Vol 99, No 2 (2018)

Theoretical and clinical medicine
Prediction of adult-onset bronchial asthma in patients with metabolic syndrom in actual practice
Kosmynina M.A., Kupaev V.I.
Abstract

Aim. Adult asthma diagnosis optimization for patients with metabolic syndrome using prognostic methods.

Methods. The study included 46 patients with metabolic syndrome. Out of them, at the time of the study 31 subjects suffered from adult-onset bronchial asthma. All participants of the study had a history and complaints collected, and a clinical examination performed. Spirometry was used to assess the severity of bronchial obstruction syndrome. To assess the severity of metabolic syndrome components, glucose and fasting insulin concentrations, and lipid profile were determined, the homeostasis index of insulin resistance was calculated. Also in all participants the concentrations of leptin and endothelin-1 in the serum were determined.

Results. Risk of adult-onset bronchial asthma in a typical patient with metabolic syndrome spikes with maximal blood pressure higher than 154/90 mm Hg, and immunoglobulin E and leptin level higher than 33 ME/ml and 3.7 ng/ml, respectively. Blood pressure level affects adult-onset bronchial asthma pathogenesis only in combination with other metabolic syndrome components. Immunoglobulin E-mediated reactions play an important role in the pathogenesis of adult-onset bronchial asthma, and leptin acts as a regulator of pathogenetic mechanism.

Conclusion. Development of adult-onset bronchial asthma in patients with metabolic syndrome may be predicted on the basis of various variables; according to our data, those variables include maximum systolic and diastolic blood pressure levels, and levels of immunoglobulin E and leptin.

Kazan medical journal. 2018;99(2):181-187
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Prevalence and risk factors for pelvic organ prolapse in female citizens of Baku
Askerova M.S., Rzakulieva L.M.
Abstract

Aim. Study of prevalence and risk factors of pelvic organ prolapse in females in Baku.

Methods. Statistical observation unit was a woman aged 45-74 years. The sample size (710 women) was determined taking into account probable prevalence of pelvic organ prolapse (20% according to literature) and margin of error (3%). All women were invited to maternity welfare centre, and a thorough examination was performed after their written consent was obtained.

Results. The proportion of women aged 45-49, 50-54, 55-59, 60-64, 65-69, and 70-74 years was 26.5±1.7, 24.9±1.6, 23.1±1.6, 10.9±1.2, 8.2±1.0 and 6.4±0.9%, respectively. Prevalence of obesity in the named groups was 31.9, 34.5, 35.4, 36.4, 27.8 and 34.8%. Proportion of women with secondary and specialized secondary education was 58.5, 58.8, 53.7, 51.9, 51.7 and 67.4% resepctively. Among women of the corresponding age groups, physical work was recorded in 47.9, 53.7, 59.8, 58.4, 13.8 and 17.4% of cases, respectively. In past medical history, no surgeries were observed in 68.1, 77.4, 73.2, 77.9, 84.5 and 84.8% of cases, resepectively. Some women had no labour in past medical history (2.1, 2.3, 2.5, 2.6, 3.5 and 4.3% in the same age groups). Statistically significantly prevalence of pelvic organ prolapse increases among those aged 60 years and older (51.6±3.6% at age 45-49 years and ≥76.6±4.8% at age 60 years and older, р=0.001), with a body mass index less than 25.0 and more than 30 kg/м2 (69.7±3.3 and 66.7±3.0%, р=0.01), with high parity and remarkable family history (63.0±2.6, р=0.01), severe connective tissue dysplasia (72.6±2.5%, р=0.001), in postmenopausal period (63.8±2.0%, р=0.01), and depending on education level (88.0±2.4% among those with pre-secondary education: р=0.001). Relative risk of pelvic organ prolapse in the population of Baku is lower compared to the literature data in the background of obesity, but is higher in the background of positive family history and depending on the amount of deliveries (p=0.05).

Conclusion. In Baku 59.9±1.8% of women aged 45-75 years have pelvic organ prolapse of different severity, incomplete uterine and vaginal prolapse are more prevalent (41.3±1.8 per 100 women); prevalence of pelvic organ prolapse is higher in women aged 60 years or older compared to those aged 45-49 (76.6±4.8% vs 51.6±3.6%, р=0.001).

Kazan medical journal. 2018;99(2):187-194
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Connective tissue dysplasia in females with primary knee and hip osteoarthritis
Izmozherova N.V., Getmanova N.A., Popov A.A., Peretolchina T.F.
Abstract

Aim. Assessment of the prevalence of connective tissue dysplasia markers in women with primary knee and hip osteoarthritis.

Methods. 203 females were examined in a cross-sectional study, with median age 58 years (55-62 years) and duration of post-menopause for 8 years (5.0-12.0 years). Severity of postmenopausal syndrome was defined by modified menopause index scores with the assessment of neurovegetative, metabolic and endocrine and psychoemotional symptoms. Backache and joint pain were assessed by visual analogue scale. Osteoarthritis was diagnosed according to clinical and radiologic criteria.

Results. In 153 patients primary osteoarthritis stage 2-3 was diagnosed (group 1), group 2 included 50 patients without osteoarthritis. Screening for connective tissue dysplasia was performed by steps. At first, L.V. Solovyova’s phenotypic screening scale modified by T.F. Peretolchina was used, and cut-off score of 1.92 points was found in 6 (12%) patients without osteoarthritis and 44 (28.8%) in osteoarthritis group, that allowed suggesting connective tissue dysplasia. Then international M.J. Glesby phenotypic scale was used: 53 (34.6%) patients with osteoarthritis and only 1 (2%) subject without osteoarthritis had three and more phenotypic traits (χ2=18.925, р <0.001), that confirms connective tissue dysplasia. On step three, according to Russian guidelines on «Inherited disorders of connective tissue» (Russian scientific society of cardiology, 2012), among examined patients three phenotypes of connective tissue dysplasia were determined: (1) joint hypermobility syndrome; (2) increased dysplastic stigmatization and (3) increased, mostly visceral dysplastic stigmatization. The latter was more prevalent in females with osteoarthritis.

Conclusion. High prevalence of connective tissue dysplasia criteria in primary osteoarthritis patients confirms the presence of dysplastic osteoarthritis phenotype and necessity of personalized attitude to patient management.

Kazan medical journal. 2018;99(2):194-200
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Bone metabolism assessment in diabetes mellitus type 1
Safarova S.S.
Abstract

Aim. To evaluate the effect of changes occuring in the organism in diabetes mellitus type 1 on the state of bone mineral density and its metabolism parameters; to determine the changes in serum markers of bone remodeling and bone mineral density in this disease.

Methods. Bone mineral density (by dual-energy X-ray absorptiometry) and serum markers of bone remodeling (total alkaline phosphatase activity, level of aminoterminal propeptide of type 1 procollagen and C-terminal telopeptide) were examined in 98 patients with diabetes mellitus type 1 and in the control group consisting of 82 subjects.

