[Medical rehabilitation in patients with anal incompetence after surgery for stage IV hemorrhoids]. / Konservativnaya reabilitatsiya patsientov s nedostatochnost'yu anal'nogo sfinktera posle khirurgicheskogo lecheniya gemorroya IV stadii.

The choice of medical rehabilitation in patients with anal incontinence is impossible without diagnostic data revealing the mechanism of fecal incontinence. The most promising are programs of comprehensive physiotherapeutic rehabilitation based on biofeedback training. The rate of anal incompetence (AI) after hemorrhoidectomy is 1.3-12.5%. However, in addition to the organic cause (surgical trauma), functional disorders of the external sphincter and pelvic floor muscles may contribute to the pathogenesis of anal incontinence, aggravating the incontinence symptoms after surgery. Therefore, these functional disorders should be diagnosed before surgery. However, medical rehabilitation programs for anal incontinence after hemorrhoidectomy are not standardized, and functional outcomes have not been studied. OBJECTIVE: To evaluate the outcomes of comprehensive rehabilitation in patients with AI after hemorrhoidectomy to improve quality of life after surgery. MATERIALS AND METHODS: A retrospective study was carried out on 46 patients (mean age 53.8±15.4 years) after hemorrhoidectomy with fecal incontinence, 13 (28.3%) males and 33 (71.7%) females. The main group included 25 patients who received comprehensive rehabilitation, including biofeedback training and tibial neuromodulation (TNM) for 15 days. The control group consisted of 21 patients who received TNM at home also for 15 days. The severity of fecal incontinence was determined using the Wexner score. The functional state of the sphincter before and after surgery was assessed using the anorectal manometry (sphincterometry) (WPM Solar, the Netherlands). RESULTS: Comprehensive rehabilitation resulted in a statistically significant clinical improvement: a decrease in the Wexner score in both males and females. No significant differences in manometry results were observed: the anal sphincter tone increased by 16.0% in females and 10.6% in males, and contractility increased by 17.7% and 15.1%, respectively. Monotherapy with TNM in control group patients improved tone indices by 8.7% in females and 6.8% in males, and contractility by 6.2 and 5.4%, respectively, which was lower than in the main group. CONCLUSION: Contraindications to physiotherapeutic procedures based on electrical stimulation, extracorporeal magnetic stimulation, and magnetic translumbosacral neuromodulation determine the only possible choice of medical rehabilitation, which is the combination of biofeedback training and TNM (as superior to TNM monotherapy). If out-patient medical rehabilitation is not feasible, patients are recommended to complement the home course with a specially designed set of exercises for anal incontinence treatment.

[Ventral decompression techniques in patients with traumatic and non-traumatic atlanto-axial dislocations]. / Metody ventral'noi dekompressii u patsientov s atlanto-aksial'nymi dislokatsiiami travmaticheskogo i netravmaticheskogo geneza.

Compression of the caudal medulla oblongata and ventral portions of the spinal cord is the most dangerous complication of atlanto-axial dislocation (AAD). AIM: The study objective was to improve surgical management of patients with ventral compression of the spinal cord in the setting of AAD of various genesis. MATERIAL AND METHODS: We analyzed treatment outcomes in 250 patients with C1 and C2 injuries and diseases for the period between 2002 and 2016. Persistent ventral compression of the neural structures in the setting of AAD was detected in 34 (13.6%) patients. Anterior or posterior dislocation was in 21 patients, vertical dislocation occurred in 7 patients, and mixed (anterior and vertical) occurred in 6 cases. The causes of AAD included odontoid fractures (21 patients, 61.8%), Jefferson fractures (6 patients, 17.6%), atlas transverse ligament rupture (1 patient, 2.9%), rheumatoid arthritis (4 patients, 11.8%), and nonspecific spondylitis (2 patients, 5.9%). RESULTS: All dislocations were divided into Halo-tractable and Halo-intractable ones. In 24 cases, ventral decompression was achieved due to Halo reposition. Additional resection of a compressing substrate was performed through the submandibular approach in 4 patients, through the transoral approach in 5 patients, and through the transnasal approach in 1 case. In the postoperative period, complications in the form of pharyngeal edema developed in 1 patient after transoral decompression. In the other cases, there were no postoperative complications. All patients had improvement in their condition in the form of regression of a neurological deficit. CONCLUSION: Halo reposition is a technique eliminating, completely or partially, ventral compression in certain traumatic and non-traumatic dislocations. The choice of a surgical corridor should be performed after preliminary Halo correction. If the nasopalatine line runs in the odontoid neck projection, the submandibular approach may be used in the case of a Halo-tractable dislocation, and the endonasal approach may be used in the case of a Halo-intractable dislocation.

