Vol 38, No 4 (2021)

Cover Page

Full Issue

Original studies

Sanitary condition of soil in the territory of Astrakhan state technical university and nearby territories of higher educational institutions

Irdeeva V.A., Arakelyan R.S., Ikenova A.A., Stepanenko E.A., Novokshchenova E.A., Alekseeva A.S., Maslyaninova A.E., Mirmanova I.M., Gadzhimuradova M.F., Artsueva K.B.

Abstract

Objective. The authors of this article studied and analyzed the sanitary condition of the soil in the territory of Astrakhan State Technical University and the nearby territories of higher educational institutions.

Materials and methods. The study was carried out in May – June 2019 on the basis of the laboratory of the Department of Infectious Diseases and Epidemiology of Astrakhan State Medical University and the laboratory of the Department of Applied Biology and Microbiology of Astrakhan State Technical University. Thirty soil samples were taken from these territories.

The studies of soil samples for parasitological indicators were performed according to the guidelines "Control Methods. Biological and Microbiological Factors. Methods of Sanitary and Parasitological Research", for microbiological indicators – "Methods of Soil Microbiological Control".

Results. The following results were obtained: the sanitary-parasitological condition of the soil in parks near higher educational institutions in Astrakhan remains very tense as evidenced by positive findings of geohelminthoses; when assessing the degree of epidemic hazard of soil, there were identified nematode eggs and adult worm Strongyloids, that corresponds to the indicators of moderately hazard soil; the presence of live strongylid larvae in the studied samples indicates contamination of the soil with feces of infested animals, and the presence of Ascaris eggs indicates contamination of the soil with sewage or feces of infested children walking and resting in these territories; the total microbial number on average gave indicators for evaluating the selected soil samples as a slightly polluted soil.

Conclusions. The sanitary and parasitological state of soil in parks of Astrakhan higher educational institutions remains rather tense as evidenced by positive findings of geohelminthoses.

Perm Medical Journal. 2021;38(4):6-17
pages 6-17 views

Frequency of endemic goiter and indicators of pituitary-thyroid profile in Arctic children

Evseeva S.A., Burtseva T.E., Klimova T.M., Danilov N.A., Chasnyk V.G., Douglas N.I.

Abstract

Objective. Analysis of the frequency of endemic goiter and indicators of the pituitary-thyroid profile in children aged 10-18 years living in the Arctic regions of Yakutia.

Materials and methods. The study was conducted among children and adolescents of the Arctic regions of Yakutia (Bulunsky, Anabarsky, Allaikhovsky, Nizhnekolymsky, Verkhnekolymsky district) during field medical expeditions in 2018–2020. A total of 392 children aged 10–18 years were examined.

Results. In 30 % of the examined children, an increase in the thyroid gland was observed, which was accompanied by elevated levels of free thyroxine. In 3 % of children, an increase in the level of thyroid-stimulating hormone was detected against the background of reduced or normal levels of free thyroxine.

Conclusions. As for the prevalence of cases of endemic goiter, the Arctic regions of Yakutia are the areas of severe goiter endemia. The results obtained justify the need for additional scientific studies to assess the degree of iodine availability (by the concentration of iodine in the urine) in different population groups and real implementation of the strategy of mass preventive measures.

Perm Medical Journal. 2021;38(4):18-24
pages 18-24 views

Study of genes involved in angiogenesis and metabolic processes of peripheral blood lymphocytes in patients with chronic endometritis

Kobaidze E.G.

Abstract

Objective. To study the polymorphisms of the genes involved in angiogenesis and in metabolic processes, to assess the level of lymphocytes in patients with chronic endometritis and practically healthy women of reproductive period.

Materials and methods. 86 patients were examined; DNA regions of the genes eNOS 1799983 (Glu298Asp), PPARA (G2528C), ApoE rs429358 (Cys130Arg), MTHFR (C677T, A1298C) were used as primers; blood lymphocytes (CD3+, CD4+, CD8+, CD19+, CD95+) were assessed.

