Vol 98, No 3 (2017)

Theoretical and clinical medicine
Ultrasound assessment of the outcomes of veno-venous bypass operations in postthrombotic disease
Ignat’ev I.M., Fomina E.E., Akhunova S.Y., Zanochkin A.V.

Aim. Assessment of the function of veno-venous bypass operations in postthrombotic disease with the use of ultrasound duplex scanning.

Methods. The results of veno-venous bypass procedures are presented including crossover autovenous bypass for unilateral postthrombotic iliac vein obstructions (during short-term postoperative period in 56 patients, during long-term period - in 68) and saphenopopliteal bypass for femoral vein obstruction (in 12 patients).

Results. Functional tests making ultrasound duplex scanning more informative in assessment of the function of bypass operations were developed. It was determined that most of crossover grafts (70.6%) have a propensity to equal «physiological» dilation leading to the requisite venous drainage from an affected extremity. Some grafts (23.6%) undergo pathological transformations like local and diffused deformed dilation, сicatricial stenosis that diminish venous drainage and require reintervention on the graft. Venous hemodynamic studies of the affected extremity with the graft being open and cross-clamped showed that in 73% of the patients the major role in the maintenance of venous return is played by crossover bypass. Long-term outcomes in 56 patients after 15 years proved patency of crossover grafts in 43 patients (79.6%). In 11 out of 12 patients (91.7%) examined during long-term postoperative period saphenopopliteal grafts were patent. It was demonstrated that they are capable of prolonged functioning without pathological dilation. Long-term outcomes of the procedure proved reliable function of the grafts and improvement of regional venous hemodynamics.

Conclusion. Ultrasound duplex scanning is the optimal method of the assessment of short-term and long-term outcomes of reconstructive bypass operations due to their noninvasiveness, safety, and high resolving power and the possibility of repetitive qualitative and quantitative studies of venous system including those in community setting.

Kazan medical journal. 2017;98(3):317-323
Neurotransmitter exchange in patients with skin melanoma
Afanas’eva Z.A., Mukhamatgaleeva L.K., Bilalov F.S., Gataullin I.G., Potanin V.P., Ismagilov A.K.

Aim. To study peculiarities of neurotransmitter exchange in patients with skin melanoma.

Methods. Neurotransmitters (adrenaline, noradrenaline, dopamine) and their ratio in blood plasma were determined in 111 patients with skin melanoma and 38 healthy donors. The patients were divided into 3 groups: primary patients, patients with relapse of the disease and without relapse. To exclude the influence of undesirable factors (stress and physical exertion) on the level of neurotransmitters, the patients’ blood was drawn 1 day after admission in the morning on an empty stomach. Adrenaline, noradrenaline and dopamine concentration in the blood plasma was determined with the use of high-yield liquid chromatography with electrochemical detection.

Results. Analyzing noradrenaline/adrenaline ratio in the studied patients’ groups we noted significant unidirectionality of the changes in the form of increased noradrenaline and decreased adrenergic link of sympathoadrenal system i.e. in patients with skin melanoma mediator link dominates over hormonal link. Evaluation of noradrenaline/dopamine and dopamine ratio demonstrated that in normal or even increased level of dopamine adrenaline and noradrenaline levels are below normal that can indicate dysfunction of enzyme systems involved in neurotransmitter exchange and/or their accumulation in tumors. Maximal disorders of neurotransmitter exchange were registered in the group of patients with the disease relapse.

Conclusion. Patients with skin melanoma have imbalance of sympathoadrenal system that creates the perspective for the use of neuropharmacological drugs and psychotherapy in the treatment and rehabilitation of such patients.

Kazan medical journal. 2017;98(3):323-328
State of regional lymph nodes and prognosis in stomach cancer
Bazhanov A.B., Tsyplakov D.E.

Aim. Multiparameter analysis of the state of regional lymph nodes of stomach cancer to reveal prognostic criteria of patients’ 5-year survival.

Methods. The regional lymph nodes removed during surgery for stomach cancer in 170 oncologic patients were studied by means of histologic, immunohistochemical, electron microscopy and morphometric methods. The 5-year survival was calculated by the direct method.

Results. It was revealed that 5-year survival directly depends on the amount of involved lymph nodes. Detection of even single tumor cells in one regional lymph node worsens the prognosis for a patient’s life. The more metastases there are in lymph tissue, the worse the prognosis is. Immunomorphologic reactions and ultrastructural changes are of substantial significance. High 5-year survival was characteristic for hyperplasia of paracortical area with increased number of CD3(+) T-cells, the ultrastructure of which corresponds to activated (immune) lymphocytes, and for sinus histiocytosis as well with increased number of CD68(+) free macrophages in regional lymph nodes with pronounced phagocytic activity. Prognosis is worse in lymphoid follicular hyperplasia with high content of CD20(+) B-cells and plasmocytes. The lowest 5-year survival was accompanied by degenerative sinus histiocytosis, atrophy or sclerolipomatosis transformation of lymphoid tissue with hypoplasia of paracortical area and lymphoid follicles. Under an electron microscope active fibroblasts are seen synthesizing collagen and large number of degenerating cell forms, particularly, lymphocytes.

Conclusion. The 5-year survival of oncologic patients with stomach cancer is determined by the amount of metastatic regional lymph nodes, presence or absence of metastases, their volume in lymphoid tissue, histologic pattern and ultrastructural cell changes; comparative analysis of these criteria allows developing prognostic algorithm.

Kazan medical journal. 2017;98(3):328-333
Use of bioresonance therapy in complex treatment of patients with diabetes mellitus type 2
Kir’yanova V.V., Vorokhobina N.V., Makhramov Z.K.

Aim. To evaluate the effectiveness of bioresonance therapy use in complex treatment of patients with diabetes mellitus type 2.

Methods. The treatment scheme including bioresonance therapy is offered for patients with diabetes mellitus type 2. All 413 patients were assigned to 3 comparable groups: the study group included 198 patients, control group - 72 patients, placebo group - 143 patients. Duration of diabetes in the study group was 5.47±0.37 years, in control group - 4.03±0.46 years, in placebo group - 4.97±0.39 years. All patients were treated according to the traditional scheme of treatment of type 2 diabetes. The study group in addition to pharmacotherapy received bioresonance therapy. Control group received only drug treatment and placebo group received drug therapy and bioresonance simulation procedures. All patients were checked for glycated hemoglobin, fasting plasma glucose, blood glucose 2 hours after a meal, urine glucose, and body mass index on admission and 3 months after treatment.

