Vol 31, No 1 (2014)

Articles
ON THE SUBJECT OF INDICATIONS AND CONTRAINDICATIONS FOR USING LAPARASCOPICALLY ASSISTED ADHESIOLYSIS IN PATIENTS WITH ACUTE ADHESIVE INTESTINAL OBSTRUCTION
Klevakin E.L., Nishnevich E.V.
Abstract
Aim. To specify the indications and contraindications for using laparascopically assisted adhesiolysis (LAA) depending on dissemination of abdominal adhesive process. Materials and methods. Since 1997, laparascopically assisted technique has been used in the clinic for surgical treatment of patients with acute adhesive intestinal obstruction (AAIO). The results of treatment of 77 patients with uncomplicated forms of AAIO using LAA and adhesiolysis performed from wide laparotomies are presented in the paper. Influence of abdominal adhesive process dissemination on duration of operations, postoperative intestinal paresis and postoperative anesthesia was studied. Impact of disseminated abdominal adhesive process on long-term results of treatment were studied in 42 (54,5%) of these patients for a period of 10 years following the surgery. Results. LAA used for elimination of AAIO in conditions of adhesive process covering 1/3 of the abdominal cavity or the whole of its store has no advantages by these indices as compared to interventions performed from wide laparotomies. Conclusion. Application of LAA for removal of uncomplicated AAIO is indicated in case of abdominal adhesive process with dissemination covering not more than 1/3 of the abdominal cavity or the whole of its store.
Perm Medical Journal. 2014;31(1):6-13
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ROLE OF COMORBID PATHOLOGY IN SURGICAL AND GYNECOLOGICAL PRACTICE TAKING INTO ACCOUNT DYSPLASTIC SYNDROME
Styazhkina S.N., Chernyshova T.E., Mikhailov A.Y., Rebro N.A., Chernenkova M.L., Vinokhodova E.M., Sultanova M.V., Poryvaeva E.L., Pakhomova I.N.
Abstract
Currently, comorbidity has become a very serious problem of medicine including surgery and gynecology. Aim. To study the comorbid pathology in patients of surgical and gynecological profile taking into account connective tissue dysplasia. Materials and methods. 100 patients of gynecological and surgical profile were examined at The First Republican Clinical Hospital. The basic surgical pathology, the cause of patients’ hospital staying, was postoperative hernia, gynecological - threat of abortion before 22 weeks. To assess the comorbidity degree, Charlson index and cumulative illness rating scale (CIRS) were used. Results. Charlson index was 4,9; CIRS - 6,4 in surgical patients and in gynecological patients - 1,5 and 3,2, respectively. The most significant and frequently occurring clinical manifestations of connective tissue dysplasia (60% and >) among patients with postoperative ventral hernia and threat of abortion are the following: valve, asthenic, vertebrogenic, visceral, cosmetic. Heart dysplasia rate is 86% in patients with primary undifferentiated connective tissue dysplasia. Conclusion. Different manifestations of undifferentiated connective tissue dysplasia among patients with postoperative ventral hernias and women with threat of abortion is a rather widespread syndrome causing the basic disease or comorbid pathology.
Perm Medical Journal. 2014;31(1):14-19
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MODERN ASPECTS FOR ASSESSING DISTAL STUMP IN PLASTIC COLON SURGERIES
Samartsev V.A., Kulakov R.Z., Sergeev A.A.
Abstract
Aim. To improve the results of plastic surgical treatment of stomed patients after obstructive resection of the distal parts of the colon. Results. The results of surgical treatment of 20 patients who underwent operations for restoration of colon continuity after obstructive resections of the distal parts of the colon (Hartman type surgery) were analyzed. The postoperative examination of colonic stump including polyfocal biopsy of mucosa indicated that in 29 cases there were detected the confirmed morphological signs of diverse colitis. Techniques of transanal anastomosis decompression and intraluminal sanation of the zone of interintestinal anastomosis were used for treatment of all patients with moderate and marked endoscopic and morphological symptoms of diverse colitis. Conclusion. Thus, assessment of the distal part of the colon after obstructive resections permits to plan restoration of intestinal canal at early stages and to improve significantly surgical results. Application of the techniques of transcanal decompression and intraluminal sanation of the zone of anastomosis is an effective method for prevention of their failure.
