Vol 95, No 3 (2014)
- Year: 2014
- Articles: 40
- URL: https://journal-vniispk.ru/kazanmedj/issue/view/106
DNA repair system defects - role in oncogenesis and cancer therapy
Abstract
Inherited and acquired abnormalities in DNA damage repair system may lead to cancer and other diseases, as well as to act as one of the key factors determining the patient’s responsiveness to chemo- and radiotherapy. Nowadays, the principles of the personalized therapy, based on specific features of disease development and pathogenesis of a solitary organism or in a small group, are applied to treat a broad number of diseases, including cancers. This approach allows to choose the most effective cancer therapy in every single case of cancer, based on the genetic analysis and expression level of specific proteins. One of the promising approaches for increasing the effectiveness of non-surgical cancer treatments - to develop the methods to increase the cancer cells sensitivity to conducted chemotherapy, based on using the DNA repair system defects for the better anti-cancer effect. The review covers some types of DNA repair system defects occurring while chemo- and radiotherapy. Perspectives of the possible influences on DNA repair mechanisms treated as possible targets for both anti-cancer treatment and for increasing the effects of cancer chemo- and radiotherapy, are discussed in the review considering the available published data and results of own research. DNA repair system defects play an important role in cancer genesis, but as well can determine the good response of patients with such defects to chemo- and radiotherapy (inducing different types of DNA damage).
Kazan medical journal. 2014;95(3):307-314
307-314
Theoretical and clinical medicine
Cardiovascular risk and unproportional high weight of left ventrical myocardium in climacteric women
Abstract
Aim. To study the distribution of cardiovascular risk factors, target organ damage, associated clinical conditions and to stratify the 10-year risk of arterial hypertension complications in menopausal females depending on presence of inappropriately high left ventricular mass. Methods. 107 females from city of Kazan aged 42-59 years entered the study, including 11 women with normal blood pressure, 16 patients with high normal blood pressure, and 80 patients with hypertension according to All-Russia scientific Society of Cardiologists classification (2010) with disease duration of 0-34 years. Mean age of patients with hypertension was 51.4±4.0 years. Patients with secondary hypertension were excluded from the study. All patients underwent a questionnaire survey, physical examination, biochemical blood test, ECG, echocardiography, and cervical extracranial vessel ultrasonography. Actual left ventricle mass was calculated according to R.B. Devereux et al. (1977) and was adjusted to the body surface area. Proper left ventricle mass was defined by G. Simone et al. (1998). Disproportion coefficient was calculated as a ratio of actual left ventricle mass to proper left ventricle mass. Left ventricle hypertrophy was diagnosed using the Sokolow-Lyon index and left ventricle mass index ≥ 110 g/m2 (Echo-signs of left ventricle hypertrophy). Results. In menopausal women, inappropriately high left ventricular mass was associated with significantly (р <0.05, Fisher exact test) higher frequency of obesity, especially its abdominal type, as well as target organ damage, including Echo-signs of left ventricle hypertrophy, very high added 10-year risk of developing arterial hypertension complications. It was also associated with significantly (р <0.05, the U-criterion) higher mean values of waist circumference, waist to hip circumference ratio, body mass index, total number of damaged target organs and 10-year risk for developing arterial hypertension complications. Conclusion. Distinguishing the patients with inappropriately high left ventricular mass among menopausal women is important for planning the measures to prevent cardiovascular events.
Kazan medical journal. 2014;95(3):315-322
315-322
Immunological aspects of pathogenesis of metabolic syndrome-related arterial hypertension
Abstract
Aim. To analyze the link between levels of adipocytokines (leptine), non-specific cytokines (interleukin-6, tumor necrosis factor-α) and arterial hypertension. Methods. 123 subjects, including 100 patients with metabolic syndrome (according to 2005 Criteria of International Diabetes Federation) and 23 healthy subjects, were examined. General examination was performed, body weight, height and waist circumference were measured, body mass index was calculated. Following laboratory test were performed: serum leptin, interleukin-6, tumor necrosis factor-α, main classes of immunoglobulin, C-reactive protein levels were measured. Results. In patients with metabolic syndrome, increased body weight was associated with increased risk of arterial hypertension. A 10-fold increase of serum leptin level (44.69±8.96 ng/ml) compared to healthy controls (4.72±1.33 ng/ml, p <0.01), was revealed. Leptin level elevation was strongly associated with increased body mass index (r=0.77; p <0.001). Tumor necrosis factor-α concentration in patients with metabolic syndrome exceeded 2 pg/ml, while in healthy controls it didn’t reach this level. Interleukin-6 level was elevated in patients with metabolic syndrome (7.32 [3.25; 7.17] pg/ml) compared to controls (1.53 [1.19; 2.49] pg/ml, Fisher’s exact test, p <0.001). Examination of immunoglobulin levels in patients with metabolic syndrome revealed decreased serum level of immunoglobulin E (97.12±66.24 IU/ml) compared to controls (60.47±19.04 IU/ml, p=0.01). Concentration of immunoglobulin G in patients with metabolic syndrome was also higher (14.61±3.50 g/l) compared to controls (12.57±2.07 g/l, p=0.009). Increased interleukin-6 and immunoglobulin G levels were associated with presence of arterial hypertension. Conclusion. Increased interleukin-6 and immunoglobulin G might be an important factor for arterial hypertension onset and progression.
Kazan medical journal. 2014;95(3):322-325
322-325
Effect of L-arginine on endothelial dysfunction in patients with congenital mitral valve prolapse
Abstract
АIM. To study the effect of L-arginine on endothelium-dependent vasodilatation in patients with congenital mitral valve prolapse and different degrees of regurgitation. Methods. The study included 86 patients [36 (41.9%) males and 50 (58.1%) females aged 15-25 (mean age 19.9±1.42) years] with signs of congenital mitral valve prolapse. The first group included 41 patients were L-arginine (Tivortin) as a prophylaxis medication. The second group included 45 patients who were not taking L-arginine. Subgroup A of each group included 20 and 22 patients with stage I of mitral regurgitation, accordingly; subgroup B of each group included 21 and 23 patients with stage II of mitral regurgitation, accordingly. Results. In patients of the first group with mitral valve prolapse and stages I and II of mitral regurgitation, distinct positive changes were observed after 6 months of treatment with L-arginine. Compared to baseline data, in patients of the first group with stage I of mitral regurgitation brachial artery diameter increased by 1,44 times (р <0.001), resistance index - by 1.5 times (р <0.001); in patients with stage II of mitral regurgitation the following parameters increased by 1.65 and 1.39 times (р <0.001 and р <0.01) accordingly. At the same time, parameters of NO-system also improved in patients of the first group with stages I and II of mitral regurgitation after 6 months of treatment: endothelial NO synthase activity increased by 1.18 and 1.29 times (р <0.05 and р <0.02) accordingly, NO level decreased by 1.17 and 1.18 times (р <0.05), inducible NO synthase activity - by 1.17 and 1.29 times (р <0.05 and р <0.02), and there was a reduction of peroxynitrite levels by 1.23 and 1.34 times (р <0.02 and р <0.01), endotheline-1 - by 1.07 and 1.26 times (р <0.05 and р <0.02), vascular endothelial growth factor - by 1.08 and 1.24 times (р <0.05 and р <0.01) accordingly. Conclusion. Recommended doses of L-arginine restores the stream-dependent vasodilation, activity of the NO-system and process of angiogenesis after 6 months of treatment.