Results. Results of glycated hemoglobin, fasting plasma glucose, blood glucose 2 hours after a meal, urine glucose, and body mass index revealed that initially studied parameters in all three groups were high. After the bioresonance therapy in complex treatment of patients with diabetes type 2 in the study group all studied parameters were statistically significantly lower compared to control and placebo groups.

Conclusion. The obtained results indicate the effectiveness of bioresonance therapy use in complex treatment of patients with diabetes mellitus type 2.

Kazan medical journal. 2017;98(3):334-337
The oral cavity state in professional athletes on the background of intense physical exercises
Safaraliev F.R., Mamedov F.Y.

Aim. To estimate the parameters of dental and immune status of professional athletes’ oral cavity on the background of intense physical exercises.

Methods. Clinical and laboratory studies of oral cavity of 122 athletes were conducted. The inclusion criteria for the study group were the athletes involved in freestyle and Greco-Roman wrestling with identical living conditions, nutrition, training, aged 19 to 27 years. Athletic experience of professional sports was 8 to 13 years. The presence of chronic catarrhal gingivitis and chronic generalized periodontitis of mild and moderate severity were identified. Biochemical studies were conducted in 92 male athletes (wrestlers of the free and classical style) aged 19 to 27 years. Samples of saliva were collected in the morning on an empty stomach 15-30 min prior to training and within 1 h after the intensive training sessions.

Results. Before the start of the training of wrestlers with intact periodontium no signs of bleeding gums were detected, but at the end of the training process due to rising intensity of physical exercise, deterioration of the hygienic condition of the oral cavity and increasing blood flow, bleeding developed. After completion of the cycle of intense physical training with heavy loads aimed at the development of strength endurance in the prelaunch period, the immune status of the examined athletes changes a little. In accordance with the received data of laboratory investigations highly qualified athletes have decreased secretory immunoglobulin A on the background of significantly increased proinflammatory cytokine in the same biotope of the oral cavity.

Conclusion. Long-term and excessive exercise often lead to changes of local immunity in the oral cavity and development of pathological processes in periodontal tissues that indicates the feasibility of their timely diagnosis and correction.

Kazan medical journal. 2017;98(3):338-343
Gender aspects of osteoporosis and their relationship to calcium balance
Fomina L.A., Zyabreva I.A.
Aim. To evaluate the state of bone tissue in comparison with calcium balance, to clarify the risk for fracture development in women of different age groups. METHODS. 92 females aged 19 to 89 years were examined clinically with densitometry of lumbar spine and femoral neck and measuring the concentration of total calcium in the blood. RESULTS. In females younger than 50 years decreased bone density according to Z-score was revealed in 30% of cases, among patients with its normal values significant trend to bone rarefaction (-2.0 SD <Z-score ≤-1.5 SD) was registered with the same rate. In the group of females older than 50 years osteopenia was revealed in 46.3% of cases and osteoporosis - in 42.7%, while more significant decrease in bone mineral density was found in the lumbar spine. Past medical history of fractures increased the rate of osteoporosis by 18%. In females older than 50 years compared to younger patients a significant increase of blood calcium concentration was revealed. Besides, statistically significant increase of its level was noted in cases of fractures in the past and osteoporosis. The revealed changes of bone tissue in females below 50 years of age are indicative of increased risk of osteoporosis development in the future. CONCLUSION. High prevalence of osteoporosis and osteopenia is revealed in the examined patients older than 50 years, and bone mineral density parameters were significantly inversely correlated with calcemia; hence, blood calcium level can be one of the criteria of bone tissue state and in combination with other risk factors for osteoporosis should be taken into account during periodic health examination of females older than 50 years.
Kazan medical journal. 2017;98(3):343-348
Posttraumatic heterotopic ossification of the elbow
Karalin A.N., Ovechkin L.A., Lavrent’ev A.V., Lushin A.V., Ivanov A.P., Natural’nyy I.A., Kazenov S.A.

Aim. To evaluate the features of formation of posttraumatic heterotopic ossification of the elbow; to develop their classification allowing to differentially resolve the issues of tactics and treatment and outcome predicting.

Methods. 292 patients were observed with elbow fractures and fracture-dislocations (group B and C according to AO/ASIF classification). 40 (14%) of them were diagnosed with posttraumatic heterotopic ossification.

Results. This complication more frequently occurred in fracture-dislocations (23 patients, 57.5%) than in T-U-shaped fractures (13 patients, 32.5%). Thus, the factor of soft tissue trauma plays one of the key roles in the occurrence of this complication. Timelines of ossification occurrence also have some patterns causing a direct relationship with the severity of the damage. Indeed, in fracture-dislocations ossification within 5 weeks after the trauma was identified in 70% of cases, while in T-U-shaped fractures and other damage - only in 40%. Herewith, some correlation is identified for patient’s age and gender: ossification occurs in the early stages more often in men under the age of 30 years. We developed a classification of posttraumatic heterotopic ossification of the elbow allowing to effectively determine the tactics, treatment and prognosis of the outcomes of ossification. In case of mild and moderate severity of ossification management is conservative and functional and occupational prognoses are favorable. In case of severe ossification surgical treatment is recommended. Primary and secondary arthritic changes should be considered. Both functional and professional prognoses are unfavorable. Results of the treatment are: good - 70%, satisfactory - 25% and unsatisfactory - 5%.

Conclusion. Dependence of occurence of posttraumatic heterotopic ossification from a number of factors was determined (magnitude of anatomical damage of the soft tissues surrounding the joint, gender and age, treatment tactics, rehabilitation methods), suggested classification allows to differentially resolve the issues of treatment and outcome prediction.

Kazan medical journal. 2017;98(3):348-354
Characteristics of bone metabolism parameters in urban citizens
Kabalyk M.A.

Aim. To reveal the features of age-dependent changes of bone tissue in urban citizens.

Methods. The study of bone metabolism parameters was performed on 629 healthy subjects of middle, elderly and senile age living in Vladivostok for longer than 10 years (55 males and 573 females). Concentration of C-terminal telopeptide of type II collagen, osteocalcin, calcitonin, parathyroid hormone, 1,25(OH)2-vitamin D, and bone isoenzyme of alkaline phosphotase were measured by ELISA. Concentration of C-terminal telopeptide of type I collagen was measured in urine.

