The effect of obesity and long-term chondroprotective therapy on the value of hyaline cartilage of the knee joints in patients with early gonarthrosis without x-ray changes Arshin E.V. (Russia, Perm), Radoshchekin M.A. (Russia, Perm), Gorshkov D.A. (Russia, Perm), Khlynova O.V. (Russia, Perm), Arshin R.Е. (Russia, Perm), Tuev A.V. (Russia, Perm) P. 8
Postoperative pulmonary embolism: opportunities for anticoagulant therapyFedorov S.A. (Russia, Nizhny Novgorod),Medvedev A.P. (Russia, Nizhny Novgorod),Abdulyanov I.V. (Russia, Kazan), Vapaev K.B. (Russia, Nizhny Novgorod), Tselousova L.M. (Russia, Nizhny Novgorod), Amirov N.B. (Russia, Kazan) P.31
The value of androgen receptor expression in triple negative breast cancer patients Shagina N.Yu. (Russia, Moscow), Polikarpova S.B. (Russia, Moscow), Vorotnikov I.K. (Russia, Moscow), Kirsanov V.Yu. (Russia, Moscow), Ponomarev V.E. (Russia, Moscow) P.35
The features of the prevalence of triglyceridemia and its importance in development of excess weight and obesity in elderly population (population research) Chobanov R.E. (Azerbaijan, Baku), Gadzhiyeva Ya.G. (Azerbaijan, Baku) P.40
Communication on the prevention and treatment of COVID-19 epidemic between Anhui province of China and federal districts along the Volga river in RussiaCui W. (China, Hefei), Min S. (China, Hefei), Nian L. (China, Hefei), Yufeng G. (China, Hefei),Changhui W. (China, Hefei), Yuanyuan Y. (China, Hefei), Maohong B. (China, Hefei), Xingwang W. (China, Hefei), Ping D. (China, Hefei), Xiaohu W. (China, Hefei), Rui L. (China, Hefei), Guanghe F. (China, Hefei),Chaozhao L. (China, Hefei) P.62
Difficulty in diagnosing mitral insufficiency in chronic obstructive pulmonary disease: boundaries of therapeutic and surgical competencies Palmova L.Yu. (Russia, Kazan), Podolskaya A.A. (Russia, Kazan), Akhmadullina A.A. (Russia, Kazan) P.80
The features of hepaticiojunoanastomosis stenosis treatment Chikaev V.F. (Russia, Kazan), Mingazetdinov M.A. (Russia, Kazan),Sharafislamov I.F. (Russia, Kazan), Bondarev Yu.V. (Russia, Kazan), Petukhov D.M. (Russia, Kazan), Bukushkina V.A. (Russia, Kazan) P.85
Acute cerebral insufficiency during percutaneous coronary surgery in a patient with acute coronary syndrome (clinical case) Sharafutdinov B.M. (Russia, Kazan),Abdrakhmanova A.I. (Russia, Kazan),Gayfullina R.F. (Russia, Kazan),Mukhametshina E.I. (Russia, Kazan),Akhmedova G.M. (Russia, Kazan), Valeev M.K. (Russia, Kazan), Amirov N.B. (Russia, Kazan) P.90
THE EFFECT OF OBESITY AND LONG-TERM CHONDROPROTECTIVE THERAPY ON THE VALUE OF HYALINE CARTILAGE OF THE KNEE JOINTS IN PATIENTS WITH EARLY GONARTHROSIS WITHOUT X-RAY CHANGES
ARSHIN EVGENY V., D. Med. Sci., professor of the Department of advanced internal medicine and cardiology of Academician E.A. Wagner Perm State Medical University, Russia, 614000, Perm, Petropavlovskaya str., 26, tel. 8-929-234-05-89, e-mail: firstname.lastname@example.org
RADOSHCHEKIN MIKHAIL A., ORCID ID 0000-0001-7746-4602; candidate of a degree of the Department of advanced internal medicine and cardiology of Academician E.A. Wagner Perm State Medical University, Russia, 614000, Perm, Petropavlovskaya str., 26; internist, cardiologist, rheumatologist of «Vita-D» medical center, Russia, 617763, Perm region, Chaikovsky, Dekabrist str., 23, build. 3, tel. 8-929-234-05-89, e-mail: email@example.com
GORSHKOV DANIL A., post-graduate student of the Department of advanced internal medicine and cardiology of Academician E.A. Wagner Perm State Medical University, Russia, 614000, Perm, Petropavlovskaya str., 26, tel. 8-995-09З-55-77, e-mail: firstname.lastname@example.org
KHLYNOVA OLGA V., D. Med. Sci., professor, corresponding member of the Russian Academy of Sciences, high level certificate internist and gastroenterologist, the Head of the Department of advanced internal medicine and cardiology of Academician E.A. Wagner Perm State Medical University, Russia, 614000, Perm, Petropavlovskaya str., 26, tel. 8-902-478-34-82, e-mail: email@example.com
ARSHIN ROMAN Е., 4th year student of Academician E.A. Wagner Perm State Medical University, Russia, 614000, Perm, Petropavlovskaya str., 26, tel. 8-929-234-05-89, e-mail: firstname.lastname@example.org
TUEV ALEXANDER V., D. Med. Sci., professor, Honored scientist of the Russian Federation, Academician of the Russian Academy of Sciences, high level certificate physician, Russia, 614000, Perm, Petropavlovskaya str., 26, tel. 8-34-22-239-31-88, e-mail: email@example.com
Abstract. Aim. Study the effect of obesity on the size of hyaline cartilage and the effectiveness of longterm chondroprotective therapy in patients with early gonarthrosis without radiological changes. Material and methods.We examined 819 patients with early gonarthrosis. Patients were without radiological signs of gonarthrosis, having clinical and ultrasonographic manifestations of the disease. Two groups comparable by gender and age were singled out: the rst group – patients with body mass index <30, and the second – ≥30. Each group included two subgroups: rst one – patients receiving combined chondroprotective therapy during 2 years, and second one – were receiving only symptomatic drugs from the group of nonsteroidal antiin ammatory drugs occasionally. Initially, and two years later, everyone was examined by ultrasound of knee joints. The dynamics of the minimum thickness of hyaline cartilage was analyzed. Results and discussion. In patients with obesity, hyaline cartilage of knee joints signi cantly decreased by (0,23±0,14) mm over 2 years, while in patients with body mass index <30, hyaline cartilage decreased only by 0,10±0,10 (p<0,05). Patients with obesity, who regularly received chondroprotectors, had better parameters after two years of therapy than patients on symptomatic therapy (0,17±0,12) mm and (0,28±0,13) mm; p<0,05. A distinct cartilage saving effect on chondroprotective therapy was also determined in patients without obesity. Against the background of chondroprotective therapy in two years the cartilage size decreased by (0,06±0,08) mm, while in the group without chondroprotectors the cartilage loss was (0,16±0,10) mm. Regardless of the body mass index, the reception of CP slowed down the decrease in the height of articular cartilage by an average of 5,26% of the original value. In obese patients, despite the positive effect of chondroprotectors on joint cartilage structure, indicators such as pain on the visual analogue scale, Leken and WOMAC index changed slightly in contrast to patients with body mass index <30. In obese patients receiving chondroprotectors, VAS index decreased by (3,42±10,61) mm, Leken index by 0,61±1,0; WOMAC index by 27,56±93,80. At the same time, in obese patients, receiving chondroprotectors, the indices were 3–4 times better (VAS decreased by 13,64±8,06; p<0,05; Leken index by 1,95±3,43; p<0,05; WOMAC by 119,40±103,63; p<0,05).Conclusion. Obesity is an important factor in the progression of gonarthrosis. The application of chondroprotective drugs at the early preradiological stage of gonarthrosis allows slowing down the decrease in the height of hyaline cartilage of knee joints and reduces the clinical manifestations of gonarthrosis both in patients with normal body weight and, to a lesser extent, obesity. To obtain a structural cartilage saving effect, chondroprotective drugs should be administered at an early preradiological stage.
