Vol 34, No 6 (2017)

Cover Page
Articles
Analysis of nonsurgical postoperative ventral hernia predictors
Lebedev S.N., Fedoseev A.V., Inyutin A.S., Muraviyev S.Y.
Abstract

Aim. The aim of this study was to detect the predictors of the postoperative herniation in midline laparotomy as the most frequent type of approach in urgent surgery. The study included retro-and-prospective analysis of 398 case histories. Analysis was performed according to 45 signs.

Materials and methods. The following parameters were taken into account: Kettle index, anterior abdominal wall status, presence of the signs of undifferentiated connective tissue dysplasia, hard physical labour, use of bandage in the postoperative period as well as blood erythrocyte and hemoglobin indices, bilirubin and creatinine levels. Separately, the following parameters were assessed: presence of aponeurosis defects (physically and by US data) and presence of hernia outpouching.

Results. According to the obtained data, the indications to preventive endoprosthetic replacement of the anterior abdominal wall were formed.

Conclusions. Combination of some factors, not connected with surgical treatment, raises the risk for herniation, being the indication to preventive endoprosthesis replacement of the abdominal wall.

Perm Medical Journal. 2017;34(6):5-11
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Surgical tactics in iatrogenic damages of esophagus caused by treatment and diagnostic interventions
Plaksin S.A., Kotelnikova L.P., Sablin E.E.
Abstract

Aim. To analyze the causes of iatrogenic damages of esophagus, estimate the surgical tactics depending on the type and localization of perforation and terms of hospitalization.

Materials and methods. Medical documentation of 89 patients with esophageal damages of various etiology was analyzed. Iatrogenic damages of esophagus were diagnosed in 37 (41,6%) patients.

Results. The most frequent cause of esophageal perforation during treatment and diagnostic manipulations was gullet bougienage for cicatrical strictures and cardiospasm. This diagnosis was based on pains, occurring after treatment and diagnostic manipulations, which critically increased after taking liquid or food, appearance of soft tissue emphyzema of the neck and mediastinal emphysema. Presence of contrast substance leakage in roentgenoscopy permitted to determine the localization and size of esophageal defect. During the recent years, in case of diagnostic difficulties or late admission to hospital, computed tomography was used. The terms of starting treatment and complications developed substantially determined its volume and surgical tactics. Accordingly, different medical techniques were undertaken.

Conclusions. Along with traditional interventions, stenting, clipping of esophageal wounds and vacuum therapy can be used to treat iatrogenic damages, indications to which need further study.

Perm Medical Journal. 2017;34(6):12-16
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Peculiar features of structural and functional indices of cardiovascular system in young men with arterial hypertension associated with metabolic syndrome
Rizvanova R.T., Maksimov N.I.
Abstract

Aim. To carry out dynamic assessment of the structural and functional indices of cardiovascular system in young men with arterial hypertension (AH) associated with excess body mass (Ebm) against the background of therapy.

Materials and methods. Examination of 86 young men aged 18-27 years, including the group of comparison with practically healthy persons ( n = 24) and the group of observation ( n = 62) was performed. The group of observation joined patients with AH without EBM and AH+EBM. The study was conducted initially and 6 months later. Patients with AH+EBM ( n = 25) were divided into 2 subgroups: group 1 (12 persons) without therapy and group 2 (13 persons) against the background of antihypertensive therapy.

Results. Six months later, in group 1 there was observed a growth of “office” systolic arterial pressure (SAP) by 3,8 % (145,0 ± 2,88 and 150,54 ± 2,99 Hg mm), p = 0,001, but in the group with antihypertensive therapy, SAP decreased by 12,7 % (145,75 ± 2,80 and 129,33 ± 1,5 Hg mm), p = 0,01 and DAP - by 12,1 % (86,5 ± 1,95 and 77,16 ± 2,41 Hg mm), p = 0,02. Pulse wave propagation velocity (PWPV) along the vessels of muscular and elastic types among patients without therapy was found to grow in dynamics by 12,2 and 16,2 %, respectively. Against the background of therapy, there was a tendency to a reliable reduction in PWPV indices.

Conclusions. Antihypertensive therapy in patients with AH+EBM, while decreasing AP, leads to reduction of LVMM, LVMMI, PWPV and IMCV. The early diagnosed lesion of target organs among young men with AH+EBM and timely antihypertensive therapy can improve structural and functional characteristics of cardiovascular complications.

