Vol 32, No 5 (2015)

Articles
DIFFERENTIAL SURGICAL TACTICS IN ACUTE APPENDICITIS AT DIFFERENT PREGNANCY TERMS
Khasanov A.G., Zhuravlev I.A., Badretdinov A.F., Badretdinova F.F., Zakirov I.A., Nurieva A.R., Gumerova G.T.
Abstract
Aim. To optimize the diagnosis and treatment of acute appendicitis at different terms of pregnancy. Material and methods. Clinical material included the results of diagnosis and treatment of 154 pregnant women admitted to surgical and delivery units of City Clinical Hospital №8 with diagnosis of acute appendicitis against the background of pregnancy. Results. Sixty seven (63,2 %) pregnant women of the main group had clinicolaboratory picture corresponding to acute appendicitis. When comparing the clinicolaboratory data with the scoring system Alvarado Score for Acute Appendicitis, diagnosis was stated in 57 (53,8 %) pregnant women ( p < 0,05). In the main group, 34 women underwent appendectomy using traditional Volkovich-Dyakonov approach, 3 women - pararectal Lenander approach; in 8 cases laparoscopic appendectomy was performed, in 4 cases - laparascopically supplemented appendectomy. In the control group, 22 (68,8 %) patients experienced appendectomy using Volkovich-Dyakonov approach, 10 - midline laparotomy. Conclusions. To diagnose acute appendicitis in pregnant women, it is expedient to use Alvarado scoring system. In pregnancy trimester I (up to 12 weeks), it is desirable to use oblique incision by Volkovich-Dyakonov or laparoscopic appendectomy. In pregnancy trimester II, it is necessary to use pararectal Lenander approach appendectomy or wide approach by Volkovich-Dyakonov (not less than 8-9 cm), For the purpose of reducing negative effect of pneumoperitoneum of laparoscopic interventions, it is expedient to use laparoscopically assisted interventions.
Perm Medical Journal. 2015;32(5):6-11
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ENTERAL INSUFFICIENCY SYNDROME AND ITS MANIFESTATIONS IN ACUTE PANCREATITIS PATIENTS
Takha K.D., Fedoseev A.V., Muraviev S.Y., Budarev V.N.
Abstract
Aim. To estimate the peculiarities of enteral insufficiency syndrome course in patients with acute pancreatitis. Materials and methods. Examination was performed in 949 patients with acute pancreatitis. Enteral insufficiency syndrome (EIS) severity was assessed taking into account the degree of severity of acute pancreatitis as well as the level of endogenous intoxication in this category of patients. Results. Among patients with mild degree of acute pancreatitis, enteral insufficiency syndrome was absent in 50,1 % (289 persons) of patients. Patients with moderate acute pancreatitis in 51,4 % (129 persons) had degree I EIS, in 24,3 % (61 persons) - degree II and in 9,2 % (23 persons) - degree III. No EIS was detected in 15,1 % (38 persons) of patients. Among patients with severe pancreatitis, II and III degrees of EIS were revealed in all the cases - 71,9 % (87 persons) and 28,1 % (34 persons), respectively. Patients with acute pancreatitis were proved to have correlation effect of enteral insufficiency syndrome on progression of endogenous intoxication ( r = 1,218; р < 0,05). Conclusions. There is direct correlation between the enteral insufficiency syndrome and the acute pancreatitis severity. Besides, there was noted direct correlation dependence between the degree of manifestation of enteral insufficiency syndrome and the endogenous intoxication, developing against the background of the basic disease.
Perm Medical Journal. 2015;32(5):12-17
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PREVENTION AND SURGICAL TECHNIQUES FOR TREATMENT OF POSTTRAUMATIC EXTREMITY OSTEOMYELITIS
Samartsev V.A., Kadyntsev I.V.
