Vol 93, No 3 (2012)

Health care in Kazan during the Great patriotic war

Faskhutdinova E.N., Mukharyamova L.M.


The article is devoted to the health care system in Kazan during the Great Patriotic War. The activity of evacuation hospitals, organization of care for the wounded has been shown. The work of Kazan Medical Institute in preparing qualified medical personnel and conducting research in the field of military medicine has been discussed.
Kazan medical journal. 2012;93(3):417-420
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Clinical medicine

Vasomodulating function of the endothelium in hemorrhagic fever with renal syndrome

Baygildina A.A.


Aim. To study the content of endothelin-1, nitric oxide (II) and the activity of angiotensin-converting enzyme in the blood of patients with hemorrhagic fever with renal syndrome, depending on the period and the severity of the disease in order to assess their role in the pathogenesis and to develop a pathogenetically substantiated correction of the changes in the systemic vascular tone. Methods. The group of dynamic study included 114 patients (102 male and 12 female) with serologically confirmed hemorrhagic fever with renal syndrome aged 22-55 years. The moderately severe form was diagnosed in 66 patients, severe uncomplicated form - in 27, severe form with complications - in 21 patients. The control group comprised 23 practically healthy volunteers. The concentration of endothelin-1 in blood plasma, the contents of metabolic products of nitric oxide (II) and the activity of the angiotensin-converting enzyme in the blood serum were determined. Results. The concentration of endothelin-1 in the blood in the dynamics of the disease significantly decreased, the content of the final stable metabolites of nitric oxide (II) and the activity of the angiotensin-converting enzyme increased with statistical significance in all periods of the disease. These changes were most pronounced during severe forms of the disease with complications. Conclusion. In moderately severe and severe uncomplicated forms of the disease the endothelium is able to maintain the systemic vascular tone and tissue perfusion at a physiological level, however in severe form with complications the changes in the synthesis of vasomodulating substances may be involved in the development of complications.
Kazan medical journal. 2012;93(3):421-426
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Diagnostic program and tactical approaches to treatment of patients with obturative colonic obstruction of tumor genesis

Malkov I.S., Toltoev M.M.


Aim. To determine the value of ultrasound investigations, colonoscopy and laparoscopy in the complex diagnosis of acute obturative colonic obstruction of tumor genesis and in selecting the optimal treatment strategy. Methods. Conducted was an anlysis of results of treatment of 112 patients with obturative colonic obstruction of tumor genesis. A set of diagnostic procedures was carried out for every admitted patient: digital rectal examination, radiography of the abdomen, ultrasound examination, fiber colonoscopy, and laboratory studies. Results. Based on the clinical and radiographic the diagnosis of obturative colonic obstruction was established in 64.3%, ultrasound investigation revealed the presence of bowel obstruction without specifying its location in 92% of the cases. Emergency colonoscopy was informative only in 55.5% of cases due to inadequate prior preparation of the colon. Using the developed methodology of preparing the colon, it was possible to perform colonoscopy up to the level of the tumor in 26 patients (92.9%) out of 28 patients. In the 32 cases minimal surgical intervention were performed by way of formation of an ileotransverse anastomosis by-pass, double-barreled ileostomy or colostomy. 80 patients underwent resection of the bowel with the tumor, including operations with the formation of a primary anastomosis, which were performed in 20 patients when the tumor was located in the right segments of the colon. In 22 patients an intraoperative colonic lavage was performed. Postoperative complications were recorded in 30 (26.8%) patients. Postoperative mortality was 24.1% (27 patients). Conclusion. Based on the radiographic and ultrasound investigations of the abdominal cavity it is possible to establish the presence of bowel obstruction without specifying the localization of the obstruction zone; in order to determine the cause of the obturative colonic obstruction it is necessary to perform an emergency colonoscopy with rigorous preparation of the colon according to the developed technique, while the volume of surgical intervention should be determined in each case individually.
Kazan medical journal. 2012;93(3):426-431
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Results of combined anesthesia application with the usage of non-narcotic analgesics in the surgical oncology practice

Tanatarov S.Z.


Aim. To evaluate the effectiveness of pre-, intra- and postoperative intravenous administration of paracetamol in combined anesthesia in patients undergoing surgical interventions in the surgical oncology practice. Methods. Examined were 35 patients aged from 43 to 75 years, operated on under combined anesthesia. During the operation and after its completion an infusion of liquid paracetamol at a dose of 3.3 mg/h was performed. Cardiac monitoring was conducted, the content of cortisol in the blood and the Bispectral Index were determined. The pain indices measured by visual analogue and digital rating scales were determined in the postoperative period. The control group included 35 patients in whom anesthesia was performed without the use of paracetamol. Results. During the infusion of paracetamol an adequate level of analgesia was achieved without development of adverse reactions on the part of the vital systems. The use of paracetamol in the early postoperative period contributed to the reduction of pain on digital rating and visual analogue scales compared to the group with basic anesthesia. Conclusion. The use of liquid paracetamol is a promising and safe method of additional analgesia.
Kazan medical journal. 2012;93(3):431-434
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Ways of improving surgical tactics in the treatment of victims of motor vehicle accidents with combined mechanical trauma

Mustafin R.R., Isaeva I.V., Anisimov A.Y.


Aim. To study the effectiveness of the surgical tactic «Damage control» in providing medical care to victims of motor vehicle accidents with associated mechanical injuries of various locations. Methods. 85 victims of motor vehicle accidents with associated mechanical injuries of various locations from 2006 to 2010 were the subjects of the clinical study. Depending on the surgical approach, which was chosen on the basis of assessment of the severity of the condition and injuries, the patients were divided into two groups. The first (main) group included 35 (41.2%) victims, in whom the stepwise tactic of trauma elimination «Damage control» was used. The second (comparison) group consisted of 50 (58.8%) patients, in whom the traditional tactic of simultaneous treatment of all lesions during the surgical intervention was applied. An analysis of the dynamics of clinical indicators, incidence of complication development and mortality was conducted depending on the chosen surgical treatment tactic. Results. The overall incidence of complications in the early postoperative period in the first group was lower by 38.0% and the mortality - by 7.7%. Conclusion. The use of the «Damage control» surgical tactic is effective in the complex treatment of victims of motor vehicle accidents with associated mechanical trauma.
Kazan medical journal. 2012;93(3):434-438
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Optimization of antifibrinolytic protection during neurosurgical operations

Sultanov L.R.


