Vol 26, No 2 (2022): LARGE JOINTS ANATOMY AND PATHOLOGY

In the more than century-long history of shoulder arthroplasty, scientists have gone from primitive ivory designs to high-tech implants made of rare metal alloys. Along the way, surgeons and inventors have faced challenges, made mistakes, and succeeded. This literature review reflects trends in the development of shoulder arthroplasty, evolutionary changes in endoprosthesis designs and principles of surgical treatment of shoulder pathology, from the late 19th century to the present. This paper details the stages of formation of the major modern philosophies of shoulder arthroplasty, such as those of Ch. Neer (anatomical prosthetics), P.M. Grammont (reversible prosthetics), and J. Zippel (surface prosthetics). In the 70s and 80s of the 20th century the components of shoulder prostheses as well as their fitting techniques continued to be improved from a biomechanical point of view. It was found that if the shoulder head and scapular component have different radii of curvature during arthroplasty, a shoulder-b lade mismatch is formed. A non-congruent joint (the radius of curvature of the head is smaller than the radius of curvature of the glenoid component) increases eccentric loads on the scapula joint implant, increases the risk of implant fracture, and reduces stability in the joint. However, such a joint allows reproduction of the natural gliding of the head. Restricting the required glide increases stress at the fixation site and can lead to loosening of the glenoid component. A number of studies have shown that a mismatch of more than 10 mm increases the risk of loosening and fractures of the scapular component, while a mismatch of 5-7 mm can be considered optimal, as it provides long-term survival of the glenoid component and the best reproduction of normal movements in the shoulder joint.

Relevance. There is no doubt that microorganisms participate in occurrence and development of septic process in joints. However, the issue of etiological significance of each agent remains controversial, because, in spite of the general trends, indicating the participation of numerous microorganisms in the development of articular pathology, each result of microbiological analysis concerns only a specific case in the territorial and clinical aspects. The aim of the study - microbiological research of synovial fluid obtained from knee joint during synovitis after its aspiration in patients of various departments of the Stavropol Regional Clinical Hospital. Materials and Methods . There were studied 198 samples of synovial fluid. Primary inoculation of puncture was performed with subsequent isolation, identification of the cultures by mass spectrometry and assessment of their antibiotic sensitivity by discodiffusion method. Results and Discussion . 11 cultures of bacterial pathogens were isolated. Gram-positive cocci - 82 %, of which 77.8 % - microorganisms of Staphylococcus genus (44.4 % S.aureus , 33.4 % S.epidermidis ), 22.2 % - other gram-positive cocci: one strain of each, Enterococcus faecium and Streptococcus mitis . Gram-negative pathogens are represented by K.neumoniae and P.aeruginosa with a total content of 18 %. Highly virulent microorganisms S.aureus , K.neumoniae and P.aeruginosa are isolated from the synovial fluid of patients of the surgical departments (orthopedotraumatological No. 1, No. 2) and the rheumatological department. Microorganisms with low virulence E.faecium , S.mitis and S.epidermidis are isolated from synovial fluid of patients of various departments. No obvious resistance of isolated pathogens to antimicrobial drugs has been registered. Conclusion . The presence and species affiliation of the microorganisms identified in synovial fluid allows predicting their etiological significance in development of septic process in joints. Their role as causative agents of nosocomial infections typical for a medical institution is not excluded. The presence of articular pathology in each of the examined departments dictates the need for a clear understanding of the importance of timely and high-quality joint aspiration followed by microbiological examination in almost all patients with damage of large joints, including patients without clinical signs of septic arthritis. Such an approach that makes it possible to identify a greater number of causative agents of septic arthritis and quickly evaluate the dynamics of their antimicrobial resistance should become an obligatory part of a comprehensive research and treatment of a patient with arthritis in multi-fi eld hospitals.

Relevance. Recently, much attention has been paid to the study of the role of various risk factors in the pathogenesis of herniation along the midline of the abdomen. The question of their interrelation with another equally important predictor of herniogenesis - connective tissue insufficiency remains understudied. The aim of the present study is to investigate the severity of connective tissue dysplasia and peculiarities of its interaction with other risk factors in different variants of midline abdominal herniotransformation. Materials and Methods. The examined group included 150 (89.2%) patients with postoperative median hernias of various sizes and 18 (10.8%) patients with primary hernias of the white line of the abdomen. In 12 (8%) cases, relapses of postoperative hernial protrusions were noted. In 12 (10.5 %) cases, relapses of postoperative hernial protrusions were noted. The surveyed group included 109 (64.8 %) women and 59 (35.2 %) men. Risk factors for median herniogenesis were evaluated in the opposite sense relative to the severity of connective tissue pathology. Results and Discussion. We evaluated the risk factors of median herniogenesis in the opposite value and direction with regard to the severity of connective tissue pathology in the observation groups. It was found out that the leading role in herniotransformation of the medial abdominal line belongs to the suppuration of postoperative medial wounds, relaparotomy and heavy physical load with the role efficiency of 66.6 %, 56.2 % and 54.5 % respectively. The lowest level of connective tissue dysplasia was observed in the groups where the risk factors of median herniogenesis were the age of patients, the presence of relaparotomy in the history and heavy physical activity. Only in the observation group, where pregnancy and childbirth in the anamnesis were the predictors, the patients with white line hernias had less severe connective tissue insufficiency by 27,9 % in comparison with the patients with postoperative median hernias. In patients with recurrent midline hernias in all risk factors, the severity of connective tissue dysplasia always reached the maximum score. Conclusion. At any predictor of hernia formation or their combined effect, the severity of connective tissue dysplasia always remained severe, which confirms one of the leading roles of connective tissue pathology in the formation of medial abdominal hernias.

