CASE REPORT ON SUCCESSFUL COLLABORATIVE THROMBOLYTIC THERAPY, MECHANICAL THROMBUS EXTRACTION, AND STENTING IN A PATIENT WITH ISCHEMIC STROKE IN THE TERRITORY OF THE RIGHT MIDDLE CEREBRAL ARTERY

VASKAEVA GULNAZ R., ORCID ID: 0000-0001-6565-7642, Neurologist, City Clinical Hospital 7 named after M. N. Sadykov, 54 Marshal Chuikov, 420103 Kazan, Russia; e-mail: gulnaz.vaskaeva@gmail.com

VALEEA KADRIYA G., ORCID ID: 0009-0001-4699-9257, Neurologist, City Clinical Hospital 7 named after M. N. Sadykov, 54 Marshal Chuikov, 420103 Kazan, Russia e-mail: valeevakadria@yandex.ru

MINGAZETDINOV MARAT A., ORCID ID: 0009-0005-6011-969X, Head of the Department of Interventional Radiology in Diagnosing and Treatment, City Clinical Hospital 7 named after M. N. Sadykov, 54 Marshal Chuikov, 420103 Kazan, Russia; e-mail: minguss@inbox.ru

YUSUPOV RAMIL I., ORCID ID: 0009-0007-0671-2833, Physician at the Department of Interventional Radiology in Diagnosing and Treatment, City Clinical Hospital 7 named after M. N. Sadykov, 54 Marshal Chuikov, 420103 Kazan, Russia; e-mail: jusupovramil@yandex.ru

DANILOVA TATIANA V., ORCID ID: 0000-0001-6926-6155, Dr. sc. med, Associate Professor at the Department of Neurology, Kazan State Medical University, 49 Butlerov str., 420012 Kazan, Russia; e-mail: tatvdan@yandex.ru

Abstract. Introduction. As of today, acute cerebrovascular accident is still the most important medical and social challenge in the modern society, due to its high growth rates of morbidity, disability, and mortality. A highly proven method of ischemic stroke treatment is reperfusion therapy, including intravenous thrombolytic therapy and mechanical thrombus extraction. Thrombus extraction is a high–tech medical procedure aimed at removing blood clots, which is the most effective way to treat patients with ischemic stroke. Aim. To illustrate the efficiency of collaborative thrombolytic therapy, mechanical thrombus extraction, and stenting. Materials and Methods. The article presents a clinical case report on a patient with ischemic stroke in the territory of the right middle cerebral artery upon the successful collaborative thrombolytic therapy, mechanical thrombus extraction, and stenting. The patient’s neurological status was assessed, and neuroimaging was performed before and after thrombolytic therapy, mechanical thrombus extraction, and stenting; laboratory tests and instrumental investigations were carried out, and secondary prevention was prescribed.Results and Discussion. Due to the successful staged reperfusion therapy including intravenous thrombolytic therapy followed by mechanical thrombus extraction using a stent retriever, and stenting of the right internal carotid artery, the physicians managed to achieve the restoration of blood flow along the right middle cerebral artery with significant clinical regression of neurological deficit, which achievement demonstrated the effectiveness, safety, and expediency of using this treatment technique. Combining these methods is efficient for the treatment of patients with ischemic stroke caused by the major artery occlusions in the anterior parts of Willis circle. In centers of vascular medicine where there is no high-tech medical care, thrombolytic therapy is administered intravenously in one medical institution, and then the patient is transferred to another one where it is possible to perform mechanical thrombus extraction, or both reperfusion therapy techniques can be used within one medical institution. Conclusions. Collaboratively performing the above procedures illustrates their high efficiency and safety. Time elapsed from the disease onset to the treatment initiation is essential to successful recanalization.

Keywords: ischemic stroke, thrombolytic therapy, mechanical thrombus extraction, stenting, stent-retriever.

For reference: Vaskaeva GR, Valeeva KG, Mingazetdinov MA et al. Case report on successful collaborative thrombolytic therapy, mechanical thrombus extraction, and stenting in a patient with ischemic stroke in the territory of the right middle cerebral artery. The Bulletin of Contemporary Clinical Medicine. 2023;16(suppl.1):7-13. DOI:10.20969/VSKM.2023.16(suppl.1).7-13.

 SUCCESSFUL CASE OF USING THE POLYMYXIN SORPTION OF ENDOTOXIN IN THE COMBINED THERAPY OF A PATIENT WITH GRAM-NEGATIVE SEPSIS CAUSED BY LATE INFECTED MISCARRIAGE

GABIDULLINA RUSHANIA I., ORCID ID: 0000-0002-7567-6043; Scopus Author ID 57215670415; Dr. sc. med., Professor, Head of the Department of Obstetrics and Gynecology named after prof. V.S. Gruzdev, Kazan State Medical University, 49 Butlerov str., 420012 Kazan, Russia. E-mail: ru.gabidullina@yandex.ru

BAYALIEVA AINAGUL ZH., ORCID ID: 0000-0001-7577-3284; Dr. sc. med., Professor, Head of the Department of Anesthesiology, Intensive Care and Emergency Medicine, Chief Anesthesiology / Intensive Care Consultant at the Ministry of Health of the Republic of Tatarstan. Kazan State Medical University, 49 Butlerov str., 420012 Kazan, Russia. E-mail: bayalieva1@yandex.ru

SHIGABUTDINOVA TATYANA N., ORCID ID: 0000-0001-7080-3878; Cand. sc. med., Deputy Chief Physician for Obstetrics and Gynecology, City Clinical Hospital 7 named after M. N. Sadykov; Chief Obstetrics & Gynecology Consultant at the Ministry of Health of the Republic of Tatarstan, 54 Chuikov str., 420103 Kazan, Russia. E-mail: shigabutdinova.tatyana@mail.ru

MELNIKOV EVGENIJ A., ORCID ID: 0009-0006-7068-7655; Cand. sc. med., Chief Medical Officer, City Clinical Hospital 7 named after M. N. Sadykov, Chief Surgery Consultant at the Ministry of Health of the Republic of Tatarstan, 54 Chuikov str., 420103 Kazan, Russia. E-mail: emelnik72@mail.ru