Aim. To conduct a retrospective analysis of intraoperative and postoperative blood loss during removal of brain tumors with the usage of tranexamic acid and infusion correction of hemodynamically significant blood losses. Methods. The study included 139 patients operated on for tumors of the brain and spinal cord, and treated with tranexamic acid. Distribution of patients according to the volume of blood loss was as follows: the first group - up to 500 ml of blood loss, 48 patients (34.5%); the second group - 500-1200 ml of blood loss, 72 patients (51.7%); the third group - more than 1200 ml of blood loss, 19 patients (13.9%). Results. The retrospective analysis has shown that 34.5% of patients (first group) were operated with the lowest blood loss - up to 10% of the circulating blood volume; 51.7% of patients (second group) - with a blood loss of 20 to 30% of the circulating blood volume. In the third group, which included 13.9% of patients, there was a blood loss of more than 30% of the circulating blood volume, which is defined as hemodynamically significant. It is in the third group, as shown by the analysis, that in addition a therapeutic dose of tranexamic acid 15-20 mg/kg was administered. The extent and intensity of intraoperative blood loss were dependent on many factors, mainly on the nature of the tumor process. Conclusion. It was established that the changes of the hemostatic system were depended on the degree of hemodilution; the use of tranexamic acid made it possible to reduce the amount of postoperative blood loss, despite the degree of intraoperative blood loss.
Kazan medical journal. 2012;93(3):438-442
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Development of left ventricular diastolic dysfunction in children who are in long-term remission of acute lymphoblastic leukemia

Teplyakova E.D., Savis’ko A.A., Shestopalov A.V., Aslanyan K.S.


Aim. To determine the frequency and nature of myocardial damage in children on the background of long-term remission of acute lymphoblastic leukemia, to assess the significance of the concentration of the N-terminal precursor of the brain natriuretic peptide and of the protein that binds fatty acids in blood serum. Methods. The observation group included 22 children aged 7 to 17 years, who are in long-term remission of acute lymphoblastic leukemia. The average duration of the remission was 6.1±1.0 years. All children were treated according to the standard and intermediate risk group protocol ALL-MB-2002. The control group included 65 children. A clinical and instrumental examination, including 12-lead electrocardiography, as well as complex transthoracic Doppler echocardiography was conducted. Analysis of the diastolic function of the myocardium was performed during assessment of the ratio of peak transmitral flow velocities (E/A), of the index of myocardial stiffness and of the time indicator B(E-Ea). The content of the N-terminal precursor of the brain natriuretic peptide and of the protein that binds fatty acids in blood serum was determined by enzyme immunoassay. Results. In 70% of the children with acute lymphoblastic leukemia who are in the remission stage for over 5 years, noted was the development of early signs of diastolic myocardial dysfunction, in 50% of the patients of this group reported was a significant increase in the concentration of the marker of heart failure - brain natriuretic peptide. At the same time, in a third of the examined individuals an increase in concentration of the protein that binds fatty acids was revealed, which may be indicative of myocardial damage at the cellular level. Positive correlation links between the indicators of initial manifestations of the evolving left ventricular diastolic dysfunction in children, who are in long-term remission of acute lymphoblastic leukemia, and the content of the N-terminal precursor of the brain natriuretic peptide have been revealed. Conclusion. The increase in the levels of the mentioned indicators makes it possible to identify high-risk groups for cardiovascular disease development among the cohort of children who are in long-term remission of acute lymphoblastic leukemia in order to develop preventive and rehabilitative programs.
Kazan medical journal. 2012;93(3):442-446
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Evaluation of the effectiveness of the double indicator method of scintigraphy in the differential diagnosis of thyroid nodules

Timofeeva L.A.


Aim. To evaluate the effectiveness of double indicator scintigraphy in the differential diagnosis of thyroid nodules. Methods. Analyzed was the data of radionuclide investigations of 25 patients with thyroid disease at the age of 36 to 72 years, who were operated on in 2009-2011. The radioisotope study was conducted in two stages. Evaluation of the scintigraphic uptake pattern of the radiopharmaceutical in the studied areas was performed visually and quantitatively. Results. The scintigraphic results were compared with cytological and histological studies. In the diagnosis of papillary thyroid cancer the sensitivity of the radioisotope investigation was 95%, specificity - 92%, diagnostic accuracy - 94%. The method was less precise and specific in the diagnosis of follicular cancer and macro-micro follicular adenomas (it gave positive results in the cases of adenoma and negative results in cases of follicular thyroid cancer). On average, the specificity of the double-phase radioisotope scintigraphy method using 99mTc-pertechnetate and technetril (99mTc-MIBI) in our study was 69%, accuracy - 75%, sensitivity - 79%. Conclusion. Radionuclide double-phase scintigraphy with the usage of 99mTc-pertechnetate and technetril (99mTc-MIBI) - is a highly informative method for the differential diagnosis of thyroid nodules, which can be used during atypical sonographic patterns and in the absence of clear histological data.
Kazan medical journal. 2012;93(3):447-450
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Porphyrin metabolism in secondary hepatic porphyria in patients with hereditary deficiency of glucose-6-phosphate dehydrogenase

Baytaeva D.A., Bessmel’tsev S.S.


Aim. The study the porphyrin metabolism during the development of secondary hepatic porphyria in patients with glucose-6-phosphate dehydrogenase deficiency. Methods. Examined were 148 male patients aged 5-19 years (median 12 years) with impaired activity of glucose-6-phosphate dehydrogenase in combination with β-thalassemia and without it. Qualitative and quantitative methods of examining the activity of this enzyme were used in order to verify the diagnosis. Taking into account the varying degree of glucose-6-phosphate dehydrogenase deficiency, the indices of metabolism of the enzyme and of the porphyrins were correlated with the severity of anemia, functional liver capacities, with parameters reflecting iron content in blood serum, bone marrow, liver and urine. The markers of intoxication were also taken into account in the development of secondary hepatic porphyria and endotoxemia. Therapeutic plasmapheresis was used to correct the revealed disorders. Results. The influence of glucose-6-phosphate dehydrogenase deficiency on the metabolism of porphyrins and liver functional status has been shown, which leads to the development of anemia and endogenous intoxication. With the help of parameters, which characterize the porphyrin metabolism in patients, secondary hepatic porphyria was revealed. It was established that determination of the content of glucose-6-phosphate dehydrogenase and porphyrins makes it possible to detect disturbances in heme synthesis at an early stage and to evaluate the compensatory abilities of the liver. An important diagnostic feature for glucose-6-phosphate dehydrogenase deficiency, regardless of severity, is the impaired synthesis of the end products of metabolism of porphyrins - uro-, copro- and protoporphyrin. The effectiveness of therapeutic plasmapheresis for hemolysis, secondary hepatic porphyria and endogenous intoxication has been shown. Conclusion. Increased excretion of uro-and coproporphyrin with urine reflects the severity of endotoxemia, and is an alternative to markers of intoxication; high concentration of free protoporphyrin and low concentration of uro- and coproporphyrin in erythrocytes is an important diagnostic sign of impaired activity of glucose-6-phosphate dehydrogenase in patients.
Kazan medical journal. 2012;93(3):451-455
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The dependence of the activity of alanine aminotransferase on the gender of the patient in viral hepatitis B

Enaleeva D.S., Beshimova D.T.


Aim. To reveal the dependence of alanine aminotransferase on the gender of the patient in the inactive form of chronic viral hepatitis B. Methods. Instrumental determination of the activity of alanine aminotransferase in 64 healthy subjects (32 males and 32 females) and 255 patients with an inactive form of chronic viral hepatitis B. According to the time of infection the patients were divided into three groups: up to 5 years, 5-10 years, and more than 10 years. Results. Normal alanine aminotransferase activity was detected in 18 (21.4%) males and 66 (78.6%) females. Among the 34 patients with constantly high indices of alanine aminotransferase activity were 24 (70.6%) males and 10 (29.4%) females, that is, increased activity is 2.8 times more frequently recorded in males. The higher absolute index of this enzyme’s activity (IU/L) in males was noted with disease duration of 5-10 years (1.25 times average increase in activity) and 10 years or more (1.5 times). Conclusion. The more marked and frequent increase in alanine aminotransferase activity among males with chronic viral hepatitis B, should be considered when interpreting the results of laboratory tests.
Kazan medical journal. 2012;93(3):456-457
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Visual acuity at intermediate distances after implantation of different models of intraocular lenses

Chuprov A.D., Ivonin K.S., Zamyrov A.A., Kudryavtseva Y.V.


