Vol 17, No 3 (2020)

The enchantment of numbers of surgical interventions and the widespread adoption of modern technologies, lead to a parallel increase in technological errors and morbidity in recent years. This article analyzes such section of surgery as «medical errors», provides a modern classification of medical errors and complications according to foreign and Russian authors. The article contains information about definition, legal foundations and principles for the prevention of unexpected consequences of surgical interventions.

Diagnostics, tactics of medical and surgical treatment of various diseases of the thyroid gland is a topical issue in patients of older age groups. The peculiarity of this category of patients is high comorbidity, so the volume of surgery should be determined not only by the type and severity of the course of thyroid pathology, but also by the clinical characteristics of concomitant diseases. To date, the issue of choosing the volume of surgery in elderly and senile patients remains debatable.

Diabetes mellitus is an independent risk factor for the development of early postoperative complications in coronary artery bypass grafting without cardiopulmonary bypass (off-pump CABG). A comparative analysis of early postoperative complications for off-pump CABG in patients with diabetes mellitus was made. A randomized study of the results of surgical treatment of patients with coronary heart disease who underwent coronary artery bypass grafting of 2 or more branches of the coronary arteries without the use of cardiopulmonary bypass included 191 patients. In patients of the main group (n = 32), the comorbid background was complicated by diabetes; in patients in the control group (n = 159), this disease was not detected. For statistical processing of the obtained data, nonparametric criteria were used (Fisher test and relative risk (RR) with a 95% confidence interval (CI)). It is proved that in patients of the main group (with diabetes) the relative risk of developing postoperative complications (acute myocardial infarction, pneumonia, acute renal failure, multiple organ failure syndrome, etc.) is significantly higher than in patients in the control group (RR = 1.36-4 .97). The use of combined anesthesia (with prolonged thoracic epidural analgesia) allowed patients of both groups to significantly reduce the risk of developing clinically significant complications (RR = 0.26-0.78). Performing off-pump CABG in patients with diabetes is associated with a significant increase in the risk of postoperative complications, and the use of combined anesthesia effectively reduces the risk of their development in patients of this category.

The prevalence of cholelithiasis among the working population ranges from 10 to 20 %. Cholecystectomy ranks first in frequency among surgical interventions. The purpose of this work is to assess the quality of life in patients with cholelithiasis 6 month after cholecystectomy. The study was conducted on the basis of three medical institutions in the Russian Federation. The patient groups were homogeneous in their composition, and the quality of life was assessed using the Gallstone Impact Checklist. The groups were compared depending on the type of operative access (laparoscopic, mini-access), and depending on the nature of the disease (symptomatic and asymptomatic variants). The results were calculated as the average calculated value ± standard deviation. The following results were obtained, which show that cholecystectomy significantly reduces the quality of life of patients. Laparoscopic access is more preferable in the presence of pain syndrome, as the main factor in reducing the quality of life. Mini-access surgery is not accompanied by a deterioration in the quality of life in patients with pain and dyspeptic syndromes, but it improves the emotional and volitional sphere of human activity.

52 patients aged 26 to 54 years (39 women and 13 men) with hypersensitivity of the teeth were examined. Taking into account the individual approach to the examination of patients, the dental status was determined, etiological factors, body features, the presence of somatic pathology, clinical manifestations of hypersensitivity of the teeth were determined, with the determination of the degree, prevalence and intensity of hyperesthesia. The study made it possible to make a rational choice of treatment and prevention measures, taking into account individual General and local manifestations of this pathology.

With the development in dentistry of dental implants is growing steadily and the number postprostatectomy complications, manifested periimplantation mucositis and dental periimplantitis. If the phenomena of mucositis are reversible, then the destruction of bone tissue around the dental implant is impossible to restore the integrity of the bone. An important diagnostic criterion is early diagnosis by a dentist of initial changes in periimplant tissue of inflammatory origin. Stress is a factor in the development of postprotetic complications. In this paper, based on the immunological parameters of blood, the factors responsible for the development of a stress-triggering reaction are determined. Based on the General and biochemical blood analysis, indicators were determined that allow assessing the stress situation in the study groups (cortisol concentration, alkaline phosphatase, Garkavi index, epinephrine, noradrenaline) in patients with postprotetic complications in the near and long-term follow-up and treatment. Proven change of immunological indices on the background of psychoemotional stress in patients with postprostatectomy complications.

