Vol 97, No 6 (2016)

Kazan medical journal is 115 years old
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Kazan medical journal. 2016;97(6):821
4th All-Russian scientific-practical conference on organizational and clinical aspects of acute care «Acute care in modern multidisciplinary medical institution, problems, objectives, and perspectives of development»
Sadykov M.N., Klyushkin I.V.
Kazan medical journal. 2016;97(6):822
Theoretical and clinical medicine
Laparoscopic appendectomy during pregnancy: hemostasiological aspects
Petrashenko I.I.

Aim. To study and evaluate changes in blood coagulation system in laparoscopic treatment of acute appendicitis in different pregnancy terms.

Methods. In a conducted study сhanges in blood coagulation system were evaluated in 75 pregnant women in different gestation periods who underwent laparoscopic appendectomy. Gestational age was from 4-5 to 35-36 weeks. Interventions were performed with the use of endovideosurgical complex «Olympus» OTV-SC. The pressure of carbon dioxide in the abdominal cavity was within 10-12 mm Hg. The indicators of blood coagulation system were evaluated with the use of automatic coagulometer «Amelung Coagulometr KC 4A» (Trinity Biotech, Ireland). For the diagnosis of intravascular coagulation D-dimer level in blood plasma was evaluated with immunoturbodimetric assay with latex-test «Tina-quant а D-Dimer» («Roche Diagnostics», USA) in the system «Roche/Hitachi Сobas c 6000». Fibrinolytic activity was evaluated with the use of M.A. Kotovschikova and B.I. Kuznik’s method.

Results. It was found that changes in hemostasis system during laparoscopic treatment of acute appendicitis in pregnant women indicate significant increase of blood coagulation potential, both before and after laparoscopic appendectomy. This state of blood clotting system can be regarded as adequate adaptive response to aggression, designed to reduce probable or actual bleeding.

Conclusion. Hemostasiologic indices during laparoscopic treatment of acute appendicitis in pregnancy are characterized by a significant intensification of the blood coagulation potential, however activation of the regulatory mechanisms of blood coagulation during endovideosurgical intervention is within the physiological norms; these changes are minimal, and laparoscopic appendectomy is the method of choice for pregnant women in different periods of gestation.

Kazan medical journal. 2016;97(6):823-827
Diagnosis and treatment of biliary hypertension syndrome in chronic pancreatitis
Shaymardanov R.S., Gubaev R.F., Khamzin I.I., Nuriev I.I.

Aim. To study the efficacy and pancreatic and biliodigestive bypass surgeries combined with or without resection of the pancreatic head in the surgical treatment of biliary hypertension syndrome in chronic pancreatitis.

Methods. The analysis of surgical treatment of 87 patients with chronic pancreatitis complicated with biliary tract obstruction was performed. In 78 patients the strictures were tubular and had a length of 2-4 cm, 9 patients had «rat’s tail» shaped strictures and a length of 5-7 cm.

Results. In 37 patients various biliodigestive anastomoses without intervention on the pancreas were performed. Unsatisfactory results of choledochoduodenal anastomosis in chronic pancreatitis in long-term follow-up were reported in 3 of 8 interviewed patients. The optimal variant of biliodigestive bypass in chronic pancreatitis with biliary hypertension syndrome is hepaticojejunal anastomosis. In 13 patients different interventions on biliary tract in combination with resection of pancreatic head by Frey were performed. In 13 patients with obstructive forms of chronic pancreatitis with severe pancreatic hypertension pancreaticojejunostomy without resection of the pancreatic head was performed. In the long-term follow up after these surgeries in 7 out of 10 patients the signs of biliary hypertension did not completely resolve. The best results were obtained by using draining pancreatic duct interventions with pancreatic head resection by Frey.

Conclusion. In tubular pancreatogenic strictures of the common bile duct when the symptoms of biliary hypertension are severe, the method of choice is hepaticojejunal anastomosis; duodenum preserving resection of pancreatic head in chronic pancreatitis complicated with biliary hypertension should be combined with bile duct draining operations.

Kazan medical journal. 2016;97(6):828-832
Modern methods of diagnosis and treatment of acute gastrointestinal bleeding of various etiology
Malkov I.S., Nasrullaev M.N., Zakirova G.R., Khamzin I.I.

Aim. Analysis of the treatment results in patients with gastrointestinal bleeding with the use of endoscopic and surgical methods of hemostasis.

Methods. Analysis of the treatment results in 421 patients with acute gastrointestinal bleeding from the urgent surgical department of City Clinical Hospital №7 of Kazan was conducted.

Results. Endoscopic methods of hemostasis in bleeding from the upper gastrointestinal tract (argon plasma coagulation, combined prolonged infiltration hemostasis with the use of 6% solution of polyglucin with mafusol, irrigation with the solution «Hemolab», ligation of the esophageal veins and Danis stent implantation) were applied to 404 patients. All patients simultaneously received conservative treatment. When using the methods of endoscopic hemostasis mentioned above in patients with bleeding from upper gastrointestinal tract the efficiency was achieved in 87.9% of cases. It was the highest when using combined endoscopic methods. Recurrent acute bleeding was diagnosed in 30 (7.1%) cases. Majority of the patients with recurrent bleeding suffered from gastric ulcer and/or duodenal ulcer (21 patients). In all 30 patients with recurrent bleeding surgical intervention with the author’s technique was performed.

Conclusion. The efficacy of endoscopic methods of hemostasis in bleeding from the upper gastrointestinal tract, especially their combined use, was revealed; differentiated approach to the use of endoscopic and surgical techniques of hemostasis depending on the source of bleeding and its intensity is required.

Kazan medical journal. 2016;97(6):832-837
Diagnostic and treatment features of concomitant injuries of pelvis and abdomen in the emergency traumatology
Chikaev V.F., Zakirov R.I., Zaydullin D.G., Il’in R.O., Fayzrakhmanova G.M.

Aim. Analysis of experience of treatment of patients with concomitant injuries of pelvis and abdomen in the emergency traumatology.

Methods. Analysis of features of diagnosis and treatment of 77 patients with concomitant pelvic injuries admitted to Kazan City Clinical Hospital №7 was conducted.

Results. The structure of concomitant pelvic injuries is characterized by a variety of injuries, often accompanied by severe shock. Concomitant pelvic injury in 74% of patients was accompanied by shock, and in 80% of cases it was II-III grade shock. To reduce the patient’s displacement in the admission ward full body CT scan was performed, and for clarifying the scope of injuries and tactics of management CT scan of injured organs was administered. During the first hour after admission to prevent dislocation of fractures and to stop intrapelvic bleeding external fixation devices in different modifications were used depending on the injury; that allowed stabilizing hemodynamics and condition of the victims. In the second step after stabilization of the patient’s state and hemodynamics and correction of homeostasis minimally invasive surgical interventions are recommended on day 5 to 7. If abdominal injury is identified, the optimal way of external fixation of fractures is C-type fixation frame, which allows adequate access for laparotomy.

Conclusion. A patient with severe concomitant trauma needs urgent full body scan with subsequent X-ray CT, staging treatment based on the principal «Damage control», early fixation of pelvic fractures with the use of external fixation devices and subsequent minimally invasive osteosynthesis, and optimal external fixation device which allows adequate access in case of surgery.

