Vol 30, No 3 (2013)

Articles
ISOSORBIDE DINITRATE EFFECT ON HEART RATE VARIABILITY, DISTURBED RHYTHM AND CONDUCTIVITY IN PATIENTS WITH STABLE FUNCTIONAL CLASS 1 AND 2 STENOCARDIA ASSOCIATED WITH HYPERTENSIVE DISEASE
Safronova E.A.
Abstract
Aim. To improve the results of treatment of patients with nonparasitic hepatic cysts and to determine optimal treatment technique depending on concomitant pathology, terms of hospitalization, number of relapses and postoperative complications. Aim. To study the effect of isosorbide dinitrate (ISDN) on heart rate variability (HRV) in patients with stable functional class (FC) 1 and 2 stenocardia (St) associated with hypertensive disease (HD). Materials and methods. 194 patients with FC 1 and 2 St HD (mean age 54,5±5,2) were examined. Along with standard methods of investigation, high resolution rhythmocardiography (RCG) using diagnostic complex KAP-RK-01-“Micor” (T.F. Mironova, V.A. Mironov, Chelyabinsk, Registration Certificate №FS 02262005/2447.06) with temporary and spectral analysis of sinus heart rhythm (SHR) wave structure was applied. Results. Under the effect of ISDN, patients with Fc 1 and 2 St HD had significant rise in general heart rate variability (SDNN). Together with such shifts, there is growth of humoral-metabolic spectral characteristics (VLF%) – reliable in the background test ( p <0,05), tendency to increase in sympathetic (LF%) with fall in parasympathetic (HF%) – significant in the background test ( p <0,0001), Valsalva ( p <0,01) and Ashner ( p <0,0001) tests, with physical load – PWC 120 ( p <0,05). Arythmogenic effect of the investigated nitrovasodilator manifested by growth of ventricular and supraventricular extrasystoles, migration of auricle pacemaker, development of synoatrial node was observed. Conclusion. The method of rhythmocardiography helps to choose an antianginal therapy and predicts side effects of organic nitrates.
Perm Medical Journal. 2013;30(3):6-13
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AORTA AS A TARGET ORGAN IN COMORBIDITY: ARTERIAL HYPERTENSION AND ACID-DEPENDENT PATHOLOGY
Beresneva L.N., Khlynova O.V., Tuev A.V., Agafonov A.V.
Abstract
Aim. To study the peculiarities of impaired elastic properties in associated course of arterial hypertension (AH) and acid-dependent diseases (ADD). Materials and methods. 35 patients suffering from AH associated with ADD (mean age 43,44±2,78) were examined. The control group consisted of 17 patients of the same age with isolated AH course. Ultrasound investigation method was used to measure the basic structural and functional parameters of the ascending part of aorta with subsequent calculation of its elastic properties by the generally accepted formulas. Results. It was revealed that patients suffering from isolated AH are characterized by presence of statistically significant higher indices of arterial rigidity as compared to patients suffering from associated AH and ADD. Conclusion. The obtained results indicate a specific type of aorta remodeling in this category of patients that can be a predictor of severe complications in comparison with the group of combined pathology.
Perm Medical Journal. 2013;30(3):14-20
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BIOELECTRIC CEREBRAL ACTIVITY IN PATIENTS WITH GENERALIZED EPILEPTIC SEIZURES IN INTERICTAL PERIOD
Shulakova K.V., Kravtsova E.Y., Kulesh A.A.
Abstract
Aim. To study the peculiarities of spectral analysis of bioelectric cerebral activity in patients with generalized epileptic seizures in the interictal period. Materials and methods. 37 patients with generalized epileptic seizures in the interictal period were examined. Control group included 27 practically healthy persons. Spectrographic analysis of electroencephalography during the waking period was carried out. Mathematical processing was performed using Statistica 8.0 for Windows. Results. The dominating frequencies of electroencephalography were reduced in patients with epilepsy. Alpha-rhythm asymmetry in favour of the dominant left cerebral hemisphere was shown in men with generalized epileptic paroxysms in the interictal period. Conclusion. The dominating rhythm frequency is to be investigated so as to confirm the diagnosis of “epilepsy”. Alpha-rhythm asymmetry among men in favour of the dominant hemisphere in the interictal period as compared with healthy persons needs further studying.
