Vol 36, No 2 (2019)

Cover Page

Clinical studies

Short-and long-term results of distal pancreatectomy

Barykov V.N., Istomin A.G., Abdrashitov R.R., Ryzhikh A.S.


Aim. To assess the results of distal pancreatectomy for malignant and benign tumors and chronic pancreatitis complications.

Materials and methods. Forty-seven patients, who underwent distal pancreatectomy, were under observation during the period from 01.01.2008 to 28.02.2019.

Results. The long-term results of surgical treatment demonstrated the following complications: pancreatic fistulas – 15 % of observations, pancreatogenic diabetes mellitus – 12.7 %, subphrenic abscesses – 10 %. In the long-term period after the surgery – from 10 years and not less than one year – 30 patients were followed up, constituting 63.8 % of the total number.

Conclusions. To prevent complications in the form of pancreatic fistula with pathological Wirsung duct dilatation more than 4–5 mm in diameter, it is necessary to form anastomosis between the pancreatic stump and the small bowel.

Perm Medical Journal. 2019;36(2):6-13
pages 6-13 views

Characteristic features of pregravid preparation of married couples with burdened reproductive anamnesis, taking into account the results of in-depth study of genital microbiocenosis

Sandakova E.A., Savelyeva N.V., Rakitina Y.V., Karpunina T.I., Gosteva E.О.


Aim. To optimize the pregravid preparation of married couples on the basis of in-depth study of genital microflora and correction of genital microbiocenosis.

Materials and methods. One hundred twenty eight married couples were examined regarding their pregravid preparation. The study included clinical investigation, colposcopy, USI of small pelvis organs, bacterioscopic investigation of vaginal isolate and urethral smear (men), bacteriological investigation of cervical mucus and ejaculate, genetic typing of strains isolated. Uterine cervix biopsy and aspiration endometrial biopsy was performed according to indications.

Results.There was detected a strong positive correlation between bacteriospermia, chronic cervicitis and chronic endometritis (r > 0.6). It proves the role of bacteriospermia in development of the ascending infection of endocervix and endometrium. At the same time, opportunistic microflora in a married couple, revealed in the presence of bacteriospermia and chronic cervicitis, in 80 % of cases is identical that makes it possible to draw an analogy with sexually transmitted infections. In most cases, chronic cervicitis was shown to be a visible marker of chronic endometritis.

Conclusions. A thorough study of genital mucosa microbiocenosis, implemented in a married couple with burdened reproductive anamnesis at the stage of pregravid preparation, permits to raise its efficiency.

Perm Medical Journal. 2019;36(2):14-20
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Short- and long-term results of angioplastic lobectomy in lung cancer surgery

Kirshin A.A., Napolskikh V.M., Styazhkina S.N.


Aim. To study the oncological expediency of using vascular techniques in organ-saving treatment of lung cancer.

Materials and methods. Over the period of 2009–2016, there were performed 92 lobectomies with resection and reconstruction of the pulmonary artery in patients with non-small carcinoma of the lung.

Results. No intraoperative complications and lethal outcomes were fixed. The postoperative complications were registered in 23 cases (25.3 %). Lethality was 3.3 %. The overall one-year survival rate in patients with stage I–III lung cancer after organ-saving surgery was 96.7 %, three-year – 65.1 %, five-year – 36.6 %, median survival rate – 53.1 months. The recurrence-free survival rate in patients with stage I–III lung cancer was: one-year – 89.9 %, three-year – 65.3 %, five-year – 48.8 %. The median recurrence-free survival rate was 49.8 months.

Conclusions.Angioplastic lobectomy provides an acceptable short and long-term result, which does not yield to the analogous indices for pulmonectomy. It confirms our opinion on the expediency of implementing this procedure regarding non-small carcinoma of the lung.

Perm Medical Journal. 2019;36(2):21-28
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Characteristic features of maxillofacial phlegmon morbidity with assessment of efficiency of detoxication therapy

Boev I.A., Godovalov A.P., Shtraube G.I., Antakov G.I.


Aim. To study the characteristic features of long-term facial phlegmon morbidity in Perm Krai with assessment of the efficiency of infusion therapy using indices of endogenous intoxication expression.

