Vol 34, No 3 (2017)

Cover Page
Articles
DYNAMICS OF SYSTOLIC AND DIASTOLIC RIGHT VENTRICULAR FUNCTION IN PATIENTS WITH MULTIPLE CORONARY ARTERY DAMAGES AFTER SURGICAL MYOCARDIAL REVASCULARIZATION
Sinelnikov Y.S., Orekhova E.N., Osetrova O.S.
Abstract
Aim. To assess the dynamics of systolic and diastolic function of the right ventricle in patients with multiple damage of coronary artery after surgical myocardial revascularization. Materials and methods. Fifty two patients with multivascular damage of coronary arteries (Syntax Score 32,2 ± 4,3 scores) were examined. Initially and 14 ± 3,3 months after the coronary artery bypass grafting (CABG), echocardiography by means of 2D-Speckle Tracking Imaging, magnetic resonance imaging (MRI) with contrast gadolinium intensification was performed. Results. According to MRI results, systolic function of the right ventricle (RV) raised (EF from 45 ± 11 % to 58 ± 11 %; р = 0,02). Longitudinal deformation of RV improved (from -16,4 ± 4,6 % to -18,4 ± 5,6 %, р = 0,0000). When estimating segmental function of RV, the correspondence of the zones of contrast accumulation by MRI data to the segments with significantly reduced longitudinal deformation both before CABG and after it was revealed. Longitudinal deformation correlates with both RV EF (before surgery RS = -0,78, р = 0,0001, after surgery RS = -0,73, р = 0,001) and gadolinium accumulation levels and segments. Conclusions. 1. Surgical myocardial revascularization is associated with decrease in volumes and rise in ejection fraction (EF) of the right ventricle by MRI data. 2. Contrast accumulation zones in RV correspond to the segments of reduced RV longitudinal deformation at the level of a free wall both before the surgery and after CABG. 3. After CABG, deformation parameters at the level of RV free wall are improved, but not normalized. The quantity of gadolinium accumulation zones in the right ventricle does not fall. 4. Diastolic function of the right ventricle both before CABG and after it depends on the diastolic function of the left ventricle.
Perm Medical Journal. 2017;34(3):5-12
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CYTOLOGICAL STUDY OF WOUND PROCESS DYNAMICS IN DIABETIC FOOT SYNDROME
Zarivchatsky M.F., Lukin P.S., Vinogradov A.B., Ponomareva T.B.
Abstract
Aim. To study the results of cytological investigation of trophic ulcers in complex treatment of patients with diabetic foot syndrome (DFS) at surgical units of polyclinics and hospitals to optimize therapeutic tactics. Materials and methods. The results of dynamic analysis of trophic ulcers cytograms of 256 patients with diabetic foot syndrome, treated at the 24-hour hospital and 60 patients - at the polyclinics, are presented in the paper. Complex treatment of patients, belonging to the main groups, was supplemented by intravenous injection of thioctic acid by means of modified infusion system; local therapy included the combination of adhesive bandages Permafoam and Atrauman Ag. Results. The cytological study of trophic ulcers in patients of the main groups, treated at the 24-hour hospital and polyclinic, indicated that in patients with statistically similar initial indices in these groups, already within the day 5, there was observed a positive dynamics in the form of decreased bacillary and coccal flora, leucocytes number, appearance of fibroblasts and epithelial cells as well as reduced number of macrophages. During this period, the cytogram changes in the groups of comparison were insignificant and statistically did not differ from the initial ones. Within the day 10th of treatment, active processes of healing, confirmed by the growth of epithelial cells in impression smears, disappearance of bacillary microflora, decrease in the number of leucocytes and macrophages were noted in the main groups. Conclusions. The offered complex for DFS treatment hastens the processes of trophic ulcer healing. The study of impression smears detected the increased number of epithelial cells in the ulcer and the reduced number of macrophages, coccal and bacillary flora already within the day 5th of treatment.
Perm Medical Journal. 2017;34(3):13-18
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MODERN PECULIARITIES OF PEDIATRIC CHRONIC GASTRODUODENITIS COURSE
Repetskaya M.N., Burdina O.M.
Abstract
