[Thoracoscopic resection of recurrent atypically located parathyroid adenoma of anterior mediastinum in a patient with hyperparathyroidism undergoing renal replacement therapy]. / Torakoskopicheskoe udalenie retsidivnoi atipichno raspolozhennoi adenomy okoloshchitovidnoi zhelezy perednego sredosteniya u patsientki s giperparatireozom, nakhodyashcheisya na zamestitel'noi pochechnoi terapii.

We present successful surgical treatment of a patient with chronic kidney disease (CKD) and hyperparathyroidism undergoing renal replacement therapy. At baseline, parathyroidectomy via cervical access was performed for parathyroid adenomas. After 6 years, clinical and laboratory relapse of disease required thoracoscopic resection of atypically located anterior mediastinal adenoma. This case demonstrates that this disease is one of the most difficult in modern medicine requiring a special approach in diagnosis and treatment. Patients with CKD and hyperparathyroidism need for follow-up, control of total and ionized serum calcium, inorganic phosphorus and parathormone, osteodensitometry, ultrasound and scintigraphy of thyroid and parathyroid glands, and, if necessary, CT or MRI of the neck and chest organs.

[Surgical treatment of a patient with stage v multinodular toxic goiter, severe thyrotoxicosis, strangulation syndrome and severe comorbidities]. / Khirurgicheskoe lechenie patsientki s mnogouzlovym toksicheskim zobom V stepeni, tireotoksikozom tyazheloi stepeni, kompressionnym sindromom i tyazhelymi soputstvuyushchimi zabolevaniyami.

The authors describe thyroidectomy in a patient with multinodular toxic goiter stage V, severe thyrotoxicosis complicated by thyro-cardiac disease, strangulation syndrome and severe comorbidities. Nodular euthyroid goiter was first diagnosed in 1992, and resection of the right thyroid lobe was performed. Progressive enlargement of thyroid gland and thyrotoxicosis occurred after coronavirus infection in February, 2020. Along with progression of thyrotoxicosis and strangulation of cervical organs, the patient suffered from portal vein thrombosis, pulmonary embolism. Myeloproliferative disease with essential thrombocythemia was also diagnosed. Volume of the right and left thyroid lobes was 69 and 101.3 cm3, respectively. X-ray examination of the esophagus revealed narrowing at C6 level up to 5-8 mm. Surgery time was 2 hours, dimension of removed right thyroid lobe - 10.0×7.5×6.5 cm, left thyroid lobe - 11.0×6.5×5.5 cm, total weight - 348 g. The patient was discharged in 6 days after surgery.

[Behavioral disorders in children and adolescents with intellectual disability]. / Rasstroistva povedeniya u detei i podrostkov s umstvennoi otstalost'yu.

The relevance of the study of behavioral disorders in children and adolescents with intellectual disability is determined by the fact that the problem is at the intersection of different disciplines (psychiatry, psychology, pedagogics, sociology, criminology). Also, there are difficulties in analyzing the interaction between biological and social factors in etiology of such disorders. The review article discusses various aspects of behavioral disorders in children and adolescents with intellectual disability - the historical background, prevalence, etiology and pathogenesis, clinical picture. The authors point to the need for a new approach to the classification of behavioral disorders in intellectual disability.

[Allogeneic umbilical cord blood cell therapy for children with autism: safety and efficacy of the method]. / Primenenie kontsentrata yadrosoderzhashchikh kletok pupovinnoi krovi u detei s autizmom: bezopasnost' i effektivnost' metoda.

OBJECTIVE: To evaluate effectiveness and safety of umbilical cord blood cells (UCBC) in children with ASD. MATERIAL AND METHODS: The study comprised 13 boys and 2 girls, mean age 7.0±0.5 years (test group), and 9 boys and 1 girl, mean age 6.0±1.3 years (control group) diagnosed with autism or autistic syndrome. UCBC were infused intravenously in a single dose of 250±20 million cells, four times at 14±3-day intervals. Dynamics of cognitive functions were assessed with WISC subscales, questionnaire Skvortsov Developmental Profile Survey and brainstem auditory evoked potentials (BAEPs) conducted before therapy and six months after the first injection. The dynamic of autistic symptoms was explored with CASD and ATEC questionnaires, fulfilled at the start of the study, 3 and 6 months later (test group) or at the start of the study, and 6 months later (control group). RESULTS: UCBC was well tolerated and caused no appreciable adverse effects. Observation revealed improvement in cognitive functioning and alleviation of autistic symptoms in patients of the test group six months after the first UCBC injection. Positive dynamics were more noticeable in the test group than in the control group receiving standard therapy. CONCLUSION: The use of UCBC is safe and might be effective in the complex therapy of autism.

[Characteristics of sleep disturbances related to substance use disorders]. / Osobennosti narushenii sna pri upotreblenii razlichnykh psikhoaktivnykh veshchestv.

