Vol 93, No 4 (2012)

Theoretical and clinical medicine
The effect of oil phytopreparations on the lipid status in an experiment
Berdgaleeva A.K., Aldiyarova N.T., Sakhanova S.K.
Abstract
Aim. To study the effect of oil extracts of the burdock root and elecampane on the lipid profile in an experimental model of cholesterolosis. Methods. Experiments were performed on 60 white nonlinear rats, weighing 180-300 g. The oil extract from the burdock root was administered intragastrically at a dose of 2.5 ml/kg, and an extract from the root of elecampane - at a dose of 1.0 ml/kg during the last 30 days on the background of a cholesterol diet. After removal of the animals from the experiment the levels of cholesterol, triglycerides, high and low density lipoproteins, phospholipids, free fatty acids were determined in the blood serum and in liver homogenates with the use of standardized sets. Results. Administration of oil extracts of the burdock root and elecampane on the background of a cholesterol diet resulted in a significant reduction in serum cholesterol level by average of 1.48 times, triglycerides level - by 1.9 times, low-density lipoproteins level - by 1.8 times, as well as in a significant increase in the level of high-density lipoproteins on average by 1.5 times compared with the pathology model. In the same conditions the oil extracts of the burdock root and elecampane significantly increased the phospholipid content in the liver tissue by 1.4 and 1.7 times, respectively, the content of free fatty acids - by 2 times in average, the content of esterified cholesterol - by about 1.5 times as compared with the pathology model. Conclusion. The studied oils have a unidirectional positive effect on the lipid content in blood serum and liver in an experimental cholesterolosis; the oil extract from the root of elecampane has a more pronounced effect.
Kazan medical journal. 2012;93(4):561-563
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Assessment of the cardiovascular risk in women of reproductive age depending on the presence of gestational arterial hypertension in the anamnesis
Sadykova A.R., Shamkina A.R., Mustafina G.R.
Abstract
Aim. To assess the cardiovascular risk in women of reproductive age, depending on the presence of gestational arterial hypertension in the anamnesis. Methods. Examined were 25 practically healthy volunteers with normal blood pressure, 33 patients with high normal blood pressure and 77 women with arterial hypertension (Classification of the All-Russian Scientific Society of Cardiologists, 2010) with a history of arterial hypertension of 0.5-24 years. The average age of patients with arterial hypertension was 40.8±4.5 years. All examined individuals were divided into two groups depending on the presence of gestational arterial hypertension. Determined were the group averages and grades (in percent) of the studied factors. Results. Among women of the reproductive age gestational arterial hypertension was significantly more common in patients with arterial hypertension compared to women with normal levels of blood pressure (62.3 vs. 16%, p <0.001 by χ2 criteria). In the group of patients with arterial hypertension who have gestational arterial hypertension, compared with those individuals with normal blood pressure, who have gestational arterial hypertension significantly more ofter (p <0.05, Fisher’s exact test) seen was the abdominal type of obesity (54.1 vs. 0%). In the group of patients with arterial hypertension who have gestational arterial hypertension, compared with individuals with normal blood pressure without gestational arterial hypertension significantly more often (Fisher’s exact test) recorded was a family history of cardiovascular disease (inxcluding arterial hypertension), obesity, especially the abdominal type; revealed were significantly (by the U criteria) higher mean values of waist circumference, waist circumference relationship to hip circumference, body mass index, total cholesterol level. A significantly (p <0.01, Fisher’s exact test) greater proportion of individuals with very high additional risk of developing complications of hypertension in the next 10 years was noted in the group of patients with arterial hypertension and gestational arterial hypertension compared to patients with high normal blood pressure and gestational hypertension (37.5 vs. 0%). Conclusion. In women of reproductive age gestational arterial hypertension is a specific risk factor for subsequent arterial hypertension that is associated with significantly greater frequency of obesity, especially the abdominal type, very high additional risk of complications of arterial hypertension, as well as significantly higher mean values of waist circumference, ratio of waist circumference / hip circumference, and total cholesterol level.
Kazan medical journal. 2012;93(4):564-569
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Auscultatory manifestations of mitral valve prolapse in children with connective tissue dysplasia
Magomedova S.M., Belozerov Y.M., Masuev K.A., Osmanov I.M.
Abstract
Aim. To study the features of auscultatory symptoms in children with mitral valve prolapse secondary to connective tissue dysplasia. Methods. Auscultation and phonocardiography was performed in 545 children and adolescents with mitral valve prolapse, including a prolapse, which is a variant of the asthenic constitution - 140, with a prolapse with undifferentiated connective tissue dysplasia - 340, with mitral valve prolapse with differentiated connective tissue dysplasia - 65 children (patients with Marfan syndrome and Ehlers-Danlos syndrome). The control group consisted of 200 children and adolescents of similar age. Results. In children with an asthenic constitution and mitral valve prolapse in most cases (90.7%) established were isolated clicks, and only iin a small percentage of cases the clicks combined with the late systolic murmur. Complaints of these children did not differ significantly in the frequency from the control values. Compared with the control group up to 6 times more frequently found was the symptom of chronic psychoemotional stress. Chronic psychoemotional stress was also observed more frequently in adolescents with mitral valve prolapse in the background of undifferentiated and differentiated connective tissue dysplasia. Children with asthenic constitution the frequency of cardiac pain did not differ from the control values. A significant increase in the frequency of cardialgia was reported in children and adolescents with undifferentiated and differentiated connective tissue dysplasia. Cardiac pain was described as stabbing, pressing, aching, and was felt in the left side of the chest without irradiation. In most children the pain continued for 5-20 min, were usually enduced by physical exertion and emotional stress, often accompanied by autonomic disturbances, which resolved spontaneously or after administration of the tincture of valerian or valokordin. The absence of ischemic changes in the myocardium according to the comprehensive investigation can be regarded as a manifestation of cardialgia as a sympathalgia related to psychoemotional features of children with mitral valve prolapse («cardiac pain is inseparable from the personality»). The auscultatory pattern suring mitral valve prolapse in the background of undifferentiated and differentiated connective tissue dysplasia was very similar. Conclusion. According to the phonocardiography and auscultatory data we can conclude that there is a certain parallelism of the severity of valve leaflet prolapse and of the sound phenomena: in isolated clicks the leaflet prolapse degree is usually minor, however in cases of isolated late systolic and holosystolic murmurs - the prolapse degree is significant.
Kazan medical journal. 2012;93(4):570-575
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Tuberculin diagnostics in pulmonary tuberculosis combined with HIV-infection
Borodulina E.A., Lebedeva N.O., Povalyaeva L.V., Tsygancov I.I., Borodulin B.E.
Abstract
Aim. To evaluate the sensitivity to tuberculin in patients with infiltrative pulmonary tuberculosis in combination with an infection, caused by the human immunodeficiency virus (HIV), using various different tests. Methods. Examined were patients with infiltrative pulmonary tuberculosis with HIV infection (134 patients, the main group) and without HIV infection (100 patients, control group). Tuberculin diagnostics included an intradermal Mantoux test with 2 tuberculin units, the skin prick test with a 100% solution of PPD-L and the intradermal test «Diaskintest». Results. In the main group, a positive reaction to the Mantoux test with 2 tuberculin units was reported significantly less frequently (56.0%) than in the comparison group (89.0%), the diagnostic value of the test decreased with a decrease in the number of CD4+ lymphocytes. The prick test was characterized by a complete correlation with the results of the Mantoux test, although having a number of advantages. The sensitivity of the «Diaskintest» in the main group was 48.3%, and in the control group - 84.6%, at the same time the sensitivity of the «Diaskintest» decreased to 17% in cases of pronounced immunodeficiency. Conclusion. The skin prick test can be used as a screening method for early detection of tuberculosis in HIV-infected individuals with CD4+ lymphocyte count of 300 cells in 1 ml or more with the aim of forming risk groups, followed by screening for tuberculosis.
