Perm Medical Journal

Endothelial dysfunction (ED) is a key pathogenetic mechanism of many diseases, including chronic liver diseases (CLD). One of the informative and effective ways to assess the presence and severity of ED in CLD is to identify laboratory biomarkers in the blood, which can be used for the assessment of the degree of liver damage and prognosis of the disease. The issues of the physiological role of the endothelium, its functional characteristics and structural and functional features of the endothelium of hepatic hemocapillaries are highlighted in this review, the factors synthesized by the endothelium are presented, ED is characterized and the importance of some biomarkers in the estimation of ED in CLD is described.

For a more effective assessment of ED in CLD and correct selection of endothelium protective therapy, a comprehensive approach using laboratory and instrumental methods, or the use of several biomarkers reflecting different functions of the endothelium, are necessary.

Objective. То determine the changes in the quality of life in patients with uterine leiomyoma after various methods of surgical treatment.

Materials and methods. The patients who underwent a planned surgery for uterine leiomyoma at Central City Hospital No. 7 in Yekaterinburg participated in the study. The validated questionnaire SF-36 “Assessment of the Quality of Life” was used; the patients filled it in before and 2 months after the surgery. The respondents were randomized into groups: those who underwent total hysterectomy (n = 20), subtotal hysterectomy (n = 20) or myomectomy (n = 20). The results are presented as median values and standard deviations.

Results. The quality of life of women has improved after the surgical treatment for uterine leiomyoma. The average quality of life indicator increased after subtotal hysterectomy by 13,2 (9,2) %, after myomectomy – by 16,6 (8,1) %, after total – by 21,6 (5,1) %.

Conclusions. Any method of surgery for uterine leiomyomas improves the quality of life of women. After total hysterectomy, the quality of life indicators are higher than after subtotal variant and organ-preserving operations.

Objective. To identify predictive risk factors for pain syndrome following two video laparoscopic methods: transabdominal preperitoneal repair (TAPP) and total extraperitoneal repair (eTEP).

Materials and methods. 460 patients (aged 18–85 years) who underwent surgical treatment for inguinal hernia at Davydovsky City Clinical Hospital from January 2019 to May 2022 were included in the study. The patients were divided into two groups: 348 patients underwent laparoscopic TAPP, and 112 patients underwent laparoscopic eTEP. To assess inguinodynia the Visual Analogue Scale (VAS) was used one day and six months after the surgery.

Results. Body mass index (BMI), hypertension, the type of hernioplasty, and prior surgeries in the lower abdomen were determined as key risk factors for inguinodynia. ROC analysis revealed negative influence of prior lower abdominal surgeries on postoperative pain, with these patients reporting less discomfort. Both early postoperative pain and chronic inguinodynia were significantly more frequent after TAPP, which we considered to be associated with the features of this method, particularly the dissection of the parietal peritoneum.

Conclusions. Advantages of laparoscopic hernioplasty in reducing the risk of chronic pain compared to open inguinal hernia repair techniques were demonstrated. However, among laparoscopic methods, TAPP is associated with a higher incidence of both early and chronic postoperative pain, likely due to the dissection of the parietal peritoneum. The lowest pain levels were observed with the use of adhesive fixation for the implant. The analysis identified significant predictors of inguinodynia risk, including BMI, hypertension, and the type of hernioplasty, emphasizing the importance of an individualized approach to choosing the method of treatment.

Objective. To improve the outcomes of surgical treatment for patients with obstructive jaundice (OJ) through the differentiated application of combined minimally invasive technologies.

Materials and methods. The results of treatment of 301 patients with OJ of various etiologies and severity levels were analyzed.

Results. Benign diseases (BD) of the hepatopancreatobiliary region (HPBR) causing OJ were observed in 175 (58.1 %) patients, while malignant neoplasms (MN) were identified in 126 (41.9 %) cases. The E.I. Galperin classification of OJ was used: class A included 117 (38.9 %) patients, class B – 132 (43.9 %), and class C – 52 (17.3 %). The method of treatment was chosen depending on the etiology and severity of OJ, the level of bile ducts obstruction, and the comorbidity. Both single-stage and two-stage procedures were performed, including cholecystectomy, as well as retrograde and anterograde endobiliary and transpapillary interventions. A significantly higher mortality rate was observed in patients with OJ caused by MN of the HPBR – 43 (34.1 %) cases. Mortality in patients with BD was 17 (10.3 %) and was associated with the presence of acute cholecystitis and paravesical purulent-septic complications. Multivariate logistic regression and ROC analysis confirmed that preoperative risk factors such as malignant etiology, class C of OJ, hyperphosphatasemia, and comorbidities (bronchial asthma, coronary heart disease, post-infarction cardiosclerosis, diabetes mellitus, and consequences of cerebrovascular disorders) increased the risk of mortality in patients with OJ significantly.

Conclusions. The treatment of patients with HPBR diseases complicated by OJ requires a differentiated approach to the selection of the optimal extent and staging of combined surgical interventions. The developed mathematical model of predicting the risk of adverse outcomes in OJ demonstrated high accuracy confirming its significance as a tool for optimizing treatment strategies for the patients with HPBR diseases complicated by OJ.

