Vol 93, No 1 (2012)

Theoretical and clinical medicine

Features of haemostasis in patients with coronary heart disease

Galyautdinov G.S., Chudakova E.A.


Aim. To identify the nature of changes in the hemostasis system in patients with chronic and acute ischemic heart disease. Methods. The first group was comprised of 46 patients with stable angina of the II-III functional class, the second group was comprised of 42 patients with acute coronary syndrome, the control group included 28 healthy individuals. In all of the examined individuals determined were the number of platelets, the amount of antithrombin III, activated partial thromboplastin time, international normalized ratio, fibrinogen content, soluble fibrin monomer-complexes, von Willebrand factor, protein C and S in blood plasma. Results. In patients with stable angina of the II-III functional class originally noted was an increase in the level of the von Willebrand factor in plasma by 43%, while in patients with acute coronary syndrome - by 67% compared with the control figures, the content of fibrinogen in blood plasma exceeded the control values by 18.8% and 68.8%, respectively. In patients with acute coronary syndrome the concensoluble fibrin monomer-complexes was initially increased. In the evaluation of plasma hemostasis in patients of both groups revealed was a significant decrease of the international normalized ratio and activated partial thromboplastin time values, which was more pronounced during acute coronary syndrome than in the control group. Conclusion. In patients with ischemic heart disease present was a thrombogenic shift of the hemostasis indices toward hypercoagulation, which is most evident in acute coronary syndrome, suggesting the presence of chronic intravascular blood coagulation.
Kazan medical journal. 2012;93(1):3-7
pages 3-7 views

The metabolitic role of the iron porphyrin complex in the development of anemic syndrome in patients with minor form of β-thalassemia

Baytaeva D.A., Bessmeltsev S.S.


Aim. To determine the significance of the main indicators of metabolism of porphyrins and markers of iron metabolism in the development of anemic syndrome during β-thalassemia minor. Methods. Examined were 58 patients with β-thalassemia minor with a concomitant deficiency of the enzyme glucose-6-phosphate dehydrogenase and 150 patients β-thalassemia minor without the concomitant enzymopathy. Hemoglobin electrophoresis was used to verify the diagnosis of β-thalassemia. Evaluated were the main indicators of porphyrin metabolism in the erythrocytes and urine in comparison with the reserve pool of iron in the blood serum, bone marrow and liver. Results. It has been shown that the assessment of soluble transferrin receptors and zinc protoporphyrin - is an alternative to assessing serum iron. Changes in the metabolism of iron is not the only cause of hypochromic microcytic anemia in patients with β-thalassemia minor. A large role is played by the fluctuations of the concentration of free forms of porphyrins in erythrocytes. With their help developed were differential diagnostic criteria, which distinguish the minor form from other forms of β-thalassemia and other iron deficiency states. During β-thalassemia minor, regardless of concomitant enzymopathy present was the instability of the main indicators of metabolism of the iron porphyrin complex. Conclusion. Extended evaluation of indicators of iron metabolism in conjunction with the assessment of precursors of porphyrin metabolism and free erythrocyte porphyrins is of high diagnostic value in determining the severity of anemia.
Kazan medical journal. 2012;93(1):7-11
pages 7-11 views

Comparative analysis of the systemic inflammatory response in rheumatic diseases

Ivanov D.V., Sokolova L.A., Gusev E.Y., Kamkina L.N., Plekhanova N.O.


Aim. To compare the course of chronic systemic inflammation during various rheumatic diseases. Methods. Examined were three groups of patients: with ankylosing spondylitis - 25 people (20 males and 5 females), with rheumatoid arthritis - 26 people (11 males and 15 females) and with systemic lupus erythematosus - 49 people (3 males and 46 females). The control group included 50 practically healthy individuals (26 males and 24 females). Analyzed were the following parameters: the content of interleukin-6, -8, -10, C-reactive protein. The integral index of the reactivity coefficient was calculated. Results. The level of the studied cytokines was significantly higher in systemic lupus erythematosus, than in ankylosing spondylitis and rheumatoid arthritis, while the content of C-reactive protein was significantly higher in ankylosing spondylitis and rheumatoid arthritis. The values of the reactivity coefficient were also significantly higher in systemic lupus erythematosus. Conclusion. The presence of systemic inflammation was determined in most patients with systemic lupus erythematosus, while ankylosing spondylitis and rheumatoid arthritis were characterized only by mild manifestations of systemic inflammatory response.
Kazan medical journal. 2012;93(1):12-17
pages 12-17 views

Age-related comparative evaluation of laboratory-functional parameters of vascular endothelial dysfunction in patients with arterial hypertension

Popova A.A., Mayanskaya S.D., Grebenkina I.A., Luksha E.B., Lebedeva L.S.


Aim. To conduct a comparative complex evaluation of the vasomotor and metabolic functions of the vascular endothelium in patients of different age groups with arterial hypertension. Methods. Examined were 98 young men and 60 elderly people with arterial hypertension of the I and II degree. The control group included 44 practically healthy young men and 45 elderly men. The endothelial function was assessed by Doppler measurements of brachial artery diameter at rest and during the test with reactive hyperemia and nitroglycerin, as well as by determining serum levels of the total amount of nitric oxide. Secondary stable products of lipid peroxidation were determined by the level of malondialdehyde. Antioxidant activity of blood was determined by evaluating the spontaneous chemiluminescence response. The diameter of the common carotid artery and the width of the intima/media complex was evaluated at rest using an ultrasound scanner. Results. Disturbance of the endothelium-dependent vasodilation in young and elderly patients with arterial hypertension of the I and II degree was accompanied by a significant decrease in production of endothelial nitric oxide. The expression of vascular endothelial dysfunction in patients of different ages with arterial hypertension of the I and II degree was in close correlation with the indicators of imbalance between the prooxidant activity and the antioxidant activity of blood, which manifested in an increase in the concentration of malondialdehyde in blood serum and in the decrease of the «antioxidant activity of blood/malondialdehyde content in blood serum» coefficient compared to groups of healthy individuals in response to pathological vasoconstriction. Conclusion. Arterial hypertension is accompanied by a progressive dysfunction of the vascular endothelium, which is more pronounced in the elderly due to reduced production of nitric oxide by the endothelium and due to the imbalance of the prooxidant-antioxidant system.
Kazan medical journal. 2012;93(1):18-22
pages 18-22 views

Dynamics of the content of biologically active substances in peripheral blood neutrophils in patients with ischemic heart disease during the course of laser therapy

Sapozhnikov M.Y.


