Thank you Doctor!
Thank you Doctor! Very attentively and patiently answers questions. Health, happiness and professional growth!!!
Very helpful
Doctor Nikolashina is a wonderful specialist! There is probably no question that she could not answer!
For a very long time I tormented the doctor, asked a bunch of questions for each and received a detailed answer. A lot was prompted and directed in the right direction. I will definitely apply for a consultation again, but I am closing my topic for now ... Of course, I have not completely solved my problem, I will still run to be examined.
I thank the doctor Olga Nikolashina for her help, it is always interesting and useful to read her opinion.
Karpova, 27 Sep 2017
Thank you so much. All questions were answered Very quickly and efficiently helped to solve my question
Dear Olga Nikolashina, I am very grateful for your help and understanding, you are a very competent specialist! Glad to have met you on this forum. I sincerely wish you all the best and, most importantly, of course, health. Regards, Anna.
Thank you Doctor!
Thank you for your quick and detailed answer!
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Education SPbGPMU (former SPbGPMA, LPMI)
Additional education Pediatric University: RNHI them. Polenov "03 Faculty: Nervous diseases University: North-Western State Medical University named after Mechnikov (formerly SPbSMA, SPbMAPO)" 05 Faculty: Therapeutic faculty
About myself I work as a therapist in a polyclinic. Current interests: beauty and health, eternal youth, aging retardation, biochemistry, biology, pharmacology, antiaging, diseases associated with aging, arterial hypertension, essential hypertension, coronary heart disease, chronic heart failure, coronary heart disease, diabetes mellitus, metabolic syndrome , prevention of Alzheimer's disease, dementia, dyscirculatory encephalopathy, consequences of stroke, consequences of acute cerebrovascular accident, psychological assistance to relatives of a seriously ill patient, psychological assistance in case of serious illnesses, why did I get sick, headache, tension headaches, migraine, osteochondrosis, osteoarthritis, polyarthritis, thyroiditis, hypothyroidism, chronic fatigue, hair loss, individual selection of antihypertensive therapy.
To uncoverReviews 12
UDC 616.971
S. V. Ryasentseva, S. B. Rybalkin,
O. E. Nikolashina, Z. A. Kogan, E. V. Orlov
TO THE QUESTION ABOUT CONNECTED SYPHILIS
Annotation. The article presents the history of the study, the main aspects of etiology, pathogenesis, classification, pathomorphological characteristics of congenital syphilis. Clinical cases of the disease on the territory of the Penza region are considered. Preventive measures are given that allow timely detection and treatment of congenital syphilis.
Key words: congenital syphilis, pale treponema, pregnancy, fetal infection, antenatal and postnatal prophylaxis of syphilis.
Abstract. The history of study, the basic aspects of an aetiology, pathogenesis, classification, postmortem characteristics of a congenital syphilis are presented in article. Clinical cases of disease are considered in territory of the Penza area. The preventive measures which allow in time to reveal and cure a congenital syphilis are resulted.
Keywords: a congenital syphilis, pale treponema, pregnancy, intrauterine infection, prenatal and postnatal syphilis prophylaxis.
Syphilis is a chronic infectious disease that occurs when infected with treponema pale. Infection occurs mainly through sexual contact, but transmission is possible transplacentally (congenital syphilis) and through household contacts (household syphilis).
The history of the onset of syphilis is still the subject of discussion among infectious disease specialists and dermatovenerologists in many countries. It is generally accepted that the disease has existed for thousands of years in all human populations, as evidenced by studies of human bone remains found during archaeological excavations.
The possibility of transmission of syphilis from parents to children was known to doctors at the end of the 15th century. It was found that a child can be born already with manifestations of syphilis, that the infection occurs in the womb and the cause of this infection is the syphilis of the parents.
