Vol 94, No 1 (2013)

Theoretical and clinical medicine
Puncture drain interventions in treatment of acute pancreatic necrosis
Korymasov E.A., Krichmar A.M., Dzharar R.M.
Abstract
Aim. To define the prognostic factors for puncture drain interventions efficiency and of an optimal time point for the open surgeries. Methods. Surgical treatment results in 56 patients with acute pancreatic necrosis are described. The first group (28 patients) included the patients treated only by. The second group (28 patients) included the patients who underwent puncture drain interventions with further open surgery. Puncture drain surgery efficiency was evaluated using laboratory data and results of instrumental examinations. Results. Body temperature, leukocytosis and a «left shift» on a white blood cell count performed not later than 7 days after the surgery were the key factors for assessing the puncture drain surgery efficiency. During the first 7 days after surgery the body temperature has come to normal in 100% of patients from the first group and in 30% of patients from the second group (c2=15,83, р <0,0005), in other 70% of patients from the second group the body temperature has come to normal later than 7 days after surgery. White blood cell count has come to normal during the first 7 days after surgery in 75% of patients from the first group and in 0% of patients from the second group (c2=11,14, р <0,0016), in 25% of patients from the first group and in all patients from the second group it has only came to normal range at least 7 days after surgery. A marked «left shift» during the first 7 days after surgery was registered in 50% of patients from the first group and in 0% of patients from the second group (c2=6,12, р <0,05), in 50% of patients from the first group and in all patients from the second group it has only came to normal range at least 7 days after surgery. A conservative approach should be preferred if these parameters improve over time and no significant changes in pancreas are seen on computed tomography, otherwise, especially when there are the signs of incomplete debridement on the computed tomography, an open-access surgery should be performed. Conclusions. Puncture drain intervention may be an independent and final method of surgical treatment or may become the first stage of combined surgical treatment in patients with acute pancreatic necrosis. Indications for an open-access surgery should be assessed 7-8 days after the puncture drain surgery was performed if no positive change of laboratory data is seen.
Kazan medical journal. 2013;94(1):1-6
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Assessment of pancreatic secretory function in children with cystic fibrosis in the Republic of Tatarstan
Timoshenko J.V., Rylova N.V.
Abstract
Aim. To assess the pancreatic secretion in children with cystic fibrosis. Methods. 38 children with cystic fibrosis aged from 1 to 18 years were included. Pancreatic elastase-1 stool level, as well as blood lipase and amylase activity were assessed by ELISA in 34 children. Results. Children were distributed to 3 groups depending on degree of elastase-1 stool level decrease: first group - with severe pancreatic insufficiency (50%), second group - with slight pancreatic insufficiency (8.8%), third group - with normal pancreatic function (41.2% of patients). Blood lipase and amylase activity was within normal ranges in all children, that can be explained by ongoing enzyme replacement treatment. The way to detect the elastase-1 stool level by ordinary non-invasive method seems to be very valuable, especially in pediatrics. Elastase test allows to reveal pancreatic malfunction without canceling enzyme replacement treatment and to supervise the pancreatic secretion. Conclusion. In children with cystic fibrosis pancreatic secretory function is affected in most of the cases. A combined examination including the elastase-1 stool level detection allows to assess the pancreatic status of patients with cystic fibrosis more precisely and to adjust the doses of pancreatic enzymes.
Kazan medical journal. 2013;94(1):6-9
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Endothelium-dependent vascular tone regulation mechanisms in patients with ischemic stroke
Dolgov A.M., Ryabchenko A.Y., Denisov E.N., Gumanova N.G.
Abstract
Aim. To study the role of nitroxidergic reactions of the circulatory system in the development of ischemic stroke. Methods. 51 patients (both males and females) with the diagnosis of ischemic stroke were examined. All patients were distributed to 3 groups according to the severity of neurological deficit. All patients underwent brain computed tomography or magnetic resonance imaging. Cerebral blood flow was examined by extra and transcranial ultrasonic dopplerography. Central hemodynamics was evaluated by echocardiography. General clinical examination, neurological and neuroophthalmological examinations were also performed. Vasomotor endothelial function was assessed using a 7 MHz linear transducer on the ultrasound unit «Medison SonoAce X8». The level of nitric oxide was assessed using its stable metabolites, nitrite and nitrate definition in serum. Neurological status was assessed according to the USA National Institutes of Health Stroke Scale. Results. Disorders of nitroxidergic mechanisms of blood vessels regulation were observed in patients with ischemic stroke. Endothelium-dependent brachial artery dilation disorders and nitric oxide persistent metabolites level decrease were related to the severity of the disease and the neurological deficit degree. Conclusion. The study of endothelium-dependent vascular tone regulation mechanisms revealed that these mechanisms are involved in the pathogenesis of ischemic stroke; the study of these mechanisms can be used to clarify the severity of neurological deficit, and possible prognosis.
Kazan medical journal. 2013;94(1):9-13
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Markers of ischemic neuronal damage, neurological complications of carotid endarterectomy and their management depending on anesthesia type
Shmelev V.V., Neymark M.I.
Abstract
Aim. to identify the anesthesia method for carotid endarterectomy providing minimal ischemic neuronal damage and decreasing the number of post-surgical complications; to adjust the optimal treatment for associated neurological disorders. Methods. An assessment of anesthesia methods was performed in 190 patients who underwent the carotid endarterectomy. The intravenous anesthesia with propofol (first group, 60 patients), regional anesthesia using deep cervical plexus block (second group, 60 patients), and inhalational anesthesia with sevoflurane (third group, 70 patients) were compared. Brain perfusion parameters, neurological status, ischemic neuronal damage markers were examined. Results. In patients undergoing carotid endarterectomy an ischemic neuronal damage is provoked due to brain perfusion decrease as a result of common carotid artery clipping regardless of anesthesia method. Inhalational anesthesia was associated with relatively lower ischemic neuronal damage markers levels. Some patients form every group have developed serious post-surgical neurological complications (stroke, transient cerebral ischemic attack, neurological status deterioration). Post-surgical complications were registered in 10 (16.7%) patients from the first group, in 9 (15%) patients form the second group, in 3 (4.3%) patients from the third group. Citicoline was the most effective drug for associated neurological disorders treatment. Conclusion. Inhalational anesthesia with sevoflurane compared to intravenous anesthesia with propofol and regional anesthesia using deep cervical plexus block limits the neuronal damage and is associated with lower number of post-surgical neurological complications, which can be treated with citicoline.
