Vol 33, No 3 (2016)

Cover Page
Articles
HEMODYNAMIC PARAMETERS AND RIGHT VENTRICULAR FUNCTION AFTER RADICAL CORRECTION OF FALLOT’S TETRAD
Omelchenko A.Y., Gorbatykh Y.N., Soinov I.A., Voitov A.V., Kulyabin Y.Y., Kornilov I.A., Chaschin O.V., Bogachev-Prokofiev A.V.
Abstract
Aim. The aim of the study was to estimate the early postoperative indices of hemodynamics in different types of the right ventricular output plasty after radical correction of Fallot’s tetrad and to assess the functional state of the right ventricle in the long-term postoperative period. Materials and methods. On the basis of SRICP named after Academician E.N. Meshalkin, a prospective cohort study of 52 patients (28 boys 24 girls), who underwent radical correction of Fallot’s tetrad, was conducted. Patients were divided into 2 groups by the type of reconstruction of the right ventricular outflow tracts: group I included patients with transannular plasty of the output part (group I, 26 patients), group II - patients with preserved fibrous ring of the pulmonary artery (group II, 26 patients). The postoperative hemodynamic status was assessed with transpulmonary thermodilution. The right ventricular function in the long-term period was estimated by means of US and MRI. Results. During the first postoperative hours, hemodynamic indices according to transpulmonary thermodilution technique were significantly lower in group I and reliably differed from group II. However, later (12, 24, 48 hour after), restoration of hemodynamic indices in group I, which did not significantly differ from group II, was observed. In the long-term period, ejection fraction of the right ventricle as a whole and of its separate parts was reliably higher in group II, while terminal diastolic volume of the right ventricle was significantly higher in group I. Pulmonary regurgitation was also significantly higher in group I - 36,7 (32; 44) versus 13,2 (3; 14) ( p < 0,01). Conclusions. Preservation of pulmonary artery fibrous ring provides better parameters of hemodynamics in the early postoperative period including systolic and diastolic functions. In the long-term period, this group of patients is less subjected to the right ventricular dysfunction.
Perm Medical Journal. 2016;33(3):6-17
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CORRECTION OF HYPERSPLENISM IN PORTAL HYPERTENSION SURGERY
Kotelnikova L.P., Mukhamadeev I.S., Burnyshev I.G., Stepanov R.A., Fedachuk N.N.
Abstract
Aim. The aim of the study was to investigate the efficiency of the distal splenorenal anastomoses without splenic artery ligation as well as Sugiura-Futagawa surgery in correction of hypersplenism. Materials and methods. Sixty six patients were operated for hepatic cirrhosis (HC) of various etiology, portal hypertension (PH), complicated by esophageal varicose veins dilatation (EVVD), hypersplenism. There were 36 men and 30 women. The patients’ age ranged from 16 to 69 years with a mean age of 40,13 ± 9,03 years. Forty five patients, urgently hospitalized in connection with continued hemorrhage from the EVVD or immediately after it, in case of ineffective conservative and endoscopic treatment underwent Sugiura-Futagawa surgery, modified by us. Results. Sugiura-Futagawa surgery with splenectomy permits to correct all the symptoms of hypersplenism in the early and long-term postoperative periods. After applying distal splenorenal anastomoses without splenic artery ligation, the number of leucocytes significantly increased just after the surgery, and one year later there was only a tendency to rise in the amount of platelets and erythrocytes compared to the preoperative level. Conclusions. Predictors of hypersplenism correction in the long-term period following the portal system decompressing surgery are the initial erythrocyte and leukocyte levels, transaminase activity, portal volumetric blood circulation.
Perm Medical Journal. 2016;33(3):18-24
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EARLY COMPLICATIONS OF TRAUMATIC DISEASE WITH MULTIPLE LOCOMOTOR INJURIES
Schekolova N.B., Ladeischikov V.M., Zubareva N.S.
