Vol 94, No 3 (2013)
- Year: 2013
- Articles: 31
- URL: https://journal-vniispk.ru/kazanmedj/issue/view/124
Theoretical and clinical medicine
Left ventricular wall myocardium structural and functional indices change in patients with arterial hypertension and subclinical hypothyroidism treated with hypotensives
Abstract
Aim. To assess the left ventricular wall myocardium structural and functional indices change over time in patients receiving hypotensive treatment for arterial hypertension associated with subclinical hypothyroidism. Methods. Sixty eight patients with arterial hypertension and subclinical hyperthyroidism were distributed to two groups. Patients of the group 1 (37 patients) received amlodipine (5-10 mg/day) and indapamide (1.5 mg/day), patients of the group 2 (31 patients) received lisinopril (5-10 mg/day) and indapamide (1.5 mg/day). Carotid artery ultrasonography and echocardiography were performed using «Philips» HD-11 XE (USA) scanner on the baseline and after 18 months of treatment. Results. Initial parameters of the left ventricular wall myocardium in all patients were comparable. Significant increase in early diastolic left ventricular filling velocity by 5.2%, decrease of late diastolic filling velocity by 11.4%, increase of peak velocities ratio on the mitral valve by 19.7% were revealed in patients of group 1 after 18 months of treatment compared to baseline. Increase in early diastolic left ventricular filling velocity by 7.0%, increase of peak velocities ratio on the mitral valve by 13.9% were registered in patients of group 2. No signs of concentric left ventricle remodeling were revealed. The share of patients with eccentric hypertrophy was not altered (18.9 and 12.9%, respectively). Conclusion. Treatment with amlodipine + indapamine and lisinopril + indapamine during 18 months improves left ventricle diastolic function.
Kazan medical journal. 2013;94(3):289-293
289-293
Association of hypertension and abdominal obesity with some features of gynecologic history
Abstract
Aim. To study the association of some gynecologic history data in hypertensive women with abdominal obesity. Methods. A cohort of 315 women aged 21-59 years, including 53 healthy volunteers with normal blood pressure, 63 female patients with prehypertension and 197 hypertensive women, was examined. The mean age of hypertensive women was 47.0±7.0 years. Patients with symptomatic hypertension were excluded from the study. The patients were questioned about gynecologic history data (the number of pregnancies, abortions, miscarriages, history of gestational hypertension) and anthropometry. Patients were divided to 2 groups according to presence (137 female patients, mean age 47.8±6.3 years) or absence (178 female patients, mean age 44.4±7.3 years) of abdominal obesity. Results. There was a significantly higher number of women who had had pregnancies (97.3 versus 83.0%), deliveries (94.7 versus 76.5%), including two and more deliveries (69.9 versus 38.2%), and two and more abortions (64.6 versus 34.0%) among hypertensive women with abdominal obesity compared to non-obese women with normal blood pressure; higher mean rates of pregnancies, deliveries and abortions, more frequent history of gestational hypertension (51.3 versus 14.9%) were revealed as well. Conclusion. The combination of abdominal obesity and hypertension in women aged 21-59 years is associated with higher number of previous pregnancies, abortions, miscarriages and pregnancies, abortions, miscarriages, and history of gestational hypertension.
Kazan medical journal. 2013;94(3):294-300
294-300
Clinical and microbiologic evaluation of current treatments for bacterial vaginosis
Abstract
Aim. To circle out the population at risk for bacterial vaginosis, and to evaluate the effect of the most promising treatments for this disease. Methods. 298 women, including 143 pregnant women, aged 18 to 45 years, with abnormal discharge from the genital tract underwent clinical, microbiologic, and gynecologic examination and were questioned about the history of the disease. The results were compared with 34 healthy controls. Vaginal swabs were taken and stained by Gram, microorganisms and key cells were calculated at microscopy, vaginal pH was measured. The tests were repeated at 1 and 6-7 months after treatment. Results. The effect of metronidazole (500 mg vaginal suppository twice daily for 5 days) was 75.3±4.9%, of chlorhexidine (16 mg vaginal suppository twice daily for 5 days) - 89.4±3.8% (р <0.05). Relapses at 6-7 months after treatment were registered in 22.1±4.8 and 7.6±3.3% of pregnant patients (р <0.02). Conclusion. Local use of metronidazole and chlorhexidine in patients with bacterial vaginosis is highly effective, has no serious side effects (including in pregnant patients) and leads to constant vaginal microbiota normalization.
Kazan medical journal. 2013;94(3):300-304
300-304
Prevention of pregnancy loss after appendectomy
Abstract
Aim. To optimize preventive measures for miscarriage after appendectomy based on a study of the gestation course pathogenetic features in acute appendicitis. Methods. 78 pregnant women who had underwent surgery for acute appendicitis during gestation (gestation term from 4 to 30 weeks) were examined. The control group consisted of healthy 37 women with normal gestation. Serum prolactin level was measured by ELISA. Leukocyte intoxication index, combined endotoxin titre, coagulation tests (fibrinogen, soluble fibrin monomers, activated partial thromboplastin time, fibrinolysis time) were also examined. serum cytokine levels (interleukine-1β, -2, -4, -6, interferon γ, tumor necrosis factor α) were measured by solid-phase enzyme immunoassay. Patients of comparison group (n=42) received standard treatment targeted on pregnancy prolongation after the surgery. Discrete plasmapheresis was added to treatment offered for patients of the main group (n=36) at 3rd and 5th days after the appendectomy. Results. Endogenous intoxication syndrome development in association with hyper coagulation and simultaneous fibrinolysis inhibition and increase of paracoagulation products levels combined with pro-inflammatory cytokines level increase was noted in pregnant patients with appendicitis. Prolactin level increased by 1.5-1.8 times at 5-7 days after surgery with further decrease at 10-14 day accompanied by risk of miscarriage. The use of discrete plasmapheresis at 3rd and 5th days after surgery contributes to maintaining stable concentrations of prolactin in pregnant women in all terms during the postoperative period, as well as endogenous intoxication indicators decrease, hemostasis and cytokine profile normalization, allowing to increase the rate of successful pregnancy outcomes after appendectomy. Conclusion. Addition of plasmapheresis as a component of complex treatment in pregnant women after appendectomy allowed to reduce the risk of miscarriage by 4 times, and the rate of miscarriage by twice, suggesting this method as a safe and effective way to prevent miscarriage.
