Vol 93, No 5 (2012)

Higher pharmaceutical education in the Republic of Tatarstan: sources of formation of educational basis, it’s development, improvement, results and achievements
Potseluyeva L.A.
Abstract
The analysis of historical and bibliographic data of pharmaceutical education foundation in the Republic of Tatarstan is presented. Over than 200-year history of higher education in Kazan, started in 1804, determined the development of not only medical, but also pharmaceutical sciences. In Kazan Emperor’s University 4 faculties were founded, including the Faculty of Medical Sciences, that included the combined Department of chemistry, technology and pharmacy (pharmaceutics), which actually consisted of several departments. The Pharmaceutical Faculty was established in Kazan Medical Institute in 1975. Departments of Pharmaceutical, analytical and toxicological chemistry, Pharmaceutical technologies, Pharmacognosy and botany, Organization and economics of pharmacy were created. First pharmacists were graduated at 1980. By June 2012, 2472 full-time students were granted the diplomas of pharmacists, 2418 were Russian citizens, 54 - foreigners. In 1998, Department of part-time education was established at Pharmaceutical Faculty, which has already graduated 606 pharmacists. Alumni of Pharmaceutical Faculty of Kazan State Medical University occupy the highest supervising posts at pharmacy network and pharmaceutical industry, which is the clear evidence of the highest quality of education they have received at the University.
Kazan medical journal. 2012;93(5):705-711
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Theoretical and clinical medicine
The use of a functional technique for neo-chords’ length determination during reconstructive operations for degenerative mitral regurgitation
Mukharyamov M.N., Dzhordzhikiya R.K., Abdul’yanov I.V., Vagizov I.I., Safarova D.F., Akhunova S.Y.
Abstract
Aim. To evaluate to effectiveness and safety of the functional technique of measuring the length neo-chords during reconstructive operations on the mitral valve for degenerative mitral regurgitation. Methods. The study included 34 patients, in whom the method of chord prosthesis with polytetrafluoroethylene sutures was used for correction of the anterior and/or posterior mitral valve leaflet prolapse. In order to determine the length of the chords a technique of functional hydraulic tests with a sliding suture knot was used by pressure infusion of a cold isotonic sodium chloride solution into the left ventricle until optimal geometry and competence of the valve leaflets was achieved. Results. No perioperative deaths were registered. The average postoperative length of hospital stay was 10±3.1 days. In 97% of the cases this technique made it possible to obtain immediate satisfactory hemodynamic results of the reconstruction. In long-term follow-up (13 months) 1 (3%) patient was re-operated for severe mitral regurgitation that was associated with the detachment of a native anterior leaflet chord, which was discovered during the operation. The two neo-chords epithelialized, became macroscopically indistinguishable from the native chords, and could be identified by the knots on the atrial side of the leaflet, their integrity was not compromised. In all other cases long-term follow-up after the operation showed a satisfactory hemodynamic functionality of the mitral valve. 76% of the operated patients had postoperative echocardiographic examination performed in our center. In 42% of patients there was no insufficiency, 44% of the patients had 1st degree regurgitation, in 14% of patients the regurgitation was classified as 1-2 degree with no signs of left atrium volume overload, left ventricular dysfunction or symptoms of heart failure. Conclusion. The functional technique for determining the length of neo-chords is an effective and safe method that makes it possible to successfully perform reconstructive operations for degenerative mitral regurgitation.
Kazan medical journal. 2012;93(5):712-716
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Perioperative serum cortisol levels at different operative accesses to femoral segment arteries
Maximov A.V., Feiskhanov A.K., Plotnikov M.V., Begicheva E.V., Tuisheva E.V.
Abstract
Aim. To compare invasiveness of reconstructive operations on arteries of aortofemoral segment using different accesses to surgical site. Methods. The analysis of the post-operative period was carried out in 40 patients who underwent aortofemoral bifurcation bypass surgery. Patients were assigned to 4 groups, each containing 10 patients. In group I surgeries were performed using mini-access of 5-7 cm, group II - mini-laparotomic access of 8-12 cm, group III - retroperitoneal mini-access, group IV - standard laparotomy. For invasiveness objectification, serum cortisol levels, forced lungs vital capacity and postoperative pain levels were measured. Results. All surgeries were performed as planned without inoperative complications. No deaths were registered. After mini-access surgeries intestinal peristalsis was defined by auscultation as soon as on 18-24 hour after the operation. Prolonged (more than 3 days) post-operative ileus was diagnosed in 3 patients, all operated using standard laparotomy. Serum cortisol level was typically elevated at the end of the surgery, but the difference was only statistically significant in patients from the group IV compared to baseline level as well as to patients with mini-access surgeries. Serum cortisol level reduced to normal at the second 24-hours after the surgery. Patients in which standard laparotomy was used reported more intense pain at the second day. Forced lungs vital capacity at day 4 was significantly reduced in patients of groups I, III and IV, with the significantly worse reduction in patients who overcame standard laparotomy compared to others. Conclusion. Mini-access reconstructive surgeries on aortofemoral segment arteries provide significant reduction of surgical trauma, which is proved by objective measurements.
Kazan medical journal. 2012;93(5):717-720
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Analysis of endoscopic interventions in patients with bowel stomas
Timerbulatov M.V., Ibatullin A.A., Gainutdinov F.M., Kulyapin A.V., Aitova L.R., Kyzylbaeva A.I., Abdeev A.A.
Abstract
Aim. To evaluate potentials and to determine indications for endoscopic interventions in case of bowel stomas surgery. Methods. Case series of 66 patients with bowel stomas who underwent endoscopic interventions at various stages is presented. The causes of stoma formation were: colon cancer (43 patients), colon diverticular disease (10), inflammatory bowel disease (5), colon trauma (4), benign colon tumors (2), dolichosigmo-id (2). Results. Laparoscopic technique was most widely used in cases of acute intestinal obstruction - 39 patients. Laparoscopic subtotal colectomy with Brooke end ileostomy was performed in 3 patients. Laparoscopically assisted reversal was completed in 11 patients after Hartmann’s procedure. Introduction of endoscopic interventions to bowel stoma surgery techniques allowed to reduce the number of post-operative complications. The terms of rehabilitation after radical interventions with complete colon stoma closure in patients with diseases of the colon requiring surgical treatment were decreased to 7-11 days. Conclusion. The use of laparoscopic techniques in bowel stoma surgery is possible at every stage of surgical rehabilitation of patients who underwent colostomy; it is safe and has a number of advantages compared to standard procedures.
Kazan medical journal. 2012;93(5):720-725
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Prevention of paracolostomal complications following abdominoperineal extirpation of the rectum
Toychuev Z.M., Gataullin I.G., Aglullin I.R., Khamitov M.R., Kaji M.R.