Key words: оsteoarthritis, gonarthritis, obesity, overweight, chondroprotectors, chondroitin sulfate, glucosamine hydrochloride.
For reference: Arshin EV, Radoschekin MA, Gorshkov DA, Khlynova OV, Arshin RE, Tuyev AV. The effect of obesity and longterm chondroprotective therapy on the size of the hyaline cartilage of the knee joints in patients with early gonarthrosis without Xray changes. The Bulletin of Contemporary Clinical Medicine. 2020; 13 (5): 714. DOI: 10.20969/ VSKM.2020.13(5).714.
1. Kabalyk MA. Rasprostranennost’ osteoartroza v Rossii: regional’nyye aspekty dinamiki statisticheskikh pokaza teley za 20112016 goda [Prevalence of osteoarthritis in Russia: regional aspects of dynamics of statistical indicators for 20112016]. Nauchnoprakticheskaya revmatologiya [Scienti c and practical rheumatology]. 2018; 4: 416422.
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GIMADEEVA ALSU D., ORCID ID: 0000-0001-7644-7587; postgraduate student of the Department of cardiology advanced training faculty of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, tel. 8-906-322-52-75, e-mail: firstname.lastname@example.org
BALEEVA LARISA V., ORCID: 0000-0002-7974-5894; assistant of professor of the Department of cardiology advanced training faculty of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, tel. 8-905-314-35-45, e-mail: email@example.com
GALEEVA ZULFIA M., ORCID: 0000-0002-9580-3695; associate professor of the Department cardiology advanced training faculty of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, tel. 8-917-265-85-64, e-mail: firstname.lastname@example.org
GALYVICH ALBERT S., ORCID ID: 0000-0002-4510-6197; D. Med. Sci., professor, the Head of the Department of cardiology of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, tel. 8-987-296-16-43, e-mail: email@example.com
Abstract. Aim. The aim of the study was to compare the level of lipoprotein (a) in patients with acute stage of myocardial infarction to clinical and laboratory parameters, instrumental parameters and lipid metabolism indicators, including type 9 proprotein convertase subtilizin/kexin (PCSK9). Material and methods. 119 patients with myocardial infarction with and without ST segment lifting on the electrocardiogram were examined [mean age (58,24±8,10) years, 97 men and 22 women]. All patients underwent a standard examination including coronary angiography. Blood samples were taken on the 2nd day after myocardial infarction. The blood lipoprotein (a) level was determined by immunoturbidimetry (RANDOX). Blood PCSK9 levels were determined by the immunoenzyme assay using the Human PCSK9 ELISA test system (BiоVendor, Czech Republic). Results and discussion. In 26 (30,2%) patients, lipoprotein (a) levels were above 50 mg/dL, and in 93 (69,7%) patients, lipoprotein (a) levels were below 50 mg/dL. The median value for lipoprotein (a) was 18,00 mg/dL (7,05–38,20): in men – 17,80 mg/dL (7,90–35,40), and in women – 19,80 mg/dL (3,90–72,15) (p=0,7974). The minimum level of lipoprotein (a) was 1 mg/dL, the maximum level was 117 mg/dL. The median for lipoprotein (a) in patients with type II diabetes was 12,50 mg/dL (5,80–19,00), in patients without diabetes – 19,90 mg/dL (7,50–50,60) (p=0,0406). In patients with type II diabetes mellitus there was revealed a signi cant direct correlation between lipoprotein (a) level and platelet count (r = 0,479, p=0,0280). Smoking patients had a signi cant inverse correlation between lipoprotein (a) level and PCSK9 (r = 0,538, p=0,0119) and a signi cant direct correlation between lipoprotein (a) level and prothrombin (r = 0 458, p=0,0214). Conclusion. Patients with myocardial infarction having type II diabetes mellitus have lower levels of lipoprotein (a) than patients without diabetes mellitus. Patients with myocardial infarction with type II diabetes mellitus have a direct correlation of lipoprotein (a) level with platelet count. Smoking patients with myocardial infarction have inverse correlation between lipoprotein (a) levels and PCSK9 and a direct correlation between lipoprotein (a) and prothrombin levels.
Key words: lipoprotein (a), myocardial infarction, type 9 proprotein convertase subtilizin/kexin (PCSK9).
For reference: Gimadeeva AD, Baleeva LV, Galeeva ZM, Galyavich AS. Lipoprotein (a) in patients with acute myocardial
infarction. The Bulletin of Contemporary Clinical Medicine. 2020; 13 (5): 1519. DOI: 10.20969/VSKM.2020.13(5).1519.
Tsimikas S. A test in context: lipoprotein(a): diagnosis, prognosis, controversies, and emerging therapies. J Am Coll Cardiol. 2017; 69: 692–711. doi.org/10.1016/j. jacc.2016.11.042.
Nordestgaard B, Langsted A. Lipoprotein (a) as a cause of cardiovascular disease: insights from epidemiology, genetics, and biology. J Lipid Res. 2016; 57: 1953–1975.
Wilson D, Jacobson T, Jones P, et al. Use of Lipoprotein(a) in clinical practice: A biomarker whose time has come. A scienti c statement from the National Lipid Association. J Clin Lipid. 2020; 1: 155156.
Paré G, Çaku, McQueen M, et al. On behalf of the INTERHEART Investigators Circulation. Lipoprotein(a) Levels and the Risk of Myocardial Infarction Among 7 Ethnic Groups. 2019; 139: 1472–1482.
Nordestgaard B, Chapman M, Ray K, et al. European Atherosclerosis Society Consensus Panel. Lipoprotein(a) as a cardiovascular risk factor: current status. Eur Heart J. 2010; 31: 2844–2853.
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Gimadeeva AD, Galyavich AS, Galeeva ZM, Bale eva LV. Urovni proprotein konvertazy subtilizin/ keksin 9 tipa u pacientov s ostrym infarktom miokarda [Levels of proprotein convertase subtilisin / kexin type 9 in patients with acute myocardial infarction]. Rossijskij kardiologicheskij zhurnal [Russian journal of cardiology]. 2020; 25: 4244.
