bluuebunny/crossref_metadata_2025 huggingface dataset:
PRENATAL ULTRASONIC DIAGNOSTICS OF ABNORMALITIES OF THE ORGAN OF VISION
Authors: Korlyakova M. N , Saidasheva Elvira I. , Voronin D. V
Published: September 2020

Aim. The objective of the present work was to evaluate the possibilities for the prenatal ultrasonic examination with a view to diagnostics of developmental abnormalities in the organ of vision and its accessory apparatus. Material and methods. A total of 1300 protocols of the comprehensive assessment of the ultrasonic picture of the orbital structures in the fetuses obtained between the 10th and 40th weeks of physiological pregnancy were available for the analysis. The screening of 1045 (80%) fetuses was carried out during the 10th-14th, 20th-24th, and 32nd -34th weeks of pregnancy. The data on 3026 fetuses with the prenatally diagnosed and postnatally verified congenital malformations were analyzed retrospectively for determining the frequency and the structure of the developmental disorders in the organ of vision. Results. The frequency of identification of congenital malformations of the organ of vision by means of prenatal echography of the fetal orbital structures was 0,262 per 1,000 full-term pregnancies. It was shown that the abnormalities in the position of the eyeballs (hypotelorism, hypertelorism, exophthalmos) are possible to diagnose during I and II trimesters of the pregnancy whereas the abnormalities of their size (microphthalmia) and number (anophthalmos, aphakia) are especially well apparent in the second half of the pregnancy; simultaneously, the abnormalities in the structure of the organs of vision (cataract), complicated disorders (cyclopia), and the abnormalties in the lacrimal sac (dacryocystocele) can be diagnosed. The abnormalities of the organ of vision and its accessory apparatus accounted for 2,8% of all congenital malformations. In the overall structure of congenital malformations, the orbital abnormalities most frequently occurred in the combination with the facial malformations (53-75%), nervous system disorders (75-78%), disturbances in the blood circulatory system (38-41%), and the diseases of the locomotor apparatus (43-63%). Conclusion. Prenatal expert ultrasonography performed in the optimal for the screening studies periods of pregnancy provides a highly efficacious (91%) tool for the diagnostics of congenital and hereditary malformations and developmental disorders including pathology of the orbit, eye, and its accessory structures.
OCULAR MANIFESTATIONS OF ECHINOCOCCOSIS IN A CHILD (A CASE FROM THE CLINICAL PRACTICE)
Authors: Saakyan S. V , Sudovskaya Tat’yana Viktorovna , Makarova A. A , Kokoeva N. Sh , Tatskov R. A , Maibogin A. M
Published: September 2020

This article was designed to report the clinical case of ocular echinococcosis in a child. The patient was characterized by ptosis, oedema of the periorbital tissues, exophthalmos, displacement of the eye bulb, its abnormal movements in all directions, strabismus, pain, and orbital cysts. Rehabilitation of the child with ocular echinococcosis included transcutaneous orbitotomy with the excision of the echinococcal cyst from the orbit.
A NEW METHOD OF ASSESSMENT ZONULAR LENS
Authors: Tarutta E. P , Harutunayn S. G , Tarasova Natalia Alexeevna , Khandzhyan A. T , Khodzhabekyan N. V
Published: September 2020

Purpose. To compare the wave front aberrations and their changes under the action of cycloplegia in eyes with myopia and hyperopia. Material and methods. We examined 46 patients: 20 (39 eyes) with myopic (average -5.2±1.5 D) and 26 patients (53 eyes) with hyperopic refraction (mean refraction +3,1±1,15 D) aged 5 - 17 years (average 11.6±0.6 years). All the patients underwent aberrometry in a darkened room before and after medical cycloplegia (instillations of 1% cyclopentolate dihydrochloride twice, with an interval of 10 minutes, aberrometry in 40 minutes after the first instillation) with the aberrometer divice OPD-ScanIII, Nidek. Result. Significant differences: horizontal trefoil (C8) and horizontal coma (C7) before cycloplegia in myopia was significantly higher, and their changes under cycloplegia significantly lower or absent. The difference of these aberrations, with are associated with the dislocation of the crystalline lens, decentration of the optical elements of the eye, provides the evidence of weak zonular tension in the eyes with myopia. The method of assessing zonular on the dynamics of the polynomias C8 and C7 in the background of cycloplegia was developed. Conclusion. The developed method of indirect assessment of the condition of the zonular lens according to the comparative aberrometry before and after cycloplegia recommended for prognosis of postnatal refraktogenesis and evaluation of progressive myopia treatment effectiveness.
APPLICATION SITEFILTER POINTS IN THE PREVENTION OF DEVELOPMENT AND PROGRESSION OF RETINOPATHY OF PREMATURITY (PRELIMINARY RESULTS)
Authors: Epikhin A. N , Epikhina Yu. N , Ushnikova O. A , Ushnikov A. N
Published: September 2020

Objective. To study a method of prophylaxis of retinopathy at the stage of nursing of premature baby and evaluate the results. Material and methods. This method has been applied during the year on the basis of the Perinatal center of the Rostov region and the ophthalmic branch of the Rostov regional children’s clinical hospital. For this study were selected two groups of patients 50 children (100 eyes) from 26.5 to 36 weeks gestational age (GW) and with birth weight from 650 to 2650 grams. All the children were divided into two groups - study and control of 25 children (50 eyes) each. In the main group since birth to full maturation of the retina or regression of the disease after surgical laser treatment used safety glasses. Results. Preliminary data showed that the application of protective red glasses while observing the basic rules of nursing preterm infants, reduced the development of PH 16% and the need for laser treatment by 20%. Conclusions. Occlumeny sitefinity method is the first method of ophthalmic prevention of occurrence and development of retinopathy of prematurity, keeping the retina intact, allowing it to develop in light conditions close to natural in utero from the moment of premature to the natural time of birth of the child.
СORNEAL BLINDNESS IN CHILDREN AND WAYS OF ITS PREVENTION
Authors: Pleskova A. V
Published: September 2020

