Vol 96, No 3 (2015)

Medical and sanitary unit of ISC «Tatneft» and the city of Almetyevsk developmental milestones
Zakirzyanov M.K., Rizatdinov L.K., Yagafarov I.R.
Abstract
Since the beginning of oil industry rapid development in our region in 1952-1957, oil industry specialists from many republics of the Soviet Union arrived. So, a problem of providing the health care services for oil industry workers aroused. Ten prefabricated panel buildings for the district hospital were built in a short time. In 1955, the city had 60 doctors and 172 nurses, 400 beds were available in hospitals. In 2002, medical and diagnostic building was built and set to work, in 2005 office building was renovated, a new surgical building of 7 floors was built in 2007. Since 2008, the medical unit has the status of a regional medical diagnostic center for the residents of the south-east of the Republic of Tatarstan. The effectiveness of the Medical and sanitary unit of JSC «Tatneft» and the city of Almetyevsk is confirmed by the annual increase in the number of treated patients, a decrease in the incidence of temporary disability among industrial workers, increased number of diagnostic manipulations and surgeries. History of the medical unit is intimately linked with the activity of JSC «Tatneft». In a historically short period of 60 years a district hospital of 10 shanty houses has turned into a largest modern medical and diagnostic center in the southeast of the Republic of Tatarstan.
Kazan medical journal. 2015;96(3):278-284
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Theoretical and clinical medicine
Six-year results of the regional medical center department of cardiac surgery
Sibagatullin N.G., Zakirzyanov M.K., Yagafarov I.R., Zakirov I.R., Tenin E.V., Khatypov M.G., Ishmuratova Z.S., Faskhutdinov N.G.
Abstract

Aim. To summarize the experience of the first years of activity in the department of cardiac surgery of the regional medical center.

Methods. 5549 patients with cardiovascular diseases were treated from December 2008 to December 2014, including 3041 patients who underwent surgeries, among them - 1585 vascular interventions, 1128 hearts surgeries. The study included patients operated on the heart and aortic arch, 238 of them had surgeries in 2014 [854 male (75.7%), 274 female (24.3%), aged 22 to 81 years (57.8±8.9)].

Results. Number of performed surgeries was assessed to find out whether it matches with the population needs. For coronary heart disease, 880 patients underwent surgeries, 10 were operated for coronary heart disease complications, 132 - for heart valve disease, 16 - for congenital heart disease, 56 - for combined heart disease, 18 - for aortic aneurysms, 16 - for cardiac tumors, 3 for pulmonary embolism and aortic dissection (type 1). The number of heart surgery using cardiopulmonary bypass in recalculation per 1 million inhabitants in 2014 was 317. Thanks to the active work of the regional medical-diagnostic center, significant progress was made in timely identification and providing specialized care to patients with cardiovascular diseases to meet the population needs in high-tech medical care in the region.

Conclusion. Evaluation of the study results reveals that the introduction of cardiac surgeries for cardiovascular diseases in the regional center promotes approximation of high-tech medical care to the population of remote regions, improves the quality of treatment in patients with cardiovascular conditions.

Kazan medical journal. 2015;96(3):285-294
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Searching for methods to predict septic complications in surgical patients
Zakiev T.Z., Tuysin S.R., Gil’fanov A.R., Sagdiev R.D., Zakieva I.V.
Abstract

Aim. To assess the significance of acute stage reactants as the marker for purulent complications in surgical patients.

Methods. We analyzed the results of treatment of 228 patients with purulent and inflammatory diseases of soft tissues, treated in 2011-2014. Acute phase reactants: C-reactive protein, albumin and fibrinogen were measured starting from the day of admission and surgical treatment and during the next 7 days. The control group (112 patients) included patients whowere treated conventionally by gauze bandage with water-soluble ointments and antiseptic solutions and broad-spectrum antibiotics. In the study group (116 patients) topical treatment of wounds was performed using «Poliderm» bandages.

Results. Application of the «Poliderm» combined dressing reduced the wounds clearance term from 4.3±0.5 to 3.2±0.4 days, active inflammation term from 8.8±1.3 to 6.4±0.7 days, epithelialization of the wound from 10.1±0.8 to 8.4±0.6 days. C-reactive protein level was 87.3±4.3 g/l at the day of admission and decreased by day 7 to 34.13±1.2 g/l, compared to 51.83±3.6 g/l on the 7th day in the control group. Albumin level was 42.73±3.7 g/l in the study group with further decrease to 40.33±1.7 g/l on the 2nd and subsequent increase up to 45.13±1.3 g/l on the day 7. Patients of the control group had albumin level decreased on the 2nd and 3rd days with further increase up to 41.73±2.1 g/l on the day 7. At the treatment start, leukocyte intoxication index was 5.923±0.4 in the main group and 5.873±0.3 in the control group. On the 2nd day, this parameter decreased to 5.12 in the main group and to 5.41 in the control group.

Conclusion. Measuring the levels of acute phase reactants (C-reactive protein, albumin, etc.) allows to assess the clinical course of a purulent and inflammatory disease, to register the good treatment effect on the 1-2nd day of treatment, even before the significant clinical changes, changes in the body temperature, white blood cell counts, erythrocyte sedimentation rate.

Kazan medical journal. 2015;96(3):294-297
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Creating an arteriovenous fistula in patients with chronic kidney disease stage 5
Zakieva I.V., Timerbulatov M.V., Galimov T.R., Tuysin S.R.
Abstract

Aim. Comparative assessment of microsurgical and traditional methods for creating an arteriovenous fistula for long-term hemodialysis in patients with chronic renal failure.

Methods. Results of arteriovenous fistula surgeries for creating arteriovenous fistula for long-term hemodialysis in 169 patients with chronic renal failure in the period from 2008 to 2013 were analyzed. The main group included 87 patients in whom arteriovenous fistula was formed by microsurgery. For fistula thrombosis prophylaxis, 40 mg of nadroparin calcium (fraxiparine) was used in this group after surgery as a postoperative bolus, followed by 7 days subcutaneous administration. Arteriovenous fistula in patients of the main group underwent anti-thrombogenic treatment: paravasal tissues and vessel outside were irrigated by 1% sodium chloride methylthioninium (methylene blue) after the main phase of the operation, followed by lysine acetylsalicylate standard solution after 2 minutes. The control group included 82 patients in whom fistula was created conventionally without using microsurgical techniques. For arteriovenous fistula thrombosis prevention, 5000 IU of sodium heparin was used 4 times a day in patients of the control group.

Results. In the main group, five cases of fistula thrombosis were observed in patients with diabetes mellitus and two in patients with chronic glomerulonephritis. In the control group, arteriovenous fistula thrombosis in the early postoperative period was recorded in 13 patients with diabetes mellitus, in four - with chronic glomerulonephritis, and in one - with polycystic kidney disease. In one (1.15%) patient of the main group and in three (3.66%) in the control group, wound infection associated with inflammatory processes development at the surgical wound was noted.

Conclusion. Microsurgical formation of arteriovenous fistula in patients with terminal stage of chronic kidney disease is the method of choice (especially with concomitant diabetes mellitus), allowing to significantly reduce the risk for arteriovenous fistula thrombosis and therefore reduce the number of unsatisfactory results.

Kazan medical journal. 2015;96(3):298-302
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Studying the processes of free-radical oxidation in patients with purulent-inflammatory diseases of soft tissues
Zakiev T.Z., Tuysin S.R., Galimov O.V., Gil’fanov A.R., Sagdeev R.D.
Abstract

Aim. To study the effects of combined dressings on the processes of free radical oxidation in patients with purulent wounds.

Methods. The performance of luminol-dependent chemiluminescence of whole blood from 30 healthy donors and 122 patients with purulent wounds, as well as tissue chemiluminescence of festering wounds tissue homogenates were examined before and after the treatment. To assess the free radical oxidation in vitro, spontaneous and zymosan-induced whole blood chemiluminescence measurement, iron-induced chemiluminescence assessment of festering wounds tissue homogenates were performed. The distribution of chemiluminescence parameters compared to normal expected distribution was analyzed to group homogeneity on these criteria.

Results. Group of donors was homogeneous in composition that allowed the calculation of mean values. By changing in whole blood chemiluminescence of patients with soft tissue festering wounds, they were allocated to two groups, in which a marked increase or decline of the investigated parameters was seen. Increased luminol-dependent blood chemiluminescence indicates excessive free radicals generation by phagocytes and is characteristic of acute inflammation. Decreased intensity of chemiluminescence was observed in the blood of patients who showed reduced functional activity of phagocytes, which, together with the clinical features indicate a long-term smoldering inflammation. The comparative assessment of «Poliderm», «Voskopran», «Polysorb», «Levomekol» medications, used for local treatment of suppurative wounds, influence on free radical oxidation in model systems in vitro, was performed.

Conclusion. There is a triple increase in chemiluminescence intensity in the acute phase of the inflammatory process, marking increased production of reactive oxygen radicals with microbicide activity); in long-term smoldering processes, chemiluminescence decreases by half, indicating reduced efficiency of protective mechanisms

Kazan medical journal. 2015;96(3):302-306
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Comparative analysis of conventional and video-assisted surgeries on thyroid and parathyroid glands
Khasanshin M.M.
Abstract

Aim. A comparative analysis of conventional and video-assisted operations effectiveness.