Aim. To study the modern clinicolaboratory peculiarities of chronic gastroduodenitis course in children. Materials and methods. Fifty five children aged 5-15 years with chronic gastroduodenitis were under observation. Complex clinicolaboratory study including biochemical blood analysis, ultrasonic investigation of abdominal cavity organs, pH-metry, fibrogastroduodenoscopy was carried out. Results. Chronic gastroduodenitis among the observed children was often associated with biliary dysfunction (80 %) and reactive changes in the pancreatic gland (72,7 %). Clinical picture of chronic gastroduodenitis was characterized by the predominance of abdominalgias (100 %), presence of dyspeptic syndrome in the form of nausea (78,2 %), eructation (76,4 %), appetite disorders (60,0 %). Children aged 5-9 years, more often had diarrhea ( p = 0,028) and periumbilical localization of abdominalgias ( p = 0,03), but in adolescents there was more often observed heartburn ( p = 0,047) and apigastral localization of abdominalgias ( p = 0,037). Elevated acid-forming gastric function was stated in 58,2 % of cases. Helicobacter pylori was revealed in 34,5 % of children. More frequently superficial gastroduodenitis (85,5 %) was diagnosed. Pangastritis was registered in 96,4 % of children, panduodenitis - in 98,2 %. Conclusions. Chronic gastroduodenitis extremely seldom occurs in the form of isolated disease. The whole gastrointestinal tract with manifestation of biliary dysfunctions, pancreatic reactive changes, digestive motor disorders is involved into the pathological process. Early diagnosis of this disease, followed by prophylactic measures to prevent the development of associated pathology of different parts of gastrointestinal tract is required.
Perm Medical Journal. 2017;34(3):19-24
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RESULTS OF SINGLE-STAGE CORRECTION OF ISCHEMIC MITRAL INSUFFICIENCY AND CORONARY ARTERY BYPASS GRAFTING IN PATIENTS WITH COMPLICATED IHD FORMS
Chragyan V.A., Arutyunyan V.B.
Abstract
Aim. The influence of mitral valve plasty on the dynamics of mitral regurgitation, risk of perioperative lethality and long-term survival rate was assessed in patients with the left ventricular ejection fraction less than 35 % in case of moderate mitral regurgitation. Materials and methods. Analysis of ischemic mitral insufficiency in case of isolated coronary bypass grafting and mitral valve plasty associated with coronary artery bypass grafting is presented in the paper. During the period from 2008 to 2011 seventy six patients, who were randomized into one of two groups, participated in the study: group 1 - coronary artery bypass grafting associated with mitral valve plasty (38 patients), group 2 - isolated coronary bypass surgery (38 patients). These patients underwent control examination before the operation, when discharged from the hospital and in the follow-up period. Results. Analysis of patients’ long-term survival rate indicated the efficiency of mitral valve plasty compared with isolated coronary bypass grafting. Predictors of relapse and mitral insufficiency progression were determined. Lethality predictors, estimated in the follow-up period, demonstrated a significant influence of heart failure class, pulmonary hypertension class and mitral valve progression.
Perm Medical Journal. 2017;34(3):25-32
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NOVEL IN DIAGNOSIS OF NON-CANCEROUS THYROID GROWTHS
Sigal Z.M., Surnina O.V.
Abstract
Aim. To detect the most sensitive and low-invasive method for diagnosis of con-cancerous growths of thyroid gland. Materials and methods. The results of examination of 735 persons aged 30-50 years with different thyroid growths were analyzed: no pathological growths were revealed in 27 %, adenoma - in 32 %, cyst - in 23 %, malignant neoplasms - in 18 %. For clinical studies, US and transillumination pulsooptometry of the thyroid gland was used. Hemodynamics and optical density were measured by means of Z.M. Sigal device and method. Results. Reliable ( p < 0,05) differences between the cyst and adenoma were found due to investigating pulse oscillation amplitude. Differential diagnosis of large growths on the basis of traditional clinicoroentgenological investigation is difficult. Conventional methods for studying thyroid growths do not give specific signs to differentiate the cyst and adenoma. Conclusions. Combination of pulsography with ultrasonic investigation as a navigational method permits to carry out non-invasive differential diagnosis of non-cancerous growths of the thyroid gland.
Perm Medical Journal. 2017;34(3):33-41
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RESULTS OF USING CAPSULE METHOD FOR GASTROINTESTINAL TRACT INVESTIGATION IN PERSONS WITH ARTERIAL HYPERTENSION
Ivanyuk E.S.
Abstract
