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ORIGINAL RESEARCH

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

Lipoprotein (а) in patients with acute myocardial infarction Gimadeeva A.D. (Russia, Kazan), Baleeva L.V. (Russia, Kazan), Galeeva Z.M. (Russia, Kazan), Galyvich A.S. (Russia, Kazan) P.15

Injuries in drivers caused by an in-vehicle car trauma Indiaminov S.I. (Uzbekistan, Samarkand), Ismailov R.A. (Uzbekistan, Samarkand), Bakhtiyorov B.B. (Uzbekistan, Tashkent) P.20

Incisional ventral hernia: incidence, causes, surgical care Klyushkin I.V. (Russia, Kazan), Fatykhov R.I. (Russia, Kazan), Shavaleev R.R. (Russia, Kazan) P.26

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

The features of the functional state of muscle fibers in patients with multiple sclerosis with spasticity according to the results of electroneuromyography Domres N.V. (Ukraine, Kiev) P.46

REVIEWS

Mutations in genes as carcinogenesis trigger mechanism Gimaeva R.R. (Russia, Kazan), Ismagilova R.K. (Russia, Kazan), Gabelko D.I. (Russia, Kazan) P.57

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

CLINICAL CASE

Clinical case of submucosal esophageal rupture in therapeutic practice Ishmurzin G.P. (Russia, Kazan), Okurlu A.F. (Russia, Kazan) P.76

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

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ORIGINAL RESEARCH

УДК 616.728.3-07:616-056.257:616.72-002-085

DOI: 10.20969/VSKM.2020.13(5).7-14

PDF download 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: 1ewa1@mail.ru

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: radoshchekin87@mail.ru

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: danilgorshcov@yandex.ru

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: olgakhlynova@mail.ru

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: 1ewa1@mail.ru

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: rector@psma.ru

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.

References

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.

2. Vos Т, Allen С, Arora М, et al. Global’naya, regional’naya i natsional’naya zabolevayemost’, rasprostranennost’ i gody zhizni s invalidnost’yu dlya 310 zabolevaniy i travm, 1990­2015 godah: sistematicheskiy analiz dlya izucheniya global’nogo bremeni bolezney, 2015 god [Global, regional and national morbidity, prevalence and years of life with disability for 310 diseases and injuries, 1990­2015: asystematic analysis for the study of the global burdenof diseases 2015]. Lantset [Lancet]. 2016; 388 (10053): 1545­1602.

3. Wolf А, P eger В. Bremya osnovnykh zabolevaniy kostno­ myshechnoy sistemy [The burden of major diseases of the musculoskeletal system]. Organ zdorov’ya Bull World [Bull World Health Organ]. 2003; 81: 646­656.

4. Benevolenskaya LI, Brzezovsky ММ. Epidemiologiya revmaticheskih boleznej [Epidemiology of rheumatic diseases]. Moskva: Meditsina [Moscow: Medicine]. 1988; 237­240.

5. Golovach IYu. Metabolicheskiy fenotip osteoartroza: dvoynaya rol’ ozhireniya [Metabolic phenotype of osteoarthritis: the double role of obesity]. Travma; povrezhdeniye [Trauma; Injury]. 2017; 5: 87­93.

6. Azamar­Lama D, Hernandez­Molina G, Ramos­Avalos B, et al. Vklad adipokinov v patogenez osteoartroza [Сontribution of Adipokines to the pathogenesis of osteoarthritis]. Vospalitel’nyye mediatory [In ammatory Mediators]. 2017; 5: 1­26.

7. Denisov LN, Nasonova VA. Ozhireniye i osteoartroz. Nauchno­prakticheskaya revmatologiya. [Obesity and osteoarthritis. Scientific and practical rheumatology]. 2010; 3: 48­51.

8. Felson DT, Lawrence RC, Dieppe PA, et al. Osteoartroz: novyye otkrytiya; Chast’ 1: bolezn’ i faktory riska [Оsteoarthritis: new ndings; Part 1: the disease and its risk factors]. Annaly vnutrenney meditsiny [The annals of internal medicine]. 2000; 133: 635­646.