AKHUNDOV RUSTAM N., ORCID ID: 0000-0002- 0158-0188; Cand. sc. med., Head of the Intensive Care Unit 1, Clinical Hospital of RT, 138 Orenburg Route str., 420064 Kazan, Russia. E-mail: rust.90@mail.ru

FATKULLIN FARID I., ORCID ID:0000-0002-5806-9153; Cand. sc. med., Head of the Observation Department, City Clinical Hospital 7 named after M. N. Sadykov, 54 Chuikov str., 420103 Kazan, Russia; Associate Professor at the Department of Obstetrics and Gynecology named after Prof. V. S. Gruzdev, Kazan State Medical University, 49 Butlerov str., 420012 Kazan, Russia. E-mail: ffatkulin@ yanndex.ru

GRIGORIEV VITALIJ S., ORCID ID: 0009-0005-6492-2439; Head of the Department of Anesthesiology and Resuscitation 1, City Clinical Hospital 7 named after M. N. Sadykov, 54 Chuikov str., 420103 Kazan, Russia. E-mail: gkb@bk.ru

KALIMULLINA GULFIRYA N., ORCID ID: 0000-0003-0503-478х; Head of the Department of Gynecology 1, City Clinical Hospital No. 7 named after M. N. Sadykov, 54 Chuikov str., 420103 Kazan, Russia. E-mail: goolfira@mail.ru

SYRMATOVA LYAJSAN I., ORCID ID: 0000-0003-2393-7157; Head of the Center of Endosurgery in Gynecology, City Clinical Hospital 7 named after M. N. Sadykov, 54 Chuikov str., 420103 Kazan, Russia. E-mail: lsirmatova@mail.ru

KAPELYUSHNIK POLINA L., ORCID ID: 0000-0003-1884-8248; postgraduate student at the Department of Obstetrics and Gynecology named after Prof. V. S. Gruzdev, Kazan State Medical University, 49 Butlerova str., 420012 Kazan, Russia. E-mail: pkapelyushnik@inbox.ru

SALAKHOVA RIMMA R., ORCID ID: 0000-0002-1568-4834; Obstetrician and gynecologist of the Department of Gynecology 1, City Clinical Hospital 7 named after M. N. Sadykov, 54 Chuikov str., 420103 Kazan, Russia. E-mail: angelo_chek173@mail.ru

Abstract. Introduction. Sepsis is one of the most serious problems of modern obstetrics, accounting for 11% of the overall structure of maternal mortality. One of the main initial causes of sepsis is endotoxin having diverse biological effects. Moreover, during sepsis development, endotoxin directly or indirectly leads to irreversible and often life-incompatible damage to organs. Columns for direct hemoperfusion with polymyxin B are used for extracorporeal endotoxin removal.Aim: Reviewing the literature on using columns with polymyxin B in sepsis treatment and describing our own clinical observation of maternal sepsis. Materials and Methods. Review of publications in electronic resources, such as PubMed, eLibrary, EMBASE, and Google Scholar. This article presents a clinical case of successful sepsis treatment during late infected miscarriage in a young patient. Results and Discussion. Currently published systematic reviews and meta- analyses prove the reduction of mortality in patients with sepsis/septic shock. A 39-year-old patient was admitted with signs of chorioamnionitis and incipient miscarriage at 20-21 weeks of pregnancy. After the delivery of a dead fetus, the picture of sepsis and septic shock developed. Removal of the uterus as the primary source of infection did not improve the woman’s condition. Positive changes were only observed after having applied the polymyxin sorption of endotoxin. This new advanced technology in medicine, thanks to the timely use, correct dose, and duration of hemoperfusion with polymyxin B, made it possible to remove bacterial endotoxins safely and effectively from the blood, which led to the successful sepsis therapy. Conclusions. Thanks to the coordinated actions of a multidisciplinary team of highly qualified specialists and the timely administration of adequate therapy, it was possible to save the patient’s life, thus preventing her from maternal mortality.

Keywords: sepsis, septic shock, endotoxin, polymyxin sorption, late miscarriage.

For reference: Gabidullina RI, Bayalieva AZh, Shigabutdinova TN et al. Successful case of using the polymyxin sorption of endotoxin in the combined therapy of a patient with gram-negative sepsis caused by late infected miscarriage. The Bulletin of Contemporary Clinical Medicine. 2023; 16 (suppl.1): 14-19. DOI: 10.20969/VSKM.2023.16(suppl.1).14-19.

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 CARBAMAZEPINE HYPERSENSITIVITY REACTION WITH EOSINOPHILIA AND SYSTEMIC SYMPTOMS (DRESS SYNDROME). Case report and literature review

DELIAN VICTORIA Y., ORCID ID: 0000-0001-6816-4253, SPIN-code: 5562-4056, Cand. sc. med., Head of the City Center for Allergology and Immunology, City Clinical Hospital 7 named after M.N. Sadykov, 54 Chuikov str., 420103 Kazan, Russia; Associate Professor at the Department of Allergology and Immunology, Kazan State Medical Academy – Branch Campus of the Federal State Budgetary Educational Institution of Further Professional Education “Russian Medical Academy of Continuous Professional Education” of the Ministry of Healthcare of the Russian Federation, 36 Butlerova str., 420012 Kazan, Russia. Tel. +7-960-038-49-09. E-mail: viktoria_delyan@mail.ru

KLYUCHAROVA ALIYA R., ORCID ID: 0000-0001-9045-5831; Cand. sc. med., Allergologist and Immunologist at the City Center for Allergology and Immunology, City Clinical Hospital 7 named after M.N. Sadykov, 54 Chuikov str., 420103 Kazan, Russia; Associate Professor at the Department of Internal Diseases, Institute of Fundamental Medicine and Biology, Kazan Federal University, 74 Karl Marx str., 420112 Kazan, Russia. E-mail: aliluia@yandex.ru