Abstract
Aim. The aim of the study was to investigate the complications of the early period of traumatic disease with multiple locomotor injuries. Materials and methods. The main complications of the early period of TD were studied in details in 83 sufferers with multiple locomotor injuries. Standard indices of clinical and biochemical blood test, its viscosity and toxicity, pain syndrome intensity and vegetative function were assessed. Results. Posthemorrhagic anemia during the 1 day of injury was registered in 15 (18 %) patients. On the 3rd day the number of patients with anemia increased to 20 (24 %) patients, but by end of early period it fell to 10 (12 %) patients. Significant changes in blood viscosity were revealed on the day 3-5 of TD. Maximum value of blood toxicity was reached by the day 7-10 after the locomotor injury. Fat embolism (FA) was developed in 3,6 % (3 persons), thromboembolic complications - in 6 % (5 persons). Local purulent complications were diagnosed in 11 patients (13 %) by the end of the early TD period. Urinary tract infection was detected in 5 (6 %) patients. During the first three days of injury, pain syndrome prevailed in 77 (92,7 %) persons. In eighteen (21 %) patients psychoneurological disorders were diagnosed. Conclusions. 1. The course of the early period of traumatic disease in sufferers with multiple locomotor injuries is complicated by anemia, disturbance of rheological properties and blood toxicity. The most dangerous are thromboembolic complications and fat embolism. 2. Psychoneurological complications are the secondary ones, and are mainly connected with vegetative dysfunction and intoxication; they characterize the level of adaptation abilities of the body and need timely correction.
Perm Medical Journal. 2016;33(3):25-30
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MODERN PECULIARITIES OF PEDIATRIC BILIARY DYSFUNCTION COURSE
Repetskaya M.N., Burdina O.M., Lishke D.V.
Abstract
Aim. The aim was to study the modern clinicolaboratory peculiarities of biliary dysfunction course in children. Materials and methods. Fifty children (aged 7-14 years) with biliary dysfunction were under observation. Complex examination with studying of biochemical and functional indices (ultrasound investigation of abdominal cavity, duodenal intubation) was carried out. Results. Biliary dysfunction in the observed children often was combined with gastritis (94,0 %), duodenitis (84,0 %), pancreatic reactive changes (74,0 %). Clinical picture of this functional disorder was characterized by prevailing abdominalgia (96,0 %), dyspeptic syndrome in the form of eructation (74,0 %), nausea (70,0 %), absence of appetite (70,0 %). More often, gall bladder hypokinesia (54,0 %) and Oddi’s sphincter hypertonus (52,0 %) were diagnosed. Billiary dysfunction was accompanied by gall bladder wall thickening (76,0 %) and increased hepatic bile flow rate (3,0 ± 0,4). Conclusions. Pediatric biliary dysfunction is often one of the components of esophageal comorbid status causing occurrence of organic gastrointestinal lesions. Early diagnosis of this functional disorder followed by prophylactic measures for prevention of the development of gastrointestinal pathology is required.
Perm Medical Journal. 2016;33(3):31-35
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EFFICIENCY OF INSTRUMENTAL METHODS FOR DIFFERENTIAL DIAGNOSIS OF MECHANICAL JAUNDICE
Alekseitsev A.V., Meilakh B.L.
Abstract
Aim. The aim of the study was to investigate the efficiency of instrumental methods for differential diagnosis of mechanical jaundice. Materials and methods. Retrospective analysis of the results of mechanical jaundice diagnosis was carried out in 253 patients. Transabdominal ultrasonography (US), endoscopic retrograde cholangiography (ERCG), percutaneous transhepatic cholangiography (PTCG), intraoperative cholangiography (ICG), computed tomography (CT), magnetic resonance imaging (MRI) were used. Results. Calculous character of disease was revealed in 133 (53 %) patients, acalculous mechanical jaundice - in 120 (47 %). Ultrasonography has a sensitivity of 87 % when revealing cholelithiais, 13 % - diagnosis of choledocholithiasis, 43 % - tumors of pancreaticoduodenal zone (PDZ). ERCG is most effective for diagnosis of choledocholithiasis and big duodenal papilla stenosis (sensitivity, 91 % and 78 %, respectively). In case of benign and malignant biliary strictures, the study is also highly informative, but can be performed only in 21 % of cases. CT and MRI demonstrate a high sensitivity (75-100 %); they are most effective when determining the character of pathological process. PTCG sensitivity in choledocholithiasis is 100 %, in PDZ tumors - 75 %, in strictures - 65 %, in indurative pacreatitis - 50 %. Conclusions. When suspecting the calculous character of disease, ERCG is the most effective method for differential diagnosis of mechanical jaundice. Differential diagnosis of acalculous mechanical jaundice is most difficult. In the majority of cases, we have to use successively some diagnostic methods, that proves their insufficient effectiveness.