Results. The average concentration of C-terminal telopeptide in the blood serum of patients with type 1 diabetes (0.525±0.03 ng/ml) was significantly higher in comparison to the control group (0.424±0.02 ng/ml; p <0.01). Proximal femoral T-score in type 1 diabetes was significantly lower than the average value in the control group: -1.44±0.15 and -0.49±0.17 (p <0.001). In the femoral neck it was -1.68±0.14 and -0.64±0.18 (p <0.001), in LI-IV zone -2.04±0.16 and -0.73±0.19, respectively (p <0.001). Moderate negative significant correlation was found between T-score (LI-IV) and level of C-terminal telopeptide (r=-0.431, p=0.000).

Conclusion. In patients with diabetes mellitus osteopenia is a relatively frequent complication, but bone loss increases with duration and decompensation of the disease; evaluation of bone mineral density and C-terminal telopeptide level (bone resorption marker) promotes detection of bone metabolism abnormalities at any stage of the disease, especially in the long-term course of type 1 diabetes.

Kazan medical journal. 2018;99(2):201-207
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To the question of electrophysiological remodeling role in the genesis of ventricular ectopy in patients with postinfarction cardiosclerosis
Mazur E.S., Mazur V.V., Jaber H.A., Orlov Y.A.
Abstract

Aim. To study the character and intensity of relationship between left ventricular dilatation, severity of electrophysiological myocardium remodeling and ectopic ventricular activity in patients with postinfarction cardiosclerosis.

Methods. 46 patients with postinfarction cardiosclerosis were examined (males, average age 57.9 years). All patients underwent echocardiography with detection of end diastolic volume of left ventricle and its ejection fraction, Holter monitoring with determining signal-averaged electrocardiogram and severity of ventricular ectopic activity with calculation of ventricular ectopic activity index. Based on the ejection fraction the patients were divided into two groups. Group 1 included 17 patients with ejection fraction ≥45%, and group 2 - 29 patients with ejection fraction <45%.

Results. Left ventricle ejection fraction in patients from group 2 was lower, and parameters of signal-averaged electrocardiogram were worse than in patients from group 1. Ventricular ectopic activity index in patients from group 2 was 5 times higher than the average index in group 1. According to correlation analysis in the combined group, signal-averaged electrocardiogram parameters more tightly correlated with end diastolic volume than with ventricular ectopic activity index. The latter more tightly correlated with end diastolic volume (r=0.67, p <0.001), than with signal-averaged electrocardiogram parameters. After calculating partial correlation coefficient and excluding the effect of end diastolic volume, correlation coefficients of ventricular ectopic activity index and signal-averaged electrocardiogram parameters became insignificant. The received data put in question the view that electrophysiological remodeling is an independent cause of severity increase of ventricular arrhythmias. More probable is that electrophysiological remodeling and ventricular ectopic activity are related pathogenetically, and correlation between them is determined by the fact that both depend on left ventricle end diastolic volume.

Conclusion. Relation between electrophysiological myocardium remodeling and ectopic ventricular activity in patients with postinfarction cardiosclerosis may depend on severity of left ventricular dilatation.

Kazan medical journal. 2018;99(2):207-212
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Efficacy of magneto-laser therapy in the treatment of ureaplasma infection
Aliev N.N., Zeynalov M.S., Alieva N.N.
Abstract

Aim. To study clinical and epidemiological data in males and females with ureaplasma infection and to evaluate efficacy of magneto-laser therapy used as additional treatment of ureaplasma infection.

Methods. 104 patients (94 men and 10 women) with urogenital ureaplasma infection were observed. Patients were divided into two groups: a study group (n=55) that received standard and magneto-laser therapy, and a comparison group (n=49) that received only standard treatment. Polymerase chain reaction was used to investigate samples for Mycoplasma hominis, Ureaplasma parvum and urealyticum, and bacteriological study for Mycoplasma hominis and Ureaplasma spp. was additionally performed with determining their antibiotic susceptibility. Magnetic therapy was conducted with the use of Michelangelo device (Italy) for 10 minutes to small pelvis area for 10 days.

Results. As a result, 78 (82.9%) males were diagnosed with uretritis, 52 (55.3%) with prostatitis, 37 (39.3%) with cystitis. In females monoinfection was more prevalent than in males (50.0% vs 40.4%). Ureaplasmosis predominantly affected subjects aged 20-29 (97.8%) and 30-39 (86.0%) years. In female group, patients aged 20-29 years prevailed, while in a male group - patients aged 30-39 years. In males, the association of Ureaplasma with Mycoplasma hominis (36.1%) prevailed.

Conclusion. Complex treatment of ureaplasma infection of urogenital tract including magneto-laser therapy demonstrated high clinical efficacy and allowed achieving clinical and laboratory cure of ureaplasma infection in 85.4% of cases.

Kazan medical journal. 2018;99(2):212-215
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Study of effectiveness of antiviral drugs (umifenovir, triazavirin) against acute respiratory viral infections
Tikhonova E.P., Kuz'mina T.Y., Andronova N.V., Tyushevskaya O.A., Elistratova T.A., Kuz'min A.E.
Abstract

Aim. Comparative study of clinical efficacy and safety of antiviral drug triazavirin and umifenovir in the treatment of patients with acute respiratory viral infections and influenza.

Methods. The study included 100 patients aged 18 to 65 years diagnosed with moderate acute respiratory viral infection. Group 1 included 34 patients receiving umifenovir 200 mg 4 times a day for 5 days, and comparison group included 32 patients who received triazavirin 1 capsule (250 mg) 3 times a day for 5 days. Group 3 (control group) included 34 patients not treated with antiviral therapy. Efficacy and safety of the studied antiviral drugs were evaluated based on clinical symptoms in the disease course and were confirmed by adaptive reactions of the organism.

Results. Among patients receiving triazavirin, recovery time and fever, headache and catarrhal syndrome resolution time were less than among patients who received umifenovir. On triazavirin treatment with favorable tolerability, symptomatic medications (antipyretics) were discontinued, and the duration of their use was less, than in patients receiving umifenovir. Evaluation of clinical efficacy of umifenovir and triazavirin for the treatment of acute respiratory viral infections and influenza demonstrated that the drugs effectively reverse the main symptoms of the disease (p <0.05), reduce complications incidence (18.1±2.1% vs. 55.9±3.2%, p <0.05) and contribute to the stabilization of adaptive reactions of the organism in contrast to the results of patients not receiving etiotropic therapy (6.9±2.9% vs. 12.8±2.7, p <0.05). During the use of umifenovir by day 4 and during the use of triazavirin by day 3 intoxication and catarrhal syndromes had been reversed, while in case of the absence of antiviral therapy, 55.8% of patients had continuing intoxication and catarrhal symptoms.

Conclusion. The results of the study allow defining umifenovir and triazavirin as the first line of defense against acute respiratory viral infections with good efficacy and tolerability of the drugs.

Kazan medical journal. 2018;99(2):215-223
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Some clinical morphological and molecular genetic aspects in patients with clinical signs of hereditary breast cancer
Shatova Y.S., Chebotareva E.A., Zlatnik E.Y., Novikova I.A., Vodolazhskiy D.I., Dzhenkova E.A.
Abstract

Aim. To study the clinical morphological and molecular genetic characteristics of clinically hereditary breast cancer with and without verified mutation of BRCA1, BRCA2 compared to sporadic breast cancer.