Fallopia (Fallopia, 1504) was the first to generalize his observations of children with syphilis and described the clinical symptoms of congenital syphilis. Naturally, due to the small acquaintance of the doctors of that time with the pathogenesis of syphilis, the unknown pathogen and the inability to cause experimental syphilis in animals, many essential questions of the problem of congenital syphilis could not be solved at that time. In the first half of the XIX century. a controversy erupted over the question of who is the culprit of the transmission of syphilis to the child - the father or the mother. Many prominent specialists of that time defended the position that the father was the culprit of the infection of the child in the womb. There were no less supporters of another theory, who considered the mother to be the culprit or who presented the possibility of infection of the fetus from both the father and the mother. In 1837, Colles, and three years later, Baumes suggested that mothers of children with congenital syphilis are immune to infection with syphilis even when they themselves do not show any signs of this disease. At the same time, it followed
the following provision: any mother who has given birth to a child with obvious manifestations of syphilis can feed him herself, without fear of infection from him. At the same time, this child poses a great danger in terms of infection for a healthy nurse. In 1856 Prophet (Pit) put forward a new position regarding the transmission of congenital syphilis by parents to children. This provision is called the Prophet's Law. Its essence lies in the fact that a mother who is sick with syphilis can have a child without visible manifestations of congenital syphilis and that he can suck on the mother's breast without any consequences even if she herself has active manifestations of the disease. From this, naturally, it followed that these children were immune to the syphilitic virus and that such immunity could last for many years. The Prophet's Law did not last long. Already at the end of the XIX century. it was refuted by the observations of clinicians on newborns who, after birth, were infected from their sick mothers with fresh syphilis with the presence of primary syphiloma.
It should be pointed out that at present, a mother who is sick with syphilis is not allowed to put her child to the breast if he was born without visible clinical and serological phenomena. A child who is breastfed by a sick mother, if he does not have syphilis, can become infected from the mother. You cannot apply a child born to a sick mother to the breast of a healthy nurse, since if he is sick with congenital syphilis, he can infect the nurse. Such a baby can be fed with expressed and boiled breast milk or with expressed milk from a nurse.
In 1875 Kassowitz published his theses, later called Kassowitz's law. The theses talked about an arbitrary gradual weakening of the possibility of transmission of congenital syphilis. This law should be understood in such a way that an increase in the time elapsed from the moment the mother became infected with syphilis until the conception of the child has a beneficial effect on the outcome of pregnancy and increases the chances of having a healthy child by a mother with syphilis. Even approximate scheme, showing how the outcome of pregnancy improves with an increase in the duration of syphilitic infection. With numerous pregnancies in a woman with syphilis, according to Kassovich's law, in the first time after infection, the pregnancy must be terminated and the onset of miscarriage. Premature birth with a dead fetus is much more common. Further, full-term, but dead children are born, after which one can expect the birth of living children on time, but with manifest manifestations of syphilis. Later, children are born alive on time and without visible manifestations of syphilis. Further, completely healthy children are finally born on time. This is the scheme of Kassovich's law.
In 1903 Matzenauer put forward a position according to which the only possible way of transmission of syphilis to children from sick parents is the transmission of infection by a sick mother through a child's seat. Matzenauer formulated his position as follows: "There is no child with congenital syphilis, without a mother with syphilis." This provision has caused heated objections of adherents of the theory of "paternal" transmission of syphilis. However, the major discoveries in the field of syphilidology that followed soon after the indicated message (the establishment of the causative agent of syphilis, the emergence of the opportunity to experiment on the stomach)
of them, inoculating them with syphilis, and serodiagnostics of syphilis) confirmed the correctness of the position put forward by Matzenauer.
So, as you know, congenital syphilis occurs as a result of the ingestion of pale treponema to the fetus through the placenta from a mother suffering from syphilis. The introduction of pale treponemas into the skin and mucous membranes leads to the development of two parallel processes in an infected adult: intensive reproduction of treponemas at the site of their inoculation and rapid spread through the lymphatic and blood vessels to all organs and tissues of the body.
Infection of the fetus can occur both in the case of a mother's illness before conception, and later, at different stages of fetal development. Pale treponema can enter the fetus through the umbilical vein, through the lymph gaps of the umbilical cord or with the mother's blood through the placenta damaged by toxins of pale treponema or other factors, since the normal placenta is impermeable to pale treponema. As a result of this, treponemal septicemia begins, which is accompanied by severe damage to the internal organs of the fetus (liver, spleen, lungs, nervous system, endocrine glands, skeletal system, etc.).