Methods. The study included 80 patients were operated from 2010 to 2015 for thyroid and parathyroid glands diseases. The first (main) group included 35 patients who underwent video-assisted surgery. The second group (comparison group) included 45 patients who were operated conventionally. Surgery for thyroid gland diseases included hemithyroidectomy, for diseases of the parathyroid glands - parathyroidectomy in patients with tertiary hyperparathyroidism and adenoma resection in patients with primary hyperparathyroidism.

Results. In video-assisted hemithyroidectomy, mean surgery duration was 42.2±3.6 min, compared to 34.4±2.8 min (p=0.086) in conventional method. Recurrent laryngeal nerve and parathyroid glands were identified in 73% of cases at conventional surgery, compared to 96% at video-assisted hemithyroidectomy (p=0.012). At video-assisted surgeries, no phonation disorders were recorded, while at conventional surgeries they were diagnosed in 7 patients (14.0%, p=0.041). Transient hypocalcemia according to the results of laboratory tests was observed in 1 (3.3%) patients after video-assisted and in 3 (6.0%) patients after conventional surgery (p=0.998). The average length of hospital stay after conventional surgery was 8.1±1.8 days, and after video-assisted surgery - 2.6±1.6 days (p=0.040). Postoperative scar size in the group of video-assisted surgery not exceeded 3 cm, in the group of conventional surgery - up to 7 cm.

Conclusion. With proper selection of patients, particularly with parathyroid gland diseases, are video-assisted surgery might be a method of choice. Using video-assisted surgery in treating patients with thyroid gland diseases allows to identify anatomical structures of the neck in detail.

Kazan medical journal. 2015;96(3):307-310
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Potential humoral markers of gastric and duodenal stress ulcers accompanied by concomitant head injury
Alyev F.I.
Abstract

Aim. To evaluate the significance of a number of humoral indicators in gastrointestinal bleeding at various stages of severe concomitant head injury.

Methods. The study included 347 patients with severe head injuries (brain contusion, intracerebral hemorrhage) associated with fractures of the extremities and pelvis (215 patients), abdominal organs injuries (75 patients), chest and lung injuries (57 patients). Samples of blood and stomach contents were taken on the 1st, 3rd, 5th, 8th, 9th, 12th, 15th and 18th days after the injury. Esophagogastroduodenoscopy was performed on the 3rd, 5th, 7th and 10th day after the trauma. Anti-streptolysin O, antihyaluronidase, C-reactive protein, sialic acids levels were determined by serum titration and precipitate formation.

Results. On the 1st day, anti-streptolysin O level exceeded normal values (by 4.1±1.3 IU/ml), reaching a maximum value by 8-10th day (exceeding the normal range by 61.3±1.7 IU/ml) with further decrease after the 15th day. Antihyaluronidase level was permanently increased from the 5th day of observation. C-reactive protein level was higher than normal from the first day of study (0.1±0.17 mg/l), with further upward trend, reaching its peak on day 9, indicating continuous inflammation. Sialic acids level in the first days was twice as high as the normal level, and remained almost at the same level until the end of the study. Endoscopic examinations in 21 patients with gastrointestinal bleeding showed that in 11 (52.4%) cases, the source of bleeding were acute gastric and duodenal erosions and ulcers, in 5 (23.8%) cases - chronic gastric and duodenal ulcers, in 5 (23.8%) cases bleeding occurred due to exacerbation of chronic duodenal ulcer.

Conclusion. Changes in serum anti-streptolysin O, antihyaluronidase, sialic acids levels in patients with severe head injuries, combined with other injuries may reflect the pathogenesis of acute gastroduodenal erosions and ulcers and be considered as the markers for their development.

Kazan medical journal. 2015;96(3):310-315
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On the possibility of an increased risk of breast cancer in patients who underwent breast surgeries for benign diseases
Klyushkin I.V., Pasynkov D.V., Busygina O.V., Pasynkova O.O.
Abstract

Aim. Assessment of risk of breast cancer secondary to earlier breast surgery for benign disease.

Methods. The initial sample group of breast cancer included 295 patients who were followed up for 2006-2010. The final sample group of breast cancer (for primary analysis) was formed from this group and included 204 patients in order to provide accurate comparison with the control group on factors affecting the breast surgery probability for benign processes for life and on the lifetime risk for breast cancer. The control group included 1141 patients. The rate of surgical interventions for benign breast diseases was compared in the breast cancer group for primary analysis and the control group.

Results. The rate of surgical interventions was significantly higher in breast cancer patients: (7.35 vs. 3.94% in the control group): odds ratio for breast cancer patients was 1.137; 95% confidence interval 0.981-1.318 (p=0.03). Duration of the gap between the initial surgical and subsequent development of breast cancer on operated side was 20.05±11.373 years (variation range - 8 to 54 years).

Conclusion. Performed breast surgery might increase the risk of future developing breast cancer; however, a long-term study is needed to confirm these data.

Kazan medical journal. 2015;96(3):316-321
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Contour analysis of mammographic images in benign and malignant breast diseases
Pasynkov D.V., Klyushkin I.V., Busygina O.V.
Abstract

Aim. Development and evaluation of the diagnostic value of techniques for quantitative analysis of masses on mammographic images satisfying the requirements of categories 2-4 in BIRADS (Breast Imaging Reporting And Data System - the system for classification and description of breast imaging results of the American College of Radiology).

Methods. Images of 375 focal lesions revealed on mammography (211 malignant and 164 benign, all were verified morphologically), satisfying the criteria 2-4 according to BIRADS classification, were analyzed. Mathematical processing was performed using the MammCheck 1.15 software package developed by authors, which uploads the obtained images. Contour, segments of area, peripheral outlines, homogeneity and inner outlines indexes were calculated.

Results.The statistical analysis of foci at standard mammography images of BIRADS 2-4 categories revealed no statistically significant difference in all four estimated parameters. When using tomosynthesis images, statistically significant difference was discovered in the outline index in the groups of benign and malignant foci (mean ± standard deviation: 1.73±1.11 vs. 3.11±2.02, respectively, p

Conclusion. Outline analysis of mammograms, including those obtained using tomosynthesis, does not provide the necessary level of specificity for the differential diagnosis of benign and malignant microcalcifications and clusters.

Kazan medical journal. 2015;96(3):322-325
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Primary percutaneous coronary interventions in patients with ST-segment elevation myocardial infarction complicated by «no-reflow» phenomenon
Iskhakov M.M., Sayfullin R.R., Yagafarov I.R., Khatypov M.G., Gazizov N.V., Nugaybekova L.A., Sayfutdinov R.G.
Abstract

Aim. To study the association of «no-reflow» phenomenon incidence and the method of primary percutaneous coronary intervention for ST-segment elevation acute myocardial infarction, and to determine the optimal tactics for primary coronary intervention.

Methods. A retrospective analysis of 1339 cases of primary percutaneous coronary intervention for ST-segment elevation myocardial infarction performed in the period from January 2008 to June 2013 was executed. Depending on surgery method, all the patients were allocated to four groups: first group - direct stenting (n=483); second group - thromboaspiration before stenting (n=142); third group - balloon angioplasty and stenting using a small-diameter balloon ≤2.0 mm (n=491); fourth group - balloon angioplasty and stenting using a small-diameter balloon and subsequent use of medium and large-diameter balloons ≥2.0 mm (n=223).

Results. «No-reflow» phenomenon was observed in 164 (12.2%) of cases, incliding 34 (7.0%) cases in the first group, 12 (8.4%) cases in the second group, 53 (10.8%) cases in the third group, and with the majority of cases seen in the fourth group - 65 (29.1%). At primary percutaneous coronary intervention, the following incidence of «no-reflow» phenomenon was observed depending on the infarct-related artery: left anterior descending artery - 85 cases (51.82% of the total number), right coronary artery - 51 (31.09%) cases, circumflex artery - 28 (17.07%) cases, and diagonal branch - 1 (0.6%) case.

Conclusion. In primary percutaneous coronary intervention with direct stenting and thromboaspiration before stenting, the incidence of «no-reflow» phenomenon is significantly lower. Patients who undergo primary percutaneous coronary intervention preceded by repeated balloon angioplasty using medium and large-diameter balloons are at higher risk for «no-reflow» phenomenon.

Kazan medical journal. 2015;96(3):325-329
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Regional experience of acute coronary syndrome surgical treatment
Yagafarov I.R., Sibagatullin N.G., Zakirov I.R., Tenin E.V., Ishmuratova Z.S., Faskhutdinov N.G., Sayfullin R.R., Bikchantaev A.A.
Abstract

Aim. To summarize the experience of surgical myocardial revascularization in acute coronary syndrome.