Kazan medical journal. 2014;95(3):326-331
326-331
Association of blood level of inflammatory mediators and morphology of coronary artery stenosis in patients with stable angina
Abstract
Aim. To study the association of morphology of coronary artery disease and pentraxin-3, tumor necrosis factor α blood levels in patients with stable angina who undergo coronary artery bypass surgery. Methods. The study included 92 patients aged 44-73 years with stable angina of II-III functional class. The coronary artery disease type was classified by AHA/ACC criteria: type A - concentric stenosis with flat plague and plague length less than 10 mm, type B - eccentric stenosis or blunt-edged stenosis with moderate calcinosis or signs of mural trombosis, with length not exceeding 200 mm, type C - stenosis with plague length over 20 mm, plague ulceration, marked calcinosis, diffuse lesions, chronic coronary artery occlusion. Pentraxin-3, tumor necrosis factor α blood levels were measured by ELISA in all patients before the surgery, 8 and 24 hours after the surgery. Results. There was a relation found between the type of stenosis and pentraxin-3 and tumor necrosis factor α blood levels. In patients with С type stenosis, pentraxin-3 blood level was 4 times higher (p <0.001) 24 hours after the coronary artery bypass surgery compared to patients with A type stenosis, and by 1.8 and 1.3 times higher compared to patients with В1 and В2 stenosis type, accordingly. Conclusion. There was a close relation revealed between the morphology of coronary artery stenosis and pentraxin-3 and tumor necrosis factor α blood levels in patients with stable angina.
Kazan medical journal. 2014;95(3):331-334
331-334
Using phospholipids as hepatoprotective agents for dyslipidemia correction in adolescents with metabolic syndrome
Abstract
Aim. To study the effect of phospholipids for lipid metabolism normalization in adolescents with metabolic syndrome. Methods. The study included 50 adolescents aged 12 to 17 years with the diagnosis of metabolic syndrome according to 2007 criteria of International Diabetes Federation. All of them had dyslipidemia and nonalcoholic fatty liver disease in the stage of steatosis, steatohepatitis. The adolescents were splitted into two groups: the treatment group (30 patients) and the control group (20 patients). Patients of the first group, as an addition to the standard treatment (metformin), took phospholipids (Rezalut) 2 capsules three times a day for 2 months, followed by a second course after 2 months gap. Patients of the first group were treated by the standard treatment only. The statistical analysis was performed by the methods of parametric and nonparametric statistics using «Statistica 6.0» software. Results. After 3 months of treatment, there was a body weight and body mass index decrease in patients of the treatment group, the difference between the groups was statistically significant (р <0.05), and preserved so after 6 months of treatment compared both to baseline data and to controls. Serum cholesterol, low-density lipids levels decreased, high-density lipids levels increased in patients of the first group, reducing the atherogenic index of plasma. No significant changes of these parameters was observed in the second group. Liver enzymes (aspartate aminotransferase, alanine aminotransferase) levels reduced significantly (р <0.05) in the treatment group compared with baseline levels; no such changes were observed in the control group. Conclusion. Prescribing phospholipids as part of the complex treatment of the metabolic syndrome is pathogenically justified.
Kazan medical journal. 2014;95(3):334-337
334-337
Improving the local treatment effect in oral lichen planus
Abstract
Aim. To assess the clinical efficacy of local use of titanium glycerosolvate aqua-complex (Tisolum) in combination with hyaluronidase as a component of the complex treatment of oral lichen planus. Methods. The study included 49 patients with typical form of oral lichen planus aged 29 to 65 years. The first group included 25 patients, who received the local treatment with glycerosolvate aqua-complex (Tisolum) in combination with hyaluronidase as a component of the complex treatment. The second group included 24 patients who were treated conventionally. Results. The patients of the treatment group reported the decrease of the oral mucosa tightness and roughness sensation 5.78±0.26 days after the treatment initiation, which was 1.5 times faster compared to the control group (8.6±0.34 days, р <0.05). On the seventh day of treatment, there was a significant papule deflorescence in 19 (76.0%) out of 25 patients of the main group, compared to 11 (45.8%) out of 24 patients of the control group (р <0.05). On the 10-th day, disappearance or downsizing of lesions without signs of active inflammation was observed in all 25 patients of the treatment group, compared to 16 (66.7%) of the control group patients (р <0.05). On the 14-th day, no mucosal lesions were observed in all 25 patients of the treatment group, which was significantly better compared to 9 (37.5%) out of 24 patients of the control group (р <0.05). Regression of clinical signs of the disease at the treatment end was registered in all patients of the main group and in 14 (58.3%) patients of the control group. Conclusion. Local use of composite gel containing titanium glycerosolvate aqua-complex (Tisolum) in combination with hyaluronidase as a component of the complex treatment of oral lichen planus is highly effective.
Kazan medical journal. 2014;95(3):338-340
338-340
Surgical treatment for pelvic organs prolapse
Abstract
Aim. To estimate and compare the features and efficacy of different surgical methods of pelvic organ prolapse correction. Methods. 120 patients with stage 4 of pelvis organ prolapse were included in the study. The different types of surgical procedures were performed («Manchester» surgery, vaginal hysterectomy, sacropexy, laparoscopic ventrosuspension). Surgical method was selected accounting the patient’s age, desire to save the uterus, presence of uterine or adnexal pathology and concomitant diseases. For long-term outcomes evaluation, patients were followed up for 6-36 month after surgery. Results. The long-term outcomes of the different types of surgeries performed in patients with stage 4 of pelvis organ prolapse were comparable. Minimal surgery time, blood loss and the hospital stay were registered in patients, in whom laparoscopic ventrosuspension combined with colpoperineorrhaphy and levatorplasty was performed, compared to «Manchester» surgery, vaginal hysterectomy and sacropexy with colpoperineoplasty. No cases of serious complications were registered. Patients with stress incontinence observed before surgery reported improvement in urination, although 6 patients (10%) still reported rare episodes of incontinence. Conclusion. In elderly patients with stage 4 of pelvis organ prolapse, laparoscopic ventrosuspension of uterus or vaginal stump with further colpoperineorrhaphy and levatorplasty could be performed; this type of surgery is technically simple, not time-consuming, and it’s results are comparable with the effectiveness of sacropexia. Thus, it could be recommended to under-trained young surgeons.
Kazan medical journal. 2014;95(3):341-347
341-347
Probit-analysis for assessing the effectiveness of various treatment methods for chronic liver failure
Abstract
Aim. To estimate the validity of probit-analysis for assessing the effectiveness of various treatment methods for chronic liver failure. Methods. The study included 292 patients with chronic liver failure. All patients were distributed to four groups, conventional treatment was performed in all patients. Patients of the 2nd group were additionally administered plasma exchange, of the 3rd group - plasma exchange and high volume continuous veno-venous hemofiltration, of the 4th - molecular adsorbent recirculating system (MARS). To determine the medium lethal time (time at which 50% of patients pass away, ТL50), probit-analysis based on studying the association between the time logarithms and probits corresponding to the observed effects, was used. Results. Standardization of patients’ mortality rate, allowing to exclude biases associated with differences of chronic liver failure severity at admission, was performed. Probit-analysis showed that there were no significant differences in between male and female patients regardless of used treatment methods. ТL50 in patients of any gender treated only by conventional methods was significantly lower compared to other methods of treatment. There was a trend of ТL50 increase in the following sequence: conventional treatment → plasma exchange → plasma exchange and high volume continuous veno-venous hemofiltration → molecular adsorbent recirculating system. Conclusion. Probit-analysis allows to determine the time of 50% mortality (ТL50) in patients with chronic liver failure. Treatment using extracorporeal methods of treatment (plasma exchange, plasma exchange and high volume continuous veno-venous hemofiltration, molecular adsorbent recirculating system) is significantly more effective compared to conventional treatment.
