Vol 97, No 2 (2016)

Theoretical and clinical medicine
Structural and electrophysiological remodeling interrelation in postinfarction cardiosclerosis and dilated cardiomyopathy
Mazur E.S., Mazur V.V., Djaber K.A., Orlov Y.A.
Abstract

Aim. To study the interrelation of ventricles echocardiographic parameters and signal-averaged electrocardiogram indicators in patients with postinfarction cardiosclerosis and dilated cardiomyopathy.

Methods. 28 patients with postinfarction cardiosclerosis (men aged 49 to 71 years) and 29 patients with dilated cardiomyopathy (men aged 24 to 61 years) were examined. All patients underwent echocardiography, by which left ventricle final diastolic and systolic volumes with ejection fraction calculation, right ventricle end diastolic and systolic volumes were determined. According to the signal-averaged electrocardiogram, filtered ventricular complex duration, the ventricular complex with an amplitude of less than 40 mV terminal part duration and signal root-mean-square (rms) amplitude of the ventricular complex last 40 ms were evaluated.

Results.. According to the correlation analysis, increase in left ventricle end-diastolic and systolic volumes and decrease in its ejection fraction, as well as an increase in right ventricle end-diastolic and systolic volumes were associated with an increase in the filtered ventricular complex duration and the ventricular complex with an amplitude of less than 40 mV terminal part duration in patients with postinfarction cardiosclerosis. The left ventricle volumes increase and ejection fraction reduction were also associated with the signal rms amplitude of the ventricular complex last 40 ms reduction in patients with postinfarction cardiosclerosis. Similar interrelation was not found in patients with dilated cardiomyopathy.

Conclusion. In patients with postinfarction cardiosclerosis cavities dilation and reduced systolic ventricular function are accompanied by the myocardium electrophysiological properties deterioration; in patients with dilated cardiomyopathy interrelation between structural and electrophysiological indicators of myocardial remodeling was not found.

Kazan medical journal. 2016;97(2):173-177
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Experience of the original endocardial electrode use for temporary pacing of cardiac function
Osmolovsky A.N., Babenkova L.V.
Abstract

Aim. To assess the effectiveness of the original puncture transvenous temporary endocardial springy electrode use in patients with myocardial infarction complicated by bradyarrhythmias.

Methods. The study included 126 patients with myocardial infarction complicated by acute bradyarrhythmias. The original endocardial electrode was used in 38 patients (main group). Temporary artificial heart rhythm control was performed using endocardial springy temporary puncture electrode in 88 cases of bradyarrhythmias (control group). Written informed consent was taken from all patients who underwent the procedure, and in the absence of contact with the patient decision to perform temporary cardiac pacing was made by a council of physicians.

Results.. Spontaneous pacing interruption occurred in 13 patients of the main group and 32 control group patients at various times of the artificial pacing. Thanks to the used original electrode constructional features, fatal cases were prevented in 11 (84.6%) patients of the main group. In 9 of 32 patients of the control group with impaired pacemaker, cardiac pacing was restored by the electrode re-fixation to the heart right ventricular endocardium. In 23 patients of the control group artificial rhythm was restored by the method of endocardial electrode reposition. The number of patients with a spontaneous interruption of temporary artificial heart rhythm control had a strong correlation with the number of patients with the identified new changes in the electrocardiogram (ST segment elevation with acute recurrent myocardial infarction; r=0.84, p

Conclusion. In case of spontaneous interruption of temporary cardiac pacing caused by the loss of myocardial electrical conduction function in the area of the contact with the electrode, for effective and safe fatal cases prevention endocardial electrodes of the original design use is recommended.

Kazan medical journal. 2016;97(2):177-181
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Clinical and pathophysiologic features of cerebral hypertensive crisis
Smychek V.B., Halinouskaya N.V.
Abstract

Aim. To specify clinical and pathophysiologic features and prognostic significance of cerebral hypertensive crisis.

Methods. The study involved 44 patients with cerebral hypertensive crisis, 53 people with coronary artery disease and 14 healthy volunteers. All patients underwent complete blood count and biochemical blood tests, vegetative status determination using questionnaire survey and recording heart rate variability parameters. In patients with cerebral hypertensive crisis systemic inflammation parameters (concentration of interleukin-6 and -8, C-reactive protein in the blood plasma) were determined. Catamnesis was specified by telephone interview.

Results. In cerebral hypertensive crisis, in contrast to coronary artery disease, the parasympathetic autonomic nervous system tone decreases, which is combined with inflammatory changes in the blood (increase in segmented leukocytes number and erythrocyte sedimentation rate), and an increase in the level of systemic inflammation markers: interleukin-6 and C-reactive protein. Vegetative regulation changes closely correlated with the inflammation level and the latter correlated with the clinical symptoms severity and determined poor prognosis in terms of recurrent transient episode. 90-day risk of ischemic stroke after cerebral hypertensive crisis was 2.3%.

Conclusion. In patients with cerebral hypertensive crisis the autonomic nervous system parasympathetic tone reduction combined with increased levels of inflammation markers in blood were revealed; adverse prognostic significance for recurrent ischemic attacks occurrence were leukocytes rate increase, band shift in leukocyte blood count, serum total calcium concentration reduction and blood plasma total protein level decrease.

Kazan medical journal. 2016;97(2):181-187
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Diagnostic and prognostic value of endothelial dysfunction markers in patients with ulcerative colitis
Stepina E.A., Khlynova O.V., Tuev A.V.
Abstract

Aim. To assess the endothelial dysfunction degree in patients with ulcerative colitis, depending on the disease attack severity, the pathological process spread, the presence of systemic manifestations, complications, and endoscopic activity of the process.