Sleep disturbances are frequently observed in patients with substance use disorders during active use as well as in withdrawal period and in remission. However, there is limited information about the association between sleep disturbances and substance use disorders. This review summarizes results of the studies on specific characteristics of sleep disturbances related to alcohol, opioids and psychostimulants (cocaine) use. Data on objective and subjective measurements of sleep characteristics at different stages of the course of an addiction disorder (active use, withdrawal, remission) are presented.

[Cognitive deficit in children with hyperkinetic disorder]. / Kognitivnyi defitsit u detei s giperkineticheskim rasstroistvom.

The review presents current data on the nature of cognitive deficit in children with hyperkinetic disorder, and possible pathophysiological mechanisms of the disease. Considering possible neurobiological components of hyperkinetic disorder, attention is given to pathological functional connections underlying specific clinical manifestations of the disease.

[Mental atony in children]. / Psikhicheskaya atoniya u detei.

The paper considers the phenomenon of «mental atony¼ in children with developmental delay, intellectual disability and autism. The condition of mental atony is a congenital or early acquired even decrease in mental tone, manifested by the reduced ability to concentrate attention, a decline of the targeted activity, difficulties in contacting, weakening of unconditioned reflexes, lack of instinctive manifestations, «mobilization¼ of mental functions by persistent verbal and tactile stimulation. The article provides the history of the «mental atony¼ theory, as well as clinical features, epidemiology, etiology, pathogenesis and nosological specificity of the condition. Moreover, the criteria for the differential diagnosis between the atonic form of intellectual disability and autism are discussed in detail. Based on the analysis of literature and the results of own clinical observations, the authors conclude that a thorough differential analysis between childhood autism and atonic form of intellectual disability in children is necessary, otherwise, there is a risk of overdiagnosis of autistic disorders. The authors also point to the role of the brain lesion, particularly in the area of reticular formation, in the occurrence of phenomena of mental atony.

[The prevalence of autism: genuine and imaginary]. / Rasprostranennost' autizma: podlinnaia i mnimaia.

In this review, the authors analyze the causes of the high prevalence of autism spectrum disorders (ASD) in recent decades. It is shown that the expansion of the boundaries of the 'autistic spectrum' concept led to a significant spread of data on its prevalence, depending on the time, diagnostic criteria, country and region. Stability of the diagnosis of ASD is not high and depends on the age of the child. Diagnostic practice in comorbid psychiatric disorders unfairly shifted toward ASD. At the same time, the hypothesis on the uniqueness of autistic manifestations in infancy is not convincingly confirmed. The practical aspect of the problem of the epidemiology of autism does not exclude, but on the contrary, presupposes early detection of nonspecific mental disorders followed by medical-psychological-pedagogical correction.

[Effect of combined application of ozone therapy and gravitational therapy on the remote results of complex treatment of geriatric patients].

The article presents the remote results of treatment of an obliterating atherosclerosis of arteries of the lower extremities of the II stage at patients of advanced and senile age after the combined use of ozone therapy and gravitational therapy. We performed a prospective randomized study in three parallel groups (139 patients). The 1st group (n=57) received standard medical therapy in combination with ozone therapy; the group was divided into two subgroups: for patients of subgroup 1a (n=28) - intravenous ozonized physiological solution was performed, for patients of subgroup 1b (n=29) - major ozonized autohemotherapy. For patients of the 2nd group (n=62) - a comprehensive treatment, including gravitational therapy in addition to medical ozone, was carried out. In this group were also identified two subgroups: subgroup 2a (n=31) - patients received standard medical therapy in combination with ozonized physiological solution and gravitational therapy, subgroup 2b (n=31) - standard medical therapy in conjunction with major ozonized autohemotherapy and gravitational therapy. The 3rd control group (n=20) included patients, who received only standard medical therapy. Dynamics of changes of a stage of a disease and the number of surgeries in the remote period was estimated (up to 7 years). After 6 months of follow-on stages of the distribution of the disease patients significantly (p>0,05) did not differ from the initial amount. Analysis of survival and probable risk at 7 years of follow-Cox regression method revealed a maximum efficiency in the subgroup 2a where the risk of probability of surgeries and also increases in a stage of a disease effectively decreased.

[Monoamine metabolism in children with hyperkinetic disorder]. / Rol' monoaminov u detei s giperkineticheskim rasstroistvom.

In this review article, the authors consider a role of interaction between noradrenergic and dopaminergic systems in children with hyperkinetic disorder without impairment of the operational system of intelligence. The uneven development of higher mental functions observed in these cases is determined by the specificity of the formation of functional systems and the inclusion of compensatory mechanisms as well.

