Vol 98, No 4 (2017)

Surgical method is the only effective method of stomach cancer treatment. On the basis of dividing the stomach into angiological segments, lymphogenic metastasis was studied, classification of gastric cancer and extraligamentous lymph nodes localizations was created. Based on the performed surgeries working classification of extended lymphodissection was suggested. The data on the formation of esophageal-intestinal anastomosis, identification of the origin of key complications after gastrectomy are given. By introducing single-raw esophago-jejunal anastomosis it was possible to almost completely eliminate complications leading to death which together account for up to 90% of the complications: suture failure, pancreatitis and pancreatic necrosis. The volume of the resected stomach was revised without worsening long-term treatment results. During gastrosplenectomies for ablastic block dissection of lymph nodes the author proposes standard binding of the splenic vessels - proximal to the left gastroepiploic artery arising from the splenic artery. The remaining part of the pancreas after gastrosplenectomy with pancreas resection is proposed to be stitched using atraumatic sutures, which avoids formation of pancreatic fistula. In the clinic we developed esophagogastrosplenectomy from laparoscopic mediastinal access with isoperistaltic right colon graft for esophageal reconstruction with anastomosis located in the neck, antethoracic esophageal reconstruction with graft from the large curvature of the stomach, as well as created original drainages of our own design, which allowed excluding peritonitis without inconsistency of the sutures and abscesses of the abdominal cavity. The author concludes that gastrectomy and subtotal distal gastric resection according to his original methods are an effective tool in the surgical treatment of gastric cancer.

Aim. To evaluate the clinical and pathogenetic value of nitric oxide metabolites measurement in the blood of patients with bronchial asthma and essential hypertension.

Methods. The study included 91 patients. Three groups were identified: patients with bronchial asthma (30 patients, group 1), patients with bronchial asthma in combination with essential hypertension (31 patients, group 2), and patients with essential hypertension (30 patients, group 3). Measurement of the level of total nitric oxide metabolites in patients’ blood was performed with the use of spectrophotometric method in light spectrum based on Griess reaction.

Results. The median level of nitric oxide metabolites had the highest value in the blood of patients with bronchial asthma and accounted for 75.6 [70.4; 80.8] umol/L. Level of nitric oxide metabolites in the blood of patients with bronchial asthma in combination with essential hypertension and patients with essential hypertension was lower, accounting for 72.4 [66.2; 81.2] and 60.0 [54.6; 62.7] umol/L respectively (p <0.001). The tendency to increasing level of nitric oxide metabolites in the blood of patients with bronchial asthma according to disease severity and disease-modifying treatment was revealed. The level of nitric oxide metabolites in the blood of patients with severe bronchial asthma was 77.4 [71.6; 82.4] μmol/L, and in patients with moderate asthma it was 72.4 [70.4; 73.9] μmol/L.

Conclusion. The level of nitric oxide metabolites in the blood of patients with combination of bronchial asthma and essential hypertension had intermediate values compared with patients with bronchial asthma alone, who had the highest level, and with patients with essential hypertension alone, who had the lowest values.

Aim. To study DNA flow cytometry parameters in patients with stage III-IV ovarian cancer receiving different treatments. Methods. Surgical material obtained from 93 female patients with verified stage III-IV ovarian cancer was studied. Patients were divided into 4 groups depending on the treatment variant: without neoadjuvant chemotherapy, with neoadjuvant chemotherapy, with neoadjuvant chemotherapy with different recombinant human interferon gamma (Ingaron) injections - intramuscular or intraperitoneal. Cell count was analyzed, and ploidy interpretation and cell cycle analysis were performed on fresh surgical material. Results. Differences in cell distribution depending on the treatment method were found. Increased proliferation rates, proliferation index, aneuploid tumors predominance in the group without drug exposure were demonstrated. Most of diploid tumours were registered in the group receiving neoadjuvant chemoimmunotherapy with intraperitoneal immunomodulator injections (83.4%) that indicates better disease prognosis. Under exposure to neoadjuvant polychemotherapy aneuploid cell number decreases to 38.4%, and chemoimmunotherapy with intramuscular and intraperitoneal recombinant human interferon gamma injections demonstrated even greater decrease - to 27.2 and 16.6%, respectively. Conclusion. Interferon gamma inclusion into the treatment contributes to a decreased number of aneuploid tumors, reduced proportion of aneuploid cells in tumors and reduced proliferation rates and proliferation index characterizing cancer aggressiveness.

