Vol 32, No 6 (2015)

Articles
METABOLIC BASIS FOR REDUCTION OF SURGICAL AGGRESSION MANIFESTATIONS IN MINI-INVASIVE INTERVENTIONS
Vlasov A.P., Zarivchatsky M.F., Kudankin R.M., Meleshkin A.V., Chamatkina E.M., Bolotskikh V.A., Abramova S.V.
Abstract
Aim. To assess the association of clinical effect of laparoscopic operations with reduction in endogenous intoxication and oxidative stress among patients with acute destructive cholecystitis complicated by acute pancreatitis. Materials and methods. The work is based on the materials of clinocolaboratory studies performed in patients with acute destructive cholecystitis complicated by acute pancreatitis. Clinicolaboratory studies were carried out in patients with acute destructive cholecystitis complicated by acute pancreatitis, who had undergone cholecystectomy using laparotomy ( n = 22) and laparoscopy ( n = 20). In group 1, progression of systemic membrane-destabilizing disorders and endotoxicosis in the early postoperative period was diagnosed. Results. When using mini-invasive laparoscopic techniques, less marked metabolic disorders were observed that is an important condition for prevention of acute pancreatitis progression. The correlation between the indices of free-radical lipoperoxidation, those of endogenous intoxication in patients after cholecystectomy fulfilled by different techniques and the basic postoperative clinicolaboratory indices including phospholipase and blood plasma alpha-amylase activity ( r = 0,763-0,934, p < 0,05) was stated. Conclusions. One of the most significant components of the best therapeutic effectiveness of low-traumatic surgeries is their ability to induce comparatively minor postoperative metabolic disorders.
Perm Medical Journal. 2015;32(6):6-13
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DIAGNOSIS AND TREATMENT OF URETHRAL AND URINARY FOREIGN BODIES IN ADULTS
Prokhorov A.V.
Abstract
Aim. To improve the quality of diagnosis and treatment of urethral and urinary foreign bodies (FB). Materials and methods. Thirty eight cases of urethral and urinary foreign bodies observed at CCUH № 47 and CCH № 57 of Moscow over the period from 1995 to 2015 were analyzed retrospectively. To diagnose FB, clinicolaboratory, roentgenological, ultrasound and endoscopic methods for investigation of urogenital organs were used. Results. The incidence rate of urethral and urinary FB was approximately 1 case per each 3500-4000 cases of acute urogenital diseases a year. More than 2/3 of patients were young men, half of them suffered from different mental diseases. In more than 1/2 of cases, different FB, predominantly household goods, were inserted into the urethra for autoerotic purpose. In 2/3 of cases foreign bodies provoked an acute ischuria and macrohematuria requiring urgent hospitalization. All patients were divided into 2 clinical groups different by age, structure of concomitant diseases, causative factors, localization and character of FB. Diagnosis of FB was carried out by the algorithm, developed by us, which included sequential use of clinicoradial, instrumental and endoscopic methods of study. Urethrocystoscopy used for diagnosis and withdrawal of FB from the urethra and urinary bladder was preferable. Conclusions. Division of patients with urethral and urinary FB into clinical groups into clinical groups contributed to optimization of diagnostic process, and in some cases helped to determine medical tactics. Clinicoradial and instrumental methods helped to diagnose, to assess sizes, localization of FB and to determine medical tactics in 85 % of patients. Surgical urethrocystoscopy, as the basic technique, permitted to withdraw urethral and urinary FB from 80 % of patients.
Perm Medical Journal. 2015;32(6):14-24
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CEREBRAL VASOMOTOR REACTIVITY IN ACUTE PERIOD OF ISCHEMIC STROKE
Kuzina O.L., Kulesh A.A., Shestakov V.V.