Methods. 45 patients with an established diagnosis of «ulcerative colitis» in the exacerbation phase and with newly diagnosed disease forms were examined. The control group included 11 apparently healthy people. As endothelial dysfunction markers vascular endothelial growth factor levels in serum and blood plasma desquamated endothelial cells amount were studied.

Results.In the group of patients with ulcerative colitis a statistically significant increase in levels of endothelial dysfunction markers (the vascular endothelial growth factor content was 506.40±287.00 pg/ml, the plasma desquamated endothelial cells number - 6.47±4.22×104/L) was found compared with the control group (p

Conclusion. In patients with ulcerative colitis endothelial dysfunction, correlated with disease activity and severity markers, was revealed; vascular endothelial growth factor levels and plasma desquamated endothelial cells number can serve as the ulcerative colitis severity criteria, as well as a sign of unfavorable disease course.

Kazan medical journal. 2016;97(2):187-191
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Ultrasound technologies in health centers - potential for early diagnosis of obesity
Spiridonova T.K., Diomidova V.N.
Abstract

Aim. To study the ultrasound technologies opportunities in the health center settings at the stage of the working-age population screening examination for the early detection of obesity.

Methods. The main group consisted of 196 people of working age with various body mass index deviations. The control group is formed of 40 people with a normal body mass index. In addition to the established examination standard in the health center, trial subjects underwent an ultrasound scan using colour Doppler imaging and power Doppler sonography of blood flow in the anterior abdominal wall and the abdominal cavity vessels to assess borders, subcutaneous and visceral fat thickness indicators. Obtained results are compared with the X-ray computed tomography data.

Results. The obesity early diagnosis criteria based on adipose tissue thickness absolute and relative indicators quantitative values according to ultrasound study were determined. Using ultrasound technologies at the stage of the working-age population screening examination in health centers settings allowed to reveal obesity - manageable risk factor of chronic non-communicable diseases - in the early stages when preventive measures in the body weight correction process are the most effective. Results showed that for the obesity early diagnosis information about the visceral fat thickness is the most important, and demonstrated the need to measure not only the absolute but also relative indicators, such as visceral fat thickness and the visceral and subcutaneous fat thickness sum amount ratio coefficients (KVF/TF), as well as the subcutaneous and visceral fat thickness (KSF/VF). It was found that sonographic indicators of visceral fat thickness more than 31.1 mm and a KVF/TF more than 0.64, even in normal body mass indicate the visceral fat excess, what helped to further identify its excess in 20.4% of the subjects with normal body mass index.

Conclusion. Due to technical simplicity, accessibility, non-invasiveness of used ultrasound technologies, their use can be recommended both for obesity early diagnosis, and for further body weight control in working age people.

Kazan medical journal. 2016;97(2):191-199
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Endoscopic removal of esophagus and stomach polyps using ligation device
Sayfutdinov I.M., Ivanov A.I., Peganova E.V.
Abstract

Aim. To approbate method of endoscopic removal of esophagus and stomach polyps using a ligation device.

Methods. During the period from 2013 to 2015, 37 endoscopic polyps removal using the variceal band ligation device «G-Flex» (Belgium) were performed to 34 patients (26 women and 8 men) aged 17 to 68 years. Removed polyps size ranged from 5 to 11 mm. Polyps localization was as follows: esophagus abdominal part and stomach cardia - 7 (19%), stomach subcardial part - 2 (5%), stomach body - 19 (52%), antrum - 9 (24%). Before polyps removal, lesions biopsy and gastric juice acidity determination were performed to all patients, in 45% of cases endosonography was performed. According to the histological study results, hyperplastic polyps were detected in 5 (15%) patients, adenomatous polyps - in 29 (85%). In 2 patients the endosonography results revealed submucosal lesion, coming from the mucous membrane muscular layer.

Results. Technical possibilities of the esophagus and stomach polyps endoscopic removal using variceal band ligation device, depending on the lesion location and size, were evaluated. In all cases, regardless of the focus localization and the comorbidity severity, a successful technical surgery performance was achieved in the absence of complications and symptoms recurrence in the early and late postoperative periods. Method advantages and disadvantages, indications for its performance in the inpatient and outpatient settings are revealed.

Conclusion. In certain indications and performance technique adherence, the esophagus and stomach polyps endoscopic removal using variceal band ligation device is a safe and radical method of upper gastrointestinal tract benign epithelial lesions treatment.

