Vol 37, No 2 (2020)

Cover Page
Review of literature
Lower airways and lungs affection in coronavirus infection covid-19 among children and adults: similarities and differences (review of literature)
Furman E.G., Repetskaya M.N., Koryukina I.P.

The review presents the data of actual publications for 2019-2020 regarding the course of a new coronavirus infection COVID-19 in children and adults. The features of a new coronavirus SARS-CoV-2, the causes of its tropism to human respiratory system are discussed. The questions of clinical and roentgenological manifestations of lung affection in COVID-19 among children and adults are described in details. The adult COVID-19 is characterized by the presence of clinical symptoms of acute respiratory viral infection: elevation of temperature (> 90 %), cough (dry or with small amount of sputum) in 80% of cases, dyspnea (55 %), fatigability (44 %), sense of stiffness in chest (> 20 %). The most severe dyspnea is being developed by the days 68 from the moment of falling ill. Separately, the peculiar features of computed tomography of the lungs in children and adults with COVID-19 are discussed. The typical signs for CT-picture of the lungs in children with COVID-19 infection and pneumonia are bilateral affection, infiltration with a typical surrounding aureole – the sign of “halo”, the symptom of “opal glass” with predominantly peripheral localization and often in combination with elevated procalcitonin level. The cases of pneumonias in newborns and children of the first year of life with COVID-19 infection are considered in the paper. A clinical case with roentgenograms of thoracic organs and results of computed tomography accompanying is presented as an illustration. The high-risk groups of complicated COVID-19 course can include children with chronic bronchopulmonary diseases, patients with immune deficiencies, hemodynamically significant heart failures and chronic renal disease.

Perm Medical Journal. 2020;37(2):5-14
Body dysmorphic disorder (dysmorphophobia / dysmorphomania): literature review
Khramtsova N.I., Zayakin Y.Y., Plaksin S.A., Kurkina V.А.

A literature review regarding body dysmorphic disorder. Analysis of Russian and foreign bibliographic sources. Dysmorphophobia (body dysmorphic disorder, dysmorphomania) is a psychopathological disorder with ideas of imaginary or exaggerated personal physical inferiority. In the general population it occurs in more than 2 %. Criteria for dysmorphophobia diagnosis are the following: excessive preoccupation with any imaginary or insignificant defect in appearance; preoccupation with a clinically significant disorder or impairment in social, occupational or other important areas of functioning; the clinical picture is not explained by another mental disorder. A unique approach to the diagnosis of dysmorphophobia has not been developed yet; clinical, pathopsychological and anamnestic methods are used as well as special questionnaires. Treatment includes drug and psychotherapeutic approaches. The disease is usually chronic, only 9 % of patients manage to achieve stable remission and only 21 % – partial. Narrow specialists are not always acquainted with dysmorphophobia; it leads to an incorrect diagnosis and treatment. It is necessary to improve methods for the timely detection and correction of this form of mental pathology in order to prevent severe personal and social consequences of the disease.

Perm Medical Journal. 2020;37(2):15-23
Original studies
Cases of mumps development in outbreak incidence: clinical and epidemiological observation
Postanogova N.O., Semerikov V.V., Sofronova L.V., Woldschmid N.B.

Objective. To study the clinically significant differential diagnostic signs of mumps.

Materials and methods. Medical records of hospital patients (form № 003/у) with mumps (n = 12) and extraordinary report of epidemiological detection of epidemic mumps focus over the period 27.11.2017 to 02.02.2018 among the members of Hockey Club “MP” were used. Quantitative data are presented as M ± α, where M – mean value, α – standard deviation; indices characterizing qualitative signs were determined in percent (%).

Results. Clinical-laboratory features of mumps during outbreak in conditions of multiyear practice of vaccine prevention are presented. Among the hospitalized patients, inflammation of parotid gland was observed in 100 %, pancreatitis – in 83 %, orchitis – in 25 %. These cases of disease in Russia are interesting in connection with a single registration of clinical cases of infection for the recent years – sporadic level of disease. The cases of disease are presented by clinical and laboratory manifestations of the same type in an organized group of subjects going in for sports, who came from North China.

