卷 39, 编号 1-1S (2020)
- 年: 2020
- 文章: 87
- URL: https://journals.rcsi.science/RMMArep/issue/view/2606
- DOI: https://doi.org/10.17816/rmmar.1S1
Articles
ELASTOGRAPHY. RESEARCH OF THE CONDITION OF THE CARTILAGE AND NEAR-ARTICULAR SOFT TISSUES IN RHEUMATOLOGY DISEASES
摘要
Currently, there are many different instrumental methods for diagnosing lesions of articular and periarticular soft tissue. The most popular of them: magnetic resonance imaging, radiography, computed tomography, ultrasound. Of the above methods, the most affordable is ultrasound, which is also according to recent studies is characterized by high sensitivity in detecting early changes in articular tissue. A type of ultrasound technique is elastography, which is aimed at diagnosing tissue elasticity by measuring its deformation under the influence of an ultrasonic wave. In rheumatology, most diseases are manifested by damage to the articular tissue, therefore their early diagnosis is very important, before clinical manifestation. The method of elastography is a very promising research method, since inflammatory and dystrophic tissues can reveal changes in their elasticity. The aim of this study was to compare color cartograms and numerical values of tissue elasticity of people exposed to rheumatic joint damage with healthy people. Of particular interest and interest was an attempt to study the cartilage tissue, namely the patellar cartilage itself, in order to assess the possibility of visualizing the elasticity of the cartilage tissue by elastography and the objectivity of numerical values when comparing two groups of people. The study included 20 people. Her own ligament of the patella, cartilage of the patella, Achilles tendon and plantar fascia were examined. As a result, a characteristic color palette of the cartogram for each group was revealed, and the average numerical values of the elasticity of the articular and soft periarticular tissues, expressed in the speed of ultrasonic wave propagation and tissue density, were calculated. The results obtained characterize these instrumental research methods, as the most accessible and sensitive in rheumatology for identifying the initial manifestations of joint pathology, but requiring more research and development of examination methods.
Russian Military Medical Academy Reports. 2020;39(1-1S):5-9
5-9
STUDYING THE ROLE OF MELATONIN AND CHRONIC INFLAMMATION IN THE DEVELOPMENT AND PROGRESSION OF THE METABOLIC SYNDROME IN YOUNG PEOPLE
摘要
A single-center observational study was conducted of 95 people who were examined at the clinic of military field therapy of the S. Kirov Military Medical Academy and the St. Petersburg National Research Academic University of the Russian Academy of Sciences. Two groups were formed: the control (n = 46) - practically healthy young men and the studied (n = 49) - young men with metabolic syndrome. Based on the results of laboratory and instrumental studies, a comparative analysis of the level of 6-COMT, markers of chronic inflammation, data of biochemical and general clinical blood tests between the studied groups, as well as a correlation analysis between the studied indicators of 6-COMT of the day and night fractions were carried out. A 2-fold decrease in the level of 6-COMT was found in young people with metabolic syndrome, an increase in the level of pro-inflammatory cytokines (IL-1, IL-6, TNF-α) and a decrease in anti-inflammatory cytokines (IL-4 and IL-10) in the study groups, in comparison with almost healthy young men. Consequently, the metabolic syndrome in young people is associated with the presence of latent sluggish inflammation due to the low concentration of melatonin in the blood, and, consequently, a decrease in its anti-inflammatory function. The scientific novelty of this study is to determine the importance of the influence of melatonin in the development and progression of the metabolic syndrome and chronic sluggish inflammatory process, which are modulated factors of cardiovascular diseases. The scientific and practical significance of this study is to determine the role of melatonin as a factor that initiates obesity and the accompanying inflammatory process in young people.
Russian Military Medical Academy Reports. 2020;39(1-1S):9-12
9-12
PECULIARITIES OF CARDIOVASCULAR RISK FACTORS IN MEN UNDER 60 YEARS OLD WITH MYOCARDIAL IN- FARCTION AND RECIDIVATING ISCHEMIC EPISODES
摘要
Recurrent ischemic events extremely negatively affects on the prognosis of myocardial infarction (MI). It has been shown that their frequency has recently increased against the background due to the increasing role of percutaneous coronary interventions. Moreover, information about the influence of risk factors of cardiovascular disease (CVD) on the development of recurrent episodes of ischemia (REI) is contradictory. The purpose of the study: a comparative assessment of the structure of CVD risk factors of men younger than 60 years old with recurrent episodes of ischemia (REI) in MI to improve prevention. It includes men from 18 to 60 years old with type I myocardial infarction with a glomerular filtration rate of 30 or more ml / min / 1.73 m2, who, in addition to the standard diagnostic algorithm, carried out a targeted search and analysis of the presence of basic and additional CVD risk factors. Patients were divided into two age-comparable groups: I - the study group, with REI (recurrent MI and / or early post-infarction angina pectoris) - 95 patients; II - without these complications - 471 people. Patients were examined and treated according to local standards at the time of hospitalization. Assessment of lipid metabolism included determination of concentrations of total cholesterol and its fractions, triglycerides, coefficient and atherogenicity indices. It is believed that the main cause of REI is the progression of coronary atherosclerosis. The main risk factors of REI include lipid metabolism disorders, physical inactivity, smoking, hypertension and obesity. Alcohol abuse, impaired renal function and diabetes mellitus have a lower frequency of observations. Recently, attention has been focused on an increase in the proportion of stent thromboses after percutaneous coronary intervention and distal embolism of the coronary arteries. Additional importance for the development of REI are physical inactivity, smoking, unstable angina, MI and history of bypass surgery, psychoemotional stress, as the cause of MI, winter and autumn periods of the year. The listed factors should be used when creating high-risk groups for the development of REI for monitoring and conducting preventive measures, as well as for prognostic modeling of REI.
Russian Military Medical Academy Reports. 2020;39(1-1S):13-15
13-15
ROLE OF A VASO-OCCLUSIVE TEST IN ESTIMATE THE CONDITION OF CRITICALLY THERAPEUTIC PATIENT
摘要
At the moment, the search continues for additional available methods, which can more fully access the degree of damage to organs and systems in sick, with a therapeutic profile in critical conditions. This research article is dedicated to the study of a vaso-occlusive test performed using the «AngioScan-01P» apparats and to the search for reliable interconnection between its parameters and clinical and laboratory results. The survey of this method allows you to determine its information content with the aim of being able to use for a comprehensive assessment of the severity of the condition of critically ill therapeutic profile. The research was conducted in the cardiological resuscitation of the St. George Hospital during 2019. We examined 47 male and female patients aged 26 to 95 years (mean age 82 years, men 75 years, women 88 years). Of these, 5 patients with acute decompensation of chronic obstructive pulmonary disease, 15 patients with pneumonia, 2 patients with pulmonary embolism, 25 patients with acute decompensation of chronic heart failure. All examined patients were included in the observation group. According to statistical data, a high correlation was established between the indicators of the vaso-occlusive test performed using the «AngioScan-01P» apparats and clinical and laboratory data: with the main indicator of liver function-prothrombin index with the main indicator of renal excretory function - creatinine, with the severity of the inflammatory process - white blood cell count, with hemoglobin oxygen saturation, with stress level and with wave type A. The vaso-occlusive test performed use the «AngioScan-01P» apparats is new, easy accessible and reproducible non-invasive method for examining patients in critical conditions and can be recommended as a multipurpose of patients in this class. Prothrombin index
Russian Military Medical Academy Reports. 2020;39(1-1S):16-20
16-20
CHARACTERISTICS OF CARDIOVASCULAR RISK FACTORS IN YOUNG PEOPLE IN THE FAR NORTH
摘要
A survey was conducted of 139 military personnel of the first age group, including 98 military personnel serving in the Far North, as well as 41 military personnel serving in a temperate climate. The survey included assessment of lifestyle (survey of parameters of physical activity, Smoking), anthropometric data (height, body weight, body mass index), physical examination, including measurement of blood pressure at rest, obtaining laboratory data (lipid spectrum, carbohydrate metabolism). It was noted that among military personnel serving in the Far North, the number of smokers was almost 2 times higher than in the comparison group, the percentage of people with high nutrition was more than 2.5 times higher, in contrast to the indicators of physical inactivity, which, however, were also higher than in the group of military personnel serving in a temperate climate. Among the representatives of the Far North group, there is also a tendency to a higher prevalence of arterial hypertension. When assessing lipid metabolism, it was shown that the level of total cholesterol and LDL cholesterol was statistically significantly higher than in the comparison group. The results of the oral glucose tolerance test after 1 hour in the study group were significantly higher, although after 2 hours it corresponded to the norm there was no statistically significant difference. As a result of the study, it was shown that service in the Far North is associated with a higher prevalence of the studied predictors of cardio-vascular risk (physical inactivity, Smoking, high nutrition, hypertension, dyslipidemia, and carbohydrate metabolism disorders).
Russian Military Medical Academy Reports. 2020;39(1-1S):20-22
20-22
EVALUATION OF THE FREQUENCY OF DEVELOPMENT OF POSTOPERATIVE CEREBRAL DYSFUNCTION DEPENDING ON THE METHOD OF PROSTHETICS OF THE AORTAL VALVE OF THE HEART
摘要
The worldwide trend towards an increase in average life expectancy is associated with an increase in the prevalence of acquired heart defects, which at a certain stage dictates the need for cardiac surgery. We examined 72 patients (52 men and 20 women) who underwent planned aortic valve prosthetics. All patients were divided into two groups depending on the method of implantation of the prosthesis: the first group-aortic valve replacement when performing open surgery using cardiopulmonary bypass, the second group-endovascular prosthetics. The first group included 48 men and 18 women, whose average age was 66 years old; the second group included 4 men and 2 women, whose average age was 73 years. All patients underwent a comprehensive examination in the preoperative and postoperative periods, including an anamnesis assessment, a neurological examination using the NIHSS and Rankin scales, neuropsychological (Montreal Cognitive Assessment and frontal dysfunction battery) and psychometric (Hospital anxiety and depression scale) tests, as well as computed tomography the head in identifying clinical signs of perioperative stroke. Postoperative cerebral dysfunction was diagnosed in 44.4% (n = 32) of patients. The overall incidence of clinical types of postoperative cerebral dysfunction was as follows: perioperative stroke - 2.8% (n = 2), symptomatic delirium of the early postoperative period - 13.9% (n = 10), delayed cognitive impairment - 33.3% (n = 24) There were no acute clinical types of postoperative cerebral dysfunction in the endovascular treatment group. Delayed cognitive impairment in both groups were detected in 33.3% (in the first group n = 22, in the second group n = 2). According to the results of the study, acute clinical types of postoperative cerebral dysfunction were absent in the endovascular treatment group, cognitive impairment was detected in 1/3 of the patients in both groups.
Russian Military Medical Academy Reports. 2020;39(1-1S):23-25
23-25
HEART DYSFUNCTION AND FEATURES OF VASCULAR WALL REMODELING IN PATIENTS WITH CHRONIC OBSTRUC- TIVE PULMONARY DISEASE
摘要
Cardiovascular diseases in patients with сhronic obstructive pulmonary disease are one of the most common comorbid conditions, exacerbate the course of сhronic obstructive pulmonary disease, increase the chances of fatality and make the prognosis worse. A study was conducted to assess changes in the heart and blood vessels in patients with сhronic obstructive pulmonary disease. The most sensitive indicators of right ventricular systolic-diastolic dysfunction were established, and a significant increase in local vascular stiffness and thickness of the intima-media complex of the carotid arteries was revealed. Visualization of heart chambers during echocardiography in patients with сhronic obstructive pulmonary disease is known to often have difficulties due to the presence of emphysema of the lungs. Therefore, the presented arsenal of used indicators of the right ventricle, being independent of the increased airiness of the lung tissue, can be especially useful in this situation. We explain the increased prevalence of cardiovascular diseases in the study group to the presence of additional risk factors that are not included in the traditional cardiovascular risk assessment,but are present in patients with сhronic obstructive pulmonary disease. The increased stiffness of the arterial wall, which we verified in patients with сhronic obstructive pulmonary disease, provides an additional increase in afterload on the myocardium, provoking a deterioration in coronary perfusion of both the left and right ventricles.
Russian Military Medical Academy Reports. 2020;39(1-1S):26-29
26-29
CHANGES IN HEART RATE VARIABILITY INDICATORS IN PATIENTS WITH OBSTRUCTIVE SLEEP APNEA SYNDROME
摘要
We studied heart rate variability in patients with obstructive sleep apnea in comparison with a group of healthy individuals without OSAS. The results obtained during the study showed that in patients with OSAS, there is a decrease in both temporal and spectral indicators of heart rate variability. We studied such indicators as the variational range of RR (VAR), the average value of all RR intervals, which gives an idea of the main level of functioning of the sinus node (avNN), the standard deviation of all NN intervals (SDNN), the number of consecutive pairs of RR intervals that differ more than 50 ms divided by the total number of all RR-intervals (pNN50), the standard deviation of the inter-interval differences, which estimates the high-frequency component of variability (rMSSD), the average of 5-minute standard deviations for the entire record (SDNNidx), standard e deviation of the values of the average NN intervals obtained for all 5-minute sections into which the registration period is divided (SDANN), the power of the very low-frequency domain (VLF), the power of the low-frequency domain of the HRV spectrum (LF), the power of the high-frequency domain of the HRV spectrum (HF), weighted average variation of the rhythmogram (SVR). Thus, it has been shown that in people with a syndrome of obstructive sleep apnea, a disturbance of the sympathoglobal balance occurs, which is a favorable factor for the occurrence of cardiovascular diseases and, in some cases, to lead to death. The obtained results emphasize the need for a more thorough examination of patients with OSAS for the presence of cardiovascular diseases and to relate these patients to the group of increased risk of their occurrence.
Russian Military Medical Academy Reports. 2020;39(1-1S):29-32
29-32
HEART RHYTHM AND CONDUCTION DISORDERS IN PATIENTS WITH EPILEPSY WITHOUT CARDIAC PATHOLOGY
摘要
Studied the frequency and types of cardiac arrhythmias and cardiac conduction in patients with epilepsy without concomitant cardiac pathology in comparison with a group of healthy individuals. The results obtained during the studies showed that in patients with epilepsy, episodes of sinus tachycardia, a single polytopic supraventricular extrasystole, as well as episodes of lengthening the QT interval and rigidity of the circadian profile were significantly more likely to occur (p <0.05). No significant differences were found in the frequency of occurrence of sinus bradycardia, atrial pacemaker migration, atrial heart rhythm, pauses in the heart for more than 2 seconds, degree 1 AV block and degree 2 AV block, mobility 1, single monotopic supraventricular extrasystoles, single monotopic ventricular extrasystoles. Other rhythm and conduction disturbances were not determined. Thus, it is shown that the presence of epileptiform activity may be associated with a higher risk of rhythm and conduction disturbances. Some of these reported disorders can be life threatening, possibly leading to cases of sudden death in epilepsy. The obtained results emphasize the need to treat patients with epilepsy as patients with a high risk of cardiovascular events and confirm the prospect of further studies to identify the risks of sudden cardiac death, as well as the possibilities of its medical correction. Promising is the further study of this problem: simultaneous daily EEG and ECG monitoring to assess changes in the ECG directly during an epileptic seizure, as well as the search and implementation of new physiological, genetic and biological markers of this pathology.
Russian Military Medical Academy Reports. 2020;39(1-1S):32-34
32-34
FEATURES OF PULSE WAVE CHARACTER IN PATIENS WITH THERAPEUTIC PROFILE IN CRITICAL STATES
摘要
Currently, one of the significant problems of critical conditions is the early diagnosis of their development, determination of the stage of an existing critical condition, prerequisites, including those identified only by instrumental methods of research, as well as the course of the disease, as well as the dynamics of the course of the disease. Currently, there is a constant search for new or improvement of existing diagnostic methods that will be able to accurately reflect the condition of the patient, the degree of development of the disease and the dynamics of its course. One of the most important requirements for the required research method is the safety of the patient, because in a patient in critical condition, any intervention in the body can lead to the development of complications and adversely affect the severity of the disease. Modern methods for the study of hemodynamics involve intervention in the body, so their use is not always justified, and sometimes even risky. In this work, a hemodynamic research method using the Angioscan-01p instrument was considered. It is based on infrared technology, which does not affect the body, but can be used to obtain data on the state of the vascular wall and characteristics of the endothelial function. In the course of the work, the advantages of this method were demonstrated and the clinical significance was justified, results were obtained that describe the relationship between clinical and laboratory parameters and indicators obtained using the AngioScan-01P instrument, and the effect of the state of the body on indicators reflecting endothelial function is described.
Russian Military Medical Academy Reports. 2020;39(1-1S):35-38
35-38
PECULIARITIES OF THE SISTOLIC FUNCTION OF THE LEFT VENTRICLE IN MYOCARDIAL INFARCTION WITH RELATED ARTERIAL HYPERTENSION IN MEN UNDER 60 YEARS
摘要
Myocardial infarction (MI) in young and middle-aged people is a socially significant problem, and arterial hypertension (AH) is one of the most important risk factors for cardiovascular complications. Despite the availability of studies on MI in the presence of AH, data on structural and functional changes in the heart and prognosis in men of young and middle age are few and contradictory. The purpose of the study was to study the structural and functional characteristics of the heart that affect the prognosis of young and middle-aged men in the acute and subacute periods of MI in the presence of AH to improve treatment and prevention. It is included 497 men from 19 to 60 years old with type I IM who, in the first 48 hours (1) and at the end of the third week of the disease (2), are performed the standard diagnostic algorithm. Patients were divided into four groups depending on the presence / absence of AH and age: up to 49 years (with AH (112 patients, without AH 75 patients) and 50-60 years (with AH 230 patients, without AH 80 patients). It was established that in the presence of AH there is a more pronounced systolic dysfunction. Such patients are more likely to have sudden cardiac death and cardiovascular complications, therefore this category of patients requires more careful monitoring for the timely detection and treatment of chronic heart failure and the prevention of cardiovascular catastrophes in the future.