Abstract
Aim. To choose the optimal skin-grafting techniques for replacement of skin defects in open extremity fractures, to optimize the ways of posttraumatic osteomyelitis treatment. Materials and methods. Retrospective and prospective analysis of the results of treatment was carried out in 1325 patients during the period of 2004-2014. All the patients were examined clinically and roentgenologically; 10,3 % underwent computed tomography, 12,8 % - ultrasonic study of soft tissues; 87 (6,5 %) patients experienced radical surgical treatment of the osteomyelitic cavity with simultaneous reconstruction of the bone. Skin-grafting techniques were used to close the wound defect in 44 patients. Results. Eighty seven patients, in connection with the developed purulent process, underwent radical surgical treatment of the osteal cavity with simultaneous reconstruction of the bone. To replace the formed osteal cavity, in 48 % of cases bone packing with colapan was used. A one-year remission was 50 %. Vaster bone defects (23 %) were covered using muscular plasty. A one-year remission was 70 %. In 28,7 % of cases, autogenous bone was used to replace the osteal cavity and liquidate the false joints accompanying osteomyelitis. A two-three year remission was observed in 75 % of cases. More often osteomyelitis is developing against the background of open extremity fractures. The peculiar feature of surgical treatment of the open fractures is its radical tactics and use of skin-grafting techniques for skin defect replacement. Conclusions. The choice of optimal technique for skin wound closing after the primary surgical treatment of the open fracture leads to reduction of necroses and soft tissues infection and, as a result, decreases the risk for acute osteomyelitis. Radical surgical tactics for treatment of the posttraumatic osteomyelitis permits to carry out surgical sterilization of the osteal cavity and bone reconstruction - to reach a long remission.
Perm Medical Journal. 2015;32(5):18-23
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PRINCIPLES FOR CORRECTION OF BONE STRUCTURE DAMAGES IN POLYTRAUMA
Denisov A.S., Schekolova N.B., Kozyukov V.G., Tikhomirov D.A., Nenakhova Y.V., Zubareva N.S.
Abstract
Aim. To detail the surgical techniques used for fractures in sufferers with polytrauma during different periods of traumatic disease. Materials and methods. Treatment of fractures in 800 sufferers with associated and multiple injuries of locomotor system were analyzed. There were 600 (75 %) men and 200 (25 %) women among the sufferers. The mean age was 43,5 years. The automobile traumatism (56 %) was dominating. Results. When correcting the bone structure injuries in polytrauma, preference was given to low-traumatic interventions (from mini access, with maximum limited blood loss), which provided a reliable operative stabilization of fragments with the possibility of avoiding additional external fixation and allowed early start of functional management. Reposition and osteosynthesis in case of bone structure injuries, when patient’s general well-being was adequate, were performed prior to toxicosis peak or were delayed till the end of early or late period of traumatic disease. Medial cervical hip fractures, when osteosynthesis was rational only during the acute period, were excluded. Conclusions. When correcting bone structure damages in patients with polytrauma, operative aids slightly differ from those used in isolated injuries.
Perm Medical Journal. 2015;32(5):24-29
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FAMILY POLYMORPHISM OF ADRB2 GENE IN CHILDHOOD BRONCHIAL ASTHMA
Ponomareva M.S., Furman E.G., Khuzina E.A., Yarulina A.M., Zhdanovich E.A.
Abstract
Aim. To study the family polymorphism of ADRB2 gene in children with bronchial asthma, living in the city of Perm. Materials and methods. Forty four children with bronchial asthma (BA) and one of child parents underwent complex clinicolaboratory examination. Blood samples were studied on filter paper and two ADRB gene polymorphisms (Arg16Gly and Gln27Glu) were determined. Results. Occurrence rate of ADRB2 gene mutation variants among the citizens of Perm (Arg16Gly - 45,55, Gln27Glu - 27,2 %) is comparable with occurrence rate in the European population (Arg16Gly - 37-41 %, Gln27Glu - 24-30 %), but differs from the Asian population indices (Arg16Gly 73 %, Gln27Glu 52,3 %). The most frequent variant of Arg16Gly polymorphism in Perm population is the variant with mutation (GG - 45,5 %), but Gln27Glu - the variant without mutation (AA - 36,4 % and CG - 36,4 %). There is observed an association of mutation available in BA children and their mothers. Conclusions. Mutation in ADRB2 gene at Arg16Gly occurs two-fold more often and at Gln27Glu - three-fold in BA children, than in practically healthy children. In one third of BA children, Arg16Gly and Gln27Glu mutation is simultaneous, moreover, Gln27Glu is always in combination with Arg16Gly. The reason for BA exacerbation in the group of children with gene mutations is more often contact with allergen, and in children without mutation - respiratory infections. Family character of ADRB2 gene polymorphism is detected only in 27,5 % of BA children.