Methods. The study included 191 female patients with verified breast cancer stage I-IIA and clinical signs of hereditary breast cancer. In order to identify mutations in genes ВRCA1/2 molecular genetic analysis of deoxyribonucleic acid from peripheral blood leukocytes was performed.

Results. The total frequency of mutations in the genes BRCA1 and ВRCA2 amounted 14.1% of the total number of examined patients. The most common mutation in clinically hereditary breast cancer among residents of the Rostov Region was 5382insC in BRCA1 gene, which corresponds to the nationwide data. Also common features of hereditary breast cancer compared to sporadic breast cancer were identified: young age at the time of disease manifestation, high prevalence of triple-negative cancer, history of infertility, increased level of p53 and androgen receptor expression, decreased level of aneuploid cell and proliferation index in the tumor.

Conclusion. In a number of clinical morphological and molecular genetic parameters, clinically hereditary breast cancer differs from sporadic breast cancer. These indicators in the future can be used as criteria for selection of patients with clinically hereditary breast cancer without confirmed BRCA1/2 mutation by standard panels for in-depth genetic testing.

Kazan medical journal. 2018;99(2):224-229
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Early and long-term results of surgical treatment of Hirschsprung's disease in children
Polukhov R.S.
Abstract

Aim. To assess the safety, functional activity and quality of life of patients with Hirschsprung's disease operated by different methods.

Methods. The study included 86 children operated on for Hirschsprung's disease. Patients were divided into four groups: group 1 - 44 (51.2%) patients underwent Duhamel-Martin procedure; group 2 - 14 (16.3%) patients underwent Soave-Boley procedure; group 3 - 22 (25.6%) patients underwent transanal endorectal resection; and group 4 - 16 (18.6%) patients underwent laparoscopical Soave-Georgeson procedure. The results were comparatively evaluated immediately and one year after the surgery. To assess the quality of life after surgery, a visual questionnaire Peds QLtm 4.0 was used.

Results. Minimal duration of the surgery and related anesthesia was registered in groups 3 and 4, the difference with groups 2 and 3 being statistically significant (p <0.05). Duration of postoperative pain management in group 1 was 3.2±0.7 days, in group 2 - 3.3±0.7 days, while in groups 3 and 4 - 2.5±0.5 days (р ˂0.05). Minimal hospital stay after the surgery was registered in group 4 (9±2 days), which is less than in group 1 by 1.7 times, in group 2 - by 1,5 times (р ˂0.05). The second shortest hospital stay was observed in patients from group 3 (10±2 days): it was 1.4 and 1.3 times shorter tahn in groups 1 and 2, respectively (р ˂0.05). At the assessment of one-year functional results satisfactory results were obtained in group 1 in 20 (45.46%) patients, in group 2 - in 7 (50%), in group 3 - in 12 (54.55%), in group 4 - in 12 (75%) patients. Unfavorable results were observed in group 1 in 6 (13.64%) patients, in group 2 - in 2 (14.29%), in group 3 - in 2 (9.09%), in group 4 - in 0 (0%). The best quality of life according to all parameters was observed among patients from groups 3 and 4 (р ˂0.05).

Conclusion. The quality of life of patients with Hirschsprung's disease after transanal endorectal resection and laparoscopic Soave-Georgeson procedure was higher than after Duhamel-Martin and Soave-Boley procedures; Soave-Boley procedure is preferable due to good regulation of the defecation act by patients.

Kazan medical journal. 2018;99(2):230-234
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Presence of metabolic syndrome does not influence intima-media thickness and interadventitial diameter of main arteries in patients with type 2 diabetes mellitus
Rzaeva R.A.
Abstract

Aim. To evaluate intima-media thickness, interadventitial diameter of common carotid arteries and their ratio in patients with type 2 diabetes mellitus as well as in combination with metabolic syndrome, previously not receiving statins.

Methods. The results of Doppler ultrasound of common carotid arteries of 233 patients were analyzed. 73 of them were diagnosed with type 2 diabetes (49 males, 24 females, average age 59.2±9.13 years), 74 - in combination with metabolic syndrome (38 males, 36 females, average age 61.38±9.16 years), and 86 did not have neither type 2 diabetes nor metabolic syndrome (52 males and 34 females, average age 58.99±7.23 years). For variables with normal distribution, mean value (M) and error of mean (m) were used, and when comparing nonparametric parameters, distribution in contingency table and χ2 was used.

Results. Mean values of intima-media thickness of common carotid arteries and the ratio of intima-media thickness to interadventitial diameter were significantly higher (p <0.05), and interadventitial diameter was significantly lower (p <0.05) in the subgroups of patients with type 2 diabetes alone and in combination with metabolic syndrome compared to patients without these diseases. Significantly more frequently the cases of increased intima-media thickness and decreased interadventitial diameter of common carotid arteries were revealed on both sides in the subgroups with type 2 diabetes alone and combined with metabolic syndrome (p <0.001), that resulted in increased ratio of intima-media thickness to interadventitial diameter being indicative of general increase of arterial wall stiffness and decreased ability to compensatory remodeling in these categories of patients.

Conclusion. In patients with type 2 diabetes mellitus and its combination with metabolic syndrome previously not receiving statins, the values of intima-media thickness, interadventitial diameter and their ratio statistically significantly differ frome those in patients without type 2 diabetes and metabolic syndrome; the presence of metabolic syndrome does not influence values of intima-media thickness, interadventitial diameter and their ratio in patients with type 2 diabetes mellitus.

Kazan medical journal. 2018;99(2):235-239
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Experimental medicine
Biochemical changes in rat muscle tissue with prolonged use of simvastatin
Vinogradova E.V.
Abstract

Aim. Analysis of biochemical changes in rat muscle tissue after prolonged use of simvastatin.

Methods. The study was conducted on mongrel male rats. Three groups were identified: control group (intact animals), comparison group (animals with induced hypercholesterolemia not reeciving the drugs), and experimental group (animals with induced hypercholesterolemia receiving simvastatin 0.0012 g/100 g of weight once a day for 2 months as an aqueous suspension through the esophageal probe). Metabolite concentration of glycolysis (pyruvic acid and lactate), activity of antioxidant protection enzymes (reduced glutathione, superoxide dismutase, catalase, glutathione reductase, glutathione peroxidase), titin isoforms and proteolytic fragments of titin and nebulin concentration were determined in the muscles of animals.

Results. After administration of simvastatin to animals with induced hypercholesterolemia, a decrease in the concentration of glycolysis metabolites (pyruvic acid and lactate) compared to comparison group was revealed, as well as multidirectional changes in the activity of antioxidant protection enzymes (decrease in activity of superoxide dismutase, glutathione peroxidase, and glutathione reductase, decreased concentration of reduced glutathione, but catalase activity remained unchanged). The analysis of structural changes in animal muscle tissue after administration of simvastatin revealed a decrease in the concentration of NT- and N2A-titin isoforms and practically complete absence of nebulin compared to the animals from the comparison group. At the same time an increase in the concentration of proteolytic fragments of titin (T2) by 1.3 times was recorded.

Conclusion. The study showed that the basis of myotoxicity of statins in their long-term use is disintegration of enzyme antioxidant processes, as well as tissue hypoxia, leading to destruction of muscle fibers and prevalence of proteolytic processes.