Kazan medical journal. 2016;97(2):199-203
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Diagnosis and treatment of anterior abdominal wall ligature fistulas
Izmaylov A.G., Dobrokvashin S.V., Volkov D.E., Pyrkov V.A., Zakirov R.F., Davlet-Kildeev S.A.
Abstract
AIM. To improve treatment results of patients with ligature fistulas of the anterior abdominal wall by the development of pyo-inflammatory wound complications diagnosis and prevention methods.METHODS. During the period from the beginning of 2001 to June, 2015, 34 patients with a ligature fistulas of the anterior abdominal wall were admitted to the Department of Surgery of Hospital for War Veterans, Kazan. Terms of ligature fistula occurrence ranged from 3 months to 5.5 years after surgery. 7 (20.6%) patients previously underwent herniotomy, 20 (58.8%) - laparotomy for various acute surgical diseases of the abdominal cavity, 2 (5.9%) - appendectomy, 5 (14.7%) - pelvic organs surgery. The patients mean age was 59±4.5 years. Patients were divided into two groups: the first - the comparison group, 23 (67.6%) patients. In this group suturing was performed with polypropylene or absorbable suture filaments, wound debridement was performed by the conventional technique using different antiseptics types: 0.5% chlorhexidine (chlorhexidine bigluconate) and 3% hydrogen peroxide solutions. The second group - the main one, included 11 (32.4%) patients. In this group polyglycolide-co-lactide (purple), USP 2/0 (3 Matric) 75 cm with the atraumatic tip suture materials were used and the wound debridement was performed with 10% aqueous hydroxyethyldimethyldihydropyrimidin (xymedon) solution using a device developed by us.RESULTS. The postoperative pyo-inflammatory complications rate in the control group was 17.4% (4 cases), in the main group - 9.1% (1 case); thereby infiltrates were registered in 3 patients of comparison group and in 1 patient of main group, seroma - in 1 patient of comparison group. Monoculture was isolated in microbiological assay of material from the surgical wounds in 86% of patients. Staphylococci, enterobacteria and non-fermentative Gram-negative bacteria were detected most often. Our results of microbiological assays point to the need for perioperative antibiotic prophylaxis.CONCLUSION. The infectious wound complications rate when using conventional methods of anterior abdominal wall ligature fistulas prevention and treatment is 17.4%, which makes it relevant to search for new methods of treatment and wound surface debridement; the author’s technique offered by us allowed to significantly reduce the wound complications rate.
Kazan medical journal. 2016;97(2):204-207
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Osteoporosis and pain severity in reproductive age patients with breast cancer
Tretyakova N.Y., Chizhikov A.V.
Abstract

Aim. To analyze the relationship of osteoporosis in reproductive age patients with breast cancer with the pain severity and osteoporosis diagnosis improvement in these patients to improve their quality of life.

Methods. The study included 63 women aged 30 to 50 years. The studied group consisted of 33 women with confirmed diagnosis of breast cancer, control group - 30 healthy, same age women of comparison group. The examination included a blood test for osteocalcin, calcitonin, alkaline phosphatase, parathyroid hormone, thyroid stimulating hormone, calcium and phosphorus. The pain severity was evaluated by McGill pain questionnaire and pain syndrome classification. Osteodensitometry was performed to all patients of studied and control groups. All patients with «breast cancer» diagnosis were examined prior to specific treatment administration and 6 months after treatment course completion. 12 patients were examined also after neoadjuvant chemotherapy.

Results.Osteopenia (initial changes of bone tissue) was revealed in 3 (10%) cases in the control group. There was no cases of osteoporosis in the control group. Clinical manifestations in the form of the 1st level pain syndrome in healthy women was registered in 6 (20%) cases. Osteoporosis develops more often in patients who underwent complex treatment with ovarian function blocking, i.e. the artificial menopause advent. Osteoporosis in breast cancer patients after combined treatment was detected in 69.7% of cases, and pain - in 75.8% of cases. Bone mineral density indicators during treatment and after it were significantly different compared to those before treatment (p

Conclusion. In breast cancer in reproductive age patients after the complex treatment, osteoporosis and pain often develop, therefore such patients need to undergo osteodensitometry for timely osteoporosis diagnosis and treatment correction.

Kazan medical journal. 2016;97(2):207-212
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Detection of malignant neoplasms procoagulant activity
Kamalov I.A., Kurtasanov R.S.
Abstract

Aim. To determine possibilities of malignant neoplasms procoagulant activity detection by idiopathic thrombosis ultrasound imaging.

Methods. 587 patients were examined. 347 patients with malignant neoplasms diagnosed in the outpatient clinic settings of the Tatarstan Regional Clinical Cancer Center (Kazan), were included in the main group. 240 patients, in which cancer pathology was excluded, were included in the control group. The groups were matched on age, sex and frequency of venous thromboembolic complications development risk factors not caused by malignant neoplasms. Both groups underwent clinical examination and ultrasound examination of the inferior vena cava, distal abdominal aorta, iliac arteries and veins, lower extremities arteries and veins.

Results. Thrombosis clinical manifestations were detected in 12 patients, including 9 patients of the main group and 3 patients of the control group. In most cases of venous thrombosis in the main group (34 people, 79%) there were no clinical signs of thrombosis and it was detected only by ultrasound examination, which allowed to detect venous thrombus in 43 patients of the main group (12.4%) and in 5 patients of the control group (2.1%; t=3.2, p <0.05).

Conclusion. The inferior vena cava system venous thrombosis frequency in patients with malignant neoplasms was significantly higher than that in patients without cancer, which indicates malignant neoplasms high procoagulant activity; ultrasonography has high sensitivity in the idiopathic thrombosis detection in cancer patients, and it should be performed regardless of the presence or absence of venous thromboembolic complications clinical manifestations.

Kazan medical journal. 2016;97(2):212-216
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Comparative analysis of different methods of anesthesia in patients with acute pancreatitis using pain scales
Shilenok V.N., Nikitina E.V.
Abstract

Aim. To conduct a comparative analysis of used anesthesia methods in patients with acute pancreatitis in intensive care units settings using pain scales.

Methods. Depending on the anesthesia type, 44 patients with acute pancreatitis were divided into three groups: the first group received intramuscular injections of nonsteroidal anti-inflammatory drugs and spasmolytics, the second group - intramuscular injections of non-steroidal anti-inflammatory drugs and opioid analgesics, the third group - epidural anesthesia with local anesthetics. Comparative analysis of pain character, intensity was conducted, its dynamics in patients of all groups amid anesthesia was evaluated using a visual analogue scale, verbal rating scale, verbal descriptor scale, McGill pain questionnaire.

