Ground glass opacities, mosaic perfusion, areas of air-trapping on a computed tomography of the lung are one of the most frequent x-ray syndromes. It`s are one of the kind of syndromes increase the density of pulmonary parenchyma. It is important to remember that the syndromes of ground glass opacities, mosaic perfusion, areas of air-trapping involve the differential diagnosis and not a diagnosis in itself. Differential diagnostic range very wide, since this syndrome commonly occurs in diseases that affect small bronchi, pulmonary vessels, alveoli and interstitial tissue. It is often observed a combination of lesions of various components of the pulmonary parenchyma. These combinations often help the doctor find the key to the correct diagnosis. Another problem in the evaluation of these syndromes are the distinction between pathological and “healthy” areas of lung tissue. Thus, in certain diseases, regions with higher density of the lung tissue may be normal lung parenchyma. The aim of this lecture is to analyze the reasons for the formation of the CT-types of ground glass opacities, mosaic perfusion, areas of air-trapping in norm and pathology, selection of distinctive features, allowing determining the elements of the lung parenchyma, the underlying pathological process, thereby narrowing the differential diagnosis of several diseases.

Myasthenia gravis is a progressive autoimmune disease, which characterized by the production of antibodies to the structures of the neuromuscular junction. High clinical heterogeneity of autoimmune myasthenia, initiating the flow, increases the urgency of studying its pathogenesis, searching for specific methods of marker diagnostics, developing algorithms for predicting the features of the development of the disease. At the present time, there are different approaches to the study of the etiology and pathogenesis of the disease, which include both serological, biochemical, genetic, etc. theory of the development of the disease. For decades, research has been carried out to find new pathogenetic links in myasthenia gravis. Today was described a number of antibodies such as for muscarin (MuSK), ryanodine receptors, to titin, lipoprotein bound receptor 4, cortactin, etc.). The serological diagnosis of myasthenia gravis has been used as a «gold standard» in clinical practice. The prognostic criteria describing the course of myasthenia gravis and the type of antibodies isolated in the blood serum of the patient. Also, already have been developed mechanisms of failure of autotolerance, triggering the production of antibodies to their own structures, and their genetic bases are also described. Thanks to the development of biotechnological methods, the researchers were able to identify the subtype of lymphocytes involved in the development of myasthenia gravis. Isolation of individual subpopulations of lymphocytes also became available. Researchers continue to search for new targets, allowing to improve diagnostics, to develop new directions in the therapy of the disease. However, despite the active study of various mechanisms for the development of myasthenia gravis, many unresolved problems still remain. The article describes briefly the main mechanisms studied in the development of myasthenia gravis, which in turn facilitates understanding of complex mechanisms of pathogenesis.

Ammonia belongs to the common neuro- and cytotoxic metabolites in the human. It is established that ammonia has hepatotoxic properties. Ammonia induces the formation of oxygen active forms, reduces the activity of endothelial NO synthase, dose-dependently decreases the cellular metabolism and proliferation of stellate cells, and promotes fibrogenesis, disturbance of intrahepatic hemodynamics and, accordingly, the formation of portal hypertension. The article demonstrates causes of hyperammonemia in pathological conditions and disturbance of physiological functions. The increased level of ammonia is associated not only with various neuropsychiatric disorders in liver cirrhosis, but also is shown in patients with chronic liver disease (CLD) at the precirrhosis stage. The presence of minimal hepatic encephalopathy in patients with chronic hepatitis is a cognitive impairment, which manifests as a de-crease in concentration, in particular when driving. The effect on hyperammonemia becomes a target for therapy in steatohepatitis of various etiologies. The use of the oral form of L-ornithine-L-aspartate effectively reduces the level of ammonia in the blood, improves cognitive function and positively affects the functional state of the liver in patients with CLD at the precirrhotsis stage.

We retrospectively studied the age, sex structure and medical conditions of urgent pathology among HIV-infected persons at Sklifosovsky Research Institute for Emergency Medicine. For the period from 2008 to 2015, the number of patient’s hospitalizations with HIV to the emergency hospital increased in 1,5 times as among men (R2 =0,63, p=0,0188), and women (R2 = 0,84, p=0,0013). The greatest number of admissions HIV-infected persons registered at the emergency departments (R2 =0,57, p=0,03). The main share of people with HIV infection were citizens in the age groups 18-30 and 31-40 years old. At the same time, we were revealed multidirectional trends connected with decreasing number of hospitalized patients in the age group of 18-30 years (R2 = 0,51, p = 0,04) and increasing in groups of 31-40 (R2 = 0,71, p = 0,008) and 41-50 years (R2 = 0,89, p = 0,0004). The share of HIV-infected men decreased from 68,1 to 65,1% while women have increased from 31,9 to 34,9%. The differentiation of the epidemic process for HIV-infection among patients in different clinical departments noticed.