The article presents the structure of corneal blindness in children and ways of its prevention. Regional features of childhood blindness according to the epidemiological studies based on socio - economic conditions of society were analyzed. The analysis of the primary childhood disability due to visual disturbances in different regions of Russia, and the causes of corneal blindness in the structure formation of the disability from an early age, according to a clinical unit (Moscow Helmholtz Research Institute of Eye Diseases, Department of Eye Pathology in Children).
THE ROLE OF MONOAMINES IN REGULATION OF ANGIOGENESIS AND PROSPECTS OF THEIR APPLICATION IN RETINOPATHY OF PREMATURITY
Authors: Katargina L. A , Denisova E. V , Osipova N. A , Panova Anna Y.
Published: September 2020

Retinopathy of prematurity is the main cause of visual impairment and blindness in infants with low birth weight and preterm gestational age, in spite of the achievements in neonatology and wide applying of diagnostic and treatment guidelines. The pathogenetic role of VEGF is determined in course of normal angiogenesis and in retinopathy of prematurity. Scientists continue the search of another significant vasoprolifirative factors and methods how to inhibit them. This review is devoted to monoamines’ role in angiogenesis. The search for the relevant literature was carried out using the Medline database.
LATE COMPLICATIONS UNFAVORABLE RESULTS OF CICATRICAL RETINOPATHY OF PREMATURITY
Authors: Kogoleva L. V , Katargina L. A , Arestova N. N , Mazanova E. V , Sudovskaya T. V
Published: September 2020

Purpose. The study of the frequency and structure of complications in IV-V degree of retinopathy of prematurity and the development of tactics for their prevention and treatment. Material and methods. A total of 134 patients (268 eyes) with IV-V degree of cicatricial retinopathy of premature infants aged 6 months - 17 years were examined. In addition to the standard ophthalmological examination, ultrasound methods were used: biometrics, echography, biomicroscopy. Results. Late complications were detected on 153 (57,1%) from 268 eyes with IV-V degrees of cicatrical ROP. The main types of complications were: flat anterior chamber, corneal and lens opacities, secondary glaucoma, progressive phthisis bulbi. Conclusions. All patients with cicatricial ROP require constant follow-up and differentiated tactics of prevention and treatment of late complications.
REHABILITATION POSSIBILITIES OF SOFT CONTACT CORRECTION IN POST-TRAUMATIC AND CONGENITAL PATHOLOGY OF CHILDREN
Authors: Neroev V. V , Verigo E. N , Selina Olga M.
Published: September 2020

Objective. To analyze the results of the use of contact correction in the rehabilitation of children with post-traumatic and congenital abnormalities. Material and methods. 424 patients, aged between 3 months and 17 years, using soft contact lenses using traditional and special methods of examination. Results and discussion. It was established that in the overwhelming number of children who were assigned to wear, the post-traumatic pathology prevailed - 341 (79.1%) patients; congenital abnormality was 83 cases (20.9%). Contact lenses were made individually according to the developed technologies from a hydrogel material by turning using biocompatible paint, which allows combining several color zones of different diameters, while achieving optimal functional and cosmetic results. Proved a significant increase in visual acuity compared with spectacle correction and correction of transparent contact lenses in 86.4% of children. Thus, the use of soft contact lenses, performing corrective, diaphragmatic and cosmetic function is a method of preventing the development of amblyopia, strabismus, contributing to the full development of the visual analyzer in children.
Nerve block anesthesia in gerontologic patients with purulent-necrotic lesions of the foot
Authors: Fomin Andrey A. , Novikov U. V , Pershakov D. R , Vozgrin D. V
Published: September 2020

Regional anesthesia was performed in 278 patients with feet gangrene. The nerve block was performed using ultrasound navigation and neurostimulation. The results of regional anesthesia and spinal anesthesia were compared in economic and clinical conditions (quality of analgesia), oxygenation and microcirculation levels were also assessed. As a result the last two were practically the same in the compared groups, bur the painless rate was higher in regional anesthesia group, so as the last one is cheaper. It's used to be mentioned, that patients after regional anesthesia being performed were active since 30 minutes after leaving the operation room, but analgesia was stable in next 12 hours.
Features of the development of thoracic paravertebral blockade as a component of anesthesia in radical mastectomy
Authors: Yaskevich Valery V. , Marochkov A. V
Published: September 2020

The aim of this work is the study of thoracic paravertebral blockade (PVB) in different anatomical parts of the chest. The usage of the PVB for 31 women was analysed. PVB was performed at the levels of Th1, Th2, Th3, Th4, Th5 and Th6, under ultrasound guidance. 1.5 ml of local anesthetic (0,75% solution of ropivacaine) was introduced on each level. The borders of altered pain sensitivity was evaluated using "pin prick" at the notional vertical lines of the chest (paravertebral, scapular, posterior axillary, mid-axillary, midclavicular and sternal). The obtained distances were measured by centimeter ruler. After blockade of spinal nerves from Th1 through Th6, the extent of the blockade of the pain sensitivity was reveded: paravertebral line at 21.7±3.9 cm, along the scapular line is a distance of 19.1±3.6 cm, on posterior axillary line of 14.5±2.6 cm, on an mid-axillary line - of 14.9±3.3 cm on the midclavicular line is 11.9±4.2 cm, sternal line - 5.4±3,3 cm. The decrease in the severity of the blockade on pain sensitivity in the midclavicular line from central to peripheral anatomical areas was observed. 71% of patients on the first day after surgery was not required additional analgesia, in 16% of cases the period of analgesia ranged from 6 to 18 hours. The decrease of the size of analgesia takeplace surface when moving from the spine to the sternum that can significantly affect the quality of anesthesia during operations on the thorax. PVB intercostal nerve Th1-Th6 with small doses of local anesthetic anesthetic is effective in ensuring operations in the amount of radical mastectomy.
Experience of applying spinal anesthesia for Cesarean section in patient of 118 cm height
Authors: Matkovskiy Andrey A. , Bykov A. S , Aleksandrov I. V , Matkovskaya L. I , Kulikov A. V
Published: September 2020

