Vol 33, No 5 (2016)

Cover Page
Articles
DIAGNOSTIC VALUE OF ALPHA-FETOPROTEIN IN PROGRESSION OF HEPATIC CIRRHOSES OF VARIOUS ETIOLOGIES
Paducheva S.V.
Abstract
Aim. To determine the diagnostic value of alpha-fetoprotein (AFP) in progression of hepatic cirrhoses (HC) of various etiologies. Materials and methods. Seventy patients with hepatic cirrhosis including 49 patients with a viral etiology of this disease, 11 persons with alcoholic genesis and 10 patients with mixed cirrhosis (virus+alcohol) were examined. The group of control joined 10 practically healthy subjects. Blood serum alpha-fetoprotein level was assessed. Results. The serum AFP level was elevated in HC patients irrespective of etiology, as compared to the control group ( p < 0,001), it directly correlated with the degree of severity by Child-Pugh scale ( r = 0,35; p = 0,004). AFP level in patients with viral and mixed HC was significantly higher than in patients with alcoholic genesis of disease ( p = 0,03 and p = 0,03, respectively). AFP level in patients with compensated stage of HC ( n = 21) was 2,39 (1,16-6,79) ME/ml, with subcompensated ( n = 23) - 2,85 (2,1-18,6) ME/ml ( p = 0,18). In patients with decompensated HC ( n = 26), AFP was 5,02 (3,2-29,6) ME/ml that was significantly higher than in classes A and B ( p = 0,01 and p = 0,02, respectively). Conclusions. Higher AFP values were registered in patients with mixed genesis HC; AFP level rises as HC grows progressively worse; it permits to diagnose the decompensation of this process.
Perm Medical Journal. 2016;33(5):5-8
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CLINICAL PECULIARITIES OF COMMUNITY-ACQUIRED PNEUMONIA COURSE INDUCED BY STREPTOCOCCUS PNEUMONIA AND STAPHYLOCOCCUS AUREUS IN HIV-INFECTED PATIENTS
Nikolenko V.V., Vorobieva N.N., Nikolenko A.V., Okishev M.A.
Abstract
Aim. To reveal the clinical peculiarities of the course of community-acquired pneumonias caused by S.pneumoniae and S. aureus . Materials and methods. Over the period of 2006-20015, clinicolaboratory examination of 676 HIV-positive patients with community-acquired pneumonia was performed on the basis of Perm Regional Clinical Infectious Hospital. Results. It was established that the leading positions of etiological agents of nontuberculous etiology belong to S. pneumonia (30,1 %) and S. aureus (21,8 %). Conclusions. The clinical course of staphylococcal pneumonia in HIV-positive patients has a great number of complications and unfavorable outcomes.
Perm Medical Journal. 2016;33(5):9-14
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EXPERIENCE OF THROMBOLYTIC THERAPY AMONG PATIENTS WITH CRITICAL ISCHEMIC STROKE IN THE CITY OF PERM
Shilonosova I.V., Shestakov V.V.
Abstract
Aim. To assess the efficiency of thrombolytic therapy in ischemic stroke patients in the hospitals of Perm. Materials and methods. Retrospective analysis of 58 case histories of patients with acute ischemic stroke, who had undergone treatment at Regional Vascular Center on the basis of CCH №4 in Perm and received systemic thrombolytic therapy in the period from February 2014 to February 2016 was carried out. Results. Thrombolysis appeared to be effective in 35 (60,3 %) patients. Hemorrhagic transformation of ischemic stroke was observed in 9 (15,5 %) patients, but even in this case, regress in manifestation of neurological deficit was noted in 7 (77,0 %) patients. Five (8,6 %) patients died. Conclusions. Reperfusion therapy in the city of Perm has become a part of routine clinical practice. The results of introducing thrombolytic therapy are comparable with Russian and foreign data.
Perm Medical Journal. 2016;33(5):15-22
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RISK FOR DEVELOPMENT OF ACUTE GASTRIC AND DUODENAL ULCERS IN TREATMENT OF PYO-INFLAMMATORY DISEASES OF SOFT TISSUES USING NONSTEROID ANTI-INFLAMMATORY DRUGS
Lukin P.S., Zarivchatsky M.F., Blinov S.A.