Kazan medical journal. 2013;94(3):304-310
304-310
Retrograde biliary stenting in patients with pancreatobiliary diseases
Abstract
Aim. To evaluate the results of retrograde biliary stenting in patients with pancreatobiliary diseases. Methods. In 2008-2012, 85 retrograde biliary stenting procedures were performed in 65 patients (28 men and 37 women) with pancreatobiliary diseases aged 33 to 86 years. Obstructive jaundice was diagnosed in 44 of 65 patients (in 67% of cases), ascending cholangitis - in 14 (21%) patients. Endoscopic biliary stenting was performed in 47 patients with benign pancreatobiliary diseases (chronic and post-surgical pancreatitis, benign common bile duct stricture, Mirizzi syndrome, intradiverticular papilla, common bile duct bile stones) and in 18 patients with malignancies (cancers of pancreas head, bile ducts and papillary cancer). Plastic biliary stents with a (diameter 2.5 to 3.3 mm) were used for stenting. Results. Endoscopic biliary stenting allows to resolve the clinical manifestations of оbstructive jaundice and cholangitis, to eliminate pain, to prevent the development of pancreatitis, to prepare patients for surgery. Serious complications of biliary stenting (stent migration in common bile duct, acute cholangitis) were observed in 5 of 85 procedures (5.9% of cases), and all were resolved after repeated endoscopic intervention. Conclusion. Endoscopic retrograde biliary stenting is a safe and effective treatment option for patients with both benign and malignant pancreatobiliary diseases, it is characterized by low rate of specific complications (5.8%) and had reduced the risk of acute pancreatitis in patients with papillostenosis and stricture of the common bile duct terminal part down to 3%.
Kazan medical journal. 2013;94(3):311-315
311-315
Comparative analysis of the interleukin-28b gene alleles in patients with hepatitis C monoinfection and combined HIV/hepatitis C infection
Abstract
Aim. To identify the frequency and to perform the comparative analysis of IL-28B genotypes distribution in patients with hepatitis C (HCV) mono-infection and combined HIV/HCV infection. Methods. 101 patients (65% - males, average age 33.85±0.62 years) were included in the study. The first group (n=58) - patients with HCV mono-infection, second (n=43) - patients with combined HIV/HCV infection. Single nucleotides polymorphism at rs8099917 and rs12979860 locuses of IL-28B gene was performed using the «AmpliSens Genoscreen-IL28V-FL» reagent kit in the viral hepatitis laboratory of the molecular diagnostics department, CSRIE, Moscow. The baseline activity of HCV infection was determined by RNA-HCV viral load >400 000 copies/mL and alanine aminotransferase level (ALT). In the first group high RNA-HCV viral load (>400 000 copies/mL) was observed in 30 (51.7%) patients, mean ALT level was 72.79±9.85 U/L; in the second group high HCV-RNA viral load was detected in 35 (81.4%) patients, mean ALT level was 85.46±7.73 U/L. In the group with combined infection 26 (60.5%) of patients received antiretroviral therapy (ART); in 14 (53.8%) of them there was no detectable viral load. The median absolute number of CD4+ lymphocytes was 0.400±0.04 cells/μL, median percentage - 25.41%±2.41. In 17 (39.5%) treatment-naïve patients the viral load was low (<10 000 copies/mL), in 11 (64.8%) of these patients mean CD4+ count was 0.470±0.04 cells/μL (25.33%±2.15); the term of HIV antibodies detection was 6.89±0.53 years. The sensitivity of the PCR method for the qualitative detection of HCV-RNA was 111.1 copies/mL, quantitative - 275 copies/mL, for HIV-RNA - 150 copies/mL. Results. In patients with HCV mono-infection the rate of unfavorable IL-28B CT and TT rs12979860 genotypes and ТG and GG rs8099917 genotypes was 45 (77.6%) и 26 (44.8%) correspondingly, favorable СС rs12979860 and ТТ rs8099917 genotypes were registered in 13 (22.4%) and 32 (55.1%) patients correspondingly. In patients with HIV/HCV infection (n=43) unfavorable IL-28B CT and TT rs12979860 genotypes and ТG and GG rs8099917 genotypes were detected in 20 (46.5%) и 13 (30.2%) of cases, and favorable СС rs12979860 and ТТ rs8099917 genotypes - in 23 (53.5%) and 30 (69.8%) of cases correspondingly. Conclusion. Results show that favorable CC rs12979860 and TT rs8099917 genotypes of the IL-28B and their combination are found quite frequently in patients with mixed HCV/HIV infection, particularly in patients with HCV genotype 3, these patients also had more significant inflammatory reaction and high HCV RNA viral load compared to HCV mono-infected patients.
