Vol 31, No 5 (2014)

Articles
DIAGNOSTIC SIGNIFICANCE OF DETERMINING OXYGEN SATURATION VALUE IN FULL-TERM NEWBORN INFANTS
Karpova A.L., Spivak E.M., Pykhantseva A.N.
Abstract
Aim. To determine the standard values of oxygen saturation and the causes of its fall in full-term newborn infants for improvement of diagnostic possibilities of pulse oximetry in neonatological practice. Materials and methods. 543 full-term newborn infants underwent pulse oximetry, 226 - echocardiographic examination. Results. Oxygen saturation standards in newborn infants were developed. It was shown that presence of fetal communications as well as small muscular defect of interventricular septum is not accompanied by decrease in its value and increase in gradient of indices between the upper and the lower extremities. The following factors lowering oxygen saturation in full-term newborn infants without organic cardiovascular diseases were detected: complicated course of pregnancy and labor, polycythemia, declined contractile ability of myocardium. Growth of gradient of indices between the upper and lower extremity was observed in case of mild cerebral ischemia and in infants with high weight and body length indices at birth.
Perm Medical Journal. 2014;31(5):6-10
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A PATIENT WITH ACUTE CORONARY SYNDROME: DRUG THERAPY AFTER DISCHARGE FROM THE HOSPITAL
Khokhlova Y.A.
Abstract
Aim. To analyze the drug therapy in patients after acute coronary syndrome. Materials and methods. Drug treatment of 257 patients who had suffered from acute coronary syndrome was analyzed after their discharge from the unit of urgent cardiology of Smolensk Clinical Emergency Hospital. Results. Shortcomings of drug therapy used for treatment of patients after acute coronary syndrome were revealed. In six months, 61,9 % of patients received statins, 76,19 % - clopidogrel, 73,81 % - beta-adrenergic blocking agents; by the end of the year - 53,52 %, 59,15 %, 70,42 % of patients, respectively. From one-third (in 6 months of follow-up observation) to half (in a year of follow-up observation) of patients were not observed at the polyclinic and in most cases did not receive an adequate drug therapy. Conclusions. Patients who suffered from acute coronary syndrome are not always followed up at the polyclinic after their discharge form the hospital and demonstrate a low loyalty to statin, clopidogrel and beta-blocker therapy. In some cases, ambulatory physicians abolish these drugs without any grounds for that.
Perm Medical Journal. 2014;31(5):11-16
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GASTRODUODENAL ULCEROUS HEMORRHAGES
Khunafin S.N., Fedorov S.V., Petrov Y.V., Vlasov A.F., Zagretdinov A.S.
Abstract
Aim. To develop the criteria for determination of surgical tactics in gastroduodenal ulcerous hemorrhages. Materials and methods. The results of treatment of 353 patients with chronic ulcerous gastric and duodenal hemorrhages were analyzed. The type of hemorrhage - arterial and venous - was used as a criterion for determination of surgical tactics in case of gastroduodenal hemorrhages. The patients were distributed according to the type of hemorrhage: 58 (16,4 %) had arterial hemorrhage, 295 (83,6 %) - venous hemorrhage. Differential diagnosis of the type of hemorrhage was performed by clinical, endoscopic and laboratory data. Results. In case of arterial hemorrhage with sharp disturbance of hemostasis, hemorrhagic shock starts rather promptly. In such situations, hemostatic therapy gives a temporary effect. In case of venous hemorrhage, its duration is long, there are no signs of hemorrhagic shock, completed hemorrhages are less recurrent and hemostatic therapy in most cases is effective. On the basis of the obtained data, RF Patent invention № 2407445 (December 27, 2010) was received by us. Conclusions. Assessment of arterial, venous and capillary type of hemorrhage permits to optimize the surgical tactics in patients with gastroduodenal ulcerous hemorrhages and to decrease the total lethality to 3,5 %.
Perm Medical Journal. 2014;31(5):17-21
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EXPERIENCE OF LAPAROSCOPIC SURGICAL TREATMENT OF PARAESOPHAGEAL HIATAL HERNIAS
Timerbulatov M.V., Senderovich E.I., Grishina E.E., Sannikov E.N.