Methods. The study included 72 patients with acute coronary syndrome who underwent coronary artery bypass grafting in the department of cardiac surgery. All patients were allocated to 3 groups depending on the urgency and the risk of intervention: first group - emergency coronary artery bypass grafting; second group - urgent coronary artery bypass grafting in patients at high risk of adverse events; third group - delayed coronary artery bypass grafting in patients at low risk of adverse events.

Results. On-pump coronary artery bypass grafting was performed in 2 (25%) patients, off-pump coronary artery bypass grafting - in 6 (75%) patients, including 3 patients who were operated using parallel off-pump coronary artery bypass grafting technique. Positive clinical results were achieved in all patients. Patients with high risk for adverse events (n=55) underwent surgery in a period of 1 to 10 days from onset of disease (average delay was 4.3±2.6 days). Surgeries using extracorporeal circulation were performed in 39 (71%), including off-pump coronary artery bypass grafting - in 16 (29%), of whom 9 patients underwent parallel off-pump coronary artery bypass grafting. Intra-aortic balloon pump was used in 4 patients. Unfavorable outcome in this group was registered in 10 (13.8%) cases. Patients with a low risk of adverse events (n=9) underwent coronary artery bypass grafting after 10 days from the onset of the disease. All patients were operated using extracorporeal circulation. Unfavorable outcomes were not registered in that group.

Conclusions. A decision to perform coronary artery bypass grafting in patients with acute coronary syndrome with ST elevation is made when it is impossible to perform coronary angioplasty due to the isolated and combined stenosis of left main coronary artery and other arteries of the heart. Coronary artery bypass grafting in patients with acute coronary syndrome associated with a high risk for adverse events should be performed as an emergency intervention using intra-aortic balloon pump. Off-pump coronary artery bypass grafting is associated with a lower risk of adverse events, require little or no blood transfusion, and reduce hospital stay.

Kazan medical journal. 2015;96(3):330-334
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Optimizing cardioplegia in cardiopulmonary bypass surgeries
Yagafarov I.R., Tenin E.V., Sibagatullin N.G., Zakirov I.R., Yagafarova L.F., Khatypov M.G., Bikchantaev A.A.
Abstract
Aim. To investigate the influence of intentional cardiac arrest before cardioplegic solution infusion on cardioplegia quality and myocardial protection. Methods. We propose a method for optimizing cardioplegia, allowing to achieve asystole and pharmacologically prepare the myocardium to aortic clamping. The developed method uses systemic and intracoronary administration of adenosine triphosphate and lidocaine to cause asystole, which gives rapid and effective cardioplegic effect without threatening hypertension in coronary arteries. The described method was used in 724 patients who underwent surgery in the period from 2008 to 2013. Normothermic perfusion mode - without myocardial cooling with ice-slush - was used in all cases. Results. Cardiac activity restored spontaneously in 89.7% of cases, manifestations of reperfusion syndrome were negated, frequency and duration of inotropic support were significantly reduced, no serious arrhythmias, like AV block, ventricular tachyarrhythmias and extrasystoles were registered. The described method creates the conditions for sinus rhythm reversion in patients with atrial fibrillation, given the favorable anatomical and physiological conditions (heart chambers volume, duration and type of atrial fibrillation). Conclusion. The described method allows optimizing the surgical stage after standard pharmacological cardioplegia, provides more efficient cardioplegic solution delivery to the myocardium, which is especially important in patients with coronary artery disease, as well as parmacological preconditioning of myocardium before a long period of ischemia and thus to improve the clinical course of post-ischemic period
Kazan medical journal. 2015;96(3):334-337
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Long-term results of eversion surgeries for internal carotid artery stenosis due to atherosclerosis
Zakirov I.R., Yagafarov I.R., Khatypov M.G., Sibagatullin N.G., Zakirzyanov M.K., Faskhutdinov N.G., Gaysin R.F., Bikchantaev A.A., Nadyrova M.N., Matveeva D.V.
Abstract

Aim. Analysis of long-term results of eversion carotid endarterectomy in patients with atherosclerotic carotid stenosis.

Methods. 272 eversion carotid endarterectomy surgeries was performed from June 2008 to December 2014 in the department of cardiac surgery. Long-term results were studied in 198 (73%) patients, with follow-up term ranging from 6 to 48 months. The method of operation serves as a criterion separating Patients were allocated into two groups by the surgery method: in the first group, eversion endarterectomy was performed by Kieny, in the second - by DeBakey.

Results. Reconstructed ipsilateral internal carotid artery was passable during the follow-up period in 100% of cases, as confirmed by ultrasonography. In the late period, the mortality in the first group was 2.3% (myocardial infarction and cancer), compared to 1.5% in the second group (myocardial infarction). Acute ischemic stroke occurred in 0.8% of the first group patients and in 1.5% of the second group patients. Restenosis of 50 to 69% were discovered in 3.7% of cases in first group and in 3% in the second group. Restenosis ≥70% were found in 1.5% in both groups of patients.

Conclusion. The obtained data confirm that both methods of eversion carotid endarterectomy are safe and reliable in treatment of carotid arteries atherosclerosis and, thus, preventing stroke.

Kazan medical journal. 2015;96(3):337-340
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Gender differences in effect of ischemic preconditioning in patients with congestive heart failure
Khayrullina S.G., Sayfutdinov R.G., Maleev M.V.
Abstract

Aim. To estimate the gender differences in effect of ischemic preconditioning in patients with congestive heart failure.

Methods. 80 patients (40 males, 40 females) with congestive heart failure of stages I, IIA and IIB aged 36 to 78 years were examined.

Results.Score model for myocardium ischemic preconditioning assessment in patients with congestive heart failure was introduced. The phenomenon of ischemic preconditioning was most often in patients with chronic heart failure stage I compared to stages IIA and IIB (p

Conclusion. The effect of ischemic preconditioning might be used as one of the factors for myocardial protection at congestive heart failure.

Kazan medical journal. 2015;96(3):341-348
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Changes in gepatopancreatobiliary system organs and quality of life in patients after cholecystectomy
Mitusheva E.I., Sayfutdinov R.G., Shaymardanov R.S., Badretdinova A.R.
Abstract

Aim. To assess the condition of hepatopancreatobiliary system and quality of life in patients in the remote period after cholecystectomy.

Methods. 88 patients with cholelithiasis who undergone cholecystectomy in 2008-2010 were examined 5 years after the surgery. Common blood count, blood biochemistry test were performed, fasting blood glucose level was measured, esophagogastroduodenoscopy, ultrasonic examination of abdominal organs, fractional duodenal intubation, fecal elastase test (ELISA, «BioServ Diagnostics», Germany) were performed. Patients filled out questionnaires to assess the quality of life: MOS SF-36 (Medical Outcomes Study Short Form), GIQLI (Gastrointestinal Quality of Life Index) before, 1 and 5 years after cholecystectomy.

Results. According to the esophagogastroduodenoscopy, 56 (63.6%) patients had duodenal reflux, 21 (23.8%) - duodenal diverticula, 9 (10.2%) - reflux esophagitis. Reduced fecal pancreatic elastase-1 was detected in 37 (42%) of patients. According to the fractional duodenal intubation, hypersecretory type was the most prevalent, 40 (45.5%) patients had hypotonic sphincter of Oddi, 48 (54.5%) - hypertonic sphincter of Oddi. All patients had crystals of calcium bilirubinate, leukocytes and bacteria in bile, microliths were identified in 76 (86%) of patients. After emergency surgery, quality of life increased by all indicators, after planned cholecystectomy for asymptomatic cholelithiasis the quality of life decreased 1 and 5 years after cholecystectomy. After planned cholecystectomy for symptomatic cholelithiasis, the surgery improved quality of life, but after 5 years indicators for quality of life returned to preoperative levels.

Conclusion. Various changes in hepatopancreatobiliary system organs are detected in patients after cholecystectomy, like disorders of bile formation and biliary excretion, sphincter of Oddi dysfunction, decreased function of the pancreas, which reduce the quality of life.

Kazan medical journal. 2015;96(3):348-353
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Bile acids serum levels in patients with nonalcoholic fatty liver disease
Minnullina Z.S., Kiyashko S.V., Ryzhkova O.V., Sayfutdinov R.G.
Abstract

Aim. To estimate the blood levels of primary, secondary, tertiary and unconjugated bile acids in patients with non-alcoholic fatty liver disease.

Methods. The study included 74 patients with non-alcoholic fatty liver disease (males - 30, females - 44) and 51 healthy individuals (males - 14, females - 37). All patients underwent anthropometry and complete clinical, biochemical and instrumental examination (measuring the subcutaneous fat layer). 64 patients had hepatic steatosis, 10 - steatohepatitis. Serum levels of bile acids (primary: cholic, chenodeoxycholic; secondary: lithocholic, deoxycholic and tertiary: ursodeoxycholic) were measured by gas-liquid chromatography on «Chromos GC-1000» (Russia) scanner.

Results. Unconjugated primary, secondary and tertiary bile acids were detected in the blood of healthy individuals and patients with non-alcoholic fatty liver disease. In healthy individuals, there were no gender differences found in the bile acids levels. Patients with non-alcoholic fatty liver disease had higher level of bile acids compared to healthy controls. There was a significant difference in the concentrations of secondary and tertiary bile acids in patients with hepatic steatosis and steatohepatitis.

