Vol 93, No 2 (2012)
- Year: 2012
- Articles: 79
- URL: https://journals.rcsi.science/kazanmedj/issue/view/127
Modern aspects of the natural course of chronic viral hepatitis B
Abstract
Currently there are about 400 million people infected with the hepatitis B virus, including five million people - in Russia. A serious problem is the development of complications of chronic viral hepatitis’ - liver cirrhosis and hepatocellular carcinoma, from which eventually 20-35% of patients die. Undoubtedly, the outstanding science achievement of the XX century was the creation of a genetically engineered vaccine against hepatitis B. The pursued immunizations on a global scale has led to significant results - reduction of the number of cases of acute forms of viral hepatitis B, the frequency of formation of the chronic variant of the disease. Despite these successes, there remains the problem of prevention of the perinatal transmission path. Identified were the risk factors for neonatal infection, amongst which the most significant are the presence of the antigen of the hepatitis B virus, which is not a part of the Dane particles (HBEAg), and the level of viremia prior to delivery. The basis of prevention is an active-passive immunization, which helps prevent infection in infants in 90-95% of cases. Encouraging results (reduction in the risk of infant infection) were obtained in studies of antiviral therapy in the III trimester of pregnancy. The introduction of new molecular biological diagnostic methods (polymerase chain reaction) made it possible to determine the genetic material of the virus in serum and tissues, the presence of mutations and genetic variability of the virus. At present, identified are the factors that determine the progression of the disease, the efficacy of antiviral therapy. Identified are the new variants of the clinical course of viral hepatitis B, depending on the profile of the serological (antigen-antibody) markers. The latent course of viral hepatitis B deserves special attention. The serological feature of this variant is the presence of «isolated» antibodies and/or deoxyribonucleic acid of the virus, or the absence of all markers of hepatitis B. It is obvious that patients with a latent course of infection pose a real threat in spreading viral hepatitis B.
Kazan medical journal. 2012;93(2):161-166
161-166
Theoretical and clinical medicine
Long-term prognosis of the course of sarcoidosis: analysis of the literature and own experience
Abstract
Aim. To evaluate the prognosis of the course of sarcoidosis in patients with a follow-up term of 10 years or more. Methods. Analysis of the literature, comparison with the data from own research. Analyzed was the data on 15 patients with sarcoidosis with the follow-up term of 10 years or more. Compared were the parameters of spirometry, blood tests, blood oxygen saturation, of the conducted treatment in the patients with remission and with a chronic course. Results. In 8 patients (53.3%) during the last follow-up visit (10 years or more after detection) noted was a stable remission (in 7 after the initial detection and in 1 after a single exacerbation). Among all the 15 patients after 10 years or more the frequency of dyspnea on exertion increased from 33.3 to 46.9%, chest pain - from 6.7 to 20%, complaints of weakness decreased from 66.7 to 53.3%, of fever - from 26.7 to 13.3%, and of cough - from 53.3 to 20%, of erythema nodosum - from 40 to 6.7%, of articular syndrome - from 60 to 20%, of splenomegaly - from 13.3 to 6.7%. When comparing the dynamics of the indicators in the subgroup with persistent remission noted was a significant decrease in the instantaneous volume rate after the exhalation of 50% of the forced vital lung capacity; blood oxygen saturation and diastolic blood pressure significantly increased, the proportion of monocytes in the leukocyte formula decreased. Registered was a significant increase in erythrocyte sedimentation rate within the physiological range. In patients with a chronic course of sarcoidosis occurred a significantly reduction of the forced vital lung capacity, of the forced expiratory volume in 1 s, of the instantaneous volume rate after exhalation of 25% of the forced vital lung capacity. Conclusion. The best prognosis had the patients, who were young adults with an acute onset, and who did not receive glucocorticoids. Pentoxifylline may improve the course and outcome of sarcoidosis.
Kazan medical journal. 2012;93(2):167-172
167-172
The features of time characteristics of heart rate variability in chronic obstructive pulmonary disease
Abstract
Aim. To study the features of time characteristics of heart rate variability during isolated chronic obstructive pulmonary disease, as well as in association with arterial hypertension and ischemic heart disease. Methods. The characteristics of heart rate variability using Holter electrocardiography monitoring, echocardiography and duplex scanning of carotid arteries were studied. The results of investigations of 298 individuals of both sexes aged 37-78 years were included into the analysis, including 79 patients with chronic obstructive pulmonary disease who were divided into three groups. The first group included 19 patients with isolated chronic obstructive pulmonary disease, the second group consisted of 25 patients with chronic obstructive pulmonary disease and arterial hypertension, the third group included 35 patients with chronic obstructive pulmonary disease and ischemic heart disease, who were divided into two subgroups: patients with (n=9) and without (n=26) a prior history of myocardial infarction. For comparison, examined were 48 patients with isolated hypertension, 132 patients with ischemic heart disease and 39 practically healthy individuals. Results. In patients with isolated chronic obstructive pulmonary disease an autonomic imbalance occurs in the form of a uniform decrease in the activity of the parasympathetic nervous system during the day and an increase of the night time heart rate, identifiable are the signs of subclinical cardiac pathology in the form of thickening of the «intima-media» complex and the formation of atherosclerotic plaques in the carotid arteries, hypertrophy of the myocardium and left ventricular diastolic dysfunction, reduced systolic velocity of the mitral valve fibrous annulus. If chronic obstructive pulmonary disease is combined with aerterial hypertension and ischemic heart disease, as opposed to isolated cardiac pathology, a monotonic tachycardia develops during the day. In cases of concomitant chronic obstructive pulmonary disease and arterial hypertension during a simultaneous decrease in all time characteristics of heart rate variability, in most patients hypertrophy of both ventricles can be visualized. Conclusion. In patients with chronic obstructive pulmonary disease the time characteristics of heart rate variability depend on the presence or absence of concomitant diseases of the cardiovascular system.
Kazan medical journal. 2012;93(2):172-177
172-177
Adrenoreactivity as a prognostic criterion of perioperative cardiac complications during extracardiac operations
Abstract
Aim. To study the adrenoreactivity of the organism and the possibility of using the value of β-adrenoreception of the erythrocyte membrane as a criterion for prediction of cardiac complications in the perioperative period during extracardiac operations. Methods. In 67 patients with acute cholecystitis and concomitant cardiac pathology requiring surgical treatment, assessed was the risk of cardiac complications according to the T.H. Lee index, and β-adrenoreception of the erythrocyte membranes according to the method of R.I. Stryuk and I.G. Dlusskaya. Three groups of patients were identified: with low, medium and high risk of cardiac complications. One month after the surgery the endpoints were studied: cardiac death, nonfatal myocardial infarction, stroke, disturbances of cardiac rhythm and conduction. Results. Perioperative complications, which presented in the form of paroxysmal atrial fibrillation and atrial flutter occurred in 8% of the patients of the medium risk group, and in the form of unstable angina in 12.5% of high risk patient group. Revealed were significant differences between the parameters of β adrenoreception of the erythrocyte membranes in patients with no risk and patients from medium and high risk groups. Established was a positive correlation between the value of β-adrenoreception of the erythrocyte membranes and the risk of perioperative cardiovascular complications. Conclusion. Revealed was a decrease of β-adrenoreactivity in patients with indications for surgery for acute cholecystitis with comorbid cardiovascular disease, which reflects the process of desensitization of adrenergic receptors of the cell membranes in the activity of neurohormones.
Kazan medical journal. 2012;93(2):177-181
177-181
Autoantibodies to activated blood coagulation factors in patients with ischemic heart disease
Abstract
Aim. To study the content of autoantibodies to activated blood coagulation factors IIa, VIIa and IXa during ischemic heart disease. Methods. The investigation of autoantibodies was performed in 31 patients (mean age 57.6±7.8 years, male to female ratio 4:1). The patients were divided into three groups: the first - patients with myocardial infarction in the acute stage (9 people), the second - patients with myocardial infarction in the subacute stage (9 people), the third - patients with stable angina (13 people). The control group included 18 practically healthy subjects comparable by age and sex. The study of the content of autoantibodies to blood coagulation factors was performed by an original immunoassay method of Tsybikova N.N. et al. Results. Established was a decrease in the content of the following autoantibodies: class M immunoglobulins to fac-tor VIIa, class G immunoglobulins - to factor VIIa, classes M and G immunoglobulins - to factor IXa in the acute phase of myocardial infarction compared with the controls, as well as a decrease in the content of class G immunoglobulins to the factor IXa in the acute stage of myocardial infarction compared with the subacute stage and stable angina. Conclusion. During ischemic heart disease a decrease in the content of autoantibodies to the activated blood coagulation factors IIa, VIIa and IXa occurs, which is presumably due to their binding with excessively formed activated coagulations factors.
Kazan medical journal. 2012;93(2):181-183
181-183
The status of element homeostasis in children and adolescents with essential arterial hypertension
Abstract
Aim. To study the features of element homeostasis in children and adolescents with different variants of essential arterial hypertension. Methods. The clinical and functional variant of arterial hypertension was established based on the data of 24-hour monitoring of the arterial blood pressure. Investigation of the element content in the blood serum and daily urine was performed using the method of atomic absorption spectrophotometry. The clearance and the excreted fraction of the investigated elements were measured. Results. Revealed was an increase of the content of lead in the blood serum, an increase in lead excretion with urine, an increase in its clearance and excreted fraction in patients with stable arterial hypertension. It has been shown that for children and adolescents with a variety of clinical and functional variants of arterial hypertension characteristic is an excess of the serum content of a toxic element (lead) over the content of an essential element (zinc), and these changes are most pronounced in the group with stable arterial hypertension. In children and adolescents with the increase in arterial blood pressure registered was a decrease in the content of zinc and magnesium in the blood serum, whereas the disturbances of element homeostasis relate to the metabolic type. The increase in the content of copper and calcium in blood serum of patients with high blood pressure is also a manifestation of the metabolic type of element homeostasis disturbances. Conclusion. The increased level of lead in blood serum in combination with its enhanced excretion may be a cofactor in the development of essential arterial hypertension in childhood and adolescence.
Kazan medical journal. 2012;93(2):184-190
184-190
Thickness of the «Intima-media» complex of brachiocephalic vessels as a significant marker of coronary atherosclerosis in ischemic heart disease
Abstract
Aim. To assess the correlation of the indices of the «intima-media» complex thickness of brachiocephalic vessels by ultrasound investigation and the degree of coronary stenosis by angiography. Methods. 239 patients with ischemic heart disease and a history of myocardial infarction participated in the study. An ultrasound investigation of brachiocephalic vessels and angiography of the coronary arteries was performed in all patients in the in-patient setting. Results. Among patients with a thickness of the «intima-media» in the range of 0.8-1.1 mm not a single case of coronary stenosis was registered. When the thickness of the «intima-media» complex was 1.3 mm or more the prevalence and extent of atherosclerotic lesions of coronary vessels increased proportionally. Conclusion. The evaluation of the «intima-media» complex thickness of the brachiocephalic vessels makes it possible to predict with high accuracy the prevalence of coronary atherosclerosis, as well as to monitor the effectiveness of the treatment of atherosclerosis.
Kazan medical journal. 2012;93(2):190-192
190-192
The effectiveness of ursodeoxycholic acid and «Uvinskaya» mineral water in the treatment of cholelithiasis and concomitant motor-tonic disturbances of the gallbladder
Abstract
Aim. To optimize the conservative treatment of patients with cholelithiasis. Methods. Conducted was a comprehensive in-depth examination and treatment of 87 patients with gallstone disease (cholelithiasis) at the stage of biliary sludge (in the initial physicochemical stage - before stone formation) with associated hypokinesia of the gallbladder. The diagnosis was verified by the means of ultrasound investigation, multifractional duodenal probing and the intensity of biliary sludge was determined by the content of cholesterol, bile acids (spectrophotometrically) and cholate-cholesterol coefficient in the bile. The content of microelements in the bile was estimated by the method of atomic emission spectroscopy with inductively coupled plasma. The spectrum of bile acids in the bile was determined by the method of matrix laser desorption ionization. The acid-producing function of the stomach was evaluated by the means of intragastric pH-metry. During endoscopy investigation a targeted biopsy of the mucous membrane of the anterior and posterior walls of the stomach was performed, followed by morphological examination of biopsy specimens. The patients were divided into two groups. Sulfate sodium-calcium mineral water «Uvinskaya» (Udmurtia) and ursodeoxycholic acid (Ursosan) was used in the treatment of patients of the observation group. In the comparison group monotherapy with ursodeoxycholic acid at a dose of 15 mg/kg body weight was conducted. Hydrotherapy in the observation group was conducted for 24 days, while medicinal treatment in both groups was continued for another 2 months. The control group consisted of 15 practically healthy individuals. Results. In the course of treatment a marked decrease in the pain in the right hypochondrium, the disappearance or reduction of dyspeptic complaints, loss of echo-positive particulates in the gall bladder and an increase in its contractility was noted in all patients of the observation group, at the same time the signs of inflammation also disappeared and the cholate-cholesterol coefficient increased. Registered was a favourable dynamics of the content of microelements in the bile. Conclusion. The combined use of the «Uvinskaya» mineral water and ursodeoxycholic acid for the treatment of cholelithiasis with biliary sludge promotes the most rapid elimination of clinical symptoms of the disease, improves the functional state of the gall bladder, reduces the lithogenic properties and normalizes the content of microelements in the bile.