Kazan medical journal. 2013;94(3):316-320
316-320
Some pathophysiologic mechanisms of cardiovascular diseases in patients with chronic prostatitis
Abstract
Aim. To study the relation of autonomic disorders severity, energy and lipid metabolism parameters, immune, hormonal disorders and structural and functional changes of the myocardium in patients with chronic prostatitis. Methods. The study included 75 patients with chronic prostatitis, who were divided into two groups: the first group consisted of 48 patients with the sympathetic autonomous nervous system hyper activation, the second group - of 27 patients with autonomic balance. Echocardiography, 24-hour ECG monitoring with heart rate variability analysis were performed in all patients. The overall serum level of non-esterified fatty acids and glycerol, red blood cells levels of macroergic substances, lipid and long-chain fatty acids fractions were measured. Hormonal profile included estimation of total testosterone level, sex hormone-binding globulin, calculated free testosterone index. Serum cytokines profile was also studied. Results. In patients with sympathetic activity and prostatitis, most of heart rate variability parameters were significantly lower compared to patients with autonomic balance and controls. Patients with left ventricle diastolic dysfunction had higher serum concentrations of pro-and anti-inflammatory cytokines. Dysautonomia with prolonged sympathetic autonomous nervous system hyper activation was frequently found in patient with chronic prostatitis (64% of cases), contributing to low fatty acids utilization in myocardium and reduced levels of glycerol (by 32.3%) and adenosine triphosphate (by 49.5%) in erythrocytes. These disorders were accompanied by left ventricular diastolic dysfunction in 19.2% of patients and by arrhythmias in over than a half of patients. Conclusion. Autonomic disorders (sympathetic autonomous nervous system hyper activation associated with decreased parasympathetic control of the cardiovascular system) are quite common in patients with chronic prostatitis, leading to fatty acids utilization impairment, resulting in blood accumulation of non-esterified fatty acids, low serum glycerol levels, adenine nucleotide imbalance) accompanied by low unbound testosterone level, serum cytokines profile imbalance, reduction of cardiac hemodynamic indicators and development of cardiac arrhythmias.
Kazan medical journal. 2013;94(3):321-327
321-327
Traumatic hand amputations, the analysis of medical aid on different levels of rural healthcare
Abstract
Aim. The analysis of diagnostic and management measures offered for patients with traumatic hand amputations at different levels of rural healthcare. Methods. The medical charts of 115 patients [including 98 (85.2%) in-patients] aged 14 to 67 years with complete and incomplete traumatic hand amputation treated since 1985 to 2010 were analysed. Results. 81 (70.4%) of patients were of working age, 18 (15.7%) - adolescents (up to 18 years of age). 65 (56.5%) of patients were blue-collar workers, 6 (5.2%) - white-collar workers, 19 (16.5%) - students, 12 (10.4%) - unemployed, 13 (11.3%) - retired. Occupational injuries were registered in 25 (21.7%) of patients, including 24 (36.9%) blue-collar workers and 1 (16.7%) white-collar worker. Traumatic hand amputations due to incised wounds were registered in 1 (0.9%) case, due to bites - 1 (0.9%) case, due to chopped wound - in 26 (22.6%) cases, due to lacerated wounds - in 35 (30.4%) cases, due to high-energy trauma - in 45 (39.1%) cases. No trauma mechanism was registered in patient’s medical charts for 7 (6.1%) cases. Traumatic hand amputations at wrist level were registered in 2 (1.7%) cases, at finger level - in 113 (98.7%) cases. The primary care was provided in regional paramedic stations and regional hospitals to 71 (61.7%) patients. High-energy traumas had the most unfavorable clinical course and were associated with worst prognosis. The chosen reconstructive surgery type depended on the mechanism of trauma, wound shape and size and the condition of surrounding tissues. The local reconstructive surgery was the most frequent choice. Complications were observed in 11.2% of cases (in 27.1% of high-energy trauma cases). Patients became constantly disabled in 4.3% of cases. Most of the medical errors were made at primary care level, including unjustified rejection of wound debridement and improper finger stump debridement. Conclusion. To optimize the medical aid for patients with traumatic hand amputations a continuous theoretical training of medical staff, providing emergency care, in quarterly seminars, is needed. Patients with traumatic hand amputations should be admitted directly to the hospital emergency room, bypassing the outpatient services.
Kazan medical journal. 2013;94(3):327-334
327-334
Required frequency of ultrasonography for detection of thrombosis with high risk for embolism in patients with malignancies
Abstract
Aim. To determine the optimal terms for detection of thrombosis with high risk for embolism in patients with malignancies receiving specialized treatment. Methods. 117 patients (50 males, 67 females - the main group) with malignancies were randomly picked out (using the random numbers tables) underwent daily ultrasonography of inferior vena cava tributaries for detection of thrombosis with high risk for embolism. Ultrasonography of inferior vena cava distal part, both common iliac veins and veins of lower extremities was done in patients while on surgical treatment, chemotherapy or radiotherapy. The control group consisted of 130 patients (58 males, 72 females) with malignancies in whom ultrasonography was performed only if clinical signs of venous thrombosis were present. Results. Ultrasonic features of venous blood flow decrease (spontaneous contrast phenomenon) in veins of lower extremities were found in 27 out of 117 main group patients on the second day. On the third day features of saphenous veins thrombosis were found in 13 patients. On the fourth day, 4 patients were diagnosed with iliofemoral thrombosis. 5 more patients developed ultrasonic features of venous blood flow decrease (spontaneous contrast phenomenon) on the fourth and fifth day. Signs of thrombosis progression and floating thrombus were found in 6 patients on the 6th and 7th day. No fatal cases of pulmonary embolism were registered in the main group. 10 patients of the control group had clinical signs of inferior vena cava tributaries and underwent distal part of inferior vena cava, both common iliac veins and veins of lower extremities ultrasonography while on specialized treatment. 5 cases of pulmonary embolism were reported in the rest of the control group patients (120 patients). Conclusion. Inferior vena cava tributaries thrombosis with high risk for embolism in patients with malignancies can be reliably detected by repeating ultrasonography every 3-4 days; Reliable diagnosis of thrombosis with high risk for embolism by means of ultrasonography during the post-surgical period allows to prevent pulmonary embolism in a timely and targeted manner.
