卷 12, 编号 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.

绪论截至2020年9月，新冠肺炎登记病例超过3000万例，死亡人数超过97万。白细胞介素6、白细胞介素1拮抗剂和JAK激酶抑制剂治疗新型冠状病毒感染的有效性分析仍在继续。目前，重点是引入俄罗斯Sputnik V SARS-COV-2疫苗。

本研究的目的是比较综合治疗与使用巴瑞克替尼和地塞米松对COVID-19引起的间质性肺炎病程的影响。

材料与方法。对North-western State Medical University named after I.I. Mechnikov诊所COVID-19治疗中心122名住院患者的病历进行了回顾性分析。所有患者被分为三组：第一组包括64例患者接受巴瑞克替尼在内的综合治疗；第二组包括33例，接受地塞米松综合治疗；第三组为对照组25例（接受标准综合治疗）。

结果。第一组患者肺损害体积为25—75%（CT II-III级）的占78.1%，大于75%—14.1%例伴有严重的临床表现，高的实验室检查。在治疗的背景下，48.4%的病例在CT上观察到阳性动态。在第二组患者中，84.9%患者的CT肺组织损伤为II-III级，临床和实验室参数符合中等病程。在综合治疗的背景下，18.2%的病例的CT表现为积极动态。在对照组中，在治疗背景下，56%的患者在CT上记录了积极的动态。在治疗过程中，三组患者的临床和实验室指标均恢复正常。

结论。第一组以共病病理和重症COVID-19患者最多。所有组的临床和实验室参数标准化。采用标准综合治疗及采用巴瑞克替尼或地塞米松治疗后，CT数据显示积极动态分别为48.4；分别为18.2和56%。

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.