Vol 33, No 6 (2016)
- Year: 2016
- Articles: 15
- URL: https://journals.rcsi.science/PMJ/issue/view/345
Articles
PECULIARITIES OF TEMPORARY AND SPECTRAL INDICES OF CARDIAC RHYTHM VARIABILITY IN ARTERIAL HYPERTENSION AND DUODENAL ULCER COMORBIDITIES
Abstract
Aim. To study the cardiac rhythm variability in patients with associated course of arterial hypertension and duodenal ulcer. Materials and methods. Eighty one persons, males, with a mean age of 35 ± 10,3 years were examined. The main group included 20 patients with duodenal ulcer (DU), 25 - with arterial hypertension (AH), 21 - AH associated with DU. The comparison group joined practically healthy men. Results. Among patients with associated course of AH and DU, the studied temporary and spectral indices of cardiac rhythm variability were decreased. Besides, increase in low-frequency component was observed in patients. The obtained data indicate dysfunction of vegetative nervous system with elevated sympathetic activation of nervous system and reduction of parasympathetic one. Conclusions. When AH is associated with DU, the latter aggravates the available excessive influence of sympathetic nervous system in AH patients, thus leading to parasympathetic insufficiency.
Perm Medical Journal. 2016;33(6):5-9
5-9
CLINICOFUNCTIONAL CHARACTERISTIC OF PATIENTS WITH ACUTE CORONARY SYNDROME WITHOUT ST SEGMENT ELEVATION AGAINST THE BACKGROUND OF ACUTE ATRIAL FIBRILLATION
Abstract
Aim. To study the clinicofunctional peculiarities of patients with acute coronary syndrome without ST segment elevation (ACSwSTE) against the background of acute atrial fibrillation (AF); to estimate the effect of AF on short-term prognosis in this group of patients. Materials and methods. Seventy one patients aged 62, [57; 70] including 38 women and 33 men, who were admitted to intensive cardiology unit with diagnosis of ACSwSTE, were examined. These patients were divided into 2 groups: group1 - ACSwSTE with acute AF, group 2 - ACSwSTE without AF. Patients’ examination, besides general clinical study, included echocardiography. Hospital lethality for the period of observation was analyzed. Results. In the group of patients suffering from ACSwSTE with AF there prevailed men. The course of ACSwSTE against the background of AF was accompanied by moderate decrease in glomerular filtration rate. According to ECG data, AF patients more often had the left ventricular myocardial hypertrophy and left atrium dilatation. Over the observation period no lethal outcomes were registered. Conclusions. Among patients with AF and ACSwSTE, enlargement of the left atrium, left atrial volume and left ventricular myocardium mass index was detected. Regardless of the common opinion, AF does not cause growth of hospital lethality in patients with ACSwSTE.
Perm Medical Journal. 2016;33(6):10-16
10-16
PECULIARITIES OF SINUS NODE PACEMAKER ACTIVITY DISREGULATION IN PATIENTS WITH ISCHEMIC HEART DISEASE, DIABETES MELLITUS AND ASSOCIATION OF THESE PATHOLOGIES
Abstract
Ключевые слова. Сахарный диабет, вариабельность ритма сердца, ишемическая болезнь сердца. Aim. The method of rhythmocardiography (RCG) was used to study the peculiarities of pacemaker activity disregulation of the sinus node of the heart in patients with ischemic heart disease (IHD), type 2 diabetes mellitus (DM2) and their association as well as to ground the significance of the associated pathology in aggravation of cardiac rhythm variability (CRV) parameters. Materials and methods. The study included patients with IHD ( n = 42), DM2 ( n = 100) and DM2+IHD ( n = 63). The groups were comparable by the age (mean age 56,9 ± 7,6 years) and gender distribution. Cardiac rhythm variability was analyzed with the method of high-performance RCG using KAP-RK-01-“Mikor” (registration certificate №FS-022б2005/2447-06). Results. The results of comparative analysis of CRV in patients with IHD ( n = 42), DM2 ( n = 100) and DM2+IHD ( n = 63) were respectively the following: total variability SDNN - 0,025 ± 0,01; 0,019 ± 0,01; 0,015 ± 0,006; root-mean-square deviations (in seconds) of humoral-metabolic σI (0,016 ± 0,006; 0,013 ± 0,007; 0,011 ± 0,005), sympathetic σm (0,010 ± 0,007; 0,008 ± 0,007; 0,005 ± 0,003) and parasympathetic waves σs (0,14 ± 0,008; 0,010 ± 0,008; 0,007 ± 0,004) and their percentage (VLF% - 58,1 ± 17,2; 56,5 ± 19,0; 48,2 ± 18,6; LF% - 13,3± 7,4; 16,4 ± 12,2; 17,9 ± 12,2; HF% - 25,6 ± 18,3; 33,8 ± 18,6; 26,9 ± 18,6). Statistically significant differences ( Z = 3,4-10,8; p < 0,05) demonstrated aggravation of CRV in DM2+IHD as compared with IHD as well as with DM2. Conclusions. More marked SN disregulations in case of DM2+IHD association as compared to those in patients with DM2 without IHD and to patients with IHD without carbohydrate metabolism disturbances were found; a negative effect of DM2 and IHD association is evident.
