Vol 98, No 4 (2017)

Ways to solve the issues of surgical treatment of stomach cancer
Akhmetzyanov F.S.
Surgical method is the only effective method of stomach cancer treatment. On the basis of dividing the stomach into angiological segments, lymphogenic metastasis was studied, classification of gastric cancer and extraligamentous lymph nodes localizations was created. Based on the performed surgeries working classification of extended lymphodissection was suggested. The data on the formation of esophageal-intestinal anastomosis, identification of the origin of key complications after gastrectomy are given. By introducing single-raw esophago-jejunal anastomosis it was possible to almost completely eliminate complications leading to death which together account for up to 90% of the complications: suture failure, pancreatitis and pancreatic necrosis. The volume of the resected stomach was revised without worsening long-term treatment results. During gastrosplenectomies for ablastic block dissection of lymph nodes the author proposes standard binding of the splenic vessels - proximal to the left gastroepiploic artery arising from the splenic artery. The remaining part of the pancreas after gastrosplenectomy with pancreas resection is proposed to be stitched using atraumatic sutures, which avoids formation of pancreatic fistula. In the clinic we developed esophagogastrosplenectomy from laparoscopic mediastinal access with isoperistaltic right colon graft for esophageal reconstruction with anastomosis located in the neck, antethoracic esophageal reconstruction with graft from the large curvature of the stomach, as well as created original drainages of our own design, which allowed excluding peritonitis without inconsistency of the sutures and abscesses of the abdominal cavity. The author concludes that gastrectomy and subtotal distal gastric resection according to his original methods are an effective tool in the surgical treatment of gastric cancer.
Kazan medical journal. 2017;98(4):485-491
Theoretical and clinical medicine
Clinical and pathogenetic value of nitric oxide measurement in the blood of patients with bronchial asthma and essential hypertensio
Shakhanov A.V., Bel’skikh E.S., Lunyakov V.A., Uryas’ev O.M.

Aim. To evaluate the clinical and pathogenetic value of nitric oxide metabolites measurement in the blood of patients with bronchial asthma and essential hypertension.

Methods. The study included 91 patients. Three groups were identified: patients with bronchial asthma (30 patients, group 1), patients with bronchial asthma in combination with essential hypertension (31 patients, group 2), and patients with essential hypertension (30 patients, group 3). Measurement of the level of total nitric oxide metabolites in patients’ blood was performed with the use of spectrophotometric method in light spectrum based on Griess reaction.

Results. The median level of nitric oxide metabolites had the highest value in the blood of patients with bronchial asthma and accounted for 75.6 [70.4; 80.8] umol/L. Level of nitric oxide metabolites in the blood of patients with bronchial asthma in combination with essential hypertension and patients with essential hypertension was lower, accounting for 72.4 [66.2; 81.2] and 60.0 [54.6; 62.7] umol/L respectively (p <0.001). The tendency to increasing level of nitric oxide metabolites in the blood of patients with bronchial asthma according to disease severity and disease-modifying treatment was revealed. The level of nitric oxide metabolites in the blood of patients with severe bronchial asthma was 77.4 [71.6; 82.4] μmol/L, and in patients with moderate asthma it was 72.4 [70.4; 73.9] μmol/L.

Conclusion. The level of nitric oxide metabolites in the blood of patients with combination of bronchial asthma and essential hypertension had intermediate values compared with patients with bronchial asthma alone, who had the highest level, and with patients with essential hypertension alone, who had the lowest values.

Kazan medical journal. 2017;98(4):492-496
Molecular genetic and morphological features of malignant neoplasms of the stomach and colon with tissue eosinophilia
Dmitrieva A.I., Yankovich K.I., Kolobovnikova Y.V., Urazova O.I., Purlik I.L., Kudyakov L.A., Novitskiy V.V.

Aim. To study molecular genetic and morphological features of neoplasms in stomach and colon cancer associated with tissue eosinophilia.

Methods. Study material was the tissue samples of malignant neoplasms of the stomach and colon obtained from the surgical procedures. Study groups were identified depending on the presence or absence of eosinophilic infiltration of the tumour tissue as well as on neoplasm localization. Medical records and outpatient patient cards were analyzed, presence of matastases in regional lymph nodes and grade of differentiation of malignant cells were evaluated. In tumour tissue expression of p53 and p21 proteins was evaluated by means of immunohistochemical technique. To study the distribution of polymorphic variants of р53 (G215C) and р21 (A1026G) genes, deoxyribonucleic acid extraction was performed from formalin-fixed and paraffin-embedded tissue samples obtained from the resection margins. Polymorphism genotyping of deoxyribonucleic acid samples was performed by restriction fragment length polymorphism analysis of amplification products with the use of polymerase chain reaction of specific genome regions with further visualization with ultraviolet light.

Results. In patients with colon cancer associated with tissue eosinophilia tumour cells were shown to have higher grade of differentiation than in patients without eosinophilia. In stomach cancer associated with eosinophilic infiltration low expression of mutant p53 protein was revealed significantly more frequently as opposed to cancer without eosinophilia. Also in patients with stomach and colon cancer, association of tissue eosinophilia with carriage of G allele of р53 (G215C) gene polymorphism was found.

Conclusion. Tissue eosinophilia in stomach and colon cancer is associated with favourable morphological cancer characteristics, low expression of mutant p53 protein and carriage of G allele of р53 (G215C) polymorphism.

Kazan medical journal. 2017;98(4):496-503
DNA-cytometric parameters in patients with ovarian cancer
Nerodo G.A., Novikova I.A., Ardzha A.Y., Nikitina V.P., Kosenko I.A., Kravtsova O.E., Bondarenko E.S.
Aim. To study DNA flow cytometry parameters in patients with stage III-IV ovarian cancer receiving different treatments. Methods. Surgical material obtained from 93 female patients with verified stage III-IV ovarian cancer was studied. Patients were divided into 4 groups depending on the treatment variant: without neoadjuvant chemotherapy, with neoadjuvant chemotherapy, with neoadjuvant chemotherapy with different recombinant human interferon gamma (Ingaron) injections - intramuscular or intraperitoneal. Cell count was analyzed, and ploidy interpretation and cell cycle analysis were performed on fresh surgical material. Results. Differences in cell distribution depending on the treatment method were found. Increased proliferation rates, proliferation index, aneuploid tumors predominance in the group without drug exposure were demonstrated. Most of diploid tumours were registered in the group receiving neoadjuvant chemoimmunotherapy with intraperitoneal immunomodulator injections (83.4%) that indicates better disease prognosis. Under exposure to neoadjuvant polychemotherapy aneuploid cell number decreases to 38.4%, and chemoimmunotherapy with intramuscular and intraperitoneal recombinant human interferon gamma injections demonstrated even greater decrease - to 27.2 and 16.6%, respectively. Conclusion. Interferon gamma inclusion into the treatment contributes to a decreased number of aneuploid tumors, reduced proportion of aneuploid cells in tumors and reduced proliferation rates and proliferation index characterizing cancer aggressiveness.
Kazan medical journal. 2017;98(4):503-508
DNA-cytometric characteristics of primary soft tissue sarcomas
Novikova I.A., Nepomnyashchaya E.M., Ul’yanova E.P., Selyutina O.N., Aliev T.A., Vashchenko L.N., Ausheva T.V., Zolotareva E.I.

