Perm Medical Journal

”Perm Medical Journal” (ISSN Key title: Permskiĭ medit︠s︡inskiĭ zhurnal) is a referred scientific and practical journal. It was founded in 1923 by Medical Society of Perm University. Since 2001 the founders of “Perm Medical Journal” are Perm State Academy of Medicine and Perm Research Center of Russian Academy of Medicl Sciences and Administration of Perm Region. Since 2017, the founder is Academician E.A. Vagner Perm State Medical University.

Editor-in-Chief: Evgeny G. Furman, MD, PhD, Corresponding Member of the Russian Academy of Sciences (Wagner State Medical University, Ministry of Health of the Russian Federation, Vice-Rector for Research)

The journal is registered by the Roskomnadzor agency (licensee ЭЛ № ФС 77-75489 on 05.04.2019).

“Perm Medical Journal” is included into the list of the leading scientific journals and editions of the Russian Federation intended for publication of basic scientific results of theses for a degree of Doctor of Science.

01.14.01 - Obstetrics and gynecology (medical sciences)
01.14.02 - Endocrinology (medical sciences)
3.1.21 - Pediatrics (medical sciences)
01.14.12 - Oncology (medical sciences)
3.1.9 - Surgery (medical sciences)
01.14.25 - Pulmonology (medical sciences)
3.2.2 - Epidemiology (medical sciences)
03.14.09 - Clinical immunology, allergology (medical sciences)
03.14.10 - Clinical laboratory diagnostics (medical sciences)

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Current Issue

Vol 39, No 5 (2022)

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Original studies

Role of neonatal respiratory infection in formation of atopic dermatitis in children
Bukina E.V., Repetskaya M.N., Furman E.G., Toropova E.A.
Abstract

Objective. To determine the role of neonatal respiratory infection in the formation of atopic dermatitis in children.

Materials and methods. A retrospective analysis of the state of health of children who suffered from intrauterine pneumonia (21 persons) compared with healthy children (19 persons) was carried out.

Results. As a result of examination in the prospective follow-up, it was revealed that the children of both groups had a burdened heredity for allergic pathology, they were on natural feeding. It was detected that fetoplacental insufficiency, as an unfavorable factor of the antenatal period, effects the formation of atopic dermatitis.

Conclusions. There was noted a high risk of atopic dermatitis in children who suffered from intrauterine pneumonia compared to children with a favorable course of the neonatal period.

Perm Medical Journal. 2022;39(5):5-11
pages 5-11 views
Comorbid diseases and conditions of patients with a novel coronavirus infection COVID-19, who died in infectious hospital
Khokhlova Y.A., Markelova L.N., Titova N.E.
Abstract

Objective. To analyze the comorbid diseases and conditions in patients with a novel coronavirus infection COVID-19, who died in the infectious hospital.

Materials and methods. Analysis of 1202 postmortem epicrises and protocols of pathologicoanatomic study of patients, who died in the infectious hospital of Smolensk on the basis of Clinical Hospital № 1 was carried out.

Results. There prevailed elderly and old patients – 81.5 %, most of them suffered from cardiovascular diseases (CVD), first of all ischemic heart disease – 92 % and arterial hypertension – 94.8 %. The most frequent risk factors/comorbid background of CVD were obesity (53.7 %), type 2 diabetes mellitus – 29.8 %. Practically all patients suffered from chronic heart failure, each third – 2b–3 stage, III–IV functional class (30.1 %). The basic comorbid diseases/conditions during hospitalization period were myocardial infarction (3.8 %), acute coronary syndrome (5.2 %), cerebral stroke (6.1 %), pulmonary embolism (4.3 %), atrial fibrillation paroxysm (8.7 %), myocarditis/pericarditis (3.8 %). In 43.1 % of patients, the comorbid pathology was on the foreground as a concurrent/concomitant/basic disease (as a basic diseases – in 12.9 % of patients).

Conclusions. Among the dead patients with COVID-19 there prevail elderly and old patients, burdened for comorbidity. Most of all, cardiovascular pathology, complicated by heart failure and associated with obesity and type 2 diabetes mellitus has an impact of the outcome of disease.

The comorbid diseases/conditions during hospitalization are determined, as a rule, by vascular thromboses of various localizations. In every tenth patient, the comorbid pathology was the direct cause of death.