Kazan medical journal. 2016;97(6):837-841
Experience of headache treatment in acute non-traumatic subarachnoid hemorrhage and evaluation of treatment effectiveness
Bayalieva A.Z., Shpaner R.Y., Ganeeva I.R.

Aim. Assessment of approaches to the identification and treatment of headache in acute non-traumatic subarachnoid hemorrhage for further study of this problem and optimization of analgesic therapy.

Methods. Medical records of 62 patients admitted to the hospital with acute non-traumatic subarachnoid hemorrhage (SAH) were retrospectively reviewed. The patients were divided into 2 groups: 19 patients underwent X-ray guided endovascular occlusion under local anesthesia and 43 patients had their aneurysm clipped under general anesthesia. Quantitative assessment of headache with the use of Visual Analog Scale (VAS) and qualitative assessment using McGill Pain Questionnaire were performed in all patients. Non-steroidal anti-inflammatory drugs (dexketoprofen, paracetamol) and opioid analgesics were used for analgesia.

Results. It was found that the wide-spread approach to the relief of headaches in SAH is not effective enough that is especially evident from the results of the second group (average VAS score in group 1 was 4.7±2.9 versus 6.3±1.8 in group 2). Achieving adequate analgesia with opioids was accompanied with excessive sedation (Richmond Agitation-Sedation Scale score was -1-2 points) complicating timely evaluation of neurological status. McGill Pain Questionnare data received and insufficient effect of the used treatment regimen allow us to suggest presence of neuropathic component of headache in non-traumatic subarachnoid hemorrhage.

Conclusion. Conventional methods and regimens of headache treatment are not effective enough so it is necessary to analyze protocol variants for headache evaluation and adequate treatment regimens considering pathogenetic mechanisms of pain in non-traumatic subarachnoid hemorrhage and the possibility of excessive sedation with opioid analgesics.

Kazan medical journal. 2016;97(6):841-845
The structure of atherosclerotic plaques of the arteries estimated at ultrasonography in patients with acute ischemic stroke
Khalilov I.G., Zakirzhanov N.R., Sharafislamov I.F., Bayazova N.I., Yaroshkevich G.E.

Aim. Evaluation of histological structure of an atherosclerotic plaque of the carotids received during carotid endarterectomy and its comparison to the data obtained at ultrasonography of carotids.

Methods. 36 patients with the history of cerebral circulatory disorders aged from 50 to 75 years (24 males and 12 females) were examined. 22 patients (14 males and 8 females) had ischemic focus at CAT scan, 7 patients had recurrent ischemic stroke and the rest had transient ischemic attacks. We performed color duplex scanning of extracranial vessels. In addition to ultrasonography contrast intensifying was performed. Sulfur hexafluoride stabilized by phospholipid shell was used as a contrast. Transcranial Doppler with functional assays was carried out as well. Pathomorphological study of the plaques removed at carotid endarterectomy was conducted.

Results. According to the results of ultrasonography conducted before the surgery and histological results, 28 plaques received during carotid endarterectomy were unstable. 60 to 90% stenoses of carotid bifurcation and internal carotids were revealed. Heterogeneous structure, disturbance of fibrous cap and ulcerations, presence of hypoechoic zones of various sizes were observed.

Conclusions. The results of ultrasonography are in accordance with histological conclusion; this method is a reliable tool that provides new opportunities for prediction of embolic complications risk and proves the necessity for carotid endarterectomy.

Kazan medical journal. 2016;97(6):846-850
Microbial landscape of intestinal contents and mucus in frequently ill children
Kerimova M.K.

Aim. To study the state of the microbial landscape of intestinal contents and mucus in frequently ill children and practically healthy children.

Methods. 340 frequently ill children aged 6 months to 6 years and 125 practically healthy children (comparison group) were examined. Along with routine clinical and immunological studies bacteriological study of stool samples and throat swab was performed and polymerase chain reaction was applied to the swab.

Results. According to the results of bacteriological study of throat swab 195 (57.4%) children reported Staphylococcus aureus, 102 (30.0%) children - Staphylococcus epidermidis, 85 (25.0%) children - Streptococcus pneumoniae, 64 (18.8%) children - Haemophilus influenzae, 64 (18.8%) children - Klebsiella pneumoniae, 170 (50.0%) children - Candida albicans. PCR revealed Chlamydia pneumoniae in 53 (15.6%) children, Chlamydia trachomatis in 33 (9.7%) children, Mycoplasma pneumonia in 54 (15.9%) children, and Cytomegalovirus in 18 (5.3%) patients. Among frequently ill children in 67.6% of cases dysbiosis was observed with reduced number of bifidobacteria and lactobacilli and increase of opportunistic microorganisms, predominantly Staphylococcus aureus.

Conclusion. The microbiota of upper respiratory tract in frequently ill children in most cases contains Staphylococcus aureus; reduced number of bifidobacteria and lactobacilli and increase of opportunistic microorganisms were noted; correlation between severity of dysbiosis and immunoglobulin A level in blood was revealed.

Kazan medical journal. 2016;97(6):850-853
Ventricular arrhythmias associated with long QT interval as a predictor of sudden cardiac death in patients with coronary heart disease and type 2 diabetes mellitus
Garipova A.F., Sayfutdinov R.G., Vagapova G.R.

Aim. To determine the prognostic value of blood glucose level changes in patients with coronary heart disease and type 2 diabetes from the perspective of their impact on the duration of QT interval and type of cardiac arrhythmias.

Methods. The study involved 101 patients of 50 years or older with a diagnosis of ischemic heart disease (stable angina, II-III functional class) and healthy volunteers. Synchronous monitoring of ECG and blood glucose measuring were performed in all surveyed patients.

Results. The average duration of QT interval in patients with coronary heart disease and type 2 diabetes was significantly higher than in patients with coronary heart disease without diabetes and in the control group. Glycaemia less than 4 mmol/L and more than 12 mmol/L and high glycemic variability (mean amplitude of glycemic excursion more than 5 mmol/L) increase the risk of QT prolongation and dangerous ventricular arrhythmias. In patients with ischemic heart disease and type 2 diabetes premature ventricular contractions (PVCs) of high grade are detected more often compared to patients without diabetes mellitus and healthy individuals. In patients with coronary heart disease and type 2 diabetes with episodes of glycaemia below 4 mmol/L prevalence of PVCs of high grade is higher than that of patients with glycaemia 4,1 to 11,9 mmol/L.

Conclusion. Patients with coronary heart disease and type 2 diabetes with blood glucose levels below 4 mmol/L and above 12 mmol/L and high glycemic variability have an increased risk of arrhythmogenic sudden cardiac death.

Kazan medical journal. 2016;97(6):854-860
Ultrasound elastography as a method of emergency diagnosis of the first signs of transient ischemia of the lower limbs in diabetic foot syndrome
Fatykhov R.I., Klyushkin I.V., Klyushkina Y.A., Minnemullin N.A., Nasrullaev M.N.

Aim. Evaluate the data of elastography characteristic for the first signs of transient ischemia of lower limbs in diabetes foot syndrome.

