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Vol 14, No 2 (2022)

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Medical tactics for bleeding after oncological interventions on the pancreas

Glushkov N.I., Kabanov M.Y., Sementsov K.V., Skorodumov A.V., Koshelev T.E., Savchenkov D.K., Alekseev V.V., Vasilchenko M.V., Loginov V.A., Vagner D.O., Andrusenko A.V., Romanova A.A.


About 60% of malignant tumors of the hepatopancreatoduodenal region are represented by neoplasms of the pancreas, accounting for 10% of the total number of malignant tumors of the gastrointestinal tract. Simultaneously with the accumulation of experience, the improvement of the instruments used and the improvement of the supply of medical institutions, the number of cases of surgical treatment of pancreatic neoplasms is growing. The geography of these interventions is expanding. Accordingly, the issues of prevention and treatment of postoperative complications during these interventions, including such a dangerous complication as bleeding, are becoming increasingly important. Postoperative bleeding is diagnosed in 22% of operated patients with a given localization of a malignant neoplasm. The review analyzes modern views on the etiology, diagnosis and treatment of bleeding after resection interventions for pancreatic tumors.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2022;14(2):5-12
pages 5-12 views

Systematic review and meta-analysis: Main points

Sigua B.V., Kotkov P.A., Kurkov A.A., Zemlyanoy V.P.


The growth of the scientific medical community publication activity has led to the emergence of large volumes of disparate, often contradictory information of varying degrees of methodological quality. In such circumstances, a single tool for processing the results of numerous clinical trials was only a matter of time, reflecting the needs of practitioners. Such a tool within the framework of the principles of evidence-based medicine was the conduct of systematic reviews, in some cases supplemented by meta-analyses. The Cochrane is now the leading scientific organization that sets the tone for all research of this kind, providing most of the research of this design every year. Without taking into account the possible negative consequences of such a monopoly, it should be noted that this organization offers a detailed algorithm for writing systematic reviews, which is in the public domain along with the necessary software. This highly transparent methodology makes writing systematic reviews a task within the reach of any professional, regardless of supervision by the Cochrane, whose guiding resource is limited. This work is based on the methodological recommendations of the Cochrane and focuses on the main stages of writing systematic reviews.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2022;14(2):13-22
pages 13-22 views

Features of interleukin status in patients with type 1 diabetes mellitus

Mailyan M.E., Pugachev M.I., Shustov S.B., Salukhov V.V., Livarsky P.A.


A hundred years have passed since the first use of insulin as the main means of therapy for type 1 diabetes mellitus. During this time, significant progress has been made in the development of insulin therapy, including the development of new insulin formulations and methods of its delivery. At the same time, over the years, expanding knowledge about the immunopathogenesis of type 1 diabetes mellitus, doctors are trying to reach a completely new level of possibilities in the treatment of this disease. At this level, methods of immunotherapeutic effects on those links of autoimmune chains will become available, which today limit both the therapy of patients with type 1 diabetes and the development of the idea of stem-cells transplantation due to the lack of a holistic understanding of ways to overcome post-transplant immune aggression against β-cells.

The review summarizes the current understanding of known interleukins involved as the most important intermediaries in the phases of initiation and immuno-mediated destruction of pancreatic β-cells. The achievements in the study of the role of key interleukins in the pathophysiology of autoimmune diabetes for marking potential application points of immunomodulatory targeted therapy are considered.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2022;14(2):23-34
pages 23-34 views

Frequency and structure of arthroscopy complications in patients with knee joint osteoarthritis

Balglei A.G., Tkachenko A.N., Khaydarov V.M., Mansurov D.S., Urazovskaya I.L.


BACKGROUND: Arthroscopy is one of the most popular techniques in traumatology and orthopedic practice. The development of the criteria for selection of patients and indications for knee arthroscopy should be carried out for the improvement of arthroscopic technology. It is important to develop safe and informative surgical access to intra-articular structures, optimize stages and techniques, minimize the complications of arthroscopic surgery.