Results. Statistically significant differences in gynecological and chronic somatic pathology were obtained in patients with chronic endometritis; they more often than practically healthy women had polymorphisms of the genes ApoE rs429358, eNOS1799983, PPARA (G2528C); patients with chronic endometritis more often had dysregulation of the immune system in the form of insufficiency of the cellular effector link of immunity and changes in the PPARA, ApoE, eNOS gene. Attention was drawn to the obtained relationships of polymorphic genes and clinical manifestations in patients with chronic endometritis, in particular, with a history of non-developing pregnancy in anamnesis, there was more often detected polymorphism of the ApoE gene, with abnormal uterine bleeding – polymorphism of PPARA, with chronic inflammatory pathology of the gallbladder – polymorphism of the MTHFR gene.

Conclusions. The prevalence of polymorphism of the genes eNOS 1799983 (Glu298Asp), PPARA (G2528C), ApoE rs429358 (Cys130Arg), MTHFR (C677T, A1298C) was obtained in patients with chronic endometrial inflammation compared with practically healthy participants in the study. Insufficiency of the cellular effector link of immunity was revealed in the majority of patients with ChE and an association with allele C genotypes G/C and C/C of PPARA 4253778 gene, with allele C genotypes G/C and C/C of ApoE42935 gene, with allele C genotypes G/C and C/C of eNOS 1799983 gene and G/C genotype of MTHFR gene (C677T, A1298C).

Perm Medical Journal. 2021;38(4):25-35
pages 25-35 views

Features of the course of myocardial infarction without coronary artery obstruction

Maksimov N.I., Grishin I.S.

Abstract

Objective. To study the clinical and laboratory features and the early post-infarction period in patients suffering from myocardial infarction with non-obstructive coronary arteries (MINOCA).

Materials and methods. A survey of 62 patients hospitalized to the Republican Clinical and Diagnostic Center of the Ministry of Health of the Republic of Udmurtia with a diagnosis of "myocardial infarction" was conducted, 30 of whom had a single-vessel lesion of the coronary bed, 32 – myocardial infarction without coronary artery obstruction.

Results. Differences in the clinical manifestations of the acute period were noted by the presence of syncope, isolated shortness of breath, and a difficult-to-explain feeling in the chest. The time from the onset of symptoms to hospitalization in the MINOCA group exceeds 1.7 hours. The MINOCA group had a much higher level of markers of myocardial necrosis (troponin I level of 8.9 ng/ml compared to 1.75 ng/ml), despite a significantly lower frequency of detection of hypokinesia zones and the number of affected segments.

Conclusions. It is necessary to improve public awareness of the symptoms of acute coronary syndrome, including its atypical manifestations. Routine PCI does not "save" from subsequent angina pectoris if it is present before MI.

Perm Medical Journal. 2021;38(4):36-41
pages 36-41 views

Features of acute purulent lymphadenites and maxillofacial adenophlegmons course in children

Khaluyta E.E., Volkov P.Y., Berdichevskaya E.V., Chernykh A.S.

Abstract

Objective. The purpose of the research was to study the features of the course of acute purulent lymphadenites and adenophlegmons of the maxillofacial region in children, to describe the species composition of pathogens, to determine their sensitivity to antibiotics of various groups.

Materials and methods. The medical histories of 147 patients were analyzed; microbiological studies were carried out (microscopic examination of clinical specimens with gram stain, cultural method, determination of sensitivity of isolated pathogen to antimicrobial drugs).

Results. Most often, acute purulent lymphadenites and adenophlegmons were observed in the submandibular tissue space (40.1 %) and in the neck (38.1 %). The main causative agents of the inflammatory process were Staphylococcus aureus (38.1 %) and Streptococcus agalactiae (BHSA) (14.3 %). Staphylococcus aureus strains had the highest sensitivity to beta-lactam antibiotics – in 83 %, to macrolides – in 60.4 %, to fluoroquinolones – in 56.6 %; 3.8 % showed resistance to lincomycin, 1.9 % – to beta-lactams. The strains of Streptococcus agalactiae (BHSA) were 100 % sensitive to beta-lactams, 73.7 % – to macrolides, they were resistant to lincomycin and macrolides (10.5 % each).

Conclusions. The data obtained are of great practical importance, since they allow to correctly orient doctors in the choice of rational antibiotic therapy.

