Science and Innovations in Medicine

Aim: to provide an anatomical description of the labyrinth and cock crest of the ethmoid bone in humans in the first period of adulthood based on computed tomography data.

Material and methods. The object of the study was 60 computed tomograms of the skull of people in the first period of mature age (22-35 years old - men, 21-35 years old - women), of different sexes, without pathology of the paranasal sinuses.

Results. In the first period of mature age, the value of the anteroposterior size of the labyrinth of the ethmoid bone on the right was 36.39±4.25 mm, on the left, 36.04±4.44 mm, with a range of values from 28.30 to 46.61 mm. The anteroposterior size of the ethmoid labyrinth on the right and left was 1.4 times greater than the height and 3 times greater than the width. The height of the ethmoid labyrinth in females on the right and left was 26.72±3.29 mm and 27.32±3.39 mm, respectively, and was significantly greater than this indicator in males. The height and anteroposterior size of the cock crest in the studied group were equal, amounting to 13.98±3.76 mm and 13.39±2.63 mm, respectively, and were 3 times greater than its width. In 25%, a pneumatized middle nasal concha was observed, and in 21%, a pneumatized cock crest.

Conclusion. The anatomical characteristics of the ethmoid bone, as an element of the nasal cavity, paranasal sinuses, internal base of the skull, and orbit, are of great importance for choosing the optimal surgical approach, in particular in endoscopic endonasal intervention.

Pelvic floor dysfunction has recently become one of the most common problems. Typical clinical manifestations of pelvic dysfunction include urinary and fecal incontinence and pelvic organ prolapse. The musculo-fascial structure of the pelvic floor plays a major role in these risks. Recognized potential factors for the development of pelvic dysfunction include age, obesity, and childbirth.

An analysis of over 50 literature sources demonstrates the importance of the muscular, mucosal, submucosal, and vascular-nerve components of the rectum in sphincter function. This knowledge will enable clinicians to perform diagnostic and therapeutic procedures with minimal adverse effects on the patient, taking into account the morpho-functional characteristics of each sphincter compartment.

Aim: to evaluate the clinical effectiveness of integrating treadmill training with a biofeedback (BFB) system into an early post-stroke rehabilitation program for managing motor disorders and improving functional outcomes.

Material and methods. The study involved 60 patients during the first 6 months after ischemic stroke. Participants were randomized into two groups: the main (experimental) group and the control group. Both groups received standard comprehensive therapy, including physiotherapy, mechanotherapy, and occupational therapy. The main group additionally underwent a course of treatment on a treadmill with BFB (Walker View), which provided feedback on parameters of the support reaction and step symmetry. For an objective assessment of dynamics, a set of clinical scales (Timed Up and Go test, 10-meter walk test, Berg Balance Scale) and instrumental analysis of gait parameters (walking speed, step length) were used. The assessment was conducted before and after a 14-day rehabilitation course.

Results. The conducted study demonstrated a statistically significant improvement in all assessed parameters in both groups, confirming the effectiveness of standard rehabilitation. However, in the main group where BFB was applied, the dynamics of improvement were better. A comparative analysis showed that these patients achieved a more pronounced reduction in the time taken to complete the “Timed Up and Go” (20% vs. 17%) and 10-meter walk tests (23.3% vs. 23.1%), a substantial increase in scores on the Berg Balance Scale (27.4% vs. 15.1%), as well as a significant increase in step length (41.2% vs. 27.3%) and no difference in walking speed.

Conclusion. The integrating treadmill training with biofeedback into an early post-stroke rehabilitation program increases the effectiveness of walking recovery compared to standard therapy. The method promotes improved gait symmetry, balance, increased speed and step length, ultimately leading to enhanced functional independence of patients. Further research is required to determine the clinical effectiveness of treadmill gait training with BFB in a larger sample of patients and with a longer follow-up.

Aim: to demonstrate the feasibility, safety, and efficacy of resection of major arteries (aorta, right/left iliac artery) and veins (inferior vena cava, right/left iliac vein) in patients with retroperitoneal non-organ liposarcomas with major vessel invasion.

Material and methods. This retrospective study included patients with retroperitoneal non-organ liposarcomas with major vessel invasion who underwent surgical treatment at the N.N. Blokhin National Medical Research Center of Oncology from 2001 to 2023. This included liposarcoma removal with multi-organ resection and resection of major arteries (aorta, right/left iliac artery) and veins (inferior vena cava, right/left iliac vein). Gore-Tex synthetic grafts were used for vascular reconstruction. In the presence of satisfactory collateral outflow, a circular resection of the inferior vena cava without grafting was performed. Complications of surgical treatment were assessed using the Clavien-Dindo scale. Statistical analysis of the study material was performed using Statistica for Windows v.10 and SPSS v21. Differences in the obtained results were considered statistically significant at a p level of ≤0.05. Survival was calculated using the Kaplan-Meier method, and the significance of differences was assessed using the log-rank test.

