Vol 30, No 4 (2013)

Articles
HYDROSURGICAL SYSTEM VERSAJET USED TO PREPARe BURNING WOUNDS FOR FREE AUTODERMOPLASTY
Samartsev V.A., Encheva Y.A., Dronov N.M., Grikhutik V.M.
Abstract
Aim. To assess the clinical efficiency of using hydrosurgical system VersaJet for patients with burning wounds. Materials and methods. Clinical efficiency of treating burning wounds with the help of the system VersaJet was assessed in 18 patients with men prevailing – 10 persons. The mean age of patients in the analyzed group was 64±12 years. The area of the wounds treated with hydrosurgical system VersaJet was 3,9±1,3%, they were mostly located on the lower and upper extremities. Results. After applying hydrosurgical system VersaJet, in 14 cases free autodermoplasty (FADP) with split skin graft (SSG) was used. Four patients underwent hydrosurgical treatment on the day 21±9 so as to prepare them for further free autodermoplasty with split skin graft. After this procedure, Fibrotul bandage with silver was applied to cover the injured surface. After treatment, one agent was sowed in 8 cases and Me number fell; in 3 investigations no microflora growth was registered. Conclusion. Hydrosurgical treatment of wounds widens the possibility of fast and selective wound surface cleansing.
Perm Medical Journal. 2013;30(4):7-11
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GROUNDING FOR INDICATIONS TO RELAPAROTOMY AND PROGNOSTICATION OF DISSEMINATED PERITONITIS OUTCOMES
Sandakov P.Y., Starikova A.I.
Abstract
Aim. To study the methods for improving estimation of treatment efficiency in patients with disseminated peritonitis (DP), in particular, to detect the necessity of relaparotomy for abdominal sanation. Material and methods. 132 patients with disseminated peritonitis were examined: prospectively – 92 cases, retrospectively – 40. To analyze the degree and dynamics of polyorgan insufficiency, “Dynamic Organ Dysfunction Assessment Scale” (DODAS) was used. Determination of 7 and more scores by this scale reliably proves the presence of polyorgan insufficiency syndrome (POIS). The scale permits to estimate patients’ status by 6 systems and organs with a maximum sum of 24 scores. The number of scores of the 1 st, 2 nd and 3 rd days after the operation was subjected to trend analysis using the program Microsoft Office Excel. The trend score analysis of polyorgan insufficiency allows to determine its stage and efficiency of treatment. As a result, we managed to determine the indications to relaparotomy at the earlier terms than when using prognostic relaparotomy index. Results. The predicted lethality in the main group was established to coincide with the real one (27,3%). In the group of comparison, the real number of lethal outcomes (85,7%) occurred to be higher than the prognosticated ones (72,0%). Sensitivity and specificity of the suggested method of relaparotomy indications determination was 0,9 and 0,8, respectively. Thus, determination of polyorgan insufficiency stage makes it possible to correct treatment and determine relaparotomy indications in time. Conclusion. The course of polyorgan insufficiency in disseminated peritonitis during the adjacent three days is subjected to the laws of polynomial function and is different by development rate and regression. Prognosis for life in disseminated peritonitis depends on the stage of polyorgan insufficiency. Efficiency of DP treatment in the postoperative period is to be estimated by means of trend analysis of polyorgan insufficiency assessment scale scores.
Perm Medical Journal. 2013;30(4):12-16
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ENDOLARYNGEAL SURGERY
Novikov V.N., Pereverzev I.A., Sheveleva N.P., Trishkin D.V., Lozhkina N.V.
Abstract
Aim. To optimize the endosurgical treatment depending on localization and genesis of laryngeal lesion. Materials and methods. The results of treatment of 17 patients with postintubation laryngeal cicatrical stenosis, 11 – with bilateral laryngeal paresis, 120 – with benign laryngeal neoplasms were studied. Results. In case of cicatrical stenosis at the level of vocal folds, it is recommended to perform laryngolysis and laryngeal bougienage with esophageal bougies of the increasing diameter; in case of cicatrical subfold space stenosis – laryngolysis followed by bougienage and installation of T-shaped silicon endoprosthesis or autocartilage plasty. Bilateral vocal fold paresis lasting for more than 8 months leads to irreversible cicatrical transformation that along with breathing through tracheostome or presence of dyspnea can be considered as indication to reconstructive surgery directed to restoration of laryngeal patency. Conclusion. Endoscopic subtotal chordectomy and neocanalization of the larynx can be effective for treatment of bilateral recurrent nerve paresis allowing to restore patency of natural respiratory tract and sonorous voice. Endolaryngeal removal of benign laryngeal tumors using precision technique or treatment of tumor base with point electrode in “fulguration” regime permits to avoid relapses practically entirely.