Kazan medical journal. 2013;94(3):335-339
335-339
Experimental medicine
The role of interfering RNA in immune response proliferative processes regulation in experimental model of endometrial cancer associated with thyroid disease
Abstract
Aim. To assess the proliferation and dendritic cells markers expression degree at short interference RNA (siRNA) transfection in endometrial cancer associated with experimental thyroid disease. Methods. Experiments were performed on female rats distributed to five groups: I - control group; IIA and IIIА - animals with simulated hypo-and hyperthyroidism and transplanted Guérin’s carcinoma, IIВ and IIIB - animals with simulated hypo- and hyperthyroidism and transplanted Guérin’s carcinoma in combination with siRNA transfection. Orthogonal tumor dimensions were measured starting from the 7-th day after tumor suspension inoculation. Proliferation and dendritic cells markers expression were assessed in tumor samples by immunohistochemistry after the exclusion of animals from the experiment. Results. siRNA inhibitory effect was more marked in animals with hypothyroidism, indicating an important role of thyroid hormones in regulating cell cycle controlling genes expression. Transfection of siRNA increased mature dendritic cells (CD83) expression in tumor tissue in animals with hypothyroidism and increased immature dendritic cells (CD1a) expression in tumor tissue in animals with hyperthyroidism. Conclusion. siRNA transfection inhibits the tumor cells proliferation mainly at hypothyroidism compared to hyperthyroidism.
Kazan medical journal. 2013;94(3):340-343
340-343
A comparative study of the new xylarate germanium (IV) complexe with lithium (xygerm-1), lithium chloride and valproic acid to the amphetamine-enhanced self-stimulation reactions in rats
Abstract
Aim. To estimate the effect of novel lythium bis(µ-xylarato)dihydrogermanate (IV) (Xygerm-1) on reinforcing properties of the lateral hypothalamus self-stimulation in rats compared to the reference drugs (lithium chloride and valproic acid) in rats with amphetamine-induced self-stimulation. Methods. To form a model of the brain self-stimulation, nichrome monopolar electrodes were implanted bilaterally in the lateral hypothalamic nucleus, followed by morphological control, and 7-10 days after the operation, the rats were trained to press a pedal for electrical stimulation of the brain. The effects of self-stimulation were assessed by analyzing the maximum rate of pedal pressing and the self-stimulation threshold. Study of the test compounds effects had been started when average self-stimulation threshold values varied by less than 10% for three consecutive sessions of the brain self-stimulation. Xygerm-1 (300-1800 mg/kg), valproic acid (30-300 mg/kg) and lithium chloride (25-200 mg/kg) were introduced as intraperitoneal injections to animals of the corresponding study groups (6 rats each). At the next stage of the experiment, effects of Xygerm-1, lithium chloride and valproic acid on amphetamine-induced (dose 0.5 mg/kg) brain self-stimulation reaction increase were studied at the same animal groups. Results. At the first stage of the experiment Xygerm-1 (1200 and 1800 mg/kg), lithium chloride (100 and 200 mg/kg) and valproic acid (300 mg/kg) had significantly increased self-stimulation threshold. High doses of Xygerm-1 and lithium chloride (1800 and 200 mg/kg correspondingly) had relevantly decreased the average self-stimulation rate. There was also a tendency for the average self-stimulation rate to decrease in animals administered valproic acid, though, not statistically significant. The use of Xygerm-1 and lithium chloride induced the dose-dependant self-stimulation threshold increase, decreased by the use of amphetamine sulfate. Rather high doses of Xygerm-1 and lithium chloride (1800 and 100 mg/kg correspondingly) had also blocked amphetamine-induced increase in pedal pressing rate. Studied doses of valproic acid did not altered the amphetamine-induced brain self-stimulation reaction increase. Conclusion. The novel compound bis(µ-xylarato)dihydrogermanate (IV) has a strong influence on behavior, in particular on the brain reward systems, which is similar to the action of lithium chloride and differs from the effect of valproic acid.
Kazan medical journal. 2013;94(3):344-349
344-349
Reviews
Diagnostic value of natriuretic peptides in pediatrics
Abstract
Natriuretic peptide hormones are the family of vasoactive substanses produced by cardiomyocytes in response to the expansion and increased pressure in the heart chambers. The review of the literature focuses on the diagnostic role of natriuretic peptides in pediatrics. The most important clinical effects of natriuretic peptides, brief history of their discovery and studying, age-related changes of serum levels are analyzed. Data of their use in the diagnosis and cardiac function monitoring in various forms of cardiomyopathy, myocardial inflammatory diseases, Kawasaki disease in children are presented. The results of studies examining the natriuretic peptides levels in children with congenital heart defects and heart transplantation in pre-and postoperative period are reviewed. The review involved the diagnostic use of natriuretic peptides in neonates, including high pulmonary hypertension and hemodynamically significant patent ductus arteriosus diagnosis in preterm infants. The possibility of the natriuretic peptides use for assessing the cardiotoxic complications risk in anti-tumor chemotherapy and for differential diagnosis of acute dyspnea due to heart failure or pulmonary diseases are discussed.
Kazan medical journal. 2013;94(3):350-354
350-354
Cardiac syndrome X. the possible role of Na+-Li+-countertransport activity and other pathophysiological mechanisms in pathogenesis
Abstract
There are numerous pathophysiological mechanisms unequally responsible for the cardiac syndrome X development. The most important is endothelium and smooth muscle cells dysfunction that can intensify vasoconstriction and depress both endothelium-dependant and endothelium-independent vasodilatation, finally leading to coronary micro vascular dysfunction as the basis of the cardiac syndrome X pathogenesis. Together with other possible mechanisms of pathogenesis, studying the importance of increased cell membrane Na+-Li+-countertransport activity seems promising. If was found that a significant number of patients with cardiac syndrome X have increased Na+-Li+-countertransport activity, which is an in vitro marker of Na+-H+-antiporter. Therefore, it is important to measure Na+-Li+-countertransport speed in patients with coronary heart disease, because its high levels increases the chance for cardiac syndrome X, which is a coronary heart disease with no anatomic signs of coronary arteries involvement.