Abstract
Aim. To carry out the comparative characteristic of anti-inflammatory drugs (nise, celebrex 200) in treatment of pyo-inflammatory diseases of the soft tissues for determination of the probability of the development of acute gastric and/or duodenal ulcers. Materials and methods. Treatment of 30 patients with abscessing hydradenitis was assessed using a randomized controlled study. All patients were divided into two groups, 15 persons each: the main and the comparison groups. In the main group, complex anti-inflammatory therapy included coxibs (celebrex 200), in the comparison group - nonsteroid anti-inflammatory drugs (nise). Results. In the comparison group, the results of fibrogastroduodenoscopy after the conducted therapy showed presence of gastric mucosa erosions in 60% of patients. In patients of the main group, no changes in gastric mucosa were observed. Conclusions. Coxibs applied as anti-inflammatory therapy in the treatment of pyo-inflammatory diseases of the soft tissues reduce risk for the development of acute gastric and/or duodenal ulcers of drug genesis.
Perm Medical Journal. 2016;33(5):23-26
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ANATOMO-SURGICAL BASIS FOR OPTIMIZATION OF LAPAROSCOPIC CHOLECYSTECTOMY TECHNIQUE
Batalova Y.S., Kagan I.I., Nuzova O.B.
Abstract
Aim. To improve the results of laparoscopic cholecystectomies by studying the anatomic variants of hepatoduodenal zone structures, when introducing laparoscope at different angles against the anterior abdominal wall. Materials and methods. Clinical studies included 70 patients with acute and chronic calculous cholecystitis, Variant anatomy of hepatoduodenal zone structures, when laparoscope is introduced at different angles against the anterior abdominal wall, was studied. Results. Typical anatomy of hepatobiliary zone structures was detected in 63 (90 %) patients. Atypical anatomy was noted in 7 (10 %) cases. Awareness of anatomic variants of hepatobiliary zone structures is necessary for the prevention of complications and improvement of therapeutic results. No anatomic peculiarities of hepatoduodenal zone were revealed in the course of US investigation. Conclusions. To make visualization of the organs of the upper store of the abdominal cavity more convenient, it is necessary to introduce laparoscope at the angle of 33-47° against the anterior abdominal wall.
Perm Medical Journal. 2016;33(5):27-31
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PECULIARITIES OF MANAGEMENT IN WOMEN OF DIFFERENT AGE GROUPS WITH ABNORMAL UTERINE BLLEDING
Ten A.R., Oboskalova T.A., Lavrentieva I.V., Vorontsova A.V.
Abstract
Ключевые слова. Аномальное маточное кровотечение, гиперплазия эндометрия. Aim. To assess management of women with abnormal uterine bleeding (AUB), who underwent surgical hemostasis. Materials and methods. Seventy nine ambulatory and hospital medical records were analyzed. There were women of two age groups: group I - 39 women with stages 4 and 3b, group II - 40 women with stages 3a and 2 by "STRAW+10" classification. In patients of menopausal transition, cases of arterial hypertension, obesity and type 2 diabetes mellitus were fixed reliably more often, while hepatobiliary diseases were revealed with similar frequency in women of both groups. Six (15,3 %) women in group I, and eleven (27,5 %) women in group II had repeated hemorrhage. The interval between the first and the repeated episode of AUB in group I was 8,4 ± 1,6 months, but in group II - 5,6 ± 2,4 months ( p = 0,03). Results. While performing histological study of endometrium, presence of simple endometrial hyperplasia (EHP) without atopy was detected in 32 (82,5 %) patients of group I; in 7 (17,9 %) patients - deficient secretory endometrial transformation was observed. In women of group II there were 2 cases (5 %) of complicated EHP without atopy and 12 (30 %) cases of multiple endometrial polyposis, in the rest 23 cases (57,5 %) glandular and glandular-fibrous EHP was developed ( p = 0,02). Only 21 (53,8 %) patients of group I and 35 (87,5 %) patients of group II underwent ambulatory antirelapsing therapy. Patients of reproductive age received progesteron drugs - 12 (57 %), "Mirena" - 7 (33,3 %) and only 2 (9,5 %) women took combined oral contraceptives. Women of group II received therapy with gonadotropin-releasing hormone agonists for 3-4 months. Conclusions. Menstrual cycle disorders are the predisposing factor for AUB development. In most cases, simple endometrial hyperplasia is a morphological substrate of AUB. Rehabilitation measures are to be conducted for prevention of abnormal uterine bleeding
Perm Medical Journal. 2016;33(5):32-37
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BLOOD ADIPOKINES DYSBALANCE IN PREGNANT WOMEN WITH OBESITY
Makarova E.L., Terekhina N.A., Padrul M.M.