Perm Medical Journal. 2021;38(4):42-47
pages 42-47 views

Dynamics of interleukin-17 in patients with multiple sclerosis and two-phase model of disease patho-genesis

Baidina T.V., Sursyakova N.V., Danilova M.A., Trushnikova T.N., Kuklina E.M.

Abstract

Objective. To study the concentration of the pro-inflammatory cytokine interleukin-17 in the blood serum of patients with multiple sclerosis.

Materials and methods. 68 patients with multiple sclerosis were examined. The severity of neurological deficit was assessed by EDSS and MSFC. The concentration of interleukin-17 in the blood serum was determined by the method of enzyme-linked immunosorbent assay.

Results. It was found that in patients with multiple sclerosis, the concentration of interleukin-17 in the blood serum, normal in the group as a whole, was induced by the effect of immunomodulatory therapy as well as the decrease in the activity of inflammatory processes with an increase in the duration of disease.

Conclusions. It was found that MDDMS therapy is most effective in the early stages of the disease; in the later stages, activities associated with neurotrophic support play a special role.

Perm Medical Journal. 2021;38(4):48-53
pages 48-53 views

Severity of inflammatory syndrome and endothelial dysfunction in steatosis and liver fibrosis

Bulatova I.A., Miftakhova A.M., Gulyaeva I.L.

Abstract

Objective. To evaluate the severity of the inflammatory syndrome by the serum concentration of proinflammatory cytokines of tumor necrosis factor alpha (TNF-α) and interleukin-6, endothelial dysfunction syndrome (ED) by the level of vasculoendothelial growth factor (VEGF) and the functional activity of Willebrand factor (WF) in the blood of patients with nonalcoholic liver steatosis (NALS) and liver fibrosis (LF) of viral genesis.

Materials and methods. 52 patients with NALS and 27 patients with LF of viral etiology (hepatitis C) were examined. The control group included 20 practically healthy individuals. The concentrations of TNF-α, IL-6 and VEGF were determined in the blood by enzyme immunoassay. The functional activity of WF was measured by the level of aggregation with the inducer ristocetin using laser aggregometer.

Results. According to the results of ELISA, an increase in serum levels of proinflammatory cytokines TNF-α and IL-6 was registered in patients of both study groups in comparison with the control, being more pronounced in patients with viral LF. Hyperproduction of VEGF was observed in both groups of patients, and the concentration of this marker was significantly higher in viral LF than in patients with NALS (p = 0.002). The functional activity of WF in patients with NALS and in the group with LF also significantly exceeded the control values, but there were no significant differences between the nosological forms (p = 0.675).

Conclusions. The course of NALS and viral LF is characterized by the development of an inflammatory syndrome and ED, associated with an increase in the production of proinflammatory cytokines TNF-α and IL-6 and hyperproduction of VEGF, more pronounced in LF. The functional activity of WF also increases in both nosological forms, but without significant differences.

Perm Medical Journal. 2021;38(4):54-61
pages 54-61 views

Normal concentration of oral fluid procalcitonin and concentration in periodontitis

Gileva O.S., Mandra Y.V., Sivak E.Y., Polushina L.G., Libik T.V., Мaksimova A.Y., Sosnin D.Y.

Abstract

Objective. To study the procalcitonin concentration (PCC) in the oral fluid of healthy persons and patients with periodontitis.

Materials and methods. The procalcitonin concentration was studied in the oral cavity of 42 patients with periodontitis (main group) and 25 patients with sanitized oral cavity (comparison group).

Results. The result medians in the comparison group by 1.658 times exceeded the median in the main group (р = 0,004315) and made up for the main group 114 (64; 144) pg/ml and for the comparison group 189 (117; 485) pg/ml. No differences in the oral fluid PCC concentration between men and women (p = 0,052) were revealed. There was not observed the dependence of the PCC content in the saliva on the age of the examined persons (R = –0.208).

Conclusions. The decrease in the oral fluid PCC concentration can be induced by the decrease in the bacterial load due to preliminary sanation of the oral cavity and dilution of the saliva as a result of activation of exudation and salivation processes in periodontium tissue inflammation.