Abstract. Introduction. A drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare, potentially life- threatening T-cell mediated reaction characterized by heterogeneous clinical manifestations and by a variable and unpredictable course. It is difficult to diagnose this reaction due to the long latent period between the start of therapy with a new drug and onset of symptoms, as well as due to no pathognomonic manifestations. Aim. Providing physicians with an algorithm for the diagnosis and treatment of DRESS syndrome exemplified by our own clinical observation.Materials and Methods. A 70-year-old female patient was hospitalized in the Department of Allergology and Immunology, complaining of generalized itchy rash on the face, body, and extremities, swelling of face and hands, and temperature rise to 37.5-38 °C. She was examined using general clinical, laboratory and instrumental methods. Results and Discussion. On examination, we found generalized maculopapular rash, increased levels of hepatic transaminases, reaching the criteria for mild drug-induced liver damage, and peripheral blood eosinophilia 25% (4,260 cells in 1 μl). Using the RegiSCAR scoring system helped to diagnose drug hypersensitivity reaction with eosinophilia and systemic symptoms, while utilizing the algorithm for assessing the causal relationship between the drug and the development of symptoms allowed considering carbamazepine as a possible cause of this reaction. The patient was treated with systemic and topical glucocorticosteroids with positive changes. Conclusions. Using the RegiSCAR scoring system developed by a team of international experts facilitates diagnosing the DRESS syndrome. Identifying and withdrawing the culprit drug is an essential condition of successfully managing patients. Systemic and topical glucocorticosteroids are the drugs of choice for the treatment of drug reactions with eosinophilia and systemic symptoms.

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 A CLINICAL CASE OF DETECTING AORTIC COARCTATION IN THE ELDERLY

ZAKIROVA ELVIRA B., ORCID ID: 0000-0002-4653-1734; Cand. sc. med., Deputy Chief Physician for Diagnostics, City Clinical Hospital 7 named after M.N. Sadykov, 54 Chuikova str., 420103 Kazan, Russia, е-mail: frolova.67@mail.ru

KUROCHKIN SERGEY V., ORCID ID: 0000-0002-8043-3871; Cand. sc. med., Head of the X-Ray Diagnostics Department and Radiologist, City Clinical Hospital 7 named after M.N. Sadykov, 54 Chuikova str., 420103 Kazan, Russia, е-mail: kurochkin.70@bk.ru

1. Банкл Г. Врожденные пороки сердца и крупных сосудов// Москва: Медицина. – 1980. – С.300-302. [Bankl H. Vrozhdennye poroki serdca i krupnyh sosudov [Congenital heart disease and large vessels]. Moskva: Medicina [Moscow: The Medicine]. 1980; 300-302. (In Russ.)].

2. Ильин А.С., Теплов П.В., Сакович В.А. Коарктация аорты как патология сердечно-сосудистой систе-мы. Наши возможности в хирургии // Сибирское медицинское обозрение. – 2018. – No 3. – С.24-33. [Il’in AS, Teplov PV, Sakovich VA. Koarktaciya aorty kak patologiya serdechno-sosudistoj sistemy. Nashi vozmozhnosti v hirurgii [Coarctation of the aorta as a pathology of the cardiovascular system. Our capabilities in surgery]. Sibirskoe medicinskoe obozrenie [Siberian Medical Review]. 2018; 3: 24-33. (In Russ.)]. DOI: 10.20333/2500136-2018-3-24-33

 CLINICAL CASE OF IGG4-ASSOCIATED PANCREATITIS

ISKHAKOVA DILYARA G., ORCID ID: 0000-0003-3829-5302; Head of the Department of Gastroenterology, City Clinical Hospital 7 named after M. N. Sadykov, 54 Chuikova str., 420103 Kazan, Russia, е-mail: iskhakova_d@mail.ru

SUBKHANGULOVA DINARA O., ORCID ID: 0000-0002-0147-8503; Student, General Medicine Faculty, Kazan State Medical University, 49 Butlerov str., 420012 Kazan, Russia, е-mail: dinara.subkhangulova0404@yandex.ru

SAFINA DILYARA D., ORCID ID: 0000-0002-5985-3089; Researcher ID H-6864-2014, RSCI Author ID 758854; Associate Professor at the Department of Internal Medicine, Institute of Fundamental Medicine and Biology, Kazan Federal University, 18 Kremlevskaya, str., 42008 Kazan, Russia, е-mail: dilyarad04@yandex.ru

SHAYKHUTDINOVA ZULFIYA A., ORCID ID: 0000-0002-3457-0138; Deputy Chief Physician, City Clinical Hospital 7 named after M. N. Sadykov, 54 Chuikova str., 420103 Kazan, Russia, е-mail: gkb7@bk.ru

IBRAGIMOVA LILIYA M., ORCID ID: 0000-0002-0457-5835; Gastroenterologist, City Clinical Hospital 7 named after M. N. Sadykov, 54 Chuikova str., 420103 Kazan, Russia, е-mail: lelik020886@mail.ru

KHAZOVA ELENA V., ORCID ID: 0000-0001-8050-2892; Scopus Author ID: 57205153574, Researcher ID O-2336-2016, RSCI Author ID 639552; Cand. sc. med., Associate Professor at the Department of Internal Medicine named after Prof. S.S. Zimnitsky, Kazan State Medical University, 49 Butlerov str., 420012 Kazan, Russia; Scientific Officer at the Academic and Research Laboratory – Emerging Vocational Competencies in Health Protection of the Institute of Fundamental Medicine and Biology, Kazan Federal University, 18 Kremlevskaya str., 420008 Kazan, Russia, е-mail: hazova_elena@mail.ru

Abstract. Introduction. IgG4-associated pancreatitis is a rare chronic autoimmune disease characterized by pancreas infiltration with IgG4 cells and by an increased IgG4 level in blood serum. Aim. Present a clinical case of IgG4-associated pancreatitis. Materials and Methods. A clinical case is presented, describing IgG4-associated pancreatitis in a 22-year- old male patient. Results and Discussion. During the examination, the following conditions were excluded: Autoimmune liver diseases (ANA, ASMA IgG, LKM-1 IgG – negative, according to liver elastography, fibrosis 0) and primary sclerosing cholangitis (based on magnetic resonance cholangiopancreatography). Pancreas dimensions were enlarged (according to computed tomography: 41.5x29x36.5 mm, smoothed lobulation; hepatosplenomegaly, intraperitoneal lymphadenopathy, and ascites minor). Against the treatment (Mesalazine, Ferrum Lek, and prednisolone 60 mg intravenously, with a transition of 50 mg per day inside), positive changes were noticed (body temperature normalized, daily stool frequency decreased). Conclusions. The case presented demonstrates the difficulties in diagnosing IgG4-associated diseases. Combination of ulcerative colitis and IgG4-associated pancreatitis described in this paper further complicates the differential diagnostic search, but at the same time, it does not exclude possible common pathogeneses of various autoimmune diseases in this group of patients.

