Vol 31, No 4 (2014)

Articles
SURGICAL TACTICS FOR TREATMENT OF PATIENTS WITH ULCEROUS GASTRODUODENAL HEMORRHAGES
Repin V.N., Chudinov A.A., Gudkov O.S., Repin M.V., Ryzhakov A.P., Kostin V.A.
Abstract
Aim. To improve the tactics for treatment of patients with ulcerous gastroduodenal hemorrhages by means of grounded choice of indications, terms and surgical technique. Materials and methods. The results of treatment of 4580 patients with ulcerous hemorrhages are presented. Stomach ulcer was diagnosed in 36 %, the rest - duodenal ulcer. At the admission department, urgent clinical analyses and esophagogastroduodenoscopy were performed. In case of continuing hemorrhage from small vessels, hemostasis was reached using alcohol irrigation and argono-plasmic coagulation, from large vessels - adrenalin solution infiltration and coagulation. Complex treatment was directed to stabilization of hemodynamics, blood replacement, inhibition of gastric secretion using proton pump inhibitors. In case of arising suspicion for hemorrhage relapse, repeated gastroscopy was conducted. The number of operated patients was 1880 (43 %). Urgently, 455 patients with continuing bleeding and failure of hemostasis were operated; 393 patients underwent stomach resection, 15 - gastrectomy, 43 - vascular suturing in the ulcer; 415 patients underwent urgent operations when there occurred a danger of bleeding relapse in patients with gigantic ulcers, presence of large thrombosed vessels in the ulcer, severe blood loss. 382 patients underwent stomach resection, 33 - excision of ulcer with vagotomy. One or two weeks after admission to the hospital, 1011 patients with long ulcerous anamnesis and earlier experienced complications were operated; 620 patients underwent stomach resection, 391 - selective proximal vagotomy (SPV). The technique of duodenal stump suturing in complicated situations and the method of gastric stump formation are presented in the paper. Results. Out of 455 urgently operated patients 91 (20 %) died, including 19 of 43 after vascular suturing in the ulcer. After urgent surgeries, 17 (4,1 %) patients died. Out of 1011 patients operated according to the plan, 8 (0,8 %) patients died. The total postoperative lethality was 6,1 %. Among 2700 patients who were not operated 35 died. The total hospital lethality was 3,3 %. Conclusions. Treatment of patients with ulcerous gastroduodenal hemorrhages remains a complicated problem. These patients should be treated at specialized centers. Esophagogastroduodenoscopy, endoscopic hemostasis, stabilization of hemodynamics, blood replacement and continuous follow-up observation of a patient with objective assessment of health status are the most important measures when patients are admitted to the hospital. Indications for operation should be strictly grounded. It is necessary to limit urgent operations at the expense of repeated gastroscopies and endoscopic methods of hemostasis so as to operate only in urgent cases. Resecting surgeries are justified in case of emergency and urgent interventions. In case of delayed operations, the most effective for patients with duodenal ulcer is selective proximal vagotomy.
Perm Medical Journal. 2014;31(4):6-11
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PERIOPERATIVE SUPERVISION OF CHILDREN WITH ADRENAL NEOPLASMS
Kovaleva O.A., Rudakova E.A., Valiulov I.M., Yurkov S.V., Gorkovets K.I., Malimon S.G.
