Vol 10, No 2 (2019)

Original Research

The effectiveness of the surgical correction of the temporomandibular joint intracapsular disorders

Lyashev I.N., Dybov A.M., Kholmogorova P.V.


Background. The prevalence of temporomandibular joint diseases covers about 40% of the population. The main place (from 70 to 82%) among these diseases is occupied by the so-called intracapsular disorders of the temporomandibular joint (TMJ). The lack of consensus on the use of treatment methods and clear protocols for the rehabilitation of patients with intracapsular TMJ disorders was the basis for the conduct of this study.

Objective. The purpose of the study was to analyze the treatment effectiveness in patients with intracapsular disorders of the temporomandibular joint using the complex of pathogenetically substantiated conservative and surgical methods. Methods. The research included 43 patients with complaints to pains and dysfunction of TMJ. Everything fulfilled the uniform protocol of inspection. Depending on disease degree to patients were assigned or a course of conservative treatment with use splint therapy, or surgical correction of defect.

Results. After analyzing the dynamics of patient treatment in the framework of this study, it was found that surgical correction of intracapsular disorders of the temporomandibular joint was effective in all patients examined by us.

Conclusion. To maintain a long-term stable result, this group of patients is shown orthodontic-orthopedic rehabilitation, with the goal of creating and maintaining correct occlusal relationships.

Journal of Clinical Practice. 2019;10(2):6-13
pages 6-13 views

A complex treatment of irreducible displacement of the temporomandibular joint disc and myofascial pain disorders with the use of botulinum toxin

Ilyin A.A., Fazylova T.A., Demchinsky E.A., Olesova V.N., Olesov E.E.


Background. An irreducible displacement of the articular disc (IDD) is one of the TMJ conditions characterized by complexity of clinical manifestations, severity and is always accompanied by myofascial pain disorders.

Objective. To improve the results of treatment of patients with TMJ IDD and myofascial pain syndromes.

Methods. We performed a clinical examination and treatment of 38 patients with irreducible displacement of the TMJ articular disc and myofascial pain disorders. As additional research methods, we used CBCT, MRI, EMG. A step-by-step treatment was conducted, including a drug therapy, injection of botulinum toxin type A (BTA) in the masticatory, temporal, lateral pterygoid muscles (LPM) bilaterally; repositional splint therapy; arthrocentesis with the lavage of both articular spaces.

Results. The overall effectiveness of the treatment was 97.4%. Out of 38 patients, 34 (89.5%) were treated without arthrocentesis with the complete restoration of the mandibular movement volume and elimination of pain syndrome.

Conclusions. An effective system has been developed for a sequential complex treatment of TMJ IDD; a new technique has been developed for a periarticular injection access to the LPM allowing administration of a drug to its upper and lower heads. The high efficiency of BTA injections in the treatment of TMJ IDD is due to the mandatory drug administration into 3 muscles: masticatory, temporal and lateral pterygoid. In the treatment of TMJ IDD, arthrocentesis is effective with lavage of the lower and upper articular spaces.

Journal of Clinical Practice. 2019;10(2):14-20
pages 14-20 views

Surgical methods of treatment of Eagle syndrome

Nazaryan D.N., Karayan A.S., Fedosov A.V.


Background. One of the most difficult in the clinical practice patients groups are patients with orofacial pain. A possible cause of pain in the face and mouth can be stylohyoid syndrome or Eagle syndrome. The clinical manifestations of the syndrome are observed in only 4-10.3% of cases among the total number of cases of elongated hyoid processes.

Objective. To develop criteria for the choice of the surgical access for a safe removal of the hyoid process depending on its anatomy.

Methods. In patients with the symptoms of stylohyoid syndrome, in the case of detecting an extended hyoid process during the clinical study, its removal was performed via an intraoral route (n=3). In the other patients (n=10) the removal was performed via an external access along the first cervical fold, or through the vertical retroaural access.

Results. In patients with stylohyoid syndrome, we observed a high efficiency of the surgical treatment and rather short times of postsurgical rehabilitation, that significantly improved the quality of life.

Conclusion. In our opinion, the surgical access through the first cervical fold is the most convenient way both from the technical viewpoint and from the viewpoint of a minimal cosmetic defect.