Abstract
Aim. To find an optimal way of end colostoma formation in patients with colorectal cancer following abdominoperineal extirpation of the rectum. Methods. Results of surgical treatment (rectum extirpation ended with sigmoidostomy) of 142 patients with malignant tumors of lower part of rectal ampulla treated from 2005 to 2012 are presented. Data of 101 patients (comparison group) were retrospectively analyzed, in whom the same approach of choosing the colostomy technique was applied. The main group consisted of 41 patients in whom the efficacy of authors-introduced technique of colostomy with alloplasty for colostomal wound consolidation from the abdominal cavity side was prospectively defined. Results. The prevalence of early post-operative stomal complications was 18,8% (in 19 out of 109 patients) in comparison group. Ileum volvulus around the stoma causing bowel obstruction was diagnosed in 2 cases, necrosis of stoma wall - in 2 patients, evisceration around stoma site - in 3 patients, perforation of sigmoid stoma - in 1 patient, stoma retraction - in 1 patient, bleeding at stoma site - in 3 patients, paracolostomal mass - in 1 patient. 14 patients from comparison group developed late post-operative stomal complications, including parastomal hernia - 8 patients, stoma prolapse - 3 patients, colostomal fistula - 1 patient, stomal stenosis - 2 patients. Treatment results in the patients from the main group were satisfactory. Early complications included 1 case of bleeding from stoma site, 1 case of partial necrosis of stoma wall. No late complications were registered. The gained data allows to provide successful rehabilitation to patients who underwent colorectal cancer surgery. The described technique is contraindicated in case of infected peritoneal effusion. Conclusion. The use of the method proposed by authors not only significantly improves colostomy results, but significantly decreases the rate of both early and late post-operative complications of stomas compared to standard methods.
Kazan medical journal. 2012;93(5):725-728
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Combined inhalational and intravenous anesthesia at surgeries in patients with gastrointestinal cancers
Neimark M.I., Tanatarov S.Z., Adylkhanov T.A.
Abstract
Aim. To define efficiency and safety of the combined inhalational and intravenous anesthesia (isoflurane + propofol) in patients operated due to gastrointestinal cancer. Methods. 163 patients who were operated due to gastric cancer (119 patients), cancer of the head of the pancreas (24 patients) and colon cancer (20 patients) were examined. Central circulation parameters, autonomic nervous system status, serum cortisol and glucose levels, bispectral index in patients who underwent inhalational or combined inhalational and intravenous anesthesia were compared. Results. There was no significant difference of the examined parameters in patients who underwent combined inhalational and intravenous anesthesia (isoflurane + propofol) compared to patients in whom only inhalational anesthesia with isoflurane was used. Combination was characterized by less change of the examined parameters compared to baseline levels and prolonged emergence from anesthesia. Conclusion. Combined anesthesia is quite safe and effective if used in oncosurgery.
Kazan medical journal. 2012;93(5):728-731
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Breast cancer immunophenotype dynamic change
Druzhkov O.B., Gataullin I.G., Druzhkov M.O.
Abstract
Aim. Comparative analysis of primary breast cancer and breast cancer local relapse phenotypes. Methods. 5808 patients with confirmed diagnosis of breast cancer, including 108 (1,86%) with local relapses, underwent surgical treatment from 2000 since 2011. 26 tumors were prospectively examined by histological and immunohistochemical methods using monoclonal antibodies to estrogen and progesterone receptors and to Her2/neu oncogene protein. Results were compared with corresponding parameters of primary tumours. Results. Local relapses occurred in 1,2% of cases after total mastectomy, and in 5,1% - after incomplete mastectomy. Surgical approach to patients with local relapse of breast cancer depended on tumor size. Ectomy of the relapsing tumor at the post-operation scar site or at anterior chest wall was preformed in 60 (55,6%) cases, simple mastectomy after incomplete mastectomy - in 33 (30,5%) cases, repeated incomplete mastectomy with breast reconstruction - in 12 (11,1%) cases, and loco-regional relapsing tumor ectomy - in 3 (2,8%) cases. Immunohistochemical phenotypes of primary and relapsing tumors were different in 15 out of 26 studied cases. Switch from hormone-negative to hormone-positive tumor was registered in 46,7% of cases, from hormone-positive to hormone-negative tumor - in 40%, isolated change of Her2/neu oncogene protein expression - in 13,3%. Conclusion. The hypothesis of change of breast cancer phenotype after treatment has been confirmed; changes of immunohistochemical parameters after the local relapse should be taken into consideration for defining the treatment tactics.
Kazan medical journal. 2012;93(5):731-734
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Ultrasonography in assessing the cervical cancer extent
Smirnov Y.A., Bogacheva T.M., Valeev R.G.
Abstract
Aim. To study the potentials of complex ultrasonography in assessing the extent of cervical cancer, defining typical ultrasonographic features of cervical cancer. Methods. 75 patients with the diagnosis of morphologically confirmed cervical cancer were examined. Continuous sampling method was used to recruit the patients. Patients underwent transabdominal, transvaginal and transrectal ultrasonography with the use of color Doppler and power Doppler modes. Results. 57 (76,5%) patients were diagnosed with squamous cell non-keratinous carcinoma, 12 (16%) - with squamous cell keratinous carcinoma, 6 (8%) - with adenocarcinoma. 43 (57,3%) patients had cancer stages I-II, 32 (42,7%) - cancer stages III-IV. The certain features of ultrasonographic images were found at different stages of cervical cancer. At cancer stage I the most typical findings were: low echogenicity area, diffuse heterogeneity of stroma, area of hypervascularity at the place of cervical cancer. Increased blood flow at the cancer site is typical for cervical cancer because of tumor vasculature hyperplasia and neoangiogenesis, the increase in number of blood vessels is proportional to tumor size. Cervix hypertrophy, fuzzy and irregular contouring, no flexion angle between the fundus and cervix were characteristic for cervical cancer stages II-III. Corpus uteri echo-structure at the tumor site portrays the tumor structure. Infiltrates in parametrium can be seen. At stage IV tumor spreads to urine bladder and rectum walls. In advanced stages uretеrs can be involved, pyelectasis and ureterectasis can develop. Conclusion. Complex ultrasonography allows to diagnose cervical cancer quite reliably and to estimate the extent of cervical cancer.
Kazan medical journal. 2012;93(5):735-738
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Model of specific diagnostics of ovarian cancer stages
Antoneeva I.I., Abakumova T.V., Gening T.P., Gening S.O., Pirmamedova S.S.