Perm Medical Journal. 2013;30(4):17-21
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RESTORATION OF BODY WEIGHT AFTER DELIVERY WITH ITS PATHOLOGICAL GROWTH DURING PREGNANCY
Pokusaeva V.N.
Abstract
Aim. To clarify the peculiarities of postnatal reduction of weight in patients with different levels of gestational body weight growth (GBWG). Materials and methods. Prospective cohort study included 118 patients: 25 with insufficient GBWG, 43 – with recommended GBMG and 5 – with excessive GBWG. Anthropometric measures (body weight, cutaneous adipose fold thickness) were fulfilled when registering pregnant women in the first trimester of gestation, on the 3 rd day and 3, 6, 9, 12 months after the delivery. GBWG level was assessed according to “The Guidelines on Pregnancy Weight Growth” depending on the initial body weight index (BWI). Results. While carrying out a multifactorial analysis with exclusion of BWI influence, reliable correlation between GBWG and the postnatal body weight reduction ( p =0,000, p =0,000, p =0,000 and p =0,011 – 3, 6, 9 months and a year after the delivery, respectively) was revealed. With the recommended GBWG, the initial weight is restored by the 9 th month after the delivery and with the insufficient one – immediately after the delivery. With the excessive GBMG, the weight is reduced slower and in a year after the childbirth 22% of women have > 5 kg and 14,0% – > 10 kg. Excessive GBMG promotes additional accumulation of fatty tissue in pregnancy and its incomplete reduction after the delivery. In a year after the delivery, percentage of a fatty body weight with excessive weight growth is significantly higher than with the recommended one ( p =0,018). Conclusion. GBWG within the recommended values is accompanied by an adequate restoration of weight by the 9 th month after the delivery irrespective of woman’s pregravid status. Insufficient weight growth leads to faster (just immediately after delivery) return to the initial weight. Excessive body weight growth in pregnancy is a risk factor for delayed postnatal reduction.
Perm Medical Journal. 2013;30(4):22-28
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CLINICAL ASSESSMENT OF ISCHEMIC HEART DISEASE COURSE IN PATIENTS AFTER CORONARY SHUNTING IN THE EARLY POSTOPERATIVE PERIOD
Polovinkina T.A.
Abstract
Aim. To assess the dynamics of the basic symptoms of ischemic heart diseases (IHD) in patients after coronary shunting (CS). Materials and methods. Clinical symptoms were studied using questionnaire method, echocardiographic investigation (ECHO CG) and daily ECG monitoring. As a result of coronary shunting, stenocardia was found to disappear in 96% of patients. All patients had pains of different degree of manifestation connected with surgery. No correlations between dynamics of clinical picture of ischemic heart disease and echocardiographic data were revealed. Results. While analyzing daily ECG monitoring data, ischemic changes were established to be absent in all operated patients with a mean daily heart rate 79,9±9,2 beat/min. Conclusion. Correction of a heart rate-controlling therapy is required in the postoperative period.
Perm Medical Journal. 2013;30(4):29-33
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PATHOGENETIC APPROACH TO DIAGNOSIS AND TREATMENT OF CHILDREN WITH CLINICOFUNCTIONAL ORTHOPEDIC DISORDERS
Schekolova N.B., Likhacheva L.V.
Abstract
Aim. To study the clinicofunctional peculiarities of children with deformed pelvis and slight asymmetry of the lower extremities length, to develop the program of differentiated treatment. Materials and methods. 140 children aged 3 to 15 years with distorted pelvis and slight asymmetry of the lower extremities length of primary (idiopathic) genesis and pathology of locomotor system of the known etiology (secondary) were examined. There were 78 girls (55,7%) and 62 boys (44,3%). Orthopedic disorders, topographic and electromyographic changes, pain syndrome and vegetative dysfunction peculiarities were studied. Efficiency of conservative orthopedic treatment was assessed in 100 children. Results. Different degrees of severity of clinicofunctional disorders were determined. Impairment of bearing was increasing in process of child growing. In case of organic orthopedic pathology, vertebral column deformity was growing progressively worse against the background of marked pelvic distortion. Neuromuscular dysfunction was detected in all the examined patients. Rehabilitation program was worked out individually taking into account the degree of manifestation of vegetative and muscular dysfunction, orthopedic and somatic pathology. Conclusion. 1. Functional orthopedic disorders are progressing while child growing and lead to the secondary changes in pelvis and vertebral column. 2. Vegetative dysfunction and asymmetry of bioelectric paravertebral muscles activity are additional means for an early diagnosis of the degree of severity and compensation state.
