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LEADING ARTICLE

Kazan Municipal Clinical Hospital № 7 — Emergency Medicine center. New organization in ideology of emergency medical service: problems, tasks, ways of solution. M.N. Sadykov, I.V. Klyushkin P. 9

ORIGINAL ARTICLES

Comparative evaluation of diagnosis and surgical treatment of portal hypertension. A.F. Yakupov, S.B. Sangadzhiyev, R.R. Mustafin, A.Y. Anisimov P.11

Predicton of risk acute kidney injury in coronary heart disease patients. O.N. Sigitova, A.R. Bogdanova P.18

Morphological features of uterus scar healing by using plasmoliftingtm method in experiment. R.I. Gabidullina, E.R. Gaynutdinova, A.A. Galeev, P.N. Rezvyakov, S.V. Fedotov, G.O. Pevnev P.24

Speed of the glomerular filtration as risk kardialnogo’s predictor at patients with sharp cholecystitis. M.T. Malkova, O.V. Bulashova, E.V. Hazova, Z.A. Shaykhutdinova P.28

Comparative analysis of parallel double daily monitoring at the shoulder artery in patients with hypertension I, II. A.Y. Cheremisina, R.G. Saifutdinov, M.F. Ismagilov P.31

Membrane disorder in pathogenesis of the major risks of the cardiovascular death — hypertention and dyslipidemia. V.N. Oslopov, N.R. Khasanov, D.N. Chugunova, K.M. Billah P.34

Syndrome of multiple organ dysfunction during the isolated craniocerebral trauma at patients in a critical condition. E.V. Kiseleva, A.V. Kuligin, Y.A. Osyko P.39

Cytokine profile of peripherals blood of smoking patients with bronchial asthma. A.V. Zhestkov, M.S. Blinchikova P.44

EXCHANGE OF EXPERIENCE

Experience of treating patients with liver cirrhosis with bleeding varices esophagus and the stomach. S.B. Sangadzhiyev, A.F. Yakupov, R.R. Musta- fin, A.Y. Anisimov P.48

Medical surgical algorithm program secondary spread of purulent peritonitis. R.R. Mustafin, A.I.Andreev, A.Y. Anisimov P.53

Gastrointestinal bleedings at patients of the coronary heart disease. V.F. Chikayev, Z.F. Kim, I.I.Gumerov, D.M. Petukhov, Y.V. Bondarev P.57

The experience of using low-flow filtration methods in the treatment of patients with acute renal failure in the multiprofile hospitals. V.A.Vdovin, T.S. Ganeev, A.N. Hannanova P.61

Improvement of prevention of post-transfusion complications by the blood test of recipients on existence isoimmune the antieritrotsitarnykh of antibodies. R.G. Turayev, E.E. Belsky P.63

Reperfusion syndrome at vascular reconstruction at patients with the syndrome of diabetic foot. K.A. Koreyba, I.V. Klyushkin, A.V. Maksimov, R.I. Fatykhov, N.M. Nuchcadievich P.67

CLINICAL CASE REPORT

Tromboemboliya тромбоэмболия of pulmonary artery is in clinic to urgent cardiology. A.A. Podolskaya, Z.F. Kim, G.Z. Afandiyeva P.71

Complicated case of diagnosis: adrenal failure under the mask of myocardial infarction. I.F. Yakupov, N.R.Chasanoff, Z.A. Shaykhutdinova, T.A. Petrova, E.N.Ivantsov P.76

HELP FOR PRACTITIONER

Video-digital registration of the results of the reaction for microprecipitation for the diagnosis of syphilis. S.G. Mardanly, N.V. Bahilina, I.A. Ermolaeva, A.E. Tugolukov, S.M. Sorokoletov, T.A. Starovoytova, Yu.Y. Vengerov P.80

Diagnostic algorithm of the acute appendicitis at pregnant women. S.V. Dobrokvashin, A.G. Izmailov, D.E. Volkov, S.L. Demyanov P.83

Anesthetic management at pregnant women with subarachnoid hemorrhages. A.Zh. Bayaliyev, R.Ya. Shpaner, E.I. Bogdanov, I.R. Ganeeva P.85

Acute coronary syndrome: from diagnosis to treatment optimization. E.I. Aglullina P.91

Treatment of gastrointestinal bleeding. M.N. Nasrullayev P.94

Optimization strategy management of patients in stable angina. E.G. Slepukha, O.V. Boulashova, Z.А. Shaichutdinova P.98

ORGANIZATION OF HEALTHCARE

Some aspects of the organization emergency cardiac care. Z.F. Kim, A.A. Podolskaya P.103

Epidemiology of neurotrauma in the Republic of Tatarstan. R.Kh. Karimov, D.O. Ismagilov P.109

Analysis of the epidemiological situation in a multidisciplinary hospital. N.D.Shaykhraziyeva P.114

Analysis of hospital stage of giving emergency medical services to patients died during. M.N. Sadykov, V.G. Beljakov, Z.G. Valeev P.116

WHEN THE ISSUE  WAS IN PRINT

Matrices of interattractor distances in assessment of autonomic nervous system residents of Yugra. R.N. Zhivoglyad, N.V. Zhivaeva, O.A. Bondarenko.120

Local thrombolysis in thrombosis of bypass grafts and prosthesis of lower extremity arteries. A.K. Gadeev, R.K. Dzhordzhikiia, V.A. Lukanihin, L.G. Mindubaev, R.A. Bredikhin, M.K. Mikhailov P.124

The forecasting and treatment of a suppuration of a bone wound at traumatic damage of the bottom jaw. T.T. Faizov, L.N. Mubarakova P.128

Intercellular ratio of blood cells as indicator of effiiciency therapy of massive blood loss. D.V. Sadchikov, A.O. Khozhenko, A.V. Kuligin, Y.A. Osyko P.131

Results of the ultrasonic method of research in the choice of the way of therapy of the syndrome of diabetic foot for complication prevention in the form of gangrene of the bottom extremity. R.I. Fatykhov, I.V. Klyushkin, K.A. Koreyba, M.N. Nasrullayev P.135

Unsolved problems of emergency vascular surgery. A.K. Gadeev, R.K. Dzhordzhikiia, V.A. Lukanihin, I.M. Ignatiev, R.A. Bredikhin, V.A. Damocev P.137

Features of diagnosis and treatment of deep vein thrombosis. R.K. Djordjikia, A.R. Belyaev, V.A. Lukanihin et al. P. 143

The role of blood cells in a syndrome of endogenous intoxication. M.M. Dmitrenko, Y.A. Osyko, A.V. Kuligin P.146

Diagnostic and treatment features in patients with concomitant abdominal injuries. V.F. Chikaev, R.A. Ibragimov, G.I. Mikusev, Ju.V. Bondarev, A.R. Aidarov P.150

Rendering the urgent help to patients with ischemic and neuroischemic forms of the syndrome of diabetic foot on «diabetic foot» center experience. K.A. Koreyba, I.V. Klyushkin, A.V. Maksimov, R.I. Fatykhov, M.N. Nasrullayev P.152

Stages of creation of the program of emergency medical service to patients with the syndrome of diabetic foot. R.I. Fatykhov, I.V. Klyushkin, K.A. Koreyba P.155

Videoendoscopic surgical treatment of perforated gastric and duodenum ulcers. M.K. Yagudin, R.F. Gubayev, I.R. Muhametov, R.F. Gumarov, V.G. Davidov, I.G. Hisamiev, O.T. Alishev, E.B. Bagautdinov P.158

Options laparoscopic treatment of perforated duodenal ulcers. M.R. Tagirov, K.M. Halilov, A.M. Zakirov, M.I. Shakirov P.161

Problems in diagnosis of ectopic pregnancy. R.I. Gabidullina, L.I. Sirmatova, E.M. Kislitsina, S.E. Savelyev P.167

___

LEADING ARTICLE

Kazan Municipal Clinical Hospital № 7 — Emergency Medicine center. New organization in ideology of emergency medical service: problems, tasks, ways of solution

M.N. Sadykov, I.V. Klyushkin

 

ORIGINAL ARTICLES

Comparative evaluation of diagnosis and surgical treatment of portal hypertension

Askar F.Yakupov, the candidate of medical sciences, the doctor the surgeon of office of surgery of GAUZ «Interregional Clinic Diagnostic Center» of Ministry of Health of the Republic of Tatarstan, Kazan, 8-927-0372882, askar1906@mail.ru

Savr B. Sangadzhiyev, the candidate of medical sciences, the doctor the surgeon of office of surgery of GAUZ «Interregional Clinic Diagnostic Center» of Ministry of Health of the Republic of Tatarstan, Kazan, 8-927-4044030, savrsan@mail.ru;

Rais R. Mustafin, the candidate of medical sciences, the manager of a reception of GAUZ «City Clinical Hospital № 7» of Kazan, the assistant to chair of fast medical care of GBOU DPO «Kazan State Medical Academy» of Ministry of Health of the Russian Federation, 8-927-2409302, rai-mustafin@yandex.ru

Andrey Y. Anisimov, the doctor of medical sciences, the professor, the chief non-staff specialist the surgeon of Ministry of Health of the Republic of Tatarstan, the deputy chief physician by medical part of GAUZ “City Clinical Hospital № 7” of Kazan, the professor of chair of an emergency medical service of GBOU DPO “Kazan State Medical Academy” of Ministry of Health of the Russian Federation, Kazan, aanisimovbsmp@yandex.ru

Abstract. Analyzed clinical, laboratory and instrumental data , the nature , severity and outcome of disease complications in three groups of patients. I group — 22 people with intrahepatic and extrahepatic portal hypertension (HSV), who routinely due to the high risk of bleeding esophageal- gastric bypass operations were performed in different versions. Group II — 15 patients CPU and intrahepatic GHG who routinely been performed by suturing VRVPZH MD Patsiora. Group III — 28 patients with cirrhosis and intrahepatic GHGs that have stitching on VRVPZH MD Patsiora was performed by emergency indications in connection with the high-spirited esophageal-gastric bleeding. the total number of complications in patients of group 1 was 27,3% in patients in group 2 — 33,3%, in patients with the third group — 57,1%. Postoperative mortality in patients of group 1 was 4,5 % in patients in group 2 had no mortality , in patients with the third group — 35,7%.

Key words: portal hypertension, esophageal-gastric bleeding.

