Vol 39, No 5 (2022)

Objective. To determine the role of neonatal respiratory infection in the formation of atopic dermatitis in children.

Materials and methods. A retrospective analysis of the state of health of children who suffered from intrauterine pneumonia (21 persons) compared with healthy children (19 persons) was carried out.

Results. As a result of examination in the prospective follow-up, it was revealed that the children of both groups had a burdened heredity for allergic pathology, they were on natural feeding. It was detected that fetoplacental insufficiency, as an unfavorable factor of the antenatal period, effects the formation of atopic dermatitis.

Conclusions. There was noted a high risk of atopic dermatitis in children who suffered from intrauterine pneumonia compared to children with a favorable course of the neonatal period.

Objective. To reflect new information on the typical anatomy of the neck in brief notes for endocrine surgeons from the classical positions and research methods of the school of Academician V.N. Shevkunenko.

Materials and methods. The design of the study (from 1994 to the present day) consisted of three main directions. While developing an optimal technique of cervical somatometry, 775 healthy individuals (300/38.7 % men, 475/61.3 % women) were examined. The topographo-anatomical block – 426 unfixed corpses of persons who died suddenly (290/68 % men, 136/32 % women). Section, dissection, plastination, morphometry, anthropometry, standard histological technique were used. The clinical part of the study included 214 patients (28/13.1 % men, 186/86.9 % women).

Results. The article presents the data of analysis and systematization of accumulated data on the typical anatomy of the neck in the form of a brief abstract for operating surgeons from the classical positions of topographic anatomists of Voronezh and St. Petersburg schools of Academician V.N. Shevkunenko.

Conclusions. The revealed new typical features of the shape, sizes, structure and position of the thyroid gland (presence or absence of the pyramidal lobe, retrothyroid processes, Zuckerkandl's tubercle), its blood supply, basic and additional guidelines for the search and visualization of the parathyroid glands and recurrent laryngeal nerve during surgery and preoperative diagnosis, the concept of high-risk areas of surgical actions, the features of the bilateral symmetrical and/or asymmetric arrangement and structure of the anatomical formations of the neck can be used during the surgery, widely introduced into the educational process of students, residents, postgraduate courses and for improving the skills of endocrine surgeons during master classes.

Objective. To analyze diagnostics and treatment of 50 patients operated for thyroid cancer (TC), to assess the information content of classification according to the TIRADS and BETHESDA systems in comparison with the final morphological study of the removed thyroid preparations.

Materials and methods. Patients were divided into 3 groups. The first group – 32 (64 %) patients with a verified thyroid cancer before surgery according to the results of fine needle aspiration puncture biopsy and a confirmed diagnosis after surgery. The second group, 4 (8 %) persons, included patients with a verified thyroid cancer before surgery, but a negative final morphological study. The third group, 14 (28 %) patients with an unverified thyroid cancer before surgery, but a confirmed diagnosis of thyroid cancer according to the results of a final morphological study. To compare the compliance of the TIRADS system with the BETHESDA system, the Kappa index was used.

Results. The highest compliance, 100 %, was found between TIRADS 5 and BETHESDA 5, with a Kappa index of 1.

Conclusions. Comparison of the results of preoperative and final morphological studies showed that the use of TIRADS and BETHESDA classifications is an informative method in diagnostics of thyroid cancer only in 48 % of cases.

Objective. To study modern diagnostic capabilities and identify available ways to improve the results of treatment of patients with NET of the digestive organs. Neuroendocrine tumors (NET) are neoplasms difficult to diagnose and treat, which are localized mainly in the digestive tract.

Materials and methods. The results of observation of 325 patients with NET were studied: gastrointestinal tract – in 189 (58.1 %) persons, pancreas – in 125 (38.5 %), without established localization – in 11 (3.4 %). NET of various malignancy prevailed – 92.3 %. Laboratory diagnostics included tumor markers (CGA, serotonin, 5-HIAA, etc.), instrumental – endoscopic (FGS, FCS), radiation (US, CT, MRI), radioisotope (PET-CT with 18-FDG, 68-Ga-peptides) and morphological (histology, immunohistochemistry) research.