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17. Löhr JM, Beuers U, Vujasinovic M, et al. European Guideline on IgG4-related Digestive Disease – UEG and SGF Evidence-based Recommendations. United European Gastroenterol J. 2020;8(6):637–666. DOI: 10.1177/2050640620934911

18. Румянцев П.О., Чухачева О.С., Козлов И.Г., и др. IgG4-ассоциированные заболевания в эндокрино-логии // Проблемы эндокринологии. – 2020. – Т. 6, No2. – С. 24–32. [Rumyantsev PO, Kozlov IG, Kolpakova EA, et al. IgG4-assotsiirovannyye zabolevaniya v endokrinologii [IGG4-related diseases in endocrinology]. Problemy endokrinologii [Problems of Endocrinology]. 2020;66(2):24-32 (in Russ)]. DOI: 10.14341/probl12285

 ROLE OF RADIOLOGICAL EXAMINATIONS IN THE TREATMENT OF PATIENTS WITH INTRAMURAL DUODENAL PSEUDOCYST

LUKASHEV ANDREY D., ORCID ID: 0000-0002-7049-8786; Radiologist, First-Year Postgraduate Student, Kazan (Volga Region) Federal University, 18 Kremlyovskaya str., 420008 Kazan, Russia; e-mail: Andrewlukashew@gmail.com

KUROCHKIN SERGEY V., ORCID ID: 0000-0002-8043-3871; Cand. sc. med., Radiologist, Head of the X-Ray Diagnostic Department, City Clinical Hospital 7 named after M. N. Sadykov, 54 Chuikov str., 420103 Kazan, Russia; e-mail: kurochkin.70@bk.ru

ZAKIROVA ELVIRA B., ORCID ID: 0000-0002-4653-1734; Cand. sc. med., Deputy Chief Physician for Diagnostics, City Clinical Hospital 7 named after M. N. Sadykov, 54 Chuikov str., 420103 Kazan, Russia; e-mail: frolova.67@mail.ru

1. Rana SS, Bhasin DK, Rao C, Gupta R. Intramural pseudocysts of the upper gastrointestinal tract. Endosc Ultrasound. 2013;2(4):194-198. DOI:10.4103/2303- 9027.121240

2. Первова О.В., Черданцев Д.В., Филистович В.Г. и др. К вопросу о классификации псевдокист подже-лудочной железы // Современные проблемы науки и образования. – 2016. – No 6. – С. 84-84. [Pervova OV, Cherdancev DV, Filistovich VG, et al. K voprosu o klassifikacii psevdokist podzheludochnoj zhelezy [The question of classification of pancreatic pseudocysts]. Sovremennye problemy nauki i obrazovaniya [Modern problems of science and education]. 2016; 6: 84-84. (In Russ.)]. URL: https://science-education.ru/ru/article/ view?id=25599

3. Tan JH, Chin W, Shaikh AL, Zheng S. Pancreatic pseudocyst: Dilemma of its recent management (Review). Exp Ther Med. 2021;21(2):159. DOI:10.3892/ etm.2020.9590

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8. Avila F. An Unusual Complication and Position of Pancreatic Pseudocyst: Gastric Intramural Pseudocyst. Gastroenterology & Hepatology: Open Access. 2015 Feb 27;2(3). DOI: 10.15406/ghoa.2015.02.00039

9. Choudhary NS, Puri R, Sud R. Gastric outlet obstruction caused by intramural duodenal pseudocysts in a young man with acute pancreatitis. Endoscopy. 2015;47 Suppl 1 UCTN: E58. DOI:10.1055/s-0034-1390721DOI:10.105 5/s-0034-1390721

10. Черданцев Д.В., Первова О.В., Жегалов П.С., и др.Возможности транслюминального дренирования постнекротических кист поджелудочной железы под ЭУС-наведением // Современные проблемы науки и образования. – 2016. – No 5. – С. 151-151. [Cherdancev DV, Pervova OV, Zhegalov PS, et al. Vozmozhnosti translyuminal’nogo drenirovaniya postnekroticheskih kist podzheludochnoj zhelezy pod EUS-navedeniem [Possibilities of transluminal drainage of postnecrotic pancreatic cysts under EUS guidance]. Sovremennye problemy nauki i obrazovaniya [Modern problems of science and education]. 2016; 5: 151-151. (In Russ.)]. URL: https://science-education.ru/ru/article/view?id=25416

 SPECIFIC FEATURES OF DIAGNOSING AND SURGICAL APPROACHES TO THE TREATMENT OF PATIENTS WITH NON-NEOPLASTIC LIVER LESIONS

MAKSIMOV ANTON I., ORCID ID: 0009-0007-7318-7485; Surgeon, City Clinical Hospital 7 named after M. N. Sadykov, 54 Chuikov str., 420103 Kazan, Russia. E-mail: antoha-228@yandex.ru

CHIKAEV VYACHESLAV F., ORCID ID: 0000-0002-4135-0387; Dr. sc. med., Professor at the Department of Traumatology, Orthopedics and Emergency Surgery, Kazan State Medical University. 49 Butlerov str., 420012 Kazan, Russia. E-mail: prof.chikaev@gmail.com

SHARAFISLAMOV ISKANDER F., ORCID ID:0000-0002-0672-7521, Head of the X-Ray Surgery Department, City Clinical Hospital 7 named after M. N. Sadykov, 54 Chuikov str., 420103 Kazan, Russia. E-mail: sharusi333@gmail.com

