Vol 38, No 3 (2021)

Cover Page

Full Issue

Original studies

Clinical and laboratory evaluation of treatment efficiency in patients with prolactinoma

Shukyurov S.D.


Introduction. Prolactinomas are rarely detected in children and are very often characterized by aggressive growth.

Objective. The aim of the study was to increase the effectiveness of drug treatment with prolactin based on the results of clinical and laboratory studies.

Material and methods. In order to determine clinical, laboratory, hormonal, functional and instrumental markers, 63 patients with microprolactinomas and 53 patients with macroprolactinomas were examined. Some biochemical parameters of blood samples, such as TSH, T4, T3, FSH, LH, GH, IGF, ACTH, cortisol and prolactin were studied in healthy individuals, in patients with microprolactinoma and macroprolactinoma 4 times: 3, 6 and 12 months after the start of treatment with cabergoline.

Results. During the study, it was determined that a mean value of FSH in blood samples obtained during hormonal studies conducted before treatment with cabergoline was 4.94 ± 0.41 IU/L, that is slightly lower than that of healthy women (n = 24) who participated in the study (5.49 ± 0.52 IU/L) (p = 0.4037). Statistical analysis within the 6th month of treatment with the appropriate drug showed a reliable decrease in a mean value of LH hormone to 1.93 ± 0.25 IU / L (p = 0.0002, p1 = 0.0232). In biopsies obtained during this study period, the minimum hormone level was 0.1 IU/L, and the maximum – 4.18 IU L.

Conclusions. Thus, the treatment of patients with macro- and microprolactinoma using cabergoline can play an important role in correcting their physical, hormonal and other parameters, and will expand the use of its analogs in practical medicine.

Perm Medical Journal. 2021;38(3):6-14
pages 6-14 views

Prevalence of sleep disorders in children 3-7 years of age in perm

Anisimov G.V., Kalashnikova T.P., Bezdomnikova E.V.


Objective. The article analyzes the clinical features of sleep in preschoolers aged 3-7 years in the city of Perm on the basis of a continuous questionnaire method.

Materials and methods. The presence of complaints related to sleep at the time of the survey was substantiated in 45 % of children of the younger age group (from 3 to 5 years) and 41 % of children in the older age group (from 5 to 7 years).

Results. Sexual dimorphism manifested itself in a significant dominance of intrasomnic disturbances with frequent awakenings and increased motor activity during sleep in older boys. Nocturnal pains and / or cramps in the leg muscles prevailed in girls of the older age group. In the structure of parasomnias in Perm preschool children, there predominated nightmares (16.5 %), night fears (13.3 %), bruxism (14.8 %), sleepwalking (12.8 %), enuresis (8.2 %). Every fifth child of preschool age had sleep with an open mouth, snoring or puffing, hyperhidrosis during sleep and chronic adenotonsillar pathology, which does not exclude the presence of obstructive sleep apnea / hypopnea syndrome in this category of children.

Conclusions. Sleep disorders were noted in a quarter of children under one year of age, manifested by difficult falling asleep, restless sleep and sleep inversion, which can be a marker of both disorders of maturation of chronobiological mechanisms and a high percentage of childhood behavioral insomnia.

Perm Medical Journal. 2021;38(3):15-21
pages 15-21 views

Value of psychological adaptation of labor-intensive underground workers in formation of arterial hypertension regarding age aspect

Malyutina N.N., Paramonova S.V., Sedinina N.S., Ustinova O.Y., Vlasova E.M.


Objective. To study the prerequisites for the development of hypertension based on the manifestation of psychovegetative dysfunction and some changes in the biochemical and functional parameters of CVS in the age aspect. Psychological adaptation of a group of underground miners in conditions of intensive labor was analyzed on the basis of indicators of psycho-vegetative status taking into account the influence of professional and psychosocial factors. In connection with the established diagnosis i.e. arterial hypertension (AH) syndrome, especially in middle-aged persons, it is of interest to study the indicators of psycho-vegetative status in the age aspect and to compare them with some changes in biochemical and functional state of cardiovascular system (CVS) in this contingent of patients.