[Features of the dynamics of clinical types of developmental delay in preschool children with residual brain damage]. / Osobennosti dinamiki klinicheskikh variantov zaderzhki psikhicheskogo razvitiya rezidual'no-organicheskogo geneza.

AIM: To study the features of the dynamics of different clinical variants of developmental delay (DD) in preschoolers with residual brain damage and analyze the relationship of these types with disease course and prognosis. MATERIAL AND METHODS: Eighty-six children (76 boys and 10 girls), aged 3-6 years, were examined. RESULTS AND CONCLUSION: The following clinical variants have been described: DD with speech impairments (motor and sensory-motor alalia); DD with hyperdynamic syndrome; DD with autistic syndrome; DD with affective instability syndrome; DD with neurotic syndromes (cerebroasthenic syndrome and other neurotic-like conditions). It is assumed that a poor prognosis in preschool children with developmental delay is associated with manifestations of the autisticand alalia syndromes.

[Use of drug-free methods of treatment in comprehensive therapy of patients with stage II chronic lower limb ischaemia].

Analysed herein are the results of treating a total of 139 patients presenting with stage II chronic lower limb ischaemia. The patients were subdivided into three groups, depending on the variant of treatment performed. Group One patients (n=57) received standard conservative therapy combined with ozone therapy, with the Group being further subdivided into two subgroups: patients of subgroup 1a (n=28) were subjected to intravenous administration of ozonated physiological solution (OPS), subgroup 1b patients (n=29) were given big autohemoozonetherapy (BAT). Group Two patients (n=62) underwent complex treatment including beside medical ozone gravitation therapy (GT). Group Two patients were also subdivided into two subgroups: subgroup 2a patients (n=31) received standard conservative therapy combined with OPS and GT, subgroup 2b patients (n=31) received standard conservative therapy in combination with BAT and GT. Group Three (Control Group) was composed of 20 patients receiving standard conservative therapy alone. The highest efficacy was observed in the subgroup of patients receiving OPS and GT, with the patients of this subgroup showing a statistically significant increase in the pain-free walking distance by 116.5% and in the ankle-brachial index by 49.2%, also demonstrating the most pronounced positive dynamics of lipid metabolism parameters: a decrease in total cholesterol by 21.3%, low density lipoproteins by 25.4%, very low density lipoproteins by 24.2% and triglycerides by 18.5%. Besides, a tendency was observed towards normalization of the haemostasis system indices: fibrinogen decreased by 21.8%, prothrombin index by 13%, fibrin monomer complexes retraction by 18.2%, and the clotting time increased by 20.7%. Hence, combined use of ozonated physiological solution and gravitation therapy in treatment of patients with stage II chronic lower limb ischaemia promotes a considerable increase in the pain-free walking distance and ankle-brachial index, as well as contributes to correction of lipid metabolic disorders and haemocoagulation.

[Pathological fantasies in children]. / Patologicheskoe fantazirovanie u deteĭ.

AIM: To develop a clinical classification of pathological fantasies (fantasy syndrome) in children and adolescents regardless of nosological attribution. MATERIAL AND METHODS: We examined 109 patients, aged 3-16 years, using psychopathological and instrumental (EEG and MRI) methods. RESULTS AND CONCLUSION: Authors developed the clinical typology of pathological fantasies in children with different mental diseases and disorders. The following variants of fantasy syndromes were singled out: 1. fantasizing with sensorealization of mental images; 2. fantastic stories (subdivided into 5 different variants): 2.1 easily provoked fantasies with situation-conditioned content; 2.2. fantasizing with increased falsehood; 2.3. sexual allegations and self-accusations; 2.4. fantasizing about imaginary worlds; 2.5. fantasies about a fictional friend); 3. playing transformation; 4. fantasies with a predominance of specific hobbies.

[Use of gravity therapy and discrete plasmapheresis in treatment of atherosclerosis obliterans].

The authors carried out a comparative analysis of the results of management of patients presenting with stage II lower-limb atherosclerosis obliterans according to the classification of A.V. Pokrovsky (1973) in three clinical groups. Group One patients (n=118) were subjected to conventional conservative therapy combined with gravitational therapy, Group Two patients (n=28) underwent plasmapheresis on the background of standard conservative therapy, and Group Three patients (n=40) in the composition of the combined therapy received gravity therapy and plasmapheresis. Prior to treatment, the patients were found to have alterations in the lipid spectrum mainly at the expense of an increase in the level of triglycerides, elevated concentration of C-reactive protein, and pronounced circulatory impairments in the lower extremities on ultrasound Doppler examination. After treatment, the most effective correction of the levels of C-reactive protein, fibrinogen and triglycerides appeared to be in those groups where patients received plasmapheresis. The use of gravitational therapy ensured a considerable increase in the regional blood flow. A combination of plasmapheresis and gravitational therapy in the composition of comprehensive therapy made it possible to act upon various links of pathogenesis of atherosclerosis obliterans and to substantially improve the treatment outcomes in this cohort of patients.

