2022 in Russian and English in the electronic databases eLibrary, PubMed, Medscape, CyberLeninka were selected.

Results. Vitamin D participates in the processes of bone tissue remodeling, affecting osteosynthesis directly and indirectly. Direct action is carried out through receptors located intracellularly in chondrocytes, osteoblasts, osteocytes and osteoclasts. Vitamin D increases the functional activity of osteoblasts and the migration of osteoclasts to the resorption site. The indirect effect is through stimulation of calcium and phosphorus absorption in the small intestine. When using a new generation of osteoprotectors with vitamin D3 fortifier, positive results were described in the treatment and prevention of pathological conditions of the musculoskeletal system.

Conclusion. In order to prevent vitamin D deficiency, the deposition of calcium salts outside the foci of osteosynthesis, prevent repeated fractures, accelerate the formation of calluses, it is necessary to popularize the diagnosis of vitamin D deficiency, as well as to use modern drugs to replenish and prevent its deficiency.

Polypathy (PP) significantly changes the tactics of the use of rehabilitation technologies, has a significant impact on the prognosis and outcome of treatment of patients, while the standards and approaches currently available when choosing one or another physiotherapeutic rehabilitation are not clearly differentiated.

Objective. To analyze the structure of PP, as well as to characterize the effectiveness potential of systemic pathogenetic physiotherapy (SPPT) in the age aspect based on the principles of evidence-based medicine, in particular retrospective cohort studies.

Materials and methods. SPPT was used in 811 patients with PP: men – 322 (39.7%), women – 489 (60.3%). We identified two cohorts of patients: group 1 – 328 (40.4%) patients aged 45–59 years; group 2 – 483 (59.6%) patients aged 60–74 years. The ratio of middle-aged and elderly patients was 1:1.4. The results of symptom-complex physiotherapy were compared in groups of end point – (-), (+).

Results. In group 1 there were 2.5 diseases per 1 patient with PP, in group 2 – 3.5 diseases. In group 1, 79.3% of patients with PP had 2 diseases, while in group 2, 60.6% of patients had 2–3 diseases. In group 2, the proportion of patients with ≥4 diseases was higher by 13.6% compared with group 1, with 3 diseases – by 29%. At the same time, the proportion of patients with 2 diseases in group 1 was higher by 42.7% compared to group 2.

Conclusion. The Lazebnik index was 3.1 diseases per 1 patient. PP is more common in elderly patients than in middle-aged patients; In elderly patients, the so-called "organotopic" pathology more noticeably exceeded that in middle-aged patients.