Abstract
Aim. To optimize the perioperative safety and to improve the results of surgical treatment of children with adrenal neoplasms. Materials and methods. The perioperative supervision of 18 patients (children aged 2 months to 15 years) with adrenal neoplasms who underwent laparoscopic adrenalectomy for different adrenal neoplasms was analyzed. The following two groups of patients were formed depending on the hormone activity of neoplasm originating from the adrenal gland: children with hormonally inactive adrenal tumors (14 cases) and patients with hormone-producing neoplasms (4 cases). Patients underwent complex examination confirming the character and localization of pathological process. Operative intervention - endoscopic adrenalectomy - was performed in conditions of multicomponent anesthesia and perioperative replacement steroid therapy. Results. The study indicated that the applied methods of general anesthesia are adequate anesthetic measures. So as to ensure safety of patients during operative intervention, uninterrupted monitoring of electrocardiography, noninvasive arterial pressure, pulsoxymetry, carbonic acid concentration in the expired gas-narcotic mixture, control of glycemia level, monitoring of blood gas composition and acid-base balance, temperature control, hourly diuresis were used. An obligatory condition for adequate perioperative supervision of children is replacement steroid hydrocortisone therapy in the perioperative period by the age dosage scheme irrespective of hormonal activity of neoplasms. The postoperative period in all cases, except one, was smooth, on the days 1-2 patients were transferred from resuscitation unit to the ward. Conclusions. For the purpose of preventing development of hypoadrenal crisis in the postoperative period after unilateral adrenalectomy irrespective of presence or absence of hormonal activity of adrenal neoplasm, it is necessary to carry out replacement steroid therapy since before the surgery it is not possible to assess the function of contrlateral adrenal gland.
Perm Medical Journal. 2014;31(4):12-20
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ANALYSIS OF CHARACTER OF PERIOPERATIVE HEMORRHAGE IN EXTENDED RADICAL RECONSTRUCTIVE-PLASTIC UROLOGICAL SURGERIES IN CONDITIONS OF PREVENTION OF THROMBOEMBOLIC COMPLICATIONS WITH FRACTIONATED AND UNFRACTIONATED HEPARINS
Sharipov R.A.
Abstract
Aim. To carry out comparative analysis of the parameters of blood coagulation system and perioperative hemorrhage for prevention of thromboembolic complications with sodium heparin or enoxaparin in 48 patients who had undergone radical cystectomy with simultaneous ileocystoplasty. Materials and methods. Prevention of thromboembolic complications was performed according to the order of MH RF №233 (09.06.2003) on confirmation of industry standard “The Protocol of Patients’ Management. Prevention of Pulmonary Artery Thromboembolia in Surgical and Other Invasive Interventions”. Results. Reliable differences in the volume of intraoperative hemorrhage in the compared groups of patients in case of comparable hemorrhage during the first two days after the operation were revealed. The total hemorrhage was: group I - 1115+84 ml, group II - 796+62ml). Conclusions. In case of comparable balance in hemostasis system, the volume of perioperative hemorrhage is less when preventing thromboembolic complications with enoxiparin.
Perm Medical Journal. 2014;31(4):21-25
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SURGICAL TACTICS IN EXTRAHEPATIC BILE DUCT INJURIES
Kotelnikova L.P., Burnyshev I.G., Bazhenova O.V.
Abstract
Aim. To optimize the tactics of surgical treatment of iatrogenic extrahepatic bile ducts (EBD) injuries in conditions of specialized clinic. Materials and methods. The nearest and long-term results of treatment of 118 patients who had been treated at Perm Regional Clinical Hospital depending on the type of injuries, terms of their diagnosis, techniques of operative intervention were studied. Results. In case of iatrogenic injuries of extrahepatic ducts, the following techniques were used: hepaticocholedochoanastomoses, hepaticojejunoanastomoses on the defunctionalized by Roux loop with exchangable transhepatic, “lost” drainages and without “frame” drainages, end-to-side choledochoduodenoanastomoses, anastomosis of the major duodenal papilla with the posterior wall of the duodenal stump. After restorative surgeries, complications were diagnosed in 19 % of cases, after reconstructive ones - in 20-28 %, after choledochoduodenoanastomoses - 50 % that was significantly higher than in other groups of patients ( r =0,32; p =0,02). Lethality after restorative operations was 19 %, after reconstructive ones ranged from 0 to 7 %, after choledochoduodenoanastomoses - 13 %, however, the difference was statistically insignificant ( r =0,00; p =0,93). Absence of surgeon's experience in surgical hepatology, formation of choledochoduodenoanastomoses, presence of cicatrically changed tissues in the region of hepatoduodenal ligament while applying biliary-enteric anastomosis contributed to development of strictures in the remote period ( r =0,29; p =0,006, r =0,35; p =0,01 and r =0,35; p =0,001, respectively). Use of frame drainages did not influence development of failures ( r =0,00; p =0,95) and cicatrical strictures of biliary-enteric fistulas ( r =0,1; p =0,41). Conclusions. 1. Application of choledochoduodenoanastomosis for restoration of bile passage after iatrogenic bile duct injuries gives unsatisfactory results. 2. Use of "frame drainages" in case of pathology of hepaticojejunoanastomoses does not decrease the number of failures and strictures of biliary-enteric fistulas. 3. In case of terminal biliary tract injury, anastomosis between the major duodenal papilla and the posterior duodenal wall or the defunctionalized by Roux loop can serve as a variant for reconstruction.