Kazan medical journal. 2012;93(4):576-579
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Metabolic changes in the lymphocytes during influenza
Sergeeva I.V., Kamzalakova N.I., Tikhonova E.P., Bulygin G.V.
Abstract
Aim. To assess the nature and intensity of metabolic processes in lymphocytes of patients with influenza according to the activity of intracellular enzymes in comparison to the severity of the disease. Methods. Determined were the enzymatic parameters of lymphocytes of 45 patients aged 18 to 42 years with a diagnosis of «influenza». Two groups of patients were formed: with moderate (24 patients) and severe (21 patients) course of the disease. Used as controls were the values the activity of intracellular enzymes of lymphocytes of 37 practically healthy individuals of comparable age. Results. In patients with a moderately severe course of the influenza compared with the controls noted was a significant increase in activity of glucose-6-phosphate dehydrogenase (3.17±0.53 and 2.74±0.31 mkE/10 000 cells, p <0.05) and glycerol-3-phosphate dehydrogenase (57.33±±5.65 and 0.84±0.16 mkE/10 000 cells respectively, p <0.001). The activity of lactate dehydrogenase was lower in patients than in controls (0.40±0.08 and 0.84±0.08 mkE/10 000 cells respectively, p <0.001). Indicators of nicotinamide adenine dinucleotide and nicotinamide adenine dinucleotide phosphate dependant isocitrate dehydrogenases in lymphocytes of patients were lower than in the controls: the first indicator in the patients was 0.17±0.02 mkE/10 000 cells, in controls - 1.95±0.25 mkE/10 000 cells (p <0.001), and for the second indicator these values were respectively 0.09±0.01 and 31.02±±2.20 mkE/10 000 cells (p <0.001). In patients with a moderately severe course of influenza the activity of nicotinamide adenine dinucleotide and nicotinamide adenine dinucleotide phosphate dependant glutamate dehydrogenases was significantly higher compared with healthy individuals: 63.67±5.32 and 0.34±0.06 mkE/10 000 cells, 1.45±0.18 and 0.11±0.02 mkE/10 000 cells respectively (p <0.001). The activity of nicotinamide adenine dinucleotide dependant malate dehydrogenase in patients was equal to 86.46±12.30 mkE/10 000 cells (in the control group 84.16±13.70 mkE/10 000 cells), and the activity of nicotinamide adenine dinucleotide phosphate dependant malate dehydrogenase was equal to 1.34±±0.25 mkE/10 000 cells (in the control group 0.33±0.07 mkE/10 000 cells, p <0.001). The activity of glutathione reductase was also higher in patients with the moderately severe course of the influenza: 5.86±0.25 mkE/10 000 cells, while the value in healthy individuals was 1.28±0.30 mkE/10 000 cells (p <0.001). In the group of patients with a severe course of influenza the activity of almost all (except for glucose-6-phosphate dehydrogenase) enzymes was higher than during the moderately severe course of disease. Conclusion. At the peak of the diseases noted were opposite changes in the activity of reactions of the pentose phosphate cycle and glycolysis. With a high functional load on the cells there is a significant reduction in the intensity of the reactions of the initial phase of the tricarboxylic acid cycle, which reduces the energy efficiency of the cycle, while the intense influx of metabolites to supply the tricarboxylic acid cycle with substrates of the amino acid metabolism provides enhanced transport of amino acids into the lymphocytes.
Kazan medical journal. 2012;93(4):580-584
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Prognostic value of serum erythropoietin in the correction of anemia using recombinant erythropoietin drugs in patients with lymphoproliferative diseases
Romanenko N.A., Berkos M.V., Bessmeltsev S.S., Potikhonova N.A., Abdulkadyrov K.M.
Abstract
Aim. To evaluate the prognostic significance of the baseline content of endogenous erythropoietin in the blood serum of patients with lymphoproliferative diseases while using recombinant erythropoietin drugs to correct the anemia. Methods. 69 patients with lymphoproliferative disorders (chronic lymphocytic leukemia, indolent forms of non-Hodgkins lymphoma and multiple myeloma) in combination with anemia, ages from 24 to 81 years, were under our observation. Treatment with recombinant erythropoietin was performed in the first group (48 patients), the second (control) group consisted of 21 patients without treatment with recombinant erythropoietin. In all patients the hemoglobin concentration was reduced to 37-100 g/l. Results. A positive response to treatment with recombinant erythropoietin for 6-16 weeks was noted in 30 out of 48 patients treated with epoetin alfa (62.5%, p <0.05). The monthly increase in hemoglobin level was 19.1±14.4 g/l, while in patients who were not responding to therapy - 2.1±4.3 g/l. In the control group of patients not receiving recombinant erythropoietin drugs the monthly increase in hemoglobin level was 2.0±4.4 g/l, which is the same as in the group who did not respond to recombinant erythropoietin and is significantly lower (p <0.01), than in patients with a positive response. In the control group, the increase in hemoglobin level >20 g/l during 20 weeks was observed only in 5 of 21 (23.4%) patients. A reduced level of endogenous erythropoietin was detected in 28 (58.3%) patients, while increased and correlating with the severity of anemia was detected in 20 (41.7%) patients. An inverse correlation was established between the positive response to treatment with recombinant erythropoietin and the baseline endogenous erythropoietin (r=-0.36, n=48, p <0,05). The positive effect of epoetin alfa was observed more frequently in patients with low serum erythropoietin level [22 of 28 (78.6%) patients responded, p <0.01], than in patients with high erythropoietin level [only 8 out of 20 (40%) patients responded to treatment, p >0.05]. Conclusion. Low concentration of endogenous erythropoietin suggests a positive response to recombinant erythropoietin products and can therefore be used as one of the predictors of response; in cases of high (above 500 mIU/ml) levels of endogenous erythropoietin the response occurs very rarely; an intermediate level of erythropoietin (130-500 mIU/ml) may also be justified for the administration of recombinant erythropoietin.
Kazan medical journal. 2012;93(4):584-590
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Treatment of patients with primary open angle glaucoma with the use of myotherapy
Korobitsin A.N.
Abstract
Aim. To evaluate the effectiveness of myotherapy, which is conducted to stabilize the glaucoma optic neuropathy in patients with primary open-angle glaucoma. Methods. Treatment with the use of myotherapy was performed in 50 patients (94 eyes) with open-angle glaucoma of the I-II stage with decompensation of intraocular pressure b-c, at the age of 45 to 67 years. The control group consisted of 50 patients (100 eyes) with similar stages of glaucoma, at the age of 47 to 60 years who were treated with vascular drugs. The complex ophthalmologic examination included visometry, auto-refractometry, biomicroscopy, gonioscopy, direct ophthalmoscopy with medical mydriasis, the Heidelberg retinal tomography of the optic disc, computer static perimetry, 24-hour tonometry, tonography, Doppler ultrasound. Repeated complex examination of all patients was performed 6-12 months after treatment. Results. In the first group stabilization of the visual function and morphological parameters of the optic nerve disc was registered in 19.1% of cases (18 eyes), a positive dynamic was registered in 74.4% of cases (70 eyes). In the second (control) group stabilization was achieved in 16% of cases (16 eyes), a positive dynamic was achieved only in 8% of cases (8 eyes), while a negative dynamic was noted in 76% of cases (76 eyes) compared with 6.4% in the first group. Conclusion. Treatment of the reflex spasm of the ciliary muscle after removal of the muscle blocks of the upper cervical spine leads to stabilization of the visual function, morphological parameters of the optic nerve and visual field expansion due to restoration of the hydrodynamic parameters as well as the cerebral and regional hemodynamics of the eye.