INDIAMINOV SAYIT I., ORCID ID: 0000-0001-9361-085X; C. Med. Sci., professor, the Head of the Department of forensic medicine of Samarkand State Medical Institute, Uzbekistan, 140100, Samarkand, A. Motrudiy str., 26, e-mail: firstname.lastname@example.org
ISMAILOV RAVSHONBEK A., ORCID ID: 0000-0002-8224-3545; lecturer of the Department of forensic medicine of Samarkand State Medical Institute, Uzbekistan, 140100, Samarkand, A. Motrudiy str., 26
BAKHTIYOROV BAKHODIR B., ORCID ID: 0000-0002-7851-4728; forensic physician of Republican Scientific and Practical Center for Forensic Expert Service, Uzbekistan, Tashkent
Abstract. Aim. The aim of the study was to investigate the nature and the features of an injury development in drivers in case of an invehicle car trauma. Material and methods. Forensic medical examination of 61 corpses of 55 «Daewoo Uz» car drivers and of 6 domestic brand car drivers, who died as a result of invehicle car trauma, was conducted. Among the dead drivers 60 were men and there was 1 woman. The age of the victims was from 21 to 59 years. Circumstances of the intracabin injury were as follows: frontal collisions with other moving vehicles – 35, roadside collisions with subsequent overturning of cars – 19, and collisions of moving cars with xed obstacles (trees, poles, fences) – 7 cases.Results and discussion. Head, chest and chest organs, as well as abdominal organs were the ones most commonly damaged in drivers. Skull injuries in drivers were often accompanied by the fractures of the bones of the vault and base of the skull, as well as the fractures of the skull facial bones: nasal, cheekbone and jaw. Damage to the chest and chest organs were characterized by fractures of the ribs, sternum, and collarbone, ruptures of the walls of the heart left ventricle and lung parenchyma. Rib fractures in drivers were more often doublesided, with predominantly upper rib fractures – from 2 to 8 ribs, mainly along the parasternal, midclavicular and axillary lines. Parenchyma ruptures of a large proportion of the liver (mainly along the diaphragmatic surface), as well as the ruptures of the spleen and intestines, were often observed among the abdominal organ trauma. Damages to bones of upper and lower extremities in drivers were observed to a much lower degree. Spinal and spinal cord injury were also less common, as well as the damage to pelvic organ structures. Conclusion. The complex of injuries in passenger car drivers in case of an invehicle car trauma is distinguished by the severity of the injury and is characterized by development of the most common combined injuries of two or more body parts.
Key words: invehicle car trauma, driver, injuries.
For reference: Indiaminov SI, Ismailov RA, Bakhtiyorov BB. Injuries in drivers caused by an invehicle car trauma. The Bulletin of Contemporary Clinical Medicine. 2020; 13 (5): 2025. DOI: 10.20969/VSKM.2020.13(5).2025.
1. Dubrovin IA, Sedyh EP, Mosoyan AS, Bychkov AA, Ahmetova DN. Harakter povrezhdenij pozvonkov u postradavshih v salone legkovogo avtomobilya pri dorozhnotransportnom proisshestvii [The nature of vertebral injuries in victims in the passenger compartment of a car in a traf c accident]. Sudebnomedicinskaya ekspertiza [Forensicmedical examination]. 2018; 1: 1215.
2. Dubrovin IA, Mosoyan AS, Gruhovskij SV, Bychkov AA. Obshchaya harakteristika travmy golovy u voditelya pri dorozhnotransportnom proisshestvii [General characteristics of a driver’s head injury in a road traf c accident]. Sudebnomedicinskaya ekspertiza [Forensic medical examination]. 2020; 2: 1924.
3. Indiaminov SI, Gamidov SSh, Bojmanov FH. Osobennosti formirovaniya povrezhdenij u peshekhodov pri ih stolknovenii s dvizhushchimisya sovremennymi legkovymi avtomobilyami [Features of the formation of injuries in pedestrians when they collide with moving modern passenger cars]. Vestnik vracha; Samarkand [Doctor’s Herald; Samarkand]. 2020; 2 (94): 3640.
4. Kovalev AV, Makarov IYu. Sovremennoe sostoyanie sudebnomedicinskoj ekspertizy avtomobil’noj travmy [The current state of forensic medical examination of a car injury]. SPb : Al’manah sudebnoj mediciny; Yuridicheskij Centr Press [SPb: Almanac of Forensic Medicine; Legal Center Press]. 2011; 11 (19): 57.
5. Kovalev AV, Momot DV, Samohodskaya OV, Zabrods kij YaD. Specifika provedeniya sudebnomedicinskih ekspertiz postradavshih v dorozhnotransportnyh proisshestviyah s uchetom sovremennogo razvitiya sistem bezopasnosti avtomobilya [The speci cs of conducting forensic medical examinations of victims of road traf c accidents, taking into account the modern development of vehicle security systems]. Sudebnomedicinskaya ekspertiza [Forensicmedical examination]. 2020; 2: 1418.
6. Kul’pin SE, Nikolaev BS, Buromskij IV. Sravnitel’nyj analiz povrezhdenij, prichinyaemyh voditelyu i passazhiru perednego sideniya pri ispol’zovanii sredstv vnutrennej bezopasnosti v sluchayah frontal’nogo i bokovogo so storony voditelya stolknoveniyah, v zavisimosti ot marki legkovogo avtomobilya [Comparative analysis of damage caused to the driver and front seat passenger when using internal security equipment in frontal and driverside collisions, depending on the car brand]. Medicinskaya ekspertiza i pravo [Medical expertise and law]. 2013; 6: 2529.
7. Leonov SV, Barinov EH, Fokina EV. Sudebnomedicins kaya diagnostika raspolozheniya voditelya i passazhira perednego siden’ya v salone legkovyh avtomobilej pri dorozhnotransportnyh proisshestviyah[Forensic diagnostics of the location of the driver and front seat passenger in the passenger compartment in road traf c accidents]. Moskva: Medicinskaya tekhnologiya [Moscow: Medical technology]. 2011; 24 p.
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9. Pigolkin YuI, Dubrovin IA, Mosoyan AS, Bychkov AA. Sudebnomedicinskaya ocenka povrezhdenij pri travme v salone dvizhushchegosya legkovogo avtomobilya, oborudovannogo sovremennymi sredstvami individual’noj bezopasnosti [Forensic medical assessment of injuries in case of injury in the passenger compartment of a moving car equipped with modern personal safety equipment]. Sudebno – medicinskaya ekspertiza [Forensic – medical examination]. 2018; 1: 1620.
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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: email@example.com
FATYKHOV RUSLAN I., C. Med. Sci., assistant of professor of the Department of general surgery of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, e-mail: firstname.lastname@example.org
SHAVALEEV RUSTEM R., surgeon of the Department surgical No 3 of City Clinical Hospital No 7, Russia, 420000, Kazan, Chuikov str., 54
Abstract. Aim. Analysis of treatment and guidelines for the management of incisional ventral hernia was performed to ensure success in the treatment of this disease, and prevention of possible early and late surgical complications. Material and methods. The number of patients enrolled in the research database is 503 for the period of 2018–2019 calendar years; the gender composition is 87,2% of women, and 12,8% of men, which is signi cantly different from the above literature data where the prevailing number is men. Age composition of operated patients is as follows: the greater number of patients under 70 years old (33%), and those over 70 years old (47,5%), indicates a long hernia history and a conservative approach in the correction of the health of this population. Size of hernia gates was less than 2 cm in 9,8% of patients, while the rest of 90,2% had hernia gates, from 5 cm to 20 cm or greater. Attention is drawn to 24,5% of patients with ventral hernia gates of 15–20 cm, which indicates a complex «severe» category of patients. Special attention was paid to anesthetization for prevention of postoperative complications. 301 patients were operated on general anesthesia with ALV, with mandatory assessment of respiratory volume during the entire operation. Plasty of hernia defect in 82% of cases was performed using a mesh graft. Results and discussion. When analyzing 503 patients operated using different techniques, we recommend, especially in the «nonstandard» course in the early postoperative period, to use ultrasound, CT, MRI on indications to test iatrogenic damage of the inner abdominal organs. Enterotomy is most likely, especially in case of pronounced adhesion process. Conclusion. In the preoperative period it is necessary to strictly evaluate all diagnostic measures with the use of «heavy» technique for the choice of therapeutic tactics (access, aid, closure) of the postoperative wound, taking into account age, physiological, morbid indicators present in a particular patient. Surgical aid should be individual for each patient (endoprosthesis, plasticity with local tissues, laparoscopic method of treatment) performed in a minimally traumatic way, following all the rules of the aid, in order to prevent early postoperative wounds. To prevent possible relapses, especially in case of «giant» ventral hernia, patients should be referred to certi ed rehabilitation centers, which have a staff of medical personnel capable of providing the correct rehabilitation strategy and rehabilitation measures in the postoperative period.