In the clinical practice of a dentist-orthopedist, patients with various diseases, abnormalities and deformities are often found. In this case, there may often be a relationship between General somatic pathology and manifestations in the oral cavity. Parkinson's disease is no exception. This paper discusses the main features of the course of the disease in the oral cavity and the principles of a differentiated approach to orthopedic treatment. So in patients with Parkinson's disease, sialorrhea (salivation, hypersalivation), dryness of the red border of the lips and oral mucosa, speech changes, «prosthetic» stomatitis are observed. At the same time, these patients have sensory and vegetative disorders, violation of muscle tone, which aggravates the process of prosthetics and creates certain difficulties for a dentist-orthopedist. Due to the spread of this disease among the elderly, who often require dental care, clinicians need to know about this pathology.

A total of 381 girls aged 17-20 years of different health groups were evaluated. Dimensional and proportional variations of the physical parameters, body component composition were analyzed by R.N. Dorokhov and V.G. Petrukhin method. Was found that the overwhelming number of women belong to the microsomal (dimensional variation), to the microcorpulent (fat component composition), to the micro-bone (bone component composition), to the micro-muscle (muscle component composition) somatic types in all three groups. According to the proportional variation of the physical parameters, a heterogeneous distribution pattern was observed.

The wedge-shaped dehydration method was used to assess the state of the oral fluid of patients with post-prosthetic complications during dental implantation against the background of various treatment methods. Oral fluid (saliva) was used as a material for the study. All patients were randomized into 4 equal groups in a 1: 1: 1: 1 ratio according to the methods of pharmacotherapy. Group I - 30 patients who underwent traditional treatment of post-prosthetic complications; Group II -30 patients, ozone therapy was performed in addition to traditional therapy; Group III - 30 people who underwent transcranial electrical stimulation against the background of traditional therapy; Group IV - treatment of 30 people with the inclusion of a combination of ozone therapy and transcranial electrical stimulation in the treatment regimen. The control group consisted of healthy individuals of the same age group. Determined the nature of the organization of the structure of the salt and the distribution of the protein substance, depending on the concentration of protein in the biological fluid (saliva). Qualitative analysis of images of saliva crystallograms was carried out in the next (before treatment, 3 days, 7 days, and 14 days) observation and therapy. As the duration of treatment increased, the structuring of the crystal lattice took place, increasing in the series: patients with traditional therapy - patients with ozone therapy - patients with transcranial electrical stimulation - patients with combined use of ozone and transcranial electrical stimulation (group IV). Special attention should be paid to the fact that the complete normalization of the structure of the oral fluid facies occurred only during the complex therapy with ozone and TPP throughout the study.

The article presents the results of the study of the nootropic activity of hesperidin and curcumin in conditions of focal cerebral ischemia. Studies were conducted on Wistar male rats, which reproduced the focal ischemia of the right middle cerebral artery. Experimental compounds and the reference drug (Mexidol) are administered intragastrally at the next day after surgery at a dosage of 100 mg/kg for three days. Researched using memory and cognitive assessment models -the method of avoiding passive (passive avoidance reaction) and active (TEA) environments. The effect of these compounds on the level of formation of lactate, pyruvate, and the degree of necrosis was studied. Against the background of focal cerebral ischemia, hesperidin significantly improved the studied parameters, curcumin did not show a positive effect on all the studied parameters, and therefore inferior to the heotropic activity on nootropic activity. The results of experimental data suggest the possibility of further in-depth study of hesperidin for cerebroprotective and nootropic activity.

Currently, miniscrews installed parallel to the roots are widely used in the practice of orthodontic treatment. When planning the placement of miniimplants, it is necessary to evaluate the anatomical factors that affect the stability of the miniscrew in the bone. For the analysis, we selected the zone of the external oblique line, where the thickness of bone tissue in the area of the first and second molars was estimated in the vertical and horizontal planes. As a result of the study, it was found that the area of the distal surface of the distal root of the second molar had the greatest thickness of bone tissue. An increase in the vestibular-oral thickness was also observed in the distal direction.

In this article, the authors analyzed the nature of gastrointestinal tract damage in preschool children due to infestation caused by Giardia parasitism. To complete this task, 131 children aged 2 to 17 years were monitored and examined.