Perm Medical Journal. 2016;33(3):36-42
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USE OF OZONOTHERAPY FOR CORRECTION OF IMMUNE DISTURBANCES IN CHILDREN WITH PERSISTING ALLERGIC RHINITIS
Illek Y.Y., Chaganov I.B., Galanina A.V., Zaitseva G.A., Leushina N.P., Mischenko I.Y., Tarasova E.Y.
Abstract
Aim. The aim of the study was to investigate the influence of ozonotherapy on the clinical indices and status of immunological reactivity in children with persisting allergic rhinitis. Materials and methods. Sixty children aged 5-10 years, suffering from persisting allergic rhinitis of moderate severity, were divided into two groups depending on the conducted therapy and observed. Group 1 ( n = 30) received complex generally accepted therapy, group 2 ( n = 30) - complex treatment combined with ozonotherapy. Clinical indices and parameters of immunological reactivity were studied in patients with allergic rhinitis. Results. Patients with allergic rhinitis, who received complex treatment combined with ozonotherapy compared to patients, who received complex generally accepted therapy alone, experienced faster onset of long clinical remission and normalization of most parameters of immunological reactivity.
Perm Medical Journal. 2016;33(3):43-49
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Comparative CLINICO-ROENTGENOLOGICAL AND FUNCTIONAL ASSESSMENT OF ALVEOLAR BONE REGENERATION IN MOLAR SOCKETS REGION IN THE NEAREST POSTOPERATIVE PERIOD
Leonova L.E., Pavlova G.A., Pershina R.G., Balueva N.M., Popov A.V.
Abstract
Aim. The aim of the study was to carry out the clinoco-roentgenological and functional assessment of the alveolar bone regeneration in the region of the extraction sockets in the nearest postoperative period. Materials and methods. Two observation groups were formed. After the surgery for extraction of a tooth, a new treatment-and-prophylactic complex was used in 16 patients of the main group for stimulation of regeneration and prevention of alveolar bone atrophy. In 25 patients of the comparison group, healing of sockets was going on traditionally - without osteoplastic materials. During 3 months clinical, roentgenological and functional studies were used to investigate the state of regional hemodynamics and morphometric parameters in the region of the extraction molar sockets. Results. The obtained data permitted to establish that a new technique for prevention of alveolar bone and gum atrophy allows to improve tissue regeneration. At the same time, in the main group the degree of alveolar bone atrophy did not exceed 2 mm and was two times less than in the comparison group. Conclusions. Thus, the proposed technique permits to form an adequate support for dental implant and to receive a good result of orthopedic treatment in the future.
Perm Medical Journal. 2016;33(3):50-55
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BIOELECTRIC MUSCLE ACTIVITY INDICES IN TREATMENT OF PATIENTS WITH INFANTILE CEREBRAL PARALYSIS IN THE FORM OF SPASTIC DIPLEGIA
Eliseev V.V.