Journal of Clinical Practice. 2019;10(2):21-26
pages 21-26 views

Internal hernia as one of the causes of abdominal pain

Kitaev V.M., Koshelev E.G., Sokolova O.V., Belyaev G.Y., Egorov A.A., Kurzantseva O.O.


Abdominal pain is often observed in clinical practice, causing diagnostic difficulties for doctors of different specialties. Internal hernias are a surgical pathology and may be the cause for the development of acute small bowel obstruction and the occurrence of pain. A modern classification of internal hernias is presented and their topographic-anatomical description is given. The analysis of the results of computed tomography (CT) scan of the abdominal cavity in 20 patients with an unidentified cause of abdominal pain was performed. According to the CT data, three patients had internal hernias that caused the development of pain syndrome. A pathological displacement of intestinal loops with partial disruption of intestinal permeability and curvature of the mesentery without critical disturbance of blood supply was demonstrated in 4 patients with abdominal pain. The findings suggest that CT may be the method of choice when examining patients with an unknown cause of abdominal pain syndrome.

Journal of Clinical Practice. 2019;10(2):27-35
pages 27-35 views

The effectiveness of complex application of osteopathy and shock wave therapy in the rehabilitation treatment of myofascial pain syndrome

Zuev D.S., Kostenko E.V., Petrova I.A.


Background. Myofascial pain syndromes are the most frequent companions of acute and chronic lumbar pain, and the problem of eliminating pain syndrome should be considered in terms of developing an effective program for diagnosis, treatment, physical rehabilitation and its accessibility for all categories of the population.

Аim. To evaluate the effectiveness of complex application of osteopathy and shock wave therapy in the rehabilitation treatment of patients with MPS.

Materials and methods. 120 patients with myofascial pain syndrome (MPS), mean age 49.65±0.89 years, mean disease duration 2.29±0.18 years were examined.

Results. With the combination of standard therapy, osteopathic treatments and extracorporeal shock wave therapy (ESWT), the severity of pain on the scale of visual analogue scale (VAS) after 12 months of observation decreased by an average of 77.1%, in the group of standard therapy in combination with ostepathic treatment, 62.2%, in group of standard therapy and ESWT by 52.8% and in the group of standard therapy by 30.9%. According to the 12-month prospective follow-up, the maximum positive effect on the severity of MPS and emotional disorders was noted in the combination of standard therapy, osteopathic treatments and ESWT.

Conclusion. The combination of these methods of treatment can be considered as a method of choice in complex programs of rehabilitation treatment of patients with MPS.

Journal of Clinical Practice. 2019;10(2):36-45
pages 36-45 views

Characteristics of sleep disorders in patients with chronic back pain

Vinogradov D.K., Doronina O.B.


Background. Insomnia is considered a risk factor for the frequency of pain, however, no reliable studies with a comprehensive analysis of the objective polysomnography data have been conducted so far.

Objective. Using the method of polysomnography, to assess the changes in the structure of sleep in the chronic pain syndrome, by the example of chronic back pain.

Methods. The study was carried out in two groups (basic and control,) in which the patients were examined according to the following algorithm: an objective examination, assessment of the neurological status, filling in neurological scales and questionnaires, a single comprehensive study of the night sleep (polysomnography).

Results. According to the data of the polysomnographic study, presomnic disorders were detected in 25% of patients, intrasomnic disorders in 48%, and postsomnic disorders in 17%.

Conclusion. These sleep patterns, measured by polysomnography, demonstrate a link between sleep disorders, changes in the psycho-vegetative status, and chronic pain syndrome.

Journal of Clinical Practice. 2019;10(2):46-52
pages 46-52 views

Long-term results of stenting of long coronary artery stenosis with consecutive implantation of stents of different types with overlapping edges in patients with acute coronary syndrome without ST-segment elevation and multivessel coronary artery disease

Bocharov A.V., Popov L.V.


Introduction. In urgent interventional cardiology practice, combinations of drug-eluting stents and bare-metal stents are sometimes forced to treat extended stenosis in a clinic-dependent artery.

