Vol 96, No 4 (2015)

Theoretical and clinical medicine
The role of vagal insulin signaling and enteric hormones in acute stomach and duodenal erosions and ulcers associated with severe concomitant traumatic head injuries
Alyev F.I.
Abstract

Aim. Clinical and experimental study of vagal insulin signaling and enteric hormones in occurrence of acute stomach and duodenal erosions and ulcers complicated by bleeding and associated with severe concomitant traumatic head injuries.

Methods. Data of 347 patients with severe concomitant traumatic head injuries for 2011-2012 were used for clinical part of the study. Serum levels of insulin, gastrin, C-peptide, histamine, growth hormone, α-amylase were determined. In the experimental part, the model of acute stomach and duodenal erosions and ulcers associated with traumatic head injury were modeled. The first group consisted of 5 intact rats, the second group included 45 rats with modeled isolated traumatic head injury, the third group included 45 rats with modeled traumatic head injury associated with traumatic lung and chest injury, the fourth group included 45 rats with modeled traumatic head injury associated with abdominal organs traumatic injury, the fifth group included 45 rats with modeled traumatic head injury associated with limb and pelvic fractures.

Results. Acute stomach and duodenal erosions and ulcers were found in 21 (6.1%) of 347 patients at endoscopy, mainly in those with the highest parameters of vagal insulin signaling and enteric hormones. At the experiment, all types of combined traumatic head injury increased the incidence of erosions as compared to the second group, with the highest incidence in the group of associated abdominal injury. Vagal stimulation and stimulation of enteric hormones secretion in animals of groups 2-5 was associated with higher incidence of erosions. In contrast, decreased vagal stimulation and enteric hormones secretion leaded to statistically significant reduction of erosions incidence in animals of groups 2-5 as compared both to the natural history of the process (first subgroup), and to animals which were administered 5% dextrose (glucose) and 0.1% histamine solutions (second subgroup).

Conclusion. The incidence of erosions and ulcers, as well as the indicators of vagal stimulation and enteric hormones secretion depend on the nature of the accompanying injury that may be taken into account in the prevention and treatment of such complications.

Kazan medical journal. 2015;96(4):485-488
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Features of enteric insufficiency syndrome in patients with widespread peritonitis
Takha K.D., Allniazi A.E., Amakhanov A.K., Inyutin A.S.
Abstract

Aim. To access the features of enteric insufficiency syndrome in patients with widespread peritonitis.

Methods. The survey of 98 patients with purulent peritonitis was performed. Enteric insufficiency syndrome severity was graded considering the stage of peritonitis treatment. The level of procalcitonin as a marker of sepsis was measured. Changes of abdominal index were analyzed.

Results. I grade of enteric insufficiency syndrome was found in 21 (21.4%) patients, II grade - in 47 (48%), III grade - in 30 (30.6%) of cases. Only enteric insufficiency syndrome grades I and II were registered in patients with reactive stage of peritonitis. At toxic stage of widespread peritonitis, II grade of enteric insufficiency syndrome prevailed and was registered in 60.8% of all cases (31 patients); III grade was diagnosed in 27.4% of cases (14 patients). At terminal stage of peritonitis, III grade of enteric insufficiency syndrome was diagnosed in 80% of patients, II degree - in 20%. In patients of the study sample, regardless of the stage of peritonitis and enteric insufficiency syndrome degree, average levels of procalcitonin were above normal, indicating the bacterial nature of intoxication. Abdominal index did not exceed 7 in patients with I grade of enteric insufficiency syndrome, 8-13 - in grade II, over 13 - in grade III.

Conclusion. A direct correlation between the enteric insufficiency syndrome and the severity of peritonitis was revealed; procalcitonin level is closely related to the severity of peritonitis and enteric insufficiency; there is a correlation between increased values of abdominal index and worsening of bowel function (r=1.841, p <0.05).

Kazan medical journal. 2015;96(4):489-492
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Right ventricular failure and pulmonary hypertension at recurrent thromboembolism of small branches of the pulmonary artery in cancer patients
Kamalov I.A., Tukhbatullin M.G.
Abstract

Aim. Develop new approaches to the diagnosis of right heart failure and pulmonary hypertension in recurrent thromboembolism of small branches of the pulmonary artery in patients with malignant tumors.

Methods. 83 patients with malignant tumors of various localizations were examined and followed-up. The main group included 49 patients with malignant tumors of various localizations and related venous thrombosis. The control group included 34 patients who did not have venous thrombosis. Patients in both groups underwent ultrasonography of inferior vena cava system veins and echocardiography at intervals of 3-4 days during the diagnosis and treatment of malignant tumors. Right ventricle ejection fraction and systolic pressure in the pulmonary artery were calculated at echocardiography.

Results. No signs of inferior vena cava system veins thromboses, right heart failure, pulmonary hypertension were identified in patients of the control group while setting up the diagnosis and treatment of malignancies. In 38 out of 49 patients of the main group, right ventricular failure and pulmonary hypertension of varying severity were detected. The condition of 46 patients of the main group gradually improved after treating with anticoagulants.

Conclusion. Recanalization of venous thrombosis is accompanied by frequent rejection of micro thrombi and embolization of small branches of pulmonary artery, causing right heart failure and pulmonary hypertension, which can be promptly detected by repeated echocardiography.

Kazan medical journal. 2015;96(4):492-497
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Features of connective tissue structure of ligaments of the uterus in female genital prolapse
Khanzadyan M.L., Demura T.A.
Abstract

Aim. To study the features of collagen I and III deposition and elastin in uterosacral ligaments and round ligaments of uterus in females with genital prolapse.

Methods. The study was performed on surgical specimens and biopsies of uterosacral ligaments and round ligaments of uterus of 15 females with genital prolapse and 15 females without prolapse who also underwent metrectomy using abdominal access. Four tissue specimens were obtained from every patient, biopsy material was fixed in 10% neutral formalin and were embedded in paraffin, and cut for the paraffin slices of 4 μm. Specimens were stained by haematoxylin and eosine, Van Gieson’s picro-fuchsin stain and Weigert’s Resorcin-Fuchsin stain, immunohistochemistry (immunoperoxidase reactions) with primary antibodies to collagen I and III and elastin were also performed.

Results. Morphologic study of the ligaments of the uterus in females with genital prolapse revealed fibrosis and fragmentation of elastin, diffuse atrophy, hyaline or mucinous degeneration of smooth muscle and extracellular matrix edema. Connective tissue disarrangement at genital prolapse was seen as decreased expression of collagen type I and elastin. Decreased elasticity determined over-stretching of uterosacral ligaments and round ligaments of uterus, which decreased microcirculation and promoted the ischemia of ligaments of uterus connective tissue. Disproportion of connective tissue proteins expression was enhanced by imbalance of collagen I and III, with the last, which is the least strong, prevailing. Stereotypic changes in the ligaments of uterus structures, seen as misallocation and placing of collagen and elastin fibers and, consequently, loosening of the elastic and collagen fibers, were revealed in patients with genital prolapse.

Conclusion. Revealed features of collagen I and III and elastin deposition in uterosacral ligaments and round ligaments of uterus in females of reproductive age with genital prolapse allow predicting the risk for development and relapses of genital prolapse.

Kazan medical journal. 2015;96(4):498-505
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Effect of monoclonal antibodies to respiratory syncytial virus in preterm children with bronchopulmonary dysplasia according to follow-up
Volyanyuk E.V., Safina A.I., Potapova M.V.
Abstract

Aim. To assess the effect and safety of palivizumab to prevent the bronchopulmonary dysplasia complications in preterm children according to follow-up.

Methods. The study included 48 very preterm infants (birth weight ranged from 732-1640 g) with bronchopulmonary dysplasia, who were divided into two groups. The main group included children who received passive immunization by palivizumab (31 children), the comparison group included un-immunized children (17 patients). The diagnosis of bronchopulmonary dysplasia in children at 28 days of postnatal life has been set according to clinical and radiological data. After being discharged from the department of pathology of newborn, children were followed-up for 12 months in the center of preterm children follow-up. Average age of patients with bronchopulmonary dysplasia was 4.2±1.3 months at passive immunization initiation. The drug was administered by intramuscular injection at a dose of 15 mg/kg once monthly.

Results. Lower respiratory tract infections were observed in 6 (19.3%) patients from the first group, including 4 cases of obstructive bronchitis and 2 cases of pneumonia. These patients received incomplete course of immunization. In children who did not receive specific prophylaxis, respiratory infections were registered in 7 (41.2%) patients, with 2 cases accompanied by severe respiratory failure requiring mechanical ventilation. No adverse effects were identified while palivizumab treatment.

Conclusion. Palivizumab is currently the only effective drug to prevent the severe respiratory syncytial virus infection; good safety of the drug makes it possible to reconsider the contraindication of its use in high-risk children with severe bronchopulmonary dysplasia.