Perm Medical Journal. 2014;31(1):20-23
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NONSPECIFIC ANTIMICROBIAL RESISTANCE STATUS AND ITS OZONE CORRECTION IN INFANTILE ATOPIC DERMATITIS
Illek Y.Y., Galanina A.V., Suslova E.V., Zaitseva G.A., Isaeva N.V., Fedyaeva E.A., Kuznetsova V.V., Rybakova T.N.
Abstract
Aim. To study the effect of ozone therapy on clinical indices and nonspecific antimicrobial resistance status in infantile form of atopic dermatitis. Materials and methods. 67 children (40 boys and 27 girls) aged 5-10 years with disseminated moderate atopic dermatitis were under observation. The observed patients were divided into two groups depending on the conducted therapy. Group 1 of patients with atopic dermatitis (35 patients) had generally accepted complex therapy, group 2 of patients with atopic dermatitis (32 patients) - complex treatment combined with ozone therapy. In both groups of patients with atopic dermatitis, blood serum anti-α-staphylolysine content, phagocytosis indices, toll-like receptors TLR-2 and TLR-6 were studied in the periods of exacerbation and clinical remission. Results. Ozone therapy included into complex treatment of patients with atopic dermatitis leads to activation and restoration of toll-like receptor function, normalization of blood serum anti-α-staphylolysine level, phagocytosis indices and faster occurrence of long clinical remission.
Perm Medical Journal. 2014;31(1):24-29
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TO TREAT OR NOT TO TREAT PREGNANT WOMEN WITH ABDOMINAL PAIN SYNDROME?
Skryabina V.V.
Abstract
Aim. To analyze the outcomes of pregnancy in women with or without abdominal pain, to detect the possible causes of developing abdominal pain syndrome. Material and methods. On the basis of retrospective analysis of medical documents of 34 patients with physiological and 234 patients with complicated course of pregnancy it was shown that clinical and laboratory signs of inflammatory processes were revealed and their pathogens were identified in most pregnant women with abdominal pain syndrome. Results. This category of patients has a more marked inflammatory reactions assessed by leukocytic intoxication index (LII) and a rather high frequency of basic pregnancy complications. Women with different in time development of abdominal pain syndrome had evident differences in the structure of the basic pregnancy complications. Women without any clinical manifestations of early unfavorable gestation course, but with more pronounced LII-assessed inflammatory reactions also have complicated pregnancy. Conclusion. All pregnant women with abdominal pain syndrome should be investigated for infections and require etiotropic treatment and prevention of fetoplacental insufficiency. Lack of clinical symptoms of unfavorable pregnancy course at early terms can not serve as a reliable criterion of its physiological course.
Perm Medical Journal. 2014;31(1):30-37
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PERIPHERAL BLOOD SEROTONIN AS A MARKER OF CEREBRAL INJURIES
Selyanina N.V., Sumlivaya O.N., Vorobieva N.N., Karakulova Y.V., Okishev M.A.
Abstract
Aim. To study the quantitative blood serum serotonin (SS) content in patients during acute period of traumatic and inflammatory cerebral injuries. Materials and methods. 72 patients with cerebrocranial injuries and 44 patients with tick-borne encephalitis were examined. The group of control included 15 healthy persons. SS was studied with the method of immunofermental hardphase analysis using the set “Serotonin ELISA”. Results. Blood SS level in patients with concussion of the brain was 148,90±59,57 ng/ml, being similar ( p >0,05) to that in the control group (187±28,9 ng/ml). In patients with moderate brain contusion, the studied neuromediator index increased to 331,81±77,14 ng/ml and was higher ( p =0,029) than in the group of patients with cerebral concussion. A mean SS level in patients with tick-borne encephalitis irrespective of clinical form of the disease was 97,2±57,1 ng/ml being lower than in healthy persons ( p =0,003). At the same time, in case of patalytic form, SS concentration was reliably lower - 45,7±23,6 ng/ml than in nonparalytic one - 115,6±54,4 ng/ml ( p =0,015). Conclusion. The obtained results show involving of peripheral humoral component of serotonin system into pathological process of neurological diseases. In case of traumatic and infectious process the changes are of different directions. On the basis of studying blood SS concentration one can predict the severity of cerebral injury in traumatic and infectious process.
