Vol 34, No 1 (2017)

Cover Page
Articles
MUSCULAR BRIDGES AS PREDICTORS OF STENT THROMBOSES
Plechev V.V., Nikolaeva I.E., Sagatdinov T.S., Risberg R.Y., Oleinik B.A., Buzaev I.V., Kharasova A.F.
Abstract
Aim. To study the influence of muscular bridges on the stent thromboses in the anterior descending artery. Materials and methods. The study included 209 patients, who underwent interventional coronary interference in the anterior descending artery. Group 1 (main) engaged 87 patients with “muscular bridges” confirmed by coronarography data. Group 2 (control) included 122 patients without the above mentioned anatomic anomaly (all patients of the control group were randomly chosen). The results, obtained since 2007, when the primary transcutaneous coronary intervention (TCCI) was carried out, were assessed. Results. While studying the indices, it was established that the repeated restenoses in the arterial stents did not differ in the main and the control groups. However, 6 patients of the main group after TCCI had repeated thromboses in the inserted stents. In the control group, 2 cases of acute thromboses prior to and after TCCI were fixed. When using nonparametric statistical criteria (chi-square criterion), differences in both groups were found to be significant ( p < 0,05). Conclusions. The number of thromboses in the arterial stents with muscular bridges tended to increase - 6 clinical cases in the main group versus 2 cases in the control. So, a new and deeper investigation of this problem with respect to anatomic variants of intramyocardial location of the coronary arteries is to be performed.
Perm Medical Journal. 2017;34(1):6-11
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CLINICAL PICTURE OF ARTERIAL HYPERTENSION ASSOCIATED WITH DUODENAL ULCER IN AMBULATORY PRACTICE OF DISTRICT THERAPEUTIST AND POLYCLINIC SURGEON
Kravtsova T.Y., Zarivchatsky M.F., Aleeva N.G., Blinov S.A., Repin V.N.
Abstract
Aim. To characterize the clinical peculiarities of duodenal ulcer (DU) associated with arterial hypertension (AH) including the conditions of acute gastrointestinal hemorrhage (GIH). Materials and methods. The examination of 25 patients suffering from AH associated with DU, 45 AH patients during the first 2-5 days from the onset of acute gastrointestinal hemorrhage, 63 patients with GIH without AH, 48 patients with isolated AH course, 69 patients with DU exacerbation without AH was carried out. Results. When the existing DU was associated with AH, there was growing of the intensity of pain and dyspepsic syndrome. When the existing AH was associated with DU, vice versa, clinical picture of duodenal ulcer was not quite evident. A great concentration of Helicobacter pylori antibodies was revealed, when AH was associated with GIH. The critical course of AH was more often determined in case of AH and DU association. Conclusions. You should be careful when using Algover’s index (“shock” index) and modern classifications of hemorrhage according to the degrees of severity, taking into account higher initial values of arterial pressure in patients with AH associated with acute GIH.
Perm Medical Journal. 2017;34(1):12-18
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IMMEDIATE AND REMOTE RESULTS OF THE LEFT-ATRIAL “LABYRINTH” SURGERY IN PATIENTS WITH CORONARY HEART DISEASE AND MITRAL VALVE PATHOLOGY
Arutyunyan V.B., Chragyan V.A., Osetrova O.A.
Abstract
Aim. To assess the medium-term results of the left-atrial modification of the surgery “labyrinth-3” in 100 patients with associated pathology of the mitral valve (MV). Materials and methods. One hundred patients (mean age 62,7 ± 4,5 years) with MV pathology, protractedly persisting form of atrial fibrillation (AF) (during 18±5,1 months) ( n = 81), persisting form of AF ( n = 15) and paroxysmal form of AF ( n = 4) were examined. All patients were operated for associated MV pathology over the period from 2010 to 2012. Etiology of mitral valve damage was estimated: degenerative damages - in 62 patients, ischemic mitral insufficiency - in 30 patients, rheumatic heart disease - in 4 patients, idiopathic annulectasia and mitral insufficiency - in 4 patients. During the pre-and postoperative periods, the general clinical and echocardiographic data, the results of Holter monitoring and coronography were assessed. Results. All patients underwent the left-atrial modification of the surgery “labyrinth-3” with correction of mitral valve pathology. Thirty one patients underwent intervention associated with coronary artery bypass grafting, 33 patients - tricuspidal insufficiency correction. Hospital lethality was 3 % - 3 patients died from multiple organ failure. During the first month ( n = 96), sinus rhythm was observed in 85 (89 %) patients including mechanical systole of the left atrium - in 18 %. Eight patients (8,2 %) had atrial fibrillation, 3 (2,8 %) patients needed introduction of electrical stimulator