Methods. In Kazan city clinical hospital №7 measurement of Young’s modulus of elasticity was performed in 12 patients with transient ischemia in diabetic foot syndrome. The methods and assessment of parameters typical for soft tissues of lower limbs we have developed earlier (patent «Method of elastography diagnosis of tissue changes in diabetic foot syndrome»). Color duplex scan of the arteries was performed according to standard method with the use of 5 to 10 MHz linear array probe starting from distal parts of limbs. Measurement of ultrasound density was performed with the use of shear wave elastography with 4 to 15 MHz wide-band linear probe. All parameters were measured in real time mode.

Results. Increase of elastomeric index (Young’s modulus of elasticity) to 23.74±2.34 kPa (93,49±1,26%) in the distal segment of the lower extremity (on the foot) is associated with development of transient disorders in the lower limbs in diabetic foot syndrome, which is not always detected with invasive methods of diagnosis.

Conclusion. Shear wave elastography is recommended for emergency medical care in diabetic foot syndrome; patients after being diagnosed with type 2 diabetes should dynamically monitor microcirculation of lower limbs that will decrease the risk of need of surgical treatment.

Kazan medical journal. 2016;97(6):860-864
Cardiopulmonary syndrome and adrenoreactivity of an organism
Gazizyanova V.M., Bulashova O.V., Nasybullina A.A., Shaykhutdinova Z.A., Podol’skaya A.A.

Aim. To study β-adrenoreactivity of the cell membrane in patients with different variants of heart failure in association with chronic obstructive pulmonary disease.

Methods. 120 heart failure patients including 68 of them who suffer from concominant chronic obstructive pulmonary disease were evaluated. Assessment of clinical features of heart failure, patients’ quality of life and study of β-adrenoreactivity were performed.

Results. Adrenoreactivity of an organism in heart failure and concominant chronic obstructive pulmonary disease was 2 times higher and was 55.4±18.8 U and in heart failure only it was 29.4±8.5 U. Intensification of β-adrenoreactivity was found to be proportional to worsening of clinical features of chronic heart failure in all patients that was more prominent in patients with pulmonary disease. Responders with heart failure in association with chronic obstructive pulmonary disease had higher values of β-adrenoreactivity of cell membranes more frequently.

Conclusion. The results of our investigation confirm increased activity of sympathetic system in heart failure and concominant chronic obstructive pulmonary disease that worsens clinical manifestations of heart failure.

Kazan medical journal. 2016;97(6):864-869
Placental pathology in case of fetal growth restriction - sonographic and morphological indicators of the critical condition
Ul’yanina E.V., Akhmadeev N.R., Khayrullina G.R.

Aim. To study the peculiarities of placental structure and the state of utero-placental and fetal-placental blood flow in fetal growth restriction.

Methods. A prospective study of 50 pregnant women admitted to the department of pathology of pregnancy with fetal growth restriction followed by a retrospective analysis of the obtained data considering risk factors and clinical course of the pregnancy and the results of morphological examination of afterbirth. For the diagnosis of fetal growth restriction ultrasound and Doppler ultrasound of blood flow in the uterine arteries and umbilical artery, and cardiotocography were performed.

Results. The most informative sonographic markers of the critical state of the fetus in case of fetal growth restriction are abnormal blood flow indicators of «mother-placenta-fetus» system (critical blood flow disorder in uterine arteries and umbilical artery grade III, blood flow disorder in the medial cerebral artery of the fetus), and also significant hypamnion and changes in placenta combined with poor results of cardiotocography. Obtained data correlated with the results of morphological examination of aftherbirth. Impaired blood flow and significant hypamnion on ultrasound indicate acute placental insufficiency, suggest poor fetal condition, including antenatal death. Petrifaction, infarction and calcification on ultrasound point to chronic placental insufficiency and compensated fetal condition, and they correlate with more favorable perinatal outcomes.

Conclusion. The findings of the study demonstrated that ultrasound, Doppler, clinical laboratory and subsequent morphological examination provide very detailed information about the state of placental structure and need for urgent care.

Kazan medical journal. 2016;97(6):869-872
Coagulation way of hemostasis in pregnant women and puerperae with pre-eclampsia in whom caesarean section was performed
Kurmanbaev T.E., Yakovlev N.V., Khasanov A.A., Mustafin I.G., Nabiullina R.M.

Aim. To evaluate clinical value of trombodynamics in diagnosing the state of coagulation way of hemostasis in patients with pre-eclampsia in whom caesarean section was performed.

Methods. The study included 66 pregnant women. The study group included 34 of them with moderate to severe pre-eclampsia. During the postoperative period all puerperae received low molecular weight heparin (Dalteparin 2500 IU subcutaneously once a day for 7 days). The comparison group consisted of 32 pregnant women. All of them had scheduled Caesarean section. LMWH was not administered in this group. Thrombodynamics assay was performed in both groups. Blood samples were taken 1-2 hours before cesarean section, 6-12 hours after the surgery before the first injection of anticoagulant if administered, and on day 5 after delivery not less than 24 hours after the injection of anticoagulant.

Results. In the group of patients with pre-eclampsia changes in trombodynamics characteristic for hypercoagulation were revealed: increase of clot growth velocity (V), clot size (CS), its relative density (D) and development of spontaneous clots (Tsp). These numbers become normal slower than in pregnant women and puerperae without pre-eclampsia and with delivery performed surgically.

Conclusion. According to trombodynamics assay, in pregnant women and puerperae with pre-eclampsia, severe hypercoagulation with increased reaction kinetics of clot formation and its physical characteristics were revealed, as well as increase of blood procoagulant potential.

Kazan medical journal. 2016;97(6):873-881
Markers of inflammation in patients with heart failure in association with chronic kidney disease
Nasybullina A.A., Bulashova O.V., Gazizyanova V.M., Malkova M.I., Mustafin E.E., Khusnutdinova G.R.

Aim. Evaluation of markers of systemic inflammation in patients with chronic heart failure in comorbidity with chronic kidney disease.

Methods. The study included 188 patients with heart failure and kidney disease including control group (76 patients) with heart failure with preserved renal function aged 38 to 83 years (mean age 66.8±10.1 years), with the duration of heart failure of about 8 years. Quantitative measurement of C-reactive protein and proteins of blood serum and daily excretion of protein with urine were performed.

Results. Glomerular filtration rate in patients without renal pathology was 71.1±11.7 ml/min/1.73 m2, and in the group with heart failure associated with kidney dysfunction it was 51.5±19.1 ml/min/1.73 m2. C-reactive protein, γ-globulin, albumin and total serum protein in patients with chronic kidney disease differed from those in patients with heart failure without kidney damage.

Conclusion. C-reactive protein and γ-globulin in the serum significantly increase in patients with heart failure and chronic kidney disease and can be used as markers of cardiac as well as renal events.

Kazan medical journal. 2016;97(6):881-887
Features of drug therapy for patients with myocardial infarction and different glomerular filtration rates
Belkorey O.S., D’yakova E.N., Oslopov V.N., Khasanov N.R.

Aim. To study the features of treatment of patients with myocardial infarction and different functional state of kidneys at outpatient and inpatient stages of treatment.