Perm Medical Journal. 2015;32(5):30-36
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COMPARATIVE ANALYSIS OF REPERFUSION THERAPY REGIMES IN MANAGEMENT OF PATIENTS WITH ST SEGMENT ELEVATION MYOCARDIAL INFARCTION IN CONDITIONS OF REAL CLINICAL PRACTICE
Lapin O.M.
Abstract
Aim. The primary transcutaneous coronary intervention (TCI) is a preferable strategy for management of patients with ST segment elevation myocardial infarction (STEMI). The aim of this work was conditioned by the necessity of taking into account the peculiar features of Perm Krai when organizing medical care to STEMI patients, that is, to present on the basis of real clinical practice the comparative analysis of efficiency of using different variants of reperfusion therapy. Materials and methods. The study joined 307 patients including 69 % of men and 41 % of women. No differences in IHD anamnesis duration between men and women both within the groups and between them were revealed. Results. Patients of group 1 underwent thrombolytic therapy (TLT) according to standard protocol using the drugs alteplase/tenectoplase. All patients before admission to the TCI-center received a double antiaggregant therapy; clopidogrel dose at the hospital stage when planning TCI increased to the load dose of 600 mg. Manifestation of resorption-necrotic syndrome taking into account opening of the infarction-dependent artery by the moment of hospitalization significantly prevailed in TLT group with intergroup differences absent in 12 hours. During the hospital stage, patients received MI therapy in accordance with up-to-date European Recommendations. Hospital lethality in the general group of STEMI patients was 8,46 %. Reliable rise in lethality in the group of primary TCI is determined by a severe status of patients in this group that confirms differences in hospital lethality index TIMI ( p = 0,003) and multivascular character of coronary artery lesions ( p = 0,000015) Conclusions. Thrombolytic therapy fulfilled in STEMI patients determines a 3-score restoration of TIMI blood flow in 26 % of cases (by coronaroangiography data). Pharmacoinvasive strategy for management of STEMI in Perm Krai contributes to a timely and adequate restoration of blood flow in the infarction-dependent artery, leads to reduction in lethality in the general group of patients to 2,67 %, among men and women to 2,2 % and 5,0 %, respectively.
Perm Medical Journal. 2015;32(5):37-43
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CORRELATION BETWEEN MICRO- AND MACRO-STRUCTURAL CEREBRAL MAGNETORESONANCE INDICES AND CLINICAL-FUNCTIONAL STATUS OF PATIENTS WITH ACUTE ISCHEMIC STROKE
Kulesh A.A., Drobakha V.E., Shestakov V.V.
Abstract
Aim. To assess the correlation between micro and macrostructural cerebral magnetoresonance indices and clinical-functional status of patients with ischemic stroke in its acute period. Materials and methods. One hundred and three patients in the acute period of ischemic stroke underwent complex MRT study of the brain with assessment of morphometric indices and fractional anisotropy (FA) of 10 zones including 5 tracts of white substance. The obtained data were analyzed in context of correlation with neurological, cognitive and functional status of patients. Results. Differences in fractional anisotropy on the side of acute ischemic stroke and in the opposite hemisphere were revealed. The focus size is connected with the severity of neurological deficit, cognitive and functional status, but not with the status of tracts. Leucoareosis area and ventricular system volume are associated with neurological, cognitive and functional status as well as with the microstructure of thalamus, hippocampus, anterior limb of internal capsule, cingulate fascicle, frontooccipital fascicle and corpus callosum. The volume of hippocampus is associated only with FA of cingulate fascicle, but not with clinical data. Conclusions. The obtained data can testify adaptive mechanisms, which can start realizing at the microstructural level already in the acute period of ischemic stroke. Chronic vascular cerebral injury is the most significant factor influencing microstructure of gray and white substance of the brain along with the focal size determining neurological, cognitive and functional status in acute stroke patients.
Perm Medical Journal. 2015;32(5):44-51
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ATHROPHY DEGREE OF ALVEOLAR VESTIBULAR PLATE AT EARLY AND LATE TERMS AFTER TOOTH EXTRACTION
Leonova L.E., Pavlova G.A., Popov A.V.
