卷 13, 编号 1 (2022)

Population reproduction is a priority task of social policy and a factor of Russia’s national security. The review presents the stages of recording the perinatal mortality indicator, which is closely related to the frequency of preterm birth. In the first stage, the criteria for registering preterm birth were 28 weeks of pregnancy, and in the second, since 2012, — 22 weeks. At both stages, due to underreporting of low birth weight babies (their transfer to the “miscarriage” group), stillbirths, including full-term babies, prevailed in the preterm birth indicator structure. The authors of the article stressed that the main cause of preterm birth (including iatrogenic) is the formation of endotoxemia syndrome, or “systemic effects of aggressive metabolites” in the mother – placenta – fetus system. In this etiopathogenetic therapeutic means are methods of efferent therapy in the form of plasmapheresis, etc. These technologies in many obstetric pathologies (thrombophilia, preeclampsia, Rh-conflict, isthmic-cesmic and chronic placental insufficiency, etc.) sanitize the mother – placenta – fetus system and allow to prolong pregnancy with a reduction of perinatal mortality index. The authors cite their own data on the use of efferent therapy methods in 102 women presenting at 22–28 weeks of pregnancy to the Perinatal Center of Saint Petersburg State Medical University from other institutions after unsuccessful treatment according to the Protocols for various obstetric complications. Pregnancies were prolonged by 2–15 weeks; all 123 children (20 twins, 1 triplet) were born alive, did not require long-term intensive care, survived and were not disabled. Six newborns died and the perinatal mortality rate was 48 : 1000, which is an order of magnitude lower than that quoted in the literature for similar pathologies and gestational ages. In conclusion of the article, it is suggested that in order to reduce perinatal mortality in Russia, all large institutions should arrange efferent therapy rooms to treat sick pregnant women using the safe, low-cost technologies developed by the authors, using domestic equipment.

Background: The total scalp electrorencephalography shows the activity of groups of cortical neurons. But each of these groups does not exist in isolation, but they are influenced by other areas, both cortical and subcortical systems of the brain. In the course of neurosurgical treatment, patients underwent resection of cortical areas in which the epileptiform focus was located. In patients with resection of the temporal lobe with structural drug-resistant epilepsy, EEG patterns of “loss of activity” are not recorded above the remote areas.

Aim: to study the mechanisms underlying the formation of electrorencephalography patterns recorded in the projection of the resected temporal lobe of the brain in patients operated on for focal drug-resistant epilepsy.

Materials and methods: There were examined 22 patients with structural pharmacoresistant epilepsy. Coherent analysis of the electrorencephalography was performed for an epoch of 30 seconds in transverse and longitudinal intrahemispheric pairs of leads.

Results: Correlation interactions between the temporal leads and their surrounding areas are enhanced after removal of the temporal lobe involved in the epileptic system.

Conclusion: The activity recorded in the postoperative period in the projection area on the scalp of the resected area is formed as a result of signal transmission from other departments.

Background: Dichorionic diamniotic twin pregnancy resulting from IVF can lead to isthmic-cervical insufficiency with concomitant complications. Against the background of the initial genital chronic infection in a woman there is a threat of septic complications for the mother-fetal couple. The complex pathology is accompanied by an accumulation of toxic substances in the mother-placenta-fetus system that requires pathogenetic treatment measures.

Clinical Cases: This paper presents data on the results of efferent therapy in two pregnant women with dichorionic diamniotic twin pregnancy complicated by fetal bladder prolapsing into the cervical canal up to the external pharynx (1 case) and with premature amniotic fluid outflow of the first fetus (2 cases). The patients received preserving therapy at the hospital and then were transferred to the perinatal center with the clinical signs of threatening abortion, endotoxemia, and moderate inflammatory response, which were treated with efferent therapy in the form of medium-volume membrane plasmapheresis combined with photodilution with ultraviolet and laser beams. There were no complications during efferent therapy. In 1 and 2 observations the pregnancies of women in the perinatal center were prolonged by 45 and 34 days with operative delivery at 27 and 31 weeks, respectively. There were no septic complications in women and children. The newborn premature infants after therapeutic and rehabilitative measures had good prospects for a full life.

Conclusion: The efferent therapy methods are safe and, in cases of IVF-infant foetuses with complicated isthmic-cervical insufficiency, are a pathogenetic measure; they help to prolong pregnancy and prevent infectious complications in the mother and fetus.