Conclusion. Blood bile acids levels were significantly higher in patients with non-alcoholic fatty liver disease than in healthy individuals. At steatohepatitis, females had higher levels of cholic, chenodeoxycholic and deoxycholic acids and lower levels of lithocholic and ursodeoxycholic acids compared to males. Significant difference in patients with hepatic steatosis and steatohepatitis was revealed only in levels of secondary and tertiary bile acids.

Kazan medical journal. 2015;96(3):354-358
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Evaluation of the level of glycoproteins in the vitreous body in degenerative diseases of the retina
Altynbaev U.R.
Abstract

Aim. A comparative assessment of fibronectin and laminin levels in the vitreous body in patients with idiopathic macular hole, epimacular fibrosis and age-related macular degeneration.

Methods. Glycoprotein levels were measured in the vitreous body of 63 patients aged 56 to 81 years (65±2.8 years). The first group included 24 patients with idiopathic macular hole, second group - 14 patients with epimacular fibrosis, third group - 15 patients with the wet form of age-related macular degeneration. The control group included 10 patients with contusion dislocation of the lens into the vitreous body without signs of retinal pathology.

Results. Laminin level in the vitreous body in patients of the control group was 0.71±0.03 mg/ml, fibronectin level - 34±5.5 mg/ml, no association of these parameters with patients’ age and sex was revealed. Laminin and fibronectin levels in vitreous body of patients with idiopathic macular hole were 0.8±0.23 and 32.8±2.1 mg/ml, respectively, in patients with epimacular fibrosis - 0.8±0.23 and 32.0±0.53 mg/ml, respectively, and in patients with wet form of age-related macular degeneration - 0.9±0.25 and 33.0±1.65 mg/ml, respectively. Strong direct association between laminin level in the vitreous body and retinal thickness was revealed in patients with idiopathic macular hole and epimacular fibrosis.

Conclusion. The link between the retinal thickness and laminin level might indicate the involvement of laminin in degenerative changes of the retina on the level of vitreoretinal interface and inner retinal layers.

Kazan medical journal. 2015;96(3):358-360
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Differential diagnosis of hemangiomas and other orbital masses
Altynbaeva L.R., Serezhin I.N., Akchurina R.A.
Abstract

Aim. To determine the differential diagnostic scintigraphic signs of hemangiomas and malignant tumors of the orbit.

Methods. Comprehensive survey of 35 patients with orbital masses included a standard eye examination, ultrasound Doppler sonography, computed tomography or magnetic resonance imaging, scintigraphy using in vivo labeled 99mTs erythrocytes, and morphological study.

Results. Scintigraphic studies using in vivo labeled 99mTs erythrocytes in 18 patients with hemangioma of the orbit, no accumulation of radiotracer in the dynamic phase of the study was observed. On the subsequent delayed planar scintigraphy and single-photon emission computerized tomography, intense delayed hyperfixation of in vivo labeled 99mTs erythrocytes in the lesion was revealed. In 8 patients with malignant orbital tumors (adenocarcinoma of the lacrimal gland - 4, osteogenic sarcoma - 1, olfactory neuroblastoma - 1, metastasis of renal cancer in orbit - 1) there was an intense accumulation of labeled erythrocytes in the projection of the affected area in all phases of the nuclear study. In patients with adenoma of the lacrimal gland, cranioorbital meningioma, orbital pseudo tumor, as well as in 1 patient with lacrimal gland adenocarcinoma, no pathological accumulation of in vivo labeled 99mTs erythrocytes in the lesion was observed at any stage of the study.

Conclusion. According to the results of scintigraphic studies: (1) patients with orbital hemangioma had no accumulation of in vivo 99mTs labeled red blood cells in the vascular (dynamic) phase of the study and had hyperfixation of radiotracer in delayed planar scintigraphy and single-photon emission computerized tomography; (2) intensive accumulation of labeled 99mTs erythrocytes in tumor vascular (dynamic) phase of the study as well as in delayed planar scintigraphy and single-photon emission computerized tomography was characteristic of malignant neoplasms with hypervascularization.

Kazan medical journal. 2015;96(3):361-364
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Morphological features of choroidal neovascular membranes in age-related macular degeneration complicated by high pigment epithelial detachment
Altynbaev U.R., Lebedeva O.I.
Abstract
Aim. To study the morphological features of choroidal neovascular membranes in patients with wet age-related macular degeneration, complicated by high pigment epithelial detachment. Methods. The study enrolled 10 patients with wet age-related macular degeneration, who underwent vitrectomy with choroidal neovascular membranes removal, including 4 patients with occult choroidal neovascularization and 6 patients with classic choroidal neovascular membrane. Results. Histologic pattern consisting of pigmented epithelium cells layer with Bruch’s membrane, fibrovascular membrane, photoreceptors segments layer and, in some of the cases, choroid fragments, was discovered in tissue specimens of patients with classic choroidal neovascular membrane. Histologic pattern of choroidal neovascular membrane in patients with occult choroidal neovascularization also consisted of pigment epithelium cells layer with Bruch’s membrane, fibrotic neovascular membrane itself and photoreceptors segments layer. Pigment epithelium cell layer, in contrast to the control group, had apparent signs of hyperplasia. Average thickness of pigment layer of the retina was 16.08±4.64 μm in patients with high pigment epithelial detachment, by 30% higher compared to the control group (11.22±3.38 μm, р <0.05). Mean Bruch’s membrane thickness was 6.7±0.19 μm in the main group, which also exceeded the similar values in the control group (5.7±3.8 μm, р <0.05). Histochemical studies revealed qualitative differences between the study groups in the levels of collagen types I and III. Glycosaminoglycans, in contrast, were detected only in the group with classic choroidal neovascular membrane. Conclusion. In patients with occult choroidal neovascular membrane complicated by high pigment epithelial detachment, Bruch’s membrane thickening was found due to collagen type 1 deposits on the outer surface, which caused a local hydrodynamics alterations and influences the bioavailability of medications.
Kazan medical journal. 2015;96(3):364-368
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Evaluation of the presence and localization of P2 receptors in human blood vessels
Ziganshin B.A., Slavin D.A., Khaziakhmetov D.F., Ziganshina A.P., Slavin L.E., Dzhordzhikiya R.K., Ziganshin A.U.
Abstract

Aim. To study the presence and localization of the P2X and P2Y receptor subtypes in the human cystic artery and great saphenous vein (with and without varicose disease).

Methods. Segments of the human blood vessels were stained using a standard two-step immunohistochemical analysis using primary and secondary antibodies. In the experiments primary antibodies to the following receptors were used: Р2Х1, Р2Х2, Р2Х3, Р2Х4, Р2Y1, Р2Y2, Р2Y4. In order to determine the presence of a receptor in a vessel sample a comparison was made between staining of the experimental and the control samples, which were not treated with primary antibodies.

Results. Immunohistochemical analysis of the cystic artery showed the presence of Р2Х1, Р2Х3, Р2Y1, Р2Y2 receptors. All receptor subtypes were found to be located in the muscular layer of the artery, whereas the P2Y1 receptor was also expressed on the surface of the endothelial cells. In the great saphenous vein without varicose disease Р2Х1, Р2Х2 и Р2Y1 receptor subtypes were identified, all of which were found to be located on the smooth muscle cells of the vein. Similarly to the cystic artery, the Р2Y1 receptor was also found within the endothelial layer of the vein. At the same time, only Р2Х2 и Р2Y1 receptor subtypes were expressed in the muscular layer of the great saphenous vein affected by varicose disease. No P2 receptor subtypes were identified on the endothelial layer of the varicose-diseased vein.

Conclusion. Different P2 receptor subtypes were found to be present in the smooth muscle and endothelial layers of the human cystic artery and great saphenous vein. The identified differences in the receptor subtypes between samples of great saphenous veins with and without varicose disease are, most likely, explained by the restructuring of the receptor apparatus as a result of varicose disease progression.