Abstract
Aim. To carry out clinicofunctional estimation of the hard and soft tissue status in the region of the removed teeth sockets; 453 patients aged 30 to 45 years with diagnosed chronic apical periodontitis were examined. Materials and methods. Complex examination of patients included clinical, functional and roentgenological methods. Regional hemodynamics in the region of the first lower molar sockets was assessed before tooth extraction, 4 weeks, 3, 6 and 12 months after it using the method of ultrasonic high-frequency dopplerography (apparatus Minimax-Doppler-Phono). Results. The conducted studies indicated that the most optimal terms for dental implantation is the period from 4 weeks to 3 month, when the level of bone tissue atrophy does not exceed 2 mm. In case of delayed implantation - 3 months and longer, there occurs a significant resorption of the bone tissue that requires additional reconstructive interventions, and consequently, prolongation of treatment and increased costs. Conclusions. Regional hemodynamic indices gradually fall at both early and late terms following the teeth extraction; it manifests impairment of microcirculation in the tissues and gingival atrophy.
Perm Medical Journal. 2015;32(5):52-56
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RESULTS OF ENDOSCOPIC REMOVAL OF FOREIGN BODIES AND BEZOARS
Davidov M.I., Brazhkin V.A., Nikonova O.E.
Abstract
Aim. To improve the techniques for treatment of patients with foreign bodies and bezoars in the gastrointestinal tract (GIT). Materials and methods. The results of endoscopic removal of gastrointestinal (GIT) foreign bodies and bezoars in 76 patients aged 3 to 83 years were studied. Fifty two patients swallowed foreign bodies themselves, 12 patients had bezoars, 12 - ligature GIT foreign bodies. Different models of fibroendoscopes (Company Olympus), various methods and instruments for removal of foreign bodies were used. Results. Endoscopic technique appeared to be effective in 12 patients with ligature foreign bodies and in all 52 patients with swallowed foreign bodies (77 subjects were removed). Complete breaking and removal was successfully performed in 9 patients with fitobezoars. Conclusions. Contraindications for endoscopic technique of foreign body and bezoar removal were determined.
Perm Medical Journal. 2015;32(5):57-60
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ECHOCARDIOGRAPHIC ASSESSMENT OF LEFT VENTRICULAR DIASTOLIC FUNCTION IN PATIENTS WITH MODERATE ISCHEMIC MITRAL INSUFFICIENCY BEFORE AND AFTER SURGICAL REVASCULARIZATION AND MITRAL ANNULOPLASTY
Orekhova E.N., Sharlaimov S.A.
Abstract
Aim. To perform the echocardiographic assessment of the diastolic function of the left ventricle in patients with moderate ischemic mitral insufficiency (IMI) before and after surgical revascularization and mitral annuloplasty. Materials and methods. The study included 48 patients aged 39 to 78 years (mean age 58,4 ± 10,5 years); there were 39 (81,2 %) men with multivascular lesion of the coronary arteries and IMI (flow area index 26,06 ± 6,4 % to left atrium area, vena contacta width 4,8 ± 0,86 mm). In the study group, there predominated patients with functional class III exertional angina (39 patients - 81,2 %) and functional class II heart failure (39 patients - 81,2 %) (CH, NYHA). The preoperative LVFF values were on average 40,4 ± 7,3 %, end-systolic volume 91,3 ± 26,3 ml, end-diastolic volume 152 ± 29,9 ml. Results. In the postoperative period, no patients with normal diastolic function or with disturbed relaxation were detected. Taking into account both transmitral blood flow and tissue Doppler, only pseudonormal and restrictive types of diastolic dysfunction (DD) were revealed, but with regard to tissue Doppler data, more often restrictive DD was found (total 42 patients, 87,5 %), whereas before the surgery, no patients with restrictive DD were revealed. Conclusions. Among patients with moderate ischemic mitral insufficiency in the preoperative period there predominates the pseudonormal type of diastolic dysfunction, but after mitral annuloplasty - restrictive one.
Perm Medical Journal. 2015;32(5):61-68
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LARGE MAGISTRAL ARTERIES’ STRUCTURE IN INSTABLE COURSE OF ISCHEMIC HEART DISEASE (BY ULTRASONOGRAPHY DATA)
Batalova A.A., Khovaeva Y.B., Gerasimova A.V., Kabirova Y.A., Golovskoy B.V.
