Vol 32, No 2 (2015)

Articles
EFFECT OF ESSENTIAL PHOSPHOLIPIDS AND SILIMARIN ON STRUCTURE-FUNCTIONAL STATUS OF LIVER IN DIFFERENT GENESIS STEATOHEPATITES
Mavlitova L.A., Khlynova O.V.
Abstract
Aim. To study the peculiar features of the effect of up-to-date hepatotropic drug “phosphonciale” on the structure-functional status of the liver in patients with steatohepatites of different genesis. Materials and methods. An open perspective controlled comparative two-stage study including patients with chronic steatohepatites was carried out. The study involved 30 patients with nonalcoholic and 26 patients with alcoholic steatohepatitis. Results. Comparative analysis of indices before the therapy indicated that in the group with nonalcoholic steatohepatitis (NASH), structure-functional disturbances of the liver parameters including cytolytic syndrome degree, fibrosis seromarker levels, hemodynamic tension in the vessels of porto-hepatic pool were manifested in a less degree. Before the therapy, certain differences in the structure-functional status of the liver among subjects with different genesis of disease were revealed. Conclusions. While carrying out monotherapy with combined drug containing essential phospholipids and silimarin, a reliable reduction in cytolysis markers and positive dynamics of fibrosis seromarker levels with improvement of porto-hepatic hemodynamic indices in both groups was established. However, significant results were reached in alcoholic steatohepatitis patients. The obtained dynamics concerning fibrosis markers grounds application of this drug for improvement of prognosis in the course of steatohepatites.
Perm Medical Journal. 2015;32(2):6-12
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ENERGY METABOLISM STATUS IN ACUTE PERIOD OF ISCHEMIC STROKE
Izhbuldina G.I.
Abstract
Aim. To study the peculiarities of carbohydrate metabolism in the acute period of ischemic stroke. Materials and methods. Sixty two patients with primary ischemic stroke associated with arterial hypertension and free of diabetes mellitus in anamnesis were examined. Fasting blood glucose, immunoreactive insulin and C-peptide levels were determined. Insulin resistance was assessed using calculation index HOMA and coefficient Caro. Results. Increase in glycemia levels to 5,31 ± 0,68 mmol/l, C-peptide to 0,90 ± 0,31 nmol/l and decline in insulin level to 9,38 ± 4,34 mcME/ml was demonstrated. C-peptide to insulin ratio values were reliably higher in patients with severe course of stroke (by 35,6 %, p < 0,05) and unfavorable outcome of disease (by 39,6 %, p < 0,05). Conclusions. Development of ischemic stroke is accompanied by high blood C-peptide levels against the background of hypoinsulinemia and minor hyperglycemia. Manifestation of disorders correlates with severity and clinical outcome of disease.
Perm Medical Journal. 2015;32(2):13-18
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LOW-INVASIVE METHOD FOR TREATMENT OF INFANTILE NONREFLEXING MEGAURETER
Menovschikova L.B., Levitskaya M.V., Gurevich A.I., Betanov Z.V., Petrukhina Y.V., Sklyarova T.A.
Abstract
Aim. To determine the efficiency of the method of endoscopic bougienage and stenting of the ureteral orifice. Materials and methods. 224 infants under one year (134 boys and 90 girls) with primary megaureter were examined. Diagnostic protocol included both clinicolaboratory and instrumental methods (ultrasonic investigation with assessment of intrarenal blood flow compared to reservoir and evacuatory urinary bladder function) as well as x-ray methods. During examination and dynamic follow-up, all patients were divided into three groups: group 1 - 68 (40,6 %) patients including those with vesico-dependent forms of megaureter for dynamic follow-up and correction of intravesical hypertension; group 2 - 15 (8,8 %) infants operated for presence of organic obstruction; group 3 - 86 (50,6 %) infants treated with endoscopic bougienage and ureteral orifice stenting. Results. Positive result of endoscopic stenting was reached in 78 infants that made 90,3%. In connection with inefficiency of endoscopic treatment, preservation of ureter delatation, decrease in renal function, 5 patients needed operative treatment after stenting, 3 patients are still followed-up. No complications when using the method of endoscopic bougienage and stenting of the distal ureteral parts were registered. Conclusions. Thus, use of low-invasive methods of endoscopic bougienage and stenting of the distal ureteral parts in treatment of early age infants with primary obstructive megaureter promotes restoration of urodynamics of the upper urinary tracts, reduction in the number of infectious complications that prevents progression of chronic renal disease.