Kazan medical journal. 2013;94(1):13-17
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Instant and long-term results of surgical treatment in patients with peripheral vascular disease as a complication of diabetes mellitus
Krepkogorskiy N.V., Sharafutdinov M.R., Ignatyev I.M., Bredikhin R.A., Galyautdinov F.S.
Abstract
Aim. To define the indications and to evaluate the effectiveness of various surgical treatment methods in patients with arterial stenosis and occlusion due to atherosclerotic vascular disease of lower extremities as a complication of diabetes mellitus. Methods. Results of surgical treatment of 52 randomly assigned patients who underwent surgeries due to peripheral vascular disease as a complication of diabetes mellitus (type 2 - 51 patients, type 1 - 1 patient) were analyzed. The following surgeries were performed: arterial reconstructive surgery - 24 (46.2%) patients (group 1), balloon catheter angioplasty and stenting - 12 (23.1%) patients (group 2), indirect revascularization surgery (revascularising osteotrepanation, endovascular prostaglandin E therapy) - 16 (30.7%) patients (group 3). Following parameters were assessed: decrease of ischemic rest pain, arterial insufficiency stage, hospitalization terms, healing of foot ulcers, mortality rate, and amputation rate. The longest foot ulcers healing terms [only in 5 patients (31.2%) at first year] were registered in the third group. 1 death was registered each in the first and in second groups (mortality rate 4.2 and 8.3% respectively), no deaths were registered in group 3. The results of trophic ulcers treatment in the patients from the third group were poor. It is tactically appropriate to prefer endovascular surgeries to open surgeries as far as in this case there is no need for local and general anesthesia allowing to decrease the number of complications and the length of rehabilitation together with comparable results. Primary open arterial reconstructive surgeries are possible in patients with diabetes mellitus as a next step after endovascular surgery or when endovascular surgery can not be done. Conclusion. Similar instant and long-term results were found after direct comparison of bypass and endovascular surgeries, allowing to recommend these surgeries in patients with peripheral vascular disease as a complication of diabetes mellitus.
Kazan medical journal. 2013;94(1):18-22
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Prevalence of the eye diseases in children living in ecologically unfavourable environment
Amirov A.N., Saifullina F.R., Zainutdinova I.I.
Abstract
Aim. To study the influence of environmental pollution on eye function in children. Methods. Prevalence of eye diseases was retrospectively studied in 1250 children aged 14-16 years using the 5-year data from medical charts. Children from a region with intensive traffic (threshold limit value exceeded for the following parameters: CO - 3.3 times higher, dust - 1.5-2 times higher, sulfur - 1.3-1.8 times higher, nitrogen dioxide - 1.5-2 times higher), were analyzed as the main cohort. Children from the control cohort lived in region with lower traffic load, with no excess of threshold limit values for basic substances. Results. The prevalence of eye diseases among the children of Kazan city was assessed as 205,4±0,3‰, it has increased over time at the analyzed time gap. Refractive errors, diseases of conjunctiva and eyelid disease were the most common eye diseases. The prevalence of eye diseases among the children from the intensive traffic district was assessed as 223,1±0,3‰, which was higher compared to the district with small traffic load - 97,9±0,4‰ (р <0,01). Refractive errors, diseases of conjunctiva and eyelid disease were the three most common eye diseases among the children from the intensive traffic district. Conclusion. The prevalence of eye diseases among the children living in the intensive traffic district of Kazan city is higher compared to the district with better environment.
Kazan medical journal. 2013;94(1):22-25
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Blood and vitreous humor cytokine profile in patients with proliferative diabetic retinopathy and post-vitrectomy hemophthalmia
Putienko A.A., Pogorely D.N.
Abstract
Aim. To study vascular endothelial growth factor (VEGF), tumor necrosis factor alpha (TNF-α), interleukin-1β (IL-1β) and interleukin-1 receptor antagonist (IL-1RA) blood and vitreous humor levels in patients with proliferative diabetic retinopathy (PDRP) and post-vitrectomy hemophthalmia. Methods. 82 patients (82 eyes) with PDRP and post-vitrectomy hemophthalmia present 2 months (from 55 to 78 days) after performed vitrectomy were examined. Results. In patients with proliferative diabetic retinopathy (PDRP) and post-vitrectomy hemophthalmia VEGF blood level remained normal in 92.7% of cases, TNF-α blood level was normal at all times, blood level of IL-1β was within normal ranges in 93.8% of cases, and IL-1RA blood level was decreased in 74.4% of cases. Vitreous humor level was above normal ranges for VEGF - in 84% of cases, for TNF-α - in 9,9% of cases, IL-1β vitreous humor level was within reference ranges at all times, and IL-1RA vitreous humor level was decreased in 84.1% of cases. Conclusion. The gained data indicates further vascular proliferation in the eye cavity as a leading factor for hemorrhage relapses, despite the vitrectomy performed.
Kazan medical journal. 2013;94(1):26-30
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The clinical diagnosis of HIV-infection in a specialized hospital
Fazylov V.H., Manapova E.R., Goltz M.L., Lustikman E.M., Beshimov A.T.
Abstract
Aim. To assess the structure of opportunistic infections and concomitant diseases, including the stage of infection, in patients hospitalized with HIV-infection. Methods. 40 cases of in-patient treatment of patients diagnosed with HIV aged 25 to 42 (mean age 34.26±1.22), male - 26, female - 14, with mean duration of infection 6,7±0,6 years were analyzed. Results. The patients were admitted to the hospital on 17±3.24 day of the disease, including cases of pulmonary diseases (on 23±3.6 day), cases of chronic hepatitis reactivation and liver cirrhosis decompensation (on 30±10.09 day), cases of acute infections (on 7±1.16 day). Previous psychoactive drug use was confirmed in 28 (70.0%) of patients. 13 (32.5%) patients received treatment with antiretroviral drugs, 3 (7.5%) have abandoned it, the rest had never been offered an antiretroviral treatment. According to the classification by V.I. Pokrovsky, the patient were staged as: stage III - 4 (10.0%) patients, stage IVA - 8 (20.0%), IVB - 11 (27.5)%, IVC - 17 (42.5%) patients. Pulmonary diseases were the most prevalent and were diagnosed in 17 (42,5%) patients, including cases of community-acquired pneumonia (focal, multisegmental, interstitial, lobular) in 8 (47.1%) patients, pulmonary tuberculosis (infiltrative, military, intrathoracic lymph nodes tuberculosis) in 9 (52.9)% patients. Liver diseases (chronic hepatitis B, chronic hepatitis B + C, liver cirrhosis) were the most frequent concomitant diseases and were found in 21 (52.5%) patients. Conclusion. Herpes zoster and liver diseases are the most predominant concomitant diseases at the early stages of HIV-infection, whereas ooportunistic infections, tuberculosis, community-acquired pneumonia and sepsis are typical in patients with late stages of HIV-infection.