[Comparative medical/social characteristics of psychiatric outpatients]. / Mediko-sotsial'naya kharakteristika vnebol'nichnogo kontingenta psikhicheski bol'nykh.

OBJECTIVE: to compare medical/social characteristics of psychiatric outpatients of rural and urban regions to optimize the activities of the regional mental health services. MATERIAL AND METHODS: Using an anonymous survey, 1042 psychiatric patients of the Orel Regional psychoneurological out-patient clinic have been examined. RESULTS AND CONCLUSION: Significant differences in the access to professional psychiatric and psychotherapeutic care between rural and urban populations of the region were shown. To overcome the imbalance, decentralization of psychiatric care and its approach to the patients are needed.

[The peculiarities of the support therapy and adherence to the treatment in psychiatric outpatients].

OBJECTIVE: To study peculiarities of the support therapy and factors hampering the compliance in psychiatric outpatients. MATERIAL AND METHODS: We questioned 1042 patients with mental diseases and 580 persons in their close social environment using the method of anonymous social questionnaire. RESULTS: The most of the respondents (78.2%) received "classic" psychotropic drugs, 21.8% - the drugs of new generations. One third of the patients (37.56%) did not take the prescribed medicine. The reasons for refusal were: polypragmasia (74.39%), poor drug tolerance (38.17%), the complex scheme of drug dosage regimen, the negative experience of the previous therapy (35.62%) and the lack of information about peculiarities of the disease (59.73%). CONCLUSION: Introduction of methods of psychosocial rehabilitation, in particular, psychoeducational and multiprofessional treatment programs, is required for psychiatric practice to improve the quality of outpatient care.

[The features of daily functioning of mentally ill patients: a sociological survey].

The data of a sociological survey of 1042 mentally ill patients are presented. The aim of the investigation was to study different aspects of daily functioning of patients with mental diseases. It has been shown that the negative consequences of mental disease are seen at every level (professional, family and social) of daily functioning.

[Treatment of patients with fractures of the odontoid of the C2 vertebra].

The study was undertaken to improve an approach to treating patients with fractures of the odontoid of the C2 vertebra. Forty-nine patients were admitted to hospital for fractures of the odontoid process on January 14, 1989 to January 3, 2004. Physical, target X-ray study of the cervical spine, computed tomography of the C1-2 vertebrae, magnetic resonance imaging of the neck were performed on admission. Type II odontoid fractures were found in 17 patients, Type III in 32, of them 5 patients were observed to have an axial fracture concurrent with Jefferson's fracture. Forty-one of the 49 patients were operated on. Eight patients underwent rigid external fixation with reposition using a Halo apparatus. In all cases, a Halo apparatus was used before surgery to correct dislocation and to fix the upper cervical part of the vertebral column. According to the type of a fracture, its duration, reducibility of atlas-axial dislocation, the patient's status, the following procedures were performed: 1) posterior combined spondylodesis of the C1-C2 vertebrae (Halifax braces) alone and in combination with transpharyngeal resection of the odontoid process; 2) transdental spiral fixation; 3) occipital spondylodesis; 4) isolated Halo reposition and fixation. In all the cases, the results of treatment were assessed as good. The effect of reposition and stabilization was achieved. The prehospital pain syndrome and neurological deficit virtually entirely regressed. It was concluded that active surgical policy in injuries of the upper cervical spine may yield the optimum clinical and orthopedic results that a differential approach is required to choose a method for decompression and stabilization depending on the type of an upper cervical vertebral injury.