Vol 96, No 4 (2015)

Aim. Clinical and experimental study of vagal insulin signaling and enteric hormones in occurrence of acute stomach and duodenal erosions and ulcers complicated by bleeding and associated with severe concomitant traumatic head injuries.

Methods. Data of 347 patients with severe concomitant traumatic head injuries for 2011-2012 were used for clinical part of the study. Serum levels of insulin, gastrin, C-peptide, histamine, growth hormone, α-amylase were determined. In the experimental part, the model of acute stomach and duodenal erosions and ulcers associated with traumatic head injury were modeled. The first group consisted of 5 intact rats, the second group included 45 rats with modeled isolated traumatic head injury, the third group included 45 rats with modeled traumatic head injury associated with traumatic lung and chest injury, the fourth group included 45 rats with modeled traumatic head injury associated with abdominal organs traumatic injury, the fifth group included 45 rats with modeled traumatic head injury associated with limb and pelvic fractures.

Results. Acute stomach and duodenal erosions and ulcers were found in 21 (6.1%) of 347 patients at endoscopy, mainly in those with the highest parameters of vagal insulin signaling and enteric hormones. At the experiment, all types of combined traumatic head injury increased the incidence of erosions as compared to the second group, with the highest incidence in the group of associated abdominal injury. Vagal stimulation and stimulation of enteric hormones secretion in animals of groups 2-5 was associated with higher incidence of erosions. In contrast, decreased vagal stimulation and enteric hormones secretion leaded to statistically significant reduction of erosions incidence in animals of groups 2-5 as compared both to the natural history of the process (first subgroup), and to animals which were administered 5% dextrose (glucose) and 0.1% histamine solutions (second subgroup).

Conclusion. The incidence of erosions and ulcers, as well as the indicators of vagal stimulation and enteric hormones secretion depend on the nature of the accompanying injury that may be taken into account in the prevention and treatment of such complications.

Aim. Develop new approaches to the diagnosis of right heart failure and pulmonary hypertension in recurrent thromboembolism of small branches of the pulmonary artery in patients with malignant tumors.

Methods. 83 patients with malignant tumors of various localizations were examined and followed-up. The main group included 49 patients with malignant tumors of various localizations and related venous thrombosis. The control group included 34 patients who did not have venous thrombosis. Patients in both groups underwent ultrasonography of inferior vena cava system veins and echocardiography at intervals of 3-4 days during the diagnosis and treatment of malignant tumors. Right ventricle ejection fraction and systolic pressure in the pulmonary artery were calculated at echocardiography.

Results. No signs of inferior vena cava system veins thromboses, right heart failure, pulmonary hypertension were identified in patients of the control group while setting up the diagnosis and treatment of malignancies. In 38 out of 49 patients of the main group, right ventricular failure and pulmonary hypertension of varying severity were detected. The condition of 46 patients of the main group gradually improved after treating with anticoagulants.

Conclusion. Recanalization of venous thrombosis is accompanied by frequent rejection of micro thrombi and embolization of small branches of pulmonary artery, causing right heart failure and pulmonary hypertension, which can be promptly detected by repeated echocardiography.

Aim. To assess the effect and safety of palivizumab to prevent the bronchopulmonary dysplasia complications in preterm children according to follow-up.

Methods. The study included 48 very preterm infants (birth weight ranged from 732-1640 g) with bronchopulmonary dysplasia, who were divided into two groups. The main group included children who received passive immunization by palivizumab (31 children), the comparison group included un-immunized children (17 patients). The diagnosis of bronchopulmonary dysplasia in children at 28 days of postnatal life has been set according to clinical and radiological data. After being discharged from the department of pathology of newborn, children were followed-up for 12 months in the center of preterm children follow-up. Average age of patients with bronchopulmonary dysplasia was 4.2±1.3 months at passive immunization initiation. The drug was administered by intramuscular injection at a dose of 15 mg/kg once monthly.

Results. Lower respiratory tract infections were observed in 6 (19.3%) patients from the first group, including 4 cases of obstructive bronchitis and 2 cases of pneumonia. These patients received incomplete course of immunization. In children who did not receive specific prophylaxis, respiratory infections were registered in 7 (41.2%) patients, with 2 cases accompanied by severe respiratory failure requiring mechanical ventilation. No adverse effects were identified while palivizumab treatment.

