Vol 94, No 4 (2013)
- Year: 2013
- Articles: 36
- URL: https://journals.rcsi.science/kazanmedj/issue/view/118
Theoretical and clinical medicine
Brain natriuretic peptide gene polymorphism in patients with congestive heart failure
Abstract
Aim. To study the influence of brain natriuretic peptide gene polymorphism (polymorphic locus Т-381С) on brain natriuretic peptide serum level and congestive heart failure onset risk and clinical features in patients with coronary heart disease. Methods. 412 patients with congestive heart failure were examined. Genotyping was performed by polymerase chain reaction. Brain natriuretic peptide N-terminal fragment level was assessed by ELISA. The control group included 211 healthy controls with no signs of cardiovascular pathology on examination. Results. In healthy people with C/C genotype the level of brain natriuretic peptide N-terminal fragment was significantly higher in comparison with people carrying T/T genotype. It was found that the T allele and T/T genotype of the T-381C natriuretic peptide gene polymorphic locus was associated with high risk, severity and unfavorable clinical course of congestive heart failure in patients with coronary heart disease. At the same time, the C allele and C/C genotype emerged as a protective factor regarding the risk, severity and clinical course of the disease. Conclusion. T/T genotype carriers of the of the T-381C natriuretic peptide gene polymorphic locus are a special subgroup associated with high risk of congestive heart failure onset and unfavorable clinical course. Therefore these patients with coronary heart disease should be considered as a group requiring an out-patient control and preventive measures targeted on congestive heart failure and premature mortality prevention.
Kazan medical journal. 2013;94(4):433-438
433-438
Complex assessment of clinical features and role of interleukin-10 g-1082a gene polymorphism in the development of slowly resolving clinical course of community-acquired pneumonia
Abstract
Aim. To perform a complex assessment of clinical, molecular and genetic factors in the development of slowly resolving pneumonia and to assess their diagnostic values. Methods. 95 patients with community-acquired pneumonia, of which 37 people had a prolonged clinical course of the disease, were examined. Interleukin-10 G-1082A gene polymorphism was evaluated in all patients by polymerase chain reaction. Logistic regression analysis was used for prognostic model construction. Results. Factors predisposing to the slowly resolving pneumonia were: concomitant chronic obstructive pulmonary disease, polymicrobial etiology, multilobar lung involvement, destructive lung lesions and presence of pleural effusion detected by X-Ray. The distribution of interleukin-10 G-1082A genotypes was consistent with Hardy-Weinberg equilibrium (χ2=3.62, p=0.057). There was a significant difference found in the symptoms and laboratory changes severity associated with interleukin-10 G-1082A gene polymorphism: patients carrying GA and AA genotypes had a milder clinical and laboratory changes and a milder course of the disease with fewer complications. Interleukin-10 -1082 GG genotype prevailed among patients with slowly resolving pneumonia. The complex use of clinical data, X-Ray findings and results of molecular and genetic typing allowed to reliably predict the course of the disease. Conclusion. The complex approach considering clinical and genetic features was the most successful for prognosis of slowly resolving pneumonia. The gained data can be used to predict the duration of community-acquired pneumonia course.
Kazan medical journal. 2013;94(4):438-444
438-444
Depression in young HIV-positive patients is associated with anemia
Abstract
Aim. To examine the interrelation between depression and anemia in HIV-positive patients. Methods. A cross-sectional study included 99 HIV-positive patients. Anemia was defined as hemoglobin concentration below 12 g/dL in women and 13 g/dL in men. Depressive symptoms were measured using the Beck Hopelessness Scale. Results. Anemia was registered in 30.3% of patients. In 54.5% of patients depression was detected (Beck Scale score ≥10). In patients with anemia the prevalence of depression was 76.7% including severe depression in 20% of patients. Mean Beck Scale score in anemia group was significantly higher compared to the group without anemia (17.57±12.90%, 95% confidence interval 13.5-20.5 and 10.06±8.07, 95% confidence interval 7.7-12.3, t=3.2, p=0.007 relevantly). Moderate reverse correlation between Beck scale scores and hemoglobin level was revealed ((r=-0.24, p=0.019). After stratification and adjusting for potential confounders, anemia was found to be associated with higher prevalence of depression in patients younger than 40 years old. The prevalence ratio for depression in patients with anemia, comparing to patients without anemia was 1.827 (95% confidence interval 1.28-2.61, λ2=8.85, p=0.0029) in this age group. Detected association did not depend on sex, family status, disease duration, CD4-level and treatment with antiretrovirals. Conclusion. Depressive symptoms are associated with anemia in HIV-patients younger than 40 years old.
Kazan medical journal. 2013;94(4):445-450
445-450
Results of endoscopic treatment in patients with obstructive jaundice
Abstract
Aim. To evaluate the results of endoscopic treatment in patients with obstructive jaundice. Methods. 136 patients with obstructive jaundice aged 27 to 88 years were referred for endoscopic transpapillary interventions from 2007 to 2012. 24 (17.6%) patients had biliary obstruction due to malignancies, most frequently - pancreatic cancer in the head of the pancreas (12 out of 24 patients, 50% of cancer cases). Among 112 (82.4%) patients with benign obstructive jaundice choledocholithiasis was diagnosed 67 (59.8%). Results. In 4 out of the 24 (16.7%) patients with malignancies and in 1 out of 112 (0.9%) patients with benign obstructive jaundice an endoscopic transpapillary intervention has failed. Single endoscopic transpapillary drainage was needed in 66 (48.5% of cases) patients, two endoscopic transpapillary decompressions - in 56 (41.2%) patients, three or more - in 14 (10.3%) patients. Papillosphincterotomy was the most frequent procedure performed, used in 136 out of 225 (60.4%) of cases. Serious complications occurred in 3.1% (7 out of 225) of completed surgeries. 1 (0.7%) patient has died of the heart failure. Endoscopic transpapillary stenting, which was performed in 19.6% of cases (44 out of 225 procedures) was the most secure treatment method with complication rate of 0%. Conclusion. The effectiveness of endoscopic transpapillary drainage in patients with obstructive jaundice of various genesis has reached 96.3%.