Perm Medical Journal. 2015;32(2):19-24
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PECULIAR FEATURES OF ANAMNESIS IN PATIENTS WITH CHRONIC ENDOMETRITIS
Kobaidze E.G., Padrul M.M., Cheremiskin V.P.
Abstract
Aim. To analyze the disease course in patients with chronic inflammation of the uterine mucosa. In modern conditions, the number of chronic forms of inflammatory diseases with latent symptomatology is growing; different pathologies are often associated. Materials and methods. The peculiar features of anamnesis, in particular, association of gynecological and somatic pathology in patients with chronic endometritis (CE) as well as sterility were determined; 232 patients with morphologically confirmed chronic endometritis were examined. Results. The following peculiarities were detected while analyzing somatic anamnesis: 132 (56,9 %) women had chronic somatic pathology; in 35 (15 %) cases two or more somatic pathologies were combined. Analysis of reproductive anamnesis revealed the following peculiarities: 178 (76,7 %) women had pregnancies in anamnesis and formed the group of patients with secondary sterility; 54 (23,2 %) patients suffered from primary sterility. While analyzing gynecological anamnesis in the examined patients, the following peculiarities were found out: more often CE patients suffered from dysmenorrhea - 140 (60,3 %) cases, uterine myoma - 32 (13,8 %), external and internal endometriosis - 36 (15,5 %), bacterial vaginosis - 112 (48,3 %) women. Besides, there was a high rate of chronic inflammatory diseases of the uterine appendages - 118 (50,9 %) cases; 60 (25,9 %) patients had different interventions on the uterine neck in anamnesis. Conclusions. Treatment with antibiotics administered to patients with chronic inflammation including CE is often directed only to weakening of symptoms, but not to eradication of possible infectious agents. Suppressive effect of drugs on immunocompetent cells of microorganisms can decline the efficiency of immune response to inflammatory process and provoke the development of autoimmune disorders in tissues.
Perm Medical Journal. 2015;32(2):25-29
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INTESTINAL COMPRESSION STAPLER: DEVELOPMENT AND FIRST EXPERIENCE OF CLINICAL APPLICATION IN ONCOSURGERY
Vlasov A.A., Vazhenin A.V., Plotnikov V.V., Vlasov A.V., Fedorov S.V.
Abstract
Aim. To develop and use new techniques of forming circular compression suture in clinical practice for improvement of the results of surgical treatment of colon cancer patients. Materials and methods. An intestinal compression stapler (ICS) was developed by us. Experimental grounding for colonic compression suture by means of this device was carried out. The results of surgical treatment of colon cancer patients made the basis of clinical study. Seventy one patients who experienced formation of colonic anastomosis by the “end to end” type using ICS were operated. The study included planned and emergency operations. Results. A mean time required for formation of colonic anastomosis was 5,8 ± 0,25 minutes. Rejection of compression devices occurred during the period of 8-2 days, mean elimination time was 9,6 ± 1,63 days. The postoperative complication was registered in 1 (1,4 %) patient. No lethal outcomes were detected. The long-term functional results were also studied. Conclusions. Application of ICS for forming anastomosis is simple, effective, reliable; it has positive indirect and remote functional results.
Perm Medical Journal. 2015;32(2):30-36
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DYNAMICS OF SPECIFIC ANTIBODY TITERS TO HEPATITIC C VIRUS PROTEINS IN SUBJECTS WITH ACUTE VIRAL HEPATITIS C AT DIFFERENT STAGES OF INFECTIOUS PROCESS
Poponin D.M., Gorovits E.S., Timasheva O.A.
Abstract
Aim. To analyze the dynamics of anti-HCV-IgG to a number of HCV proteins in different periods of acute viral hepatitis C using modification of immune-enzyme analysis (IEA) developed by the authors. Materials and methods. The specific class G antibody titers (anti-HCV-IgG) to hepatitis C virus proteins were determined by means of the authors' modification of the method of immune-enzyme analysis in 30 patients with acute hepatitis C (AHC) during the periods of marked clinical manifestations and remission of disease. At the same time, viral RNA (RNA-HCV) concentration was assessed with polymerase chain reaction (PCR). The studied processes were compared with each other using the correlation analysis method. Results. A reliable increase in titers of the studied anti-HCV-IgG spectrum in dynamics of acute viral hepatitis C from the stage of marked clinical manifestations to remission was established; RNA-HCV concentration significantly declined in dynamics of the infectious process. An evident correlation link between these processes was registered. Conclusions. The offered method can be used for more precise diagnosis of the stage of acute viral hepatitis C.