Perm Medical Journal. 2013;30(3):21-25
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CLINICAL AND POLYSOMNOGRAPHIC PECULIARITIES OF SLEEP IN CHILDREN WITH ATTENTION DEFICIT AND HYPERREACTIVITY SYNDROME (ADHS)
Konshina N.V.
Abstract
Materials and methods. 13 patients (aged 6 to 9 years) with diagnosis of ADHS that was verified by criteria MCB 10 and results of survey SNAP-IV were examined. Comparison group included 10 pupils of the same age. Clinical estimation of sleep and standard polysomnographic investigation without adaptation night were used. The sleep stage was identified according to Rechtschaffen A., Kales A. standards, 1968. Results. Analysis of the obtained data detected the following: reduced duration of sleep in children with ADHS to 6, 3 hours compared to children of comparison group (7,5 hours), prolonged drowsiness period and latent fast sleep phase (FSP) ( p <0,005). At the same time, FSP duration decreased to 65,9 minutes reaching the reliable differences compared to the analogous indices of healthy pupils (97,3 min). Among patients with ADHS, delta sleep period ( p <0,005) was prolonged, wake period during sleep significantly ( p <0,0001) increased to 12%, whereas in group 2 it was 0,95%. The number of awakenings lasting for more than 3 minutes also raised. As a result, the revealed peculiarities of sleep in the examined children influenced the integrative index – sleep efficiency index which appeared to be distinctly lowered in ADHS children. The standard sleep efficiency index approaches 100%, being in ADHS children 81,5% ( p <0,005). Conclusion. The obtained results demonstrate a multilayer disintegration of brain activity in case of developing ADHS including involvement of integrative apparatuses of sleep into pathological process. The problems of interference of all the three variants of functional status of the brain (awakening, SSP, FSP) in ADHS are still unsolved.
Perm Medical Journal. 2013;30(3):26-29
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COMPARATIVE CLINICONEUROPSYCHOLOGICAL ASSESSMENT OF COGNITIVE DISORDERS IN PATIENTS WITH ALZHEIMER’S DISEASE, VASCULAR AND MIXED COGNITIVE DISTURBANCES AT DIFFERENT STAGES OF COGNITIVE DEFICIENCY
Mantashova A.M.
Abstract
Aim. To compare clinical manifestations and neuropsychological profile of cognitive disorders in patients with Alzheimer’s disease, vascular and mixed vasculodegenerative cognitive disorders at different stages of cognitive deficiency. Materials and methods. In 106 patients of The Center of Cognitive Disorders the status of four cognitive domains including memory, speech, visual-spatial and regulatory-dynamic functions was estimated during complex neuropsychological examination. Results. The applied method of comparing of neuropsychological parameters of patients at the identical stage of cognitive deficiency showed that differences in cognitive profiles between the indicated groups depend on the stage of the process. Conclusion. Differential diagnosis of three considered in the paper cognitive disorders types can be completely performed only at the stage of moderate dementia with evaluation of episodic, semantic memory and visual-spatial functions.
Perm Medical Journal. 2013;30(3):30-36
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CHANGES IN HEPATIC HEMODYNAMICS IN PATIENTS WITH CALCULOUS CHOLECYSTITIS IN EARLY POSTOPERATIVE PERIOD
Ganeeva E.R., Popov A.V., Ershova A.I.