Results. Baseline pain intensity in patients of all groups was high. Patients estimated this pain as «very strong». The time and the level of pain intensity reduction for various anesthesia types had differences. Pain syndrome was eliminated slower in patients of the second group. By the end of the 1st day, patients of this group continued to complain of «strong» pain. Pain intensity decreased only on the 2nd day - patients reported «moderate» pain. Pain syndrome was not completely eliminated in these patients for 2 days of anesthesia. 97.7% of patients reported that the visual analogue scale is the most acceptable pain assessment scale for them.

Conclusion. In patients with acute pancreatitis, the most optimal anesthesia types are intramuscular nonsteroidal anti-inflammatory drugs with spasmolytics and prolonged epidural anesthesia with local anesthetics; intramuscular administration of opioid analgesics with non-steroidal anti-inflammatory drugs is less effective in relieving pain.

Kazan medical journal. 2016;97(2):217-221
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The skin microbiota in pregnant women suffering from atopic dermatitis
Lonshakova-Medvedeva A.Y., Monakhov K.N., Suvorov A.N., Lavrova O.V.
Abstract

Aim. To study the skin microbiota of pregnant women suffering from atopic dermatitis.

Methods. 53 women of reproductive age suffering from atopic dermatitis (28 pregnant and 25 non-pregnant) were examined. The control group included dermatologically healthy women (25 pregnant and 25 non-pregnant). Prior to treatment initiation and on 15-day of study pathological process spread, the SCORAD index (scoring of atopic dermatitis - atopic dermatitis severity assessment), dermatology life quality index determination were conducted. In addition, microbiological study of material taken from the forehead, elbow bend skin and visually unaltered forearm skin was performed.

Results. In women (pregnant and non-pregnant), suffering from atopic dermatitis skin total bacterial load is increased. In all groups, the skin microbiota is presented mainly by staphylococci: in dermatologically healthy people - coagulase-negative, in atopic dermatitis - Staphylococcusя aureus. In atopic dermatitis Staphylococcus aureus is isolated from both lesions and visually unaltered skin. In pregnant women with atopic dermatitis skin bacterial load was higher, Staphylococcus aureus was found more commonly. The skin microbiota in dermatologically healthy women was more diverse in respect of species comparing with patients with atopic dermatitis. Basic care remedies use leads to clinical improvement and a decrease in the skin total bacterial load and Staphylococcus aureus load. Daily use of emollients has no effect on saprophytic microorganisms.

Conclusion. In pregnant patients with atopic dermatitis higher skin total bacterial load and higher rate of skin colonization by Staphylococcus aureus are observed.

Kazan medical journal. 2016;97(2):222-229
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The study of immune system state, substance P, hemostasis and interrelation between these systems in respiratory diseases in frequently ill children
Kerimova M.K.
Abstract

Aim. To study immune system state, hemostasis system, the neuropeptide level (substance P) and their interrelation in respiratory diseases in frequently ill children.

Methods. 340 frequently ill children, 125 rarely ill children and 30 apparently healthy children aged 6 months to 6 years were studied in the acute period of the disease, and in the period of clinical remission. Diagnosis was made on the basis of medical history, clinical signs, instrumental and laboratory assessment results. CD3+, CD4+, CD8+, CD19+ lymphocytes count, serum immunoglobulin classes A, G, M, E levels, interleukin-1β, -2, -6, -8, tumor necrosis factor α, substance P were determined.

Results. Strong negative correlation was revealed between the CD4+-cells level, interleukin-2, interferon γ and hemostasis system parameters. Substance P, interacting mainly with interleukin-1β and -2, CD4+-cells, interferon γ, indirectly interacts with the hemostasis system. In recurrent obstructive bronchitis and complicated acute pneumonia course substance P content increase was higher (4.6-fold compared with healthy children). The fact that the immune system indicators, including cytokine status, substance P and hemostasis system do not normalize during respiratory disease clinical remission in frequently ill children indicates the infection persistence, the inflammatory process continuation during clinical remission.

Conclusion. Along with the immune system, the nervous system and hemostasis system play an important role in respiratory diseases severity in frequently ill children, their complications, prolonged duration, recurrence and transition into a chronic condition.

Kazan medical journal. 2016;97(2):229-235
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Possibilities of digital radiography in the coronary arteries calcification diagnosis in patients with rheumatoid arthritis
Sultanova M.J., Azizov V.A., Sadigova T.A.
Abstract
AIM. To assess coronary calcification nature in patients with rheumatoid arthritis using digital radiography.METHODS. Chest and distal upper extremities X-ray examination results of the 60 patients with rheumatoid arthritis were retrospectively analyzed. The patients mean age was 54.3±7.8 years, mean disease duration - 8.34±0.3 years. The correlation closeness assessment of qualitative features in the observed group was performed by Pearson correlation coefficient.RESULTS. When performing distal upper extremities X-ray examination, in 9 (15.0±4.6%) patients stage I, in 16 (26.7±5.7%) - II, in 21 (35.0±6.2 %) - III, in 14 (23.3±5.5%) patients - stage IV rheumatoid arthritis was found. In 19 (31.7±6.0%) patients coronary calcifications were visualized in the anterior interventricular branch of the left coronary artery, in 14 (23.3±5.5%) patients - in the circumflex branch of the left coronary artery, in 10 (16.7±4.8%) - in the right coronary artery, in 10 (16.7±4.8%) patients - the main trunk of the left coronary artery. In 7 (11.7±4.1%) patients aortic arch calcifications were found. It was found that the coronary calcifications incidence was higher in more prolonged disease course. Correlation relationship between coronary calcifications and rheumatoid arthritis stage was determined: in 7 (77.8±4.1%) patients with stage I, 14 (87.5±4.8%) patients with stage II and in all patients with stage III and IV coronary and aortic calcifications of various nature were identified. The coronary calcification incidence and prevalence had a direct correlation with the patient’s age: in most cases (66.7±10.3%) patients aged 55-60 years had multivessel calcification (≥3).CONCLUSION. There is a close correlation relationship between coronary calcifications and rheumatoid arthritis stages; coronary calcification incidence and prevalence in patients with rheumatoid arthritis depends on age, as well as the disease duration and stage, which is particularly important in the treatment strategy determination.
Kazan medical journal. 2016;97(2):236-239
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Lymph-stimulating therapy in the systemic inflammatory response syndrome correction
Musaev A.I., Usubakunov U.E.
Abstract

Aim. To determine the effectiveness of indirect antibiotics and lymphotropic therapy for the systemic inflammatory response syndrome correction in patients who underwent abdominal surgery.