9. Luyten FP, Burma­Zeinstra S, Dell’accio F, et al. K kriteriyam klassi katsii rannego osteoartroza kolennogo sustava [To classi cation criteria of early osteoarthritis of the knee joint]. Seminary po revmatizmu artrita [Seminars on Arthritis rheumatism]. 2017; 47 (4): 457­463.

 

УДК 616.127-005.8-07

DOI: 10.20969/VSKM.2020.13(5).15-19

PDF download LIPOPROTEIN (а) IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION

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: alsena@bk.ru

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: larisabaleeva151@gmail.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: maktub29@mail.ru

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: agalyavich@mail.ru

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.

References

  1. 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.

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  4. 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.

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  9. van der Valk F, Bekkering S, Kroon J et al. Oxidized phospholipids on lipoprotein(a) elicit arterial wall in ammation and an in ammatory monocyte response in humans. Circulation. 2016; 134: 611–624.

  10. Catapano A, Graham I, De Backer G, et al. 2016 ESC/ EAS guidelines for the management of dyslipidaemias. Eur Heart J. 2016; 37: 2999–3058.

  11. Lim T­S, Yun J­S, Cha S­A. et al. Elevated lipoprotein(a) levels predict cardiovascular disease in type 2 diabetes mellitus: a 10­year prospective cohort study. Korean J Intern Med. 2016; 31 (6): 1110–1119.

  12. Ridker P, Rifai N, Bradwin G, Rose L. Plasma proprotein convertase subtilisin/kexin type 9 levels and the risk of rst cardiovascular events. Eur Heart J. 2016; 37: 554–560.

  13. Tavori H, Christian D, Minnier J, et al. PCSK9 Association With Lipoprotein(a). Circ Res. 2016; 119: 29­35.

  14. 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.

 

УДК 614.86:340.624.3

DOI: 10.20969/VSKM.2020.13(5).20-25

PDF download INJURIES IN DRIVERS CAUSED BY AN IN-VEHICLE CAR TRAUMA

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: antonina_amurovna@mail.ru

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.

References

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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.

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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.

8. Pan’kov IV, Sarkisyan BA, Votincev AA. Povrezhdeniya voditelya i passazhira perednego sideniya pri nesmertel’noj vnutrisalonnoj travme v legkovyh avtomobilyah ino­ strannogo proizvodstva [Damage to the driver and front seat passenger due to non­fatal intra­passenger injury in foreign­made passenger cars]. Mezhdunarodnyj zhurnal prikladnyh i fundamental’nyh issledovanij [International Journal of Applied and Basic Research]. 2014; 1: 174­177.

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11. Fokina EA. Ustanovlenie raspolozheniya voditelya i passazhira perednego siden’ya v salone legkovyh avtomobilej, oborudovannyh sovremennymi sredstvami bezopasnosti, pri dorozhno­transportnyh proisshestviyah [Establishing the location of the driver and front seat passenger in the passenger compartment of cars equipped with modern safety equipment in case of road accidents]. Moskva [Moscow]. 2009; 124 p.

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13. Hedi Hamdane, Thierry Serre, Robert Anderson, Joël Yerpez. Accident simulation and reconstruction for enhancing pedestrian safety: issues and chal­ lenges. Hannovre, Germany : ESAR 2014 – 6th Inter­ national Conference: Expert Symposium on Accident Research. 2014; 11P.

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УДК 617.55-007.43-089.844

DOI: 10.20969/VSKM.2020.13(5).26-30

PDF download INCISIONAL VENTRAL HERNIA: INCIDENCE, CAUSES, SURGICAL CARE

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

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: 74ruslan@rambler.ru

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.

References

  1. Shaymardanov RSh, et al. Algoritm ul’trazvukovogo skanirovaniya posleoperatsionnoy rany i profilaktika ranevykh oslozhneniy posle implantatsionnoy gernio­ plastiki ventral’nykh gryzh [Algorithm of ultrasound scanning of a postoperative wound and prevention of wound complications after implantation hernioplasty of ventral hernias]. Kazanskiy meditsinskiy zhurnal [Kazan medical journal]. 2004; 85 (3): 187­191.

  2. 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.

  3. Deryugina MS. Otdalennyye rezul’taty lecheniya gigant­ skikh gryzh posle akushersko­ginekologicheskikh operatsiy [Long­term results of treatment of giant hernias after obstetric and gynecological operations]. Khirurgiya [Surgery]. 1997; 6: 62­63.