Successes of modern medicine give possibility to women with dwarfism to bear pregnancy. However questions of anesthetic protection for this patient category are not solve to date. The author presented an experience of Ekaterinburg perinatal center concerned perioperative support and anesthesiological tactics applied for women with dwarfism.
POSITION OF CONTROLLED NAVIGATION PARANEURAL BLOCKADES OF ROPIVACAINE IN THE TREATMENT OF TENSION HEADACHES
Authors: Sgibnev A. V , Ershov Vadim I.
Published: September 2020

Control: The article describes the experience of the application of a local anesthetic for ropivokaina paraneural navigation-controlled blockades great occipital nerve in tension headaches. OBJECTIVE: To evaluate the efficacy of navigation-controlled blockades in patients with tension-type headache. Materials and Methods: 87 patients were divided into two groups, were included in isledovanie. One of which received standard therapy in the treatment of the second group used the navigation-controlled large occipital nerve blockade. Treatment efficacy was assessed by the degree of intensity of pain during the treatment, the level of alarm occurrence dissomnicheskie violations, the level of life of patients with tension-type headache was assessed on the index influence headache HIT - 6 at the time of admission and 3 months after completion of therapy. Results and Conclusion: The findings suggest that the use of navigation-controlled paraneural greater occipital nerve blockade with local anesthetic ropivacaine as part of combination therapy of headache voltage leads to significantly better regression of pain and reduce the severity of secondary neurotic disorders.
EFFECT OF DEXAMETHASONE ON QUALITY OF THE ANALGESIC EFFECT OF PERIPHERAL BLOCKADES
Authors: Zabolotskii Dmitriy V. , Koriachkin V. A , Savenkov A. N , Fel’ker E. Y , Lavrenchuk A. V
Published: September 2020

Objective. The aim of the work was to assessment the analgesic effect of dexamethasone at peripheral nerve blockades. Material and methods. The study included 166 patients, including 45 children aged from 3 to 16 years of age, randomized into 3 groups. For blockages in peripheral nerves of the 1st group received 0.5% solution ropivacine, in the 2 nd group - 0.5% solution ropivacine and dexamethasone intravenous, 3 rd group - 0.5% solution ropivacine and dexamethasone. Results. Duration period painless adults was 12.8±7.1 h, 22.8±4.8 h and 24,1±6,8 h, children 8.3±1.5 h, 10.4±1.7 h and 20±5 h, respectively. It is shown that the use of dexamethasone protects the patient from nociceptive afferentation in the postoperative period. Possible mechanisms of the analgesic effect of dexamethasone was discussed. Conclusion. Further research is needed to study the mechanism of analgesic action of dexamethasone.
THE EFFECTIVENESS OF NEURAXIAL ANESTHESIA TECHNIQUES IN DIABETIC FOOT SURGERY
Authors: Zayashnikov Stanislav V. , Bautin A. E , Iakovlev A. S , Gurin M. N , Glebov V. S , Dalmatova A. B , Mazurenko S. I
Published: September 2020

Introduction. Common is considered that surgical procedures in patients with diabetes mellitus (DM) must be performed at a stable level of blood glucose and at a stable hemodynamic. Aim. Determine effective anesthesia technique for diabetic foot (DF).surgery. Materials and methods. 30 patients (59.5 (53; 67) yr old, 16 female and 14 male) with DM and DF surgery were included in a retrospective study. Spinal anesthesia was used in 10 patients (SA group). In the presence of contraindications to spinal anesthesia we used the blockade of the sciatic nerve (SNB group, 10 patients), or general anesthesia with tracheal intubation (GA group, 10 patients). Data are presented as median (25th, 75th percentile). Results. In the SA group mean arterial pressure (MAP) decreased from baseline by more than 20% in 80% of patients, in the SNB group - in 30% (p = 0,03) and in the GA group - in 60% of patients (ns). The median of maximum decrease in MAP during anesthesia was 25 (20; 27)% for the SA group, 16 (13; 22)% for the SNB group (p = 0,03) and 21 (15; 24)% for the GA group (ns). Infusion volume was lower In SNB group than in the SA group (500 (500; 750) vs 1500 (1500; 2000) ml, p
PREDICTION OF CRITICAL INCIDENT DURING EPIDURAL ANESTHESIA IN GYNECOLOGICAL PATIENTS
Authors: Golovataya Maria V.
Published: September 2020