Methods. There were two groups with systemic inflammatory response syndrome in the postoperative period: 212 patients with various diseases of the abdominal cavity, who received conventional systemic complex therapy, and 146 patients whose complex treatment included antibiotics and lymphotropic therapy (administration of the cephalosporin antibiotics with lymphotropic mixture into the tibia subcutaneous tissue with the prior venous stasis creation). In both groups, patients with destructive forms of cholecystitis and appendicitis complicated by local or general peritonitis dominated. The dynamics of systemic inflammatory response syndrome clinical indicators, as well as laboratory parameters were assessed: the white blood cells count, leukocyte intoxication index, C-reactive protein and blood albumin. The data obtained on the 1st, 3rd and 5-6 days after surgery were analyzed.

Results. In both groups clinical and laboratory symptoms positive dynamics was noted, which was more pronounced in the main group. In the control group leukocyte intoxication index increased on the third day and then decreased, but did not reach normal values on 10th day, while in the main group leukocyte intoxication index decreased already on the third day with its full normalization to 10th day. A faster normalization of white blood cell count, albumin level and C-reactive protein concentration decrease are also observed in the main group. Using indirect lymphotropic therapy was associated with reduction of postoperative complications and lethality rates.

Conclusion. Lymphotropic therapy is an effective method of the systemic inflammatory response syndrome correction and can be recommended for the postoperative management of patients with abdominal surgery.

Kazan medical journal. 2016;97(2):239-244
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Experimental medicine
Role of P53 protein in activation of atm- and parp-mediated dna damage repair (DDR) pathways induced by topoisomerase type II inhibitors
Ramazanov B.R., Khusnutdinov R.R., Galembikova A.R., Dunaev P.D., Boichuk S.V.
Abstract

Aim. To study the mechanisms of doxorubicin genotoxic effects in terms of poly-(ADP)-ribose-polymerase (PARP) and the ATM-kinase (Ataxia Telangiectasia Mutated) inhibition in cell lines with different p53 status.

Methods. The study was conducted on BJ and BJp53DD human fibroblasts cell lines, cultured in DMEM medium supplemented with fetal bovine serum, L-glutamine and antibiotics. Inhibition of PARP and ATM-kinase activity was attained by adding synthetic inhibitors Nu1025 and Ku55933 respectively. Chemotherapy drug doxorubicin was used to induce deoxyribonucleic acid (DNA) damages. Cell viability analysis was performed using MTS-test. Repair system proteins and apoptotic markers expression was assessed by western blotting. Cells distribution by cell cycle phases was performed by flow cytometry.

Results. Adding PARP and ATM-kinase inhibitors to the BJ p53DD cell line culture resulted in a significant reduction in the viable cells number amid DNA damage induction caused by doxorubicin. Cell death in these samples occurs according to the apoptosis mechanism, what was confirmed by the increase in hypodiploid cells number and increased expression of cleaved forms of PARP-1 and caspase-3. The above-described effects of the type II topoisomerase inhibitor doxorubicin were significantly higher in BJ fibroblasts line with non-functional p53 protein (p53DD) compared with conventional BJ human fibroblasts line.

Conclusion. In the context of the failure of p53-dependent mechanisms of cell cycle regulation in BJ p53DD human fibroblasts, PARP and ATM-kinase activity inhibition leads to increased cell death by apoptosis mechanism induced by the doxorubicin action.

Kazan medical journal. 2016;97(2):245-249
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Effect of L-arginine and L-name on lysosomal cysteine proteases activity and lysosomal membranes permeability in rat aorta
Arapova A.I., Fomina M.A.
Abstract

Aim. To study the effect of L-arginine and its analogue N-nitro-L-arginine methyl ester (L-NAME) alone and in combination on lysosomal cysteine proteolysis and lysosomal membranes state in rat aorta.

Methods. The study was performed on male Wistar rats kept under standard vivarium conditions and divided into three control and three experimental groups of 8 animals each. The experimental samples included groups with L-arginine and/or L-NAME administration. The indicators were studied in the rat aorta homogenate precipitating and non precipitating fractions. Acid phosphatase activity was determined by a standardized method of «end point», the cathepsins B, L and H activity was studied by spectrofluorimetric method.

Results. When simulating the changes of nitric oxide synthesis level using L-arginine, the increase of the total cathepsins activity was detected, acid phosphatase lability coefficient was reduced, what is characterized by general lysosomal membranes stabilization. L-NAME group, in contrast, is characterized by a decrease in the cathepsin B and H activity indicators, differences from arginine group were observed in the cathepsin H in lysosomal and general fractions, lysosomal membrane is labile. Combined drugs administration reduces the total cathepsins activity, while there is an increase of the acid phosphatase total activity, all indicators suggest lysosomal membranes labilization.