Aim. To study the dynamics of the content of catecholamines, serotonin, histamine and heparin in peripheral blood neutrophils of patients with ischemic heart disease under the influence of laser therapy. Methods. Examined were 124 patients with angina, who were divided into two groups: those receiving basic treatment (β-blockers, antiplatelet drugs, nitrates, statins) with a course of laser therapy - 76 people, and those receiving only basic treatment - 48 people. The control group included 32 healthy individuals. Results. In patients with angina the content of catecholamines, serotonin, histamine is higher, while the content of heparin is lower than in healthy individuals. Under the influence of laser therapy, which was conducted simultaneously with the basic treatment, a decrease occurred in the level of catecholamines by 1.6 times, of serotonin by 1.5 times, of histamine by 1.6 times and an increase occurred in the amount of heparin by 1.9 times. Conclusion. Laser therapy effects the contents of all studied biologically active substances, bringing them closer to those of healthy people.
Kazan medical journal. 2012;93(1):22-25
pages 22-25 views

Dynamics of the content of histamine in the blood cells of patients with angina under the influence of low intensity laser exposure

Sapozhnikov M.Y., Sapozhnikova A.A., Pavlov A.F., Sapozhnikova S.Y., Sofronova E.V.


Aim. To study the dynamics of the content of histamine in blood cells of patients with angina under the influence of laser therapy. Methods. Investigated was the effect of continuous low-intensity laser radiation on the content of histamine in blood cell of 124 patients with stable angina and 32 practically healthy individuals. Results. In patients with angina the content of histamine in blood cell was higher than in healthy individuals. Under the influence of laser therapy, which was applied to acupuncture points - the «meridians» of the heart and pericardium, the content of histamine decreased and by the end of treatment was the same as in healthy individuals. Conclusion. Laser therapy has a favorable effect on the content of histamine in patients with angina.
Kazan medical journal. 2012;93(1):25-27
pages 25-27 views

Results of surgical treatment of cardiac myxomas

Korostelev A.N., Kiprensky A.Y., Kiprensky Y.V., Gerasimov A.N.


Aim. To determine the algorithm of in vivo diagnosis and surgical treatment of cardiac myxomas. Methods. Summarized was the experience of diagnosis and surgical treatment of 65 cases of cardiac myxomas. Examination of patients included electrocardiography, phonocardiography, radiography, angiocardiography, selective coronary angiography, two-dimensional transthoracic echocardiography, transesophageal echocardiography, computed tomography and magnetic resonance imaging with contrast, a biopsy, and a morphological study. Results. Among the examined patients (mean age 42.4±1.5 years) cardiac myxomas were diagnosed, which were localized in the left and/or right chambers of the heart. All patients underwent surgery. The tactics of surgical treatment were dependant on the tumor size, its mobility, involvement of the valve apparatus and conduction pathways of the heart into the pathological process, and concomitant diseases. The prognosis of the natural course of cardiac myxomas is unfavorable. In the diagnosis of space-occupying lesions (myxomas) of the heart chambers, which are often combined with valvular pathology, the most informative are echocardiography, computed tomography and magnetic resonance imaging. The final verification of the diagnosis should be made using emergency and routine pathological studies. Conclusion. Timely surgical removal of the myxomas with simultaneous correction of the concomitant cardiac pathology makes it possible to restore the intracardiac haemodynamics and to prevent thromboembolic complications.
Kazan medical journal. 2012;93(1):28-33
pages 28-33 views

Comparative evaluation of the effect of different methods of surgical treatment of chronic pancreatitis on the quality of life of patients

Karpachev A.A., Parfenov I.P., Khlynin A.Y., Yarosh A.L., Soloshenko A.V., Polyanskiy V.D.


Aim. To conduct a comparative evaluation of the effectiveness of surgical treatment of chronic pancreatitis and define the quality of life of patients depending on the methods of surgical treatment. Methods. The study included 81 of the 165 patients with chronic pancreatitis, who underwent the following operations: endoscopic transmural interventions through the wall of the stomach and duodenum, endoscopic transpapillary surgery, percutaneous interventions for sanitation and drainage of the cystic cavity, laparotomic operations of internal drainage, resection interventions. The quality of life of patients was assessed using the general health questionnaire SF-36. Results. The lowest level of life quality was established in the group of patients after endoscopic transpapillary interventions. Statistically significant differences in the level of physical and psychological health were established when comparing patients after endoscopic transpapillary interventions and after endoscopic transmural surgical interventions, which were carried out through the wall of the stomach and duodenum; differences only in the level of physical health were noted when comparing with the group of resection interventions. Conclusion. The quality of life of patients with chronic pancreatitis depends on the type of surgical intervention, age and sex of the patients.
Kazan medical journal. 2012;93(1):34-38
pages 34-38 views

Surgical treatment of patients with osteoarthritis of the ankle joint

Plakseychuk Y.A., Salikhov R.Z., Soloviev V.V.


Aim. To evaluate the results of treatment using the authors’ proposed method of arthrodesis of the ankle and subtalar joints, based on the combination of bone grafting with compression in the Ilizarov apparatus. Methods. Conducted was a clinical and radiographic evaluation of the results of arthrodesis in the Ilizarov apparatus in 286 patients with osteoarthritis of the ankle and subtalar joints (during the last 15 years). 36 (12.6%) patients (the main group) were operated on using the authors’ proposed technique. Results. Bone adhesion as a result of arthrodesis was achieved in all patients of the main group. Excellent functional results were achieved in 11 out of 36 patients (30.5%), good results - in 22 (61.1%) patients, satisfactory results - in 3 (8.4%) patients. Bone adhesion as a result of arthrodesis in 250 patients of the comparison group was achieved in 243 patients (97.2%). In this group excellent functional results were achieved in 76 out of 250 patients (30.4%), good results - in 145 (58%) patients, satisfactory results - in 21 (8.4%) patients, poor results - in 8 (3.2%) patients. Conclusion. The proposed method of biarticular arthrodesis makes it possible to improve the trophism of the arthrodesis zone, to conduct the correction of posttraumatic deformities in the region of the ankle and subtalar joints, provides a durable and solid bone ankylosis of the ankle and subtalar joints, and makes it possible to achieve adhesion even in severe forms of osteoarthritis of the ankle and subtalar joints.
Kazan medical journal. 2012;93(1):38-43
pages 38-43 views

Guided correction of posttraumatic deformities of the vertebral column

Tomilov A.B., Kuznetsova N.L.


