Vol 24, No 2 (2018)
- Year: 2018
- Articles: 11
- URL: https://journal-vniispk.ru/0869-2106/issue/view/2259
Articles
THE DEVELOPMENT AND IMPLEMENTATION OF THE MOST OPTIMAL SYSTEM OF INTERACTION OF A LARGE MULTI-FIELD CHILDREN HOSPITAL WITH INSURANCE COMPANIES CONCERNING PROGRAMS OF VOLUNTARY MEDICAL INSURANCE
Abstract
Actuality of the study. Nowadays, in the Russian Federation, medical organizations have, independently of organizational legal form, a right to provide paid services both to population and legal persons. The purpose is to develop and implement an optimal system of interaction of large multi-type children hospital with insurance organizations. Materials and methods. The process of development of organization of medical services provision was studied within the frameworks of voluntary medical insurance during 2011-2017 in the Z.A. Bashliaeva children municipal clinical hospital. Results. During 2011-2016 an increasing of annual amount of funds received from medical services provision according voluntary medical insurance programs up to 14 times. The experience of optimal interaction of medical organization with insurance companies according voluntary medical insurance programs. Conclusion. It is appropriate to pay a special attention to effective interaction between medical organization and insurance company, to algorithm of functioning of medical organization during qualitative medical care support of children population in conditions of multi-type hospital complex.
Medical Journal of the Russian Federation. 2018;24(2):60-64
60-64
DOES THE SCALE SAME-TT2R2 FUNCTIONS IN REAL CLINICAL PRACTICE?
Abstract
◆The possibilities of anticoagulant therapy in patients with atrial fibrillation significantly increased during last years. The warfarin therapy can be ineffective in those patients who can't neatly follow regimen of treatment, to control international normalized ratio in blood or international normalized ratio is retained with difficulty on recommended level. The scale SAMe-TT2R2 is considered as appropriate one to apply for more exact preliminary evaluation of possibility of achieving anticoagulation under application of antagonists of vitamin K. The purpose of study was to validate scale SAMe-TT2R2 on the group of observed out-patients in a real clinical practice. The study included 55 patients receiving warfarin because of non-valvular atrial fibrillation. In 30 patients (54.5%) a paroxysmal atrial fibrillation was observed and in 25 patients (45.5%) - permanent form of this disease. The examined group included 14 females and 41 males with average age of 71,3 ± 7,52 years. The patients receiving warfarin were in target range of international normalized ratio (2-3) 64,3 ± 12,91%of intake time. The percentage of patients residing within target range of international normalized ratio 60% of time and more comprised 58.9%. In average, patients taking during a year warfarin as anticoagulant controlled international normalized ratio 9,6 ± 0,41 times. In the examined group, 30 patients had according scale SAMe-TT2R2 0-1 point and 25 patients - 2 and more points. The scale had low diagnostic value (the square under ROC-curve 0.582), low sensitivity model 0.429 and moderate specificity 0.758 in relation to prediction of residence time in the target range of international normalized ratio 60%. For the value TTR 60% the diagnostic value turned out higher - 0.619 (sensitivity 0.547, specificity 0.789).
Medical Journal of the Russian Federation. 2018;24(2):65-68
65-68
THE ESTIMATION OF TOTAL SATURATION INDEX AS A TECHNIQUE OF HEALTH STATUS CONTROL
Abstract
For the first time, the method of ozonization permitted to determine standard values of level of unsaturation in healthy people. The samples for analysis can be isolated from blood plasma or blood serum, cellular membranes, tissues, exudates, female milk. To analyze 0.05 ml of plasma of blood serum and 200 000 cells are more than enough. The method has high sensitivity (1%), selectivity and performance (0.5-3.0 min per single analysis). The method permits to establish risk groups under mass examination of population, to forecast course and development of disease, to detect onset of latent period or complication, to control efficiency of the chosen scheme of treatment.