Conclusion. Palivizumab is currently the only effective drug to prevent the severe respiratory syncytial virus infection; good safety of the drug makes it possible to reconsider the contraindication of its use in high-risk children with severe bronchopulmonary dysplasia.

Aim. To assess the efficacy of laser photocoagulation treatment for patients with chronic central serous chorioretinopathy.

Methods. The study included 17 eyes of 15 patients with relapse of central serous chorioretinopathy of different etiology, including 9 men. Patient’s age ranged from 34 to 55 years. Mean disease duration ranged from 3 months to 8 years. All study subjects underwent a standard ophthalmic examination including best-corrected visual acuity testing, intraocular pressure measurement, bioophthalmoscopy, color vision testing, visual field testing, optical coherence tomography, fluorescent angiography of the retina before and after the treatment. Fluorescein sodium salt (100 mg/ml, ampules of 5 ml, «Novartis Pharma» was used as a contrast. Before the treatment, neuroepithelial layer detachment height was 385.09±14.1 µm, the best-corrected visual acuity ranged from 0.41 to 0.82. The study group did not include the patients with secondary choroidal neovascularization. Diode laser with wave length of 532 nm («Carl Zeiss») was used for laser photocoagulation. The laser photocoagulation procedure was done using the following parameters: exposure time 0.05-0.1 sec, the spot diameter 100-200 µm, and the impulse energy of 100-200 mJ.

Results. Significant improvement of visual acuity, disappearance of relative central scotoma proven by instrumental methods was seen in all patients. Best-corrected visual acuity was 0.91, decrease of neuroepithelial layer detachment height with adherence of all layers of the retina was reduced to 171.12±11.5 µm on the 3-5 day after laser photocoagulation. Patients were followed up from 1 to 6 months, with treatment results staying stable.

Conclusion. Laser photocoagulation of a retina in treatment of chronic central serous chorioretinopathy allows to achieve encouraging morphologic and functional results.

Aim. The influence of the chronic psycho-emotional stress on the cognitive function was studied.

Methods. 160 railroad engineers of main-line locomotives, whose occupation is acknowledged to be one of the most stressful, were examined. 100 healthy volunteers were examined as a control group. A scale of psychological tension PSM-25 was used to evaluate the effect of the stress. Neurohumoral response to stress was studied by the activity of the hypothalamic-pituitary-adrenal axis, defining adrenocorticotropic hormone, cortisol and corticosterone concentrations. Cognitive functions were examined by the neuropsychological tests: Schulte tables, F. Grobov tables, Burdon correction tests. Attention assessment was emphasized due to railroad engineer’s profession specifics. Result. The reaction of the hypothalamic-pituitary-adrenal axis depended on the duration of chronic psycho-emotional stress: resistance period with reduced levels of the stress hormones in the next 5-7 years replaced the period of activation in the first years (with increased production of adrenocorticotropic hormone, cortisol and corticosterone). The reactivation of the hypothalamic-pituitary-adrenal axis occurred after 12-15 years. Neuropsychological tests revealed that the effect of chronic psycho-emotional stress was accompanied by decreased cognitive functions compared to controls. Time for passing the tests and the number of errors increased, productivity, stability and attention concentration dropped. The term of cognitive function disorders onset and their severity depend on chronic psycho-emotional stress duration. The extract of Ginkgo biloba (EGb 761, 240 mg per day for three months) intake has significantly improved the results of neuropsychological retests.

Conclusion. Chronic psycho-emotional stress leads to deterioration of cognitive functions, and, in particular, attention. The use of Ginkgo biloba (EGb 761) extract is rational for treatment of cognitive malfunction.

Aim. To study the relationship of clinical presentation and psychopathological mechanisms at the commitment of grave socially dangerous acts by schizophrenic patients.

Methods. The sample consisted of 201 schizophrenic patients who have committed grave socially dangerous acts targeted at the life and health of people. The investigation that included social-demographic, anamnestic and clinical data was performed. The sample was divided into three subgroups according to psychopathological mechanisms of grave socially dangerous acts commitment, determined by authors: unconditional-psychotic mechanism (n=46), conditional-psychotic mechanism (n=76) and negative-personality mechanism (n=79).