Abstract
Aim. To present the experience of laparoscopic surgical treatment of paraesophageal hiatal hernias. Materials and methods. During the period of 2012-2014, at the clinic of faculty surgery, on the basis of abdominal surgery unit of City Clinical Hospital №21, nine patients with paraesophageal hernias containing not less than 50 % of the stomach underwent laparoscopic surgery. At the stage of preoperative examination, complex of the generally accepted methods included magnetic resonance tomography of diaphragam and monometry of lower esophageal sphincter. Results. Laparoscopic surgical treatment consisted of complete excision of the hernial pouch, crurography, prosthetic plasty of diaphragm crura with the area of hernial defect in the diaphragm more than 4 cm 2 followed by peritonization of the net using hernia pouch fragment, fundoplication. Patients with colonic paraesophageal hernia did not experience fundoplication. A mean time of the operation was 110 minutes. No intraoperative, early, late postoperative complications were observed. Conclusions. Laparoscopic surgical treatment of paraesophageal hernias is a safe method, but some details and technique of operative means remain the issue of discussion: for example, is it always necessary to carry out fundoplication in case of surgical treatment of paraesophageal hernias, what technique of diaphragm plasty is an optimal one.
Perm Medical Journal. 2014;31(5):22-29
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PECULIARITIES OF CHRONIC INFLAMMATORY PROCESS IN GASTRIC MUCOSA DEPENDING ON MOLECULAR-GENETIC CHARACTERISTIC OF HELICOBACTER PYLORI IN ADOLESCENTS
Kormschikov I.S., Spivak E.M., Levit R.M.
Abstract
Aim. To establish the peculiarities of chronic inflammatory process in gastric mucosa depending on molecular-genetic characteristic of Helicobacter pylori ( Hp ) in adolescents. Materials and methods. Endoscopic and morphological examination of 56 adolescents aged 15-18 years with Hp -associated chronic gastroduodenitis was carried out. Genetic typing of Hp was performed in gastrobiopsy material. Results. High frequency (42,86 %) of high-pathogenic Hp strains with detection of VacA, CagA, IceA, BabA and Urel-subunit of urease was stated. Inflammatory process involving Hp with such molecular-genetic characteristics was proved to be well marked and active. The degree of inflammation directly correlates with occurrence of microerosions, hyperplasia foci and morphological signs of initial gastric mucosa atrophy.
Perm Medical Journal. 2014;31(5):30-33
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LONG-TERM RESULTS OF CORONARY STENTING IN PATIENTS WITH IHD AND CONCOMITANT TYPE 2 DIABETES MELLITUS: VIEW THROUGH THE EFFICIENCY PRISM OF DOUBLE DISAGGREGANT THERAPY
Kalugina O.Y.
Abstract
Aim. To assess the state of vascular-thrombocytic hemostasis and estimate the influence of disaggregant therapy on long-term results of coronary stenting in patients with ischemic heart disease (IHD) and concomitant type 2 diabetes mellitus (DM). Materials and methods. Retrospective analysis of influence of concomitant type 2 diabetes mellitus (DM) on the long-term results of IHD intervention treatment using the technique of coronary stenting as well as efficiency of double disaggregant therapy is presented in the paper. 165 patients were examined: group 1 - 96 patients with IHD and concomitant type 2 DM, group 2 - 69 IHD patients without carbohydrate metabolism disorders. Results. No significant differences between the groups in the average number of installed stents were revealed; type 2 DM patients more often underwent implantation of stents longer than 20 mm (χ 2=4,01, p=0,0454). According to ADP test data, no differences between the groups in the absence rate of effective clopidogrel-induced disaggregation in 48 hours after the beginning of double disaggregant therapy (19 (28,8 %) patients of the main group and 22 (27,5 %) -comparison group, p=0,05) were detected. According to the data of ASPI-test with arachidonic acid, ASA resistance statistically significantly predominated in patients of the main group - 13 (19,7 %) patients. Dynamic analysis of aggregatograms of patients from each group resulted in no statistically significant differences according to all the studied tests by the day 30 of double antiplatelet therapy in the main group, whereas in IHD patients without carbohydrate metabolism disorders growth of disaggregation conditioned by both clopidogrel and ASA was observed. Correlation analysis showed in patients with concomitant type 2 DM dependence of fatal outcome on absence of sufficient disaggregation effect of both clopidogrel and ASK. Conclusions. Combination of IHD with type 2 DM is accompanied by lesser efficiency and greater acetylsalicylic acid resistance rate in patients who underwent coronary stenting that can serve as a basis for necessity of platelet aggregation control with individualization of therapy and active use of new disaggregants in this group of patients.