Cushing’s syndrome often develops due to an excessive intake of glucocorticoids with oral, intravenous, intramuscular administration, but it is possible to get a similar complication with intranasal administration. In this article, we present two cases of children who received nasal eye drops with dexamethasone. The use of drugs for 5–6 months in one case, and 3 years in another led to the formation of a typical clinical picture of the syndrome. The patients showed progressive dysplastic obesity with a moon-shaped face, atrophic skin changes with the appearance of red-violet, crimson stretch marks, and a decrease in the growth rate. There were some peculiarities in the results of laboratory and instrumental examination, due to age-sex characteristics and the duration of taking dexamethasone. According to the totality of anamnestic, clinical and laboratory parameters, instrumental examination, a drug-induced cushingoid syndrome was diagnosed. Subsequent follow-up after discontinuation of the drug confirmed the diagnosis. The presented clinical cases emphasize that the eye drops contain high doses of steroids and can lead to the development of Cushing’s syndrome, especially in children with intranasal use. When using nasal drops, it should be borne in mind that glucocorticoids will enter the mouth and be absorbed through the gastrointestinal tract. One should take into account the possibility of psychological dependence on such drops and, as a result, uncontrolled consumption by adolescent children.

Rhinogenic intracranial complications, such as brain abscess and thrombosis of the veins and sinuses of the brain, are still a formidable, life-threatening pathology, often resulting in death, despite the widespread development of antibiotic therapy and adherence of patients to the treatment. Often the cause of the development of intracranial complications is the exacerbation of a chronic inflammatory process in the paranasal sinuses, while acute ENT pathology of the sinuses leads to the development of rhinogenic complications only in a small percentage of cases. Unfortunately, the high development of radiation and laboratory diagnostics does not always allow diagnosing these conditions in time and providing adequate surgical care. In childhood and adolescence, it is important to perform a timely complete and at the same time minimally invasive, non-disabling, surgical intervention. An analysis of foreign literature in recent years shows that neurosurgical operations in various volumes (from trepanopuncture of the brain to craniotomy) occur in the vast majority of cases of treatment of rhinogenic intracranial complications. The article presents two clinical cases of patients with intracranial complications successfully treated in the Department of Otorhinolaryngology of St. Petersburg State Pediatric Medical University without a highly traumatic neurosurgical operation. The combination of endonasal endoscopic surgery and massive adequate conservative therapy (antibiotic therapy in combination with the use of anticoagulants for sinus thrombosis) allows the patient to recover without resorting to neurosurgical intervention.

研究的迫切性。在俄罗斯的医疗保健领域，初级保健机构人员严重短缺。

本论文的目的是对选择医生职业的理由与医学院毕业生在初级保健机构工作的意愿之间的关系进行分析。

论文的研究资料和方法。在2019/2020学年，在圣彼得堡国立儿科医学大学用调查表征询了104名毕业班的大学生的意见，而且是不记名的。在分析过程中分出来了与职业选择相关的动机，并对大学毕业后立即担任地段儿科医生的意愿进行了相关分析。

结论。所有104名实习医师回答了调查表中的18个问题。据分析结果，77%的人有信心当医生是一个正确的选择；82%的人指出，医生的职业价值就在于治病救人，60%的人认为医生一般上享有崇高的社会地位，47%的人认为有机会赚到足够的钱。受访者指出了医生职业的下列劣势：17%人认为他们不太喜欢对待患者，80%的受访者指出人们对医生持不尊重的态度，68%的人认为法律责任的要求很高，—62%的人认为难以赚到足够的钱。但是，尽管在医疗活动中有所有的负面因素，58%的受访者标示希望在毕业后当地段儿科医生，42%的人希望继续学习并获得其他医疗专业。学生们提出了解决基层医疗机构人才短缺问题的方法。研究结果表明，大多数儿科大学毕业生对所选职业的正确性充满信心。

结论。这项研究的结果可能有助于卫生组织专家吸引医学院毕业生在基层医疗机构就业，解决基层医疗机构人才短缺问题，提高医疗卫生服务质量。

The profession of a doctor involves great physical activity and high working capacity. Of course, physical education and sports play an important role in the process of preparing student youth for social and professional activities, have significant potential in the formation of a system of knowledge and skills related to professional safety, health protection, and the prevention of certain diseases of doctors. It is impossible to overestimate the importance of physical culture in the formation of the professional qualities of the future medical work, the use of its means and methods for the rapid and complete restoration and working capacity of the doctor. The festival of students of medical and pharmaceutical universities of Russia “Physical culture and sports — the second profession of a doctor” is called upon to attract medical students to active sports life. In the article, the authors pay special attention to a retrospective review of the emergence and further holding of the departmental Sports Festival. The result of the presented analytical review was the determination of the results of student speeches in accordance with the affiliation to a particular medical university. During the study, the statistical data of the competition protocols were analyzed. Today, ten years later, you can summarize some of the results of the past eight festivals of medical universities in Russia, determine their role and place in improving the system of higher professional education, and evaluate the effectiveness.