Kazan medical journal. 2015;96(4):505-509
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Clinical and morphological assessment of low frequency ultrasound use in delayed eruption of teeth
Gasymova Z.V.
Abstract

Aim. Development of a new method stimulating eruption of impacted teeth, reducing side effects and the term of orthodontic treatment.

Methods. Considering the high numbers of patients who sought medical aid with delayed eruption of teeth, rational method of low-frequency ultrasound was used for stimulating eruption of impacted teeth. The stimulation process was performed by «SIAZ-EGS Med-Stomo» device, with the oscillation frequency of 26.5 kHz, intensity of 1 W/cm, amplitude of 40-60 μm, a wavelength 0,012 m, developed in Azerbaijan. Clinical and morphological methods, including examination of gingival tissue biopsies from the area where low-frequency ultrasound was applied, were used. After clinical and radiographic examination and identifying the impacted tooth with a favorable location on dental panoramic radiography, if there was a space in the tooth row, the area of the tooth projection at the gum was directly affected by low-frequency ultrasound daily or every other day for 5-10 seconds. An average of 1-5 procedures up to the tooth eruption was performed.

Results. Microscopy of epithelial cover and stroma proved the absence of inflammation, thickening of outermost layer on the gum surface. Cells of the intermediate layer revealed the intact nucleus, loosening with linear swelling and cell dissociation. Cellular and tissue changes in gingival tissue seen after the treatment with low-frequency ultrasound may indicate the boosting of the impacted teeth eruption due to the syndrome of molecular contusion, improving the microcirculation and loosening the gum tissues.

Conclusion. The results of comprehensive orthodontic treatment using low-frequency ultrasound ito stimulate the eruption of impacted teeth may be recommended for practical use.

Kazan medical journal. 2015;96(4):510-514
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Laser photocoagulation for patients with chronic central serous chorioretinopathy
Gilyazova A.A., Samoylov A.N., Khafiz’yanova R.K.
Abstract

Aim. To assess the efficacy of laser photocoagulation treatment for patients with chronic central serous chorioretinopathy.

Methods. The study included 17 eyes of 15 patients with relapse of central serous chorioretinopathy of different etiology, including 9 men. Patient’s age ranged from 34 to 55 years. Mean disease duration ranged from 3 months to 8 years. All study subjects underwent a standard ophthalmic examination including best-corrected visual acuity testing, intraocular pressure measurement, bioophthalmoscopy, color vision testing, visual field testing, optical coherence tomography, fluorescent angiography of the retina before and after the treatment. Fluorescein sodium salt (100 mg/ml, ampules of 5 ml, «Novartis Pharma» was used as a contrast. Before the treatment, neuroepithelial layer detachment height was 385.09±14.1 µm, the best-corrected visual acuity ranged from 0.41 to 0.82. The study group did not include the patients with secondary choroidal neovascularization. Diode laser with wave length of 532 nm («Carl Zeiss») was used for laser photocoagulation. The laser photocoagulation procedure was done using the following parameters: exposure time 0.05-0.1 sec, the spot diameter 100-200 µm, and the impulse energy of 100-200 mJ.

Results. Significant improvement of visual acuity, disappearance of relative central scotoma proven by instrumental methods was seen in all patients. Best-corrected visual acuity was 0.91, decrease of neuroepithelial layer detachment height with adherence of all layers of the retina was reduced to 171.12±11.5 µm on the 3-5 day after laser photocoagulation. Patients were followed up from 1 to 6 months, with treatment results staying stable.

Conclusion. Laser photocoagulation of a retina in treatment of chronic central serous chorioretinopathy allows to achieve encouraging morphologic and functional results.

Kazan medical journal. 2015;96(4):514-517
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Algorithm of morphological assessment for predicting clinical course of juvenile nasopharyngeal angiofibroma
Abdurakhmanov O.B.
Abstract

Aim. To determine the association between morphological characteristics of tumor growth and clinical manifestations of progression.

Methods. The study included 118 patients with juvenile nasopharyngeal angiofibroma who were examined and treated at the department of head and neck cancer of Cancer Research Center of Uzbekistan from 2003 to 2013. The main group included 69 patients with primary nasopharyngeal angiofibroma, control group - 49 patients with relapsing tumors who underwent surgery. Standard histological examination was performed in all patients. The algorithm for determination of morphological changes degree was developed based on approach proposed by K.M. Mardaleyshvili (1985), which was modified by authors.

Results. Seven most important morphological features of juvenile nasopharyngeal angiofibroma were outlined. On this basis, we proposed to determine the degree of morphological changes for the prediction and treatment monitoring, which is a graded scale for the signs in each of the seven groups. In the main group of patients with cell type of juvenile nasopharyngeal angiofibroma growth, the scores ranged from 10 to 13, marking the 1st degree of morphological changes. Patients with vascular fibrous type of tumor growth had 18-19 points, which corresponds to the 2nd degree of morphological changes in the tumor. Tumor samples of patients with vascular fibrous type of juvenile nasopharyngeal angiofibroma had the most evident morphological changes in the tumor tissue, which corresponded to 3rd degrees with the scores reaching 28.

Conclusion. The proposed algorithm for determining the grade of morphological characteristics may be used for determining the treatment tactics and monitoring the tumor growth in patients with juvenile nasopharyngeal angiofibroma, as well as the prognostic factor.

Kazan medical journal. 2015;96(4):518-522
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The influence of chronic psycho-emotional stress on cognitive function
Lutskiy I.S., Lutskiy E.I.
Abstract

Aim. The influence of the chronic psycho-emotional stress on the cognitive function was studied.

Methods. 160 railroad engineers of main-line locomotives, whose occupation is acknowledged to be one of the most stressful, were examined. 100 healthy volunteers were examined as a control group. A scale of psychological tension PSM-25 was used to evaluate the effect of the stress. Neurohumoral response to stress was studied by the activity of the hypothalamic-pituitary-adrenal axis, defining adrenocorticotropic hormone, cortisol and corticosterone concentrations. Cognitive functions were examined by the neuropsychological tests: Schulte tables, F. Grobov tables, Burdon correction tests. Attention assessment was emphasized due to railroad engineer’s profession specifics. Result. The reaction of the hypothalamic-pituitary-adrenal axis depended on the duration of chronic psycho-emotional stress: resistance period with reduced levels of the stress hormones in the next 5-7 years replaced the period of activation in the first years (with increased production of adrenocorticotropic hormone, cortisol and corticosterone). The reactivation of the hypothalamic-pituitary-adrenal axis occurred after 12-15 years. Neuropsychological tests revealed that the effect of chronic psycho-emotional stress was accompanied by decreased cognitive functions compared to controls. Time for passing the tests and the number of errors increased, productivity, stability and attention concentration dropped. The term of cognitive function disorders onset and their severity depend on chronic psycho-emotional stress duration. The extract of Ginkgo biloba (EGb 761, 240 mg per day for three months) intake has significantly improved the results of neuropsychological retests.

Conclusion. Chronic psycho-emotional stress leads to deterioration of cognitive functions, and, in particular, attention. The use of Ginkgo biloba (EGb 761) extract is rational for treatment of cognitive malfunction.

Kazan medical journal. 2015;96(4):523-531
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Complex evaluation of drug abuse prevention effectiveness in young people of Kursk region
Timoshilov V.I., Sidorov G.A.
Abstract

Aim. To perform the complex evaluation of drug abuse prevention effectiveness in young people of Kursk region.

Methods. 110 primary care physicians and healthcare managers and 459 young people aged 10-19 years (mean age 15.5±1.04 years) polled. The statistical analysis included calculation of extensive indicators, (numbers of responders who gave the certain answers), mean values with confidence intervals and variation (coefficient of variation, Cv).

Results. Doctors evaluated the effectiveness of the preventive measures categories allocated based on a content analysis of legal documents and teaching materials. The, now doctors and health professionals consider informing young people about the dangers of drugs as the most effective measure in the current circumstances, early detection and treatment of drug abusers - the least effective. Average integrated assessment of prevention quality by young people was 4.31±0.7 points, variation was sufficiently high (Cv=25%). 82.8% of adolescents consider themselves satisfied with the information they were provided, 85.7% were satisfied with the way of presenting the data. Performed informational and educational work has strengthened understanding of the dangers of drugs in 71.9% of adolescents.

Conclusion. The quality of all ongoing preventive work was rated by youth as above average, while significant variation was seen. Results of the survey are the basis of developing system for drug abuse prevention management among youth, introduced in Kursk region.

Kazan medical journal. 2015;96(4):531-536
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Relationship of clinical presentation and psychopathological mechanisms at the commitment of grave socially dangerous acts by schizophrenic patients
Chembaev B.R., Eshimbetova S.Z.
Abstract

Aim. To study the relationship of clinical presentation and psychopathological mechanisms at the commitment of grave socially dangerous acts by schizophrenic patients.

