Vol 34, No 2 (2017)

Cover Page
Articles
LEFT ATRIUM SURGICAL ISOLATION IN PATIENTS WITH ATRIAL FIBRILLATION, IHD AND MITRAL VALVE PATHOLOGY
Arutyunyan V.B., Chragyan V.A.
Abstract
Aim. To analyze the results of the left atrium isolation in the treatment of atrial fibrillation among patients with ischemic heart disease (IHD) and mitral valve (MV) pathology. Materials and methods. Case histories of 100 patients, operated during the period from January 2009 to December 2012 were analyzed retrospectively. All the patients underwent left atrium isolation procedure “left atrial maze” associated with mitral valve pathology correction. Results. Four patients died in the early postoperative period. The mean duration and completeness of case monitoring was 11,3 ± 2,5 months (from 0,5 to 15 months) and 93,75 %, respectively. Patients free from atrial fibrillation and acute cerebral circulation abnormalities during the first postoperative year made 75 % and 98,7 %, respectively. Taking into account the results of multiple-factor analysis, it was established that increase in the MV fibrous ring diameter (OR 1,47; p = 0,027; CI 1,04-2,08) and tricuspid insufficiency equal to 2+ and higher (OR 11; p = 0,038; CI 1,13-106,4) served as independent predictors of fibrillation relapse and atrial flutter within the postoperative months 6 and 12. Conclusions. According to the results of the early follow-up period, left atrium isolation “left atrial maze” in treatment of atrial fibrillation associated with mitral valve pathology correction is an effiective technique for sinus rhythm restoration, and its results are comparable with those of the other modifications of “maze” procedure.
Perm Medical Journal. 2017;34(2):5-14
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OPPORTUNITIES OF CONSERVATIVE ORTHOPEDIC CORRECTION OF POSTINSULT UPPER EXTREMITY SPASTICITY
Schekolova N.B., Zinoviev A.M.
Abstract
Aim. To study the peculiarities of formation of orthopedic pathology of the upper extremity in invalids after stroke and to offer new methods of rehabilitation treatment. Materials and methods. The examination of 88 patients after stroke with motor abnormalities, formed in the arm against the background of spastic hemiparesis, was carried out. Results. Central and peripheral pain syndromes in the shoulder joint on the side of paresis, muscular spasticity and arm joint contractures were diagnosed. Pain syndrome was corrected, vascular drugs, massage, curative gymnastics, physiotherapeutic procedures and prosthetic-orthopedic devices were administered. A unified orthesis, produced from sheet thermoplastic material using the method of vacuum molding in the form of cartridge, covering the hand and a part of the forearm was developed. Orthesis permitted to fulfill a staged, controlled orthopedic correction of the elevated muscular tonus of the hand, thus changing its position at three stages of rehabilitation. The hand was gradually taken from the pathological position. Efficiency of this correction was estimated by muscular strength, tonus, dynamics of pain syndrome and articular movements. Conclusions. Timely diagnosis of the postinsult orthopedic pathology of the upper extremity, early terms of starting treatment, complex approach, adequacy of prosthetic-orthopedic goods contribute to efficiency of rehabilitation measures.
Perm Medical Journal. 2017;34(2):15-19
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DIAGNOSTIC AND THERAPEUTIC OPPORTINITIES OF VIDEOTHORACOSCOPY IN PLEURAL EFFUSION OF DIFFERENT ETIOLOGY
Plaksin S.A., Farshatova L.I.
Abstract
Aim. To estimate the diagnostic and therapeutic value of videothoracoscopy in patients with pleural effusions (PE) of different etiology. Materials and methods. The experience of surgical treatment of 244 patients, who underwent videothoracoscopy (VTS) for pleural effusions of different etiology, was summarized. Results. Etiology of exudative pleurisy was rather various, however, in 110 patients (45,1 %) exudation accumulation was caused by malignant tumors. Pleurisy of inflammatory genesis was detected in 93 (38,1 %) cases including 38 cases of specific etiology. Noninflammatory pleurisies were diagnosed in 18 (7,4 %) cases. Fifteen patients (6,1 %) with pancreatogenic pleurisies and eight patients (3,3 %) with transsudates (cardiogenic, hepatogenic, nephrogenic) formed separate groups. Conclusions. Diagnostic videothoracoscopy is the method of choice in differential diagnosis of pleural effusions of different genesis and are efficient in 97,1 % of cases. Videothoracoscopy permits to state the cause of exudative pleurisy more precisely owing to visualization of changes in the pleura and possibility to obtain histological verification of diagnosis.
