Kazan medical journal

Brain abnormalities can cause resistant epileptic seizures and significant neurological deficits. In this article we present the clinical cases of cerebral hemiatrophy (Dyke–Davidoff–Masson syndrome) and polymicrogyria with a description of their classical clinical features and radiological and electrophysiological characteristics. The classical signs of Dyke–Davidoff–Masson syndrome in neuroimaging are cerebral hemiatrophy, calvarial thickening, and hyperpneumatization of the frontal sinuses. Polymycrogyria characterized by a gross defect of the cortex with multiple small superficial gyri can manifest as hemi- or tetraparesis, focal epilepsy, and developmental delay. Further study of brain abnormalities, obtaining high-quality images with neuroimaging and their careful analysis can help improve the efficiency of diagnosis and treatment of patients with this pathology.

The article presents a case of the use of medicamentous technique redicing blood loss with terlipressin — a long-acting synthetic analogue of antidiuretic hormone. This pharmaceutical drug causes constrictin of arterioles, veins and venules, which leads to the reduction of blood flow in the visceral organs and pressure reduction in the portal system. In our federal institution of healthcare, a patient with chronic pancreatitis complicated by segmentary portal hypertension and portal cavernoma underwent proximal resection of pancreatic head by C. Fray, placing of a longitudinal pancreatojejunoanastomosis and azigoportal disconnection. The description of this case is aimed at drawing attention to relatively new and developing methods of medicamentous technique redicing blood loss, which in combination with surgical methods allows reducing perioperative blood loss in upper abdominal surgeries.

This review presents the results of various studies on the problem of cardiovascular events and the risk of their development as well as long-term mortality in young patients with cerebrovascular accidents or strokes. In recent decades, there has been a tendency to rejuvenation of cerebrovascular diseases often leading to fatal outcomes. At present, the question of the course of stroke in the acute stage of the disease is most studied. Meanwhile, the study of late, including long-term (5 years or more) results of the stroke is important for planning the organization of medical care using the principles of evidence-based medicine. The long-term prognosis for young patients who underwent strokes is of particular interest from a medical and social point of view due to the increase of life expectancy and basic responsibilities at a difficult stage of life. According to a meta-analysis carried out on the results of prospective studies, it was found that the prognosis of a “young” stroke is not as favorable as it was previously thought with respect to the development of cardiovascular diseases or psychosocial consequences as well as mortality. It was shown that the risk of death among young patients aged 18 to 49 years who survived a 30-day primary stroke, compared to the risk of death in the general population, remained increased even after 15 years. However, this issue remains still insufficiently studied. Further research is needed in this area.

Aim. To characterize the peculiarities of the dynamics of the level of corticosteroid receptors in the myocardium of animals with different resistance to hypoxia in the post-resuscitation period.

Methods. Experimental studies were carried out on male non-inbred white rats, divided into 2 groups by hypoxia resistance. A 5-minute arrest of the systemic circulation was modeled under ether anesthesia with intrathoracic clamping of the cardiovascular cluster with subsequent resuscitation. The observation period was 35 days. The content of corticosterone and aldosterone was determined in the blood plasma, the concentration of glucocorticoid and mineralocorticoid receptors in myocard homogenates was determined as well.

Results. On days 1 to 3 of the post-resuscitation period in rats highly resistant to hypoxia, the dynamics of plasma corticosterone concentration and the content of corticosteroid receptors was unidirectional. Starting from the 5th day, against the background of a statistically significant decrease in the level of plasma corticosterone, a gradual increase in the density of corticosteroid receptors, mostly glucocorticoid, was observed, most pronounced on the 14th day and remaining until the end of the observation. In animals with low resistance to hypoxia, the dynamics of corticosteroid receptors was characterized by a predominance of mineralocorticoid content in almost all periods of observation. On days 1–3 of post-resuscitation period on the background of high concentrations of corticosteroid hormones, the minimum content of glucocorticoid receptors was noted. A decrease in the mineralocorticoid receptor level was recorded only on the first day, and in all subsequent periods of the experiment, the control indicators were significantly higher by 1.4–1.6 times. Strengthened mineralocorticoid signaling in the myocardium, characteristic of animals with low resistance to hypoxia, may be associated with the development of hypertrophy and fibrosis, inflammation, impaired electrical function. An increase in glucocorticoid receptors, characteristic of animals with a high resistance to hypoxia, has an adaptive effect, limiting the inflammatory response, the potential mechanism may be associated with increased expression of type 11β-hydroxysteroid dehydrogenase.

Conclusion. The identified features can have a significant influence on the course of the post-resuscitation period and determine the long-term forecast.

Aim. To assess the frequency of pregnancy complications in women with type 1 diabetes mellitus and without diabetes combined with urinary infection and the effect of various treatment options for urinary infection on the frequency of pregnancy complications in type 1 diabetes.

Methods. Pregnant women with urinary tract infection were examined: 110 people with type 1 diabetes (main group) and 133 women without diabetes (comparison group). The diagnosis of urinary infection was confirmed by a double bacteriological culture. Patients of the main group were divided into three subgroups depending on the method of treatment of urinary tract infection: subgroup A received antibiotic therapy and phytopreparation (Centaurium + Lovage root + Rosemary leaves), subgroup Б received antibiotic therapy, subgroup B received phytopreparation. After treatment, the preservation of pregnancy complications such as the threat of miscarriage, proteinuria, intrauterine infection of fetus, anemia, premature birth, which developed on a background of urinary tract infection, was evaluated. The significance of differences in groups was evaluated using the Pearson chi-square tests, and the effectiveness of each type of therapy was evaluated using the McNemar test.

Results. The risk of miscarriage, intrauterine infection, anemia, and premature birth was higher in pregnant women of main group with all types of urinary infection, preeclampsia with pyelonephritis, and asymptomatic bacteriuria. Both complex therapy of pyelonephritis (antibiotics with phytopreparation) and monotherapy with antibiotics were effective in eliminating the threat of miscarriage, intrauterine infection and anemia. Adding herbal medicine to antibiotic therapy for pyelonephritis reduced the preterm birth rate compared with antibiotic monotherapy, and other complications did not reveal differences between subgroups. In asymptomatic bacteriuria, complex therapy and monotherapy with antibiotics were effective in eliminating the threat of miscarriage, intrauterine infection and anemia. Monotherapy with a phytopreparation in pregnant women with type 1 diabetes did not lead to the elimination of these complications. Combination therapy asymptomatic bacteriuria was more effective than antibiotic monotherapy in terms of the effect on preterm delivery and equally effective in terms of the threat of miscarriage, intrauterine infection and anemia.

Conclusion. Adding phytopreparation to antibiotic therapy for pyelonephritis and asymptomatic bacteriuria in pregnant women with type 1 diabetes mellitus to prevent premature birth seems appropriate; monotherapy of asymptomatic bacteriuria with a phytopreparation is ineffective for eliminating the threat of miscarriage, intrauterine infection, anemia, therefore antibiotics should be prescribed at the beginning of therapy for asymptomatic bacteriuria.