Methods.A retrospective study included 179 patients admitted to the hospitals of Moscow North-Eastern Administrative District with verified diagnosis of myocardial infarction. Depending on glomerular filtration rate all patients were divided into two groups: patients with acute myocardial infarction and with GFR of ≥60 ml/min/1.73 m2, and those with GFR

Results. Prevalence of arterial hypertension among patients with decreased functional state of kidneys was 94.5% vs. 76.8% among patients with preserved kidney function (p=0.004), prevalence of ischemic heart disease was 36.4% vs. 18.8% respectively (p=0.021). Outpatients administration rate of ACE inhibitors to patients with decreased kidney function was 18.2% and that of statins was 1.8%. Among patients with history of myocardial infarction 24.4% received aspirin, and 35.6% received another antithrombotic medication (P2Y12 platelet receptor inhibitor).

Conclusions. Arterial hypertension and history of myocardial infarction, prolonged inpatient stay were observed more frequently in patients with decreased kidney function; outpatient administration of ACE inhibitors, statins and antithrombotic medications to patients with history of myocardial infarction and decreased kidney functional ability was rare.

Kazan medical journal. 2016;97(6):887-892
Diagnostic aspects of closed abdominal injuries
Malkov I.S., Filippov V.A., Korobkov V.N., Khalilov K.M., Tagirov M.R., Gabitov I.M.

Aim. To study diagnostic value of various diagnostic methods for patients with closed abdominal injury, to develop a diagnostic algorithm to make a reasonable conclusion about the amount and severity of injuries of the abdomen.

Methods. Various diagnostic methods used in closed abdominal injuries from 120 patients admitted to Surgical Department №2 of Kazan city clinical hospital №7 from 2007 to 2015 were analyzed. Majority of victims (65%) with closed abdominal trauma were males aged 20 to 50 years.

Results. Efficiency of diagnostic program for patients with closed abdominal injury used in clinical practice was studied. In a closed abdominal trauma, injury of abdominal organs was detected in 52.5% of patients. 71.4% of those injuries were isolated and 28.6% were concomitant. According to frequency of injuries liver took the first place 15 (23.8%), followed by spleen on the second place (14; 22.2%) and kidneys (12; 19.1%) and intestine (12; 19.1%) on the third, bladder on the fourth (7; 11.1%), and pancreas on the fifth place (3; 4.8%). Importance of radiological methods and laparoscopy was demonstrated. Clinical examination and laboratory diagnostic techniques allow making a timely diagnosis in only 40% of victims. Informativity of radiologic study was 64%. The accuracy of ultrasound in damaged kidneys was 100%, that in rupture of liver was 72%, of spleen, 69%, and of the intestine (0%). Diagnostic accuracy of laparoscopy was 98.9%.

Conclusion. Experience and extensive acquaintance with modern literature allowed the authors to present the algorithm of examination of patients with suspected closed abdominal trauma.

Kazan medical journal. 2016;97(6):892-897
Surgical tactics in patients with pancreatic necrosis and its complications
Krasil’nikov D.M., Abdul’janov A.V., Zajnullin I.V., Borodin M.A., Zefirov R.A., Imamova A.M.

Aim. Improving the results of surgical treatment of patients with pancreatic necrosis and its complications based on developing optimal variants of surgical interventions for each case.

Methods. The article presents experience of surgical treatment of 344 patients with pancreatic necrosis admitted to surgical clinic №1 of Kazan state medical university in Republican clinical hospital (Kazan) during the period from 2009 to 2015. According to the developed procedure of choosing the optimal treatment options for patients with pancreatic necrosis, depending on the stage, degree of involvement of pancreas and retroperitoneal space and the presence of complications, patients underwent a variety of options and combinations of types of surgical interventions. Under the guidance of X-ray 124 surgeries were performed, in 69 (20.1%) cases surgical interventions under ultrasound (US) guidance were completed with open surgical intervention.

Results. Videolaparoscopic interventions with therapeutic and diagnostic purposes were performed in 198 patients with lethal outcomes in 3 (3.1%) cases. As a completed intervention videolaparoscopy was performed in 49 (24.7%) cases. 226 (65.7%) patients underwent open surgery. Most patients required combined surgical treatment, which included a combination of minimally invasive procedures and open surgery in 199 (57.9%) patients.

Conclusion. Use of combined methods of surgical treatment in patients with infected pancreatic necrosis greatly improves treatment outcomes; a combination of minimally invasive and open surgery can significantly reduce postoperative mortality in pancreatic necrosis from 17.8% to 12.5%.

Kazan medical journal. 2016;97(6):898-903
Cerebrovascular reactivity in patients with cerebral contusion and its possible pharmacological correction
Garifullin R.F., Danilov V.I., Karimov R.H.

Aim. Evaluation of dimephosphone as a medication for correction of cerebrovascular reactivity damage in patients with acute traumatic brain injury of mild to moderate severity.

Methods. The study included 40 patients with acute traumatic brain injury admitted to the Department of Neurosurgery of Kazan City Clinical Hospital №7. All patients were divided into 2 groups: patients who did not receive dimephosphone were included in group 1, in group 2 patients received drug therapy identical to that in group 1 but with additional 15% solution of dimephosphone 15 ml 3 times a day for 12 days. Evaluation of cerebral blood flow was conducted by transcranial Doppler with the use of analyzer of blood flow velocity «Sonomed 300M». Patients underwent daily functional tests (compression test, hypercapnic test, hypocapnic test) during the days 1 to 12 of hospital stay.

Results. The conducted study confirms disorders of cerebrovascular reactivity in patients with acute traumatic brain injury. Also it was found that patients treated with dimephosphone as part of comprehensive therapy at a dose of 15 ml of 15% solution 3 times a day, cerebrovascular reactivity indices (index of vasomotor reactivity, overshoot coefficient) recovered significantly faster.

Conclusion. All patients in the acute period of traumatic brain injury with cerebral contusion have disorders of cerebrovascular reactivity; recovery of cerebrovascular reactivity in patients with traumatic brain injury is accelerated by inclusion of dimephosphone in comprehensive treatment.

Kazan medical journal. 2016;97(6):903-908
Possibility of pre-emptive analgesia with gabapentin for laparoscopic surgeries in gynecologic oncology
Bayalieva A.Z., Khusainova I.I., Gabitov N.A., Filippova N.E.

Aim. To study the effect of gabapentin on females in laparoscopic surgery in gynecology.

Methods. The study included 2 groups of patients aged 25 to 75 years admitted for scheduled laparoscopic hysterectomy. A total number of patients was 161. Distribution between the groups was carried out based on the use of pre-emptive analgesia with gabapentin before surgery at a dose of 600 mg orally.

Results. In both groups absence of predisposition to neuropathic pain in females scheduled for hysterectomy due to benign diseases was revealed. Significant difference between the groups in pain intensity after 24 hours after the surgery and development of adverse opioid-caused events such as light sedation, nausea and vomiting due to inhibitory effect of gabapentin on trigger areas of the brain were revealed. There is also marked difference in the need for opioid analgesics at stages of surgical treatment.

Conclusion. Use of gabapentin prior to surgery decreased the level of reactive anxiety and stress response to surgery by 44.8%, which reduced the need for opioid analgesics in intra- and postoperative periods; in the group of females who received gabapentin, postoperative nausea and vomiting were less prominant by 33%.

