Журнал клинических случаев

The volume 5 and 5th issue of Journal of Clinical Case Reports compiles 13 excellent manuscripts including 9 clinical case reports and a research article on various pathological conditions. An interesting research article by Vega-Hernandez et al, described the association between four polymorphisms on the Vitamin D Receptor (VDR) with respect to clinical manifestations of Psoriasis Vulgaris (PsV) in a Mexican patient population. Their results indicate polymorphisms of FokI, ApaI, BsmI and TaqI in the VDR gene are not associated with the risk of presenting PsV in the Mexican population. They found an association between FokI polymorphism of VDR gene and two major clinical variables, suggesting that the genotype [T/T]/ff may be a protective factor for nail involvement and age of onset in Mexican patients with PsV.

Introduction: spondylodiscitis represents 3-5% of all cases of osteomyelitis. S. aureus is isolated in 50% of cases. Mortality ranges is 0-11%. Disability may occur. Diagnosis is often a challenge. Lumbar spine is preferentially affected with multifocal involvement in 4% cases. Septic shock mortality rate is high (22-76%). Purpose: to describe a case of septic shock due to pyogenic multifocal spondylodiscitis successfully-treated in Intensive Care Unit (ICU). Methods: 63-year-old woman presented in Emergency Department complaining 7 days back pain, weakness and diarrhea. Clinical setting suggested intra-abdominal infection. Rapid hemodynamic derangement required ICU transfer to treat septic shock and multiple organ failure. Cerebrospinal fluid (CSF) analysis showed normal count cells and hyperproteinorachia. Methicillin-sensitive S. aureus (MSSA) was isolated from blood cultures and in a very low charge from CSF. In addiction C. difficile toxin was found. Vertebral spine Magnetic Resonance Imaging showed spondylodiscitis in multiples vertebral bodies and intervertebral disks, paravertebral and Psoas muscles abscesses. Further anamnestic information allowed identification of recent wrist wasp sting (infected by the same MSSA). In ICU, patient underwent C. albicans fungemia and P. aeruginosa sepsis. She was treated with antibiotics and we performed advanced-cardiovascular-support, protective-mechanicalventilation and continuous-venovenous- hemofiltration. Results: after 79 days, patient was transferred to rehabilitation ward and then back home. Conclusions: despite previous delay in sepsis recognition and its underlying cause, early application of intensive support and close adherence to Survival Sepsis Campaign treatment guidelines were critical issues for the survival of this unusual spondylodiscitis case.

Background: Cholangiocarcinoma (CCA) is a malignant epithelial cancer of the biliary tract characterized by late diagnosis and poor outcomes. We report the case of a young healthy caucasian male patient who presented with non-specific symptoms, normal blood tests and atypical radiological findings of CCA. Case presentation: A 30-years-old Caucasian man, employed as welder in a yacht components factory, without known risk factor for CCA, was admitted because of acute upper abdominal pain, nausea and vomiting. Patient’s medical history was significant only for heroin abuse treated with methadone maintenance therapy. Imaging findings on Computed Tomography and Magnetic Resonance of the abdomen showed multiple intrahepatic lesions of undetermined nature. The biopsy of hepatic lesions finally revealed an intrahepatic cholangiocarcinoma. Conclusion: Although there is no case described in literature of CCA due to opioid consumption, hepatotoxic Heroin and Methadone exposition may have exerted a role on cholangiocytes proliferation, increasing proinflammatory and mutagenic stimuli and down-regulating local pro-apoptotic factors, leading ultimately to CCA development in this young patient.

Granular Cell Tumor (GCT) is a rare female genital tract tumor. Most of the tumors are benign, however malignant variants have been reported in cases of multicentric or metastatic diseases. We present a case of an infiltrative variety of benign granular cell tumor that was totally excised under general anesthesia. Wider local excision was made following recurrence of the tumor after nine months. There was no evidence of the disease during four years of follow up.