Kazan medical journal. 2013;94(4):450-455
450-455
Features of cytokine profile in patients with local and generalized soft tissue infections
Abstract
Aim. To determine the features of cytokine profile in patients with local and generalized soft tissue infections. Methods. The treatment results of 2350 patients with soft tissues infections since 1998 to 2012 were analyzed. ELISA test was used to measure tumor necrosis factor alpha and interleukin-1 receptor antagonist levels in 300 randomly picked patients with local (75 patients, comparison group) and generalized (225 patients, main group) forms of soft tissue infections. Results. In patients with generalized infections, tumor necrosis factor alpha level was 1.5 times higher in patients with mild systemic inflammatory response, 3.5 times higher - in patients with moderate and 6.7 times higher in patients with severe systemic inflammatory response compared to healthy controls. Interleukin-1 receptor antagonist levels were also elevated and related to the degree of inflammatory response, thus, it was the highest (2 times higher compared to controls) in patients with moderate systemic inflammatory response, while in patients with mild and severe inflammation it was only 30-40% higher. The significant increase in tumor necrosis factor alpha level associated with normal interleukin-1 receptor antagonist level is characteristic for different forms of sepsis. At the same time, increase in interleukin-1 receptor antagonist level associated with minimal changes in tumor necrosis factor alpha level can be used as a diagnostic criteria for compensated inflammatory response I patients with local infections cytokine profile was normal. The severity of systemic inflammation and clinical course of generalized infection depended not only on the absolute increase of cytokine levels, but on pro-inflammatory (tumor necrosis factor alpha) and anti-inflammatory (interleukin-1 receptor antagonist) cytokine levels misbalance. Conclusion. Examining the serum cytokine levels allows to confirm the diagnosis of generalized infection on early stages and to differentiate between compensated and non-ompensated systemic inflammatory response.
Kazan medical journal. 2013;94(4):455-459
455-459
Immune and cytokine disorders in patients with chronic foot osteomyelitis
Abstract
Aim. To study the cell and humoral immunity and cytokine status in patients with chronic foot osteomyelitis associated with diabetes mellitus and atherosclerosis. Methods. Immune and cytokine status was assessed in 20 patients with chronic foot osteomyelitis. Results were compared to control group of 20 healthy blood donors. Patients underwent clinical examination, lymphocyte populations phenotypes, phagocytes, immunoglobulins and interleukins concentration were studied. Statistical analysis was performed using «Excel» and «Statistica 10» software. To compare immunological parameters, Newman-Keuls test was used. Results. Development of foot osteomyelitis was associated with decreasing of phagocytic activity, absolute and relative number of T-helpers, NK-cells, increasing of T-cytotoxic cells number, pro- and anti-inflammatory cytokines levels. Conclusion. A marked suppression of cell-mediated immunity and increased blood levels of pro- and antiinflammatory cytokines were found in patients with chronic foot osteomyelitis. Standard treatment decreased, but did not normalize the immune and cytokine imbalance.
Kazan medical journal. 2013;94(4):460-463
460-463
Clinical and morphologic comparison of pancreatic damage in acute destructive pancreatitis
Abstract
Aim. To compare structural changes revealed at autopsy with clinical data, allowing to clinically predict the pancreatic damage in patients with acute destructive pancreatitis. Methods. Case histories and post-mortem pancreatic tissue samples from 12 patients who died of acute destructive pancreatitis, were examined. Results. Autopsies revealed the similar frequency of pancreatic anterior and posterior surface damage. Three types of pancreatic damage were observed: (1) total or extensive necrosis - 5 cases; (2) pancreatic fatty degeneration - 3 cases; (3) inflammatory changes with local necrotic lesions - 4 cases. Pancreatic morphologic changes were matched with clinical data and results of laboratory and instrumental tests that were performed in the patients who died from pancreatitis. The most significant clinical and laboratory changes were seen in patients with extensive necrosis, while in patients with pancreatic fatty degeneration and local necrotic lesions clinical presentations and changes in laboratory and instrumental tests were not so severe. Conclusion. Macro- and microscopic changes in pancreas observed in patients with acute destructive pancreatitis can be characterized as total or extensive necrosis, pancreatic fatty degeneration and acute inflammation with local necrotic lesions; matching the clinical and morphologic data revealed the relation between the extent of the pancreatic damage and clinical severity of acute destructive pancreatitis.
Kazan medical journal. 2013;94(4):464-468
464-468
Efficacy of erythropoiesis-stimulating agents and their effect on quality of life in anemic patients with lymphoproliferative diseases
Abstract
Aim. To study the effect of different erythropoiesis-stimulating agents and to assess their influence on quality of life in anemic patients with lymphoproliferative diseases. Methods. The study included 137 patients with lymphoproliferative diseases (Burkitt’s lymphoma, B-cell chronic lymphocytic leukemia, multiple myeloma) and anemia, who were distributed to 2 groups. The first group consisted of 90 patients who received chemotherapy and erythropoiesis-stimulating agents [epoetinum alpha 40 000 IU once a week (n=41) or epoetinum beta 30 000 IU once a week (n=27) or darbaepoetinum alpha 500 μg once every third week (n=22)]. The treatment duration varied from 4 to 20 weeks (mean 9.3±4.1 weeks). The second (control) group included 47 patients with comparable baseline clinical and hematological characteristics receiving only chemotherapy. Patients were estimated as treatment responders if there was an increase of hemoglobin level by 20 g/L or hemoglobin level reached at least 110 g/L. All patients were administered FACT-An (Functional Assessment of Cancer Therapy, Anemia scale) questionnaire to assess quality of life. Results. In patients receiving erythropoiesis-stimulating agents the positive treatment response was more frequent compared to the control group (68.9 и 29.8% correspondingly). The number of patients requiring erythrocytes transfusion decreased from 29 to 10 (34.5%) in the first group and from 14 to 8 (57.1%) in the control group. There was no significant differences found in comparing different erythropoiesis-stimulating agents. The positive response was observed in 68.3% of patients treated with epoetinum alpha, 70.1% - epoetinum beta, 68.2% - darbaepoetinum alpha. The significant increase in quality of life measured by FACT-An was observed in erythropoiesis-stimulating agents responders. Conclusion. The administration of erythropoiesis-stimulating agents in patients with lymphoproliferative diseases and anemia is an effective way of controlling anemia, significantly reducing the need for erythrocytes transfusion and improving quality of life.
Kazan medical journal. 2013;94(4):468-473
468-473
Intracranial hypertension syndrome and hemoglobin level in infants who had suffered cerebral ischemia in neonatal period
Abstract
Aim. To study the relationship between the clinical and neurosonographic indicators of the hypertensive syndrome and blood hemoglobin level in infants with perinatal disorders of the central nervous system. Methods. A total of 58 children with a diagnosis of «Perinatal hypoxic-ischemic brain damage in the form of hypertensive syndrome» were examined at the age of 12 months and younger. Clinical, neurological examination, neuroimaging, laboratory tests and statistical analysis were performed. Results. The majority of infants who had suffered a hypoxia during labor and had clinical and neurosonographic signs of intracranial hypertension also had different stages of blood hemoglobin level decrease. Comparing the neurosonography data and hemoglobin levels, it was found that children with anemia dominated among children with primary accumulation of cerebrospinal fluid in the interhemispheric fissure. Neurosonography revealed interhemispheric fissure widening in 30 (51.7%) of infants, ventricular system widening - in 28 (48.3%) of infants. The anemia rate was high in infants with interhemispheric fissure widening - in 19 (63.3%) out of 30 infants. Anemia was more frequent in the full-term infants with interhemispheric fissure widening - 4 (87.5%) out of 16 infants, whereas prematurely born infants with interhemispheric fissure widening had relevantly higher rate of normal hemoglobin level - 9 (64.3%) out of 14 infants. In 28 infants with ventriculomegaly 23 (82.1%) had widened anterior horns of the lateral ventricles. In 14 (59.3%) of infants with dilatation of the anterior horns of the lateral ventricles hemoglobin level was within the age-appropriate normal limits. Conclusion. Reduced hemoglobin level aggravates the symptoms of intracranial hypertension, and the continuing anemia leads to tissue edema, which leads to a rapid increase of degenerative changes in the brain, causing mental and physical retardation.
