Vol 40, No 4 (2023)

Objective. To study the postural balance disorders in children with a one-sided high riding trochanter, depending on the direction of displacement of the general center of pressure (COP) of the body in the frontal plane.

Material and methods. A two-platform stabilometric study of 16 patients aged 11 to 16 years (M ± m = 13.1 ± 0.76) with a one-sided high riding trochanter of the femur was conducted. The children were divided into two groups: group I – 6 patients with a shift of the general COP  towards the affected lower limb (33[19 – 42] mm), group II – 10 patients with a displacement of the general COP  towards the intact lower limb (17 [8–36] mm). The control group included 16 healthy children of the same age.

Results. Depending on the displacement of the general COP towards the affected or intact lower limb, different values and ratios of stabilometric parameters were observed in patients of both groups individually under each of the contralateral lower limbs. The most pronounced asymmetry of the indicators of the postural balance of the lower extremities compared with the norm was revealed in the second group of patients. Among them, the median difference of sagittal displacement of the COP between the contralateral limbs DY was 45 mm, while in patients of the first group, the median DY was 7 mm. The medians of angular velocities Ω between the lower extremities were correlated as 36 to 23 degrees/s in the second group compared with 27 to 29 degrees/s in the first. Also, in patients of the second group, the highest indicator of excessive quartile deviation of the angle of the direction of oscillations of the vector diagrams α on the affected lower limb was revealed – 62° compared with the intact 11°.

Conclusions. Significant asymmetry of postural balance indicators in patients of the second group may be due to compensatory reactions of the body to prevent gross destabilization of the entire postural control system, therefore, such an imbalance corresponds to an adequate postural strategy.

Objectives. To conduct a comparative analysis of the role of connective tissue dysplasia in the development of diverticular disease.

Materials and methods. At the screening stage of a single-stage study, clinical, functional, and radiological predictors of connective tissue dysplasia with diagnosed diverticular disease were evaluated. At the second stage of the study, a colonoscopy was performed. The disease was diagnosed by the combination of phenotypic signs of dysmorphic genesis.

Results. At the first stage, in 82 % of cases patients were concerned about their asthenic syndrome. Thirty-two patients with confirmed connective tissue dysplasia underwent colonoscopy. Diverticular disease was diagnosed in 28 patients (89.6 %).

Conclusions. High comorbidity of patients is associated with genetically determined disorders of connective tissue metabolism, manifested by a high frequency of diverticular formation. With a large number of diagnosed phenes, we can predict a rapid progression of diverticular disease. The frequency and severity are due to changes in the mechanical properties of the connective tissue of the submucosal layer.

Introduction. Heart rhythm disturbances often complicate the clinical course of chronic heart failure, especially when heart failure is combined with metabolic syndrome. The influence of different exogenous and endogenous factors on the formation and aggravation of existing cardiac rhythm disturbances in such patients is insufficiently studied, in particular, the influence of metabolic syndrome, previous myocardial infarction and surgical myocardial revascularization.

Objective. To conduct a comparative analysis of the detected heart rhythm abnormalities in patients with chronic heart failure with and without an associated metabolic syndrome and to estimate the role of previous myocardial infarction and surgical revascularization on the detection rate of cardiac rhythm abnormalities.

Material and methods. One hundred and twenty patients with functional class II-III chronic heart failure due to coronary heart disease including 90 (75.0 %) patients with signs of metabolic syndrome and 30 (25.0 %) patients without metabolic syndrome were examined. Anthropometric data (height, weight, body mass index, waist volume), clinical course, data of laboratory and instrumental methods of examination were assessed. Electrocardiography, echocardiography with determination of myocardial structural and functional parameters, Holter electrocardiogram monitoring, assessment of blood lipid profile were performed.