Perm Medical Journal. 2015;32(2):37-42
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REPLACEMENT OF INCLUDED DENTITION DEFECTS COMPLICATED BY HORISONTAL SECONDARY DEFORMITIES WITH FIXED-DISASSEMBLED BRIDGE PROSTHESIS
Starkova A.V.
Abstract
Aim. To elevate the efficiency of orthopedic treatment of patients with dentition defects complicated by horisontal secondary deformities of fixed-disassembled bridge prosthesis. Materials and methods. Taking into account the disadvantages of bridge constructions as well as raised awareness of patients and careful attitude to their health, fixed-disassembled bridge prosthesis was developed for replacement of the included 1-2-teeth-length dentition defects. Results. Prosthesis is produced from monolithic material, in particular, it can be all-metal or all-ceramic, for example, manufactured from zirconium oxide without coating. Conclusions. The developed construction is esthetic and firm enough, its use permits to decrease the terms of orthopedic treatment, to heighten efficiency of chewing function, to reduce traumatic level during preparation of supporting teeth owing to exclusion of tooth pulp removal and polishing of minimum hard tissue volume.
Perm Medical Journal. 2015;32(2):43-46
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METHOD OF USING SPECIAL MUSICAL PROGRAMS DURING MINERALOTHERAPY COURSES IN CONDITIONS OF SYLVINIT MICROCLIMATIC WARDS
Kirichenko L.V., Barannikov V.G., Varankina S.A., Kholhryakova V.P., Dementiev S.V.
Abstract
Aim. To estimate the influence of the offered original audio illustration on the functional status of patients with respiratory diseases during their treatment in salt microclimatic wards. Materials and methods. The study object: original musical programs for audio illustration during a ten-day course of sylvinite therapy; 42 middle-aged patients with allergic respiratory diseases. The rate of sensomotor reaction to light and sound, attention, health, activity, mood were assessed. External respiration parameters (respiratory rate, lung capacity, Stange’s tests) were determined thrice in dynamics. Results. Special musical programs positively influence functional status of the basic systems of the body in middle-aged pulmonological patients, enhancing the efficiency of complex therapy. The obtained data permitted to develop and offer musical programs for pre-school children taking into account peculiar features of the development of their nervous system and auditory analyzer. Conclusions. The developed method of using special musical programs while carrying out mineralotherapy in conditions of sylvinite microclimatic wards positively influences functional status of the basic systems of the body in middle-aged pulmonological patients, thus elevating the efficiency of complex therapy. The results of this study indicate prospective value of using special musical illustration in pre-school age groups.
Perm Medical Journal. 2015;32(2):47-51
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Effects of electromagnetic fields on patients. Preliminary results of double blind study and review of the literature
D’Ajello F., Maglie C., Yuzakov A.A., Baydarov A.A.
Abstract
Between October and January 2013 an international study group have conducted a double blind study on 60 consecutive patients admitted to verify effects on patients exposed to effect of Very Low Magnetic field generated by “Biodispositivo”, to evaluate effect on pain, local back mobility, reduction of local and diffused inflammatory effects.This study is a result of a collaboration between Perm State Politechnical Academy which evaluated intensity and orientation of magnetic field and some differents Italian medical center, and sponsored by Full Point company, an Italian company that produce magnetic device named “Biodispositivo”.
Perm Medical Journal. 2015;32(2):52-57
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DYNAMICS OF MICROCIRCULATION INDEX CHANGES IN ISCHEMIC SPINAL MARROW EXPOSED TO RECOMBINANT ERYTHROPOIETIN AND LASER EMISSION (experimental study)
Volodrenko A.M., Giniatullin R.U., Kozel A.I., Astakhova L.V.
Abstract
Aim. To study the dynamics of microcirculation index in the focus of experimental spinal marrow ischemia in rats exposed to recombinant erythropoietin and laser emission. Materials and methods. The work was carried out on 80 sexually mature rats, divided into four test series - 20 animals each. In animals of series one, the control group, the spinal marrow ischemia was modeled. In series two, animals were intraperitoneally introduced 1000 ME of recombinant erythropoietin in 3, 24 and 48 hours. Animals of series three after the operation were exposed to skin irradiation with diode laser in the zone of ischemia. In test series four, laser emission of the ischemic focus was combined with introduction of recombinant erythropoietin. Assessment of microcirculation index was performed in animals of all the series during each period of the test using the unit LAKK-01 (Russian Federation) with subsequent mathematical and statistical processing by means of the program “Lasma” (Russian Federation). Results. The study results reliably indicate that recombinant erythropoietin possesses an antiapoptotic and antihypoxic effect, stimulates angio- and neurogenesis, but when exposed to laser emission of infrared range it promotes strengthening of microcirculation in the focus of ischemia. Conclusions. Combined effect of recombinant erythropoietin and laser emission in the zone of ischemic lesion of the spinal marrow significantly raises the local blood flow. It is accompanied by an early regress of neurological disorders and activation of behavior in animals.