Kazan medical journal. 2014;95(3):348-351
348-351
Clinical and functional features of the nasal cavity, paranasal sinuses and pharynx in patients with chronic obstructive pulmonary disease in remission
Abstract
Aim. To assess functional condition of the nasal cavity, paranasal sinuses, pharynx in patients with remission of chronic obstructive pulmonary disease. Methods. Patients were distributed to 2 groups. The main group included 49 patients with stages II and III of chronic obstructive pulmonary disease in remission, control group included 50 healthy non-smoking volunteers without any known respiratory diseases. Patients underwent general examination, completed by rigid endoscopic examination, examination of ciliary clearance, anterior active rhinomanometry, olfactometry, nasal cavity and paranasal sinuses computed tomography. Pharynx examination included nasal cavity posterior endoscopy, mesopharyngoscopy, lower part of the parynx was examined by rigid endoscope with viewing angle of 70°. Results. Ciliary clearance was 26.7±3.06 minutes in patients of the main group, compared to 16.4±1.11 minutes in patients of the control group. Smell acuity was 1.86±0.11 units in patients of the main group, compared to 2.3±0.15 units in patients of the control group. Signs of nasal and pharyngeal diseases, including signs of chronic inflammation of nasal mucosa and chronic catarrhal pharyngitis was found in 30 patients. Conclusion. Patients with chronic obstructive pulmonary disease had higher prevalence of chronic rhinitis and pharyngitis, worse smell acuity and impaired ciliary clearance compared to healthy controls.
Kazan medical journal. 2014;95(3):352-356
352-356
Community-acquired pneumonia treatment: predictors of fatal outcomes
Abstract
Aim. To analyze the quality of the medical aid in cases of community-acquired pneumonia with fatal outcomes and further development of recommendations for optimizing treatment strategy and tactics. Methods. Retrospective analysis of 62 medical charts of in-patients who passed away from community-acquired pneumonia during the calendar year. Results. The major part of all fatal outcomes of community-acquired pneumonia were seen at the intensive care units, to which the majority of such patients (41 cases, 66.1%) were admitted right from the admission ward. Differences of treatment tactics in patients with community-acquired pneumonia were revealed depending on the department type (internal diseases, intensive care unit, pulmonology) where the patients were admitted. The treatment manipulations structure and common mistakes made in administrating antibacterial and non-anti-infective drugs in cases of community-acquired pneumonia with fatal outcomes were analyzed. Anti-microbial treatment was assessed as completely adequate only in 18% of cases. In cases of severe community-acquired pneumonia with fatal outcomes the most commonly administered antibacterial drug was ceftriaxone (41 cases, 66.1%). At the same time, the potential of semisynthetic aminopenicillins was not unlocked (only 9 cases, 14.5%). The most common contraventions of rational anti-microbial treatment principles were irrational combinations, inadequate daily dosage and antimicrobial treatment change sequence. A trend for inappropriate administration of corticosteroids in patients with severe and extremely severe community-acquired pneumonia in the intensive care units was observed. The use of other non-anti-infective drugs (anticoagulants, diuretics, mucolytic agents and bronchodilators) as components of complex treatment in patinets with life-threatening community-acquired pneumonia should be strictly limited by their indications for use. Conclusion. Rational anti-bacterial treatment performed in compliance with national recommendations (2010) is the cornerstone of treating community-acquired pneumonia.
Kazan medical journal. 2014;95(3):356-361
356-361
Gender differences of left ventricular remodeling in patients with chronic heart failure
Abstract
Aim. To determine the gender differences in risk factors of left ventricular remodeling in patients with chronic heart failure associated with arterial hypertension and coronary heart disease. Methods. The study included 112 patients aged 45 to 60 years with myocardial scaring after myocardial infarction and functional class I-III of heart failure by NYHA. Patients were distributed to 2 groups: 1st included 60 males (mean age 54.8±3.3 years), 2nd - 52 females (mean age 55.8±3.1 years). To assess the cardiac function, all patients underwent echocardiography (B- and M-modes). Models of left ventricle architectonics were identified according to such parameters as left ventricle wall relative thickness index and left ventricular mass index. Results. Leading causes for heart failure in female patients were hypertension (50% of cases) and ischemic heart disease (23.1% of cases, 79.5% of ischemic heart disease cases were not associated). In males, ischemic heart disease was the leading reason for chronic heart failure (78.3% of cases, among them 80.9% with a history of survived myocardial infarction). In females, chronic heart failure was more often associated with isolated diastolic dysfunction (78.8% of cases versus 65% in males, p <0.05), and left ventricle ejection fraction was stable. Unfavorable types of left ventricle remodeling in terms of prognosis were more common among females, including eccentric left ventricle hypertrophy (67.3% of cases versus 53.3% in males, p <0.05) and concentric left ventricle hypertrophy (21% of cases versus 18.3% in males, p >0.05). Conclusion. There are gender differences in patients with chronic heart failure: prevalence of hypertension in women, and coronary heart disease in men; higher rate of isolated diastolic dysfunction prognostically unfavorable types of left ventricle remodeling (eccentric and concentric left ventricle hypertrophy) in females.
Kazan medical journal. 2014;95(3):362-366
362-366
Awareness of patients seeking a medicogenetic counseling as a factor for prevention of hereditary and congenital diseases
Abstract
Aim. To evaluate the awareness of patients of questions of medical genetics at the stage of family planning before pregnancy. Methods. Sociological, statistical and analytical analysis was performed. 350 respondents participated in the survey, including 304 pregnant women. Results. 219 (62.6%) of 350 respondents reported that they didn’t know the risk factors for hereditary and congenital diseases. Smoking as a risk factor was noted by 32 (9.1%) of all respondents, alcohol abuse - by 7 (2%), drug abuse - by 3 (0.9%), medication intake - by 24 (6.9%), infections - by 20 (5.7%), the presence of disease with hereditary predisposition - by 25 (7.1%), malnutrition - by 20 (5.7%) respondents. Approximately half of all respondents reported that they «know about the threads associated with hereditary and congenital diseases for the health status of their future child», 39.1% «knew, but not enough», 11.2% «didn’t know». Out of 350 respondents, 299 (85.4%) have never seek for medicogenetic counseling for pregnancy planning before. The main reasons for seeking for medicogenetic counseling were: abnormal biochemistry test results found at screening - in 169 (55.6%) of cases, seeking for prognosis of the future child health - in 61 (20.1%) of cases, age over 35 years - in 39 (12.8%) cases. Almost one-third of all responders (33.2%) did not know about methods for hereditary and congenital abnormalities prevention, 41.2% «knew, but not enough», and only 25.6% thought that they knew about those methods. Conclusion. The patients are seeking for the medical and genetic counseling in retrospect, when they already have health problems, and they are not informed about medical and genetic counseling, as well as are unaware of the importance of risk factors and methods for hereditary and congenital abnormalities prevention.