Results. In patients with the unconditional-psychotic mechanism, the acute psychopathological symptoms such as catatonic, affective and delusional syndromes, acute delusional conditions were prevalent by the time of commitment of socially dangerous acts. In patients with this mechanism of catatonic schizophrenia, remittent course or intermittent-progressive course with the increased production of negative symptoms in remission were significantly more common. In patients with the conditional-psychotic mechanism, paranoid schizophrenia was prevalent, which was characterized by a continuous course without remissions, delusions without hallucinations, or chronic paranoid states. In patients with the negative-personality mechanism, the major psychopathological syndromes were defect and final states; residual schizophrenia and paranoid form of schizophrenia were common, intermittent-progressive course with stable but not increasing negative symptoms had dominated. The highest average duration of the disease at the time of committing a socially dangerous action was associated with the negative-personality mechanism. It was 13.56±9.00 years, which is considerably higher than at unconditional-psychotic mechanism (7.02±7.40 years) and at conditional-psychotic mechanism (7.38±8.35 years).

Conclusion. When developing treatment and prevention measures, it is necessary to take into account the psychopathological mechanisms of commitment of grave socially dangerous acts combined with data of clinical presentation.

Aim. To develop an algorithm for diagnosis and integrated treatment of the poor people of the Republic of Bashkortostan, taking into account the possibility of using state support programs.

Methods. The study sample included 296 low-income patients (women over 58 years, men over 63 years) receiving social pension supplements. As a comparison group, 300 patients of retirement age, who had paid for orthodontic treatment by themselves, were recruted.

Results. Out of 296 patients, 211 (71.28%) had previous orthopedic treatment, the remaining 85 (28.72%) had never received orthopedic treatment. All poor patients received treatment according to the full comprehensive program of preferential dentures. Orthopedic treatment using the non-removable prosthesis was performed in 39 (13.17%) patients, removable dentures - in 27 (9.12%), combined prosthetics - in 230 (77.70%). In 300 patients who paid for orthopedic treatment from their own funds, 133 (44.33%) patients got removable prosthesis, 70 (23.33%) patients - non-removable dentures, combined prosthetics was used in the remaining 97 (32.33%). An algorithm of therapeutic and preventive measures for low-income citizens in order to improve oral health and quality of life, as well as to optimize the use of financial resources, was developed. It consists of five stages: I - examination of the anamnesis vitae and the history of the disease; II - Diagnosis and treatment of comorbidities; III - full mouth debridement; IV - selection and rational prosthetics, medical treatment; V - follow-up examination in 1 and 6 months. An integral indicator of quality of life after the conducted complex treatment has improved by 15.11 points (27.0%). Some criteria for the quality of life has improved by more than 2 points (3.51%): «Physical discomfort» - by 2.133, «physical disorders» - by 2.916, «psychological disorders» - by 2.855 points.

Conclusion. The program of preferential dentures allows to expand the range of the treatment options with the use of new technologies; implementation of this program is not a direct source of health improvement, but serves as an auxiliary arm of social support and helps to minimize the severe health consequences for the examined population.

Aim. Morphometric and immunohistochemical study of hepatocyte proliferative activity in 18-days-old infant rates after a mechanical trauma of the liver.

Methods. After an artificial mechanical injury of the liver with a steel needle in 18-days old infant rats, a biologically active substance «Suvar» in a dose of 50 mg/kg (n=36) was administered to animals. After animals were withdrawn from the experiment, a morphometric study (where the number of mitoses of hepatocytes for every 7000 cells were calculated) and immunohistochemistry of liver tissue were performed. For the immunohistochemistry, two commercially available monoclonal antibodies kits (manufactured by «Santa Cruz») were used: (1) proliferative activity marker Ki-67; (2) apoptosis marker bcl-2. Immunohistochemistry was performed according to standard protocol. Thirty-six operated infant rats, in whom the biologically active substance was not administered, were analyzed as the controls.