Kazan medical journal. 2018;99(2):240-244
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Effect of pivaloyl-substituted pyrrole containing heterocyclic compounds on DNA repair pathways in Ewing sarcoma cells
Galembikova A.R., Boychuk S.V., Dunaev P.D., Khusnutdinov R.R., Zykova S.S.
Abstract

Aim. To examine deoxyribonucleic acid (DNA) damage repair and cell cycle regulatory mechanisms of Ewing sarcoma cells exposed to pivaloyl-substituted pyrrole containing heterocyclic compounds.

Methods. The study was performed on A673 Ewing sarcoma cell line. The tumor cells were incubated for 48 h in the presence of pivaloyl-substituted pyrrole containing heterocyclic compounds (compounds №20 and №24). Western blot analysis was utilized to examine expression of the markers of DNA single-strand (phosphorylated forms of ATR and Chk1) and double-strand breaks (phosphorylated forms of H2AX, АТМ, DNA-PK, BRCA-1, Chk-2). Analysis of the cell cycle phases was performed by flow cytometry (BD FacsCanto, USA).

Results. Pivaloyl-substituted pyrrole containing heterocyclic compounds substantially increased the expression of histone 2A phosphorylated on serine 138 (γ-H2AX) that indicates DNA damage (double-strand breaks). Under exposure to pivaloyl-substituted pyrrole containing heterocyclic compounds the studied cells increased expression of phosphorylated forms of ATM-kinase and BRCA-1. Also cell cycle disorders leading to substantial G2/M arrest and enhanced apoptosis of tumor cells were observed.

Conclusion. Pivaloyl-substituted pyrrole containing heterocyclic compounds induced DNA double-strand breaks in A673 Ewing sarcoma cell line; in response to DNA damage in tumor cells, the mechanisms of DNA double-strand breaks repair were activated; despite activation of DNA repair mechanisms, A673 cells underwent cell cycle arrest in the G2/M-phase and apoptosis.

Kazan medical journal. 2018;99(2):245-248
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Experimental purulent corneal ulcer in rabbits as a model to study ocular dosage forms
Ozhmukhametova E.K., Mussin M.N., Bayachmetov A., Adambosynov B., Khutoryanskiy V.V.
Abstract

Aim. The aim of this work was to develop experimental model of purulent corneal ulcer in rabbits for its application in the studies of ocular dosage forms.

Methods. Rabbits body temperature was measured in three groups: (1) without corneal injury; (2) with the injury and formation of purulent ulcer, but without any therapy; (3) with the injury and formation of purulent ulcer, treated with ciprofloxacin. In parallel, swabs containing purulent discharge were taken for microbiological analysis. In the end of 10-days experiment rabbits (groups 2 and 3) were sacrificed; their corneas were extracted and analysed.

Results. One day following the injury all rabbits had a purulent discharge, moderate eyelids edema and conjunctival hyperemia. Rabbits in groups 2 and 3 had a purulent corneal ulcer developed. The mean body temperature in group 1 was 38.6±0.1 °С; in group 2 it was 40.0±0.3 °С, in group 3 it was 39.1±0.3 °С. The levels of infection in group 2 in the beginning and on 10-th day of experiments were 1.0×107 colony forming units (CFU) and 4.3×106 CFU, respectively (not significant, p >0.1). In group 3 these levels were 1.0×107 CFU and 4.6×103 CFU, respectively (significant, p <0.0001). The histological investigation of enucleated eyes with corneal ulcers revealed the presence of edema, stratification, deep epithelial defects, endothelium desquamation, and corneal infiltration by neutrophils.

Conclusion. Formation of a corneal ulcer leads to an increase in animal body temperature, which depends on timely therapy. Rectal temperature measurements in rabbits could serve as an easy parameter to follow the development of inflammation.

Kazan medical journal. 2018;99(2):248-254
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Antiimmunosuppressive action of 3d-metal gluconates in experimental immunodeficiency
Knyazeva O.A., Urazaeva S.I., Konkina I.G., Saptarova L.M., Gazdalieva L.M., Murinov Y.I.
Abstract

Aim. Evaluation of the effect of 3d-metal gluconates on complement-fixing function of immunoglobulin G and functional activity of complement.

Methods. The study was conducted in vivo on 2.5-3 month-old white laboratory mice weighing 25-28 g with secondary immunodeficiency, which was induced by a single intraperitoneal injection of cyclophosphamide, as well as in vitro in a test system using sensitized sheep erythrocytes. Immunological studies were performed in intact animals, and before and after the administration of Mn, Co, Cu, and Zn gluconates to mice with induced immunodeficiency. The content of immunoglobulin G and its complexes with subcomponent of the complement first component C1q was determined in serum by ELISA using specific monoclonal antibodies.

Results. Two-week oral administration of 3d-metal gluconates (Mn, Co, Cu, Zn) in a dose of 1/10 LD50 to immunodeficient mice was shown to cause a significant increase in the level of immunoglobulin G and its complexes with C1q. The greatest increase in concentration was observed with the introduction of zinc gluconate. Also by means of sensitized sheep erythrocytes in vitro, cobalt and, to a lesser extent, manganese gluconates were shown to increase the functional activity of C1q.

Conclusion. 3d-metal gluconates (Mn, Co, Cu, Zn) demonstrate immunocorrecting properties: increase the content of immunoglobulin G and its complexes with C1q, significantly decreasing as a result of cyclophosphamide effect; cobalt and manganese gluconates have a stimulating effect on the functional activity of complement by its classical pathway, which indicates different mechanisms of immunocorrection action of studied metal gluconates and requires further studies.

Kazan medical journal. 2018;99(2):255-259
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Reviews
Pathophysiologic aspects of the development of cognitive disorders in chronic heart failure in elderly patients
Pokachalova M.A., Silyutina M.V.
Abstract

The present literature review presents current views on pathophysiologic aspects of the formation and progression of cognitive disorders in chronic heart failure in elderly patients. Advanced age itself is an important predictor of the development of cardiovascular, neurodegenerative and other diseases. Involutive changes of cardiovascular system are known to potentiate the development of chronic heart failure. Heart failure in older people usually develops gradually. Formation of the cognitive deficit in heart disease is associated with chronic cerebral ischemia as well as a cascade of neurochemical processes occurring in the brain, eventually forming a vicious circle. Often the symptoms of cerebral ischemia due to reduced stroke volume occur much earlier than congestion signs in other organs and systems. Chronic cerebral ischemia that occurs due to violation of cerebral hemodynamics, is associated with both extracerebral and intracerebral causes, which in turn contributes to the development of chronic brain hypoxia and aggravation of cognitive dysfunction. Thus, the features of the development and course of disease in people of older age groups indicate that in geriatric practice existing diagnostic schemes are not always applicable. When observing patients of elderly and senile age with chronic heart failure, during the assessment of their condition and running diagnostic tests, special attention should be payed to the earliest detection of cognitive dysfunction signs in order to correct the patient's treatment and improve quality of life.