Aim. Determination of deoxyribonucleic acid (DNA) content and cell distribution in mytotic cycle phases in the groups of patients with primary soft tissue sarcomas.

Methods. Study material was the tumours of patients with primary soft tissue sarcomas. Study methods included histological, DNA cytometric and statistical methods.

Results. Differences in proliferative activity and proliferation index in primary sarcomas depending on the tumor differentiation grade and disease stage were revealed. Differences in the numbers of diploid, aneuploid and polyploid cells depending on the cell cycle phases were determined in each group and between groups. Depending on the differentiation grade of soft tissue sarcoma, parameters of the cell cycle in soft tissue sarcomas were as follows: well-differentiated tumors (G1) were diploid in 100% of cases, and moderately differentiated tumors (G2) were aneuploid in 50% of cases. Poorly differentiated tumors (G3) were characterized by significantly higher content of aneuploid cells, in comparison with G2 tumors (33.1±5.2 and 16.5±6.8, respectively). Analysis of kinetic parameters of cell cycle demonstrated decreased proportion of cells in G1/G0 cell cycle phase from G1 to G3, accompanied by a statistically significant increase of the proportion of cells in S phase (p ˂0.05).

Conclusion. DNA cytometric study of cell cycle parameters demonstrated high biological potential of primary soft tissue sarcomas; high malignant potential can probably be determined by two parameters: proportion of the cells in G2+М phase and cell loss factor.

Kazan medical journal. 2017;98(4):509-513
Cognitive trajectory of patients in the recovery period after ischemic stroke: role of neuroinflammation and structural cerebral factors
Kulesh A.A., Drobakha V.E., Kuklina E.M., Shestakov V.V.

Aim. To study the role of neuroinflammation and cerebral structural factors in the development of cognitive impairment in the recovery period of ischemic stroke.

Methods. In 55 patients with ischemic stroke the assessment of global cognitive status in acute and recovery period of ischemic stroke, evaluation of cytokine concentrations (interleukin-1β, interleukin-4, interleukin-6, interleukin-10 and tumor necrosis factor α) in cerebrospinal fluid and blood serum, as well as a number of MRI morphometric and diffusion tensor parameters were performed.

Results. Predictors of stable cognitive status were low concentration of interleukin-6 and -10 and interleukin-1β and -10 dominance in cerebrospinal fluid, high fractional anisotropy of ipsilateral superior longitudinal fasciculus in the acute phase of stroke. Predictors of positive trend of cognitive status include low level of C-reactive protein, intermediate values of fractional anisotropy of the designated tract, high level of high-density lipoproteins in serum and interleukin-10 in cerebrospinal fluid, codominance of interleukin-1β and -6 in serum and interleukin-10 in cerebrospinal fluid, predominance of interleukin-10 over interleukin-1β in serum, as well as lesser degree of stenosis of the ipsilateral internal carotid artery. Predominance of interleukin-1β over interleukin-10 in serum, large volume of the brain ventricles, lower values of fractional anisotropy of ipsilateral superior longitudinal fasciculus, low level of high-density lipoproteins and greater degree of stenosis of the ipsilateral internal carotid artery can be considered as predictors of negative trend of cognitive status.

Conclusion. The trajectory of cognitive status in the recovery period of ischemic stroke is determined by the profile of neuroinflammation in conjunction with microstructural integrity of the ipsilateral superior longitudinal fasciculus, as well as severity of atherosclerosis of the carotid artery on the side of stroke, level of high-density lipoproteins and ventricular dilation in the acute period of the disease.

Kazan medical journal. 2017;98(4):513-518
Utility of autoantibodies in insulin-dependent diabetes mellitu
Akhmedov G.A.

Aim. To study relationship of levels of autoantibodies GAD 65, IА-2 and С-peptide with DRB1_1 and DRB1_2 genotypes of human leukocyte antigen and presence of ketoacidosis in children with newly diagnosed diabetes mellitus among the population of Azerbaijan.

Methods. 128 children with newly diagnosed diabetes mellitus were examined. The average age of children was 8.7±0.40 years. GAD 65 and IA-2 autoantibodies were measured.

Results. During the study no correlation between concentration of autoantibodies GAD 65 and IA-2 was found (r=0.067, p=0.46). Also no correlation was revealed between GAD 65 autoantibodies and C-peptide concentration (r=+0.025, p=0.011). Comparison of HLA DRB1_1 and DRB1_2 autoantibodies in 106 children also demonstrated no correlation. At the same time, positive correlation was found between glucose level and GAD 65 (r=+0.21, p=0.02). In children without ketoacidosis, but with high IA-2 (n=9) negative correlation with HbA1c level in the blood was revealed (r=-0.79, p <0.05). Children with severe ketoacidosis (n=9) with the level of IA-2 and GAD 65 autoantibodies above normal, inverse correlation between the level of blood glucose (r=-0.67, p <0.05) and mentioned autoantibodies (r=-0.72, p <0.05) was revealed. Children with high IA-2 in the blood (n=9) had a positive correlation of this parameter with the level of C-peptide (r=+0.75, p <0.05).

Conclusion. The study found no correlation between the levels of GAD 65 and IA-2 autoantibodies in children with diabetes mellitus and ketoacidosis.

Kazan medical journal. 2017;98(4):519-521
Characteristics of hepatitis A on the background of chronic hepatitis B
Bushmanova A.D., Sukhoruk A.A., Ivanova N.V., Esaulenko E.V.

Aim. To characterize clinical presentation of hepatitis A on the background of chronic hepatitis B.

Methods. The study was conducted in 2012-2015 in Saint Petersburg Clinical infectious diseases hospital n.a. S.P. Botkin. Retrospective analysis of 259 medical records of in-patients diagnosed with hepatitis A was conducted on random samples. Etiology of the disease was confirmed with ELISA test for serological markers of hepatitis A, B and C.

Results. Etiological structure of hepatitis A-mixed: combination of hepatitis A + chronic hepatitis B - 74.0%, hepatitis A + chronic hepatitis B + chronic hepatitis C - 11.0%, hepatitis A + chronic hepatitis C - 8.0%, hepatitis A + chronic hepatitis of unknown etiology - 7.0%. Age differences in the groups of patients with hepatitis A were revealed: mono- and mixed infections (35.5±11.74 and 40.7±13.72 years, respectively; р=0.026). Hepatitis A had moderate course regardless of infection with other hepatotropic viruses but in 1 patient with chronic hepatitis B resulting in cirrhosis severe course of the disease lead to death. Clinical presentation of hepatitis A as mono- and mixed infection was characterized by typical symptoms. Changes in blood chemistry in mixed infection were characterized by higher cytolytic activity, hypoalbuminemia, lesser decrease of urea level.