Perm Medical Journal. 2016;33(6):17-23
17-23
CHANGES IN BLOOD FREE FATTY ACID CONTENT AMONG CHILDREN WITH LATENT FORM OF CHRONIC RENAL FAILURE
Abstract
Aim. To assess the status of blood free fatty acid balance in children with megaureter diagnosed latent form of chronic renal failure. Materials and methods. The study design: prospective, controlled, nonrandomized, one-centered. The study included 40 children, divided into 2 groups. The main group ( n = 22) - patients after surgical intervention for megaureter with developing renal dysfunction. The comparison group - 18 relatively healthy children with a mean age of 6,1 ± 1,3 years. Results. It was revealed by the authors that in patients of the main group statistically significantly raised the content of a number of fatty acids. When conducting correlation analysis between the levels of blood total protein, erythrocytes and leukocytes with free fatty acid pool, it was detected that there are reliable, differently directed strong correlations between some of them. Conclusions. Children, who underwent surgical intervention for megaureter followed by development of latent chronic renal failure, differ from healthy children by both total protein content and qualitative composition of blood free fatty acids.
Perm Medical Journal. 2016;33(6):24-28
24-28
ASSESSMENT OF MORPHOLOGICAL ADENOID TISSUE CHANGES IN AGE ASPECT AMONG CHILDREN WITH DENTO-MAXILLARY ANOMALIES
Abstract
Aim. To study the structural peculiarities of the adenoid tissue in children with dento-maxillary anomalies considered in age aspect as well as possible correlations. Materials and methods. Three groups of children were formed: group 1 - children aged 3 to 5 years, group 2-5 to 8 years, group 3-8 and older, who underwent surgical treatment of adenoid growth. Histological study of the ablated tissue was carried out. Results. In children of group 1, adenoid tissue structure provided the adaptation of local immune system to the exposure of local exogenous factors and formation of respiratory immune barrier that can be considered as a phase of formation of local immune barrier. In children of group 2, barrier function of epithelium was weakened in connection with focal squamous cell metaplasia. The symptoms of chronic inflammation with adequate reaction of lymphoid tissue and stress of immune response were noted. In group 3, persistence of microbial agents in crypts with inflammatory cells available was revealed. It was a symptom of chronic inflammation due to exhaustion of the local lymphoid tissue. Conclusions. Processes taking place in the structure of adenoids serve as a local immune response to the exposure of exogenous factors.
Perm Medical Journal. 2016;33(6):29-35
29-35
COMPLEX APPROACH TO DIAGNOSTICS AND MANAGEMENT OF INFECTED PANCREATONECROSIS
Abstract
Aim. To improve the diagnostics and management of patients with infected pancreatonecrosis. Materials and methods. Eighty one patients with infected pancreatonecrosis were treated at the surgical unit of City Clinical Hospital № 21 of the city of Ufa from 2010 to 2015. Complex assessment of the patients’ health status was conducted on the basis of integral scales such as Ranson, Glasgow, BISAP, modified Marshall, APACHE II, APACHE III, APACHE IV, MEWS, CTSI, EPIC, HAPS. Infected pancreatonecrosis was diagnosed on the basis of procalcitonin, C-reactive protein, lipopolysacharide of gram-negative bacteria levels, CT with bolus contrast. Laparoscopic surgery with retroperitoneoscopic sanations of retroperitoneal cellular tissue with phlegmon available was performed. Besides, assisted sequestrnecrectomies with handport inserted into the left hypochondrium and formation of omentoburstoma were carried out. Results. A mean period of staying at the hospital was 80 ± 3,7 days; lethality - 27,3 %. External pancreatic was formed in 21,8 %. Pancreatic pseudocysts were formed in 20 %. Conclusions. This algorithm permitted to diagnose infected pancreatonecrosis. Mini-invasive techniques allowed to reduce mortality and quantity of the postoperative complications.