Medical Journal of the Russian Federation. 2018;24(2):69-72
69-72
THE CLINICAL PHARMACOKINETIC PARALLELS OF PERI-OPERATIONAL ANTIBIOTICS PREVENTION IN ABDOMINAL SURGERY
Abstract
The purpose of study is to evaluate features of pharmacokinetics and efficiency of cefoperazone as a mean of peri-operational antibiotic prevention under surgical treatment of ventral hernia. Material and methods. The results of herniotomy and meshed endoprosthesis replacement were analyzed in 459 patients who, 20 minutes before the operation, received intravenous bolus injection of 1 g of cefoperazone with purpose of preventing wound infection. The pharmacokinetics of medication was analyzed according developed technique of capillary electrophoresis using device KAPEL-105M («Lumex», St. Petersburg). The analysis was applied to blood, urine and tissues of wound (skin, subcutaneous cellular tissue, aponeurosis, muscle, peritoneum) taken after 20, 40 and 60 minutes after injection of cefoperazone. The results. The first stage of study established that content of cefoperazone in subcutaneous fat is as much as possible approximated to its concentration in blood and it is 2-3 times higher in peritoneum. At the 60th minute a higher level of cefoperazone is observed in all tissues except subcutaneous cellular tissue though it is most stable there. At that, wound complications are established in 9 (1.95%) patients, including 2 (0,44%) patients шт the form of seroma. Discussion. In case of intravenous injection cefoperazone is distributed in tissues in the way that up to 60th minute of study, a significant decreasing of medication level (p<0.05) is observed in skin, muscle and peritoneum. The minimal concentration remains in cellular tissue which is «incubator» of microflora. The established character of pharmacokinetics of cefoperazone explains possibility of infectious inflammation in this weak part of wound. Conclusion. The technique of capillary electrophoresis permits to control objectively pharmacokinetics of cefoperazone detecting its concentration in biological objects. The bolus injection of cefoperazone 20 minutes before operation is associated with its highest concentration in skin, aponeurosis and peritoneum and minimal but stable level of concentration in subcutaneous fat. The established pharmacokinetics of cefoperazone guarantees a preventive importance of peri-operational antibiotics prevention under operative treatment of ventral hernia with meshed endoprosthesis.
Medical Journal of the Russian Federation. 2018;24(2):73-77
73-77
THE PARTIAL TRANSPLANTATION OF DESCEMET’S MEMBRANE WITH ENDOTHELIUM (½ AND ¼ DMEK)
Abstract
The lamellar keratoplasty is the first operation of choice under selective pathology of cornea. In view of satisfactory results of endothelium surgery similar operations are implemented at more earlier stages that increases need in donor tissue. The life-span of population increases hence number of patients in need of cornea transplantation also increases and number of intact cadaver corneas decreases because of stable increasing of number of surgical interventions at the frontal section of eye. The purpose of study is to analyze operations of partial transplantation of Descemet's membrane with endothelium (½ DMEK and ¼ DMEK). Material and methods. The analysis was applied to the results of 10 operations ½ DMEK (semi-DMEK, hemi-DMEK) and 10 operations ¼ DMEK, implemented at eyes of 20 patients with primary endothelium dystrophy. The average age of patients made up to 64,9±10,4 years. The average visual acuity prior to implementation of partial DMEK amounted to 0,14 ± 0,08, average central thickness of cornea, according data of optical coherent tomography, made up to 669 ± 91 мкм. Results. In 16 out of 20 cases of partial DMEK, restoration of transparency of cornea, resorption of edema and increasing of visual acuity was achieved. In other 4 cases, during one week after partial DMEK, a subtotal DMEK was implemented. In 16 cases, average visual acuity increased up to 0,8 ± 0,3 three months later after operation. Conclusion. The techniques of partial transplantation of Descemet's membrane with endothelium (¼ DMEK и ½ DMEK) are efficient for treatment of primary endothelium pathology of cornea and permit to apply donor's material as much as possible rationally.