Abstract
Aim. To assess the blood serum adipokine content in pregnant women with obesity of different type and degree. Materials and methods. Leptin, resistin, adiponectin content was studied in the blood serum of 65 pregnant women with obesity. Results. Among pregnant women with obesity, the number of pregnancy, labour and postnatal complications is significantly higher, the newborn health status is worse. Blood serum leptin content in pregnant women with obesity by 4 times exceeded the content of this hormone in healthy pregnant women. In the blood serum of pregnant women with android obesity, decrease in adiponectin (4,18 ± 0,39 mkg/ml) content as compared to patients with gynoid obesity (8,70 ± 0,55 mkg/ml) was revealed. Reliable rise in blood serum resistin level among pregnant women with obesity (9,8 ± 0,83 ng/ml) versus pregnant women with normal body mass(6,28 ± 0,6 ng/ml) was found. Conclusions. Direct correlation dependence between the body mass and the leptin content was registered that indicates compensatory stimulation of this hormone production by placenta for the prevention of hypoxia and fetoplacental insufficiency development. Decrease in the level of adiponectin and rise in the level of resistin among pregnant women with android obesity cause the development of gestation diabetes mellitus and formation of mother’s and fetal complications.
Perm Medical Journal. 2016;33(5):38-42
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GENDER TYPES IN DISSEMINATED SCLEROSIS PATIENTS
Pichkaleva Y.A.
Abstract
Aim. To study the gender in patients with disseminated sclerosis and to consider its correlation with some clinical characteristic features of disease. Materials and methods. The gender of 84 patients with disseminated sclerosis was determined using Sandra Bem survey; the clinical picture was assessed by EDSS scale, the quality of life indices - SF-36 scale and asthenia - MFI-20 scale. Results. The examined patients were mainly of the feminine and andogynous gender types. Among these genders, as compared with patients of the other type, aggravated quality of physical functioning, lesser activity and more marked disability, especially by the pyramidal and cortical systems, was proved. Debut remoteness and disability degree correlated with Sandra Bam index. Conclusions. The proved correlation between feminization and the duration of disease, aggravation of disability indices, quality of physical functioning quality, as well as reduction in activity allows to suspect progression of disseminated sclerosis in proper time and to change management tactics.
Perm Medical Journal. 2016;33(5):43-46
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PRESERVED AMNIOTIC MEMBRANE IN TISSUE-ENGINEERING COMPLEX STRUCTURE OF ANTERIOR EPITHELIAL CORNEAL LAYER
Milyudin E.S., Kuchuk K.E., Bratko O.V.
Abstract
Aim. To carry out experiment study of the possibility of cultivation of anterior corneal epithelial cells on the surface of silico-dried plasticized amniotic membrane “Flexamer”. Materials and methods. Histological study of amniotic membrane “Flexamer”, preserved by silico-drying and additionally sterilized by gamma rays, was conducted. The cultivated cells of the anterior corneal epithelium were precipitated on the surface of biomaterial “Flexamer”. Morphological assessment of the quality of fixation and biotoxicity of silico-dried plasticized amniotic membrane “Flexamer” was fulfilled. Results. A typical peculiar feature of biomaterial “Flexamer” is a minimum damage of the structure of epithelial layer, despite obvious cell viability. The studied tissue is also characterized by a good safety of all the rest layers of the amniotic membrane. The cultivated anterior corneal epithelium cells, precipitated on the surface of silico-dried plasticized amniotic membrane “Flexamer”, formed colonies and continued to proliferate. By the days 10-12, the second - third layer of epithelial cells was formed. By this time, the cells acquire a polygonal form and a nuclear-cytoplasmic index, more typical for the corneal epithelium. Conclusions. The conducted experimental study confirms safety of biologically active substances, which are concentrated mostly in the epithelial layer of amnion after its drying over the silica gel. Good fixation of cultivated cells, absence of cytotoxicity allow to make a conclusion about the possibility of applying biomaterial “Flexamer” as a substrate for formation of tissue-engineering complex with use of anterior corneal epithelial cells.