Aim. To investigate the status of gastrointestinal tract (GIT) mucosa, using videocapsule enteroscopy (VCE) in patients with chronic abdominal and dyspeptic syndromes, including hypertensive persons. Materials and methods. Examination of 38 patients with complaints for stomachache and dyspepsia was conducted; 19 of them had arterial hypertension (AH) in anamnesis; 19 patients underwent VCE with miniature videocamera in MiroCam capsule (Korea). Results. Seven (18,4 %) persons were diagnosed gastroduodenal lesion, 5 (13,6 %) patients - small intestinal pathology, 4 (10,53 %) - changes in the colon. Associated pathology of gastroduodenal zone and small intestine were detected in 15 (39,47 %) patients, and combined pathology of gastroduodenal zone and colon was found in 7 (18,4 %) patients. Conclusions. Videocapsule enteroscopy is a high-informative diagnostic method, especially for the treatment of small intestinal pathology, in hypertensive patients as well. It is safe, even when antihypertensive drugs are taken by patients not systematically.
Perm Medical Journal. 2017;34(3):42-46
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COMPARATIVE ASSESSMENT OF EFFICIENCY OF “DIRECT” METHODS FOR UREAPLASMOSIS DIAGNOSIS IN PREGNANT WOMEN
Melnikova T.A., Gorovits E.S., Padrul M.M., Rabotnikova G.I.
Abstract
Aim. To compare the diagnostic value of some “direct” methods for diagnosis of ureaplasmosis in pregnant women. Materials and methods. The variant of polymerase chain reaction and direct immunofluorescence were used to examine 112 Ur. urealyticum-infected pregnant women, including 53 women with the level of colonization < 104 CFU/ml and 59 women with the titer > 104 CFU/ml. The group of comparison consisted of practically healthy women with negative results of bacteriological investigation for ureaplasmosis. Results. In the studied material of all ureaplasma-infected (by bacteriological test data) pregnant women, DNA fragments of the pathogen were detected; in 86,44 % of women with a high ureaplasma titer (by bacteriological test data), DNA of the pathogen in the concentration of 5,0·104 DNAcopies/ml and more was registered. The same high concentrations of DNA were stated in 43,4 % of the examined women with ureaplasma titer (by bacteriological test data) lower than etiologically significant values. Direct immunofluorescence was less effective. Conclusions. For laboratory diagnosis of pregnant ureaplasmosis, it is necessary to combine bacteriological method with PCR that permits to diagnose ureaplasmosis more effectively.
Perm Medical Journal. 2017;34(3):47-50
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EXPERIMENTAL GROUNDING FOR USING INFRARED LASER LIGHT IN ENDODONTIC TREATMENT
Mozgovaya L.A., Kosolapova E.Y., Zadorina I.I., Mozgovaya S.V., Fokina N.B., Rochev V.P., Gavrilenko M.S.
Abstract
Aim. To raise the quality of endodontic treatment of chronic forms of apical periodontitis using modern technologies. Materials and methods. Complex examination and endodontic treatment of 143 patients (aged 24-56 years) suffering from chronic forms of apical periodontitis was carried out. Simultaneously, in dynamics of treatment, bacteriological content of 427 teeth root canals and film-forming ability of 86 enterococcal strains were studied. Results. The conducted studies confirm the efficiency of using laserotherapy in the treatment of patients with chronic forms of apical periodontitis. Infrared laser light, applied in complex treatment of chronic apical periodontitis, has an antibacterial effect on Gram - and Gram+ anaerobic colonies that permits to reduce the semination of teeth root canals to 93,2 % and contributes to 1,3 time higher restoration of bone tissue in the periapical region than with traditional method of endodontic treatment. Conclusions. The techniques of disinfection of root canals by means of hydrodynamic irrigation and infrared laser light, included into the complex of endodontic interventions, allow to conduct the treatment of chronic apical periodontitis for one visit, thus reducing the number of the possible complications.
Perm Medical Journal. 2017;34(3):51-58
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EXPERIMENTAL STUDY OF REPARATIVE PROPERTIES OF TITANIUM CELLULAR STRUCTURES
Vasilyuk V.P., Shtraube G.I., Chetvertnykh V.A.
Abstract
Aim. To determine by means of metallography the architectonics of cellular implants, produced with the method of stereolithography; to compare the structure of different materials and the degree of their fixation to the bone in (cellular titanium, Uglecon-M and porous titanium) experimental conditions. Materials and methods. The results of modeling and production of implants based on cellular structures (Wigner-Seitz cell) are presented in the paper. Three-dimensional systems were used for modeling, stereolithographic technology - for production. The results of studying cellular implants from titanium using the universal metallographic microscope Altami MET-5D with enlargement from 50X to 200X are indicated. Results. It was revealed that the surface of cellular dams is not smooth, but uneven at the expense of microscopic deepenings and protrusion of metal. There are microtubules, clearly seen on the section, which are chaotically located; some of them are through, the others are blindly closed. In the implant dam microtubule, there is a grown connective tissue, filling all its space, which does not yield by its density to the connective tissue in the cells. It was established that the degree IV fixation of cellular implants was registered in 55,6 % of animals, porous Uglecon-M implants - in 28,6 %, porous titanium implants - in 41,6 %, that proves high reparative properties of cellular constructions. Conclusions. Dams, forming the cells of implants, have the structure of porous titanium, which possesses reparative properties. The degree IV cellular implant fixation was determined in 55,6 % of animals that indicates high reparative properties of cellular constructions.