Materials and methods. The results of the study of psycho-vegetative status of 60 underground miners with AH syndrome (age 46.8 ± 2.0 years, experience – 22.0 ± 2.4 years) using the method of psychophysiological testing as well as analysis of some clinical, functional and laboratory parameters are presented.

Results. The adaptive psycho-vegetative phenotypes in a group of underground workers with AH syndrome in the age aspect were identified.

Conclusions. With an increase in the length of service among labor-intensive workers, the characteristics of psycho-vegetative status change qualitatively in the form of elevated anxiety and neuro-psychical stress with a decrease in the function of attention combined with a negative relationship of these parameters with increasing age, that is accompanied by dysfunction of CVS; studying of this aspect allows identifying the prerequisites for the development of hypertension so as to form a risk group in time.

Perm Medical Journal. 2021;38(3):22-31
pages 22-31 views

Surgical treatment of liver echinococcosis

Zarivchatskiy M.F., Mugatarov I.N., Kamenskikh E.D., Kolyvanova M.V., Teplykh N.S.


Objective. To improve the results of treatment of patients with liver echinococcosis and carry out a comparative assessment of techniques of surgical treatment depending on the nature of postoperative complications, hospital stay and antirecurrent efficacy.

Materials and methods. The experience of complex examination and treatment of 65 patients with liver echinococcosis for the period of 1999-2019 was analyzed. Open echinococectomy was performed in 21 patients, atypical liver resection – in 18 patients, anatomical liver resection – in 14 patients, pericystectomy – in 10, laparoscopic echinococectomy – in 1, percutaneous puncture of an echinococcal cyst under ultrasound control – in 1 patient.

Results. The time of inpatient treatment of patients after open echinococectomy was 23.5 ± 4.3 days, after pericystectomy – 19.8 ± 1.4 days, after liver resection – 14.4 ± 2.7 days, after laparoscopic echinococcectomy – 6, after percutaneous puncture echinococcal cyst – 7 days. Postoperative complications were observed in 52.4 % of patients who underwent open echinococectomy, in 20 % of patients after pericystectomy, and in 15.6 % after liver resection. There were no relapses of liver echinococcosis in all the groups. Mortality was 1.5 % and was recorded after open echinococectomy.

Conclusions. The most effective techniques for preventing postoperative complications are pericystectomy and liver resection. The duration of surgery and the average length of hospital stay with minimally invasive methods of treatment are shorter. However, the use of these methods of treatment remains controversial due to the possibility of intra-abdominal spread of the parasite. Patients with parasitic liver cysts after surgical treatment are subjected to dynamic follow-up observation (ultrasound examination of the liver, enzyme-linked immunosorbent assay, computed tomography of the abdominal organs) after 3-6 months for at least 5 years.

Perm Medical Journal. 2021;38(3):32-40
pages 32-40 views

Prediction of developing temporomandibular joint dysfunction in patients with maxillary dental anomalies

Danilova M.A., Ishmurzin P.V.


Objective. To describe the basic predictors of developing dysfunction of temporomandibular joint (TMJ) in patients with maxillary dental anomalies.

Materials and methods. An open, prospective, controlled clinical experimental study was carried out; 250 patients aged 18 to 35 (mean age 23.5 ± 2.6 years) with maxillary dental anomalies including 134 persons with temporomandibular joint dysfunction and 116 with normal articular function were examined.

Results. A multidimensional disperse analysis permitted to conclude that an extremely high (95–100 %) probability of occurring temporomandibular joint dysfunction is determined with the presence of combination of two and more functional disorders with a complex of other (occlusive and cephalometric) preclinical markers of dysfunction; a high (75–95 %) probability of development – when one functional disorder is associated with a gnathic form of dentition occlusion anomaly; a medium degree (45–75 %) of probability of occurring dysfunction – with the presence of gnathic form of dentition occlusion anomaly with roentgenological changes in TMJ and the absence of functional “signs”; a low (15–45 %) probability – when detecting a dentoalveolar form of occlusion anomaly or dentition anomaly combined with roengenological changes in the joint and the absence of functional disorders; a very low (0–15 %) probability of dysfunction development – with the presence of congested position of incisors, anomalies of separate teeth position in the sagittal plane in the frontal part and the absence of functional disorders.