Results. Biochemical markers of bone metabolism in older age groups are different from the parameters of middle age. In the second period of middle age statistically significant decrease of C-terminal telopeptides level (z=2.88, p <0.05) and increase of parathyroid hormone level (z=-3.04, p <0.01) were revealed. With age, people of elderly and senile age have increasing bone isoenzyme of alkaline phosphatase level (z=-3.28, p <0.01; z=-2.58, p <0.05) reflecting prevalence of mineralizing properties of bone matrix. In people of elderly and senile age misbalance of hormonal regulation of bone-tissue metabolism was revealed presenting as a decrease of somatotropic hormone level (z=2.87, p <0.05; z=2.12, p <0.05) and escalation of parathyroid hormone (z=-4.49, p <0.001; z=-3.10, p <0.01).

Conclusion. Bone metabolism changes occur already in the second period of middle age; bone matrix mineralization is changed due to reduced level of matrix proteins functioning as domains of mineralization; as they age, misbalance develops in hormonal factors regulating bone metabolism eventually leading to the reduction of bone regeneration intensity.

Kazan medical journal. 2017;98(3):354-358
Frequency of genetic polymorphism of calcium channels gene CACNA1C in healthy individuals and patients with arterial hypertension
Pushkarev B.S., Bol’shakova O.V., Sibiryakova T.V., Emel’yanov A.S., Gerasimov A.A., Vitkovskiy Y.A.

Aim. To determine the frequency of polymorphism of calcium channels gene CACNA1C (rs1006737) in healthy individuals and patients with hypertension.

Methods. 94 patients with arterial hypertension and 102 healthy residents were examined. The age ranged from 18 to 35 years. Detection of SNP calcium channel genes CACNA1C (rs1006737) was performed by real time PCR. Checking of sampling genotypes’ for being in Hardy-Weinberg equilibrium and χ2-test were performed, and hazards ratio (OR) was evaluated as well.

Results. It was established that allele G of CACNA1C gene (rs1006737) was 1,3 times less frequent in patients with hypertension compared to control group, and its frequency was 0.58 vs. 0.76, respectively (χ2=14.42, р=0.0001). In patients with hypertension allele A was detected 1.75 times more often with the frequency 0.42, and in healthy individuals the frequency was 0.24 (χ2=14.42, р=0.0001). Use of general inheritance model demonstrated that G/G genotype was 1.5 times less frequent and A/A genotype was 3.2 times more frequent in patients with hypertension than in healthy individuals (χ2=12.75, р=0.002). The risk of hypertension development was higher in carriers of allele A (HR=2.3, 95% CI 1.49-3.53, p=0.0001) and genotype A/A (HR=3.9, 95% CI 1.49-9.68, p=0.002) of SNP gene of CACNA1C molecule (rs1006737).

Conclusion. Allele A and genotype A/A SNP CACNA1C (rs1006737) are predisposing factors to the development of arterial hypertension, carriership of G allele and genotype G/G CACNA1C (rs1006737) reduces the risk of hypertension development.

Kazan medical journal. 2017;98(3):359-362
Clinical and immunogenetic features of neonates with perinatal infections
Ragimova N.D., Guliev N.D.

Aim. Investigation of cytokine status and the association between promoter regions polymorphism of interleukin-6, -10 and -18 genes in neonates with perinatal infections.

Methods. Complex examination of 743 neonates with perinatal infections was conducted. The level of interleukin-1β, -6, -10, -18, and TNFα was measured with the use of standard method of enzyme-linked immunosorbent assay («sandwich» variant). Polymorphic variants of genes were analyzed with the methods of polymerase chain reaction and restriction fragment length polymorphism.

Results. The results of the received data are indicative of the general tendency to increasing level of cytokines both in full-term and preterm infants with perinatal infections. Our study revealed the role of allelic variants at positions -174 G/C, -572 G/C, -597 G/A of interleukin 6, at positions -1082 G/C, -819 T/C of interleukin-10 and at positions -656 T/G, -137 G/C of interleukin-18 genes in the risk of development and progression of infections. It was determined that the presence of G allele at -174 and -572 positions of interleukin-6 gene, C allele at -819 and -137 positions of interleukin-10 and -18 genes, respectively, and G allele at -656 position of interleukin-18 gene was associated with the risk of perinatal infections in newborns. Conclusions. In neonates with perinatal infections imbalance of cytokine profile was revealed, that can be confirmed by increased level of pro-inflammatory cytokines (interleukin-1β, -6, -18, and TNFα) and decreased level of anti-inflammatory cytokine (interleukin-10) compared to uninfected neonates. Allelic variants of cytokine genes of interleukin-6 at position -572 G/C, interleukin-10 at position -819 T/G and interleukin-18 at position -652 T/G and 137 G/C are significantly associated with infectious diseases. Increased risk of prenatal infections is associated with genotypes GG of interleukin-6, TT of interleukin-10 and TT and GG of interleukin-18. Detection of haplotypes and haplogenotypes in the population of healthy and infected neonates revealed favorable haplotypes: GCC and GGG of interleukin-6, ATA of interleukin-10 and AGG and CGC of interleukin-18.

Kazan medical journal. 2017;98(3):362-369
Assessment of the state of lipid peroxidation and antioxidant system in children with nephrotic form of glomerulonephritis
Beglyarov R.O.

Aim. Study of the activity of lipid peroxidation and state of antioxidant system in children with a nephrotic form of chronic glomerulonephritis.

Methods. 104 children with a nephrotic form of glomerulonephritis were examined. The average age of children was 10.18±4.03 years. 46.2% of children were in remission, 32.7% of children had 1st degree of activity, 14.4% had 2nd degree, and 6.7% had 3d degree of nephrotic syndrome. Control group included 30 children without chronic glomerulonephritis. The levels of diene conjugates, malonic dialdehyde, catalase, reduced glutathione, glutathione peroxidase, and glutathione reductase in blood plasma and erythrocytes were determined.