Medical Journal of the Russian Federation. 2018;24(2):78-82
78-82
THE CONTENT OF SERUM CYTOTOXINS UNDER LIVER CIRRHOSIS OF VIRAL ETIOLOGY AT VARIOUS STAGES OF COMPENSATION
Abstract
The study was implemented concerning the level of interleukins 2 and 6 (IL-2 and IL-6), tumor necrosis factor alpha (TNF-α) under hepatic cirrhosis (HC) of viral etiology classes А, В, С according Child-Pugh. The purpose was to evaluate level of serum cytokinemies and their relationship under HC of viral etiology depending on class of severity according Child-Pugh and level of portal pressure. The cytokines concentration was determined using technique of solid-phase enzyme-linked immunosorbent assay. It is established that against the background of decreasing of compensation of HC occurs increasing of serum level of IL-2, IL-6 and TNF-α within the limits of reference values at the exception of level of IL-6 under HC class C. In the given category of patients, level of IL-6 exceeds reference values and is within the limits of 9,94-25,21 pg ̸ml with average concentration 14,89±4,96 pg ̸ml. It is demonstrated that quantitative ratios and degrees of relationships between cytokines are determined by compensation of cirrhosis. The correlation relationships are mostly expressed in the form of feedback between TNF-α and IL-6 (r = 0,499) in case of HC class A. and in the form of direct relation between TNF-α and IL-2 (r = 0,421) in case of HC class B. It is proved that against the background of decreasing of compensation of HC increasing is occurring of serum levels of IL-2, IL-6 and TNF-α within the limits of reference values with the exception of level of IL-6 in case of HC class C. In the given category of patients’ level of IL-6 exceeds reference values and is within limits of 9,94-25,21 pg/ml with average concentration 14,89 4,96 pg/ml.
Medical Journal of the Russian Federation. 2018;24(2):83-86
83-86
THE FEATURES OF APPLICATION OF MINERAL OF SYLVINITE IN COMPLEX TREATMENT OF ENT-DISEASES
Abstract
The active implementation of sylvinite therapy in modern medical practice and appearance of new modifications of salt devices gave occasion to widening of area of application of this curative method. It is proposed to apply sylvinite physiotherapy room in complex treatment of chronic catarrhal pharyngitis as a most wide-spread disease of ENT-organs presented in all age groups and especially in persons of young age. The inner environment of facility was evaluated by hygienic methods. The levels of such curative factors impacting patients as aeroionization, multi-component fine-dispersed dry salt aerosol, stable micro-climate was within therapeutically significant limits. The in-depth microbiological analysis of inner environment of the given facility that substantiated availability of bacterio-static effect of mineral sylvinite on bacterial culture S.aureus and high efficiency of functioning of physiotherapy facility. The clinical studies covered 52 patients with chronic catarrhal pharyngitis: 27 - observation group (common treatment+syvinite therapy) and 25 - comparison group (common therapy only). In the result of applied treatment all patients achieved amelioration of health condition and local immunity of mucous membrane of throat. However, in the comparison group positive dynamics was less expressed. The obtained results confirmed possibility of application of characteristics of natural mineral sylvinite in complex treatment of chronic catarrhal pharyngitis and other inflammatory diseases of ENT-organs.
Medical Journal of the Russian Federation. 2018;24(2):87-92
87-92
THE PLASMA FLOWS IN SURGICAL PRACTICE
Abstract
Nowadays, the various techniques of thermal energy are applied for dissection and coagulation of biological tissues in surgery. The plasma surgery technology is on of the leading one among them. Multiple publications concerning application of plasma flows testify the following advantages: bloodless dissection of tissues, hemostasis and sterilization of wound surface, making of optimal conditions for subsequent regeneration of tissue substrate, especially due to stimulating effect of molecules of exogenous nitrogen oxide (II) of air plasma jet. On the basis of publication data, the analysis is applied to efficiency of the given technology, features of plasma physical effect in various regimen, possibilities of combined application of this technology with other physical chemical methods. The article presents in details historical aspects of development of plasma technology in Russia, types of plasma installations, specific thermal alterations of organs and tissues after plasma processing in surgical regimen. The method was successfully approved in abdominal and thoracic surgery, operative gynecology, stomatology and oncology. However, plasma technology is mostly called-for in contaminated surgery. This technology, in combination with surgical processing, provides efficient elimination of necrotizing masses and pathogenic flora; thorough hemostasis with formation of mechanically isolating scab as a barrier for in-hospital infection. The fast settlement of inflammatory occurrences in the very wound and in tissues of para-vulnar zone and also stimulating effect on regeneration processes testify positive effect of sanation with various plasma flows in treatment regimen.