Aim. To study the rehabilitative effect of treatment of cataracts by implanting trifocal refractive-diffractive soft intraocular lens MIOL-Record 3. Methods. 192 patients (216 eyes) who were operated on for cataract participated in the study. The first (main) group included 63 patients (72 eyes) in whom cataract extraction and implantation of the domestic trifocal refractive-diffractive monolithic (soft) intraocular lens MIOL-Record 3 was performed. The second group included 64 patients (70 eyes) in whom cataract extraction and implantation of the domestic bifocal refractive-diffractive lens MIOL-Accord was performed. The third group consisted of 65 patients (74 eyes) in whom cataract extraction and implantation of the domestic monofocal lens MIOL-2 was performed. Preoperative examination was performed the day before surgery, postoperative - after 7 days, 1, 3, 6 and 12 months. Results. The mean value of visual acuity at a distance of 50 cm without correction in the group of patients with MIOL-Record 3 1 month after surgery was 0.42±0.01 and was significantly higher than such in patients with MIOL-Accord and MIOL-2 - 0.14±0.01 and 0.1±0.001, respectively. A questionnaire survey revealed that in the group with MIOL-Record 3 additional correction with glasses is never used at the intermediate distance in 98.62% of the cases, in groups with MIOL-Accord - in 54.28%, and with MIOL-2 - in 25.68% of cases. Patients with MIOL-Record 3 were completely satisfied with the results of surgery in 70.84% of the cases, and in groups with MIOL-Accord and MIOL-2 - in 54.28, and 27.03% of cases, respectively. Conclusion. The conducted studies have established the best rehabilitative effect of the treatment of cataract during implantation of a trifocal refractive-diffractive intraocular lens MIOL-Record 3.
Kazan medical journal. 2012;93(3):458-460
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Adaptive changes of the indices of the cardiovascular system and serum content of a number of hormones under examination stress condition

Lavrov O.V., Pyatin V.F., Shirolapov I.V.


Aim. To study the features of the indices of the cardiovascular system and serum concentrations of several hormones and biogenic amines among the students under the impact of examination stress. Methods. The study was conducted on a group of young conditionally healthy volunteers. The starting group of study subjects consisted of 203 students who prior to participation in the study passed a medical examination, including medical history, calculation of body mass index, physical, instrumental and laboratory investigations. As a result, 93 students were selected; their own indicators outside the examination period were used as controls. The study individuals had an investigation of the state of autonomic reactions (measurement of systolic and diastolic blood pressure, heart rate, Kerdo autonomic index) conducted 1 hour before and within 1 hour after the examination. The hormonal status was investigated by enzyme immunoassay. The results of the study were verified using the software package «StatPlus». Results. Sympathicotonic nature of the vegetative response dominated, according to which two categories of students were allocated: with a steady and significant increase in Kerdo autonomic index (53%) and with the lack of such growth rate (47%). In the study of the hormonal profile a reduction in the serum concentrations of thyroid-stimulating hormone and cortisol levels, an increase in blood content of the tested biogenic amines - histamine, epinephrine (adrenaline), serotonin was revealed. Conclusion. The established changes in the indices of the cardiovascular and endocrine systems emphasize the individual nature of each subject’s reactions, and therefore require clustering of students into groups according to the characteristics of autonomic and hormonal responses to psychoemotional stress.
Kazan medical journal. 2012;93(3):461-464
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Features of etiopathogenesis of psychosomatic and somatoform disorders

Marincheva L.P., Zlokazova M.V., Solov’ev A.G.


Aim. To identify the features of etiopathogenesis of somatoform and psychosomatic disorders in adolescents. Methods. Examined were 426 adolescents and their families. The main group - 321 patients of the Kirov City Children’s Clinical Hospital, which included two subgroups: 117 adolescents with somatoform autonomic dysfunction, and 204 - with psychosomatic disorders; the mean age was 15.1±1 years. The control group consisted of 105 adolescents who were students of secondary schools in the city of Kirov with the first group of health; the mean age was 15.1±1 years. The clinical-psychopathological method of investigation, questionnaire surveys, and experimental psychological tests were used in order to perform the study. Results. The conducted study confirms the multifactor nature of the pathogenesis of psychosomatic disorders (identified was the importance of biological, psychological and social factors) and makes it possible to suggest that the onset of symptoms of psychosomatic disorders is formed according to the main stages of the nonspecific response to stress, from the autonomic neurotic reactions during somatoform autonomic dysfunction (at the stage of resistance) to the development of the psychosomatosis picture - during the development of psychosomatic disorders (at the exhaustion stage). The level of disease development is determined by both the individual predisposition and the spectrum of adaptive responses to stress. All this confirms the need for earliest detection of somatoform autonomic dysfunction in order to prevent the development into a chronic process and its progression. Conclusion. Complex treatment is of great importance, including the personal-oriented psychotherapy aimed at the development of adaptive mechanisms for coping with stress.
Kazan medical journal. 2012;93(3):465-468
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Features for the autonomic balance during tuberculin diagnosis in accordance with the mantoux method and using the skin prick test

Borodulina E.A., Kozlova O.S., Seredina Y.P., Korolev V.V., Pyatin V.F., Amosova E.A.


Aim. To evaluate the dynamics of the autonomic balance in children during tuberculin diagnosis (Mantoux test and skin prick test) by investigating the heart rate variability. Methods. In 30 children (14 boys and 16 girls) aged 7.5±0.54 years the parameters of heart rate variability were recorded before and during the Mantoux test and skin prick test. Results. The comparative analysis of the used diagnostic techniques revealed advantages of the prick test method: during the diagnostic testing procedure with the skin prick test the increase in the heart rate of all children was less by 53%, sympathetic activation of the regulation of cardiac activity according to the NN50 parameter (number of pairs of cardiac intervals, differing from the neighbouring ones by more than 50 ms) was lees by 35%, the activity of the sympathetic and parasympathetic tone was less by 32 and 15% compared to such during the Mantoux test. The index of tension of the regulatory systems during the skin prick test was 25% less than during the normal tuberculin test carried out with a syringe. Conclusion. During the performance of the skin prick test a general tendency of preservation of the vagal influence on the cardiac function in children was revealed in contrast to the Mantoux test; the technique of injecting tuberculin using the skin prick test is associated with development of less emotional stress in children.
Kazan medical journal. 2012;93(3):468-473
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Diagnosis of psychovegetative disorders in adolescents with diseases of the upper gastrointestinal tract

Kokurkin G.V., Akimova V.P.