Objective. A comparison of long-term results of treatment of patients with coronary heart disease and multivessel coronary lesions, which performed stenting of the clinic-dependent artery by two successive partially overlapping stents using stents of the 3rd generation with drug coating or a combination of the 3rd generation stent with drug coating and a bare-metal stent for acute coronary syndrome without St segment elevation and later — complete functional myocardial revascularization by endovascular method.

Methods. The minimum overall length sentiremos section was made 55 mm. In main group included 32 patients for whom revascularization clinic-dependent artery performed endovascular intervention with the use of 2 stents 3-generation drug-coated sirolimus and biodegradable polymer implanted overlap. In 30 patients (control group), clinic-dependent artery revascularization was also performed by a combination of implanted overlap stents, one of which was a 3rd generation stent with sirolimus drug coating and biodegradable polymer, and the other was a bare-metal stent. There were no statistically significant differences between the groups in clinical, demographic and operational characteristics.

Results. The analysis of the results revealed a significant difference between the groups in the frequency of repeated revascularization of the target artery, which were observed more often in the control group.

Conclusion. When performing an extended stenting of the clinic-dependent artery in patients with acute coronary syndrome without ST segment elevation, overlapping of the drug-coated stent and the bare-metal stent should be avoided, since the antirestenotic effect of the drug-coated stent is leveled when overlapping with the bare-metal stent, but this strategy can be used in case of full coverage of the stenotic lesion or closure of the dissection.

Journal of Clinical Practice. 2019;10(2):53-59
pages 53-59 views


Differential diagnosis short-lasting unilateral neuralgiform headache attacks and trigeminal neuralgia

Parkhomenko E.V., Nartov S.E.


The article presents diagnostic criteria, comparative characteristics of short-lasting unilateral neuralgiform headache attacks, including short-term unilateral neuralgic headaches with conjunctival injection and lacrimation (SUNCT) and short-term unilateral neuralgic headaches with cranial autonomic symptoms (SUNA), differential diagnosis with trigeminal neuralgia.

Journal of Clinical Practice. 2019;10(2):60-65
pages 60-65 views

Pain in amyotrophic lateral sclerosis

Voitenkov V.B., Ekusheva E.V.


In this review, we discuss different aspects of pain syndrome in patients with amyotrophic lateral sclerosis: etiology, incidence, pathophysiology and main clinical features. Also we review the modern approaches to the treatment of pain in amyotrophic lateral sclerosis. Pain is actually not rare in this condition: it appears in 80% of patients, affecting their quality of life and functional activity, leading to the development of depressive and anxiety disorders. Pain in amyotrophic lateral sclerosis is often overlooked by clinicians, since their attention may focus on the motor symptoms of the disease. Thus, a more careful approach is needed to diagnose and treat pain in amyotrophic lateral sclerosis.

Journal of Clinical Practice. 2019;10(2):66-73
pages 66-73 views

Pain management and stroke prevention in HHV-3-associated infection

Kolokolov O.V., Bakulev A.L., Shuldyakov A.A., Makarov N.S., Sitkali I.V., Kolokolova A.M., Kravchenya S.S.


The modern information on the epidemiology, pathogenesis, clinical manifestations, diagnosis and pain management in HHV-3-associated neuro-infection is presented. The criteria for the phased diagnostics and approaches to the rational therapy for shingles and postherpetic neuralgia are presented. The conditions aimed at the prevention of pain due to the damage to peripheral nervous system and stroke due to HHV-3-associated vasculopathy are discussed.

Journal of Clinical Practice. 2019;10(2):74-84
pages 74-84 views

Clinical case

Chronic prostatitis: differential diagnosis. Case report discussion

Kovalyk V.P., Ekusheva E.V.


The diagnostics of chronic pelvic pain is a complex interdisciplinary problem. It requires a thorough and detailed clinical examination involving clinicians of various specialties. Neuropathic pain in the structure of chronic pelvic pain is present in 1/3 of patients, which call the need for a close cooperation between the urologist and neurologist at all the stages of the management of these patients. The presented clinical analysis demonstrates an algorithm for such an interdisciplinary interaction, which provides a care for a patient with this complex and debilitating pathology.

Journal of Clinical Practice. 2019;10(2):85-90
pages 85-90 views

The chest pain in neurological practice. Non deesset...