Perm Medical Journal. 2014;31(5):34-42
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INSULIN RESISTANCE IN PATIENTS WITH ARTERIAL HYPERTENSION AND CEREBROVASCULAR PATHOLOGY
Novikova L.B., Izhbuldina G.I., Sharipova E.V., Timerbaeva D.A.
Abstract
Aim. To study the peculiar features of carbohydrate metabolism in patients with arterial hypertension (AH) depending on manifestation of cerebrovascular complications. Materials and methods. 38 patients with arterial hypertension associated with type 2 diabetes mellitus (group 1) and 47 patients with arterial hypertension without diabetes (group 2) were examined. Blood glucose, immunoreactive insulin and C-peptide levels were determined in all the examined patients. Insulin resistance was assessed using the design index НOMA and Сaro coefficient. Results. Growth of HOMA index up to 6,31±0,47 in group 1 and 3,18±0,42 in group 2 as well as decrease in C-peptide levels in group1 - by 55,1 %, in group 2 - by 46,9 % was shown. In both groups, HOMA index values were significantly higher in patients with ischemic insult in anamnesis (by 21 and 18 %, respectively; p <0,05). Conclusions. Development of arterial hypertension is accompanied by decline in tissue sensitivity to insulin, impaired synthesis and secretion. Manifestation of disturbances correlates with severity of cerebrovascular complications.
Perm Medical Journal. 2014;31(5):43-47
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IMPAIRED COAGULATION HEMOSTASIS IN VITAMIN B 12-DEFICIENCY ANEMIAS
Zhelobov V.G., Tuev A.V., Agafonov A.V.
Abstract
Aim. To reveal the presence of hemostatic disturbances in vitamin B 12-deficient anemias. Materials and methods. Coagulation hemostasis, lipid oxidation and epithelial vasodilating function indices were studied in 22 patients with vitamin B 12-deficient anemia. The control indices were assessed in 25 practically healthy persons. The examined group of patients and the control group were comparable by sex and age. Results. Lipid peroxidation parameters estimated in patients with megaloblastic anemias confirmed reliable increase in plasma malonic dialdehyde (MDA) content ( p =0,0041). Simultaneously, significant decrease in antioxidant activity (AOA) of both plasma ( p =0,00041) and erythrocytes ( p =0,0006) was detected. Reliable shortening of activated partially thromboplastin time (APTT) and lengthening of XIIa-kallikrein-dependent fibrinolysis (XDF) in long-ailing patients ( p =0,040 and p =0,023) indicated aggravation of disturbances in coagulation and fibrinolytic components of hemostasis sytem in case of B 12-DA while the disease is progressing. Analysis of the obtained data shows that the parameter characterizing the activity of lipid (plasmа.MDA) free-radical oxidation (FRO) is negatively connected with duration of autocoagulation test (ACT) and APTT ( r =0,53, p =0,026 and r =0,56, p =0,009). Plasma AOA directly correlates with duration of prothrombin time (PTT) ( r =0,42, p =0,039). Conclusions. Hemic hypoxia conditioned by the degree of severity of anemia is accompanied by activation of free-radical lipid oxidation and development of oxidative stress. Decline in blood antioxidant potential and increase in malonic dialdehyde concentration in plasma and erythrocytes leads to endothelial dysfunction, development of hypocoagulation, inhibition of fibrinolysis and appearance of laboratory signs of chronic DIVC syndrome.
Perm Medical Journal. 2014;31(5):48-52
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LIPID METABOLISM STATUS IN PATIENTS WITH SOME FORMS OF BRONCHIAL ASTHMA
Zaikina M.V.
Abstract
Aim. To study the lipid spectrum indices in patients with some forms of bronchial asthma (BA). Materials and methods. 49 persons were examined, 32 - men with a mean age of 21,6 years including 18 patients with mild persisting BA, 16 - with BA of intermitting course, 15 - conditionally healthy persons. Venous blood sampling was carried out; the main lipid spectrum indices were determined. Results. Lipidogram indices in the group of conditionally healthy subjects remained within the permissible standards. Significant increase in total cholesterol (CS) level taking into account the severity of bronchial asthma was established. The analogous regularities were detected while analyzing a low-density lipoprotein cholesterol level. Conclusions. A high-density lipoprotein cholesterol level reliably decreased in patients with bronchial asthma depending on its severity compared to healthy persons of the same age. It seems to be rational to search for the other correlations including correlations with inflammatory and endothelial dysfunction indices.