Results. The results of comparative analysis indicate a number of characteristic features of the clinical course of chronic heart failure with concomitant metabolic syndrome, expressed by  deterioration of both myocardial electrical stability, and structural and functional heart state. According to Holter monitoring data, there was detected a significant frequency of supraventricular and ventricular extrasystoles, atrial fibrillation of various types, combined forms of arrhythmias in patients with concomitant metabolic syndrome. Echocardiographic studies revealed a significant increase in the left ventricular wall thickness combined with decreased systole-diastolic size of the heart. According to the laboratory study, there was observed a significant deterioration of all blood plasma lipid profile parameters with an increase in the atherogenicity index among patients with concomitant metabolic syndrome. Four variables (presence of metabolic syndrome, previous myocardial infarction, previous aortocoronary bypass surgery and angioplasty with stenting of affected coronary arteries) were analyzed as the factors provoking the occurrence or progression of cardiac rhythm disturbances. Two independent factors associated with the occurrence of cardiac rhythm disturbances were identified: the presence of concomitant metabolic syndrome and previous myocardial infarction that led to the development of postinfarction cardiosclerosis. The factor associated with the reduction of cardiac rhythm disturbances in the long-term period was also determined: revascularization by aortocoronary bypass and/or angioplasty with stenting of the affected coronary vessels in patients with chronic heart failure associated with coronary artery disease.

Conclusions. There was identified the factor associated with the reduction of heart rhythm disturbances in the long-term period – revascularization by aortocoronary bypass and/or angioplasty with stenting of the affected coronary vessels in patients with chronic heart failure associated with coronary artery disease.

In this review, the literature data regarding the influence of oxidative stress (OS) on the female reproductive system and fertility are analyzed. Oxidative stress occurs as a result of balance disturbance in the system of the formation of free radicals and mechanisms of antioxidant defense. During the last decade, there have been conducted many studies, demonstrating interaction between the oxidative stress and the development of various pathological processes. The influence of the oxidative stresses on the state of female reproductive system and fertility is of special interest. When analyzing the available for today data regarding OS and its effect on the body, it is becomes evident that this process is very important in physiology and reproductive pathology, development of gynecological and obstetric pathologies and fertility. The significance of OS in the pathogenesis of reproductive disturbances should be taken into account when developing new therapeutic methods. This issue needs further discussion and studying.

Objective. To improve the diagnostics of destructive pancreatitis based on the concentrations of fibrinogen degradation products and lysozyme in blood serum and peritoneal exudate.

Materials and methods. One hundred and two patients with acute pancreatitis were examined and the diagnostic significance of fibrinogen and lysozyme degradation products was assessed. The age of the patients ranged from 19 to 63 years. The patients were treated in surgical hospitals of the city of Astrakhan. Of them, 74 patients diagnosed an edematous form of acute pancreatitis, received conservative treatment, and 28 patients with destructive forms of pancreatitis were operated on. The reference values of the studied markers were evaluated in 39 healthy individuals (donors).

Results. In the blood serum of patients with destructive pancreatitis, the concentration of fibrinogen degradation products was 2.0 [0.68;13.2] mg/l, that is significantly higher than in the group of patients with edematous acute pancreatitis, as well as in the control group. After the surgery, in the peritoneal exudate of 28 operated patients with destructive pancreatitis, the concentrations of fibrinogen degradation products increased by 0.93 times compared to the group with edematous acute pancreatitis and by 3.1 times significantly higher than in the control group. There were no statistically significant differences in the concentrations of fibrinogen degradation products in the peritoneal exudate and in the blood serum of patients with destructive pancreatitis. The concentration of lysozyme in the blood serum of patients with destructive pancreatitis was 20 [5.0;46.5] mg/l, that is significantly higher than in the control group and in the edematous form of acute pancreatitis. After the surgery, the concentration of lysozyme in the peritoneal exudate was 2.5 times significantly higher in patients with destructive pancreatitis than in the control group. The average lysozyme concentration in the peritoneal exudate of patients with destructive pancreatitis exceeded the serum concentrations by 2.1 times in comparative equivalent.

