Vol 31, No 6 (2014)

Aim. To describe the technique for transventricular segmental sutural annuloplasty of mitral valve. Materials and methods. Predictors for mitral valve annuloplasty performed through the left ventricular access in chronic aneurism of the left ventricle associated with ischemic mitral insufficiency were determined. The method was compared with ring mitral annuloplasty of the mitral valve. Results. The technique for transventricular mitral valve annuloplasty is comparable with the ring mitral annuloplasty. Conclusions. In practice, this technique showed sufficient efficiency and simplicity; it is less traumatic. During the study, relative indications and contraindications for application of this technique were determined.

Aim. To analyze the results of surgical treatment of gastrointestinal hemorrhages. Materials and methods. The results of treatment of 464 patients with hemorrhages from chronic gastric and duodenal ulcers were analyzed by us. Patients were divides into two groups depending on treatment. In group 1 (control, n =111), treatment of ulcerous hemorrhages was performed with traditional techniques, in group 2 (main, n =353) - morphological and histological status of vessels and architectonics in the zone of ulcer was studied. The type of hemorrhage (arterial or venous) can be used as a criterion for determination of surgical tactics in ulcerous gastroduodenal hemorrhages. Results. According to the type of hemorrhage, patients were distributed in the following way: 58 (16,4 %) had arterial hemorrhage, but 295 (83,6 %) - venous. Differential diagnosis was carried out by clinical, endoscopic and laboratory data. For the first time, the method for assessment of significance of using the type of hemorrhage for determination of surgical tactics in ulcerous gastroduodenal hemorrhages was developed (RF Patent Invention №2407445; 27.10.2010). Conclusions. Efficiency of conservative therapy was on average 80%: venous hemorrhage - 78,2%, arterial - 1,8%. So, it needs to use an active surgical tactics for patients with arterial type of hemorrhage and active-differential one - for those with venous type of hemorrhage.

Prevalence of metabolic syndrome in the total population is 14-24%, metabolic syndrome associated with hypothyroidism occurs in 5-10 % of cases. Aim. To study the polyneural disorders in patients with metabolic syndrome using clinicoelectroneuromyographic characteristics. Materials and methods. Clinical and electroneuromyographic examination of patients with metabolic syndrome and hypothyroidism was carried out; peculiarities of the course of peripheral polyneuropathy in this group of patients were singled out. To clarify electroneuromyographic characteristics, stimulation technique for fibular, tibial, sural nerves was used; “F-wave” index was analyzed. Results. According to cumulative clinical and electroneuromyographic data, sensor polyneuropathy was diagnosed in 22 (55 %) patients with metabolic syndrome and sensomotor polyneuropathy - in 16 (40 %), normal parameters - in 2 (5 %) patients. Conclusions. The obtained data have broadened our knowledge on complications of metabolic syndrome and on inclusion of peripheral distal polyneuropathy with metabolic syndrome into the group of dismetabolic polyneuropathies.

Aim. To study the long-term results of neuroprotector retinalamine therapy in patients with open-angle glaucoma. Materials and methods. 48 patients (77 eyes) including 20 men and 28 women with compensated primary open-angle glaucoma (POAG) of initial (I) and developed (II) stages were examined. Group I (main) involved 27 patients, 40 eyes (mean age 63,28±8,86 years): stage I glaucoma was detected on 24 % of eyes, stage II - on 76%; against the background of traditional complex neuroprotector therapy retinalamine was administered lymphotropically on the side of the damaged eye. Group 2 (control) included 21 patients, 37 eyes (mean age 64,65±7,92 years); traditional neuroprotector therapy was performed. Results. After the course of treatment, visual function improved in both groups, however, in the main group - 0,1 increase in visual acuity was observed in 50% of cases, but in the control - only in 29,8%. The number of scotomas in the standard points decreased in the main group by 3 times, in the control - by 1,5times. Three months later, these functions remained previous in both groups. Six months late, both groups indicated fall in the visual acuity and rise in the number of scotomas, but in the main group vision fall was registered in 10 % of cases, and in the control - in 32,4 % of cases. Positive dynamics was fixed in the main group during the period up to 24 months in 24 patients on 37 eyes (93,5 %). In the control group, stabilization of visual functions during the same period was reached in 59,2 %. Conclusions. Dedystrophic therapy courses combined with lymphotropic introduction of retinalamine increase the efficiency of treatment and contribute to long preservation of visual functions in patients with primary open-angle glaucoma at the initial and developed stages.

Aim. To optimize the surgical tactics for treatment of patients with deforming osteoarthrosis of the first metatarsophalangeal articulation of the foot depending on the stage of disease. Materials and methods. Long-term results of treatment of the first metatarsophalangeal articulation osteoarthrosis were analyzed in 50 patients depending on the character of pathology and stage of disease. Clinical and roengenological study, biomechanical and statistical methods were used in diagnosis and management. Differentiated surgical tactics for treatment was developed, a new technical solution was offered. Outcomes of surgical treatment were followed up in 36 (72,2 %) patients. Good results were reached in 31 (86,1 %) patients, satisfactory - in 5 (13,9%) patients. Conclusions. Differentiated approach to treatment of osteoarthrosis of the first metatarsophalangeal articulation of the foot in most cases gives positive results and depends on choice of optimal method in each concrete case taking into account the degree and severity of deformation.

