Patterns in life quality changes of Irkutsk city’s inhabitants according to SF-36 questionnaire

Actuality. At the moment, one of the current trends in medicine and sociology is the study of life quality in population. The motivation for this study was the lack of population-based studies on life quality assessment for adult population conducted in Irkutsk, taking into account the individual characteristics of all age groups with questionnaire SF-36. Purpose. To evaluate standard criteria for Irkutsk adult population's life standard in terms of the age and gender by means of the standard questionnaire SF-36. Materials and methods. The article represents the interview results received from 579 Irkutsk dwellers at the age of 18-85. The Russian version of SF-36 Questionnaire has been used for the present research. The criteria were estimated according to 8 scales. The levels of the respondents' physical well-being, socio-environmental adaptation, psycho-emotional changes and viability were specified. Moreover, the respondents' clinical-anamnestic status including complaints, anamnestic evidences for somatic pathology and earlier surgical interventions were evaluated as well. The received data were processed by Statistica 6.0 software with the use of nonparametric and multiple factor analysis. Results. The results determine the levels of physical functioning, social adaptation, psycho-emotional changes and the viability of Irkutsk residents of different age, gender and socio-professional groups. Conclusions. The presence of comorbidity in varying degrees affected the quality of life

Unstable Hemostasis and Specific Postoperative Complications (Literature Review)

Perioperative bleeding occupies a leading place among all surgical complications and, despite the rapid development of surgery, remains relevant to this day. In addition to an increase in mortality, bleeding can cause the development of other postoperative complications, which lead to disability of patients and to a decrease in the quality of life in all age groups. Most perioperative bleeding are caused by technical errors. This article reviews the problem of perioperative bleeding from the point of view of impaired coagulation capabilities of the body. The main etiopathogenetic features of hemostasis during the development of this complication are considered. The analysis of postoperative complications, which were directly or indirectly caused by bleeding during or after surgery, is presented. The prevalence of these complications in various areas of surgery has been demonstrated. More detailed study of the hemostasis system and the identification of predictors of hemostasis difficulties before the surgery may cause an improvement in the results of surgical treatment and reduce the number of postoperative complications and the duration of hospital stay. Accordingly, this will lead to a decrease in the cost of treatment and an increase in patient satisfaction with the medical care. In connection with the above, there is a great interest among surgeons and anesthesiologists in preventing the development of perioperative bleeding

Clinical features of sporadic multigland parathyroid disease

Background. Sporadic multigland parathyroid disease (MGD) account for 1/4 of all cases of primary hyperparathyroidism (PHPT). There are no specific signs of MGD in comparison with single-gland parathyroid disease in PHPT. The only radical treatment is surgical, therefore, determining the number of excessively functioning parathyroid glands at the preoperative stage is important for choosing the extent of the operation and the success of the treatment in general.The aim. To identify the specific signs of multigland parathyroid disease in patients who underwent surgery for primary hyperparathyroidism. Methods. We conducted a single-center prospective study including 126 cases of surgical treatment of PHPT from December 2019 to June 2021. The study included an analysis of demographic, clinical, laboratory parameters and visual methods of topical diagnosis of parathyroid glands (ultrasound, scintigraphy, multislice computed tomography). The main endpoint of the study was the identification of characteristic signs of MGD in patients with PHPT.Results. Lower values of creatinine (p ≤ 0.01; Mann – Whitney U-test), albuminadjusted calcium (p ≤ 0.05; Mann – Whitney U-test), parathyroid hormone (p ≤ 0.01; Mann – Whitney U-test), glomerular filtration rate (p ≤ 0.01; Mann – Whitney U-test) and inconsistency of two methods of preoperative imaging (p ≤ 0.01; χ2) were set as specific signs of multigland compared with single-gland parathyroid disease. Conclusion. The results of preoperative biochemical and imaging studies can become the basis for differentiating single-gland and multigland parathyroid disease in primary hyperparathyroidism

