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LEADING ARTICLE

Year of work on emergency action in medical institution: analysis, tasks, perspectives of their implementation. M.N. Sadikov, I.V. Klyushkin P.13

ORIGINAL ARTICLES

New approaches in prevention of postoperative complications at replacing hernioplasty of postoperative ventral megahernias. O.T. Alishev P.15

Diagnosis and prevention of thrombosis splenic vein in patients infected pancreatic necrosis. A.I. Andreev, A.Yu. Anisimov P.22

Current methods of visualization and diagnostic of avascular necrosis of hip. I.F. Akhtiamov, R.Kh. Zakirov, V.V. Lobashov P.29

Different methods of non-operative treatment of hip avascular necrosis in childhood. I.F. Akhtiamov, V.V. Lobashov P.40

Acute hypocalcemia in patients on program hemodialysis after parathyroidectomy. R.Sh. Vakhitova, V.A. Damotsev, A.R. Belyaev, R.M. Minabutdinov, M.I. Khasanova P.48

Sparing treatment of cervical pregnancy in emergency gynecology (clinical observation). R.I. Gabidullina, M.A. Mingazetdinov, L.I. Syrmatova, I.M. Shestakova P.51

Plasmolifting methodin laparoscopic access in experiment. R.I. Gabidullina, E.R. Gaynutdinova, A.A. Galeev, S.V. Fedotov, I.R. Galimova P.56

Outcomes of surgical treatment of the acute pulmonary embolism with cardiopulmonary bypass. R.K. Dzhordzhikiya, I.I. Vagizov, M.N. Mukharyamov P.59

Relaparotomy at the treatment of acute mesenteric circulatory disorder. S.V. Dobrokvashin, D.E. Volkov, A.G. Izmailov P.63

Surgical treatment of patients with acute mediastinitis. S.V. Dobrokvashin, R.R. Mustafin, A.G. Khakimov, D.V. Bolshakov, R.K. Minnemullin, S.L. Demyanov P.65

Medical and psychological rehabilitation of victims in social cataclysms. K.Sh. Zyyatdinov, V.V. Fattakhov, B.G. Shigapov, Sh.G. Asadullin, N.V. Maksumova P.68

Ambulance emergency care: problems of validity challenges with cardiac pathology. G.P. Ishmurzin, R.R. Gizatullin P.72

Acute aortic dissection in emergency cardiology clinic. Z.F. Kim, N.R. Khasanov, V.V. Scherbak, S.R. Zogot, Z.A. Shaikhutdinovа P.78

Acute disease of the thoracic aorta in the urgent cardiology clinic. Z.F. Kim, N.R. Khasanov P.85

Sonography in the diagnosis of «unrecognized» rib fractures. Ju.A. Klyushkina, I.V. Klyushkin, R.M. Gazizyanova P.93

Hemodynamic changes in vascular reconstruction in patients with diabetic foot syndrome. K.A. Koreyba, I.V. Klyushkin, R.I. Fatykhov P.98

Emergency to the patients with ischemic and neuroischemic forms of diabetic foot syndrome at the example of «Diabetic foot» Center. K.A. Koreyba, I.V. Klyushkin, R.I. Fatykhov, A.R. Minabutdinov P.101

Index CAVI in patients with chronic arterial insufficiency. F.A. Magamedkerimova, M.I. Malkova, I.G. Khalilov, N.R. Khasanov P. 105

β-Bloсkers in cardiac patients at noncardiac surgery. M.I. Malkova, M.N. Sadykov, O.V. Bulashova, E.V. Khazova, Z.M. Mukhtarov P. 111

Predicting the risk of recurrent bleeding from the upper gastrointestinal tract at the present stage. I.S. Malkov, G.R. Zakirova, I.I. Khamzin, K.M. Khalilov P. 117

Acute manifestations of nervous system in the practice a physician. T.V. Matveeva, R.F. Mullaianova P. 121

Benign paroxysmal positional vertigo: difficulties of the diagnosis. R.F. Mullaianova, E.Z. Yakupov P. 124

Surgical treatment of acute aortic dissection experience type A in technical evolution and surgical risk factors modifying context. M.N. Mukharyamov, R.K. Dzhordzhikiya, I.I. Vagizov P. 126

Mechanisms of orthostatic hypotension in patients with autonomic dysfunction due to chronic cerebral ischemia with predominantly vertebrobasilar insufficiency. A.V. Nalbat, E.Z. Yakupov P. 131

Combined treatment of patients with gastrointestinal bleeding. M.N. Nasrullayev P. 134

Study of the structure of calls for psychiatric ambulance team into somatic hospitals of Kazan. G.V. Orlov, I.A. Mitrofanov, Y.V. Troshina P. 138

A fixed combination of perindopril and amlodipine in hypertensive patients with acute coronary syndrome: a clinical experience. A.A. Podolskaya, E.I. Aglullina P. 142

Polymorphism of genes of pro -inflammatory cytokines in association with risk of acute myocardial infarction. A.A. Podolskaya, E.V. Maykova, L.M. Sharafetdinova, O.A. Kravtsova P. 147

Neurologic presentations of gestosis (clinical observation). N.A. Popova, I.F. Khafizova, E.Z. Yakupov P. 151

Anaphylactic shock in a multidisciplinary clinic. N.M. Rakhmatullina, N.A. Sibgatullina, Ja.V. Pastushenko, G.N. Zakirova, D.G. Akhmedzyanova, L.V. Makarova P. 155

Patients with swallowing disfunctions in ICU № 2 of city clinical hospital № 7. Diagnostic aspects. A.K. Sabirova, D.A. Biryukov P. 160

Chronic kidney disease as a risk factor of acute kidney injury during surgical revascularization coronary vessels in patients with ischemic heart disease. O.N. Sigitova, A.R. Bogdanova P. 164

Prognosis in patients with systolic and diastolic heart failure. E.G. Slepukha, O.V. Bulashova, A.A. Nasibullina, V.M. Gazizyanova P. 169

Emergency medical service to patients with the syndrome of diabetic foot. R.I. Fatykhov, I.V. Klyushkin, K.A. Koreyba P. 173

Formation of clinical groups at the syndrome of diabetic foot taking into account the electrothermometry and sonoelastometriya of the shift wave. R.I. Fatykhov, I.V. Klyushkin, K.A. Koreyba P. 176

Contribution of aspirin in improving prognosis in patients with heart failure. E.V. Khazova, O.V. Bulashova, M.I. Malkova, Z.A. Shaikhutdinova P. 179

Guillain—Barre syndrome and pregnancy: diagnostics and management (clinical observation). A.R. Khakimova, N.A. Popova, E.Z. Yakupov P. 183

Severe bronchial asthma: role and place of glucocorticosteroids. R.F. Khamitov, L.Yu. Palmova, Z.N. Yakupova, K.R. Sulbaeva P. 188

A case of acute disseminated encephalomyelitis with late onset (clinical observation). I.F. Khafizova, N.A. Popova, E.Z. Yakupov P. 193

Features of therapy of gastrointestinal bleeding in emergency surgery due to etiological attributes. V.F. Chikaev, R.A. Ibragimov, Y.V. Bondarev, R.R. Shavaleev, D.M. Petukhov P. 198

Diagnosis and treatment features for patients with concomitant trauma, admitted to «level-1» hospital. V.F. Chikaev, R.A. Ibragimov, D.G. Zaidullin, N.T. Khairullin, A.R. Aidarov P. 202

Diagnostics and surgical tactics at wounds of heart. R.Sh. Shaimardanov, R.F. Gubaev, V.N. Korobkov, V.A. Filippov P. 205

Gout in the general medical practice. N.G. Shamsutdinova, S.P. Yakupova P. 208

A rare case of post-traumatic pericardial diaphragmatic hernia complicated by transverse colon strangulation and perforation. M.K. Yagudin, R.F. Gubaev P. 212

«Fewer-port» modifications of the laparoscopic cholecystectomy for the treatment of chronic cholecystitis. M.K. Yagudin, R.F. Gubaev P. 217

«Quickly, but not too quickly»: questions of organization urgent neurology care. E.Z. Yakupov P. 219

The practical significance of the method of heart rate variability’s study in patients with ischemic stroke. E.Z. Yakupov, K.S. Ovsyannikova P. 222

Sleep disorders among patients of therapeutic hospitals. E.Z. Yakupov, Y.V. Troshina, E.A. Aleksandrova, L.Y. Shagiakhmetova, E.V. Shebasheva P. 226

AUTOR INDEX P. 232

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LEADING ARTICLE

Year of work on emergency action in medical institution: analysis, tasks, perspectives of their implementation

M.N. Sadikov, I.V. Klyushkin

 

ORIGINAL ARTICLES

New approaches in prevention of postoperative complications at replacing hernioplasty of postoperative ventral megahernias

OMURBEK T. ALISHEV, graduate student of Department of surgery of SBEI APE «Kazan State Medical Academia» of Ministry of Health of Russia, tel. +7-906-113-25-91, e-mail: alishev-omur@mail.ru

Abstract. The objective of the research is to improve the results of surgical treatment of patients with postoperative large ventral hernias in conjunction with the accompanying morbid obesity and somatic diseases through the development of an algorithm of using early postoperative period. Material and methods. The study included 103 patients with the large and giant postoperative ventral hernias operated during the period from 2010 to 2014. A representative sample is divided into two groups: the frst group (basic) included 45 patients. PVC catheters were set into their periprosthetic tissues for the purpose of long-acting local analgesia and prevention of wound complications. The irrigation of wound with ozonated solution of anesthetic was conducted through the tissues. Also we carried out the preparation and monitoring of intra-abdominal pressure aimed for prevention of abdominal compression syndrome. This prevention method was developed by us. The second group (comparison) included 58 patients. For them the prevention of wound complications was carried out in conventional way. Also they received narcotic analgesics to relieve the pain. To assess the severity of the local infammatory response we used ultrasound study of surgical wounds. In both groups in order to assess pain intensity we used numeric rating scale. Results. In main group on the 5—6 day 9th patients had seromas in the subcutaneous fat. In comparison group wound complications were reported in 16 patients: 11 cases of seromas, 3 pyo-infammatory effects, 1 formed ligature fstula. Observations showed that the average level of pain in patients of the main group was (3,81±0,40) points. The level of pain in the comparison group — (5,3±0,4) points. Conclusion. The periprosthetic irrigation with ozonated solution of ropivacaine provides adequate analgesia, reduces wound complications, and promotes early activation of patients.

Key words: abdominal compartment syndrome, intra-abdominal pressure, endoprosthesis, postoperative pain syndrome, anterior abdominal wall.

 

References

1.   Beloborodov, V.A. Rezul'taty hirurgicheskoi korrekcii posleoperacionnyh ventral'nyh gryzh [The results of surgical correction of postoperative ventral hernias] / V.A. Beloborodov, V.M. Cmailo, S.A. Kolpakov // Sibirskoe medicinskoe obozrenie [Siberian medical review]. — 2012. — № 6. — S.63—66.
2.   Belokonev, V.I. Kompleksnoe lechenie bol'nyh s posle-operacionnoi ventral'noi gryzhei [The complex treatment of patients with postoperative ventral hernia] / V.I. Belokonev, Z.V. Kovaleva, A.V. Vavilov // Hirurgiya [Surgery]. — 2008. — № 2. — S.42—47.
3.   Egiev, V.N. Sravnenie rezul'tatov plastiki bryushnoi stenki «tyazhelymi» i «legkimi» polipropilenovymi endoprotezami pri lechenii posleoperacionnyh ventral'nyh gryzh [The comparison of the results of the abdominal wall plasty with «heavy» and «light» polypropylene endoprostheses for the treatment of postoperative ventral hernias] / V.N. Egiev, S.N. Shurygin, D.V. Chizhov // Moskovskii hirurgicheskii zhurnal [Moscow journal of surgery]. — 2012. — № 2. — S.20—23.
4.   Kuznecov, N.A. Rol' operacionnogo dostupa v razvitii posleoperacionnyh ventral'nyh gryzh [The role of the surgical approach in the development of postoperative ventral hernias] / N.A. Kuznecov, I.V. Schastlivcev, S.N. Caplin // Hirurgiya [Surgery]. — 2011. — № 7. — S.62—66.
5.   Kulikov, L.K. Hirurgicheskoe lechenie obshirnyh i gigantskih posleoperacionnyh ventral'nyh gryzh [Surgical treatment of large and giant postoperative ventral hernias] / L.K. Kulikov, O.A. Buslaev, S.V. SHalashov [i dr.] // Novosti hirurgii [Surgery news]. — 2013. — № 2. — S.37—44.
6.   Ovechkin, A.M. Posleoperacionnoe obezbolivanie v abdominal'noi hirurgii: novyi vzglyad na staruyu temu [Postoperative analgesia in abdominal surgery: a new perspective on old topic] / A.M. Ovechkin, I.A. Karpov, S.V. Lyuosev // Anesteziologiya i reanіmatologіya [Anesthesiology and reanimatology]. — 2003. — № 5. — S.71—76.
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8. Timoshin, A.D. Hirurgicheskoe lechenie pahovyh i posleoperacionnyh gryzh bryushnoi stenki [Surgical treatment of postoperative inguinal and abdominal wall hernias] / A.D. Timoshin, A.V. Yurasov, A.L. Shestakov. — M.: Triada-H, 2003. — 144 s.
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12. Cozacov, Y. Is the use of prosthetic mesh recommended in severely obese patients undergoing concomitant abdominal wall hernia repair and sleeve gastrectomy? / Y. Cozacov, S. Szomstein, F.M. Safdie [et al.] // J. Am. Coll. Surg. — 2014. — Vol. 218, № 3. — P.358—362.
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17. Le, D. Mesh choice in ventral hernia repair: so many choices, so little time / D. Le, C.W. Deveney, N.L. Reaven [et al.] / Am. J. Surg. — 2013. — Vol. 205, № 5. — P.602—607.
18. Llaguna, O.H. Incidence and risk factors for the development incisionalhernia following elective laparoscopic versus open colon resections / O.H. Llaguna, D.V. Avgerinos, J.Z. Lugo [et al.] // Am. J. Surg. — 2010. — Vol. 200, № 2. — P.265—269.

 

 

Diagnosis and prevention of thrombosis splenic vein in patients infected pancreatic necrosis.

ANDREY I. ANDREEV, Ph.D., a physician-surgeon of Department of surgery number 3 of SAIH «City clinical Hospital № 7» in Kazan, Russia, tel. 8-843-221-39-76

ANDREW YU. ANISIMOV, M.D., Professor of Department of emergency medical care SBEI DPo «Kazan State Medical Acadmia» Russian Ministry of Health, chief expert of Ministry of Health of the republic of tatarstan, deputy chief physician of SAIH «City clinical Hospital № 7» Kazan, Russia, tel. 8-843-221-36-70

Abstract. The data of the experimental and clinical sections of the Exploration aimed at improving the results of treatment of patients infected with pan-kreonekrozom through the introduction of diagnostic and surgical techniques aimed at early detection and prevention of thrombosis splenic vein. In an experiment on 40 morphological foating corpses of both sexes shows that between infected pancreatic necrosis and pathological changes in the vessels of the portal system is strong. The corpse, which was the cause of death of the infected panukreonekroz, revealed a complex predominantly productive changes according to the type of productive panvaskulita a basis for the subsequent changes in the vascular lumen, violations of local mikrogemoreologii. These changes were found in the vessels of the portal basin, mainly in selezе-night and portal veins. In the clinical section. In 45 patients investigated the vessels of the portal system me-Todd endoscopic ultrasonography. Based on the comparison endosonografche-ing data with the fnal clinical diagnosis, formed on the basis of the whole complex of instrumental diagnostics (ultrasound, CT, endoscopy), the sensitivity of the endo-ultrasonography in the diagnosis of thrombosis of the portal system in infected pankreo-necrosis was 88% and specifcity — 96%. Inclusion of a comprehensive medical-diagnostic program infects patients with necrotizing pancreatitis, bathrooms and method endoUZI ozonirrigoaspiratsionnoy rehabilitation providing advanced-shenstvovannoy procedure allowed in 34,3% of cases diagnosed thrombosis of the portal system, reduce postoperative mortality from 46,7 to 32,4%, reduce the number of complications from 63,3 to 44,1%, reduce the time of hospital treatment from (56,5±0,11) to (41,6±0,6) days.

Key words: infected pancreatic necrosis, extrahepatic portal hyper-tensor, splenic vein thrombosis, diagnosis, surgical treatment.

 

References

1.   Anisimov, A.Yu. Opyt hirurgicheskogo lecheniya bol'nyh infcirovannym pankreonekrozom [Experience of surgical treatment of patients infected pankreo-necrosis] / A.YU. Anisimov, A.I. Andreev // Medicina v Kuzbasse [Medicine in Kuzbass]. — 2009. — № 8. — S.4—5.
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4.   Gavrilov, V.B. Spektrofotometricheskoe opredelenie soderzhaniya gidroperekisei lipidov v plazme krovi [Spectrophotometric determination of hydroperoxide content-whether lipids in blood plasma / V.B. Gavrilov, M.I. Mishkorudnaya // Laboratornoe delo [Lab. business]. — 1983. — № 3. — S.33—36.
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Current methods of visualization and diagnostic of avascular necrosis of hip.

ILDAR F. AKHTIAMOV, M.D., Professor, chief of Department of orthopeadic, trauma and urgent surgery of SBEI HPe «Kazan State Medical university» of Ministry of Health of Russia, Kazan, e-mail: yalta60@mail.ru

RUSTEM KH. ZAKIROV, doctor of republic clinical Hospital, Kazan, e-mail: nauka@rchkzn.ru

VLADISLAV V. LOBASHOV, doctor of children of republic clinical Hospital, Kazan, tel. 8-937-778-51-70, e-mail: lobashoff@ya.ru

Abstract. Aim. In this article we are comparing a diagnostic and imagine opportunity of hip necrosis by X-ray, MRI and CT. Material and methods. There are especial changes in different stages of hip necrosis in more than 150 cases. Particularly effciency of MRI and CT is pointed up in a guess about stability of hip elements. Summary. Authors conclude that not only does such hi-tech methods as CT and MRI put forward a detail information of a bone and paraarticular structures in initial stages but also in a post-operative period in severe cases, therefore it give a diagnose rapidly and it allows to start appropriate treatment.

Key words: diagnostic of avascular necrosis of hip, CT, MRI, X-ray.

 

References

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8.   Prohorov, V.P. Idiopaticheskii asepticheskii nekroz golovki bedra u vzroslyh [Idiopathic aseptic necrosis of the femoral head in adults] / V.P. Prohorov // Kazanskii medicinskii zhurnal [Kazan medical journal]. — 1981. — T. 62, № 6. — S.48—52.
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11.  Remizov, N.V. Luchevaya diagnostika zabolevanii tazobedrennogo sustava i ee rol' pri planirovanii i kontrolya rezul'tatov endoprotezirovaniya [Radiological diagnosis of diseases of the hip joint and its role in the planning and monitoring of the results of arthroplasty]: dis. … kand. med. nauk / N.V. Remizov. — M., 2004. — 312 s.
12. Samuchkov, M.L. Degenerativno-distrofcheskie zabo-levaniya tazobedrennogo sustava (etiologiya, patogenez, lechenie) [Degenerative-dystrophic diseases of the hip joint (etiology, pathogenesis, treatment)] / M.L. Samuchkov, I.L. Smirnova. — M., 1989. — S.12—17.
13. Shaposhnikov, Yu.G. O nekotoryh problemah endopro-tezirovaniya sustavov [About some problems of arthroplasty] / Yu.G. Shaposhnikov // Endoprotezirovanie v travmatologii i ortopedii [Arthroplasty in traumatology and orthopedics]. — M.: CITO, 1993. — 205 s.

 

Different methods of non-operative treatment of hip avascular necrosis in childhood

ILDAR F. AKHTIAMOV, M.D., Professor, chief of Department of orthopeadic, trauma and urgent surgery, of SBEI HPE «Kazan State Medical university» of Ministry of Health of Russia, Kazan, e-mail: yalta60@mail.ru

VLADISLAV V. LOBASHOV, doctor of children of republic clinical Hospital, Kazan, tel. 8-937-778-51-70, e-mail: lobashoff@ya.ru

Abstract. Legg—Calve—Perthes was developed 100 years ago and still under close attention of orthopedic surgeons. Children from 3 to 12 years old are affected of Legg—Calve—Perthes disease, often outcome is invalidism. Technique of operative treatment is diffcult enough, it has negative outcome in rate 31—59% it depends on type of operative treatment, sometimes it obtain such consequences as osteoarthritis of hip and hip replacement in outcome. Some cases of Perthes disease may inverse regeneration process. That is why using non-operative treatment and fnding new methods are very important for medical doctors and patients.

Key words: avascular necrosis of hip in childhood, Legg—Calve—Perthes disease, non-operative treatment, conservative.

 

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Acute hypocalcemia in patients on program hemodialysis after parathyroidectomy.

RENATA SH. VAKHITOVA, nephrologist of autonomous public health care institution «Emergency Hospital № 2», Kazan, graduate student of Department of therapy and family medicine of SBEI АPE «Kazan State Medical Academy» of Ministry of Health of Russia, Kazan, Russia, tel. 8-905-020-02-96

VLADIMIR A. DAMOTSEV, Chief of hemodialysis Department of autonomous public health care institution «Emergency Hospital № 2», Kazan, Russia, tel. 8-917-905-32-68

AIRAT R. BELYAEV, Сhief doctor of autonomous public health care institution «emergency Hospital № 2», Kazan, Russia, tel. (843) 238-36-04

RAFAEL M. MINABUTDINOV, chief of surgery Department of autonomous public health care institution «emergency Hospital № 2», Kazan, Russia, tel. (843) 238-19-18

MILYAUSHA I. KHASANOVA, Ph.D., clinical assistant professor of Department of urology and nephrology of SBEI APe «Kazan State Medical Academy» of Ministry of Health of Russia, Kazan, Russia, tel. 9-033-07-67-32

Abstract. Aim — to assess the severity of acute hypocalcemia syndrome «hungry bones» after parathyroidectomy concerning hyperparathyroidism in patients on program hemodialysis. Material and method. Five patients were observed before and after parathyroidectomy. The regular monitoring of blood calcium (total and ionized), phosphorus, intact parathyroid hormone were estimated in postoperative period. Clinical signs of hypocalcemia were measured after calcium drug administration. Results. Clinical and laboratory signs of acute hypocalcemia performed in patients after parathyroidectomy quickly subsided after calcium drug administration. Prophylactic intake of Alfacalcidol + Calcium carbonate and intravenous injection of calcium gluconate at the end of the hemodialysis procedure are effective. Conclusion. Personalized approach to patient management after parathyroidectomy contributes to the favorable postoperative period and helps to avoid serious complications such as laryngospasm, convulsions and coma.

Key words: postoperative hypocalcemia, secondary hyperparathyroidism, parathyroidectomy, hungry bone syndrome.

 

References

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13. Total thyroidectomy in geriatric patients: A retrospective study / F. Tartaglia, G. Russo, M. Sgueglia [et al.] // International Journal of Surgery. — 2014. — Vol. 2. — Р.33—36.