Perm Medical Journal. 2017;34(6):17-21
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Antioxidant status of patients with atherothrombotic variant of ischemic stroke
Shestakov V.V., Selezneva S.I., Sosnin D.Y.
Abstract

Aim. To study the dependence of antioxidant status (AOS) on the age, sex, localization and size of the damage focus in patients during the most acute period of the development of atherothrombotic variant of ischemic stroke.

Materials and methods. Seventy four patients (main group) in the most acute period of atherothrombotic variant of ischemic stroke were examined. The group of comparison, comparable by age and sex, included 15 healthy persons. The total blood serum antioxidant status was investigated using an assay kit of “Vector-Best” Company B-7501 (“Vector-Best”, Russia).

Results. AOS value in the comparison group was 1,69 ± 0,17 mmol/l (median 1,72; interquartile range 1,53-1,83 mmol/l) that corresponded to the standard interval, indicated in the assay kit guidelines (1,3-1,8 mmol/l). OAS did not differ in men and women (criterion U = 26,0; p = 0,816). In patients of the main group, AOS was reduced ( p = 0,000034); AOS value was 1,14 ± 0,4 mmol/l (median 1,12 mmol/l, interquartile range 0,81-1,45 mmol/l). Age, sex and localization of stroke focus did not reliably influence the degree of AOS fall. Moderate reverse correlation between the focal sizes and decreased AOS value was established. Spearman’s rank correlation coefficient was -0,79 ( p < 0,001).

Conclusions. Decrease in AOS during the most acute period of developing atherothrombotic stroke does not depend on sex, age, ischemic focus localization, but it depends on sizes of the focus, subjected to ischemization.

Perm Medical Journal. 2017;34(6):22-28
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Peculiar features of brahiocephalic arteries remodeling in patients with instable angina
Khovayeva Y.B., Golovskoy B.V., Gerasimova A.V., Ermachkova L.V.
Abstract

Aim. To characterize the remodeling of brachiocephalic arteries in patients with instable angina, taking into account morphological type.

Materials and methods. Duplex scanning of brachiocephalic arteries was performed in 66 patients with instable angina and 59 practically healthy persons, comparable by sex and age.

Results. It was established that in patients with instable angina remodeling of the vessels of brachiocephalic region occurs earlier, than in healthy persons, and diameter of the vessels of elastic type is changed to a greater degree. Remodeling of diameters is associated with the elevation of pumping ability of the heart. IMC of the vessels of combined and muscular types of brachiocephalic region in patients is essentially larger already by the age of 40 and grows with age.

Conclusions. Hardness of the wall of brachiocephalic arteries of all types is higher in patients, than in healthy persons and grows with aging, with increase in pulse and systolic pressure, dyslipidemia.

Perm Medical Journal. 2017;34(6):29-33
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Anxious-depressive symptomatology and brain-derived neurotrophic factor level in patients with tension headache
Tyan K.V., Kalinsky P.P., Rakitova A.V.
Abstract

Aim. To study the correlation between the blood serum brain-derived neurotrophic factor (BDNF) level and the manifestation of anxious-depressive symptomatology in patients with tension headache.

Materials and methods. The study involved 82 patients with tension headache. The method of immune-enzyme assay with test-system ELISA kit was used to measure the blood serum BDNF concentration.

Results. The BDNF level in patients with episodic infrequent and frequent tension headaches was comparable with the group of control. Among patients with chronic tension headache, decrease in BDNF level as compared to group 1, group 2 and the control was revealed. The BDNF level is changed, depending on the duration and intensiveness of tension headache.

Conclusions. Chronic tension headache causes exhaustion of not only mediator, but of neurotrophic systems of the brain as well. Blood serum BDNF concentration measured permits to assess activity of cerebral neuroplastic processes and to choose neurotrophic therapy for a more rapid triggering of serotoninergic system and arresting of anxious-depressive syndrome.

Perm Medical Journal. 2017;34(6):34-39
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POSSIBILITIES OF USING MELD SCALE FOR DETERMINING HEPATIC CIRRHOSIS DEGREE OF SEVERITY
Paducheva S.V., Bulatova I.A., Schekotova A.P., Tretyakova Y.I., Schekotova I.V.
Abstract

Aim. To study the possibility of using MELD scale for determining the degree of severity of hepatic cirrhosis (HC) and determine its diagnostic characteristics.

Materials and methods. Thirty patients with HC, including 15 patients with compensated HC stage (class A+B) by Child-Pugh scale and 15 persons with decompensated HC (class C), were examined. Total blood bilirubin and creatinine concentrations were assessed, INR and MELD index were calculated.