Materials and methods. Manifestations of epidemic process of facial phlegmons were studied on the basis of a detailed retrospective analysis of sickness rate among the inhabitants of Perm Krai for the period of 2011–2016. In group 1, all patients besides standard therapy, underwent infusion therapy, and in group 2 – standard therapy alone. Prior to and after the therapy, peripheral blood cellular composition was assessed, and leukocytic indices of intoxication were calculated.

Results. A long-term dynamics of facial phlegmon morbidity was established to show the irregularity of process expression according to years. Growth of the quantity of patients is provided by increase in the number of cases with complicated forms. Besides, males play a significant role in formation of sickness rate: the chances for the development of phlegmon among them are 1.49 times higher than in females. In the age structure of morbidity, prevail persons aged 21–30 and 31–50. A half of patients have endogenous intoxication. The course of infusion therapy essentially reduces the expression of endogenous intoxication.

Conclusions. There is observed a tendency to growth of facial phlegmon morbidity that is probably connected with changes in etiological structure of pathogenic agents as well as with formation of pathosymbiosis of some opportunistic pathogenic microorganisms. As a rule, phlegmon is being developed against the background of endogenous intoxication, conditioned by both microbial metabolites and tissue destruction products. The efficiency of correction of endogenous intoxication using infusion therapy is shown.

Perm Medical Journal. 2019;36(2):29-35
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Application of combined technique for laparotomy wound closure in urgent surgery

Inyutin A.S., Fedoseev A.V., Krymov O.V., Muravyov S.Y., Rustamov V.I.


Aim. To improve the results of patients’ treatment after midline laparotomy by reducing the number of the postoperative ventral hernias and eventrations.

Materials and methods.There were examined 111 urgent patients, operated through the median laparotomic approach. The main group included 48 persons, for whom,on completion of intervention,the white line was sutured with a chess-staggered suture(patent of RF № 2644846, 14.02.18). In the control group, for median aponeurosis interrupted sutures were used.

Results. In the early postoperative period, in the control group there were 2 (3 %) eventrations, in the main group – no eventrations. After one year of observations, in the main group – 3 (6 %) patients with aponeurosis defects by the postoperative scar USI and 2 (4 %) patients with hernias were found out. In the control, one year after the surgery, there were 6 (9.5 %) aponeurosis defects and 5 (8 %) postoperative hernias.

Conclusions. Application of interrupted chess suture in combination with staggered sutures is the way to prevent eventrations and postoperative ventral hernias in urgent surgery.

Perm Medical Journal. 2019;36(2):36-43
pages 36-43 views

Methods of diagnosis and technologies

Sensitization rate and sum of sige-antibodies to apple grades of various colours. Association of these indices with severity of atopic dermatitis

Prilutsky A.S., Tkachenko K.E., Baranova O.V., Sorokina O.V.


Aim. To assess the rate of sensitization to the grades of apples of various colours and analyze the association of the obtained indices and total sIgE levels of these grades with the severity of atopic dermatitis.

Materials and methods. The blood sera of 215 patients, suffering from alimentary allergy, were studied. The detection rate of sensitization and that of specific immunoglobulin E (sIgE) concentration sum to allergens of apple grades with various coating colours as well as the association of these indices with the degree of severity of atopic dermatitis (AD) was analyzed. Test-systems were used for immune-enzyme analysis of production. Statistical analysis of the obtained results was performed using the program “MedStat” (Donetsk).

Results. It was shown that the detection rate of sensitization to the grades with mixed red colour is reliably higher (p < 0.001) compared to the grades without coating colour. The degree of AD severity correlates with the total quantity of apple grades, to which sensitization has been revealed (p < 0.01), with the quantity of grades with mixed red colour, to which sensitization has been found (p < 0.01) and with sIgE sum to the grades with mixed red colour (p < 0.01). Reliable differences (p = 0.006) in the degree of severity of atopic dermatitis among persons, sensitized to apple grades and with no sensitization to this fruit were established.

Conclusions.The obtained data are to be used when choosing a diet and correcting it for persons with alimentary allergy and atopic dermatitis.

Perm Medical Journal. 2019;36(2):44-50
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Morphological characteristic of inguinal lymph nodes in HIV infection

Gulyaeva N.I., Freind G.G., Shmagel N.G., Korolevskaya L.B., Saidakova E.V., Shmagel K.V.