Kazan medical journal. 2014;95(3):367-370
367-370
Effect of dynamic electroneurostimulation in treatment of community-acquired pneumonia in preschool children
Abstract
Aim. To assess the effect of dynamic electroneurostimulation in treatment of community-acquired pneumonia in preschool children. Methods. The main group consisted of 45 preschool children with community-acquired pneumonia, in whom 7-day treatment course of dynamic electroneurostimulation was included as the component of the complex treatment. The control group included 55 children in whom conventional tactics was applied. Results. General intoxication syndrome was resolved at 3.2±1.1 day in children of the main group compared to 7.7±1.4 day in the control group. The use of dynamic electroneurostimulation reduced the duration of respiratory distress by more than 1.5 times (6.8±1.3 day), regression of physical lung changes was observed at 10.3±1.4 on average, compared to the end of the second week at the control group. Resolving of the clinical symptoms in children of the main group was accompanied by statistically significant (p <0.05) reduction of basic parameters of systemic inflammation (increased white blood cells count, high neutrophil count, left shift) by 7th day of treatment. The level of C-reactive protein reduced by 7 times in children of the main group, compared to 2.3 times in comparison group (p <0.05). Chest X-ray on the 7th day showed complete resolving of inflammatory changes in 20 (44.4%) patients of the main group, while no such cases were observed in control group (p <0.001). At the same time, no positive change of X-ray picture was revealed in 25 (45.5%) children of the control group, while there were no such cases in the main group (p <0.001). On the 11th day of treatment complete resolving of inflammatory changes was found in 43 (95.6%) children of the main group, compared to 34 (61.8%) children of the control group (p <0.05). Conclusion. Including of dynamic electroneurostimulation in complex treatment of community-acquired pneumonia in children reduces the recovery time, hospital stay and treatment cost.
Kazan medical journal. 2014;95(3):370-374
370-374
Attitude of medical students to alcohol and nicotine
Abstract
Aim. To determine the attitude of medical students to alcohol and nicotine. Methods. An anonymous survey of 118 5th year students (43 male students, 75 female students; mean age 22.6±0.9 years) of Irkutsk State Medical University was conducted. A self-composed questionnaire allowing to evaluate the students’ attitude to alcohol and nicotine was used. No cases of turndown were observed. Results. 17 (39.5%) out of 43 male students and 31 (41.3%) out of 75 female students were active smokers. 29.4% male students and 58.1% female students smoked up to 5 cigarettes per day, 58.8 and 38.7% - 5 to 10 cigarettes per day, 11.8 and 3.2% - over 10 cigarettes per day, accordingly. The majority of students (88.2% amle and 70.9% female students) smoked «light» cigarettes, 11.8 and 29.1% - «superlight». 25 (58.1%) male students and 47 (62.7%) female students reported that they were alcohol takers. Most of male students (84%) were drinking beer, most of female students (74.5%) - wine. 96% male and 36.2% female students took strong spirits. 17 (39.6%) male and 22 (29.3%) reported episodes of partial amnesia after alcohol consumption. 5 (20%) out of 25 male and 16 (34%) out of 47 female students reported they would like to reduce their alcohol consumption. Conclusion. The study showed that alcohol consumption and tobacco smoking is a rather common in the respondents; this problem requires further study.
Kazan medical journal. 2014;95(3):375-378
375-378
Low proliferative level is a poor prognostic factor for colon adenocarcinoma
Abstract
Aim. To match up the proliferative activity of colon adenocarcinoma cells with tumor stage and survival rate. Methods. Ki-67 protein expression was evaluated by immunohistochemical methods in 217 patients with primary colon adenocarcinoma. After epitope retrieval and endogenous peroxidase inhibiting by 3% solution of hydrogen peroxide, histologic samples were stained by antibodies to Ki-67 protein (clone SP6, dilution 1:300) and polymer systemic detection with diaminobenzidine as a chromogenic substrate. Nuclear counterstain was performed using Mayer’s hematoxylin solution. Results. Assessment of colon adenocarcinoma proliferative activity showed a significant difference between the number of cases with high (>70%) and relatively low (≤30%) proliferative levels in groups with metastatic cancers and non-metastatic tumors. In patients with no relapses, colon adenocarcinoma proliferative activity assessment showed proliferation level exceeding 70% in 21 (95%) out of 22 cases, in a single case proliferation level of 60% was found according to Ki-67, no cases of proliferation level lower than 50% was found. Statistical analysis showed that proliferative activity was significantly lower in patients with metastatic colon adenocarcinoma compared to cases of adenocarcinoma without metastases (p= 0.0019). We observe one clinical case of aggressive colon adenocarcinoma with omental, peritoneal, paraumbilical metastases in 28-year old patient, in whom proliferative activity by Ki-67 was measured as 20%. Conclusion. Low proliferative level in colon adenocarcinoma is a poor prognostic factor for possible metastasing and cancer recurrence.
Kazan medical journal. 2014;95(3):378-382
378-382
Clinical and experimental background for new method of bowel anastomosis
Abstract
Aim. To improve the results of bowel resection using newly designed bowel anasthomosis method. Methods. A new method of forming enteroenteroanastomosis was proposed and developed, based on calculating the vitality index for suture strip, arterial blood hemoglobin saturation and microcirculation after preparing the suture strip. After that, holder sutures are overcast at the preserved major vessel at mesenteric and counter-mesenteric edges of suture strips of efferent and afferent bowels. A running sero-muscular suture is formed between the edges, followed by 1-2 nodal sero-muscular side sutures and invagination of suture strips to the efferent loop. After that, a running sero-muscular suture is formed on the front of the anastomosis. Results. Pre-clinical testing was performed on 40 dogs, with no cases of anastomosis leak. Clinical testing included 30 patients who underwent colectomy. Enteroenteroanastomosis was formed by the proposed method, preceded by suture strip microcirculation examination. In patients of the control group who underwent colectomy, enteroenteroanastomosis was formed by classical double-row suture without examining suture strip microcirculation. No cases of anastomosis leak were registered in the main group, compared to 4 cases in the control group. Conclusion. Clinical and experimental studies have shown the effectiveness of the developed enteroenteroanastomosis.
Kazan medical journal. 2014;95(3):383-385
383-385
Experimental medicine
General casual hypothermia as a threat of thrombosis in rats
Abstract
Aim. To study the hemostasis at the pre-reactive period of cold injury occurred at the third stage of the decompensated phase of general casual hypothermia. Methods. Experiments were performed on on 23 Wistar rats. General casual hypothermia was simulated by placing the animals in individual cages in a freezer with in-temperature of -25 °C. Animals were kept in the freezer until the rectal body temperature of +30 °С. Blood samples of 10 animals, kept at 22°C during the same exposure time, were used as a control. Hemostasis parameters, including platelets and coagulation panel, as well as blood serum anticoagulant and fibrinolytic activity, were assessed in peripheral blood. Induced platelet aggregation was measured by aggregometer, with 10 μg/ml adenosine diphosphate solution as the inductor. Results. General casual hypothermia was not associates with changes in the peripheral blood. At the same time, increased platelet count by 19% (р <0.05) and reduced platelet aggregation activity by 9 times (р <0.05) was observed. The coagulation panel at the pre-reactive period of cold injury was associated with Echitox coagulation time increase by 42% (р <0.05), together with fibrinogen concentration drop by 25% (р <0.05). Increased polymerization time of circulating soluble fibrin monomer complexes by 36% (р <0.05) was suggestive of reduced I clotting factor serum concentrations. In the same animals, the serum concentration of soluble fibrin monomer complexes was increased by 96% (р <0.05), suggesting the increased clotting activity. Conclusion. Decompensated phase of general casual hypothermia was associated with significant changes of on the hemostasis. The set of observed changes was suggestive of increased clotting activity as the response to the cold trauma and predisposition to clotting in experimental animals.