Perm Medical Journal. 2022;39(5):12-20
pages 12-20 views
Reference notes for operating surgeons from classical positions and research methods of academician V.N. Shevkunenko (1872–1952) school based on new data regarding typical anatomy of the neck
Romashchenko P.N., Maleev Y.V., Fomin N.F., Vshivtsev D.O., Krivolapov D.S., Chernykh A.V., Golovanov D.N., Malyukov N.A.
Abstract

Objective. To reflect new information on the typical anatomy of the neck in brief notes for endocrine surgeons from the classical positions and research methods of the school of Academician V.N. Shevkunenko.

Materials and methods. The design of the study (from 1994 to the present day) consisted of three main directions. While developing an optimal technique of cervical somatometry, 775 healthy individuals (300/38.7 % men, 475/61.3 % women) were examined. The topographo-anatomical block – 426 unfixed corpses of persons who died suddenly (290/68 % men, 136/32 % women). Section, dissection, plastination, morphometry, anthropometry, standard histological technique were used. The clinical part of the study included 214 patients (28/13.1 % men, 186/86.9 % women).

Results. The article presents the data of analysis and systematization of accumulated data on the typical anatomy of the neck in the form of a brief abstract for operating surgeons from the classical positions of topographic anatomists of Voronezh and St. Petersburg schools of Academician V.N. Shevkunenko.

Conclusions. The revealed new typical features of the shape, sizes, structure and position of the thyroid gland (presence or absence of the pyramidal lobe, retrothyroid processes, Zuckerkandl's tubercle), its blood supply, basic and additional guidelines for the search and visualization of the parathyroid glands and recurrent laryngeal nerve during surgery and preoperative diagnosis, the concept of high-risk areas of surgical actions, the features of the bilateral symmetrical and/or asymmetric arrangement and structure of the anatomical formations of the neck can be used during the surgery, widely introduced into the educational process of students, residents, postgraduate courses and for improving the skills of endocrine surgeons during master classes.

Perm Medical Journal. 2022;39(5):21-32
pages 21-32 views
Dissection of the VI cervical lymph collector for papillary thyroid cancer
Aleksandrov Y.K., Dyakiv A.D.
Abstract

Objective. To assess the expediency and necessity of implementing the dissection of the central cervical lymph nodes (group VI) in patients with papillary thyroid cancer.

Materials and methods. The results of preoperative examination, surgical treatment and its follow-up were evaluated in 210 patients, who along with thyreoidectomy, underwent dissection of the central cervical lymph nodes (group VI).

Results. It was established that for papillary thyroid cancer, a high frequency of cervical lymph node metastasis is typical. During the preoperative examination, (US and cytological study), metastases were detected in 23.5 % of patients, and while pathomorphological study of the removed central neck cellular tissue – in 47.4 % more. Therefore, preventive dissection of the central cervical lymph nodes (VI group) is worthwhile.

Though expansion of the volume of operations in patients with papillary thyroid cancer at the expense of dissecting the central cervical lymph nodes in addition to the thyroid gland, leads to insignificant elevation of the number of complications but in the remote period (3–5 years), volume expansion of operations has no negative impact on the indicators of physical and psychical components of the life quality.

Conclusions. The obtained objective information regarding the presence or absence of metastatic lesion of the cervical lymph nodes permits to ground the process staging in papillary thyroid cancer and form treatment tactics.

Perm Medical Journal. 2022;39(5):33-40
pages 33-40 views
Features of diagnostics and treatment of malignant thyroid neoplasms
Makarov I.V., Pismennyi I.V., Pismennyi V.I., Galkin R.A., Ruzanova A.A.
Abstract

Objective. To analyze diagnostics and treatment of 50 patients operated for thyroid cancer (TC), to assess the information content of classification according to the TIRADS and BETHESDA systems in comparison with the final morphological study of the removed thyroid preparations.

Materials and methods. Patients were divided into 3 groups. The first group – 32 (64 %) patients with a verified thyroid cancer before surgery according to the results of fine needle aspiration puncture biopsy and a confirmed diagnosis after surgery. The second group, 4 (8 %) persons, included patients with a verified thyroid cancer before surgery, but a negative final morphological study. The third group, 14 (28 %) patients with an unverified thyroid cancer before surgery, but a confirmed diagnosis of thyroid cancer according to the results of a final morphological study. To compare the compliance of the TIRADS system with the BETHESDA system, the Kappa index was used.