Aim. To develop a method of diagnosing psychovegetative disorders in adolescents with diseases of the upper gastrointestinal tract. Methods. Examined were 120 adolescents. The main group - 90 adolescents with diseases of the upper gastrointestinal tract (mean age 15.9±2.5 years): extroverts (the first group - 31 people), centroverts (the second group - 37 people), introverts (the third group - 22 people). The control group - 30 practically healthy adolescents aged 14 to 18 years: 18 boys and 12 girls. This group included examined individuals, who did not report any complaints to the state of health, without chronic somatic and neuropsychiatric diseases in the anamnesis, with no deviations in the physical status. Conduced were clinical examination, determined was the level of extra-introversion, stomach acid-producing function, the nature of autonomic regulation, assessed was the psycho-emotional state, conducted was fibroesophagogastroduodenoscopy, ultrasound investigation of the liver, biliary tract, pancreas, stomach and duodenum. Results. Introverts had an unfavorable course of the diseases of the upper gastrointestinal tract. All patients of this group were diagnosed was duodenal ulcers; often several parts of the digestive system were involved in the pathological process. The most common and severe symptoms were heartburn, vomiting, nausea, loss of appetite, in 65.7% of patients revealed was an increase in acid production, in 86.4% - Helicobacter pylori infection. Autonomic regulation was characterized by vagotonia. Hypertrophic diffuse gastroduodenitis and duodenal erosions were diagnosed in extroverts. The main clinical syndrome was pain, established were moderate disturbances of the acidity of the gastric juice (in 43.5% of patients of this group), and Helicobacter pylori infection (48.4%). Autonomic regulation was characterized by sympathicotonia. Among centroverts the diseases of the upper gastrointestinal tract had a very mild course, most often superficial gastroduodenitis was present. Among the clinical symptoms flatulence was often reported. Compared with other groups disturbances of the acidity of gastric juice (15.3%) and Helicobacter pylori infection (18.9%) were reported with less frequency. Autonomic regulation was characterized by autonomic dysfunction of both vagotonic and sympathicotonic types. Conclusion. The data on personality characteristics (Eysenck’s questionnaire), psycho-emotional state (I.D. Spielberger test) and autonomic regulation (variation cardiointervalography) can be used in predicting the course of diseases of the upper gastrointestinal tract in adolescents.
Kazan medical journal. 2012;93(3):473-478
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Creation of artificial chords during mitral valve replacement in patients with rheumatic heart disease

Abdul’yanov I.V., Mukharyamov M.N., Dzhordzhikiya R.K., Vagizov I.I.


Aim. To evaluate the effectiveness and safety of the use of artificial chords using polytetrafluoroethylene sutures during mitral valve replacement in patients with rheumatism. Methods. The study included 134 patients operated on for isolated rheumatic mitral valve disease. Immediate (10 days) and long-term (24 months) results were evaluated in the three groups of patients, depending on the method of valve replacement: creation of prosthetic chords using polytetrafluoroethylene sutures (37 patients), preservation of native chords (67 patients), total excision of the subvalvular apparatus (control group, 30 patients). Results. 24 months after surgery in the group of prosthetic chords and the group of preserved native chords recorded was a significant decrease in the pulmonary artery pressure, the left atrial size and a reduction in the end-diastolic left ventricular size. In the control group of patients reported was a reduction in left ventricular ejection fraction in long-term follow up. Conclusion. The use of polytetrafluoroethylene sutures in order to create new chords demonstrated their safety and effectiveness in preserving the physiological left ventricular geometry; artificial chords, as well as the preserved native chords, have a positive effect on the left ventricular contractile function in the remote postoperative period.
Kazan medical journal. 2012;93(3):479-484
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Integrated ultrasound investigation and magnetic resonance tomography in the diagnosis of focal thyroid pathology

Timofeeva L.A.


Aim. To determine the features an integrated ultrasound investigation and magnetic resonance tomography in the diagnosis of focal thyroid pathology. Methods. Integrated ultrasound examination was conducted in 1440 patients with focal lesions of the thyroid gland at the age of 17-76 years, and magnetic resonance tomography was performed in 91 patients (65 females and 26 males). Results. It was established that the informativeness of the ultrasound investigation is characterized by the following parameters: sensitivity - 92.1%, specificity - 78.6%, and diagnostic accuracy - 90.3%; the informativeness of magnetic resonance tomography: sensitivity - 94.1%, specificity - 89.6 %, and diagnostic accuracy - 91.0%. Conclusion. Integrated use of ultrasound investigation and magnetic resonance tomography significantly increases the informativeness during primary diagnosis of focal thyroid diseases.
Kazan medical journal. 2012;93(3):484-487
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The state of the oxidation-reduction system in patients with primary open angle glaucoma

Gazizova I.R.


Aim. To study the state of the oxidation-reduction system in patients with primary open-angle glaucoma. Methods. Conducted were biochemical studies of the state of the oxidation-reduction system in 30 patients with primary open-angle glaucoma. The level of lipid peroxidation of cell membranes was determined in blood serum by the method of accumulation of malondialdehyde based on its interaction with thiobarbituric acid. The state of the antioxidant system was assessed according to the activity of superoxide dismutase, catalase, glutathione reductase and the content of thiol disulfide groups in the blood. The concentration of lactate in the blood serum was determined using an automated analyzer. Results. In patients with a chronic course of glaucoma elevated levels of oxidized thiol groups of proteins, increased activity of antioxidant enzymes, activation of lipid peroxidation processes, increased lactate content have been identified. Conclusion. Changes in the oxidation-reduction system in patients with primary open-angle glaucoma may be a sign of mitochondrial dysfunction.
Kazan medical journal. 2012;93(3):488-490
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The role of subvalvular structures in the development of mitral valve prolapse in children

Belozerov Y.M., Magomedova S.M., Abakarova Z.S., Osmanov I.M.


Aim. To assess the role of subvalvular structures in the development of mitral valve prolapse in children. Methods. Conducted was an echocardiography investigation with comparative analysis of structural and functional parameters of subvalvular structures in healthy children (50 individuals) and children with mitral valve prolapse divided in two groups: first group - without regurgitation (34 children), the second group - with regurgitation (16 children). Results. In healthy children identified were strong correlation links between echocardiographic indices of the subvalvular structures of the mitral valve and the functional parameters of the left ventricle. The diameter of the anterolateral group of papillary muscles directly correlated with the thickness of the interventricular septum, while the diastolic distance between the papillary muscles - with the end diastolic diameter of the left ventricle. It was established that the following factors may contribute to the pathogenesis of mitral valve prolapse: (1) long papillary muscles and the corresponding chords of the valve, (2) a weak (relative to the norm) contractile ability of the papillary muscles, (3) hyperkinesis of the left ventricular apex, and (4) no relationship between the apical and the global ejection fraction. These factors contribute to the fact that the papillary muscles and chords constrain the mitral valve cusps to a lesser extent during systole, which in turn easily bulge into the left atrium under the influence of systolic blood pressure. Apical hyperkinesis contributes to even closer approximation of the subvalvular structures with the cusps. Conclusion. Mitral valve prolapse is attributed to desynchronization of the function of papillary muscles and of the left ventricle; the development of functional mitral regurgitation during mitral valve prolapse is associated with dyssynchrony of the papillary muscles’ activity.
Kazan medical journal. 2012;93(3):490-493
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Changes in the content of some cytokines during chronic heart failure

Kuzmin A.G., Gorbunov V.V., Goryainova E.V., Bogatikov E.V., Koshevaya O.D.