Abstract
Aim. The aim of the study was to compare the efficiency of therapeutic complexes including functional programmed or usual muscle electrostimulation by the results of elecromyogram analysis. Materials and methods. Patients aged 3-16 years were presented in 3 groups. Group 1 (38 children) with infantile cerebral paralysis (ICP) in the form of spastic diplegia received functional programmed muscle electrostimulation. Group 2 (control) (33 children with analogous diagnosis) received passive muscle electrostimulation. Group 3 (for determining standard indices) (41 patients without cerebral paralysis) had no treatment. Results. In patients of the first group, there was observed a reliable ( p < 0,05) increase in a relative amplitude of bioelectric activity of the stimulated leg and back muscles (> 20 % in a number of muscles), significant ( p < 0,05) growth in a relative synchronism by the time of contraction of these muscles (> 15 % in a number of muscles). In children of the second group, dynamics of indices was significantly ( p < 0,05) less. Conclusions. The best result was obtained in the group of patients, who underwent treatment with functional programmed muscle electrostimulation.
Perm Medical Journal. 2016;33(3):56-61
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CORRELATION BETWEEN UPPER DENTITION AND SMILE PARAMETERS
Polyakova V.V.
Abstract
Aim. The aim of the study was to estimate the influence of different anthropometric parameters of the upper dentition on esthetic parameters of the smile in patients with dentomaxillary anomalies accompanied by the narrowing of the upper dentition. Materials and methods. Forty eight patients underwent clinical examination with facial photometry and anthropometric study of plaster model of the upper jaw. Five parameters were taken into consideration: transverse size of the upper dentition in the regions of canines, first premolars and first molars, buccal corridors, visible dentition width. Results. All five parameters were compared with each other by means of scatter diagram. No correlation between the parameters was observed. Four clinical cases, confirming absence of correlation between the studied parameters, were described. Conclusions. There is no correlation between the narrowed upper dentition and the size of buccal corridors, visible while smiling. It is necessary to study these parameters in patients before, in the course of and after treatment.
Perm Medical Journal. 2016;33(3):62-66
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PROPERTIES OF CELLULAR STRUCTURES IN BONE DEFECT RECONSTRUCTIONS
Vasilyuk V.P., Shtraube G.I., Chetvertnykh V.A.
Abstract
Aim. The aim of the study was to show in animal experiment the integration of the bone tissue into the titanium cellular structure, inserted into artificially made bone defects, and to analyze the results of morphological investigations. Materials and methods. Together with the staff of the Chair of Machine Engineering and Resistance of Materials (Head - Doctor of Technical Science, professor A.M. Khanov) of Perm State National Technical University, we modeled implants with cellular structure using three-dimensional systems and produced them according to stereolithographic technology (Stereolithography-SLA); three types of them were developed, taking into account the sizes of cells, type of construction, type, degree and localization of bone defects. The experiments were conducted on outbred white rats aged 3 months, with the body mass of 180 g. These implants were inserted into the region of animals’ tail base. The operation was performed under the local anesthesia with ledocain (0,5 %, 1,0 ml) and the study lasted for 3 months. The implants with the size of cells equal to 250 mcm, 550 mcm and 850 mcm were implanted to rats. The results of bone defect plasty applying titanium cellular implants with different sizes of cells, 250 mcm, 550 mcm and 850 mcm, were estimated; the data of morphological studies, given in comparison with “Uglecon-M”, are presented. Results. Implants with cellular structure were produced by stereolithographic technology (Stereolithography-SLA) and inserted into the bone structure of animals. The experiment showed a total penetration of the surrounding tissues into the cellular structure of implants. The best results were achieved by means of titanium implants with the size of cells equal to 850 mcm versus porous “Uglecon-M”. Conclusions. It was found that the tissue is surrounding all the three types of implants, forms the capsule, penetrates into the cells, but fills it depending on the size.
Perm Medical Journal. 2016;33(3):67-73
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ASSESSMENT OF RISK FOR HEALTH HAZARD IN PETROCHEMICAL PRODUCTION WORKERS EXPOSED TO CHEMICAL FACTOR
Timasheva G.V., Gizatullina D.F., Gimaeva Z.F., Karimova L.K., Mavrina L.N., Beigul N.A.