Kazan medical journal. 2012;93(2):193-196
193-196
The search for genetic factors of predisposition to the development of liver cirrhosis in the course of viral hepatitis B in patients from the Republic of Bashkortostan
Abstract
Aim. To identify the clinical and genetic associations of polymorphisms of the detoxification of xenobiotics genes during liver cirrhosis that developed as a result of viral hepatitis B. Methods. The study randomly included 38 patients with liver cirrhosis at the age of 25 to 54 years. The control group consisted of 147 healthy individuals. Conducted was an analysis of mutations in the deletion polymorphism of gene CYP1A1, leading to the replacement of the amino acid isoleucine with valine (Ile462Val) in position 462 of the cytochrome P-450 CYP1A1 and polymorphism of the gene GSTM1, which codes an enzyme antioxidant enzyme from the family of glutathione-S-transferase in patients with liver cirrhosis, which developed as a result of hepatitis B with the aim to identify possible associations with an increased risk and severity of the disease. Results. Revealed was a statistically significant increase in the proportion of patients with genotype Ile-Val/(+) compared to genotype Ile-Ile/(+), established was an association between the genotype S65C/N with polymorphism S65C of the gene HFE and liver cirrhosis of combined genesis (viral B + toxic). Conclusion. Ile462Val genotype of the CYP1A1 gene of the cytochrome P450, as well as the presence of a deletion of the glutathione-S-transferase M1 gene are risk factors for the development of liver cirrhosis secondary to hepatitis B.
Kazan medical journal. 2012;93(2):197-203
197-203
The functions and geometry of the left ventricle in patients with chronic glomerulonephritis
Abstract
Aim. To study the functions and the geometry of the left ventricle in patients with chronic glomerulonephritis at different stages of chronic kidney disease, depending on the presence of arterial hypertension and dyslipidemia. Methods. Observed were 156 patients with chronic glomerulonephritis (80 men and 76 women, mean age 40.23±1.1 years), including 91 people with arterial hypertension (observation group), 65 patients without arterial hypertension (comparison group). The observation and comparison groups were divided into subgroups depending on the stage of chronic kidney disease: the first subgroup - stage 1-2, the second subgroup - stage 3-4, the third subgroup - stage 5. The control group consisted of 30 healthy people. Conducted were general clinical, laboratory and instrumental investigations. Results. Left ventricular hypertrophy was formed at stage 1-2 of chronic kidney disease in 52.5% of patients with chronic glomerulonephritis with arterial hypertension, at stage 3-4 - in 69.2%, at stage 5 - in 80.0%. The dominant type of hypertrophy was concentric; with the decrease in kidney function the frequency of eccentric hypertrophy increased. In the early stages of chronic kidney disease the incidence of left ventricular dysfunction was almost similar in arterial hypertension (62.5%) and normal blood pressure (60.0%). With the decline of the kidney function in the presence of arterial hypertension the incidence of left ventricular dysfunction reached up to 84.6% at stage 3-4 and up to 88.0% - at stage 5 of chronic kidney disease. No influence of the lipid profile on the function and the geometry of the left ventricle were found. Conclusion. In patients with chronic glomerulonephritis with arterial hypertension with the decrease in kidney function increases the frequency of left ventricular hypertrophy; in the early stages of chronic kidney disease the incidence of left ventricular dysfunction is the same in patients with and without hypertension, increasing with the decline in renal function in patients with hypertension.
Kazan medical journal. 2012;93(2):204-207
204-207
Urogenital manifestation of climacteric syndrome, its treatment
Abstract
Aim. To study of the effectiveness of the drug mesodiethylethylendibenzosulfonate (Sagenit) in women with urination disorders in the climacteric period. Methods. During the years 2009-2010 at the Department of Urology and Nephrology of Altai State Medical University were examined, treated and followed-up 40 women of the climacteric period (aged 43 to 64 years) with urination disorders. All patients were prescribed Sagenit, 1 tablet a day for 1-6 months. Results. Sagenit was well tolerated by female patients for a long period of time, had no significant side effects, which would require discontinuation of the drug. After the conducted treatment the time of urination lengthened, the volume of urination increased and the maximal urinary flow rate decreased. The positive effect of therapy (improvement of the quality of life) was reported by 75% of the surveyed women. Conclusion. Sagenit was shown to be effective in treating women with urination disorders in climacteric period.
Kazan medical journal. 2012;93(2):208-211
208-211
Clinical and epidemiological features of pyo-inflammatory diseases in the newborns
Abstract
Aim. To study the clinical and epidemiologic features of pyo-inflammatory diseases in the newborns. Methods. Examined were 60 newborn infants who were admitted to hospital for treatment of pyo-inflammatory diseases in the department of pathology of the newborns of the Republican Clinical Infectious Diseases Hospital. In order to determine the etiology of the disease a bacteriological culture analysis from a variety of epitopes - skin, eyes, navel, nose, throat, intestine was conducted in all children. Results. The vast majority (76.7%) of the infants were born full term and as a result of natural childbirth. The most frequently reported were the infections of the skin and mucous membranes - vesiculo-pustulosis (40%), purulent conjunctivitis (20%) and omphalitis (15%), less frequently - pneumonia (6.7%), pyoderma (5%), felon (5 %) and urinary tract infections (8.3%). In 81.7% of cases the pyo-inflammatory diseases had a moderately severe course. Inflammatory changes in the blood were found only in 26.7% of cases, they manifested by leukocytosis and neutrophilia with varying degrees of severity. The vast majority (81.6%) of cases the disease developed in the first 3 days after birth, indicating either an intranatal or intrauterine mechanism of infection of these newborns. In 42.5% cases the women experienced infectious diseases of the urogenital tract during pregnancy. During microbiological investigation of the external epitopes S. aureus and S. epidermidis were the most frequently seeded strains. Conclusion. The most common pyo-inflammatory diseases in newborn infants, who are hospitalized in an infectious diseases hospital, were diseases of the skin and mucous membranes - vesiculo-pustulosis, purulent conjunctivitis and purulent omphalitis, the development of which occurred in the first 3 days after birth, and the main etiological factors of their emergence were S. aureus and S. epidermidis.
Kazan medical journal. 2012;93(2):211-214
211-214
New opportunities for local therapy of pustular skin diseases
Abstract
Aim. To study the effectiveness of a universal antiseptic Betadine (international nonproprietary name - povidone-iodine) in the treatment of pustular skin diseases. Methods. The study had the form of an open, non-comparative one, which involved 25 patients aged from 2.5 to 40 years (mean age 16.1±1.2 years) with disease duration from 1 to 7 days (mean 4.2±0.8) with various forms of pyoderma: 21 patients with streptococcal impetigo and 4 patients with folliculitis. Assessment of safety of the study was carried out on the basis of clinical and laboratory data, patient tolerability of the substance, the expert-opinion of the physician-researcher. Changes in the quality of life as a result of treatment of patients with pyoderma using Betadine solution was evaluated by a questionnaire SKINDEKS-29. Results. All patients willing used the proposed betadine solution. No reasons for discontinuation of treatment during the study (including side effects, allergic reactions or exacerbation of the cutaneous process) were identified. Deterioration of the quality of life on the «Emotions» scale of SKINDEKS-29 questionnaire at the beginning of treatment was 49.8±1.3 points («sometimes»), during the second visit - 26.8±0.9 points («rarely»), by the end of treatment (third visit) - 10.2±0.3 points («no»); on a scale of «Function» at the beginning of treatment - 77.8±1.8 («often»), during the second visit - 53.2±1.6 («sometimes»), by the end of treatment - 16.2±0.8 points («no»); on a scale of «Symptoms» at the beginning of treatment - 51.2±1.3 («sometimes»), during the second visit - 27.6±2.8 («rarely»), by the end of treatment - 12.3±0.3 points («no»). Conclusion. Betadine is characterized by high clinical efficacy in pustular skin diseases, good tolerance, absence of adverse reactions, a positive impact on the quality of life and can be recommended as a therapeutic and prophylactic agent.
Kazan medical journal. 2012;93(2):214-216
214-216
Lymphocyte-platelet adhesion and aggregation of platelets in patients with erysipelas
Abstract
Aim. To study the lymphocyte-platelet adhesion in patients with various forms of erysipelas in the dynamics of treatment. Methods. 90 patients with erysipelas participated in the study: 20 with the erythematous-bullous form and 20 with the erythematous form. According to the recurrence of the disease the patients were divided into two groups: the main group (40 patients with the primary form of erysipelas) and the comparison group (50 people with recurrent erysipelas). The control group, which was comparable by sex and age, was comprised of 55 healthy people. The index of lymphocyte-platelet adhesion and hemostasis were studied in all patients. Results. The index of lymphocyte-platelet adhesion sharply declined already during the onset of the disease, despite the fact that no significant changes in the content of the absolute number of lymphocytes compared to healthy individuals during this period were identified. Severe course (erythematous-bullous form) was accompanied by significant shifts in the parameters of lymphocyte-platelet adhesion, and their dynamics made it possible to evaluate the effectiveness of treatment. Conclusion. The ability of lymphocytes to adhere to the surface of platelets is reduced during erysipelas; platelet hyperaggregation develops during the first days of onset of clinical manifestations, the nature and duration of which depends on the form of the disease.
Kazan medical journal. 2012;93(2):216-220
216-220
Monitoring of the activity of antibodies against hantavirus in patients with hemorrhagic fever with renal syndrome
Abstract
Aim. To determine the diagnostic significance of antibodies to Hantavirus in patients with hemorrhagic fever with renal syndrome, depending on the period and the severity of the course of disease. Methods. Studied was the content of specific antibodies (immunoglobulins G) to hantaviruses in blood serum in the rapidly precipitating and slowly precipitating circulating immune complexes by enzyme immunoassay using a test system «Hantagnost» in modification. Studied were 226 patients with hemorrhagic fever with renal syndrome (24 patients with mild form, 105 with moderate and 97 patients with severe form of the disease) in the febrile, oliguric and polyuric periods. Results. Specific antibodies (immunoglobulins G) were present already in the febrile period of the disease in all (100%) patients in the serum and in the rapidly precipitating circulating immune complexes. Antibodies in the slowly precipitating complexes in the febrile period were found only in patients with severe and moderate forms of hemorrhagic fever with renal syndrome, in subsequent periods they were found significantly more frequently in patients with a severe course of disease. Severe forms of hemorrhagic fever with renal syndrome caused the most pronounced serologic response with a maximal content of immunoglobulins G to Hantaviruses in the oliguric period. During the period of polyuria the severe forms of hemorrhagic fever with renal syndrome were accompanied by significantly lower levels of free circulating antibodies and a high level of bound antibodies compared with moderate and mild forms of the disease. Conclusion. In patients with hemorrhagic fever with renal syndrome anti-Hantavirus antibodies (immunoglobulins G) in serum and in the rapidly precipitating immune complexes are detected already at the early stages of the disease in 100% of the cases; the frequency of detection of antibodies in the slowly precipitating circulating immune complexes in the early stages depends on the severity of disease: they are present in 100% of patients with a severe form of the disease, in 50% - with the moderate form, and with the mild form - can not be detected.
Kazan medical journal. 2012;93(2):221-225
221-225
Justification of the diagnostic algorithm in determining the indications for pathogenetic therapy of dental caries
Abstract
Aim. To justify the importance of the diagnostic algorithm in the management of patients with dental caries. Methods. Summarized were authors’ personal and literature data on the factors and conditions of realization of a cariogenic situation, on the predictors of dental caries, as well as on the role of the diagnostic measures. Stressed was the significance of the physical status of the parents and of the normal course of pregnancy for optimal formation of organs and tissues of a child’s oral cavity, which predetermines the healthy dental status of the adult. Results. Presented was the diagnostic algorithm for dental caries, with an emphasis on the importance of assessing the state of local immunity of the oral mucosa, the need for obtaining primary anamnestic information. Outlined were the signs of salivary disorders that contribute to the formation of a cariogenic situation. The items presented in this article may serve as a basis for construction of a diagnostic algorithm for the management of patients with dental caries with the aim of for subsequent planning and implementation of effective pathogenetic therapy of the disease. Conclusion. The correctly selected diagnostic algorithm in the management of patients with dental caries allows the dentist to obtain objective information about the features of the emergence and development of the disease and to define the indications for pathogenetic therapy.
