Vol 36, No 1 (2019)

Cover Page
Clinical studies
“Step-by-Step” technology as minimally invasive ambulatory method of treating chronic hemorrhoid
Krochek I.V., Sergiyko S.V., Anchugova A.E.

Abstract

Aim. To carry out the comparative analysis of the results of ambulatory treatment of patients with chronic hemorrhoid using “Step-by-Step” technology and surgeries in hospital conditions.

Materials and methods. The results of treatment were analyzed in 4 representative groups: 31 patients of the main group underwent a staged “Step-by-Step” hemorrhoidectomy in ambulatory conditions, 29 patients of the first group of comparison – Longo operation, 32 patients of the second group of comparison – laser hemorrhoidectomy, 29 patients of the third group of comparison – Milligan-Morgan operation.

Results. In the main group, the rate of complications was noted in 1.4 %, after Longo operation – 9.8 %, after laser hemorrhoidectomy – 6.6 %, after Milligan-Morgan – 11.2 %. Relapse of disease was registered in 0.6 % of patients of the main group, 6.1 % – first group of comparison, 3.8 % – second group and 3.5 % – third groups.

Conclusions. The best treatment results were obtained in patients after using the technology “Step-by-Step” at the expense of a minimum rate of complications and less number of relapses that permits to recommend this technique for a wide clinical application.

Perm Medical Journal. 2019;36(1):6-13
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Regarding operative treatment of thoracoabdominal injuries
Amarantov D.G., Zarivchatsky M.F., Kholodar A.A., Nagaev A.S., Gudkov O.S.

Abstract

Aim. To improve the results of treatment in patients with thoracoabdominal injuries (TAI) by means of creating the method of determining indications for the use of classical or endoscopic surgeries in respect of this pathology.

Materials and methods. Seventy-six sufferers from TAI were divided into 2 groups.

Results. The method of successive determination of indications for the use of classical or endoscopic surgeries in patients with TAI was created on the basis of treatment of 41 (53.95 %) patients of group II. This method was used to treat 35 (46.05 %) patients of group I.

Conclusions. Rational approach to the choice between the use of advantages of classical and endoscopic surgeries depending on characteristics of clinical situation permitted to elevate the quality of treatment in patients with TAI.

Perm Medical Journal. 2019;36(1):14-20
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Peculiar features of pregnancy and labor course in patients with different classes of obesity
Alieva F.K.

Abstract

Aim. To study the course and outcomes of pregnancy and labor in women with obesity.

Materials and methods. The results of retrospective study of 110 medical cards of pregnant women and their labor anamnesis are presented in the work. Peculiar features of pregnancy and labor course in patients depending on the class of obesity were studied. Digital material was processed using the program “Microsoft Excel” (data analysis package), Biostat. To determine the normality of distribution, Shapiro-Wilk criterion was used, followed by calculation of Fisher’s exact criterion. Odds ratio with CI 95 % was evaluated.

Results. It was revealed that irrespective of excess body mass value, pregnancy and labor in women with obesity are accompanied by complications. At the early stages of gestation, all women with obesity have a high rate of a threat of miscarriage, anemia, at the late stages – a threat of hypertensive disorders, anemia and impaired carbohydrate metabolism. The greatest incidence of Cesarean section was detected in women with class 3 obesity – 87 % versus 54 % and 43 % with class 1 and 2 obesity, respectively.

Conclusions. Obesity during pregnancy is an actual problem owing to elevated risk of the development of unfavorable outcomes for a mother and a fetus.

Perm Medical Journal. 2019;36(1):21-26
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Coinfection of gastric mucosa with Helicobacter Pylori and Epstein-Barr virus as a factor of ineffectiveness of antihelicobacter chronic gastritis therapy in adolescents
Akkuratova I.S., Spivak E.M., Manyakina O.M.

Abstract

Aim. To assess the character of bacterial-viral infection of the gastric mucosa and dynamics of inflammatory process in adolescents with chronic gastritis in case of antihelicobacter therapy failure.

Materials and methods. Seventy two adolescents with chronic gastritis aged 11–18 years (mean age 13.8 ± 0.4) were examined prior to and after antihelicobacter therapy.