Objective. To estimate the results of lipopolysaccharide adsorption using a domestic Efferon LPS cartridge in the complex treatment of maternal sepsis and septic shock.

Materials and methods. In Perm Regional Clinical Hospital, a comprehensive treatment of 22 patients with maternal sepsis or septic shock was carried out using LPS adsorption with domestic Efferon LPS columns in Perm Regional Clinical Hospital. The results of clinical and laboratory examination were compared before extracorporeal selective adsorption of endotoxin and in 24, 48 and 72 hours. The APACHE and SOFA scales were used. The level of inflammation biomarkers and endotoxin activity were determined.

Results. After LPS adsorption, the median SOFA score decreased significantly to 5 (p = 0.00). A distinct decline was observed in the levels of creatinine, lactate dehydrogenase, procalcitonin, interleukins 1b, 8, 10, a tendency to decrease in the amount of C-reactive protein, presepsin, interleukin 6, tumor necrosis factor and endotoxin activity. The maximum effect of LPS adsorption using Efferon LPS columns occurred after the first session. After the second procedure, the severity on SOFA scale, endotoxin activity, procalcitonin and lactate levels decreased insignificantly. In 72 hours, the amount of procalcitonin and lactate tended to increase again.

The hospital 28-day mortality rate was 22.73 %. The fatal outcomes correlated with the patients` initial condition. The higher the scores on the APACHE, SOFA scales, the Charlson index, the initial dose of norepinephrine (r = 0.38, p = 0.00; r = 0.37, p = 0.00; r = 0.34, p = 0.00; r = 0.43, p = 0.02, respectively) were, the worse was the result of the comprehensive treatment for maternal sepsis. Improvement of the clinical condition on the SOFA scale, an oxygenation index, and a decrease in vasopressors dose (r = 0.71, p = 0.00; r = -0.54, p = 0.00; r = 0.61, p = 0.00, respectively), as well as the results of laboratory studies (lactate – r = 0.58, p = 0.00; EAA – r = 0.57, p = 0.00; PCT – r = 0.59, p = 0.00) had a medium or strong correlation with the patients` recovery.

Conclusions. The inclusion of lipopolysaccharide adsorption with domestic Efferon LPS columns in the comprehensive treatment for maternal sepsis and septic shock makes it possible to achieve a significant improvement in the patients` clinical condition, reduce the level of inflammation biomarkers, endotoxin activity and interleukins.

Objective. To assess the opportunities and efficiency of integration of lean production tools and methods into the practical activities of primary and specialized medical care on the example of multidisciplinary dental clinic «Dental-Lux» LLC, Saratov

Materials and methods. This study included the following stages: primary data collection by anonymous sociological survey using telecommunication devices (a phone or a tablet), placing the questionnaire on the clinic's website and at the reception desk; analyzing the data and making suggestions for improving the activity on the basis of these data; elimination of the shortcomings detected in the survey and implementation of the improvements into the daily practice; repeated patient survey (using the same method and the same questionnaire) with an assessment of patients’ satisfaction with the quality of dental care in Saratov. The authors conducted a survey of 128 residents of Saratov who receive dental care in the multidisciplinary dental clinic «Dental-Lux» LLC, Saratov («Dental-Lux» LLC). A specially designed questionnaire included questions about the respondents, as well as a block of questions concerning patients’ satisfaction with the process and quality of dental care at «Dental-Lux» LLC. For mathematical processing, the results of the study were initially entered into an electronic database; the analysis of the study results was carried out using the method of descriptive statistics.

Results. While carrying out the study, it was found out that the majority of the respondents were satisfied with the quality of dental care provided on an outpatient basis. This indicates the focus of the organization of specialized dental care in «Dental-Lux» LLC on the patients’ requirements and the desire to meet their needs. The research has shown that inefficient organization of the registration office work and making an appointment to the doctor contributed to the low degree of patients’ satisfaction significantly. The authors believe that, in order to solve the problem, it is necessary to optimize the work of the registration desk by introducing modern technologies and ensuring uniform distribution of responsibilities among the employees.

Conclusions. While conducting the study it was determined that the organization of medical care, including the non-state healthcare institutions, requires continuous improvements and changes. Identifying problem areas and working on them are key aspects in the improvement of treatment and diagnostic process organization. It is important to address each of the above factors individually in order to increase the level of patients’ satisfaction. A continuous internal audit and further correction of the identified problems in any medical organization will raise the level of satisfaction with medical care among the population.

Objective. To analyze the organization of medical care for patients having experienced acute coronary syndrome (ACS) in terms of rehabilitation and long-term follow-up in Perm Krai (PK).

Materials and methods. Specialists from the Ministry of Health of Perm Krai and employees of Perm State Medical University (PSMU) conducted an audit of the organization of rehabilitation process and long-term follow-up of patients who have suffered from ACS using the regional data of 2024.