ANDREEV ANDREY I., ORCID ID: 0000-0002-5960-0225 Surgeon, City Clinical Hospital 7 named after M. N. Sadykov, 54 Chuikov str., 420103 Kazan, Russia. E-mail: aandreyi@yandex.ru

TOLKACHEVA DIANA V., ORCID ID: 0009-0005-9566-9528; Student of Pediatrics Faculty, Kazan State Medical University. 49 Butlerov str., 420012 Kazan, Russia. E-mail: dianochkakarimova25@gmail.com

Abstract. Introduction. Etiology of benign non-neoplastic liver lesions is quite diverse. They are usually represented by both purulent inflammatory and parasitic foci. Non-tumor lesions are characterized by severe course and by difficulties in diagnosing and managing the patients. Aim. The aim of the study was to analyze the characteristics of the diagnostic search and surgical treatment of patients with non-neoplastic liver lesions, based on the experience of our clinic. Materials and Methods. Treatment cases of 34 patients with non-tumor liver foci were analyzed by our team. We studied the steps of diagnosing non-neoplastic liver lesions and the surgical approaches to treatment, based on the etiology and nature of each liver lesion. Results and Discussion. In 79% (n=27) of all cases, focal diseases have been observed over the last three years. Etiologically, liver segment lesions were different. In 53.6% (n=18) of cases, 2-3 segments were affected simultaneously. In 11.7% (n=4) of cases, bilobar liver damages were detected. In liver abscesses, minimally invasive surgical approaches were used predominantly; in 70.9% (n=24) of cases, percutaneous abscess drainage was performed under ultrasound navigation. In 8.8% (n=3) of cases, abscess was redrained with a catheter; in 5.8% (n=2) of cases, abscess cavity was evacuated by puncturing. In cholangiogenic abscesses, the leading purpose was to resolve the hypertension of the bile ducts, followed by the abscess drainage. Smaller cholangiogenic abscesses were managed conservatively. Mortality was 5.8%. (n=2) in all groups of interest. Conclusion. In diagnosing the non-neoplastic liver lesions, an integrated approach is required, considering the present history and laboratory findings. In this case, the diagnosis standard is the use of ultrasound technology and computed tomography scans, while magnetic resonance imaging is indicated for diagnosing pathological factors relating to bile ducts. Surgical approaches are dependent on the nature of the pathological process. Minimally invasive technique under ultrasound navigation is the key technique for treating patients with purulent inflammatory liver lesions.

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2. Ветшев П.С., Мусаев Г.Х., Шарипов Р.Х. Мини-инва-зивные технологии в лечении эхинококкоза печени(клиническая лекция) // Анналы хирургической гепа-тологии. – 2021. – Т.26, вып.4. – С. 77–86. [Vetshev PS, Musaev GKh, Sharipov RKh. Mini-invazivnye tekhnologii v lechenii ekhinokokkoza pecheni (klinicheskaya lekciya) [Minimally invasive technologies in the treatment of liver echinococcosis (clinical lecture)]. Annaly khirurgicheskoy gepatologii [Annals of HPB surgery]. 2021; 26 (4): 77–86. (In Russ.)]. DOI: 0.16931/1995-5464.2021-4-77-86

3. Рузибаев Р.Ю., Курьязов Б.Н., Сапаев Д.Ш. и др. Со-временная оценка проблемы диагностики и хирургиче-ского лечения эхинококкоза // Вестник Национального медико-хирургического центра им. Н.И.Пирогова – 2019. – Т14, No1. – С.134 – 139. [Ruzibaev RYu, Kuryazov BN, Sapaev DSh, et al. Sovremennaya ocenka problemy diagnostiki i hirurgicheskogo lecheniya ekhinokokkoza [Modern assessment of the problem of diagnosis and surgical treatment of echinococcosis]. Vestnik Nacional’nogo mediko-hirurgicheskogo centra im. N.I.Pirogova. [Bulletin of the National Medical and Surgical Center named after N.I.Pirogov]. 2019; 14(1):134 – 139. (In Russ.)].

4. Хасанов А.Г., Шайбаков Д.Г., Шамсиев Р.Э., и др. Пунк-ционое лечение абсцессов печени // Современные проблемы науки и образования. – 2020. – No 4. – С.132- 138. [Khasanov AG, Shaybakov DG, Shamsiev RE, et al. Punkcionoe lechenie abscessov pecheni. [Puncture treatment of liver abscesses]. Sovremennye problemy nauki i obrazovaniya. [Modern problems of science and education]. 2020; 4: 132-138. (In Russ.)].

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6. Щекотуров И.О., Бахтиозин Р.Ф., Серова Н.С., Шан-таревич М.Ю. Лучевые методы диагностики очаговых образований печени. REJR. – 2018. – Т.8, вып. 4. –С.194–207. [Schekoturov IO, Bakhtiozin RF, Serova NS, Shantarevich MY. Luchevye metody diagnostiki ochagovyh obrazovanij pecheni [Radiological methods in diagnostics of focal liver lesions]. REJR. 2018; 8(4):194-207. (In Russ.)]. DOI:10.21569/2222-7415-2018-8-4-194-207

7. Сигуа Б.В., Земляной В.П., Качиури А.С. Эндовиде-охирургия в лечении больших непаразитарных кист печени // Вестник Северо-Западного государствен-ного медицинского университета им И.И. Мечникова. 2019. – Том 11, No1. – С.55-60. [Sigua BV, Zemlyanoi VP, Kachiuri AS. Endovideohirurgiya v lechenii bol’shih neparazitarnyh kist pecheni [Endovideosurgical in the treatment of large liver cysts]. Vestnik Severo-Zapadnogo gosudarstvennogo medicinskogo universiteta im I.I. Mechnikova [Bulletin of the I.I. Mechnikov Northwestern State Medical University].2019; 11(1): 55-60. (In Russ.)]. DOI:10.17816/201911155-60

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 RUPTURE OF AN UNOPERATED UTERUS IN THE FIRST HALF OF PREGNANCY: A CLINICAL OBSERVATION