Results. It was established that after treatment against the background of regression of clinical symptoms, in most patients no positive dynamics of process manifestation or its progression was noted both in the body and antral part of the stomach.

Conclusions. In the absolute majority of adolescents with the absence of Hp eradication (78.7 %) there was observed colonization with positive Hp strains and persistence of Epstein-Barr virus (68.1 %). It allows considering patients with such co-infection as a risk group for the absence of Hp eradication.

Perm Medical Journal. 2019;36(1):27-30
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Surgical tactics for elderly patients with deforming arthrosis of first metatarsophalangeal joint of foot
Tokarev A.E., Kozyukov V.G., Schekolova N.B., Nenakhova Y.V.

Abstract

Aim. To analyze the results of various types of surgical interventions, used in elderly patients with deforming arthrosis of the first metatarsophalangeal joint of the foot.

Materials and methods. The long-term results of treatment of osteoarthrosis of the first metatarsophalangeal joint of the foot were analyzed in 70 elderly persons depending on the stage of disease. Clinical, roentgenological investigation, biomechanical and statistical methods were used for diagnosis and treatment. Results. Surgical tactics of treatment for elderly patients depending on the stage of disease was developed, outcomes of surgical treatment were followed up in 55 patients. Good results were reached in 47 (85.4 %) patients, satisfactory – in 8 (15.6 %) patients, no unsatisfactory results were noted.

Conclusions. Differentiated approach to treatment depends on the choice of optimal method in each concrete case taking into account the stage of disease, character of deformity; early complex postoperative rehabilitation permits to obtain favorable cosmetic and functional outcome, improve patients’ quality of life.

Perm Medical Journal. 2019;36(1):31-34
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Methods of diagnosis and technologies
Updating of methodical approaches to noninvasive sampling of pulmonary surfactant biosamples
Shmyrova A.I., Pshenichnikova-Peleneva I.M., Kononova L.I., Korobov V.P.

Abstract

Aim. To study the influence of conditions of sampling and storage of pulmonary surfactant (PS) biosamples in the exhaled air barbotate on its surface activity and biochemical structure, so as to develop clinical recommendations for PS status assessment.

Materials and methods. Tensiometry methods were used to study the glass, fluoroplastic and five polymer containers. Reproducibility of the results of physicochemical parameters of native material was assessed using thin-layer chromatography. Calibration of methods and scaling was implemented using exogenous surfactant solution.

Results. It was detected that for identification of phosphatidylcholine in the samples, it is necessary to introduce not less than 0.15 mcg of exogenous surfactant and for dipalmitoylphosphatidylcholine – from 0.5 mcg and more. The efficiency of PS sampling with the method of exhaled air barbotage varies from 30 % to 50 % from the volume of surfactant, excreted with one average statistical human expiration.

Conclusions. Sampling of native material using the method of exhaled air barbotage was performed. Tensiometric and chromatographic scales were compiled. Variability of sampling degree was noted. It was shown that if the conditions of storage and transport are observed, there are no marked changes in the material.

Perm Medical Journal. 2019;36(1):35-44
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Oncological risks of MTHFR, BRCA1 AND BRCA2 gene mutations in patients with chronic endometritis
Kobaidze E.G.

Abstract

Aim. To assess the oncological risks for the MTHFR, BRCA1 and BRCA2 gene mutation in patients with chronic endometritis.

Materials and methods. Eighty six patients were examined: 33 practically healthy women and 53 patients with chronic endometritis. A part of the DNA of MTHFR (C677T, A1298C), BRCA1 (3361C > T), BRCA2 (Ser455Ser) genes was used as primers, ultrasound investigation of the mammary glands was implemented.

Results. Among patients with chronic endometritis, there was detected a high rate of benign mammary gland dysplasia, chronic pathology of gastrointestinal tract organs.

Conclusions. Patients with chronic endometritis have significant oncological risks, minor MTHFR and BRCA1 gene alleles were revealed in them more often than major ones, that, against the background of raised oncological pathology, acquires special significance.