Conclusions. Assessment of the levels of fibrinogen degradation products, lysozyme in the blood and exudate allows to diagnose the destruction of the pancreas, as well as to determine the correct treatment tactics.

Objective. To study and characterize the incidence of ascariasis in the population of the Astrakhan Region for 2017–2021.

Materials and methods. The diagnosis of ascariasis was made on the basis of epidemiological anamnesis, clinical picture of the disease (complaints and symptoms) as well as laboratory examination of feces (coproovoscopic method) – detection of parasite eggs in the biological material of patients (feces).

Results. From 2017 to 2021, 91 cases of human infection with ascarids were registered in the Astrakhan region, of which the incidence rate among children was 54.9 % (50 persons). Ascariasis was registered directly in the city – 41.8 % (38 persons) and in the districts of the Astrakhan Region – 58.2 % (53 persons). Most of the patients – 86.8 % (79 persons) complained about the presence of certain symptoms of the disease: pain in the epigastric region – 87.3 % (children) and 59.5 % (adults), nausea – 73.4 % (58 persons) and hyporexia – 68.4 %. When addressing for medical aid, in addition to anamnesis of the disease, an epidemiological anamnesis was also clarified: 97.8 % (89 persons) did not observe the rules of personal hygiene – this group of patients ate unwashed fruit and/or berries – 83.1 % (74 persons), did not wash their hands before eating – 79.8 % (71 persons). Onychophagy was noted by 16.5 % (15 persons including 12 children). Geophagy occurred in 9.9 % (9 persons – all children). After diagnosing, all patients were prescribed drugs with pirantel – 91.2 % (83 persons) and albendazole – 8.8 % (8 persons).

Conclusions. Ascariasis is an urgent problem of domestic healthcare, especially for pediatricians. Ascariasis is widespread throughout the Astrakhan Region, being detected, to a greater extent, in residents of the districts of the Astrakhan Region, that can testify to the consumption of unwashed fruit or berries contaminated with ascarid eggs, as well as possible soil contamination. Typical complaints were pain in the epigastric region, nausea, vomiting, diarrhea, hyporexia. Presumably, the main cause of the ascarid disease in residents of the Astrakhan Region could be the use of untreated wastewater and its sediments as organic fertilizers in collective and farm enterprises, as well as in individual households.

One of the most common functional disorders in abdominal surgery during the early postoperative period is intestinal paresis. It accounts for 12 % of all types of intestinal obstruction. Postoperative intestinal paresis complicates significantly the course of the early postoperative period and greatly influences the outcome of the surgical intervention. All disorders of the motor and evacuatory function of the gastrointestinal tract, from insignificant discoordination of the motor function to paresis and paralytic obstruction, are often the leading cause of all kinds of postoperative complications. The clinical case of the treatment of the postoperative intestinal paresis using a saline enteral solution in a patient after repeated relaparotomies on the background of secondary peritonitis is presented. Efficiency of the postoperative paresis treatment was assessed by intra-abdominal pressure measurement, X-ray investigation and auscultatory peristalsis evaluation.

Introduction. The problem of hereditary metabolic diseases remains relevant. Mucolipidosis (ML) is a hereditary, autosomal recessive orphan disease caused by a defect in the GNPTAB gene, which encodes alpha and beta subunits of the enzyme N-acetylglucosamine-1-phosphotransferase. Deficiency of this enzyme leads to the accumulation of acid hydrolases in the lysosomes of the liver, spleen, lung and brain cells. The disease is rare, has no pathognomonic symptoms at the initial stages and therefore deserves special attention of clinicians. Patients with ML are characterized by a special phenotype: multiple stigmas of dysembriogenesis, ricket-like skeletal changes, mental retardation. The diagnosis is confirmed by a genetic study.

Materials and methods. A case of type II/IIIA mucolipidosis in a three-year-old boy is presented.