Objective: Gamma knife surgery is an important therapeutic strategy for treatment of a non-functioning pituitary adenoma, as it suppresses tumor growth. However, in rare cases, the lesion may unexpectedly re-grow after gamma knife surgery. This report presents such rare cases of late recurrence of sellar lesions. Case Description: Two cases of non-functioning pituitary adenomas underwent gamma knife surgery. Tumor re-growth occurred following radiation therapy in case 1 at 6 years after gamma knife surgery, while expanding radiation necrosis from the irradiated tumor appeared in case 2 at 8 years after gamma knife surgery. The cases required additional radical removal of the expanding lesion with endoscopic trans-sphenoidal surgery, resulting in successful total removal. Conclusion: A patient with a non-functioning pituitary adenoma should be carefully followed for a long period, even after undergoing gamma knife surgery, to examine for lesion re-growth. In such a case, it is important that the removal operation should be considered immediately to release the compression.

????????? ??????????? ?????????? ????????? ????????? ??-?? ?????????? ?????????????????? ?????????? ?? ?????? ?????? ????? ????????. ?? ???????? ? ?????? ????? ?????????????? 11-??????? ??????? ??? ??????????? ?????????? ??????????, ? ???????? ??? ??????? ??????????? ??????? ??????? ??????????? ?????. ??????????? ???????????? ??????? ?????????????? ????, ?????????????? ????? ??????? ?????????-???????????? ??????????. ??????????????? ???????????? ???? ??????????. ??? ????????????? ?????; ?????????????? ????????????, ???? ? ????? ????? ???? ???????????. ???????????? ?????????? (??) ? ????????-??????????? ?????????? (???) ??????????? ??????? ???????????? ???????? ??????? ??????????? ?????. ?????? ?????????? ???????? ???? ?????????? ????? 4 ?????? ??????????????? ???????. ??????????? ???????? ??????? ???????? ?????? ????????, ???????? ? ??????? ???????????? ??????. ?? ??? ??? ? ?????????? ???? ??????? ?????? ???? ???????. ??? ????? ???????? ? ?????????? ????? ?????????????? ???????????? ? ???????? ???????????.

FLT3 — ????? ?????????? ??? ??? ?????? ?????????? ??????? , ?????????? ??????????? ?????????????. ?? ???????? ? ?????? ???????? ? FLT3-ITD-????????????? ????????? ?????? ?????????? ???????? ????? ??????? ???? ???????? ??????. ??-?? ??????? ?????? ?? ???????????? ??????? ? ???????? ????? ???????????????? ???????? ?? ?????? ???????????? ??????? ??????????? ????????????? ???????????. ????? ??????????????? ?????? ???????? ??????????? ??????????????. ?????????????? ???????? ?????????????? ??????? FLT3-TKD . ????????? ?????????? ??????????? ???????????? ?????? FLT3-ITD/TKD in vitro ? ??????? ???????? ?????????? ??????? ? ????????? ???????????? in vivo. ????????????????????? ??????? ??????????? ????????????? ????? ???????? ???????????? ? ????????? ????????? ? FLT3-ITD+ ?????? ?????????? ????????.

