Vol 35, No 2 (2018)

Cover Page
Original studies
Predictors of external pancreatic fistulas development after surgical treatment of infected pancreatonecrosis
Kotelnikova L.P., Kudryavtsev P.L.
Abstract

Aim. To determine the risk factors for the development of external pancreatic fistulas in the outcome of infected pancreatonecrosis, which do not close as a result of conservative treatment.

Materials and methods. The results of treatment were analyzed in 44 patients with pancreatonecrosis. The influence of different risk factors for the development of external pancreatic fistulas after surgery for infected pancreatonecrosis was studied, using Spearman’s correlation coefficient.

Results. The repeated surgeries one year after pancreatonecrosis were required by 9 % of patients in connection with pancreatic cysts and for 11.36 % – with external pancreatic fistulas. There was observed a positive correlation of a mean value between the formation of external pancreatic fistulas, which did not close after intensive conservative therapy and the localization of necrosis zone in the region of isthmus (r = 0.31, p = 0.00), its depth 50 % and more (r = 0.46, p = 0.00), quantity of outflow (r = 0.55, p = 0.00) with amylase activity > 1000 units (r = 0.53, p = 0.00).

Conclusions. Localization of necrosis zone in the region of isthmus, necrosis depth 50 % and more, quantity of control drainage outflow > 150 ml, high amylase activity in drainage > 1000 units are predictors of the formation of external pancreatic fistulas in the outcome of acute destructive pancreatitis, which need surgical correction.

Perm Medical Journal. 2018;35(2):5-10
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Peculiarities of roentgenological picture of pulmonary tuberculosis upon HLA-DRB1 gene polymorphism depending on pro-and-antiinflammatory cytokines concentration
Stepanova N.A., Kantemirova B.I., Galimzyanov K.M.
Abstract

Aim. To study the peculiar features of roentgenological picture of pulmonary tuberculosis in patients with polymorphous HLA-DRB1 allels in the genotype in associations with pro-and-antiinflammatory cytokines concentration.

Materials and methods. The complex clinicoimmunogenetic examination of 64 patients with pulmonary tuberculosis was carried out. The patients’ age ranged 18 to 52 years. The gene HLA-DRB1 polymorphism was determined using the method of polymerase chain reaction with DNA, previously extracted from blood samples. Cytokine concentration was determined in the peripheral blood before specific treatment, using the assay kits of “Vector-BEST Company” (Russia).

Results. The prevailing clinical form of pulmonary tuberculosis among patients was infiltrative one – 40 (62.5). Bacterioexcretion was stated in 89.5 % of cases. Roentgenological picture of pulmonary tuberculosis in patients with HLA-DRB1 *04, *13, *14, *16 alleles was characterized as disseminated injury of lung tissue with destructive changes, the concentration of IL-1b, TNF-α exceeded the standard values by more than 3 times (r = 0.88; р = 0.040), IL-2, IL-10, g-INF was lower than standard values by more than 4–5 times (r = 0.75; р = 0.003).

Conclusions. When studying HLA-DRB1 gene polymorphism and pro-and-antiinflammatory cytokines concentrations in patients with pulmonary tuberculosis, it was established that patients with HLA-DRB1 *01, *07, *08, *10, *15 alleles more often, compared to the others, had disseminated injury of lung tissue, in most cases with its destruction as well as dysbalanced cytokine balance in the direction of deep immunosuppression.

Perm Medical Journal. 2018;35(2):11-18
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Peculiarities of complaints among young women with idiopathic arterial hypotension
Baev V.M., Agafonova T.Y., Igumnova O.A.
Abstract

Aim. To study the peculiar features of complaints among young women with idiopathic arterial hypotension (IAH) and determine their frequency.

Materials and methods. Comparative analysis of complaints frequency between two groups of women aged 18–23 was carried out: the test group of patients, suffering from IAH (n = 210) with SAP 97 (92–98) mm Hg and the control group (n = 96) with normal arterial pressure with SAP 123 (121–125) mm Hg.

Results. 58 % of women with IAH walk less than 5 km a day that is reliably more frequently compared to women with normal arterial pressure. Women with IAH, having moderate physical and emotional load, more often have complaints of dyspnea (25 %) and thoracic pains (40 %). When suffering from IAH, patients more often complain of pain in their legs, especially while walking (35 %), dizziness (38 %), pain and paleness of hand and leg fingers in cold (36 %); 12% of women with IAH have nocturia.

Perm Medical Journal. 2018;35(2):19-25
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Functional disorders of maxillofacial region in children with cerebral paralysis
Danilova M.A., Bronnikov V.A., Zalazaeva E.A.
Abstract

Aim. To reveal the peculiar features of functional disorders in maxillofacial region among children with cerebral paralysis.