Perm Medical Journal. 2015;32(2):58-62
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STEREOANATOMICAL ANALYSIS OF ARTERIAL SYSTEM IN HUMAN KIDNEY
Kafarov E.S., Vagabov I.U., Fedorov S.V.
Abstract
Aim. To study the spatial and level organization of different arterial canal links in the human kidney. Materials and methods. Forty preparations of kidneys from persons aged 22-90 years who died from diseases not connected with renal pathology served as a study material. The methods of anatomical preparation, those of producing corrosive preparations of renal arterial system followed by their 3D-scanning were used. Variants and types of arterial vessel branching were studied in stereoprojection. Results. It was detected that the renal artery was divided into two branches (85 % of cases) on 34 out of 40 corrosive preparations of renal arterial vessels. On 6 out of 40 corrosive preparations of renal arterial vessels the renal artery was divided into 3 branches (15 % of cases). Results. The results of stereoanatomical studies of renal arterial vessels showed that spatial and level organization of different links of renal arterial canal depends on both variants of division and types of intraorgan branching of renal arterial system. Conclusions. Taking into account the types of intraorgan branching of renal artery and level organization of links, there is observed a quantitative and qualitative difference in the number of vessels of the third and forth link, that influences the number of segments in the kidneys, thus resulting in reconsideration of a classical five-segmental structure of the kidney.
Perm Medical Journal. 2015;32(2):63-69
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STUDY OF DENTAL STATUS IN ATHLETES OF PERM KRAI GOING FOR FORCE NONCONTACT KINDS OF SPORT
Ozhgikhina E.S.
Abstract
Aim. To assess the dental status of force athletes in Perm Krai and develop the method of prevention of dental system (DS) pathology in this category of patients. Materials and methods. The dental study of 30 athletes with different training level, who are going in for noncontact kinds of sport, was performed. At the stage 1 (preclinical), questionnaire design of the participants of the study using the developed specific questionnaire was carried out. At the stage 2 (clinical), dental status of patients was assessed. Results. The survey results showed that 35,7 % of interviewed patients were aware of the possibility of aggravation of dental pathological processes when going in for force noncontact kinds of sport, 78,6 % of athletes knew about the necessity of using sport kapps during sport training, but only 7 % applied them constantly. It was determined when estimating the dental status of athletes that a mean value of KPU index was 9,9 ± 5,46, but CPITN - 2 ± 0,67. Noncarious injuries of the teeth were observed in 60 % of the examined athletes. Conclusions. It was determined by the results of the conducted study that it is necessary to work out a complex of measures promoting maintenance of dental health in this category of patients, to introduce programs for prevention of dental diseases among athletes and to develop a new design of individual sport dental splint taking into account all the parameters of dental system and specific character of sport.
Perm Medical Journal. 2015;32(2):70-75
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QUALITY RATING OF YOUTH NARCOSUSCEPTIBILITY PREVENTION WITH INVERSE TIES METHOD
Timoshilov V.I., Batavina I.A.
Abstract
Aim. To develop and introduce the principle of inverse regulating ties into the system of quality rating of measures on prevention of narcosusceptibility among young people. Materials and methods. To carry out the study, a questionnaire including questions aimed at estimation of youth’s satisfaction with preventive measures was developed. 459 persons participated in the survey. The participants’ means age was 15,5 ± 1,04 years. Results. 82,8% of survey participants were satisfied with the volume of information, 85,7% - with form of its presentation. Absence of novelty was noted by 20,9 % of respondents, ignorance on safety of some narcotics - by 6,1%; 71% of respondents were satisfied with information on treatment, 29% had a wrong impression on the opportunities of medicine and only 35,7% were ready to address for medical care. Conclusions. Insufficient level of succession while carrying out different measures and lack of information on the opportunities of modern narcology in combination with inadequate motivation for medical care was stated.