in connection with weakness of sinus node. Six months after the surgery ( n = 71), sinus rhythm was registered in 59 (83 %) patients, mechanical systole of LA - in 55 % of them; one year after the surgery ( n = 39), sinus rhythm was detected in 31 (81 %) patients, mechanical systole of LA - in 48 %. During one year, a two-chamber electrical stimulator was introduced to 4 patients more, in connection with atrioventricular blockade. During 12 months, 80 % of patients were free from atrial fibrillation, 98,7 % were free from acute stroke. Conclusions. The procedure of the left-atrial “labyrinth” associated with correction of MV pathology does not elevate lethality and is efficient in 80 % of patients. Mechanical function frequency of LA in patients with sinus rhythm is being increased during a year in half of patients. Cumulative freedom from stroke is 98,7 % a year.
Perm Medical Journal. 2017;34(1):19-25
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CLINICAL SIGNIFICANCE OF CARBOHYDRATE METABOLISM INDICES IN PATIENTS WITH ACUTE ISCHEMIC STROKE
Izhbuldina G.I., Novikova L.B.
Abstract
Aim. To study the peculiarities of carbohydrate metabolism in the acute period of ischemic stroke, to estimate the influence of metabolic disorders on the severity and outcome of disease. Materials and methods. The examination of 126 patients with acute ischemic stroke, associated with arterial hypertension, was carried out; 64 of them suffered from type 2 diabetes mellitus. Fasting blood glucose, immunoreactive insulin and C-peptide were determined. Results. The results of comparative assessment of hormonometabolic profiles depending on the outcome of disease indicate the significantly higher indices of C-peptide to insulin ratio in patients without health status improvement. Выводы. It was stated that the development of ischemic stroke is accompanied by high blood C-peptide levels in patients with diabetes mellitus in anamnesis and without it. Manifestation of disorders is associated with the severity and clinical outcome of this disease.
Perm Medical Journal. 2017;34(1):26-31
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POSTPRANDIAL HEMODYNAMIC CHANGES IN ABDOMINAL VESSELS OF HEALTHY CHILDREN
Zaitseva O.S., Spivak E.M.
Abstract
Aim. To characterize the response of the abdominal vessels to food load in healthy children and to determine the referent values of postprandial changes in the regional blood flow. Materials and methods. The Doppler investigation of the abdominal vessels before and 30 minutes after the standard breakfast with determination of their diameters, linear and volumetric rate indices, resistance index was performed in 44 healthy children aged 3-15 years. Results. During the postprandial phase, the dilatation of the superior mesenteric artery, celiac trunk, hepatic and splenic arteries, portal vein and splenic veins was observed in healthy children. Increase in volumetric blood flow rate is revealed in all these vessels that reflects intensification of blood circulation in the abdominal organs. Conclusions. The character and degree of changes in hemodynamic parameters after food intake have no age differences in healthy children. Reference values of the postprandial blood flow changes in the abdominal vessels for children aged 3-15 years were obtained.
Perm Medical Journal. 2017;34(1):32-34
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POSTERIOR SEPARATION HERNIOPLASTY TAR IN TREATMENT OF POSTOPERATIVE VENTRAL HERNIAS W3
Samartsev V.A., Gavrilov V.A., Parshakov A.A., Kuznetsova M.V.
Abstract
Aim. To improve the results of surgical treatment in patients with the postoperative ventral hernias W3 using the method of posterior separation hernioplasty TAR. Materials and methods. Twenty seven patients with the postoperative ventral hernias W3, who underwent the posterior separation hernioplasty by TAR technology, including 14 (51,85 %) patients with simultaneous operations were examined. For all patients, the technology of uninterrruped suture using long-resorbable suture materials with immobilized antibacterial drugs was applied. Results. In the postoperative period, marginal skin necrosis developed in 1 (3,70 %) patient, retromuscular hematoma in 1 (3,70 %) patient. The regional ozonotherapy used contributed to faster reduction of infectious-inflammatory process. No lethal outcomes were fixed. Conclusions. Modern surgery of the postoperative ventral hernias is an actual medical, social and economic problem. The method of separation plasty of the anterior abdominal wall used in case of the postoperative ventral hernias W3 should be chosen individually for each patient.
Perm Medical Journal. 2017;34(1):35-42
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HYGIENIC ASSESSMENT OF POSSIBILITY OF USING SYLVINITE DEVICE IN COMPLEX TREATMENT OF CHRONIC CATARRHAL PHARYNGITIS
Selivanova S.A.
Abstract