Kazan medical journal. 2013;94(3):355-361
355-361
Role of genetic factors in the development of congestive heart failure
Abstract
The article reviews studies of gene polymorphisms effects on the phenotype and the prognostic value of the genotype determination in patients with congestive heart failure. The results of studies analyzing the impact of angiotensinogen, angiotensin-converting enzyme, β2-adrenoreceptor genes polymorphism on the development of hypertension, myocardial and carotid arteries damage, and congestive heart failure prognosis are surveyed. However, despite the large number of studies addressing the association of polymorphic markers of candidate genes and phenotype, no consensus on the impact of candidate genes on the major systems involved in the pathogenesis of congestive heart failure has been achieved so far. Due to gene distribution variability in different populations, the studies of ethnic and geographical association of candidate genes with congestive heart failure development, as well as studies of phenotypic markers of the disease, are still relevant.
Kazan medical journal. 2013;94(3):362-366
362-366
Healthcare mangement
Health of the migrants as a social problem
Abstract
An analysis of law and enactments, mass-media publications, statistics and healthcare institutions documents, interviews with experts and diasporas leaders was performed to assess the contemporary international and Russian approaches to migrants health and to reveal the features of healthcare services provided for migrants in the Republic of Tatarstan. A social risk connected to migrants health is associated with increase of number of migrant workers with ailments, returning to their communities for treatment and rehabilitation. In societies receiving migrant workers there is an increase of socially dangerous diseases spreading risk due to low immunity, poor nutrition and sanitary life conditions, cultural distress and social isolation. The governmental policy of healthcare and medical services provided for migrants diverges in different countries between a right for free medical care and curtail of such right. «One window» medical examination method provided for migrants in the Republic of Tatarstan shows its effectiveness in decreasing risk and improving the sanitary and epidemiologic situation among this particular community and the whole society. It is concluded that continuous interaction with public, consideration of migrants’ health status and needs, embedding the problem on regional and federal levels should be an important aspects of providing accessible health care for migrants.
Kazan medical journal. 2013;94(3):367-372
367-372
Medical and managerial aspects of labor migration by the example of the Republic of Tatarstan
Abstract
Aim. To define the steps for improving the medical aid availability for labor migrants basing on the migration environment of the Republic of Tatarstan assessment, review of legislative acts and results of own research. Methods. Legislative acts and subordinate legislative acts regulating the medical aid and medical care for labor migrants were studied. Annual statistical forms of the Federal Migration Service of RT and 400 standard questionnaires filled by labor migrants covering social-demographic questions, health care and health assessment in 2007-2010 in three cities of the Republic of Tatarstan were analyzed. Results. The number of labor migrants in the Republic of Tatarstan is growing and the scope of their activities is expanding. However, of medical care coverage remains low: 14-28.3% of registered migrants, although potentially dangerous communicable diseases were found in 2.0-2.97% of cases. Questioning of 400 labor migrants in three cities of the republic determined that 55-69% of the respondents do not have an access to health care facilities. There is a number of outstanding issues that requires legislation initiatives to improve the regulatory framework, to improve the coverage and to expand the medical examinations list necessary for labor migrants registration, to improve medical aid and to create an insurance system for labor migrants. Conclusion. Results of the research indicate the need for further study of medical and managerial aspects of labor migration and the relevance of improving the legislative framework to improve access to medical aid for labor migrants.
Kazan medical journal. 2013;94(3):373-376
373-376
Diagnosis and treatment of acute bowel obstruction
Abstract
Aim. To improve treatment outcomes in patients with acute bowel obstruction. Methods. 1479 patients with bowel obstruction (75.7% - small bowel obstruction, 24.3% - large bowel obstruction) were examined. Patients were treated according to the local treatment protocol, 1003 (68%) patients underwent surgery. Results. The following procedures were performed at the stage of bowel obstruction diagnosis and treatment: conventional adhesiolysis was performed in 425 cases, laparoscopic adhesiolysis - in 425 cases, small bowel resection with further anastomosis - in 151 cases, small bowel resection with ileostomy - in 15 cases, phytobezoar fragmenting - in 56 cases, enterotomy and phytobezoar removal - in 2 cases. In patients with large bowel obstruction the following procedures were performed: large bowel segmental resection with further anastomosis - in 38 cases, large bowel segmental resection with colostomy - in 38 cases, large bowel partial resection with colostomy - in 54 cases, right hemicolectomy with primary anastomosis - in 43 cases, left hemicolectomy with primary anastomosis - in 58 cases, manual intussusception reduction - in 65 cases, side anastomosis - in 31 cases. In 69 cases of bowel obstruction primary anastomosis was performed using the metal ring frame. Conclusion. To reduce the rate of complications, the need for the surgery should be diagnosed as soon as possible, coagulopathies should be compensated, and surgery tactics should be defined, including the primary anastomosis formation.
Kazan medical journal. 2013;94(3):377-381
377-381
The role of radiotherapy at specialized treatment of malignant tumors and technical equipment of radiotherapy service in the Republic of Tatarstan
Abstract
Aim. To study the qualitative indicators for radiotherapy of patients with malignancies and the level of technical equipment of radiotherapy service in the Republic of Tatarstan. Methods. The incidence of malignant tumors, the number of patients treated with radiotherapy at the Tatarstan Regional Clinical Cancer Center since 2002 to 2012 were assessed. The comparative analysis of relative parameters characterizing the radiotherapy service and the level of technical equipment of radiotherapy service in the Republic of Tatarstan compared to Turkey and Japan. Results. The increase in number of patients treated with radiotherapy over time was noted. Nevertheless, compared to data from Turkey and Japan, the share of patients who offered radiotherapy as a method of complex treatment of patients with malignancies in the Republic of Tatarstan stays below the recommended levels compared to Turkey and Japan. Only 18.4% of patients receive radiotherapy during the first year of the disease. The remote radiotherapy equipment rate in the Republic of Tatarstan is twice lower compared to Turkey and Japan. Only 50% of the minimal recommended technical equipment units quantity for remote radiotherapy are available in the Republic of Tatarstan, with over than a half of this number out-of-date. Conclusion. Healthcare optimization and wide use of out-patient service along with modernizing the radiotherapy service allowed to increase the coverage of patients with malignancies with radiotherapy during the last years, hence the use of radiotherapy as a method of complex treatment of patients with malignancies in the Republic of Tatarstan stays below the recommended levels, to increase in further, the re-equipment of the radiotherapy service with the modern equipment for remote radiotherapy is necessary.