Key words: incisional ventral hernia, preoperative preparation, surgical access, manual, mesh graft, technique of using mesh graft.
For reference: Klyushkin IV, Fatykhov RI, Shavaleev RR. Incisional ventral hernia: incidence, causes, surgical care. The Bulletin of Contemporary Clinical Medicine. 2020; 13 (5): 2630. DOI: 10.20969/VSKM.2020.13(5).2630.
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Nelyubin PS, Galota YeA, Timoshin AD. Khirurgicheskoye lecheniye bol’nykh s posleoperatsionnymi i retsidivnymi ventral’nymi gryzhami [Surgical treatment of patients with postoperative and recurrent ventral hernias]. Khirurgiya [Surgery]. 2007; 7: 6974.
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FEDOROV SERGEY A., ORCID ID: 0000-0002-5930-3941; C. Med. Sci., cardiovascular surgeon of Specialized Heart Surgery Clinical Hospital named after Academician B.A. Korolev, Russia, 603950, Nizhny Novgorod, Vaneev str., 209, e-mail: email@example.com
MEDVEDEV ALEXANDER P., ORCID ID: 0000-0003-1757-5962; D. Med. Sci., professor of the Department of advanced surgery named after B.A. Korolev of Volga Research Medical University, Russia, 603005, Nizhny Novgorod, Minin I Pozharsky sq., 10/1, e-mail: firstname.lastname@example.org
ABDULYANOV ILDAR V., ORCID ID: 0000-0003-2892-2827; C. Med. Sci., cardiosurgeon, the Head of the Department of cardiology, X-ray endovascular 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: email@example.com
VAPAEV KUDRAT B., ORCID ID: orcid.org/0000-0003-4224-5404; postgraduate student of the Department of advanced surgery named after B.A. Korolev of Volga Research Medical University, Russia, 603005, Nizhny Novgorod, Minin I Pozharsky sq., 10/1, e-mail: firstname.lastname@example.org
TSELOUSOVA LADA M., ORCID ID: 0000-0002-6005-2684; postgraduate student of the Department of advanced surgery named after B.A. Korolev of Volga Research Medical University, Russia, 603005, Nizhny Novgorod, Minin I Pozharsky sq., 10/1, e-mail: email@example.com
AMIROV NAIL B., ORCID ID: 0000-0003-0009-9103; SCOPUS Author ID: 7005357664; D. Med. Sci., professor of the Department of general medical practice of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, e-mail: firstname.lastname@example.org
Abstract. Aim. The aim of the study was to evaluate the effectiveness of anticoagulant therapy in treatment of post operative pulmonary thromboembolism. Material and methods. The study enrolled 51 patients with postoperative 32 pulmonary embolism who underwent anticoagulant therapy in Nizhny Novgorod hospitals from January 2017 to De cember 2019. The mean age of patients was (59,5±9,7) years. Of them 20 (39,22%) were men and 31 (60,78%) were women. Miller’s index in the overall group was (23,8±3,9) points. According to the original PESI scale, the pulmonary embolism severity index was 96,7±34,6. In all cases, thrombolysis actilyse was performed in accordance with current guidelines. Results and discussion. At the hospital stage, we recorded 17 fatal outcomes. Thus, the hospital survival rate was 66,7%. At the moment of discharge we observed residual pulmonary hypertension as well as the phenomena of right ventricular insuf ciency. Conclusion. Anticoagulant therapy in postoperative pulmonary embolism of high and intermediate high risk is not a suf ciently effective method of treatment, and it can be part of a comprehensive treat ment plan to prevent recurrence of pulmonary embolism. In the group of patients of intermediatelow and low risk it is a reliable and safe method of treatment.
Key words: pulmonary embolism, anticoagulant therapy.
For reference: Fedorov SA, Medvedev AP, Abdulyanov IV, Vapaev KB, Tselousova LM, Amirov NB. Postoperative pulmonary embolism: opportunities for anticoagulant therapy. The Bulletin of Contemporary Clinical Medicine. 2020; 13 (5): 3134. DOI: 10.20969/VSKM.2020.13(5).3134.
Claeys MJ, Vandekerckhove Y, Cosyns B, Van de Borne P, Lancellotti P. Summary of 2019 ESC Guidelines on chronic coronary syndromes, acute pulmonary embolism, supraventricular tachycardia and dislipidaemias. Acta Cardiologica. 2020; 10: 18. PMID: 31920149. https://doi. org/10.1080/00015385.2019.1699282.
Jaff MR, McMurtry MS, Archer SL, Cushman M, Golden berg N, Goldhaber SZ, Jenkins JS, et al. Management of massive and submassive pulmonary embolism, iliofemo ral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scienti c statement from the American Heart Association. Circulation. 2011; 123 (16): 17881830.
Gregson J, Kaptoge S, Bolton T, Pennells L, Willeit P, Burgess S, Bell S, Sweeting M, Rimm EB, Kabrhel C, Zöller B, Assmann G, et al. Cardiovascular Risk Factors Associated With Venous Thromboembolism. JAMA Car diol. 2019; 4 (2): 163173.
Comfere TB, Sprung J, Case KA, et al. Predictors of mortality following symptomatic pulmonary embolism in patients undergoing noncardiac surgery. Canadian Journal of Anaesthesia. 2007; 54 (8): 634–641.
Gangireddy C, Rectenwald JR, Upchurch GR, et al. Risk factors and clinical impact of postoperative symptomatic venous thromboembolism. Journal of Vascular Surgery. 2007; 45 (2): 335–342.
Vorob’eva NM, Panchenko EP, Ermolina OV, Balak honova TV, Dobrovol’skiĭ AB, Titaeva EV, Khasanova ZB, Postnov AI, Kirienko AI. Prolongation of enoxaparin therapy to one month promotes recanalization of the occlusively thrombosed deep veins. Terapevticheskii arkhiv. 2011; 83 (8): 3337.
Kari AO, Samantha C, Arnav A. Procedurespeci c Risks of Thrombosis and Bleeding in Urological Cancer Sur gery: Systematic Review and Metaanalysis. European Urology. 2018; 73 (2): 242251. https://doi.org/10.1016/j. eururo.2017.03.008.