However, despite the early penetration of the pathogen into the fetus, pathological changes in its organs and tissues develop only in the U-U1 months of pregnancy. Therefore, active anti-syphilitic treatment in the early stages of pregnancy can ensure the birth of healthy offspring. Since secondary syphilis occurs with symptoms of spirochetemia, the risk of having a sick child is greatest in pregnant women with secondary syphilis. In addition, transmission of syphilis to offspring occurs mainly in the first years after infection of the mother; later this ability gradually weakens. The outcome of pregnancy in a woman with syphilis is different: it can end in late miscarriage, premature birth, the birth of sick children with early or late manifestations of the disease or latent infection. The possibility of infection of the fetus through the transmission of infection through the sperm has not yet been proven [1-4].
It has been experimentally proven that pale treponemas are found in the blood in any period of syphilis. Infectiousness of blood depends on the period and duration of syphilis, that is, the more active the infection, the more pale treponemas are in the blood. And also, infection of recipients can occur during blood transfusion from patients who are still in the incubation period of syphilis.
All these factors of the pathogenesis of syphilitic infection, in our opinion, make it possible to explain the cases of the birth of children with congenital syphilis against the background of negative reactions by the fact that the mother can transmit pale trepidation and infect the fetus when the disease is still in the incubation period.
Depending on the clinical symptoms, the characteristics of the course of the disease and the timing of its manifestation, congenital syphilis is divided into syphilis of the fetus, early congenital syphilis (from the moment of birth to 4 years), late congenital syphilis (in children over 4 years of age), latent congenital syphilis, which is observed in almost all age groups.
Congenital syphilis of the fetus is preceded by a specific change in the placenta. Pale treponemas, penetrating the placenta, cause the severity
anatomical and morphological changes manifested by edema, connective tissue hyperplasia and necrotic changes. Vascular lesions of the endo-, meso- and perivasculitis type characteristic of syphilitic infection are accompanied by severe sclerosis of the villi, degeneration of the epithelium, and cellular infiltration of the vessel walls with their obliteration. An increase in the mass of the placenta is typical for syphilis. If the normal ratio of the mass of the placenta to the mass of the fetus is 1: 6, then in the presence of a syphilitic infection, this ratio changes to 1: 3. Excessive development of granulation tissue and abscesses in the villous vessels is especially pronounced in the embryonic part of the placenta. The final confirmation of the diagnosis of syphilis is the detection of pale treponemas in the umbilical cord and organs of the fetus. In the placenta, pale treponemas are found less often. The largest number of pale treponemas are found in internal organs fetus: liver, spleen, adrenal glands. This circumstance explains the frequency of miscarriages and stillbirths in untreated women with syphilis.
Cases of the birth of children with congenital syphilis against the background of negative serological reactions in women during pregnancy are described in the literature many times. Most of these cases are explained by anergy and a defect in laboratory tests.
To prove our conclusions, we present cases from practice.
In August 2007, a three-month-old girl was admitted to the Regional Children's Clinical Hospital in the direction of one of the central district hospitals of the Penza region with a diagnosis of urinary tract infection, severe anemia, acute right-sided pneumonia, hematological disease.
From the history of the child's development: from the first pregnancy, urgent labor, cephalic presentation, delivery by Caesarean section for the weakness of labor forces; birth weight 3,210 kg, height 53 cm; was breastfed for one week, then transferred to artificial; during the epidemiological investigation it was found that a child at the age of one month and ten days developed a profuse rash (Fig. 1).
The nature of the rash has not been described. The child is consulted by an allergist who describes small papular elements throughout the skin, diagnoses atopic dermatitis, prescribes desensitizing therapy and a diet. Despite treatment, the rash persists and new elements appear. After one month, the child's condition worsens, new papular elements appear on the feet, infiltration in the groin and other areas. There was no consultation with a dermatologist for two months of the presence of rashes. Before the routine vaccination of a child in general analysis blood reveals a decrease in hemoglobin to 67 g / l, an acceleration of ESR up to 70 mm / h. With a diagnosis of severe anemia, the child is first admitted to the district children's hospital. At that time, there was a cough during feeding, regurgitation after each meal, anxiety when urinating. Objectively: revealed an increase in the liver up to 3 cm, spleen up to +2 cm, peeling on the skin. General condition of moderate severity. After the appointment of cefatoxin, a single rise in temperature to 39.4 ° C was noted. A pale pink rash is described on the shins (Fig. 2).