Perm Medical Journal. 2021;38(4):62-69
pages 62-69 views

Detection of potentially malignant diseases of the oral cavity in dental care

Rykhlevich A.A.

Abstract

Objective. To study the detection of potentially malignant diseases of the oral cavity in the provision of dental care in outpatient settings

Methods. The analysis of the reporting form 039-2/y-88 for 2011–2020 and medical records of 2400 patients who received dental care on an outpatient basis was carried out.

Results. Over the past 10 years, the proportion of people who underwent treatment of the oral mucosa has decreased, relative to the total number of admitted patients and the number of primary patients. Potentially malignant diseases of the oral cavity were diagnosed on an outpatient basis in 7.5 % of cases: leukoplakia – 1.75 %, erythroplakia – 0.4 %, lichen planus – 1.25 %, candidiasis – 4.7 %. In 65.5 % of the out-patient medical record issued for the treatment and extraction of teeth, there is no description of the oral mucosa, in 26.8 % – a description of the normal state is given, in 7.7 % – it is indicated that there are changes in the oral mucosa, of which 5.3 % of the changes are described with varying degrees of detail. At the same time, complaints of burning, pain in the mouth when eating and talking are present in 19.5 % of the out-patient medical record issued during the treatment and removal of teeth.

Conclusions. The frequency of diagnosing potentially malignant diseases of the oral cavity in the provision of dental care in outpatient settings is lower than the data of Russian epidemiological studies. Dentists in outpatient settings do not pay due attention to the condition of the oral mucosa.

Perm Medical Journal. 2021;38(4):70-75
pages 70-75 views

Review of literature

Exosomes and myocardial infarction: scientific and practical interest

Khlynova O.V., Rodionov R.A., Karpunina N.S., Shishkina E.A.

Abstract

A review of the literature on the biological role of exosomes in the pathophysiology of a number of pathological conditions, including damage to the heart muscle in the variant of myocardial infarction (MI), is presented. In the last decade, exosomes have begun to be actively studied; a lot of data have appeared on their nature and role in intercellular transport and signaling both in normal conditions and in pathology. Exosomes are important carriers of biological information, facilitating intercellular communication and participating in the pathophysiology of various cardiovascular diseases. In myocardial infarction, massive cardiomyocyte death triggers a strong inflammatory response, which is a vital process for cardiac damage, repair, and remodeling. A growing body of evidence suggests that exosomes are involved in the inflammatory response and immune regulation after MI.

Perm Medical Journal. 2021;38(4):76-84
pages 76-84 views

Rehabilitation of patients with chronic heart failure: opportunities and unresolved issues

Vladimirskiy V.E., Bobylev Y.M.

Abstract

The review is devoted to the problem of rehabilitation of patients with chronic heart failure (CHF). About 7 % of the population of our country have confirmed CHF. This fact is a reason for serious concern since this pathology is the main cause of death of patients from cardiovascular diseases. Until the end of the 20th century, the presence of symptomatic CHF in a patient was a contraindication for physical rehabilitation. However, over the past 10-15 years, rehabilitation care for this category of patients has been recommended by many medical communities. This review provides data on the mechanisms of the effect of physical activity on patients with CHF. Much attention is paid to clinical studies and meta-analyzes, which assess the clinical effectiveness of cardiac rehabilitation (CR) in patients with CHF. It has been shown that the effectiveness of this aid differs in different groups of CHF patients. Attention is paid to the description of the CR methodology among patients with CHF. Alternative opinions of the authors on the effectiveness of different types of training regimes are presented, methods for assessing the intensity of physical exercises are described. The review provides data on different models of organizing the delivery of rehabilitation care to CHF patients.

Perm Medical Journal. 2021;38(4):85-103
pages 85-103 views

Methods of diagnosis and technologies

Modern view in diagnosis of uremic pseudoperitonitis and peritonitis in patients on renal replacement therapy (programmed hemodialysis)

Zurnadzhyants V.A., Kchibekov E.A., Gasanov K.G., Kchibekov A.A.