 

Sparing treatment of cervical pregnancy in emergency gynecology (clinical observation)

RUSHANYA I. GABIDULLINA, M.D., Professor of the Department of obstetrics and gynecology № 2 of SBEI HPE «Kazan State Medical university» of Ministry of Health of Russia, Kazan, Russia, tel. 8-917-289-93-10, e-mail: ru.gabidullina@yandex.ru

MARAT A. MINGAZETDINOV, Head of Department of the angiosugery of SAiH «ccH № 7», Kazan, Russia, tel. 8-904-760-80-51

LEYSAN I. SYRMATOVA, Head of Department of the gynecological of SAIH «CCH № 7», Kazan, Russia, tel. 8-843-237-72-48

IRINA M. SHESTAKOVA, gynecologist of Department of the gynecological of SAIH «CCH № 7», Kazan, Russia, tel. 8-927-404-95-72

Abstract. In the article described a case study of cervical pregnancy with organsparingtreatment in a 25 years woman. The studies encompassed ultrasound using a transvaginal color Doppler probe to visualize an ovum; determination of the borders between the chorion and the cervical stroma, as well as the degree of blood fow in the chorionic area; estimation of the time course of changes in the β-subunit of human chorionic gonadotropin (β-HCG) in the serum; general clinical examinations. Superselectiveuterine artery embolization with intraarterial injection of methotrexate was successfully performed. After reducing the levelof human chorionic gonadotropin and absence of blood fow confrmed by control arteriography, fetal egg evacuation was made. Blood loss during surgery was 10 mL. Recovery period was 4 days. Sparing treatment of cervical pregnancy with uterine artery embolization with intraarterial methotrexate reduces risk of bleeding and saves reproductive function in young femal.

Key words: cervical pregnancy, uterine artery embolization, methotrexate.

 

References

1.   Adamyan, L.V. Kombinirovannoe lechenie zhenschin s sheechnoi beremennost'yu [Combination treatment in women with cervical pregnancy] / L.V. Adamyan, I.S. CHernova, A.V. Kozachenko // Akusherstvo i ginekologiya [Оbstetrics and gynecology]. — 2012. — № 4. — S.103—108.
2.   Ailamazyan, E.K. Neotlozhnaya pomosch' pri ekstremal'nyh sostoyaniyah v ginekologii [Emergencycare under extreme conditions in gynecology] / E.K. Ailamazyan, I.T. Ryabceva. — 2-e izd., dop. — M.: Medicinskaya kniga; N. Novgorod: NGMA, 2003. — 183 s.
3.   Grishin, I.I. Novye vozmozhnosti v lechenii sheechnoi beremennosti [New Opportunities in Treatment of Cervical Pregnancy] / I.I. Grishin, Yu.E. Dobrohotova, S.A. Kapranov // Lechebnoe delo [Medical care]. —
2010. — № 4. — S.93—97.
4.   Kulakov, V.I. Rukovodstvo po operativnoi ginekologii [Manual of operative gynecology] / V.I. Kulakov, N.D. Selezneva, S.E. Beloglazova. — M.: MIA., 2006. — 640 s.
5.   Makarov, I.O. Organosohranyayuschaya operaciya pri sheechnoi beremennosti u pacientki reproduktivnogo vozrasta (klinicheskoe nablyudenie) [Sparing surgery in a patient of reproductive age with cervical pregnancy (clinical observation)] / I.O. Makarov, G.L. Ermolenko, N.M. Hairudinova // Akusherstvo, ginekologiya, reprodukciya [Оbstetrics, Gynecology, Reproduction]. —
2011. — T. 5, № 2. — S.21—22.
6.   Strizhakov, A.N. Vnematochnaya beremennost' [Ectopic pregnancy] / A.N. Strizhakov, A.I. Davydov, L.D. Belokerkovceva, M.N. SHahlamova. — 2-e izd. — M.: Medicina, 2001. — 215 s.
7.   Tarabanova, O.V. Organosberegayuschaya taktika lecheniya pacientok s sheechnoi beremennost'yu [Organosaving tactics of curing patients with cervical pregnancy] / O.V. Tarabanova, A.N. Grigorova, T. V. Chernousova [i dr.] // Kubanskii nauchnyi medicinskii vestnik [Kuban scientifc medical Bulletin]. — 2011. — № 5. — S.160—162.
8.   Teregulova, L.E. Razlichnyi podhod k konservativnomu organosohranyayuschemu lecheniyu sheechnoi beremennosti v zavisimosti ot rezul'tatov ul'trazvukovogo issledovaniya s cvetovym dopplerovskim kartirovaniem [Various approach to conservative organ preservation treatment of cervical pregnancy depending on the result of the ultrasound investigation with color Doppler imaging] / L.E. Teregulova, L.D. Egamberdieva, N.I. Tuhvatshina [i dr.] // Prakticheskaya medicina [Practical medicine]. — 2013. — № 7(76). — S.72—77.
9.   Chehoeva, A.N. Klinicheskoe nablyudenie sheechnoi beremennosti s primeneniem sovremennyh organo-sohranyayuschih metodov lecheniya u pacientki reproduktivnogo vozrasta [The clinical investigations of cervical pregnancy with applications of modern organ-preserving metods of treatment in the reproductive age patient] / A.N. Chehoeva, L.V. Callagova, I.M. Betoeva [i dr.] // Vestnik novyh medicinskih tehnologii [Bulletin of new medical technologies]. — 2012. — № 4. — S.122—124.
10. Sites of ectopic pregnancy: A10 year population — based study of 1800 cases / J. Bouyer, J. Coste, H. Fernadez [et al.] // Hum. Reprod. — 2002. — № 17. — P.3224— 3230.
11.  Headley, A. Management of cervical ectopic pregnancy with uterine artery embolization: a case report / A. Headley // J. Reprod Med. — 2014. — Vol. 59, № 7/8. — P.425—428.
12. Jurcovic, D. Diagnosis and treatment of early cervical pregnancy: a review and a report of two cases treated conservatively / D. Jurcovic, E. Hacket, S. Campbell // Ultrasound Obstet. Gynecol. — 1996. — Vol. 8. — P.373—380.
13. Cervical pregnancy: a report of four cases / K.I. Kochi, T. Hidaka, K. Yasoshima [et al.] // J. Obstet. Gynaecol. Res. — 2014. — Vol. 40. — № 2. — P.603—606.
14. Outcome, complications and future fertility in women treated with uterine artery embolization and methotrexate for non-tubal ectopic pregnancy / H.I. Krissi, L. Hiersch, N. Stolovitch [et al.] // Eur. J. Obstet. Gynecol. Reprod. Biol. — 2014 — Vol. 27, № 182. — P.172—176.
15. Successful conservative management of cervical ectopic pregnancy: A case series / J.E. Taylor, T.M. Yalcinkaya, M.E. Akar // Arch. Gynecol. Obstet. — 2011. — № 283. — P.1215—1217.
16. Cervical pregnancy: Past and future / F.B. Ushakov, U. Elchalal, P.J. Aceman, J.G. Schenker // Obstet.Gynecol. Surv. — 1997. — № 52. — P.45—59.
17. Cervical pregnancy: The importance of early diagnosis and treatment / G. Vela, T. Tulandi // J. Minim. Invasive Gynecol. — 2007. — № 14. — P.481—484.
18. Multidose methotrexate treatment of cervical pregnancy / H.S. Weibel, A. Alserri, C. Reinhild, T. Tulandi // J. Obstet. Gynecol. Can. — 2012. — № 34. — P359—362.
19. Cervical ectopic pregnancy: Review of the literature and report of a case treated by single-dose methotrexate therapy / J. Yankowitz, J. Leake, G. Huggins [et al.] // Obstet. Gynecol. Surv. — 1990. — № 45. — P.405— 414.
20. Cervical pregnancy — a conservative stepwise approach / M. Yitzhak, R. Orvieto, S. Nitke [et al.] // Hum. Reprod. — 1999. — № 14. — P.847—849.

 

 

Plasmolifting methodin laparoscopic access in experiment

RUSHANYA I. GABIDULLINA, M.D., Professor of Department of obstetrics and gynecology № 2 SBEI HPE «Kazan State Medical university» Russian Ministry of Health, Kazan, Russia, e-mail: ru.gabidullina@yandex.ru

ELVIRA R. GAYNUTDINOVA, doctor of gynecological department of SAIH «City Clinical Hospital № 7», Kazan, tel. 8-937-614-94-95, e-mail: elvlion@rambler.ru

AZAT A. GALEEV, doctor of gynecological department of SAIH «Central city clinical hospital № 18», Kazan, tel. 8-987-296-84-46, e-mail: lamantinos@mail.ru

SERGEY V. FEDOTOV, Deputy chief of obstetrics and gynecology of SAIH «City clinical hospital № 7», Kazan, e-mail: nataliyafedotova1972@mail.ru

ILMIRA R. GALIMОVA, deputy chief of obstetrics and gynecology of SAIH «Republic clinical hospital Ministry of health of tatarstan republic», Kazan, tel. 8-987-226-92-87

Abstract. The article is dedicated to comparative morphological evaluation of uterus tissues regeneration process in scar region with using plasmolifting technology in experimental research on female rabbit. Plasmolifting technology includes local introduction of injection form of autoplasma, inriched with platelet, containing growth factors and including cytokines that stimulate reparative and anabolic processes in damaged tissues. 36 animals took part in experiment, randomized into control and experimental groups, in equal amount. Uterus seam region in experimental group animals was pricked all round with platelet rich plasma. Taking samples for immunohistochemical research was carried out on 7 and 30 day. Morphological evaluation included immunohistochemical research using antibodies against desmin, calponin, alfa-smooth muscle actin. On 7 day of postoperative period in uterus tissues, processed with platelet rich plasma, we noted more ordered disposition of cellular elements, lesser infammatory reaction, signifcant expression of myometrium markers during immunohistochemical research. On 30 day scar could be attributed to be morphologically wealthy.

Key words: platelet rich plasma, plasmolifting, uterus scar.

 

References

1.   Ahmerov, R.R. Autostimulyaciya regenerativnyh processov pri lechenii atrofcheskih sostoyanii kozhi i ee pridatkov: posobie dlya vrachei [Regenerative processes autostimulation in treatment of skins atrophic conditions: manual for physicians] / R.R. Ahmerov, R.F. Zarudii, I.N. Rychkova [i dr.]. — M., 2011. — S.5—8.
2.   Buyanova, S.N. Vozmozhnosti rekonstruktivnoi hirurgii matki v korrekcii reproduktivnoi funkcii u pacientok s miomoi matki [Possibilities of reconstructive surgery of the uterus to correct reproductive function in patients with uterine myoma] / S.N. Buyanova, M.V. Mgeliashvili, S.A. Petrakova // Rossiiskii vestnik akushera-ginekologa [Russian obstetrician-gynecologists herald]. — 2011. — № 5. — S.89—92.
3.   Buyanova, S.N. Miomektomiya vne i vo vremya beremennosti: pokazaniya, osobennosti hirurgicheskoi taktiki i anestezii, predoperacionnaya podgotovka [Myometomy in pregnancy and non-pregnancy: indication, the specifc features of surgical policy and anesthesia, and preoperative preparation and rehabilitation] / S.N. Buyanova, L.S. Logutova // Rossiiskii vestnik akushera-ginekologa [Russian obstetrician-gynecologists herald]. — 2013. — № 2. — S.95—96. 4. Phenotypic heterogeneity of rat arterial smooth muscle cell clones: implication soft he development of experimental
intimal thickening / M.L. Bochaton-Piallat, P. Ropraz, F. Gabbiani, G. Gabbiani // Arteriosclerosis Thrombosis Vascular Biology. — 1996. — Vol. 16. — P.815—820.
5.   Platelet rich plasmas: grouth factor content and roles in wound healing / J.P. Frechette, I. Martineau, G. Gagnon // J. Dent. Res. — 2005. — Vol. 84. — P.434—439.
6.   Molecular aspects of myogenesis / J.P. Merlie, M. Buckingham, R.G. Whalen // Curr. Top. Dev. Biol. — 1977. — Vol. 11. — P.61.

 

Outcomes of surgical treatment of the acute pulmonary embolism with cardiopulmonary bypass

ROIN K. DZHORDZHIKIYA, M.D., Рrofessor, Сhief of Department of surgical diseases of SBEI HPE «Kazan State Medical University», Kazan, Russia, tel. +7-987-296-51-72, e-mail roink@mail.ru

ILDAR I. VAGIZOV, Сhief of the cardiac surgery Department 2, ICDC, Kazan, Russia

MURAT N. MUKHARYAMOV, Ph. D., cardiovascular surgeon of Department of cardiac surgery, ICDC, Kazan, Russia, tel. 8-917-263-58-41, e-mail: mukharyamov@yahoo.com

Abstract. The aim of the study — evaluation of surgical treatment outcomes of the acute pulmonary embolism. Methods. 34 cases of surgical procedures for acute pulmonary embolism (APE) from 2006 till 2014 were retrospectively analyzed. Meanagewas 54±15 (from 22 till 76 years). Male — 16. Iliac-femoral segment deep veinthrombosis was a netiologic factorin 86% of cases. Massive APE with hemodynamic compromise, contraindications or non-effective thrombolytic therapy or mobile foating thrombus in right heart chambers were considered as an indications for open surgical procedure. All procedures were conducted with cardiopulmonary bypass. Results. All patients underwent thrombectomy from pulmonary trunk (6 cases) left and right pulmonary arteries basin (22) or right heart chambers (3). In cases of «old» thrombus were revealed endarterectomy was performed with a short periods of intermittent circulatory arrest for proper visualization. The mean cardiopulmonary bypass time was 48±16. Prolonged ventilation period (4—7 days) was required in 7 cases. Postoperative mortality was 8,8% (3 cases). Pulmonary artery pressure was measured before discharged and was signifcantly decreased compared with the preoperative values (34,6±12) mmHg and (65±18) respectively. Also decrease of right ventricle size and its function improvement were detected in all cases. Long term (2—6 yeras) follow up of 26 patients revealed the absence of pulmonary hypertension in a majority (76%) of study cohort. Recurrent pulmonary embolism was detected in 3 cases. Conclusions: surgical treatment of APE is associated with good early and long-term outcomes.

Key words: acute pulmonary embolism, pulmonary thrombectomy, cardiopulmonary bypass.

 

References

1.   Kirienko, A.I. Tromboemboliya legochnyh arterii: diagnostika, lechenie, proflaktika [Pulmonary embolism: diagnostics, treatment and profylaxys] / A.I. Kirienko, A.A. Matyushenko, V.V. Andriyashkin, D.A CHurikov // Consilium medicum. — 2001. — T. 3, № 6. — S.224— 228.
2.   Rossiiskie klinicheskie rekomendacii po diagnostike, lecheniyu i proflaktike venoznyh tromboembolicheskih oslozhnenii [Russian clinical recommendations for diagnosis, treatment and prophylaxis of venous thromboembolic complications] // Flebologiya. — 2010. — T. 4, vyp. 2, № 1. — S.19.
3.   Flebologiya [Flebology] / pod red. V.S. Savel'eva. — M.: Medicina, 2001. — 664 s.
4.   Fokin, A.A. Hirurgicheskaya profilaktika i lechenie tromboembolii legochnyh arterii [Surgical profylaxis and treatment of pulmonary embolism] / A.A. Fokin, V . P. Prihod'ko, A.P. Medvedev, V.V. Vladimirskii. — Chelyabinsk, 2010. — 297 s.
5.   014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism The Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC) Endorsed by the European Respiratory Society (ERS) / S. Konstantinides, A. Torbicki, G. Agnelli [et al.] // European heart journal. — 2014. — № 283. — P.48.
6.   Cardiac Biomarkers for Risk Stratifcation of Patients With Acute Pulmonary Embolism / N. Kucher, S.Z. Goldhaber // Circulation. — 2003. — Vol. 108. — P.2191—2194.
7.   Guidelines for the Diagnosis, Treatment and Prevention of Pulmonary Thromboembolism and Deep Vein Thrombosis (JCS 2009) // Circulation. — 2011. — Vol. 75. — Р.1258— 1281.
8.   Modern surgical treatment of massive pulmonary embolism: Results in 47 consecutive patients after rapid diagnosis and aggressive surgical approach / M. Leacche, D. Unic, S.Z. Goldhaber [et al.] // J. Thoracic. Cardiovasc. Surg. — 2005. — Vol. 129. — P.1018—1023.
9.   Outcome of pulmonary embolectomy / P.D. Stein, M. Alnas, A. Beemath, N.R. Patel // Am. J. Cardiol. — 2007. — Vol. 99. — P.421—423.
10. Pulmonary Embolectomy for Acute Massive Pulmonary Embolism / C. Dauphine, B. Omari // Ann. Thorac. surg. — 2005. — Vol. 79. — P.1240—1244.
11.  The clinical cource of pulmonary embolism / J.L. Carson, M.A. Kelley, A. Duff [et al.] // Engl. J. Med. — 1992. — Vol. 326. —P.1240—1245.
12. Venous thromboembolism (VTE) in Europe. The number of VTE events and associated morbidity and mortality / A.T. Cohen, G. Agnelli, F.A. Anderson [et al.] // Thromb. Haemost. — 2007. — Vol. 98(4). —P.756—764.
13. Venous tromboembolism according to age the impact of an aging population / P.D. Stein, R.D. Hull, F. Kayali [et al.] // Arch. Intern. med. — 2004. — Vol. 164(20). — P.2260—2265.

 

 

Relaparotomy at the treatment of acute mesenteric circulatory disorder

SERGEY V. DOBROKVASHIN, M.D., Professor, Head of the Department of general surgery of SBEI HPE «Kazan State Medical university», e-mail: gsurgery1@yandex.ru

DMITRY E. VOLKOV, Ph.D., associate professor of Department of general surgery of SBEI HPE «Kazan State Medical university», e-mail: gsurgery1@yandex.ru

ALEXANDER G. IZMAILOV, Ph.D., associate professor of Department of general surgery of SBEI HPE «Kazan State Medical university», e-mail: izmailov_alex@mail.ru

Abstract. Material and methods. Over the past 15 years, we have observed 61 (100%) patients with acute occlusion of the mesenteric vessels. Among them, there were 32 (52,5%) men and 29 (47,5%) women. All patients had comorbidity diseases: 46 (75%) patients had various forms of cardiac arrhythmia, 51 (83.6%) patients had hypertension, the effects of cerebral blood fow was observed in 15 (24,5%), 14 patients (22 9%) had previous acute myocardial infarction. All patients were operated on. Results and discussion. The diagnostic video laparoscopy was performed at all patients with suspected mesenteric occlusion. In 15 (24,5%) patients because of a lack signs of disaster in the abdominal cavity, the intervention was limited to inspection of the abdominal cavity, followed video laparoscopy control drainage of the abdominal cavity single lumen tube, and these cases are regarded as manifestations of chronic ischemia of the abdominal cavity. The conversion to the defnition of further surgical tactics after a revision of the abdomen and bowel necrosis establishing boundaries was required at 46 (75%) patients. Bowel viability was assessed during the operation to its color, the presence of peristalsis, pulsation of the mesenteric vessels.

Key words: mesenteric vessels, acute occlusion, treatment.

 

References

1.   Does a second-look operation improve survival in patients with peritonitis due to acute mesenteric ischemia? A fve-year retrospective experience / O. Kaminsky, I. Yampolski, D. Aranovich [et al.] // World Journal of Surgery. — 2005. — Vol. 29(5). — P.645—648.
2.   Acute mesenteric ischemia: classifcation, evaluation and therapy / G Lock // Acta Gastro-Enterologica Belgica. — 2002. — Vol. 65(4). — P.220—225.
3.   Acute mesenteric ischemia / J. Vokurka, J. Olejnik, V. Jedlicka [et al.] // Hepato-Gastroenterology. — 2008. — Vol. 55(85). — P.1349—1352.

 

Surgical treatment of patients with acute mediastinitis

SERGEY V. DOBROKVASHIN, D.M., Head of the Department of general surgery of SBEI HPE «Kazan State Medical University» of Russian Ministry of Health, Kazan, Russia, tel. 557-39-46, e-mail: gsurgery1@yandex.ru

RAIS R. MUSTAFIN, Ph.D., deputy Сhief physician of the medical work of Municipal Hospital № 16, Kazan, Russia, tel. 8-927-240-93-02, e-mail: klinika.16@tatar.ru

ALMAZ G. KHAKIMOV, аcting Head of Department of thoracic surgery of Municipal Hospital № 16, Kazan, Russia, tel. 222-06-53, e-mail: klinika.16@tatar.ru

DMITRY V. BOLSHAKOV, surgeon of Department of thoracic surgery of Municipal Hospital № 16, Kazan, Russia, tel. 8-917-936-93-08, e-mail: klinika.16@tatar.ru

RAMIL K. MINNEMULLIN, surgeon of Department of thoracic surgery of Municipal Hospital № 16, Kazan, Russia, tel. 8-904-662-34-51, e-mail: klinika.16@tatar.ru

SERGEY L. DEMYANOV, assistant of the Department of general surgery of SBEI HPE «Kazan State Medical University» Russian Ministry of Health, Kazan, Russia, tel. 8-904-764-85-45, e-mail: sl.demyanov@live.ru

Abstract. Aim — to improve outcomes in patients with acute mediastinitis different etiologies. Material and methods. Analyze the experience of the treatment of 28 patients with acute mediastinitis different etiologies. Among the causes of acute mediastinitis frst place is occupied by different kinds of damage to the esophagus (50%), in second place — odontogenic and paratonsillar abscesses (32,1%). When the infammatory process in the mediastinum preference Vneplevralnaya accesses (62%). Satisfactory results were obtained in the treatment of 26 patients (92,8%). Lethal outcome occurred in 2 (7,2%) patients. The main causes of deaths were sepsis and progression of mediastinitis. Conclusions. Among the causes of acute mediastinitis frst place is occupied damage to the esophagus, followed by cellulitis and neck odonto- tonzilogennoy nature. 26 sluchayah (92,8%) satisfactory results of treatment. The average length of hospital stay of patients with posterolateral upper mediastinitis was 13,5 days, patients with total posterior mediastinitis — 46 days, with front mediastinitis — 30,3 days. Mortality rate was 7,2% (2 patients). The main causes of deaths were sepsis and progression of mediastinitis.

Key words: acute mediastinitis, odontogenic mediastinitis, abscess neck, esophageal perforation, empyema.

 

References

1.   Slesarenko, S.S. Mediastinit [Mediastinitis] / S.S. Sle-sarenko, V.V. Agapov, V.A. Prelatov. — M.: ID MEDprak-tika-M, 2005. — 200 s.
2.   Zor'kin, A.A. Mediastinit: etiologiya, patogenez, klinika, diagnostika i lechenie [Mediastinitis: etiology, pathogenesis, clinical features, diagnosis and treatment] / A.A. Zor'kin // Infekcii v hirurgii [Infections in surgery]. — URL: http:// www.abolmed.ru/img/mediastinitis.pdf
3.   Osobennosti hirurgicheskogo lecheniya nishodyaschego mediastinita [Features of surgical treatment of descending mediastinitis] / A.G. Vysockii, D.O. Stupachenko, D . V. Vegner, V.V. Tahtaulov // Vestnik neotlozhnoi i vosstanovitel'noi mediciny [Messenger of urgent and recovery medicine]. — 2012. — T. 13, № 2. — S.239— 241.
4.   Rezul'taty lecheniya pacientov s ostrym mediastinitom razlichnoi etiologii [The results of treatment of patients with acute mediastinitis various etiologies] / Yu.V. Chikinev, E.A. Drobyazgin, T.S. Kolesnikova [i dr.] // Medicina i obrazovanie v Sibiri [Medicine and education in Siberia]. — 2013. — № 3. — S.33.
5.   Plaskin, S.A. Varianty hirurgicheskoi taktiki pri mediastinitah razlichnoi etiologii [Variants of surgical tactics in mediastinitis various etiologies] // Nauchno-medicinskii vestnik central'nogo CHernozem'ya [Scientifc and medical bulletin of the central Chernozem region]. — 2007. — № 30. — S.35—37.
6.   Ennker, I.C. Management of sterno-mediastinitis / I.C. Ennker, J.C. Ennker // HSR ProcIntensiv Care Cardiovask Anesth. — 2012. — № 4. — Р.233—241.
7.   Leung Wai Sang, S. Preoperative hospital length of stay as a modifable risk factor for mediastinitis after cardiac surgery / S. Leung Wai Sang [et al.] // J. Cardiothorac. Surg. — 2013. — № 9. — Р.45.

