Vol 32, No 4 (2015)

Articles
GENDER PECULIARITIES OF ANTITHROMBOTIC THERAPY IN PATIENTS WITH MYOCARDIAL INFARCTION UNDERGOING TRANSCUTANEOUS CORONARY INTERVENTION
Lapin O.M.
Abstract
Aim. To ground the individual gender approach to antithrombotic therapy in patients with myocardial infarction undergoing transcutaneous coronary intervention (TCI). Materials and methods. Seventy patients with reliable prevalence of subjects belonging to the senior age categories among women ( n = 30) 71,5 ± 9,8 versus 62,6 ± 13,7 among men ( n = 39) ( p = 0,003) were examined. Results. Combination of such factors as male sex and senior age was revealed to determine a high risk for hemorrhagic complications (CRUSADE) in women as compared to men - 10,0 ± 3,4 versus 6,6 ± 3,4 scores ( p = 0,0001). Among the treated patients, there were no repeated ischemic events, stent thromboses, mild and severe hemorrhagic complications. Taking into account a short period of semiejection and high safety profile of bivalirudin, its administration and inclusion into antithrombotic therapy for patients with elevation of ST segment in the frame of pharmacoinvasive strategy (combination of prehospital thrombolytic therapy and TCI) is most grounded among females. Conclusions. This variant of therapy permits to minimize the risk for development of the postoperative and hemorrhagic complications among women with myocardial infarction.
Perm Medical Journal. 2015;32(4):6-12
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DIAGNOSIS AND TREATMENT OF PRIMARY AND SECONDARY HYPERPARATHYROIDISM
Zarivchatsky M.F., Blinov S.A., Denisov S.A., Kolevatova A.P., Dilman A.B., Teplykh N.S.
Abstract
Aim. To improve the results of treatment in patients with primary and secondary hyperthyroidism. Materials and methods. During the period of 2001-2014 we operated 24 patients with primary hyperthyroidism and 38 patients with secondary hyperthyroidism. Results. No complications were observed in the early and follw-up postoperative periods. In the postoperative period patient's health status was monitored. Hypocalcemia was detected in 39 out of 62 patients; it was compensated by intake of calcium preparations during 2-3 weeks. Conclusions. To improve the results of treatment in patients with hyperparathyroidism, screening investigations of risk groups and patients undergoing program hemodialysis are required. Substruction scintigraphy is an obligatory method for preoperative examination of patients with hypothyroidism. Adequate preoperative preparation permits to prevent the intraoperative complications connected with hormonal disorders.
Perm Medical Journal. 2015;32(4):13-18
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OPPORTUNISTIC UPPER AIRWAY AND EAR DISEASES IN PATIENTS WITH LATE STAGE OF HIV-INFECTION
Charushin A.O.
Abstract
Aim. To study the opportunistic diseases of the upper airways and the ear at the late stages of disease in HIV-infected patients who underwent treatment at resuscitation and intensive care units (RICU) of infectious hospital, to reveal peculiarities of their clinical course for improvement of diagnosis and management. Materials and methods. Forty six HIV-infected patients with opportunistic diseases of the upper airway and the ear were observed at RICU of Perm Regional Clinical Infectious Hospital for the period of 2014-2015. Their diagnosis was based on complex clinicoinstrumental, biochemical and microbiological methods with subsequent isolation and classification of Candida fungi from the fauces mucosa. Results. All the observed patients had pathology of the upper airways, mainly of the fauces: fungus and tumor diseases. In most patients (95%), different clinical forms of oropharyngeal candidiasis and its combinations were diagnosed. There predominated acute pseudomembranous candidiasis and angular cheilitis. In etiological structure of oropharengial candidiasis, Candida albicans (73,9%) was dominating. Conclusions. A timely and full diagnosis of opportunistic diseases of the upper airways and the ear in HIV-infected patients performed at the late stages of diseases permits to determine etiological character of pathological process, clinical form and severity of lesions for adequate management and prevention of complications.
Perm Medical Journal. 2015;32(4):19-24
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OPPORTUNITIES OF NONMEDICAMENTOUS CORRECTION OF PAIN SYNDROME AND ORTHOPEDIC DISTURBANCES IN DEGENERATIVE-DYSTROPHIC SPINAL COLUMN CHANGES
Schekolova N.B., Taskaev A.L.