Perm Medical Journal. 2019;36(1):45-54
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Immunomodulating effect of magnetoinfrared laser therapy in children with chronic pyelonephritis
Illek Y.Y., Vyaznikova M.L., Leushina N.P., Mischenko I.Y., Ryseva L.L., Solovyova G.V., Tarasova E.Y., Suetina I.G., Khlebnikova N.V.

Abstract

Aim. To determine the influence of magnetoinfrared laser therapy on the status of immunological reactivity in children with chronic pyelonephritis (CP).

Materials and methods. One hundred thirty children aged 8 to12 years, suffering from relapsing course of chronic pyelonephritis, were observed. Group 1 (43 patients) received complex conventional therapy, group 2 (27 patients) – complex treatment, associated with magnetoinfrared laser therapy. The blood lymphocyte population and subpopulation, blood serum immunoglobulin and circulating immune complexes content, phagocytosis indices, blood serum cytokine content was studied in children with chronic pyelonephritis at the active stage of disease, at the partial and full clinicolaboratory remission stages.

Results. The CP patients of group 1, who received complex conventional therapy, demonstrated a full, but not long clinicolaboratpory remission with preservation of marked changes in immunological reactivity parameters. In CP patients of group 2, who experienced complex treatment associated with magnetoinfrared laser therapy courses, there occurred full clinicolaboratory remission and normalization of immunological reactivity indices.

Conclusions. The results of clinical observations and special studies demonstrate high clinical, immunomodulating and antirelapsing effects of complex treatment combined with magnetoinfrared laser therapy in children with chronic pyelonephritis.

Perm Medical Journal. 2019;36(1):55-62
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Body fat mass in patients with chronic obstructive pulmonary disease as a risk factor for right ventricular structural-functional changes
Kostareva R.A., Golovskoy B.V., Podyanova A.I., Gerasimova A.V.

Abstract

Aim. To study the correlation between the body fat mass (BFM) and the structural-functional characteristics of right ventricle (RV) in patients with different body mass, suffering from chronic obstructive pulmonary disease (COPD).

Materials and methods. Echocardiography, ultrasound determination of subcutaneous and premesenterial layer thickness, assessment of leptin level was performed in 72 COPD patients, who were divided into three groups: group 1 – patients with normal body mass (n = 31), group 2 – patients with excess weight (n = 21), group 3 – patients with class I-II obesity (n= 20).

Results. Among COPD patients, body mass index (BMI) growth causes increase in BFM and subcutaneous and premesenterial fat thickness, elevation in blood serum leptin level, but decrease in lean body mass (LBM). The global longitudinal systolic strain of the free wall of RV in COPD patients with obesity (–17.39 ± 3.64, p = 0.002) and elevated body mass (–17.96 ± 5.69, p = 0.006) is reduced.

Conclusions. Among COPD patients with different body mass, the global longitudinal systolic strain of RV free wall aggravates as leptin level and body fat mass grow that can be the reflection of mechanical exposure and epicardial fat pressure on the right ventricle.

Perm Medical Journal. 2019;36(1):63-69
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Preventive and social medicine
Duration and tension of postvaccinal pneumococcal immunity in HIV-positive patients
Nikolenko V.V., Feldblyum I.V., Vorobyova N.N., Nikolenko A.V., Sumlivaya O.N., Okishev M.A.

Abstract

Aim. To study the duration and tension of the postvaccinal pneumococcal immunity in HIV-positive patients, immunized with polysaccharide vaccine.

Materials and methods. One hundred HIV-infected patients (age range 20 to 50 years) with stages 3 and 4 A of disease, having the number of CD4+ T-lymphocytes in blood not less than 440 mcl–1, were immunized with polysaccharide 23-valent pneumococcal vaccine.

Results. The maximum effect regarding polysaccharide pneumococcal vaccine immunization of HIV-positive persons was established at the stage 3 of disease. When immunizing HIV-positive patients with stage 4 A and decrease in CD4+- T-lymphocytes to 310 [300; 330] cells per mcl-1, the effect resulting from immunization reduced.

Conclusions. Taking into account the revealed maximum effect of immunization of HIV-positive patients with polysaccharide pneumococcal vaccine at the stage 3 of disease, this risk group should be immunized at the earlier periods of infectious process development. HIV-positive patients with the stage 4 A and decrease in CD4+ – T- blood lymphocytes to 310 [300;330] cells per mcl–1 should receive antiretroviral therapy followed by revaccination.