Kazan medical journal. 2013;94(1):30-34
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Changes of intestinal microbiota in patients with HIV
Khasanova G.R., Anokhin V.A., Bikkinina O.I., Shakhbazova E.N., Kotlyar E.Y., Nagimova F.I.
Abstract
Aim. To assess the changes in intestinal microbiota in patients with HIV. Methods. The cultures of stool samples of 317 patients with different stages of HIV [13 (4.1%) patients - with the acute infection stage (2A, 2B, 2C), 217 (68.5%) - with the stage III, 87 (27.4%) - with the stages IVA-B according to classification by Pokrovsky V.I., 2001] were examined by plating on the growth medium and further microbiologic examination. Results. Changes in intestinal microbiota were found in 94% of the patients. The decrease in the obligatory microorganisms quantity, especially in bifidobacteria (lower than reference ranges in 70.3% of patients) was the most frequent finding. Bacterial overgrowth of conditionally pathogenic biota (mainly S. aureus and Candida) was registered in 57.1% of patients. The intestinal microbiota composition did not depend on the clinical stage of HIV infection and presence of opportunistic infections, with only CD-4 count associated with the degree of intestinal microbiota changes. Conclusion. Intestinal microbiota changes are typical for patients with HIV infection at all stages of the disease regardless of opportunistic infections presence. Low CD-4 count is associated with higher severity of intestinal microbiota changes.
Kazan medical journal. 2013;94(1):34-39
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Comparative analysis of echocardiography, multispiral computed tomography, myocardial perfusion scintigraphy to evaluate left ventricular volume and left ventricular ejection fraction
Galyavich A.S., Rafikov A.Y., Saifullina G.B.
Abstract
Aim. To perform a comparative analysis of multislice computed tomography (MSCT), echocardiography and single photon emission computed tomography (SPECT) in the evaluation of left ventricular end-diastolic volume (LV EDV) and left ventricular ejection fraction (LVEF). Methods. The study included 44 patients (15 female, 29 male) aged of 21 to 73 years (mean age 55±11 years). LV EDV and LVEF were assessed by noninvasive MSCT coronary angiography. echocardiography and SPECT were also performed. Results. There was a statistically significant difference found between the LV EDV medians for the following pairs: MSCT vs Quantitative Gated SPECT (QGS), MSCT vs SPECT using 4D MSPECT regimen, MSCT vs echocardiography. There was no statistically significant difference determined for the following pairs: echocardiography vs SPECT, QGS SPECT vs 4D MSPECT. Difference between the LV EDV were calculated using the Bland-Altman method as following: MSCT vs echocardiography - 55±33 ml, MSCT vs QGS SPECT - 38±29 ml, MSCT vs 4D MSPECT - 30±33 ml. Differences in the LVEF evaluation methods were: MSCT vs echocardiography - 2,5±7,2%, MSCT vs QGS SPECT - 0,9±8,3%, MSCT vs 4D MSPECT - 1,2±8,1%. The highest LV EDV values were registered by MSCT, the lowest - by echocardiography, with the values registered by SPECT lying in between MSCT and echocardiography volumes. Conclusion. MSCT, echocardiography and SPECT present different left ventricular volume and similar LVEF data.
Kazan medical journal. 2013;94(1):39-43
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To the issue of normalizing the heart rhythm in patients with mitral valve disease complicated by atrial fibrillation
Yambatrov A.G., Medvedev A.P., Chiginev V.A., Zhurko S.A., Pichugin V.V.
Abstract
Aim. To examine an opportunity of sinus rhythm recovery in patients with mitral valve disease and atrial fibrillation (AF) by the means of surgery and concomitant procedures. Methods. 180 patients with AF who underwent mitral valve surgery using cardiopulmonary bypass in 2007-2011 were examined. Patients’ mean age was 52.5±0.5 years, 71 (39.4%) were male, 109 (60.6%) - female. Patients were divided into 3 groups: 22 patients with paroxysmal AF were included in Group I. 109 patients with persistent AF who underwent mitral valve surgery only were allocated to the Group II. 49 patients with persistent AF who underwent additional pulmonary vein isolation (radiofrequency ablation) were included in the Group III. Results. 83 (46.1%) of patients had single mitral valve disease, 62 (34.4%) of patients had multiple valve disease with involvement of tricuspid valve, 21 (11.7%) of patients had multiple valve disease with involvement of aortic valve, 21 (11.7%) of patients had all abovementioned valves involved. Mean arrhythmia duration was 36.3±3.8 months. Sinus rhythm was restored during the surgery in 16 (72.7%) patients of the Group I, in 60 (55.0%) patients of the Group II, in 41 (83.7%) patients of the Group III. Sinus rhythm was still registered at the discharge in 14 (63.6%), 19 (17.4%) and 13 (26.5%) respectively. Conclusion. It is possible to recover and hold regular rhythm in early postoperative period in more than 60% of cases in patients who underwent surgery for mitral valve disease and concomitant paroxysmal AF. Simultaneous radiofrequency ablation performed in patients with persistent AF increases sinus rhythm recovery rate in first day after surgery.
Kazan medical journal. 2013;94(1):43-49
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Non-invasive mechanical ventilation for reperfusion myocardial injury prevention after endovascular surgeries in patients with ST-elevation myocardial infarction (STEMI)
Neimark M.I., Zayashnikov S.V., Kalugina O.A., Berestennikova L.N.