Medical Journal of the Russian Federation. 2018;24(2):93-98
93-98
THE SEPSIS-INDUCED ENCEPHALOPATHY
Abstract
The article presents a review of publications concerning sepsis-induced encephalopathy. The sepsis-induced encephalopathy is a disorder of cognitive functions frequently occurring in sepsis without any relationship with inflammation central nervous system. This condition is an actual problem against the background of increasing of number of patients with infection and sepsis. The main pathophysiologic mechanism of sepsis-induced encephalopathy is considered derangement of hematoencephalic barrier and also increasing of concentration of aromatic amino acids. The clinical symptomatic of hematoencephalic barrier is characterized by disorder of consciousness level and also by disorders of sleep, deficiency of attention, delirium down to coma. To confirm diagnosis of sepsis-induced encephalopathy various diagnostic scales are applied and instrumental and laboratory diagnostic techniques. In treatment of the given pathology key positions are elimination of infection and correction of metabolic disorders.
Medical Journal of the Russian Federation. 2018;24(2):99-103
99-103
THE COMPLEX REGIONAL PAIN SYNDROME
Abstract
The article considers clinical manifestations, pathogenesis and therapy of complex regional pain syndrome. The historical reference on this issue is provided. The description of clinical case of complex regional pain syndrome with positive effect against the background of applied therapy is presented. It is emphasized that besides complications related to monitoring of this category of patients, the presented case is an evidence of inadequate studying of pathogenesis of complex regional pain syndrome. The pathophysiologic concepts explaining development of complex regional pain syndrome are presented: activation of neurogenous inflammatory alterations, development of pathologic sympathetic afferent links and neuroplastic alterations in central nervous system. The focus is made on mal-adaptive character of neuroplastic alterations of sensory and motor cortex. The results of modern neuro-visual methods of study are analyzed permitting to look from a new perspective on origin of clinical disorders in this condition. The significance of disorders of cerebral links in case of complex regional pain syndrome. These results are based on analysis of functional links («connectom in rest»), temporarily and space characteristics of which are altered in presence of chronic pain. The conclusion is made that the very impact of functional links altered under complex regional pain syndrome provides possibilities for new methods of treatment of this state.
Medical Journal of the Russian Federation. 2018;24(2):104-108
104-108
THE LIFE AND BIOGRAPHY OF THE LEGENDARY PROFESSOR V.F. VOYNO-YASENETSKY, THE ARCHBISHOP AND SURGEON (TO THE HUNDRED FORTIETH ANNIVERSARY: 1877-1961)
Abstract
V.F. Voyno-Yasenetsky, after receiving diploma of physician, improved in the clinic of P.I. Diakov, and in the Institute of topographic anatomy and operative surgery at F.A. Rein. In 1905-1914 V.F. Voyno-Yasenetsky worked as Zemstvo physician in hospitals of the Simbirsk, Kursk and Vladimir gubernias and during the First world War he was a surgeon and chief physician of infirmary for the wounded. In 1915 V.F. Voyno-Yasenetsky published in St. Petersburg the book «The regional anesthesia» with one's own illustrations. In 1919 he defended the doctoral dissertation about regional anesthesia in the Moscow University. The dissertation was awarded by the Warsaw University. In 1917-1930 he worked as a surgeon of municipal hospital in Tashkent and from March 1917 he became the chief physician. From 1920 V.F. Voyno-Yasenetsky is a professor of the Chair of Topographic Anatomy and Operative Surgery in the Turkestan University. His input into practical surgery is analyzed. The operation of removal of sacroiliac symphysis with rear part of wing of ilium affected by purulent process belongs to him (resection of pelvis according Voyno-Yasenetsky). The original mode of closure of wound positioned at periphery of diaphragm also belong to him (Voyno-Yasenetsky mode ). He proposed original mode of mobilization of spleen and ligation of vessels under splenectomy (Voyno-Yasenetsky mode). V.F. Voyno-Yasenetsky described such important for surgeons topographic anatomic reference points as a projection of sciatic nerve on skin of a rear surface of thigh (Voyno-Yasenetsky line) and area of outlet of sciatic nerve from under gluteal fold (Voyno-Yasenetsky point). In 1946, V.F. Voyno-Yasenetsky was honored with the Stalin Award Degree I for books «The essays of contaminated surgery» (1943) and «The late resections under infected gunshot wounds of joints» (1944).
Medical Journal of the Russian Federation. 2018;24(2):109-112
109-112