VSKM 2018 N 5

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ORIGINAL RESEARCH

Cognitive function assessment in patients with unstable angina. Andreicheva E.N. P. 9

Functional classification of the diabetic foot syndrome and its application value. Bensman V.M., Savchenko Yu.P., Triandafilov K.G. P. 13

Combined acute cerebrovascular disease and myocardial infarction treatment experience. Bilalova R.R., Ibragimova G.Z., Zaytseva A.R., Koroleva E.M., Iskhakova A.R. P. 17

Transcranial doppler sonography application for аngiospasm prognosis in patients with nontraumatic subarachnoid hemorrage. Valeeva K.G., Yakupova A.A. P .23

Cerebrovascular reactivity in patients with cerebral concussion and the opportunities of its pharma- cological correction. Garifullin R.F., Danilov V.I., Karimov R.Kh. P. 26

The principles of complex nutritional status disorder correction in patients with spinal cord injury. Gumarova L.Sh., Bodrova R.A., Nazipova A.Ya., Busurgina E.A. P. 31

Managed infusion therapy for unspecified substance toxic effects. Davydova V.R., Ustimov D.Yu., Berdnikova E.A. P. 35

Family history of coronary heart disease and left main coronary artery stenosis genetic markers in patients with acute coronary syndrome. Ivantsov E.N., Magamedkerimova F.A., Makarov M.A., Fadeev G.A., Khasanov N.R. P. 44

Prevalence of the main cardiovascular risk factors in the limited category of male workers. Kim Z.F., Sadykov M.N., Delyan A.M., Galiullin I.M., Nurieva L.M., Kalimullin B.A. P. 48

Managed tissue regeneration mathematical model in patients with diabetic foot syndrome. Koreyba K.A., Klyushkin I.V., Minabutdinov A.R., Koreyba E.A. P. 52

Laparoscopic lysis of adhesions in treatment of patients with acute adhesive small intestinal obstruction. Malkov I.S., Bagautdinov E.B., Filippov V.A., Tagirov M.R., Khalilov Kh.M., Misiev D.Kh. P. 55

Complex treatment in patients with obstructive jaundice in diseases of hepatic, pancreatic and duodenal zone. Malkov I.S., Nasrullaev M.N., Zakirova G.R., Khamzin I.I. P. 58

Personalized approach to perioperative risk assessment in patients with cardiovascular diseases in emergency care clinic. Malkova M.I., Bulashova O.V., Khazova E.V. P. 63

Informative value of visual analysis of radiologic gray – scale images. Pasynkov D.V., Klyushkin I.V., Pasynkova O.O. P. 69

Improving the clinical efficiency of mammography reports. Pasynkov D.V., Klyushkin I.V., Pasynkova O.O., Fedorov A.L. P. 74

Smoking among medical professionals: perspectives of present day. Khamitov R.F., Fatykhova K.R., Okurlu A.F., Salimova L.M., Mingaleeva G.F. P. 80

Electroneurophysiologic criteria for acute facial nerve neuropathy course prognosis according to the blink reflex evaluation data. Yakupov R.A., Yakupova A.A., Busurgina E.A., Nazipova A.Ya. P. 82

REVIEWS

Arterial hypertension acute management in internal diseases. Abdrakhmanova A.I., Amirov N.B., Tsybulkin N.A., Frolova E.B., Gaifullina R.F. P. 86

Acute adverse reactions for contrast medium infiltration in medical practice. Akhmedzyanova D.G., Rakhmatullina N.M., Sibgatullina N.A., Delyan V.Yu., Zakirova G.N., Trofimova O.R., Panteleymonova P.M. P. 101

Magnetic resonance imaging in emergency cardiology: an introduction of modern diagnostic method. Delyan A.M., Frolova E.B., Tsybulkin N.A., Malov А.А. P. 105

Mild encephalopathy with reversible splenial corpus callosum lesion: literature review and case report in urgent neurologic clinical practice. Perov R.I., Khakimova A.R., Popova N.A. P. 110

The place of acute hypersensitivity drug reactions when using local anesthetics in multidisciplinary clinic setting. Rakhmatullina N.M., Akhmedzyanova D.G., Sibgatullina N.A., Delyan V.Yu., Zakirova G.N., Trofimova O.R., Panteleymonova P.M. P. 115

Metabolic syndrome as a causative factor of medical emergencies. Frolova E.B., Tsybulkin N.A., Abdrakhmanova A.I. P. 119

The effect of ii type diabetes mellitus on the course and prognosis of chronic heart failure in hospital register patients. Khazova E.V., Bulashova O.V., Oslopov V.N., Malkova M.I. P. 125

Association of cardiovascular risk and disproportionately high left ventricular myocardial mass. Shamkina A.R. P. 129

The features of panic attack differental diagnosis in admission department. Shikov A.S., Yakupov E.Z. P. 135

HELP FOR PRACTITIONER

Acute vestibular vertigo in the practice of neurologist of admission and diagnostic department. Zagidullina K.L., Popova N.A. P. 140

Lumbosacral plexopathy: clinical case description. Chizh R.S., Khakimova A.R. P. 143

Spontaneous hematoma of the anterior abdominal wall in emergency surgery clinic, sonographic aspects. Sharafislamov I.F., Klyushkin I.V., Klyushkina Ju.A., Mikhaylova O.N., Badretdinova A.R. P. 149

CLINICAL CASE

Cervix delamination in a patient with invasion of placenta previa to the uterine scar after cesarean section (clinical case presentation). Gabidullina R.I., Kalimullina G.N., Mikhaylova O.N., Mingazetdinov M.A., Shigabutdinova T.N., Sharafislamov I.F., Syrmatova L.I., Faizova G.R. P. 154

Syncope as a manifestation of pulmonary embolism. Oslopov V.N., Sadykova A.R. P. 159

Clinical scenario of recurrent severe pneumonia at the debut of anca-associated vasculitis. Palmova L.Yu., Podolskaya A.A., Pozdnyak V.А., Gabdrakhmanova G.R. P. 164

Pelvic organ disorders in patients with myasthenia gravis: clinical case presentation. Khafizova I.F., Galyavieva A.R. P. 170

Experience of IPOM method application in rupture of the diaphragm with the limitation period and small intestine perforation in the pleural cavity. Chikaev V.F., Bondarev Yu.V., Mannanov R.F., Mikhaylov A.R. P. 173

Zollinger-Еllison syndrome diagnosis and treatment (clinical case). Shaymardanov R.Sh., Gubayev R.F., Gafurov K.D., Nuriyev I.I., Bagautdinov E.B., Sharafiyev S.Z., Kurbanov R.R. P. 177

Spontaneous esophagus rupture treatment by endoscopic stenting (clinical case). Shaymardanov R.Sh., Gubayev R.F., Khamzin I.I., Gafurov K.D., Khisamiyev I.G., Bagautdinov E.B., Makarov D.V., Gostiaeva T.A., Sorokina E.S. P. 181

MEDICIN’S HISTORY

Neurosurgical department at city clinical hospital No 7 in Kazan is an emergency neurosurgery clinic of high medical technologies. Sadykov M.N., Danilov V.I., Karimov R.Kh., Khairullin N.T., Gabasov M.V., Panykhov A.G., Ismagilov D.O., Abdullin R.R., Ahmadullin R.N., Valeev I.E., Garifullin R.F., Dorofeeva O.I., Murtazin M.R., Mulikhov M.N., Timerbaev R.R., Khaliullin A.Kh. P. 187

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ORIGINAL RESEARCH

UDC 616.12-009.72-07:616.89-008.45/.47-07

DOI: 10.20969/VSKM.2018.11(5).9-12

PDF download COGNITIVE FUNCTION ASSESSMENT IN PATIENTS WITH UNSTABLE ANGINA

ANDREICHEVA ELENA N., C. Med. Sci., associate professor of the Department of internal medicine of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, е-mail: elena_andre@mail.ru

Abstract. Aim. To evaluate cognitive functions and compliance to treatment in patients hospitalized with a diagnosis of coronary heart disease and unstable angina. Material and methods. A survey of 70 patients younger than 55 years old hospitalized with primary diagnosis of acute coronary syndrome, diagnosed with coronary heart disease and unstable angina, during the examination, has been performed. The study was conducted on the 5-6th day of hospital stay, after stabilization of the clinical condition. Patients with the history of myocardial infarction, cerebrovascular disease, diabetes mellitus or atrial fibrillation have not been enrolled in the study. McNair & Kahn self-assessment questionnaire, MMSE mental status assessment test and Moriska – Green test were used to evaluate compliance to the treatment. Results and discussion. Absence of cognitive impairment was found in 10% of patients, mild cognitive function impairment was observed in 74,7% of the patients, short-term memory was affected in the majority of the cases (80% of patients). Compliance analysis of pre-hospital treatment showed that only 11,7% of patients were demonstrating high adherence to treatment. Conclusion. Cognitive function deficiency in patients with unstable angina can lead to inadequate compliance to the doctor’s recommendations for further treatment, and, therefore, it can be associated with a worse prognosis for cardiovascular mortality. Therefore, identifying cognitive impairment at the early stages can affect patient’s prognosis through increased adherence to treatment.

Key words: cognitive functions, unstable angina, compliance.

For reference: Andreicheva EN. Cognitive function assessment in patients with unstable angina. The Bulletin of Contemporary Clinical Medicine. 2018; 11 (5): 9–12. DOI: 10.20969/VSKM.2018.11(5).9-12.

REFERENCES

1. Zaharov VV. Nejropsihologicheskie testy; Neobhodimost’ i vozmozhnost’ primeneniya [Neuropsychological tests; Necessity and possibility of application]. Consilium Medicum. 2011; 13 (2): 82-90.

2. Smulevich AB, Syrkin AL, Drobizhev MYu, Ivanov SV. Psihokardiologiya [Psychocardiology]. Moskva: Meditsinskoye informatsionnoye agentstvo [Moscow: Medical Information Agency]. 2005; 784 p.

3. Chukaeva II. Chto takoe priverzhennost’ k lecheniyu i chto mozhno sdelat’ dlya ee uluchsheniya (na primere arterial’noj gipertonii) [What is adherence to treatment and what can be done to improve it (on the example of arterial hypertension)]. Lechebnoe delo [Journal of General Medicine]. 2012; 2: 21-26.

4. Lukina YV, Kutishenko NP, Martsevich SY. Problema priverzhennosti v sovremennoj medicine: vozmozhnosti resheniya, vliyanie na rezul’tativnost’ terapii i iskhody zabolevaniya [The problem of adherence to the treatment in modern medicine: possibilities of solution, impact on the effectiveness of therapy and disease outcomes]. Racional’naya farmakoterapiya v kardiologii [Rational Pharmacotherapy in Cardiology]. 2017; 13(4): 519-524.

5. Ageev FT, Smirnova MD, Fofanova TV. Povyshenie priverzhennosti k terapii: «delo tekhniki»?[ Increased adherence to therapy: «the matter of technology»?]. Serdechnaya Nedostatochnost’ [Russian Heart Failure Journal]. 2011; 12 (4): 66: 238-243.

6. Folstein MF, Folstein SE, McHugh PR. «Mini-mental state». A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975; 12: 189-198.

7. McNair DM, Kahn RJ. Self-assessment of cognitive defi cits. Assessment in geriatric psychoparmacology (T Crook, S Ferris, R Bartus (Eds)). 1983; 137-143.

8. Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. 1986; 24 (1): 67-74.

9. Markin SP. Narushenie kognitivnyh funkcij vo vrachebnoj praktike [Cognitive impairment in medical practice]. Voronezh: VGMA. 2008; 42 p.

10. Drobizhev MYu, Makuh EA, Dzantieva AI. Kognitivnye rasstrojstva v obshchej medicine. [Cognitive disorders in general medicine]. Lechashchij vrach [Lechashchi vrach]. 2007; 7: 33-35.

11. Zaharov VV. Vserossijskaya programma issledovanij epidemiologii i terapii kognitivnyh rasstrojstv v pozhilom vozraste (“Prometej“) [National Research Programme of Epidemiology and treatment of cognitive disorders in the elderly (“Prometheus”)]. Nevrologicheskij Zhurnal [Journal of Neurology]. 2006; 11: 27–32.

12. Kryukov NN, Portnova EV. Rol’ arterial’noj gipertonii i supraventrikulyarnyh aritmij v narushenii kognitivnoj funkcii: sovremennoe sostoyanie problemy [The role of arterial hypertension and supraventricular arrhythmias in the violation of cognitive function: the current state of the problem]. Raczional`naya farmakoterapiya v kardiologii [Ration Pharmacother Cardiol]. 2013; 9 (5): 519-524.

13. Skoog I, Lernfelt B, Landahl S et al. 15-year longitudinal study of blood pressure and dementia. Lancet. 1996; 347 (9009): 11301.

14. Forette F, Seux ML, Staessen JA et al. Prevention of dementia with antihypertensive treatment: new evidence from the Systolic Hypertension in Europe (SystEur) study. Arch Intern Med. 2002; 162 (18): 204652.

15. Ageev FT, Fofanova TV, Smirnova MD, Thostov ASh, Nelyubina AS, Kuz’mina AE, Galaninskij PV, Kadushina EB, Nuraliev EYu, Hejmec GI. Primenenie metodov tekhnicheskogo vozdejstviya na priverzhennost’ terapii u bol’nyh serdechnososudistymi zabolevaniyami v ambulatornoj praktike. Itogi godichnogo nablyudeniya [Technology-based methods in the improvement of therapy compliance among ambulatory cardiac patients: one-year follow-up data]. Kardiovaskulyarnaya terapiya i  profi laktika [Cardiovascular Therapy and Prevention]. 2012; 11 (4): 36-41.

 

UDC 617.586-002.44-06:616.379-008.64

DOI: 10.20969/VSKM.2018.11(5).12-16

PDF download FUNCTIONAL CLASSIFICATION OF THE DIABETIC FOOT SYNDROME AND ITS APPLICATION VALUE

BENSMAN VLADIMIR M., D. Med. Sci., professor of the Department of general surgery of Kuban State Medical University, Russia, 350063, Krasnodar, Mitrofan Sedin str., 4

SAVCHENKO YURIY P., D. Med. Sci., professor, Head of the Department of general surgery of Kuban State Medical University, Russia, 350063, Krasnodar, Mitrofan Sedin str., 4

TRIANDAFILOV KONSTANTIN G., C. Med. Sci., surgeon of Scientific Research Institute – Regional Clinical Hospital No 1 named after prof. S.V. Ochapovsky, Russia, 350086, Krasnodar, 1 May str., 167

Abstract. Common classification of diabetic foot syndrome by F.M. Wagner does not consider the diversity of its clinical types. It does not distinguish between purulent fusion of the foot tissues and gangrene, ulcers or suppuration. It does not consider the activity of inflammation or degree of ischemia. The classification of the University of Texas and PEDIS provide more information about diabetic foot syndrome. However, they also use the concept of «ulcer» more, while doctors often deal with neuropathy, infection, osteoarthropathy or ischemia. Finally, the classification of F.M. Wagner cannot be applied because it lacks recommendations for treatment. Aim. The aim of the study is to develop applied classification of diabetic foot syndrome, reflecting its main manifestations and therapeutic prognostic capabilities, taking into account modern data. Material and methods. The report is based on the 26-year experience of treatment of 1340 patients with diabetic foot syndrome, aged 7 to 34 years. Males were represented by 53%, females – by 47%. Patients’ age was from 27 to 83 years. The II type diabetes was diagnosed in 85,5% of patients. Almost half of the patients (48,5%) had been previously operated on with poor results. Clinical examination and study of glycemia was supplemented by Doppler ultrasonography and transcutaneous oximonitoring (TcPO2). Two-stage surgical treatment was performed according to the principles of active management in purulent surgery, developed at the Institute of Surgery named after A.V. Vishnevsky under the guidance of M.I. Kuzin and B.M. Kostyuchenka. The first step is to perform a secondary surgical treatment of a nidus of purulent infection, achieving the conversion of a purulent wound into contaminated one. In order to stop exudative disorganization it is often necessary to perform repeated surgical treatment. At the second stage the wound is being closed with a suture or tissue plastic. Results and discussion. Diabetic foot syndrome can be classified as neuropathic, neuroischemic and ischemic. It has been proposed to separate infected osteoarthropathy into independent classification category. Sharing this view, the signs of each of the four classification types of diabetic foot syndrome are neuropathic, neuroosteoarthropathic, neuroischemic, and ischemic. The neuropathic type of the diabetic foot syndrome is characterized by predisposition to purulent diseases and slower regeneration. Charcot’s neuroosteoarthropathy is distinguished by tarsal bone fragmentation, vegetative neuropathy, resistance to purulent infection, and wound healing by primary tension. Ischemia and acral necrosis are the characteristics of neuroischemic and ischemic types of diabetic foot syndrome. Conclusions. The practical application of the proposed functional classification contributes to solution of strategic issues and ensures the preservation of the supporting foot in (88,3±1,2)% of the surgically treated patients. Postoperative mortality, associated mainly with sepsis and hip amputation, was (6,2±0,7)%. Purulent and necrotic postoperative complications decreased, respectively, from (27,2±2,6)% to (3,7±0,9)% and from (33,6±3,0)% to (9,6±1,6)% (p<0,01).

Key words: classification, diabetic foot syndrome, diabetes mellitus.

For reference: Bensman VM, Savchenko UP, Triandafilov KG. Functional classification of the diabetic foot syndrome and its application value. The Bulletin of Contemporary Clinical Medicine. 2018; 11 (5): 12–16. DOI: 10.20969/VSKM.2018.11(5).12-16.

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1. Wagner FM. A classification and treatment program for diabetic, neuropatic and disvascular foot problems; In the American Academy of Orthopedics Surgeons instructional course lectures. St Louis: Mosby. 1979; 143-165.

2. Kuzin MI, Kostjuchenok ed. Rany i ranevaja infekcija [Wounds and wound infection]. Moskva: Medicina [Moscow: Medicine]. 1981; 688 p.

3. Gostishhev VK, Afanas’ev AN. Standarty lechebno-diagnos- ticheskih meroprijatij u bol’nyh diabeticheskoj osteoartropatiej i gnojno – nekroticheskimi porazhenijami stop [Standards of therapeutic and diagnostic measures in patients with diabetic osteoarthropathy and purulent – necrotic lesions of the feet]. Standarty diagnostiki i lechenija v gnojnoj hirurgii [Standards of diagnosis and treatment in purulent surgery]. 2001; 107-112.

4. Bensman VM. Hirurgija gnojno-nekroticheskih oslozhnenij diabeticheskoj stopy; Vtoroe izdanie [Surgery of purulent- necrotic complications of diabetic foot. Second edition]. Moskva: Medpraktika-M [Moscow: Medpraktika-M]. 2015; 496 p.

5. Mitish VA, Pashalova JuS, Eroshkin IJa, Galstjan GR, Blatun LA. Gnojno-nekroticheskie porazhenija pri nejroishemicheskoj forme sindroma diabeticheskoj stopy [Purulent-necrotic lesions in the neuroischemic form of diabetic foot syndrome]. Hirurgija [Surgery]. 2014; 1: 48-52.

6. Strjapuhin VV, Bensman VM, Lishhenko AN. Vybor hirur- gicheskoj taktiki pri lechenii gnojno-nekroticheskih oslozhnenij ishemicheskih form sindroma diabeticheskoj stopy [The choice of surgical tactics in the treatment of purulent-necrotic complications of ischemic forms of the diabetic foot syndrome]. Vestnik jeksperimental’noj i klinicheskoj hirurgii [Bulletin of experimental and clinical surgery]. 2011; 4 (3): 462- 468.

 

UDC 616.831-005.4-06:616.127-005.8

DOI: 10.20969/VSKM.2018.11(5).16-22

PDF download COMBINED ACUTE CEREBROVASCULAR DISEASE AND MYOCARDIAL INFARCTION TREATMENT EXPERIENCE

BILALOVA RESEDA R., C. Med. Sci., high level certificate specialist on functional diagnostics of City Clinical Hospital No 7, Russia, 420103, Kazan, Chuykov str., 54, тel. (843) 221-39-72

IBRAGIMOVA GULNARA Z., ultrasonic medical investigation second-class specialist of City Clinical Hospital No 7, Russia, 420103, Kazan, Chuykov str., 54, tel. +7-937-282-48-51, e-mail: morgens_vesna@mail.ru

ZAYTSEVA ALBINA R., high level certificate neurologist, Head of the Department of intensive care and resustitation No 2 of City Clinical Hospital No 7, Russia, 420103, Kazan, Chuykov str., 54, tel. (843) 221-36-60

KOROLEVA ELVIRA M., high level certificate neurologist, Head of the office of neurophysiological studies of City Clinical Hospital No 7, Russia, 420103, Kazan, Chuykov str., 54, e-mail: okorolev@yandex.ru

ISKHAKOVA ALIYA R., high level certificate specialist on functional diagnostics of City Clinical Hospital No 7, Russia, 420103, Kazan, Chuykov str., 54, e-mail: al-rust@mail.ru

Abstract. The problem of acute cerebral circulation disorder and myocardial infarction, as well as their interrelation, is highly relevant due to significant incidence of these diseases and a high percentage of disability and mortality. Aim. The aim of the study is to evaluate the effectiveness of thrombolytic therapy in combination of acute cerebrovascular accident and myocardial infarction. Material and methods. Clinical case of a young man with ischemic stroke and concomitant myocardial infarction, who was administered thrombolytic therapy, is presented. Results and discussion. Round-the-clock observation of a patient in the intensive care unit made it possible to diagnose the combination of stroke with myocardial infarction in a timely manner. In this case, positive results were obtained by arresting the disease of the cardiovascular system and the brain, preserving the working ability of the patient. Cooperation of neurologist, cardiologist, specialists on radiation and functional diagnostics for treatment and diagnosis of the patient leaded to positive result since the moment of admission till discharge of the patient from the hospital.Conclusion. The presence of complex symptoms during the examination of patients requires cardiologist and neurologist to be alert to conduct a targeted search for a combination of myocardial infarction and acute cerebral circulation disorder. It is extremely important to timely recognize the cases of combined myocardial infarction and acute cerebral circulatory disorders, as the late diagnosis leads to errors in profile hospitalization strategy and causes delays in providing specialized medical care.

Key words: ischemic stroke, acute coronary syndrome, thrombolytic therapy.

For reference: Bilalova RR, Ibragimova GZ, Zaitseva AR, Koroleva EM, Ishakova AR. Combined acute cerebrovascular disease and myocardial infarction treatment experience. The Bulletin of Contemporary Clinical Medicine. 2018; 11 (5): 16–22.DOI: 10.20969/VSKM.2018.11(5).16-22.

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  7. Klinicheskiye rekomendatsii po provedeniyu tromboliticheskoy terapii u patsiyentov s ishemicheskim insul’tom utverzhdeny resheniyem Prezidiuma Vserossiyskogo obshchestva nevrologov 17/02/2015. [Clinical recommendations for conducting thrombolytic therapy in patients with ischemic stroke were approved by the decision of the Presidium of the All-Russian Society of Neurology February 17, 2015]. 2015; 49 p.

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UDC 616.831.94-005.1-073.432.19

DOI: 10.20969/VSKM.2018.11(5).22-25

PDF download TRANSCRANIAL DOPPLER SONOGRAPHY APPLICATION FOR АNGIOSPASM PROGNOSIS IN PATIENTS WITH NONTRAUMATIC SUBARACHNOID HEMORRAGE

VALEEVA KADRIA G., neurologist, specialist in functional diagnostics of Stroke department of City Clinical Hospital No 7, Russia, 420130, Kazan, Chuykov str., 54, e-mail: valeevakadria@yandex.ru

YAKUPOVA AIDA A., D. Med. Sci., associate professor of the Department of neurology and neurosurgery of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49; Head of Neurology Research Сenter of Stroke department of City Clinical Hospital No 7, Russia, 420103, Kazan, Chuikov str., 54, e-mail: aidayakupova@yandex.ru

Abstract. Aim. The aim of the study was to evaluate transcranial Doppler sonography application for detection, monitoring and prognosis of complications of subarachnoid hemorrhage. Material and methods. Data analysis of transcranial Doppler sonography performed in 30 patients [(59±1,05) years] with subarachnoid hemorrhage was carried out at angiology center at City Clinical Hospital No 7. Results and discussion. When analyzing the data of transcranial Doppler sonography performed in 30 patients, 4 groups were identified, divided according to the type and severity of angiospasm. The indicators of linear blood flow velocity, the pulsatile index, Lindengaard index, and cerebrovascular reactivity coefficient were evaluated in each group. When comparing between the groups, a high degree of positive correlation was obtained between the maximum linear blood flow velocity and the Lindengaard index (r=+0,60; p<0,01). Assessment of the severity of spasm and aneurysm location showed that pronounced spasm prevails in patients with aneurysms in the anterior cerebral artery, which is an anterior connective artery. The absence of spasm was found in patients with internal carotid artery aneurysms (p<0,05). The results of the analysis showed that cerebrovascular reactivity coefficient, Lindengaard Index, and slightly less pulsative index (p<0,0001), have the greatest value for predicting the disease. A positive correlation was found between increased blood flow velocity and echo signs of intracranial hypertension (r=0,42; p<0,01). Conclusion. Analysis of transcranial Doppler data application showed that this method of investigation is effective and highly sensitive for detecting, monitoring and predicting the complications of spontaneous subarachnoid hemorrhage and the outcome of the disease.

Key words: subarachnoid hemorrhage, transcranial Doppler sonography, angiospasm.

For reference: Valeeva KG, Yakupova AA. Transcranial Doppler sonography application for angiospasm prognosis in patients with nontraumatic subarachnoid hemorrage. The Bulletin of Contemporary Clinical Medicine. 2018; 11 (5): 22–25. DOI:10.20969/VSKM.2018.11(5).22-25.

REFERENCES

1. Protas RN, Lukomskiy IV, Alekseyenko YuV, Pashkov AA. Prichiny vozniknoveniya i osobennosti klinicheskikh proyavleniy netravmaticheskikh subarakhnoidal’nykh krovoizliyaniy [Causes and features of clinical manifestations of non-traumatic subarachnoid hemorrhage]. Zdravookhranenie Belorussii [Healthcare of Belarus]. 1994; 8: 11-13.

2. Sarrafzadeh A, HauxD, Sakowitz O, et al. Acute focal neurological deficits in aneurysmal subarachnoidhemorrhage: relation of clinical course, CT findings, and metabolite abnormalitiesmonitored with bedside microdialysis. Stroke. 2003; 34 (6): 1382-1388.

3. Charpentier C, Audibert G, Guillemin F, et al. Multivariate analysis of predictors of cerebral vasospasm occurrence after aneurysmal subarachnoid hemorrhage. Stroke. 1999; 30 (7): 1402-1408.

4. Krylov VV, Grigor’yeva YeV, Khamidova LT, Muslimov RSh. Sravnitel’nyy analiz dannykh komp’yuternoy tomografii i intrakranial’noy dopplerografii u patsiyentov s tserebral’nym angiospazmom [Comparative analysis of computed tomography and intracranial Doppler imaging in patients with cerebral angiospasm]. Nevrologicheskiy zhurnal [Neurological Journal]. 2016; 6: 344-352.

5. Stulin ID et al. Rol’ instrumental’nogo monitoringa v diagnostike i prognozirovanii ONMK [The role of instrumental monitoring in the diagnosis and prediction of stroke]. Zhurnal nevrologii i psikhiatrii imeni SS Korsakova [Journal of Neuroscience and Psychiatry named after SS Korsakov]. 2003; 9: 154.

6. Leylyuk VG, Leylyuk SYe. Ul’trazvukovaya angiologiya (2 ye izdaniye) [Ultrasonic Angiology (2nd edition)]. Moskva: Real’noye vremya [Moscow: Real time]. 2003; 322 p.

7. Torbey MT, Hauser TK, Bhardwaj A. Effect of age blood flow velocity and incidence of vasospasm after aneurysnal subarahnoid hemorrhage. Stroke. 2001; 32: 2005-2011.