Aim. To determine the changes in the content of cytokines, systolic intraventricular and interventricular dyssynchrony in patients with chronic heart failure. Methods. The study included 223 patients (174 males, 49 females) who suffered a Q wave myocardial infarction of the left ventricle, with clinical manifestations of chronic heart failure with functional class III according to the classification of the New York Heart Association. Pro- and anti-inflammatory cytokines (tumor necrosis factor alpha, interleukin-6, -4, and -10, interferon-gamma) were studied in blood plasma by enzyme immunoassay. Dyssynchrony was studied by pulsed-wave Doppler investigation, M-mode measurements of the left ventricle and pulsed-wave mode of tissue Doppler investigation of the myocardium. Results. Noted was an elevation of levels of tumor necrosis factor alpha, interleukin-6, interferon gamma, in combination with a reduction in the content of interleukin-4 and -10 in all groups. The maximum increase in the content of tumor necrosis factor alpha and interleukin-6 was found in the group of eccentric hypertrophy and dilatation of the left ventricle. Positive correleation links of medium strength have been established between the levels of interleukin-6 and the degree of interventricular mechanical delay, and between systolic and diastolic myocardial stress. In the group with eccentric hypertrophy and dilation of the left ventricle the content of tumor necrosis factor alpha directly correlated with the time interval from the beginning of the Q wave on the electrocardiogram to the beginning of the oflow in the left ventricular outflow tract, as well as with the concentration of N-terminal fragment of the precursor of the human brain natriuretic peptide. During remodeling according to the type of eccentric hypertrophy without dilatation of the left ventricle observed were positive correlation links of medium strength between the content of the tumor necrosis factor alpha and the intraventricular mechanical delay, end-diastolic pressure in the left ventricle. In the group of concentric hypertrophy the content of the tumor necrosis factor alpha and interleukin-6 is positively associated with electrocardiographic interval from the Q wave to the beginning of the systolic Doppler artifact S. Conclusion. One of the factors, which contributes to the preservation of abnormal levels of tumor necrosis factor alpha and interleukin-6 in blood plasma is the intraventricular and interventricular dyssynchrony; the combination of dilatation, myocardial hypertrophy, systolic and diastolic left ventricular dysfunction, dyssynchrony and the toxic effects of proinflammatory cytokines on the myocardium contributes to progression of chronic heart failure.
Kazan medical journal. 2012;93(3):494-498
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Experimental medicine

Study of the absorptive intestinal function in an experimental model of chronic alcohol intoxication

Yakovleva L.M., Lezhenina S.V., Maslova Z.V., Kupriyanov S.V.


Aim. To study the absorptive function of the rat intestine on the background of prolonged alcohol intoxication. Methods. The study was performed on 24 nonlinear white male rats (12 animals in the control and experimental groups) weighing 220-240 g, which had a daily consumption of 20° ethanol solution (ethyl alcohol) for the duration of 180 days. After 6 months perfusion of the isolated segment of jejunum with a dextrose (glucose) solution 35 mmol/L was performed by in the rats the method A.M. Ugolev. The luminescence-histochemical method was used to examine the content of catecholamines and serotonin in the neuroamine containing structures. Results. In the control rats, the rate of absorption in the first 10 min of perfusion reached a maximum value with a further decrease in the intensity of absorption. The content of serotonin and catecholamines in the absorptive epithelial layer of the jejunal villi was lower than in the muscle membrane. In the experimental rats the content of biogenic amines in the wall of the jejunum increased: the amount of serotonin in the absorptive layer of the villi increased up to 122% and in the muscle membrane - up to 126%. The content of catecholamines also increased up to 154% in the muscle membrane and up to 124% in the epithelial layer in the area of the villi compared with controls. In conditions of chronic alcohol intoxication the rate of absorption of dextrose (glucose) during perfusion in the first 30 minutes was reduced by 33% compared with the control. During the next hour, the intensity of absorption reduced by 45% (55% of control). After 1.5 hours the absorption increased slightly, accounting for 64% of the control value and by the end of the 2nd hour the intensity of the absorption reached 91%. Conclusion. An increase in content of catecholamines and serotonin in the mucous and muscular layers of the intestine in chronic alcohol intake and a decrease in the intensity of the absorption of dextrose (glucose) was established; in the setting if modified combined effects of neurotransmitters on smooth muscle cells an increased motor effect is formed, which is accompanied by rapid evacuation of the intestinal chyme with a reduction in the rate of absorption
Kazan medical journal. 2012;93(3):499-502
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Functional status of neutrophils during carbon tetrachloride intoxication in rats

Alekhin E.K., Mufazalova L.F., Mufazalova N.A.


Aim. To study the damaging effect of acute carbon tetrachloride intoxication on the functional status of neutrophils in an experiment. Methods. The experiments were performed on 90 non-inbred white rats weighing 200-220 g; two groups were identified - experimental group and control group (45 animals in each). Carbon tetrachloride was administered intragastrically to the experimental group (1.25 ml/kg 50% solution in olive oil) for the duration of four days. Determined were the number of leukocytes, neutrophils and lymphocytes in the peripheral blood, the intensity of the oxygen-dependent metabolism (through spontaneous and induced nitro blue tetrazolium test), the absorption and antimicrobial activity, the content of myeloperoxidase and cationic proteins in neutrophils. The results were recorded on the 7th, 14th and 28th day from the end of the toxicant administration. Results. On the 7th day in rats of the experimental group leukopenia was registered in the form of reduction in the number of lymphocytes, the inactivation index decreased, which was confirmed by reduction of the number of myeloperoxidase-positive cells and of the mean cytochemical coefficient; noted was a decrease in the absorptive capacity of neutrophils. On the 14th day leukopenia persisted, which was now in the form of an even decrease in the number of neutrophils and lymphocytes; with the continued decrease in the phagocytic index an increase in the number of cells involved in phagocytosis was registered. By the 28th day the number of lymphocytes increased in the presence of neutropenia; the decrease in the number of myeloperoxidase-positive cells and of the mean cytochemical coefficient in the myeloperoxidase system, reduction of the indices of the induced test with nitro blue tetrazolium and of the proportion of cells positive for cationic proteins persisted. Conclusion. Acute intoxication with carbon tetrachloride leads to profound dysfunction of neutrophils (leukopenia, decreased absorption and microbicidal activity of neutrophils, reduced myeloperoxidase activity and the content of cationic proteins), which is not eliminated by the 28th day of observation.
Kazan medical journal. 2012;93(3):502-504
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The effect of new quaternary phosphonium salts with highest alkyl substituents on the permeability of cell membranes for sodium ions in vitro

Orlova O.V., Oslopov V.N., Sidullina S.A.