Abstract
Aim. To estimate the cerebrovascular reactivity in the acute period of ischemic stroke and its association with clinicoinstrumental data. Materials and methods. The time-averaged maximum velocity (TAMX) of blood flow was assessed in 25 patients in the medial cerebral artery from the two sides initially, and at the minutes 1 st, 5 th, 10 th after hypercapnic test (HT) followed by semi-orthostatic test. On the basis of the obtained parameters, reactivity index (RI) was calculated. The data were analyzed in the context of correlation with patients’ neurological, cognitive and functional status as well as MRT data and laboratory indices. Results. On the side of the focus, a significant increase in the average velocity and RI during HT was noted without any rise on the opposite side. A further semi-orthostatic load led to decrease in the velocity from both sides that was more marked contralaterally. The most important determinants of cerebrovascular reactivity (CVR) indices were the level of patients’ education, systolic arterial pressure at admittance to the hospital, lipid spectrum, thickness of “intima-media” complex, amount and sizes of acute ischemic foci. In its turn, CVR indices were associated with a global cognitive status of patients and their functional status at discharge from the hospital. Conclusions. Cerebrovascular reactivity in the acute period of ischemic stroke is more marked on the side of the focus and is determined by complex of parameters associated with common cardiovascular risk. Correlation between CVR, global cognitive status and functional status at discharge from the hospital permits to consider it as one of predictors of the outcome in the acute period of disease.
Perm Medical Journal. 2015;32(6):25-30
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DIAGNOSTIC VALUE OF DAILY URINE METANEPHRIN TEST IN CHROMAFFIN TISSUE TUMORS
Kotelnikova L.P., Fedachuk A.N.
Abstract
Aim. To assess the sensibility and specificity of daily urine metanephrin test in chromaffin tissue tumors. Materials and methods. The results of laboratory tests - daily urine metanephrins - were analyzed using immunoenzyme method in 64 patients with tumor diseases. Results. The method sensibility for pheochromocytoma was 76,2 %, for its malignant forms - 50 %; the method specificity was 65,1 %. There was established a significant rise in metanephrin level in the daily urine in case of pheochromocytoma as compared with the other adrenal tumors ( r = 0,38; p = 0,001), as well as in patients with a significant increase in arterial pressure, hypertensive crises, or persistent course of disease both in the group with pheochromocytomas and in the group with the other adrenal tumors ( r = 0,31; p = 0,1). The tendency to decrease in sensibility of daily urine metanephrins with growth in malignant tumor potential by PASS scale in case of chromaffin tissue tumors ( r = -0,32; p = 0,14) was noted. When analyzing the degree of elevation of daily urine metanephrins, significant dependence of pheochromocytoma available ( r = 0,49; p = 0,004) on matanephrin level ( r = 0,49; p = 0,004) was detected. The latter is reaching 100% in case of 4,6-fold increase in metanephrin and normetanephrin content.
Perm Medical Journal. 2015;32(6):31-35
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ROLE OF CALCIUM-PHOSPHATE BIONS IN PATHOGENESIS OF ATHEROSCLEROSIS: TOXICITY FOR ENDOTHELIUM
Kutikhin A.G., Velikanova E.A., Filipiev D.E., Mukhamadiyarov R.A., Matveeva V.G., Antonova L.V., Golovkin A.S., Russakov D.M., Grigoriev E.V., Brusina E.B., Barbarash O.L.
Abstract
Aim. To assess the toxicity of calcium-phosphate bions (CPB) for epithelium in vitro and in vivo . Materials and methods. Artificial CPB synthesis, standard methods for cell culturing, phase-contrast microscopy, transmission electronic microscopy, annexin-V/7-aminoactinomycin D-test, 3-(4,5-dimethylthiazol-2-il)-2,5-diphenyltetrazolium bromide (MTT-test), immune-enzyme assay, original experimental model of rat aortal angioplasty using balloons for coronary angioplasty, hematoxylin-eosin stain and Van Gieson’s stain, histological analysis, statistical analysis were used. Results. CPB were internalized by endothelial cells of the EA.hy 926 line. The share of cells exposed to late apoptosis/necrosis was significantly higher, whereas, the share of bioplasts was significantly lower in the cultures of CPB-exposed cells as compared to the control cultures; no dose-dependence was revealed. The levels of interleukin-6 and interleukin-8 were significantly higher in the supernatant from CPB-exposed cells versus the control cultures. There was also observed a significant hyperplasia of intima in 3 CPB- exposed rats, but not in the controls. The intima to media ratio in the abdominal aorta wall was also significantly higher in CPB-exposed rates in comparison with the control rats. Conclusions. Calcium-phosphate bions have a toxic effect on endothelial cells.