Results. Meld index with use of total bilirubin, creatinine indices and INR is increasing as HC is progressing from 5 at the compensated stage to 26 at the decompensated stage ( p < 0,001) and directly correlates with the degree of severity of cirrhosis, estimated by Child-Pugh scale ( r = 0,64; p = 0,005). The threshold value of MELD index to differentiate the compensated HC stage from the decompensated one was 11.

Conclusions. Design parameter of MELD permits to differentiate the degrees of HC severity with sensitivity equal to 73,3 % and specificity - 84,6 %. When MELD index is less than or equal to 11, the compensated stage of HC is diagnosed, when it exceeds 11, the decompensated cirrhosis is specified.

Perm Medical Journal. 2017;34(6):40-44
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Opportunities of ultrasound investigation and z.m. sigal transillumination pulsooptometry in differential diagnosis of mammary neoplasms
Sigal Z.M., Surnina O.V.
Abstract

Aim. To assess the opportunities and advantages of the method of transillumination pulsooptometry and ultrasound visualization in differential diagnosis of benign and malignant mammary neoplasms.

Materials and methods. The study material of 532 persons aged 30-50 years was analyzed. All patients underwent ultrasound diagnosis of the mammary gland, pulsooptometry according to Z.M. Sigal (1981), computed and magnetic resonance imaging, ductography, mammography. To varify the nature of growth, biopsy material was subjected to histological analysis.

Results. Out of 532 patients examined, mammary cancer was revealed in 130 women, non-cancerous neoplasms of various etiology - in 402.

Conclusions. In spite of all achievements in modern medicine and development of new diagnostic and treatment methods, US combined with transillumination pulsooptometry is most available and reliable.

Perm Medical Journal. 2017;34(6):45-51
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Response of peripheral blood flow on apnea in young women with idiopathic arterial hypotension
Agafonova T.Y., Baev V.M., Samsonova O.A., Dusakova R.S.
Abstract

Aim. To study the response of peripheral vessels hemodynamics to apnea in young women with idiopathic arterial hypotension.

Materials and methods. Comparative analysis of the results of ultrasonic scanning of peripheral arteries and veins using apnea test between 19 women with idiopathic arterial hypotension - SAP 98 (92-98) mm Hg and 11 women with normal arterial pressure - SAP 124 (121-126) mm Hg was carried out. Women’s age in both groups was 18-25 years. Arterial pressure and peripheral oxygen saturation were measured. Angioscanning in lying position and at rest as well as angioscanning prior to and 20 seconds after breath-holding was fulfilled. Diameter and blood velocity were estimated in the brachial, radial and posterior tibial arteries and veins.

Results. Apnea in young hypotensive women was found to induce increase in the diameter of a larger number of arteries than in the control group and fall in arterial blood velocity with the absence of venous blood velocity dynamics.

Conclusions. The abovementioned changes in the peripheral blood flow among women with hypotension are to be considered as manifestation of deadaptation, expressed by extreme endothelium-dependent dilatation of resistive vessels and inhibition of vasotonic response, probably, associated with excessive nitric oxide endothelial production.

Perm Medical Journal. 2017;34(6):52-58
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Structure of reproductive losses
Olina A.A., Sadykova G.K., Galinova I.V.
Abstract

Aim. To assess the dynamics of reproductive losses in Perm during the period of 2006 to 2016.

Materials and methods. The following statistical forms were analyzed: 13 “Data on abortion”; 32 “Data on medical care rendered to pregnant, parturient women and puerperas”; 14 “Data on hospital activity” in Perm over the period from 2006 to 2016, taking into account changes in live birth criteria, registered in 2012.

Results. Decrease in reproductive losses is an important reserve for improving demographic situation. Reproductive losses are the losses of conception product at all the stages of fetus development, caused by spontaneous and stimulated abortion, dead birth as well as death of first-year of life children. For the analyzed period, increase in the number of labors by 8 times and reduction in the number of medical abortions (losses - 71 %) was noted. In the structure of pregnancies with abortive outcome, the share of extrauterine pregnancy remains at the same level. A threefold decrease in dead births is observed.

Conclusions. Reproductive losses in Perm are the following: I place - early miscarriage; II - extrauterine pregnancy; III - late miscarriage; IV - mortinatality. The place, occupied by the losses of desired pregnancies, becomes more and more significant. That is why we need to accentuate specialists’ attention on the problems of family planning, pregravid preparation and management of pregnancy at early terms.

Perm Medical Journal. 2017;34(6):59-66
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Childhood ophthalmologic traumatism in perm krai
Gavrilova T.V., Chereshneva M.V., Orlova N.A.
Abstract

Aim. To analyze severe traumatic injuries of visual organs in children of Perm Krai.