Kazan medical journal. 2015;96(3):368-376
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Clinical observations
Treating the patient with acute rupture of penetrating atherosclerotic ulcer of the thoracic aorta
Yagafarov I.R., Sayfullin R.R., Iskhakov M.M., Gazizov N.V., Khatypov M.G., Zakirov I.R., Sibagatullin N.G., Sayfutdinov R.G.
Abstract
Spontaneous rupture of the aorta - a violation of the integrity of the aortic wall which is not caused by an aneurysm, trauma, dissection or disintegrating tumor process, and is an acute life-threatening condition. According to some authors, the main cause of spontaneous rupture of the aorta is a penetrating atherosclerotic ulcer of the aorta, which is an ulceration of aortic atherosclerotic plaque leading to penetration of the internal elastic plate in media. We present a case of successful hybrid surgical treatment of patient with spontaneous rupture of the descending thoracic aorta with the formation of para-aortic hematoma and left-sided hemothorax. The patient underwent a hybrid operation - aortic arch and descending thoracic aorta prosthetic repair, subclavian bypass with left subclavian artery ligation, left-sided thoracotomy, and pleural cavity sanitation. No intraoperative complications were observed, the patient was taken off the ventilator on day 2. The control computed tomography performed on day 10, revealed correct and stable stent graft position with no signs of continued bleeding, endoleak. The patient was discharged in satisfactory condition on day 14. Due to the high hospital mortality of open surgery on the thoracic aorta in case of penetrating atherosclerotic ulcers, as well as the predominance of elderly patients with severe comorbidities that contraindicate open surgery using cardiopulmonary bypass, endovascular and hybrid technologies, which are minimally invasive and traumatic, come to the fore. Endovascular prosthetic repair in case of penetrating atherosclerotic ulcer of aortic arch and descending thoracic aorta is an effective and safe procedure in patients at high risk, showing encouraging long-term results.
Kazan medical journal. 2015;96(3):377-380
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Reviews
Modern radionuclide methods in diagnosing orbital masses
Altynbaeva L.R., Gabdrakhmanova A.F.
Abstract
Anatomic and topographic features of orbit structure and similar clinical symptoms in many diseases of different etiologies explain the complicated early diagnosis of orbital diseases. Therefore, the diagnostic algorithm for orbital masses is mainly based on instrumental diagnostic methods, especially radiology. Over the past 20-30 years, radiologic diagnosis of orbital tumors took a step forward thanks to the introducing such methods as computer tomography, magnetic resonance imaging and ultrasound into clinical practice. However, these methods of investigation, despite their great diagnostic possibilities, not always allow to obtain objective information on the tumor biology, tumor malignancy grade and characteristics of their metabolism. A significant step forward in this direction was the development and introduction of modern nuclear medicine techniques such as single photon emission computed tomography and positron emission (two-photon) tomography into clinical practice. These methods allow to visualize the functional processes in normal conditions and to perform a kind of non-invasive biopsy in case of neoplastic disorders. The use of nuclear medicine in oncology is based on hyperfixation of some radiopharmaceuticals in malignant tumors that provides important data for diagnosis and differential diagnosis based on the study of physiological and biological tumor features. The review highlights brief historical facts, as well as the results of using the most informative and safe radiopharmaceuticals. Literature analysis concludes that radionuclide tests at some point might be a method of choice for differential diagnosis of orbital masses.
Kazan medical journal. 2015;96(3):381-384
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Modern approaches to abdominal drainage in diffuse peritonitis
Salakhov E.K., Salakhov K.K.
Abstract
An overview of domestic and foreign literature reflecting modern approaches to abdominal drainage in diffuse peritonitis is presented. Materials and methods of drainage are described, the results of some randomized clinical trials exploring the effectiveness of abdominal drainage are analyzed. This medical manipulation is one of the first methods of debridement, which does not lose importance to this day, despite a long history. Drains reduce and inhibit the antibacterial and absorbent function of the peritoneum. At this stage, silicone drains, known for flexibility, durability and the possibility of long-term use are widespread. Use of drainages is limited in time, as they are not biologically inert and become bounded from the abdominal by adhesions and fibrin deposits. So far, there are heated debates about how to drainage, drainage installation method, frequency of use and indications. Good performance of the drainages can be achieved only if they function constantly, like in abdominal dialysis. Of course, this does not mean that drains should not be used in treatment of peritonitis, but they should be placed under strict indications. Thus, despite the large experience, the question of the abdominal drainage utility at peritonitis remains open, as currently applied improved methods for drainage have several disadvantages and the use of any method is often controversial. The development of new, highly effective methods of abdominal cavity debridement in peritonitis is an actual task, especially at the present stage of medical technologies development.
Kazan medical journal. 2015;96(3):385-390
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«No-reflow» phenomenon: clinical aspects of reperfusion failure
Iskhakov M.M., Tagirova D.R., Gazizov N.V., Nugaybekova L.A., Sayfutdinov R.G.
Abstract
«No-reflow» phenomenon is the most striking example of myocardial reperfusion clinical failure. It is caused by a lack of adequate blood flow in tissues after successful recanalization of infarct-related artery and is of multifactorial nature. The main reason for «no-reflow» is microvascular damage, of both structural and functional nature. Microvascular microemboli formation is also of particular importance in developing this phenomenon. In patients with acute coronary syndrome undergoing thrombolysis, percutaneous coronary intervention or coronary artery bypass surgery, the risk for «no-reflow» is about 30% or more. In case of planned endovascular interventions, «no-reflow» prevalence ranges from 0.3 to 2%. Patients with «no-reflow» have highly increased risk of complications such as reduced systolic function, heart muscle remodeling, dilatation, cardiac chambers hypertrophy/hyperplasia, left ventricular aneurysm etc. In addition, «no-reflow» increases the risk of death. Predisposition for «no-reflow» might be associated with a number of local and systemic factors. For diagnosing this phenomenon, angiographic grading of coronary blood flow restoration (Thrombolysis in Myocardial Infarction - TIMI) and myocardial perfusion (Myocardial Blush Grade - MBG) is recommended. For the most accurate «no-reflow» diagnosis, different methods for myocardium visualization might be used. The most studied treatments of ongoing «no-reflow» are: vasodilators administered intracoronary (verapamil, adenosine, sodium nitroprusside) at percutaneous coronary intervention or coronary artery bypass surgery; systemic antiplatelet agents; mechanical protection from distal embolization. Given the multifactorial nature of the «no-reflow», further search for the novel methods for prevention and treatment of this phenomenon is needed.
Kazan medical journal. 2015;96(3):391-396
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Oral complications of radiotherapy: approaches to prevention and treatment
Zurnachyan A.A.
Abstract
The use of high-energy radiation sources covering large areas of head and neck, together with increased chances for clinical recovery leads to increased rates of radiation complications - a variety of changes in the surrounding healthy tissues and organs. One of the most common oral mucosa complications of radiation therapy is radiation mucositis. Its pathogenesis is based on developing erythematous lesions that turn into ulcer defects with a trend of merging to form an increasingly large focuses. After reaching its peak, inflammatory reaction regresses. The incidence of radiation mucositis is over 60% at standard mode radiotherapy and nearly 100% at hyperfractionated radiotherapy. In addition to the pecularities of radiotherapy, the incidence of mucositis also depends on the tumor type, patient’s age, the initial state of the oral cavity, the patient’s nutritional status. Cryotherapy using a helium-neon laser and drugs (pentoxifylline, thalidomide, simvastatin, analgesics, anesthetics) are recommended for treatment. Reducing the procedure time by improving medical technology, using pulsed fluoroscopy instead of constant, using additional protective filters and changing the X-ray beam focus site may significantly reduce the frequency of radiation complications.
Kazan medical journal. 2015;96(3):397-400
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Healthcare mangement
Medical and sanitary unit of JSC «Tatneft» - an example of effective public-private partnership
Zakirzyanov M.K., Yagafarov I.R., Sibagatullin N.G., Kharisov R.R., Bakirov A.G.
Abstract

Aim. To present the experience of the regional medical diagnostic center of Medical and sanitary unit of JSC «Tatneft» and the city of Almetyevsk, considering timeliness, availability and quality of high-tech medical aid.

Methods. This paper presents an analysis of high-tech medical care provided to patients with cardiovascular diseases in the private hospital under the state order. A retrospective analysis of the high-tech medical aid of «interventional cardiology» and «cardiovascular surgery» sections provided in 2009-2014.

Results. Analysis of the results for the last 5 years showed an annual increase in the number of ongoing research and surgeries in the areas of «interventional cardiology and arrhythmology», «cardiovascular surgery». Hospital mortality from myocardial infarction in Medical and sanitary unit of JSC «Tatneft» and the city of Almetyevsk in the last 3 years did not exceed 9%. Actively launched «Hybrid Surgery» project allowed to perform complex operations on the aorta and aortic valve in patients with a high risk at open surgery. «Electronic out-patient clinic», the system for data management, is introduced at the medical and sanitary unit, allowing to abandon paper outpatient charts, simplify and accelerate the work of outpatient services. Information-analytical system of the Ministry of Health of the Republic of Tatarstan allows electronic records for performed interventions, following up outpatients who underwent surgeries, timely providing them with preferential drugs through local outpatient clinics. Electronic data management increased the quality of the medical aid, improved its availability and provided better control. Surgical and endovascular treatment of patients with coronary artery disease, hybrid surgery, arrhythmology are the most promising areas in the healthcare development in the southeast of the Republic.

Conclusion. Medical and sanitary unit of JSC «Tatneft» and the city of Almetyevsk is an example of effective public-private partnership, using the funding from the state budget of the Republic of Tatarstan and «Tatneft» for completing the state order on providing high-tech medical aid to patients with cardiovascular diseases.

Kazan medical journal. 2015;96(3):401-406
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Transfusiology of the XXI century: problems, goals, future perspectives
Managing platelets bank in the regional blood supply service
Zarubin M.V., Zaznobov M.E., Kurnosov N.V., Kaporskaya T.S., Kiselev I.V., Zhiburt E.B.
Abstract

Aim. To develop the system of regional management of platelets bank based on the analysis of platelet concentrate supplies to Irkutsk region healthcare facilities.

