Professor Sergei Iakovlevich Kulnev, student and follower of the founder of the Russian syphilidology Veniamin Mikhailovich Tarnovsky, was the head of the Department of Skin and Venereal Diseases at St. Petersburg Medical Institute for Women in the difficult years of its formation – from 1903 to 1924. In fact, the merit of establishing the Department with clinic in the newly formed educational institution for women belongs to him. In 1913, with the active participation of S.Ia. Kulnev, the separate building for the Department of Skin and Venereal Diseases was built, and to this day, it is still located at this premise. Also, for almost a quarter of a century (from 1901 to 1924) S.Ia. Kulnev was the chief physician of the Kalinkinsky Hospital, the oldest specialized dermatological and venereal hospital in Russia and in Europe, where, in fact, Russian syphilidology was born.

In Soviet times, the merits of S.Ia. Kulnev who was an actual state councillor and representative of the famous noble Russian family, as an organizer of the Department with Clinic of Skin and Venereal Diseases, was undeservedly ignored.His activity appeared to be in the shadow of achievements of his brightest students, graduates of Medical Institute for Women A. A. Sakhnovskaia and O.N. Podvysotskaia, who alternately headed the Department after the death of Sergei Iakovlevich.

The objective of the article, dedicated to the 160th anniversary of the birth of Professor Kulnev, was the desire to pay tribute to the memory of a remarkable physician, teacher and man, whose whole life was devoted to the development of Dermatovenereology and the organization of women’s medical education in Russia. The property of S. Ia. Kulnev is not only a thing of the past. His works laid the foundation of today’s educational, scientific and medical activities of the Dermatovenereology Department of Pavlov First St. Petersburg State Medical University. 

IIn 2018, the 150th anniversary of Dmitrii I. Shirshov was celebrated. The article is devoted to Shirshov’s biography and describes his research pathway, the main achievements in obstetrics, gynecology and urogynecology. In addition, the article tells about the characteristic of his clinical and teaching activities.

The most important historical stages of formation of scientific ideas of gastroesophageal reflux and its complications are presented in the article; the main milestones in the development of gastroesophageal reflux disease surgery are reflected.

The article discusses the importance of university clinics and historical aspects of their development both abroad and in Russia. The history of the development of university clinics goes side by side with the development of medical education in general. The concept of university clinics has been laid down since the time of the ancient East. The European stage of the formation of university clinics dates back to the Middle Ages and the Renaissance period. Nowadays, university clinics work according to the model of cooperation between the university and the clinic, or according to the model of integration of the clinic into the university. In Russia, in fact, Peter the First laid the notion of university clinics that facilitated the opening of hospital schools. The importance of combining the educational and therapeutic process is proved. Thus, this combination improves the quality of medical care.

Emergency medical education is becoming increasingly challenging as a result of shifting the workplace of emergency physician from ambulance to Emergency Department. Prehospital specialist rarely uses infusion therapy, instrumental methods of treatment and diagnostic independently. Comparison shows the need of longer education for hospital practices, because additional ultrasound and reanimatology trainings are required.

Introduction. Infectious diseases make a significant contribution to the recurrence and disability, and therefore cause economic damage to the country, which is an indisputable argument in favor of the creation of a system of rehabilitation of children with infectious diseases.

The objective of the study was the economic justification of the need to organize a multidisciplinary children’s rehabilitation center, including after infectious diseases. 

Material and methods. Based on the long-term experience of the only center in the Russian Federation for the treatment of children’s infections and the data of the statistical service we calculated the economic effect obtained as a result of reducing the recurrence of infectious diseases and disability caused by them among the child population.

Results. The study found that the annual economic losses associated with the treatment of relapses of infectious diseases among children would be 4.344 billion rubles and 39.713 billion rubles due to the payment of disability benefits. The economic loss associated with the reduction of days of incapacity of parents obliged to care for children who need care due to infectious diseases is 2.791 billion rubles. In addition, the indirect economic loss caused by the under-produced products and the GDP decline due to the disability of such children already in working age is 30.102 billion rubles.

Conclusion. We proved the significant economic effect that would be received at the opening of the rehabilitation center for children. The economic effect is caused by the reduction of both direct and indirect economic losses. 

Introduction. The development of the system of emergency medical care in emergency department inevitably brings up issues of its availability and quality. Moreover, if the leading pathological syndrome resulting in the hospitalization and threating to the patient’s life deserves priority attention, so the accompanying pathology often remains in the shadow. Thus, venereal diseases, in particular, syphilis is epidemiologically dangerous disease as for the patients having this illness and for the patients surrounding them and the medical personnel carrying out the medical process. 