[Clinical presentations and a classification of oligophrenia psychoses in children].

The article discusses the clinical variants of psychosis in children with mental retardation. A particular group of psychotic disorders - oligophrenia psychosis, is described. A total of 28 children (19 boys) who were hospitalized in a psychiatric hospital or treated as outpatients from 1992 to 2012 were examined. The average age of the patients was 12±1.3 years. The duration of follow-up (analysis of medical records or direct clinical observation) was up to 18 years. Almost all children had mild mental retardation (only one patient had moderate mental retardation). Diagnosis corresponded to ICD-10 codes F06.07, F06.27, F06.29, F06.817 or F06.819. Mental retardation corresponded to the second code section F70 (F71 in one case). Clinical and psychopathological methods, follow-up study, statistical analysis of the data were used. Four clinical variants of oligophrenia psychoses in children were identified: 1) psychosis with amentive confusion, 2) schizophreniform psychosis, 3) verbal hallucinosis, 4) psychosis with a predominance of psychomotor agitation.

[Clinical typology of organic psychosis in children and adolescents].

Observation of a group of children and adolescents, aged 8-17 years, with organic psychosis are reviewed. Four main variants, including organic schizoid psychoses; organic affective psychoses; periodic organic psychoses and organic hallucinosis, are described.

[Ultrasound duplex scanning in the assessment of the effectiveness of gravitation therapy and conservative treatment of patients with atherosclerosis obliterans of the lower extremities]. / Pokazateli ul'trazvukovogo dupleksnogo skanirovaniia v otsenke éffektivnosti gravitatsionnoi terapii i konservativnogo lecheniia bol'nykh obliteriruiushchim aterosklerozom arterii nizhnikh konechnostei.

Ultrasound duplex scanning was used to compare the results of the treatment of 162 patients suffering from atherosclerosis obliterans of the lower extremities. It is to be noted that 50 patients were administered only gravitation therapy, 72 patients underwent a complex of treatment measures including, in addition to gravitation therapy, physiotherapy and drug treatment, and 40 patients received conservative treatment alone. The assessment criteria were the maximal systolic velocity of blood flow (V(max)), end diastolic mean, velocity (V(min)), mean maximal velocity (V(mean)), volume velocity of blood flow (V(vol)), ankle/brachial index (ABI), and index of regional perfusion (IRP), proposed by us and representing the percent ratio of the volume velocity of blood flow to the minute heart volume (MHV). It has been revealed in the course of the treatment that the best clinical outcome was recorded in patients who received a complex of treatment measures. The use of gravitation therapy alone provided better treatment results as compared to those obtained in patients administered standard conservative therapy. Of all the indicators used, only V(mean), V(vol), ABI and IRP are of the clinical significance. However, the most significant information on the segmental blood flow was obtained on the assessment of the IRP whose values did not depend on the changes in central hemodynamics. In contrast to the ABI, the advantage of the IRP lies in the possibility of blood flow assessment in different segments and arteries of the extremities. So, the use of the quantitative indicators of ultrasound duplex scanning and, first of all, of the IRP, allows an objective evaluation of the segmental blood flow and may serve one of the significant criteria of the treatment effectiveness.

[Effect of mild gravitational overload on the progression of lower limb arteriosclerosis obliterans]. / Vliianie gravitatsionnykh nagruzok nebol'shikh velichin na techenie obliteriruiushchego ateroskleroza arterii nizhnikh konechnostei.

The paper analyses the effect of mild gravitational overload (MGO) produced by patient's centrifugation in short-radius centrifuge in cranio-sacral orientation (+Gz) as a part of combined therapy for lower limb arteriosclerosis obliterans. Total 211 patients with I-II grade disease were divided into 3 groups: the first group (59 patients) was treated only by MGO, the second (100 patients) received both MGO and conventional conservative therapy, the third control group (52 patients) underwent conventional therapy only. The best clinical outcome was achieved in the 1st and 2nd groups. Pain-free walking distance increased 2-5-fold (vs 1.5 in control), mean volume blood flow velocity in different arterial beds increased 21-33% (vs 7.5% in control), index of regional perfusion - 25-29% (vs 10% in control), ankle-brachial index - 0.09-0.17 (vs 0.03 in control). Computer termography revealed recovery of leg and foot termographic picture in 86.67%, 92.59%, and 42.86% of cases in the 1st, 2nd and 3rd groups, respectively. Similarly, exercise tolerance measured by bicycle ergometry increased in the 1st and 2nd groups 1.5-1.9-fold (mean 60-85 s) and 1.3-fold (mean 37 s) in control. Thus mild gravitational overload has demonstrated clinical effectiveness in complex therapy of lower limb arteriosclerosis obliterans.