Vol 37, No 6 (2020)

Irina Petrovna Koryukina was born on February 21, 1953 in Perm in a family of doctors. In 1970 she graduated with a gold medal from school number 22 with in-depth study of the French language, in the same year she entered the medical faculty of the Perm State Medical Institute (PSMI), in 1976 she graduated with honors. From 1976 to 1978 she studied in residency, and from 1978 to 1981 - in graduate school at the Department of Faculty Pediatrics, PSMI. Since 1981 - Assistant, and from 1985 to 1992 - Associate Professor of the Department, since 1992 - Head of the Department of Pediatrics of the Faculty of Advanced Training for Physicians. From 2002 to 2005 - vice-rector for scientific work of the Perm State Medical Academy, since 2005 - rector.

Andrey Valentinovich Nikolenko was born on February 26, 1972 in the city of Chusovoy, Perm Region, into a family of medical workers. Graduated from the medical faculty of the Perm State Medical Academy in 1994, clinical residency, full-time postgraduate study. Academic degree: candidate of medical sciences, academic title: associate professor (2005). Since 2001 - Assistant at the Department of Hospital Surgery, Anesthesiology and Reanimatology with the course of Oncology and Surgery at FUV. In 2008, he organized and headed the Department of Mobilization Preparation of Health Care and Disaster Medicine. Since 2015, he headed the Department of Anesthesiology and Reanimatology. Since 2018 - the Department of Anesthesiology, Reanimatology and Emergency Medicine. During his work, the head with his help trained more than 100 specialists who graduated from residency, the negative growth in the staff of anesthesiologists-resuscitators was stopped (the staff shortage decreased by 30% in four years).

Objective. To assess the role of iron metabolism changes in the pathogenesis of chronic diffuse liver diseases (CDLD). Assessment of the hepatic fibrosis progression and the most significant factors, influencing it, is still an actual target of modern medicine. A certain interest from the point of view of complex approach to studying the mechanism of development and progression of fibrosis is the determination of serum markers of iron metabolism.

Materials and methods. The study included 170 patients with CDLD: 150 with chronic viral hepatitis C and 20 with alcohol hepatic cirrhosis (AHC). Iron metabolism indices and functional hepatic biochemical tests were studied. Expression of hepatic fibrosis in hepatitis was estimated by means of the liver density index with the scale METAVIR using the data of ultrasound elastography (Fibroscan 502, Echosens, France); fibrosis development rate was calculated with T. Poynard method. The control group enclosed 100 persons.

Results. There was revealed a significant elevation of the blood ferritin concentration among patients with chronic hepatitis up to 107.9 [31; 250] ng/ml compared with the control (22.0 [11; 33] ng/ml) and to 325.8 [209; 401] ng/ml in patients with AHC.

Conclusions. Progression of fibrosis into cirrhosis in patients with CDLD is interconnected with iron metabolism disorders in the form of increased ferritin concentration, which correlates with the parameters of liver lesion severity that confirms a direct involvement of iron metabolism disorders in CDLD pathogenesis.

Objective. To develop a model of an integral index for complex assessment of varicose vein risk factors and estimate the influence of pregnancy on the occurrence of chronic vein diseases. Varicose veins (VV) and chronic venous insufficiency are one of the most widespread human diseases. This pathology in pregnancy has a clear picture, which is quite different from varicose veins in non-pregnant women.

Materials and methods. Analysis of 1974 individual medical cards of pregnant women and puerperas of Maternity Hospital № 2 for the period of 2016–2019 was carried out. Out of them, 456 cards had a diagnosis of varicose veins of the lower limbs. The method was based on statistical analysis and integral indices.

Results. The following risk diapasons were determined: low risk (favorable prognosis) – 0.44–0.85; medium risk (favorable prognosis is possible) – 0.86–1.28; high risk (unfavorable prognosis) – 1.29–2.13. The quantity of pregnancies is not an unfavorable prognosis for women. Long statistical loads give unfavorable prognosis (1.34–1.43); family predisposition is an unfavorable prognosis (1.66); lifting loads depending on the quantity in grams (1000 – favorable sign; 5000–10 000 – unfavorable (1.21–1.870)); wearing tight clothes is not an unfavorable prognosis (0.88); hypodynamia – medium risk (1.14); diet – low and medium risk (0.75–0.95), obesity – high risk (1.24–2.15).

