Vol 30, No 5 (2013)

Articles
HEMORRHAGE PREVENTION AND COMPENSATION IN HEPATIC RESECTION SURGERY
Zarivchatsky M.F., Mugatarov I.N., Kamenskikh E.D., Gavrilov O.V., Malginov K.E., Kolevatov A.P., Pankov K.I.
Abstract
Aim. To improve the results of surgery in patients with focal hepatic diseases using rational surgical tactics, purposeful transfusion therapy and effective hemostatic means. Materials and methods. During the period from 1995 to 2003, 398 patients with focal hepatic diseases were treated. 257 patients (64,6%) underwent hepatic resection including 98 (38,1%) – large hepatic resections (3 segments), 159 (61,9%) – minor hepatic resections. Patients were divided into two groups – the main group ( n =137) and the comparison group ( n =120). In the main group, 54 (39,4%) patients underwent large resections, 83 (60,6%) – minor ones. In the comparison group, 44 (36,7%) had large hepatic resections, 76 (63,3%) – minor ones. In the main group the following means were applied: preoperative autoblood reservation, principle of operation from the vessels, hepatic tissue dissection by means of ultrasonic destructor-aspirator and harmonic Ultracision «Johnson&Johnson» scalpel, Pringle manoeuvre, argonoplasmic coagulation of resected hepatic stump surface, local hemostatic means. In the comparison group, hepatic-duodenal ligament compression, isolation of vasculosecretory elements by resection line using digitoclasy, hepatic stump suturing was used by indications so as to prevent hemorrhage. Results. The volume of intraoperative hemorrhage in the main group reached 1100±20 ml, in the comparison group – 2700±250 ml ( p <0,001). The average number of transfused doses of allogenic blood in the main group was 2,1±0,3, in the comparison group – 12,5±1,3 ( p <0,001). The average volume of previously prepared transfused autoblood in the main group was 0,83±0,1 dose, in the comparison group it was not used. After preoperative autoblood reservation was included into the program, the average volume of transfused allogenic blood decreased from 11,1±1,6 to 1,5±1,1 doses ( p <0,001) in case of large hepatic resections and from 3,6±1,1 doses to 0 – in minor resections ( p <0,001). The postoperative lethality in the main group was 2,2% ( n =3), in the comparison group – 9,2% ( n =11). Conclusion. Introduction of modern equipment into surgical practice for the purpose of performing hepatic parenchyma dissection permits to reduce the volume of hemorrhage and the number of doses of infused donor erythromass. Local hemostatic means applied decrease the risk of developing hemorrhage and biliary excretion from the wound surface of hepatic stump in the postoperative period. The developed system of intraoperative and perioperative safety in hepatic resection surgery allows to reduce the risk of operative intervention, to lower the number of postoperative complications.
Perm Medical Journal. 2013;30(5):6-12
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RESULTS OF SURGICAL TREATMENT OF METASTATIC HEPATIC LESION
Kotelnikova L.P., Palatova L.F., Bazhenova O.V.
Abstract
Aim. To assess the prognostic factors and total survival rate after hepatic resection in connection with its metastatic lesion. Materials and methods. General duration of life was studied in 57 patients operated for hepatic metastases from colorectal cancer (group 1) and in 18 – from noncolorectal cancer (group 2). Results. Total survival rate in group 1 ranged from 4 to 78 months and averaged 22±16,6 months. Duration of life in group 2 averaged 12,7±8,5 months. Negative medium value correlation was established between the duration of life after metastatic liver surgery and the following six factors: low degree of differentiation of primary large intestinal tumor ( p =0,001), regional lymph node metastases ( p =0,022), hepatic cirrhosis ( p =0,017), development of postoperative complications ( p =0,014) and metastatic relapses (p=0,0015), intraoperative hemotransfusion ( p =0,020). At the same time, pre-and postoperative chemotherapy raises the general duration of life ( p =0,025, p =0,032). Conclusion. 1. Long-term results confirm expediency of surgical treatment of hepatic metastases from both colorectal and noncolorectal cancer. 2. Low degree of differentiation of primary tumor, presence of metastases to regional lymph nodes, hepatic cirrhosis, development of postoperative complications and metastatic relapses as well as intraoperative hemotransfusion unfavourably influence the postoperative duration of life.