Aim. To carry out the hygienic and clinical studies of the possibility of using sylvinite physiotherapeutic room in complex treatment of chronic catarrhal pharyngitis. Materials and methods. The objects for studying: sylvinite physiotherapeutic room, 52 patients, diagnosed chronic catarrhal pharyngitis (age: 20-25 years). Hygienic methods were used to study the aeroionization and aerosol environment, microclimate. According to the results of pharyngoscopy, 5-score sensoanalogous and visual-analogous scales were filled in. The local immunity indices of pharyngeal mucosa (SIgA, IL4, IL8) were assessed. Results. Physiotherapeutic factors contributed to decrease in the degree of manifestation of clinical signs of this disease as well as to elevation of the local immunity of pharyngeal mucosa. Conclusions. The results of the study proved good prospects for using sylvinitotherapy in complex treatment of patients with chronic catarrhal pharyngitis.
Perm Medical Journal. 2017;34(1):43-48
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PRINCIPLES OF DIAGNOSIS AND SURGICAL TREATMENT OF ISCHEMIC MITRAL REGURGITATION COMBINED WITH CORONARY BYPASS GRAFTING
Chragyan V.A., Myalyuk P.A., Arutyunyan V.B.
Abstract
Aim. To assess and analyze the results of surgical treatment carried out in patients with ischemic mitral insufficiency. Materials and methods. The results of surgical treatment of 74 patients with ischemic mitral insufficiency were analyzed. The preoperative assessment of the significance of mitral insufficiency and the causes of its development was carried out using echocardiography, the protocol of which included parameters giving quantitative characteristic of space correlations of the mitral valve structures (fibrous ring diameter, interpapillary distance, annulopapillary distance, cusp tension area, cusp coaptation depth) that permitted to give objective estimation of its function. The results of the preoperative examination indicated presence of the postinfarction remodeling of the left ventricle (LV) cavity, decrease in its contractile function and essential deformation of the mitral valve structures. Results. All patients underwent myocardial revasculization, different variants (reconstruction or replacement) of correction of ischemic mitral insufficiency and surgical remodeling of LV cavity. After the surgery, decrease in LV cavity as well as increase in ejection fraction was registered; after the mitral valve plasty, significant improvement of space-geometric left ventricle to mitral valve ratios at the expense of reduction of cusps-influencing tension forces was revealed. Conclusions. The recovery of normal mitral valve function was the result of geometric reconstruction of LV and valve apparatus.
Perm Medical Journal. 2017;34(1):49-57
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PREDICTORS OF CLINICO-EPIDEMIOLOGICAL WHOOPING COUGH DIAGNOSIS IN CHILDREN
Deryusheva A.V., Lvova I.I., Degotina N.S., Banko N.V., Uvarova E.Y.
Abstract
Aim. To develop the modern predictors of clinico-epidemiological diagnosis of whooping cough in children. Materials and methods. The retrospective study included 56 children aged 2 months to 6 years, who were hospitalized for whooping cough infection. Diagnostic verification was carried out by means of a double bacteriological study of fauces mucosa as well as serological study of blood serum in dynamics of the disease. Standard study included general blood and urine analyses, biochemical blood analysis, epidemiological anamnesis and clinical examination. To assess the significance of diagnostic predictors, analytical (optimal quantization) and statistical (Pirson criterion) methods were used. Results. Diagnosis of whooping cough was found to be verified using laboratory methods in 59,0 % (33/56) of children: bacteriological method - in 12,1 %, serological - in 87,9 %. Statistically significant clinico-epidemiological predictors of whooping cough infection were determined without laboratory confirmation of diagnosis in 23 (41 %) children. Conclusions. In case of typical clinical picture of whooping cough and negative results of bacteriological/serological study, it was suggested to use the following predictors as additional diagnostic criteria: absence of whooping cough vaccination, age - under 1 year, marked leucosis (Le > 15·109) of lymphocytic character with normal ESR and contact with protractedly coughing persons.
Perm Medical Journal. 2017;34(1):58-62
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CYSTATIN С FOR ASSESSMENT OF RENAL GLOMERULAR FILTRATION RATE IN CHILDREN AND ADOLESCENTS
Kiselnikova O.V., Spivak E.M., Mozzhukhina L.I.
Abstract