AIM: The publications describing results of knee arthroscopy in patients with knee osteoarthritis have been analyzed in the study.

MATERIALS AND METHODS: A systematic literature review has been conducted by searching in the Pub-Med/MEDLINE database and eLibrary. The search depth was 20 years; a keyword searching has been performed (including the keywords “complications”, “indications/contraindications for arthroscopy”). Possible relevant peri-, intra- and postoperative complications of knee arthroscopy are discussed.

RESULTS: Knee joint arthroscopy is the treatment of choice for trauma, injury and orthopedic disease. However, arthroscopy of the knee joint does not always bring a positive effect. The number of negative consequences of this surgical intervention, according to the statistics, range from 0.1 to 2.6% of all cases of knee joint arthroscopy. Complications can be local and systemic and develop both in the early postoperative and in the long-term period after the operation. The review is devoted to the analysis of the data concerning the frequency and structure of knee arthroscopy complications in patients with osteoarthritis of knee joints.

CONCLUSIONS: Intra- and postoperative complications of arthroscopic surgery of the knee joint include nerve and vascular lesions, port disposition, thrombosis, pulmonary embolism, instrument breakage, and compartment syndrome associated with a defect in the joint capsule and leakage of irrigation fluid. In the postoperative period, complications such as hemarthrosis, thrombosis, pulmonary embolism, infection and synovial fistulas are possible. Complications of the late postoperative period of arthroscopic interventions are arthrofibrosis, Ahlback’s disease or aseptic osteonecrosis of the femur or tibia, as well as complex regional pain syndrome.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2022;14(2):35-47
pages 35-47 views

Evolution of surgical treatment for breast cancer

Kcheuso A.V., Shapovalov S.G., Savchenkov D.K., Koshelev T.E., Votinova A.O.


Breast cancer holds the leading position among women’s cancer. Nowadays extensive experience has been acquired in surgical treatment of this disease. However, a significant proportion of young and middle-aged patients, the expansion of adjuvant therapy capabilities and the effectiveness of integrated treatment dictate a need to pay more attention to the aestheticity of surgical interventions. The review analyzes the results of the modern studies on the effectiveness and aestheticity of the most common types of surgical treatment of breast cancer; the evolutionary trends in oncosurgery are presented.


HERALD of North-Western State Medical University named after I.I. Mechnikov. 2022;14(2):49-58
pages 49-58 views

Clinical relevance of IL-6 gene rs1800795 polymorphism in patients with ischemic heart disease and chronic heart failure

Khazova E.V., Valiakhmetov R.V., Murzakova A.R., Bulashova O.V.


BACKGROUND: Inflammatory cascade contributes to the development of chronic heart failure. In this way, Interleukin-6 measurement in serum is relevant for understanding a course and prognosis in patients with chronic heart failure. Interleukin-6 expression correlates with IL-6 gene rs1800795 polymorphism.

AIM: This study analyzes the research articles about Interleukin-6 effects and IL-6 gene rs1800795 polymorphism in the patients with cardiovascular diseases with ischemic etiology.

MATERIALS AND METHODS: Systematic review and synthesis of findings of independent studies addressing the association between Interleukin-6 measurement and IL-6 gene rs1800795 polymorphism in the patients with coronary artery disease and chronic heart failure, including prognosis assessment.

RESULTS: The articles that were focused on the clinical features and outcomes in the patients with coronary artery disease and chronic heart failure depending on Interleukin-6 level have been analyzed. IL-6 gene rs1800795 polymorphism and its clinical significance have been introduced from the perspective of Interleukin-6 expression, C-reactive protein and lipids level in the blood. The meta-analysis data indicate the correlation between the rs1800795 and risk of coronary artery disease in comparison with homozygotes, as well as additive, recessive and dominant models. This review demonstrates relationship of polymorphism determination to left ventricular functioning, risks of chronic heart failure progression and future cardiovascular diseases.