Conclusion. In the etiological structure of mixed hepatitis combination of hepatitis A and chronic hepatitis B was predominant; in most cases hepatitis A had moderate course but in superinfection more severe course of the disease can be observed - up to lethal outcome.

Kazan medical journal. 2017;98(4):521-526
Diagnosis and treatment of pelvic congestion syndrome in women with interventional radiology methods
Verezgova S.V., Troik E.B.

Aim. Evaluation of the results of venography and efficacy of gonadal veins embolization in female patients with pelvic congestive syndrome and concomittant genital pathology.

Methods. The study included 61 patients with pelvic varicosities diagnosed on the basis of ultrasound and Doppler studies of the veins with obligatory use of Valsalva test. The average age of the patients was 34.11±0.98 years. Patients were divided into groups according to the presence or absence of concomitant genital pathology: group A - 16 patients with pelvic varicose veins without concomitant genital pathology; group B - 20 patients with pelvic varicose veins and endometriosis; group C - 25 patients with pelvic varicose veins and other genital pathology. All patients underwent selective pelvic vein embolization by the combined method with the use of coils and sclerosants. The variants of anatomical structure of venous system in patients from three groups were clarified according to the results of venography. Efficacy of the method was assessed by the change in pelvic pain intensity according to Visual Analogue Scale before and after embolization.

Results. Bilateral pelvic varicose veins in all groups was the most prevalent variant diagnosed in venography. In groups A and C 87.5 and 84% of patients, respectively, noted improvement. In group B 35% of patients reported improvement, while 65% maintained pain after embolization. However, even while maintaining pain, decrease of its intensity was reported by 35% of patients, but in 6 (30%) of cases it required surgical organ-resecting treatment.

Conclusion. Venograghy in pelvic congestive syndrome in women is characterized by stagnation of venous blood in the venous system of pelvis with the reflux and valvular incompetence; endovascular method confirmed its high efficiency for relieving pelvic pain syndrome; we had no complications during the study.

Kazan medical journal. 2017;98(4):526-530
Prevalence of anomalies of dentoalveolar-facial system among school children residing in rural area
Tikhonov V.E., Mitin N.E., Grishin M.I.

Aim. Study of the prevalence of dentofacial anomalies among school children of grades 1 to 11 of one of the districts of Ryazan Oblast.

Methods. We conducted an examination of 663 school children aged 7 to 16 years in one of the districts of Ryazan Oblast. The obtained data were recorded in the form of the oral cavity examination of the Central scientific research institute of dental and maxillofacial surgery.

Results. As a result of examination it turned out that prevalence of teeth and occlusion anomalies in school children ranges from 61 to 89%, and in most age groups it is at a fairly stable level of 80%, which is very high. An alarming fact is that at the age of 7 to 10 years combined teeth and occlusion anomalies were detected in the range from 88.6±3.79% to 82.9±4.16%; it indicates that only every fifth child has a healthy dentofacial system. At the age of 11 this indicator is much lower, while among school children aged more than 16 years it is at the level of 75.6±6.7%.

Conclusion. High prevalence of dentofacial system anomalies was revealed among children of school age in one of the districts of Ryazan Oblast; sufficiency of qualified personnel would provide timely diagnosis of early forms of anomalies, correct disorders and ensure normal development of the child’s dentoalveolar-facial system.

Kazan medical journal. 2017;98(4):530-533
Morphological characteristics of reflux gastritis
Galiev S.Z., Amirov N.B., Baranova O.A.

Aim. To study morphological features of gastric mucosa in duodenogastric reflux and the connection of the latter with the level of acidity of gastric contents, presence of H. pylori infection and contractile function of the gallbladder.

Methods. 65 patients were examined: 10 people were included in control group, and in 55 patients reflux gastritis was identified according to gastrointestinal endoscopy. Gastric contents were analyzed for the level of acidity and concentration of bile acids. For all patients histological examination of biopsy material of gastric mucosa at the level of the body and antrum was performed.

Results. Correlation between the acidity level and the concentration of bile acids in gastric contents taken from an empty stomach was found (r=-0.408; p=0.033). In patients with H. pylori pH-level was higher compared to the control group (p=0.047), at the same time the level of bile acids had no significant difference in both groups. Discharge coefficient of the gallbladder in patients with duodenogastric reflux did not differ from the control group. In patients with duodenogastric reflux significant differences from the control group were found in the rate of such morphological signs as chronic inflammatory cell infiltration (p=0.013) and mucosal edema (p=0.032) at the level of the antrum, foveolar hyperplasia at the level of the body of the stomach (p=0.0315).

Conclusion. The degree of duodenogastric reflux has a correlation with acidity of gastric juice; presence or absence of H. pylori does not affect the degree of duodenogastric reflux in primary reflux gastritis; pathomorphological features of duodenogastric reflux are gastric mucosa edema and chronic inflammation at the level of the antrum, foveolar hyperplasia at the level of the body of stomach.

Kazan medical journal. 2017;98(4):533-538
Factors influencing survival of patients suffering from nonspecific aortoarteritis
Borodina I.E., Shardina L.A.

Aim. To identify the factors influencing survival of patients with Takayasu arteritis with the use of Kaplan-Meier mono-factor analysis.

Methods. As the factors influencing survival we analyzed gender, smoking status, tachycardia, arterial hypertension, comlications, left common iliac artery involvement, character of disease progression, and social factors. 96 patients suffering from nonspecific aortoarteritis and observed in Regional clinical hospital №1 in 1998-2016 were examined.

Results. Survival of patients suffering from nonspecific aortoarteritis was influenced by: male gender (p=0.0030), smoking (р=0.00762), tachycardia at the time of diagnosis (p=0.01762), arterial hypertension at the time of diagnosis (p=0.04150), involvement of left common iliac artery (p=0.02970), more than 3 complications (p=0.00062), progressive course of the disease (p=0.00016), being divorced (p=0.00018). 5-year survival was 99%, 10-year survival - 95%, 15-year survival - 93%.

Conclusion. The following factors were identified as influencing survival of patients with Takayasu arteritis: male gender, smoking, tachycardia and arterial hypertension at the time of diagnosis, involvement of left common iliac artery, more than 3 complications, progressive course of the disease and being divorced.

Kazan medical journal. 2017;98(4):538-545
Influence of insomnia and emotional disorders on the development of cognitive impairment in patients with chronic brain ischemia and arterial hypertension
Yakupov E.Z., Grigor’eva T.S.

Aim. To study correlation between sleep disorders, cognitive impairment and emotional state in patients suffering from chronic brain ischemia and artreial hypertension.

Methods. The study included 65 patients of Kazan City clinical hospital №7: 35 males and 30 females aged 21 to 92. Self-Administered Gerocognitive Exam test, Spielberg-Hanin scale, questionnaire developed by the authors, Pittsburgh sleep quality assessment were used.