Perm Medical Journal. 2019;36(1):70-76
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Infant mortality at home in Perm Krai. Main causes and prevention
Kochergina E.A., Trefilov R.N., Blyumberg N.V.

Abstract

Aim. To assess the most frequent causes of infant mortality at home in Perm Krai, to give the main recommendations for its prevention.

Materials and methods. Retrospective study of 165 cases of the death of children under 1 year of age in Perm Krai over the period of 2013-2016 was carried out.

Results. Among the causes of the death of children under 1 year of age at home, the most frequently registered were the following: sudden infant death syndrome (SIDS) – 47.9 %, traumas – 24.8 % and respiratory diseases – 18.8 %. In case of SIDS, the share of premature infants was 16.7 %, more than a half of infants had various signs of morphofunctional immaturity (58.8 %). Mothers’ smoking during pregnancy and after giving birth to a child occurred in 78.6 % of SIDS cases. Half of cases of death at home from traumas in children under age 1 is connected with mechanical asphyxia while sleeping, 33 % – as a result of gastric content aspiration into respiratory tract, 16.7 % – owing to nonobservance of safe conditions of sleep. Infant death in consequence of traumas more often than the other causes of death was accompanied by social risk (75.0 % of cases), regarding SIDS social risk was noted in 66.7 %, acute respiratory diseases – in 50.0 %.

Conclusions. Prevention of the main causes of death at home among infants under 1 year of age consists in a timely detection of prognostic risk and initiation of standard preventing measures.

Perm Medical Journal. 2019;36(1):77-83
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Characteristic of epidemiological process of tick-borne viral encephalitis in child population of Siberian federal district regions
Shirokostup S.V., Lukyanenko N.V.

Abstract

Aim. To detect the characteristics of the epidemic process of tick-borne encephalitis among the child population of the regions of Siberian Federal District with evaluation of the efficiency of preventive measures regarding this infection.

Materials and methods. The data of official statistical reports of Rospotrebnadzor, regional healthcare services were used in the study. Data processing was fulfilled using the program Statistica 13.0.

Results. Over the period from 2000 to 2017, a mean long-term tick-borne encephalitis morbidity rate among the persons under seventeen in Siberian Federal District was 6.2 ± 1.39 0/0000 that is by 39.7 % lower than the analogous index in the adult population (8.7 ± 0.82 0/0000, p < 0,001). In the study, there was analyzed the efficiency of preventive measures among children and adolescents and revealed the leading factors, essentially influencing the formation of a tendency of tick-borne viral encephalitis morbidity.

Conclusions. The territories of potential risk for this infection within the borders of SFD among the child population were determined.

Perm Medical Journal. 2019;36(1):84-90
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Results of catamnestic observation of cytomegalovirus infection in children
Permyakova A.V., Pospelova N.S., Deryusheva A.Y.

Abstract

Aim. To study the characteristic features of cytomegalovirus excretion into the blood, saliva and urine of children aged 1-3 years with different forms of infectious process.

Materials and methods. There were analyzed the results of observation of 65 children aged 1-3 years with acute cytomegalovirus infection, who received ambulatory treatment and were observed in catamnesis of 6 months. Cytomegalovirus infection markers were determined in blood, saliva and urine serologically (IgM, IgG) and using the method of quantitative PCR.

Results. The maximum quantity of virus was found to be determined during the acute form of cytomegalovirus infection in the saliva, exceeding the value of 6.0 lg of CMV DNA copies/ml (median 4.9 lg of CMV DNA copies/ml). In the blood and urine of patients with the acute form of infection, the quantity of virus is within low and mean values of viral load (3.4 lg of CMV DNA copies/ml and 3.85 lg of CMV DNA copies/ml). Six month after the acute form of infection, no CMV DNA was determined in the blood, it decreased to 2.8 lg of CMV DNA copies/ml in the saliva and to 3.0 lg of CMV DNA copies/ml in the urine.