8. Hunt W, Hess R. Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg. 1968; 28: 14-20.

 

UDC 616.831-001.34-06:616.133.33

DOI: 10.20969/VSKM.2018.11(5).25-30

PDF download CEREBROVASCULAR REACTIVITY IN PATIENTS WITH CEREBRAL CONCUSSION AND THE OPPORTUNITIES OF ITS PHARMACOLOGICAL CORRECTION

GARIFULLIN RENAT F., neurosurgeon of the Department of neurosurgery of City Clinical Hospital No 7, Russia, 420103, Kazan, Chuykov str., 54, tel. 8-904-662-13-97, e-mail: doctor-nerv@mail.ru

DANILOV VALERIJ I., D. Med. Sci., professor, Head of the Department of neurology and neurosurgery of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, e-mail: asadullina_z@mail.ru

KARIMOV RAVIL KH., C. Med. Sci., Chief specialist for neurosurgery of City Clinical Hospital No 7, Russia, 420103, Kazan, Chuykov str., 54, e-mail: ravilkarimov@gmail.com

Abstract. Aim. Investigation of cerebral vessel reactivity in patients with brain concussion and the opportunities of its pharmacological correction by dimephosphone was performed. Material and methods. 50 patients diagnosed with cerebral concussion have been enrolled at the study. All patients were hospitalized to the Department of neurosurgery of the City Clinical Hospital No7. The patients were divided into 2 groups. The patients of the first and the second groups received drug treatment in accordance with the guidelines for mild traumatic brain injury treatment, approved at XXXIII Plenum of Board Association of Neurosurgeons of Russia. The patients of the second group were additionally receiving 15 ml 15% dimephosphone solution 3 times a day per os since the first day and during the entire period of hospital stay. Transcranial Doppler sonography was applied to measure linear velocity of blood flow in the anterior cerebral artery, middle cerebral artery and posterior cerebral artery with functional test performance (compression test, hypercapnic test, hypocapnic test) since day 1 till day 7 of hospital stay.Results and discussion. All patients demonstrated impaired cerebral circulation compensatory functions. The results obtained indicate a decrease in cerebrovascular reactivity. The use of dimephosphone in combination with standard drug treatment in patients with brain concussion leads to a more rapid recovery of cerebral circulation regulatory mechanisms. Conclusion. It was established that impaired cerebral vessel reactivity appears in all patients with cerebral concussion. Oral administration of 15% dimephosphone solution promotes faster normalization of the functions.

Key words: dimephosphone, cerebrovascular reactivity, brain concussion, mild brain trauma.

For reference: Garifullin RF, Danilov VI, Karimov RKh. Cerebrovascular reactivity in patients with cerebral concussion and the opportunities of its pharmacological correction. The Bulletin of Contemporary Clinical Medicine. 2018; 11 (5): 25–30. DOI:10.20969/VSKM.2018.11(5).25-30.

REFERENCES

1. Potapov AA, Lihterman LB, Zel’man VL, Kornienko VH, Kravchuk AD. Dokazatel’naya nejrotravmatologiya [Evidence- based neurotraumatology]. Moskva [Moscow]: Vneshtorgizdat. 2003; 715 p.

2. Lihterman LB, Potapov AA. Klinicheskoe rukovodstvo po cherepno-mozgovoj travme: Klassifikaciya cherepno-mozgovoj travmy [Clinical guide to traumatic brain injury: Classification of traumatic brain injury]. Moskva [Moscow]: Antidor. 1998; 1: 47-123.

3. Danilov VI, Pankova VP, Studencova IA, Vizel’ AO. Eksperimental’no-klinicheskoe obosnovanie primeneniya dimefosfona pri operacionnoj i cherepno-mozgovoj travmah [Experimental and clinical substantiation of the use of dimephosphone in the operating room and traumatic brain injury]. Nejrohirurgiya [Neurosurgery]. 2002; 2: 43-48.

4. Garifullin RF, Danilov VI, Karimov RH. Reaktivnost’ tserebral’nykh sosudov u patsiyentov s ochagami ushiba golovnogo mozga i vozmozhnosti yeyo farmakologicheskoy korrektsii [Cerebrovascular reactivity in patients with cerebral contusion and its possible pharmacological correction]. Kazanskij medicinskij zhurnal [Kazan medical journal]. 2016; 97 (6): 903-908.

 

UDC 616.832-001-083.2

DOI: 10.20969/VSKM.2018.11(5).30-34

PDF download THE PRINCIPLES OF COMPLEX NUTRITIONAL STATUS DISORDER CORRECTION IN PATIENTS WITH SPINAL CORD INJURY

GUMAROVA LAYSYAN SH., assistant of professor of the Department of rehabilitation and sports medicine of Kazan State Medical Academy – the branch of Russian Medical Academy of Postgraduate Education; physiotherapist, physician of the Department of stroke of City Clinical Hospital No 7, Russia, 420103, Kazan, Chuikov str., 36, e-mail: lyaisan@inbox.ru

BODROVA REZEDA A., D. Med. Sci., associate professor, Head of the Department of rehabilitation and sports medicine of Kazan State Medical Academy – the branch of Russian Medical Academy of Postgraduate Education, Russia, 420012, Kazan, Butlerov str., 36, e-mail: bodrov7@yandex.ru

NAZIPOVA ALFIYA YA., C. Med. Sci., Head of the Department of stroke of City Clinical Hospital No 7, Russia, 420103, Kazan, Chuikov str., 54, e-mail: Nazipova.A@yandex.ru

BUSURGINA ELENA A., neurologist of the Department of stroke of City Clinical Hospital No 7, Russia, 420103, Kazan, Chuikov str., 54, e-mail: Elena.busurgina@mail.ru

Abstract. Aim. The aim of the research was to study the effectiveness of complex nutritional status correction in patients with spinal cord traumatic diseases. Material and methods. 76 patients with traumatic disease of the spinal cord in intermediate or late recovery period, assessed in terms of nutritional status over time have been enrolled in the study. The patients with malnutrition against the background of standard therapy in the main group underwent comprehensive correction of nutritional status with additional administration of hypercaloric mixtures for high-protein enteral nutrition in combination with active-passive mechanotherapy. The patients in control group underwent rehabilitation measures according to the standard approaches, including vascular therapy, physical therapy, massage, and physiotherapy. Results and discussion. As a result of the correction, the proportion of patients with mild and moderate malnutrition became significantly lower in the main group I compared to the control group (p=0,05). Peak oxygen consumption increased by 37,6% in patients of the main group compared with the control group, where mechanotherapy was not performed. Improvement in motor and social activity according to the FIM scale was found to be 25,8% in patients with spastic brain disease of the main group (p<0,001). Conclusion. The combination of adequate nutritional support associated with in time active-passive mechanotherapy leads to normalization of nutritional status in patients with traumatic spinal cord disease (p=0,05), increased tolerance to physical exertion (p<0,01) and improved motor and social indicator activity (p<0,0001).

Key words: spinal cord injury, malnutrition, nutritional support, active/passive mechanotherapy.

For reference: Gumarova LSh, Bodrova RA, Nazipova AYa, Busurgina EA. The principles of complex nutritional status disorder correction in patients with spinal cord injury. The Bulletin of Contemporary Clinical Medicine. 2018; 11 (5): 30–34.DOI: 10.20969/VSKM.2018.11(5).30-34.

REFERENCES

1. Furlan JC, Sakakibara BM, Miller WC, Krassioukov AV. Global incidence and prevalence of traumatic spinal cord injury. Can J Neurol Sci. 2013; 40 (4): 456-464. DOI: 10.1017/ S0317167100014530.

2. Lebedev VV, Krylov VV, Halchevsky VM. Komp’uternaya tomographiya v neotlozhnoi hirurgii [Computerized Tomography in Neurosurgical Neurosurgery]. Moskva: Meditsina [Мoscow: Меdicine]. 2005; 360 p.

3. Basilevskaya ZV, Golovniy LL, Kirkinskaya TA. Struktura letal’nosti pri povrezhdenii pozvonochnika i spinnogo mozga [Structure of mortality in case of spinal cord injury]. Voprosy neirohirurgii [Questions of neurosurgery]. 1980; 6: 37-41.

4. Kuznetsova EYu, Garkusha LG, Sidorova GV. Kliniko- epidemiologicheskaya kharakteristika invalidov s oslozhnennoy pozvonochno-spinnomozgovoy travmoy, kak osnova bazovoy programmy reabilitatsii [Clinico-epidemiological characteristics of disabled people with complicated spinal cord trauma, as the foundation of the basic rehabilitation program]. In VIII Vserossiyskaya nauchno-prakticheskaya konferentsiya Polenovskie chteniya; Tezicy dokladov [VIII All-Russian scientific-practical Conference, Polenov readings; Conference proceedings]. Sankt-Peterburg [St Petersburg]. 2009; 96-97.

5. Dragun VM, Bersnev VP, Valerko VG. Taktika khirurgicheskogo lecheniya povrezhdeniy sheynogo otdela pozvonochnika [Tactics of surgical treatment of cervical spine injuries]. In VIII Vserossiyskaya nauchno-prakticheskaya konferentsiya Polenovskie chteniya; Tezicy dokladov [VIII All-Russian scientific-practical Conference, Polenov readings; Conference proceedings]. Sankt-Peterburg [St Petersburg]. 2009; 89.

6. Black McL Peter, Barrow Daniel L. Complications and Sequelae of Head Injury. Thieme Verlagsgruppe. 1992; 201 p. 7. Wong S, Derry F, Jamous A, et al. Profile and prevalence of malnutrition in children with spinal cord injuries – assessment of the Screening tool for Assessment in Paediatrics (STAMP). Spinal Cord. 2011; 50: 67-71.

8. Wong S, Derry F, Jamous A, Hirani SP, Grimble G, Forbes A. The prevalence of malnutrition in spinal cord injuries patients: a UK multicentre study. Br J Nutr. 2011; 108 (5): 918-923. DOI: 10.1017/s0007114511006234.

9. Gumarova LSH, Bodrova RA. Potrebnost’ v nutritivnoy podderzhke u patsiyentov s posledstviyami travm tsentral’noy nervnoy sistemy [Assesment of need in nutritional support in patients with the consequences of central nervous system injuries]. Zhurnal nevrologii i psikhiatri imeni SS Korsakova [Journal of Neurology and Psychiatry named after SS Korsakov]. 2016; 3: 83-87. DOI: 10.17116/ jnevro20161163183-87.

10. Ivanova GE, Krylov VV, Tsykunov MB, Polyaev BA. Reabilitatsiya bol’nyh s travmaticheskoy bolezn’yu spinnogo mozga [Rehabilitation of patients with traumatic spinal cord injury]. Moskva: Moskovskiye uchebniki i kartolitografiya [Moscow: Moscow textbooks and cartolithography]. 2010; 640 p.

11. Prikaz No330 MZ RF ot 05/08/13 «O merah po usovershenst- vovaniyu lechebnogo pitaniya v lechebno-profilakticheskih uchrezhdeniyah RF» [Order 330 of the Ministry of Health of the Russian Federation of 05/08/03 «About measures to improve therapeutic nutrition in medical institutions of the Russian Federation»]. 2003; http://ivo.garant.ru/#/ document/12132439:0

12. Zaborova VA, et al. Energoobespechenie I pitanie v sporte [Energy supply and nutrition in sports]. Moskva: Fizicheskaya kul’tura [Moscow: Physical Culture]. 2011; 107 p.

  1. Dhall Sanjay S, Hadley Mark N, Aarabi Bizhan, Gelb Daniel E, Hurlbert R John. Nutritional support after spinal cord injury. Neurosurgery. 2012; 72: 255-259. DOI: 10.1227/ neu.0b013e31827728d9.

  2. Krylov KYu, Savin IA, et al. Metabolicheskiy monitoring u bol’nykh v ostrom periode tyazheloy cherepno-mozgovoy travmy [Metabolic monitoring in patients in acute period of severe craniocerebral trauma]. Vestnik anesteziologii I reanimatologii [Messenger of anesthesiology and resuscitation]. 2012; 9 (6): 29-33.

 

UDC 616-099-085.032.14+[615.31:547.461.4].03

DOI: 10.20969/VSKM.2018.11(5).35-43

PDF download MANAGED INFUSION THERAPY FOR UNSPECIFIED SUBSTANCE TOXIC EFFECTS

DAVYDOVA VERONIKA R., C. Med. Sci., assistant of professor of the Department of anesthesiology, intensive care and disaster medicine оf Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, tel. 8-919-632-62-11, e-mail: vevojuyar@gmail.com

USTIMOV DMITRY YU., assistant of professor of the Department of anesthesiology, intensive care and disaster medicine of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49; anesthesiologist-intensivist of City Clinical Hospital No 7, 420103, Kazan, Chuikov str., 54

BERDNIKOVA EKATERINA A., anesthesiologist-intensivist of City Clinical Hospital No 7, 420103, Kazan, Chuikov str., 54

Abstract. Aim. To improve the quality of treatment of patients admitted to the intensive care unit with a diagnosis of «T40.9. Poisoning with other or unspecified psychodisleptics (hallucinogens)» and «T43.9. Poisoning with unspecified psychotropic drugs». Material and methods. 90 patients [62 men (68,8%) and 28 women (31,2%)] admitted to intensive care unit No 1 at city clinical hospital No 7 in 2014–2017 in a comatose state diagnosed with T40.9 and T43.9 (according to ICD-10) were enrolled at the study. The patients were divided into 3 groups of 30 people randomly upon admission. The time of the study considered the time of hospital stay. All patients underwent clinical and laboratory examination and necessary treatment. Results and discussion. According to the study, it was revealed that infusion therapy managed according to lactate and ScvO2 monitoring leaded to faster homeostasis improvement in group II and III comparing to group I with monitoring solely lactate. The decrease in lactate level in group II and III occurred faster, which indicates an earlier tissue oxygen balance restoration. A larger daily volume of infusion therapy and higher doses of vaso-inotropic support were required for patients of groups II and III. However, recovery in these patients occurred faster than in group I. As a result of infusion therapy optimization on the basis of joint monitoring of lactate and ScvO2 clearance, coma symptoms were reduced beforehand, which was the criterion of recovery. The use of 1,5% meglumine sodium succinate also led to an earlier tissue oxygen balance restoration compared with the control group. In meglumine sodium succinate group tachycardia decreased faster but blood pressure was elevating more slowly due to the special properties of this method. The best indicators of coma reduction were recorded in group III, where monitoring of ScvO2 was combined with the use of 1,5% meglumine sodium succinate. Conclusion. Pathogenetic therapy should be used to stabilize tissue oxygen balance in the course of treatment of severe poisoning with unspecified toxic psychotropic substance. Tissue oxygen balance restoration, assesses by reaching the target values of lactate and ScvO2, accelerates the reduction of coma. The use of the 1,5% meglumine sodium succinate drug in treatment of poisoning, due to the toxic effect of an unspecified psychotropic substance, allows providing the target level of detoxification against the background of pathogenetic infusion therapy, reducing the duration of delirium and the time spent in the intensive care unit. The best results were obtained in combination of infusion therapy, managed according to central venous saturation (ScvO2) monitoring and 1,5% meglumin sodium succinate infusion.

Key words: anesthesiology, resuscitation, poisoning with unspecified chemical substance, infusion therapy, venous saturation, meglumine sodium succinate.

For reference: Davydova VR, Ustimov DYu, Berdnikova EA. Managed infusion therapy for unspecified substance toxic effects. The Bulletin of Contemporary Clinical Medicine. 2018; 11 (5): 35–43. DOI: 10.20969/VSKM.2018.11(5).35-43.

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31. Kondrashova MN, Maevsky EI, Gusar IB, Anisimov VN, Kaminsky YuG, Kosenko EA. Endogenous succinate in mitochondria respiration under different states of organism. Bologna, Italy: First European bioenergetic conference: abstracts. 1980; 371–372.
32. Rumyantseva SA, Kriticheskiye sostoyaniya v klinicheskoy praktike [Critical states in clinical practice]. Moskva: MIG «Meditsinskaya kniga» [Moscow: MIG “Medical book”]. 2010; 640 p.
33. Usenko LV, Kligunenko YeN, Krishtafor AA, Kanyuka GS. Perftoran i zhizn’ v obshchestve posle perenesennoy travmaticheskoy i netravmaticheskoy ishemii golovnogo
mozga; Perftororganicheskiye soyedineniya v biologii i meditsine [Perftoran and life in society after a traumatic and non-traumatic cerebral ischemia; Perfluoroorganic compounds in biology and medicine]. Pushchino: Nauka [Pushchino: Science]. 2001; 156–163.
34. Usenko LV, Kligunenko YeN, Doronin AG. Dinamika funktsional’nogo sostoyaniya kory golovnogo mozga pri lechenii eksperimental’noy cherepno-mozgovoy travmy yantarno-kislym natriyem [Dynamics of the functional state of the cerebral cortex in the treatment of experimental craniocerebral trauma by amber-acid sodium]. Dnepropetrovsk: Aktual’nyye problemy teoreticheskoy i klinicheskoy meditsiny [Dnepropetrovsk: Actual problems of theoretical and clinical medicine]. 1996; 64–67.
35. Isakov VA, Kovalenko AL, Turkin VV, Aspel’ YuV. Primeneniye novykh immunotropnykh i antioksidantnykh sredstv v terapii grippa i ORZ: Rukovodstvo dlya vrachey [The use of new immunotropic and antioxidant agents in the treatment of influenza and acute respiratory disease: A guide for physicians]. SPb. 2001; 74 p.
36. Kligunenko YeN, Bondar’ VK, Doronin AG. Funktsional’noye sostoyaniye kory golovnogo mozga i obmen biogennykh aminov pod vliyaniyem natriya suktsinata pri eksperimental’noy CHMT [Functional state of the cerebral cortex and exchange of biogenic amines under the influence of sodium succinate in the experimental TBI]. Kustanay: Materialy IV nauchno- prakticheskaya konferentsiya anesteziologov Kazakhstana; Chast’ III [Kustanay: Proceedings of the IV scientific-practical conference of anesthesiologists of Kazakhstan. Part III]. 1986; 56–60.
37. Gusev YeI, Skvortsova VI. Ishemiya golovnogo mozga [Ischemia of the brain]. Moskva: Meditsina [Moscow: Medicine]. 2001; 328 p.

 

UDC 616.1-056.7:616.132.2-007.271

DOI: 10.20969/VSKM.2018.11(5).43-47

PDF download FAMILY HISTORY OF CORONARY HEART DISEASE AND LEFT MAIN CORONARY ARTERY STENOSIS GENETIC MARKERS IN PATIENTS WITH ACUTE CORONARY SYNDROME

IVANTSOV EVGENIY N., assistant of professor of the Department of introduction into internal medicine of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, e-mail: zhenia.iva91@gmail.com

MAGAMEDKERIMOVA FERIDA A., assistant of professor of the Department of introduction into internal medicine of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, e-mail: ferida_oradro.92@mail.ru

MAKAROV MAXIM A., C. Med. Sci., assistant of professor of the Department of introduction into internal medicine of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, e-mail: maks.vfrfhjd2011@yandex.ru

FADEEV GRIGORIY A., physician of the Department of X-ray and endovascular diagnosis and treatment of City Clinical Hospital No 7, Russia, 420103, Kazan, Chuikov str., 54, e-mail: vazax@bk.ru

KHASANOV NIYAZ R., D. Med. Sci., Head of the Department of introduction into internal medicine of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, e-mail: ybzp@mail.ru

Abstract. Aim. The aim of the study is to analyze hereditary cardiovascular history and left coronary artery atherosclerotic lesions in non-smoking patients with acute coronary syndrome in association with the VEGF-A gene rs699947 polymorphism. Material and methods. 122 non-smoking patients with acute coronary syndrome aged from 29 to 87 years [mean age was (66,5±1,01) years] hospitalized to the cardiology department at Kazan City Clinical Hospital No 7 have been enrolled in the study. Among them there were 50 men and 72 women. There were 32 patients with unstable angina and 90 patients with myocardial infarction of different localization in the study group, including 61 patients with ST segment elevation on electrocardiogram. A family history of cardiovascular diseases was evaluated in all patients, coronary angiography and VEGF-A gene rs699947 polymorphism determination by PCR were performed. Results and discussion. Aggravated family history of coronary heart disease was more common among AA genotype carriers (51,7%) than in CC genotype carriers (13,5%; p=0,001). The differences with the carriers of the VEGF-A gene ACrs699947 genotype were not statistically significant (42,9%; p=0,5). There was a significantly lower incidence of aggravated family history among carriers of CC genotype compared to AC genotype carriers (p=0,003) and to all allele A carriers (45,9%; p=0,0004). The aggravated family cardiovascular history was more common among allele A carriers, than in allele C carriers (45,9% and 31,2%, respectively; p=0,03). Middle and severe left coronary artery stenosis was observed in 17 (13,9%) patients. The highest incidence of stenosis of the left coronary artery trunk was observed in AU genotype carriers (23,2%) comparing to all other patients (4,3%; p=0,0036). The analysis also showed that left coronary artery trunk stenosis was significantly less frequently observed in CC genotype carriers (2,7%) compared to AU genotype carriers (23,2%; p=0,007) and allele A carriers (18,8%; p=0,035). Conclusion. The data obtained indicate the association of allele A with hereditary burden of coronary heart disease, and the AU genotype with atherosclerotic lesion of the left coronary artery stem with a certain protective function of the VEGF-A gene CC rs699947 in relation to the hereditary predisposition to coronary heart disease and significant atherosclerotic lesion of the trunk of the left coronary artery.

Key words: rs699947, VEGF-A gene, acute coronary syndrome, IHD, genetics, atherosclerosis of the left main coronary artery.

For reference: Ivantsov EN, Magamеdkerimova FA, Makarov MA, Fadeev GA, Khasanov NR. Family history of coronary heart disease and left main coronary artery stenosis genetic markers in patients with acute coronary syndrome. The Bulletin of Contemporary Clinical Medicine. 2018; 11 (5): 43–47. DOI: 10.20969/VSKM.2018.11(5).43-47.

REFERENCES

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  5. Sianos G, Morel M-A, Kappetein AP, Morice M-C, Colombo A, Dawkins K, et al. The SYNTAX Score: an angiographic tool grading the complexity of coronary artery disease. EuroIntervention J Eur Collab Work Group Interv Cardiol Eur Soc Cardiol. 2005; 1 (2): 219-227.

  6. Chikwe J, Kim M, Goldstone AB, Fallahi A, Athanasiou T. Current diagnosis and management of left main coronary disease. Eur J Cardio-Thorac Surg Off J Eur Assoc Cardio- Thorac Surg. 2010; 38 (4): 420-428.

  7. Barbarash O, Polikutina O, Tavlueva E, Barbarash N. Left main coronary artery stenosis: cardiologist view. Kreat Kardiologiya. 2015; (2): 5-20.

  8. Petch MC. The progression of coronary artery disease. Br Med J Clin Res. 1981; 283 (6299): 1073-1074.

  9. Bergelson BA, Tommaso CL. Left main coronary artery disease: assessment, diagnosis, and therapy. Am Heart J. 1995; 129 (2): 350-359.

  10. Zateeyshchikov YES, Minushkina LO, Chumakova OS, Sidorenko BA. Geneticheskiye issledovaniya v kardiologii: prognozirovaniye riska neblagopriyatnykh iskhodov i problema personalizirovannogo lecheniya [Genetic studies in cardiology: predicting the risk of adverse outcomes and the problem of personalized treatment]. Kremlevskaya Meditsina; Klinicheskiy Vestnik [Kremlin Medicine; Clinical Herald]. 2014; (1): 84-91.

11. Hsiao P-J, Lu M-Y, Chiang F-Y, Shin S-J, Tai Y-D, Juo S-HH. Vascular endothelial growth factor gene polymorphisms in thyroid cancer. J Endocrinol. 2007; 195 (2): 265-270.

12. Cui QT, Li Y, Duan CH, Zhang W, Guo XL. Further evidence for the contribution of the vascular endothelial growth factor in the coronary artery disease susceptibility. Gene. 2013; 1, 521 (2): 217-221.

13. Centers for Disease Control and Prevention (US), National Center for Chronic Disease Prevention and Health Promotion (US), Office on Smoking and Health (US). How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease: A Report of the Surgeon General [Internet]. Atlanta (GA): Centers for Disease Control and Prevention (US); 2010 [cited 2018 Aug 6]. http://www. ncbi.nlm.nih.gov/books/NBK53017/

14. Expert Consensus Document. Third Universal Definition of Myocardial Infarction. Rev Esp Cardiol Engl Ed. 2013; 66 (2): 132.

15. İşcanlı MD, Aksu NM, Evranos B, Aytemir K, Özmen MM. Comparison of the TIMI and Gensini score in patients admitted to the emergency department with chest pain, who underwent coronary angiography. Med Sci Monit Int Med J Exp Clin Res. 2014; 20: 343-349.

16. Reference SNP (refSNP) Cluster Report: rs699947. https:// www.ncbi.nlm.nih.gov/projects/SNP/snp_ref.cgi?rs=699947

17. Fagerberg L, Hallström BM, Oksvold P, Kampf C, Djureinovic D, Odeberg J, et al. Analysis of the human tissue-specific expression by genome-wide integration of transcriptomics and antibody-based proteomics. Mol Cell Proteomics MCP. 2014; 13 (2): 397-406.

18. Yang B, Cross DF, Ollerenshaw M, Millward BA, Demaine AG. Polymorphisms of the vascular endothelial growth factor and susceptibility to diabetic microvascular complications in patients with type 1 diabetes mellitus. J Diabetes Complications. 2003; 17 (1): 1-6.

19. Awata T, Kurihara S, Takata N, Neda T, Iizuka H, Ohkubo T, et al. Functional VEGF C-634G polymorphism is associated with the development of diabetic macular edema and correlated with macular retinal thickness in type 2 diabetes. Biochem Biophys Res Commun. 2005; 333 (3): 679-685.

20. Abhary S, Burdon KP, Gupta A, Lake S, Selva D, Petrovsky N, et al. Common sequence variation in the VEGFA gene predicts the risk of diabetic retinopathy. Invest Ophthalmol Vis Sci. 2009; 50 (12): 5552-5558.

21. Nakamura S, Iwasaki N, Funatsu H, Kitano S, Iwamoto Y. Impact of variants in the VEGF gene on progression of proliferative diabetic retinopathy. Graefes Arch Clinic Exp Ophthalmol Albrecht Von Graefes Arch Klin Exp Ophthalmol. 2009; 247 (1): 21-26.

22. Chun M-Y, Hwang H-S, Cho H-Y, Chun H-J, Woo J-T, Lee K-W, et al. Association of vascular endothelial growth factor polymorphisms with nonproliferative and proliferative diabetic retinopathy. J Clin Endocrinol Metab. 2010; 95 (7): 3547-3551.

23. Abdel Fattah RA, Eltanamly RM, Nabih MH, Kamal MM. Vascular Endothelial Growth Factor Gene Polymorphism is not Associated with Diabetic Retinopathy in Egyptian Patients. Middle East Afr J Ophthalmol. 2016; 23 (1): 75-78.

24. Tu J, Wang S, Zhao J, Zhu J, Sheng L, Sheng Y, et al. rs833061 and rs699947 on the promoter gene of the vascular endothelial growth factor (VEGF) and associated lung cancer susceptibility and survival: a meta-analysis. Med Sci Monit Int Med J Exp Clin Res. 2014; 20: 2520-2526.

25. de Mendonça GRA, Brito ABC, Rocha RM, Delamain MT, de Andrade Natal R, Soares FA, et al. Association of VEGFA-2578 C> A polymorphism with clinicopathological aspects and outcome in follicular lymphoma patients. Blood Cancer J. 2016; 6 (8): e464.

 

UDC 616.1-055.1-053.8-02

DOI: 10.20969/VSKM.2018.11(5).48-51

PDF download PREVALENCE OF THE MAIN CARDIOVASCULAR RISK FACTORS IN THE LIMITED CATEGORY OF MALE WORKERS

KIM ZULFIYA F., C. Med. Sci., Head of the Department of сardiology No 1 of City Clinical Hospital No 7; associate professor of the Department of internal medicine No 2 of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, e-mail: profz@yandex.ru

SADYKOV MARAT N., C. Med. Sci., the Minister of health of Republic of Tatarstan, Russia, Kazan, e-mail: minzdrav@tatar.ruDELYAN ARTUR M., Head physician of City Clinical Hospital No 7, Russia, 420137, Kazan, Chuykov str., 54, tel. +7 (8843) 521-51-75, e-mail: gkb7@bk.ru

GALIULLIN ILGIZ M., Head of the Department for non-budget activities of City Clinical Hospital No 7, Russia, 420137, Kazan, Chuykov str., 54, e-mail: gkb7@bk.ru

NURIEVA LUIZA M., 5-year student of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, e-mail:nurievaluiza@list.ru

KALIMULLIN BULAT A., 5-year student of pediatric faculty of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, e-mail: diongiran@mail.ru

Abstract. Aim. The aim of the study was to estimate the prevalence of the main factors of cardiovascular risk among working men on the example of enterprise N. in the city of Kazan. Material and methods. Condition of the cardiovascular system was assessed in 678 men aged 22–66 years. The patient examination plan included electrocardiography, echocardiography, ultrasound Doppler sonography of the brachiocephalic arteries, general and biochemical blood tests (determination of glycemia, lipid profile), and a consultation of cardiologist. The risk of fatal cardiovascular complications in the next 10 years as well as their vascular age was calculated in the patients (according to the SCORE, Systematic Coronary Risk Evaluation scale). Results and discussion. The age structure of the studied group of men, who are employees of the enterprise, is 22–66 years old. The prevalence of hypertension and asymptomatic atherosclerosis among men working at the enterprise is quite high: 39,5 and 33,9%, respectively. According to the results of the survey the evidence for cardiovascular pathology was not detected in 334 (49,26%) persons. More than half (52,7%) of healthy men of working age showed an increased risk of fatal cardiovascular disease development, and 68,6% had an early aging of the cardiovascular system. Calculated vascular age was significantly (up to 15 years) greater than chronological one even in young men (34–36 years old) of the examined group. 12 patients were referred for further examination for the newly diagnosed diabetes mellitus, coronary artery disease or significant changes in the hemogramm. Medical examination ended with the diagnosis of a prognostic significant disease, including acute myocardial infarction for 44% of male employees of the enterprise N. Conclusion. The findings, as well as the prevalence of modifiable risk factors for cardiovascular diseases and their complications, determine the need for screening in employees of the enterprises and organizations in order to modify lifestyles and select the optimal medical treatment. Attention should be paid separately to the fact that young healthy subjects of 34–36 years old also have early vascular aging. It is possible to use the estimated «patient’s vascular age» indicator as an additional instrument of «doctor–patient» communication and for increasing compliance in patients, especially in the young ones.

