卷 35, 编号 9 (2024)

About 25% of the adult population suffers from pain in the knee joint, the number of requests for medical help in the world reaches 4 million per year. The causes of chronic pain, in addition to inflammatory arthropathy, pathologies of the capsular-ligamentous apparatus and degenerative-dystrophic changes, can be pathologies of hyaline cartilage and subchondral bones – osteochondropathy. Among osteochondropathy of the knee joint, osteochondritis dissecans is of greatest importance in clinical practice. Although osteochondritis dissecans has been known for a century and a half, its exact cause remains unclear. Osteochondritis dissecans is a form of osteonecrosis that affects the subchondral epiphyses of long bones. In 75%, the knee is affected – the condyles (Konig's disease): in 64% of cases – the medial condyle, in 32% – the lateral, less often the pathology is localized in the patella (Leven's disease), the femoral trochlea and the tibial plateau. Osteochondritis dissecans is typically unilateral, but 7% to 25% of patients have bilateral involvement.

The gold standard for staging osteochondritis, assessing the stability of the lesion and determining treatment tactics is arthroscopy. It is recommended to begin radiological diagnosis of osteochondritis dissecans with plain radiographs to localize the lesion. The prognosis for osteochondritis dissecans of the knee joint depends on the patient’s age, location and stage of the disease. In general, the prognosis for children is more favorable than for adults.

The article considers modern surgical methods of treatment of obliterative atherosclerosis of lower limb arteries. The most relevant domestic and foreign literature sources containing information on modern approaches to the treatment of obliterative atherosclerosis of lower limb arteries were analyzed. Development of traditional vascular and endovascular surgery became the reason for the emergence of hybrid surgery, which is applicable in the treatment of occlusion with the length of more than 20 cm. The use of combined methods makes it possible to increase the efficiency and expand the range of surgical care, including in situations that were previously considered hopeless. Having studied modern surgical methods for the treatment of obliterative atherosclerosis, we can conclude that the hybrid method combines traditional vascular and endovascular techniques of surgical intervention, has low traumatization and a wide range of possibilities.

The peripheral nervous system injuries can lead to long-term or total disability of the patient. The article presents the classification of peripheral nervous system injuries, and clinical picture. Such methods of instrumental diagnostics as stimulation electroneuromyography, needle electromyography, ultrasound diagnostics, magnetic resonance imaging are described.

In the Russian Federation, 2024 has been declared the year of the family, which, in the context of the growth of domestic industrial production, determines the importance of preserving the reproductive health of women working in harmful and unfavorable working conditions, preventing the adverse effects of factors in the working environment and the labor process on women’s health indicators. The review examines publications presented in the RSCI, PubMed, Scopus, and Google Scholar databases, which cover mainly the last 10 years (2013–2023).

An increase in the number of cases of cardiovascular, endocrine and other diseases may be associated with an imbalance between the excessive formation of free radicals and the implementation of antioxidant defense mechanisms. The article analyzes the composition of the new domestic angioprotector Gemonorm and evaluates the prospects for its use in the prevention and complex therapy of circulatory pathologies caused by oxidative stress.

The problem of diagnosing primary hyperaldosteronism remains relevant. A rare manifestation of primary hyperaldosteronism is secondary hypokalemic myoplegia, which may be the initial manifestation and cause difficulties in diagnosing primary hyperaldosteronism. It is expedient to describe new cases of primary hyperaldosteronism with an analysis of clinical features, possible diagnostic errors and difficulties.

A clinical case of a patient with hypokalemic myopathic syndrome is presented. The level of potassium, aldosterone, renin in blood plasma was studied, and the aldosterone-renin ratio was determined. Adrenal adenoma was con-firmed by multispiral computed tomography and histology. Clinical observation demonstrates differential diagnostic difficulties of primary hyperaldosteronism, which were associated with a variety of clinical manifestations, nonspecificity of symptoms, dependence on the presence of hypokalemia, and erroneous diagnoses in anamnesis. Attention is drawn to the longterm normocaliemic course of primary hyperaldosteronism with arterial hypertension, which was regarded as a hypertensive disease. Primary hyperaldosteronism was suspected when myopathic syndrome appeared and dominated the clinical picture of the disease.

Primary hyperaldosteronism, determining the occurrence of secondary hypokalemic myoplegia, presents significant differential diagnostic difficulties and requires physicians to be aware of the features of the clinical manifestations of primary hyperaldosteronism, alertness to the adrenal tumor, adequate assessment of the clinical picture, the use of a modern complex of diagnostic tools, internosological diagnostics and a multidisciplinary approach to therapy.

Objective. To analyze effectiveness of the original complex of psychocorrection and transcutaneous electrical neurostimulation (TENS) in patients with post-stress disorders.

Materials and methods. The study involved 120 men whose professional activity is associated with a high level of stress. The study participants were divided into 2 groups depending on their age: younger than 40 years (n=60) and older than 55 years (n=60). Patients underwent clinical examination, psychological testing, and clinical examination of cardiovascular activity. At the 1^st stage, two types of psychorelaxation (autogenic and respiratory training) were compared (each group was divided into 2 subgroups [n=30] depending on the type of training). In the 2^nd stage, each group was divided into 2 subgroups (n=30) in which true hardware technique (TENS) or its imitation in the form of placebo was applied.