Conclusions. The knowledge of the above-mentioned predisposing factors (“signs”) of the disturbance of the joint function can be used as an instrument for prediction of the probability of developing the temporomandibular joint dysfunction in patients with maxillary dental anomalies.

Perm Medical Journal. 2021;38(3):41-47
pages 41-47 views

Review of literature

Heart injury in COVID-19: immediate and long-term follow-up

Karpunina N.S., Khlynova O.V., Shumovich I.V.


The article presents a review of bibliographic data on risk factors and mechanisms of the damage to the heart tissues in a new coronavirus infection. The direct viral-associated injury, as well as the influence of the components of the cytokine storm are analyzed. Myocarditis, cardiac arrhythmias are considered. In addition, the first results of long-term follow-up observations of patients who underwent COVID-19 were summarized, and the change in arterial stiffness was assessed.

Perm Medical Journal. 2021;38(3):48-60
pages 48-60 views

Modern view on the problem of splint therapy in treatment of chronic tension type headache

Astashina N.B., Starikova N.L., Valiakhmetova K.R.


The review presents the epidemiology of tension type headache. The key points of etiology, pathogenesis and clinical picture are described, modern therapeutic approaches to the treatment of chronic tension headache are considered. The data on the possibility of using prosthetic and splint therapy for correction of health status in patients with chronic tension type headache are presented. The necessity of conducting research aimed at determining the role of using occlusive splints and the significance of correcting occlusive relationships in chronic tension type headache is grounded.

Perm Medical Journal. 2021;38(3):61-67
pages 61-67 views

Methods of diagnosis and technologies

Study of emotional disorders in dermatological and cardiological patients

Elkin V.D., Kobernik M.Y., Sedova T.G., Borodina E.N., Andrusenko A.A.


Objective. To study the character and features of emotional disorders in patients of dermatological and cardiological profile. Emotional changes, accompanying many somatic diseases, have a negative effect and aggravate their course, worsening the quality of life and functioning.

Materials and methods. 68 persons, divided into two groups, participated in a single-stage study: group I included 38 patients with dermatoses without any concomitant diseases of the internal organs; group II – 30 cardiological patients without dermatological pathology in anamnesis. Complex research included general clinical and laboratory methods as well as psychological study using the Hospital Anxiety and Depression Scale HADS, Zung Self-Rating Depression Scale, Montgomery – Asberg Depression Scale, Spielberger – Hanin Anxiety Scales. To assess the results, the methods of parametric and nonparametric statistics were used.

Results. When assessing the parameters by the Hospital Anxiety and Depression Scale HADS, in dermatological patients clinically and subclinically expressed anxiety was manifested more evidently, and in cardiological patients, it was depression. According to the data obtained by the Zung and Hamilton scales, depression also predominated in cardiological patients but anxiety symptoms and disorders reliably more often were observed in patients of dermatological profile. As for studying depression using the Montgomery-Asberg scale, in dermatological patients it was revealed less often, in the structure of symptoms there prevailed a small depressive episode. According to Spielberger – Hanin Scale, anxiety was more expressed in dermatological patients.

Conclusions. Emotional disorders in dermatological and cardiological patients are reliably different. In dermatological patients, they are characterized by increased anxiety in case of an insignificant depressive disorder. In cardiological patients, there prevail depressive changes, especially mild depression; anxiety symptomatology is not expressed.

Perm Medical Journal. 2021;38(3):68-75
pages 68-75 views

Features of postural control in children with severe forms of idiopathic scoliosis

Nikityuk I.E., Vissarionov S.V.


Objective. The study of postural stability in children with severe degrees of idiopathic scoliosis and assessment of body balance disorders after surgical correction of spinal deformity.