Perm Medical Journal. 2013;30(5):13-20
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DIAGNOSTIC AND TREATMENT ALGORITHM FOR PATIENTS WITH POSTCHOLECYSTECTOMY SYNDROME
Repin M.V., Popov A.V., Mikryukov V.Y., Wagner T.E.
Abstract
Aim. To develop diagnostic and treatment algorithm for patients with postcholecystectomy syndrome (PCES) based on integral assessment of clinical, laboratory and instrumental studies. Materials and methods. While carrying out multifactor analysis of clinical, laboratory and instrumental studies in 164 patients with PCES, the most significant evaluation signs were singled out. Score assessment system to divide patients into 4 groups was worked out. Results. This gradation was found to correspond to Roman consensus for patients with Oddi’s sphincter dysfunction. Patients of group 1 were indicated surgery. Patients of groups 2, 3 and 4 require estimation of bile outflow by means of hepatobiliscintigraphy (HBSG). Some patients had normal bile outflow, but in 68% of patients it was quickened, so there is Oddi’s sphincter failure. To make the reason of clinical manifestations more precise, computer tomography and magnetic resonance cholangiopancreatography was applied. Algorithm of diagnosis and choice of medical tactics was developed on the basis of integral estimation of the results of investigations. Conclusion. The developed algorithm for patients with PCES makes determination of sequences of studies and choice of medical tactics easier. HBSG allows to objectively estimate the state of bile outflow which in most cases is not disturbed and even quickened. After cholecystectomy, it is necessary to exclude other causes of patients’ sufferings and take them into consideration when performing repeated surgeries.
Perm Medical Journal. 2013;30(5):21-27
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COMBINED OPEREATIONS FOR CALCULOUS CHOLECYSTITIS AND CHRONIC PANCREATITIS AGAINST THE BACKGROUND OF ARTERIOMESENTERIAL DUODENAL COMPRESSION
Repin V.N., Repin M.V., Efimushkina A.S., Mikryukov V.Y.
Abstract
Aim. To improve the diagnosis of arteriomesenterial duodenal compression (AMDC), to develop combined operations for calculous cholecystitis and chronic pancreatitis in patients with chronic disturbance of duodenal permeability. Materials and methods. The results of examination and operative treatment of 99 patients with biliary and pancreatic diseases against the background of AMDC are presented in the paper. Roengenological method was used to diagnose AMDC. Duodenal motility was investigated by means of the method of open catheter using silicon pressure sensor of “Motorola” Firm with original microscheme and graphic image program. Results. 33 patients with calculous cholecystitis underwent cholecystectomy combined with duodenum draining operations; 27 patients were formed Gregory-Smirnov’s duodenojejunoanastomosis. So, the jejunum is crossed in 15–20 cm from its starting point, thus Ru loop is formed and duodenojejunoanastomosis is put to the right from the mesenterial vessels. The rest 6 patients underwent duodenal passage resection with duodenojejunoanastomosis formed in front of mesenterial vessels – Robinson’s operation. The same draining operations were performed in 10 patients with the postcholecystectomy syndrome caused by AMDC. In seven patients choledochoduodenoanastomosis was formed earlier together with cholecystectomy and against the background of AMDC it was displayed by reflux-cholangitis. Early postoperative complications were conditioned by motor-evacuation disturbances. In 3 patients evacuation disturbances after Robinson’s operation were connected with development of anastomosis in the zone of duodenojejunoanastomosis. Hemorrhages in the early period occurred in 3 patients. The results of the follow-up period from 1 to 5 years were studied in 67 operated patients. Conclusion. The choice of the operation in chronic duodenal obstruction caused by AMDC should be individually grounded. The less traumatic duodenum draining operation is Gregory-Smirnov’s anastomosis. It is more preferable by functional results as well.
Perm Medical Journal. 2013;30(5):28-33
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CLINICAL SIGNIFICANCE OF ABDOMINAL ISCHEMIA SYNDROME
Barkhatova N.A., Barkhatov I.V.