Kazan medical journal. 2018;99(2):260-264
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Medical thermography: capabilities and perspectives
Morozov A.M., Mokhov E.M., Kadykov V.A., Panova A.V.
Abstract

Medical thermography is a modern diagnostic method that is currently gaining popularity due to high informative value and non-invasiveness. The aim of the study was to review the capabilities and prospects of medical thermography in modern medicine. The analysis of domestic and foreign literature on the application of medical thermography methods for the period of 2012-2017 was performed. The article presents the capabilities of imaging in various fields of medicine, evaluates the prospects of further development of the method, advances and disadvantages of thermography were identified. It also provides the review of the application of medical infrared thermography in clinical medicine. The experience of thermography application in various medical fields was investigated: angiology, otolaryngology, surgery, neurology, obstetrics and gyenecology, etc. Apart from medical aspects of this topic, the article discusses the history of medical thermography as well as provides the physical principles of this method. At present, thermal imaging can solve a wide range of problems: determining the presence of changes in the human body, and, as a result, the probability of pathology development, monitoring the effectiveness of treatment and rehabilitation. Every year more and more studies are carried out, confirming the high efficiency, reliability and safety of thermography, thermographic screenings are suggested, that can be assumed as prediction of future method's popularity.

Kazan medical journal. 2018;99(2):264-270
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Etiopathogenic bases for patellofemoral arthritis development
Said F.M., Akhtyamov I.F., Kudryavtsev A.I., Nuriakhmetov A.N.
Abstract

Patellofemoral arthritis is nowadays an actual issue of traumatology and orthopedics. High prevalence of this pathology around the world (6.9 to 36.1%) is associated with multiple etiological causes, responsible for certain difficulties in diagnosis and complexity of determining an individualized pathogenetic method of treatment. The pathology, often occurring in the young age, is called «delayed or late arthritis», due to the fact that it is often ignored in the early stages of its development. This leads, in the final stages of disease, to manifestation of classic osteoarthritis involving all the structures of the knee joint in the process. The literature review is devoted to the study of etiology, pathogenesis and anatomical features of the development of patellofemoral arthritis. From the clinical point of view, the most important factors, influencing patellofemoral arthritis course, are analyzed. They include mechanisms of the disease, anatomical features of patella, trochlear surface and femoral condyles, which affect the disease course. The article discusses the risk factors of patellofemoral arthritis, such as weakness of vastus muscles of quadriceps femoris, increased knee Q-angle, increased femoral anteversion and tibial rotation, abnormalities of patellar and tibial epicondyles morphology. In addition the study presents some data about dysplasia of the condyles and femoral trochlea and patella, disposition of the patella and dysplasia of the quadriceps. Variations of configuration and position of patella affecting its stability are described and presented. The article also focuses on the influence of internal tibial rotation and femoral anteversion on the development of disease, as well as patellar instability as a multifactorial cause.

Kazan medical journal. 2018;99(2):270-278
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Pathogenetic justification for the therapy of idiopathic thrombocytopenic purpura (primary immune thrombocytopenia) in adults
Zotova I.I., Gritsaev S.V.
Abstract

The review presents current data on key mechanisms of the pathogenesis of idiopathic thrombocytopenic purpura and comparative characteristics of main therapy methods. In recent years, the interest in studying this long known disease has significantly increased, and basic approaches to diagnosis and treatment have been revised. Recognition of the importance of immune-mediated mechanism of development of this disease led to the replacement of the term used for many years «idiopathic thrombocytopenic purpura» to «immune thrombocytopenia». Moreover, development of hemorrhagic manifestations (purpura) is known to be characteristic not for all patients. The basis for the disease development is imbalance between the process of platelet production and destruction, as reflected in decrease of platelet production and increase of their elimination. Conventional treatment methods such as corticosteroids and splenectomy are directed at the suppression of a complex of cell interactions that lead to increased platelet destruction. Modern therapy for idiopathic thrombocytopenic purpura - thrombopoietin receptor agonists, on the contrary, stimulate the platelet production and are recommended for the use when loss or lack of response to previous therapy are observed. Most likely the efficacy of these drugs in resistant idiopathic thrombocytopenic purpura is associated with a fundamentally different, alternative mechanism of action. The idiopathic thrombocytopenic purpura group of patients is heterogeneous both in the character of the disease course and possible response to treatment. A limited number of clinical trials of some treatment methods for idiopathic thrombocytopenic purpura and differing criteria for assessing the response to therapy complicate their direct comparison. The imperfection of certain treatment options, due to development of adverse events, and unpredictability of response to treatment necessitate the search for new approaches to the selection of the optimal variant of treatment of idiopathic thrombocytopenic purpura taking into account the individual characteristics of patients.

Kazan medical journal. 2018;99(2):279-286
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Social hygiene and healthcare management
Epidemiologic aspects of breast cancer incidence in Baku
Vatankha S.S.
Abstract

Aim. Study of incidence and mortality from breast cancer in different administrative territorial districts of Baku in 2016.

Methods. Statistical report forms №7 were used (reports on malignant neoplasms of the Ministry of Healthcare of Azerbaijan Republic) as well as the database of cancer registry of the National center of oncology of Baku in 2016. Primary incidence index (per 100 000), standardized incidence ratio (per 100 000), prevalence rate (per 100 000), extensive index (% compared to other types of oncologic pathology revealed in Baku in 2016), lethal index (%), crude mortality rate (per 1000), aggressiveness index were calculated.

Results. In the structure of malignant neoplasms in Baku among females, breast cancer takes the first place (extensive index 31.6%). 7.4-fold variation of breast cancer morbidity in different administrative districts was observed (p <0.05) - from 142.4 per 100 000 in Yasamal raion of Baku to 19.1 per 100 000 in Qaradag raion (p <0.05). Variation of prevalence rate was less prominent (3.1 times, p <0.05): from 655.8 per 100 000 in Sabail raion to 209.4 per 100 000 in Binagadin raion. Crude mortality rate was similar in all districts and varied from 0.1 to 0.5 per 1000. More than 30-fold variation of lethal index was observed with the average index in Baku of 17.3%. The more distantly from the center of the city the district is located, the higher the lethal index was (p <0.05). One of the main parameters determining neoplasm prognosis was extension of tumor at the moment of its diagnosis. Among primary patients, those with clinical stages I-II prevailed (59.3%), the proportion of patients with stage III was 22.0%, stage IV - 18.7%. Agressiveness index varied from 0.1 (in Pirallahi raion) to 0.5 (in Binagadin and Sabail raions), the total city index was 0.4. With the growing age, increasing standardized incidence ratio was observed, and its peak value was in the age group 50-59 years (14.5 per 100 000). Generally, in Baku breast cancer incidence among females regardless of their age was 47.7 per 100 000, and it was significantly higher in Baku than generally in the republic (35.0 per 100 000, p <0.001).

Conclusion. The first place in the structure of oncology diseases among female citizens of Baku is taken by breast cancer (31.6%), women aged 50-70 years have the highest risk of the disease; the highest lethal index was reported for females with breast cancer living in the most distant districts of Baku that indicates the necessity for improved preventive activity in those districts.

Kazan medical journal. 2018;99(2):287-290
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Reproductive health of women after abdominal delivery living in different regions of the Kyrgyz Republic
Samigullina A.E., Vybornykh V.A.
Abstract

Aim. Study of somatic and obstetric and gynecologic morbidity of women of the Kyrgyz Republic after Cesarean section.