 

References

1. Anisimov, A.Yu. Problemy i perspektivy hirurgii portal’noi gipertenzii / A.Yu. Anisimov, S.B. Sangadzhiev, M.V. Kuznecov [i dr.] // Kazanskii medicinskii zhurnal. — 2008. — № 6. — S.745—751.
2. Eramishancev, A.K. Portokaval’noe shuntirovanie ili proshivanie varikozno rasshirennyh ven pischevoda i zheludka. Chto vybrat’? / A.K. Eramishancev, R.A. Musin, E.D. Lyubivyi // Annaly hirurgicheskoi gepatologii. — 2005. — T. 10, № 2. — S.76.
3. Zyyatdinov, K.Sh. Statistika zdorov’ya naseleniya i zdravo-ohraneniya (po materialam Respubliki Tatarstan za 2001—2005 gody): ucheb.-metod. posobie / Kazan. gos. med. akad., Respub. med. inform.-analit. centr MZ RT; K.Sh. Zyyatdinov, A.A. Gil’manov, V.G. Sherputovskii [i dr.]; pod red. I.G. Nizamova. — Kazan’, 2006. — 276 s.
4. Kotiv, B.N. Portokaval’noe shuntirovanie. Problemy i perspektivy / B.N. Kotiv, I.I. Dzidzava, S.A. Alent’ev // Pervaya mezhdunarodnaya konferenciya po torako-abdominal’noi hirurgii. — M., 2008. — S.179.
5. Lebezev, V.M. Portokaval’noe shuntirovanie u bol’nyh s portal’noi gipertenziei: avtoref. dis. ... d-ra med. nauk / V.M. Lebezev. — M., 1994. — 21 s.
6. Nazyrov, F.G. Hirurgiya portal’noi gipertenzii u bol’nyh cirrozom pecheni v Central’no-Aziatskom regione / F.G. Nazyrov, X.A. Akilov, A.V. Devyatov // Annaly hirurgicheskoi gepatologii. — 2003. — T. 8, № 1. — S.19—28.
7. Paciora, M.D. Hirurgiya portal’noi gipertenzii / M.D. Paciora. — 2-e izd., dop. — Tashkent, 1984. — 319 s.
8. Rebrova, O.Yu.Statisticheskii analiz medicinskih dannyh. Primenenie paketa prikladnyh programm STATISTICA / O.Yu. Rebrova. — M.: Media Sfera, 2006. — 305 s.
9. Shercinger, A.G. Taktika pri ostryh krovotecheniyah iz varikozno rasshirennyh ven pischevoda i zheludka / A.G. Shercinger // Rossiiskii gastroenterologicheskii zhurnal. — 2001. — № 3. — S.40—42.
10. Garcia, N. Portal hypertension. / N. Garcia, A.J. Sanyal // Clin. Liver. Dis. — 2001 — Vol. 5, № 2. — Р.509—540.
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12. Merkel, C. Decrease in galactose elimination capacity as a surrogate marker for death in cirrhotics with alcohol abuse: effect of abstinence from alcohol / C. Merkel, G. Marchsmi, A. Farbi [et al.] // Surrogate Markers to Asses Efficacy of Treatment in Chronic Liver Disease. Basel. — 1995. — P.14.
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14. Terblanche, J. The management of portal hypertension: controversies / J. Terblanche // J. Gastroenterol. Hepatol. — 2002. — № 17. — Р.439—440.

 

Predicton of risk acute kidney injury in coronary heart disease patients

Olga N. Sigitova, MD, Head of the Department of General Practice GBOU VPO « Kazan State Medical University» Russian Ministry of Health, chief expert nephrologist Ministry of Health of the Republic of Tatarstan, Kazan, Russia, tel. +79173962417, e-mail: osigit@rambler.ru

Alina R. Bogdanova, assistant professor Department of General Practice GBOU VPO «Kazan State Medical University» Russian Ministry of Health, Kazan, Russia, tel. +79272466394, e-mail: _alinochka@mail.ru

Abstract. Aim. Identifying risk factors for acute kidney injury in patients with coronary heart disease after revascularization of the coronary vessels and the development of recommendations for the prevention of acute kidney injury. Matherial and method. The study included 56 patients with coronary artery disease with stenotic coronary atherosclerosis undergoing rapid revascularization of the heart vessels. Studied history, clinical and laboratory parameters, estimated glomerular filtration rate by Cockcroft-Gault, renal ultrasound, Doppler ultrasound of renal vessels. Results. Out of the significant risk factors for the development of a direct relationship acute kidney injury proved only with a reduction in the initial glomerular filtration rate (below 60 ml/min) with a combination of multiple risk factors increases the likelihood of acute kidney injury. Conclusion. Patients with coronary artery disease with stenotic coronary atherosclerosis in need of rapid revascularization of the coronary vessels, are at high risk of acute kidney injury, a major risk factor acute kidney injury is starting GFR less than 60 ml/min. The mortality of patients undergoing revascularization complicated by acute renal failure was 25%.

Key words: ischemic heart disease, coronary revascularization, acute kidney damage, risk factors.

 

References

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Morphological features of uterus scar healing by using plasmoliftingtm method in experiment

Rushanya I. Gabidullina, doctor of medical sciences, the professor of chair of obstetrics and gynecology № 2 of Public Educational Institution of Higher Professional Training KGmu Roszdrava, e-mail: ru.gabidullina@yandex.ru

Elvira R. Gaynutdinova, the doctor gynecologic отделения ГАУЗ № 7 GKB, Kazan, 8-937-614-94-95, e-mail: elvlion@rambler.ru

Azat A. Galeev, the doctor of gynecologic office of GAUZ TsGKB № 18, Kazan, 8-987-296-84-46, e-mail: lamantinos@mail.ru

Pavel N. Rezvyakov, the associate professor of normal anatomy of Public Educational Institution of Higher Professional Training KGmu Roszdrava, e-mail: rezvyakovp@gmail.com

Sergey V. Fedotov, the manager of delivery room of GAuz GKB № 7, e-mail: NataliyaFedotova1972@mail.ru

Georgy O. Pevnev, the graduate student of the Kazan (Volga) Federal University, e-mail: anatomists@rambler.ru

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 receiving platelet rich plasma by whole blood centrifuging in special test-tubes. These test-tubes contain unique gel, that allows to disperse blood on fractions, one of which is platelet rich plasma. 38 animals took part in experiment, divided 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 inflammatory reaction, significant 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.

 

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Speed of the glomerular filtration as risk kardialnogo's predictor at patients with sharp cholecystitis

Maria I. Malkova, edging. medical sciences, manager office of functional diagnostics of GAUZ GKB № 7, Kazan, Russia, ph. 8-960-051-61-16, e-mail: marimalk@yandex.ru

Olga V. Bulashova, doct. medical sciences, professor of chair of propaedeutics of internal diseases of GBou VPo «Kazan State medical university» of ministry of Health of Russia, Kazan, Russia, ph. 8-987-296-14-03, e-mail: boulashova@yandex.ru

Elena V. Khazova, graduate student of chair of propaedeutics of internal diseases of GBOU VPO «Kazan State Medical university» of ministry of Health of Russia, Kazan, Russia, ph. 8-905-313-97-10, e-mail: hazova_elena@mail.ru

Zulfia A. Shaykhutdinova, the deputy chief physician by medical part of GAUZ GKB № 7, Kazan, Russia

Abstract. Research objective — studying of function of kidneys at patients with various degree of kardialny risk when performing surgical intervention concerning sharp cholecystitis. Material and methods: 274 patients with sharp cholecystitis with accompanying kardiaс pathology are surveyed. Depending on degree of kardialny risk on T.H. Lee et al. (1999) groups were allocated: the very low — 18% (n=50), low — 44% (n=121), an average — 26% (n=70) and high — 12% (n=35) of risk. In 24 hours prior to operation and for the 3rd days after it to patients function of kidneys was determined by the speed of a glomerular filtration (SGF) calculated on a formula MDRD. Results. At patients of average risk reliable decrease in SKF in 48 hours after operation with (63,4±18,8) ML/min/1,73 in sq.m to (54,8±22,5) ml/min./1,73 sq.m (p=0,017) is revealed. In 48 hours after operation patients with cardiovascular complications had significant increase in SKR and decrease in SKF in comparison with those indicators for patients without complications [(136,9±70,0) µmol/l against (89,4±32,9) µmol/l, p=0,023; (44,3±21,9) ML/min/1,73M2 against (62,5±21,7) ML/min/1,73 sq.m, p=0,034]. The carried-out regression analysis with use of model of Coke defined that the SKF level for the 3rd days after operation (βi=-0, 025, p=0,028 and the relative size of extent of influence of ki=14,3 of %) appeared a factor which is authentically increasing risk of development of cardiovascular complications in a surveyed cohort.

Key words: speed of a glomerular filtration, cardiovascular diseases, kardialny risk.

 

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2. Lee, T.H. 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.
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Comparative analysis of parallel double daily monitoring at the shoulder artery in patients with hypertension I, II

Anna Y. Cheremisina, Rafik G. Saifutdinov, Maksum F. Ismagilov

Abstract. The aim of the study was to investigate the asymmetry of blood pressure at the same time on two hands by ambulatory blood pressure monitoring in hypertensive patients I, II stage , taking into account the type of vegetative response and its role in the course of hypertension. Design and methods The study included 124 patients with hypertension I, II stage (n=49 and n=54), a group of healthy subjects (n=21). BP measurement was performed simultaneously on two hands during the day. Assessed the state of the autonomic nervous system, ultrasonic research extracranial vessels. Statistical analysis was performed using the «Statistics 7». Results: When carrying out daily monitoring in parallel on both hands there is a group of patients (16%), with asymmetry of blood pressure over 12 mmHg This group is distinguished mainly dominated sympathicotonic type of vegetative response , also in this group according in the evaluation of autonomic nervous system imbalance expressed in the sympathetic division of the ANS. In the group of patients with asymmetry in blood pressure greater than 12 mm Hg. Art. revealed a significant increase in performance variability and lack of night-time reduction in blood pressure, compared to the group without asymmetry in blood pressure, which is an unfavorable factor for the flow of essential hypertension. Conclusion. The asymmetry of the systolic blood pressure bigger than 12 mm Hg and more can be considered a risk factor for adverse flow arterial hypertension.

Key words: hypertension, blood pressure monitoring, daily blood pressure, autonomic nervous system.

 

References

1. Guidelines for the Management of Arterial Hypertension // J. Hypertension. — 2013. — Vol. 31 (7). — P.l281, 1357. [The task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) 2013].
2. McManus, R.J. Do differences in blood pressure between arms matter? / R.J. McManus, J. Mant, Ch. Claёrk //The Lancet. — 2012. — Vol. 379. — P.872—873.
3. Shavarova, E.K. Risk serdechno-sosudistyh oslozhnenii u pacientov s arterial’noi gipertoniei: evolyuciya vzglyadov / E.K. Shavarova, E.T. Mufteeva, Zh.D. Kobalava // Arterial’naya gipertenziya. — 2009. — T. 15, № 3. — S.314—319.
4. An independent relationship between muscle sympathetic nerve activity and pulse wave velocity in normal humans / E. Swierblewska, D. Hering, T. Kara [et al.] // J. Hypertens. 2010. — Vol. 34. — P.979—984.
5. Non-dipping pattern of hypertension and obstructive sleep apnea syndrome / J. Wolf, D. Hering, Narkiewicz // Hypertens. Res. — 2010. — Vol. 33(9). — P.867—871.
6. Shupina, M.I. Rasprostranennost’ arterial’noi gipertenzii i serdechno-sosudistyh faktorov riska u lic molodogo vozrasta / M.I. Shupina, D.V. Turchaninov // Sibirskii medicinski zhurnal. — 2011. — T. 26, vyp. 2, № 3. — S.152—156.
7. Dzizinskii, A.A. Pul’sovoe davlenie kak faktor riska porazheniya organov-mishenei u bol’nyh arterial’noi gipertoniei / A.A. Dzizinskii, K.V. Protasov, D.A. Sinkevich [i dr.] // Sibirskii medicinskii zhurnal. — 2009. — T.90, vyp. 1, № 7. — S.27—30.
8. Osipova, O.A. Sravnitel’nyi analiz pokazatelei sutochnogo monitorirovaniya arterial’nogo davleniya u bol’nyh arterial’noi gipertenziei i hronicheskoi serdechnoi nedostatochnost’u / O.A. Osipova, S.B. Suyazova, M.A. Vlasenko [i dr.] // Fundamental’nye issledovaniya. — 2012. — № 7, ch. 1. — S.146—152.
9. Takagi, T. Evaluation of morning blood pressure elevation and autonomic nervous activity in hypertensive patients using wavelet trans form of heart rate variability / T. Takagi, M. Ohishi, N. Ito // Hypertens. Res. — 2006. — Vol. 29 (12). — P.977—987.
10. Singh, M. Pathogenesis and clinical physiology of hypertension / M. Singh, G.A. Mensah, G.Bakris // Cardiol. Clin. 2010. — Vol. 28 (4). — P.545—559.