Material and methods. The study of 18 patients aged 14–17 years with idiopathic scoliosis of the III–IV degree with localization of the main arc according to Lenke I, III, V and VI was conducted. The vertical balance of the body was evaluated using a stabilometric platform MBN "Biomechanica" (LLC "MBN", Moscow) before and 9–10 days after the surgical correction of spinal deformity using transpedicular spinal systems. The results were compared with a stabilometric survey of 18 healthy children.

Results. In patients with idiopathic scoliosis before surgery, a decrease in the stability of the vertical balance of the body, manifested by pronounced deviations from the nominal values of the stabilometric parameters, was revealed. The correlation analysis showed a pathologically strong relationship between the length L, the area S and the amplitude of fluctuations of the pressure center A in patients’ statokinesiograms compared to the group of healthy children.

In the immediate postoperative period, the postural control system disorders are aggravated in patients.

Conclusions. In children with severe idiopathic scoliosis, violations of the postural control system were revealed, which led to the formation of a suboptimal motor stereotype due to dysfunction of sensorimotor integration.

Perm Medical Journal. 2021;38(3):76-87
pages 76-87 views

Morphological basis for possibility of applying electrochemical method with use of nanotechnological biosensors in diagnosis of colorectal cancer

Belkin A.N., Freind G.G., Kochetov A.G.


Objective. To assess the efficacy of electrochemical method using biosensors for studying the activity of alkaline phosphatase as a marker of functional atypism in the fresh and formalin-fixed biopsies of the colorectal cancer by means of comparing with the results of morphological study.

Materials and methods. Electrochemical method was used to study the fragments of tumors (adenocarcinomas) of the colon and colon mucosa from 78 patients who underwent endoscopic study of the colon. The results of electrochemical and morphological studied were assessed and compared.

Results. In the material from 70 patients, a mean value of the current strength, obtained while studying the tumor fragments, was 49.2 (95 % CI 41.3 – 88.9) nA and 33.1 (95 % CI 9.5 – 44.2) nA in case of “fresh” and formalin-fixed biopsies, respectively. A mean value of the current strength, obtained while studying mucosa fragments, was 119.7 (95 % CI 96.8 – 167.1) nА and 59.6 (95 % CI 48.3 – 71) nA in case of “fresh” and formalin-fixed biopsies, respectively. While conducting immunohistochemical study, in the tumor tissue a low expression of alkaline phosphatase compared to unchanged mucosa was detected.

Conclusions. Electrochemical method applying nanotechnological biosensors was shown to be used for a rapid, direct estimation of alkaline phosphatase content in the biopsies of the colorectal carcinoma. The obtained results allow considering electrochemical method as an additional method for assessment of functional atypism of tumor cells.

Perm Medical Journal. 2021;38(3):88-96
pages 88-96 views

Capabilities of computer analysis of breath sounds in patients with COVID-19

Furman E.G., Charushin A.O., Eirikh E.S., Furman G.B., Sokolovsky V.L., Malinin S.V., Sheludko V.S., Polyanskaya D.A., Kalinina N.M., Shtivelman D.K.


Objective. To develop methods for a rapid distance computer diagnosis of COVID-19 based on the analysis of breath sounds. It is known that changes in breath sounds can be the indicators of respiratory organs diseases. Computer analysis of these sounds can indicate their typical changes caused by COVID-19, and can be used for a rapid preliminary diagnosis of this disease.

Materials and methods. The method of fast Fourier transform (FFT) was used for computer analysis of breath sounds, recorded near the mouth of 14 COVID-19 patients (aged 18–80 years) and 17 healthy volunteers (aged 5–48 years). The frequency of breath sound records ranged from 44 to 96 kHz. Unlike the conventional methods of computer analysis for diagnosis of diseases based on respiratory sound studying, we offer to test a high-frequency part of FFT (2000–6000 kHz).

Results. While comparing the breath sound FFT in patients and healthy volunteers, we developed the methods for COVID-19 computer diagnosis and determined the numerical criteria in patients and healthy persons. These criteria do not depend on sex and age of the examined persons.

Conclusions. The offered computer methods based on the analysis of breath sound FFT in patients and volunteers permit to diagnose COVID -19 with relatively high diagnostic parameters. These methods can be used in development of noninvasive means for preliminary self-express diagnosis of COVID-19.

