[Management of a patient with diabetes mellitus after total pancreatectomy. Case report].

In modern diabetology, the most important condition for a personalized approach to patient management is to determine the type of diabetes mellitus. Particular attention is drawn to a large, but at the same time insufficiently studied group of patients with diabetes mellitus due to diseases of the pancreas or as a result of surgical interventions on the pancreas, in particular, patients who, for a number of vital indications, undergo total pancreatectomy and the mechanism of development of impaired glucose homeostasis have not been studied in these patients. To date, there are no specific algorithms for managing this category of patients. This clinical example emphasizes that the management of glycemia in patients with diabetes mellitus as a result of total pancreatectomy is an extremely difficult task that requires a multidisciplinary approach in the treatment of this category of patients, the participation of an endocrinologist at all stages of patient treatment.

[Late capsular block syndrome]. / Sindrom kapsul'nogo bloka posle fakoémul'sifikatsii katarakty.

The article describes 5 cases of capsular block syndrome (CBS). This late cataract surgery complication has not been sufficiently covered in Russian scientific literature. Diagnostics were based mainly on slit-lamp biomicroscopy and anterior segment optical coherence tomography. In all cases, examination revealed a retro-optical space filled with content of different transparency and homogeneity (transparent liquid, opaque liquid, regenerative lens material). The condition caused visual acuity to decrease in each case. Patient management included follow-ups (2 cases), yttrium-aluminum-garnet laser (YAG-laser) puncture of posterior lens capsule (1 case) or YAG-laser posterior capsulotomy (2 cases). YAG-laser treatment resulted in visual functions improvement.

[The modern methods for the rehabilitation of adolescents suffering obesity]. / Sovremennye tekhnologii reabilitatsii podrostkov s ozhireniem.

BACKGROUND: To-day, obesity spreads dramatically fast all over the world not only among the adults but also among the children. According to the data available from the scientific literature, the number of adolescents suffering from obesity in Russia increased more than 1.5 times during the period from 2006 till 2015. The combination of non-drug therapeutic measures (including diet therapy, therapeutic physical exercises, and psychophysiological technologies) constitutes the basis for the treatment of obesity. Russia has gained a vast experience with the management of this condition with the use of natural and preformed therapeutic agents. AIM: The main objective of the present study was the comparative assessment of the effectiveness of the rehabilitation programs for the obese subjects with based on the application of alternative and complementary therapeutic modalities for the treatment of the adolescent girls with obesity. MATERIAL AND METHODS: The study included 86 girls with obesity at the age of 13-17 years who were randomly divided into 3 groups matched for the age and anthropometric characteristics. All the patients were prescribed a treatment course, including motivational training and aerobic exercise, in addition to the routine recommendations for the short-term modification of eating habits. The vacuum therapy was additionally included in the combined treatment protocol for the patients of the first group (n=28) while the patients of the second group (n=29) received the treatment in the spa capsule (SC) and the girls of the third group (n=29) underwent transcranial magnetic stimulation therapy. RESULTS: The analysis of the results obtained in this study has demonstrated a significant reduction of the body weight, waist and hip circumferences in the patients of all study groups (p<0.05). The comparison of these results with the baseline characteristics showed that the use of combined physiotherapy including the treatment in the spa capsule had significant advantages over local vacuum therapy in terms of weight dynamics (p=0.009), body mass index (p=0.009), hip circumference (p=0.019) and the chest skinfold thickness (p=0.02). CONCLUSION: The use of alternative and complementary therapeutic modalities in the combination with motivational training and aerobic exercises effectively contributes to the weight loss in the obese adolescent girls, with the combined pysiotherapeutic treatment having advantages over local therapy methods.

[The experience with the application of the selective electro-stimulation impacts in the children presenting with the disturbances of the locomotor function].

AIM: The objective of the present study was the improvement of the effectiveness of medical rehabilitation of the children presenting with the disturbances of the locomotor function using a «LymphaVision¼ apparatus for the selective electrical stimulation. MATERIALS AND METHODS: The study included 42 patients with movement disorders divided into two groups depending on the method of non-drug therapy. The main group was comprised of the patients receiving the treatment by electrical stimulation with the use of the «LymphaVision¼ apparatus while the remaining patients made up the group of comparison (they were treated with by means of Vermel electrophoresis with the use of a 1% sodium bromide solution). The increase of the muscular strength evaluated based on the scoring system and the number of motor skills were used as the criteria of the effectiveness of the treatment. The applied Statistica for Windows package, version 6.0 («StatSoft¼, USA). Was employed for the statistical analysis of the data obtained. The significance and number of differences between two independent samples of the quantitative features were assessed using the Mann-Whitney U test. The Wilcoxon matched pairs test was used to compare the two matched groups. RESULTS: The children comprising the group treated by means of selective exposure to electrical stimulation with the use of the «LymphaVision¼ apparatus in the course of the rehabilitation process exhibited a significant increase in the strength of the muscles of the lower extremities and the trunk over the baseline values (p=0.003 and p=0.04 respectively) and acquired a significantly greater number of the new motor skills (p=0.02). CONCLUSION: The application of the proposed method is characterized by the highly pronounced clinical efficiency. This approach is pathogenetically well-substantiated for the treatment of the children presenting with the locomotor disorders developing as the consequences of perinatal lesions in the central nervous system and promotes the restoration of the capabilities of the child's body, such as normalization of the muscle tone, increase of the motor activity and muscle strength.