Abstract
Aim. To study the dynamics of perioperative changes in intrahepatic blood flow after cholecystectomy depending on clinical course of disease in patients with cholecystitis. Materials and methods. Intrahepatic blood flow was studied in 52 patients prior to cholecystectomy on the days 7 and 12 after the surgery using bioimpedance computer system “Polyrheocardiograph-01 Perm” with functional load. Results. Cholecystectomy in patients with latent and dyspeptic forms of calculous cholecystitis is accompanied by more adequate compensatory response of microcirculatory hepatic bed than in patients with clinical cholecystolithiasis symptoms. Conclusion. Cholecystectomy in patients with latent and dyspeptic forms of calculous cholecystitis is accompanied by normalization of intrahepatic circulation. In patients with pain form, compensatory arterialization of hepatic blood flow is formed. Operative intervention in patients with destructive cholecystitis is a risk factor for developing intrahepatic blood flow shunting and postsinusoidal hypertension.
Perm Medical Journal. 2013;30(3):37-40
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PRIMARY PLASTIC OPERATIONS FOR OPEN HAND AND FINGERS INJURIES DIRECTED TO RESTORATION OF GRASP FUNCTION
Tokarev A.E., Kozyukov V.G.
Abstract
Aim. To study different surgical techniques and aids for primary surgical treatment of patients with traumatic hand and fingers defects so as to determine the most effective ones in restoration of anatomic structures of the hand and its grasp function. Materials and methods. Analysis of surgical treatment of 283 patients with open injuries of the hand and fingers and 417 operations was carried out. Primary surgical treatment was performed at early terms: 275 sufferers – during the first 6-12 hours, 18 persons with later admission had delayed surgery. Ultrasonic treatment of wounds and magneto-laser exposure was used to prepare the wounds for skin-and skin-bone grafting. Hyperbaric oxygenation was applied in the early postoperative period. Results. In connection with peculiarities of surgical treatment of patients with open hand and fingers injuries clinical observations were divided into three groups: primary restorative surgeries of the first finger, primary restorative surgeries in case of ulnar fingers defects and primary restorative surgeries in severe hand injuries. Analysis of direct results of treatment of 283 patients with severe hand and fingers injuries showed that 242 (87%) patients had primary tension wound healing with full graft and transplant taking. Outcomes of treatment were followed up in 176 sufferers (62%). Positive results were reached in 153 (87%) patients, unsatisfactory – in 23 (13%). Conclusion. The principal peculiar feature of primary surgical treatment in case of severe extensive injuries of the hand and fingers is its primary reconstructive character with rational use of a complex of plastic surgery facilities providing restoration of the basic function of the hand – its grasp function.
Perm Medical Journal. 2013;30(3):41-45
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IMPACT OF OZONOTHERAPY ON CLINICOIMMUNOLOGICAL INDICES IN ADOLESCENT ATOPIC DERMATITIS
Illek Y.Y., Suslova E.V., Gainanova A.M., Kuznetsova V.V., Galanina A.V., Leushina N.P., Mischenko I.Y., Sizova O.G., Tarasova E.Y.
Abstract
Aim. To study the impact of ozonotherapy on clinical indices and immunological reactivity status in patients with an adolescent form of atopic dermatitis. Materials and methods. 62 adolescents (24 boys and 38 girls) at the age of 12–15 with moderate course of disseminated atopic dermatitis (AD) were under observation. The observed patients were divided into two groups depending on the conducted treatment. Group 1 of AD patients (n=31) received complex generally accepted therapy, group 2 of AD patients ( n =31) – complex treatment combined with ozonotherapy. In both groups of AD patients, in the periods of disease exacerbation and clinical remission, blood lymphocyte population and subpopulation content (CD3-, CD4-, CD8-, HLA-DR +, CD16-, CD20-lymphocytes), blood serum G, A, M, E immunoglobulin and circulating immune complexes content, phagocytosis indices and blood serum proinflammatory cytokine content were investigated. Results. In the group of patients with atopic dermatitis receiving complex generally accepted therapy marked changes in immunological reactivity parameters preserved during clinical remission. In the group of patients with atopic dermatitis receiving complex treatment combined with ozonotherapy clinical remission occurred faster and most immunity indices normalized. Conclusion. High clinical, immunomodulating and antirecurrent effects of ozonotherapy, availability, absence of complications and side reactions permit to recommend it for wide use in complex treatment of patients with an adolescent form of moderate atopic dermatitis.