MINNULLINA FARIDA F., ODCID ID: 0000-0001-8270-085x; Author ID: 384178; Dr. sc. med., Associate Professor at the Department of Surgery, Obstetrics, and Gynecology, Institute of Fundamental Medicine and Biology, Kazan Federal University, 74 Karl Marx str., 420012 Kazan, Russia; Head of the Department of Gynecology 2 of City Clinical Hospital No. 7, 54 Marshal Chuikov str., 420103 Kazan, Russia. E-mail: minnullina_f@mail.ru

MUKHAMETZYANOVA LILIYA M., ORCID ID: 0000-0002-2034-4308 assistant, Department of Obstetrics and gynecology, Institute of Biology and Fundamental Medicine of Kazan Federal University, Russia, 420012, Kazan, Karl Marx Str., 74; doctor of the gynecological department 2 of the State Clinical Hospital No. 7, Russia, 420103, Kazan, Marshal Chuikov Str., 54, e-mail: mmm-liliya@yandex.ru

Abstract. Introduction. Uterine rupture is a rare and life-threatening complication for patient and fetus. This pathology is mostly associated with pregnancy and occurs in late preterm periods, but there are also some cases of non-pregnant uterus ruptures described. Aim. This study is aimed at showing and analyzing the importance of uterine ruptures, even without any uterine scars and in the first half of pregnancy. Materials and Methods. This paper describes the clinical case of a multigravida patient with the rupture of unscarred uterus in the second trimester of pregnancy. Results and Discussion. A 32-year-old female patient was admitted to the department of gynecology at the gestational age of 16 weeks, complaining of severe abdominal pains, with the signs of intraabdominal bleeding. Histopathic rupture of the uterus was detected in the emergency laparotomy. Conclusions. Absence of uterine scars does not prevent from potential rupture of the uterus Timely diagnosis is necessary, and an emergency surgical intervention must be performed to save the patient’s life at any suspicion on uterine rupture. Even with early pregnancies, uterine rupture risks must be considered, especially regarding women with a history of uterine cavity surgeries. There is a question of the necessity to perform elective hysteroscopy during pregnancy planning to patients with the past history of uterine curettage.

Keywords: spontaneous uterine rupture, rupture of unscarred uterus, rupture of pregnant uterus

For reference: Minnullina FF, Mukhametzyanova LM. Rupture of an unoperated uterus in the first half of pregnancy: A clinical observation. The Bulletin of Contemporary Clinical Medicine. 2023; 16(suppl.1): 61-64.DOI: 10.20969/VSKM.2023.16 (suppl.1).61-64.

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3. Tanos V, Toney ZA. Uterine scar rupture - Prediction, prevention, diagnosis, and management. Best Pract Res Clin Obstet Gynaecol. 2019; 8 (59): 115-131. DOI: 10.1016/j.bpobgyn.2019.01.009

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6. Tan LK, Beh ST. Uterine rupture in Singapore: Trends and lessons learnt. Ann Acad Med Singap. 2021; 50(1):1-2. DOI: 10.47102/annals-acadmedsg.2020651

7. McLeish SF, Murchison AB, Smith DM, Ghahremani T, Johnson IM, Magann EF. Predicting Uterine Rupture Risk Using Lower Uterine Segment Measurement During Pregnancy With Cesarean History: How Reliable Is It? A Review. Obstet Gynecol Surv. 2023; 78(5): 302-308. DOI: 10.1097/OGX.0000000000001143

8. Perdue M, Felder L, Berghella V. First-trimester uterine rupture: a case report and systematic review of the literature. Am J Obstet Gynecol. 2022; 227(2): 209-217. DOI: 10.1016/j.ajog.2022.04.035

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 CLINICAL CASE OF ACROMEGALY IN A FEMALE PATIENT WITH RHEUMATOID ARTHRITIS

NASYBULLINA FARIDA A., ORCID ID: 0000-0003-2180-4414; Researcher ID GXH-3189-2022; RSCI Author ID 777510; SPIN-code: 3121-0016; Endocrinologist at the Endocrinology Department, City Clinical Hospital 7 named after М. N. Sadykov, 54 Chuikov str., 420103 Kazan, Russia; tel.: +79172561759, email: nasybullinaf@mail.ru

PETROVA TATIANA A., ORCID ID: 0009-0007-7063-3857; Head of the Endocrinology Department, City Clinical Hospital 7 named after М. N. Sadykov, 54 Chuikov str., 420103 Kazan, Russia; email: tanuha1976@bk.ru

MYAGKOVA NATALIA A., ORCID ID: 0009-0002-6619-244X; Endocrinologist at the Endocrinology Department, City Clinical Hospital 7 named after М. N. Sadykov, 54 Chuikov str., 420103 Kazan, Russia; email: natmyag@gmail.com

VAGAPOVA GULNAR R., ORCID ID: 0000-0001-8493-7893, Scopus Author ID: 56663181000, Researcher ID: C-1421-2019, RSCI Author ID: 284254, MD, Professor, Corresponding Member of the Academy of Sciences of the Republic of Tatarstan, Head of the Department of Endocrinology, Kazan State Medical Academy – Branch of the Russian Medical Academy of Postgraduate Education, 11 Mushtari str.; 420012 Kazan, Russia; email: g.r.vagapova@gmail.com

VALEEVA FARIDA V., ORCID ID: 0000-0001-6000-8002; SPIN code 2082-3980; Author ID: 784269; Dr. sc. med., Professor, Head of the Department of Endocrinology, Kazan State Medical University, 49 Butlerova str., 420012 Kazan, Russia; e-mail: val-farida@yandex.ru

1. Marie P. Sur Deux Cas D’acromegalie; Hypertrophie ́ Sin- guliere non Congenitale ́ des Extremite ́ ś Superieures ́ , Inferieures ́ et Cephalique ́. F. Alcan. 1886.