Results. The diagnosis was made immediately after the birth, and confirmed by the age of 4 months. Since his birth, the child had a characteristic phenotype and changes in the internal organs: ventriculomegaly, bicuspid aortic valve, increased kidney size, gallbladder deformity, splenomegaly, as well as changes in the bone tissue. Up to the age of one year, the child did not suffer from respiratory infections, but significantly lagged behind in physical and psychomotor development. Acute respiratory viral infections with bronchoobstructive syndrome and pneumonia  after the age of one, sharply slowed down his development and worsened the course of the underlying disease. At the age of 3 years and 11 months, the child does not sit, does not stand, does not walk, does not control the functions of the pelvic organs, does not talk. In the recent months, there has been noted a violation of the act of swallowing and the child was gastrostomized.

Conclusions. The description of the  case is aimed at attracting the attention of pediatricians to the peculiarities of following up children with this pathology at the district polyclinic as well as  ensuring a multidisciplinary approach when monitoring a patient with accumulation diseases, and conducting timely specific preventive measures against intercurrent diseases (vaccination).

Objective. To study the properties of the immune response with G-01 solution at the example of melanoma (B-16).

Material and methods. Experiments were conducted on the offspring of heterosexual BALB/c aged 8 weeks. Groups of offspring were not separated by sex. In the work, a 20 % solution of G-01 was used, administered subcutaneously 0.5 ml 2 times a day for 2 days with the presence of an adjutant (aluminum hydroxide). In the first experiment, the solution was used as a prophylactic drug, in the second – as a therapeutic one, which was used on the 6th day after the transplantation of melanoma (B-16).

Results. In the first experiment, one month after the applied treatment scheme (prophylactic) with G-01 solution, an attempt was made to transplant the melanoma (B-16) subcutaneously to 10 mice of the main group. The control group consisted of 6 mice. After 3 weeks, an increase in the neoplasm of the right axillary region was detected in 2 mice of the main group. The neoplasm regressed during the next 3 weeks. In the control group, melanoma transferred in 5 out of 6 mice, with subsequent development of the disease and fatal outcome on average on the 60th day of the disease. In the second experiment, two groups (10 animals each) were analyzed: control and main. The tumor transferred in 100 % of cases in both groups. The injected solution on the 6th day after the transplantation of melanoma (B-16) did not affect the growth of the tumor. Mice died in both groups. The average duration of life in both groups was 36 and 38 days, respectively. There were no statistically significant differences in the groups.

Conclusions. The prospect of using G-01 solution in medicine as a preventive agent of natural origin was established. This method of inducing an immune response with G-01 solution can be used to prevent the development of a solid tumor of melanoma B-16. The subcutaneously injected 20 % solution of G-01 – 0.5 ml 2 times a day for 2 days – has no effect on melanoma on the 6th day after the transplantation.

In 2023, the Perm Medical Journal celebrates its centenary. The history of the creation of the first specialized medical publication in the Urals is given. The journal was created at a difficult time for the country. But already in 1923, the founders of the journal understood its necessity and significance for the medical science of the Ural region. The contents of the journal, as today, included original research, reviews and abstracts, analysis of clinical cases, coverage of the activities of scientific societies and an extensive chronicle. The pages of the journal covered issues of theoretical, clinical and social medicine, organization of healthcare, training of medical personnel, development and formation of the resorts in the Urals. Works of Perm scientists on the most pressing problems of science and health care in the Western Urals were published. The mission of the Perm Medical Journal is now to accumulate and disseminate modern scientific knowledge, the results of fundamental and applied scientific research among medical specialists in order to ensure integration into the global scientific community, exchange experience and maintain a high level of qualification of doctors and researchers. The journal allows authors to publish scientific results and provides access to private content that promotes the global exchange of knowledge and experience.

The article describes the life, scientific, professional path of the Associate Professor, the first Head of the Department of Physics of Izhevsk State Medical Institute, a teacher and public figure Nikolay Nikolaevich Ezhov.