Methods. The sample consisted of 201 schizophrenic patients who have committed grave socially dangerous acts targeted at the life and health of people. The investigation that included social-demographic, anamnestic and clinical data was performed. The sample was divided into three subgroups according to psychopathological mechanisms of grave socially dangerous acts commitment, determined by authors: unconditional-psychotic mechanism (n=46), conditional-psychotic mechanism (n=76) and negative-personality mechanism (n=79).

Results. In patients with the unconditional-psychotic mechanism, the acute psychopathological symptoms such as catatonic, affective and delusional syndromes, acute delusional conditions were prevalent by the time of commitment of socially dangerous acts. In patients with this mechanism of catatonic schizophrenia, remittent course or intermittent-progressive course with the increased production of negative symptoms in remission were significantly more common. In patients with the conditional-psychotic mechanism, paranoid schizophrenia was prevalent, which was characterized by a continuous course without remissions, delusions without hallucinations, or chronic paranoid states. In patients with the negative-personality mechanism, the major psychopathological syndromes were defect and final states; residual schizophrenia and paranoid form of schizophrenia were common, intermittent-progressive course with stable but not increasing negative symptoms had dominated. The highest average duration of the disease at the time of committing a socially dangerous action was associated with the negative-personality mechanism. It was 13.56±9.00 years, which is considerably higher than at unconditional-psychotic mechanism (7.02±7.40 years) and at conditional-psychotic mechanism (7.38±8.35 years).

Conclusion. When developing treatment and prevention measures, it is necessary to take into account the psychopathological mechanisms of commitment of grave socially dangerous acts combined with data of clinical presentation.

Kazan medical journal. 2015;96(4):536-542
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New approach in complex treatment of purulent odontogenic diseases and inflammatory complications of mandibular fractures
Faizov T.T., Mubarakova L.N.
Abstract

Aim. To evaluate antioxidant and therapeutic effects of multivitamins on the area of inflammation in the complex treatment of purulent odontogenic diseases and inflammatory complications of mandibular fractures.

Methods. The study included 120 patients with acute odontogenic suppurative inflammatory diseases and infectious inflammatory complications of mandibular fractures. Control group included 23 healthy subjects aged of 20 to 27 years. Levels of phosphorus (P), calcium (Ca), silicon (Si), strontium (Sr), and zinc (Zn) in the oral fluid were measured by atomic absorption and atomic emission spectroscopy with inductively coupled plasma. Therapeutic effect of «Vinibis» adaptogen containing a complex of vitamins, macro- and micronutrients, amino acids of natural origin was analyzed.

Results. All patients receiving «Vinibis» adaptogen had the following changes in the oral fluid. In acute purulent odontogenic periostitis because of the increased concentration of strontium up to 0.1374±0.0334 mg/l (p <0.05), ratio of Ca/Sr decreased from 2532±446 at the admission down to 792±373 (p <0.05) at discharge. A reduction in the calcium concentration to control values in 5-7 days of hospitalization was established: in acute odontogenic osteomyelitis down to 60.43±4.24 mg/l, and in odontogenic osteophlegmon - down to 54.36±1.95 mg/l. Strontium levels in odontogenic phlegmonous adenitis significantly decreased from 0.3172±0.0868 mg/l at admission to 0.0501±0.0073 mg/l at discharge. In cases of traumatic mandibular fractures, complicated with wound festering, Ca/Si ratio approached the control values at the early stages (5-7 days of admission) and were 134.81±10.27 (p >0,05). The reduction of Ca/Si ratio compared to control values on day 7 was discovered at traumatic mandibular fractures, complicated by wound festering and phlegmon, down to 138.54±12.23 (p >0.05), as well as in chronic traumatic osteomyelitis complicated by phlegmon down to 137.95±11.01 (p >0.05).

Conclusion. Differentiated use of «Vinibis» adaptogen, considering its potential antioxidant action due to the value of vitamins synergy coefficient of 1.14, might improve the efficiency of complex treatment of purulent odontogenic inflammatory diseases and complications of mandibular fractures.

Kazan medical journal. 2015;96(4):543-549
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Optimizing the treatment and preventive measures in poor patients with secondary edentulism
Dyumeev R.M., Bulgakova A.I., Islamova D.M.
Abstract

Aim. To develop an algorithm for diagnosis and integrated treatment of the poor people of the Republic of Bashkortostan, taking into account the possibility of using state support programs.

Methods. The study sample included 296 low-income patients (women over 58 years, men over 63 years) receiving social pension supplements. As a comparison group, 300 patients of retirement age, who had paid for orthodontic treatment by themselves, were recruted.

Results. Out of 296 patients, 211 (71.28%) had previous orthopedic treatment, the remaining 85 (28.72%) had never received orthopedic treatment. All poor patients received treatment according to the full comprehensive program of preferential dentures. Orthopedic treatment using the non-removable prosthesis was performed in 39 (13.17%) patients, removable dentures - in 27 (9.12%), combined prosthetics - in 230 (77.70%). In 300 patients who paid for orthopedic treatment from their own funds, 133 (44.33%) patients got removable prosthesis, 70 (23.33%) patients - non-removable dentures, combined prosthetics was used in the remaining 97 (32.33%). An algorithm of therapeutic and preventive measures for low-income citizens in order to improve oral health and quality of life, as well as to optimize the use of financial resources, was developed. It consists of five stages: I - examination of the anamnesis vitae and the history of the disease; II - Diagnosis and treatment of comorbidities; III - full mouth debridement; IV - selection and rational prosthetics, medical treatment; V - follow-up examination in 1 and 6 months. An integral indicator of quality of life after the conducted complex treatment has improved by 15.11 points (27.0%). Some criteria for the quality of life has improved by more than 2 points (3.51%): «Physical discomfort» - by 2.133, «physical disorders» - by 2.916, «psychological disorders» - by 2.855 points.

Conclusion. The program of preferential dentures allows to expand the range of the treatment options with the use of new technologies; implementation of this program is not a direct source of health improvement, but serves as an auxiliary arm of social support and helps to minimize the severe health consequences for the examined population.

Kazan medical journal. 2015;96(4):549-553
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Diagnostics and treatment of congenital heart diseases in newborns
Mirolyubov L.M., Petrushenko D.Y., Kalinicheva J.B., Sabirova D.R.
Abstract

Aim. Early detection and timely appropriate surgical treatment of congenital heart disease in order to reduce infant mortality.

Methods. The algorithm was designed for the prediction of critical conditions in congenital heart disease in newborns. The algorithm is simple to use, because it does not set a pediatrician-neonatologist a difficult task for the accurate diagnosis of congenital heart disease, but leads physician from the syndromic diagnosis to a certain group of diseases and, therefore, appropriate strategy of patient treatment and management. The algorithm combines both syndromes and hemodynamic conditions causing them. The conditions are divided into fetal-dependent and fetal-independent, which determines the time of surgery. The questionnaire consisting of a series of questions with multiple choice answers helps the doctor to see into the symptoms and syndromes. The questions are made in a way to emphasize the certain signs, the details of medical history and disease progression to pediatricians. It is important to notice that 13 out of 20 questions are based on the medical history and clinical picture, 7 questions are based on the test results such as electrocardiography, radiography, and do not include echocardiography.

Results. Since 2000, the questionnaire was implemented in the Republic of Tatarstan as a recommended diagnostic algorithm for examining newborns with congenital heart disease. Since 2003, the questionnaire and algorithm for prediction of the critical conditions was introduced by the order №867 of the Ministry of Health of the Republic of Tatarstan «On measures to improve health care in congenital heart disease in children». Remote consultations with maternity hospitals are strictly based on them. They carry a certain training load, and when doctors pronounce aloud all the items of the test, the examination algorithm gradually becomes automatic.

Conclusion. During 13 years of using the proposed diagnostic algorithm for congenital heart disease with physiological rationale for palliative care and timely terms of surgery, the mortality rate from congenital heart disease in the Republic of Tatarstan has significantly dropped.

Kazan medical journal. 2015;96(4):628-632
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Experimental medicine
Immunohistochemical and morphometric study of hepatocyte proliferation in 18-days old infant rats after a mechanical trauma being administered «Suvar» biologically active substance
Romanova L.P., Malyshev I.I., Vorob’eva O.V.
Abstract

Aim. Morphometric and immunohistochemical study of hepatocyte proliferative activity in 18-days-old infant rates after a mechanical trauma of the liver.

Methods. After an artificial mechanical injury of the liver with a steel needle in 18-days old infant rats, a biologically active substance «Suvar» in a dose of 50 mg/kg (n=36) was administered to animals. After animals were withdrawn from the experiment, a morphometric study (where the number of mitoses of hepatocytes for every 7000 cells were calculated) and immunohistochemistry of liver tissue were performed. For the immunohistochemistry, two commercially available monoclonal antibodies kits (manufactured by «Santa Cruz») were used: (1) proliferative activity marker Ki-67; (2) apoptosis marker bcl-2. Immunohistochemistry was performed according to standard protocol. Thirty-six operated infant rats, in whom the biologically active substance was not administered, were analyzed as the controls.