????????: ?????????????? ??????? ????? ????? ????????????? ? ?????? ? ??????. ?????????? ????????? ? ????????? ????? ? ????????? ?????, ??????????? ??? ?????????????? ????, ????? ??????????? ? ??????????. ???????? ??????? ???????? ??????? ???????, ???????????? ? ????????????? ?????????, ???????????? ??????? ???. ???????? ??????: 64-?????? ??????? ????????? ? ??????????? ?????? ? ????? ????? (8,5x5,5 ??). ??????????? ??????? ??????? ???????? ??????????????????????? ?????????, ??? ?????? ?????????????? ????? ????????????? ???????? ??? ??????????? ??????????????????????? ?????????. ??? ?? ???????? ?????????????? ?????????????? ?????????? ? ????? ????? ? ? ?????? ????? ??????. ???? ????????? ????????????, ??????? ???????? ???????????? ?????????????? ?????????????? ??????????? ?????. ????? ??????????? ??????????????. ??????????????? ????????? ????? ???????? ???????? ?????????? ??????????????. ???????????? ?????? ??????? ?????????????? ?????? ???????????. ???? ????????? ???????????? ?????, ? ?? ????? ? ?????????? ???????????????? ???????????? ? ?????????? EGFR. ????? ???? ?????? ???? ?????????? ?????? ????????, ?????????? ? ???????. ??-?? ?????? ????????? ????????????? ???????? ?? ?????????????. ??????????: ?? ???????? ? ??????????? ?????? ?????? ?????????????? ????????? ????????? ???? ??? ??????? ?????????? ??????????????? ?????????????? ??????? ?????. ??? ?? ????? ???? ??????? ??? ??????????? ?????????? ????? ??????????????? ?????????. ????????????????? ? ??????????????????? ????????? ????????? ????????? ? ????????? ??????? ???????? ??? ?????????? ?????????????? ????????, ????? ??? ????????. ????????? ????????? ????????? ???? ??????????? ???????? ?????, ? ??????? ?? ?????????????????, ??????? ???? ????????? ?????? ???? ?????????????? ? ?????? ???????? ?? ??????????? ??????? ? ??????? ???????????.

????????? ? ???????? ??????? ?????? ??????? ????? ?????????? ? 1896 ????. ???? ???????????? ?????????? ???????? ? ???? ??????? ???????, ??????? ?????? ???? ??????? ? 1854 ????.

????? ????? ???????????? ? ??????????????? ?????????? ???????????? ? ??????? ????? ?????? ????????. ???? ? ????????????? ? ???? ????????? ???????? ????????? ????????????? ???????????. ???????????????? ???????????? ??? ?????????? ???? ? ??????????? ????????? ? ??????????? ???????? ????? ? ????????? ? ??????????????? ??????????, ?????????? ????????????, ? ??????? ?????? ???. ???? ???????????????? ????? ?????? ?????????????? ? ?????? ??????? ? ?????????? ??????? ????????????, ? ????????? ????? ? ??????? ?????? ?? ????? ????????? ? ??????? ? ??????? ??????? ?????????. ?? ??? ??? ? ?????????? ??????? ????????? ??????? ? ???????, ??, ????????? ??? ????????, ?? ?????? ?????? ???????????????? ? 103-??????? ???????? ?? ????.

???????? ????????????? ??????? IgD (?? IgD) ?????????? ????? 2% ???? ??????? ??????? ? ?????? ????? ?????? ???????. ??-?? ????? ???????? ????????? ?? ???? ??????????? ? ?????????? ??????????. ????? ? ?????? ??????? ?? ???????????? ?????? ????????????? ??????? IgD. ??????? ????????? ????????? 56 ???, ? ??????? ?????????? ???? ?????????, ?????? ???? ? ???? ? ??????. ? ???????? ????? ??????????? ??????????????? ???????? (?????????????? ??????????), ???????? ??????????????? ? ?????-???????????????. ?????????? ????????? ?????? ????????? ? ????????????? ???????? IgD ??????????? ????? ? ????????? ??????? ?????? ??????? ?? ????????? ? ??????? ????????? ??. ??????????? ??????????? ? ??????? ????????? ? ?? IgD ?? ????? ??, ??? ? ????????? ? ??????? ????????? ?? ???????????????. ??? ????????? ??????????? ??????? ????? ????????? ????? ????????????? ????? ????????? ???????, ???????????? ?? ???????? ?????????????????? ??????? ?? ? ????? ????.