Perm Medical Journal. 2017;34(2):20-25
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ANALYSIS OF PREGNANCY COURSE IN UR.UREALYTICUM INFECTED WOMEN DEPENDING ON GENITAL TRACT COLONIZATION DEGREE
Melnikova T.A., Padrul M.M., Gorovits E.S., Rabotnikova G.I.
Abstract
Aim. To carry out the comparative analysis of pregnant anamnestic data depending on the presence and degree of genital Ur. Urealyticum colonization. Materials and methods. Pregnancy anamnesis was studied in 112 women infected with Ur. Urealyticum , including 53 women with colonization level up to 104 CFU/ml and 59 women - >104 CFU/ml. The comparison group consists of 40 uninfected with ureaplasma practically healthy pregnant women. Results. The burdened obstetric-gynecological anamnesis was essentially more often registered in pregnant women infected with ureaplasma - 74,46 % versus 55,0 % in the comparison group, mostly in women with a high titre of ureaplasma genital colonization. The main pathologies were vaginites, premature labor and postnatal infectious inflammatory complications. Chronic pyelonephritis in infected women was observed 2,5 times more often. Conclusions. Practically 80 % of Ur. Urealyticum infected pregnant women had complicated pregnancy, more frequently (84,75 %) registered in case of colonization of the genital tract with ureaplasmas in the titre of more than 104 CFU/ml.
Perm Medical Journal. 2017;34(2):26-30
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PREDICTION OF COLORECTAL ANASTOMOSIS FAILURE
Zitta D.V., Terekhina N.A., Subbotin V.M.
Abstract
Aim. To study the possibilities of using chemiluminescent blood analysis and determining blood plasma lactate content for prediction of colorectal anastomosis failure. Materials and methods. Chemoluminescent blood analysis was carried out and blood plasma lactate content was determined within the days 1, 4 and 8 after the surgery in 78 patients with colorectal cancer, who had undergone the radical surgical intervention. Blood of 10 donors was used as a control. All patients were divided into 2 groups. Group I included 5 patients with interintestinal anastomosis failure developed, group II included the rest 73 persons. Results. Before the treatment started, a reliable elevation of chemiluminescence intensity was revealed in patients with colorectal cancer. Within the days 1 and 4 after the surgery, chemiluminescence indices were significantly higher in the group of patients with anastomosis failure than in patients of the second group. By the postoperative day 8, patients of group II experienced normalization of chemiluminescence indices, whereas in patients with anastomosis failure these indices remained reliably increased. Within the postoperative days 1 and 4, blood plasma lactate content significantly raised in patients of group I. No changes in lactate level among patients with uncomplicated postoperative course were noted. Conclusions. Chemiluminescent erythrocyte analysis and determination of blood plasma lactate content within the postoperative day 1 can be used to predict colorectal anastomosis failure in patients with malignant neoplasms of the colon.
Perm Medical Journal. 2017;34(2):31-36
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OPTIMIZATION OF METHODS FOR PARODONTIUM INFLAMMATORY DISEASES COMPLEX TREATMENT USING LOW INTENSITY LASER EMISSION
Mozgovaya L.A., Fokina N.B., Rochev V.P., Mozgovaya S.V., Gavrilenko M.S., Shmidt D.V., Zadorina I.I.