Results. In children with chronic glomerulonephritis the concentration of diene conjugates and malonic dialdehyde was elevated in blood plasma and erythrocytes. In erythrocytes their concentration was statistically significantly higher at all degrees of activity of nephrotic syndrome than in control group. The level of catalase in patients’ blood plasma in comparison with the control value was reduced by 16.6%, in erythrocyte mass - by 25.9% (p <0.05). The amount of reduced glutathione in blood plasma was reduced by 9.4%, in erythrocytes - by 40.0% (p <0.05). The level of glutathione peroxidase in children with chronic glomerulonephritis was reduced in blood plasma by 16.5%, in erythrocytes - by 44.5% (p <0.05). In blood plasma of children with chronic glomerulonephritis the concentration of glutathione reductase was reduced by 33.3%, in erythrocytes - by 49.1% (p <0.05).

Conclusion. Children with nephrotic form of chronic glomerulonephritis at all degrees of activity are characterized by high lipid peroxidation activity and reduced antioxidant system activity.

Kazan medical journal. 2017;98(3):370-375
Dynamics of indicators of disability causеd by eye diseases in assessment of efficiency of periodic health examination of the population of Azerbaijan
Agaeva R.B.

Aim. Analysis of thе dynamics of рrimary and rереatеd disability causеd by еyе disеasеs among all cohorts of age groups of the рoрulation of Azеrbaijan undеr dispensary observation. Mеthods. Analysis of thе dynamics of рrimary and rереatеd disability causеd by еyе disеasеs all over the republic was conducted over a 10-year period (2001-2010) on the basis of statistical databasе of Mеdical Labor Еxреrt Committее of Azеrbaijan. A stratified gender and age analysis was conducted according to disability groups. Indicators of obviousness were calculated and forecasting with the use of approximation method for time series. Rеsults. During all observation years men composed the major proportion: 58.8±1.4% among newly registered and 57.3±1.2% among repeatedly registered disabled. The main cohort among newly registered disabilities caused by eye diseases during all observation years was presented by patients of working age (19 to 59 years). During the study period disability causеd by еyе disеasеs among working-agе grouр increased with a tеndеncy to incrеasing рroрortion of womеn among nеwly rеgistеrеd disablеd with eye рathologiеs. Against thе background of рositivе dynamics of increase of all rерortеd casеs of rереatеd disability causеd by eye рathologiеs, a statistically significant incrеasе in thе рroрortion of patients with group I disabilitiеs was rеvеalеd.

Conclusion. Against thе background of рositivе dynamics of increase of all rерortеd casеs of rереatеd disability causеd by ophthalmopathies, a statistically significant incrеasе in thе рroрortion of patients with group I disabilitiеs was rеvеalеd; dynamics of the proportion of patients under dispensary observation included in disability group demonstrated minor tendency to reduction all over the republic.

Kazan medical journal. 2017;98(3):376-381
New technologies in ophthalmology
The department of ophthalmology of Kazan state medical university is 150 years old
Shagaleeva Z.Z., Samoylov A.N., Belyakova K.V., Puzyreva K.Y.

The article presents in detail the emergence and development of the Department of ophthalmology of Kazan state medical University. The Department of ophthalmology was organized in 1867 on the basis of the medical faculty of the Imperial Kazan University, the first head was Mikhail Vasilyevich Nikolsky. Since the creation, the Department is headed by outstanding scientists-ophthalmologists, who had made theoretical and practical contributions in domestic and global ophthalmology. To date the main focus areas of the Department of ophthalmology are development and introduction of new treatment methods for the diseases of ocular media, primary and secondary glaucoma, vitreoretinal pathology. For clinical interns and residents simulation training operating rooms are organized to train and improve practical skills. At the Department of ophthalmology of Kazan state medical university meetings of students’ scientific society are systematically conducted and students of the medical College and clinical interns and residents including those from near and far abroad countries are trained.

Kazan medical journal. 2017;98(3):382-389
Surgical treatment of «dry» forms of central chorioretinal dystrophy with the use of platelet-rich blood autoplasma
Arsjutov D.G.

Aim. To study the impact of platelet-rich blood autoplasma on the capability of the retinal regeneration in nonexudative forms of central chorioretinal dystrophy with the use of microinvasive vitreoretinal surgery.

Methods. Surgical treatment was performed on 14 patients with central chorioretinal dystrophy aged 29 to 87 years. The surgery technique consisted of 3-port 25+, 27 Ga vitrectomy with posterior hyaline membrane and internal limiting membrane peel with subsequent central retinal exfoliation with 38 Ga cannula and balanced sodium solution and subretinal injection to the formed in macule space 0.1-0.2 ml of platelet-rich autolplasma.

Results. As a result of the treatment according to this technique during the long-term period after the surgery (1 to 9 months) thickness of fovea reduced to 85-150 µm in average staying stable during the whole observation period. In 9 patients pigment epithelium thickened from 24 to 38 µm in parafoveolar area and fovea area. Corrected vision in 3 patients reached 0.1, and in the rest it did not exceed 0.06, herewith, all patients noted consistently improved vision. All patients had favorable evolution of photosensitivity according to microperimetry in average from 0.1-0.5 to 8.5-11 dB with a tendency of fixation point movement from periphery to the center.

Conclusion. Vitreoretinal surgery 25+, 27 Ga for nonexudative forms of central chorioretinal dystrophy with the use of subretinal injection of platelet-rich autoplasma is a microinvasive, safe, effective method of the treatment of such pathology improving vision characteristics and anatomical and physiological characteristics of the eye involved.

Kazan medical journal. 2017;98(3):390-393
Ocular dirofilariasis: case reports
Zumbulidze N.G., Khokkanen V.M., Kasymov F.O., Marchenko O.A., Yarovoy D.A., Chudinova O.V.

The article deals with the problem of ditofilariasis - the only facultative for the human in Russian Federation zoonotic parasitic helminth. Over the last years, there is a pronounced tendency to increased number of animals and humans dirofilariasis cases in the temperate climate area. The spread of the disease (which until quite recently was considered as endemic for tropical climate countries and southern regions of our country) is related to a wide causative agent circulation in the environment and to the spread of the great number of stray dogs and lack of adequate measures aimed on detection and treatment of infected animals. Moreover, there is a year-round risk of infection caused by «basement» Culex mosquitoes and in an urban setting. Herewith, the problem of dirofilariasis caused by Dirofilaria repens and Dirofilaria immitis nematodes is poorly known and there are no sufficient data on its true prevalence in our country. In the article, clinical cases of ocular dirofilariasis caused by Dirofilaria repens are presented, diagnosed in Ural and North-Western Regions of the Russian Federation. Upon larvoscopic examination, Dirofilaria repens immature female was identified in all four cases. The article contains short literature review of dirofilariasis problem in Russia and morbidity prognosis. The need for thorough epidemiological anamnesis and use of ultrasound, laboratory and larvoscopic examination for clinical diagnosis of ocular dirofilariasis is reviewed. The main aspects of conservative and surgical treatment of parasitic infection are presented. The late diagnosis of dirofilariasis caused by absence of pathognomonic symptoms at early stages of the disease requires wider awareness and clinical suspicion of this pathology.