 

Medical and psychological rehabilitation of victims in social cataclysms

KAMIL SH. ZYYATDINOV, M.D., Рrofessor, head of the department of an emergency medical service, medicine of accidents and mobilization preparation of health care of SBEI APe «Kazan State Medical Academy» of Ministry of Health Russia, Kazan, Russia, e-mail: smp-mk-mpz@kgma.info

VASYL V. FATTAKHOV, M.D., Рrofessor, of department of surgery of SBEI APE «Kazan State Medical Academy» of Ministry of Health Russia, Kazan, Russia, e-mail: vvfat@mail.ru

BARI G. SHIGAPOV, Ph.D., associate professor of an emergency medical service, medicine of accidents and mobilization preparation of health care of SBEI APE «Kazan State Medical Academy» of Ministry of Health Russia, Kazan, Russia, e-mail: smp-mk-mpz@kgma.info

SHAMIL G. ASADULLIN, Ph.D., associate professor of an emergency medical service, medicine of accidents and mobilization preparation of health care of SBEI APE «Kazan State Medical Academy of Ministry of Health Russian federation, Kazan, Russia, e-mail: smp-mk-mpz@kgma.info

NELIA V. MAKSUMOVA, assistant to chair of functional diagnostics of SBEI APe «Kazan State Medical Academy» of Ministry of Health russi, Kazan, Russia, e-mail:nv_maks@mai.ru

Abstract. In article medical, social and psychological consequences of stay of the person in a zone of conducting combat operations, their manifestation, clinical symptomatology are considered. The potential contingent having opportunity to appear in the conditions of conducting combat operations is defned. Foreign experiment on the studied question is lit. Clinical experience of studying of a condition of mental and physical health of participants and veterans of military operations, police offcers, medical formations is stated. Process of carrying out rehabilitation actions in the conditions of the rehabilitation center is described. Article represents practical interest for therapists, reabilitolog, psychologists, and other experts to which circle of patients participants and veterans of military operations, employees of the medical and saving contingents, relatives which died in military operations, emergency situations and other katasklizm can get.

Key words: participants of military operations, post-traumatic stressful frustration, rehabilitation, state of health.

 

References

1. Agafonov, V.A. Kompleksnaya reabilitaciya uchastnikov boevyh deistvii i kontrterroristicheskih operacii [Complex rehabilitation of participants of military operations and Counter-terrorist operations] / V.A. Agafonov, T. V. Odegova, L.L. CHichadeeva, O.L. Starodubceva // Gospital'naya medicina [Hospital medicine]. — 2013. — № 9. — S.33—34.

2. Litvincev, S.V. Boevaya i psihicheskaya travma [Fighting and mental trauma] / S.V. Litvincev, E.V. Snedkov, A.M. Reznik. — M.: Medicina, 2005. — 432 s.
3.   Myakotnyh, V.S. Patologiya nervnoi sistemy u veteranov sovremennyh voennyh konfiktov [Patologiya of nervous system at veterans of the modern military conficts] / V.S. Myakotnyh. — Ekaterinburg: Izd-vo UGMA, 2009. — 322 s.
4.   Pankratova, S.A. Rasprostranennost' faktorov riska serdechno-sosudistyh zabolevanii u byvshih uchastnikov boevyh deistvii [Rasprostranennost of risk factors of cardiovascular diseases at the former participants of military operations] / S.A. Pankratova, T.A. Raskina, I.A. Shibanova // Medicina v Kuzbase [Medicine in Kuzbass]. — 2011. — T. 10, № 1. — S.19—24.
5.   Cybaeva, L. Social'no-psihologicheskaya adaptaciya uchastnikov boevyh deistvii [Sotsialno-psikhologicheskaya adaptation of participants of military operations] / L. Cybaeva // Razvitie lichnosti [Development of the personality]. — 2007. — № 1. — S.165—171.
6.   Patofziologiya otdalennogo perioda boevyh stressovyh povrezhdenii [Pathophysiology of the remote period of fghting stressful damages] / Yu.K. Yanov, V.Yu. Shanin, A.A. Strel'nikov [i dr.] // Klinicheskaya medicina i patofziologiya [Clinical medicine and pathophysiology]. — 1997. — № 1. — S.78—85.
7.   Exercise challenge in Gulf War Illness reveals two subgroups with altered brain structure and function / R.U. Rayhan, B.W. Stevens, M.W. Raksit [et al.] // PLoS One. — 2013. —Vol. 14, № 8(6). — P.e63903.

 

 

Ambulance emergency care: problems of validity challenges with cardiac pathology

GENNADY P. ISHMURZIN, associate Professor of the Department of internal diseases № 2 of SBEI HPe «Kazan state medical university» of Ministry of health of Russia, Kazan, Russia, tel. 8-909-30-610-43, e-mail: ishm08@mail.ru

RASIM R. GIZATULLIN, student of the faculty of social work and higher nursing education of SBEI HPe «Kazan state medical university» of Ministry of health of Russia, Kazan, Russia, tel. 8-908-102-12-65, e-mail: razim87.87@mail.ru

Abstract. The aim of the research was to investigate the problems of validity challenges with cardiac pathology and the establishment of a comprehensive system optimizing the emergency care (EC) of cardiac patients on the basis of information technologies and algorithms developed action with regard to scientifc factors that affect the effciency and quality of this provision EC cardiac patients. Method and techniques of research. The study was conducted by the method of the study the main information sources station EC. To obtain empirical data was used to study the «Card calls», «Log calls ECs managers». Statistical processing of the empirical data consisted of establishing the validity of differences between samples, the correlation analysis. The analysis included only those relationships whose signifcance was p<0,05. Results and discussion. When analyzing maps calls and log calls revealed that the major share of challenges with cardiac pathology are hypertension, acute coronary syndrome (ACS), heart rhythm disturbance, rhythm disturbances. Seasonality calls not differ in reliability. The proportion of calls depending on the time of day most (45,3%) percentage of calls falls on the evening (from 18.00 to 23.59). The overall mortality rate of patients at all occasions is 1,7%, while cardiac diseases — 2,2%, and the ischemic cardiac disease was 7,2%.

Key words: ambulance, cardiac pathology, coronary heart disease.

 

References

1. Bagnenko, S.F. Rukovodstvo po skoroi medicinskoi pomoschi [Guide to emergency medical care] / S.F. Bagnenko, A.L. Vertkina, A.G. Miroshnichenko. — M.: GEOTAR-Media, 2012. — 853 s.

2. Borodulin, V.I. Skoraya medicinskaya pomosch': spravochnik prakticheskogo vracha [Emergency medical care: the Handbook of practical doctor] / V.I. Borodulin, A.V. Topolyanskii. — 10-e izd. — M.: MIA, 2013. — 784 s.
3.   Vishnyakov, N.I. Avtomatizirovannaya sistema kontrolya urovnya organizacii i kachestva vnebol'nichnoi medicinskoi pomoschi naseleniyu [Automated control system level of organization and quality out-of-hospital medical care to the population] / N.I. Vishnyakov, V.A. Petrashevich, N.G. Petrova, A.R. Prous, L.L. Sharafutdinova // Sovershenstvovanie statistiki zdorov'ya i zdravoohrane-niya v RF [Improvement of statistics on health and health care in the Russian Federation]: sb. nauch.-prakt. rabot. — M., 2005. — S.101—105.
4.   Gaponova, N.I. Dinamika zatrat na terapiyu giperto-nicheskogo kriza pri optimizacii lekarstvennogo obespecheniya na dogospital'nom etape [Dynamics of expenses for treatment of hypertensive crisis when optimizing the pharmaceutical supply prehospital] / N.I. Gaponova, N.F. Plavunov, B.Ji. Baratashvili // Racional'naya farmakoterapiya v kardiologii [Rational pharmacotherapy in cardiology]. — 2012. — T . VIII, № 1. — S.57—60.
5.   Luk'yanova, A.G. Sravnitel'nyi analiz rashozhdenii diagnozov na dogospital'nom i gospital'nom etapah [A comparative analysis of differences in diagnoses of pre-hospital and hospital stages] / A.G. Luk'yanova, V.I. Belokrinickii, D.F. Husainova // Vrach skoroi pomoschi [The ambulance doctor]. — 2011. — № 8. — S.15—18.
6.   Mohov, A.A. Osobennosti zakonodatel'nogo regulirovaniya okazaniya ekstrennoi i neotlozhnoi pomoschi v Rossii [Peculiarities of legal regulation of the emergency and urgent care in Russia] / A.A. Mohov // Pravovye voprosy v zdravoohranenii. — 2011. — № 9. — S.22—33.
7.   Petrashevich, V.A. O novom opyte raboty neotlozhnoi pomoschi / V.A. Petrashevich, N.G. Petrova, L.L. Sharafutdinova // Social'no-ekonomicheskie problemy sovremennogo zdravoohraneniya: tez. Vseros. konf. o rganizatorov zdravoohraneniya [Legal issues in health care]. — Saratov, 2013. — S.110—120.
8.   Ruksin, V.V. Neotlozhnaya kardiologicheskaya pomosch' na dogospital'nom etape [Emergency cardiac care at the prehospital stage] / V.V. Ruksin. — M.: InformMed, 2010. — 208 s.
9.   Ruksin, V.V. Neotlozhnaya kardiologiya [Emergency cardiology] / V.V. Ruksin. — M.: GEOTAR-Media, 2007. — 512 s.
10. Harchenko, V.I. Smertnost' ot boleznei sistemy krovo-obrascheniya v Rossii i v ekonomicheski razvityh stranah. Neobhodimost' usileniya kardiologicheskoi sluzhby i modernizacii medicinskoi statistiki v Rossiiskoi Federacii (analiticheskii obzor oficial'nyh dannyh Goskomstata) [Mortality from circulatory diseases in Russia and in economically developed countries. The need to strengthen the cardiology service and modernization of medical statistics in the Russian Federation (analytical review of offcial data of state statistics Committee)] / V.I. Harchenko, E.P. Kakorina, M.V. Koryakin [i dr.] // Rossiiskii kardiologicheskii zhurnal [Russian Cardiol. J.]. — 2005. — № 2. — S.5—17.
11.  El'kis, I.S. K voprosu sovershenstvovaniya raboty uchastkovogo terapevta po okazaniyu neotlozhnoi pomoschi na dogospital'nom etape [To the question of the improvement district physician for emergency care prehospital] / I.S. El'kis // Terapevticheskii arhiv [Therapeutic archive]. — 2007. — № 1. — S.13— 14.

 

Acute aortic dissection in emergency cardiology clinic.

ZULFIYA F. KIM, Ph.D., Head of the Department of cardiology № 1 of clinical Hospital № 7 of Kazan, associate professor of the Department of internal medicine № 2 of SBEI HPE «Kazan State Medical University», Kazan, Russia, tel. 8-917-255-55-74, e-mail: profz@yandex.ru

NIAZ R. KHASANOV, M.D., Professor of the Department of propedeutics of SBEI HPE «Kazan State Medical university», Kazan, Russia

VICTOR V. SCHERBAK, doctor of Department of computer and magnetic resonance tomography clinical Hospital № 7 of Kazan

SVETLANA R. ZOGOT, Ph.D., Head of the Department of computer and magnetic resonance tomography of clinical Hospital № 7 of Kazan, Assistant in the Department of general surgery of SBEI HPe «Kazan State Medical university», Kazan, Russia

ZULFIYA A. SHAIKHUTDINOVА, deputy Head physician on medical work of clinical Hospital № 7 of Kazan

Abstract. The article describes the Аnevrizme of the aorta and most terrible of her aggravation-severe delamination or dissection: causes of development, predisposing factors, symptoms. Development of the clinical presentation of acute aortic bundle depends on the distribution of dissection and involvement in the branches of the aorta, brachiocephalic or coronary arteries. Acute aortic dissection can proceed under different clinical masks. The article contains two observations with vaguely defned acute thoracic bundle. In the frst case, the patient's condition could be interpreted as acute coronary syndrome, characterized by life-threatening violation of rhythm, the second simulated pulmonary thromboembolism with marked respiratory distress. In such situations a careful analysis of all the symptoms and the results of the examination of the patient, that would establish the correct diagnosis and choose the optimal methods of treatment. Clinical cases are illustrated with elektrokardiogrammams, x-ray and tomogramms.

Key words: aortic aneurysm, acute aortic dissection.

 

References

1.   Syvolap, V.D. Rasslaivayuschaya anevrizma aorty (klinicheskii sluchai) / V.D. Syvolap, V.H. Kalenskii, S.M. Kiselev [i dr.] // Zaporozhckii medicinskii zhurnal. — 2008. — № 5. — S.52—55.
2.   2014 ESC Guidelines on the diagnosis and treatment of aortic diseases Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC).

 

Acute disease of the thoracic aorta in the urgent cardiology clinic

ZULFIYA F. KIM, Ph.D., Head of the Department of сardiology № 1 of clinical Hospital № 7 Kazan, associate of professor of the Department of internal medicine № 2 of SBEI HPE «Kazan State Medical University», tel. 8-917-255-55-74, e-mail: profz@yandex.ru

NIYAZ R. KHASANOV, M.D., Professor of the Department of propedeutics of SBEI HPE «Kazan State Medical university», Kazan, Russia

Abstract. The article is devoted to the updated guidelines of Article published in 2014, the new leadership of the European society of Cardiology on the diagnosis and treatment of diseases of the chest and abdominal aorta. The focus of the authors is an acute aortic dissection. There are the pathogenesis, classifcation, methods of rapid and effective diagnosis of aortic dissection in the article. Authors describe the comparative informative value of visualization techniques in the diagnostics of diseases of the aorta. The article contains detail the clinical manifestations of aortic dissection, its possible complications. Described principles of risk assessment based on the analysis of predisposing factors, the characteristics of the pain, the results of the clinical examination of the patient. The article contains the principles of preventive and therapeutic treatment, including medical, surgical and Endovascular approaches. Interesting and useful for practitioners is a block diagram of the action with suspected aortic dissection in a patient.

Key words: acute aortic dissection, aortic aneurysm, acute aortic syndrome.

 

References

1. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/ SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for
Cardiovascular Angiography and Interventions Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine / L.F. Hiratzka, G.L. Bakris, J.A. Beckman //Circulation. — 2010. — Vol. 121. — e266—e369.
2.   2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) / G. Mancia, R. Fagard, K. Narkiewicz [et al.]// Eur. Heart J. — 2013. — Vol. 34. — P.2159—2219.
3.   2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC) / R. Erbel, V. Aboyans, C. Boileau [et al.] // Circulation. — 2014. — Vol. 35, № 41. — P.2873—2926.
4.   Abdominal aortic aneurysm expansion: risk factors and time intervals for surveillance / A.R. Brady, S.G. Thompson, F.G. Fowkes [et al.]//Circulation. — 2004. — Vol. 110. — P.16—21.
5.   Characteristics and in-hospital outcomes of patients with cardiac tamponade complicating type A acute aortic dissection / D. Gilon, R.H. Mehta, J.K. Oh [et al.] //Am. J. Cardiol. — 2009. — Vol. 103. — P.1029—1031.
6.   Clinical presentation, management, and short-term outcome of patients with type A acute dissection complicated by mesenteric malperfusion: observations from the International Registry of Acute Aortic Dissection / M.Di. Eusanio, S. Trimarchi, H.J. Patel [et al.] //J. Thorac. Cardiovasc. Surg. — 2013. — Vol. 145. — P.385—390.
7.   Comparison of the effect on longterm outcomes in patients with thoracic aortic aneurysms of taking versus not taking a statin drug / I.S. Jovin, M. Duggal, K. Ebisu [et al.] // Am. J. Cardiol. — 2012. — Vol. 109. — P.1050—1054.
8.   Dissecting aneurysm of the descending aorta. Improved surgical results in 91 patients / G.J. Reul, D.A. Cooley, G.L. Hallman [et al.] //Arch. Surg. — 1975. — Vol. 110. — P.632—640.
9.   Does this patient have an acute thoracic aortic dissection? / M. Klompas // JAMA. — 2002. — Vol. 287. — P.2262— 2272.

10. Effect of medical and surgical therapy on aortic dissection evaluated by transesophageal echocardiography. Implications for prognosis and therapy. The European Cooperative Study Group on Echocardiography / R. Erbel, H. Oelert, J. Meyer [et al.] //Circulation. — 1993. — Vol. 87. — P.1604—1615.
11 . Effect of statin drugs on thoracic aortic aneurysms / L.H. Stein, J. Berger, M. Tranquilli, J.A. Elefteraides // Am. J. Cardiol. — 2013. — Vol. 112. — P.1240—1245.
12. Global and regional burden of aortic dissection and aneurysms / U.K.A. Sampson, P.E. Norman, G.R. Fowkes [et al.] //Global. Heart. — 2014. — Vol. 8. — P.171— 180.
13. Infuence of clinical presentation on the outcome of acute B aortic dissection: evidences from IRAD / S. Trimarchi, J.L. Tolenaar, T.T. Tsai [et al.] //Cardiovasc. Surg. (Torino). — 2012. — Vol. 53. — P.161—168.
14. Intimal tear without hematoma: an important variant of aortic dissection that can elude current imaging techniques / L.G. Svensson, S.B. Labib, A.C. Eisenhauer, J.R. Butterly // Circulation. — 1999. — Vol. 99. — P.1331—1336.
15. Losartan added to beta-blockade therapy for aortic root dilation in Marfan syndrome: a randomized,open-label pilot study / H.H. Chiu, M.H. Wu, J.K. Wang [et al.] // Mayo Clin. Proc. — 2013. — Vol. 88. — P.271—276.
16. Losartan reduces aortic dilatation rate in adults with Marfan syndrome:a randomized controlled trial / M. Groenink, A.W. den Hartog, R. Franken [et al.] // Eur. Heart J. — 2013. — Vol. 34. — P.3491—3500.
17. Mechanism of coronary malperfusion due to type-a aortic dissection / R.A. Janosi, T. Buck, R. Erbel // Herz. — 2009. — Vol. 34. — P.478.
18. Populationbased study of incidence and outcome of acute aortic dissection and premorbid risk factor control: 10-year
results from the Oxford Vascular Study / D.P. Howard, A. Banerjee, J.F. Fairhead [et al.] // Circulation. — 2013. — Vol. 127. — P.2031—2037.
19. Progression of aortic dilatation and the beneft of long-term beta-adrenergic blockade in Marfan’s syndrome / J. Shores, K.R. Berger, E.A. Murphy, R.E. Pyeritz // N. Engl. J. Med. — 1994. — Vol. 330. — P.1335—1341.
20. Randomized comparison of cold blood and cold crystalloid renal perfusion for renal protection during thoracoabdominal aortic aneurysm repair / S.A. Lemaire, M.M. Jones, L.D. Conklin [et al.] // J. Vasc. Surg. — 2009. — Vol. 49. — P.11—19 (discussion 19).
21. Repair of ascending aortic dissection. Influence of associated aortic valve insuffciency on early and late results / R.K. Jex, H.V. Schaff, J.M. Piehler // J. Thorac. Cardiovasc. Surg. — 1987. — Vol. 93. — P.375—384.
22. Signifcance of serum troponin I elevation in patients with acute aortic dissection of the ascending aorta / E. Bonnefoy, P. Godon, G. Kirkorian [et al.] // Acta. Cardiol. — 2005. — Vol. 60. — P.165—170.
23. Statin therapy is associated with improved survival after endovascular and open aneurysm repair / J.L. de Bruin, A.F. Baas, M.W. Heymans [et al.] // J. Vasc. Surg. — 2014. — Vol. 59. — P.39—44 e1.
24. Stroke and outcomes in patients with acute type A aortic dissection / E. Bossone, D.C. Corteville, K.M. Harris [et al.] // Circulation. — 2013. — Vol. 128. — S.175—179.
25. Surgical management of the ruptured aortic arch / H. Moro, J. Hayashi, M. Sogawa // Ann. Thorac. Surg. — 1999. — Vol. 67. — P.593—594.
26. The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease / P.G. Hagan, C.A. Nienaber, E.M. Isselbacher [et al.] // JAMA. — 2000. — Vol. 283. — P.897—903.

 

 

Sonography in the diagnosis of «unrecognized» rib fractures

JULIA A. KLYUSHKINA, Ph.D., Assistant of the Department of ultrasound diagnostics of SBEI APE «Kazan State Medical Academy» of the Ministry of Health of Russia, Kazan, tel. 8-919-625-68-25, e-mail: klyushkina_1974@mail.ru

IVAN V. KLYUSHKIN, M.D., Professor of the Department of general surgery of SBEI HPE «Kazan State Medical university» of the Ministry of Health of Russia, Kazan, tel. 8-919-624-96-40, e-mail: hirurgivan@rambler.ru

ROSALIA M. GAZIZYANOVA, Ph.D., deputy Сhief physician rB MEA MOH, Kazan, Russia, tel. 8-987-296-13-12

Abstract. The urgency of the problem of the treatment of chest injuries especially «incomplete fracture» complicated decreasing chest rise and its volume remains relevant. Podcherkivaetcya relevance of the number of «unrecognized» rib fractures. Patients treated with the diagnosis of a bruised chest. The X-ray method of research because of the complexity of the structure of the thorax, the tangential effect does not always provide accurate diagnostic information. The aim of the work — to determine the diagnostic value of sonography in the diagnosis of the combined severity of the injury of the chest. The work was conducted jointly by clinicians and forensic experts. Use modern diagnostic ultrasound equipment, the survey was conducted in multiploskostnyh projections. Take into account the state of the cortical bone, the state of the vessels and nerves of the chest wall, reducing the volume of the thorax. Patients were examined in the supine and standing, allows for the most easily accessible. The results obtained. Visualized single and multiple rib fractures, vascular damage with the formation of hematomas in the acute period, when visualized fracture healing callus. Sensitivity information content was higher accuracy than traditional diagnostic rentgenograficheskoy chest injuries. Given this data, we recommend to enter ultrasonography in patients with primary inspection chest injuries.

Key words: ultrasound, injuries ribs bruised chest, tangential effect.

 

References

1.   Pomozgov, A.I. Tomografya grudnoi kletki [Tomography of the chest] / A.I. Pomozgov, S.K. Ternovoi, D.S. Babii, N.M. Lepihin. — Kiev, 1992. — 287 s.
2.   Shahov, B.E. Osnovy rentgenodiagnostiki kostno-sustavnogo apparata i organov grudnoi kletki: metod. rekomendacii [Basics of X-ray osteoarticular apparatus and thoracic organs: the method. Recommendations] / B.E. Shahov, Yu.N. Filippov, A.N. Semizorov, N.A. Teret'eva. — N. Novgorod: Izd-vo Nizhegorodskoi gosudarstvennoi medicinskoi akademii, 2001. — 29 s.
3.   Altunin, V.F. Lechenie bol'nyh s oslozhnennymi perelomami reber [Treatment of patients with complicated fractures of the ribs] / V.F. Altunin, V.I. Evseev // Sovetskaya medicina [Soviet medicine]. — 1981. — № 6. — S.39—43.