Aim. To improve the results of treatment of patients with post-traumatic deformity of the vertebral column. Methods. Analyzed were the results of treatment of 400 patients with fractures of the thoracic and lumbar vertebrae. Lesions of types A2, A3 and B according to the classification of the Association of osteosynthesis were seen in 70% of cases, lesions of type C - in 30%. The external transpedicular «Crab» construction was used in 100 patients. An internal transpedicular construction of the Scientific Research Institute «Syntez» was used in 300 cases. Transpedicular spondylosynthesis with intraoperative correction of the deformity with an original repositioning device was performed in all patients. Explosion fractures with the destruction of the vertebral body and stenosis of the spinal canal demanded the implementation of decompressive-stabilizing interventions in 25% of the cases. Conducted were clinical and radiological (spondylography, computed tomography, magnetic resonance imaging) studies. Results. Proposed was a technique of guided correction of posttraumatic deformities of the vertebral column. Unstable fractures and dislocation-fractures, lesions of intervertebral discs in the thoracic and lumbar segments of the vertebral column, inveterate lesions, posttraumatic deformities of the thoracic and lumbar segments of the vertebral column served as indications for using guided correction. Kyphotic deformity at the level of the damaged segment was corrected in 98% of observed cases with hypercorrection in the range of 2°. The vertical size of the vertebral body was restored up to 100% in the early posttraumatic period and up to 82.3% in the remote posttraumatic period. Subluxation was corrected in 86.9%, while dislocation of the fractured vertebra was corrected in 96.7% of cases. Conclusion. The proposed method of correction of posttraumatic deformities of the vertebral column makes it possible to provide similar treatment results of patients operated both with using the external fixation device of the vertebral column «Crab» and using the submersible transpedicular construction of the Scientific Research Institute «Syntez».
Kazan medical journal. 2012;93(1):44-48
pages 44-48 views

Endoscopic ultrasonography in the diagnosis of thrombosis of the portal blood vessels in patients with infected pancreatic necrosis

Andreev A.I., Anisimov A.Y.


Aim. To study the effectiveness of endoscopic ultrasound investigation in the diagnosis of thrombosis of blood vessels of the portal system. Methods. Endoscopic investigation using an ultrasound gastric videoscope manufactured by «Olimpus» was performed in 35 patients who had suffered from infected pancreatic necrosis (the main group) and in 10 healthy volunteers (the control group). Results. In the control group of healthy volunteers no signs of thrombosis of the blood vessels of the portal system were revealed. In the main group thrombosis of the blood vessels of the portal system was detected in 12 patients (34.3% of cases) during endoscopic ultrasound investigation, of which in 3 patients (25%) the thrombus was localized in the splenic vein, and in 9 patients (75%) - in the portal vein. In 10 (83.3%) patients identified were varicose veins of different localization and degrees of severity, including 4 patients (40%) - with esophageal varices, and 6 patients (60%) - with dilated varicose veins of the gastric cardia. Conclusion. Endoscopic ultrasound investigation, being a highly informative non-invasive diagnostic method, provides objective information about the presence of portal vein thrombosis and the extent of transformation of varicose veins of the esophagus and stomach.
Kazan medical journal. 2012;93(1):49-52
pages 49-52 views

The effect of preoperative chemoradiotherapy on the latency of the genital nerve and the contractility of the anal sphincter

Shelygin Y.A., Rasulov A.O., Dzhanaev Y.A., Boyko A.V., Droshneva I.V.


Aim. To study the effect of chemoradiotherapy on the latency of genital nerves and contractility of the anal sphincter in patients with rectal cancer. Methods. Analyzed were 20 cases of rectal cancer T2-3NXM0 (12 males, 8 females). Complex treatment included preoperative chemoradiation therapy (total focal dose 47 Gy, fluorouracil - 2.5-3 g, cisplatin - 90 mg), surgical intervention and postoperative adjuvant chemotherapy for the period from 2009 to 2010. Before the initiation and after the chemoradiotherapy conducted was an evaluation of latency of the genital nerve and needle electromyography of the anal sphincter. Results. Due to the conduction of chemoradiotherapy the median latency of the right branch in males increased significantly from 2.9 to 4.3 ms, in females from 2.1 to 2.4 ms. The increase in the latency of the left branch of the genital nerve was observed in males (from 5.4 to 10.9 ms), while in women registered was a decrease of the indices (from 4.3 to 2.5 ms). A significant reduction of the potential of the external sphincter at rest (from 226.5±157.3 to 196.9±141 mV) and during conation (from 369.7±226.4 to 262.4±138.1 mV), regardless of gender. Conclusion. Conduction of preoperative chemoradiotherapy for cancer of the lower and middle ampullary part of the rectum leads to a decrease in the conduction speed along the genital nerve predominantly in male patients, and is accompanied by a decrease in electrical potentials of the external anal sphincter.
Kazan medical journal. 2012;93(1):52-56
pages 52-56 views

Prevention of complications of transvesical adenomectomy with a blind suture of the urinary bladder

Zubkov E.A., Sitdykova M.E.


Aim. To determine the frequency and develop methods for prevention of possible complications of transvesical adenomectomy. Methods. Conducted was an analysis of results of surgical treatment of 492 patients with prostate adenoma. One-stage suprapubic transvesical adenomectomy with a primary blind suture of the urinary bladder and hemostasis of the adenoma bed was performed in 347 patients. Results. In the postoperative period inflammatory complications of the urinary tract were observed in 5 (1.4%) out of 347 operated patients. It was established that the frequency and nature of both early and late pyo-inflammatory and obstructive postoperative complications of the suprapubic adenomectomy depend on the method of hemostasis of the bed of the adenoma and on the time of urination recovery. Conclusion. The main measures of prevention of complications during suprapubic adenomectomy are hemostasis of the bed of the adenoma by temporary retriganization with removable hemostatic ligatures, early recovery of urethral voiding (2-4 days) and application of antibiotics to the bed of the adenoma via the drainages of the deference ducts.
Kazan medical journal. 2012;93(1):56-61
pages 56-61 views

A complex approach to the diagnosis and treatment of pelvic pain in women: clinical and economic aspects

Moskovenko N.V.