Kazan medical journal. 2017;98(3):393-397
Analysis of surgical treatment results of macular holes in the Samara region
Petrachkov D.V., Zolotarev A.V., Zamytskiy P.A., Karlova E.V., Kazakov I.S.

Aim. Analysis of anatomical and functional results of surgical treatment of full-thickness macular holes.

Methods. We conducted a retrospective analysis of medical records of 194 outpatients (194 eyes) on whom surgical treatment of macular hole was performed in Samara Clinical Ophthalmic Hospital n.a. T.I. Eroshevskiy during 2015-2016.

Results. On day 5 after surgery in 96 (97.9%) patients with a hole of more than 400 µm operated according to inverted flap technique, and in 93 (96.9%) patients with hole of less than 400 µm, on whom removal of the internal limiting membrane around the hole was performed, we observed macular hole closure. The best corrected visual acuity of patients with the hole of more than 400 µm increased to 0.18±0.13 (p <0.05), with the hole of less than 400 µm increased to 0.19±0.12 (p <0.05). 1 month after the surgery the best corrected visual acuity increased to 0.26±0.14 (p <0.05) and 0.49±0.15 (p <0.05), respectively. 6 months after the surgery, the average best corrected visual acuity increased to 0.31±0.12 (p <0.05) and 0.62±0.13 (p <0.05), respectively.

Conclusion. Surgical treatment of full-thickness macular holes of less than 400 µm led to the closure of the hole in 96.9% of cases, and macular holes of more than 400 µm - in 97.9% of cases; statistically significant increase of the best corrected visual acuity in any size of the hole was revealed already on day 5 after the surgery with positive dynamics during the following period of observation.

Kazan medical journal. 2017;98(3):397-400
Clinical features of toxic optic neuropathies
Sheremet N.L., Khanakova N.A., Zhorzholadze N.V., Nevinitsyna T.A.

Aim. To study the features of the clinical symptoms of toxic optic neuropathy.

Methods. 21 patients (42 eyes) with toxic optic neuropathy were examined with the use of standard ophthalmic exam, computer visual field test, spectral optical coherence tomography of the retina and optic nerve.

Results. Toxic optic neuropathies were caused by the acute (4 patients) or chronic (10 patients) alcohol intake, drug abuse (6 patients) and medications (ethambutol, 1 patient). In all patients bilateral visual deterioration with central scotomas with various levels of light sensitivity reduction and prominent dyschromatopsia was revealed. The features of structural changes were reveled in patients with toxic optic neuropathy: the primary thinning of the retinal inner layers with further peripapillary retinal nerve fiber layer thickness loss. Severity of the structural changes ranged from the predominant damage of the retinal inner layers and minor decrease in the temporal peripapillary sector thickness to profound atrophy of the ganglion cell complex and optic nerve. In acute and chronic alcohol abuse after the treatment and complete alcohol cessation 43% of patients noted recovered visual function.

Conclusion. Severity of the symptoms of toxic optic neuropathy, intensity and the rate of atrophy development, and prognosis depend on the nature of the toxin, its dose and exposure time, genetic features in each case; such algorithm of the changes is probably connected to the pathogenesis based on mitochondrial dysfunction.

Kazan medical journal. 2017;98(3):400-403
Polypoidal choroidal vasculopathy
Abdulaeva E.A.

The article presents literature review devoted to the issue of polypoidal choroidal vasculopathy. The studies of Russian and foreign researchers were reviewed. Epidemiological and clinical characteristics of polypoidal choroidal vasculopathy, diagnostic features and modern treatment methods, the results of clinical studies are presented. Polypoidal choroidal vasculopathy is a subtype of neoascular AMD with specific characteristics including predisposition of certain races, clinical features, serosanguineous complications of different severity, tendency to relapsing course of neovascularization and development of secondary serosanguineous exfoliation. It was registered most frequently in patients aged 50 to 65 years. Prevalence among Caucasians is 4 to 9.8%, and among Asians - 23.9 to 54.7%. Diagnosis of polypoidal choroidal vasculopathy requires the use of fluorescent angiography, indocyanine green angiography and optical coherence tomography. Polyps regression accordng to angiography is considered one of the aims of initial therapy of active polypoidal choroidal vasculopathy. According to Expert group of polypoidal choroidal vasculopathy, while using laser photocoagulation and photodynamic therapy, affecting both polyps and vasculature is required. As a result of the analysis of population studies, the results of treatment with laser coagulation, photodynamic therapy (independently and in combination with angiogenesis inhibitors) and monotherapy with angiogenesis inhibitors were demonstrated. Regardless of the achieved results of polypoidal choroidal vasculopathy diagnosis, the treatment issues require further investigation. Additional studies are required to evaluate long-term correlation between initial polyp regression, relapses, response to repeated therapy and functional results.

Kazan medical journal. 2017;98(3):403-409
Analysis of changes in serum levels of endothelin-1 in patients with retinal vein occlusion
Shelankova A.V., Budzinskaya M.V., Plyukhova A.A., Mikhaylova M.A., Nurieva N.M.

Aim. To analyze the level of endothelin-1 in blood serum in patients with retinal venous occlusions. Metods. 60 patients with macular edema due to retinal vein occlusion (RVO) were included in the study. 19 patients were diagnosed with central retinal vein occlusion, 9 of them had non-ischemic type and 10 had ischemic type of central retinal vein occlusion. 41 patients had branch retinal vein occlusion, 23 of them had non-ischemic type and 18 had ischemic type of occlusion. Patients underwent fluorescein angiography and optical coherence tomography fundus imaging. Before intravitreal injection of ranibizumab, the level of endothelin-1 in the blood serum was determined. Analysis was performed in patients’ subgroups depending on the localization of occlusion, type of occlusion, disease relapse, presence of optic disc swelling.