Perm Medical Journal. 2015;32(2):76-80
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SPECIALIZED SECONDARY SCHOOL LEAVERS’ ADAPTATION AT MEDICAL INSTITUTIONS
Vorobieva O.D.
Abstract
Aim. To work out and introduce the system of paramedical personnel adaptation at public health institutions. Materials and methods. The work was based on questionnaire data of Nizhny Novgorod Medical Base College leavers over the period of 2012-2014. Nurses, college leavers, who started their work at public health institutions and nurses with essential practical experience of work were surveyed. Results. Tutorship gives a possibility for training and development directly at the place of work, to observe the results of development and education; college leavers are ready to get acquainted with their tutors at the stage of practice. Conclusions. It is necessary to introduce a flexible and mobile system of tutorship at public health institutions, to start acquaintance with tutors at the stage of practice, to optimize the process of raising professional competence of tutor nurses.
Perm Medical Journal. 2015;32(2):81-85
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CROHN'S DISEASE AND PREGNANCY: CLINICAL CASE
Kiryanova N.V., Mikhaleva E.N., Voronova E.I., Zinkovskaya T.M.
Abstract
A case of favorable pregnancy course and birth of healthy baby in a woman with Crohn's disease and dissemination of granulomatous process to the perineal region is described in the paper.
Perm Medical Journal. 2015;32(2):86-90
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TO THE PROBLEM OF DIFFERENTIAL DIAGNOSIS OF HEPATOLIENAL SYNDROME. CLINICAL OBSERVATION
Babushkina G.D., Kiryanova N.V., Mikhailovskaya L.V., Golubeva M.E., Petukhova I.V.
Abstract
A case of chronic B-lymphatic leukemia developing at the first stages with splenomegalia without peripheral lymphoadenopathy, peripheral blood leukocytosis and lymphocytosis. Is described. Moderate hepatomegalia and portal hypertension added later on permitted to diagnose cryptogenic hepatic cirrhosis, but there were no signs of hepatocellular failure typical for this diagnosis. Two years later, there occurred peripheral blood lymphocytosis, increase in peripheral and abdominal lymph nodes, lymphoid bone marrow transformation with partial cellular anaplasia in the marrow punctuate; immunophenotyping of peripheral blood cells: monoclonal B-lymphocyte proliferation corresponding to B-chronic lymphatic leukemia - small lymphocyte lymphoma. Portal hypertension was caused by location of increased lymph nodes in the portal vein system. Diagnosis of hepatic cirrhosis was annulled.
Perm Medical Journal. 2015;32(2):91-97
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PROBLEMATIC QUESTIONS OF MODERN GASTROENTEROLOGY
Tsimmerman Y.S.
Abstract
Problematic questions of modern gastroenterology are discussed in the paper.
Perm Medical Journal. 2015;32(2):98-118
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INTESTINAL MICROBIOM AND FUNCTIONAL ACTIVITY OF PANCREATIC GLAND IN PATIENTS WITH ACUTE LEUKEMIA: CLINICAL AND PROGNOSTIC SIGNIFICANCE (review of literature)
Golubeva O.V., Khlynova O.V.
Abstract
Analysis of the results of native and foreign studies devoted to investigation of significance of changes in intestinal microbiota state and pancreatic gland (PG) functioning in patients with acute leukemia (AL) is presented in the paper. These materials are especially interesting for prognosis and treatment of complications in AL patients including severe diarrheal syndrome and a number of infectious processes. Besides, the data presented can be motivation to search of new schemes on correction of the detected disorders in the state of intestinal microflora and PG functioning. It can lead to changes in tactics of patients’management.
Perm Medical Journal. 2015;32(2):119-126
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NONALCOHOLIC FATTY HEPATIC DISEASE AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE: IS THERE A BASIS FOR COMORBIDITY? (review of literature)
Bykova G.A., Khlynova O.V., Tuev A.V.
Abstract
The basic aspects of epidemiology of such diseases as nonalcoholic fatty hepatic disease (NAFHD) and chronic obstructive pulmonary disease (COPD) which are widespread in the population with steadily growing morbidity are considered in the paper. Theories of the development of these nosologies, in the opinion of both native and foreign authors, are presented. While analyzing the literature data, common links in pathogenesis of the above diseases such as systemic inflammation and oxidant stress were revealed, but in the studies of foreign authors there was also noted influence of NAFHD on the respiratory function. Currently, the associated course of NAFHD and COPD needs further studies.
Perm Medical Journal. 2015;32(2):127-134
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