Abstract
Aim. To characterize the pain syndrome and to work out in detail the orthopedic disorders in patients with degenerative-dystrophic changes in the spinal column, to ground the efficiency of force kinesitherapy in the course of treatment. Materials and methods. One hundred and sixty six patients with degenerative-dystrophic diseases of the spinal column, who underwent the course of force kisenitherapy, were studied. There were 92 (55,42 %) men and 74 (44,58 %) women. The mean age of men was 35,2 years, women - 44,6 years. Brain workers predominated - 111 (66,87 %) subjects. Pain intensity was estimated by the scale “VAS” and the questionnaire “Index of Existing Pain”. Results. Pains localized in the lumbosacral spinal column were registered in 54 (32,93 %) patients, in the cervical spinal column - 18 (23,17 %), in the thoracic spinal column - 20 (12,20 %) patients. Pains in the hip joint were registered in 14 (8,5 %) patients, in the ankles - 8 (4,9 %), in the knee joints - 7 (4,9 %), in the shoulder joints - 6 (3,7 %) patients. Thirty three (20,12%) patients had complaints for headaches. According to visual analogue scale for pain (VAS), a mean level of pain severity among the examined patients scored 7,4 ± 0,05 ( p < 0,05). According to self-rating, severe pain was registered in 60 (48 %) patients, moderate - in 57 (45,6 %), mild - in 8 (6,4 %) patients. Bearing disturbance, scoliosis, flat-foot, asymmetry of extremity length with pelvis deformation, disturbed muscular tonus, gonarthrosis, coxarthrosis were diagnosed in patients. The aim of kinesitherapy was connected with the necessity for relaxation of the overstrained and strengthening of the weak muscles. Force trainers working by circular method were used. Pain severity prior to the onset of kinesitherapy course scored from 6 to 8 and averaged 7,05 ± 0,5. Three months later, a mean pain index was 1,01 ± 0,01 scores. Conclusions. During the follow-up period, all patients had reduced manifestation of pain syndrome and positive dynamics of orthopedic disturbances.
Perm Medical Journal. 2015;32(4):25-31
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RESULTS OF COMPLEX TREATMENT IN PATIENTS WITH DIABETIC FOOT SYNDROME
Lukin P.S., Panin A.S., Zarivchatsky M.F., Blinov S.A.
Abstract
Aim. To improve the results of treatment in patients with diabetic foot syndrome by means of differentiated application of conservative measures using advanced infusion system associated with local treatment by combination of adhesive bandages; to estimate the quality of life in patients with diabetic foot syndrome. Materials and methods. The results of treatment of 60 patients with diabetic foot syndrome are presented in the paper. All patients with diabetic foot syndrome were divided into two groups: the main group and the comparison group - 30 persons each. Complex treatment of patients of the main group was added by intravenous introduction of thioctic acid preparations using advanced infusion system. Local treatment was carried out with additional use of adhesive bandages Permafoam comfort and Atrauman Ag. Patients’ quality of life was estimated by means of the developed questionnaire. Results. Among the patients of the main group, improvement was observed by the day 5,0 ± 0,2. In the comparison group, the patients who underwent infusion in the ordinary way, without isolation of infusion system, therapeutic effect was noted by the day 9,0 ± 0,8. Trophic ulcer healing in the main group occurred by the day 21,0 ± 3,6, in the comparison group - by the day 32,0 ± 4,8. In 30 % of the main group patients, psychological status changed after treatment from “satisfactory” to “good”; in the comparison group - the changes were not significant, within the numerical intervals of the first day of treatment. Conclusions. The offered algorithm of conservative treatment of diabetic foot syndrome associated with combination of adhesive bandages Permafoam comfort and Atrauman Ag in complex management of trophic ulcers has a good therapeutic effect, reduces the terms of treatment, significantly improves patients’ quality of life.
Perm Medical Journal. 2015;32(4):32-36
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PECULIAR FEATURES OF ARTICULAR PAIN SYNDROME IN GIRLS WITH CONNECTIVE TISSUE DYSPLASIA SIGNS
Tikhomirova N.Y., Eliseeva L.N.