Perm Medical Journal. 2014;31(5):53-57
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EFFICIENCY OF USING STIMULATING AUTOFACTORS FOR REGENERATION OF LOCAL INFLAMMATORY AND ULCEROUS PROCESSES
Mikhailov A.Y., Pronichev V.V., Soloviev A.A., Styazhkina S.N., Chernenkova M.L., Ledneva A.V.
Abstract
Aim. To determine the efficiency of stimulating autofactors in treatment of trophic skin ulcers. Materials and methods. The results of cytological picture of treatment of lower extremity trophic ulcers are presented in the paper. Analysis was carried out by the results of studying 65 patients who received complex conservative treatment of lower extremity trophic ulcers and 65 patients with complex conservative treatment added by stimulating autofactors - autoplasmic heparin precipitate containing elevated gradient of fibronectin and autokeratinocyte concentration. Both groups included patients with trophic ulcers against the background of diabetic foot syndrome and patients with trophic ulcers of venous pathology. Results. Differences in regeneration cytological picture of trophic ulcers in case of diabetic foot syndrome and those of venous pathology were determined. Conclusions. The offered method of treatment of lower extremity trophic ulcers is effective and can be recommended for practical medicine.
Perm Medical Journal. 2014;31(5):58-64
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DYNAMICS OF MORPHOFUNCTIONAL STATUS INDICES IN PUPILS WITH ATOPIC BRONCHIAL ASTHMA AFTER REHABILITATION AT CHILDREN’S SANATORIUM
Kuzina E.N., Spivak E.M.
Abstract
Aim. To assess the dynamics of health parameters in pupils with atopic bronchial asthma after rehabilitation course in conditions of children’s sanatorium. Materials and methods. Functional status parameters and adaptive reserve of muscular, respiratory and cardiovascular systems were determined in 42 pupils aged 7-15 before, after and in 1 year after rehabilitation course in conditions of children’s sanatorium. Results. After treatment at children’s sanatorium, pupils suffering from atopic bronchial asthma showed improved functional status and increased adaptive reserve of physiological systems of the body. The effect of rehabilitation is preserved in most patients during a year after completion of sanatorium treatment.
Perm Medical Journal. 2014;31(5):65-68
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NEW OPPORTUNITIES IN PREDICTION OF RISK FOR DEVELOPMENT OF PROFESSIONAL ALLERGIC DISEASES
Shagalina A.U., Bakirov A.B., Masyagutova L.M., Karimov D.O.
Abstract
Aim. To work out complex of methods for assessment of risk for development of professional allergic diseases. Materials and methods. Gene polymorphism was analyzed using the method of multiplex polymerase chain reaction. Genomic DNA was extracted from peripheral blood with the method of phenolic-chloroform extraction. To control correspondence of the observed distribution of genotype frequencies to theoretically expected balanced distribution according to Hardy-Weinberg law, χ 2 criterion was applied. The integrated risk index was calculated for a concrete person according to prognostic map taking into account gradations for each risk factor by means of summing the scores and comparing the obtained values with the risk scale. Results. New professional allergic disease risk markers were found. In presence of genotype CC ( OR =3,23) and allele C ( OR =2,07) of polymorphic graft rs2069812 of gene IL5, risk for development of PBA increased by 3 and 2 times, respectively. In presence of allele T of polymorphic graft rs3939286 of gene IL33, risk for development of allergic dermatitis increased by 1,5 times ( OR =1,56). Elevated risk for development of allergic rhinitis was determined by genotype CT and allele T of polymorphic graft rs3939286 of gene IL33 ( OR =1,35, OR =1,45, respectively). Integrated risk index (P) for a concrete person was calculated individually according to prognostic map taking into account presence of gradations for each risk factor by means of summing the scores and comparing the obtained value with the risk scale: P = Σ scores. Risk scale was calculated by determination of risk range. The border of minimum risk is equal to the sum of minimum values of scores for all factor gradations P min= Σ scores corresponding to R min=14. The border of maximum risk is equal to the sum of maximum values scores for all factor gradations P max= Σ scores corresponding to R max=23. Conclusions. The offered methods permit to assess the risks for development of professional diseases of allergic etiology with high reliability.
Perm Medical Journal. 2014;31(5):69-74
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SOCIOHYGIENIC CHARACTERISTIC OF WOMEN WITH BREAST CANCER UNDERGOING ORGAN-PRESERVING SURGERY
Parandei I.N., Orlov O.A.