Materials and methods. Retrospective analysis was fulfilled according to the data of case registers of emergency ophthalmologic stations of Perm Regional Clinical Hospital and “City Clinical Hospital № 2 named after F.Kh. Gral” as well as case histories of children with visual organs injuries hospitalized to ophthalmological units of the same institutions for 2 years (2014-2015).

Results. During 2 years, 39 801 persons, including 4078 (10,2 %) children, addressed to two emergency ophthalmological stations in connection with visual organs injuries; 41 children were hospitalized: 30 (73 %) boys and 11 (27 %) girls aged 1-17 years. Most children had eye injuries, received at home - 23 persons (56,1 %), in the street - 17 (41,5 %), at school (manual training) - 1. Injured visual organ - 43 eyes: wounds - 31 (72 %) eyes, contusions - 8 (19 %), burns - 4 (9 %).

Conclusions. Injuries of visual organs, which require hospitalization to specialized units and rendering emergency surgical and conservative care, are registered in children of Perm Krai. A part of injured patients after hospital treatment preserved low visual acuity or had no object vision. Thus, it is necessary to take active measures for prevention of eye injuries and their consequences.

Perm Medical Journal. 2017;34(6):67-71
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Role of emotional disorders in strategy of static equilibrium among patients of old age
Sosnitskay D.M., Baidina T.V., Danilova M.A.
Abstract

Aim. To detect the mechanisms of maintaining static equilibrium in old patients with complaints for vertigo, depending on disorders in emotional sphere.

Materials and methods. Eighty two patients of old age (75-89) with complaints for vertigo were examined. On the basis of clinical data and results of psychometric testing, 2 groups of patients were formed: patients with emotional disorders and those free of them. Functional stabilometric study (open eyes test, Romberg test, optokinetic test) in European standard was performed using stabilometer (MBN-Biomechanics Company).

Results. Disturbances of static equilibrium among old patients with emotional disorders are reflected in changed stabilometric parameters of functional tests and are represented by instablity of low-variable parameter - center-of-pressure displacement velocity, improvement of parameters in repeated studies with short exposition and in complicated functional tests.

Conclusions. Emotional disorders influence the strategy of maintaining static equilibrium in patients of old age. It effects postural activity and can be measured quantitatively using computer stabilometry. Functional character of ataxia in patients with emotional disorders is manifested by variability of stabilometric parameters and improvement of parameters, as functional tests are complicated. The most sensible is the parameter of center-of-pressure displacement velocity.

Perm Medical Journal. 2017;34(6):72-80
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Influence of benzimidazole derivatives on formation of oxidative stress under physical load
Kataev A.V.
Abstract

Aim. To study the influence of benzimidazole derivatives on the formation of oxidative stress under the impact of physical load.

Materials and methods. Physical load (PL) was induced on intact outbred male rats by daily swimming for 21 days. Physical load, induced by swimming, is a convenient model of muscular work and it can be dosed. It, as a forced for rats procedure, caused stress, the development of which was controlled by changes in adrenal mass indices and blood leucocyte number in the animals.

Results. The impaired behavioral reactions, decreased antioxidant activity in the liver and brain homogenates, elevated peroxidation product content, raised hemiluminescence intensity was detected.

Conclusions. Negative manifestations of the developed psychoemotional and oxidative stress were restrained by the introduction of dibazol and synthesized potassium salt 2-[1-(1,1-dioxothietanyl-3)benzimidazolyl-2-thio] acetic acid.

Perm Medical Journal. 2017;34(6):81-86
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Role of cerebellum in formation of postural and cognitive functions: clinical example with schmahmann syndrome
Akhmadeeva L.R., Kharisova E.M., Derevyanko K.P.
Abstract

The data on the etiology and pathogenesis of cerebellar cognitive affective syndrome (CCAS) as well as clinical observations are presented in the paper. Schmahmann J.D. and Sherman J.C. described the spectrum of behavioral and cognitive disorders, which are the results of cerebellum stroke and are called CCAS. This syndrome includes disturbances of executive functions and is characterized by perseverations, absent-mindedness or disatractibility, visual-spatial disorders, speech production difficulties and personality changes. The authors considered the historical description of this syndrome, its etiology, pathogenesis and presented their own clinical observation of CCAS in a 70-year-old woman.

Perm Medical Journal. 2017;34(6):87-91
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Chronic uterine inflammation: some pathogenetic aspects
Kobaidze E.G.
Abstract

Currently, molecular-genetic studies attract attention of many scientists; there are contradictory and ambiguous data on some genes and their role in chronic inflammations of pelviс organs. Some immunogenetic aspects of pathogenesis of chronic endometritis are presented in this review; the role of mutual effect of gene dysregulation and immune system is indicated, the data on possible link between functional endometrium status and pathological polymorphism of some genes are cited.