Abstract
Aim. To determine the occurrence and detection rate of the most significant clinicoinstrumental signs of chronic abdominal ischemia in patients with acute mesenterial insufficiency. Materials and methods. The results of treatment of 165 patients with chronic abdominal ischemia and acute mesenterial insufficiency syndromes were analyzed. For the purpose of revealing the most significant symptoms of chronic abdominal ischemia which widen the opportunity of early diagnosis of acute mesenterial insufficiency, all patients were divided into two groups. The main group included 87 patients with the signs of chronic mesenterial insufficiency and ischemic visceropathies (ischemic gastropathy, hepatopathy, pancreatopathy, colopathy) confirmed by ultrasonic dopplerographic investigation of unpaired aorta branches. The comparison group consisted of 78 patients with different types of acute mesenterial insufficiency. During the study, comparative analysis of clinical and anamnestic data, results of laboratory, endoscopic and ultrasonic methods of investigation of internal organs and visceral vessels was carried out. Results. The most typical clinical, endoscopic and ultrasonic symptoms of chronic abdominal ischemia were detected; occurrence rate of these symptoms in patients with acute disturbance of visceral circulation was analyzed. The most significant clinical symptoms and morphological manifestations of chronic visceral insufficiency were determined that allows in case of acute abdominal pain syndrome to suspect pathology of unpaired abdominal aorta branches and to perform early diagnosis of acute mesenterial insufficiency. Correlation between the lethality, late diagnosis and waiting tactics of treatment was established. Optimal approaches used for early diagnosis of acute and decompensation of chronic mesenterial insufficiency were determined. Conclusion. Early diagnosis as well as laparotomy and revasculizing surgery on the mesenteric artery performed by both abdominal and vascular surgeon essentially improve prognosis of this disease.
Perm Medical Journal. 2013;30(5):34-39
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PRIMARY AND RECONSTRUCTIVE STOMACH SURGERY WITH BILATERAL DUODENAL DEFUNCTIONALIZING
Nikitin N.A., Avdeeva M.M.
Abstract
Aim. To assess the results of bilateral defunctionalizing of duodenum (DD) in primary and reconstructive stomach interventions. Materials and methods. Bilateral defunctionalizing of duodenum in primary and reconstructive stomach interventions were analyzed in 29 patients. The indications to bilateral defunctionalizing of duodenum in 23 cases were severe forms of chronic disturbances of duodenal patency, in 6 – short adductor bowel after Bilrot-II stomach resection. Inclusion of duodenum into the passage of digestive juice in all cases was performed by means of transverse duodenojejunal anastomosis. Sixteen patients underwent antiperistaltic variant of anastomosis (in 4 cases through the enteral insertion), 13 – isoperistaltic one (in 1 case through the enteral insertion). Results. In the early postoperative period, 2 (6,9%) patients died, 27 patients during 3–8 days were treated in conditions of resuscitation unit. Enteral feeding and peristaltic stimulation with the device «Endoton» was included into complex treatment. Long-term results were studied in 19 patients during the period of 1 to 16 years using questionnaire design. Conclusion. In the long-term period the best results were obtained in patients with isoperistaltic variant of duodenojejunal anastomosis.
Perm Medical Journal. 2013;30(5):40-47
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RESULTS OF COMPLEX TREATMENT OF PYOINFLAMMATORY DISEASES
Lukin P.S., Vinogradov A.B., Palakyan K.P., Shvetsova Y.A., Volkov A.G.
Abstract
Aim. To improve the results of treatment of patients with pyoinflammatory diseases of soft tissues and diabetic foot syndrome by means of differential changes in surgical methods and adequate conservative measures. Materials and methods. The paper presents the results of treatment of 474 patients with diabetic foot syndrome and 40 – with pyoinflammatory diseases of soft tissues. All patients with diabetic foot syndrome were divided into two groups: the main group and the comparison group – 234 and 240 patients, respectively. Complex therapy of patients of the main group additionally included intravenous introduction of thioctic acid drugs (thiogamm) using the modernized infusion system and antihomotoxic means. Local therapy was supplemented with adhesive bandages (Permafoam), expediency of which depending on the stage of wound process was studied in 40 patients (two groups – 20 persons each) including 24 (60%) women and 16 (40%) men with different nosological forms. In the main group, adhesive bandages (Permafoam) were used, in the comparison group – levomicol. Results. The suggested complex of conservative measures used for patients with diabetic foot syndrome significantly reduced the number of amputations, thus in the main group 8,06% of patients underwent high amputations at the femur level, 4,03% – low amputations at the shin and foot level, 12,9% – necrectomy, 6,45% – phlegmonas, but in the comparison group 9,79%; 8,06%; 34,38% and 45,38%, respectively. Among patients of the main group, where efficiency of adhesive bandages was studied, decrease in the length, width and depth of wounds on the days 5 th and 10 th of treatment quickened versus the comparison group by 35% and 30%, respectively. Conclusion. The suggested algorithm of treatment in patients with marked damage of distal parts of magistarl arteries permitted to preserve extremities in 85,91% of patients. Adhesive bandages “Permafoam” applied in local treatment of pyoinflammatory diseases of soft tissues have a positive medical effect, reduce the total time of bandaging and patient’s disability period, lower the costs of treatment.