Kazan medical journal. 2012;93(4):590-594
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Analysis of the effectiveness of medical and laser treatment of patients with diabetic retinopathy
Kuzovnikov V.V., Nevmerzhitskaya V.A., Lazarenko V.I.
Abstract
Aim. To evaluate the effectiveness of traditional medical and laser treatment of nonproliferative and preproliferative diabetic retinopathy. Methods. Examined was a total of 80 eyes of 66 patients with nonproliferative and preproliferative diabetic retinopathy. In accordance with the stage of the disease and the type of treatment, all patients were divided into two groups. The first group consisted of 34 individuals (39 eyes) with nonproliferative diabetic retinopathy who received medical treatment, the second group - 32 individuals (41 eyes) with preproliferative diabetic retinopathy who received medical and laser treatment. The patients had visual acuity measurement, biomicroscopy, ophthalmoscopy, refractometry, perimetry, a study of the central field of vision, and rheoophthalmography performed before surgery, after surgery (at discharge), 10 days, 6 months and 1 year postoperatively. Results. The indices of visual functions, the hemodynamic and electrophysiological parameters have the same dynamics in the first and second groups throughout the observation period. In both groups a positive effect of the performed treatment was noted, which is almost entirely offset by 6-month post-treatment, and by one year after treatment a negative dynamic develops, which is associated with the progressive course of the disease. Conclusion. The lack of effectiveness of the standard treatment of nonproliferative and preproliferative diabetic retinopathy is the justification for a search for new treatment methods.
Kazan medical journal. 2012;93(4):594-597
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Prevention of complications after endoscopic retrograde cholangiopancreatography and papillosphincterotomy
Krasilnikov D.M., Safin R.S., Vasil’ev D.Z., Zakharova A.V., Mirgasimova D.M., Yusupova A.F.
Abstract
Aim. To improving the results of treatment of patients with obstructive jaundice on the basis of analysis of the causes of complications after endoscopic cholangiopancreatography and papillosphincterotomy. Methods. Conducted was an analysis of medical records of 703 patients with obstructive jaundice for the period 2006-2010. Results. Endoscopic retrograde cholangiopancreatography was performed in 542 patients. In 22 (4.06%) patients the study could not be performed due to anatomical features in the terminal portion of the common bile duct and in the descending section of the duodenum. If cases when it was necessary, cholangiopancreatography was accompanied by papillosphincterotomy. In total this procedure was conducted in 488 patients, including repeated procedures (2 to 4 times) - in 186 patients, and with concomitant lithoextraction - in 265 patients. The overall incidence of complications after endoscopic interventions for obstructive jaundice was 8.5% (46 cases) and the mortality rate was 1.1% (6 cases). Pancreatic necrosis developed in 7 (1.3%) cases, of which 3 (0.5%) with a lethal outcome, bleeding occured in 28 (5.7%) patients from the incision zone during papillosphincterotomy, perforation of the duodenum with a lethal outcome occurred in 1 (0.2%) case, jamming of the Dormia baskets occured in 10 (3.77%) patients, 2 (0.4%) of the cases had a lethal outcome. Adequate preparation for the procedure, adequate and effective premedication, sparing technique of endoscopic retrograde cholangiopancreatography and interventions on the major duodenal papilla, adequate and rational therapy after the diagnostic procedure and the operation are believed to be effective prevention measures of acute pancreatitis after endoscopic retrograde cholangiopancreatography and endoscopic papillosphincterotomy. Prevention of bleeding is mainly attributed to patient preparation: before the intervention it is necessary to examine the coagulation and clotting of blood, haemostatic agents should be administered before the operation and in complex cases papillosphincterotomy should be conducted in several stages with an interval of 3-6 days. For prevention of duodenal perforation the usage of a catheter cannula with an atraumatic distal end, and elimination of rough manipulations are recommended. In order to prevent jamming of the Dormia basket a thorough diagnosis is required, detection of large dense concretions on the background of stenosis of the terminal common bile duct should lead to refusal of conduction of lithoextraction. Conclusion. The use of endoscopic retrograde cholangiopancreatography and endoscopic papillosphincterotomy with adequate procedure performance in specialized endosurgical departments makes it possible to enhance the quality of diagnosis, reduce the incidence of complications and improve the results of treatment of patients with obstructive jaundice.
Kazan medical journal. 2012;93(4):597-601
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Late stomal complications and their surgical correction
Timerbulatov M.V., Ibatullin A.A., Gaynutdinov F.M., Kulyapin A.V., Aitova L.R., Kyzylbaeva A.I., Abdeev A.A., Fatkhullin A.S.
Abstract
Aim. To conduct a detailed analysis of the causes of development of late stomal complications, to determine the indications for surgical correction, to evaluate the effectiveness of new methods of surgical treatment. Methods. Conducted was an analysis of the causes of late stomal complications in 141 patients with a stoma of the colon. Results. A parastomal hernia was diagnosed in 44 (31.2%), prolapse - in 29 (20.6%), stricture - in 9 (6.4%) patients. Introduced into practice were new methods of surgical correction of complicated stomas. Parastomal hernia was detected in 44 (31.2%) patients - 26 (59.1%) females and 18 (40.9%) males, all patients with this complication were older than 50 years, the age group 71-80 years included 43.5% of patients. Since 2005 performed were 17 reconstructive operations for parastomal hernias (Russian Federation patent №2406454 and №2395238). Stoma prolapse was observed in 29 (20.6%) patients, 10 cases - in patients aged 71 to 80 years. Most often this complication developed in patients with double-barreled transverse stomas - in 10 (76.9%) of 13 patients. 4 patients underwent surgery due to prolapse. Stoma stricture was diagnosed in 9 (6.4%) patients. In 7 patients with a stoma stricture in the early postoperative period registered was festering of the parastomal wound (4 cases), marginal necrosis of the stoma (2 cases), and stoma retraction (1 case). Correction with the use of stents for the prevention of recurrence (Russian Federation patent №2357681) was conducted in all cases. The so-called «lock-stoma» was diagnosed in 16.3% of cases (23 patients). Although this condition does not belong to stomal complications in its pure form, however in most cases it causes the inability to use the incontinence bag, reducing the quality of life. Conclusion. Despite the inevitability of the development of parastomal complications, provided proper surgical techniques can either prevent or delay their appearance; reconstructive operations for complicated stomas, conducted by moving the stoma to a new place with retroperitoneal conduction makes it possible to obtain satisfactory results, significantly improve the quality of life that promotes full social adaptation of stomal patients.
Kazan medical journal. 2012;93(4):602-606
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Results of complex treatment of patients with knee osteoarthritis and varicose diseases of the lower extremities
Shcheglov E.A.
Abstract
Aim. To evaluate the results of complex treatment with application of methods of correction of chronic venous insufficiency in patients with osteoarthritis of the knee joints in combination with varicose disease of the lower extremities. Methods. Examination of a cardio-vascular surgeon, orthopedist or rheumatologist, triplex scanning the veins of the lower extremities, arthrosonography and X-ray imaging of the knee joints, assessment of the severity of chronic venous insufficiency according to a CEAP scale [Clinical signs, Etiologic classification, Anatomic distribution, Pathophysiologic Dysfunction (1984)], and the degree of gonarthrosis according to the special Leken’s index and WOMAC index (Western Ontario and McMaster Universities Arthritis Index). The investigations were performed before treatment and repeatedly during the year in the course of treatment. According to the indications both conservative therapy and surgical treatment were used. Results. As a result of the complex treatment of patients achieved was a reduction in the severity of symptoms of gonarthrosis, which manifested with a decrease in the total value of the Leken’s index and the WOMAC functional index. Positive results were obtained in the group of patients who underwent surgery, and in the group of patients who received conservative treatment. Conclusion. Inclusion in the treatment of the methods aimed at eliminating manifestations of chronic venous insufficiency leads to improved results of treatment of osteoarthritis of the knee joints.