 

Membrane disorder in pathogenesis of the major risks of the cardiovascular death — hypertention and dyslipidemia

Vladimir N. Oslopov, Niyaz R. Khasanov, Diana N. Chugunova, Khan Mutasim Billakh

Abstract. Hypertension and dyslipidemia are the most significant factors-risk of cardiovascular death and are often combined with each other. During the Framingham study found that high blood pressure increases the risk of coronary heart disease by 5 times. Elevated triglycerides and LDL cholesterol increase the risk of cardiovascular complications in patients with arterial hypertension. Proved negative effect of lipid disorders and atherosclerosis on blood pressure. Both diseases are mutually influence each other A.L. Myasnikov considered atherosclerosis and hypertension as two clinical-anatomical manifestations of the unified disease. According to the Yu.V. Postnov’s membrane theory, the origins of hypertension are in widespread changes in the structure and function of cell membranes , which is manifested in violation of monovalent ion transport across the cell membrane. A recent study found a significant increase in the rate of transmembrane ionotransport in patients with arterial hypertension and hypercholesterolemia .A common pathogenic basis for lipid composition of plasma and increase in blood pressure may be the change of the structure and function of cell membranes. There is no doubt that a violation of the structure and function of cell membranes , which occurs in hypertension plays one of the most important and perhaps decisive role in the development of the lipid profile , the formation of atherosclerotic vascular wall , organ damage and remodeling of the cardiovascular system.

Key words: hypertension, dyslipidemia, atherosclerosis, the concept of a membrane disorder.

 

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Syndrome of multiple organ dysfunction during the isolated craniocerebral trauma at patients in a critical condition

Evgeniya V. Kiseleva, physician anesthesiologist, the Saratov Regional Hospital, Saratov, Russia, tel. 8-906-313-78-58, e-mail: kiss.hi-hi @ mail.ru

Alexander V. Kuligin, doctor of medical science, professor, Department of emergency and anesthesiology-resuscitation help, Saratov Medical University V.I. Razumovsky Ministry of health of Russia, Saratov, tel. 8-903-328-79-37, e-mail: avkuligin@yandex.ru

Yana A. Osyko, ordinator, Department of emergency and anesthesiology-resuscitation help, Saratov medical university V.I. Razumovsky ministry of health of Russia, Saratov, tel. 8-905-324-34-53, e-mail: yana_osyko@mail.ru

Abstract. Specific weight of the closed craniocereberal trauma at patients takes the 3rd place in structure of a lethality of the population. High frequency of occurrence of a craniocereberal trauma, lethality, development of polysystem dysfunction at this pathology defined the purpose of the real research. Studying of degree of expressiveness and influence on an outcome of a disease of a syndrome of multiple organ dysfunction at patients with the isolated craniocereberal trauma was carried out. 30 clinical records of patients with the isolated closed craniocereberal trauma, aged from 18 till 50 years, without accompanying pathology are retrospectively studied. The assessment of cerebral insufficiency, external breath, gas transmission function of blood, liver function, condition of proteinaceous and carbohydrate exchanges, functions of kidneys, a gastrointestinal path was carried out. Quantitative indices of the central haemo dynamics, level of endogenous intoxication were studied. Researches were conducted in the first, third, seventh and tenth days. The obtained data were processed by the main methods of variation statistics with calculation of the following criteria: selective average, average error of a selective average. Formation fact in evidence a syndrome of multiple organ dysfunction at patients with the isolated closed craniocereberal trauma. Various degree of expressiveness of dysfunctions of studied systems on different terms of the closed craniocereberal trauma is revealed. The interrelation between expressiveness of dysfunction, number of the involved systems and an outcome of studied pathology is found. Involvement in the syndrome of multiple organ dysfunction functional systems is carried out by a mixed way. When the comparison between the groups of patients with different outcome degree of dysfunction of each of the systems in the group of patients with fatal outcome in average 30% higher.

Key words: multiple organ dysfunction syndrome, traumatic brain injury, Polysystem dysfunction.

 

References

1. Вone, I. neurology in practice: sleep and coma / I. Вone, G.N. Fuller // Journal of neurology, neurosurgery and Psychiatry. — 2001. — Vol. 71, № 1. — P.1—2.
2. Vilenskii, B.S. Neotlozhnaya nevrologiya / B.S. Vilenskii. — SPb.: Foliant, 2006. — 512 s.
3. Savin, I.A. Rekomendacii po intensivnoi terapii u pacientov s neirohirurgicheskoi patologiei: posobie / I.A. Savin, M.S. Fokin. — M.: NII neirohirurgii im. akad. N.N. Burdenko RAMN; OOO «IPK «Indigo», 2013. — 168 s.
4. Carenko, S.V. Neiroreanimatologiya. Intensivnaya terapiya cherepno-mozgovoi travmy / S.V. Carenko. — M.: Medicina, 2009. — 384 s.

 

Cytokine profile of peripherals blood of smoking patients with bronchial asthma

Alexander V. Zhestkov, professor, the head of the chair of clinical microbiology, Immunology and Allergology of the Samara State Medical University, tel. 260-33-61, e-mail: zhestkovav@yandex.ru

Marina S. Blinchikova, the correspondence PhD student of the chair of clinical Microbiology, Immunology and Allergology of the Samara State Medical University, tel. 8-917-102-50-07, e-mail: marina_blinchikova@mail.ru

Abstract. Purpose of the study: to review the options of immunological profile in smoking patients with bronchial asthma, the features of the impact of smoking on the immunological options of patients’ blood. Materials and methods. The study included 44 patients with bronchial asthma at the age from 18 to 65 years old (the average age of the 51,8 years). Results and their discussion. It was proven that smoking patients with diagnosed bronchial asthma had upgraded levels of IL-17, VEGF and TSLP, inducing inflammation, and significantly reduced level of anti-inflammatory IL-10. In addition, it was proven that these changes were more expressed in smoking patients, smoking a large number of cigarettes during the day and with a long record of active smoking. Conclusion. The smoking patients had expressed changes of the cytokine profile compared to the non-smoking patients with bronchial asthma.

Key words: bronchial asthma, cytokine profile, smoking, thymic stromal lymphopoietin, vascular endothelial growth factor.

 

References

1. Global’naya strategiya lecheniya i profilaktiki bronhial’noi astmy (peresmotr 2011 g.) / pod red. A.S. Belevskogo. — M.: Rossiiskoe respiratornoe obschestvo, 2012. — S.18—20.
2. Koiko, R. Immunologiya / R. Koiko, D. Sanshain, E. Bendzhamini. — M.: Izdat. centr «Akademiya», 2008. — S.170—171.
3. Sibiryak, S.V. Citokinovaya regulyaciya biotransformacii ksenobiotikov i endogennyh soedinenii / S.V. Sibiryak, V.A. CHereshnev, A.S. Simbircev [i dr.]. — Ekaterinburg, 2006. — S.20—21.
4. Simbircev, A.S. Citokiny: klassifikaciya i biologicheskie funkcii / A.S. Simbircev // Citokiny i vospalenie. — 2004. — T. 3, № 2. — S.16—23.
5. Chereshnev, V.A. Immunofiziologiya / V.A. Chereshnev, B.G. Yushkov, V.G. Klimin, E.V. Lebedeva. — Ekaterinburg: UrO RAN, 2002. — S.118—121.
6. DeFranco, A.L. Immunity. The immune response in infections and inflammatory disease / A.L. DeFranco, R.M. Lockley, M. Robertson. — London, 2007. —P.97—99, 130—131.

 

EXCHANGE OF EXPERIENCE

Experience of treating patients with liver cirrhosis with bleeding varices esophagus and the stomach

Savr B. Sangadzhiyev, the candidate of medical sciences, the doctor the surgeon of office of surgery of GAUZ «Interregional Clinic Diagnostic Center» of Ministry of Health of the Republic of Tatarstan, Kazan, 8-927-404-40-30, e-mail: savrsan@mail.ru

Askar F. Yakupov, the candidate of medical sciences, the doctor the surgeon of office of surgery of GAUZ «Interregional Clinic Diagnostic Center» of Ministry of Health of the Republic of Tatarstan, Kazan, 8-927-037-28-82, e-mail: askar1906@mail.ru

Rais R. Mustafin, the candidate of medical sciences, the manager of a reception of GAUZ «City Clinical Hospital № 7» of Kazan, the assistant to chair of an emergency medical service of GBOU DPO «Kazan State Medical Academy» of Ministry of Health of the Russian Federation, 8-927-240-93-02, e-mail: rai-mustafin@yandex.ru

Andrey YU. Anisimov, the doctor of medical sciences, the professor, the chief non-staff specialist the surgeon of Ministry of Health of the Republic of Tatarstan, the deputy chief physician by medical part of GAUZ «City Clinical Hospital № 7» of Kazan, the professor of chair of an emergency medical service of GBOU DPO «Kazan State Medical Academy» of Ministry of Health of the Russian Federation, Kazan, e-mail: aanisimovbsmp@yandex.ru

Abstract. Group I (comparison) — 77 in patients with liver cirrhosis (LC), complicated by bleeding from esophageal varices and gastric (VRVPZH) treatment program that included a waiting conservative tactics using surgical methods only as the «operation of despair». Group II (basic) — 28 patients with liver cirrhosis complicated by bleeding from VRVPZH, a comprehensive treatment program that included an active surgical approach using an improved operation, MD Patsiora. Using the proposed active surgical approach to reduce the total number of complications from 97,4% to 25,0%, the incidence of liver failure — from 16,9% to 14,3%, lower postoperative mortality from 100% to 35,7%, in-hospital mortality from 76,6% to 35,7%.

Key words: cirrhosis of the liver, bleeding.