Perm Medical Journal. 2014;31(1):38-43
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OUR EXPERIENCE OF USING ORGAN-PRESERVING OPERATIONS IN VISCEROPTOSIS
Plechev V.V., Latypov R.Z., Titov A.R., Chabin A.V., Gainetdinov E.F.
Abstract
Aim. To assess the efficiency of using organ-preserving visceroptosis correction. Materials and methods. Operative treatment of 65 patients with compensated and subcompensated forms of visceroptosis by means of organ-preserving technique developed at BSUM Clinic was conducted. Results. Application of this technique of operative treatment of visceroptosis permitted to obtain positive results in 58% of cases, satisfactory - in 31%, no results were achieved in 11% of patients with decompensated form of colostasis. Conclusion. The suggested organ-preserving technique is indicated and effective in both compensated and subcompensated forms of gastro-colonoptosis and in isolated transversoptosis with colonic bends of the large intestine. There are no any severe complications as far as technical aspect is concerned. This technique is not effective in decompensated forms of coloctasis caused by visceroptosis.
Perm Medical Journal. 2014;31(1):44-48
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REINNERVATION OF REPLANTED EXTREMITY
Ibragimov R.K., Timerbulatov M.V., Galimov T.R., Kazbulatov S.S.
Abstract
Aim. To increase the efficiency of treatment of patients with traumatic amputation of the extremity using epiperineural peripheral nerve suture during replantation. Materials and methods. The results of complex surgical treatment of 64 patients with traumatic amputations of extremity segments are presented in the paper. In patients of the main group (34 patients), extremity replantation included, along with traditional stages, epiperineural suture of the nerve. The results were assessed 6 months later by clinical data taking into account topography of innervated tissues, extremity function, vascular ultrasound, roentgenography, measured electropotential of superficial tissues (Gerasimov A.A. 1986), stimulation electromyography. Results. Clinical analysis of the main group data demonstrated decrease in unsatisfactory results of reinnervation from 43,3% to 23,52% ( р <0,05), partial restoration of motor disorders from 80% to 97,06% ( р >0,05), and vegetotrophic function accompanied by development of trophic ulcers from 76,7% to 97,06% ( р >0,05) that in general improved the results of extremities replantation by 19,78% ( p <0,05). Conclusion. Application of epiperineural suture during replantation permits to reduce the number of unsatistactory results of peripheral nerve restoration by 19,78% ( p <0,05), to restore partially the motor function by 17,06% ( p <0,05), to lower the risk of developing neurotrophic ulcers of the replanted extremity by 20,36% ( p <0,05).
Perm Medical Journal. 2014;31(1):49-52
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MICROBIAL PICTURE OF ABDOMINAL SURGICAL INFECTIONS IN PATIENTS OF MULTIFIELD HOSPITAL
Volkov A.G., Zarivchatsky M.F.
Abstract
Aim. To study the microbial picture in patients with abdominal surgical infection (ASI) in conditions of a multifield hospital for choosing the program of antibiotic therapy. Materials and methods. The results of microbial picture monitoring in patients with abdominal infection are presented. Results. 6930 bacteriological inoculations from 462 patients with acute appendicitis, acute cholecystitis, acute pancreatitis and peritonitis were studied. 244 patients with gram-negative and gram-positive microfora microorganisms detected in abdominal exudates underwent clinical investigation. Conclusion. In abdominal diseases the representatives of gram-negative microflora including Escherichia coli kind were stated to prevail among the pathogens; its share in the structure of abdominal microorganisms is not less than 40%.