Russian Military Medical Academy Reports. 2020;39(1-1S):38-40
38-40
MYOCARDIAL INFARCTION PECULIARITIES IN MEN UNDER 60 YEARS OLD WITH BRONCHIAL ASTHMA
摘要
The study of comorbidity for the therapy personification is one of the methods for improving the myocardial infarction (MI) prevention of recent years. The data on the MI clinical features in young and middle-aged men suffering from bronchial asthma (BA) are few and contradictory. The research purpose is to assess risk factors for cardiovascular diseases (CVD), the course of myocardial infarction, and hemodynamic changes in men aged less than 60. They include men from 18 to 60 years old with type-I MI. The standard diagnostic algorithm was performed in the first 48 hours (1) and at the end of the third week of the disease (2). The patients were divided in two groups of comparable age: I - six patients with BI; II - a control group of 424 people without any lung diseases. The study showed that the main MI risk factors in men with BA were a history of chronic heart failure (HF), a hereditary burden of coronary heart disease, and atherogenic dyslipidemia. The patients with BA had atypical variants of the MI course with predominance of disease complications such as cardiac arrhythmias and cardiac asthma. Moreover, the patients with BA had more pronounced hemodynamic disturbances both in acute and subacute periods of MI. Such patients should stay under medical supervision to identify and treat chronic HF and should be further examined to exclude non-atherosclerotic variants of coronary artery disease or embolism.
Russian Military Medical Academy Reports. 2020;39(1-1S):40-43
40-43
PROGNOSTIC SIGNIFICANCE OF 1-HOUR HYPERGLYCEMIA IN YOUNG AGE
摘要
At Department of Hospital Therapy Military Medical Academy has been performed prospective study with the participation of 122 st servicemen. Patients after primary carrying out oral glucose tolerance test have been divided into 2 groups: 1 - 60 men with the level of nd glycemia ≥ 8,6 mmol/l after 1 hour of the test; 2 - 62 with a normal 1-hour glycemia. All of the examined patients initially and over time have been evaluated lipid, carbohydrate metabolism, an ultrasound scaning of the heart and of the common carotid arteries. The patients st curation have been realized for 3.8 to 1.5 years. In the initial examination, the two samples were compared in AH (78% vs 74% for the 1 and nd 2 groups, respectively, p>0.05) at average blood pressure values of 156/98 and 153/97 mm Hg. accordingly (p>0.05); AO (42% vs 40%, p>0.05), BMI 29.3 vs 27.4 ± 4.2 kg/m (p=0.015); hypodynamia (42% vs 38%, p>05). Smoking prevailed in men in the 1st group (53 vs 31%, χ =5.0; p=0.02). Against the background of drug therapy, there was an achievement of normotensia in 35 and 46% of patients in the 1 and 2 2 2 st nd groups, respectively (p>0.05); smoking cessation - in 30 and 15% of the subjects (p>05). Alimentary obesity after curation was determined in 67 2 and 50% of men in these subgroups (χ =3,6; p=0.05), which indicated a negative dynamics compared to the initial anthropometric data (p>0.05). Has been identified a number of characteristics for patients with early postprandial hyperglycemia: more atherogenic changes in lipid spectrum, high incidence of prediabetes and diabetes mellitus type 2 in the dynamics. Has been observed more active progression of atherosclerosis as a thickening of the intima-media complex for men with 1-hour hyperglycemia. The presence of 1-hour hyperglycemia is an early marker of development prediabetes and diabetes mellitus type 2, with the result that this indicator should be assessed in everyday clinical practice, along with levels of fasting plasma glucose and 2-hour plasma glucose after postload test.
Russian Military Medical Academy Reports. 2020;39(1-1S):43-47
43-47
THE ROLE OF DETERMINING SOME GENETIC POLYMORPHISMS IN PATIENTS WITH NEURO-CIRCULATOR ASTHE- NIA AND HYPERTENSIVE HEART DISEASE OF STAGE I
摘要
Arterial hypertension is a multifactorial disease, a significant role in the pathogenesis of which is played by a genetic factor. In recent years, many studies have been carried out to identify genes in various diseases, including arterial hypertension, and candidate gene databases have appeared, to which the results of these studies have been added. There are known polymorphisms of genes associated with the development of arterial hypertension, as well as with a change in the pharmacodynamics of antihypertensive drugs. The following genes and the peculiarities of metabolism and activity of pressor systems associated with their polymorphisms are most studied: genes of the cytochrome system (CYP2D6, CYP2C9, CYP11B2); genes of the renin-angiotensin-aldosterone system: ACE (angiotensin-converting enzyme gene), AGT (angiotensinogen gene), AGTR1 and AGTR2 (angiotensin 1 and angiotensin 2 receptor genes). The objective of the study was to study the frequency of detection of gene polymorphisms associated with the development of arterial hypertension in patients with hypertensive neurocirculatory asthenia and stage I hypertension. A total of 77 conscripts and contract employees between the ages of 18 and 40 were examined. Using the amplifier, the following genes were studied by polymerase chain reaction and detection: the p-450 cytochrome gene (CYP11B2) and the AGT renin-angiotensin-aldosterone system gene: 704 T> C. Polymorphisms of candidate genes for arterial hypertension were found in 100% of the examined. AGT polymorphisms: 704 T> C and CYP11B2 were more often detected in stage I hypertension than in hypertensive neurocirculatory asthenia. Conducting genetic research at a young age in patients with hypertensive neurocirculatory asthenia will reveal a risk group for the development of hypertension.
Russian Military Medical Academy Reports. 2020;39(1-1S):47-49
47-49
EFFECT OF LONG-TERM USE OF CPAP THERAPY ON WEIGHT DYNAMICS IN PATIENTS WITH SEVERE OSA
摘要
At the clinic of propaedeutics of internal diseases, 33 patients were selected for whom a severe degree of OSA was diagnosed by cardiorespiratory monitoring (YAG ≥ 30 sob / h). All patients had a history of drowsiness (drowsiness school according to the Epworth questionnaire 12 ± 3), the presence of snoring during sleep, and short-term respiratory arrest. Two groups were formed using telephone monitoring: the first group was patients with severe OSAS who purchased a device for CPAP therapy (15 people, 13 of them were men and 2 women), the second group were patients with severe OSAS who did not buy or only are going to purchase a device for CPAP therapy (18 people, 17 of them are men and 1 woman). When analyzing the data, it was found that patients who purchased a device for CPAP therapy 85% have good compliance with the therapy, use the device> 4 hours per night 80% of the nights. With good compliance with therapy, the average weight of the patients of the first group before the start of therapy was 132 ± 8 kg, then at the time of the survey the average weight decreased to 118 ± 5 kg. In patients of the second group without CPAP therapy, the average weight was 111 ± 8 kg, after a trial course and recommendations from the attending physician for weight loss, at the time of the survey, the average weight of the group decreased to 105 ± 5 1 kg. Based on these data, it can be concluded that patients of the first group on CPAP therapy reduced their weight from the original by 1%, in contrast to the second group, where the weight decreased by 6%. According to the results of the study, patients with OSAS who have good compliance with therapy have a higher percentage in weight loss compared with patients without CPAP therapy.
Russian Military Medical Academy Reports. 2020;39(1-1S):49-51
49-51
EMPEGFILGRASTIM: APPLICATION IN ONCOHEMATOLOGY
摘要
Extimia (empegfilgrastim) is the first original Russian drug from the group of granulocyte colony-stimulating factors for the prevention and treatment of febrile neutropenia, a dangerous infectious complication associated with the hematological toxicity of cancer chemotherapy. Being a pegylated form of filgrastim, empegfilgrastim has a more pronounced therapeutic effect, and also has an increased half-life. Over the past few years, the drug has confidently entered the clinical practice of Russian oncologists, however, there are no publications on the experience of its use in the field of oncohematology. This article presents the results of a retrospective comparison of two groups of patients who received chemotherapy for blood system tumors. Patients from the first group received empegfilgrastim as prevention and treatment of neutropenia, patients from the second group received filgrastim. The results showed that, on average, the use of empegfilgrastim th reduced the recovery period of the absolute number of neutrophils by 3 days, and the period of 4 grade neutropenia (agranulocytosis) by 3,8 days during intensive and high-dose chemotherapy courses. Also, the use of empegfilgrastim allowed patients with high and extremely high risks of developing febrile neutropenia to receive 10,3% more planned chemotherapy courses on time without reducing the dose rate of chemotherapy.
Russian Military Medical Academy Reports. 2020;39(1-1S):51-54
51-54
POLYMORPHIC α-ADDUCTIN(ADD1) GENE OPTIONS ASSOCIATED WITH CARDIOVASCULAR PATHOLOGY
摘要
Modern approaches to drug therapy should be based not only on effectiveness, but also on a comprehensive assessment of the safety of drugs. Pharmakogenetic testing allows to define efficiency and safety of therapy, to choose the most effective medicine as prime therapeutic means that leads to reduction of quantity of the medical products necessary for adequate treatment. At present, advances in clinical genetics are associated with the isolation of alleles (variants) of various genes, the assessment of their frequency and the detection of associations of certain alleles with phenotypic manifestations, with an attempt to identify prognostic signs. On the basis of complex pharmakogenetic analysis is possible to identify significant of genetic markers in the prediction of the flow and effectiveness of pharma-cotherapy of arterial hypertension. The study involved 40 of patients with arterial hypertension. Performed pharmakogenetic testing with the study of polymorphisms of gene α-adductin. As a result of which it was possible to obtain results: “normal” alleles of the α-adductin G / G gene were found in the majority of the studied (29 out of 40 patients), while the “risk” allele of the α-adductin G / T gene and the “risk” allele T / T - in 11 studied patients, and the frequency of occurrence of the G / T allele is 4 times greater than the T / T allele. The identification of genetic markers in cardiology is subjected to intensive study and research in order to identify genetic risk. Thus,оn the basis of the results of genetic testing can not only build the forecast of disease, but also rationally choose the drug therapy, which helps to prevent the development of severe complications.
Russian Military Medical Academy Reports. 2020;39(1-1S):54-55
54-55
THE IMPORTANCE OF BIOTRANSFORMATION GENE POLYMORPHISM IN THE SELECTION OF ANTITHYROSINE KI- NASE THERAPY FOR CHRONIC MYELOID LEUKEMIA
摘要
One of the urgent problems in helping patients with chronic myeloid leukemia BCR / ABL1 + (CML) is the development of various types of toxicity of tyrosine kinase inhibitors (TKI), which may be based on impaired drug metabolism. The paper presents preliminary results of a study of the polymorphism of genes of the enzyme system involved in the biotransformation of drugs (genes CYP2C9, CYP3A4, CYP3A5, CYP4E2 and VKORC1) in patients with CML with or without symptoms of dasatinib intolerance. It was found that in patients with non-hematologic toxicity-specific effects of dasatinib therapy (recurrent pleural effusions), the frequency of occurrence of various single-nucleotide polymorphisms was 100% compared with the control group. Polymorphism rs2740574 (AG) of the CYP3A4 cytochrome isoenzyme gene, the main enzyme involved in dasatinib metabolism, was detected in 20% of subjects, based on which it was concluded that the functional activity of this enzyme is not a reliable predictive indicator of the toxic effect, but there can be one from the causes of its occurrence, which requires further study. It was also found that rs99232231 (GA) polymorphism of the VKORC1 vitamin K-reductase gene was detected in 60% of subjects; a decrease in the functional activity of this enzyme may be one of the causes of adverse events. The results obtained indicate the prospect of further development of the topic in order to search for new approaches to the choice of treatment for TKI and the prediction of complications in CML.
Russian Military Medical Academy Reports. 2020;39(1-1S):56-58
56-58
CLINICAL MARKERS OF KIDNEY DYSFUNCTION DEVELOPMENT IN THE INITIAL PERIODS OF MYOCARDIAL IN- FARCTION IN MEN AGE 60 YEARS
摘要
Renal dysfunction (DP) in myocardial infarction (MI) significantly worsens the prognosis of the disease in men under 60 years of age. The aim of the study was to assess the significance of various factors for the development of DP at the end of the subacute period of myocardial infarction (MI) in men under 60 to improve prevention. It includes men from 18 to 60 years old with type I IM who, in the first 48 hours (1) and at the end of the third week of the disease (2), performed the standard diagnostic algorithm, which included complex echocardiography and lipid metabolism assessment. Patients were divided into two age-comparable groups: I - the study group, with a decrease in glomerular filtration rate at the end of the third week of MI less than 60 ml / min / 1.73 m2 (renal dysfunction (DP)) - 21 patients; II - without impaired renal function - 176 people. It was found that the most significant indicators of the risk of developing DP at the end of the subacute MI were the index of the final systolic volume of the left ventricle, the size of the left atrium, tachycardia of more than 108 per minute and hypertriglyceridemia (6.7 mmol / l or more) in the first hours of the disease in association with aneurysm of the left ventricle and its thrombosis, fibrillation and atrial flutter both before the development of MI and during the period of the disease. The combination of these factors with a history of unstable angina, prothrombin level (84% or more), GRACE value (134 points or more) and TIMI (8 points or more), dyslipidemia at the end of the subacute period of the disease indicates a high risk of developing DP in this period. The listed factors can be used to form a high-risk group for the development of this condition for more in-depth observation and prevention activities.
Russian Military Medical Academy Reports. 2020;39(1-1S):58-60
58-60
ABOUT THE INFLUENCE OF INFLAMMATION IN COURSE OF ANEMIA IN HEMODIALYSIS PATIENTS
摘要
Concomitant inflammation in nephrogenic anemia is one of the most frequent complications among patients undergoing programmed hemodialysis, which can lead to the worst results of the correction of anemic syndrome. The study conducted a comparative analysis of the course of nephrogenic anemia in 31 patients with end-stage chronic kidney disease undergoing programmed hemodialysis. 2 groups were distinguished: the first group - 10 patients with laboratory signs of inflammation (C-reactive protein> 5.0 mg / l); the second group - 21 patients with no signs of inflammation (C-reactive protein <5.0 mg / L). The following laboratory parameters were evaluated: hemoglobin level, C-reactive protein, serum ferritin, gas transport function of venous blood. The quality of life of patients was assessed using the FACT questionnaire (the Functional Assessment of Cancer Therapy scale). According to the results of the study, it was found that patients with systemic inflammation have a functional iron deficiency (the median level of ferritin was 335.5 μg / l and 234.2 μg / lv in the first and second groups, respectively). In both groups, patients have similar laboratory indicators of hemoglobin level (median 98 g / l and 106 g / l in the first and second groups, respectively) and venous blood saturation (median 59.95% and 62.5%), which indicates high efficiency combination of erythro-poiesis-stimulating therapy with intravenous iron. At the same time, among patients with inflammation, a lower quality of life was observed (median scores on the FACT-An 40 and 29 scale). Concomitant inflammation in nephrogenic anemia does not affect the severity of peripheral tissue hypoxia. A statistically significant (p <0.05) inverse correlation was found between the activity of inflammatory markers (leukocytosis, C-reactive protein) and the hemoglobin level in the group of patients with inflammation.
Russian Military Medical Academy Reports. 2020;39(1-1S):61-64
61-64
PECULIARITIES OF CARDIOVASCULAR RISK FACTORS IN MEN UNDER 60 YEARS OLD WITH UNFAVOURABLE COURSE OF MYOCARDIAL INFARCTION
摘要
Adverse indicators of morbidity and mortality from myocardial infarction (MI) with a high frequency of detection of cardiovascular diseases (CVD) risk factors actualizes the search for ways to improve their prevention. The purpose of the study: a assess the risk profile of CVD in men younger than 60 years with MI, depending on the outcome of the nearest to improve prevention. It includes men from 18 to 60 years old with MI of type I with a glomerular filtration rate of 30 or more ml/min/1.73 m2. In addition to the standard diagnostic examination, patients underwent a targeted search for the presence of primary and secondary risk factors for CVD. Patients were divided into two age-comparable groups: I - the study group; 30 patients who died during the first eight weeks of the disease; II - survivors - 536 patients. It has been established that the main risk factors for CVD in the group of adverse outcomes are tobacco using, physical inactivity, signs of social and psychological maladaptation, seasonal deterioration and hereditary burden of coronary heart disease, alcohol abuse and a history of heart failure. Hypertension, overweight, diabetes mellitus and chronic foci of infection were observed somewhat less frequently. The closest unfavorable prognosis was associated with smoking, alcohol abuse, signs of social maladaptation, the presence of MI and heart failure, as well as a history of revascularization. The use of these indicators will help to improve the characteristics of the developed forecast models and the effectiveness of prevention. Statistical treatment of data packets performed using Statistica 10.0 and SAS JMP software applications 11. Quantitative indices are represented as: M ± S, where M - average; and S - standard deviation. The significance of differences was determined by U-Mann-Whitney test. For binary and nominal terms it was evaluated by chi-square test. The level of statistical significance when received error probability less than 0.05.
