Perm Medical Journal

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.

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.

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.

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.

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.

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.

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.

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.