Abstract
Aim. To estimate the structure of large arteries of musculoelastic and muscular types in persons with instable stenocardia in different age groups and to assess manifestation and prevalence of atherosclerotic process. Materials and methods. Sixty six persons with instable stenocardia were examined. Ultrasound investigation of arteries was performed, vascular wall thickness to internal and external arterial diameter and to intima-media complex (IMC) thickness ratio indices were calculated, echostructure of atherosclerotic plaques was determined. Results. It was established that in different age decades, among patients with instable stenocardia there occurs growth in internal and external diameters, more marked in muscular type arteries, as well as increase in IMC and wall thickness. Conclusions. With each decade of life there occurs increase in the number of atherosclerosis-affected vascular pools and atherosclerotic plaques as well as percentage of instable atheromas.
Perm Medical Journal. 2015;32(5):69-76
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COMPARATIVE EFFICIENCY OF COMPUTERIZED ANALYSIS OF RESPIRATORY NOISE SPECTRUM ENERGETIC CHARACTERISTIC IN THREE POINTS FOR DIAGNOSIS OF BRONCHOOBSTRUCTIVE SYNDROME IN PEDIATRIC BRONCHIAL ASTHMA
Furman E.G., Rocheva E.V., Malinin S.V., Furman G.B., Sokolovsky V.L.
Abstract
Aim. The present work was aimed at development of the technique for computerized diagnosis of pediatric bronchial asthma based on analysis of respiratory noises. Materials and methods. Computerized system for respiratory noise recording was used to receive sound signals from three points located in the mouth, above the trachea and above the right lung (on the front surface of the chest) in 51 pupils (aged 11,2 ± 3,2 years) suffering from bronchial asthma and in 22 healthy volunteers (aged 11,6 ± 2,5 years). Record of patient’s respiratory noises was fulfilled using electronic device with subsequent computational investigation of specific spectral characteristics of this sound. The technique for computerized diagnosis, permitting to perfect the possibilities of respiratory noise processing by means of fast Fourier transport (FFT), is offered in the paper. The suggested technique can be used for diagnosis of bronchoobstructive syndrome (BOS) in children with bronchial asthma. Results. There were suggested empirical criteria for balancing parameters of FFT spectrum, which allow us to develop software for automatic diagnosis of pediatric bronchial asthma. It was also indicated that computerized analysis of the respiratory noise spectrum power is of great diagnostic value (AUV varies from 0.783 to 0.895). The offered approach can be used for diagnosis of bronchial asthma (mainly in the oral cavity points and above the trachea) and for differential diagnosis between BA and other pulmonary diseases in the point above the right upper lobe. Conclusions. The suggested approach to analysis of respiratory noises can become one of additional techniques for BOS diagnosis. It can be used for remote monitoring of asthma patients in the regime of real time, as well as for control of treatment efficiency. Application with program can be inserted into the smartphone or low-cost embedded system for contactless analysis of respiratory noises that is important for remote diagnosis.
Perm Medical Journal. 2015;32(5):77-88
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ASSESSMENT OF HEMATOLOGICAL AND MORPHOLOGICAL INDICES IN EXPERIMENTAL ANIMALS WHILE IMPLANTATING CARBON COMPOSITION FIBER
Sedegova O.N., Astashina N.B., Loginova N.P., Godovalov A.P.
Abstract
Aim. To study in experiment the response of biological tissues and systems of experimental animals to implantation of carbon composition fiber. Material and methods. During the experiment, two groups of outbred white rats (males) were used: group 1 included 25 animals, who were intramuscularly implanted “pure” carbon fiber (CF); group 2-25 animals with intramuscularly introduced finished CF. the control group consisted of 20 animals kept in the same conditions as experimental groups, but without implantation of any materials. To determine the cell composition of peripheral blood, the samples were taken from the caudal vein. Phagocytic activity of peripheral blood leukocytes was studied with V.N. Kaplin method using formalinized sheep erythrocytes. Results. It was detected that when using carbon materials there is observed activation of monocytic-macrophage and lymphocytic links of immune system during the first 7 days that later contributes to formation of reparative process. Conclusions. The experimental data confirmed the biological compatibility of carbon fiber that permits to use it in practical dentistry.