Conclusions. The obtained results permitted to detect the most significant risk factors for varicose veins during pregnancy. Medium and high-risk indices are the following: long statistical loads, family predisposition, lifting loads, hypodynamia, diet and obesity. They influence the development of varicose veins. There is a possibility to present a prospective prognosis for pregnant women and develop a complex of measures to decrease risks for chronic vein diseases taking into account individual features of patients.

Objective. To evaluate the effect of the genetic characteristics of Helicobacter pylori on the nature of pathomorphological disorders in the gastric mucosa in chronic Hp-associated gastritis in young people.

Material and methods. Forty-two adults (25 men and 17 women) aged 19 to 40 years with Hp-associated chronic gastritis were examined. The severity and activity of inflammation, as well as the presence of atrophy and intestinal metaplasia were determined in gastrobioptates. Genetic typing of Hp was performed for 16 pathogenicity factors of infect: CagA, CagM, CagT, CagH, CagC, CagF, CagE, VacAs1 and As2, IceA, Baba; HpaA; OipA, AlpB; UreB and UreI using polymerase chain reaction.

Results. Pathogenic Hp strains were detected in 59.5 % of patients. Factors of adhesion – HpaA (83.3 %), OipA (81 %), and AlpB (83.3 %) were identified with the highest frequency. In 57.1 % of cases, cytotoxin of the Cag group was detected, and 54.8 % of patients had a positive CagA-status. The VacA S₁ allele was registered in 73.8 %, VacA S₂ in 4.8 %, IceA in 38.1 %, and BabA in 45.2 % of cases. The presence of Hp strains in the gastric mucosa, which have three or more pathogenicity island genes, significantly increases the severity and activity of the inflammatory process, revealing signs of moderate atrophy of the digestive tract and intestinal metaplasia.

Conclusions. Colonization of the gastric mucosa in young patients with Hp-associated chronic gastritis by highly pathogenic Hp strains leads to severe violations of its morphology.

Objective. To establish the features of epidemiology and clinical manifestations of congenital malformations of the urinary system in the zone of environmental distress.

Material and methods. We analyzed the overall prevalence of nephropathies and the proportion of congenital malformations of the urinary system in the dynamics from 2001 to 2019; 697 patients aged 1–18 years were examined with assessment of clinical and anamnestic, laboratory, instrumental and radiological data in accordance with diagnostic standards and protocols. We studied the features of epidemiology and clinical manifestations of congenital kidney and urinary tract diseases in an area with an unfavorable environmental situation.

Results. Over the past 2 decades, the general prevalence of nephropathies in the children's population has increased with an elevation in the proportion of congenital malformations of the urinary system. These indicators are significantly higher in an area with a high level of anthropogenic environmental pollution than in an area with a relatively favorable environmental situation. Features of congenital pathology of the kidneys and urinary tract in patients living in an environmentally unfavorable zone were revealed: the presence of mass deficiency, reduced resistance, combination with undifferentiated connective tissue dysplasia syndrome, more frequent attachment of microbial-inflammatory process, decreased concentration and evacuation function of the kidneys.

Conclusions. These features of epidemiology and clinical manifestations of congenital malformations of the urinary system in patients living in a region with a high level of environmental pollution should be taken into account when carrying out their medical support.

The article presents a literature review regarding the formation of chronic obstructive pulmonary disease in conditions of the exposure of industrial aerosols. It shows a high frequency of occupational respiratory hazards, characterizes the diseases caused by air pollution with industrial and indoor pollutants, allergens and toxins in different occupational groups as well as basic conditions for development of dust pathology of the lungs.

Objective. To determine the suture technique, which provides better hemodynamic indices in aortic valve replacement. Aortic valve AV) pathology is a widespread pathology among elderly persons and since the share of them increases every year, the number of surgeries for AV replacement is growing. Many factors can influence the hemolytic characteristics of AV prosthesis including construction of cusps and supporting ring. Suture technique can also influence the hemodynamic results of AV replacement. Conventional technique for attaching mechanical valve is an interrupted sealing suture.

Materials and methods. Patients who underwent AV prosthetics isolated prosthetics, prosthetics combined with coronary artery bypass grafting, with mitral valve repair, tricuspid valve repair or aortic prosthetics) over the period from January 2015 to September 2018 were studied. All statistical calculations were fulfilled using IBM SPSS Statistics 23.0 IBM Corp., Armonk, NY).