Abstract
Aim. To ground the expediency of using low intensity laser light in complex treatment of inflammatory diseases of parodentium. Materials and methods. The study included 110 pupils aged 9-15 years, belonging by their general somatic status to health groups I-II with no marked dentomaxillary anomalies. Simultaneously, 86 patients without somatic pathology, having inflammatory diseases of parodentium tissues of different degree of manifestation, were under observation. Results. Laserotherapy has a multifactor pathogenetic effect, thus, contributing to normalization of parodentium tissue blood circulation and elevating local immunity of the oral cavity that prolongs the period of remission or results in full recovery. Conclusions. The obtained results permit to recommend low intensity laser emission to be included into complex of therapeutic measures for patients with inflammatory diseases of maxillofacial region.
Perm Medical Journal. 2017;34(2):37-44
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CHRONIC RENAL DISEASE PREDICTORS IN HYPERTENSIVE PATIENTS WITH ATRIAL FIBRILLATION
Lebedeva Y.I., Nekrutenko L.N., Tuev A.V.
Abstract
Aim. To determine the predictors of decreased glomerular filtration rate (GFR) in hypertensive patients with atrial fibrillation. Materials and methods. Thirty patients with II stage hypertensive disease (HD) associated with persisting form of atrial fibrillation were examined. The program of examination included blood serum biochemical analysis with creatinine determination, GFR calculation by CKD-EPI formula, echocardiography, hemostasis indices. The results were statistically processed using the program Statistica 10,0. Results. GFR level was decreased with patient’s aging ( R = -0,49, p = 0,0006), reduced cardiac ejection fraction ( R = 0,44, p = 0,0163), left atrium size enlargement ( R = -0,66, p = 0,0001), raised von Willebrand factor activity ( R = -0,40, p = 0,0286) and accelerated thrombin formation by the external path (prothrombin time) of blood coagulation ( R = 0,54, p = 0,0023). Conclusions. Willebrand factor activity, prothrombin time, cardiac ejection fraction, left atrium size and patient’s age are predictors of chronic renal disease formation in hypertensive patients with atrial fibrillation.
Perm Medical Journal. 2017;34(2):45-50
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CYTOMEGALOVIRUS DETECTION FREQUENCY IN INFANTS BORN OWING TO USE OF AUXILIARY REPRODUCTIVE TECHNOLOGIES
Permyakova A.V., Lvova I.I., Makhmudova S.E.
Abstract
Aim. To determine the frequency of detecting cytomegaloviral infection (CMVI) in infants born as a result of extracorporal fertilization (ECF). Materials and methods. Medical documentation and examination of 46 infants under 1 year, who were born by means of ECF, were analyzed. To detect CMV DNA and determine its quantitative content, PCR in a real-time mode (test-system “AmpliSens® SMV-screen/monitor-FL” (Russia)) was used. Saliva and urine served as the study material. Results. CMV DNA, determined in the saliva and urine, indicated the following: in 78,3 % (36/46) of infants, no viral DNA was revealed in any of media. In 21,7 % (10/46) of infants, salivary CMV DNA was detected, in 17,4 % (8/46) - urinary. Viral load median of CMV DNA in the saliva was 5,5l g copies of DNA/ml (confidence interval, CI - 4,9; 6,1), in the urine - 4,6 lg copies of DNA/ml (CI - 4,0; 5,2) with no reliable difference for the studied media. Finally, the share of CMV-positive infants, born by means of ECF within the first year of life was 21,7 %. Conclusions. Infants, born owing to ECF, in 65,2 % of cases are premature; CMVI frequency, verified by PCR-positive salivary and urinary tests among them is 21,0 %.
Perm Medical Journal. 2017;34(2):51-55
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PECULIARITIES OF GANGLIONIC CONDUCTION OF EXCITATION AFTER DEPANCREATIZATION
Tyutyunschikova V.D., Kadyrova E.V.