Perm Medical Journal. 2013;30(3):46-52
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DETECTION OF GLYCOGEN IN FLAT EPITHELIAL CELLS AND NEUTRAL MUCOPOLYSACCHARIDES IN MONOLAYER COLUMNAR UTERINE CERVIX EPITHELIUM IN TRANSFORMATION ZONE AMONG PATIENTS WITH HPV-INFECTION
Vetelina V.V.
Abstract
Aim. To study the patterns of detecting glycogen in ectocervix epithelium and neutral polysaccharides – in columnar epithelium in the zone of transformation among patients with human papilloma virus infection (HPV-infection). Materials and methods. The object of the study – 105 women aged 25 to 39 years who were diagnosed HPV-infection using PCR-method. Patients underwent standard gynecological examination and extended colposcopy with target (colposcopically oriented) biopsy of the uterine cervix. Bioptic material was subjected to histological investigation with generally accepted histological methods. Polysaccharide content of mucopolysaccharides was investigated on the basis of histochemical methods including analytical and enzymatic treatment (PAS-reaction with control diastase reactions; semiquantitative estimation of results by mean cytochemical coefficient). Histological specimens cells were calculated with 400-enlargement (x 400) of microscope on the test area of 0,042 mm 2, not less than in 5 vision fields for each specimen. Statistical analysis was performed using the program package Biostat. Statistical processing of the results was conducted with Kruscal-Wallis method. Results. Analysis of carbohydrate content (glycogen and neutral mucopolysaccharides) in the cells of multilayer flat and monolayer columnar glandular epithelium of uterine cervix in HPV-infected patients demonstrated decrease in flat epithelial cells glycogen content as CIN was progressing just till its full disappearance in patients with CIN III, as well as decrease in columnar (glandular) epithelial cells neutral mucopolysaccharide content as CGIN was progressing. The obtained data agree with a modern notion of dysplastic processes in flat and glandular uterine cervix epithelium and reflect dysplastic changes in multilayer flat and monolayer columnar epithelium which accompany human papilloma virus infection. Conclusion. Histological investigation of bioptic material obtained from patients with uterine cervix pathology associated with HPV-infection established the regularities of changes in multilayer flat ectocervix epithelium glycogen content as CIN was progressing and neutral mucopolysaccharide content as CGIN was progressing.
Perm Medical Journal. 2013;30(3):53-59
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USE OF ADDITIVE TECHNOLOGIES FOR RESTORATION OF FACIAL SKELETON DEFECTS
Vasilyuk V.P., Shtraube G.I., Chetvertnykh V.A.
Abstract
Aim. To study and introduce the technology of three-dimension imaging systems of computer modeling (CAD-system) when producing implants which represent a structure of cells from different biocompatible materials (steel, AISI 316L, powder titanium VT-5 and others). Materials and methods. The work is based on the data regarding Wigner–Seitz cells representing a space with a center in some point of Bravais lattice. The minimum volume area limited by planes will be a Wigner–Seitz cell. Implants with cellular structure (Wigner–Seitz cell) were produced from different materials such as steel AISI 316L, powder material – titanium VT-5, foamy polyurethane – photopolymer SI 500 using innovative technologies which permit to create the products exactly copying facial skeleton bone structures consisting of cells with a regular geometrical form. Results. Implants which represent a cylinder repeating the form of the lower jaw manufactured from steel AISI 316L, powder titanium VT-5, foamy polyurethane - photopolymer SI 500 with complicated geometric structure in the form of penetrating Wigner–Seitz cells fixed to the lower jaw by means of 4 titanium screws, two from each side, (Patent invention № 2469682, 2012) were produces by innovative technology. Conclusion. Three-dimension system technology, SLS technology, is an important step forward in visualization that allows to introduce it into different spheres of science including the sphere of medicine and implantology, in particular. Formation of bone tissue in the cellular structure of an implant using osteogenesis-accelerating preparations at the earliest possible terms significantly improves restoration of facial skeleton defects.