Perm Medical Journal. 2017;34(3):59-64
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STUDYING OF TUMOR NECROSIS FACTOR and INTERLEUKIN RECEPTORS expression in hepatic TISSUE of ANIMALS PROTRACTEDLY RECEIVING NIMESULIDE
Lazarenko L.V., Kosareva P.V., Samodelkin E.I., Khorinko V.P.
Abstract
Aim. To study the immunohistochemical expression of TNFαR1 and IL-2Rα in hepatic tissue of animals (rats) with modeled NSAID-associated hepatitis. Materials and methods. The study of TNFαR1 and IL-2Rα in the hepatic tissue of experimental animals was carried out using antibodies TNFR1 (poly) 100 μl, bs-2941R, Rabbit Anti-TNF Receptor I Polyclonal Antibody (Bioss) and IL-2Rα (poly) 1 ml (М-19), sc-666 (Santa Cruz Biotechnology, INC), antibodies species-specific to rat tissue antigens. To reveal the antibodies, Uno Vue detection system, 100 tests, UMR 100PD, object-plates with polylysine coating Menzel were applied. The study was performed using the hepatic tissue of animal of experimental groups, who were administered nimesulide (Naiz®) during 21 days in the following doses: 0,5 mg/kg (therapeutic dose) ( n = 25); 2,5 mg/kg ( n = 20); 5 mg/kg ( n = 24). Intact animals ( n = 21) were used as the control. Antigen-positive cells were identified by the appearance of brown staining while examining preparations at light-optic level. The results of this reaction were assessed with semiquantitative method - in “crosses” (in connection with markers localization on the cellular membrane) and by the number of positively stained cells - in scores. Manifestation of markers expression was evaluated “in crosses” when successively examining the fields of vision under the microscope (from 10 to 20 in each histological section); according to the intensity of staining, the fields of vision were attributed to 4 groups: with negative reaction (-), weakly positive (+), positive (++) and distinctly positive (+++). The markers expression was assessed by a six-score system: 2 scores - up to 20% of stained cells; 4 scores - from 20 to 40 % of stained cells; 6 scores - more than 40 % of stained cells. Results. When studying immunohistochemical expression of TNFαR1in the hepatic tissue of rats with modeled NSAID-associated hepatitis, in all experimental groups there was observed immunopositiveness of the liver parenchyma and that of some cells of portal tract bile-ducts epithelium. Thus, when using nimesulide for a long time, the readiness of liver parenchyma epithelial cells to apoptosis, conditioned by the action of tumor necrosis factor, was stated. Conclusions. There was observed IL-2Rα expression in the liver parenchyma and in a part of bile-ducts of portal tracts among animals of all experimental groups that can be explained by the presence of autoimmune processes. Elevated TNFαR1 and IL-2Rα expression in the liver tissue was noted in animals of experimental group, who received a fivefold dose of nimesulide. Decreased expression of receptors in animals, who took a tenfold dose, can be associated with extensive necroses in the liver parenchyma.
Perm Medical Journal. 2017;34(3):65-71
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PREVALENCE OF NONINFECTIOUS DISEASES AMONG ADULT POPULATION IN MOSCOW
Sandakov Y.P.
Abstract
Aim. To analyze the noninfectious diseases morbidity for 2012-2016 among the adult population at one of diagnostic centers of the city of Moscow. Materials and methods. Statistical processing of data, presented in statistical accounts for 2006-2016 “Information on the number of diseases, registered in patients, living in the region of service of medical institution” (F.12) (Diagnostic Centre №3 of Moscow Healthcare Department) was carried out. Results. The analysis carried out confirmed the existing information that the diseases, conditioning the morbidity of the adult population of Moscow are the following: blood circulation system diseases, respiratory diseases, injuries, poisonings and some other consequences of external causes, musculoskeletal system and connective tissue diseases, eye and its accessory apparatus diseases, digestive diseases, endocrine system diseases, nutritional disorders and metabolic disorders. The total prevalence of the diseases of blood circulation system including diseases, characterized by increased blood pressure, chronic ischemic heart disease, cerebrovascular diseases, is statistically reliably ( p ˂ 0,05) higher in persons over the able-bodied age, than in the able-bodied population during the whole period considered (2012-2016). In its majority, the morbidity rate has a negative dynamics and no prognostic growth is observed. Conclusions. Over the five-year period, there was registered a statistically reliable ( p ˂ 0,05) decrease in the prevalence of noninfectious diseases among the able-bodied population.