Kazan medical journal. 2016;97(6):908-912
Cardiogenic syncope in therapeutic practice
Abdrakhmanova A.I., Amirov N.B., Tsibul’kin N.A., Frolova E.B., Mikhoparova O.Y., Oshchepkova O.B.
Recent publications devoted to the etiology, diagnosis and treatment of cardiogenic syncope were reviewed. The analysis of the current state of views on a pathogenesis, classification and features of a clinical picture of syncope of cardiogenic etiology was performed. Cardiogenic syncope has a 20-30% mortality. The highest risk is characteristic for the age more than 45 years, heart failure, history of ventricular tachycardia, nonspecific changes on ECG. With three and more risk factors the probability of a sudden cardiac death within the next year can reach 80%. The cause of cardiogenic syncope is reduction of cerebral blood flow. Cardiogenic syncope can be caused by a fall in blood pressure, cardiac output and total peripheral vascular resistance. Cardiogenic syncope may be the result of bradycardia and asystole, supraventricular and ventricular tachycardia, pulmonary embolism, dissecting aortic aneurysm, structural defects and cardiac anomalies, presence of myxoma or mobile atrial clot, cardiac tamponade, constrictive pericarditis, acute myocardial ischemia, abnormalities of the coronary arteries, dysfunction of prosthetic valve and cardiac pacemakers. In the diagnosis of cardiogenic syncope anamnesis and data received on physical examination are important. Instrumental examination should include electrocardiography, detection of comorbid conditions, exercise stress tests such as cycle ergometry or treadmill test, Holter ECG monitor, echocardiography, and coronary angiography for suspected acute myocardial ischemia.
Kazan medical journal. 2016;97(6):913-917
Pros and cons of Danis stent application in esophageal bleeding
Anisimov A.Y., Loginov A.V., Anisimov A.A., Nasrullaev M.N.

Aim. A critical analysis of world clinical experience of endoscopic hemostasis with self-expanding nitinol Danis stents application in acute bleeding from esophageal varices.

Methods. Literature data of last 10 years about self-expanding nitinol Danis stents application at the peak of esophageal bleeding or in high risk of its recurrence were analyzed.

Results. The advantages of Danis stent include minimal injury, good tolerance by the patient, providing physiological drainage of saliva and the possibility of fluid and food intake through the mouth, possibility of a repeated endoscopic inspection of the esophagus and stomach after the application of the stent, reducing the risk of aspiration pneumonia, the impossibility of removal or displacement by the patient in agitation. According to most authors, Danis stent allows saving time to get ready for safe transjugular intrahepatic portocaval shunt (TIPS), surgical intervention or liver transplantation. This time should be used for performing all procedures necessary to stabilize the patient’s condition and clarify the nature of the existing pathology. Disadvantages include high risk of migration from the esophagus into the stomach with loss of its plugging function, limitation for treatment of only esophageal varices, development of small erosions or ulcers on the mucous membrane of the esophagus after removal of the stent. When Danis stent was used as a final method of treatment in patients who do not fit for TIPS or liver transplant, the mortality rate reached 50%.

Conclusion. To date, it is not yet clarified whether endoscopic hemostasis with self-expanding nitinol Danis stents should be firmly used in the treatment algorithm of patients with variceal bleeding; confirmation of initial clinical results in further comparative randomized controlled trials is necessary.

Kazan medical journal. 2016;97(6):918-925
Main causes of difficult intubation
Gorbunov S.V., Bayalieva A.Z., Ustimov D.Y., Nagimullin R.R.
Difficult or unsuccessful intubation occur in anesthesiologist’s practice infrequently but such situations may have direct threat to a patient’s life. Often mortality associated with anesthesia is caused precisely by difficulties of intubation. The article deals with analyses of the causes of possible difficult intubation in the practice of anesthesiologist and intensivist in planned and emergency situations. Mallampati test, evaluation of thyromantal distance and mobility of atlanto-occipital joint can be used to predict difficult intubation. According to most recent publications, the most effective way to predict it is the «LEMON» score. Ample opportunities for overcoming difficulties of tracheal intubation are created by recently introduced techniques of videolaryngoscopy - different types of video laryngoscope-modifications of Macintosh blades. Their features compared to classic intubation with the use of Macintosh and Magil blades are excellent view and complete visual control of structures of the larynx.
Kazan medical journal. 2016;97(6):925-931
Diabetic autonomic neuropathy as a risk factor for emergencies
Sakovets T.G.
Diabetic autonomic neuropathy includes damage of various organ systems. The manifestations of autonomic neuropathy usually occur in setting of distal sensory motor polyneuropathy but autonomic disorders may be presented disproportionately compared to sensory and motor disorders. Diabetic autonomic neuropathy increases the risk of cardiac arrhythmias and sudden death, significantly reduces the patients’ quality of life, and exacerbates other vascular complications of diabetes mellitus. There are cardiovascular, gastrointestinal and urogenital forms of diabetic autonomic neuropathy and damaged function of autonomic nerve fibers involving respiratory system, pupils, sudoriferous glands, thermoregulatory and endocrine system. Cardiovascular autonomic neuropathy is the most studied, clinically meaningful and prognostically pejorative form of autonomic neuropathy. Autonomous diabetic neuropathy can cause frequent emergency admissions of patients with this pathology, increased mortality in patients with diabetes, which requires informing of general practitioners, endocrinologists, and intensivists about the features of the clinical manifestations and course of this disease.
Kazan medical journal. 2016;97(6):931-934
Possibility of reducing blood loss during and after multiple birth
Akhmadeev N.R., Fatkullin F.I., Khayrullina G.R., Bystritskaya N.Y.
Multiple pregnancy and multiple birth are pathologic obstetric situations. Recently occurrence of multiple pregnancy has increased due to increase of the age at planned pregnancy and widespread use of assisted reproductive technologies including in vitro fertilization. As a result clinicians practicing in obstetrics face more frequent multiple pregnancies, mostly twins. Risk of bleeding during multiple pregnancy, delivery and the postpartum period is estimated as high and is two times higher than in single pregnancy. The main causes of postpartum hemorrhage in multiple pregnancy are uterine hypotony or atony. Hemostatic changes occurring during pregnancy, unspecific and specific complications of multiple pregnancy are important as well. Correct management of the second period of a multiple vaginal delivery allows reducing the volume of blood loss. Method of fetal extraction in the intact amniotic sac allows reducing the influence of external factors on neonate’s head and the volume of blood loss during Cesarean section. Blood loss reducing is caused by amniotic sac compressing the vessels and therefore decreasing bleeding from the uterine incision for the time enough to extract the fetuses. Active management of the third period of vaginal delivery and afterbirth extraction with traction of umbilical cord during Cesarean section are crucial. Suggested regimens of uterotonics (oxytocin, carbetocin, misoprostol) and antifibrinolytics (tranexamic acid) reduce the risk of postpartum hemorrhage.
Kazan medical journal. 2016;97(6):934-938
Social hygiene and healthcare management
Improvement of health centers performance
Starodubov V.I., Soboleva N.P., Savchenko E.D.