Aim. To determine the diagnostic value of blood serum cystatin C level as a marker of kidney damage in children and adolescents. Materials and methods. Twenty nine patients (aged 4-18 years) with type 1 diabetes mellitus, complicated by diabetic nephropathy (DN) and 30 healthy persons of the same age were examined. Glomerular filtration rate (GFR) was assessed according to creatinine serum levels (Schwartz formula) and cystatin C (Hoek equation). Results. Serum concentration of creatinine in all patients ranged in referent values; decrease in GFR by Schwartz formula was detected only in one patient (3,4 %). Blood serum cystatin C level in DN patients was significantly higher than in healthy children; GFR values calculated using cystatin C were reliably lower than by Schwartz formula. Children’s and adolescent’s DN in 100 % of cases is accompanied by GFR fall. Conclusions. Assessment of cystatin C serum concentration permits to diagnose early changes in GFR when children have diabetic damage of kidneys. This index is significantly more precise GFR marker than serum creatinine.
Perm Medical Journal. 2017;34(1):63-66
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PECULIARITIES OF REVEALING AND CLINICAL MANIFESTATIONS OF SPONDYLITIS IN HIV-INFECTED PATIENTS
Mamaeva L.A.
Abstract
Aim. To determine the peculiarities of revealing and clinical manifestations of spondylitis in HIV-infected patients. Materials and methods. The case history data of 116 patients, hospitalized to the unit of surgical tuberculosis of the institute hospital, were analyzed. Results. In the group of HIV-infected patients with spondylitis there prevailed parenteral narcomania, hepatitis C, staying at institutions of confinement in anamnesis, acute onset of disease, generalization of tuberculous process with specific etiology of spondylitis, not so often - developing congestive abscess and neurological deficit in the form of paresis and plegia. Tuberculous etiology of spondylitis associated with HIV-infection is more often confirmed by molecular-genetic method of study. Conclusions. The obtained data can be used by physicians for a timely detection of tuberculous spondylitis at the earlier stage, chemotherapy and surgical treatment of patients.
Perm Medical Journal. 2017;34(1):67-72
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CRANIOMETRIC CHARACTERISTICS OF ADULT SPHENOIDAL SINUSES OBTAINED WITH CONE-RAY COMPUTED TOMOGRAPHY
Supilnikov A.A., Gelashvili P.A., Yukhimets S.N., Islamova E.S.
Abstract
Aim. To study the life-time linear parameters of the sphenoidal sinus cavities in different reformats of cone-ray computed tomography (CRCT). Materials and methods. Measurements of cranial structures were fulfilled using tomograms of planed examinations, carried out at “Railway Dental Polyclinic” of Samara station “RR” in 2010-2014. They were obtained with cone-ray computed tomograph Galileos, (Sirona Company) with the software Galaxis. Eighty two persons with a mean age of 38,05 ± 0,77 years were examined. Results. The life-time linear parameters of the sphenoidal sinuses in different CRCT reformats were studied through the standard and additional craniometric points. Correlation links between the anatomic indices, characterizing the contour and the internal relief of sphenoidal sinuses were detected. Conclusions. The data on size characteristics and associated variability of the paranasal sinuses, obtained by means of standard CRCT, supplement and concretize the information database of medical craniology that is significant not only for orthodontics, but for otorhinolaryngology, ophthalmology, neurosurgery, as well.
Perm Medical Journal. 2017;34(1):73-78
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HYGIENIC METHOD FOR ASSESSMENT OF SYLVINITE DEVICES FUNCTIONING EFFICIENCY
Khokhryakova V.N.
Abstract
Aim. To develop and ground a new hygienic method for complex assessment of functioning efficiency of sylvinite devices. Materials and methods. The studies were carried out in the sylvinite devices of 3 types: saline microclimatic ward, sylvinite physiotherapeutic room and saline sylvinite device. The overall number of measurements was 108. Mann-Whitney criterion was used for statistical processing of the data. Results. The hygienic method for assessment of the efficiency of sylvinite devices functioning, based on registration of antimicrobial effect of their internal environment on the growth characteristics of museum strain S.aureus (strain number 201188, № 906) was developed. When using this method in different types of sylvinite rooms, a bacteriostatic effect, which confirms formation of special biopositive environment rendering a complex influence on the microorganisms S.aureus , was established. Conclusions. The suggested method for assessment of the efficiency of functioning of physiotherapeutic potassium salt devices permits to take into account a complex of environmental factors, it simplifies and reduces the price of the process of determining the quality of functioning and can be successfully used for control of device exploitation.
Perm Medical Journal. 2017;34(1):79-83