Results. The number of ki-67 positive hepatocytes in experimental animals on the 3rd, 5th,7th and the 9th day after the operation was significantly higher compared to controls. This was in accordance with the changes of the number of mitoses in hepatocytes, where the greatest number of mitoses was also registered on 3rd, 5th,7th and the 9th day. Both in experimental and in control infant rats, only single cells marked bcl-2 antibodies were found. The gained results support the opinion of the majority of the researchers that the liver regenerates mainly due to hepatocyte proliferation.

Conclusion. Morphometric study and immunohistochemistry confirmed that biologically active substance «Suvar» stimulates hepatocyte proliferation of hepatic cells, allowing better healing of liver injury compared to control animals.

Kazan medical journal. 2015;96(4):554-557
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Reviews
Features of pregnancy and delivery in patients with pregnancy-induced hypertension
Khasan S.M.
Abstract
Pregnant women with hypertensive disorders have a high risk for premature birth and early delivery due to the increased severity of hypertension associated with low effect of treatment. Vaginal birth in patients with hypertensive disorders are often complicated by premature rupture of membranes, labor abnormalities, abnormal blood loss. Emergency abdominal delivery is performed together with complex intensive therapy. A common approach to the management of pregnancies with mild and moderate forms of hypertension is treatment associated with prolongation of pregnancy. Therapeutic and protective regimen in childbirth is created by phased long-term epidural analgesia. Indications for induced delivery - I-II degree of nephropathy in the absence of a positive therapeutic effect for 1-2 weeks. Regarding to severe forms of hypertensive disorders, many researchers tend to think of the need for early delivery, to avoid complications. At the same time, early delivery often leads to birth with premature fetus, which contributes to worsening of perinatal outcomes in patients with hypertensive disorders. Currently the possibility of conservative management of pregnant with hypertensive disorders at the gestation term of less than 32 weeks using glucocorticoids may significantly improve perinatal outcomes. Conservative management is only possible in large clinical settings with careful selection of patients. Currently, there are different approaches to the selection of methods and timing of delivery in hypertensive disorders. The optimal strategy is based on a differentiated approach that takes into account the severity of hypertensive disorders and the probability of complications for mother and fetus. At the same time, the diversity of the pathogenesis of hypertensive disorders determines the presence of different variants of its clinical manifestations, clinical course and complications, making it difficult to properly assess its severity.
Kazan medical journal. 2015;96(4):558-563
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Methods for liver resection
Akhmetzyanov F.S., Idrisov M.N.
Abstract
The paper presents the development of liver resection methods; it is a brief description of the evolution of improvement and implementation of many scientists’, researchers’ and practical doctors’ ideas, mainly aimed at preventing severe complications, the most common and important of which are bleeding and bile leakage, leading to a series of irreversible consequences and patients death. All described methods originate from each, from simple to complex - from elementary crushing of the liver tissue with two fingers and ligation of tubular structures to compression clips and cryo-scalpel. In the XX century, due to developments in medical technologies and medical physics new contemporary methods of microwave coagulation, using plasma surgical units and radiofrequency generators appeared. Hemo- and cholestasis effects of each method have its own advantages and disadvantages, which are reflected in the presented review. So far, the choice of liver resection method, excluding the most complications of intra- and postoperative periods is a matter of the sole initiative of each hepatic surgeon. The problem of preventing the most frequent complications is related to the surgery method and requires further studies and improvements. The survey does not reflect our own technique developed for liver resection used for 10 years, which is presented for a patent registration and further publication with detailed description of this technique and the results of operations, both immediate and long term.
Kazan medical journal. 2015;96(4):563-567
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Educational programs for patients and persons providing palliative care as a way to improve its quality in geriatrics
Ponomareva I.P., Tkachenko E.V.
Abstract
The efficiency of educational programs implementation in geriatrics in managing the palliative care training was explored. The article presents the literature review devoted to the problem of performing educational programs for patients and their relatives on the palliative care management in geriatrics. Currently there is an unresolved contradiction: on the one hand - the growing number of elderly and senile patients with severe pathology, accompanied by a significant dependency on others, on the other hand - the lack of professional staff and the lack of care, family problems in the competent care management, lack of specialized training and information programs. The situation is aggravated by the lack of interagency cooperation, and the inability to realize in practice the main principle of palliative care - multidisciplinary approach. Review of the literature demonstrated that the development and implementation of educational programs in palliative care, raising awareness of patients and their families are able to solve not only medical, but also economic problems, reducing the number of hospitalizations by twice, number of ambulance calls by twice as well. Introducing the information and education programs for patients with chronic conditions significantly reduces the risk of complications and, consequently, the cost of treatment and rehabilitation. Features of palliative care programs in geriatrics is teaching not only the patients, but their relatives by specialists with medical education, as well as and training of volunteers, social service professionals by academic specialists, taking into account the clinical, psychological and social characteristics of older patients.
Kazan medical journal. 2015;96(4):567-571
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Efficiency of intra-articular, periarticular, local intramuscular and perineural injection therapy in the treatment of nociceptive and neuropathic pain syndromes
Bogdanov E.I., Sakovets T.G., Altunbaev R.A.
Abstract
Diseases of the musculoskeletal system are accompanied by nociceptive, neuropathic pain which is, in addition to kinesitherapy, physical therapy and acupuncture, widely treated using the local injection therapy. This treatment method is commonly used by physicians of different specialties for about 100 years and includes intra-articular, periarticular, perineural, intramuscular administration of different medicines, homeopathic remedies or medical devices. Hyaluronic acid salts, nonsteroid anti-inflammatory drugs, glucocorticosteroids, local anesthetics, vitamin B12, botulinum toxin A medications are often used for the treatment of degenerative conditions, posttraumatic joint disease, delayed complications of aseptic, bacterial and viral inflammatory, rheumatic processes within and out of the joints, such as: pathology of periarticular soft tissues as a consequence of local physical overload after acute injury, chronic microtrauma, sport trauma, affected facet joints and periarticular space at patients with dorsopathy, local muscle hypertonus (myofascial pain syndrome), neuropathy. The unique medication Hyalrepair-02/10 chondroreparant® based on the solid-state modificated hyaluronic acid salts and biogenic metabolites (non-drug bioorganic depot complex consisting of hyaluronic acid, amino acids and ascorbyl phosphates) is widely used at spine diseases and diseases of the musculoskeletal system, and it has showed good safety at local injection therapy. Heterogeneity of target tissues at patients with the musculoskeletal disorders, pharmacological substances as a part of injection drugs, and dosages of medicines and medical devices as well as individual patient reactions to the local therapy depending on severity of the disease, compensatory abilities and other reasons determines the necessity of carrying out a clinical comparison between different types of local injections with various groups of preparations.
Kazan medical journal. 2015;96(4):571-577
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Healthcare mangement
Hemodialysis service in the Azerbaijan Republic
Babaev F.G., Guseynov K.M.
Abstract

Aim. To study the organizational aspects of hemodialysis aid to the population of Azerbaijan.

Methods. The structure of patients requiring hemodialysis was studied using personal data and statistical reporting of the hemodialysis service of the Azerbaijan Republic using historical, analytical, statistical research methods.

Results. The trend for increased numbers of patients receiving a hemodialysis is shown. It is specified that Azerbaijan is the endemic area for nephrolithiasis. 950-970 patients per million have a renal disease. In 2011, 211,306 procedures of hemodialysis were performed, compared to 291,852 procedures in 2013, including 823 primary patients. The total number of patients requiring hemodialysis in 2013 was 913 patients in Baku and 898 patients in regions (1811 patients in total). The understaffing of dialysis departments with nephrologists is presented, the number of available specialists is almost 4 times less than required. Thus, it is shown that dialysis departments of the republican medical setting have 119 doctors and 294 nursing staff, the staffing rate is 1.1-1.2 nephrologist per 100,000 population, while the standard is 4-4.5.

Conclusion. The need for additional management measures to improve the service in this group of patients, as well as new training programs on hemodialysis therapy in universities and medical colleges is explained.

Kazan medical journal. 2015;96(4):578-580
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Prevalence of traumatic brain injury in children of Russian Federation: epidemiology and economic aspects
Valiullina S.A., Sharova E.A.
Abstract

Aim. To define epidemiological features of traumatic brain injury in children and to assess economic losses caused by this condition.

Methods. The prevalence of traumatic brain injury in children for the period of 2003-2012 in Russia according to State Statistical Database. Direct and indirect economic losses (overall and per patient) were calculated for 2012.

Results. The study revealed an increase of traumatic brain injury prevalence in children for the analyzed period, with the domestic traumatism prevailing among all brain trauma injuries, especially in girls. The amount of economic losses due to traumatic brain injury in children of Russian Federation in 2012 was about 4 milliard roubles. However, this figure is considerably underestimated, because the amount of expenses per one patient with traumatic brain injury is a quarter less compared to the standard sum per one case traumatic brain injury according to the standards of obligatory health insurance. On the one hand, it may be explained by high admission rate in children with minor head injury. On the other hand, it may be a result of insufficient healthcare funding as well as unaccounted expenses for medical care and drug coverage, especially in children with severe traumatic brain injury.