Perm Medical Journal. 2017;34(6):92-100
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Chronic duodenal patency abnormalities: modern view on the problem
Studenikin L.V.
Abstract

The review of native and foreign special literature on chronic duodenal patency abnormalities is presented; their association with cholelithiasis is indicated. Variants of surgical correction of motor duodenal pathology are assessed. The published results confirm perspective value of the development of the methods of low-invasive simultaneous laparoscopic treatment of chronic duodenal patency abnormalities in patients with chronic calculous cholecystitis.

Perm Medical Journal. 2017;34(6):101-109
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Anxiety and depressive symptoms and level of Brain Derived Neurotrophic factor in patient with tension-type headache
Tian K., Kalinsky P., Rakitova A.
Abstract

Purpose. Studying of correlation of Brain-Derived Neurotrophic Factor (BDNF) level in blood serum and expressiveness of anxiety and depressive symptoms in patients with tension-type headache.

Materials and methods. The research has included 82 patients with tension-type headache. For measurement of BDNF concentration in serum used a method of the enzyme immunodetection - the ELISA Kit test system.

Results. The BDNF level at patients with incidental infrequent and frequent TTH was comparable to group of control. The BDNF level at a chronic tension-type headache was decreased in comparison with the 1st, 2nd group and group of control The BDNF level changes depending on duration and intensity of tension-type headache. 

Conclusions. There is exhaustion not only the mediator, but also neurotrophic systems of a brain at a chronic tension-type headache. Measurement of BDNF concentration in serum will allow to estimate activity of cerebral neuroplasticity processes and to pick up neurotrophic therapy for faster start of serotonin system and knocking over of anxiety and depressive syndrome.

Perm Medical Journal. 2017;34(6):
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Peculiarities of structural-functional parameters of cardiovascular system in young men with arterial hypertension in combination with overweight
Rizvanova R., Maximov N.
Abstract

Aim. To evaluate the dynamics of structural-functional parameters of cardiovascular system in young men with arterial hypertension (AH) in combination with overweight (BMI) during therapy.

Materials and methods. The study included 86 young men 18-27 years old, from which the comparison group included practically healthy (n=24), and the observation group (n=62). The monitoring group comprised patients with hypertension without BMI and hypertension+BMI. The study was conducted at baseline and after 6 months. Patients with hypertension+BMI (n=25) were distributed into 2 groups: 1 gr.(12 people) without therapy and 2 gr.(13чел.) on the background of antihypertensive therapy.

Results. After 6 months in 1st gr. marked increase in office systolic blood pressure by 3.8% (145±2,88 and 150,54±2,99 mmrt.St.), p=0.001 and in the group where received antihypertensive therapy experienced a decline in GARDEN at 12.7% (145,75±2,80 and 129,33±1,5 mmrt.St.), p=0.01; DBP decrease by 12.1% (86,5±1.95 and 77,16±2,41 mmrt.St.), p=0.02. PWV in the muscular and elastic vessels types in patients without treatment in the dynamics was observed an increase of 12.2% and 16.2% respectively. During therapy there was a trend of the reliable decrease of PWV.

Conclusions. Antihypertensive therapy in patients AG+BMI, lowering of blood pressure leads to a decrease in LVM, lvmwi, PWV and VCIM. Early detection of damage to target organs from young patients with hypertension+BMI and timely antihypertensive therapy can improve the structural and functional characteristics of cardiovascular complications.

Perm Medical Journal. 2017;34(6):
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Peculiarities of structural-functional parameters of cardiovascular system in young men with arterial hypertension in combination with overweight
Rizvanova R., Maximov N.
Abstract

Aim to evaluate structural and functional performance of the cardiovascular system in young men with arterial hypertension (AH) combined with excessive body mass (BMI) in the dynamics.

Materials and methods. The study included 86 young men 18-27 years old, from which the comparison group included practically healthy (n=24), and the observation group (n=62). The monitoring group comprised patients with hypertension without BMI and hypertension+BMI. The study was conducted at baseline and after 6 months. Patients with hypertension+BMI (n=25) were distributed into 2 groups: 1 gr.(12 people) without therapy and 2 gr.(13чел.) on the background of antihypertensive therapy.