Aim. To improve the results of treatment of chronic pelvic pain in women secondary to chronic nonspecific salpingoophoritis and chronic cystitis. Methods. Examined were 91 women of reproductive age suffering from pelvic pain. The patients comprised two groups. The first group included 68 women in the treatment of which physical exercise therapy, electromagnetic resonance radiation and laser treatment were used. The comparison group included 23 women who received conventional therapy. Used were the generally accepted clinical and special methods of investigation: determined was the content of gonadotropic and steroid hormones, conducted were sonographic, urodynamic studies, laser Doppler flowmetry, assessed was the heart rate variability by the R.M. Baevskiy technique. The medical and psychological examination of women included a study of a women’s personality traits with the help of classical psycho-diagnostic methods. Results. Chronic pelvic pain in women is accompanied by a disturbance of the autonomic balance, increase in the activity of the regulatory systems and psychoemotional disorders, in the structure of which anxiety and depression conditions dominate. The influence of these disturbances on the major categories of quality of life has been established. After treatment was completed marked improvement was observed in the women of the main group; herein the disappearance of major symptoms, normalization of laboratory data, ultrasound investigation data, indicators of microcirculation occurred in a shorter time; the duration of treatment decreased. In the long-time registered was a decrease of the frequency of exacerbations of the disease in the main group of women by 2.6 times relative to the comparison group of patients. The economic effectiveness of the proposed methods of treatment was 40.2%. Conclusion. The usage of physiotherapy techniques in the treatment of pelvic pain made it possible to reduce the treatment time, reduce the frequency of exacerbations of the disease, to establish an economic effect.
Kazan medical journal. 2012;93(1):61-67
pages 61-67 views

Correction of microcirculation disturbances in the wall of the urinary bladder in women with urination disorders

Neymark A.I., Razdorskaya M.V., Sizov K.A.


Aim. To assess the dynamics of the microcirculation indices in the mucous layer of the urinary bladder on the background of conservative treatment of women with urination disorders. Methods. Examined were 40 women with complaints of urination disorders, who were repeatedly treated regarding this reason. 20 female patients who underwent standard complex conservative therapy represented the first group. The second group included 20 patients who in addition received an α1-adrenergic blocker terazosin in a dose 2 mg at night. The course of treatment ranged from 1 to 3 months. Results. 9 (45%) women of the first group and 16 (80%) patients of the second group observed a positive effect of the treatment. In the patients of the second group registered was a more rapid normalization of clinical signs and indicators of laser Doppler flowmetry: an increase in neurogenic tone in precapillaries, in the bypass index and in the index of effectiveness of microcirculation, an increase in the microcirculation parameter and in the coefficient of variation, which indicates an improvement in the microhemocirculation. Conclusion. The study of blood flow through the capillary vascular bed by laser Doppler flowmetry makes it possible to study the microcirculation in the mucosa of the urinary bladder wall in order to monitor the effectiveness of the conducted therapy.
Kazan medical journal. 2012;93(1):68-72
pages 68-72 views

The clinical effectiveness of impulse electrotherapy in the complex treatment of patients with chronic endometritis

Radzinskiy V.E., Petrov Y.A., Polina M.L.


Aim. To evaluate the clinical effectiveness of impulse electrotherapy in the complex treatment of patients with different variants of chronic endometritis based on the evaluation of adaptive reactions and immune status. Methods. Conducted was a clinical and laboratory examination of 550 women with early reproductive losses, who were divided into three groups. Studied was the efficacy of electro-impulse therapy with high-amplitude short-wavelength low-frequency electrical signals using the apparatus «SKENAR» (SKENAR-therapy) in the complex treatment of 269 women with chronic endometritis (first group). The second group included 67 women with similar variants of chronic endometritis, who were treated without the physiotherapy component. 54 patients refused the proposed rehabilitation activities (third group). Results. New data has been obtained on the adaptive reactions of the female body before and after treatment during different types of chronic endometritis. The frequency of disadaptation was highest during the hypoplastic form of chronic endometritis. Shown was the high efficiency of electro-impulse therapy, using the apparatus «SKENAR» in the complex treatment of chronic endometritis due to the normalization of parameters of immunoreactivity. It was established that SKENAR-therapy of chronic endometritis promotes early normalization of adaptive reactions in comparison to conventional methods of treatment. Conclusion. Rehabilitation treatment of chronic endometritis in combination with electro-impulse therapy with high-amplitude short-wavelength low-frequency electrical signals contributes to the recovery of immunoreactivity and to the formation of favorable adaptation reactions.
Kazan medical journal. 2012;93(1):72-76
pages 72-76 views

Changes in the vaginal microbiota in women with cervical diseases

Andosova L.D., Kachalina O.V., Belov A.V., Kudel’kina S.Y.


Aim. To study the relationship between the condition of the vaginal microbiota and the severity of pathological changes of the cervical epithelium. Methods. Studied were 99 female patients aged from 18 to 56 years with secondary and precancerous cervical processes: the first group - 20 women with cervical ectopias; the second group - 20 females with cervical intraepithelial stage I neoplasia; the third group - 19 women with stage II neoplasia; the fourth group - 20 patients with cervical intraepithelial stage III neoplasia (cancer in situ); the fifth group - 20 women with invasive cancer. The investigation of the vaginal biocenosis was conducted by the real-time polymerase chain reaction technique. Results. Established was a correlation between the dysbiotic vaginal changes and cervical lesions. In the first group normocenosis was reported in 4 women (20%), in the groups with cervical intraepithelial stage III neoplasia (cancer in situ) and with cervical cancer - only in 1 woman, accounting for 5% of the total number of patients in the group. In the first group in 16 women out of 20 (80%) noted was the dominance of Lactobacillus, in the groups with cervical intraepithelial neoplasia the proportion of such patients decreased, reaching for the fourth and fifth groups - 45 and 50% respectively. Conclusion. Imbalance of the urogenital tract microbiota may contribute significantly to the development and progression of cervical lesions.
Kazan medical journal. 2012;93(1):76-79
pages 76-79 views

Substantiation of the tactics of recurrent surgical interventions in the surgical treatment of concomitant strabismus

Zhukova O.V., Yamschikov N.V., Stepanov V.K.