Conclusion. The reduction of economic losses due to pediatric traumatic brain injury is possible not only by preventing new cases of traumatic brain injury but also by optimizing medical care.

Kazan medical journal. 2015;96(4):581-587
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Current state of demographic reproduction in Kyrgyz Republic
Atambaeva R.M., Mingazova E.N.
Abstract

Aim. To study the changes of reproductive and demographic characteristics and socio-economic indicators of the Kyrgyz Republic, determining the major trends of these changes.

Methods. Social-hygienic, statistical and analytical methods were used. The changes of the main social, demographic and reproductive indicators of the Kyrgyz Republic for the period of 2007-2011 were studied.

Results. The main reproductive and demographic trends and the changes of the socio-economic indicators: significant number of residents were still poor and extremely poor (almost half the population); women prevailed among the unemployed - nearly one in ten females was unemployed, in young women (under 28 years) - one in seven; the population increased due to the birth rates being higher than the death rates with a negative balance of external migration, natural population increase was - 21 persons per 1,000; the fertility rate increased from 2.7 to 3.1; family with average number of children became more common compared to large families; the number of births by unmarried women and young women aged 15-19 increased; maternal and infant mortality rates decreased, while maintaining high rates (2 times or more above the European standard), increased number of abortions in the country, including abortions in 15-19 years old girls, and others.

Conclusion. Changes in reproductive and demographic processes in the Kyrgyz Republic can be seen as a consequence of a significant drop in living standards of the Kyrgyzstan population; a significant number of negative trends that were revealed is the basis for a detailed study of the causes and factors determining them, followed by a scientific substantiation of programs on reproductive health of the Kyrgyz Republic population.

Kazan medical journal. 2015;96(4):587-593
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Sensitivity and specificity of the treatment methods included in the standards of health resort treatment
Agasiyev A.R.
Abstract

Aim. To estimate the sensitivity and specificity of the treatment methods of health resort treatment according to standards of the Russian Federation.

Methods. A fourfold table was created using the data of standards and sensitivity, specificity and predictive value parameters of health resort treatments were determined. 10 groups of diseases: arterial hypertension, ischemic heart disease, cerebrovascular disease, autonomic disorders, polyneuropathy, radiculopathy and plexopathy, urolithiasis, glomerular disease, liver diseases, gallbladder diseases, diseases of biliary tract and pancreas, diabetes mellitus, joint diseases. Comparison of therapeutic effects of recommended methods for the diseases was performed. The comparison was performed by the fourfold table scheme.

Results. Treatment methods were allocated to the following groups: (1) methods used in all patients irrespective of the main disease; (2) methods used at the majority groups of diseases with different frequency; (3) methods which were selectively administered in certain groups of diseases. It was shown that the existing treatment methods in a set of standards differ by sensitivity, specificity and predictive value, which is associated with insufficient differentiation of indications for their use.

Conclusion. While providing the health resort treatment, a choice of treatment methods by a doctor in charge considering the main and concomitant conditions plays the major role.

Kazan medical journal. 2015;96(4):593-597
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Assistance to the practicing physician
Clinical cases of mastocytosis in clinical practice
Rakhmatullina N.M., Garifullina G.Z.
Abstract
Mastocytosis is a relatively rare group of diseases caused by the proliferation of mast cells in various organs and tissues. The article presents data on the etiology, pathogenesis, clinical presentations, diagnosis and differential diagnosis of mastocytosis, and own clinical observations. Presented clinical cases picture the features of the clinical course of the disease in different age groups. The first clinical case clearly shows the onset of the disease in early childhood (6 months), and misdiagnosis of this disease. The clinical picture of mastocytosis was wrongly assessed as a manifestation of atopic dermatitis, for which the patient received topical treatment without clinical effect. The second clinical observation is in 30 year old patient. The nature and spreading of the disease were assessed, proper treatment was administered. Both patients improved after treatment. Presented clinical observations reflect the importance of the problem in medical practice. Early diagnosis improves the prognosis of the disease and improves the quality of life.
Kazan medical journal. 2015;96(4):598-601
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IX Russian Seminar dedicated to the memory of Prof. N.A. Belokon’
Predictors of atherosclerosis development in children and adolescents with juvenile arthritis
Balykova L.A., Samoshkina E.S., Krasnopol’skaya A.V., Shchekina N.V., Trupanova P.A.
Abstract

Aim. To study the prevalence of metabolic disorders in children with juvenile arthritis.

Methods. A comprehensive clinical and laboratory examination of 82 children and adolescents aged 10-18 years with juvenile idiopathic arthritis and 50 healthy children of the control group was performed. All patients with juvenile arthritis received disease-modifying anti-rheumatic drugs and/or glucocorticoids (intraarticular injections or pulse therapy) and/or biologics.

Results. Complete clinical picture of metabolic syndrome (a combination of the two mandatory criteria - hypertension, glucose intolerance or dyslipidemia with increasing waist circumference above the 90th percentile) was found in 30 (36.5%) of 82 patients and was not found in any child from the control group (p <0.05). Such manifestations as dyslipidemia, abdominal obesity and hypertension, which correlate with disease activity and dose of glucocorticoids, were the most common. One-third of patients with juvenile arthritis had «intima-media» complex thickening and vascular wall structure disorders, which were associated with high disease activity, insulin resistance and other features of the metabolic syndrome.

Conclusion. Juvenile arthritis is associated with high prevalence of metabolic disorders, only partially (hypertension and carbohydrate metabolism disorders) associated with the glucocorticoid intake, but mostly mediated by high inflammatory disease activity.

Kazan medical journal. 2015;96(4):602-609
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Hypervagotonic binodal dysfunction in children. Features of the natural course
Vasichkina E.S., Kruchina T.K., Lebedev D.S., Egorov D.F.
Abstract

Aim. To evaluate the clinical and electrophysiological picture of binodal disease in children, as well as studying the clinical course of this disease.

Methods. To study the clinical and electrophysiological picture of autonomic binodal disease, 426 patients under 18 years old were examined; the average age was 15.35±2.43 years (3-17.9). Patient’s complaints, medical history were examined, ECG, 24-hour ECG, stress ECG (treadmill or bicycle test), echocardiography, transesophageal electrophysiologic study were performed. In the case of a combination with pathological signs of sinus node dysfunction and atrioventricular node conduction disorders with the normalization of all parameters after the atropine administration, hypervagotonic binodal dysfunction was diagnosed. To assess the clinical course of the disease, a group of 72 children was selected, who were monitored repeatedly. Mean follow-up duration was 33 months.

Results. During the study period, sinus node dysfunction and atrioventricular blocks completely resolved in 14 (19.44%), seen as normal clinical picture with no complaints, normal heart rate, no signs of sinoatrial block or atrioventricular block, normalization of Wenckebach point position. Another 35 (48.62%) had only one node dysfunction resolved (either sinoatrial or atrioventricular - Wenckebach point position within the age normal values and/or atrioventricular block resolved). In 23 (31.94%) - deterioration of the sinus node and atrioventricular node dysfunction was observed.

Conclusion. There are significant differences in the frequency characteristics of heart rhythm and electrophysiological parameters of sinus node function in children with a favorable clinical course of binodal disease and progressive course of the disease.

Kazan medical journal. 2015;96(4):609-615
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Difficult questions of Kawasaki syndrome treatment
Degtyareva E.A., Kantemirova M.G., Zhdanova O.I., Tyul’kina S.A., Kul’kova D.M.
Abstract

Aim. To summarize the existing literature data and to optimize protocols of anticoagulant therapy for Kawasaki syndrome.

Methods. A review of treatment results in 10 patients with Kawasaki syndrome, where an individual approach to anticoagulation led to a positive result, and surgical treatment was not required, is presented.

Results. In 5 of 6 patients with timely diagnosis and treatment according to the protocol, transient ectasia of coronary arteries with further normalization of their size within 4-7 months of follow up was detected. In one child on the 12th day of the disease small aneurysms of the right and left coronary arteries were identified. They disappeared after 7 months from the debut of the disease. In 3 patients, diagnosis and treatment have been delayed. In this group, a giant aneurysm of the proximal left anterior descending branch of the left coronary artery with the signs of thrombosis was discovered in a child aged 9 months on the 45th day of the disease. Anticoagulation with heparin with further switching to dalteparin sodium (Fragmin) was accompanied by adequate anticoagulation to the 3rd day of treatment. Aneurysms decreased to 2-4 mm without signs of thrombosis after 24 months of treatment with warfarin in combination with acetylsalicylic acid (Aspirin). In a girl of 1 year and 4 months of age, on the 20th day of the disease, it was complicated by exudative pericarditis with high risk for tamponade, which required a pericardial puncture and catheterization, and a giant aneurysm of the right coronary artery with the signs of thrombosis was found on the 45th day of the disease. Adequate anticoagulation was reached on the 3rd day of treatment with dalteparin sodium (Fragmin). Long-term use of warfarin in combination with acetylsalicylic acid (Aspirin) was continued. At follow-up at 4 months aneurysm of the right coronary artery has not decreased, but the size and the density of the blood clot reduced significantly. A year later, the aneurysm decreased to 5-6 mm without signs of thrombosis. At the next case of a 3 year old child, who was treated according to the treatment standards, ectasia of the right and left coronary arteries was revealed on the 14th day of treatment, disappearing after of long-term use of acetylsalicylic acid (Aspirin).