Perm Medical Journal. 2013;30(4):34-40
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EPIDEMIOLOGY OF FOREIGN BODIES IN CHILDREN
Rudakova E.A., Kovaleva O.A., Yurkov S.V., Evseenkova T.G.
Abstract
Aim. To study the epidemiology of gastrointestinal and respiratory tract-located foreign bodies in children. Material and methods. 359 clinical observations were analyzed. Children with respiratory tract-located (97 patients) and gastrointestinal tract-located (262 patients) foreign bodies were hospitalized into Children’s Surgery Clinic of Perm State Academy of Medicine named after Academician E.A. Wagner. Results. Epidemiology of foreign bodies in childhood was studied. Diagnostic and tactical algorithms of removing foreign bodies depending on their location, period of remaining, availability of complications were considered. Clinical cases of long remaining of foreign bodies in the esophagus and complications caused by this pathology are presented as examples. Conclusion. Small children use foreign bodies more often. The structure of gastrointestinal tract-located foreign bodies changed; the share of swollen batteries and magnets increased, causing development of serious complications. Respiratory tract-located foreign bodies occur rarer, however, they more often induce severe disturbances of vital functions
Perm Medical Journal. 2013;30(4):41-48
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LIPID-RELEASING LEUKOCYTE ABILITY IS A RISK FACTOR FOR DEVELOPING ATHEROSCLEROSIS AND ATHEROSCLEROTIC PROCESS ACTIVITY MARKER IN PATIENTS WITH OBLITERATING ARTERIAL LOWER EXTREMITIES ATHEROSCLEROSIS AND DIABETIC FOOT SYNDROME
Kharuzina O.V., Sandakov P.Y., Mishlanov V.Y., Seredenko N.N., Vladimirsky V.E.
Abstract
Aim. To determine the pathogenetic significance of nonspecific inflammation factors in atherogenesis and lipid-releasing leukocyte ability (LRLA) in patients with obliterating arterial lower extremities atherosclerosis in combined course of atherosclerosis of different vascular pools (coronary, branchiocephalic arteries) and diabetic foot syndrome. Materials and methods. The study included 83 patients: 72 patients with obliterating atherosclerosis of lower extremities vessels, 11 – with diabetic foot syndrome. The control group consisted of 20 practically healthy persons. All patients were investigated with instrumental and laboratory methods. Lipid-releasing leukocyte ability was assessed using Professor A.V. Tuev, Professor V.Yu. Mishlanov method. Patients underwent operative treatment including prosthetics, shunting, endarterectomy, thrombectomy, sympathectomy, stenting, balloon dilatation depending on the course of disease, level of arterial bed lesion, degree of extremities ischemia and associated pathology. Results. Comparative analysis of the results of laboratory LRLA values was carried out in patients with isolated associated lesion of lower extremities arteries and diabetic foot syndrome. In the groups of patients with isolated and associated atherosclerosis there are reliable differences. After operative treatment, LRLA is decreased that causes reduction of atherogenesis risk. No differences were detected in case of association with diabetic foot syndrome. Ambulatory treatment in the postoperative period included angioprotectors, disaggregants, statins (simvastatin – 20–40 mg or atorvastatin – 10 mg, constantly). Conclusion. LRLA is a risk factor for developing obliterating atherosclerosis of lower extremities and associated lesion of arterial bed. Maximum LRLA values were revealed in the group of patients with diabetic foot syndrome and associated lesion of different arterial pools. Effective operative treatment of patients with OLEA is accompanied by significant decrease in LRLA value. No LRLA dynamics in the postoperative period among patients with DF syndrome was de
Perm Medical Journal. 2013;30(4):49-55
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HISTOPATHOLOGICAL ECTOCERVIX EPITHELIUM CHANGES IN PATIENTS WITH HPV-INFECTION
Vetelina V.V.