Kazan medical journal. 2012;93(4):606-611
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Mathematical modeling of an optimal mini-access for reconstruction of arteries of the aortofemoral segment
Maksimov A.V., Mayanskaya S.D., Plotnikov M.V., Gaysina E.A.
Abstract
Aim. To determine the optimal size and location of the mini-laparotomic access for the reconstruction of arteries of the aortofemoral segment. Methods. The method of mathematical modeling was used. The parameters of the mini-access were calculated depending on the sex of the patient, as well as for a variety of clinical situations (operations for occlusive disease, for abdominal aortic aneurysm, including the propagation of the aneurysmal dilatation to the iliac arteries). Topography of the aorta and iliac arteries was determined on the basis of computer tomograms of 155 patients (61 of them with an aneurysm of the infrarenal aorta). Results. It was established that for the purpose of creation of an adequate access an incision of 6.8-7.0 cm in length at the level of the umbilicus and above is sufficient during surgery for occlusive disease. No significant gender differences were found. During aortic aneurysm the required length of the mini-laparotomic access is significantly increased up to 7.6 cm (p=0.003), and in cases of propagation of the aneurysmal dilatation on to the common iliac arteries - up to 8.5 cm (p=0.001). In the latter case its location also changes: approximately half of the length of the access incision is located below the umbilicus. Conclusion. Mathematical modeling of the optimal mini-access makes it possible to optimize the use of mini-laparotomy in various clinical situations.
Kazan medical journal. 2012;93(4):611-616
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The risk of development of multiple primary malignant tumors involving the thyroid gland
Afanas’eva Z.A., Bakunin S.F.
Abstract
Aim. To determine the relative risk of developing other malignant tumors in patients with thyroid cancer and and the risk of developing thyroid cancer in patients with other malignancies. Methods. A retrospective analysis of 116 patients with multiple neoplasia including thyroid gland involvement was conducted for the period from 1973 to 2010. In order to estimate the relative risk of development of multiple neoplasias including thyroid gland lesions used was the following formula: relative risk = [a / (a + b)] / [c / (c + d)], where a is the number of patients with thyroid cancer with a second malignancy; b is the number of patients with thyroid cancer without a second malignancy; c is the number of patients in the population affected by the same malignant disease, as patients in group a; d is the number of people in the population without any cancer-related pathology. Results. In patients with carcinomas of the thyroid gland the relative risk is higher than in the general population for developing metachronous lymphoma (41.8 for men, 31.7 for women), renal cell carcinoma (55.6 for men, 18.5 for women), prostate cancer (35.7), lung and bronchus cancer (18.8 for women), melanoma (17.1 for women), colon cancer (16.7 for women), cervical cancer (15.8), uterine cancer (11.8), breast cancer (11.5 for women), skin cancer (9.5 in women) and the simultaneous development of renal cell carcinoma (33.8 for men and 46.3 for women), prostate cancer (24.4), melanoma (20.6 for women), cancer of the esophagus (19.4 for men, 17.8 for women), colon cancer (19.0 for men), lymphomas (12.8 for men), cervical cancer (11.3), breast cancer (11.0 for women), skin cancer (8.5 for women). The relative risk of developing metachronous cancer of the thyroid gland is higher than that in the population in patients with melanoma (108.0 in men, 50.4 for women), with malignant neoplasms of the lymphoid tissue (40.2 for men, 40.8 for women), uterine cancer (11.8), skin cancer (8.7 in women), breast cancer (8.0 for women). Conclusion. During preventive medical examinations of patients with thyroid cancer the relative risk of developing subsequent cancers must be taken into account for early diagnosis of multiple neoplasias.
Kazan medical journal. 2012;93(4):616-623
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Small cell lung cancer: effectiveness of different treatment regimens, long-term results and prognosis
Ramazanova M.S., Kislichko A.G.
Abstract
Aim. To evaluate the efficacy and safety of different treatment regimens of patients with small cell lung cancer. Methods. Examined were 76 patients, 17 (22.4%) females and 59 (77.6%) males, mean age 62±4.87 years, divided into two groups. The first group consisted of 46 (60.5%) individuals with a generalized form of the disease, the second group consisted of 30 (39.5%) patients with localized cancer. Results. In patients with a localized form of lung cancer the most effective treatment method was a combination of surgical treatment with chemotherapy. In this group in the near-term period noted was a complete regression of the disease, while in the long-term period - a statistically significant improvement of 2- and 3-year survival compared with patients receiving chemotherapy alone. In patients with a generalized form of small cell lung cancer the best immediate and long-term results were observed after chemoradiotherapy compared with chemotherapy alone, which was reflected in statistically significant improvement of parameters of partial remission and stabilization of the disease, as well as improved 1- and 2-year survival. Conclusion. The use of chemotherapy in combination with surgical treatment for localized forms and chemoradiotherapy for generalized forms of small cell lung cancer is characterized by higher indices of treatment efficacy compared to administration of just chemoradiotherapy or chemotherapy, respectively.
Kazan medical journal. 2012;93(4):623-627
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Diagnosis and perfection of the complex treatment of patients with neuromuscular dysfunction syndrome of the temporomandibular joints
Sidorenko A.N.
Abstract
Aim. To improve the complex treatment of patients with neuromuscular dysfunction syndrome of the temporomandibular joints. Methods. Clinical examination, electromyography of masticatory muscles, computed tomography in 24 patients (main group) with a neuromuscular dysfunction syndrome of the temporomandibular joints. The control group included 10 healthy individuals aged 18 to 32 years with intact tooth rows, orthognatic bite, and without pathology of the temporomandibular joints. In cases of deviation of the mandible at the time of opening the mouth in 7 (29.2%) patients the complex of therapeutic measures included a myo-gymnastic exercise, which consisted of shifting the mandible with the palm of the hand towards the opposite side of the deviation. During zigzag movements of the mandible in 12 (50%) patients assigned was myo-gymnastic exercise, aimed at keeping the lower jaw with the palms of both hands in the sagittal plane during a vertical opening of the mouth. In 5 (20.8%) patients with a small limitation of mouth opening and lateral displacement of the mandible myo-gymnastics were used that included exercises designed to stretch and cause reflex relaxation of the masticatory muscles, as well as the displacement of the mandible in the palm of the hand to the side opposite to its deviation. All patients from the start of treatment were prescribed a course (10 sessions) of therapeutic massage of the masticatory muscles and 10 sessions of transcranial electrostimulation in 8 (33.3%) patients to relax the chewing muscles in its hypertonicity, to relieve spasm of the lateral pterygoid muscle, and removal the significant pain syndrome. Results. By the 5-6th session of transcranial electrostimulation the pain and tension in the masticatory muscles on the affected side with neuromuscular dysfunction disappeared, the range of motion of the mandible was restored, atypical movement of the mandible stopped. Examination of 24 patients at 2 years after treatment showed that 22 patients had a sustained, positive result, no complaints or recurrences were observed. In 2 patients after treatment noted was significant tension in the masticatory muscles, they were re-appointed for transcranial electrostimulation. Conclusion. Developed and proposed was an improved method of complex treatment of patients with neuromuscular dysfunction syndrome of the temporomandibular joints without the use of drugs, which has shown high effectiveness.
Kazan medical journal. 2012;93(4):627-631
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Dental status of school children with physical development disorders who live in rural areas
Shaydullin I.M., Khamitova N.K.