Conclusions. During mumps outbreak in Perm, the clinical picture was characterized by a unilateral inflammation of the parotid salivary glands followed by bilateral damage and involvement of other glandular organs (pancreas, ovaries). The cause of mumps ictus in the studied territory was the infection, brought to an organized team of the hockey club “MP” against the background of reduced with age concentration of the level of protective antibodies to mumps.

Perm Medical Journal. 2020;37(2):24-32
Orthopedic aspects of functional connective-tissue mobility structures in development and course of intra-articular pathology of knee joint
Ladeischikov V.M., Denisov A.S., Zagorak D.P.

Objective. To reveal the influence of functional mobility of connective-tissue structures on the development and course of intra-articular pathology of the knee joint.

Materials and methods. Patients (n = 279) with intra-articular pathology of the knee joint after the arthroscopic treatment were examined. The state of functional mobility of connective-tissue structures was diagnosed using the “express method for dysplastic state of connective tissues in conditions of ambulatory-polyclinic service”. Statistical analysis was carried out with Pirson correlation criteria.

Results. The paper is devoted to analysis of the influence of functional connective-tissue structure mobility on the development and course of intra-articular pathology of the knee joint. Subjects with low functional mobility of the connective-tissue structures were established to be more often subjected to chondromalacia of cartilaginous tissue of the femoral medial condyle and injury of the medial meniscus. Such pathology as slipping patella, Goff body hypertrophy and knee joint chondromatosis are typical for subjects with hypermobility of the connective-tissue structures.

Conclusions. High degree of functional mobility of connective-tissue structures significantly contributes to “preservation” of cartilaginous cover of the femoral medial condyle, even with concomitant pathology of the knee joint available. For men with high functional mobility of connective-tissue structures, the most common diseases are knee joint chondromatosis and Goff body hypertrophy, and for women – slipping patella. For women with low functional mobility of connective-tissue structures, the most typical is pathology of the medial meniscus.

Perm Medical Journal. 2020;37(2):33-40
Iatrogenia as a cause of postcholecystectomy syndrome
Sitnikov V.A., Ibragimova D.R., Kasimova N.R., Styazhkina S.N.

Objective. To analyze the most frequent diagnostic, tactical and technical errors of young doctors, leading to postcholecystectomy syndrome.

Materials and methods. The analysis was based on the clinical material of 87 patients from the Surgical Department of Regional Clinical Hospital №1 and City Clinical Hospital №2 of Izhevsk regarding reconstructive and restorative surgeries on the biliary tract for the last 40 years (1978–2018).

Results. The reasons, causing iatrogenic injuries of the bile ducts during cholecystectomy, are diagnostic, tactical, technical. Diagnostic errors are more often associated with inadequate diagnosis of cholelithiasis and cholecystitis (underestimation of history, complaints, clinical picture of the disease and its complications; failure or impossibility of FGDS; insufficient topical diagnosis while ultrasound investigation of the biliary tract and abdominal organs). Tactical errors in surgeries on the gallbladder include: overly expectant tactics, incorrect choice of surgical approach and method of anesthesia, lack of experience of the surgeon, inadequate revision of the biliary tract during surgery, refusal from surgical cholangiography and external drainage of the choledoch in case of doubtful patency of the bile duct. Technical reasons are specific features of the anatomy of the extrahepatic biliary tract, factors complicating the surgery, violation of surgical technique when performing an operation on the bile duct.

Conclusions. Correct and timely diagnosis of bile diseases as well as qualified technique of surgical intervention will minimize the development of post-cholecystectomy syndrome and other iatrogenic complications.

Perm Medical Journal. 2020;37(2):41-47
Features of effect of low-intensity laser irradiation on prokaryotic and eukaryotic cells
Godovalov A.P., Yakovlev M.V., Batog K.A., Remennikova M.V., Bykova L.P., Pastukhov D.M.