Kazan medical journal. 2012;93(2):225-227
225-227
The effect of removable acrylic dental prostheses on immune homeostasis of the oral mucosa depending on the applied materials and structures
Abstract
Aim. To pathogenetically substantiate the effectiveness of performing prosthetic appliances of the dentition defects and predicting the results of occlusal rehabilitation of patients with pathology of the dental system based on the analysis of immune homeostasis of the oral mucosa. Methods. Examined were 39 people with secondary partial (I and II class according to Kennedy) and complete lack of teeth aged from 25 to 85 years, for whom removable acrylic dentures were manufactured. The control group included 18 people aged 20-85 years with abnormal dentition, requiring preliminary surgical preparation for prosthetics. Three age groups were identified: 20-40 years (first group), 40-60 years (second group), aged 60 and above (third group). Conducted was a morphological study of prosthetic bed biopsies obtained after 3, 6 and 12 months after returning the prostheses with immunohistochemical determination of markers for CD68, CD204, and CD163, with high specificity for dendritic cells, mast cells and macrophages, respectively, providing the immune homeostasis of the oral mucosa. For identification of intraepithelial lymphocytes determined was the expression of CD4 and CD8. In order to evaluate the intensity of regeneration of epithelial cells determined was the expression of the Ki-67 marker. Results. In the individuals of the first and second age groups noted was the predominance of dendritic, mast cells, CD4+ and CD8+. In patients of the third group the dynamics of the content of CD68+ and CD163+ cells in the mucosa of the prosthetic bed was less pronounced. A direct strong correlation relationship between the proliferation index and the number of CD68+, CD204+, CD4+, CD8+ cells, which provide the immune homeostasis of the oral mucosa in these patients, was established. A direct strong correlation relationship between the clinical changes in the oral cavity in the process of usage of the removable dentures and the absolute number of lymphocytes and dendritic cells in the inflammatory infiltrate was established. Revealed were the dynamics of changes in mitotic activity of keratinocytes in the process of usage of the removable dentures and the correlation of these parameters with the terms of use of the prostheses. Conclusion. The changes of the immune homeostasis parameters of the oral mucosa with this type of prosthesis can be considered a basis for pathogenetic substantiation of treatment and predicting the outcomes of occlusal rehabilitation of dental patients.
Kazan medical journal. 2012;93(2):227-230
227-230
Indicators of the functional state of the autonomic nervous system in different age group patients with temporomandibular joint pain dysfunction syndrome
Abstract
Aim. To study the functional state of the autonomic nervous system and of the adaptative capabilities of the organism in patients of different age groups with temporomandibular joint pain dysfunction syndrome. Methods. The study included 234 patients with temporomandibular joint pain dysfunction syndrome (22 men and 212 women) aged 12 to 35 years, without anomalies of the dentition, who were divided into three age groups. Three control groups consisted of 30 healthy subjects (3 men and 27 women, 10 men in each age group) with intact dentition, and orthognathic bite. A clinical dental examination, and a multi-dimensional verbal-color pain test were conducted. In order to assess the functional status of the autonomic nervous system and the adaptive capacity of the organism used were the schemes of examination for detecting signs of autonomic disorders, a physicians questionnaire «Study Design for detecting signs of autonomic disorders», an autonomic test - «Questionnaire for detecting signs of autonomic changes for the patient» and a questionnaire, adapted for children and adolescents, cardiointervalography. Results. In all 234 patients with temporomandibular joint pain dysfunction syndrome revealed were the signs of autonomic dysfunction, possessing vagotonic features in 93.9% of the cases. An unbalanced condition of the autonomic nervous system in association with the temporomandibular joint pain dysfunction syndrome was registered significantly (p <0.05) more frequently in patients of the mature age group. According to cardiointervalography, in the patients revealed was a primarily vagotonic or hypersympaticotinic type of response, a significant predominance (p <0.05) of the functional stress adaptation mechanisms, mismatch of the processes that control heart rhythm until the breakdown of the adaptation mechanism. Conclusion. The revealed instability of the autonomic regulation and the features of autonomic responses in patients of different age groups with the temporomandibular joint pain dysfunction syndrome are necessary to consider when developing and selecting methods of pathogenetic therapy.
Kazan medical journal. 2012;93(2):231-235
231-235
Analysis of the effectiveness of rehabilitation measures for dental caries
Abstract
Aim. To evaluate the effectiveness of rehabilitation measures for dental caries. Methods. Studied were 246 patients aged 18-50 years (146 women and 100 men) who received dental treatment for dental caries and its complications, the duration of follow-up was 18 months. Conducted was an expert evaluation of 246 medical records of dental patients and patients’ management. The hygienic status of the oral cavity was assessed by the criteria of OHI-S (Oral Hygiene Index Simplified) and PHP (Patient Hygiene Performance), for values of OHI-S (PHP) 0.6±0.1 (0.4±0.03) the status was considered good, for values 1.3±0.1 (0.7±0.02) - satisfactory, for values 2.6±0.1 (1.8±0.04) - unsatisfactory. Results. Good oral hygiene status was noted in 64 patients (first group), satisfactory - in 88 (second group), unsatisfactory - in 94 patients (third group). In the third group, the share of fully intact restorations and fillings during middle and deep caries after 6 months was 89 and 81%, at 12 months - 80 and 78.2%, after 18 months - 79.7 and 71.8%, respectively; in the second group after 6 months - 94 and 92.8%, after 12 months - 89 and 85.3%, after 18 months - 87.5 and 81.2%, respectively; in the first group at 6 months - 96 and 96%, after 12 months - 96 and 91.3%, after 18 months - 94.5 and 90.5%, respectively. Only 152 of the 246 patients fulfilled all the recommendations and prescriptions, 34 (13.8%) did not complete the rehabilitation of the oral cavity. Prevention and rehabilitation activities were performed in 30% of cases: in 15% - in full, in the remaining 15% primarily professional oral cleaning and remineralization therapy was conducted. Conclusion. The program of rehabilitation of dental patients should include regular inspections, monitoring of the oral hygiene, professional cleaning of the oral cavity, grinding and polishing of the restorations and fillings, pathogenetic therapy.
Kazan medical journal. 2012;93(2):235-237
235-237
The state of the eyes in patients with end-stage chronic renal failure depending on the method of renal replacement therapy
Abstract
Aim. To assess the state of the organ of vision in patients with end-stage chronic renal failure, who are on renal replacement therapy with hemodialysis and peritoneal dialysis. Methods. Examined were 35 patients with end-stage chronic renal failure. The first group consisted of 20 patients receiving renal replacement therapy with hemodialysis, the second group consisted of 15 patients treated with continuous ambulatory peritoneal dialysis. In addition to the standard ophthalmologic techniques (visual acuity, tonography, perimetry, biomicroscopy and ophthalmoscopy) conducted were optical coherence tomography and photographic imaging of the retina. The following data were also taken into account: arterial blood pressure, blood hemoglobin, creatinine and urea levels and indicators of phosphorus-calcium metabolism. Results. Regardless of the method of blood dialysis of all patients had decreased corrected visual acuity. In the patients of the first group it was 0.88±0.13, in the second group - 0.71±0.19. Also in both groups revealed was a concentric narrowing of the visual fields by 5-10%. Conclusion. In patients on hemodialysis, revealed was more severe course of retinopathy; in patients on continuous peritoneal dialysis, the most frequently encountered was swelling of the retina, metastatic calcification manifested to a lesser extent.
Kazan medical journal. 2012;93(2):238-241
238-241
On improving medical care for patients with metastatic tumors of the central nervous system in the Republic of Tatarstan
Abstract
Aim. To optimize medical care for patients with metastatic tumors of the central nervous system in the Republic of Tatarstan. Methods. The database of the Cancer Registry of the Republican Clinical Oncology Dispensary of the Ministry of Health Care of the Republic of Tatarstan and the case histories of patients treated in the neurosurgical departments for the period from 1998 to 2007 served as the material for this study. Results. Lung cancer, breast cancer, kidney cancer and melanoma were the most frequent types of cancers to metastasize to the central nervous system. There was a significant discrepancy between the predicted and the detected number of patients with metastatic lesions of the central nervous system. Studied was the quality of medical care provision to this category of patients. In the Republic of Tatarstan established is a modern instrumental base for the timely diagnosis of metastatic lesions of the central nervous system and their complex treatment in accordance with the current guidelines. However, the effectiveness of diagnostic and therapeutic measures still remains unsatisfactory. Conclusion. A set of measures for optimizing medical care for patients with metastatic tumors of the central nervous system has been developed in the Republic of Tatarstan.
Kazan medical journal. 2012;93(2):241-245
241-245
Introduction of modern surgical methods of treatment of patients with fractures of the proximal femur
Abstract
Aim. To evaluate the qualitative and quantitative changes in the surgical approaches to the treatment of traumatic injuries of the proximal femur. Methods. Conducted was an analysis of the introduction of modern methods of surgical treatment of patients with injuries of the proximal femur for the period from 2004 to 2010. Discussed were the variants of osteosynthesis and endoprosthetic hip replacement for fractures of the neck and the trochanteric region of the femur in 1007 injured patients. Results. Over the period of 4 years it became possible to double the surgical activity of the trauma department through systematic personnel training and through the use of new structure-designs for osteosynthesis and arthroplasty. The main problem was recognized to be the lack of a system of surgical treatment and rehabilitation of such a complex group of patients. Conclusion. The analysis of results showed the need for development of specific standards of treatment of patients with fractures of the proximal femur both in Kazan city and at the level of the Republic of Tatarstan.
Kazan medical journal. 2012;93(2):245-249
245-249
Combination of autoplasty with autodermoplasty in the treatment of lateral abdominal hernias
Abstract
Aim. To improve the outcomes of treatment in patients with lateral abdominal hernias by combining autoplastic methods with autodermoplasty. Methods. 42 case histories of patients with lateral abdominal wall hernias, operated in the first surgical department of the State Institution «Republican Clinical Hospital», Tiraspol city, from 2001 to 2011 were subjected to retrospective analysis. In all of the cases surgical treatment was performed. Combined methods of hernioplasty, which combine autoplasty with autodermoplasty, were applied. The authors’ personal patented method of hernioplasty was also used among others. Results. According to the classification of Chevrel-Rath (2000) 23 (54.7%) of the patients had inferolateral hernias, 5 (11.9%) patients - supra-lateral hernias, 8 (19%) patients - lumbar hernias, there were also 2 (4.8%) patients each with transrectal, pararectal and paracolostomy hernias. Despite their small number in the total amount of postoperative hernias (17.5%), 26 (65%) patients had large and giant lateral hernias, while recurrences were present in 7 (16.7%) cases. Treatment results were satisfactory. Complications and recurrence occurred in 1 (2.9%) patient each. Conclusion. The combination of autoplasty with autodermoplasty is an effective method of treatment for inferolateral, supra-lateral, pararectal, transrectal, paracolostomy and lateral hernias; during lumbar hernias autodermoplasty even with two autodermal grafts was not as effective, and therefore justified is the search for new methods of hernioplasty.
Kazan medical journal. 2012;93(2):250-255
250-255
Surgical correction of severe forms of hypospadias in children
Abstract
Aim. To search for an optimal method of surgical correction of proximal forms of hypospadias in children. Methods. During the period between 1998 and 2011 at the department of urology treated were 51 children with severe forms of hypospadias. Of the 51 patients under observation 13 patients had 21 operations performed out of our medical institution, at our hospital the patients underwent 98 operations: 7 types of urethroplasty in 51 patients. Results. The best results were obtained with a tubularized incised plate urethroplasty. After this intervention significantly fewer complications developed compared to the Duplay operation (p <0.001) and the techniques involving skin flaps - the so-called «flap» methods (p <0.05). After many years of applying various techniques for correction of proximal forms of hypospadias, in the author’s arsenal remain three: the tubularized incised plate urethroplasty, the Snodgraft intervention, and the two-stage Bracka operation. All of these operations bring together one key point - urethroplasty is performed from the urethral plate. Conclusion. The formation of the urethra from the urethral plate provides a positive functional and cosmetic result.