CONCLUSIONS: The present study demonstrates that IL-6 gene rs1800795 polymorphism can provide comprehensive insights for prognosis assessment in patients with chronic heart failure.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2022;14(2):59-66
pages 59-66 views

Original research

Results of applying author’s manual method for repositioning shoulder dislocation

Slabospitskii M.A., Mokhov D.Y., Tkachenko A.N.


BACKGROUND: Shoulder joint dislocation is the most frequent among all types of dislocations. There are many ways to correct a dislocation of the shoulder. There are many ways to reduce a dislocated shoulder in both outpatient and inpatient settings. The results of conservative treatment of patients with shoulder dislocation are not always positive.

AIM: To analyze the results of the author’s manual technique for repositioning shoulder dislocation.

MATERIALS AND METHODS: The study was conducted from 2013 to 2020 inclusive with unselected sampling; the study base is the trauma center of the City Hospital No. 1 by N.I. Pirogov. Criteria for including the patients in the study — primary dislocation of the shoulder. Diagnosis: “Closed traumatic dislocation of the shoulder” in total — 1968 people. Non-inclusion criteria — secondary dislocation. In the outpatient setting, successful reduction of the shoulder was carried out in 1159 (58.9%) patients; after unsuccessful reduction, 809 (41.1%) patients were hospitalized with shoulder dislocation. The outpatient patients were randomly divided into two groups: in group 1 (n = 1552) the shoulders were adjusted using traditional methods with local anesthesia, the patients in group 2 (n = 416) received treatment according to the author’s manual technique without local anesthesia. There were no statistically significant differences in gender, age, and type of dislocation in both groups.

RESULTS: The use of manual techniques was effective in 85% of the cases (352 people), 64 people were hospitalized (15%). The effectiveness of using traditional methods with the use of local anesthesia was 52% (dislocation was repositioned in 807 patients), the rest of the patients were treated in the inpatient setting.

CONCLUSIONS: The use of the author’s manual technique in patients with shoulder dislocation in the outpatient setting has higher efficiency compared to traditional methods due to the fact that more patients receive assistance in the outpatient setting. In addition, this type of treatment is carried out without anesthesia, which also reduces the cost of treatment.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2022;14(2):67-74
pages 67-74 views

Arterial hypertension and diabetes developed in pregnancy

Zagarskikh E.Y., Partsernyak S.A., Rishchuk S.V., Proshchai G.A.


BACKGROUND: Gestational diabetes mellitus is a significant medical and social problem in most countries. Despite the relatively high level of development of modern medicine, following the growth of obesity and type 2 diabetes, the prevalence of gestational diabetes mellitus is also increasing worldwide.

AIM: To identify the frequency and structure of carbohydrate metabolism disorders and to compare the level of blood pressure in a random sample of pregnant women registered in the Perinatal center.

MATHERIALS AND METHODS: The analysis of the data of examination of carbohydrate metabolism of pregnant women who are registered in the Perinatal Center (Leningrad region, Gatchina), has been carried out. The analysis of medical documentation, survey, endocrinological and gynecological examination, calculation of the body mass index and the study of carbohydrate metabolism have been carried out.

RESULTS: There is an increase in the number of pregnant women with impaired carbohydrate metabolism over the years of observation. Gestational diabetes on diet therapy was 64.4% in 2019, 31.0% — in 2020, 65.1% — in 2021, on insulin therapy — 32.2, 62.3, 28.9% respectively. There was an increase in the number of women with type 1 and type 2 diabetes diagnosed before pregnancy and newly diagnosed diabetes during pregnancy. Body mass index and blood pressure levels are higher and glycated hemoglobin levels are lower in diet-treated pregnant women with gestational diabetes compared with insulin therapy. An increase in glycated hemoglobin was found annually in a group of women with gestational diabetes mellitus on insulin therapy.