Objective. To study the possibility of using LED blue, red, and green radiations of a new apparatus to eliminate prokaryotic cells and maintain human cell viability. Currently, laser technologies are widely used in medical practice. However, there are relatively few studies on the effect of laser radiation with similar parameters on the viability of prokaryotic and eukaryotic cells.

Materials and methods. As a radiation generator, the LFDT-02 diode medical laser of a new type from the Perm Scientific and Production Instrument-Making Company was used. Staphylococcus aureus 66G cultures were irradiated with a different wavelengths laser (exposure time – 2 min, power – 22 mV). After that, the viability of microorganisms was evaluated by direct seeding on nutrient media. To study the effect of laser radiation on macroorganism cells, fasting samples of buccal epithelium were obtained in 17 practically healthy volunteers aged 20–25 years with an intact periodontium and dentition, without somatic pathology. To assess cell viability, a vital dye was used – 0.1 % trypan blue solution. The exposure time and power do not differ from those for the studied S. aureus strain. To assess the morphological changes of epithelial cells, preparations were prepared for microscopy, which, after fixation, were stained according to the Romanovsky-Giemsa method.

Results. When evaluating the effect of laser radiation, especially in a clinical setting, it is necessary to take into account its possible effect not only on cells of conditionally pathogenic microorganisms, but also on human cells. In the present study, it was shown that laser radiation with a power of 22 mV allows one to achieve a bacteriostatic effect against S. aureus but it also significantly reduces the viability of buccal epithelial cells, that can be considered, on the one hand, as a side effect of laser radiation and, on the other hand, the removal of dying cells filled with microorganisms, can enhance the effect of ongoing therapy.

Conclusions. Based on the results obtained, it can be concluded that the laser radiation of a diode laser with a wavelength of 405 nm (blue) and 650 nm (red) has a pronounced bacteriostatic effect. However, a significant damaging effect of red radiation on macroorganism cells was found.

Perm Medical Journal. 2020;37(2):48-53
Application of biomechanical research methods in evaluating results of surgical treatment of children with Legg – Calve – Perthes disease
Baindurashvili A.G., Kostomarova E.A., Nikityuk I.E., Kononova E.L., Barsukov D.B., Baskov V.E., Pozdnikin I.Y., Bortulev P.I.

Objective. To study the functional state of the musculoskeletal system in patients with Legg – Calve – Perthes disease after surgical treatment.

Material and methods. The study of 31 patients at the age of 8 to 13 years with unilateral Legg – Calve – Perthes disease (LCPD) was performed in the period from 2 to 5 years after surgical treatment. In the control group (15 children), correcting (varus) osteotomy (VO) was fulfilled, in the main group (16 children) – triple pelvic osteotomy (TPO), and the group of healthy children (18 persons) was examined as well. Walking biomechanics was studied using of the STEDIS complex (Neurosoft LLC, Ivanovo, Russia). The vertical balance of the body was evaluated on a stabilometric platform MBN "Biomechanics" (LLC NMF MBN, Moscow).

Results. After surgical treatment, the indicators of vertical balance and biometry of the step phases in both groups of children with LCPD did not reach the same level as in healthy individuals at the indicated follow-up dates. The least significant indicators of step phase asymmetry were found in patients after TPO compared with patients after VO. In patients after VO, the destabilization of the center of pressure significantly exceeded that in patients after TPO.

Conclusions. Biomechanical studies allow us to compare the functional results of various techniques of surgical treatment of children with unilateral LCPD. After TPO operation, patients have a more complete restoration of the supportability of the affected lower limb compared to VO operation.

Perm Medical Journal. 2020;37(2):54-64
Use of echocardiographic parameters of longitudinal mechanics to estimate diastolic function of systemic ventricle in patients after fontan operation
Sinelnikov Y.S., Matanovskaya T.V., Orekhov S.A.

Objective. To study the possibilities of using echocardiographic parameters of longitudinal mechanics to assess the diastolic function of the systemic ventricle (SV) in patients after Fontan operation.