Results. Nonspecific symptoms were noted in 38–48 % of patients, asymptomatic course – in 20–25 %. The sensitivity of CGA was 54 %, serotonin and 5- HIAA – depended on the presence of carcinoid syndrome and the prevalence of the tumor. Multiphase CT is the main method of diagnosis of small intestinal NET, which allows you to differentiate pancreatic NET by the degree of malignancy. The surgical intervention provides the best results in the treatment of patients with non-metastatic NET, but in case of generalized tumors, its combination with antitumor therapy prolongs the duration of life in patients by 2 times.

Conclusions. Personalized therapeutic and diagnostic tactics, taking into account the clinical and morphological features of NET, ensures optimal detection and treatment, improves survival and quality of life among patients.

The article presents a review. Information on metabolism of vitamin D and its significance in the formation of the brain in the prenatal and postnatal periods is given. An up-to-date data regarding the effect of vitamin D on neurogenesis, activity of neurotransmitter systems, formation of cognitive status and quality of emotional state in children and adolescents is analyzed. The role of vitamin D in pathogenesis of autistic spectrum disorders, resistant forms of epilepsy, deviant variants of development in children is discussed.

Objective. To improve the results of treatment in patients with benign nodular pathology of the thyroid gland (TG) by means of perfecting the technique of minimally invasive treatment with a high-intensive laser under the sonographic control.

Materials and methods. An original technique of laser-induces thermotherapy (LITT) of the thyroid nodule with the ablation of the vessels, feeding the nodule was developed and introduced. The procedure was used in the treatment of 91 patients with benign nodular pathology of the thyroid gland, 116 patients underwent laser-induced thermotherapy by the standard technique (comparison group). Three months later, US was used to assess and compare the results of treatment in both groups. The results of thermometry were analyzed depending on the initial volume of the TG nodular neoplasm.

Results. A decrease in the nodules with the initial volume up to 2 cm³ in both groups was statistically significant and took place practically similarly – 78.7 % in the main group and 71.7 % in the comparison group. When exposing the nodules of larger sizes, the efficiency of standard LITT method fell. In the comparison group, patients with the nodular sizes of 6–8 cm² had a decrease in the volume only by 25.8 % % (from 6.74 cm³ to 5.0 cm³⁾. When using an original method of thermoablation (TA), a decrease in the nodules of the same size was 69.3 % (from 6.98 cm³ to 2.14 cm³). The difference was statistically significant (p = 0,003) that proves the efficiency of this technique. In the subgroup with the nodules > 8 cm³, a nodular volume decrease was 33.3 % (from 11.05 to 7.36 cm³) in the main group and 28.8 % (from 14.07 to 10.02 cm³) in the comparison group. The difference was not statistically significant (p = 279).

Conclusions. Laser-induces thermotherapy of the thyroid gland with the ablation of the vessel, feeding the nodule, leads to a statistically significant reduction of the benign colloid nodular neoplasms of any size. The original technique indicated higher efficiency compared with standard LITT in relation to the nodules sized from 6 to 8 cm.

Objective. To ground from clinical, topographo-anatomical positions the choice of the most rational techniques of parathyroidectomy in patients with hyperparathyroidism, which permit to reduce the intraoperative injury, to minimize operative complications, persistence and hyperparathyroidism relapse rates, to elevate the quality of life.

Materials and methods. The research had two stages. Topographo-anatomical stage was realized at two levels: 1) on the anatomical material including 15 dead bodies; 2) on the plated end-grain cuttings of the dead bodies’ necks (n = 4). During a clinical stage, the results of examination and treatment of 182 patients with hyperparathyroidism, operated with traditional and different minimally invasive techniques, were studied.

Results. The analysis of short-term results of surgical treatment of hyperparathyroidism patients in the retrospective group allowed determining the starting points for the topographo-anatomical stage of the research. The data received during the topographo-anatomical stage permitted to substantiate the choice of minimally invasive endoscopically-assisted technique for parathyroidectomy as the most rational and safety one. Introduction of the study results into surgical treatment of patients of the prospective group showed the efficiency of MIVAP technique in the form of decrease in the frequency of surgical complications from 12.1 to 6.0 % (all complications are attributed to I and II degree by Clavien-Dindo classification and had transitory character) with the reduction of the time of operative intervention and average duration of hospital treatment after the surgery.