Abstract
Aim. To determine the need for pressure controlled non-invasive mechanical ventilation for reperfusion myocardial injury prevention in patients with ST-elevation myocardial infarction (STEMI). Methods. The study enrolled 61 patients admitted to the intensive care unit within 6 hours from the debut of chest pain, ST-segment elevation on electrocardiogram and oxygen saturation less than 90%. A percutaneous coronary intervention on an affected coronary artery was performed in all patients 30-90 minutes from admission. Non-invasive mechanical ventilation using the «MAQUET Servo-s» machine was started in patients of the first group (31 patients, mean age 66.3±10.7 years, males - 19, females - 12) with positive end expiratory pressure of 2-6 cm H2O, pressure support of 6-10 cm H2O, 40-60% O2 gas mix. Patients of the second group (comparison group, 30 patients, mean age 63.5±9.8 years, males - 16, females - 14) were offered a conventional treatment of ST-elevation myocardial infarction, including inhalations of humidified oxygen (6-8 liters per minute) using a nasal cannula. Results. Systolic, diastolic blood pressure and heart rate were 123.0±9.4 mm Hg, 81.2±11.3 mm Hg, 70.1±6.1 beats per minute in patients of the first group in 6 hours after admission. In patients of the comparison group the following parameters were measured as 157±12.4 mm Hg, 90.2±10.1 mm Hg, 92.6±10.2 beats per minute. The absolute risk increase of arrhythmias related to reperfusion myocardial injury was 17.8% (р <0.05) for the patients from the second group. Ejection fraction on a transthoracic echocardiogram (Teichholz method) was measured as 47.0±4.0 and 60.5±7.4% in patients from the first and the second groups respectively (р <0.05). Conclusion. Non-invasive mechanical ventilation decreases the risk for arrhythmias related to reperfusion myocardial injury, and increases the ejection fraction compared to conventional treatment and can be applied in patients with STEMI.
Kazan medical journal. 2013;94(1):50-54
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Prevalence of atopic dermatitis symptoms and its relation to respiratory allergy in preadolescent children
Shamov B.A., Safiullina I.G., Beshimova A.B.
Abstract
Aim. To study the prevalence of atopic dermatitis symptoms and its relation to bronchial asthma symptoms in children of 7-8 years of age. Methods. 8880 children aged 7-8 years were examined (3000 children - in 2002, 2865 children - in 2006, 3015 children - in 2010). A questionnaire survey for atopic dermatitis symptoms was conducted as a part of international unified program «International Study of Asthma and Allergy in childhood». Results. Significant differences in prevalence of atopic dermatitis symptoms according to the questionnaire survey and as documented in medical charts were determined. The prevalence of atopic dermatitis symptoms has raised from 12.5±0.4% in 2002 to 20.4±1.5% in 2010 (р <0.001). The prevalence of atopic dermatitis symptoms early onset (younger than 2 years of age) decreased from 7.6±1.0 to 4.9±0.8% (p <0.05). The prevalence of atopic dermatitis relapses during the past calendar year increased from 3.2±0.6 to 4.8±0.8% (p <0.05). Meanwhile, the diagnosis of atopic dermatitis was set up in preadolescent children 7-8 years of age fore frequently: to 4.0±0.7% in 2002 compared to 13.8±1.3% in 2010 (p <0.001). The prevalence of atopic dermatitis and bronchial asthma combination increased from 3.4±0.4 to 7.8±1.0% (p <0.001). A strong relation between presence of atopic dermatitis symptoms and bronchial asthma symptoms was discovered (from 0.76 to 1.00, p <0.05). Conclusion. The prevalence of atopic dermatitis symptoms and bronchial asthma symptoms is still growing in preadolescent children 7-8 years of age, a relation between presence of abovementioned diseases symptoms was discovered.
Kazan medical journal. 2013;94(1):55-59
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Influence of wedged cervical lesions and dentine hypersensitivity on quality of life
Islamova D.M., Bulgakova A.I., Valeev I.V., Dumeev R.M.
Abstract
Aim. To study the influence of wedged cervical lesions and dentin hypersensitivity on quality of life. Methods. 118 patients with wedged cervical lesions and dentin hypersensitivity were examined. The quality of life was assessed using the Oral Health Impact Profile (OHIP-14) 14-item questionnaire focusing on seven dimensions of impact (functional limitation, pain, psychological discomfort, physical disability, psychological disability, social disability and handicap). Treatment in patients of the first group (57 patients) included dentin hypersensitivity relief using the «Nanoflyuor» fluoride varnish and dental restoration in patients with medium and promoted stages of wedged cervical lesions. Patients of the control group were treated with «Gluftored» fluoride liquid, dental restoration was performed in patients with medium and promoted stages of wedged cervical lesions. Results. Patients with superficial wedged cervical lesions had lower OHIP-14 scores, indicating better quality of life, with promoted wedged cervical lesions - higher OHIP-14 scores. OHIP-14 scores were higher in patients aged 31-40 and 41-50 years, and lower in patients aged 18-30 years and over 51 years. After treatment of promoted wedged cervical lesions OHIP-14 scores were better in the treatment group compared to the control group with statistically significant difference in functional limitation and physical disability dimensions scores, as well as in combined OHIP-14 score. In patients with medium-stage wedged cervical lesions there was a relevant difference in functional limitation, pain and psychological disability scores. There were no significant differences between the groups in patients with superficial wedged cervical lesions. Conclusion. Dentin hypersensitivity and bad dental appearance influence the patients’ comfort decreasing their quality of life, with minimal influence in patients with superficial wedged cervical lesions and maximal influence in patients with promoted wedged cervical lesions.
Kazan medical journal. 2013;94(1):59-63
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Neuroendocrine disorders in women with epilepsy depending on anticonvulsants intake
Mekhtieva S.N.
Abstract
Aim. To assess the influence of epilepsy and anticonvulsants on central control of hormone release and ovarian function in women of reproductive age. Methods. The reproductive and endocrine functions were assessed in 82 female patients with epilepsy, of whom 37 did not receive anticonvulsants (first group), 45 patients were on anticonvulsant treatment (second group). 17 healthy females (control group) were also assessed. Serum levels of estradiol, progesterone, prolactin, luteinizing hormone, follicle-stimulating hormone and dehydroepiandrosterone were estimated during follicular (n=48) and luteal (n=34) stages of menstrual cycle. Results. Estradiol serum level was below normal ranges, and prolactin serum level - above normal limits at follicular stage of menstrual cycle in female patients not treated with anticonvulsants. In luteal phase serum levels of estradiol, progesterone, dehydroepiandrosterone exceeded the reference ranges, and testosterone levels were lower than normal in both patients treated and not treated with anticonvulsants. Comparison of two groups showed that estradiol serum level was lower in untreated patients in both stages of menstrual cycle compared to patients treated with anticonvulsants. There was a marked difference in endocrine function at all levels of reproductive neuroendocrine regulation in untreated female patients compared to female patients treated with anticonvulsants with major transformations in female patients with epilepsy not treated with anticonvulsants. Conclision. Epilepsy and treatment with anticonvulsants can influence the central regulation of hormone release in females.