Key words: cardiovascular risk factors, prevention.

For reference: Kim ZF, Sadykov MN, Delyan AM, Galiullin IM, Nurieva LM, Kalimullin BA. Prevalence of the main cardiovascular risk factors in the limited category of male workers. The Bulletin of Contemporary Clinical Medicine. 2018; 11 (5): 48–51. DOI:10.20969/VSKM.2018.11(5).48-51.

REFERENCES

1. Bokeriya LA, Pokrovskogo AV ed. Natsional’nyye rekomendatsii po vedeniyu patsiyentov s zabolevaniyami brakhiotsefal’nykh arteriy [National guidelines for the management of patients with diseases of the brachiocephalic arteries]. Moskva [Moscow]. 2013; 72 p. http://www.angiolsurgery.org/ recommendations/2013/recommendations_brachiocephalic. pdf

2. Yezhov MV, Sergiyenko IV, Aronov DM et al. Diagnostika i korrektsiya narusheniy lipidnogo obmena s tsel’yu profilaktiki i lecheniya ateroskleroza. Rossiyskiye rekomendatsii VI peresmotr [Diagnosis and correction of lipid metabolism disorders for the prevention and treatment of atherosclerosis Russian recommendations VI revision]. Moskva [Moscow]. 2017; 18 p. http://webmed.irkutsk.ru/doc/pdf/noa.pdf

3. Troitskaya YeA, Vel’makin SV, Kobalava ZhD. Kontseptsiya sosudistogo vozrasta: novyy instrument otsenki serdechno- sosudistogo riska [The concept of vascular age: a new tool for assessing cardiovascular risk]. Arterial’naya gipertenziya [Arterial hypertension]. 2017; 23 (2): 160-171.

 

DOI: 10.20969/VSKM.2018.11(5).51-54

PDF download MANAGED TISSUE REGENERATION MATHEMATICAL MODEL IN PATIENTS WITH DIABETIC FOOT SYNDROME

KOREYBA KONSTANTIN A., C. Med. Sci., associate professor of the Department of surgical diseases of Kazan State Medical University, Honored doctor of the Republic of Tatarstan; Head of «Diabetic foot» Center, Russia, 420012, Kazan, Butlerov str., 49, e-mail: korejba_k@mail.ru

KLYUSHKIN IVAN V., D. Med. Sci., professor of the Department of surgical diseases of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, e-mail: hirurgivan@rambler.ru

MINABUTDINOV AYDAR R., surgeon of «Diabetic foot» Center of Clinic of Medical University, Russia, Kazan, Kamal str., 12, e-mail: aidoctor@mail.ru

KOREYBA ELENA A., therapist, gastroenterologist of Hospital for Veterans of war, Russia, Kazan, Isaev str., 5, e-mail: elenakorejba@yandex.ru

Abstract. Soft tissue injuries in the lower extremities in patients with diabetes mellitus complicated by diabetic angiopathy and, as a consequence, the onset of diabetic foot syndrome are often accompanied by soft tissue injuries, which significantly impair the patients quality of life and often lead to disability. Aim. Evaluation of the effectiveness of various methods of surgical treatment of wound tissue defects in diabetic foot syndrome has been performed according to the principles of evidence-based medicine and taking into account clinically significant events – outcomes, based on a mathematical model for effectiveness evaluation. Material and methods. Patients with diabetic foot syndrome, presenting with the wounds of the soft tissues and skin, corresponding to Wagner 2-4 classification, treated at the «Diabetic foot» Center in Kazan in 2016 have been enrolled in the study. The patients were divided into two groups in accordance with the morbid defect closure method. Results and discussion. Results of treatment were evaluated in terms of clinically significant values for patients, such as the outcomes: favorable and unfavorable. Various indicators of relative and absolute risks and benefits were also calculated when using various methods of wound treatment. Conclusion. The use of modern bioplastic materials in treatment of ulcerative defects in diabetic foot syndrome appears to be the most justified. It contributes to epithelization of the defects and to relief of clinical manifestations of the disease, which leads to favorable outcomes in 100% of cases. When closing a defect via autodermoplasty with a split free skin flap or using interactive dressings, the adverse clinical outcome was 16%. The positive outcomes of the proposed treatment lead to favorable results, improving the quality of life of the patients.

Key words: diabetic foot syndrome, bioplastic materials, autodemplasty, evaluation of the effectiveness of defect treatment.

For reference: Korejba KA, Klyushkin IV, Minabutdinov AR, Korejba EA. Managed tissue regeneration mathematical model in patients with diabetic foot syndrome. The Bulletin of Contemporary Clinical Medicine. 2018; 11 (5): 51–54. DOI: 10.20969/ VSKM.2018.11(5).51-54.

REFERENCES

1. Fatyhov RI, Klyushkin IV, Korejba KA. Formirovanie skhemy infuzionnoj terapii pri sindrome diabeticheskoj stopy

[Formation of the scheme of infusion therapy in diabetic foot syndrome]. Obshchestvennoe zdorov’e i zdravoohranenie [Public Health and Health Care]. 2013; 2: 38-40.

2. Fatyhov RI, Klyushkin IV, Korejba KA. Osobennosti infuzionnoj lechebnoj taktiki pri sindrome diabeticheskoj stopy [Features of infusion treatment tactics in diabetic foot syndrome]. Vestnik sovremennoj klinicheskoj mediciny [The Bulletin of Contemporary Clinical Medicine]. 2014; 7 (5): 31-34.

3. Kotel’nikov GP, Shpigel’ AS. Dokazatel’naya medicina; Nauchno-obosnovannaya medicinskaya praktika: Monografiya [Evidence-based medicine; Scientific-based medical practice: Monograph]. Samara: SamGMU [Samara: Samara State Medical University]. 2000; 19-24.

4. Voronin AS. Razrabotka i eksperimental’no-klinicheskoe obosnovanie ispol’zovaniya fitoterapevticheskih ranevyh pokrytij v mestnom lechenii ran i ranevoj infekcii kozhi i myagkih tkanej [Development and experimental and clinical substantiation of the use of phytotherapeutic wound dressings in the local treatment of wounds and wound infections of the skin and soft tissues]. Volgograd. 2012; 22 p.

5. Korejba KA, Fatihov IR, Gaziev AR, Gazieva EG, Korejba EA. Sistema pomoshchi bol’nym s sindromom diabeticheskoj stopy: patent 2506894 Rossiyskaya Federaciya: MPK 51 A61B5/00/ [The system of care for patients with diabetic foot syndrome: Patent 2506894 Russian Federation: IPC51A61B5/00/]. Kazan: Kazanskij Gosudarstvennyj Medicinskij Universitet [Kazan: Kazan State Medical University]. 2012; 2012135893.

6. Korejba KA, Korejba EA, Korejba VK, Bashkirceva NYu. Sposob lecheniya defektov myagkih tkanej u bol’nyh s sindromom diabeticheskoj stopy: patent 2619257 Rossiyskaya Federaciya: MPK51 A 61 K38/39/ [A method for the treatment of soft tissue defects in patients with diabetic foot syndrome: Pat. 2619257 Russian Federation: MPK51A61K38/9/]. Kazan: Kazanskij Gosudarstvennyj Medicinskij Universitet [Kazan: Kazan State Medical University]. 2016; 2016136925.

7. Korejba KA, Komarov AN, Minabutdinov AR. Sovremennye otechestvennye biomaterialy «G-derm» (Dzhiderm) v hirurgii defektov kozhi i myagkih tkanej: Uchebnoe posobie [Modern domestic biomaterials “G-derm” (Dzhyderm) in surgery of skin and soft tissue defects: Study Guide]. Sankt-Peterburg: Svoe izdatel’stvo [St Petersburg: Own publishing house]. 2018; 38 p.

 

UDC 616.341-007.272-089:616.381-072.1

DOI: 10.20969/VSKM.2018.11(5).54-58

PDF download LAPAROSCOPIC LYSIS OF ADHESIONS IN TREATMENT OF PATIENTS WITH ACUTE ADHESIVE SMALL INTESTINAL OBSTRUCTION

MALKOV IGOR S., D. Med. Sci., professor, Head of the Department of surgery of Kazan State Medical Academy – the branch of Russian Medical Academy of Postgraduate Education, Russia, 420012, Kazan, Butlerov str., 36, tel. +7-965-594-40-07, e-mail: ismalkov@yahoo.com

BAGAUTDINOV ELDAR B., postgraduate student of the Department of surgery of Kazan State Medical Academy – the branch of Russian Medical Academy of Postgraduate Education, Russia, 420012, Kazan, Butlerov str., 36, tel. +7-917-936-11-11, е-mail: eldarbagautdinoff@yandex.ru

FILIPPOV VYACHESLAV A., C. Med. Sci., associate professor of the Department of surgery of Kazan State Medical Academy – the branch of Russian Medical Academy of Postgraduate Education, Russia, 420012, Kazan, Butlerov str., 36, tel. +7-917-900-43-52, e-mail: vyacheslav_f@mail.ru

TAGIROV MARAT R., C. Med. Sci., surgeon of the Department of surgery No 2 of City Clinical Hospital No 7, Russia, 420103, Kazan, Chuikov str., 54, tel. +7-904-664-03-89, е-mail: tagirov72@yandex.ru

KHALILOV KHALIL M., C. Med. Sci., Head of the Department of surgery No 2 of City Clinical Hospital No 7, Russia, 420103, Kazan, Chuikov str., 54, tel. +7-951-067-52-58, е-mail: halilov.dog7@mail.ru

MISIEV DZHALIL KH., postgraduate student of the Department of surgery of Kazan State Medical Academy – the branch of Russian Medical Academy of Postgraduate Education, Russia, 420012, Kazan, Butlerov str., 36, tel. +7-927-443-95-95, е-mail: misievdjalil91@mail.ru

Abstract. Aim. The aim of the study was to specify the indications for laparoscopic adhesiolysis and to determine its effectiveness in treatment of patients with acute adhesive small intestinal obstruction through the use of comprehensive therapeutic and diagnostic program. Material and methods. Results of treatment of 354 patients with acute adhesive small intestinal obstruction hospitalized to departments of surgery number 1 and number 2 of the City Clinical Hospital No 7 in Kazan over the past 5 years were analyzed. Indications for laparoscopic adhesiolysis were established in 47 patients. The main condition for performing an endosurgical operation was the presence of a space free from visceroparietal adhesions, sufficient for visual control of performed manipulations and providing the necessary amplitude of movement for the instruments. The diagnostic significance of clinical and radiological methods of investigation in assessing the prevalence of adhesions in the abdominal cavity was studied. The anterior abdominal wall was divided into 4 sectors for a better visual representation of the prevalence of adhesions during ultrasound visualization. Results and discussion. The highest sensitivity (92%) was observed when using x-ray computed tomography with contrast. The developed complex diagnostic program was crucial in choosing the method of surgical intervention (laparotomy or laparoscopy) in patients with adhesive small intestinal obstruction. Conclusion. Laparoscopic adhesion can be considered as an effective method of treatment for the patients with acute adhesive small intestinal obstruction, performance of which should be regulated according to the severity of patient’s condition and the prevalence of adhesive process. It is necessary to use a comprehensive diagnostic program, the leading place in which belongs to radiologic methods of investigation, to determine the prevalence of adhesive process.

Key words: acute adhesive small intestinal obstruction, diagnostic ultrasound, x-ray computed tomography, laparoscopic adhesiolysis.

For reference: Malkov IS, Bagautdinov EB, Filippov VA, Tagirov MR, Khalilov KM, Misiev DKh. Laparoscopic lysis of adhesions in treatment of patients with acute adhesive small intestinal obstruction. The Bulletin of Contemporary Clinical Medicine. 2018; 11 (5): 54–58. DOI: 10.20969/VSKM.2018.11(5).54-58.

REFERENCES

1. Chekmazov IA. Spaechnaya bolezn’ bryushiny [Adhesive disease of peritoneum]. Moskva: GEOTAR-Media [Moscow: GEOTAR-Media]. 2008; 160 p.

2. Tarakanov VA, Kolesnikov EG. Pozdnyaya spaechnaya kishechnaya neprokhodimost’ v detskom vozraste: diag- nosticheskiy algoritm [Late adhesive intestinal obstruction in childhood: diagnostic algorithm]. Kubanskiy nauchnyy meditsinskiy vestnik [Kuban scientific medical Bulletin]. 2009; 109 (4): 50-54.

3. Timofeev ME, Volkov VV, Shapoval’yants SG. Ostraya rannyaya spaechnaya tonkokishechnaya neprokhodimost’ na sovremennom etape: vozmozhnosti laparoskopii v diagnostike i lechenii. [Acute early adhesive intestinal obstruction at the present stage: the possibilities of laparoscopy in diagnosis and treatment]. Endoskopicheskaya khirurgiya [Endoscopic surgery]. 2015; 2: 36-52.

4. Catena F, Di Saverio S, Kelly MD et al. Bologna Guidelines for Diagnosis and Management of Adhesive Small Bowel Obstruction (ASBO): 2010 Evidence-Based Guidelines of the World Society of Emergency Surgery. World Journal of Emergency Surgery. 2011; 6: 24.

5. Khubutiya MSh, Yartseva PA. Endokhirurgiya pri neotlozhnykh zabolevaniyakh i travme: rukovodstvo [Endosurgery in case of acute diseases and trauma: guidance]. Moskva: GEOTAR- Media [Moscow: GEOTAR-Media]. 2014; 240 p.

6. Radzikhovskiy AP, Kolesnikov EB, Mendel’ NA. Lapa- roskopicheskaya diagnostika i lechenie ostroy tonkokishech- noy neprokhodimosti [Laparoscopic diagnosis and treatment of acute intestinal obstruction]. Khirurgiya Ukrainy [Surgery in Ukraine]. 2010; 2: 89-94.

7. Dobrokvashin SV, Volkov DE, Izmaylov AG. Nekotorye aspekty lecheniya bol’nykh s ostroy kishechnoy neprokhodimost’yu [Some aspects of treatment of patients with acute intestinal obstruction]. Vestnik sovremennoy klinicheskoy meditsiny [Bulletin of modern clinical medicine]. 2014; 5: 53-55.

8. Salomone Di Saverio, Federico Coccolini, Marica Galati et al. Bologna Guidelines for Diagnosis and Management of Adhesive Small Bowel Obstruction (ASBO): 2013 update of the Evidence-Based Guidelines from the World Society of Emergency Surgery ASBO working group. World Journal of Emergency Surgery. 2013; 42: 14.

9. Maung Adrian A, Johnson Dirk C, Piper Greta L, et al. Evaluation and management of small-bowel obstruction: An Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg. 2012; 73: 362-369.

  1. Kozlova YuA, Mumladze RB, Olimpiev MYu. Rol’ rent- genovskoy komp’yuternoy tomografii v diagnostike kishechnoy neprokhodimosti [The role of X-ray computed tomography in the diagnosis of intestinal obstruction]. Annaly khirurgii [Annals of surgery]. 2013; 4: 5-11.

  2. Malkov IS. Izbrannye razdely neotlozhnoy abdominal’noy khirurgii: Monografiya [Selected sections of emergency abdominal surgery: Monograph]. Kazan’: izdatel’stvo Kazanskogo gosudarstvennogo tekhnicheskogo universiteta [Kazan: Kazan State Technical University Press]. 2013; 408 p.

  3. Burch J, Moore E, Moore F, Franciose R. The abdominal compartment syndrome. Surgery clinic of North Am. 1992; 76: 833-842.

  4. Blinnikov OI, Dronov AF, Smirnov AN. Laparoskopicheskie operatsii pri ostroy spaechnoy kishechnoy neprokhodimosti u detey [Laparoscopic surgery for acute adhesive intestinal obstruction in children]. Moskva: Materialy mezhdunarodnogo kongressa [Moscow: Materials of the international Congress]. 1993; 82-88.

 

UDC 616.36-008.5-08

DOI: 10.20969/VSKM.2018.11(5).58-62

 
MALKOV IGOR S., D. Med. Sci., Head of the Department of surgery of Kazan State Medical Academy – the branch of Russian Medical Academy of Postgraduate Education, Russia, 420012, Kazan, Butlerov str., 36, tel. +7-965-594-40-07, e-mail: ismalkov@yahoo.com
NASRULLAEV MAGOMED N., D. Med. Sci., professor of the Department of surgery of Kazan State Medical Academy – the branch of Russian Medical Academy of Postgraduate Education, Russia, 420012, Kazan, Butlerov str., 36, e-mail: msh.avia@yandex.ru
ZAKIROVA GUZELIA R., C. Med. Sci., assistant of professor of the Department of surgery of Kazan State Medical Academy – the branch of Russian Medical Academy of Postgraduate Education, Russia, 420012, Kazan, Butlerov str., 36
KHAMZIN ILDAR I., Head of the Department of endoscopy of City Clinical Hospital No 7, Russia, 420103, Kazan, Chuikov str., 54
Abstract. Aim. The aim of the study is to improve the results of treatment in patients with obstructive jaundice through a combination of endoscopic and conservative treatment methods. Material and methods. A retrospective analysis of the results of treatment of 928 patients with obstructive jaundice of tumor and non-tumor genesis was performed. Results and discussion.It has been revealed that the application of endoscopic methods for biliary system decompression allows improving the results of treatment. Our observations of patients with mechanical jaundice of tumor and non-tumor origin with varying degrees of liver failure suggest that the earliest and the most important component of complex treatment for this group is the earliest decompression of the biliary tract by one of the minimally invasive decompression methods, including endoscopic papillotomy and biliary stenting. The degree of liver failure is an important criterion that determines the strategy and approach in management of patients with obstructive jaundice. Drug tretment and infusion therapy adequate in composition and volume, carried out against the background of one of the types of biliary tract decompression stands for the basic treatment of endotoxemia and hepatic insufficiency in obstructive jaundice, which corresponds to modern views on the problems of treatment of obstructive jaundice.Conclusion. Endoscopic interventions are indicated in acute, recurrent and chronic obstruction of the large duodenal papilla, manifested by clinical symptoms of the hypertension in hepatic, pancreatic and biliary zone ducts. Biliary system decompression with the use of transpapillary prosthetics is an effective minimally invasive surgical intervention, which is used as temporary for benign and malignant lesions of hepatic, pancreatic and biliary zone organs. It can be permanent in inoperable tumors of hepatic, pancreatic and biliary zone organs, performed to restore the bile outflow to duodenum. It is necessary to carry out adequate infusion therapy, including solutions with antihypoxic and hepatoprotective action, to restore homeostasis in patients with obstructive jaundice and for liver failure prevention.
Key words: obstructive jaundice, endoscopic interventions, infusion and transfusion therapy.
For reference: Malkov IS, Nasrullaev MN, Zakirova GR, Khamzin II. Complete treatment of painful mechanical jellies with hepatopenetic regeneration zones. The Bulletin of Contemporary Clinical Medicine. 2018; 11 (5): 58–62. DOI: 10.20969/ VSKM.2018.11(5).58-62.

REFERENCES

1. Vetshev PS. Mekhanicheskaya zheltukha: prichiny i diagnosticheskiye podkhody (lektsiya) [Mechanical jaundice: causes and diagnostic approaches (lecture)]. Annaly khirurgicheskoy gepatologii [Annals of surgical hepatology]. 2011; 16 (3): 50-57.

2. Gal’perin EI, Vetshev PS. Rukovodstvo po khirurgii zhelchnykh putey [Guide to surgery of the biliary tract]. Moskva: Vidar-M [Moscow: Vidar-M]. 2009; 568 p.

3. Costamagna G, Pandolfi M. Endoscopic stenting for biliary and pancreatic malignancies. J Clin Gastroenterol. 2004; 38: 59-67.

4. Williams EJ, Taylor S, Fairclough P, et al. Risk factors for com plication following ERCP; results of a large-scale, prospective multicenter study. Endoscopy. 2007; 39 (9): 793-801.

5. Akhaladze GG. Patogeneticheskiye aspekty gnoynogo kholangita, pochemu net sistemnoy vospalitel’noy reaktsii pri mekhanicheskoy zheltukhe [Pathogenetic aspects of purulent cholangitis, why there is no systemic inflammatory reaction in obstructive jaundice]. Annaly khirurgicheskoy gepatologii [Annals of surgical hepatology]. 2009; 14 (2): 9-15.

6. Pautkin YuF, Klimov AYe. Mekhanicheskaya neprokhodimost’ zhelchnykh putey (mekhanicheskaya zheltukha) [Mechanical obstruction of the biliary tract (mechanical jaundice)]. Moskva: Profil’ [Moscow: Profile]. 2010; 224 p.

7. Malkov IS, Shaymardanov RSh, Korobkov VN, Filippov VA. Infuzionnaya terapiya pri mekhanicheskoy zheltukhe [Infusion therapy for obstructive jaundice]. Kazan’: Materialy Respublikanskoy nauchno-prakticheskoy konferentsii «Mekhanicheskaya zheltukha – aktual’naya problema abdominal’noy khirurgii» [Kazan: Proceedings of the Republican Scientific and Practical Conference «Mechanical Jaundice – the Current Problem of Abdominal Surgery»]. 2014; 21-23.

8. Malkov IS. Izbrannyye razdely neotlozhnoy abdominal’noy khirurgii [Selected sections of emergency abdominal surgery]. Kazan’: Izdatel`stvo KGTU [Kazan: Publishing house of KSTU]. 2013; 408 p.

9. Bekbauov SA, Glebov KG, Kotovskiy AYe. Endoskopicheskiye transpapillyarnyye vmeshatel’stva v lechenii bol’nykh s sindromom mekhanicheskoy zheltukhi [Endoscopic transpapillary interventions in the treatment of patients with obstructive jaundice]. Endoskopichskaya khirurgiya [Endoscopic surgery]. 2013; 4: 36–39.

10. Glebov KG, Kotovskiy AYe, Dyuzheva TG. Kriterii vybora konstruktsii endoproteza dlya endoskopicheskogo stentiro- vaniya zhelchnykh protokov [Criteria for selecting the design of the endoprosthesis for endoscopic stenting of the bile ducts]. Annaly khirurgicheskoy gepatologii [Annals of Surgical Hepatology]. 2014; 19 (2): 55-65.

11. Glebov KG, Dyuzheva TG, Petrova NA, Bekbauov SA, Kotovskiy AYe. Endoskopicheskoye transpapillyarnoye stentirovaniye zhelchnykh protokov metallicheskimi samoraskryvayushchimisya endoprotezami [Endoscopic transpapillary stenting of the bile ducts with metal self-opening endoprostheses]. Annaly khirurgicheskoy gepatologii [Annals of Surgical Hepatology]. 2012; 17 (3): 65–74.

  1. Kotovskiy AYe, Urzhumtseva GA, Glebov KG, Perova NA. Endoskopicheskiye tekhnologii v lechenii zabolevaniy organov gepatopankreatoduodenal’noy zony [Endoscopic technologies in the treatment of diseases of the organs of the hepatopancreatoduodenal zone]. Annaly khirurgicheskoy gepatologii [Annals of Surgical Hepatology]. 2010; 15 (1): 9–21.

  2. Deryabina YeA, Bratnikova GI, Vasil’yev AV. Povysheniye bezopasnosti lechebnykh endoskopicheskikh retrogradnykh kholangiopankreatografiy u bol’nykh s dobrokachestvennymi obstruktivnymi zabolevaniyami zhelchevyvodyashchikh putey [Improving the safety of therapeutic endoscopic retrograde cholangiopancreatography in patients with benign obstructive diseases of the biliary tract]. Meditsinskaya vizualizatsiya [Medical Visualization]. 2010; 2: 73-80.

  3. Malkov IS, Zakirova GR, Korobkov VN, Nasrullayev MN. Endoskopicheskiye vmeshatel’stva i korrektsiya narusheniy gomeostaza u patsiyentov s mekhanicheskoy zheltukhoy [Endoscopic interventions and correction of disorders of homeostasis in patients with obstructive jaundice]. Kazanskii medicinskii zhurnal [Kazan medical journal]. 2015; XCVI (3): 444-447.

  4. Schneider L, Büchler MW, Werner J. Acute pancreatitis with an emphasis on infection. Infect Dis Clin North Am. 2010; 24: 921-941.

  5. Werner J, Hartwig W, Hackert T et al. Multidrug strategies are effective in the treatment of severe experimental pancreatitis. Surgery. 2012; 151 (3): 372-381.

  6. Malkov IS, Shaymardanov RSh, Korobkov VN, Filippov VA. Metody intensivnoy terapii v lechenii pechenochnoy nedostatochnosti pri mekhanicheskoy zheltukhe [Intensive therapy methods in the treatment of hepatic failure with obstructive jaundice]. Kazan’: Materialy Respublikanskoy nauchno-prakticheskoy konferentsii «Mekhanicheskaya zheltukha – aktual’naya problema abdominal’noy khirurgii» [Kazan: Proceedings of the Republican Scientific and Practical Conference «Mechanical Jaundice – the Current Problem of Abdominal Surgery»]. 2014; 23-28.

  7. Nasrullayev MN, Zakirova GR, Khamzin II. Vozmozhnosti endoskopicheskikh metodov v optimizatsii lecheniya bol’nykh s mekhanicheskoy zheltukhoy [The possibilities of endoscopic methods in optimizing the treatment of patients with obstructive jaundice]. Kazan’: Materialy mezhregional’noy nauchno – prakticheskoy konferentsii «Aktual’nyye voprosy khirurgii» [Kazan: Proceedings of the interregional scientific – practical conference «Actual issues of surgery»]. 2018; 70-73.

 

UDC 616.366-002.1-089-06:616.1

DOI: 10.20969/VSKM.2018.11(5).62-68

PDF download PERSONALIZED APPROACH TO PERIOPERATIVE RISK ASSESSMENT IN PATIENTS WITH CARDIOVASCULAR DISEASES IN EMERGENCY CARE CLINIC

MALKOVA MARIA I., C. Med. Sci., Head of the Department of functional diagnostics of City Clinical Hospital No 7, Russia, 420103, Kazan, Chuikov str., 54; assistant of professor of the Department of introduction to internal medicine of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, tel. 8-960-051-61-16, e-mail: marimalk@yandex.ru

BULASHOVA OLGA V., SCOPUS Author ID: 6507198087; D. Med. Sci., professor of the Department of introduction to internal medicine of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, tel. 8(843) 296-14-03, e-mail: boulashova@yandex.ru

KHAZOVA ELENA V., ORCID ID: https://orcid.org/0000-0001-8050-2892; C. Med. Sci., associate professor of the Department of introduction to internal medicine of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, tel. 8-905-313-97-10, e-mail: hazova_elena@mail.ru

Abstract. Annually more than 100 million elderly patients in the world undergo non-cardiac surgery. Around 1 million of them experience myocardial infarction and cardiac arrest during intra- or early postoperative periods. Mortality due to cardiovascular causes remains high and reaches 0,5–1,5%. Acute cholecystitis is one of the most common diseases in surgical practice. The contribution of cardiovascular diseases to all-cause mortality in patients with acute cholecystitis over the age of 60 is more than 50%. At present, accurate diagnosis and effective treatment of the disease are necessary when working in an interdisciplinary team considering the shortest possible stay of patients in the hospital. Empirically, it was necessary to obtain a conclusion on somatic status from physician of therapeutic profile for each patient before surgery. Any, even minor, surgical procedure is associated with the risks of developing intra- and postoperative complications that have to be anticipated and attempted to prevent. Aim. Determine an optimal perioperative management strategy for patients with cardiovascular diseases in acute cholecystitis including individual assessment of cardiac risk in order to prevent and reduce the incidence and severity of cardiovascular complications and surgical treatment planning. Material and methods. 274 patients with cardiovascular diseases and acute cholecystitis (AC) were the subjects of the study. Results and discussion. The greatest prognostic significance in evaluating cardiovascular complications within 30 days after surgery in patients with cardiovascular disease and acute cholecystitis was demonstrated by such parameters as: rhythm disturbances as ventricular extrasystole (2–5 gradations according to B. Lown and M. Wolf) and atrial fibrillation (p=0,012), clinical symptom assessment value according to Yu.N. Belenkova – V.Yu. Mareyev scale (p=0,009), left ventricle posterior wall thickness (p=0,037), heart rate and diastolic blood pressure after the operation (p=0,009 and p=0,033), glomerular filtration rate and the INR level after the operation (p=0,036 and p=0,007). Conclusion.Integrated cardiac risk assessment and perioperative management of patients with cardiovascular diseases in acute cholecystitis can reduce the incidence of cardiovascular complications within 30 days after surgery from 33,5 to 20% (p=0,005) and lower mortality rates from cardiovascular diseases from 4,5 to 1,9%.