[Pathogenesis and target therapy of acute respiratory distress syndrome].

The paper summarizes results of experimental studies and clinical observations of the pathogenesis and effectiveness of respiratory, non-respiratory and pharmacological treatment methods for acute respiratory distress syndrome caused by direct and indirect damaging factors. The article deals with differences and peculiarities of morphological changes and lung functional disorders, clinical, laboratory and instrumental signs of various origins in ARDS and justifies necessity of differential diagnosis and differential treatment of ARDS, depending on the reasons for its development. Furthermore the article discusses an algorithm for differential diagnosis and differential treatment for ARDS caused by direct and indirect damaging factors.

[Hemodynamic efficacy of modified gelatin in patients with acute blood loss and sepsis].

The paper presents the results of a clinical trial using the new modified gelatin-based drug hemofusin to correct dyshidria in patients with blood loss and sepsis. Based on the findings, the authors provide evidence for the high clinical efficacy of this drug and the expediency of its incorporation into a complex of infusion therapy in this patient contingent.

[Efficiency of normobaric hypoxytherapy in the combined rehabilitation of children and adolescents with arterial hypertension].

The present study included 166 children and adolescents presented with arterial hypertension. It has demonstrated high efficiency of normobaric hypoxytherapy of this condition. Its advantages over the standard electrotherapeutic sleep treatment is confirmed by the results of 24 hour arterial pressure monitoring. Criteria for the efficiency of combined rehabilitation have been developed including average day and night time arterial pressure, its maximum level, day and night hypertension time indices.

[Choice of the parameters of artificial ventilation in patients with acute respiratory distress syndrome]. / Vybor parametrov iskusstvennoi ventiliatsii legkikh u bol'nykh s ostrym respiratornym distress-sindromom.

The paper presents the results of use of two modes of controlled artificial ventilation (ALV) in adult patients with acute respiratory distress syndrome of various genesis: 1) ALV with its controlled volume, the descending pattern of inspiratory flow, the limitation of respiratory volume in the airways (RV, 6-8 ml/kg; Ptr.peak < 30 cm H2O), 2) ALV with its controlled volume, the orthogonal pattern of inspiratory flow (RV, 12-15 ml/kg, Ptr.peak > 35 cm H2O). It also shows the advantages and disadvantages of these respiratory procedures in this group of patients.

[Use of the solutions of hydroxyethyl starch and reamberin in the combined treatment of severe gestosis]. / Primenenie rastvorov gidroksiétilkrakhmala i reamberina v komleksnom lechenii tiazhelogo gestoza.

The effects of the solutions of hydroethyl starch (HES) and reamberin on hemodynamics, metabolism, and water-sector disorders were studied in patients with severe gestosis. The study covered 42 puerperas who were divided into 3 groups: 1) 10 patients with severe gestosis and normal acid-alkali balance (AAB); 2) 10 with severe gestosis and metabolic acidosis; 3) 22 pueperas with physiological single pregnancy (a control group). Group 1 patients were given infusions of 6% HES solution, 5-6 ml/kg; Group 2 received in addition to 6% HES solution in the above dose infusions of 1.5% reamberin solution, 5 ml/kg. In patients with severe gestosis, hemodynamic, water-sector, and metabolic monitoring on puerperal days 1-5 were found to identify changes in oxygen supply and consumption, water balance, and AAB. In Group 1 patients, HES infusion on days 1-2 after delivery decreased the content of systemic water, extracellular and interstitial fluid, increased oxygen supply; in Group 2, combined infusion therapy with GES and reamberin on puerperal days 1-2 led to an increase in oxygen supply and consumption and a reduction in interstitial hyperhydration and to normalization of AAB.

[Postpartum emergencies: some aspects]. / Nekotorye aspekty kriticheskikh sostoianii v poslerodovom periode.