Aim. To assess the effect of newly synthesized quaternary phosphonium salts with highest alkyl substituents (C10, C12, C14, C16, C18) on the permeability of cell membranes for sodium ions in vitro. Methods. In vitro studied was the effect of different concentrations of new quaternary phosphonium salts with highest alkyl substituents on the cell membrane permeability to sodium ions according to the rate of Na+-Li+-countertransport in the erythrocyte membrane. Results. Low concentration (0.001 mM) of substance C10 increased the rate of Na+-Li+-countertransport in the erythrocyte membrane by 11.9%, substance C12 - by 11.8%, substance C14 - by 12.7%, substance C16 - by 13%, substance C18 - by 12.3%. Higher concentrations of substances (0.01-0.05 mM) had no significant effect on the cell membrane permeability to sodium ions. Conclusion. An increase in the rate of Na+-Li+-countertransport in the erythrocyte membrane is influenced by minimal concentrations of a substance, under the influence of other concentrations the rate of Na+-Li+-countertransport doe not change.
Kazan medical journal. 2012;93(3):505-507
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Prospects for using agonists and antagonists of P2 receptors in clinical ophthalmology

Ziganshina A.P., Ziganshin B.A., Samoilov A.N., Ziganshin A.U.


This literature review focuses on the role of purinergic P2-receptors in the physiology and pathophysiology of the eye, as well as on the possibilities of pharmacologic stimulation of these receptors. The most important studies from the clinical point of view on the involvement of purinergic neuronal transmission in the physiological processes have been analyzed, ranging from normal embryogenesis to cell apoptosis in age-related degenerative diseases of the eye. Data on the effect of agonists and antagonists of P2 receptors on corneal wound healing, lacrimal fluid production, regulation of intraocular pressure, neurotransmission, proliferation of glial tissue in the retina has been presented along with data on the possibilities of modulating these processes by using potential drugs acting via P2 receptors.
Kazan medical journal. 2012;93(3):508-512
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The role of genetic polymorphism in the formation of atherosclerosis in the vessels of lower extremities

Katina M.N., Gayfullina R.F., Valiullin V.V., Rizvanov A.A., Khamitov R.F., Rizvanova F.F.


Personalized medicine involves the use of methods of genomics and proteomics by physicians for early diagnosis, prediction of the nature of the disease course and the choice of medicines and their doses based on personalized characteristics of the individual patient. Advances in the study of the human genome make it possible to reveal the interrelation between the individual mutations in the human genes (polymorphisms) and predisposition to certain diseases. Currently there are more than 10 million single-nucleotide polymorphisms in the human genome, however their biological role remains poorly understood. On the basis of a literature search of electronic full-text and abstract-only versions of articles, which was conducted in the PUBMED, OMIM and GENE databases, collected was the information on genetic predisposition to systemic atherosclerosis. The review is dedicated to polymorphisms of the major genes that play a role in the pathophysiology of atherosclerosis of the lower extremities.
Kazan medical journal. 2012;93(3):513-516
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Epidemiology and healthcare management

Prevalence of the metabolic syndrome in an unorganized population taking into account different criteria of its diagnosis

Isaeva E.N.


Aim. To study the prevalence of metabolic syndrome in an unorganized population of Orenburg city. Methods. The sample was formed by the method of random numbers. Examined were 301 people aged 25 to 75 years, of which 148 were males and 153 females. Studied were the socio-demographic characteristics and medical history (including filling out of a questionnaire), the clinical status of study participants (with the measurement of blood pressure, height, weight, waist and hip circumference, biochemical blood analysis to determine the concentration of glucose and lipid profile). In order to identify the metabolic syndrome the following diagnostic criteria were used: of the Work Group on the treatment of adults of the National Cholesterol Education Program of the U.S. (2001-2005), of the International Diabetes Federation (2005) and of the All-Russian Scientific Society of Cardiology (2009). Results. The prevalence of abdominal obesity was reduced by using less stringent thresholds for waist circumference. The most common variant of the metabolic syndrome was the combination of the following components: abdominal obesity, arterial hypertension and a low content of high-density lipoproteins. According to the criteria of the International Diabetes Federation such a combination occurred in 7.6%, while in accordance with the Criteria of the Work Group on for the treatment of adults of the National Cholesterol Education Program of the U.S. - it occurred in 4.3%. Conclusion. The frequency of registration of the metabolic syndrome depends on the criteria for its diagnosis.
Kazan medical journal. 2012;93(3):517-519
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The study of the prevalence of articular syndrome and pathology of the musculoskeletal system through a telephone questionnaire survey

Krechikova D.G., Erdes S.F., Milyagin V.A.


Aim. To establish the prevalence of complaints of joint swelling and arthralgia among the population of Smolensk city, to assess their correlation with the presence of rheumatic diseases. Methods. A cross-sectional telephone questionnaire survey of residents of six therapeutic districts of two municipal polyclinics of Smolensk city was conducted. Interviewed were 2737 people (64.8% females and 35.2% males). The average age of respondents was 49.1±17.6 years. Results. Swelling of the joints at the time of the survey was revealed in 665 (24.3%) of respondents, in the majority of which (583 people, 21.3%) the symptoms persisted for more than the last 12 months. Pain in the knee joints was observed in 1141 (41.7%) residents, including arthralgia lasting more than a year - in 1012 (37.0%) people. The relationship between both of the symptoms and the gender (the predominance of women) and age (an increasing linear nature of the frequency of complaints in males and non-linear with a peak in the group of 70-80-year-olds - in females) was revealed. It was established that only 41.3% of respondents with joints swelling and 30.9% with arthralgia had a previously established diagnosis of rheumatic disease. Conclusion. The study results suggest that there is high prevalence of rheumatic complaints among residents of Smolensk city with a predominance of articular disease in women and individuals of older age groups; revealed was the fact of low awareness of the population of the existing rheumatic disease.
Kazan medical journal. 2012;93(3):519-521
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Analysis of the causes of death in HIV-infected individuals in 2008-2010 according to the data of the clinical infectious diseases hospital named after S.P. Botkin, St. Petersburg

Rakhmanova A.G., Yakovlev A.A., Dmitrieva M.I., Vinogradova T.N., Kozlov A.A.


Aim. To analyse the causes of death of individuals infected with the human immunodeficiency virus (HIV)/patients with acquired immunodeficiency syndrome (AIDS) in the Clinical Infectious Diseases Hospital named after S.P. Botkin in 2008-2010 taking into account the timing of disease, comorbidities, and clinical and laboratory data. Methods. The study included 439 HIV-infected individuals, who died in the Clinical Infectious Diseases Hospital named after S.P. Botkin in 2008-2010. Two groups of patients were identified: deaths from HIV/AIDS (n=306) and from other diseases (n=133, HIV infection was considered to be a concomitant disease). In both groups, analyzed were the short-term mortality rates, the presence of drugs and/or alcohol dependency, and the main causes of death (according to autopsy results). Results. In the group of patients who died of HIV-infection/AIDS and who did not receive antiretroviral therapy, generalized tuberculosis was diagnosed most often (65.7% of cases). Other rare diseases were pneumocystis pneumonia, cryptococcosis, cerebral toxoplasmosis, generalized fungal infection, cerebral lymphoma, and cytomegalovirus infection. The most frequent causes of death in the group of patients whose HIV-infection was considered to be a concomitant diseases were chronic viral hepatitis in the cirrhotic stage (42.9%) and septic thromboendocarditis, which were mainly diagnosed in social maladjusted patients: patients with alcoholism or intravenous drugs users. During evaluation of the short-term mortality rates it was established that 21 to 29% of patients in different years died on the 1st-3rd day after admission, which was related to extremely severe conditions of the patients. In Russia, including St. Petersburg, an annual increase in the number of new cases of HIV infection and increased mortality are registered, which indicates the severity of the epidemic and makes it possible to predict the increase in the number of patients requiring hospital treatment. Conclusion. The main causes of death among HIV-infected individuals in 2008-2010 were generalized tuberculosis and chronic viral hepatitis in the stage of cirrhosis; the high index of short-term mortality among HIV-infected patients suggests the need for measures for early detection of HIV-positive individuals and their medical examination, as well as an increase in the number of beds in order to provide specialized care to HIV-infected individuals in St. Petersburg.
Kazan medical journal. 2012;93(3):522-526
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Morbidity and prevalence of the genitourinary system diseases in children in the Udmurt Republic

Strelkova T.N.