The article presents the results of a survey of schoolchildren aged 7-8 living in the Altai Republic. Anthropometric studies of pupils in general secondary schools have been conducted and their level of physical development has been determined using the index method. The study found that the children of this age group have a low level of physical development and their type of build is defined as asthenic, more pronounced among girls. There's also a body mass deficit. Lack of physical development can be related to climatic characteristics, nutritional patterns and lifestyles.

The authors analyzed the sanitary and parasitological state of the soil of the Astrakhan region for 2014 - 6 months of 2020, using the materials of their own laboratory research and research of the center for hygiene and epidemiology in the Astrakhan region. In total, during the analyzed period, 8 144 soil samples were studied, and 16 288 studies were performed. The total number of samples that did not meet the sanitary and parasitological indicators was 6,7 %. Thus, in 2014, 16,7 % of soil samples (n = 1368) were examined for sanitar-parasitological indicators, of which 5,0 % of samples did not meet the standards. In 2015, soil studies were also conducted - 12,2 %, of which 6,4 % were unsatisfactory. Thus, in 2016, 15,1 % of soil samples were examined, of which 9,3 % were unsatisfactory. In 2017, 13,4 % of soil samples were examined, of which 7,4 % were unsatisfactory. In 2018, studies of soil samples for parasitic indicators amounted to 16,8 %, of which 7,4 % were unsatisfactory. In 2019 17,5 % of soil samples were examined - the largest number of samples studied compared to previous years. 6,5 % of the samples did not meet the standard indicators. For 6 months of 2020, 8,3 % of soil samples were examined, of which 4,2 % did not meet the sanitary and parasitological indicators. Thus, the sanitary-parasitological state of the soil in recent years continues to be relatively unfavorable, as evidenced by positive findings in the form of larvae and eggs of helminths, as well as in the form of cysts of pathogenic intestinal protozoa. The presence of Strongylid larvae and Toxocar eggs in the soil indicates contamination of this object with the feces of invasive animals (cats and/or dogs). And the presence of unfertilized Ascaris and blastocysts eggs indicates contamination of this object with the feces of infected people, or there was an accident and a break in the sewer network at this object.

In experiments on female rats, the effect of afobazole at doses of 5 mg/kg (group 1) and 100 mg/kg (group 2) on sexual behavior and fertility was studied. It was found that in the structure of sexual behavior in rats of females treated with afobazole with a 2-week course, the duration of sexual activity and the number of lordoses decreased statistically insignificantly and dose-dependently (by 12,5 and 37,5 %, respectively), with a simultaneous tendency to increase the number emotional approaches. In addition, according to the results of fertility studies in female rats, an increase in the pregnancy index by 14,6 % (p > 0,05) was noted in both study groups, and in pregnant women, an increase in fertility, respectively, by 33,7 % (p < 0,05) and 20,4 % (p < 0,05) and a dose-dependent decrease in the total (pre- and post-implantation) fetal death by 26,4 % (p > 0,05) and 54,5 % (p < 0,05). Based on the studies, it was concluded that afobazole had a positive effect on 2-weekly administration to rats of females at doses of 5 mg/kg and 100 mg/kg on fertility processes, with a slight tendency of its deprimative effect on sexual activity.

A survey of 86 pregnant women was conducted in order to study the hygienic state of the oral cavity at different stages of pregnancy. It was found that 62 (72,09 %) of pregnant women were motivated to visit the dental office to maintain their own health and the health of the unborn baby, 20 women (23,25 %) were concerned about the safety of their own dental system, 4 women (4,65 %) did not understand the need to visit a dentist. The dental status of pregnant women was assessed based on dental indices: OHI-S, CPITN, PMA, and the H. R. Muhleman gum bleeding index. The dependence of the level of oral hygiene on the duration of pregnancy was revealed, at the same time, the severity of the inflammatory process did not depend on the trimester.

The article presents a clinical case of laparoscopic surgical treatment of type II endoleaks after aortic aneurysm resection on shutdown and aorto-iliac bifurcation prosthetics. This complication developed a year after the operation and was verified by CT-aortography. The growth of the aneurysmal sac up to 5,7 cm in diameter and signs of endoleak due to the right lumbar artery at the L 4 level were detected. After appropriate preparation, laparoscopic resection of the aneurysmal sac and stitching of the lumbar artery was performed. The postoperative period was uneventful. The patient was rehabilitated as soon as possible. Observation for 36 months, blood flow in the aneurysmal sac is not determined. Thus, laparoscopic techniques can be successfully used to correct complications after operations for abdominal aortic aneurysm.