Results. The highest compliance, 100 %, was found between TIRADS 5 and BETHESDA 5, with a Kappa index of 1.

Conclusions. Comparison of the results of preoperative and final morphological studies showed that the use of TIRADS and BETHESDA classifications is an informative method in diagnostics of thyroid cancer only in 48 % of cases.

Perm Medical Journal. 2022;39(5):41-47
pages 41-47 views
Hormone-inactive adrenal tumors in clinician’s practice
Chzhen T.R., Kiseleva T.P.
Abstract

Objective. To study the clinical picture, malignancy potential of hormone-inactive adrenal tumors (HIAT) by the results of computed tomography (CT) to identify the most significant clinical and diagnostic signs.

Materials and methods. Case histories of 65 patients operated for HIAT (group 1) and 52 ambulatory records of HIAT patients (group 2) observed in the polyclinic were retrospectively studied. All patients underwent survey, antropometry, biochemical blood analysis, adrenal hormone level, CT of adrenal glands.

Results. The operated patients in 81.6 % of cases were under sixty, nonoperated – in 73 % of cases over sixty. The size of tumor in patients of group 1 in 84.7 % exceeded 4 cm, in group 2 – in 98.1 % was less than 4 cm. HIAT size, CT-density in NF were significantly lower (р = 0,000 and р = 0,000, respectively), but the level of morning cortisol, observation period and age were significantly higher in the group of nonoperated patients. (р = 0,013, р = 0,000 and р = 0,000, respectively). According to the results of comparative analysis of the clinical manifestations of the autonomous cortisol secretion (arterial hypertension, obesity) in the groups of nonoperated and operated patients with HIAT, statistically significant differences were established (р = 0,000, р = 0,002 respectively). In group 1, stage 2 AH was diagnosed more often and obesity – rarely. No statistically significant differences were detected in the analysis of carbohydrate metabolism disorders, osteoporosis, dyslipidemia (р = 0,531, р р = 0,322, р = 0,105). Correlation analysis of HIAT size with the period of dynamic observation and CT-density in NF showed a negative notable (р = -0,606, р = 0,000) and a positive moderate (р = 0,391, р = 0,036) (respectively) tightness of links by Chaddock scale. In case of a 1 cm increase in HIAT size, CT-density in NF is expected to rise by 1,857 HU.

Conclusions. 1. To determine the indications to adrenalectomy, it is necessary to take into account the size and native density of the adrenal tumor by the results of computed tomography as well as clinical and laboratory data. With the values of HIAT size ≥ 4.0 cm in combination with CT-density in NF ≥ 12 HU, adrenalectomy is recommended. 2. In case of a 1 cm increase in HIAT size, rise in CT-density by 1,857 HU is expected. It is worthwhile to control CT-phenotype of HIAT in nonoperated ambulatory patients to determine the malignancy potential of HIAT and up-to-date surgical treatment.

Perm Medical Journal. 2022;39(5):48-57
pages 48-57 views
Modern opportunities and problematic aspects of diagnostics and treatment of patients with neuroendocrine tumors
Lysanyuk M.V., Romashchenko P.N., Maistrenko N.A.
Abstract

Objective. To study modern diagnostic capabilities and identify available ways to improve the results of treatment of patients with NET of the digestive organs. Neuroendocrine tumors (NET) are neoplasms difficult to diagnose and treat, which are localized mainly in the digestive tract.

Materials and methods. The results of observation of 325 patients with NET were studied: gastrointestinal tract – in 189 (58.1 %) persons, pancreas – in 125 (38.5 %), without established localization – in 11 (3.4 %). NET of various malignancy prevailed – 92.3 %. Laboratory diagnostics included tumor markers (CGA, serotonin, 5-HIAA, etc.), instrumental – endoscopic (FGS, FCS), radiation (US, CT, MRI), radioisotope (PET-CT with 18-FDG, 68-Ga-peptides) and morphological (histology, immunohistochemistry) research.

Results. Nonspecific symptoms were noted in 38–48 % of patients, asymptomatic course – in 20–25 %. The sensitivity of CGA was 54 %, serotonin and 5- HIAA – depended on the presence of carcinoid syndrome and the prevalence of the tumor. Multiphase CT is the main method of diagnosis of small intestinal NET, which allows you to differentiate pancreatic NET by the degree of malignancy. The surgical intervention provides the best results in the treatment of patients with non-metastatic NET, but in case of generalized tumors, its combination with antitumor therapy prolongs the duration of life in patients by 2 times.