Results. It was shown that reduced sleep quality in patients with chronic brain ischemia is associated with worsening cognitive impairment. Among responders with poor subjective sleep quality only 21% had cognitive function within normal limits, while in 88% of patients with good subjective sleep quality cognitive function was normal. High level of anxiety was found to cause poor sleep quality. 57% of patients were diagnosed with high level of situational anxiety combined with poor subjective sleep quality and among patients with good sleep quality in only 12% of responders high level of situational anxiety was found. In patients increase of the level of anxiety is associated with more frequent cognitive impairment. Only 38% of patients with high level of anxiety had normal cognitive function compared to 85% of responders with low level of anxiety and normal function.

Conclusion. Sleep quality and level of anxiety influence the development of cognitive disorders in patients with chronic brain ischemia.

Kazan medical journal. 2017;98(4):545-551
Analysis of mortality in patients with severe community-acquired pneumonia on the background of influenza A (H1N1) pdm09
Sergeeva I.V., Demko I.V., Korchagin E.E.

Aim. To analyze clinical and morphological features of lethal outcomes in influenza A (H1N1) pdm09.

Methods. The article provides an analysis of 21 cases of death from severe complicated influenza A (H1N1) pdm09. A clinical example is presented. The diagnosis of influenza A (H1N1) pdm09 was laboratory-confirmed by polymerase chain reaction in vivo in nasopharyngeal swab samples. The diagnosis of influenza A (H1N1) pdm09 was also confirmed posthumously by polymerase chain reaction with detection of influenza virus antigens in autopsy materials.

Results. The deceased were 25 to 63 years old, were admitted on day 5 to 8 from the beginning of the disease (in average, 6.4±0.6 days), among them 12 (57%) females and 9 (43%) males. The risk factors were overweight and obesity in 18 (85.7%) patients. Lethal outcome occurred as a result of acute respiratory failure and acute respiratory distress syndrome. Morphologically severe total involvement of trachea, lungs and bronchi with congestion of internal organs was detected. Clinical manifestations of acute respiratory failure and acute respiratory distress syndrome were morphologically associated with alveolar damage. In all cases of death diffuse alveolar damage and multiple organ changes were diagnosed.

Conclusion. Severe course of influenza A (H1N1) pdm09, complicated with community-acquired viral and bacterial pneumonia, was associated with the development of infectious-toxic shock; lethal outcome occured as a result of ARF acute respiratory failure and acute respiratory distress syndrome; severe total involvement of trachea, lungs and bronchi with congestion of internal organs was confirmed morphologically.

Kazan medical journal. 2017;98(4):551-557
Species spectrum of microflora of upper digestive tract mucosa and its effect on the development of pathology in children
Kazakova M.A., Pozdeev O.K., Valeeva Y.V., Morozova L.G., Fayzullina R.A.

Aim. To study microbial landscape of duodenal mucosa and bile samples from children with disorders of the upper digestive tract.

Methods. The study material included 69 biopsy samples of duodenal mucosa obtained during upper endoscopy and bile samples (106 samples) obtained at fractional duodenal sounding of 106 children. An expanded set of growth media (5% blood agar, Endo’s medium, Ploskireva’s medium and alkaline bile agar) was used followed by biochemical identification, that allows revealing a wide range of contamination with aerobic and facultative anaerobic microorganisms.

Results. It was found that in children with isolated forms of chronic gastroduodenitis and functional gallbladder disorders the frequency of H. pylori detection was significantly higher compared to other children who have organic desease of biliary system in the form of chronic сholecystitis.

Conclusion. Infection is the trigger mechanism for the development of combined pathology of the upper digestive tract and the biliary system; in organic cholepathies mixed infection combined with H. pylori infection is more common.

Kazan medical journal. 2017;98(4):557-563
Evaluation of efficacy of treatment of patients with diabetes mellitus type 2 with the use of different treatment schemes
Mekhdiev S.K., Mustafaev I.I., Mamedov M.N.

Aim. To study pharmaco-epidemiological features of hypoglycemic treatment combinations in patients with diabetes mellitus type 2.

Methods. Cross-sectional epidemiologic study included 528 patients who responded the questions from ARIC questionnaire about the scheme of conducted antidiabetic treatment. Glycemia <7 mmol/l was estimated as normal, and glycated hemoglobin ≥7% - as decompensation.

Results. Mono- and combined treatment was received by 94.3% of patients. In treatment tactics there were no statistically significant gender differences. 3% of patients followed only diet therapy, 4.5% received metformin monotherapy, 23.7% took sulfonylureas. 50.8% of patients received insulin monotherapy, 49.2% received 2 insulin medications. In patients receiving metformin, sulfonylureas, insulin and combined therapy glycemia was higher, than in naive patients (7.7%, p <0.05; 8.8%, p <0.05; 17.7%, p <0.01 and 9.8%, p <0.01, respectively), and there were no statistically significant differences in glycohemoglobin levels. 75.3% were administered dual therapy, 22.4% - triple therapy, 2.7% - quaternary therapy. In 93.9% of cases with dual therapy and in 69.4% with triple therapy the tretment was rational. On different schemes of hypoglycaemic treatment adequate control of diabetes mellitus was not achieved in most patients.

Conclusion. Although 97.3% of patients with diabetes type 2 received treatment, in 81% of them decompensation was revealed; to correctly manage the disease doctors should follow international guidelines, widely use new generations of antidiabetics and rational combinations, and to improve adherence of patients to treatment, improvement of work of diabetic schools is recommended.

Kazan medical journal. 2017;98(4):564-571
Correction of anemic syndrome in patients with chronic heart failure with intravenous iron-containing complex
Zakhidova K.K.

Aim. To evaluate efficacy of intravenous iron (III) hydroxide sucrose complex for anemic sydrome correction in patients with chronic heart failure and anemia.

Methods. 126 patients with chronic heart failure of ischemic etiology of I-IV NYHA functional class were examined, 92 of them were diagnosed with anemia. The average age of patients was 60.6±1.4 years. All patients were randomized into 2 groups. Group 1 included 49 patients with chronic heart failure and anemia who received only basic therapy, including angiotensin converting enzyme inhibitors, β-blockers, diuretics, digoxin, and nitrates. Group 2 included 43 patients with chronic heart failure, anemia and iron deficiency who received combination therapy with intravenous iron (III) hydroxide sucrose complex (Venofer) and basic therapy. In all patients on the treatment levels of hemoglobin, ferritin, transferrin saturation, erythropoietin, N terminal pro brain natriuretic peptide, interleukin 1, interleukin 6, tumor necrosis factor α in plasma, parameters of systolic and diastolic function of the left ventricle myocardium by echocardiography and doppler echocardiography were evaluated dynamically.

Results. In patients with chronic heart failure of I-IV NYHA class and anemia (group 1) on the background of basic therapy, no positive dynamics was registered for levels of hemoglobin, hematocrit, ferritin, transferrin saturation, erythropoietin, N terminal pro brain natriuretic peptide, interleukin 1, interleukin 6, and tumor necrosis factor α. In group 2 during therapy there was a significant increase of the level of hemoglobin, plasma ferritin and transferrin saturation.

