Vol 94, No 6 (2013)
- Year: 2013
- Articles: 36
- URL: https://journal-vniispk.ru/kazanmedj/issue/view/114
Etiological and pathogenetic aspects of diagnosis and treatment of viral hepatitides
Abstract
The commencement address highlights the results of the long-term scientific research of the department of infectious diseases of the Kazan State Medical University on the problems of viral hepatitides diagnosis, treatment and prevention. The era of research of the acute viral hepatitides was based primarily on the clinical and biochemical differential diagnosis, considering epidemiologic data and specific prevention (vaccination) of hepatitis A and B. The development of modern technologies opened up new opportunities for etiologic decoding and morphologic evaluation of the infectious process activity in chronic viral hepatitis B, D and C. The results of hepatitis B and C genotyping, opening new opportunities for epidemiologic evaluation of their prevalence and antiviral treatment efficacy prediction, especially in family settings, are presented. A serious contribution is made to the study of latent HBV-infection, which is forming the long-term outcomes to cirrhosis and primary hepatocellular carcinoma. Pathogenetic connection of the systemic endotoxinemia, gastrointestinal bacterial overgrowth syndrome and immune dysfunction defined the morphologic and clinical and pathogenetic activity of the chronic viral hepatitis considering its molecular biologic verification. Contemporary diagnostics of chronic viral hepatitis (including HIV-coinfection) allowed to obtain the encouraging results in the development of the modern methods of antiviral (interferone, cytokines, nucle-os(t)ide analogs) and pathogenetic (metabolic correction - dimethyloxobuthylphosphonyldimethylate (dimephosphon), medical ozone, hepatoprotectors) treatment, in perspective - clinical use of direct antiviral agents (inhibitors of protease, polymerase etc.).
Kazan medical journal. 2013;94(6):785-792
785-792
Theoretical and clinical medicine
Effect of isosorbide dinitrate on sinoatrial node pacemaker activity in patients with stable angina pectoris of III and IV functional classes associated with hypertension
Abstract
Aim. To study the effect of isosorbide dinitrate on heart rate variability in patients with III and IV functional classes of stable angina and concomitant essential hypertension. Methods. The study involved 122 patients with III and IV functional classes of stable angina and concomitant essential hypertension, mean age 58.4±5.8 years. All patients underwent electrocardiography, Doppler echocardiography, 24-hour ECG monitoring. Rhythmocardiography was performed in the morning before the drug intake (acetylsalycilic acid, beta-blockers, statins, angiotensin-converting enzyme inhibitors) and 1.5 hours after 10 mg isosorbide dinitrate intake. Results. There was a statistically significant increase in overall heart rate variability at Valsalva’s maneuver and active postural test in patients with III and IV functional classes of stable angina and concomitant essential hypertension, which was most likely due to the amplitude of humoral-metabolic waves. The amplitude of the sympathetic pacing fluctuations increased in all samples, while the parasympathetic pacing fluctuation amplitude decreased at Valsalva’s maneuver, Ashner’s test and while lying flat. There was a vegetative spectrum shift towards the humoral-metabolic effect in sympathetic active postural test, sympathetic shift in all tests except for sympathetic active postural test, and significant decrease in parasympathetic effect at Ashner’s test, sympathetic active postural test and while lying flat. Conclusion. In patients with III and IV functional classes of stable angina and concomitant essential hypertension there was an increase in the overall heart rate variability mainly due to the humoral-metabolic and sympathetic waves amplitude increase and parasympathetic amplitude decrease. Isosorbide dinitrate intake resulted in vegetative spectrum redistribution towards humoral and sympathetic metabolic regulation patterns and decrease of parasympathetic regulation pattern, which normally prevails.
Kazan medical journal. 2013;94(6):793-798
793-798
Metabolism of quantity elements and essential trace elements in patients with essential arterial hypertension in different ecological settings
Abstract
Aim. To study the specifics of lead, zinc, copper, magnesium and calcium metabolism in children and adolescents with essential arterial hypertension living in different ecological settings. Methods. 100 children and adolescents aged 13-17 years with arterial hypertension, living in «industrial» (52 patients) and «residential» (48 patients) areas were examined in cardiology ward. 33 healthy children and adolescents comparable by age and gender were included as healthy controls. According to 24-hour blood pressure monitoring, groups with stable, labile arterial hypertension and «white coat hypertension» were formed. The levels of elements in 24-hour urine and in serum were measured by atomic absorption spectrophotometry. Results. In children and adolescents with stable arterial hypertension living in industrial areas, parameters of 24-hour blood pressure monitoring (mean 24-hour and mean daytime systolic blood pressure values, time of systolic hypertension, mean 24-hour and mean daytime blood pressure values) were higher compared to the same parameters in children from residential areas, the difference was statistically significant. The study of elements metabolism revealed increased lead exposure in children with essential arterial hypertension living in industrial areas, and misbalance of essential elements in those patients compared to the same parameters in children from residential areas. Conclusion. Results suggest increased exposure to arterial hypertension and marked misbalance of essential elements in children and adolescents with essential arterial hypertension living in industrial areas.
Kazan medical journal. 2013;94(6):798-803
798-803
Peripheral blood flow in patients with graves’ disease depending on level of thyroid status compensation
Abstract
Aim. To study the features of peripheral blood flow using laser Doppler flowmetry in patients with Graves’ disease depending on level of thyroid status compensation. Methods. 45 patients with Graves’ disease were divided into three groups 15 patients each depending on level of thyroid status compensation. The first group included patients with compensated hyperthyroidism, the second - with subcompensated hyperthyroidism, the third - with decompensated hyperthyroidism. All patients received combined thyrotropic (thiamazole 15-30 mg, average dose 22.4±1.7 mg) and cardio- and vasotropic therapy (metoprolol 50-100 mg, average dose 72.1±3.3 mg, and fozinopril 10-20 mg, average dose 17.8±2.4 mg), doses were individually adjusted. Results were compared with the control group (15 healthy patients). The peripheral blood flow was evaluated using LAKK-01 («LAZMA», Russia) device. Results. The comparison of control group and patients with Graves’ disease depending on level of thyroid status compensation demonstrated substantial differences. Doppler flowmetry registered increased blood flow, square deviation, variation coefficient in patients with diffuse thyrotoxic goitre, reflecting increase of tissue blood perfusion and reduced vascular tone. The analysis of the frequency histogram showed that the increase of average blood flow amplitude in case of hyperthyroidism was initiated by increase in amplitudes of all flaxmotions characterizing metabolic processes in capillaries. The relevant correlation between registered variables of blood flow and level of thyroid status compensation was registered. The most marked changes were revealed in patients with subcompensated and decompensated hyperthyroidism. In patients with compensated hyperthyroidism, the blood flow was altered the least compared to control group. Increased impact of active blood flow modulation mechanisms due to neurogenic activity and vascular tone was revealed. At the same time, endothelial activity was decreased. Predominance of sympathetic stimuli and compensatory mechanisms intensifying were discovered. Conclusion. The changes of peripheral blood flow in patients with Graves’ disease were typical for congestive-hyperemic type of microcirculation. Intensity of blood flow alterations is defined by thyroid status compensation. However, even the complete clinical and laboratory compensation doesn’t result in total recovery of capillary blood flow compared to healthy people.
Kazan medical journal. 2013;94(6):804-807
804-807
Arterial stiffness of peripheral vasculature in patients with chronic obstructive pulmonary disease and its association with arterial hypertension
Abstract
Aim. To study the structural and functional state of vascular wall, arterial stiffness of large peripheral arteries (common carotid arteries, renal arteries) in patients with severe chronic obstructive pulmonary disease and its association with arterial hypertension. Methods. The study included 67 patients of working age, mainly males, having chronic obstructive pulmonary disease. Among them, 52 patients had severe chronic obstructive pulmonary disease (defined by GOLD III, 2011), 15 had concomitant arterial hypertension of I and II stage. Structural and functional status of common carotid arteries, renal arteries was assessed by measurement of intima-media thickness, arterial stiffness indexes were calculated. Arterial elasticity indices: arterial compliance, elastic index, Young’s elastic modulus were calculated based on the results of ultrasonography of main arterial wall parameters (diameter, arterial wall thickness) and blood pressure measurement. Results. A decrease in common carotid arteries and renal arteries wall elasticity was revealed in patients with chronic obstructive pulmonary disease. Increase of stiffness index in patients with severe chronic obstructive pulmonary disease associated with arterial hypertension, marking the decreased arterial wall elasticity, was registered both in common carotid arteries and renal arteries. Conclusion. In common carotid arteries vascular wall thickness contribute the most in vascular wall stiffness increase, compared to altered hemodynamics in renal arteries. Development of arterial hypertension in these patients is a predicting factor for further large vessel remodeling associated with hypoxia.
Kazan medical journal. 2013;94(6):808-812
808-812
Cardiovascular comorbidity and free radical mediated processes imbalance in patients with acute stroke
Abstract
Aim. To study the free radical imbalance in patients with acute cerebrovascular disease and cardiovascular comorbidity and to determine its prognostic value. Methods. 141 patients with acute cerebrovascular disease of different severity aged 28-94 years (mean age 65.48±13.44 years) with various concomitant conditions were included. Ischemic stroke was diagnosed in 87 (61.7%), haemorragic stroke - in 35 (24.8%), transient ischemic attack - in 19 (13.5%) patients. Free radical processes in blood serum were examined repeatedly based on oxidative and peroxidative markers of oxidative stress. Results. Among the observed patients, 25.5% had one or no cardiovascular diseases, 24.8% had two, 27.0% had three and 22.7% had four and over. The increase in free radical imbalance was related to the increase in concomitant conditions number - there was a decrease of leukocyte chemiluminescence basal intensity by 1,76 times in patients with 4 cardiovascular diseases and above compared to 1 cardiovascular disease; increase of zymosan-stimulated leukocyte chemiluminescence intensity by 1.44 times; depression of antiperoxide activity of secondary serum by 1.36 times and increase of malondialdehyde by 1.5 times (р <0.05). Unfavorable outcome was observed in 9.7% of patients with 1 cardiovascular disease, which is 2.66 times lower compared to patients with acute cerebrovascular disease and 2 cardiovascular diseases (р <0.05), 3.55 times lower compared to patients with 3 cardiovascular diseases (р <0.05) and 2.67 times lower compared to patients with ≥4 cardiovascular diseases (р <0.05). Conclusion. Indices of free radical processes may be used as additional markers for prognosis and functional outcome evaluation of acute cerebrovascular disease with concomitant cardiovascular diseases.
Kazan medical journal. 2013;94(6):813-817
813-817
Cytokine profile in adolescent girls with candidal vulvovaginitis
Abstract
Aim. To establish the pathogenic value of serum cytokine (interleukin-6 and interleukin-8) production in patients with candidal vulvovaginitis to optimize diagnostic and therapeutic approaches. Methods. 74 adolescent girls suffering from candidal vulvovaginitis aged from 12 to 19 years were examined. The diagnosis of candidal vulvovaginitis was verified according to the international classification of World Health Organization (ICD-X codes B37.3 and N77.1). At the stage of clinical examination, medical and general history was analyzed, general and gynecological examination was performed. The diagnosis of candidiasis was confirmed by the presence of vegetative forms of Candida spp. (budding yeast cells, pseudomycelium and/or mycelium) in Gram-stained smears from the mucous membranes of the vulva, urethra. The control group consisted of 20 healthy patients of appropriate age and sex. Serum levels of interleukin-6 and interleukin-8 were measured by enzyme-linked immunosorbent assay using «ELISA interleukin-6» and «ELISA interleukin-8» test systems (ZAO «Vector-Best», Russia). Results. The study has shown increased serum levels of interleukin-6 in adolescent patients with candidal vulvovaginitis. Interleukin-6 level in peripheral blood was significantly higher in patients with candidal vulvovaginitis (21.7±2.4 pg/ml) compared to controls (9.4±1.5 pg/ml, p <0.02). Serum interleukin-8 level was also significantly higher (51.2±2.1 pg/ml) in patients with candidal vulvovaginitis compared to controls (23.9±1.04 pg/ml, p <0.01). Conclusion. The revealed features of interleukin-6 and interleukin-8 production may be used as additional objective criteria of the orientation of the inflammatory response in patients with various forms of vaginal candidiasis. The changes of the studied parameters might reflect the state of the immune system and the severity of the inflammatory response.
Kazan medical journal. 2013;94(6):817-820
817-820
Differentiated approach to the use of the modern surgical technologies in patients with tubal infertility
Abstract
Aim. To elaborate the differentiated approach to the surgical treatment of the patients with tubal and peritoneal infertility using the endoscopic and microsurgical methods and to evaluate its efficiency. Methods. 1840 female patients with infertility underwent complex clinical and laboratory examination, including endoscopy. 1257 patients underwent surgical treatment. Endo-video-surgical interventions were carried out in 1070 women, microsurgical techniques were applied in 187 patients. Results. The laparoscopic reconstructive plastic surgery was the most effective manipulation in patients with the disease of the distal part of the fallopian tubes and peritoneal adhesions. Treatment results were defined by the severity of distal part of the uterine tubes damage and severity of peritoneal adhesions in the pelvic cavity. The most favorable results of the treatment were noted after salpingo-ovariolysis (success rate 61.4%), by 2.3 times exceeding the pregnancy frequency after salpingoneostomy (26.9%; p <0.001) and by 1.6 times compared to fimbrioplasty (39.2%; p <0.001). In patients with proximal occlusion, results depended on the type of the tubular occlusion. In 69.7% patients with proximal occlusion due to synechiae, small polyps, foreign bodies, hysteroscopic interventions were an effective method of recanalization, allowing to restore the reproductive function in 40.2% patients. The microsurgical method demonstrated the 5.9 fold higher efficiency in patients with fibroid proximal occlusion of the uterine tubes compared to the laparoscopic methods (41.7% vs 7.1%). The microsurgical method was the most effective in patients with true fibrous proximal occlusion after the surgery on uterine tubes for tubular pregnancy and surgical sterilization. Conclusion. The differentiated approach to the surgical treatment of the patients with tubal infertility allowed to use the endo-video-surgical method in 85.1% of cases, improving the treatment’s results due to the decrease the surgical trauma and surgery duration, due to economic and cosmetic effect.
Kazan medical journal. 2013;94(6):821-825
821-825
Mediastinitis after cardiac procedures via median sternotomy: comparative analysis of outcomes
Abstract
Aim. To compare the effectiveness of poststernotomy mediastinitis treatment in 41 patients who underwent vacuum-assisted closure or closed irrigation treatment. Methods. A retrospective analysis of 41 cases of sternal wound infection identified in patients who underwent cardiac surgery between 2007 and 2012. 18 patients (the first group) were treated using closed irrigation, 23 patients (the second group) - using vacuum-assisted closure. We compared the time interval for wound healing and drainage, serum levels of C-reactive protein and blood leukocyte counts on admission and at different time points until discharge. Results. In patients who were treated using vacuum-assisted closure, wound debridement and healing were achieved at shorter terms, and lower rate of complications were observed. There were 8 (44.4%) relapses requiring repeated surgery and debridement in the first group compared to 3 (13%, p=0.01) in the second group. C-reactive protein level decreased more rapidly in patients who were treated using vacuum-assisted closure (p <0.02). The duration of hospital stay was 67±4.1 days in the first group compared to 29.6±8.4 days in the second group (p=0.019). Moreover, patients who were treated using vacuum-assisted closure did not experience any significant discomfort and stayed active. Histological examination of the soft tissues showed marked lymphoid and plasma-cell reaction and neoangiogenesis by the end of the second week of vacuum-assisted closure. Conclusion. The use of vacuum-assisted closure shortens the term of wound debridement, granulating tissue formation and the duration of hospital stay compared to closed irrigation treatment.
Kazan medical journal. 2013;94(6):826-831
826-831
Diagnosis and treatment of chronic colostasis in children with dolichosigmoid
Abstract
Aim. To choose the proper tactics of constipation diagnosis and treatment in children with dolichosigmoid. Methods. 75 patents with various colonic diseases featured by constipation, were treated, dolichosigmoid was diagnosed in 36 (48%). All patients with dolichosigmoid were distributed to 3 groups. The first group included 22 (61.1%) patients with compensated stage, the second group - 9 (25%) with subcompensation, the third group included 5 (13.9%) patients with decompensated stage. The diagnosis was performed by anamnesis and results of clinical and laboratory examinations (blood analysis, urinalysis, stool analysis, intestinal microbiota test), fibrocolonoscopy was performed in 13 (36.1%), radiologic examination of colon - in 36 (100%), barium follow-through test - in 36 (100%), multispiral computed tomography with contrast media and virtual colonoscopy with 3D-reconstruction - in 8 (22.2%), sphincterometry - in 13 (36.1%), morphological examination of the biopsy samples obtained at fibrocolonoscopy - in 7 (19.4%), duplex ultrasonography of great intestinal vessels - in 9 (25%) of patients. Results. Out of 36 patients with dolichosigmoid, 29 (80.6%) received non-surgical treatment, remaining 7 (19.4%) children underwent surgery. One-stage sigmoid resection with colocolic end-to-end anastomosis formation was performed in 3 (8.3%) patients, one-stage left-sided hemicolectomy with colocolic end-to-end anastomosis formation - in 2 (5.6%), two-staged surgery - left-sided hemicolectomy with proctoplasty by Svenson-Chiatt-Isakov and colocolic end-to-end anastomosis formation - in 2 (5.6%). The best result was obtained in case of left-sided hemicolectomy, the sigmoid resection does not give a good result itself, with frequent relapses of constipation. Conclusion. The treatment of chronic colostasis should be started with non-surgical treatment, and only after rigorous evaluation; the indications for a surgical treatment are: subcompensated stage not responding to medical treatment and decompensated stage of the disease.
Kazan medical journal. 2013;94(6):831-838
831-838
A method of surgical treatment of unstable severe forms of juvenile femoral head epiphysiolysis
Abstract
Aim. To analyze the long-term results of the designed method for the open epiphysis reduction in patients with severe unstable forms of juvenile femoral head epiphysiolysis. Methods. The article describes the method of surgical treatment of severe forms of unstable juvenile femoral head epiphysiolysis and long-term outcomes in 21 patients. The indications for the method were the unstable form of juvenile femoral head epiphysiolysis and slipped capital femoral epiphysis with a slip angle of more than 40 degrees. The age of patients at time of treatment ranged from 11 to 16 years, follow-up period - from 2 to 15 years. Five patients underwent a comprehensive biomechanical study within one year after surgery. Results. The early and late results of the femoral head epiphysis open reduction were analyzed. Positive results were obtained in 19 cases (good results in 17, satisfactory in 2). The complication rate was 14.3% and included 3 cases of avascular femoral head necrosis, no cases of chondrolysis were revealed. According to biomechanical examination data performed in five patients 1 year after the surgery, almost complete functional recovery of the musculoskeletal system was revealed. Conclusion. Analysis of the results showed that being properly executed the open reduction of the femoral head with a corrective femoral neck osteotomy allowed to restore normal anatomic proportions and function of the affected joint, positive result was maintained for the entire follow-up period.
Kazan medical journal. 2013;94(6):838-843
838-843
Temporomandibular joint dysfunction due to benign joint hypermobility syndrome
Abstract
Aim. To mark out the main features of temporomandibular joint dysfunction in patients with benign joint hypermobility syndrome. Methods. 90 patients with temporomandibular joint dysfunction were examined. The first group included 53 (58.89%) patients with benign joint hypermobility syndrome, the second group - 37 patients with temporomandibular joint dysfunction without any signs of benign joint hypermobility syndrome. Functional joint examination including clinical examination, examination of jaw diagnostic models in articulators, X-ray and magnetic resonance imaging, was performed. The diagnosis of benign joint hypermobility syndrome was set up by clinical findings according to national recommendations of Russian Society of Cardiology. Results. Two main trends were found in patients with benign joint hypermobility syndrome. Joint hypermobility was present in 27 (50.94%) out of 53 patients aged 30 years and older. Temporomandibular joint dysfunction in those patients was quite severe, associated with pain and limited range of mandibular movement. In 49.06% of cases in patients with benign joint hypermobility syndrome aged younger than 30 years, bone symptoms were present. Those patients were complaining of joint noises. In 38.46% of cases, gothic palate or frontal teeth crowding were observed. According to magnetic resonance imaging, there was a condylar processes asymmetry at occlusion in 41 (77.36%) patients with benign joint hypermobility syndrome. Conclusion. Clinical and morphologic signs of temporomandibular joint dysfunction in patients with benign joint hypermobility syndrome are associated with predisposed changes in temporomandibular joint capsule and ligaments. Temporomandibular joint dysfunction is a typical and regular feature of benign joint hypermobility syndrome.
Kazan medical journal. 2013;94(6):843-846
843-846
Comparative assessment of different methods of congenital glaucoma surgical treatment considering patient’s age
Abstract
Aim. To study the effectiveness of antihypertensive operations of trabeculotomy ab externo and sinus trabeculoectomy in our modification in patients with congenital glaucoma and to justify its application. Methods. The following surgeries were performed: trabeculotomy ab externo - on 57 eyes of 51 patients, sinus trabeculoectomy - on 46 eyes of 42 children, classic trabeculoectomy - on 23 eyes of 19 patients, and trabeculoectomy with elements of intrascleral autodrainage in our modification - on 23 eyes of 23 patients. Among them, 22 patients were younger than 1 month, aged from 1 to 6 months - 30, from 6 months to 1 year - 18, from 1 to 3 years - 15 and from 3 to 5 years old - 8 patients. Results. Long-lasting hypotension was achieved in 86.95% of patients after sinus trabeculoectomy, in 80.39% of patients after trabeculotomy ab externo. The best results were obtained in patients younger than 6 months. In the older age groups, antihypertensive effect of trabeculotomy ab externo markedly decreased and was only 50% at the age of 3-5 years. The results after sinus trabeculoectomy were comparable in all age groups. Conclusions. Trabeculotomy ab externo can be recommended as an operation of choice during the first months of life in congenital glaucoma patients, based on the characteristics of the anterior chamber angle.
Kazan medical journal. 2013;94(6):847-850
847-850
About the optic disc size
Abstract
Aim. To compare the dependence of retinal nerve fibre layer thickness on the optic disc size in confocal scanning laser ophthalmoscopy and optical coherence tomography. Methods. 201 outpatient’s cards with verified diagnosis of glaucoma or with suspicion of glaucoma were retrospectively analyzed. The mean age of the patients was 64 (56; 72) years [Me, (Q1; Q3)]. A group of patients who underwent confocal scanning laser ophthalmoscopy (181 eyes), and a group who underwent optical coherence tomography (183 eyes), were separated. Besides, all the groups were twice divided into 3 subgroups each, by means of cluster analysis and on the basis of size classification: large, medium and small. Results. According to the data of confocal scanning laser ophthalmoscopy, the bigger is the optic disc, the thinner is retinal nerve fibre layer (Rs=-0.22; р=0.001). In optical coherence tomography, different correlation was observed, the bigger is the optic disc, the thicker is the retinal nerve fibre layer (Rs=0.15; р=0.03). Conclusion. The size of the optic disc was related to the retinal nerve fibre layer thickness in both examination modes: there was an inverse relation found in confocal scanning laser ophthalmoscopy - the bigger the optic disc, the thinner is the retinal nerve fibre layer), and there was a direct dependence found in optical coherence tomography (the bigger is the optic disc, the thicker is retinal nerve fibre layer), thus it is important to consider the size of the optic disc while estimating the retinal nerve fibre layer thickness.
Kazan medical journal. 2013;94(6):850-853
850-853
The changes of anatomic and topographic characteristics of eye anterior segment after uncomplicated cataract phacoemulsification
Abstract
Aim. To study the changes of anatomic and topographic characteristics of the eye anterior segment after uncomplicated cataract phacoemulsification using corneal incision with intraocular soft lens implantation. Methods. The data of ultrasound biomicroscopy and noncontact tonometry of 58 eyes (56 patients, 32 females, 24 males aged 54 to 78 years) before and after cataract phacoemulsification were analyzed. Paitents with survived ocular trauma, refractive keratoplasty, glaucoma, uveitis, and surgical complications (incomplete capsulorrhexis, posterior capsule rupture, ciliary zonule disinsertion, corneal burn). Apart from the common examinations (visual acuity testing, tonometry, tonography, eye A- and B-ultrasonography, biomicroscopy), all patients underwent eye ultrasound biomicroscopy. Results. Anterior chamber depth increased from 2.73±0.10 to 4.17±0.06 mm (p ≤0.001). Trabecula-iris distance measured at 500 μm from the scleral spur, increased from 0.38±0.02 to 0.47±0.02 mm (p ≤0.001). Anterior chamber angle increased from 28.69±1.87 to 42.73±1.56 degrees (p ≤0.001), the angle between the iris and the sclera increased from 32.78±1.39 to 41.36±0.84 degrees (p ≤0.001), the angle between the sclera and ciliary processes increased from 39.48±1.29 to 45.30±1.16 degrees (p ≤0.001). Intraocular pressure according to the non-contact tonometry data decreased from 18.16±1.29 to 13.55±0.95 mm Hg (p ≤0.001). Conclusion. Anterior chamber depth, trabecula-iris distance, anterior chamber angle, the angle between sclera and iris and the angle between sclera and ciliary processes increased significantly after phacoemulsification with intraocular lens implantation. Intraocular pressure decreased significantly according to the non-contact tonometry data.
Kazan medical journal. 2013;94(6):853-858
853-858
Spiral computed tomography angiography in the evaluation of hepatocellular carcinoma vascularity and malignancy degree
Abstract
Aim. To study the vascularity and malignancy degrees of hepatocellular carcinoma using spiral computed tomography angiography considering its morphological differentiation and tumor size. Methods. A comprehensive clinical and radiological examination of 300 patients (males - 170 (56.6%), females - 130 (43.4%), mean age 52.0±3.2 years) with hepatocellular carcinoma, who were picked out from 2550 patients with malignancies treated in 2005-2013, was performed. Liver cirrhosis was diagnosed in 70 (23.33%) out of 300 patients with hepatocellular carcinoma. The features of tumor bloodflow were assessed using color Doppler ultrasonography and spiral computed tomography angiography (by 4 phases of examination) considering tumor size and tumor morphological differentiation. Results. According to the morphological study results of samples from 123 patients, high-grade differentiated hepatocellular carcinoma was diagnosed in 40 patients, moderately differentiated - in 53, poorly differentiated - in 30 patients. A correlation of tumor vascularity with histological differentiation degree and tumor size was revealed. The difference in high-grade differentiated hepatocellular carcinoma maximal computed tomography density increment gradients at arterial phase compared to liver parenchyma maximal computed tomography density increment was 17 Hounsfield units in tumors sized up to 5 cm and 12 Hounsfield units in 32 (80%) of 40 patients with tumors sized over 5 cm. Thus, high-grade differentiated hepatocellular carcinoma was associated with increased vascularity in 80.0%, normal vascularity - in 8.0%, low vascularity - in 12.0% of cases. The difference in moderately differentiated hepatocellular carcinoma computed tomography density increment gradients compared to liver parenchyma was assessed as 20 and 25 Hounsfield units in tumors with the corresponding size in 45 (89.4%) out of 53 patients. Moderately differentiated hepatocellular carcinoma was associated with increased vascularity in 89.4%, normal vascularity - in 4.0%, low vascularity - in 6.6% of cases. Poorly differentiated hepatocellular carcinoma was associated with increased vascularity only in 7 out of 30 patients. Conclusion. The correlation of tumor vascularity with histological differentiation degree and tumor size was revealed. Increased vascularity was observed in high-grade differentiated and moderately differentiated hepatocellular carcinoma, low vascularity - mainly in poorly differentiated hepatocellular carcinoma.
Kazan medical journal. 2013;94(6):858-864
858-864
Indicators of mental health of pre-school children in Irkutsk amid the wide introduction of information technologies
Abstract
Aim. To assess the mental activity of pre-school children amid the wide introduction of information technologies. Methods. 176 children aged from 5.5 to 6.5 years were observed at the institution of pre-school education of Irkutsk central district from 1998 to 2012. Two groups were formed: the first group included 101 child who attended childcare center in 1998, the second group - 76 children who attended childcare center in 2012. Age groups of pre-school children were formed according to their age (from 5 years 5 months 30 days of age to 6 years 5 months 30 days of age). The mental activity was assessed using the figure tables by V.Y. Anfilov assessing the number of made mistakes and number of lines run through. Every missed line was equal to one mistake made. The productivity coefficient Q was calculated as Q=c2/c+d, where с - the number of lines run through; d - the number of mistakes (mistakes were not standardized). Results. The parameters of productivity did not change significantly in 2012 compared to 1998. The number of lines run through at Anfilov’s test increased by 1.8 times (р <0.05) in children of the second group (examined in 2012), the number of mistakes made increased by 7.5 times (р <0.05). Among the girls of the second group, the number of lines run through increased by 1.6 times (р <0.05), the number of mistakes made increased by 6.3 times (р <0.05). The trend was clearer in boys, in whom the number of lines run through increased by 2.0 times (р <0.05), the number of mistakes made increased by 8.3 times (р <0.05). Conclusion. The speed of information processing has increased, and the quality of information processing has dropped in contemporary pre-school children. The overall productivity did not change.
Kazan medical journal. 2013;94(6):864-866
864-866
Objective monitoring of neuromuscular transmission in laparoscopic surgery
Abstract
Aim. To assess the importance of quantitative neuromuscular transmission monitoring in laparoscopic surgery. Methods. 30 patients [11 (37.7%) males, 19 (63.3%) females, mean age 52.3±7.18 years] who underwent laparoscopic surgery and general anesthesia associated with skeletal muscles relaxation, were examined. The degree of neuromuscular transmission recovery and time to trachea extubation performed by an anesthetist after the end of surgery (like laparoscopic cholecystectomy, appendectomy) and general anesthesia associated with skeletal muscles relaxation were assessed using quantitative monitoring of neuromuscular transmission and «blind» control. Results. In 21 patients no drugs were used to reverse the skeletal muscles relaxation. Trachea extubation in this group was performed 10.5 minutes after the end of surgery in average at the neuromuscular transmission Train of Four (TOF) level of 43-81% for 15 patients and at the TOF level over 90% in 6 patients. In 9 patients, sugammadex (2 mg/kg) was used for neuromuscular transmission reversal, the average level of neuromuscular blockade (TOF) in those patients was 41±6.5%. TOF average recovery time up to 90% was 1 minute 48 seconds. Trachea extubation was performed no later than 4 minutes after the sugammadex administration. Conclusion. The subjective assessment of neuromuscular transmission recovery, based on the assessment of clinical signs, is not able to completely exclude the residual muscle relaxation. Objective monitoring of neuromuscular transmission is required to determine the time of intubation, administration of maintenance doses of muscle relaxants, and for assessment of efficacy of reversal and possibility for trachea extubation.
Kazan medical journal. 2013;94(6):866-869
866-869
Comparison of the effects of rituximab, tumor necrosis factor alpha inhibitors and non-steroidal antiinflammatory drugs on ankylosing spondylitis clinical activity and sacroileitis intensity on magnetic resonance imaging
Abstract
Aim. To investigate the effect of rituximab in ankylosing spondylitits on disease activity and on intensity of sacroileitis detected by magnetic resonance imagigng compared to tumor necrosis factor alpha inhibitors and non-steroidal anti-inflammatory drugs. Methods. The study included 91 patient [14 (15.4%) females, 77 (84.6%) males, mean age - 34.4±9.13 years, disease duration - 6.6±3.8 years] with established diagnosis of ankylosing spondylitits. The main group included 20 patients (17 males, mean age 36.9±9.9 years) who were treated with rituximab. The comparison group included 36 patients (30 males, mean age 34.3±8.6 years) treated with tumor necrosis factor alpha inhibitors. The control group consisted of 35 patients (30 males, mean age 33.4±9.3 years) treated with non-steroidal anti-inflammatory drugs and sulfasalazine. Disease activity was measured by BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) and ASDASESR (Ankylosing Spondylitis Disease Activity Score) scores before the treatment initiation, at the 2nd, 8th, 16th and 24th weeks of treatment. Magnetic resonance imaging of sacroiliac joints was performed before the treatment initiation and at the 24th week of treatment, T1 and STIR sequences were analyzed. Results were processed using the SPARCC (Spondyloarthritis Research Consortium of Canada) scoring methodology. Results. There was a significant reduction of the disease clinical activity measured by BASDAI score (from 6.19±1.48 to 3.70±0.91, p <0.01) and ASDASESR score (form 3.43±0.72 tо 2.11±0.46, p <0.01) in patients treated with rituximab at the week 24. Mean SPARCC score reduced from 15.9±7.2 to 4.6±8.2 (p <0.01). The influence of rituximab on clinical activity of the disease was superior over the effect of the standard treatment (BASDAI and SPARCC scores 5.22±1.14 and 7.8±7.1 accordingly at the week 24, p <0.05), but inferior over the effect of tumor necrosis factor alpha inhibitors (BASDAI and SPARCC scores 2.03±0.64 и 4.9±7.0 accordingly at the week 24, p <0.01). Conclusion. Anti B-cell therapy is effective in treating active ankylosing spondylitis and leads to the decrease of the clinical symptoms intensity and disease activity measured by BASDAI и ASDASESR scores. The effect of rituximab was superior over the effect of non-steroidal anti-inflammatory drugs and sulfasalazine and inferior over the effect of tumor necrosis factor alpha inhibitors.
Kazan medical journal. 2013;94(6):870-876
870-876
Healthcare mangement
Predominantly single-channel funding of healthcare institutions: experience of the Republic of Tatarstan
Abstract
In accordance with the Constitution of Russian Federation, the state guarantees health protection and access to free medical care in state healthcare institutions to each citizen. The questions of healthcare funding in Russia seem to be a topic of interest, especially considering the ongoing conversion to predominantly single-channel funding of healthcare institutions. Despite the lengthy discussions about the pros and cons of that system, experts have not come to a consensus about the need for universal introduction of predominantly single-channel funding of public healthcare institutions so far. The article reviews the experience of predominantlysingle-channel funding of healthcare institutions introduction and realization in the Republic of Tatarstan. The differentiation of funding duties in the region was studied; the ratio of funding sources of the Program of state guarantees for access to free-of-charge medical aid for Russian citizens was analyzed. The analysis showed that switching to predominantly single-channel funding of healthcare institutions does not lead to a major changes in healthcare funding system of Russian Federation and does not contribute to the immediate solution of the existing problems.
Kazan medical journal. 2013;94(6):877-884
877-884
Assessment of glaucoma morbidity in Irkutsk region
Abstract
Aim. To study the changes of glaucoma prevalence from 1992 to 2012 and to define the main epidemiologic trends by statistical analysis. Methods. Considering the fact that 80% of patients with glaucoma who live in Irkutsk Region, undergo primary deep examination in the Interbranch Scientific and Research Complex «Eye Microsurgery» named after S.N. Fedorov, the gained data were extrapolated on the epidemiological situation in the region at whole. The analysis of 300 000 medical charts of patients who were diagnosed with glaucoma and attended the Irkutsk branch of Interbranch Scientific and Research Complex «Eye Microsurgery» named after S.N. Fedorov from 1992 to 2012 were analyzed, with the morbidity level assessment according to the following criteria: form and stage of glaucoma, gender, age, patients’ place of residence. The data were processed using regression analysis and analysis of variance. Results. The increase in glaucoma morbidity from 45.2 to 140.6 on 1000 examined patients, mainly affecting women, was revealed. A better detection of glaucoma on preclinical stages was noted. At the same time, the detection rate of glaucoma at advanced stages remains stable. Four periods, in which the prevalence growth significantly exceeds the predicted results, were determined. These periods corresponded to the introduction of new diagnostic technologies, conducting management measures, and change in staff of ophthalmologists. Conclusion. The obtained statistical results allow analyzing and estimating the epidemiologic situation on glaucoma, identifying the main trends of its development, getting prognostic models for key epidemiological indicators and can be used in prediction of the basic epidemiological trends.
Kazan medical journal. 2013;94(6):885-889
885-889
An estimation of compliance of acute community-acquired pneumonia detection in children with local healthcare protocols
Abstract
Aim. To study the rationale for the diagnostic tests use and their compliance with the lists recommended by local protocol of healthcare for acute community-acquired pneumonia in children and to develop management measures to improve the diagnosis of the disease. Methods. Methods of comparative and statistical analysis were applied to assess the use of diagnostic tests conducted in 2011 at the prehospital and hospital stages in 240 children admitted to Children’s Regional Hospital, Chernigov, Ukraine depending on patients’ age and severity of the acute community-acquired pneumonia. Results. It was found that the list and the conduction of the diagnostic tests in children with moderately severe pneumonia deviated from the recommended national protocol requirements without reasonable clinical indications. Additionally to the obligatory tests (full blood count, chest X-ray) every second child was administered electrocardiography, and every fifth - liver function test. Chest X-ray was re-done in 14.4% of children aged 1-3 years and 12.0% of children aged 4-16 at admission. Low coverage level with examinations performed on out-patient stage in children regardless of their clinical condition was revealed, leading to a waste of resources of the hospital for the diagnosis of the disease. Conclusion. The results of the study demonstrate the need for adopting and implementing the management decisions to improve the diagnosis of acute community-acquired pneumonia in children based on the obtained evidence.
Kazan medical journal. 2013;94(6):890-893
890-893
The modeling of seasonal fluctuations of demand for medications to treat bronchial asthma for the hospitals of the Republic of Tatarstan
Abstract
Aim. To model the seasonal fluctuations of demand for medications to treat bronchial asthma for the hospital use in healthcare facilities of the Republic of Tatarstan. Methods. Statistical methods of absolute and relative differences, seasonality index construction, ABC/XYZ- analysis, modeling of seasonal fluctuations were used for the assessment. Results. By using ABC/XYZ-analysis the estimation of the consumption of certain medications to treat bronchial asthma in hospitals of the Republic of Tatarstan was given. The AX group was the largest share in the total trade (48.27%), but contributed only to 5.88% of the total nomenclature positions number. BX and CX groups, accounting for 0.73% and 0.21% of total consumption respectively, contributed to 1.96% of the nomenclature positions each. 7.84% of assortment positions provided 22.34% of turnover (group AY). Drugs of BY group provided 8.36% of the total sales, and 11.76% of assortment positions, the proportion of CY group (19.61% of items) accounts only for 2.93% of the sales; anti-asthmatic drugs of group Z, the largest by assortment positions number (AZ - 1.96%, BZ - 9.80%, CZ - 39.23%) provided a total of 17.16% of turnover. Assortment positions for modeling the seasonal fluctuations of the demands (AY, BY) were selected. According to the proposed algorithm, the presence of seasonality for each drug was checked. 90 models of seasonal fluctuations were designed and their reliability was tested. The prognosis based on the designed models of demand for medications to treat bronchial asthma for the hospital use in healthcare facilities of the Republic of Tatarstan was given. Conclusion. Assessment of the future demand for anti-asthmatic drugs based on the designed models may allow to optimize the use of funding allocated for the drug provision of patients with bronchial asthma while treated as in-patients.
Kazan medical journal. 2013;94(6):894-897
894-897
Medical education
A new way of interaction between a teacher and a student as a factor for self-development of teachers and students on the example of biochemistry course
Abstract
Aim. To develop and introduce a new educational method for theoretical subjects stimulating creativity of students and teachers on the example of biochemistry course. Methods. The new educational method is based on close and creative cooperation between a teacher and a student while creating situational, professionally and personally-oriented tasks reviewing molecular mechanisms of the human body processes. The feedback from teachers participating in program was gained using questionnaires. Results. Basing on the described method, the «Creative Personality» program was developed, serving as a tool for the development of professional competencies and creativity in highly motivated students and as an andragogy tool stimulating teachers’ self-development. The abovementioned studying form inculcating the students and developing in teacher the vitally important skill of creating a quality products. Apart form the activating the cognitive activities in teachers and students and increasing the study progress, the method is a great help to the faculty staff, as it increases the bank of the tasks used in studying process as an educational or control tool. The best situational tasks created by students who were surveyed by their mentors, were included in the «Biochemistry» textbook (2012) written by a group of authors edited by S.E. Severin, noting the students’ authorship. Conclusion. The new method of cooperative creative work of teachers and students was created for development of creative activity in highly motivated students and improving teachers’ self - development while creating situational, professionally and personally-oriented tasks that can be used in a study process and can deepen the students’ knowledge and create conditions for the development of professional competencies both in students and teachers.
Kazan medical journal. 2013;94(6):898-900
898-900
Clinical observations
Solar maculopathy. Results of five years of follow-up
Abstract
Aim. To investigate the clinical features of solar maculopathy in a long run by optical coherence tomography. Methods. 31 patients (40 eyes) complaining on scotoma appeared after sun gazing without protection were referred to an advisory clinic of Republican Clinical Hospital of Ophtalmology, Kazan. The mean age of patients was 25.2 years, mean visual acuity - 0.72. In addition to the standard examinations, all patients underwent optical coherence tomography. The patients were followed up for up to 5 years. The examinations were performed before the treatment initiation and repeated on the 15th, 30th and 90th day after the treatment completion. 7 patients (8 eyes) were followed up for 5 years. Results. According to the results of optical coherence tomography, focal retinal edema was found in 9 patients (18 eyes) at the first week. Patients received antioedematic drugs and antioxidants. According to the results of optical coherence tomography a lamellar defect has been formed in fovea centralis on 15th day of treatment. Mean visual acuity improved to 0.78. On 30th and 90th days of treatment, lamellar defect persisted, visual acuity remained unchanged. After 5 years, 7 patients (8 eyes) were re-examined. The mean visual acuity was 0.78, the lamellar defect was still observed by optical coherence tomography. No macular degenerative and dystrophic changes were observed in followed up patients. Conclusion. Sunlight causes permanent damage of the retina. In the first week after the sunburn, marked focal retinal edema in the foveolar area was observed on the tomography, with further formation of a lamellar defect that was not accompanied by degenerative changes in the long-term period. Optical coherence tomography is an informative method of diagnosing solar maculopathy.
Kazan medical journal. 2013;94(6):901-903
901-903
Prevention of fatal pulmonary embolism in a patient with stomach cancer
Abstract
A clinical case of a 71-year old patient with stomach cancer and concomitant lower extremity deep venous thrombosis diagnosed before the surgical treatment is presented. The patient was administered anticoagulants, and despite the treatment, a diagnosis of deep venous thrombosis with high risk for thromboembolism was set up. Considering high risk for pulmonary embolism, an inferior vena cava filter was implanted in infrarenal part of inferior vena cava at the first stage. On the second day after the cancer surgery (subtotal stomach resection with lymphadenectomy), clot detachment and its dislocation from the left common femoral vein to the area where the cava filter was implanted with further fixation were diagnosed. Accurate diagnosis of lower extremity deep venous thrombosis with high risk for thromboembolism set up by ultrasonography and timely inferior vena cava filter implantation saved the patient with cancer from developing pulmonary embolism.
Kazan medical journal. 2013;94(6):903-905
903-905
Experimental medicine
Cytokines regulate HIV-1 replication and lymphocyte apoptosis in vitro
Abstract
Aim. To study the ability of cytokines - interleukin-2, interleukin-7 and tumor necrosis factor alpha to induce human immunodeficiency virus type 1 (HIV-1) replication and lymphocyte apoptosis in vitro. Methods. Peripheral blood mononuclears were separated by centrifugation on a ficoll paque solution specific density gradient. Lymphocytes were cultivated in RPMI 1640 medium with addition of L-glutamine, embryonal bovine serum, antibiotics and cytokines (interleukines-2, -4, -7, tumor necrosis factor alpha). To infect the lymphocytes, a laboratory strain of HIV-1 NL4-3 (NIH Res&Reag. Prog., USA) was used. HIV-1 replication was assessed by р24gag viral protein level in culture supernatants (ELISA) and its cytozolic level in lymphocytes (flow cytometry). Lymphocyte apoptosis was assessed by flow cytometry using the following parameters: (1) decrease of transmembrane mitochondrial potential; (2) increase in phosphatidyl serine molecules expression. Lymphocyte activation was assessed by CD25 and HLA-DR molecules expression (flow cytometry). Results. Cytokines induce the HIV-1 replication in lymphocytes in vitro. HIV-1 replication was noted only if inactivated lymphocytes were present in the culture. At the same time, lymphocytes not expressing the classical activation markers (CD25 and HLA-DR) were present among the lymphocytes producing HIV-1 indicating the possible alternative mechanism of HIV-1 replication, not dependent on cell activation. This fact might also be an evidence of viral replication processes in the pool of latently-infected lymphocytes, not expressing the classic activation markers. The abovementioned cytokines promote apoptotic death of uninfected lymphocytes in vitro, backing up the infected cells viability and thus promoting HIV-1 replication. Conclusion. Cytokines (interleukines-2, -4, -7, tumor necrosis factor alpha) which are known as factors supporting the immune system homeostasis and immune response formation, might also play a negative role in HIV-1 pathogenesis - induce HIV-1 replication in lymphocytes and, probably, lead to reactivation of the pool of latently-infected lymphocytes, deepening the lymphopenia and leading to disease progression.
Kazan medical journal. 2013;94(6):906-910
906-910
The change of splenic morphometric parameters in aged laboratory animals exposed to ionizing radiation after undergoing stem cells transplantation
Abstract
Aim. To study the changes of splenic morphometric parameters in aged laboratory animals exposed to ionizing radiation in the dose of 4Gr after multipotent mesenchymal and hematopoietic stem cells transplantation. Methods. The experiments were conducted on 72 white male laboratory mice at the third year of life with the body weight of 50 g. Multipotent mesenchymal stem cells and hematopoietic stem cells were obtained from 8 laboratory female mice with the body weight of 30 g aged 3-4 months, the gestation term was 14 days. The first group (36 animals exposed to radiation) was subdivided to 2 subgroups of 18 animals each. The suspension of multipotent mesenchymal stem cells (6 000 000 cells/kg) and hematopoietic stem cells (330 000 cells/kg) was introduced as single intravenous injection to the experimental subgroup (18 animals) 1 hour after the animals were exposed to radiation. The animals of control subgroup (18 animals) were injected 0.2 ml of normal saline. The second group included two subgroups 18 mice each that underwent the same procedure without being exposed to radiation. 9 animals from each group were withdrawn from the study at 1st and 7th day each. The lymphoid follicle gross area, area of the T-cell and B-cell zones, general numbers of cells in the red pulp of spleen, including erythrocyte and lymphocyte count, were measured in splenic histologic specimens using the morphometric «BioVision 2008» software. Results. It was shown that on the 7th day after exposure to ionizing radiation followed by stem cells transplantation, the area of thymus-independent zone of lymphoid follicle restored back to normal ranges. The effect of multipotent mesenchymal stem cells and hematopoietic stem cells transplantation also resulted in the increase of the number of cells in the red pulp of spleen. There were no significant changes observed in numbers of erythroid cells and white blood cells in the spleen red pulp compared to control subgroup. At the same time, the leukocyte number in the red pulp of spleen restored to normal values. Conclusion. The restoration of the basic morphometric parameters in spleen of aged laboratory animals exposed to ionizing radiation may be explained be increased homing of splenic colony-forming units with subsequent activation of extramedullary hematopoiesis in spleen, and apoptosis-reducing effect of multipotent mesenchymal stem cells.
Kazan medical journal. 2013;94(6):911-914
911-914
Comparative study of different models of alloxan-induced diabetes mellitus
Abstract
Aim. To compare the clinical course of diabetes mellitus induced by alloxan using classic and modified technique. Methods. Experiments were carried out on mature white mongrel rats, which were divided into two groups: the first group (25 rats) was administered a 200 mg/kg single dose of alloxan (classic model), the second group (25 rats) was administered 150 mg/kg of alloxan at the first day, 100 mg/kg of alloxan at the second day and 100 mg/kg of alloxan at the fourth day. 25 intact rats were examined as a control group. The animals were withdrawn from the experiment by decapitation on the 10th and 21st day, blood and tissue samples were taken for the laboratory testing. The animals’ status (mortality, grooming behavior, body weight, food and water intake) were measured by visual examination. The levels of glucose and lipids were assessed using enzyme colorimetric detection («Human» laboratory kits, Germany, FP-901 analyzer), insulin and C-peptide levels were examined by enzyme-linked immunosorbent assay («Chemwell» analyzer, «DEMENITECKILL-WELLSEE» laboratory kits, Germany); levels of diene conjugates and malonic dialdehyde - using the photocolorimetry based on the colored thiobarbituric acid products. Results. In the first group, the mortality reached 68%, mean weight loss - 41.2%. Blood glucose level at the 10th and 21st days was higher by 370.7 и 146.2% respectively compared to intact animals. Insulin level decreased by 95.8 and 83.7%, C-peptide level - by 96 and 83.7%. In the second group, mortality was 32%, mean body weight loss - 36.5%, blood glucose level at the 10th and 21st days elevated by 364.5 and 151.5%, insulin level decreased by 96.1 and 82.9%, C-peptide level - by 96.0 and 83.7% respectively. A moderate hyperlipidemia was observed in both groups with increased levels of cholesterol, triglycerides, low and very-low density lipoproteids, free fatty acids and decreased levels of high density lipoproteids. The concentration of diene conjugates and malonic dialdehyde increased rapidly to a variable degree depending on the tissue anti-oxidative activity. Conclusion. When diabetes mellitus is modeled by the use of alloxan, an acute form of alloxan-induced diabetes is observed on the 10th day, a chronic form - on the 21st day in both groups. The modified model of alloxan-induced diabetes showed 36% less mortality rate compared to the classic model.
Kazan medical journal. 2013;94(6):915-919
915-919
Reviews
Glucocorticoid pulse therapy аnd carbohydrate metabolism in rheumatic diseases
Abstract
Glucocorticoids are used in clinical practice for more than 50 years and are a great advance in the treatment of systemic inflammatory diseases. High doses of intravenous glucocorticoids (pulse therapy) are effective in conditions requiring rapid immunosuppression and antiinflammatory effect, such as systemic lupus erythematosus, rheumatoid arthritis, glomerulonephritis and systemic vasculitides. The advantage of this method are increased efficacy and lower rate of complications associated with prolonged administration of glucocorticoids. At the same time, glucocorticoid pulse therapy is associated with increased risk of hyperglycemia or even can be a cause of steroid-induced diabetes in patients without known hyperglycemia, as well as worsen glycemia control in patients with diabetes. Increased hepatic gluconeogenesis, inhibition of glucose uptake and metabolism in peripheral tissues and altered both receptor and post-receptor insulin action can lead to an increased serum glucose levels. In patients with inadequate compensatory reserves of pancreas, a clinical picture of diabetus mellitus can develop while treated with glucocorticoids. Blood glucose levels begin to rise 6-12 hours after the infusion of high doses of glucocorticoids. Risk factors for developing glucose intolerance and diabetes include advanced age, obesity, family history of diabetes and high cumulative doses of glucocorticoids. Glucocorticoid-induced diabetes is a common complication of pulse therapy, but exact causes are still not elucidated yet, current literature data on glucocorticoid-induced hyperglycemia are scarce.
Kazan medical journal. 2013;94(6):920-923
920-923
Statins and primary prevention of cardiovascular diseases: is there any point?
Abstract
Increased blood cholesterol level is one of the most studied risk factors for cardiovascular diseases. While benefits of statins in secondary prevention are shown, their role in primary prevention is not clear. To assess the potential benefits of statin use in primary prevention of cardiovascular diseases, we searched databases for published data in English language for secondary analyses of clinical trials of statin use in primary prevention of cardiovascular diseases. The data on clinical outcomes were extracted to calculate the ratio of beneficial effect to no effect (benefit/no effect ratio - BNER). One Cochrane systematic review and 5 meta-analyses were found, including 27 clinical trials. The authors of four out of six reviews declared potential conflict of interests with pharmaceutical companies manufacturing statins. We could not extract data on individual outcomes because they were not reported. For deaths of all causes, the BNER was 3:3 as assessed in 6 analyses. Only three reviews examined the effects of statins on coronary events and all reported positive effect of statins. Four out of six reviews reported data on coronary heart disease mortality and all found no positive effect of statins. Cardiovascular events and mortality were evaluated in two and three reviews, respectively, which showed positive effect of statins. Thus, there is no convincing evidence for statin use in primary prevention. The new studies, if carried out, should be of longer duration and follow-up, should use individual outcomes. Prevention with statins in patients with no history of cardiovascular disease should be performed with great caution, if considered at all.
Kazan medical journal. 2013;94(6):924-932
924-932
Hypokalemic myoplegia
Abstract
Acute generalized muscle weakness may have a different underlying cause. Among all urgently admitted patients, hypokalemia is observed in more than 20% of cases. Usually blood potassium concentration decrease is not fatal, but severe hypokalemia can be life-threatening for the patient suffering from cardiovascular diseases and respiratory disorders. Hypokalemia manifests clinically by muscle pain, weakness, the intestinal motility disorders, constipation, marked decrease in serum potassium levels can lead to fatal rhabdomyolysis. The key hormones that regulate the total stock of potassium in the body and its normal redistribution of intra- and extracellular fluid are insulin and catecholamines, interacting with β-adrenergic receptors. Regulation of blood potassium level is provided by insulin and it is a feedback (hyperkalemia stimulates insulin secretion, decreased potassium levels inhibits it). The level of catecholamines is not determined by potassium concentration, however, it influences the serum potassium level. Hypokalemia is usually the result of potassium loss due to abnormal renal (treatment with thiazides, high doses of corticosteroids, antibiotics, primary hyperaldosteronism due to adenoma, adrenal carcinoma, bilateral adrenal hyperplasia, Liddle, Bartter’s, Gitelman’s syndromes, 11β-hydroxysteroid dehydrogenase, 11β-hydroxylase, 17α-hydroxylase deficiency, Cushing’s syndrome) or extrarenal (intense vomiting, diarrhea due to excessive laxative use, salmonellosis, yersiniosis, HIV-infection, bowel tumors, chemotherapy, radiation therapy in cancer patients, celiac disease, jejunoileal bypass, a lack of potassium in food) potassium loss, an also a transmembrane shift of potassium (hypokalemic familial periodic paralysis, β2-agonist, bronchodilators, theophylline intake). Hypokalemic myoplegia may lead to fatal complications, requiring doctors of various specialties’ to know the clinical manifestations of hypokalemia, which may have different underlying cause.
Kazan medical journal. 2013;94(6):933-938
933-938
Radio-endovascular methods in prevention and treatment of arrosive bleedings in patients with destructive pancreatitis
Abstract
The review decribes the radio-endovascular methods in prevention and treatment of arrosive bleedings in destructive pancreatitis. The importance of non-surgical treatment in patients with aseptic forms of destructive pancreatitis is presented. It is stressed that the problem of an optimal surgical treatment choice in patients with pancreatolysis is not solved. Efficiency of minimally invasive surgery for treating destructive pancreatitis is shown. Radio-endovascular treatment methods, including intraarterial drug infusions and pancreatic arteries embolization to prevent and treat pancreatic inflammation and arrosive bleedings from visceral arteries aneurisms, are among such options. Researches of domestic and foreign authors give the clinical basis for selective drug introduction into coeliac artery in destructive pancreatitis treatment. Clinical cases of visceral arteries (lienal, gastroduodenal, left colonic, intrahepatic) embolization are reviewed as a way of hemorrhagic complications prevention and emergency treatment in destructive pancreatitis. The problem of arrosive bleedings in destructive pancreatitis at the present stage can be adequately controlled in the conditions of specialized surgical ward equipped with operational radio-endovascular facilities and multispiral computed tomographic scanner.
Kazan medical journal. 2013;94(6):938-941
938-941
The modern approach to the diagnosis of chronic constipation
Abstract
A review of literature devoted to the problems of chronic constipation diagnosis is presented. Chronic constipation occurs in all population groups and manifests with persistent or intermittent failure to pass stools. According to the Russian and foreign authors, a significant increase in constipation syndrome prevalence has been seen recently. The variety of etiological factors determines the challenge in diagnostics, and the variety of treating methods - the importance of exact and timely identification of the underlying cause. The definition of constipation syndrome and its classification is presented from the modern point of view, the most widespread risk factors of constipation are reviewed. The different views on the diagnostic algorithms in patients with constipation syndrome are discussed, the need for special questionnaires use to objectively assess patient’s complaints is emphasized. Various methods of instrumental examination of colonic anatomical and functional characteristics and tests assessing the anorectal function are described. Different authors’ opinions on informative value of different diagnostic tests to assess the colonic follow-through are presented. It is concluded that approach to constipated patients is the difficult task, requiring a complex of different clinical and instrumental methods of examination. Thereby an organic etiology of constipation needs to be excluded on a first priority basis. To answer the question if the constipation syndrome is secondary to other disease or is a primary functional disorder is possible only after patient’s careful examination and exclusion of all possible colonic and extracolonic causes. The paper should be interesting for general practitioners, gastroenterologists, coloproctologists and surgeons.
Kazan medical journal. 2013;94(6):942-946
942-946
Kazan anatomic scientific school of V.N. Tonkov and its siberian branches
Abstract
Anatomic scientific school of Tonkov is one of the established scientific and scholar schools in Russian medicine. The school has reached its rise at the period when Vladimir Nikolaevich Tonkov headed the department of anatomy at the Academy of Military Medicine, however, the scientific and life journey of that great anatomist is intimately related to the department of anatomy of the medical faculty at the Emperor’s Kazan University, where V.N. Tonkov was admitted at a hard time for the department. The situation has changed with his arrival. V.N. Tonkov was a talented scientist and scholar. He has founded the basis of a new scientific field in studying vascular system, anthropologic studies, that were traditional for the department, were continued. The certain merit of V.N. Tonkov was the foundation of the study museum at the department. Vladimir Nikolaevich headed the department of anatomy for 10 years (1905-1915). It was in Kazan where the famous anatomic Tonkov’s scientific school, honoured by its followers, alumni of Emperor’s Kazan University, who had grown up within its walls, got an outstanding education and left alma mater as a professor to honor the native university in other cities of Russia. From all of the V.N. Tonkov’s students, only V.A. Popov and K.M. Yakhontov did not leave the Kazan University. Both died in Kazan, being staff members of the department of anatomy. Honored scientific researcher and academician A.D. Speransky, the head of the department of anatomy of Omsk Medical Institute professor B.N. Bazhanov, the head of the department of anatomy of Saratov Medical Institute professor V.I. Bik had started their scientific career as students of V.N. Tonkov. They have always noted that they belong to the Kazan anatomic scientific school headed by Tonkov. K.V. Romodanovsky and I.S. Malinovsky, also students of V.N. Tonkov, have contributed to the development of medical education in the Universities of Siberia. The first head of the department picked out from the Emperor’s Kazan University alumni for its centennial history was the student of V.N. Tonkov, Nikolay Dmitrievich Bushmakin, who later participated in creation of medical faculty in Irkutsk University, and of Khabarovsk Medical Institute.
Kazan medical journal. 2013;94(6):947-954
947-954
Jubilees
Professoru Il'daru Faridovichu Fatkullinu - 60 let
Kazan medical journal. 2013;94(6):955-956
955-956