Perm Medical Journal. 2015;32(6):36-44
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SUBPOPULATION LYMPHOCYTE STRUCTURE IN EXPERIMENTAL MOUSE INFECTION CAUSED BY VARIANTS OF ONE TICK-BORNE ENCEPHALITIS VIRUS STRAIN
Motuzova O.V., Akhmatova E.A., Khomenkov V.G., Akhmatova N.K., Lebedinskaya O.V., Karganova G.G.
Abstract
Aim. To study the immunophenotypical peculiarities of mice lymphocytes in experimental infection caused by clones 57 and 58, as the variants of one Tick-borne encephalitis virus (TBEV) strain. Materials and methods. The influence of variants 57 and 58, extracted from the population of one TBEV strain, on immunophenotypical peculiarities of infected mice lymphocytes was studied. Results. In our study, variants 57 and 58 were close by their effect on the structure of lymphocyte subpopulations. The viruses did not influence T lymphocyte number, but in this or that extent, they caused decrease in the number of NKT ( p < 0,05) and T-regulatory cells ( p < 0,05). Both variants also elevated ( p < 0,05) the level of cells with early activation marker (CD45/CD25). The specific feature of variant 57 was induction of B lymphocyte number (CD45/CD/19, p < 0,05). Mixed infection of animals with variants 57 and 58 induced disbalance of immune response, characterized by fall in the number of T lymphocyte, T helper, NK cell pools and rise in B lymphocyte level. Conclusions. Thus, the ability of TBEV variants, as the components of one viral population, to modulate effector functions of hereditary and adaptive immunity at early stages of infectious process was demonstrated.
Perm Medical Journal. 2015;32(6):45-50
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UVEITES MORBIDITY IN PERM KRAI POPULATION
Konkova A.Y., Gavrilova T.V., Chereshneva M.V.
Abstract
Aim. To study the uveites morbidity among the population of Perm Krai. Materials and methods. Retrospective analysis of morbidity state regarding eye and its accessory apparatus diseases over the period of 14 years (2000-2013) and uveites morbidity during 12 years (2003-2014) was carried out. Results. The general and primary morbidity rate of eye and its accessory apparatus diseases as well as uveites was detected to have a tendency to growth in the population of the Russian Federation, Privolzhsky Federal Region and Perm Krai. Conclusions. Analysis of uveites morbidity among the population of Perm Krai indicated negative tendencies; the growth of primary uveites morbidity occurred to be more rapid than that of visual organ diseases as a whole. Negative dynamics of morbidity is typical for all eye and its accessory apparatus diseases.
Perm Medical Journal. 2015;32(6):51-55
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MEDICAMENTOUS THERAPY OF GERIATRIC PATIENTS BY MEANS OF MOBILE EMERGENCY TEAMS
Chereshneva N.D., Smirnov A.V., Soloninina A.V.
Abstract
Aim. To develop the proposals regarding optimization of medicamentous aid to aged patients at the prehospital stage. Materials and methods. The reasons for calling a doctor and administration of drugs to aged patients by emergency teams were analyzed. For this purpose, cards of emergency calls belonging to 153 patients [aged] 60 and older were used. Results. Analysis of the structure of basic diagnoses by MKB-10 codes showed that the diseases of circulation system are prevailing. The symptoms, causing emergency calling were chest (heart) pains, high pressure, stomach-ache. The greatest number of drugs prescribed falls at “nervous system” and “cardiovascular system”. The following drugs became the leaders by the number of administrations: ketorolac, glycine, dexamethasone, diphenhydramine, captopril, nitroglycerin, sodium metamizol; 8,1 % of drugs are not included into the complex of remedies for emergency ambulance. Analysis of application instructions for the drugs not included into the complex of remedies indicated that such drugs as bromdihydrochlorophenilbenzodiazepine, lily-of-the-valley leaves glycoside, bisoprolol, methionil-glutamil-hystidil-phenylalanile-prolyl-glycyl-proline, mebeverine, strophanthine can be recommended for inclusion into the complex of remedies for emergency teams. Conclusions. The studies proved the necessity of correcting the drug list for rendering emergency medical aid to aged persons.