Materials and methods. While carrying out complex neurological, stomatological and logopedic examination of 120 patients (age 3 to15 years) with the above mentioned diagnosis, the following was assessed: the course of speech development (first words, phrases), state of general, fine and speech motor activity, speech sounding, status of speech apparatus.

Results. The data on frequency and structure of functional maxillofacial disorders in children with cerebral paralysis were obtained. Thus, dysfunction of swallowing was detected in 32,5 % of cases. In 53,33 % of cases from the total number of the examined patients, there was revealed the impaired chewing function in the form of slow chewing process, which occurred in 100,0 % of cases among children with double hemiplegia. Impaired speech development in the form of pseudobulbar dysarthria (spasticoparetic, spasticorigid) and anarthria was diagnosed in 82 (68,33 %) persons, speech development corresponded to age in 38 (31,67 %) children.

Conclusions. The obtained data on peculiar features of functional maxillofacial disorders, observed among children with different clinical variants of spastic cerebral paralysis forms, should be used in practical health care for planning treatment-and-prophylactic measures at rehabilitation centres.

Perm Medical Journal. 2018;35(2):26-31
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Peculiar features of immunogenetic parameters in children with atopic diseases
Illek Y.Y., Vyaznikova M.L., Leushina N.P., Mischenko I.Y., Ryseva L.L., Solovieva G.V., Tarasova E.Y.
Abstract

Aim. To determine the peculiarities of distributing antigens of major histocompatibility complex in children with atopic dermatitis and children with bronchial asthma.

Materials and methods. Serologic typing of HLA class I-complex antigens and molecular typing of HLA class II-complex antigens was fulfilled in 52 children (age range 5 to 14 years) with disseminated moderate and severe atopic dermatitis and 122 children (age range 5 to 14 years) with moderate and severe atopic bronchial asthma.

Results. Among children with atopic dermatitis, there was found high incidence rate of HLA-complex antigens B15, B16, B17, DRB1*13 and DQB1*0602-8, presentation of which was associated with elevation of relative risk for the development of disease by 3.3–8.4 times. In children with atopic bronchial asthma, the observed high incidence rate of HLA-complex antigens A26, B18 and DRB1*17 was associated with rise of relative risk for the development of disease by 3.0–9.1 times.

Perm Medical Journal. 2018;35(2):32-36
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Structural-functional peculiarities of left atrium remodeling in patients with different body mass, suffering from chronic obstructive lung disease
Kostareva R.A., Khovaeva Y.B., Podyanova A.I.
Abstract

Aim. To study the left atrium (LA) remodeling in patients with different body mass, suffering from chronic obstructive lung disease (COLD).

Materials and methods. Seventy two patients with COLD, who were divided into 3 groups, underwent echocardiography: group 1– patients with normal body mass (n = 31), group 2 – patients with excessive weight (n = 21), group 3 – patients with degree I obesity (n = 20).

Results. Among patients with COLD, belonging to group 3, indexed parameters of minimum (15.43 ± 1.62 ml/м2, р = 0.004) and presystolic (20.52 ± 1.88 ml/м², р = 0.03) volumes of LA increased; these patients also demonstrated growth of maximum upper-lower size of LA with elevation of its linear maximum and minimum sizes, when compared with patients of group 1. Patients with different body mass, suffering from COLD, have similar volumes of passive and active depletion and their corresponding fractions. COLD patients with excessive body mass and obesity showed moderate pulmonary hypertension.

Conclusions. Patients with obesity, suffering from COLD, have significantly elevated indexed parameters of presystolic and minimum LA volumes, which can be considered as early markers of impaired function of LA. Increased minimum LA volume can be one of the factors of gas exchange impairment.

Perm Medical Journal. 2018;35(2):37-42
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Assessment of calcium-phosphorous metabolism in patients with early infantile caries by laboratory data
Kamenskikh D.V.
Abstract

Aim. To assess the laboratory indices of calcium-phosphorous metabolism in patients with early infantile caries (EIC).

Materials and methods. Complex clinicolaboratory examination of 34 children (age range 36 to 72 months), diagnosed early infantile caries, was carried out. Patients’ dental status was stated; a number of laboratory studies to estimate calcium phosphorous metabolism with further mathematical processing of the obtained material was fulfilled.