Objective - to estimate frequency of occurrence of critical incidents during epidural anesthesia in gynecological patients with different sensitivity of peripheral chemoreflex. Material and Methods: prospective observational blind study, 54 gynecological patients, elective surgery. The day before the surgery, the sensitivity of peripheral chemoreflex was determined by the duration of an arbitrary threshold apnea in a test with a delayed respiration. According to the duration of the test, the patients were divided into groups: high (group «1») and medium (group «2») sensitivity of peripheral chemoreflex. During the operation and in the early postoperative period, critical incidents were recorded. Results and Conclusion(s). During epidural anesthesia in gynecological patients from intraoperative critical incidents is revealed hypotension. The frequency of occurrence of hypotension was 32.1% in patients of group «1» and 15.4% in patients of group «2». High sensitivity of peripheral chemoreflex in patients during epidural anesthesia is a predictor of unstable hemodynamics, as well as the risk of postoperative nausea and vomiting.
EPIDURAL MORPHINE IN PEDIATRIC ONCOLOGIC SURGERY
Authors: Matinyan Nune V. , Letyagin I. A , Martynov L. A , Sotnikov A. V , Kazantsev A. P , Rybakova D. V
Published: September 2020

Epidural administration of opioids effectively prevents the sensitization of nociceptive neurons of the posterior horn of the spinal cord, induced by surgical trauma, without the development of motor and autonomic blockade. Study includes 52 patients aged 1 month to 18 years with malignant tumors who underwent surgical treatment at the Pediatric Oncology and Hematology Research Institute, during 2009-2016 years. Surgeries were combined (thoraco-laparotomy). The method of epidural use of morphine in pediatric oncosurgery is presented.
INFLUENCE OF CYTOCHROME P-450 GENETIC POLYMORPHISMS ON THE MAIN AND SIDE EFFECTS OF TRAMADOL IN THE POSTOPERATIVE PERIOD
Authors: Sokolov D. A , Lyuboshevskiy Pavel A. , Ganert A. N
Published: September 2020

One of the approaches to increasing the effectiveness and safety of postoperative analgesia can be its personification. The goal of the study was to evaluate the efficacy of tramadol analgesia depending on the polymorphisms of the CYP2D6 gene, the cytochrome P-450 isoenzyme, involved in drug biotransformation into the active metabolite. 96 patients with elective endoscopic gynecology procedures were examined. Polymorphisms G1846A and C100T, which reduce the activity of the isoenzyme CYP2D6, were detected, and the intensity of postoperative pain, the autonomic nervous system state by cardiointervalography and hemostasis using rotational thromboelastometry were evaluated. Polymorphisms were detected in 29 (30.2%) patients, united in the 1-st group. The second group consisted of 67 patients without gene polymorphisms. Patients with polymorphisms have a higher pain scores; the frequency of postoperative nausea and vomiting, on the contrary, was significantly lower. According to cardiointervalography, sympathicotonia was observed in Group 1 patients after surgery, while in Group 2 patients the indices did not change significantly compared to baseline. The parameters of hemostasis in patients of the 2nd group were characterized by moderate hypercoagulability (shortening of clotting time and clot formation time), whereas in the firsts group, relative hypocoagulation (decrease in α angle, and clot firmness) was noted. Conclusion. In female carriers of G1846A and C100T polymorphisms of the CYP2D6 gene, the effectiveness of post-operative analgesia based on tramadol is reduced. They have a lower incidence of postoperative nausea and vomiting, and moderate hypocoagulation. Probably, these phenomena are associated with a change in the ratio between the drug and its active metabolite - O-desmethyltramadol.
BLOCKADE OF THE PERIPHERAL NERVES IN THE ANESTHETIC MANAGEMENT OF NEUROSURGICAL INTERVENTIONS ON THE HEAD
Authors: Markevich Denis P. , Marochkov A. V
Published: September 2020

Objective: to evaluate the effectiveness of peripheral nerve blockades innervating the scalp, in combination with general anesthesia in intra- and postoperative analgesia in patients with neurosurgical interventions. Materials and methods. The efficiency of 105 blockages of the peripheral nerves of the scalp in 18 patients with neurosurgical interventions on the head was evaluated. The age of the patients was 47.5 ± 15.5 years. Patients were operated on for intracranial traumatic and non-traumatic hematomas, brain tumors and the need for plastic of postoperative skull defects. The technique of blockade of the nerves of the head is described: supratrochlear, supraorbital, zygomaticotemporal, auriculotemporal, greater auricular, greater and lesser occipital nerves. The technique of ultrasound imaging of the great occipital and auriculotemporal nerves is presented. Results. In all 18 patients, according to intra- and postoperative monitoring, adequate anesthesia was provided. In 2 of 18 patients, an additional fentanyl injection was required to skin incisiondue to an increase in blood pressure and heart rate by 25% of the baseline values, and an increase in CSI until 82 units. The volume of local anesthetic for blockade in one patient was 7.68 ± 1.67 ml of ropivacaine or of bupivacaine. Time for blockade in one patient was 11.4 ± 4.0 minutes. The intensity of pain on a linear visual analog scale in the first day was 0.3-2 points. Conclusion. Blockages of the peripheral nerves of the head were effective in 16 (88.9%) of 18 patients. The safety of blockades was provided by using small volumes (7.68 ± 1.67 ml ) of 0.75-1.0% solution of ropivacaine or 0.5% solution of bupivacaine.
SCIENTIFIC WORLDVIEW OF PROFESSOR A. DOGLIOTTI (1897-1966) (TO THE 120 ANNIVERSARY SINCE BIRTH)
Authors: Morgoshiia Temuri Sh.
Published: September 2020