Perm Medical Journal. 2016;33(5):47-53
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COGNITIVE POTENTIAL ACTIVATION IN EXPERIMENTAL ANIMALS ENTERALLY INTRODUCED HISTONDEACETYLASE INHIBITOR PRECURSORS
Kuznetsov S.B., Kuznetsov V.F., Obernebesova T.P.
Abstract
Aim. To study the effect of short-chain fatty acids (SCFA), as natural histondeacetylase inhibitors, on cognitive function of experimental animals. Materials and methods. Cognitive peculiarities of 32 white outbred male mice, aged 15 to 16 weeks, were studied. Mice were divided into 4 groups depending on their diet and tested in T-shaped labyrinth. Results. In the control group, after a thrice-repeated training in a T-shaped labyrinth, the formation of reflex was revealed in 2 out of 9 experimental animals ( p > 0,05). In the group of animals, who in addition to usual nutrition received fructooligosaccharides (inulin), reflex was obtained in 2 out of 7 experimental animals ( p > 0,05). In the group of animals, who additionally took wheat bran, reflex was formed in 3 animals out of 8 ( p > 0,05). In the animals of group 4, who additional received a natural complex containing SCFA and fermentable dietary fibers (BAS “Reckicen-RD”), this reflex was formed in 6 animals out of 8 ( p < 0,05). Conclusions. It was stated that when using a natural complex of FDF and SCFA, the experimental animals’ learning capability in the T-shaped labyrinth statistically significantly increased versus the control group.
Perm Medical Journal. 2016;33(5):54-59
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POLYMORPHISM OF VITAMIN D RECEPTOR (VDR) GENE IN SAMPLING OF EUROPEAN RUSSIA AND PRIURALIYE POPULATION
Kozlov A.I., Vershubskaya G.G., Negasheva M.A.
Abstract
Aim. To assess the genotype frequencies of VDR BsmI (rs1544410) and FokI (rs10735810) in ethnic Russian population and in different groups of the population of Volgo-Kamsky region and Priuraliye. Materials and methods. Samplings of Russians of the European part of RF ( n = 96) and Eastern Finns including Komi-Permyaks ( n = 71), Komis ( n = 190) and Udmurts ( n = 86) were examined. Genotype frequencies were determined using the method of PCR-amplification. Results. Russians differ for the inhabitants of Moscow (without taking into account ethnic origin) by the distribution of VDR FokI ( p = 0,09001), but not BsmI. Eastern Finns in the regions of their historical residence do not differ by VDR FokI and BsmI, but they differ from Russians by BsmI frequencies ( p = 0,0856). Conclusions. The obtained results agree with the assumption about the specificity of VDR allel frequencies in different ethnic groups.
Perm Medical Journal. 2016;33(5):60-66
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AESTHETIC CORRECTION OF FIGURE AND QUALITY OF LIFE ASSOCIATED WITH BODY IMAGE
Plaksin S.A., Khramtsova N.I., Zayakin Y.Y.