Aim. To substantiate the recommendations on the tactics of recurrent operations for strabismus in children on the basis of histological investigation of the fragments of «weakened» muscles. Methods. Conducted was a retrospective analysis of recurrent surgical treatment of 2 patients with concomitant convergent strabismus. In order to determine the cause of dysfunction of the muscles conducted was a histological study of 80 fragments of the lateral rectus muscles, which were excised during surgical treatment of convergent strabismus. Results. Muscle fibers were found only in the distal sections during the resection of the lateral rectus muscles at a distance of 8.5-9 mm. Taking into consideration the fact that at point were the muscle transitions into the tendon located are the palisade nerve endings, which may play the major role in the contraction process, the exceedence of the above mentioned amount of muscle resection during strabismus surgery is dangerous, since it can lead to the disruption of the eye mobility. Conclusion. During recurrent operations for strabismus correction it is recommended to use major recessions of the «strong» muscles, and for ease of muscle fixation at a great distance from the attachment point - the technique of the «sliding noose».
Kazan medical journal. 2012;93(1):79-82
pages 79-82 views

Lipid criterion of hardness as an auxiliary parameter during investigation of the lens nucleus in cataract patients

Chuprov A.D., Kudryavtseva J.V.


Aim. To identify the lipid markers of changes in the mechanical characteristics of the lens nucleus on the example of sulfur gland secretions of the ear canal. Methods. Examined were 50 patients aged from 52 to 83 years with cataracts of varying degrees of maturity. Studied was the composition of the higher fatty acids of the lens nucleus and of the earwax in patients. The evaluation of lens nucleus hardness was performed on an original device. Results. Palmitic acid, stearic acid and polyunsaturated fatty acids were dominant in the earwax, less was the content of lauric and linolenic acids. Revealed was a strong correlation between the content of polyunsaturated fatty acids in the earwax and the hardness of the lens. Developed was a method for predicting the hardness of the lens nucleus and for evaluating lipid metabolism in the lens. Conclusion. Lipid composition of the earwax may serve as an auxiliary parameter for determining the hardness of the lens nucleus and for justification of the choice of lens phacoemulsification method.
Kazan medical journal. 2012;93(1):83-85
pages 83-85 views

Characteristics of the clinical forms and optimization of treatment of dacryocystitis in the newborns

Galeeva G.Z., Samoylov A.N., Musina L.T., Russkikh E.I.


Aim. To optimize the treatment of dacryocystitis in the newborns, to reduce the frequency of recurrent nasolacrimal duct catheterization. Methods. Examined were 207 children suffering from catarrhal (the first group - 57 children, 73 affected eyes), purulent (the second group - 139 children, 158 eyes) and phlegmonous (the third group - 11 children, 12 eyes) dacryocystitis. A control group was also formed - 12 children without inflammatory eye diseases. Conducted was a clinical examination, determined was the lysozyme activity of the tears, analyzed was the effectiveness of medicinal and surgical treatment, and conducted was a microbiological investigation with the study of sensitivity of the pathogenic microorganisms to antibacterial drugs. Results. In catarrhal dacryocystitis of the newborns identified were seven species of microorganisms, most commonly found were S. epidermidis (more than 50%) and S. aureus (12.4%), in 19.2% of cases no pathogen was identified. The etiology of purulent dacryocystitis was more diverse - 23 species of pathogens, the leading pathogens were S. aureus (15.2%), S. pneumoniae and S. epidermidis (13.9% each), E. faecium (8.2%). In the phlegmonous form of the disease revealed were 4 types of pathogens, most commonly S. epidermidis (45.5%) and S. aureus (27.2%). In 9.1% of cases no pathogen was identified. The causative agents of catarrhal and purulent dacryocystitis of the newborns showed the greatest sensitivity to pikloxydine (100% and 93.3%), chloramphenicol (86.7% and 79.7%) and ciprofloxacin (87.0% and 72.2%). Revealed was the reduction of lysozyme activity of the tears both in the affected and in the unaffected eyes of children with dacryocystitis. During the analysis of the results of surgical treatment the frequency of relapses in the first group (catarrhal dacryocystitis of the newborns) was 8.3%, while in the second group (purulent dacryocystitis) it was significantly higher - 13.7%. Conclusion. In order to reduce the frequency of relapses conservative treatment should be conducted with respect to the microbial etiology, forms of the disease, and sensitivity of pathogens to antimicrobial agents before catheterization of the nasolacrimal duct.
Kazan medical journal. 2012;93(1):85-88
pages 85-88 views

Peculiarities of the functional state of external respiration of primary school children during adaptation to different efforts

Zayneev M.M., Ziyatdinova N.I., Zefirov T.L.


Aim. To study the peculiarities of external respiratory functioning in boys of 8, 9 and 10 years in various periods of the academic year at rest, after a dosed dynamic and static loads. Methods. Examined were 38 practically healthy boys with an average level of physical development. Observation was conducted in three age groups of boys: 8, 9 and 10 years. The functional state of the respiratory system was assessed by the magnitude of lung volumes and ventilation parameters. The test with an isometric load was performed in a sitting position by squeezing a dynamometer in the left hand with a force equal to 50% of the maximal effort produced within 1 min. Results. In the 8-year-old boys noted was the tension of the functional state of the respiratory system at the beginning of the academic year. By the year of the end, the static load causes a decrease of the reserves of external respiration and static lung volumes, and an increase of the frequency component. In the 9-year-old boys at all study periods the static load leads to less favorable shifts in the respiration parameters in comparison with the dynamic load. In the 10-year-old boys at the beginning of the academic year both types of loads lead to adverse shifts of the parameters of external respiration, by the middle of the year adaptive capacities of the respiratory system become optimized. Conclusion. Local static load causes adverse shifts in the respiratory system of the primary school children, accompanied by a decrease in efficiency of the ventilation function of the lungs and by adverse reaction of the parameters of biomechanics.
Kazan medical journal. 2012;93(1):89-92
pages 89-92 views

Prevention of health losses in adolescents with phenotypic manifestations of connective tissue dysplasia

Ivanova E.A., Plotnikova O.V., Glotov A.V., Demchenko V.G.


Aim. Develop a program to prevent health losses in adolescents with connective tissue dysplasia. Methods. Analyzed was the clinical data of 241 adolescents for the period 2006-2009, 113 adolescents formed the main group, 128 - the control group. The statistical rules and standards for determining the grouping signs and group boundaries on the basis of phenotypic and visceral traits of connective tissue dysplasia were taken into consideration. Results. The proposed program for prophylaxis of health loss provides the following stages: informational, analytical, and organizational-executive with an educational component along with curative and preventive measures. The proposed program of prophylaxis provides complete information on the health status of adolescents with connective tissue dysplasia, promotes the reduction of the frequency of progression of signs of dysplasia. Conclusion. The program provides an opportunity to optimize the existing approaches to identifying and assessing factors that influence health, and promote more efficient use of the available resources in the education and healthcare systems.
Kazan medical journal. 2012;93(1):93-97
pages 93-97 views

Analysis of the causes of a stably high incidence of tick-borne borreliosis in rural districts of Udmurtia

Guznischeva N.G., Zakirov I.G.