Perm Medical Journal. 2021;38(3):97-109
pages 97-109 views

Experimental analysis of crack resistance indicators of demineralized tooth enamel after combined infiltration treatment

Gileva O.S., Levitskaya A.D.


Objective. To study the indicators of crack resistance of the demineralized enamel treated with combined infiltration method using the method of scratch testing.

Materials and methods. To study the elastic-strength properties of the enamel in vitro, 24 intact teeth removed by orthodontic indications were used, on the vestibular surface of the crown of which, there was modelled an artificial caries of the enamel by the patented technology. A number of multilevel studies confirmed the formation of caries. Scratch testing was performed on the sections of the intact enamel; demineralized enamel infiltrated by light composite using the modified method with a four-minute regime of conditioning; enamel laminated with bioactive hybrid glass ionomer.

Results. The developed model of artificial caries corresponded to the enamel in vivo. The critical load of the start of formation of the intact enamel microcracks (Lc1) was 9.82 ± 0.81 N; demineralized enamel – 6.34 ± 0.92 N; infiltrated by modified method – 8.23 ± 0.61 N; bioactive glass ionomer – 0.82 ± 0.17 N. The critical load of formation of the chevron cracks (Lc2) of the intact enamel was 18.21 ± 0.68 N; demineralized – 14.21 ± 1.35 N; after infiltration – 10.1 ± 0.30 N; in bioactive glass ionomer, no parameters were registered on all the tested samples. The critical load of formation of the intact enamel chips (Lc3) was 15.73 ± 0.73 N; demineralized enamel – 5.02 ± 0.64 N; after infiltration – 22.43 ± 0.44 N; bioactive covering – 2.21 ± 0.12 N.

Conclusions. A comparative analysis of the results of scratch testing of the enamel permitted to characterize the biomaterial from the position of physical material science, determine the critical loads of the start of forming microcracks, double-helical cracks, chips.

Perm Medical Journal. 2021;38(3):110-121
pages 110-121 views

Preventive and social medicine

Experience of work of multidisciplinary hospital in conditions of mass admission of patients with COVID-19

Konovalov P.P., Shperling I.A., Arsentyev O.V., Buyanov A.L., Ankudinova A.V.


Objective. Generalization of management decision-making experience and analysis of organizational measures taken during the preparation of a multidisciplinary hospital for mass admission of infectious patients with COVID-19.

Materials and methods. The materials of the study included the generalized data on the results of work of a multidisciplinary hospital in conditions of mass admission of patients with COVID-19. The current guidelines, defining the key spheres of work of the head of medical organization and practical results of their implementation are analyzed.

Results. The article analyzes the main activities of a multidisciplinary hospital in conditions of mass admission of patients with COVID-19. It is established that a set of measures, including preparatory preventive solutions, timely planning, re-profiling into a multidisciplinary infectious hospital with reserve beds (including resuscitation beds), creation of mobile teams to provide medical care in the foci of the territorial area of medical responsibility, timely training and reallocation of medical personnel to maximize the effective use of staff resources, reasonable routing of infectious patients, introduction of a three-level system for providing medical care to patients with COVID-19, made it possible to effectively use the available forces and resources of a multidisciplinary hospital during the COVID-19 pandemic.

Conclusions. The measures taken proved to be effective, allowing a full provision of emergency medical care throughout the epidemic period, and resuming the provision of planned care in a full volume without reducing the safety of patients' stay in the hospital. Differentiation of patients flows, constant monitoring of the body temperature in both patients and medical workers themselves, constant use of PPE and motivated disinfection, regular check of employees for coronavirus infection (nasopharyngeal smear for COVID-2019 as well as blood ELISA for this infection) permitted to minimize the risks of spreading coronavirus infection in conditions of medical organization.

Perm Medical Journal. 2021;38(3):122-130
pages 122-130 views

Questions of ethical regulation of immunobiological therapy of some occupational lung diseases

Shpagina L.A., Panacheva L.A., Zolotukhina E.V.


