Journal of Volgograd State Medical University

The article is devoted to the training of a surgeon – one of the most complex, painstaking and costly types of education. From the point of view of deontology and the legal framework, students do not have the opportunity to perform various manipulations on patients or participate in operations. In this regard, there is a problem of hyposkillia (lack of practical skills). Clinical skills include not just performing manipulations, but mastering clinical thinking as a special form of human knowledge to comprehend the nature of the disease, mental activity to combine clinical observations, paraclinical studies and personal practical experience. Some ways of solving this problem are proposed, which will improve the training of a competent surgical specialist.

The analysis of textbook and modern literature sources devoted to the graphic construction of human dental arches was carried out in order to select the optimal research methods, taking into account the individual characteristics of the craniofacial morphology. The features of the construction of dental arches according to the Hawley method are presented and the possibilities of using this technique only for some types of dental arches are shown. Information is given on the amendments to the calculations of the radius of the Hawley circle, taking into account the geometric laws of the circle. Attention is paid to the shape of the dental arch of the milky period of the bite and the possibility of using the Schwartz method in children only with optimal occlusive ratios without signs of anomalies of the dentition-jaw system is noted. Amendments to the A. Schwartz method are presented, taking into account the size of the teeth and the size of the diastem component. The method for determining the size of the dental arches by the parameters of diagnostic triangles and the dental pentagon is shown. Methods of graphic construction of predicted forms of arcs with their anomalies, as well as with defects of long length, including complete adentia, are presented. This analysis can be useful to orthopedic dentists and orthodontists when choosing methods of prosthetic and orthodontic treatment.

The imagination of purposeful movements and their implementation activates the same areas of the cerebral cortex, which is actively used in the creation of the brain computer – interface and its implementation in the field of healthcare in the form of neuro-controlled exoskeletal limbs and robots that perform complex medical manipulations using the human brain. Playing musical instruments contributes to the development of upper limb motor skills and the development of interneuronal connections of the cerebral cortex. The aim of the work was to study brain activity when imagining purposeful movement in persons playing musical instruments. Brain activity was measured using electroencephalography. Interhemispheric asymmetry was determined using a complex method to determine the leading hemisphere. Because of the conducted research, it was found that the skills of playing musical instruments, even in the absence of sensory afferentation from the periphery during the imaginary initiation of movement, contribute to a stronger combined activation of the sensory and motor areas of the cortex.

The emergence of a new hypoxic therapy regimen in which hypoxic intervals alternate with hyperoxic intervals (30 % O₂) led to the need to study the effectiveness of hypoxic-hyperoxic therapy for the treatment of progressive myopia. An ophthalmologic study was performed on 116 male patients from 8 to 21 years of age with severe myopia. Doppler study of cerebral vessels, determination of indices of functional respiratory system were carried out. Interval hypoxia-hyperoxia therapy proved to be an effective alternative method for improving visual function of the eye and preventing further progression of myopia as a result of improved blood supply to the central and peripheral parts of the visual analyzer.

The main criterion for assessing the engraftment of dental implants is their high-quality osseointegration [1]. Unreasonable loads exerted on a dental implant integrated into the bone tissue lead to its premature rejection. Adequate osseointegration of dental implants is also influenced by their shape, size, quality of their installation, adherence to the operating protocol, as well as the start date of subsequent prosthetics [2]. A qualitative method for determining the stability of an installed dental implant is the method of periotestmetry. In the absence of general somatic pathologies and disorders in the structure of the dental system, stable osseointegration of dental implants, periotestometry data (averaged values for 16 strokes) are in the range from -8 to 0 units. The aim of the study was to analyze the osseointegration of installed dental intraosseous-on bone implants by performing periotestmetry. Materials and methods: The study group consisted of 116 patients who received 167 dental implants. At 1, 2, 4 months, half a year, a periotestmetric study was conducted using the Periotest M apparatus. Results and discussion: The analysis of the parameters obtained in the course of the study revealed the dependence of the periotestmetric data and the quality of osteontegration of intraosseous-extraosseous dental implants. Conclusion: The study of the indicators of periotestmetric data for intraosseous-bone dental implants made it possible to qualitatively predict the results of orthopedic treatment, and also made it possible to assess the degree of osseointegration of the installed dental implants.