Abstract
Aim. To determine the dental status of students with physical development disorders in rural schools. Methods. Examined were 360 school students of the Alkeyevsky region of the Republic of Tatarstan aged from 7 to 12 years. The comprehensive assessment of physical development included determination of the biological age, constitutional body type, height and weight. The evaluation was conducted on a scale of regression. Occlusion was assessed according to the classification of L.S. Persin (1989). Determined was the extent of dental caries, the depth of the vestibule of the oral cavity, examined was the condition of the frenulums of the lips and tongue, the shape of the head, the respiratory and swallowing functions. Results. Disorders of physical development were detected in 32.2% of children, with prevalence of excessive weight gain in 58.6% of cases. Pathological bite was found in 296 (82.2%) of the school students: deep premaxillary occlusion - 22.6%, close positioning of the teeth - 52.7%. The index of the extensiveness of caries was 5.6±2.4 in the group of children with excess body weight and 4.8±2.9 in underweight children. Revealed were anomalies in the attachment of soft tissues of the oral cavity: a shallow vestibule - 63.4%, impaired attachment of the frenulums of lips and tongue - 47.3%. Mouth breathing was detected in 26.3% of children with impaired physical development, which in children with excess weight gain was found in 7.1% of students, and in the group of underweight children was noted in 37.5% of students. Infantile type of swallowing was found in 26.3% of examined students. Conclusion. School students who live in rural areas often have physical development disorders and a poor dental status: high frequency of malocclusion, dental caries, disorders of the breathing, chewing and swallowing, as well as anomalies in the attachment of soft tissues and a small vestibule of the oral cavity.
Kazan medical journal. 2012;93(4):632-633
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The need for treatment of complicated caries of deciduous teeth in children
Shiryak T.Y., Saleev R.A., Urazova R.Z., Anisimova O.Y.
Abstract
Aim. To determine the role of complications of caries of deciduous teeth in the structure of pathology of hard dental tissues. Methods. Conducted was a dental examination and treatment of 1016 children aged 1 to 9 years who were treated at the children’s dental clinic. Results. The overall prevalence of caries was 78.64%, the need for treatment was - 73.82%. Complications of dental caries were found in 60.83% of cases. 55.21% of children had temporary tooth pulpitis, 41.24% - had a diagnosis of «periodontitis». Premature removal of deciduous teeth was performed in 12.11% of cases. At an early age (1-3 years) 47.35% of the children were registered as having affected deciduous teeth, almost half of them had teeth with complicated dental caries (20.0%). In children of preschool age (4-6 years) the prevalence of caries disease was 92.17%, and complications of caries were diagnosed in 78.80% of cases. In the group of primary school children (7-9 years) the proportion of children with affected temporary teeth was 98.34%. 86.77% of children had deciduous teeth with complications of caries. Every child who comes to children’s dentist at an early age, already has an average of 2.33 affected teeth, in the preschool age - 4.8 teeth, in the primary school years - 5.02 affected deciduous teeth. In evaluating the intensity of dental caries it was established that each child had on average 1.96 teeth with uncomplicated caries and 2.08 teeth with caries complications. Treatment or retreatment was necessary in 70.69% of cases of affected teeth, of them uncomplicated caries accounted for 35.96%. Conclusion. Revealed was a high prevalence and need for treatment of complicated caries of deciduous teeth starting from an early age.
Kazan medical journal. 2012;93(4):634-637
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Evaluation of the effectiveness of personality-oriented educational programs for rehabilitation of young patients with chronic non-calculous cholecystitis
Khismatullina G.Y., Ulyamaeva V.V., Volevach L.V., Bashirova E.S.
Abstract
Aim. To study the effectiveness of personality-oriented educational program in the rehabilitation of young patients with chronic non-calculous cholecystitis. Methods. Examined were 64 people aged 18 to 35 years with a diagnosis of «chronic non-calculous cholecystitis in the remission phase». Conducted was a comprehensive examination and a clinico-psychological evaluation of the levels of personal and reactive anxiety, according to the method of Spielberger-Hanin, psychological diagnosis of types of attitudes to the disease, assessment of the quality of life according to the «ESADA» (Evaluation of the Situation of Adaptation, DysAdaptation). All patients participated in the educational personality-oriented program, which included individual counseling, coming up with a treatment and rehabilitation plan, visiting the «gastro-school». Results. As a result of educating of 64 patients the number of people with high levels of reactive anxiety decreased from 5 (7.8%) to 2 (3.1%), with a moderate level - from 27 (42.2%) to 21 (32.8%) and the number of individuals with low levels of anxiety increased from 32 (50.0%) to 41 (64.1%). The proportion of patients with high levels of personal anxiety decreased significantly: from 57.8 to 29.7% (p <0.001). Noted was an increase in the number of people with moderate and low levels of anxiety: from 32.8 to 43.8% and from 9.8 to 26.6%, respectively (p <0.001). The number of individuals with the type of attitude to the disease of the first block increased, with a clear trend towards an increase in patients with an ergopathic type attitude to the disease by the end of classes: from 6.3 to 25.0% (p <0.001). Among the type of attitide to the disease of the second block the largest positive trend was registered among individuals with anxious (from 23.4 to 12.5%) and hypochondriacal (from 43.8 to 29.7%) types. Before training only 9 (14.1%) patients were compliant with guidelines on therapeutic nutrition, 19 (29.7%) patients maintained the diet, but not on a regular basis; and after the training 41 (64.4%) individuals started maintaining the diet, 23 (35.9%) people - not on a regular basis. Prior to the training 7 (10.9%) patients had regular physical exercise, 18 (28.1%) - occasional physical exercise; upon completion of the training 18 (28.1%) patients engaged in regular physical exercise, 39 (60.9%) - in occasional physical exercise. 4 (6.3%) patients were able to «cope with the stress» prior to training, and 34 (53.1%) patients - upon completion of training. Conclusion. The developed personality-oriented educational program for patients with diseases of the biliary system has proven its effectiveness: the features of the psycho-emotional area have improved, favorable healthy lifestyles habits have developed.
Kazan medical journal. 2012;93(4):637-641
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Prediction of atrial fibrillation according to levels of serum markers of inflammation during arterial hypertension
Vasilets L.M., Agafonov A.V., Khlynova O.V., Ratanova E.A., Grigoriadi N.E., Krivaya A.A., Trenogina K.V.
Abstract
Aim. To study the parameters of inflammation during atrial fibrillation in patients with arterial hypertension and to determine the possibility of their predictive significance in relation to development of the arrhythmia. Methods. Examined were 97 individuals with arterial hypertension, mean age 50.53±8.10 years. Formed were two groups: patients with arterial hypertension without the arrhythmia and patients with atrial fibrillation on the background of arterial hypertension. Among the examined patients with atrial fibrillation revealed were patients with persistent or recurrent persistent forms of atrial fibrillation, the latter were examined both without and during the paroxysm of arrhythmia. The comparison group was comprised of 21 practically healthy individuals. In all patients determined was the content of C-reactive protein, tumor necrosis factor-alpha, and fibrinogen. Results. Paroxysms of atrial fibrillation were accompanied by a significant increase in the concentration of the tumor necrosis factor-alpha. The level of C-reactive protein had an inverse correlation with the severity of atrial fibrillation, that is, in cases of persistent atrial fibrillation it was lower than in cases of paroxysmal forms of atrial fibrillation, as well as in patients with arterial hypertension without the arrhythmia. Conclusion. Variation in the levels of inflammation markers is an independent predictor of atrial fibrillation in patients with arterial hypertension.
Kazan medical journal. 2012;93(4):642-646
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Features of social adaptability and autonomic stability of adolescents with metabolic syndrome
Chervinskikh T.A., Kolesnikova M.B., Naymushina E.S., Zhuikova G.V.