SHAGINA NATALIA YU., ORCID ID: 0000-0003-2902-077X; senior laboratory assistant of the Department of oncology of Sechenov First Moscow State Medical University (Sechenov University), Russia, 119991, Moscow, Trubetskaya str., 8, e-mail: Gonchemail@example.com
POLIKARPOVA SVETLANA B., ORCID ID: 0000-0003-3621-7394; D. Med. Sci., professor of the Department of oncology of Sechenov First Moscow State Medical University (Sechenov University), Russia, 119991, Moscow, Trubetskaya str., 8, e-mail: firstname.lastname@example.org
VOROTNIKOV IGOR K., D. Med. Sci., professor, leading researcher of the Department surgical No 15 (oncomammology) of Research Institute of Clinical Oncology named after N.N. Trapeznikov, Russia, 115487, Moscow, Kashirsk highway, 24, e-mail: email@example.com
KIRSANOV VLADISLAV YU., ORCID ID: 0000-0003-1034-4432; C. Med. Sci., associate professor of the Department of oncology of Sechenov First Moscow State Medical University (Sechenov University), Russia, 119991, Moscow, Trubetskaya str., 8, e-mail: Kirsanov_v_yu@staff.sechenov.ru
PONOMAREV VALERYI E., ORCID ID: 0000-0003-0153-3311; assistant of professor of the Department of oncology of Sechenov First Moscow State Medical University (Sechenov University), Russia, 119991, Moscow, Trubetskaya str., 8, e-mail: firstname.lastname@example.org
Abstract. Aim. The aim of the study was to determine the prognostic value of androgen receptor expression in patients with triple negative breast cancer. Material and methods. The research was performed retrospectively based on Department No 15 (Oncommmunology) at the N.N. Blokhin Oncology Research Center of the Russian Ministry of Health. A comparative analysis of the clinical course of the disease of androgenpositive triple negative breast cancer was performed depending on the level of androgen receptor expression. The level of expression was assessed by the Allred system, 1–3 points were rated as low level of expression, while 4–8 points – as high. The results were statistically processed using Statistica 10.0 for Windows 2000 software package. We used Spearman correlation analysis, Mann – Whitney test, general survival and none relapse survival rates in the study groups. Results and discussion. Immunohistochemical method determined the presence of expression of androgen receptors in TN BC. The comparative characteristics of two groups of patients depending on the level of expression were given. The mean age of the patients was (52,5±3,1) years in the group of weak positive expression and (54,2±2,2) years in the group with high positive expression. Among concomitant diseases and risk factors prevailed the following: uterine myoma, obesity, absence of pregnancy and childbirth, and smoking. The studied groups did not differ in clinical characteristics. Histological study of the tumor obtained from operational material revealed that the most common type in both groups is nonspeci c in ltrative cancer. The in uence of androgen receptor expression level on 5year nonrelapse survival rate of patients was convincingly demonstrated, which allows estimating the prognostic value of the studied marker. Conclusion. The study showed that the incidence of triple negative breast cancer was 18%, with androgen positive tumors occurring in 58,8% of cases. At the same time, there were signi cantly more cases with high level of androgen receptor expression (p=0,05). Comparative analysis of the clinical course of the disease and morphological characteristics of the tumor revealed a difference in the average Ki67 level after biopsy of (66,6±3,3)% in the group with weak positive expression and (48,3±6,0)% in the group with high expression. The difference is statistically signi cant (p=0,05). It was found that the indicators of relapsefree survival are signi cantly higher among the patients of the second group with a high level of expression. Thus, we can consider the level of androgen receptor expression as a prognostic factor in triple negative breast cancer.
Key words: breast cancer, triple negative breast cancer, androgen receptors.
For reference: Shagina NY, Polikarpova SB, Vorotnikov IK, Kirsanov VY, Ponomarev VE. The value of androgen receptor expression in triple negative breast cancer patients. The Bulletin of Contemporary Clinical Medicine. 2020; 13 (5): 3539. DOI: 10.20969/VSKM.2020.13(5).3539.
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4. Tun NM, et al. Risk of having BRCA1 mutation in highrisk women with triplenegative breast cancer: a metaanalysis. Clinical Genet. 2014; 85 (1): 43–48.
5. Hu R, Dawood S, Holmes MD, et al. Androgen receptor expression and breast cancer survival in postmenopausal women. Clinical Cancer Res. 2011; 17 (7): 18671874.
6. Krylov AYu, Krylov YuV, Zubritskiy MG, Kurstak IA, Lyalikov SA, Basinskiy VA. Klinikomorfologicheskiy analiz vyyavleniya BRCA1 s immunogistokhimicheskoy otsenkoy ekspressii retseptorov androgenov i Ckit (CD117) pri troynom negativnom rake molochnoy zhelezy u zhenshchin Grodnenskoy oblasti [Clinical and morphological analysis of BRCA1 detection with immunohistochemical assessment of the expression of androgen receptors and Ckit (CD117) in triple negative breast cancer in women of Grodno region]. Problemy zdorov’ya i ekologii [Problems of health and ecology]. 2016; 4 (50): 2528.
THE FEATURES OF THE PREVALENCE OF TRIGLYCERIDEMIA AND ITS IMPORTANCE IN DEVELOPMENT OF EXCESS WEIGHT AND OBESITY IN ELDERLY POPULATION (population research)
CHOBANOV RAFIG E., D. Med. Sci., professor, the Head of the Department of public health and health management of Azerbaijan Medical University, Azerbaijan, AZ1022, Baku, Gasimzade str., 14, tel. (+994)125-64-93-37, e-mail: email@example.com
GADZHIYEVA YAGUT G., C. Med. Sci., senior lecturer of the Department of public health and health management of AzerbaijanMedical University, Azerbaijan, AZ1022, Baku, Gasimzade str., 14, tel. (+994)125-64-93-37, e-mail: firstname.lastname@example.org
Abstract. Aim. The aim of the research was to study of the prevalence of hypertriglyceridemia and its importance in development of excess weight and obesity at the population level. Material and methods. A survey of 2013 inhabitants was conducted in Baku (SF36). At the same time nger blood sample was taken to measure triglyceride level. Accutrend plus portative device (test system) was applied. Body weight was assessed using the World Health Organization index.Results and discussion. Hypertriglyceridemia was found in (33,7±1,1)% of inhabitants. In (24,5±1,0)% persons triglyceride level was (1,7±2,2) mmol/l. It was (2,3–5,6) mmol/l in (7,7±0,6)% of the participants. 5,7 mmol/l and greater values was seen in (1,5±0,2)% of them. Excess body weight was registered in (18,9±0,9)% of inhabitants. Different degrees of obesity were observed in (29,8±1,0)% of them. It was determined that body weight depends on triglyceride level. Triglyceride level was higher than 2,3 mmol/l in all cases of obesity. Conclusion. Hypertriglyceridemia, when combined with low physical activity and inadequate nutritional behavior, promotes development of excess body weight and obesity. Hypertriglyceridemia and obesity increase the risk of cardiovascular disease development.
Key words: interdependence, hypertriglyceridemia, obesity, population research.
For reference: Chobanov RE, Gadzhieva YaG. The features of the prevalence of triglyceridemia and its importance in development of excess weight and obesity in elderly population (population study). The Bulletin of Contemporary Clinical Medicine. 2020; 13(5): 4045. DOI: 10.20969/VSKM.2020.13(5).4045.