The article discusses the presentation of the features of cerebellar remodeling after traumatic brain injury (TBI) in the highlands. The experiment was carried out on 106 outbred male rats weighing 210–290 g in compliance with the rules of laboratory practice. In high-altitude conditions, in contrast to low-altitude conditions, significant changes occur in the cerebellum, namely, changes in the membrane potential of cells, ectopia of Purkinje cells, pronounced changes in molecular and granular layers.

To evaluate the effectiveness of preventive measures in relation to the development of acute postmanipulatory pancreatitis in patients after endoscopic transpapillary interventions. Materials and methods: In the period from September 2021 to June 2022, 73 endoscopic transpapillary interventions for benign pathology and malignant pathology were performed in patients. The analysis of the frequency of the development of acute postmanipulatory pancreatitis in different time intervals in patients who underwent prophylaxis in various ways, depending on the combination of risk factors. Results and discussion: Acute postmanipulatory pancreatitis developed in 2 (3.7 %) patients who underwent transpapillary interventions in various volumes for complicated cholelithiasis. Drug prophylaxis of acute postmanipulatory pancreatitis was carried out in the preoperative period for all patients. Preventive stenting of the main pancreatic duct was performed in the presence of a combination of risk factors. Conclusion: The analysis of the results of endoscopic transpapillary interventions made it possible to identify the most significant measures that allowed to reduce the number of developed to 3 acute postmanipulatory pancreatitis to 3.7 % and thereby increase the safety of transpapillary interventions.

Introduction: Surgical operations remain the main and most effective option for the treatment of liver echinococcosis. With the development and mastering of the method, laparoscopic operations are being used more and more widely. New technologies aimed at improving treatment outcomes are being developed and implemented in laparoscopic surgical methods. The purpose of the study is to present and evaluate the results of treatment of operated patients with liver echinococcosis using new technologies. Materials and methods: The results of treatment of 19 patients (9/47.4 % men, 10/52.6 % women) with liver echinococcosis, who were treated with organ-sparing laparoscopic resection techniques using new technologies in the surgical department No. M.A. Podgorbunsky. Results: There was no statistically significant advantage in dissection rate among the methods used (p = 0.74). In the group of patients with the applied hemostatic matrix Floseal, the time of hemostasis was significantly less than in the group without using the method (p = 0.001). In the group of patients with the improved laparoscopic Pringle maneuver, the blood loss was significantly less than in the group without using the technique (p = 0.00008). Findings: A new patented improved method of temporary hemostasis in laparoscopic resection interventions on the liver in the study proved its effectiveness. The use of the Floseal hemostatic matrix made it possible to reduce the time of hemostasis, and, accordingly, reduce the duration of the operation and reduce intraoperative blood loss in general. The laparoscopic method of surgical intervention using the above technologies is effective and safe in the treatment of medium-sized echinococcal liver cysts.

At the moment, the problem of infertility does not lose its relevance. In the structure of this disease, the violation of reproductive function in women is dominant. The present study is devoted to the study of the influence of concomitant extragenital pathology on the success of assisted reproductive technology procedures. The data of 184 women who underwent infertility treatment by ART methods in clinics of the Volgograd region in the period from 2015 to 2020 were analyzed. The following parameters of the patients were studied: age, gynecological history, the main cause of infertility, transferred diseases of non-productive organs, the protocol of ovarian stimulation with gonadotropins, the number of mature follicles by the end of stimulation, the number of received, fertilized eggs, the number of embryos by day 3, 5. It has been established that concomitant extragenital pathology affects the processes of folliculogenesis and qualitatively affects oogenesis.