Perm Medical Journal. 2013;30(5):48-53
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EFFICIENCY OF COMPLEX THERAPY IN ACUTE PERIPROCTITIS
Vlasov A.P., Kulygin I.V.
Abstract
Aim. To study the efficiency of ozonotherapy and antioxidant/antihypoxant remaxol in complex treatment of acute periproctitis. Materials and methods. The work is based on clinical observation of patients with acute purulent periproctitis ( n =46) divided into two groups. In the control group ( n =26), patients with periproctitis received basic (antibiotics, detoxicants, anti-inflammatory, antihistaminic and other drugs) therapy, in the main group – this therapy was added by intravenous introduction of 0,89% ozonized isotonic sodium chloride solution. Results. It was stated by clinicolaboratory investigations that complex treatment of acute periproctitis including ozonotherapy and remaxol in the early postoperative period significantly heightened the efficiency of treatment that was proved by positive dynamics of some clinical and laboratory parameters. The ability of ozonotherapy to reduce an alternative phenomena, to raise reparative potential of tissue structures at the expense of improvement of microcirculation in the damaged tissue wound structures is an important mechanism for realizing medical effects. Conclusion. Application of complex therapy resulted in correction of a number of homeostatic indices of the body. Essential decrease in manifestation of endogenous intoxication syndrome and rapid restoration of functional erythrocyte status was proved.
Perm Medical Journal. 2013;30(5):54-59
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MINILAPAROTOMIC TECHNOLOGIES IN DIAGNOSIS AND TREATMENT OF POSTOPERATIVE INTRA-ABDOMINAL COMPLICATIONS
Samartsev V.A., Sandakov P.Y., Busyrev Y.B., Zinets S.I., Osokin A.S., Gavrilov V.A.
Abstract
Aim. To improve the results of surgical treatment of intra-abdominal postoperative complications at the expense of differentiated use of minilaparotomic and endovideosurgical technologies. Materials and methods. Treatment of 617 patients who underwent repeated operative interventions on abdominal organs in connection with different early postoperative intra-abdominal complications were analyzed. Mini-invasive repeated medicodiagnostic operative interventions were performed in 268 (56,4%) cases for acute destructive pancreatitis and its complications, in 65 (13,7%) cases – regarding postoperative biliary complications, in 37 (7,8%) – postoperative appendectomy complications, 31 (6,1%) – postoperative stomach and bowel complications. For the purpose of making prognosis of early postoperative intra-abdominal complications and diagnosis of intra-abdominal hypertensive syndrome, 95 patients underwent indirect measurement of intra-abdominal pressure. Results. Intra-abdominal pressure monitoring with determination of the degree of intra-abdominal hypertension was the basic factor for choosing the tactics of further surgery. The developed algorithm of surgical tactics permitted to decrease the number of relaparotomies to 142 (23%).
Perm Medical Journal. 2013;30(5):60-66
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ESTIMATION OF VASCULAR TONUS REGULATION IN PATIENTS WITH BILIARY-DEPENDENT PANCREATITIS
Ershova A.I., Popov A.V., Podtaev S.Y., Mizeva I.A., Ganeeva E.R., Gulyaeva I.L.
Abstract
Aim. To study the state of systemic and regional microcirculation in patients with biliary-dependent pancreatitis. Materials and methods. 12 patients with biliary-dependent pancreatitis were examined. Besides the standard methods of examination, rheohepatography and precision thermometry was performed. Results. In practically healthy persons, skin temperature amplitudes are reliable decreased in response to cold stress, but after its termination they restore till the initial values during three minutes. In biliary pancreatitis, skin temperature fluctuations in endothelial frequency range fall during the cold test and do not change later on. In neurogenic and myogenic frequency ranges, skin temperature fluctuations decrease during the pressor test and restore to the initial values by the 10 th minute after the test. Endothelial and neurogenic disregulation of vascular tonus is associated with disturbances of regional circulation and serves as one of risk factors for development of pancreatogenic hepatic and renal dysfunction. Disturbance of endothelial vasoregulation system is closely connected with hemorheological changes in blood. Conclusion. Development of biliary-dependent pancreatitis is accompanied by endothelial dysfunction and decrease in activity of neurogenic and myogenic mechanisms of vascular tonus regulation.