Achilles Mario Dogliotti, the surgeon station wagon, the author a set of new interventions in neuro, onko-and a heart surgery performed the first-ever successful operation with use of the cardiopulmonary bypass on August 7, 1951. Dogliotti paid special attention and fruitfully was engaged in surgery of a liver and biliary tract. He developed a way of removal of bile in cases when it is impossible to use the general bilious channel with a resection of a part of the left share of a liver (Dogliotti’s way); operation at damage of outside bilious ways with sewing together of a channel on a rubber tube and removal of its disteel end through a front wall of a stomach and a front belly wall outside (Dogliotti’s operation); a way of drainage of biliary tract with carrying out a drainage tube with several side openings outside through the general bilious channel in a duodenum (Dogliotti’s way). A number of interesting innovations offered Dogliotti in cardiovascular surgery. So, it possesses a way of prosthetics of the mitralny valve the pericardium rag on a leg entered into a heart cavity through its wall and attached between the papillary muscles (Dogliotti’s method). He offered some modifications of operations at the inborn and acquired heart diseases. For partial compression of large vessels of Dogliotti developed the tool having three working bransh (a surgical clip of Dogliotti-Vishnevsky), I developed the device for artificial blood circulation and some other original tools for cardiovascular surgery. One of first-ever it made operation with use of extracorporal blood circulation in clinic. Also its researches and clinical application of a moderate and deep hypothermia in heart surgery are known. A. Dogliotti “The treatise on anesthesiology” (1952), “The operational equipment” (1956), “Surgery of bilious ways” (1958) published about 300 scientific works on surgery, including the monograph “Surgical Semiotics and Diagnostics” (1948). I created a number of original tools for cardiovascular surgery, I designed the device for artificial blood circulation, I offered some modifications of operations at the inborn and acquired heart diseases. One of first-ever I made operation in the conditions of extracorporal blood circulation.
COMPARISON OF ANESTHESIA AND PERIOPERATIVE ANALGESIA OPTIONS IN ENDOSCOPIC SLEEVE GASTRECTOMY IN PATIENTS WITH MORBID OBESITY
Authors: Neimark M. I , Kiselev Roman V.
Published: September 2020

Patients with morbid obesity have an increased sensitivity of the respiratory center to opioids, which leads to an increased incidence of respiratory diseases, which dictates the need to limit the use of opioids in the structure of anesthesia. Purpose of the trial. Comparison of the impact of anesthesia options with minimal use of opioids during the perioperative period. Materials and methods. A randomized trial of 59 patients with a body mass index > 35 kg/m2, which was performed endoscopic sleeve gastectomy. Depending on the type of anesthesia, patients are divided into two groups. In the 1st group (n-30), the operation was performed under conditions of combined anesthesia based on low-flow inhalation of desflurane in combination with prolonged epidural analgesia (PEA) with of ropivacaine in group 2 (n-29), the operation was performed under conditions of combined anesthesia based on low flow inhalation of desflurane in combination with a combination with an infusion of the analgesic-sympatholytic solution. The indicators of the adequacy of anesthesia, central and peripheral hemodynamics, monitoring of neuromuscular conduction, the efficiency of postanesthesia recovery and the quality of postoperative analgesia were studied. Results and Conclusion. It was revealed that surgical intervention in conditions of low-flow inhalation anesthesia on the basis of desflurane in combination with PEA ropivacaine promotes faster postnanaesthesia recovery and effective postoperative analgesia.
EXPERIENCE OF THE OBJECTIVE STRUCTURED CLINICAL EXAMINATION IN THE FRAMEWORK OF STATE CERTIFICATION OF GRADUATES OF THE CLINICAL ORDINATURE ON SPECIALTY «ANESTHESIOLOGY AND RENAMATOLOGY»: STATION «PUNCTION AND CATHETERIZATION OF THE EPIDURAL SPACE»
Authors: Lakhin Roman E. , Tsygankov K. A , Andreenko A. A , Faizov I. I , Shchegolev A. V
Published: September 2020

The purpose of the study was to test the evaluation sheet and assess the practical skills of the clinical residents of the second year at the station «Puncture and catheterization of the epidural space» during an objective structured clinical examination. Materials and methods: 28 clinical residences of the second year of study were included in the study with the practical part of the final exam in the specialty «Anesthesiology and Reanimatology». Manipulation was performed on a phantom-simulator, which allows to simulate a puncture and catheterization of the epidural space reliably. Evaluation of manual skills, independently of each other, was carried out by two teachers. Results: 28 (100%) residents successfully passed the station. The time for passing the station to one examiner was 4.05 (4.41, 5.16) min. The most common mistakes during the manipulation were associated with the need for more than one attempt at successful puncture and catheterization of epidural space 10 (35.7%), and in 6 (21.4%) cases it was required to change the interstitial gap. Controlling the performance of the evaluation sheet demonstrated the possibility of its use by different teachers at the station. The difference in the completed evaluation sheet was less than 4%.
DOMESTIC ANESTHESIOLOGY IN THE FIRST HALF OF THE XX CENTURY: SCIENTIFIC PRIORITIES
Authors: Morgoshiia Temuri Sh.
Published: September 2020