Perm Medical Journal. 2015;32(6):56-62
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PRODUCTION AND NONPRODUCTION RISK FACTORS FOR DEVELOPMENT OF OCCUPATIONAL STRESS IN PETROCHEMICAL INDUSTRY WORKERS
Gimaeva Z.F., Kaptsov V.A., Karimova L.K., Mavrina L.N., Beigul N.A.
Abstract
Aim. To develop the complex of preventive measures directed to elevation of stress-resistance among petrochemical production workers. Materials and methods. Hygienic studies regarding the assessment of working conditions were carried out at the place of work of petrochemical production workers and enclosed hygienic estimation of environmental factors and working process according to P 2.2.2006-05. Intensity and hardness of working process was assessed at 95 places of work. To estimate the value of psychosocial factors of production and nonproduction nature, sociopsychological studies including anonymous questionnaire by specially developed forms and psychological testing (test method) using Hospital Anxiety and Depression Scale - HADS (Zigmond A.S. et al) were conducted. Results. The results of hygienic studies for estimation of the intensity of working process indicated that neuroemotional loads are the most typical for all occupational groups. The most intensive was operators’ work attributed to harmful class 3.1, artificers’ work - to admissible class. Conclusions. The factors inducing formation of stress status in workers of petrochemical production were revealed on the basis of the results of hygienic and sociopsychological studies.
Perm Medical Journal. 2015;32(6):63-70
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MYELODYSPLASIA SYNDROME. CLINICAL CASE REPORT
Babushkina G.D., Kiryanova N.V., Popova N.I., Golubeva M.E., Firsova G.V., Kiryanova T.V.
Abstract
In 2004 anemia and thrombocytosis were accidentally detected in a patient aged 53. In 2011 myelodysplasia syndrome was suspected, when myelogram indicated the following parameters: mixed normoblastic and megaloblastic type of hematosis, hyperplasia of megakaryocytic process, monocytic reaction. In 2015 differential diagnosis with oncopathology and myeloid leucoses was conducted. The diagnosis was: myelodysplasia syndrome, severe refractory anemia, thrombocytosis, myocardiodystrophia, heart failure IIA. Therapy was started with low doses of cytosar having positive effect.
Perm Medical Journal. 2015;32(6):71-77
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RESULTS OF TREATMENT OF CHYLOPERITONEUM IN NEWBORN CHILDREN
Rudakova E.A., Kovaleva O.A., Openysheva A.V., Koroleva M.A.
Abstract
Description of two clinical cases of chyloperitoneum in newborns is presented in the paper. The causes of development, methods for diagnosis and management are considered.
Perm Medical Journal. 2015;32(6):78-83
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POSSIBILITIES OF STUDYING SMALL INTESTINAL STATUS IN PATIENTS WITH ARTERIAL HYPERTENSION
Ivanyuk E.S., Lozhkina N.V., Ivanyuk A.S., Khlynova O.V., Tuev A.V.
Abstract
The problems discussed in the paper are the following: expediency and possibilities of studying the status of the small intestine (SI) in persons with arterial hypertension (AH); whether the small intestine can be considered as a target organ in AH; what are the peculiarities of SI and AH pathology comorbidity. For this purpose, analysis of native and foreign studies devoted to the assessment of small intestinal mucosa in patients with digestive system pathology was used to hypothesize application of capsule endoscopy among subjects with AH and gastrointestinal dyspepsia symptoms.