Perm Medical Journal. 2013;30(5):67-71
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ADDITIONAL METHOD FOR DIAGNOSIS OF PATHOLOGICAL PROCESS IN ACUTE PANCREATITIS
Lisienko V.M., Mikaelyan E.V.
Abstract
Aim. To determine the significance of biophysical methods in dynamics of pathological process of acute pancreatitis so as to change treatment and operative tactics in case of purulo-necrotic complications of pancreonecrosis. Materials and methods. Blood serum liquid crystal status indices were studied in 220 patients with acute pancreatitis using the method of polarization microscopy and blood serum refraction index using the method of refractometry which were compared with clinical, laboratory and apparatus data. Results. Dynamics of biophysical indices when pathological process is getting progressively worse among patients with different forms of acute pancreatitis is of great diagnostic significance as compared to clinicolaboratory indices. Conclusion. Biophysical indices included into complex of clinicolaboratory diagnosis of progressive pathological process in acute pancreatitis promote improvement of the nearest medical results.
Perm Medical Journal. 2013;30(5):72-77
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SIGNIFICANCE OF OCTAPEPTIDE CHOLECYSTOKININ IN DEVELOPMENT OF ODDI’S SPHINCTER DYSFUNCTION OF INORGANIC ETIOLOGY AFTER CHOLECYSTECTOMY IN PATIENTS OPERATED FOR CALCULOUS CHOLECYSTITIS
Vinnik Y.S., Serova E.V.
Abstract
Aim. To improve the results of treatment of patients with cholelithiasis, calculous cholecystitis and Oddi’s sphincter dysfunction of inorganic etiology. Materials and methods. 214 patients of both sex (aged 25–80) with acute calculous cholecystitis (ACC) and postcholecystectomy syndrome (PCES) were examined. All patients were divided into 4 groups depending on the scheme of treatment carried out. Results. Cholecystokinin level determined in patients with cholelithiasis makes it possible to assess the severity of functional biliary disorders. Cholecystokinin concentration <0,5 ng/ml with absence of organic pathology from the side of the organs of hepatopancreatoduodenal zone indicates Oddi’s sphincter dysfunction of functional nature. In case of a two-fold decrease in cholecystokinin level on the day 9 th after cholecytectomy, the probability of development of Oddi’s sphincter dysfunction of functional nature is increased by 22,6% that requires administration of selective spasmolytic drugs. Conclusion. The developed scheme of complex therapy allows to eliminate manifestations of postcholecystectomy syndrome of functional etiology at earlier terms compared to patients cured with traditional conservative therapy.
Perm Medical Journal. 2013;30(5):78-85
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INTRAOPERATIVE AND PERIOPERATIVE SAFETY IN ENDOCRINE SURGERY
Zarivchatsky M.F., Blinov S.A., Denisov S.A., Kolevatov A.P., Teplykh N.S., Dilman A.B.
Abstract
Aim. To modernize the system of intraoperative and perioperative safety in endocrine surgery. Materials and methods. Experience of treating 5350 patients with thyroid pathology, 41 – with hyperparathyroidism and 53 – with adrenal diseases using the system of intraoperative and perioperative safety is presented in the paper. Results. Complex method of preoperative preparation of patients, sparing bloodless technique allowed to decrease the number of the postoperative hemorrhages among patients with thyrotoxicosis to 0,4%, hypoparathyrosis – to 1,3%, damaged recurrent nerve – to 0,5%, thyrotoxic reactions – to 1,8%, to reduce the period of hospitalization to 4–5 days, to reach favorable functional and cosmetic results. In patients operated for hyperparathyrosis, no complications were fixed. According to retrospective investigation, calcium metabolism stabilized by the 3 rd week after the operation and was preserved during all the follow-up period. Conclusion. Safety of endocrine surgery is provided by precise determination of indications to the surgery, adequate preoperative examination and preparation to the surgery, rational operative intervention and postoperative follow-up observation. Application of the developed system of intraoperative and perioperative safety permitted to shorten the period of preoperative preparation, to decrease duration of operative intervention and the number of complications. Safety system is effective in the presence of “closed” cycle of treatment including out-patient reception, endocrinological unit, surgical clinic, resuscitation and intensive care unit, postoperative observation by endocrinologist and operating surgeon.