Abstract
Aim. The aim of the study was to assess the changes in a number of hematological and biochemical indices among workers of petrochemical production in response to exposure of a chemical factor. Materials and methods. Hygienic studies on assessment of conditions of work were carried out in the working zone of petrochemical production workers and included hygienic assessment of industrial environment and working process according to R 2.2.2006-05. To study the indices of workers’ hemostasis the following clinicolaboratory methods were used: general clinical analysis, biochemical study of functional status of the hepatobiliary system with determination of indicator enzyme activity, total bilirubin and its fraction content and thymol test, as well as investigation of lipid metabolism with estimation of total cholesterol (TC), alpha-cholesterol, triglyceride (TG), low-density lipoprotein cholesterol (LDLC), atherogenic index (AI). Results. The results of biochemical study indicated chronic exposure of chemical factor. Conclusions. The key harmful factor of industrial environment in repairmen is air pollution of the working zone with chemicals exceeding the allowable value by 1,5-8 times. Changes in a number of clinicolaboratory indices, which are comparable with the level and character of biological effect of harmful substances, were revealed among repairmen.
Perm Medical Journal. 2016;33(3):74-81
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CLIMATE AND NEWBORN INFANTS BIRTH GROWTH AND WEIGHT IN RUSSIA
Vershubskaya G.G., Kozlov A.I., Kasatkina Y.A.
Abstract
Aim. The aim of the study was to monitor the correlation between the infants birth growth weight and the climatic characteristics using regional statistical indices. Materials and methods. Mean birth growth and birth weight values of 790 276 newborn infants from 42 subjects of the Russian Federation with the share of the Russian population not less than 85 % (2007) were taken from the database of Social Insurance Fund. Mean temperature of July and January, mean wind speed, average annual horizontal surface insolation (kw·day/m2) were used as the parameters characterizing climatic conditions of the region. Climate severity was estimated by Bodman index values and annual temperature difference. Results. Newborn infant’s birth weight is decreasing with climate severity growing: it correlates with the average temperature of January ( r = + 0,56), Bodman index values ( r = -0,49) and interseasonal (July-January) temperature difference ( r = -0,54). Newborn infant’s birth growth is directly connected with insolation level ( r = 0,31) that agrees with the notion of the role of UV-radiation in metabolism of fetal bone tissue. Conclusions. 1. Newborn infant’s birth weight is decreasing with fall in a mean temperature of January, increase in climate severity and growth of season temperature difference. 2. Newborn infant’s birth growth is increasing with rise in an average annual insolation level.
Perm Medical Journal. 2016;33(3):82-88
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HYGIENIC ASSESSMENT OF RISK FACTORS FOR HIV-INFECTION AND NARCOMANIA PREVALENCE AMONG MEDICAL STUDENTS
Kulesh T.A., Sidorova O.G., Kulesh A.M., Glukhikh M.V., Mel A.V.
Abstract
Aim. The aim of the study was to carry out the hygienic assessment of risk factors for HIV-infection and narcomania prevalence among medical students. Materials and methods. Questionnaire was used to interrogate 2645 students of medical university, 1-6-year students. Socio-personal characteristics of students, level of knowledge on the problems of narcomania and HIV-infection, students’ opinion on the reasons of drug use and ways of reducing narcomania and HIV-infection threat, peculiarities of sexual behavior were studied. Subjective opinion of students on narcomania, spreading among them, was received. Results. It was established that risk factors for HIV-infection and narcomania among medical students are the following: not full family, passive leisure, low internal locus of control. The level of students’ awareness on narcomania and HIV-infection can be estimated as fragmental and insufficient. There is a relatively high level of stigma and discrimination in students’ attitude to HIV-infected persons. Conclusions. The main way for reducing the threat of narcomania and HIV-infection, singled out by students, is decrease in a risky behavior including sexual one. Students’ subjective opinion showed that there are subjects using drugs among them. It is necessary to introduce advanced technologies for preventive work both at the universities and students youth organizations.