Perm Medical Journal. 2014;31(1):53-57
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ENDOSCOPIC HEMOSTASIS IN PORTAL ESOPHAGEAL HEMORRHAGES AMONG PATIENTS WITH HEPATIC CIRRHOSIS
Samartsev V.A., Protasov V.V.
Abstract
M State Academy of Medicine named after Academician E. A. Wagner, Perm, Russian Federation Aim. To assess the efficiency of combined endoscopic hemostasis technique in case of esophageal portal hemorrhages according to intrahospital lethality criteria and one-year survival rate among patients with hepatic cirrhosis (HC). Materials and methods. Retrospective analysis of treatment of 33 HC patients with portal hypertension syndrome, complicated esophageal dilated varicose veins (EDVV) hemorrhage over the period of 2008-2012 is presented in the paper. 21 patients of the main group underwent endoscopic ligation (EL) combined with endoscopic sclerotherapy (ES) of EDVV; 14 patients of the comparison group underwent EL alone. Results. In the main group, patients’ intrahospital lethality was lower (9,5% vs 33,3%), but one-year survival rate - higher (71,4% vs 66,7%) than in the comparison group. Conclusion. Combined endoscopic hemostasis in HC patients with EDVV hemorrhage is accompanied by decrease in intrahospital lethality and rise in one-year survival rate.
Perm Medical Journal. 2014;31(1):58-63
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ASSESSMENT OF LEFT ATRIUM MECHANICAL FUNCTION IN HEALTHY ADULTS
Matanovskaya T.V., Tuev A.V., Orekhova E.N., Sukhanov S.G.
Abstract
Aim. To accumulate the data on the range of standard values of the left atrium (LA) mechanical function indices using the technique of vector analysis of endocardium movement velocity in healthy adults. Materials and methods. 144 healthy adult volunteers aged 18-64 (40,4±13) years were examined. All of them underwent echocardiography using the technique of vector analysis of endocardium movement velocity. The global (integral) endocardium movement velocity (vel), strain rate (SR) and longitudinal strain (LS) indices of the left atrium were obtained. These indices were studied to assess the local (segmental) values from the chosen points. Results. While studying mechanical function in healthy subjects, indices characterizing a global mechanical function of the left atrium and those demonstrating contribution of each LA segment during different phases of LA cycle were received. The left atrium roof indices were found to have lower strain rate and strain indices and higher figures of regional side and low wall indices. Conclusion. The obtained data on the strain rate and longitudinal strain can be used as standard ones to assess LA mechanical function.
Perm Medical Journal. 2014;31(1):64-72
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MODERN APPROACH TO DIAGNOSIS AND TREATMENT OF PRIMARY HYPERPARATHYROIDISM
Pamputis S.N.
Abstract
Aim. To determine the opportunities of subsequent use of a fine-needle aspiration puncture biopsy (FAPB) for assessment of intact parathyroid hormone (iPTH) level in the needle lavage (FAPB/PTH) and interstitial laser photocoagulation (ILPh) in treatment of primary hyperparathyroidism (PHPT). Materials and methods. 24 PHPT patients with thyroid changes US-visualized before the surgery were examined and operated. For the purpose of topic diagnosis, FAPB/PTH of the detected formations was performed. After belonging of these formations to thyroid changes was confirmed, patients underwent ILPh. Results. The conducted FAPB/PTH confirmed belonging of the visualized formations to thyroid changes. As a result of ILPh following FAPB/PTH, the changed thyroid regions were destroyed and the basic laboratory indices fell to the desired values. Thanks to subsequent use of FAPB/PTH and ILPh, the cause of PHPT including changes thyroid with elimination of its functional activity was liquidated in all patients. Conclusion. Subsequent use of FAPB/PTH and ILPh permits to liquidate PHPT cause with great accuracy, without anesthesia, without cosmetic defect in conditions of an out-patient department.
Perm Medical Journal. 2014;31(1):73-77
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SIGNIFICANCE OF FINE-NEEDLE ASPIRATION PUNCTURE BIOPSY IN DIAGNOSIS OF NODULAR THYROID FORMATIONS
Gubanova A.B., Freind G.G.