Kazan medical journal. 2013;94(4):473-477
473-477
Clinical and psychological features of patients with cerebral vascular diseases and response to treatment
Abstract
Aim. To study clinical and paraclinical features in patients with cerebral vascular diseases and their response to treatment. Methods. 121 patients with cerebral vascular diseases (32 males, 89 females, mean age 63.6±8.8 years) were studied before and after the treatment. Patients were divided into groups according to the disease severity. Neurological status, emotional sphere were assessed, other study methods were also used. Results. Neurological symptoms characterizing pyramidal, vestibulo-cerebellar and extrapyramidal syndromes were the most frequent in patients with various cerebral vascular diseases. Symptoms characterizing vestibulo-cerebellar syndrome improved after treatment: dynamic ataxia was present in 66.7% of patients with hypoxic ischemic encephalopathy stage I before treatment compared to 29.2% after treatment, in 44.0% of patients with hypoxic ischemic encephalopathy stage II before treatment compared to 32.0% after treatment, truncal cerebellar ataxia was present in 86.7% of patients before and in 64.0% of patients after treatment and was associated with cognitive potential increase revealed at emotional sphere estimation. The effectiveness of the treatment was confirmed by other study methods. Conclusion. Neurological symptoms including lateral nystagmus, truncal and appendicular ataxia, characterizing vestibulocerebellar syndrome, may be improved after treatment in patients with all groups of cerebral vascular disorders, with the decrease of emotional factor influence and further improvement of the cognitive potential.
Kazan medical journal. 2013;94(4):478-482
478-482
The influence of hand-arm vibration syndrome on quality of life of industrial and agricultural workers
Abstract
Aim. To investigate the health-related quality of life among the patients with hand-arm vibration syndrome in the Kabardino-Balkar Republic. Methods. The study included 198 patients aged 36-65 years. The health-related quality of life (HRQoL) was assessed using the SF-36 questionnaire before and after recreation treatment. Patients were divided to 3 groups according to disease severity: hand-arm vibration syndrome stage 1 - 54 (27.3%) patients, stage 2 - 75 (37.9%) patients, stage 3 - 69 (34.8%) patients. Results. Marked decrease in all HRQoL parameters measured by SF-36 was observed at the baseline. After the recreation treatment there was a significant improvement in all HRQoL parameters in all groups (particularly on «vitality» and «emotional role functioning»). The most prominent improvement was observed in patients with early stages of hand-arm vibration syndrome. Conclusion. Patients with hand-arm vibration syndrome suffer from severe decrease of HRQoL. Recreation therapy improves the HRQoL, especially on early stages of hand-arm vibration syndrome.
Kazan medical journal. 2013;94(4):483-487
483-487
Role of biosynthetic dressings in treatment of superficial burns of II-IIIa degree
Abstract
Aim. To improve the treatment of patients with burns, provide the protection and creation of an optimal «wet» environment for wound healing. Methods. Results of «Biokol», «Biokol-gel» and «Gelepran» regenerative complexes use to treat burn wounds of II-IIIA degree were examined. 75 patients with burns of II-IIIA degree involving 4 to 80% of body surface were examined. Patients were divided into 2 groups. The first group (main group) consisted of 40 patients who were treated using «Biokol» wound dressings and «Biokol-gel». The second group (control group) consisted of 35 patients in whom «Gelepran» hydrogel wound dressing was used. Treatment results were evaluated on the basis of clinical, cytological and microbiological examinations of wound content. Results. 4-5 days after treatment initiation a significant decrease of pathogenic microorganisms detection rate was registered in both groups accompanied by edge epithelization. The rate of Ps. aeruginosa, Рroteus, Kl. pneumonea detection varied from 2.5 to 5% in patients of the first group and from 2.5 to 8.5% - in patients of the second group. No cases of St. viridians detection were registered in patients of the first group. Cytologic picture was described as inflammatory in 76% of patients of the first group and in 59% of patients of the second group, as inflammatory-regenerative in 24 and 32% of cases accordingly. On the sixth day of treatment the detection rate for the inflammatory type of cytogram has reduced, resulting in reduction of neutrophils count to 62% in the first group and to 72% in the second group. An increase of fibroblasts number reaching 30% in the first group and 23% in the second group was also observed, corresponding to the clinical course. Conclusion. Combined use of wound dressing and gel (regenerative complex) showed the best result. «Biokol-gel» created a moist environment activating wound cleansing of residual fibrin and necrotizing tissues and reducing the epithelilization time compared to the «Gelepran» wound dressing. «Biokol» also acted as a mechanical protection and provided the maintenance of favorable conditions in the wound.
Kazan medical journal. 2013;94(4):487-491
487-491
Results of adding metformin and orlistat to complex treatment of stable angina associated with metabolic syndrome
Abstract
Aim. To evaluate the complex therapy with the addition of metformin and orlistat in treatment of II-III functional class stable angina associated with metabolic syndrome. Methods. The study included 143 patients with stable angina at the age of 36 to 70 years (mean age 54.2±3.6). Of these, 59 patients (control group) received standard treatment (isosorbide 5-mononitrate 40 mg/day, amlodipine 5 mg/day, acetylsalicylic acid 100 mg/day, carvedilol 25 mg/day, atorvastatin 20 mg/day, eprosartan 600 mg/day), and 84 patients (study group) were additionally administered metformin 1000 mg/day and orlistat 360 mg/day. Clinical and laboratory examinations (serum glucose and lipid level measurements) as well as instrumental examinations (electrocardiography, Doppler echocardiography, 24-hour electrocardiography and blood pressure monitoring) were performed before the treatment, 3, 6 and 12 months after the treatment start. Results. After 12 months of treatment mean systolic blood pressure in patients of the main group reduced by 24.5%, diastolic - by 18.8%, fasting serum glucose level - by 14.3% compared to the baseline level. Cholesterol level reduced by 13.8%, triglycerides - by 14.7%, low density lipoproteins - by 14.0%, blood level of high density lipoproteins increased by 11.6%. Body weight index reduced by 10.3%. Conclusion. Adding of 1000 mg of metformin and 360 mg of orlistat daily decreased the fasting serum glucose level by 14.3%, body weight index by 10.3%, and reduced the number of angina episodes by 19.6%, of painless myocardial ischemia by 36.3%, as well as increased physical ability tolerance by 26.5%.