Conclusions. Minimally invasive endoscopically-assisted parathyroidectomy with the lateralization of the lobe of the thyroid gland, preservation of the upper and lower thyroid vessels in conditions of intraoperative neuromonitoring and photodynamic visualization of the parathyroid gland can be considered an optimal surgical technique.

Objective. To analyze and evaluate the factors connected with age and territorial distribution among women with unfavorable maternal outcomes.

Materials and methods. A retrospective epidemiological analysis of official statistics data on all cases of unfavorable maternal outcomes (deceased women and women with near-miss – "almost dead") by age and structure at the place of residence (city, village) in comparison with successful outcomes in Perm Krai (PK), Privolzhsky Federal Region (PFR) and the Russian Federation (RF) for 1997–2020 was carried out.

Results. In the age structure of deceased women in PK, the main share of 46.7 % was occupied by women aged 20–29 and 30–39 years, that differed from the comparison group. Among the mothers with successful outcomes in PK, PFR and RF, women aged 20–29 years were in the first place – 59.3, 62.5 and 60.2 %, respectively, that is 1.3 times higher than the corresponding proportion in MM. In the second place, there were women aged 30–39 years – 29.6; 27.9 and 29.1 %, respectively, that is 1.6 times less than the deceased women of the corresponding age. The percentage of young mothers aged 15–19 was 9.2; 7.7 and 8.9 %, respectively, that is 1.4 times higher than that of the deceased women.

The age structure of women with failed maternal mortality (FMM) differed slightly from that of deceased women and significantly – from all puerperas in PK, PFR, RF. Thus, according to the ave-rage long–term data, the main share of women with FMM was women aged 20–29 years – 51.8 %. The percentage of puerperas aged 20–29 years in PK, Privolzhsky Federal Region and the Russian Federation was 59.3, 62.5 and 60.2 respectively. In the second place in PK are women with FMM aged 30–39 years – 31.5 %. The share of puerperas aged 30–39 years in PK, PFR and RF is 29.6 %, 27.9 % and 29.1 %, respectively. In the third place, there are young puerperas with FMM aged 15–19 years – 14.8 %. The proportion of such patients in PK, PFR and RF is 9.2, 7.7 and 6.6 %, respectively.

According to the average long–term data, the proportion of urban residents prevailed among the deceased women – 60.0 %. In the rural areas, the proportion of women who died was 40.0 %.

By the place of residence, the share of women with FMM did not differ from the corresponding data in the MM group and amounted to 57.4 % in the city and 42.6 % in the village. In PK, PFR and RF, this ratio was 72.7 and 27.3 %; 71.6 and 28.4 %; 73.3 and 26.7 % respectively in all the compared territories).

Conclusions. The risk groups for MM and FMM were women aged 20–29 years, residents of the city and village, high-risk group – rural women 30–39 years.

Klinefelter syndrome is a genetic disease in males (1 per 1000 newborns) due to the presence of a doubled X chromosome in the karyotype (47XXY karyotype), the most common cause of primary hypogonadism. It is characterized by polymorphism of clinical manifestations, the most common of which are primary male infertility, obesity, metabolic syndrome, type 2 diabetes mellitus, osteopenia and osteoporosis. Clinical variability leads to the development of associated conditions against the background of changes in hormonal regulation and observation by different specialists, as a result – to late diagnosis of the syndrome. Endogenous hypercorticism in 20–30 % is caused by Itsenko – Cushing's syndrome, in the structure of which about 70–80 % are unilateral adrenal adenomas (corticosteromas). ACTH-independent hypercorticism leads to a number of metabolic and cardiovascular disorders, including abdominal obesity, arterial hypertension, steroid diabetes, and osteoporosis. Long-term suppression of ACTH, according to the feedback principle, leads to suppression of the secretion of hormones of the pituitary endocrine glands (including sex steroids). The clinical observation illustrates the complex pathophysiological disorders that occur when the hypothalamic-pituitary-adrenal / gonadal axis is disturbed in a combination of two syndromes, as well as the importance of a comprehensive examination of endocrinological patients.

The article presents a clinical observation of first appeared non-ST elevation myocardial infarction in a 43-year-old young woman with three risk factors: chronic stress, smoking, dyslipidemia. Significant stenosis of the LAD (left anterior descending artery) was diagnosed and surgical intervention was performed: plasty and stenting of the LAD.