Abstract
Aim. To study the vegetative ganglion function after partial ablation of the pancreas. Materials and methods. Electrical activity of the postganglionic trunk fibers of the upper cervical sympathetic ganglion, with preganglionars stimulated by the rectangular impulse of supramaximal strength of 0,5 msec duration, was studied on 42 animals in the control and after depancreatization. Acetylcholine (AC) content in the ganglion before and after partial depancreatization, excitation conduction velocity by preganglionic fibers, amplitude and duration of postganglionic fibers action potential (AP), lability with stimulation of 10-40 Hz, posttetanic potentiation (PTP) was investigated. To assess the reliability of differences, Student’s t test was used. Critical significance level when controlling statistical hypotheses was accepted as equal to 0,05. Results. Ganglionic acetylcholine content on the day 9 after pancreatectomy decreased by three times. It was accompanied by the reduction of velocity of excitation spreading along the preganglionic fibers of the upper cervical sympathetic ganglion. Simultaneously, growth of latent period duration and postganglionic trunk action potential was registered. Development of pessimum with stimulation frequency of 20-40 Hz is significantly quickened, but posttetanic potentiation, typical for ganglion, completely disappears and is changed by the posttetanic depression. It proves fall in lability and functional properties of vegetative ganglion in the operated animals. Conclusions. Introduction of acetylcholine and lipocaic fully or partially compensated the occurring impairment of ganglionic conduction of excitation.
Perm Medical Journal. 2017;34(2):56-61
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ANALYSIS OF MORPHOLOGICAL CHANGES IN INTACT AND STAPHYLOCOCCUS AUREUS № 6 INFECTED MICE WHEN IMMUNIZED WITH PROTEIN-CONTAINING ANTIGENS
Astashkina E.A., Lebedinskaya O.V., Gruber I.M.
Abstract
Aim. To study the morphological changes in the organs of intact mice and Staphylococcus aureus № 6 infected animals, introduced different S.aureus -secreted protein-containing antigens (PCA) and their protective activity. Materials and methods. 180 male mice of BALB/c line were studied. Mice were doubly immunized subcutaneously in the volume of 0,1 ml with different doses of “original” PCA (0,75; 1,8; 3,0 and 12 mkg), PCA I and PCA II (1,2mkg). Morphological changes in mice organs were investigated after introducing different doses of PCA without animals infection and with preliminary immunization on the model of generalized process development, when infected in the retroorbital sinus with the sublethal dose of S.aureus № 6 equal to 0,1 LD50. To conduct morphological studies, spleen, lungs and right kidney of experimental animals were taken. Paraffin sections of the organs including serial kidney sections (with the interval of 200 mcm) were stained with hematoxylin and eosin. When generalized staphylococcal infection in experimental animals was formed, there was developed and used a “renal” model with the offered indices of abscess process formation and parallel analysis of inoculation results. Results. It was established that complex study of the influence of S.aureus- secreted PCA on the parameters of adaptive immunity, including the study of antigenic and protective activity, morphological changes in the organs, use of “renal” model with the developed indices of abscess process formation and parallel analysis of inoculation results, is informative and adequate. Conclusions. The secreted protein-containing antigens - “original” and PCA II - are the promising preparations to be studied and used for the development of antistaphylococcal vaccines.
Perm Medical Journal. 2017;34(2):62-73
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COLLECTION AND ANALYSIS OF STATISTICAL DATA ON DEATH AND BIRTH cases AT THE END OF XIX - BEGINNING OF XX CENTURY IN PERM PROVINCE
Stepnov S.M., Nyamtsu A.M.
Abstract
Aim. To determine the basic changes in analysis of statistical data on the cases of death and birth at the boundary of XIX - XX centuries and at the beginning of XXI century. Materials and methods. Analytical approaches used for studying the population number, birth and death rates at the end of XIX - beginning of XX centuries, compared with modern methods of analysis of the mentioned demographic processes, were estimated. Results. It was revealed that for analysis of demographic data at the boundary of centuries, climatic conditions were the prevailing factors in estimation of birth and death rates. When calculating the population number, religion was taken into consideration. Conclusions. In sanitary statistics, mortality was not analyzed depending on the causes of death; some categories of the population of the Russia Empire were not taken into account, so demographic picture of the region was not reflected in full measure.