Methods. Retrospective cohort study was conducted in 2016 in Kyrgyz state medical institute of retraining and advanced training. Three regions of the Kyrgyz Republic were selected: Bishkek, Jalal-Abad and Issyk-Kul regions. 908 pregnant women after abdominal delivery were chosen as the subject of the study and divided into three groups: group 1 (Bishkek) - 305 pregnant women, group 2 (Jalal-Abad region) - 300 females, group 3 (Issyk-Kul region) - 303 females. The age was 15 to 49 years. The incidence of gynecologic and extragenital pathology and complications during previous pregnancies were studied.

Results. Gynecologic pathology in past medical history was revealed in 15.8% of females, while women from group 1 are statistically significantly more likely to have gynecologic diseases than women from group 3. Females from group 2 had gynecologic pathology more rarely. In the structure of gynecologic incidence, sexually transmitted infections take the first place, cervical ectopy takes the second place and uterine fibroids - the third place. Extragenital pathology was detected in 38.2% of pregnant women. In its structure the first ranked place is taken by urinary tract diseases (12.3%), the second one - by infectious and parasitic diseases (11.6%), and the third place - by cardiovascular diseases (3.2%). Pathological course of pregnancy was also more frequent in group 1 than in group 2; there was no significant difference with group 3. Spontaneous abortion interrupted previous pregnancy in 19.8% of women, 5% had premature births, significantly more frequently in group 1, as well as preeclampsia.

Conclusion. The most unfavorable region is the city of Bishkek, female residents of Jalal-Abad region are less susceptible to diseases; in general, gynecologic pathology was revealed in 15.8% of females, extragenital pathology - in 38.2% of pregnant women; pathological course of pregnancy was statistically more frequent in group 1 than in group 2, without significant difference with group 3.

Kazan medical journal. 2018;99(2):291-296
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Analysis of the incidence of dermatomycosis in Azerbaijani Republic during 2000-2016
Ahmedova S.D.
Abstract

Aim. To conduct epidemiological analysis of the incidence of dermatomycosis (superficial mycoses of skin and its appendages) in the Republic of Azerbaijan during 2000-2016, as well as clinical epidemiological monitoring during 2011-2016.

Methods. Analysis of incidence of visits was performed in the Republican dermato-venerologic clinic, children's republican dermato-venerologic dispansary №3, city dermato-venerologic dispansary №1 of the Republic of Azerbaijan according to the forms of state statistical observation №9 («Information about predominantly sexually transmitted diseases, fungal skin infections and scabies») approved by the decree of Azerbaijan State Statistical Commission No. 72/5 issued on 04.12.2000. Clinical analysis of dermatomycosis incidence during 2011-2016 was performed based on the results of laboratory (microscopic) verification of mycelium of the fungus.

Results. During 2000-2016 in the Republic of Azerbaijan steady increase of the incidence of superficial mycoses of skin and its appendages was observed. In 2000 the incidence was 2783. In 2016, 12 630 cases were recorded, which is the peak value and is 4.5 times higher than in 2000. Clinical analysis of incidence of superficial mycoses of skin and its appendages in 2011-2016 demonstrated that the diagnosis of pityriasis versicolor (keratomycosis) took the leading place (33.5%). The second place in the prevalence was taken by smooth skin mycoses (32.7%), the third place - by candidiasis (skin and visible mucous membranes - 17.1%), the fourth place - by onychomycosis (14.5%), and the last place - by mycosis of the scalp and face (2.2%). Young population (10-20 years) is susceptible to keratomycosis, and adult population (30-50 years) - to smooth skin mycosis. We suggest that it is related to climate-geographic features, increased insolation, and as a result - to sweating and to disordered lipid-alkaline protective skin barrier. To confirm our hypothesis further investigation is necessary.

Conclusion. Incidence of superficial mycoses of skin and its appendages, increased by 4.5 times was revealed; the leading position in prevalence is taken by pityriasis versicolor, the second - by smooth skin mycoses and the third - by skin and visible mucous membranes candidiasis.

Kazan medical journal. 2018;99(2):296-300
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Clinical observations
Paraneoplastic Sjogren’s syndrome in gastric cancer
Khamitov R.F., Molostvova A.F., Salimova L.M.
Abstract

In clinical practice, various masks of oncological diseases are often found. Some of them can manifest as a variety of syndromes or symptom complexes that resemble many non-oncologic diseases, including diffuse connective tissue diseases. In some cases, paraneoplastic syndrome facilitates diagnosing a malignant neoplasm in the early stages, but, unfortunately, can also mimic the tumor process by its more prominent manifestations, which lead to late establishment of the true cause of the disease, and therefore postpone specific treatment, creating significant clinical problems. Aim of the study was to reveal pathogenetic relationship between cancer and paraneoplastic syndrome on the example of our clinical observation. A clinical case of diagnosed paraneoplastic syndrome in the form of secondary Sjogren's syndrome, which developed long before the diagnosis of stomach cancer was made, as well as the results of clinical, instrumental, and laboratory examination of the patient, are presented. Questions of epidemiology, etiopathogenesis, and clinical picture of paraneoplastic syndrome are covered. The presented clinical case made it possible to outline the features of the course of paraneoplastic Sjogren's syndrome in gastric cancer and to identify a number of criteria for the diagnostic algorithm of this nosology. In particular, such criteria include general pathogenetic mechanisms, development only in malignant tumors, nonspecific clinical and laboratory manifestations, lack of parallelism with local symptoms of the tumor, the possibility of occurrence of paraneoplastic Sjogren's syndrome before development of local tumor symptoms and reappearance after its relapse. Oncologic diseases are characterized not only by specific symptoms characteristic for a certain organ damage (pain, bleeding, dysfunction, etc.), but also by a variety of nonspecific manifestations (fatigue, subfebrile temperature, weight loss, etc.) regardless of the nature, location and prevalence of the tumor process.

Kazan medical journal. 2018;99(2):301-304
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A clinical case of polyneoplasia
Akhmetzyanov F.A., Valiev N.A., Egorov V.I., Burba D.V.
Abstract

Primary multiple neoplasms (polyneoplasia) are among the interesting and insufficiently studied fields of oncology. The term polyneoplasia is usually used for two or more malignant neoplasms in a single patient, which occur synchronously or metachronously. Over the last decade, an increase of primary multiple tumors prevalence has been observed. In 2015 39 195 new cases of primary multiple tumors were registered in Russia and comprised 6.7% of all incident malignant neoplasms. Primary multiple metachronous and primary multiple synchronous tumors with two neoplasms development are observed most often, with three more rarely, and with four or more very rarely. In average, 0.1% of a total number of oncologic patients have at least three malignant neoplasms. Primary multiple tumors of gastrointestinal tract are observed most often. The current article presents a clinical case of four synchronous tumors in a single patient localized in major duodenal papilla, sigmoid, transverse colon and lung.