Perm Medical Journal. 2015;32(5):89-94
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HEALTH RISK FACTORS FOR FIRST-YEAR OF LIFE INFANTS DEPENDING ON TYPE OF FAMILY
Senyushkin A.N., Repetskaya M.N., Podluzhnaya M.Y.
Abstract
Aim. To determine the risk factors for health of infants of the first year of life depending on the type of their families. Materials and methods. So as to reveal the risk factors determining the health of the first-year of life infants depending on the type of their families, perinatal anamnesis of 144 infants from full families, 36 - from incomplete families and 73 - from multi-child families was studied. The work was conducted on the bases of City Children’s Clinical Polyclinic №1of Motovilikhinsky region of the city of Perm. Results. While studying the ambulatory health cards it was detected that risk for occurrence of different pathologies was more often registered in children from incomplete and multi-child families. At present there are 9 risk groups singled out. We analyzed the terms of realization of health risk factors for the first-year of life infants from different types of families. In one-month-old infants of the first year of life from full families, reliably more often the following risk factors are realized: 1 (high risk for ARVI, impaired health status during social adaptation), 3 (risk for rickets, anemia, dystrophy) and 5 (pyo-septic and fetal infections). Beginning from the age of 3 months, infants from incomplete families have risk factor 2 (risk for development of CNS pathology) and in multi-child families there is a great possibility for realization of risk factor 4 (risk for congenital and hereditary pathology). Conclusions. When determining the risk factors for first-year of life infants, it is necessary to take into account the type of a family (full, incomplete, multi-child). The revealed terms of risk factors realization in infants should be the basis for development of individual preventive measures.
Perm Medical Journal. 2015;32(5):95-99
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RETROSPECTIVE ASSESSMENT OF HEALTH STATUS IN LONG AND FREQUENTLY FALLING ILL CHILDREN
Startseva S.E., Krasavina N.A.
Abstract
Aim. To study the health status of children who long and frequently fall ill. Materials and methods. Complex assessment of the health status of long and frequently falling ill children (LFFIC) was given. Sociological survey was carried out among pediatricians and parents on treatment of children with acute respiratory viral infection (ARVI). Results. It was detected that boys fall ill with ARVI more often. Every child had ARVI 5-6 times (mean data) during 4 years. All children had “light” interval between ARVI cases. Between the third and the forth cases of illness “light” interval was noted in 48 (47,1 %) children during 1-2 months, in 33 % (32,4 %) of children - during 3 months, and in 21 children (20,5 %) - during 6 months. Among LFFIC, otolaryngologic pathology and respiratory diseases (ARVI, bronchitis) are observed most frequently. Conclusions. Analysis of children, who long and frequently fall ill, detected pharmacological load of drugs per one child during ARVI treatment. There was noted an ungrounded administration of antibacterial therapy by pediatricians during the first day of illness as well as from the days 3-4. Lack of unified rehabilitation system after acute respiratory viral infection leads to frequent diseases. Availability of “light” interval permits to single out LFFIC risk group.
Perm Medical Journal. 2015;32(5):100-105
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INFLUENCE OF NASAL OBSTRUCTION ON NEUROPSYCHICAL STATUS OF PATIENTS WITH CHRONIC POLYPOUS RHINOSINUSITIS
Shishkin A.A., Karakulova Y.V., Voronchikhina N.V.
Abstract
Aim. To study the psychological status of patients with chronic polypous rhinosinusistis (CPR). Materials and methods. Twenty seven patients with CPR aged 22 to 75 years were examined. The control group included 12 persons. Otorhinolaryngological status was assessed by VAS scale, anxiety and depression by CES-D scale, hospital anxiety and depression scale (HADS), Speilberger-Hanin test, general health status by SAN questionnaire; asthenia - MFI-20. “Statistica 8.0” program including descriptive statistics ( Me and Q ) and nonparametric methods (Mann-Whitney U-test) was used for processing of the obtained results. The differences were considered reliable with p < 0,05. Results. Using VAS scale, the nasal respiration was estimated as 3,0 (2,0; 3,0) scores; at discharge this index increased to 9,0 (8,0; 9,0) scores, the nasal discharge amount was 5,0 (3,0; 7,0) scores at admission to hospital and decreased to 3,0 (2,0; 4,0) scores at discharge from hospital. Depression median by CES-D scale at admission was 12,0 (9,0; 19,0), by Hospital Anxiety and Depression Scale (HADS) - 4,0 (3,0; 5,0) and 3,0 (1,0; 6,0), respectively. Elevated reactive anxiety according to Spielberger-Hanin test was detected in 35,29 % of patients, personal anxiety was increased in 41,18 % of patients. Clinically manifested asthenia was observed in 47 % of the examined patients using MFI-20 scale data. According to SAN, the overall indices median was at admittance 5,07 (4,2; 6,0), at discharge - 5,87 (5,31; 6,31). Conclusions. Patients with CPR have mild depression, asthenization and worsened quality of life by SAN scale. General asthenic indices have a reliable correlation dependence on the nasal respiration. After treatment, patients’ nasal respiration reliably improved, asthenia and SAN indices decreased.