Aim. To study the role of neuroinflammation and cerebral structural factors in the development of cognitive impairment in the recovery period of ischemic stroke.

Methods. In 55 patients with ischemic stroke the assessment of global cognitive status in acute and recovery period of ischemic stroke, evaluation of cytokine concentrations (interleukin-1β, interleukin-4, interleukin-6, interleukin-10 and tumor necrosis factor α) in cerebrospinal fluid and blood serum, as well as a number of MRI morphometric and diffusion tensor parameters were performed.

Results. Predictors of stable cognitive status were low concentration of interleukin-6 and -10 and interleukin-1β and -10 dominance in cerebrospinal fluid, high fractional anisotropy of ipsilateral superior longitudinal fasciculus in the acute phase of stroke. Predictors of positive trend of cognitive status include low level of C-reactive protein, intermediate values of fractional anisotropy of the designated tract, high level of high-density lipoproteins in serum and interleukin-10 in cerebrospinal fluid, codominance of interleukin-1β and -6 in serum and interleukin-10 in cerebrospinal fluid, predominance of interleukin-10 over interleukin-1β in serum, as well as lesser degree of stenosis of the ipsilateral internal carotid artery. Predominance of interleukin-1β over interleukin-10 in serum, large volume of the brain ventricles, lower values of fractional anisotropy of ipsilateral superior longitudinal fasciculus, low level of high-density lipoproteins and greater degree of stenosis of the ipsilateral internal carotid artery can be considered as predictors of negative trend of cognitive status.

Conclusion. The trajectory of cognitive status in the recovery period of ischemic stroke is determined by the profile of neuroinflammation in conjunction with microstructural integrity of the ipsilateral superior longitudinal fasciculus, as well as severity of atherosclerosis of the carotid artery on the side of stroke, level of high-density lipoproteins and ventricular dilation in the acute period of the disease.

Aim. To characterize clinical presentation of hepatitis A on the background of chronic hepatitis B.

Methods. The study was conducted in 2012-2015 in Saint Petersburg Clinical infectious diseases hospital n.a. S.P. Botkin. Retrospective analysis of 259 medical records of in-patients diagnosed with hepatitis A was conducted on random samples. Etiology of the disease was confirmed with ELISA test for serological markers of hepatitis A, B and C.

Results. Etiological structure of hepatitis A-mixed: combination of hepatitis A + chronic hepatitis B - 74.0%, hepatitis A + chronic hepatitis B + chronic hepatitis C - 11.0%, hepatitis A + chronic hepatitis C - 8.0%, hepatitis A + chronic hepatitis of unknown etiology - 7.0%. Age differences in the groups of patients with hepatitis A were revealed: mono- and mixed infections (35.5±11.74 and 40.7±13.72 years, respectively; р=0.026). Hepatitis A had moderate course regardless of infection with other hepatotropic viruses but in 1 patient with chronic hepatitis B resulting in cirrhosis severe course of the disease lead to death. Clinical presentation of hepatitis A as mono- and mixed infection was characterized by typical symptoms. Changes in blood chemistry in mixed infection were characterized by higher cytolytic activity, hypoalbuminemia, lesser decrease of urea level.

Conclusion. In the etiological structure of mixed hepatitis combination of hepatitis A and chronic hepatitis B was predominant; in most cases hepatitis A had moderate course but in superinfection more severe course of the disease can be observed - up to lethal outcome.

Aim. Study of the prevalence of dentofacial anomalies among school children of grades 1 to 11 of one of the districts of Ryazan Oblast.

