Vol 37, No 3 (2020)

Objective. To study the prevalence, etiopathogenesis, clinical features, diagnosis and treatment of enterolithiasis.

Materials and methods. For 26 years, 30 patients (16 men, 14 women) with intestinal calculi were observed. Elderly and senile patients prevailed (18 persons). Six patients had enterolites, 24 – coprolites. In general, 41 calculi measuring from 2.5 to 22 cm (31 concrement was 6 cm and larger) were diagnosed in patients. Calculi were most often formed in the sigmoid and rectum. Fibrocolonoscopy, proctosigmoidoscopy, ultrasound, computed tomography were used.

Results. It was established that chronic colonic stasis, congenital and acquired intestinal diseases, intake of indigestible and extraneous for the intestine substances (chalk, barium, magnesium and aluminum salts) played a leading role in the formation of intestinal calculi. In 25 patients, calculi caused complications, of which the most severe were perforation of the intestine and acute intestinal obstruction.

Conclusions. Improvement of diagnostics and the developed differentiated treatment tactics permitted to improve treatment results better and achieve recovery in all 30 patients.

Objective. The incidence rate of tick-borne encephalitis in Perm Krai annually exceeds that in the Russian Federation by several times, and therefore, the aim of the study was to reveal the clinical and epidemiological characteristics of the course of infection.

Materials and methods. A continuous retrospective clinical and laboratory survey including 314 adult patients admitted to the Perm Regional Clinical Infectious Diseases Hospital in 2014-2019 was carried out.

Results. The following features were revealed: the disease is diagnosed more often in persons over 41 years old, infection mainly occurs when visiting the forest and park areas. That is why, it is necessary to reduce the number of infection carriers. In every fifth patient, the disease is characterized by the development of an inapparent form, as well as mixed infection in association with pathogens circulating in ticks in the territory of Western Ural ticks.

Conclusions. In 45.9 % of cases, the infection has a moderate and severe course, involving not only meninges but also the brain substances into the pathological process that requires early diagnosis and timely adequate therapy.

Objective. To study the state of carbohydrate metabolism in patients after distal pancreatic resection and its effect on the development of postoperative complications.

Materials and methods. Over 10 years, 47 patients have been operated on with various tumors of the body/tail of the pancreas and complications of chronic pancreatitis. In 16 of them, concomitant diabetes mellitus was diagnosed before surgery, and in 31 patients, carbohydrate metabolism was normal.

Results. After surgery, from a group of patients with unchanged carbohydrate metabolism, 8 (25.8 %) developed diabetes mellitus. The following postoperative complications – pancreatic fistula, inflammatory infiltrates and "fluid leakages” in the abdominal cavity – occurred in 68 % of cases. Out of 24 patients with diabetes mellitus, complications were registered in 21 (87.5 %) and of 23 diabetes-free patients – in 11 (47.8 %).

Conclusions. The total risk for the development of the postoperative abdominal complications after the distal resection in patients with diabetes mellitus, diagnosed before and after the intervention, is 7.6 times higher than in patients without diabetes.

According to the literature data, the article considers the occurrence and development of acute and chronic osteomyelitis. The basic principles of classification and terminology are presented. The authors paid special attention to the features of the clinical manifestations of osteomyelitis and its spread, identified clinically important focal changes in osteomyelitis. The etiology, pathogenesis and features of pathophysiology with a different mechanism for the development of osteomyelitis are considered. The moments, affecting the formation of orthopedic outcomes in the form of deformations, shortening of limbs are noted. The authors examined the complications and tactical features in the treatment of the effects of osteomyelitis. The importance of a systematic approach to treatment, the determination of the stages and their contents, taking into account the main process and the anatomical and functional expediency, are accentuated.

Objective. To analyze the results of cytological screening for cervical cancer in women, living in the Perm Territory.

Materials and methods. The work is based on the results of a cytological study of 4670 women aged 29 to 70 years who underwent additional medical examinations in medical institutions of Perm and the Perm Territory for the period from 2017 to 2019.

Results. It was established that regardless of the place of residence, normal cytograms prevail. Inflammatory changes were more often observed in the urban population than among women living in the village. As age increased, the number of neoplastic changes in the cervix increased with a peak incidence at the age of 50. Detection of cervical cancer in the Perm Territory was 0.03 % that corresponds to the average statistical indicators in Russia, although this apparently reflects the problems of hypodiagnosis in cytological screening, since in the country in recent years the incidence of cervical cancer and mortality from it has been increasing.

Conclusions. The cytological method is a key step in cervical cancer screening, since it allows you to identify early pathological changes in case of adequate collection of material, correct staining of preparations, and a highly qualified cytologist.

In modern obstetrics, an abnormal placental invasion is a serious problem associated with the following high perinatal losses: massive obstetric bleeding that leads to the death of both the mother and the fetus.

Objective. The purpose of the study was to analyze the methods of delivery in patients with placenta accreta.

Materials and methods. The study group consisted of 31 patients aged 25 to 42 years with placenta ingrowth, who underwent metroplasty in the Perinatal Center of V. D. Seredavin Samara Regional Clinical Hospital in the period from May 2018 to December 2019. Most often, placental ingrowth was detected in the second trimester of pregnancy (41.94 %). In 5 cases, placental ingrowth was diagnosed in the operating room (16.3 %). On average, the time of detection of ingrowth is 24.96 weeks of gestation.

Results. Out of 31 patients we observed, 27 underwent metroplasty using complex compression hemostasis, and 1 patient underwent temporary balloon occlusion of the internal iliac arteries. The total volume of blood loss was 1625 ± 485 ml, and the median was 1455 ml. Only 5 (17.24 %) patients had a blood loss of more than 2000 ml, and there was no blood loss of more than 3000 ml.

Conclusions. Introduction of organ-preserving operations allows maintaining a woman's reproductive health, avoiding massive blood loss, and improving perinatal outcomes. Patients with a scar on the uterus after cesarean section, with placentation on the anterior wall and in the area of the scar on the uterus should be immediately sent to the third level of rendering specialized medical care.

Цель. Анализ деятельности работы санитарной авиации по оказанию медицинской помощи беременным в Республике Саха (Якутия).

Материалы и методы. Представлен анализ работы санитарной авиации по эвакуации и оказанию неотложной и экстренной медицинской помощи беременным по отчетным данным Республиканского центра медицины катастроф за 2014–2019 гг.

Результаты. За период 2014–2019 гг. эвакуация беременных санитарной авиацией занимает ежегодно 3-е место среди всех вызовов. Около 30 % вызовов обслуживается санитарной авиацией из арктических районов Республики Саха (Якутия). Эффективность данной работы в арктических районах неоспорима: за последние годы значительно снижена младенческая смертность и не допущено случаев материнской смертности.

Выводы. Маршрутизация и эвакуация беременных из арктических районов Республики Саха (Якутия) привела к значительному снижению младенческой смертности и отсутствию случаев материнской смертности.

The history of the Department of Pathological Anatomy of Molotov Medical Institute during the Great Patriotic War of 1941–1945 is presented. The working conditions of the department, the formation of pathological anatomy service in Perm and region, the active work of the department in training personnel for pathology departments, the creation of the society of pathologists, the scientific work of the department are shown.