Russian Military Medical Academy Reports. 2020;39(1-1S):64-66
64-66
FEATURES OF THE PULMONARY HYPERTENSION FORMATION IN MEN UNDER 60 YEARS OLD IN THE SUBACUTE PERIOD OF MYOCARDIAL INFARCTION
摘要
Pulmonary hypertension is a polyetiological condition that can complicate myocardial infarction and weigh down its course [7, 8, 19]. The aim of the study is to assess the risk factors for the development and progression of pulmonary hypertension against the background of myocardial infarction. The study included men aged 18 to 60 years with myocardial infarction who had a standard diagnostic algorithm performed in the first 48 hours (1) and at the end of the third week of the disease (2). The patients were divided into three groups: I - the study group, with pulmonary hypertension arising on the background of myocardial infarction (average pressure in the pulmonary artery is 25 mm Hg. and more) - 84 patients; II - with a normal level of average pressure in the pulmonary artery (less than 25 mm Hg.) in the subacute period of myocardial infarction-183 patients; group III - 184 patients with elevated levels of average pressure in the pulmonary artery at both points of the study. As a result, it was found that the main risk factors for the development of pulmonary hypertension in the subacute period of myocardial infarction are bradycardia on ECG in history, the presence of chronic cerebral circulation disorders, the tendency to bradycardia during physical examination, lower than in the control groups, indicators of cardiac output, heart index, left ventricular mass index, left ventricular mass index in the first 48 hours of the disease; higher levels of sodium concentration in blood plasma in the first 48 hours of the disease, the atherogenicity coefficient at the end of the third week of the disease, than in patients of control groups.
Russian Military Medical Academy Reports. 2020;39(1-1S):67-69
67-69
DEPENDENCE OF TYPES OF LEFT VENTRICULAR MYOCARDIUM REMODELING ON THE LEVEL OF ARTERIAL PRES- SURE IN PATIENTS OF THE THERAPEUTIC HOSPITAL
摘要
291 patients were examined at the clinic, there were 191 male and 100 female patients, for the presence of left ventricular hypertrophy using echocardiography. All included patients were divided into 4 types depending on left ventricular remodeling. To determine the type of heart remodeling, we used the determination of the left ventricular mass index (the ratio of the left ventricular myocardial mass to the body surface area) using echocardiography, and the determination of the relative thickness of the left ventricular wall (the ratio of the doubled thickness of the posterior wall of the left ventricle to its end diastolic size). Arterial hypertension was detected in 186 patients: 117 males and 69 females. A statistical analysis of the data was carried out, which took into account the gender of the patients. We found the dependence of the type of remodeling on the level of blood pressure. According to the results of the study, it was found that the normal geometry of the left Известия Рос. Воен.-мед. акад. 2020. №1. Том 1 Прил.
Russian Military Medical Academy Reports. 2020;39(1-1S):69-71
69-71
THE INTERPRETATION OF MR-IMAGES OF THE IDIOPATHIC NORMAL PRESSURE HYDROCEPHALUS, ALZHEIMER'S DISEASE AND THEIR COMBINATION
摘要
The most common neurodegenerative diseases in the elderly and senile, the main manifestation of which are intellectualmnestic disorders, include Alzheimer's disease, mixed and vascular dementia, and idiopathic normal pressure hydrocephalus. Idiopathic normal pressure hydrocephalus, or the Hakim-Adams syndrome, is characterized by the expansion of liquor-containing spaces, which leads to a specific clinical picture: gait disturbance, cognitive deficit and dysuric disorders. The diagnosis is complicated by its combination with Alzheimer's disease in 75% of cases (the syndrome «AD-iNPH»). Magnetic resonance imaging is a method that helps in conducting differential diagnosis and determining further treatment tactics. The study revealed specific neuroimaging signs using several scales: iNPHRadScale, MTA scale of atrophy of the medial temporal lobe, GCA scale of global (diffuse) cortical atrophy, scale of atrophy of the parietal lobe (Koedam). There were examined 45 people which old was 50 to 90 years: 20 with a diagnosis of idiopathic normal pressure hydrocephalus, 17 with Alzheimer's disease, 8 with the «AD-iNPH» syndrome. It was found that Hakim-Adams syndrome is characterized by an expansion of cerebrospinal fluid cavities, which was confirmed by the iNPHRadScale scale: acute angle of the corpus callosum, presence of a high Evans index, expansion of sylvian fissures, periventricular hyperintensity, narrowing of paraphalcinar grooves without significant atrophy. Patients with «AD-iNPH» syndrome were characterized by the expansion of cerebrospinal cavities of the brain, obtuse angle of the corpus callosum, the presence of periventricular hyperintensity, a decrease in the height of the hippocampus and expansion of the choroid gap, diffuse atrophy of the brain substance, that is, a combination of dilatation and neurodegenerative processes. The atrophy of the substance of the brain was characteristic of patients with Alzheimer's disease, which is confirmed by the scales of atrophy of the medio-basal parts of the temporal and parietal lobes. It is necessary to comprehensively evaluate brain MR-images in patients with suspected idiopathic normal pressure hydrocephalus and Alzheimer's disease using several scales.
Russian Military Medical Academy Reports. 2020;39(1-1S):71-74
71-74
THE DETERMINATION OF BIOMARKERS OF CEREBROSPINAL FLUID OF IDIOPATHIC NORMAL PRESSURE HYDRO- CEPHALUS AND ITS COMBINATION WITH ALZHEIMER'S DISEASE
摘要
The idiopathic normal pressure hydrocephalus (Hakim-Adams syndrome) is characterized by the expansion of liquor-containing cavities, which is clinically manifested by a triad of symptoms: impaired gait, cognitive impairment, and impaired urination. One of the most common diseases associated with iNPH is Alzheimer's disease. Both diseases are found in the same age group with similar complaints of memory impairment. In clinical practice, their differential diagnosis is based on the identification of the Hakim-Adams triad. However, the determination of the combination of these two states, which is observed with a frequency of up to 75%, is a difficult task. In the study, the concentrations of biomarker proteins of amyloidosis and neurodegeneration in cerebrospinal fluid were determined. A total of 47 patients were examined (14 with a diagnosis of idiopathic normotensive hydrocephalus, 25 with Alzheimer's disease, 8 with their combination). The level of proteins in the cerebrospinal fluid was assessed using enzyme-linked immunosorbent assay (ELISA). Tablets for 96 samples were used to determine each of the evaluated indicators: the content of beta-amyloid (Aβ-42), tau protein (tau) and 218-phosphorylated tau protein (ftau). The neurodegeneration coefficients were calculated (ftau/Aβ-42, tau/Aβ-42). Specific cerebrospinal fluid changes in patients with idiopathic normotensive hydrocephalus were found to have higher levels of amyloid beta, a decrease in the content of tau and phosphorylated tau protein compared with patients with Alzheimer's disease. In the case of a combination of diseases (“comorbidity”), the presence of “intermediate” results by liquorological indicators is characteristic. A higher level of amyloid beta compared with Hakim-Adams syndrome indicates amyloidogenesis. We also revealed patterns of transformation of moderate cognitive impairment into dementia (according to the ratio of tau / Aβ-42 and ftau / Aβ-42).
Russian Military Medical Academy Reports. 2020;39(1-1S):74-77
74-77
ANEMIA AS A MARKER OF RHEUMATIC DISEASE ACTIVITY
摘要
Rheumatic diseases are often accompanied by changes in the blood system, including anemia. Anemia not only worsens the quality of life of patients, but also adversely affects the course of rheumatic disease. Therefore, the work has been studied assessed the degree of severity of anemia of rheumatic diseases, correlation between anemia and rheumatoid arthritis activity has been identified, and the effectiveness of basic anti-inflammatory therapy on anemia in patients was assessed rheumatoid arthritis. 99 patients diagnosed with non-differentiated arthritis aged 23 to 65 years were enrolled in the study. Among them were 79 women (79.8%), the average age was 52.3 ± 9.72 years, and 20 men (20.2%), the average age was 46 ± 19.6 years. All patients were tested for rheumatoid arthritis by DAS 28, hemograms, which included determination of hemoglobin concentration, erythrocytes, mean hemoglobin content in erythrocyte. 77 (77.7%) patients were examined in dynamics after 6 months with the same volume of clinical-laboratory methods. In the course of the study it is established that in rheumatoid arthritis, a sufficiently high degree of severity of anemia in the debut of the disease is detected. The higher the degree of disease activity, the higher the severity of anemia, including hypochromia. The application of the principles of "treatment before goal" with the appointment of adequate basic anti-inflammatory therapy allows achieving remission or low activity in more patients, which leads to a significant decrease in the frequency of occurrence of anemia syndrome.
Russian Military Medical Academy Reports. 2020;39(1-1S):77-81
77-81
DIAGNOSTIC POTENTIAL OF THE CAPNOGRAPHY METHOD FOR ASSESSING THE SEVERITY OF METABOLIC DIS- ORDERS IN PATIENTS IN THE INTENSIVE CARE UNIT
摘要
The review is devoted to the pathogenetic features of the formation of metabolic disorders in critical state medicine and to integral methods for monitoring their severity - capnography and the calculated indicators obtained using this method. A component of the pathogenesis of the septic process is metabolic stress, characterized by a violation of all types of metabolism, forming a cycle of interdependent processes that potentiate tissue oxygenation and microcirculation disorders. It was revealed that in the scientific literature this condition has been defined as microcirculatory-mitochondrial distress syndrome. Almost all metabolic processes are accompanied by the completion of glucose catabolism by the formation of carbon dioxide and water, carbon dioxide, in turn, having high diffusion activity, quickly gets from the tissues through the microvasculature into the systemic circulation and is eliminated with exhaled air. In this regard, it is possible to dynamically assess the level of metabolism in tissues by the volume percentage of CO2 in exhaled air, which is implemented in the method of capnography. The use of capnography is an important element of intensive care. The informativeness of the method of capnography is sufficient for an integrated assessment of the severity of metabolic changes when monitoring the vital functions of patients in ICU with various types of pathology, accompanied by changes in the energy balance of the body and the speed of metabolic processes. The diagnostic value of capnography lies in the method of its continuous implementation, non-invasiveness, relative low cost, as well as the ability to automatically inform the medical staff when registering capnogram values that are critical for the patient. It is advisable to take into account the possibility of including the method of capnography in clinical guidelines and treatment protocols for diseases and conditions requiring controlled correction of metabolic disorders.
Russian Military Medical Academy Reports. 2020;39(1-1S):81-84
81-84
PECULIARITIES OF MYOCARDIAL INFARCTION IN MEN LESS THAN 60 YEARS OF AGE, THAT COMPLICATED BY ATRIAL FIBRILLATION OR FLUTTER
摘要
Myocardial infarction, complicated by fibrillation and / or atrial flutter in young and middle-aged men, is one of the main predictors of disability and increased mortality in many countries of the world. Objective: to evaluate the features of the course and complications of myocardial infarction in men younger than 60 years old, complicated by atrial fibrillation and / or flutter in the acute period to improve prevention. The research included 566 men from 18 to 60 years old, including those with developed supraventricular arrhythmias in the acute period of myocardial infarction, in the first 48 hours of the disease. Patients were divided into two age-comparable groups: the first group contains patients with concomitant rhythm disturbances such as fibrillation or atrial flutter in the early period of myocardial infarction, in all 42 people, the second group - control, which contain patients after myocardial infarction without rhythm disturbances, total 476 men. Atrial fibrillation and / or flutter are common (8.1%) complications of myocardial infarction in young and middle-aged men. The presence of atrial fibrillation and / or flutter negatively affects the prognosis, significantly increasing the risk of death and life-threatening complications (heart rhythm and conduction disturbances (ventricular and supraventricular tachycardia and ventricular fibrillation), cardiogenic shock, pulmonary edema, heart failure, pneumonia, aneurysm and its thrombosis) and chronic heart failure. These patients need additional examination (echocardiography and monitoring of metabolic parameters in dynamics) and long-term observation due to pronounced structural and functional changes in the heart and a significant increase in the risk of fatal complications.
Russian Military Medical Academy Reports. 2020;39(1-1S):85-87
85-87
ASSESSMENT OF THE STRESS LEVEL IN PATIENTS OF THE THERAPEUTIC PROFILE IN CRITICAL CONDITION
摘要
Critical conditions are the result of acute diseases or chronic decompensation. With them, part of the vital functions of the body are usually violated or there is a threat of their violation in the coming hours. Bacteriemia, products of septic and aseptic inflammation, hyksemia and hypoxia of organs and peripheral tissues, lead to impaired function of the organs that were initially not involved or not initially involved in the initial process. To improve the quality of medical care for patients with a therapeutic profile in critical condition, the development of new methods for assessing the severity of their condition continues. In acute and chronic stressful influences, regulatory systems are depleted, which plays an important role in the development of threatening conditions and deaths. The circulatory system is very sensitive to stress reactions. An analysis of heart rate variability (HRV) is a reliable indicator of stress levels in the body. HRV can be estimated by electrocardiographic indicators, or by pulse oximetric, which are easier to do in clinical practice. Angioscan-01P is a personal diagnostic device for analyzing the state of the vascular wall. It allows you to measure not only the stress index (visualization of the Baevsky index using a chart), but also the degree of stiffness of the vessels (the reciprocal of the elasticity of the vessels), the saturation index (saturation of hemoglobin with oxygen). To determine the role of the stress index, it is necessary to compare it with the main clinical and laboratory indicators of liver and kidney function, the state of the vascular wall, and endothelial function. The found reliable relationships can be used to improve the study evaluating the status of critical patients with a therapeutic profile.
Russian Military Medical Academy Reports. 2020;39(1-1S):87-90
87-90
FACTORS THAT CONTRIBUTE TO REDUCING THE QUALITY OF LIFE OF PATIENTS WITH GLIAL BRAIN TUMORS
摘要
Neuro-oncological diseases, which often lead to disability of the able-bodied population of developed countries, are one of the most pressing problem of modern medicine. Improving quality of life of neurooncological patients becomes one of the main goals of treatment due to the unfavorable prognosis. In this regard, the purpose of this research was to study factors affecting the quality of life of people with brain tumors in the preoperative period. The study involved 73 patients with gliomas of varying degrees of malignancy before surgery. The quality of life was assessed using the questionnaire "European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire 30". The results of the survey are presented in the form of numerical values for global health, as well as separately on the functional and symptomatic scales. Research on the impact of such parameters as: the preservation of the ability to self-service, involvement in the pathological process of functionally significant areas of the cerebral cortex, the presence of epileptic seizures, on the quality of life was estimated in this article. Participants were divided into groups for each of these characteristics. Statistical analysis was carried out between each of them. Inability to self-care without outside help and involvement of functionally significant areas of the cerebral cortex were associated with a significant decrease in the quality of life on both functional and symptomatic scales. In the presence of epilepsy, regardless of the frequency of seizures, a similar correlation was not observed.
Russian Military Medical Academy Reports. 2020;39(1-1S):91-94
91-94
TRANSLINGUAL ELECTRICALSTIMULATION IN THE COMPLEX SYSTEM OF RESTORING THE FUNCTION OF MAIN- TAINING BALANCE IN PATIENTS WITH THE CONSEQUENCES OF ACUTE CEREBRAL CIRCULATION DISORDERS
摘要
A clinical evaluation of the effectiveness of the translingual electrical stimulation method in the system of complex treatment of violations of the function of maintaining static and dynamic balance in patients with long-term consequences of acute cerebral circulation in the vertebral-basilar pool was carried out. In order to improve stability, the patient trained the function of maintaining balance by consistently performing exercises in the standing position and in motion. A total of 6 patients were examined. Each of them received two courses of treatment with 10 procedures. During the second year, the exercises were supplemented with translingual electrical stimulation during the procedure. The total training time was 20 minutes per procedure. The following scales were used to evaluate the effectiveness: the Berg scale, The « Timed Up and Go» (TUG) for 10 meters, and ВАШ (patient satisfaction was evaluated). It is shown that the joint use of training in combination with translingual electrical stimulation is more effective than the isolated use of exercises, and it is well tolerated by patients, and contributes to their compliance. The absence of the need to use stationary equipment allows using the proposed method at all stages of rehabilitation treatment of patients with acute cerebral circulation disorders in the vertebral-basilar pool, including independently under the dynamic control of a doctor.
Russian Military Medical Academy Reports. 2020;39(1-1S):94-98
94-98
RISK FACTORS OF CARDIOVASCULAR PATHOLOGY AND ACUTE KIDNEY INJURY IN MYOCARDIAL INFARCTION IN MEN UNDER 60 YEARS
摘要
Acute kidney injury (AKI) worsens prognosis of patients with myocardial infarction (MI). Improvement AKI prevention is essential for public health. The purpose of the study. Assess the significance of risk factors cardiovascular diseases (CVD) for the development of AKI in the initial periods of MI in men younger than 60 for improve prevention. Material and methods. A comparative analysis of the frequency detection of risk factors CVD and associated pathology in groups of men under 60 years old, experimental group, with AKI (24 patients, mean age: 50,2 ± 5,0 years old) and control group (542 patients; mean age: 50,6 ± 7,1 years old; р˃ 0,05) with no AKI in the acute and subacute periods of MI. Results. In the experimental group more often than in the control group, MI was observed in the winter (70,8 and 37,0%, respectively; p˂ 0,05), repeated MI with a time after the primary MI more than one year (45,8 and 25,2%, respectively; p˂ 0,05), peptic ulcer (29,2 and 14,1%, respectively; p˂ 0,05), revascularization operations (45,8 and 17,8%, respectively; p˂ 0,05), and coronarography (42,9 and 14,5%, respectively; p˂ 0,05) in anamnesis , peripheral angiopathy (83,3 and 62,3%, respectively; p˂ 0,05) and overweight less than 10 years (70,8 and 40,7%, respectively; р˂ 0,05), and psycho-emotional stress, as a factor provoking the onset of the disease (62,5 and 38,8%, respectively; р˂ 0,05). Conclusion. Combinations of the risk factors CVD should be used for prognostic modeling and formation of risk groups for the development of AKI in the initial periods of MI for the purpose of monitoring observation and the timely implementation of a set of preventive measures.