Kazan medical journal. 2013;94(4):492-496
492-496
The effect of dosed isometric exercise on the respiratory system parameters change in second grade male students
Abstract
Aim. To study the respiratory system adaptive reactions to dosed isometric load in 9 years old boys during the academic year. Methods. Pulmonary function parameters change at rest and their response to isometric load were measured repeatedly in 38 second grade male students during the academic year (October, February, May). An automated cardiopulmonologic AD-03M complex was used to perform the pulmonary tests. The dosed isometric load was applied using a hand-held dynamometer at 50% from maximal grip strength within a minute. Correlation analysis of the measured parameters was performed. Statistical analysis was performed using Student’s t-test. Results. The comparative analysis of the respiratory system parameters in 9 years old boys during the academic year showed the increase in pulmonary volumes and lung function at rest. Dosed isometric load caused decrease in lung function tests and lung function reserves. An increased reactivity and decreased profitability of pulmonary system reactions was observed in 9 years old boys by the end of the second school year as a response to isometric load. Conclusion. The respiratory system of second grade male students is not well adapted for isometric load leading to its over-functioning at the end of the academic year.
Kazan medical journal. 2013;94(4):496-500
496-500
Reviews
Organ-saving treatment of invasive bladder cancer
Abstract
The review describes the modern approaches to open and endoscopic surgery, chemo- and radiotherapy in organ-saving treatment of invasive bladder cancer. Bladder cancer nowadays ranks the second among urological malignancies. Incidence of bladder cancer in Russia has increased by 58.6% over the past 10 years, with the share of invasive tumors reaching 30%. According to the European Association of Urology guidelines, the radical cystectomy with ureterocolonic diversion is the standard treatment of muscle-invasive bladder cancer. However, the extensive surgical trauma, comorbidities and exhaustion of patients, disability and social adaptation failure as well as the high mortality rate restrict the use of cystectomy. Thereby, taking into account the dynamic development of chemo- and radiotherapy allowing to reduce the recurrence rate, more and more experts are inclined to use organ-saving treatment of invasive bladder cancer. Organ-saving treatment has several advantages: it is less complicated and costly, preserves sexual function, decreases the risk of kidney damage and provides a good quality of life. Still, scanty publications are comparing results of cystectomy and organ-saving treatments of invasive bladder cancer, causing controversial opinions and highlighting the need for further studies.
Kazan medical journal. 2013;94(4):501-505
501-505
Chronic mesenteric ischemia: clinical features and diagnostic challenges
Abstract
Up-to-date data on the prevalence of chronic mesenteric ischemia syndrome with unpaired visceral branches of the abdominal aorta involvement in asymptomatic, subcompensation and decompensation stages are presented. The frequency of acute mesenteric thrombosis in the background of steno-occlusive disease is analyzed. The data on the mortality rate, determining the need for early diagnosis and timely chronic mesenteric ischemia treatment, are presented. Modern challenges in clinical, instrumental and radiographic diagnosis of chronic mesenteric ischemia due to clinical presentations variability and low specificity as well as lack of targeted approach for chronic mesenteric ischemia diagnosis in routine practice, are reviewed. Most rationale approaches for timely chronic mesenteric ischemia diagnosis and treatment are outlined. Studying of different clinical subtypes of chronic mesenteric ischemia, as well as elaboration of new diagnostic approaches and methods, contemporary diagnosis and treatment algorithms development on all stages of in- and out-patient service is needed.
Kazan medical journal. 2013;94(4):505-509
505-509
Ozone therapy in ophthalmology
Abstract
Currently, ozone therapy is a method of treatment used in various fields of medicine, e.g., in treatment of neuropathies, liver diseases, as well as in cosmetology, surgery, traumatology, obstetrics, gynecology, urology, cardiology, pulmonology, gastroenterology, neurology, dentistry, otorhinolaryngology, ophthalmology. Recently, ozone therapy is increasingly used clinically as a complement to the classical treatment, which is contributed by the low cost and relative safety of the method. Ozone therapy as a modern and effective method of treatment continues to evolve, finding new areas of application, mechanisms of its action are being clarified, new techniques and new indications are offered. The main properties of ozone therapy are the stimulation of the antioxidant defense system, hypoxia reduction and metabolism activation, including carbohydrate and lipid metabolism, and improving blood circulation. Currently papers devoted to the application of ozone in ophthalmology in treatment of age-related macular degeneration, viral conjunctivitis and keratitis, corneal degenerations, purulent corneal ulcer, pigmentary retinal degeneration, optic neuritis and atrophy, degenerative changes of the choroid, high myopia, hemophthalmia, rhegmatogenous retinal detachment, diabetic retinopathy are known.
Kazan medical journal. 2013;94(4):510-516
510-516
Healthcare mangement
Scientific rationale for medical and preventive measures improvement in lyme disease endemic areas (based on the data of Udmurt Republic)
Abstract
Aim. To provide the scientific rationale for medical and preventive measures improvement in Lyme disease endemic areas. Methods. Epidemiologic and biostatistical analysis of preventive measures holding in Lyme disease endemic areas was performed. Results. A decrease in mean longstanding prevalence of Lyme borreliosis by 31.5% was observed in the Udmurt Republic since 1999 to 2010. The tick-invaded area has increased by 25%, there was an increase in a borrelia-harboring ticks rate by 34.6%. The number of patients seeking medical aid because of the tick bites has increased by 25.4%, which can be attributed to increased social awareness. 62.5% of patients diagnosed with Lyme borreliosis were over 41 years old, the rate of unemployed patients was 61.1%. High prevalence of Lyme borreliosis in peasants living in highly endemic areas (southern part of the Udmurt Republic) related to low medical aid appealability due to tick bites and therefore untimely medical preventive measures, was registered. The prevalence of erythema migrans-free disease has increased 4.3 times. Among the Lyme borreliosis forms associated with erythema migrans, the 1.6 times increase in multiple erythema prevalence was observed, with increase by 24 times in the areas of high disease prevalence. The most severe disease course was observed in patients over 61 years old with erythema migrans-free disease. A single oral dose of doxycycline should be used for disease prevention in all patients seeking medical aid because of the tick bite. Conclusion. The offered preventive algorithm for Lyme disease allowed to prevent the disease development in 99.7% of all cases, the economical efficacy of doxycycline prophylaxis counted on 1 borrelia-harboring tick bite was estimated as 20 400 rubles.