Abstract
Aim. To assess the role of a fine-needle aspiration biopsy in diagnosis of nodular thyroid formations. Materials and methods. The results of cytological investigation of nodular thyroid formations were analyzed in 270 patients using Bethesda criteria (2010). Results. While comparing the data of preoperative cytological investigation and the results of postoperative histological study the efficiency of cytological method in diagnosis of benign and malignant thyroid formations was assessed. Conclusion. It was established that in the group of patients with cytological certificates of “follicular tumor”, papillary or follicular thyroid cancer was diagnosed by means of subsequent histological studies in 70,6%.
Perm Medical Journal. 2014;31(1):78-83
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ASSESSMENT OF OPERATIVE TRAUMA SEVERITY IN GASTRIC CANCER SURGERY BY THE RESULTS OF STUDYING HEMOSTATIC FACTORS
Girev E.A., Orlov O.A., Zarivchatsky M.F., Denisov M.Y., Zhigulev A.N., Mayakina O.B., Isakov V.I., Kuznetsov Y.A.
Abstract
Aim. Experience of surgical treatment of 50 patients with gastric cancer using a new retractor - a subsequent technical development of M. Z. Sigal’s retractor and its modification worked out by E. A. Girev, V. V. Ferapontov - is presented in the paper. Comparative assessment of hemostatic indices when applying different instrumental techniques of improving operative approach in surgery of gastric cancer was carried out. Materials and methods. Patients were divided into two groups: the main group ( n =25) and the comparison group (n=25) with different instrumental techniques of forming operative approach. In both groups, ulnar venous blood was taken for analysis before the operation, during the operation and on the days 3, 7 and 14 after the operation. The following hemostatic indices were assessed: 1) thrombocyte number; 2) spontaneous thrombocyte aggregation; 3) blood coagulation time; 4) APTT - activated partial thromboplastin time; 5) PTT - prothrombin time; 6) international normalized relation (INR) calculated by the formula: INR=(patient’s prothrombin time /normal plasma prothrombin time); 7) thrombin time; 8) fibrinogen; 9) antithrombin III; 10) von Willebrand factor; 11) XIIa-dependent fibrinolysis; 12) hematocrit. Hemostasis indices were determined by the generally accepted methods. Results. Changes in prothrombin time and fibrinogen occurred simultaneously and almost did not exceed the normal physiological bounds. It indicated absence of negative effects of retractor hooks on hepatic function. Hemostatic indices including international normalized relation (INR), thrombin time, antithrombin III, blood coagulation time, XIIa-dependent fibrinolysis, von Willebrand factor after gastrectomy were altered simultaneously in both groups, without statistically reliable differences. Dynamics of changes in antithrombin III in all the observed groups varied within physiological norm. On the day 3 rd after the surgery, fall to critical level was detected in the comparison group. In the main group, these changes were not noted. Conclusion. Turning of hepatic tissue aside by means of two hooks using RGF-2 retractor in patients who underwent gastectomy does not worsen hepatic function in the postoperative period compared to the group of patients with RGF-1. Application of retractor RGF-2 decreases patient’s anticoagulative system activity, thereby, reducing the operative trauma.
Perm Medical Journal. 2014;31(1):84-89
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METABOLIC DISORGANIZATION AND ENDOTHELIAL DYSFUNCTION AS CAUSES OF IMPAIRED HEMOSTASIS IN ACUTE LEUCOSES
Zhelobov V.G., Tuev A.V., Nekrutenko L.A., Agafonov A.V.