Conclusion. Patients with chronic heart failure of I-IV NYHA functional class, anemia, iron deficiency and normoerythropoietinaemia or hypererythropoietinaemia, administration of intravenous iron (III) hydroxide sucrose complex (Venofer) with basic therapy is recommended.

Kazan medical journal. 2017;98(4):571-576
Role of thymidylate synthase as a predictor of neoadjuvant chemoradiation therapy in rectal cancer
Aliyarov Y.R., Melikova L.A., Kerimov A.K., Bagirova E.E., Mekhdizade S.G.

Aim. To study the level of thymidylate synthase gene expression in biopsy material from patients with rectal cancer treated with neoadjuvant chemoradiation therapy.

Methods. Analysis of treatment of 101 patients with locally advanced rectal cancer (T3-4, N0-2, M0) was conducted. Measurement of the level of thymidylate synthase gene expression was performed by polymerase chain reaction. To extract ribonucleic acid Qiagen (RNA easy FFPEkit; Qiagen,GmbH,Germany) reagents were used.

Results. Cancer pathomorphosis stage TRG 1 was revealed in 23 (22.7%) patients, TRG 2 - in 31 (30.7%) patients, TRG 3 - in 32 (31.7%) patients, complete clinical response (i.e. complete tumor resorption TRG 4) - in 15 (14.9%) patients. Analysis of thymidylate synthase gene expression in patients with poor response to chemoradiation therapy showed that in 34.8% of cases high expression was revealed, while in 65.2% of cases - low expression. Among patients with complete clinical response significant prevalence of patients with high expression of thymidylate synthase gene was revealed - 73.3%, and in 26.7% of patients with pathomorphosis of grade 4 low expression of this gene was registered. In patients with tumor regression grade 2 and 3 no significant difference in patients’ ratio was revealed. The most prominent correlation according to the level of thymidylate synthase gene expression was found in patients without the response to conducted chemoradiation therapy (with prevalence of patients with low expression) and complete tumor regression (with prevalence of patients with high expression).

Conclusion. There is inverse correlation between the grade of tumor regression and thymidylate synthase gene expression; evaluation of the level of thymidylate synthase gene expression and response of rectal cancer to neoadjuvant chemoradiation therapy requires further investigation both on molecular and clinical levels.

Kazan medical journal. 2017;98(4):576-580
Effect of combined methods of rehabilitation on respiratory system of overtrained athletes
Abbasova E.A.

Aim. Study of changes of athletes’ respiratory system developing after overtraining and its recovery due to combined rehabilitation (with the use of anti-gravity treadmill).

Methods. The control group (group 1) included active athletes - 35 people (with traditional training). All athletes with overtraining (group 2) were divided into two subgroups: group 2A (23 people) - overtrained athletes after combined rehabilitation (anti-gravity treadmill in combination with the traditional training) and group 2B (24 people) - overtrained athletes who had traditional rehabilitation. The stress test was carried out on a stationary KETTLER exercise bike (Germany).

Results. All parameters of external respiration function at rest in athletes of group 2A were statistically significantly higher than those of the athletes from group 2B. In athletes from group 2A peak expiratory flow rate achieved during the forced inspiration and expiration at rest were higher than those of athletes fron group 2B. After physical exertion all of the above mentioned parameters of external respiration function in athletes from group 2A were higher than in group 2B (p <0.05) both due to improved bronchial patency and increased capacity parameters that reflect restrictive lung properties.

Conclusion. Inclusion of anti-gravity treadmill into the program of combined rehabilitation for overtrained athletes provides significant improvement of external respiration function - increased restrictive and obstructive parameters of the lungs.

Kazan medical journal. 2017;98(4):580-585
Role of infections in autoimmune disease development
Moskalets O.V.
Since the discovery of immunologic tolerance phenomenon, active discussion of the role of genetic and environmental factors in autoimmune disease development has persisted. One of such factors is infections. Microorganisms are considered to be triggers of autoimmune diseases but their role is still not completely understood. Animal experiments conclusively demonstrate how the certain microorganism or its antigen can cause autoimmune pathology. At the same time the results of clinical studies performed on patients with different autoimmune pathologies are hardly decisive and often are contradictory. It should be taken into account that patients with already existing disease were studied in most cases, so interpretation of the data on the association of certain causative pathogens with certain autoimmune pathology should be performed cautiously. The review contains key hypotheses about possible mechanisms of autoimmune reaction development in infections: hypotheses about latent antegens/cryptoantigens, antigen modification, superantigen presence, epitope spectrum extension, molecular mimicry, adjuvant and non-specific effect, antigen complementarity, and idiotypic-antiidiotypic interactions. Their advantages and disadvantages are presented, their comparison is performed. In most cases facts proving one of the hypotheses can be reconsidered in favor of another one. A number of early hypotheses need to be reviewed taking into account modern understanding of innate and adaptive immunity. As more data about relation between infection and autoimmunity is collected, new hypotheses can be developed integrating main claims of previous hypotheses and adding the new ones.
Kazan medical journal. 2017;98(4):586-591
Changes of various natural autoantibodies concentration in gestational complications
Zamaleeva R.S., Cherepanova N.A., Frizina A.V., Bukatina S.V., Frizin D.V.
Natural regulatory autoantibodies (immunoglobulins G) are one of the tools of the immmune system to control antigen-molecular organism homeostasis. Taking into account transplacental transfer of immunoglobulins G, determination and analysis of autoantibodies concentration during pregnancy promotes understanding of the immunopathological processes underlying normal and impaired course of gestation. The subject of autoantibodies is becoming more relevant due to the paradigm shift in modern medicine: a turn from treatment to disease prevention. The review analyzes scientific research in which the concentration of various natural autoantibodies was studied to predict such obstetrical complications as massive bleeding, fetoplacental insufficiency, preeclampsia, delayed fetal growth, and miscarriage. Studies which allow suggesting fetus’s pathological condition and perinatal pathology based оn the woman’s blood concentration of some regulatory autoantibodies are of particular interest. Autoantibodies to total myelin protein, proteins S-100 (Soluble at 100% saturation - Ca-dependent regulator of cellular functions) and MP-65 (membrane protein), double-stranded deoxyribonucleic acid, β2-glycoprotein, cardiolipin, low-density lipoproteins, total phospholipids, chorionic gonadotropin, phosphatidylserine, prothrombin, angiotensin II, membrane antigens of platelets, kidneys and liver mitochondria, nervous tissue components NF-200 (axonal specific protein), and GFAP (astrocyte filament protein), and neuron-specific enolase were the most important for pregnancy. Study and systematic analysis of the dependence of normal gestational course from the certain regulatory antibodies concentration in prregnant woman’s blood facilitate searching new methods for the earliest detection and prevention of the pathology of pregnancy and fetus.
Kazan medical journal. 2017;98(4):591-596
Skin microbiocenosis in children with atopic dermatitis
Zaynullina O.N., Pechkurov D.V., Khismatullina Z.R.
The review of domestic and foreign literature presents data on the quantitative and qualitative parameters of skin microbiocenosis in norm and atopic dermatitis. Issues of the role of horny layer of the epidermis as well as the role of the epidermal barrier function disorders in increasing susceptibility to infectious agents were considered. United pathogenetic concept of atopic dermatitis is not completely clear, as reflected by insufficient effectiveness of this disease treatment. The researchers associate it with significant but little-studied role of bacterial skin infections in children with atopic dermatitis. The review summarizes scientific evidence of the role of bacterial, viral and fungal infections in the development and progression of atopic dermatitis. It was shown that the hallmark of atopic dermatitis is increased patients’ skin colonization with bacteria, viruses and fungi. In maintaining of chronic skin inflammation in atopic dermatitis in children the role of Staphylococcus aureus is specifically emphasized. It was demonstrated that skin barrier function impairment contributes to the establishment of secondary infection, and at the same time pathogenic microbial contamination/infection enhances skin barrier disorder, which increases the possibility of antigen absorption through the skin creating a vicious circle leading to further activation of immune system and maintenance of chronic inflammation. The factors creating favorable conditions for the growth and development of bacterial and fungal microflora were distinguished, that predispose to atopic dermatitis complicated by secondary infection, providing aggravating effects on the course of atopic dermatitis in children and leading to the development of severe forms of the disease and resistance to concentional treatment.
Kazan medical journal. 2017;98(4):597-602
Social hygiene and healthcare management
Key performance indicators of homecare service for patients older than working age
Shlyafer S.I.