Material and methods. We examined 29 children aged 8,6 ± 3,16 years with a functionally single ventricle of the heart after performing a total cavopulmonary connection with fenestration of extracardiac conduit. By computed tomography there were evaluated: myocardial mass index (MMI) SV, ejection fraction (EF) SV, cardiac output (CO) SV, cardiac index (CI) SV. In addition to conventional echocardiographic (Echo) parameters, we also studied: diastolic velocity parameters of the longitudinal mechanics of the SV during the early rapid filling phase (SR E), in the phase of late diastolic filling (SR A), the ratio of the peaks of the strain rate (SR E/SR A), the stiffness index of a «functionally single» atrium, the atrial strain in conduit phase (AS cd), reservoir (ASr), and in the contractile phase (AS ct).

Results. Reduced values of the SI, CO and CI SV, an increase in MMI SV, normal values of EF SV. The parameters of the longitudinal diastolic strain rate in the early and late filling phases of e SV showed a direct significant correlation with SI, CO and CI SV and inverse correlation with E/e '. Parameters of longitudinal strain of the «functionally single» atrium in all phases were reduced, they all correlated with E / e´, SR E / SR A, MMI SV, SI, CO and CI SV. There was no statistically significant relationship between the parameters of the longitudinal function of the atrium in all phases and atrial stiffness with sex and body surface area.

Conclusions. 1. The parameters of the longitudinal diastolic strain rate can be used to identify the diastolic dysfunction of the systemic ventricle in children after Fontan operation. 2. The hemodynamic parameters of the systemic ventricle (stroke index, cardiac output, cardiac index) determine the parameters of its diastolic mechanics. 3. The reservoir, conduit, and contractile atrial function in patients after total cavopulmonary connection are associated with both characteristics of diastolic longitudinal strain rate and hemodynamic parameters of systemic ventricle.

Perm Medical Journal. 2020;37(2):65-82
Methods of diagnosis and technologies
Experience and possibilities of video laparoscopy in emergency abdominal surgery
Turbin M.V., Cherkasov M.F., Melikova S.G., Ustimenko I.V.

Objective. To evaluate the effectiveness and improve treatment outcomes for patients with acute abdominal pathologies using video laparoscopy. Materials and methods. The paper is based upon a ten-year experience of using video laparoscopy in emergency abdominal surgery. Within a decade (2008 – 2018), 23127 patients had been admitted to the surgical department of City Emergency Hospital in the city of Rostov-on-Don; among them 19748 patients were operated on. Video laparoscopic surgeries for acute appendicitis, acute cholecystitis, acute intestinal obstruction, perforated gastric and duodenal ulcers, and other acute abdominal surgical pathologies were performed in 15124 patients; the share of these interventions was 76.6 % of all cases.

Results. Initially, when laparoscopy was introduced in emergency abdominal surgery, diagnostic laparoscopy was used in more than a half of the performed surgeries, mainly for acute appendicitis and abdominal injuries. Today, video endoscopic surgery is widely used for acute cholecystitis, acute pancreatitis, perforated ulcers, strangulated hernias, torsions of epiploic appendages of the colon and of the greater omentum. An effective use of video laparoscopy for therapeutic purposes allows increasing the number of laparoscopic operations performed in patients with emergency surgical pathology of abdominal organs.

Conclusions. Video laparoscopy in urgent surgery allows establishing a diagnosis in time, performing dynamic video laparoscopy, eliminating concomitant pathology, diagnosing and, in some cases, preventing postoperative complications. Video laparoscopic surgery is easier for patients to tolerate; it reduces the number of complications, the period of staying at the hospital and the rehabilitation period, and opens up new possibilities for helping patients with emergency surgical conditions.

Perm Medical Journal. 2020;37(2):83-92
Optimization of management of patients with coloproctological profile in outpatient surgical treatment of hemorrhoids
Lisichkin A.L., Busyrev Y.B., Karpunina T.I.