Methods. Irkutsk Regional Blood Transfusion Center expedition service reporting forms, branch statistical reports, accounting records of blood supply service facilities of Irkutsk Region for 2014 were analyzed.

Results. To ensure the proper supply of Irkutsk region healthcare facilities with platelet concentrate, the main activities for stock management were determined: (1) key customers interaction management - by exploring the need for platelets and developing a mechanism for request planning for the next 7-9 days; (2) advance request execution - by donor acquisition, platelet concentrate production management, interaction with other institutions of the blood supply service; (3) platelet donation campaign. Regional management system for platelet stock was developed.

Conclusion. Regional management system for platelet stock consists of 7 elements: (1) constant interaction with key customers: daily monitoring of healthcare facilities’ needs for platelet concentrate and planned advance requests for platelet concentrates; (2) anticipatory appointments for donors for platelet apheresis; (3) formation of platelet donors registry; (4) providing pediatric dosages of platelet concentrates for pediatric healthcare facilities; (5) combination of different ways of platelet concentrates preparation (production of platelet concentrates recovered from regular blood donors blood allows to create a «safety net» for emergencies); (6) arranging the planned production of platelet concentrates for Irkutsk at the branches of Irkutsk Regional Blood Transfusion Center, as well as in other Irkutsk Region regional blood supply service facilities; (7) promotion of platelet donation in blood supply service facilities.

Kazan medical journal. 2015;96(3):407-413
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Introduction of NAT-testing for infections for screening blood donors in Republic of Kazakhstan
Savchuk T.N., Burkitbaev Z.K., Abdrakhmanova S.A., Skorikova S.V., Kuz’min N.S.
Abstract
Aim. To evaluate the effectiveness of NAT-screening (nucleic acid amplification technologies) for infections in blood donors in Kazakhstan. Methods. Statistical data of blood donors screening examinations in the Republic of Kazakhstan in 2012-2014 were evaluated. Results. In 2014, the number of examined donors increased by 3.4% compared with 2012. The number of deferrals due to positive screening results for serological markers decreased by 10.9%, while the share of such donors decreased by 13.8% [p <0.01; odds ratio (OR) - 0.86, 95% confidence interval (CI 95%) - 0.83-0.88); χ2=136.76]. In 2014, 100% of donations were screened using NAT-testing (312,510 donors). Most of the NAT-screening in Kazakhstan is performed using closed automated systems. In 2012, 1 Blood Center conducted a polymerase chain reaction screening by open circuit polymerase chain reaction systems, in 5 blood centers polymerase chain reaction was performed with manual sample preparation. In 2014, the number of deferrals due to positive NAT-testing results has increased by 44.3%, the share of such donors - by 38.7% (p <0.01; OR=1.39, 95% CI=1.15-1.67); χ2=11.82). Seronegative NAT-positive samples were discovered according to the results of discriminant test, including human immunodeficiency virus - 2 (0.8%) samples, hepatitis B virus -182 (73.4%), hepatitis C virus - 60 (24.2%), negative result - 4 (1.6%). Conclusion. The introduction of screening NAT-testing of donated blood prevented transfusion of blood infected with: human immunodeficiency virus - 1 in 150,000 donations, hepatitis B virus - 1 in 1.650 donations, hepatitis C virus - 1 in 5,000 donations.
Kazan medical journal. 2015;96(3):414-417
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Major histocompatibility complex genetic variants in potential hematopoietic stem cells donors in Republic of Kazakhstan
Burkitbaev Z.K., Raisov S.D., Turganbekova A.A., Ramil’eva I.R., Yakiyaeva D.U., Baymukasheva D.K., Abdrakhmanova S.A., Zhiburt E.B.
Abstract

Aim. To compare the prevalence of HLA-system antigens genetic variants in potential hematopoietic stem cells donors in Kazakhstan and worldwide.

Methods. Prevalence of HLA-antigens genetic variants in blood samples of potential hematopoietic stem cells donors included in hematopoietic stem cells donors register of Kazakhstan was analyzed and compared to a «Allele frequencies in Worldwide populations» database developed by the Royal Liverpool University Hospital.

Results. The biggest overlap of Kazakhstan and World registers was seen in the distribution of 31-01 allele: 68 (4.5%) in Kazakhstan register, 1678 (4.63%) worldwide; odds ratio (OR) = 0.97 (0.76 to 1.24), F=0.851441, χ2=0.06. The biggest difference between the two registers was found in the distribution of locus A antigens: A 02-01 (χ2=24.59), A 02-07 (χ2=24.42), A 32-01 (χ2=27.1), A 02-37 (χ2=23.96), A 11-38 (χ2=3.96). In locus B alleles, the biggest overlap between the two comparison groups was in В 14:02 allele: Kazakhstan register - 31 (2.05%), worldwide register - 757 (2.01%) [OR=1.02 (0.71 to 1.47), F=0.851990, χ2=0.01], followed by 38:02 (χ2=0.02), 44:05 (χ2=0.03), in 27:07 (χ2=0.04), 54:01 (χ2=0.07). The biggest difference between the two registers was in 13:02 (χ2=256.9), 08:01 (χ2=26.92) locus B alleles. Distribution of locus C alleles was discovered to have the biggest statistical similarity of two registers provided by C 07:01 (χ2=0.07), 08:02 (χ2=0.15), 15:02 (χ2=0.23) 12:03 (χ2=0.76). The biggest difference in the distribution of locus C alleles between the two registers was in 06:02 (χ2=125.78) and C 03:02 (χ2=103.64).

Conclusion. The overlap of HLA-antigens genetic variants distribution in Kazakhstan and global registers varies from 41 to 52% by loci (locus A - 50%, B - 52%, C - 48%, DRB1 - 51%, DQB1 - 41%, mean 48.4%, median 50%). Kazakhstan register contains information on unique HLA-antigens genetic variants not included in the general database, manifesting the need for national register development and its integration into the «Allele frequencies in Worldwide populations» register.

Kazan medical journal. 2015;96(3):417-425
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Absence of natural group anti-A, anti-B antibodies (isohemagglutinins) and blood transfusion tactics in this blood group
Turaev R.G., Bel’skaya E.E., Somova N.S., Egorova M.A.
Abstract
Aim. To analyze the clinical data obtained at donor and recipient blood testing obtained in clinical diagnostic laboratory. Methods. Blood of donors and recipients for erythrocyte-containing blood-derived products was examined. Gel method was used for immunologic and hematologic testing. Results. A donor and recipients with the absence of natural group antibodies (isohemagglutinins) were identified. Those subjects were consulted for treatment with blood transfusion. According to the regulations, blood transfusion is provided considering the blood group of recipient. In described cases, serum analysis revealed no natural group antibodies, hence, no antibodies should be present in administered plasma coagulation hemostasis correctors. Conclusion. In the presented clinical cases, due to the absence of natural group antibodies (isohemagglutinins) АВ0 (IV) group serum is preferable if the blood transfusion is needed. Keywords: blood components, natural group antibodies, isohemagglutinins, agammaglobulinemia, Wiskott-Aldrich syndrome, non-Hodgkin’s lymphoma.
Kazan medical journal. 2015;96(3):425-428
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Thrombocytopenia after autologous stem cell transplantation
Protopopova E.B., Mochkin N.E., Sultanbaev U.S., Mel’nichenko V.Y., Shestakov E.A., Zhiburt E.B.
Abstract
Aim. Characteristics of thrombocytopenia and finding ways of predicting platelet transfusions at autologous hematopoietic stem cell transplantation in patients with hematologic and autoimmune diseases. Methods. Thrombocytopenia period after autologous hematopoietic stem cell transplantation in patients with autoimmune (group I, n=87) and hematological (group II, n=82) diseases was evaluated. Results. It was revealed that in patients with hematological oncologic diseases platelet count before the transplantation and on the first day after it is connected with the length of thrombocytopenia and the number of transfused platelets units. In patients with autoimmune diseases, low platelet count on the first day after transplantation might be used as a predictor for the transfusion risk. Day of thrombocytopenia onset is predictive of its duration and the need for blood components. In patients with hematological oncologic diseases, severe thrombocytopenia at day 14 before the transfusion is associated with further transfusion of 3 or more units of platelets. Platelet count at the first day after the transfusion is related to the number of platelet units transfused and thrombocytopenia duration. Onset of thrombocytopenia with platelet count lower than 20 and 10×109/L is predictive of its duration and the need for blood components. In patients with hematological oncologic diseases, early onset of thrombocytopenia is associated with further transfusion of larger doses of platelets. Conclusion. The revealed differences may be used as the criteria for predicting platelet transfusions in patients after autologous hematopoietic stem cell transplantation.
Kazan medical journal. 2015;96(3):428-431
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Hematological and biochemical screening of blood donors in the Republic of Bashkortostan
Sultanbaev U.S., Ayupova R.F., Salikhova A.K., Absalyamova L.A., Khabibullina Y.A., Zakirova I.R., Talipova R.A., Kuz’min N.S., Vergopulo A.A., Kayumova L.I.
Abstract

Aim. To assess the hematological and biochemical screening effectiveness in blood donors in the Republic of Bashkortostan.