  4. Veretennik GI, Alekseyev GI. Khirurgicheskoye lecheniye posleoperatsionnykh gryzh bryushnoy stenki [Surgical treatment of incisional hernias of the abdominal wall]. Vestnik Rossiiskogo universiteta druzhby narodov [Bulletin of the Russian University of Friendship of Peoples]. 1999; 1: 131­133.

  5. Natsional’nyye klinicheskiye rekomendatsii po gerniologii; Razdel posleoperatsionnyye ventral’nyye gryzhi [Na­ tional clinical guidelines for herniology; Section of postoperative ventral hernia]. http://herniaweb.ru/ assets/%D0%BD%D0%BA%D1%80­%D0%BF%D0%BE­ %D0%B3%D0%B5%D1%80%D0%BD%D0%B8%D0 %BE%D0%BB%D0%BE%D0%B3%D0%B8%D0%B8­ (%D0%BF%D0%BE%D1%81%D0%BB%D0%B5%D0 %BE%D0%BF%D0%B5%D1%80%D0%B0%D1%86% D0%B8%D0%BE%D0%BD%D0%BD%D0%B0%D1% 8F­%D0%B3%D1%80%D1%8B%D0%B6%D0%B0).pdf

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  9. Izmaylov SG. Lecheniye posleoperatsionnykh vent­ ral’nykh gryzh apparatnym sposobom pod kontrolem vnutribryushnogo davleniya [Treatment of postoperative ventral hernias by hardware method under the control of intra­abdominal pressure]. Vestnik gerniologii [Bulletin of herniology]. 2004; 4: 36­40.

10. Korenkov M, Sauerland S, Paul A, Neugebauer EA. Incisional hernia repair in Germany at the crossroads: a comparison of two hospital surveys in 1905 and 2001. Zenralbl Chir. 2002; 8 (127): 700­705.

11. Daurova TT. Osobennosti lecheniya gryzh peredney bryushnoy stenki u bol’nykh pozhilogo i starcheskogo vozrasta [Features of treatment of hernias of the anterior abdominal wall in elderly and senile patients]. Sovetskaya meditsina [Soviet Medicine]. 1985; 2: 71­73.

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13. Kuchkin YuV, Kutukov VYe, Pecherov AA, Shpekht DYu. Sposoby alloplastiki bol’shikh i gigantskikh posleopera­ tsionnykh gryzh [Methods for alloplasty of large and giant incisional hernias]. Gerniologiya [Herniology]. 2005; 1: 30­32.

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УДК 616.131-005.755-085.273

DOI: 10.20969/VSKM.2020.13(5).31-34

PDF download POSTOPERATIVE PULMONARY EMBOLISM: OPPORTUNITIES FOR ANTICOAGULANT THERAPY

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: sergfedorov1991@yandex.ru

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: medvedev.map@yandex.ru

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: ildaruna@mail.ru

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: jaguar12.01@bk.ru

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: ladamc@rambler.ru

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: namirov@mail.ru

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.

References

  1. 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.

  2. 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.

  3. 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.

  4. 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.

  5. 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.

  6. 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.

  7. 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.

 

УДК 618.19-006.6

DOI: 10.20969/VSKM.2020.13(5).35-39

PDF download THE VALUE OF ANDROGEN RECEPTOR EXPRESSION IN TRIPLE NEGATIVE BREAST CANCER PATIENTS

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: Gonch-ponch@mail.ru

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: svetaonc@mail.ru

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: i.vorotnikov@mail.ru

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: vep321@mail.ru

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.

References

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2. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018; 68 (6): 394–424.

3. Carey L, et al. Triple negаtive breast cancer: disease entity or title of convenience? Nat Rev Clinical Oncol. 2010; 7 (12): 683­692.

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.

 

УДК 616-056.257-053.9

DOI: 10.20969/VSKM.2020.13(5).40-45

PDF download 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: mic_amu@mail.ru

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: mic_amu@mail.ru

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

DOI: 10.20969/VSKM.2020.13(5).46-56

PDF download 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: nata003@ukr.net

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.