Aim. To identify of the most active centers of infection of tick-borne borreliosis in Udmurtia and to determine the causes of high morbidity level. Methods. Conducted was a comparative analysis of the dynamics of the incidence of tick-borne borreliosis in various administrative districts of Udmurtia, taking into consideration the confinedness to the landscape and geographical areas, identified were the risk groups for tick-borne borreliosis. The incidence tick-borne borreliosos and the indices of spontaneous infection of donors with borreliae in various landscape-geographical zones of Udmurtia were subjected to a comparative assessment, studied was the medical and economical effectiveness of preventive measures. The study was carried out by conventional methods. Results. It was established that in all the administrative districts of Udmurtia at risk of tick-borne borrelliosis are schoolchildren, pensioners and unemployed people, the risk of the disease increases after 41 year of age regardless of gender or place of residence. Established was a higher medical and economical effectiveness of emergency chemoprophylaxis of borreliosis in the first 48 hours after the tick bite in comparison with the currently used acaricidal treatment. Conclusion. The reasons for high incidence of tick-borne borreliosis in rural districts of Udmurtia - low appealability of the population for medical care after tick bites and a lack of motivation for chemoprophylaxis in school children, pensioners and unemployed people.
Kazan medical journal. 2012;93(1):98-102
pages 98-102 views

Diagnostic tactics for thyroid nodules

Timofeeva L.A.


Aim. To determine the optimal diagnostic tactics for nodules of the thyroid gland. Methods. Examined were 1124 patients with thyroid nodules in the age from 14 to 60 years and older, of whom 159 - with malignant tumors, 180 - with adenomas, 620 - with colloid nodes, 165 - with cysts. Among the surveyed group were 844 women and 280 men. The group of healthy individuals included 400 people. The material for cytology was obtained by fine-needle aspiration biopsy (1004 studies), from smears from the cut surface of the tumor (76 studies) and from puncture biopsies of enlarged regional lymph nodes (44 studies). Results. During ultrasound investigation hypoechoic, heterogeneity, roughness and blurred contours, the presence of the internal structure of small echo-negative inclusions are characteristic for thyroid cancer. As the number of these features increases the likelihood of confirmation of a malignant tumor of the thyroid increases as well. The ultrasound picture of nodular colloid goiter is characterized by a single nodule or multiple nodules in the tissue of the thyroid gland of low or isoechoic density, sometimes with a limiting «rim». The presence of the latter feature causes difficulties in the differential diagnosis between nodular goiter and thyroid adenoma. Out of the 907 informative cases in 144 patients (15.8%) cancer was diagnosed cytologically. Conclusion. A complex diagnostic approach to the examination of thyroid nodules using fine-needle aspiration puncture biopsy of the nodules under the control of ultrasound and subsequent cytological investigation of the punctate provides valuable information on the nature of pathological changes of the thyroid gland.
Kazan medical journal. 2012;93(1):103-107
pages 103-107 views

Experimental medicine

The effect of new derivatives of tietan-1,1-dioxide on some mediator systems of the brain

Ivanova O.A., Nikitina I.L., Alekhin E.K., Miftahova A.F.


Aim. To study the effect of new derivatives of 3 substituted tietan-1,1-dioxide on some mediator systems of the brain in order to determine the possible mechanism of antidepressant effect of these compounds. Methods. In an experiment with male mice studied was the effect of three most active derivatives of tietan-1,1-dioxide, which exhibit antidepressant properties [3 methooxytietan-1,1-dioxide (H14), 3-(2-isopropoxy-5-methylphenoxy)-tietan-1,1-dioxide (H40) and 3-phenylsulphonyltietan-1,1-dioxide (N69)] on the neurotransmitter systems of the brain. In the experiments used were the tests of pharmacological interaction with a sympatholytic reserpine, with a nonselective agonist of dopamine receptors apomorphine, with a dopamine receptor antagonist haloperidol, with a precursor of serotonin 5-oxytryptophan, with a precursor of dopamine levodopa, with an α2-adrenoceptor agonist clonidine, and with an agonist of M-cholinoceptors arecoline. Results. It has been shown that the spectrum of neuropharmacological effects of new derivatives of tietan-1,1-dioxide (H14, H40, N69) is diverse and is associated with the effects on the adrenergic, dopaminergic and serotonergic brain structures. Thus, H14 reduces the severity of hypothermia induced by reserpine, apomorphine, clonidine, and levodopa, as well as the severity of reserpine ptosis, haloperidol catalepsy and 5- oxytryptophan hyperkinesis. H40, in contrast to H14, has no effect on haloperidol catalepsy and hypothermia induced by levodopa, while H69 has no effect on clonidine-induced hypothermia. All the compounds do not alter the latent period and duration of the arecoline tremor. Conclusion. New derivatives of tietan-1,1-dioxide possess properties, which are inherent to antidepressants, and may be recommended for further in-depth study of their antidepressant activity.
Kazan medical journal. 2012;93(1):108-112
pages 108-112 views

Possible involvement of adenosine triphosphate in the mechanisms of protein sensibilization effect on the functional properties of the diaphragm and skeletal muscles

Teplov A.Y., Farkhutdinov A.M., Grishin S.N., Minnebaev M.M., Torshin V.I.