Key words: perioperative risk, acute cholecystitis, prognosis, cardiovascular diseases.

For reference: Malkova MI, Bulashova OV, Khazova EV. Personalized approach to perioperative risk assessment in patients with cardiovascular diseases in emergency care clinic. The Bulletin of Contemporary Clinical Medicine. 2018; 11 (5): 62–68.DOI: 10.20969/VSKM.2018.11(5).62-68.

REFERENCES

  1. Weiser TG, Regenbogen SE, Thompson KD et al. An estimation of the global volume of surgery: a modeling strategy based on available data. Lancet. 2008; 372: 139-144.

  2. Poldermans D, Bax JJ, Boersma E et al. Guidelines for pre-operative cardiac risk assessment and perioperative cardiac management in non-cardiac surgery: the Task Force for Preoperative Cardiac Risk Assessment and Perioperative Cardiac Management in Non-cardiac Surgery of the European Society of Cardiology (ESC) and endorsed by the European Society of Anaesthesiology (ESA). Eur Heart J. 2009; 30 (22): 2769-2812.

  3. Brett AS. Coronary assessment before noncardiac surgery current strategies are flaved. Circulation. 2008; 117 (24): 3145-3151.

  4. Fleisher LA, Poldermans D. Perioperative beta blockade: where do we go from here? Lancet. 2008; 371 (9627): 1813- 1814.

  5. Devereaux PJ, Goldman L, Cook DJ, et al. Perioperative cardiac events in patients undergoing noncardiac surgery: a review of the magnitude of the problem, the pathophysiology of the events and methods to estimate and communicate risk. JAMC. 2005; 173 (6): 627-634.

  6. Kumar R, McKinney WP, Raj G, et al. Adverse cardiac events after surgery: assessing risk in a veteran population. J Gen Intern Med. 2001; 16: 507-518.

  7. Barbarash OL, Repnikova RV, Shoforus’ TV, Golofaeva OI. Vliyanie beta-blokatorov na uroven’ arterial’nogo davleniya, perioperacionnye oslozhneniya i dlitel’nost’ gospitalizacii u pacientov s promezhutochnym riskom serdechno- sosudistyh oslozhnenij pri planovoj holecistektomii: otkrytoe sravnitel’noe randomizirovannoe issledovanie [The effect of beta-blockers on blood pressure, perioperative complications and length of hospital stay in patients with intermediate risk of cardiovascular complications during routine cholecystectomy: an open randomized comparative study]. Racional’naya Farmakoterapiya v Kardiologii [Rational Pharmacotherapy in Cardiology]. 2010; 6 (5): 667-672.

8. Walsh SR, Oates JE, Anderson JA, et al. Postoperative arrhythmias in colorectal surgical patients: incidence and clinical correlates. Colorect Dis. 2006; 8: 212-216.

9. Graesdal A, Aagnes I, Lappegard KT. Postoperative cardiovascular complications. Tidsskr nor Laegeforen. 2005; 125 (21): 2942-2945.

10. Briskin BS, Lomidze OV. Vliyanie polimorbidnosti na diagnostiku i iskhod v abdominal’noj hirurgii u pozhilyh [the Influence of polymorbidity on the diagnosis and outcome in abdominal surgery in the elderly]. Klin Gerontol [Klin gerontol]. 2008; 4: 30-33.

11. Kheterpal S, O’Reilly M, Englesbe J et al. Preoperative and intraoperative predictors of cardiac adverse events after general, vascular, and urological surgery. Anesthesiology. 2009; 110: 58-66.

12. Ivashkina VT ed. Gastroenterologiya; Klinicheskie rekomendacii [Gastroenterology; Clinical guidelines]. Moskva [Moscow]: GEOTAR-Media; 2009; 2: 208 p.

13. Lazebnik LB, Kopaneva MI, Ezhova TB. Potrebnost’ v medicinskoj pomoshchi posle operativnyh vmeshatel’stv na zheludke i zhelchnom puzyre (obzor literatury i sobstvennye dannye) [the Need for medical care after surgery on the stomach and gall bladder (literature review and own data)]. Ter Arhiv [Ter Archive]. 2004; 2: 83-87.

14. Wilson E, Gurusamy K, Gluud C, Davidson BR. Cost-utility and value-of-information analysis of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. British J of Surgery. 2010; 97 (2): 210-219.

15. Rybachkov VV, Kabanov EN, Limina MI. Ostryj holecistit u bol’nyh starcheskogo vozrasta [Acute cholecystitis in patients of senile age]. V pomoshch’ prakticheskomu vrachu [to help the practical doctor]. 2008; 4: 57-61.

16. Dobrokvashin SV, Korejba KA, Volkov DE. Izbrannye lekcii po obshchej hirurgii [Selected lectures on General surgery]. Kazan’. 2009; 191 p.

17. Didkovskaya NI, Razumov AC, Plotnikova EYu. Osobennosti vegetativnoj regulyacii serdechnogo ritma u pacientov s zhelchnokamennoj bolezn’yu do i posle holecistektomii [Peculiarities of autonomic regulation of heart rate in patients with cholelithiasis before and after cholecystectomy]. Medicina v Kuzbasse [Medicine in Kuzbass]. 2009; 3: 28- 31.

18. Knaus WA, Draper EA, Wagner DP, et al. Prognosis in acute organ-system failure. Ann Surg. 1985; 202: 685-693.

19. Le Gall JR, Loirat P, Alperovitch A, et al. A simplified acute physiology score for ICU patients. Critical Care Medicine. 1984; 12 (11): 975-977.

20. Marshall J, Cook D, Criston N. Multiple Organ Dysfunction Score: a reliable descriptor of a complex clinical outcome. Crit Care med. 1995; 23: 1638-1652.

21. Vincent JL, Moreno R, Takala J, et al. The SOFA (Sepsis- related Organ Failure Assessment score to describe organ dysfunction/failure; On behalf of the Working Group on Sepsis- Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med. 1996; 22: 707-710.

22. Biccard BM, Rodseth RN. Utility of clinical risk predictors for preoperative cardiovascular risk prediction. Br J Anaesth. 2011; 107 (2): 133-143.

23. Barbarash OL, Repnikova RV. Rol’ beta-adrenoblokatorov v profilaktike serdechno-sosudistyh oslozhnenij pri nekardiologicheskih vmeshatel’stvah [the role of beta- blockers in the prevention of cardiovascular complications in non-cardiac interventions]. Serdce [Heart]. 2011; 10 (2): 79-84.

 

UDC 616-073.75:612.843.366

DOI: 10.20969/VSKM.2018.11(5).69-73

PDF download INFORMATIVE VALUE OF VISUAL ANALYSIS OF RADIOLOGIC GRAY-SCALE IMAGES

PASYNKOV DMITRY V., C. Med. Sci., Head of the Department of radiologic diagnostics of Republican Oncology Center of the Republic of Mari El, Russia, 424037, Yoshkar-Ola, Osipenko str., 22, e-mail: passynkov@mail.ru

KLYUSHKIN IVAN V., D. Med. Sci., professor of the Department of general surgery of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, e-mail: hirurgivan@rambler.ru

PASYNKOVA OLGA O., C. Med. Sci., associate professor of the Department of ecology of Mari State University, Russia, 424000, Yoshkar-Ola, Lenin square, 1, e-mail: olgaved@inbox.ru

Abstract. Aim. The aim of the study was to assess the discriminative ability of the human eye (of the scale 0-255 shades of gray) during the conventional visual analysis of medical images with the help of modern high-resolution monitors in the real clinical radiology settings. Materials and methods. 20 radiologists and specialists in ultrasound diagnostics were offered: a) to assess whether they distinguish a square against a uniform background, the brightness of which differed by a given number of grayscale; b) to reproduce a random polygon with 4–7 angles on a uniform background, the brightness of which also differed by a given number of grayscale. The same experiments were repeated after applying the white (with 255 shade brightness) or black (with 0 shade brightness) random noise on the images. Results and discussion. Maximal visually perceived gray scale difference values in the optimal conditions for visual assessment [highest screen brightness and room darkening [50 lux)] were the following: (8±2) shades – in the range of 0–15 shades (black color), (3±1) shades – in the range of 16–30 shades, and (3±1) shades – in the range of 255 shades. Applying the random white noise in almost all cases increased the maximal visually perceived gray scale difference values by (5±2) (mean) shades. On the contrary, the black noise had no influence on this value.Conclusion. Even in the best conditions for the visual assessment (homogenous object on the homogenous background) the system computer generated 3–5 times more information compared to visual perception. Such limited ability of the human eye requires development of mathematical approaches to image analysis in order to maximize the amount of diagnostic information.

Key words: medical image, grayscale, minimal visually perceived difference.

For reference: Pasynkov DV, Klyushkin IV, Pasynkova OO. Informative value of visual analysis of radiologic gray-scale images. The Bulletin of Contemporary Clinical Medicine. 2018; 11 (5): 69–73. DOI: 10.20969/VSKM.2018.11(5).69-73.

REFERENCES

1. Kimpe T, Tuytschaever T. Increasing the Number of Gray Shades in Medical Display Systems–How Much is Enough? Journal of Digital Imaging. 2007; 20 (4): 422-432. doi:10.1007/ s10278-006-1052-3.

2. Barten PGJ. Physical model for contrast sensitivity of the human eye. Proc SPIE Int Soc Opt Eng. 1992; 1666: 57–72. 3. Muka E, Mertelmeier T, Slone RM, Senol E. Impact of phosphor luminance noise on the specification of high-resolution CRT displays for medical imaging. Proc SPIE Int Soc Opt Eng. 1997; 2431: 210–221.

4. Xue Z, Antani S, Long LR, Demner-Fushman D, Thoma GR. Window Classification of Brain CT Images in Biomedical Articles. AMIA Annual Symposium Proceedings. 2012; 2012: 1023-1029.

5. Busygina OV, Bakhtiozin RF, Pasynkov DV, Klyushkin IV. Varianty rentgeno-ul’trazvukovykh izmeneniy posle operativnykh vmeshatel’stv na molochnykh zhelezakh po povodu dobrokachestvennykh protsessov [Variants of X-ray ultrasound changes after surgery on the mammary glands about benign processes]. Rossiyskiy elektronnyy zhurnal luchevoy diagnostiki [Russian Electronic Journal of Radiation Diagnostics]. 2017; 7 (2): 78-87.

6. Egoshin I, Pasynkov D, Kolchev A, Kliouchkin I, Pasynkova O. Automatic differentiation cystic and solid breast lesions at ultrasonic images. International journal of computer assisted radiology and surgery. 2018; 13 (1): 1-27.

 

UDC 618.19-073.75:004.9

DOI: 10.20969/VSKM.2018.11(5).73-79

PDF download IMPROVING THE CLINICAL EFFICIENCY OF MAMMOGRAPHY REPORTS

PASYNKOV DMITRY V., C. Med. Sci., Head of the Department of radiology diagnostics of the Republican Oncology Center of the Republic of Mari El, Russia, 424037, Yoshkar-Ola, Osipenko str., 22, e-mail: passynkov@mail.ru

KLYUSHKIN IVAN V., D. Med. Sci., professor of the Department of general surgery of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, e-mail: hirurgivan@rambler.ru

PASYNKOVA OLGA O., C. Med. Sci., associate professor of the Department of ecology of Mari State University, Russia, 424000, Yoshkar-Ola, Lenin sguare, 1, e-mail: olgaved@inbox.ru

FEDOROV ALEXEY L., C. Med. Sci., associate professor of the Department of Fundamental Medicine, Mari State University, Russia, 424000, Yoshkar-Ola, Lenin sguare, 1, e-mail: alex-doctor74@mail.ru

Abstract. Aim. To develop the software that creates the full structured mammography report in accordance with BIRADS 2013 and reduces the turn-around time as much as possible. We also aimed to test the effectiveness of our software. Material and methods. For complete analysis we used 504 mammography reports created in 17 medical institutions. We also assessed the time needed to make the standard mammography report from 25 radiologists working in breast care for at least 3 years. For evaluation the ability for imaginable reproduction of source mammography image after the corresponding report reading we asked physicians to draw their impression and compared their drawing with the source image. Results and discussions.Our automated mammography report significantly increased the informativity compared to all other reports creation methods nearly by 2 times (p<0,05), reduced the average time required for report creation by 3 times (p<0,05), except the creation with the help of electronic template in cases when visible lesions were absent) as well as increased the accuracy of source image reproduction according to the report up to 20% (p<0,05). Conclusion. The routine usage of our software can considerably save the radiologist working time, rise the accuracy of reporting and the completeness of imaginable image reconstruction with the help of only mammography report.

Key words: mammography, report, software.

For reference: Pasynkov DV, Klyushkin IV, Pasynkova OO, Fedorov AL. Improving the clinical efficiency of mammography reports. The Bulletin of Contemporary Clinical Medicine. 2018; 11 (5): 73–79. DOI: 10.20969/VSKM.2018.11(5).73-79.

REFERENCES

  1. The Royal College of Radiologists. How many radiologists do we need? A guide to planning hospital radiology services. London: The Royal College of Radiologists, 2008.

  2. Albrecht L, Busse R, Tepe H, Poschmann R, Teichgräber U, Hamm B, de Bucourt M. [Turnaround time for reporting results of radiological examinations in intensive care unit patients: an internal quality control]. Radiologe. 2013; 53 (9): 810-816. DOI: 10.1007/s00117-013-2537-y.

  3. Sokolovskaya E, Shinde T, Ruchman RB, Kwak AJ, Lu S, Shariff YK, Wiggins EF, Talangbayan L. The Effect of Faster Reporting Speed for Imaging Studies on the Number of Misses and Interpretation Errors: A Pilot Study. J Am Coll Radiol. 2015; 12 (7): 683-688. DOI: 10.1016/j.jacr.2015.03.040.

  4. Busygina OV, Bakhtiozin RF, Pasynkov DV, Klyushkin IV. Varianty rentgeno-ul’trazvukovykh izmeneniy posle operativnykh vmeshatel’stv na molochnykh zhelezakh po povodu dobrokachestvennykh protsessov [Variants of X-ray and ultrasound changes after surgery on the mammary glands about benign processes]. Rossiyskiy elektronnyy zhurnal luchevoy diagnostiki [Russian Electronic Journal of Radiation Diagnostics]. 2017; 7 (2): 78-87.

  5. Hall FM. Language of the Radiology Report: American Journal of Roentgenology. 2000; 175: 1239-1242. DOI: 10.2214/ ajr.175.5.1751239.

  6. Rao AA, Feneis J, Lalonde C, Ojeda-Fournier H. A Pictorial Review of Changes in the BI-RADS Fifth Edition. RadioGraphics. 2016; 36 (3): 623-639.

  7. Egoshin I, Pasynkov D, Kolchev A, Kliouchkin I, Pasynkova O. Automatic differentiation cystic and solid breast lesions at ultrasonic images. International journal of computer assisted radiology and surgery. 2018; 13 (1): 1-273.

  8. Prikaz Ministerstva zdravookhraneniya RF ot 26 oktyabrya 2017 goda No 869n “Ob utverzhdenii poryadka provedeniya dispanserizatsii opredelennykh grupp vzroslogo naseleniya”. [Order of the Ministry of Health of the Russian Federation of October 26, 2017 No. 869n “On approval of the procedure for conducting clinical examination of certain groups of the adult population”].

  9. Pasynkov DV, Pasynkova OO. Avtomatizirovannyy protokol mammografii (versiya 1.22) [Automated mammography protocol (version 1.22)]. Svidetel’stvo o gosudarstvennoy registratsii programmy dlya EVM No2015616681 ot 16 marta 2015 goda [Certificate of state registration of computer programs No2015616681 dated March 16, 2015]. 2015.

 

UDC 613.84:614.25-056.83

DOI: 10.20969/VSKM.2018.11(5).79-82

PDF download SMOKING AMONG MEDICAL PROFESSIONALS: PERSPECTIVES OF PRESENT DAY

KHAMITOV RUSTEM F., D. Med. Sci., professor, Head of the Department of internal medicine of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, tel. 8-917-272-96-72, e-mail: rhamitov@mail.ru

FATYKHOVA KIRA R., assistant of professor of the Department of internal medicine of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, tel. 8-987-221-83-50, e-mail: kira_sulbaeva@mail.ru

OKURLU ALFIA F., C. Med. Sci., assistant of professor of the Department of internal medicine of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, tel. 8-917-394-99-62, e-mail: alfiaf@yandex.ru

SALIMOVA LILIA M., assistant of professor of the Department of internal medicine of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, tel. 8-917-232-86-63, e-mail: calimova.lili@gmail.com

MINGALEEVA GULNAZ F., assistant of professor of the Department of internal medicine of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, tel. 8-987-292-55-37, e-mail: m.gulnaz.f@mail.ru

Abstract. Aim. The aim of the research was to study the features of tobacco smoking in medical medium. Material and methods. An original questionnaire of 68 questions was developed, 13 of which were directly related to the smoking habit. 80 doctors of outpatient and inpatient clinics of Kazan (57 women and 23 men) aged 25 to 69 years were interviewed in person.Results and discussion. Adherence to smoking was detected in a small percentage of cases among the surveyed doctors (mostly in men). At the time of the survey only 7,5% of doctors noted that they were committed to smoking, and another 2,5% smoked in the past. It might be related to the regional features or to the exclusion of nurses from the survey. The decrease in smokers with an increase in medical experience of more than 5 years was also a positive finding. The fact of easy attitude to smoking hookah and electronic cigarettes, as well as to smoking in general, even among non-smoking doctors, is alarming. The leading threat of cancer was among significant reasons for quitting smoking (in 53%), but only 14% of doctors considered addiction to be a significant cause. Conclusion. Attention should be paid to the identified potential negative factors, such as smoking in young doctors, easy attitude to e-cigarettes, hookah and the threat of tobacco dependence. It is necessary to continue active anti-tobacco campaign at the national level with legislative support, paying significant attention to the medical medium.

Key words: doctors, smoking, hookah, e-cigarettes.

For reference: Khamitov RF, Fatykhova KR, Okurlu AF, Salimova LM, Mingaleeva GF. Smoking among medical professionals: perspectives of present day. The Bulletin of Contemporary Clinical Medicine. 2018; 11 (5): 79–82. DOI: 10.20969/ VSKM.2018.11(5).79-82.

REFERENCES

  1. Langat M, Patrik M, Perederij NA. Kurenie – nezavisimyj faktor riska smerti: problemy v Rossii i Kenii [Smoking as an independent risk factor for death: problems in Russia and Kenya]. Bjulleten’ medicinskih Internet-konferencij [Bulletin of medical Internet conferences]. 2017; 1 (6): 287.

  2. Hamitov RF, Sulbaeva KR, Aver’janova DE, et al. Tabakokurenie vo vrachebnoj srede: realii segodnjashnego dnja [Tobacco smoking among doctors: the realities of today]. Moskva: XXVI Nacional’nyj kongress po boleznjam organov dyhanija [Moscow: XXVI National Congress on respiratory diseases]. 2016; 175: 143.

  3. Petrova EJu, Stakanova TV, Turkina NV. Tabakokurenie sredi medicinskih rabotnikov [Tobacco smoking among medical practitioners]. Medicinskaja sestra [Medical nurse]. 2011; 3: 47-49.

  4. Babanov SA, Ivkina ON, Agarkova IA. Tabakokurenie i drugie faktory riska, vlijajushhie na zdorov’e medicinskih rabotnikov [Tobacco use and other risk factors affecting health care workers]. Vestnik Kostromskogo gosudarstvennogo universiteta imeni NA Nekrasova [Bulletin of the Kostroma State University named after Nekrasov NA]. 2010; 1 (16): 9-12.

  5. Hamitov RF, Doronina LA, Dem’janova EV. Oshibki diagnostiki pri tjazheloj hronicheskoj obstruktivnoj bolezni legkih: znachenie dlja ishodov lechenija [Fault diagnosis in severe COPD: implications for treatment outcomes]. Prakticheskaja medicina [Practical medicine]. 2016; 6 (98): 22-26.

 

DOI: 10.20969/VSKM.2018.11(5).82-85

PDF download ELECTRONEUROPHYSIOLOGIC CRITERIA FOR ACUTE FACIAL NERVE NEUROPATHY COURSE PROGNOSIS ACCORDING TO THE BLINK REFLEX EVALUATION DATA

YAKUPOV RADIK A., D. Med. Sci., professor, Director of the educational and research center of Volga State Academy of Physical Education, Sports and Tourism, Russia, 420010, Kazan, Universiade Village, 35, e-mail: r.a.yakupov@gmail.com

YAKUPOVA AIDA A., D. Med. Sci., associate professor of the Department of neurology and neurosurgery of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, e-mail: aidayakupova@yandex.ru

BUSURGINA ELENA A., neurologist of the Department of neurology for stroke patients of City Clinical Hospital No 7, Russia, 420130, Kazan, Chuikov str., 54, e-mail: elena.busurgina@mail.ru

NAZIPOVA ALFIYA YA., C. Med. Sci., Head of the Department of neurology for stroke patients of City Clinical Hospital No 7, Russia, 420130, Kazan, Chuikov str., 54, e-mail: nazipova.a@yandex.ru

Abstract. Aim. The aim of the study was to assess the informative value of the electroneurophysiological indices of the blink reflex in evaluation of the severity and prognosis for the course of the pathological process in acute facial neuropathy.Material and methods. A total of 57 patients [23 women and 34 men, mean age (39,7±0,8) years] with idiopathic facial nerve acute neuropathy were examined. Electroneuromyographic study of the blink reflex was used to assess the severity and prognosis of the peripheral lesion of the facial nerve. Results and discussion. It was established that the presence of the R1 component of the blink reflex on the side of the lesion is a favorable prognostic sign. It characterizes the high probability of complete recovery of the facial nerve function in a short period of time without complications. The absence of R1 component with the presence of R2 component corresponds to moderately positive prognosis with a longer recovery period, the presence of signs of residual paresis and a high incidence of secondary facial muscle contraction. The loss of all components of the blink reflex characterizes the high degree of facial nerve damage and is an unfavorable prognostic sign in terms of functional recovery. Conclusion. Electroneurophysiologic study of the blink reflex is informative for assessing the severity and prognosis of the course of acute facial nerve neuropathy. Blink reflex evaluation can be recommended for the use in neurological clinic for treatment and rehabilitation of patients with peripheral facial nerve lesions.

Key words: facial nerve neuropathy, blink reflex, prognosis.

For reference: Yakupov RA, Yakupova AA, Busurgina EA, Nazipova AY. Electroneurophysiologic criteria for acute facial nerve neuropathy course prognosis according to the blink reflex evaluation data. The Bulletin of Contemporary Clinical Medicine. 2018; 11 (5): 82–85. DOI: 10.20969/VSKM.2018.11(5).82-85.

REFERENCES
 

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2. Udelson YB, Ivanichev GA. Vtorichnaya kontraktura mimicheskikh myshts [Secondary contracture of facial muscles]. Smolensk: SGMI [Smolensk: SSMI]. 1994; 138 p.

3. Aoyagi M. Accuracy of the prognostic diagnosis in acute peripheral facial palsy. Nip J Gakkai Kaiho. 2005; 108: 1–7.

4. Karpovich EI, Gustov AV. Neyrofiziologicheskiye kriterii otsenki i prognozirovaniya tyazhesti techeniya nevropatii litsevogo nerva u detey [Neurophysiological criteria for assessing and predicting the severity of the course of facial nerve neuropathy in children SS Korsakov]. Zhurnal nevrologii i psikhiatrii imeni SS Korsakova [Journal of Neurology and Psychiatry named after SS Korsakov]. 2001; 11: 34–38.

  1. Savitskaya NG, Yankevi DS, Ostafiichuk AB, et al. Elektromiografiya: prognoz i otsenka effektivnosti terapii pri paraliche Bella [Electromyography: prognosis and evaluation of the effectiveness of therapy for Bell’s palsy]. Nevrologiya, neyropsikhiatriya, psikhosomatika [Neurology, Neuropsychiatry, Psychosomatics]. 2011; 3: 60–64.

  2. Esteban AA. Neurophysiological approach to brainstem reflexes; Blink reflex. Neurophysiol Clin. 1999; 29 (1): 7–38.

  3. Grusman GB. Elektromiograficheskoye issledovaniye migatel’nogo refleksa pri porazhenii perifericheskoy nervnoy sistemy [Electromyographic examination of the blinking reflex in the defeat of the peripheral nervous system SS Korsakov]. Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova [Journal of Neurology and Psychiatry named after SS Korsakov]. 1974; 11: 1649–1653.

  4. Nikolaev SG. Praktikum po klinicheskoy elektromiografii [Workshop on clinical electromyography]. Ivanovo: Ivanovskaya gosudarstvennaya meditsinskaya akademiya [Ivanovo: Ivanovo State Medical Academy]. 2003; 264 p.

  5. Medic VA. Statistika v meditsine i biologii: Rukovodstvo. V dvukh tomakh [Statistics in Medicine and Biology: A Guide; In 2 volumes]. Moskva: Meditsina [Мoscow: Medicine]. 2000; 764 p.

 

REVIEWS

UDC 616.12-008.331.1(048.8)

DOI: 10.20969/VSKM.2018.11(5).86-100

PDF download ARTERIAL HYPERTENSION ACUTE MANAGEMENT IN INTERNAL DISEASES

ABDRAKHMANOVA ALSU I., C. Med. Sci., associate professor of the Department of clinical vedicine fundamental basis of Institute of biology and fundamental medicine of Kazan Federal University, Russia, 420012, Kazan, K. Marx str., 74, e-mail: alsuchaa@mail.ru

AMIROV NAIL B., ORCID ID: 0000-0003-0009-9103; SCOPUS Authоr ID: 7005357664; D. Med. Sci., professor of the Department of general medical practice No 1 of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, e-mail: namirov@mail.ru

TSYBULKIN NIKOLAY A., C. Med. Sci., associate professor of the Department of cardiology, roentgenendovascular and cardiovascular surgery of Kazan State Medical Academy – the branch of Russian Medical Academy of Postgraduate Education, Kazan, Russia, 420012, Kazan, Butlerov str., 36, e-mail: kdkgma@mail.ru

FROLOVA ELVIRA B., C. Med. Sci., deputy Head physicion of City Clinical Hospital No 7, Russia, 420103, Kazan, Chuykov str., 54, е-mail: frolova.67@mail.ru

GAIFULLINA RAUSHANIA F., C. Med. Sci., associate professor of the Department of fundamental basis of clinical medicine of Institute of biology and fundamental medicine of Kazan Federal University, Russia, 420012, Kazan, K. Marx str., 74

Abstract. Aim. Analysis of recent publications on the etiology, pathogenesis, classification, diagnosis and treatment of arterial hypertension has been performed. Material and methods. Review of publications on hypertension in scientific and medical literature was carried out. Results and discussion. Proportion of arterial hypertension reaches 43% in the structure of cardiovascular diseases. An episode of increase in the blood pressure is associated with 40% of total mortality, 70% of cerebral strokes and 50% of acute coronary events. The pathogenesis of hypertension is not fully understood. Total cardiovascular risk evaluation is determined by the magnitude of blood pressure, the presence of risk factors, subclinical lesion in target organs and by the presence of cardiovascular, cerebrovascular or renal diseases. Diagnosis of arterial hypertension and examination includes repeated blood pressure measurement; history taking; physical examination; laboratory and instrumental diagnosis. The target blood pressure for all categories of patients is <140/90 mm Hg (in diabetes <140/85 mm Hg). Individual patient management tactics are determined upon assessing total cardiovascular risk. Lifestyle changes are recommended for all patients. Five main medication classes are recommended for treatment of arterial hypertension, those are: angiotensin-converting enzyme inhibitors, AT II receptor blockers, calcium antagonists, β-blockers and diuretics. All these classes of drugs are suitable for starting and supporting therapy, both as monotherapy and as a part of certain combinations. Imidazoline receptor agonists, α-blockers and direct renin inhibitors can be used as additional in combination therapy. The choice of drug is influenced by many factors, the most important of which are the presence of risk factors; target organ damage; cardiovascular, cerebrovascular or renal diseases; comorbidities; previous treatment experience; the likelihood of interaction with drugs that are prescribed for concomitant diseases; socio-economic factors, including the cost of treatment. Conclusion. The knowledge of modern views on the problem of arterial hypertension helps the doctor in everyday practice.

Key words: arterial hypertension, essential hypertension, diagnosis, treatment.