Abstract
Aim. To present the sociohygienic characteristic of women with breast cancer (BC) using the materials of sociological survey. Materials and methods. To assess a typical sociohygienic “portrait”, patients were offered to fill in an individual questionnaire developed by us which contained 28 questions of open, half-open and closed type by four parts: mode and conditions of life, conditions of work, self-rating of somatic and reproductive health, level of knowledge and habits concerning healthy way of life. 200 patients living in Perm and Perm Krai who had undergone organ-preserving operations for BC were surveyed. Results. Analysis of survey results permitted to give a sociodemographic, socioeconomic and sociohygienic characteristic of women suffering from breast cancer. Patients’ social status, living conditions, marital status and its satisfaction were analyzed. Main risk factors for development of breast cancer connected with bad habits, harmful production factors, somatic diseases were revealed. Analysis of obstetric and gynecological anamnesis allowed to make a conclusion about women’s reproductive health. To assess women’s level of knowledge on habits of healthy way of life, the program of questionnaire study included the question concerning the most significant, in women’s opinion, elements of healthy mode of life. Conclusions. According to the data of this study, a complex medicosocial characteristic of women with breast cancer undergoing organ-preserving surgery was given. The detected typical sociohygienic characteristics (medicosocial “portrait”) are of practical significance for timely diagnosis, formation of risk groups and breast cancer management; they also make basis for estimation of women’s quality of life in the nearest and long-term periods.
Perm Medical Journal. 2014;31(5):75-80
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BASIC TECHNIQUES AND MATERIALS FOR BONE DEFECT REPLACEMENT AFTER REMOVAL OF LESION FOCUS IN TUMOR AND TUMOR-LIKE CHILDREN DISEASES
Belokrylov N.M., Denisov A.S., Belokrylov A.N., Sotin A.V.
Abstract
Techniques for treatment of tumors and tumor-like children diseases by means of removing the injured region and replacement of the bone defect are presented in the paper. Revision of modern studies on this subject including all the main theses of the recent decade and key publications is carried out. Native orthopedists actively study foreign sources and work in this direction. The authors of this paper have considered the tactics regarding radical decision on removal of defect and necessity of bone fixation for preventing pathological fractures. The role of extrafocal bone fixation, in particular, bilocal osteosynthesis is stated. All the basic materials used in Russia for bone defect replacement are mentioned. The role of cyst washing and of the other approaches to conservative therapy, cryotherapy, variants of surgical treatment including curettage, cyst resections, partial removal of bone segments is evaluated. Tactics used for bone autoplasty and combined microsurgical approaches is discussed. Publications on application of biological, synthetic and semisynthetic materials are discussed in details. Attention is paid to use of allogenic bone, its preparations and demineralized bone allografts, which do not need taking of the own bone. Whole ceramic products were not used in children practice. An interesting direction is application of the following materials: collapan, “Chronos”, highly porous cellular carbon. For defects, especially marginal ones, development in the sphere of nanotechnologies including use of stromal cells is perspective. Further development of cellular transplantology and tissue engineering is required. The authors consider use of combined materials to be beneficial for bone defect replacement.
Perm Medical Journal. 2014;31(5):81-90
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DISTURBANCE OF ENDOMETRIAL FUNCTION IN CHRONIC METRITIS
Kobaidze E.G., Padrul M.M.
Abstract
In the review of literature, there are presented modern clinicomorphological, immunohistochemical, hysteroscopic criteria of endometrial function disturbance in chronic endometritis. The role of receptor disorders in development of chronic inflammation of endometrium is discussed. The data on mechanisms of implantation process disturbance in chronic endometritis are considered.
Perm Medical Journal. 2014;31(5):92-101
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A CASE OF NORVEGIAN (CORTICAL) SCABIES
Drozhdina M.B., Koshkin S.V., Boyarintseva G.G., Iutinsky E.M.
Abstract
A case of Norvegian (cortical) scabies in women of pensionable age with lesion of a hairy part of the head, face, body, upper and lower extremities against the background of associated pathology of internal organs in the form of cardiovascular lesion, chronic iron-deficiency anemia, diffuse-nodular thyroid changes, chronic cystopyelonephritis and impaired glucose tolerance is described. Positive effect was received as a result of etiotropic, pathogenetic and symptomatic therapy combined with tonic treatment.
Perm Medical Journal. 2014;31(5):102-105
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