Results. The number of ki-67 positive hepatocytes in experimental animals on the 3rd, 5th,7th and the 9th day after the operation was significantly higher compared to controls. This was in accordance with the changes of the number of mitoses in hepatocytes, where the greatest number of mitoses was also registered on 3rd, 5th,7th and the 9th day. Both in experimental and in control infant rats, only single cells marked bcl-2 antibodies were found. The gained results support the opinion of the majority of the researchers that the liver regenerates mainly due to hepatocyte proliferation.

Conclusion. Morphometric study and immunohistochemistry confirmed that biologically active substance «Suvar» stimulates hepatocyte proliferation of hepatic cells, allowing better healing of liver injury compared to control animals.

Pregnant women with hypertensive disorders have a high risk for premature birth and early delivery due to the increased severity of hypertension associated with low effect of treatment. Vaginal birth in patients with hypertensive disorders are often complicated by premature rupture of membranes, labor abnormalities, abnormal blood loss. Emergency abdominal delivery is performed together with complex intensive therapy. A common approach to the management of pregnancies with mild and moderate forms of hypertension is treatment associated with prolongation of pregnancy. Therapeutic and protective regimen in childbirth is created by phased long-term epidural analgesia. Indications for induced delivery - I-II degree of nephropathy in the absence of a positive therapeutic effect for 1-2 weeks. Regarding to severe forms of hypertensive disorders, many researchers tend to think of the need for early delivery, to avoid complications. At the same time, early delivery often leads to birth with premature fetus, which contributes to worsening of perinatal outcomes in patients with hypertensive disorders. Currently the possibility of conservative management of pregnant with hypertensive disorders at the gestation term of less than 32 weeks using glucocorticoids may significantly improve perinatal outcomes. Conservative management is only possible in large clinical settings with careful selection of patients. Currently, there are different approaches to the selection of methods and timing of delivery in hypertensive disorders. The optimal strategy is based on a differentiated approach that takes into account the severity of hypertensive disorders and the probability of complications for mother and fetus. At the same time, the diversity of the pathogenesis of hypertensive disorders determines the presence of different variants of its clinical manifestations, clinical course and complications, making it difficult to properly assess its severity.

The efficiency of educational programs implementation in geriatrics in managing the palliative care training was explored. The article presents the literature review devoted to the problem of performing educational programs for patients and their relatives on the palliative care management in geriatrics. Currently there is an unresolved contradiction: on the one hand - the growing number of elderly and senile patients with severe pathology, accompanied by a significant dependency on others, on the other hand - the lack of professional staff and the lack of care, family problems in the competent care management, lack of specialized training and information programs. The situation is aggravated by the lack of interagency cooperation, and the inability to realize in practice the main principle of palliative care - multidisciplinary approach. Review of the literature demonstrated that the development and implementation of educational programs in palliative care, raising awareness of patients and their families are able to solve not only medical, but also economic problems, reducing the number of hospitalizations by twice, number of ambulance calls by twice as well. Introducing the information and education programs for patients with chronic conditions significantly reduces the risk of complications and, consequently, the cost of treatment and rehabilitation. Features of palliative care programs in geriatrics is teaching not only the patients, but their relatives by specialists with medical education, as well as and training of volunteers, social service professionals by academic specialists, taking into account the clinical, psychological and social characteristics of older patients.

Aim. To study the organizational aspects of hemodialysis aid to the population of Azerbaijan.

Methods. The structure of patients requiring hemodialysis was studied using personal data and statistical reporting of the hemodialysis service of the Azerbaijan Republic using historical, analytical, statistical research methods.

Results. The trend for increased numbers of patients receiving a hemodialysis is shown. It is specified that Azerbaijan is the endemic area for nephrolithiasis. 950-970 patients per million have a renal disease. In 2011, 211,306 procedures of hemodialysis were performed, compared to 291,852 procedures in 2013, including 823 primary patients. The total number of patients requiring hemodialysis in 2013 was 913 patients in Baku and 898 patients in regions (1811 patients in total). The understaffing of dialysis departments with nephrologists is presented, the number of available specialists is almost 4 times less than required. Thus, it is shown that dialysis departments of the republican medical setting have 119 doctors and 294 nursing staff, the staffing rate is 1.1-1.2 nephrologist per 100,000 population, while the standard is 4-4.5.