Perm Medical Journal. 2016;33(6):36-41
36-41
DISTURBED ADIPONECTIN SECRETION IN PATIENTS WITH ASSOCIATED CHOLELITHIASIS AND TYPE 2 DIABETES MELLITUS
Abstract
Aim. To study adiponectin secretion and its disturbance in patients suffering from cholelithiasis (C) associated with type 2 diabetes mellitus (DM2). Materials and methods. Adiponectin secretion was studied in 22 patients with cholelithiasis associated with DM2, arterial hypertension (AH), nonalcoholic hepatic fatty disease (NAHFD), obesity (group 1) and in 10 women with polymorbid pathology, but without cholelithiasis (group 2). Results. Blood adiponectin level in patients of group 2 decreased as compared with its level in the group of young healthy women, respectively 14,26 ± 1,01 mkg/ml and 17,9 ± 1,15 mkg/ml ( p < 0,05). Blood adiponectin level in patients of group 1 was higher versus patients of group 2 and was equal to 15,79 ± 1,75 mkg.ml. Conclusions. Patients suffering from DM2 associated with obesity, AH, dislipidemia and, NAHFD had decreased adiponectin secretion. When cholelithiasis is associated with polymorbid pathology, a higher level of blood adiponectin is observed, despite lipid metabolism disorders and atherogenesis. So, delay of adiponectin secretion, caused by cholestasis in such patients, can’t be excluded.
Perm Medical Journal. 2016;33(6):42-49
42-49
PECULIARITIES OF ABDOMINAL VESSELS HEMODYNAMICS IN PEDIATRIC MUCOVISCIDOSIS
Abstract
Aim. To characterize the hemodynamics in the abdominal cavity vessels among children with mucoviscidosis depending on the type of hepatic lesion. Material and methods. Thirty one patients with mucoviscidosis aged 7-17 years were examined. Dopplerograpy was used to estimate hemodynamics in the vessels of the abdominal cavity including determination of their diameters, linear and volumetric blood flow rates and resistance index. Results. Dilatation of abdominal vessels in mucoviscidosis, decrease in linear blood flow rate and rise in resistance index in children’s celiac trunk with essential disorders of the liver structure was found. In the venous vessels, growth of volumetric blood flow rate was registered as the degree of structural hepatic parenchyma disorders increased. Conclusions. Mucoviscidosis in children with marked disorders of liver structure is characterized by dilatation of abdominal arteries and veins, except abdominal aorta and postcava. Changes in regional hemodynamic parameters for this category of patients were manifested by decrease in linear and rise in arterial and venous volumetric blood flow rate as well as growth in resistance index.
Perm Medical Journal. 2016;33(6):50-54
50-54
PROAPOPTOTIC MARKERS IN DISSEMINATED SCLEROSIS
Abstract
Aim. To study the quantitative content of blood serum sAPO-1/FAS in patients with disseminated sclerosis (DS) and healthy adults. Materials and methods. The data from 1084 patients with disseminated sclerosis, residents of Perm Krai, were analyzed. Risk factors for the development of this disease were determined on the basis of a large sampling. Emotional status and quantitative sAPO-1/FAS content was studied in the group of patients consisting of 46 persons, who did not differ from a massive sampling by sex, age, disability degree, severity and type of disease course. Results. Disseminated sclerosis prevalence in Perm Krai was 41,2 cases per 100 thousand of the population (01.01.2014). Risk factors for DS development are the following: viral infections as factors “triggering” the onset and exacerbation of DS, chronic tonsillitis and measles in anamnesis, mother’s age ranging 31 to 40 years, contact with dyes and metals after reaching the age of 15, durable work using computer as well residence near chemical plants. Conclusions. Patients with disseminated sclerosis have a high degree of reactive and personal anxiety, comorbid with preclinical stage of depression. A mean content of blood serum sAPO-1/FAS in DS patients exceeds the healthy persons’ parameters and correlates with disability degree by EDSS scale. The obtained data prove participation of proinflammatory reactive factor of sAPO-1/FAS (sCD-95) apoptosis in mechanisms of DS neurodegenerative process.
Perm Medical Journal. 2016;33(6):55-59
55-59
BLOOD NEUROTROPHINS IN CHRONIC CEREBRAL ISCHEMIA
Abstract
Aim. To study the emotional and cognitive statuses, quality of life as well as quantitative content of neurotrophic factors such as blood serum BDNF, CNTF in patients with stages I and II chronic cerebral ischemia (CCI). Materials and methods. Seventy three patients (13 men and 60 women with a mean age of 63 ± 6 years) with CCI were examined and treated at the Health Resort “Klyuchi”. All of them underwent psychometric testing and determination of serum neurotrophic factors (brain-derived neurotrophic factor (BDNF), ciliary neurotrophic factor (CNTF). Results. Cognitive and emotional disorders of different degrees and decrease in quantitative blood serum BDNF content (386,4 ± 107 pg/ml) was revealed. A mean index of CNTF was 125 ± 10,5 pg/ml, that did not differ from the control figures; BDNF level correlated with the degree of cognitive disorders and manifestation of neurological deficit. Conclusions. Among CCI patients there was observed a reduction in cognitive functions connected with deficit of cerebral neurotrophic factor BDNF in blood, which occurs, probably, as a result of decrease in cerebral activity in conditions of depleted cerebral blood flow.