Abstract
Aim. To identify the features of social adaptability and autonomic stability of adolescents with metabolic syndrome. Methods. The parameters of social adaptation and autonomic stability of 300 obese adolescents were studied. The main group included 150 adolescents (mean age 14.0±0.12 years) who were diagnosed with metabolic syndrome. The comparison group consisted of 150 adolescents (mean age 13.9±0.14 years) with primary uncomplicated obesity. A two-factor personality questionnaire of M. Gavlinova («society - autonomic nervous system») was used. Anthropometric indices (body weight, body mass index, height, waist circumference, hip circumference, waist/hip circumference ratio) were evaluated, the blood pressure was measured. General and biochemical blood tests and urine tests were performed (determination of the level of glucose, insulin, triglycerides, cholesterol, lipoproteins of high and low density, uric acid), as well as instrumental investigations. Results. In the group of adolescents with metabolic syndrome the mean body mass index 29.21±0.37 was significantly higher (p <0.001) compared to 26.07±0.46 in the group of patients with uncomplicated obesity. The waist/hip circumference ratio was significantly higher in adolescents with metabolic syndrome: 0.89±0.41 vs. 0.80±0.12 in the control group. In 92.71% of adolescents with metabolic syndrome arterial hypertension was diagnosed. In adolescents of the first group found were and laboratory markers of the metabolic syndrome: dyslipidemia in the form of hypertriglyceridemia (2.04±0.08 mmol/l) and decrease of the concentration of high-density lipoproteins (1.1±0.04 mmol/l). The average fasting blood glucose level was 5.78±0.02 mmol/l, the index of the model of homeostasis assessment for insulin resistance was 6.64±0.21. In the group of adolescents with metabolic syndrome the average score on the scale of social adaptation was low (8.48±0.13), whereas in the group without metabolic syndrome it was 13.51±0.22, which was significantly higher than in the main group (p <0.001), and was evidence of normal social adaptation. Low level of social adaptation was observed more frequently in girls than boys in both groups. Established was a correlation between the body mass index and social adaptability (r=-0.358), and with autonomic stability (r=0.378), p <0.05. Conclusion. Social adaptability and autonomic stability of adolescents with metabolic syndrome depend on the severity of clinical and metabolic changes and on the sex, thus this must be taken into account during treatment and rehabilitation.
Kazan medical journal. 2012;93(4):647-650
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The nature of the course of the retention period in adolescents after orthodontic treatment depending on the state of the autonomic nervous system
Singatullina D.R., Khamitova N.K.
Abstract
Aim. To study the condition of the autonomic nervous system in groups of adolescents in the period of retention after active orthodontic treatment with non-removable equipment. Methods. Examined were 100 adolescents aged 13-17 years in the period of retention after active orthodontic treatment. The baseline autonomic tone was assessed according to the combined table of sympathetic and parasympathetic reactions (Wayne A., 1981) in the modification of N.A. Belokon’ et al. (1986) for children and adolescents, taken into account were the heart rate, respiratory rate, systolic and diastolic blood pressure. In order to evaluate the adaptation of the organism used was a mathematical analysis of the heart rhythm (cardiointervalography), determined was the mode (Mo), the amplitude of the mode (AMo), and the variational span (ΔX). Results. Revealed were two groups of patients with different variants of the course of retention: favorable course without recurrence (53%) and unfavorable course with recurrences (47%). In the group of patients with recurrences cardiointervalography most frequently showed a asympaticotonic (41.7%) or hypersympaticotonic (58.3%) type of autonomic reactivity. In all patients of the group with recurrences noted was a disturbance of the adaptation processes. The state of adaptation is regarded as unsatisfactory in 72.6% of cases, as the complete adaptation failure - in 27.4%. Conclusion. A recurrence during the period of retention after active orthodontic treatment occurs significantly more frequently in the group of patients with high constraint and overload of the autonomic reactivity, with a mismatch of cardiac rhythm management processes, with a reduction of the adaptive capacity of the organism to the level of complete failure of adaptation; patients who have expressed sympathicotonia, are at risk for destructive periodontal disease and require special attention during the retention period.
Kazan medical journal. 2012;93(4):651-653
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The use of double catheter epidural anesthesia in the lumbar segment of the spine during surgical correction of funnel chest deformity
Safin R.R., Anisimov O.G.
Abstract
Aim. To provide clinically effective epidural anesthesia during corrective thoracoplasty in children with congenital deformity of the chest with the use of an access, which makes it possible to minimize the probability of accidental spinal cord injury during the procedure. Methods. Conducted was a prospective study of 40 adolescents randomized to the main group (thoracic epidural anesthesia combined with general anesthesia) and the comparison group (general anesthesia), 20 observations in each group. In order to evaluate the effectiveness of the method at the time of surgery determined was the level of cortisol and glucose, and after the operation recorded were the times of resolution of the pneumothorax and of the intensity of pain. Results. In the main group a slight decrease in the biochemical markers of stress was noted in contrast to their moderate increase by the end of the operation in the comparison group. Associated complications and pain in the postoperative period in the main group were expressed to a lesser extent than in the comparison group. Conclusion. Thoracic epidural anesthesia combined with general anesthesia may be the method of choice during surgical correction of the funnel chest deformity.
Kazan medical journal. 2012;93(4):654-656
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Emotional burnout syndrome among dentists
Petrov P.I., Mingazov G.G.
Abstract
Aim. To study the emotional burnout syndrome among dentists in relation to age, gender, work experience and specialization. Methods. Examined were 200 dentists enrolled for training at the Department of Dentistry and Maxillofacial Surgery of the Institute of Postgraduate Education of Bashkir State Medical University in 2010/2011 academic year. The test of V.V. Boiko «Methods of diagnosing the level of emotional burnout» was used. Results. Symptoms of emotional burnout were found in 53.8% of respondents. The magnitude of the phases of emotional burnout was independent of age, gender, length of service as a dentist (p >0.05). When accounting for occupational specialization differences were found in the entry «driven into a cage» (p=0.019). This symptom was most pronounced in dental therapists, followed by dental surgeons. Among dentists-orthopedists the symptom of «emotional detachment» was predominant (p=0.027). Conclusion. Emotional burnout syndrome develops in the course of professional activities of a dentist, professional specialization of the dentist affects the development of this syndrome.
Kazan medical journal. 2012;93(4):657-660
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Measurements of the optical density of the alveolar process bone tissue of the jaws during periodontal diseases with the use of three-dimensional computed tomography
Bondarenko N.N., Balakhontseva E.V.
Abstract
Aim. To determine the optical density of the alveolar process bone tissue in normal conditions and during various forms of periodontal pathology. Methods. With the use of clinical and radiographic methods examined were 120 patients (with a healthy periodontium, with chronic generalized catarrhal gingivitis of moderate severity, with chronic periodontitis of a mild, moderate and severe degree). On the three-dimensional computer tomograms in each group of patients determined was the optical density of the alveolar process bone tissue from the medial and distal sides of the root of the following teeth 1.6, 1.7, 2.7, 2.6, 3.6, 3.7, 4.7, 4.6, 1.1, 3.1 (the teeth numbers have been recommended by the World Health Organization in order to determine the index of treatment needs of the periodontal disease), and studied were its changes depending on the severity of periodontal disease. Statistical analysis was performed using computer programs «Microsoft Excel», «Biostatistica». Results. In periodontal disease noted was a reduction in the optical density of bone tissue of the alveolar processes of the jaws with a firm relashionship with the severity of disease. In chronic generalized catarrhal gingivitis of moderate severity the optical bone density ranged from 40.445±1.264 to 633.744±5.226 arbitrary units, in mild forms of chronic generalized periodontitis - from -119.664±1.511 to 344.972±4.019, in moderate forms of chronic generalized periodontitis - from -232.589±3.088 to 203.841±1.604, in severe chronic generalized periodontitis - from -464.080±2.398 to -53.991±1.435 arbitrary units. Conclusion. Changes in optical density of bone tissue of the alveolar process of the jaws is an objective criterion for evaluating the status of periodontal tissues, an important diagnostic feature, which also makes it possible to predict the course of the disease and monitor the effectiveness of treatment.