Russian Military Medical Academy Reports. 2020;39(1-1S):98-102
98-102
ISCHEMIC STROKE IN YOUNG PEOPLE. FEATURES OF ETIOPATHOGENESIS AND SECONDARY PREVENTION
摘要
Cerebrovascular diseases holds the second place in the structure of mortality and the first place in the structure of primary disability. Meanwhile, the proportion of ischemic strokes in the population is 80%, in which 11-15% of cases occur in young people. More than 1 mln. people who have suffered a stroke live in the Russian Federation, while one third of them are people of working age. Only 40% of young people with a diagnosed ischemic stroke return to work. The etiology of ischemic strokes in young people often remains unclear, which complicates secondary prevention. In our study, we determined the features of etiopathogenesis and secondary prevention of ischemic stroke in young people. For this, 10 patients aged 19 to 45 years with diagnosed ischemic stroke were examined. The incidence of etiopathogenetic subtypes of ischemic stroke in young people differs from the general population, because this pathology is more common among people of an older age group. Ischemic stroke of unknown etiology are most often diagnosed owing to a certain difficulty in verifying risk factors. In 3 patients, concomitant diseases were identified that are risk factors for the development of ischemic stroke, which were not known before the vascular event, therefore, these patients did not receive primary prevention of ischemic stroke. When searching for a possible pathology of the blood coagulation system in 40%, screening tests turned out to be positive, which affected the measures for the secondary prevention of ischemic stroke.
Russian Military Medical Academy Reports. 2020;39(1-1S):102-105
102-105
COMPARATIVE EFFICIENCY OF ALLAPININ AND PROPANORM IN VENTRICULAR EXTRASISTOLIA IN PATIENTS WITH CORONARY HEART DISEASE
摘要
Ventricular extrasystoles is one of the most frequent arrhythmias in patients with coronary artery disease, and a progressive increase in the number of extrasystoles is associated with a risk of transformation of existing arrhythmias into life-threatening ventricular arrhythmias. The use of antiarrhythmic therapy helps to reduce their number and reduce the severity of symptoms. In order to study the effectiveness of propafenone and allapinin in patients with coronary artery disease, 28 men with "frequent" and "very frequent" ventricular extrasystoles were included in the study. The group of patients taking Allapinin at a dose of 75 mg/day included 12 people and the group taking Propanorm 450 mg/day - 16 people. After 1 month, Holter monitoring of the electrocardiogram was carried out: criteria for a positive antiarrhythmic effect in the form of a twofold reduction in extrasystoles were noted in 50% of patients in the allapinin group and in 56.3% in the propanorm group. Thus, in patients with coronary heart disease and frequent ventricular extrasystole, the use of class I antiarrhythmic drugs is accompanied by a positive result of antiarrhythmic therapy.
Russian Military Medical Academy Reports. 2020;39(1-1S):105-108
105-108
PECULIARITIES OF CARDIOVASCULAR RISK FACTORS IN MEN UNDER 60 YEARS OLD WITH MYOCARDIAL IN- FARCTION AND METABOLIC SYNDROME
摘要
Cardiovascular diseases, particularly myocardial infarction the cause of death of 45% of young and middle-aged men. One of the most serious and common risk factors for myocardial infarction is excess body weight - obesity that leads to metabolic and hemodynamic disorders. Modern prevention methods should take into account the comorbidity of patients for a more individual approach to treatment. The causes and mechanisms behind the predisposition of patients with myocardial infarction and metabolic syndrome (MS) to larger myocardial injury damage have not been sufficiently studied. The aim of the study is to assess the frequency of observation of risk factors of cardiovascular diseases in men under 60 years of age to improve the prevention methods. It includes men from 18 to 60 years old with type I myocardial infarction, who performed a standard diagnostic algorithm in the first 48 hours and at the end of the third week of the disease. Patients were divided into two age-comparable groups: I - investigated, with metabolic syndrome - 85 patients; II - without metabolic syndrome - 481 people. It has been established that the main risk factors for development of myocardial infarction in men with metabolic syndrome are diabetes mellitus, obesity, dyslipidemia, arterial hypertension, alcohol abuse, hypodynamics in history. These patients require observation for timely verification and correction of chronic heart failure, further additional examination to verify and eliminate comorbid risk factors, treatment and prevention of repeated myocardial infarctions.
Russian Military Medical Academy Reports. 2020;39(1-1S):108-111
108-111
DIAGNOSTIC SIGNIFICANCE OF LIPOPROTEIN (A) LEVEL IN THE DEVELOPMENT OF CARDIOVASCULAR EVENTS
摘要
Currently, the quantitative level of lipoprotein (a) (Lp(a)) is becoming increasingly important, because even when the target levels of low-density lipoprotein cholesterol are reached, patients have a high risk of cardiovascular complications. The similarity of Lp(a) to low-density lipoproteins is in the presence of a Central core consisting of cholesterol esters and triglycerides surrounded by phospholipids. The structure of Lp(a) allows us to consider it as a participant in the processes of atherogenesis and thrombosis. There is a dose-dependent effect: the higher the concentration of Lp(a) in plasma, the more intense its accumulation in the vascular wall. Unlike other lipoproteins, the level of Lp(a) circulating in the blood is controlled by the apolipoprotein (a) gene. The purpose of this work was to determine the diagnostic value of the Lp(a) level in the development of cardiovascular events. 30 people were examined: 20 of them were patients with myocardial infarction or ischemic stroke more than 3 months ago and less than 10 years before the start of the study; the other 10 were a control group of healthy volunteers. All patients underwent a biochemical blood test to determine lipids and Lp(a). As a result, there was a direct correlation between Lp(a) levels with age, repeated cardiovascular events, HDL and LDL-C concentrations, and a negative relationship with triglyceride levels. Conclusions were made about the Association of high levels of Lp(a) with an increased risk of cardiovascular events in patients with established cardiovascular disease, and the need for further study of Lp(a) levels to determine the target value for the development and progression of cardiovascular diseases was identified.
Russian Military Medical Academy Reports. 2020;39(1-1S):112-114
112-114
POLYMORPHISM OF NITROGEN OXIDE SYNTHESIS GENES (NO), AS A PREDICTOR OF FORMATION OF CARDIO- VASCULAR PATHOLOGY
摘要
Spend a genetic analysis of the blood of 41 patients with using polymerase chain reaction (PCR) to detect the presence of a mutation in the nitric oxide synthase (NO) genes. All patients were clinically diagnosed with diseases of the cardiovascular system. Among the patietnts there are a part of them, based on an anamnesis, that have a relationship between the genetic predisposition and the presence of cardiovascular diseases which were also observed in parents and grandparents of the examined patients. During the study there were 2 polymorphic variants of genes of type III synthase nitric oxide (NOS3, endothelial or eNOS) - T786C and G894T. As a result there were revealed that 70% of the patients have a mutation of at least one of the polymorphic variants of the NOS3 genes and only 30% of the patients have a “ normal” allels, which indicates that there is a relationship between genetic mutations of nitric oxide synthase (NO) and an increased risk of developing diseases of the cardiovascular system in patients, in particular, such as neurocirculatory asthenia, hypertension, coronary heart disease. Besides there are a relationship between polymorphism of nitric oxide synthase genes (NOS3 or eNOS) and the risk of developing a pathology such as stroke, which is a prognostically unfavorable sign and it can lead to aggravation of concomitant diseases of the cardio-vascular system and the development of their complications, also it can lead to a decrease in the quality and life expectancy of patients. A decrease in the synthesis of nitric oxide (NO) affects the physiological properties of platelets which is manifested by a high risk of blood clots and an increase in mortality among patients.
Russian Military Medical Academy Reports. 2020;39(1-1S):114-116
114-116
A CASE REPORT PERIOPERATIVE NEUROPATHY OF THE SCIATIC NERVE
摘要
In recent years, there has been a persistent tendency to increase the number of hip replacement operations, which is associated with the prevalence of coxarthrosis, as well as with a decrease in the age threshold for their manifestation. Along with this, the number of possible complications increases proportionally, including perioperative neuropathies, which can lead to long-term disability with a high frequency of disability. In this regard, the purpose of this article is to analyze the risk factors for perioperative sciatic nerve neuropathy, as well as the form and degree of damage during hip replacement. This article presents a clinical case of perioperative sciatic nerve neuropathy as a complication of hip replacement. The history of the disease is described in detail with the data of instrumental diagnostics. You can trace the pattern of development of this complication and identify the causal relationship between risk factors and the lesion itself. It is worth noting that this article provides an overview of the current literature on this problem with reference to this clinical case. It becomes clear that at all stages of surgical treatment, it is necessary to identify risk factors in order to prevent sciatic nerve damage. Recovery of the damaged nerve is long and not always complete, which largely determines the unsatisfactory result of treatment. Therefore, in the process of preoperative preparation is necessary to assess the risk of development of postoperative neuropathies. Also, do not forget about the importance of conducting rehabilitation activities in the early postoperative period. Timely diagnosis of perioperative nerve damage will help clarify the patient's further management tactics.
Russian Military Medical Academy Reports. 2020;39(1-1S):116-119
116-119
STATE OF THE UPPER DEPARTMENTS OF THE GASTROINTESTINAL TRACT IN PATIENTS WITH ISCHEMIC HEART DIS- EASE ON THE BACKGROUND OF RECEPTION OF ORAL ANTIAGREGANTS AND ANTICOAGULANTS
摘要
An analysis of 120 case histories of patients hospitalized in the clinic of the hospital therapy of S.M. Kirov Military medical academy for 2018 with various forms of coronary heart disease, among which 30 patients were diagnosed with angina pectoris, 11 had myocardial infarction, 30 had post-infarction cardiosclerosis, and 50 patients had a constant form of atrial fibrillation. 70.8% of patients had hypertension. 120 patients showed a high risk of developing thromboembolic complications, and therefore they were prescribed oral anticoagulants and / or antiplatelet therapy. The presence of lesions of the upper gastrointestinal tract was revealed in all patients with coronary heart disease taking antiplatelet and / or anticoagulant therapy. The analysis of the results of fibroesophagogastroduodenoscopy revealed the following diseases of the upper gastrointestinal tract: esophagitis reflux in 28.33% of patients, including erosive - 1.67%, chronic gastritis - in 59.17%, including erosive 10.8% peptic ulcer - 12.5%. In order to treat and prevent erosive and ulcerative bleeding from the upper gastrointestinal tract, only 42.5% of patients were prescribed drugs from the group of proton pump inhibitors. Thus, it is advisable for patients with various forms of coronary heart disease and a high risk of cardioembolic complications to start treatment with oral antiplatelet agents and / or anticoagulants with fibroesophagogastroduodenoscopy to timely identify the pathology of the esophagus, stomach and duodenum, and it is also necessary to conduct fibroesophagastroduodenoscopy in dynamics for timely detection of pathology, treatment and reduction of the risk of erosive and ulcerative bleeding. In order to treat and prevent erosive and ulcerative changes in the upper gastrointestinal tract in patients with coronary heart disease, drugs from the group of proton pump inhibitors for long-term use should be prescribed simultaneously with oral anticoagulants and / or antiplatelet agents.
Russian Military Medical Academy Reports. 2020;39(1-1S):120-122
120-122
PECULIARITIES OF CARDIOVASCULAR RISK FACTORS IN SMOKING MEN UNDER 50 YEARS OLD WITH MYOCARDIAL INFARCTION
摘要
The unfavorable situation of morbidity and mortality from myocardial infarction (MI) and the high prevalence of the main risk factors for cardiovascular diseases (CVD) make us search for new ways to improve their prevention. The purpose of the study: a comparative assessment of the structure of CVD risk factors in men younger than 50 years with MI, depending on tobacco use to improve prevention. It includes men from 18 to 50 years old with type I MI with a glomerular filtration rate of 30 or more ml / min / 1.73 m2, who, in addition to the standard diagnostic algorithm, carried out a targeted search and analysis of the presence of basic and additional risk factors for CVD. Patients were divided into two age-comparable groups: I group-studied, smoking patients - 168 patients; II grope - non-smokers - 41 people. It has been established that the main risk factors for CVD in the group of smokers are lipid metabolism disorders, physical inactivity, chronic foci of infections, overweight and arterial hypertension. Despite the lower prevalence of major CVD risk factors in male smokers compared with non-smokers, it is often associated with a pathology of the respiratory system, a history of heart rhythm disturbances, more pronounced purine metabolism disorders, and the presence of chronic foci of infection. The listed factors should be used in compiling high-risk groups for the development of MI and its complications and the implementation of preventive measures. Determination of the seasonal distribution of cases performed by seasonal climate through sustainable transition points average air temperature in the 0 and 15° C at the meteorological station of Saint-Petersburg.
Russian Military Medical Academy Reports. 2020;39(1-1S):122-124
122-124
DETECTION OF LATENT INTESTINAL DYSFUNCTION OF MILITARY PERSONNEL
摘要
The relevance of the problem of diagnosis of irritable bowel syndrome in military personnel is determined by its prevalence among the population, which is an average of 15-25% in the structure of pathology of the gastrointestinal tract, as well as a significant decrease in the quality of life of such patients, a possible negative impact on their performance of official duties. A study was conducted in a group of military personnel using an original visual questionnaire for evaluating bowel function, the purpose of which is to identify hidden bowel dysfunction. Military personnel were asked to describe the number and nature of defecations in the previous week using the Bristol scale of fecal forms. These data were later processed using the world health organization's clinical guidelines. According to the results of the research, a group of military personnel with hidden intestinal dysfunction was identified: 57.1% of them have intestinal dysfunction with a predominance of constipation, 28.6% - intestinal dysfunction with a predominance of diarrhea, and 14.3% - mixed-type intestinal dysfunction. It is also noted that there is often a difficulty in diagnosing this disease due to the low turnout of patients to specialists on this issue, and that the use of an original visual questionnaire for evaluating bowel function allows to overcome the psychological barrier in patients, provided the correct, competent questionnaire, to improve the differential diagnosis among diseases of the lower digestive tract. The expediency of using this original visual questionnaire for evaluating bowel function in the in-depth medical examination of military personnel for further expansion of diagnostic measures for the purpose of early diagnosis of organic pathology and timely treatment of diseases of the gastrointestinal tract is demonstrated.
Russian Military Medical Academy Reports. 2020;39(1-1S):125-127
125-127
THE MOST SENSETIV INDICATORS OF «ANGIOSCAN-01P»
摘要
Medical assistance is constantly continuing to develop new methods for the comprehensive assessment of the severity of patients. Invasive assessment methods have several advantages: range of data received, their accuracy, specificity of results, high information content. However, invasive examination methods themselves carry risks associated with the manipulation, take a long time interval for their conduct and evaluation, require a developed laboratory and high-quality supply. From this point of view, the search and development of new, highly informative, easily interpreted methods for non-invasive assessment of the patient’s condition are more preferable, since they do not carry risks associated with the manipulation for patients, they can provide dynamic tracking of state changes, require less time for interpretation. This article is devoted to the study of the most sensitive indicators of «Angioscan-01P», whose patient examination technique is based on the photoplathysmography method. The main parameters of the angioscan we studied were the stiffness of the vascular wall (%), the predominant type of pulse wave (%), the level of stress (arbitrary units), as well as the study of endothelial function by the method of vasoocclusion test, by means of which the ability of blood vessels to endothelially dependent vasodilation is assessed. We searched for reliable relationships between our chosen angioscan parameters and the results of clinical laboratory tests (PTI (%), creatinine (mmol/l), hemoglobin oxygen saturation (%) and the level of inflammatory response, which we estimate by the number of leukocytes (10 G/l) The reliable relationships we found can be used to improve the study of assessing the status of critical patients with a therapeutic profile.
Russian Military Medical Academy Reports. 2020;39(1-1S):127-132
127-132
A CLINICAL CASE OF SYMPTOMATIC DELIRIUM OF THE EARLY POSTOPERATIVE PERIOD AFTER SURGERY FOR A FEMORAL FRACTURE
摘要
Symptomatic delirium of the early postoperative period (SDEPP) is a common clinical type of postoperative cerebral dysfunction in surgery. The most common and common risk factors for all types of surgical interventions are: age, concomitant comorbid diseases, previous cognitive deficit, impaired vision and hearing. An important provoking factor of SDEPP is the use of anticholinergics, narcotic drugs, withdrawal symptoms, systemic infections, iatrogenic complications, metabolic disorders and pain. Severe infectious complications are typical risk factors of SDEPP and some authors consider delirium to be the earliest clinical manifestation of these complications. At present, it is also known that dementia increases the risk of SDEPP, while a higher initial educational level significantly reduces it. SDEPP is frequently found after structural alteration of the reticular formation, ventrolateral area of the hypothalamus and frontal lobes. There is evidence that alteration to the basal ganglia, lingual gyrus (on both sides), bilateral or right-sided damage to the prefrontal gyrus, superficial parietal cortex, and thalamus may be associated with the development of SDEPP. The current understanding of the pathogenesis of SDEPP includes supposed role of systemic inflammatory reaction that starts during the perioperative period, and is possibly exacerbated by the anticholinergic effect of drugs administered during this period. However, this hypothesis and the relationship between peripheral inflammation and neuroinflammation need further study. An important element in the pathogenesis of postoperative cerebral dysfunction in trauma and orthopedic surgery is cerebral embolism. During the surgical operations on the hip and knee joints, cerebral microemboli were found in 40-100% of patients. But at present, the connection of this fact with the onset of postoperative cerebral dysfunction has not been proved. The article presents a clinical case of symptomatic delirium of the early postoperative period in a patient according to the profile of traumatology and orthopedics.