Kazan medical journal. 2013;94(4):517-522
517-522
To the question of the population health assessment methodology
Abstract
Aim. To develop a methodology for individual, group, regional and population health estimation. Methods. Offered methodology includes physical health assessment and assessment of morphologic and functional condition of organ systems in a healthy human. Physical health assessment was performed in 808 young males aged 17-21 years in the city of Krasnoyarsk. Anthropometry, body mass index calculation, Tanner maturation index, ageing speed coefficient calculation by B.B. Gorelkin and A.G. Pinhasov, bioelectrical impedance analysis and statistical analysis were performed. Results. Youth males had a height of 176.87±0.26 sm, body weight of 69.23±0.45 kg. According to calculated body mass index, healthy weight was found in 71.41% males, 12.75% were overweight, 3.96% were obese, 11.88% were underweight. Shoulders and pelvis diameters were assessed as 37.01±0,11 and 27.72±0.09 sm respectively. Tanner maturation index calculation has shown that 54.83±1.20% males were andromorphous, the others had different types of gender inversions: 18.69±0.94% were hynecomorphous, 26.49±1.07% were mesomorphous. Ageing speed coefficient calculation has revealed the discrepancy of calendar and biologic age (the latter was higher) in all hynecomorphous young males, meaning that hynecomorphism can be estimated as a predictor of early ageing and can be used in complex health assessment. The core of the offered methodology for population health estimation is the health assessment on all stages of ontogenesis, including all levels from organism to molecular, that would allow to develop the standards for health assessment and assessment of morphologic and functional condition of organ systems. Conclusion. The listed methods would allow to estimate organism’s morphologic and functional condition, and revealed physical development abnormalities would allow to correct them timely before the clinical onset of any diseases.
Kazan medical journal. 2013;94(4):522-526
522-526
Results of the targeted program «Social support for providing access to prosthetic dentistry for certain citizen categories of the Republic of Вashkortostan» evaluation
Abstract
Aim. Тo study the oral health among the poor citizens and the implementation of the program of preferential prosthetic dentistry in the Republic of Bashkortostan. Methods. The study involved 80 patients with prosthetic dentistry in the past who were asked to complete a survey questionnaire and underwent clinical examination. Statistical processing was performed using Microsoft Excel and Statistica 6.0 software. Results. Secondary partial adentia prevailed in poor, reaching 83.75%, with secondary complete adentia reaching 16.25%. The average age of patients was 63.4 years: female patients - 64.66 years, male patients - 67.25 years. 100% of patients had concomitant somatic diseases, with most of the patients having 2-3 comorbidities. Among concomitant conditions, musculoskeletal diseases were observed in 71% of cases, cardiovascular diseases - in 50% of cases, endocrine diseases - in 35% of cases. 86.25% of patients named financial strait as the main cause of a late visit to a dentist, the remaining 13.75% indicated a lack of time, poor health and unwillingness to care for themselves as the reason. Conclusion. Low-income patients need further support in preferential dentistry and oral health examination.
Kazan medical journal. 2013;94(4):526-528
526-528
Analysis of mortality in patients with stroke according to data of Republican hospital №1 (Tyva Republic)
Abstract
Aim. To study the change in overall mortality in in-patients with stroke admitted to the department of neurology from 2010 to 2012. Methods. The analysis of the overall mortality in in-patients with stroke admitted to the department of neurology of Republican Hospital №1 was performed using the statistical data from 2010 to 2012. Results. In 2012 overall mortality from stroke has increased by 4.59% compared to 2011. Among the patients who died of stroke in 2012, patients with cerebral hemorrhage dominated over the patient with ischemic stroke. 14% of patients succumbed within first 24 hours, which can be explained by a severe condition of admitted patients. Arterial hypertension, alone and in combination with cerebral atherosclerosis and diabetes mellitus, was the most often concomitant condition in patients who died of stroke at the department of neurology. The reasons for death in patients with cerebral hemorrhage were cerebral edema associated with brain herniation, progression to intraventricular hemorrhage and brainstem hemorrhage. The reason for death in patients with ischemic stroke was recurrent cerebral infarction. There was 1 case of concomitant myocardial infarction in a patient with cerebral hemorrhage. Conclusion. The number of patients who has died of stroke - 200, an autopsy was performed in 81%; the highest mortality was observed in patients aged 51-60 years, the lowest - in patients aged 18 to 30 years (1.5%). Discrepancy between clinical and postmortem diagnosis was observed in 2 cases.
Kazan medical journal. 2013;94(4):529-531
529-531
Assistance to the practicing physician
The experience of treating locally advanced metastatic renal cell carcinoma with inoperable metastases to retroperitoneal lymph nodes
Abstract
Aim. To list and review the combined treatment options in patients with locally advanced metastatic renal cell carcinoma with inoperable metastases to retroperitoneal lymph nodes based on the results of diagnosis and treatment of two patients. Methods. Patients underwent primary tumor resection with further immunotherapy in first case and further immunoradiotherapy in second case. Results. The results of locally advanced metastatic renal cell carcinoma successful treatment are presented. Patient U., aged 73 years was admitted to the oncology department with Karnofsky performance-status score of 50-60 points. The diagnosis of right kidney cancer was set up in 2008, but the patient has refused surgery. At the end of 2011 after general status worsening she was hospitalized for planned surgery. Upper and medium midline laparotomy was performed using the general anesthesia. Enlarged right kidney in retroperitoneum and a batch of paraaortic and paracaval metastatic lymph nodes 13-15 cm in diameter were found at revision, right kidney was substituted by tumor tissue with areas of normal kidney parenchyma at the upper kidney pole, the tumor diameter was 10 cm. Renal artery and vein were gradually separated out of lymph nodes batch with a lot of technical difficulties and stitched and tied up. The specimen was removed as a whole together with paranephric tissues. Post-surgical treatment was complicated by an endogenous intoxication. Immunotherapy with intramuscular oxodihydroacridinylacetate sodium 500 mg every 48 hours i/m could only be started in a month after the surgery. Nowadays the patient is alive and continuing the treatment with oxodihydroacridinylacetate sodium, that induced the clinical improvement and reduced the size of the rest of the affected lymph nodes. Patient K. aged 50 years was admitted by ambulance with the same diagnosis as the first patient, and was treated using the same principles with an addition of radiotherapy. The overall patient’s condition improved after the treatment, there was a reduction of low back pain intensity and reduction of paraaortic and paracaval metastatic lymph nodes aggregate on palpation. Conclusion. Primary tumor resection in presence of inoperable metastatic retroperitoneal lymph nodes with further immunotherapy and radiotherapy can lead to clinical improvement and increase of the patient’s life duration.
Kazan medical journal. 2013;94(4):532-536
532-536
Orthoses in diabetic foot treatment and prevention
Abstract
Aim. To define the role of orthoses in the treatment and rehabilitation of patients with diabetic foot syndrome. Methods. The review of the literature addressing the use of special orthopedic shoes in the treatment and rehabilitation of patients with complicated diabetes mellitus was performed. Results. The common requirements for orthopedic shoes for patients with complicated diabetes mellitus are the following: (1) rigid sole with an artificial curvature; (2) boot-tree elevated by 8 mm due to arch supporter, adequate volume, wide sole, removable insole; (3) insole without functional memory; (4) thermally variable elastic material, advisably with silver ions, for the lining; (5) minimal number of sutures at the lining; (6) no elastic material at the front of the shoe and at the lining at the toes; (7) increased volume and enough space for the toes; (8) front slant of 15°; (9) potential ability to adjust the inner volume of the shoe; (10) hard counter - stabilizing hard back with additional softening at the lining side; (11) heel with a front slant or a solid sole without a heel; (12) smooth non-traumatic surface suitable for scrubbing including cleansing with antiseptics. The indications for orthopedic relief in patients with diabetic foot syndrome are explained. Economic superiority of organ-preserving approaches in such patients is shown. There is an opposition for conservative methods of treatment of patients with diabetic foot syndrome, nevertheless, an amputation can not be estimated as a positive treatment outcome in such patients. Almost 70-90% of ulcers in this group of patients are healed without amputation. Limb-saving treatment and the use of specially selected shoes are cheaper and more cost-effective compared to the limb loss. Conclusion. The use of orthopedic shoes in patients with diabetic foot syndrome is used both for treatment and rehabilitation. This technique can reduce the risk of ulceration and prevent organ-sparing surgeries.