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УДК 616.832-004.2 -07:616.747/.748-009.12-073.97
THE FEATURES OF THE FUNCTIONAL STATE OF MUSCLE FIBERS IN PATIENTS WITH MULTIPLE SCLEROSIS WITH SPASTICITY ACCORDING TO THE RESULTS OF ELECTRONEUROMYOGRAPHY
DOMRES NATALIYA V., neurologist of the Department of demyelinating diseases of the nervous system of Kiev City Clinical Hospital No 4; doctoral student of the Department of neurology of A.A. Bogomolets National Medical University, Ukraine, 03110, Kiev, Solomenskaya str., 17, tel. +38-093-745-66-39, e-mail: email@example.com
Abstract. Aim. The aim of the study was to assess the functional state of muscle bers in spasticity in patients with multiple sclerosis (MS) according to the results of electroneuromyography. Material and methods. The study of elec troneuromyography indices was performed on 51 MS patients with spasticity (26 women and 25 men aged 24 to 71, mean age 43,8±1,6). The study was conducted via application of a stimulation noninvasive technique using a Nihon Kohden apparatus (motor bers of n. medianus, n. tibialis, and sensory bers of n. medianus, Fwave n. medianus,n. tibialis, and Hre ex). Spasticity of the upper and lower extremities was assessed using the Modi ed Ashworth Scale.Results and discussion. Signi cant decrease in the amplitude of the Mresponse was revealed when examining both the upper and lower extremities in MS patients with minimal clinical signs of spasticity. Indicators of late electro physiological phenomena (Famplitude mean) changed only in the lower extremities, where the level of spasticity was higher. Threshold levels of the Mamplitude were identi ed in order to assess the risk of a high total score of spasticity >12. Conclusion. The results of the study revealed the main electrophysiological indicators of early manifestations of spasticity in MS patients. The main electrophysiological indicator of the early manifestations of spasticity in patients with multiple sclerosis is a decrease in the amplitude of Mresponse. The mean Famplitude decreases according to the increase in spasticity in the lower extremities in patients with multiple sclerosis having different levels of spasticity.
Key words: spasticity, multiple sclerosis, Мamplitude, electrophysiologic phenomena.
For reference: Domres NV. The features of the functional state of muscle bers in patients with multiple sclerosis with spasticity according to the results of electroneuromyography. The Bulletin of Contemporary Clinical Medicine. 2020; 13 (5): 4656. DOI: 10.20969/VSKM.2020.13(5).4656.
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УДК 616-006.04:575.224.2 (048.8)
GIMAEVA REGINA R., ORCID ID: 0000-0002-4906-166X; resident of Institute of biology and fundamental medicine of Kazan Federal University, Russia, 420012, Kazan, Karl Marx str., 74; laboratory and research assistant of «OpenLab. Genetic and Cellular Technologies» research laboratory of Precision and Regenerative Medicine Сenter of Institute of biology and fundamental medicine, Russia, 420021, Kazan, Parizhskaya Kommuna str., 9, e-mail: firstname.lastname@example.org
ISMAGILOVA RUZILIA K., ORCID ID: 0000-0002-0811-8498; junior researcher of «OpenLab Omics Technologies» of Institute of biology and fundamental medicine of Kazan Federal University, Russia, 420021, Kazan, Parizhskaya Kommuna str., 9, e-mail: email@example.com
GABELKO DENIS I., lecturer of the Department of clinical medicine fundamental basis of Institute of biology and fundamental medicine of Kazan Federal University, Russia, 420012, Kazan, Karl Marx str., 74, e-mail: firstname.lastname@example.org
Abstract. Aim. The aim of the study was to analyze medical literature on mutations in genes that induce carcinogenesis. Material and methods. The analysis of scienti c and medical literature devoted to carcinogenesis and molecular genetic markers of oncological diseases was conducted. Results and discussion. Genetic instability plays a leading role in induction and promotion of carcinogenesis. Carcinogenesis is in uenced by mutations in genes and by adverse environmental factors. It is also known that exogenous and endogenous factors also affect the speed of their occurrence. The accumulation of mutations in cells leads to the development of both hereditary cancer diseases and sporadic tumors. Mutations in speci c genes are genetic markers of a certain type of cancer diseases. That is why it is extremely important to identify in time «genetic breakdowns» in the genes associated with the development of a certain type of tumor, as it will allow detecting speci c changes long before its clinical manifestations occur as well as taking the necessary measures. Conclusion. Today, modern methods of DNA research allow to detect mutations in speci c genes and to predict the possibility of their corresponding cancer. The search for speci c disease markers at the preclinical stage of tumor is one of the important tasks of practical oncology, as it allows to start treatment earlier and to slow down the process of carcinogenesis, as well as to conduct monitoring and prevention in patients with high risk of development and progression of a certain type of tumor process.
Key words: DNA, protooncogenes, suppressor genes, carcinogenesis, genetic mutations.
For reference: Gimaeva RR, Ismagilova RK, Gabelko DI. Mutations in genes as carcinogenesis trigger mwchanism. The Bulletin of Contemporary Clinical Medicine. 2020; 13 (5): 5761. DOI: 10.20969/VSKM.2020.13(5).5761.
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COMMUNICATION ON THE PREVENTION AND TREATMENT OF COVID-19 EPIDEMIC BETWEEN ANHUI PROVINCE OF CHINA AND FEDERAL DISTRICTS ALONG THE VOLGA RIVER IN RUSSIA
CUI WANG, the First Affiliated Hospital of Anhui Medical University, Shushan Qu, Hefei Shi, Anhui Sheng, China
MIN SHAO, the First Affiliated Hospital of Anhui Medical University, Shushan Qu, Hefei Shi, Anhui Sheng, China
NIAN LIU, the First Affiliated Hospital of Anhui Medical University, Shushan Qu, Hefei Shi, Anhui Sheng, China
YUFENG GAO, the First Affiliated Hospital of Anhui Medical University, Shushan Qu, Hefei Shi, Anhui Sheng, China
CHANGHUI WANG, the First Affiliated Hospital of Anhui Medical University, Shushan Qu, Hefei Shi, Anhui Sheng, China
YUANYUAN YANG, the First Affiliated Hospital of Anhui Medical University, Shushan Qu, Hefei Shi, Anhui Sheng, China
MAOHONG BIAN, the First Affiliated Hospital of Anhui Medical University, Shushan Qu, Hefei Shi, Anhui Sheng, China
XINGWANG WU, the First Affiliated Hospital of Anhui Medical University, Shushan Qu, Hefei Shi, Anhui Sheng, China
PING DING, the First Affiliated Hospital of Anhui Medical University, Shushan Qu, Hefei Shi, Anhui Sheng, China
XIAOHU WANG, the First Affiliated Hospital of Anhui Medical University, Shushan Qu, Hefei Shi, Anhui Sheng, China
RUI LI, the First Affiliated Hospital of Anhui Medical University, Shushan Qu, Hefei Shi, Anhui Sheng, China
GUANGHE FEI, the First Affiliated Hospital of Anhui Medical University, Shushan Qu, Hefei Shi, Anhui Sheng, China, e-mail: email@example.com
CHAOZHAO LIANG, the First Affiliated Hospital of Anhui Medical University, Shushan Qu, Hefei Shi, Anhui Sheng, China, e-mail: firstname.lastname@example.org
Abstract. The ongoing coronavirus infection (COVID19) pandemic is associated with high rates of morbidity and mortality. Russia, as a transport hub between Europe and Asia, has been hit hard by COVID19. The aim of this publication is topresent the materials of a teleconference held between experts from Anhui province in China and experts from the federal districts of Russia. Material and methods. Discussion of methods of prevention and treatment of the new coronavirus infection COVID19, as well as issues affecting the immune aspects of the disease, complications and possible longterm followup for patients after a new coronavirus infection. Results and discussion. The situation was especially dif cult for the federal district along the Volga River, so we shared and discussed questions on the prevention and treatment of the COVID19 epidemic, which were asked by the experts of the region. Conclusion. The presented article is theresult of an online meeting of the doctors from the Volga region of Russia with experts from Anhui province in China.