The relationship between cardiorespiratory disorders and diabetic foot syndrome has not been adequately studied. In particular, there is no information on the strength of the respiratory muscles in this category of patients. The purpose of the study: to determine the presence of respiratory muscles weakness in patients with type 2 diabetes mellitus complicated by diabetic foot syndrome. Materials and methods. 72 patients were examined, 16 of them with type 2 diabetes mellitus complicated by the neuroischemic type of diabetic foot syndrome I-IV st. Wagner made up the first (main) group. The second group (comparisons) included 29 patients with type 2 diabetes mellitus not complicated by diabetic foot syndrome. The third group (comparisons) were 27 patients without diabetes. The groups were randomized by sex and exclusion criteria. Determination of the strength of the respiratory muscles was carried out by measuring the maximum static pressure levels at the mouth level that the patient created during maximum inspiration and maximum expiration in closed airways. Results. The forces of the respiratory muscles with inspiratory effort in patients with type 2 diabetes mellitus complicated by diabetic foot syndrome was reduced by 18.5 cm of water column (p <0.01) compared with diabetic patients without diabetic foot syndrome and by 17.3 cm water column (p <0.01) compared with patients without diabetes. The expiratory effort showed a decrease in the forces of the respiratory muscles in the patients of the first group by 49.4 cm of water column (p <0.01) compared to patients of the second group and by 27.4 cm of water column (p <0.05) compared to patients third group. In women with diabetic foot syndrome, the inspiratory muscular forces was reduced in comparison with patients without diabetic foot and without diabetes syndrome by 27.1 (p <0.01) and by 23.3 (p< 0.05) cm of water column, respectively. In men with diabetic foot syndrome, the same index was lowered by 13.9 (p> 0.05) and 17.7 (p <0.05) cm of water column, respectively, compared to the second and third groups, respectively. The expiratory effort revealed a decrease in the forces of the respiratory muscles in men in all groups in approximately the same range, without a significant difference between the groups. In women with diabetic foot syndrome, there is a marked decrease in the strength of the expiratory muscles: by 48.4 cm of water column (p <0.01), compared to women of the second group and by 20.6 cm of water column (p <0.05) patients of the third group. Conclusions. Patients with diabetes mellitus complicated by diabetic foot syndrome showed a decrease in the strength of inspiratory and expiratory muscle. In women with diabetic foot syndrome, there is a more pronounced decrease in the strength of the respiratory muscles during exhalation compared to men with this pathology.

The aim of the article. The purpose of our study was to study the clinical and neurophysiological features of nocturnal painful paresthesias in the upper limbs. Material and methods. The article presents the results of a survey of 107 patients with pain and night paresthesias in their hands. It was revealed that the syndrome of nocturnal painful paresthesias is mixed in etiology and has myofascial pain syndromeas an initial part. The clinical symptomatology of nocturnal pains and paresthesias in the hands of patients with myofascial pain syndrome of the shoulder girdle and upper limbs was described. Results. It is shown that active myofascial trigger points are the key link in the clinical picture formation of the syndrome of nocturnal painful paresthesias in patients with myofascial pain syndrome. In the study of short-latency somatosensory evoked potentials from the upper extremities, the pathological peak Px in the CVII-Fpz lead is described, which is the marker for the presence of a pathologically enhanced excitation generator in the supragmentary structures. Conclusions. The syndrome of nocturnal painful paresthesias is mixed in etiology and has, as an initial link, myofascial pain syndrome. Detection of a pathologically enhanced excitation generator in the supsegmental sections of the sensitive pathway in the registration of short-latency somatosensory evoked potentials is an adequate method for diagnosing painful paresthesias.

The aim: to study the quality of life of patients with varicose disease of lower extremities, treated for the period from 2007 to 2016 in an operational way, including the RFA method. Materials and methods. We used the following materials in our work: medical histories of the patient of the surgical department, summary data from the department of statistics Departmental Hospital at the station Tyumen JSC «Russian Railways», data of ultrasonic angioscanization of veins of lower extremities. We used the research methods: statistical method, clinical, expert analysis and system approach. The degree of chronic venous insufficiency of lower extremities was determined using the clinical section of the international classification of CEAP (1995). Results and discussion. We analyzed the quality of life of patients with varicose disease of lower extremities after surgical treatment for the period from 2007 to 2016. It was found that the overwhelming majority of patients (83%) had a hereditary factor from the etiologic factors of the disease, obesity in 57% of cases, long-term static loads in 44%, and hormonal contraceptives in 5% of cases. We gave a subjective evaluation of the results of surgical treatment with the classical method (phlebectomy) and the method of radiofrequency obliteration of veins. The average duration of temporary disability of railwaymen after crossectomy and phlebectomy was (18 ± 2,5) days, while after the RFO the majority of patients (70.5%) returned to their usual life on the day of the operation, 23.5% after 2 days after surgery, 8.8% — after 3 days after the operation. It is shown that the promptly conducted operative treatment in a planned manner, without waiting for the development of complications of varicose veins, significantly improves some sections of the patient’s quality of life. Conclusion: the process of rehabilitation of patients in the postoperative period is reduced 3 times if surgical intervention with varicose disease of lower extremities is performed by the method of endovenous segmental radiofrequency obliteration of veins.