Perm Medical Journal. 2016;33(3):89-96
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HAIRY CELL LEUKEMIA. CLINICAL OBSERVATION
Babushkina G.D., Kiryanova N.V., Golubeva M.E., Popova N.I., Borodina E.N., Mikhailovskaya L.V., Shutylev A.A., Firsova G.V., Sheina I.P.
Abstract
Hairy cell leukemia can develop against the background of primary damage of the spleen (splenic lymphoblastic metaplasia) with leukemization; splenectomy and chemotherapy in the suppressing doses can be effective and contribute to long remission.
Perm Medical Journal. 2016;33(3):97-101
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SCROTUM ABSCESS
Prokhorov A.V.
Abstract
The problems of etiology, pathogenesis, clinical course, diagnosis, treatment and prognosis of scrotum abscess are discussed in the present literature review. Scrotum abscess is a rare disease; it is developing predominantly as a complication of different acute diseases of organs of the scrotum, small pelvis, retroperitoneal space, abdominal cavity, instrumental and operative interventions connected with them. Scrotum abscess is manifested by a nonspecific clinical picture of acute diseases of scrotum organs; rarely - it has an obliterated clinical course, simulating specific orchitis or malignant scrotum disease. Scrotum abscess is observed among patients of any age, mostly in subjects with burdened immunodeficient comorbid background. In diagnosis of this disease, the leading place belongs to radiation studies, and in its treatment - to surgical techniques. At present, prognosis for scrotum abscess treated with modern techniques is favourable.
Perm Medical Journal. 2016;33(3):102-109
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EFFICIENCY OF ORTHOPEDIC TREATMENT FOR PATIENTS WITH ACQUIRED MAXILLOFACIAL DEFECTS USING DENTAL MINI-IMPLANTS. REVIEW OF LITERATURE
Kiparisov Y.S.
Abstract
Nowadays, dental implantation has occupied one of the leading places in a complex of methods for treatment of different dental diseases; one cannot but estimate its role in restoration of patients’ quality of life. The number of applied dental implants is growing; indications for dental implantation are widening. Reconstructive-restorative surgeries on the jaws are in common ambulatory practice. Wide spreading of dental implantation techniques made it possible to use implants not only for patients with partial and full absence of teeth, but also in such a problematic category of patients as those with acquired jaw-bone defects. One of varieties of dental implantation is mini-dental implantation. Indisputable advantage of this technology is a possibility of direct load that is important for stabilization of both traditional removable dentures and resectional, forming and substitution dentures, used by patients after the performed oral surgery. Fixation of removable dentures with dental mini-implants improves the prosthesis stability, function, phonation and esthetics. Use of these implants is very effective from the economic point of view that should be taken into consideration while planning orthopedic treatment.
Perm Medical Journal. 2016;33(3):110-114
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MANAGEMENT OF DENTAL PATIENTS RECEIVING ANTICOAGULATION THERAPY
Kaigorodov V.A.
Abstract
Analysis of native and foreign special literature regarding the management of dental patients, who receive anticoagulation therapy, is presented in the review. Knowledge of specialists on this problem was estimated; recommendations on raising the level of skill were made. Peculiarities of managing dental patients with anticoagulation therapy, based on recently developed methodical recommendations for therapeutic and surgical reception of patients, are described. The problem of orthopedic management of dental patients is accentuated.
Perm Medical Journal. 2016;33(3):115-119
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PERM MEDICAL JOURNAL. HISTORICAL MILESTONES ON THE PATH TO THE HUNDREDTH ANNIVERSARY OF HIGHER MEDICAL EDUCATION IN URAL
Koryukina I.P., Rudakova E.A., Kovaleva O.A.
Abstract
The main stages of foundation and establishment of scientific edition “Perm Medical Journal” are presented in the paper. The most interesting moments of development of a printed organ of medical science are considered; actual problems of public health service of Perm Krai are discussed, achievements of modern medicine in this country and abroad are reviewed in the paper. The journal chronology shows in details the periods of 1923-1933, 1934-1994, from 1994 to present day.
Perm Medical Journal. 2016;33(3):120-130
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