Kazan medical journal. 2012;93(2):255-260
255-260
The results of dismembered flap pyeloplasty for hydronephrosis in children
Abstract
Aim. To evaluate the effectiveness of dismembered flap pyeloplasty for extensive obstruction of the pyeloureteral segment in children. Methods. Dismembered flap pyeloplasty throughout the period 2001-2010 was performed in 9 children (first group), mean age 69 months, 7 (77.8%) boys and 2 (22.2%) girls. Left-sided hydronephrosis was diagnosed in 8 (88.9%) cases, right-sided hydronephrosis - in 1 (11.1%) case. Dismembered flap pyeloplasty was performed in those cases, when after the resection of the ureter and during an attempt to form a direct uretero-pyelo-anastomosis excessive tension of the tissues occurred. In order to replace the resected part of the ureter used was a tubularized U-shaped flap of the renal pelvis, which was anastomosed in an «end to end» fashion with the proximal section of the ureter. The comparison group (second group, 58 patients) included patients who had undergone dismembered pyeloplasty with the formation of uretero-pyelo-anastomosis in the horizontal plane after standard resection of the dysplastic area of the proximal ureter. Results. In the early postoperative period, clinical manifestations of urinary tract infections were recorded in 1 (11.1%) of 9 patients, treated medically. The degree and rate of reduction of the increased anteroposterior size of the renal pelvis after dismembered flap pyeloplasty significantly lagged behind the comparable parameters of patients undergoing standard dismembered pyeloplasty, and at the same time, one year after the operation noted was a marked decrease in the anteroposterior size of the renal pelvis by almost 3 times as compared to the preoperative values. Conclusion. Implementation of dismembered flap pyeloplasty for extensive ureter obstruction makes it possible to achieve good short- and long-term results in the treatment of hydronephrosis in children.
Kazan medical journal. 2012;93(2):261-265
261-265
The choice of surgical treatment method of patients with bacterial liver abscesses
Abstract
Aim. To improve the results of surgical treatment of patients with bacterial abscesses of the liver. Methods. During the period from 2000 to 2010 treated were 118 patients with bacterial liver abscesses, 75 men and 43 women aged from 18 to 80 years (mean age 52.1 years). Management of the patients was based on the developed algorithm of diagnosis and treatment of liver abscesses. Two groups of patients were formed: the main group (treatment consisted of percutaneous puncture and drainage of the abscesses under ultrasound guidance) - 94 patients, the comparison group - 24 patients. In the comparison group surgical interventions were performed using the transabdominal access: laparotomy, opening and drainage of the abscess (18 patients), hepatic resection (3 patients), left-sided hemihepatectomy (2 patients), right-sided hemihepatectomy (1 patient). Results. In the patients of the comparison group the following early postoperative complications developed: wound infection - 4, intra-abdominal hemorrhage - 1, bile leakage - 1, abscesses of the abdominal cavity - 2, exudative pleuritis - 2, pneumonia - 3 cases. The average duration of patient hospitalization was 19.5±1.6 bed-days. In the main group the average duration of patient hospitalization was 9.2±±0.6 bed-days. Early postoperative complications in patients of the main group included: intra-abdominal hemorrhage - 1, bile leakage - 1, abscesses of the abdominal cavity - 1, exudative pleuritis - 2, pneumonia - 2 cases. There were no deaths in either of the groups. Conclusion. Puncture and drainage of bacterial liver abscesses under ultrasound guidance is an effective method of treatment that makes it possible to reduce the number of abdominal operations, reduce the number of postoperative complications and shorten the hospital stay.
Kazan medical journal. 2012;93(2):265-269
265-269
Endovasal laser vein obliteration in patients with varicose disease of the lower extremities in the ambulatory practice
Abstract
Aim. To evaluate the results of treatment of patients with varicose disease of the lower extremities using endovenous laser obliteration. Methods. Endovenous laser obliteration of the saphenous and perforating veins was used in the treatment of 72 patients with varicose disease of the lower extremities by applying a laser with a wavelength of 1.56 µm. The intervention technique included puncturing and catheterizing of the great saphenous vein or small saphenous vein under ultrasound angioscanning control followed by an introduction of the laser fiber-optic light guide and advancing it to the level of the saphenofemoral or saphenopopliteal junction. After paravasal introduction of the anesthetic solution the laser obliteration was performed under ultrasound control. Results. Postoperatively noted was the low intensity of pain, low severity of ecchymosis and no tenderness along the obliterated veins. No complications were recorded. 40 patients were examined in follow-up during the period from 2 to 4 months after the endovenous laser obliteration. The degree of obliteration of 39 great saphenous veins, 2 small saphenous veins and 8 perforating veins was evaluated. In all cases complete obliteration of veins subjected to laser exposure was noted, no abnormal refluxes or areas of preserved blood flow were revealed. Conclusion. The endovenous laser obliteration is a mini-invasive effective method of providing a complete occlusion of the blood vessel, which eliminates the vertical and horizontal pathological reflux in varicose disease of the lower extremities; this technique can be used in an outpatient setting.
Kazan medical journal. 2012;93(2):270-273
270-273
Diagnosis and treatment of snoring and sleep apnea syndrome
Abstract
Aim. To assess the effectiveness of modern methods of diagnosis and surgical treatment of night snoring. Methods. Conducted was polysomnography in 117 patients suffering from snoring at night. In the case of evident signs of obstruction, patients were offered surgical treatment. Results. Out of 117 people with snoring polysomnography revealed obstructive sleep apnea syndrome: in 35 - mild form, 11 - moderate severity, 1 - severe. In 69 patients benign snoring was revealed, which does not lead to a decrease in blood oxygen saturation. Simultaneous complex surgical treatment was performed in 38 patients who according to polysomnography revealed upper airway obstruction. The obstruction was eliminated by endoscopic surgical correction of the intranasal structures and the nasopharynx, and minimally invasive uvuloplasty using the method of radiofrequency coagulation. Postoperatively the patients received local medications biclotymol (hexaspray), fusafungine (bioparox), rinsing of the pharynx with antiseptics. Positive effect (disappearance of snoring) was achieved in 29 patients after an average of 1.5-2 months after surgery, in 6 patients with obstructive sleep apnea syndrome of the II and III degree of severity and co-morbidities the episodes of apnea and hypopnea decreased significantly. In 3 patients with recurrent polypous rhinosinusitis secondary to bronchial asthma (2 patients) and encephalopathy (1 patient), surgical intervention (endoscopic polysinusotomy, radiofrequency uvuloplasty) did not achieve the desired effect and the patients were referred for conservative treatment. Conclusion. The method of polysomnography and surgical treatment strategy of night snoring meet the modern requirements and in most cases have shown to be effective.
Kazan medical journal. 2012;93(2):273-276
273-276
Refraction characteristics of the vision organ of school children living and studying in the area with high intensity of automobile traffic
Abstract
Aim. To conduct an analysis of the refraction of the vision organ of school children living and studying in an area with high intensity of automobile traffic, and in children living in a more environmentally clean area. Methods. The investigation of eye refraction in 62 children (124 eyes) of school age, living and studying in an area with high intensity of automobile traffic. Hygienic assessment of the environment in the study areas. Results. In the majority of the school children living and studying in an area with high intensity of automobile traffic a myopic refraction was revealed in contrast to the control area, where the frequency of myopia was less. The obtained data on the frequency of myopic refractive disorders in the children’s population were above the average statistics for the Russian Federation. A significant relationship between the nature and intensity of air pollution and the occurrence of myopia in children was established. We assume that one of the risk factors for myopia development is air pollution emissions by a complex of hazardous substances. Conclusion. Prophylaxis of eye diseases of children living in ecologically unfavorable areas of large cities is much needed; therapeutic measures for vision organ dysfunctions of this cohort should be implemented taking into account the influence of adverse environmental factors.
Kazan medical journal. 2012;93(2):276-278
276-278
Features of community-acquired pneumonia treatment with 3rd generation cephalosporins in combination with azithromycin and as monotherapy
Abstract
Aim. To refine the indications for oral administration of a combination of 3rd generation cephalosporins together with azithromycin and also as monotherapy in patients with moderate and severe community-acquired pneumonia. Methods. A questionnaire was developed to evaluate the clinical and laboratory data on the 1st, 3rd, 5th, 7th and 10-14th days of treatment. The patients were included in the study if clinical signs of pneumonia were present, the disease occurred outside a hospital, and if there was radiological verification of lung tissue infiltration. The study included 77 patients (32 women and 45 men) aged 16 to 84 years. In 56 patients (73%) pneumonia had signs of a moderate course, in 21 (27%) - a severe course. Results. As a result of treatment the number of patients without shortness of breath significantly increased. The difference in comparison with the time of hospitalization was statistically significant starting from day 7 of treatment in patients treated with ceftriaxone and azithromycin (31 and 69%, p <0.05). Intergroup differences also became significant on the same time since treatment initiation (43% of patients on monotherapy, p <0.05). The increase in the proportion of patients without shortness of breath, receiving only ceftriaxone in comparison with the beginning of treatment became significant only by the 10th day (18 and 54%, p <0.05). Conclusion. A combination antibiotic therapy is indicated for patients with a severe course of disease and clinically significant dyspnea, as well as for women with a moderate community-acquired pneumonia with a productive cough. No significant differences in the safety and tolerability of the studied variants of treatment options have been revealed.
Kazan medical journal. 2012;93(2):278-281
278-281
Diagnostic significance of ethanolamine content in blood and urine during nephropathies
Abstract
Aim. To assess the significance of changes in the content of ethanolamine in biological fluids in the diagnosis of nephropathies. Methods. Examined were 246 patients (56% men, 44% women) aged 17 to 68 (41.1±13.1) years and 75 healthy subjects (49% men, 51% women) aged between 16 and 72 (31. 4±12.4) years. The first group consisted of 55 patients with essential hypertension, the second - 47 patients with insulin-dependent diabetes mellitus in the compensation stage, the third - 65 patients suffering from gout. The fourth group included patients with secondary (due to systemic lupus erythematosus - 29 people) and primary chronic glomerulonephritis. We used non-parametric statistical methods: analysis of the differences between the two groups was performed using U-criteria of Mann-Whitney, among three or more groups - the Kruskal-Wallis test; to identify the dependencies - Spearman correlation analysis was used. Results. The content of ethanolamine in the blood correlated poorly with the age, but only in patients with gout (r=-0.3, p=0.03). The concentration of ethanolamine in the blood was significantly lower in the first three groups, in urine was not significantly different from controls only in patients with gout (p=0.05). It is in the first, second and third groups that the majority of patients had a higher body mass index, arterial hypertension and metabolic disorders. There was an inverse relationship between the content of ethanolamine in the blood and the body mass index (r=-0.35, p=0.0001), the concentration of cholesterol in the blood (r=-0.27, p=0.02), weak positive - with creatinine levels (r=0.14, p=0.04). The ANOVA analysis revealed a negative relationship between the concentration of ethanolamine in the blood and body mass index (at f=20.3; p <0.001). Established were significant differences in terms of ethanolamine level in blood and urine when compared to patients with arterial hypertension and without it (p=0.01), as well as when comparing patients with and without dyslipidemia (p=0.02). Conclusion. The decrease in the concentration of ethanolamine in the blood may be a predictor of hemodynamic disturbances in the glomeruli of the kidneys; the content of ethanolamine in the blood is closely related with hypertension and obesity, and in the urine - is not associated with diseases of the diseases of the kidney glomerular apparatus, but correlates with the severity of tubular disorders in gout.
Kazan medical journal. 2012;93(2):282-287
282-287
Laparoscopic sanitation of the abdominal cavity in complex treatment of patients with generalized peritonitis
Abstract
Aim. To develop a method of programmed laparoscopic sanitation in patients with generalized forms of peritonitis with the use of low-frequency ultrasound energy. Methods. Conducted was an analysis of results of treatment of 211 patients with generalized peritonitis admitted to the surgical department of the City Clinical Hospital №7 from 2000 to 2010. The main group comprised 37 patients in whom laparoscopic sanitation with the use of low-frequency ultrasound was performed. The control group included 174 patients who underwent conventional relaparotomy due to progression of the pathological process in the abdominal cavity. Results. The proposed method of laparoscopic sanitation helped to reduce mortality by 12%, and the development of postoperative complications by 8% compared with control group in patients of the II stage of severity of peritonitis according to the Mannheim peritoneal index. Conclusion. The developed method of programmed videolaparoscopic sanitations of the abdominal cavity with the use of low-frequency ultrasound in patients with generalized peritonitis has a pronounced bactericidal and bacteriostatic effect.