The article notes that the problems of anesthesia in the first half of the XX century were developed by joint efforts of surgeons and anaesthesiologists, who distinguished their discipline as a narrow specialty from clinical medicine. Local anesthesia by the method of creeping infiltrate, anatomically developed and physiologically grounded prof. A.V. Vishnevsky, has become very popular not only in our country, but also abroad. It is shown that many other surgeons began to perform under local anesthesia surgical interventions on the organs of the thoracic cavity, esophagus, lungs, and heart. About 90% of lung operations for tumors, bronchiectasis, tuberculosis were performed using the creeping infiltrate method under local anesthesia. It was stressed that in the 50s of the 20th century it became evident that in many cases of severe and deeply traumatic surgery, especially on the chest cavity, only protection against pathological reflexes in the field of intervention achieved by the Novocaine blockade is insufficient, since it was necessary to preserve and maintain the function of the whole organism. The use of barbiturates in surgery has received a lot of attention, and a technique has been developed that made it possible to carry out large operations lasting up to 2 hours or more (under the action of hexenal). It was shown that hexenal anesthesia was not injected and almost all of it was abandoned. In the post-war period, intratracheal ether-oxygen anesthesia began to be used in surgical practice. It was noted that the absence of vomiting, the patient’s open face, bronchial tamponade, the ability to increase intrabronchial pressure, spread the lungs, provide artificial ventilation and maintain a high oxygen content in the blood - all this contributed to the spread of this method. Consequently, anesthesia in surgical interventions, the use of modern pharmacological agents and anesthesia at that time, turned into special problems, the solution of which became practiced by doctors specially trained in the field of therapy, physiology, pharmacology and pathological physiology. Thus, a new discipline arose, anesthesiology, and all preparation for surgery, anesthesia during surgery and an early postoperative period is transferred to the direct management of anesthesiologists.
What are the best ways to develop the Federation of anesthesiologists-reanimatologists? From questionnaire to action programme
Authors: Abazova I. S , Abdulaev R. B , Akulov M. S , Aslanukova A. N , Afonchikov V. S , Bayalieva A. Zh , Belkin A. A , Butrov A. V , Gel'fand B. R , Gorbachev V. I , Gorobets E. S , Grigoriev E. V , Gritsan A. I , Dashevskiy S. P , Doroginin S. V , Dunts P. V , Egin A. I , Zhenilo V. M , Zabolotskikh I. B , Zaitsev A. V , Zalesny A. S , Zilber A. P , Kaminskiy M. Yu , Karelov A. E , Kirov M. Yu , Kitiashvili I. Z , Koryachkin V. A , Kokhno V. N , Kudryashov K. A , Kuz'kov V. V , Kulikov A. V , Kurapeev I. S , Lavrentiev A. A , Lazarev V. V , Lebedinskiy Konstantin M. , Levshankov A. I , Leiderman I. N , Lekmanov A. U , Lubnin A. Yu , Lyuboshevskiy P. A , Mazurok V. A , Makarevich A. N , Malyshev Yu. P , Markov O. V , Martynov D. V , Merenkov V. G , Mironov P. I , Molchanov I. V , Nedashkovskiy E. V , Nikolaenko E. M , Nikolenko A. V , Ovechkin A. M , Ovsyannikov A. N , Ovchinnikov S. G , Oskanova M. Yu , Popov A. S , Protsenko D. N , Pjataev N. A , Rechkalov V. A , Saltanov A. I , Sviridov S. V , Sitkin S. I , Slepushkin V. D , Smirnov G. A , Stadler V. V , Stepanenko S. M , Sumin S. A , Sukhotin S. K , Tolkach A. B , Fisher V. V , Tsypin L. E , Shapovalov K. G , Shevchenko V. P , Shen' N. P , Shifman E. M , Shumatov V. B , Shchegolev A. V , Yaroshetskiy A. I
Published: September 2020

The article is devoted to summing up the work of the Federation of anesthesiologists and reanimatologists of Russia and proposing the prospects of its development.
Clinical-morphological features of lobular, nodular and diffuse forms of adenomyosis
Authors: Kogan Elena A. , Paramonova N. B , Shklyar A. A , Fayzullina N. M , Adamyan L. V
Published: September 2020

The purpose of the study was to investigate clinical, morphological and immunohistochemical features and pathogenetic interrelationship between focal, nodular and diffuse forms of adenomyosis. There was investigated surgical samples of removed uterines and their fragments; patients were divided into 3 groups, the 1st group was consisted of 16 cases with focal adenomyosis, the 2nd - 24 females with nodular form of adenomyosis, the 3rd - 21 female with diffuse form of adenomyosis. All patients were underwent general clinical examination, instrumental and laboratory observation with the aim of the verification of the diagnosis. There were executed macro- and microscopic immunohistochemical investigations of fragments of the tissue from the zone of endometrioid heterotopias, surrounding myometrium and eutopic endometrium. There were used antibodies: Ki-67, PTEN, ER, PR (“DAKO”), p16 (“Roshe”). There was established the significant increase in the expression of proliferation marker Ki-67, in parallel with a decrease in the expression level of PTEN, ER, PR from the focal to the nodular and diffuse forms of adenonomyosis. Thus it seems to be possible to consider focal, nodular and diffuse forms of adenomyosis as forms-phases of adenomyosis, that according both to histological characteristics of adenomyosis and immunohistochemical markers offocal and nodular forms may antedate the diffuse form of adenomyosis, that is also confirmed by the detection of a combination of all of these forms. Diffuse form of adenomyosis can be assumed to have the highest potential for the growth and dissemination of the pathological process in the uterine.
Pathophysiological role of free radical processes in pregnancies end in miscarriage
Authors: Sosnova Elena A. , Bolevich S. B , Pokaleneva M. Sh
Published: September 2020

Pregnancy end in miscarriage proves to be the one of the main problems of modern obstetrics and gynecology. Miscarriage rate currently accounts for 15-27%. Among the causes of miscarriage there are discriminated genetic, anatomic, endocrine, infectious, immunologic, and thrombophilic factors. In the exclusion of all of above mentioned reasons the genesis of spontaneous abortion is considered to be unclear (idiopathic). In recent years, more and more often the attention of clinicians is attracted by pathophysiological aspects of the participation offree radical processes in molecular and cellular mechanisms of the development of alteration in pregnancy end in miscarriage. So far, information both on the generation of reactive oxygen species (ROS) by leukocytes and the state ofprotective antioxidant system in women with habitual loss ofpregnancy has failed to be systematized.
Obesity and metabolic disorders as a risk factor of endometrial hyperplasia, uterine fibroids and adenomyosis
Authors: Stanoevich I. V , Kudrina E. A , Zholobova Mariya N. , Masyakina A. V , Kovaleva A. M
Published: September 2020