CONCLUSIONS: The high prevalence of carbohydrate metabolism disorders and the associated increase in blood pressure in pregnant women in Saint Petersburg and the Leningrad Region justifies a targeted search for carbohydrate metabolism disorders in pregnant women.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2022;14(2):75-84
pages 75-84 views

Endovisual technologies in the diagnosis and treatment of closed injuries of the pancreas

Khadjibaev F.A., Atadjanov S.K., Mustafaev A.L.


BACKGROUND: To date, there is no consensus on the optimal treatment and diagnostic algorithm for patients with closed pancreatic injury in cases where emergency surgery is not required. Patients with suspected pancreatic injury require the closest attention and maximum efforts aimed at establishing an accurate diagnosis.

AIM: To optimize the method of diagnosis and surgical intervention for closed abdominal trauma with damage to the pancreas.

MATERIALS AND METHODS: We have analyzed the results of treatment of 125 patients with pancreatic injuries who were treated in the surgical department of the Republican Scientific Center for Emergency Medical Aid and its branches from 2011–2021 among the victims, men predominated — 104 (83.2%) patients, women — 21 (16.8%), age ranged from 20 to 60 years. For the study, two groups of patients with damage to the pancreas with a closed abdominal injury have been formed. Group I included 84 victims in the period from 2011 to 2016 using traditional surgical interventions. Group II included 41 patients in the period from 2016 to 2021 using endovideosurgical technologies for the diagnosis and treatment of patients with a closed injury of the pancreas.

Isolated trauma of the pancreas was diagnosed in 22 (26.1%) patients, combined — in 103 (82.4%). Injuries of the pancreas in case of a closed injury were localized mainly in the tail of the pancreas, less often in the head, body and isthmus.

RESULTS: Resection of the pancreas was performed in the predominant number of cases with III degree of damage, when there was damage to the tail of the gland with a violation of the integrity of the MP. In group I, this volume of operation was performed in 1 out of 4 cases of distal damage to the gland, in group II, resection was also performed in 1 out of 3 cases of damage to the pancreas with ΙΙΙ degree of damage. Suturing was carried out with a hemostatic purpose in case of damage to the integrity of the blood vessel in the projection of the pancreas. It was used in 9 (10.7%) cases in group I and also in 3 (7.3%) cases in group ΙΙ, in both cases II and III degree of damage to the pancreas occurred. Opening of the hematoma of the pancreas was performed in 6 (7.1%) cases in group I, in 4 of which with the I degree of damage to the gland, in the II group it was performed in 3 (7.3%) cases also with I and II degrees of damage. Among our patients in group II there were 12 patients with degree I damage to the pancreas. 6 patients underwent diagnostic videolaparoscopy, bursoscopy (pancreatoscopy), drainage of the omental sac. There were no significant differences in the number of complications in patients undergoing laparotomy and laparoscopy. This indicates that both methods can adequately inspect the abdominal cavity and establish a diagnosis.

Of the 125 victims with dominant damage to the pancreas, 17 (13.6%) died. According to our data on the Pancreatic Injury Mortality Scale, there were no lethal outcomes with mild severity. In the group with moderate severity, 4 (8.6) patients died in group I and in group II, 1 (2.1%) patient, with a severe case, 9 (52.9%) patients died in group I and in group II — 3 (17.6%) patients. The main causes of death in 9 patients were severe destructive post-traumatic pancreatitis, 6 victims had injuries with severe traumatic and hemorrhagic shock, 2 had multiple complications of combined injuries, chest, brain.

CONCLUSIONS: In our opinion, therapeutic laparoscopy can be used for isolated injuries of the pancreas and only for injuries according to American Association for the Surgery of Trauma (AAST) I degree. With II degree of damage, it is better to end the operation with precision hemastosis with drainage of the stuffing bag. At the III degree of damage to the pancreas, it is possible to perform a distal resection. Indications for tamponing rarely arise exclusively within the framework of the treatment tactics “Damage control” and when it is impossible to stop bleeding from the pancreas.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2022;14(2):85-92
pages 85-92 views

Clinical and metabolic features of diabetic encephalopathy

Golovkin V.I., Privalova M.A., Garan T.A., Gulak D.A.