Kazan medical journal. 2013;94(1):63-67
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Experimental medicine
Cardiomyocyte apoptosis in vasorenal hypertension as a consequence of catabolism error
Azova M.M., Blagonravov M.L., Frolov V.A.
Abstract
Aim. To investigate the effects of phosphocreatine and ethylmethylhydroxypyridine succinate on cardiomyocyte apoptosis intensity and degree of ventricular cardiomyocytes hypertrophy in rabbits with vasorenal hypertension (VH) model. Methods. VH was modeled on rabbits by artificial abdominal aortic stenosis by one-third of the diameter just above the renal arteries arising. Rabbits were divided to 4 groups: rabbits with 4-week VH without treatment, rabbits with 4-week VH treated with phosphocreatine, rabbits with 4-week VH treated with ethylmethylhydroxypyridine succinate, and healthy rabbits (control group). Cardiomyocyte apoptosis intensity and degree of ventricular cardiomyocytes hypertrophy was assessed in all of the rabbits by evaluation of nuclear-cytoplasmic ratio. Results. Use of phosphocreatine or ethylmethylhydroxypyridine succinate led to a significant reduction of the apoptotic index in the left ventricular myocardium, whereas the similar effect on the right ventricle was only typical for phosphocreatine. None of these drugs had an effect on myocardial hypertrophy degree, which remained on the same level as in the untreated hypertensive animals. Conclusions. Energy deficiency is one of the factors inducing cardiomyocyte apoptosis, so administration of phosphocreatine or ethylmethylhydroxypyridine succinate might be an important component of heart failure prevention and treatment in hypertension. Myocardial hypertrophy has no effect on the cardiomyocyte apoptosis intensity in case of proper energy supply.
Kazan medical journal. 2013;94(1):68-70
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Influence of dry extract of gentiana algida on clinical course of experimental pneumonia
Mondodoev A.G., Kokhan S.T., Konovalov P.V., Shantanova L.N., Akhmetyanov L.A.
Abstract
Aim. To assess the effect of dry extract of Gentiana algida in experimental bronchopneumonia of combined etiology. Methods. The experiments were conducted on 32 white Wistar rats (body weight of 180-200 g). The animals were divided in 4 groups, 8 animals each. Bronchopneumonia was caused by dichlorvos inhalations followed by pharyngeal contamination by Staphylococcus aureus (1 bln/ml). Dry extract of Gentiana algida was given intragastrically at a dose of 200 mg/kg once a day for 7 days to the study group rats. Control group rats received distilled water with the same regimen. Comparison group rats received 40 mg of alantonum known as a mucolytic, anti-inflammatory and antibacterial agent. The fourth group consisted of intact animals. The clinical course of the disease was assessed according to the clinical symptoms, peripheral blood count, O2 and CO2 partial blood pressure, lung tissue histological examination and lipid peroxidation processes intensity and antioxidant enzymes activity. Results. Treatment of experimental bronchopneumonia by dry extract of Gentiana algida at a dose of 200 mg/kg was associated with lower mortality, less severe clinical course, lower respiratory rate. Also, a statistically significant erythrocyte sedimentation rate and white blood cells count decrease was noted, indicating the anti-inflammatory effect of the extract. Partial arterial blood pressure of respiratory gases has normalized, indicating the lung ventilation improvement. The effect of dry extract of Gentiana algida according to the noted parameters was superior to alantonum used as a comparison drug. Anti-inflammatory effect of the tested plant extract might be a result of lipid peroxidation inhibition, confirmed by statistically significant decrease of the peroxidation products (malonic dialdehyde and conjugated dienes) and increase of antioxidant protection enzymes (superoxide dismutase and catalase) activity. Conclusion. Dry extract of Gentiana algida at a dose of 200 mg/kg has a positive effect in treatment of acute experimental bronchopneumonia, promoting the respiratory organs morphologic and functional status normalization in laboratory animals at the earlier stages of the disease.
Kazan medical journal. 2013;94(1):71-74
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Increased activity of poly(ADP-ribose)-polymerase in PML-depleted cells - novel perspectives for cancer therapy
Boichuk S.V., Ramazanov B.R., Mustafin I.G., O G.
Abstract
Aim. To investigate the relationship between PML expression and poly(ADP-ribose)-polymerase (PARP) activity in physiological conditions and at genotoxic stress induced by chemotherapy and ionizing radiation. Methods. The study was conducted on BJ fibroblasts cultured in DMEM/199 medium supplemented with fetal bovine serum, L-glutamine and antibiotics. PML down-regulation was achieved by short interfering ribonucleic acid transfection. To induce deoxyribonucleic acid (DNA) damage in BJ fibroblasts, doxorubicin and hydroxyurea or ionizing radiation were used. PARP activity, formation of DNA double-strand breaks and DNA damage response were examined by Western blotting and immunofluorescence microscopy. Results. PML knockdown was accomplished with an increased PARP activity, confirmed by an increased expression of poly-ADP-ribose (PAR) polymers. At PML knockdown ant DNA damage caused by chemotherapy and ionizing radiation, there is a significant increase in PAR polymers expression as well as increase in the number of cells containing PAR foci. Conclusion. Increased activity of poly(ADP-ribose)-polymerase at PML knockdown and DNA damaging conditions indicates the compensatory response due to insufficiency of the homologous recombination mechanisms. The phenomenon found widens the spectrum of malignancies that might be potentially sensitive to the therapy with poly(ADP-ribose)-polymerase inhibitors.
Kazan medical journal. 2013;94(1):75-79
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Reviews
The problem of concomitant diseases with a focus on the cardiovascular system condition in patients with arterial hypertension and acid-related diseases
Khlynova O.V., Tuev A.V., Beresneva L.N., Agafonov A.V.
Abstract
At present, the problem of concomitant diseases still remains very important for medical science as well as for medical practice. Arterial hypertension is one of the most actual global healthcare problems, holding the leading place among cardiovascular diseases. Acid-related diseases, including gastroesophageal reflux disease and duodenal ulcer are also widely-spread with the tendency of prevalence growth, and are having the leading place among gastrointestinal diseases. The combination of arterial hypertension and acid-related diseases is a new state of an organism regulation. Their synchronism is not accidental, as both diseases share links of the general etiology and pathogenesis. The daily arterial pressure profile and heart rhythm variability has a number of distinctive features when the diseases collide. The presence and progression of esophageal and duodenal mucous membranes inflammation in these patients promotes the certain arterial blood pressure profile formation. The data concerning the prevalence, common etiology and pathogenesis, features of hemodynamics and clinical manifestations in patients with arterial hypertension associated with peptic ulcer disease and gastroesophageal reflux disease are reviewed. Data of autonomic regulation features, 24-hour blood pressure profile and central hemodynamics condition in patients the combination with the mentioned diseases are also covered.