The review deals with the role of endocrine and metabolic deteriorations in the development of overlapping clinically manifested benign hyperplastic lesion of endo- and myometrium. Hyperleptinemia is a powerful potentiating factor of endocrine diseases of the uterus. Modern correction of both endocrine and metabolic disorders is a key component of the comprehensive treatment and prevention of hyperplastic diseases of the uterus.
Sample Biological Material Operating Procedure for the method of molecular-biological techniques (PCR diagnostics)
Authors: Kaptilnyy Valery A.
Published: September 2020

Review describes a method of diagnostics with the use of the polymerase chain reaction (PCR diagnostics) of infections in patients in modern obstetric-gynecological practice. Particular attention is paid to urogenital tract pathogens to be diagnosed by the method of nucleic acid amplification. There are described the preparation for the study, purposes, the technology of amplification procedure. There is shown the difference in the detection of the DNA and RNA pathogen. The presented photographs show in detail all the stages of obtaining scrapings from the urogenital tract.
METHODOLOGY OF SAMPLING OF BIOLOGICAL MATERIALS FOR MICROSCOPIC METHOD OF RESEARCH IN THE OBSTETRIC-GYNECOLOGICAL PRACTICE
Authors: Kaptil’nyy Vitaliy A.
Published: September 2020

The article is devoted to the microscopic method of research in modern obstetrical and gynecological practice. Special attention is paid to the value of the method, the diagnostic significance of the results of the examination. There is described the preparation for the study, the purpose and methodology of the exercise. The attached photos show in detail all the stages of sampling a free discharge from the urogenital tract.
GENITAL HERPES AND PREGNANCY
Authors: Belova Anastasiya V. , Astsaturova O. R , Naumenko N. S , Nikonov A. P
Published: September 2020

Herpes simplex virus of two types - HSV-1 and HSV-2, which can manifest as a primary and recurrent infection is the etiological factor of genital herpes. Herpes simplex virus is one of the most common sexually transmitted infections, in connection with which there is an increase in physical and psychological morbidity, which often remains an underestimated medical problem. With the vertical transmission of HSV during labor, diseases that are dangerous to the life and health in newborns can occur. Pregnant women with a primary infection of genital herpes belong to the high-risk group for the transmission of HSV to the newborn. Prophylaxis and prevention of vertical transmission of HSV are implemented in three directions: prevention of the recurrence of maternal genital HSV infection; prevention of transmission of the virus during pregnancy and childbirth; puerperal prophylaxis of the disease in a neonate infant born of a mother belonging to a high-risk group. This review focuses on such important aspects as laboratory diagnosis of HSV, antiviral therapy and prevention of viral infection during pregnancy, delivery and in the early neonatal period.
ANTIOXIDANT STATUS OF THE FOLLICULAR LIQUID AND ITS RELATION WITH THE QUALITY OF EMBRYON IN INFERTILITY PATIENTS PASSING THROUGH THE PROCEDURE OF EXTRACORPORAL FERTILIZATION
Authors: Proskurnina Elena V. , Shestakova M. A , Rabadanova A. K , Sozarukova M. M , Shalina R. I
Published: September 2020

The aim of the study is to evaluate the antioxidant properties of the follicular fluid with a new chemiluminescent method in women with a reduced ovarian reserve and tubal factor of the infertility, undergoing in vitro fertilization (IVF) procedure, and to compare the obtained data with embryo quality. Material and methods. Samples of the follicular fluid were obtained during oocyte sampling in 16 women with a reduced ovarian reserve and 16 women with a tubal peritoneal factor of the infertility. Patients in both groups were matched for the age, body mass index and hormonal stimulation protocol (short protocol). The antioxidant activity of the follicular fluid was measured by the method of luminol-activated chemiluminescence using 2,2’-azobis (2-amidinopropane) dihydrochloride as a source of radicals. The total antioxidant activity (AOA) and antioxidant activity due to the action of proteins (AOA-b) were determined. Results. The kinetic curve of chemiluminescence of the follicular fluid is similar in shape to the curve of the antioxidant activity of the blood plasma. As in blood plasma, antioxidant activity is caused by uric acid and proteins - albumins and globulins. As a result of the study, three groups of patients were identified, whose AOA significantly differed: patients with low embryo quality and decreased antioxidant activity, AOA 11.4 ± 2.5 mM ascorbate (n = 16); patients with a good quality embryo, AOA 21.4 ± 3.8 mM (n = 10); patients with a low embryo quality and an elevated AOA of 33.7 ± 2.9 mM (n = 6). Conclusions. Based on the comparison of AOA (in ascorbate units) with the quality of the embryo, three areas can be proposed: 1) a zone of reduced antioxidant activity (less than 15 μM, oxidative stress) - these patients had embryos of poor quality; 2) the zone of normal AOA (15-30 μM) - the patients received good quality embryos; 3) zone of increased AOA (more than 30 μM, antioxidant stress) - embryos of poor quality. Thus, it can be assumed that optimal development of embryos in the follicle requires the optimal value of antioxidant activity, since both its reduction (oxidative stress) and increase (antioxidant stress) adversely affect the quality of the embryo and the outcome of IVF. These data correspond to the modern concept that optimal development of the oocyte requires an optimal level of production of reactive oxygen species.
MODERN METHODS OF VISUALIZATION OF PATHOLOGICAL PLACENTATION
Authors: Kadyrova A. F , Puzakov K. B , Murashko Andrey V. , Seredina T. A , Gadaeva I. V
Published: September 2020