? ???? ?????? ??????????????? ????????? ????? ????? ????? ?????? ????????? ?????????: ??????? ?????????? ????????/???????? ?????? ?????? (SBS/AHT) ? ?????????????? ???????????? ?????????????? ???????????????? (TCA) (??????????????). ????????????? ??????? ???? ????????????????? ? ????????? ???? ????? ?????????? ???????? ???????????. ?????????????????? ???????????? ??????? ???????????? ??????????? ? ??????????????? ?????????????, RMI ?????????? ???????????????? ???????????? ????????, ?????????????? ? ?????? ???????? ???? ? ??????????? ?????, ? ????????????????? ?????????? ???? ?????????????? ?? ???????????? (99,4 ???/?) ? ??? ????????? ???????????? (154 ???/?) ? ?????. ??? ???????????????? ????????, ????? ??? ?????????? ???????? II, ???????? ??????????? ???? ? ????????????? ?????????? , ???? ????????? . ??????????? ????????????? ????????, ??? ? ??????? ? ???? ??? ?????? ?? ????????????. ????????????????? ?????? ????? ??????? ? ????????? ??? ????? ??????? ??? ?????????????? ???????????? ???????????. ??????? ????? ?????? ????????? ????????? ? ??????? ?????????? ????? ??????????????, ? ????? ??? ?? ???? ?? ??? ?? ???????? ???????? ???? ??????????. ???? ???????? ????? ????? ????? ??????, ? ???????? ???????? ???????????? ????????????? ? ????? ????????, ??? ????????? ???????? ????????? ? ??????? ???????? ????????. ??? ??? ?????? ???????????? ????????? ?????? ????? ???????? ?????????? ????????/???????? ?????? ?????? ? ?????????????? ???????????? . ??? ???????? ?? ??????? ? ?????????? ? ???????? ????? ????????, ???????? ? ????????? ??????????? ????????? ??????????????? ????????????????? ??????? ? ?????? SBS/AHT.

??????????????? ????????? ????? ?????????? ?????????? ???????????????? ????????, ??? ??????? ?? ????????? ????????? ??? ?????? ????????????? ????? ??? ?????? ?????? ??? ??? ????? ?????? ????????????????? ??????????. ?????? ??????????????? ???????????????? ?????????? ?????? ??????? ? ???????? ?????? ?? ????? ??? ?????????? ??????? ? ????????????? ?????????. ?????????? ???????????? ????? ????????? ?????? ????????? ?? ????????????????? ? ????? ???????? ? ???????????? ???????????. ?? ???????? ? ?????? ????????????? ???????????????? ?????????? ? 44-?????? ??????? ? ????????? ????????????? ???????? ?? ??????? ???????, ?????????????? ????????? ???????? . ??? ???????????? ????? ???? ?????????? ??????? ?????. ????????? ?????? ????????????? ?? ?????????????? ???????, ? ? ???? ???????????? ?????????? ????????? ?? ????. ????????? ??????? ? ????? ???????? ????????? ??????????? ???????????????? ??????????, ??????? ???????? ????? ??? ?????? ????? ???????????, ? ??????? ?? ??????? ????? ????? ?????? ???????? ?????? ?????? ???????????? ??????. ????? ???? ?????? ???????? ????????????? ???????? ?????? ????????????? ???????????????? ??????????. ????? ????, ?????? ?????? ???? ??????????? ????????????????? ?????????? ????? ?????????, ? ????????? ?????? ????? ???????????? ? ??????????. ??? ?????? ?????????? ??? ? ???????? ?????? ?????? ?????????? ????? ????????????? ????????, ? ????? ?????????, ??????? ????? ??????????? ????????????? ?????????????????. ?????????? ??????? ????? ???? ??????????????, ? ????? ???????? ????? ?????????? ????????.

??? ????? ? ?????? ??????????? ?????, ?? ????? ?????? ???????. ?????????????? ??????, ?? ???????? ????? 1% ???? ??????? ???? ????? ???????????? ?????? ? ????? 0,1% ??????????. ????? ?? ???????? ? 83-?????? ???????-???????? ???????????? ???? ? ???????????????????????? ?????????? ?????????? ?????????? ????? ????? ? ???????? ??????????? ?????? ? ?????????? ????????? ????? ????????? ?????? ????? ???????? ??????? ??????. ? ?????????? ?? ??????? ??????? ?????? ???? ?????.