Perm Medical Journal. 2014;31(4):26-32
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ENDOSCOPIC TREATMENT OF EPITHELIAL ESOPHAGEAL AND GASTRIC NEOPLASIAS
Novikov V.N., Sandratskaya A.V., Vedernikov V.E., Lozhkina N.V., Vologzhanina L.G., Sursyakova L.I., Yakovleva E.V.
Abstract
Aim. To optimize endosurgical treatment of the epithelial esophageal and gastric neoplasias. Materials and methods. The results of treatment of 41 patients with polypoid formations of abdominal esophagus and stomach on the wide basis including 16 patients diagnosed hyperplastic polyp with moderate and severe dysplasia, 23 - adenoma with moderate and severe dysplasia, 1 - low-differentiated microcarcinoma in the hyperplastic polyp with moderate dysplasia, 1 - low-differentiated microcarcinoma in the tubular adenoma were studied. Results. Examination of patients with epithelial esophageal and gastric neoplasias by means of videoesophagogastroduodenoscopy with biopsy of tissue and mucosa in the region of its basis, chromoscopy and endosonography permits to exclude expansion of the process to the submucosal and muscular layers and to determine the possibility of radical endoscopic treatment. In case of localized dysplasia of gastric endothelium, mucosal resection with formation of a false stalk and welding of stalk-forming tissues can be considered as an effective measure for prevention of malignant transformation and in case of microcarcinoma - a radical variant of treatment.
Perm Medical Journal. 2014;31(4):33-38
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COMPARATIVE ANALYSIS OF REHABILITATION MANAGEMENT TACTICS FOLLOWING COMMUNITY-ACQUIRED PNEUMONIA IN CHILDREN
Minaeva N.V., Syutkina Y.A.
Abstract
Aim. To carry out the comparative analysis of health status in children after pneumonia in catamnesis with drug rehabilitation or without it. Materials and methods. Children aged 3-15 years were observed during one year after community-acquired pneumonia including 25 children with drug rehabilitation and 13 - without it. Resistance index, rate and duration of acute respiratory diseases, number and duration of antibioticotherapy in 3, 6, 9, 12 months after the recovery was assessed. Results. Elevated respiratory morbidity reaching 10-12 cases a year preceded pneumonia. Differences in resistance dynamics and peculiarities of antibioticotherapy in the groups during the first 3-6 months after the recovery were detected. Conclusions. 65% of pneumonia children had impaired resistance. During 6 months following the recovery, the course of nonspecific immunomodulator glucosaminilmuramildipeptide used in combination with interferon inductor and antioxidant stabilizes resistance, reduces need in antibiotics in case of recurrent infections; absence of rehabilitation causes a 1,5 fold worsening of resistance and increased need in antibiotics.
Perm Medical Journal. 2014;31(4):39-44
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LOCAL IMMUNE RESPONSE OF CERVICAL MUCUS NEUTROPLILES IN WOMEN WITH INFLAMMATORY DISEASES OF LOWER UROGENITAL PART UNDER THE EFFECT OF HEALTHY MEN'S DIFFERENT SPERM FRACTIONS
Mayakova V.B.