Results. The analyzed laboratory studies showed the absence of pathological regulation of calcium-phosphorous metabolism in the body of the examined patients. The correlation analysis of caries intensity and daily urinary calcium and phosphorus levels in patients of type I revealed weak correlation feedback, r = –0.21, r = –0.25. The analogous analysis in patients of types II and III detected moderate feedback and the similar statistical data, namely, r = –0.26, r = –0.34 and r = –0.27, r = –0.29, respectively.

Conclusions. Interaction between the deficit of the excreted calcium and phosphorus in the daily urine and the risk for development of early infantile caries was found in patients with EIC. Laboratory diagnostic studies, so as to administer adequate drug therapy for correction of separate indices of calcium-phosphorous metabolism, are necessary. It should be also noted that among patients with decompensated form of caries course, low calcium indices are more often associated with low phosphorus indices in the urine against the background of hematological parameters, which keep within the standards.

Perm Medical Journal. 2018;35(2):43-47
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Clinical and economic efficiency of treatment in patients with tuberculosis in conditions of day hospital
Shurygin A.A., Makarova E.A., Matasova E.V.
Abstract

Aim. To study the clinical and economic efficiency of treatment in patients with tuberculosis in conditions of day hospital when compared with treatment of patients in conditions of 24-hour hospital.

Materials and methods. The results of treatment of patients with first-ever lung tuberculosis in conditions of day hospital were analyzed.

Results. 76.7 % of patients, by the moment of discharge from the hospital, successfully completed the course of treatment.

Conclusions. Clinical efficiency of treatment in the day hospital did not differ from specialized indices of antituberculous work that confirms its significant economic efficiency.

Perm Medical Journal. 2018;35(2):48-52
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Analysis of activity of prenatal diagnosis service in Perm krai
Olina A.A., Sadykova G.K., Shirinkina E.V.
Abstract

Aim. To analyze the work of prenatal diagnosis im Perm and Perm Krai for the period of 2012–2016.

Materials and methods. Statistical forms 32 for Perm and Perm Krai (PK) over the period of 2012–2016 were analyzed.

Results. During 2012–2016, in Perm Krai there was observed decrease in the absolute number of women with completed pregnancy by 6.3 %, whereas in the city of Perm this index raised by 1.8 %. Positive dynamics concerning complex screening coverage during the first trimester was detected. Calculation of index from the number of women with completed pregnancy in Perm Krai demonstrated a basic rate of growth 63.6 %, in Perm – 77.2 %. The analyzed absolute and relative indices showed increase in the number of the revealed CM in Perm Krai and Perm by 80 %.

Conclusions. Centralization of prenatal diagnosis in Perm and Perm Krai permitted to improve preventive measures for detecting congenital malformations in the early terms of pregnancy.

Perm Medical Journal. 2018;35(2):53-58
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On problems and algorithm of prescribing combined medicinal preparations, containing small quantities of narcotic drugs and psychotropic substances
Porseva N.Y., Soloninina A.V., Rostova N.B.
Abstract

Aim. To analyze the regulating documents and work out the algorithm of prescribing combined medicinal preparations, containing small quantities of narcotic drugs, psychotropic substances, their precursors and other pharmacological active substances.

Materials and methods. The normative documents, regulating the order of prescribing and selling combined medicinal preparations, containing narcotic drugs, psychotropic substances and their precursors were analyzed.

Results. Some normative documents to regulate the order of prescribing combined medicinal preparations, containing narcotic drugs and psychotropic substances, present problems. To simplify the procedure of prescribing such medicinal preparations, there was suggested an algorithm, explaining: the choice of prescription form; conditions of prescribing combined medicinal preparation by trade name; terms of prescription validity and possibilities of their prolongation; regulated possibilities for exceeding norms of prescribing medicinal preparations and order of their registration.

Conclusions. The suggested algorithm of the order of prescription will promote observation of requirements of the existing normative acts.

Perm Medical Journal. 2018;35(2):59-67
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Hygienic assessment of foreign students’ living conditions in the hostel of perm state medical university
Koryukina I.P., Kulesh T.A., Zueva T.V., Arbuzova T.P.
Abstract

Aim. To present the hygienic assessment of foreign students’ living conditions in the hostel of Perm State Medical University.

Materials and methods. Sanitary-epidemiological estimation of arrangement, equipment and maintenance of the hostel for Indian students was performed. Hygienic assessment of the hostel territory, rooms and accommodations for common use, equipment and facilities of the building and rooms was presented. In the living and auxiliary rooms, sanitary-hygienic tests (measurements) regarding microclimate (90), infrared radiation (20), noise level (45), electromagnetic radiation (40), natural and artificial light (65) were fulfilled.