Kazan medical journal. 2013;94(1):80-85
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Connective tissue features influencing the results of abdominal hernia repair
Slavin L.E., Chugunov A.N., Borissova I.Y., Shakirova A.Z., Aliullova R.R.
Abstract
Nowadays connective tissue disorders are considered to play a great role in abdominal hernia formation and recurrence. Benign hypermobility syndrome is associated with diffe-rent diseases of locomotive system (flat foot, scoliosis), varices of lower extremities, progressive myopia, mitral valve prolapse, tracheobronchomalacia etc. This predisposing factor favors abdominal wall debilitation, anatomical aperture’s enlargement and hernia formation. As a result, benign hypermobility syndrome hampers the post-operative scar organization even in small-sized hernias and is an important risk factor of abdominal hernia recurrence. That is why the individual choice of abdominal hernioplasty technique is justified. There is no established optimal technique of abdominal hernioplasty allowing no complications and recurrences. Thus, the understanding of morphological manifestations of tissue reaction inside the mesh endoprosthesis particularities may become of great importance to prevent abdominal hernioplasty complications. Abdominal hernioplasty technique choice is based on individual selection of endoprosthesis, depending on individual characteristics of patient’s connective tissue, abdominal hernioplasty method and endoprosthesis tendency to shrinking in late postoperative period.
Kazan medical journal. 2013;94(1):86-89
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Features of anesthesia in pregnant women with subarachnoid hemorrhages
Bayalieva A.Z., Shpaner R.Y., Bogdanova E.I., Ganeeva I.R.
Abstract
The review of the literature on anesthesia in pregnant women with subarachnoid hemorrhage is presented. Physiological changes of pregnancy should by undoubtedly taken into consideration while performing anesthesia and surgery because of the comorbidities. Particularly, the oxygen intake is higher in pregnant. Adequate systolic pressure is also a very important parameter maintaining the intrauterine blood flow and fetus perfusion during the whole term of pregnancy. Medications used in pregnant women can also influence the fetus. From the clinical point of view, the selection of anesthetics and other medications allowed for use in pregnant women should be limited to medications that are proven to be safe. Pharmacological effects of the medications, used for anesthesia and treatment of pregnant women with subarachnoid hemorrhage are covered in the review, including their influence on fetus. Surgical treatment options for pregnant women at different pregnancy terms with different conditions requiring neurosurgery are surveyed. Post-surgical rehabilitation of pregnant women with subarachnoid hemorrhage is reviewed. In each particular clinical case an individual anesthesia plan should be created considering the pregnancy term and features of the disease.
Kazan medical journal. 2013;94(1):89-95
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The who concept of essential medicines and the who ethical criteria for medicinal drug promotion: history and lessons for domestic pharmaceutical sector
Ziganshina L.E., Niyazov R.R., Ziganshin A.U.
Abstract
The review covers the history and evolution of the WHO initiatives in pharmaceutical policy - for better and safer use of medicines, their scientifically based selection and ethical promotion. The WHO Concept of Essential Medicines, the WHO vision of the Rational Use of medicines and the WHO Ethical Criteria for Medicinal Drug Promotion are reviewed. Contribution of these WHO designed initiatives, definitions and documents to Global Health, particularly relating to modern Russian health system problems is discussed. The principles and methodology of drug selection are presented. The review describes health system benefits of the WHO Essential Medicines Concept implementation at a national level. Advantages of the WHO Model List of Essential Medicines use not only as a model product, but as a model process and an healthcare instrument are emphasized. The WHO principles of the Rational Use of Medicines, the history of its International development, the WHO key strategies towards the Rational Use of Medicines and the major barriers on the way are described. The history of the WHO Ethical Criteria for medicinal drug promotion development is presented in line with the basic principles and objectives of this unique international document. The core goal of the WHO Ethical Criteria is to improve health and healthcare through the rational use of medicines. The global implementation of the WHO Essential Medicines Concept and the ever growing barriers to the rational use of medicines and advances in public health, as well the advances and problems of the Russian national health system, are discussed in the historical perspective.
Kazan medical journal. 2013;94(1):95-100
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Diseases of the eye in chronic alcoholism
Iskhakova R.R., Saifullina F.R.
Abstract
Chronic alcoholism is a disease affecting all the vital organs, including development of functional and organic eye disorders in 2-70% of cases. Alcoholic (ethanol) amblyopia with such features as slow gradient visual acuity decrease in both eyes (although visual acuity can decrease down do a very low grade, the complete blindness is rare) is among the disorders in patients with chronic alcoholism. Fundus of the eye at the beginning of the disease is normal in most of the cases, sometimes an optic nerve congestion and mild features of optic neuritis can be observed. Sometimes optic nerve hyperemia or anemia can be observed. Simple optic nerve atrophy seen as the temporal parts or the entire disc blanching can be seen at the late stages. Alcohol toxicity can also result as peripheral vision decrease, with degree of it increasing depending on the clinical manifestations of the alcoholism. Generally, eye disorders in patients with chronic alcoholism in most of the cases manifest as central retinal area damage and combination of retinal and optic nerve involvement.
Kazan medical journal. 2013;94(1):101-105
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The role of pro-inflammatory cytokines in diabetic nephropathy in pregnant women with type 1 diabetes mellitus
Gazizova G.R.
