Vol 31, No 2 (2014)

Aim. To characterize the presence and manifestation of psychovegetative disorders in patients with ulcerous colitis (UC). Materials and methods. 64 patients in the phase of exacerbation were examined. The mean age was 35,82±10,99 years. The control group included 30 healthy subjects comparable by sex and age. Hospital Anxiety and Depression Scale (Zigmond A.S. and Snaith R.P., 1983), Spielberger-Khanin Anxiety Scale. A.M. Wein Questionnaire, cardiography with active orthostatic test were used during the work. Results. As a result of studying, subclinical and clinically expressed anxiety was detected in 65% of UC patients. Depressive disorders occurred in 43% of patients. Significant correlations between anxiety-depressive disorders, vegetative disturbances and UC severity were revealed. In 69% of UC patients, changes in vegetative background and vegetative provision of activity characterized by decrease in power of all spectrum of waves and growth of central (humoral) effects in response to orthostress are not able to assure an adequate adaptive level. Conclusion. Psychovegetative disorders manifested by anxiety, depression and vegetative disbalance were revealed in UC patients that permits to consider this disease from psychosomatic positions.

In spite of applying the newest antibiotics as well as modern innovation techniques for drug and surgical treatment sepsis, morbidity has not decreased till now. Aim. To reveal the clinical peculiarities of the course of generalized bacteriemia caused by dominating etiological agents in patients hospitalized to infectious hospital. Materials and methods. 119 patients with generalized bacteriemia hospitalized to Perm Regional Clinical Infectious Hospital in 2005-2012 underwent examination and treatment. Results. The dominating etiological agents causing generalized bacteriemia in patients hospitalized to infectious hospital were Staphylococcus aureus and Streptococcus pneumonia that should be taken into consideration as far as empiric antibacterial therapy in concerned. Conclusion. Hepatic lesion with cytolysis and bilirubinemia syndrome takes the first place in development of multiple organ failure. This disease can be accompanied by septic shock and patient’s death in spite of modern and adequate therapy used. In case of staphylococcal sepsis, there are disorders in hemostasis system and renal failure.

Aim. To increase the efficiency of revascularization of replanted extremity segment by means of including indirect endolymphatic heparin therapy into complex of medical measures. Materials and methods. The results of complex treatment of 42 patients with traumatic amputation of extremity segments are presented in the paper. In the postoperative period, treatment of patients of the main group (22 patients) included, along with traditional, prolonged lymphotropic anticoagulant therapy using 1% methylene blue in complex with heparin. The results were estimated with standard clinicolaboratory studies and arterial and venous ultrasound investigation. Results. Clinical analysis carried out in the main group of patients showed decrease in the number of microvascular anastomoses venous thromboses of replanted extremity segments from 20% to their absence ( p >0,05), decline in purulo-necrotic complications from 15% to their absence ( p >0,05), rise in the total number of satisfactory results for extremity segments’ replantation from 60% to 81,81% ( p <0,05) and reduction in bed-days from 28,89±4,12 to 23,13±5,07 ( p >0,05). Conclusion. Lymphotropic anticoagulant therapy using 1% methylene blue with heparin associated with standard introduction of heparin to patients with replanted extremities contributes to reduction of risk of developing venous thromboses of microvascular anastomoses by 20%, allows to reduce the terms of hospital period by 19,97% and can be an additional method for prevention of purulo-necrotic complication development in patients with replanted extremities.

Aim. To improve the results of correction and stabilization of scoliotic spinal deformity using posterior screw and combined systems. Materials and methods. The results of surgical treatment of 138 patients aged 3-48 were studied; 76% of patients were operated at the age of 11-17 years old. In 95% of patients, idiopathic and dysplastic scoliosis was diagnosed. Four groups of patients were singled out. In group 1, Harrington rods added by Luke’s fixation and posterior spondylodesis were used for 9 patients, in group 2 - 101 patients underwent a single-stage correction using posterior transpedicular screw and combined systems, in group 3 (18 patients) - 16 patients underwent a three-stage correction (1 - thoracotomy resection of the 4-5 th intervertebral disks, deformation mobilization and front corporodesis, 2 - craniotibial extension for 4-5 weeks) and 2 patients a two-stage correction (1 - thoracotomy resection of the 4-5 th intervertebral disks, mobilization and front corporodesis) and in group 4 (10 patients), patients with congenital anomalies of vertebral development predominantly against the background of disturbed formation (active postlateral semivertebras in the lumbar and inferothoracic parts) underwent resection and (or) vertebra osteotomy and posterior spondylodesis with back access using computer navigation. In groups 3 and 4, the same types of fixation devices as in group 2 were placed at the last stage. Clinicoroentgenological data, magnetic resonance and computer tomography parameters were studied. Results. In group 1, correction did not exceed 50% of the initial one. The lowest traumatism of intervention and high efficiency of a single-access and single-stage correction using posterior pedicular screw and combined systems was observed in group 2 (73%). In this group of patients with the initial deformation value up to 50°, correction was 90% of the initial value, in patients with the initial value of 51-100°, correction was 78% of the initial value. When using these fixation devices, in groups 2,3 and 4 a mean value of deformation correction of the basic arc was 69% of the initial one with screw transpedicular systems alone and 61% - with combined systems ( р <0,05). Correction loss during the period of 2-4 years was not more than 5% of the direct result ( р <0,05). Complications made 4,3%, they were eliminated conservatively and did not influence long-term results. Conclusion. Application of transpedicular and combined systems is a high-efficient variant of surgical treatment of scoliotic deformities with correction not less than 60% of the initial value irrespective of variant of surgical treatment. This technique gives minimal loss of correction in the postoperative long-term period.