Results. Objective assessment of social factor and living conditions, influencing adaptation of foreign students to new climatico-geographic conditions was obtained. The living conditions for foreign students in the hostel of Perm State Medical University correspond to sanitary-epidemiological rules and standards, except for the level of noise.

Conclusions. Favorable social and living conditions, offered to Indian students in the student’s hostel, help them to overcome difficulties, connected with adaptation of foreign medical students.

Perm Medical Journal. 2018;35(2):68-74
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Specifics of follow-up observation regarding two diseases
Sandakov Y.P.
Abstract

Aim. To study the specifics of addressing for medical care among patients under follow-up observation regarding two diseases.

Materials and methods. The data, obtained from ambulatory medical records of 159 patients under follow-up observation for two diseases, were analyzed using the methods of descriptive and inductive statistics.

Results. From among patients, who were under follow-up observation concerning two diseases, there were more women (58.5 %) and pensioners (95.5 %). A mean age was 68,1 ± 11,6 years. The most frequent cause of observation regarding the first disease are the diseases of cardiovascular system (71.7 %), the second – the diseases of endocrine system (52.8 %). A mean duration of the first disease, as the cause of follow-up observation, was 10.8 ± 6.9, the second – 9.9 ± 8.2 years. There is no statistically significant difference between mean duration of disease among pensioners and able-bodied persons (the first disease t = –0.6 p = 0.5; the second disease t = –0.9, p = 0.4). There is no correlation between age and duration of disease: the first disease (χ2 = 0.04, р = 0.8) and the second (χ2 = 0.08, р = 0.6). There is statistically significant difference between mean duration and follow-up observation time of the first disease t = 5.4, р ˂ 0.0001 and the second t = 2.6, р = 0.012. There is statistically significant difference between the number of planned and real visits for the first disease t = 3.5, р = 0.001. Exacerbations were registered in 94.3 %, concomitant diseases – in 90.6 %, emergency calls – in 71.7 %, hospitalization – in 60.4 %, urgent hospitalization – in 36.7 %.

Conclusions. In the group of patients under follow-up observation regarding two diseases, there prevail persons of pension age; the main cause of follow-up observation is the diseases of cardiovascular system; profile specialists were randomly addressed to; the basic way of disease detection is follow-up observation; the disease duration, but not the age influence the severity of status; untimely start of observation and unsatisfactory quality of follow-up was revealed; loyalty to treatment depends on individual motivation of patients; follow-up, conducted by narrow specialists, is not more effective, than that by therapeutists.

Perm Medical Journal. 2018;35(2):75-84
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Grounding of using treatment-and-rehabilitation complex for patients with occupational lumbosacral radiculopathy
Shaikhlislamova E.R., Karimova L.K., Gallyamova S.A., Urmantseva F.A., Iskhakova D.R., Alakaeva R.A.
Abstract

Aim. To ground and estimate the efficiency of using nonmedicamentous methods of treatment in patients with occupational radiculopathy of lumbosacral level.

Materials and methods. Sixty seven patients, diagnosed occupational lumbosacral radiculopathy, were examined; patients’ neurological status, manifestation of pain syndrome by 10-score visual analog scale and neuromuscular state by stimulation electroneuromyography data prior to and after treatment were assessed.

Results. Treatment-and-rehabilitation complex included magnetic-laser therapy, acupuncture, combined with curative gymnastics. By the completion of treatment, positive dynamics regarding nearly all neurological states, including reduced manifestation of painful sensations, increased volume of active movements in the lumbar spine, decreased hyperesthesia rate and hypoesthesia intensity in the zone of injured roots, decreased occurrence of Lasegue test was observed. Dynamics of electroneuromyographic parameters was expressed by improved conduction of nerve impulses through the peripheral low extremity nerves and roots L4, L5, S1 of cerebrospinal nerves.

Conclusions. Application of the offered complex provided positive effect by the end of treatment in 82.3 % of cases.

Perm Medical Journal. 2018;35(2):85-92
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Contribution of academician Ye. A. Vagner into development of national surgery, medicine and public health (on the occasion of 100th birthday anniversary)
Koryukina I.P., Zarivchatsky M.F., Podluzhnaya M.Y.
Abstract

The materials, reflecting the course of life and creative work of Ye.A. Vagner, are presented in the paper. His work as a talented surgeon, great scientist, first Academician of the Academy of Medical Sciences of the USSR in the Ural, State prize winner, founder of scientific surgical school, remarkable pedagogue and tutor, experienced head of higher medical school is shown. During 25 years he was the head of Perm State Medical Higher School, named now after him. The contribution of Ye.A. Vagner into development of not only national, but also world surgery, medicine, public health is invaluable.