Kazan medical journal. 2014;95(3):385-388
385-388
Effect of calcium channel blockers long-term use on blood level of luteinizing hormone and estradiol in rats
Abstract
Aim. To define the effect of calcium channel blockers long-term use on blood level of luteinizing hormone and estradiol in female rats. Methods. 82 mature female outbreed rats were distributed to seven groups. The rats of the first (control) group were administered 0.2 ml of 0.9% saline intraperitoneally for 21 day. Instead of saline, 5 and 25 mg/kg of verapamil were used in rats of the second and third groups, 5 and 10 mg/kg of nifedipine - in rats of the 4th and 5th groups, 5 and 20 mg/kg of diltiazem - in rats of the 6th and 7th groups accordingly. Blood levels of luteinizing hormone and estradiol were determined by ELISA after animals were withdrawn from the study. Results. In rats treated with calcium channel blockers, a dose-dependent decrease of luteinizing hormone and estradiol blood levels were observed. High doses of verapamil (group 3) decreased the level of luteinizing hormones and estradiol by 50% compared to control group, high doses of diltiazem (group 7) - by 50%. Only minor changes were observed in rats who were administered nifedipine, even in high doses. Conclusion. Observed decrease of blood estradiol level indicate the influence of calcium channel blockers directly on ovarian function; decrease of blood luteinizing hormone level might by secondary due to positive feedback between the estradiol and luteinizing hormone secretion and reflect decreased estradiol blood level.
Kazan medical journal. 2014;95(3):389-392
389-392
Comparative analysis of modeled femoral fractures osteosynthesis stability
Abstract
Aim. To perform the comparative analysis of osteosynthesis stability in splintered fractures on the example of modeled fractures of femur with metalwork. Methods. Bone fragments fixation methods using internal fixators, blocking intramedullary nails, external fixation devices. Round wooden rod with external diameter of 35 mm, internal diameter of 25 mm, which was saw in the middle with two cuts directed at an angle of 45° to the rod axis to form the triangle fragment, was picked for femur model for the purpose of experiment. The stability of bone fragments fixation using plates with angle stability, pin- and nail-type external fixation devices and blocking intramedullary nails was assessed. To test the stability of the «bone-fixing device» complex, torsional test machine КМ-50-1 №66, power press П-10 №92, pull test machine Р-10 №1677 were used. Results. Compared to external fixation device, fixation using plates with angle stability was 6 times more stable at axial load and by 43.5% at lateral load. The stability of blocking intramedullary nail at axial load was higher compared to external fixation device. At rotary load, the stability of blocking intramedullary nail was 2 times lower compared to external fixation device. Conclusion. On a model of splintered double-lever femur fractures, fixation using plates with angle stability was the most stable fixation mode.
Kazan medical journal. 2014;95(3):392-394
392-394
Change of acute stage reactants level in experimental intramedullary osteosynthesis
Abstract
Aim. To assess the plasma protein fractions as organism’s reaction to osteosynthesis by medical devices made of medical steel and of medical steel coated by titanium and gafnium nitrides mixture. Methods. Diaphyseal tibial fracture was modeled on 30 rabbits with further assessment of animal organism reaction to osteosynthesis by pins made of medical steel and of medical steel coated by super-hard metal nitrides mixture. The change of blood plasma protein fractions and acute phase reactants was used as an indicator. Measurements were performed before the osteosynthesis and on the 5th and 180th day after the surgery. Results. Together with the stable level of total blood protein, dysproteinemia characteristic for acute phase of the inflammation was observed after the trauma and reparatory process induction. Two-waived reaction was registered. The first developed at the 5th day after the surgery and was characterized by the drop of blood albumin level together with α- and β2-globulin levels increase, the reaction was observed in the intervention group earlier compared to control group. The second wave developed at the 180th day and was characterized by β2- and γ-globulin levels increase. The registered changes corresponded with the phases of acute non-specific response, which includes the overproduction of «positive» and decreased production of «negative» acute phase reactants by liver, influenced by cytokines, as well as later adaptive immune response. Conclusion. Overall, the intensity of acute phase reactions was lower in the intervention group, indicating less damage associated with titanium and gafnium nitrides coated implants use.
Kazan medical journal. 2014;95(3):395-398
395-398
Influence of toxoplasma gondii antigens on features of immune status at prenatal and early postnatal periods: experimental study
Abstract
Aim. To detect the features of immune status at prenatal and early postnatal periods under the influence of Toxoplasma gondii antigens. Methods. The experimental study was performed on Wistar white rats, who were the offspring of the female rats who were sensitized by T. gondii corpuscular antigen during the III trimester of pregnancy - group 1 (n=96) and on animals who were administered T. gondii corpuscular antigen at firs day of life - group 2 (n=103). Control group consisted of intact rats. Common blood test, levels of antibody-forming cells and CD3+ cells were assessed at 60 day after birth. Results. Neutrophil blood count was 1.9 times higher in the group 1 rats compared to group 2. Eosinophil blood count was 1.4 times lower in the group 1 compared to control group (р=0.01), and 2 times lower in the group 2 compared to control group (р=0.002). At the same time, lymphocyte count was comparable in the group 1 rats and control group, while it was 1.4 times lower in the group 2 compared to control group (р=0.04). Together with that, there was a reduction of CD3+ cells and antibody-forming cells in blood and spleen, which was more marked in the 2nd group. Lymphoadenopathy, thymus dysgenesia, reduced blood and spleen T-cells levels, low humeral immunity were found in Wistar white rats, who were the offspring of the female rats who were sensitized by T. gondii corpuscular antigen during the III trimester of pregnancy. Conclusion. The influence T. gondii corpuscular antigen on rats during perinatal period results in secondary immunodeficiency, persisting at 60 day of life.
Kazan medical journal. 2014;95(3):398-401
398-401
Liver and skeletal muscle ceramides in alloxan-induced diabetes
Abstract
Aim. To study of liver and sceletal muscle ceramides in alloxan-induced diabetes at different periods after alloxan exposure. Methods. Repeated experiments were performed on white male rats. Diabetes was modeled by alloxan hydrochloride solution intraperitoneal injection. The disease development was monitored using clinical and laboratory parameters. Ceramides in tissues were determined in intact animals (control), at the 10, 20, 30, 45 and 60 day after the alloxan injection. Ceramides level in the plates was determined by thin layer chromatography using the external standard. Results. In intact animals, ceramides level in liver was twice as high as in muscle. At all terms after alloxan injection, ceramide level was significantly higher compared to controls, and was in muscle compared to liver, with similar change pattern. Up to the 20th day, a significant increase of ceramide level was observed compared to control (eightfold in liver and sevenfold in muscle). By 30th day, a partial recovery was registered, followed by subsequent increase of ceramide level. This indicates the influence of compensation mechanisms in the early stages of the experiment with further decompensation on late stages. Conclusion. In alloxan-induced type 1 diabetes, ceramide level in insulin-dependent tissues depends on the term after the alloxan injection; the findings are of great importance for the research of secondary insulin resistance, as well as other diabetes-associated pathological conditions, exact mechanisms.