Kazan medical journal. 2018;99(2):304-306
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Sudden cardiac death as an onset of myocardial infarction
Sadykov M.N., Frolova E.B., Tsibul'kin N.A., Akhmetzyanova E.F., Aynutdinova I.A., Mingazetdinov M.A., Aglullina E.I., Yagudina E.N.
Abstract

Sudden cardiac death is an actual problem of current cardiology. Ventricular arrhythmias are considered the main mechanism of its development: ventricular fibrillation and flutter, sustained ventricular tachycardia and asystoly. Pathological changes of electrophysiologic processes in myocardium and conducting system of ventricles are the reasons of arrhythmia development. Coronary heart disease is considered the most frequent etiological factor of sudden cardiac death. Acute ischemia in the onset of myocardial infarction can be the cause of fatal arrhythmias leading to sudden cardiac death. Well-timed cardiopulmonary resuscitation and cardioversion allow restoring the heart activity. The article presents short review of scientific medical literature on the subject of sudden cardiac death in myocardial infarction. The clinical value of this pathology is illustrated with an example from practice - a case of the onset of acute myocardial infarction in the form of sudden cardiac death.

Kazan medical journal. 2018;99(2):307-313
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Clinical experiences
Readmissions for chronic obstructive pulmonary disease in actual clinical practice
Yakupova A.F., Zinnatullina A.R., Khamitov R.F.
Abstract

Aim. Identification of risk factors for readmissions associated with exacerbation of chronic obstructive pulmonary disease followed by identification of possible quality defects in the provision of medical care to patients in the outpatient and hospital stages.

Methods. A retrospective analysis of the medical records of patients with exacerbation of chronic obstructive pulmonary disease admitted twice or more to the therapeutic department of one of the hospitals of Kazan during the period from January 1, 2015 to June 30, 2016.

Results. The risk factors for readmissions were found to be the following: male sex (relative risk 2.29; 95% CI 0.78-6.69; р ˂0.05), age over 70 years (relative risk 2.069; 95% CI 1.01-4.2; р ˂0.05), smoking for more than 40 years (relative risk 5.3; 95% CI 1.6-17.5; р ˂0.05), duration of the disease more than 6 years (relative risk 2.4; 95% CI 0.98-6.18; р ˂0.05), presence of three or more concomitant diseases, primarily cardiovascular pathology (relative risk 13.0; 95% CI 1.89-90.14; р ˂0.05). Important reasons for subsequent exacerbations after discharge from the hospital are patients' nonadherence and defects of the provision of medical care in the hospital.

Conclusion. The revealed defects of the quality of medical care indicate the need to intensify the implementation of the federal clinical guidelines for chronic obstructive pulmonary disease in actual medical practice; due to the difficulty of modifying the identified risk factors, the main efforts should be directed at treatment optimization with adherence control, as well as full use of the potential for non-drug treatment in the form of guidelines for maintaining physical activity, early smoking quitting and patients' rehabilitation.

Kazan medical journal. 2018;99(2):314-322
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Recommendations for determining optimal age for the treatment of congenital heart defects
Mirolyubov L.M.
Abstract

The article presents the analysis of congenital heart defects classifications from the practical point of view. A variant of our classification of congenital heart defects is presented with the rationale for optimal time of surgical correction. The scheme-classification allows predicting possible critical hemodynamic states in children with congenital heart defects and is used in the practice in the Republic of Tatarstan for more than 15 years. Organizational measures taken during the recent decades in the field of cardiac and vascular surgery according to goal-oriented programs of the Government of RF and Ministry of healthcare of RF under the direct control of the chief cardiac surgeon of the Ministry of healthcare of RF academician L.A. Bokeriya, resulted in significant improvement of the situation with this specialty in Russia. In particular, regarding treatment of congenital heart defects, the number of surgeries in RF (about 15 000 per year) exceeds the number of children born with congenital heart defects (12 000 to 13 000 per year). Thus, in the nearby future the surgery waiting list will be completed, and some time later the named numbers will become equal. In the Republic of Tatarstan the waiting list for the surgeries for congenital heart defects was completed in 2005 due to additional financing from the president M.Sh. Shaymiev, and since then all children with congenital heart defects are registered soon after birth and are operated on in the optimal time that determines the minimal risk of postsurgical complications and lethal outcomes.

Kazan medical journal. 2018;99(2):322-326
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Use of rubber seton in the treatment of anorectal fistulae
Karpukhin O.Y., Sakulin K.A.
Abstract

Aim. To determine the efficacy of brand new industrial synthetic material for surgical treatment of patients with complicated anal fistulae and advantages of its use for ligature method of chronic paraproctitis treatment.

Methods. Between 2010 and 2017, 175 patients (average age 47 years) with extra- and transsphincteric fistula were treated with a ligature. The study group consisted of 67 patients treated with rubber seton, comparison group included 108 patients treated with nylon ligature.

Results. The results of clinical use of two seton types for the treatment of rectal fistulae are presented. Rubber thread with circular section as seton was proved to be inexpensive and effective material, advantages of which result from its physical properties. Thus, dissection of muscle tissue due to rubber elasticity becomes more efficient due to the greater reserve of compression than in case of rigid nylon seton, and that reduces the number of contractions. In addition, physical properties of the material, such as its high surface wettability, offer good drainage, and homogeneity of the material not absorbing the fluids, in turn, provides avoidance of the «wick effect» with the spread of infection into the wound. So, the treatment of anorectal fistulae with ligature with the use of rubber seton demonstrates the best therapeutic results and is preferable for patients.

Conclusion. Use of rubber seton in treatment of complicated anal fistulae allows reducing hospital stay, provides better drainage of the surgical wound, and reducing the number of complications and required contractions, thus, minimizing the associated pain syndrome.

Kazan medical journal. 2018;99(2):326-329
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Capabilities of single-photon emission computed tomography combined with computed tomography in diagnosis of neck masses
Maksimova N.A., Arzamastseva M.A., Agarkova E.I., Engibaryan M.A.
Abstract

Aim. Assessment of the capabilities of planar scanning combined with X-ray computed tomography in the diagnosis of neck masses.

Methods. The study included 9 patients with neck masses examined at Rostov Scientific Research Institute of Oncology. Patients with suspected retrosternal nodal growth and ectopic thyroid gland on clinical and ultrasound examinations received single-photon emission computed tomography combined with computed tomography. The technique included the following stages: (1) planar scanning; (2) volumetric dynamic emission tomography of relevant areas; (3) X-ray spiral computed tomography; (4) archiving, combining scan parameters; (5) post-processing and reconstruction of images and assessment of the results.

Results. Ultrasound study of neck masses in our study did not provide complete evaluation of surrounding anatomical structures due to large size of masses and did not allow identifying the connection between mass lesions and thyroid gland and evaluating relationship between the tumor and trachea, esophagus, great vessels. As a result of our study, with the use of single-photon emission computed tomography combined with computed tomography, among 9 patients with neck masses 5 (55.5%) patients were diagnosed with retrosternal thyroid lesions, 3 (33.3%) - ectopic thyroid gland and 1 (11.2%) - metastasis of neuroendocrine (small cell) carcinoma. 3 (60%) out of 5 patients with retrosternal thyroid lesions had a nodular goiter with retrosternal component and 2 (40%) patients had thyroid cancer with a nodular goiter. Conclusions. A combination of hybrid technologies of single-photon emission computed tomography and computed tomography for the identification of neck masses is a highly informative method providing single-step determination of the lesion location and assessment of its topographic and anatomical relationship with surrounding anatomical structures which allows optimizing the examination and choosing further management strategy.