References

  1. Zavalishin IA, Barhatova VP, Shitikova IE. Spasticheskiy parez [Spastic Paresis]. V knige «Rasseyannyy skleroz; Izbrannyye voprosy teorii i praktiki»; Moskva: Minzdrav Rossii, NII nevrologii RAMN [In the book «Multiple Sclerosis; Selected questions of theory and practice»; Moscow: Russian Ministry of Health, Research Institute of Neurology, Russian Academy of Medical Sciences]. 2000; 436–455.

  2. Pandyan AD, Gregoric M, Barnes MP, Wood D, Van Wi­ jck F, Burridge J, Hermens H, Johnson GR. Spasticity: clinical perceptions, neurological realities and meaningful measurement. Disabil Rehabil. 2005; 7­21; 27(1­2): 2­6. doi: 10.1080/09638280400014576. PMID: 15799140.

  3. Patejdl R, Zettl UK. Spasticity in multiple sclerosis: Con­ tribution of in ammation, autoimmune mediated neuronal damage and therapeutic interventions. Autoimmun Rev. 2017; 16 (9): 925­936. doi: 10.1016/j.autrev.2017.07.004. Epub 2017 Jul 8. PMID: 28698092.

4. Schapiro RT. Managing symptoms of multiple sclero­ sis. Neurol Clin. 2005; 23 (1): 177­87. doi: 10.1016/j. ncl.2004.09.001. PMID: 15661093.

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6. Barnes MP, Kent RM, Semlyen JK, McMullen KM. Spas­ticity in multiple sclerosis. Neurorehabil Neural Repair. 2003; 17 (1): 66­70. doi: 10.1177/0888439002250449. PMID: 12645447.

7. Hemmett L, Holmes J, Barnes M, Russell N. What drives quality of life in multiple sclerosis? QJM. 2004; 97 (10): 671­676. doi: 10.1093/qjmed/hch105. PMID: 15367738.

8. Hoang PD. Spasticity and Multiple Sclerosis. MS Practice (Australia), June 2009. Retrieved from https://www.msau­ stralia.org.au/ le/278/download?token=cK4rr3lc.

9. Balci BP. Spasticity Measurement. Noro Psikiyatr Ars. 2018; 55 (Suppl 1): S49­S53. doi: 10.29399/npa.23339. PMID: 30692856; PMCID: PMC6278623.

10. Damiano DL, Quinlivan JM, Owen BF, Payne P, Nelson KC, Abel MF. What does the Ashworth scale really measure and are instrumented measures more valid and precise? Dev Med Child Neurol. 2002; 44 (2): 112­118. doi: 10.1017/ s0012162201001761. PMID: 11848107.

11. Hobart JC, Cano SJ, Zajicek JP, Thompson AJ. Ratingscales as outcome measures for clinical trials in neurol­ ogy: problems, solutions, and recommendations. Lancet Neurol. 2007; 6 (12): 1094­1105. doi: 10.1016/S1474­ 4422(07)70290­9.

12. Kohan AH, Abootalebi S, Khoshnevisan A, Rahgozar M. Comparison of modi ed Ashworth scale and Hoffmann re ex in study of spasticity. Acta Med Iran. 2010; 48 (3): 154­157. PMID: 21137650.

13. Pandyan AD, Price CI, Barnes MP, Johnson GR. A biome­ chanical investigation into the validity of the modi ed Ash­ worth Scale as a measure of elbow spasticity. Clin Rehabil. 2003; 17 (3): 290­293. doi: 10.1191/0269215503cr610oa. PMID: 12735536.

14. Beer S. Management of Spasticity in Multiple Sclero­ sis (MS). 2014; https://www.excemed.org/ms­alumni/ resources/management­spasticity­multiple­sclerosis­ms

15. Drory VE, Neufeld MY, Korczyn AD. F­wave characteristics following acute and chronic upper motor neuron lesions. Electromyogr Clin Neurophysiol. 1993; 33 (7): 441­446. PMID: 8261985.

16. Voerman GE, Gregoric M, Hermens HJ. Neurophysi­ ological methods for the assessment of spasticity: the Hoffmann re ex, the tendon re ex, and the stretch re­ ex. Disabil Rehabil. 2005; 7­21; 27 (1­2): 33­68. doi: 10.1080/09638280400014600. PMID: 15799143.