Aim. To analyze new possibilities of fractional determination of the expired air nitric oxide. Materials and methods. 120 children aged 2-18, ill with bronchial asthma, primary ciliary dyskinesia (PCD) and other diseases were examined. To carry out fractional determination of the expired air nitric oxide, Analyzer CLD88 (ECO MEDICS®, Switzerland) was used. Estimation of the results of alveolar test (subsequent thrice-repeated determination of Fe NO with the expiratory rate of 30, 100 and 300 l/min) was performed by the following parameters: Ca NO (alveolar NO concentration); Caw NO (NO concentration in the upper airway tissues); Daw NO (NO duffusion rate); Jaw NO (NO flow from the upper airway tissues); Fe NO50 (extrapolated Fe NO value with the expiratory rate of 50 ml/s). Results. Caw NO level moderately correlated (r=0,58) with the nasal nitric oxide level and ranged from 5,7 ppb (in PCD patients) to 473,5 ppb (in a child with severe BA associated with exacerbated allergic rhinitis). Higher correlation degree was revealed between Jaw NO level (166,6÷8815,8 pl/s) and Fe NO and Fe NO50 level ( r =0,82 and r =0,78, respectively). Conclusion. Differentially diagnostic significance of the determined indices in bronchial asthma and primary ciliary dyskinesia was shown.

Aim. To study tumor necrosis factor-alpha (TNFα), circulating immune complex (CIC) levels, phagocytosis parameters and their correlation with functional hepatic tests in patients with chronic hepatitis C (CHC), Materials and methods. 90 patients with CHC and 20 practically healthy persons were examined. Blood serum functional hepatic tests, TNFα and CIC concentrations were studied using immunofermental analysis (IFA) method. Blood plasma phagocytic leukocyte activity, phagocytic index and phagocytic number were investigated. Results. In CHC patients, there was a reliable compared to the control group increase in TNFα concentration and CIC level: 1,9 pg/ml (min - 1,1; max - 4,2) and 54,5% (36-80), respectively. Phagocytic leukocyte activity and phagocytic number were lowered compared to the norm ( p =0,0001, p =0,02). Significant correlations between TNFα, CIC, phagocytosis depression and hepatic cytolysis and cholestasis indices were detected. Conclusion. Expression of immunoinflammatory syndrome correlates with severity of hepatic lesion in CHC patients.

Aim. The objective of our study was to investigate the status of endothelium in patients with metabolic syndrome. Metabolic syndrome (MS) is a block of hormonal and metabolic disorders united by a common pathophysiological mechanism - insulin resistance (IR). The connecting link between IR and cardiovascular diseases is endothelial dysfunction. Materials and methods. The problem was solved by means of assessment of vascular tonus changes using skin temperature range wavelet-analysis and VEGF determination while performing indirect cold test. Results. Serum VEGF concentration in MS patients was reliably higher than in practically healthy persons. In patients with MS, cold test response significantly differed from the control group. While carrying out cold test, the amplitude reliably decreased in endothelial and neurogenic bandwidth without its rise by the end of the study. There was revealed a reliable direct correlation between VEGF and BMI ( r =0,59; p <0,05), VEGF and WC ( r =0,58; p <0,05), VEGF and DAP ( r =0,57; p <0,05), VEGF and total cholesterol levels ( r =0,74; p <0,05). Conclusion. Thus, endothelial dysfunction in MS patients is displayed by impaired vasodilation in physiological cold test, but increase in patients’ VEGF level can be considered as an additional marker of cardiovascular risk.

Aim. To determine the peculiarities of bone visceral cranium structure constitution in children aged 7-10 with cross occlusion and transversal lower jaw displacement according to roentgenocephalometric data of direct teleroentgenogram of the head. Materials and methods. The results of roentgenocephalometric analysis of direct head teleroentgenograms of 60 children aged 7-10 with cross occlusion and transversal displacement of the lower jaw are presented in the paper. Parameters characterizing different anomalies in bone cranium structure constitution were determined. Results. Patients were divided into three groups depending on the degree of the lower jaw side displacement. Group 1 included 38 (63,3±6,2%) children with degree 1 lower jaw displacement; group 2 consisted of 12 (20±5,2%) children with degree 2 lower jaw displacement; group 3-10 (16,7±4,8%) children with degree 3 lower jaw displacement. Conclusion. Thus, no direct dependence between the bone structure constitution of maxillofacial region and the degree of their asymmetry with increase in transversal displacement of the lower jaw was noted.