Kazan medical journal. 2014;95(3):402-404
402-404
Reviews
Local antibiotic therapy in infection of arteficial joints
Abstract
The aim of the study is to analyze possible options for treating patients with deep paraprothetic infection of major joints performing a literature review. Arthroplasty has occupied its specific place in a range of surgical operations used in treating patients with joint diseases. The rate of possible complications developing on different stages of treatment does not decrease while the number of operations increase. The most difficulties are associated with deep paraprothetic infection, because in this case in is only possible to save the implant in 20% of patients mainly with early infections. The rate for infective complications in specialized orthopedic centers while ward treatment does not exceed 1% in case of primary arthroplasty, but significantly increases several years after the surgery. The most used treatment for paraprothetic infection is serial revision arthroplasty. The comparative analysis of single-staged and two-staged treatment was performed. The second one is based on using antibiotic-loaded bone cement spacers. The analysis reveals that using antibiotic-loaded bone cement spacers is an effective method of treatment for deep paraprothetic infection. Two-staged treatment method with temporary spacer implantation is preferable in treating infective complications of arthroplasty. Furhter progress of this method may be associated with optimizing the choice of antibiotic filling, developing new spacer structures and forms, and in combining local and general antibiotic administration.
Kazan medical journal. 2014;95(3):405-411
405-411
Healthcare mangement
Cancer incidence and mortality in the Amur oblast
Abstract
Aim. To analyze the incidence and mortality from malignancies in the Amur Oblast. Methods. The evaluation was based on statistical data analysis of incidence and mortality from malignancies. Results. Incidence of malignancies in the last 5 years in the Amur Oblast increased up to 346.3 per 100 000 in 2012. Main localizations for malignancies were: the first place - lung malignancies; the second - skin malignancies; the third - breast malignancies; the fourth -stomach malignancies (41.1, 39.7, 37.3, 23.9 per 100 000 accordingly). The areas with the highest prevalence of cancers - Konstantinovsky, Zavitinsky, Bureysky, Zeysky districts - were outlined, with the prevalence of 441.9; 438.7; 420.6 and 384.4 per 100 000 per year. Mortality from cancer in the Amur Oblast in 2012 was 180.7 per 100 000, one-year mortality rate increased to 31.8%. The most frequent cancer types leading to unfavorable outcomes were malignancies of digestive organs - 34.9% of all fatal outcomes, respiratory system organs - 24.2%, female reproductive system - 6.6%, breast - 6.5%, kidneys and urinary tract - 6.01%. Conclusion. The incidence and mortality from malignancies in the Amur Oblast increased in 2012 compared to 2008.
Kazan medical journal. 2014;95(3):412-415
412-415
Management of providing surgical medical care in non-state day patient healthcare facilities of the railways in 2002-2011
Abstract
Aim. To study the changes of the of non-state day patient healthcare facilities performance indicators on providing ambulatory surgical care. Methods. Data of joint statistical reports of railway transport health facilities issued at 2002-2011, as well as documents that regulates providing surgical care to the population of the Russian Federation, Rosstat and Russian Health Ministry statistical data for the same period, were used for the analysis. Results. Surgical aid provided in day patient healthcare facilities of different types was changing differently. In out-patient clinics, the number of operations increased twicefold during 10 years, surgical aid provision per 10 000 population increased almost by 3 times (287%) over the 10-year period. The opposite trends were observed in day care facilities of the hospitals - the number of operations decreased, as well as surgical aid provision per 10 000 population and surgical procedures rate on 100 discharged patients from 6.5 to 3. In 2002, the structure of outpatient surgeries in day patient healthcare facilities was the following: skin and subcutaneous tissue surgeries - 41.8%, female reproductive organs - 51.4%, ears, nose and throat - 2.7%. By 2011, the structure has changed: with 70.3% surgeries performed on female reproductive organs, and 18.3% - on skin and subcutaneous tissue. Comparative assessment of the development of surgical care in day patient healthcare facilities based in out-patient clinics of JSC «Russian Railways» revealed that in this matter railway medical complex was more dynamic and developing rapidly. Conclusion. Non-state health facilities of the transport industry (for example, medical complex of JSC «Russian Railways») have all the managerial and legislative backgroung for further development of out-patient surgery within the framework of 24-hour hospital substituting technologies in in day patient healthcare facilities based in out-patient clinics.
Kazan medical journal. 2014;95(3):415-421
415-421
Ethnic and epidemiological characteristics of HIV-infected patients died in 2009-2010 in the Republic of Tatarstan
Abstract
Aim. The research goal was to evaluate the ethnical and epidemiological characteristics of the deceased HIV-infected patients in the Republic of Tatarstan. Methods. Causes of death among HIV-infected patients were analyzed. Depending on ethnicity they were divided into two groups: group 1 (n=276, 71.1%) - Russian nationality, group 2 (n=112, 28.9%) - Tatar nationality. Results. Mortality of HIV-infected persons of group 1 was 3.2 times higher than among patients of group 2 (18.4 and 5.6 per 100 000 respectively, p <0.001). In both groups majority of patients (79.0 and 62.5% in 1 and 2 groups) were infected through drug injections. Highest mortality rate was observed in HIV-infected males younger than 40 years who lived in urban areas and was associated with tuberculosis, lung and cardiovascular diseases. The mean disease duration after diagnosis in the 1st and 2nd groups was similar (5.2±0.3 and 5.1±0.4 years, respectively). Shorter survival period was observed in females, older than 50 years, persons infected through sexual contact and patients with comorbidities. Conclusion. In the Republic of Tatarstan mortality among HIV-infected persons of Russian nationality was higher than in a group with Tatar nationality. Disease duration of HIV-infected persons had no association with their ethnic group.
Kazan medical journal. 2014;95(3):421-425
421-425
Social and epidemiological characteristics of alcohol use disorders in the Kostroma region
Abstract
Aim. Prediction of primary, general morbidity and mortality of persons with alcohol use disorders, registered at a dispensary in the Kostroma region of Russian Federation. Methods. Statistical data for 24 districts of the Kostroma region, 1999-2012 was analyzed. In addition to graphical method and mapping the least-squares method, ranking, estimation of absolute increase/decrease and the average annual growth/loss rate were used. Information was obtained from the statistical reports of regional addictions dispensary (statistical form number 37), Statistical yearbook of National Research Center of Addictions, Ministry of Health of Russian Federation. Results. Structure of patients treated for alcohol disorders in the Kostroma region almost virtually unchanged over the past 10 years, the proportion of persons with chronic alcoholism was 46.5%, drinkers with harmful consequences - 32.4%, alcoholic psychosis - 21.1%. In 2012 the number of primary identified alcohol consumers with harmful impact on the health was 72.8% less compared to the average index for Russian Federation and 27.5% compared to Central Federal District. We have revealed mild, prone to stabilization trend of increase in the incidence of chronic alcoholism and psychosis for 14 years studied, average annual growth rate was 0.64%. Based on the primary incidence of alcoholism and psychosis the top three districts were: Sudislavsky, Susaninsky and Mezhevskoy, indicators in these areas were almost 2-3 times higher than the average regional index. In 2012 in 12 districts of Kostroma region no cases of alcoholic psychosis were registered. The latter fact is in doubt, as in 7 of 12 districts the positions of addiction psychiatrists were vacant. Over the past 3 years only 38% of patients who required to be treated for alcoholism were admitted for hospital care and 16.7% - for ambulatory care. Conclusion. Analysis of epidemiological data on alcohol situation in the Kostroma region testifies to its stabilization with the trend to improve; established territorial features show the necessity of purposeful planning of preventive measures.