Methods. The results of hematological and biochemical screening in blood donors in the Republic of Bashkortostan in 2008-2013 were studied.

Results. Centralizing and modernizing of blood donors examinations at the Republican Blood Transfusion Centre of the Bashkortostan Republic in 2008-2013 has led to an increase in the number of clinical blood analyses by 53.1%, reaching from 74.1 to 666.9% for some parameters. Studying platelet counts allows to choose platelets donors, whose blood is optimally used for preparing platelet-rich transfusion media. Leukocytosis (5.01%, 1748 of 34 899 subjects), leukopenia (0.1%; 34 of 34 899 subjects) and alterations in erythrocyte sedimentation rate (4.83%, 1574 of 32 581 subjects) may indicate a bacterial infection. In the presence of these signs, it might be appropriate do disallow donating platelets to prevent bacterial contamination of platelet concentrates and complications in the recipient, all the more so as the current mandatory control of blood products sterility is far from being perfect. Deviations in reticulocytes levels during the 6 years of follow up was discovered in 26 (0.05%) of 52 379 donors and in all cases was associated with a low concentration of hemoglobin. Obviously, the screening of this indicator is needless. The substantial part of potential donors infected with hepatitis B virus (80.6%) and C (65.2%) showed no evidence of cytolysis, which once again raises the question of the diagnostic value of alanine aminotransferase level screening in blood donors testing.

Conclusion. The excessiveness for combined screening for hemoglobin and hematocrit levels, reticulocyte concentrations, bilirubin levels was demonstrated. Efforts targeted at the forming of stable population of donors reduced the donation exemptions due to low hemoglobin level and presence of specific markers for viral hepatitis.

Kazan medical journal. 2015;96(3):432-437
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Distribution of blood groups among the donors of the Republic of Tatarstan
Belopukhov V.M., Turaev R.G., Bel’skaya E.E., Gadyl’shina R.S., Gimatdinova N.S.
Abstract

Aim. To study the peculiarities of AB0, Rh and Kell blood group distribution in donors of the Republic of Tatarstan in detail.

Methods. Blood samples of 180 279 donors of blood components (erythrocytes, platelets, serum) donated form 2008 to 2014 both in hospital and mobile settings were analyzed. The material for the study was the blood donors of blood components (red blood cells, plasma and platelets) for the period 2008-2014, the city, donated blood, both in stationary and in exit conditions. Typing erythrocyte antigens for AB0, Rh and Kell systems was performed using «Scangel» gel technology by «Hemos SP II» and IH-1000 immunohematologic analyzers using the diagnostic card produced by «Bio-Rad laboratories», as well as by microtray method on «Galileo Neo» automated scanner, and on plate by anti-A, anti-B, anti-AB, anti-A1, anti-C, anti-Cw, anti-c, anti-D, anti-E anti-e and anti-Kell monoclonal reagents produced by «LLC Gematolog» (Moscow), LLC «Mediklon» (St. Petersburg), «ImuMed» (Germany). AB0 blood group was also determined by the cross method using own-produced AB0 standard isohemagglutinating sera and AB0 standard red blood cells. Rhesus blood group was also determined by own-produced universal a-D, a-DC reagent, used to identify Du gel cards produced by «Bio-Rad laboratories», «Grifols» were used for Du detection. Statistical analysis was performed and the data were obtained using the automated information system for Transfusions management, installed in the Republican Blood Centre in 2008.

Results. Analysis of AB0 system blood groups distribution in the Republic of Tatarstan showed that blood group 0 (I) was the most common - 33.7%, 31.1% donors had A (II) blood group, 23.7% donors - B (III) group, 11.5% - AB0 (IV) group. Anti-A1 irregular agglutinin was found in 5 (0.57%) out of 878 donors with A2 (II) group, and in 53 (12.4%) of 428 A2B (IV) donors. The shares of Rh (D)-positive and Rh (D)-negative donors (87.4 and 12.6%, respectively), was revealed. Rh-positive donors included donors having antigen phenotypes C, E, and Du.

Conclusion. Formation and completion of a serologically tested donor’s database in the Republic of Tatarstan is required to compile the gene geographic map of the region.

Kazan medical journal. 2015;96(3):437-440
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Evolution of the motivation for donating blood and blood components in the regions of the Republic of Kazakhstan
Skorikova S.V., Burkitbaev Z.K., Abdrakhmanova S.A., Savchuk T.N., Zhiburt E.B.
Abstract

Aim. To evaluate features of the evolution of blood donation in Kazakhstan, including motivation and types of donations.

Methods. Statistical data of blood donations in the Republic of Kazakhstan for 2010-2014 were studied.

Results. In 2014, 51.8% of all blood donations in Kazakhstan were done by voluntary donors, 35.5% - by recipient’s relatives. The median proportion of paid donations in 2012-2014 years dropped by twice: 15.3; 10.5 and 7.6%, respectively. The number of platelet donations in 2010-2014 years increased by 717.3, of which 77% came from the cities of Astana and Almaty, where high-tech medical care is mainly provided. The number of plasma donations in 2014 compared to 2010 year has decreased by 35.7%, while its share in total number of donations dropped by 40.2%. Preparations are underway to contract plasma fractionation, becomes an actual the problem of determining blood donor reserves for plasma donations.

Conclusion. Voluntary blood donations (51.8%) prevail in Republic of Kazakhstan; the the number of platelet donations increased by 717.3% in 2010-2014, the number of plasma donations dropped by 40.2%, which reveals the potential for implementing contract fractionation.

Kazan medical journal. 2015;96(3):441-443
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Endoscopic surgeries and correction of homeostasis disorders in patients with obstructive jaundice
Malkov I.S., Zakirov G.R., Korobkov V.N., Nasrullayev M.N.
Abstract
Aim. To improve the treatment results of patients with obstructive jaundice using endoscopic methods for restoring biliary tract patency. Methods. A retrospective analysis of treatment results of 636 patients, treated in the surgical departments of City Clinical Hospital №7, Kazan, Russia in 2004-2014 with obstructive jaundice induced by tumors and other diseases was performed. Results. It was revealed that using endoscopic techniques for biliary system decompression allows to improve the treatment results. Our observations of patients 2014 with obstructive jaundice induced by tumors and other diseases suggest that the most important element of a comprehensive treatment of such patients is the earliest possible biliary tract decompression using minimally invasive approach, including endoscopic papillotomy and biliary tract stenting. The liver failure stage is an important criterion that defines patient management in case of obstructive jaundice. In patients with obstructive jaundice, treatment of endogenous toxemia and liver failure, according to the contemporary approaches, is based on drug administration and infusions of the required volume and contents, associated with one of the methods for biliary decompression therapy adequate in its formula and size. Conclusion. Endoscopic surgeries are indicated in the majority of acute, recurrent, and chronic large duodenal papilla obstruction cases. Performing endoscopic retrograde cholangiopancreatography, endoscopic pancreatic sphincterotomy in obstructive jaundice not associated with biliary tumors may refuse the surgical approach or reduce its volume and surgical injury.
Kazan medical journal. 2015;96(3):444-447
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Features of infusions and tranfusions within the complex treatment in patients with multisystem trauma
Chikaev V.F., Vdovin V.A., Galyautdinov F.S., Ibragimov R.A.
Abstract

Aim. To analyze features of infusions and transfusions within the complex treatment in patients with multisystem trauma.

Methods. Features of infusions and transfusions were analyzed in 286 patients with multisystem trauma.

Results. The first stage of infusions and transfusions is antishock. In cases of severe bleeding it is important to prevent the cardiac arrest of «empty» heart, to maintain the circulating blood volume, cardiac output and blood pressure at a safe level (systolic blood pressure BP >80-90 mm Hg). The second stage is emergency surgery and surgical hemostasis (abdominal surgery, removal of intracranial hematoma, the most sparing reposition methods). At surgery, anyway, there is an additional blood loss related to surgery itself, but it is possible to compensate the blood loss with patient’s own blood, using machine methods of reinfusion. Infusions and transfusions are performed at general anesthesia. The third stage is the period of treatment in the intensive care unit. Infusions and transfusions should eliminate multiple disorders: volemic, oxygen transport, ionic, toxic, immune, energy and plastic. The goal of infusions and transfusions is to maintain the water-electrolyte metabolism; to treat the anemia and to ensure the efficient oxygen transport; microcirculation improvement; detoxification and metabolites excretion.

Conclusion. In multisystem trauma, the treatment success depends on the timely diagnosis, proper estimation of trauma severity, blood loss and general condition of the patient, infusions and transfusions depend on the treatment stage and injuries.

Kazan medical journal. 2015;96(3):448-451
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Clinical experience of using «Haemoblock» hemostatic solution in surgical practice
Andreev A.I., Ibragimov R.A., Kuznetsov M.V., Fatykhov A.M., Anisimov A.Y.
Abstract

Aim. The clinical assessment of safety and hemostatic effect of «Haemoblock» hemostatic solution for arresting active bleeding from abdominal cavity tissues at open and laparoscopic surgeries.