Kazan medical journal. 2013;94(4):536-541
536-541
The rational method of orthodontic treatment in rural school children
Abstract
Aim. To analyze the effect of orthodontic devices in treating malocclusion in rural schoolchildren. Methods. The first group consisted of 25 schoolchildren aged 9-10 years with malocclusions treated with Frankel functional regulator, the second group consisted of 25 schoolchildren of the comparable age treated with function generating bite. Treatment results were assessed after 12 months of treatment in both groups. The treatment success was defined by calculation of the Pont’s and Korkhaus indices of dental arch dimensions. An adaptation to orthodontic devices was controlled monthly. Results. Schoolchildren treated with Frankel functional regulator abandoned treatment in 24% of cases (6 out of 25 cases), while treated with function generating bite - in 8% of cases (2 out of 25 cases). Dental arch expansion was registered in both groups. In patients treated with Frankel functional regulator the dental arch expansion reached 2.4-3 mm (mean value 2.7±0.3 mm), with function generating bite - 2.8-3.2 mm (mean value 3.0±0.2 mm). Conclusion. Function generating bite was the most rational malocclusion treatment in rural schoolchildren, its use was associated with lesser number of dropouts due to discomfort and allowed to achieve better results.
Kazan medical journal. 2013;94(4):542-544
542-544
Behçet’s disease in clinical practice
Abstract
Behçet’s disease is a chronic relapsing multisystemic vasculitis involving vessels of different diameter. The disease is characterized by involvement of skin and mucosa, eyes, gastrointestinal tract, joints, vessels, genitourinary system and neurological symptoms. According to data, male/female ratio is 2-10:1 The etiology of the disease is still unclear. Diagnosis is mainly based on thorough analysis of clinical manifestations. According to the International Study Group for Behçet’s Disease Diagnostic Criteria, combination of recurrent oral aphthosis and at least any two of the following: severe or scarring genital aphthosis, eye lesions (posterior uveitis, retinal vasculitis), skin lesions (nodular erythema, pseudofolliculitis, acne-like lesions) and positive pathergy test is needed to classify the patient as a patient with Behçet’s disease. Several clinical subtypes of Behçet’s disease are distinguished depending on predominant involvement of different organs and systems, including skin and mucosa, joints, eyes, or neurological manifestations. There are no specific laboratory tests for Behçet’s disease. The treatment approaches are variable depending on clinical manifestations. The effect of systemic corticosteroids, colchicine, azathioprine, chlorambucil, cyclophosphamide, sulfasalazine, methotrexate, cyclosporine, infliximab was proven. All the abovementioned requires the good clinical knowledge on Behçet’s disease from practicing doctors of different specialties, particularly - physicians. A case of highly active acute Behçet’s disease with nose, pharynx, eye and oral cavity mucosa, scrotum skin involvement is presented in the article. Questions of differential diagnosis are reviewed, specific treatment program with efficacy analysis is presented.
Kazan medical journal. 2013;94(4):545-548
545-548
Experimental medicine
Features of hemostatic activity of 2-[3-methyl-1-h-propyl-7-(1,1-dioxothiethanyl-3) xantinyl-8-thio] acetic acid cyclohexilammonium salt
Abstract
Aim. To study the systemic hemostatic activity of firstly synthesized 2-[3-methyl-1-h-propyl-7-(1,1-dioxotiethanyl-3) xantinyl-8-thio] acetic acid cyclohexilammonium salt in vitro and in vivo. Methods. Experiments in vitro using the blood samples form healthy male donors, and in vivo on male rats by intraperitoneal injection of the equimolar concentrations of researched substances. The effect of the firstly synthesized xantine and etamsylate derivative on the platelet functional activity in vitro and in vivo was studied using a platelet aggregation laser analyzer «Biola 230 LA» (Russia). 20 mkg/ml of adenosinediphosphate and 5 mg/ml of collagen (produced by «Technologia-Standart» company, Russia) were used as an aggregation inducers. Aggregation was analyzed using the AGGR software. General aggregation parameters, maximal aggregation value, maximal aggregation speed, average size of platelet aggregates were analyzed. Experimental assessment of specific systemic hemostatic activity in vivo was made in accordance with the parenchymal hemorrhage model on mature male rats. Coagulation time and blood loss volume were registered. Results. 2-[3-Methyl-1-h-propyl-7-(1,1-dioxotiethanyl-3) xantinyl-8-thio] acetic acid cyclohexilammonium salt showed a pro-aggregative effect both in vitro and in vivo. 2-[3-Methyl-1-h-propyl-7-(1,1-dioxotiethanyl-3) xantinyl-8-thio] acetic acid cyclohexilammonium salt pro-aggregative effect which was observed both in vitro and in vivo increased the systemic hemostatic activity, exceeding the results of the control group and etamsylate group. Conclusion. The findings reveal potentially high systemic hemostatic activity of 2-[3-methyl-1-h-propyl-7-(1,1-dioxotiethanyl-3) xantinyl-8-thio] acetic acid cyclohexilammonium salt and confirm the need for further studies of this compound and its equivalents in order to create highly effective selective hemostasis correctors on their basis.