Conclusions. Personalized therapeutic and diagnostic tactics, taking into account the clinical and morphological features of NET, ensures optimal detection and treatment, improves survival and quality of life among patients.

Perm Medical Journal. 2022;39(5):58-68
pages 58-68 views

Review of literature

Effect of vitamin D on brain development during ontogenesis: literature review
Kalashnikova T.P., Popovskaya A.V., Minasanova A.V.
Abstract

The article presents a review. Information on metabolism of vitamin D and its significance in the formation of the brain in the prenatal and postnatal periods is given. An up-to-date data regarding the effect of vitamin D on neurogenesis, activity of neurotransmitter systems, formation of cognitive status and quality of emotional state in children and adolescents is analyzed. The role of vitamin D in pathogenesis of autistic spectrum disorders, resistant forms of epilepsy, deviant variants of development in children is discussed.

Perm Medical Journal. 2022;39(5):69-79
pages 69-79 views
Post-transcriptional micro-RNAs in diagnostics and personalization of treatment in patients with thyroid tumors: literary review
Lukyanov S.A., Sergiyko S.V., Ilyina T.E.
Abstract

Among the unsolved problems in the treatment of patients with nodular thyroid pathology, there is a large number of diagnostic operations associated with difficulties in cytological diagnostics of follicular neoplasia, limited by opportunities in preoperative assessment of the malignant potential of thyroid cancer. A decrease in the effectiveness of targeted therapy in patients with radioiodresistant thyroid cancer occurs due to the ability of the tumor to activate parallel proliferative signaling pathways. It is assumed that the key to solving these problems lies in understanding various genetic changes in the tumor cell, such as point mutations, insertions and deletions, gene merges, rearrangements or gene translocations. A special place in this list is occupied by microRNAs. It is a class of small non-coding RNAs, which regulate post-transcriptional gene expression and thereby participate in cell differentiation, proliferation, angiogenesis, apoptosis resistance and activation of thyroid cancer metastasis. This review contains information about microRNAs detected in various types of thyroid tumors of diagnostic, prognostic and therapeutic interest. While some of them have been introduced into routine practice, others are new and require additional research before clinical use.

Perm Medical Journal. 2022;39(5):80-92
pages 80-92 views

Methods of diagnosis and technologies

Laser-induced thermotherapy of thyroid nodules with ablation of vessels feeding the nodule
Petrov V.G., Sozonov A.I., Baksheev E.G., Ivashina E.G., Ermakova A.A., Ermakova P.A.
Abstract

Objective. To improve the results of treatment in patients with benign nodular pathology of the thyroid gland (TG) by means of perfecting the technique of minimally invasive treatment with a high-intensive laser under the sonographic control.

Materials and methods. An original technique of laser-induces thermotherapy (LITT) of the thyroid nodule with the ablation of the vessels, feeding the nodule was developed and introduced. The procedure was used in the treatment of 91 patients with benign nodular pathology of the thyroid gland, 116 patients underwent laser-induced thermotherapy by the standard technique (comparison group). Three months later, US was used to assess and compare the results of treatment in both groups. The results of thermometry were analyzed depending on the initial volume of the TG nodular neoplasm.

Results. A decrease in the nodules with the initial volume up to 2 cm3 in both groups was statistically significant and took place practically similarly – 78.7 % in the main group and 71.7 % in the comparison group. When exposing the nodules of larger sizes, the efficiency of standard LITT method fell. In the comparison group, patients with the nodular sizes of 6–8 cm2 had a decrease in the volume only by 25.8 % % (from 6.74 cm3 to 5.0 cm3). When using an original method of thermoablation (TA), a decrease in the nodules of the same size was 69.3 % (from 6.98 cm3 to 2.14 cm3). The difference was statistically significant (p = 0,003) that proves the efficiency of this technique. In the subgroup with the nodules > 8 cm3, a nodular volume decrease was 33.3 % (from 11.05 to 7.36 cm3) in the main group and 28.8 % (from 14.07 to 10.02 cm3) in the comparison group. The difference was not statistically significant (p = 279).