In this study, we analyzed and summarized statistical literature data on the prevalence of diseases corresponding to the symptom complex of upper flaccid paramonoparesis in general and data provided from official reports of healthcare institutions in the Republic of Tatarstan and the Volgograd region in particular, in which the EXAR-34 exoskeleton can be used for orthotics. The results obtained can be taken as the basis for the possibility of introducing the EXAR-34 exoskeleton into production, as the only passive exoskeleton model produced in the Russian Federation by the INNOMED LLC enterprise for medical purposes.

Aim: to determine the most preferable tactics of surgical treatment of patients with critical ischemia of the lower extremities of atherosclerotic genesis and diabetes mellitus based on a comparison of the results of revascularizing interventions. Methods: The study involved 82 patients who were treated in the department of vascular surgery due to critical ischemia of the lower extremities as a result of atherosclerotic occlusive-stenotic lesion of the femoral arterial segment against the background of diabetes mellitus. After the diagnostic stage and preoperative preparation, the patients were divided into two groups depending on the nature of the intervention performed: endovasal revascularization or femoropopliteal autovenous bypass grafting above the knee joint gap. In the postoperative period, dynamic observation of patients was continued with a predominant assessment of the clinical status. Results: Clinically, circulatory decompensation requiring repeated intervention or amputation was observed in 9 (30 %) patients from the first group and in 13 (25 %) patients from the second. High amputation was performed in 2 (6.6 %) study participants from the endovasal revascularization group and 3 (5.7 %) from the open surgery group. Over the entire observation period, 2 (6.7 %) and 4 (7.8 %) patients died in the groups under consideration, respectively. No statistically significant differences were obtained for any of the studied parameters, however, repeated interventions were significantly more frequently performed in patients undergoing endovascular revascularization. Conclusion: When analyzing the advantages and disadvantages of endovascular and open surgery in patients with diabetes mellitus and critical ischemia, the first should be preferred due to the possibility of repeated repetition throughout the patient’s life. Particular attention should be paid to conservative therapy and assessment of clinical status in the late postoperative period.

Repeated cesarean section operations are becoming a daily practice in obstetric institutions of the 2nd and 3rd groups. With each subsequent operation, due to adhesions or infectious complications (obstetric peritonitis), the risks of injuries to organs adjacent to the uterus increase. Objective: development of a method for preventing to the bladder injury during repeated cesarean section operations. Materials and methods: Prospective cohort studies were performed in 320 patients with the scar after Caesarean Section who underwent a repeated cesarean section: 186 patients were operated in plan and 134 – in urgent situation. All patients had given the hydropreparation of paravesical tissue by 0.5 % solution of novocaine 20 ml, which was injected under the vesicouterine fold from the side of the round ligaments for the prevention injury of bladder. Statistical processing was carried out using the Statistica 13 package. Results and discussion: With partial mobilization of the posterior wall, bladder injury in group 1 was in 2 patients, in group 2 – in 4 patients (χ² = 1.544, p = 0.215). The injury of the bladder walls in group 2 occurred in patients operated on for obstetric peritonitis and was caused by pronounced infiltration of paravisical tissue and inflammatory changes in the lower segment of the uterus. Conclusions: The developed method by hydropreparation the paravesical tissue allows minimizing the number of bladder injuries with a pronounced adhesive process in the lower segment of the uterus or tissue infiltration with purulent-inflammatory complications.

In experiments on rats, the pharmacokinetics of compound RU-891 was studied with single and multiple intravenous administration. Data on the linear dependence of pharmacokinetic parameters are obtained. The approximation coefficient is set equal to 0.9779. Changes in pharmacokinetic parameters with a three-time administration were not detected.