Russian Military Medical Academy Reports. 2020;39(1-1S):132-134
132-134
FREQUENCY OF DELAYED COGNITIVE IMPAIRMENT AND OTHER CLINICAL TYPES OF POSTOPERATIVE BRAIN DYSFUNCTION IN HIP REPLACEMENT SURGERY
摘要
Much attention is paid to the study of postoperative complications in traumatology, since they affect the outcome of surgical treatment, the duration of hospitalization, and also reduce the quality of life of patients. Among the postoperative complications in patients with a traumatological profile, special attention is paid to changes in the functions of the central nervous system in the postoperative period, which constitute postoperative cerebral dysfunction - a change in the structural and functional state of the brain of predominantly vascular origin, which occurs in surgical practice in the intraoperative or early postoperative periods, manifested in the form of transient or persistent dysfunctions of the nervous system. Postoperative cerebral dysfunction is pathogenetically heterogeneous, clinically polymorphic, and includes three clinical types: perioperative cerebral stroke, symptomatic delirium of the early postoperative period, and delayed cognitive impairment. A feature of the development of postoperative cerebral dysfunction in orthopedics may be fat and bone marrow cerebral embolism, which most often occurs when cement fixation is used. Cerebral embolism contributes to damage to the blood-brain barrier, swelling of the brain substance. It can potentiate and participate in the mechanisms of neuroinflammation, leading to the development of the above clinical types of postoperative brain dysfunction. But despite the detection of fat emboli in the middle cerebral artery by transcranial dopplerography in many patients with endoprosthetics of large joints of the lower extremities, the connection of this fact with the development of postoperative cerebral dysfunction has not yet been studied.
Russian Military Medical Academy Reports. 2020;39(1-1S):135-137
135-137
ALZHEIMER'S DISEASE IN PAINTING
摘要
Alzheimer's disease has not been spared and painting, which is able to reflect changes in both the psychological and physical condition of the artist, which allows you to feel the severity of the disease and the helplessness of such patients, both in front of themselves and in front of society. Alzheimer's disease is characterized by several criteria, such as reduced cognitive abilities, where a large number of variations in memory loss are given high priority, regulatory functions and speech also suffer, and personality and behavior changes. However, special attention should also be paid to violations of the visual-spatial function. The aim of the work was to identify artists who suffered from Alzheimer's disease, analyze their work before the onset of the disease and during its progression, find the main signs of the disease in painting, and systematize these signs. We used the method of vertical and horizontal analysis, as well as a comparison method based on a number of NINCDS-ADRDA criteria that allow us to find and systematize the obtained data. The study revealed common features of pathological deviations in works of art by artists with Alzheimer's disease - the appearance of two-dimensionality and simplification (simplicity) in painting, the total number of angles decreases and their sharpness decreases, the deterioration of perspective and atmosphere in the image, the loss of meaning and content, sometimes there was a transition to abstraction, copying previous works when creating a new work. There was a decrease in the ability to perform previous work, a decrease in cognitive functions compared to the previous functional level, especially violations of visual and spatial functions and memory, as well as a decrease in regulatory abilities.
Russian Military Medical Academy Reports. 2020;39(1-1S):138-140
138-140
ALZHEIMER'S DISEASE IN CINEMATOGRAPHY
摘要
At the moment, the disease has affected more than 44 million people and this figure is growing exponentially. Therefore, we can assume that Alzheimer's disease-the scourge of the future generation, its study is engaged in the best minds of our time. This problem has not escaped the cinema, which is able to reveal and give the General public the simplest explanation of the essence of the disease and transfer it to the place of a person with Alzheimer's disease, to feel the severity of the disease and the helplessness of such patients, both before themselves and before society. The purpose of the work is to assess the cinematic interest in Alzheimer's disease, to find all possible films and TV series where Alzheimer's disease may appear, to evaluate the signs of the disease in the characters of the pictures by psychoneurological criteria, to analyze the possibility of using cinematography in the field of raising awareness of the population and medical staff about this disease. According to the main keywords, the main films of cinema for 50 years were found with the help of special search services and additional scientific literature. This study allows us to see the peculiarity of the transmission of clinical symptoms of dementia by actors through their roles. According to a number of criteria, 28 films were included in the research list, which allowed to systematize the obtained data and information from the scientific literature. The subjects were evaluated: the first-the clinical symptoms of the disease, the second-the General ability to function in everyday life, the third-behavior. All of the above features were found, but cognitive disorders dominate. Behavioral disorders are also shown well, disorders of motor functions are presented less often. Most films are informative enough to convey the standard course of Alzheimer's disease.
Russian Military Medical Academy Reports. 2020;39(1-1S):141-144
141-144
THE STRUCTURE OF THE POSTOPERATIVE CEREBRAL DYSFUNCTION AFTER THE HEART VALVE SURGERY
摘要
In the structure of heart valve defects, the aortic valve is most often susceptible to pathological changes - 64.5%. Conservative treatment of valvular heart disease is mainly aimed at reducing the severity of heart failure, at a certain stage the implementation of a surgical operation becomes a vital manipulation. The aim of the study was to evaluate the frequency and determine the structure of postoperative cerebral dysfunction during surgical correction of acquired aortic valve defects, as well as to compare it with other cardiac surgery for heart valve defects in cardiopulmonary bypass. We examined 134 patients (86 men and 48 women, average age 64 years), who underwent planned operations for prosthetics of heart valves in conditions of cardiopulmonary bypass. Postoperative cerebral dysfunction was diagnosed in 41% (55 of 134 patients). The incidence of postoperative cerebral dysfunction during prosthetic surgery for aortic stenosis is 49% with the following structure: perioperative stroke 4.3%, symptomatic delirium of the early postoperative period 25.5% and 29.8% delayed cognitive impairment. In patients with other operations on the heart valves, postoperative cerebral dysfunction was diagnosed in 36.8%: perioperative stroke 1.15%, symptomatic delirium of the early postoperative period, delayed cognitive impairment 23.2%. There were no significant differences in the incidence of perioperative stroke and delayed cognitive impairment (p>0.05). Acute clinical types of postoperative cerebral dysfunction and symptomatic delirium early postoperative period were significantly more often (p<0.05) detected after prosthetics for aortic stenosis.
Russian Military Medical Academy Reports. 2020;39(1-1S):144-146
144-146
PECULIARITIES OF MYOCARDIAL INFARCTION IN MEN UNDER 60 YEARS OF AGE WITH ULCERATIVE DISEASE
摘要
Combined pathology occupies a special place in the modern development of methods for the prevention of myocardial infarction (MI). Patients with myocardial infarction and peptic ulcer disease (PUD) are difficult to curate due to significant limitations in therapy. PUD negatively affects the prognosis of MI. In this regard, the study of the characteristics of the course of MI in young and middle-aged men with PUD for their use in the development of individual prophylaxis seems relevant. The purpose of the study was to study the characteristics of risk factors for cardiovascular diseases, the clinical course, structural and functional state of the myocardium, hemodynamics and quality of life in men under 60 with MI and PUD to improve preventive measures. It includes men from 18 to 60 years old with type I IM who underwent standard diagnostic research methods. Patients were divided into two groups: I - the studied, with PUD - 109 patients; II - without concomitant diseases of the digestive system - 358 patients as a control group. The incidence of PUD is 19.2% among young and middle-aged men with MI. The course of the disease in this group of patients is less favorable in the total number of complications, the frequency of thrombosis, bleeding, supraventricular tachycardia and incomplete atrioventricular block. The presence of a history of the disease with a higher frequency of inpatient treatment, coronary angiography, unstable angina pectoris in combination with more pronounced signs of heart failure in the first hours of myocardial infarction over a large circle of blood circulation indicates increased risks of side effects of standard hypocoagulation therapy in this group against microcirculatory disorders in the digestive organs, what needs to be considered when treating these patients.
Russian Military Medical Academy Reports. 2020;39(1-1S):147-149
147-149
EVALUATION OF LONG TERM RESULTS FOR AUTOLOGOUS TRANSPLANTATION OF HEMATOPOIETIC STEM CELLS IN PATIENTS WITH MULTIPLE SCLEROSIS
摘要
The aim of the study was to analyze the long-term effictiveness of high-dose immunosuppressive therapy (HDIST) followed by autologous hematopoietic stem cell transplantation (AHSCT) in long-term observation (more than 20 years) of two MS patients. This therapy was performed for the first time in Russia at the S.M.Kirov Military Medical Academy. The therapy was carried out for the first time in Russia at the S.M. Kirov Military Medical Academy at the Department of Hematology and Clinical Immunology together with the Department of Nervous Diseases in 1999 and 2000. The research was carried out by long-term dynamic observation of changes in neurological status according to EDSS (Expanded Disability Status Scale), recording of disease exacerbations and control of brain magnetic resonance imaging (MRI) results. It has been established that as a result of conducting a HDIST with AHSCT, a record duration of more than twenty years of remission without any additional treatment is possible in comparison with other PITRS. At the same time, a high frequency of side effects was observed during the therapy. Thus, taking into account its high effictiveness, manifested as a regression of neurological symptoms and long-term long-term remission with no activity on MRI, HDIST with AHSCT is one of the promising methods of MS treatment. Significant frequency and severity of side effects requires further improvement of treatment technology as well as observation to assess the safety of this therapy.
Russian Military Medical Academy Reports. 2020;39(1-1S):149-151
149-151
SPECIFIC MECHANISMS OF THROMBOSIS FORMATION AT PH-NEGATIVE MYELOPROLIFERATIVE NEW FORMATIONS
摘要
The most relevant Ph-negative myeloproliferative neoplasms (MPN) include: polycythemia vera (PI), essential thrombocythemia (ET), and primary myelofibrosis (PMF). Thrombosis and thromboembolism currently remain the main cause of disability and mortality in MPN. Most modern methods of specific cytoreductive therapy for MPN do not significantly affect the incidence of thrombotic complications, and in some cases may even contribute to their development. Therefore, the use of antithrombotic, primarily antiplatelet, therapy remains the most effective direction of prevention. Currently, various anticoagulants are becoming more common. For their introduction into hematological practice, a clear understanding of the formation of specific mechanisms of pathological thrombosis in MPN is necessary. To this end, we analyzed the disease-specific pathogenetic mechanisms of "thrombophilia" in various Ph-negative MPN.
Russian Military Medical Academy Reports. 2020;39(1-1S):151-154
151-154
CHARACTERISTICS OF LIPID, CARBOHYDRATE AND ADIPOKINE METABOLISM IN VARIOUS METABOLIC TYPES OF OBESITY IN MILITARY MEN
摘要
Obesity is a multifactorial pathology. The medical community still has debatable questions about the multidirectional impact of obesity on the body. So there is still no reliable scientific data on metabolically healthy obesity, the obesity paradox. The aim of the study is to compare the prevalence and structure of metabolic disorders in men with "metabolically healthy" and "metabolically neutral" obesity. The analysis of 590 case histories of male patients aged 30 to 45 years who were treated in the hospital therapy clinic was carried out. At the first stage of the study, patient data were divided into 3 groups depending on the presence of abdominal obesity and metabolic syndrome criteria: the metabolically healthy obesity group-155 people with a body mass index >30 kg / m without insulin resistance, the metabolic syndrome group-134 men with a body mass index >30 kg / m2 and metabolic syndrome, the control group-301 men without abdominal obesity. At the second stage of the study, the same indicators were compared in groups of patients with metabolically neutral obesity (86 men) and metabolically healthy obesity (155 men). The study examined the prevalence of various metabolic types of abdominal obesity. In the study sample, metabolic syndrome occurred in 23% of cases, metabolically healthy obesity in 26% of cases, of which 55% included a group with metabolcally neutral obesity, and 51% of cases had normal body weight. Determining the level of leptin in alimentary obesity is a necessary diagnostic criterion that characterizes the likelihood of metabolic disorders. In practical medical practice, it is advisable to use the term and criteria for "metabolically neutral" type of obesity, which allow stratifying patients who need active prevention and treatment.
Russian Military Medical Academy Reports. 2020;39(1-1S):155-158
155-158
IMMUNOLOGICAL FEATURES OF YERSINIOUS COLITS AND INFLAMMATORY DISEASES OF THE INTESTINE. MECHANISM OF THEIR POSSIBLE ASSOCIATION
摘要
Nflammatory bowel disease (IBD) is a disease with not fully understood triggering factors. Lack of sufficient knowledge about the mechanisms of disease development inhibits the development of a scientifically based management strategy for patients with IBD. There is insufficient evidence of yersiniosis in IBD. In the course of work, the immunological features of IBD and infectious colitis caused by Y. pseudotuberculosis and Y. enterocolitica were studied. An analysis was made of the clinical and immunological features of UC, CD, and yersiniosis colitis based on the data from the case histories of two groups of patients. The work uses the results of an in-depth study of case histories of 78 patients with IBD. Data are presented on the presence of changes in the quantitative composition of Th2 lymphocytes, changes in the quantitative and qualitative composition of the intestinal microflora in patients with IBD. The inflammatory process after infectious colitis caused by Yersinia opens the door to the development of chronic inflammation, that is, the development of IBD. An analysis was made of the clinical and immunological features of UC, CD, and yersiniosis colitis based on the data from the case histories of two groups of patients. The results were compared with the analysis of scientific literature on the research topic. Among patients with IBD who have a history of the disease “yersiniosis colitis” (16 patients), only 10 have positive PCR results for intestinal yersiniosis. Thus, the development mechanism of IBD is a complex, multifaceted process, which involves many etiopathogenetic factors that overlap and complement each other.
Russian Military Medical Academy Reports. 2020;39(1-1S):158-160
158-160
APPLICATION OF VARIOUS MEANS OF STUDYING THE QUALITY OF LIFE TO ASSESS THE CONSTITUTIONAL SYMPTOMS OF MYELOPROLIFERATIVE NEOPLASMS
摘要
The chronic nature of the course, as well as the limited possibilities of specific therapy, determine the particular relevance of the use of quality of life assessment tools in planning the follow-up and treatment of patients with myeloproliferative neoplasms (MPN). Despite this, the issue of the lack of specific and sufficiently accurate methods for assessing the quality of life in patients with MPN remains unresolved. Currently, the MPN10 questionnaire is recommended for assessing symptoms in patients with MPN and symptoms of myelofibrosis. Given the low stage of validation in Russia and the narrow symptomatic focus of the questionnaire for a more complete and accurate assessment of the quality of life, it is recommended that it be used simultaneously with nosologically non-specific validated questionnaires. A comparative study of the effectiveness of various quality agents was conducted (SF-36, EQ-5D-5L, EORTC QLQ-C30, MPN-10), which revealed the relationship between the influence of constitutional symptoms and quality changes in patients with Ph-negative MPN (n = 20). The EQ-5D-5L questionnaire is the most sensitive tool for assessing the quality of life to the influence of constitutional symptoms of the disease. Thus, it is necessary to note the importance of using strictly specific tools for assessing the quality of life in relation to each nosological unit. However, the results of this study prove that changes in the quality of life in patients with Ph-negative MPN are not always due to the influence of constitutional symptoms. That is why the question of finding the most appropriate means of assessing the quality of life for this group of oncohematological diseases remains relevant. At the moment, for a more complete and accurate assessment of the quality of life of patients with Ph-negative MPN, simultaneous use of MPN-10 in combination with EQ-5D-5L is recommended.
Russian Military Medical Academy Reports. 2020;39(1-1S):161-164
161-164
PECULIARITIES OF CARDIOVASCULAR RISK FACTORS IN MEN UNDER 60 YEARS OLD WITH MYOCARDIAL INFARCTION AND CHRONIC INFLAMMATORY DISEASES OF THE LUNGS
摘要
An important direction in improving the prevention of internal diseases in recent years is the reviewing of comorbidity for individualization of therapy. At the same time, data on the prevalence of risk factors for myocardial infarction (MI) in young and middle-aged men suffering from chronic lung diseases (CLD) are contradictory. The aim of the study was to assess risk factors for cardiovascular diseases (CVD) in men under the age of 60 with MI and CLD. It includes men from 18 to 60 years old with type I IM who, in the first 48 hours [8] and at the end of the third week of the disease [1], performed the standard diagnostic algorithm. Patients were divided into two age-comparable groups: I - with chronic lung disease (chronic bronchitis (136 patients) and bronchial asthma (6 patients)); II - without lung diseases - 424 patients as a control group. It has been established that the prevalence of CLD among men with MI younger than 60 years is 25.1% (bronchial asthma - 1.1%, chronic bronchitis - 24.0%). The predominant risk factors for MI in men younger than 60 years old with CLD are smoking (95.1%), atherogenic dyslipidemia (92.0%), chronic foci of infections of the internal organs (75.4%), hereditary burden of hypertension (54.2 %) and ischemic heart disease (40.8%), winter season (40.8%), non-ulcer pathology of the digestive system (26.1%), frequent colds (24.6%) and extrasystole (19.7%) history. The selection of risk groups among men under 60 years of age with this combination with the correction of modifiable risk factors will improve the results of prophylaxis and prognosis in such patients.