Abstract
Aim. To detect the peculiar features of articular pain syndrome in girls with connective tissue dysplasia (CTD) signs as well as frequency of osteoarticular CTD signs n the group of patients with articular pain syndrome. Materials and methods. One hundred and thirty three girls with a mean age of 21,52 ± 1,86 years were investigated. All the examined patients were divided into two groups on the basis of articular pain syndrome available. Group 1 enclosed 11 persons without pain syndrome. Group 2 included 122 patients with articular pain syndrome. All the examined persons underwent anthropometric and phenotypical investigations aimed at revealing osteous and articular CTD manifestations. Results. In the group with articular pain syndrome, such diseases as scoliosis (71,3 %), longitudinal platypodia (46,7 %), funnelform thoracic deformation (4,91 %) and articular hypermobility (54,9 %) occur reliably more often. When analyzing the obtained data, it was stated that the most frequent localization of pain are the lumbar (25,51 %), thoracic (13,10 %), and cervical (12,41 %) parts of the vertebral column, the knee (20 %), hip (6,21 %), sacroiliac (5,51 %), ankle (4,82 %) joints. Pain arises while moving (71,83 %), in the day-time (65,51 %). “Mechanical” (64,71 %) and “inflammatory” (27,94 %) character of pain were the most frequent. Pain syndrome is characterized by a wave-like course without progression (34,72 %). The beginning of pain syndrome is in most cases acute (47,82 %) or chronic (45,62 %). Arthralgias start at the age of 17,26 ± 3,39 years.
Perm Medical Journal. 2015;32(4):37-42
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FOURNIER’S GANGRENE
Prokhorov A.V.
Abstract
Aim. To study the peculiar features of clinicolaboratory radial picture, diagnosis and treatment of Fournier’s gangrene (FG). Materials and methods. The work was based on retrospective analysis of three cases of FG for the period of 2005-2015. In all cases FG patients were admitted to urological clinic with diagnosis of different acute inflammatory diseases of scrotum organs (AIDSO). At the prehospital stage, FG was not recognized. All patients had cormobid immunodeficient background. To diagnose, standard clinicolaboratory studies, roentgenography and ultrasonography of the urogenital organs were carried. Results. Incidence rate of FG was 1 case per every 13 500 AIDSO cases. At the receiving unit, patients underwent clinicoradial examination and AIDSO was excluded in all of them, FG was diagnosed in 2 patients and suspected in 1. When carrying out clinicoradial examination, FG was characterized in all patients by marked systemic inflammatory reaction of the body, progressive course, intensive pains, edema, necrosis and emphysema of external genital organs, and in 1patient - by partial uncovering of testicles and seminiferous tubules. Two patients experienced emergency necrectomy of the scrotum and perineum soft tissues. Two patients recovered, one patient died from septic shock. Conclusions. FG is a rare severe disease requiring emergency surgery. At its early stage it can stimulate AIDSO. Diagnostic criteria of FG are the following: acute onset, septic state, quickly progressing course, local manifestation in the form of severe pains, edema, erythemas, necrosis and emphysema of the external genital organs. Roentgenography and ultrasonography permit to clarify the borders of FG dissemination, to carry out differential diagnosis of FG and other AIDSO, to choose management tactics in time. Treatment of FG is based on emergency operative intervention, antibacterial and antishock therapy. Prognosis of FG is determined by the terms of rendering medical care; delayed medical measures are accompanied by development of infectious-toxic shock and its complications.
Perm Medical Journal. 2015;32(4):43-50
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BIOMECHANICAL MODELING OF CHOLEDOCH BILE FLOW IN CHOLEDOCHOLITHIASIS IN THE PROJECT “VIRTUAL PHYSIOLOGICAL HUMAN”
Samartsev V.A., Kuchumov A.G., Nyashin Y.I.