Kazan medical journal. 2012;93(2):287-289
287-289
Reviews
The properties and role of tumor necrosis factor alpha in the pathogenesis of HIV infection
Abstract
This review presents the current understanding regarding the tumor necrosis factor alpha: its origin, receptors, main properties and its role in the pathogenesis of HIV infection (the infection, caused by the Human Immunodeficiency Virus). Tumor necrosis factor alpha induces viral replication in CD4+ T lymphocytes, monocytes and macrophages, promotes death of uninfected CD4+ T lymphocytes as well as CD8+ by the mechanism of apoptosis, allowing the progression of immunodeficiency. Tumor necrosis factor alpha maintains the viability of infected CD4+ T lymphocytes, contributing to the formation of the viral reservoir in the patient. Elevated levels of the tumor necrosis factor alpha in the blood plasma of HIV-infected individuals should be regarded as a marker of disease progression.
Kazan medical journal. 2012;93(2):290-293
290-293
The effectiveness of clopidogrel in the prevention of thrombotic complications in patients with acute coronary syndrome and genetic factors
Abstract
This review article presents the current views on genotyping during administration of clopidogrel - an antiplatelet drug from the class of thienopyridines, for patients with acute coronary syndrome. Highlighted were the data on genetic disorders affecting the absorption and metabolism of clopidogrel. The gene ABCB1 (MDR1) encodes the intestinal transporter P-glycoprotein. The variability of this gene may affect the bioavailability of clopidogrel. However, data on the relationship between C3435T polymorphism of ABCB1 gene and the expression of P-glycoprotein still remain controversial. Differences in the effects of C3435T may reflect the differences in the frequency of ABCB1 polymorphism among ethnic groups and the complex of effects of different polymorphisms in the same gene within a haplotype, or confounding factors of the environment. The most important role in the metabolism of clopidogrel is played by cytochrome P-450 (iso-enzyme CYP2C19). Several large studies have confirmed the prognostic significance of CYP2C19 polymorphism in patients receiving clopidogrel. In a recent meta-analysis of nine pharmacogenetic studies of clopidogrel, which included 9685 patients with acute coronary syndrome, revealed was a significant association between the homozygous and heterozygous alleles with reduced CYP2C19 function and an increased risk of death due to cardiovascular disease, myocardial infarction or stroke. Two large randomized studies of CYP2C19 genotyping did not reveal any relationship between its variants and the occurrence of cardiovascular events in patients with acute coronary syndrome or atrial fibrillation. Thus, in genetic studies of the antiplatelet effectiveness of clopidogrel, there are many uncertainties; domestic data on this subject is extremely scarce.
Kazan medical journal. 2012;93(2):294-297
294-297
Modern diagnostic methods in diabetic foot syndrome
Abstract
Presented was the comparative characteristic of modern methods of diagnosing tissue viability in the diabetic foot syndrome with the assessment of their advantages and disadvantages. An analysis of articles was conducted devoted to diagnostic methods that are used in diabetic foot syndrome. Doppler ultrasound investigation of lower extremity arteries makes it possible to determine the level of trophic disturbances, the degree of stenosis, the type of blood flow, however the informativeness of the method decreases during distal forms of lesions, mismatch of indicators of regional ischemia and hemodynamic severity with the clinical picture is possible. Duplex scanning makes it possible to evaluate the hemodynamics, the condition of the arterial wall, the presence of atherosclerotic plaques, gives an idea about the state of small vessels including collaterals, but does not always provide an opportunity to solve the problem of topical diagnosis. The method of radiopaque angiography and duplex scanning with contrast is not suitable for routine control of the vascular bed condition because of the invasiveness, toxicity of contrast agents and radiation exposure to the patient. In assessing the speed and volume of the out-flowing peripheral lymph and blood using rheolymphovasography the volume of the limbs and the development of subcutaneous fat, the ambient temperature, the psycho-emotional condition of the patient - all have a significant impact on the result. Impedance measurement can clearly identify the trophic disorders in the soft tissues, but can not be used to evaluate the bones. Thermal imaging study is characterized by its rapidness and objectivity, however, makes it impossible to determine the boundaries of trophic disorders. The state of the peripheral innervation can be assessed by electromyography, and chronaxiemetry electro-diagnosis. The first method is not widely used due to high equipment cost, complexity and lack of selectivity, the second one is still poorly understood. Laser Doppler flowmetry makes it possible to evaluate the level of macro- and microcirculation, even in preclinical stages, but it requires specially trained personnel. Biopsy of soft tissues with histological, histochemical, ultrastructural studies make is possible to assess the latent forms of diabetic foot syndrome; limitations are due to the invasiveness of the methods. In order to improve the quality of diagnosis of the diabetic foot syndrome is necessary to develop new methods of medical imaging, which should have the advantages superior to those of the traditional methods and have a minimum of contraindications.
Kazan medical journal. 2012;93(2):298-301
298-301
Modern approaches to local treatment of pyo-necrotic complications of the diabetic foot syndrome
Abstract
The analysis of publications devoted to modern methods of treatment of pyo-necrotic complications of diabetic foot syndrome has been presented. Identified were the most important principles of therapeutic tactics for this type of pathology. In order to create optimal conditions for wound healing after surgical sanitation local drug treatment is carried out - a thorough wound detersion with application of the isotonic sodium chloride solution or a neutral bathing solution, periodic (as needed) necrectomies, application of bandages, in accordance with the phase of wound healing process. The choice of medication for local treatment depends on the one hand on the type of lesion of the lower limbs, on the other - on the diabetes related morbidity and phase of wound healing. In the first phase of wound healing antiseptics are used: iodophors, polyhexanide (lavasept), hydroxymethyl quinoxaline dioxide (dioxidine), and in the absence of ischemia - compositions based on gelevine, water-soluble base ointments. In the second phase used were various wound covers based on collagen, as well as oil and hydrogel dressings. Ready-to-use bandages are also used, which are multi-layered system, comprised of a cellulose substrate, collagen, fibroblasts, growth factor, coated with plates of silicon to control humidity. The disadvantage of the ready-to-use dressings is the impossibility of controlling the wound on a daily basis. One of the trends in the treatment of chronic diabetic wounds is the use of living skin cells that serve as a source of growth factors, cytokines and other proteins that stimulate the healing process. The use of local immunomodulators is seen as promising. Treatment should be individualized and systemic antibiotic therapy is required. The main principle of local treatment is the creation of optimal conditions for accelerating the healing process.
Kazan medical journal. 2012;93(2):301-303
301-303
Intervertebral disc homeostasis at normal conditions and during pathology
Abstract
Intervertebral discs are rather complex structural units of the spine. It is believed that a disturbance of the factors of their homeostasis immediately leads to changes in the bone tissue of the vertebral bodies and, consequently, to pathological changes at the level of the vertebral-motor segment. It follows that the maintenance of normal metabolism within the discs is one of the key directions in the prevention of many clinically important lesions involving the entire vertebral complex. The causes of metabolic processes disorders in the intervertebral disc can be divided into several levels: chronic diseases that directly affect the blood supply to the spinal column as a whole; diseases that affect the permeability of the capillary zone of the subchondral zone of the vertebral bodies; disturbances in the delivery of nutrients into the disc through its matrix, which serves an important selective barrier. However, regardless of the level of the causes of metabolic disorders, all of which eventually lead to anatomical and functional changes in the intervertebral discs and to their subsequent incapacity to provide the daily life cycle of the vertebral complex, consisting of periods of stress and relaxation. Thus, based on the known literature data we can conclude that: the intervertebral discs to date, remain poorly understood elements, however even from a narrow range of studies on this subject it is evident that their functionality is largely dependent on the properties of the disc matrix and the interstitial nature of metabolic processes.
Kazan medical journal. 2012;93(2):304-307
304-307
Atex allergy in health care workers
Abstract
Presented was a review of the literature devoted to allergy to the components of latex among health care workers. Described were three types of reactions to natural rubber latex: (1), contact dermatitis, (2) type I allergic reactions associated with immunoglobulin E, and (3) type IV allergic reactions. Clinical symptoms of latex allergy can manifest as local [contact dermatitis (dermatitis from irritation), allergic contact dermatitis, contact urticaria] and/or systemic (rhinitis, conjunctivitis, difficulty in breathing attacks, widespread urticaria, Quincke’s edema to the extent of an anaphylactic shock) reactions. For the diagnosis of latex sensitization the applicational («glove») test is of particular importance, which consists of controlled wearing of latex gloves for 1 hour or more before the onset of symptoms of skin irritation, local and systemic allergic reactions become evident. Prick test - the most unified, technological and highly sensitive (up to 97% in the diagnosis of latex sensitization) method out of all the skin tests, virtually eliminates the occurrence of nonspecific reactions due to skin irritation or the reactions of its vessels. In the Russian Federation the prick test for the diagnosis of allergy to latex is not yet available, as the latex allergen has not yet been registered. There are publications, indicating the high sensitivity of the nasal provocation test in the diagnosis of latex allergy. The latex-specific immunoglobulin E is mainly detected by the radioallergosorbent test and enzyme immunoassay, sometimes by immunoblotting. The elimination of contact with latex products is the basis of the etiological treatment. The issue of the rational employment of health workers is very relevant. With latex allergy elimination diet is recommended to eliminate the products with cross-allergenic properties with latex: bananas, avocado, kiwi, chestnuts, peaches, tomatoes, shrimp, walnuts, etc. The usage of powder-free gloves with low allergenic potential led to a sharp reduction in the incidence of allergic reactions to latex among health care workers.
Kazan medical journal. 2012;93(2):307-311
307-311
Pathogenesis of atherosclerosis of arteries of the lower extremities: candidate genes and their polymorphism
Abstract
Personalized medicine involves the use of genetic methods by physicians for early diagnosis, prediction of the nature of the disease course and the choice of medicines and their doses based on personalized characteristics of the individual patient. Advances in the study of the human genome make it possible to reveal the interrelation between different varieties of alleles of human genes (polymorphism) and predisposition to certain diseases. Currently there are more than 10 million single-nucleotide polymorphisms in the human genome, but their biological role remains poorly understood. On the basis of a literature search of electronic full-text and abstract-only versions of articles’, which was conducted in the PUBMED, OMIM and GENE databases, collected was the information on genetic predisposition to systemic atherosclerosis. The review is dedicated to polymorphisms of the major genes that play a role in the pathophysiology of atherosclerosis of the lower extremities.
Kazan medical journal. 2012;93(2):311-314
311-314
Substantiation of the use of tseloform sorbent in the treatment of pyo-inflammatory diseases of maxillofacial area
Abstract
Aim. To study the characteristics of composition of the new sorbent tseloform by the method of electron paramagnetic resonance and to evaluate its impact on the content of free radicals in the gum tissue during experimental periodontitis. Methods. Using the method of electron paramagnetic resonance studied were the characteristics of the composition of the sorbent tseloform, as well as its influence on the content of free radicals in the experimental model of periodontitis. Results. The method of electron paramagnetic resonance made it possible to determined that the sorbent tseloform initially contains a large amount of free radicals (up to 4.6±0.3×1020 for 1 cm3 of a sample), and that is 4.6-4.8 times (p <0.01) greater than in the samples of raw materials and the antiallergenic preparation from cotton cellulose nazaval (England). On the model of acute periodontitis in rats shown was a dramatic increase in the content of nitrogen oxide (II) in the pathologically altered gingival tissue: up to 7.5±0.61×10-7 M (р <0.05). During local treatment with the sorbent tseloform the level of nitric oxide significantly decreased in the gum: up to 3.12±1.85×10-7 M (р <0.05). Conclusion. The sorbent tseloform contains significantly more free radicals than the original raw material, and during local use has a positive effect on the course of the pathological process in an experimental model of periodontitis.
Kazan medical journal. 2012;93(2):315-317
315-317
Healthcare mangement
Modelling the health condition of medical workers using a multivariate statistical analysis
Abstract
Aim. To identify the most important differential diagnostic criteria of the immunological parameters with the help of discriminant analysis in order to assess the level of health of medical personnel of an oncology dispensary. Methods. With the aim to model the generalized indicators of the health level, evaluated was the health of physicians and nurses, and a cross-sectional study of the immune status of health workers of the oncology dispensary was conducted. Firstly the content of T- and B-lymphocytes with different phenotypes was studied. The model «level of health of medical workers» was built on the basis of a sample of 96 observations (the group of medical personnel, the work of whom is associated with emitting apparatuses). The control group consisted of 98 people of the same medical institution, who are mainly office staff. Results. The health status can be described using macro parameters. At the same time under the state of health in the most general sense a specific value of the hierarchically interrelated parameters of the additive model of health is understood. Carrying out a differential diagnosis based on the assessment of clinical and laboratory data, functional parameters and their significance makes it possible to predict the level of health of medical workers. Conclusion. Informative features for differential diagnosis are the work at the department of radiology, working in surgical departments, working with the emitting apparatuses, secondary professional or higher professional education of the worker, the age of the employee, gender of the employee and the employee’s length of service for the department; the most informative features - work at the department of radiology (F=22.292), at the surgical departments (F=7.890), as well as work with the emitting apparatuses (F=3.985).