The objective of the study was to assess the current state of the problem of medical care for patients with venereal pathology in an emergency department.

Material and methods. The material for the study was the data of medical records of patients in multispecialised emergency department of St. Petersburg for 4 years: 1088 – with positive serological reaction and 4500 – without dermatovenereal pathology (DVP).

Results. By the results of the research, the diagnosis of syphilis was based only on the enzyme immunoassay test for syphilis and the diagnosis of syphilis remained unspecified; the efforts to prevent the spread of syphilis in emergency department were insufficient, did not allow carrying out appropriate preventive, therapeutic and diagnostic measures.

Conclusion. Development of new models and principles of the organization of the diagnostic and treatment process, including the introduction of methods of express diagnosis in emergency department is required. 

Introduction. The organization of primary specialized dental care for children is of paramount importance due to the wide prevalence of lesions the dentoalveolar region, leading to formation of foci of odontogenic infection, which cause diseases of many systems and organs.

The objective of the study is to analyze the state of the network and personnel of children’s dental service, identify trends in their dynamics, and determine main indicators of the work.

Material and methods. We analyzed materials of official statistical reporting (f. 30) for 5 years on the network of public health organizations providing dental care for children. Research methods - statistics, determination of extensive and intensive indicators, the materiality of their differences using the criterion of reliability t (significant differences were recognized at t>3), time-series analysis.

Results. We obtained the data on the availability of child population with pediatric stomatologist, dentists and dental hygienists, staffing, qualifying characteristics. There is a tendency to increasing the staff of stomatologist and dentists, while reducing their staffing. There is a significant deficit among the personnel and staff of dental hygienists. We identified main indicators of the outpatient dental service to provide specialized care for children: frequency of visits by children to stomatologists of different specialties, dentists and dental hygienists, the average number of visits per year for a child and 1 disease, the ratio of preventive visits to treatment, the frequency (per 1000 visits) and structure of different types of dental care for children. Clinic attendance by children for dental and oral diseases was 1318.7 0/00, on average, more than 1.3 visits for a child; there are 2.4 repeated visits per primary visit for the disease. On average, 437.7 out of every thousand visits over 5 years were related to the course of prevention and 265.5 were visits for planned rehabilitation.

Conclusions. It is advisable to introduce forms of accounting and reporting documentation for the registration of dental and oral diseases in different age groups of the population, including children (type f. 25-u and f. 12). (of type f. 25 and s. 12). 

Background. Foundation of specialised centres or units of acute spinal surgery in general acute hospitals is to be considered a tendency of much importance in development of metropolitan systems for management of trauma victims with spinal injuries.

Objective. To analyse size and structure of the patient inflow, contents and outcomes of treatment of trauma victims with thoracic and lumbar spine injuries in a setting of a specialised centre for acute spinal surgery located in a major city in our country.

Material and methods. 1,760 trauma victims with thoracic and lumbar spine injuries admitted to an urban centre for acute spinal surgery of St. Petersburg in 2010 through 2016: 1,204 (68.4%) – isolated neurologically intact, 410 (23.3%) – isolated with spinal cord injury, 146 (8.3%) – spinal injuries in polytraumatised patients. An analysis of health administrative and clinical data was performed using non-parametric statistics.

Results. During the period the centre worked, the number of annually admitted trauma victims increased 3.44 times, while notably, in the annual structure of the inflow, of which a fraction of isolated neurologically intact injuries decreased from 75.4% to 64.5%, there was an increase in fractions of persons with isolated spine and cord injuries (from 20.2 to 25.0%; р=0.2878) and with spinal injuries and polytrauma (from 4.4 to 10.5%; р=0.0718). The surgical rate was observed to increase from 69.3% to 81.9% (р = 0.0036), especially in trauma victims with unstable isolated neurologically intact injuries. In the annual structure of surgical work, a fraction of early procedures constantly increased (from 27.8 to 91.6%; р=0.0001), the increase rate appearing most stable in neurologically intact patients with isolated injuries. The treatment outcomes showed high values by all measures.

Conclusion. The setting of a specialised secondary care centre for acute spinal surgery of a major city delivers high effectiveness and favourable outcomes of treatment of trauma victims with spinal injuries owing to the centralisation of their inflow, broad use of modern medical technology, and the tactic of early surgery. 