Abstract

Objective. Determination of blood serum β2-microglobulin and lactoferrin concentration in patients on renal replacement therapy (programmed hemodialysis) for the diagnosis of uremic pseudoperitonitis and peritonitis.

Materials and methods. We examined 56 patients admitted to the Surgical Department of Astrakhan Clinical Hospital “RZhD-Medicine” and City Clinical Hospital № 3, and studied the concentration of blood serum β2-microglobulin and lactoferrin in patients urgently hospitalized with suspicion of uremic pseudoperitonitis or peritonitis, who receive renal replacement therapy (programmed hemodialysis). The control group included 50 outpatients on renal replacement therapy (programmed hemodialysis). The study did not include patients with suspected peritonitis who did not receive renal replacement therapy (programmed hemodialysis). The period of the study is 2019–2021.

Results. The concentration of serum β2-microglobulin is statistically higher than normal in all patients receiving renal replacement therapy (programmed hemodialysis) in anamnesis. The most statistically high concentration of β2-microglobulin was detected in patients with uremic pseudoperitonitis (n = 39), and was 30000 ± 6680 ng/ml compared with the concentration in the blood serum among patients with peritonitis 6000 ± 519.9 ng/ml. The concentration of lactoferrin is statistically high in peritonitis (n = 17) and was 3480 ± 439 ng/ml compared with uremic pseudoperitonitis 1160 ± 148 ng/ml. In the control group of outpatients (n = 50), who received renal replacement therapy (programmed hemodialysis), no statistically significant concentrations of blood serum β2-microglobulin and lactoferrin were detected.

Conclusions. A clear dependence of β2-microglobulin and lactoferrin concentrations on the severity of uremic pseudoperitonitis and peritonitis was established. Statistically high values of β2-microglobulin concentration were obtained in patients with uremic pseudoperitonitis, and the level of lactoferrin was statistically high in peritonitis.

Perm Medical Journal. 2021;38(4):104-111
pages 104-111 views

Interdisciplinary system approach and concept of experimental and analytical method of material selection and design planning in order to improve effectiveness of periodontitis treatment

Astashina N.B., Rogozhnikova E.P., Merzlyakov A.F., Nikitin V.N.

Abstract

Objective. One of the most important tasks of dentistry at the present stage is creation of structures, which ensure a unity of dental system form and function and bring it closer to its original natural state. This approach permits to expand significantly the range of orthopedic treatment tasks and implement medical and technical requirements for materials, structures of dentures and splinting devices.

Materials and methods. The article reflects the results of an experimental study to determine the Poisson's ratio of the Dental D thermoplastic material used as a structural material for the manufacture of a new therapeutic and preventive dental splint as well as a biomechanical analysis of changes in the displacement amplitude of the teeth included in the splint.

Results. As a result, an accurate quantitative assessment of the developed method of tooth immobilization in mild periodontitis is given taking into account the behavior of the bone tissue of the lower jaw, hard tissues of the teeth and periodontium as well as in case when the dentition is affected by the chewing load.

Conclusions. The analysis of the obtained data allowed us to form practical recommendations for use of the developed design at the stages of orthopedic treatment of patients with the initial stage of periodontal pathology in order to reduce functional overload of dentition and maintain mobility of teeth at physiological level.

Perm Medical Journal. 2021;38(4):112-120
pages 112-120 views

Clinical and laboratory markers of early diagnosis of diabetic polyneuropathy

Karakulova Y.V., Sosnin D.Y., Filimonova T.A., Nekrasova I.V.

Abstract

Objective. To study the content of the brain-derived neurotrophic factor (BDNF) and tropomyosin receptor of type B kinase (TrkB) in patients at an early stage of diabetic polyneuropathy. Late diagnosis of diabetic polyneuropathy (DPN) is largely due to the presence of a subclinical stage, at which damage to the nervous system develops in the absence of complaints from the patient.

Materials and methods. 64 patients with type 2 diabetes mellitus and 11 persons of the control group were examined with an assessment of the pain status and the degree of peripheral neuropathy using PainDetect, TSS, NSS, NDS scales. Disturbance of nerve conduction along the nerves of the lower extremities was studied using electroneuromyography (ENMG). The study of the quantitative content of BDNF and TrkB in the serum was carried out with enzyme immunoassay.