 

Hemodynamic changes in vascular reconstruction in patients with diabetic foot syndrome

KONSTANTIN A. KOREYBA, Ph.D., Associate Professor of Department of general surgery of SBEI HPE «Kazan State Medical university» of Ministry of Health of Russia, Kazan, Russia, tel. 8-927-412-87-03, e-mail: korejba_k@mail.ru

IVAN V. KLYUSHKIN, M.D., Professor of Department of general surgery of SBEI HPe «Kazan State Medical university» of Ministry of Health of Russia, Kazan, Russia, tel. 8-919-624-96-40, e-mail: hirurgivan@rambler.ru

RUSLAN I. FATYKHOV, Ph.D., Assistant of Department of general surgery of SBEI HPE «Kazan State Medical university» of Ministry of Health of Russia, Kazan, Russia, tel. 8-927-400-02-95, e-mail: 74ruslan@rambler.ru

Abstract. Diabetic foot is a formidable and late complications of diabetes. The purpose of the study. Evaluate the possibility of using a combined surgical approach — complex festering and vascular surgery patients with the syndrome of diabetic foot. Material and methods. In providing comprehensive quality medical care decisive stage of therapy is to achieve a reconstructive surgery. Results and discussion. Technically, the successful execution of the intervention does not guarantee restoration of peripheral blood fow and limb salvage, if not adequately formed the postoperative period, which is a major complication of reperfusion syndrome. It represents the collection of complications following the restoration of blood fow in the previously ischemic tissues and organs. Currently there are no common approaches and standards of conservative treatment of this pathology. Some vascular intervention only in the arcades of the foot. Conclusion. The paper presents a method for the prevention of reperfusion syndrome in vascular reconstruction in patients with arterial bed of diabetic foot syndrome used in the Center «Diabetic foot» Kazan.

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

 

References

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

 

 

Emergency to the patients with ischemic and neuroischemic forms of diabetic foot syndrome at the example of «Diabetic foot» Center

KONSTANTIN A. KOREYBA, Ph.D., Associate Professor of Department of general surgery of SBEI HPE «Kazan State Medical university» of Ministry of Health of Russia, Kazan, Russia, tel. 8-927-412-87-03, e-mail: korejba_k@mail.ru

IVAN V. KLYUSHKIN, M.D., Professor of Department of general surgery of SBEI HPE «Kazan State Medical university» of Ministry of Health of Russia, Kazan, Russia, tel. 8-919-624-96-40, e-mail: hirurgivan@rambler.ru

RUSLAN I. FATYKHOV, Ph.D., Assistant of Department of general surgery of SBEI HPE «Kazan State Medical university» of Ministry of Health of Russia, Kazan, Russia, tel. 8-927-400-02-95, e-mail: 74ruslan@rambler.ru

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

Abstract. Diabetic foot syndrome — is one of the formidable and late complications of diabetes, often the outcome of the pathology is the fulfllment of a traumatic surgical benefts. The purpose of the study. Evaluate the work of the center «Diabetic foot» of Kazan. For emergency medical care perspective is the creation of specialized centers, including the necessary specialists, diagnostic equipment and the use of modern medications. Material and methods. The article presents the experience of the Center «Diabetic foot» of Kazan for emergency angiosurgical care to patients with purulent-necrotic complications of diabetic foot syndrome. Results and discussion. The possibilities of the center, the percentage of qualifed medical assistance as well as to combine work two clinics: Center «Diabetic foot» and angiosurgical branch of the Republican Clinical Hospital of the city of Kazan. Zaklyuchenie.Vydeleny key steps to assist the prospects for their improvement and optimization as the example mentioned clinics, and at the level of outpatient care, the Department of general surgery.

Key words: diabetic foot syndrome, acute diabetic foot, vascular reconstruction.

 

References

1.   Katel'nickii, I.I. Pervyi opyt kolichestvennoi ocenki rezul'tatov terapevticheskogo angiogeneza [First experience of a quantitative assessment of results of a therapeutic angiogenez] / I.I. Katel'nickii, G.A. Alekseeva // KTTI. — 2012. — № 6. — S.83—85.
2.   Klyushkin, I.V. Ocenka effektivnosti konservativnoi terapii sindroma diabeticheskoi stopy [Effciency evaluation of conservative therapy of a syndrome of diabetic foot] / I.V. Klyushkin, R.I. Fatyhov, K.A. Koreiba // Saharnyi diabet i hirurgicheskie infekcii: materialy Mezhdunar. nauch.-prakt. kongr., posvyasch. 40-letiyu so dnya osnovaniya v Institute hirurgii im. A.V. Vishnevskogo otdela ran i ranevyh infekcii. — M., 2013 — S.150.
3.   Klyushkin, I.V. Formirovanie shemy infuzionnoi terapii pri sindrome diabeticheskoi stopy [Forming of the scheme of infusional therapy in case of a syndrome of diabetic foot] / I.V. Klyushkin, K.A. Koreiba, R.I. Fatyhov // Obschestvennoe zdorov'e i zdravoohranenie [Public health and health care]. — 2013. — № 2. — S.38—40.
4.   Koreiba, K.A. Genterapevticheskie tehnologii v korrekcii angiogeneza pri sindrome diabeticheskoi stopy [Genterapevticheskiye's of technology in correction of an angiogenez in case of a syndrome of diabetic foot] / K.A. Koreiba, A.V. Sharafutdinov // Sovremennye napravleniya razvitiya mediciny-2014: Mezhdunar nauch.-prakt. konf.: sb. st. — Bryansk, 2014. — S.12—15.
5.   Staroverov, I.N. Pervyi opyt lecheniya genterapevticheskim preparatom bol'nyh pri sochetanii ateroskleroza i diabeticheskoi angiopatii nizhnih konechnostei [The frst experience of treatment by a genterapevtik preparation of patients in case of a combination of atherosclerosis and a diabetic angiopathy lower extrymethy] / I.N. Staroverov, Yu.V. Chervyakov, O.M. Lonchakova, O.N. Vlasenko //
Aktual'nye voprosy diagnostiki, lecheniya i proflaktiki sindroma diabeticheskoi stopy: V Vseros. nauch.-prakt. konf., posvyasch. 200-letiyu Kazan. gos. med. un-ta. — Kazan', 2013. — S.89—91.
6.   Shval'b, P.G. Bezopasnost' i kratkosrochnaya effektivnost' genoterapevticheskogo preparata u pacientov s hronicheskoi ishemiei nizhnih konechnostei [Bezopasnost and short-term effciency of a genoterapevtik preparation at patients with chronic ischemia lower extremity] / P.G. Shval'b, R.E. Kalinin, S.V. Gryaznov // Kardiologiya i serdechno-sosudistaya hirurgii [Cardiology and cardiovascular surgery]. — 2011. — № 4. — S.61—66.
7.   Pavelkin, A.G. Ocenka effektivnosti tromboliticheskoi terapii pri oslozhnennyh formah diabeticheskoi stopy [Quality of effciency of thrombolytic therapy at the complicated forms of diabetic foot] / A.G. Pavelkin, A.N. Belyaev // Medicnskii al'manah [Medical almanac]. — 2012. — № 4(23). — S.88—91 (N. Novgorod: OOO «Yunion Print»).
8.   Pavlova, M.G. Sindrom diabeticheskoi stopy [Sindrom of diabetic foot] / M.G. Pavlova, T.V. Gusov, N.V. Lavrischeva // Trudnyi pacient [Diffcult patient]. — 2006. — № 1. — S.25—28.
9.   Sergeeva-Kondrachenko, M.Yu. Diabeticheskaya neiropatiya [Diabetiс neuropathy] / M.Yu. Sergeeva-Kondrachenko // Remedium — Povolzh'e [Remedium — the Volga region]. — M., 2012. — S.17—25.
10. Altland, O.D. Low-intensity ultrasound increases endothelial cell nitric oxide syntase activity and nitric oxide synthesis / O.D. Altland // J. Thromb. Haemost. — 2004. — Vol. 2. — P.637—643.
11.  Bode, B. Ultrasound-Guided Fine Needle Aspirations of PET-CT Findings During Staging of Malignancies / B. Bode // Ultrasound in Medicine and Biology. — 2011. — Vol. 37, № 8S. — S28.04.
12. Bota, S. The Usefulness of Liver and Spleen Stiffness Evaluated by Means of Acoustic Radiation Force Impulse Elastography for the Prediction of Esophageal Varices in Cirrhotic Patients / S. Bota, I. Sporea, R. Sirli // Ultrasound in Medicine and Biology. — 2011. — Vol. 37, № 8S. — S29.04.

 

 

Index CAVI in patients with chronic arterial insufficiency

MARIA I. MALKOVA, Ph.D., Аssistant of Department of propaedeutics of internal diseases of SBE HPE «Kazan State Medical university» of Ministry of Health of Russia, Head of the Department of functional diagnostics of city Hospital № 7, Kazan, Russia, e-mail: marimalk@yandex.ru

MARAT N. SADYKOV, Ph.D., Сhief medical officer of city Hospital № 7, Kazan, Russia

OLGA V. BULASHOVA, M.D., Рrofessor of Department of propaedeutics of internal diseases of SBE HPE «Kazan State Medical university» of Ministry of Health of Russia, Kazan, Russia, e-mail: boulashova@yandex.ru

ELENA V. KHAZOVA, Ph.D., Аssistant of Department of propaedeutics of internal diseases of SBE HPE «Kazan State Medical university» of Ministry of Health of Russia, Kazan, Russia, e-mail: hazova_elena@mail.ru

ZIA M. MUKHTAROV, graduate student of Department of surgery SBEI APe «Kazan State Medical Academy» of the Ministry of Health of Russia, Kazan, tel. 8-927-672-40-70

Abstract. A research objective — to estimate infuence of perioperaive β-blockers application on cardiac risk in abdominal surgery. Material and methods. Under supervision there were 87 patients with acute cholecystitis having this or that cardiac pathology and indications for perioperative β-blockers’ therapy, who was divided into 2 groups: to patients of the 1 group (44 persons) was added to standard therapy; to patients of the 2 group (43 persons) β -blockers weren't added because of the contraindications. Results. β-blockers therapy within (36,0±7,8) days before operation showed reliable decrease in heart rate in 24 hours after operation in comparison with the patient not receiving treatment b-blockers. Use in the preoperative period led to decrease by 40% of number of approach of fnal points, than in group without inclusion β-blockers in treatment. β-blockers therapy reduced cardiovascular mortality at patients with high cardiac risk, but at the same time there was a doubtful increase in frequency of hospitalization concerning cardiovascular. Conclusion. Perioperative β-blockers application at patients with acute cholecystitis of an average and high cardiac risk reduces the heart rate and the systolic arterial pressure.

Key words: β-blockers, perioperative cardiac risk, nonacardiac surgery.

 

References

1.   Effect of atenolol on mortality and cardiovascular morbidity after noncardiac surgery. Multicenter Study of Perioperative Ischemia Research Group / D.T. Mangano, E.L. Layug, A. Wallace, I. Tateo // N. Engl. J. Med. — 1996. — Vol. 335. — P.1713—1720.
2.   The effect of bisoprolol on perioperative mortality and myocardial infarction in high-risk patients undergoing vascular surgery. Dutch Echocardiographic Cardiac Risk Evaluation Applying Stress Echo-cardiography Study Group / D. Poldermans, E. Boersma, J.J. Bax [et al.] // N. Engl. J. Med. — 1999. — Vol. 341. — P.1789—1794.
3.   Perioperative beta-blockade (POBBLE) for patients undergoing infrarenal vascular surgery: results of a randomized double-blind controlled trial / A.R. Brady, J.S. Gibbs, R.M. Greenhalghet [et al.] // J. Vasc. Surg. — 2005. — Vol. 41. — P.602—609.
4.   The effects of perioperative beta-blockade: results of the Metoprolol after Vascular Surgery (MaVS) study, a randomized controlled trial / H. Yang, K.Raymer, R.Butler [et al.] // Am. Heart. J. — 2006. — Vol. 152. — P.983— 990.
5.   Effect of perioperative beta-blockade in patients with diabetes undergoing major non-cardiac surgery: randomised placebo controlled, blinded multicentre trial / A.B. Juul, J. Wetterslev, C. Gluud [et al.] // Bmj. — 2006. — Vol. 332. — P.1482—1488.
6.   Effects of extended — release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial):
a randomised controlled trial / P.J. Devereaux, H. Yang, S. Yusuf [et al.] // Lancet. — 2008. — Vol. 371. — P.1839—1847.
7.   A meta-analysis of safety and effectiveness of perioperative beta-blocker use for the prevention of cardiac events in different types of noncardiac surgery / O. Schouten, L.J. Shaw, E. Boersma [et al.] // Coron. Artery Dis. — 2006. — Vol. 17. — P.173—179.
8.   Bisoprolol and fuvastin for the reduction of perioperative cardiac mortality and myocardial infarction in intermediate — risk patients undergoing non — cardiovascular surgery; a randomized controlled trial (DECREASE-IV) / M. Dunkelgrun, E. Boersma, O. Schouten [et al.] //Ann. Surg. — 2009. — Vol. 249. — P.921—926.
9.   Guidelines for pre-operative cardiac risk assessment and perioperative cardiac management in non-cardiac surgery: the Task Force for Preoperative Cardiac Risk Assessment and Perioperative Cardiac Management in Non-cardiac Surgery of the European Society of Cardiology (ESC) and endorsed by the European Society of Anaesthesiology (ESA) / D. Poldermans, J.J. Bax, E. Boersma [et al.] // Eur. Heart. J. — 2009. — Vol. 30(22). — P.2769—2812.
10. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery / T.H. Lee, E.R. Marcantonio, C.M. Mangione [et al.] // Circulation. — 1999. — Vol. 100. — P.1043—1049.
11.  Hlatky, M.A. A brief self-administered questionnaire to determine functional capacity (the Duke Activity Status Index) / M.A. Hlatky, R.E. Boineau, M.B. Higginbotham [et al.] // Am. J. Cardiol. — 1989. — Vol. 64. — P.651— 654.
12. Fletcher G.F. Exercise standards for testing and training: a statement for health-care professionals from the American Heart Association / G.F. Fletcher, G.J. Balady, E.A. Amsterdam [et al.] // Circulation. — 2001. — Vol. 104. — P.1694—1740.

 

 

Predicting the risk of recurrent bleeding from the upper gastrointestinal tract at the present stage

REGINA F. MULLAIANOVA, neurologist of neurology emergency Department of SAiH «City clinical Hospital № 7», Kazan, Russia, tel. 8-917-281-89-42, e-mail: murefa@mail.ru

EDUARD Z. YAKUPOV, M.D., Professor, Head of Department of neurology, neurosurgery and medical genetics of SBEI HPE «Kazan State Medical University» of Ministry of Health of Russia, tel. 8-987-290-25-62, e-mail: ed_yakupov@mail.ru

Abstract. Benign paroxysmal positional vertigo (BPPV) — a disease that occurs in a variety of lesions of the inner ear characterized by episodes of momentary dizziness, developing paroxysmally (paroxysmal) by changing the position of the head. The disease has a mechanical nature so it is called benign. The cause of dizziness when BPPV are fragments of the otolith membrane, which when free movement penetrate the endolymphatic space of the semicircular canals. Reasons causing vertigo creates certain diffculties in diagnosis. Vertigo characteristic of lesions of the peripheral vestibular system as well as its central departments. It is necessary to clarify the nature of dizziness, his consistency, duration, dependence on the position of the body and head. The use of positional maneuvers leading to complete relief of vertigo attacks.

Key words: BPPV, dizziness, otoliths, nystagmus.

 

References

1.   Brandt, T. Golovokruzhenie [Vertigo] / T. Brandt, M. Diterih, M. Shtrupp; per. s angl. — M.: Praktika, 2009. — 200 s.
2.   Vereschagin, N.V. Nedostatochnost' krovoobrascheniya v vertebral'no-bazilyarnoi sisteme [Circulatory insuffciency in the vertebrobasilar system] / N.V. Vereschagin // Consilium Medicum. — 2003. — T. 5, № 2. — S.56—61.
3.   Epidemiologiya, klinika i lechenie betaserkom golovokruzheniya pri nachal'nyh i obratimyh formah cerebrovaskulyarnoi patologii [The epidemiology, clinical features and treatment of vertigo betaserk in initial and reversible forms of cerebrovascular pathology] / G.V. Gornostaeva, Yu.Ya. Varakin, N.S. Alekseeva [i dr.] // Zhurnal nevrologii i psihiatrii im. S.S. Korsakova. — 2005. — № 105(9). — S.14—17.
4.   Kosivceva, O.V. Golovokruzhenie v nevrologicheskoi praktike (obschie voprosy diagnostiki i lecheniya) [Dizziness in neurological practice (general diagnosis and treatment)] / O.V. Kosivceva, M.V. Zamergrad // Zhurnal nevrologii, neiropsihiatrii, psihosomatiki. — 2012. — Vyp. 1. — S.48—51.
5.   Parfenov, V.A. Golovokruzhenie v nevrologicheskoi praktike [Dizziness in neurological practice] / V.A. Parfenov, M.V. Zamergrad // Nevrologicheskii zhurnal. — 2005. — № 10. — S.29—33.
6.   Sheremet, A.S. Golovokruzhenie kak priznak porazheniya vestibulyarnogo analizatora. Diagnosticheskie stereotipy [Vertigo as a sign of the defeat of the vestibular analyzer. Diagnostic stereotypes] / A.S. Sheremet // Consilium Medicum. Otolaringologiya. — 2001. — № 4. — S.15.
Brandt, T. Management of vestibular disorders / T. Brandt // J. Neurol. — 2000. — № 247. — Р.491—499.
8.   Dohlman, G. Investigators in the function of the semicurcular canals / G. Dohlman //Acta Otolaryngol. Suppl. (Stockh). — 1944. — Vol. 51. — Р.211.
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10. Epley J.M. The canalith repositioning proctdure: for treatment of enign paroxysmal positional vertigo / J.M. Epley // Otolaryngol Head Neck. Surg. — 1992. — Vol. 107, № 3. — Р.399—404.
11 . Semont, A. Benign paroxysmal positional vertigo and provocative maneuvers / A. Semont, G. Freyss, E. Vitte // Ann. Otolaryngol Chir. Cervicofac. — 1989. — Vol. 106, № 7. — Р.473—478.

 

Surgical treatment of acute aortic dissection experience type A in technical evolution and surgical risk factors modifying context

MURAT N. MUKHARYAMOV, PhD., cardiovascular surgeon of Department of cardiac surgery, ICDC, Kazan, Russia, tel. 8-917-263-58-41, e-mail: mukharyamov@yahoo.com

ROIN K. DZHORDZHIKIYA, M.D., Рrofessor, Сhief of Department of surgical diseases of SBEI HPE «Kazan State Medical university», Kazan, Russia, tel. +7-987-296-51-72, e-mail roink@mail.ru

ILDAR I. VAGIZOV, Сhief of the cardiac surgery Department 2, ICDC, Kazan, Russia

Abstract. Acute aortic dissection type A (Stanford classifcation) is anextremely dangerous condition with high mortality rate. Reduction of diagnostic procedures period and early surgical intervention are benefcial. Single center experience of surgical treatment of acute aortic dissection, surgical risk factors analysis are summarized in the current study. Modifcation of the surgical protocols of the ascending aorta replacement, antegrade perfusion during cardiopulmonary bypass, selective brain perfusion during circulatory arrest, use of the local hemostatic materials lead to the signifcant improvement of early and mid-term outcomes and reduction of perioperative mortality rates. However, residual postoperative malperfusion syndrome detection, differential diagnosis and treatment requires further investigation.

Key words: acute aortic dissection, thoracic aorta replacement.

 

References

1.   Bokeriya, L.A. Serdechno-sosudistaya hirurgiya-2012. Bolezni i vrozhdennye anomalii sistemy krovoobrascheniya [Cardio-vascular surgery 2012. Acquired and congenital circulatory diseases] / L.A. Bokeriya, R.G. Gudkova. — M.: NCSSH im. A.N. Bakuleva RAMN, 2013. — 191 s.
2.   Belov, Yu.V. Neposredstvennye i otdalennye rezul'taty hirurgicheskogo lecheniya anevrizm i rassloenii voshodyaschego otdela i dugi aorty [Early and long term results of surgical treatment of ascending aorta and aortic arch aneurisms and dissections] / Yu.V. Belov, A.B. Stepanenko, F.V. Kuznechevskii // Rossiiskii kardiologicheskii zhurnal. — 2004. — № 5. — S.5—17.
3.   2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/ SVM guidelines for the diagnosis and management of patients with thoracic aortic disease / L.F. Hiratzka, G.L. Bakris, J.A. Beckman [et al.] //Journal of the American College of Cardiology. — 2010. — Т . 55, № 14. — P.e27—e129.
4.   Arterial access through the right subclavian artery in surgery of the aortic arch improves neurologic outcome and mid-term quality of life / F.F. Immer, B. Moser, E.S. Krähenbühl [et al.] // Ann. Thorac. Surg. — 2008. — № 85. — P.1614—1618.
5.   Axillary artery: an alternative site of arterial cannulation for patients with extensive aortic and peripheral vascular disease / S.F. Sabik, B.W. Lytle, P.M. McCarthy [et al.] // J. Thorac. Cardiovasc. Surg. — 1995. — № 109. — P.885—890; discussion P.890—881.
6.   Evidence, lack of evidence, controversy, and debate in the provision and performance of the surgery of acute type A aortic dissection / R.S. Bonser, A. Ranasinghe, M. Loubani [et al.] // Journal of the American College of Cardiology. — 2011. — Т. 58, № 24. — P.2455—2474.
7.   German registry for acute aortic dissection type A (GERAADA): lessons learned from the registry / T. Krüger, E. Weigang, I. Hoffmann [et al.] // Thorac. Cardiovasc. Surg. — 2010. — Vol. 58. —P.154—158.
8.   Impact of perfusion strategy on outcome after repair for acute type A aortic dissection / C.D. Etz, K. von Aspern, E. Silva J. da Rocha [et al.] // The Annals of thoracic surgery. — 2014. — Vol. 97, №. 1. — С.78—85.
9.   Kuzmik, G.A. Natural history of thoracic aortic aneurysms / G.A. Kuzmik, A.X. Sang, J.A. Elefteriades // Journal of vascular surgery. — 2012. — Vol. 56, №. 2. — С.565— 571.
10. Neurological outcomes after immediate aortic repair for acute type A aortic dissection complicated by coma / T.P. Tsukube, T. Hayashi, T. Kawahira [et al.] // Circulation. — 2011. — Vol. 124. — P.S163—7.
11.  «Time is money» Early mortality in type A acute aortic dissection: insights from the IRAD registry / C. Strauss, K. Harris, S. Hutchison [et al.] // Journal of the American College of Cardiology. — 2013. — Vol. 61. — №. 10S.
12. Tsai, T.T. Acute aortic dissection: perspectives from the International Registry of Acute Aortic Dissection (IRAD) / T. T. Tsai, S. Trimarchi, C.A. Nienaber // Eur. J. Vasc. Endovasc. Surg. — 2009. — Vol. 37. — P.149—159.