Aim. To assess the morphological changes in inguinal lymph nodes among patients with stage 4a HIV infection, who receive antiretroviral therapy.

Materials and methods. There were examined 12 HIV-infected patients with stage 4a, treated at “Perm Regional Center for Prevention and Fight against AIDS and Infectious Diseases”, who received antiretroviral therapy for 2 years. Two groups of patients were formed: group I – 6 persons, whose CD+ blood lymphocyte number was more than 350 in 1 mcl; group II – 6 persons with CD+ blood lymphocyte number less than 350 in 1 mcl. Inguinal lymph nodes (ILN) were taken under local anesthesia, histological preparations were prepared by traditional scheme, stained with hematoxylin and eosin using Masson three-colour staining. In immunohistochemical reactions expression of Ki-67 and CD+ markers was estimated.

Results.Histoarchitectonics of lymph nodes was changed as a result of massive development of sclerosis in the region of hilum, capsule and trabecules. Against the background of sclerosis, there occurred lymphocyte depletion, change in structure of stromal cells and neoangiogenesis in all the zones of the lymph node. In the regions of sclerosis, death of lymphocytes was revealed. In patients of the second group, more active development of follicles with the centers of reproduction in the lymph node cortical substance, as well as growth of the number of Ki-67 maker-expressing cells was established

Conclusions.In the inguinal lymph nodes, the development of sclerotic processes causes the death of T-lymphocytes, which, in their turn, are the source of lymphotoxin-β formation. Loss of CD+-T-lymphocytes is accompanied by deficit of lymphotoxin-β and induces the loss of fibroblastic reticular cells themselves, which through the production of IL-7 support the vital activity of T-cells.

Perm Medical Journal. 2019;36(2):51-59
pages 51-59 views

Preventive and social medicine

Physiological and neuropsychological features of adaptation to training in conditions of Western Ural among foreign students from India

Koryukina I.P., Kulesh T.A., Arbuzova T.P., Zueva T.V., Petrischeva A.V., Shulkina S.G., Cherkasova V.G., Karakulova Y.V., Seksyaev N.E., Chainikov P.N.


Aim. To study the physiological and neuropsychological features of adaptation to training in conditions of Western Ural among foreign students from India.

Materials and methods. The object of study – first-year foreign students from India and Russian students of E.A. Vagner Perm State Medical University (52 and 47 persons, respectively). There were studied the parameters of physical development and cardiovascular system, including those with loading, as well as hypoxia tolerance tests. The following indices were calculated: body mass index (BMI), Robinson and Kerdo index, cardiac performance index (CPI), strength index (SI). The health level was calculated by G.L. Apanasenko. Peculiar features of students’ neuropsychical status were studied using the following surveys: Spilberger-Hanin Anxiety Scale to determine personal and situational anxiety, Beck Depression Inventory (BDI), scale for assessment of depression symptoms CES-D, scale for assessment of quality of life SF-36 with subscales, Epworth Sleepiness Scale, asthenia scale MFI-20, CAM (cenesthesia, activity, mood).

Results. Among Indian students, dispersion of BMI values and lower dynamometry indices were established. Hypoxia tolerance in the groups was similar. Kerdo index values in the group of Indian students showed a tendency to vagotonia, in the control group – to normotonia. No significant differences in other indices were registered. Health level in the studied groups was in “dangerous” zone regarding the risk for development of chronic noninfectious diseases, especially in the group of Indian students. The situational anxiety level by Spilberg 1 scale, and depression level by CES-D scale were reliably higher in the group of foreign students (p < 0.0001). SF-36 PF and SF-36 GH scores in Indian students were reliably lower versus Russian. Psychical component of health by SF-36 MH subscale was significantly higher in Russian students.

Conclusions. Among first-year students from India, who study at Perm State Medical University, there is observed a complex adaptive syndrome, which needs to be taken into account and corrected to prevent deadaptation disorders and raise progress in studies as well as quality of life and health status.

Perm Medical Journal. 2019;36(2):60-67
pages 60-67 views

Allergic morbidity in patients of different age groups

Minaeva N.V., Devyatkova E.A.


Aim. To analyze the regularities of the prevalence of allergic diseases in patients of different age groups.