Abstract
Aim. To study some causes of impaired blood coagulation in patients with acute leucoses. Materials and methods. Hemostasis indices, lipid peroxidation and antioxidant defense status were studied in 45 patients with acute leucoses. Disturbances in the system of hemostasis among patients with acute leucoses concern all the constituents. Besides hypoproduction of platelets connected with bone marrow metaplasia and platelet deposit in the enlarged spleen and liver, consumption of the latter in conditions of DIVC-syndrome is an actual cause of thrombocytopenia. It should be noted that disturbances in coagulation component of hemostasis are revealed also in its internal component that can serve as a marker of endothelial lesion in malignant blood diseases. Prooxidant stress formed in hemoblastoses complicated by anemias is an endogenous factor damaging endothelium. Conclusion. Endothelial lesion is a result of lipid peroxidation activation and antioxidant defense inhibition. Instability of cellular membranes and systemic endothelial lesion are manifested by decrease in its vasodilating function and initiation of blood coagulation processes.
Perm Medical Journal. 2014;31(1):90-94
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PHYSICAL PROPERTIES OF VERKHNEKAMIE POTASSIUM SALTS USED IN AMBULATORY CONDITIONS
Rusanova E.A., Barannikov V.G., Kirichenko L.V.
Abstract
Aim. To give the hygienic assessment of internal environmental physical factors of natural sylvinite unit in conditions of polyclinic. Materials and methods. The data of hygienic studies carried out in the saline sylvinite ward were analyzed. Results. A new type of sylvinite unit possesses a complex of physical factors positively effecting the human body. Conclusion. In case of observing hygienic service conditions, this construction can be recommended for application at polyclinics.
Perm Medical Journal. 2014;31(1):95-97
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PECULIARITIES OF OXIDATIVE STRESS IN CHRONIC HEPATITIS C
Schekotova A.P., Ulitina P.V., Bulatova I.A., Nenasheva O.Y.
Abstract
Aim. To study the blood serum lipid peroxidation processes and antioxidant enzymes activity in patients with chronic hepatitis C (CHC) and to assess the correlation between these parameters and impairment of functional hepatic tests. Materials and methods. Malonic dialdehyde concentration (MDA), superoxide dismutase (SOD), catalase (CAT) and glutathione reductase (GR) activity as well as alanine and asparagine transaminases (ALT and AST), cholestasis tests were determined in 46 patients with CHC. The control group included 26 persons comparable by their sex and age. Results. Increase in MDA concentration to 6,26±3,2 ( p <0,001) compared with the control was observed in CHC patients. Raised activity of enzymes was detected: SOD compared to the control group heightened to 40,39±12,78 ( p <0,001), but GR - to 31,66±9,64 mcmol/l/min ( p <0,001); CAT activity was significantly reduced: 9,93±4,91 mcat/l ( p <0,001). Direct reliable correlation between MDA level and transaminases, between GR and AST were found. Reverse reliable correlation between MDA and CAT ( r =-0,319, p =0,048) were observed. Decrease in CAT correlated with increase in cytolysis indices - ALT and AST. Conclusion. Among CHC patients, blood serum lipid peroxidation activation correlates with the degree of manifestation of hepatocyte cytolysis syndrome. At the same time, oxidative stress is not accompanied by an adequate growth of activity of antioxidant enzymes.
Perm Medical Journal. 2014;31(1):98-102
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INVESTIGATION OF INTERLEUKIN-17 AND INTERLEUKIN-17F GENE (RS763780) POLYMORPHISM IN CHRONIC HEPATITIS C
Bulatova I.A.
Abstract
Aim. To study interleukin-17 (IL-17) level and IL-17F gene (rs763780) polymorphism in patients with chronic hepatitis C (CHC). Materials and methods. Biochemical indices of alanine aminotransferase, aspartate aminotransferase, gamma-glutamiltransferase, lactate dehydrogenase, lipid spectrum markers, blood serum IL-17 level and single-nucleotide substitution in IL-17F gene (rs763780) were investigated and analyzed in 150 persons (50 donors without chronic viral hepatitis and 100 patients with CHC) living in Perm Territory. Results. The increased IL-17 level was noted in 14% of CHC patients. In both groups of the examined patients predominated CC genotype. There were no pathological homozygotes GG in both cohorts. No reliable difference in genotype frequencies in both cohorts (c 2=0,70; p =0,71) was stated. Allele ratio of the studied marker in both groups was also characterized by great similarity (c 2=0,69; p =0,41). No correlation between IL-17F gene (rs763780) polymorphism and blood serum IL-17 content was established. Reliable correlation between IL-17 and cytolysis, cholestasis and total cholesterol markers was revealed; correlation between IL-17F gene (rs763780) polymorphism and blood serum lipid spectrum was found. Conclusion. During the study, no statistically significant difference between genotype frequencies and marker alleles of IL-17F gene in healthy persons and CHC patients was detected.