Perm Medical Journal. 2017;34(3):72-77
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SOME PSYCHOLOGICAL CHARACTERISTICS OF PATIENTS IN PERIOPERATIVE PERIOD
Ten A.R., Prokhorova O.V., Bakurinskikh A.B., Ershov S.A., Murzin A.V.
Abstract
Aim. To carry out a comparative estimation of the influence of surgical treatment on women’s psychological status. Materials and methods. A pilot cohort prospective study was conducted. Psychological status in the pre-and-postoperative period was assessed in women aged 20-45 years, who had to be operated. Group 1 included 30 women with general surgical pathology, group 2-30 patients treated at gynecological unit. Results. The level of situational anxiety, associated with gynecological surgeries, was more stable and did not reduce after the surgery. No significant differences regarding the dynamics of health status and mood in patients of gynecological and surgical profile were detected. Conclusions. The level of patients’ activity after gynecological surgeries (mean postoperative activity index - 40) tended to decrease.
Perm Medical Journal. 2017;34(3):78-84
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NOSOLOGICAL STRUCTURE AND DERMATOSCOPIC PECULIARITIES OF SKIN NEOPLASMS IN MEDICAL STUDENTS. RISK FACTORS FOR DEVELOPMENT OF MALIGNANT TRANSFORMATIONS ASSESSED BY SURVEY DATA
Morozova A.D., Sedova T.G., Elkin V.D.
Abstract
Aim. To determine the nosological clinical and dermatoscopic structure of benign neoplasms of the skin with assessment of risk factors for malignant transformation. Materials and methods. Clinical and dermatoscopic examination of 50 medical students (mean age 23,5 ± 3,1) was conducted. To assess risk factors for nevus malignization, a questionnaire, consisting of 5 parts was developed. Clinical examination included visual examination of skin and dermatoscopy of the detected elements with their quantitative calculation, estimation of pigment distribution and determination of nevus structure. Results. A high level of affection with skin neoplasms was detected in young persons; benign tumors of melanogenic nature (100 %) and epidermal tumors (64,0 %) prevailed. Safe from the point of view of malignization nevuses, including boundary (40,0 %) and dermal (56,0 %), were characterized by benign signs of dermatoscopic picture. Conclusions. The risk group, requiring dynamic clinical and dermatoscopic follow-up, included students with multiple nevuses (20,0 %) and dermatoscopic signs of active changes in them (14,0 %), as well as those with multiple sun lentigo (41,2 %), localized on the skin of the upper shoulder girdle (52,9 %).
Perm Medical Journal. 2017;34(3):85-92
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FAVOURABLE PREGNANCY TERMINATION IN STAGE 5(D) CHRONIC RENAL DISEASE: CLINICAL CASE
Kasatov A.V., Balakireva V.V., Semyagina L.M., Nikolenko A.V., Ivanyuk G.Y., Kurnosov R.V., Balkova T.N., Kivrina T.M., Semyagin I.A.
Abstract
The case of prolongation of pregnancy in a woman with stage 5 (D) chronic renal disease, resulting in favourable termination for a mother and a baby, is presented in the paper.
Perm Medical Journal. 2017;34(3):93-99
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THE CASE OF SUCCESSFUL PREGNANCY TERMINATION IN A COUPLE WITH HIGH ANTIGENIC IDENTITY BY HLA SYSTEM AGAINST THE BACKGROUND OF ADMINISTRATION OF IMMUNOMODULATORS BEFORE AND DURING PREGNANCY (clinical case)
Skryabina V.V., Zarubskaya I.V.
Abstract
The case of a successful termination of pregnancy in a couple with habitual noncarrying of pregnancy against the background of high antigenic identity by HLA system, who underwent the immunomodulating therapy at the stage of pregravid preparation and during pregnancy, without using the methods of active and passive immunization, is described in the paper. The choice of management tactics for this patient is based on the analysis of literature regarding the above problem.
Perm Medical Journal. 2017;34(3):100-108
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New in the diagnosis of benign thyroid formations
Sigal Z.M., Surnina O.V.
Abstract