Aim. To study the effect of adenosine triphosphate on the contractile function and non-quantum secretion of acetylcholine at the endplate zone (H-effect) of isolated mouse muscles on the background of protein sensibilization. Methods. The experiments were performed on white mice. Sensibilization was carried out by ovalbumin with an aluminum hydroxide gel. Mechanomyography studies were performed on isolated preparations of the diaphragm and of two leg muscles in isometric conditions. The contractions were recorded by a photoelectric converter. In order to study the condition of the postsynaptic membrane of the muscle fibers measured was the non-quantum secretion of acetylcholine. Compared were the parameters of muscle contraction before and after 5 min of perfusion with a solution of adenosine triphosphate. Results. In the diaphragm and in the soleus muscle the dynamics of the force vector of the muscular contraction correlated with the changes in the H-effect in all the studied experimental models. However, the extent of these changes in the sensibilized animals is less pronounced. Conclusion. It is possible that adenosine triphosphate affects the functional properties of both muscle during protein sensibilization; the change in the contraction force of the long extensor digitorum muscle during sensibilization is not related to the mechanisms of muscle excitation, mediated by adenosine triphosphate.
Kazan medical journal. 2012;93(1):113-116
pages 113-116 views

Activity of antioxidant enzymes and processes of free radical oxidation in experimental hypothyroidism and correction of thyroid shifts with iodized polysaccharide complexes

Kamilov F.K., Mamtsev A.N., Kozlov V.N., Abdullina G.M., Lobyreva O.V.


Aim. To determine the activity of antioxidant enzymes in rat liver tissue on the background of thiamazole hypothyroidism, and also after its correction with iodine-containing organo-mineral complexes. Methods. Studies were conducted on rats, which were divided into four groups: the first group - the control, in animals of the second, third and fourth groups hypothyroidism was induced by daily intragastric administration of thiamazole at a dose 2.5 mg per 100 g body weight for the duration of 3 weeks. Beginning from the 22-day of the experiment the animals of the fourth group for the duration of a month received a biologically active additive in a dose that provides the daily requirement of iodine in rats, while the animals of the third group were on the standard diet of the vivarium. The activity of superoxide dismutase and glutathione peroxidase was determined using a set of reagents «RANSOD Randox» manufactured by «Laboratories Ltd.», the catalase activity was determined by the method of M.A. Korolyuk. Results. Experimental hypothyroidism in rats was characterized by a decrease in the concentrations of free thyroxine, an increase in the content of total triiodothyronine and thyroid-stimulating hormone. In animals treated with tiamazol, the superoxide dismutase activity was 85.6% of the activity level of the control animals, glutathione activity - 77.3% of the level of intact animals. The catalase activity in hypothyroidism decreased significantly - down to 40% of the control level (p ≤0.001). In the liver homogenate of rats, treated for 1 month with «iodine biopolymer» after hypothyroidism induction, the superoxide dismutase activity almost reached the control values and accounted for 95.5% of the activity of intact animals. The activity of glutathione peroxidase and catalase, was even slightly higher than the control values, reaching 115.6 and 112.7% of levels of activity in the control group, respectively (p ≤0,05). At the same time in the animals, which were on a standard diet, the activity of the studied enzymes remained below the control values, with the catalase activity - significantly lower (49.9% of the control, p ≤0,001). Conclusion. The introduction of an iodine-containing biologically active compound on the background of hypothyroidism made it possible to restore the activity of thyroid-dependant antioxidant enzymes, to normalize the functional state of the pituitary-thyroid system and to inhibit the processes of lipid peroxidation in the liver the of animals.
Kazan medical journal. 2012;93(1):116-119
pages 116-119 views


Mechanisms of development of alcohol-dependant osteoporosis

Goryachev D.N., Mukhamedzhanova L.R.


Presented were the current published data on the mutual influence of different factors on the initiation and progression of disorders of formation of the bone organic matrix and its mineralization during chronic ethanol intoxication. Emphasized was the role of the toxic effect of ethanol on the osteoblastic cells, which is expressed in the increasing viscosity of the cytoplasm, disruption of the architectonics of the cytoplasmic membrane, disorganization of the polyribosomal complexes and reduction of the collagen synthesis functions. Established was the role of immune pathology, which included the formation of antibodies to a number of autogenous tissues. Found were antibodies to collagen type I, which was modified by acetaldehyde and possessed cytotoxicity. In patients with alcohol dependence noted was an increase in the concentration of interleukin-6, which stimulates the early stages of hematopoiesis and osteoclastogenesis. The mechanism of development of alcohol-dependant osteoporosis is understood as a cascade of related processes, which are linked in the circulus vitiosus. Only the initial stages of this cascade have certain specificity. The morphological consequences are mostly similar and do not differ from those of other forms of secondary systemic osteoporosis, however give the characteristic features to the clinical course.
Kazan medical journal. 2012;93(1):120-122
pages 120-122 views

The condition of the hepatobiliary system in children with cystic fibrosis

Kondratieva O.V., Rylova N.V.


Presented was an overview of domestic and foreign literature on the condition of the hepatobiliary system in children with cystic fibrosis. Due to an increasing life expectancy of cystic fibrosis patients in the last decade, the frequency of complications from the hepatobiliary system (cholestatic hepatitis, portal hypertension, liver cirrhosis), which, according to various authors, range from 20 to 80%, also increases. The most pronounced changes in the liver and the gall bladder are characteristic for children with moderate pulmonary symptoms and predominantly with the intestinal form of the disease. The risk factors for liver damage in cystic fibrosis are - pancreatic insufficiency, «severe» mutation, male sex, meconium ileus in the past medical history and earlier age at which the disease was diagnosed. Complex ultrasound assessment of the liver parenchyma and blood flow in the portal vascular system and in the celiac trunk make it possible to specify the severity of fibrosis and to identify early signs of portal hypertension. Magnetic resonance imaging can confirm the presence of liver cirrhosis and determine collateral circulation associated with portal hypertension. Magnetic resonance cholangiography and radionuclide imaging make it possible to determine the status of intra- and extrahepatic biliary system. There is currently no effective treatment that could prevent the progression of liver damage. There are reports of the beneficial effects of ursodeoxycholic acid drugs. Perspective directions of treatment - liver transplantation and genetic engineering. Methods of conservative, endoscopic and surgical treatment of bleeding esophageal varices are used during the portal hypertension syndrome.
Kazan medical journal. 2012;93(1):122-125
pages 122-125 views

Healthcare mangement

Essential issues of organization of the anesthesiology and resuscitation service

Davydova V.R., Khuzikhanov F.V.


Рresented was the current state of the anesthesiology and resuscitation service. Identified were the key performance indicators, which affect the quality and efficiency of the service at the present stage of healthcare reformation. Discussed was the question of developing standards of care in the field of intensive care.
Kazan medical journal. 2012;93(1):126-129
pages 126-129 views

Mathematical modeling of the health condition of medical workers

Ermolina T.A., Shishova A.V., Martynova N.A., Kalinin A.G., Krasilnikov S.V.