Aim. Development of a model of strengthening and preservation of health to improve the activities of children’s and adult health centers.

Methods. A statistical method was used: dynamic analysis of the number of population of Russian Federation in 2010-2015, analysis of budget funds received for preventive work by medical prevention centers in 2014. By the use of a modeling method the scheme of organizational support of children’s and adult health centers was developed.

Results. Designed structure for children and adult health centers with a new direction of activity will contribute to more rational organizational support at various levels of health care, as well as improving the quality and effectiveness of preventive care. The proposed new titles of health centers (child center for health preservation; center for reproductive, family and personal health for adults) reflect the direction of their activities, basically provide improvement of family health at all stages of family development (childhood, youth, working-age and old people) and orientation to a healthy lifestyle. The peculiarity of the new direction of centers’ activity is greater attention to reproductive and mental health. Promoting mental health in adults should begin in childhood. Increased activity of children’s centers will strengthen health throughout life.

Conclusion. Health center should be located in a medical organization; its name should reflect the direction of its activities; the basis of the center for the adults should become a family; strengthening of reproductive and sexual health will contribute to improvement of demographic situation in the country; it is necessary to increase funding for preventive care for the population.

Kazan medical journal. 2016;97(6):939-944
Study of incidence of eye diseases in the adult population older than 30 years in Azerbaijan
Agaeva R.B.

Aim. To study the basic trends of prevalence of eye diseases among the population of Azerbaijan Republic older than 30 years with the use of geographic information system (GIS) analyst.

Methods. Analysis of incidence and prevalence of diseases of eye and adnexa in the Republic of Azerbaijan was carried out over a ten-year period (2001-2010). Medical geographical mapping of indicators of incidence by regions of the Republic was conducted with the use of GIS parameters of the program ArcGIS.

Results. The results of analysis of prevalence of eye diseases in adult population in 2001-2010 demonstrate its variation in different years of the study reaching maximum values in 2006 and 2010. Incidence rate of eye diseases in adults increased sharply in 2007 almost remaining at the same level during all subsequent years. The maximum absolute value of 1% growth was observed in 2010. The structure of disease incidence demonstrates dominance of cataract (51.1%) as a predominant pathology that explains the necessity to perform early diagnosis of this disease and thorough dispensary observation for prevention of its progression. Ranking of territories revealed characteristic high detection of eye diseases in the regions and cities of the Republic with developed infrastructure. Territorial difference in prevalence and incidence were revealed in the regions of the Republic of Azerbaijan.

Conclusion. Design of medical geographical maps based on GIS technologies can streamline organization of preventive measures in ophthalmic practice.

Kazan medical journal. 2016;97(6):945-949
Medico-economic performance of treatment of patients with chronic obstructive pulmonary disease and bronchial asthma in case of emergency admission
Ishmurzin G.P.

Aim. To study medico-economic performance of outpatient and inpatient treatment of patients with chronic obstructive pulmonary disease (COPD) and bronchial asthma (BA) during emergency hospitalization and the influence of workshops on them.

Methods. 75 case histories of patients with COPD and asthma treated in the department of internal medicine №1 of Kazan city polyclinic №3 were analyzed. Conventional clinical, pharmakoepidemiological, medico-economic methods of research, evaluation of quality of life and level of patient’s knowledge about the disease and statistical methods were used.

Results. The study revealed that the number of ambulance calls in the groups undergoing training decreased significantly compared to the period before training. So, in the group taught at COPD workshop the number of ambulance calls decreased to 1.43 times, and in the group of BA workshop it decreased to 1.58 times. The change in the number of admissions and the number of ambulance calls causes leads to decreased health care costs for the treatment of patients with COPD and BA. The cost of outpatient treatment of 1 case of asthma (including personal patient’s expenses) is 2280.2 rubles. Average cost of 1 case of outpatient treatment of COPD is 3095.6 rubles. Training patients with asthma at asthma workshop resulted in saving health costs of 5593.512 rubles for each patient trained due to reducing the cost of inpatient treatment and emergency medical care. The effect of training of patients at COPD workshop resulted in saving health costs of 7180.78 rubles. The total amount of budget savings for the treatment of all cases of BA and COPD was 465 544.4 rubles.

Conclusion. Influence of patients’ training at workshop resulted in saving costs of health care system and decreased number of ambulance calls.

Kazan medical journal. 2016;97(6):950-958
Analysis of admissions with bronchial asthma and chronic obstructive pulmonary disease exacerbations
Pal’mova L.Y., Podol’skaya A.A., Shaykhutdinova Z.A., Zaplatova D.A., Druzhkova E.B.

Aim. To study the factors worsening the course of chronic obstructive pulmonary disease and bronchial asthma.

Methods. At the first stage, assessment of 1561 case histories of patients with internal diseases was performed, of whom 341 had lung diseases. A more detailed analysis with the assessment of the clinical characteristics of hospitalized patients was conducted at the second stage of our study, which included evaluation of 38 case histories of patients over a 6-month period in 2016.

Results. In the structure of mortality from lung disease chronic obstructive pulmonary disease is the dominant cause (53.8%) predominating deaths from pneumonia (46.2%). Mean age of patients who died from chronic obstructive pulmonary disease was 67.2±5.97 years. Exacerbation of chronic obstructive pulmonary disease was the cause of hospitalization in 24 (63.2%) cases, bronchial asthma in 11 (28.9%) cases, chronic obstructive pulmonary disease and asthma overlap syndrome was observed in 3 (7.9%) cases. Exacerbation of chronic bronchoobstructive pathology was mostly caused by respiratory tract infections (84.2% of cases), which required administration of pluripotent antibacterial therapy. In 60.5% cases deterioration of concomitant diseases was observed with cardiovascular diseases prevailing (arterial hypertension, chronic heart failure decompensation).

Conclusion. When organizing the strategy of urgent care for patients with chronic bronchoobstructive diseases, paying more attention to assessment of comorbidities is relevant; it is critical to raise awareness of practicing physicians of the criteria for the diagnosis of asthma and chronic obstructive pulmonary disease overlap syndrome.

Kazan medical journal. 2016;97(6):958-962
Clinical observations
Boerhaave syndrome in emergency abdominal surgery
Chikaev V.F., Bondarev Y.V., Mavzyutov A.L., Sorokina E.S.

Aim. To present a case of spontaneous rupture of esophagus taking into account its rarity, diversity of clinical manifestations, complexity of making a diagnosis and treatment of this disease.

Methods. Over the past three years in Kazan City Clinical Hospital №7 three cases of the esophageal damage were registered. The age of the patients ranged from 48 to 67 years, including 2 females and 1 male with spontaneous rupture of esophagus.