Results. After 6 months in 1st gr. marked increase in office systolic blood pressure by 3.8% (145±2,88 and 150,54±2,99 mmrt.St.), p=0.001 and in the group where received antihypertensive therapy experienced a decline in GARDEN at 12.7% (145,75±2,80 and 129,33±1,5 mmrt.St.), p=0.01; DBP decrease by 12.1% (86,5±1.95 and 77,16±2,41 mmrt.St.), p=0.02. PWV in the muscular and elastic vessels types in patients without treatment in the dynamics was observed an increase of 12.2% and 16.2% respectively. During therapy there was a trend of the reliable decrease of PWV.

Conclusions. Antihypertensive therapy in patients AG+BMI, lowering of blood pressure leads to a decrease in LVM, lvmwi, PWV and VCIM. Early detection of damage to target organs from young patients with hypertension+BMI and timely antihypertensive therapy can improve the structural and functional characteristics of cardiovascular complications.

Perm Medical Journal. 2017;34(6):
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Peculiarities of structural-functional parameters of cardiovascular system in young men with arterial hypertension in combination with overweight
Ризванова Р., Максимов Н.
Abstract

Aim to evaluate structural and functional performance of the cardiovascular system in young men with arterial hypertension in combination with excess body weight in the dynamics.

Materials and methods. The study included 86 young men aged 18-27 years, from which the comparison group included practically healthy (n=24), and the observation group (n=62). The latter were distributed into 2 groups: patients with arterial hypertension (AH) no excessive body mass (BMI) and hypertension+BMI. The next stage of the research was conducted in the dynamics after 6 months, which was attended by 35 people. Patients with hypertension+BMI (n=25) were distributed into 2 groups: 1 gr. (12 people) without therapy and 2 gr. (13чел.) on the background of antihypertensive therapy.

 

Results. According to the results of re-examination in the 1st group, the marked increase in office systolic blood pressure by 3.8% ( 145±2,88 and 150,54±2,99 mmrt.st.), p=0.001 and in the group where received antihypertensive therapy experienced a decline in GARDEN at 12.7% ( 145,75±2,80 and 129,33±1,5 mmrt.st.), p=0.01; DBP decrease by 12.1% (86,5±1.95 and 77,16±2,41 mmrt.st.), p=0.02. Index Sokolov – Lyon ECG decreased in patients receiving antihypertensive therapy was 29.3%. When comparing indicators ECHO KG: the 1st group – TSKJ increased by 7.2%, during therapy, the decrease was 3.3 %. LVM in the 2nd group decreased by 5.2 percent. Indicators VCIM on standard plots were comparable. PWV in the muscular and elastic vessels type patients without treatment in the dynamics was observed an increase of 12.2% and 16.2% respectively. In patients on a background therapy there was a trend of the reliable decrease of PWV.

Conclusions. Antihypertensive therapy in patients AG+BMI lowering of blood pressure leads to a decrease in LVM, lvmwi, PWV and VCIM. Early detection of damage to target organs from young patients with arterial hypertension in combination with BMI and timely antihypertensive therapy can improve the structural and functional characteristics of cardiovascular complications.

Perm Medical Journal. 2017;34(6):
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The structure of reprodactive loses
Olina A., Sadykova G., Galinova I.
Abstract

Relevance: Reducing reproductive losses is an important reserve for improving the demographic situation. Reproductive losses – the loss of products of conception in all stages of development of the fetus by spontaneous and forced abortion, stillbirths and death of babies in their first year of life.

Objective: to assess the dynamics of reproductive losses in Perm from 2006 to 2016.

Materials and methods: the analysis of statistical forms: 13 "Information about the termination of pregnancy"; 32 "Information about medical care for pregnant women, women in labor and childbirth"; 14 "Information about the activities of the hospital" in Perm for the period from 2006 to 2016 was carried out including changes in criteria of live birth in 2012.

Results: During the analyzed period there was an increase in births in 8 times and reducing the number of medical abortions (decrease 71%). In the structure of the pregnancies with abortive outcome, the proportion of miscarriage has increased in 8 times, the proportion of ectopic pregnancy remains at the same level. A decrease in the stillbirth rate is in 3 times.

Conclusions: Reproductive losses in Perm are performed: the first place – the miscarriage in early terms; the second place – the ectopic pregnancy; the third place – the miscarriage in the later stages; the forth place - stillbirths. The loss of desired pregnancies is taking more place, so we consider that it appropriate to focus the attention of specialists on the issues of family planning, pregravid preparation and maintenance of pregnancy in the early stages.