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NATURAL COMPLEX OF FERMENTABLE DIETARY FIBERS AND SHORT CHAIN FATTY ACIDS IN PROINFLAMMATORY STATUS CORRECTION
Kuznetsov S.V., Kuznetsov V.F., Negodyaeva N.L., Obernebesova T.P.
Abstract
Aim. To study the influence of a natural complex of short chain fatty acids (SCFA), as inhibitors of histondeacetylases and fermentable dietary fibers (FDF), as SCFA precursors on the immunogram indices in patients with inflammatory processes of different localization. Materials and methods. Twenty one patients received a natural complex of FDF and SCFA - BAS “Rekicen RD®” - 1 table-spoon or 1 dessert-spoon (depending on age) 3 timed a day, 30 minutes prior to food intake. The generally accepted methods were used to study different parameters of immune status before and after taking a natural FDF and SCFA complex. Results. The normalizing influence of a natural FDF and SCFA complex on the total number of lymphocytes, monocytes, intensity of phagocytosis, IgA, IgM, IL-1β concentration as well as the number palpable lymph nodes was established in patients. Conclusions. The analyzed data indicated that the FDF and SCFA complex used, statistically significantly reduces proinflammatory cytokine IL-1ß level to the norm, thus contributing to normalization of immunogram parameters.
Perm Medical Journal. 2017;34(1):84-89
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ASTRAGALUS GLYCYPHYLLUS L. FATTY AND ORGANIC ACIDS
Pozdnyakova T.A., Bubenchikov R.A.
Abstract
Aim. To study the fatty and organic acids in Astragalus glycyphyllus L . Materials and methods. The object of this study was a dry-grinded grass of Astragalus glycyphyllus L. , prepared in 2016 in Kursk region during the period of mass plant blossoming. The method of gas-liquid chromato-mass-spectrometry was used to study the qualitative composition and quantitative content of fatty and organic acids of the plant. Results. Astragalus glycyphyllus L. contains 19 fatty and 10 organic acids. Fatty-acid composition of Astragalus glycyphyllus L. , presented by saturated, monounsaturated and polyunsaturated acids, is characterized by a low coefficient of polyunsaturated acids. Conclusions. The obtained results prove the possibility of using Astragalus glycyphyllus L. in medical and pharmaceutical practice as a source of organic and fatty acids including omega-3 and omega-3-based drugs.
Perm Medical Journal. 2017;34(1):90-94
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BIOLOGICAL AGE AND AGE CHANGES RATE IN ATHLETES OF PLAYING KINDS OF SPORT AND UNTRAINED PERSONS
Chainikov P.N., Cherkasova V.G.
Abstract
Aim. To reveal the peculiarities of biological age and age changes rate in athletes of playing kinds of sport and persons, not engaged in sports. Materials and methods. The study included 141 persons: athletes - 61 persons (men - 31, women - 30) and subjects, who do not go in for sports - 80 persons (men - 34, women - 46). All the participants were of period I mature age. Biological age and age changes rate were determine by anthropometric data. Results. Athletes of playing kinds of sport demonstrated lower biological age and slowed age changes rate in comparison with persons, who do not go in for sports. The biological age in the group of athletes was lower than the chronological one; the biological age in the group of persons, not engaged in sport, was higher than the chronological one. Conclusions. The study indicated a positive influence of systematic physical activity of playing kinds of sport on the processes of body ageing, namely, reduction of biological age and slowing of age changes rate. This kind of physical activity can be recommended to persons of mature age for formation of programs of optimal motor regimen.
Perm Medical Journal. 2017;34(1):95-99
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COMORBID COURSE OF GASTROESOPHAGEAL REFLUX DISEASE AND NONALCOHOLIC AMYLOID LIVER DISEASE AS RISK FACTOR FOR CARDIAC PATHOLOGY
Lyu K.M.
Abstract
Theoretical review of data regarding the association of cardiac pathology with comorbid course of gastroesophageal reflux disease and nonalcoholic amyloid liver disease is presented in the paper. Pathogenesis of these diseases is considered. The associated influence of these diseases was proved to elevate risk for the development of cardiac pathology by several times.
Perm Medical Journal. 2017;34(1):100-106
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PROFESSOR VASILY NIKOLAEVICH PARIN - THE FOUNDER OF THE CHAIR OF HOSPITAL SURGERY OF ACADEMICIANYE.A. VAGNER PERM STATE MEDICAL UNIVERSITY
Nechaev O.I., Palatova L.F.
Abstract
The paper is devoted to the birthday anniversary of V.N. Parin - the founder of the Chair of Hospital Surgery of Academician Ye.A. Vagner Perm State Medical University.
Perm Medical Journal. 2017;34(1):107-111
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HYGIENIC WAY OF ASSESSMENT OF SYLVINITE CHAMBERS FUNCTIONING EFFICIENCY
Khokhriakova V.
Abstract