Materials and methods. Epidemiological indices of allergic diseases were studied in children, adolescents, adults and elderly persons using official statistical data.

Results. The general and primary morbidity, allergopathology structure and its dynamics were evaluated in patients of different age groups. The data, obtained in Perm Krai and the Russian Federation, were compared.

Conclusions. The level of atopic dermatitis (AD) is the highest in children, allergic rhinitis (AR) – in adolescents, bronchial asthma (BA) – in adolescents and elderly persons. The cases of BA prevail in the structure of allergopathology in all age groups, besides children. Among children AD cases make 50.5 % of all allergic diseases. In dynamics, AD has a tendency to reduction of general morbidity in all age groups, BA – in children; a tendency to elevation is typical for AR in children and adolescents, BA – in adolescents, adults and elderly persons.

Perm Medical Journal. 2019;36(2):68-74
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Analysis of long-term dynamics of circulatory system morbidity in population of Perm and Perm Krai

Kasatov A.V., Stepnov S.M.


Aim. To analyze a long-term dynamics of the primary morbidity of circulatory system in the population of Perm and Perm Krai.

Materials and methods. The primary circulatory system morbidity per 1000 of the population of Perm Krai and Perm was analyzed under the materials of Perm Regional Medical Information-Analytical Center. Statistical processing of the data was performed using Microsoft Excel 2016.

Results. Over the period from 2007 to 2017, there was established a growth of the level of primary circulatory system morbidity as a whole and ischemic heart disease in particular among the population of Perm Krai and Perm. Morbidity rate was essentially higher in the inhabitants of Perm Krai but annual gain rate – more significant in the urban population that is explained by availability and quality of medical care and social factors. The growth of the level of primary diseases, characterized by increased arterial pressure, is insignificant during this period of observation. The average annual increase was 1.54 % in the inhabitants of Perm and 0.53 in Perm Krai.

Conclusions. The level of primarily detected circulatory system diseases in the population of Perm Krai and Perm essentially raised for 11 years of observation. Primary IHD morbidity indices as well as average annual rate of their growth is significantly higher than the analogous indices of diseases, characterized by increase in arterial pressure.

Perm Medical Journal. 2019;36(2):75-80
pages 75-80 views

Safety of using the preparation “Licopid®” in opinion of experts in various specialities

Krasheninnikov A.E., Matveev A.V., Andronova T.M., Guryanova S.V., Shilova N.V., Kozlov I.G.


Aim. To study the safety of the preparation “Licopid®” using the data, obtained with the method of questioning of doctors of various specialities. The reactant of “Licopid®” tablets is glucoseminylmuramildipeptide – a synthetic analogue of the structural fragment of bacterial cells membrane (peptidoglycan), which is an activator of congenital and acquired immunity;it strengthens the defense of the body from viral, bacterial and fungal infections; it has an adjuvant effect in development of immunological reactions.

Materials and methods. The object of this study were the answers of 2315 specialists to the questions of surveys regarding the safety of using immunomodulator“Licopid®” in their practical activity. The regions, involved into the survey were the following cities: Moscow, Kazan, Krasnodar, Ekaterinburg, St. Petersburg, Chelyabinsk, Novosibirsk, Perm, Samara and Voronezh as well as Krasnodar Krai. Processing of the results was fulfilled with the methods of descriptive statistics; the obtained data were compared with the method based on calculation of chi-square criterion.

Results. The analyzed results showed that 962 respondents (41.5 %) indicated the fact of revealing undesirable reactions (UR) of the preparation “Licopid®” in their own practice. It was noted by them that all undesirable reactions were not severe and predicted, i.e. they were indicated in the instruction for medical use of “Licopid®” 1 mg and 10 mg.

Conclusions. While conducting questioning, the authors revealed statistically significant differences in the structure of respondents’ answers depending on the region of residence and medical speciality. At the same time, for all UR, indicated in instruction, subjectively estimated occurrence rate of reactions coincided with that, declared upon registration, except myalgias and arthralgias, which were noted by doctors much rarely.

Perm Medical Journal. 2019;36(2):81-92
pages 81-92 views

Physiologo-hygienic grounding for using physical properties of natural potassium salts to increase duration of chronic cardiovascular and respiratory diseases remission

Ryazanova E.A., Barannikov V.G., Kirichenko L.V., Sidorova D.A.