Kazan medical journal. 2012;93(2):318-321
318-321
Personal mobile medical pharmaceutical electronic card of a customer (patient) as a tool for optimizing medical and pharmaceutical service for the population
Abstract
Aim. To create a united informational space for members of the health care system and to optimize the pharmaceutical and medical services by improving the use of digital technologies. Methods. Theoretical and empirical modelling. Results. Proposed was the project entitled «Personal mobile medical and pharmaceutical electronic patient card» that makes it possible to combine all the aspects of pharmaceutical patient’s history and some medical information into a united informational database with the aim of rational organization of the personalized choice of drugs for each individual patients at any stage of delivering medical or pharmaceutical care. On the example of patients with diabetes, especially those in need of constant medical and pharmaceutical supervision, it was shown that the proposed project is an important component of optimizing the pharmaceutical activity, which makes it possible to enhance the quality, speed and efficiency of medical and/or pharmaceutical care. Conclusion. Practical application of the proposed project will make it possible to unify the system of delivering pharmaceutical care, provide access to patient information, and improve the quality of individual health care services for people affected by socially significant diseases.
Kazan medical journal. 2012;93(2):322-323
322-323
Planning dental services using the methods of marketing
Abstract
Aim. To justify the use of marketing methods in the activities of dental institutions. Methods. During the period 2008-2011 conducted was a sociological survey of 857 patients with detailed clinical examination; eight predictive models were developed. Used were variational statistics, regression analysis, mathematical modeling, expert method. Results. 171 (27.0%) men and 460 (73.0%) women went to seek care in commercial dental institutions. 267 (33.0%) men and 459 (67.0%) women went to seek care in state dental institutions. The referability of women to dentists was higher in both cases (p <0.05). Women aged 20-29 years preferred to go to commercial dental institutions (32.0±2.3%), than to the state ones (17.0±1.8%, p <0.001), while men, on the contrary, went to the state (37.0±2.4%) rather than commercial dental institutions (20.0±2.0%, p <0.001). At the age of 30-39 years the women went to state dental institutions (33%) more frequently than to commercial dental institutions (29%), while men - mostly to commercial dental institutions (26%) compared with the state (17%). Among the reasons for seeking dental treatment in a commercial organization the first one is the lack of queues at the reception: to surgeons 46.1±1.7%, therapists 58.3±1.7% and orthopedists 60.0±1.85%; the second place is held by a convenient patient schedule: for the profile of surgery 34.2±1.6%, therapy - 26.7±1.5%, orthopedics - 22.0±1.4%, and the contribution of other causes did not exceed 10.0±1.0%. Proposed were eight prognostic models in the form of regression analysis equations for complex evaluation of the influence of factors, which determine the choice of a health care institution, and the referral to the therapist-dentist, surgeon-dentist, orthopedist-dentist, and orthodontist both in public and private health care organizations. Conclusion. Prognostic matrices, calculated using the formulas of mathematical analysis, can be used when planning outpatient dental care, justifying the required number of dentists’ positions in the state and commercial dental organizations.
Kazan medical journal. 2012;93(2):324-326
324-326
Methodological justification of preparing medical workers of medical and preventive treatment institutions of the Republic of Tatarstan for providing medical care in the event of occurrence of centers of mass sanitary losses
Abstract
Aim. To optimize the training of medical personnel for providing emergency medical care to the general public. Methods. Socio-hygienic, statistical and experimental. A questionnaire-based survey was conducted among 450 medical doctors and 136 members of the nursing personnel in order to determine the subjective level of knowledge in the field of organizing medical evacuation procedures in the centers of mass sanitary losses. Conducted was an initial testing of 108 doctors and 106 members of the nursing personnel in order to objectively assess their level of knowledge followed by a final post-training test. A new technology for training health professionals has been developed and recommended for inclusion into the program of medical postgraduate education. Results. If the doctors prior to training had the level of preparedness to provide first medical care in centers of sanitary losses of 49.71%, then after training, this figure increased to 75.38% (p <0.001). Among the nursing staff the level of preparedness prior to training did not exceed 51.88% of the cases, while after the training it reached 74.28% (p <0.001). Thus, after training according to the proposed methodology the level of knowledge in organizing medical care to the affected casualties in centers of sanitary losses at the pre-hospital stage increased by 47.89% (p <0.001 for t=12.19). The survey of health professionals showed that 97.2% of health workers gave a positive evaluation of our proposed method of training. Conclusion. The proposed technology makes it possible to increase the level of training of medical personnel in organizing and delivering health care.
Kazan medical journal. 2012;93(2):326-329
326-329
Hygiene
The physiological significance of body weight at birth for subsequent age periods of life
Abstract
Aim. To study the significance of the features of early development of a child’s body, estimated on the basis of the anthropometric data at birth for subsequent age periods. Methods. The study involved practically healthy 1-5 year students with normal birth weight, 439 males and 112 females, mean age was 21.13±±0.08 years. Measurements of systolic and diastolic arterial blood pressure were performed using an automated tonometer, heart rate variability was studied on a computer electrocardiography device in accordance with the generally accepted guidelines. Conducted was a multiple regression analysis, in which as an independent random variable were the age and height of the mother, the sex of the newborn, the serial number of delivery, and as a dependent variable - the birth body weight. Results. Established was a significant correlation between birth body weight and body length (β=0.163; p=0.000), maternal age (β=0.137; p=0.001), month (season) of birth (β=-0.2012; p=0.003) and sex (β=-0.1009; p=0.003) of the child. Noted was a correlation of the respiration rate with the body weight at birth both during the semester period (r=-0.2; p=0.05) and during the examination period (r=0.26; p=0.03). Conclusion. During the examination period the correlation between birth weight and the values of functional parameters (respiratory rate, tidal volume, arterial blood pressure) of the students increases, therefore, birth body weight among the surveyed students was a predictor of the functional state of the respiratory system, cardio-vascular and autonomic nervous systems.
Kazan medical journal. 2012;93(2):330-334
330-334
Methodological aspects of studying predisposition to allergic diseases in children of agricultural workers
Abstract
In this article presented was the substantiation of the methodology of studying the work environment factors among parents, particularly the mothers, and their influence on the development of allergic diseases in children taking into account the specifics of the working conditions in the agricultural sector. The proposed study algorithm includes investigation of sanitary conditions of labor and adverse industrial factors in women of the reproductive age, employed in the agricultural sector, as well as investigation of the incidence of disease, including allergic disease, among their children. Analysis of variance allows us to quantitatively determine the significance and share impact of the industrial environment factors and of the working process of parents, as well as the of the social and hygienic conditions on the incidence of allergic disease of their children. Complex studies make it possible to determine the clinical and immunological features of allergic diseases in children of agricultural industry workers, to develop and validate the criteria for long-term effects of the factors of professional activity of parents of the agricultural industry on the formation of allergic diseases in children, as well as to determine the proportion of the effect of individual risk factors on the parameters and structure of allergic diseases of preschool children with their isolated and combined effects. The study of the relationship «professional female hazards - allergic diseases of the child» is based on the usage of a united methodological approach, which includes hygienic, sociological, allergological, immunological methods of investigation and makes it possible to determine the significance of occupational exposures of parents in the implementation of mechanisms of allergic diseases development in children and to develop a model of priority measures for improving prevention of allergic diseases in children of agricultural workers.
Kazan medical journal. 2012;93(2):334-336
334-336
Clinical observations
Williams syndrome (syndrome of idiopathic hypercalcemia)
Abstract
Williams syndrome was first described in 1961 by J.C.P. Williams et al. The population frequency is 1:7500-10 000 live births; the ratio of boys and girls is about 1:1. The nature of this genetic disease is the loss of genetic material (microdeletion) of the long arm of chromosome 7. During microdeletion the loss of elastin, LIM-kinase-1 and replication factor C2 (RFC) genes occurs, some of the «lost» genes have not yet been identified. A more rare form of the syndrome exhibits deletions on chromosomes 11 and 12 - 11q13-q14, and 22q. Presented was the authors’ clinical observation. A child was born from the second pregnancy (the first one ended in miscarriage at 12 weeks of the term), which had a physiological course, first childbirth was given at the term of 40 weeks, the newborns body weight at birth was 2600 g, body length 49 cm. At 1 year 8 months the baby’s height was 80 cm, body weight was 10 kg 800 g, head circumference - 50 cm, chest circumference - 51 cm. Multiple stigmas of dysembryogenesis were present. The head was irregularly shaped, the large fontanelle was closed. A marked face dysmorphism: a broad forehead, the unusual shape of the eyes with swelling around them, epicanthal fold, drooping full cheeks, the characteristic shape of the nose with a rounded blunt end and anteriorly open nostrils, a small pointed chin, a large open mouth, full lips, especially the lower one, progeny, small teeth, jagged, and affected by caries. The thorax was narrow, a depressed sternum in the form of a «сobbler’s chest». The muscle tone was moderately reduced. The psychomotor development at the level of a 8-9 months old. Cardiologist’s conclusion: a congenital heart defect, hypoplasia of the isthmus of the aortic arch. Conclusion of the geneticist: multiple stigmas of dysembryogenesis, a characteristic phenotype. Karyological analysis 46,XY - without karyotype abnormalities. Chromatography of the amino acids - without any pathology. Diagnosis: Williams syndrome. Diagnosis of Williams syndrome sometimes possesses known difficulties. The described clinical case illustrates the possibilities of diagnosing the syndrome, based primarily on a careful analysis of the medical history, of the clinical picture and physical examination.
Kazan medical journal. 2012;93(2):337-339
337-339
Transfusiology of the XXI century: problems, goals, future perspectives
Safety in transfusiology
Abstract
This article presents a list of investigations that need to be conducted before the procurement of preparations for blood transfusion. Analyzed were the results of the work in identifying bloodborne infections in the donor of the Central Military District of the Russian Ministry of Defence. Over the 3 years of work of the blood transfusion station of the 354th District Military Clinical Hospital identified were 36 people infected with hepatitis B, 56 - with Hepatitis C, 10 - with syphilis.
Kazan medical journal. 2012;93(2):340-341
340-341
341-342
Clinical and morphological characteristics of generalized purulent peritonitis in the terminal stage
343-344
Pathogenetic substantiation of infusion therapy using modern methods of visualization in diabetic foot syndrome
Abstract
Aim. To propose a pathogenetically substantiated infusion therapy based on the results of a comprehensive evaluation of lower limb ischemia in diabetic foot syndrome. Methods. Energetic Doppler sonography of the blood vessels of the lower extremities in its distal part and electrothermometry in 32 patients with diabetic foot syndrome and critical limb ischemia was conducted in addition to the general clinical imaging studies (radiography, ultrasonography in the «gray scale» mode). Considering the obtained data the treatment strategy in these patients (conservative or surgical) was determined together with a physician-endocrinologist. Results. Presented is an example of tactics formation for conservative infusion therapy of a patient with diabetes mellitus, which is complicated by the diabetic foot syndrome with critical limb ischemia. Compiled was an individual treatment algorithm. At the initial stage crystalloid solutions (slow drip, followed by urination stimulation) were administered. Next prescribed were vitamins from group B (cyanocobalamin 0.25 mg and pyridoxine 50 mg) in order to regulate the metabolism of key neuromediators and amino acids. The complex of treatment included the nonsteroidal anti-inflammatory drug diclofenac (25 mg). This was followed by administration of dextran solutions (reopolyglukine), in combination with an antiplatelet solution (pentoxifylline). At the final stage of therapy administered was prostaglandin E1 (alprostadil, 3-4 infusions per course). Local treatment: osmotic agents were applied to the right foot as semi-alcohol compresses to relieve swelling, improve microcirculation and promote closure of the fistulas. After the conducted treatment noted was an improvement in general condition, pain symptoms subsided, the fistula closed, the soft tissue on the foot had no signs of inflammation. Recovery of the parameters of microcirculation signify the relief of arterial and venous stasis. Conclusion. This treatment scheme will make it possible to improve the course of the disease, reduce the time of treatment and disability of patients, will also improve their quality of life.