Methods. We conducted an examination of 663 school children aged 7 to 16 years in one of the districts of Ryazan Oblast. The obtained data were recorded in the form of the oral cavity examination of the Central scientific research institute of dental and maxillofacial surgery.

Results. As a result of examination it turned out that prevalence of teeth and occlusion anomalies in school children ranges from 61 to 89%, and in most age groups it is at a fairly stable level of 80%, which is very high. An alarming fact is that at the age of 7 to 10 years combined teeth and occlusion anomalies were detected in the range from 88.6±3.79% to 82.9±4.16%; it indicates that only every fifth child has a healthy dentofacial system. At the age of 11 this indicator is much lower, while among school children aged more than 16 years it is at the level of 75.6±6.7%.

Conclusion. High prevalence of dentofacial system anomalies was revealed among children of school age in one of the districts of Ryazan Oblast; sufficiency of qualified personnel would provide timely diagnosis of early forms of anomalies, correct disorders and ensure normal development of the child’s dentoalveolar-facial system.

Aim. To identify the factors influencing survival of patients with Takayasu arteritis with the use of Kaplan-Meier mono-factor analysis.

Methods. As the factors influencing survival we analyzed gender, smoking status, tachycardia, arterial hypertension, comlications, left common iliac artery involvement, character of disease progression, and social factors. 96 patients suffering from nonspecific aortoarteritis and observed in Regional clinical hospital №1 in 1998-2016 were examined.

Results. Survival of patients suffering from nonspecific aortoarteritis was influenced by: male gender (p=0.0030), smoking (р=0.00762), tachycardia at the time of diagnosis (p=0.01762), arterial hypertension at the time of diagnosis (p=0.04150), involvement of left common iliac artery (p=0.02970), more than 3 complications (p=0.00062), progressive course of the disease (p=0.00016), being divorced (p=0.00018). 5-year survival was 99%, 10-year survival - 95%, 15-year survival - 93%.

Conclusion. The following factors were identified as influencing survival of patients with Takayasu arteritis: male gender, smoking, tachycardia and arterial hypertension at the time of diagnosis, involvement of left common iliac artery, more than 3 complications, progressive course of the disease and being divorced.

Aim. To analyze clinical and morphological features of lethal outcomes in influenza A (H1N1) pdm09.

Methods. The article provides an analysis of 21 cases of death from severe complicated influenza A (H1N1) pdm09. A clinical example is presented. The diagnosis of influenza A (H1N1) pdm09 was laboratory-confirmed by polymerase chain reaction in vivo in nasopharyngeal swab samples. The diagnosis of influenza A (H1N1) pdm09 was also confirmed posthumously by polymerase chain reaction with detection of influenza virus antigens in autopsy materials.

Results. The deceased were 25 to 63 years old, were admitted on day 5 to 8 from the beginning of the disease (in average, 6.4±0.6 days), among them 12 (57%) females and 9 (43%) males. The risk factors were overweight and obesity in 18 (85.7%) patients. Lethal outcome occurred as a result of acute respiratory failure and acute respiratory distress syndrome. Morphologically severe total involvement of trachea, lungs and bronchi with congestion of internal organs was detected. Clinical manifestations of acute respiratory failure and acute respiratory distress syndrome were morphologically associated with alveolar damage. In all cases of death diffuse alveolar damage and multiple organ changes were diagnosed.

Conclusion. Severe course of influenza A (H1N1) pdm09, complicated with community-acquired viral and bacterial pneumonia, was associated with the development of infectious-toxic shock; lethal outcome occured as a result of ARF acute respiratory failure and acute respiratory distress syndrome; severe total involvement of trachea, lungs and bronchi with congestion of internal organs was confirmed morphologically.

Aim. To study pharmaco-epidemiological features of hypoglycemic treatment combinations in patients with diabetes mellitus type 2.

Methods. Cross-sectional epidemiologic study included 528 patients who responded the questions from ARIC questionnaire about the scheme of conducted antidiabetic treatment. Glycemia <7 mmol/l was estimated as normal, and glycated hemoglobin ≥7% - as decompensation.