Aim. To create a mathematical model for identification of the relationship between the health of medical workers and the social and occupational factors, as well as a number of laboratory parameters. Methods. In an oncological hospital conducted was a cross-sectional study of the immune status of medical workers, principally the content of subpopulations of T and B lymphocytes. The model «level of health of medical workers» is based on an examination of 96 members of the medical staff who work on radiation emitting equipment, which were divided into five groups according to the nosological forms of identified diseases. The control group consisted of 98 individuals of the same medical facility, who are office workers. Results. In the individuals, who are exposed to radiation, revealed was a reduction in the functional activity of T lymphocytes, as well as an increase in the activity of natural killer cells. In the first and fifth groups (risk of tumors and diseases of the nervous system) noted was a sharp decrease in the expression of the antigens of the major histocompatibility complex system, and a reduction of the number of HLA-DR cells. In the first and second groups (risk of tumors and respiratory diseases) a decrease in the number of cells with receptors for transferrin CD71 occurred. Conclusion. The presented method of mathematical interpretation of the immunological parameters of blood will make it possible to determine the appurtenance of new study objects to a particular risk group, that is, to identify a predisposition to various diseases.
Kazan medical journal. 2012;93(1):129-134
pages 129-134 views

Dynamics of the volume and structure of hospital admissions for emergency indications in surgical hospitals of the Stavropol territory with disorders of the digestive organs

Mikhaylova J.V., Son I.M., Muravev K.A.


Aim. To determine the volume and structure of hospital admissions for emergency indications in the surgical hospitals of the Stavropol Territory, of the North Caucasus Federal District and of the Russian Federation with disorders of the digestive organs over a 10-year period. Methods. Conducted was a comparative analysis of the volume and structure of hospital admissions for emergency indications in surgical hospitals over a 10-year period. Results. The number of individuals admitted to Russian hospitals for emergency medical treatment for disorders of the digestive system from 2001 to 2010 has increased by 4.6%. There was a significant reduction in the number of cases of acute appendicitis and perforated gastric and duodenal ulcers, while the share of acute pancreatitis and acute intestinal obstruction increased. Conclusion. Acute pancreatitis, appendicitis and cholecystitis - are the most common emergency conditions in the Stavropol Territory in the pathology of the organs of the abdominal cavity.
Kazan medical journal. 2012;93(1):134-138
pages 134-138 views

Scientific methodological justification of organization of an inter-district center of perinatal medicine

Aberhaeva L.S., Gilmanov A.A.


Aim. To evaluate the effectiveness of the implementation of an organizational model of providing medical care for pregnant women, women in labor, new mothers and newborns care at an inter-district level. Methods. In the process of an organizational experiment evaluated were the quantitative and qualitative indices of the obstetrical services in the districts of the Zakamskiy region of the Republic of Tatarstan for the period 2005-2010. In order to assess the medical and social effectiveness used were the sociological, statistical methods and the method of expert evaluations. Results. The inter-district center of perinatal medicine makes it possible to concentrate in one place a significant number of pregnant women and newborns from a group of «moderate risk» with an economically justified staffing and logistical stocking of this center. An important indicator of the medico-social effectiveness of work of the Centre after the modernization during the period 2006-2010 was a statistically significant increase in the proportion of women who completed pregnancy with childbirth, from 756 to 972, births in due period - from 89.3 to 96.4%, a decrease in the proportion of preterm births from 4.7 to 3.2%. The new medical organizational technologies, which were implemented in the Center, have reduced the number of diseased newborns, which were sent for the second stage of treatment to the Pediatric hospital, to 15.6% during the surveyed period. The proportion of satisfactory evaluations of the organization of observation and treatment, which were given by the female patients of the Chistopol inter-district Center of perinatal medicine, has increased from 68.8 to 87.7%. Conclusion. Reorganization of the work of the obstetrical institutions into the type of an inter-regional perinatal center and the introduction of new technologies contributes to the improvement of qualitative parameters of the work of the prevention and treatment facility, as well as to the increase in patient satisfaction with the quality of care.
Kazan medical journal. 2012;93(1):138-141
pages 138-141 views

Assistance to the practicing physician

A case of a single double inlet cardiac ventricle with transposition of great vessels

Oslopov V.N., Makarov M.A., Khabibullina R.T., Afanaseva T.Y.


Presented was an observation of a 19-year old patient with a congenital heart defect (a single double inlet right cardiac ventricle in combination with a corrected transposition of the great vessels), which was complicated by acute heart rhythm disturbance (atrial flutter), and heart failure. With the help of echocardiography (2D-, M-mode, color Doppler scan) diagnosed was the single ventricle with transposition of the great vessels (a rare variant of B III). The peculiarity of this clinical case is the preservation of the sinus rhythm during 19 years, despite the marked remodeling of the myocardium. The sharp deterioration in clinical status of the patient was due to a disturbance of the cardiac rhythm: atrial flutter with a 2:1 conduction on to the ventricle. Clinical improvement was achieved by pharmacological blockade of atrioventricular conduction in combination with an increase of the inotropic myocardial function.
Kazan medical journal. 2012;93(1):142-144
pages 142-144 views

History of medicine

To the centenary of the death of an outstanding russian pediatrician Petr Mikhailovich Argutinskiy-Dolgorukov

Pikuza O.I., Shoshina N.K., Faizullina R.A.


In this article described were the main milestones of life of the founder of the pediatric school in Kazan - Professor P.M. Argutinskiy-Dolgoruky. He made great efforts to organize the teaching of pediatrics in Kazan University at the European level, was one of the founders of a new pediatric hospital on the Arskiy field in 1900. Professor P.M. Argutinskiy-Dolgorukov devoted his scientific career mainly to the study of infectious diseases. In Russia P.M. Argutinskiy-Dolgorukov was the founder of the studies of malaria in children. Progressive methods of diagnosis and treatment were introduced into the clinical practice under the guidance of the Professor, including such as the method of treatment of scarlet fever with the Moser serum, the study of measles, X-ray examinations at the patient’s bedside.
Kazan medical journal. 2012;93(1):145-146
pages 145-146 views

The history of organization of care for psychiatric patients in Kazan and in Kazan province from the establishment and to the end of the XIX century

Mendelevich D.M., Sozinov A.S., Morozova E.V.


Present was the historical data, dedicated to the establishment of psychiatric care in Kazan province.
Kazan medical journal. 2012;93(1):146-152
pages 146-152 views


pages 153-156 views

Book review

pages 157 views

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