Quality of life of patients with singleand multigland parathyroid disease in sporadic primary hyperparathyroidism before and after surgical treatment

Background. In 15–25 % of cases, the cause of primary hyperparathyroidism (PHPT) is multigland parathyroid disease. The complexity of clinical and laboratory prognosis, low efficiency of imaging methods, inaccurate assessment of the radicality of the surgery are the components of the problem of this variant of the disease. Quality of life (QOL) is an important criterion for the effectiveness of surgical treatment. A study of the QOL in patients with multigland parathyroid disease in PHPT has not been previously conducted in our country. The aim of the study. To assess the quality of life of patients with single- and multigland parathyroid disease in sporadic primary hyperparathyroidism before and after parathyroidectomy (PTE). Methods. As part of a prospective observational study, the quality of life of 64 patients with PHPT before and after PTE was assessed using SF-36 (Short Form 36) questionnaire: main group (n  =  13) – patients with multigland parathyroid disease; comparison group (n = 51) – patients with single-gland parathyroid disease. The quality of life indicators of the patients were compared with those in a sample of the Irkutsk region population similar in gender and age. Results. Before performing PTE, the quality of life of patients with PHPT was lower than that of the Irkutsk region population. The greatest decrease in both health components was registered in the main group. In 90 % of patients, the quality of life improved after PTE, while in the main group changes were established 1 year after the surgery, in the comparison group – 6 months after the surgery. Transient complications (laryngeal paresis) and disease outcomes (hypocalcemia, hypoparathyroidism) did not interfere with the improvement of quality of life in both groups. When persistence was detected, no significant improvement in QOL was established. Conclusion. The quality of life of patients with PHPT is significantly reduced. PTE improves the QOL of these patients, and only persistence of the disease does not allow this to be achieved. Therefore, surgical tactics aimed at reducing the frequency of persistence will achieve a decent quality of life in the majority of patients with multigland parathyroid disease in PHPT

Disputable Issues of Etiology and Pathogenesis of Tertiary Hyperparathyroidism

Hyperparathyroidism is a clinical and laboratory syndrome characterized by high production of the chief cells of the parathyroid hormone, a calcium-phosphorus metabolism disorder and the organ failure (kidneys, bone tissue).There are primary, secondary and tertiary hyperparathyroidism.This literature review is focused on tertiary hyperparathyroidism and includes the following sections: definition of different forms of hyperparathyroidism, the role of vitamin D in the tertiary hyperparathyroidism development, the development of tertiary hyperparathyroidism in chronic kidney disease patients, the development of tertiary hyperparathyroidism in patients after kidney transplantation, differential diagnosis various forms of hyperparathyroidism, indications for surgical tertiary hyperparathyroidism treatment in patients with kidney disease, in patients with normal kidney function.Objective. The objective of this literature review is to study the current information about this definition, pathogenesis, diagnosis and treatment of tertiary hyperparathyroidism.Methodology. The literature review was taken in English data bases MEDLINE (Pubmed), Scopus, Cochlear library, using following keywords: “secondary hyperparathyroidism pathogenesis diagnosis treatment”, “tertiary hyperparathyroidism pathogenesis diagnosis treatment”, “development of tertiary hyperparathyroidism from secondary hyperparathyroidism”, “chronic vitamin D deficiency, hyperparathyroidism”, “early stages of chronic renal failure, hyperparathyroidism”. Also, search for the same keywords was completed in Russian data base Elibrary.Discussion. Both the lack of a common understanding of this problem, and the presence of diverse and contradictory data of the etiology and pathogenesis indicate the need for further study of tertiary hyperparathyroidism

“Nothing on Earth Passes without a Trace...”