 

References

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8. Zyyatdinov, K.Sh. Statistika zdorov’ya naseleniya i zdravoohraneniya (po materialam Respubliki Tatar- stan za 2001—2005 gody): ucheb.-metod. posobie / Kazan. gos. med. akad., Respub. med. inform.-analit. centr MZ RT; K.Sh. Zyyatdinov, A.A. Gil’manov, V.G. SHerputovskii [i dr.]; pod red. I.G. Nizamova. — Kazan’, 2006. — 276 s.
9. Kicenko, E.A. Rezul’taty operacii M.D. Paciory u bol’nyh cirrozom pecheni i portal’noi gipertenziei / E.A. Kicenko, E.K. Zavorotnaya, I.CH. Abdullaev // Annaly hirurgicheskoi gepatologii. — 2005. — T. 10, № 2. — S.80.
10. Kotiv, B.N. Portokaval’noe shuntirovanie. Problemy i perspektivy / B.N. Kotiv, I.I. Dzidzava, S.A. Alent’ev // Pervaya mezhdunarodnaya konferenciya po torako-abdominal’noi hirurgii. — M., 2008. — S.179.
11. Nazyrov, F.G. Hirurgiya portal’noi gipertenzii u bol’nyh cirrozom pecheni v Central’no-Aziatskom regione / F.G. Nazyrov, X.A. Akilov, A.V. Devyatov // Annaly hirurgicheskoi gepatologii. — 2003. — T. 8, № 1. — S.19—28.
12. Paciora, M.D. Hirurgiya portal’noi gipertenzii / M.D. Paciora. — 2-e izd., dop. — Tashkent, 1984. — 319 s.
13. Rebrova, O.Yu. Statisticheskii analiz medicinskih dannyh. Primenenie paketa prikladnyh programm STA- TISTICA / O.Yu. Rebrova. — M.: Media Sfera, 2006. — 305 s.
14. Shercinger, A.G. Blizhaishie i otdalennye rezul’taty proshivaniya varikozno rasshirennyh ven pischevoda i zheludka u bol’nyh s portal’noi gipertenziei / A.G. Shercinger, E.A. Kicenko // Annaly hirurgicheskoi gepatologii. — 1998. — T. 3, № 3. — S.172—182.
15. Shercinger, A.G. Taktika pri ostryh krovotecheniyah iz varikozno rasshirennyh ven pischevoda i zheludka / A.G. Shercinger // Rossiiskii gastroenterologicheskii zhurnal. — 2001. — № 3. — S.40—42.
16. Shercinger, A.G. Taktika lecheniya pischevodno-zheludochnyh krovotechenii u bol’nyh s portal’noi gipertenziei / A.G. SHercinger, S.B. Zhigalova, Z.Sh. Margiani, A.B. Gamidov // Annaly hirurgicheskoi gepatologii. — 2005. — T. 10, № 2. — S.93.
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18. Jenkins, S.A. Somatostatin in acute bleeding esophageal varices / S.A. Jenkins // Drugs. — 2000. — Vol. 44,№ 12. — P.36—55.
19. Rikkers, L.F. Surgical Management of Acute Variceal Hemorrhage / L.F. Rikkers, G. Jin // World J. Surg. — 1994. — Р.193.
20. Warren, W.D. Resent Advances in the Management of Variceal Bleeding / W.D. Warren, J.B. Whilfhead // Jap. J. Surg. — 1986. — Р.77.

 

Medical surgical algorithm program secondary spread of purulent peritonitis

Rais R. Mustafin, the candidate honey of sciences, the manager of a reception of GAUZ «City Clinical Hospital № 7» of Kazan, the assistant to chair of an emergency medical service of GBOU DPO «Kazan State Medical Academy» of Ministry of Health of the Russian Federation, 8-927-240-93-02, e-mail: rai-mustafin@yandex.ru

Andrey I. Andreev, the candidate honey of sciences, the doctor surgeons of office of surgery of GAUZ «City Clinical Hospital № 7» of Kazan, 8-987-293-51-64, e-mail: aandreyi@yandex.ru;

Andrey Yu Anisimov, the doctor honey of sciences, the professor, the chief non-staff specialist the surgeon of Ministry of Health of the Republic of Tatarstan, the deputy chief physician by medical part of GAUZ «City Clinical Hospital № 7» of Kazan, the professor of chair of an emergency medical service of GBOU DPO «Kazan State Medical Academy» of Ministry of Health of the Russian Federation, Kazan, e-mail: aanisimovbsmp@yandex.ru

Abstract. This article analyzes the clinical benefit of an integrated approach to the surgical treatment program algorithm of patients with secondary widespread purulent peritonitis. Analysis of clinical material for the period from 1984 to 2012 showed that of the 27 954 operations on the abdominal cavity 2 358 (8,5%) were performed at the secondary widespread purulent peritonitis of different etiology. Inclusion in the range of therapeutic interventions in patients whose condition was characterized by the extremely serious nature, prevalence of the process according to the peritoneum and the degree of contamination (amount of points on the APACHE II score of at least 20, Mannheim peritonitis index of 20 or above), the open method — peritoneostomii — with the planned milestone bailouts peritoneum in the postoperative period allowed to accelerate the pace of regression of endogenous intoxication, reduce complications, reduce mortality from 68,3 to 32,4%, reduce the length of stay in the bed with a (53,4±3,9) days to (39,7±2,1) days.

Key words: Secondary widespread purulent peritonitis, peritoneostomiya.

 

References

1. Anisimov, A.Yu. Peritoneostomiya v lechenii razlitogo gnoinogo peritonita: avtoref. dis. ... kand. med. nauk / A.Yu. Anisimov. — Kazan’, 1991. — 21 s.
2. Bakulev, A.N. Predislovie k knige P.L. Sel’covskogo «Razlitye gnoinye peritonity» / A.N. Bakulev. — M., 1963. — S.3.
3. Galimzyanov, A.F. Drenazh iz gidratcellyuloznoi plenki v lechenii bol’nyh rasprostranennym peritonitom: avtoref. dis. ... kand. med. nauk / A.F. Galimzyanov. — Kazan’, 2005. — 24 s.
4. Galyautdinov, F.Sh. EHAR-anolit i imipenem-cilastatin natriya v lechenii bol’nyh rasprostranennym peritonitom: avtoref. dis. ... kand. med. nauk / F.Sh. Galyautdinov. — Kazan’, 2004. — 24 s.
5. Gostischev, V.K. Peritonit / V.K. Gostischev, V.P. Sazhin, A.L. Avdovenko. — M.: Medicina, 1992. — 273 s.
6. Grekov, I.I. Materialy k voprosu o lechenii razlityh gnoinyh peritonitov / I.I. Grekov // Izbrannye trudy / pod red. P.A. Kupriyanova. — L.: Medgiz, 1952. — S.202—235.
7. Eryuhin, I.A. Hirurgiya gnoinogo peritonita / I.A. Eryuhin // 50 lekcii po hirurgii / pod red. V.S. Savel’eva. — M.: Media Medika, 2003. — S.320—326.
8. Eryuhin, I.A. Hirurgicheskie infekcii: novyi uroven’ poznaniya i novye problemy / I.A. Eryuhin // Infekcii v hirurgii. — 2003. — № 1. — S.2—7.
9. Zimagulov, R.T. Zondovaya korrekciya sindroma kishechnoi nedostatochnosti v lechenii bol’nyh rasprostranennym peritonitom: avtoref. dis. ... kand. med. nauk / R.T. Zimagulov. — Kazan’, 2004. — 23 s.
10. Kuzin, M.I. Aktual’nye voprosy klassifikacii i lecheniya rasprostranennogo gnoinogo peritonita / M.I. Kuzin // Hirurgiya, 1996. — № 5. — S.9—15.
11. Mustafin, R.R. Intraoperacionnaya gipotermicheskaya sanaciya bryushiny v lechenii bol’nyh s rasprostranennym peritonitom: avtoref. dis. ... kand. med. nauk / R.R. Mustafin. — Kazan’, 2003. — 22 s.
12. Savel’ev, B.C. Abdominal’nyi sepsis: sovremennaya koncepciya i voprosy klassifikacii / B.C. Savel’ev, B.R. Gel’fand, V.A. Gologorskii [i dr.] // Annaly hirurgii. — 1999. — № 6. — S.14—18.
13. Simonyan, K.S. Peritonit / K.S. Simonyan. — M.: Medicina, 1971. — 294 s.
14. Fedorov, V.D. Sovremennye predstavleniya o klassifikacii peritonita i sistemah ocenki tyazhesti sostoyaniya bol’nyh / V.D. Fedorov, V.K. Gostischev, A.S. Ermolov, T.N. Bognickaya // Hirurgiya. — 2000. — № 4. — S.58—62.
15. Shurkalin, B.K Gnoinyi peritonit / B.K. Shurkalin. — M.: Dva Mira Prin., 2000. — 222 s.
16. Bone, R.C. American Collage of Chest Physicians / Society of Critical Care Medicine Consensus Conference: Definitions for sepsis and organ failure and guidelines for use innovative therapies in sepsis / R.C. Bone, A.B. Balk, F.B. Cerra [et al.] // Grit. Care Med. — 1992. — Vol. 20, № 6. — P.864—874.
17. Nathens, A.B. Tertiary Peritonitis Clinical features of a complex nosocomial infections / A.B. Nathens, O.D. Rotstein, J.C. Marshall // World J. Surg. — 1998. — Vol. 22. — P.158—163.
18. Wegner, G. Zur Lehre von der Aetiologie der acuten Peritonitis / G. Wegner // Virchow's Archiv. — 1876. — Bd. 20.

 

Gastrointestinal bleedings at patients of the coronary heart disease

Vyacheslav F. Chikaev, the doctor of medical sciences, the professor of chair of traumatology, an orthopedics and HES GBOU VPO the Kazan State medical university. Ministry of Health of Russia, Kazan, 8-927-434-48-29, e-mail: prof.chikaev@gmail.com

Zulfia F. Kim, the candidate of medical sciences, канд.мед.наук, the associate professor, GBOU VPO the Kazan State medical university. ministry of Health of Russia, zav. kard. otdeleniye № 2 GAuz «ГкБ № 7» Kazan, e-mail: profz@yandex.ru

Ilnaz I.Gumerov, the surgeon of GAUZ «GKB № 7» Kazan, e-mail: gumerov.ilnaz@gmail.com

Denis M. Petukhov, the surgeon of GAUZ «GKB № 7» Kazan, e-mail: petuhoff@gmail.com

Yury V. Bondarev, the candidate of medical sciences, the manager. surgical unit № 3 GAUZ «ГКБ № 7» Kazan

Abstract. We made the analysis of treatment of patients with gastrointestinal bleeding combined with CHD. Our surgical department annually receives an average of (254±24) patients with gastro-intestinal bleeding. Two largest groups of patients with gastrointestinal bleeding were with a Mallory—Weiss syndrome (53,8%) and gastroduodenal ulcers (40,9%). The combination of CHD and chronic diseases of abdominal cavity causes diagnostic difficulties and demands dynamic supervision as cardiologist, and the surgeon. The prognosis of patients with coronary heart disease, complicated by bleeding (may vary to severity), is worse, because of reduced coronary flow reserve. Also the coronary disaster is compounded by the anemia, dysregulation of hemostasis and homeokinesis of central hemodynamics in addition with violation of kidney function, with an increase in serum creatinine. A thorough collecting the anamnesis is obligate and in the presence of pathology from a gastrointestinal path (stomach and duodenum ulcers etc.) anticoagulant therapy must be carried out very carefully, also antiulcer therapy must be included in the treatment scheme since first days. Early diagnostics of gastrointestinal bleeding, elimination of the reasons of an anemiс syndrome, are actual in the global problem of prevention, treatment and improving the prognosis at CHD.