Perm Medical Journal. 2013;30(3):60-65
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APPLICATION OF SYLVINITE DEVICES IN COMPLEX TREATMENT OF INFLAMMATORY PERIODONTIUM DISEASES
Barannikov V.G., Leonova L.E., Kirichenko L.V., Omarova L.V., Varankina S.A., Pavlova G.A., Dementiev S.V.
Abstract
Aim. To give hygienic and clinical assessment of applying sylvinite devices in complex treatment of imflammatory periodontium tissue diseases. Materials and methods. The object of the study – the building equipped with two sylvinite devices. Hygienic methods were used to assess microclimate, ionizing radiation background, aeroionization and aerosol environment. The study included 49 patients (aged 20–25) diagnosed chronic generalized catarrhal gingivitis including 24 persons who underwent treatment by means of salt device. External examination was conducted; objective status of periodontium according to hygienic and periodontological indices was assessed. Results. Sylvinite devices contributed to formation of special internal environment with a complex of medical factors such as favorable aeroionization background, constant salt multicomponent aerosol concentration and stable microclimate. Sylvinite therapy included into the treatment of patients with chronic catarrhal gingivitis had a positive effect on periodontium tissues status and normalized local immunity indices of the oral cavity. Conclusion. The results of studies proved good perspectives for using silvinite devices in complex treatment of inflammatory periodontium diseases.
Perm Medical Journal. 2013;30(3):66-71
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USE OF STIMULATING ELECTRONEUROMYOGRAPHY FOR STUDYING OF IMPAIRED NEUROMUSCULAR SYSTEM IN AGRICULTURAL WORKERS
Masyagutova L.M., Bakirov A.B., Gallyamova S.A., Iskhakova D.R.
Abstract
Aim. To study the peculiarities of functional status of neuromuscular system in workers of agricultural complex. Materials and methods. Bioelectric activity of muscles and peripheral nerves using stimulating electroneuromyography (SENMG) method was analyzed in 200 agricultural workers with musculoskeletal diseases. Total synchronous potential while irritating motor nerves (M-response form) and action potential (AP) while stimulating sensor (sensitive) fibers were determined. The latent period, amplitude and duration of these waves were calculated. Results. The impaired function of neuromuscular system in agricultural workers was found to be characterized by staging of its formation which can be objectivized by means of stimulating electroneuromyography. The most significant SENMG criteria are the following: distortion of the evoked response (type of response), increase in residual latency > 3mc on the hands and >3,5 mc on the legs, decrease in proximal-distal coefficient value < 100%. Conclusion. Knowledge of peculiarities of neuromuscular disturbances formation and course allows to provide early diagnosis, prevention and treatment of agricultural workers.
Perm Medical Journal. 2013;30(3):72-77
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ENDOSONOGRAPHIC MEASUREMENT OF ESOPHAGEAL VEIN PRESSURE IS A NEW TECHNOLOGY FOR DETERMINING RISK OF PORTAL HYPERTENSION COMPLICATIONS
Olevskaya E.R.
Abstract
Aim. To assess the risk degree of occurring portal genesis hemorrhages in patients with hepatic cirrhosis. Materials and methods. The method of assessment of esophageal vein pressure combining direct endoscopic investigation and ultrasonic scanning was developed using endoscopic ultrasonography (EUS). Measurement of esophageal varicose vein (EVV) pressure was performed in 16 patients (9 men, 7 women, mean age – 56 years) suffering from hepatic cirrhosis. Results. The pressure values in esophageal veins ranged from 410 mm of water column to 730 mm of water column. All patients with hemorrhage in anamnesis had pressure > 600 mm of water column. The fulfilled endoscopic ligation appeared to be ineffective in case of vein pressure >700 mm of water column. Esophageal vein pressure determined with the suggested method objectively reflects hypertension in the portal tract. Conclusion. The above method is a low-invasive procedure allowing to assess all the most significant risk factors of hemorrhage including varics value, changes in vein-covering mucosa, vascular wall thickness, vein pressure.