Abstract
Aim. To develop the model of specific diagnostics of III-IV stages of ovarian cancer. Methods. 404 patients with I-IV stages of primary ovarian cancer according to International Federation of Gynecology and Obstetrics classification were examined. Ultrasonography of genitalia and internal organs, chest X-ray in order to detect possible remote metastases, cytological, histological and immunohistological examination of tumor mass, as well as «lipid peroxidation - antioxidants» system condition of tumor tissue and patients’ serum were examined. Results. Elevated level of a lipid peroxidation product, malondialdehyde, was found in tumor tissue of patients with ovarian cancer, with levels of malondialdehyde growing from clinical stage I to clinical stage III of the disease. Leukocyte counts of peripheral blood statistically significantly decreased at stages I-III and elevated at stage IV. However, aerobic and anaerobic cytotoxicity of neutrophils decreases. An algorithm of supplementary diagnostic tools use to define the stage of ovarian cancer was developed, as well as differentiation coefficient calculation formula. Conclusion. Defining the serum levels of malondialdehyde, catalase and glutathione reductase activity allows to calculate the coefficient for differentiation between stages III and IV of ovarian cancer, and detection of cation proteins level, myeloperoxidase activity and phagocytic index allows to calculate the coefficient for differentiation between stages II and III of ovarian cancer.
Kazan medical journal. 2012;93(5):739-743
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Causes of non-effectiveness of secondary prophylaxis of ischemic stroke
Vasilevskaya O.V., Safina D.D., Silant’eva I.V.
Abstract
Aim. To study the aspects of prevention and risk factors of a recurrent ischemic stroke. Methods. 50 patients who suffered a recurrent ischemic stroke in the period from October 2010 to February 2011 participated in the study. Past medical history information was obtained according to a specially designed questionnaire. Information on the regularity of medication administration (antihypertensive, antithrombotic, lipid lowering), maintenance of a diet, and modes of physical activity was collected. Results. The main measure of prevention of thrombosis in patients after an ischemic stroke was acetylsalicylic acid, 11% of patients took it regularly. The patients did not use the modern and more effective drug clopidogrel. In the group of patients with a cardioembolic ischemic stroke the recommended anticoagulation therapy with warfarin was not conducted. 89% of the patients were compliant with antihypertensive medications before the development of a recurrent stroke, however only 15 (30%) patients took the drugs regularly under blood pressure control. The majority of patients (70%) at first administered the antihypertensive medications according to the prescription instructions, but then in accordance to well-being. None of the patients knew and controled their cholesterol level. Statin therapy was not conducted in any patient. The recommended hypolipidemic diet was maintained by 44% of patients, 25% of them - routinely. The number of smokers up to the recurrence of the ischemic stroke was 66%, of which only 15.2% reduced the number of cigarettes. 10% of patients stopped drinking alcohol, 34% - decreased its use, 22% did not change the level of alcohol consumption, 34% of patients noted that they did not consume alcoholic beverages. Only 44% of patients altered their physical activity, started going for a walk in the fresh air. A decrease in adherence to therapy after an average of 2 months after initiating treatment was established. A direct relationship between the quality of prophylaxis and the time of recurrent ischemic stroke occurrence was revealed according to the following parameters: normalization of the blood pressure levels, antithrombotic therapy, control of blood glucose levels, termination of smoking, cessation of alcohol abuse. Conclusion. The majority of the patients did not take the necessary measures for the prevention of ischemic stroke; organization of educational activities is necessary to raise awareness among the patients about this disease.
Kazan medical journal. 2012;93(5):744-748
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Effectiveness of sporobakterin probiotic in patients with chronic hepatitis C
Knyaz’kina O.V., Kagan Y.D., Skachkov M.V.
Abstract
Aim. To assess the effect of Sporobacterin probiotic for correction of bowel dysbiosis syndrome in patients with chronic hepatitis C. Methods. Bacteriological examination of stool samples from 100 patients with chronic hepatitis C was performed to detect the bowel dysbiosis syndrome. Some immunity parameters such as CD3+, CD4+, CD8+ and CD19+ blood counts, serum immunoglobulin A, G and M levels, phagocytic coefficient and phagocytic index, metabolic activity of neutrophils, serum circulating immune complex levels were also examined. Viral load was assessed using a polymerase chain reaction. These measurements were repeatedly done in patients who received Sporobacterin (main group, 50 patients) and compared to results of 25 patients taking Bifidumbacterin as well as 25 patients who were not taking probiotics. Results. Bowel dysbiosis syndrome was present in 85% of patients with hepatitis C. In patients taking Sporobacterin during three months, moderate degree of dysbiosis significantly reduced from 1.88±0.15 to 0.38±0.1. Majority of patients from this group recovered intestinal microbiota - 72±6.35%, while initially only 14±4.91% of these patients had normal intestinal microbiota level. Before the treatment 38±6.86% of patients were diagnosed with III degree of bowel dysbiosis syndrome, compared to absence of such diagnoses after the treatment period. After 1 month of the treatment, number of patients with normal count of bifidobacteria in 1 g of stool was significantly higher in the group treated with Sporobacterin (50±7.07%), compared to the group treated with Bifidumbacterin (24±8.54%), as well as number of patients with marked reduction of lactobacteria in 1 g of stool (0 vs 16±7.3%). There was a marked and significant reduction of viral load in patients treated with Sporobacterin, which decreased from 8.3±3.46×106 copies/ml initially to 0.8±0.24×106 copies/ml after 1 month of treatment and to 0.094±0.022×106 copies/ml after 3 months of treatment. After 3 months of treatment the number of patients with the following conditions reduced significantly: elevated leukocyte count from 32.5±7.41 to 6.25%, decreased CD8+ count - from 42.5±7.82 to 6.25%, increased serum immunoglobulin G level - form 25±6.85 to 18.75±9.76%. Conclusions. Use of Sporobacterin for treatment of bowel dysbiosis syndrome in patients with chronic hepatitis C is highly effective and superior to treatment with Bifidumbacterin, Sporobacterin may modulate the immune response and decrease the viral load in patients with chronic hepatitis C.
Kazan medical journal. 2012;93(5):748-752
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Clinical signs, diagnosis and complex treatment of temporomandibular joint osteoarthritis
Sidorenko A.N.
Abstract
Aim. To improve complex treatment of temporomandibular joint osteoarthritis. Methods. 45 patients with temporomandibular joint osteoarthritis aged 18-75 years were examined. The main group consisted of 25 patients who were treated using transcranial electric stimulation. Comparison group consisted of 20 patients in whom standard treatment was applied. Control group consisted of 10 healthy volunteers and was used to compare blood cytokine and β-endorphin levels. Clinical examination, computed tomography, immunological blood analysis were performed in all patients. Results. After the complex treatment all the symptoms resolved, and the position of mandibular condyles in mandibular fossae of the temporal bone and results of immunological blood analysis normalized. The baseline level of β-endorphin of patients with temporomandibular joint osteoarthritis did not differ from control group. After transcranial electric stimulation β-endorphin serum levels were significantly raised at day 6 and especially at day 9, while in patients with standard treatment the β-endorphin serum levels were only slightly higher compared to baseline levels. Decrease of interleukin-6 serum levels was more significant in the transcranial electric stimulation group. Transcranial electric stimulation has also leaded to elevation of interleukin-10 serum levels up to normal ranges at day 9, compared to low level (5 times below normal range) at all times in the standard treatment group. After 2 years of treatment there was no symptoms of the disease, normal ranges of motion in temporomandibular joints and no relapses registered in 24 out of 25 patients from transcranial electric stimulation group compared to 11 out of 20 patients from standard treatment group. In 1 patient from transcranial electric stimulation group and 9 patients from standard treatment group clicking on the involved side was still present, those patients were re-treated. Conclusion. Usage of transcranial electric stimulation as a component of complex treatment of patients with temporomandibular joint osteoarthritis increases the effectiveness of their treatment.