Perm Medical Journal. 2017;34(6):
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POSSIBILITIES OF ULTRASOUND INVESTIGATION AND TRANSILLYUMINATSIONNA PULSOOPTOMETRII ACCORDING TO Z.M. SIGAL IN DIFFERENTIAL DIAGNOSTICS OF NEW GROWTHS OF MAMMARY GLANDS
Sigal Z.M., Surnina O.V.
Abstract

Aim. To estimate an opportunity and advantages of a method of a transillyuminatsionny pulsooptometriya and ultrasound in differential diagnostics of benign formations and malignant neoplasm  of a mammary gland.

Materials and methods. Research of 532 people aged 30 to 50 years. To all patients carried out ultrasound of a mammary gland. Scanning was carried out by the linear sensor 5-7 Mhz. Estimated echogenicity, structure, the sizes and vascularization of educations with measurement of high-speed indexes, indexes of peripheral resistance and the pulsation index. Measurements of hemodynamics and optical density were carried out using the device and the method of Z.M. Sigal. Carried out a computer tomography,  magnetic resonance tomography, a ductography, a mammography. For verification of the nature of education carried out the histologic analysis of the bioptat received at a puncture of mammary glands and during operation. Analyzed structure of tissue, existence of various pathological inclusions, their quantity and the sizes.

Results. Despite all achievements in the modern medicine and creation of new methods of diagnostics and treatment, ultrasound in combination with transillyuminatsionny pulsooptometriya is the most available and reliable.

Conclusions. 1. At ultrasound fibroadenomas of education had mainly ovoidny form (85%), with the lowered echogenicity (87%), the homogeneous structure and smooth, legible contours. A cyst in turn in  99% of a round form, anekhogenny, the homogeneous structure and with smooth contours, at 80% located on the course of ductus lactiferi. By means of ultrasound on our way allows to carry out noninvasively and efficiently a puncture biopsy.

  1. Reliable specific indexes by means of a translyuminatsionny pulsooptometriya according to Z.M. Segal of volume formations of mammary glands of an optical density and APO are established. In a cyst of APO there was the least 8,0±0,5 mm, at the same time an optical density - less than 0,08. At a fibroadenoma of APO was the greatest 17,33±3,38 mm, and an optical density - 0,3±0,15. At a malignant neoplasm - an optical density 0,5±0,12.
Perm Medical Journal. 2017;34(6):
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The structure of reprodactive loses
Olina A., Sadykova G., Galinova I.
Abstract

Relevance: Reducing reproductive losses is an important reserve for improving the demographic situation. Reproductive losses – the loss of products of conception in all stages of development of the fetus by spontaneous and forced abortion, stillbirths and death of babies in their first year of life.

Objective: to assess the dynamics of reproductive losses in Perm from 2006 to 2016.

Materials and methods: the analysis of statistical forms: 13 "Information about the termination of pregnancy"; 32 "Information about medical care for pregnant women, women in labor and childbirth"; 14 "Information about the activities of the hospital" in Perm for the period from 2006 to 2016 was carried out including changes in criteria of live birth in 2012.

Results: During the analyzed period there was an increase in births in 8 times and reducing the number of medical abortions (decrease 71%). In the structure of the pregnancies with abortive outcome, the proportion of miscarriage has increased in 8 times, the proportion of ectopic pregnancy remains at the same level. A decrease in the stillbirth rate is in 3 times.

Conclusions: Reproductive losses in Perm are performed: the first place – the miscarriage in early terms; the second place – the ectopic pregnancy; the third place – the miscarriage in the later stages; the forth place - stillbirths. The loss of desired pregnancies is taking more place, so we consider that it appropriate to focus the attention of specialists on the issues of family planning, pregravid preparation and maintenance of pregnancy in the early stages.

Perm Medical Journal. 2017;34(6):
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Surgical tactics of iatrogenic esophageal injuries caused by medical and diagnostic interventions
Kotelnikova L., Plaksin S., Sablin E.
Abstract

The aim of this study was to investigate reasons for iatrogenic esophagus injuries caused by medical and diagnostic interventions and to estimate the results of the treatment depending on their type, localization and the time interval from trauma.

Material and method. During last 30 years 90 patients with traumatic injuries of the esophagus were treated, among them - 36 with iatrogenic esophagus injuries due to medical and diagnostic interventions (40%). Most cases were from perforation after boogie of stricture (25) and cardiospasm (2), others - from stenting (6), upper endoscopy (3) and gastric probe (1).