Methods. A total of 26 patients underwent surgeries. In 11 cases of acute calculous cholecystitis the drug was delivered to the bleeding surface during laparoscopic surgery by gauze soaked in «haemoblock» solution, which was introduced through 5 mm laparoscopic port (the first group). In 15 cases of acute adhesive intestinal obstruction, the drug was applied to the wound surface by moistened gauze during the open surgery (the second group).

Results. In 23 (88.5%) cases of 26, stable hemostatic effect was obtained. Mean hemostasis time was 2.09±0.2 minutes in the first group and 2.53±0,15 minutes in the second group. The first group of patients, hemostasis occurred within 1-3 minutes in 10 (90.9%) of 11 patients, no secondary bleeding and suppuration was noticed. One patient (9.1%) of the first group developed recurrent bleeding from the gallbladder bed, requiring repeated surgery. Two (13.3%) patients of the second group had recurrent bleeding, requiring additional re-use of the drug with an exposure of 4 min. After using «Haemoblock», no postoperative complications such as fistula formation of adhesions, as well as reactive abdominal cavity effusions, were observed. No toxic of allergic reactions, irritating effect on the surrounding tissues no influence on systemic hemostasis were reported.

Conclusion. «Haemoblock» is an effective local hemostatic that could be used as additional treatment to control parenchymal bleeding at abdominal and laparoscopic surgery.

Kazan medical journal. 2015;96(3):451-455
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Clotting activity of camphene derivatives
Rakhmatullina A.A., Turaev R.G., Kiselev S.V., Nikitina L.E., Bodrov A.V.
Abstract
Aim. To study of the influence of new synthetized sulfur-containing derivatives of camphene on the thrombocytes aggregating ability and clotting activity of human blood plasma in vitro. Methods. Sulfides and sulphones of camphene were synthesized by thiols electrophilic addition reaction. The structures of the synthetized compounds were clarified by using of 1H and 13C nuclear magnetic resonance, chromato-mass spectrometry and X-ray analysis. Clotting activity of the synthetized compounds was assessed by studying the spontaneous platelet aggregation and plasma coagulating activity of the venous blood of patients with ischemic heart disease. The induced platelets aggregation was studied on plasma obtained from healthy donors. Results. The synthetized compounds demonstrated anti-aggregating and anti-coagulating activity: they inhibited spontaneous and induced thrombocyte aggregation as well as reduced coagulating ability of human plasma. Both camphene sulphone and mainly camphene sulfide (in contrast with acetylsalicylic acid and clopidogrel) totally inhibited thrombocytes aggregation induced by adrenaline, adenosine diphosphate, collagen and arachidonic acid, and decreased the influence of ristocetin. Anticoagulant activity of the synthetized substances is associated to their potential to inhibit thrombocyte activation and to reduce the catalyst activity of phospholipid surface participating in coagulating complexes and clotting factors formation. Conclusion. Low toxicity of terpenoids together with discovered anticoagulant activity of sulfur-containing derivatives of camphene revealing the promising potential of these drugs for further development of novel medical treatments for treating and prevention of different types of thrombophilia.
Kazan medical journal. 2015;96(3):455-458
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On the 70th anniversary of the Victory Day (9th may)
Blood and blood components preparation, storage and supply during the Great Patriotic War
Turaev R.G., Khasanova G.R., Klyushkin I.V., Boykova O.V.
Abstract
During the Great Patriotic War, work of health workers not only in frontline medical institutions of different levels, but also directly on the battlefield was invaluable. Sanitary losses, especially among combat medics taking the wounded from the battlefield, were the most crucial. During the war, military hospitals were established throughout the territory of the USSR where over 22 million of wounded were treated. 85% of them returned to the Army. The role of blood transfusion stations staff who supplied front and rear medical facilities by blood and its components is invaluable. The objective of the article - to illustrate the role and importance of medical service and its part - medical institutions dealing with blood and blood components collection, storage, processing and supply to military units, hospital, performing transfusions for the wounded. Archival materials and statistical data gained from various publications, wartime and postwar, were used. The gained data confirm the invaluable role of these services in providing medical aid to the wounded and the sick during the Great Patriotic War, as well as describe reorganization and flexible tactics of the blood service staff in accordance with the Great Patriotic War periods in supplying medical service with blood and its components. Blood service staff training and management measures allowed to uninterrupted supply front and rear medical institutions with blood. Blood service in different periods of the Great Patriotic War had undergone significant management changes in the section of the donation, processing and supply of medical facilities with blood, enabling to attract huge crowds of people in the USSR to donate blood, to ensure an uninterrupted, adequate supply of troops with blood.
Kazan medical journal. 2015;96(3):459-463
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Department of prosthetic dentistry staff - participants of the Great Patriotic War
Yudina G.N., Saleeva G.T., Saleev R.A.
Abstract
Leonid Mendeleevich Demner was born in August 3, 1923. In February 1944, he was drafted into the Red Army on the Leningrad front and served as a troop of 286th infantry division separate ski battalion, later - as a military translator of the 286th Infantry Division 996th Infantry regiment and in division headquarters of the same division in the 1st Ukrainian Front. He w as awarded with the Order of «Red Star», «World War II degree», the medal «For courage», «For Victory over Germany in the Great Patriotic War» and other awards. Discharged in May 1946, he worked as a dental technician trainee, dental technician and caster prosthodontist in denture clinic of Chernivtsi, and as a dentist, prosthetist in aviation hospital in Lviv. Since 1951 to 1956 he was a student of Molotov’s State Medical University. In 1956-1959 he worked in Izhevsk as the children’s department head and an orthodontist. In 1959-1962 he was a postgraduate student at the Department of Prosthetic Dentistry of Kazan Medical Institute. In 1963 he presented his PhD thesis, and in 1972 - doctoral dissertation. In 1969-1990 he worked as the head of the Prosthetic Dentistry Department of Kazan Medical Institute. Gabdulkhak Gil’mullovich Nasibullin was born in November 30, 1923. In 1937 he entered the Kazan midwifery school. In May 1942 he was drafted into the Soviet Army and sent as a battalion physician assistant to the 383rd Infantry Regiment. He served as a combat medic of the 7th Guards Army 167th separate tank battalion, medical platoon commander of the 81st Guards Division 233rd Infantry Regiment Battalion at the Steppe Front and 2nd Ukrainian Front. He was awarded with the Order of «Red Star» and «World War II degree», 12 medals. In 1950 he graduated from Kazan Dental Institute. Later, he worked as a dentist in the Perm region. In 1953-1956 he was trained as a clinical resident at the Department of Prosthetic Dentistry of Perm Medical Institute. In 1956-1976, he worked at the Department of Prosthetic Dentistry of Kazan Medical Institute. In 1964 he presented his PhD thesis, and in 1975 - his doctoral dissertation. In 1976-1982, he headed the department of orthopedic surgery and dentistry of the Institute of Postgraduate Medical Education named after V.I. Lenin in Kazan. In 1982-1993, he headed the Department of Prosthetic Dentistry at the Kazan State Medical Academy.
Kazan medical journal. 2015;96(3):464-470
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History of medicine
Grand Duchess Alexandra Petrovna (nun Anastasia) and the activities of the Pokrovsky monastery-hospital in Kiev in the late XIX and early XX century
Blokhina N.N.
Abstract
The article describes the activities of the Pokrovsky monastery-hospital in Kiev, created by the efforts of the Grand Duchess Alexandra Petrovna (1838-1900), who took the monastic vows in 1889 under the name Anastasia. The monastery became widely known in the late XIX - early XX century for the highly skilled medical aid provided to the population since its inception up to the events of 1917. It was a unique complex of medical settings located in the same area and equipped with modern medical equipment comparable with the many World’s clinics of that time. In this monastery-hospital, pilgrims with different diseases who came at Pokrovsky monastery in Kiev were provided the required qualified, affordable medical care. Thanks to the Grand Duchess Alexandra Petrovna, her attentive attitude to all the latest innovations, novel treatment methods were developed and introduced to the work of monastery medical settings. In addition, she was able to create a special atmosphere and goodwill towards the sick. But, being engaged in devising new methods of providing medical care to patients, she was able to create a special and inviting atmosphere with respect to the patient. With the ever-increasing circle of her organizational and economic activities, being in charge of the monastery-hospital problems of great importance, Grand Duchess reserved the right to nurse her patients. She worked by vocation, at the behest of the soul. Her example of selfless labor in the monastery medical settings where monastic sisters held the medical staff responsibilities for the patients care was important for all of the staff. Her assistants - Sisters of Charity - she fostered by her own example of selfless aid to a sick person. This favorable work atmosphere was very effective helping cure the sick.
Kazan medical journal. 2015;96(3):471-477
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Jubilees
60 years to Professor Sergey Vasil’evich Dobrokvashin
 
Abstract
Kazan medical journal. 2015;96(3):478
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95 years to Farid Khasbiullovich Fatkullin
 
Abstract
Kazan medical journal. 2015;96(3):479-480
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