2. Petrossians P, Adrian FD, Natchev E et al. Acromegaly at diagnosis in 3173 patients from the Liege Acromegaly Survey (LAS) Database. Endocrine Related Cancer. 2017; 24: 505–518. DOI: 10.1530/ERC-17-0253

3. Паневин Т.С., Алексеева Л.И., Мельниченко Г.А. Рев-матические проявления акромегалии // Остеопороз и остеопатии. — 2019. — Т. 22, No2. — С.14-22. [Panevin TS, Alekseeva LI, Melnichenko GA. Revmaticheskie proyavleniya akromegalii [Rheumatic manifestations of acromegaly]. Osteoporoz i osteopatii [Osteoporosis and Bone Diseases]. 2019; 22(2): 14-22. (In Russ.)]. DOI: 10.14341/omet10245

4. Dal J, Feldt-Rasmussen U, Andersen M et al. Acromegaly incidence, prevalence, complications and long-term prognosis: a nationwide cohort study. European Journal of Endocrinology. 2016; 175: 181–190. DOI: 10.1530/ EJE-16-0117

5. Hoskuldsdottir GT, Fjalldal SB, Sigurjonsdottir HA. The incidence and prevalence of acromegaly, a nationwide study from 1955 through 2013. Pituitary. 2015; 18: 803– 807. DOI: 10.1007/s11102-015-0655-4

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9. Пронин В.С., Молитвословова Н.Н. Акромегалия.Этиология, патогенез, клиника, диагностика, лече-ние/Под ред. Академика РАН и РАМН И.И. Дедова,член-корр Г.А. Мельниченко. – М. – 2009. [Pronin VS, Molitvoslavova NN. Akromegaliya. Etiologiya, patogenez, klinika, diagnostika, lechenie. [Acromegaly. Etiology, pathogenesis, clinic, diagnosis, treatment]. M; 2009 (In Russ.)]

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 DIAGNOSIS OF MYOCARDITIS IN A CARDIOLOGIST’S PRACTICE

PODOLSKAYA ALLA A., ORCID ID: 0000-0002-9474-7601; Сand. sc. mеd., Head of Саrdiology Department 4, City Hospital 7 named after M. N. Sadykov, 54 Chuikov str., 420103 Kazan, Russia; Associate Professor at the Department of Internal Medicine, Kazan State Medical University; 2 Mavlyutova str., 420101 Kazan, Russia; e-mail: alla.podolsckaya@ yandex.ru

BILALOVA AIGUL M., ORCID ID: 0009-0007-2689-7310; Physician at Cardiology Department 4, City Clinical Hospital 7 named after M. N. Sadykov, 54 Chuikov str., 420103 Kazan, Russia; e-mail:aigulka1493@mail.ru

SHAYKHUTDINOVA ZULFIYA A., ORCID ID: 0000-0002-3457-0138; Deputy Chief Physician for Medical Affairs, City Clinical Hospital 7 named after M. N. Sadykov, 54 Chuikov str., 420103 Kazan, Russia; e-mail: gkb7@bk.ru
ZAKIROVA ELVIRA B., ORCID ID: 0000-0002-4653-1734, Cand. sc. med., Deputy Chief Physician for Diagnostics, City Clinical Hospital 7 named after M. N. Sadykov, 54 Chuikov str., 420103 Kazan, Russia; e-mail: frolova.67@mail.ru

KIM ZULFIYA F., ORCID ID: 0000-0003-4240-3329; Cand. sc. med., Deputy Chief Physician for Treatment of City Clinical Hospital 7, Kazan, Russia; Chief Visiting Cardiologist of the Ministry of Health of the Republic of Tatarstan; Associate Professor at the Department of Internal Medicine # 2 of Kazan State Medical University, 49 Butlerov str., 420012 Kazan, Russia; e-mail: profz@yandex.ru

Abstract. Introduction. Diseases with EKG-detected infarction-like changes include myocarditis, pericarditis, hypertrophic and non-hypertrophic cardiomyopathy, Takotsubo cardiomyopathy, pulmonary embolism, aortic dissection, stroke, and subarchnoid hemorrhage. It is therefore extremely important to differentiate these diseases from true myocardial infarction, as the approaches to the therapy and management of such patients will differ fundamentally. Aim.To draw the attention of cardiologists and therapists to myocarditis as one of potential causes of erroneous diagnosis / overdiagnosis of acute myocardial infarction. Materials and Methods. This study presents a clinical case of acute myocarditis, probably streptococcal, manifesting as acute coronary syndrome. Clinical, laboratory, and instrumental indicators and medical documents were analyzed. Results and Discussion. Analyzing this clinical case of a young patient and considering a pronounced pain syndrome (acute pressing pains in his heart area) lasting for 30-40 minutes and EKG-detected changes (sinus tachycardia with a heart rate of 93 per minute, ST elevation by 2 mm above the isoline in II, III, aVF, up to 1.5 mm in V5-V6), the physicians initially suspected acute coronary syndrome with ST-elevation. Taking into account his pain syndrome, subfibrility, inflammatory changes detected in laboratory examinations, EKGfindings, and no local or global changes in echocardiography, acute myocarditis was suspected and then proven using cardiovisualization, namely magnetic resonance imaging of the heart, which allowed verifying the diagnosis and assess the nature and localization of myocardial damage complying with EKG-detected changes in the patient. After the inpatient treatment, the patient was discharged to the outpatient stage with improvement. Conclusions. The clinical case presented made it possible to suspect acute myocarditis manifesting as acute coronary syndrome with ST-elevation, while advanced cardiovisualization techniques finally proved the diagnosis of myocarditis. We can hope that a wider use of heart MRI will further enhance the diagnostic capabilities of this technique in cardiology.

Keywords: myocarditis, acute coronary syndrome, differential diagnosis, troponin, heart MRI.