Results. Mono- and combined treatment was received by 94.3% of patients. In treatment tactics there were no statistically significant gender differences. 3% of patients followed only diet therapy, 4.5% received metformin monotherapy, 23.7% took sulfonylureas. 50.8% of patients received insulin monotherapy, 49.2% received 2 insulin medications. In patients receiving metformin, sulfonylureas, insulin and combined therapy glycemia was higher, than in naive patients (7.7%, p <0.05; 8.8%, p <0.05; 17.7%, p <0.01 and 9.8%, p <0.01, respectively), and there were no statistically significant differences in glycohemoglobin levels. 75.3% were administered dual therapy, 22.4% - triple therapy, 2.7% - quaternary therapy. In 93.9% of cases with dual therapy and in 69.4% with triple therapy the tretment was rational. On different schemes of hypoglycaemic treatment adequate control of diabetes mellitus was not achieved in most patients.

Conclusion. Although 97.3% of patients with diabetes type 2 received treatment, in 81% of them decompensation was revealed; to correctly manage the disease doctors should follow international guidelines, widely use new generations of antidiabetics and rational combinations, and to improve adherence of patients to treatment, improvement of work of diabetic schools is recommended.

Aim. To study the level of thymidylate synthase gene expression in biopsy material from patients with rectal cancer treated with neoadjuvant chemoradiation therapy.

Methods. Analysis of treatment of 101 patients with locally advanced rectal cancer (T3-4, N0-2, M0) was conducted. Measurement of the level of thymidylate synthase gene expression was performed by polymerase chain reaction. To extract ribonucleic acid Qiagen (RNA easy FFPEkit; Qiagen,GmbH,Germany) reagents were used.

Results. Cancer pathomorphosis stage TRG 1 was revealed in 23 (22.7%) patients, TRG 2 - in 31 (30.7%) patients, TRG 3 - in 32 (31.7%) patients, complete clinical response (i.e. complete tumor resorption TRG 4) - in 15 (14.9%) patients. Analysis of thymidylate synthase gene expression in patients with poor response to chemoradiation therapy showed that in 34.8% of cases high expression was revealed, while in 65.2% of cases - low expression. Among patients with complete clinical response significant prevalence of patients with high expression of thymidylate synthase gene was revealed - 73.3%, and in 26.7% of patients with pathomorphosis of grade 4 low expression of this gene was registered. In patients with tumor regression grade 2 and 3 no significant difference in patients’ ratio was revealed. The most prominent correlation according to the level of thymidylate synthase gene expression was found in patients without the response to conducted chemoradiation therapy (with prevalence of patients with low expression) and complete tumor regression (with prevalence of patients with high expression).

Conclusion. There is inverse correlation between the grade of tumor regression and thymidylate synthase gene expression; evaluation of the level of thymidylate synthase gene expression and response of rectal cancer to neoadjuvant chemoradiation therapy requires further investigation both on molecular and clinical levels.

Since the discovery of immunologic tolerance phenomenon, active discussion of the role of genetic and environmental factors in autoimmune disease development has persisted. One of such factors is infections. Microorganisms are considered to be triggers of autoimmune diseases but their role is still not completely understood. Animal experiments conclusively demonstrate how the certain microorganism or its antigen can cause autoimmune pathology. At the same time the results of clinical studies performed on patients with different autoimmune pathologies are hardly decisive and often are contradictory. It should be taken into account that patients with already existing disease were studied in most cases, so interpretation of the data on the association of certain causative pathogens with certain autoimmune pathology should be performed cautiously. The review contains key hypotheses about possible mechanisms of autoimmune reaction development in infections: hypotheses about latent antegens/cryptoantigens, antigen modification, superantigen presence, epitope spectrum extension, molecular mimicry, adjuvant and non-specific effect, antigen complementarity, and idiotypic-antiidiotypic interactions. Their advantages and disadvantages are presented, their comparison is performed. In most cases facts proving one of the hypotheses can be reconsidered in favor of another one. A number of early hypotheses need to be reviewed taking into account modern understanding of innate and adaptive immunity. As more data about relation between infection and autoimmunity is collected, new hypotheses can be developed integrating main claims of previous hypotheses and adding the new ones.