Kazan medical journal. 2012;93(4):660-662
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Reviews
Role of genetic polymorphism in the pathogenesis of cerebrovascular disease
Gayfullina R.F., Katina M.N., Rizvanova F.F., Kravtsova O.A., Rizvanov A.A.
Abstract
Presented was a review of the most recent literature devoted to the main genes responsible for the formation of atherothrombosis of the cerebral vessels. The aim was to analyze the data in the literature regarding several genetic factors responsible for the development of cerebrovascular disease, particularly ischemic stroke. Conducted was an electronic search of full-text and abstract-only versions of articles, which cover the aspects of genetic susceptibility to ischemic stroke, according to the databases PUBMED, OMIM and GENE using the following main keywords: «cerebrovascular disease», «ischemic stroke», «cerebral atherosclerosis», «gene polymorphism», «mutation». Medical diagnostics today has modern technologies of genotyping, which make it possibe to accurately determine the genotype of a person, thus opening up wide prospects for the development of personalized medicine. The majority of genetic variations is due to single nucleotide substitutions that lead to quantitative changes in expression or affect the biological properties of the proteins. Approximately 10 million single nucleotide polymorphisms are known, however their biological significance is not always obvious. Currently hereditary predisposition to atherosclerosis is being actively studied, identified were the genetic variants of genes of blood lipid metabolism, endothelial dysfunction, hemostatic system, and proteins involved in platelet aggregation and thrombosis. An individual «genetic passport» makes it possible to determine the risk factors for atherosclerotic lesions of blood vessels in a specific individual long before the development of the disease. Determination and investigation of groups of genes that are responsible for the development of atherosclerosis in people living in specific areas is still of utmost relevance. Based on these studies it is possible to establish specific test systems for the Republic of Tatarstan for diagnosing predisposition to the development of certain forms of atherosclerosis, the widespread introduction of which will significantly reduce the mortality and disability of the population, the economic and social damage.
Kazan medical journal. 2012;93(4):663-667
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Modern possibilities for correction of disturbances of cellular energetics in ophthalmology
Gazizova I.R.
Abstract
Disturbances in the mitochondrial functions that are responsible for energy metabolism of the cell, plays an important role in the development of many diseases of the eye. Among diseases of the vision organ the one with sufficient evidence of mitochondrial pathology is Leber’s release, which is associated with mutations of the mitochondrial deoxyribonucleic acid. This article provides an overview of the published literature on the research investigations of modern methods and means of correction of mitochondrial dysfunction during inflammatory and neurodegenerative diseases of the eye. Describe were the potential methods of replacement therapy and protection of mitochondria from the aggressive effects of free radicals. With the help of gene technology an increase in the number of antioxidant enzymes in the cells of the retina can be achieved. Recent authors have focused on the possibility of using mitochondria-targeted antioxidants. The possibility of controlling the main links of the apoptotic cascade and reducing the loss of retinal ganglion cells using gene therapy has been investigated in an experiment. Restoration of the balance of calcium and mitochondrial membrane potential in the phenomenon of excitotoxicity has been shown by using calcium channel blockers. We believe that gene therapy of mitochondrial dysfunction is the most promising trend for the correction of cellular energetic disturbances in ophthalmology.
Kazan medical journal. 2012;93(4):668-671
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Regarding the issue of abdominal drainage
Salakhov E.K.
Abstract
The article discusses with main questions regarding drainage of the abdominal cavity, the types of drains and drainage devices. The outcome of surgery on the abdominal organs is largely dependent on effective drainage. There is still debate regarding the drainage techniques, shape and drainage material, indications and frequency of use. In deciding whether abdominal drainage is needed it is necesary to determine the most optimal method, its effectiveness and possible complications. Abdominal drainage is a necessary and important final stage of many operations, and sometimes the primary method of surgical intervention. At the same time, at the time of draining the abdominal cavity it is essential to know about the negative sides of the drainage and complications. There are certain difficulties in assessing the impact of abdominal drainage.
Kazan medical journal. 2012;93(4):671-674
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Epidemiology and healthcare management
The experience of using botulinum toxin in neurological practice in the Republic of Tatarstan
Zalyalova Z.A., Khasanova D.M., Kalashnikova O.S.
Abstract
Aim. To assess the dynamics of botulinum therapy in the treatment of patients with severe disorders of movement in Tatarstan according to the data of the Clinical and Diagnostic Center for Extrapyramidal Pathology and Botulinum Therapy of the Republic of Tatarstan. Methods. Epidemiological, clinical and statistical analysis of the results of using botulinum therapy in the Republic of Tatarstan. Results. During the period 2004-2010 569 people were referred to the Clinical and Diagnostic Center for Extrapyramidal Pathology and Botulinum Therapy. Meanwhile, given the prevalence of major conditions, in which botulinum therapy is indicated, the number of people needing these injections in the Republic of Tatarstan is at least 1514 pe-ople. With the inclusion of botulinum toxin in 2008 to the list of additional drug provision botulinum therapy become more affordable, this being reflected in the statistics of growth of this type of medical care. Over 80% of those in need of care are young patients of working age, able to return to work through regular botulinum therapy. Botulinum therapy in a number of neurological diseases is virtually the only effective means of symptomatic treatment, which reduces the level of disability. Its advantages are not only its high effectiveness, but also the possibility of conducting the procedure on an outpatient basis. Conclusion. Based on the assessment of the dynamics of botulinum therapy it is considered necessary to establish regional programs, which would provide botulinum toxin to patients who are not disabled, but acutely in need of injections.
Kazan medical journal. 2012;93(4):675-677
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Epidemiology of post-traumatic epilepsy in the Republic of Tatarstan
Yarmukhametova M.R.
Abstract
Aim. To conduct a comprehensive study of epidemiological and clinical characteristics of patients with post-traumatic epilepsy among the adult population of three districts of the Republic of Tatarstan. Methods. The study was conducted in 2009 in three districts: Arskiy, and Baltasinskiy Tetyushskiy. Cases of active epilepsy were recorded according to the results of household walkovers, continuous investigation of medical outpatient records in healthcare institutions, registration cards of the calls of the ambulance station. Clinical and neurological examinations, including examination of a neurologist, EEG, and in addition - magnetic resonance and computed tomography were performed in cases of newly diagnosed epilepsy, as well as to confirm the diagnosis. Results. Of the established causes of symptomatic epilepsy the most common one was traumatic brain injury (25.09%), notably in males (n=52, 19.47%) on average three times more frequently than in females (n=15, 5.61%). Most commonly the injuries were seen in the age group 30-49 years (5-6 times more common in men). In 23.88% (n=16) of patients with post-traumatic epilepsy more than 12 attacks per year were registered, in 73,14% (n=49) - 1-12 attacks per year, 2.98% (n=2) patients were in medical remission. 83.58% of patients received monotherapy. The most commonly prescribed medications - valproic acid salt, carbamazepine, topiramate, both as monotherapy and as part of polytherapy. Conclusion. A high prevalence of post-traumatic epilepsy (25.09%) was revealed; an insufficient degree of control of epileptic seizures was noted, which was often due to irrational drug therapy.
Kazan medical journal. 2012;93(4):677-680
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Analysis of population appealability for emergent medical care for cardiac reasons
Paikov V.L., Ishmetov R.P.