Objective. Protein is an important component in the process of functioning of the body. But for those who have kidney disease, excessive consumption of protein, leads to the opposite effect. Since the glomeruli of blood vessels can not completely filter blood, toxic substances accumulate in the body. This leads to the disease of other organs. Therefore, the topic is important for research. The main goal of the work is to study the morphological changes in the structures of the tubular and vascular systems of the kidneys under protein loading. Regulation of protein homeostasis is provided by structural and functional systems and can be accompanied by proteinuria. Material and methods. Therefore, in order to study the structural bases of integration of functional kidney systems in the regulation of protein homeostasis, the author created a model for the disturbance of protein homeostasis in blood in rats. For the experiments, mature non-native white rats weighing 140-160 g were used, which were divided into three groups. Results. After the experiment, during the first day, the afferent and widening of the efferent arterioles, an increase in the percentage of glomeruli, was seen. The structure of the proximal tubule cells did not change. On the third day, the degree of opening of the blood capillaries, surface and juxtamadullar nephrons, exceeds the parameters of the control animals. As a result of the morphological study of the kidney, it was established that, under different physiological conditions, there are regular changes in the cells of the SOUTH and capillaries of the glomeruli of superficial and juxtamedullary nephrons, which are aimed at increasing the functional reserve of the kidneys in regulating protein homeostasis. Conclusion. It was established that a single protein load is accompanied by activation of the juxtaglomerular complex, a change in the functioning of the nephrons.

Over the past decades, there has been an increase in the incidence of thyroid cancer in most countries, and the most common form of thyroid cancer is papillary thyroid cancer. Application of radioiodine therapy for papillary thyroid cancer depends on the degree of postoperative risk of the disease recurrence. Radioactive iodine is recommended after radical thyroidectomy in case of intermediate or high risk of recurrence, that reduces the probability of disease progression and increases survival. The aim of radioiodine therapy is the ablation of thyroid tissue left after thyroidectomy and metastases, accumulating radioactive iodine. The recommended activity of the drug for radioablation is 30 mCi in the intermediate risk group and 30 to 150 mCi with a high risk of recurrence, but total doses and multiplicity of courses varies widely. The acute side effects of radioiodine therapy, the probability of which increases with a radioiodine dose of more than 100 mCi, include allergic reactions to iodine, post-radiation parotitis and sialadenitis, gastritis, cystitis, pulmonitis (with lung metastases), myelodepression, transient amenorrhea and hypo-spermia. The listed violations are transient and last from several days to several months. In the presented article the clinical case of papillary thyroid cancer with metastases in the lymph nodes of the neck was examined. The patient underwent thyroidectomy, central lymphadenectomy and radiotherapy. One year after the third course of radioiodine therapy the patient experienced the development of post-radiation gastritis, myelodepression and myelitis, manifested by a marked pain syndrome in the cervical spine and sensory and movement disorder of hands and legs. Pulse therapy with glucocorticoids in combination with drugs that improve microcirculation, neuromuscular conduction and reduce the severity of neuropathic disorders allowed to stop post-radiation complications.

In the article the interdisciplinary problem of drug allergy being analysed, namely its systemic symptoms. There have been shown the variants of systemic allergic reactions and the characteristics of the toxic epidermal necrolysis or Lyell`s syndrome as one of the most serious and rare form of illness. There has been carried out the analysis of the clinical case of the Lyell`s syndrome with diagnostic difficulties in the beginning phase of the disease and favorable outcome. There has been proved the dynamics of clinical signs and their reversed development.

The paper deals with the problem of recognizing systemic lupus erythematosus, which is getting a rather common disease. It present a clinical case of a female patient with type 2-diabetes mellitus, arterial hypertension, hyperuricemia, who developed systemic lupus erythematosus at the age of 52. The onset of a new disease in a patient with comorbidity is often concealed by the symptoms of the new disease. It troubles the well-timed diagnostics of the new disease. The diagnosis of systemic lupus erythematosus was established according to the accepted criteria in Federal clinical recommendations. The author emphasize that according the Federal clinical recommendations a long-course we of Hydroxychloroquine adder to the basic therapy proved to be effective in relieving clinical manifestations of systemic lupus erythematosus and preventing its exacerbations. Detailed differential diagnostics in the presented case is given in discussion. The considerable attention is paid to diagnosing and treatment of the fastprogressing lupoid nephrite. The example of standard pulse-therapy is given at the fast-progressing lyupus-nephrite for an induction of remission and its effectiveness for knocking over of a nephrotic syndrome on a concrete example is shown. The authors considered pathological processes which lead to fast progression of secondary nephrotic syndrome. Recently opened pathophysiological mechanisms of development of anemia of chronic disease are presented for it contributes to more complete of systemic lupus erythematosus path ways. Search of the reason of not expressed joint syndrome with systemic manifestations was run among probable autoimmune and exchange diseases for people of the senior age group. Specific laboratory indicators of function of a liver indicated the diagnosis of lupoid hepatitis. Probable mechanisms of injury of a liver to a concrete clinical case are described. Work of authors has cross-disciplinary character and it can be useful to experts of theoretical and applied medicine.