Results. Differences in the systemic level of endothelin-1, depending on the localization of occlusion, presence of ischemic type and relapse, the disease was not detected (p ≥0.05). With the development of optic disc swelling, a statistically significant increase in the level of endothelin-1 was noted in peripheral blood: 38.73 fmol/ml in patients with optic disc swelling and 27.65 fmol/ml in patients without it (p=0.018).

Conclusion. In patients with optic disc swelling a statistically significant increase of endothelin-1 in blood was revealed.

Kazan medical journal. 2017;98(3):409-412
The method of eyeglass lenses processing and a device for its performing
Shishkin A.V., Korepanov A.V., Petrov A.V., Akhkiyamova A.V.

Aim. To develop an inexpensive and efficient method of increasing the hydrophilicity of the lens surface and a device for its implementation.

Methods. To implement the claimed method, a gas discharge device was created. Processing of glasses with plastic lenses in a high-frequency gas discharge (cold plasma) was performed in 47 myopes and 43 hypermetropes. Gas discharge was generated under the following conditions: 1 MHz, 10-20 W, pressure of 0.3-0.01 mm Hg. Processing was carried out for 30-900 seconds. As a result hydrophilic properties of the lens surface were observed in all processed lenses.

Results. On the surface of the lenses a large number of hydrophilic functional groups are formed so during water vapour condensation the formation of a water film occurs instead of forming microdrops. Thus, transparency of the lenses is not disturbed. The hydrophilic properties of the lens surface was maintained in an average for 3-4 weeks. Gas discharge eyeglass lens processing provides a long-term effect of eyeglass lens unsteaming, mechanical stability and safety of the surface, reliable exploitation of the glasses.

Conclusion. We have proposed a fundamentally different way of physical-chemical modification of the lens surface, which is not inferior to existing methods but produces significantly better results.

Kazan medical journal. 2017;98(3):412-414
Experimental medicine
Impact of dichloroethane on the microbicidal activity of neutrophils and mononuclear phagocytes
Men’shikova I.A., Mufazalova N.A., Kamilov F.K., Mufazalova L.F.

Aim. To study the damaging effect of dichloroethane on the functional state of neutrophils and peritoneal macrophages.

Methods. Dichloroethane was administered to animals intragastrically daily in olive oil at a dose of 0.84 mg/kg of body weight for 60 days so that the total dose was 0.1 of 50% lethal dose. The number of leukocytes, neutrophils and lymphocytes in peripheral blood, intensity of oxygen-dependant metabolism (induced test with nitro blue tetrazolium), antimicrobial activity in the conditions of functioning and blockade (by sodium azide), oxygen-dependent factors of microbicidity, content of myeloperoxidase and cationic proteins in neutrophils and peritoneal macrophages were measured. The results were recorded the next day after introduction of the toxicant. Fungicidal activity was measured by the number of colony-forming units of C. albicans, growing on day 3 at culture medium.

Results. Intoxication with dichloroethane for 60 days leads to the formation of leukopenia, mainly due to the decreased number of neutrophils while reducing the number of lymphocytes. This is accompanied by inhibition of oxygen-dependant killing of neutrophils as a result of suppression of peroxidase-dependant mechanisms of microbicidity (the formation of oxygen active forms decreases). Besides, decrease of activity of oxygen-independant mechanisms of killing develops, which correlates with a reduction of cationic proteins level. Suppression of oxidative and non-oxidative mechanisms of microbicidity of peritoneal macrophages. This is accompanied by a decrease of oxygen-dependant metabolism intensity, myeloperoxidase activity and cationic protein level in these cells.

Conclusion. Intoxication with dichloroethane for 60 days in a total dose of 0.1 of 50% lethal dose has a profound damaging effect on the cells of phagocytic link of nonspecific resistance: formation of leukopenia, suppression of oxidative metabolism and microbicidal activity of neutrophils and mononuclear phagocytes occur.

Kazan medical journal. 2017;98(3):415-418
Social hygiene and healthcare management
Structure of emergency outpatient adult visits in Naberezhnye Chelny
Iskandarov I.R., Gil’manov A.A.

Aim. The study of the structure of emergency outpatient adult visits in Naberezhnye Chelny.

Methods. 2471 cases of primary outpatient visits for acute and chronic diseases of adult population of the city of Naberezhnye Chelny in 2011-2013 were analyzed. For statistical analysis of the data analysis of contingency tables with the assessment of statistical significance using Pearson criterion χ2 was used. The critical level of significance was set at p=0.05.

Results. In the studied population 48.4% of primary outpatient visits were made by males and 51.6% - by females. In the general structure of visits patients aged 50 to 59 years were prevalent. Up to a quarter of the emergency outpatients noted the beginning of the disease on the weekends and holidays. The percent of visits to the polyclinic on weekends or holidays was extremely low (3.0% in the general structure of visits), while the highest rates of emergency visits to the polyclinic by adults were observed during the first half of the week. The highest number of primary emergency visits to the polyclinic among both males and females was on Mondays (28.8%).

Conclusion. In the structure of visits made on Mondays and Tuesdays, the proportion of patients who became ill on weekends and holidays, amounted almost 30%.

Kazan medical journal. 2017;98(3):419-423
The influence of habitat factors on the prevalence of kidney and bladder cancer in bioclimatic zones of Primorsky krai
Kiku P.F., Alekseeva G.N., Moreva V.G., Volkov M.V., Yudin S.V.

Aim. To evaluate the prevalence of kidney cancer and bladder cancer under the influence of environmental factors in different bioclimatic and ecological zones of Primorsky Krai.

Methods. The initial data were the incidence of kidney and bladder cancer (form №12) according to administrative territories of Primorsky Krai during the period from 1994 to 2014. In assessing the risk of prevalence of malignant neoplasms of kidneys and bladder in bioclimatic zones (maritime climate of the coast, transitional climate from maritime to continental and continental climate), ranking of territories of the region by zones of ecological stress was used: critical, intense, satisfactory, and relatively benign. To calculate the impact of habitat factors on the urologic oncology, information entropy and correlation and regression analyses were used.

Results. The groups of areas with low, medium and high incidence of malignant neoplasms of the bladder and kidneys were distinguished. High prevalence of oncourologic pathology was determined in the areas of critical and intense environmental situation, where the coal, mining and chemical industry, construction industry, machine-building plants are located, and in areas with intensive chemicalization of agriculture. It was revealed that bladder cancer prevalence has a tendency to rise from the continental bioclimatic zone to the coast in all ecological zones, mainly due to differences in the structure of coast and continental areas bioclimate. It was shown that high morbidity rate is associated with drinking water quality, overall pollution of the environment, and depends on the chemical composition of groundwater and sanitary condition of soils.

