Vol 12, No 4 (2020)

Pancreatic cancer accounts for 8–10% of all cases of malignant tumors of the digestive organs and 50–60% — of pancreaticoduodenal malignant neoplasms. Over the past 30 years the incidence of pancreatic cancer in Russia has increased by 30%. The main method of treatment this category of patients requires surgical intervention. Extensive experience has been gained in using various types of surgical therapy. The review analyzes the results of modern studies on the efficacy and safety of the most common of them.

Introduction. More than 30 million cases and more than 970 thousand fatalities from COVID-19 have been registered. The effectiveness of interleukin-6 and interleukin-1 antagonists and janus kinase inhibitors in the treatment of new coronavirus infection is still being analyzed. At present, the emphasis is placed on the introduction into a wide practice of a Russian vaccine named Sputnik V.

Purpose. To compare the effect of complex therapy with baricitinib and dexamethasone on the course of COVID-19 interstitial pneumonia.

Materials and methods. A retrospective analysis of the medical records of 122 people hospitalized at the North-Western State Medical University named after I.I. Mechnikov was carried out. All the patients were divided into three groups: the first one — 64 patients who received therapy including baricitinib; the second one — 33 patients whose therapy included dexamethasone; the third one — 25 patients in the comparison group.

Results. In the first group of patients the lung damage was 25-75% (2-3 degree CT) in 78.1% of the patients, more than 75% in 14.1% of the patients, which was accompanied by severe clinical symptomatology and high laboratory activity. Against the background of the tharapy, positive dynamics of CT was observed in 48.4% of the cases. In the second group of patients the volume of pulmonary tissue damage by CT of 2-3 degrees was observed in 84.9% of the examined patients, clinical and laboratory activity corresponded to the moderate course of the disease. Against the background of the complex therapy, positive dynamics according to CT examination was observed in 18.2% of the cases. In the comparison group, positive dynamics according to CT was observed in 56% of the patients against the background of the therapy. Normalization of clinical and laboratory parameters was observed in all the patients from three study groups on the background of treatment.

Conclusions. In the first group the majority of the patients had he highest number of comorbid pathologies and severe course of COVID-19. Normalization of clinical and laboratory parameters was observed in all the groups of patients. As a result of standard comprehensive therapy, as well as therapy involving baricitinib or dexamethasone, positive dynamics according to CT data was observed in 48.4%, 18.2% and 56% of the patients, respectively.

Introduction. Treatment and rehabilitation of ischemic stroke patients is an important medical and social problem.

The purpose of the study is to compare effectiveness of different complex rehabilitation methods for improving patient functional abilities and social adaptation.

Materials and methods. 114 patients, aged 61.1 ± 10.7 years, in early and late rehabilitation period of ischemic stroke were examined. Group I (n = 73, age 63.2 ± 10.9) was represented by the patients that received conventional rehabilitation treatment ambulatory or in neurological department with additional biological feedback; patients of group II (n = 41, aged 60.4 ± 10.3) received ambulatory conventional rehabilitation treatment.

Results. There was no significant difference in the patients’ age of groups I and II. The most frequent stroke location in the middle cerebral artery in the II group patients was in the right hemisphere (p < 0.05). The improvement of damaged function was revealed in both groups. Clinical scale data on discharge indicated more severe manifestations in the I group patients. In the main group, the restriction of daily activity in women was more pronounced than in men (p < 0.05).

Conclusions. Rehabilitation treatment in post-stroke patients led to functional improvement. Clinical manifestations in the patients that require rehabilitation in hospital, were more severe in comparison with ambulatory rehabilitated group. Data on more pronounced disturbances in activities of daily living in women compared to men require further study.

Despite the ongoing preventive measures aimed at reducing the formation of adhesions in the abdominal cavity with an increase in the number of surgical interventions on the abdominal organs, the number of patients admitted to surgical hospitals with adhesions of the small intestine is also increasing. It should be noted that annually about 1–2% of previously operated patients undergo treatment in surgical departments while the exceptional fact is that 50–70% are patients with acute adhesive ileus of the small intestine and the mortality rate in this group ranges from 13 to 55%. In recent years the literature has been actively discussing the advantages of minimally invasive technologies in the treatment of adhesive small bowel obstruction since the use of traditional methods often leads to the development of complications with repeated (in 60% of cases) surgical interventions. The purpose of this study was the development and implementation of an improved therapeutic and diagnostic algorithm in patients with adhesive small bowel obstruction which made it possible to improve the results of treatment. A comparative analysis of 338 patients with adhesive small bowel obstruction who were treated in the surgical departments of the St. Elizabeth Hospital in St. Petersburg in the period from 2016-2019 was carried out. All the patients were divided into 2 groups: the main (I) group (2018-2019), which consisted of 198 patients who received the improved diagnostic and treatment algorithm as well as the comparison group (II) (2016-2017) which included 140 cases — these are patients examined according to the standard protocol and operated on in the traditional way. Moreover, in 98 cases, it was possible to resolve acute adhesive small intestinal obstruction in a conservative way, and 240 patients underwent surgical treatment. The developed diagnostic algorithm is based on the consistent application of the most informative diagnostic methods. At the same time the indications and the sequence of their application were established which ultimately made it possible to shorten the preoperative time interval as well as to determine the optimal treatment strategy with the choice of the type of surgical treatment (laparotomy or laparoscopy). The proposed treatment and diagnostic algorithm allowed to reduce the complication rate from 46.5% (53) to 22.2% (28) (р < 0,001), and the mortality rate from 14.9% (17) to 3.9% (5) (p < 0,01).

Currently, diagnostic scales are being actively developed to help doctors diagnose and make decisions regarding the treatment tactics of certain diseases. In particular, there are diagnostic scales for acute appendicitis. However, we found no publications describing the results of assessing the sensitivity of diagnostic scales for acute appendicitis in relation to patients admitted to infectious diseases hospitals, as well as the results of comparing the sensitivity of these scales in patients in general surgery and infectious diseases hospitals. Thus, based on the sufficient clinical material, we have analyzed the results of comparing the sensitivity of some diagnostic scales of acute appendicitis in relation to patients in general surgical hospitals and patients being treated in hospitals with an infectious profile. The results of the study show that the sensitivity of diagnostic scales in relation to acute appendicitis in patients treated in infectious diseases wards is lower than in patients in surgical departments of the general profile. The following result may be explained by “masked” course of acute appendicitis (when “simulating” the symptoms of acute intestinal infection), as well as the blurred clinical picture of acute appendicitis in patients with acute and chronic infectious diseases.

Rheumatoid arthritis is the most common inflammatory joint disease and one of the most common chronic inflammatory diseases. The leading role in the pathogenesis of rheumatoid arthritis is the damage to the endothelial glycocalyx — a thin dynamic layer of macromolecules located on the surface of the endothelium and consisting of proteoglycans, glycoproteins and glycosaminoglycans, which contributes to the maintenance of rheumatoid arthritis activity. Therefore, early detection of violations of the vasculr endothelium condition, especially the endothelial glycocalyx, will identify a group of patients with a poor prognosis. In this context, the method of dark-field microscopy may be promising. It allows non-invasive and in vivo assessment of the thickness of the sublingual endothelial glycocalyx, which will make it possible to search for new unconventional risk factors for the unfavorable course of rheumatoid arthritis and cardiovascular risk in these patients, as well as personalize treatment by developing a complex of preventive and therapeutic measures aimed at restoring endothelial function, reducing the risk of cardiovascular complications, disability and mortality from rheumatoid arthritis. The unique capabilities of this research method are demonstrated by the example of the clinical case.