Perm Medical Journal. 2013;30(3):78-81
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PATIENTS’ QUALITY OF LIFE AND COGNITIVE STATUS DURING PERIOD of REHABILITATION AFTER INSULT
Amirakhova L.S.
Abstract
Aim. To study the quality of life in patients during rehabilitation period after the first ischemic insult, to assess their physical abilities, psychological status using quiestionnaire MOS SF-36. Materials and methods. Complex examination of 70 patients after the first ischemic insult (31 women and 39 men) aged 40-74 was carried out. Results. Statistically significant decrease in cognitive and emotional status, presence of physical and mental asthenia in patients during rehabilitation period after the first ischemic insult was detected that essentially lowers quality of life and delays rehabilitation process. Conclusion. During rehabilitation treatment, it is necessary to take into account presence of cognitive and emotional disorders significantly reducing rehabilitation potential and to correct them in time.
Perm Medical Journal. 2013;30(3):82-86
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WAYS OF IMPROVING AMBULATORY CARE AT CHILDREN’S POLYCLINICS
Senyushkin A.N.
Abstract
Aim. To optimize assessment of the efficiency of preventive service in pediatric district. Materials and methods. Sociological survey of 200 parents and medical staff was carried out for reaching the aim. The real status of preventive service at the example of 366 children of the first year of life who were rendered medical care at children’s polyclinics of Municipal Budgetary Institution of Public Health “City Children’s Clinical Polyclinic №1” (CCCP) of Motovilikhinsky region of the city of Perm was studied. Functional model of district pediatrician’s activity regarding work with children of the first year of life was worked out. Results. Analysis of sociological survey showed that positive assessment of preventive activity conducted at children’s polyclinics was given only by 26% of parents, negative – by 14%, no estimation – 60%. Only a quarter of pediatricians and half of nurses gave satisfactory estimation of preventive activity in their district. At the same time, the share of preventive service in the actual volume of district pediatrician’s activity was 25-30%. Preventive activity quality criterion used for estimation of the efficiency of district pediatrician’s work permitted to reveal the reasons of the existing drawbacks and to change organization of preventive service at children’s polyclinic. Organizational and functional computer model for assessment of the activity of district pediatrician was created. Practical introduction of this system into the work of CCCP allowed to improve the quality of rendering preventive care to children and to widen its actual volume in the common activity of district pediatrician by 25% (25 to 50%). Conclusion. The developed model of district pediatricians’ activity regarding their work with children of the first year of life contributes to raising the quality of preventive service that positively influences health status of early age children.
Perm Medical Journal. 2013;30(3):87-92
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LIVER FIBROSIS DIAGNOSIS: ARE THE METHODS PERFECT?
Shirokikh I.N., Mavlitova L.A., Tuev A.V., Khlynova O.V.
Abstract
High viral hepatitis morbidity, prevalence of overweight and alcohol abuse make the problem of early diagnosis of chronic liver diseases rather urgent. It is known that presence and degree of manifestation of liver fibrosis is of great significance for the choice of therapeutic tactics and assessment of prognosis for this category of patients. In the course of decades, biopsy was the only method for assessment of liver fibrosis. However, invasiveness and complexity of its realization, errors at the stage of interpreting morphological picture require development of noninvasive and precise methods for diagnosis of fibrosis. At present, there was suggested a number of instrumental and laboratory methods pretending to the role of “a perfect method”. Some instrumental methods demonstrate a high diagnostic accuracy but are expensive and need special equipment. Serum fibrosis markers, determined for today, are highly sensitive and specific only in case of marked fibrosis but they are low-informative for early diagnosis. Thus, searching of noninvasive, available and precise method for assessment of liver fibrosis is still going on.
Perm Medical Journal. 2013;30(3):93-102
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