Conclusion. Ranking of territories by the prevalence of oncourology gives the possibility to make further operational decisions on the development of the complex of top-priority preventive and health-improving activities for specific areas.

Kazan medical journal. 2017;98(3):423-429
Hospitalized morbidity of Omsk population as a result of acute intoxication of chemical etiology in 2015
Sabaev A.V.

Aim. Analysis of hospitalized morbidity of the population of Omsk as a result of acute poisoning of chemical etiology in age and gender groups depending on the toxicant in 2015.

Methods. The rate of admissions of patients who suffered acute poisoning of chemical etiology in 2015 was analyzed according to gender in age groups 15-19 years, 20-29 years, 30-39 years, 40-49 years, 50-59 years, 60 years and older. According to the etiology all acute poisonings were divided into the following groups: ethanol and its surrogates, medications, drugs, psychoactive substances other than plant-based, caustic and other poisons.

Results. During the analyzed period the majority of patients admitted to the center for the treatment of acute poisoning in Omsk were males in whom the incidence of hospitalization was 4.1 times higher than in females. The highest hospitalization rate due to acute chemical poisoning was observed in the age group of 20-29 years among males and 15-19 years among females. Acute alcohol intoxication was observed more frequently among males aged 40-49 years and among females aged 30-39 years that is indicative of the peak rate of severe chronic alcohol abuse in these age groups.

Conclusion. The high rate of consumption of modern psychoactive synthetic substances, «designer» drugs, which replaced plant-based drugs, defines the nature of toxicological situation in the region.

Kazan medical journal. 2017;98(3):430-433
Comparative analysis of children’s physical development in different age groups in Voronezh region 15 years apart (1997-1999 and 2011-2014)
Zhdanova O.A.

Aim. To investigate physical development of children in Voronezh region in different age groups in 2011-2014 in comparison with the regional studies data in 1997-1999.

Methods. The study was performed on 5644 children aged 1-18 years of health groups I and II in comparison with the data of 10 247 children aged 1-14 years examined in 1997-1999. Body height, weight and body mass index Z-scores, calculated using WHO AnthroPlus software, were evaluated.

Results. Children’s Z-score values for body height in 2011-2014 were higher than in 1997-1999 in all age groups and at the age of 1-9 years these values exceeded World Health Organization (WHO) standards. Girls’ height approached the standards in 10-14 and 15-18 years, and boys’ height - in 15-18 years. Body weight of children aged 2-8 years was higher than the regional data in 1997-1999 and WHO standards approaching them at the age of 9. Body mass index increase compared to WHO standards was revealed in children aged 1-4 years (p=0.000), and in 2011-2014 the reported differences were less prominent than in 1997-1999. In 2011-2014 among 15-18-years-old girls the shift of body mass index values to the lack of body weight was noted, in 1997-1999 the same changes were found out for 10-14-years-old girls.

Conclusion. In 2011-2014 specific attention was required to be paid to physical development of children at the age from 1 to 4 years due to overweight risk of and girls aged 15-18 years due to probable underweight risk.

Kazan medical journal. 2017;98(3):433-439
Multifactoriality of HIV morbidity dynamics among females in the Republic of Tatarstan
Agliullina S.T., Khasanova G.R., Mukharyamova L.M., Nagimova F.I.

Aim. To analyze the morbidity structure of infection caused by human immunodeficiency virus (HIV-infection) in women in the Republic of Tatarstan during the period from 1996 to 2016.

Methods. We conducted a retrospective epidemiological analysis of HIV-infection morbidity in women in the Republic of Tatarstan during the period from 1996 to 2016 with the evaluation of morbidity structure by age, transmission routes, social and family status. Statistical and graphic-analytical methods were used. Extensive morbidity rates of HIV-infection in women (18 years and older) were calculated.

Results. In the Republic of Tatarstan during the period from 1996 to 2016 HIV-infection was diagnosed in 6815 women with increasing incidence from 0.1 to 30.2 cases per 100 000 women. The increase of the proportion of women older than 30 years in the morbidity structure was observed during this period. Comparative analysis of the parameters from 2001 and 2016 revealed a statistically significant increase of the proportion of married women from 37.5±2.5 to 46.2±2.2% (p <0.01), and of employed women as well from 24.5±2.2 до 36.9±2.1% (p <0.001). By 2002 most of newly detected infection cases were observed among women consuming injection drugs, however since 2000 the increase of sexual transmission has been observed. During the period from 1996 to 2016 61.7% of HIV-positive women were infected through sexual contact.

Conclusion. During the evaluated period of epidemic most HIV-infected women were diagnosed at the age of 20 to 39 (79%), sexual transmission route was prevalent (61.7%); a shift of incidence to higher age groups and socio-adapted groups and the increase of importance of sexual transmission of HIV were observed, that is a reflection of the generalization of HIV epidemic in the region.

Kazan medical journal. 2017;98(3):440-445
Clinical observations
A clinical case of the treatment of a patient with metastatic inoperable liver cancers with the use of radiofrequency ablation combined with regional chemotherapy and chemoembolization
Shavrina Y.A.

The article is devoted to the clinical case of the treatment of a patient with metastatic inoperable liver cancers. Regardless of primary tumor localization virtually every third cancer patient has hepatic metastases. The only radical method of the treatment of primary and metastatic liver cancer allowing to achieve long term survival is an organ resection but most frequently multiple liver metastases are diagnosed. In such spread of the process expanded liver resection is indicated accompanied by high rate of complications and mortality. All of this makes the surgeons use novel methods of minimally invasive organ-saving treatment for patients with primary and secondary liver neoplasms. Such case is an example of effective use of radiofrequency ablation in its different sequence with regional chemotherapy and chemoembolization of hepatic artery for the treatment of a patient with colon adenocarcinoma and hepatic metastases. The patient underwent 6 courses of polychemotherapy, 3 courses of radiofrequency ablation and 5 courses of hepatic artery chemoinfusions and chemoembolization of tumor vessels in the liver. Total patient’s lifetime from the moment of detection of hepatic metastases from colorectal cancer was 25 months.

Kazan medical journal. 2017;98(3):446-448
An imported case of tropical malaria in the Republic of Sakha (Yakutia)
D’jachkovskaja P.S., Slepcova S.S.