 

REVIEWS

УДК 616-006.04:575.224.2 (048.8)

DOI: 10.20969/VSKM.2020.13(5).57-61

PDF download MUTATIONS IN GENES AS CARCINOGENESIS TRIGGER MECHANISM

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: gimaeva.regina2013@yandex.ru

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: ruz-ismagilova@yandex.ru

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: freeden777@mail.ru

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.

References

1. Imyanitov EN, .Hanson KP. Molekulyarnaya onkologiya: Klinicheskie aspekty [Molecular Oncology: Clinical Aspects]. SPb: Izdatel’stvo SPbGPMA [SPb: Publishing house of SPbGPMA]. 2007; 211 p.

2. Gorbunova VN, Imyanitov EN. Genetika i kancerogenez [Genetics and carcinogenesis]. SPb: Izdatel’stvo SPbGPMA [SPb: Publishing house of SPbGPMA]. 2007; 24 p.

3. Moiseenko VM. Spravochnik po onkologii [Oncology Handbook]. SPb: Izdatel’stvo «Tsentr Tomm» [Publishing house “Center Tomm”]. 2008; 258 p.

4. Lyzhko NA. Molekulyarno­geneticheskie mekhanizmy iniciacii, promocii i progressii opuholej [Molecular genetic mechanisms of initiation, promotion and progression of tumors]. Rossijskij bioterapevticheskij zhurnal [Russian biotherapeutic magazine]. 2017; 16 (4): 7­17.

5. Pal’ceva MA, Zaletaeva DV. Sistemy geneticheskih i epigeneticheskih markerov v diagnostike onkologicheskih zabolevanij [Systems of genetic and epigenetic markers in the diagnosis of cancer]. Moskva: Izdatel’stvo Medicina [Moscow: Publishing House Medicine]. 2009; 384 p.

6. Nurgalieva AH, Mustafin RN, Gilyazova IR, et.al. Onkogenetika i epigenetika [Oncogenetics and Epi­ genetics]. Ufa: RITS BashGU [Ufa: RITs BashSU]. 2018; 102 p.

7. Komleva EO. Molekulyarnye i geneticheskie markery opuholevogo rosta [Molecular and genetic markers of tumor’s growth]. SPb: Gorodskoj klinicheskij onko­ logicheskij dispenser [SPb: City Clinical Oncology Dispenser]. 2010; 148 p.

8. Hanson KP, Imyanitov EN. Funkcional’naya onko­ genomika – novoe napravlenie v molekulyarnoj onkologii [Functional oncogenomics – a new direction in molecular oncology]. Molekulyarnaya medicina [Molecular medicine]. 2004; 1: 3–9.

9. Poddubnaya IV. Mestnorasprostranennyj i metastaticheskij rak molochnoj zhelezy: problemy terapii i perspektivy primeneniya lapatinoba v kombinacii s ingibitorami aromatazy v kachestve terapii pervoj linii [Locally advanced and metastatic breast cancer: problems of therapy and prospects for the use of lapatinoba in combination with aromatase inhibitors as rst­line therapy]. Sovremennaya onkologiya [Modern oncology]. 2010; 1: 15–18.

10. Zaridze DG, Nemcova MV, Delektorskaya VV, et. al. Molekulyarnye markery v onkologii [Molecular Markers in Oncology]. Klinicheskaya laboratornaya diagnostika [Clinical Laboratory Diagnostics]. 2013; 9: 26­32.

 

УДК 616.98:578.834.1

DOI: 10.20969/VSKM.2020.13(5).62-75

PDF download 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: verarus@foxmail.com

CHAOZHAO LIANG, the First Affiliated Hospital of Anhui Medical University, Shushan Qu, Hefei Shi, Anhui Sheng, China, e-mail: verarus@foxmail.com

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.

References

  1. Cardiac Implications of Novel Wuhan Coronavirus (COVID­19 ). ACC Clinical Bulletin (2020). https://www. dicardiology.com/article/cardiac­implications­novel­ coronavirus

  2. Li B, et al. Prevalence and impact of cardiovascular metabolic diseases on COVID­19 in China. Clin Res Cardiol. 2020; 109: 531­538. doi:10.1007/s00392­020­ 01626­9 (2020)

  3. Huang C, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020; 395: 497­506. doi:10.1016/S0140­6736(20)30183­5 (2020)

  4. Guo T, et al. Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID­19). JAMA Cardiol. 2020. doi:10.1001/jamacardio.2020.1017 (2020).