Conclusions. Thus, the amount of cytomegalovirus DNA in the biological media of the body such as blood, saliva and urine is maximal during the acute form of disease that can be used as a diagnostic method.

Perm Medical Journal. 2019;36(1):91-96
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Use of principles of pathogenetic treatment of decompensated form of early childhood caries in preschool children
Danilova M.A., Machulina N.A., Kamenskikh D.V.

Abstract

Aim. To ground the individualized pathogenetic approach to treatment of dental caries in preschool children.

Materials and methods. We carried out the controlled randomized retrospective study, which included 111 children aged 12 to 72 months with decompensated form of caries course. Patients of the main group received pathogenetic treatment of dental caries, patients of the comparison group received symptomatic treatment and a complex of preventive measures. Patients of both groups were monitored after 6, 12 and 24 months.

Results. The analyzed changes in caries intensity from the onset of performing individualized pathogenetic treatment of early childhood caries detected that 6 months later, a mean quantity of newly damaged surfaces was thrice as less in patients of the main group than in the comparison group. The data received one year after the onset of treatment, demonstrate a significant decrease in the growth of caries intensity of surfaces on average by one surface in persons of the main group compared to the comparison group (0.35 ± 0.12 and 1.57 ± 0.87, respectively, p = 0.05).

Conclusions. The choice of rational approaches to the treatment of early childhood caries should be substantiated by histomorphological status of temporary teeth hard tissues, physicochemical parameters of oral fluid and pathogenetic protocols, adapted to specificity of early childhood caries course.

Perm Medical Journal. 2019;36(1):97-101
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Review of literature
Oleic, palmitic triglycerides, very low density lipoproteins. Atherosclerosis, arterial atheromatosis and ischemic heart disease pathogenesis
Titov V.N., Schekotova A.P.

Abstract

In the clinic and experiment, the basic factor in pathogenesis of hyperlipoproteinemia, atherosclerosis and atheromatosis is disturbance of physicochemical parameters of very low density lipoproteins (VLDLP). They are secreted into the blood flow by hepatocytes in biological reaction of exotrophia, external nutrition, biological function of trophology – nutrition. When there are no genetic disorders, VLDLP parameters are determined mainly by substrate induction, realization of biological reaction of exotrophia. Aphysiological induction of substrate is: a) high content of exogenous palmitic saturated fatty acid and palmitic position forms of triglycerides in the food of Homo sapiens, when a patient uses an excessive amount of meat and little carbohydrates for food. We believe that for primary prevention of ischemic heart disease the following is required: a) as for normalization of biological function of endoecology – to reduce the supply of ligandless palmitic low density lipoproteins in the intima and b) to inhibit atheromatosis of elastic type arteries including coronary artery atheromatosis. To inhibit atherosclerosis, it is necessary to normalize the biological function of nutrition, reduce the amount of meat food, replacing it by fish, while increasing the amount of vegetable food according to parameters of general biology. The basic in prevention of atherosclerosis, atheromatosis and IHD, we suppose, is activation of cognitive biological function. This is positioning of organism in the unity of: a) metabolic reactions in vivo b) exposure of environmental factors and c) social conditions, understanding of the fact that in phylogenesis, the species Homo sapiens was formed as herbivorous species with carnivorous (fish-eating) past in the ocean. If there is no critical understanding of the necessity of optimization of biological nutritional function in patients “meat-eaters”, neither prevention of atherosclerosis and atheromatosis, nor treatment of IHD will be successful. Nothing different in biology or medicine is available.

Perm Medical Journal. 2019;36(1):102-117
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Inflammatory bowel diseases: fertility, pregnancy, labor
Sandakova E.A., Khlynova O.V., Zitta D.V., Stepina E.A., Koposova K.A., Okisheva L.G.

Abstract

Inflammatory bowel diseases (IBD) including ulcerous colitis (UC) and Crohn’s disease (CD) are widely spread among young persons and therefore there are many questions from both patients and specialists regarding management tactics for this category of patients. The paper presents the main items of The Second European Consensus on Reproduction and Pregnancy in Patients with IBD including the questions of fertility, optimization of pregnancy planning, characteristic features of its course, labor and postpartum period.

Perm Medical Journal. 2019;36(1):118-125
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