Aim. To identify the pattern of distribution of nephropathy in a limited population (living in the same area) with the same risk factors ratio for the development of this disease. Methods. Conducted was an analysis of annual statistical reports of the nephrological morbidity in the Udmurt Republic, covering 306,355 children. Calculated were the intensive parameters that characterize the incidence among child population, using the method of calculating the relative magnitudes of clarity. Presented was a retrospective analysis of 8379 case histories of children admitted to the Children’s Nephrology Department of the Budget Institution of the Ministry of Health Care of the «Republican Children’s Clinical Hospital of the Ministry of Health care of the Udmurt Republic» with diseases of the urinary system. Results. Revealed was a high incidence of urinary tract pathology in children of all age groups with a tendency for increase in both the general and primary morbidity, regardless of the place of residence. Stated was an increase in the detection rate of chronic renal failure in early childhood, which in 86.1% of cases developed secondary to congenital and hereditary diseases of the urinary system. Conclusion. The obtained data should be considered when planning the children’s nephrology urology services of the Udmurt Republic.
Kazan medical journal. 2012;93(3):526-529
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Prevalence of excessive body weight and obesity among industrial enterprise workers according to long-term studies

Yashin D.A., Kalev O.F., Kaleva N.G., Yashina L.M.


Aim. To assess the dynamics of the prevalence of excessive body weight (pre-obesity) and obesity, to identify gender differences among the workers of an industrial enterprise in the period 1994-2010. Methods. Population-based cross-sectional complex preventive studies of 2566 industrial workers (1579 males and 987 females) aged 18-64 years in order to identify the non-infectious diseases were conducted in 1994, 1999 and 2000. Pre-obesity, obesity and other risk factors were assessed according to the criteria of the program on Countrywide Integrated Noncommunicable Diseases Intervention of the World Health Organization and according to Russian recommendations regarding the metabolic syndrome. Results. The prevalence of excessive body weight (35.3%) and obesity (12.2%) in 2010 for males was significantly higher than in 1999 (31.1 and 7.7% respectively), the prevalence of obesity alone among them was significantly higher in 2010 than in 1994. In females the prevalence of obesity in 2010 was significantly higher than in 1999 (26.7 and 19.9% respectively) with no significant differences in the frequency pre-obesity (34.0 and 39.6% respectively). The prevalence of pre-obesity and obesity among females in 2010 did not differ significantly from such in 1994. Conclusion. Revealed was an increase in the prevalence of pre-obesity and obesity in males and females in the period from 1999 to 2010; mean body mass indices and frequency of pre-obesity and obesity in females were significantly higher than in males at all periods of the prospective study.
Kazan medical journal. 2012;93(3):529-532
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On the prevalence of somatic pathology among patients with mental disorders

Mendelevich B.D., Kuklina A.M.


Aim. To determine the medical and statistical features of somatic pathology in patients of a therapeutic district with severe mental disorders. Methods. Conducted was a comparative clinical statistical analysis of data on patients’ referral to outpatient psychiatric health services (924 people, the main group) and patients of one therapeutic district of Naberezhnye-Chelny city (2250 pe-ople, the comparison group) for the year 2010. The method of observation - comprehensive, obtaining the necessary medical and statistical information - copying of the data from the ambulatory patient records. Results. In the structure of the somatic pathology among patients of the therapeutic district (comparison group) according to the referral data the leading position is held by cardiovascular disease (32.2%), diseases of the nervous (24%) and respiratory (21.1%) systems. In the group of patients with mental disorders the leading nosological group were diseases of the nervous system (30.2%) and cardiovascular disease (28.2%). Patients of the main group rarely visited the district physician themselves, most often it occured after the referral of a psychiatrist in order to pass the medical and social assessment, or to obtain medications. Conclusion. Due to the lack of criticism for their own condition, the patients with chronic mental illnesses rarely come to visit physicians of the therapeutic service, thus greater attention to this on behalf of the psychiatrists and other specialists is needed, as well as of the relatives of patients.
Kazan medical journal. 2012;93(3):532-534
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The medical and demographic situation in Kazan in the late XX and XXI centuries

Alyavetdinov R.I., Shamsiyarov N.N.


Aim. To assess the demographic situation in the city of Kazan in 1995-2010. Methods. An assessment has been conducted based on the analysis of the dynamics of population size and composition, indices of fertility and mortality. Calculations of intensive and extensive indicators and their dynamic comparison were used as the research methods. Results. The maximum value of natural decrease in the population of Kazan, resulting from excess mortality above the level of fertility, fall on the period 2000-2001. However, beginning from 2002 this parameter began to decrease, and in 2010, when the rates of mortality and fertility equaled, registered was a zero natural growth. Reduction in the total fertility rate of the population of the city in the last decade of the twentieth century gave way to the growth of this indicator in 2001-2010. In the structure of mortality of the population in the city of Kazan the leaders are diseases of the cardiovascular system (61.1%), then - malignant tumors (16.3%), followed by - traums, poisoning and accidents (10.3%). The mortality remains high in the working-age population and almost a four-fold prevalence of middle age male mortality over female mortality has been established. The slight increase in the population of Kazan is due to the influx of migrants to the city and to the annexation of the village communities to the city. In the population structure the proportion of middle-aged and elderly citizen increases, while the proportion of children decreases. Conclusion. The demographic situation, which determines the strategy of organization of medical care for the population, should be under the survailance of the society.
Kazan medical journal. 2012;93(3):535-537
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New methods of diagnosis and treatment

Correction of stress urinary incontinence in women using a free suburethral loop

Neymark A.I., Razdorskaya M.V., Neymark B.A.