Abstract
Aim. To study the histopathological changes in ectocervix epithelium among patients with HPV-infection. Materials and methods. The object of the study – 105 women aged 25 to 39 with PCR-diagnosed HPV-infection. Patients underwent standard gynecological investigation and widened colposcopy with a target (colposcopically oriented) uterine cervix biopsy. Biopsy material was subjected to histological investigation using the generally accepted histological methods. Statistical analysis was performed with the program package Biostat. For the purpose of assessing significance of differences between distribution of qualitative signs in the studied samples, χ 2 criterion and Z criterion were used. Results. Patients with HPV-infection had some morphological variants of changes in uterine cervix mucosa that depends on presence and degree of multilayer pavement epithelium dysplasia. It was established that while CIN is progressing, expression of such HPV-infection signs as manifestation of koilocytosis and hyper-and parakeratosis is reduced. Besides, there is a tendency to chronization of inflammatory changes in uterine cervix lamina as CIN degree is growing. As CIN degree is growing, there is increase in cervical glandular intraepithelial neoplasia degree (CGIN). Conclusion. As a result of histological investigation of biopsy material taken from HPV-infected patients with uterine cervix pathology, regularities of changes in the character of reactive ectocervix processes connected with CIN progressing were established.
Perm Medical Journal. 2013;30(4):56-61
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RESULTS OF STUDYING CHLAMIDOPHILA PNEUMONIAE AND MYCOPLASMA PNEUMONIAE ANTIBODY TITERS AND INFLAMMATORY MARKERS IN PATIENTS WITH CHRONIC RESPIRATORY DISEASES DEPENDING ON PRESENCE OF ISCHEMIC HEART DISEASE AND CARDIOVASCULAR DISEASES RISK FACTORS
Valeeva A.G.
Abstract
Aim. To study the blood serum inflammatory markers and Chlamidophila pneumoniae and Mycoplasma pneumoniae antibody titer concentrations in patients with chronic respiratory diseases (CRD) depending on presence of ischemic heart diseases (IHD) and risk factors of cardiovascular diseases. Materials and methods. 58 patients with CRD were examined. Group 1 included 20 patients with CRD associated with IHD, group 2 – 38 CRD patients without IHD. Blood serum Chlamidophila pneumoniae and Mycoplasma pneumoniae antibodies (Ig Aand Ig G) as well as inflammatory marker concentrations were determined. Results. High rate of positive Chlamidophila pneumoniae and Mycoplasma pneumoniae antibody titers was revealed in both groups. Optical density ratio coefficient > 1,1 was detected in 16 persons (80%) of group 1 and in 25 persons (66%) of group 2. In both groups, CRP concentrations were increased. In group 1, rise in IL-6 (mean value 7,2±9,04) and IFNγ (13,6±5,19) concentrations was observed, in group 2 – rise in IL-4 (10,4+8,68) concentration was fixed. Conclusion. Chlamidophila pneumoniae and Mycoplasma pneumoniae antibodies occur equally frequently both in patients with associated CRD and IHD and CRD patients without IHD. Differences between two groups in IL-6, INFγ and IL-4 content were found.
Perm Medical Journal. 2013;30(4):62-66
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DIAGNOSTIC SIGNIFICANCE OF CLINICAL AND INSTRUMENTAL INDICES IN CHILDREN AND ADOLESCENT OBESITY
Akhmedova R.M., Sofronova L.V., Koryukina I.P.
Abstract
Aim. To study the correlation and diagnostic significance of body weight index (BWI), waist circumference and adipose tissue mass depending on age and sex in children with obesity and metabolic syndrome. Materials and methods. 380 pupils including 99 children with overweight, 185 – with obesity and 96 – with normal weight were examined. The study was carried out on the basis of children’s health centers of the city of Perm. Relative adipose tissue mass was determined with bioimpedance method using the body composition analyzer ABC-01 “Medass”. Results. In youths, correlation between body weight index and adipose tissue mass was weak. Waist circumference in girls of all ages and pre-peburtal and pubertal boys highly correlated with adipose tissue mass. In youths aged 16–18, the above mentioned correlation was weak. Conclusion. Determination of body weight index and waist circumference is highly informative for diagnosis of obesity in girls of all ages and in pre-peburtal and peburtal boys. Precise diagnosis of obesity in youths requires additional assessment of body composition.