Perm Medical Journal. 2016;33(6):60-65
60-65
CARBOHYDRATE METABOLISM INDICES IN BODY TISSUES EXPOSED TO LOW TEMPERATURES
Abstract
Aim. To analyze the indices of tissue carbohydrate metabolism for determination of tanatogenesis processes and establishment of immediate causes of death in sufferers with craniocerebral injury and drowning in conditions of low temperatures of environment. Materials and methods. Tissue glycogen and lactate content (hepatic, skeletal muscular and myocardial) was studied using sectional material from 111 persons, who died from craniocerebral injury as a result of traffic accident and 80 persons - from drowning in cold water. Material from 16 persons, who died from cardiac pathology, served as a control. Two groups of comparison were formed: 25 and 30 persons, who died from hypothermia. Results. The most informative and significant for diagnosis was lactate content in the skeletal muscle, critically decreasing with death occurring as a result of hypothermia. Thus, an immediate cause of death from craniocerebral injury as well as drowning in conditions of low temperatures of environment is hypothermia (more than a half of cases). Conclusions. Glycogen and lactate content in the skeletal muscle permits to assess the immediate cause of death in persons, who had suffered from craniocerebral injury and from drowning in conditions of low temperatures. Absence or significant fall in glycogen content as well as decrease in lactate content < 41 mcmol/g in skeletal muscle prove hypothermia to be an immediate cause of death.
Perm Medical Journal. 2016;33(6):66-71
66-71
ORGANIZATIONAL PROBLEMS OF MICROBIOLOGICAL AIR MONITORING AT MEDICAL INSTITUTIONS
Abstract
Aim. To study the documents, regulating the content of different air microorganisms in rooms of medical institutions. Materials and methods. Peculiar features of documents acting in the Russian Federation, which regulate microbiological contamination of air in medical institutions were studied. Results. The main drawbacks in standards, which don’t permit to diagnose in a proper way health care-associated infections (HCAI) were revealed. Conclusions. It is necessary to work out unified methods and supplements to sanitary-and-epidemiological rules and standards, allowing to determine the principle requirements for a complex of organizational, treatment-and-prophylactic, sanitary and antiepidemic measures, directed to prevention and reduction of HCAI.
Perm Medical Journal. 2016;33(6):72-77
72-77
HEALTH OF MEDICAL STAFF OF PENSIONABLE AGE WORKING AT EMERGENCY STATION
Abstract
Aim. To estimate the conditions of work for medical staff of pensionable age, working at emergency station. Materials and methods. Morbidity of medical staff of pensionable age was studied, morbidity indices were compared with those of the population, biochemical blood indices of medical staff working at a large-scale emergency substation were studied. Conditions of work were investigated for determining risk factors negatively influencing workers’ health status. Results. Emergency medical staff risk is attributed to harmfulness of class 3; it is associated with work in conditions of active thoroughfare. The studied biochemical blood indices indicated the most significant changes in lipid metabolism, resulting in high cardiovascular morbidity and nervous pathology indices. Conclusions. Among medical staff of emergency stations, percentage of workers of pensionable age is high. Health status is characterized by high cardiovascular and nervous system sickness rate as well as occupational burning syndrome.
Perm Medical Journal. 2016;33(6):78-82
78-82
ASSESSMENT OF NONSPECIFIC BODY PROTECTION BY DETERMINING ORAL FLUID HUMORAL FACTORS
Abstract
Aim. To study the correlation between the salivary humoral immunity factors and the health status in different age groups of the population. Materials and methods. Children of preschool and school age as well as young soldiers participated in the study. So as to assess the activity of humoral immunity factors, the authors’ method for determining an individual value of human nonspecific body protection (NBP) in the oral fluid was used. Results. The study carried out confirms the possibility of using the above method for determining an individual NBP value and prediction of treatment efficiency for different oral diseases. Conclusions. The obtained results permit to recommend a safe express method, which does not need blood sampling; saliva sampling can be fulfilled at the place of treatment, work or training of the examined patient.
Perm Medical Journal. 2016;33(6):83-89
83-89
MUSCULAR BRIDGE AS A CAUSE OF ANTERIOR MYOCARDIAL INFARCTION DEVELOPMENT: CLINICAL CASE
Abstract
The work is devoted to estimation of the availability of such congenital anomaly of coronary arteries as myocardial muscular bridge. A clinical case, when muscular bridge caused the development of acute myocardial infarction, is presented and considered. The possible reasons for development of myocardial infarction in patients with muscular bridge available are described.
Perm Medical Journal. 2016;33(6):90-94
90-94