Results. The analysis of the results of psychorelaxation showed its greater effectiveness (regardless of the type) in the middle-aged group, whereas in older patients the higher effectiveness of respiratory training was established. In spite of this, psychorelaxation (irrespective of its type) was less effective in correction of psychosomatic disorders in elderly patients in comparison with the middle-aged group, which determines the possibility of additional application of TENS in the elderly group. At the same time, the combined application of respiratory training and TENS contributed to a reliable increase in the effectiveness of treatment.

Conclusion. The study has shown the effectiveness of the proposed therapeutic complex (psychocorrection and TENS), which indicates the prospect of its introduction into the practice of new programs for restoring the health of socially important contingents.

Smoking is not only a modifiable risk factor for adverse pregnancy outcomes, it is primarily a risk factor for the development of pathology of the respiratory system, eventually turning into chronic obstructive pulmonary disease (COPD). The high prevalence of tobacco smoking among pregnant women, confirmed by numerous studies, demonstrates the underestimation of the high risks of COPD development. The present study substantiates the relevance of timely detection of pathological changes in the bronchi in smokers in primary care and the formation of motivations to quit smoking. It is the desired pregnancy that can cause complete cessation of smoking, thereby reducing the risks of developing not only the pathology of the smoker's lungs, but also the pathology of the fetus.

Asthma is one of the most common inflammatory diseases in the world. One of the factors in the development of this disease is a low concentration of mannose-binding lectin (MBL), encoded by the MBL2 gene.

Purpose. To study the distribution of genotypes and alleles of polymorphic variants of the MBL2 gene in children with asthma.

Material and methods. The study included children with diagnosed bronchial asthma (n=400) (Krasnoyarsk). The control group consisted of children comparable in gender and age to the patients (n=229) and newborns (n=302). GINA-202 guidelines were used to determine the severity of the disease.

Results. Statistically significant differences were identified for polymorphisms localized in the first exon of the gene – rs1800450 and rs1800451. A low occurrence of the BB rs1800450 genotype in sick and healthy children was revealed, which may be associated with early mortality or disability due to severe infections with severe MBL deficiency. Homozygotes for the mutant allele C of the rs1800451 MBL2 polymorphism were not found in any of the comparison groups, which indicates a rare distribution of this allele in Caucasian populations.

Conclusion. The present study showed that polymorphisms in the MBL2 gene play a predisposing role in the development of diseases of the bronchopulmonary system using the example of asthma.

Most epidemiological studies are devoted to studying the prevalence of risk factors (RFs) for cardiovascular diseases (CVD) in the general population, but this problem has not been sufficiently studied in people of working age.

Purpose. To study the prevalence of CVD risk factors and their relationship with outcomes in working-age patients with arterial hypertension (AH).

Material and methods. Data from 13,994 working-age patients with hypertension who were observed on an outpatient basis were analyzed. The analysis was carried out according to the following CVD risk factors: gender, age, body mass index (BMI), smoking history, diabetes mellitus (DM), levels of systolic and diastolic blood pressure (BP), cholesterol, glucose, glomerular filtration rate, risk on the SCORE scale. The effect of risk factors on unfavorable outcome of the disease was also studied.

Results. Patients with AH of working age, who were observed and treated on an outpatient basis, had fairly good control of AH (average values – 135/80 mm Hg). Women had lower systolic BP, total cholesterol levels and BMI were higher than men. Men were more likely to have a history of smoking and T2DM. Among all patients, T2DM was detected in 4.7% of cases, while patients with DM were older in age, had a higher BMI, and were more likely to smoke compared to patients without DM. In patients with T2DM, BP control was better (average value – 130/80 mm Hg), the level of total cholesterol did not differ significantly from patients without DM. During the observation period, 234 (1.7%) patients died (from coronary heart disease – 69.7%, from CVD – 30.3%). The following risk factors for unfavorable outcome were identified: age, male gender, increased systolic BP, smoking, presence of diabetes, increased risk score on the SCORE scale.

The article presents a brief review of the literature, as well as the results of our own observations and the results of surgical interventions in patients with a rare and insufficiently studied disease – Eagle’s syndrome or stylohyoid syndrome (SHS). According to modern concepts, the disease is quite rare (in 4% of the population) and is accompanied by chronic orofacial pain syndrome. There are certain difficulties in diagnosing this disease and determining the optimal treatment tactics. The article presents the results of successful surgical treatment of 7 patients with SHS, discusses indications for surgical treatment, and reflects aspects of diagnosis and management of patients.

Objective. To compare the effectiveness of two methods of local application of essential oils in complex rehabilitation programs for patients with lumbosacral dorsopathies.

Materials and methods. The study involved 90 patients with lumbosacral dorsopathies who were divided into 3 groups: Group 1 (n=30; comparison group) – patients were given segmental massage with a 1% blend of oils (rosemary, cajaput and pearlberry diluted in 100 ml of base oil) recommended for dorsopathies; Group 2 (n=30; main) – patients were given biopuncture with this blend of oils; Group 3 (n=30; control) – patients were given biopuncture with sesame oil as a placebo. All patients also received standard therapy.

Results. Local application of essential oils to reflexogenic points in the main group was shown to reduce pain syndrome, improve the amplitude of movement in the lumbar spine, reduce anxiety, and increase tolerance to psychological stress in comparison with the segmental massage group (comparison group) and the control group.