 

 

Mechanisms of orthostatic hypotension in patients with autonomic dysfunction due to chronic cerebral ischemia with predominantly vertebrobasilar insufficiency

ANNA V. NALBAT, Ph.D., Assistant of Department of neurology, neurosurgery and medical genetics of SBEI HPE «Kazan State Medical University», Kazan, Russia, e-mail: an.na.box@mail.ru

EDUARD Z. YAKUPOV, M.D., Professor, Head of Department of neurology, neurosurgery and medical genetics, of SBEI HPe «Kazan State Medical University», Kazan, Russia, e-mail: ed_yakupov@mail.ru

Abstract. Aim. The purpose of our study was to evaluate the mechanisms of orthostatic hypotension in patients with autonomic dysfunction due to chronic cerebral ischemia with predominantly vertebrobasilar insuffciency. Material and methods. The features of autonomic reactivity and autonomic maintenance of activity during the orthostatic test in 36 patients aged 50-70 with chronic cerebral ischemia were analyzed. Results. In patients with chronic cerebral ischemia affected the structures perfused with vertebrobasilar vessels the autonomic failure was shown. It, in turn, was the result of suffering of the central autonomic structures located in the area of reticular formation, inferior olive of the medulla oblongata and red nuclei of the midbrain, which was confrmed by magnetic resonance tomography. Conclusion. In patients with autonomic dysfunction due to chronic cerebral ischemia with predominantly vertebrobasilar insuffciency orthostatic hypotension during the orthostatic test was a manifestation of a lack of autonomic reactivity and autonomic support of activity.

Key words: orthostatic hypotension, autonomic dysfunction, chronic brain ischemia, vertebrobasilar insuffciency.

 

References

1.   Kadykov, A.S. Hronicheskie sosudistye zabolevaniya golovnogo mozga (discirkulyatornaya encefalopatiya) [Chronic cerebrovascular diseases] / A.S. Kadykov, L.S. Manvelov, N.V. Shahparonova. — M.: GEOTAR-Media, 2006. — 224 s.
2.   Mihailov, V.M. Variabel'nost' ritma serdca: opyt prakticheskogo primeneniya metoda [Heart rate variability: experience in the practical application of the method] / V.M. Mihailov. — 2-e izd., pererab. i dop. — Ivanovo: Ivanov. gos. med. akad., 2002. — 290 s.
3.   Okorokov, A.N. Diagnostika boleznei vnutrennih organov: v 10 t. [Diagnosis of the internal diseases] / A.N. Okorokov // Diagnostika boleznei serdca i sosudov [Diagnosis of diseases of the heart and blood vessels]. — M.: Med. lit.,
2003. — T. 7. — 416 s.
4.   Serdechno-sosudistye zabolevaniya u pozhilyh [Cardiovascular diseases in the elderly] / A.I. Dyadyk, A.E. Bagrii, E.V. Schukina [i dr.]; pod red. A.I. Dyadyka, A.E. Bagriya. — Kiev: OOO «Lyudi v belom», 2013. — 172 s.
5.   Consensus statement on the definition of orthostatic hypotension, pure autonomic failure, and multiple system atrophy / The Consensus Committee of American Autonomic Society and the American Academy of Neurology // Neurology. — 1996. — № 46. — P.1470.
6.   Orthostatic hypotension predicts mortality in middle-aged adults: The Atherosclerosis Risk in Communities (ARIC) study / K.M. Rose, M.L. Eigenbrodt, R.L. Biga [et al.] // Circulation. — 2006. — № 114. — P.630—636.
7.   Primer on the Autonomic Nervous System / V. Accurso, M. Alvarenga, L.A. Arnold [et al.]; ed. D. Robertson. — 2-nd ed. — California; San Diego: Elsevier Academic Press,
2004. — 459 p.
8.   Prognosis of diastolic and systolic orthostatic hypotension in older persons / H. Luukinen, K. Koski, P. Laippala, S.L. Kivela // Archives of Internal Medicine. — 1999. — № 159. — P.273—280.
9.   Sclater, A. Orthostatic hypotension: A primary care primer for assessment and treatment / A. Sclater, K. Alagiakrishnan // Geriatrics. — 2004. — № 59. — P.22—27.

 

Combined treatment of patients with gastrointestinal bleeding

MAGOMED N. NASRULLAYEV, M.D., Professor of the Department of clinical anatomy and outpatient surgery SBEI APE «Kazan state medical Academy» of Ministry of health Russia, Kazan, Russia, tel. (843) 272-47-71, e-mail: mail: msh-oao-кар@уаndex.ru

Abstract. Optimization of treatment of gastrointestinal bleedings. Material and methods. Under supervision there were 29 patients with the diagnosis gastric bleeding. All patient after the carried-out conservative therapy executed operation — bandaging of branches small and big perigastrichesky arches in the feld of a bleeding source. Results and their discussion. All patient after the diagnosis of gastric bleeding were appointed by the conservative therapy. Replaceable therapy: at easy severity of blood loss the volume of infusions makes 800-1000 ml with a ratio of crystalloid (80%), colloids (20%). Infusion volume at moderate severity of blood loss is equal 1500-2300 ml in a ratio-kristalloidy (60%), colloids (30%), fresh frozen plasma (20%), and at the heavy makes 2700 and more than a ml [crystalloid (20%) + colloids (30%) + fresh frozen plasma (30%) + the eritrotsitny weight (20%)]. The replacement therapy requires careful monitoring of hemodynamic parameters and fuid load given the unpredictability of the body's response to blood loss and its replacement. In the absence of effect from carried-out therapy surgery is executed. Conclusion. The treatment by the patients with gastrointestinal bleedings has to be complex, taking into account specifc features of the specifc patient, and also accompanying pathology.

Key words: a gastrointestinal bleedings, a conservative therapy, the degree of blood loss, infusion.

 

References

1. Pal'cev, A.I. Problemy zdorov'ya i bolezni, diagnostiki i lecheniya s istoriko-flosofskih pozicii [Issues of health and
disease, diagnosis and treatment with the historical and philosophical positions] / A.I. Pal'cev // Rossiiskii zhurnal gastroenterologii, gepatologii, koloproktologii. — 2011. — T. 11, № 5. — S.181.
2.   Bagnenko, S.F. Primenenie protokolov organizacii lechebno-diagnosticheskoi pomoschi pri yazvennyh gastroduodenal'nyh krovotecheniyah v klinicheskoi praktike [Application protocols organization of medical diagnostic aid in ulcerative gastroduodenal bleeding in clinical practice] / S.F. Bagnenko, G.I. Sinenchenko, V.G. Verbickii, A.A. Kurygin // Vestnik hirurgii. — 2007. — № 4. — S.71—75.
3.   Gostischev, V.K. Ostrye gastroduodenal'nye yazven-nye krovotechenie ot strategicheskih koncepcii k lechebnoi taktike [Acute gastroduodenal ulcer bleeding from strategic concepts to medical tactics] / V.K. Gostischev, M.A. Evseev. — M.: Anto-Eko, 2005. — 352 s.
4.   Evseev, M.A. Antisekretornye preparaty v neotlozhnoi hirurgicheskoi gastroenterologii [Antisecretory drugs in emergency surgical gastroenterology] / M.A. Evseev. — M., 2009. — 173 s.
5.   Zvenigorodskaya, L.A. Osobennosti klinicheskogo techeniya i lekarstvennoi terapii yazvennoi bolezni u pozhilyh bol'nyh [Clinical features and drug therapy of peptic ulcer disease in elderly patients] / L.A. Zvenigorodskaya // Consilium medicum. — 2007. — T. 10, № 8. — S.27—33.
6.   Sacukevich, V.N. Ostrye zheludochno-kishechnye krovotecheniya iz hronicheskih gastroduodenal'nyh yazv [Acute gastrointestinal bleeding from chronic gastroduodenal ulcers] / V.N. Sacukevich, D.V. Sacukevich // Kremlevskaya medicina. — 2000. — № 2. — C.100— 105.
7.   Barkun, A. The Canadian Registry on Nonvariceal Upper Gastrointestinal Bleeding and Endoscopy (RUGBE): endoscopic hemostasis and proton pump inhibition are associated with improved outcomes in a real-life setting. / A. Barkun, S. Sabbah, R. Enns [et al.] // Am. J. Gastroenterol. — 2004. — Vol. 99. — P.1238— 1246.
8.   Barkun, A. The Nonvariceal Upper GI Bleeding Consensus Conference Group. Clinical Guidelines Consensus Recommendations for Nonvariceal Upper Gastrointestinal Bleeding / A. Barkun, M. Bardou, J.K. Marshall [et al.] // Annals of Internal. Medicine. — 2003. — Vol. 139(10). — P.857.
9.   Lassen, A. Complicated and uncomplicated peptic ulcers in a Danish county 1993—2002: a population-based cohort study / A. Lassen, J. Hallas, O.B. Schaffalitzky de Muckadell // Am. J. Gastroenterol. — 2006. — Vol. 101. — P.945—953.
10. Calvet, X. Endoscopic treatment of bleeding ulcers: has everything been said and done? / X. Calvet, M. Vergara, E. Brullet //Gastroenterol Hepatol. — 2005. — Vol. 28(6). — P.347—353.
11 . Grainek, I.M. Management of acute bleeding from a peptic ulcer / I.M. Grainek, A.M. Barkum, M. Bardou // N. Engl. J. Med. — 2008. — № 359. — Р.928—937.
12. Lim, C.H. The outcome of suspected upper gastrointestinal bleeding with 24-hour access to upper gastrointestinal endoscopy: a prospective cohort study / C.H. Lim, D. Vani, S.G. Shah [et al.] // Endoscopy. — 2006. — Vol. 38. — P.581—585.
13. Viviane, A. Estimates of costs of hospital stay for variceal and nonvariceal upper gastrointestinal bleeding in the United States / A. Viviane, B.N. Alan // Value Health. — 2008. — Vol. 11. — P.1—3.

 

 

Study of the structure of calls for psychiatric ambulance team into somatic hospitals of Kazan

GRIGORIY V. ORLOV, Ph.D., teaching assistant of Department of psychiatry and narcology of SBEI HPE «Kazan State Medical university» Russian Ministry of Health, Kazan, Russia, tel. (843)236-41-24, e-mail: vrah16@mail.ru

IVAN A. MITROFANOV, psychiatrist of Department of the first care aid, Kazan, Russia, tel. 8-927-418-74-32, e-mail: vanek_doc@mail.ru

YULIA V. TROSHINA, graduate student of the Department of neurology, neurosurgery and medical genetics of SBEI HPE «Kazan State Medical university» Russian Ministry of Health, Kazan, Russia, tel. 8-927-422-64-22, e-mail: troshina.yulia@yandex.ru

Abstract. Aim. The purposes of our study were to research the structure and reasons of calls psychiatric ambulance teams of somatic and multifunctional hospitals of Kazan, determinate the characteristic features of patients. Matherial and methods. Under our observation were structures of 87 calls to psychiatric ambulance teams during period since 01.12.2012 to 14.10.2014 and looking through its documentations. Results. It was found that the validity of the call psychiatric teams in health care facilities (when the occasion to call really meant to do it) is 65,51%, which is much higher than among the total number of calls to the psychiatric emergency teams (42,84%) [5], despite the fact that 60,92% of hospitalization in a psychiatric or narcological hospital was denied. Moreover, the absence of psychosomatic departments in multidisciplinary health care facilities, the algorithm to identify mental disorders in somatic hospitals, evaluation criteria indications for emergency psychiatric care and the lack of methodological support reduces the effectiveness of emergency psychiatric care in somatic hospitals.

Key words: psychiatric ambulance team, somatic hospital, psychiatric care in hospital.

 

References

1.   Elfimova, E.V. Organizacionno-pravovye aspekty deyatel'nosti psihiatricheskoi sluzhby v somaticheskom LPU [Procedural and institutional aspects of psychiatric care performance in somatic hospitals] / E.V. Elfmova, M.A. Elfmov // Zamestitel' glavnogo vracha [Deputy chief physician]. — 2010. — № 7. — S.14—27.
2.   Kozyrev, V.N. Somatopsihiatricheskaya i neotlozhnaya psihiatricheskaya pomosch' [Somatic-psychiatric and emergency psychiatric care] / V.N. Kozyrev // Social'naya i klinicheskaya psihiatriya [Social and clinical psychiatry]. — 1997. — T. 7, № 1. — S.116—118.
3.   Drobizhev, M.Yu. Rasprostranennost' psihicheskih rasstroistv v obschemedicinskoi seti [Prevelance of mental diseases in general medical system] / M.Yu. Drobizhev // Psihiatriya i psihofarmakoterapiya [Psychiatry and psychopharmacotherapy]. — 2002. — № 5. — S.175— 180.
4.   Smulevich, A.B. Psihofarmakoterapiya i problemy organizacii psihiatricheskoi pomoschi v somaticheskom stacionare [Psychopharmacotherapy and psychiatric care organization problems in somatic hospital] / A.B. Smulevich, A.L. Syrkin, V.N. Kozyrev, M.Yu. Drobizhev // Klinicheskaya medicina [Clinical medicine]. — 2000. — № 10. — S.22—27.
5.   Orlov, G.V. Analiz struktury i effektivnosti vyzovov psihiatricheskih brigad skoroi pomoschi [The analysis of structure and effectiveness of psychiatric emergency team calls] / G.V. Orlov, I.A. Mitrofanov // Prakticheskaya medicina [Practical medicine]. — 2014. — № 2. — S.86—90.

 

 

A fixed combination of perindopril and amlodipine in hypertensive patients with acute coronary syndrome: a clinical experience

ALLA A. PODOLSKAYA, PhD., associate of Professor of the Department of internal diseases № 2 of SBEI HPE «Kazan State Medical university» of Ministry of Health Russia, Kazan, Russia, e-mail: alla.podolsckaya@yandex.ru

ELLA I. AGLULLINA, Head of cardiology Department № 2 SAIH «City clinical Hospital № 7», Kazan, honoured Doctor of the republic of Tatarstan, Kazan, Russia, tel. 8-917-271-75-73, e-mail: ellaaglullina779@mail.ru

Abstract. Arterial hypertension and coronary heart disease is a frequent combination in patients suffering from diseases of the cardiovascular system, as arterial hypertension is one of the major risk factors for coronary artery disease and accelerates the development of atherosclerosis, therefore, these two diseases frequently coexist. Objective. The article refects results of the study of the effcacy and tolerability of a fxed combination of perindopril + amlodipine for patients with acute coronary syndrome (ACS) in combination with arterial hypertension (AH) III stage, 2 and 3 degree. Retsults and conclusion. It is shown that the drug provides a high antihypertensive effcacy throughout the day, the purpose of perindopril in combination with amlodipine 10/5 mg resulted in a signifcant decrease in blood pressure, heart rate. The drug was well tolerated and required no antihypertensive therapy by the end of observation.

Key words: acute coronary syndrome, hypertension, the fxed combination, blood pressure control, perindopril + amlodipine.

 

References

1.   Karpov, Yu.A. Prestarium u bol'nyh arterial'noi gipertoniei i ishemicheskoi bolezn'yu serdca (ili faktorami riska) — bezopasnoe dostizhenie celevogo urovnya arterial'nogo davleniya (PREM'ERA): rezul'taty klinicheskogo etapa nacional'noi programmy [Prestarium in patients with arterial hypertension and ischemic heart disease (or risk factors) — secure the achievement of target blood pressure (Premiere): the results of the clinical phase of the national programme] / Yu.A. Karpov, S.A. Shal'nova, A.D. Deev // Kardiologiya. — 2006. — № 6. — S.21—27.
2.   Rossiiskoe medicinskoe obschestvo po arterial'noi gipertonii (RMOAG), Vserossiiskoe nauchnoe obschestvo kardiologov (VNOK). Diagnostika i lechenie arterial'noi gipertenzii. Rossiiskie rekomendacii (chetvertyi peresmotr) [Russian Medical Society of hypertension (RMOAG), All-Russian Scientifc Society of Cardiology (GFCF). Diagnosis and treatment of hypertension. Russian recommendations (fourth revision )] // Sistemnye gipertenzii. — 2010. — № 3. — S.5—26.
3.   Perepech, N.B. Lechenie bol'nyh s sochetaniem arterial'noi gipertenzii i ishemicheskoi bolezni serdca — novye
vozmozhnosti [Treatment of patients with a combination of hypertension and coronary heart disease — new opportunities] / N.B. Perepech // Consilium Medicum. — 2011. — T. 13, № 5. — S.20—25.
4.   ADVANCE Collaborative Group. Effects of fxed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus (the ADVANCE trial): a randomised controlled trial // Lancet. — 2007. — Vol.370. — P. 828 — 840.
5.   Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendrofumethiazide as required, in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA): a multicentre randomised controlled trial / B. Dahlof, P.S. Sever, N.R. Poulter [et al.] // Lancet. — 2005. — Vol. 366. — P.895—906.
6.   Cleland, J.G.F. The perindopril in elderly people with chronic heart failure (PEP-CHF) / J.G.F. Cleland, M. Tendera, J. Adamus [et al.] // Eur. Heart J. — 2006. — Vol. 27. — P.2338—2345.
7.   Neaton, J.D. Serum cholesterol, blood pressure, cigarette smoking, and death from coronary heart disease: overall fndings and differences by age for 316,099 white men / J.D. Neaton, D. Wentworth // Arch. Intern. Med. — 1992. — Vol. 152. — Р.56—64.
8.   Ferrari, R. Effects of ACE inhibition with perindopril on left ventricular remodeling and clinical outcome / R. Ferrari // Arch. Intern. Med. — 2006. — Vol. 166. — P.659—666.
9.   Benazepril plus amlodipine or hydrochlorotiazide for hypertension in high-risk patients / K.A. Jamerson, M.A. Weber, G.L. Bakris [et al.] // N. Engl. J. Med. — 2008. — Vol. 359. — P.2417—2428.
10. Outcomes in hypertensive patients at high cardiovascular risk treated with valsartan- or amlodipine-based regimens: VALUE, a randomised trial / S. Julius, S.E. Kjeldsen, M. Weber [et al.] // Lancet. — 2004. — Vol. 363. — P.2022—2031.
11.  Pepine, C.J. A calcium antagonist vs a non-calcium antagonist hypertension treatment strategy for patients with coronaryartery disease. The International Verapamil-Trandolapril Study (INVEST): a randomized controlled trial / C.J. Pepine, E.M. Handberg, R.M. Cooper-DeHoff [et al.] // JAMA. — 2003. — Vol. 290. — P.2805—2816.
12. Ferrari, R. Optimizing the treatment of hypertension and stable coronary artery disease: clinical evidence for fxed-combination perindopril/amlodipine / R. Ferrari // Curr. Med. Res. Opin. — 2008. — Vol. 24. — P.3543—3557.
13. Hatala, R. SYMBIO: Results of a longitudinal study of optimized blood pressurelowering therapy with fixed combination perindopril/amlodipine / R. Hatala K. Bachanova, R. Sidlo [et al.] // J. Hypertens. — 2010. — Vol. 28. — P.98—99.
14. The Task Force for the management of arterial hypertension of the European Society of Hypertension and of the European Society of Cardiolody. 2007 Guidelines for the management of arterial hypertension // J. Hypertens. — 2007. — Vol. 25. — 1105—1187.
15. The ALLHAT Offcers and Coordinators. Major outcomes in high-risk hypertensive patients randomized to ACE inhibitor or calcium channel blocker vs diuretic (ALLHAT) // JAMA. — 2002. — Vol. 288. — P.2981—2997.
16. The EUROPA investigators. Effcacy of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: randomised, double-blind, placebo-controlled, multicentre trial (the EUROPA study) // Lancet. — 2003. — Vol. 362. — P.782—788.
17. The PROGRESS Collaborative Group. Randomised trial of a perindopril-based blood-pressure-lowering among 6105 individuals with previous stroke or transient ischaemic attack // Lancet. — 2001. — Vol. 358. — P.1033—1041.

 

 

Polymorphism of genes of pro -inflammatory cytokines in association with risk of acute myocardial infarction

ALLA A. PODOLSKAYA, PhD., associate Professor of the Department of internal diseases № 2 SBEI HPE «Kazan State Medical University», e-mail: alla.podolsckaya@yandex.ru

EVGENIYA V. MAYKOVA, candidate of biological science, assistant of the Department of biochemistry and biotechnology of Kazan federal university, e-mail: kazan.gen@gmail.com

LILIYA M. SHARAFETDINOVA, post-graduate student of the Department of biochemistry and biotechnology of Kazan federal university, e-mail: l_sungatullina@mail.ru

OLGA A. KRAVTSOVA, candidate of biological science, associate Professor of the Department of biochemistry and biotechnology of Kazan federal university, e-mail: okravz@yandex.ru

Abstract. One of the theories of atherosclerosis is an infammatory theory, according to which the narrowing of the main blood vessels due to the presence of a chronic infammatory reaction, the main markers which are C-reactive protein (CRP) and cytokines imbalance which is refected in increased levels of Pro-infammatory interleukins (IL-1, IL-6, TNF-α and others) and decreased secretion of anti-infammatory cytokines (IL-4, IL-8, IL-10 and others). Objective. Evaluation of cytokine status in acute myocardial myocardin the basis of some proinfammatory cytokines and analysis of the Association of polymorphism in the coding of their genes with the risk of myocardial infarction. Material and methods. The level of proinfammatory cytokines (IL-1, IL-6, TNF-α) serum determined in 56 patients diagnosed with acute myocardial infarction and 20 apparently healthy donors; genotyping the polymorphic loci encoding genes was performed in 260 patients with acute myocardial infarction and 201 conditionally healthy donor. Conclusions.In acute myocardial infarction observed increase in the levels of some proinfammatory cytokines, such as TNF-α and IL-1, and the polymorphism of these genes contributes to the formation of a hereditary predisposition to the development of myocardial infarction, regardless of gender, and can also infuence the form of acute myocardial infarction (with teeth or without teeth Q).

Key words: acute myocardial infarction, cytokines, tumor necrosis factor (TNF-α), interleukin 1 (IL-1), gene polymorphism.

 

References

1.   Galyavich, A.S. Diagnostika i lechenie infarkta miokarda bez pod'ema segmenta ST na EKG [Diagnosis and treatment of myocardial infarction without ST-segment elevation on the ECG] / A.S. Galyavich. — Kazan': ID MEDDok, 2012. — 20 s.
2.   Nasonov, E.L. S-reaktivnyi belok - marker vospaleniya pri ateroskleroze (novye dannye) [C-reactive protein — a marker of infammation in atheroscleroze (new data)] / E.L. Nasonov, E.V. Panyukova, E.N. Aleksandrova // Kardiologiya. — 2002. — № 7. — C.53—62.
3.   Paleev, F.N. Rol' citokinov v patogeneze ishemicheskoi bolezni serdca [The role of cytokines in the pathogenesis of coronary heart disease] / F.N. Paleev, I.S. Belokopytova, B.I. Minchenko // Kreativnaya kardiologiya. — 2011. — № 1. — S.75—78.
4.   Kaptoge, S. C-reactive protein concentration and risk of coronary heart disease, stroke, and mortality: an individual participant meta-analysis / S. Kaptoge, E. Di Angelantonio, G. Lowe [et al.] // Lancet. — 2010. — Vol. 375, № 9709. — P.132—140.
5.   Libby, P. Infammation in atherosclerosis / P. Libby // Arterioscler. Thromb. Vasc. Biol. — 2012. — Vol. 32(9). — P.2045—2051.
6.   Michael, V. Pro- and anti-infammatory Cytokine networks in Atherosclerosis / V. Мichael // SRN Vascular. Medicine. — 2012. — Vol. 2012. — P.1.
7.   Pearson, T.A. CDC/ AHA Workshop on markers of infammation and cardiovascular disease: application to clinical and public health practice / T.A. Pearson, G.A. Mensah, Y. Hong, // Smith Circulation. — 2004. — Vol. 110, № 25. — P.543—544.
8.   Ridker, P.M. Inflammatory biomarkers and risks of myocardial infarction, stroke, diabetes, and total mortality: implications for longevity / P.M. Ridker // Nutr. Rev. — 2007. — Vol. 65, № 12, pt. 2. — P.253—259.
9.   Vitiello, L. Microvascular infammation in atherosclerosis / L. Vitiello, I. Spoletini, I. Gorini // IJC Metabolic & Endocrine. — 2014. — Vol. 3. — P.1—7.