Kazan medical journal. 2013;94(3):381-386
381-386
Clinical manifestations of community-acquired pneumonia according to data of Samara region hospitals
Abstract
Aim. To describe the clinical manifestations of community-acquired pneumonia in patients of the Samara region. Methods. The retrospective clinical data analysis of 241 patients’ [130 (53.9%) males, 111 (46.1%) females, mean age 41.8±0.8 years] medical charts (case histories and out-patient cards) who were treated from 2007 to 2012, was performed. Specially developed individual registration cards were used for data collection. Results. Patients had the following concomitant diseases: hypertension - 10 (4.8%) patients, coronary heart disease - 10 (4.8%) patients, chronic non-obstructive bronchitis - 9 (4.3%) patients, chronic obstructive pulmonary disease - 6 (2.9%) patients, HIV infection - 5 (2.4%) patients, malignancies - 5 (2.4%) patients, bronchial asthma - 3 (1.4%) patients. Patents called for medical aid at 7.8±1.3 day after the disease onset, 48 (26.7%) were using self-administered drugs before going to medical professional. The leading clinical signs were fever - in 97 (53.9%) patients and cough - in 89 (49.4%) patients. 36 (20.0%) patients reported a chest pain, 55 (30.5%) - shortness of breath, 71 (39.4%) - productive cough. Typical X-ray symptoms were present in all cases. Conclusion. The main clinical manifestations of community-acquired pneumonia were cough and fever, patients called for medical aid at the late stages of the disease and extensively used self-administered drugs.
Kazan medical journal. 2013;94(3):386-388
386-388
Medical and statistical mortality features in urban elderly population of the Republic of Tatarstan
Abstract
Aim. To analyze the change over time in the mortality level, mortality reasons and age and sex related features in urban population of elderly (elder than 60 years) people in 2001-2010 using the data of Republican medical informational and analytical centre of the Healthcare Ministry of the Republic of Tatarstan. Methods. Logical and systemic analysis, statistical grouping, comparative method were used. Results. During the studied period, men had 1.5 times higher level of mortality compared to women. There was an 4.7% increase in overall mortality rate (males - 4.6%, females - 5.1%). The leading reason for death were cardiovascular diseases, with malignancies and external factors on the second and third place. Since 2008, respiratopy diseases had occupied the third position for the leading reasons for death in men, gastrointestinal diseases - in women. The increase in overall mortality rate was due to people over 80 years, there was a reliable trend for mortality rate reduction in other groups. The mortality associated with gastrointestinal diseases has increased. Conclusion. The observed mortality trends require to draw a special attention to the problems of the oldest population; more detailed analysis, detection of the exact reasons and efforts to decrease the mortality associated with gastrointestinal (in men) and respiratory (in women) diseases are the principal tasks.
Kazan medical journal. 2013;94(3):389-392
389-392
Quality of life in disabled patients with the diseases of limbs depending on individual psychological traits
Abstract
Aim. To study the quality of life, characteristic traits and emotional features in disabled patients with functional and structural damage of limbs. Methods. Disabled patients with functional and structural damage of limbs who addressed to the center of prosthesis and ortopedy for limb prosthesis were studied. 318 patients (males - 267 (83.3%), females - 51 (16.7%), aged 18 to 66 years) with limb stumps (including congenital limb defects) who addressed to the centre since 2008 to 2010 were randomly picked out to be included in the trial. The complex study of the following context factors included in the International Classification of Functioning, Disability and Health: quality of life, individual psychological traits, emotional sphere and motivation, social, cultural and nature environment. Patients were divided into 5 groups: aged 19 to 29 years, 30 to 39 years, 40 to 49 years, 50 to 59 years, over 60 years of age. Results. In the group of patients aged 19 to 29 years, the most intimately related to the quality of life were: situational anxiety and pedantic types demonstrative and of accentuated personality. In the group of patients aged 30 to 39 years the limitations due to amputations increased the influence on depression formation. In the group of patients aged 40 to 49 years the conjugacy of patients’ emotional and personal traits with the quality of life strengthened. Meanwhile, the influence of depression on patients’ quality of life and personality increased. n the group of patients aged 50 to 99 years the most influential was the triad of situational anxiety, personal anxiety and depression. In patients over 60 years of age quality of life was strongly related to patient’s psychologic and emotional condition, especially with situational anxiety. Conclusion. Different age groups of the patients who underwent a limb amputation, need an individualized and specialized rehabilitation programs, considering the interrelation between emotional, individual and psychological personal traits and parameters of quality of life.
Kazan medical journal. 2013;94(3):392-396
392-396
Discussions
The strategy of improving medical service for sports and physical culture in the Republic of Tatarstan on the eve of 2013 Summer Universiade
Abstract
The problems of healthcare system formation and management for physical culture and sports are discussed within the framework of prevention and rehabilitation areas development in the Republic of Tatarstan. The 2013 Summer Universiade is acknowledged as the largest event in the international sports, involving 13 000 sportsmen participating in 27 different summer sports. Physical culture and sports healthcare is known to be the one of the most crucial factors influencing sporting achievements. Since 2013 the Centre for Medical Prevention has started to create the informational and analytical system required for integral, in-depth and systemic image of physical culture and sports healthcare status and problems in the Republic of Tatarstan. A multi-layer matrix of the data gathering within the healthcare system, including the elements of physical culture and sports healthcare. We offer to create a national program the basing on the modern methodology of science for studying and solving complex social problems. The development of the local program devoted to physical culture and sports healthcare improvement can be a model of similar methodology-based program formation with a wider coverage, allowing to provide the preventive and rehabilitation healthcare for the whole population.