Conclusion. The need for additional management measures to improve the service in this group of patients, as well as new training programs on hemodialysis therapy in universities and medical colleges is explained.

Aim. To study the changes of reproductive and demographic characteristics and socio-economic indicators of the Kyrgyz Republic, determining the major trends of these changes.

Methods. Social-hygienic, statistical and analytical methods were used. The changes of the main social, demographic and reproductive indicators of the Kyrgyz Republic for the period of 2007-2011 were studied.

Results. The main reproductive and demographic trends and the changes of the socio-economic indicators: significant number of residents were still poor and extremely poor (almost half the population); women prevailed among the unemployed - nearly one in ten females was unemployed, in young women (under 28 years) - one in seven; the population increased due to the birth rates being higher than the death rates with a negative balance of external migration, natural population increase was - 21 persons per 1,000; the fertility rate increased from 2.7 to 3.1; family with average number of children became more common compared to large families; the number of births by unmarried women and young women aged 15-19 increased; maternal and infant mortality rates decreased, while maintaining high rates (2 times or more above the European standard), increased number of abortions in the country, including abortions in 15-19 years old girls, and others.

Conclusion. Changes in reproductive and demographic processes in the Kyrgyz Republic can be seen as a consequence of a significant drop in living standards of the Kyrgyzstan population; a significant number of negative trends that were revealed is the basis for a detailed study of the causes and factors determining them, followed by a scientific substantiation of programs on reproductive health of the Kyrgyz Republic population.

Mastocytosis is a relatively rare group of diseases caused by the proliferation of mast cells in various organs and tissues. The article presents data on the etiology, pathogenesis, clinical presentations, diagnosis and differential diagnosis of mastocytosis, and own clinical observations. Presented clinical cases picture the features of the clinical course of the disease in different age groups. The first clinical case clearly shows the onset of the disease in early childhood (6 months), and misdiagnosis of this disease. The clinical picture of mastocytosis was wrongly assessed as a manifestation of atopic dermatitis, for which the patient received topical treatment without clinical effect. The second clinical observation is in 30 year old patient. The nature and spreading of the disease were assessed, proper treatment was administered. Both patients improved after treatment. Presented clinical observations reflect the importance of the problem in medical practice. Early diagnosis improves the prognosis of the disease and improves the quality of life.

Aim. To study the prevalence of metabolic disorders in children with juvenile arthritis.

Methods. A comprehensive clinical and laboratory examination of 82 children and adolescents aged 10-18 years with juvenile idiopathic arthritis and 50 healthy children of the control group was performed. All patients with juvenile arthritis received disease-modifying anti-rheumatic drugs and/or glucocorticoids (intraarticular injections or pulse therapy) and/or biologics.

Results. Complete clinical picture of metabolic syndrome (a combination of the two mandatory criteria - hypertension, glucose intolerance or dyslipidemia with increasing waist circumference above the 90th percentile) was found in 30 (36.5%) of 82 patients and was not found in any child from the control group (p <0.05). Such manifestations as dyslipidemia, abdominal obesity and hypertension, which correlate with disease activity and dose of glucocorticoids, were the most common. One-third of patients with juvenile arthritis had «intima-media» complex thickening and vascular wall structure disorders, which were associated with high disease activity, insulin resistance and other features of the metabolic syndrome.

Conclusion. Juvenile arthritis is associated with high prevalence of metabolic disorders, only partially (hypertension and carbohydrate metabolism disorders) associated with the glucocorticoid intake, but mostly mediated by high inflammatory disease activity.

Aim. To summarize the existing literature data and to optimize protocols of anticoagulant therapy for Kawasaki syndrome.

Methods. A review of treatment results in 10 patients with Kawasaki syndrome, where an individual approach to anticoagulation led to a positive result, and surgical treatment was not required, is presented.