Relevance. The current limits of endoscopic removal of sialolithes are limited to 3-5mm, larger sialolithes require crushing, but an effective and safe technology has not yet been found. The solution to this problem is primarily related to the technologies of shock wave lithotripsy. Currently, various methods of lithotripsy using extracorporeal and intracorporeal sources are described in the literature. The positive experience of urological laser lithotripsy served as the basis for our study of the possibilities of using the thule laser device FiberLase U2 for the fragmentation of sialolithes. Materials and Methods. The study included 16 clinical observations of patients diagnosed with sialolithiasis who underwent sialoendoscopy with additional application of the technique of intra-c urrent crushing of the concretion with a thule laser device FiberLase U2 with subsequent extraction of fragments. Results and Discussion. Sialolithes were fragmented in all 16 clinical cases, regardless of shape and structure. Large fragments were removed using basket traps and endoscopic forceps. In 9 out of 16 observations, the operation ended with the complete removal of the stone and all its visible fragments (until the duct was completely cleaned). In 7 patients, fragments remained in the duct, which could not be removed. During the crushing process, we observed an undesirable effect of retrograde migration of the stone with a pulse impact, as well as the resulting suspension of small fragments and air bubbles complicated the visibility and the operation process. Also, in 3 cases, when the stone was destroyed, the laser beam hit the duct wall, which was accompanied by weak bleeding and for a while hindered endoscopic visibility and required active irrigation. Conclusion. At the first time, the technology of thule laser lithotripsy was used that made possible the destruction of sialolithes and remove stones larger than 5 mm. This approach expands the limits of endoscopic surgery of sialolithiasis. At the same time, there is a number of important problems that require further study and improvement of the method.

Relevance. Currently, many ideas about the manifestation of emotions between people are changing, but kissing remains one of the most important forms of social interaction. There is a lot of information about the multitude of pathogens transmitted with kisses, however, most people are not aware of it. This topic is not paid enough attention to, both in society as a whole and among the youth audience. The aim of the study . This research aims to identify the degree of awareness among young people about the possibility of transmission of various microorganisms during kissing, as well as to determine the relevance of this problem . Materials and Methods. Analysis of scientific literature on microorganisms transmitted by contact of the mucous membranes of the oral cavity. The empirical method consisted of testing, which involved 140 people aged 16 to 25 years. The survey included six questions to assess the level of knowledge about infectious agents transmitted with kisses, as well as the relevance of this topic among young people. Results and Discussion. The survey reveals that 97 % of respondents know that the transmission of bacterial infection is possible with a kiss, while 57 % have heard about the danger of transmission of only some microorganisms or do not know about them at all. Every sixth participant of the survey (18 %) has personally encountered or knows from acquaintances that they have suffered from infectious diseases caused by kissing. 88 % of respondents believe that this topic is poorly covered in the media. It should be emphasized that 91.4 % of the respondents would like to learn more about this topic. An average of 65 % of respondents are interested in protectеtive factors of the oral cavity and potential pathogens of diseases of the upper respiratory tract’s mucous membranes, 56.4 % of young people would like to learn more the functioning of the oral immune system. Conclusion. The study has shown that the topic of infections’ transmission during kissing is relevant among young people. Since not enough attention is paid to this issue in the society, the amount of available information on this topic is rather little. The majority of respondents would like to learn more about the possible transmission of infectious diseases’ pathogens during kissing.

The low incidence of skin sarcoidosis in the practice of a dermatologist, numerous clinical manifestations, similarities with other dermatoses cause difficulties in timely diagnosis, lead to diagnostic errors, and, as a consequence, untimely therapy. The presented clinical observation demonstrates the important role of conducting a detailed differential diagnostic search in patients with suspected skin sarcoidosis. Cutaneous manifestations of the pathological process can be combined with lesions of the lymph nodes, respiratory system and other organs, precede them or be isolated, in this regard, each patient with a verified diagnosis of skin sarcoidosis should be examined to exclude systemic signs of the disease. It should be emphasized that sarcoidosis of the skin can have a paraneoplastic character, being a marker of lymphoproliferative processes, myelodysplastic syndrome, therefore, correct and timely verification of the skin process may be a prerequisite for early diagnosis of other, possibly subclinically occurring pathological processes in the patient.

The 20th century is the time of the birth of many scientific areas, including the physiology of the kidneys and water-salt metabolism. This article is devoted to the history of the development of one of its directions - the issue of regulation of sodium homeostasis in the body. This article is the first attempt in the Russianspeaking space to summarize the achievements in the study of sodium regulation. For many decades, scientists from different countries have studied the influence of various factors on sodium excretion: blood pressure, atrial peptides, hormones of the neurohypophysis and adrenal glands, renal nerves, infusion of various substances, etc. It was found that sodium excretion does not directly depend on changes in blood pressure and glomerular filtration rate. Atrial peptides causing natriuresis were discovered, their structure and mechanism of action were described in detail. The role of the hormones of the neurohypophysis - vasopressin and oxytocin - in the excretion of sodium, as well as the role of aldosterone and angiotensin II in the reabsorption of this cation was shown. It has been shown that the administration of hypertonic solutions of sodium chloride causes a greater natriuretic response than the administration of other substances (sodium sulfate and acetate, glucose, mannitol, etc.), and the idea of the existence of sodium-s ensitive receptors has also been put forward.