For reference: Abdrahmanova AI, Amirov NB, Tsibulkin NA, Frolova EB, Gaifullina RF. Arterial hypertension acute management in internal diseases. The Bulletin of Contemporary Clinical Medicine. 2018; 11 (5): 86–100. DOI: 10.20969/VSKM.2018.11(5).86-100.

REFERENCES

1. Rekomendacii po lecheniju arterial’noj gipertonii ESH/ESC 2013 [Recommendations for the management of arterial hypertension ESH/ESC 2013]. Rossijskij kardiologicheskij zhurnal [Russian journal of cardiology]. 2014; 1: 7-94

2. Kobalava ZhD. Novye Evropejskie rekomendacii po arterial’noj gipertonii: dolgozhdannye otvety i novye voprosy [New European guidelines on arterial hypertension: the long- awaited answers and new questions]. Arterial’naja gipertenzija [Hypertension]. 2014; 1: 19- 26.

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  2. Vorob’eva OD, Denisenko MB, Elizarov VV, et al. Demograficheskij ezhegodnik Rossii: Statisticheskij sbornik [Demographic Yearbook of Russia: Statistical compilation]. Moskva: Rosstat [Moscow: Russtat]. 2013;116 p.

  3. Bojcov SA, Balanova JuA, Shal’nova SA, et al. Arterial’naja gipertonija sredi lic 25–64 let: rasprostranennost’, osvedomlennost’, lechenie i kontrol’: Po materialam issledovanija JeSSE [Arterial hypertension among persons 25-64 years: prevalence, awareness, treatment and control: Based on the materials of the ESSE study]. Kardiovaskuljarnaja Terapija i Profilaktika [Cardiovascular Therapy and Prevention]. 2014; 4: 4–14.

  4. Muromceva GA, Koncevaja AV, Konstantinov VV et al. Rasprostranennost’ faktorov riska neinfekcionnyh zabolevanij v rossijskoj populjacii v 2012–2013 gg. Rezul’taty issledovanija JeSSE [The prevalence of non-infectious disease risk factors in the Russian population in 2012-2013 Results of the ESSE study]. Kardiovaskuljarnaja terapija i profilaktika[Cardiovascular Therapy and Prevention]. 2014; 13(6): 4–11.

  5. Bokarev IN. Arterial’naja gipertonija: sovremennyj vzgljad na problem [Arterial hypertension: modern opinion on the issue]. Klinicheskaja medicina [Clinical medicine]. 2015; 8: 65-70.

  6. Bokarev IN, Dulin PA, Ovchinnikov JuV et al. Arterial’naja gipertonija: sovremennoe sostojanie problem [Arterial hypertension: current state of the problem.]. Klinicheskaja medicina [Clinical medicine]. 2017; 7: 581-585.

  7. Karpov JuA. Evropejskie rekomendacii po serdechno – sosudistoj profilaktike 2016 goda: lechenie arterial’noj gipertonii [European guidelines for cardiovascular prevention, 2016: the treatment of hypertension].Atmosfera; Novosti kardiologii [Atmosphere; News of cardiology]. 2016; 3: 14-22.

  8. Lewington S, Clarke R, Qizilbash N, et al. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002; 360 (9349): 1903-1913.

  9. Lawes CM, Hoorn SV, Rodgers A. Global burden of blood-pressure-related disease, 2001. Lancet. 2008; 371 (9623): 1508-1513.

  10. Ong KL, Cheung BM, Man YB, et al. Prevalence, awareness, treatment, and control of hypertension among United States adults 1999–2004. Hypertension. 2007; 49: 69–75.

  11. Canale MP, Manca di Villahermosa S, Martino G, et al. Obesity- related metabolic syndrome: mechanisms of sympathetic overactivity. Int J Endocrinol. 2013; 2013: 865-965.

  12. Rosano C, Watson N, Chang Y, et al. Aortic pulse wave velocity predicts focal white matter hyperintensities in a biracial cohort of older adults. Hypertension. 2013; 61: 160–165.

  13. Di Minno M, Di Minno A, Songia P, et al. Markers of subclinical atherosclerosis in patients with aortic valve sclerosis: A meta- analysis of literature studies. Int J Cardiol. 2016; 15: 364-370.

  14. Faconti L, Bruno RM, Ghiadoni L, et al. Ventricular and vascular stiffening in aging and hypertension. Curr Hypertens Rev. 2015; 11: 100–109.

  15. Gerhard-Herman M, Smoot LB, Wake N, et al. Mechanisms of premature vascular aging in children with hutchinson-gilford progeria syndrome. Hypertension. 2012; 59: 92–97.

  16. Karras A, Haymann JP, Bozec E, et al. Large artery stiffening and remodeling are independently associated with all-cause mortality and cardiovascular events in chronic kidney disease. Hypertension. 2012; 60: 1451–1457.

  17. Kaess BM, Rong J, Larson MG, et al. Aortic stiffness, blood pressure progression, and incident hypertension. JAMA. 2012; 308: 875–881.

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  19. Obi Y, Streja E, Mehrotra R, et al. Impact of Obesity on Modality Longevity, Residual Kidney Function, Peritonitis, and Survival Among Incident Peritoneal Dialysis Patients. Am J Kidney Dis. 2017; pii: S0272-6386(17)30980-0.

22. Zhang X, Lerman LO. Obesity and renovascular disease. Am J Physiol Renal Physiol. 2015; 309 (4): 273-279.

23. Struben J, Chan D, Dube L. Policy insights from the nutritional food market transformation model: the case of obesity prevention. Ann N Y Acad Sci. 2014; 1331: 57-75.

24. Ceron CS, Marchi KC, Muniz JJ, Tirapelli CR. Vascular oxidative stress: a key factor in the development of hypertension associated with ethanol consumption. Curr Hypertens Rev. 2014; 10 (4): 213-222.

25. Chiasson VL1, Munshi N, Chatterjee P, Young KJ, Mitchell BM. Pin1 deficiency causes endothelial dysfunction and hypertension. Hypertension. 2011; 58 (3): 431- 438.

26. Virdis A, Neves MF, Duranti E, Bernini G, Taddei S. Microvascular endothelial dysfunction in obesity and hypertension. Curr Pharm Des. 2013; 19 (13): 2382-2389. 27. Ghiadoni L, Taddei S, Virdis A. Hypertension and endothelial dysfunction: therapeutic approach. Curr Vasc Pharmacol. 2012; 10 (1): 42-60.

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UDC 616-073.755.4-06:616-056.3(048.8)

DOI: 10.20969/VSKM.2018.11(5).100-104

PDF download ACUTE ADVERSE REACTIONS FOR CONTRAST MEDIUM INFILTRATION IN MEDICAL PRACTICE

AKHMEDZYANOVA DAMIRA G., assistant of professor of the Department of allergy and immunology of Kazan State Medical Academy – the branch of Russian Medical Academy of Postgraduate Education, Russia, 420012, Kazan, Butlerov str., 36; allergist-immunologist, high level certificate physician of City Clinical Hospital No 7, Russia, 420103, Kazan, Chuikov str., 54, tel. 8-917-913-39-93, e-mail: ahmdamira@yandex.ru

RAKHMATULLINA NAILJA M., C. Med. Sci., associate professor, Head of the Department of allergy and immunology of Kazan State Medical Academy – the branch of Russian Medical Academy of Postgraduate Education, Russia, 420012, Kazan, Butlerov str., 36; Head of City allergy center of City Clinical Hospital No 7, Russia, 420103, Kazan, Chuikov str., 54, tel. 8-903-342-99-12, e-mail: nailia.rakhmatullina@gmail.com

SIBGATULLINA NAILJA A., C. Med. Sci., assistant of professor of the Department of allergy and immunology of Kazan State Medical Academy – the branch of Russian Medical Academy of Postgraduate Education, Russia, 420012, Kazan, Butlerov str., 36; allergist-immunologist of City allergy center of City Clinical Hospital No 7, Russia, 420103, Kazan, Chuikov str., 54, tel. (843) 221-39-36, e-mail: aminasib@ mail.ru

DELYAN VICTORIA YU., C. Med. Sci., assistant of professor of the Department of allergy and immunology of Kazan State Medical Academy – the branch of Russian Medical Academy of Postgraduate Education, Russia, 420012, Kazan, Butlerov str., 36, tel. (843) 221-39-36, e-mail: viktoria_delyan@mail.ru

ZAKIROVA GUZEL N., assistant of professor of the Department of allergy and immunology of Kazan State Medical Academy – the branch of Russian Medical Academy of Postgraduate Education, Russia, 420012, Kazan, Butlerov str., 36; allergist-immunologist of City allergy center of City Clinical Hospital No 7, Russia, 420103, Kazan, Chuikov str., 54, tel. (843) 221-39-36, e-mail: zakirova.guzel@gmail.com

TROFIMOVA OLGA R., assistant of professor of the Department of allergy and immunology of Kazan State Medical Academy – the branch of Russian Medical Academy of Postgraduate Education, Russia, 420012, Kazan, Butlerov str., 36; allergist-immunologist of City allergy center of City Clinical Hospital No 7, Russia, 420103, Kazan, Chuikov str., 54, tel. (843) 221-39-36. e-mail: troff80@gmail.com

PANTELEYMONOVA POLINA M., resident of the Department of allergy and immunology of Kazan State Medical Academy – the branch of Russian Medical Academy of Postgraduate Education, Russia, 420012, Kazan, Butlerov str., 36, e-mail: gamble@list.ru

Abstract. Aim. The aim of the study was to draw the attention of practitioners to the problem of side effects of contrast medium application. Material and methods. A number of specialized literature sources devoted to the diagnostic efficacy and safety of iodinated intravascular contrast media were studied, in particular, the dependence of these two characteristics on each other. Significance of patient’s comorbid state and importance for precise history taking before conducting diagnostic procedures are also noted. Statistical data obtained in earlier studies showing the frequency of adverse reactions and the type of their clinical manifestations is provided. Adverse reaction classification proposed by the guidelines on contrast media application of the European Society of Urogenital Radiology is considered. Clinical case of a patient hospitalized in allergy department of City Clinical Hospital No 7 with a diagnosis of angioedema developed during examination with contrast medium infiltration was carefully studied. Results and discussion. The possibility of acute adverse reaction development in a patient with uncomplicated allergy history not included in risk groups was demonstrated. The presence of symptoms resembling a true allergy without immunological mechanism involvement was proved. Conclusion. The leading role of individual approach to managing a patient with indicated contrast medium study has been established.

Key words: iodinated intravascular contrast media, adverse reactions.

For reference: Akhmedzyanova DG, Rakhmatullina NM, Sibgatullina NA, Delyan VU, Zakirova GN, Trofimova OR, Panteleymonova PM. Acute adverse reactions for contrast medium infiltration in medical practice. The Bulletin of Contemporary Clinical Medicine. 2018; 11 (5): 100–104. DOI: 10.20969/VSKM.2018.11(5).100-104.

REFERENCES

1. Polyaev YuA, Yudin AL, Shimanovskiy NL. Primenenie kontrastnyih sredstv v luchevoy diagnostike [The use of contrast agents in radiodiagnosis]. Moskva [Moscow]: Kalganov. 2010; 432 p.

2. Shimanovskiy NL. Bezopasnost yodsoderzhaschih rentgenokontrastnyih sredstv v svete novyih rekomendatsiy mezhdunarodnyih assotsiatsiy ekspertov i klinitsistov [Safety of iodine-containing X-ray contrast agents in the light of new recommendations of international associations of experts and clinicians]. Russian electronic journal of radiology. 2012; 2 (1): 11.

3. Vitko NK, Ter-Akopyan AV, Pankov AS, Tagaev NB. Primenenie rentgenokontrastnyih veschestv v interventsionnoy kardiologii i angiologii: istoriya, oslozhneniya i ih profilaktika [The use of radiocontrast substances in interventional cardiology and angiology: history, complications and their prevention]. Russian electronic journal of radiology. 2012; 2 (1): 28.

4. Fominyih VP, Fineshin IN, Sharikov PV. Rentgenokontrastnyie preparatyi: Vzglyad reanimatologa [Radiopaque contrast drugs: The view of the resuscitator]. Russian electronic journal of radiology. 2012; 2 (1): 34.

5. Shehadi WH, Toniolo G. Adverse reactions to contrast media: a report from the Committee on Safety of Contrast Media of the International Society of Radiology. Radiology. 1980; 137: 299-302.

6. Haitov RM. Klinicheskaya allergologiya: Rukovodstvo dlya prakticheskih vrachey [Clinical Allergology: A Guide for Practitioners]. Moskva [Moscow]: MED-press-inform. 2002; 624 p.

7. Shimanovskiy NL. Kontrastnyie sredstva: rukovodstvo po ratsionalnomu primeneniyu [Radiopaque agents: guidelines for rational use]. Moskva [Moscow]: GEOTAR-Media. 2009; 464 p.

8. European Society of Urogenital Radiology. ESUR guidelines on contrast media, version 9.0. 2014; http://www.esur.org/ esur-guidelines/

9. Federalnyie klinicheskie rekomendatsii po diagnostike i lecheniyu lekarstvennoy allergii [Federal Clinical Recommendations for the Diagnosis and Treatment of Drug Allergies]. 2014; http://nrcii.ru/docs/la.pdf.

 

UDC 616.12-073.756.8(048.8)

DOI: 10.20969/VSKM.2018.11(5).104-109

PDF download MAGNETIC RESONANCE IMAGING IN EMERGENCY CARDIOLOGY: AN INTRODUCTION OF MODERN DIAGNOSTIC METHOD

DELYAN ARTUR M., Head physicion of City Clinical Hospital No 7, Russia, 420103, Kazan, Chuykov str., 54, е-mail: Artur.Delyan@tatar.ru

FROLOVA ELVIRA B., C. Med. Sci., deputy Head physicion of City Clinical Hospital No 7, Russia, 420103, Kazan, Chuykov str., 54, е-mail: frolova.67@mail.ru

TSYBULKIN NIKOLAY A., C. Med. Sci., associate professor of the Department of cardiology, roentgenendovascular and cardiovascular surgery of Kazan State Medical Academy – the branch of Russian Medical Academy of Postgraduate Education, Russia, 420012, Kazan, Butlerov str., 36, e-mail: kdkgma@mail.ru

MALOV АLEKSEI А., assistant of professor of the Department of oncology with the course of radiation diagnostics and radiotherapy of Kazan State Medical University; radiologist of City Clinical Hospital No 7, Russia, 420103, Kazan, Chuykov str., 54, е-mail: malov_aleksei@inbox.ru

Abstract. Aim. To characterize modern ideas of heart magnetic resonance imaging (MRI) and the main aspects of its clinical apply and demonstrate results of heart MRI introduction in clinical practice of our hospital. Material and methods. A review of scientific medical literature on heart MRI was performed. Efficiency of heat MRI was assesed. Results and discussion. Heart MRI can be used for diagnostics of variety cardiologic diseases. One of main scopes of MRI in cardiology is assessment of integrated and regional contractility of myocardium. High precision of method allows to accurately differentiate an endocardium disorders and to define contractility of myocardium segments. High temporary resolution of cardiac MRI allows to track and characterize process of reduction on certain sites of myocardium. Advantage of MRI allows possibility of internal structure of myocardium assessment. Cardiac MRI correlates segmental myocardium contractility to internal structure of separate segment. Practical use of cardiac MRI includes further equipment and software updates to improve sensitivity of method. Conclusion.Magnetic resonance imaging in cardiology is modern and perspective diagnostic method allowing to estimate all key structural and functional parameters of heart in patients with an ischemic heart disease and other myocardium diseases. Initial results of introduction of this method in routine clinical practice confirms high diagnostic value of this method for identification and differential diagnostics of cardiologic diseases, especially in difficult clinical cases.

Key words: magnetic resonance imaging, heart diseases, diagnostics.

For reference: Delyan AM, Frolova EB, Tsybulkin NA, Malov АА. Magnetic resonance imaging in emergency cardiology: an introduction of modern diagnostic method. The Bulletin of Contemporary Clinical Medicine. 2018; 11 (5): 104–109. DOI:10.20969/VSKM.2018.11(5).104-109.

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5. Dieringer MA, Hentschel J, de Quadros T, et al. Design, construction, and evaluation of a dynamic MR compatible cardiac left ventricle model. Med Phys. 2012; 39 (8): 4800-

4806.

  1. Zech WD, Schwendener N, Persson A, et al. Temperature dependence of postmortem MR quantification for soft tissue discrimination. Eur Radiol. 2015; 25 (8): 2381-2389.

  2. De Senneville BD, Roujol S, Jaïs P, et al. Feasibility of fast MR-thermometry during cardiac radiofrequency ablation. NMR Biomed. 2012; 25 (4): 556-562.

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  4. Dunet V, Schwitter J, Meuli R, Beigelman-Aubry C. Incidental extracardiac findings on cardiac MR: Systematic review and meta-analysis. J Magn Reson Imaging. 2016; 43 (4): 929-939.

  5. Nappi C, Altiero M, Imbriaco M, et al. First experience of simultaneous PET/MRI for the early detection of cardiac involvement in patients with Anderson-Fabry disease. Eur J Nucl Med Mol Imaging. 2015; 42 (7): 1025-1031.

  6. Kuetting DL, Sprinkart AM, Dabir D, et al. Assessment of cardiac dyssynchrony by cardiac MR: A comparison of velocity encoding and feature tracking analysis. J Magn Reson Imaging. 2016; 43 (4): 940-946.

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UDC 616.831.39(048.8)

DOI: 10.20969/VSKM.2018.11(5).109-114

PDF download MILD ENCEPHALOPATHY WITH REVERSIBLE SPLENIAL CORPUS CALLOSUM LESION: LITERATURE REVIEW AND CASE REPORT IN URGENT NEUROLOGIC CLINICAL PRACTICE

PEROV ROMAN I., resident of the Department of neurology, neurosurgery and medical genetic of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, e-mail: astronomerbellatrix@yandex.ru

KHAKIMOVA ALBINA R., neurologist of the Department of neurological No 2 of City Clinical Hospital No 7; assistant of the Department of neurology, neurosurgery and medical genetic of Kazan State Medical University, Russia, 420137, Kazan, Chuikov str., 54, e-mail: dralbina@mail.ru

POPOVA NATALIA A., Head of the Department of neurological No 2 of City Clinical Hospital No 7, Russia, 420137, Kazan, Chuikov str., 54, e-mail: p_nathali@mail.ru

Abstract. Aim. To review modern concepts of moderate encephalopathy with reversible lesion of the corpus callosum, a rare neurological syndrome characterized by foci detected by magnetic resonance imaging. Material and methods. A review of scientific medical literature on moderate encephalopathy with reversible lesion of the corpus callosum and a clinical example.Results and its discussion. The pathogenesis of this syndrome is unknown, however, it has been suggested that the syndrome is associated with infection, metabolic disorders, drug therapy, subarachnoid hemorrhages, malignant tumors, injuries and other conditions. Clinical manifestations may include convulsive seizures, impaired consciousness, dizziness, motor impairment, blindness, ataxia, tremors, and hallucinations, which are usually preceded by fever. The MRI picture is presented by mild hyperintensity foci on T2-weighted images, iso-intensive or slightly hypo-intensive on a T1-weighted image, showing reduced diffusion in the DWI mode, a low visible diffusion coefficient on the ADC. We conducted a clinical observation of a 47-year-old patient who was admitted after a convulsive seizure with complaints of «heaviness» in her head, memory impairment with difficulty remembering current events from the moment of hospitalization to the department, recognition of strangers (friends), general weakness, emotional imbalance with periodic tearfulness. The next day after admission, 1,5 T MRI showed changes in the corpus callosum. A differential diagnosis with infectious lesions, ischemia of the corpus callosum was performed. Further series of MRI neuroimaging performed with a 1,5 T MRI apparatus at the 6th week of the disease showed that the focus in the corpus callosum did not significantly changed. On control examenation after 12 weeks from the onset of the disease, there was no negative dynamics in the neurological status. Conclusions. In case of clinical suspicion of moderate encephalopathy syndrome with reversible lesion of the corpus callosum, it is necessary to conduct a full clinical and instrumental examination of the patient, including magnetic resonance imaging, and to detect changes during this study, conduct further dynamic monitoring. It is also extremely necessary to conduct a thorough differential diagnosis of this condition with other possible neurological disorders.

Key words: splenial corpus callosum lesions, MERS-syndrom.

For reference: Perov RI, Khakimova AR, Popova NA. Mild encephalopathy with reversible splenial corpus callosum lesion: literature review and case report in urgent neurologic clinical practice. The Bulletin of Contemporary Clinical Medicine. 2018; 11 (5): 109–114. DOI: 10.20969/VSKM.2018.11(5).109-114.

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3. Takanashi, J, Maeda, M, Hayashi, M. Neonate showing reversible splenial lesion. Arch Neurol. 2005; 62: 1481–1482.
4. Miyata R, Tanuma N, Hayashi M, Imamura T, Takanashi J, Nagata R, et al. Oxidative stress in patients with clinically mild encephalitis/encephalopathy with a reversible splenial lesion (MERS). Brain Dev. 2012; 34 (2): 124–127.
5. Starkey J, Kobayashi N, Numaguchi Y, Moritani T. Cytotoxic Lesions of the Corpus Callosum That Show Restricted Diffusion: Mechanisms, Causes, and Manifestations. Radiographics: a review publication of the Radiological Society of North America, Inc. 2017; 37 (2): 562-576.
6. Takanashi J, Tada H, Maeda M, Suzuki M, Terada H, Barkovich AJ. Encephalopathy with a reversible splenial lesion is associated with hyponatremia. Brain Dev. 2009; 31 (3): 217–220.
7. Malik AM. The reversible corpus callosum splenium lesion associated with hypoglycemic encephalopathy. Neurohospitalist. 2013; 3: 169.
8. Kim JH, Choi JY, Koh SB, Lee Y. Reversible splenial abnormality in hypoglycemic encephalopathy. Neuroradiology. 2007; 49: 217-222.
9. Takanashi J-I, Barkovich AJ, Yamaguchi K-I, Kohno Y. Influenza-associated encephalitis/encephalopathy with a reversible lesion in the splenium of the corpus callosum: a case report and literature review. Am J Neuroradiol. 2004; 25: 798–802.
10. Fluss, J, Ferey, S, Menache-Starobinski, C, Delavelle, J, Van Bogaert, P, Vargas, MI. Mild infl uenza-associated encephalopathy/encephalitis with a reversible splenial lesion in a Caucasian child with additional cerebellar features. Eur J Paediatr Neurol. 2010; 14 (1): 97–100.
11. Fuchigami T, Goto K, Hasegawa M, et al. A 4-year-old girl with clinically mild encephalopathy with a reversible splenial lesion associated with rotavirus infection. J Infect Chemother. 2013; 19: 149–153.
12. J-i T, Shiihara T, Hasegawa T, et al. Clinically mild encephalitis with a reversible splenial lesion (MERS) after mumps vaccination. J Neurol Sci. 2015; 349: 226–228.
13. Tomizawa Y, Hoshino Y, Sasaki F, et al. Diagnostic utility of Splenial lesions in a case of Legionnaires’ disease due to Legionella pneumophila; Serogroup 2. Intern Med. 2015; 54: 3079–3082.
14. Shibuya H, Osamura K, Hara K, Hisada T. Clinically mild encephalitis/encephalopathy with a reversible splenial lesion due to Mycoplasma pneumoniae infection. Intern Med. 2012; 51: 1647–1648.
15. Takayuki O, Yasuyuki S, et al. Clinically mild encephalitis/encephalopathy with a reversible splenial lesion associated with febrile urinary tract infection. Eur J Pediatr. 2014; 173 (4): 533–536.
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17. Kometani H, Kawatani M, Ohta G, et al. Marked elevation of interleukin-6 in mild encephalopathy with a reversible splenial lesion (MERS) associated with acute focal bacterial nephritis caused by Enterococcus faecalis. Brain Dev. 2014; 36: 551–553.
18. Ko SY, Kim BK, Kim DW, et al. Reversible splenial lesion on the corpus callosum in nonfulminant hepatitis a presenting as encephalopathy. Clin Mol Hepatol. 2014; 20: 398–401.
19. Renard D, Taieb G, Briere C, Bengler C, Castelnovo G. Mild encephalitis/encephalopathy with a reversible splenial, white matter, putaminal, and thalamic lesions following anti-Yorhombencephalitis. Acta Neurol Belg. 2012; 112: 405-407.
20. Alakbarova N, Eraslan C, Celebisoy N, Karasoy H, Gonul AS. Mild encephalitis / encephalopathy with a reversible splenial lesion (MERS) development after Amanita phalloides intoxication. Acta Neurol Belg. 2015: 1–3.
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UDC 615.216.2.065:616-056.3

DOI: 10.20969/VSKM.2018.11(5).115-118

PDF download THE PLACE OF ACUTE HYPERSENSITIVITY DRUG REACTIONS WHEN USING LOCAL ANESTHETICS IN MULTIDISCIPLINARY CLINIC SETTING

RAKHMATULLINA NAILJA M., C. Med. Sci., associate professor, Head of the Department of allergy and immunology of Kazan State Medical Academy – the branch of Russian Medical Academy of Postgraduate Education; Head of City allergy center of City Clinical Hospital No 7, Russia, 420103,Kazan, Chuikov str., 54, tel. 8-903-342-99-12, e-mail: nailia.rakhmatullina@gmail.com

AKHMEDZYANOVA DAMIRA G., assistant of professor of the Department of allergy and immunology of Kazan State Medical Academy – the branch of Russian Medical Academy of Postgraduate Education; allergist-immunologist of high level certificate physician of City allergy center of City Clinical Hospital No 7, Russia, 420103, Kazan, Chuikov str., 54, tel. 8-917-913-39-93, e-mail: ahmdamira@yandex.ru

SIBGATULLINA NAILJA A., C. Med. Sci., assistant of professor of the Department of allergy and immunology of Kazan State Medical Academy – the branch of Russian Medical Academy of Postgraduate Education; allergist-immunologist of City allergy center of City allergy center of City Clinical Hospital No 7, Russia, 420103, Kazan, Chuikov str., 54, tel. 8-937-623-43-01, е-mail: aminasib@ mail.ru

DELYAN VICTORIA YU., C. Med. Sci., assistant of professor of the Department of allergy and immunology of Kazan State Medical Academy – the branch of Russian Medical Academy of Postgraduate Education, Russia, 420012, Kazan, Butlerov str., 36, tel. (843)221-39-36, е-mail: viktoria_delyan@mail.ru

ZAKIROVA GUZEL N., assistant of professor of the Department of allergy and immunology of Kazan State Medical Academy – the branch of Russian Medical Academy of Postgraduate Education; allergist-immunologist of City allergy center of City Clinical Hospital No 7, Russia, 420103, Kazan, Chuikov str., 54, tel. (843)221-39-36, е-mail: zakirova.guzel@gmail.com

TROFIMOVA OLGA R., assistant of professor of the Department of allergy and immunology of Kazan State Medical Academy – the branch of Russian Medical Academy of Postgraduate Education; allergist-immunologist of City allergy center of City Clinical Hospital No 7, Russia, 420103, Kazan, Chuikov str., 54, tel. (843)221-39-36, е-mail: troff80@gmail.com

PANTELEYMONOVA POLINA M., resident of the Department of allergy and immunology of Kazan State Medical Academy – the branch of Russian Medical Academy of Postgraduate Education, Russia, 420012, Kazan, Butlerov str., 36, e-mail: gamble@list.ru

Abstract. Aim. The aim of the study is to focus the attention of doctors of various specialties on the need to differentiate the approach of local anesthetic application, to identify the role of various characteristics and properties of local anesthetics in the process of drug selection. Material and methods. We analyzed the case histories of 2780 patients with various diagnoses. The patients were hospitalized in allergy department at City Clinical Hospital No 7 of Kazan in 2015–2017 due to the onset of symptoms of an acute drug hypersensitivity reaction after taking the procedures with the use of local anesthetics for their underlying disease. Results and discussion. The principles of local anesthetic administration in patients being at risk due to the presence of chronic somatic disease or aggravated allergic history are presented. The analysis of reactions to drugs in a multidisciplinary clinic was performed. Recommendations for prevention of side effects of drugs aimed at maintaining overall comfortable psycho-physiological state of the patients, concerning both the choice of local anesthetic drug and the technique of the procedure itself, were given. Conclusion. It is necessary to take into consideration the side effects of the drug itself and the comorbid conditions of the patient when appointing local anesthetics.

Key words: local anesthetics, drug side effects.

For reference: Rakhmatullina NM, Akhmedzyanova DG, Sibgatullina NA, Delyan VU, Zakirova GN, Trofimova OR, Panteleymonova PM. The place of acute hypersensitivity drug reactions when using local anesthetics in multidiscipline clinic setting. The Bulletin of Contemporary Clinical Medicine. 2018; 11 (5): 115–118. DOI: 10.20969/VSKM.2018.11(5).115-118.