Perm Medical Journal. 2014;31(1):103-108
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MATHEMATIC MODELING OF DESTRUCTIVE AND CYSTIC TUMOR-LIKE PROCESSES IN PROXIMAL FEMORAL PART
Belokrylov N.M., Sotin A.V., Demidov F.A., Belokrylov A.N.
Abstract
Aim. To create the instrument for forming surgical tactics based on predicting the processes of bone destruction in aseptic necrosis and tumor-like cystic processes in the bone tissue of proximal part of the hip using spatial mathematical hip joint model. Materials and methods. For the purpose of studying the pathogenetic mechanism of developing local destructive and tumor-like processes with formation of cystic cavities, a spatial hip joint model developed by the authors was used. By means of the method of finite elements, deformation mode of femoral and caxal bones was calculated taking into account different localizations and sizes of bone tissue destruction foci as a result of bone tissue necrosis and tumor-like processes. Results. The developed model was individualized on the basis of real clinicoroentgenological and anatomic data. Stress fields occurring in normal and “pathologically changed” hip joint, character of these changes corresponded to the posed clinical problem. The created model permitted to study the effect of the form of pathologically changed hip joint on distribution of strain in the whirlbone connective tissue and in case of the other problem posed - in methaphyseal and metadiaphyseal parts of the hip. There is a real possibility to prognosticate the character of pathological fracture, to reveal the areas of critical strain depending on the bone form, foci localization, strength characteristics, forces of different muscular groups and their directions, sizes of formed bone wall defect and other parameters important for a surgeon-orthopedist. Conclusion. The developed model is a good instrument for studying pathogenesis of destructive and cystic foci in the bone tissue, formation of surgical tactics, solving technical problems of defect replacement, determination of risk degree and necessity of using metal pawls or external immobilization in rehabilitation period.
Perm Medical Journal. 2014;31(1):109-115
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EMBRYONIC AND DEFINITIVE HISTOTOPOGRAPHIC PECULIARITIES OF HUMAN ESOPHAGEAL MEMBRANES’ UPPER AND LOWER THIRDS
Vodolazov A.V., Tokarev V.N., Gelashvili P.A.
Abstract
Aim. To study the embryonic and definitive histotopographic peculiarities of vascularization of the upper and lower thirds of esophageal membranes in human ontogenesis. Materials and methods. Esophaguses of 17 human embryos (10-36 weeks) and 6 adults (18 to 42- year-olds) were studied using classical morphological methods. Results. In 17-18-week-old- embryos, contacts between the vessels of internal venous network in the area of the upper and lower esophageal sphincter were revealed. Both venous networks of submucosal basis are underdeveloped. Germination of arteries occurs earlier in the upper part of esophagus and in the site of esophageal passage to the stomach. In 36-38-week-old embryos, microcirculatory channel of future sphincters is differentiated in layers. In adults, loop-shaped capillaries of mucosa are just near the basal layer cells forming firm tortuous lines in the lower third of esophagus. Venules fall into internal venous network of mucosal basis. Conclusion. In human ontogenesis, formation of tissue correlation between the upper and lower thirds of esophageal membranes occurs in parallel and is determined by the terms of microcirculatory cannel formation, functional status and pathological processes.
Perm Medical Journal. 2014;31(1):116-120
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PATHOHISTOLOGICAL CHANGES IN INBRED WHITE RATS’ THYMUS AND SPLEEN DURING ACUTE STRESS
Matkina O.V.