BACKGROUND: Actual mindset, concerning the pathogenesis of type 2 diabetes mellitus and its complications, is described in the glucocentric, lipocentric and lipokine theories. At the same time, it is known, that acute cerebrovascular disorder in type 2 diabetes mellitus can also develop with normoglycemia. The mechanism of association between obesity and type 2 diabetes mellitus in metabolic syndrome has not yet been studied, and 40% of diabetic patients are not obese. In the physiological state hyperglycemia is prevented by pancreatic regulatory oligopeptides rather than insulin, and protein glycation occurs before the development of diabetes symptoms. That facts indicate the need to continue investigation of the pathogenesis in general and diabetic encephalopathy in particular from the standpoint of metabology in order to substantiate the peptidergic theory of the diabetes mellitus and dyscirculatory encephalopathy pathogenesis.

AIM: To consider little-known clinical, morphological and metabolic manifestations of diabetic encephalopathy from the standpoint of improving the disease diagnosis.

MATHERIALS AND METHODS: Among 162 elderly and senile patients in the pre-stroke and stroke stages of diabetic encephalopathy, modern methods of radiological, laboratory, histological, psychometric and clinical analysis have been used: the relationship between low total cholesterol and disease progression has been determined according to Schulte and MMSE psychometric tests with the same hyperglycemia in different age groups sick; cases of amyloid angioencephalopathy on magnetic resonance imaging in the ultrasensitive weighted imaging mode and amyloidosis have been identified.

Staining post-mortem ultrathin tissue biopsy sections with Congo red allowed to find amyloid deposition in 12% of autopsy cases in the absence of diagnosing amyloidosis during life; preparations, in which Congo red staining was positive for the presence of amyloid, were taken for inspection in polarizing light and typing of amyloid. Staining of histological preparations with hematoxylin-eosin and Van Gieson revealed a morphological characteristic of diabetic encephalopathy different from that of atherogenic and hypertensive dyscirculatory encephalopathy; using immunological studies, a statistically significant increased content of induced interleukin-1β production, a trigger for the serum amyloid analogue in the liver synthesis, was determined, and an experimental method for beta-amyloid peptide adhesion by monocytes and the density of amyloid expression on the surface of monocytes in patients with diabetic encephalopathy at senile age at 2–3 times higher than the density of the peptide in the elderly and in the patients with dyscirculatory encephalopathy of the same old age.

RESULTS: It has been established that a fairly frequent and early manifestation of metabolic disorders in diabetic encephalopathy is a violation of protein metabolism with its final conformation into toxic amyloid tissue components. These observations indicate the multifactorial nature of diabetic encephalopathy. Literature data on the parametabolism of the serotonin mediator and tryptophan in the pathogenesis of diabetic encephalopathy are presented.

CONCLUSIONS: Modern immunological, morphological, and histochemical capabilities make it possible to diagnose the conformation of the protein matrix and develop a protein-centric hypothesis of diabetic encephalopathy.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2022;14(2):93-100
pages 93-100 views

Case report

Clinical case of Whipple’s disease

Osipenko M.F., Nadeev A.P., Venzhina Y.Y., Zhuk E.A.


The article presents a clinical case of 68-years old patient with a Whipple’s disease. The diagnosis was made after 10 years of following-up in presence of gastroenterological symptoms. On examination flattened rounded villi with the content of PAS-positive (PAS — periodic acid Schiff) foamy macrophages, highly specific for Whipple’s disease, have been described in the biopsy specimen of the distal duodenum. The therapy led to a distinct positive dynamics persisting for 1 year.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2022;14(2):101-108
pages 101-108 views

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