Conclusions. Laser-induces thermotherapy of the thyroid gland with the ablation of the vessel, feeding the nodule, leads to a statistically significant reduction of the benign colloid nodular neoplasms of any size. The original technique indicated higher efficiency compared with standard LITT in relation to the nodules sized from 6 to 8 cm.

Perm Medical Journal. 2022;39(5):93-103
pages 93-103 views
Surgical aspects of topographic and anatomical changes in the neck after hemithyroidectomy
Zhirnova A.S., Abramzon O.M., Lyashchenko S.N.
Abstract

Objective. To develop the optimal surgical techniques for repeated interventions on the thyroid gland, taking into account topographic and anatomical changes in the neck after a previous hemithyroidectomy.

Materials and methods. The results of repeated surgical treatment of 69 patients (divided into two groups) with various pathologies of the thyroid gland were analyzed. Patients of the main group (39 person) underwent magnetic resonance imaging of the soft tissues of the neck before the surgery. In the comparison group (30 person), reintervention in the volume of thyroidectomy was performed in the classical way without tomography.

Results. Based on magnetic resonance imaging of the soft tissues of the neck, the topographic anatomy of its anterior section in patients after hemithyroidectomy was studied. Two types of disposition of organs and structures were revealed: anterior lateral and posterior medial. The first type is characterized by an anterior displacement of the esophagus to the posterior surface of the lateral lobe of the thyroid gland and the neurovascular bundle. In the second type, a tight contact between the thyroid gland and the short muscles of the neck and displacement of the carotid artery and jugular vein posteriorly and medially was detected. Surgical techniques for repeated surgical intervention have been adjusted for each type of disposition.

Conclusions. The proposed techniques made it possible to minimize the length of surgical access, the duration of intervention, the severity of pain syndrome, as well as the number of intra- and postoperative complications.

Perm Medical Journal. 2022;39(5):104-111
pages 104-111 views
MIVAP is the optimal parathyroidectomy technique
Romashchenko P.N., Fomin N.F., Vshivtsev D.O., Maistrenko N.A., Krivolapov D.S., Maleev Y.V., Pryadko A.S., Starchik D.A.
Abstract

Objective. To ground from clinical, topographo-anatomical positions the choice of the most rational techniques of parathyroidectomy in patients with hyperparathyroidism, which permit to reduce the intraoperative injury, to minimize operative complications, persistence and hyperparathyroidism relapse rates, to elevate the quality of life.

Materials and methods. The research had two stages. Topographo-anatomical stage was realized at two levels: 1) on the anatomical material including 15 dead bodies; 2) on the plated end-grain cuttings of the dead bodies’ necks (n = 4). During a clinical stage, the results of examination and treatment of 182 patients with hyperparathyroidism, operated with traditional and different minimally invasive techniques, were studied.

Results. The analysis of short-term results of surgical treatment of hyperparathyroidism patients in the retrospective group allowed determining the starting points for the topographo-anatomical stage of the research. The data received during the topographo-anatomical stage permitted to substantiate the choice of minimally invasive endoscopically-assisted technique for parathyroidectomy as the most rational and safety one. Introduction of the study results into surgical treatment of patients of the prospective group showed the efficiency of MIVAP technique in the form of decrease in the frequency of surgical complications from 12.1 to 6.0 % (all complications are attributed to I and II degree by Clavien-Dindo classification and had transitory character) with the reduction of the time of operative intervention and average duration of hospital treatment after the surgery.

Conclusions. Minimally invasive endoscopically-assisted parathyroidectomy with the lateralization of the lobe of the thyroid gland, preservation of the upper and lower thyroid vessels in conditions of intraoperative neuromonitoring and photodynamic visualization of the parathyroid gland can be considered an optimal surgical technique.

Perm Medical Journal. 2022;39(5):112-124
pages 112-124 views
Evaluation of treatment efficiency of diabetic foot syndrome using immunohistochemical studies
Styazhkina S.N., Bayramkulov E.D., Kiryanov N.A., Sharifullina E.R., Zharova A.A.
Abstract

Objective. To evaluate the results of complex conservative treatment of patients with diabetic foot syndrome using immunohistochemical methods of studying tissue bioptates of the affected foot regions.