Perm Medical Journal. 2013;30(5):86-92
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PREPARATION OF PATIENTS WITH THYROTOXICOSIS TO OPERATIVE TREATMENT TAKING INTO ACCOUNT PSYCHOVEGETATIVE STATUS AND HEMODYNAMIC PECULIARITIES
Tarbeeva N.S., Smirnova E.N.
Abstract
Aim. To estimate the psychovegetative status and hemodynamic peculiarities of patients with noncompensated thyrotoxicosis, to determine contribution of these factors into efficiency of pre-and postoperative management of patients with thyrotoxicosis. Materials and methods. The study included 30 patients with Graves-Basedow’s disease (mean age 47,31±10,74; mean duration of disease 4,52±3,05) in the status of thyrotoxicosis: TSH<0,005 mME/l, free T4 5,35±2,71 ng/dl, free T3 12,90±3,04 pmol/l. Instrumental investigation of cardiovascular system including daily arterial pressure monitoring, Holter ECG monitoring; cardiac rhythm variability was analyzed using Holter’s records. Psychoemotional status was assessed by means of psychometric testing. The initial vegetative tonus was studied with A. M. Vein method. Eight patients with subclinical thyrotoxicosis (TSH 0,2±0,1 mMe/l, free T4 1,1±0,1 ng/dl) and 11 patients with compensated hypothyrosis after strumectomy (TSH 2,8±0,2 mME/l, free T4 1,1± 0,1 ng/dl) taking into account their psychovegetative status formed the comparison group. Results. In patients with thyrotoxicosis, there were cardiovascular disorders in the form of ventricular and supraventricular extrasystoles, atrial tachycardia paroxysms (10% of patients), absence of adequate decrease in nocturnal pressure (daily systolic arterial pressure index 3%, daily diastolic arterial pressure index 6,2), growth of pulse pressure, fall in general cardiac rate variability (75% of patients). Psychoemotional status was characterized by presence of anxious-depressive disorders. Pathological effect of anxious status on cardiac rhythm (positive correlation between anxiety level and ventricular premature beats frequency r =0,67, p =0,04) was noted. When estimating emotional sphere in patients with standard TSH level, we paid attention to expression of depressive disorders. Conclusion. Change in thyroid function (thyrotoxicosis) is characterized by disturbance of vegetative regulation of cardiovascular activity and psychoemotional disorders. Complex of instrumental studies and psychometric tests detect these disorders. Anxiety-depressive disorders existing for a long time, changes in initial vegetative tonus are able to deepen cardial dysfunction, to complicate preparation of patients to operative treatment and to decrease compliance after the conducted radical therapy.
Perm Medical Journal. 2013;30(5):93-98
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ROLE OF ULTRASONIC INVESTIGATION IN DIAGNOSIS OF ADRENAL INCIDENTALOMAS
Dvornikov M.V.
Abstract
Aim. To determine the capabilities of ultrasonic method of investigation in diagnosis and differentiation of adrenal neoplasms. Materials and methods. Protocols of ultrasonic investigations (US) of 89 patients with verified adrenal tumors treated at Yaroslavl Clinical Hospital over the period from 2002 to 2013 were analyzed. Patients’ age was 25–83 with a mean age of 56,50±11,45 including 62 women (70%) and 27 men (30%). 42 patients underwent aspiration cutting puncture biopsy (ACPB) under the US control. Results. Diagnostic and informative significance of ultrasonic method of investigation was indicated. The role of US as a method of visual control in case of puncture biopsy of adrenal incidentalomas was emphasized. Techniques raising the efficiency of adrenal neoplasm biopsy, taking into account the experience of more than 10 thousand interventions on the other organs under the US control were proposed, Conclusion. US is an operator-dependent method of diagnosis. Ultrasonic picture can be used to assume morphological structure of the revealed hormonally inactive adrenal tumors. The size of adrenal tumor can not be a criterion of its morphological structure. Sonography makes it possible to provide visual control of ACPB.
Perm Medical Journal. 2013;30(5):99-103
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ASSESSMENT OF ENDOTHELIAL FUNCTION AND DEGREE OF ITS LESIONS IN SURGICAL PATIENTS USING PLETHYSMOGRAPHY METHOD
Plaksin S.A., Khramtsova N.I., Koshkina A.A., Sharshavina E.G.