Perm Medical Journal. 2013;30(4):67-73
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OPPORTUNITIES OF USI IN DIAGNOSIS OF CENTRAL AND PERIPHERAL LYMPHATIC SYSTEM PATHOLOGY
Pushkarev V.P., Lekomtsev B.A., Gainutdinov V.O.
Abstract
Aim. To improve the results of treatment of patients with chronic lymphovenous failure of the lower extremities by introducing new methods for diagnosis of peripheral and central lymphodynamics. Materials and methods. Peripheral and central lymphodynamics (thoracic lymphatic channel – TLC) was studied in 40 patients with chronic lymphovenous failure (CLVF) of the lower extremities of different severity. The other 40 patients without vascular pathology signs underwent the same investigations. Lymphodynamics was studied with USI-scanner (Aloka SSD – 4000; Acuson X-300). Results. In CLVF patients, TLC orifice diameter was up to 3,24±1,32 mm. TLC arch diameter was 6,19±1,48 mm that is significantly larger than in comparison group ( p <0,01). Linear lymph flow velocity (LLFV) in the main group was 11,47±4,31 cm/s, PLFV – 117,93±69,54 ml/min. Both indices are reliably ( p <0,01) higher than in comparison group that confirms dynamic failure of TLC orifice in CLVF patients. Some peripheral lymphodynamics indices were studied. The obtained data show lymph hyperproduction, prove presence of lymphatic hypertension in patients with CLVF both at the periphery and at the TLC level as well as development of dynamic TLC orifice failure. Conclusion. The results of the study demonstrate efficiency of USI with colour duplex scanning of lymph nodes in CLVF patients for detecting lymphatic hypertension at different levels and what is especially important – at the neck TLC level.
Perm Medical Journal. 2013;30(4):74-78
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ROENTGENOENDOVASCULAR EMBOLIZATION OF NEPHROTRANSPLANT ARTERIES AS A STAGE OF TRANSPLANTECTOMY
Akhtyamov R.R., Kurbangulov I.R., Fedorov S.V., Mukhamedianov I.F., Nuriakhmetov R.R.
Abstract
Aim. To improve the results of surgical treatment of patients with chronic transplant nephropathy (CTN) in nephrotransplantectomy (NTE) using preventive endovascular transplant arteries embolization (ETAE). Materials and methods. The results of clinical examination and surgical treatment of 30 patients with chronic transplant nephropathy in the period from 2004 to 2012 were assessed. Patients were divided into two groups: group 1, in which NTE was performed after ETAE and group 2 – NTE without ETAE. Both groups were compared by the hemorrhage volume, surgical complications, medical measures. Results. Intraoperative hemorrhage in group 1 was from 20 to 50 ml, on the average 40±10,5 ml. In group 2 – from 100 to 600 ml, on the average 295±50,4 ml ( p =0,04). No surgical complications, such as vascular damage when performing NTE in group 1 were noted. In group 2 there was registered vascular damage in 15% of cases ( n =3).No intra-and postoperative hemotransfusions connected with hemorrhage were detected in group 1. In group 2 erythrocytic mass infusion was administered in 75% of cases ( n =15). Conclusion. Preventive ETAE permits to significantly reduce the hemorrhage degree (from 295±50,4 ml to 40±10,5 ml) during NTE that is very important for patients with nephrogenic anemia against the background of tCPN transplant. ETAE allows to completely abolish immunosuppression in the early period after this manipulation, to carry out nephrectomy in the delayed terms and to grade the risk of immunological conflict with subsequent allotransplantations to these recipients.
Perm Medical Journal. 2013;30(4):79-83
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SENSITIVITY AND SPECIFICITY OF HYALURONIC ACID, DE RITIS COEFFICIENT AND VASCULOENDOTHELIAL GROWTH FACTOR DETERMINATION FOR DIAGNOSIS OF CHRONIC HEPATITIS AND HEPATIC CIRRHOSIS
Schekotova A.P., Bulatova I.A., Roitman A.P.