Materials and methods. Examination and treatment of 129 patients (aged 16 to 80 years) with 1 and 2 type diabetes mellitus, whose course of the disease was complicate by the development of diabetic foot syndrome (DFS) was carried out. The main group (group 1) included 89 patients, who underwent complex conservative treatment added by the preparations mexidol and roncoleukin. Mexidol was used intravenously 10 ml for 10 days, and then tableted drugs in the dose of 125 ml. Roncoleukin was administered intravenously in the dose of 1.0–0.500 units: the 1st day after admission to hospital – as a preoperative preparation; after the surgery – on the 3rd day. The comparison group (group 2) enclosed 40 persons. They received a standard conservative treatment of DFS including sugar-containing, hypotensive and hypolipidemic drugs as well as a local therapy using sorption bandages. Before treatment and two weeks after, the tissue bioptates of the affected regions were taken from patients. For morphological study of bioptates, histochemical methods were applied: Mallory’s toluidine blue staining in Heidenhain modification, PAS reaction. The number of leukocytes, lymphocytes, Ki-67 protein proliferation index, P53 protein expression were calculated.

Results. The morphological study before the onset of treatment showed that the inflammation had a marked character in all the bioptates. The margins of the ulcerous defect were infiltrated with polymorphonuclear leukocytes. The number of neutrophils was 75 %, lymphocytes – 25 %. The results of immunohistochemical analysis were the following: Ki-67 protein proliferation index was 2 %, P53 protein expression – 2.9 %. Treatment of the control group (group 2) with the standard method resulted in a complete purification of the trophic ulcer from necrotic mass on the day 21st. In the infiltrate, there prevailed lymphocytes (70 %), the number of neutrophils decreased to 30 %. The result of immunohistochemical study was an increase in Ki-67 biomarker expression up to 7 %, P53 biomarker expression – 5 %. Combined treatment of DFS applying mexidol and roncoleukin (group 1) demonstrated a maximum restorative effect already on the 6–14 day. In the infiltrate, the number of lymphocytes was 85 %, neutrophile leukocytes fell to 15 %, Ki-67 biomarker proliferation index grew to 15 %, P53 biomarker expression – to 5.9 %.

Conclusions. The use of immunohistochemical methods of research of ulcer bioptates in treatment of DFS makes it possible to reliably evaluate the dynamics of wound process. The application of original preparations roncoleukin and mexidol in complex treatment contributes to a faster reduction of inflammatory process and purification of wounds that is confirmed by an increase in Ki proliferation index and P53 apoptosis.

Perm Medical Journal. 2022;39(5):125-131
pages 125-131 views

Preventive and social medicine

Unfavorable maternal outcomes: age structure and territorial distribution
Berseneva S.N., Isaeva N.V., Padrul M.M., Chercasova E.V.
Abstract

Objective. To analyze and evaluate the factors connected with age and territorial distribution among women with unfavorable maternal outcomes.

Materials and methods. A retrospective epidemiological analysis of official statistics data on all cases of unfavorable maternal outcomes (deceased women and women with near-miss – "almost dead") by age and structure at the place of residence (city, village) in comparison with successful outcomes in Perm Krai (PK), Privolzhsky Federal Region (PFR) and the Russian Federation (RF) for 1997–2020 was carried out.

Results. In the age structure of deceased women in PK, the main share of 46.7 % was occupied by women aged 20–29 and 30–39 years, that differed from the comparison group. Among the mothers with successful outcomes in PK, PFR and RF, women aged 20–29 years were in the first place – 59.3, 62.5 and 60.2 %, respectively, that is 1.3 times higher than the corresponding proportion in MM. In the second place, there were women aged 30–39 years – 29.6; 27.9 and 29.1 %, respectively, that is 1.6 times less than the deceased women of the corresponding age. The percentage of young mothers aged 15–19 was 9.2; 7.7 and 8.9 %, respectively, that is 1.4 times higher than that of the deceased women.

The age structure of women with failed maternal mortality (FMM) differed slightly from that of deceased women and significantly – from all puerperas in PK, PFR, RF. Thus, according to the ave-rage long–term data, the main share of women with FMM was women aged 20–29 years – 51.8 %. The percentage of puerperas aged 20–29 years in PK, Privolzhsky Federal Region and the Russian Federation was 59.3, 62.5 and 60.2 respectively. In the second place in PK are women with FMM aged 30–39 years – 31.5 %. The share of puerperas aged 30–39 years in PK, PFR and RF is 29.6 %, 27.9 % and 29.1 %, respectively. In the third place, there are young puerperas with FMM aged 15–19 years – 14.8 %. The proportion of such patients in PK, PFR and RF is 9.2, 7.7 and 6.6 %, respectively.