??????????? ??????? ????????? ? ???????? ?? ?????????? ??????????????? ??????? ?????? ? ???????? ?????? ????. ???????????? ????????, ??? ??? ??????? ?????????? ?????. ?????????? ???????????? ? ????????????????? ?????????? ????????, ??? ??? ???????????? ?????????? ?????????? ? ?????????? ? ????? ???????, ??????? ??????? ??????? ??????? ??????. ???? ????????? ????????? ?????? ?????????????????? ????????, ?????????? ?????? ? ?????????????????????. ???? ????????? ?????????, ???????????? ?????????? ? ????????????????????? ??????? ???????????. ?????????? ?????????? ?????????? ??????? ????????????? ??? ???? ?? ???????????????? ????????? ? ???????, ? ??????? ??????????? ????????????? ???????????.

???????????: ???????????? (??????? ????????? ????????????) — ????????????? ???????????? ???????????, ????????????????? ????????? ???????????????? ?????? ???????????? ??????. ??????? ????????? ?????? ??????????????? ??????? ????????? ?????? ?????????????? ????, ??? ???????? ? ???????????? ?????????? ?????? ? ????????? ??????????? ? ???????????? ?????????? ?????????? ?? ?????. ????: ??????? ???????? ? ?????? ???????? ????????? ?????? ? ???????????? ? ?????? ? ???? ?? ????????. ?????? ? ??????????: ? 68-??????? ??????? ??????????????? ??????????????? ??? ????????? ????? , ????????? ????????????? ?????. ? ???? ??? ????????? ???????, ? ?? ?????? ??????????????????? ???????????? ? ???????????? (35 ??????? ?? 70 ??). ????? 12 ??????? ? ???? ????????? ??????????????? ???????? ????-???????????? ??? ? ?????? ?????????? ?????????? ?? ?????, ??????? ?????? ????????? ?????????? ? ????????? C3-T3. ??? ?????? ?????? ???? ??????????????? ????????????, ? ????????????? ??????????? ?????????????? ???????. ?????? ?????? ??????? ?????????? ????? ???????, ? ??? ???? ??????? ???????? ? ?????????? ???????????? ?? ????? ? ???????????? ??????????? ? ??????? ? ?????????? ??????? ????????????, ? ????? ?????????? ?? C3 ?? ??????? ? ?????????????? ??????????????. ??????? ?????????? ???????????????? ???????????? ?? ?????? ?????. ?????????????? ???????????? ?? ??????? ???????? ??????? ??? ?????????? ?????????? ?????? ??? ????? ????????? ????????. ??????????: ??? ?????? ????? ? ???????? ????????? ?????? ? ???????????? ? ?????? ? ???? ?? ????????, ????????? ?????????????????????? ????????????? ??? ????????????????? ?????????.

??????? ?????? — ??? ???????????? ???????????, ????????????????? ?????????? ?????? ??? ???????????, ??? ? ????????????, ?????????????, ??????????? ?????????? ????, ????????? ???????? ????????? ? ???????? ? ??????????????? ???????????? ??????????. ?? ???????? ? 14-???????? ???????? ? ??????????? ????????? ??????? ??????, ? ???????? ????? ??? ????????? ?????????? ?????, ??????? ???????????? ? ??????? ?????????? ????? ? ???????? 4 ???????. ????? ????? ???? ???????????????? ?????? ???? ??? ????? ? ???????? ? ????????? ??????, ? ???????? ?????????-??????????? ????????????? ??????? ????? ??????????? ?????????? ? ?????. ?? ????????? ????????? ?????????????? ???????? ??? ???????? ??????, ? ????? ????? ????? ???? ????????? ? ????????????? ???????? ?????.