  5. Wang D, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus­Infected Pneu­ monia in Wuhan, China. JAMA. 2020. doi:10.1001/ jama.2020.1585 (2020).

  6. Deng Q, et al. Suspected myocardial injury in patients with COVID­19: Evidence from front­line clinical observation in Wuhan, China. Int J Cardiol. 2020; 311: 116­121. doi:10.1016/j.ijcard.2020.03.087

  7. Zhao X, Liu B, Yu Y, et al. The characteristics and clinical value of chest CT images of novel coronavirus pneumonia. J Clin Radiol. 2020; 75: 335­340.

  8. Zhang L, et al. Deep Vein Thrombosis in Hospitalized Patients with Coronavirus Disease 2019 (COVID­19) in Wuhan, China: Prevalence, Risk Factors, and Outcome. Circulation. doi:10.1161/CIRCULATIONAHA.120.046702

  9. Edler C, et al. Dying with SARS­CoV­2 infection­an autopsy study of the first consecutive 80 cases in Hamburg, Germany. Int J Legal Med. 2020; 134: 1275­1284. doi:10.1007/s00414­020­02317­w

  10. Boccia M, et al. COVID­19 and coagulative axis: review of emerging aspects in a novel disease. Monaldi Arch Chest Dis. 2020; 90: doi:10.4081/monaldi.2020.1300

11. Li Yanan, Li Man, Wang Mengdie, et al. Acute cere­ brovascular disease following COVID­19: a single center, retrospective, observational study. J Stroke Vasc Neurol. 2020. https://www.researchgate.net/ publication/340154622_Acute_Cerebrovascular_ Disease_Following_COVID­19_A_Single_Center_ Retrospective_Observational_Study

12. Tang N, et al. Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. J Thromb Haemost. 2020; 18: 1094­1099. doi:10.1111/jth.14817

13. Chen L, Li Q, Zheng D, et al. Clinical Characteristics of Pregnant Women with Covid­19 in Wuhan, China. J N Engl J Med. 2020; 382 (25): e100.

14. Dashraath P, Wong JLJ, Lim MXK, et al. Coronavirus disease 2019 (COVID­19) pandemic and pregnancy. J Am J Obstet Gynecol. 2020; 222 (6): 521­531.

15. Mégarbane Bruno. Chloroquine and hydroxychloroquine to treat COVID­19: between hope and caution.J Clin Toxicol (Phila). 2020; unde ned: 1­2.

16. Chen J. A pilot study of hydroxychloroquine in treatment of patients with common coronavirus disease­19 (COVID­19). Journal of Zhejiang University. 2020; 10089292. doi: 10.3785/j.issn.10089292.2020.03.03

17. Geleris Joshua, Sun Yifei, Platt Jonathan, et al. Observational Study of Hydroxychloroquine in Hospitalized Patients with Covid­19. J N Engl J Med. 2020; 382: 2411­ 2418.

18. RECOVERY Collaborative Group, Horby Peter, Lim Wei Shen, et al. Dexamethasone in Hospitalized Patients with Covid­19 – Preliminary Report. J N Engl J Med. 2020; NEJMoa2021436. doi: 10.1056/NEJMoa2021436.

19. Chen Wenyu, Yao Ming, Fang Zhixian, et al. A study on clinical effect of Arbidol combined with adjuvant therapy on COVID­19. J Med Virol. 2020; doi:10.1002/jmv.26142.

 

CLINICAL CASE

УДК 616.329-072.1-089

DOI: 10.20969/VSKM.2020.13(5).76-79

PDF download CLINICAL CASE OF SUBMUCOSAL ESOPHAGEAL RUPTURE IN THERAPEUTIC PRACTICE

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: ishm08@mail.ru

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: alfiaf@yandex.ru

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.

References

1. Korymasov EA, Benyan AS. Spontanniy rasryv pische­ voda, oslozhnenniy gnoynym mediastenitom i sepsisom [Spontaneous rupture of the esophagus, complicated by purulent mediastinitis and sepsis]. Hirurgiya; Zhurnal imeni NI Pirogova [Surgery; Journal them NI Pirogov]. 2011; 1: 70­71.