Kazan medical journal. 2012;93(2):344-346
344-346
Cases of alloimmunization with rh-antigen D in patients with uncomplicated transfusion history
Abstract
Aim. To attract the attention of practicing physicians to the problem of transfusion safety of erythrocyte-containing preparations to patients at risk for the emergence of post-transfusion complications. Methods. Gel technique, diagnostic panel of erythrocytes for screening and identification of alloimmune antibodies. Results. During the study of blood samples of patients identified were alloantibodies to the D antigen of the Rh-system and provided were recommendations for blood transfusions with individual selection. Conclusion. Antibodies to erythrocyte antigens of the Rh-system can be synthesized as a result of immunization due to an incompatible blood transfusion or incompatible pregnancies, as well as in cases of intravenous drug use, in the antigen D immunized donors.
Kazan medical journal. 2012;93(2):347-348
347-348
On the prevention of occupational infection of health care workers with bloodborne pathogens
Abstract
Medical personnel of health care institutions are a group of occupational risk for infectious diseases. The aim of the present study was to draw attention of the medical personnel to the relevance of preventing nosocomial infection by bloodborne pathogens while performing professional duties. According to the blood service of the Central Military District among the donor-servicemen for the past 5 years the proportion of carriers of hepatitis B viral markers reached 7.9%, of hepatitis C - 8.0%, HIV - 1.7%. Presented in detail were the precautions while conducting invasive procedures and other manipulations with medical products, which are contaminated with biological fluids, discussed were the requirements of the sanitary legislation on this issue. The basic principle of prevention of occupational infection is compliance with the rules of sanitation and anti-epidemic regimen while providing service to any patient.
Kazan medical journal. 2012;93(2):348-351
348-351
Development of a genetic test for evaluating 5-year survival of patients with acute myeloid leukemia and myelodysplastic syndrome
Abstract
Aim. To study the mutations in the gene CEBPA - a transcription factor that plays an important role in myeloid differentiation. Methods. Venous blood or bone marrow biopsy specimen samples from 16 patients with acute myeloid leukemia served as the materials for the study. The method of investigation - polymerase chain reaction followed by sequencing. Results. The obtained data was analyzed; the patients are under active surveillance. Since the most common and prognostically meaningful are the combinations of N- and C-terminal mutations, in the case of a «hot spot» detection (the combination of certain mutations) a more feasible test can be developed. Identifying groups of patients with favorable and unfavorable prognosis will dramatically affect the tactics of patient management: its radicalism, aggressiveness and cost of treatment. Conclusion. A small number of examinees does not yet make it possible to establish a statistically significant correlation between specific mutations and prognostic significance, as well as to identify the combinations of most frequent mutations.
Kazan medical journal. 2012;93(2):351-353
351-353
Application of blood salvaging technologies in cardiosurgical patients operated under cardiopulmonary bypass
Abstract
Aim. To evaluate the effectiveness of blood salvaging technologies in cardiosurgical patients operated under cardiopulmonary circulation. Methods. Analysis of perfusion protocols and transfusion cards of cardiosurgical patients operated using cardiopulmonary bypass during the period 2010-2011. Two groups of patients were identified: the first group - with the application of blood salvaging technologies (906 patients), the second group - without the application of this technique (122 patients). Blood from the operative wound was collected during the operation, processed, filtered through the «Cell-saver» machine from «Fresenius» company and was then re-introduced into the patient’s bloodstream. After completion of cardiopulmonary bypass the blood remaining in the circuit of the cell-saver machine and blood that was discharged through the drainage tubes was returned to the patient after being processed. Results. In the first group at the end of the operation 314.6±28.6 ml of washed red blood cells were returned to the patient from the heart-lung machine, while during the first postoperative day, the amount of the returned autologous erythrocytes from the drainage tubes was 72.8±12.5 ml. In this group, only 45 (4.9%) patients required donor erythrocyte mass transfusion, its volume per patient amounted to 172.3±31.8 ml. In the first group 182 (20.1%) patients required transfusion of fresh frozen plasma with the aim of achieving hemostasis, its volume amounted to 425±51.3 ml. In the second group 51 (41.8%) patients received erythrocyte mass transfusion in the volume of 346.7±31.1 ml, and 86 (70.5%) - received fresh frozen plasma in the amount of 568.7±41.2 ml. Hemoglobin content and hematocrit at the end of the operation and on the first postoperative day were significantly higher in the first group compared to the second group (p <0.01). These changes were associated with both intraoperative bleeding and with the loss of blood through the drainage tubes on the first postoperative day in the second group of patients. Compensation for these losses required transfusion of blood components significantly more frequently (p <0.001) and in larger volumes (p <0.01) than in the first group. Conclusion. Blood salvaging technologies using the «Cell-saver» machine during cardiac surgery under cardiopulmonary bypass significantly reduce blood loss, reduce the number of postoperative hospital days and complications, and are less expensive.
Kazan medical journal. 2012;93(2):354-356
354-356
Ozonized erythrocyte mass in the treatment of patients with ulcerative gastroduodenal bleedings
Abstract
Aim. To determine the effect of ozone on blood coagulation system and to develop the tactics of treatment of patients with acute gastroduodenal ulcerative bleedings in order to prevent postoperative complications. Methods. Analyzed were the results of treatment of 328 patients (males) with acute gastroduodenal ulcerative bleedings who were treated at the department of emergent surgery of the Veterans Hospital of Kazan during the period of 2005-2009. Ozone therapy was used in the complex treatment in 66 patients of the main group with acute gastroduodenal ulcerative bleedings. The comparison group included 262 patients who underwent complex treatment according to the traditional scheme. Electronic coagulography machine was used to assess the effects of ozone on blood coagulation. Results. Tissue oxygenation improved after transfusion of the erythrocyte mass treated with ozone, which significantly reduced the progression of necrotic ulcer. The use of ozone therapy in patients with this pathology has led to a decrease in postoperative mortality from 24.7 to 16.7%. Conclusion. The use of ozone following this technique in the complex treatment of patients with acute gastroduodenal ulcerative bleedings is an important component of prevention of a myocardial infarction, acute ischemic attacks and thrombotic disorders.
Kazan medical journal. 2012;93(2):357-359
357-359
Assessment of biochemical parameters of blood serum in patients with chronic pyo-inflammatory diseases of the lower extremities
Abstract
Aim. To assess the dynamics of wound healing process based on the biochemical parameters of blood serum in patients with phlegmons of the lower extremities treated with various methods of ozone therapy. Methods. Conducted was dynamic monitoring of the biochemical parameters in patients with pyo-inflammatory diseases of the lower extremities. Depending on the method of treatment the patients were divided into three study groups and a control group, 29 people in each. The first group consisted of patients in whon in combination with traditional treatment local ozone therapy was performed. The second group consisted of patients who received intravenous and local ozone therapy in combination with traditional treatment. The third group consisted of patients who received traditional treatment with intraarterial and local ozone therapy. The control group consisted of patients who received traditional treatment. Results. The results showed that during treatment with ozone therapy a relief of endogenous intoxication and a significant improvement in albumin concentration takes place compared with the control group. Conclusion. A more rapid decrease in endogenous intoxication, relief of inflammation at the local and systemic levels occurs secondary to ozone therapy; most effective are intraarterial and local applications of ozone.
Kazan medical journal. 2012;93(2):360-362
360-362
Protecting the health of medical personnel in the light of prevention of nosocomial infections and occupational exposure
Abstract
Prevention of nosocomial infections and occupational diseases among health care workers is an important component of the activity of the station for blood transfusion. This article outlines the directions and shows how this is prevention should be achieved.
Kazan medical journal. 2012;93(2):362-364
362-364
Diagnosis and treatment of disseminated intravascular coagulation syndrome
Abstract
Disseminated intravascular blood coagulation syndrome is a rather complex pathology, accompanied by multi-directional shifts in the overall haemostasis. This article presents the diagnostic algorithm and treatment strategy, depending on the stage of disseminated intravascular blood coagulation syndrome.
Kazan medical journal. 2012;93(2):364-366
364-366
Key aspects of treatment of multiple organ failure
Abstract
Multiple organ failure syndrome often develops during serious diseases significantly worsening the condition of the patient and creating difficulties in treatment. The authors propose a scheme for treatment of the multiple organ failure syndrome, depending on the dominant pathological condition.
Kazan medical journal. 2012;93(2):366-368
366-368
The experience of using infusions of thrombolytic agents in the complex treatment of complicated forms of diabetic foot syndrome
Abstract
The article presents the experience of using infusion thrombolytic agents in the complex therapy of patients with complicated diabetic foot syndrome. Presented was a vivid clinical case. This method made it possible to optimize the treatment of this group of patient.
Kazan medical journal. 2012;93(2):368-369
368-369
Prostaglandin E1 in vascular reconstructive operations in patients with diabetic foot syndrome
Abstract
The article presents the results of using prostaglandin E1 in the perioperative period in patients with diabetic foot syndrome who underwent reconstructive operations on the blood vessels of the lower extremities. This method made it possible to optimize the treatment of this group of patient.
Kazan medical journal. 2012;93(2):370-371
370-371
Heart rate variability in the assessment of «benefit/risk» of infusion therapy
Abstract
In order to assess the correctness of choice of medicinal treatment of a disease, safety of intravenous transfusions, the effectiveness of treatment Chosen was a method for the analysis of heart rate variability using a complex of diagnostic functional changes in the cardiac rhythm, «Kardioanalizator “Expert 01”» (СJSC «NPO “Markiz”», Saint-Petersburg). In patients with hypersympathicotonia marked was a tendency for rigidity of cariac rhythm, overstress condition, depletion and collapse of the adaptive systems. Treatment of such patients, including infusion therapy, should be done in a hospital setting. Among patients with hypervagotonia such phenomena are not registered, although the rigidity of the cardiac rhythm is possible in them as well. For this reason, the planning of rehabilitation programs requires an individual approach. Based on heart rate variability indices, formed were groups of patients for outpatient infusion therapy at the ambulatory hospital. Patients with risk factors for development of acute vascular disease should be referred for inpatient treatment.
Kazan medical journal. 2012;93(2):371-373
371-373
Extracorporeal methods of detoxication in the complex treatment hepatitis
Abstract
Aim. To study the effectiveness of extracorporeal methods of detoxification in the complex treatment of hepatitis’. Methods. Observed were 39 servicemen who received treatment for viral hepatitis’ A, B and C, at the age of 18 to 40 years (in 13 people - a severe form of viral hepatitis A, in 3 - a moderate form of hepatitis A, in 18 - severe form, and in 5 - moderate form of hepatitis B and C). Diagnostic criteria for chronic viral hepatitis’ include data of virological, clinical, laboratory and morphological studies. Percutaneous needle biopsy of the liver made it possible to make a diagnosis during chronic viral hepatitis based on a histological study, to monitor the effectiveness of treatment, to exclude congenital metabolic liver disease. Results. On the background of administration of the traditional scheme of treatment (regimen, diet, interferon therapy, detoxification, metabolic support, glucocorticosteroids, immune stimulants, antihistamines, bile acid absorbents, adsorbents, cholagogues drugs, hepatoprotectors), the average duration of treatment of viral hepatitis was 30-45 days. During the usage of extracorporeal methods of detoxification (plasmapheresis and hemosorption) the duration of treatment was significantly shorter. Conclusion. The usage of extracorporeal detoxification methods can shorten the treatment of viral hepatitis A, B and C.
Kazan medical journal. 2012;93(2):374-375
374-375
Analysis of quarantined donor plasma at the Republican blood transfusion station from 2009 to 2011
Abstract
With the aim of ensuring safety of transfusion of plasma and its products conducted is a deposit of the plasma with the prohibition of use for a certain period of time - plasma quarantine. The needs of medical institutions in the quarantined and inactivated plasma are met to the full extent.