Results. The study included 28 patients with retroperitoneal non-organ liposarcomas with invasion of the great vessels: 9 (32.1%) men and 19 (67.9%) women, aged 22 to 73 years (median age 49.5 [42.5; 55.0] years). Eleven patients (39.3%) had a primary tumor, and 17 (60.7%) had a recurrent tumor. In 13 patients (46.4%), liposarcoma corresponded to stage Ib according to the TNM classification, in 6 (21.4%), stage IIIa, and in 9 (32.1%), stage IIIb. Multinodular liposarcoma was diagnosed in 12 cases (42.9%). In 13 patients (46.4%), the tumor had a high degree of differentiation (G1), in 7 (25%), moderate grade (G2), and in 8 (28.6%), low grade (G3). Neoadjuvant chemotherapy (doxorubicin + ifosfamide) was received by 6 patients (21.4%) with a stabilizing effect. All 28 patients underwent radical surgery. Along with liposarcoma removal, resection of the main arteries (aorta, right/left iliac artery) was performed in 9 (32.1%) cases, resection of the main veins (inferior cava, right/left iliac veins) in 13 (46.5%) cases, and resection of arteries and veins in 6 (21.4%) cases. Multiorgan resections of 1-5 organs were performed in 21 (75%) patients. The incidence of surgical complications of class III according to the Clavien-Dindo scale and above was 21.4% (n=6), postoperative mortality was 3.6% (n=1). The follow-up periods for 28 patients ranged from 2.3 to 189.8 months (median 62.5 [14.8; 84.6] months). During this time, disease progression occurred in 20 (71.4%) patients, local recurrence developed in 12 (42.9%), distant metastases in 7 (25%), and both local recurrence and distant metastases in 1 (3.6%). Eight (28.6%) patients died from liposarcoma progression. The overall 1- and 3-year survival rates were 96.4±3.5%, 5-year survival rates were 84.4±8.5%, and 10-year survival rates were 39.8±14.6% (median overall survival was 88.8 [72.3; -] months). The progression-free survival rates of liposarcoma were 84.8±7.0%, 48.9±11.2%, 21.7±9.5%, 5.4±5.3% and 21.7 [12.2; 52.5] months, respectively. Multivariate Cox regression analysis showed that the overall survival of 28 patients with retroperitoneal non-organ liposarcoma with invasion of great vessels was negatively affected by 3 independent factors: low degree of tumor differentiation, the presence of multinodular tumor and the presence of tumor invasion of organs located near the retroperitoneal non-organ liposarcoma, for which multiorgan resection was performed. Progression-free survival in retroperitoneal non-organ liposarcoma with great vessel invasion was statistically significantly negatively impacted by two independent factors: low tumor differentiation and the presence of tumor recurrence.

Conclusion. The results of our study demonstrated that radical surgical treatment of patients with retroperitoneal non-organ liposarcoma with great vessel invasion, including the aorta, is feasible in a specialized clinic. This treatment is associated with an acceptable complication rate and ensures a high overall 5-year survival rate of 84.4±8.5%.

Aim: to identify patterns of lung cancer incidence in the population of the Republic of Tatarstan and its dependence on air pollution and the cyclicity of solar activity.

Material and methods. The following data were used as initial data: data on lung cancer incidence available in the cancer registry of the Republican Clinical Oncology Dispensary of the Ministry of Health of the Republic of Tatarstan for the period from 2012 to 2021; data on emissions into the atmosphere and concentrations of carcinogens in the atmospheric air, available in the State reports “On the state of the natural environment of the Republic of Tatarstan” of the Ministry of Ecology and Natural Environment of the Republic of Tatarstan.

Results. The study demonstrated a high degree of correlation between the comprehensive index of air pollution with carcinogens (IAPc) and the incidence of lung cancer in the population (r=0.79 at the level of α=0.05). To identify the relationship between the solar activity and the incidence of lung cancer, a statistical analysis of the long-term incidence rate of the population and the level of solar activity was carried out using the relative number of sunspots (Wolf number, W). The correlation factor between W and the incidence of lung cancer is significant at α=0.05, the value being r=0.72, which indicates a noticeable strength of the relationship between the studied indicators.

Conclusion. Improving the monitoring system, monitoring the state of the external environment, and measures to prevent air pollution will help reduce the incidence of cancer, including lung cancer.

Aim: to analyze the results of applying a new approach to the prehabilitation of patients with total knee arthroplasty (TKA).

Material and methods. The study included 33 patients with knee osteoarthritis of stages III–IV according to the classification of Kellgren & Lawrence. 4 weeks before the operation, the patients underwent a comprehensive examination, which included a clinical examination, scales (WOMAC, KOOS, VAS), motor tests (2MWT, TUG) and electroneuromyography (ENMG) of the quadriceps, biceps femoris and calf muscles. Based on the identified leading OA syndrome, patients were stratified into three subgroups depending on the verified phenotype (chronic pain, inflammatory, and biomechanical disorders).

Results. An analysis of the results 72 hours before surgery and 72 hours, 4 and 12 weeks after TKA, showed that in the preoperative period, patients achieved statistically significant improvements in the form of a decrease in WOMAC scores to 38.0 (37.0; 39.0), a decrease in VAS pain to 6.0 (5.0; 6.0) points and an increase in motor activity of the examined muscles. In the postoperative period, at a follow-up period of 12 weeks after TKA, a full-fledged clinical and functional recovery was noted, confirmed by the results of the WOMAC, VAS, and 2MWT questionnaire scales: 15.0 (14.0; 17.0) points, 1.0 (0.0; 1.0) points, 154.06 ± 11.73 meters, respectively.

Conclusion. The developed approach to prehabilitation provides a significant improvement in the clinical and functional condition of patients both in the pre- and postoperative periods during knee replacement.

Splenic abscess as an independent disease accounts for no more than 1% of all acute surgical diseases of the organs of the abdomen. Diagnosis of splenic abscess is complex and ineffective without the use of instrumental methods, among which ultrasound and CT are of primary importance. Up to 30% of splenic abscesses are cured with conservative treatment. Surgical treatment methods include both modern minimally invasive and traditional open surgical interventions. Mortality from splenic abscess remains high, up to 50%.

This article presents a clinical case of splenic abscess in an elderly patient, likely of embolic origin that developed due to atrial fibrillation. The article justifies the abandonment of minimally invasive and organ-preserving treatment methods in favor of splenectomy via a laparotomy approach.