Aim. To analyze the performance indicators of hospitals at home for the patients older than working age in Russian Federation in 2011-2015.

Methods. Analytical and statistical methods were used. Performance indicators of hospitals at home for patients of pension age in Russian Federation were analyzed based on departmental and federal statistical observation forms during the period of 2011-2015.

Results. In the country during the period of 2011-2015, the number of people older than working age increased by 13.1% and their proportion in total population increased from 22.3 to 24.55% was revealed. In 2011-2015 the number of home care patients of pension age increased by 2.1%. Analysis of the distribution of the number of patients treated in hospitals at home of medical organizations showed that elderly were mostly treated in central district, district and city hospitals, and polyclinics. The average duration of hospital stay of patients older than working age in hospitals at home was 11.1 days and was one day less than the average duration of hospital stay of the elderly in health care organizations providing in-patient service (12.1 days).

Conclusion. Over 5 years, proportion of patients older than working age among all patients treated in hospitals at home increased from 57.1 to 64.3% was observed; in 2015 in the regions of the Russian Federation significant variance of the number of patients older than working age treated in hospitals at home (from 0.01 to 98.9 per 1000 population of corresponding age) was revealed.

Kazan medical journal. 2017;98(4):603-606
Periods of epidemic process of HIV infection and AIDS-related diseases in Perm Krai
Ivanova E.S., Charushin A.O., Vorob’eva N.N., Gibadulin R.G., Shelud’ko V.S., Zhalnin V.V.

Aim. To identify the periods of the development of epidemic process of HIV infection in Perm Krai, characteristics of the structure of key AIDS-related diseases.

Methods. Analysis of prevalence of HIV infection and AIDS-related diseases was performed in Perm Krai based on the data of official statistics for 1988-2015. For this purpose data were taken from retrospective study of original medical records (individual outpatient‘s medical cards), form №61 approved by the resolution of Rosstat №1 issued at 09.01.2008 «Information on the groups of HIV-infected patients». Frequency and the strucutre of key opportunistic infections at different periods of the epidemic process were identified.

Results. 5 periods of the development of epidemic process of HIV infection were identfied in Perm Krai during 1995-2015: period of sporadic, stable level of incidence (1995-1998), period of sudden increase of incidence determining epidemic issues (1999-2001), period of decreasing and stable incidence (2002-2006), periods of growth (2007-2010) and activation (2011-2015) of the epidemic process due to sexual transmission of infection. In more than one third of the patients (33.29%) combination of opportunistic infections was registered that contributes to their severe course, diagnostic issues and untimely treatment. Parenteral route of transmission is the most prevalent among males (intravenous injection of drugs) and its proportion in the structure of transmission routes is 82.7±8.9%. Among females sexual transmission is prevalent.

Conclusion. In the dynamics of the development of epidemic process of HIV infection in Perm Krai (1995-2015) 5 periods were identified; at the modern stage among HIV infected patients AIDS-related diseases prevalently with central nervous system and internal organ damage are diagnosed: candidiasis, cytomegalovirus infection, toxoplasmosis, cryptococcosis and tuberculosis (stage 4b, 4c of HIV infection).

Kazan medical journal. 2017;98(4):607-612
The accessibility of information about medical services in the context of the social justice of health care
Savel’eva Z.V., Kuznetsova I.B., Mukharyamova L.M.

Aim. To reveal the spectrum of opinions and issues regarding accessibility of information about medical services and on-line booking of doctor’s appointments among population and experts.

Methods. The methods included semi-structured interviews and focus groups with population and experts. Total of 17 individual and group interviews with experts were conducted in the Republic of Tatarstan and 12 in the Republic of Mari-El (n=59 people); 28 individual interviews and focus groups with the population were conducted in Tatarstan and 13 in Mari-El (n=113 people).

Results. New informational technologies with a positive impact on openness and accessibility of health care system have nevertheless some serious issues in realization connected with organizational, infrastructural, economic, social cultural and psychological factors: (1) insufficient information provided to the population about the state warranties of health care program; (2) inaccessibility of websites for some prevention and treatment facilities; (3) age inequality both in access to information about the services and in on-line booking of doctor’s appointments.

Conclusion. There is an urgent need for goal-directed policy to overcome inequality in the access to information among different social groups, and also for creation of equal conditions for development and supporting informational technologies in medical institutions and centers.

Kazan medical journal. 2017;98(4):613-617
Clinical observations
Clinico-morphological characteristics of a rare case of pleomorphic cardiac rhabdomyosarcoma
Gadzhieva L.R., Pirogov Y.S., Pavochkina E.S.
Pleomorphic sarcomas are a group including some of poorly differentiated mesenchymal malignancies, which differ in morphology, molecular and biological properties and clinical outcomes. They are relatively rare tumors comprising, by different assessments, 5 to 7% of all mesenchymal malignancies. The tumors affect soft tissues of the limbs, body, retroperitoneal space and mediastinum. The morphologic substrate of pleomorphic sarcomas is polymorphic tumor cells of fibroblast cell lines, smooth myocytes, rhabdomyoblasts, Schwann cells, etc. Accuracy of morphologic diagnosis of pleomorphic sarcomas ranges between 13 to 26%. In practice it means that histological type of pleomorphic sarcoma is correctly defined only in a quarter of patients. Meanwhile, the importance of defining the histological type before starting the treatment is explained by the fact, that accurate histological and simultaneous molecular characteristics of pleomorphic sarcomas points the way to selective therapy of such tumors. The article presents the results of our observation of a 27-year-old patient with pleomorphic cardiac rhabdomyosarcoma. In this case cardiac tumor, first defined during echocardiography, is one of metastases of pleomorphic rhabdomyosarcoma of neck soft tissues. But at retrospective analysis its primary nature cannot be ruled out. The difficulties of morphologic diagnosis occurring during tumor verification are objective as the diversity of tissues - sources of pleomorphic sarcomas - creates extremely complex histological presentation and exceptionally embarrasses defining the histogenesis of the tumor.
Kazan medical journal. 2017;98(4):618-621
Clinical experiences
Use of a physiotherapeutic device for complex treatment of inflammatory diseases of prostate
Zhiborev B.N., Zhiborev A.B., Rakcheev B.Y.