Abstract
Aim. To determine the diagnostic capabilities of the method of plethysmography so as to assess endothelial function in patients of surgical profile. Materials and methods. Endothelial function indices were measured with plethysmography using postocclusive reactive hyperemia tests in 20 thoracic patients before and after the thoracic surgery and in practically healthy subjects diagnosed local lipodysfunction before and after the lipoaspiration. Results. In patients of thoracic profile, significant decrease in reflection index and rise in hardness index immediately after the surgery, as well as significant growth of hardness index on the day 5 th after the intervention was detected. Endothelial function index has a tendency to lower in thoracic patients as compared to healthy persons. Conclusion. Plethysmography using occlusive test is a simple, easy, informative method of determination of endothelial dysfunction degree in thoracic patients.
Perm Medical Journal. 2013;30(5):104-109
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PATHOGENETIC APPROACH TO CORRECTION OF TRAUMATIC DISEASE MANIFESTATIONS
Shevalaev G.A., Vlasov A.P., Mitroshin A.M., Isaev O.N.
Abstract
Aim. To determine the pathogenetic efficiency of antioxidant therapy in correction of hemostasis disorders of traumatic disease. Materials and methods. The work is based on materials of clinicolaboratory investigations of patients with long cortical bone fractures. In the main group, complex therapy was added by antioxidant mexidol. Results. It was shown that in traumatic damages there occurs a marked syndrome of endogenous intoxication which is accompanied by essential disturbance of functional erythrocyte status conditioned by membrane-destabilizing phenomena based on lipid metabolism disorders. Application of antioxidant mexidol in patients with long cortical bone fractures leads to significant reduction of expression of hemostatic disturbances connected with traumatic disease and surgical aggression. Conclusion. Efficiency of this drug is conditioned by its ability to significantly decrease expression of membrane-destabilizing processes at the expense of lowering (by 11,5–27,5%) lipid peroxidation intensity and phospholipase activity (by 14,4–31,8%).
Perm Medical Journal. 2013;30(5):110-115
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NEW APPROACH TO TREATMENT OF EXPERIMENTAL DISSEMINATED PANCREONECROSIS
Rantsev M.A., Sarapultsev P.A., Chupakhin O.N., Sarapultsev A.P., Khodakov V.V., Danilova I.G., Sidorova L.P.
Abstract
Aim. To study the possibilities of correcting inflammatory reaction in experimental disseminated pancreonecrosis using the representative of substituted 5R 1,R6 2,3,4-thiadiazin-2-amines group – compound “L-17” and the drug tamerit. Materials and methods. Pancreonecrosis modeling was carried out on rats by the author’s model (Patent RST RF № 2400820, 27.09.2010). The main group consisted of rats receiving the compound “L-17”, the group of comparison – animals with pancreonecrosis model getting tamerit, the control group – animals without treatment. Results. Use of the compound L-17 and tamerit change the course of inflammatory process in experimental disseminated pancreonecrosis blocking development of marked systemic inflammation (sepsis). During the first day, high IL-6 and IL-10 level in the group without treatment indicated formation of septic process and evidently correlated with high level of lethality. Conclusion. The compound L-17 from the group of substituted 5R 1,R6 2,3,4-thiadiazin-2-amines shows that compounds of this group have an immunomodulating effect.
Perm Medical Journal. 2013;30(5):116-119
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LIPID DEGENERATION IN PHEOCHROMOCYTOMAS MIMICING ADRENOCORTICAL TUMORS (TWO observations)
Kalinin A.P., Polyakova G.A., Britvin T.A., Bezuglova T.V.
Abstract
Lipid (fatty) degeneration occurs rare in pheochromocytomas. The paper presents description of two observations of adrenal pheochromocytoma with lipid degeneration. Histological and immunological studies proved accumulation of lipids in tumor cells. In the first observation, the following background diseases were noted: Sanarelli-Schwarzman syndrome, autoimmune thyroiditis, hypothyrosis, degree II-III obesity. In the second observation, taking into account local expression of tenascin-C, we can speak about uncertain potential of tumor malignancy. These observations are of special interest regarding differential diagnosis of pheochromocytoma with fatty degeneration and concurrent tumors (cortical adenoma and pheochromocytoma) and mixed tumors such as adenomas containing cortical substance cells (adenoma-pheochromocytoma)
Perm Medical Journal. 2013;30(5):120-124
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ORGANIZATION OF SPECIALIZED MEDICAL CARE RENDERED TO PATIENTS WITH ACUTE ARTERIAL OBSTRUCTION
Korelin S.V., Makarova N.P., Khmelniker S.M.