Kazan medical journal. 2012;93(5):753-757
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Comparative assessment of marginal adjoining of fillings and dental inlays in patients with xerostomia
Komarova K.V., Polenichkin V.K., Ratkina N.N.
Abstract
Aim. To study change of electrometric index of fillings and dental inlays marginal adjoining on the border with hard tooth tissues in patients with xerostomia over time. Methods. 40 patients (male - 11, female - 29) aged from 28 to 56 years with xerostomia, in whom 80 dental restorations were completed. Inclusion criteria were the following: signed informed consent, diagnosis of xerostomia, preserved chewing function of mandibular and maxillar teeth, and presence of an antagonist of the examined tooth. Patients were divided into two subgroups (40 patients each) depending on the treatment method used: dental filling (1st group) or dental inlay (2nd group). Both fillings and inlays were made of packed restorative composite Filtek P60. Dental dam was used to isolate restored tooth from saliva. Marginal adjoining control at the border «tooth-composite» was made by «DentEst» (Geosoft, Russia) electrometric device. Comparative evaluation of marginal adjoining quality at «tooth-filling» and «tooth inlay» border was performed at 3, 6, 9 and 12 months after treatment. Results. 10 minutes after treatment mean values of marginal permeability in the first group did not significantly differed from the second group, indicating good marginal adjoining. 3 months after the treatment at electrometry marginal adjoining was incomplete in 1 filling out of 40, compared to the second group where marginal permeability was still good at 12 months after treatment. The functional examination of restored teeth with good marginal adjoining at a period from 3 to 12 months after treatment showed that this number reduced from 98 to 45% in the first group and from 100 to 95% in the second group. Differences between groups were statistically significant. Conclusion. In patients with xerostomia tooth reconstruction using dental inlay is more effective than use of dental filling.
Kazan medical journal. 2012;93(5):757-759
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Functional status of maxillofacial area in children with asymmetric congenital abnormalities and acquired maxillofacial deformities
Silin A.V., Satygo E.A., Semenov M.G., Semeleva E.I., Kondrateva N.A., Trushko M.B.
Abstract
Aim. To determine the masticatory muscles functional activity change in children with congenital abnormalities of maxillofacial area and acquired maxillofacial deformities at the stages of reconstructive plastic surgery. Methods. 10 children at the age from 10 to 14 years with acquired (1st group - 5 patients with secondary temporomandibular joint osteoarthritis, asymmetric micrognathia) and unilateral congenital maxillofacial deformities (2nd group - 5 patients with I-II branchial arches syndrome, asymmetric micrognathia) were examined. Occlusion parameters and electromyographic features of masticatory muscles were analyzed. Results. Occlusal contact estimation did not reveal any significant differences between the groups. The symmetry of masticatory muscles at teeth clenching was higher in children with acquired asymmetric micrognathia (the index of asymmetry at electromyography 1.95±2.1%) compared to children with congenital asymmetric micrognathia (the index of asymmetry at electromyography 23.06±18.8%), p=0.005. Total activation index of masticatory muscles at electromyography ranged from 143 to 64% in patients with temporomandibular joint osteoarthritis and from 127 to 75% in children with I-II branchial arches syndrome. None of the patients included in the study had any complaints of temporomandibular joint and masticatory muscles condition. This was confirmed by no difference in muscular balance static index in two groups. Nevertheless, in patients with I-II branchial arches syndrome a much more sufficient asymmetry was observed. Orthodontic treatment and reconstructive surgery did not succeed in asymmetry index restoration to normal ranges. Conclusion. In children with symmetric abnormalities and acquired deformities functional status of maxillofacial area can be rapidly restored after reconstructive treatment at well-planned orthodontic rehabilitation; maxillofacial area functional status in patients with unilateral abnormalities can not be fully restored, since muscle asymmetry persists for a long time.
Kazan medical journal. 2012;93(5):760-763
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Clinical and instrumental criteria in predicting the clinical course of chronic posttraumatic uveitis after penetrating ocular trauma
Maracheva N.M., Panova I.E.
Abstract
Aim. To identify the prognostic criteria for the recovery or transformation to chronic form in patients with prolonged clinical course of uveitis associated with penetrating ocular trauma basing on the results of clinical examination and instrumental methods. Methods. 120 patients with chronic clinical course of post-traumatic uveitis were examined 2-3 months after the penetrating ocular trauma using clinical examination and ultrasonography of eye and orbita. 1st group consisted of 60 convalescents, 2nd included 60 patients with chronic disease. The control group consisted of 40 healthy volunteers. Ultrasonography included measurement of innermost eye coat thickness and the retrobulbar part of the optic nerve thickness measured 10 mm behind the eyeball bilaterally. Results were statistically analyzed. Results. Prognostic criteria for recovery or chronic inflammation development in chronic post-traumatic uveitis were found. They are: G-index and interocular asymmetry coefficient of innermost eye coat and optic nerve thickness. At calculation of G-index, which characterizes inflammatory consequences of trauma, presence of cornea imbibition, rubeosis iridis, cataract, vitreous body fibrosis, pulled-in cornea and sclera scars, retinal and choroidal detachment, the eyeball subatrophy, decreased eye fluid pressure, optic nerve thickening. The value of all the parameters equaled 1. An interocular thickness asymmetry coefficient characterized innermost eye coat thickness or optic nerve thickness ratio in injured eye compared to other eye. 2-3 weeks after the trauma characteristic G-index value of G ≥4, an interocular asymmetry coefficient value of ≥1,3 for innermost eye coat thickness and ≥1,1 for optic nerve thickness are the indicators of a high risk of chronic development. Lesser values predict recovery. Conclusion. Use of the set of found prognostic criteria in patients with prolonged clinical course of uveitis provides high prognosis accuracy of 93,3% at predicting recovery or chronic uveitis development.
Kazan medical journal. 2012;93(5):764-767
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Genetic predictors of theophylline efficacy and safety in children with bronchial asthma
Kantemirova B.I., Starodubtsev A.K., Sychev D.A., Griganov V.I.