REFERENCES

1. World Allergy Organization. White book on Allergy. 2011–2012; www.worldallergy.org/UserFiles/file/WAOWhite-Book-on- Allergy_web.pdf

2. Haitov RM. Lekarstvennaya allergiya [Drug allergy]: Metodicheskie rekomendatsii dlya vrachey [Methodical recommendations for doctors]. Moskva [Moscow]: Farmarus Print Media. 2012; 71 p.

3. Kashkin KP, Goryachkina LA. Klinicheskaya allergologiya i immunologiya [Clinical allergology and immunology]: Rukovodstvo dlya praktikuyuschih vrachey [A Guide for Practitioners]. Moskva [Moscow]: Miklosh. 2009; 363–381.

4. Mashkovskiy MD. Lekarstvennyie sredstva: posobie dlya vrachey [Drugs: a Handbook for Doctors]. Moskva: Novaya volna [Moscow: New Wave]. 2012; 309–316.

5. Mulroy M. Mestnaya anesteziya [Regional Anesthesia]. Illyustrirovannoe prakticheskoe rukovodstvo [An Illustrated Procedural Guide]. Moskva: BINOM, Laboratoriya znaniy [Moscow: BINOM, Laboratory of Knowledge]. 2012; 299 p.

6. Reyharta M. Neblagopriyatnyie pobochnyie reaktsii lekarstvennyih sredstv [Adverse drug reactions]. Moskva [Moscow]: Litterra. 2007; 239 p.

7. Gruchalla RS. Drug allergy. J Allergy Clin Immunol. 2003; 111 (2): 548–559.

8. Maksimovskaya LN, Roschina PI. Lekarstvennyie sredstva v stomatology: Spravochnik [Drugs in stomatology: Directory]. Moskva: Meditsina [Moscow: Medicine]. 2000; 240 p.

9. Kanonenko YuG, Rozhko NM, Ruzin GP. Mestnoe obezbolivanie v ambulatornoy stomatologii [Local anesthesia in outpatient dentistry]. Moskva: Kniga Plyus [Moscow: Book Plus]. 2017; 22 p.

10. Shaydo LP, Lampusov VB, Bodyakina EA. Provedenie mestnoy anestezii ambulatorno u patsientov gruppyi riska [Conducting local anesthesia in patients at risk in outpatient settings]. Stomatologiya segodnya [Dentistry Today)]. 2002; 6: 10-11.

 

UDC 616-008.9(048.8)

DOI: 10.20969/VSKM.2018.11(5).118-124

PDF download METABOLIC SYNDROME AS A CAUSATIVE FACTOR OF MEDICAL EMERGENCIES

FROLOVA ELVIRA B., C. Med. Sci., deputy Head of City Clinical Hospital No 7, Russia, 420103, Kazan, Chuykov str., 54, е-mail: frolova.67@mail.ru

TSYBULKIN NIKOLAY A., C. Med. Sci., associate professor of the Department of cardiology, roentgenendovascular and cardiovascular surgery of Kazan State Medical Academy – the branch of Russian Medical Academy of Postgraduate Education, Russia, 420012, Kazan, Butlerov str., 36, е-mail: kdkgma@mail.ru

ABDRAKHMANOVA ALSU I., C. Med. Sci., associate professor of the Department of clinical medicine fundamental basis of Institute of biology and fundamental medicine of Kazan Federal University, Russia, 420012, Kazan, K. Marx str., 74, е-mail: alsuchaa@mail.ru

Abstract. Aim. The aim of the study was to characterize the modern views on the metabolic syndrome and its clinical aspects.Material and methods. Review of scientific medical literature on a subject of metabolic syndrome has been performed. Results and discussion. Metabolic syndrome is a common disease including a complex of risk factors for cardiovascular diseases. The main components of metabolic syndrome are the disturbances of carbohydrate and fat metabolism, arterial hypertension and abdominal obesity. Development of metabolic syndrome is bound to the unity of pathogenesis of its components. Prognostic value of metabolic syndrome is defined by rising of risk of cardiovascular complications and mortality from cardiovascular diseases. The prevalence of metabolic syndrome is determined by the lifestyle of the patient and ones genetic predisposition. The greatest share of such patients is in the industrial countries. It makes up to a quarter of the population. The risk of diabetes mellitus in metabolic syndrome is increased fivefold in comparison with population level. Conclusion. Metabolic syndrome is the disease including a complex of risk factors for cardiovascular diseases. The main components of metabolic syndrome are disturbances of carbohydrate and fat metabolism, arterial hypertension, and abdominal obesity. Development of metabolic syndrome is bound to the unity of pathogenesis of its components. The prognostic value of metabolic syndrome is defined by rising of risk of cardiovascular complications and mortality from cardiovascular diseases.

Key words: metabolic syndrome, diabetes mellitus, cardiovascular complications.

For reference: Frolova EB, Tsybulkin NA, Abdrahmanova AI. Metabolic syndrome as a causative factor of medical emergencies. The Bulletin of Contemporary Clinical Medicine. 2018; 11 (5): 118–124. DOI: 10.20969/VSKM.2018.11(5).118-124.

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DOI: 10.20969/VSKM.2018.11(5).124-129

PDF download THE EFFECT OF II TYPE DIABETES MELLITUS ON THE COURSE AND PROGNOSIS OF CHRONIC HEART FAILURE IN HOSPITAL REGISTER PATIENTS

KHAZOVA ELENA V., ORCID ID: https://orcid.org/0000-0001-8050-2892; C. Med. Sci., associate professor of the Department of introduction to internal medicine of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, tel. 8-905-313-97-10, e-mail: hazova_elena@mail.ru

BULASHOVA OLGA V., SCOPUS Author ID: 6507198087; D. Med. Sci., professor of the Department of introduction to internal medicine of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, tel. 8(843) 296-14-03, e-mail: boulashova@yandex.ru

OSLOPOV VLADIMIR N., SCOPUS Author ID: 6602523658; D. Med. Sci., professor of the Department of introduction to internal medicine of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, tel. 8 (905)316-25-35, e-mail: kpvbol@yandex.ru

MALKOVA MARIA I., C. Med. Sci., Head of the Department of functional diagnostics of City Clinical Hospital No 7, Russia, 420103, Kazan, Chuikov str., 54; assistant of professor of the Department of introduction to internal medicine of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, tel. 8-960-051-61-16, e-mail: marimalk@yandex.ru

Abstract. Chronic heart failure is recognized as a potentially fatal stage of any cardiovascular disease, characterized by significant economic costs of the health care system in terms of improving the clinical status of patients and their quality of life, reducing the risk of adverse clinical outcomes. Aim. The aim of the study was to analyze the problem of comorbidity of chronic heart failure and type II diabetes in hospital register patients. Material and methods. Analysis of studies on the prevalence, pathogenesis and prognosis in patients with chronic heart failure in combination with type II diabetes was performed. Results and discussion. One of the frequent associated conditions in chronic heart failure is diabetes mellitus, recognized as the cause of chronic heart failure in 12% of patients. The prevalence of diabetes mellitus in patients with heart failure is significantly higher than in the general population (25% vs 9%), rising sharply to 40% in patients hospitalized due to acute heart failure decompensation. Chronic heart failure progression was shown to slow down when HbA1c≥1% decreased throughout the year in patients with type II diabetes with initially poor glycemic control. Hospital treatment of type II diabetes patients for acute heart failure decompensation is recognized as one of the most significant predictors of cardiovascular death: the risk of death in the next 18 months increases 5 times (RR 4,96; 95% CI 3,29–7,47), exceeding the relative risk of death after myocardial infarction of 3,12 and 3,08 after a stroke. Conclusion. The article presents epidemiological and pathophysiological aspects of the association of chronic heart failure and diabetes. The combination of heart failure and diabetes mellitus can be explained by such common pathophysiological processes as neurohumoral activation, oxidative stress and endothelial dysfunction. The data from the studies on the features of the course and prognosis of heart failure in patients with type II diabetes are highlighted.

Key words: chronic heart failure, type II diabetes mellitus, prognosis, comorbidity.

For reference: Khazova EV, Bulashova OV, Oslopov VN, Malkova MI. The effect of II type diabetes mellitus on the course and prognosis of chronic heart failure in hospital register patients. The Bulletin of Contemporary Clinical Medicine. 2018; 11 (5): 124–129. DOI: 10.20969/VSKM.2018.11(5).124-129.

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UDC 616.124.2-007.61-06:616.1(048.8)

DOI: 10.20969/VSKM.2018.11(5).129-134

PDF download ASSOCIATION OF CARDIOVASCULAR RISK AND DISPROPORTIONATELY HIGH LEFT VENTRICULAR MYOCARDIAL MASS

SHAMKINA AYGUL R., C. Med. Sci., assistant of professor of the Department of introduction to internal medicine of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, e-mail: schamkina.aigul@yandex.ru

Abstract. The concept of «disproportionately high left ventricular myocardial mass», reflecting an increase in the mass of the left ventricular myocardium to a greater extent than required by hemodynamic load due to increased arterial pressure, was proposed in 1998 by de G. Simone et al. Aim. The aim of the study was to explain the concept of the association of cardiovascular risk and disproportionately high mass of the left ventricular myocardium based on literature data and on our own research. Material and methods. This review presents the literature data and the results of our own research on the association of disproportionately high mass of the left ventricular myocardium and cardiovascular morbidity and mortality. Results and discussion. The results of numerous studies indicate an unfavorable prognostic value of the disproportionately high mass of the myocardium of the left ventricle, regardless of the presence of traditionally defined criteria for left ventricular hypertrophy. However, the results obtained should not be interpreted as the inability to identify high-risk patients with generally accepted criteria for left ventricular hypertrophy. In addition, the value of the disproportionate increase in the mass of the myocardium of the left ventricle for stratification of cardiovascular risk in patients with arterial hypertension remains unclear. Conclusion.Disproportionately high left ventricular myocardium mass identification will help clinicians to conduct more accurate individual cardiovascular risk assessment in order to begin a complex of adequate therapeutic and preventive measures in patients, especially in young people, at an earlier stage. Further research in this area is required.

Key words: inappropriately high left ventricular mass, cardiovascular risk, arterial hypertension.

For reference: Shamkina AR. Association of cardiovascular risk and disproportionately high left ventricular myocardial mass. The Bulletin of Contemporary Clinical Medicine. 2018; 11 (5): 129–134. DOI: 10.20969/VSKM.2018.11(5).129-134.

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  9. Chazova IE, Oschepkova EV, Zhernakova YuV. Diagnostika i lechenie arterial’noj gipertenzii: klinicheskie rekomendacii [Diagnostics and treatment of arterial hypertension: clinical recommendations]. Kardiologicheskij vestnik [Cardiological Bulletin]. 2015; 1: 3-29.

  10. Mancia G, Fagard R, Narkiewicz K et al. Rekomendacii po lecheniyu arterial’noj gipertonii; ESH/ESC 2013 [Recommendations for treatment of arterial hypertension; ESH/ESC 2013]. Rossijskij kardiologicheskij zhurnal [Russian journal of cardiology]. 2014; 1: 7−94.

  11. Frohlich ED, Tarazi RC. Is arterial pressure the sole factor responsible for hypertensive cardiac hypertrophy? Am J Cardiol. 1979; 44 (5): 959−963.

  12. Simone G, Devereux RB, Kimball TR et al. Interaction between body size and cardiac workload: influence on left ventricular mass during body growth and adulthood. Hypertension. 1998; 31: 1077−1082.

  13. Frohlich ED. State of the Art lecture. Risk mechanisms in hypertensive heart disease Hypertension. 1999; 34 (4 Pt 2): 82−89.

  14. Konradi AO, Rudomino OT, Shlyakhto EV. Rasprostranennost’ i demograficheskie determinanty remodelirovaniya miokarda u bol’nyh gipertonicheskoj bolezn’yu [Prevalence and demographic determinants of myocardial remodeling in hypertensive patients]. Terapevticheskij arhiv [Therapeutic archive]. 2005; 8: 28-32.

  15. Razumov VV, Bondarev OI, Zadorozhnaya MP. Proliferaciya kardiomiocitov kak zabytyj mekhanizm remodelirovaniya serdca (analiticheskij obzor i sobstvennye nablyudeniya) [The proliferation of cardial myocytes as a forgotten mechanism of cardiac remodeling (analysis and own observations)]. Fundamental’nye issledovaniya [Fundamental research]. 2015; 1: 1268-1274.

  16. Simone G, Verdecchia P, Pede S et al. Prognosis of inappropriate LV mass in hypertension; The MAVI study. Hypertension. 2002; 40: 470−476.

25. Muiesan ML, de Simone G, Ganau A et al. Inappropriate left ventricular mass: Reliability and limitations of echocardiographic measurement for risk stratification and follow-up in single patients. J Hypertens. 2006; 24 (11): 2293−2298.

26. Muiesan ML, Salvetti M, Paini A et al. Inappropriate left ventricular mass changes during treatment adversely affects cardiovascular prognosis in hypertensive patients. Hypertension. 2007; 49 (5): 1077-1083.

27. Cioffi G, Faggiano P, Vizzardi E et al. Prognostic effect of inappropriately high left ventricular mass in asymptomatic severe aortic stenosis. Heart. 2011; 97 (4): 301-307.

28. Chen SC, Chang JM, Liu WC et al. The ratio of observed to predicted left ventricular mass is independently associated with increased cardiovascular events in patients with chronic kidney disease. Hypertens Res. 2012; 35 (8): 832−838.

29. Nardi E, Palermo A, Mulè G. Inappropriately high left ventricular mass: marker of very high cardiovascular risk in patients with chronic kidney disease? Hypertens Res. 2012; 35 (8): 800−801.

30. Shamkina AR, Sadykova AR, Gizyatoullova RI. Evaluation of total cardiovascular risk in child-bearing age women in dependence on incidence of inappropriately high left ventricular mass [Stratification of risk of complications in women of reproductive age with arterial hypertension, depending on the presence of disproportionally to the high left ventricular mass and its degree of severity]. Prakticheskaya medicina [Practical medicine]. 2012; 60 (5): 118−121.

31. ShamkinaAR,SadykovaAR.Koehfficientdisproporcional’nosti massy miokarda levogo zheludochka – sushchestvennyj prediktor povysheniya stepeni riska razvitiya oslozhnenij arterial’noj gipertenzii u zhenshchin reproduktivnogo vozrasta [The left ventricular myocardial mass disproportion coefficient is a significant predictor of increasing the risk of arterial hypertension complications in women of reproductive age]. Kardiovaskulyarnaya terapiya i profilaktika [Cardiovascular therapy and prevention]. 2015; 14 (Suppl.): 241.

32. Sadykova AR, Shamkina AR, Gizyatullova RI. Serdechno- sosudistyj risk i neproporcional’no vysokaya massa miokarda levogo zheludochka u zhenshchin klimaktericheskogo perioda [Cardiovascular risk and unproportional high weight of left ventrical myocardium in climacteric women ]. Kazanskij medicinskij zhurnal [Kazan medical journal]. 2014; 94 (3): 315−322.

33. Sadykova AR, Shamkina AR, Gizyatullova RI. Stratifikaciya riska razvitiya oslozhnenij arterial’noj gipertenzii u zhenshchin klimaktericheskogo perioda v zavisimosti ot stepeni vyrazhennosti neproporcional’no vysokoj massy miokarda levogo zheludochka [Stratification of total cardiovascular risk in hypertensive menopausal women in dependence on incidence of inappropriately high mass of left ventricular myocardium]. Prakticheskaya medicina [Practical medicine]. 2014; 82 (6): 95−100.

34. Huang BT, Peng Y, Liu W et al. Inappropriate left ventricular mass and poor outcomes in patients with angina pectoris and normal ejection fraction. Coron Artery Dis. 2015; 26 (2): 163-169.

35. Kobalava ZD, Kotovskaya AF, Safarova SV et al. Neproporcional’no vysokaya massa miokarda levogo zheludochka u bol’nyh arterial’noj gipertoniej: klinicheskie associacii i osobennosti remodelirovaniya [Inappropriately high left ventricular mass in patients with hypertension: clinical associations and peculiarities of remodeling]. Kardiologia [Cardiology]. 2008; 11: 19−28.

36. Cioffi G, Rossi A, Zoppini G et al. Inappropriate left ventricular mass independently predicts cardiovascular mortality in patients with type 2 diabetes. Int J Cardiol. 2013; 168 (5): 4953−4956.

37. Hermes W, Franx A, Pampus MG et al. Cardiovascular risk factors in women who had hypertensive disorders late in pregnancy: a cohort study. Am J Obstet Gynecol. 2013; 208 (6): 474, e1−8.

38. Nilsson P, Boutouyrie P, Laurent S. Vascular aging: a tale of EVA and ADAM in cardiovascular risk assesstment and prevention. Hypertension. 2009; 54: 3−10.

 

UDC 616.891.6-039.31-079.4(048.8)

DOI: 10.20969/VSKM.2018.11(5).135-139

PDF download THE FEATURES OF PANIC ATTACK DIFFERENTAL DIAGNOSIS IN ADMISSION DEPARTMENT

SHIKOV ALEXEY S., postgraduate student of the Department of neurology, neurosurgery and medical genetics of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, e-mail: as.shikov@yahoo.com

YAKUPOV EDUARD Z., D. Med. Sci., professor, Head of the Department of neurology, neurosurgery and medical genetics of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, e-mail: ed_yakupov@mail.ru

Abstract. Aim. The aim of the study was to review the differential diagnosis of panic attacks in admission department. Material and methods. Review of scientific medical literature on the differential diagnosis of panic attacks in admission department was performed.Results and discussion. One of the most difficult tasks for a doctor is to make a correct diagnosis. In admission department it is often complicated by time limitations and by the lack of available opportunities for diagnostic examinations. Panic attacks occupy a special position among the most common reasons for patients to refer to the admission department, as these patients seek for medical care 4 times more often. Due to the high variability of the clinical picture of panic attacks, during the attack patients refer to neurologists, cardiologists, pulmonologists, general practitioners or surgeons. Specialists in internal medicine are not always able to recognize a panic attack, which contributes to making the wrong diagnosis. The complexity of the differential diagnosis between panic attacks and «serious» somatic diseases often causes patients to undergo numerous expensive examinations, the negative results of which do not help to establish the correct diagnosis and frighten patients even more. The long existence of symptoms, the lack of accurate diagnosis, and, consequently, of correct treatment lead to creation of patient’s lasting belief in existence of a «dangerous» disease. Conclusion. The article explains why primary care physicians are in a unique position, which allows them to detect the signs of panic attacks in a patient in time and assign them for specialized treatment. Timely measures taken can significantly reduce the number of calls to the admission department, and thereby reduce economic losses.

Key words: panic attacks, stroke, epilepsy, myocardial infarction, differential diagnosis.

For reference: Shikov AS, Yakupov EZ. The features of panic attack differential diagnosis in admission department. The Bulletin of Contemporary Clinical Medicine. 2018; 11 (5): 135–139. DOI: 10.20969/VSKM.2018.11(5).135-139.

REFERENCES

  1. Katon W. Panic disorder: relationship to high medical utilization, unexplained physical symptoms, and medical costs. The Journal of clinical psychiatry. 1996; 57: 11–18.

  2. Kao L-T, Xirasagar S, Chung K-H, Lin H-C, Liu S-P, Chung S-D. Weekly and Holiday-Related Patterns of Panic Attacks in Panic Disorder: A Population-Based Study. PLoS ONE. 2014; 9 (7): e100913.

  3. Stahl SM, Soefje S. Panic attacks and panic disorder: the great neurologic imposters. Seminars in neurology. 1995; 15: 126–132.

  4. Craske MG, Kircanski K, Epstein A, Wittchen HU, Pine DS, Lewis-Fernández R, Stein M. Panic disorder: a review of DSM- IV panic disorder and proposals for DSM-V. Depression and Anxiety. 2014; 27 (2): 93-112.

  5. Ley R. The many faces of Pan: psychological and physiological differences among three types of panic attacks. Behav Res Ther. 1992; 30 (4): 347-357.

6. Meuret A, Ritz T. Hyperventilation in panicdisorder and asthma: empirical evidence and clinical strategies. Int J Psychophysiol. 2010; 78 (1): 68–79.

7. Yakupov EZ. Sostoyaniye integrativnykh sistem mozga pri sindrome vegetativnoy disfunktsii [The state of integrative brain systems in the syndrome of autonomic dysfunction]. Kazan`: Kazanskiy gosudarstvennii medicinskii universitet [Kazan: Kazan State Medical University]. 2006; 25 p.

8. Hendrickson R, Popescu A, Ghearing G, Bagic A. Panic attack symptoms differentiate patients with epilepsy from tho se withpsychogenic nonepileptic spells (PNES). Epilepsy an d Behavior. 2015; 37: 210–214.

9. McDevitt-Petrovic O, Kirby K, Shevlin M. The prevalence of non-cardiac chest pain (NCCP) using emergency department (ED) data: a Northern Ireland based study. BMC Health Services Research. 2017; 17: 549.

10. Vertkin AL, Topolyansky AV. Algoritmy diagnostiki: bol’ v grudnoy kletke [Diagnostic algorithms: chest pain]. Russkiy Meditsinskiy Zhurnal [Russian Medical Journal]. 2016; 14: 913-916

11. Reis L, Lameiras R, Cavilhas P, Escada P. Epidemiology of Vertigo on Hospital Emergency. Acta Médica Portuguesa. 2016; 29 (5): 326-331.

12. Saber Tehrani AS, Coughlan D, Hsieh YH, et al. Rising annual costs of dizziness presentations to US emergency departments. Acad Emerg Med. 2013; 20 (7): 689–696.

13. Vanni S, Pecci R, Casati C, et al. Standing, a four-step bedside algorithm for differential diagnosis of acute vertigo in the Emergency Department. Acta Otorhinolaryngologica Italica. 2014; 34 (6): 419-426.

14. Meurer WJ, Low PA, Staab JP. Medical and Psychiatric Causes of Episodic Vestibular Symptoms. Neurologic Clinics. 2015; 33 (3): 643-659.

15. Vein AM, Djukova GM, Vorobieva OV. Is panic attack a mask of psychogenic seizures?--a comparative analysis of phenomenology of psychogenic seizures and panic attacks. Funct Neurol. 1994; 9 (3): 153–159.

16. Dyukova G, Vorobyova O, Shepeleva I. Patent No 1757644A1 «Sposob differentsial’noy diagnostiki panicheskikh atak i psikhogennykh pripadkov» [Patent No 1757644A1 “Method for differential diagnosis of panic attacks and psychogenic seizures”]. Moskva [Moscow]. 1992.

 

HELP FOR PRACTITIONER

UDC 616.28-008.55

DOI: 10.20969/VSKM.2018.11(5).140-143

PDF download ACUTE VESTIBULAR VERTIGO IN THE PRACTICE OF NEUROLOGIST OF ADMISSION AND DIAGNOSTIC DEPARTMENT

ZAGIDULLINA KRISTINA L., neurologist of the Department of neurology No 2 of City Clinical Hospital No7, Russia, 420137, Kazan, Chuykov str., 54, tel. 8(843) 237-93-23, e-mail: ZagidullinaKristina@yandex.ru

POPOVA NATALIYA A., C. Med. Sci., Head of the Department of neurology No 2 of City Clinical Hospital No7, Russia, 420137, Kazan, Chuykov str., 54, tel. 8(843) 237-93-23, e-mail: p_nathali@mail.ru

Abstract. Aim. Evaluation of additional methods of clinical examination in patients with acute dizziness was performed. Material and methods. Additional methods for examining patients in admission and diagnostic department mode were analyzed based on clinical cases. The time spent by the doctor on conducting positional tests, including Dix-Hallpike and McClure-Pagnini positional tests, the study of the vestibulo-ocular reflex and Halmaghi test, was calculated. An example of a patient suffering from long-lasting dizziness that had mistakenly been diagnosed with a transient ischemic attack many years ago is provided. As a result of alternative approach to clinical examination of the patient with vertigo, the diagnosis was revised to «benign paroxysmal positional vertigo». The following clinical case of a patient with acute peripheral vestibulopathy exemplified the need to check vestibulo-ocular reflex. Results and discussion. Additional methods of investigation at the level of admission and diagnostic department are quickly feasible and have a high diagnostic value. The use of additional methods by neurologist to examine patients with dizziness minimizes the time of diagnosis, facilitating timely treatment. The time spent on positional tests fully justifies their use in an emergency diagnostic department, because they allow one to quickly eliminate the most common causes of dizziness. Conclusion. Assessment of the vestibular-ocular reflex requires several additional minutes to general neurological examination. However, it accurately determines whether the patient has vestibulopathy.

Key words: diagnosis of dizziness, benign paroxysmal positional dizziness, vestibuloocular reflex, positional tests.

For reference: Zagidullina KL, Popova NA. Acute vestibular vertigo in the practice of neurologist of admission and diagnostic department. The Bulletin of Contemporary Clinical Medicine. 2018; 11 (5): 140–143. DOI: 10.20969/VSKM.2018.11(5).140-143.

REFERENCES

1. Babiyak VI, Govorun MI, Nakatis YaA. Otorinolaringologiya: Rukovodstvo, v dvukh tomakh; tom 2 [Otolaryngology: Guide in two volumes; volume 2]. Sankt Peterburg: Piter [St Petersburg: Peter]. 2009; 832 p.

2. Brazis PU, Dzhozef K Mesd’yu, Khose Biller. Topicheskaya diagnostika v klinicheskoy nevrologii [Topical Diagnosis in Clinical Neurology]. Moskva: MED-press-inform [Moscow: MED-press-inform]. 2009; 389-409.

3. Brandt T, Diterikh M, Shtrupp M. Golovokruzheniye [Dizziness]. Moskva: Praktika [Moscow: Praktika]. 2009; 13- 51, 61-62, 67-90.

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5. Mel’nikov OA, Zamergrad MV. Dobrokachestvennoye pozitsionnoye golovokruzheniye [Benign vertigo]. Lechashchiy vrach [The attending physician]. 2000; 1: 15-19.

6. Pal’chun VT, Kunel’skaya NL, Rotermel YeV. Diagnoz i lecheniye dobrokachestvennogo paroksizmal’nogo golovokruzheniya [Diagnosis and treatment of benign paroxysmal dizziness]. Vestnik otorinolaringologii [Bulletin of Otorhinolaryngology]. 2007; 1: 4-7.

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9. Herdman SJ. Treatment of benign paroxysmal vertigo. Phys Ther. 1990; 70: 381-388.

10. Von Brevern M. Benign paroxismal positional vertigo. Semin Neurol. 2013; 33 (3): 204-211.

 

DOI: 10.20969/VSKM.2018.11(5).143-148

PDF download LUMBOSACRAL PLEXOPATHY: CLINICAL CASE DESCRIPTION

CHIZH ROMAN S., neurologist of the Department of neurology No 2 of City Clinical Hospital No 7, Russia, 420103, Kazan, Chuikov str., 54; postgraduate student of the Department of neurology, neurosurgery and medical genetics of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, e-mail: chizh_romunas@mail.ru

KHAKIMOVA ALBINA R., neurologist of the Department of neurology No 2 of City Clinical Hospital No 7, Russia, 420103, Kazan, Chuikov str., 54; assistant of professor of the Department of neurology, neurosurgery and medical genetics of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, e-mail: dralbina@mail.ru

Abstract. Aim. The aim of the study is to perform analysis of modern views on lumbosacral plexopathy in neurologist practice and to present a clinical case. Material and methods. Observation and clinical examination findings of the patient diagnosed with lumbosacral plexopathy are presented. Results and discussion. Lumbosacral plexopathy is a syndrome of isolated lumbosacral plexus lesion. In the majority of cases it appears to be primary manifestation of the underlying disease. Lumbosacral plexopathies develop due to various conditions such as neoplasms, infectious diseases, trauma, complications of radiation therapy for pelvic neoplasms, hematoma or other vascular lesions in the retroperitoneal or pelvic region, mechanical damage or stretching, inflammation, infiltration or idiopathic causes. Clinically lumbosacral plexopathy manifests as an acute or subacute onset of pain syndrome, and then there is a motor deficiency in one limb with possible involvement of a healthy limb and a decrease in body weight. In this case, motor deficiency prevails over the sensitive disorders. Neurophysiological examination, magnetic resonance imaging of the lumbar segment and plexus, cerebrospinal fluid analysis and other measures aimed at diagnosing the underlying disease are required to diagnose lumbosacral plexopathy. A case of diagnosis and differential diagnosis of lumbosacral plexopathy with suspected lymphoproliferative disease is presented. Conclusion. The modern concept of lumbosacral plexopathy includes identification of the primary disease that caused damage to the lumbosacral plexus. According to the findings in the described case, it is worth noting that doctors of all specialties should take into account that often profile diseases may have clinical manifestations related to a different specialty.

Key words: lumbosacral plexopathy, lumbosacral plexus, peripheral neuropathy.

For reference: Chizh RS, Khakimova AR. Lumbosacral plexopathy: clinical case description. The Bulletin of Contemporary Clinical Medicine. 2018; 11 (5): 143–148. DOI: 10.20969/VSKM.2018.11(5).143-148.