 

Neurologic presentations of gestosis (clinical observation)

NATALIA A. POPOVA, PhD., assistant of the Department of neurology, neurosurgery and medical genetics of SBEI HPE «Kazan State Medical university» of Russian Ministry of Health, Head of the Department of urgent neurology, clinical Hospital № 7, Kazan, Russia, tel. 8-917-269-59-32, e-mail: p_nathali@mail.ru

IRINA F. KHAFIZOVA, PhD., assistant of the Department of neurology, neurosurgery and medical genetics of SBEI HPe «Kazan State Medical university» of Russian Ministry of Health, Kazan, Russia, tel. 8-917-249-31-87, e-mail: sclerdissem@mail.ru

EDUARD Z. YAKUPOV, M.D., professor, Head of the Department of neurology, neurosurgery and medical genetics of SBEI HPe «Kazan State Medical university» of Russian Ministry of Health, Kazan, Russia, tel. 8-987-290-25-62, e-mail: ed_yakupov@mail.ru

Abstract. Gestosis is one of the prevailing causes of maternal mortality. The basis of gestosis is systemic infammatory reaction with endotheliosis development, which is clinically declares itself in arterial hypertension, proteinuria, edema. Often gestosis is accompanied with neurologic presentations which are left with no due reguard. These include vegetative nervous system dysfunction, cerebral edema, acute hypertensive encephalopathy, acute stroke, posterior reversible encephalopathy syndrome. The article considers the most often neurologic presentations of gestosis. It cites a clinical observation of a patient with a rough clinical course of gestosis. Urgent delivery on 27—28 week term was complicated with hemorrhage, disseminated intravascular coagulation syndrome, acute renal insuffciency, consciousness depression. The neurologic presentations were represented mainly with gross oculomotorius disorder. Central pontin myelinolys is considered to be the hypothetical reason for neurologic defciency development.

Key words: gestosis, oculomotorius disorder, MRI, central pontin myelinolys.

 

References

1. Volkova, E.Yu. Central'nyi pontinnyi i ekstrapontinnyi mielinoliz u podrostka [Central pontin and extrapontin myelinolys of adolescence] / E.Yu. Volkova, M.Yu. Bobylova, A.A. Alihanov [i dr.] // Zhurnal nevrologii i psihiatrii im. S.S. Korsakova [The Korsakov’s Journal of Neurology and Psychiatry]. — 2008. — № 2. — C.77—82.
2.   Gur'ev, D.L. Techenie i ishody beremennosti, oslozh-nennoi preeklampsiei, v zavisimosti ot tipa central'noi materinskoi gemodinamiki [Pre-eclampsy complicated pregnancy course and termination according to central maternal haemodynamics] / D.L. Gur'ev, M.B. Ohapkin, N.Yu. Karpov, D.V. Blinov // Akusherstvo i ginekologiya [Midwifery and gynaecology]. — 2011. — № 7. — C.14—19.
3.   Lihachev, S.A. Nevrologicheskie proyavleniya gestoza [Neurologic presentations of gestosis] / S.A. Lihachev, A.V. Astapenko, E.L. Osos // Medicinskie novosti [Medical news]. — 2008. — № 14. — C.22—26.
4.   Medvinskii, I.D. Rol' sindroma sistemnoi vospalitel'noi reakcii v patogeneze gestoza (prognoz razvitiya, diagnostika, vybor metoda anesteziologicheskoi zaschity) [The role of systemic infammatory reaction in gestosis pathogeny]: avtoref. dis. … d-ra med. nauk / I.D. Medvinskii. — Chelyabinsk, 2004. — 56 s.
5.   O materinskoi smertnosti v RF v 2012 g. [Maternal mortality in Russian Federation in 2012] // Metodicheskoe pis'mo Departamenta medicinskoi pomoschi detyam i sluzhby rodovspomozheniya MZ RF. — M., 2013.
6.   Ryleeva, M.S. Nevrologicheskie simptomy i kliniko-laboratornye pokazateli gomeostaza v progno-zirovanii gestoza beremennyh [Neurologic symptoms and laboratorial indexes of homeostasis in toxemia of pregnancy prediction]: avtoref. dis. … kand. med. nauk / M.S. Ryleeva. — Saratov, 2004. — 29 s.
7.   Savel'eva, G.M. Eklampsiya v sovremennom akusherstve [Eclampsy in modern obstetrics] / G.M. Savel'eva, R.I. Shalina, M.A. Kurcer [i dr.] // Akusherstvo i ginekologiya [Midwifery and gynaecology]. — 2010. — № 6. — S.4—9.
8.   Skvorcova, V.I. Sindrom zadnei obratimoi encefalopatii [Posterior reversible encephalopathy syndrome] / V.I. Skvorcova, L.V. Gubskii, E.A. Mel'nikova // Zhurnal nevrologii i psihiatrii im. S.S. Korsakova [The Korsakov’s Journal of Neurology and Psychiatry]. — 2010. — № 5. — S.104—109.
9.   Stahovskaya, L.V. Central'nyi pontinnyi i ekstrapontinnyi mielinoliz [Central pontin and extrapontin myelinolys]/ L.V. Stahovskaya, L.G. Erohina, N.N. Leskova, L.V. Gubskii // Zhurnal nevrologii i psihiatrii im. S.S. Korsakova [The Korsakov’s Journal of Neurology and Psychiatry]. — 2000. — T. 100, № 2. — S.55— 58.
10. Global causes of maternal death: a WHO systematic analysis / L. Say, D. Chou, A. Gemmill, O. Tuncalp // The Lancet Global Healt. — 2014. — Vol. 2, issue 6. — P.e323—e333.
11.  Brown, W.D. Osmotic demyelination disorders: central pontine and extrapontine myelinolysis / W.D. Brown // Curr. Opin. Neurol. — 2000. — Vol. 13. — P.691—697.
12. Clifford, D.V. Osmotic demyelination syndrome. Lack of pathologic and radiologic imaging correlation / D.V. Clifford, M.N. Gado, B.R. Levy // Arch. Neurol. — 1989. — Vol. 46. — P.343—347.
13. Chou, M.C. Posterior reversible encephalopathy syndrome: magnetic resonance imaging and diffusion-weighted imaging in 12 cases / M.C. Chou, P.H. Lai, L.R. Y e h // Kaohsiung J. Med. Sci. — 2004. — Vol. 20(8). — P.381—388.

 

 

Anaphylactic shock in a multidisciplinary clinic

NAILJA M. RAKHMATULLINA, Ph.D., docent, Head of the Department of allergology and immunology of SBEI APE «Kazan State Medical Academy», Kazan, Russia, tel. 8-903-342-99-12, e-mail: nailia.rakhmatullina@gmail.com

NAILJA A. SIBGATULLINA, Ph.D., assistant of the Department of allergology and immunology of SBEI APE «Kazan State Medical Academy», Kazan, Russia, tel. 8-937-623-43-01, e-mail: aminasib@mail.ru

JULIJA V. PASTUSHENKO, assistant of the Department of allergology and immunology of SBEI APe «Kazan State Medical Academy», Kazan, Russia, tel. 8-927-414-01-79, e-mail: vyatkina81@mail.ru

GUZEL N. ZAKIROVA, the doctor-allergist-immunologist of the city clinical hospital № 7, Kazan, Russia, tel. 8-906-114-17-72, e-mail: zakirova.guzel@gmail.com.

DAMIRA G. AKHMEDZYANOVA, the doctor-allergist-immunologist of the city clinical hospital № 7, Kazan, Russia, tel. 8-917-913-39-93, e-mail: ahmdamira@yndex.ru

LJUDMILA V. MAKAROVA, Head of the Department of allergology of the city clinical hospital № 7, Kazan, Russia, tel. 8-903-341-26-84

Abstract. Aim. The purpose of the work was to conduct a comparative analysis of the frequency of hospitalization of patients with the diagnosis of anaphylactic shock in the condition of allergy department of GAUZ Municipal Clinical Hospital N7. Material and method. We have analyzed the 137 medical case histories with a diagnosis of anaphylactic shock. The diagnosis was made based on the medical case history, the clinical course of the disease, a sudden onset, the development of characteristic symptoms. The study evaluated age of the patient, gender, etiologic factor, the severity of anaphylactic shock. Results. The analysis of medical case histories over the period from 2011 to 2013 revealed that the total number of patients with anaphylactic shock was 137 patients, of which predominantly patients in the age of 25,2±6,2. Group differences on gender were not statistically signifcant. Conclusion. During the period from 2011 to 2013 in the structure of hospital morbidity, the number of patients with anaphylactic shock is not signifcantly changed. Leading etiological factor of anaphylaxis are medications (antibiotics, nonsteroidal anti-infammatory drugs, anesthetics).

Key words: anaphylactic shock, sensitization, epinephrine.

 

References

1.   Allergologiya: Federal'nye klinicheskie rekomendacii [Allergology. Federal clinical recommendations] / gl. red. akad. RAN R.M. Haitov, prof. N.I. Il'ina. — M.: Farmus Print Media, 2014. — S.35—46.
2.   Astaf'eva, N.G. Anafilaksiya: klyuchevye aspekty diagnostiki, lechenie i profilaktika v sovremennyh klinicheskih rukovodstvah [Anaphylaxis: key aspects of diagnosis, treatment and prevention in the current clinical guidelines] / N.G. Astaf'eva, I.V. Gamova, L.A. Goryachkina [i dr.] // Farmateka. — 2013. — S.8—15.
3.   Berezovskaya, Z.B. Anaflakticheskii shok u bol'nyh s lekarstvennoi allergiei [Anaphylactic shock in patients with drug allergies] / Z.B. Berezovskaya, I.I. Mishuk, I.G. Slepova, O.L. Karasik // Vrachebnoe delo. — 1991. — № 3. — S.4—8.
4.   Drynov, G.I. Aktual'nye problemy sovremennoi allergologii [Actual problems of modern allergy] / G.I. Drynov. — M.: OOO «Probel-2000», 2003. — S.200—203.
5.   Allergologiya i immunologiya: Nacional'noe rukovodstvo. Kratkoe izdanie [Allergology and immunology. National guidance. Brief edition] / pod red. R.M. Haitova, N.I. Il'inoi. — M.: GEOTAR-Media, 2012. — 640 s.
6.   Lopatin-Bryomzen, A.S. Lekarstvennyi shok [The drug shock] / A.S. Lopatin-Bryomzen. — M.: Medpraktika, 2000. — 196 s.
7.   Campbell, R.L. Evaluation of National Institute of allergy and infectious Diseases/Food Allergy and Anaphylaxis Network criteria for the diagnosis of anaphylaxis in emergency department patients / R.L. Campbell, J.B. Hagan, V. Manivannan [et al.] // J. Allergy Clin. Immunol. — 2012. — Vol. 129. — Р.748—752.
8.   Lieberman, P. Epidemiology of anaphylaxis: fndings of the American College of Allergy, Astma and Immunology Epidemiology of Anaphylaxis Working Group / P. Lieberman, C.A. Camargo, K. Bohlke [et al.] // Ann. Allergy Astma Immunol. — 2006. — Vol. 97(5). — Р.596—602.
9.   Simons, F. Pharmacologic treatment of anaphylaxis: can the evidence base be strengthened? / F. Simons, R. Estelle // Curr. Opin. Allergy Clin. Immunol. — 2010. — Vol. 10(4) — Р.384—393.

 

 

Patients with swallowing disfunctions in ICU № 2 of city clinical hospital № 7. Diagnostic aspects

AIGYUL K. SABIROVA, neurologist of Department neurology for patients with stroke of city clinical Hospital №7, Kazan, tel. +7-937-610-56-34, e-mail: frey5@yandex.ru

DMITRII A. BIRYUKOV, endoscopist of department of endoscopy of city clinical Hospital № 7, tel. +7-919-688-82-83

Abstract. Aim. To show the role of endoscopic method of swallowing detection in determining the methods of enteral nutrition. The article describes the episode introduction in practice of endoscopic method of swallowing detection in patients with stroke, that helps in evaluation of this pathology. Methods. The data of medical records of hospital patients, yearly accounts. Results. We have tried to make a comparative analysis of the clinical method and the method of endoscopic detection of swallowing disorders, their impact on the incidence of complications such as aspiration pneumonia. Аnalyzing the results of the instrumental method of swallowing detection revealed that 9,7% of patients ICU №2 of City Clinical Hospital №7 needs in enteral feeding tube or gastrostomy. Identifcation of dysphagia as having indications for setting probe or gastrostomy helped to reduce aspiration and further complications, such as aspiration pneumonia in patients with stroke that may cause to a reduction in mortality in patients with acute stroke.

Key words: swallowing disfunctions, method for detecting swallowing, aspiration pneumonia.

 

References

1.   Parfenov, V.A. Ishemicheskii insul't [Ischemic stroke] / V.A. Parfenov, D.R. Hasanova. — M.: Medicinskoe informacionnoe agentstvo [Medical Information Agency], 2012. — 298 s.
2.   Skvorcova, V.I. Stanovlenie sistemy okazaniya medicinskoi pomoschi bol'nym s cerebral'nym insul'tom v Rossiiskoi Federacii [Formation of the system of care for patients with cerebral stroke in the Russian Federation] / V.I. Skvorcova, L.V. Stahovskaya, V.G. Lelyuk [i dr.] // Sovershenstvovanie okazaniya medicinskoi pomoschi bol'nym s sosudistymi zabolevaniyami: materialy Vseros. nauch.-prakt. konf. [Materials of the Russian scientifc-practical conference «Improving care for patients with vascular disease»]. — M., Real Taim, 2011. — S.13—33.
3.   Insul't. Diagnostika, lechenie, profilaktika [Stroke. Diagnosis, treatment and prevention] / pod red. Z.A. Suslinoi, M.A. Piradova. — M.: MEDpress-inform, 2009. — 288 s.
4.   Middleton, S. Implementation of evidence-based treatment protocols to manage fever, hyperglycaemia, and swallowing dysfunction in acute stroke (QASC): a cluster randomised controlled trial / S. Middleton, P. McElduff, J. Ward [et al.] // Lancet. — 2011. — Vol. 11. — Р.1699—1706.
5.   Baroni, A. Risk factors for swallowing dysfunction in stroke patients / A. Baroni, S.R. Fabio, R.O. Dantas [et al.] // Arquivos de gastroenterologia. — 2012. — Vol. 49, № 2. — Р.118—124.
6.   Finalyson, O. Risk factors, inpatient care, and outcomes of pneumonia after ischemic stroke / O. Finalyson, M. Kapral, R. Hall [et al.] // Neurology. — 2011. — Vol. 77, № 14. — Р.1338—1345.
7.   Leroy O, Vandenbussche C, Coffnier C. Community-acquired aspiration pneumonia in intensive care units. Epidemiological and prognosis data. / O. Leroy, C. Vandenbussche, C. Coffnier [et al.] // Am. J. Respir. Crit. Care Med. — 1997 — Vol. 1. — P.1922—1929.

 

Chronic kidney disease as a risk factor of acute kidney injury during surgical revascularization coronary vessels in patients with ischemic heart disease

OLGA N. SIGITOVA, M.D., Head of the Department of general practice SBEI HPE «Kazan State Medical University» Russian Ministry of Health, Kazan, Russia, tel. 8-917-396-24-17, e-mail: osigit@rambler.ru

ALINA R. BOGDANOVA, assistant of Professor of the Department of general practice SBEI HPE «Kazan State Medical university» Russian Ministry of Health, Kazan, Russia, tel. 8-927-246-63-94, e-mail: _alinochka@mail.ru

Abstract. The aim of the study was to investigate the risk factors and outcomes of acute kidney injury in patients with coronary heart disease after surgical revascularization of the coronary vessels. The study included 56 patients with coronary artery disease who underwent operative revascularization of the heart, in 2 groups: 1 (observation) — who developed postoperative acute kidney injury (28 patients, 69±1,7, M/F=1/1); 2 (comparison) — a preserved renal function (28 patients, 56,8±1,7, M/F=6/1). Control group — 30 healthy subjects (M/F=3/1, 59,3±0,6). Studied history, clinical and laboratory parameters, estimated glomerular fltration rate by Cockcroft—Gault; data ultrasonography of the kidneys. From a study of risk factors for signifcant direct relationship of acute kidney injury proved to decrease initial glomerular fltration rate less than 63 ml/min; with a combination of multiple risk factors increases the likelihood of its development. Mortality of patients undergoing revascularization complicated by acute kidney injury, was 25%.

Key words: chronic kidney disease, acute kidney injury, coronary revascularization, coronary heart disease, risk factors.

 

References

1.   Grigoryan, Z.E. Kardiorenal'nye vzaimootnosheniya na nachal'nyh stadiyah hronicheskoi bolezni pochek [Cardiorenal relationship in the early stages of chronic kidney disease] / Z.E. Grigoryan, M.E. Evsev'eva // Nefrologiya i dializ [Nephrology and Dialysis]. — 2007. — T. 9, № 2. — S.173—176.
2.   Rudenko, T.E. Renokardial'nye vzaimodeistviya: vozmozhnosti terapevticheskih vmeshatel'stv [Renoсardiaс interaction: possibilities of therapeutic interventions] / T.E. Rudenko, I.M. Kutyrina // Effektivnaya farmakoterapiya. Urologiya i nefrologiya [Effective pharmacotherapy. Urology and Nephrology]. — 2012. — S.57—61.
3.   Smirnov, A.V. Problemy diagnostiki i stratifkacii tyazhesti ostrogo povrezhdeniya pochek [Problems of diagnosis and severity stratifcation of acute kidney injury] / A.V. Smirnov, I.G. Kayukov, O.A. Degtereva [i dr.] // Nefrologiya [Nephrology]. — 2009. — № 3. — S.9—18.
4.   Tomilina, N.A. Ostraya pochechnaya nedostatochnost' [Acute renal failure] / N.A. Tomilina, O.L. Podkorytova // Nefrologiya i dializ [Nephrology and Dialysis]. — 2009. — T. 11, № 1. — S.4—20.
5.   Kuitunen, A. Acute renal failure after cardiac surgery: evaluation of 6 the RIFLE classifcation / A. Kuitunen // Ann. Thorac. Surg. —2006. — Vol. 81, № 2. — Р.542—546.
6.   Acute renal failure — definition, outcome measures, animal 7 models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) / B. Rinaldo, C. Ronco, J. Kellum [et al.] // Critical Care. — 2004. —Vol. 8. — Р.204—212.
7.   Bilateral Acute Tubular Necrosis after Unilateral Extracorporeal 8. Shock-Wave Lithotripsy / D. Kleinknecht, J.-L. Pallot, P. Chauveau // Nephron. — 1994. — Vol. 66. — Р.360—361. 8. Lee, S.H. Clinical outcomes and therapeutic strategy in patients with 9 acute myocardial infarction according to renal function: data from the Korean Acute Myocardial Infarction Registry / S.H. Lee // Circ. J. — 2008. — Vol. 72, № 9. — Р.1410—1418.
9.   Liano, F. Epidemiology of acute renal failure: a prospective, multicenter, community-based study. Madrid Acute Renal Failure Study Group / F. Liano, J. Pascual // Kidney Int. — 1996. — Vol. 50, № 3. — Р.811—818.
10. Hospital acquired renal insuffency: a prospective study / S. Hou, D. Bushinsky, J. Wish [et al.] // Amer. J. Med. — 1983. — Vol. 74. — P.243—248.

 

 

Prognosis in patients with systolic and diastolic heart failure

ELENA G. SLEPUKHA, Ph.D., Assistant of the Department of internal medicine SBEI HPE «Kazan State Medical university» of Ministry of Health of Russia, Head of the Department of cardiology «Municipal Hospital № 7», Kazan, Russia, e-mail: slepuha@fromru.com

OLGA V. BULASHOVA, M.D., Professor of Department internal medicine propaedeutics SBEI HPE «Kazan State Medical university» of Ministry of Health Russia, Kazan, Russia, e-mail: boulashova@yandex.ru

ALSU A. NASIBULLINA, student of Department internal medicine propaedeutics SBEI HPE «Kazan State Medical university» of Ministry of Health Russia, Kazan, Russia, e-mail: almed-89@mail.ru

VIOLETTA M. GAZIZYANOVA, resident of Department internal medicine propaedeutics SBEI HPE «Kazan State Medical university» of Ministry of Health Russia, Kazan, Russia, e-mail: violettakoshka@rambler.ru

Abstract. Because of the high morbidity and mortality in patients suffer from heart failure (HF) it was actual to investigate patients prognosis of heart failure with diastolic and systolic myocardial function. Aim of this study was to investigate in heart failure patients outcome. Material and methods: we examined 133 patients (men and women) with CHF. Outcomes which was investigated follow: hospitalization due to HF decompensation during 5 years, hospitalization deal with cardiovascular diseases during 1 year, common mortality, cardiovascular mortality. Results. Investigation showed that HF is progressive disease, needs often hospitalization due to decompensation and is characterized by high mortality. Worse prognosis was in patients suffered from CHF, caused by ischemic heart disease in combination with myocardial infarction and with systolic left ventricular function. Key words: heart failure, cardiovascular events, prognosis, ejection fraction of left ventricular.