Fig. 1 Early congenital syphilis. Multiple roseolous elements on the skin of the face, trunk, limbs
Fig. 2 Early congenital syphilis. Roseous and papular elements on the skin of the plantar surface of the foot
Due to the lack of positive dynamics, the child was transferred to the Regional Children's Clinical Hospital. Upon admission: a state of moderate severity, liver +3.5 cm, spleen +1 cm, pale pink spots on the skin of the cheeks, scanty mucous discharge with an admixture of blood
vi from the nose, chest radiographs show signs of focal pneumonia. Neonatologists called a dermatovenerologist to exclude congenital syphilis in a child. After additional research methods, X-ray of the tubular bones revealed pathological restructuring of the bone structure in the metaphyses of the lower third of both forearms, foci of destruction in the form of an enlightenment and a seal cavity, a pronounced periosteal reaction in the form of complex periostitis and more coarse periostitis on the bones of the lower extremities, especially the thighs. Conclusion: the data indicate early congenital syphilis.
Laboratory РW 4+ (1:16), 4 + 4 + (1: 200), ELISA CAT +, IgM +, IgG +, in general blood analysis Hb 86 g / l, ESR 63 mm / h, Le 14.6 109 / l. On the basis of clinical and laboratory data, a council of doctors diagnosed the child with early congenital syphilis with clinical manifestations (hepatosplenomegaly, syphilitic rhinitis, roseolous rash). The child's mother was examined in parallel: ELISA CAT +, IgM-, IgG + (1: 2560), RW 4+ (1:16) 4 + 4 + (1: 200). Objectively, there are papules on the right sole, roseola of the trunk, inguinal lymphadenitis. Diagnosis: Lues II recens. Received inpatient treatment.
The child's father was examined: there are psoriasiform papules on the palms and soles, papular rash on the head of the penis, inguinal lymphadenitis on the left. RW 4+ (1:16) 4 + 4 +. Diagnosis: Lues II recidiva.
During the epidemiological investigation, it was found that the mother was registered for pregnancy in the period of 8-10 weeks at the antenatal clinic at the place of residence in the district center. When registering RW: neg, neg, neg. During pregnancy, rashes on the skin and mucous membranes were not observed. At 30 weeks gestation RW: neg., Neg., Neg. At 34-35 weeks of pregnancy, she was hospitalized in the pathology department of the maternity hospital of the Central District Hospital for mild preeclampsia, RW: neg., Neg., Neg. A month later, at 37-38 weeks of pregnancy, she entered the Regional Maternity Hospital in Penza for delivery, where she was tested for syphilis by ELISA: CAT - neg.
This case shows that the woman was examined in laboratories in different cities by different methods of testing for syphilis (RW, ELISA), which showed negative results throughout pregnancy, which excludes anergy and laboratory diagnostic errors.
The second case of the birth of a child who was diagnosed with early congenital syphilis against the background of negative serological blood reactions in the mother during pregnancy was observed by us in 2000. The boy was born at the end of October 1999. He was admitted to the Regional Children's Hospital at the age of two months at a planned order on December 30 with suspected pneumonia. Two weeks before admission, a rash appeared on the trunk and limbs (at the age of 1.5 months). At the beginning of January 2000 he was consulted by a dermatovenerologist. On the skin of the trunk, limbs, soles there was a roseolous rash, peeling. Liver +6 cm, spleen +4 cm. Nasal breathing is difficult. In laboratory research: EM 4+ (1:32), RW: 4 + 4 + 4 +; RIF 200-2 +, abs 3+; ELISA IgA 0.5 g / l, IgM 5 g / l, IgG 4.8 g / l. The child was diagnosed with early congenital syphilis with clinical manifestations (hepatosplenomegaly, roseolous rash). The child's mother was examined. There were no external manifestations of syphilis. RW EM: 4+ (1:32), 4 + 4 +; RIF 200 4+ abs 4+. Diagnosis: early latent syphilis. An epidemiological investigation was carried out, as a result of which it was found: RW at 17 weeks: neg.,
neg., EM: neg.; RW at 26 weeks: neg., Neg., EM: neg. At 35-36 weeks of pregnancy, she was hospitalized in one of the maternity hospitals with a diagnosis of fetoplacental insufficiency, anemia. Here RW: neg., Neg., EM: neg. Urgent labor in October. In childbirth RW: neg., Neg., EM: neg.