Results. The increased serum concentrations of BDNF (p = 0.001) and TrkB (p = 0.007) were found with the development of clinically evident DPN as compared to patients without DPN. In patients with diabetes mellitus with subclinical DPN, there was established a statistically significant increase in serum BDNF expression (2.97 [2.44; 3.37] ng/ml in comparison with the values both in the control group (p = 0.022) and in diabetic patients without DPN (p = 0.017). The mean TrkB level in this group was 4.29 [3.48; 5.62] ng/ml, that is also higher than the corresponding values for patients without DPN (p = 0.032) and the control group (p = 0.025). The serum BDNF level correlates with the duration of diabetes mellitus (R = 0.524; p = 0.02), the intensity of neuropathic pain (R = 0.402; p = 0.001), the degree of axonal damage according to ENMG data (R = -0.242; p = 0.03). Correlations between the serum TrkB content and the severity of diabetes mellitus course (R = 0.482; p = 0.01), pain intensity (R = –0.383; p = 0.001), and impaired nerve conduction (R = –0.359; p = 0.003) were found.

Conclusions. The elevated expression and increased serum concentrations of BDNF and TrkB occur at the initial stage of the damage of peripheral nerve fibers and correlate with the degree of compensation for carbohydrate metabolism, the duration of diabetes and the severity of neural conduction disorders. The data obtained allow us to consider the increased serum levels of BDNF and TrkB as the markers of subclinical stage of diabetic polyneuropathy.

Perm Medical Journal. 2021;38(4):121-128
pages 121-128 views

Analysis of surgical treatment of liver hemangiomas

Mugatarov I.N., Zarivchatsky M.F., Samartsev V.A., Bankovskaya L.A., Kamenskikh E.D., Karakulov O.G., Kolyvanova M.V., Teplykh N.S., Shevchuk V.V.

Abstract

Objective. Development of criteria for optimal tactics of surgical treatment of liver hemangiomas of various sizes and localizations.

Materials and methods. A retrospective analysis of 247 patients with hepatic hemangiomas observed on an outpatient basis and in a hospital was carried out; 59 of them (23.89 %) were operated including 12 men and 47 women over the period of 1999–2019. Liver resection with hemangioma was performed in 30 patients, hemangioma enucleation – in 21, X-ray endovascular occlusion – in 8 patients. The diagnosis was established on the basis of ultrasound of the abdominal organs, CT and MRI with contrast as well as angiographic research methods.

Results. The postoperative complications developed in 4 (6.78 %) cases: reactive pleurisy was detected in 2 patients after the right-sided hemihepatectomy, hematomas in the resection zone of segments of the right lobe of the liver with a tumor were diagnosed in 2 patients. All complications were eliminated by conservative measures. There were no lethal outcomes.

Conclusions. Surgical treatment of patients with hemangiomas includes resection of the liver with a tumor, enucleation of the hemangioma, and various types of local destruction. In order to reduce the blood circulation of the tumor and decrease the risk of intraoperative blood loss, the ECA of the branches of the hepatic artery was indicated. A comparative analysis of the results of treatment of patients with liver hemangiomas using various methods of surgical interventions made it possible to develop optimal surgical tactics, a system of intra- and perioperative safety in this category of patients.

Perm Medical Journal. 2021;38(4):129-141
pages 129-141 views

Preventive and social medicine

Age-related aspects of parasitic morbidity among children in Perm

Kochergina E.A., Proskurnova Y.N., Gushchin M.O.

Abstract

Objective. To analyze the dynamics of the incidence of helminthiasis among children, who live in the city of Perm.

Materials and methods. We have retrospectively analyzed the monthly reports of the Center for Hygiene and Epidemiology of the Perm Region for 2015–2020. These reports include the dynamics of the incidence of helminthiasis among four age groups of children: from 1 month to 2 years, 3–6 years, 7–14 and 15–17 years.