Perm Medical Journal. 2015;32(6):84-95
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DIFFERENCES IN PHYLOGENETIC FACTORS OF ETIOLOGY AND PATHOGENESIS UNITY OF METABOLIC PANDEMIAS - CIVILIZATION DISEASES
Titov V.N.
Abstract
Regulation of metabolism in vivo can be understood when considering the formation in phylogenesis of the function of humoral, hormonal mediators, vegetative regulators separately: a) at the cell level; b) in paracrinally regulated cell communities (PC), organs and systems and c) at the body level. Each of regulation levels was formed at different stages of phylogenesis; the completion of levels occurred, we suppose, when reaching “relative biological perfection”. Formation of organs and organ systems was finished also, in our opinion, at the level of this perfection. When three levels reached sequentially were analyzed in Homo sapiens , it was revealed with systemic approach that through “relative biological perfection” at the level of the body, “regular mismatch” of metabolism is observed. Phylogenetic mismatch of the regulation of metabolism at three levels of “relative biological perfection” are etiological factors of “metabolic pandemias” of each of “civilization diseases”. All “metabolic pandemias” including atherosclerosis, metabolic arterial hypertension, IR status, obesity, metabolic syndrome and nonalcoholic fatty liver disease are disorders of one, late in phylogenesis, biological function of locomotion. Etiological basis for metabolic (essential) arterial hypertension is a regular mismatch: a local compensation of disturbances of the biological response metabolism ↔ microcirculation in the distal arterial bed with endothelium-dependent vasodilatation and only systemic compensation at the level of the body in the proximal part. For millions of years, there coexist two functionally connected and phylogenetically separated pools of fatty cells: the earlier visceral fatty cells (VFC) and the later subcutaneous adipocytes. Insulin blocks TG hydrolysis and release of nonetherified fatty acids (NEFA) into the blood plasma only from adipocytes; hormone cannot block lipolysis in phylogenetically early VFC and inhibit the effect of phylogenetically early hormones on them. Increase in blood plasma NEFA in the course of biological response of stress in vivo does not accompany proportional growth in albumin concentration. The function of phylogenetically early resident macrophages and monocytes ↔ macrophages, differentiated in intima of arteries in situ and ex tempore , is not identical. Biological response of fatty cells deposit into adipocytes occurs in the form of nonpolar triglycerides in lipoprotein composition, but their release - only in the form of polar NEFA.
Perm Medical Journal. 2015;32(6):96-114
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DEVELOPMENT OF SURGICAL SCIENCE AND PRACTICE IN PRIKAMIYE DURING THE GREAT PATRIOTIC WAR OF 1941-1945 (TO THE 70 TH ANNIVERSARY OF GREAT VICTORY)
Zarivchatsky M.F., Podluzhnaya M.Y., Azanova N.Y.
Abstract
Archival documents demonstrating development of surgical science and practice during the years of the Great Patriotic War (1941-1945) are considered in the paper. The achievements and great contribution into organization, development of theory and practice of surgical service became possible only as a result of cooperation between scientists and practical surgeons.
Perm Medical Journal. 2015;32(6):115-121
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A HUNDRED-YEAR HISTORY OF ONE OF THE OLDEST URAL HOSPITALS - CITY CLINICAL HOSPITAL № 2 NAMED AFTER F. CH. GRAL
Gryaznov V.N., Davidov M.I.
Abstract
A hundred-year history of City Clinical Hospital № 2 named after F. Ch. Gral is presented in the paper. The hospital was open on October 17, 1915 in the building preserved up to now and is a monument of history and architecture. The first director of clinical hospital was leib-surgeon of the imperial family V. N. Derevenko. The outstanding native scientists including academician E. A. Wagner, professor D. P. Kuznetsky, V. N. Parin, B. V. Perin, I. A. Ivanov, Ya. S. Tsimmerman and others worked in the hospital. In 1928 Commissioner of Education A. V. Lunacharsky called this hospital “a pearl of Ural”. During a hundred years’ history, 28 physicians of this hospital were awarded the title “Honoured Physician of Russia”.
Perm Medical Journal. 2015;32(6):122-128
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