Results. In 5 of 6 patients with timely diagnosis and treatment according to the protocol, transient ectasia of coronary arteries with further normalization of their size within 4-7 months of follow up was detected. In one child on the 12th day of the disease small aneurysms of the right and left coronary arteries were identified. They disappeared after 7 months from the debut of the disease. In 3 patients, diagnosis and treatment have been delayed. In this group, a giant aneurysm of the proximal left anterior descending branch of the left coronary artery with the signs of thrombosis was discovered in a child aged 9 months on the 45th day of the disease. Anticoagulation with heparin with further switching to dalteparin sodium (Fragmin) was accompanied by adequate anticoagulation to the 3rd day of treatment. Aneurysms decreased to 2-4 mm without signs of thrombosis after 24 months of treatment with warfarin in combination with acetylsalicylic acid (Aspirin). In a girl of 1 year and 4 months of age, on the 20th day of the disease, it was complicated by exudative pericarditis with high risk for tamponade, which required a pericardial puncture and catheterization, and a giant aneurysm of the right coronary artery with the signs of thrombosis was found on the 45th day of the disease. Adequate anticoagulation was reached on the 3rd day of treatment with dalteparin sodium (Fragmin). Long-term use of warfarin in combination with acetylsalicylic acid (Aspirin) was continued. At follow-up at 4 months aneurysm of the right coronary artery has not decreased, but the size and the density of the blood clot reduced significantly. A year later, the aneurysm decreased to 5-6 mm without signs of thrombosis. At the next case of a 3 year old child, who was treated according to the treatment standards, ectasia of the right and left coronary arteries was revealed on the 14th day of treatment, disappearing after of long-term use of acetylsalicylic acid (Aspirin).

Conclusion. At further development of standards and following up antithrombotic treatment in patients with the complicated forms of Kawasaki disease, the possibility of individual treatment adjustment based on the detection of thrombophilia genetic markers, which increase the risk for thrombotic complications, should be considered.

Aim. To summarize and to distinguish the features of diagnosis and treatment of congenital heart diseases in adults characteristic for the contemporary cardio surgery, by a retrospective study of case reports.

Methods. The study analyzed the medical charts of 245 adults with congenital heart diseases treated in the Cardio surgical department №2 of the Interregional Clinical and Diagnostic Center between 2007 and 2015 years. The comparison group included 701 adult patients with congenital heart diseases treated in the Kazan Center of Cardiovascular surgery between 1987 and 1997.

Results. The prevalence of congenital heart diseases in adults remains significant. In recent years, the share of operations for these diseases is 5.4% of all cardiac interventions. The most frequent pathology is atrial septal defects. The most frequent complications of septal defects are tricuspidal valve insufficiency (83%) and pulmonary hypertension (77%). Comorbidities include: hypertensive heart disease (36%), cardiac arrhythmias (31%) and ischemic heart disease (33%). The number surrendered surgeries decreased from 28.8% in 1997 to 3.7% in 2014. Postoperative mortality has decreased from 3.3% to 1%. Nowadays a significant amount of operations (56%) is transcatheter occlusion. There is an experience of such surgeries in defects of secondary atrial septum and patent ductus arteriosus.

Conclusion. Congenital heart diseases in adults are characterized by severe impairment of haemodynamics, leading to arterial pulmonary hypertension and tricuspid insufficiency, therefore, require early diagnostics and timely treatment before the onset of complications. 68% of such adult patients suffer from comorbidities that increase the risk of surgical interventions. Endovascular surgeries are low invasive, have minimal complication rate and produce good immediate and long-term results.

Aim. To study the level of the N-terminal fragment of brain natriuretic peptide in children with congenital heart disease after surgical treatment and to determine its prognostic value in the postoperative period.

Methods. A preoperative and postoperative examination of 113 children with congenital heart disease who were treated in the cardiac surgery department, was performed. Patients were allocated to four groups depending on the functional class of heart failure. Serum concentration of N-terminal brain natriuretic peptide fragment was determined by electrochemiluminescence before and one day after the surgery.

Results. Postoperative levels of the N-terminal fragment of brain natriuretic peptide correlated with the duration of mechanical ventilation, the time that patient spends in the intensive care unit, the intensity of cardiotonic support. On the 1st day after the surgical intervention the concentration of this peptide was significantly increased in patients of the first, second and third group, by average of 7.8 times, due to the direct effect on the heart cells, surgical trauma, influence of cardioplegic solution, heart function alteration and heart failure associated with operative and post-operative period. In 24 patients of the fourth group, the N-terminal fragment of brain natriuretic peptide has significantly decreased on the first day after surgery. In 7 patients of the fourth group, the growth of the N-peptide level was reported, complicated postoperative period, sometimes with fatal outcome, took place in these cases. The level of this marker is associated with the frequency of postoperative complications, reoperations, and its threshold level for determining high-risk group for complications was 5400 pg/ml.