Abstract
Diabetic nephropathy is one of the most frequent and unfavorable complications of pregnancy in terms of prognosis in patients with diabetes mellitus. The combination of pregnancy and uncompensated diabetes with such complications as diabetic nephropathy, diabetic retinopathy, diabetic neuropathy, leads to overproduction of pro-inflammatory cytokines, thromboses and ischemic necroses of the fetoplacental tissues, and low blood level of immunosuppressive cytokines increases the severity of the disease. This mechanism may be one of the reasons of the spontaneous abortion and pregnancy loss in early pregnancy term in women with diabetes. For a long time the leading role in diabetic nephropathy formation was acknowledged for hyperglycemia, dyslipidemia, oxidative stress, and arterial and renal intraglomerular hypertension. Diabetic nephropathy was recognized as non-immune and non-inflammatory process. Currently diabetic nephropathy is considered as a series of inflammatory reactions involving inflammatory cytokines and chemokines, consisting in the migration of monocytes or macrophages to the kidneys and glomerular and interstitial fibrosis development. Recent studies prove the role of immune-inflammatory reactions in diabetic kidney damage development and confirm an imbalance of the collagen exchange regulating factors, even at the stage of reversible renal dysfunction - microalbuminuria. The close relationship found between hyperglycemia, overproduction of growth factors and nephrosclerosis development in diabetes mellitus. The detection of pro-inflammatory cytokines and fibrogenic growth factors in the urine of patients with diabetes, especially in pregnant women with diabetes, can be used to prompt diagnosis and evaluation of processes occurring in the kidneys, to study the degree of sclerosis, and as a consequence, to predict kidney functional disorders development. Keywords: diabetes mellitus, pregnancy, diabetic nephropathy, cytokines, growth factors.
Kazan medical journal. 2013;94(1):105-110
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Epidemiology and healthcare management
Analysis of in-hospital stage of emergency medical care and 24-hour mortality in emergency patients
Valeev Z.G., Belyakov V.G., Salyahova L.Y.
Abstract
Aim. To reveal the management defects of timely and sufficient emergency care provision at emergency patient admission. Methods. The mortality among the adult Kazan city inhabitants who were urgently admitted to Municipal Emergency Hospital was examined in a retrospective cohort study. The retrospective analysis of in-patients medical charts, ambulance accompanying talons and autopsy protocols of 543 patients who has succumbed during the first 24 hours after being admitted to Municipal Emergency Hospital №1 Kazan, Russia since January 1st, 2009 to December 31, 2011, was performed, emergency medical care on the pre-hospital stage was analysed. Results. The number of patients who got the out-patient care in the admission department of the emergency hospital has increased during the last several years, distracting admission department staff form their primary job and causing errors in medical care. The number of errors due to the medical care mismanagement can be estimated as 23.3%. Low staff qualification, lack of subspecialty consultations or councils and lack of case monitoring are among the reasons. Conclusion. Providing high quality medical aid in out-patients clinics would allow Emergency hospitals to focus on admitting and treating patients with life-threatening emergencies.
Kazan medical journal. 2013;94(1):111-114
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Sources and amounts of financial support for medical care in the institutions of the federal penitentiary service
Tulenkov A.M., Ponomarev S.B.
Abstract
Aim. To evaluate the state financial guarantees for providing medical care to prisoners of penitentiary institutions. Methods. The general assessment of actual state funding of penitentiary healthcare as well as the shares of separate sources in funding of penitentiary healthcare at facilities of Russian Federal Penitentiary Service. Results. The combined funding of penitentiary healthcare increased up to 3 861 568.7 thousands of rubles in 2011 (twofold compared to 2009). Per capita funding was equal to 3844.0 rubles per year per Russian Federal Penitentiary Service facilities prisoner - 2.34 times higher compared to 2009. Hence, despite the total funding increase, the handicap compared to national healthcare funding is still huge. Conclusion. The gained data provides a real-time picture of the penitentiary healthcare funding and is necessary for improvement of medical and sanitary services in the Russian Federal Penitentiary Service institutions.
Kazan medical journal. 2013;94(1):114-116
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The contemporary status of the blood donorship in the Mari El Republic
Zangerova E.Y.
Abstract
Aim. To detect the weak points of the existing system of blood donors’ draw in, to define the paths of blood donorship development in the Republic of Mari El. Methods. The analysis of the existing system of donorship at the period from 2002 to 2011 was conducted according to the data of combined yearly reports, data of united blood transfusion center of the Republic of Mari El database, data of Russia’s blood transfusion system facilities activity analysis. The changes in the number of blood donors, activity of blood donors, and detection of blood-transmitted diseases markers were evaluated. Results. No need for further significant increase in the number of active donors was detected, since the modern methods of blood and blood components preparation allows to increase the amounts of required blood components by other ways. The decrease in donors’ mean age was registered, the share of donors younger than 30 increased 2.8-fold compared to 2002 and 1.46-fold compared to 2007. The mean age of donors is 33,94±0,14 years, gender distribution (females - 39.2%, males - 60.8%) do not collide with the gender distribution of the general population. The share of plasma donors has significantly increased (4.8-fold in 2011). Since 2009 the share of first-time donors has increased to 42.9%, indicating the instability of the group of people ready to donate blood. Electronic database introduction and active use allows to exclude people with blood-transmitted diseases and other absolute contraindications from donating blood. The share of people willing to donate blood with registered blood-transmitted diseases has relatively dropped from 4.18% in 2007 to 1.42% in 2011. Conclusion. The main goal of blood transfusion services of Mari El Republic is still to increase the number of permanent donors, donating blood regularly, it will allow to increase the safety of blood components produced and provide the blood transfusion services stability.
Kazan medical journal. 2013;94(1):116-120
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Features of medical specialist formation in the Republic of Tajikistan
Bandaev I.S., Miraliev S.R.
Abstract
Aim. To study the features and to define the fundamental principles of rational training of the highly skilled specialist doctor in the Republic of Tajikistan. Methods. Complex analysis of the doctor’s formation and training process was performed. Data from the ambulatory, hospital and highly specialized medical care segments, academic faculties, teaching and clinical centers of family medicine of the Republic of Tajikistan were examined. 256 tutors and student doctors trained in the educational institutions of the Republic of Tajikistan from 2000 to 2012 were questioned. Results. 90 (35.2%) out of 256 doctors have changed their specialty, among them 48 (18.8%) - once, 26 (10.2%) - twice, 12 (4.9%) - 3 times, 3 (1.3%) doctors - 4 times and more. The average share of the current specialty experience from the total medical experience was equal to 84.3%. Over a half of the doctors (137 out of 256, 53.5%) were working for one employer in their career, the rest (119 out of 256, 46.5%) have changed the job, among them: 36 (30.3%) - once, 10 (8.4%) - twice, 9 (7.6%) - three times and more. Specialty changes hindered the aggrandizement. A share of the doctors having the higher qualification grade increased with the overall experience and the experience on the given specialty. 65 out of 256 (25.4%) doctors had the qualification degree, among them: 15 (5.9%) - highest degree, 34 (13.3%) - first degree, 16 (6.2%) - second degree. The number of the doctors with highest qualification degree was higher by 8.0% in doctors with 1-10 years of specialty experience and by 39.4% in doctors with specialty experience over 20 years. Conclusion. Constant regular work for one employer favored the specialist formation, whilst frequent job change halts the doctor’s «anchoring» in one exact specialty and hampers the professional growth.