Abstract
Aim. To ground the role of biomechanics in development of the model of biliary system within the norm and pathology in the frame of the project “Virtual Physiological Human”. The model will be based on the methods of computational biomechanics using anatomical, experimental, physiological data of hepatopancreatoduodenal (HPD) organs obtained by means of radial diagnostic methods determining the unique anatomy of a patient. Mathematical solution of the task of bile flow in the common bile duct in case of chloledocholithiasis is presented as an initial stage in realization of dynamic modeling of bile flow in the anhepatic bile-excreting tracts. Materials and methods. The problem was posed and the mathematical model of bile flow in the choledoch with concretion in its acute blockade was developed. The model is based on solution of the Navier-Stokes equation recorded for non-newton fluid (Casson fluid) in special conditions. Results. Flow rate profiles, dependence of duct lumen bile flow on time and concretion size as well as dependence of biliary pressure on choledoch and concretion diameter are presented in the paper. Conclusions. The worked out mathematical model permits to estimate dynamics of the postoperative period and to predict the development of specific complications based on changes in the values of choledoch biliary pressure from the side of HPD organs. Moreover, estimation of biliary pressure in the duct is objective for determination of biliary decompression efficiency during endoscopic transpapillary interventions on the large duodenal papilla when the pressure is high and the bile excretion volume is less than 35 % of the proposed standard.
Perm Medical Journal. 2015;32(4):51-56
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DYNAMICS OF CLINICOLABORATORY CHANGES IN SUFFERERS WITH MULTIPLE AND ASSOCIATED LOCOMOTOR SYSTEM INJURIES
Schekolova N.B., Mudrova O.A., Zubareva N.S.
Abstract
Aim. To study the dynamics of pain syndrome, blood lactate, stress level and vegetative dysfunction in sufferers with multiple and associated injuries of the locomotor system. Materials and methods. Fifty six sufferers including 37 men and 19 women were investigated. Two groups were formed: group 1 - multiple locomotor system injuries in 30 patients; group 2 - locomotor system injuries associated with mild craniocerebral injury in 26 patients. Pain syndrome manifestation was studied by visual analogue scale for pain (VAS), stress level (SL) and Kerdo index (KI). Venous blood lactate concentration was determined. Results. Pain, autonomous reflectory or circulatory changes connected with it, led to formation of hypoxia, vegetative nervous system dysfunction. Severe vegetative disorders were usually detected in complex injuries, creating increased difficulties in reposition and fixation of fragments. Qualitative reposition of bone fragments was an adequate way for prevention of vegetative disturbances in severe locomotor system injury. It is necessary to assess hypoxia manifestation, stress and vegetative dysfunction levels in case of multiple and associated injury so as to carry out rational treatment of locomotor system injuries and their complications. Conclusions. 1. Traumatic disease course in case of multiple and associated injuries is accompanied by anemia and development of hypovolemic shock. Venous blood lactate was considered as an index of adequate oxygen delivery to organs and tissues. 2. Vegetative disturbances characterized the level of adaptive opportunities of the body. When considering these injuries as a stress status, complex approach to management of treatment and rehabilitation process was developed.
Perm Medical Journal. 2015;32(4):57-62
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NEURONET SYSTEM FOR INFANTILE ALLERGIC AND INFECTIOUS RHINITIS DIAGNOSIS
Minaeva N.V., Kumpan N.A., Yasnitsky L.N., Shiryaeva D.M.
Abstract
Aim. To develop the system of differential diagnosis of infectious and allergic rhinitis. Materials and methods. The data of 217 children with infectious and allergic rhinitis were used to develop the diagnostic system based on neuron network technology. Results. Differential diagnostic system permitting to diagnose with great accuracy “infectious rhinitis” and “allergic rhinitis” by means of minimum number of input parameters was worked out. Virtual computer experiments, estimating the role of passive smoking for the purpose of predicting these diseases, indicated contradictory results requiring further studies. Conclusions. The diagnostic system worked out can be used by the principle of “preliminary diagnosis of allergic rhinitis without allergologist” in the work of pediatricians, therapeutists, general practitioners as well as for screening diagnosis in conditions of “Health Centers”.
Perm Medical Journal. 2015;32(4):63-67
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CORRELATION BETWEEN SEROTONIN AND CYTOKINE CHANGES IN PATIENTS WITH TICK-BORNE ENCEPHALITIS
Sumlivaya O.N.