Abstract
Aim. To study the structure of appealability of the population for emergency medical care for cardiac reasons, and the conformity between the cardiac cause and diagnosis. Methods. Analyzed was the statistical data of appealability of the population for emergency medical care for cardiac reasons in a large industrial center of the Republic of Tatarstan, city of Kazan. Register cards of ambulance calls for the year 2010 served as materials for the study. Results. It was established that cardiac reasons account for 30% of all adult requests for emergency medical care. The main flow (96.4%) was formed by the primary appeals to the ambulance station, and much less frequently (3.6%) by primarily detectable visits to health institutions for acute forms of ischemic heart disease and arrhythmias. Analyzing the structure of cardiac reasons in nature of the requests for care it was revealed that the proportion of disease with a sudden cardiac profile is 37.1%, with acute care of different profiles - 44.5%, sudden illness of other profiles - 16.5%, other - 1.9%. The proportion of disease with a sudden cardiac profile in the structure of other reasons for seaking medical care is 5.5%. During primary referral to the ambulance station the frequency of diseases with a sudden cardiac profile varies depending on the reason and ranges from 24 to 38.9%. Conclusion. These established features of the analysis of appealability of the population for emergent medical care for cardiac reasons provides the basis for the establishment and improvement of the algorithm of questions to ask the caller of an ambulance and its introduction into the work of the dispatching service, which will increase the frequency of conformity of the cause and diagnosis.
Kazan medical journal. 2012;93(4):680-682
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Hygiene
Modulation of cell life cycle during exposure to phenols
Zaitseva N.V., Dolgikh O.V., Dianova D.G.
Abstract
Aim. To evaluation the life cycle characteristics of cells under conditions of exposure to phenols. Methods. Examined were 128 people: the main group included 90 people with an occupational specialty «insulator», the control group included 39 people with no exposure to industrial hazards. Materials of working environment attestaion, the results of industial control, data of analytical chemical analysis on the content of substances (phenol) in the working area were used. Using a capillary gas chromatograph the content of organic compounds in the blood (phenol, o-cresol, m-cresol, p-cresol) was determined. Phenotyping of lymphocytes was performed by flow cytometry. Populations and subpopulations of lymphocytes (CD3+, CD4+, CD8+, CD19+, CD95+, CD3+CD16+CD56+, CD4+CD25+, CD4+CD25+127-) were determined by membrane immunofluorescence using a panel of labeled monoclonal antibodies. Registration of apoptosis of lymphocytes was performed by determining the expression of phosphatidylserine using annexin V conjugated with fluorescein isothiocyanate. Results. Among those who work in conditions of exposure to phenols (main group) noted were changes in the quantitative and qualitative composition of the cell-lymphocytic link of the immune system. Revealed were signs of activation of the immune system, which is expressed in a significant (p <0.05) increase in the expression of early activation antigens on the immune cells (11.33±0.33%) compared with the control values (7.82±0.39%). At the same time, the number of regulatory lymphocytes (0.81±0.05%) increased with statistical significance (p <0.05), providing suppressive effect on various types of immune cells with respect to the values obtained in the control group (0.55±0.06%). Registered was a significant reduction in the number of markers that characterize apoptotic cell death: the expression of a receptor for the tumor necrosis factor-alpha type I (1.39±0.11%), transcription factor p53 (1.44±0.11%) compared with such in the the control group (3.31±0.27% and 3.42±0.29% respectively, p <0.05). Analysis of the immunograms has demonstrated that those who work in conditions of phenol exposure have significantly (p <0.05) reduced levels of apoptotic (2.17±0.09%) and necrotic (7.69±0.25%) cells with respect to such numbers registered in the control group (apoptotic - 4.77±0.42%, necrotic - 13.06±1.17%). Noted was a statistically significant negative relationship between indicators that determine the activation-induced cell death and the content of phenol in the blood of the main group of examined individuals. Conclusion. Exposition of phenols leads to the development of immune disorders, in particular changes in the quantitative and qualitative composition of the cell-lymphocytic link of the immune system and can induce apoptotic death of immunocompetent cells.
Kazan medical journal. 2012;93(4):683-686
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Clinical observations
Limitations of automated computer electrocardiogram analysis
Oslopov V.N., Sadykova A.R., Fedoseeva T.S.
Abstract
Aim. To draw the attention of physicians to the need for careful analysis of electrocardiograms, especially those obtained by using an automatic analyzer, with the obligatory account of the clinical picture of the disease. Methods. Normal electrocardiography, electrocardiography with the usage of a diagnostic system «Valenta», echocardiography, clinical examination of a patient with fibrosing alveolitis. Results. In the patient with fibrosing alveolitis the automatic analyzer of electrocardiograms «Valenta» misinterpreted the 3S-type of the electrocardiogram as a left anterior fascicular bundle branch block, and the doctor-functionalist did not notice the error. Taking into account the clinical picture of disease and monitoring of the dynamics of electrocardiogram the misinterpretation error was corrected. Presented were the arguments for understanding the pathogenesis of changes in the electrocardiogram in a patient with progressive Hamman-Rich disease. Conclusion. Diagnostic algorithms for automated interpretation of the electrocardiogram have limitations in terms of universal recognition of heart disease; the electrocardiogram report, even in the presence of the auto-interpretation, must be a formulated by a physician taking into account both the clinical picture of the disease as well as other diagnostic methods of patient examination.
Kazan medical journal. 2012;93(4):687-691
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Medical cybernetics
Compilation of medical data in the MS Excel program using the procedure of multifactorial «intermediate outcomes»
Grigor’ev R.A., Akhmetzyanov F.S.
Abstract
Aim. To optimize the compilation of statistical data on oncology patients according to survival and mortality. Methods. Compilation of statistical data by using the multifactorial «intermediate outcomes». Results. A program code has been used from 1990 to the present time to compile statistical data on survival and mortality of patients with gastric cancer operated on at the Kazan City Oncology Dispensary. This code makes it possible to evaluate the sensitivity of selected statistical indicators to the factors specified by the researcher, which makes it possible to regard it as a universal method for analysis of the databases in cases where the number of combinations of factors is large. The method has a high processing speed and reduces the total amount of operator commands. The universality of the program intends the use of its functions to compile the results of iterative calculations. The procedure of multifactor intermediate outcomes was implemented on the basis of MS Excel by means of Visual Basic for Applications. The proposed program of three-factor «intermediate outcomes» serves as a convenient and fast tool for finding relevant factors. Reliability of the analysis of the effectiveness of the treatment strategy for oncology patients increases significantly during application of the proposed program. Conclusion. Testing of the algorithm for analysis of the database of results in medicine and summarizing the results of iterative calculations (for example, a recursive method and the moving window method) and the equations with different combinations of time series in econometrics may indicate the viability of the algorithm as an extremely powerful tool of analysis and generalization of databases.
Kazan medical journal. 2012;93(4):692-698
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History of medicine
The role of faculty of the Imperial Kazan university in the establishment of the Imperial Tomsk university
Kiyasova E.V., Sozinov A.S.
Abstract
In 1888 the first in Siberia Tomsk University was established. The decision regarding its establishment was taken in 1878 by the Russian Emperor Alexander II, but was implemented 10 years later by the Emperor Alexander III. The difficulty in founding the Siberian University was, above all, the hard task of forming the teaching faculty group to work at a distance from the European part of Russia. The crucial role in the establishment of Tomsk University was played the staff members of the Imperial Kazan University. Since Tomsk University was originally established only within the Medical Faculty, the staff members of the Medical Faculty of Kazan University were of the highest demand. The staff members of the Imperial Kazan University played a crucial role in the formation of scientific schools, the educational process and university traditions in Tomsk.
Kazan medical journal. 2012;93(4):699-703
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Obituary
Professor Nataliya Nikolaevna Arkhipova
 
Abstract
Kazan medical journal. 2012;93(4):704
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