Perm Medical Journal. 2015;32(5):106-111
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CARDIOREHABILITATION OF PATIENTS WITH ACUTE CORONARY SYNDROME IN CONDITIONS OF HEALTH RESORT “UST-KACHKA”. SIGNIFICANCE OF THERAPEUTIC PHYSICAL TRAINING
Andreeva T.V., Svetlakova L.V., Syromyatnikova L.I.
Abstract
Aim. To present the formation stages and modern possibilities for cardiorehabilitation in conditions of Health-Resort “Ust-Kachka” with estimation of the efficiency of two regimes of physical rehabilitation in patients after myocardial infarction (MI). Materials and methods. Statistical accountability of specialized cardiological unit (SCU) of Health Resort Ust-Kachka was carried out; 28 men aged 38-58 (50,89 ± 5,97 years) were examined so as to assess physical component of cardiorehabilitation. Results. Since 1978 at specialized cardiological unit for aftercare of MI patients at Health Resort Ust-Kachka, rehabilitation was rendered to 24614 patients with MI, 757 - with unstable stenocardia. For patients of group 1, a 24-day rehabilitation program included individually selected dosed physical exercises ( n = 14) controlled by medical staff. For group 2 ( n = 14), active physical training was not conducted by the reason of patients’ refusal. Active physical rehabilitation permits to reach a significant reduction in the functional class of heart failure from 1,29 ± 0,61 to 0,71 ± 0,47 ( p = 0,013) as compared to an uncertain tendency of comparison group that was proved by the data of a 6-minute walking test, as well as to optimize the lipid spectrum parameters. Conclusions. Rehabilitation in conditions of SCU of Health Resort Ust-Kachka encloses physical, psychological, medicamentous aspects and measures for the secondary MI prevention. The obtained results of active physical rehabilitation efficiency are to be taken into consideration in the program of psychological rehabilitation, so to raise patients’ loyalty and motivation for exercise therapy.
Perm Medical Journal. 2015;32(5):112-119
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QUALITY OF LIFE AS CRITERION FOR REHABILITATION EFFICIENCY IN CHILDREN WITH ATTENTION DEFICIt AND HYPERACTIVITY SYNDROME
Startsev A.A.
Abstract
Aim. To assess the quality of life dynamics in children with attention deficit and hyperactivity syndrome (ADHS) against the background of complex rehabilitation measures including hypoxi-hypercapnic training with respiratory training stimulator (RTS) ”Carbonic”. Materials and methods. Sixty three children (aged 10-15) diagnosed ADHS were examined: the main group (MG) - 33 children, the comparison group (CG) - 30 children. Children’s quality of life was assessed with PedsQL 4.0 questionnaire before and after treatment. Results. After treatment, there was observed an increase by the following scales: “Emotional State” - (43,1 % ( p < 0,05) in MG and 20% ( p < 0,05) in CG), “Communication” (67,2 % ( p < 0,05) in MG and 31,8 % ( p < 0,05) in CG), “School” (17% ( p < 0,05) in MG and 12,9 % ( p < 0,05) in CG). Conclusions. Among children with ADHS, the lowest indices regarding the quality of life were obtained by “Emotional State” and “Communication” scales. After rehabilitation course including RTS ”Carbonic”, positive dynamics of “Emotional State” by 43,1 % ( p < 0,05) and “Communication” by 67,2 % ( p < 0,05) was noted.