Conclusion. L-arginine at a dose of 500 mg/kg causes increase in the total cathepsins B, L and H activity in rat aorta due to lysosomal fraction; L-arginine action leads to lysosomal membranes stabilization; L-NAME group in cathepsin H shows a decrease in the cathepsins secretion level with decreased total activity due to both factions; combined administration of arginine + L-NAME group in cathepsin B is characterized by an increase in secretion due to lysosomes membrane labilization.

Kazan medical journal. 2016;97(2):250-255
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Reviews
Fournier’s gangrene
Prokhorov A.V.
Abstract
The review highlights the issues of etiology, pathogenesis, clinical and laboratory picture, radiodiagnosis, treatment and prognosis of fulminant perineum gangrene, or Fournier’s gangrene. According to modern concepts, Fournier’s gangrene is one of the rare forms of necrotizing fasciitis of polymicrobial etiology with a primary lesion of the skin, subcutaneous tissue and superficial fascia of the scrotum, penis, and perineum. Fournier’s gangrene refers to acute surgical diseases of pyonecrotic nature and is characterized by rapid septic course, high mortality, reaching 80%, in spite of the modern antibiotic therapy advances. Over the last decade the Fournier’s gangrene incidence increased in 2.2-6.4 times, due to the increasing number of immunocompromised patients in the population. The disease most often occurs in older men with diabetes, alcoholism and obesity. The Fournier’s gangrene occurrence is preceded by different inflammatory diseases of the colon, urinary organs, scrotum and perineum skin. The disease diagnosis in full-scale stage usually is not difficult. In rare cases, namely in the disease early stages, various radiological methods of investigation, laboratory tests and exploratory surgery with affected soft tissues express biopsy are used with differential diagnosis purposes. The cornerstone in the Fournier’s gangrene treatment is an emergency surgical intervention in combination with a powerful anti-bacterial and anti-shock therapy. To improve the wound healing course and reduce the septic complications risk, new methods of adjuvant treatments such as hyperbaric oxygen therapy and vacuum therapy are used. Hospitalization duration in Fournier’s gangrene is usually lengthy, due to the need to use repeated sanitation necrectomy and reconstructive plastic surgery and are associated with considerable economic costs for treatment. The Fournier’s gangrene prognosis depends on the timing of specialized medical care provision and, above all, on the time interval between the disease onset and surgery performing.
Kazan medical journal. 2016;97(2):256-261
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Possibilities of positron emission tomography in the metastatic breast cancer diagnosis
Ramazanova M.S., Kislichko A.G., Glushkov E.A.
Abstract
An analysis of published data on the possibilities of the positron emission tomography method application in complex diagnostic and treatment activities in metastatic breast cancer was performed. The possibilities are described and the method characteristics according to series of studies, in particular with regard to the various localization metastases identification are given. It is noted that, compared with conventional imaging techniques, positron emission tomography is more sensitive and specific method of distant metastases diagnosis. The results of clinical studies on assessment of the method application possibilities in the detection of breast cancer metastases in lymph nodes, various organs and bone metastases are given. It has been shown that the introduction of sodium fluoride into practice allowed to use this agent as bone tissue biomarker, which can be used in positron emission tomography performing. The data that the simultaneous use of positron emission tomography with 18F-fluorodeoxyglucose and computed tomography has a high diagnostic value in relation to the breast cancer distant metastases detection are presented. The method possibilities for the various forms of primary invasive breast cancer identification, including invasive ductal and lobular cancer are considered. The prospects analysis for a further increase of opportunities for positron emission tomography application is performed, in particular, reports on the possibility of so-called hybrid scanning using positron emission tomography and magnetic resonance imaging are considered. It is highlighted that the most important aim of the method use in clinical practice in the prospect may be local-regional recurrence and distant metastasis monitoring after primary treatment for breast cancer.
Kazan medical journal. 2016;97(2):262-267
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Possibilities of laparoscopic technologies in diagnostics and treatment of patients with generalized peritonitis
Salakhov E.K., Salakhov K.K.
Abstract
The review presents the opportunities and experience of using laparoscopic techniques for the diagnosis and treatment of patients with generalized peritonitis. Primarily, laparoscopy was used only as a diagnostic method to visually assess the abdominal cavity state with minimum damage to tissues. The laparoscopy rapid development is associated with new videoendoscopy equipment emergence. Laparoscopy in abdominal cavity acute surgical diseases can reduce the unnecessary laparotomy number, which is very important for senile and elderly patients with severe comorbidities. Currently, many authors consider laparoscopic sanitation as an alternative method to abdominal cavity programmed revisions and sanitations. Gathered to date experience demonstrated a fairly broad possibilities of laparoscopy in the peritonitis treatment. Abdominal cavity videoendoscopy sanitation techniques development, combined with endoscopic elimination of the peritonitis causes and, thus, the ability to refuse the laparotomy, are relevant. The result of the operative laparoscopy use has been a significant reduction in the duration of patients stay in hospital. Different authors note wound complications reduction, patients’ rehabilitation period reduction, rapid pain relief and a good cosmetic effect, associating it with the minimally invasive nature of the surgery. It should be clearly understand that endovideosurgery possibilities are limited by several factors, which are difficult to predict in advance. In this regard, the most important issue is to determine a clear range of indications and contraindications for the method use in this complex area of surgery, as well as methodology improvement.
Kazan medical journal. 2016;97(2):268-274
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Cardiorenal syndrome: pathogenesis, clinical picture
Tsibul’kin N.A., Novozhilova A.A., Khakimova D.M.
Abstract
Owing to the commonality of a number of pathogenetic mechanisms, cardiovascular system and kidneys diseases often occur together, mutually exacerbating the severity. The circulatory system and the circulating plasma amount are in many respects regulated by the kidneys functional activity. The parameters of systemic hemodynamics and left ventricular function influence on renal function. The discovery of the mechanisms of renal function impairment influence on the heart state and activity contribute to a fuller understanding of the two systems mutual influence. Currently it is recognized that the frequent combination of cardiovascular and renal diseases based primarily on common pathogenic mechanisms of both forms of pathology and their mutually aggravating influence. In accordance with the modern classification there are five types of cardiorenal syndrome: (1) acute renal dysfunction amid acute-onset cardiac dysfunctions; (2) chronic renal dysfunction due to chronic cardiac pathology; (3) acute cardiac dysfunctions due to acute renal impairment; (4) long-term cardiac and cardiovascular system disorders in patients with chronic renal dysfunction; (5) combined cardiorenal pathology due to other organs and systems dysfunction. The clinical significance of this disease is that doctors of various specialties might face it in their practice: physicians, cardiologists, endocrinologists, resuscitators. Cardiorenal syndrome diagnosis is based on patient constant monitoring in several ways, including laboratory and instrumental indicators, allowing timely suspect the initial stages of this pathology development. This increases the research relevance in this field and clinical value of obtained through them practical conclusions and recommendations, reflected in a number of international documents.
Kazan medical journal. 2016;97(2):274-278
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Social hygiene and healthcare management
Features of monthly and seasonal dynamics of mortality risk from circulatory system diseases in Sumgait
Hatamzade E.M.
Abstract