Aim. To produce a frozen-dried vaccine form for prevention of infections induced by Haemophilus influenza of type b (HIB-vaccine), its standardization and preclinical assessment. Materials and methods. HIB-vaccine quality was estimated by the following parameters: quantitative determination of polyribosilribitol phosphate (PRP), solubility, drying mass loss, sterility, osmolarity, immunogenicity. Preclinical assessment of HIB-vaccine safety was performed on outbred white mice using standard methods including the study of acute and chronic toxicity, pathomorphological, hematological and biochemical investigations. Results. Technology of producing a frozen-dried drug form of HIB-vaccine was developed. To determine the identity of HIB-vaccine titanic component, an original method based on coagglutination reaction was offered. It was shown that a frozen-dried HIB-vaccine stimulates production of PRP antibodies in rabbits at the level comparable with AKT-HIB and Kimi-HIB vaccines (16,91, 17,19 and 15,28 mkg/ml, respectively). When using AKDS-Hep V+HIB and aAKDS-Hep V+HIB vaccines, a higher level of antibodies to polysaccharide (42,91 and 40,31 mkg/ml), respectively) as compared to monovaccines ( p <0,05) was observed. While studying HIB-vaccines in the tests of acute and chronic toxicity, no decrease in animal body mass as well as essential changes in biochemical and hematological indices was stated that proves absence of toxic effects of the drug. Conclusion. The studied physiochemical properties, sterility, identity, immunogenicity and specific safety showed that a frozen-dried form of synthetic conjugated vaccine for prevention of type b hemophilic infection, produced by the developed technology, completely corresponds to the requirements of European Pharmacopeia and can be used as a component of combined vaccines for prevention of diphtheria, tetanus, whooping cough, hepatitis B and hemophilic infection of type b .

Aim. To produce and control the experimental series of exhausted diphtheritic and tetanic anatoxins, not containing thiomersal, to study the vaccine storage stability, to conduct the comparative analysis of the obtained results and assess the comparability of drug containing thiomersal and free of it. Materials and methods. Experimental series of the drugs “ADS-M-anatoxin”, “AD-M-anatoxin” and “AS-anatoxin” free of thiomersal and commercial series of these preparations with thiomersal added were used as the object of studying. Safety, efficiency of vaccines and their physical-chemical properties were studied with generally accepted methods. Results. The data on control of experimental series (thiomersal-free) prove that the drugs ADS-M-anatoxin, AD-M-anatoxin and AS-anatoxin correspond to the requirements of normative documentation by all the parameters and do not differ from the series with preservative added. In conditions of storage at the temperature of 2 to 8°C, thiomesal-free drugs by their physical-chemical properties and safety are stable during all the period of shelf life established for drugs containing thiomersal. Specific activity of experimental series of the drug on completion of its shelf life corresponds to normative documentation requirements. On the basis of the obtained data, documents for making changes in registration dossier regarding the drugs “ADS-M-anatoxin”, “AD-M-anatoxin” and “AS-anatoxin” were prepared. Conclusion. The technology developed at Perm Branch of “SPA Microgen” of Ministry of Hhealth of Russia permits to produce thiomersal-free vaccines which by their physical-chemical parameters, safety and efficiency are identical to thiomersal-containing vaccines.

Aim. To study the influence of a sylvinite lecture-hall on the status of basic systems of the body and working capacity of students in dynamics of practical course training. Materials and methods. The object - 92 students aged 22-25, who were divided into two groups. Respiratory, cardiovascular and nervous system status was studied. Working capacity level was determined by Anfimov’s correcting test and forehead skin temperature. Psychoemotional status was assessed using “SAN” test, Spielberger-Khanin Scale and Self-Rating Questionnaire CES-D. Results. Training of students in conditions of a sylvinite lecture-hall has positive effects on psychoemotional and physiological status of the basic systems of the body and their working capacity in dynamics of studies and course. Conclusion. The obtained data grounded the availability of using sylvinite lecture-halls in educational process so as to maintain mental working capacity and exclude students’ tiredness.

Among the causes of asthma-like diseases there is a rare congenital vascular pathology - vascular tracheal ring clinically manifested by heavy breathing (sometimes - associated with dysphagia). The reported clinical observation of a fifteen-year-old patient with vascular tracheal ring permits to accentuate attention of physicians, pediatricians, pulmonologists on peculiarity of diagnosis and optimal low-invasive surgery of such patients.