Perm Medical Journal. 2015;32(5):120-125
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PREVENTION OF COMPLICATIONS IN AMBULATORY SURGICAL ORAL CAVITY OPERATIONS
Leonova L.E., Sutorikhina A.S., Pavlova G.A., Popov A.V.
Abstract
Aim. To determine the dynamics of pain sensitivity in patients undergoing ambulatory surgical interventions. Materials and methods. Eighty six patients (53 women and 33 men, aged 18 to 45 years), who required ambulatory surgical care, underwent complex dental examination. Prevalence indices and dental caries intensity indices, oral cavity and parodentium hygienic status were studied. To assess painful sensations, 86 patients were surveyed by means of questionnaire. The questionnaire consisted of 6 sections assessing 23 characteristics of pain. Results. The conducted studies detected a high level of prevalence and intensity of the main dental diseases among patients, who asked for ambulatory surgical care. The perioperative application of complex program including medical preventive measures for patients with difficult eruption of the third lower molar and radicular cyst results in fast arresting of soft tissue inflammation in the region of surgery and essential analgetic effect. Conclusions. Introduction of complex preventive program indicates a positive dynamics of dental status indices that will subsequently lead to fall in general sickness rate among patients.
Perm Medical Journal. 2015;32(5):126-130
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GUILLAIN-BARRE SYNDROME OCCURRENCE IN PATIENTS WITH FRONTAL EPILEPSY AND VASCULITIS
Prygunova T.M., Karpovich E.I., Chernigina M.N., Elshina O.D., Beresneva E.E.
Abstract
Guillain-Barre syndrome (GBS) is an acute quickly progressing autoimmune disease of peripheral nervous system. Its etiology and pathogenesis are not studied till now and, therefore, remain the subject of discussions. In modern studies, the problems of comorbidity of this disease with different pathologies are discussed. The cases of simultaneous occurrence of GBS with myositis, transverse myelitis, mycoplasmal pneumonia are described. In this paper there is presented a case report on GBS occurrence in patients with frontal epilepsy and vasculitis. Marked immunocompomise of the body, participation of multiple viral-bacterial agents allows to speak about the available genetic predisposition to different types of immunopathological reactions, in particular GBS. The question of whether these diseases are comorbid or these are different processes needs further study, discussion and practical alertness in relation to these states.
Perm Medical Journal. 2015;32(5):131-137
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SIGNIFICANCE OF ZINC DEFICIT IN OCCURRENCE OF REPRODUCTIVE HEALTH DISORDERS (REVIEW of LITERATURE)
Olina A.A., Sadykova G.K.
Abstract
The results of native and foreign studies devoted to investigation of the role of zinc in functioning of female reproductive system are presented in the paper. The data of literature show the significance of zinc deficit in realization of such pregnancy complications as miscarriage, prematurity, preeclampsia, gestation diabetes mellitus, fetal developmental defect. The presented data permit to improve the system of pregravid preparation, thus, preventing gestation complications.
Perm Medical Journal. 2015;32(5):138-143
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METHODS FOR OPTIMIZATION OF HYGIENIC CARE OF REMOVABLE AND FIXED PROSTHETIC CONSTRUCTIONS ON MINI-IMPLANTS. REVIEW OF LITERATURE
Kiparisova D.G.
Abstract
Currently, a method for dental implantation has occupied a reliable position in the structure of dental aid. Dental mini-implants with the diameter of less than 3 mm are often used for implantation. They are applied for fixation of removable dental prostheses, thus, increasing its stability and as abbatments for fixation of short nonremovable constructions. Mini-implants are indicated when thickness of the alveolar crest is insufficient for placing traditional implants, but the bone structure preserved. The main reason for developing inflammatory process in the periimplant tissues in the late postoperative period is non-observance of the schedule of patients’ visits to parodontist (hygienist). Implants constantly contact with different liquids in the oral cavity (oral, gingival, food). Besides, prosthetic construction on implants is a substance accumulating microbial residue, which, in its turn, can be the source for developing inflammatory reaction in the implant-surrounding tissue. Therefore, qualitative professional hygiene and use of modern means for individual hygiene of the oral cavity as a whole and prosthetic construction on implants, in particular, is an important constituent of successful dental treatment. The data of literature regarding modern methods for hygienic care of prosthetic constructions on mini-dental implants are analyzed in the present paper.
Perm Medical Journal. 2015;32(5):144-148
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