Perm Medical Journal. 2018;35(2):93-100
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Features of complaints in idiopathic arterial hypotension in young women
Baev V., Agafonova T., Igumnova O.
Abstract

Goal. To study the features of complaints in young women with idiopathic arterial hypotension (IAH) and determine their frequency.

Materials and methods. A comparative analysis of the frequency of complaints between two groups of women aged 18-23 was conducted: a test group with IAH (n=210) with SBP 97(92-98 mmHg), and control group (n=96) with normal arterial pressure at SBP 123(121-125) mm Hg.

Results. 58% of women with IAH, which is more often than women with normal blood pressure, walk less than 5 km per day. Women with IAH with moderate physical and emotional stress often report complaints of shortness of breath (25%) and pain (40%) in the chest. With IAH, they often complain of pain in the legs, especially when walking (35%), dizziness (38%), pain and blanching of the fingers or toes in the cold (36%). 12% of women with IAH have a nocturia.

Conclusions. Young women with IAH per day are walking less than 5 km, often complain of complaints of shortness of breath and chest pain, pain in the legs, dizziness, pain and blanching of fingers or toes in the cold. 12% of women with IAH note nocturia.

Perm Medical Journal. 2018;35(2):
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HYGIENIC EVALUATION OF FOREIGN STUDENTS ACCOMMODATION CONDITIONS IN THE HOSTEL OF THE PERM STATE MEDICAL UNIVERSITY
Koryukina I., Kulesh T., Zueva T., Arbuzova T.
Abstract

Aim. Hygienic assessment of foreign students living conditions in the hostel of Perm State Medical University.

Materials and methods. Sanitary and epidemiological assessment of the structure, facilities and maintenance of the Indian students’ hostel was conducted. The hygienic assessment of the site and territory of the dormitory at its location, living rooms and places of common use, facilities and furnishing of the building is given. Sanitary hygienic measurements of the microclimate (90), infrared radiation (20), noise levels (45), electromagnetic radiation (40), natural and artificial illumination (65) were performed in living rooms and auxiliary rooms.

Results. An objective assessment of the socio-biological factors influencing on the adaptation of foreign students to new climatogeographical conditions was obtained.

It was established that the living conditions of foreign students in the dormitory of the Perm State Medical University correspond to sanitary and epidemiological rules and regulations, excepting the noise level.

Conclusions. Overcoming the difficulties associated with the adaptation of medical students from India is facilitated by favorable social and domestic conditions for living in a student dormitory.

Perm Medical Journal. 2018;35(2):
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Articles
CLINICAL AND ECONOMIC EFFICIENCY OF TREATMENT OF TB PATIENTS IN A DAY HOSPITAL
Shurygin A., Makarova E., Matasova E.
Abstract

Aim. Study of the clinical and economic effectiveness of  therapy of patients with tuberculosis in a day patient facility in comparison with patients in a day-and-night hospital.

Materials and methods. The results of treatment of patients with newly diagnosed pulmonary tuberculosis in a day hospital were analyzed.

Results. 76.7% of patients completed the course of treatment efficiently at the time of discharge from the day hospital.

Conclusions. It was found that the clinical efficiency of treatment of patients in the day hospital does not differ from the sectoral indicators of anti-tuberculosis work, at the same time it has significant economic efficiency.

Perm Medical Journal. 2018;35(2):
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Predictors for clinically relevant pancreatic fistulas after surgical treatment infected pancreatic necrosis.
Kotelnikova L., Kudryavsev P.
Abstract

Aim to analyze the risk factors for clinically relevant pancreatic fistulas after surgical treatment of infected pancreatic necrosis. Methods and materials. We conducted a retrospective analysis of 44 successive cases of surgical treatment infected pancreatic necrosis. Risk factors for development clinically relevant pancreatic fistulas were investigated by Spearman’s correlation coefficient.

Results. In the follow-up the reoperations were performed due to pancreatic fistulas in 11,36% and to pseudocysts – in 9%. Conversely, a significant moderate correlation was observed between clinically relevant pancreatic fistulas and the following factors: pancreatic necrosis in the neck (r=0,31, p=0,00), its depth 50% and more (r=0,46, p=0,00), volume of drainage fluid output (r=0,55, p=0,00) and drain amylase level (r=0,53, p=0,00). Conclusion. Pancreatic necrosis in the neck, its depth 50% and more, volume of drainage fluid output more than 150 ml (r=0,55, p=0,00) and drain amylase level more 1000 U/L were risk factors for pancreatic fistulas after surgical treatment of infected pancreatic necrosis

Perm Medical Journal. 2018;35(2):
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