Kazan medical journal. 2013;94(3):397-402
397-402
Modern approaches to the rehabilitation of the drug addicts
Abstract
The aim of the presented paper is to analyze the approaches to the non-pharmaceutical rehabilitation of the drug addicts based on the example of the Social and Rehabilitative Centre «Roza Vetrov» of the municipal pedagogic institution «Podrostok». The following rehabilitative approaches were used: (1) labor and environmental rehabilitation; (2) group and family psychotherapy; (3) different trainings; (4) supported employment and workplace accommodation. Destigmatization is an obligatory psychotherapeutical procedure starting the rehabilitation. Rehabilitative environment is a special micro social group with adjusted behavior. Trainings are a complex of psycho corrective procedures with different targets. Adaptive psychotherapy is the necessary part of the rehabilitation and bringing the patients back to the micro social group they are used to be a member of. Family psychotherapy is performed by discussing the problems of co-abuse, possible options of manipulative behavior in drug addicts and their families. At the stage of workplace accommodation and professional orientation behavior modes are formed, necessary for successful entry into the professional labor.
Kazan medical journal. 2013;94(3):402-405
402-405
Assistance to the practicing physician
Role of quality of life estimation in early diagnosis of abdominal angina
Abstract
Aim. To assess the Gastrointestinal Symptom Rating Scale (GSRS) questionnaire as an ambulatory screening test for early diagnosis of abdominal angina. Methods. An assessment of abdominal symptoms severity and quality of life was performed using the GSRS questionnaire in 110 patients with abdominal angina. No sings of abdominal angina and no vascular abnormalities were found at Doppler sonography in 39 (35.5%) of patients (main group). In 71 (64.5%) patients distributed to the second group signs of insufficient blood flow (including vascular wall calcification and thickening, medium and small arteries compression and narrowing up to 40-70%, and inadequate blood flow after exercise. Results. There were no statistically significant differences found in prevalence of abdominal pain, reflux and diarrhea between two groups. Dyspepsia was noted in 29 (74.4%) patients of first group and in 71 (100%) patients of the second group. Average GSRS scores were 3.67±0.51 and 5.07±0.32 accordingly in those patients. Constipation was present in 16 (41%) patients of first group and in 54 (76.1%) patients of the second group, with the GSRS score 1.33±0.31 and 3.04±0.32 accordingly in those patients. Average total GSRS score was significantly higher in patients with abdominal angina - 13.51±0.84 points versus 9.94±1.13 in patients without signs of abdominal angina on Doppler sonography. Conclusion. The use of GSRS questionnaire allows to detect syndromes characteristic for abdominal angina.
Kazan medical journal. 2013;94(3):406-408
406-408
Choosing the surgical treatment method for benign prostatic hyperplasia
Abstract
Aim. To assess the surgical treatment outcomes for benign prostatic hyperplasia. Methods. The surgical treatment outcomes for benign prostatic hyperplasia were analyzed in 72 patients. 44 patients underwent transvesical prostatectomy ended with blind urinary bladder stitch, 28 patients with a prostate volume of less than 60 ml were offered transurethral resection of prostate. The patients’ mean age was 73.6 years. Inclusion criteria were: average urination flow rate (Qav) <10 ml/sec, total international prostate symptom score (I-PSS) >19, residual urine volume >50 ml. Prostate volume ranged from 29 to 150 ml. All interventions were performed using regional anesthesia. The effect of surgical treatment was assessed 3 months after the surgery was performed. Results. Self urination was restored at 2-3rd day. All patients had no residual urine. Urine flow parameters in patients after transvesical prostatectomy were: maximum urination flow rate (Qmax) - 24±1.3 ml/sec, Qav - 11.6±1.1 ml/sec; in patients after transurethral resection of prostate: Qmax - 17.2±0.8 ml/sec, Qav - 11.4±1.2 ml/sec. I-PSS index in the transvesical prostatectomy group was 2.3±0.3 compared to 9.7±1.1 points in transurethral resection of prostate group. Irritative symptoms prevailed in patients from transurethral resection of prostate group, 23 (82%) of them have improved after 1 month treatment with α1-adrenoblockers. Conclusion. Transvesical prostatectomy ended with blind urinary bladder stitch is still a radical and effective option for benign prostatic hyperplasia surgical treatment. Transurethral resection of prostate is effective in patients with prostate volume less than 60 ml and requires additional medical correction of irritative symptoms during the postoperative period.
Kazan medical journal. 2013;94(3):409-412
409-412
Influence of anesthesia type on the wound healing after inguinal hernia surgeries
Abstract
Aim. To estimate the influence of anesthesia type on the inguinal hernia rate surgery complication rate, considering the hernia type. Methods. 276 patients aged 35-65 years treated for inguinal hernia (history of hernia from 3 months to 3 years) from 2007 to 2011 were analyzed. The surgery was performed using local anesthesia in 146 patients (first group) and using epidural anesthesia in 102 patients (second group); 28 patients underwent surgery using general anesthesia (third group). A combination of 4 mL 10% lidocaine, 20 mL of 7.5 mg/mL ropivacaine solution and 60 mL 0.9% saline were used for local anesthesia in patients of the first group. 2% solutions of lidocaine and ropivacaine were used for epidural or spinal anesthesia in patients of the second group. Results. Mean surgery duration was shortest at the first group - 50.5±1.2 min. Mean surgery duration at the second group was 73.2±2.2 min, 61.8±5.0 min - at the third group (р1,2 <0.001, р1,3=0.003, р2,3=0.017). Mean activation terms were 4.2±0,1 hours for the patients of the first group (local anesthesia), 20.3±0.2 hours - for the patients of the second group (epidural anesthesia), 10.5±0.2 hours - for the patients of the second group (general anesthesia). Postoperative pain measured by visual analogue scale occurred at significantly shorter terms after the surgery and was more intense for the first 3 days in patients of the first group. The pain intensity elevated gradually in patients of the first group starting from the second day after the surgery, pain lasted significantly in the second and third group patients compared to the first group. Complications were registered in 15 (10.3%) of the first group patients, in 12 (11.8%) of the second group patients and in 5 (17.9%) of the third group patients (р1,2=0.836; р1,3=0.237; р2,3=0.525). Conclusion. A combination of analgesics solutions based on their pharmacologic features and two-phase vasoactivity ability has shown good analgesic effect at local anesthesia. The type of anesthesia determines the duration of surgery and the rate of post-surgical complications as a consequence.