Kazan medical journal. 2013;94(4):549-552
549-552
Anxiolytic effect of 2-oxyindolin-3-glyoxylic acid derivatives: computer prediction and experimental confirmation
Abstract
Aim. To complete the computer prediction of possible spectrum of biological activity of simple amides of 2-oxyindolin-3-glyoxylic acid derivatives and to test their anxiolytic activity in experiment. Methods. The prediction of possible spectrum of biological activity of simple amides of 2-oxyindolin-3-glyoxylic acid derivatives was performed using PASS (Prediction of Activity Spectra for Substances) software. The experimental part was performed on 140 adult rats of both sexes. Animals were distributed to subgroups (n=10 in each subgroup) according to age and gender. Experimental screening for anxiolytic action was performed using the Vogel’s «conflict situation» method. Results. 12 compounds highly potential for anxiolytic activity were selected after the computer prediction. Glutamate, serotonin, aspartate receptors blockade, gamma-aminobutyric acid (GABA)-receptors stimulation and depression of GABA-aminotransferase were in the list of possible mechanisms of action. Along with anxiolytic activity anticonvulsive, antipsychotic, antihypoxic and hypnotic effects were predicted. During the Vogel’s «conflict situation» test, 2-Hydro-N-naphthalen-1-yl-2-(2-oxo-1,2-dihydro-indol-3-ylidene)-acetamide, 2-Hydro-2-(2-oxo-1,2-dihydro-indol-3-ylidene)-N-phenyl-acetamide and N-[(2-Oxo-1,2-dihydro-indol-3-ylidene)-phenethylcarbamoyl-methyl]-benzamide had significantly decreased the latent time for taking water from drinking place. At the same time, 2-Hydro-N-naphthalen-1-yl-2-(2-oxo-1,2-dihydro-indol-3-ylidene)-acetamide, 2-Hydro-2-(2-oxo-1,2-dihydro-indol-3-ylidene)-N-phenyl-acetamide, N-[(2-Oxo-1,2-dihydro-indol-3-ylidene)-phenethylcarbamoyl-methyl]-benzamide and 3-Hydroxy-3-(2-oxo-cyclohexylmethyl)-1-piperidin-1-ylmethyl-1,3-dihydro-indol-2-one compounds had significantly increased the number of punished attempts for getting water, assuming anxiolytic activity. Among 2-oxyindolin simple amides derivatives 2-Hydro-N-naphthalen-1-yl-2-(2-oxo-1,2-dihydro-indol-3-ylidene)-acetamide had the strongest anxiolytic effect in test with punished behavior. Conclusion. Computer prediction of 2-oxyindolin-3-glyoxylic acid derivatives anxiolytic effect was confirmed experimentally.
Kazan medical journal. 2013;94(4):553-560
553-560
The features of neuroendocrine changes in cranial injury associated with diabetes mellitus
Abstract
Aim. To study the features of neuroendocrine regulation in cranial injury associated with diabetes mellitus. Methods. Experiments were carried out on 100 male white rats that were divided into the following groups: the first group (n=10) - control group consisted of 10 intact animals, the second group (n=40) - rats with simulated traumatic cranial injury, the third group (n=10) - rats with experimental diabetes mellitus, the fourth group (n=40) - rats with simulated traumatic cranial injury and experimental diabetes mellitus. Experimental diabetes mellitus was induced by a single streptozotocin solution intraperitoneal injection. Animals were withdrawn from the experiment at 3, 24 hours, 5 and 14 days after the traumatic cranial injury. The mathematical analysis of the cardiac rhythm variability was performed by ECG intervals data analysis. Corticosterone serum levels were measured using ELISA. Results. Based on a comprehensive ECG intervals data analysis, it was found that after experimental traumatic cranial injury the imbalance of autonomic nervous system with increased sympathetic autonomic nervous system function occurs, manifesting as a deregulation of cholinergic and adrenergic effects on sinoatrial node. In diabetes, an increase of the role of sympathetic effects on the sinus node functioning also occurred. Revealed autonomic nervous system deregulation after experimental traumatic cranial injury associated with experimental diabetes mellitus were associated with sympathetic autonomic nervous system over-function, parasympathetic autonomic nervous system exhausting and decreased recovery speed. There was a relevant increase in corticosterone serum concentration reaching its maximum 24 hours after traumatic cranial injury. Conclusion. A significant autonomic nervous system sympathetic shift and autonomic regulation intensifying characterizes the clinical course in traumatic cranial injury associated with diabetes mellitus, a positive correlation of corticosterone serum concentration and sympathetic autonomic nervous system over-function was revealed in animals with experimental traumatic cranial injury, particularly when associated with experimental diabetes mellitus.
Kazan medical journal. 2013;94(4):560-565
560-565
Actual problems of ophthalmology
Quality of life as part of the diagnostic and treatment process in patients with uveal melanoma
Abstract
Aim. To study of individual components of quality of life and the impact of various factors on quality of life in patients with choroidal melanoma after treatments. Methods. 122 patients (80 women, 42 men, mean age 59.89±11.95 years) were questioned. The first group included 48 patients who underwent an organ-sparing procedure (eye enucleation); the second group included 72 patients with choroidal melanoma who underwent an organ-saving procedure (brachytherapy, transpupillary thermotherapy, or combination of both methods). To investigate the quality of life, Functional Assessment of Cancer Therapy-General (FACT-G) questionnaire was used. Evaluation was carried out during the first three months after treatment, up to 1 year, 1 to 3 years, as well as 3 years or more after hospital discharge. Results. Quality of life parameters as the evaluation of the total well-being in patients following enucleation, and after brachytherapy, laser treatment and combinations of those at different terms after treatment, were defined. Total quality of life score in patients who underwent an organ-sparing procedure at the late terms after the surgery (more than 3 years) was significantly higher compared to patients who underwent an organ-saving procedure (FACT-G scores 78.79±14.28 and 67.93±13.92), with no significant differences in quality of life at earlier terms. Conclusion. An organ-saving treatment is associated with a significant total quality of life score reduction, and performing enucleation in patients with choroidal melanoma is characterized by significantly higher quality of life levels at long-term follow-up. The decline in the quality of life in patients with choroidal melanoma after enucleation is directly related to the visual acuity of the second eye.
Kazan medical journal. 2013;94(4):566-568
566-568
Clinical features of primary multiple eyelid basal cell carcinoma
Abstract
Aim. Identification of clinical and epidemiological features of primary multiple eyelid basal cell carcinoma. Methods. 53 patients with multiple eyelid basal cell carcinoma were included in the main group, the control group included 98 patients with solitary forms of eyelid basal cell carcinoma, who were not diagnosed with primary multiple lesions during 7 years of follow-up. Diagnosis of a malignant disease of the eye was based on the disease history, complex ophthalmic clinical and instrumental examinations, the diagnosis of multiple eyelid basal cell carcinoma was verified by cytological and histological examination. Magnetic resonance imaging and computed tomography of the orbit, brain, abdominal cavity were used to assess the area of malignancy. Results. Primary multiple eyelid basal cell carcinoma was diagnosed mainly in elderly patients over 70 years old (58.49% of patients), whereas a solitary basal cell carcinoma was significantly more common in patients of the younger age group - from 30 to 59 years old (24.49% of patients). Neoplastic process in primary multiple eyelid basal cell carcinoma was mainly localized on the skin of the outer canthus (13.20%), presenting mainly as nodular form (64.15%), with differentiated tumor dominating morphologically. Primary multiple eyelid basal cell carcinoma is diagnosed in 1.64% of patients with tumors of organ of vision, with two metachronous tumors in most of the cases (69.81%), associated with skin epithelial malignant tumors, breast, uterine, kidney and rectal cancer. Conclusion. The clinical features of primary multiple eyelid basal cell carcinoma are the following: age of 70 years and over, verification at T1N0M0 cancer stage, predominantly nodular form (64.15%), with differentiated tumor dominating morphologically.