Key words: new coronavirus infection, COVID19.
For reference: Cui Wang, Min Shao, Nian Liu, Yufeng Gao, Changhui Wang, Yuanyuan Yang, Maohong Bian, Xingwang Wu, Ping Ding, Xiaohu Wang, Rui Li, Guanghe Fei, Chaozhao Liang. Communication on the prevention and treatment of COVID19 epidemic between Anhui province of China and Federal districts along the Volga river in Russia. The Bulletinof Contemporary Clinical Medicine. 2020; 13 (5): 6275. DOI: 10.20969/VSKM.2020.13(5).6275.
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ISHMURZIN GENNADY P., ORCID ID: 0000-0002-0962-5790; C. Med. Sci., associate professor of the Department of internal medicine of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, tel. +7-843-224-51-31, e-mail: email@example.com
OKURLU ALFIYA F., ORCID ID: 0000-0001-8890-1468; C. Med. Sci., assistant of professor of the Department of internal medicine of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, tel. +7 432 24513, e-mail: firstname.lastname@example.org
Abstract. Spontaneous esophageal rupture (Boerhaave syndrome, nontraumatic esophageal rupture, esophageal apoplexy or «banquet esophagus») is a lifethreatening condition that requires rapid diagnosis and treatment and is characterized by a rupture of all layers of the esophagus wall, due to a sharp increase in intraesophageal pressure. This abnormality is a rare disease, and according to various estimates, from 2 to 3% of all cases of damage to the esophagus and due to the rarity, variety of clinical pictures and lack of awareness of most doctors leads to delay in making the correct diagnosis. Aim. The aim of the study was to present a clinical case of spontaneous rupture of the thoracic part of the esophagus observed in therapeutic practice. Material and methods. In our clinical case, the patient was rst taken to the emergency cardiology department, then to the therapeutic department and only then to the surgical department. Only supplementary methods of examination and cooperation of doctors of different specialties allowed making the correct diagnosis. Results and discussion. In the course of clinical observation, we saw how dif cult it was to decide on the nal diagnosis. It required cooperation of several specialists. Attention is drawn to the fact that the patient’s treatment strategy depends on the diagnosis, sometimes quite the opposite, as in this case. Disaggregate and anticoagulant therapy was provided in the therapeutic department, while after transfer to a surgical hospital the patient received haemostatic and infusion therapy. Conclusion. Delayed diagnosis and improper therapeutic strategy can lead to a transmural esophageal rupture, which can be complicated by mediastinitis, pneumonitis, pericarditis, pleura empyema and death. Therefore, increased awareness and alertness in this disease is required not only from surgeons, but also from nonsurgical physicians, allows us to hope for the development of the principles of individualized approach to each patient and the widespread introduction of modern, lowimpact diagnostic methods, to optimize strategies and develop common algorithms of treatment, which will subsequently lead to a reduction in the mortality rate in this category of patients.
Key words: Boerhaave syndrome, spontaneous rupture of the esophagus, angina pectoris.
For reference: Ishmurzin GP, Okurlu AF. Clinical case of submucosal esophageal rupture in therapeutic practice. The Bulletin of Contemporary Clinical Medicine. 2020; 13 (5): 7679. DOI: 10.20969/VSKM.2020.13(5).7679.
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DIFFICULTY IN DIAGNOSING MITRAL INSUFFICIENCY IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE: BOUNDARIES OF THERAPEUTIC AND SURGICAL COMPETENCIES
PALMOVA LYUBOV YU., ORCID ID: 0000-0003-0052-830X; C. Med. Sci., associate professor of the Department of internal medicine of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, e-mail: email@example.com
PODOLSKAYA ALLA A., C. Med. Sci., the 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
AKHMADULLINA ALBINA A., student of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49
Abstract. Aim. The aim of the study was to evaluate the limits of therapeutic and surgical competence on a speci c clinical example of comorbid disease with mixed genesis dyspnea. Material and methods. The clinical case (patient N, 66 years old) was assessed as a combination of chronic obstructive pulmonary disease with pronounced clinical symptoms, severe ventilation disorders and stage III hypertension with mitral valve prolapse, 3rd degree mitral regurgitation, complicated by stage IIA chronic heart failure, functional class III. Results and discussion. In the absence of the expected effect of the therapy of chronic obstructive pulmonary disease against the background of pathological melody of the heart auscultation it is necessary to consider the possibility of combined pulmonary and cardiac abnormalities. In this case, the priority is to perform transthoracic ECHOcardioscopy. In case of doubtful results, it is necessary to apply more informative methods in specialized wellequipped clinics. Thorough analysis of clinical and instrumental data made it possible to diagnose comorbid condition that required reconstructive plastic surgery on mitral valve along with conservative therapy of chronic diseases. Conclusion. The described clinical case study is an example of an interdisciplinary approach that allowed achieving adequate compensation for the condition by using reconstructiveplastic methods on the mitral valve and effective conservative therapy of comorbid disease. Modern cardiac surgery has effective means for mitral apparatus correction in the presence of marked mitral insuf ciency. In this clinical situation, a strategy for mitral valve plasty was chosen with a Carpentier ring with an arti cial chord implantation.
Key words: mitral insuf ciency, chronic obstructive pulmonary disease, comorbidity, valve reconstruction.
For reference: Palmova LY, Podolskaya AA, Akhmadullina AA. Dif culty in diagnosing mitral insuf ciency in chronic obstructive pulmonary disease: boundaries of therapeutic and surgical competencies. The Bulletin of Contemporary Clinical Medicine. 2020; 13 (5): 8084. DOI: 10.20969/VSKM.2020.13(5).8084.