???? ? ???????? ????? ??????????? ?? ????? ???????????? ??-?? ????????????? ??????????? ?? ??????-???????????? ??????? ?????? ? ???????????? ??????????? ?????? ??????????. ???????? ????????? ???????????? ??????????? ?????, ??? ???? ??????? ????? ???????? ???????? ????????????????, ??????? 1 ?? 10 000 ?????????? ??????1. ??????? ????? ????? ??????? ?????????? ?????????? ??????? ?? ????? ???????????? . ????????? ??????? ?????? ???????? ??????? ???????????????? ??????? ? ???????? ???????, ????????, ??????????????, ??????????? ??????, ????? ????? ???????? (GP), ?????????????, ???????????? ? ?????????? ??????, ??? ???????? ? ????? ?????? ? ?????? ??????. ???? ??????? ????? ???????? ??????????? ???? ? ????????? ???????????? ???????????, ????? ?????????? , ?????????? ??????? ????? ? ????????? ?????????? ??????? ? ???????????, ???????????? ????? ???????? ????????????? (VTE), ????????????? ????????????? ? ????????????? ????????????? ? ???????, ??????? ??? ????? ??????? ?? ?????? ? ????? ?????.

??????????? ??????????? ??????? ??????? ? ???????????????????? ???????, ??????? ????? ?????? ? ??????? ???????? ????? ?????????????? ????? ??? ????????????? ???????? ????????? ?????. ???????? ? ??????????? ???????? ???????? ???????? ????????? ??? ???? ??????, ?????????? ??????????, ? ?????????? ???????????????? ? ??????? 6–8 ????? ???????? ? ??????????? ???????? ?????? ?????????.

??????????????? ??????? ? ??????? ?????? ??????????? ?????? ?????. ?? ????????? ?????? ?????????? ? ??????? ?????? ???????????? ? ??????????? ? ???? ?? ?????????????? ??????? ?????. 85-?????? ??????? ????????? ? ???? ???????? ? ???????? ?? ??????? ???????????? ? ???????? ????. ??????????? ??????????? ??????? ????????, ??? ??? ???????? ????? ???????? ???????. ???????? ???? ????????? ???????????? ??????? ??????? .

????????: ?????????????? ?????????? ?????? (???) — ????????????????? ???????, ????? ????????? ??? ????????? «????????????». ??? ?????? ??????????? ?????? ??????? ?????????????????, ????????, ???????????? ?? ??????????? II ???? ??? ?????? ?????. ???? ????? ??? ??????????? ? ??????? ?????? ? ?????? ???????? ?????????. ???????? ???????????????? ????, ?????????????? ?????????? ????? ????: ???????????, ??????????????, ???????? ? ???????????????. ??????? ???????: 40-?????? ?????????, ???????, ???? ????????????????? ??-?? ?????????????? ??????? ? ???????? ?????????????? ????????? ? ?????? ?????? ????. ????????? ???? ??????????????? ????????????????? ????????? ??? ????? ? ????????? ???????????????? ? ??????? ???????????? ?????????? (??). ?? ????? ?????????? ???????? ??? ??????? ???? ????????? ? ???????? ????????????? ???????. ????? ???????????? ???????????? ? ?????????????? ???????????????????? ???????????? (VATS) ???? ????????? ???????????? ? ?????? ????????????? ?????? ???????????????????? ?????????, ? ????? ????????? ????????? ???????? ???? ???????. ??????? ???? ?????????????? ??????????? ????? ?????????????? ????????????, ?????????? ??? ???? ?????? ?????????? ? ???????? ? ?????????? ??????????????? . ????????? ???????? ?? ??????? ?? ???????????????, ?? ???????????????? ???????????. ??????????: ?????????????? ?????????? ??????? ????????????? ? ????????? ? ????????????????? ?????????????????? «???????????????» ??????????? ??? ?????????, ??? ? ?????????????? ????. ?????? ????????????? ???????? ????????? ???????????? ??????????? ??????? ??????? PSH, ? ?????????? ???????? ????? ??????? ?? ??????????? ?????????.