Aim. Evaluation of efficacy of complex treatment of patients with the diagnosis of chronic prostatitis and patients with the main diagnosis of benign prostatic hyperplasia and concomitant chronic prostatitis with the use of physiotherapeutic device for the treatment of inflammatory prostatic diseases «MAVIT».

Methods. Clinical efficacy of the treatment with the use of the «MAVIT» device was studied in complex treatment of 45 patients with chronic prostatitis. Group 1 consisted of 25 patients diagnosed with stage I-II benign prostatic hyperplasia complicated with chronic prostatitis. Group 2 included 20 patients with proven diagnosis of chronic prostatitis. Efficacy was evaluated immediately after the course of treatment and during the following 12 months. For evaluation of biotissue influence of the «MAVIT» device on blood flow in prostate, transrectal color Doppler ultrasound was performed in 10 patients from group 2 before and after physiotherapeutic session. Peak flow rate, index of peripheral vascular resistance as well as organ vascular density were studied.

Results. The treatment results were evaluated in both groups at months 3 to 12. All patients reported reduction or disappearance of dysuria, subjective improvement of urination, reduction of pain in genitals. Improvement of urination was registered based on the results of examination (IPSS scale, uroflowmetry, ultrasound of prostate, residual urine, transrectal color Doppler ultrasound).

Conclusion. In patients with symptomatic benign prostatic hyperplasia at conservative stage of the disease complex treatment of chronic prostatitis with the use of physiotherapeutic factors has pathogenetic value and, if necessary, allows preparing a patient for the surgery; the received results allow recommending the «MAVIT» device for the treatment of chronic prostatitis including patients with stage I-II benign prostatic hyperplasia.

Kazan medical journal. 2017;98(4):622-628
Results of the treatment of the marginal periodontium inflammation with the use of diode laser prior to orthopedic rehabilitation
Maksimova N.V.

Aim. Evaluation of the results of treatment of marginal periodontium inflammation with the use of diode laser prior to prosthetic treatment with fixed prosthetic constructions.

Methods. The study involved 54 patients with a diagnosis of moderate or severe chronic generalized periodontitis referred by orthopedists for the treatment of marginal periodontium inflammation at the stage of preprosthetic preparation. All patients were divided into 2 groups. The study group consisted of 33 patients who underwent conservative treatment with the use of diode laser. The comparison group consisted of 21 patients who underwent anti-inflammatory treatment with the use of Vector Paro device. The study results were evaluated 3, 6 and 12 months after the procedure.

Results. On examination after 5 days hyperemia and edema of the gum significantly decreased in 36% of patients in the study group (they had repetitive procedure of laser curettage performed) and totally disappeared in 64%. Also no bleeding on probing was registered, the gum was firmly against the tooth tissue. All patients from the study group reported clinically significant decrease of bleeding according to Muhlemann-Saxer papillary bleeding index. Before treatment in patients from both groups the periodontal pocket depth was in average 4.98±1.96 mm and the proportion of pockets deeper than 4 mm was 24.4%. Gum recession was in average 0.94±1.02 mm.

Conclusion. Use of laser therapy with high intensity diode laser in the complex treatment of periodontal diseases is reasonable and effective as it allows achieving stable remission, that is proved by clinical examination and indices, and significant reduction of periodontal treatment duration prior to orthopaedic treatment.

Kazan medical journal. 2017;98(4):628-631
Use of TI-RADS system in differential diagnosis of thyroid cancer
Timofeeva L.A., Aleshina T.N.

Aim. To evaluate the effectiveness of ultrasound classification of thyroid palpable abnormalities using TI-RADS system for thyroid cancer detection in the Chuvash Republic.

Methods. The study is based on the results of examining of 296 patients (study group) with thyroid palpable abnormalities. All patients from the study group had multi-parametric ultrasound imaging performed using modern methods and techniques (B-mode, color and power Doppler mapping). Based on ultrasound data received, signs of malignancy of thyroid palpable abnormalities by TI-RADS system were identified. Data from ultrasound protocols were compared with cytological and morphological findings. Fine needle biopsy was used as «gold standard» for the diagnosis of thyroid cancer.

Results. All patients from study group were divided according to echographic characteristics into 4 subgroups by TI-RADS scale: TI-RADS 3, TI-RADS 4a, TI-RADS 4b, TI-RADS 5. Out of the total number of patients thyroid cancer in TI-RADS 3 subgroup was determined in 14 (4.7%) cases, TI-RADS 4a - in 36 (12.2%), TI-RADS 4b - in 66 (29.1%), TI-RADS 5 - in 160 (54.0%) cases. Among patients from TI-RADS 3 subgroup papillary cancer was detected in 6.7% (11) cases, follicular cancer - in 2.5% (3); in TI-RADS 4a subgroup papillary carcinoma was detected in 61.1% of cases, follicular cancer - in 36.1%, medullary cancer - in 2.8%; in TI-RADS 4b in 76.4% of cases papillary carcinoma was detected, in 31.4% - follicular cancer and in 1.2% - medullary cancer; in TI-RADS 5 subgroup in 46.3% of cases papillary carcinoma was detected, in 46.9% - follicular cancer, in 5.6% - medullary cancer and in 1.3% - anaplastic carcinoma was detected.

Conclusion. Suggested TI-RADS classification makes it possible to standardize thyroid ultrasound protocol; introduction of TI-RADS classification into algorithm of early radiological diagnosis of thyroid cancer allows improving thyroid cancer diagnosis.

Kazan medical journal. 2017;98(4):632-636
Experience in performing posterior separation plasty in giant postoperative ventral hernias
Malkov I.S., Filippov V.A., Shaymardanov R.S., Korobkov V.N., Gubaev R.F., Erkhu E.E.

Aim. To present the experience in performing posterior separation plasty according to Yu. Novitskiy, to evaluate the efficacy and safety of the technique.

Methods. The results of treatment of 22 patients with giant middle postoperative ventral hernias, treated in the surgical department №1 of Kazan City clinical hospital №7 in 2013-2016, were analyzed. 9 patients had open posterior separation plasty of the abdominal wall in Yu. Novitskiy’s modification performed (study group). Comparison group included 13 patients who had standard tension-free inlay-plasty.