Conclusion. At further development of standards and following up antithrombotic treatment in patients with the complicated forms of Kawasaki disease, the possibility of individual treatment adjustment based on the detection of thrombophilia genetic markers, which increase the risk for thrombotic complications, should be considered.

Kazan medical journal. 2015;96(4):615-619
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Features of Kawasaki disease in early childhood
Lukushkina E.F., Meshcheryakova V.V., Afraymovich M.G., Konopleva T.V., Kostareva T.Y., Yaskovets A.A., Azovtseva I.A., Katmarchiev A.R.
Abstract
Kawasaki disease causes diagnostic difficulties due to insufficient knowledge of doctors, and therefore often goes under the «disguise» of other diseases and therefore is under-recognized in Russia so far. Laboratory tests reveal leukocytosis, increased erythrocyte sedimentation rate, hypochromic anemia and thrombocytosis, accompanied by hypercoagulation. Late diagnosis and treatment of Kawasaki disease increase the risk for thrombosis and coronary arteries aneurysms, myocardial infarction at a young age, death. The results of the original research targeted to analyze the clinical course and outcomes of Kawasaki disease in 15 infants treated at the department of children under one year of age of the Nizhny Novgorod Regional Pediatric Clinical Hospital during the last 6 years, are presented. The cardiovascular conditions included pericarditis in 4 patients, coronary arteritis in 2 patients, coronary arteritis with dilation of the coronary arteries entrance and thickening of the walls - in 4, myocarditis - in 1 patient, 1 patient had no signs of cardiovascular involvement. All patients without coronary artery aneurysms were treated with intravenous immunoglobulin (1-2 g/kg per course), acetylsalicylic acid (80-100 mg/kg daily) up to fever reduction, followed by 3-5 mg/kg per day up to the normal values of acute inflammation markers and platelet counts, and aggregation inhibitors. In 2 patients, Kawasaki disease led to death, thus in both cases the diagnosis and, consequently, treatment initiation were late. Early diagnosis and rational treatment of Kawasaki disease (high doses of intravenous immunoglobulin in combination with acetylsalicylic acid) is the key to a favorable outcome. Fever of unknown origin, which lasts 7 days or more in a child of an early age, is an absolute indication for echocardiography with mandatory visualization of the coronary arteries. Tactics of following up patients, who underwent Kawasaki disease, is determined by the degree of coronary lesions and the risk of myocardial ischemia.
Kazan medical journal. 2015;96(4):619-623
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Changes in tactics and treatment results in congenital heart diseases in adults during the last 15 years (investigation based on the data of cardio-surgical departments of the Republic of Tatarstan)
Dzhordzhikiya R.K., Vagizov I.I., Kharitonov G.I., Bilalov I.V., Mukharyamov M.N.
Abstract

Aim. To summarize and to distinguish the features of diagnosis and treatment of congenital heart diseases in adults characteristic for the contemporary cardio surgery, by a retrospective study of case reports.

Methods. The study analyzed the medical charts of 245 adults with congenital heart diseases treated in the Cardio surgical department №2 of the Interregional Clinical and Diagnostic Center between 2007 and 2015 years. The comparison group included 701 adult patients with congenital heart diseases treated in the Kazan Center of Cardiovascular surgery between 1987 and 1997.

Results. The prevalence of congenital heart diseases in adults remains significant. In recent years, the share of operations for these diseases is 5.4% of all cardiac interventions. The most frequent pathology is atrial septal defects. The most frequent complications of septal defects are tricuspidal valve insufficiency (83%) and pulmonary hypertension (77%). Comorbidities include: hypertensive heart disease (36%), cardiac arrhythmias (31%) and ischemic heart disease (33%). The number surrendered surgeries decreased from 28.8% in 1997 to 3.7% in 2014. Postoperative mortality has decreased from 3.3% to 1%. Nowadays a significant amount of operations (56%) is transcatheter occlusion. There is an experience of such surgeries in defects of secondary atrial septum and patent ductus arteriosus.

Conclusion. Congenital heart diseases in adults are characterized by severe impairment of haemodynamics, leading to arterial pulmonary hypertension and tricuspid insufficiency, therefore, require early diagnostics and timely treatment before the onset of complications. 68% of such adult patients suffer from comorbidities that increase the risk of surgical interventions. Endovascular surgeries are low invasive, have minimal complication rate and produce good immediate and long-term results.

Kazan medical journal. 2015;96(4):623-628
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Organization of specialized care for children with cardiovascular diseases at the republican heart center in Republic of Bashkortostan
Nikolaeva I.E., Rayanova R.R., Yakovleva L.V., Shaybakova L.R., Onegov D.V., Khabibullin I.M.
Abstract
The organization of cardiologic and cardio surgical care for children and adolescents in Republican Heart Center of Republic of Bashkortostan is characterized. The hospital has a united block for providing specialized medical care. Departments of cardio surgery, pediatric cardiology and intensive care unit №1 are based on the same floor. The advantages of staged approach and continuity of care for children and adolescents with cardiovascular diseases is emphasized. Registers for prenatal diagnosis of congenital heart diseases (includes 7894 children and adolescents by December 31, 2012), for pulmonary hypertension are developed and used in the Republican Heart Center for timely cardio surgery in patients with congenital heart diseases. The main directions of medical care for children with cardiovascular diseases in Republic heart center are cardiac surgery of congenital heart diseases, pediatric cardiology, radiosurgery of congenital heart diseases, emergency cardiology and cardiac surgery, and neonatal cardiac surgery. 4500 cardiovascular surgeries are performed annually, including 398 on children aged 0-17 years, among them 224 on assisted circulation. Department of cardio surgery annually performs about 100 surgeries on infant patients with «critical» congenital heart diseases, contributing up to 35% of all children who underwent surgery, including 30 surgeries per year on newborns. The outpatient clinics examines over 15 thousand children per year. The basis of the successful maintaining the public health is good teamwork of highly specialized professionals in the atmosphere of a clear motivation, enthusiasm and high morals.
Kazan medical journal. 2015;96(4):633-635
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Prognostic value of N-terminal fragment of brain natriuretic peptide in pediatric cardiac surgery
Saidova V.T., Sabirova D.R., Nemirovskaya E.M., Bulatov V.P., Mirolubov L.M.
Abstract

Aim. To study the level of the N-terminal fragment of brain natriuretic peptide in children with congenital heart disease after surgical treatment and to determine its prognostic value in the postoperative period.

Methods. A preoperative and postoperative examination of 113 children with congenital heart disease who were treated in the cardiac surgery department, was performed. Patients were allocated to four groups depending on the functional class of heart failure. Serum concentration of N-terminal brain natriuretic peptide fragment was determined by electrochemiluminescence before and one day after the surgery.

Results. Postoperative levels of the N-terminal fragment of brain natriuretic peptide correlated with the duration of mechanical ventilation, the time that patient spends in the intensive care unit, the intensity of cardiotonic support. On the 1st day after the surgical intervention the concentration of this peptide was significantly increased in patients of the first, second and third group, by average of 7.8 times, due to the direct effect on the heart cells, surgical trauma, influence of cardioplegic solution, heart function alteration and heart failure associated with operative and post-operative period. In 24 patients of the fourth group, the N-terminal fragment of brain natriuretic peptide has significantly decreased on the first day after surgery. In 7 patients of the fourth group, the growth of the N-peptide level was reported, complicated postoperative period, sometimes with fatal outcome, took place in these cases. The level of this marker is associated with the frequency of postoperative complications, reoperations, and its threshold level for determining high-risk group for complications was 5400 pg/ml.

Conclusion. The concentration of the N-terminal fragment of brain natriuretic peptide on day 1 after surgical intervention in patients with congenital heart disease can be used to predict the clinical course of postoperative period; the level above 5400 pg/ml is considered to be a risk factor for postoperative complications and reoperations.

Kazan medical journal. 2015;96(4):635-641
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Evaluating the diagnostic value of clinical examination in combination with dual-zone pulse oximetry for diagnosis of critical congenital heart diseases in newborns
Ushakova S.A., Zharkova I.Y., Fomichev M.V., Khait O.V., Guseva E.N., Yarkova I.A., Parshukova L.N., Zhukova E.Y., Dedyukina E.S., Egorova L.A., Fomicheva I.G., Egorova E.S.
Abstract

Aim. To evaluate the diagnostic significance of clinical examination in combination with pulse oximetry for diagnosis of critical congenital heart disease in newborns in the early neonatal period.