The review of unique “memorial” edition “Life of Remarkable People of Physical and Mathematical Faculty” devoted to genesis and main stages of formation of physical and mathematical school in Samara (Samara State Socio-Pedagogical University) is presented. A detailed analysis of the presented material is made, which covers almost a century-old history of the physical and mathematical school, from the 1930s until today. Attention is focused on the composition of the book, reflecting its main idea: to show the continuity of generations and the importance of each teacher both as a person and as a scientist, as well as a teacher who contributed to the development of the scientific school

Morphological criteria for sporadic multiple parathyroid gland disease

Background. There are no specific morphological signs for sporadic multiglandular disease (MGD) in primary hyperparathyroidism (PHPT). The aim of the study. To study the structure of the morphological substrate of primary, secondary and tertiary hyperparathyroidism and to assess the effectiveness of morphological criteria in the diagnosis of sporadic multiglandular disease in primary hyperparathyroidism. Methods. The study included 69  patients; 18  patients with PHPT and sporadic multiglandular disease (npreparation  =  31) formed the main group, 51  patients (npreparations  =  104) – the comparison group. The comparison group was divided into 3 subgroups: 1) patients with PHPT and solitary parathyroid gland (PTG) lesions – 26 patients (npreparations = 26); 2) patients with secondary hyperparathyroidism (SHPT) – 15 patients (npreparations = 48); 3) patients with tertiary hyperparathyroidism (TGPT) – 10 patients (npreparations = 30). Results. The morphological structure of the comparison groups is homogeneous: group  1 is represented by parathyroid adenoma (26  (100  %)), groups  2 and  3 – by hyperplasia (48 (100 %) and 30 (100 %), respectively). Most of the PTG specimens of the main group are represented by hyperplasia (25 (80 %)), and in 1/5 cases – by adenomas (6 (19.4 %)). Sporadic multiglandular disease in PHPT was characterized by a predominant frequency of detecting the absence of a capsule and a rim of unchanged tissue, as well as the presence of adipocytes (pχ2 < 0.01). Components of the  PTG morphological structure make it possible to identify changes specific to  the  sporadic multiglandular disease in PHPT, with a diagnostic efficiency of 76.5–90.3 %. Conclusion. Sporadic multiglandular disease in any clinical variant of hyperparathyroidism is characterized by a high prevalence of hyperplasia – 80 % in PHPT and 100  % in SHPT and  TGPT. The following morphological criteria for sporadic multiglandular disease in PHPT have been established: the presence of adipocytes in the PTG parenchyma (diagnostic efficiency (DE) – 90 %)); absence of a capsule (DE = 78 %) and a rim of unchanged gland tissue (DE = 76 %)

Surgical Treatment of Secondary Hyperparathyroidism at Ectopic Parathyroid Gland in Anterior-Superior Mediastinum (Literature Review and Clinical Case)

Parathyroidectomy is the leading treatment for drug-refractory secondary and tertiary hyperparathyroidism in patients with chronic kidney disease. Difficulties in performing this surgery are mainly associated with the anatomical features of the parathyroid glands, in particular with the variability of their number and topographic anatomy. Ectopic parathyroid glands are one of the most common causes of persistence or recurrence of secondary hyperparathyroidism after surgery. One of the common variants of ectopia is the localization of the parathyroid gland in the anterior-superior mediastinum. The article discusses the features of surgical treatment of secondary hyperparathyroidism in patients with end-stage chronic kidney disease with this ectopia. A new method of treating hyperparathyroidism in patients with an atypical location of the parathyroid gland in the anterior-superior mediastinum is presented. This method is characterized by low invasiveness of access, ease of implementation without using special equipment and instruments. The proposed method was used in the treatment of a patient with secondary hyperparathyroidism due to chronic renal failure as a result of chronic glomerulonephritis. The duration of hemodialysis at the time of the surgery was more than 17 years. In the presented clinical case, ectopia of one of the pathologically altered parathyroid glands in the anterior-superior mediastinum was found at the preoperative stage. As a method of surgical treatment, we carried out total parathyroidectomy with autotransplantation of a fragment of parathyroid tissue into the brachioradialis muscle. Thanks to this method, it was possible to remove the atypically located parathyroid gland from the cervicotomy access and to discharge the patient within the standard terms for a given volume of surgery