Introduction. In systemic autoimmune diseases with joint damage (SADJD), impaired angiogenesis occurs, which plays a key role in the progression of proliferative synovitis and in the development of lesions of the internal organs. Excessive production of vascular endothelial growth factor VEGF-A, the main mediator of angiogenesis, leads to an increase of the inflammatory process.

The objective of the work was to study the relationship of VEGF-A with glutathione metabolism parameters, activity of the process and immune status in systemic autoimmune diseases with joint damage.

Material and methods. 58 patients with systemic autoimmune diseases with joint damage were examined. The comparison group consisted of 45 healthy individuals. The main clinical parameters and rheumatoid factor (RF) were analyzed. To determine the activity of the process, we calculated the indices DAS28 for patients with rheumatoid arthritis (RA) and BASDAI for patients with ankylosing spondylarthritis (AS). The activities of the enzymes glutathione peroxidase (GPO), glutathione reductase (GR), superoxide dismutase (SOD) and the content of GSH were determined in erythrocytes.

Results. The level of serum VEGF-A in patients with systemic autoimmune diseases with joint damage was increased more than 30 %, in erythrocytes the concentration of GSH and GPO activity were 2 times lower and almost 2 times lower respectively, and GR activity was reduced by about 20 % compared with donors. A correlation was found between the level of VEGF-A and GR activity (R = 0.579; P = 0.03) in RA patients with moderate activity of the process, and absence of relationship between these parameters and the activity of the process in AS. The activity of both GPO and GR in patients with RF was lower by more than 1.5 times, and SOD activity was twice lower than control. The VEGF-A level in the blood plasma was determined by the method of non-competitive enzyme immunoassay.

Conclusion. The increase in VEGF-A level in the blood plasma of patients with systemic autoimmune diseases with joint damage is most pronounced in RA patients with moderate activity of the process and is associated with the presence of RF. The relationship of VEGF-A and GR activity indicates a special role for this enzyme in the regulation of angiogenesis in RA. 

Pharmacoresistent depression is still an unsolved problem. Various non-pharmacological methods are used to solve it. There are invasive and non-invasive approaches to solving this problem. The article publishes a clinical case in which pharmacoresistance was overcome by using one of the methods of vestibular neuromodulation – chemical intratimpanal destruction of vestibular receptors.

Introduction. Hirschsprung’s disease is a congenital anomaly characterized by the absence of ganglion cells in submucosal and intramuscular layers of intestinal wall that leads to the intestinal obstruction. 70–80 % of cases are isolated malformation but it can be combined with chromosomal abnormalities and other malformations. Coexistence of Hirschsprung’s disease with intestinal atresia is extremely rare. It can cause significant difficulties in diagnostics and treatment.

Material and methods. Patient A, a boy, was transferred to the surgical department at the age of two days with a history of intestinal obstruction. He had abdominal X-ray studies: intestinal obstruction. The contrast enema showed microcolon that was coiled in the pelvis. Patient was prepared to the surgical treatment. Intraoperatively colonic atresia was identified at 10 sm from the ileocecal valve. A double colostomy was performed to the child and biopsy on the level of mucous fistula was taken. Histological study showed the aganglionosis of the distal colon. At the age of 4 months, the patient underwent Soave-Swenson endorectal pullthrough procedure with intraoperative extended express-biopsy that confirmed the absence of ganglion cells in whole distal bowel. The aganglionic part was resected, the ileocecal valve with the part of the colon of 10 cm long was mobilized and the endorectal bringing the colon down to the perineum was performed by Soave – Swenson. Postoperative recovery was uneventful.

Results. A high index of suspicion is required to promptly diagnose Hirschsprung’s disease in a child with colonic atresia despite the rare combination of these two anomalies. In this case the histological study allowed to recognize association of colonic atresia with Hirschsprung’s disease and helped to avoid complications after further surgery.

Conclusions. Early detection of coexisting of these two anomalies helps to prevent the development of serious postoperative complications. 

Uterine leiomyoma is rarely accompanied by the detection of distant metastases, including lungs. The basis of modern strategies of diagnosis of metastatic leiomyoma is the carrying out incisional or excisional biopsy of identified lesions with the subsequent performance of the immunohistochemical studies. Taking into account the indolent course of the disease, in modern practice, the main tactics of management of such patients is a long-term follow-up with the appointment of antiestrogen therapy.