Methods. A retrospective analysis of the screening results for dual-zone pulse oximetry in combination with clinical examination in 4201 newborns (2211 girls and 1990 boys) was performed for the period from June 2013 to December 2014. Criteria of inclusion were: healthy full-term neonates (94%) and preterm infants with a gestational age of >34-35 weeks (6%); no signs of diseases that require intensive care at birth; performed pulse oximetry. Results of physical examination, SpO2, echocardiography were examined in newborns with positive test. Diagnostic value of the method for detecting the critical congenital heart defects was evaluated in terms of sensitivity and specificity.

Results. In the structure of congenital diseases of the circulatory system, diagnosed in the neonatal period, congenital heart defects, mainly with ductus-dependent hemodynamics, contributed to 19%. The efficiency of critical congenital heart defects timely diagnosis is increasing recently due to prenatal detection (62.5% of cases) and diagnosis in the early neonatal period (87.5% of cases). Screening with dual-zone pulse oximetry performed at 24-48 hours after birth has facilitated the postnatal diagnosis. Positive results of dual-zone pulse oximetry were registered in 10 infants (0.24% of the total number of examined newborns). In 8 cases, echocardiography verified critical congenital heart defects; false-positive test was seen in 2 cases, false-negative test - in 1 case.

Conclusion. The specificity of pulse oximetry for diagnosis of severe congenital heart defects in the early neonatal period is very high (99.9 %), the sensitivity is 87.5%, with a small probability of false positives, that allows to consider the dual-zone pulse oximetry as a useful diagnostic method complementary to a thorough clinical examination of the newborn.

Kazan medical journal. 2015;96(4):641-646
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Myocardial hypertrophy in infants in pediatric practice
Basargina E.N., Ermolenko V.S., Sil’nova I.V.
Abstract

Aim. To identify the features of the diseases associated with myocardial hypertrophy, for an earlier differential diagnosis to determine the treatment tactics and to initiate the early treatment.

Methods. Clinical examination, family history, cardiac ultrasound with Doppler, ECG, 24-hour ECG monitoring, and computed tomographic aortography and genetics counseling (if indicated) were preformed.

Results. During 14 years of observations, 92 patients were included, among them: children with idiopathic hypertrophic cardiomyopathy - 49 (53%), followed by children with Noonan syndrome - 11 (11.9%), Pompe disease - 6 (6.5%), hypertension - 6 (6.5%), Leopard syndrome - 5 (5,4%), Friedrich ataxia - 4 (4.3%), Danon disease - 3 (3.2%), cardiofaciocutaneous syndrome, fatty acids beta-oxidation disorder and mucopolysaccharidosis type I (Hurler syndrome) - 2 (2.1%), carnitine deficiency and GM1-gangliosidosis - 1 (1.2%).

Conclusion. Consudering the possibilities of modern medicine, diagnosis of left and/or right ventricular hypertrophy in pediatric general practice and pediatric cardiology is an important factor for the subsequent diagnostic search, earliest possible specific therapeutic interventions to prevent unfavorable outcomes of the diseases.

Kazan medical journal. 2015;96(4):647-653
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Nutritional status correction options in children with congenital heart disease
Gandaeva L.A., Basargina E.N., Borovik T.E., Zvonkova N.G.
Abstract

Aim. To justify the need of nutritional status assessment and correction in children with congenital heart disease.

Methods. Clinical examination, somatometric methods (height, weight, head and chest circumference measuring) were used. Anthropometric data were evaluated using the WHO Anthro, WHO AnthroPlus (2009) programm. The following parameters were analyzed: weight/age, weight/height, height/age, body mass index/age.

Results. The review summarizes the existing data on the etiology and pathogenesis of protein-losing enteropathy and methods of its correction. Own observation is described. A girl, born in 1999 from the fifth pregnancy, occurring on the background of toxicosis and threat of abortion, premature second delivery. Birth weight was 1280 g, length 34 cm. Congenital heart disease (double discharge of the right ventricle main vessels, common open atrioventricular canal, defect of interventricular septum, common atrium, the «riding» mitral valve, left ventricle hypoplasia) is diagnosed in maternity hospital. One year after the Fontan surgery was conducted (in August, 2011) hypoproteinemia (total protein content of 44 g/l) was noticed for the first time in the biochemical blood analysis, and swelling appeared on her feet. Intravenous administration of 20% albumin solution was performed numerously, however without positive changes, plasma protein level was low (37 g/l). According to the guidelines, the child was assigned to a specialized diet with «Nutrien standard» 200 ml/dayas an additional source of protein. The child was discharged from the hospital with improvement and recommendations to continue treatment as an outpatient. At follow-up examination in 6 months at our center (November, 2012) the condition was stable, we managed to stop manifestations of exudative enteropathy and to normalize the total protein levels (November, 2012 - 73 g/l), albumin (46 g/l), and blood electrolytes; the girl gained body weight by 2 kg and height increased by 9 cm.

Conclusion. Complex examination and treatment of children with congenital heart disease should include nutritional status assessment and, if necessary, its correction.

Kazan medical journal. 2015;96(4):654-659
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Endothelial dysfunction as the key link of chronic diseases pathogenesis
Mel’nikova Y.S., Makarova T.P.
Abstract
Endothelium is the unique «endocrine tree» lining absolutely all cardiovascular system organs of the body. Endothelial cells form a barrier between the blood and tissues, perform a number of important regulatory functions, synthesizing and releasing a wide range of biologically active substances. The strategic location of the endothelium allows it to be sensitive to haemodynamic changes as well as to the signals carried by the blood and signals of underlying tissues. Balanced release of biologically active substances contributes to homeostasis maintenance. The data concerning the multiple mechanisms of endothelium participation in the origin and development of various pathological conditions is accumulated so far. This is not only due to its participation in vascular tone regulation, but also due to the direct influence on atherogenesis, thrombus formation, and protection of the vascular wall integrity. Endothelial dysfunction is considered as a pathological condition of the endothelium based on impaired synthesis of endothelial factors. As a result, endothelium is unable to provide the haemorheological balance of the blood, resulting in disorders of different organs and systems functions. Endothelial dysfunction is a key link in pathogenesis of many diseases and their complications. The role of endothelial dysfunction in the development of chronic diseases such as atherosclerosis, arterial hypertension, chronic heart failure, diabetes mellitus, chronic obstructive pulmonary disease, chronic kidney disease, inflammatory bowel disease, and others has been proven recently. The review provides data on the functions of vascular endothelium and its dysfunction. Types of endothelial dysfunction are described. Modern concept of endothelial dysfunction as the key link of pathogenesis of many chronic diseases is presented. Endothelial dysfunction precedes the development of clinical manifestations of diseases, so the study of the endothelium condition at early stages of the diseases is promising and could be of great diagnostic and prognostic value.
Kazan medical journal. 2015;96(4):659-665
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The role of serotonergic system in cardiovascular diseases development in children
Sadykova D.I., Nigmatullina R.R., Aflyatumova G.N.
Abstract
The role of the serotonin system as a link in the pathogenesis of atherosclerosis and arterial hypertension is widely discussed during the recent decades. Serotonin and histamine are part of humoral system of physiological processes regulators and modulators which under pathological conditions are transformed into factors contributing to the disease development. The membrane serotonin transporter has been identified on neurons, platelets, myocardium and smooth muscle cells. The higher is the activity of membrane transporter, the higher is the platelet serotonin concentration, its release into the blood plasma increases thus implementing its negative effects on platelets and wall of the vessels. 5-HT1A, 5-HT2 and 5-HT3 receptor subtypes play a key role in the central mechanisms of regulation of cardiovascular activities while peripheral effects of serotonin on the vascular system are mediated by 5-HT1, 5-HT2, 5-HT3, 5-HT4 and 5-HT7 receptor subtypes. Activation of 5-HT1A receptors causes inhibition of central sympathetic influences and further bradycardia, while 5-HT2 receptors activation - arousal of the sympathetic division, blood pressure elevation, and tachycardia. With the development of anaerobic processes serotonin via 5-HT2 receptors triggers apoptosis of cardiomyocytes leading to the development and progression of heart failure. Participation of 5HT2B receptors in the regulation of heart development during embryogenesis was shown on the mutant mice: cardiomyopathy with ventricular mass loss due to reduction of cardiomyocytes number and size was revealed. The involvement of 5-HT4 receptors in the development of sinus tachycardia and atrial fibrillation; in turn, the use of 5-HT4 receptor antagonists proved to be effective in the treatment of this kind of arrhythmias. Therefore, the study of the serotonergic system role in the development of cardiovascular diseases will allow to open new links in the pathogenesis of arterial hypertension in childhood.
Kazan medical journal. 2015;96(4):665-669
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Myocarditis in yound athletes
Degtyareva E.A., Kantemirova M.G., Zhdanova O.I., Trosheva O.N.
Abstract
Aim. Development of informative differential diagnostic criteria of inflammatory myocardial involvement in young athletes. Methods. A total of 163 athletes (swimmers, football players and sailing athletes) aged 9 to 24 years (mean age 14.74±0,23 years, SD=3.03) were examined. Complete clinical and functional examination was performed. Remodeling of the left ventricle was studied in accordance with R. Devereux (1992) and B. Maron (2005) echocardiographic criteria. Myocardial morphometry results were compared with immunobiochemical markers of myocardial damage and titer of antimyocardial antibodies to the endothelium, cardiac conduction system, cardiomyocytes, and smooth muscle. Results. In 10 out of 40 athletes with echocardiographic signs of pathological remodeling of the left ventricle, the indicators of myocardial damage used as immunobiochemical screening tests, were increased, high titers of antimyocardial antibodies (more than 1:160), arrhythmias, sever conduction disorders, and high concentrations of infectious risk factors were revealed, allowing to diagnose subacute myocarditis. Conclusion. Subacute myocarditis should be excluded in athletes with echocardiographic signs of left ventricular myocardial remodeling and a high concentration of «infectious» risk factors based on immunobiochemical markers of myocardial damage and antimyocardial antibodies titer.
Kazan medical journal. 2015;96(4):669-674
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Variability of heart rhythm and features of psychological status in young hockey players
Yakovleva L.V., Shangareeva G.N.
Abstract