Russian Military Medical Academy Reports. 2020;39(1-1S):165-167
165-167
ESTIMATION OF THE NUTRITION STATUS AND PURINE EXCHANGE IN MEN OF YOUNG AND MIDDLE AGES WITH PRE-HYPERTENSION AND ARTERIAL HYPERTENSION OF 1 DEGREE DEPENDING TO THE CATEGORY OF CARDIOVASCULAR RISK
摘要
We studied blood pressure, heart rate, body mass index, waist circumference, and purine metabolism of 239 military men of young and middle age with hypertension and arterial hypertension of 1 degree, stratified into the categories of low and medium cardiovascular risk according to the Framingham risk scale. To clarify the role of risk factors for arterial hypertension in the formation of the clinical picture and structural and functional changes of men with initially low and medium risk factors for the development of cardiovascular diseases according to the Framingham risk scale, we studied the correlation between body weight parameters and age, heart rate, office parameters blood pressure, risk on the Framingham risk scale, waist circumference and uric acid. It was revealed that young and middle-aged men with pre-hypertension and arterial hypertension of 1 degree, classified as medium cardiovascular risk, are characterized by significantly higher values of blood pressure, heart rate, body mass index, waist circumference, blood uric acid level and average risk according to Framingham scale compared with subjects of low calculated risk. It is concluded that transformation of pre-hypertension into arterial hypertension, as well as the estimated low cardiovascular risk to medium, is accompanied by an increase in heart rate, body mass index, waist circumference and an increase in uric acid in the blood serum. This indicates the advisability of expanding the volume of regularly performed screening studies in male military personnel with determination of the level of uric acid of blood doesn’t from the age of 41, but from the age of 25-30 and to evaluate the cardiovascular risk not only on the SCORE scale, but also on Framingham scale of total cardiovascular risk
Russian Military Medical Academy Reports. 2020;39(1-1S):167-170
167-170
STUDY UF POLYMORPHISMS OF GENES ASSOCIATED WITH THE DEVELOPMENT OF THROMBOPHILIA IN INDIVIDUALS AT RISK OF SUDDEN CARDIAC DEATH
摘要
Mortality from cardiovascular diseases in the Russian Federation is one of the highest in the world and is 575 per 100,000 inhabitants for January-November 2019. The main causes of death from cardiovascular disease are the progression of chronic cardiovascular failure and sudden cardiac death. The risk of sudden cardiac death is determined based on history, physical examination, laboratory and instrumental studies. Those at risk should be given preventive measures to prevent and reduce the likelihood of sudden cardiac death. One of the causes of sudden cardiac death is coronary heart disease, which can occur in people with thrombophilia. In Russia, the number of registered venous thrombosis is 145-200 cases annually (per 100,000 population), with more than 70% of cases being subclinical, posing a risk of fatal thromboembolism and cardiovascular diseases. The goal of our work was to study the polymorphism of genes, which are single-nucleotide replacements of the bases associated with thrombophilia, and their effect on the development of sudden cardiac death. The peculiarity of many variant (polymorphic) genes is that over time they may not appear. Pathological symptoms occur only under additional conditions (surgery, obesity, pregnancy, use of hormonal contraceptives, increased levels of homocysteine in the blood, long period of immobility, etc.). The study involved 80 people who were tested for blood using DNA technology kits. Modicified risk factors for cardiovascular diseases have been identified.
Russian Military Medical Academy Reports. 2020;39(1-1S):171-172
171-172
BEHAVIORAL RISK OF FACTOR TYPE “A” AND ITS APPLICATION IN THE DIAGNOSTICS OF RHEUMATOID ARTHRITIS
摘要
Diagnosis of immune-mediated rheumatic diseases is a multi-stage and complex process. Many researchers have recognized that rheumatoid arthritis is of a psychosomatic nature. The study of psychosomatic status is a promising direction today in the comprehensive diagnosis of various diseases. This section is multidimensional, which gives the rheumatologist a wide diagnostic field for the search for certain patterns in the development of the disease. Many concepts have been proposed that try to explain the selectivity of damage to organs and systems during periods of psychoemotional stress. It should be noted that this crucial issue of psychosomatic medicine is still unresolved. Some concepts are aimed at the physiological basis of this disease. Others, on the contrary, pay more attention to the psychological approach, losing sight of the physiological foundations of the body laid down by nature. his one-sided approach to the problem under consideration is not permissible, since these systems are interconnected. The unique work of American cardiologists M. Friedman and R. Rosenman made it possible to combine all these factors, adding to his model the functional response of the system to the impact of a specific (psycho-emotional) load. This concept (1959) was developed on the basis of many years of experience working with cardiological patients and called them “a behavioral risk factor for coronary heart disease (type A)”. It has proven its effectiveness and has been successfully applied by a number of domestic and foreign scientists not only on cardiological patients, but also on patients with gastroenterological, psychological and neurological profiles. This work is an attempt to apply this concept to patients with rheumatoid arthritis.
Russian Military Medical Academy Reports. 2020;39(1-1S):173-176
173-176
FORECASTING A “DIFFICULT” LAPAROSCOPIC CHOLECYSTECTOMY
摘要
At present, the problem of treating patients with cholelithiasis (cholelithiasis) is becoming increasingly important. This is due to the widespread prevalence of diseases of the biliary system, reaching more than 10% of the world's population, with the number of patients increasing annually [5]. Today, the laparoscopic cholecystectomy (LCE) is the gold standard in the treatment of cholelithiasis. Currently, over 700,000 LCEs are performed annually in the United States [13]. In Russia, this figure is about 170,000 operations per year. The advent of laparoscopic techniques in the treatment of cholelithiasis has led to new and poorly understood complications. The most dangerous and disabling complications of cholecystectomy were and remain bile duct injuries (RVP), which are found in 0.4-3.5% of laparoscopic cholecystectomies. Considering the annual amount of LCE produced in the Russian Federation and the frequency of RVP during their implementation, we can get the absolute amount of RVP that should be expected. This number is about 1700 RVP annually [8,9,10]. The presence in some cases of LCE of severe complications, conversions, and a wide scatter of operating time led practicing surgeons to think about identifying technically difficult or “difficult” LCE from the total number of such operations, as well as the need to establish risk factors for the development of complications of this group of interventions. The article presents a retrospective study of 1024 patients who underwent laparoscopic cholecystectomy for acute and chronic cholecystitis in 2012-2019. As a result of the study, factors were identified that significantly increased the complexity of laparoscopic cholecystectomy, among them: age older than 58.5 years, near-bubble infiltrate according to ultrasound, tension of the wall of the pancreas. Based on the logistic model, a nomogram was created to assess the risk of complex laparoscopic cholecystectomy, which allows choosing the rational treatment tactics in patients with gallstone disease to reduce the incidence of postoperative complications and mortality.
Russian Military Medical Academy Reports. 2020;39(1-1S):177-181
177-181
INCREASED ACTIVITY OF ASPARTATE AMINOTRANSFERASE AND ALANINE AMINOTRANSFERASE AS A PREDICTOR OF POSTOPERATIVE PULMONARY EMBOLISM
摘要
Early diagnosis and prevention of pulmonary embolism is an urgent problem of modern medicine. Cancer patients have been described as a special group of the high risk for the development of this complication especially in the postoperative period. This article presents clinical observations of two patients with oncological pathology who had pulmonary embolism in the postoperative period. The diagnosis has been confirmed by CT angiography. The dynamics of transaminases activity in the postoperative period has been analyzed, certain regularities of their activity have been found, and the correlation of the obtained data with the links of the pathogenesis of pulmonary embolism has been studied. In the postoperative period there was a gradual increase of the activity of AST and ALT both no more than 5 times, then at the time of the appearance of clinical symptoms in the form of shortness of breath - a slight decrease in the activity of both indicators, followed by a sharp rise in activity. Probably such changes are associated with changes in pulmonary microcirculation, damage of the lung tissue cells. The study of the dynamics of AST and ALT activity in blood serum is an available method and is proposed as one of the ways of early diagnosis of pulmonary embolism.
Russian Military Medical Academy Reports. 2020;39(1-1S):181-184
181-184
RETROSPECTIVE ANALYSIS OF LONG-TERM RESULTS OF ENDOVIDEO SURGICAL TREATMENT OF INGUINAL HER- NIA BY LAPAROSCOPIC TRANSABDOMINAL PREPERITONEAL HERNIOPLASTY
摘要
The urgency of the treatment of inguinal hernias is due to the widespread occurrence of this pathology (3-7% of the population), a significant incidence of people of working age (40% of all cases of hernias), and a relatively high relapse rate (10-30%). The first publications on the development of transabdominal preperitoneal plasty (TAPP) technique are appearing in Russia, while the minimum relapse rate (0.8-2.2%) is reported. The negative features of laparoscopic operations include postoperative neuralgia and paresthesia, the development of hematomas and the accumulation of serous fluid in the inguinal region, a long period of development of the technique, the high cost of equipment and supplies. Domestic explants and herniostaplers appeared on the market. There are single reports of the results of their use. This requires dynamic screening of the immediate and long-term results of the use of new materials, the study of the consequences of treatment at the stage of acquiring operational experience. Objective: to generalize the accumulated experience and study the immediate and long-term results of transabdominal preperitoneal plasty. Direct results for 2 months were studied in 60 patients. Of these, 45 were questioned in a remote period. The quality of life was assessed using the standard SF-36 Health status survey. 12 out of 45 patients surveyed underwent examination and ultrasound. The results of the use of explants and staplers of domestic and foreign production are compared. An analysis of the data revealed a good quality of life for patients in the distant postoperative period after TAPP, a low relapse rate, which gives reason to continue using this method. There were no statistically significant differences in the frequency of complications in patients with the installation of domestic and foreign explants and the fixators used. A small number of observations require further research.
Russian Military Medical Academy Reports. 2020;39(1-1S):184-188
184-188
INTRAOPERATIVE PHOTODYNAMIC IMAGING OF THE PARATHYROID GLANDS USING 5-AMINOLEVULINIC ACI
摘要
The main treatment method of the manifest forms of primary and tertiary hyperparathyroidism is surgical. In doing so, the success of surgical intervention is determined by the removal of all pathologically altered parathyroid tissue. In spite that the only interoperative increasing of the parathyroid hormone may validate the radicalism of intervention, nowadays the fluorescence diagnostic, techniques, which provides the visualisation and differentiation of altered and unchanged parathyroid glands during the surgery, are being developed. The results of examination and treatment of patients with surgical diseases of the parathyroid glands who were operated using a minimally invasive endoscopically-assisted technique under conditions of intraoperative parathyroid monitoring with 5-aminolivulenic acid. Examination of patients was carried out in the framework of international protocols and clinical recommendations. All patients underwent preoperative topical diagnosis of pathologically altered parathyroid glands, including ultrasound examination of the neck and scintigraphy with 99mTc-technetrile. An intraoperative search for parathyroids accumulating 5-aminolevolenic acid was carried out using a polarized blue source in a darkened operating room. As a result of the study, it was found that the use of intraoperative parathyroid monitoring with 5-aminolevulinic made it possible to search and differential diagnosis of not changed parathyroid glands and parathyroid, thereby facilitating the radicalism of interventions, the prevention of postoperative hypoparathyroidism, relapse and persistence of the disease. Thus, photodynamic imaging of the parathyroid glands is a safe auxiliary methodology aimed at achieving a new level of evidence and safety of surgical interventions in primary and tertiary hyperparathyroidism.
Russian Military Medical Academy Reports. 2020;39(1-1S):188-191
188-191
ALGORITHM OF PROVIDING SPECIALISED MEDICAL CARE OF THE WOUNDED WITH FRACTURES OF EXTREMITIES WITH INJURY OF NEUROVASCULAR BUNDLE
摘要
The study is relevant due to the large proportion of the wounded with damage to the limbs, which makes up 54-70%, of which the proportion of the wounded with gunshot bone fractures reaches 35-40% [13]. With mechanical injuries, comminuted fractures of the tubular bones occur in 15.4 -16.1% of cases [5]. There is high frequency of injuries of the limb due to the lack of coverage by individual armor protection [3]. The problem of treating these injuries is the difficulty in restoring the function of the affected limb. This study aims to develop the most effective algorithm for the treatment of wounded with a fracture of long tubular bones and damage to the main vascular-uneven bundle. A comparative analysis of the results of the treatment of fractures of long bones of the extremities was conducted. The main criteria in the analysis are the frequency of complications (infectious and non-infectious) [5] and the length of hospital stay [1, 2, 10]. The analysis found that the most effective method of bone tissue restoration is intraosseous osteosynthesis, in which the treatment duration is 24.1 ± 9.7 days, and the complication rate is 18.05% [10]. However, it can be used only after achieving stabilization victims with isolated wounds. If it is impossible to switch to intra-focal osteosynthesis, it is necessary to remount the external fixation apparatus with the final reposition of bone fragments [3]. Preference should be given to spokerod devices, in which a minimum treatment period of 30.1 ± 9.5 days is observed [1], and the complication rate is 20.02% [5]. Analysis of the complete treatment algorithm for the wounded with a fracture in the length of the tubular bone and damage to the main neurovascular bundle was made.
Russian Military Medical Academy Reports. 2020;39(1-1S):191-195
191-195
THE POSSIBILITIES OF MINIMALLY INVASIVE TECHNOLOGIES IN COMPLEX TREATMENT OF PATIENTS WITH RECURRENT BLEEDING FROM ULCERS DIEULAFOY
摘要
An ulcer or Dielafua disease is a rare disease that manifests itself through an anomaly of the vessels of the submucosal layer of the stomach and the formation of an acute ulcer with profiled bleeding from an unusually large artery of artery artery. Typical for this disease are repeated relapses of bleeding, the treatment of which is one of the current and unresolved problems in clinical practice. The article demonstrates two clinical cases of treatment of patients with recurrent bleeding from Dielafua ulcer, who used a complex of endoscopic, endovascular methods of hemostasis in combination with open surgery. In the first clinical observation a patient with Dieloafua ulcer on the background of liver cirrhosis of portal hypertension syndrome is presented. Due to repeated recurrence of hemorrhage, the patient used a combined endoscopic hemostasis (injection, clipping, argon-plasma coagulation), laparotomy, gastrotomia, suturing of the Dieloafua ulcer of the stomach floor. However, the final hemostasis was achieved by endovascular method. Super-selective embolization of the bleeding source, the branches of the left gastric artery, was performed.In the second clinical observation in a patient with multiple recurrences of bleeding from Dieloafuan ulcer against the background of combined endoscopic hemostasis and impossibility of selective embolization due to the risk of spleen infarction, a laparotomy was performed, complete devascularization of the abdominal section of the esophagus and stomach by large and small curvature with preservation of the right gastric artery.The possibilities of minimally invasive technologies in complex treatment of patients with recurrent bleeding from Dielafua ulcer are shown on clinical examples.
Russian Military Medical Academy Reports. 2020;39(1-1S):195-198
195-198
VISUAL ACUITY RESEARCH USING OPTATIPES WITH DIFFERENT PROFILE OF OPTICAL DENSITY
摘要
One of the main diagnostic methods in ophthalmology is visual aquity examination. It is one of the most important examinations for revealing of aggravants, malingerers and dissimulaters for expert maters. Survey data of visual acuity research is comparing in 2 groups of tables (tables for visual acuity research: Golovin-Sivtsev’s table, Landolt’s rings; tables for assessment the distance of optotypes’ recognition). The disappearing distance of optotypes’ recognition (shapes with a complex contour profile) was measured. They have a unique particular - the closeness of recognition and detection thresholds, what increases the accuracy of visual acuity accuracy measurements and researchers’ attention to them. As a result of the exploration, we brought to light that the optical profile of the optotype has influence on the distance of it’s recognition, and also depends on the complexity of the configuration. It is easier to detect optotypes in the form of a vanishing Landolt ring for probationers, as opposed to"bar worlds". The results’ coincidence to observing the size of optotypes depends on the complexity of the configuration and it is due to internal irradiation ("crowding effect" - a phenomenon of visual perception). The provided data gives possibility to understand that the degree of correlation may differ due to different ranges presented in the article. The exploration and modification of tables allow us to improve the methodology for visual acuity studying and increasing the accuracy of the result, without departing from modern standards. Modified optotypes viden the possibilities of accurate determination of visual acuity in cases of simulation of aggravatio and dissimulatio.
Russian Military Medical Academy Reports. 2020;39(1-1S):199-203
199-203
ARMAVISCON IN RECOVERY TREATMENT OF SOLDIERS WITH GONARTROSIS
摘要
The improvement of restorative treatments for patients with knee gonarthrosis has so far remained one of the most pressing and complex problems of modern reabilitology. Despite the wide range of drugs available, and the manipulations and physiotherapy methods used, the recovery of motor activity in military personnel when gonarthrosis is exacerbated remains a difficult task, requiring an integrated approach to its solution. To this end, the Department of Surgery of Injuries and Limb Diseases of the Clinic of Outpatient and Polyclinic Care of the S.M. Kirov Military medical academy treated 70 soldiers with gonarthrosis of the knee joint with intra-articular injection therapy hyaluronates (Armaviscon). Clinical method, radiation diagnostic methods were used to assess the initial condition of the affected joint and clinical effectiveness. The clinical study included military personnel whose military work involves heavy loads on the lower limbs between the ages of 21 and 84 suffering from deforming arthrosis. Analysis of the obtained data showed safety and sufficient effectiveness of "Armaviskon" application in treatment of knee joint gonarthrosis in patients. The highest efficacy of the drug was observed at the early stages of gonarthrosis development.
Russian Military Medical Academy Reports. 2020;39(1-1S):203-205
203-205
THE COMPARATIVE ANALYSIS OF USING VIDEOTHORACOSCOPIC AND OPEN OPERATIONS FOR THE TREATMENT OF PATIENTS WITH TUMORS OF THYMUS
摘要
Annually over 2,000,000 new cases of non-small-cell lung cancer are diagnosed worldwide. Preoperative N-staging is the most important diagnostic step to determine the prognosis and tactics of further treatment of patients with lung cancer. 20-30% of patients with early stage NSCLC have local or distant recurrence of the disease and 5-year survival in these patients varies from 40 to 85.5%. In this context, there is a need to develop new methods for intraoperative evaluation of regional lymph nodes. One of these methods is the detection and histological examination of a signal lymph node. This approach allows to perform a targeted evaluation of the first lymph node on the path of tumor spread in order to determine the state of the remaining regional lymphatic collectors. However, today there is no “ideal” method for detecting a signal lymph node. It requires developing new approaches to visualizing the pathways of lymph outflow. Objective: compare and evaluate the effectiveness of using methylene blue solutions to visualize lymphatic outflow pathways in laboratory animals (outbred rat). Animals were randomized into 2 groups - 8 in each. The first group was injected subcutaneously in the left thigh with a 1% aqueous solution of methylene blue, the second group - solution of methylene blue with human serum albumin. Depending on the time of exposure, animals were divided randomly into 4 subgroups - 15, 30, 45 and 60 minutes. There was evaluated the effectiveness of marking the pathways of lymph out-flow from the injection site. The effectiveness of marking the pathways of lymph outflow from the injection site was evaluated. As a result of the study, it was demonstrated that the use of a 1% methylene blue solution allows us to adequately visualize the pathways of lymph outflow. The disadvantage of the drug is migration to the next order LN with an exposure lasting 30 minutes. A solution of methylene blue in combination with human serum albumin has a comparable quality of LN visualization. However, it has a slow (> 60 minutes) migration, which is preferred during surgery.