The critical states occurring during pregnancy, labor, and early puerperium were analyzed. Seventy puerperas treated at intensive care units (ICU) were examined. The patients were divided into 5 groups: 1) those with preeclampsia (n = 15); 2) eclampsia (n = 22); 3) massive blood loss (n = 17); 4) pyoseptic complications (n = 10); 5) acute respiratory failure (n = 6). The APACHE II scale severity was 22 +/- 5.3 scores. The mean age of puerperas is 29.2 +/- 7.2 years. Total mortality was 14.3%. Parametric and non-parametric statistic methods were used to analyze the reasons for referral of the patients to ICU, their age composition, the association of an outcome to the time of their referral to ICU, the duration of stay there and at hospital, mortality, the time of controlled ventilation, the incidence of multiorgan failure. The common reasons for referral of the puerperas from maternity homes to ICU were eclampsia, preeclampsia, and massive blood loss. Acute respiratory distress syndrome (52.9%), encephalopathy (44.3%), coma (47.1%), and intestinal insufficiency (38.6%) were predominant in the pattern of multiorgan failure in intensive care obstetric patients. When emergencies occurred in puerperas, earlier referral from maternal homes to ICU caused a reduction in mortality from 33.% at referral on day 3 after their occurrence to 23.5% at referral on day 2, and to 11.5 at referral on day 1.

[Effect of perftoran on the oxidant-antioxidant system in patients with severe trauma and blood loss]. / Vliianie perftorana na sostoianie oksidantno-antioksidantnoi sistemy u bol'nykh s tiazheloi travmoi i krovopoterei.

Diminution of reperfusion and re-oxygenation lesions is an important task in the treatment of patients with severe injury and blood loss. From this standpoint the influence of perforan on the condition of the oxidant-antioxidant system was studied in patients with severe combined trauma. The application of perftoran in the early post-trauma period was found to intensify the processes of lipid peroxidation and, simultaneously, to normalize the parameters of the antioxidant-protection system.

[Use of orthostasis during artificial pulmonary ventilation in patients with acute parenchymal pulmonary lesion]. / Primenenie ortostaza v usloviiakh IVL u bol'nykh s ostrym parenkhimatoznym porazheniem legkikh.

The paper contains the results of a study involving an inclined body positioning (45 degrees orthostasis) under the conditions of artificial pulmonary ventilation applied to patients with acute parenchymatous pulmonary lesion of different etiologies. The impact of the method produced on pulmonary gas exchange, hemodynamics, transport and consumption of oxygen as well as its efficiency and disadvantages, indications and contraindications are in the focus of attention.

[Dynamics of prekallikrein and kallikrein inhibitors in development of acute pulmonary lesion (experimental study)]. / Dinamika prekallikreina i ingibitorov kallikreina pri razvitii ostrogo povrezhdeniia legkikh.

The reaction of the kallikrein-kinin blood system was studied in an experimental acute pulmonary lesion caused by a prolonged intravenous infusion of thrombin solution. It was established that the progressing of the acute pulmonary lesion brings about an increasing activation of the kallikrein-kinin blood system with a limited check by the lungs. It is displayed by lower levels of prekallikrein and its inhibitors observed first in the venous and later in the arterial blood. Bradykinin was shown to exhaust and impair the metabolic pulmonary activity. The conclusion is that the indices of the kallikrein-kinin blood system reflect the integrity of the pulmonary metabolic activity and can be biochemical markers of an acute pulmonary lesion.

[Assessment of unbalance in water compartments of patients with gestosis]. / Otsenka disbalansa vodnykh sektorov u bol'nykh s gestozami.

The water-sector misbalance was studied in 53 puerperants. The method of bio-impedance spectrometry was made use of to determine the total body water, extra-cellular- cellular- and interstitial water as well as the circulating blood volume. The levels of extra-cellular and interstitial water were found to be reliably higher in patients with moderate gestosis on day 1 after delivery versus healthy subjects. Stable trends towards normalizing the volumes of extra-cellular and interstitial water were registered by day 5. As for patients with sever gestosis, a reliably increasing total body water as well as extra-cellular and interstitial water persisted in them by day 5 after delivery versus the controls.

[Role of autoPEEP in the optimization of the respiratory pattern in patients with acute parenchymatous lung diseases]. / Rol' autoPDKV v optimizatsii respiratornogo patterna u bol'nykh s ostrym parenkhimatoznym porazheniem legkikh.

The paper presents the results of a study of the impact of autoPEEP (positive end-expiratory pressure) on gas exchange in the lungs, their biomechanical characteristics, the transport and consumption of oxygen by inverting the inspiration/expiration ratio under the volume-controlled mechanical ventilation of the lung (VCMVL) in patients with acute parenchymatous lung lesion, as well as how to choose the optimum inspiration/expiration ratio in VCMVL by analyzing the pattern of total PEEP (the sum of positioning and autoPEEP) in this group of patients.

[Oxygen debt as a prognostic criteria in patients with multiple organ failure]. / Kislorodnyi dolg kak kriterii prognoza u bol'nykh s poliorgannoi nedostatochnost'iu.

Signs of oxygen debt were studied in 28 patients with systemic inflammatory response and polyorgan failure. The parameters of oxygen debt, oxygen consumption, saturation of mixed venous blood, and heart rate can be used as criteria of therapy efficiency. The probability of a favorable outcome is increased if the mean 24-h oxygen debt is less than 30 ml/min x m2, oxygen consumption more than 158 ml/min x m2, mixed venous blood saturation less than 64%, and heart rate less than 114 stroke/min.