REFERENCES

1. Dyck PJ, Thaisetthawatkul P. Lumbosacral plexopathy. Continuum (Minneap Minn). 2014; 20 (5): 1343–1358. DOI: 10.1212/01.CON.0000455877.60932.d3.

2. Planner AC, Donaghy M, Moore NR. Causes of lumbosacral plexopathy. Clin Radiol. 2006; 61 (12): 987-995. DOI: 10.1016/j.crad.2006.04.018.

3. Mumentaler M, Shtyor M, Myuller-Fal’ G ed. Porazheniya perifericheskih nervov i koreshkovye sindromy [Lesions of peripheral nerves and radicular syndromes]. Moskva [Moscow]: MEDpress-inform. 2014; 2: 437–460.

4. Delanain S, Lefaix JL, Pradat PF. Radiationinduced neuropathy in cancer survivors. Radiother. Oncol. 2012; 105 (3): 273-282. DOI: 10.1016/j.radonc.2012.10.012.

5. Stoehr M. Traumatic and postoperative lesions of the lumbosacral plexus. Arch Neurol. 1978; 35 (11): 757-760. DOI: 10.1001/archneur.1978.00500350061013.

6. Kim H, Kang SH, Kim DK, et al. Bilateral ischemic lumbosacral plexopathy from chronic aortoiliac occlusion presenting with progressive paraplegia. J Vasc Surg. 2014; 59 (1): 241-243. DOI: 10.1016/j.jvs.2013.04.008. 

7. You JS, Park YS, Park S, Chung SP. Lumbosacral plexopathy due to common iliac artery aneurysm misdiagnosed as intervertebral disc herniation. J Emerg Med. 2011; 40 (4): 388-390. DOI: 10.1016/j.jemermed.2007.11.070.

8. Garces-Sanchez M, Laughlin R, Dyck PJ et al. Painless diabetic motor neuropathy: a variant of diabetic lumbosacral radiculoplexus neuropathy? Ann Neurol. 2011; 69 (6): 1043-1054. DOI: 10.1002/ana.22334.

9. Staff NP, Engelstad J, Klein CJ et al. Post-surgical infl ammatory neuropathy. Brain. 2010; 133 (10): 2866-2880. DOI: 10.1093/brain/awq252.

10. Strakowski JA. Electrodiagnosis of plexopathy, PM&R. 2013; 5 (5S): S50-S55. DOI: 10.1016/j.pmrj.2013.03.017.

11. Robbins NM, Shah V, Benedetti N, et al. Magnetic resonance neurography in the diagnosis of neuropathies of the lumbosacral plexus: a pictorial review. Clin Imaging. 2016; 40 (6): 1118-1130. DOI: 10.1016/j.clinimag.2016.07.003.

12. Capek S, Howe BM, Amrami KK, Spinner RJ. Perineural spread of pelvic malignancies to the lumbosacral plexus and beyond: clinical and imaging patterns. Neurosurg Focus. 2015; 39 (3): Е14. DOI: 10.3171/2015.7.FOCUS15209.

 

UDC 616.746.1-003.215-073.432.19

DOI: 10.20969/VSKM.2018.11(5).149-153

PDF download SPONTANEOUS HEMATOMA OF THE ANTERIOR ABDOMINAL WALL IN EMERGENCY SURGERY CLINIC. SONOGRAPHIC ASPECTS

SHARAFISLAMOV ISKANDER F., assistant of professor of the Department of ultrasonic diagnostics of Kazan State Medical Academy – the branch of Russian Medical Academy of Postgraduate Education; Head of the Center for X-ray-surgical interventions of City Clinical Hospital No 7, Russia, 420103, Kazan, Chuikov str., 54

KLYUSHKIN IVAN V., D. Med. Sci., professor of the Department of surgical diseases of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, e-mail: hirurgivan@rambler.ru

KLYUSHKINA JULIA A., C. Med. Sci., Head of the Department of ultrasonic diagnostics of City Clinical Hospital No 7, Russia, 420103, Kazan, Chuikov str., 54

MIKHAYLOVA OLGA N., physician of the Department of ultrasonic diagnostics of City Clinical Hospital No 7, Russia, 420103, Kazan, Chuikov str., 54

BADRETDINOVA ALSU R., physician of the Department of ultrasonic diagnostics of City Clinical Hospital No 7, Russia, 420103, Kazan, Chuikov str., 54, е-mail: sharusi333@gmail.com

Abstract. Spontaneous hematoma of the anterior abdominal wall (Spontaneus rectus sheat hematoma, RSH) is a rare and serious cause of acute abdominal pain resulting from damage to the artery and spontaneous hemorrhage in the rectus abdominis muscle. Such a phenomenon can be observed in athletes, in the elderly, in certain infectious diseases, in collagenoses with vascular lesions, in blood dyscrasias, as well as during treatment with anticoagulants, in case of abdominal wall tension due to coughing, sneezing or physical exertion. Spontaneous hematoma of the anterior abdominal wall in pregnant women can be distinguished in a different group. The incidence of this pathologic condition among all patients admitted to the emergency room with acute abdominal pain is about 1,8%. Mortality rate associated with this disease is about 4% and it reaches 13% in pregnant women. The hematoma of the rectus abdominis muscle is 3 times more common in women. Aim.The aim of the study is to draw attention of doctors to the possibility of simulating acute abdomen in cases of spontaneous anterior abdominal wall hematoma, in particular, in pregnant women. Material and methods. Clinical case of a rupture of anterior abdominal muscle in a 37-year-old pregnant woman with a gestational age of 33 weeks admitted to the emergency department with a diagnosis of acute cholecystitis is presented. Results and discussion. After consultations of a surgeon, obstetrician-gynecologist, laboratory and additional instrumental examinations, including ultrasound examination of the anterior abdominal wall with a high-frequency ultrasound sensor, the final diagnosis was stated as 33 weeks of gestation; hematoma of the anterior abdominal wall; anemia of moderate severity. Minimally invasive surgical intervention: puncture of the hematoma. The diagnosis was confirmed. The diagnosis of acute surgical condition of the abdominal organs was removed. Subsequently, conservative treatment of the patient was carried out. Conclusion. Spontaneous rupture of the rectus abdominis muscle is a rare and potentially life-threatening condition, especially during pregnancy. Most of the complications are associated with incorrect diagnosis and late treatment, therefore, the earliest and the most correct diagnosis of this condition is required. Ultrasound examination of the anterior abdominal wall with a high-frequency ultrasound sensor is necessary when complaints of acute abdominal pain occur in pregnant women. The golden standard for the rest of the patients is computed tomography.

Key words: hematoma, anterior abdominal wall, diagnosis, ultrasound diagnosis.

For reference: Sarafislamov IF, Klyushkin IV, Klyuchkina JA, Mikhailov ON, Badretdinova AR. Spontaneous hematoma of the anterior abdominal wall in emergency surgery clinic. Sonographic aspects. The Bulletin of Contemporary Clinical Medicine. 2018; 11 (5): 149–153. DOI: 10.20969/VSKM.2018.11(5).149-153.

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1. Whetzel TP, Huang V. The vascular anatomy of the tendinous intersections of the rectus abdominis muscle. Plast Reconstr Surg. 1996; 98: 83–89.

2. Klyushkina YuA, Klyushkin IV. Ul’trazvukovaya vizualizaciya v vyyavlenii prichin boli v golenostopnom sustave [Ultrasound imaging in identifying the causes of pain in the ankle joint]. Ul’trazvukovaya diagnostika [Ultrasound diagnosis]. 2014; 3: 124-125.

3. Carriquiry CE. Anatomy and physiology of the abdominal wall. Operat Tech Plast Reconstr Surg. 1996; 3: 2–6.

4. Milloy FJ, Anson BJ, McAfee D. The rectus abdominis muscle and the epigastric arteries. Surg Gynecol Obstet. 1960; 110: 293.

5. Rozen WM, Ashton MW, Taylor GI. Reviewing the vascular supply of the anterior abdominal wall: redefining anatomy for increasingly refined surgery. Clin Anat. 2008; 21: 89.

6. Fothergill WE. Hematoma in the abdominal wall simulating pelvic new growth. Br Med J. 1926; 1 (3413): 941– 942.

7. Sheth HS, Kumar R, DiNella J, Janov C, Kaldas H, Smith RE. Evaluation of risk factors for rectus sheath hematoma. Clin Appl Thromb Hemost. 2014; 22: 292–296.

8. Klingler PJ, Wetscher G, Glaser K, Tschmelitsch J, Schmid T, Hinder RA. The use of ultrasound to differentiate rectus sheath hematoma from other acute abdominal disorders. Surg Endosc. 1999; 13: 1129–1134.

9. Ducatman BS, Ludwig J, Hurt RD. Fatal rectus sheath hematoma. JAMA. 1983; 249: 924–925.

10. Hatjipetrou A, Anyfantakis D, Kastanakis M. Rectus sheath hematoma: A review in literature. Int J Surg. 2015; 13: 267–271.

11. Berna JD, Garcia-Medina V, Guirao J, Garcia-Medina J. Rectus sheath hematoma: diagnostic classification by CT. Abdom Imaging. 1996; 21: 62–64.

12. Moreno Gellageo A, Aguayo JL, Flores B, Soria T, Hernandez Q, Ortiz S, et al. Ultrasonography and computed tomography reduce unnecessary surgery I abdominal rectus sheath haematoma. Br J Surg. 1997; 84 (9): 1295–1997.

13. Carnett JB. Intercostal neuralgia as a cause of abdominal pain and tenderness. J Surg Gynecol Obstet. 1926; 42: 625–632.

14. Ramirez MM, Burkhead 3rd JM, Turrentine MA. Spontaneous rectus sheath hematoma during pregnancy mimicking abruptio placenta. Am J Perinatol. 1997; 14: 321–323.

15. Ramzisham AR, Sagap I, Ismail AM. Spontaneous rectus sheath hematoma in pregnancy. Med J Malaysia. 2003; 58: 125–127.

16. Riera C, Deroover Y, Marechal M. Embolization of a rectus sheath hematoma in pregnancy. Int J Gynaecol Obstet. 2009; 104: 145–146.

17. Teske JM. Hematoma of the rectus abdominis muscle: report of a case and analysis of 100 cases from the literature. Am J Surg. 1946; 71: 689–695.

18. Tolcher MC, Nitsche JF, Arendt KW, Rose CH. Spontaneous rectus sheath hematoma in pregnancy: case report and review of the literature. Abstet Gynecol Srv. 2010; 65: 517– 522.

 

CLINICAL CASE

UDC 618.3

DOI: 10.20969/VSKM.2018.11(5).154-158

PDF download CERVIX DELAMINATION IN A PATIENT WITH INVASION OF PLACENTA PREVIA TO THE UTERINE SCAR AFTER CESAREAN SECTION (clinical case presentation)

GABIDULLINA RUSHANYA I., D. Med. Sci., professor of the Department of obstetrics and gynecology of Kazan State Medical University, Russia, Kazan, Butlerov str., 49, tel. 8-917-28-99-310, e-mail:  ru.gabidullina@yandex.ru

KALIMULLINA GULFIRA N., Head of the Department of gynecology of City Clinical Hospital No 7, Russia, Kazan, Chuykov str., 54, tel. 8-917-85-58-413

MIKHAYLOVA OLGA N., physician of the Department of ultrasonic diagnosis of City Clinical Hospital No 7, Russia, Kazan, Chuykov str., 54, tel. 8-950-32-06-346

MINGAZETDINOV MARAT A., Head of the Department of angiosugery of City Clinical Hospital No 7, Russia, Kazan, Chuykov str., 54, tel. 8-904-76-08-051

SHIGABUTDINOVA TATYANA N., Head freelance obstetrician-gynecologist of the Ministry of Health of Republic Tatarstan, Head specialist on obstetrics and gynecology of City Clinical Hospital No 7, Russia, Kazan, Chuykov str., 54, tel.8-905-31-08-680

SHARAFISLAMOV ISKANDER F., Head of Center of radiologic surgery of City Clinical Hospital No 7, Russia, Kazan, Chuykov str., 54, tel. 8-917-88-62-626

SYRMATOVA LАYSAN I., Head of the Center of gynecologic endosurgery of City Clinical Hospital No 7, Russia, Kazan, Chuykov str., 54, tel.8 -843-237-72-48

FAIZOVA GULNAZ R., gynecologist of City Clinical Hospital No 7, Russia, Kazan, Chuykov str., 54, tel. 8-999-164-63-06

Abstract. Aim. The aim of the study was the presentation of a case of traumatic anterior сervical lip delamination in a pregnant woman with 2 uterine scars after cesarean section who underwent uterine artery embolization for placenta praevia accreta.Material and methods. Research methods included transvaginal ultrasonography with color Doppler imaging for the purpose of visualization of the ovum, determination of the boundaries between placenta and uterine myometrium in scar projectionr, blood flow intensity in the area of abnormal placental invasion as well as general clinical studies. Results and discussion. Apatient with a frozen pregnancy having bloody discharge from the genital tract was diagnosed with a central placenta previa and its ingrowth into the uterine scar after cesarean section. The superselective uterine artery embolization was successfully performed. Four days later, prolapse of the membranes of the fetal bladder into the anterior cervical lip was revealed. Changing the localization of placenta to the anterior uterine wall and release of the internal uterine mouth area, the absence of ultrasound signs of the growth of the placenta into the myometrium in the projection of the uterus scar after the EMA and the absence of blood flow in the scar served as indications for single-stage emptying of the uterus by means of dilation and curettage. Blood loss was 80 ml. The anatomical structure of the cervix was restored. Conclusion. The increase in the rate of Caesarean section is followed by an expected increase in the number of complications, including the appearance of the new types not previously presented in the literature, the management strategy of which is not currently known.

Key words: cervix, placenta praevia, placenta accreta, uterine scar, cesarean section.

For reference: Gabidullina RI, Kalimullina GNo, Mihaylovava ONo, Mingazetdinov MA, Shigabutdinova TNo, Sharafislamov IF, Syrmatova LI, Faizova GA. Cervix delamination in a patient with invasion of placenta previa to the uterine scar after cesarean section (clinical observation). The Bulletin of Contemporary Clinical Medicine. 2018; 11 (5): 154–158. DOI: 10.20969/ VSKM.2018.11(5).154-158.

REFERENCES

1. Caughey AB, Cahill AG, Guise JM, Rouse DJ. Safe prevention of the primary cesarean delivery. Am J Obstet Gynecol. 2014; 210 (3): 179-193.

2. Peter JM, Matthew R. Cesarean Delivery: A Multimodality Imaging Review of Acute and Chronic Complications. Contemporary Diagnostic Radiology. 2018; 41 (13): 1–7.

3. Timor-Tritsch IE, Monteagudo A. Unforeseen consequences of the increasing rate of cesarean deliveries: early placenta accreta and cesarean scar pregnancy: a review. Am J Obstet Gynecol. 2012; 207 (1): 14-29.

4. Savel’eva GM, Kurcer MA, Breslav IYu et al. Vrastanie predlezhashchej placenty (placenta accreta) u pacientok s rubcom na matke posle kesareva secheniya. Klinikomorfologicheskoe sopostavlenie [Invasion of placenta previa in patients with a uterine scar after cesarean section: clinical and morphological sections]. Akusherstvo i ginekologiya [Оbstetrics and gynecology]. 2015; 11: 41-45.

5. Jauniaux E, Bhide A. Prenatal ultrasound diagnosis and outcome of placenta previa accreta after cesarean delivery: a systematic review and meta-analysis. Am J Obstet Gynecol. 2017; 217 (1): 27-36.

6. Jauniaux E, Collins S, Burton GJ. Placenta accreta spectrum: pathophysiology and evidence-based anatomy for prenatal ultrasound imaging. Am J Obstet Gynecol. 2018; 218 (1):  75-87.

7. Rezvani M, Shaaban AM, Kennedy AM. The role of multimodality imaging after cesarean delivery. Ultrasound Q. 2015; 31 (1): 5-18.

8. Pagani G, Cali G, Acharya G et al. Diagnostic accuracy of ultrasound in detecting the severity of abnormally invasive placentation: a systematic review and meta-analysis. Acta Obstet Gynecol Scand. 2018; 97 (1): 25-37.

9. Cao S, Zhu L, Jin L et al. Uterine artery embolization in cesarean scar pregnancy: safe and effective intervention. Chin Med J (Engl). 2014; 127 (12): 2322-2326.

10. Strizhakov A№, Davydov AI, Kosachenko AG. Plasticheskie operacii pri staryh razryvah shejki matki; №yuansy hirurgicheskoj tekhniki [Plastic surgery in old lacerations of the uterine cervix; №uances of surgical technique]. Voprosy ginekologii, akusherstva i perinatologii [Gynecology, Obstetrics and Perinatology]. 2016; 15 (3): 70–74.

 

UDC 616.131-005.755-039.5:616.8-009.832

DOI: 10.20969/VSKM.2018.11(5).159-163

PDF download SYNCOPE AS A MANIFESTATION OF PULMONARY EMBOLISM

OSLOPOV VLADIMIR N., D. Med. Sci., professor of the Department of introduction to internal diseases of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, e-mail: KPVBol@yandex.ru

SADYKOVA AIDA R., C. Med. Sci., associate professor of the Department of introduction to internal diseases of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, e-mail: KPVBol@yandex.ru

Abstract. Pulmonary embolism is the most insidious disease in cardiology practice. The variety of its clinical manifestations is very wide, ranging from asymptomatic cases to shock and sudden death. Aim – to report the intravitam diagnosed case of pulmonary embolism. Recurrent syncope was the leading manifestation of disease, which is met rarely in clinical practice.Material and methods. Pulmonary embolism has been diagnosed in 42 y.o. Caucasian woman. Physical examination, complete blood count, biochemical blood test, D-dimer determination, chest X-ray examination, electrocardiography, echocardiography, multidetector-row helical computed tomographic angiography of the pulmonary artery were performed. Patient’s condition was observed during 2 years from the date of admission. Results and discussion. Disease coursed with recurrent episodes of syncope. Standard diagnostic methods demonstrated borderline values of the diagnostic criteria: D-dimer values did not correspond to severity and extent of embolism, electrocardiograms showed insignificant changes. Diagnose was verified by helical multidetector-row computed tomographic angiography of the pulmonary artery. Conclusion. This case shows relativevalue of standard diagnostic methods, discrepancy of embolism extent and meanings of diagnostic criteria. Contemporary innovative diagnostic methods introduced in the Tatarstan Republic hospitals allowed to diagnose case of pulmonary embolism manifested with recurrent syncopal states.

Key words: pulmonary embolism, syncope, myoma of uterus.

For reference: Oslopov VN, Sadykova AR. Syncope as a manifestation of pulmonary embolism. The Bulletin of Contemporary Clinical Medicine. 2018; 11 (5): 159–163. DOI: 10.20969/VSKM.2018.11(5).159-163.

REFERENCES

1. Mazur NA. Prakticheskaya kardiologiya [Pracical cardiology]. Moskva: ID «Medpraktika-M» [Moscow: PH «Medpraktika-M»]. 2009; 616 p.

2. Shpector AV, Vasil’eva EYu. Kardiologiya; Klinicheskie lekcii [Cardiology; Clinical lectures]. Moskva: AST; Astrel’ [Moscow: AST; Astrel]. 2008; 688-700.

3. Torbicki A, Perrier A, Konstantinides S, et al. Guidelines on the diagnosis and management of acute pulmonary embolism; The Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC); European Heart Journal. 2008; 29: 2276–2315.

4. Goldhaber SZ, Visani L, De Rosa M. Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet. 1999; 24 (353): 1386-1389.

5. Oslopov VN, Sadykova AR, Ahmetzyanova EF, Krivonosova SSh. Trudnosti diagnostiki tromboembolii legochnoi arterii u pacientki s gigantskoi miomoi matki [Difficulties in the diagnosis of pulmonary embolism in patient with gigantic myoma of the uterus]. Prakticheskayya medicina [Practical medicine]. 2010; 5 (44): 136-138.

6. Oslopov VN, Sadykova AR, Gilmanov AA, Tregubova MG. Sluchai polnogo vyzdorovleniya pacientki s tromboemboliei obeih vetvei legochnoi arterii, obuslovlennoi gigantskoi miomoi matki [Complete recovery of a patient with pulmonary embolism of both branches of pulmonary artery, caused by gigantic myoma of the uterus]. Prakticheskayya medicina [Practical medicine]. 2012; 9 (65): 175-179.

 

DOI: 10.20969/VSKM.2018.11(5).163-169

PDF download CLINICAL SCENARIO OF RECURRENT SEVERE PNEUMONIA AT THE DEBUT OF ANCA-ASSOCIATED VASCULITIS

PALMOVA LYUBOV YU., C. Med. Sci., associate professor of the Department of internal medicine of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, e-mail: palmova@bk.ru

PODOLSKAYA ALLA A., C. Med. Sci., Head of the Department of internal medicine of City Clinical Hospital No 7; associate professor of the Department of internal medicine of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49

POZDNYAK VALERY А., student of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49

GABDRAKHMANOVA GUZEL R., resident of the Department of internal medicine of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49

Abstract. Aim. Тo focus the attention of clinicians in general medical practice on recurrent pneumonia as a possible pulmonary manifestation of systemic connective tissue diseases. Material and methods. Сlinical case of ANCA-associated vasculitis, that appeared under the mask of recurrent bilateral pneumonia in a woman in the postmenopausal period is presented. Comprehensive analysis of clinical, laboratory and instrumental parameters and medical records was performed. Results and discussion. Recurrent pneumonia in a relatively short period of time (about 2 months) in a woman of 53 years was a grave cause for return to the beginning of the history of the disease and reassessment of all detected signs and symptoms. Attention was drawn to the lack of hypothermia, the contact with a person with the signs of acute respiratory viral infection, a small time interval after the first case of infiltration in the lungs and a high erythrocyte sedimentation rate at the time of discharge. Negative dynamics in the lungs were recorded via x-ray computed tomography against the background of clinical deterioration (repeated shortness of breath and fever). Lung affection was bilateral in nature and appeared as multiple reticular changes and sections of frosted glass. All these factors served as a good reason for rehospitalization. Radiologically proved organized pneumonia along with the signs of kidney damage, a doubtful effect of massive combined antibiotic therapy forced to doubt the diagnosis of community-acquired pneumonia. Immunological testing with autoantibody and circulating immune complex count was a logical diagnostic step. Detection of IgG to myeloperoxidase along with signs of lung and renal tissue damage made it possible to diagnose ANCA-associated systemic vasculitis. Adequate correction of the complex therapy has led to significant clinical improvement, as well as to visible positive dynamics in the lungs according to computed tomography. Conclusion. Return to the beginning of the history of the disease by means of analysis of the first symptoms and establishment of the possible relation with provoking factors becomes relevant in repeated pulmonary infiltrations. The search for comorbid conditions as well as the reevaluation of existing diagnostic methods and their comparison with the newly obtained data appears to be equally important. Delay with the use of highly informative diagnostic methods is unacceptable in case of recurrent pulmonary inflammation. In the majority of cases it makes possible to verify even minimal organ changes. The described clinical case is an example of a holistic diagnostic approach that allowed objectifying the debut of ANCA-associated systemic vasculitis in general therapeutic practice.

Key words: recurrent pneumonia, cryptogenic organizing pneumonia, ANCA-associated vasculitis.

For reference: Palmova LY, Podolskaya AA, Pozdnyak VА, Gabdrakhmanova GR. Сlinical scenario of recurrent severe pneumonia at the debut of ANCA-associated vasculitis. The Bulletin of Contemporary Clinical Medicine. 2018; 11 (5): 163–169.DOI: 10.20969/VSKM.2018.11(5).163-169. 

REFERENCES

  1. Dobrykh VA, Ukhabotin AS, Sredniy PA, Makarevich AM, Uvarova IV. Povtornaya pnevmoniya (prediktory retsidiva) [Recurrent pneumonia (predictors of relapses)]. Dal’nevostochnyy meditsinskiy zhurnal [Far Eastern Medical Journal]. 2016; 2: 122-127.

  2. Ishida T, Tachibana H, Ito A, Ikeda S, Furuta K, Nishiyama A, Noyama M, Tokioka F, Yoshioka H, Arita M. Clinical characteristics of pneumonia in bedridden patients receiving home care: A 3-year prospective observational study. J Infect Chemother. 2015; 21 (8): 587-591.

  3. Kevric Ines, Morehead Richard S. Significant Aspirations: Recurrent Pneumoni. The American journal of Medicine. 2013; 126 (11): 956–959.

  4. Chubukova OA, Shkarin VV. Osobennosti epidemiologii vnebol’nichnyh pnevmonij s sochetannoj etiologiej [Epidemiology features of community-acquired pneumonia with a combined etiology]. Medicinskij al’manah [Medical Almanac]. 2017; 4 (49): 149-154.

  5. Chuchalin AG, Sinopalnikov AI, Kozlov RS et al. Klinicheskie rekomendacii po diagnostike, lecheniyu i profilaktike tyazheloj vnebol’nichnoj pnevmonii u vzroslyh [Clinical Guidelines on Diagnosis, Treatment and Prophylaxis of Severe Community- Acquired Pneumonia in Adults]. Rossijskoe respiratornoe obshchestvo (RRO); Mezhregional’naya associaciya po klinicheskoj mikrobiologii i antimikrobnoj himioterapii (MAKMAH) [Russian Respiratory Society; Interregional Association for Clinical Microbiology and Antimicrobial Chemotherapy (IACMAC)]. 2014; 82 р.

  6. Ryzvanovich YuA, Vovkogon EV. Recidiviruyushchaya kriptogennaya organizuyushchayasya pnevmoniya na fone sarkoidoza legkih [Recurrent cryptogenic organizing pneumonia associated with pulmonary sarcoidosis]. Rossijskij elektronnyj zhurnal luchevoj diagnostiki [Russian electronic journal of radiology]. 2013; 3 (3): 57-62.

  7. Baigozina EA, Sovalkin VI, Podgurskaya EP. Differencial’naya diagnostika kriptogennoj organizuyushchejsya pnevmonii u bol’nogo s vtorichnym immunodeficitom. [Differential diagnosis of cryptogenic organizing pneumonia in a patient with secondary immunodeficiency]. Klinicheskaya medicina [Clinical Medicine]. 2012; 11: 62-63.

  8. Petrova DV, Kornilova TA, Tseymah IYa, Kramar IP, Belyakova II, Sosnova OL, Shoikhet YaN. Osobennosti klinicheskogo techeniya idiopaticheskih intersticial’nyh pnevmoniya v zavisimosti ot morfologicheskogo varianta [Clinical manifestations of idiopathic interstitial pneumonia depending on its morphological form]. Sibirskij medicinskij zhurnal [Siberian Medical Journal]. 2013; 3: 47-51.

  9. Frédrique Capron, David Center, Thomas V. Colby, Jean- François Cordier, Roland M. duBois, American Thoracic Society / European Respiratory Society International Multidisciplinary Consensus Classification of the Idiopathic Interstitial Pneumonias. Am J Respir Crit Care Med. 2002; 165: 277-304.

  10. Yumatova EA. Komp’yuternaya tomografiya v diagnostike organizuyushchejsya pnevmonii [Computed tomography in the diagnosis of organizing pneumonia]. Moskva: RGMU [Moscow: The Russian State Medical University]. 2010; 24 p.

  11. Beketova TV, Nasonova EL ed. ANCA-associirovannye sistemnye vaskulity [ANCA-associated systemic vasculitis]. Moskva: GEOTAR-Media [Moscow: GEOTAR-Media]. 2014; 46 p.

 

UDC 616.74-009.17-06:[616.62+616.352]-008.222

DOI: 10.20969/VSKM.2018.11(5).169-172

PDF download PELVIC ORGAN DISORDERS IN PATIENTS WITH MYASTHENIA GRAVIS: CLINICAL CASE PRESENTATION

KHAFIZOVA IRINA F., C. Med. Sci., associate professor of the Department of neurology, neurosurgery and medical genetics of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, e-mail: sclerdissem@mail.ru

GALYAVIEVA ADELYA R., neurologist of the Department of neurology No 2 of City Clinical Hospital No 7, Russia, 420103, Kazan, Chuikov str., 54; postgraduate student of the Department of neurology, neurosurgery and medical genetics of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, e-mail: gal-adelya@mail.ru

Abstract. Aim. The aim of the study was to present the case of pelvic disorders in a patient diagnosed with myasthenia gravis. Material and methods. A complex examination was carried out. The features of the clinical course and medical care provided in City Clinical Hospital No 7 in Kazan to a patient with myasthenia gravis were revealed. Results and discussion.Myasthenia gravis is a neuromuscular disease associated with autoimmune damage by antibodies against skeletal muscle postsynaptic acetylcholine receptors. The disease belongs to the orphan group. The incidence ranges from 0,3 to 2,8 per 100 000. It is estimated, that the disease has affected more than 700 000 people worldwide. The prevalence of myasthenia gravis is higher in women, which is typical for autoimmune diseases. In classical type, clinical manifestations of the disease are represented by fluctuating muscle weakness in separate skeletal muscle groups. The degree of severity varies from mild to pronounced, which is life-threatening for the patients. Diagnosis of myasthenia gravis is a difficult task not only because of a rare incidence, but also due to a heterogeneous clinical picture that resembles a large number of other diseases. However, the pelvic organ dysfunction is rare in the clinical course of myasthenia gravis. Seven cases of de novo urination disorders in myasthenia gravis and 2 cases of fecal incontinence have been described in literature. Our report is about 54-year-old woman with seropositive generalized myasthenia gravis without thymoma, who presents with impaired pelvic organ function evident as urinary/fecal incontinence. Conclusion. The clinical case indicates that pelvic dysfunction can appear as one of the symptoms of myasthenia gravis. So that, neurologists should be aware of this rare manifestation of the disease

Key words: myasthenia gravis, pelvic organ dysfunction.