 

References

1. Belenkov, Yu.N. Lechenie serdechnoi nedostatochnosti v ΧΧΙ veke: dostizheniya, voprosy, uroki dokazatel'noimediciny / Yu.N. Belenkov, V.Yu. Mareev // Kardiologiya. — 2008. — № 2. — S.6—16.
2.   Mosterd, А. The prognosis of heart failure in the general population: the Rotterdam Study / А Mosterd [et al.] // Eur. Heart J. Cardiol. — 2001. — Vol. 22. — Р.1318—1327.
3.   Shlyahto, E.V. Sovremennye metody ocenki prognoza pri serdechnoi nedostatochnosti [Modern methods investigation of prognosis in patients with heart failure] / E.V. Shlyahto // Serdechnaya nedostatochnost' [Heart failure]. — 2009. — № 10(6). — S.322—333
4.   Bulashova, O.V. Klinicheskoe znachenie opredeleniya skorosti Na+/Li+-PT u bol'nyh s hronicheskoi serdechnoi nedostatochnost'yu [Clinical mearning detecting Na+/ Li+ — cotransport in patients with chronic heart failure] / O.V. Bulashova, V.N. Oslopov, T.V. Matveeva // Kazanskii medicinskii zhurnal [Kazan medical journal]. — 2003. — № 6. — S.409—413.
5.   Danielyan, M.O. Prognoz i lechenie hronicheskoi serdechnoi nedostatochnosti (dannye 20-letnego nablyudeniya) [Prognosis and treatment chronic heart failure (during 20 years)]: avtoref. dis. … kand. med. nauk / M.O. Danielyan. — M., 2001. — 24 s.
6.   Khan, H. Late outcomes of heart surgery in patients 70 years or older / H. Khan, S. Magnetti, E. Davis, J. Zhang // Ann. Torac. Surg. — 2000. — Vol. 69. — Р.165—170.
7.   Olivetti, G. Gender differences and aging: effects of the human heart / G. Olivetti, G. Giordano, D .Corradi // J. Am. Cardiol. — 1995. — Vol. 26(4). — Р.1068—1079.
8.   Bulashova, O.V. Sostoyanie cerebral'nogo krovotoka u bol'nyh hronicheskoi serdechnoi nedostatochnost'yu s razlichnym tipom disfunkcii miokarda levogo zheludochka [Cerebral blood circulation condition in patients with chronic heart failure with different type of left ventricular myocardial dysfunction] / O.V. Bulashova, T.G. Falina, N.A. Kostromova // Kazanskii medicinskii zhurnal [Kazan medical journal]. — 2002. — T. 83, № 4. — S.205—207.
9.   Lazarev, P.V. Prognoz bol'nichnoi letal'nosti u bol'nyh s ostroi dekompensaciei hronicheskoi serdechnoi nedostatochnosti [Prognosis of hospital morbidity in patients with acute decompensation of heart failure] / P.V. Lazarev, L.G. Aleksandriya, A.A. Shavarov // Kardiologiya [Cardiology]. — 2013. — № 2. — S.19— 24.
10. Mareev, V.Yu. Sravnitel'naya harakteristika bol'nyh HSN v zavisimosti ot velichiny FV po rezul'tatam Rossiiskogo mnogocentrovogo issledovaniya EPOHA-O-HSN [Patients comparative characteristics of chronic heart failure with different ejection fraction] / V.Yu. Mareev, M.O. Danielyan, Yu.N. Belenkov // Zhurnal Serdechnaya nedostatochnost' [Heart failure journal]. — 2006. — № 7(4). — S.164— 171.
11.  Yancy, C.W. ADHERE Scientifc Advisory Committee and Investigators. Clinical presentation, management, and in-hospital outcomes of patient admitted with acute decompensated heart failure with preserved systolic function: a report from the Acute Decompensated Heart Failure National Registry (ADHERE) Database / C.W. Yancy, M. Lopatin, L.W. Stevenson [et al.] // J. Am. Coll. Cariol. — 2006. — Vol. 47. — P.76— 84.
12. Lam, C.S. Cardiac dysfunction and noncardiac dysfunction as precursors of heart failure with reduced and preserved ejection fraction in the community / C.S. Lam, A. Lyass, E. Kraigher-Krainer [et al.] // Circulation. — 2011. — Vol. 124(1). — P.24—30.
13. Roger, V.L. Heart Disease and Stroke Statistics 2012 Update: A Report From the American Heart Association / V.L. Roger, A.S. Go, D.M. Lloyd-Jones [et al.] // Circulation. — 2012. — Vol. 125. — P.2—220.
14. McMurray, J.J. Left Ventricular Systolic Dysfunction, Heart Failure and the Risk of Stroke and Systemic Embolism in Patients with Atrial Fibrillation: Insights from the ARISTOTLE Trial / J.J. McMurray, J.A. Ezekowitz, B.S. Lewis [et al.] // Circ. Heart Fail. — 2013. — Vol. 6(3). — P.451—460.

 

 

Emergency medical service to patients with the syndrome of diabetic foot

RUSLAN I. FATYKHOV, Ph.D., Assistant of Department of general surgery of SBEI HPE «Kazan State Medical university» of Ministry of Health of Russia, Kazan, Russia, tel. 8-927-400-02-95, e-mail: 74ruslan@rambler.ru

IVAN V. KLYUSHKIN, M.D., Professor of Department of general surgery of SBEI HPE «Kazan State Medical university» of Ministry of Health of Russia, Kazan, Russia, tel. 8-919-624-96-40, e-mail: hirurgivan@rambler.ru

KONSTANTIN A. KOREYBA, Ph.D., asistent of Professor, Department of general surgery of SBEI HPE «Kazan State Medical university» of Ministry of Health of Russia, Kazan, Russia, tel. 8-927-412-87-03, e-mail: korejba_k@mail.ru

Abstract. The existing provisions of the correction of metabolic syndrome disorders diabetic foot do not allow to stop the pathological process. Often this is due to the lack of a clear and adequately constructed stage curatio patient from diagnosis to treatment process. The purpose of the study. To implement adequate preventive and curative programs should use diagnostic methods and tools that allow for timely evaluate the pathological process. Existing diagnostic methods do not resolve the problem. Material and methods. Based on the diagnostic methods developed by the author to develop a program of correction of pathology. Results and discussion. The authors demonstrate the application they developed new methods of diagnosis in the syndrome of diabetic foot — ultrasound sonoelastometry and elektrotermometry and confrmed by patents. Based on the result of new methods of diagnosis, shows the gradual, step by step program of correction of the disease. Conclusion. Compliance with copyright recommendations suppresses the clinical picture and the progression of the disease, minimizing the need to perform surgery, and in the case of its performance level of surgical choose from a position of evidence-based medicine.

Key words: therapy, syndrome of diabetic foot, electrothermometry, ultrasonic sonoelastometriya.

 

References

1.   Myskina, N.A. Process reparacii troficheskih yazv u bol'nyh saharnym diabetom [Repair processes of trophic ulcers in patients with diabetes] / N.A. Myskina, A.Yu. Tokmanova, M.B. Anciferov // Problemy endokrinologii [Problems of Endocrinology]. — 2004. — № 2. — S.34—38.
2.   Pavelkin, A.G. Ocenka effektivnosti tromboliticheskoi terapii pri oslozhnennyh formah diabeticheskoi stopy [Evaluating the effectiveness of thrombolytic therapy in complicated forms of diabetic foot] / A.G. Pavelkin, A.N. Belyaev // Medicinskii al'manah [Med. almanac]. — 2012. — № 4(23). — S.88—91.
3.   Pavlova, M.G. Sindrom diabeticheskoi stopy [Diabetic foot] / M.G. Pavlova, T.V. Gusov, N.V. Lavrischeva // Trudnyi pacient [Diffcult patient]. — 2006. — № 1. — S.25—28.
4.   Red'kin, Yu.A. Sindrom diabeticheskoi stopy: diagnostika, lechenie, proflaktika [Diabetic foot syndrome: diagnosis, treatment, prevention] / Yu.A. Red'kin, I.V. Baharev // Kachestvo zhizni [Quality of Life]. — M., Medicina, 2003. — S.33—41.
5.   Sergeeva-Kondrachenko, M.Yu. Diabeticheskaya neiropatiya [Diabetic neuropathy] / M.Yu. Sergeeva-Kondrachenko // Remedium—Povolzh'e [Remedium— Volga]. — M., 2012. — S.17—25.
6.   Fatyhov, R.I. Osnovnye faktory postroeniya konservativnoi terapii s ocenkoi ee effektivnosti metodom elektrotermometrii pri sindrome diabeticheskoi stopy [Key factors for constructing conservative therapy with the evaluation of its effectiveness by electrothermometry for diabetic foot syndrome] / R.I. Fatyhov, I.V. Klyushkin // Fundamental'nye issledovaniya [Fundamental research]. — 2012. — № 5(2). — S.355—358.
7.   Fatyhov, R.I. Sovremennyi vzglyad na problemu oslozhnenii saharnogo diabeta [Modern view of the problem of diabetes complications] / R.I. Fatyhov, I . V. Klyushkin, YU.A. Klyushkina // Fundamental'nye issledovaniya [Fundamental research]. — 2013. — № 3(1). — S.206—210.
8.   Altland, O.D. Low-intensity ultrasound increases endothelial cell nitric oxide syntase activity and nitric oxide synthesis / O.D. Altland // J. Thromb. Haemost. — 2004. — Vol. 2. — P.637—643.
9.   Bode, B. Ultrasound-Guided Fine Needle Aspirations of PET-CT Findings During Staging of Malignancies / B. Bode // Ultrasound in Medicine and Biology. — 2011. — Vol. 37, № 8S. — SS28.04.
10. Bota, S. The Usefulness of Liver and Spleen Stiffness Evaluated by Means of Acoustic Radiation Force Impulse Elastography for the Prediction of Esophageal Varices in Cirrhotic Patients / S. Bota, I. Sporea, R. Sirli [et al.] // Ultrasound in Medicine and Biology. — 2011. — Vol. 37, № 8S. — SS29.04.

 

Formation of clinical groups at the syndrome of diabetic foot taking into account the electrothermometry and sonoelastometriya of the shift wave

RUSLAN I. FATYKHOV, Ph.D., Assistant of Department of general surgery of SBEI HPE «Kazan State Medical university» of Ministry of Health of Russia, Kazan, Russia, tel. 8-927-400-02-95, e-mail: 74ruslan@rambler.ru

IVAN V. KLYUSHKIN, M.D., Professor of Department of general surgery of SBEI HPE «Kazan State Medical university» of Ministry of Health of Russia, Kazan, Russia, tel. 8-919-624-96-40, e-mail: hirurgivan@rambler.ru

KONSTANTIN A. KOREYBA, Ph.D., Assistent of Professor, Department of general surgery of SBEI HPE «Kazan State Medical university» of Ministry of Health of Russia, Kazan, Russia, tel. 8-927-412-87-03, e-mail: korejba_k@mail.ru

Abstract. Absence of diagnostic algorithm at complication of a diabetes mellitus — a syndrome of diabetic foot promotes low effciency of medical process and the high frequency of performance of surgical grants, in the form of ablations of segments of the lower extremity. New diagnostic receptions which realization is possible at all stages of treatment are necessary for the solution of this problem: from the level of out-patient and polyclinic links before hospitalization. The purpose of the study — estimate value of an electrothermometry and sonoelastografya at identifcations of level of trophic disturbances in soft tissues of the lower extremity. Results and discussion. One of the perspective directions to the answering specifed demands is ultrasonic diagnostics. In article opportunities and restrictions of application, the existing methods of ultrasonic diagnostics are surveyed at a syndrome of diabetic foot. Conclusion. To be carried out the comparative analysis of the available diagnostic receptions with defnition of the key characteristics allowing to estimate qualitatively and quantitatively a pathological condition allows to create clinical groups for performance of a medical grant.

Key words: ultrasonic diagnostics, a syndrome of diabetic foot, apoptosis border-a necrosis.

 

References

1.   Avdovenko, A.L. Differencirovannyi podhod k lecheniyu diabeticheskoi stopy [The differentiated approach to treatment of diabetic foot] / A.L. Avdovenko, V.P. Sazhin, V.N. Emkuzhev // Standarty diagnostiki i lecheniya v gnoinoi hirurgii: tez. dokl. [Diagnostics and treatment standards in purulent surgery]. — M., 2001. — S.72— 73.
2.   Akulova, F.D. Reografiya. Instrumental'nye metody issledovaniya serdechno-sosudistoi sistemy [Reografya. Tool methods of research of cardiovascular system] / F.D. Akulova. — M.: Medicina, 1986. — S.340—341.
3.   Burleeva, E.P. Rezul'taty kompleksnogo lecheniya bol'nyh s gnoino-nekroticheskimi formami diabeticheskoi stopy [Results of complex treatment of patients with it is purulent — necrotic forms of diabetic foot] / E.P. Burleeva, M.F. Bahtin, M.Yu. Shutov // Standarty diagnostiki i lecheniya v gnoinoi hirurgii [Diagnostics and treatment standards in purulent surgery]: tez. dokl. — M., 2001. — S.100—101.
4.   Davydenko, V.V. Stimulirovannyi angiogenez — novoe napravlenie v lechenie pri ishemicheskih sostoyaniyah [Stimulated angiogenesis the new direction in treatment at ischemic conditions] / V.V. Davydenko, V.M. Maks // Vestnik hirurgii [Messenger of surgery]. — 2000. — № 1. — S.117—119.
5.   Klyushkin, I.V. Adekvatnoe provedenie konservativnoi terapii — garant effektivnogo lecheniya sindroma diabeticheskoi stopy [Adequate carrying out conservative therapy — the guarantor of effective treatment of a syndrome of diabetic foot] / I.V. Klyushkin, R.I. Fatyhov // Fundamental'nye issledovaniya [Basic researches]. — M., 2011. — S.79—83.
6.   Kozlov, V.I. Issledovanie kolebanii krovotoka v sisteme mikrocirkulyacii [Research of fuctuations of a blood-groove in system of microcirculation] / V.I. Kozlov, V.G. Sokolov // Primenenie lazernoi dopplerovskoi foumetrii v medicinskoi praktike: materialy II Vseros. simp. — M., 1998. — S.8—12.
7.   Lelyuk, V.G. Ul'trazvukovaya angiologiya [Ultrasonic angiologiya] / V.G. Lelyuk, S.E. Lelyuk. — M.: Real'noe vremya, 2003. — 322 s.
8.   Fatyhov, R.I. Kombinirovannaya ul'trasonografiya v opredelenii stadii techeniya i lechebnoi taktiki pri ostryh gnoinyh zabolevaniyah pal'cev kisti [The combined ultrasonografya in defnition of a stage of a current and medical tactics at sharp purulent diseases of fngers] / R.I. Fatyhov // Kazanskii medicinskii zhurnal [Kazan medical magazine]. — 2008. — № 5. — S.671—673.
9.   Fatyhov, R.I. Analiz rezul'tatov konservativnogo lecheniya sindroma diabeticheskoi stopy [Analysis of results of conservative treatment of a syndrome of diabetic foot] / R.I. Fatyhov, I.V. Klyushkin // Aktual'nye voprosy diagnostiki, lecheniya i proflaktiki sindroma diabeticheskoi stopy: III Vseros. nauch.-prakt. konf. s mezhdunarodnym uchastiem. — Kazan', 2011. — S.28—31.
10. Yakushina, T.N. Konservativnaya terapiya trofcheskih yazv goleni [Conservative therapy of trophic ulcers of a shin] / T.N. Yakushina, V.G. Kupeev, L.M. Vaslavskii // Sovremennye aspekty klinicheskoi mediciny[Modern aspects of clinical medicine]: sb. nauch. tr.. — Tula, 2002. — S.55—57.

 

 

Contribution of aspirin in improving prognosis in patients with heart failure

ELENA V. KHAZOVA, Ph.D., аssistant Professor of the Department of internal medicine propaedeutics of SBEI HPE «Kazan State Medical university» of Ministry of Health Russia, Kazan, Russia, tel. 8-905-313-97-10, e-mail: hazova_elena@mail.ru

OLGA V. BULASHOVA, D.M., Professor of internal medicine propaedeutics of SBEI HPE «Kazan State Medical university» of Ministry of Health Russia, Kazan, Russia, e-mail: boulashova@yandex.ru

MARIA I. MALKOVA, Ph.D., Assistant of the Department of internal medicine propaedeutics of SBEI HPE «Kazan State Medical university» of Ministry of Health of Russia, Head of the Department of functional diagnostics of SAIH «City Hospital № 7», Kazan, Russia, e-mail: marimalk@yandex.ru

ZULFIJA A. SHAIKHUTDINOVA, deputy chief physician of SAiH «city clinical Hospital № 7», Kazan, Russia

Abstract. The relevance of this work due to the high level of mortality in patients with chronic heart failure (CHF), including by reason of thromboembolic complications. Question of acetylsalicylic acid (ASA) in patients with CHF remains debated. Aim of this study was to investigate the prognosis of chronic heart failure in patients treated with antiplatelet therapy, and without it. Material and Methods: 125 patients with ischemic CHF FC I-IV at the age of 65,1±10,1, has conducted a 6-minute walk test, ECG and echocardiography study evaluated the clinical condition using a scale SHOKS. After a year from the beginning of the study collected information on cardiovascular events within 1 year after enrollment. Results. Patients with heart failure who were not taking ASA, often fatal thromboembolic complications were observed. Inclusion in the ASA therapy often accompanied by non-fatal cardiovascular events.

Key words: chronic heart failure, prognosis, acetylsalicylic acid.

 

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15. Aspirin for preventing the recurrence of venous thromboembolism / C. Becattini, G.A. Agnelli, A. Schenone // N. Engl. J. Med. — 2012. — Vol. 366. — P.1959— 1967.
16. Aspirin in the secondary prevention of unprovoked thromboembolism: the WARFASA and ASPIRE studies / S. Birocchi, E. Scannella, L. Ferrari, G. M.Podda // Intern. Emerg. Med. — 2013. — Vol. 8. — P. 757—760.
17. Nacional'nye rekomendacii VNOK i OSSN po diagnostike i lecheniyu HSN (III peresmotr) [National guidelines GFCF and PRAs for diagnosis and treatment of CHF (III revision)] / V.Yu. Mareev, F.T. Ageev, G.P. Arutyunov [I dr.] // Zhurnal serdechnaya nedostatochnost' [Journal of Heart failure]. — 2010. — № 1(57). — S.3—62.

 

Guillain—Barre syndrome and pregnancy: diagnostics and management (clinical observation)

ALBINA R. KHAKIMOVA, neurologist of the neurologic Department № 2 of SAIH «clinical city hospital № 7», Kazan, assistance of Department of neurology, neurosurgery, medical genetics of SBEI HPE «Kazan State Medical university» of Ministry of Health of Russia, Kazan, Russia, e-mail: al.khakimova@gmail.com

NATALIA A. POPOVA, Ph.D., Head of the neurologic Department № 2 of SAIH «clinical city hospital № 7», Kazan, assistance of Department of neurology, neurosurgery, medical genetics of SBEI HPE «Kazan State Medical university» of Ministry of Health of Russia, Kazan, Russia, e-mail: p_nathali@mail.ru

EDUARD Z. YAKUPOV, M.D., Head of the Department of neurology, neurosurgery, medical genetics of SBEI HPE «Kazan State Medical university» of Ministry of Health of Russia, Kazan, Russia, e-mail: ed_yakupov@mail.ru

Abstract. The Guillain—Barre syndrome is an acute infammatory polyradiculoneuropathy. Only 6% of the total incidence of GBS develop during pregnancy, and these cases don’t differ from the general population: 1,7 per 100 000 per year. Clinically GBS during pregnancy does not differ from GBS in the general population. Our paper presents the observations connected with the patient N, female, born in 1985, with a diagnosis of acute demyelinizing infammatory polyneuropathy (Guillain—Barre syndrome) in the form of rough uneven tetraparesis, peripheral prosoparesis on the right, moderate pseudoradicular syndrome, atony of the colon with dynamic features. 22—23 weeks of pregnanby. Cryptogenic hepatitis with moderate cytolysis syndrome. Mild iron defciency anemia. In this case there is a necessity for multidisciplinary treatment of a patient. Since the use of intravenous immunoglobulins does not cause signifcant changes in circulating blood volume, it may be a better treatment option for GBS during pregnancy.

Key words: Guillain—Barre syndrome, pregnancy.

 

References

1.   Levin, O.S. Polinevropatii: klinicheskoe rukovodstvo [Polyneuropathy: clinical guidance] / O.S. Levin. — M.: MIA, 2011. — 496 s.
2.   Asbury, A.K. Assessment of current diagnostic criteria for Guillian—Barre syndrome / A.K. Asbury, D.R. Cornblath // Ann. Neurol. — 1990. — Vol. 27.— P.21—24.
3.   Chan, L.Y. Guillain—Barre syndrome in pregnancy / L.Y. Chan. M.H. Tsue, T.N. Leung // Acta obstetrician et gynecologica Scandinavica. — 2004. — Vol. 83. — P.319—325.
4.   Clinically diagnosed Guillain—Barre syndrome in pregnancy: case report and review of literature / A.K. Koledade, A.O. Oguntayo, S.A. Abubakar [et al.] // Case Reports in Clinical Medicine. — 2014. — Vol. 3. — P.487—490.
5.   Diagnosis of Guillain—Barré Syndrome and Validation of Criteria / C. Fokke, B. Berg, J. Drenthen [et al.] // Brain. — 2014. — Vol. 137, № 1. — P.33—43.
6.   Guillain—Barre syndrome in pregnancy: an unusual case / M.H. Zafar, M.M. Naqash, T.A. Bhat [et al.] // J. Fam. Med. Primary Care. — 2013. — Vol. 2. — P.90—91.
7.   Hughes, R.A. Guillain—Barre syndrome / R.A. Hughes, D.R. Cornblath// Lancet. — 2005. — Vol. 366. — P.1653— 1666.
8.   Iannello, S. Guillain—Barre syndrome: pathological, clinical, and therapeutical aspects / S. Iannello. — New-York: Nova Biomedical Books, 2005. — 234 p.
9.   Landry Guillain—Barre Strohl syndrome in pregnancy: use of high-dose intravenous immunoglobulin / M. Seoud, M. Naboulsi, A. Khalil [et аl.] // Acta obstetrician et gynecologica Scandinavica. — 1999. — Vol. 78. — P.912—918.
10. Landry Guillain—Barre syndrome in pregnancy. Report of three cases treated with plasmapheresis / T.J. Hurley, A.D. Brunson, R.L. Archer [et al.] //Obster. Gynecol. — 1991. — Vol. 78. — P.482—485.
11.  Nath, M.P. Pregnancy with Guillain—Barre syndrome — anaesthetic challenges and management/ M.P. Nath // J. Clin. Case Rep. — 2014. — Vol. 4. — P.397
12. Parry, G.J. Guillain—Barre syndrome: from diagnosis to recovery / G.J. Parry, J.S. Steinberg. — AAN Enterprises, 2007. — 264 p.
13. Successful maternal and fetal outcome of Guillain— Barre syndrome complicating pregnancy: case report / S.A. Inamdar, A.H. Inamdar, R. Chaudhary [et al.] // Int. J. Reprod. Contracept obstet Gynecol. — 2013. — Vol. 2, № 3. — P.478—479.
14. The epidemiology of Guillain—Barre syndrome worldwide. A systematic literature review/ A. McGrogan , G.C. Madle, H.E. Seaman [et al.] // Neuroepidemiology. — 2009. — Vol. 32, № 2. — P.150—163.

 

Severe bronchial asthma: role and place of glucocorticosteroids

RUSTEM F. KHAMITOV, M.D., Рrofessor, Head of the Department of internal diseases № 2 of SBEI HPE «Kazan State Medical university» of Ministry of Health of Russia, Kazan, Russia, tel. +7-917-272-96-72, e-mail: rhamitov@mail.ru

LIUBOV YU. PALMOVA, Ph.D., аssistant of the Department of internal diseases № 2 of SBEI HPE «Kazan State Medical university» of Ministry of Health of Russia, Kazan, Russia, tel. +7 917 232 4045, e-mail: palmova@bk.ru

ZUKHAIRA N. YAKUPOVA, Ph.D., Associated of the Department of internal diseases № 2 of SBEI HPE «Kazan State Medical university» of Ministry of Health of Russia, Kazan, Russia, tel. +7-917-906-30-16

KIRA R. SULBAEVA, аssistant of the Department of internal diseases № 2 of SBEI HPE «Kazan State Medical university» of Ministry of Health of Russia, Kazan, Russia, tel. +7-987-221-83-50, e-mail: kira_sulbaeva@mail.ru

Abstract. Bronchial asthma (BA) is represented by a global problem, with signifcant loss to public health. The most part of expense is determined by severe asthma, which caused 250 thousand deaths per year. Severe asthma is a heterogeneous disease with another phenotypes, for example, such as eosinophilic asthma. Comorbidities have a negative infuence on the disease's current, complicating treatment tactic. Before the reconsidering of the treatment in severe asthma, it is necessary to ensure patient compliance, the correct use of inhalation devices, eliminating of risk factors effect. High-dosed inhaled corticosteroids have the leading role in the pharmacological treatment of severe asthma in combination with another controlling medication and / or systemic corticosteroids. The main objective is to achieve and preserve control over the current of disease. International recommendations demand a valuation of eosinophils in sputum and nitric oxide in exhaled air in development of therapeutic tactic. In severe patients, the treatment except corticosteroid therapy may include an anti-IgE agents, methotrexate, macrolide antibiotics, antifungals. Further researches in severe asthma should be aimed at the development of direct phenotype-associated therapy.

Key words: severe bronchial asthma, inhaled corticosteroids, systemic corticosteroids.