Key words: gastrointestinal bleeding, coronary artery disease, patient.

 

References

1. Kurygin, A.A. Neotlozhnaya hirurgicheskaya gastroenterologiya / A.A. Kurygin, Yu.M. Stoiko, S.F. Bagnenko. — SPb.: Piter, 2001. — 568 s.
2. Sotnikov, V.N. Endoskopicheskaya diagnostika i endoskopicheskie metody lecheniya krovotechenii iz verhnih otdelov pischevaritel’nogo trakta: ucheb. posobie / V.N. Sotnikov, T.K. Dubinskaya, A.A. Razzhivina. — M.: RMAPO, 2000. — 48 s.
3. Fyodorov, E.D. Endoskopicheskii gemostaz s ispol’zovaniem argonoplazmennoi koagulyacii pri ostryh zheludochno-kishechnyh krovotecheniyah: pervyi klinicheskii opyt / E.D. Fyodorov, R.V. Plahov, M.E. Timofeev, A.I. Mihalev // Klinicheskaya endoskopiya. — 2003. — № 1. — S.12—15.
4. Hanevich, M.D. Krovotecheniya iz hronicheskih gastroduodenal’nyh yazv u bol’nyh s vnutripechenochnoi portal’noi gipertenziei / M.D. Hanevich, V.I. Hrupkin, G.K. Zherlov. — Novosibirsk: Nauka, 2003. — 348 s.
5. Forrest, J.A. Endoscopy in gastrointestinal bleeding / J.A. Forrest, N.D. Finlayson, D.J. Shearman // Lancet. — 1974 — Vol. 2 (7877). — P.394—397.
6. Vreeburg, E. Validation of the Rockall risk scoring system in upper gastrointestinal bleeding / E. Vreeburg, C. Terwee, P. Snel [et al.] // Gut. — 1999 — Vol. 44 (3). — P.331—335.
7. Thygesen, K. On behalf of the Joint ESC/ACCF/AHA/WHF Task Force for the Redefinition of Myocardial Infarction. Universal definition of myocardial infarction / K. Thygesen, J.S. Alpert, H.D. White // Eur. Heart. J. — 2007. — Vol. 28 (20). — P.2525—2538.
8. Sumarokov, A.B. Krovotecheniya u bol’nyh s ishemicheskoi bolezn’yu serdca pri provedenii terapii antiagregantami / A.B. Sumarokov, L.I. Buryachkovskaya, I.A. Uchitel’ // Cardio Somatika. — 2011. — № 3. — S.29—35.
9. Siller-Matula, J. Impact of clopidogrel loading dose on clinical outcome in patients undergoing percutaneous coronary intervention: a systemic review and meta-analysis / J. Siller-Matula, K. Huber, G. Christ [at al.] // Heart. — 2011. — Vol. 97. — P.98—105.
10. Usman, M.H. Combination Antiplatalet Therapy for Secondary Stroke Prevention: Enbanced Efficacy or Double Trouble? / M.H. Usman, D.J. Nagarakanty [at al.] // Stroke. — 2009. — Vol. 103. — P.1107—1112.
11. Poputchikova, E.A. Ostrye erozii i yazvy zheludka i dvenadcatiperstnoi kishki, oslozhnennye krovotecheniem, u bol’nyh infarktom miokarda: avtoref. dis. ... kand. med. nauk / E.A. Poputchikova. — M., 2003. — 24 s.
12. Latfullin, I.A. Depressiya segmenta ST pri ishemicheskoi bolezni serdca s soputstvuyuschei anemiei / I.A. Latfullin, Z.F. Kim // Vrach. — 2001. — № 2. — S.26—28.

 

The experience of using low-flow filtration methods in the treatment of patients with acute renal failure in the multiprofile hospitals

Vladimir A.Vdovin, the candidate of medical sciences, the assistant to chair of anesthesiology and resuscitation, medicine of accidents, GBOU VPO «Kazan State Medical University» of Ministry of Health of the Russian Federation, Kazan, the doctor of office of anesthesiology and reanimation of GAUZ GKB № 7 Kazan, e-mail: VdovinVA2001@mail.ru

Talgat S. Ganeev, candidate of medical sciences, doctor of office of anesthesiology and GAUZ «Interregional Kliniko-diagnostic Center» reanimation, Kazan

Aygul N. KHannanova, doctor of GAUZ City clinical hospital № 7 Kazan, e-mail: Aigul_hannanova@mail.ru

Abstract. In this article the effectiveness of low-flow techniques in continuous renal replacement therapy. This treatment was performed to 29 patients who developed postoperative acute renal failure. The criteria for selection were: Injury — urine output less than 0,5 mL/kg/h, creatinine increase by 2 times and Failure — urine output less than 0,3 mL/kg/h, creatinine increase by 3 times. The severity by APACHE II score was (23±1,1) to (27±1,2) points. The number of affected organs were from 3 to 4. 116 procedures of continuous veno-venous hemofiltration (CVVH) were done. The results give reason to recommend using of low-flow filtration techniques in intensive care units by the expert in resuscitation. Low-flow filtration methods have a pronounced therapeutic effect on surgical correction of homeostasis in patients with acute renal failure. The early inclusion of EG methods in patients with acute renal failure can reduce mortality by 31%.

Key words: acute renal failure, methods of extracorporal hemocorrection.

 

References

1. Gurevich, K.Ya. Koncepciya kliniki ekstrakorporal'noi gemokorrekcii / K.Ya. Gurevich, A.L. Kostyuchenko // Efferentnaya terapiya. — 1995. — T. 1, № 1. — S.8—13.
2. Kiselyov, V.O. Ostraya pochechnaya nedostatochnost' v strukture oslozhnenii posle vspomogatel'nogo krovoobrascheniya v kardiohirurgii / V.O. Kiselyov, Yu.K. Podoksenov, I.V. Ponomarenko [i dr.] // Nefrologiya i dializ. — 2005. — № 3. — S.394—395.
3. Yakovleva, I.I. Sovremennyi vzglyad na pokazaniya dlya zamestitel'noi pochechnoi terapii u bol'nyh reanimacionnogo profilya / I.I. Yakovleva // Nefrologiya i dializ. — 2005. — № 3. — S.400—401.

 

Improvement of prevention of post-transfusion complications by the blood test of recipients on existence isoimmune the antieritrotsitarnykh of antibodies

Ramil G. Turayev, the candidate of medical sciences, the chief physician of the state autonomous healthcare institution «Republican center of blood of Ministry of Health of the Republic of Tatarstan»,tel. 273-78-33, e-mail: rspk@tatar.ru

Elena E. Belskаyа, managing immunological office of the state autonomous healthcare institution «Republican center of blood of Ministry of Health of the Republic of Tatarstan», tel. 272-26-61

Abstract. Every day in the hospital of a stationary type spend tens of transfusions of blood components. A study of the blood of the patients before the transfusion therapy regulated by the MoH orders. However, not in all medical institutions providing the full complex of these studies. In this work contains the results of the study of blood recipients and mothers received in immunological office station of blood transfusion of the Republic of Tatarstan for the period 2007—2012 years. These findings suggest the need for a more careful approach to the operation of transfusion of blood components, as a matter of fact, transfusion of blood transplantation is a liquid tissue. For the safety of transfusion, you must perform the whole complex of examination of a patient’s blood, specified in the orders of the Ministry of health of the Russian Federation and the Republic of Tatarstan. Pay special attention to risk the emergence of post-transfusion complications. Sensitization to foreign antigens of red cells is one of the causes of severe post-transfusion reactions and complications in health facilities. To ensure the safety of blood for transfusion is of great importance is the timely detection of antibodies against antigens of red cells from donors, pregnant women and recipients of blood cells. Another important factor is the choice of research methods, because of the received one or the other method of the results depends on the safety of transfusion and, as a consequence, the effectiveness of this procedure.

Key words: immune to anti-erythrocytary antibodies, blood components, complications after the transfusion.

 

References

1. Donskov, S.I. Gruppy krovi cheloveka: rukovodstvo po immunoserologii / S.I. Donskov, V.A. Morokov. — M., 2011.
2. Donskov, S.I. Gruppy krovi sistemy Rhesus. Teoriya i praktika / S.I. Donskov. — M., 2005.
3. Zhiburt, E.A. Transfuziologiya / E.A. Zhiburt. — SPb., 2002.
4. Zhiburt, E.A. Benchmarking zagotovki i perelivaniya krovi / E.A. Zhiburt. — M.: Rossiiskaya akademiya estestvennyh nauk, 2009.
5. Mineeva, N.V. Gruppy krovi cheloveka. Osnovy immuno- gematologii / N.V. Mineeva. — SPb., 2004.
6. Prokop, O. Gruppy krovi cheloveka / O. Prokop, V. Geler. — M.: Medicina, 1991.
7. Prikaz № 908 «Ob ustanovlenii regional’nyh standartov tehnologii issledovaniya funkcii organov i tkanei s ispol’zovaniem special’nyh procedur».
8. Prikaz MZ RF ot 25.11.2002 g. № 363 «Ob utverzhdenii instrukcii po primeneniyu komponentov krovi».
9. Transfuziologiya. Nacional’noe rukovodstvo. — M.: GEOTAR-9. Media, 2012.
10. Tehnicheskoe rukovodstvo amerikanskoi associacii bankov krovi. — 12-e izd. na rus. yaz. — Milan: Evropeiskaya shkola transfuzionnoi mediciny, 2000.