Kazan medical journal. 2013;94(1):120-123
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Clinical features and prognosis in patients examined in medical and social expertise bureaus due to peptic ulcer disease
Soshina A.A., Sergeeva V.V., Zinyaeva T.V.
Abstract
Aim. To study the clinical features, disability degree and expert examination results in patients with peptic ulcer disease. Methods. Acts of expertise of patients with peptic ulcer disease (gastric ulcer - 44 patients, duodenal ulcer - 47 patients) performed in medical and social expertise bureau on internal diseases of Saint-Petersburg, Russia from 2009 to 2011 were examined. Results. The most frequent peptic ulcer disease risk factors found in both of the groups were: predisposing diet and dietary habits (65.9% of patients with gastric ulcer, 78.7% of patients with duodenal ulcer), smoking (53.2 and 63.6% respectively), stress (70.5 и 87.2% respectively). In 10 (22.7%) patients with gastric ulcer and in 38 (80.9%) patients with duodenal ulcer peptic ulcer disease was associated with presence of Helicobacter pylori. There was a combination of predisposing factors in a majority of patients. In most of the cases a moderate activity and a long term of the disease was registered. Complications were diagnosed in 30 (68.2%) patients with gastric ulcer and in 27 (57.4%) patients with duodenal ulcer, most frequently: gastrointestinal bleeding - 19 (43.2%) and 12 (25.5%) patients respectively, gastric outlet obstruction - 10 (22.7%) and 9 (19.2%) patients respectively. According to the medical and social expertise algorithm 19 (43.2%) patients with gastric ulcer and 17 (36.2%) patients with duodenal ulcer were primarily rated as disability degree III, 3 (6.8%) and 2 (4.3%) patients respectively - as disability degree II. Contraindicated jobs and labor conditions, low labor, functional and social status were the reasons of setting up the status of disabled. Conclusion. The preliminary data show that peptic ulcer disease is not only a medical, but a major social problem, requiring novel treatment and prevention methods, as well as personal rehabilitation programs development and improvement.
Kazan medical journal. 2013;94(1):124-127
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Risk factors for frequently relapsed ulcerative colitis
Tsurcan S.I.
Abstract
Aim. To define the factors for frequently relapsed ulcerative colitis . Methods. The clinical course of ulcerative colitis in 306 patients with the diagnosis of ulcerative colitis confirmed by endoscopy and histology was assessed in the 5-year prospective cohort study. A positive clinical course with long periods of remission and rare relapses (≤1 per year) was registered in 184 (60.1%) of patients, a progressive clinical course with frequent relapses (over 2 per year) was registered in 122 (39.9%) patients. A list of possible risk factors of unfavorable course were analyzed, univariate and multivariate stepwise discriminant comparative analysis was used for statistical processing. Results. Age at onset younger than 30 years, non-smoking, high disease activity at the onset, complications and extraintestinal manifestations, disease duration over 6 months until the specific treatment start, inadequate treatment at disease onset, over 6 months required to achieve remission, and a short maintenance treatment period are the risk factors for frequent ulcerative colitis relapses. When combined, the relative risk for frequent ulcerative colitis relapses is 75.8%. No demographic, social, hygiene factors, family and medical history data, comorbidities were associated with certain clinical types of ulcerative colitis. Conclusion. The most significant risk factors for frequently relapses ulcerative colitis - disease duration until the specific treatment start, treatment at disease onset, disease duration before remission is achieved - are modifiable factors, therefore, the adequate and timely treatment can improve the disease prognosis.
Kazan medical journal. 2013;94(1):128-130
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Assistance to the practicing physician
Diagnosis of abnormalities of upper dental arch and its segments
Ayupova F.S.
Abstract
Aim. To improve the graphic method of analysis of the upper dental arch and its segments, to increase the accuracy of upper dental arch abnormalities detection and to minimize orthodontist’s man-hours. Methods. The plaster models of 32 maxillae with dentoalveolar abnormalities were studied before and after treatment. The graphs of individual normal dental arches and its sizes were created by using the geometric and graphic method by Hawley-Herber-Herbst. The regularities were found based on the gained data; graphs of individual normal dental arches (stereotyped patterns) were created using the Adobe Photoshop CS3 software. Dentoalveolar abnormalities were visually examined by directed applying the stereotyped patterns and pictured before and after treatment. 64 models were examined overall. Results. A relation was found: incisors and canines dental crowns half-sum relates to the length and width of Hawley-Herber-Herbst individual normal dental arch graph as 1:2,3:1,3. Considering the relation found, the set of stereotyped patterns was created. The pattern was chosen for the studied model according to the patient incisors and canines dental crowns width. The visual examination allows to recognize and to record (take a picture) teeth malposition, abnormalities of the upper dental arch and its segments in transverse and sagittal planes for correction control. The photos of the models at different stages of orthodontic treatment with stereotyped patterns applied can be added to the patients’ medical chart, indicating the present occlusal rehabilitation success. Conclusion. The offered way of detection of upper dental arch and its segments abnormalities does not require significant time to be performed, is informative and can be implied to clarify the dentoalveolar abnormalities treatment plan.
Kazan medical journal. 2013;94(1):131-133
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Clinical observations
A rare case of intestinal obstruction as a result of phytobezoar
Bolshakov D.V., Valiullin N.Z., Burganov R.R.
Abstract
Intestinal obstruction (ileus) due to bezoar is a rare condition. Its combined prevalence among all cases of intestinal obstruction varies from 0.5 to 1%. An observed case is reported. A patient was admitted at the emergency ward with abdominal pain,nausea, bloating, and constipation. At examination - bloating, abdominal distention, moderate abdominal muscular defense at palpation, paraumbilical tenderness. Colon cleansing was started with a good effect. Gastrointestinal fluoroscopy: at 4 and 8 hours after introduction of barium contrast it is located in the dilated loops of small bowel with persisting air fluid levels. The diagnosis of unresolved intestinal obstruction was set up. The midline laparotomy, small bowel decompression by Abbott-Miller, peritoneal drainage with two tubes were performed. Final diagnosis: «Intestinal obstruction (phytobezoar), non-infected peritonitis».
Kazan medical journal. 2013;94(1):134-135
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Jubilees
Professoru Almazu Askhatovichu Akhunzyanovu - 75 let
 
Abstract
Kazan medical journal. 2013;94(1):136-137
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