The review of domestic and foreign literature presents data on the quantitative and qualitative parameters of skin microbiocenosis in norm and atopic dermatitis. Issues of the role of horny layer of the epidermis as well as the role of the epidermal barrier function disorders in increasing susceptibility to infectious agents were considered. United pathogenetic concept of atopic dermatitis is not completely clear, as reflected by insufficient effectiveness of this disease treatment. The researchers associate it with significant but little-studied role of bacterial skin infections in children with atopic dermatitis. The review summarizes scientific evidence of the role of bacterial, viral and fungal infections in the development and progression of atopic dermatitis. It was shown that the hallmark of atopic dermatitis is increased patients’ skin colonization with bacteria, viruses and fungi. In maintaining of chronic skin inflammation in atopic dermatitis in children the role of Staphylococcus aureus is specifically emphasized. It was demonstrated that skin barrier function impairment contributes to the establishment of secondary infection, and at the same time pathogenic microbial contamination/infection enhances skin barrier disorder, which increases the possibility of antigen absorption through the skin creating a vicious circle leading to further activation of immune system and maintenance of chronic inflammation. The factors creating favorable conditions for the growth and development of bacterial and fungal microflora were distinguished, that predispose to atopic dermatitis complicated by secondary infection, providing aggravating effects on the course of atopic dermatitis in children and leading to the development of severe forms of the disease and resistance to concentional treatment.

Aim. To analyze the performance indicators of hospitals at home for the patients older than working age in Russian Federation in 2011-2015.

Methods. Analytical and statistical methods were used. Performance indicators of hospitals at home for patients of pension age in Russian Federation were analyzed based on departmental and federal statistical observation forms during the period of 2011-2015.

Results. In the country during the period of 2011-2015, the number of people older than working age increased by 13.1% and their proportion in total population increased from 22.3 to 24.55% was revealed. In 2011-2015 the number of home care patients of pension age increased by 2.1%. Analysis of the distribution of the number of patients treated in hospitals at home of medical organizations showed that elderly were mostly treated in central district, district and city hospitals, and polyclinics. The average duration of hospital stay of patients older than working age in hospitals at home was 11.1 days and was one day less than the average duration of hospital stay of the elderly in health care organizations providing in-patient service (12.1 days).

Conclusion. Over 5 years, proportion of patients older than working age among all patients treated in hospitals at home increased from 57.1 to 64.3% was observed; in 2015 in the regions of the Russian Federation significant variance of the number of patients older than working age treated in hospitals at home (from 0.01 to 98.9 per 1000 population of corresponding age) was revealed.

Aim. To reveal the spectrum of opinions and issues regarding accessibility of information about medical services and on-line booking of doctor’s appointments among population and experts.

Methods. The methods included semi-structured interviews and focus groups with population and experts. Total of 17 individual and group interviews with experts were conducted in the Republic of Tatarstan and 12 in the Republic of Mari-El (n=59 people); 28 individual interviews and focus groups with the population were conducted in Tatarstan and 13 in Mari-El (n=113 people).

Results. New informational technologies with a positive impact on openness and accessibility of health care system have nevertheless some serious issues in realization connected with organizational, infrastructural, economic, social cultural and psychological factors: (1) insufficient information provided to the population about the state warranties of health care program; (2) inaccessibility of websites for some prevention and treatment facilities; (3) age inequality both in access to information about the services and in on-line booking of doctor’s appointments.

Conclusion. There is an urgent need for goal-directed policy to overcome inequality in the access to information among different social groups, and also for creation of equal conditions for development and supporting informational technologies in medical institutions and centers.