Aim. To implement physiologo-hygienic studies regarding the period of remission of chronic diseases after sylvinite therapy for introducing them into medical practice.

Materials and methods. Hygienic assessment of internal environment conditions of modern saline devices taking into account their constructive features was carried out. Physiological functions of the main systems of an organism were analyzed in patients, who received the course of mineral prophylaxis.

Results. In modern sylvinite constructions there is formed a favorable environment, rendering a positive preventive influence on patients’ organism.

Conclusions. Physical properties of natural potassium salts, used to prevent chronic diseases, contribute to prolongation of remission period.

Perm Medical Journal. 2019;36(2):93-97
pages 93-97 views

Biology and experimental medicine

Changes in growth characteristics and biofilm-forming activity of Escherichia coli with cholesterol available

Bykova L.P., Trapeznikov Y.P., Godovalov A.P.


Aim.To assess the growth properties and formation of E. сoli biofilms with different concentrations of cholesterol available.

Materials and methods. E. coli strains were cultivated in the meat-peptone broth with cholesterol added in the concentration of 3, 5, 7 and 9 mmol/l as well as in the nutrient medium without cholesterol. The growth parameters and cholesterol concentration in the samples prior to and after cultivating microorganisms and the effect of cholesterol on biofilm-forming activity of E. coli was determined.

Results. Cholesterol was shown to have no bactericidal effect on E. coli, however, it is able to change the duration of growth phases of the strains that is, possibly, caused by adaptation to the presence of cholesterol and switching of metabolic pathways. Cholesterol has a stimulating effect on accumulation of biomass by the test-strain and its biofilm-forming activity.

Conclusions. In the study performed, the ability of E. coli to metabolize human cholesterol was shown.

Perm Medical Journal. 2019;36(2):98-101
pages 98-101 views

Experimental study of possible development of abstinence syndrome after long use of energetic drinks

Zenkova E.A.


Aim. To study in experiment the possible syndrome of withdrawal after a 30-day peroral use of energetic drinks.

Materials and methods.In the groups of laboratory animals, who had caffeine solution (CS) and energetic drink (ED), as the only source of drinking in free access so as to form a stable use, and in the control group of rats, who received purified water (duration of experiment – 4 weeks), one day after the withdrawal there were studied body mass indices, behavioral functions (cognitive processes, anxiety, behaviour) and rectal temperature.

Results. The 1.5-2-fold reduction of motor activity in white rats was established; it was reflected in decreased number of postures and crossed squares in the device “open field”.The increase in anxiety level against the background of energetic drink withdrawal was detected in “dark-light camera” with perforations. At the same time, no changes in motor activity and anxiety level were registered in the group of caffeine users. The following characteristic features of withdrawal syndrome as tooth chatter and gnashing, shaking arms and pads, ptosis, were registered in 87.5 %, 75 % and 37.5 %, respectively, in the group of energetic drink users, and 14.3 %, 42.9 %, 28.6 % in the group of caffeine solution users. During a 30-day period of using energetic drink by white rats, there was observed a negative dynamics of their weight.

Conclusions. The decrease in motor activity, increase in anxiety level and presence of a number of signs, does not allow excluding the presence of withdrawal syndrome after a long use of energetic drinks, and in most cases, expression of the signs of withdrawal syndrome exceeds that of caffeine. This fact, in our opinion, needs more detailed studying.

Perm Medical Journal. 2019;36(2):102-107
pages 102-107 views

Clinical case

Difficulties in differential diagnosis of symptomatic hypertensions

Khovaeva Y.B., Zinkovskaya T.M., Moiseenko N.P., Voronova E.I., Batalova A.A., Ivanova N.V., Perepelitsyna O.N.


The paper presents a case of pregnant woman with polycystic ovary syndrome, which occurred after hemorrhagic stroke and detected dissecting aneurysm of the ascending aorta at the sinus level. Removal of non-viable fetus was performed, coronaroangiography, resection of aneurysm of ascending aorta and replacement of valve-containing conduit was successfully implemented.

Perm Medical Journal. 2019;36(2):108-116
pages 108-116 views

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