Aim. To establish the presence and character of relationship between species composition of microorganisms associated with periodontitis and concomitant somatic pathology. Materials and methods. 106 patients with periodontitis (observation group) and 66 patients without parodentium pathology were examined after oral cavity sanation (comparison group). Test-systems developed by us were used to study with PCR method the occurrence rate of P. gingivalis, T. denticola, S.oralis, S. sanguis, S. mutans, S. salivarius, S. sobrinus, S. macacae in the dental parodontal pocket and saliva content . Results. General somatic pathology among periodontitis patients was registered more often (by 33,2 %) than in comparison group ( p =0,0001). At the same time, in the group of observation, patients with periodentitis and general somatic pathology had parodontal pocket S. mutans, S. oralis, S. sobrinusus reliably more often (by 45 %, 43,2 % and 33,8 %, respectively, p <0,01) than patients of the same group without concomitant somatic pathology. Conclusions. Among patients with chronic periodontitis, qualitative changes in oral microbiocenosis are associated with functional status of different organs and systems of macroorganism.

Perspective directions of work on development of new types of biopathogens are presented in the paper. Convention on prohibition of biological weapon does not prevent development of new biopathogens. Success in gene engineering and molecular biology opens huge opportunities for receiving new biological agents and modification of the known ones. The basic directions in development of new types of biopathogens are the following: modification of especially dangerous infectious agents; modification of slow infectious agents; modification of uncontrolled infectious agents; synthesis of regulatory genes on the basis of viral vectors; modification of latent viruses; modification of oncogenes and oncogenic viruses; development of movable genetic elements based on phages, plasmids et c; synthesis of genes coding immunoprivileged organ and tissue proteins; modification of animal and plant toxins with elevated resistance to environmental factors; synthesis of genes coding formation of chemical and low concentration biological compounds with toxic or other regulatory effect. Development of new biopathogens will be accompanied by working out new methods for delivering such agents to the target. It is possible to develop a weapon possessing a high degree of selectivity and damaging genome of organism-target of a certain race, ethnos, nation.

Aim. To determine the dynamics of patients’ oral hygiene level at the stages of ambulatory surgical interventions. Materials and methods. 65 patients aged 18-45 who addressed for rendering ambulatory surgical aid experienced complex dental examination. Dental caries prevalence and intensity indices, oral hygiene and parodentium tissues status were studied; a survey with a developed questionnaire was carried out to examine 65 patients for the purpose of determining the level of hygienic knowledge and habits. Results. The performed studies revealed a high prevalence and intensity level of the main dental diseases among patients who addressed for rendering ambulatory surgical aid. Rare visits to dentists, unbalanced nutrition and unsatisfactory habits of individual hygiene were noted. Conclusions. Introduction of complex preventive program results in positive dynamics of dental status indices that subsequently leads to decrease in general morbidity of patients.

Aim. To carry out hygienic estimation of dynamics of the basic medical factors of saline units (SU) while their exploitation for the purpose of grounding preventive sanitary-technical works. Materials and methods. Saline microclimatic wards “C” (SMW “C”) of different exploitation periods (to 1 month, from 1 to 2 years, and more than 2 years) were studied. By means of hygienic methods, the main medical factors including saline aerosol concentration, radiation background, aeroionization were determined. Microbial landscape of the air by the total microbial number, presence of mycelia and yeast fungi as well as golden staphylococcus with inoculation of the corresponding media was estimated. Results. Dependence of physical factors of internal environment on operation life of sylvinite units was found. Increase in the period of saline units’ exploitation caused decline in air aeroionization. In a year after SMW exploitation, mycelia and yeast fungi having a marked allergenic effect on patient’s organism were detected. Conclusions. To correct the main therapeutic factors, additional air preparation and mechanical treatment of reaction surface of the mineral is to be carried out in 1 year after SU exploitation.

A clinical case of hereditary thrombophilia caused by mutation of blood coagulation factor V (Leidan mutation) is presented in the paper. The peculiar features of this case are: first - heterozygote mutation manifested at the age of 30, second - development of a rare side effect of indirect oral anticoagulant - warfarin - skin necrosis. Warfarin necroses occur in deficiency of C and S proteins. Combination of genetic defects in the system of hemostasis and pathology of gastrointestinal tract originated from patient’s childhood led to essential changes in pharmacodynamics and pharmacokinetics of indirect anticoagulant. This clinical example demonstrates need in introduction of moleculogenetic testing into clinical practice not only for diagnosis, but for choosing drugs, as well. Pharmacogenetic approach can be one of the keys to individualization of drug therapy.