 

Reperfusion syndrome at vascular reconstruction at patients with the syndrome of diabetic foot

Konstantin A. Koreyba, candidate of medical sciences, associate professor of the general surgery, GBOU VPO «Kazan State medical university» of ministry of Health of Russia, tel. 8-9274-128-703, e-mail: korejba_k@mail.ru

Ivan V. Klyshkin, professor, doctor of medical sciences, professor of chair of the general surgery, GBOU VPO «Kazan State medical university» of ministry of Health of Russia, Kazan, tel. 8-919-624-96-40, e-mail: hirurgivan@rambler.ru

Alexander V. Maksimov, the manager. office of vascular surgery № 1 GAUZ «MZ Republican Clinical Hospital of the Republic of Tatarstan», MD, associate professor of cardiology and angiologiya of GBOU DPO «Kazan Medical Academy» of Ministry of Health of Russia, Kazan

Ruslan I. Fatykhov, candidate of medical sciences, assistant to chair of the general surgery, GBOU VPO «Kazan State Medical university» of ministry of Health of Russia, Kazan, tel. 8-927-4-000-295, e-mail: 74ruslan@rambler.ru

Magomed N. Nasrullayev, Doctor of medical sciences, Professor of the Department of clinical anatomy and outpatient surgery «Kazan state medical Academy» of Ministry of Health of Russia, tel. 8-432-72-47-71, e-mail: msh-oao-кар@уаndex.ru

Abstract. The syndrome of diabetic foot is terrible and late complication of diabetes. One of the perspective directions of therapy is application of the combined surgical approach — a complex of purulent and vascular surgery. When rendering the complex qualified medical care by a decisive stage of therapy implementation of reconstructive intervention is. The technically successfully executed intervention doesn’t guarantee restoration of a peripheral blood-groove and extremity preservation if the postoperative period where the main complication is the reperfusion syndrome isn’t adequately created. It represents set of the complications following restoration of a blood-groove in earlier ischemic bodies and fabrics. Now there are no uniform approaches and standards of conservative therapy of this pathology. The way of prevention of a reperfusion syndrome is presented in article at vascular reconstruction of the arterial course at patients with a syndrome of the diabetic foot, applied in the Diabetic Foot Center of Kazan.

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

 

References

1. Anikin, A.I. Znachenie ocenki mikrocirkulyatornyh narushenii v hirurgicheskom lechenii gnoino-nekroticheskih porazhenii pri sindrome diabeticheskoi stopy: dis. ... kand. med. nauk / A.I. Anikin. — M., 2009. — 146 s.
2. Bilenko, M.V. Ishemicheskie i reperfuzionnye povrezhdeniya organov (molekulyarnye mehanizmy, puti preduprezhdeniya i lecheniya): monografiya / M.V. Bilenko. — M.: Medicina, 1989. — 368 s.
3. Gavrilenko, A.V. Reperfuzionnyi sindrom v rekonstruktivnoi hirurgii sosudov nizhnih konechnostei / A.V. Gavrilenko, I.I. Dement’eva, E.D. Shabaltas // Annaly hirurgii. — 2002. — № 3. — S.19—22.
4. Dudanov, I.P. Novyi vzglyad na terminologiyu, klassifikaciyu i uchet ostryh ishemicheskih i reperfuzionnyh povrezhdenii myagkih tkanei konechnosti / I.P. Dudanov, D.A. Mezhenin, A.M. Mezhenin // Regionarnoe krovoobraschenie i mikrocirkulyaciya. — 2003. — № 2. — S.8—10.
5. Kuznecov, M.R. Sovremennye aspekty diagnostiki, profilaktiki i lecheniya reperfuzionnogo sindroma / M.R. Kuznecov, V.M. Koshkin, K.V. Komov // Angiologiya i sosudistaya hirurgiya. — 2006. — T. 12, № 1. — S.133—143.
6. Mezhdunarodnoe soglashenie po Diabeticheskoi stope. — 6. 2000.
7. Neimark, M.I. Anesteziya i intensivnaya terapiya v hirurgii aorty i ee vetvei: monografiya / M.I. Neimark, I.V. Merkulov. — Petrozavodsk: Izd-vo «IntelTek», 2005. — 272 s.
8. Castronuovo, J.J. Skin perfusion pressure measurement is valuable in the diagnosis of critical ischemia / J.J. Castronuovo, H.M. Adera, M. Janice [et al.] // J. Vase Surg. — 1997. — Vol. 26. — P.629—637.

 

CLINICAL CASE REPORT

Pulmonary embolism in clinic of urgent cardiology

Alla A. Podolskaya, candidate of medical sciences, associate Professor of the Department of internal diseases № 2, Kazan State Medical University, e-mail: alla.podolsckaya@yandex.ru

Zulfia F. Kim, candidate of medical sciences, associate Professor of the Department of internal diseases № 2, Kazan State Medical University, head of Department of cardiology № 1 of the GAUSE «City clinical hospital № 7», e-mail: alla.podolsckaya@yandex.ru

Guzel Z. Afandiyeva, student of group 1612 of medical faculty of the Kazan state medical university

Abstract. According to the literature in the structure of mortality from cardio — vascular diseases, pulmonary embolism is the third largest after myocardial infarction and stroke. In economically developed countries, 0,1% of people die each year from pulmonary embolism. Risk factors for pulmonary embolism are common and occur in many areas of medicine (surgery, gynecology, oncology, traumatology, orthopedics, internal medicine, cardiology). Diagnosis of pulmonary embolism is a rather difficult task for physicians due to the fact that the clinical picture is dominated by asymptomatic or «masked» form, the clinical picture is often associated with coronary heart disease, especially acute coronary syndrome. Specific diagnostic methods, such as angiography, scintigraphy, perfusion-ventilation studies with isotopes, spiral CT and magnetic resonance imaging are not always feasible in routine clinical practice. During his lifetime diagnosis of pulmonary embolism is set less than 70% of cases. Mortality among patients without pathogenic therapy, according to various authors, is 40% or more, with massive pulmonary embolism is 70% and in a timely manner started therapy ranged from 2 to 8%. The article provides a clinical case of pulmonary embolism requiring differential diagnosis of acute coronary artery disease, and major clinical and instrumental criteria to identify pulmonary embolism.

Key words: pulmonary embolism, acute coronary syndrome.

 

References

1. Kotel'nikov, M.V. Diagnostika i lechenie tromboembolii legochnoi arterii / M.V. Kotel'nikov, N.Yu. Kotel'nikova // Rusckii medicinskii zhurnal. — 2008. — № 16. — S.1110—1115.
2. Rossiiskie klinicheskie rekomendacii po diagnostike, lecheniyu i profilaktike venoznyh tromboembolicheskih oslodzhnenii // Flebologiya. — 2010. — T. 4, № 1, vyp. 2. — S.3—40.
3. Latfullin, I.A. Neotlozhnaya kardiologiya / I.A. Latfullin, Z.F. Kim, R.I. Ahmerova. — M.: MEDpress, 2010. — 112 s.

 

Complicated case of diagnosis: adrenal failure under the mask of myocardial infarction

Iskander F. Yakupov, candidate of medical sciences, manager of anesthesiology and reanimation № 3 GAUZ office «City Clinical Hospital № 7» Kazan, ph. +7-937-615-35-68, e-mail: isyakup2000@mail.ru

Niyaz R.Khasanof, doctor of medical sciences, associate professor of propaedeutics of internal diseases of Public Educational Institution of Higher Professional Training «Kazan state medical university», ph. +7-987-290-60-21, e-mail: ybzp@mail.ru

Zulfia A. Shakhutdinova, the deputy chief physician on medical work of GAUZ «City Clinical Hospital № 7», Kazan, ph. +7-960-048-26-37

Tatyana A. Petrova, acting the manager of office of endocrinology of GAUZ «City Clinical Hospital № 7», Kazan, ph. +7-905-311-21-86

Evgeny N. Ivantsov, student of medical faculty of Public Educational Institution of Higher Professional Training «Kazan state medical university», ph. +7-958-620-44-86

Abstract. Adrenal failure — a clinical syndrome characterized by insufficient secretion of hormones of the adrenal cortex as a result of malfunction of one or more parts of the hypothalamic-pituitary-adrenal system. Such signs as severe hypotension, anuria, acrocyanosis, thready pulse, changes in the electrocardiogram and complaints of the heart can be regarded as signs of shock, having a cardiac nature. The article present an example of the diagnosis and treatment of patient presenting with suspected myocardial infarction and cardiogenic shock. Diagnosis of her adrenal failure allowed to help her and save her live. The exact history taking, adequate evaluation of its clinical condition allowed in the first hours of its arrival to avoid an aggressive diagnostic procedures — coronary angiography. Tandem treatment of patient by resuscitators, cardiologists, endocrinologists at the hospital with the control levels of blood hormones, endoscopic and ultrasound diagnostic procedures was the key to success in the treatment of this patient. During treatment with infusions, hormones, vasopressors managed to stabilize the patient’s condition, gradually to increase the blood pressure, later to abandon of the vasopressors introduction. She was discharged from hospital on the back of significant clinical improvement.

Key words: adrenal failure, shock, myocardial infarction.

 

References

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8. Shtern, N. Bolezni kory nadpochechnikov / N. Shtern, M. Tak // Endokrinologiya / pod red. N. Lavina. — M.: Praktika, 1999. — S.173—221.

 

HELP FOR PRACTITIONER

Video-digital registration of the results of the reaction for microprecipitation for the diagnosis of syphilis

S.G. Mardanly, N.V. Bahilina, I.A. Ermolaeva, A.E. Tugolukov, S.M. Sorokoletov, T.A. Starovoytova, Yu.Y. Vengerov

Abstract. Video-digital registration of the results (VCR) tested the reaction for microprecipitation (RMP) with cardiolipin antigen used in the diagnosis of syphilis as a screening test. Shows a high degree of conformity of the estimates of the intensity of the reaction under its visual and instrument accounting and also the possibility of replacing the traditional ranking («cross») the method of accounting the account in conventional units intensity of the reaction obtained in digital image processing by reaction with the use of hardware-software complex «Expert-lab». Shows the principal possibility of the evaluation of the antibody concentration in IU/ml on the values of the intensity of the reaction in conventional units.

Key words: video-digital registration of the results (VCR), reaction for microprecipitation (RMP), diagnostics of syphilis, hardware-software complex «Expert-lab».

 

References

1. Dmitriev, G.A. Differencial’nyi kliniko-laboratornyi diagnoz / G.A. Dmitriev, N.V. Frigo. — M.: Medicinskaya kniga, 2004. — 364 s.
2. Starovoitova, T.A. Videocifrovaya registraciya dlya immuno- logicheskih i biohimicheskih issledovanii v praktike klinicheskoi laboratornoi diagnostiki: avtoref. dis. ... d-ra med. nauk / T.A. Starovoitova. — M., 2010. — 49 s.
3. Starovoitova, T.A. Videocifrovoi analiz dlya laboratornoi diagnostiki: kompleks «Ekspert-Lab» na osnove skanera dlya dokumentirovaniya, ob’ektivizacii i registracii rezul’tatov lateks-agglyutinacionnyh, gemagglyutinacionnyh testov, izoserologicheskih i immunofermentnyh issledovanii / T.A. Starovoitova, V.V. Zaiko, N.A. Steriopolo [i dr.] // Laboratoriya. — 2006. — № 1. — S.19—22.
4. Starovoitova, T.A. Videocifrovoi analiz dlya laboratornoi diagnostiki: kompleks «Ekspert-Lab» na osnove skanera dlya dokumentirovaniya i registracii rezul’tatov lateks-agglyutinacionnyh testov i immunofermentnyh issledovanii / T.A. Starovoitova, N.A. Steriopolo, V.V. Zaiko [i dr.] // Materialy dokladov seminarov i konferencii v ramkah vystavki «AnalyticaExpo-2006». — M., 2006. — S.42—43.
5. Mardanly, S.G. Laboratornaya diagnostika TORCH-infekcii s primeneniem test-sistem firmy «EKOlab» i analizatora «Ekspert-Lab» / S.G. Mardanly, V.V. Zaiko, A.E. Tugolukov, T.A. Starovoitova // Vestnik sovremennoi klinicheskoi mediciny. — 2013. — T. 6, vyp. 2. — S.10—16.