Conclusion. The concentration of the N-terminal fragment of brain natriuretic peptide on day 1 after surgical intervention in patients with congenital heart disease can be used to predict the clinical course of postoperative period; the level above 5400 pg/ml is considered to be a risk factor for postoperative complications and reoperations.

Aim. To identify the features of the diseases associated with myocardial hypertrophy, for an earlier differential diagnosis to determine the treatment tactics and to initiate the early treatment.

Methods. Clinical examination, family history, cardiac ultrasound with Doppler, ECG, 24-hour ECG monitoring, and computed tomographic aortography and genetics counseling (if indicated) were preformed.

Results. During 14 years of observations, 92 patients were included, among them: children with idiopathic hypertrophic cardiomyopathy - 49 (53%), followed by children with Noonan syndrome - 11 (11.9%), Pompe disease - 6 (6.5%), hypertension - 6 (6.5%), Leopard syndrome - 5 (5,4%), Friedrich ataxia - 4 (4.3%), Danon disease - 3 (3.2%), cardiofaciocutaneous syndrome, fatty acids beta-oxidation disorder and mucopolysaccharidosis type I (Hurler syndrome) - 2 (2.1%), carnitine deficiency and GM1-gangliosidosis - 1 (1.2%).

Conclusion. Consudering the possibilities of modern medicine, diagnosis of left and/or right ventricular hypertrophy in pediatric general practice and pediatric cardiology is an important factor for the subsequent diagnostic search, earliest possible specific therapeutic interventions to prevent unfavorable outcomes of the diseases.

Endothelium is the unique «endocrine tree» lining absolutely all cardiovascular system organs of the body. Endothelial cells form a barrier between the blood and tissues, perform a number of important regulatory functions, synthesizing and releasing a wide range of biologically active substances. The strategic location of the endothelium allows it to be sensitive to haemodynamic changes as well as to the signals carried by the blood and signals of underlying tissues. Balanced release of biologically active substances contributes to homeostasis maintenance. The data concerning the multiple mechanisms of endothelium participation in the origin and development of various pathological conditions is accumulated so far. This is not only due to its participation in vascular tone regulation, but also due to the direct influence on atherogenesis, thrombus formation, and protection of the vascular wall integrity. Endothelial dysfunction is considered as a pathological condition of the endothelium based on impaired synthesis of endothelial factors. As a result, endothelium is unable to provide the haemorheological balance of the blood, resulting in disorders of different organs and systems functions. Endothelial dysfunction is a key link in pathogenesis of many diseases and their complications. The role of endothelial dysfunction in the development of chronic diseases such as atherosclerosis, arterial hypertension, chronic heart failure, diabetes mellitus, chronic obstructive pulmonary disease, chronic kidney disease, inflammatory bowel disease, and others has been proven recently. The review provides data on the functions of vascular endothelium and its dysfunction. Types of endothelial dysfunction are described. Modern concept of endothelial dysfunction as the key link of pathogenesis of many chronic diseases is presented. Endothelial dysfunction precedes the development of clinical manifestations of diseases, so the study of the endothelium condition at early stages of the diseases is promising and could be of great diagnostic and prognostic value.

Aim. Development of informative differential diagnostic criteria of inflammatory myocardial involvement in young athletes. Methods. A total of 163 athletes (swimmers, football players and sailing athletes) aged 9 to 24 years (mean age 14.74±0,23 years, SD=3.03) were examined. Complete clinical and functional examination was performed. Remodeling of the left ventricle was studied in accordance with R. Devereux (1992) and B. Maron (2005) echocardiographic criteria. Myocardial morphometry results were compared with immunobiochemical markers of myocardial damage and titer of antimyocardial antibodies to the endothelium, cardiac conduction system, cardiomyocytes, and smooth muscle. Results. In 10 out of 40 athletes with echocardiographic signs of pathological remodeling of the left ventricle, the indicators of myocardial damage used as immunobiochemical screening tests, were increased, high titers of antimyocardial antibodies (more than 1:160), arrhythmias, sever conduction disorders, and high concentrations of infectious risk factors were revealed, allowing to diagnose subacute myocarditis. Conclusion. Subacute myocarditis should be excluded in athletes with echocardiographic signs of left ventricular myocardial remodeling and a high concentration of «infectious» risk factors based on immunobiochemical markers of myocardial damage and antimyocardial antibodies titer.