Russian Military Medical Academy Reports. 2020;39(1-1S):205-209
205-209
THE METHOD OF OBJECTIVE ASSESSMENT OF THE SEVERITY OF THE POSTOPERATIVE INFLAMMATORY RESPONSE WHEN PERFORMING CATARACT PHACOEMULSIFICATION, INCLUDING IN COMBINATION WITH ENDOSCOPIC LASER CYCLODESTRUCTION
摘要
The research work is devoted to the development of a method for an objective assessment of the postoperative inflammatory response in patients undergoing combined intervention (cataract phacoemulsification with endoscopic laser cyclodestruction) in comparison with standard cataract phacoemulsification. Performing a combined intervention can significantly improve visual function, as well as simultaneously reduce intraocular pressure. The question arises about the safety and effectiveness of this tactic in comparison with standard phacoemulsification. In this regard, it is of great interest to compare the postoperative inflammatory response, as well as the creation of an algorithm for its objective assessment. As a result of a study based on optical coherence tomography, a method was developed that allows to evaluate objectively the postoperative inflammatory response. The purpose of this study is to develop an algorithm and conduct an objective analysis of the severity of the postoperative inflammatory response in patients undergoing combined intervention (cataract phacoemulsification with endoscopic laser cyclodestruction) in comparison with standard phacoemulsification. The study involved 30 patients (30 eyes). The main group - 15 patients (15 eyes) with uncompensated open-angle glaucoma in various stages and an initial complicated cataract. The control group consisted of 15 patients (15 eyes) with an initial age-related cataract. On the morning of the day after the intervention, patients of both groups underwent optical coherence tomography of the anterior segment of the eye. During the analysis, 10.0 ± 7.5 inclusions were detected in the main group, and 2.5 ± 2.3 in the control group. The difference is statistically significant (p <0.001). The developed algorithm allows you to objectively assess the degree of inflammatory reaction in the anterior chamber of the eye. Comparison with the control group virtually eliminates the effect of phacoemulsification on the inflammatory response. During the analysis of the severity of the postoperative inflammatory reaction, a greater number of inflammatory inclusions were revealed after a combined intervention.
Russian Military Medical Academy Reports. 2020;39(1-1S):209-212
209-212
STUDY OF WOUND BALLISTICS AND MACROSCOPIC CHANGES IN EXPERIMENTAL OPEN GLOBE TRAUMA USING HIGH-SPEED VIDEO AND PHOTO RECORDING OF VIOLATIONS
摘要
This study focuses on such an important topic as gunshot open globe injury received in the course of combat operations [6], at home [7] and at work [3]. This topic is relevant because gunshot open globe injury is the most common injury for military ophthalmologists [2, 5]. An experimental reproducible standardized model of a type B gunshot open globe injury (without a foreign body) was developed to study the features of this injury in S.M. Kirov Military medical academy [1]. Due to the wide variety of gunshot injuries to the eye in appearance and internal structure [4, 8], it became necessary to record changes during the experiment. Therefore, it was decided to use high-speed photo and video shooting. Thus, it is possible to conclude that there is currently a need to develop a technique for photo and video recording of an image of a gunshot open globe injury. The study is divided into several stages, including specific tasks. The study includes literature analysis, modeling of various types of gunshot open eye injury, and visualization of changes using high-speed photo and video fixation. The result of this study is the developed method of high-speed photo and video fixation and description of macroscopic changes in various types of gunshot open globe injury. The study was carried out on the basis of two institutions. The first part of the work was carried out in Institute of military medicine, the other part was conducted at the Department of ophthalmology named after Professor V.V. Volkov, S.M. Kirov Military medical academy in 2018-2020 years.
Russian Military Medical Academy Reports. 2020;39(1-1S):213-216
213-216
THE ROLE OF ENDOSCOPIC INTERVENTIONS IN THE THYROID AND PARATHYROID SURGERY
摘要
Nowadays, in the thyroid surgery a great experience of using different variants of minimally invasive approaches, including endovideosurgical and da Vinci surgical robotic technologies. However, there are still no approved recommendations (protocols) for the application of these approaches; indications and contraindications remain the subject of debate and rely on the experience of the individual authors. Based on the indicated positions the purpose of our study was to determine the criteria for selecting patients with surgical diseases of the thyroid and parathyroid glands for the reasonable implementation of optimal minimally invasive surgical interventions. The article analyzes the results of a comprehensive medical examination and treatment of 417 patients with surgical diseases of the thyroid and parathyroid glands, who were operated by using various minimally invasive procedures. The medical examination of patients was conducted under international protocols and management guidelines. The patients were divided into four groups based on the nature of the minimally invasive techniques used: the 1st (n = 151) includes the patients, who underwent minimally invasive nonendoscopic thyroidectomy; the 2nd (n = 141) - is a minimally invasive video-assisted thyroidectomy; the 3rd (n = 110) - is an endoscopic thyroidectomy with the use of axillo-bilateral-breast approach; the 4th (n = 15) - is a transoral endoscopic thyroidectomy vestibular approach. It was stated that the main criteria that determine the rationale for minimally invasive interventions on the thyroid gland are: the nodule size and the thyroid volume; hyperfunctioning thyroid and clinical thyroiditis; substernal extension; extrathyroid extension and the necessity of implementation of central neck dissection due to central and laterocervical lymph node metastases. The application of the determined criteria based on the integrated use of modern diagnostic techniques for patients with surgical diseases of the thyroid and parathyroid glands can justify the selection of optimal surgical interventions, avoid unreasonable operations, to avoid increasing of the frequency of specific complications, reduces surgical trauma and duration of stay in hospital, improves cosmetic outcome and enhances the quality of life of the patients.
Russian Military Medical Academy Reports. 2020;39(1-1S):216-218
216-218
"GOLD STANDARD" OF ENDOSCOPIC INGUINAL HERNIOPLASTY
摘要
Endoscopic operations performed by a herniological patient are becoming increasingly common in specialized hospitals. At the same time, despite the large flow of patients in this category, the optimal option for minimally invasive surgery is not yet specified. Thus, the problem remains unresolved: which of the endoscopic plasty methods is preferable - TAPP (transabdominal preperitoneal plasty) or TEP (total extraperitoneal plasty)? The aim of the study was to evaluate the results of surgical treatment of patients with inguinal hernias with a minimally invasive method according to the TAPP and TEP methods, followed by justification of the appropriateness of using one or another endoscopic technique. The results of treatment of 1015 patients with inguinal hernias operated on from 2014 to 2019 were studied. (331 patients were operated laparoscopically - TAPP and 684 patients - according to the TEP technique). The learning curve with TAPP averaged 30 interventions performed, with TEP 45-50. The duration of surgery using the TAPP technique was longer compared to TEP. In all cases, the early postoperative period was uneventful, pain according to the VAS scale was greater in the group of patients operated on laparoscopically. Later postoperative complications developed with the same frequency - in the TAPP group in 0.9% of patients, after TEP in 1.2% of patients. Relapse of the disease was diagnosed in 3 cases (0.9%) after laparoscopic hernioplasty, and after surgery according to the TEP technique, in 3 cases (0.4%). At the same time, TEP hernioplasty favorably differed from laparoscopic intervention by the absence of the need to use endogeniostepler, less pain and a shorter postoperative bed-day.
Russian Military Medical Academy Reports. 2020;39(1-1S):218-221
218-221
DIAGNOSTICS OF CHRONIC DACRYOCYSTITIS
摘要
The analysis of objective research data obtained during the examination of patients suffering from chronic dacryocystitis is presented. The importance of modern as well as traditional methods was defined. It was shown that the modern diagnostic method - lacrimal endoscopy is indicative and informative, not only with confirmed chronic dacryocystitis but also in the absence of pathological changes in the lacrimal ducts in patients of the control group. The aim of the studi was to improve the quality of diagnosis of chronic dacryocystitis. There are traditional methods for diagnosing chronic dacryocystitis. They were also used in patients of the control group (without pathology of lacrimation) and in patients with chronic dacryocystitis. Refers to them sounding of the lacrimal ways, washing them with lacriminal cannulas, slit lamp biomicroscopy, color nasal lacrimal test 2% fluorescein sodium solution for its implementation, lacrimal endoscopy with lacrimal endoscope. A total of 20 patients were examined. In the control group of patients, with the help of lacrimal endoscopy, the normal appearance of the mucous membrane of the lacrimal tubules, lacrimal sac, the nasolacrimal duct was determined. Active patency of the tear ducts was confirmed by a positive color nasal lacrimal breakdown. When performing endoscopy of the lacrimal passages in patients of the second group, the criteria for pathological changes in the lacrimal sac and nasolacrimal duct, characteristic for chronic dacryocystitis, are determined: hyperemia, the presence of detachable, grayish folds of the mucous membrane, whitish-gray membrane in the area of stricture. The preliminary diagnosis of chronic dacryocystitis was also confirmed by traditional diagnostic methods: color lacrimal-nasal functional test, diagnostic sounding. and lacrimal lavage, dacryocystography. As a result of the study, it was found that lacrimal endoscopy significantly expands the possibilities of diagnosing chronic dacryocystitis, confirms and complements the data of traditional research methods, allows you to see structural changes along the tear ducts, determines the degree and level of obliteration. The combination of traditional diagnostic methods and lacrimal endoscopy allows the surgeon to choose the most appropriate way of surgical treatment of this pathology.
Russian Military Medical Academy Reports. 2020;39(1-1S):221-223
221-223
MODERN FEATURES OF PHISYOLOGICAL CHILDBIRTH BIOMECHANISM
摘要
A study was carried out on the topic “Modern Features of the Biomechanism of Physiological Childbirth”. The most favorable is the biomechanism of childbirth in the front view of the embryonic insertion of the fetal head in the first position. With such a biomechanism of childbirth, the fetal shank passes through the planes of the small pelvis of the malm with an oblique size, and at the second moment of the biomechanism of childbirth it makes an internal rotation of the head by 45 degrees, and therefore there are fewer complications both from the side of the fetus and the mother. Clinical observations have shown that more often labor begins in the rear view of the occipital insertion of the fetal head, the internal rotation of the fetal head occurs 135 degrees when moving from the wide part to the narrow part of the pelvic cavity or on the pelvic floor. The result of this rotation is the transition of the fetus to the anterior view of the occipital insertion. A tendency towards an increase in the frequency of asnKLITIC insertion of the fetal head, especially in the posterior view, a change in the position of the fetus, even after the birth of the fetal head during its external rotation, is determined. The revealed features of the biomechanism of physiology births were more often observed with premature outflow of amniotic fluid, lengthened the duration of the pernode of expulsion, and increased the frequency of injuries of the maternal soft birth canal. Studying the peculiarities of the biomechanism of childbirth with various insertions of the fetal head is necessary for timely changes in the tactics of labor management, including changes in approaches to obstetric manual benefits in order to reduce injuries to the mother and the fetus.
Russian Military Medical Academy Reports. 2020;39(1-1S):223-226
223-226
COMPARATIVE ANALYSIS OF SCALES FOR OPTIMAL DIAGNOSIS OF BILIARY SEPSIS IN PATIENTS WITH ACUTE CHOLANGITIS
摘要
The article gives a retrospective clinical study of 82 patients being treated at the clinic of faculty surgery named after S.P. Fedorov of the Military Medical Academy named after S.M. Kirov with the diagnosis "Acute cholangitis." Patients were divided into "no sepsis" (n = 42) and "with sepsis" (n = 40) groups. The following data were analyzed: clinical, surgical. In the postoperative period, early diagnosis of sepsis development was carried out in patients diagnosed with Acute cholangitis. The diagnosis was based on complaints, objective examination and laboratory and instrumental methods. Patients were assessed with diagnostic scales such as SOFIA, APACHE II, APACHE III, SAPS2, SAPS3.В the following analysis of their accuracy, sensitivity, specificity of prognostic positive and negative capacity, and statistical method of ratio OSH and Criterion Chi-square was used. The SOFIA scale in this study is the "gold standard" in the diagnosis of sepsis in patients with acute cholangitis. This is related to the least number of indicators among other scales, and the SOFIA scale does not require additional examination of the patient by another specialist. The APACHE III and SAPS3 scale requires a license agreement as opposed to a SOFIA scale. However, in our study, the use of the APACHE II scale showed the highest specificity (85.71%) and prognosticality of the negative result. The SAPS2 scale showed the greatest sensitivity (95.00%) and prognostics of the positive result. The most accurate scale is APACHE III, its accuracy is 73.17%. The lowest accuracy and sensitivity is SAPS3 (Se = 55.00%), (Ac = 64.63%).
Russian Military Medical Academy Reports. 2020;39(1-1S):226-230
226-230
METHOD FOR REPLACING EXTENSIVE DEFECTS IN LONG TUBULAR BONES USING 3D PRINTING
摘要
The fact that the scientific substantiation and promotion worldwide of the method of Ilizarov is the greatest achievement of domestic medicine, and the method of its use in filling bone deficit of upper and lower extremities have become the gold standard treatment of such patients [7]. It is known that frequent causes of the formation of a massive bone defect are injuries from projectiles with high kinetic energy, local infection, cancer, and excessive surgical aggression [4]. For a long time, the preservation of limb function in such patients was possible only in the case of non-focal transosseous compression-distraction osteosynthesis with non-free bone grafting according To G. A. Ilizarov [7]. However, the duration and result of treatment often did not fully satisfy both the patient and the attending physician [1]. The use of regenerative medicine in the practice of restoring the structural properties of damaged tissues with the help of bioactive implants allows us to count on solving difficult clinical cases in modern traumatology and surgery [12]. The question of replacing extensive defects in long tubular bones has always been relevant for both damage surgery and Oncology. Bone defects often require, in addition to the use of extra-focal transosseous compression-distraction osteosynthesis with non-free bone grafting according to GA. Ilizarov, using bone grafts or prosthetics. Titanium alloy is now widely used in dentistry and orthopedic surgery due to its relative bio-inertness and excellent mechanical and biological properties [5]. Titanium and its combined alloys are superior to all materials available in surgery that are used to replace bulk bone defects [6]. With the advent and development of 3D printing methods using metals, new opportunities for the use of titanium and its alloys have emerged, and it is now possible to create high-precision porous structures to replace bone defects in accordance with clinical needs. During the work, a prototype of the prosthesis model was developed and created using 3D printing, which is promising for further development and implementation in clinical practice
Russian Military Medical Academy Reports. 2020;39(1-1S):231-232
231-232
PREDICTION OF POSTOPERATIVE COMPLICATIONS IN PATIENTS WITH MECHANICAL JAUNDICE
摘要
Mechanical jaundice is the most widespread and severe syndrome of surgical diseases of hepatopancreatobiliary zone. Modern development of surgical technologies allows applying one- or two-stage surgical interventions in this category of patients. Single-stage tactics is characterized by performing a radical surgical intervention, but is associated with a high frequency of postoperative complications and lethality, reaching up to 60 - 70% [9,10]. Two-stage approach is conditioned by drainage of bile ducts and execution of radical surgical intervention after elimination of mechanical jaundice phenomena that takes on the average from 4 to 6 weeks. This approach reduces the frequency of postoperative lethality development up to 30% [16, 19], but increases the frequency of infectious complications development [20] and is associated with the increase of time before the radical operation, which becomes key in patients with mechanical jaundice of tumor origin, because no more than 16% are resectable at the moment of mechanical jaundice manifestation [10]. Thus, correct assessment of hepatic insufficiency and choice of the most rational approach are the key points of patient management. Objective of the study: to improve treatment results of patients with mechanical jaundice. Materials and methods. The examination of 17 patients with mechanical jaundice who were treated in the clinic of general and hospital surgery was carried out. The interrelation between the severity of mechanical jaundice according to E.I. Galperin, hepatic insufficiency determined by the green clearance test in Indocyanine, the state of coagulation link of hemostasis revealed by means of low-frequency piezotromboelastography and development of postoperative complications was assessed. Piezotromboelastography and Indocyanine green clearance test demonstrated a relationship to surgical complications. They are accessible, minimally invasive, promising to be introduced into a broad clinical practice. However, the accumulation of material, its analysis, and systematization of data are required.
Russian Military Medical Academy Reports. 2020;39(1-1S):233-239
233-239
ASSESSMENT OF MILITARY PERSONNEL LIFE QUALITY BEFORE AND AFTER COXARTHROSIS COMPLEX TREATMENT WITH GIPLURONIC ACID
摘要
Recovery of motor activity of military personnel of power structures and athletes after aggravation of deforming arthrosis of the hip joint (coxarthrosis) remains today an unsolved problem. The causes of deforming arthrosis are contusions of the soft tissues of the hip joint, long-standing injuries of its capsule-ligamentous apparatus, long-term loads on the musculoskeletal system in athletes during training and competitions, as well as the impact of cold on the body. The consequences of untimely and ineffective treatment of osteoarthritis are expressed in a decrease in motor activity and quality of life, the inability for health reasons to maintain their physical fitness at the required level, the transition of a soldier to a dynamic observation group for medical reasons, a decrease in the quality of performing military professional duties for official purposes in daily activities and combat situations, the termination of military applied and other sports. Despite the wide range of different treatment methods, the issue remains very relevant. For this purpose, the Department of surgery for injuries and diseases of the extremities of the outpatient clinic of the Kirov Military medical Academy treated 35 servicemen suffering from coxarthrosis using intra-articular njection therapy with hyaluronic acid preparations. Assessment of the quality of life of patients and the condition of the affected joint before and after treatment was evaluated using clinical methods, SF SF-36 and the Vash questionnaire. The analysis of the obtained results allows us to speak about the effective treatment of coxarthrosis with hyaluronic acid preparations, which is reflected in the improvement of clinical signs, as well as the criteria for assessing the quality of life.