Kazan medical journal. 2014;95(3):426-433
426-433
Nutrition hygiene
Characteristics of mineral composition of food used in primary schools
Abstract
Aim. To define the mineral content in foods supplied for preschool facilities in Irkutsk by laboratory methods. Methods. Food samples (whole cow milk, white bread, potato, apple, beef, «Gerkules» oat) were analyzed. The results were compared with data of food chemical contents used as reference values by «Center for Biotic Medicine» for evaluating food mineral contents. Analytic tests were performed using atomic emission spectroscopy with inductively coupled argon plasma and mass spectroscopy with inductively coupled argon plasma. Results. Food samples analysis in preschool facilities of Irkutsk revealed that these samples have significant differences in mineral contents compared with foods used in the European part of Russia. In common, examined foods contains less macro- and microelements, especially Ca, Fe, P, Si. In animal products (milk, meat) the differences were more significant both in number of elements and in absolute differences, compared to plant food (bread, potato, apple, cereal). Animal products contains less zinc. Conclusion. The gained data highlight the need for improving children’s catering, as well as for development and use of preventive measures aimed to reduce risks for diseases associated with macro- and microelements deficiencies.
Kazan medical journal. 2014;95(3):434-438
434-438
Lectures
The role of primary care physicians in diagnosis and follow-up of patients with chronic viral hepatites B, C and D
Abstract
By 01.01.2013 in the Republic of Tatarstan there were 23 970 Hepatitis B Surface Antigen carriers and 4546 patients with active Hepatitis B out of 28 516 registered patients who were infected with Hepatitis B. Our experience shows that not only inactive chronic Hepatitis B Surface Antigen carriers, but also patients with different clinical forms of Hepatitis B might be estimated as Hepatitis B Surface Antigen carriers. The feature of chronic viral hepatitides is a discrepancy between the scarce clinical picture and presence (in 15-30% of cases) of active inflammation in liver tissue. Since 2009, patients with positive ELISA test for antibodies to Hepatitis C virus are no longer registered in the national registry of infective diseases of Russian Federation. In the Republic of Tatarstan, such patients with antibodies to Hepatitis C virus were still registered up to 2012 (50 266 patients were registered by 01.01.2012). According to our own data, Hepatitis C viral RNA was found at polymerase chain reaction to Hepatitis C virus in 61% of cases out of 957 patients tested. According to our own data, when using the combined treatment (interferon alpha and ribavirin), lasting virologic response was obtained in 65.7% cases of type 1 genotype of Hepatitis C and almost in 100% of cases of other genotypes out of 163 cases of chronic Hepatitis C, which corresponds to worldwide standards. By 01.01.2013, 295 patients with liver cirrhosis as the result of chronic Hepatitis C were followed up at the consultative and diagnostic center of Republican Clinical Hospital of Infective Diseases with the upward trend. The retrospective analysis of 130 case histories of patients with liver cirrhosis revealed that Hepatitis C was firstly diagnosed at the stage of established liver cirrhosis in 57.7% of cases. Timely diagnosis and periodic medical examination in cases of chronic Hepatitis C allows to implement the individual, personalized approach in such patients and to choose the adequate treatment and follow-up.
Kazan medical journal. 2014;95(3):439-445
439-445
Assistance to the practicing physician
Method for recurrent gastrointestinal bleeding prognosis
Abstract
Aim. To assess the clinical value of continuous monitoring of rheographic parameters in patients with high risk of recurrent gastrointestinal bleeding for early pre-clinical diagnosis of recurrent bleeding. Methods. The study included 50 patients with upper gastrointestinal bleeding aged 50 to 70 years who were admitted having hemorrhagic shock III after endoscopic hemostasis. Continuous integral whole body rheography by «Diamant-M» computer complex was used for systemic circulation assessment. Results. Three types of hemodynamic reactions were revealed at integral whole body rheography: hypertonic (35 cases: increased integral tonicity coefficient up to 86 units and total peripheral vascular resistance over 3000 dyn/s·cm-5), hypotonic (35 cases: decreased integral tonicity coefficient down to 77 units and less, total peripheral vascular resistance less than 1500 dyn/s·cm-5, possible M-like waves of rheography curve) and intermediate (integral tonicity coefficient between 77 and 83 units, total peripheral vascular resistance between 1500 and 2000 dyn/s·cm-5). Integral tonicity coefficient between 80 and 113 units and total peripheral vascular resistance between 1500 and 3000±120 dyn/s·cm-5 were important indicators while monitoring for possible recurrent gastrointestinal bleeding. Conclusion. Blood loss compensation monitoring by continuous non-invasive rheography in patients at high risk for recurrent gastrointestinal bleeding allows not only diagnose recurrent gastrointestinal bleeding in a timely manner, but also to assess the effect of the treatment conducted.
Kazan medical journal. 2014;95(3):446-449
446-449
A method of reconstruction of female genitalia in girls with virilization
Abstract
The most common cause for female virilization is congenital adrenal hyperplasia. For anticipating the serious psychological distress related to ambiguous genitalia, these patients require plastic surgery. At present, two-step methods are preferred as more reliable. However, the surgical treatment in this case extends over several years, and can greatly affect patient’s psychosocial status. Based on the analysis of known surgical treatments, we proposed a one-step method of feminizing genitoplasty. The advantages of the proposed method allows one-step surgical treatment of girls with virilized genitalia at an earlier age, before the child reaches the period of sexual self-identity. This approach provides less psychosocial distress and reduces the number of interventions, maintaining the adequate sensitivity of the clitoris, providing moist and age-appropriate vaginal opening by using the preputium of the penis homolog and urogenital sinus mucosa at genitoplasty. The abovementioned advantages increases the surgical treatment quality and quality of life in girls with virilized genitalia. The method is reproducible by pediatric surgeons with basic knowledge of children’s anatomy. Yet, a lengthy follow-up is needed to assess the long-term treatment results.
Kazan medical journal. 2014;95(3):450-454
450-454
Endoscopic vein harvesting in coronary artery bypass surgery
Abstract
The greater saphenous vein is the most available and frequently used conduit for coronary artery bypass grafting. Conventional (open) vein harvesting procedure requires the longitudinal skin and subcutaneous fat incision along the full conduit length. Endoscopic vein harvesting has been developed in the middle-1990s as less invasive alternative for open vein harvesting. Using this novel technique allows to harvest the whole greater saphenous vein through 3 cm long skin incision. The article reviews the history, the role and current status of endoscopic vein harvesting in coronary artery bypass surgery. Literature data of the impact of that minimally invasive approach on infective and non-infective leg wound complications, as well as postoperative pain, patient satisfaction and live quality are presented. The cost-effectiveness data of the method, resulting in reduction of treatment costs of leg wound complications both at the hospital and after patient’s discharge are mentioned. The influence of endoscopic vein harvesting on morphologic and functional conduit quality is discussed. Special attention is devoted to mid- and long-term outcomes after coronary artery bypass surgery with endoscopic vein harvesting. The majority of research including angiographic control gives evidence of comparable parameters of bypass patency after the conventional vein harvesting and endoscopic vein harvesting procedures. Recent multicenter trials showed no statistically significant differences between the conventional vein harvesting and endoscopic vein harvesting procedures in such indirect graft patency indicators as mortality, myocardial infarction rate, need for repeated revascularization and recurrence of angina pectoris. Recent findings advocate safety and clinical effectiveness of endoscopic vein harvesting.