Objective. Various aspects of the organization and optimization of diagnosis and treatment, including surgical, in patients with hemorrhoids – one of the most common diseases in coloproctology – are still the subject of discussion. Problems of the postoperative period can be prolonged spasm of anal sphincter, severe pain syndrome and delayed postoperative bleeding.

Materials and methods. We conducted a one-center prospective study in 214 patients, undergoing surgical treatment for stage 3–4 chronic hemorrhoids. The most common surgery for hemorrhoids was a different combination of hemorrhoidal artery ligation (HAL), rectomucopexy (RAR) and excision of one to three external hemorrhoids in one and the same patient. In all the observations, we used a specially developed questionnaire, including a visual-analog scale (VAS) and registration of taking anesthetiсs per day, so as to objectify the assessment of the level of pain after surgery. Identification of local inflammation included taking a blood sample in an amount of 0.1 ml when punctured with a GU insulin syringe during anoscopy and enzyme-linked immunosorbent assay in accordance with test system instructions and determining interleukin 1 (IL-1), interleukin 4 (IL-4), tumor necrosis factor (FNO-α) and interleukin 8 (IL-8). Results. According to the results obtained (severity of pain syndrome and amount of anesthetics, absence of complications), patients were conditionally divided into three groups – with mild reaction to surgery – 44 (20.5 %), moderate – 100 (46.5 %) and severe – 70 (32.5 %). In the group with mild reaction, the level of the analyzed indices was almost consistent with the norm; in group II, there was an elevation of two of them; in group III, the level of at least three tests was higher than the norm.

Conclusions. More favorably, the postoperative period proceeds against the background of initially unexpressed local inflammation. The proposed additional examination method, which allows identifying subclinical local inflammation and assessing its severity, should help to optimize the selection and, as a result, increase the efficiency and safety of surgical treatment of hemorrhoids on an outpatient basis.

Perm Medical Journal. 2020;37(2):93-100
Quality of life study in patients with nodular and multinodular forms of euthyroid goiter
Zaivchatsky M.F., Volkov Y.V., Denisov S.A., Teplykh N.S., Blinov S.A., Amarantov D.G., Kolyvanova M.V.

Objective. To study and estimate the quality of life in patients with nodular and multinodular forms of euthyroid goiter prior to the surgery and in different postoperative periods.

Materials and methods. The method of random study was used to examine 100 patients with nodular and multinodular forms of euthyroid goiter, who were treated at Perm Regional Treatment and Diagnostic Center “Center of Hepatic and Endocrine Surgery” in 2009–2017. To study patients’ quality of life, SF-36 survey was used. The quality of life indices were assessed prior to the surgery, 1 and 6 days after the surgery as well as 3 and 6 postoperative months.

Results. The quality of life in patients with nodular and multinodular forms of euthyroid goiter is subjected to the influence of not only preoperative factors but also factors, occurring in both early and long-term postoperative periods. Special attention is to be paid to psychological factors of the preoperative period. Three and six months after the surgery, patients with initial compression of cicatricial deformity of the neck organs had improved psychoemotional indices.

Conclusions. Studying of the quality of life permits to estimate the efficiency of surgical treatment in patients with thyroid diseases. Relative decrease in the quality of life indices among patients with nodular and multinodular forms of euthyroid goiter are most evidently manifested in the early postoperative period. In case of favorable course of the postoperative period, improvement of physical activity is observed in 5 days, psychological – in six months. Six months later, the quality of life indices in patients with both forms of goiter did not differ from those in the comparison group.

Perm Medical Journal. 2020;37(2):101-108
Anniversaries and information on events
On the 120th birthday of Professor A.V. Pshenichnova - founder of the Perm School of Microbiologists
Gorovits E.S., Kuzyaev R.Z., Timasheva O.A.

March 23, 2020 marks the 120th anniversary of the birth of the famous scientist who left a bright trace in Russian science, A.V. Pshenychnova. Alexey Vasilievich - creator of the Perm School of Microbiologists, Honored Scientist of the RSFSR, State Prize Laureate, Doctor of Medical Sciences, Professor.

Perm Medical Journal. 2020;37(2):109-115

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