The child's father in May 1999 noticed a sore on the penis. He was treated with bicillin on the advice of friends. He did not subject his wife to treatment. In January 2000, the father of the child twice had RW: neg., Neg., EM: neg. Received preventive treatment.
Based on the presented cases, the following conclusions can be drawn:
1. To exclude such cases, in our opinion, antenatal
prevention of congenital syphilis should include:
screening for syphilis of future fathers, when women are observed in the antenatal clinic for pregnancy. This measure, in addition, will reduce the number of syphilis in pregnant women.
2. Postnatal prophylaxis during postpartum follow-up by obstetricians-gynecologists should include a blood test for syphilis.
3. It is advisable for women who need preventive treatment during pregnancy, if a syphilitic infection is detected in a sexual partner, to carry out preventive treatment after 20 weeks of pregnancy.
List of references
1. Rodionov, A. N. Syphilis: a guide for doctors / A. N. Rodionov. - SPb. : Peter, 2007.
2. Skin and venereal diseases: manual / ed. Yu.K. Skripkina. - M.: Medicine, 1996.
3. Kartamyshev, A. I. Skin and venereal diseases / A. I. Kartamyshev. -M. : MEDGIZ, 1953.
4. Milich, M. V. Evolution of syphilis / M. V. Milich. - M.: Medicine, 1987.
5. Samtsov, A. V. Syphilis. Medical atlas / A. V. Samtsov, V. V. Barbinov, O. V. Terletsky. - SPb. : DEAN, 2007.
6. Syphilis congenital early (diagnosis, clinical picture, prevention, principles
treatment): informational and methodological letter / Regional skin
venereal dispensary; State medical University... -Rostov n / a: Hephaestus, 1996.
7. Congenital syphilis (diagnosis, clinical picture, treatment and prevention): guidelines / Health Administration Administration Ryazan region; Ryazan Regional Clinical Skin and Venereal Diseases Dispensary (ROKKVD). - Ryazan, 1999.
Ryasentseva Svetlana Vladimirovna dermatovenerologist, polyclinic department,
GUZ "Penza regional center specialized types of medical care "
Email: [email protected]
Ryasentseva Svetlana Vladimirovna STD and skin specialist, outpatient department, State Medical Facility “Penza Regional Center of specialized medical care”
Nikolashina Olga Evgenievna Senior Lecturer, Department of Microbiology, Epidemiology and Infectious Diseases,
Medical Institute, Penza state University; head of the polyclinic department of the State Institution "Penza Regional Center for Specialized Types of Medical Aid"
Email: [email protected]
Rybalkin Sergey Borisovich Candidate of Medical Sciences, Associate Professor, Department of Microbiology, Epidemiology and Infectious Diseases, Medical Institute, Penza State University; chief physician,
State Institution "Penza Regional Center for Specialized Types of Medical Aid", Honored Doctor of the Russian Federation
Email: [email protected]
Kogan Zakhar Aleksandrovich Assistant, Department of Microbiology, Epidemiology and Infectious Diseases, Medical Institute, Penza State University
Email: [email protected]
Orlov Evgeny Vladimirovich
doctor of Medical Sciences, Professor, Head of the Department of Skin and Venereal Diseases,
Samara State Medical University
Email: [email protected]
Nikolashina Olga Evgenyevna
Senior lecturer, sub-department
of microbiology, epidemiology
and infection deceases, Medical Institute,
Penza State University,
head of the outpatient department
at State Medical Facility “Penza Regional
Center of specialized medical care "
Ribalkin Sergey Borisovich Candidate of medical sciences, associate professor, sub-department of microbiology, epidemiology and infection deceases, Medical Institute, Penza State University; chief physician, State Medical Facility “Penza Regional Center of specialized medical care”, Honored Medical Worker of the Russian Federation
Kogan Zakhar Alexandrovich Assistant, sub-department of microbiology, epidemiology and infection deceases, Medical Institute, Penza State University
Orlov Evgeny Vladimirovich Doctor of medical sciences, professor, head of sub-department of STD and skin deceases, Samara State Medical University
UDC 616.971 Ryasentseva, S.V.