Aim. The aim of the study was to reveal the most sensitive and minimally invasive method in the diagnosis of benign thyroid formations.

Materials and methods. Research of 735 people aged 30 to 50 years with various formations in the thyroid gland was analyzed: 27% didn't have pathological formations, 32% had adenoma, 23% had a cyst, and 18% had malignant neoplasms. In clinical studies, we performed ultrasound and transillumination thyroid pulseoptometry. Measurements of hemodynamics and optical density were carried out using the device and the method of Z.M. Sigal

Results. Authentic differences (P <0.05) cysts from adenoma were detected due to studies of the amplitude of pulse oscillations. Differential diagnostics of volumetric formations on the basis of traditional clinico-radiographic research is difficult. Conventional methods of studying thyroid formations don't give specific signs for differentiating cysts and adenomas.

Conclusions. The combination of pulsography and ultrasound as a navigation method allows non-invasive differential diagnosis of benign thyroid formations.

Perm Medical Journal. 2017;34(3):
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STUDY OF REPAROTIVNYH PROPERTIES OF CELLULAR STRUCTURES MADE OF TITANIUM IN THE EXPERIMENT
Vasylyuk V., Straube G., Chetvertnykh V.
Abstract

Aim. Using metallography to determine the architectonics wire mesh implant made by the method of stereolithography. In the experiment to compare the structure of different materials and their degree of fixation in the bone (wire mesh of titanium, Plekon and porous titanium).

Material and methods. The paper presents the simulation results, fabrication of the implants, which perform cellular structure (cell Wigner-Seitz). When applied three-dimensional modeling system, and in the production – technology stereolithography. The results of the research porous implants from titanium using a universal metallographic microscope Altami MET-5D by increasing from 50Х up to 200X.

Results. It was found that the surface of the walls are not smooth, but bumpy due to the microscopic depressions and protrusions of the metal. The cone micro canals are clearly seen, scattered that some of them are cross-cutting, others end blindly. In the microchannel jumpers implant founded sprouted connective tissue filling all the space, the density is not inferior to the connective tissue located in the cells. Established that the fourth degree of fixation of mesh implants was identified in 55.6% of the animals of porous Placona-M - y 28.6% of the subjects, of porous titanium – 41,6%, indicating a high reparative properties of cellular structures.

Conclusions. The Jumper forming cells of the implant structure have a structure of porous titanium with reparative properties. IV the degree of fixation of mesh implants was identified in 55.6% of animals, indicating a high reparative properties of cellular structures.

Perm Medical Journal. 2017;34(3):
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