Abstract
Aim. To characterize in experiment pathological changes in the thymus and spleen of white rats in acute stress. Materials and methods. The experiment included 40 animals. Two experimental groups, 20 animals each, was formed: group I - intact animals living in standard vivarium conditions; group II - acute cold stress modeled in the following way: temperature +4 °C, exposition - 1,5 hours. On the day 10 th of the experiment the animals were withdrawn from the experiment and autopsy material was taken for subsequent histological study (spleen, thymus, Peyer’s plaques). Results. In the group with cold stress, vascular disorders (connective tissue edema and vascular plethora) and inversion of layers were observed in thymic tissue by the day 10 th of the experiment. In the cerebral and cortical layers, the areas of lymphocyte death, stroma collagenization were visualized and a large number of thymic bodies were formed. In thymic tissue, a great number of mast cells in the interlobular connective tissue, connective tissue of septa inside the lobules near the blood vessels as well as in the thymic parenchyma - in the lobular cortical substance and in the areas of lymphoid cell death - were detected. In the experimental group, marked signs of accidental thymic involution against the background of hemodynamic disorders as well as reaction of reticuloepithelial elements and mast cells were revealed. In the spleen of animals of this group there was decrease in white pulp volume - 22,98±2,45%; p <0,05 as compared to the control group. Conclusion. While comparing the data of histological study of animal organs the following patterns were found in both experimental and control groups: in animals exposed to acute stress changes typical for acute stress including reduction of thymic and splenic lymphoid tissue were revealed.
Perm Medical Journal. 2014;31(1):121-128
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ORGANIZATION OF PRENATAL DIAGNOSIS IN THE CITY OF PERM
Padrul M.M., Olina A.A., Sadykova G.K.
Abstract
Aim. A significant place in the structure of perinatal and infantile morbidity and mortality is occupied by congenital malformations. Thus, prevention of hereditary and congenital pathologies in Russia has not only medical, but important social significance. Materials and methods. At present, a complex screening of the first trimester of pregnancy is organized for patients of the city of Perm in the regimen of one-day clinic “The Center of Family Planning and Prenatal Diagnosis” on the basis of Perm State Academy of Medicine. Results. The work of the Center (3 months, April-June 2013) was analyzed and showed the following: 1. 3753 patients were registered at the antenatal clinics including 3391 (90,4%) - before 14 weeks of pregnancy (early attendance). 2. 2539 consultations were conducted before prenatal diagnosis that makes 67,7% of the registered patients and 75% of those registered before 14 weeks of pregnancy. 3. 2702 patients underwent US investigation that makes 78% of patients consulted at the Center. The share of US in the total number of patients registered at the antenatal clinics of Perm is 58%. Taking into account US results, pathological states were diagnosed in 22 patients (0,8% of all US performed), dead pregnancy - 11, anembryony - 9, twins with embryo reduction - 2. Conclusion. Centralization of prenatal diagnosis and investigations carried out in the regimen of one-day clinic at Perm Center permitted to improve preventive measures concerning congenital malformations at early terms of pregnancy.
Perm Medical Journal. 2014;31(1):129-133
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EDUCATIONAL PROGRAMS IS THE WAY TO PRESERVE YOUTH’S REPRODUCTIVE HEALTH
Olina A.A., Safargalieva E.Y.
Abstract
Aim. To realize the educational programs on reproductive health protection among students and pupils. Materials and methods. Medicodemographic situation in a large industrial city (Perm) was analyzed. There was formed a group of lecturers for introduction of educational programs. More than 800 lectures were read, the quantity of listeners exceeded 20 000. Results. The number of abortions in the group of 15 to17-year-olds decreased by 75,6% (2006 - 546 cases, 2012 - 133) and the absolute number of abortions in the group of 18 to19-year-olds - by 71,2% (2006 - 962, 2012 - 277). Conclusion. Realization of national projects led to stabilization of birth rate indices, however, the preserved high level of abortions and ageing of women of reproductive age indicate a low reproductive potential. Informational and educational programs for youth are to be considered high-efficient for preserving reproductive health.
Perm Medical Journal. 2014;31(1):134-137
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