Kazan medical journal. 2014;95(3):455-459
455-459
A novel method for assessing valvular mechanism of deep inguinal ring considering the objective topographic anatomical criteria
Abstract
Aim. To develop a method to assess the valvular mechanism of deep inguinal ring based on objective topographic anatomical criteria. Methods. The research was performed on 123 native corpses of persons without pathology of the anterior abdominal wall. Morphometric examination of the inguinal canal was carried out. The shape of the inguinal gap was determined, inguinal gap and inguinal canal length was measured, as well as deep inguinal ring length and height and deep inguinal ring height. Oval fissured inguinal gap was revealed in 49 (39.8%) persons, intermediate oval - in 51 (41.5%), triangular - in 23 (18.7%). Results. The dependence of the length of the inguinal canal, inguinal gap length, deep inguinal ring size and its standing height on the inguinal gap shape was examined. The method for an objective assessment of the deep inguinal ring valvular mechanism was proposed. The method is based on determining the deep inguinal ring location in reference to the internal oblique abdominal muscles by estimating the integral rate of the inguinal canal length and the inguinal gap length and deep inguinal ring height. Three options for the deep inguinal ring location: upper lateral, lower medial and boundary location are described. Deep inguinal ring positions were determined by cluster analysis. In cases of upper lateral position, which was observed in 28 (22.8%) of cases, the valvular mechanism of deep inguinal ring was stable. In cases of deep inguinal ring lower medial position (41 cases, 33.3%), the opposite results were gained. In cases of deep inguinal ring boundary location (54 cases, 43.9%), the valvular mechanism is stable, but may become insolvent if destructive changes of the lateral abdominal muscles and deep inguinal ring expansion were present. Conclusion. An objective method of assessing the deep inguinal ring valvular mechanism, based on determining the deep inguinal ring location in reference to the oblique abdominal muscles was developed.
Kazan medical journal. 2014;95(3):460-464
460-464
Bioethics
Actual issues of deontological ethics in surgical oncology
Abstract
Issues of deontological ethics in medicine were discussed in numerous papers, including publications of special conferences. N.N. Petrov in his book wrote: «Surgery depends on science, which is continuously growing and expanding. It also depends on the technique: hand, instrumental, electric, continuously developing and simplifying facing seemingly insurmountable difficulties. Teachers provide information about the science, and techniques to young surgeons, of whom all are keenly interested in it. But surgery is not limited to science and technology. Painfully affecting the human body, getting deeply inside it, surgery reaches the top of its opportunities only in case when it is decorated with the highest manifestation of selfless care of the sick person, and that not only of his body, but also about the state of his mind». Much has changed during this period of time, more accurate diagnostic methods appeared, unprecedented success was achieved in anesthesiology and critical care. The article covers questions related to ethics arising while treating patients with malignancies. Various aspects of deontological ethics, i.e. proper attitude and decisions while treating patients with malignancies, have certain features specific for surgical oncology. Questions of contraindications to surgery are solved at different stages of the patient treatment: during outpatient examination, exploration, at operation itself, after completing surgery. Some examples of ethical errors are given. Conclusion on refusing the surgery should be, in every case, absolutely reliable, rigorously documented, which prohibits false solutions. Decision should be based on a clear understanding of the pathogenesis of the patient’s body changes in each case. The questions of indications for surgery, its feasibility and extent should be decided ex concilio.
Kazan medical journal. 2014;95(3):465-468
465-468
Actual aspects of medical ethics in training of the pediatrician
Abstract
Nowadays the problems of medical ethics are gaining the special significance as a result of changes in social and economic relations, healthcare modernization due to appearance of new effective methods for instrumental and laboratory examinations, treatment approaches, development of market relations in medicine. The aim of the presented paper is to cover the actual aspects of medical ethics in pediatrics. The paper reviews the ethical aspects of the work of a in detail. Differentiated approach in choosing pediatrician interns, which is based not only on academic progress, but also on professional and moral qualities of the medical university alumni and continuity in their upbringing starting form the first years of the medical school until the end of post-graduate education, seems rationale. It is during the student years when the cognitive and moral values of a forthcoming specialist are formed, which may be a criterion of a suitability of working with children. The roles of the competition, including the modular approach to knowledge evaluation, professional competencies and rating system are stressed. Considering the modern requirements to a young professional, the accent is made on the role of the leading tutor in a forthcoming specialist formation. The requirements to a higher education teacher and the importance of the moral atmosphere in hospitals and faculties for forming the ethical features of a forthcoming pediatrician and improving his/her professional level according to the medical progress are outlined. Thus, teaching pediatrics has a lot of particularities, including teaching the basics of medical ethics, having an extremely important role in professional education of pediatricians for proper forming of the young professional according to contemporary life requirements.
Kazan medical journal. 2014;95(3):469-471
469-471
Discussions
Association between the systolic arterial blood pressure level and inter-arm asymmetry
Abstract
Aim. To determine the association between the systolic arterial blood pressure level and the inter-arm asymmetry measurements in healthy individuals. Methods. 580 healthy volunteers aged 20 to 60 years (401 females, 179 males) were included in the study. Arterial blood pressure was measured in both left and right wrists using an automatic blood pressure sensor with the detector of hand position in a quiet, comfortable environment. Depending on the systolic arterial blood pressure level on the left arm, subjects were distributed to 5 groups: the 1st - blood pressure of 99 mm Hg and lower; 2nd - 100-119; 3rd - 120-129; 4th - 130-139; 5th -140 and over. Each group were further subdivided to 3 subgroups depending on the inter-arm blood pressure level asymmetry (difference of blood pressure levels on both arms): 1st - symmetry, 2nd - acceptable asymmetry (not exceeding 15 mm Hg), 3rd - abnormal asymmetry (16 mm Hg and over). Results. The major part of the examined subjects had systolic arterial blood pressure level between 100 and 119 mm Hg, systolic blood pressure below 99 mm Hg was registered more rarely. Among 580 examined subjects, abnormal asymmetry was more frequently seen in patients with blood pressure below 99 mm Hg and exceeding 140 mm Hg, the lowest frewuency was in the group with blood pressure between 120 and 129 mm Hg. The right arm was the dominating arm for the asymmetry in subjects with blood pressure below 119 mm Hg, in other cases the dominating arm was not determined. Conclusion. The study demonstrates the presence of vascular inter-arm asymmetry in systolic blood pressure in individuals who perceive themselves as healthy. Inter-arm asymmetry depended on the level of systolic arterial blood pressure.
Kazan medical journal. 2014;95(3):472-474
472-474
Letters to the Editor
Nasha bezmernaya blagodarnost' kazanskim vracham
Kazan medical journal. 2014;95(3):475-476
475-476
Jubilees
Professoru Foatu Shaykhutdinovichu Akhmetzyanovu - 70 let
Kazan medical journal. 2014;95(3):477-478
477-478
Obituary
Professor Raisa Sharafutdinovna Abdrakhmanova
Kazan medical journal. 2014;95(3):479-480
479-480