Kazan medical journal. 2018;99(2):330-336
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The first experience of the use of two-fraction adaptive intracavitary/interstitial brachytherapy in the treatment of cervical cancer
Isaev I.G., Akperov K.S., Guliev E.G., Alieva N.R., Alieva N.S.
Abstract

Aim. The study of the results of chemoradiotherapy for cervical cancer with the use of two-fraction brachytherapy.

Methods. The article presents analysis of the examination and treatment results of 17 patients with IIB-IIIB stage cervical cancer. The average age was 51±4.6 years (44 to 62 years). External beam radiotherapy was performed with single boost dose of 1.8 Gy to total dose of 45 Gy. Also the patients received 40 mg/m2 of weekly cisplatin. Intracavitary/interstitial high dose-rate brachytherapy with insertion of parametrial needles consisted of two weekly fractions of 10.0 Gy.

Results. Due to the use of interstitial needles the average dose was 82.2 Gy when recalculated to classical 2 Gy fractions. The median follow up was 16±3,2 months. The used radiotherapy modality for cervical cancer allowed achieving complete tumor involution in 16 (94.1%) patients and partial involution only in 1 (5.9%) case. All females had favorable tolerance and received the entire regimen of planned radiation.

Conclusion. The first experience of the use of concurrent chemoradiotherapy for locally advanced cervical cancer with external beam radiotherapy, two-fraction intracavitary/interstitial adaptive brachytherapy with single boost dose of 10 Gy and 5 weekly infusions of 40 mg/m2 of cisplatin showed high probability of complete and partial tumor response rate with favorable tolerance and acceptable incidence and severity of toxicity.

Kazan medical journal. 2018;99(2):336-341
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A retrospective analysis of the results of surgical treatment of large macular holes
Samoylov A.N., Fazleeva G.A., Khaybrakhmanov T.R., Samoylova P.A., Fazleeva M.A.
Abstract

Aim. A retrospective analysis of the results of surgical treatment of large idiopathic macular holes depending on the technique of surgical intervention.

Methods. The results of surgical treatment of 60 patients (60 eyes) with idiopathic macular holes with a diameter of more than 800 μm were studied in the Republican clinical ophthalmology hospital of Kazan. The average age of the patients was 66.2±5.37 (61-74) years. The patients underwent complex ophthalmological examination before the surgery and 10 days and 1 month after the surgery, including visometry, tonometry and optical coherence tomography. Patients were divided into two groups (30 subjects each), comparable in clinical and epidemiological parameters: group 1 - standard surgical tactics, group 2 - surgical treatment according to the method proposed by professor A.N. Samoylov. Visual acuity with correction before surgery in group 1 was 0.11±0.05, in group 2 - 0.12±0.06.

Results. Ten days after the surgery, group 1 had anatomical closure in 23 (76.7%) patients, anatomical result was not achieved in 7 (23.3%) patients. In group 2, complete closure of the rupture was achieved in 27 (90.0%) patients, incomplete - in 3 (10.0%) patients. In 1 month in group 1, complete closure of the macular rupture was observed in 22 (73.3%) patients, in 8 (26.7%) patients the result was not achieved. In group 2, complete closure of the rupture was determined in 28 (93.3%) patients, incomplete closure - in 2 (6.7%) patients. Visual acuity 1 month after the surgery in group 1 was 0.15±0.08, and in group 2 - 0.32±0.11 (p <0.05).

Conclusion. Surgical treatment of large idiopathic macular holes according to the modified technique of the inverted internal limiting membrane flap proposed by professor A.N. Samoylov, provides better anatomical and functional results in comparison with the standard technique (p <0.05).

Kazan medical journal. 2018;99(2):341-344
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Clinical justification for preventive surgeries for abdominal wall hernias and cholelithiasis in cardiovascular surgical patients
Sangadzhiev S.B., Slavin L.E., Zimagulov R.T., Yakhin R.R., Sangadzhiev M.S., Slavina A.L., Podshivalov A.G., Gaynanov M.A.
Abstract

Aim. Clinical justification for the necessity of sanitation surgeries for cholelithiasis and abdominal wall hernias in patients intended for heart valve surgery.

Methods. The study is based on the analysis of operative treatment results of 54 patients admitted to surgical department of Interregional clinical diagnostic center (Kazan) in 2007-2017 with cholelithiasis and abdominal wall hernias, who underwent laparoscopic cholecystectomy or herniotomy before or after an open heart surgery in cardiac surgical department No. 2 of the hospital. All patients were divided into two clinical groups. Group 1 consisted of 36 patients with a history of prosthetic heart valve, taking long-term warfarin. The comparison group included 18 patients, who at the first stage before cardiac surgery underwent sanitation surgeries for cholelithiasis and/or abdominal wall hernias. As part of the research, statistical analysis of intergroup differences was performed using non-parametric Mann-Whitney U-tests. Intergroup differences were determined by gender, age and type of cardiac and general surgical pathology.

Results. The analysis of the study groups showed that the average hospital stay among patients with long-term use of indirect anticoagulants was 15±1 day and varied from 12 to 19 days. The results indicate more than two-fold increase of an average hospital stay compared to patients, who underwent the same surgeries before cardiac interventions (р <0.05).

Conclusion. Before performing cardiac valve replacement with planned life-term or long-term use of anticoagulants with concomitant general surgical pathology (cholelithiasis, abdominal wall hernias with a tendency to strangulate), at the first stage, it is reasonable to perform so called sanitation surgeries aimed at eliminating abdominal pathology; such approach significantly decreases hospital stay of patients, and potentially contributes to lower probability of hemorrhagic complication incidences during the surgery and in the early post-operative period.

Kazan medical journal. 2018;99(2):345-349
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Cochrane Review Summaries
Fresh versus frozen embryo transfers for assisted reproduction
 
Abstract

Вопрос обзора. Мы рассмотрели доказательства эффективности и безопасности стратегии «замораживания всех эмбрионов» у женщин, подвергающихся экстракорпоральному оплодотворению (ЭКО) или интрацитоплазматической инъекции сперматозоидов (ИКСИ), по сравнению с традиционной стратегией ЭКО/ИКСИ в отношении кумулятивной частоты живорождения и риска синдрома гиперстимуляции яичников (СГЯ).

Kazan medical journal. 2018;99(2):350-351
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Risk of endometrial cancer in subfertile women undergoing ovarian stimulation
 
Abstract

Цель обзора. Выяснить, увеличивают ли лекарства, используемые для стимуляции овуляции, риск развития эндометриального рака у женщин, которым для наступления беременности необходима медицинская помощь.

Kazan medical journal. 2018;99(2):351
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Oestrogen for premenstrual syndrome
 
Abstract

Вопрос обзора. Эстрогены широко используются для подавления овуляции, главным образом в качестве противозачаточного средства. Это первый систематический обзор, целью которого является оценка эффективности и безопасности неконтрацептивных эстрогенсодержащих препаратов (пероральные, накожные, имплантат и гель) в борьбе с симптомами предменструального синдрома (ПМС).

Kazan medical journal. 2018;99(2):351-352
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