Aim – to develop and to prove new hygienic way of complex sylvinite chambers efficiency assessment.

Materials and methods. Researches were conducted in sylvinite constructions of 3 types: saline microclimatic chamber, sylvinite physiotherapeutic room and saline sylvinite device. Total of researches was 108. Mann-Whitney U-test was used for statistic data processing.

Results. The way of sylvinite chambers efficiency assessment was developed. It was based on registration of their antimicrobial influence on growth indicators of S.aureus.

In all explored rooms the bacteriostatic effect was established that proved formation of special biopositive inner environment, which exerted complex influence on microorganisms S.aureus.

Conclusions. The offered method of physiotherapeutic potash salts constructions efficiency definition allows to consider complex of inner environment factors, simplifies and reduces the price of quality assessment process and it can be applied to holding control actions for exploit sylvinite chambers.
Perm Medical Journal. 2017;34(1):
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HYGIENIC ASSESSMENT OF SYLVINITE DIVICE USING OPPORTUNITY IN COMPLEX THERAPY OF CHRONIC CATARRHAL PHARINGITIS
Selivanova S.
Abstract

Summary and key words

HYGIENIC ASSESSMENT OF SYLVINITE DIVICE USING OPPORTUNITY

IN COMPLEX THERAPY OF CHRONIC CATARRHAL PHARINGITIS

S.A. Selivanova*1

1 FederalState Budgetary Educational Institution of Higher Education “Academician Ye. A. Vagner Perm State Medical University” of the Ministry of Healthcare of the Russian Federation, s. Perm, Russian Federation.

Aim. To conduct hygienic and clinical researches of sylvinite physiotherapeutic chamber using opportunity in complex treatment of chronic catarrhal pharyngitis.

Materials and methods. Objects of researches were sylvinite physiotherapeutic chamber and 52 patients with chronic catarrhal pharyngitis at the age of 20-25 years. Airionozation, salt aerosol and microclimate were estimated by hygienic methods. 5-mark sensory-analog and visual-analog scales were filled in. Local immunity indicators of pharynx mucosa (SIgA, IL4, IL8) were investigated.

Results. Physiotherapeutic factors of sylvinite physiotherapeutic chamber promoted decreasing of disease clinical sings expression degree and increasing of pharynx mucosa local immunity.

Conclusions. Results of researches testify about prospects of sylvinite physiotherapeutic chamber therapeutic factors in complex treatment of chronic catarrhal pharyngitis.

Perm Medical Journal. 2017;34(1):
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