Results. A 48-year old patient was admitted to the hospital complaining of vomiting with blood followed by appearance of retrosternal pain which appeared immediately after the holiday and nutritional stress. Emergency fibrogastroduodenoscopy (FEGDS) was performed. Endoscopy revealed signs suggestive of diaphragmatic hernia, and 2 ruptures of esophageal mucous membrane up to 3 cm on the left wall of esophagus above the cardiac sphincter. The diagnosis of Mallory-Weiss syndrome complicated with bleeding was made. Surgery: laparotomy, abdominal revision. The abdominal cavity had dark hemorrhagic discharge, inflamed peritoneum and signs of diffuse peritonitis. Diaphragmatic crurotomy was performed. Revision of abdominal esophagus revealed two longitudinal ruptures of the left esophageal wall 1.5 and 3 cm long 8 cm up from the cardiac sphincter. The ruptures were sutured by discontinuous atraumatic encircling stitch. Lower mediastinum was drained with two double-lumen tubes, the gastric probe was installed through the nose. During the follow up CT scan and ultrasound of thoracic cavity were performed. Liquid nutrition through the probe lasted up to 20 days. The mediastinum was lavaged through double-lumen tube with an aqueous solution of chlorhexidine and chymotrypsin up to 32 days. The patient was discharged on day 34 in a satisfactory condition.

Conclusion. One of the etiologic factors of spontaneous esophageal rupture may be diaphragmatic hernia of the esophagus with increased intraesophageal pressure; early surgical intervention, suturing of esophageal rupture, mediastinal drainage and lavage in the postoperative period are fundamental steps in the treatment of esophageal rupture.

Kazan medical journal. 2016;97(6):963-966
Evacuation of embryo in the presence of intrauterine adhesions
Gabidullina R.I., Savel’ev S.E., Gabitov N.A., Mikhaylova O.N., Sirmatova L.I., Nazmutdinova N.R.
Asherman syndrome is a controversial topic in gynecology without a clear consensus for treatment. This pathology is characterized by adhesions in the uterine cavity. The main cause of this disorder is injuries to the gravid uterus especially in abortion, during postnatal period or after missed miscarriage. Menstrual disorders and infertility are characteristic clinical features of Asherman syndrome. Pregnancy may be complicated with premature labor, placenta previa and placenta accreta. Introduction of hysteroscopy has changed diagnosis and management of intrauterine synechiae and it is therefore considered the most valuable tool nowadays. Preferred treatment method is hysteroscopic lysis of adhesions combined with estrogens. A clinical case of asymptomatic Asherman syndrome in a 29 year old female is presented in the article. Bipolar hysteroscopic resection of synechiae in combination with curettage was proved to be an effective and safe method of treatment.
Kazan medical journal. 2016;97(6):967-970
Acute debut of neuroacanthocytosis in clinical practice
Zagidullina K.L., Popova N.A.
Neuroacanthocytosis is a rare autosomal dominant disease, which in its clinical manifestation is characterized by choreiform hyperkinesis, mental and cognitive disorders, signs of polyneuropathy and cardiomyopathy, and the basis of the disease is presence of modified erythrocytes (acanthocytes) in peripheral blood. The disease is characterized by autosomal dominant type of inheritance (the gene was mapped on chromosome 9q21), sporadic cases are possible. Description of a clinical case of a 63-year old patient with neuroacanthocytosis delivered by an ambulance with a preliminary diagnosis of stroke is provided. The patient complained of severe general fatigue, whole body shivering, and involuntary compulsive uncontrollable movements in the limbs, body, and face. The patient noted changes in her voice, probably due to compulsive movements of her tongue, lightheadedness, and shaky walk. Almost all physical and laboratory findings were within normal. Taking into account acuteness of the disease, its attack at the time of hypertensive emergency and patient’s age, circular cause was suggested, computed tomography of the brain and magnetic resonance imaging were performed. The results of neuroimaging ruled out the pathology of cerebral circulation. Ultrasound of neck vessels revealed nothing abnormal. Purposeful repeated blood analysis revealed that 85% of erythrocytes were acanthocytes and after that the correct diagnosis was made. The peculiarities of this clinical case are acute manifestation of symptoms and relatively late debut of the disease.
Kazan medical journal. 2016;97(6):971-973
Difficulties of diagnostics in emergency in a patient with acute bacterial sialadenitis
Faizov T.T., Mubarakova L.N., Ivanov O.A., Voronina E.M., Khamitova A.R.
Acute bacterial sialadenitis is observed in common pathologies accompanied by food intake disruption leading to cachexy. Generally, detection of acute bacterial sialadenitis is not a challenge. But diagnosis of acute serous bacterial sialadenitis causes difficulties with differentiating it from exacerbation of chronic parenchymal and intersticial sialadenitis, especially at the early stages of these diseases, as well as from acute viral sialadenites, for example acute influenzal sialadenitis. We present a clinical case of a patient with acute serous sialadenitis who had the extended evaluation only after unsuccessful course of conventional conservative treatment to find out the main cause of the disease that led to delayed diagnosis and prolonged hospital stay.
Kazan medical journal. 2016;97(6):973-975
Difficulties of diagnosing acute intermittent porphyria in clinical practice
Zagidullina K.L., Popova N.A., Astashina E.E.
Acute intermittent porphyria is an inherited metabolic disease with autosomal dominant inheritance pattern. The pathogenesis of the disease includes disturbed function of vegetative regulation. Attacks of acute intermittent porphyria are rare, sometimes are fatal, but in practice they often remain undiagnosed. Significant difficulties are attributed to unspecific clinical manifistations of acute intermittent porphyria. The patients initially visit surgeons with a clinical presentation of acute abdomen. As a result porphyrinogenic diagnostic and remedial procedures are administered including anesthetics and laparoscopy with anesthesia, which worsen the attack and prognosis. Porphyria being an orphan disease and polymorphism of clinical presentation, absence of medications for its treatment in health care facilities in Russian Federation cause challenges for physicians. The article deals with clinical observation of two patients with a diagnosis of acute intermittent porphyria first made in the neurology department. A 53-year old female was brought in to the neurology department by an ambulance in obtundation after a series of generalized tonoclonic spasms with hyperthermia. A 21-year old female was admitted to the surgical department due to intensive epigastric pain, nausea, repeated episodes of vomiting, an episode of diarrhea and significant general fatigue causing impossibility to move. Presented clinical cases reflect a general situation when for a long period of time the patients were wrongfully admitted to different departments, and cover a problem of late and untimely diagnosis of the disease.
Kazan medical journal. 2016;97(6):975-978
A rare form of metabolic myopathy in a neurologist’s practice
Zagidullina K.L., Popova N.A., Filippova Y.V.
Secondary metabolic myopathies develop in endocrine pathologies, different somatic diseases, electrolyte disorders and in some vitamin deficiency. Myopathic syndrome caused by vitamin D deficit is a rear pathologic condition, for this reason it is difficult to diagnose it. Proper diagnosis has a vital importance for proper treatment choice. The article describes a rear form of the metabolic myopathy in a young female admitted to the neurology department because of significant leg weakness. A thorough examination revealed no pathology of internal organs. On physical examination moderate lower flaccid paresis with reduced tendon reflexes was revealed. Muscle tone was normal. The absence of systemic inflammatory changes in blood tests as well as normal biopsy results ruled out dermatomyositis and polymyositis. Blood tests revealed deficiency of 25-OH-vitamin D. On vitamin D monotherapy leg weakness completely resolved. In case of myopathic syndrome it is necessary to have in mind such rear causes for its development as vitamin D deficiency.
Kazan medical journal. 2016;97(6):978-981
Clinical experiences
Radioechocardiography in the evaluation of pulmonary hypertension
Akberov R.F., Zogot S.R., Tsibul’kin N.A.