 

References

1.   Rebrov, A.P. Primenenie glyukokortikosteroidov pri astmaticheskom sostoyanii (obzor) [The use of gluco-corticosteroids in asthma status (review)] / A.P. Rebrov, N.A. Karoli // Terapevticheskii arhiv [Therapeutic archive]. — 2001. — № 3. — S.63—67.
2.   Hamitov, R.F. Hronicheskaya obstruktivnaya bron-holegochnaya patologiya v klinicheskoi praktike: rukovodstvo dlya vrachei [Chronic obstructive bronchopulmonary pathology in clinical practice. Guide for physicians] / R.F. Hamitov. — Kazan', 2005. — 134 s.
3.   Chuchalin, A.G. Tyazhelye formy bronhial'noi astmy [Severe bronchial asthma] / A.G. Chuchalin // Terapevticheskii arhiv [Terapevticheskij arhiv]. — 2001. — № 3. — S.5—9.
4.   Asthma / еd. by F. Chung, L.M. Fabbri // European Respiratory Monograph. — 2003. — № 8(23). — 458 p.
5.   Casale, T.B. Severe asthma. In: Global Atlas Of Asthma / T.B. Casale; еd. C.A. Akdis, I. Agache. — Published by EAACI, 2013. — P.112—114.
6.   Global Strategy for Asthma Management and Prevention, Global Initiative for Asthma (GINA). Date last updated: May 2014. — URL: http://www.ginasthma.org
7.   International ERS/ATS guidelines on defnition, evaluation and treatment of severe asthma / K.F. Chung, S.E. Wenzel, J.L. Brozek [et al.] // Eur. Respir. J. — 2014. — Vol. 43. — P.343—373.
8.   Van Wijk, R.G. Socioeconomic costs of asthma / R.G. van Wijk // Global Atlas Of Asthma / еd. C.A. Akdis, I. Agache. — Published by EAACI, 2013. — P.18—20.

 

A case of acute disseminated encephalomyelitis with late onset (clinical observation)

IRINA F. KHAFIZOVA, Ph.D., assistant of the Department of neurology, neurosurgery and medical genetics of SBEI HPE «Kazan State Medical university» of Ministry of Health of Russian, Kazan, Russia, tel. 8-917-249-31-87, e-mail: sclerdissem@mail.ru

NATALIA A. POPOVA, assistant of the Department of neurology, neurosurgery and medical genetics of SBEI HPE «Kazan State Medical university» of Ministry of Health of Russian, Head of the Department of urgent neurology, of clinical Hospital № 7, Kazan, Russia, tel. 8-917-269-59-32, e-mail: p_nathali@mail.ru

EDUARD Z. YAKUPOV, M.D., Professor, Head of the Department of neurology, neurosurgery and medical genetics of SBEI HPE «Kazan State Medical university» of Ministry of Health of Russian, Kazan, Russia, tel. 8-987-290-25-62, e-mail: ed_yakupov@mail.ru

Abstract. Acute disseminated encephalomyelitis (ADEM) is a monophasic autoimmune demyelinating disease of the central nervous system. The diagnosis of ADEM is based on clinical and radiological features. With this, the presence of encephalopathy shall be obligatory for diagnosis. ADEM is considered a rare childhood disease and is even rarer in adult population. Clinical manifestations of ADEM in adult differs from children. In general, the late age of onset can led to misdiagnosis and confuse of physicians. We report an unusual case of a 67-year-old man with ADEM developing after gastrointestinal manifestations. In our case neurological manifestations included mental status change, motor aphasia, apraxia and hemiparesis. MRI studies showed a combination of abnormalities in the white matter of the cerebral hemispheres, brainstem and the deep gray nuclei. In the report we reviewed differences between ADEM in children and adult.

Key words: acute disseminated encephalomyelitis, magnetic resonance imaging, multiple sclerosis.

 

References

1.   Gusev, E.I. Rasseyannyi skleroz [Multiple sclerosis] / E.I. Gusev, I.A. Zavalishin, A.N. Boiko. — M.: Real Taim, 2011. — 528 s.
2.   Clinical and diagnostic aspects of multiple sclerosis and acute monophasic encephalomyelitis in pediatric patients: a single centre prospective study / M. Atzoril, P.A.Battistella, P. Perinil [et al.] // Multiple Sclerosis. — 2009. — Vol. 15. — P.363—370.
3.   Banwell, B. Acute disseminated encephalomyelitis big one / B. Banwell, S. Narula. — URL: http://www.medmerits.com/ index.php/article/acute_disseminated_encephalomyelitis/ P4
4.   Dale, R.C. Acute disseminated encephalomyelitis or multiple sclerosis: can the initial presentation help in establishing a correct diagnosis? / R.C. Dale, J.A. Branson // Arch. Dis. Child. — 2005. — Vol. 90. — P.636—639.
5.   Acute disseminated encephalomyelitis, multaphasic disseminated encephalomyelitis and multiple sclerosis in children / R.C. Dale, C. de Sousa, W.K. Chong [et al.] // Brain. — 2000. — Vol. 123. — P. 2407—2422.
6.   Hahn, J.S. Acute disseminated encephalomyelitis in children / J.S. Hahn, D. Ph. Sankar. — 2002. — URL:http://web.stanford.edu/~jhahn/pubs/ADEM_ Children_Stanford_1992-2000-Hahn.pdf
7.   Khosroshahi, N. Acute disseminated encephalomyelitis in a 5-month old infant / N. Khosroshahi, F. Mahvelati, K. Kamrani // Iran. J. Child. Neurology. — 2008. — Vol. 8. — P.53—55.
8.   Acute Disseminated Encephalomyelitis in Childhood; Epidemiologic, Clinical, and Laboratory Features / N. Khosroshahi, K. Kamrani, F. Mahvelati [et al.] // IJMS. — 2007. — Vol. 32, № 3. — P.143—146.
9.   Le Pira, A. Acute disseminated encephalomyelitis: two pediatrics case reports / A. Le Pira, I. Lombardo, R. La Fata // Acta Pediatrica Mediterranea. — 2009. — Vol. 25. — P.45.
10. Lee, Y.J. Acute disseminated encephalomyelitis in children: differential diagnosis from multiple sclerosis on the basis of clinical course / Y.J. Lee // Korean. J. Pediatr. — 2011. — Vol. 54(6). — P.234—240.

 

 

Features of therapy of gastrointestinal bleeding in emergency surgery due to etiological attributes

VYACHESLAV F. CHIKAEV, M.D., Professor of Department of traumatology, orthopaedics and ECS SBEI HPE «Kazan State Medical university» of Ministry of Health of Russia, Kazan, Russia, e-mail: prof.chikaev@gmail.com

RINAT A. IBRAGIMOV, Ph.D., surgeon of Depatment surgical № 3 of SAHI CCH № 7 of Kazan, e-mail: rinatibr@mail.ru

DAMIR G. ZAIDULLIN, Ph.D., Head of 1-st Depatment of traumatology of SAHI CCH № 7 of Kazan, e-mail: damrez@mail.ru

NAIL T. KHAIRULLIN, neurosurgeon of neurosurgery Depatment of SAHI of CCH № 7 OF Kazan, e-mail: Kh.nail.talg@mail.ru

AZAT R. AIDAROV, surgeon of Depatment surgical № 3 of SAHI CCH № 7 of Kazan, e-mail: azat041@yandex.ru

Abstract. Objective — to analyze the structure of associated trauma and principles of diagnosis and treatment of patients hospitalized in a multidisciplinary «level-1» hospital. Material and methods. We made the analysis of damage structure in 286 patients with concomitant trauma admitted to the neurosurgical and trauma departments, SAHI CCH № 7 of Kazan. The largest group with concomitant brain injury (as dominant injury) consisted of patients with brain concussion: n=99 (51,8%), with a brain contusion: n = 43 cases (22,5%). Concomitant traumas with dominant injury of the musculoskeletal system were most in combination with tubular bones n = 67 (71,3%), of which n=7 (10,4%) were secondary open fractures. In the 2,4% of all observed patients we diagnosed concomitant damage of the abdomen. At all stages of health care the base of success consists of diagnosis timeliness, objective assessment of the severity and status of patients. Diagnostic and treatment of patients with concomitant injury bases on the principle of «damage control».

Key words: concomitant trauma, neurosurgery, traumatology, the victim.

 

References

1.   Povrezhdeniya zhivota pri sochetannoi travme [Abdominal injury with concomitant trauma]/ M.M. Abakumov, N.V. Lebedev, V.I. Malyarchuk. — M.: Medicina, 2005. — 176 s.
2.   Vereschagin, E.I. Intensivnaya terapiya tyazheloi sochetannoi cherepno-mozgovoi travmy [Intensive therapy in concomitant and severe traumatic brain injury] / E.I. Vereschagin, I.P. Vereschagin. — Novosibirsk,
2007. — 84 s.
3.   Gumanenko, E.K. Voenno-polevaya hirurgiya lokal'nyh voin i vooruzhennyh konfiktov [Military surgery in local wars and armed conficts]: rukovodstvo dlya vrachei / E.K. Gumanenko, I.M. Samohvalov. — M.: GEOTAR-Mediya, 2011. — 672 s.
4.   Gumanenko, E.K. Politravma. Aktual'nye problemy i novye tehnologii lecheniya [Polytrauma. Current problems and new treatment technologies] / E.K. Gumanenko // Novye tehnologii lecheniya v voenno-polevoi hirurgii i hirurgii povrezhdenii mirnogo vremeni. — SPb., 2006. — S.2—12.
Sokolov, V.A. Mnozhestvennye sochetannye travmy [Multiple concomitant injury] / V.A. Sokolov. — M.: GEOTAR-Media, 2006. — 512 s.
6.   Giannoudis, P.V. Surgical priorities in damage control in polytrauma / P.V. Giannoudis // J. Bone. Joint. Surg. Br. — 2003. — Vol. 85. — P.478—483.
7.   Bochicchio, G.V. The management of complex liver injuries / G.V. Bochicchio // Trauma Quart. — 2002. — Vol. 15. — P.55—76.
8.   Kouraklis, G. Damage control surgery / G. Kouraklis, C. Vagianos // Arch. Hellenic. Med. — 2002. — Vol. 19. — P.216—257.

 

Diagnostics and surgical tactics at wounds of heart

NAILYA G. SHAMSUTDINOVA, Ph.D., Associate Professor of Department of hospital therapy SBEI HPE «Kazan State Medical university» of Ministry of Health of the Russia, Kazan, Russia, e-mail: nailya@e-diva.ru

SVETLANA P. YAKUPOVA, Ph.D., Associate Professor of Department of hospital therapy SBEI HPE «Kazan State Medical university» Ministry of Health of the Russia, Kazan, Russia, Head specialist-rheumatologist Ministry of Health of the republic of Tatarstan, e-mail: YakupovaSP@mail.ru

Abstract. Gout is a systemic disease associated with the deposition of crystals of sodium monourat in different tissues, resulting in the development of infammation. Given that the primary clinical manifestation of gout is acute arthritis, it is necessary to carry out a differential diagnosis with other diseases with similar clinical symptoms. A reliable diagnosis can be set at detection crystals of sodium monurat in the synovial fuid, but it is not always available in practice. Therefore, you must use a comprehensive assessment — clinical, laboratory and instrumental. Asymptomatic elevations of uric acid is not an indication for hyperuricemic therapy. The lecture presents current information on the classifcation, principles of diagnosis and treatment of this disease. Due to the frequent concomitant metabolic disorders occurring in gout, important multidisciplinary approach to managing these patients.

Key words: gout, gouty arthritis, diagnosis and treatment of acute and chronic gouty arthritis.

 

References

1.   Multinational evidence-based recommendations for the diagnosis and management of gout: integrating systematic literature review and expert opinion of a broad panel of rheumatologists in the 3e initiative/ F. Sivera, M.Andrés, L. Carmona [et al.] // Ann. Rheum. Dis. — 2013. — Vol. 10. — P.1—8.
2.   Barskova, V.G. Racional'nye podhody k diagnostike podagry (po materialam rekomendacii Evropeiskoi antirevmaticheskoi ligi) [Rational approach to the diagnosis of gout (based on the recommendations of the EULAR)] / V.G. Barskova // Sovremennaya revmatologiya [Modern rheumatology]. — 2007. — № 1. — S.10—12.
3.   Rasshifrovka diagnoza s pomosch'yu polyarizacionnoi mikroskopii posle 12 let suschestvovaniya artrita (opisanie sluchaya) [Explanation of the diagnosis by means of polarization microscopy after 12 years of arthritis (case report)] / M.S. Eliseev, I.S. Denisov, R.A. Osipyanc [i dr.] // Sovremennaya revmatologiya [Modern rheumatology]. — 2011. — № 4. — S.44—46.
4.   Barskova, V.G. Chto dolzhen znat' terapevt o vedenii bol'nogo ostrym podagricheskim artritom [That the therapist should know about patient care with acute gouty arthritis] / V.G. Barskova // Sovremennaya revmatologiya [Modern rheumatology]. — 2012. — № 3. — S.84—86.
5.   Barskova, V.G. V pomosch' molodomu revmatologu: na prieme bol'noi s podagricheskim artritom [To help the young rheumatologist: on reception of patients with gouty arthritis] / V.G. Barskova, M.S. Eliseev // Sovremennaya revmatologiya [Modern rheumatology]. — 2010. — № 3. — S.53—57.
6.   Muhin, N.A. Podagra: liki bolezni [Gout: Variants of the disease] / N.A. Muhin // Sovremennaya revmatologiya [Modern rheumatology]. — 2007. — № 1. — S.5—9.
7.   Eliseev, M.S. Novye mezhdunarodnye rekomendacii po diagnostike i lecheniyu podagry [New international guidelines for the diagnosis and treatment of gout] / M.S. Eliseev // Nauchno-prakticheskaya revmatologiya [Scientifc-Practical Rheumatology]. — 2014. — № 2. — S.141—146.
8.   Febuksostat — novyi preparat v terapii podagry [Febuxostat — a new drug in the treatment of gout] / V.G. Barskova, E.V. Il'inyh, E.L. Nasonov // Nauchno-prakticheskaya revmatologiya [Scientific-Practical Rheumatology]. — 2011. — № 2. — S.52—58.
9.   Kanakinumab (ingibitor interleikina 1β) — proryv v vozmozhnostyah terapii pri podagre [Kanakinumab (inhibitor of interleykin1β) — innovation in the possibilities of therapy of gout] / M.S. Eliseev, V.G. Barskova, E.L. Nasonov // Nauchno-prakticheskaya revmatologiya [Scientifc-Practical Rheumatology]. — 2013. — № 4. — S.428—431.

 

A rare case of post-traumatic pericardial diaphragmatic hernia complicated by transverse colon strangulation and perforation

MANSUR K. YAGUDIN, Ph.D., the Department of surgery of Almetievsk central District Hospital, tatarstan, Russia, tel. 8-937-294-38-13, e-mail: mansur_jagudin@mail.ru

RUSLAN F. GUBAEV, the Department of surgery of Municipal Hospital № 7 of Kazan, MoH of tatarstan, Russia, tel. 8-919-642-98-07, e-mail: gubaevrus@mail.ru

Abstract. The purpose of this article was to report an extremely rare case of post-traumatic intrapericardial diaphragmatic herniation of the transverse colon complicated by strangulation directly at the pericardial defect and perforation in left pleural cavity. Materials and Methods. We report a case of a 42-year-old male patient presenting post-traumatic pericardial diaphragmatic hernia with transverse colon strangulation and perforation diagnosed intraoperatively after being operated on in the emergency setting for acute abdomen and chest pain. Results and Discussion. Celiotomy and thoracotomy were employed. The gangrenous bowel was resected and colostomy was performed. The patient made an uneventful recovery and was discharged in satisfactory condition in 15 days postoperatively. The patient undergoing reversal colostomy at 3 months after the primary procedure and did not have any recurrences. Conclusion. Chronic post-traumatic colonic herniation through the diaphragmatic defect into the pericardial sac is an extremely rare entity. Only 96 cases have been reported in the world literature until now. This case appears to be the frst report of pericardial herniation demonstrating that colon may be strangulated directly at the pericardial defect.

Key words: post-traumatic pericardial diaphragmatic hernia, strangulation, pericardial defect, pleural empyema.

 

References

1.   Plehanov, A.N. Hirurgiya travmaticheskih diafragmal'nyh gryzh [Traumatic diaphragmatic hernia] / A.N. Plehanov // Vestnik hirurgii. — 2012. — T. 171, № 5. — S.107—110.
2.   Case report Traumatic intrapericardial diaphragmatic hernia: case report and literature review / A. Reina, E. Vidana, P. Soriano [et al.] // Injury. Int. J. Care Injured. — 2001. — Vol. 32. — P.153—156.
3.   Laparoscopic repair of traumatic intrapericardial diaphragmatic hernia / B.L. McCutcheon, U.Y. Chin, G.J. Hogan [et al.] // Hernia. — 2010. — Vol. 14. — P.647—649.
4.   Laparoscopic repair of a traumatic intrapericardial diaphragmatic hernia / S. Kuy, J. Juern, J.A. Weigelt // JSLS. — 2014. — Vol. 18, № 2. — P.333—337.

 

«Fewer-port» modifications of the laparoscopic cholecystectomy for the treatment of chronic cholecystitis

MANSUR K. YAGUDIN, Ph.D., the Department of surgery of Almetievsk central District Hospital, tatarstan, Russia, tel. 8-937-294-38-13, e-mail: mansur_jagudin@mail.ru

RUSLAN F. GUBAEV, the Department of surgery of Municipal Hospital № 7 of Kazan, MoH of tatarstan, Russia, tel. 8-919-642-98-07, e-mail: gubaevrus@mail.ru

Abstract. The purpose of this article was to report an extremely rare case of post-traumatic intrapericardial diaphragmatic herniation of the transverse colon complicated by strangulation directly at the pericardial defect and perforation in left pleural cavity. Material and Methods. We report a case of a 42-year-old male patient presenting post-traumatic pericardial diaphragmatic hernia with transverse colon strangulation and perforation diagnosed intraoperatively after being operated on in the emergency setting for acute abdomen and chest pain. Results and Discussion. Celiotomy and thoracotomy were employed. The gangrenous bowel was resected and colostomy was performed. The patient made an uneventful recovery and was discharged in satisfactory condition in 15 days postoperatively. The patient undergoing reversal colostomy at 3 months after the primary procedure and did not have any recurrences. Conclusion. Chronic post-traumatic colonic herniation through the diaphragmatic defect into the pericardial sac is an extremely rare entity. Only 96 cases have been reported in the world literature until now. This case appears to be the frst report of pericardial herniation demonstrating that colon may be strangulated directly at the pericardial defect.

Key words: laparoscopic cholecystectomy, trocar port incisions, postoperative complications.

 

References

1. Gololobov, Yu.N. Kosmeticheskaya modifikaciya vypolneniya laparoskopicheskoi holecistektomii iz treh tochek [Tree-ports cosmetic modifcation of laparoscopic
cholecystectomy] / Yu.N. Gololobov, O.V. Galimov, E.I. Senderovich [i dr.] // Endoskopicheskaya hirurgiya [Endoscopic Surgery]. — 1998. — № 2. — S.19— 20. 2. Orehov, G.I. Laparoskopicheskaya holecistektomiya iz dvuh dostupov kak pervyi operacionnyi opyt pri hronicheskom kal'kuleznom holecistite [First experience of double-access laparoscopic cholecystectomy for chronic gallstone cholecystitis] / G.I. Orehov // Endoskopicheskaya hirurgiya [Endoscopic Surgery]. — 2010. — № 6. — S.12—13.

 

 

«Quickly, but not too quickly»: questions of organization urgent neurology care

EDUARD Z. YAKUPOV, M.D., Professor, Head of the Department of neurology, neurosurgery and medical genetics SBEI HPE «Kazan State Medical university», Russian Ministry of Healh, Kazan, Russia, e-mail: ed_yakupov@mail.ru

KSENYA S. OVSYANNIKOVA, graduate student оf Department of neurology, neurosurgery and medical genetics SBEI HPE «Kazan State Medical university», Russian Ministry of Healh, Kazan, Russia, tel. 8-974-448-011, e-mail: oks-88@list.ru

Abstract. Aim. Provide an analysis of the application of research methods of heart rate variability (HRV) in patients with ischemic stroke in the practice of medicine. Objectives. To identify the positive and negative aspects of the research methodology of HRV during Holter monitoring and recording of short segments, based on the work of domestic and foreign authors; on the basis of the data obtained to evaluate the practical signifcance of the methodology. Results. The identifed shortcomings and merits of the method are disclosed, consists of a comprehensive assessment of functional status and monitoring of therapy in patients; personalized approach to the selection of a therapeutic strategy; capability to predict the outcome of the disease; use in the feld of rehabilitation medicine. Conclusion. The research method of HRV can be used in the practice of medicine. To facilitate the implementation in daily practice of physicians of different specialties necessary to conduct a large-scale study to compile tables of normal HRV parameters, as well as the most common diseases.

Key words: ischemic stroke, heart rate variability, practical medicine, personalized medicine.

 

References

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Sleep disorders among patients of therapeutic hospitals

EDUARD Z. YAKUPOV, M. D., Head of the Department of neurology, neurosurgery and medical genetics of SBEI HPE «Kazan State Medical university» of Russian Ministry of Health, Kazan, Russia, tel. 290-25-62, e-mail: ed_yakupov@mail.ru

YULIA V. TROSHINA, graduate student of the Department of neurology, neurosurgery and medical genetics of SBEI HPE «Kazan State Medical university» of Russian Ministry of Health, Kazan, Russia, tel. 8-927-422-64-22, e-mail: troshina. yulia@yandex.ru

EKATERINA A. ALEKSANDROVA, graduate student of the Department of neurology, neurosurgery and medical genetics of SBEI HPE «Kazan State Medical university» of Russian Ministry of Health, Kazan, Russia, tel. 8-917-711-62-30, e-mail: lunatik867@rambler.ru

LILIYA Y. SHAGIAKHMETOVA, functional diagnostics doctor of SAHcf «republic clinical hospital № 2», tel. +7(903)340-64-96, e-mail: liliyaY@yandex.ru

ELENA V. SHEBASHEVA, neurologist of republic clinical Hospital of veteran of war's, republic Maryi-el, Russia, tel. +7 (902) 358-84-86, e-mail: elena_shebasheva@mail.ru

Abstracts. Aim. To reveal prevalence of sleep disorders among hospital inpatients in Kazan applying special continuous questionnaires. Materials and methods. We interviewed 1117 respondents and in the fnal analysis were included 715 forms with male rate 157 (21,9%), female — 558 (78,1%), among them 422 (59%) were citizens, 293 (41%) — villagers. There were used specially elaborated questionnaire, Epworth Sleepiness Scale (ESS), Hospital Anxiety and Depression Scale (HADS). Results. 71% of respondents complained of insomnia. But only 5,15% of them had a visit to doctor about this problem. And only 7,3% were asked about quality of their sleeping during consulting process about different health disorders by doctors. 37,7% of interviewed individuals couldn’t term a specialist, that they would be referred to, if they have problems with sleeping. After separating respondents on 3 group according to Visual Analog Scale, it was noted that 44% have 5-6 sleeping hours, 18% less than 4, thus wise 62% of sample representatives sleep under 6 hours. Treating sleep disorders 37% use benzodiazepines, 54% prefer herbal therapy. Conclusion. Dissociation between subjective estimation of sleeping process quality and value of complaints were revealed. It gave us an information about low awareness of population about sleeping disorders problem. There is signifcant undervalue of relevance of insomnia, and inattention in its adequate correction. Tendency to autotherapy of insomnia was found. Medical society underestimates the importance of this sociomedical problem.

Key words: somnology, insomnia, inpatients, sleep condition, BMI.

 

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