[The last illness of I.S. Turgenev].

The article discusses the causes and course of the last illness of I.S. Turgenev. The writer was consulted by many famous French and Russian doctors who made various diagnoses and used various methods of treatment. The primary disease that caused Turgenev's death is myxosarcoma (one of the sarcoma variants), involving soft tissues and thoracic vertebrae. The article presents data and discusses alternative diagnostic versions about the nature of the disease and the causes of death of the great Russian writer.

[Exudative pericarditis with tamponade after COVID-19. Case report].

A description of a COVID-19 patient with the development of exudative pericarditis complicated by cardiac tamponade is provid. A peculiarity of this case is the presence of an underlying disease in the patient (chronic lymphocytic leukemia), which was in remission for 1.5 years after chemotherapy. Another feature of the patient was the relatively small area of lung damage and the hemorrhagic nature of the pericardial effusion, which persisted for a long time. The insignificant activity of inflammatory markers was noteworthy. Possible mechanisms of development and features of the course of exudative pericarditis in the described patient, issues of diagnosis and treatment of this category of patients are discusse.

[Dr. Sergey P. Botkin's case sheet].

The article presents and discusses Botkin's case sheet focused on his cardiac disease. Analysis of the clinical symptoms and course of the disease provides an opportunity from the standpoint of modern clinical cardiology to characterize the features of Botkin's disease course at all stages of its cardiological continuum and assess the diagnostic capabilities and managing approach to such patients. The comorbidity of ischemic heart disease and gallstone disease in the case of Dr. Sergey P. Botkin, a Russian general practitioner, pathologist, physiologist, and one of the founders of scientific medicine in Russia, is being discussed.

[Clinical case conference in medical practice and education: Origins and current status].

A genesis of clinical case conference as a form of case discussion that integrates medical and educational functions is presented. The role of the following top figures of medicine in the development of clinical case conference is described: J.-M. Charcot, S.P. Botkin, G.A. Zakharin, V.N. Vinogradov, A.L. Myasnikov, E.M. Tareev, N.A. Mukhin. The article pays special attention to clinical case conference in Russian medical education. The role of clinical case conferences in shaping medical judgment in a clinician and a student is discussed.

[A case of granulomatous tubulointerstitial nephritis in a patient with pulmonary sarcoidosis].

A clinical observation is presented of a patient with pulmonary sarcoidosis, who was diagnosed with kidney damage after three years with the development of chronic renal failure and the need for replacement therapy. A histological examination of the renal biopsy revealed a granulomatous process in the interstitial tissue, which was regarded as an extrapulmonary manifestation of sarcoidosis. Pulse therapy with glucocorticoids was prescribed and an attempt was made to reduce hemodialysis sessions.

[In-hospital Myocardial Infarction: Scale of the Problem].

All cases of acute myocardial infarction (AMI) can be divided into outpatient-onset AMI and in-hospital-onset AMI depending on the place and circumstances of their development. In this review we consider the problem of in-hospital AMI. Special attention is paid to specific features of its clinical manifestations and the scale of the clinical problem. Possible causes of difficulties in the diagnosis and treatment of this condition are presented in comparison with those in patients with outpatient-onset AMI.

Iatrogeniа in internist practice.

The article presents the history of the issue, the concept of iatrogenia, possible negative consequences of the interaction of the doctor and the patient in modern conditions. The main forms of iatrogenic (psychogenic, hospital, iatrogenic diagnostic procedures, medicinal, etc.) are given. An important place is occupied by implantation of iatrogenic (patients with artificial heart valves, cardio-implanted electronic devices, coronary stents, articular endoprostheses). The most vulnerable to the development of iatrogenic are elderly and senile patients. The interdisciplinarity of the iatrogenic problem and its educational significance for therapists, general practitioners, clinical pharmacologists, pathologists. Keywords: iatrogeniа, iatrogenic events, undesirable drug reactions, мedical error.

[Optimization of Invasive Treatment Strategy in Patients With Non-ST Elevation Acute Coronary Syndrome].

OBJECTIVE: to compare strategies of invasive treatment of patients with non-ST elevation acute coronary syndrome (NSTEACS) hospitalized in 2014 and 2015. MATERIALS AND METHODS: We have analyzed treatment strategy used in patients with NSTEACS hospitalized in cardio-reanimation department of a city hospital during one month in two successive years (January 2014 and November 2015). We have compared indications to, and timing of coronary angiography, numbers of performed percutaneous coronary interventions (PCI) and coronary artery bypass grafting surgeries. RESULTS: Portion of patients subjected to invasive procedures in 2014 was 26 %, in 2015-42 %. All 32 primary procedures were PCIs. An increase was due to delayed interventions (24-72 hours), which were not performed in 2014. We also more often used selective multivessel coronary stenting, what facilitated availability of invasive treatment for elderly patients. Hospital mortality of patients with NSTEACS decreased from 16 to 7 %.

Abscess of the spleen in a patient with infectious endocarditis.

A patient with infective endocarditis (IE), complicated by the development of the abscess of the spleen, is described. The diagnosis of IE was verified several months after the onset of clinical symptoms (fever, hemorrhagic skin rashes, splenomegaly).The patient suspected hemorrhagic vasculitis and lymphoma of the spleen, which were not confirmed. With transesophageal echocardiography, vegetations on the aortic valve have been identified, and, according to CT, a spleen infarct with suspected abscess. A successful simultaneous operation was performed - aortic valve replacement and splenectomy. An abscess was found in the spleen. The patient is discharged in a satisfactory condition.

Infection in the clinic of internal diseases.

In the modern clinic of internal diseases, the specific gravity of the infectious pathology, manifested by various clinical syndromes, is increasing. Infectious pathology is represented by diseases of the respiratory system, heart disease (infective endocarditis, cardioimplant infections, viral myocarditis), infectious arthropathies, extrahepatic manifestations of viral hepatitis, cytopenic syndromes, various manifestations of sepsis and some other conditions.In most cases, the diagnosis and management of such patients is the responsibility of the internist, who must be able to suspect the infection and carry out its verification. In the process of diagnostic search and management of patients, close interaction of the internist with a clinical microbiologist, clinical pharmacologist and other related specialists is necessary.

[Ferrous sulfate in the treatment of iron deficiency anemia: The positions continue]. / Sul'fat zheleza v lechenii zhelezodefitsitnoi anemii: pozitsii sokhraniaiutsia.

The paper discusses treatment strategy and tactics for iron deficiency anemia. It gives data on the comparative efficacy of different iron sulfate drugs, their bioavailability, effects on peroxidation processes, and side effects. The paper also considers the clinical significance of a dosage form of iron-containing drugs with a sustained iron release, as well as ways to reduce the frequency and magnitude of side effects when ferrous sulfate is used.

[Eosinophilic Necrotizing Myocarditis Complicated by Myocardial Rupture].

In this female patient eosinophilic myocarditis was complicated by myocardial rupture and hemopericardium with cardiac tamponade. Special features of this case were old age of the patient, fulminant course of the disease, myocardial infarction-like ECG changes, absence of peripheral blood eosinophilia. Presentation is accompanied by discussion of issues of epidemiology, clinical course, diagnostics, and possible causes of eosinophilic myocarditis.