Abstract
Aim. To study the prevalence of С734A polymorphic marker of CYP1А2 genotype in population of children of different ethnical groups, and to estimate the phenotypic activity of CYP3A4 izoenzyme by age and gender for further increasing the theophylline treatment safety in children with bronchial asthma. Methods. 250 healthy children aged from 1 to 10 years from different ethnical groups (Russians, Kalmyks, Ingush, Chechens, Tatars). Each ethnical group consisted of 50 children. CYP1А2 izoenzyme genotype (by С734A polymorphic marker) was detected by polymerase chain reaction. CYP3A4 izoenzyme of liver cytochrome P 450 activity was measured by calculating urine 6-β-hydrocortisone level to urine cortisol level ratio. Urine 6-β-hydrocortisone and cortisol levels were measured by high precision Liquid chromatography-mass spectrometry. Results. It is the first time when high prevalence of CYP1А2 genotype was reported in children of 5 different nationalities living in Astrakhan region, associated both with slow and rapid CYP1А2 substrate drug metabolism, showing the importance of further individual studies on CYP1А2 genotype polymorphism. Age and gender-related features of CYP3A4 izoenzyme phenotype activity, that should be taken into account while choosing the most effective and safe methylxanthines dosing, were revealed. Conclusion. Before the long-term drug therapy of bronchial asthma using theophylline it is rational to investigate CYP1А2 gene polymorphism and CYP3A4 izoenzyme phenotype activity to increase treatment safety.
Kazan medical journal. 2012;93(5):768-772
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Prospective analysis of lipid profile parameters, inflammatory response and endothelial function markers before and after percutaneus coronary intervention in patients with stable angina
Petelina T.I., Musikhina N.A., Gapon L.I., Dementjeva N.V.
Abstract
Aim. To conduct the prospective study assessing the biochemical laboratory parameters in patients with stable angina and hemodynamically significant coronary artery stenosis before and 12 months after transluminal balloon-catheter angioplasty. Methods. 40 patients (males and females), mean age 57,3±9,6 years with stable angina and chronic coronary artery disease were examined. Patients were divided into 2 groups based on the absence (1st group, 14 patients) or presence (2st group, 26 patients) of hemodynamically significant coronary artery stenosis on selective coronary angiography. Patients with hemodynamically significant coronary artery stenosis underwent percutaneous transluminal coronary angioplasty (PTCA) with stenting (drug-coated stents). Blood lipid profile, inflammatory markers and endothelial dysfunction markers were measured before the surgery and 12 months after treatment. Results. In patients with hemodynamically significant coronary artery stenosis statistically significant association of hemodynamically significant coronary artery stenosis presence with atherogenic lipid fractions levels, inflammatory markers (high-sensitivity C-reactive protein, tumor necrosis factor-alpha) and an endothelial function parameter (endothelin-1) were revealed. Long-term results of PTCA with stenting included the significant decrease of atherogenic and increase of anti-atherogenic fractions in lipid profile. There also was a prolonged inflammatory response characterized by high-sensitivity C-reactive protein (hs-CRP) level elevation, and the endothelin system dysfunction retaining. Conclusion. Persistent hs-CRP level increase as well as endothelin-1 level increase suggest a high risk of late stent thrombosis, it should be taken into account while following-up patients at the late stages after PTCA.
Kazan medical journal. 2012;93(5):772-776
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The influence of thrombolytic therapy on clinical and instrumental parameters of left ventricular remodeling in the late post-infarction period of myocardial infarction with Q-wave
Khairutdinova G.M.
Abstract
Aim. To evaluate clinical and instrumental parameters of late left ventricular remodeling in patients with myocardial infarction with Q-wave depending on use of thrombolysis. Methods. 87 patients with myocardial infarction with Q-wave on electrocardiography (ECG) were included. First group consisted of 34 patients in whom thrombolytic therapy was performed, second group consisted of 53 patients in whom thrombolysis was not used due to late referral (over 12 hours from initial symptom onset, 88,7%), concomitant hemorrhagic stroke (3,8%), previously reported uncontrolled arterial hypertension (7,6%). All patients were followed up at 3-4 weeks, 60 and 120 months after the onset of myocardial infarction, examination included ECG, echocardiography, clinical examination. Results. In patients of both groups increase of total R-wave amplitude on repetitive ECGs was associated with relative left ventricle wall thickening, increase of left ventricular mass index, decrease of systolic and diastolic wall stresses caused by compensatory hypertrophy of intact cardiomyocytes according to results of correlation analysis. Increase of total amplitude of QS-waves on repetitive ECGs was associated with left ventricular cavity dilatation and spherification with wall thickening, increase of systolic and diastolic wall stresses. Patients in whom thrombolysis was not used had significantly higher rates of angina at post-infarction period. No statistically significant differences of ECG and echocardiography parameters between two groups of patients were found during the whole follow-up period. Non-significant increase of total R-wave amplitude and QS-waves amplitude was registered in patients in whom thrombolysis was started not later than 90 minutes from initial symptom onset compared to patients in whom thrombolysis was started later. Conclusion. Comparison of ECG and echocardiography parameters over time did not reveal any statistically significant differences between the groups with and without thrombolysis.
Kazan medical journal. 2012;93(5):777-782
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Cytomorphological characteristics and cytokine profile of induced sputum and nasal secretions of children with community-acquired pneumonia and acute bronchitis
Galimova L.F., Pikuza O.I., Agafonova E.V.
Abstract
Aim. To characterize the mechanisms of nonspecific airway inflammation using the parameters of induced sputum and nasal secretions in children with community-acquired pneumonia and acute bronchitis. Methods. A total of 100 children aged 7 to 16 years with acute respiratory system diseases including 49 patients with community-acquired pneumonia and 51 patients with acute bronchitis were examined. The control group consisted of 25 healthy children and was age- and gender-comparable. The cellular composition, degree of neutrophils and epithelial cells destruction, and cytokines levels both in nasal secretions and in induced sputum were measured. Results. The increase of neutrophils number was accompanied by a high degradation degree in induced sputum оf children with community-acquired pneumonia in contrast to children with acute bronchitis. A simultaneous decrease of alveolar macrophages number was observed. An increase of pro-inflammatory cytokines levels (interleukine-8, -17 and tumor necrosis factor α) with a marked decrease of anti-inflammatory cytokine level (interleukine-10), characteristic for community-acquired pneumonia, correlated with the degree of cell components degradation and depend on the morphological forms of inflammatory lung disease. Conclusion. With increasing severity of inflammation in the respiratory tract number of destructive changes of neutrophils also increases and disbalance of pro- and anti-inflammatory cytokines deepens.
Kazan medical journal. 2012;93(5):783-787
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Experimental medicine
Influence of triphenyltetradecylphosphonium bromide on the Na+-Li+- countertransport rate in the erythrocyte membrane in patients with genetically different permeability of cell membranes to sodium
Orlova O.V., Oslopov V.N., Sidullina S.A.