The deterioration of the attachment of the placenta is associated with an increased risk of the development of its premature detachment, postpartum hemorrhages, intrauterine and intranatal fetal death. The fused placenta occurs approximately in 9% of women with placenta previa and in 0.004% of women without placenta previa. The timely made diagnosis of this pathologyis critically important for choosing the amount of surgical intervention for delivery, which is always associated with increased blood loss. This review examines issues of the diagnosis of placenta attachment. Data on advantages and disadvantages of ultrasound and MRI methods are given. The frequency of abnormal placentation is known to correlate with the increase in the number of surgical interventions on the uterus, in particular, the operation of cesarean section. In this regard, there is a need for accurate and early diagnosis of placenta attachment. Currently, the ultrasound method is leading in the detection this pathology, but this method has its drawbacks. In this review, the authors attempted to collect experience with the use of MRI for early diagnosis of abnormal placentation.
MODERN CONDITION OF THE PROBLEM OF THE PREMATURE RUPTURE OF MEMBRANES DURING FULL-TERM PREGNANCY (REVIEW OF LITERATURE)
Authors: Astafev V. V , Nazarova S. V , Li A. D , Podzolkova N. M
Published: September 2020

Premature rupture of membranes (PRM) during full-term pregnancy is a common obstetric complication. Childbirths on the background of PRM are accompanied by an increase in the frequency of the operative deliveries, as well as various obstetric complications. However, for all the diversity of tactics, techniques, clinical recommendations devoted to actions of a doctor in the management of PRM patients, the question of their choice depends on many factors. For more than 20 years of studying the PRM problem, a technique for preparing the cervix, providing 100% result has not been developed. With all the variety of choice of methods, none of them is devoid of shortcomings (contraindications to the use, cost-effectiveness, compliance of the patient, etc.). In this regard, the optimal choice of the tactics of labor in PRM cases is the insurance of the preservation of the health of the future generation.
OXIDATIVE STATUS OF BLOOD PLASMA IN REFRACTORY PREGNANCY LOSS
Authors: Pokaleneva Marya Sh. , Nesterova A. M , Sosnova E. A , Bolevich S. B , Proskurnina E. V
Published: September 2020

The habitual miscarriage of the pregnancy is one of the most urgent problems in obstetrics and gynecology. There was performed a study of the antioxidant activity of blood plasma by kinetic chemiluminescence, the determination of tryptophan fluorescence was used to evaluate the oxidative modification of albumin. The study included 28 pregnant women with the threat of abortion (TA), 19 of them had a diagnosis of habitual miscarriage, and 9 women - an undeveloped pregnancy. The control group 1 included 61 women with normal pregnancy, the control group 2 - 22 non-pregnant women, control group 3 - 5 women after spontaneous miscarriage (up to 22 weeks).The results showed spontaneous abortion to be followed by the decline in the antioxidant capacity of the plasma, which indicates to the development of oxidative stress; on the contrary, in women with an undeveloped pregnancy, the antioxidant capacity was higher. In the determination of the proportion of oxidized albumin in all patients, but nonpregnant women, there were noted negative values indicating to the presence of specific antibodies or, possibly, cytokines possessing tryptophan fluorescence.
OBSTETRIC AUDIT BASED ON ROBSON TEN-GROUP CLASSIFICATION SYSTEM
Authors: Miroshnikov Anatoly E. , Zharkin N. A
Published: September 2020

The problem of the increase in the frequency of Cesarean section delivery has not been resolved yet. Firstly, a large variation in the initial state of puerpera, secondly, a wide variety of indications to the operation fail to allow revealing main determinants. In order to develop and implement effective measures to reduce the rate of the abdominal delivery, an understandable, logical classification of patients is necessary. The World Health Organization recommends the use of Robson Ten-Group Classification System. This study executed with the use of the Robson scale reveals the contingent of patients in whom the decline in the frequency of abdominal deliveries is possible. The authors propose a set of measures aimed at reducing the rate of Cesarean section in institutions of the second level.
TACTICS OF THE MANAGEMENT OF PREMATURE DELIVERIES: TO WHAT PATIENTS TOCOLYSIS IS INDICATED AND SHOULD HELP
Authors: Ignatko Irina V. , Shvyreva E. A , Lebedev V. A , Churganova A. A , Bogacheva N. A , Sorokina V. M
Published: September 2020

The urgency of the problem of premature birth (PB) is caused due to a high early neonatal mortality rate among preterm infants (60-70%), the prevalence rate of neurologic diseases (up to 50%), including infantile cerebral palsy, visual, hearing disorders and other chronic diseases. The frequency of PB in the population varies between 7 and 15%, however, despite the great possibilities of modern midwifery, there is a pronounced tendency to increase this index. The analysis of the lethality of prematurity in perinatal centers of the Department of Healthcare of the city of Moscow in 2016, obviously shows the main part of it to be presented by with extremely low body weight infants. Thus, preventing the premature birth, especially at the term of 24-27 weeks, is an important task for medicine all over the world. Atosiban (tractocile) - a competitive antagonist of human oxytocin at the level of receptors, the first drug designed to inhibit labor. For the purpose of tocolysis 54 women at the 26-34 weeks of the gestation period got the treatment with tractocile. Tocolysis with atosiban was effective in 90.7% of cases with a slight shortening of the cervix (no more than 5 mm) regardless of the gestational age. The introduction of the drug leads to a decrease in the intensity and jugulating pain syndrome in the first 6 hours following the administration, which confirms its effectiveness and allows increase chances of a favorable outcome of pregnancy. The absence of the infection of the kidneys and urinary tracts during pregnancy and genital tract, the onset of tocolysis up to the 31st week of the gestation and the absence of ischemic-cervical insufficiency, which indicates the need for quality and rational management of pregnancy at the outpatient stage are most important factors for the success of tocolysis and prolongation of pregnancy for more than 48 hours.