Clinical course of malaria depends on the type of a pathogen and immune status of the infected person. In the diagnosis the significant role is played by epidemiological anamnesis. Tropical malaria is characterized by severe course with high mortality, therefore its timely detection is of primary importance for favorable outcome. Absence of clinical suspicion of malaria due to fairly rare occurrence of the disease in the region may contribute to late detection and development of severe life threatening forms of the disease. In Russia predominantly malaria cases imported from endemic areas are registered. In the republic of Sakha (Yakutia) malaria occurs sporadically. In this publication description of a severe form of imported (from Dominican Republic) tropical malaria case is given.

Kazan medical journal. 2017;98(3):448-451
Clinical experiences
Acoustic microscopy in orthodontology
Gasymova Z.V.

Aim. Assessment of the possibility to use the method of ultrasound acoustic microscopy to control the state of microstructure of hard tooth tissues under the brackets.

Methods. The study was conducted with the use of scanning acoustic microscope ELSAM (Leitz, Germany) in Emanuel Institute of biochemical physics, Moscow. The studied material for acoustic microscopy corresponds to 34 teeth (premolars) with brackets fixed to them, which were removed due to orthodontic indications at different time points after brackets placement.

Results. In most cases on acoustic images of the removed teeth there were no revealed changes of physical and mechanical enamel properties, fissures or excess porosity both directly under the brackets and in the areas adjacent to the sealer margin. But in some cases along with good enamel state after long-term brackets placement minor changes in the structure of hard tooth tissues were revealed. In particular, the method of acoustic microscopy allowed to detect in the tooth enamel such minor defects as fissures and areas of reduced mineralization and increased porosity.

Conclusion. Acoustic microscopy as a novel method to obtain clear structural images of hard tooth tissue state allows detecting minimal changes of the structure of hard tissues and performing medical interventions based on them.

Kazan medical journal. 2017;98(3):452-456
Choice of sternal closure technique in patients with poststernotomy mediastinitis
Gorbunov V.A., Dzhordzhikiya R.K., Mukharyamov M.N., Vagizov I.I., Omelyanenko A.S.

Aim. Comparison of the efficacy of different sternal closure techniques for patients with poststernotomy mediastinitis.

Methods. From 2011 till 2016 29 patients after cardiothoracic surgeries complicated by poststernotomy mediastinitis and sternal dehiscence were observed. Depending on the used technique of re-osteosynthesis the patients were divided into 3 groups. In the group 1 re-osteosynthesis was performed with steel surgical wire, in group 2 - with titanium nickelide staples, and in group 3 - with developed by authors modernized U-shaped wire suture on the padding consisting of perforated metal sheet (titanium mesh). All patients during pre-operative period had vacuum wound drainage performed. In some patients during re-osteosynthesis vancomycin paste was used.

Results. The rate of sternal dehiscence recurrence in the group 1 was 30%, in group 2 - 12.5% and in group 3 - 9% (р1-2=0.08, р1-3=0.04, р2-3=0.2). The average hospital stay in group 1 was 51 days, in group 2 - 27 days and in group 3 - 24 days (р1-2=0.05, р1-3=0.07, р2-3=0.4). In inharmed bone tissue of the sternum titanium nickelide staples use decreases the risk of recurrent sternal dehiscence by 17.5% compared to widely used osteosynthesis method with the use of steel wire.

Conclusion. Osteosynthesis method suggested by the authors demonstrated its reliability in 91% of cases; use of vancomycin paste during re-osteosynthesis allowed avoiding recurrent wound infection both in short- and long-term periods in 100% of cases.

Kazan medical journal. 2017;98(3):456-461
A case of maternal death in a pregnant woman with fulminant hepatitis C
Saryeva E.G.

The article presents a description and analysis of a rare case of fulminant form of viral hepatitis C in a pregnant woman. A pregnant 24-year old patient (3d pregnancy, 1st delivery), was admitted to the hospital in a critical condition with suspected obstructive jaundice. As a result of diagnostic process the following diagnosis was made. Pregnancy, 36-37 weeks. Cephalic presentation. Antenatal intrauterine fetal death. Acute icteric viral hepatitis C, fulminant course. C-section was performed. In spite of fluid therapy during and after the surgery, the patient developed multiple organ failure which caused death. In spite of adequate resuscitation, the fulminant viral hepatitis C caused compromised liver function and multiple organ failure development, which became the cause of maternal death. We believe that intensified medical educational activity including nursing of the pregnant women and increased quality of other medical organizational activities are required that will lead to decreased maternal mortality rate on the periphery.

Kazan medical journal. 2017;98(3):462-465
Diskussiya po stat'e E.G. Saryevoy «Sluchay materinskoy smertnosti u beremennoy s ful'minantnym techeniem gepatita C»
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Kazan medical journal. 2017;98(3):466-467
History of medicine
Children’s republican clinical hospital - a 40-year-long path in the history of pediatric healthcare in Tatarstan
Valiullina S.A., Doronina L.A.

Children’s republican clinical hospital of the Republic of Tatarstan has undergone a forty-year-long path in its development. Today it is a modern medical institution uniting a high-tech hospital, an emergency hospital and an organizational and methodological center. It is also a coordinator of pediatric healthcare in Tatarstan. However, it all began with the Government’s decision to build a modern pediatric republican center on the outskirts of the city. The article describes in detail how the hospital was built, how surgical and pediatric services were created and developed, how the staff was trained, how modern technologies were introduced, how the hospital was modernized to solve strategic tasks, what role the Departments of pediatrics and pediatric surgery have played and still play. History is made by people, so the article contains the detailed description of formation of the hospital staff and reflects the role of its first Chief physician E.V. Karpukhin who took an active part in hospital’s construction, in creation of its services and headed this hospital for 33 years. The efforts of the large team have made the Children’s republican clinical hospital one of the best among children’s hospitals in Russia.

Kazan medical journal. 2017;98(3):468-475
Letters to the Editor
A word about the colleague: a scientist, teacher and friend
Kazan medical journal. 2017;98(3):476
Professor Irek Alimzyanovich Salikhov is 90 years old
Kazan medical journal. 2017;98(3):477-478
Professor Leyla Kazbekovna Shaydukova is 60 years old
Kazan medical journal. 2017;98(3):478-479
Farid Khasbiullovich Fatkullin
Kazan medical journal. 2017;98(3):480

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