Abstract
Aim. To study the influence of triphenyltetradecylphosphonium bromide [(PPh)3P+C14H29] Br- on the cell membranes permeability to Na+ by determining the rate of Na+-Li+-counter transport in erythrocyte membrane depending on it’s variable initial condition. Methods. Blood samples of 10 healthy volunteers with different Na+-Li+-counter transport rate distribution in erythrocyte membrane were analyzed: I quartile (5 subjects) - low permeability, III quartile (5 subjects) - moderately high permeability. Results. Na+-Li+-counter transport rate change in erythrocyte membrane under the influence of triphenyltetradecylphosphonium bromide depends on genetically determined initial membrane permeability. In subjects belonging to III quartile of Na+-Li+-counter transport the initial membrane permeability is high, and after administration of 0.001 and 0.005 μM concentrations of [(PPh)3P+C14H29] Br- membrane permeability to Na+ increased. In subjects belonging to I quartile of Na+-Li+-counter transport (low initial permeability) [(PPh)3P+C14H29] Br- did not alter membrane permeability to Na+. Conclusion. Triphenyltetradecylphosphonium bromide increases erythrocyte membrane permeability to Na+ in subjects belonging to III quartile of Na+-Li+-counter transport and dose not influence subjects belonging to I quartile of Na+-Li+-counter transport.
Kazan medical journal. 2012;93(5):789-791
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Reviews
Problems of healthy lifestyle forming in children and young students
Yakovleva T.V., Ivanova A.A., Terletskaya R.N.
Abstract
A review of literature concerning various aspects of children’s and young students’ health and behavioral risk factors affecting its forming is presented. The significant role of pre-school and school education factors in maintaining and improving of younger generations’ health is revealed. Negative aspects of the educational process are: overload with the additional classes adapted from primary school programs at kindergartens, academic overload, irrational schedule, use of innovative teaching methods and technologies that are not suitable for students’ age and physiological features; authoritarianism of modern school, sanitary and epidemiologic requirements noncompliance. Additional risk factors are present in older adolescents: high incidence of out-of-school labor activities (up to 50% of pupils), bad habits, the emergence of occupational exposures, low levels of knowledge in the sphere of self-safety behavior, as well as external causes. Apart from irrational day regimen, academic overload, intensity of exams, behavioral factors are also in the basis of students’ health decrease. The absence of system approach and continuity in solving of the children’s and young students’ healthy lifestyle problems is demonstrated.
Kazan medical journal. 2012;93(5):792-795
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Clinical and immunological parallels in patients with drug addiction
Hamitov R.F., Mustafin I.G., Chernova O.L.
Abstract
Drug addiction is a current serious medical and social problem. The continuing all over the world during the last several decades tendency of narcotic drug use growth has leaded to significant increase in the number of patients with drug abuse and number of associated internal diseases. A huge number of diseases have the particular features of clinical course in drug addicts with chronic drug intoxication compared to patients without it, which is related primarily to serious disorders of drug addicts’ immune system, i.e. with marked immunodeficiency. Immunotropic drug effects were and still are closely studied, a lot of data concerning various cellular and humoral immunity impairments in patients with substance abuse were gained, but most of them are controversial, scattered and not systemic. Because of immunity reconstitution developing in patients with drug abuse, different infections including viral hepatites, HIV-infection, pneumonias, tuberculosis, infective endocarditis and septicemia are characteristic for this patient subgroup. Further research on etiology, immunopathogenesis and clinical features of those diseases in drug addicts are still actual.
Kazan medical journal. 2012;93(5):796-799
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Fast track surgery - a multimodal strategy for managing surgical patients
Mazitova M.I., Mustafin E.R.
Abstract
Multiple factors are involved in the recovery of patients without significant complications and in reduction of the duration of their stay in hospital. The search for effective treatment methods for surgical patients with minimal risk led to the emergence and development of a new concept - fast track surgery. This is a package of healthcare services, which provides a modern approach to the preoperative, intraoperative and postoperative phases of patient management, the combined effect of which is in the reduction of complications, postoperative pain, stress responses and organ dysfunction, as well as early rehabilitation. Reducing the cost of treatment, time of in-hospital stay, faster return to normal life and work - are the benefits of a multimodal strategy for management of surgical patients. Promising initial results obtained using the fast track program, raise the issue of the need to change the traditional system of surgical care in order to improve postoperative results and to further study of each component of this program. Further improvement of this technique requires combined use of minimally invasive surgeries, pharmacological suppression of stress and effective multimodal non-opioid analgesia with active rehabilitation techniques.
Kazan medical journal. 2012;93(5):799-802
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Rational use of medicines: contribution to development of healthcare systems
Shaydullina L.Y., Ziganshina L.E.
Abstract
Development of World Health Organization (WHO) Rational Use of Medicines concept internationally and its implementation in the Russian Federation is reviewed. The need to consolidate efforts for the introduction of the WHO-developed strategy for the use of medicines improvement is explained. The WHO strategy to improve the use of medicines is described. Abundance of medicines, medicinal products and various formulations of the same active substances, as well as of promotional materials, which often mislead healthcare community and consumers, requires establishment of a system promoting effective and safe use of medicines and ensuring access to essential medicines of all members of the society. The factors which contribute to irrational use of medicines, avoidable causes, and consequences of irrational use of medicines are presented. Current situation in the Russian Federation regarding the use of medicines: legal and regulatory framework, the results of the registration process, documents valid on a national level and in particular regions that determine pharmaceutical policy is described in detail. Methodology of assessing prescribing practices and medicine consumption recommended by the World Health Organization for implementation and use globally is revealed. The implementation of the WHO concept of the rational use of medicines in the Republic of Tatarstan is described as an example. An illustration of the authors’ findings on effects of clinical pharmacology services on containment of medicines’ costs at the level of internal diseases department of municipal hospital is presented. The leading thesis of WHO Rational Use of Medicines concept - the establishment of independent multidisciplinary regional structures responsible for the quality use of medicines - is substantiated.
Kazan medical journal. 2012;93(5):803-806
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Evaluation of myocardial viability in patients with coronary heart disease complicated with advanced left ventricular dysfunction
Saifullina G.B., Ibatullin M.M., Sadykov A.R., Valiullina N.M.
Abstract
Review of the literature on myocardial viability evaluation at the stage of surgical treatment planning in patients with coronary heart disease complicated with advanced left ventricular dysfunction is presented. In significant number of patients myocardial revascularization may improve regional and global heart function, and lead to further clinical improvement. The underlying pathophysiology involves different types of reversible myocardial dysfunction (hibernation, stunning), which may co-exist within the same patient’s myocardium. Potentially reversible left ventricular dysfunction is characterized by preserved cell membrane integrity and cardiomyocyte metabolism (sufficient to maintain cellular functions and cell membrane integrity in conditions of chronic or repetitive ischemia). Another important objective when assessing myocardial viability - pre-operative evaluation of post-infarction aneurysms in patients with severe left ventricular dysfunction. Results of clinical trials assessing the effectiveness of surgical revascularization in patients with ischemic cardiomyopathy as well as the results of the clinical trial on surgical treatment of ischemic heart failure are presented. A spectrum of non-invasive methods of myocardial viability evaluation, including the most studied nuclear, allows to identify cases of reversible left ventricular dysfunction in patients with congestive heart failure and to make a prognosis on success of the surgical treatment.