Aim. The aim of the study was to evaluate the population mortality seasonal dynamics in the settings of emergency medical care availability.

Methods. The study was conducted in Sumgait based on the medical certificates of death data analysis for 2013. The average daily number of deaths from all causes and from circulatory system diseases, the monthly number of death cases proportion in the structure of annual death cases, the proportion of deaths from circulatory system diseases among the total number of deaths were calculated.

Results. The average daily number of deaths from all causes was 4.42, including 2.72 cases - from circulatory system diseases. The average daily number of death cases from all causes below the annual average rate was observed in June, July, August and September, and when performing the seasonal analysis - in summer and autumn; from circulatory system diseases - in January, June, September and December. The winter and spring increase in all-cause mortality rate was registered, whereas the mortality rate peak was characteristic for February and March. In the seasonality analysis the largest proportion of death cases number from circulatory system diseases in the structure of total annual mortality rate was in the spring. The proportion of deaths from circulatory diseases among the death causes of Sumgait population was 61.5±1.2%. In winter, the proportion of deaths from circulatory system diseases in the structure of causes of death from all causes was minimal (53.3±2.3%), and in the summer - the maximum (68.9±2.4%).

Conclusion. The regularity of mortality seasonal dynamics in Sumgait is the winter-spring increase and summer decrease in all-cause mortality rate; distinctive feature of the mortality seasonal dynamics in Sumgait is associated with mortality risk increase in spring due to circulatory system diseases.

Kazan medical journal. 2016;97(2):279-282
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Epidemiology
Analysis of HIV-infection incidence in women in the Tatarstan Republic
Agliullina S.T., Khasanova G.R., Nagimova F.I., Stavropolskaya L.V.
Abstract

Aim. To analyze the long-term dynamics and assess incidence territorial and age structure of infection caused by the human immunodeficiency virus (HIV-infection) in women in the Tatarstan Republic for the period from 1987 to 2015.

Methods. Statistical and graphic-analytical methods were used. Intensive rates of HIV-infection incidence in women (aged 18 years and older), including certain age groups, were calculated and incidence territorial and age structure was analyzed. The incidence average prognostic index in 2016 and its possible maximum and minimum values were determined.

Results.From 1996 to 2015 the incidence increased from 0.1 to 31.2 cases per 100 thousand female population. The incidence average prognostic index in 2016 was 37.2 per 100 thousand female population. In adult population (over 18 years) incidence structure the proportion of HIV-infected women in 2001 increased by 2.5 times: from 14.8±0.7% in 2001 to 36.3±1.3% in 2015 (p

Conclusion. Long-term dynamics of HIV-infection incidence in women in the Tatarstan Republic has a significant upward tendency; the shift to older age groups and significant rates variability by Republic districts in the incidence structure in women were revealed.