Relevance: A key aspect of success after dental implant surgery is obtaining reliable osseointegration of the installed dental implant. In modern literary sources, the problem of consistency of osseointegration after the installation of dental implants is quite often touched upon. A number of authors argue that the quality of osseointegration of a dental implant depends primarily on its primary stability. Long-term studies show that bone tissue permanently undergoes various resorption and recovery processes [1, 2]. Purpose – to determine the effectiveness of alkaline phosphatase and collagen protein osteocalcin in oral fluid after dental implantation. Materials and methods: Clinical studies were carried out on the basis of the Clinics of the Samara State Medical University of the Ministry of Health of Russia. A total of 240 patients with a diagnosis of partial absence of teeth were operated on. All patients received dental implants. The median age was 44.2 years (24 to 62 years; 182 women and 58 men). Results and discussion: At the stage of orthopedic rehabilitation, most patients had a low index of oral hygiene, OHI-S averaged (2.63 ± 0.27) c.u. All patients suffering from poor oral hygiene were recommended professional hygiene with the removal of soft and hard dental deposits. At the stage of dental implantation, the OHI-S and Mulleman index was (0.66 ± 0.03) and (0.49 ± 0.03) c.u. respectively. Conclusions: The results of the study showed that the increase in the titer of alkaline phosphatase and the collagen protein osteocalcin was statistically insignificant. The level of acid phosphatase titer in the oral fluid reaches its critical value two weeks after the dental implantation operation. Studies have shown that this indicator remains active up to six months after surgery. This indicator can be used to interpret various emerging trophic processes occurring in bone tissue after dental implantation.

The correct execution of teeth preparation for metal-ceramic crowns requires a certain range of dental bores, different in shape and cutting properties. However, according to a 2014 study, orthopedic dentists tend to use a reduced set of burs in their daily practice. The research material is the results of a survey of 59 orthopedic dentists of urban dental clinics, obtained by the questionnaire method. Data on the frequency of use of hogs of various shapes and grain size were obtained. There is an expansion of the range of tools used according to the criteria of grain size and shape. Despite this, there is a tendency to use a reduced set of dental burs and the prevalence of coarse-grained burs in its composition.

Postresection hepatic insufficiency is a formidable complication after liver resections, leading to an unfavorable course of the postoperative period and, often, to a fatal outcome. The article presents a clinical case of successful surgical treatment of tumor of the liver and prophylactics of hard remnant liver insufficiency. The article presents the results of treatment of a patient with a large liver tumor by a staged method, a review of the immediate data is given retrospectively by describing the course of diagnosis and treatment of the disease. We have illustrated a case of successful two-stage surgical treatment of a patient with a large hemangioma of the liver using laparoscopic ligation of the right branch of the portal vein, which makes it possible to prevent the development of severe post-resection liver failure.

There is no data in the literature on the course of myocardial infarction in patients after COVID-19. Purpose – to use a clinical example to present a case of postinfarction left ventricular aneurysm in a patient after undergoing COVID-19. Materials and methods: Patient T., 49 years old, was admitted to the federal state budgetary institution “Federal Center of Cardiovascular Surgery” of the Ministry of Health of the Russian Federation (Astrakhan) with complaints of pain in the heart with irradiation in the left shoulder and lower jaw. Considers himself ill for 7 days. It is known from anamnesis of life that the patient suffered COVID-19 two weeks ago. He has been suffering from arterial hypertension for a year. Results: A clinical example demonstrates that COVID-19 affects course of myocardial infarction: it is a risk factor for the development of post infarction aneurysm of the left ventricle in the early stages after a myocardial infarction. Myocardial infarction was accompanied by the formation of pathological Q waves, impaired conduction of the right leg of the Gis bundle a decrease in the ejection fraction of the left ventricle, acute occlusion of the right coronary artery. Postinfarction aneurysm of the left ventricle had an anterior-septal – apical localization. In addition, the study of highly sensitive troponin T and N-terminal fragment of the pro-brain natriuretic peptide type B in patients with myocardial infarction complicated by postinfarction aneurysm of the left ventricle after COVID-19 is also important for determining the stages of development of pathological processes in this pathology, evaluating the effectiveness of therapy and the outcome of this pathology.