Abstract
Aim. To compare the possibilities of using blood hyaluronic acid (HA), de Ritis coefficient and vasculoendothelial growth factor (VEGF) determination for diagnosis of hepatic fibrosis in chronic hepatitis and hepatic cirrhosis. Materials and methods. Blood serum HA, aspartic transaminase/ alanine transaminase (AST/ALT) ratio, VEGF were determined in 100 patients with chronic hepatits C and 50 patients with hepatic cirrhosis at the outcome of hepatitis C. The control group included 34 persons. Results. While carrying out correlation analysis, reliable correlations between both direct fibrosis marker – HA and indirect test – de Ritis coefficient and VEGF were revealed. The sensitivity of HA determination for diagnosis of cirrhosis with the concentration higher than 100 ng/ml is 100%, specificity – 80%, negative prognostic value for exclusion of HC – 1,0. The AST/ALT ratio demonstrates 96% sensitivity with the point of division 1,5, specificity – 69%, negative prognostic value – 0,76. The test sensitivity of VEGF determination for differential diagnosis of cirrhosis and hepatitis with the point of division 312,3 pg/ml is 90%, specificity – 80%, efficiency – 84%, negative prognostic value for exclusion of HC – 0,89. Conclusion. Determination of VEGF concentration can be used for differential diagnosis of hepatic cirrhosis and chronic hepatitis as an indirect hepatic fibrosis marker since efficiency of this test somewhat yields to HA and exceeds AST/ALT ratio.
Perm Medical Journal. 2013;30(4):84-90
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AGE DYNAMICS OF ELECTRIC IMPEDANCE SPIROMETRY INDICES in children aged 3–16
Ustiantseva T.L.
Abstract
Aim. To study the age peculiarities of electric impedance spirometry indices in children aged 3 to 16 years. Materials and methods. 58 patients were divided into 3 age groups and examined: group 1 – aged 3 to 7years, group 2 – aged 8 to 11, group 3 – aged 12 to15. Patients underwent spirometry tests and impedance spirometry by the author’s method (Mishlanov V.Yu., 2011) using netbook “BIA-lab Spiro” and ultrasonic inhaler Musson-3. The method of bipolar impedancemetry consists in registration of modular impedance value (Z) and phase angle (φ) on the frequencies 20, 98, 1000, 5000, 10000 and 20000 Hz of a low power alternating electric current during inhalation of 0,9% sodium chloride solution. Results. It was established that the group of children aged 4–7 had the lowest values of modular impedance value (Z) on all the frequency ranges. Reliable correlation between spirometry indices and electric impedance spirometry were fixed. Correlation dependence of modular electric impedance value (Z) on children’s age, height and weight was detected. Conclusion. Modular electric impedance value (Z) depends on the age, height and weight. Prospects for applying the method of electric impedance spirometry so as to study the functions of external respiration in pediatric practice were determined.
Perm Medical Journal. 2013;30(4):91-96
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CLINICAL USE OF INFORMATION PROCESSING AND ANALYSIS SYSTEM BASED ON ARTIFICIAL NEURAL NETWORK OF “MULTILAYER PERCEPTRON” TYPE
Fedorov S.V., Kashaev M.S., Kashaev T.R.
Abstract
Aim. To improve the results of surgical treatment of patients with thyroid gland pathology by means of developing electronic computer (EC) program allowing to optimize diagnosis, observation and prognosis of the disease course. Materials and methods. Together with the Chair of Computer Engineering and Information Security of Ufa State Aviation and Technical University the program “Intellectual System for Diagnosis of Thyroid Pathology Based on Neuronet Technologies” was developed. Results. The authors worked out and registered EC program “Intellectual System for Diagnosis of Thyroid Pathology Based on Neuronet Technologies” permitting to collect, store and analyze information on patients. The program is also capable of presenting the supposed diagnosis and result of treatment on the basis of the introduced information. Analysis of 148 case histories and ambulatory records of patients with diffuse toxic goiter was carried out; accuracy of diagnosis was > 90%; accuracy of disease outcome prediction was >75%. Conclusion. The applied modern methods of diagnosis and processing of the obtained data by means of biomedical statistics as well as neuronet information processing and analysis system make it possible to optimize patients’ management, storage and processing of medical information and permits to conduct differential diagnosis of diseases.
Perm Medical Journal. 2013;30(4):97-102
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CONSTITUTIONAL PECULIARITIES OF COSTODIAPHRAGMATIC PLEURAL RECESS
Balandina I.A., Amarantov D.G., Britok V.A.