Kazan medical journal. 2013;94(4):568-571
568-571
Local and systemic antioxidant status in experimental purulent corneal ulcer
Abstract
Aim. To examine the systemic and local (corneal) free radical status in rabbits with experimental purulent corneal ulcers. Methods. The study was performed on the male chinchilla rabbits with an average weight of 3500±200 g 10 intact rabbits (10 eyes) served as controls. Staphylococcal purulent corneal ulcer was modeled on 40 animals (40 eyes) as described by N.A. Adamova (1999). The animals were euthanized at 3rd, 7th, 14th, and 21st day of the experiment. The concentration of malondialdehyde, protein-free thiols, as well as superoxide dismutase, glutathione peroxidase and glutathione-S-transferase activity were determined in cornea homogenate and erythrocyte lysate. The obtained data were processed by the one-factorial dispersive analysis (ANOVA), Newman-Keuls test. Results. In all animals the purulent ulcer occurred 12-24 hours after staphylococcus culture introduction. From day 1 to day 3 of the experiment, the clinical picture of a purulent ulcer corresponded to an infiltration stage. From day 3 to day 7 of the experiment, palpebral edema developed, the purulent discharge lasted out, and in some cases even intensified. From day 7 to day 21 of the experiment, corneal infiltration decreased both by area and intensity. In 11,1% scaring corneal opacity formation began. Experimental purulent corneal ulcer development was accompanied by lipid peroxidation activation both in cornea and in erythrocytes, shown by increased malondialdehyde concentration, decreased protein-free thiols level and antioxidant glutathione peroxidase, glutathione-S-transferase and superoxide dismutase enzymes activity. There was a strong direct relationship between the erythrocyte malondialdehyde level and corneal malondialdehyde concentration, and inverse relationship between erythrocyte malondialdehyde level and erythrocyte superoxide dismutase activity. Conclusion. The development of experimental staphylococcal corneal ulcers is accompanied by the development of local and systemic oxidative stress.
Kazan medical journal. 2013;94(4):571-575
571-575
Patterns of eye structural and functional changes in presbyopia
Abstract
Aim. To identify patterns of structural and functional interrelationship in the eye in presbyopia formation. Methods. 60 patients with emmetropia without eye diseases in two age groups: from 18 to 30 years old and from 45 to 60 years old were examined. In addition to the standard ophthalmic examinations the following methods were used: assessment the pupil size in different lighting conditions, examination of the anterior and middle segment of the eye by means of ultrasound biomicroscopy and using a rotating Scheimpflug camera («Pentacam»). Results. Patients with presbyopia showed lens enlargement with simultaneous shortening of anterior portion of Zinn ligament, reduction of anterior chamber depth and volume, decrease of an adjunction angle between the iris and the cornea, ciliary body thickness reduction, and the increased distance between trabeculae and the crown of the ciliary body. The most pronounced decrease of the thickness of the ciliary body, length of the Zinn ligament and the increase of distance between trabeculae and ciliary processes were noted in the horizontal plane with a maximum change in the internal segment. The spatial deformation of the posterior chamber and changes of the anterior chamber angle were more pronounced in the lower and outer quadrants. Pearson’s correlation analysis revealed the vanishing of a significant number of correlations, characteristic for the physiologically properly formed eye with a proportionate refraction and the appearance of new relationships, directed to preserve the normal physiology of intraocular fluid, and stability of visual image receiving. Conclusion. Presbyopia development is characterized by a set of structural and functional changes, the spatial transformation of the eyeball that must be considered when performing surgical interventions in patients with presbyopia.
Kazan medical journal. 2013;94(4):575-580
575-580
Technology of phacoemulsification in extensive zonular defects of zinn ligament fibers
Abstract
Aim. To describe the technique and to assess the results of phacoemulsification in eyes with extensive zonular defects of Zinn ligament fibers. Methods. Phacoemulsification was performed through a 2.2- mm corneal tunnel incision on adhesive viscoelastic bed. The lens was stabilized with a capsular tension ring. The operation was finished with intraocular implantation and its suturing to the iris. The study included 36 patients [42 eyes, 23 males (63.9%), 13 females (36.1%)] in whom phacoemulsification has been performed. Visual acuity before surgery ranged from 0.01 to 0.7 (mean 0.2±0.18). Intraocular pressure ranged from 15 to 25 mm Hg (mean 19.2±4.5 mm Hg). Corneal astigmatism value before surgery ranged from 0 to 2.25 D (mean 0.87±0.63 D). Results. Postoperatively the following complications were observed: an inflammatory reaction in 3 eyes (7.1%), inflammation of Descemet’s membrane in 3 (7.1%) cases, ocular hypertension in 9 (21.4%) eyes. All the complications were drug treated within 3-5 days. On the second day mean visual acuity was assessed as 0.56±0.12,1 month after surgery - 0.70±0.16,6 months after surgery - 0.75±0.21, and 1 year after surgery - 0.74±0.19. Corneal induced astigmatism 1 year after the surgery ranged from 0.0 to 1.5 D (mean 0.39±0.16 D). Conclusion. The presented technology of phacoemulsification is relatively safe, effective and provides a possibility to rehabilitate patients with cataract combined with extensive zonular defects of Zinn ligament fibers in minimal terms.
Kazan medical journal. 2013;94(4):580-586
580-586
Conjunctival melanoma. What has changed over 55 years?
Abstract
Aim. To study the changes of conjunctival melanoma clinical characteristics over 55 years according to data of oncological department of Moscow ophthalmological clinical hospital. Methods. The change of conjunctival melanoma clinical characteristics over 55 years was studied. Two patient groups were compared. Group I included patients who were treated and observed in Moscow ophthalmological clinical hospital in 1956-1970, group II included patients who were treated and observed in Moscow ophthalmological clinical hospital in 1982-2013. Medical charts (i.e., case records, clinical histories, pathohistological reports, questionnaires of patients who received beta-applicator therapy etc.) were analyzed. Results. Over 55 years, the prevalence of conjunctival melanoma did not increase. In recent years, conjunctival melanoma has been diagnosed mainly in older patients, however, sex distribution has not changed. Nowadays, small size tumors dominated in primary patients while tumor pigmentation remain unchanged. Tumors localized at corneal limbus and bulbar conjunctiva, i.e. at palpebral fissure, as well as at lacrimal caruncle and plica semilunaris, were still the most frequent, which is associated with intensive insolation of these areas. Total 10-year survival rate in conjunctival melanoma patients was high (>80%) over the whole period. Conclusion. Small size tumors predominance indicates that conjunctival pigment tumors diagnostics improved over recent decade due to ophthalmic equipment development, oncological suspicion increase and the possibility to refer patients to specialized ophthalmic oncological centers.
Kazan medical journal. 2013;94(4):586-588
586-588
Jubilees
Professoru Gilyazutdinovu Il'daru Abdullaevichu - 70 let
Kazan medical journal. 2013;94(4):589
589
Obituary
Dilyara Gubaevna Takhavieva
Kazan medical journal. 2013;94(4):590
590