Kazan medical journal. 2012;93(5):806-810
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Epidemiology and healthcare management
Alteration of medical radiation exposure annual collective effective dose of the population of Tatarstan from 1998 to 2010
Ryzhkin S.A., Ivanov S.I., Patyashina M.A., Ismagilov R.K.
Abstract
Aim. To find out the contemporary principles of collective effective dose of medical radiation formation gained due to medical X-ray and radiological examinations. Methods. Data analysis of radiation and hygiene passports of Republic of Tatarstan territory for the period from 1998 to 2010 was fulfilled. Change of healthcare radiation sources number over time was defined. Number of performed medical X-ray and radiological examinations, average patient’s individual and total effective radiation doses were compared. Results. The number of medical X-ray and radiological examinations increased annually. The rate of different X-ray and radiological examinations as well as gained total effective radiation doses has changed significantly during the analyzed period of time. Use of digital technologies in radiology allowed to decrease average patient’s individual doses to 0.16 mSv for chest photofluorography and to 0.15 mSv for standard X-ray. In recent years, X-ray computed tomography is the largest contribution (40.6%) to the collective effective medical exposure dose of the population. Conclusion. Ionizing radiation use in medical practice remains one of the leading sources of the combined population radiation, primarily due to modern X-ray and radiological examinations; it requires attention and development of special arrangement, technical, prevention measures to decrease unfavorable influence of radiation to population.
Kazan medical journal. 2012;93(5):811-816
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Modern death risk factors in patients with community-acquired pneumonia
Povalyaeva L.V., Borodulin B.E., Borodulina E.A., Chernogaeva G.Y., Chumanova E.S.
Abstract
Aim. To study death risk factors in patients with community-acquired pneumonia in municipal hospitals in Samara. Methods. 75 cases of deaths of patients hospitalized because of community-acquired pneumonia were studied (study group), 300 convalescent patients with community-acquired pneumonia discharged from the hospital were included in the control group. The retrospective comparative «case control» study was performed. Results. Mean age of the patients who died was 47.4±2.2 years; men were more prevalent (70.6%), time since admission date till death was 6.5±2.5 days, more than a third (36.0%) died before 24 hours after admission. The study group contained significantly higher number of unemployed (72.0%) and intravenous drugs users (16.0%). HIV infection was found in 37.3% of the patients who died, compared to 19.6% prevalence in control group. Multifactorial logistic regression of clinical signs revealed the following death risk factors in patients with community-acquired pneumonia: infiltrates on X-ray involving more than one lung lobe, arterial hypotension (systolic blood pressure ≤100 mm Hg, diastolic blood pressure ≤60 mm Hg), tachypnea (breath rate over 25 per minute). Conclusion. Factors having the highest positive prognostic value for a lethal outcome at patients with community-acquired pneumonia are: late admission, multilobar pneumonia; arterial hypotension; tachypnea; HIV infection, social unemployment and male gender.
Kazan medical journal. 2012;93(5):816-820
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The analysis of the drug supply system for patients with bronchial asthma in the Republic of Tatarstan
Shakirova D.H., Fassakhov R.S., Kamaeva A.Z.
Abstract
Aim. To analyze the current drug supply system for patients with bronchial asthma in the Republic of Tatarstan. Methods. Systematic, marketing, statistical, retrospective, situational analysis was performed. Bronchial asthma incidence data, data of drug supply system for patients with bronchial asthma in the Republic of Tatarstan were analyzed. Results. From 2005 to 2011 the number of patients with a diagnosis of bronchial asthma has increased by 23.9%, and there were 25 700 newly diagnosed cases. Out of 215 medications to treat bronchial asthma registered in the country, 68 are produced in Russia. The rate of inhaled medications produced by domestic is only 15.91%. Outpatients are provided with drugs under the federal and regional programs of preferential drug supply. In 2010 - over 81 thousand, in 2011 - over 87 thousand of prescriptions were issued under the program of vital drug supply for patients with bronchial asthma. The cost of drug supply exceeded 60 million rubles in 2010, in 2011 it was about 67 million rubles. There was a 5.87% increase of number of patients covered by drug supply in 2010-2011. If the patient denies the drug supply, he/she is responsible to pay for his medication, the approximate cost of treatment of patient with bronchial asthma is over 28 000 rubles per year. In 2011 the number of patients supplied under the regional supply program has significantly increased by 76.29% leading to decrease of cost of medications supplied per 1 patient. Conclusions. The need to find evidence-based solutions to the problems of drug supply system for patients with bronchial asthma at the regional level was identified.
Kazan medical journal. 2012;93(5):820-823
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The association of the FTO gene polymorphism with overweight in russian population
Nasibulina E.S., Shagimardanova R.R., Borisova A.V., Ahmetov I.I.
Abstract
Aim. To investigate the association of the first intron of FTO (fat mass and obesity associated) gene T/A (rs9939609) polymorphism and overweight in Russian population. Methods. 107 (females 48, males 59) overweight (body mass index 25.0-29.9 kg/m2) subjects or subjects with obesity (body mass index ≥30 kg/m2) were included. The control group (body mass index ≤24.9 kg/m2) consisted of 453 subjects (females 323, males 130). Genotyping for the T/A (rs9939609) polymorphism of the FTO gene was performed by polymerase chain reaction (PCR) and restriction enzyme digestion. Results. The frequency of the FTO A allele in subjects with overweight or obesity was significantly higher compared to controls (45.3% vs. 33.4%; p=0.0015). The genotype distribution of the FTO gene T/A polymorphism (TT - 32.7%, TA - 43.9%, AA - 23.4%) in a group of subjects with overweight or obesity was significantly different compared with controls (TT - 44.6%, TA - 43.9%, AA - 11.5%; p=0.0028). The relative risk of being overweight or obese was 2.4 for subjects with the FTO AA genotype. Conclusions. The results of the presented study suggest an association of the FTO gene T/A polymorphism with the risk of obesity, which is consistent with the data of numerous studies.
Kazan medical journal. 2012;93(5):823-826
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Prevalence of sustained arterial hypertension, white coat hypertension and masked hypertension among working women
Kalcheva E.Y., Oslopov V.N., Zakharova O.V.