Abstract
Aim. The work is devoted to studying of constitutional peculiarities of costodiaphragmatic pleural recess for development of an optimal excess when performing thoracoscopy in patients with basal empyemic pleura. Materials and methods. The study was performed on 75 male corpses of the second period of mature age of brachymorphic, mesomorphic and dolichomorphic constitution types. Results. The width of V–XI intercostals spaces in the costodiaphragmatic recess projection was determined, the depth of costodiaphragmatic recess for every type of constitution was studied. The authors conducted comparative topographic-anatomical assessment of thoracocenteses fulfilled in the IV–IX intercostals spaces by the axillary lines from the position of reaching an optimal parameters of operative availability. Conclusion. On the basis of the obtained results the optimal places of carrying out an operative access while performing endoscopic sanation of costodiaphragmatic pleural recess were found.
Perm Medical Journal. 2013;30(4):103-109
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MORPHOFUNCTIONAL CHARACTERISTICS OF IMMUNE RESPONSE IN DIFFERENT METHODS OF ADMINISTRATION OF OPPORTUNISTIC BACTERIA ANTIGENS
Utkina N.P., Ilinykh E.A., Lebedinskaya O.V., Akhmatova N.K.
Abstract
Aim. To investigate morphological, functional and immunophenotypic features of the immune response using mucosal and parenteral methods of administration of the complex of opportunistic microorganism antigens. Materials and methods. Functional, morphological and immunophenotypic characteristics of immunocompetent cells and organs of mice (80, SWA line) in intact animals (control), as well as the above characteristics in intranasal (3-fold in the dose of 500 ug / mouse), peroral (3-fold in the dose of 2 mg / mouse) and subcutaneous (2-fold in the dose of 200 mg / mouse), methods of administration of multicomponent vaccine Immunovac VP-4 containing the complex of opportunistic microorganism antigens were investigated. Mononuclear leukocytes of spleen, lymph nodes and lymphoid tissue of the small intestine were used to evaluate the expression level of markers (CD3, NK 1.1, CD3/NK, CD4, CD25, CD4/CD25, CD8, CD19, MHC II, CD5.2 (B1), TCR (Tγδ) with the help of monoclonal antibodies («Caltag Laboratories», USA) by means of a flow cytometer FacsCalibur («Beckman Coulter F-500", USA). Cytotoxic activity of natural killers against neoplastic K562 line in MTT assay was revealed. Morphological studies were performed on serial paraffin sections stained with histological and histochemical methods. Statistical processing of the data was performed using statistical package StatSoft 8.0. Results. It was revealed that the investigated complex of opportunistic bacteria antigens causes significant activation of effectors of innate immunity both in parenteral and mucosal immunization. It is displayed in increased levels of expression of differentiation, co-stimulating, adhesive molecules on the surface of mononuclear leukocytes, in proliferation of key effectors of mucosal immunity (Tγδ-B 1 and B- lymphocytes, NK cells), increase in their functional activity, changes in the pattern, cellular composition of immunocompetent organs and lymphoid tissue, regional to the site of administration and distant from it that indicates formation of not only local, but systemic immunity as well. Conclusion. The obtained data allow us to extend the strategy for using vaccines and immunomodulators of bacterial origin by means of non-parenteral immunization methods to create protection from a broad spectrum of pathogens.
Perm Medical Journal. 2013;30(4):110-120
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ASSESSMENT OF HEIGHT-WEIGHT INDICES IN STUDENTS OF THE FIRST COURSE OF TREATMENT-AND-PROPHYLACTIC FACULTY
Devyatkova G.I., Schepetkova E.R., Kilanova M.O., Mel A.I.
Abstract
Aim. To describe height-weight indices, to calculate body weight index, to assess differences on the basis of questioning students of the first course of Treatment-and-Prophylactic Faculty. Materials and methods. 50 students the first course of Treatment-and-Prophylactic Faculty underwent questioning. Each subject being tested, orally answered three suggested questions (indicate sex, height, weight). There were 15 young men and 35 girls. The obtained data were divided into 3 groups: 2 girls and 2 young men (8%) were short, 28 girls and 7 young men (70%) – of a medium height, 5 girls and 6 young men (22%) – tall. Reliability of differences was estimated by means of Student’s test (t). There was an attempt to reveal dependence between height and weight using correlation analysis. Results. The obtained data permit to confirm reliability of differences between tall and short young men, since temp<tcrit (0,161<2,31), reliability between height differences in girls is unreliable, since temp>tcrit (2,659>2,37). Correlation coefficient r =0,726382146 that proves an average degree of linear connection between parameters. Conclusion. It was found out that the majority of students of the first course of Treatment-and-Prophylactic Faculty are of a medium height making 70% of the total number of subjects being tested, 22% of students are tall and 8% are short. The studied weight of students of the first course of Treatment-and-Prophylactic Faculty permitted to state that 80% of students have a normal for their height weight. However, 8% of students have a deficit of body weight but 12%, on the contrary, – overweight. This fact evidences importance of a timely revealing of these contingents, necessity of preventive work, their examination for the purpose of detecting reasons and improving health for further training.