Abstract
Aim. To study the character of changes in serum serotonin (SS) and alpha-TNF, IL-6, IL-10 cytokine concentrations among patients with acute tick-borne encephalitis (TBE). Materials and methods. Sixty four patients with paralytic and nonparalytic TBE forms were examined. The control group included 25 healthy persons. Blood SS, IL-6, alpha-TNF and IL-10 concentrations were determined with the method of immune-enzyme analysis. Results. A mean SS level, irrespective of clinical form of disease, was 97,2 ± 57,1 ng/ml that is significantly lower than in healthy persons - 258,0 ± 136,5 ng/ml ( p = 0,003). The study of cytokine concentrations in all TBE forms at infection peak showed reliable difference from the control group with growth in the following indices: IL-6 4,4 ± 2,1 pg/ml versus 1,3 ± 0,2 pg/ml ( p = 0,005), IL-10 0,9 ± 0,6 pg/ml versus 0,06 ± 0,02 pg/ml ( p = 0,0001) and alpha-TNF 0,5 ± 0,3 pg/ml versus 0,08 ± 0,03 pg/ml ( p = 0,049). Conclusions. Interconnected changes in cytokines and serotonin neurotransmitter in tick-borne encephalitis indicate active participation of central mechanisms in regulation of immune response.
Perm Medical Journal. 2015;32(4):68-73
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METHOD FOR DETERMINATION OF NATURAL MINERAL SYLVINITE CONTENT IN PHYSIOTHERAPEUTIC POTASSIUM SALT CONSTRUCTIONS
Kirichenko L.V., Barannikov V.G., Rusakov S.V., Rusakova O.L., Safonova D.N., Varankina S.A., Khokhryakova V.P., Dementiev S.V.
Abstract
Aim. To develop and estimate a new method for calculation of mineral sylvinite content in salt constructions using software. Materials and methods. The program for determination of percentage ratio of salts offered by us was written in C# language in Microsoft Visual Studio 2010. Sylvinite to halite ratio in the salt screens was estimated by means of color separation of digital image of the sylvinite screen. Results. The study results prove the benefit of the method used for determination of even the smallest sylvinite droplets in the sylvinite screens. Conclusions. The proposed less durable and more precise method for determination of mineral sylvinite percentage in sylvinite with computer program can be successfully used for estimation of therapeutic properties of salt constructions. The offered method for calculation of sylviniye area in potassium salt constructions permits also to predict their therapeutic efficiency at the stage of planning.
Perm Medical Journal. 2015;32(4):74-77
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NEW ASPECTS FOR USING MINERAL PREVENTION IN AMBULATORY CONDITIONS
Ryazanova E.A., Barannikov V.G., Kirichenko L.V., Dementiev S.V., Sidorova D.A.
Abstract
Aim. To ground from hygienic and economic positions the possibilities of using modern sylvinite constructions at polyclinics. Materials and methods. Hygienic estimation of conditions of the internal environment of salt microclimatic ward “Sylvine-Universal” and physiotherapeutic sylvinite room was performed taking into account their constructive peculiarities. Economic efficiency obtained as a result of introduction of modern constructions into practical health service was calculated. Results. Modern sylvinite constructions possess a complex of physical factors capable of rendering positive influence on the human body. Conclusions. A complex of studies, carried out in sylvinite constructions, revealed benefit of their use at polyclinics.
Perm Medical Journal. 2015;32(4):78-84
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MEDICOSOCIAL CHARACTERISTIC OF PATIENTS WHO UNDERWENT LIPOSUCTION
Khramtsova N.I., Plaksin S.A.
Abstract
Aim. To determine the medicosocial characteristic of patients who underwent liposuction. Materials and methods. Medicosocial parameters and long-term results of patients who underwent mechanical and water-jet liposuction at The Center of Plastic Surgery of Perm Regional Clinical Hospital from 2007 to 2015 were analyzed. Results. During 9 years, two hundred persons underwent liposuction at The Center of Plastic Surgery. The majority of patients were women (96 %) with the mean age of 35,7 ± 9,1 years, mean body mass index - 24,5 ± 3,6 kg/m 2. Most patients were the citizens of Perm (65,5 %). The social structure was presented by patients with higher and specialized secondary education. The most popular zones of lipoaspiration for women were the following: lumbar regions, abdomen and hips, for men - abdomen and lumbar region. In one-three years following the surgery, there were obtained 76 % of good and excellent results. Conclusions. Mechanical and water-jet techniques of lipoaspiration fulfilled at The Center of Plastic Surgery of the city of Perm indicated high clinical efficiency, possibility of using local anaesthesia in the ambulatory conditions, as well as high satisfaction with operative results.