For reference: Khafizova IF, Galyavieva AR. Pelvic organ disorders in patients with myasthenia gravis: clinical case presentation. The Bulletin of Contemporary Clinical Medicine. 2018; 11 (5): 169–172. DOI: 10.20969/VSKM.2018.11(5).169-172.

REFERENCES

  1. Sanders DB, Wolfe GI, et al. International consensus guidance for management of myasthenia gravis. Neurology. 2016; 87 (4): 419–425.

  2. Gilhus NE, Verschuuren JJ. Myasthenia gravis: subgroup classification and therapeutic strategies. Lancet Neurology. 2015; 14: 1023–1036.

  3. Meriggioli MN, Sanders DB. Autoimmune myasthenia gravis: emerging clinical and biological heterogeneity. Lancet Neurology. 2009; 8 (5): 475–99.

  4. Deenen JCW, Horlings CGC, Verschuuren JJGM, Verbeek ALM. The epidemiology of neuromuscular disorders: a comprehensive overview of the literature. J Neuromuscul Dis. 2015; 2 (1): 73–85.

  5. Khan Z, Bhola A Urinary incontinence after transurethral resection of prostate in myasthenia gravis patients. Urology. 1989; 34 (3): 168–169.

  6. Marouani I, Kraoua I, Benrhouma H, et al. Seronegative myasthenia gravis with bladder dysfunction. Rev Neurol. 2012; 168: 299–300.

  7. Kaya C, Karaman I. Case report: A case of bladder dysfunction due to myasthenia gravis. Int Urol Nephrol. 2005; 37: 253–255.

  8. Pannek J, Grigoleit, U. Successful treatment of overactive bladder in a child with Myasthenia gravis. Scand J Urol Nephrol. 2008; 42 (4): 397–398.

  9. Berger AR, Swerdlow M, Herskovitz S. Myasthenia gravis presenting as uncontrollable flatus and urinary/fecal incontinence (letter). Muscle Nerve. 1996: 19 (1): 113-114.

  10. Sandler PM, Avillo C, Kaplan SA. Detrusor areflexia in a patient with myasthenia gravis. Int J Urol. 1998; 5 (2): 188–190.

  11. Antoniou A, Mendez Rodrigues J, Comi N. Successful treatment of urodynamic detrusor over-activity in a young patient with Myasthenia gravis using pretibial nerve stimulation with follow-up to two years. Journal of the Royal Society of Medicine Open. 2016; 7 (8): 1–3.

 

UDC [616.26-001.48-036.14-06:616.381-002-02:616.341-007.251]-089

DOI: 10.20969/VSKM.2018.11(5).172-176

PDF download EXPERIENCE OF IPOM METHOD APPLICATION IN RUPTURE OF THE DIAPHRAGM WITH THE LIMITATION PERIOD AND SMALL INTESTINE PERFORATION IN THE PLEURAL CAVITY

CHIKAEV VYACHESLAV F., D. Med. Sci., professor of the Department of traumatology, orthopedics and extreme situation surgery of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, е-mail: prof.chikaev@ gmail.com

BONDAREV YURY V., D. Med. Sci., Head of the Department of Surgery No 3 of City Clinical Hospital No 7, Russia, 420000, Kazan, Chuykov str., 54

MANNANOV RAVIL F., surgeon of the Department of Surgery No 3 of City Clinical Hospital No 7, Russia, 420000, Kazan, Chuykov str., 54

MIKHAYLOV ALEXEY R., surgeon of the Department of Surgery No 3 of City Clinical Hospital No 7, Russia, 420000, Kazan, Chuykov str., 54

Abstract. Aim. The aim of the study is to present the experience of using IPOM technique in restoring a diaphragm rupture with a limitation period in conditions of peritonitis and empyema, as a result of small intestine perforation into the pleural cavity.Material and methods. A comprehensive analysis of medical care provided to a 58-year-old male patient admitted to City Clinical Hospital No 7 in Kazan with limitation period, rupture and total defect of the diaphragm, small intestine perforation into the pleural cavity with development of peritonitis and pleural empyema was conducted. The patient was hospitalized to the surgical department No 3 with a diagnosis of appendicular infiltration. According to chest X-ray examination: the dome of the diaphragm had smooth and clear contours, the left dome was relaxed to the level of the anterior segment of the 3rd rib. The case was regarded as chronic relaxation of the diaphragm. The infiltrate resolved as a result of conservative therapy. The patient was discharged on the 10th day in a satisfactory condition. On day 7 after discharge, the patient was hospitalized with the symptoms of acute appendicitis. Median laparotomy was performed under general anesthesia. When the infiltrate was divided an abscess was opened, sigmoid colon perforation into the abscess cavity was revealed, an appendectomy with partial resection of the sigmoid colon was performed, sigmostomy was exteriorized. Results and discussion. In the postoperative period on the 12th day the patient noted deterioration of the condition and the symptoms of peritonitis appeared. Emergency relaparotomy was performed. Revision of the abdominal cavity has showed that the stomach, small intestine, spleen and splenic angle of the colon were displaced into the left pleural cavity. There was 500 ml of enteric content in the pleural cavity. The left dome of the diaphragm was practically absent. The edges of the diaphragm scar have changed. Defect of the diaphragm was of the V degree. The cause of peritonitis was perforation of an acute ulcer of the ileum, which has been released into the pleural cavity. Sanitation of the pleural and abdominal cavities was performed by washing with 0,5% chlorhexidine aqueous solution. Restoration of the diaphragm was not possible due to a large tissue defect. The IPOM (intraperitoneal onlay of mesh) principle was applied using Parietex «Optimized Compozite Mesh» for prosthesis of the diaphragm. The perforation of the ileum was sutured with a double suture. Decompression of the intestine was performed by Abbott – Miller intubation of the small intestine. The surgery was completed with resigmostomy. Complex multicomponent therapy, monitoring and correction of vital body functions were carried out in the postoperative period. The left lung straightened on the second day according to the chest chest x-ray. The mediastinum was restored, and residual cavity in the sinus was resolved in the process of treatment. The patient was discharged 30 days after relaparotomy in a satisfactory condition. According to the control x-ray in three months, the lung was straightened. Conclusion. IPOM method application using Parietex «Optimized Compozite Mesh» can be recommended for prosthetics of large diaphragm defects.

Key words: patient, damage, diaphragm, peritonitis.

For reference: Chikaev VF, Bondarev YuV, Mannanov RF, Mikhaylov AR. Experience of IPOM method application in rupture of the diaphragm with the limitation period and small intestine perforation in the pleural cavity. The Bulletin of Contemporary Clinical Medicine. 2018; 11 (5): 172–176. DOI: 10.20969/VSKM.2018.11(5).172-176.

REFERENCES

1. Chikayev VF, Ibragimov RA, Sheykhov ShA, Yaradaykin VV, Akhtyamov IF. Osobennosti diagnostiki i lecheniya povrezhdeniy diafragmy v neotlozhnoy khirurgii [Features of diagnosis and treatment of damage to the diaphragm in emergency surgery]. Prakticheskaya meditsina [Practical Medicine]. 2013; 1, 2 (69): 178–181.

2. Romanov RV, Fedayev AA, Petrov VV, Khodak VA, Parshikov VV. Sovremennoye sostoyaniye problemy intraperitoneal’noy plastiki bryushnoy stenki sinteticheskimi endoprotezami [The current state of the problem of intraperitoneal plasty of the abdominal wall with synthetic endoprostheses]. Sovremennyye tekhnologii v meditsine [Modern technologies in medicine]. 2012; 4: 16–1170.

3. Yegiyev VN, Lyadov VK. Klinicheskiy opyt laparoskopicheskoy intraperitoneal’noy plastiki posleoperatsionnykh gryzh [Clinical experience with laparoscopic intraperitoneal plasty of postoperative hernia]. Gerniologiya [Gernology]. 2008; 1: 44-48.

4. Khodak VA, et al. Primeneniye sinteticheskikh materialov pri peritonite i eventratsii [The use of synthetic materials for peritonitis and eventration]. Krasnoyarsk: Materiali 7-y Vserossiiskoy konferencii obshchestva khirurgov [Krasnoyarsk]. 2012; 402–403.

5. Ioffe AYu, Zakharash MP, Abu-Shamsiya R. Metodika intraperitoneal’noy gernioplastiki s ispol’zovaniyem kompozitnoy setki Proceed [Methods of intraperitoneal hernioplasty using Proceed composite mesh]. Gerniologiya [Gernology]. 2009; 3 (23): 17.

6. Tsereteli Z, Pryor BA, Heniford BT. Laparoscopic ventral hernia repair (LVHR) in morbidly obese patients. Hernia. 2008; 12: 233–238.

7. Lyadov VK, Yermakov NA, Yegiyev VN. Opyt intra- peritoneal’nogo primeneniya proteza SIL PROMESH pri ventral’nykh gryzhakh [Experience of intraperitoneal application of the SIL PROMESH prosthesis in ventral hernias]. Gerniologiya[Gernology]. 2009; 3 (23): 25-26.

8. Voeller GR. Innovations in ventral hernia repair. Surg Technol Int. 2007; 16: 117-122.

9. Lorenz R. Proceed ventral patch – the simple solution for umbilical. Hernia. 2009; 1 (13): 24.

 

UDC 616.342-002.44:616.37-006

DOI: 10.20969/VSKM.2018.11(5).177-180

PDF download ZOLLINGER – ЕLLISON SYNDROME DIAGNOSIS AND TREATMENT (clinical case)

SHAYMARDANOV RAVIL SH., C. Med. Sci., professor of the Department of surgery of Kazan State Medical Academy – the branch of Russian Medical Academy of Postgraduate Education, Russia, 420012, Kazan, Butlerov str., 36

GUBAYEV RUSLAN F., Head of the Department of surgery No 1 of City Clinical Hospital No 7, Russia, 420012, Kazan, Chuikov str., 54, tel. 221-39-81, e-mail: gubaevrus@mail.ru

GAFUROV KAMIL D., surgeon of the Department of surgery No 1 of City Clinical Hospital No 7, Russia, 420012, Kazan, Chuikov str., 54

NURIYEV ILMIR I., surgeon of the Department of surgery No 1 of City Clinical Hospital No 7, Russia, 420012, Kazan, Chuikov str., 54

BAGAUTDINOV ELDAR B., surgeon of the Department of surgery No 1 of City Clinical Hospital No 7, Russia, 420012, Kazan, Chuikov str., 54

SHARAFIYEV SIREN Z., C. Med. Sci., surgeon of the Department of surgery No 1 of City Clinical Hospital No 7, Russia, 420012, Kazan, Chuikov str., 54

KURBANOV RADIK R., resident of the Department of surgery of Kazan State Medical Academy – the branch of Russian Medical Academy of Postgraduate Education, Russia, 420012, Kazan, Butlerov str., 36

Abstract. Aim. To share the experience of diagnosis and treatment of the patient G., born in 1975, with Zollinger – Ellison syndrome. Material and methods. Patient G. was hospitalized on 25.11.2017 for gastrointestinal bleeding. Results and discussion. Endoscopic examination showed an ulcerative defect up to 7 mm on the anterior wall in the descending section of the duodenum, covered with a dark clot. Conclusion: peptic ulcer of duodenum, complicated by bleeding, Forrest IIb st. The bleeding was arrested by drug treatment. In history, 40 days ago on November 14, 2017, in the same ward, the surgery was performed for jejunum ulcer perforation. Anti-ulcer drugs were received. Considering the history of the disease, atypically low location of duodenal ulcer, the incidence of complications, despite the anti-ulcer treatment, Zollinger – Ellison syndrome was suspected. Laboratory tests showed an increase in serum gastrin by more than 20 times. An endoscopic ultrasound examination of the hepatic, pancreatic and biliary zone revealed a pancreatic head tumor sized 32×23 mm. Gastrinoma of the pancreatic head was diagnosed. Enucleation of the pancreatic head gastrinoma surgery was performed. According to the results of histology it was a neuroendocrine tumor. In the postoperative period, the level of serum gastrin decreased to normal values. Conclusion. Zollinger – Ellison syndrome should be considered in frequent exacerbations of gastric or duodenal ulcer or ulcer bleeding, in the history of gastric resection, especially with ulcer localization in the distal duodenum. The gold standard for laboratory diagnosis of Zollinger – Ellison syndrome is serum gastrin evaluation. Compared with the other methods (ultrasound, X-ray computed tomography, magnetic resonance imaging) the most informative method of gastrinoma imaging is endoscopic ultrasound study. Nevertheless, magnetic resonance imaging is considered to be one of the most sensitive imaging methods in liver and hand metastases in patients with neuroendocrine tumor. The method of choice for gastrinoma treatment is a surgery.

Key words: Zollinger – Ellison syndrome, gastrinoma, diagnosis and treatment.

For reference: Shaymardanov RSh, Gubayev RF, Gafurov KD, Nuriyev II, Bagautdinov EB, Sharafiyev SZ, Kurbanov RR. Zollinger – Ellison syndrome diagnosis and treatment (clinical case). The Bulletin of Contemporary Clinical Medicine. 2018; 11 (5): 177–180. DOI: 10.20969/VSKM.2018.11(5).177-180.

REFERENCES

1. Jensen RT, Gardner JD, Raufman JP, et al. Zollinger- Ellison syndrome: current concepts and management. Ann Intern Med. 1983; 98: 59-75.

2. Schwarting H, Osse G, Sippel M, et al. Morphometry of the pancreatic islets in patients with insulinomas and fastrinomas; Regulatory peptides: Abstracts of the 4th international symposium on gastrointestinal hormonts. Amsterdam: Elsevier. 1983; 129.

3. Halfdanarson TR, Rubin J, Farnell MB, et al. Pancreatic endocrine neoplasms: epidemiology and prognosis of pancreatic endjcrine tumors. Endocrine-related cancer. 2008; 15 (2): 409-427.

4. Lorenz K, Dralle H. Surgical treatment of sporadic gastrinoma. Wien Klin Wochen-schr. 2007; 119 (19-20): 597-560. 

5. Fraker DL, Norton JA, Saeed ZA, et al. A prospective study of perioperative and postoperative control of acid hypersecretion in patients with Zollinger-Ellisonsyndrome undergoing gastrinoma resection. Surgery. 1988; 104: 1054-1063.

6. Ellison EC, Wilson SD. The Zollinger-Ellison syndrome: reapraisal and evaluation of 260 registered cases. Ann Surg. 1964; 160: 512-530.

7. Ellison EC, Wilson SD. The Zollinger-Ellison syndrome: a comprehensive review of historical, scientific, and clinical considerations. Curr Probl Surg. 2009; 46 (1): 12-106.

8. Kloppel G, Anlauf M. Epidemiology, tumor biology, and histopathological classifi cation of neuroendocrine tumors of the gastrointestinal tract. Best Pract & Res Clin Gastroenterol. 2005; 19 (4): 507-517.

9. Chernousov AF, Parnova VA, Egorov AV, et al. Diagnostika i lechenie bol’nyh s sindromom Zollingera-Ellisona [Diagnosis and treatment of patients with Zollinger-Ellison syndrome]. Sovremennye aspekty hirurgicheskoj endokrinologii [Modern aspects of surgical endocrinology]. 2010; 385-388.

10. Stadil H, Bardram L, Gustafsen J, Efsen F. Surgical treatment of Zollinger-Ellisin syndrome. World J Surgery. 1993; 17: 463-470.

 

UDC 616.329-007.251-089

DOI: 10.20969/VSKM.2018.11(5).181-185

PDF download SPONTANEOUS ESOPHAGUS RUPTURE TREATMENT BY ENDOSCOPIC STENTING (clinical case)

SHAYMARDANOV RAVIL SH., C. Med. Sci., professor of the Department of surgery of Kazan State Medical Academy – the branch of Russian Medical Academy of Postgraduate Education, Russia, 420012, Kazan, Butlerov str., 36

GUBAYEV RUSLAN F., Head of the Department of surgery No 1 of City Clinical Hospital No 7, Russia, 420012, Kazan, Chuikov str., 54, tel. 221-39-81, e-mail: gubaevrus@mail.ru

KHAMZIN ILDAR I., Head of the Department endoscopy of City Clinical Hospital No 7, Russia, 420012, Kazan, Chuikov str., 54GAFUROV KAMIL D., surgeon of the Department of surgery No 1 of City Clinical Hospital No 7, Russia, 420012, Kazan, Chuikov str., 54

KHISAMIYEV ILDAR G., surgeon of the Department of surgery No 1 of City Clinical Hospital No 7, Russia, 420012, Kazan, Chuikov str., 54

BAGAUTDINOV ELDAR B., surgeon of the Department of surgery No 1 of City Clinical Hospital No 7, Russia, 420012, Kazan, Chuikov str., 54

MAKAROV DENIS V., endoscopist of the Department of endoscopy of City Clinical Hospital No 7, Russia, 420012, Kazan, Chuikov str., 54

GOSTIAEVA TAMARA A., endoscopist of the Department of endoscopy of City Clinical Hospital No 7, Russia, 420012, Kazan, Chuikov str., 54

SOROKINA ELENA S., radiologist of the Department of MRT and RCT of City Clinical Hospital No 7, Russia, 420012, Kazan, Chuikov str., 54

Abstract. Aim. The aim of the study is to share the experience of treatment of a patient with Boerhaave syndrome. Spontaneous rupture of the esophagus (Boerhaave syndrome) is a serious disease that requires urgent surgical treatment. Timely diagnosis plays a crucial role in success of treatment. Material and methods. An observation of diagnosis and treatment in a patient with Boerhaave syndrome was performed. Results and discussion. The patient became ill acutely after heavy drinking and vomiting. Suddenly, complaints of pronounced epigastric pain without irradiation, nausea, and repeated vomiting of «coffee grounds» type appeared. The diagnosis «Boerhaave syndrome» was established after the examination. An urgent surgery was performed under endotracheal anesthesia. Laparotomy, longitudinal diaphragmotomy, closure of esophageal rupture, gastrostomy, drainage of the mediastinum and abdominal cavity has been carried out. The postoperative period was relatively smooth. Mediastinitis has resolved, but 1 month after the operation the patient developed an esophageal-mediastinal fistula, which did not tend to close, despite active, then passive drainage of the mediastinum. Danish stent was installed. The patient was discharged under observation. A month later, the stent was removed without any technical difficulties. The wound of the esophagus healed. Liquid food intake was permitted. Adherence to diet and regimen, surgeon follow-up at the place of residence were recommended. Conclusion. This case shows that esophageal-mediastinal fistula development after spontaneous esophagus rupture is an indication for early stenting. Boerkhaave syndrome is a rare disease, the diagnosis of which is being established on the basis of endoscopic and radiologic (X-ray, CT) methods of investigation. The treatment is surgical. Spiking of the esophagus defect during laparotomy is a surgery of choice. Endoscopic stenting is indicated in case of suture inconsistency leading to esophago-mediastinal fistula development.

Key words: Boerhaave syndrome, spontaneous esophagus rupture, esophageal stenting.

For reference: Shaimardanov RSh, Gubaev RF, Khamzin II, Gafurov KD, Khisamiev IG, Bagautdinov EB, Makarov DV, Gostyaeva TA, Sorokina ES. Spontaneous esophagus rupture treatment by endoscopic stenting (clinical case). The Bulletin of Contemporary Clinical Medicine. 2018; 11 (5): 181–185. DOI: 10.20969/VSKM.2018.11(5).181-185.

REFERENCES

 1. Rudin EP. Povrezhdeniya pishchevoda: uchebnoye posobiye [Damage to the esophagus: Study Guide]. Moskva: Tsentr, institut usovershenstvovaniya vrachey [Moscow: Center, Institute of Advanced Medical Studies]. 1989; 32 p.

2. Chernousov AF, Bogopol’skij PM, Kurbanov FS. Hirurgiya pishchevod: rukovodstvo dlya vrachej [Surgery of esophagus: a Guide for Doctors]. Moskva: Medicina [Moscow: Medicine]. 2000; 340–352.

3. Mishchenko N. Sindrom Burgave [Boerhaave syndrome]. Medicinskaya gazeta «Zdorov’e Ukrainy» [Medical newspaper «Health of Ukraine»]. 2010; 2: 17.

4. Kotiv BN, Dzidzava II, Brednev AO, et al. Minimal’no invazivnye metody v lechenii spontannogo razryva pishchevoda [Minimally invasive methods in the treatment of spontaneous esophageal rupture]. Novosti hirurgii [Surgery news]. 2015; 4: 467–473.

5. Kochupov VP. Sluchaj uspeshnogo lecheniya spontannogo razryva pishchevoda (sindrom Burhave) [The case of successful treatment of spontaneous rupture of the esophagus (Boerhaave syndrome)]. Kremlevskaya medicina; Klinicheskij vestnik [Kremlin medicine; Clinical Herald]. 2011; 4: 108–110.

6. Rabadanov KM. Spontannyj razryv pishchevoda [Spontaneous rupture of the esophagus]. Hirurgiya [Surgery]. 2014; 6: 81–83. 7. Rinchikov VB, Plekhanov AN, Cybikdorzhiev BD et al. Pervyj opyt primeneniya endoskopicheskoj vakuumno-aspiracionnoj terapii v lechenii spontannogo razryva pishchevoda (sindrom Burhave) [The first experience of the use of endoscopic vacuum-aspiration therapy in the treatment of spontaneous rupture of the esophagus (Boerhaave’s syndrome)]. Byulleten’ VSNC SO RAMN [Bulletin of the WCSC of the Russian Academy of Medical Sciences]. 2017; 1: 136–140.

8. Shestyuk AM. Sovremennye podhody k lecheniyu povrezhdenij grudnogo otdela pishchevoda [Modern approaches to the treatment of thoracic esophagus rupture]. Novosti hirurgii [Surgery news]. 2010; 1: 30–36.

 

MEDICIN’S HISTORY

UDC 616.8-089-082(470.41-25)

DOI: 10.20969/VSKM.2018.11(5).186-191

PDF download NEUROSURGICAL DEPARTMENT AT CITY CLINICAL HOSPITAL No 7 IN KAZAN IS AN EMERGENCY NEUROSURGERY CLINIC OF HIGH MEDICAL TECHNOLOGIES

SADYKOV MARAT N., C. Med. Sci., Minister of Health of the Republic of Tatarstan, Russia, 420111, Kazan, Ostrovsky str., 11/6, e-mail: minzdrav@tatar.ru

DANILOV VALERIJ I., D. Med. Sci, professor, Head of the Department of neurology and neurosurgery of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, e-mail: asadullina_z@mail.ru

KARIMOV RAVIL KH., C. Med. Sci., Chief specialist for neurosurgery of City Clinical Hospital No 7, Russia, 420103, Kazan, Chuikov str., 54, e-mail: ravilkarimov@gmail.com

KHAIRULLIN NAIL T., Head of the Department of neurosurgery of City Clinical Hospital No 7, Russia, 420103, Kazan, Chuikov str., 54

GABASOV MARSEL V., neurosurgeon of the Department of neurosurgery of City Clinical Hospital No 7, Russia, 420103, Kazan, Chuikov str., 54

PANYUKHOV ALEKSANDER G., neurosurgeon of the Department of neurosurgery of City Clinical Hospital No 7, Russia, 420103, Kazan, Chuikov str., 54

ISMAGILOV DAMIR O., neurosurgeon of the Department of neurosurgery of City Clinical Hospital No 7, Russia, 420103, Kazan, Chuikov str., 54

ABDULLIN RINAT R., neurosurgeon of the Department of neurosurgery of City Clinical Hospital No 7, Russia, 420103, Kazan, Chuikov str., 54

AKHMADULLIN RISHAT N., neurosurgeon of the Department of neurosurgery of City Clinical Hospital No 7, Russia, 420103, Kazan, Chuikov str., 54

VALEEV ISKANDER E., neurosurgeon of the Department of neurosurgery of City Clinical Hospital No 7, Russia, 420103, Kazan, Chuikov str., 54

GARIFULLIN RENAT F., neurosurgeon of the Department of neurosurgery of City Clinical Hospital No 7, Russia, 420103, Kazan, Chuikov str., 54

DOROFEEVA OLGA I., neurologist of the Department of neurosurgery of City Clinical Hospital No 7, Russia, 420103, Kazan, Chuikov str., 54

MURTAZIN MARAT R., neurosurgeon of the Department of neurosurgery of City Clinical Hospital No 7, Russia, 420103, Kazan, Chuikov str., 54

MULIKHOV MARAT N., neurosurgeon of the Department of neurosurgery of City Clinical Hospital No 7, Russia, 420103, Kazan, Chuikov str., 54

TIMERBAEV RISHAT R., neurosurgeon of the Department of neurosurgery of City Clinical Hospital No 7, Russia, 420103, Kazan, Chuikov str., 54

KHALIULLIN AZAT KH., neurosurgeon of the Department of neurosurgery of City Clinical Hospital No 7, Russia, 420103, Kazan, Chuikov str., 54

Abstract. Aim. The aim of the study was to acquaint the readers with the experience of the neurosurgical emergency department reorganization at Kazan City Clinical Hospital No 7, which might be useful in terms of introduction of the high-tech methods into the work of health institutions. Material and methods. The neurosurgery department of the City Clinical Hospital No 7 in Kazan provides round-the-clock emergency assistance to the districts of Kazan with a population exceeding 600 thousand people.Results and discussion. A total of 5035 people were hospitalized during 2015–2017. Surgical activity was 35,4%. The overall mortality rate is 4,8%. Postoperative mortality is 10,6%. The main directions of high-tech surgery are head and spinal injuries, vascular diseases of the brain, degenerative lesions of the spine. Modernization of the emergency neurosurgery department has contributed to the treatment of significant number of patients in the city of Kazan according to the modern standards. The department has introduced new up-to-date emergency neurosurgical organization models for treatment of the residents of Kazan with traumatic brain or spinal cord lesions, vascular brain disorders, degenerative-dystrophic diseases of the spine, hydrocephalus and other neurosurgical pathological conditions. Objective performance indicators of the emergency neurosurgery department of Kazan City Clinical Hospital No 7 indicate its effective reorganization into the clinic of high medical technologies.Conclusion. The experience of the department can be useful for high-tech assistance in neurosurgery department operation.

Key words: high-tech medical care, results of neurosurgical operations.

For reference: Sadykov MN, Danilov VI, Karimov RKh, Khairullin NT, Gabasov MV, Panykhov AG, Ismagilov DO, Abdullin RR, Ahmadullin RN, Valeev IE, Garifullin RF, Dorofeeva OI, Murtazin MR, Mulikhov MN, Timerbaev RR, Khaliullin AKh. Neurosurgical department of City Clinical Hospital No 7 in Kazan is an emergency neurosurgery clinic of high medical technologies. The Bulletin of Contemporary Clinical Medicine. 2018; 11 (5): 186–191. DOI: 10.20969/VSKM.2018.11(5).186-191.

REFERENCES

1. Shul’man HM. Hirurgicheskoe lechenie kompressionnyh form osteohondroza poyasnichnogo otdela pozvonochnika s protezirovaniem mezhpozvonkovyh diskov [Surgical treatment of compression forms of degenerative disc disease of the lumbar spine with intervertebral disc prosthesis]. Izdatel`stvo Kazanskogo universiteteta [Publishing house of Kazan University]. 1980; 238 p.

2. Khajrullin NT. Kazanskij nejrohirurgicheskij centr vysokih medicinskih tekhnologij [Kazan neurosurgical center for high medical technologies]. Nevrologicheskij vestnik. 2009; 3; 5-13.

3. Potapov AA, Krylov VV, Likhterman LB, Talypov AE, Gavrilov AG, Petrikov SS. Klinicheskiye rekomendatsii po lecheniyu postradavshikh s tyazheloy cherepno-mozgovoy travmoy [Clinical recommendations for the treatment of victims with severe traumatic brain injury]. 2014; http://ruans.org/Files/ Pdf/Guidelines/head_injury.pdf

4. Fraerman AP. Klinicheskaya klassifikaciya sochetannoj cherepno-mozgovoj travmy [Clinical classification of combined traumatic brain injury]: Metodicheskie rekomendacii [Guidelines]. Moskva [Moscow]. 1989; 7 p.