On the issue of congenital syphilis / S. V. Ryasentseva, S. B. Rybalkin, O. E. Nikolashina, Z. A. Kogan, E. V. Orlov // Izvestiya vysshikh educational institutions... Volga region. Medical sciences. - 2009. - No. 4 (12). -S.59-66.
It was recorded through the site, conveniently. The administrator called back, recalled the time of the visit and the name of the doctor. I liked everything, both the atmosphere and the doctor's reception itself. There is a positive trend, I feel much better. Thank you, I will be treated with you.
Anonymous review 13.01.2020
At the end of December, I came to see this therapist with a complaint of low-grade fever, which I have been continuing for 3 months. I provided the doctor with all the tests that I had, blood and urine tests, including ultrasound, which indicated "compaction of the walls of the gallbladder", apparently this served as the basis for the fact that there was no need to look for the cause further. For some reason, Elena Mikhailovna Gudozhnikova decided that the whole problem was in the gallbladder, and there was no point in further investigating. As a result, I was diagnosed with "Chronic acalculous cholecystitis", I'm just still interested in her decision. Why would cholecystitis come from if I was not tormented by any pains, and nothing terrible was found in the ultrasound scan !!! And most of all I am outraged that I paid 800 rubles for the appointment and left with nothing. In the data of a physical study, he writes "the skin is pale pink in color, the tonsils are not enlarged, the stomach is painless" and so on, I do not understand how this can be determined without looking at my throat, no one felt my stomach, did not listen to my breathing, but in the end we write " no wheezing "... Why write what you don't do? Most of all, it outrages that the temperature wrote 36.6, but did not measure it, it always keeps me 37.1-37.3. And it was said that the doctors did not consider the temperature at all, and they say, you are a white-skinned girl, the temperature may be that. I have certainly never heard such nonsense from anyone else. I do not recommend going to such doctors. Waste your time and money. Also, the diagnosis will be wrong. All health!
Anonymous review 12.01.2020
I paid attention to 3 surgeons, but chose Seymur Aliyev, as there were real live recommendations from friends. It is difficult to choose a surgeon based on reviews on the Internet. I advise you to ask your friends and not believe everything that is on the Internet. I'm glad that I ended up with Seymour, but of course, not everyone will believe the review)
Anonymous review 11.01.2020
Evgeniy 10.01.2020
With rare, even for the present time, rudeness and rudeness on the part of the nephrologist E.B. Moskvina. encountered today while trying to get at least some kind of advice on the condition of my wife, a wheelchair user of the first group of disabilities after a stroke. At first, she, Moskvina, for some reason did not like my look, although I was wearing dark glasses (the weather was sunny). He is aggressive with you - she said, although I just entered and greeted. (By the way, she did not deign to correspond). Then she found fault that they say you are a man, and the referral is written out in a woman's name and that we do not give consultations without a patient. No attempt to explain the situation in any way. had no effect. Began to insist, threatened to call security. I kicked out and advised to complain to the 301 office (what does it matter to her?) Yes, her place is in the zoo, in the monkey house, and not in a medical institution. By the way, there was no one in office 301. Probably on purpose. The administrators could not say anything intelligible to me downstairs. Then I tried to call from home. No result. One robot. No one else answers, although the time was 15-30. Friday however. Yes, after the New Years. Probably sick were ill.
Evgeniy 10.01.2020
There was a knee injury, I suffered pain for several years under stress, an MRI showed that I had a damaged meniscus. Erofeeva immediately said that arthroscopy was needed, that we would put you on your feet and run a month after the operation. I trusted an experienced doctor, because everyone almost said that this was one of the best doctors and reviews are almost everywhere positive, and signed up for arthroscopy. In February 2019, they performed an operation on me in 10 minutes, poked at my knee, washed it a little and said that everything was clean and everything was fine, they didn't really explain anything, they sewed it up and took me to the ward, lay there for a couple of hours and sent me home. (the operation was paid!) A month later, as they said, I was just limping, my knee hurt. Two months later, I began to walk normally, but my knee also hurt, I did another MRI and it showed that I also had a meniscus injury! I went to other doctors, they all said that there was damage. That is, in fact, Erofeeva and her team simply opened my knee, picked it up, washed it and closed it, but the problem remained! Now a year has passed, my knee hurts worse than before the operation. They just collect money and do not really treat, I do not advise you to go to her and to the 4th polyclinic for such operations!