Aim. Development of mathematical models of circulation (considering anomaly in hemorheology) allowing to diagnose functional condition of vessels/cardiovascular system.

Methods. Echocardiography, mathematical modeling, sedimentation and rheology laws, human mechanics and physiology methods were used for developing mathematical models.

Results. The following mathematical models were obtained: for determination of colloid dispersive blood system viscosity, considering concentration of dispersive phase (blood cells) and blood structure formation; velocity of inconvenient blood cells sedimentation depending on flow velocity of sediment and cell concentration; parameters of blood elasticity and viscosity as a connection between the velocity change and blood viscosity, Young`s elasticity and change tension; blood filtration in vessels (modified form of Darcy`s law) considering tension and changes of destroyed and undestroyed colloid blood system structure velocity. It was shown that impairments of blood flow velocity leads to blood cells sedimentation and thrombus structure formation, which is not moving according to Newton’s law. New indicators for diagnosing functional condition of vessels and estimating the severity of vascular insufficiency are introduced.

Conclusion. Developed hemorheologic models allow to adequately estimate human cardiovascular bloodflow.

During the Great Patriotic War in Kazan, evacuation hospitals were established in Kazan. Teachers of the Kazan State Dental Institute made an invaluable contribution to their work, offering advice and medical aid to the wounded and sick. During the war, members of the department significantly improved the quality of the treatment of the wounded in the maxillofacial region, which contributed to their rapid recovery and return to the troops or to labor. The Great Patriotic War was a special period for the Department of Orthopedic Dentistry of Kazan State Dental Institute, when everything was aimed at providing high quality care and rehabilitation of patients. Staff members of the department of orthopedic dentistry proposed a number of original methods, orthotics and prostheses for the treatment of severe wounds in the maxillofacial region, which have been successfully used in those years. The designs of these devices and prostheses are not outdated; they are successfully used today to treat patients with maxillofacial injuries. Researches of thoughtful and talented scientists, whose labors are methodically published not only in scientific works, but also in prosthetic dentistry textbooks, valuable for the professional development of a new generation of students of dental faculties. Teaching staff of the department of orthopedic dentistry cherishes the memory of the staff members, who contributed to the development and improvement of dental education in the city of Kazan.

The article describes the Kiev Pokrovsky monastery hospitals for outpatients, providing the medical aid at the end of XIX and at the beginning of XX century for the population of South-West and North-West region of the Russian Empire. Interesting documentary facts are enlightened: «December 6, 1898 Emperor Nicholas II Highest deigned to call the hospital and clinic for outpatients as the “Free hospital and clinics for outpatients of Emperor Nicholas II at the Kiev female cenobitic monastery”». The article uncovers the activities of a magnificent doctor Nikolay Viktorovich Solomka, companion of the Grand Duchess Aleksandra Petrovna, who was able to find proper word for moral and spiritual influence on patients while addressing to the colleagues and sisters. Medicine in Kiev Pokrovsky Monastery-hospital was praised by an authoritative person and statesman, Academician Georgiy Ermolaevich Reyn (in future - long-term chairman of the Medical Board of the Ministry of Internal Affairs, the first chief superintendent of the Main Directorate of Public Health). According to the report of the scientific mission of doctor A. Turkevich to the Kiev Pokrovsky Monastery-hospital, discovered by author, we can get a picture of the state of affairs in the medical facilities of the monastery. Achievements, raising the Monastery-hospital on the unprecedented level, are becoming evident. It is no coincidence that doctors - Delegates of the «Pirogov’s VI Congress» and doctors - delegates of the «X Congress of Russian naturalists and doctors» praised all of his hospital institutions and medical personnel while being acquainted with the Kiev Pokrovsky Monastery-Hospital.