Vol 13, No 3 (2022)

Background: Thoracoscopic ablation is an effective treatment of patients with atrial fibrillation. Nowadays, 2 types of ablative devices are available in clinical practice allowing one to perform the thoracoscopic procedure — Medtronic and AtriCure. However, the contemporary clinical literature does not have enough data that would compare these two approaches. Aims: to perform a comparative analysis of the short-term results of two minimally invasive strategies in thoracoscopic ablation for atrial fibrillation. Methods: 232 patients underwent thoracoscopic ablation for atrial fibrillation in two clinical centers for the period from 2016 to August 2021. The patients were divided into 2 groups. The first group was represented by those patients to whom a Medtronic device was applied (n=140), the second group was treated with an AtriCure device (n=92). The patients were comparable in their age, gender, initial severity of the condition. The follow-up consisted of laboratory tests, chest Х-ray, electrocardiography, 24-hour Holter monitor, echocardiography. The structure and prevalence of postoperative and intraoperative complications, specifics of the postoperative period were compared between the two groups. Results: According to the structure and prevalence of intraoperative complications the 2 groups are comparable to each other: 4.3% and 1.1% for the 1st group and 2nd group, respectively (p >0.05). The postoperative complications had developed in 6 (4.3%) and 5 (5.4%) patients in groups 1 and 2, respectively (p >0.05). At the time of discharge from hospital, a sinus rhythm was registered in 93.6% of patients (1st group), and 85.9% (2nd group) (p <0.05). Conclusions: Both strategies have demonstrated comparable short-term results in patients with lone atrial fibrillation. A further research is needed to evaluate the effectiveness of this strategy in a long-term period.

Background: Surgical resection is the treatment of choice for Klatskin tumor, when possible, but unfortunately, many patients present with the late-stage and unresectable disease. A large number of studies have confirmed that arterial chemotherapy is safe and effective for the palliative treatment of primary and secondary hepatic malignancies. Aim: To evaluate the safety and efficacy of hepatic arterial infusion in patients with Klatskin tumor. Methods: Between 2010 and 2021, 14 of 119 patients with inoperable Klatskin tumor were treated with hepatic arterial infusion of GemCis at the A.M. Granov RRCRST. All the patients had obstructive jaundice and received percutaneous transhepatic biliary drainage. Chemotherapy was started when the serum bilirubin level became normal (averagely on the 106th day from percutaneous transhepatic biliary drainage). In total, 19 (from 1 to 4 per patient) hepatic arterial infusion cycles were performed. Results: Percutaneous transhepatic biliary drainage complications such as cholangitis (n=2) and local peritonitis (n=1) developed in 3 patients (21%) and were successfully treated using minimally invasive techniques. The toxicity of chemotherapy was observed in 8 of 14 patients (57%): I–II degree hematological toxicity (43%) and gastrointestinal toxicity (50%); these complications were cured by medical therapy. The overall mean survival was 286 days (9.6 months), the median survival was 283 days (9.4 months). Conclusions: Our preliminary results show that hepatic arterial infusion in patients with Klatskin tumor is safe, but has limited effectiveness. The combination of arterial infusion with other methods such as radiotherapy, intra-ductal photodynamic therapy, radiofrequency ablation, target therapy, should be investigated.

New variants of SARS-CoV-2 such as Omicron BA.2, BA.4/5, BA.2.12.1 and BA 2.75 are characterized by higher infectivity and the ability to escape virus-neutralizing antibodies against previous coronavirus variants. The S-trimer of BA.2 and its phylogenetic derivatives are characterized by a predominant «Up»-conformation, which facilitates the interaction with ACE2 on target cells and promotes the resistance to neutralizing antibodies. The immunity acquired from the infection with earlier strains is non-sterile for both early and later strains; the booster systemic immunization does not significantly affect the effectiveness of antiviral immunity, and its feasibility is currently being questioned. Studies of the mucosal immune response have shown that intranasal immunization with adenovirus vaccines provides more pronounced protective immunity than systemic reimmunization does. A promising approach is the creation of multivalent inhaled next generation vaccines containing immunoadjuvants that activate B- and T-cell mucosal immunity. Currently, a large number of intranasal vaccines are undergoing phase I/II trials, while the preclinical and preliminary clinical results indicate that this method of vaccination provides a better mucosal immune response at the entry site of the virus than systemic immunization does. This strategy may provide a long-term immune protection against the currently existing and yet unknown new strains of SARS-CoV-2.

The review of data from randomized clinical trials, results of systematic reviews, international and national clinical recommendations on the problem of pulmonary rehabilitation in chronic pulmonary disease was carried out. This analysis of the studies included the databases eLibrary, Medline, PubMed and Cochrane libraries on the problem of pathophysiology and methods of physical rehabilitation of chronic pulmonary disease. The analysis took into account the opinions of expert groups of clinical recommendations developers of the Russian respiratory society, the European respiratory society, and the American thoracic society, presented in this review. The data of studies confirm the clinical effectiveness of physical rehabilitation methods for chronic pulmonary disease that take into account the unique needs of a complex patient. Pulmonary rehabilitation improves the physical activity, quality of life associated with health, reduces the incidence of exacerbations and mortality of patients with chronic pulmonary disease. Increasing the availability and improving pulmonary rehabilitation programs based on individual assessment of the patient's physical capabilities will increase the use of this method of treatment.