Multiglandular Parathyroid Disease: the Results of Surgical Treatment

Background. Sporadic multiple gland disease in primary hyperparathyroidism occurs in 7 to 33 % of cases. The absence of specific risk factors, low sensitivity of imaging methods, and low efficiency of bilateral neck exploration and intraoperative monitoring of parathyroid hormone indicate the complexity of the diagnosis and treatment of this disease’s form. Aim of the research. To analyze the results of surgical treatment of multiple lesions of the parathyroid gland in primary and secondary hyperparathyroidism. Methods. There was retrospective study, which included 100 observations of surgical treatment for primary and secondary hyperparathyroidism in the thoracic department of Irkutsk Regional Clinical Hospital from May 2018 to September 2019. The main point was to identify the frequency of surgical treatment outcomes in patients with multiple parathyroid lesions. As part of the study, potential predictors of multiple gland disease in primary hyperparathyroidism were analyzed. Results. Multiple gland disease in primary hyperparathyroidism occurs in 29 % of cases and causes persistence of the disease (p ≤ 0.01). Signs of multiple gland disease in primary hyperparathyroidism include the level of ionized calcium, parathyroid hormone (p ≤ 0.05), creatinine level and glomerular filtration rate (p ≤ 0.01). A negative result of intraoperative monitoring correlates with persistence of primary hyperparathyroidism in multiple lesions (χ2, p ≤ 0.05). Selective parathyroidectomy is associated with persistence of hyperparathyroidism in multiple lesions (χ2, p ≤ 0.05), while total parathyroidectomy is associated with remission of the disease (χ2, p ≤ 0.05). We did not find a statistically significant relationship between the results of surgical treatment for morphology of the parathyroid glands (χ2, p > 0.1). Conclusion. Multiple gland disease is the main cause of persistence of primary hyperparathyroidism. This form of the disease corresponds to lower levels of calcium, parathyroid hormone, and kidney function. Persistence factors have been established: removal of less than four parathyroid glands and a negative result of intraoperative monitoring of parathyroid hormone. Bilateral neck exploration does not reduce the incidence of disease persistence

Experience of surgical treatment of secondary hyperparathyroidism

Surgical treatment of secondary hyperparathyroidism (HPT) in patients having renal replacement therapy (RRT) is a current problem. The aim of our study was to optimize the treatment of secondary HPT based on the comparative analysis of effectiveness of the surgeries with different extents. We conducted a retrospective analysis of the results of surgical treatment of uremic HPT in 34 patients. 36 surgeries were performed including 34 primary (16 subtotal parathyroidecomies (PTE), 13 total parathyroidecomies (total PTE 1), 5 total parathyroidecomies with central neck dissection and resection of superior mediastinum and superior thymus horns (total PTE II)) and 2 repeated surgeries (total PTE 11 and parathyroidadenomectomy). Gross examination of 134 surgical specimens revealed dyssynchronous pathological changes in parathyroid glands (PTG), normal PTG structure was found in 2 cases. Recurrent HPT was found in 3 cases, persistent HPT - in 9 cases, hypoparathyroidism - in 5 cases after subtotal PTE and in 9 cases after total PTE with autotransplantation (p = 0,267). Target values of parathyroid hormone were registered in 8 patients, including 4 patients after subtotal PTE and 4 patients after total PTE (p > 0,95). Morbidity was similar in all types of surgeries (p > 0,5). Analysis of morbidity determined that simultaneous surgery of thyroid gland increased the risk of laryngeal paralysis (р = 0,028). The decrease in occurrence of secondary HPT persistence (with the source accessible for removal through cervical approach) at total PTE based on the removal of parathyroid glands of all localizations accessible through cervical approach (including thyroid gland lobes with diagnosed ectopia, central cervical fat pad, superior mediastinum and superior thymus horns) was registered (NNT = 4)