Abstract
The possibility of normal functioning of female reproductive system is provided by immunological barriers and normal realization of immunoregulating mechanisms. Immune hemostasis is changed in case of inflammatory diseases of reproductive tract that can impair the normal reproductive process. Aim. To determine the mechanisms of local immune response of cervical mucus neutrophiles in women with inflammatory diseases of the lower part of urogenital tract (IDLPUT) under the effect of healthy men's sperm and fractions. Materials and methods. Cervical mucus of 20 women with IDLPUT (by the results of microscopic, bacteriological, serological, molecular-biological methods of study) in the first phase of menstrual cycle was placed into 1,0 ml of Hanks' solution, thoroughly suspended and studied. Seminal fluid of 20 practically healthy men was divided into components by centrifugation during 10 minutes at 3000 turns per minute. Thus, supernatant and sedimentary parts of ejaculate were produced. For further study, cervical mucus and Hanks' solution, cervical mucus and whole seminal fluid, cervical mucus and sperm sediment, cervical mucus and supernatant part of sperm were incubated for 30 minutes at 37ºC in the ratio of 1:1. After incubation, viability and functional activity of cervical secretion neutrophiles was assessed. Viability and functional activity values of cervical mucus neutrophile suspension in Hanks' solution were accepted as the control (group 1). Comparison groups included viability and functional activity values of cervical mucus neutrophiles under the effect of whole sperm (group 2), under the effect of sedimentary fraction of sperm (group 3), under the effect of supernatant fraction of sperm (group 4). Results. Under the effect of healthy men's sperm supernatant, phagocytic function of cervical mucus neutrophiles in women with IDLPUT is growing as compared to the effect of sediment when phagocytosis indices reliably decrease. When analyzing viability of cervical mucus cells (in women with IDLPUT) under the effect of different fractions of healthy men's sperm, there are observed changes in the ratio of cells during different phases of vital cycle. Supernatant part of sperm significantly lowered the number of bioplasts. Conclusions. Whole seminal fluid and its supernatant fraction decrease viability of cervical mucus neutrophiles; sedimentary fraction has inhibiting action on phagocytic function of cervical mucus neutrophiles, whereas supernatant fraction stimulates it.
Perm Medical Journal. 2014;31(4):45-51
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BLOOD MONOCYTE DEHYDROGENASE ACTIVITY IN PATIENTS WITH CHRONIC VIRAL HEPATITIS C DEPENDING ON VIRAL LOAD
Alieva A.A.
Abstract
Aim. To study the changes in blood monocyte metabolic activity among patients with chronic viral hepatitis C (CVHC) depending on viral load. Materials and methods. Cytochemical study of 140 patients with chronic viral hepatitis C depending on viral load was carried out. Metabolic activity of blood monocytes before treatment was determined. Investigations were conducted using R.P. Nartsissov's method. Results were calculated with semiquantitative method of Kaplow. Results. Among CVHC patients with low viral load there was elevated activity of metabolic enzymes, but in patients with high viral load it was decreased. In the group of patients with "1" genotype having high viral load inhibition of blood monocyte dehydrogenase activity was stated, but in patients with "not 1" genotype - strengthening of metabolic enzymes activity. Among patients with "1" genotype having low viral load there was noted an insignificant increase in dehydrogenase activity, but in those with "not 1" genotype - a 2-2,5 fold growth in metabolic enzymes activity. In CVHC "1" genotype patients with high viral load, sharp inhibition of G-6-PhDG by 5,2 times was observed, activity of the rest enzymes lowered to a variable degree (SDG - by 1,7 times, LDG - by 1,5 times). This group with low viral load had a 1,5 fold growth in metabolic activity of enzymes. No essential differences in CVHC "not 1" genotype patients with high and low viral load were detected during our study. Conclusions. Among CVHC patients with high viral load independently of genotype, inhibition of dehydrogenases in blood monocytes was observed, but in patients with low viral load - tension of metabolic enzymes. Enzymatic activity of neutrophiles with "1" genotype was reliably lower than in "not 1" genotype irrespective of viral load (high or low). However, in patients with "1" genotype high viral activity significantly decreased enzymatic activity that was not observed in patients with "not 1" genotype. Key words. Chronic viral hepatitis C, viral load, dehydrogenase, blood monocytes.