Anonymous review 09.01.2020
ATTENTION! People, everyone who has a problem with the fifth point, sign up to him! I'll start over! Before him I had 4 doctors who said that there is a chronic fissure, treated it - smeared with ointments, inserted candles. A friend of a relative advised me to contact Ruslan Alexandrovich, who at the first examination immediately said that there is a fistula that opens into a crack, so she will never heal due to ointments and even more so candles. So much information dumped on me that I thought something was wrong. He advised me to do an MRI of soft tissues first in order to understand how the fistula is going. Then he turned to the Research Institute of Coloproctology, where everything was confirmed. They offered to do an operation - to put a thick thread, which will cut the muscles from 6 to 12 months. The prospect of walking for up to a year with a thread and then walking by yourself is not small. I returned again to Dr.Rategov, who suggested starting with a laser, the probability of going back to the beginning is 13%, but I took a chance, and now I have been living for 8 months normal life with a scar up to 5mm in diameter, without cuts and threads for 12 months !!! THANK YOU SO MUCH!!!
Anonymous review 09.01.2020
Disgusting attitude towards patients. Offer of expensive procedures. And when I tried to refuse this doctor, they almost snapped at me with fists. There is only one question for the clinic - check the staff carefully.
Anonymous review 08.01.2020
I do not recommend this doctor unambiguously. A lot of time wasted. Elena Anatolyevna was unable to see bleeding erosion and a large number of concomitant diagnoses. She was observed for several years, no abnormalities were diagnosed! She said to go and try to get pregnant, but I, as it turned out, first needed to be thoroughly treated. When I came to her after visiting a gynecologist in Krasnodar and told her about the diagnosis, I heard only one thing in response: it means that in a short period of time everything has become so bad for you! And, since In Krasnodar, they did not do an ultrasound scan, but sent me to go to the place of residence, I did it at Elena Anatolyevna's. And then the diagnoses fell into question! I needed 2 ultrasounds on different days of the cycle, I came to her again after 2 weeks. At that moment she no longer remembers me as a patient, does an ultrasound scan and says that there are NO DEVIATIONS, EVERYTHING IS CLEAR. He sits down at the computer to make a description, finds the last result two weeks ago and immediately begins, stammering, to change the doctor's verdict! As a result, I wrote again that the ultrasound revealed pathologies. Those. I am far from unfounded asserting that Elena Anatolyevna Zhuravleva makes a diagnosis not on the basis of what she sees herself, but on the basis of the diagnosis with which you came to her from another specialist! Women, I have a screaming appeal to you: if you do not want to waste precious time and lose, by the way, not a small amount of money, then look for another specialist!
Anonymous review 08.01.2020
It is very pleasant to deal with such a professional in his field, thank you very much for your professionalism and kindness. THANK!!!
Anonymous review 05.01.2020
Sergei Alexandrovich Petrin, as far as I can count, began to perform mammoplasty operations when I was still at the institute, I can't count how many operations he already had. I knew right away that I was in the right hands. At the consultation, I looked at several photos before and after (without faces, of course) - options that could be considered for me. Sergey Alexandrovich spoke about the most modern and effective methods. He answered my questions very meticulously and enthusiastically. After that, everything was discussed and planned with me. I arrived for the operation on the appointed day. Thanks to the qualifications and experience of the doctor, I got my breasts, the one that I showed him what I want. Mine has become so beautiful and sexy, but mine, with my data, is not exactly the same with another girl! Scars and scars are not visible. Everything is so comfortable, and the presence of implants does not bother at all. Now I always look great, I can even wear a regular shirt, and my chest does its job! I don’t know how difficult it was for the doctor to work with me, but he met my expectations 100 percent! Thank you, Sergey Alexandrovich! More health and strength to you!