Results. Conservative treatment was successful in two cases with blunt injury not longer than 2,5sm. Esophageal stenting was made in 3 cases. The attempt of clipping the esophageal defect was unsuccessful twice. The vacuum system was installed in one case. Esophageal trauma patients were more likely to require surgery (32, 86,7%) Ten patients underwent suturing of the wound. In the case of perforation the esophagus, narrowed due to stricture, the subtotal resection with gastroplasty through posterior mediastinum was made (7). At late receipt of 9 patients with purulent complications the treatment was limited to drainage of the mediastinum. Complications have developed in 8 cases: insolvency of sutures (3), esophageal-tracheal fistula (2), arrosive bleeding (2), pancreatonecrosis (1). The mortality was 34,2% (13) because of purulent complications (7), depletion (3) and bleeding (3).

Conclusion. The choice of operation of iatrogenic esophageal injuries depends on type, localization and time interval from trauma. The possibilities of using stenting, clipping and vacuum therapy of esophageal wounds require further research.

Perm Medical Journal. 2017;34(6):
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THE POSSIBILITY OF USING THE MELD SCALE FOR DETERMINING SEVERITY OF LIVER CIRRHOSISTHE
Bulatova I., Paducheva S., Shchekotova A., Shchekotova I.
Abstract

Objective: to Study the possibility of using the MELD scale to determine the severity of CKD and to determine its diagnostic capabilities.
Methods:we Examined 30 patients with CKD, of which 15 patients were compensated stage of CKD (grade a+) Child-Pugh and 15 people with decompensated cirrhosis (class C). In the blood was evaluated the concentration of total bilirubin and creatinine were calculated INR and the MELD index.
Results: the Calculated MELD index using the indicators of total bilirubin, creatinine and INR increased with the progression of CKD 5 in the stage of compensation to 26 in decompensated stage (p<0.001) and directly correlated with the severity of cirrhosis, assessed by Child-Pugh (rs=0,64; p=0.005). The threshold index value of MELD for the differentiation of compensated stage decompensated CPU from equal to 11.
Conclusions:MELD Calculated index allows to differentiate the degree of severity of CKD with a sensitivity of 73.3% and a specificity of 84.6%. When the value of the index, MELD less than or equal to 11 are diagnosed with compensated stage of the CPU, a value of more than 11 sets of decompensated cirrhosis.Ваши исправления помогают повысить качество машинного переводаСообщить об ошибке

Perm Medical Journal. 2017;34(6):
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Original studies
Reaction of peripheral circulation to apnoea in young women with idiopatic arterial hypotency
Agafonova T.Y., Baev V.M., Samsonova O.A., Sharhatullovna R.R.
Abstract

Summary. The aim of the study was to study the response of peripheral vascular hemodynamics to apnea in young women with idiopathic arterial hypotension. Material and methods. A comparative analysis of the results of ultrasound scanning of peripheral arteries and veins was carried out in a trial with apnea between 19 women with idiopathic arterial hypotension - SBP 98 (92-98) mmHg and 11 women with normal arterial pressure - SBP 124 (121-126) mmHg. The age of women in both groups was 18-25 years. Measurement of blood pressure, peripheral oxygen saturation. Angioscanning was performed lying down, at rest, before and after a 20 second respiratory arrest. We studied the diameter, velocity of blood flow in vertebral, humeral, radial and posterior tibial arteries, and veins. Results. Apnea in young women with hypotension causes an increase in the diameter of a larger number of arteries than in the control group. With hypotension, there was a decrease in the rate of blood flow in the arteries in the absence of dynamics of venous blood flow velocity. Conclusions. These changes in peripheral blood flow in arterial hypotension should be considered as a manifestation of disadaptation. Disadaptation is caused by excessive endothelium-dependent dilatation of resistive vessels and oppression of the vasotonic reaction. Disadaptation is associated with excessive production of endothelium nitric oxide. 

Perm Medical Journal. 2017;34(6):
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Review of literature
Duodenal dyskinesia
Studenikin L.
Abstract

Represents an overview of Russian and foreign special literature on chronic duodenal ileus, showed its connection with cholelithiasis. Comparison of surgical correction of motor pathology of the duodenum. Published results point to the development methods of minimally invasive laparoscopic simultaneous treatment of chronic duodenal patency in patients with chronic calculous cholecystitis.

Perm Medical Journal. 2017;34(6):
views
Modern look to duodenal dyskinesia.
Studenikin L.
Abstract

Represents an overview of Russian and foreign special literature on chronic duodenal ileus, showed its connection with cholelithiasis. Comparison of surgical correction of motor pathology of the duodenum. Published results point to the development methods of minimally invasive laparoscopic simultaneous treatment of chronic duodenal patency in patients with chronic calculous cholecystitis.

Perm Medical Journal. 2017;34(6):
views

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