Perm Medical Journal. 2014;31(4):52-56
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FUNCTIONAL ACTIVITY OF NEUTROPHILES SECRETED FROM FEMALE PERIPHERAL BLOOD UNDER THE EFFECT OF SEMINAL FLUID AND EJACULATE CELL ELEMENTS
Savelieva A.A.
Abstract
Nowadays, immunological aspect of sterility is an important and priority direction to be studied. Aim. To study the effect of seminal fluid and cell elements of ejaculate received form healthy men on lysosomal, phagocytic activity of neutrophiles secreted from female peripheral blood as well as intracellular oxygen-dependent metabolism and ability of these cells to form extracellular nets. Materials and methods. The level of neutrophilic extracellular trap and functional activity of neutrophiles secreted from peripheral blood of 17 healthy women (aged 19-35) during the first phase of menstrual cycle under the effect of seminal fluid (SF) and ejaculate cell elements (ECE) of healthy men (aged 18-36) in vitro was assessed. Spermiologic analysis included WHO standard indices. Seminal fluid characterized by normozoospermia state was used in the study. Seminal fluid DNCase concentration was determined with the method of immunofermental analysis. Neutrophilic granulocyte functional activity indices to be studied were the following: lysosomal, phagocytic activity, intracellular oxygen-dependent metabolism of the studied cells. Simultaneously, the experiment using the drug “pyrogenal” as a neutrophile activator was performed. The same indices influenced by SF and ECE were estimated. Results. Decreased phagocytic activity of neutrophilic granulocytes was stated. The level of extracellular nets formed by neutrophiles was shown to fall under the effect of seminal fluid and to raise while interacting with ejaculate cell elements. The role of pyrogenal as an activator is proved by statistical results. Conclusions. Phagocytic activity of neutrophilic granulocytes is decreased under the effect of not only seminal fluid, but ejaculate cell elements, as well. Neutrophiles interacting with seminal fluid and cell elements of ejaculate are activated on the way of NETosis. Seminal fluid of healthy men possessing DNCase activity contributes to destruction of neutrophilic extracellular traps.
Perm Medical Journal. 2014;31(4):57-62
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EFFICIENCY OF CRYODESTRUCTION METHOD FOR TREATMENT OF BASAL CELL EYELID CARCINOMA
Borodina S.N., Devyatkova A.S., Subbotina I.N., Gavrilova T.V.
Abstract
Aim. To analyze the efficiency of treatment and follow-up results of observation in patients who underwent cryodestruction for eyelid basalioma. Materials and methods. 30 patients with basalioma of eyelids were observed during the period of 2011-2013. Results. Out of 30 cases of neoplasms, there were 17 (56,6 %) ulcerous forms, 10 (33,3 %) - nodular, 3 (10,1 %) - superficial. By the stage of disease, dissemination of tumor process corresponded to T 1 N 0 M 0 in 4 (13 %) patients, T 2 N 0 M 0 - in 20 (67 %), T 3 N 0 M 0 - in 6 (20) patients. Cryodestruction of cancerous neoplasms of eyelids with carbonic acid snow was conducted. Relapse (continuous growth) of the nodular form T 3 N 0 M 0 localized on the lower eyelid was noted only in one (3,3 %) case of follow-up observation in 6 months. Conclusions. Cryodestruction using carbonic acid snow is an effective radical method for treatment of basal cell eyelid carcinoma; it is well survived by a patient.