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 ASSOCIATION BETWEEN VASCULAR CALCIFICATIONS AT MAMMOGRAPHY AND HYPOTHYROIDISM: CASE SERIES REPORT AND LITERATURE REVIEW

PASYNKOVA OLGA O., ORCID ID: 0000-0001-9117-8151; Scopus Author ID: 8248104000; Web of Science Researcher ID AGW-8627-2022, RSCI Author ID 218546; SPIN-code: 7853-0545. Cand. sc. med., Associate Professor, Associate Professor at the Department of Fundamental Medicine, Medical Institute of Mari State University, 1 Lenin sq., 424000 Yoshkar-Ola, Russia. E-mail: o.o.pasynkova@yandex.ru

KRASILNIKOV ALEXEI V., ORCID ID: 0000-0002-3992-8135, Chief Physician of the Republic’s Clinical Veterans’ Hospital, 24 Osipenko str., 424037 Yoshkar-Ola, Russia. E-mail: krasdoc@yandex.ru

PASYNKOV DMITRY V., ORCID ID: 0000-0003-1888-2307, Scopus Author ID: 57194777454; Web of Science Researcher ID: HJH-2122-2023, RSCI Author ID: 963099; SPIN-код: 7264-3745; Cand. sc. med., Associate Professor at the Department of Diagnostic Ultrasound, Kazan State Medical Academy; Head of the Department of Radiology and Oncology, Medical Institute, Mari State University; Head of Radiology Department, Republic’s Clinical Oncological Dispensary. E-mail: passynkov@mail.ru.

 EVIDENT BREAST VASCULAR CALCIFICATIONS AS A PROMISING OSTEOPOROSIS MARKER

PASYNKOV DMITRY V., ORCID ID: 0000-0003-1888-2307, Scopus Author ID: 57194777454; Web of Science Researcher ID: HJH-2122-2023, RSCI Author ID: 963099; SPIN-код: 7264-3745; Cand. sc. med., Associate Professor at the Department of Diagnostic Ultrasound, Kazan State Medical Academy; Head of the Department of Radiology and Oncology, Medical Institute, Mari State University; Head of Radiology Department, Republic’s Clinical Oncological Dispensary; e-mail: passynkov@mail.ru

PASYNKOVA OLGA O., ORCID ID: 0000-0001-9117-8151; Scopus Author ID: 8248104000; Web of Science Researcher ID AGW-8627-2022, RSCI Author ID 218546; SPIN: 7853-0545. Cand. sc. med., Associate Professor, Associate Professor at the Department of Fundamental Medicine, Medical Institute of Mari State University, 1 Lenin sq., 424000 Yoshkar-Ola, Russia; e-mail: o.o.pasynkova@yandex.ru

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 MAGNETIC RESONANCE IMAGING IN DIAGNOSING LEFT ATRIAL MYXOMA

SADYKOV ANVAR R., ORCID ID: 0009-0005-3416-2109; Chief Specialist in Cardiac Surgery, Department of Vascular Surgery, Interregional Clinical Diagnostic Center, 12а Karbyshev str., 420101 Kazan, Russia; e-mail: ansad_64@mail.ru

ZAKIROVA ELVIRA B., ORCID ID: 0000-0002-4653-1734; Cand. sc. med., Deputy Chief Physician for Diagnostics, City Clinical Hospital 7 named after M. N. Sadykov, 54 Marshal Chuikov str., 420103 Kazan, Russia; e-mail: frolova.67@mail.ru

KUROCHKIN SERGEY V., ORCID ID: 0000-0002-8043-3871; Cand. sc. med., Head of the X-Ray Diagnostic Department, Radiologist, City Clinical Hospital 7 named after M. N. Sadykov, 54 Marshal Chuikov str., 420103 Kazan, Russia; e-mail: kurochkin.70@bk.ru

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 MINIMALLY INVASIVE TECHNIQUES TO TREAT THE COMPLICATIONS OF ACUTE PANCREATITIS

CHIKAEV VYACHESLAV F., ORCID ID: 0000-0002-4135-0387; Dr. sc. med., Professor, Department of Traumatology, Orthopedics and Emergency Surgery, Kazan State Medical University, 49 Butlerov str., 420012 Kazan, Russia, е-mail: prof.chikaev@gmail.com

PETUKHOV DENIS M., ORCID ID: 0000-0002-5946-2950; Surgeon, City Clinical Hospital 7 named after M. N. Sadykov, 54 Chuikov str., 420103 Kazan, Russia, е-mail: petuhoff@gmail.com

MAKAROV DENIS V., ORCID ID: 0000-0003-2246-9849; Endoscopist, City Clinical Hospital 7 named after M. N. Sadykov, 54 Chuikov str., 420103 Kazan, Russia, е-mail: makarovden90@gmail.com

KUROCHKIN SERGEY V., ORCID ID: 0000-0002-8043-3871; Cand. sc. med., Radiologist, Head of the X-Ray Diagnostics Department, City Clinical Hospital 7 named after M. N. Sadykov, 54 Chuikov str., 420103 Kazan, Russia, е-mail: kurochkin.70@bk.ru

Abstract. Introduction. Hollow organ perforations accompanying pancreatic necrosis are a severe complication. In this case, surgical intervention is limited to a degree due to the extensive process in the upper abdomen and the patient’s functional condition. Aim. To share our experience in the minimally invasive repair of gastric perforation in a case series of severely infected pancreatic necroses and retroperitoneal phlegmons. Materials and Methods. We analyzed a case series in our clinic over 5 years, including the necrotizing forms of acute pancreatitis with complications, such as acute perforations of hollow organs. This paper describes the minimally invasive surgeries we performed to treat perforations in upper abdominal. Results and Discussion. In 3 of 4 cases in our clinic, acute perforations of the upper gastrointestinal tract developed along with necrotizing pancreatitis were successfully released using the minimally invasive approach.Conclusions. Hollow organ perforation is one of the most severe complications of infected pancreatic necrosis resulting from the aggressive effects of pancreatic secretion. In this case, the tactical approach depends on the nature and localization of perforation, the course of pancreatic necrosis, and the patient’s functional condition. For perforation of acute gastric ulcers, it is technically possible to use a minimally invasive approach using endoscopic clips, which has been successfully demonstrated in our clinic. We hope that our experience will allow avoiding extended operations in this category of patients.

Keywords: pancreatic necrosis, gastric perforation, clips, endoscopic clipping.

For referenсe: Chikaev VF, Petukhov DM, Makarov DV, Kurochkin SV. Minimally invasive techniques to treat the complications of acute pancreatitis. Bulletin of Modern Clinical Medicine. 2023; 16(suppl.1):97-100.DOI: 10.20969/VSKM.2023.16 (suppl.1).97-100.

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