Results. Altogether, from January 2015 to September 2018, 439 patients underwent AV prosthetics; 321 patient 73.1 %) underwent isolated AV replacement. Unsealed technique had less frequency of occurrence of “prosthesis-patient" mismatch PPM), especially in the small aortic ring compared with the other suturing techniques. The suture type was the following: sealing and figure-of-eight suture and the number of sutures more than 16 were the risk factors for moderate and severe PPM in logistic regressive analysis; the suture technique was an independent risk factor for moderate and severe PPM.

Conclusions. An interrupted mattress unsealed suture permits to implant the AV prosthesis on the native fibrous ring of the valve with less frequency of occurrence of “prosthesis-patient" mismatch and promotes improvement of hemodynamics in patients with a small fibrous ring of the aortic valve.

Objective. To carry out a comparative analysis of the results of epithelial coccygeal course treatment using laser-induced interstitial thermotherapy LIT) under ultrasound control and traditional open excision. The high trauma rate of traditional operations in the epithelial coccygeal course ECC), the duration of hospital stay, pain syndrome force surgeons to search for new technologies in the treatment of this pathology.

Materials and methods. A retrospective analysis of the treatment results of 369 patients with ECC who were admitted to the clinic for elective surgery in the period from 2009 to 2019 was carried out. There were 264 men 71.5 %) and 105 women 28.5 %). The mean age was 26.9 ± 7.2 years. The patients were divided into 2 groups: 190 patients of the main group underwent surgery using a fiber-optic laser under ultrasound guidance, 179 patients of the comparison group underwent traditional radical excision of ECC with application of primary sutures or various types of plastic.

Results. The severity of pain syndrome after surgery in patients of the main group was 1.7 ± 0.6 points, in the comparison group 3.5 ± 1.3 points by a five-point visual analogue scale VAS) for pain. The duration of inpatient treatment in the main group was 1.8 ± 0.4 days, in the comparison group 11.5 ± 1.7 days. Moreover, in 197 76.1 %) patients of the main group, the operation was performed on an outpatient basis. The restoration of working capacity in the main group occurred after 5.2 ± 1.2 days, and in the comparison group – after 17.4 ± 2.8. After traditional operations, the relapse of the disease was noted in 11.7 %, and after laser treatment, slightly more than 12.1 %. Satisfaction with the results of treatment in the main group was noted in 95.1 %, and in the comparison group in 90 % of patients.

Conclusions. The obtained results of treatment allow us to recommend the technique of interstitial laser obliteration of the coccygeal cyst under ultrasound navigation developed in the clinic for widespread use in practical work of surgeons.

Objective. The aim was to assess the impact of production and non-production risk factors on the formation of mental health disorders in chemical workers.

Materials and methods. 201 employees of the main and 352 employees of the group of control were examined by a clinical method using a clinical structured psychiatric interview; questionnaires to identify additional non-production risk factors; questionnaire of neurotization. The calculations were carried out in the environment of the statistical system R. For modeling dependencies and calculating probabilities, logistic regression models were built, factor analysis was carried out.

Results. The dependence of the formation of prenosological mental disorders in workers on the temporal characteristics, the level of material support and the actual production factors was revealed. The proportion of persons with mental deadaptation MD) in the main group 72.5 %) and the group of control 27.5 %) significantly differ from each other p ≤ 0.001).

Conclusions. 1. The structure and the actual risk of MD formation among workers in the production of gunpowder is determined by harmful labor factors, depends on economic security, evolves depending on time characteristics. 2. For persons working under the influence of a chemical factor of the production environment in combination with explosive and fire hazardous works, the leading is astheno-vegetative symptomatology in combination with the personality type of conversion reaction. In the first 9 years of experience, general neurotic reactions are observed with a pronounced contribution from all scales, indicating the tension of adaptation mechanisms up to the formation of decompensation. With an increase in the length of time, the reactions are transformed into a conversion type of response according to the somato-vegetative type with a phobic radical and obsessions, and subsequently manifest themselves in relative independence from characterological reactions. 3. The degree of severity of reactions is characterized by variability, significantly overlapping the types of disorders that can be considered in the framework of «Other mood disorders» F38.0 and F38.1), which does not give grounds to classify them as F30-F34, since they are not sufficiently pronounced and severe.

The article describes the current understanding of the takotsubo syndrome concerning the issues of pathogenesis, differential diagnosis with acute coronary syndrome and strategy of management. There is presented our own clinical observation of a patient with an atypical form of cardiac dysfunction and myocardial geometry.