Russian Military Medical Academy Reports. 2020;39(1-1S):239-241
239-241
RECTO-SIGMOID INHIBITOR MOTOR REFLEX IN DIAGNOSTICS OF CHRONIC CONSTIPATION
摘要
The study of the functional state of the colon is important not only for the objectification of its pathology, but also in the planning of treatment of its diseases. Compared to evacuation, an assessment of the motor function of the colon is not so common in clinical practice. However, the data obtained in this case are often very valuable and convenient for understanding the dysfunction of the colon. This study reports a study of the contractile response of the sigmoid colon to dilation of the rectal ampule in patients with complaints of constipation. To assess the motor function of the sigmoid colon, the method of balloon manometry was used. Using a recording device with three pressure sensors and a computer for data processing in the Exel program, studies were performed in 9 patients with slow-transit chronic constipation and in 6 patients with irritable bowel syndrome with constipation. In a rectal ampoule, a rubber balloon fixed to a catheter was inflated with air until distinct urge to defecate appeared, and against this background, the motor reaction of the distal part of the sigmoid colon was evaluated. It was found that dilation of the rectal ampoule leads to inhibition of the contractile activity of the sigmoid colon. This reflex (inhibitory recto-sigmoid motor reflex) was detected both in patients with irritable bowel syndrome and in patients with chronic constipation. The conclusion is drawn on the importance of a functional study of the sigmoid colon, which allows not only to identify dysfunction of the nervous structures of the intestine, but can also be used to justify the option of forming an intestinal anastomosis after resection of the colon in patients with chronic constipation.
Russian Military Medical Academy Reports. 2020;39(1-1S):242-244
242-244
THE TECHNIQUE OF LATERAL ULTRASONIC DISSECTION IN THE SURGICAL TREATMENT OF HEMORRHOIDS PA- TIENTS
摘要
The high incidence of hemorrhoids, along with the frequent development of postoperative complications and relapses of the disease, does not allow one to doubt that improving the treatment results of patients with this pathology remains one of the urgent problems of modern surgery. The aim of the study was to evaluate the effectiveness of surgical treatment of hemorrhoids using the original technique of lateral ultrasonic dissection in the "cutting" mode. A comparative analysis of the immediate results of surgical treatment was performed in two groups of patients with 3-4 stages of chronic hemorrhoids. The main group included 20 patients in whom the original hemorrhoidectomy technique with lateral ultrasonic dissection was used. The control group consisted of 20 patients who underwent Milligan-Morgan hemorrhoidectomy using electrocoagulation. There was no statistically significant difference between the indicated groups by age, gender structure of patients, as well as by the main characteristics of the disease. Results of the comparative analysis demonstrated that the frequency of complications, the intensity of the pain syndrome, as well as the length of stay in the hospital among the representatives of the main group turned out to be less than in the control. Thus, the use of hemorrhoidectomy with lateral ultrasonic dissection in the “cutting” mode ensures a favorable course of the early postoperative period and accelerates the rehabilitation of patients.
Russian Military Medical Academy Reports. 2020;39(1-1S):245-247
245-247
EPIDEMIOLOGY OF NOSOCOMIAL INFECTION COMPLICATIONS IN A SURGICAL CLINIC
摘要
The analysis of the data of literary sources of domestic and foreign researchers on the problem of the occurrence and development of nosocomial infections in general and in the surgical departments in particular is carried out. The relevance of the study is confirmed by the following data: the spread of nosocomial infections in the Russian Federation is 2.5 million annually; the minimum damage inflicted by them in Russia alone is approximately 6-7 million rubles. The data of foreign scientists have been studied, suggesting that infections in the field of hirirurgic intervention were recorded in 13% of cases after performing "clean" operations, in 16% after and in 29% after < contaminated>. In St. Petersburg, with selective studies, the frequency of infections in the field of surgical intervention revealed 9% of patients among 1,500 operated It was revealed that the number of potential causative agents of nosocomial infections increases every year due to opportunistic bacteria that differ in biological characteristics from hospital strains and have multiple drug antibiotic resistance. A retrospective and prospective analysis of the frequency of occurrence of microorganisms in patients of the surgical department of 2008-2019 was carried out. The microbial spectrum and prevalence of nosocomial infection pathogens in the surgical department were investigated. An epidemiological analysis of the causative agents of nosocomial infection in patients with pneumonia, infections in the surgical field and urinary tract, as well as with generalized infections, was carried out. The analysis of the bacterial flora of the clinical microbiological culture of the wound discharge, sputum, urine and blood was carried out. The following microorganisms were most prevalent in these samples: Staphylococcus aureus, Acinetobacter baumannii, Candida albicans, Klebsiella pneumonia. A tendency to increase the proportion of Candida albicans in patients of the surgical department, as well as a high prevalence of Staphylococcus epidermidis in blood cultures, was revealed.
Russian Military Medical Academy Reports. 2020;39(1-1S):247-249
247-249
ABOUT HELPFUL METHODS FOR TEMPORARY STOP OF EXTERNAL BLEEDING
摘要
In field surgery, there is an acute question of stopping external bleeding [3]. In the literature, the effectiveness of time-sensitive temporary hemostasis agents has been well studied, but there are no data on the effectiveness of available tools. The aim of the study was to determine the effectiveness of improvised means of temporarily stopping external bleeding. In the course of scientific work, the improvised methods of temporarily stopping external bleeding (tourniquet, twist, waist belt, wire) were investigated in comparison with a timeline hemostatic tourniquet in a group of 30 people. The application time, pain, and application efficiency by the presence of a Doppler signal above the radial and posterior tibial arteries were studied. Statistical data processing was performed using the Chi-square test, the Fisher test and the Kruskal-Wallis test. The results showed that the cessation of blood flow when using the belt was observed only in 6 (20%) cases on the hip, in 15 ( 50%) cases on the shoulder; wires - on the thigh in 6 cases (20%) and 18 (60.0%) cases on the shoulder, which is much less common in comparison with a personnel harness (p <0.001). When using a braid-twist from a scarf, the cessation of blood flow on the shoulder was observed in 29 96.7%) cases and 25 (83.3%) cases on the thigh; time rope - in 28 (93.33%) and 22 (73.33%) cases, respectively (p = 0.37066). The average ( application time of the studied methods was 42.38 ± 1.41 sec. There were no statistically significant differences in the application time of the studied methods (p = 0.8 on the shoulder, on the thigh p = 0.06). When scoring shoulder pain, there were no statistically significant differences between the methods (p = 0.22), the average score was 2.01 ± 0.64 points, on the thigh - the data were statistically significant (p = 0.0038), the most painful was the twist - 2.95 ± 2.03 points, the least painful was the waist belt 1.07 ± 1.17 points. As a result, the low efficiency of the waist belt and wire as improvised means of temporarily stopping external bleeding was proved. The effectiveness of the twist-tow is comparable to a timeline hemostatic tourniquet.
Russian Military Medical Academy Reports. 2020;39(1-1S):249-252
249-252
PRACTICAL DAMAGE SURGERY COURSES - A MODERN APPROACH TO TRAINING MILITARY SURGEONS
摘要
The training of military surgeons to assist the wounded is one of the fundamental directions for improving the medical support of troops. One of the most effective forms of training surgeons in the treatment of severe wounds and injuries is considered to be continuing education courses in trauma centers of the first level. For military surgeons this center is the Department of Field Surgery of the Military Medical Academy named after S.M. Kirov. However, in recent years, due to the steady decrease in the number of incoming wounded, the demonstrativeness of the educational process, the possibility of real participation of students in the treatment process have decreased. To increase the efficiency of training of military surgeons, to improve their manual skills, it is necessary to introduce new forms of training. The most promising of them is the introduction of combined practical courses using simulators and real tissues. The first such course in Russia was practical course on damage surgery SMART (Modern Methods and Algorithms for the Treatment of Wounds and Injuries), created by the teaching staff of the Department of Military Surgery of the Military Medical Academy named after S.M. Kirov, during course participants were given the opportunity to listen to a short lecture cycle on pressing issues of damage surgery and military field surgery, as well as to work out the most relevant life-saving surgical operations and manipulations that form the basis of Damage Control tactics. The aim of the study was to substantiate the introduction of practical courses for surgeons on issues of field surgery and to evaluate their efficiency. The efficiency of the SMART training course has been proven by testing the initial and final level of knowledge of 55 participants.
Russian Military Medical Academy Reports. 2020;39(1-1S):252-255
252-255
SURGICAL TREATMENT TACTICS FOR PATIENTS WITH ACUTE PANCREATITIS
摘要
The article contains information about the tactics of surgical treatment of patients with acute pancreatitis of medium and severe severity of the disease. The relevance of the topic is dictated by the high frequency of the disease, a significant proportion of unsatisfactory treatment results, as well as the fact that generally accepted tactics for surgical treatment of patients with acute pancreatitis currently does not exist. The article presents the data that the most perspective tactics of multistage surgical treatment is. At development of infectious complications such approach allows to reduce lethality, in comparison with patients who have undergone open interventions. The first stage of surgical treatment of acute pancreatitis at development of acute liquid accumulations in the second week of the disease is more often carried out a little invasive interventions to reduce accumulation of toxic substances and to prevent polyorganic insufficiency. The first stage of surgical treatment can also be laparoscopic surgery, which is diagnostic in order to differentiate the disease and determine the severity of acute pancreatitis. The second stage of surgical treatment in the development of infectious complications may also be a minimally invasive surgery. At the second stage of the surgical treatment large size drainages are put in order to wash and clean the abdominal cavity from the aggregations formed there. The third stage of surgical treatment of acute pancreatitis is the open access operation, the task of this operation is necksrevestrectomy. Exactly such tactics of surgical treatment of acute pancreatitis of medium and heavy degree of severity is the most perspective as lethality of the given tactics is minimal and development of infectious complications occurred less often.
Russian Military Medical Academy Reports. 2020;39(1-1S):255-257
255-257
INFLUENCE OF PLATELET-RICH PLASMA ON REPAIR CORNERAL REGENERATION
摘要
The study is devoted to the development of a reliable, reproducible and effective way to create chronic corneal erosion (CCE) in experimental animals, as well as the assessment of the clinical and morphological features of corneal regeneration in response to the use of platelet-rich plasma (PRP) under experimental chronic corneal erosion (ECCE). It relates to experimental medicine, namely to ophthalmology, and military ophthalmology in particular. Studies were performed on 12 chinchilla rabbits (24 eyes). At the first stage, all animals were reproduced a model of experimental chronic erosion of the cornea: local ultraviolet (UV) irradiation with an exposure of 45 min on the previously deepithelized surface of the cornea. At the second stage, all the studied animals were divided into three groups (4 rabbits in each). In the 1st main group (MG), instillation of PRP was carried out in 1 drop every 1 minute for 10 minutes (10 drops) once, in the 2nd group they were treated according to the above method daily for 5 days. In the control group (CG), treatment for PRP was not used. As a result of the study, it was shown that local exposure to ultraviolet radiation prevents the corneal epithelization in the irradiation zone up to the 30th day of the experiment. In this case, the relief of inflammation and the completion of epithelization of the irradiated area becomes possible only after the growth of superficial vessels to it. The therapeutic effect of the use of platelet-rich plasma in experimental chronic erosion of the cornea due to growth factors, adhesive molecules and dissolved fibrin contained in it is based on the formation of a normal adhesion complex between the epithelium and the Bowman membrane and stimulation of reparative regeneration, as a result of which the corneal epithelium is restored.
Russian Military Medical Academy Reports. 2020;39(1-1S):257-260
257-260
ANALYSIS OF IMMEDIATE AND LONG-TERM RESULTS OF TREATMENT OF VASCULAR LIMB INJURY
摘要
The experience of treatment of 35 patients with acute vascular trauma of limbs aged 20-50 years (29 of them are men (83%)) who were treated at the clinic of military field surgery of the S.M. Kirov Military Medical Academy was analyzed during the period from 01.01.2001 to 01.07.2011. Assessment of the immediate results of surgical treatment was performed using the original database that accumulates information on the treatment of patients with injuries of the main vessels of the limbs. The criterion for the development of surgical treatment tactics was the modified VPH-MESS scale, which makes it possible to predict with high reliability the need for amputation or the ability to save the limb. It was shown that half of the victims were delivered to the clinic with a shock of the I-II degree (46%), 43% were in a terminal state, every tenth victim was admitted to the clinic without signs of shock. The average VPH-MESS score was 6.77 ± 1.80. During surgical treatment (73% emergency operation), halting of profuse external bleeding in half of the cases was done without applying a vascular suture, in a quarter with a vascular suture, auto-venous prosthetics were performed to two victims. 59% of patients in the postoperative period had complications. It was shown that 62% of the victims retained their bearing ability, the sensitivity and movements of the injured limb were restored, the range of movements was reduced in 15%, 20% had a markedly reduced sensitivity and limited amplitude of movement. Additionally, long-term results of their treatment (from 1 year to 7 years) were analyzed in 12 patients using the questionnaire for assessing the quality of life of SF-36. The quality of life of victims with damage to the vessels of the extremities in the long term after treatment corresponds to the quality of life of healthy people: the level of generalized physical health component (RSH) was 51.01 ± 5.4, generalized psychological component of health (MSN) was 57.89 ± 3.9. The indicator of the psychological component of health significantly exceeds the parameter of the physical component of health (p<0.05).
Russian Military Medical Academy Reports. 2020;39(1-1S):260-263
260-263
PROFESSIONAL PATHOLOGY OF MILITARY SERVICE DUE TO NOISE EXPOSURE
摘要
Noise, being a general biological stimulus, affects all organs and systems of the body. When exposed to noise, certain physiological changes and pathological conditions develop, which depend on specific conditions: the level and nature of the noise, the duration of its exposure. Noise occupies one of the leading places among the adverse factors in the Armed Forces (AF), its impact leads to a decrease in military professional capacity and an increase in the incidence of military personnel. This is facilitated by the high mechanization and power supply of weapons and military equipment, the absence and insufficient number of personnel protection from noise (collective and individual), which in most cases have low acoustic efficiency. In the Sun, noise was not identified as a harmful factor leading to the development of occupational pathology; the issues of professional selection and examination of noise pathology were not fully developed. Military personnel who have been exposed to intense noise for a long period of time have diseases of noise genesis, which, however, in accordance with the regulatory legal documents in force in the Armed Forces, are not considered occupational diseases. After dismissal from the Armed Forces, such persons are not adequately protected socially, since the causal relationship of the pathology revealed in them has the phrase “the disease was received during the military service” instead of the necessary disease was received while performing military service duties (“military trauma”).
Russian Military Medical Academy Reports. 2020;39(1-1S):263-265
263-265
PREOPERATIVE DIAGNOSIS OF COMPLICATIONS IN PATIENTS WHO HAVE UNDERGONE GASTROPANCREATODUODENAL RESECTION
摘要
The article presents a retrospective study of 64 patients with pancreatic pathology who underwent gastropancreatoduodenal resection. As a result of the study, it was noted that 33 patients developed postoperative complications, most of which were classified as grade III Clavien-Dindo. The analysis of the effectiveness of the new preoperative diagnostic score for pancreatic resections is performed. When calculating points on the PREPARE score, it was found that the expected (prognostic) low risk of developing postoperative complications corresponded to 48 patients, the intermediate - 10, and the high - 6. In fact, only 22 patients from the "low-risk" group had complications (6 - "mild" I-II degree in Cl.- D., 16- "heavy" III-V degree in Cl.- D.), 6 from the " intermediate " group (2 and 4, respectively) and 5 from the "high" group (all "heavy" III-V degree in Cl.- D.), which totaled 33 cases. Using ROC analysis, it was found that there were significant differences in PREPARE points (AUC=0.645, pAUC=0.047 [0.510-0.779]) and no differences in risk groups (AUC=0.601, pAUC=0.167 [0.461-0.740]). The results of the study indicate that the diagnostic score of preoperative diagnostics for pancreatic resections PREPARE may have a prognostic ability, when evaluated before surgery by points. Patients from the "high" risk prognostic group are of particular interest for the study. The use of the PREPARE score in patients who have undergone gastropancreatoduodenal resection can be an effective prognostic indicator of the development of postoperative complications, the need for and delay of the patient in the hospital, which will help reduce postoperative mortality. However, further research is needed on the predictive capabilities of the PREPARE score to include more patients.
Russian Military Medical Academy Reports. 2020;39(1-1S):265-267
265-267
FEATURES OF ARTERIAL BLOOD SUPPLY IN THE LOWER THIRD OF THE LEG AND ANKLE JOINT IN INDIVIDUALS WITH ATHEROSCLEROSIS OBLITERANS OF THE LOWER EXTREMITIES
摘要
Diseases of the cardiovascular system in most economically developed countries occupy a leading position among the causes of morbidity, disability and mortality. In 60-80% of patients with obliterating atherosclerosis of the vessels of the lower extremities with multiple and distal forms of pathology, severe ischemia develops, leading to amputation of the limb in 20-30%. Objective: based on the data of X-ray contrast angiography, show the features of arterial blood supply to the lower third of the leg and ankle joint and evaluate the compensatory potential. The images of 20 patients with atherosclerosis obliterans of the lower extremities were studied. Thus, we can say that the compensatory blood flow in these areas is well developed. But a large number of anastomoses on angiograms with atherosclerosis was not characterized by adequate blood supply, in this regard, it was manifested by the depletion of the compensatory capabilities of the vascular bed and its gradual defeat, resulting in ischemia and foot necrosis.
Russian Military Medical Academy Reports. 2020;39(1-1S):267-269
267-269