According to the average long–term data, the proportion of urban residents prevailed among the deceased women – 60.0 %. In the rural areas, the proportion of women who died was 40.0 %.

By the place of residence, the share of women with FMM did not differ from the corresponding data in the MM group and amounted to 57.4 % in the city and 42.6 % in the village. In PK, PFR and RF, this ratio was 72.7 and 27.3 %; 71.6 and 28.4 %; 73.3 and 26.7 % respectively in all the compared territories).

Conclusions. The risk groups for MM and FMM were women aged 20–29 years, residents of the city and village, high-risk group – rural women 30–39 years.

Perm Medical Journal. 2022;39(5):132-138
pages 132-138 views

Clinical case

A difficult endocrinological patient in oncological practice. Own clinical obseration
Yashina D.P., Afanasyeva Z.A., Sharapov T.L.
Abstract

Klinefelter syndrome is a genetic disease in males (1 per 1000 newborns) due to the presence of a doubled X chromosome in the karyotype (47XXY karyotype), the most common cause of primary hypogonadism. It is characterized by polymorphism of clinical manifestations, the most common of which are primary male infertility, obesity, metabolic syndrome, type 2 diabetes mellitus, osteopenia and osteoporosis. Clinical variability leads to the development of associated conditions against the background of changes in hormonal regulation and observation by different specialists, as a result – to late diagnosis of the syndrome. Endogenous hypercorticism in 20–30 % is caused by Itsenko – Cushing's syndrome, in the structure of which about 70–80 % are unilateral adrenal adenomas (corticosteromas). ACTH-independent hypercorticism leads to a number of metabolic and cardiovascular disorders, including abdominal obesity, arterial hypertension, steroid diabetes, and osteoporosis. Long-term suppression of ACTH, according to the feedback principle, leads to suppression of the secretion of hormones of the pituitary endocrine glands (including sex steroids). The clinical observation illustrates the complex pathophysiological disorders that occur when the hypothalamic-pituitary-adrenal / gonadal axis is disturbed in a combination of two syndromes, as well as the importance of a comprehensive examination of endocrinological patients.

Perm Medical Journal. 2022;39(5):139-143
pages 139-143 views
Diagnostic difficulties of small intestinal neuroendocrine tumors: clinical case
Kotelnikova L.P., Shatrova N.A., Trukhacheva E.A.
Abstract

The objective of the study was to demonstrate the difficulties of diagnosing the neuroendocrine tumor (NET) of the small intestine at the example of a concrete clinical case. In the case presented, clinical manifestations of the disease were nonspecific and the examination began from a low-informative method – multispiral computed tomography (MSCT) without a bolus contrast study that was the reason of wrong diagnosis for 7 months. The detection of the swollen lymph node in the mesentery was interpreted incorrectly; additionally, only endoscopic investigation of the stomach and large intestine was used. By means of MSCT-angiography we succeeded to diagnose not only the lymph node conglomerate in the mesentery, but to reveal a tumor sized 9´15 cm in the ileac wall. Laparoscopy with lymph node biopsy after its morphological study permitted to verify the diagnosis before the surgery.

To reduce the period of diagnostics of small intestinal NET, general practitioners should be informed on specific features of clinical manifestations of the disease and rational diagnostic methods. MSCT-angiography showed its efficiency in detection of small-sized small intestinal NET, and laparoscopy with biopsy of the mesentery lymph node will permit to verify the diagnosis before surgery.

Perm Medical Journal. 2022;39(5):144-149
pages 144-149 views
Stress-induced myocardial infarction in young women: сlinical observation
Irkabaeva M.M., Zhuravleva A.S., Kurnikova I.A., Malyutina N.N., Avdoshina S.V., Polikarpova T.S., Kobelevskaya N.V., Bychkovа L.V.
Abstract

The article presents a clinical observation of first appeared non-ST elevation myocardial infarction in a 43-year-old young woman with three risk factors: chronic stress, smoking, dyslipidemia. Significant stenosis of the LAD (left anterior descending artery) was diagnosed and surgical intervention was performed: plasty and stenting of the LAD.

Perm Medical Journal. 2022;39(5):150-160
pages 150-160 views


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