Perm Medical Journal. 2015;32(4):85-91
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HYGIENIC ASPECTS FOR ASSESSMENT OF LABOUR CONDITIONS AND THEIR INFLUENCE ON HEALTHY WORKERS ENGAGED IN PHTHALIC ANHYDRIDE INDUSRTRY
Salimgareeva T.M., Karimova L.K., Beigul N.A., Mavrina L.N., Gimaeva Z.F.
Abstract
Aim. To study the working conditions of the workers of the main occupational groups including operators of processing systems, machinists of pumping and compressor equipment, repairmen. Materials and methods. Complex hygienic studies were conducted in phthalic anhydride industry. Eighty four work places with 159 workers engaged in them were examined. The studies were performed using the generally accepted methods in accordance with working regulations. Results. Working conditions of phthalic anhydride industry workers are characterized by air exposure of chemical agents in the working zone, in-plant noise, unfavorable microclimate, hard and intensive work. Intensity of environmental factors and working process correspond to the third class of the second degree of occupational hazard. Medium occupational risk for health impairment was stated. Conclusions. On the basis of the studies, a system of guidelines directed to provision of safe working conditions, decrease in occupational and production-caused diseases, as well as traumatism was developed.
Perm Medical Journal. 2015;32(4):92-96
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ROLE OF TRANSCUTANEOUS CORONARY INTERVENTIONS IN TREATMENT OF MYOCARDIAL INFARCTIONS AT REGIONAL VASCULAR CENTER
Kireev K.A., Fokin A.A.
Abstract
Aim. To improve the results of treatment in patients with acute coronary pathology. Materials and methods. Retrospective analysis of work of Regional Vascular Center of Non-governmental Health Institution “Railway Clinical Hospital of Chelyabinsk OJSC “Russian Railways” for the period of 2012-2014 was carried out. Results. A three-year experience of rendering specialized medical care in case of myocardial infarction in the framework of regional program included 1192 cases that made 51,4 % of all patients hospitalized for acute coronary syndrome: 845 (70,9 %) patients underwent reperfusion interventions, 776 (65,1 %) - emergency transcutaneous coronary interventions. Participation coefficient of Railway Clinical Hospital (RCH) in diagnostic and therapeutic work among regional vascular centers was 19,6 % and 26,2 %, respectively. A three-year lethality (2012-2014) was 10,8 % (2012 - 10,4 %, 2013 - 12,5 %, 2014 - 10,3 %). The best lethality indices among patients with reperfusion therapy were 7,5 %, the worst ones - in patients without reperfusion treatment - 18,5 %. Conclusions. The work of RCH in rendering specialized medical care for patients with acute coronary pathology is characterized by significant decrease in lethality from 16 % in 2007-2011, when no endovascular techniques were used, to 10,8 % in the studied period of 2012-2014.
Perm Medical Journal. 2015;32(4):97-103
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TECHNIQUES FOR AUTOGENOUS SURGICAL RECONSTRUCTION OF SMALL INTESTINE IN SHORT BOWEL SYNDROME
Khasanov R.R., Gumerov A.A., Khagl K.I., Vessel L.M.
Abstract
Short bowel syndrome (SBS) is one of the main reasons of intestinal insufficiency development. The SBS therapy is aimed at promotion of an adequate development and growth, prevention of complications and, finally, patient’s refusal from parenteral nutrition and change for complete enteral nutrition. Multiple studies prove efficiency of autogenous surgical reconstruction (ASR) of the small intestine in treatment of short bowel syndrome. They can be divided into two large groups: techniques directed to slowing of intestinal transit by formation of valves, anti-peristaltic segments and others; and techniques for intestinal lengthening by means of reconstruction of the small intestine dilated while intestinal adaptation that allows to use all the intestinal mucosa for absorption and prevents development of intestinal content stagnation. Reduction of patient’s need in parenteral nutrition and, finally, refusal from parenteral nutrition is the main target of small intestine ASR in patients with short bowel syndrome. Choice of technique and patients for surgical treatment, time required for surgical treatment of SBS are very important factors for reaching positive results.
Perm Medical Journal. 2015;32(4):104-115
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