Perm Medical Journal. 2014;31(4):63-66
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INFLUENCE OF MINERAL SYLVINITE ON BACTERIAL CULTURE GROWTH INDICES IN SALT-THERAPY UNITS
Khokhryakova V.P., Maslov Y.N., Kirichenko L.V., Barannikov V.G., Varankina S.A.
Abstract
Aim. To study the influence of natural mineral sylvinite on the growth indices of bacterial cultures in laboratory conditions. Materials and methods. A series of experiments on the basis of original model of sylvinite unit was carried out. The object of this study - microbial culture S.aureus . Its inoculation on the blood agar followed by daily incubation was performed. The size of colonies and diameter of hemolysis zones were measured using binocular magnifier with ocular-micrometer (enlargement ×8). Results. A reliable fall in the size of S.aureus colonies and diameter of hemolysis zones around them was experimentally proved. The obtained results demonstrate a marked inhibiting effect of natural mineral sylvinite on S.aureu growth indices and hemolytic activity . Conclusions. The performed microbiological studies detected a significant antibacterial effect of mineral sylvinite.
Perm Medical Journal. 2014;31(4):67-69
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DEPENDENCE OF ABDOMINAL CAVITY SIZE ON CONSTITUTION TYPE
Amarantov D.G., Fedorova N.A., Borodulina I.I., Vyguzova K.B.
Abstract
Aim. To study the size of abdominal cavity for determination of optimal parameters of median laparotomy. Materials and methods. The work was carried out using the results of anatomometric studies of 30 male corpses of the second period of mature age. Parameters of abdominal cavity in subjects with different types of constitution were studied. Original method for determining the optimal length of median laparotomy depending on the type of constitution and the size of patient's anterior abdominal wall was developed. Results. The depth of abdominal cavity at the level of 10 th rib ends and at the level of the upper anterior spines of huckle-bones was revealed to exceed the depth of abdominal cavity at the level of umbilicus in persons with all the types of constitution. Conclusions. An optimal length of median laparotomy in persons with dolichomorphic type of constitution should be equal to 54 % of the distance between the upper anterior iliac spines, in persons with mesomorphic type of constitution - 37 %, but in those with brachymorphic type of constitution - 33 % of this distance.
Perm Medical Journal. 2014;31(4):70-74
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EFFICIENCY ASSESSMENT OF ANTITUBERCULOUS VACCINE IN CHILDREN WITH ATOPIC DERMATITIS
Grymova N.N., Sanakoeva L.P.
Abstract
Aim. To determine the peculiarities of skin reaction course at the site of BCG vaccine administration and mechanisms of development of postvaccinal tuberculin allergy in children with moderate atopic dermatitis (AtD). Materials and methods. In 92 children with atopic dermatitis of medium degree of severity and 166 healthy children vaccinated BCG on the 3-5 days of life, efficiency of vaccination at the site of vaccine administration (character, diameter of skin signs) by skin reaction in 1,5-2, 3-4, 5-9 months, 1, 2, 3 years after immunization as well as tuberculin sensitivity by Mantoux test with 2 TE PPD-L in 1, 2, 3 years after vaccination were assessed. Results. It was established that manifestation of disease in 95,7 % of children with AtD coincides with development of skin reaction at the site of BCG administration with the following peculiar features: delayed start, more frequent formation of pustule in the period of infiltration, slower healing of affect and formation of a scar of lesser diameter than in healthy children. Among AtD children, the postvaccinal allergy was revealed with equal frequency in 1 (78 %), 2 (77,3 %) and 3 (72,8 %) years; in 1 and 2 years after vaccination it was less marked than in healthy children. In 3 years after vaccination, there was a twofold growth in the number of negative reactions by Mantoux test among healthy children. Conclusions. Efficiency of BCG vaccination in children with Atd determined by the size of scar in 1 year after immunization and tuberculin sensitivity with 2TE PPD-L occurred to be lower than in healthy children.