Kazan medical journal. 2016;97(2):283-287
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Assistance to the practicing physician
Modern methods of allergen-specific immunotherapy in allergic rhinitis treatment
Rakhmatullina N.M., Pastushenko Y.V., Trofimova O.R., Sibgatullina N.A., Akhmedzyanova D.G., Zakirov G.N.
Abstract
The article presents the modern methods of allergen-specific immunotherapy in patients with allergic rhinitis. Allergen-specific immunotherapy - a method of treating allergic diseases, involves reducing the organism’s sensitivity to the allergen effects by repeated administration of allergen extract, starting with the minimum dose. Given the allergic rhinitis high prevalence, as well as its tendency to increase, strong interest in effective methods of its treatment is fully justified. Over the last 20 years, it has become clear that asthma and rhinitis are two types of manifestations of a single pathological process in the airways. It has been proven that allergic disease clinical features may change over time. In addition, patients with allergy are prone to multivalent sensitization. Currently none of the drugs used to relieve allergic rhinitis symptoms can not change the organism’s response to an allergen. Allergen-specific immunotherapy can reduce allergic disease symptoms severity, reduces the need in drugs use, decreases the chance of additional sensitization to other allergens, prevents the asthma development. This therapy has become one of the most widely used effective methods of atopic diseases treatment: seasonal and perennial rhinoconjunctivitis, atopic asthma. Allergen-specific immunotherapy can lead to a change in the immunological response to the relevant allergens in early stages, acting through regulatory cells. Current studies are aimed, on the one hand, at reducing the therapeutic allergovaccines ability to cause allergic reactions, on the other - to maintain or enhance their immunogenic properties. Achieving this goal is possible by changing the route of administration and delivery of therapeutic allergens (non-injection methods of allergen-specific immunotherapy), and using a variety of allergens modification techniques.
Kazan medical journal. 2016;97(2):288-294
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Congenital heart anomaly «single ventricle»: structural and functional diagnosis in everyday practice
Samigullina D.N., Tsibulkin N.A.
Abstract
Diagnosis and description of rare congenital heart anomalies are great challenges for the ultrasonographer. The biggest difficulties arise in hospitals, which do not have specialization in pediatrics or cardiac surgery. A rare form of congenital heart defects is a group of anomalies, unitedly defined as «single ventricle». Severe hemodynamic disturbances and unfavorable course of the disease reduce the possibility to detect this defect in adolescence or adulthood. Single ventricle, as the anomaly main feature, can occur in different forms of pathology. The most commonly single ventricle syndrome includes left heart hypoplasia, tricuspid atresia, and double inlet single ventricle syndromes. The most favorable course have cases when a single ventricle anatomically is left ventricle along with separate and properly formed atrioventricular valves, in the absence of main arteries significant stenosis and their normal location. This variant of a double inlet single ventricle is known as the «Holmes heart». Echocardiographic diagnosis allows to detail the anatomical and functional defects that are present in each case. Detailed identification of diagnostic features allows to specify the diagnosis and avoid inconsistencies in the obtained data interpretation. We present a clinical case of one of the most rare forms of these disease. The described case feature, in addition to its rarity, is long compensated course of defect. The lack of obvious signs of heart failure in this case may be due to a number of factors, such as a balance between the pulmonary and systemic circulation, absence of progressive changes in the pulmonary circulation blood vessels, atrioventricular valves functional adequacy, the absence of stenosis and valves changes of the main arteries, anatomically left ventricle with sufficient contractility.
Kazan medical journal. 2016;97(2):295-299
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History of medicine
To the 150th anniversary of pathological anatomy department of Kazan medical university
Shakirova A.Z., Tsyplakov D.E.
Abstract
The article presents data on the main stages of formation and development of the pathological anatomy department of Kazan (Imperial) University from department approval under the auspice of Professor A.V. Petrov in December, 1965 to its reorganization by merging of two departments - Pathological Anatomy and Pathological Physiology in June, 2014. Data on the department heads for the 150-year history are summarized, the main directions of scientific research conducted under the department heads supervision are described. Particular consideration is given to the Kazan scientists-pathologists achievements and contribution in fundamental and practical pathological anatomy, related subjects, clinical practice, social sciences, students’ education and doctors of various specialties training. Joint General Pathology department faculty new challenges are identified, namely transition plan generation, educational process radical restructuring in order to optimize it according to modern requirements for the higher and postgraduate education system. Initiated and conducted measures in connection with the department reorganization in the framework of new General Pathology discipline allowing to preserve the pathological anatomy structural and organizational integrity as a basic science, which is also of great practical importance, are presented.
Kazan medical journal. 2016;97(2):300-306
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To the history of «compassionate widows» activities and training in St. Petersburg and Moscow hospitals for the poor during the emperor Alexander I reign
Blokhina N.N.
Abstract
The article considers the «compassionate widows» activities and training at the beginning of the ХIХ century - the time of «Compassionate Widows’ Institute» formation in the Russian Empire. Empress Maria Fedorovna set up hospitals for the poor in St. Petersburg and Moscow, in each of which 200 patients in need of medical care were treated. Patients in the vast majority claimed to not only the close attention of the doctors who performed treatment at their time level, but also careful care. That is why in these hospitals quite many «khozhatyy» and «sidel’nitsa» worked. There should be quite intent control over them. In 1815, in St. Petersburg after a year of testing of «volunteered widows of the St. Petersburg Widows’ House», who cared for the sick at St. Petersburg hospital for the poor, after a solemn oath the title of «compassionate widow» was given to 16 of 24 widows. In January, 1818, Empress Maria Fedorovna ordered to engage «compassionate widows» to the patients care in the Moscow hospital for the poor, what was put into practice by this hospital main physician Kh.F. Oppel’. In the same year «compassionate widows» (two experienced and four under consideration) were taken to this hospital, sent to the two-week duty from Moscow Widow’s House. The probationary period lasted for a year, after which «compassionate widows» took the oath in the temple of the church. In the hospitals for the poor (in 1828 known as the «Marian») both in St. Petersburg and in Moscow «compassionate widows» who voluntarily devoted themselves to «look after the sick», were trained and instructed by clinicians. Evidence of «compassionate widows» extensive training in Moscow is a famous physician Kh.F. Oppel’ guidance «Guidelines and rules, how to look after the sick, for the benefit of everyone engaged in this duty, and in particular for compassionate widows, especially dedicated themselves to this title». This is the first Russian book, dedicated to the upbringing in female nursing staff the feelings of mercy and humanity when practicing their professional and civic duty. Kh.F. Oppels’ book is a remarkable historical and medical literary monument. It is the first medical guidance for the patients care, published in our country in Russian and addressed directly to the female medical staff.
Kazan medical journal. 2016;97(2):306-310
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Jubilees
Professoru Rustemu Shamil'evichu Khasanovu - 60 let
 
Abstract
Kazan medical journal. 2016;97(2):311
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Professoru Roinu Kondrat'evichu Dzhordzhikii - 70 let
 
Abstract
Kazan medical journal. 2016;97(2):312
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