Aim. To evaluate the efficacy and safety of implantation of a free synthetic loop (Tension-free Vaginal Tape - TVT) in the treatment of stress urinary incontinence in women. Methods. Examined and operated were 80 patients suffering from stress urinary incontinence. Suburethral implantation of a free loop (sling) in 3 patients was performed using standard TVT kit, while in 77 - using the IVS kit (Intravagynal Sling), which has some design differences from the TVT kit. Results. The observation period ranged from 3 months to 5 years. According to a questionnaire survey designed by the authors, which includes 21 questions, the following results were obtained: good - in 72 (90%) patients, satisfactory - in 6 (7.5%), unsatisfactory - in 2 (2.5%) patients. According to uroflowmetry, after the conducted treatment the duration and volume of urination increased, the maximal urine flow rate decreased to the normal values. Conclusion. The operation of implantation of a free synthetic loop serves as a rational and effective treatment method for the correction of stress urinary incontinence in women without prolapse of the vaginal walls; the success of intervention largely depends on the proper selection of patients and on the surgical technique.
Kazan medical journal. 2012;93(3):538-541
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Polypropylene endoprostheses in the surgical treatment of strangulated postoperative ventral hernias

Fatkhutdinov I.M.


Aim. To determine and implement the best ways to position mesh endoprostheses in the anterior abdominal wall during strangulated postoperative ventral hernias; to introduce methods of non-stretch hernioplasty into emergency surgery of giant hernias. Methods. 115 patients (27 males and 88 females) with strangulated postoperative ventral hernias aged 30-73 years were under observation. Depending on the size of the hernia and on the intraoperative findings different methods of implantation of the mesh endoprostheses were used, which prevented the mesh contact with subcutaneous fat and abdominal organs. For small and medium-sized hernias the mesh was placed under or over the abdominal membrane, it was fixed to the abdominal wall, the aponeurosis was sewn together in an «edge to edge» fashion. In cases with giant hernias non-stretch hernioplasty was performed. During the operation of non-stretch hernioplasty, dissection and excision of the hernial sac was performed in such a way that made it possible to use it to cover the abdominal wall defect. Results. In the early postoperative period in 17 (14.8%) patients seromas had formed in the wound, which were treated by needle puncture under ultrasound guidance. Postoperative mortality was 5.2% (6 people). In 5 cases the deaths were due to myocardial infarction and pulmonary embolism. One patient developed peritonitis due to suture insufficiency of the enteric anastomosis. Of all patients with lethal outcomes five patients were admitted after more than 6 hours from the start of the strangulation, one patient was admitted after 3 hours. Conclusion. The usage of techniques that delimit the mesh prosthesis from the abdominal cavity and subcutaneous tissue, and the introduction of non-stretch methods for giant hernias in the surgical treatment of strangulated postoperative ventral hernia contribute to improved outcomes of treatment in this group of patients.
Kazan medical journal. 2012;93(3):541-544
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Experience in the treatment of opium withdrawal syndrome with naloxone under general anesthesia

Verkhnev V.A., Krasnoschekova N.N.


Aim. To summarize the results of treatment of opium withdrawal syndrome with naloxone under general anesthesia in a municipal hospital. Methods. During the period 2001-2010 examined were 102 pa-tients, of whom 80% were aged 20 to 30 years. Treatment was performed on a contractual basis, after a preliminary examination according to a unified program. After admission to the intensive care unit conducted was the general intravenous anesthesia with mechanical ventilation. Naloxone was administered in a bolus every 15 minutes during the first hour of anesthesia with the aim to detoxify, followed by 0.4-0.8 mg/h during the following 24 hours of treatment. Residual effects of the withdrawal syndrome were treated with additional drug therapy, including diazepam, clonidine, droperidol. The effectiveness of treatment was analyzed on the basis of the absence of clinical signs of the withdrawal syndrome, as well as with the test «NARCOCHEK». Results. By the end of the first day of treatment in 100% of patients no opiates were found in the urine. Weakness and depression was noted in 90 people, while in 18 noted was aggressive behavior, and at the same time the autonomic disorders were absent in all patients. The in-hospital course of treatment time amounted to 1.5 days. There were no complications during treatment. Conclusion. This method of therapy promotes rapid and painless relief of withdrawal syndrome, while serving only as the initial phase of treatment and rehabilitation of patients with opioid dependence.
Kazan medical journal. 2012;93(3):544-546
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On providing the continuity of dynamic observation of students on the basis a medical institution of the university

Polovnikova A.A., Ponomarev S.B., Soboleva N.P., Alekseenko S.N., Ivanov E.V., Aleksandrov A.B.


Aim. To improve measures aimed at ensuring the continuity of the dynamic health monitoring of students on the basis of medical institutions of the University. Methods. On the basis of the technology «client-server», which is oriented on the management system of the Firebird databases, developed was an information-analytical system of dynamic observation of the health of students. Results. This system presumes a specific algorithm for the medical examination, first of all the screening methods: psychological testing, measurement of anatomical and physiological parameters, obtaining of the medical history, physical examination, cardiorhythmography and routine clinical and laboratory tests. With the help of original methods the medical information system provides a complex report on the state of health of the student and on the risks of the most common diseases in this age group. Conclusion. Health care providers of medical institutions of a University can use the developed system for dynamic monitoring of the health of the students.
Kazan medical journal. 2012;93(3):547-549
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Clinical observations

Beta-lactam antibiotics as a probable cause of acute respiratory distress syndrome

Skipskiy I.M., Efimov N.V.


Described was a case of massive (right upper and middle lobe and basal segments of the left lower lobe) clinically atypical pneumonia, «rapidly» resolving during treatment with beta-lactam antibiotics, but complicated by acute respiratory distress syndrome, acute respiratory failure, infectious and toxic shock, cerebral and pulmonary edema that led to a lethal outcome. No macroscopic pathological signs of pneumonia were found, histologically in one of the sections of the lower lobe of right lung in the alveoli some serous-leukocyte exudate was found. The paradox of the situation (pneumonia almost resolved, but the patient died) became the reason to conduct a retrospective analysis, which showed that over the preceding 10 years, there were 27 cases of progressive pneumonia (3.1% of 873 cases of pneumonia), usually atypical during treatment with beta-lactam antibiotics, four of which, including the described one, had a fatal outcome caused by acute respiratory distress syndrome. The remaining patients in whom beta-lactam antibiotics were changed to macrolides, recovered. This suggests the ability of beta-lactam antibiotics to participate in the pathogenesis of acute respiratory distress syndrome, or even be its cause.
Kazan medical journal. 2012;93(3):550-553
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History of medicine

M.S. Kulaev - public health administrator of the Tatar and Bashkir ASSR

Ziyatdinov K.S., Kin’yabulatov A.U., Zagidullin S.Z., Sharafutdinova N.K., Aminov T.Z.


Mukhametkhan Sakhipkireevich (Mstislav Aleksandrovich) Kulaev was not only a physician and a talented administrator, but also had broad and progressive views for his time on the ways of developing education in Bashkiria. He believed that it must go through the exposure of the Bashkir population to the Russian culture and through the Russian to the European culture.
Kazan medical journal. 2012;93(3):554-555
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Professor Victor Khristianovich Frauchi (the 110thanniversary of his birth)

Agafonov A.A., Frauchi I.V.


The article presents historical data about the life of Victor Khristianovich Frauchi and memories of him, which raises the appearance of not only an outstanding scientist and educator, but also of an easy-going, expansive, highly decent man, with his personal features and little maggots that cause a kind smile. And they are not contradictory.
Kazan medical journal. 2012;93(3):556-558
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Professor Vladimir Feoktistovich Bogoyavlenskiy

Kazan medical journal. 2012;93(3):560
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