Results. Enterobiosis, ascariasis and toxocarosis predominate in the structure of the morbidity in the city of Perm. We found that over the past five years, there has been an increase in the incidence of enterobiosis by 16 %, but the increase in the incidence of ascariasis and toxocarosis reduced – 18 and 25 %, respectively. The rate of decline remains insufficient and the incidence of enterobiosis exceeds the All-Russian one by 2.8 times, ascariasis by 2.7 times and toxocarosis by 4.3 times in comparison with the incidence of parasitic infestations in the Russian Federation. We found that the peak incidence of each nosology falls on the preschool age from 3 to 6 years. Just at this age period, children enter organized groups for the first time, get acquainted with the world through "taste it" and have low sanitary skills.

Conclusions. A routine parasitic screening is effective, since in 2020, more than a half of sick children in Perm were identified during preventive examinations (65.7 %) and only in 34.3 % of cases the diagnosis of parasitic infestation was established on the basis of clinical data.

Perm Medical Journal. 2021;38(4):142-149
pages 142-149 views

Clinical case

Experience of managing neonates and breastfed in-fants with grade IV bilateral hydronephrosis

Nikolaev S.N., Sergeeva S.V., Menovshchikova L.B., Levitskaya M.V., Shumikhin V.S., Erokhina N.O., Burkin A.G.

Abstract

To analyze the clinical cases of four patients with grade IV bilateral hydronephrosis. Ultrasound examination of the urinary system was used as the main examination method. During the first stage of surgical treatment, all children underwent preliminary urinary diversion; a month later, the results were assessed. The result of the preliminary urinary diversion was the implementation of the Heines-Andersen-Kucher reconstructive operation. According to the control ultrasound performed a month after the nephrostomy, pelvis on the nephrostomy was reduced in all cases, parenchyma thickness increased by an average of 4.5 times, improvement in intragranular blood flow was noted. Evaluation of the effectiveness of pyeloplasty was carried out according to three criteria: restoration of urodynamics, restoration of kidney function and the presence of infectious complications. The parenchyma of the operated kidney grew by an average of 3 times, the pelvis decreased by an average of 3.5 times. Restoration of intrarenal blood flow to the cortical layer, inclusive, was noted in 5 of 8 renal units. Before pyeloplasty, there were marked changes in the renal parenchyma and a decrease in its function by an average of 34 ± 14 %; a year after reconstructive surgery, the changes became moderate, there was an improvement in renal function, a decrease in function by 25 ± 10 %. In our opinion, the starting method for providing urgent surgical care to neonates and breastfed infants with grade IV GN is preliminary urinary diversion, which allows us to determine the functional reserve of the renal parenchyma, delay reconstructive surgery, thereby giving time for the restoration of renal function and avoiding organ-carrying surgery.

Perm Medical Journal. 2021;38(4):150-158
pages 150-158 views

Features of diagnosis of inflammatory lesions of central nervous system in HIV-infected patients at terminal stage of disease: clinical case

Karakulova Y.V., Seksyaev N.E., Sosnin D.Y.

Abstract

The authors of the article describe a case of the damage to the central nervous system by fungi of the genus Cryptococcus in a HIV-infected patient. The features of clinical manifestations and laboratory diagnostics are characterized. Special attention is paid to the discrepancy between the sharply changed appearance of the cerebrospinal fluid obtained during lumbar puncture and the clinical picture of the disease as well as the data of laboratory analysis of cerebrospinal fluid.

Perm Medical Journal. 2021;38(4):159-166
pages 159-166 views

Anniversaries and information on events

Professor Boris Markovich Datskovsky: hundredth anniversary of birth

Elkin V.D., Kobernik M.Y., Sedova T.G., Kuznetsov I.D., Plotnikova E.V., Zhukova A.A.

Abstract

The article is dedicated to the Head of the Department of Dermatovenerology from 1988 to 1995, MD, PhD, Professor Boris Markovich Datskovsky. This year we celebrate the hundredth anniversary of his birth. The main stages of his biography are presented, directions of his scientific, organizational, social and medical activity are described. Boris Markovich Datskovsky was an outstanding person, excellent teacher and lecturer, talented scientist, highly qualified dermatovenerologist and manager of public healthcare.

Perm Medical Journal. 2021;38(4):167-170
pages 167-170 views

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