Pleomorphic sarcomas are a group including some of poorly differentiated mesenchymal malignancies, which differ in morphology, molecular and biological properties and clinical outcomes. They are relatively rare tumors comprising, by different assessments, 5 to 7% of all mesenchymal malignancies. The tumors affect soft tissues of the limbs, body, retroperitoneal space and mediastinum. The morphologic substrate of pleomorphic sarcomas is polymorphic tumor cells of fibroblast cell lines, smooth myocytes, rhabdomyoblasts, Schwann cells, etc. Accuracy of morphologic diagnosis of pleomorphic sarcomas ranges between 13 to 26%. In practice it means that histological type of pleomorphic sarcoma is correctly defined only in a quarter of patients. Meanwhile, the importance of defining the histological type before starting the treatment is explained by the fact, that accurate histological and simultaneous molecular characteristics of pleomorphic sarcomas points the way to selective therapy of such tumors. The article presents the results of our observation of a 27-year-old patient with pleomorphic cardiac rhabdomyosarcoma. In this case cardiac tumor, first defined during echocardiography, is one of metastases of pleomorphic rhabdomyosarcoma of neck soft tissues. But at retrospective analysis its primary nature cannot be ruled out. The difficulties of morphologic diagnosis occurring during tumor verification are objective as the diversity of tissues - sources of pleomorphic sarcomas - creates extremely complex histological presentation and exceptionally embarrasses defining the histogenesis of the tumor.

Aim. Evaluation of efficacy of complex treatment of patients with the diagnosis of chronic prostatitis and patients with the main diagnosis of benign prostatic hyperplasia and concomitant chronic prostatitis with the use of physiotherapeutic device for the treatment of inflammatory prostatic diseases «MAVIT».

Methods. Clinical efficacy of the treatment with the use of the «MAVIT» device was studied in complex treatment of 45 patients with chronic prostatitis. Group 1 consisted of 25 patients diagnosed with stage I-II benign prostatic hyperplasia complicated with chronic prostatitis. Group 2 included 20 patients with proven diagnosis of chronic prostatitis. Efficacy was evaluated immediately after the course of treatment and during the following 12 months. For evaluation of biotissue influence of the «MAVIT» device on blood flow in prostate, transrectal color Doppler ultrasound was performed in 10 patients from group 2 before and after physiotherapeutic session. Peak flow rate, index of peripheral vascular resistance as well as organ vascular density were studied.

Results. The treatment results were evaluated in both groups at months 3 to 12. All patients reported reduction or disappearance of dysuria, subjective improvement of urination, reduction of pain in genitals. Improvement of urination was registered based on the results of examination (IPSS scale, uroflowmetry, ultrasound of prostate, residual urine, transrectal color Doppler ultrasound).

Conclusion. In patients with symptomatic benign prostatic hyperplasia at conservative stage of the disease complex treatment of chronic prostatitis with the use of physiotherapeutic factors has pathogenetic value and, if necessary, allows preparing a patient for the surgery; the received results allow recommending the «MAVIT» device for the treatment of chronic prostatitis including patients with stage I-II benign prostatic hyperplasia.

Aim. To evaluate the effectiveness of ultrasound classification of thyroid palpable abnormalities using TI-RADS system for thyroid cancer detection in the Chuvash Republic.

Methods. The study is based on the results of examining of 296 patients (study group) with thyroid palpable abnormalities. All patients from the study group had multi-parametric ultrasound imaging performed using modern methods and techniques (B-mode, color and power Doppler mapping). Based on ultrasound data received, signs of malignancy of thyroid palpable abnormalities by TI-RADS system were identified. Data from ultrasound protocols were compared with cytological and morphological findings. Fine needle biopsy was used as «gold standard» for the diagnosis of thyroid cancer.