Kazan medical journal. 2012;93(2):375-377
375-377
The significance of extracorporeal hemocorrection in the treatment of disease of the therapeutic profile
Abstract
Aim. To evaluate the effectiveness of extracorporeal hemocorrection during a various spectrum of therapeutic diseases. Methods. To date we have conducted more than 10,000 operations of extracorporeal hemocorrection. The most widely used for therapeutic diseases was hemodialysis: during end-stage chronic kidney disease, temporary renal failure, caused by exacerbation of the underlying disease, poisoning with dialysing toxins, severe disorders of electrolyte composition of the blood, fluid overload with the development of pulmonary edema, severe endotoxemia. Results. Plasmapheresis played a major role in the treatment of somatic patients with dyslipidemia, obstructive jaundice, destructive pancreatitis, septic processes, liver failure and poisoning. Extracorporeal ultraviolet irradiation of blood was used mainly for pneumonia, gastric and duodenal ulcers, hyperthyroidism, viral hepatitis, neural infections, pyelonephritis, acute pancreatitis, burn disease, acute and chronic pyo-inflammatory processes of various locations. We have identified many disadvantages and complications during the usage of hemosorption and this narrowed down the indications of this method hemocorrection and detoxification. We believe the contraindications for hemodialysis to be cancers, uncontrolled arterial hypotension, ongoing internal bleeding; for the plasmapheresis - terminal condition of the patient, the lack of vascular access, uncontrolled arterial hypotension. Conclusion. The experience of extracorporeal hemocorrection gained in the clinics of Samara Military Medical Institute and continued within the setting of a hospital, requires further detailed investigation. Improvement of the above mentioned methods we assume to lead in the direction of their combined use.
Kazan medical journal. 2012;93(2):378-379
378-379
The usage of a hydraulic model of the vascular system in the development of verification units for blood pressure measuring devices
Abstract
The hydraulic model of the human circulatory system was discussed, presented from the position of classification and systematization of the major blood vessels, identified were the main consumers of the circulatory system, considered in detail was the area of regulation associated with the processes of blood pressure and heart rate measurement.
Kazan medical journal. 2012;93(2):380-382
380-382
Organizational measures for the prevention of complications of blood transfusion
Abstract
Organization of the blood transfusion therapy in a hospital is an essential element in delivering medical care to the wounded, injured and sick. In each medical department of the hospital a physician responsible for the organization of transfusion therapy is appointed by the order of the chief. The provision of donor blood and its components for the elective surgical interventions is carried out on the basis of preliminary requests of the attending physicians. It is unacceptable to conduct elective surgical interventions without the required number of screened blood components. In order to conduct blood transfusions when providing emergency care there should be a supply of fresh frozen plasma and frozen erythrocytes in the hospital in the amount of a monthly requirement. All blood transfusion must have a clear clinical rationale and should be performed in strict accordance with current instructions for use of blood components. The completed measures for determination of blood component’s compatibility with the blood of the recipient, the name, amount, passport data of each transfusion environment have to be reflected in the blood transfusion protocol.
Kazan medical journal. 2012;93(2):383-384
383-384
Current status of training and retraining of the medical personnel on the blood service
Abstract
There is an urgent necessity to work on optimizing the network of blood services institutions and to address the problem of staffing with highly qualified personnel - physicians-transfusiologists, nurses and technical staff. The authors propose a number of measures that contribute to solving this severe problem.
Kazan medical journal. 2012;93(2):385-386
385-386
Infusion therapy in complex outpatient rehabilitation of patients with obliterating atherosclerosis of arteries of the lower extremities
Abstract
Infusion therapy in the outpatient setting holds the leading role in the treatment of patients with stages IIA and IIB of obliterating atherosclerosis of the lower extremities. In order to assess the risk of complications of infusion therapy used was a screening method for the analysis of heart rate variability using a complex of diagnostic functional changes in the cardiac rhythm, «Kardioanalizator “Expert 01”». Identification of patients taking into account the vegetative status according to heart rate variability (sympathetic-, normo- or parasympathotonia) makes it possible to adequately form group and individual rehabilitation programs, to determine the amount and time of treatment procedures, to predict possible complications. Infusion therapy, restoration of macro- and microcirculation is the basis of the effectiveness of rehabilitation programs for chronic arterial insufficiency of the extremities. In the implementation of treatment and rehabilitation programs the combination of arterial and venous systems disorders should be taken into account, as well as the need for concurrent correction of these changes.
Kazan medical journal. 2012;93(2):386-388
386-388
The significance of electrothermometry indices for organization of adequate infusion therapy in diabetic foot syndrome
Abstract
Aim. To determine the criteria for conservative infusion therapy with the assessment of its effectiveness using the electrothermometry method. Methods. One of the major complications of diabetes is the diabetic foot syndrome. This diagnosis is established on the basis of clinical data and imaging studies. The resulting parameters are objective, but the specificity, selectivity, and the multiplicity of diagnostic procedures negate the effectiveness of these methods, making it difficult to consequently form treatment strategy. Registration of temperature parameters during different degrees of ischemic disturbances of the lower limbs by electrothermometry was performed with the subsequent formation of the algorithm of conservative therapy. Results. In patients with diabetic foot syndrome determined was the direct correlation between the degree of tissue ischemia of the lower extremities and the variation of temperature parameters. The formation of the course of conservative therapy was performed after evaluating the obtained parameters; its formation was based on the main pathogenetic links. Clinical data and the parameters of electrothermometry served as the method of dynamic control. Conclusion. Despite the achieved successes in the modern diagnosis of the diabetic foot syndrome, there still remains a number of inaccuracies, the key ones among then are the difficulties associated with determining the level of trophic disorders; electrothermometry makes it possible to expand the diagnostic horizons, and the obtained result can serve as a prognostic guide for the formation of the tactics of therapy and as a method of dynamic control.
Kazan medical journal. 2012;93(2):389-390
389-390
Infusion-transfusion therapy in the treatment of patients with acute bleedings from the upper gastrointestinal tract
Abstract
Aim. To improve the treatment outcomes of patients with acute bleedings from the upper gastrointestinal tract by improving methods of endoscopic hemostasis and prediction of disease recurrence. Methods. The results of treatment of 776 patients with bleedings from the upper gastrointestinal tract have been analyzed. Methods of conservative therapy, endoscopic hemostasis and surgical treatment were used in combination with infusion therapy. Results. Established was the necessity of a differentiated method of endoscopic hemostasis, depending on the localization of the bleeding source, its intensity and effectiveness during ongoing bleedings. Infusion therapy should be initiated from the moment of verification of the diagnosis of acute bleeding from the upper gastrointestinal tract, regardless of the degree of blood loss, and already in the hospital’s emergency department. In cases of mild bleedings the infusion volume is 800-1000 ml: 80% crystalloids + 20% of colloids. The volume of infusion in moderate blood loss is 1500-2300 ml: 60% crystalloids + 20 colloids % + 20% fresh frozen plasma. The volume of infusion in severe blood loss is 2700 ml and more: 20% of crystalloids + 30% colloids + 30% fresh frozen plasma + 20% erythrocyte mass. Replacement therapy requires careful monitoring of the hemodynamic parameters and infusion load due to the unpredictability of body reactions to blood loss and its replacement. In the absence of an effect of conservative treatment within 6-24 hours an emergency operation is indicated with the choice of an optimal method based on an assessment of the physiological status on a POSSUM scale of assessment. Conclusion. Implementation of substitution therapy, which correlates to the degree of blood loss, critically important in order to eliminate ischemia of the wall of the gastrointestinal tract and prevent recurrence of bleeding; the usage of new approaches to the prediction of recurrent bleedings and improvement of methods of endoscopic haemostasis reduces the frequency of their occurrence, duration of in-hospital stay of patients and postoperative mortality.
Kazan medical journal. 2012;93(2):390-394
390-394
Autotransplantation of immobilized stromal bone marrow cells during lumbar spondylosyndesis in an experiment
Abstract
Aim. To assess the ability of immobilized autologous bone marrow stromal cells to provide an effective repair with the formation of a robust bone block in the area of the interbody defect of the spinal motor segment after total removal of the intervertebral disc. Methods. Studied were the effects of autotransplantation of different cell fractions isolated from the bone marrow (mononuclear, stromal cells and stromal stem cells) on the formation of the anterior bone block during interbody spondylosyndesis in an experiment on 24 mongrel dogs of different sexes (mean weight 18.3 kg, the mean diameter of the lumbar vertebral bodies according to radiographic study 18.6 mm). All animals underwent the crest puncture the right wing of the ilium, with aspiration of 10 ml of bone marrow, conducted was a total diskectomy at the level of the bodies of the VII and VIII lumbar vertebras with replacement of the interbody defect with a porous metal cylinder of the Nickel titanium of an appropriate shape and size. All animals were randomly divided into four groups, 6 in each. In the first group the interbody defect was filled with a porous metal cylinder only, in the second group - with the fraction of bone marrow mononuclear cells, in the third - with the fraction of stromal cells, in the fourth - with the fraction of culture-grown stromal cells. Results. In the first (control) group established were the signs of delayed formation of the anterior bone block, formation of the hypertrophic interbody pseudarthrosis. Noted was the formation of coarse fibrous capsule in the zone of «implant-bone» contact, an excess of cartilage tissue, the small size and low proliferative activity of osteoblasts, hypoplasia of the blood vessels. In the second group determined was the forming artificial bone block with paravertebral hyperostosis, radiologically - microdislocation of the implant with protrusion into the body of the adjacent vertebra and partial osteointegration with the porous structure of the fixer in the contact «implant-bone» zone. Bone formation occurred by the type of secondary osteogenesis with an excess of cartilage tissue. In the third and fourth groups formed was a robust artificial bone block, no signs of implant dislocation were observed. Determined was the full osteointegration of the porous structure of the fixer in the contact «implant-bone» zone. The newly formed bone tissue surrounded the implant in a muft-like fashion and grew into its porous structure, grew into the periosteal zone of adjacent vertebral bodies, well adhering with their surface. Conclusion. The proposed method of correction of osteoreparation disorders can be considered as an alternative to osteoplastic operations with the transplantation of massive bone grafts, as well as in conditions of systemic disorders of the ostepoetic function with a critical shortage of endogenous progenitors of bone cells.
Kazan medical journal. 2012;93(2):395-397
395-397
Characteristics of oxygen carriers in modern blood substitutes
Abstract
Intraoperative and posttraumatic blood loss can be compensated by the introduction of crystalloid and colloid solutions. Blood transfusion is an effective method, but has several disadvantages: it may cause severe hemolytic reactions, infections and immune disorders. Blood substitutes based on oxygen-carrying molecules can solve most of these problems. The search for alternatives to donor blood and its preparations has continued for a long time, but only at this stage a few of the oxygen carriers have reached the phase of clinical trials. Artificial oxygen carriers are pharmacological agents used to improve oxygen delivery, regardless of the functions of erythrocytes, which perform solely a transport function of oxygen delivery. In this article, the authors have tried to reflect the current stage in the development, implementation and usage of oxygen carriers.
Kazan medical journal. 2012;93(2):398-400
398-400
History of medicine
On the evacuation of the Imperial moscow educational home to Kazan during the Civil war of 1812
Abstract
The article presents the events that took place at the Imperial Moscow educational home during the Civil War in 1812, when Napoleon’s army entered Moscow. A description is provided of the period of evacuation of children older than 11-12 years of age to Kazan accompanied by doctors and other employees of the House, as well as the actions directly in the Educational home in Moscow, where young children had been left. Kazan became a shelter for the older children. Owing to the brilliant organizational abilities of the main supervising officer I.A. Tutolmin, to the high professionalism of the chief physician Kh. Oppel and to the doctors, who accompanied the evacuated children, as well as to the hospitality of Kazan city and the medical and pharmaceutical services of the city it was possible to avoid major outbreaks of infectious diseases and save the lives of many children.
Kazan medical journal. 2012;93(2):401-403
401-403
Graduate of the medical faculty of Kazan imperial university, health care organizer of the Bashkir ASSR, honorary physician of RSFSR N.N. Bayteryakov
Abstract
The outcome of the work of Nurelgayan Nuriakhmedovich Bayteryakov is thousands of saved lives, the fact that always maintained his high morale, energy and high surgical activity. The article discusses the difficult and worthy life path of this amazing man.
Kazan medical journal. 2012;93(2):404-405
404-405
For the sake of public health (to the 120th anniversary of the honored worker of science, professor Eugeniya Alekseevna Domracheva)
Abstract
To the 120th Anniversary of the Honored Worker of Science, Professor Eugeniya Alekseevna Domracheva, an anniversary essay that reflected her life and career. Presented were the biographical data and memories of relatives, friends, students and colleagues. The essay contains photos from the family and the Department’s archives. The article vividly recreates a portrait of Soviet woman - a doctor, a teacher and a scholar, who gave more than 50 years of her life to serving the Motherland.
Kazan medical journal. 2012;93(2):406-409
406-409
Jubilees
Professor Davyd Moiseevich Mendelevich
Kazan medical journal. 2012;93(2):410
410
Book review
Na kn.: Fedorov I.V., Sigal E.I., Burmistrov M.V. Oslozhneniya endoskopicheskoy khirurgii, ginekologii i urologii. Prakticheskoe rukovodstvo. - M.: Triada-Kh, 2011. - 522 s
Kazan medical journal. 2012;93(2):411
411