2. 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: 467­473.

3. Kochukov VP. Spontanniy rasryv pischevoda (Sindrom Burkhave) [Spontaneous rupture of the esophagus (Burhave Syndrome)]. Hirurgiya; Zhurnal imeni NI Pirogova [Surgery; Journal them NI Pirogov]. 2012; 7: 83­84.

4. Rajhan Md Al’, Bulynin VV, Zhdanov AI. Sravnitel’nye rezul’taty lecheniya spontannogo razryva pishchevoda [Comparative results of treatment of spontaneous esophageal rupture]. Sankt­Peterburg: VII mezhdunarod­ nyy kongress «Aktual’nyye napravleniya sovremennoy kardio­torakal’noy khirurgii [St. Petersburg: VII international congress «Actual directions of modern cardio thoracic surgery»]. 2017; 140­141.

 

УДК 616.24:616.126.422-07

DOI: 10.20969/VSKM.2020.13(5).80-84

PDF download 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: palmova@bk.ru

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.

References

1. Oganov R.G., Simanenkov V.I., Bakulin I.G, et al. Komorbidnaya patologiya v klinicheskoy praktike. Algo­ ritmy diagnostiki i lecheniya: natsional’nyye klinicheskiye rekomendatsii [Comorbid pathology in clinical practice. Diagnostic and treatment algorithms: national clinical guidelines]. Kardiovaskulyarnaya terapiya i pro laktika [Cardiovascular therapy and prevention]. 2019; 18 (1): 5­66.

2. Diagnostika i lechenie pacientov s hronicheskoj obs­ truktivnoj bolezn’yu legkih i hronicheskoj serdechnoj nedostatochnost’yu: Nacional’nye klinicheskie reko­ mendacii RNMOT [Diagnosis and treatment of patients with chronic obstructive pulmonary disease and chronic heart failure: National clinical recommendations of the RSMST]. M. 2018; 61 p. https://www.rnmot.ru/ public/uploads/RNMOT/clinical/2018/%D0%A5% D0%9E%D0%91%D0%9B%20%D0%B8%20%20 %D0%A5%D0%A1%D0%9D%20%D1%80%D0%B5%D0%BA%D0%BE%D0%BC%D0%B5%D0%BD%D0%B4 %D0%B0%D1%86%D0%B8%D0%B8%20%D0%BF%D 1%80%D0%BE%D0%B5%D0%BA%D1%82.pdf

3. Seguela P­E, Houyel L, Acar P. Congenital malformations of the mitral valve. Arch. Cardiovasc. Dis. 2011; 104 (8­9): 465­479.

4. Shlyahto YV. Kardiologiya; Nacional’noe rukovodstvo [Cardiology; National guideline]. Moskva: GEOTAR­Media [Moscow: GEOTAR­Media]. 2019; 800 p.

5. Iung B, Baron G, Butchart EG, et al. A prospective survey of patients with valvular heart disease in Europe: the Euro Heart Survey on Valvular Heart Disease. European Heart Journal. 2003; 24 (13): 1231–1243.

6. Iung B, Delgado V, Lazure P, Murray S, et al. Educational needs and application of guidelines in the management of patients with mitral regurgitation. A European mixed­ methods study. European Heart Journal. 2018; 39 (15): 1295–1303. 7. Dziadzko V, Clavel MA, Dziadzko M, et al. Outcome and undertreatment of mitral regurgitation: a community cohort study. Lancet Journal. 2018; 391 (10124): 960­969.

8. Abzaliev KB, Tuleutaev RM, Ongarbayev K, et al. Oslozhneniya blizhajshego perioda rekonstruktivno­

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

 

УДК 616.367-007.271-089

DOI: 10.20969/VSKM.2020.13(5).85-89

PDF download THE FEATURES OF HEPATICIOJUNOANASTOMOSIS STENOSIS TREATMENT

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: bukushonok@yandex.ru

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.

References

1. Prudkov MI. Osnovy minimal’no invazivnoj hirurgii [Basics of minimally invasive surgery]. 2007; 64 p.

2. Ivanov SV, Golikov AV, Tarabrin DV, Klimkin AS. Taktika lecheniya yatrogennyh povrezhdenij i striktur vnepech­ enochnyh zhelchnyh putej [Tactics for the treatment of iatrogenic injuries and strictures of the extrahepatic bili­ary tract]. Rossiyskiy meditsinskiy zhurnal «Medicinskoe obozrenie» [Russian medical journal: Medical Review]. 2018; 12: 16­18.