Perm Medical Journal. 2014;31(4):75-82
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INFANTILE RETINOBLASTOMA MORBIDITY IN PERM KRAI
Chereshneva M.V., Gavrilova T.V., Vyuzhanina O.A.
Abstract
Aim. To analyze the cases of retinoblastoma in Perm Krai. Materials and methods. Retrospective analysis of case histories of 29 children diagnosed retinoblastoma who had undergone medical examination at Perm Children's Oncohematological Center during 18 years (1996-2013) was performed. Results. Out of 29 children aged 1 year 5 months to 18 years who were diagnosed retinoblastoma on 37 eyes there were 15 (51,7 %) boys and 14 (48,3 %) girls. Nearly in half of cases retinoblastoma was diagnosed at the first year of life - 48,3 %. More often the left eyes were affected - 24 (65 %); 15 children live in the towns of Perm Krai (51,7 %) and half of them live in Perm. Burdened heredity was detected only in 1 (3,4 %) child with monocular form, 1 case of retinoblastoma - in 2 stepbrothers (by father) with binocular retinoblastoma. Occupational hazard of parents was noted in 4 families; concomitant diseases were found in 15 mothers (51,7 %). Monocular form of retinoblastoma was registered in 21 children, binocular - in 8 children; 26 (70,3 %) injured eyes were enucleated in 25 children with the following polychemotherapy; organ-preserving methods of treatment (polychemotherapy and radial therapy) were applied on 7 eyes. Parents of 2 children with binocular form of retinoblastoma refused from therapy, and as a result of severe state of health against the background of generalized metastatic disease, these children died. Conclusions. Modern diagnostic equipment which appeared at the regional center and oncological suspicion among pediatric ophthalmologists give hope of earlier diagnosis and organ-preserving treatment. It is necessary to carry out medical-genetic consultation among parents of risk group.
Perm Medical Journal. 2014;31(4):83-86
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ANALYSIS OF INDICES OF PRIMARY INVALIDITY CAUSED BY MUSCULOSKELETAL AND CONNECTIVE TISSUE DISEASES IN THE RUSSIAN FEDERATION, SIBERIAN FEDERAL DISTRICT AND ITS SUBJECT TERRITORIES IN 2011-2013
Boltenko Z.V.
Abstract
Aim. To determine the mechanisms of forming primary invalidity caused by musculoskeletal and connective tissue diseases in Siberian Federal District and its subjective territories. Materials and methods. Estimation was based on the analysis of statistical data; dynamic comparison and ranking method were used as the methods of studies. Results. In Siberian Federal District a high level of primary invalidity caused by musculoskeletal and connective tissue diseases in 2011-2013 is observed in Kemerovsky, Irkutsky and Novosibirsky regions. A low level of primary invalidity as a result of the mentioned pathology is noted in Omsk and Tomsk regions and the Republics of Khakasia and Tyva. Conclusions. The detected tendencies in dynamics of indices of primary invalidity caused by musculoskeletal and connective tissue diseases in the Russian Federation, Siberian Federal district and its subject territories can serve as a basis for development of the program of prevention of invalidity and rehabilitation of invalids.
Perm Medical Journal. 2014;31(4):87-94
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ALTERNATIVE CONDUITS FOR CORONARY ARTERY BYPASS GRAFT OPERATIONS
Kadyraliev B.K.
Abstract
During the last ten years the number of patients with ischemic heart disease is significantly increasing. The majority of these patients have no or have lack of autovessels suitable for coronary artery bypass grafting. These are patients with repeated operations, bilateral varicose disease or venectomy of lower extremity veins. Since availability of automaterial is limited, different prostheses from synthetic and biological materials have been suggested. However, at present small diameter vascular prostheses with reliable long-term results remain an inconceivable dream for coronary surgeons owing to their limited use and unclear long-term results, and in some cases - contraindications to their use.
Perm Medical Journal. 2014;31(4):95-101
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