Abstract
Aim. To improve the direct and long-term results of treatment of patients with acute arterial obstruction by means of rational organization of medical care. Materials and methods. Retrospective analysis of the activity of vascular surgery unit in relation to rendering the first aid to patients with diseases and injuries of magistral vessels for the last 29 years was carried out. At the first stage of this work (from 1984 to 1993), 946 patients were operated for acute arterial obstruction. During the second period, (from 1994 to 2012), 2054 operations for acute arterial obstruction were performed. Results. At the first stage of this work, we gave preference to the principle of removing a patient “by ourselves” for rendering assistance to patients with urgent diseases and vascular injuries. Out of all urgently operated patients only one third was operated “at departure” and only 30,9% of patients were rendered specialized aid during the first 12 hours. For the purpose of solving the problem, that is, reduction of the terms of rendering specialized aid to patients with urgent pathology and vascular injury, the system of organizing assistance to this category of patients was revised. The number of operated patients reaches 80,4% when angiosurgeon is rendering medical care at the hospital where a patient is staying for 12 hours. Blood flow is restored in 80,1% of patients. Conclusion. Specialized assistance should be maximally brought nearer to patients with urgent vascular pathology and reduced in time. The optimal method for rendering an urgent angiosurgical aid consists in creation of specialized emergency teams of constant readiness in collaboration with Territorial Center of Catastrophe Medicine.
Perm Medical Journal. 2013;30(5):125-128
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HEALTH STATUS MONITORING OF DIFFERENT DONOR CATEGORIES
Zaitseva G.A., Kovtunova M.E., Matrokhina O.I., Isaeva N.V., Danilova I.N., Kulikova M.M., Ivashkina E.P.
Abstract
Aim. To study the status of immunity, thrombocyte component of hemostasis, protein metabolism and iron metabolism for complex assessment of health status in different categories of donors. Materials and methods. Immunological study was carried out using level 1 and 2 tests characterizing the status of cellular and humoral immunity components and nospecific resistance of the body. Functional thrombocyte activity was estimated with turbidimetric method. The total protein content was determined using colorimetric method. Iron metabolism indices were studied with the methods of immunoradiometric and immunochemiluminescent analysis. Results. In donors awarded by the breastplate “Honorary Donor of Russia”, there were observed disorders in immunogram regarding cellular, humoral immunity and nonspecific protection with the frequency of 7,4–18% of the examined patients. Increase in interleukin 1-ß and tumor necrosis factor-α was revealed in 7,5% of donors. However, frequency of the detected deviations of immunological indices in the group of Honorary Donors did not differ from that of primary donors. Reduction of aggregation platelet ability with different inductors was observed in 20–25% of the observed persons. The number of deviations from the standard values of protein metabolism indices per 1 donor was 0,865. Men and women aged 18–23 should be considered the best group of plasma donors for fractionation. Among regular donors of blood and its components, decrease in hemoglobin level caused tension of adaptive mechanisms displayed by elevated production of erythropoietin and strengthening of expression of soluble transferring receptors. Conclusion. A deepened monitoring of active donors’ health is necessity. The obtained data will permit to judge about health status of the population in the region.
Perm Medical Journal. 2013;30(5):129-135
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DEVELOPMENT OF Russian MEDICAL LEGISLATION IN THE PRE-REVOLUTIONARY PERIOD
Kuranov V.G.
Abstract
The present paper is devoted to the legal transformation of Russian medical legislation in the period before the revolution of 1917. Ten centuries of development of Russian medical law can be divided into two stages: ancient times and imperial period. Development of legislation in the sphere of rendering medical care is analyzed in the context of the history of Russian state system as a whole. The basic normative-legal acts of the Russian state dealing with the problems of medical activity are considered in the paper. Among them there is The Russian Truth, Sudebnik – the year 1497, Army Regulations of Peter I, Medical Regulations – the year 1857. The author keeps track of the legal and organization aspects of forming Russian public health service beginning from folk medicine to the state one.
Perm Medical Journal. 2013;30(5):136-142
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PROFESSOR MIKHAIL FEDOROVICH ZARIVCHATSKY (the 70th anniversary)
- -.
Abstract
Perm Medical Journal. 2013;30(5):143-146
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