Shirshova E.V., Annenkova O.Y., Ekusheva E.V., Petrov V.N.


Chest pain can be a “mask” of a life-threatening condition, which the practitioner must remember. One of such life-threatening condition is aortic aneurysm, which diagnosis presents significant difficulties in routine clinical practice. Clinical manifestations of thoracic aortic aneurysms are extremely variable and non-specific and are mainly depends on the size of the aneurysmal sac, its localization and extent, as well as the etiology of the disease. Here we present a clinical case report of a 48 y.o. patient who died because of the acute cardiac tamponade as a complication of dissecting thoracic aorta aneurysm. The lack of symptoms and clinical instrumental data, initially suggesting the presence of life-threatening disease did not allow the physician to suspect aortic aneurysm and urgently take action regarding it.

Journal of Clinical Practice. 2019;10(2):91-96
pages 91-96 views

A rare clinical case of surgical treatment of a periarticular cyst of the facet joint of the lumbar spine

Potapov V.E., Koshkareva Z.V., Zhivotenko A.P., Sklyarenko O.V., Gorbunov A.V., Glotov S.D., Sorokovikov V.A.


Background. Periarticular cysts of the facet joint, due to their rare occurrence, often slip away from the attention of clinicians. However their formation and progression may cause compression of vascular-neural structures with subsequent manifestations of severe neurological disorders.

Description of the clinical case. We present a rare clinical case of surgical treatment of a periarticular cyst of the facet joint. A comprehensive examination of the patient S. revealed: Dorsopathy with degenerative spinal canal stenosis at LV-SI level; spondyloarthrosis; periarticular facet cyst at LV-SI level on the left; radiculopathy LV on the left, in the acute stage; pronounced pain and musculo-tonic syndrome. Complaints of the patient: constant pain in the lumbar spine, extending to the left lower extremity and aggravating when walking at a distance of 50-100 meters; feeling numb when walking on the plantar surface of the left foot. When examining the local status, a forced posture with a bowed head and torso forward was noted; smooth lumbar lordosis and antalgic right-sided scoliosis; tension of paravertebral muscles. Neurological examination revealed LVradiculopathy on the left with moderate paresis of the extensor muscles of the left foot and ipsilateral Lasègue's positive test. MRI examination revealed spinal canal stenosis, facet joint cyst at the level of LV-SI with dimensions of 14×8×8.5 mm. An operative intervention was performed: reconstructive decompressive-stabilizing spinal surgery with a single block removing the articular facet with a periarticular cyst at the left LV-SI level with subsequent posterior transpedicular fixation of the vertebral motor segment. Two months after the operation, complete medical and social rehabilitation of the patient was achieved. No complaints.

Conclusion. In case of compression of a periarticular cyst of vascular-neural structures with severe neurological disorders, surgical treatment with the cyst removal is recommended.

Journal of Clinical Practice. 2019;10(2):97-103
pages 97-103 views

Healthcare system administration

Treatment of patients with chronic pain in Russia. Time of change

Genov P.G., Vostretsova Y.V.


According to WHO, about 20% of population suffers from chronic pain. First pain clinics whose purpose was to provide care to such kind of patients started to appear in 1961. There are reportedly about 15 multidisciplinary pain clinics in Russia nowadays.The development of this medical branch in Russia is restrained by several factors: the absence of legal basis for pain specialists, the lack of educational programs, clinical standards and recommendations, as well as absence of state medical insurance rates for chronic pain care.

Journal of Clinical Practice. 2019;10(2):104-107
pages 104-107 views

The organizations of specialized medical care for patients with headache

Baiushkina L.I.


Primary headaches are common diseases in the clinical practice. Affecting the active, able-bodied population, impairing the quality of life and causing social maladjustment, they are of immense social significance. The medical care for patients with headaches ought to be complex and include a patient’s educational program, rational pharmaceutical therapy, detection and correction of comorbid functional disorders, nonpharmaceutical therapy. Despite an adequate therapy, the treatment satisfaction remains low and stimulates development of individualized treatment algorithms, that take into account the patient’s personal characteristics. They should be applicable both for the self treatment and for the use in the neurological and general practice.

Journal of Clinical Practice. 2019;10(2):108-113
pages 108-113 views

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