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9. plasticheskih operacij na mitral’nom klapane s ispol’ zovaniem kol’ca Karpant’e [Complications of the immediate period of reconstructiveplastic operations on the mitral valve using the Carpentier ring]. Vestnik AGIUV [AGIUV Bulletin]. 2016; 4: 3238. Mitral’naya regurgitaciya: klinicheskie rekomendacii, utvergdennie associaciej serdechnososudistyh hirurgov Rossii; Vserossijskim nauchnym obshchestvom kardiologov; Rossijskim nauchnym obshchestvom rentgenendovaskulyarnyh hirurgov i intervencionnyh radiologov [Mitral regurgitation: clinical guidelines, approved the Association of cardiovascular surgeons of Russia; AllRussian scienti c society of cardiologists; Russian scientific society of Xray endovascular surgeons and interventional radiologists]. Moskva [Moscow]. 2016; 30 p. https://serdceplus.ru/wpcontent/ uploads/2020/03/2016.%D0%9C%D0%B8%D1%82% D1%80%D0%B0%D0%BB%D1%8C%D0%BD%D0% B0%D1%8F%D1%80%D0%B5%D0%B3%D1%83%D 1%80%D0%B3%D0%B8%D1%82%D0%B0%D1%86 %D0%B8%D1%8F1.pdf
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
MINGAZETDINOV MARAT A., the Head of the Department of X-ray diagnostic and treatment methods of City Clinical Hospital No 7, Russia, 420000, Kazan, Chuykov str., 54
SHARAFISLAMOV ISKANDER F., the Head of X-ray surgery center of City Clinical Hospital No 7, Russia, 420000, Kazan, Chuykov str., 54
BONDAREV YURY V., C. Med. Sci., the Head of the Department of surgery No 3 of City Clinical Hospital No 7, Russia, 420000, Kazan, Chuykov str., 54
PETUKHOV DENIS M., surgeon of the Department of surgery No 3 of City Clinical Hospital No 7, Russia, 420000, Kazan, Chuykov str., 54
BUKUSHKINA VICTORIA A., resident of the Department of surgical diseases of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, e-mail: firstname.lastname@example.org
Abstract. Aim. The aim of the study was to analyze treatment features in patients with stenosis of hepaticojejunoanas tomosis on the example of a clinical case. Material and methods. For the last 5 years 4 patients have been treated in the surgical department No 3 of City Clinical Hospital No 7 after a con ict with common bile duct in laparoscopic chole cystectomy. In all cases, common bile duct damage was detected immediately during the surgery. Common bile duct damage was identi ed as type D by J. Bergman, type I by Bismuth – more than 2 cm of the total hepatic duct were saved. In two cases hepaticojejunoanastomosis according to E.I. Galperin was performed at once. In the third case, when the drainage tube was removed through the suspended small intestine through the anastomosis, a mono lament line was performed through the liver by removal of both ends in the subcutaneous tissue and their preservation according to the type of lost drainage. In the fourth case, the patient came from another clinic after hepaticojejunoanastomosis on the disconnected loop according to Roux presenting the symptoms of obstructive jaundice with the total bilirubin values of 278 μmol/l, and direct bilirubin of – 190 μmol/l. Results and discussion. In two cases, in the postsurgery period, there were symptoms of choledochojejunoanastomosis stenosis with obstructive jaundice, cholangitis and cholangiogenic abscesses development. In the rst case, an antegrade percutaneous transhepatic access to the hepatic ducts was performed. Axiom Artis Zee Floor angiograph was applied for drainage using Fielder intervention conductor and Emerald 150 cm diagnostic conductor with J(3 mm) tip. Contrast examination and subsequent antegrade drainage of hepatic ducts with installation of drainage along the conductor was performed under Xray control. In a long time (1,5 years) the resolution of stenosis of hepaticojejunoanastomosis was achieved by an antegrade installation of biliary nitinol stent SXELLA under Xray control. In the second case, stenosis of anastomosis was dilated with a Sapphire 1,0×20 mm cylinder catheter on a coronary conductor Fielder. The permeability was restored. The external lobe lumbar drainage was installed. Within a week serum bilirubin biochemical parameters were reduced to 40 μmol/l, and the temperature was normalized. Conclusion. Our observations indicate that Axiom Artis Zee Floor angiograph can be applied to detect the nature of hepaticojejunoanastomosis stenosis. With the use of interventional coronary techniques in hepaticojeju noanastomosis stenosis, depending on its type, cylinder dilatation or stenting can be performed.
Key words: stenosis, hepaticojejunoanastomosis, obstructive jaundice.
For reference: Chikaev VF, Mingazetdinov MA, Shara slamov IF, Bondarev YV, Petukhov DM, Bukushkina VA. The features of hepaticojejunoanastomosis stenosis treatment. The Bulletin of Contemporary Clinical Medicine. 2020; 13 (5): 8589. DOI: 10.20969/VSKM.2020.13(5).8589.
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ACUTE CEREBRAL INSUFFICIENCY DURING PERCUTANEOUS CORONARY SURGERY IN A PATIENT WITH ACUTE CORONARY SYNDROME (clinical case)
SHARAFUTDINOV BULAT M., ORCID ID: 0000-0002-4149-118; C. Med. Sci., the Head of the Department of X-ray surgical methods of diagnostics and treatment of Medical Unit of Kazan Federal University, Russia, 420012, Kazan, Chekhov str., 1, e-mail: email@example.com
ABDRAKHMANOVA ALSU I., ORCID ID: 0000-0003-0769-3682; SCOPUS Author ID: 57192296744; C. Med. Sci., associate professor of the Department of clinical medicine fundamental basis of the Institute of biology and fundamental medicine of Kazan Federal University, Russia, 420012, Kazan, Karl Marx str., 74, e-mail: firstname.lastname@example.org
GAYFULLINA RUSHANIA F., ORCID ID: 0000-0002-0922-5850; C. Med. Sci., associate professor of the Department of clinical medicine fundamental basis of the Institute of biology and fundamental medicine of Kazan Federal University, Russia, 420012, Kazan, Karl Marx str., 74; first deputy chief physician for clinical affairs of Medical Unit of Kazan Federal University, Russia, 420012, Kazan, Chekhov str., 1, e-mail: email@example.com
MUKHAMETSHINA EMMA I., ORCID ID: 0000-0002-9778-8302; deputy chief physician for therapeutic affairs of Medical Unit of Kazan Federal University, Russia, 420012, Kazan, Chekhov str., 1, e-mail: firstname.lastname@example.org
AKHMEDOVA GUZEL M., ORCID ID: 0000-0003-0857-8934; SCOPUS Author ID: 55674079300; C. Med. Sci., associate professor of the Department of neurology of Kazan State Medical Academy – the branch of Russian Medical Academy of Postgraduate Education, Russia, 420012, Kazan, Butlerov str., 36, e-mail: email@example.com
VALEEV MARAT K., ORCID ID: 0000-0002-0570-0220; cardiologist of Medical Unit of Kazan Federal University, Russia, 420012, Kazan, Chekhov str., 1, e-mail: firstname.lastname@example.org
AMIROV NAIL B., ORCID ID: 0000-0003-0009-9103; SCOPUS Author ID: 7005357664; D. Med. Sci., professor
of the Department of general medical practice of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, e-mail: email@example.com
Abstract. Aim. The aim of the study was to describe a clinical case of acute circulatory failure in a patient with acute coronary syndrome during percutaneous coronary intervention. Material and methods. Patient B. was admitted to the hospital with the acute coronary syndrome manifestations. Laboratory tests and a standard electrocardiography were conducted. The patient was urgently sent to the Xray operating room for coronary angiography with the possibility of percutaneous coronary intervention. The study was performed according to the standard technique using the Siemens Artis Q Floor angiographic complex (Germany). Results and discussion. Coronary angiography data revealed an occlusion from the proximal segment of the right coronary artery, with signs of a massive blood clot in the proximal segment, so it was decided to perform a percutaneous coronary intervention. At the stage of recanalization, the patient showed signs of severe neurological de cit. Taking into account the acute neurological de cit, the patient underwent a cerebral angiography to determine further treatment tactics, according to which occlusal thrombosis of the main artery was revealed. The rst stage was thrombaspiration of the main artery; the second stage was a cylinder angioplasty of the right coronary artery. In the postsurgical period, the patient showed positive dynamics such as regression of neurological de cit, and hemodynamics stabilization. Conclusion. If an acute neurological clinic is detected during PCS, rst of all, it is necessary to expand diagnostic measures to identify the cause of this condition as an emergency. The use of mechanical thromboaspiration of the cerebral arteries against the background of myocardial infarction, characterized by high rates of recovery of cerebral blood ow in the course of treatment of acute ischemic stroke.
Key words: percutaneous coronary intervention, complication, clinical case.
For reference: Sharafutdinov BM, Abdrakhmanova AI, Gayfullina RF, Mukhametshina EI, Akhmedova GM, Valeev MK, Amirov NB. Acute cerebral insuf ciency during percutaneous coronary surgery in a patient with acute coronary syndrome: clinical case. The Bulletin of Contemporary Clinical Medicine. 2020; 13 (5): 9094. DOI: 10.20969/VSKM.2020.13(5).90 94.
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