Results. The average duration of surgery in the study group was 143.9±10.7 min, in comparison group - 136.6±12.1 min. In the study group there were no serious complications in the immediate postoperative period. In 3 cases at control ultrasound examination clinically insignificant seromas were found which did not require additional treatment and self-resolved within the period of 3 weeks. In one case there was lymphorrhea from the wound for 9 days. Healing of a surgical wound in all cases was by primary intention. Average hospital stay was 10.2±0.6 days. There were no lethal outcomes. Recurrence of the disease in the observed period was not registered.

Conclusion. Posterior separation plasty of the abdominal wall in Yu. Novitskiy’s modification is a safe and effective technique that allows recommending this surgery to the surgeons operating patients with giant postoperative ventral hernias.

Kazan medical journal. 2017;98(4):636-640
Digital radiography in the diagnosis of coronary calcinosis: capabilitites and perspectives
Sultanova M.D.

Aim. To study the capabilities of digital radiography in the diagnosis of coronary calcifications and to perform a comparative analysis of the received results with the results of multidetector computed tomography.

Methods. We analyzed in a comparative aspect the results of examination of 90 patients who underwent both types of diagnostic procedures. Among the patients, 46 were males, 34 were females, the average age was 59±4.3 years, and the age of male patients was significantly higher than that of female patients. Statistical analysis was performed using variational, discriminant, correlation methods, evidence-based medicine methods and ROC-analysis.

Results. A comparative analysis of the results showed that the reason, why coronary calcifications visualized in all arteries at multidetector computed tomography are not visible on digital X-ray, is their decreased firmness, so these calcifications were soft enough. Visualization of calcifications on digital chest X-ray is limited to certain calcium score values, which for anterior interventricular branch of left coronary artery is 355, for circumflex branch of the left coronary artery - 385, for right coronary artery - 367, for left main coronary artery - 393, for aortic arch - 396. Coronary calcifications with similar and higher calcium score values can be detected with digital radiography, which allows integrating this method in screening for cardiovascular diseases risk. The sensitivity, specificity and overall value of digital radiography for the detection of coronary calcifications were 59.5±3.3, 85.5±2.9 and 70.0±2.4, respectively.

Conclusion. Detection of coronary calcifications in digital radiography is limited to certain calcium score values; in all coronary arteries at multidetector computed tomography, as the calcium score of coronary calcifications increases, the sensitivity and spesifity of their visualization in digital X-ray examination increase as well.

Kazan medical journal. 2017;98(4):640-644
Percutaneous endoscopic microgastrostomy as a method of the long-term enteral nutrition therapy and therapeutic treatment of patients
Samigullin M.F., Bilalov I.V., Duglav E.A., Kosolapova T.V., Kundukhova F.T., Khabibulina A.R.

Aim. Analysis of the experience of percutaneous endoscopic microgastrostomy use for the long-term enteral nutrition therapy and therapeutic treatment of patients with Parkinson’s disease.

Methods. The group of 4-year observation period (2012-2016) included 20 patients aged 55 to 72 with severe form of Parkinson’s disease, mostly males. All patients had microgastrostomy performed in 2008-2012 with the use of «Frezenius» set. Through microgastrostomy levodopa-carbidopa was administered by microdrainage to jejunum.

Results. During the first year of functioning of gastrostomy the following complications occured: gastric juice leakage to the skin surface causing the skin maceration (in 2 cases), growth of hypergranulations around gastrostomy (in 3 cases), prolapse of the supporting ring of microgastrostomy to subcutaneous fat causing abscess (in 2 patients). By the end of the fourth year of observation 3 more patients developed prolapse of microgastrostomy to subcutaneous fat without suppuration. The authors in each certain case used different preventive methods and treatment of complications. To prevent gastric juice leakage and growth of hypergranulation, correction of tube fixation and local treatment are necessary; to prevent prolapse of the supporting ring of gastrostomy use of prolene mesh is appropriate. The microgastrostomy should be changed once in 3-4 years with proper care. When microdrainage is used for medication administration through gastrostomy to jejunum, its replacement is necessary at least once in 2 years to prevent bezoar development on catheter.

Conclusion. Puncture microgastrostomy performed under endoscopic control can be effectively used for long-term nutrient and medications administration to digestive tract.

Kazan medical journal. 2017;98(4):645-649
History of medicine
The pages of history of Kazan scientific school of dermatology: the life and work of V.F. Burgsdorf
Fayzullina E.V., Fedorova N.A., Leukhin R.V.
The article briefly covers the main stages of life and activities of V.F. Burgsdorf (1864-1935), his scientific achievements and priorities as the founder of one of Russian largest scientific schools, representatives of which made a huge contribution to the development of domestic dermatology. Special attention was paid to the contribution of V.F. Burgsdorf to the creation of the second in Russia phototherapy department in A.G. Ge’s Dermatology and Venereology clinic in Kazan, on the territory of which Republican Dermatology and Venereology Dispensary is currently located. The work in A.G. Ge’s (1889-1925) Dermatology and Venereology clinic became one of the most productive periods of life and activities of V.F. Burgsdorf. In November, 1900, V.F. Burgsdorf opened phototherapy department with support from professor A.G. Ge. Due to his medical and public authority V.F. Burgsdorf received large donations from Her Imperial Majesty the Empress Maria Feodorovna for further development of the department. V.F. Burgsdorf devoted most of his life to the development of treatment and prevention of skin and venereal diseases, organization of scientific research and improvement of medical education in Russia, and greatly improved the system of medical care for patients.
Kazan medical journal. 2017;98(4):650-656
Development of mental health system in Azerbaijan
Rasulov A.R.
The article describes the main stages of development of mental health system in Azerbaijan. The first «mental health institution» with 30 beds in Azerbaijan appeared in 1892 in the city of Baku. The need for expansion of mental health care, associated with the intensive growth of the population of the capital, led to the increase in the number of beds to 60, and in the beginning of the twentieth century another 60-bed psychiatric hospital was founded. After the establishment of Soviet power in Azerbaijan in the mid-1920s, the leadership of health care discussed the issues of organization of psychiatric care in the country. One of proposals was to create psycho-neurological institute and the colony for 150 mentally ill. In 1960s due to introduction of new therapeutic methods of treatment, more opportunities to treat patients on an outpatient basis appeared. In 1990s the decline of traditional mental health service occured. Currently in Azerbaijan a large-scale reform in the field of mental health is implemented. Protection of the rights of mentally ill, creating a modern community-based services, human resources development, participation in international research in the field of mental health are among priorities.
Kazan medical journal. 2017;98(4):656-661
Competition of student scientific research papers
Small intestine involvement in primary immunodeficiency
Borkhanova E.G., Chuklyaeva A.V.
Common variable immunodeficiency is the most frequent among all primary immunodeficiencies and is characterized by decrease of immunoglobulin secretion which causes the extent of clinical presentation of the disease. In 17-70% of patients with common variable immunodeficiency, lymphoid hyperplasia of organs of gastrointestinal tract is revealed due to which these patients come into the view of gastroenterologists. The article describes clinical observation of a patient with small intestinal involvement in common variable immunodeficiency.
Kazan medical journal. 2017;98(4):662-664

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