Aim. To study the heart rate variability and characteristics of psychological status in young hockey players in professional sports.

Methods. 65 young hockey players of «Salavat Yulaev» children’s youth sports school of Olympic reserve were examined. The mean age was 14.7±0.5 years, sports experience - 8.75±1.5 years. Determination of the vegetative regulation type and spectral analysis of heart rate variability was performed on a hardware-software «Polispektr-8» complex manufactured by «Neurosoft». Vegetative regulation state was determined by the vagosympathetic balance ratio (LF/HF). The following parameters of heart rate variability were measured: TP (total power of spectrum), HF (high-frequency waves power), LF (low-frequency waves power), VLF (very low frequency waves power), heart rate was calculated. A questionnaire survey was performed using five-factor personality questionnaire known as the «Big Five».

Results. Parasympathetic type of vegetative tone regulation was identified in 30 (46.1%) of young hockey players, balanced initial vegetative tone - in 28 (43.1%) patients, sympathetic type - in 7 (10.8%) patients. Changing of the vegetative regulation type in athletes with sympathetic regulation demonstrates a shift in autonomic balance towards the predominance of sympathetic influence, which is non-physiological for athletes. Such a state of maladjustment can lead to overwork, overstrain, significant reduction in work efficiency and later - to the development of diseases and injuries. According to psychological testing signs of mental and emotional stress and adaptive processes strain were revealed.

Conclusion. The results of the study allow to reasonably implement a differentiated approach to psychological support of the training process taking in account the functioning of the autonomic nervous system.

Kazan medical journal. 2015;96(4):675-679
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Discussions
Thoughts about an article «Comparative analysis of conventional and video-assisted surgeries on thyroid and parathyroid glands»
Korymasov E.A.
Abstract
Kazan medical journal. 2015;96(4):680
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Medical cybernetics
Developing mathematical models for cardiovascular system functional assessments
Rzaev E.A., Rasulov S.R., Rzaev A.G.
Abstract

Aim. Development of mathematical models of circulation (considering anomaly in hemorheology) allowing to diagnose functional condition of vessels/cardiovascular system.

Methods. Echocardiography, mathematical modeling, sedimentation and rheology laws, human mechanics and physiology methods were used for developing mathematical models.

Results. The following mathematical models were obtained: for determination of colloid dispersive blood system viscosity, considering concentration of dispersive phase (blood cells) and blood structure formation; velocity of inconvenient blood cells sedimentation depending on flow velocity of sediment and cell concentration; parameters of blood elasticity and viscosity as a connection between the velocity change and blood viscosity, Young`s elasticity and change tension; blood filtration in vessels (modified form of Darcy`s law) considering tension and changes of destroyed and undestroyed colloid blood system structure velocity. It was shown that impairments of blood flow velocity leads to blood cells sedimentation and thrombus structure formation, which is not moving according to Newton’s law. New indicators for diagnosing functional condition of vessels and estimating the severity of vascular insufficiency are introduced.

Conclusion. Developed hemorheologic models allow to adequately estimate human cardiovascular bloodflow.

Kazan medical journal. 2015;96(4):681-685
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History of medicine
Methods of orthopedic treatment developed during the great patriotic war and post-war years by the orthopedic dentistry department Staff of Kazan State Dental Institute
Yudina G.N., Saleeva G.T., Saleev R.A., Degtyarev I.M.
Abstract
During the Great Patriotic War in Kazan, evacuation hospitals were established in Kazan. Teachers of the Kazan State Dental Institute made an invaluable contribution to their work, offering advice and medical aid to the wounded and sick. During the war, members of the department significantly improved the quality of the treatment of the wounded in the maxillofacial region, which contributed to their rapid recovery and return to the troops or to labor. The Great Patriotic War was a special period for the Department of Orthopedic Dentistry of Kazan State Dental Institute, when everything was aimed at providing high quality care and rehabilitation of patients. Staff members of the department of orthopedic dentistry proposed a number of original methods, orthotics and prostheses for the treatment of severe wounds in the maxillofacial region, which have been successfully used in those years. The designs of these devices and prostheses are not outdated; they are successfully used today to treat patients with maxillofacial injuries. Researches of thoughtful and talented scientists, whose labors are methodically published not only in scientific works, but also in prosthetic dentistry textbooks, valuable for the professional development of a new generation of students of dental faculties. Teaching staff of the department of orthopedic dentistry cherishes the memory of the staff members, who contributed to the development and improvement of dental education in the city of Kazan.
Kazan medical journal. 2015;96(4):686-692
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To the 85th anniversary of the pediatric education in Russia
Al’bitskiy V.Y., Polunina N.V., Sozinov A.S., Abrosimova M.Y.
Abstract

Aim. To illustrate the role of pediatric education in establishing the public health care system for children.

Methods. Historical-genetic and historical-comparative methods were used.

Results. Pediatrics in the second half of the nineteenth century was formed as an independent science and the subject of teaching, Departments of childhood diseases were opened in Russian universities. Among the factors that contributed to the formation of the state system of pediatric care, was a critical situation in the children healthcare of the Russian Empire and the high level of children mortality. In the early twentieth century, medical and social measures to solve this problem were introduced in the country. Immediately after the October Revolution, the construction of the Soviet system of motherhood and childhood protection started. Basics of creating pediatric education in Russia are connected with the establishment of the Faculty of maternal, infant and child health at the Second Moscow Medical Institute in 1930 and the Leningrad Pediatric Medical Institute in 1935, which were World’s pioneers in pediatric training. Pediatric faculty of the Kazan State Medical University opened in 1933. In 80-s of the twentieth century, pediatricians were prepared by 57 pediatric faculties all over the Soviet Union.

Conclusion. Due to the large and fruitful work of graduates of pediatric faculties, there was a significant improvement in children health, manifested primarily as the significant decrease in infant mortality.

Kazan medical journal. 2015;96(4):692-696
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Emperor Nicholas II free hospital and clinic for visiting patients at the Kiev Pokrovsky monastery at the end of XIX and beginning of XX century
Blokhina N.N.
Abstract
The article describes the Kiev Pokrovsky monastery hospitals for outpatients, providing the medical aid at the end of XIX and at the beginning of XX century for the population of South-West and North-West region of the Russian Empire. Interesting documentary facts are enlightened: «December 6, 1898 Emperor Nicholas II Highest deigned to call the hospital and clinic for outpatients as the “Free hospital and clinics for outpatients of Emperor Nicholas II at the Kiev female cenobitic monastery”». The article uncovers the activities of a magnificent doctor Nikolay Viktorovich Solomka, companion of the Grand Duchess Aleksandra Petrovna, who was able to find proper word for moral and spiritual influence on patients while addressing to the colleagues and sisters. Medicine in Kiev Pokrovsky Monastery-hospital was praised by an authoritative person and statesman, Academician Georgiy Ermolaevich Reyn (in future - long-term chairman of the Medical Board of the Ministry of Internal Affairs, the first chief superintendent of the Main Directorate of Public Health). According to the report of the scientific mission of doctor A. Turkevich to the Kiev Pokrovsky Monastery-hospital, discovered by author, we can get a picture of the state of affairs in the medical facilities of the monastery. Achievements, raising the Monastery-hospital on the unprecedented level, are becoming evident. It is no coincidence that doctors - Delegates of the «Pirogov’s VI Congress» and doctors - delegates of the «X Congress of Russian naturalists and doctors» praised all of his hospital institutions and medical personnel while being acquainted with the Kiev Pokrovsky Monastery-Hospital.
Kazan medical journal. 2015;96(4):697-702
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Obituary
Professor Kamil’ Shagarovich Zyyatdinov
 
Kazan medical journal. 2015;96(4):703-704
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