Perm Medical Journal. 2017;34(2):74-79
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EXPERIENCE OF RENDERING MEDICAL CARE TO CARDIOLOGICAL PATIENTS IN PERM KRAI: RESULTS, DIFFICULTIES, OBJECTIVES
Naumov S.A., Tuev A.V., Karpunina N.S., Naumov A.S., Melnikova L.P.
Abstract
Aim. To assess the effectiveness of new forms of rendering medical care to patients with acute coronary syndrome (ACS) in 2014-2016. Meterials and methods. Retrospective collection of information on the activity of medical service in Perm and Perm Krai regarding rendering medical care to patients with acute coronary syndrome was carried out. Results. Thanks to introduction of new forms of organization of medical care to patients with acute coronary syndrome in Perm Krai, we managed for the recent five years to reduce mortality from myocardial infarction (MI) from 49,1 to 41,6 per 100000 of the population. In 2016, the number of transcutaneous coronary interventions for MI was 49 %. Hospital lethality caused by MI in hospitals with angiographic units decreased by 26,4 % for the recent 4 years - to 8,1 % in 2016. Conclusions. Creation of ambulatory intermunicipal centers, intensification of organizational, methodical and educational function of cardiologist needs further development. It is necessary to form the registers on acute coronary syndrome, chronic heart failure, atrial fibrillation. The essential objective is to develop a three-stage system of rehabilitation for patients with cardiovascular diseases.
Perm Medical Journal. 2017;34(2):80-86
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ANTICOMMISSURAL BARRIERS IN ABDOMINAL SURGERY: UP-TO-DATE STATE OF PROBLEM
Samartsev V.A., Kuznetsova M.V., Gavrilov V.A., Kuznetsova M.P., Parshakov A.A.
Abstract
Widening of the spectrum and volume of surgical interventions causes rise in frequency of peritoneal commissures. Development of commissural process in the abdominal cavity is connected with chronic abdominal pain syndrome, reducing the quality of patients’ life, disturbance of female reproductive function as well as acute commissural bowel obstruction. The only technique for elimination of already existing abdominal commissures is mechanical adhesiotomy. Surgery is considered to be justified in case of acute bowel obstruction, it is connected with technical difficulties and high risk for organ and tissue traumatization; it provokes formation of additional commissures. Especially significant are pathogenetically grounded methods for prevention of commissure formation. During the recent decades, one of the main places in prevention of peritoneal commissures is occupied by specialized medicinal preparations - anticommissural barriers. Their use is pathogenetically grounded and most promising. The information on present-day anticommissural barriers and prospects of their use for prevention of peritoneal commissures is presented in this review.
Perm Medical Journal. 2017;34(2):87-93
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CARDIOVASCULAR AND INFLAMMATORY BOWEL DISEASES: COMORBIDITY OR POLYMORBIDITY?
Khlynova O.V., Tuev A.V., Vasilets L.M., Kuznetsova E.S.
Abstract
The review of literature, devoted to the problem of associated course of cardiovascular diseases among patients with inflammatory bowel diseases (IBD) (Crohn’s disease and ulcerous colitis) is presented in the paper. The data on the prevalence, common etiological and pathogenetic factors, peculiarities of clinical picture in IBD patients, when associated with a number of cardiovascular diseases, were analyzed. The results of work aimed at characterization of peculiar features of patients’ genetic, immunological and hemostesiological profile with syntropia of these diseases are indicated.
Perm Medical Journal. 2017;34(2):94-102
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CLINICAL CASE OF SCLEROATROPHIC LICHEN THERAPY USING PHOTODYNAMIC LASER
Ten A.R., Oboskalova T.A., Vorontsova A.V., Lavrentieva I.V., Vishneva E.M.
Abstract
Polyetiology and pathogenetic peculiarities of scleroatrophic lichen cause diagnostic and therapeutic complications. One the possible methods for the therapy of scleroatrophic lichen is photodynamic laser therapy. This high-technology method has been used in Russia for more than 20 years. One of clinical cases of scleroatrophic lichen therapy in conditions of ambulatory clinic with analysis of dynamic follow-up data is presented in the paper.
Perm Medical Journal. 2017;34(2):103-109
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