3. Dacenko BM, Borisenko VB. Modi kacii are yuksnogo holedohoeyunoanastomoza s vosstanovleniem passazha zhelchi v dvenadcatiperstnuyu kishku [Modi cations of are ux choledochojejunanastomosis with restoration of passage of bile into the duodenum]. Mezhdunarodnyj medicinskij zhurnal [International Medical Journal]. 2008; 1: 102­110.

4. Horon’ko YuV, Ermolaev AN, Dmitriev AV, Horon’ko EYu. Vybor biliodigestivnoj rekonstrukcii pri posledstviyah yatrogennyh povrezhdenij vnepechenochnyh zhelchnyh protokov [The choice of biliodigestive reconstruction in the aftermath of iatrogenic damage to the extrahepatic bile ducts]. Fundamental’nye issledovaniya [Basic research]. 2014; 10 (3): 571­574.

5. Shojhet YaN, Ustinov GG. Rekonstruktivnye i vos­ stanovitel’nye operacii pri intraoperacionnom povrezhdenii zhelchnyh protokov [Reconstructive and reconstructive surgery for intraoperative damage to the bile ducts]. Byulleten’ VSNC SO RAMN [VSNC SB RAMS]. 2011; 4 (80): 120.

6. Bonnel DH, Fingarhut AL. Percutaneous transhepatic bal­ loon dilatation of benign bilioenteric strictures: long­term results in 110 patients. Am J Surg. 2012; 203 (6): 675–683.

7. Gastaca M. Biliary complications after orthotopic liver transplantation:a review of incidence and risk factors. Transplant Proc. 2012; 44 (6): 1545–1549.

8. Gal’perin EI, Vetshev PS. Rukovodstvo po hirurgii zhelch­ nyh putej [Biliary Surgery Guide]. 2009; 560 p.

9. Gal’perin EI, Chevokin AYu. Faktory, opredelyayushchie vybor operacii pri «svezhih» povrezhdeniyah magistral’nyh zhelchnyh protokov [Factors determining the choice of surgery for «fresh» damage to the main bile ducts]. Annaly hirurgicheskoj gepatologii [Annals of Surgical Hepatology]. 2009; 14 (1): 49­56.

10. Vorobej AV, Orlovskij YuN, Lagodich NA, Orekhov VF. Striktura gepatikoeyunoanastomoza, oslozhnennogo vnutripechenochnym holangiolitiazom [Hepaticojejuno­anastomosis stricture complicated by intrahepatic chol­ angiolithiasis]. Vestnik hirurgii [Bulletin of surgery]. 2018; 177 (1): 90­93.

11. Gubachev KG, Fokin AM. Yatrogennye povrezhdeniya vnepechenochnyh zhelchnyh protokov pri laparoskopi­ cheskoj holecistektomii [Iatrogenic damage to extrahepatic bile ducts with laparoscopic cholecystectomy]. Vestnik Ivanovskoj medicinskoj akademii [Bulletin of the Ivanovo Medical Academy]. 2017; 22 (3): 24­27.

12. Rybachkov VV, Razdrogin VA, Gerasimovskij NV, Kiri­ lyuk AA, Sajgushev AV, Filatov MS, Sokolov VI. Sposob endoskopicheskoj korrekcii pri strikture gepatikoeyuno­ anastomoza cherez «slepoj konec» po metodu Ru petli tonkoj kishki [The method of endoscopic correction forstricture of hepaticoyunoanastomosis through the «blindend» according to the method of Ru loop of the small in­ testine]. Vestnik RUDN, seriya Medicina [RUDN University Bulletin, series Medicine]. 2013; 1: 70­76.

 

УДК 616.831-005:616.132.2-089

DOI: 10.20969/VSKM.2020.13(5).90-94

PDF download 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: bulaty555@mail.ru

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: alsuchaa@mail.ru

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: rushana78@mail.ru

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: emmaim@mail.ru

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: guzel29@mail.ru

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: valeev_med@mail.ru

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: namirov@mail.ru

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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