Background: Thoracic outlet syndrome — compression of the brachial plexus in the area between the clavicle and the first rib — is a commonly spread and important pathology. It occurs, as usual, after a trauma or due to an anatomical malformation of this area. Thoracic outlet syndrome can be combined with a shoulder joint pathology. In the case of a conservative treatment's failure, the standard surgical procedure is decompression of the brachial plexus in the thoracic aperture. This procedure is usually done via an open approach. The development of the endoscopic surgical technique of decompression allows reducing the risk of complications and recurrences, improving the cosmetic result and relieving the rehabilitation period. Clinical case description: A 73-year-old female patient with a clinical picture of posttraumatic brachial plexopathy and a massive shoulder rotator cuff tear. The patient underwent a conservative treatment for 6 months after the trauma without a significant improvement. To confirm the diagnosis, ENMG and an ultrasound investigation of the brachial plexus, as well as MRI of the shoulder joint were performed. Simultaneous shoulder joint arthroscopy with subacromial spacer implantation and brachial plexus decompression in the thoracic aperture were performed to the patient. According to the VAS-scale (Visual Analogue Scale), the severity of pain syndrome before the surgery was 10 cm, while 6 months after the surgery, it decreased to 1 cm. According to the DASH scale (Disabilities of the Arm, Shoulder, and Hand), the dysfunction of the of shoulder joint before the surgery was 76 points, while 6 months after the surgery, it decreased to 12 points. The range of motion in the shoulder joint before the surgery was as follows: flexion 105°, abduction 95°, external rotation 15°, which increased to 160°, 165°, and 45°, respectively, 6 months after the surgery. Conclusion: The results allow us to characterize the method of simultaneous shoulder joint arthroscopy and endoscopic decompression of the brachial plexus in the thoracic aperture as a low-traumatic and effective technique. The technique provides complete brachial plexus decompression in the thoracic aperture which promotes restoration of the function of the upper extremity and shoulder joint, and elimination of pain syndrome from the upper extremity area.

Background: Variants of the CHD7 gene found in the OMIM 608892 genomic material are present in 83–95% of patients suffering from the CHARGE syndrome. The aim of this report is to evaluate the clinical and functional results of cataract phacoemulsification with implantation of a toric intraocular lens in a patient with a very rare pathology — Hall–Hittner syndrome. Clinical case description: Under observation was patient V., who successfully underwent cataract phacoemulsification on the right eye with implantation of an intraocular lens for complicated cataract against the background of combined congenital eye pathology confirmed by the diagnostic data before and after the surgery. The optimal visual functions were reached after the successful surgical treatment. The patient was subjectively satisfied with the restored visual functions in the right eye. Conclusion: The clinical case demonstrates a successful implementation of cataract phacoemulsification with implantation of a toric intraocular lens in a patient diagnosed with complicated cataract against the background of combined congenital eye pathology, which suggests the possibility of a surgical treatment for such patients.

Background: Currently, there is an increase in cancer among the elderly. Despite the obvious advances in the healthcare related to the diagnosis of the disease and its treatment, oncopathology occupies a high position in the structure of the overall morbidity. Clinical case description: Patient T., 62 years old, came to an internist with the complaints of constant pulling pains in the lower abdomen, a stool disorder in the form of alternating constipation and diarrhea, presence of blood in the stool over the past 6 months, a weight loss of 8 kg over the past 4 months. She was examined independently two years ago, when the disorders of the gastrointestinal tract appeared for the first time, which she associated with constant stressful situations at work. According to the study results, no significant deviations were found. The patient also underwent 16s-RNA sequencing of the intestinal microbiome, which revealed significant changes in many clusters of bacteria (a decrease in the quantitative composition of Lactobacterium, Bifidobacterium, Akkermansia, Faecalibacterium, which is the main representative of the normal intestinal flora, that may indicate a decrease in the protective barrier function of the colonic mucosa, an increase in Fusobacterium, as well as other representatives of the pathogenic flora). Presently, within the framework of laboratory and instrumental studies, the following diagnosis was established: "Malignant formation of the colon (colorectal cancer). T3M0N1". A repeated study of the intestinal microbiota was carried out, according to the results of which an increase in Fusobacterium up to 7.5% was observed, along with a sharp decrease in the representatives of the normoflora (<1%). Conclusion: Changes in various bacterial clusters of the intestinal microbiota can serve as an early marker for the verification of malignant neoplasms of the large intestine. Determining the amount of Fusobacterium in the intestinal microbiome can be an indicator of the first diagnostic line, which helps to identify the pathological process at the stage of precancer, take timely therapeutic measures, improve the quality of life, and increase its longevity.