???????????: ????????? ????? — ?????? ??????????? ? ?????, ? ??? ???? ??? ??????????? ? 5-?? ??????. ????????? ?????????? ?????? ???????? ?????????? ??????, ??????? ???????? ???????? ????????????????? ? ?????? ???????? ??????? ?????; ?????????????????? ??????, ????? ?????? ????? ???????????? ???????; ? ?????????? ??????. ??????: ? ???? ?????? ?? ???????? ? ?????????????????? ????????? ?????? ? 2-?????? ???????, ??????? ?????????? ? ???? ??????? ? ???????? ?? ???????? ??????? ????? ???? ????? ??????? ?????. ????????? ??? ????????, ????? ?? ?????????? ?? ???? ?????????, ????????????? 5-? ????? ? ????? ????????? ????????. ??????: ???????????? ??????? ???????? ?????????? ?????? ????? ???????????????? ??-?? ?????????? ?????????? ????????? ??????????????? ????? ???????. ??????????? ?? ????? ?????, ???????????, ??????? ??????? ?????????, ????? ?????????: ????? ??????????? ????? ???????? ? ?????????? ????????????? ?????????, ???? ? ???? ??????? ????????? ??????? ? ?????????? ????????? ???????, ???????? ???????? ???????? ???????? ???????????? ?????? ?1.

??????? 71 ???? ??????? ? ????????? ?????????????? ?????? ???????? ???? ?????? ??????? ????? ??? ??? ?????. ??????????? ??????????????? ??????? ?????? ???? 20/32 ?? ?????? ????? ? 20/25 ?? ????? ?????, ????????????? ??????????? ????????? ?????? ????????????. ?????????????? ? ??????? ?????? ? ??????????? ???????????? ???????? ??? ???? ? ?????. ?????????? ??????????? ?????????? (???) ?????? ?? ????????? ???????, ??????? ????????? ?????????? ??????????? ? ??????????????? ??????????????????? ???? ? ?????. ????????-??????????? ?????????? ????? ???????? ???????, ????????????? ? ?????? ???????-?????????? ???????, ?? ??????????????? ??????? ???? ??????. ????? 2 ?????? ???????????? ???????? ??? ???????? ??? ?????????????? ?????? ? ?????? ???????? ??????? ????????, ??? ???????? ?????????? ???????? ?????? ??????. ??????????: ???????? ????? ??????? ???????? ????? ?????????? ??????????? ??? ??????????????? ? ?????????????????????? ?????????. ????????? ?????? ? ????? ??????? ????? ?????? ??????? ???????? ?????????, ????? ??? ?????????? ????????.

????????????? ?????????? ???????? ???????? ????????? ??? ?????????-??????????? ???????? ????. ???????????? ????????, ????????? ????????????? ?????????????? ? ?????? ???????? ??????? ???, ??????????, ? ???????????? ?????????? (??) ??? ??????? ??? ????? ?????????? ???????? ?????? ?????????? ??? ???????? ????. ??????: 13-?????? ????????? ????????? ? ??????????, ?????????? ???????? ? ??????????. ? ??? ??? ??????? ???? ? ?????????? ????????????? ? ?????????? ???????????. ????????????? ? ???? , ????????? ??????????? ??????? ? ?????? ??????? ??????? ??? ?????????????????? ?????????? ???????????? ??????? ?? ?? ????????? ?????. ????????????? ????????? ????? ?? ??????? ????????????? ? ????, ??????? ?? ?????????? ?? ?? ?????? ???????????? ??????????. ?????????? ??? ????????? ???? ????????? ????? ????, ??? ? ???????? ????? ??? ????????? MRSA. ????????? ???? ???? ??????? ??? ???????? ??. ??????? ???????? ? ?????????????? ??????? ??????????, ? ??????? ????????? ???????? ?? ???? ???????????? ? ??????? ?????? ??????????????? ? ???????? ?????. ?????????: ????????? ???? ???????? ?? ???????? ????? ???????????? ????????? ? ??????????????? ????????. ??????????: ?????????? ??????? ??????? ??? ? ???????????? ?? ? ???????? ????????????????? ???????? ??????? ??? ??????? ???????????? ??????????? ???????????? ????????????? ? ????????????? ????????????, ????????? ????. ??????????????????, ??????? ??????? ??? ? ???????? ????? ?????????? ??? ??, ????????? ???????? ????? ? ????????????? ??????????????.