 

Diagnostic algorithm of the acute appendicitis at pregnant women

S.V. Dobrokvashin, A.G. Izmailov, D.E. Volkov, S.L. Demyanov P.83

Abstract. Results of treatment of 23 pregnant women on materials of the surgical department of Hospital for veterans of wars in Kazan in three years were analysed From them 15 (65,2%) pregnant women with the confirmed diagnosis of acute appendicitis have been operated, under anaesthetic. Among the operated: phlegmonic appendicitis was revealed at 7 (47%) patients, catarrhal at 8 (53%). According to literature the acute appendicitis during pregnancy meets in 0,03 — 5,2% of cases. According to our data, the acute appendicitis was noted in 0,7% of cases from total of the operated patients. The most frequent symptoms of the operated patients: morbidity at a palpation in the right iliac and right mezogastral area at 11 patients (73,3%), Kokher’s symptom at 6 patients (40%), Sitkovsky and Bartomye—Michelson at 8 patients (53,3%), Shchetkin’s symptom—Blyumberg was revealed at 2 patients (13,3%). In 3 (20%) cases the diagnostic laparoscopy with the subsequent conversion for an appendektomiya in I trimester of pregnancy, without complications is executed.

Key words: pregnant women, acute appendicitis, diagnostic laparoscopy.

 

References

1. Kriger, D.G. Ostryi appendicit / D.G. Kriger, A.V. Fedorov, P.K. Voskresenskii. — M.: Medicina. 2007. — S.234.
2. Patent na izobretenie № 2293561. Sposob diagnostiki ostrogo appendicita u beremennyh / S.G. Izmailov, G.A. Izmailov, S.V. Dobrokvashin, A.G. Izmailov (20 fevralya 2007). — FIPS RF. — M., 2007.
3. Strizhakov, A.N. Beremennost’ i ostryi appendicit / A.N. Strizhakov, O.R. Baev, E.I. Cherkezova// Vest- nik akusherstvа i ginekologii. — 1999. — № 1. — S.123—129.
4. Shaimardanov, R.Sh. Instrumental’nye metody issledovaniya v diagnostike ostrogo appendicita u beremennyh / R.Sh. Shaimardanov, R.F. Gumarov // Kazanskii medicinskii zhurnal. — 2010. — T. 91, № 5. — S.622—625.

 

Anesthetic management at pregnant women with subarachnoid hemorrhages

Aynagul Zh. Bayaliyeva, the doctor of medical sciences, the head of the department of anesthesiology and resuscitation, medicine of accidents of GBOU VPO «Kazan State Medical University», tel. 8-960-051-83-04

Roman Ya. Shpaner, the candidate of medical sciences, the manager of anesthesiology and reanimation № 3 GAUZ office «Interregional Kliniko-Diagnostichesky Center», the assistant to chair of anesthesiology and resuscitation, medicine of accidents of GBOU VPO «Kazan State Medical University», tel. 8-917-927-85-28, e-mail: rshp@bk.ru

Elinа I. Bogdanova, the doctor the anesthesiologist-resuscitator of office of anesthesiology and reanimation № 3 GAUZ «Interregional Kliniko-Diagnostichesky Center», Kazan, tel. 8-905-317-25-92

Irina R. Ganeyeva, the doctor the anesthesiologist-resuscitator of office of anesthesiology and reanimation № 3 GAUZ «Interregional Kliniko-Diagnostichesky Center», the senior laboratory assistant of chair of anesthesiology and resuscitation, medicine of accidents of GBOU VPO «Kazan State Medical University», tel. 8-917-257-35-55

Abstract. Physiological changes occurring in the body of pregnant should necessarily be taken into account during anesthesia during surgical procedures associated with co morbidity. Do not forget about laying and developing the body of the fetus. Clinical diagnosis of intracranial pathology is very difficult in pregnant women, since neurological symptoms can be mistaken for manifestations of pregnancy. Given the importance of all of the above for the safety of mother and fetus, this article describes the physiological changes the body in pregnant women. Showing pharmacological effects of drugs used for anesthesia, and for the treatment of patients in this category, their effect on the fetus. Variants of surgical treatment of pregnant women with neurosurgery pathology at different stages of pregnancy. We consider the postoperative management of women with subarachnoid hemorrhage.

Key words: subarachnoid hemorrhage, pregnancy, anesthesia of pregnant.

 

References

1. Аllen, G. Anesthetic management of the pregnant patient for endovascular coiling of an unruptured intracranial aneurysm / G. Аllen, Р. Farling, D. McAtamney // Neurocritical Саге. — 2005. — Vol. 4. — P.1—3.
2. Bateman, В.Т. Intracerebral hemorrhage in pregnancy: frequency, risk factors, and outcome / В.Т. Bateman, Н.С. Schumacher, C.D. Bushnell [et аl.] // Neurology. — 2006. — Vol. 67. — P.424—433.
3. Cohen-Gadol, А.А. Neurosurgical management of intracranial lesions in the pregnant patient: а 36-year institutional experience and review of the literature / А.А. Cohen-Gadol, J.A. Friedman, J.D. Friedman [et аl.] // Journal of Neurosurgery. — 2009. — Vol. 111. — P.1150—1157.
4. Соореr, D.W. Fetal and maternal effects of phenylephrine and ephedrine during spinal anesthesia for cesarean delivery / D.W. Соореr, М. Carpenter, Р. Mowbray [et аl.] // Anesthesiology. — 2002. — Vol. 97. — P.1582—1590.
5. Gaist, D. Parity and risk of subarachnoid hemorrhage in women. А nested case-control study based on na- tional Swedish registries / D. Gaist, L. Pedersen, S. Cnat- tingius, Н.Т. Sorensen // Stroke. — 2004. — Vol. 35. — P.28—33.
6. Hoff, R.G. Hypotension in anaesthetized patients during aneurysm clipping: not as bad as expected? / R.G. Hoff, G.W. van Dijk, S. Mettes [et аl.] // Acta Anaesthesiologica Scandinavica. — 2008. — Vol. 52. — P. 1006— 1017.
7. Kenn, S. Prone positioning for ARDS following blunt chest trauma in late pregnancy / S. Kenn, S. Weber-Carstens, К. Weizsaecker, S. Bercker // lnternational Journal of Obstetric Anesthesia. — 2009. — Vol. 18. — P.268—271.
8. Kizilkilic, О. Endovascular treatment of ruptured intracranial aneurysms during pregnancy: report of three cases / О. Kizilkilic, S. Albayram, I. Adaletti [et аl.] // Archives of Gynecology аnd Obstetrics. — 2003. — Vol. 268. — P.325—333.
9. Kuczkowski, К.М. Nonobstetric surgery during pregnancy: What are the risks of anesthesia? / К.М. Kuczkowski // Obstetrical and Gynecological Survey. — 2003. — Vol. 59. — P.52—58.
10. Neindorff, М. Fetomaternal pharmacology: anaesthesiological approach in surgical interventions during pregnancy / М. Neindorff // Anaesthesist. — 2010. — Vol. 5. — Р.479—490.
11. Ng, J.11. Neurosurgery and pregnancy / J. Ng, N. Kitchen // Journal of Neurology, Neurosurgery and Psychiatry. — 2008. — Vol. 79. — P.745—752.
12. Pedersen, Н. Obstetric anesthesia / Н. Pedersen, А.С. Santos, М. Finster // Handbook of clinical anesthesia / P.G. Barash, B.F. Cullen, R.K. Stoelting [et al.]. — Philadelphia, USA: Lippincott, 1991. — P. 343—355.
13. Rosen, М.А. Management of anesthesia for the pregnant surgical patient / М.А. Rosen // Anesthesiology. — 1999. — Vol. 91. — P.1159—1163.
14. Selo-Ojeme, D.O. Aneurysmal subarachnoid haemorrhage in pregnancy / D.O. Selo-Ojeme, L.A.G. Marshman, А. Ikomi [et аl.] // European Journal of Obstetrics and Gynaecology. — 2004. — Vol. 116. — P.131—143.
15. Tuncali, В. Intraoperative fetal heart rate monitoring during emergency neurosurgery in а parturient / В. Tuncali, М. Aksun, К. Katircioglu [et al.] // Journal of Anesthesia. — 2006. — Vol. 20. — P.40—4З.
16. Van de Velde, М. Anesthesia for non— obstetric surgery in the pregnant patient / М. Van de Velde, F. dе Buck // Minerva Anestesiologica. — 2007. — Vol. 73. — P.235—240.
17. Wang, С. Strategies and experimental models for evaluating anesthetics: effects on the developing nervous system / С. Wang, W. Slikker // Anesthesia and Analgesia. — 2008. — Vol. 106. — P.1643—1658.
18. Wang, L.P. Neuroanesthesia for the pregnant woman / L.P. Wang, M.J. Paech // Anesthesia and Analgesia. — 2008. — Vol. 107. — P.193—200.
19. Weiner, С.Р. Uteroplacental blood f1ow / С.Р. Weiner, J.C. Eisenach // Obstetric anesthesia, principles and practice / D.H. Chestnut еd. — 3rd еd. —Philadelphia, USA: Elsevier Mosby, 2004. — P.37—48.
20. Zakowski, М.I. The placenta: Anatomy, physiology, and transfer of drugs / М.I. Zakowski, N. Herman // Obstetric anesthesia, Principles and Practice / D.H. Chestnut еd. — 3rd еd. —Philadelphia, USA: Elsevier Mosby, 2004. —P.49—65.

 

Acute coronary syndrome: from diagnosis to treatment optimization

Ella I. Aglullina, head of cardiology department № 2 GAUSE «City Clinical Hospital № 7», honoured Doctor of the Republic of Tatarstan, Russia

Abstract. Among the causes of death of the population is now dominated by diseases of the circulatory system. About half of the deaths from diseases of the cardiovascular system accounted for coronary heart disease. The most dangerous is the period of acute ischemic heart disease, clinical variants of which are combined by the term «acute coronary syndrome». The introduction of the term in practice due to the appearance of clinical symptoms, allowing diagnosis of ischemia and the need for urgent remedial measures that improve prognosis in patients with acute coronary syndrome. In this article, an algorithm for the diagnosis and treatment of patients with acute coronary syndrome with ST-segment elevation and segment elevation ST, as well as detailed review of drugs primenyamyh for emergency cardiac care.

Key words: acute coronary syndrome, thrombolytic therapy, percutaneous coronary intervention.