Kazan medical journal. 2013;94(3):413-417
413-417
Prevention of large and giant postoperative ventral hernia prosthetic hernioplasty postoperative complications
Abstract
Aim. To evaluate the effectiveness of regional prolonged irrigation with ropivacaine ozonated solution at large and giant postoperative ventral hernia prosthetic hernioplasty. Methods. 77 patients who underwent a planned surgery for large and giant postoperative ventral hernia from 2010 to 2012 were examined. All patients were distributed to two groups. The main group included 26 patients in whom a polyvinyl chloride catheter was installed in periprosthetic tissue for the wound irrigation using anesthetic (ropivacaine) ozonated solution for regional prolonged anesthesia and wound complications prevention as well as for preoperative preparation and intra-abdominal pressure monitoring for abdominal compression syndrome prevention using the technique developed by authors. The comparison group consisted of 51 patients in whom prevention of wound complications was carried out conventionally, and who received narcotic analgesics. Ultrasonography of postoperative wound area was used for local inflammation intensity assessment. Pain was assessed using numeric visual analogue scale in both groups. Results. 4 (15.4%) patients of the main group developed subcutaneous tissue seroma at the 5-6th day. In comparison group wound complications were registered in 15 (29.4%) patients, including 11 cases of seromas, 2 cases of suppurative inflammation, 1 case of ischemic necrosis of the wound edges, and also an isolated case of limphorrhea which occurred on the first day. The observations showed that the average pain level among patients of the main group was 3.8±0.4 points, compared to the control group - 5.3±0.4 points. Conclusion. Periprosthetic irrigation with ropivacaine ozonated solution provides adequate anesthesia, reduces the number of wound complications and promotes early rehabilitation.
Kazan medical journal. 2013;94(3):417-420
417-420
Clinical observations
Central nervous system involvement at the onset of systemic sclerosis
Abstract
A rare clinical case of a 23-year old patient with central nervous system damage at the onset of systemic sclerosis at the age of 14 is presented. The patient was born with cerebral damage which was taken as a reason of the neurological manifestations that developed long later (epileptic attacks at 14 years of age, autism at 17 years of age). At the clinical examination diffuse asymmetric scleroderma as face and hand teleangiectasias, chest hyper pigmentation and shin skin hyper pigmentation and hardening were present. A characteristic look with reduced mimics, significant jaw movement limitation, tongue mobility limitation (patient was not able to touch the palate with the tongue) were also present. Patient had swollen fingers with limited finger motions, reduced hand muscular strength due to sclerodactyly. A shadow in the right lung middle lobe on the chest X-ray was found. According to physical examination results and laboratory data the following diagnosis was set up: «Juvenile systemic sclerosis, chronic form with slow progression, spreading stage: leg induration, sclerodactyly, chest hyper pigmentation, face teleangiectasias, basal pneumosclerosis, myocarditis, myocardiosclerosis, glomerulonephritis, esophageal achalasia, hepatitis, autism, epileptic attacks, polyarthritis, left elbow periarticular calcinosis, complicated relapsing aspiration pneumonia». The characteristical features of this case are the atypical clinical course, appearance of the diagnostic markers after 8 years of the disease with multisystemic involvement of internal organs, skin and joints. Because of the late start of the corticosteroid treatment, relapsing aspiration pneumonia, low corticosteroid treatment compliance the patient has succumbed.
Kazan medical journal. 2013;94(3):421-423
421-423
History of medicine
The global impact of Kazan neurohistochemical school and its founder professor A.N. Mislavsky; cherishing the traditions in further studies
Abstract
Kazan school of neurohistology has a 150 years history. It became famous while headed by Aleksandr Nikolaevich Mislavsky. Honoured scientist of Russian Federation, Professor A.N. Mislavsky headed the faculty of histology of Kazan Medical Institute since 1921 till 1958. Well-known physicians V.S. Zimnitsky and I.M. Oxman worked under A.N. Mislavsky’s supervision, studying innervation of respiratory, gastrointestinal, urinary and other organ systems. An utterly new data on afferent and efferent nerve elements ratios in digestive tract, including concept of type 1 and 2 Dogiel cells were internationally acknowledged. Being a student of Professor K.A. Arnstein, a founder of Kazan school of neurohistology, A.N. Mislavsky favored the foundation of a number of crucial centers conducting research on neuromorphology. Perspectives of neurohistology development in Kazan are linked to keeping up with basic for Kazan school of neurohistology studies, including studying nervous system phylogenesis and ontogenesis and the significance of dysgenesis in disease development using novel research techniques.
Kazan medical journal. 2013;94(3):424-429
424-429
Jubilees
Professoru Raise Sharafutdinovne Abdrakhmanovoy - 90 let
Kazan medical journal. 2013;94(3):430-431
430-431
Professoru Rifkatu Mingazovichu Tazievu - 70 let
Kazan medical journal. 2013;94(3):431-432
431-432