Aim. To study the capabilities of radioechocardigraphy in the evaluation of pulmonary hypertension of various causes, early non-invasive detection of pressure increase in the pulmonary artery.

Methods. The study included 800 patients with congenital (269) and acquired (217) mitral valve diseases, pulmonary embolism (140), primary pulmonary hypertension (57), coronary heart disease with acute myocardial infarction (117) of different age and gender. Digital radiography, linear tomography of chest, ECG, echocardiography, multidetector computed tomography angiography, and ultrasound of inferior vena cava were performed.

Results. Radiocardiography combined with linear tomography and measurement of Moore index, right atrium index, transpulmonary distance, and width of right descending pulmonary artery at the level of intermediate bronchus, allows determining the degree, type (arterial, venous, capillary, and mixed) and cause of pulmonary hypertension. Digital radiography and linear tomography in 80% cases reveal signs of pulmonary embolism. Echocardiography makes it possible to study hemodynamics in pulmonary hypertension, to detect the dilation of the right heart, inferior vena cava, and renal veins, and to calculate the systolic pressure in the right ventricle, pulmonary artery, and right atrium. Radioechocardigraphy allows determining the cause and degree of pulmonary hypertension, and hemodynamic disorders. Sensitivity of the method for diagnosis of pulmonary hypertension is 89%, specificity is 90%, and precision is 92%.

Conclusion. Radioechocardigraphy is a highly effective method for diagnosis of pulmonary hypertension; ultrasound of inferior vena cava, iliac veins, and veins of the lower limbs allows to determine the source of pulmonary embolism, to diagnose embologenicity of thromboses and to evaluate the need for vena cava filters.

Kazan medical journal. 2016;97(6):982-988
Spondylodiscitis: early diagnosis and management of patients
Khafizova I.F., Popova N.A., Panyukhov A.G., Gumerov F.R.
Spondylodiscitis is an inflammatory disease of vertebral structures involving intervertebral discs and adjacent vertebral bodies and joints. The main complaint is back pain that is known to be the most prevalent complaint in the general population. Diagnosis of spondylodiscitis is difficult and is often characterized by delay from the debut of symptoms. It is due to the rarity of the disease and non-specificity of its symptoms. The aim was to determine the basic principles of early diagnosis of pyogenic spondylodiscitis. In the present study performed in Kazan City clinical hospital №7, a retrospective analysis of 7 cases of spondylodiscitis during the period from may 2014 to September 2016 was performed. The diagnosis was maid with the use of neuroimaging. In most cases, the lumbar spine was affected. The most common presentation was pain syndrome, moderate to severe. Delay in making a diagnosis from the beginning of the disease was 86.2 days. After antibiotic therapy all patients noted improvement. The study demonstrated that early diagnosis of spondylodiscitis remains a challenge and at the same time requires timely adequate treatment with antibacterial agents. Magnetic resonance imaging is a method of choice for making a diagnosis.
Kazan medical journal. 2016;97(6):988-993
Assistance to the practicing physician
Severe pneumonia in clinical practice
Khamitov R.F., Pal’mova L.Y., Sulbaeva K.R.
Severe pneumonia is the actual problem of present respiratory medicine due to the pronounced impact on mortality and economic expenses of health care. For this reason the aim was to study the regional predictors of fatal severe pneumonia with subsequent development of guidelines for optimizing various aspects of diagnosis and treatment of these group of patients. Retrospective analysis of 62 case histories of admitted patients, who died from severe pneumonia during the calendar year, was performed. The results showed that lethal outcomes of severe pneumonia mostly occur in intensive care units. Analysis of performed laboratory and instrumental diagnostic procedures was conducted to reveal the most significant prognosis markers. The main mistakes in administering medications, firstly antimicrobial, were analyzed. Antibiotic therapy was proclaimed completely optimal only in 18% of cases. The analysis allows to make conclusions about the need for rational minimization of diagnostic complex for hospitalized patients with severe pneumonia with mandatory measurement of oxygen saturation, sputum study and chest X-ray in two projections directly on the first day. Along with timely correction of treatment these methods will allow optimizing the total cost of treatment. Ceftriaxone is a leading administered drug in severe pneumonia with lethal outcomes. Appearingly, first of all, it is determined by the absolute predominance of cheap generic drug forms in pharmaceutical market which do not provide adequate clinical efficiency. Underrated high potential of semisynthetic aminopenicillins in severe pneumonia treatment was identified.
Kazan medical journal. 2016;97(6):994-999
Сardiovascular autonomic neuropathy as a diabetes complication
Latfullin I.A., Kim Z.F., Mingazetdinov M.A.
The article deals with one of the possible complications of diabetes mellitus - cardiovascular autonomic neuropathy as a variant of diabetic neuropathy. The basic pathogenic mechanisms of development of this condition and clinical manifestations depending on the patient’s age, duration and degree of diabetes compensation, are described. Diagnostic criteria for heart involvement in diabetes mellitus are discussed in detail, from asymptomatic course to sudden patient’s death, from instrumental findings to acute biventricular failure development. The main findings from patient’s work-up (ECG, echocardiography) are named. The principles of prevention and treatment of heart disease in diabetes mellitus are provided. Theory is accompanied by our own clinical observation and is illustrated with ECG. In the clinical case tactics of treatment and prevention of diabetic cardiopathy are suggested.
Kazan medical journal. 2016;97(6):1000-1002
New methods of diagnosis and treatment
Instrumental correction during surgical treatment of patients with large soft tissue lipomas
Izmaylov A.G., Dobrokvashin S.V., Volkov D.E., Pyrkov V.A., Zakirov R.F., Davlet-Kil’deev S.A., Akhmetzyanov R.A.

Aim. To improve the results of surgical treatment of patients with large soft tissue lipomas by developing and implementing of adaptation-distraction device for rapprochement of wound edges.

Methods. During the period from 2012 to June, 2016, 61 patients with various localization of large soft tissue lipomas were hospitalized to the department of surgery of Kazan Hospital for war veterans. The patients were divided into 2 groups: control group included 35 (57.4%) patients who had the traditional mass excision with wound sealing, and the study group included 26 (42.6%) patients, on whom instrumental method was applied with the use of adaptation-distraction device for rapprochement of wound edges in order to reduce tissue trauma during removal of the lump and suturing tissues.

Results. Clinical use of adaptation-distraction device for removing various tumors of the skin and subcutaneous tissue has demonstrated its advantage over traditional methods. Optimal conditions for radical removal of the tumor with maximum compliance with the rules of ablastics and antiblastics with minimal blood loss (20-45 ml) are created. In control group postoperative wound complications included 2 (5.7%) hematomas and 1 (2.8%) seroma. In the study group 1 (3.8%) patient had hematoma.

Conclusion. Use of adaptation-distraction device provides preliminary circular local tissue compression directly near the tumor and in its base, which leads to local preventive hemostasis in surgical wound area without shutting down the blood flow in surrounding tissues; the device allows to make the imposition of primary seams not interrupting the surgery and to avoid eruption.

Kazan medical journal. 2016;97(6):1003-1006

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