ИНФЕКЦИОННЫЕ ОСЛОЖНЕНИЯ ПОСЛЕ РЕКОНСТРУКТИВНЫХ ОПЕРАТИВНЫХ ВМЕШАТЕЛЬСТВ У БОЛЬНЫХ РАКОМ МОЛОЧНОЙ ЖЕЛЕЗЫ. ОПИСАНИЕ КЛИНИЧЕСКОГО СЛУЧАЯ

Introduction. Currently, there is no global consensus regarding the management of breast cancer patients with implant-associated infections. Some studies clearly recommend their removal and surgical debridement with consecutive antimicrobial treatment, while others prefer long-term antibacterial therapy (at least 1 month) with the effectiveness of such conservative approach of 36–73 %.Case description. A 43-year-old patient suffering from brca1-positive right breast cancer t2n0m0 (invasive carcinoma of non-specific type g3, er – 8, pgr – 0, her-2/neu – 0, ki67 (%) – less than 20 %), underwent radical skin-preserving mastectomy on the right with simultaneous implant reconstruction and preventive subcutaneous mastectomy on the left with simultaneous implant reconstruction. Peri-implant infection in the left breast was observed on the 21st day after surgery.Results. The patient received empirical therapy with cefepim. Microbiological examination of the punctate revealed the causative agent of infection – methicillin-resistant staphylococcus aureus (mrsa) (1×105cfu/ml). Daptomycin 6 mg/kg/day was added to therapy. After 8 weeks, the patient received oral moxifloxacin 400 once daily, for another 3 weeks. A complete response was achieved. The patient has no signs of infection for 3 years.Conclusion. Long-term etiotropic antibacterial therapy with daptomycin followed by oral moxifloxacin resulted in a stable clinical effect.Актуальность. В настоящее время в мире нет единого мнения в отношении тактики ведения пациенток с раком молочной железы с имплант-ассоциированными инфекциями. В одних исследованиях однозначно рекомендованы их удаление и хирургическая санация c последующей антибактериальной терапией, в других – отдается предпочтение длительной антимикробной терапии (не менее 1 мес), при этом эффективность консервативного подхода достигает 36–73 %.Клинический случай. Пациентке 43 лет, страдающей BRCa1-положительным раком правой молочной железы t2n0M0 (инвазивная карцинома неспецифического типа G3, eR – 8, PgR – 0, Her-2/neu – 0, Ki67 (%) – менее 20 %), были выполнены радикальная кожесохранная мастэктомия справа с одномоментной реконструкцией имплантом и профилактическая подкожная мастэктомия слева с одномоментной реконструкцией имплантом. на 21-е сут после операции развилась инфекция в области импланта левой молочной железы.Результаты. Пациентке эмпирически была назначена терапия цефепимом. При микробиологическом исследовании пунктата был выявлен возбудитель инфекции – метициллин-резистентный золотистый стафилококк (MRSA) в количестве 1×105кОЕ/мл. к терапии был добавлен даптомицин 6 мг/кг/сут. Через 8 нед пациентка была переведена на пероральный моксифлоксацин 400 мг 1 раз в сут, который получала еще 3 нед. на фоне лечения был получен полный эффект. Больная без признаков инфекции в течение 3 лет.Заключение. Длительная этиотропная антибактериальная терапия с использованием даптомицина с переходом на пероральный моксифлоксацин позволила получить стойкий клинический эффект и своевременно провести адъювантное противоопухолевое лечение

PRIMARY SYNOVIAL CHONDROMATOSIS OF THE SHOULDER (CASE REPORT)

Primary synovial chondromatosis of a shoulder is quite rare in clinical practice. The diagnostics of this pathology has to include the histological examination of intraarticular material to detect the signs of tissue malignant transformation. Currently surgical intervention of this disease involves the removal of intra-articular cartilaginous bodies and local synovectomy of the affected joint by arthroscopic or open methods. The authors describe the clinical, histologic and arthroscopic features of primary synovial chondromatosis of the shoulder in order to assess the possibility of its minimally invasive correction. The clinical example of diagnostics and treatment of patient with this pathology was presented

LONG-TERM RESULTS OF ARTHROSCOPIC TREATMENT FOR INSTABILITY AT RECURRENT SHOULDER JOINT, CAUSES OF FAILURE

The authors analyse the results of the performance of arthroscopy stitch on the injured capsule with the use of anchor on 46 patients with anterior recurring instability of the shoulder joint within a period of time from 6 months to 4 years. When assessing the results of the given treatment, functional scales, clinical examination methods and radiological methods have been used. The article presents the results of arthroscopy diagnosis of the interior joint damage accompanying the recurring instability of the shoulder joint. The effectiveness of the conducted operations was 93,5%. The occurrence of postoperative relapses of joint instability (reoccurring dislocations) in 3 patients (6,5%) was caused by the presence of significant damage of bone formations in the shoulder joint – the shoulder-blade joint socket and the shoulder-bone head as well as the reduction of the strength and elasticity of the soft-tissue structures

ARTHROSCOPY POSSIBILITIES IN TREATMENT OF INJURIES OF THE SHOULDER ROTATOR CUFF

The authors analyzed the results of arthroscopic treatment 58 patients with various injuries of rotator cuff. Follow-up was from 4 months to 3 years (average 18 ± 5,2 months) after surgery. The quantitative MRI characteristics allowing to define prognostically unfavorable variants of rotator cuff surgery are presented. The authors considered the ways out of such situations including the partial restoration of the rotator cuff structures by arthroscopic method and reverse shoulder arthroplasty