Results. In 2023, the total mortality rate per 100,000 population in Perm Krai was higher than the Russian average (1333.8 versus 1206.2). However, there was a decrease in the mortality rate by 4.1 % compared to 2022. The structure of mortality from diseases of the circulatory system: chronic forms of coronary heart disease (CHD) was 46.5 %, acute myocardial infarction (MI) accounted for 4.3 % of CVD. The number of patients with CHD was 76,870 in 2018 and 80,867 in 2023, but only 65,322 (68.0 %) of them were under a long-term follow-up in 2023. The number of patients with the history of ACS being under medical supervision decreased from 6,859 people in 2018 to 5,948 people in 2023. The proportion of patients with ACS who got the first stage cardiac rehabilitation became 3 times less. In 2023, the coverage of follow-up monitoring of patients with MI (84.3 % versus 91.6 % in the Russian Federation) and stroke (83.4 % versus 91.0 % in the Russian Federation), newly diagnosed patients with diseases of the circulatory system (67.8 % versus 73.1 %) and newly diagnosed patients with coronary heart disease (68.0 % versus 78.8 % in the Russian Federation) remains low. Detection rate of coronary heart disease (3.8 % versus 4.9 % in the Russian Federation) and cerebrovascular disease (3.5 % versus 5.0 % in the Russian Federation) among patients is poor.

Conclusions. To improve the long-term follow-up of patients with ACS in Perm Krai, we propose several key measures: organizing a monthly analysis of the effectiveness of long-term follow-ups, on-site counseling and training by specialists from the leading institutions of the region, ensuring continuity between inpatient and outpatient departments and informing the population. It is also necessary to intensify the rehabilitation process in general.

Right ventricular myocardial infarction (RVMI) is quite a rare and difficult to diagnose disease. The leading method in the diagnosis of RVMI is a standard electrocardiography (ECG) in 12 leads, but a reliable establishment of this pathology is possible only with the use of mirror-image right precordial leads. In the presented clinical case, a 68-year-old patient was admitted to the hospital with complaints of weakness in the right extremities, speech impairment, nausea and vomiting. A complete examination was carried out and conservative treatment was initiated. Despite the treatment being administered, the patient's condition continued to deteriorate progressively, and therefore it was decided to transfer the patient to the intensive care unit, where an ECG revealed the likelihood of ischemia of the anterolateral and lower walls. The next day, respiratory and cardiac arrest was diagnosed, and resuscitation measures had no effect. During autopsy, cardiomyocyte necrosis zones with perifocal inflammation were found in the myocardium of the right ventricle, corresponding to myocardial infarction within 6 to 12 hours. Clinical observation emphasizes the importance of timely diagnosis of RVMI, especially against the background of severe metabolic disorders in the organism caused by diabetes mellitus.

A clinical case of liver echinococcosis complicated by cyst rupture into the bile ducts and gallbladder is presented. It is a rare but serious condition which requires emergency medical care.

Liver echinococcosis is a serious medical problem, especially in endemic regions. Complications of the disease, such as cyst rupture into the bile ducts with the development of obstructive jaundice, aggravate the clinical course of the disease significantly, leading to cholangitis, hepatic abscesses and liver failure. It is a clinical case of a 36-year-old patient with an echinococcal hepatic cyst that ruptured into the biliary tree, which led to the development of obstructive jaundice and cholangitis. Diagnostic methods, including ultrasound, magnetic resonance imaging and endoscopic retrograde cholangiopancreatography are described, as well as the successful use of endoscopic papillosphincterotomy and choledochotomy with the removal of parasite elements and drainage of the biliary tract.

Objective. To study the bacteriotropic properties of "KLYUCHI" mineral water in relation to bacteria of the genera Bifidobacterium, Lactobacillus and Escherichia.

Materials and methods. The impact of "KLYUCHI" mineral water on the representatives of the indigenous microbiota of the gastrointestinal tract was determined. Probiotic strains L. plantarum 8P-A3 and B. bifidum 1 were cultivated on a "starvation" nutrient medium. The level of accumulation of cellular biomass, pH, acid-forming activity and concentration of the carbohydrate component were assessed in the culture fluid, The influence of mineral water on the physiological state of bacterial cells was studied by determining the intensity of bioluminescence of the genetically engineered strain E. coli lum+ using various solvents for rehydration of the lyophilized indicator culture.

Results. "KLYUCHI" mineral water had a significant stimulating effect on the accumulation of biomass and acid formation of the tested strains of lactobacilli and bifidobacteria. The stimulating effect was more pronounced in the bifidobacteria culture. Contact of bacterial cells with mineral water both in the form of a solvent for the lyophilized culture and as an additional component of the nutrient medium provided almost equivalent results. Mineral water had a pronounced stimulating effect on the bioluminescence of the indicator strain, increasing the intensity of its luminescence twice compared to the control.

Conclusions. The stimulating effect of “KLYUCHI” mineral water on the representatives of the indigenous intestinal microbiota confirms the validity of its use in the treatment of gastrointestinal diseases, eating and metabolic disorders, as well as in probiotic therapy.

This article highlights the life path of the talented and goal-oriented surgeon, Boris Borisovich Kapustin, from a resident to an outstanding surgeon, the head of the Department of Hospital Surgery of Izhevsk State Medical Academy.