Results. All patients from study group were divided according to echographic characteristics into 4 subgroups by TI-RADS scale: TI-RADS 3, TI-RADS 4a, TI-RADS 4b, TI-RADS 5. Out of the total number of patients thyroid cancer in TI-RADS 3 subgroup was determined in 14 (4.7%) cases, TI-RADS 4a - in 36 (12.2%), TI-RADS 4b - in 66 (29.1%), TI-RADS 5 - in 160 (54.0%) cases. Among patients from TI-RADS 3 subgroup papillary cancer was detected in 6.7% (11) cases, follicular cancer - in 2.5% (3); in TI-RADS 4a subgroup papillary carcinoma was detected in 61.1% of cases, follicular cancer - in 36.1%, medullary cancer - in 2.8%; in TI-RADS 4b in 76.4% of cases papillary carcinoma was detected, in 31.4% - follicular cancer and in 1.2% - medullary cancer; in TI-RADS 5 subgroup in 46.3% of cases papillary carcinoma was detected, in 46.9% - follicular cancer, in 5.6% - medullary cancer and in 1.3% - anaplastic carcinoma was detected.

Conclusion. Suggested TI-RADS classification makes it possible to standardize thyroid ultrasound protocol; introduction of TI-RADS classification into algorithm of early radiological diagnosis of thyroid cancer allows improving thyroid cancer diagnosis.

Aim. To study the capabilities of digital radiography in the diagnosis of coronary calcifications and to perform a comparative analysis of the received results with the results of multidetector computed tomography.

Methods. We analyzed in a comparative aspect the results of examination of 90 patients who underwent both types of diagnostic procedures. Among the patients, 46 were males, 34 were females, the average age was 59±4.3 years, and the age of male patients was significantly higher than that of female patients. Statistical analysis was performed using variational, discriminant, correlation methods, evidence-based medicine methods and ROC-analysis.

Results. A comparative analysis of the results showed that the reason, why coronary calcifications visualized in all arteries at multidetector computed tomography are not visible on digital X-ray, is their decreased firmness, so these calcifications were soft enough. Visualization of calcifications on digital chest X-ray is limited to certain calcium score values, which for anterior interventricular branch of left coronary artery is 355, for circumflex branch of the left coronary artery - 385, for right coronary artery - 367, for left main coronary artery - 393, for aortic arch - 396. Coronary calcifications with similar and higher calcium score values can be detected with digital radiography, which allows integrating this method in screening for cardiovascular diseases risk. The sensitivity, specificity and overall value of digital radiography for the detection of coronary calcifications were 59.5±3.3, 85.5±2.9 and 70.0±2.4, respectively.

Conclusion. Detection of coronary calcifications in digital radiography is limited to certain calcium score values; in all coronary arteries at multidetector computed tomography, as the calcium score of coronary calcifications increases, the sensitivity and spesifity of their visualization in digital X-ray examination increase as well.

The article briefly covers the main stages of life and activities of V.F. Burgsdorf (1864-1935), his scientific achievements and priorities as the founder of one of Russian largest scientific schools, representatives of which made a huge contribution to the development of domestic dermatology. Special attention was paid to the contribution of V.F. Burgsdorf to the creation of the second in Russia phototherapy department in A.G. Ge’s Dermatology and Venereology clinic in Kazan, on the territory of which Republican Dermatology and Venereology Dispensary is currently located. The work in A.G. Ge’s (1889-1925) Dermatology and Venereology clinic became one of the most productive periods of life and activities of V.F. Burgsdorf. In November, 1900, V.F. Burgsdorf opened phototherapy department with support from professor A.G. Ge. Due to his medical and public authority V.F. Burgsdorf received large donations from Her Imperial Majesty the Empress Maria Feodorovna for further development of the department. V.F. Burgsdorf devoted most of his life to the development of treatment and prevention of skin and venereal diseases, organization of scientific research and improvement of medical education in Russia, and greatly improved the system of medical care for patients.

Common variable immunodeficiency is the most frequent among all primary immunodeficiencies and is characterized by decrease of immunoglobulin secretion which causes the extent of clinical presentation of the disease. In 17-70% of patients with common variable immunodeficiency, lymphoid hyperplasia of organs of gastrointestinal tract is revealed due to which these patients come into the view of gastroenterologists. The article describes clinical observation of a patient with small intestinal involvement in common variable immunodeficiency.