Objective. Taking into account a high prevalence of occupational pathology associated with the exposure of industrial aerosols, to analyze the principles of therapy used for patients with these diseases.

Materials and methods. The regulating medical documents, the data of preventive medical examinations as well as the principles of therapy applied for patients with occupational diseases, which are presented in scientific literarure, are analyzed.

Results. The role of harmful production factors in the formation of pneumoconiosis and alveolitis, which join the group of interstitial lung diseases (ILD), has been proved. The outcome of these occupational diseases is fibrosing alveolitis with the development of diffuse pulmonary fibrosis. In the treatment of ILD, immunobiological drugs (IBD) are used to suppress the immune processes selectively affecting the monoclonal antibodies, blocking of which interrupts inflammation and in 90 % of cases stops the further development of the disease.

Conclusions. The use of immunobiological drugs in clinical practice should be carried out within the framework of ethical and legal regulation between the patient and the doctor.

Perm Medical Journal. 2021;38(3):131-140
pages 131-140 views

Analysis of changes in regulatory framework of the russian federation on examination of relationship between diseases and profession for 40 years

Boiko I.V., Grebenkov S.V., Andreenko O.N., Loginova N.N.


The evolution of the national regulatory framework in the field of examination of connection between the disease and the profession for the period from the 80s of the twentieth century to the present is analyzed.

Materials and methods. The regulatory framework of domestic professional pathology regarding examination of relationship between diseases and profession is evaluated

Results. It was noted that for the specified period, in the normative acts the organizational issues of the examination of the connection between the disease and the profession did not have a satisfactory solution. A feature of most regulatory documents in the field under consideration, issued recently, is a certain logical inconsistency.

Conclusions. To radically improve the current situation, it is necessary to immediately adopt for practical application the mandatory criteria, which prove the occupational origin of health disorders in workers.

Perm Medical Journal. 2021;38(3):141-152
pages 141-152 views

Clinical case

Successful case of Benthal de Bono surgery in Cabrol modification with one-step aortic arch prosthesis and repeat coronary artery bypass surgery in a patient with de Bakey type 1 acute aortic dissection

Kadyraliev B.K., Arutyunyan V.B., Kucherenko S.V., Pavlova V.N., Spekhova E.S., Enginoev S.T.


The ascending aortic aneurysm occurs in 45 % of cases from the total number of aortic aneurysms of various localization. The incidence rate of combination of the aortic disease with aneurysm per 100 000 of the population is 5.9. The problem of prosthetics of the aortic root and aortic valve due to aneurysm and the changed AV is rather actual. The main principle of aneurysm surgery is the prevention of the risk of dissection and rupture with reconstruction of normal dimensions of the ascending aorta. Currently, there are different techniques for the treatment of root aneurysms and ascending aorta. The standard techniques are aortic root replacement, aortic valve reconstruction with replacement of aortic root or ascending aorta and partial or full replacement of aortic arch depending on the situation.

The Bentall De Bono operation at present remains a “golden standard” of surgical treatment of the aneurysms of the root and ascending aorta with changed aortic valve. This surgery can have the following complications: thrombotic, thromboembolic followed by conduit dysfunction, formation of false anastomosis aneurysms, hemorrhage, compression of coronary artery orifices due to tension in the zone of coronary anastomoses.

Perm Medical Journal. 2021;38(3):153-158
pages 153-158 views

Anniversaries and information on events

Surgeon, doctor, teacher – Veniamin Arsenyevich Sitnikov: 85th anniversary

Styazhkina S.N., Zarivchatsky M.F., Zaitsev D.V., Galyautdinova A.I.


The article is devoted to the outstanding surgeon, Professor of the Department of the Faculty Surgery of Izhevsk State Medical Academy, MD, PhD, member of the European Association of Intensive Care, Academician of the Russian Academy of Laser Sciences, member of the International Association of Hepatology Surgeons, Honored Doctor of the Russian Federation – Sitnikov Veniamin Arsenyevich.

Perm Medical Journal. 2021;38(3):159-161
pages 159-161 views

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies