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Соntents

LEADING ARTICLE

Republican Blood Center: new perspectives of development. R.G. Turaev, I.V. Kljushkin, L.N. Sibgatullina, M.M. Vorontsova, G.R. Khasanova P.9

ORIGINAL STUDIES

Infusion support and gene-therapy technology in treatment of diabetic foot. K.A. Koreyba,R.I. Fatyhov, I.V. Klyushkin, A.V. Sharafutdi-nov, A.R. Minabutdinov P.11

An analysis of changes population structure of stored red blood cells using atomic force microscopy.I.М. Lamzin, R.М. Khayrullin, M.Е. Hapman P.16

Recommended groups of drugs in the infusion therapy in patients with diabetic foot. K.A. Koreyba,A.R. Minabutdinov, M.A. Usmanov, A.V. Sharafutdinov P.21

Importance of infusion-transfusion therapy in treatment of patients with acute bleeding from the upper gastrointestinal tract. I.S. Malkov, G.R. Zakirova, M.N. Nasrullaev P.24

Infusion therapy regimens in complex treatment of diabetic foot syndrome. K.A. Koreyba,A.R. Minabutdinov, A.V. Sharafutdinov, R.I. Fatyhov P.29

Features of infusion medical tactics in diabetic foot syndrome. R.I. Fatykhov, I.V. Klyushkin, K.A. Koreyba P.32
Disseminated intravascular coagulation in myocar-dial infarction. K.S. Zyyatdinov, V.M. Belopukhov, I.F. Yakupov, D.A. Suslov, A.V. Ivanova,L.V. Solovjeva, B.G. Shigapov P.34

Community-acquired pneumonia in elderly. R.F. Khamitov, L.Yu. Palmova, Z.N. Yakupova,K.R. Sulbaeva P.40
Comparative bioinformatic analysis of patientswith hypertensive disease in the north of Russian Federation on medicamental and complex regenerative treatment. R.N. Zhivoglyad, A.G. Danilov, O.A. Bondarenko, N.V. Zhivaeva P.44

Influence of intramuscular hemotherapy in childhood on female reproductive funcion. V.M. Belopukhov, R.G. Turaev, E.E. Bel'skaya, R.S. Gadyl'shin P.50

EXCHANGE OF EXPERIENCE

Some aspects of treatment of patients with acute intestinal obstruction. S.V. Dobrokvashin, D.E. Volkov, A.G. Izmailov P.53

Platelets concentrate transfusion role in cardiac surgery. L.S. Fatkullina, R.K. Dzhordzhikiya I.M. Rahimullin, R.R. Khamzin, M.N. Mukharyamov, M.A. Sungatullin, R.M. Mukminova P.56

Intrabone infusions in emergency medicine.V.M. Belopukhov, Sh.G. Asadullin, B.G. Shigapov, A.V. Volgina P.59

A study of the influence of pinane thioterpenoidson human hemostasis and platelets functional activity. M.M. Vorontsova, R.G. Turayev, S.V. Kiselev, L.E. Nikitina, I.G. Mustafin, R.М. Nabiullina P.63

NEW METHODS

Profiles of bronchoalveolar lavage fluid in modelingof transfusion-related acute lung injury. K.K. Mamatova, G.G. Belov P.68

HELP FOR PRACTITIONER

Diagnosis and treatment of sarcoidosis: Summaryof Federal Conciliative Clinical Recommendations
(Part II. Diagnosis, Treatment, Prognosis). A.G. Chu-chalin, A.A. Vizel, M.M. IlkovIch, S.N. Avdeev, N.B. Amirov, O.P. Baranova, S.E. Borisov, I.Yu. Vizel, O.V. Lovacheva, N.V. Ovsyannikov, D.V. Petrov, V.V. Romanov, M.V. Samsonovа, I.P. Solovyova, I.E.Stepanian, I.E. Tyurin, A.L. Cherniayev, E.I. Shmelev, N.M. Shmeleva P.74

ORGANIZATION OF HEALTHCARE

The dynamics of the primary donor’s activity in open-burg region. E.V. Dronov, R.G. Gilmutdinov,I.V. Zakharova, D.N. Begun P.82

Analisis of blood products application in Tatarstan Republic health care facilities. R.G. Turaev, E.E. Bel'skaya P.85

REVIEWS

The modern state of bleeding from variceal en-larged veins of esophagus and stomach. E.A. Kitsenko, A.Y. Anisimov, A. I. Andreev P.89

INTERNATIONAL EXPERIENCE

The national health system and respiratory care in Spain. Adolfo Baloira Villar P.99

 

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LEADING ARTICLE

Republican Blood Center: new perspectives of development

R.G. Turaev, I.V. Kljushkin, L.N. Sibgatullina, M.M. Vorontsova, G.R. Khasanova

 

ORIGINAL STUDIES

Infusion support and gene-therapy technology in treatment of diabetic foot

Konstantin A. Koreyba, MD, PhD, Department of General Surgery of SBEI HPE «Kazan State Medical University» of Ministry of Health of Russia, Kazan, Russia, tel. 8-927-412-87-03, e-mail: korejba_k@mail.ru

Ruslan I. Fatyhov, MD, Assistant, Department of General Surgery of SBEI HPE «Kazan State Medical university» of Ministry of Health of russia, Kazan, russia, tel. 8-927-400-02-95, e-mail: 74ruslan@rambler.ru

Ivan V. Klyushkin, MD, Professor, Department of General Surgery of SBEI HPE «Kazan State Medical university» of Ministry of Health of russia, Kazan, russia, tel. 8-919-624-96-40, e-mail: hirurgivan@rambler.ru

Artur V. Sharafutdinov, doctors surgery Department of purulent-septic surgery CKH № 5 of the Ministry of Health of Russia, Kazan, resident Department of General Surgery of SBEI HPE «Kazan State Medical university» of Ministry of Health of russia, Kazan, russia, tel. 8-927-415-85-49, e-mail: arthur.shara @ mail.ru

Aydar R. Minabutdinov, surgeon center «Diabetic Foot», Kazan, Russia, resident chair of surgical diseases № 2 of SBEI HPE «Kazan State Medical University» of Ministry of Health of Russia, Kazan, Russia, tel. 8-965-589-88-91, e-mail: aidoctor@mail.ru

Abstract. Syndrome of diabetic foot is one of terrible late complications of diabetes. Aim: to estimate influence of infusion therapy in combination with introduction of single cassette high purity supercoiled form of pCMV-VEGF165 plasmids on angiogenesis dynamics and the course of wound process in patients with neuroischemic diabetic foot with level of defeat of W3—4 and a diabetic angiopathy with chronic arterial insufficiency IIIB—IVA. To develop modern high-technology approaches of therapy of patients with diabetic foot, allowing to reduce rate of high (superpatellar) amputations of lower extremities and to improve quality of life. Materials and methods. There were observed 5 patients with: a syndrome of diabetic foot, W3—4 level of defeat, a diabetic angiopathy, chronic arterial insufficiency IIIB-IVA in stage of a neuroischemic form. Patients received single cassette high purity supercoiled form of pCMV-VEGF165 plasmids against infusion therapy. Results and discussion. We almost proved feasibility and efficiency of infusion support in case of application the single cassette high purity supercoiled form of pCMV-VEGF165 plasmids. Conclusion. Efficiency of infusion therapy with introduction the single cassette high purity supercoiled form of pCMV-VEGF165 plasmids is proved and is established effectively in case of treatment of patients with a syndrome of diabetic foot (classification by Wagner 3—4).

Key words: diabetic foot, modern high-tech approach in the treatment, infusion therapy.

 

References

1. Katel'nickii, I.I. Pervyi opyt kolichestvennoi ocenki rezul'tatov terapevticheskogo angiogeneza [First experience of a quantitative assessment of results of a therapeutic angiogenez] / I.I. Katel'nickii, G.A. Alekseeva // KTTI. — 2012. — № 6. — S.83—85.
2. Klyushkin, I.V. Ocenka effektivnosti konservativnoi terapii sindroma diabeticheskoi stopy [Efficiency evaluation of conservative therapy of a syndrome of diabetic foot] / I.V. Klyushkin, R.I. Fatyhov, K.A. Koreiba // Saharnyi diabet i hirurgicheskie infekcii: materialy Mezhdunar. nauch.-prakt. kongr., posvyasch. 40-letiyu so dnya osnovaniya v institute hirurgii im. A.V. Vishnevskogo otdela ran i ranevyh infekcii. — M., 2013. — S.150.
3. Klyushkin, I.V. Formirovanie shemy infuzionnoi terapii pri sindrome diabeticheskoi stopy [Forming of the scheme of infusional therapy in case of a syndrome of diabetic foot] / I.V. Klyushkin, K.A. Koreiba, R.I. Fatyhov // Obschestvennoe zdorov'e i zdravoohranenie. — 2013. — № 2. — S.38—40.
4. Koreiba, K.A. Genterapevticheskie tehnologii v korrekcii angiogeneza pri sindrome diabeticheskoi stopy [Gentera- pevticheskiye's of technology in correction of an angiogenez in case of a syndrome of diabetic foot] / K.A. Koreiba, A.V. SHarafutdinov // Sovremennye napravleniya razvitiya mediciny-2014: Mezhdunar. nauch.-prakt. konf.: sb. st. — Bryansk, 2014. — S.12—15.
5. Staroverov, I.N. Pervyi opyt lecheniya genterapevticheskim preparatom bol'nyh pri sochetanii ateroskleroza i diabeticheskoi angiopatii nizhnih konechnostei [The first experience of treatment by a genterapevtik preparation of patients in case of a combination of atherosclerosis and a diabetic angiopathy lower extrymethy] / I.N. Staroverov, YU.V. CHervyakov, O.M. Lonchakova, O.N. Vlasenko // Aktual'nye voprosy diagnostiki, lecheniya i profilaktiki sindroma diabeticheskoi stopy: V Vseros. nauch.-prakt. konf., posvyasch. 200-letiyu Kazan. gos. med. un-ta. — Kazan', 2013. — S.89—91.
6. Shval'b, P.G. Bezopasnost' i kratkosrochnaya effektivnost' genoterapevticheskogo preparata u pacientov s hronicheskoi ishemiei nizhnih konechnostei [Bezopasnost and short-term efficiency of a genoterapevtik preparation at patients with chronic ischemia lower extremity] / P.G. SHval'b, R.E. Kalinin, S.V. Gryaznov // Kardiologiya i serdechno-sosudistaya hirurgiya. — 2011. — № 4. — S.61—66.

 

An analysis of chanGes population structure of stored red blood cells usinG atomic force microscopy

Ivan М. Lamzin, postgraduate student of the Department of Human Anatomy, fSBei HPe «ulyanovsk State University», Ministry of Education and Science of Russian Federation, Ulyanovsk, Russia, tel. 8-917-633-34-26, e-mail: ivanlamzin@gmail.com

Radik М. Khayrullin, MD, Professor, chief of chair of Human Anatomy, fSBei HPe «ulyanovsk State university», Ministry of education and Science of Russian Federation, Ulyanovsk, Russia, tel. 8-842-232-65-65, e-mail: prof.khayrullin@gmail.com

Marat Е. Hapman, PHD, Head doctor of ulyanovsk Blood center, of Ministry of Health of russian federation, ulyanovsk, russia, tel. 8-842-232-54-80, e-mail: ospk@mv.ru

Abstract. A big number of researches have been dedicated to the examining of the morphological and functional diversity of the erythrocyte population of healthy human beings. Up till now qualitative differences between separate erythrocytes of the sample have been studied, for example, while checking their tolerance to various hemolytic substances. An atomic-force microscopy is a modern method that gives an opportunity to visualize cells and investigate their biophysical characteristics. One of the biophysical criterions that enable to assess the quality of the cell is its stiffness. The degree of the stiffness changes can show the extent of the destructive processes of the cell ageing. The aim of this work was to investigate the age heterogeneity of the erythrocyte population of the stored red blood cells at different stages of storing according to the criterion of the cell stiffness. Material and methods. 5 series of dry cytosmears of the red blood cells have been investigated: specimens of the first series were made of red blood cells on the first day of the storing; the second, third, fourth, and fifth series included dry specimens of the stored red blood cells which had been kept in blood bank at a temperature 4°С for 7, 14, 21 and 35 days respectively. Stored red blood cells were taken from blood packed in blood bags «Baxter» (USA) with the use of the additive «CPDA-1». After imaging with atomic force microscope, 5 RBC were chosen randomly in every specimen; on each of them membrane stiffness was checked in 9 points. Then the mean value of Young modulus was calculated for each cell. The numbers of the measures were total 220 erythrocytes out of 44 specimens. Young modulus values of each series of the samples was distributed over intervals formed with the step 0,4 KPa, with subsequent calculation of percentages and forming the erythrocyte formula for each storage period. Conclusion. The present study shows the dynamics of changes in the erythrocyte population heterogeneity according to such biophysical parameter as cells stiffness. The AFM studying revealed the biophysical and «age» heterogeneity of the population of stored red blood cells that must be considered while forming the conclusion about their quality.

Key words: erythrocytes, atomic-force microscopy, Young’s modulus (YM), stored red blood cells (sRBC), cells ageing, erythrocyte formula.

 

References

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3. Girasole, M3. . Structure and function in native and pathological erythrocytes: a quantitative view from the nanoscale / M. Girasole, S. Dinarelli, G. Boumis // Micron. — 2012. — Vol. 43, № 12. — P.1273—1286.
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5. Lamzin, I.M5. . Issledovanie izmenenii biofizicheskih svoistv eritrocitov pri hranenii v eritrocitsoderzhaschih sredah s pomosch'yu atomno-silovoi mikroskopii [The study of changes of biophysical properties of red blood cells in storage in erythrocyte-containing solutions using atomic force microscopy] / I.M. Lamzin, R.M. Hairullin // Saratovskii nauchno-medicinskii zhurnal [Saratov Journal of Medical Scientific Research]. — 2014. — T. 10, № 1. — S.44—48.
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Recommended groups of drugs in the infusion therapy in patients with diabetic foot

Konstantin A. Koreyba, MD, PhD, Department of General Surgery of SBEI HPE «Kazan State Medical University» of Ministry of Health of Russia, Kazan, Russia, tel. 8-927-412-87-03, e-mail: korejba_k@mail.ru

Aydar R. Minabutdinov, surgeon Сenter «Diabetic Foot», Kazan, Russia, tel. 8-965-589-88-91, e-mail: aidoctor@mail.ru

Marat A. Usmanov, head of purulent-septic surgery GKB № 5, Kazan, Russia, tel. 8-927-402-45-80, e-mail: usmarat@list.ru

Artur V. Sharafutdinov, doctors surgery department of purulent-septic surgery GKB № 5 of the Ministry of Health of Russia, Kazan, Russia, tel. 8-927-415-85-49, e-mail: arthur.shara @ mail.ru

Abstract. Lesion of target organs in diabetes mellitus has defining value in choice of tactics of treatment. A choice of infusion therapy in patients with diabetic foot combined with diabetic nephropathy has primary importance. Nowadays there are no common approaches and standards of conservative treatment of this terrible complication of a diabetes mellitus. Research objective: to manage adequate disintoxication therapy in necrotic suppurative inflammation and intoxication, occurring in patients with diabetic foot. Materials and methods: on the basis of the Diabetic Foot Center was begin application of a complex preparation of the electrolytes with disintoxication, antishock action and rheological effect. Results and their discussion: schemes of infusion therapy of diabetic foot complicated with a diabetic nephropathy are presented in article. Schemes of treatment, applied in the Kazan Diabetic Foot Center are provided. Results of research are given; recommendations on infusion therapy in patients with diabetic foot are made. Conclusion. Application of complex preparations infusions of electrolytes for patients with a diabetic foot reduces hospitalization term in a hospital due to treatment of a pathological state.

Key words: diabetic foot syndrome, diabetic nephropathy, infusion therapy.

 

References

1. Anikin, A.I. Znachenie ocenki mikrocirkulyatornyh narushenii v hirurgicheskom lechenii gnoino-nekroticheskih porazhenii pri sindrome diabeticheskoi stopy [Role of an assessment of microcirculatory disturbances in surgical treatment it is purulent — necrotic lesions at a syndrome of diabetic foot]: avtoref. dis. ... kand. med. nauk / A.I. Anikin. — M., 2009. — 16 s.
2. Dedov, I.I. Algoritmy specializirovannoi medicinskoi pomoschi bol'nym saharnym diabetom [Algorithms of a specialized medical care sick diabetes mellitus] / I.I. Dedov, M.B. SHestakova, A.A. Aleksandrov [i dr.] // Saharnyi diabet. — 2011. — Vyp. 5 (pril. 3). — S.72.
3. Klyushkin, I.V. Infuzionnaya terapiya v kompleksnom lechenii sindroma diabeticheskoi stopy [Infusional therapy in complex treatment of a syndrome of diabetic foot] / I.V. Klyushkin, K.A. Koreiba, R.I. Fatyhov // Transfuziologiya XXI veka: problemy, zadachi, perspektivy [International scientific and practical conference on organizational and clinical sections in transfusiology. Transfusiology of XXI blepharons, problem, task, prospect]: Mezhdunar. nauch.-prakt. konf. po organizacionnym i klinicheskim razdelam v transfuziologii. — Kazan': ID «MedDok», 2013. — S.100—103.
4. Koreiba, K.A. Infuzionaya terapiya v perioperacionnyi period pri rekonstruktivnyh operaciyah u bol'nyh s sindromom diabeticheskoi stopy [Infuzion therapy during the perioperatsionny period at reconstructive operations at patients with a syndrome of diabetic foot] / K.A. Koreiba, M.A. Usmanov, A.R. Minabutdinov [i dr.] // Sovremennye aspekty diagnostiki i lecheniya saharnogo diabeta s pozicii vracha i medicinskoi sestry [Materials of scientific and practical conference with the International participation «Modern aspects of diagnostics and diabetes mellitus treatment from a position of the doctor and the nurse»]: materialy nauch.-prakt. konf. s mezhdunarodnym uchastiem. — M., 2014. — S.13—14.

 

Importance of infusion-transfusion therapy in treatment of patients with acute bleeding from the upper gastrointestinal tract

Igor S. Malkov, MD, Head department of surgery of SBEI APE «Kazan State Medical Academy» of Ministry of Health of Russia, tel. 8-965-594-40-07, e-mail: ismalkov@yahoo.com

Guzeliya R. Zakirova, PhD, Assistant of Department of surgery of SBEI APE «Kazan State Medical Academy» of Ministry of Health of Russia, tel. 8-927-407-24-16, e-mail: guzeliya-x@mail.ru

Magomed N. Nasrullaev, MD, professor of surgery department of surgery of SBEI APE «Kazan State Medical Academy» of Ministry of Health of Russia, tel. 8-965-594-40-07, 8-987-297-02-62, e-mail: MSH-OAO-KAP@yandex.ru

Abstract. Research objective. Acute bleedings from upper gastrointestinal tract is a serious and cost-based surgical pathology quite often results to lethal outcome. Material and methods. We analyzed the results of treatment 776 patients with acute upper gastrointestinal bleedings hospitalised on the first level of treatment to GAUZ GKB № 7 MZ RT. Results and discussion. Demonstrated that the differentiated approach to tactics of maintaining patients with upper gastrointestinal bleedings influences to results. We revealed direct relationship of successful treatment from terms before hospitalization, availability of blood components, a type of treatment — surgical or conservative. Conclusion. Shoved the necessity of the differentiated approach to endoscopic hemostasis depending on characteristics of a bleeding point, its intensity and efficiency in proceeding bleedings. It is necessary to use the modern methods of medical diagnostics with use of the advanced achievements of medical technologies. Managing the adequate replacement therapy is a necessary component of successful treatment.

Key words: acute gastroduodenal bleedings, endoscopic hemostasis, surgical therapy. infusion-transfusion therapy

 

References

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4. Gubler, E.V. Vychislitel'nye metody analiza i raspoznavaniya patologicheskih posledstvii [Computing methods of the analysis and recognition of pathological consequences] / E.V. Gubler. — L.: Medicina, 1978. — 296 s.
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Infusion therapy regimens in complex treatment of diabetic foot syndrome

Konstantin A. Koreyba, MD, PhD, Department of General Surgery of SBEI HPE «Kazan State Medical University» of Ministry of Health of Russia, Kazan, Russia, tel. 8-927-412-87-03, e-mail: korejba_k@mail.ru

Aydar R. Minabutdinov, surgeon center «Diabetic Foot», Kazan, resident chair of surgical diseases № 2 of SBEI HPE «Kazan State Medical University» of Ministry of Health of Russia, Kazan, Russia, tel. 8-965-589-88-91, e-mail: aidoctor@mail.ru

Artur V. Sharafutdinov, doctors surgery department of purulent-septic surgery GAUZ GKB № 5, Kazan, Russia, resident Department of General Surgery of SBEI HPE «Kazan State Medical University» of Ministry of Health of Russia, Kazan, Russia, tel. 8-927-415-85-49, e-mail: arthur.shara @ mail.ru

Ruslan I. Fatyhov, MD, Assistant, Department of General Surgery of SBEI HPE «Kazan State Medical University» of Ministry of Health of Russia, Kazan, Russia, tel. 8-927-400-02-97, e-mail: 74ruslan@rambler.ru

Abstract. The syndrome of diabetic foot is one of the terrible complications of diabetes mellitus and one of the main reasons for disability and mortality. The quantity of lethal outcomes after surgical treatment — amputation the bottom extremities segments reaches 30—50% in the first year. The diabetic angiopathy, neuropathy, osteoarthropathy have defining value in development and course of diabetic foot, and also in planning of preventive actions. Research objective: to choose the optimum tactics of treatment and infusion therapy of diabetic foot for better outcome. Results and discussion. schemes of infusion therapy are presented in article. We made the short analysis of drugs from the register of medicines of the Russian Federation, the indication and contraindication is provided to application of the preparations used in the Diabetic Foot Center of Kazan, recommendations of carrying out conservative therapy are made. All drug administrations done after discussion of medicamental tactics, in committee. Endocrinologists, vascular surgeons are necessary. Conclusion. Treatment of patients with a diabetic foot has to be based on pathogenesis, stage-by-stage and continuous. It is important to explain the fact of whole-life treatment to the patient and his relatives.

Key words: diabetes, diabetic foot syndrome, classification, infusion therapy.

 

References

1. Myskina, N.A. Process reparacii troficheskih yazv u bol'nyh saharnym diabetom [Process of a reparation of trophic ulcers at patients with a diabetes mellitus] / N.A. Myskina, A.Yu. Tokmanova, M.B. Anciferov // Problemy endokrinologii [Problem of endocrinology]. — 2004. — № 2. — S.34—38.
2. Pavelkin, A.G. Ocenka effektivnosti tromboliticheskoi terapii pri oslozhnennyh formah diabeticheskoi stopy [Quality of efficiency of thrombolytic therapy at the complicated forms of diabetic foot] / A.G. Pavelkin, A.N. Belyaev // Medicinskii al'manah [Medical almanac]. — 2012. — № 4 (23). — S.88—91.
3. Pavlova, M.G. Sindrom diabeticheskoi stopy [Sindrom of diabetic foot] / M.G. Pavlova, T.V. Gusov, N.V. Lavrischeva // Trudnyi pacient [Difficult patient]. — 2006. — № 1. — S.25—28.
4. Sergeeva-Kondrachenko, M.Yu. Diabeticheskaya neiropatiya [Diabetiс neuropathy] / M.Yu. Sergeeva-Kondrachenko. — M.: Remedium — Povolzh'e [Remedium — the Volga region], 2012. — S.17—25.
5. Altland, O.D. Low-intensity ultrasound increases endothelial cell nitric oxide syntase activity and nitric oxide synthesis / O.D. Altland // J. Thromb Haemost. — 2004. — Vol. 2 — P.637—643.
6. Bode, B. Ultrasound-Guided Fine Needle Aspirations of PET-CT Findings During Staging of Malignancies / B. Bode // Ultrasound in Medicine and Biology. — 2011. — Vol. 37, № 8. — S.28.04.
7. Bota, S. The Usefulness of Liver and Spleen Stiffness Evaluated by Means of Acoustic Radiation Force Impulse Elastography for the Prediction of Esophageal Varices in Cirrhotic Patients / S. Bota, I. Sporea, R. Sirli [et al.] // Ultrasound in Medicine and Biology. — 2011. — Vol. 37, № 8. — S.29.04.

 

Features of infusion medical tactics in diabetic foot syndrome

Ruslan I. Fatykhov, PhD, assistant professor of the general surgery of SBEI HPE «Kazan State Medical university» of Ministry of Health of russia, Kazan, russia, tel. 8-927-400-02-95, e-mail: 74ruslan@rambler.ru

Ivan V. Klyushkin, MD, prof. of the general surgery of SBEI HPE «Kazan State Medical University» of Ministry of Health of Russia, Kazan, Russia, tel. 8-919-624-96-40, e-mail: hirurgivan@rambler.ru

Konstantin A. Koreyba, PhD, assistant professor of the general surgery of SBEI HPE «Kazan State Medical University» of Ministry of Health of Russia, Kazan, Russia, tel. 8-927-412-87-03, e-mail: korejba_k@mail.ru

Abstract. Aim. To allocate and describe the main stages of infusion correction of a condition of the patient with diabetic foot syndrome with possible assessment of efficiency of the treatment and ultrasonography control. Material and methods. The condition of a peripheric blood flow at 56 patients with clinic of a syndrome of diabetic foot is surveyed. Results. Restoration of peripheric blood supply in soft tissues of distal departments of the bottom extremities prove efficiency of created tactics of infusion correction of a pathological state. Conclusion. Application of radial control methods of treatment efficiency at a stage of stationary observation allows to allocate the main positions of diabetic foot course. Creation the conservative therapy program based on radial methods findings, dynamic control of carried-out treatment, allows to approach the problem of effective conservative tactics of therapy objectively.

Key words: syndrome of diabetic foot, diagnostics, conservative therapy.

 

References

1. Lelyuk, V.G. Ul'trazvukovaya angiologiya [Ultrasonic angiologia] / V.G. Lelyuk, S.E. Lelyuk. — M.: Real'noe vremya, 2003. — 322 s.
2. Morozov, V.V. Hronaksimetricheskaya elektrodiagnostika kak kriterii effektivnosti regionarnoi limfotropnoi terapii v lechenii bol'nyh s sindromom diabeticheskoi stopy [Hronaksimetric electrodiagnostics as criterion of efficiency of regionarny lymphotropic therapy in treatment of patients with a syndrome diabetic foot] / V.V. Morozov, YU.A. Arhipov, O.G. Avdonina // Byulleten' Sibirskogo otdeleniya Rossiiskoi akademii medicinskih nauk [The Bulletin of the Siberian unit of the Russian Academy of medical sciences: Quarterly scientific-theoretical magazine]. — 2002. — № 1. — S.16—18 (Novosibirsk).
3. Myskina, N.A. Process reparacii troficheskih yazv u bol'nyh saharnym diabetom [Process of a reparation of trophic ulcers at patients with a diabetes mellitus] / N.A. Myskina, A.YU. Tokmanova, M.B. Anciferov // Problemy endokrinologii [Endocrinology problems]. — 2004. — № 2. — S.34—38.
4. Pavelkin, A.G. Ocenka effektivnosti tromboliticheskoi terapii pri oslozhnennyh formah diabeticheskoi stopy [Quality of efficiency of thrombolytic therapy at the complicated forms of diabetic foot] / A.G. Pavelkin, A.N. Belyaev // Medicinskii al'manah [Medical almanac]. — № 4 (23). — 2012. — S.88—91 (N. Novgorod, OOO «YUnion Print»).
5. Pavlova, M.G. Sindrom diabeticheskoi stopy [Sindrom of diabetic foot] / M.G. Pavlova, T.V. Gusov, N.V. Lavrischeva // Trudnyi pacient [Difficult patient]. — 2006. — № 1. — S.25—28.
6. Sergeeva-Kondrachenko, M.Yu. Diabeticheskaya neiropatiya [Diabetic neyropathy] / M.Yu. Sergeeva-Kondrachenko // Remedium — Povolzh'e [Remedium the Volga region]. — M., 2012. — S.17—25.
7. Fatyhov, R.I. Osnovnye faktory postroeniya konservativnoi terapii s ocenkoi ee effektivnosti metodom elektrotermometrii pri sindrome diabeticheskoi stopy [Major factors of creation of conservative therapy with an assessment of its efficiency an electrothermometry method a syndrome of diabetic foot] / R.I. Fatyhov, I.V. Klyushkin // Fundamental'nye issledovaniya [Basic researches]. — 2012. — № 5 (2). — S.355—358.
8. Fatyhov, R.I. Sovremennyi vzglyad na problemu oslozhnenii saharnogo diabeta [A modern view on a problem of complications of diabetes mellitus] / R.I. Fatyhov, I.V. Klyushkin, YU.A. Klyushkina // Fundamental'nye issledovaniya [Basic researches]. — 2013. — № 3 (1). — S.206—210.

 

Disseminated intravascular coagulation in myocardial infarction

Kamil S. Zyyatdinov, Valeriy M. Belopukhov, Iskander F. Yakupov, Denis A. Suslov, Alexsandra V. Ivanova, Ljudmila V. Solovjeva, Bary G. Shigapov

Abstract. Disseminated intravascular coagulation (DIC) is a clinicopathologic disorder, characterized by activation the systemic mechanisms regulating coagulation which leads to the formation of fibrin clots, and then to organ dysfunction with simultaneously reducing the number of platelets and coagulation factors, and this, in turn, may lead to bleeding. DIC never occurs in isolation, patient always has some main disease, which leads to the formation of DIC. The article presents an example of diagnosis and treatment of patient admitted in critical condition to the emergency cardiac clinic with a myocardial infarction and cardiogenic shock. Emergency medical measures, coronary angiography, stenting left main coronary artery on the background of recurrent ventricular fibrillation averted the death of the patient on the first day. However, ischemic damage to organs and tissues resulted to multiple organ failure and disseminated intravascular coagulation, which was fatal to the patient. The article analyzes the dynamics of laboratory parameters of blood in comparison with literature data.

Key words: disseminated intravascular coagulation, DIC-syndrome, shock, myocardial infarction, multiple organ failure.

 

References

1. Akca, S. Time course of platelet counts incritically ill patients / S. Akca, P. Haji-Michael, P. Suter [et al.] // Critical Care Medicine. — 2002. — Vol. 30. — P. 753—756.
2. Asakura, H. Decreased plasma activity of antithrombin or protein C is not due to consumption coagulopathy in septic patients with disseminated intravascular coagulation / H. Asakura, Y. Ontachi, T. Mizutani [et al.] // European Journal of Haemotology. — 2001. — Vol. 67. — P. 170—175.
3. Bick, R.L. Disseminated intrasvascular coagulation: objective clinical and laboratory diagnosis, treatment and assessment of therapeutic response / R.L. Bick // Seminars in Thrombosis and Hemostasis. — 1996. — Vol. 22. — P. 69—88.
4. Boisclair, M.D. Assesment of hypercoagulable states by measurement of activation fragments and peptides / M.D. Boisclair, H. Ireland, D.A. Lane // Blood Reviews. — 1990. — № 4. — P. 25—40.
5. Collins, P.W. Global tests of haemostasis in critically ill patients with severe sepsis syndrome compared to controls / P.W. Collins, L.I. Macchiavello, S.J. Lewis [et al.] // British Journal of Haematology. — 2006. — Vol. 135. — P. 220—227.
6. Feinstein, D.I. Treatment of disseminated intravascular coagulation [Review; 122 refs] / D.I. Feinstein // Seminars in Thrombosis&Hemostasis. — 1988. — Vol. 14. — P. 351—362.
7. Feinstein, D.I. Guidelines for the diagnosis and management of disseminated intravascular coagulation / D.I. Feinstein // British Journal of Haematology. — 2009. — Vol. 145. — P. 24—33.
8. Levi, M. Disseminated intravascular coagulation / M. Levi, C.H. Ten // New England Journal of Medicine. — 1999. — Vol. 341. — P. 586—592.
9. Levi, M. Coagulation abnormalities in critically ill patients / M. Levi, S.M. Opal // Critical Care. — 2006. — № 10. — P. 222.
10. Mannucci, P.M. Prevention and treatment of major blood loss / P.M. Mannucci, M. Levi // New England Journal of Medicine. — 2007. — Vol. 356. — P. 2301—2311.
11. Nakamura, Y. Enhanced fibrinolytic activity during the course of hemodialysis / Y. Nakamura, S. Tomura, K. Tachibana [et al.] // Clinical Nephrology. — 1992. — Vol. 38. — P. 90—96.
12. Olson, J.D. The incidence and significance of hemostatic abnormalities in patients with head injuries / J.D. Olson, H.H. Kaufman, J. Moake [et al.] //Neurosurgery. — 1989. — Vol. 24. — P. 825—832.
13. Pernerstorfer, T. Heparin blunts endotoxin-induced coagulation activation / T. Pernerstorfer, U. Hollenstein, J. Hansen [et al.] // Circulation. — 1999. — Vol. 100. —P. 2485—2490.
14. Shorr, A.F. D-dimer assay predicts mortality in critically ill patients without disseminated intravascular coagulation or venous thromboembolic disease / A.F. Shorr, R.F. Trotta, S.A. Alkins [et al.] // Intensive Care Medicine. — 1999. — Vol. 25. —P. 207—210.
15. Spero, J.A. Disseminated intravascular coagulation. Findings in 346 patients / J.A. Spero, J.H. Lewis, U. Hasiba // Journal of Thrombosis and Haemostasis. — 1980. —Vol. 43. — P.28—33.
16. Toh, C.H. Disseminated intravascular coagulation: old disease, new hope / C.H. Toh, M. Dennis // BMJ. — 2003. — Vol. 327. — P. 974—977.

 

Community-acquired pneumonia in elderly

Rustem F. Khamitov, MD, professor, Head of the Department of Internal Diseases № 2 of SBEI HPE «Kazan State Medical University» Russian Ministry of Health, Kazan, Russia, tel. 8-917-272-96-72, e-mail: rhamitov@mail.ru

Liubov Yu. Palmova, PhD, Assistant professor of the Department of Internal Diseases № 2 of SBEI HPE «Kazan State Medical University» Russian Ministry of Health, Kazan, Russia, tel. 8-917-232-40-45, e-mail: palmova@bk.ru

Zukhaira N. Yakupova, PhD, Associated professor of the Department of Internal Diseases № 2 of SBEI HPE «Kazan State Medical University» Russian Ministry of Health, Kazan, Russia, tel. 8-917-906-30-16

Kira R. Sulbaeva, Assistant professor of the Department of Internal Diseases № 2 of SBEI HPE «Kazan State Medical University» Russian Ministry of Health, Kazan, Russia, tel. 8-987-221-83-50, e-mail: kira_sulbaeva@mail.ru

Abstract. Pneumonia is an actual problem nowadays. The continuing morbidity and mortality rates can be explained not only by treatment errors, but also by late diagnostic. Old age contributes to the difficulty of timely diagnosis of the disease. Due to the increasing rate of pneumonia in the elder population, the disease is a particular problem in this group. Old age is a risk factor of adverse outcome of pneumonia in itself. Features of the disease are determined by changing classical course of pneumonia, a great influence of comorbidities, effects of supporting treatment of accompanying diseases, peculiarities of laboratory and instrumental diagnostic of pneumonia in the elder group, changes in the metabolism of prescribed antimicrobial agents and their interaction with the comorbidity treatment drugs. All these factors should be adequately considered in the maintenance of pneumonia treatment in elderly patients.

Key words: community-acquired pneumonia, elderly, diagnostics, antibacterial therapy.

 

References

1. Vyortkin, A.L. Rol' hronicheskogo allergicheskogo vospaleniya v patogeneze bronhial'noi astmy i ego racional'naya farmakoterapiya u pacientov s polipatiei [The role of chronic allergic inflammation in the pathogenesis of asthma and its rational pharmacotherapy in patients with polypathy]/ A.L. Vyortkin, A.S. Skotnikov // Lechaschii vrach [Attending physician]. — 2009. — № 4. — S. 61—67.
2. Vnebol'nichnaya pnevmoniya u vzroslyh: prakticheskie rekomendacii po diagnostike, lecheniyu i profilaktike [Community-acquired pneumonia in adults: guidelines for diagnostics, treatment and prevention]/ A.G. CHuchalin, A.I. Sinopal'nikov, R.S. Kozlov [i dr.] // Klinicheskaya mikrobiologiya antimikrobnoi himioterapii [Clinical Microbiology and Antimicrobial Chemotherapy]. — 2010. — T. 12, № 3. — S. 1—40.
3. Vnebol'nichnye pnevmonii: rekomendacii po diagnostike i lecheniyu [Community-acquired pneumonia: recommendations for diagnostics and treatment]: ucheb.-metod. posobie dlya slushatelei poslevuzovskogo i dopolnitel'nogo professional'nogo obrazovaniya [Teaching aid for students of postgraduate and professional education] / R.F. Hamitov, A.A. Vizel', N.B. Amirov, G.V. Lysenko. — Kazan': KGMU; IPK «Brig», 2012. — 101 s.
4. Klinicheskie rekomendacii po diagnostike, lecheniyu i profilaktike tyazheloi vnebol'nichnoi pnevmonii u vzroslyh [Clinical Recommendations for diagnosis, treatment and prevention of severe community-acquired pneumonia in adults] / A.G. CHuchalin, A.I. Sinopal'nikov, R.S. Kozlov [i dr.]. — M.: RRO; MAKMAH, 2014. — 82 s.
5. Comparison of adherence between twice and thrice daily regimens of oral amoxicillin/clavulanic acid / C. Llor, C. Bayona, S. Hernandez [et al.] // Respirology. — 2012. — № 17. — Р. 687—692.
6. Prevalence of multimorbidity among adults seen in family practice / M. Fortin, G. Bravo, C. Hudon [et al.] //Ann. Fam. Med. — 2005. — № 3. — Р. 223—228.
7. The risk of hypotension following co-prescription of macrolide antibiotics and calcium-channel blockers / A.J. Wright, T. Gomes, M.M. Mamdani [et al.] // CMAJ. — 2011. — Vol. 183, № 3. — Р. 303—307.
8. Van Wijk, R.G. Socio-economic costs of asthma // Global Atlas Of Asthma / R.G. van Wijk, ed. C.A. Akdis, I. Agache. — Published by EAACI, 2013. — P. 18—20.
9. Woodhead, M. Pneumonia / M. Woodhead, P. Palange, A.K. Simonds // Respiratory Medicine. — 2-nd ed. — Sheffield, European Respiratory Soc, 2013. — Р. 199— 202.

 

Comparative bioinformatic analysis of patientswith hypertensive disease in the north of Russian Federation on medicamental and complex regenerative treatment

Raise N. Zhivoglyad, MD, professor of the Department of morphology, of Sei HPe «Surgut State university», Surgut, Russia, e-mail: rrdg@mail.ru

Alexey G. Danilov, post-graduate student of SEI HPE «Surgut State University», Russia, tel. 8-982-564-58-24, e-mail: danilovalexey88@mail.ru

O.A. Bondarenko, post-graduate student of SEI HPE «Surgut State University», Surgut, Russia, e-mail: bondolaa@mail.ru

N.V. Zhivaeva, post-graduate student of SEI HPE «Surgut State University», Surgut, Russia, e-mail: severnatasha@mail.ru

Abstract. Aim. To carry out comparative analysis of patients with hypertensive disease before and after medical and complex rehabilitation treatment; to reveal features of chaotic dynamic behavior of autonomic nervous system parameters, cardio-respiratory, coagulation, lipid systems on the background of different treatments. Material and methods. Patients with uncomplicated hypertensive disease (HD) were divided into 2 groups: control group (combination medicamental therapy), the trial one was treated with complex rehabilitation treatment on the basis of hirudoreflexotherapy; the degree of activity of autonomic nervous system by heart rate variability, systolic blood pressure (SBP), diastolic blood pressure (DBP), coagulation and total cholesterol before and after treatment was estimated in each patient. Results and discussion. Comparative analysis of multiple parameters before and after treatment of patients with HD of the two groups showed that in the main group activity of central mechanisms of heart rate regulation decreased significantly, blood coagulation features improved, cholesterol reduced. In general, it proves rise of organism sanogenetic potential and adaptative abilities. Conclusion. It was established that after course of complex rehabilitative treatment in comparison of usage only medicamental treatment quasi-attractors parameters of human body vector state (HBVS) changed greater, so pathology attractor transferred into sanogenesis attractor.

Key words: hypertensive disease, hirudoreflexotherapy, parameters of quasi-attractors, sanogenesis.

 

References

1. Efimova, L.P. Ambulatornoe nablyudenie bol'nyh gipertonicheskoi bolezn'yu v usloviyah severa: metod. rekomendacii / L.P. Efimova; Surgut. gos. un-t HMAO-YUgry. — 3-e izd. — Surgut: IC SurGU, 2013. — 48 s.
2. Glezer, M.G. Arterial'naya gipertoniya: ucheb. posobie dlya vrachei obschei praktiki / M.G. Glezer [i dr.]. — M.: Moskva, 2011. — 152 s.
3. Epifanov, V.A. Vosstanovitel'naya medicina: uchebnik / V.A. Epifanov. — M.: GEOTAR-Media, 2012. — 304 s.
4. Zhivoglyad, R.N. Girudoterapiya i vosstanovitel'naya medicina: monografiya / R.N. Zhivoglyad; Surgutskii GU HMAO-YUgry. — Surgut: Izd-vo OOO «Taimer», 2012. — 237 s.
5. Chazova, I.E. Diagnostika i lechenie arterial'noi gipertenzii: klinicheskie rekomendacii / I.E. Chazova [i dr.]. — M.: Moskva, 2013. — 65 s.
6. Es'kov, V.M. Obrabotka informacii, sistemnyi analiz i upravlenie / V.M. Es'kov, A.A. Hadarcev. — Tula: Tul'skii poligrafist, 2011. — 237 s.
7. Zhivoglyad, R.N. Samoorganizaciya i sanogenez v usloviyah girudorefleksoterapii: monografiya / R.N. Zhivoglyad [i dr.]; Surgut. gos. un-t HMAO-YUgry. — Surgut: IC SurGU, 2013. — 147 s.
8. Kuklina, O.I. Girudoterapiya / O.I. Kuklina, A.V. SHabrov, A.S. Tverdohlebov [i dr.]. — SPb.: Izd-vo «OOO Severnyi dom», 2006. — T. 1. — 356 s.
9. Munshi, Y.  Leeching in the history / Y. Munshi, I. Ara, H. Rafique, Z. Ahmad // Pak. J. Biol. Sci. — 2008. — Vol. 1. — P. 1650—1653.
10. Ahmad, T. Clinical importance of Leech therapy / T. Ahmad, M. Anwar // Indian Journal of Traditional Knowledge. — 2009. — Vol. 8. — P. 443—445.

 

Influence of intramuscular hemotherapy in childhood on female reproductive funcion

Valery M. Belopukhov, MD, Professor, Head of the Department of Anesthesiology & intensive care and Transfusion SBEI APE «Kazan State Medical Academy», Russian Ministry of Health, e-mail: bvm12345@mail.ru

Ramil G. Turaev, PhD, chief medical officer of SAIH «Republican Blood Center of the Ministry of Health of the Republic of Tatarstan», e-mail: rspk@tatar.ru

Elena E. Bel'skaya, head of the clinical diagnostic laboratory of SAIH «Republican Blood Center of the Ministry of Health of the Republic of Tatarstan», tel. 8-927-417-76-07, e-mail: E.Belskaya@tatar.ru

Rice S. Gadyl'shin, physician clinical diagnostic laboratory of SAIH «Republican Blood Center of the Ministry of Health of the Republic of Tatarstan»

Abstract. Introduction. History of the discovery of blood groups systems is a story of trial and error, the price of which often became someone's life and / or health. The discovery of the Rh factor (Rh D antigen system) and its role in the etiology and pathogenesis of hemolytic disease of the newborn was a major achievement of Karl’s Landsteiner immunoserological school. This discovery in medicine and biology is comparable to the discovery of ABO blood system. Clinical practice has been enriched with new methods of diagnosis, prevention and treatment of syndromes caused by blood group factors. The aim of this work is the case analysis of hemolytic disease in newborn caused by anti-erythrocytic antibodies of anti-D specificity in high titer. Material and methods. Material for the study was the blood sample of a pregnant P., who applied to cross-check the Rh-antogen and to define erythrocytic antibodies at 16 weeks. Results and discussion. The presence in the blood of pregnant erythrocytic P. anti-D antibodies led to the development of severe forms of hemolytic disease of the fetus. Screening of pregnant women for anti-erythrocytic antibodies should be carried out regardless of the Rh- antogen. Conclusion. Focused study of serum from patients who undergone blood transfusion and pregnant women will help to avoid the development of post-transfusion complications of hemolytic type.

Key words: hemolytic disease of the newborn, immunological incompatibility erythrocytic antibodies.

 

References

1. Prikaz Ministerstva zdravoohraneniya Respubliki Tatarstan ot 15.07.2010 № 908 «Ob ustanovlenii regional'nyh standartov issledovaniya organov i tkanei s ispol'zovaniem special'nyh procedur» [Ministry of Health of the Republic of Tatarstan from 15.07.2010 № 908 «On the establishment of regional standards study of organs and tissues with the use of special procedures»].
2. Prikaz Ministerstva zdravoohraneniya Respubliki Tatarstan ot 27.04.2004 № 691 «O sovershenstvovanii prekoncepcionnoi, prenatal'noi i postnatal'noi profilaktiki immunokonfliktnoi beremennosti v Respublike Tatarstan» [Ministry of Health of the Republic of Tatarstan from 27.04.2004 № 691 «On improving the preconception, prenatal and postnatal pregnancy prevention immunokonfliktnoy in the Republic of Tatarstan»].
3. Metodicheskoe pis'mo Ministerstva zdravoohraneniya i social'nogo razvitiya Rossiiskoi Federacii ot 16.12.2011 № 15-4/10/2/12699 «Gemoliticheskaya bolezn' ploda u beremennyh s rezus-sensibilizaciei. Diagnostika, lechenie, profilaktika» [Methodological letter from the Ministry of Health and Social Development of the Russian Federation of December 16, 2011 № 15-4 / 10/2/12699 «hemolytic disease of the fetus in pregnant women with Rh sensitization. Diagnosis, treatment, prevention»].
4. Pis'mo Ministerstva zdravoohraneniya i social'nogo razvitiya Rossiiskoi Federacii ot 10.10.2008 № 15-4/3118-09 «O poryadke provedeniya immunogematologicheskih issledovanii u beremennyh, rozhenic, plodov i novorozhdennyh» [Letter from the Ministry of Health and Social Development of the Russian Federation dated 10.10.2088, the № 15-4 / 3118-09 «On the procedure of immuno studies in pregnant women, pregnant women, fetuses and newborns].

 

EXCHANGE OF EXPERIENCE

Some aspects of treatment of patients with acute intestinal obstruction

Sergey V. Dobrokvashin, PhD, Professor, Head of the Department of General Surgery, of SBEI HPE «Kazan State Medical University», e-mail: gsurgery1@yandex.ru

Dmitry E. Volkov, Associate Professor, Department of General Surgery, of SBEI HPE «Kazan State Medical University», e-mail: gsurgery1@yandex.ru

Alexander G. Izmailov, Associate Professor, Department of General Surgery, of SBEI HPE «Kazan State Medical University», e-mail: izmailov_alex@mail.ru

Abstract. The purpose of the research is to improve the results of treatment of patients with acute intestinal obstruction, by developing and implementing a rational program of prevention and treatment of postoperative complications. Material and methods. For 4 years in surgery department at HfVW in Kazan 106 patients with various forms of acute intestine obstruction were hospitalized (IPOs). Diagnosis was based on anamnesis and examination, the radiographic signs, ultrasound, diagnostic radiopaque. All hospitalized patients received standard treatment aimed primarily to combating shock and intoxication, correction of water-electrolyte and protein balance, restore natural passage through the intestines. Results and discussion. As a result of treatment ileus resolved conservatively in 83 (78,3%) patients, in 23 (21,7%) cases due to the ineffectiveness of conservative methods, patients were operated on. The approaches of infusion therapy at various stages of intestinal obstruction are determined. Postoperatively, the frequency of purulent-septic complications was 17,3% (4 cases). Postoperatively, 1 patient died. Overall postoperative mortality was 4,3%. Conclusion. The complex treatment of patients with acute intestinal ileus certainly influenced by such factors as the patient's age, length of stay, the pathological process in the abdominal cavity, the presence and nature of comorbidity.

Key words: infusion therapy, purulent-septic complications, acute intestinal obstruction, perioperative antibiotic prevention.

 

References

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2. Kochnev, O.S. Ekstrennaya hirurgiya zheludochno-kishechnogo trakta [Emergency surgery of the gastrointestinal tract] / O.S. Kochnev. — Kazan', 1984. — S. 288.
3. Klevakin, E.L. Laparoskopiycheskie assistirovannye operacii v lechenii bol'nyh s ostroi spaechnoi kishechnoi neprohodimos- t'yu [Laparoscopy assisted surgery in the treatment of patients with acute adhesive intestinal obstruction] / E.L. Klevakin // Novye tehnologii v hirurgii: Mezhdunar. hirurgicheskii kongr., 5—7 okt. 2005 [International Surgical Congress. New technologies in surgery]. — Rostov n/D., 2005. — S. 213.
4. Hadzhibaev, A.M. Diagnostika i lechenie ostroi kishechnoi neprohodimosti [The diagnosis and treatment of acute intestinal obstruction] / A.M. Hadzhibaev, N.A. Hodzhimuhamedova, F.A. Hadzhibaev // Kazanskii medicinskii zhurnal [Kazan Medical Journal]. — 2013. — T. 94, № 3. — S. 377—381.
5. Milyukov, V.E. Patogeneticheskie mehanizmy razvitiya peritonita pri ostroi tonkokishechnoi neprohodimosti [Pathogenetic mechanisms of peritonitis at the acute intestinal obstruction] / V.E. Milyukov, M.R. Sapin // Hirurgiya [Surgery]. — 2005. — № 7. — S. 40—46.
6. Malkov, I.S. Redkii sluchai ostroi kishechnoi neprohodimosti [The rare case of acute intestinal obstruction] / I.S. Malkov, V.A. Filippov, A.P. Kirshin [i dr.] // Kazanskii medicinskii zhurnal [Kazan Medical Journal]. — 2010. — T. 91, № 6. — S. 810—811.
7. Rybachkov, V.V. Neirogumaral'nye izmeneniya pri ostroi kishechnoi neprohodimosti [Neyrogumoral changes in the acute intestinal obstruction] / V.V. Rybachkov, M.I. Maiorov, O.A. Manakov // Vestnik hirurgii [Journal of Surgery]. — 2005. — T. 164, № 1. — S. 25—28.
8. Minnullin, M.M. Diagnostika i hirurgicheskoe lechenie bol'nyh s ostroi kishechnoi neprohodimost'yu [The diagnosis and surgical treatment of patients with acute intestinal obstruction] / M.M. Minnullin, D.M. Krasil'nikov, Ya.Yu. Nikolaev // Prakticheskaya medicina [The practice of medicine]. — 2014. — № 02 (78). — S. 46—51.

 

Platelets concentrate transfusion role in cardiac surgery

Luciya S. Fatkullina, leading specialist for transfusiology Minestery of helth of Republic of Tatarstan, chief of blood components preparation department Interregional Clinical-diagnostic Center (ICDC), Kazan, Russia, tel. 8-903-377-45-08, e-mail: lusik65@rambler.ru

Roin K. Dzhordzhikiya, chief of department of surgical diseases of Kazan State Medical university, professor. Kazan, Russia, tel. 8-987-296-51-72, e-mail: roink@mail.ru

Ildar M. Rahimullin, cardiovascular surgeon, perfusist, department of cardiac surgery, ICDC, Kazan, Russia, tel. 8-919-688-44-98, e-mail: kardiosurgery@bk.ru

Rail R. Khamzin, cardiovascular surgeon, perfusist, department of cardiac surgery, ICDC, Kazan, Russia, tel. 8-927-677-78-03, e-mail: raul1965@mail.ru

Murat N. Mukharyamov, cardiovascular surgeon, department of cardiac surgery, ICDC, Kazan, Russia, tel. 8-917-263-58-41, e-mail: mukharyamov@yahoo.com

Marat A. Sungatullin, cardiovascular surgeon, department of cardiac surgery, ICDC, Kazan, Russia, tel. 8-965-587-90-92, e-mail: blaide88@mail.ru

Regina M. Mukminova, Blood components preparation department, ICDC, Kazan, Russia, tel. 8-965-599-67-68, e-mail: reginka87@rambler.ru

Abstract. Aim. The aim of the current study is the evaluation of the platelets concentrate transfusion for correction of cardiopulmonary bypass induced or initial thrombocytopenia in patient undergoing cardiac surgery. Methods. 132 cases were retrospectively analyzed. Platelets concentrate were prepared by combined differential centrifugation method. Results. Platelets concentrate with the mean volume of 350 ml transfusion in early postoperative period led to the significant postoperative bleeding decrease in 96,7%. The increase in platelets count by 17% were observed in all cases. Conclusion. Platelets concentrate transfusion has a significant impact on hemostasis improvement in patients with initial or cardiopulmonary bypass induced thrombocytopenia.

Key words: cardiac surgery, thrombocytopenia, platelets concentrate, transfusion, hemostasis.

 

References

1. Bokeriya, L.A. Bolezni i vrozhdennye anomalii sistemy krovoobrascheniya [Disease and congenital malformations of the circulatory system] / L.A. Bokeriya, R.G. Gudkova // Serdechno-sosudistaya hirurgiya. — 2012. — № 3. — S. 210.
2. Vasil'ev, S.G. Organizaciya transfuzionnoi terapii v lechebno-profilakticheskih uchrezhdeniyah [Organization of transfusion therapy in health care settings] / S.G. Vasil'ev, S.L. Farafontova, L.N. Sibgatullina [i dr.]. — Kazan', 2001. — S. 258.
3. Tokareva, Yu.N. Tehnicheskoe rukovodstvo amerikanskoi associacii bankov krovi: per. s angl. / Yu.N. Tokareva. — M., 2000. — S. 1056.
4. Mel'nikova, V.N. Tehnologiya zagotovki leikofil'trovannyh trombocitov dlya obespecheniya immunologicheskoi i infekcionnoi bezopasnosti ih transfuzii [Technical Manual of the American Association of Blood Banks. ESTM lane. Translated from English] / V.N. Mel'nikova, G.Yu. Kir'yanova, O.I. Filippova. — M., 2010. — S. 15.
5. Rumyancev, A.G. Klinicheskaya transfuziologiya [Clinical transfusiology] / A.G. Rumyancev, V.A. Agranenko. — M.: GEOTAR-Medicina, 1997. — S. 576.
6. Keckalo, M.V. Iskusstvennoe krovoobraschenie i kardio- plegicheskaya zaschita miokarda [Cardiopulmonary bypass and cardioplegic myocardial protection] / M.V. Keckalo, I.V. Kuznecov, S.V. Shahmaeva. — M., 2009. — S. 33—54.
7. Lokshin, L.S. Grudnaya i serdechno-sosudistaya hirurgiya [Thoracic and Cardiovascular Surgery] / L.S. Lokshin, G.O. Lur'e, A.A. Timchenko. — M.: MIA, 2001. — S. 15—17.

 

Intrabone infusions in emergency medicine

Valery M. Belopukhov, the head of the department of anesthesiology, resuscitation and transfusiology of SBEI APE «Kazan State Medical Academy» of Ministry of Health of Russia, MD, the professor, tel. 8-917-920-55-70, e-mail: bvm12345@mail.ru

Shamil G. Asadullin, the associate professor of an emergency medical service, medicine of accidents and mobilization preparation of health care of SBEI APE «Kazan State Medical Academy» of Ministry of Health of Russia, MD, tel. 8-843-233-34-93, e-mail: strannik.s@mail.ru

Bari G. Shigapov, the associate professor of an emergency medical service, medicine of accidents and mobilization preparation of health care of SBEI APE «Kazan State Medical Academy» of Ministry of Health of Russia, MD, tel. 8-906-115-26-85, e-mail: smp-mk-mpz@kgma.info

Angelina V. Volgina, the competitor of chair of anesthesiology, resuscitation and transfusiology of SBEI APE «Kazan State Medical Academy» of Ministry of Health of Russia

Abstract. Urgency of the clinical situation and observed inaccessibility of veins, their spasms, contribute to difficulties of intravenous drugs and infusion-transfusion solutions administration. Destabilizing factors of human life are natural disasters, technological accidents, which lead to the development of severe injuries of vital organs and systems, as well as a severe violation of the basic indicators of homeostasis. In complex of therapeutic measures aimed to normalize the metabolic disorders, one of the most important places takes transfusion-infusion therapy. The article presents the historical aspects of intraosseous infusion, feasibility and advisability of this method in critical care and in the pre-admission phase. We consider the technique of intraosseous access. The material is based on data from domestic and foreign literature. The article is a point of interest to specialists in emergency medicine, medical transfusion, ambulance, anesthesiology, intensive care specialists, surgeons, traumatologists.

Key words: intraosseous infusion, critical conditions, transfusion, resuscitation.

 

References

1. Atyasov, N.I. Novye tehnologii ispol'zovaniya venoznogo rusla kostei v ekstremal'noi medicine [New technologies of use of the venous course of bones in extreme medicine] / N.I. Atyasov, I.N. Atyasov. — Saransk, 2001. — S. 210—212.
2. Atyasov, N.I. Vnutrikostnye vlivaniya lekarstvennyh i drugih zhidkostei po ekstrennym pokazaniyam na dogospital'nom etape [Intra bone injections of medicinal and other liquids according to emergency indications at a pre-hospital stage] / N.I. Atyasov, V.G. Sharov, G.A. Boyarinov. — Saransk, 1998. — S. 67—68.
3. Vsevolodov, G.F. Vnutrikostnye veny trubchatyh kostei cheloveka [Intra bone veins of tubular bones of the person] / G.F. Vsevolodov // Arhiv anatomii, gistologii, embriologii. — 1953. — T. 4, № 4. — S. 77—81.
4. Dolbneva, E.L. Vnutrikostnyi dustup — sovremennoe reshenie problemy sosudistogo dostupa v kriticheskih situaciyah i pri serdechno-legochnoi reanimacii [Intra bone access — a modern solution of the problem of vascular access in critical situations and at warm and pulmonary reanimation] / E.L. Dolbneva, E.S. Petrosyan // Medicina neotlozhnyh sostoyanii [Medicine of urgent conditions]. — 2012. — № 1 (40). — S. 124—130.
5. Pikovskii, V.Yu. Vnutrikostnoe vvedenie lekarstvennyh preparatov v komplekse intensivnoi terapii na dogospital'nom etape [Intra bone introduction of medicines in a complex of intensive therapy at a pre-hospital stage] / V.Yu. Pikovskii // Medicina kriticheskih sostoyanii [Medicine of critical conditions]. — 2013. — № 5/6. — S. 49—53.
6. Prikaz Minzdravsocrazvitiya RF ot 31.03.2008 № 154n «O vnesenii izmenenii v prikaz Ministerstva zdravoohraneniya i social'nogo razvitiya Rossiiskoi Federacii ot 1 dekabrya 2005 № 752 «Ob osnaschenii sanitarnogo transporta» [The order of the Ministry of Health and Social Development of the Russian Federation of 31.03.2008 № 154n «About modification of the order of the Ministry of Health and Social Development of the Russian Federation of December 1, 2005 № 752 «About equipment of sanitary transport»].
7. Prikaz Minzdrava RF ot 07.08.2013 № 549n «Ob utverzhdenii trebovanii k komplektacii lekarstvennymi preparatami i medicinskimi izdeliyami ukladok i naborov dlya skoroi medicinskoi pomoschi» [The order of Ministry of Health of the Russian Federation of 07.08.2013 № 549n «About the approval of requirements to a complete set medicines and medical products of laying and sets for an emergency medical service»].
8. Shulyak, G.M. Vnutrikostnyi metod obezbolivaniya i ego anatomicheskoe obosnovanie [Intra bone method of anesthesia and its anatomic justification of] / G.M. Shulyak, A.T. Akilova. — L.: Medgiz, 1953. — S. 153.
9. The circulation in the mammalian bone marrow / C. Drinker, K. Drinker, C. Lund // Am. J. Physiol. — 1922. — № 62. — S. 1—92.
10. Comparison of two intraosseous access devices in adult patients under resuscitation in the emergency department: A prospective, randomized study / B.A. Leidel, C. Kirchhoff, V. Braunstein [et al.] // Resuscitation. — 2010. — № 81 (8). — Р. 994—999.

 

A study of the influence of pinane thioterpenoids on human hemostasis and platelets functional activity

Marina M. Vorontsova, Deputy Chief of Quality Control of «Republican hemotransfusion center of Tatarstan Ministry of Health», Kazan, Russia, tel. 8-987-297-78-34, e-mail: rspk@tatar.ru

Ramil G. Turayev, PhD, Chief medical officer of «Republican hemotransfusion center of Tatarstan Ministry of Health», Kazan, Russia, tel. 8-987-400-57-84, e-mail: rspk@tatar.ru

Sergei V. Kiselev, MD, Professor of the General and Organic Chemistry Department of SBEI HPE «Kazan State Medical University» of Russian Ministry of Health, Kazan, Russia, tel. 8-960-040-10-34, e-mail:svkiselev08@mail.ru

Lilia E. Nikitina, Chief of General and Organic Chemistry Department of SBEI HPE «Kazan State Medical University» of Russian Ministry of Health, Kazan, Russia, tel. 8-903-307-50-70, e-mail: nikitl@mail.ru

Ilashat G. Mustafin, MD, Chief of biochemistry Department of SBEI HPE «Kazan State Medical University» of Russian Ministry of Health, Kazan, Russia, tel.8-919-624-96-24, e-mail: ilshat64@mail.ru

Rosa М. Nabiullina, postgraduate student of biochemistry Department of SBEI HPE «Kazan State Medical University» of Russian Ministry of Health, Kazan, Russia,, tel. 8-917-898-72-50, e-mail: nabiullina.rosa@yandex.ru

Abstract. Aim of the study — investigation the influence of new sulfur-containing derivatives of β-pinene on the functional activity of human platelets and blood clotting activity in human plasma. Material and methods. A number of sulfides and sulfoxides of pinane series have been synthesized based on β-pinane. Sulfides have been obtained by the electrophilic addition reaction of thiols to the double bond of β-pinene in the presence of ZnCl2. Oxidation of sulfides into corresponding sulfoxides has been conducted with the Ti(O-i-Pr)4/R-C6H5CH(OH)COOH/t-BuOOH oxidative system. The structures of compounds obtained have been established by the use of IR and 1Ни13С NMR spectroscopy, mass spectrometry and X-ray analysis. The acute toxicity of the compounds studied was determined by parenteral (intraperitoneal) route on outbred white mice of both sexes. Blood coagulating activity of obtained compounds has been established by platelet aggregation rate using G. Born method, thrombotic dynamics and surface-dependent coagulation tests. Functional condition of stored platelets was assessed by flow cytometry by counting the number of microvesicles in platelet preparations. In spontaneous aggregation of platelets and plasma coagulating activity assessment we used venous blood of patients with coronary artery disease and marked changes in the hemostatic system. Induced platelet aggregation and its micro vesiculation have been investigated on plasma obtained from healthy donors. Results and discussions. All obtained compounds possessed anti-aggregating and anti-coagulating activity. Unlike sulfoxide, pinanyl sulfide showed a more pronounced inhibitory effect on coagulation factors activation, which depended on the presence of microvesicles in the plasma. The most water-soluble compound — sulfoxide almost completely inhibits spontaneous and collagen and arachidonic acid induced aggregation of thrombocytes as well as coagulating ability. Sulfide and increasingly sulfoxide of pinane series increased stability of platelets in platelet concentrate storage. Conclusions. In current study we demonstrated that blood coagulating activity of obtained substances is conditioned by the selective inhibition of platelet aggregation, decrease of microvesicles emission and suppression of their activity.Taking into account low toxicity of thioterpenoids, sulfur-containing monoterpenoids of pinane series are promising potential drugs for preventive measures and medical treatment of thrombophilia and as agents for blood stabilization.

Key words: β-pinene, sulfides and sulfoxides, platelets, platelet microvesicles, antiaggregatory and anticoagulating activity.

 

References

1. Aref'ev, A.V. Razrabotka sinteticheskogo podhoda k diastereomernochistym sul'foksidam pinanovogo ryada [Development of synthetic approach to diastereomerically pure sulfoxides of pinane series] / A.V. Aref'ev, V.A. Starceva, L.E. Nikitina // Himiya v interesah ustoichivogo razvitiya [Chemistry for Sustainable Development]. — 2012. — № 2. — S. 249—252.
2. Zubairov, D.M. Mikrovezikuly v krovi, funkcii i ih rol' v tromboobrazovanii [Microvesicles in the blood, functions and their role in thrombus] / D.M. Zubairov, L.D. Zubairova. — M.: GEOTAR-Media, 2009. — 167 s.
3. Nikitina, L.E. Prirodnye i tiomodificirovannye monoterpenoidy [Natural and Thio-modified Monoterpenoids] / L.E. Nikitina, N.P. Artemova, V.A. Starceva. — Saarbryukken: Izd-vo «LAPLAMBERT», 2012. — 176 s.
4. Preparation and Properties of Two Polymorphic Modifications of β-Hydroxysulfoxide of the Pinane Series / A.V. Aref’ev, V.A. Startseva, L.E. Nikitina [et al.] // Russian Journal of General Chemistry. — 2012. — Vol. 82, № 3. — Р. 440—445.
5. Synthesis and antifungal activity of sulfides, sulfoxides and sulfones based on (1S)-(-)-β-pinene / V.V. Gavrilov, V.A. Startseva, L.E. Nikitina [et al.] // Pharmaceutical Chemistry Journal. — 2010. — Vol. 44, № 3. — Р. 126—129.
6. Chemical composition and antifungal activity of the essential oil softhree species of Artemisia onsomesoil-bornephyto pathogens/ M. Farzaneh, M. Ahmadzadeh, J. Hadian [et al.] // Commun. Agric. Appl. Biol. Sci. — 2006. — Vol. 71, iss. 3. — P. 1327—1333.
7. A role of the fast ATP-gated P2X1 cation channel in trombosis of small arteries in vivo / B. Hechler, N. Lenain, P. Marchese [et al.] // J. Exp. Med. — 2003. — Vol. 198. — P. 661—667.
8. Inhibition of platelet functions and thrombosis through selective or nonselective inhibition of the platelet P2 receptors with increasing doses of NF449 [4,4´,4´´,4´´´-[carbonylbis (imino-5,1,3-benzenetriylbis-(carbonylimino))] tetrakis-benzene-1,3-disulfonicacidoctasodium salt / B. Hechler, S. Mangenat, M.L. Zighetti [et al.] //J. Pharmacol. Exp. Ther. — 2006. — Vol. 314. — P. 232—243.
9. A heparin-based method for flow cytometric analysis of microparticlesdirecty from platelet-poor plasma in calcium containing buffer / L.V. Iversen, O. Ostergaard, Ch.T. Nielsen [et al.] // J. Immunol Methods. — 2013. — Vol. 388 (1—2). — P. 49—59.
10. Synthesis and antifungal activity of compounds of the pinnae series / L.E. Nikitina, V.A. Startseva, I.A. Vakulenko [et al.] // Pharmaceutical Chemistry Journal. — 2009. — Vol. 43, № 5. — Р. 251—254.
11. The ATP-gated P2X1 ion channel actsas a positive regulator of platelet responses to collagen / C. Oury, E. Toth-Zsamboki, C.Thys [et al.] // Thromb. Haemost. — 2001. — Vol. 86. — P. 1264—1271.
12. Overexpression of the platelet P2X1 ion channel in transgenic mice generates a novel prothrombotic phenotype / C. Oury, M.J. Kuijpers, E. Toth-Zsamboki [et al.] // Blood. — 2003. — Vol. 101. — P. 3969—3976.
13. Effects of enhanced P2X1 receptor Ca2+ signals functional responses in human platelets / M.G.Rolf, M.P. Mahaut-Swith// Thromb. Haemost. — 2002. — Vol. 88. — P. 495—502.

 

NEW METHODS

Profiles of bronchoalveolar lavage fluid in modeling of transfusion-related acute lung injury

Kaliman K. Mamatova, Competitor of the Department of Pathological Anatomy of the Kyrgyz-russian Slavic university, Bishkek, Kyrgyzstan, e-mail: kalima_m@mail.ru

Georgy G. Belov, MD, Professor of Pathological Anatomy of the Kyrgyz-Russian Slavic university, Bishkek, Kyrgyzstan, e-mail: bagdan1954@mail.ru

Abstract. The purpose of the study was to examine changes in the biophysical and biochemical parameters of bronchoalveolar lavage fluid in modeling the transfusion-related acute lung injury (TRALI) in dogs and show the possibility of application them as biomarkers. Material and methods. In an experiment on 24 dogs TRALI syndrome was simulated by transfusion of heterogeneous blood (human blood, group IV). Then lungs were washed with 0.5% glucose solution in the first few minutes, 1 hour, 1 day and 3 days. In bronchoalveolar lavage (BAL) we determined surface activity of the surfactant, identified the products of lipid peroxidation (LPO), free hemoglobin, potassium and sodium ions. Results. Revealed a sharp decline of surface activity intra- and extracellular lung surfactant registered in first hour, as well as an appearance of free hemoglobin in BAL, increase of potassium ions, potassium/sodium ratio and the lipid peroxidation products increase. Conclusion. The changes of the studied parameters can be considered as markers of «shock lung».

Key words: transfusion-related acute lung injury, bronchoalveolar lavage, lung surfactant, electrolytes, lipid peroxidation, free hemoglobin.

 

References

1. Belov, G.V. Ocenka sostoyaniya surfaktantnoi sistemy legkih [Quality condition of surfaktantny system of lungs] / G.V. Belov, A.A. Arbuzov, N.N. Brimkulov. — Bishkek, 2005. — 104 s.
2. Butina, E.V. HLA-sensibilizaciya — risk razvitiya, posttransfuzionnye oslozhneniya, metody profilaktiki [HLA-sensibilization — risk of development, posttransfusion complications, methods prophylaxis] / E.V. Butina, G.A. Zaiceva, Yu.I. Yugov [i dr.] // Gematologiya i transfuziologiya [Hematology and transfusiology]. — 2003 . — T. 48, № 4. — S. 26—29.
3. Gavrilov, V.B. Spektrofotometricheskoe opredelenie soderzhaniya gidroperekisei lipidov v plazme krovi [Spektrofotometric definition of the maintenance of hydroperoxides of lipids in blood plasma] / V.B. Gavrilov, M.I. Mishkorudnaya // Laboratornoe delo [Lab. Business]. — 1983. — № 3. — S. 33—36.
4. Gerasimova, N.D. Risk posttransfuzionnyh oslozhnenii / N.D. Gerasimova, A.V. Karavaev [Risk of posttransfusion complications] // Vestnik sluzhby krovi Rossii [Bulletin of service of a blood of Russia]. — 2010. — № 2. — S. 6—12.
5. Donskov, S.I. Immunologicheskaya bezopasnost’ perelivaniya eritrocitov (razvitie koncepcii) [Immunologic safety of transfusion of erythrocytes (development of the concept)] / S.I. Donskov, T.V. Gaponova // Vestnik sluzhby krovi Rossii [Bulletin of service of a blood of Russia]. — 2013. — № 2. — S. 1—9.
6. Karpun, N.A. Ostroe povrezhdenie legkih, associirovannoe s transfuziei, u kardiohirurgicheskih bol’nyh [The acute injury of lungs associated with a transfusion at cardiac patients] / N.A. Karpun, V.V. Moroz, A.P. Afonin [i dr.] // Obschaya reanimatologiya [General reanimotologia Is lousy]. — 2008. — T. IV, № 3. — S. 23—29.
7. Lyulyaeva, O.D. Transfuzionnye ostrye povrezhdeniya legkih — glavnoe smertel’noe oslozhnenie [Transfusion acute damages of the mild — the main lethal complication] / O.D. Lyulyaeva, N.A. Fyodorov, S.A. Pavlov // Rossiiskie medicinskie vesti [Russian medical messages]. — 2008. — № 4. — S. 31—35.
8. Tyulyulyueva, A.K. Sostoyanie surfaktanta legkih, oksidativnogo statusa i elektrolitnogo balansa u krolikov pri primenenii fizioterapevticheskih metodov: avtoref. ... kand. biol. nauk [Quality surfactant of lungs, the oxidative status and electrolytic balance at rabbits at application of physiotherapeutic methods] / A.K. Tyulyulyueva. — Bishkek, 2011. — 16 s.
9. Shestakov, E.A. Inogruppnaya krov’ v donorskom konteinere [Different blood in the donor container] / E.A. Shestakov, I.I. Suhorukova, E.A. Klyueva, E.B. Zhiburt // Vestnik Nacional’nogo mediko-hirurgicheskogo centra im. N.I. Pirogova [The bulletin of National medical and surgical center of N.I. Pirogov]. — 2010. — № 1. — S. 110—113.
10. Shifman, E.M. Dzheims Blandell i «edinburgskii sled» v razvitii gemotransfuzii (sobstvennoe issledovanie) [James Blundell and «the Edinburgh trace» in development of a hemotransfusion (own research)] / E.M. Shifman, G.V. Filippovich // Obschaya reanimatologiya [General reanimotologia]. — 2006. — № 3. — S. 61—66.
11. Koh, M.B.C. Transfusion errors and management / M.B.C. Koh, R. Alcantara // ISBT Series. — 2009. — Vol. 4. — P. 216—220.
12. Popovsky, M.A. Further characterization of transfusion-related acute lung injury: demographics, clinical and laboratory features, and morbidity / M.A. Popovsky, N.R. Haley // Immunohematology. — 2000. — Р. 157—159.
13. Sittiman, С.C. Transfusion-related acute lung injury: epidemiology and a prospective analysis of etiologic factors / С.C. Sittiman, L.K. Boshkov, Z. Mehdizadehkashi [et al.] // Blood. — 2003. — Vol. 101 (2). — P. 454—462.
14. Toy, P. Transfusion-related acute lung injury: Definition and review / P. Toy, M. Popovsky, E. Abraham [et al.] // Crit. Care Med. — 2005. — Vol. 33. — P. 721—726.

 

HELP FOR PRACTITIONER

Diagnosis and treatment of sarcoidosis. Summary of Federal Conciliative Clinical Recommendations. Part II. Diagnosis, Treatment, Prognosis

Alexander G. Chuchalin, Professor, MD, Director FGBI «Institute of Pulmonology» FMBA of Russia, Chairman of the Russian Respiratory Society, Chief Specialist supernumerary therapist pulmonologist the Ministry of Health, Academician, e-mail: chuchalin@inbox.ru

Alexander A. Vizel, Professor, MD, Head of the Department of Phthisiopulmonology of SBEI HPE «Kazan State Medical University» of Russian Ministry of Health, Chief supernumerary specialist pulmonologist Ministry of Health of Tatarstan, e-mail: lordara@inbox.ru

Mikhail M. IlkovIch, Professor, MD, Head of the Department of Pulmonology FPO with clinic Medical University PSPbGMU them. IP Pavlova Russian Ministry of Health, Chief supernumerary specialist pulmonologist St. Petersburg, e-mail: mih.ilkovich@yandex.ru

Sergey N. Avdev, Professor, MD, Deputy Director for Science FGBI «Institute of Pulmonology» FMBA of Russia, e-mail: serg_avdeev@list.ru

Nail B. Amirov, Ph. D., Professor of General Practice Medical University «Kazan State Medical University» of Ministry of Health of Russia, professor, Academician of RAE, e-mail: namirov@mail.ru

Olga P. Baranova, MD, senior researcher IL D Institute of Pulmonology, Medical University PSPbGMU them. acad. Pavlov of Russian Ministry of Health, e-mail: dr_baranova@mail.ru

Sergey E. Borisov, Professor, MD, Deputy Director for Research and clinical work of the Moscow City Scientific and Practical Center for Tuberculosis Department of Health in Moscow, e-mail: sebarsik@gmail.com

Irina Yu. Vizel, MD, assistant lecturer therapy and family medicine GBOU DPO «Kazan State Medical Academy» Russian Ministry of Health, e-mail: tatpulmo@mail.ru

Olga V. Lovacheva, MD, Head endoscopy department FGBI «Central Research Institute of Tuberculosis», RAMS, Professor of phthisiology SBEI DPO «Russian Medical Academy», e-mail: lovol@zmail.ru

Nikolay V. Ovsyanikov, Ph. D., Head of Pulmonology BUZ Omsk region «City Clinical Hospital № 1. Kabanov», e-mail: niklajjovs@rambler.ru

Dmitry V. Petrov, pulmonologist pulmonology clinic cabinet BUZ Omsk region «City Clinical Hospital № 1. Kabanov», e-mail: dmitrpetrov@bk.ru

Vladimir V. Romanov, Professor, MD, Leading researcher of the differential diagnosis of pulmonary tuberculosis and extracorporeal therapies FGBI CTRI RAMS, MD, e-mail: romanov@internets.ru

Maria V. Samsonovа, MD, Head of the Laboratory of Pathological Anatomy and Immunology FGBI «Institute
of Pulmonology» FMBA Russia, e-mail: samary@mail.ru

Irina P. Solovyova, MD, Head of the Laboratory of Pathological Anatomy of the First Moscow State Medical University of Sechenov, Professor, e-mail: ripporg@mail.ru

Igor E.Stepanian, Professor, MD, Leading researcher of the differential diagnosis of pulmonary tuberculosis and extracorporeal therapies FGBI CTRI RAMS, MD, e-mail: drstepanyan@mail.ru

Igor E. Tyurin, Professor, MD, Head of the department of radiation diagnosis, radiotherapy and medical physics GBOU DPOR MAPO, Chief Specialist in diagnostic imaging Ministry of Public Health, e-mail: igortyurin@gmail.com

Andrey L. Cherniayev, Professor, MD, Head of the Department of Pathology FGBI «Institute of Pulmonology» FMBA of Russia, e-mail: cheral12@gmail.com

Evgeny I. Shmelev, Professor, MD, Head of the differential diagnosis of pulmonary tuberculosis and extracorporeal therapies FGBI CTRI RAMS, e-mail: eishmelev@mail.ru

Natalia M. Shmeleva, Ph. D., pulmonologist District Northern Administrative District of Moscow, e-mail: eishmelev@mail.ru

Abstract. An abridged adaptation of the Russian federal clinical guidelines for the diagnosis and treatment of sarcoidosis is presented. Material prepared by experts and includes all evidence up to date, the world's achievements in the study of this disease and a huge own clinical experience of the authors. In the first part the etiology, pathogenesis, epidemiology, clinical manifestations of sarcoidosis with various organs and systems involvement is revealed. The second part shows the path of the diagnostic and differential diagnostic search, determining management of patients with sarcoidosis, drug therapy options, prevention, and prognosis. Studying these recommendations allows doctors of all specialties to be qualified to conduct diagnostic search and adequate therapy of the disease, and to identify further management tactics. These guideline is intended for a wide range of practitioners and researchers.

Key words: sarcoidosis, diagnosis, treatment.

 

References

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2. Vizel', I.Yu. Sostoyanie bol'nyh sarkoidozom v ishodno i 10 let spustya pri razlichnoi taktike ih vedeniya (mul'ticentrovoi analiz) / I.Yu. Vizel', E.I. Shmelev, O.P. Baranova [i dr.] // Pul'monologiya. — 2012. — № 4. — 29—33.
3. Daurov, B.I. Sarkoidoz / B.I. Daurov. — M.: Overlei, 2006. — 264 s.
4. Disseminirovannye zabolevaniya legkih / pod red. prof. M.M. Il'kovicha. — M.: GEOTAR-Mediya, 2011. — 480 s.
5. Il'kovich, M.M. Sarkoidoz organov dyhaniya / M.M. Il'kovich, L.N. Novikova, V.S. Luchkevich. — SPb., 1996. — 66 s.
6. Intersticial'nye bolezni legkih / pod red. N.A. Muhina. — M.: Littera, 2007. — 432 s.
7. Intersticial'nye zabolevaniya legkih: rukovodstvo dlya vrachei / Pod red. M.M.Il'kovicha, A.N.Kokosova. — SPb.: Nordmedizdat, 2005. — 560 s.
8. Porazhenie serdechno-sosudistoi sistemy pri sarkoidoze / A.A. Vizel', N.B. Amirov, F.A. Mingaleev, R.N. Amirova // Vestnik mezhregional'nogo kliniko-diagnosticheskogo centra. — 2004. — T. III, vyp. 1. — S.129—134.
9. Potanin, A.V. Invazivnaya diagnostika pri sindromah vnutrigrudnoi limfadenopatii i disseminacii / A.V. Potanin, I.Yu. Vizel', V.P. Potanin, A.A. Vizel' // Vestnik sovremennoi klinicheskoi mediciny. — 2011. — T. 4, vyp. 3. — S.56—60.
10. Pul'monologiya: klinicheskie rekomendacii / pod red. A.G. Chuchalina. — M.: GEОTAR-Media, 2009. — 336 s.
11. Pul'monologiya. Nacional'noe rukovodstvo. Kratkoe izdanie / pod red. A.G. Chuchalina. — M.: GEОTAR-Media, 2013. — 800 s.
12. Rabuhin, A.E. Sarkoidoz / A.E. Rabuhin, M.N. Dobrohotova, N.S. Tonitrova. — M.: Medicina, 1975. — 175 s.
13. Sarkoidoz / pod red. A.G. Homenko, O. Shvaigera. — M.: Medicina, 1982. — 296 s.
14. Sarkoidoz: monografiya / pod red. A.A. Vizelya (Seriya monografii Rossiiskogo respiratornogo obschestva; gl. red. serii A.G. Chuchalin). — M.: Atmosfera, 2010. — 416 s.
15. Sarkoidoz: ot gipotezy k praktike / pod red. A.A. Vizelya. — Kazan': FEN, 2004. — 348 s.
16. Sarkoidoz i porazhenie organov sistemy pischevareniya / A.A. Vizel', N.B. Amirov // Vestnik sovremennoi klinicheskoi mediciny. — 2010. — T. III, vyp. 1. — S.43—50.
17. Suslina, Z.A. Neirosarkoidoz / Z.A. Suslina, B.A. Kistenev, M.Yu. Maksimova, V.A. Morgunov. — M.: MEDpress-inform, 2009. — 208 s.
18. Torakal'naya hirurgiya: rukovodstvo dlya vrachei / pod red. L.N. Bisenkova. — SPb.: Gippokrat, 2000. — S.85—114.
19. Filippov, V.P. CHrezbronhial'naya biopsiya legkih v diagnostike disseminirovannyh processov / V.P. Filippov, L.V. Ozerova, K.M. Lebedev [i dr.]// Problemy tuberkuleza. — 1985. — № 3. — S.23—27.
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21. Shmelyov, E.I. Differencial'nayadiagnostikadisseminirovannyh zabolevanii legkih neopuholevoi prirody / E.I. Shmelyov // Russkii medicinskii zhurnal. — 2001. — № 21. — S.918—922.
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25. Coker, R.K. Guidelines for the use of corticosteroids in the treatment of pulmonary sarcoidosis / R.K. Coker // Drugs. — 2007. —Vol. 67(8). — P.1139—1147.
26. Cremers, J.P. Multinational evidence-based World Association of Sarcoidosis and Other Granulomatous Disorders recommendations for the use of methotrexate in sarcoidosis: integrating systematic literature research and expert opinion of sarcoidologists worldwide / J.P. Cremers, M. Drent, A. Bast [et al.] // Curr. Opin. Pulm. Med. — 2013. — Vol. 19(5). — P.545—561.
27. De Leyn, P. Conventional mediastinoscopy / P. De Leyn. // Multimedia Manual Cardiothoracic Surgery. — 2004. —Vol. 2005, is. 0324; 10.1510/mmcts.2004.000158.
28. Yanardağ, H. Clinical Value of Mediastinoscopy in the Diagnosis of Sarcoidosis: An Analysis of 68 Cases / H. Yanardağ // Thorac. Сardiovasc. Surg. — 2006. — Vol. 54(3). — P.198—201.
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30. Interstitial lung diseases / ed. by D. Olivieri, R.M. du Bois // European Respiratory Monograph. — 2008. — Vol. 5. — 257 p. (Monograph 14).
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36. Park, M.K. Steroid-sparing effects of pentoxifylline in pulmonary sarcoidosis / M.K. Park, Jr. Fontana, H. Babaali [et al.]// Sarcoidosis Vasc. Diffuse Lung. Dis. — 2009. — Vol. 26(2). — P.121—131.
37. Ramiro, S. Safety of synthetic and biological DMARDs: a systematic literature review informing the 2013 update of the EULAR recommendations for management of rheumatoid arthritis / S. Ramiro, C. Gaujoux-Viala, J.L. Nam [et al.] // Ann. Rheum. Dis. — 2014. — Vol. 73(3). — P.529—535.
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39. Rocco, G. Awake single-access (uniportal) video-assisted thoracoscopic surgery for peripheral pulmonary nodules in a complete ambulatory setting / G. Rocco, V. Romano, R. Accardo [et al.] // Ann. Thorac. Surg. — 2010. — Vol. 89(5). — P.1625—1627.
40. Sarcoidosis: Monography ERS / ed. by M. Drent, U. Costabel. — 2005. — 32 p.
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42. Von Bartheld, M.B. Endosonography vs conventional bronchoscopy for the diagnosis of sarcoidosis: the GRANULOMA randomized clinical trial / M.B. von Bartheld, O.M. Dekkers, A. Szlubowski [et al.] // JAMA. — 2013. — Vol. 309(23). — P.2457—2464.
43. Vorselaars, A.D.M. Prediction of relapse after discontinuation  of infliximab therapy in severe sarcoidosis / A.D.M. Vorselaars, A. Verwoerd, C.H.M. van Moorsel [et al.] // Eur. Respir. J. — 2014. — Vol. 43(2). — P.602—609.
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46. Yim, A.P. VATS major pulmonary resection revisited — controversies, techniques, and results / A.P. Yim // Ann. Thorac. Surg. — 2002. — Vol. 74(2). — P.615—623.

 

 

ORGANIZATION OF HEALTHCARE

The dynamics of the primary donor’s activity in orenburg region

Evgeny V. Dronov, intern, tel. 8-922-818-44-91, e-mail: jd1012@yandex.ru

Rinat G. Gilmutdinov, PhD, Honored doctor of the Russian Federation, the chief doctor of SBHI «Orenburg Regional Blood Transfusion» tel. 8 (3232) 31-55-78

Irina V. Zakharova, head of equipment donors of SBHI «Orenburg Regional Blood Transfusion», e-mail: orenedc@mail.ru

Dmitri N. Begun, PhD, assistant professor of public health and health care № 1 SBEI HPE «Orenburg State Medical Academe», e-mail: doctorbegun@yandex.ru

Abstract. Aim. To reveal the regularity of donor activity of the primary donors in 2007 in Orenburg region. Material and method: we examined the dynamics of donations from 402 donors in 2007—2014, period of donor activity; we have defined the probability of failure/termination of activity in the relevant time’s intervals. Results. we determined that the greatest loss of primary donors occurs in the second year of «donor experience», followed by stabilization of reduction. Noted, that number of active donors increased from the second year of donorship and persisted in the study group in 2008—2009. We demonstrated that only 3,9% of the primary donor donations continue for 8 years or more. Most of the donations (84,7%) were carried out in the first 4 years. To estimate the probability of termination of donor’s activity Survival Analysis was applied. The analysis showed that the highest probability that the donor will stop donorship observed in primary donors (49,8%). Conclusion. we identified the role of attracting new donors and the importance of optimal work with recurrent donors.

Key words: donor, donorship, dynamics of activity.

 

References

1. Vershinina, O.A. Mediko-social'naya harakteristika pervichnyh donorov krovi i ee komponentov: avtoref. dis. ... kand. med. nauk / O.A. Vershinina. — SPb., 2011. — 24 s.
2. Grishina, O.V. Opyt i perspektivy gosudarstvennogo regulirovaniya problem donorstva krovi / O.V. Grishina // Transfuziologiya. — 2009. — T. 10, № 3/4. — S.4—10.
3. Zarubin, M.V. Sociologiya i motivaciya donorov Irkutskoi oblasti / M.V. Zarubin // Sibirskii medicinskii zhurnal. — 2014. — T. 124, № 1. — S.83—86.
4. Klyueva, E.A. Sociologiya i motivaciya donorov Ivanovskoi oblasti / E.A. Klyueva, E.V. Spirina, E.B. Zhiburt // Vestnik sluzhby krovi Rossii. — 2010. — № 3. — S.5—7.
5. Klyueva, E.A. Sovershenstvovanie klinicheskoi i proizvodstvennoi raboty sluzhby krovi sub'ekta Rossiiskoi Federacii: avtoref. dis. ... kand. med. nauk / E.A. Klyueva. — M., 2012. — 29 s.
6. Krasnyakov, V.K. Sovershenstvovanie donorstva krovi i ee komponentov v Sankt-Peterburge: avtoref. dis.... kand. med. nauk / V.K. Krasnyakov. — SPb., 2009. — 21 s.

 

Analisis of blood products application in tatarstan republic health care facilities

Ramil G. Turaev, PhD, chief medical officer of SAIH «Republican Blood Center of the Ministry of Health of the Republic of Tatarstan», e-mail: rspk@tatar.ru

Elena E. Bel'skaya, head of the clinical diagnostic laboratory of SAIH «National Blood Center of the Ministry of Health of the Republic of Tatarstan», tel. 8-927-417-76-07, e-mail: E.Belskaya@tatar.ru

Abstract. Introduction. Use of blood components in hospitals is one of the most important components of the treatment process. Not a single unit of a large hospital, providing medical assistance, including emergency, can not do without the use of the components of blood. Since blood is a unique environment that can be obtained only from the person — the donor, the rational use of this valuable product is one of the strategic objectives for blood services, which is engaged in procurement and processing of blood and medical institutions, which are consumers of the product. The purpose of this paper was to analyze the use of blood components and medical institutions of the Republic of Tatarstan. Rational use of blood products is not possible without an integrated approach to service-related blood and clinical transfusiology, which must be solved comprehensively. Material and methods. Materials for the study were transfusiology documentation and medical records of inpatients underwent transfusion therapy. A retrospective analysis was performed. Results and discussion. Demand for blood components is relevant in Tatarstan health care. Transfusion activity ranged from 1,8 to 82%, depending on the profile of the hospital, number of recipients received transfusions with individual selection a blood component containing red blood cells increased. Likelihood of immunization to clinically significant transfusion dangerous antigens thereby decreased. Conclusion. Currently implemented concept of gene therapy component carried out by strict indications, i.e. the components of blood, in which the patient lacks. In each case, the doctor prescribes and applies the blood component that is most necessary to the patient. This allows you to achieve the required therapeutic effect with the minimum volume of transfusions.

Key words: blood, blood components, blood service.

 

References

1. Zhiburt, E. Benchmarking zagotovki i perelivaniya krovi: rukovodstvo dlya vrachei / E. Zhiburt. — M.: Rossiiskaya akademiya estestvennyh nauk, 2009. — 364 s.
2. Tehnicheskoe rukovodstvo amerikanskoi associacii bankov krovi: per. s angl. — Milan: Evropeiskaya shkola transfuzionnoi mediciny, 2000. — 1035 s.
3. Ragimov, A.A. Transfuziologiya. Nacional'noe rukovodstvo / A.A. Ragimov. — M.: GEOTAR-Media, 2012. — 405 s.

 

REVIEWS

The modern state of bleeding from variceal enlarged veins of esophagus and stomach

Eugene A. Kitsenko, MD., Professor, Department of Emergency Surgery and portal hypertension fSBi «russian research center of Surgery named. Acad. B.V. Petrovsky rAMS», Moscow, russia, tel. 8-495-471-04-62

Andrey Y. Anisimov, MD., Professor, Department of Emergency Medical Care SBEI APE «Kazan State Medical Academy», Russian Ministry of Health, Chief Specialist, expert surgeon Ministry of Health of the Republic of Tatarstan, deputy chief doctor of the medical part of SAIH «City Clinical Hospital № 7», Kazan, Russia, tel. 8-843-221-36-70

Andrey I. Andreev, PhD. Sciences, surgeon Department of Surgery number 3 of SAIH «City Clinical Hospital № 7» Kazan, Russia, tel. 8-843-221-39-76

Abstract. Modern views on the etiology, pathogenesis, classification, diagnosis and treatment of bleeding from esophageal and gastric varices changed viens for different versions of portal hypertension are presented. Summarized own clinical experience in treating patients with portal hypertension of various origins, complicated by bleeding from esophageal and gastric varices. We made the comparative analysis of modern methods of treatment of patients with portal hypertension of various etiologies. Summarized own clinical experience in treating 115 patients with portal hypertension of various origins, complicated by bleeding from esophageal and gastric varices. In 77 patients (control group) treatment program included a waiting conservative tactics. In this group variceal needling as a «desperate operation» was performed only in 13 (16,9%) patients. In 38 patients (study group) active surgical tactics using M.D. Patsiora operation was applied as much as possible before the onset of early hepatic decompensation. Inclusion the active surgical tactics in the treatment program for compensated (Class A) and subcompensated (Class B) patients with hepatic cirrhosis, complicated by bleeding from esophagealand gastric varices made possible to reduce the total number of complications from 97,4 to 23,0%, including the number of recurrent bleedings — from 31,2 to 6,8%, the incidence of liver failure — from 89,6 to 33,7%, reduced hospital mortality from 76,6 to 32,2%.

Key words: bleeding, varices enlarged esophagus and gastric, portal hypertension.

 

References

1. Anisimov, A.Yu. Diagnosticheskaya i lechebnaya taktika u bol'nyh s portal'noi gipertenziei [Diagnostic and therapeutic strategy in patients with portal hypertension] / A.Yu. Anisimov, M.V. Kuznecov, A.F. Yakupov. — Kazan', 2008. — 48 s.
2. Borisov, A.E. Krovotecheniya portal'nogo geneza [Bleeding portal genesis] / A.E. Borisov, M.I. Kuz'min-Kruteckii, V.A. Kaschenko. — SPb., 2001. — S.25—49.
3. Eramishancev, A.K. Krovotecheniya iz VRV pischevoda i zheludka: diagnostika, lechebnaya taktika (lekciya) [Bleeding from the esophagus and stomach BPB: diagnostics, medical tactic (lecture)] / A.K. Eramishancev, E.A. Kicenko, A.G. SHercinger, S.B. Zhigalova // Annaly hirurgicheskoi gepatologii [Annals of surgical hepatology]. — 2006. — T. XI, № 2. — S.105—111.
4. Eramishancev, A.K. Portal'naya gipertenziya [Portal hypertension] / A.K. Eramishancev, A.G. Shercinger, E.A. Kicenko // Klinicheskaya hirurgiya: nacional'noe rukovodstvo [Clinical Surgery: national leadership]. — 2009. — S.626—665.
5. Zhigalova, S.B. Endoskopicheskie tehnologii v lechenii i profilaktike krovotechenii iz varikozno-rasshirennyh ven pischevoda i zheludka u bol'nyh s portal'noi gipertenziei [Endoscopic techniques in the treatment and prevention of bleeding from esophageal varices and stomach in patients with portal hypertension]: avtoref. dis. ... d-ra med. nauk / S.B. Zhigalova. — M., 2011. — 46 s.
6. Ivashkin, V.T. Bolezni pecheni i zhelchevyvodyaschih putei: rukovodstvo dlya vrachei [Diseases of the liver and biliary tract. Guide for Physicians] / V.T. Ivashkin. — M.: ID «M-Vesti», 2002. — 200 s.
7. Kotiv, B.N. Hirurgicheskaya taktika i lechenie pischevodno-zheludochnyh krovotechenii pri portal'noi gipertenzii [Surgical tactics and treatment of esophageal-gastric bleeding in portal hypertension]: avtoref. dis. ... d-ra med. nauk / B.N. Kotiv. — SPb., 1998. — 18 s.
8. Mosharova, A.A. Lechenie i profilaktika krovotecheniya iz varikozno-rasshirennyh ven pischevoda [Treatment and prevention of bleeding from esophageal varices] / A.A. Mosharova, A.L. Vertkin // Neotlozhnaya terapiya [Emergency treatment]. — 2012. — № 1. — S.12—19.
9. Paciora, M.D. Hirurgiya portal'noi gipertenzii [Surgery of portal hypertension] / M.D. Paciora. — Tashkent: Medicina, 1984. — 319 s.
10. Sherlok, Sh. Zabolevaniya pecheni i zhelchnyh putei [Diseases of the liver and biliary tract] / Sh. Sherlok, Dzh. Duli. — M.: GEOTAR-Medicina, 1999. — 864 s.
11. Shercinger, A.G. Patogenez, diagnostika, profilaktika i lechenie krovotechenii iz varikoznyh ven pischevoda i zheludka u bol'nyh portal'noi gipertenziei [Pathogenesis, diagnosis, prevention and treatment of bleeding from varicose veins of the esophagus and stomach in patients with portal hypertension]: avtoref. dis. ... d-ra med. nauk / A.G. SHercinger. — M., 1986. — 30 s.
12. Abraldes J.G. The treatment of acute variceal bleeding / J.G. Abraldes, J. Bosch // J. Clin. Gastroenterol. — 2007. — Suppl. 3. — S312—S317.
13. Abraldes, J.G. Hepatic venous pressure gradient and prognosis in patients with acute variceal bleeding treated with pharmacologic and endoscopic therapy / J.G. Abraldes, C. Villanueva, R. Bañares [et al.] // J. Hepatol. — 2008. — P. 229—236.
14. Angels, E. Self-Expandable Metal Stents in the Treatment of Acute Esophageal Variceal Bleeding / E. Angels // Gastroenterology Research and Practice. — 2011.
15. Bosch, J. Portal hypertension and gastrointestinal bleeding / J. Bosch, J.G. Abraldes, A. Berzigotti, J.C. Garcia-Pagan // Semin. Liver Dis. — 2008. — P.3—25.
16. De Franchis, R. Revising consensus in portal hypertension: report of the Baveno V consensus workshop on methodology of diagnosis and therapy in portal hypertension / R. de Franchis // J. Hepatol. — 2010. — P.762—768.
17. Garcia-Pagán, J.C. Endoscopic band ligation in the treatment of portal hypertension / J.C. Garcia-Pagán, J. Bosch // Nat. Clin. Pract. Gastroenterol. Hepatol. — 2005. — Р.526—535.
18. Garcia-Tsao, G. Management of varices and variceal hemorrhage in cirrhosis / G. Garcia-Tsao, J. Bosch // Engl. J. Med. — 2010. — P.823—832.
19. Garcia-Tsao, G. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis / G. Garcia-Tsao, A.J. Sanyal, N.D. Grace, W. Carey // Hepatology. — 2007. — Р.922—938.
20. Gilles, P. The Transjugular Intrahepatic Portosystemic Shunt in the Treatment of Portal Hypertension: Current Status / P. Gilles, B. Louis, L. Michel [et al.] // International Journal of Hepatology. — 2012. — Vol. 2. — P.12—15.
21. Gluud, L.L. Banding ligation versus b-blockers as primary prophylaxis in esophageal varices: systematic review of randomized trials / L.L. Gluud, S. Klingenberg, D. Nikolova, C. Gluud // J. Gastroenterol. — 2007. — P.2841— 2849.
22. Gonzalez, R. Metaanalysis: Combination endoscopic and drug therapy to prevent variceal rebleeding incirrhosis / R. Gonzalez, J. Zamora, J. Gomez-Camarero [et al.] // Ann. Intern. Med. — 2008. — P.109—122.
23. Miñano, C. Clinical pharmacology of portal hypertension / C. Miñano, G. Garcia-Tsao // Gastroenterol. Clin. North. Am. — 2010. — № 39. — Р.681—695.
24. Orloff, M.J. Randomized trial of emergency endoscopic sclerotherapy versus emergency portacaval shunt for acutely bleeding esophageal varices in cirrhosis / M.J. Orloff, J.I. Isenberg, H.O. Wheeler [et al.] // J. Am. CollSurg. — 2009. — № 209. — Р.25—40.
25. Ripoll, C. Should the Hepatic Venous Pressure Gradient Be Sequentially Measured to Monitor B-Blocker Therapy in the Prophylaxis of Variceal Hemorrhage? / C. Ripoll, Р. Tandon, G. Garcia-Tsao // Controversies in hepatology: The experts analyze both sides. horofare: SLACK Incorporated. — 2011. — Р.123.
26. Salvador, A. Acute esophageal variceal bleeding: Current strategies and new perspectives / A. Salvador, G. Antonio, G. Joan // World J. Hepatol. — 2010. — № 7. — Р.261—274.
27. Wright, G. A self-expanding metal stent for complicated variceal hemorrhage: experience at a single center / G. Wright, H. Lewis, B. Hogan [et al.] // Gastrointest. Endosc. — 2010. — № 7. — Р.71—78.
28. Zehetner, J. Results of a new method to stop acute bleeding from esophageal varices: implantation of a self-expanding stent / J. Zehetner, A. Shamiyeh, W. Wayand, R. Hubmann // Surg. Endosc. — 2008. — P.149—152.

 

INTERNATIONAL EXPERIENCE

The national health system and respiratory care in Spain

Adolfo Baloira Villar, MD, Pulmonologist, Professor Respiratory Division, Universitary Hospital of Pontevedra (Spain), coordinator unit of Genetics of Pulmonary Hypertension, Vigo university (Spain), e-mail: adolfo.baloira.villar@sergas.es

Abstract. According to the WHO Spanish public health system is among the 10 best in the world, covering virtually the entire population but it does not mean that there are no major problems to solve. Current article reviews the Spanish National Health System organization based on two levels of care: Primary care and Specialized Care. Author specify all groups who are covered by the National Health System, portfolio of services of the National Health System, available technical resources and management of respiratory diseases in Spain. Organization of the Departments of Pulmonology is given by author’s own experience. The ways of prescription and control of respiratory drugs in Spain are described. A brief history of the Spanish Society of Respiratory Disease (SEPAR) and its activities is given.

Key words: Spanish, Health System organization, management of respiratory diseases.

 

References

1. Ley General de Sanidad [General Health Law] Boletín Oficial 1. del Estado. — 1986. — Vol. 102.
2. Sistema Nacional de Salud [Spanish Health System]. — 2. 2010. — URL: http://www:msps.es/organizacion/sns/librosSNS.htm
3. Soto Campos, J.G.3. Allocation of pulmonologists and thoracic surgeons in Spain / J.G. Soto Campos, F.J. Alvarez Gutierrez, F. Abad Cavaco [et al.] // Arch. Bronconeumol. — 2002. — Vol. 38. — P. 209—213.
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