Abstract
Aim. To study the influence of the results of aesthetic surgical interventions on the quality of life, associated with imagined appearance, in patients with local lipodystrophias. Materials and methods. Qualitative and quantitative parameters of the quality of life, associated with imagined appearance, were analyzed in 22 women with local lipodysthrophy on the basis of clinical interview, clinicoanamnestic, anthropometric, experimental-psychological (BIQLI survey) methods. Dynamics of satisfaction with their own appearance in the interval of 1-3 years after the surgical correction (liposuction) was studied. Results. The total score of the quality of life level, associated with women’s attitude to their own appearance, was 29,1 ± 13,8 in women with local lipodystrophy, 21,7 ± 20,2 in the group of comparison ( p = 0,08). In the interval of 1-3 years after the aesthetic surgical correlation, the body contour was estimated as “excellent” by 10 (45 %) patients, “good” - 7 (32 %), “satisfactory” - 3 (14 %), “unsatisfactory” - 2 (9 %). Low scores were connected with the local postoperative deformations in the zone of surgical intervention. Satisfaction with their appearance after the surgery and, as a result, subjective rise in the quality of life was evaluated as “excellent” by 8 (36 %) patients, “good” - by 11 (50 %) patients. Conclusions. Patients with local lipodystrophy, whose quality of life initially was highly dependent on subjective perception of the body image, were much more satisfied with their own appearance in the long-term period after the liposuction.
Perm Medical Journal. 2016;33(5):67-71
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HEALTH STATUS OF ATHLETES ENGAGED IN PLAYING KINDS OF SPORT BY RESULTS OF MEDICAL EXAMINATION
Chainikov P.N.
Abstract
Introduction. A high level of physical, psychoemotional and social load in conditions of modern sport negatively influences the health of young athletes and can cause the development of somatic pathology. When planning sport activity, it is necessary to pay attention to serious medical examination, aimed at early diagnosis and prevention of diseases and injuries. Aim. To study health and functional status of young athletes, who are engaged in playing kinds of sport and not observed in the structure of medical and physical culture dispensary. Materials and methods. Sixty eight young athletes from the city of Perm (aged 12,8 ± 3,2 years); 47 men and 21 women engaged in the following kinds of sport: basketball, ice hockey, volleyball. Results. Harmonic physical development was detected in 55 athletes (80,8 %), disharmonic physical development - in 13 athletes (19,2 %). Associated pathology was not revealed in 11 athletes (16,1 %), pathology was available in 57 (83,8 %) athletes. Two and more nosological forms of chronic diseases per one athlete were registered in 57,3 % (39 athletes) of cases. Conclusions. High incidence rate of diseases is observed among young athletes, who are engaged in playing kinds of sport and not observed in the structure of medical and physical culture dispensary. In the structure of young athletes’ diseases there prevail pathologies of locomotor, cardiovascular and nervous systems.
Perm Medical Journal. 2016;33(5):72-76
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GROUNDING FOR METHOD OF INTERNAL ENVIRONMENT CORRECTION IN SYLVINITE WARD
Ryazanova E.A., Barannikov V.G., Khokhryakova V.P., Dementiev S.V., Maslov Y.N.
Abstract
Aim. To evaluate and ground the use of ultraviolet air recirculator in the saline microclimatic ward “Sylvin-Universal”. Materials and methods. Hygienic and microbiological assessment of internal environment in the saline microclimatic ward “Sylvin-Universal” with conventional operating mode and in process of work of ultraviolet bactericidal air recirculator was carried out. Results. Ultraviolet bactericidal irradiation did not change physical properties of internal environment in the sylvinite ward. Conclusions. The conducted studies permit to recommend application of ultraviolet irradiator before each course of sylvinite therapy for the purpose of air disinfection.
Perm Medical Journal. 2016;33(5):77-81
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PHENOMENON OF MUTUAL AGGRAVATION OF INJURIES IN POLYTRAUMA
Shapkin Y.G., Seliverstov P.A.
Abstract
The results of modern experimental and clinical studies, regarding mutual influence of injuries on each other in case polytrauma, are presented in the review. Multiple severe injuries cause the phenomenon of their mutual aggravation, that is, the correlation of pathophysiological processes with worsening of patient’s status of health, growth of risk for development of complications and lethal outcome. Craniocerebral trauma, severe thoracic and abdominal injuries, long and pelvic bone fractures are the most significant in formation of this phenomenon. Mechanisms for realization of mutual aggravation of injuries include shock and hemorrhage, coagulopathy, systemic inflammatory reaction and posttraumatic complications. Mutual influence of injuries is to be taken into account for prediction and prevention of complications, development of pathogenetic methods of therapy and optimization of surgical tactics in treatment of polytrauma.
Perm Medical Journal. 2016;33(5):82-94
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