Perm Medical Journal. 2013;30(4):121-123
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CORRELATION BETWEEN PROGRESS IN STUDIES AND COPING-BEHAVIOUR OF STUDENTS IN STRESS SITUATIONS
Mozgovaya L.A., Rochev V.P., Paklin R.V., Mozgovaya S.V.
Abstract
Aim. To study the correlation between progress in studies and coping-behaviour of academic students in stress situations. Materials and methods. The study included students of the Stomatological Faculty of Perm State Academy of Medicine named after Academician E.A. Wagner (81 persons) as well as students of the Faculty of Law and Economic Faculty of PSNRU (52 persons) who were divided into 3 groups by their results in studies. To assess their psychological health, the method of “Coping-behaviour in Stress Situations” (S. Normann et al., 2002) adapted by T.A. Kryukova (2004) was used. It can be applied for teacher’s activity. Results. Correlation between students’ results and indices of their psychological health in the period of training at higher school was established. For this purpose, the questionnaire consisting of 48 statements which reflect frequency of using the intended types of personal reactions in stress situations by 5 forms of behavioral strategies (problem-oriented, emotionally-oriented, emotionally-oriented for avoidance, abstraction, search for social support) was used. Conclusion. The obtained results of the study permit to recommend teachers of higher schools to realize an individual approach to students while carrying out an individual teaching and educational work.
Perm Medical Journal. 2013;30(4):124-129
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PREVALENCE OF OSTEOPENIC SYNDROME IN CHILDREN WITH LOCOMOTOR DISEASES living in perm territory
Schepetkova E.R., Devyatkova G.I., Ponomarev S.A.
Abstract
Aim. To reveal the rate of osteopenic syndrome in children with pathology of musculoskeletal system in the regions of Perm Territory. Materials and methods. 2003 children with locomotor pathology living in the regions of Perm Territory were examined. There were 1113 boys and 890 girls. The data were divided into 3 age groups from 7 to 10 years (58% of healthy children), 11–14 (60% of healthy children) and 15–18 (53% of healthy children); 32–40% of them were children with osteopenic syndrome. Taking into account that bone strength reflects integration of two main characteristics including mineral bone strength and bone quality, all patients underwent densitometry by means of the device DTX 200 (USA, Denmark). Results. The data regarding significant prevalence of osteopenic syndrome were obtained, reduction of mineral bone tissue density (MBTD) was revealed in 38-43% (mean value) of persons in the children’s population. The most unfavorable territories were singled out. Conclusion. It was stated with disperse analysis methods that such factor as child age has a poorly expressed connection with the degree of osteoporosis: 15% of children diagnosed osteopenia were detected for the first time at the age of 16-18. This fact shows importance of timely detection of endemic for Perm Territory situation and necessity of working out territorial programs for early prevention of this pathology.
Perm Medical Journal. 2013;30(4):130-134
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INFECTIONS CONNECTED WITH RENDERING MEDICAL CARE. EPIDEMIOLOGY AND PREVENTION (Review lecture)
Koza N.M.
Abstract
The problems of epidemiology and prevention of infections connected with rendering medical care (ICMC) in the framework of The National Prophylaxis Conception approved in November 2011 by Chief Sanitary Inspector of the Russian Federation are discussed in the lecture. This group of infections is defined, changes in terminology and classification of ICMC indicated in the conception for harmonization of native normative documents with international requirements are presented. Mechanisms of developing epidemic ICMC process at medical institutions of various profile, systems of preventive and antiepidemic measures and epidemiological inspection are considered from the point of view of the latest scientific achievements. Contribution of the Department of Epidemiology of PSAM named after Academician E. A. Wagner to development of theoretical and practical aspects of ICMC prevention is shown in the lecture.
Perm Medical Journal. 2013;30(4):135-143
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THE 20th ANNIVERSARY OF OBLIGATORY MEDICAL INSURANCE
Babin V.V., Novoselova I.K., Podluzhnaya M.Y., Ryzhakov S.A.
Abstract
Perm Medical Journal. 2013;30(4):144-146
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