Abstract
Aim. The prevalence of sustained arterial hypertension, white coat hypertension (isolated clinical arterial hypertension) and masked hypertension (isolated ambulatory arterial hypertension) among employed women of Kazan was studied. Cardiovascular risk factors in these conditions were evaluated. Methods. The study cohort included 108 patients. The examination was conducted at the jobsite and included questionnaires, blood pressure measurements, anthropometry, fasting glucose level and lipid profile examination. Assessment of blood pressure in everyday conditions was performed by 24-hour monitoring of blood pressure or home blood pressure measurements over 4 days. Results. The prevalence of sustained hypertension in the study cohort was 31.6%, white-coat hypertension - 4.6%, masked hypertension - 13.9%. Among patients with white coat hypertension and masked hypertension most of the patients had two or more cardiovascular risk factors; the distribution of risk factors number in these groups was similar to a group of patients with sustained hypertension. Conclusion. Among the employed women the prevalence of sustained arterial hypertension was high, the prevalence of masked hypertension was quite high, the prevalence of white coat hypertension was lower than expected.
Kazan medical journal. 2012;93(5):826-829
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Assistance to the practicing physician
Features of static, paralytic and iatrogenic foot joints deformities diagnosis and treatment
Ezhov M.Y., Batalov O.A., Ezhov Y.I.
Abstract
Aim. To evaluate the efficiency of treating patients with orthopedic foot diseases for previous 30 years, including treatment using high technology methods. Methods. 700 patients aged from 16 to 85 years underwent surgical treatment. All foot state parameters were scored using a 10-point grading system. To specify the transversal arch parameters, computed tomography and magnetic resonance tomography were performed. To assess the general condition of the foot, vascular ultrasound, electroneuromyography, biomechanical examination using ink print mats and podometry. In treating patients with hallux valgus in most of the cases (55%) straightening surgery of first metatarsus partial removal at proximal epiphysis was preferred. First metatarsophalangeal endoprosthesis, orhtopedic casts and various types of osteotomy for hallux valgus straightening were also used. Results. Patients had the mean total foot condition score at 31.3 points (normal range is upper than 50) indicating grade II-IV, after the surgical treatment the mean total foot condition score was 46.7 points in 91.6% of treated patients. Inappropriate staging of surgical treatment has leaded to inadequate treatment outcomes, in particular, surplus caput osteotomy of first metatarsus leaded to first metatarsophalangeal joint osteoarthritis progression and to hallux varus development. Conclusion. Appropriate pre-surgical planning and use of high technology methods of surgical treatment allows to compensate even advanced foot deformities.
Kazan medical journal. 2012;93(5):830-834
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The role of pharmaco-electroencephalographic monitoring in treatment of patients with resistant forms of epilepsy
Stolbova E.A., Bein B.N.
Abstract
Continuous electroencephalography monitoring plays an important role in assessing the effect of anticonvulsant treatment. To illustrate this, an own clinical experience of continuous electroencephalography monitoring in a patient with giant subcortical-periventricular heterotopia at the stage of anticonvulsant selection is presented. A clinical case of symptomatic epilepsy as a result a giant subcortical-periventricular brain heterotopia was observed. Seizures were resistant to ongoing treatment. Epileptic seizure and coincident epileptic brain activity were registered for the first time in this patient only at continuous electroencephalography monitoring. On brain magnetic resonance imaging signs of giant subcortical-periventricular heterotopia of right frontal and temporal lobes were found. The combination of anticonvulsants was changed, allowing to achieve clinical remission, which was proved by repetitive electroencephalography after 7 months of treatment. The role of continuous electroencephalography monitoring to determine the effect of administered anticonvulsant treatment is shown. Heterotopias are a group of subcortical displasias - various maturation abnormality of the cerebral cortex, which are often associated with neurological deficits, onset as an epileptic seizure is characteristic. The particular feature of the presented case is minimal neurological deficit observed. The onset of epileptic seizures in the patient was at the age of 12 despite considerable morphologic brain changes.
Kazan medical journal. 2012;93(5):834-837
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Clinical observations
Mammary gland in vulva (rare clinical case)
Kozlov L.A., Zhuravleva V.I.
Abstract
A rare clinical case of a patient with fibroadenoma of the vulva’s right labium majus with a typical hystological structure of mammary grand is described. The patient noticed a tumor of the right labium majus approximately 10 years before admission. After the childbirth while breastfeeding patient noticed a whitish discharge form the tumor which looked like breast milk. At the oncologic dispensary biopsy was performed after the tumor punction, atypical basal epithelium was found, and the basal cell carcinoma was suspected. Histological examination revealed fibroadenoma with a typical hystological structure of mammary grand.
Kazan medical journal. 2012;93(5):838-840
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Atypical clinical course of pneumonia in a patient with ummunodeficiency, iron-deficient anemia and dietary supplement intake
Saifutdinov R.G., Minnullina Z.S.
Abstract
A clinical case pneumonia and multiple organ dysfunction syndrome in a patient with iron-deficiency anemia and previous intake of a dietary supplement for weight loss is presented, including results of examinations, observation and treatment. A 22 years old female was admitted with complaints on dyspnea, dry cough, malaise, «pulsing» head ache at the back of the head, vertigo while walking, fever up to 39 °С during the previous 3 days. Basing on the results of chest X-ray and laboratory examination the diagnosis of «Community-acquired subtotal right-sided pneumonia of mixed origin, severe clinical course, respiratory failure grade III, complicated by toxic shock syndrome, toxic pulmonary edema, disseminated intravascular coagulopathy stage I. Acute cardiac failure, acute respiratory distress syndrome. Acute iron-deficiency anemia. Acute erosive hemorrhagic gastritis. Obesity, II degree» was set up. In spite of active treatment patient’s condition deteriorated due to intoxication, cardiac failure and respiratory distress progress. Autopsy revealed that the patient has died of severe viral pneumonia, although such an extensive pneumonia is not typical for a 22-year old patient. Severe pneumonia development may be explained by immunodeficiency intensified by acute iron-deficiency anemia, which can be a possible side effect of previous intake of a dietary supplement for weight loss and alimentary factors.
Kazan medical journal. 2012;93(5):840-843
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Pathogenetic treatment of the patient with splenic marginal zone lymphoma complicated by Evans syndrome
Romanenko N.A., Bessmeltsev S.S., Abdulkadyrov K.M.
Abstract
A case report of a patients with splenic marginal zone lymphoma, in whom clinical remission was initially achieved by 5 continuous courses of combined treatment with fludarabine 25 mg/m2 and cyclophosphamide 350 mg/m2 at days 1-3. Nevertheless, 6 months after patient developed a clinical picture of Evans syndrome, characterized by severe hemolytic anemia, thrombocytopenia and neutropenia. Corticosteroid treatment accompanied by blood transfusion was initiated, the effect was marginal and short-lasting. Switch to rituximab monotherapy allowed to archieve complete clinical and hematological remission with full blood count parameters reversal.
Kazan medical journal. 2012;93(5):843-846
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