 

References

1. Rekomendacii Evropeiskogo kardiologicheskogo obschestva po diagnostike i lecheniyu ostryh koronarnyh sindromov, ne soprovozhdayuschihsya pod’emom segmenta ST // Europ. Heart Journal. — 2007. — Vol. 28(13).
2. Kalla, K. Implementation of guidelines improves the standart of care: the Vennese registry on reperfusion strategies in ST-elevation myocardial infarction (Venna STEMI registry) / K. Kalla, G. Christ, R. Karnit [et al.] // Circulation. — 2006. — Vol. 113(20). — P.2398—2405.
3. Keeley, E.C. Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a qvantitative revew of 23 randomised traels / E.C. Keeley, J.A. Boura, C.L. Grines // Lancet. — 2003. — Vol. 361. — P.13—20.
4. Zahn, R. Decreasing hospital mortality between 1994 and 1998 in palients with acute myocardial infarction treated with primary angioplasty but not in patients trea ted with intravenous thrombolysis. Results from the pooled data of the Maxsimal individual Therapy in Acute Myocardial Infarction (MITRA) Registry and the Myocardid infarction Registry (MIR) / R. Zahn, S. Schneider [et al.] // J. Am. Coll. Cardiol. — 2000. — Vol. 36(7). — P.2064—2071.
5. Wijns, W. Gwidelines on myocardial revaseularization: The Task Force on Myocardial Revascularization of th European Society of Cardiology (ESC) and the European Assouation for Cardio-Thoracic Surgery (EACTS) / W. Wijns, Ph. Kolh, N. Danchin [et al.] // Eur. Heat J. — 2010. — Vol. 31. — P.2501—2555.

 

Treatment of gastrointestinal bleeding

Magomed N. Nasrullayev, Doctor of medical sciences, Professor of the Department of clinical anatomy and outpatient surgery «Kazan state medical Academy» Ministry of health and social development of Russia, Kazan, Russia, tel. 8-432-72-47-71, e-mail: msh-oao-кар@уаndex.ru

Abstract. Optimization of treatment of gastrointestinal bleedings. Material and methods. Under supervision there were 25 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 field 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 fluid 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 specific features of the specific patient, and also accompanying pathology.

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

 

References

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3. Gostischev, V.K. Ostrye gastroduodenal’nye yazvennye krovotecheniа: ot strategicheskih koncepcii k lechebnoi taktike / V.K. Gostischev, M.A. Evseev. — M.: Anto-Eko, 2005. — 352 s.
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6. Sacukevich, V.N. Ostrye zheludochno-kishechnye krovotecheniya iz hronicheskih gastroduodenal’nyh yazv / V.N. Sacukevich, D.V. Sacukevich // Kremlevskaya medicina. — 2000. — № 2.
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.
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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.

 

Optimization strategy management of patients in stable angina

Elena G. Slepukha, PhD, department manager kardiology № 3, GAUZ «City Clinical Hospital № 7», Russia, Kazan, tel. 8-903-340-08-09, e-mail: slepuha@fromru.com

Olga V. Bulashova, mD, professor, Gou VPo «Kazan State medical university» Russian ministry of Health, Kazan, tel. 88432961403, e-mail: boulashova@yandex.ru

Zulfia А. Shaichutdinova, head of the medical unit GAUZ «City Clinical Hospital № 7», Russia, Kazan, tel. 8-960-048-26-37, e-mail: gkb7@bk.ru

Abstract. Cardiovascular diseases are the leading cause of morbidity and mortality in developed countries. Current treatment of stable coronary artery disease is the appointment optimal medical therapy, which in some patients may be supplemented by revascularization in the form of coronary artery bypass grafting or percutaneous coronary intervention. According to the recommendations of the leading cardiology and cardiac surgery communities, revascularization is justified when it is expected a positive effect on quality of life (symptoms, functional status, etc.), as well as against the forecast exceeds the expected adverse effects of this procedure. Myocardial revascularization has gained great popularity in the clinical practice of recent decades, but the long-term results in the evaluation of complex and contradictory.

Key words: coronary artery disease, revascularization, stenting, stable angina, percutaneous coronary intervention.

 

References

1. Akchurin, R.S. Nacional’nye rekomendacii po diagnostike i lecheniyu stabil’noi stenokardii. 2008 g. / R.S. Akchurin, Yu.A. Vasyuk, Yu.A. Karpov // Kardiovaskulyarnaya terapiya i profilaktika. — 2008. — № 7 (6) (prilozhenie 4). — 40 s.
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3. Belenkov, Yu.N. Kardiologiya. Nacional’noe rukovodstvo / Yu.N. Belenkov, R.G. Oganov. — M.: GEOTAR-Media, 2010. — S.147—160.
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11. Eagle, K.A. ACC/AHA Guidelines for Coronary Artery Bypass Graft Surgery: A Report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines. American College of Cardiology/ American Heart Association / K.A. Eagle, R.A. Guyton [et al.] // J. Am. Coll. Cardiol. — 1993. — Vol. 34 (4). — P.1262—1347.
12. Gibbons, R.J. ACC/AHA 2002 guideline update for the management of patients with chronic stable angina-summary article: a report of the American College of Cardiology/American Heart Associations Task Force on practice guidelines(Committee on the Management of Patients with Chronic Stable Angina) / R.J. Gibbons, J. Abrams, K. Chaterjee [et al.] // J. Am. Coll. Cardiol. — 2003. — Vol. 41 (1). —P.159—168.
13. Lawric, M. Results of coronary bypass more than five years after operation in 434 patients: clinical treadmill exercise and angiographic correlation / M. Lawric, G. Morris, J. Howell [et al.] // Am. J. Cardiol. — 1977. — Vol. 40, № 8. — P.665—672.
14. Murphy, M. Treatment of chronic stable angina: a preliminary report of survival data of the randomised Veterans Administration Cooperative Study / M. Murphy, H. Hultgren, K. Detre [et al.] // N. Engl. J. Med. — 1977. — Vol. 297, № 9. — P.624—627.
15. Patel, M.R. ACCF/SCAI/STS/AATS/AHA/ASNC 2009 Appropriateness Criteria for Coronary Revascularization: a report by the American College of Cardiology Foundation Appropriateness Criteria Task Force, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, American Associations for Thoracic Surgeons, American Heart Association, and the American Society of Nuclear Cardiology Endorsed by the American Society of Echocardiography, the Heart Failure Society of America, and the Society of Cardiovascular Computed Tomography / M.R. Patel, G.J. Dehmer, J.W. Hirshfeld [et al.] // J. Am. Coll. Cardiol. — 2009. — Vol. 53 (6). — P.530—553.
16. Yusuf, S. Effect of coronary artery bypass graft syrgery on survival. Overview of 10-year results from randomized trials by the Coronary Artery Bypass Graft Surgery Trialists Collaboration / S. Yusuf, D. Zucker, P. Peduzzi [et al.] // Lancet. — 1994. — Vol. 344 (8922). — P.563—570.

 

ORGANIZATION OF HEALTHCARE

Some aspects of the organization emergency cardiac care

Zulfia F. Kim, candidate of medical sciences, associate Professor of the Department of internal diseases № 2, Kazan State Medical University, head of Department of cardiology № 1 of the GAUSE «City clinical hospital № 7», e-mail: profz@yandex.ru

Alla A. Podolskaya, candidate of medical sciences, associate Professor of the Department of internal diseases № 2, Kazan State Medical University

Abstract. Reduction in mortality from cardiovascular disease — a priority health issues affecting not only the development of new therapeutic and diagnostic approaches to this disease, but also by optimizing the organization of the various stages of care. Relevant is the issue of continuity between the various levels of medical care (ambulance, hospital emergency cardiology, high-tech hospital, rehabilitation). This article highlights the most relevant organizational aspects of emergency care for acute coronary syndrome. The authors analyzed the frequency of readmissions of patients with coronary heart disease. According to the results of the questionnaire survey among hospitalized patients, the causes of delays in seeking professional medical advice. The degree of awareness of patients about the nature, course and prognosis of the disease. Due to the fact that the effectiveness of the therapy depends on the patient’s adherence to treatment, his understanding of the nature of the disease, the necessary preventive measures suggested possible ways to improve it.

Key words: acute coronary syndrome, acute myocardial infarction, angina pectoris.

 

References

1. Abina, E.A. Dinamika rasprostranennosti ishemicheskoi bolezni serdca i osnovnyh faktorov riska / E.A. Abina, O.I. Volozh, E.I. Solodkaya [I dr.] // Kardiologiya. — 2007. — № 6. — S.13—18
2. Galyavich, A.S. Diagnostika i lechenie infarkta miokarda bez pod’ema segmenta ST na EKG / A.S. Galyavich. — Kazan’: ID MEDDok, 2012. — 20 s.
3. Dimov, A.S. K obosnovaniyu sistemnogo podhoda v prevencii vnezapnoi smerti kak vozmozhnogo puti resheniya problemy sverhsmertnosti v Rossii (obzor). CHast’ I. Kardiovaskulyarnye aspekty sverhsmertnosti v Rossii: analiz situacii i vozmozhnosti profilaktiki / A.S. Dimov, N.A. Maksimov // Kardiovaskulyarnaya terapiya i profilaktika . — 2013. — № 12 (2). — S.98—104
4. Chazov, E.I. Puti snizheniya smertnosti ot serdechno-sosu- distyh zabolevanii / E.I. Chazov // Terapevticheskii arhiv. — 2008. — № 8. — S.11—18.

 

Epidemiology of neurotrauma in the Republic of Tatarstan

Ravil Kh. Karimov, edging. medical sciences, manager. neurosurgical отд. GAUZ «№ 7 GKB» tel. +7-987-296-31-35, e-mail: ravilkarimov@gmail.com

Damir O. Ismagilov, neurosurgeon, GAUZ «№ 7 GKB», tel. +7-927-433-28-11, e-mail: meg1205@mail.ru

Abstract. Studying of prevalence of a neurotrauma in RT, its outcomes and efficiency of treatment for the purpose of definition of the priority directions on optimization of the organization of medical care in the region at this pathology. Statistical data on incidence and the mortality connected with a neurotrauma in the Republic of Tatarstan are provided. Results are stated in compliance with the MKB-10 codes according to selection of a database of Fund of obligatory medical insurance for 2008 and 2009. Requests for medical care, hospitalization, lethal cases are considered. It is established that the quantity is out-patient or permanently treated patients with injuries of the head were made by 55 234 people, with a frequency equal to 1 465,6 on 100 000 population. Prevalence of sharp injuries of the head (without their consequences) was equal 1 343,2, traumas of soft tissues of the head — 587,4 on 100 000 population. Craniocereberal trauma 23 354 persons, including the dead, with prevalence received 619,6 cases, and various clinical forms of consequences of injuries of the head on negotiability to medical institutions made 154,4 cases on 100 000 population. Frequency of hospitalization on all contingent of injuries of the head equaled 339,6 on 100 000 people, a hospital lethality — 2,6%. Mortality of the population from injuries of the head made 31,1 cases on 1 000 000 population. In compliance with the chosen I. C.D.-10 codes 2784 cases of a sharp injury of a backbone and a spinal cord in the Republic are established. In 45 cases of PSMP 20 cases (44%) at a pre-hospital stage ended with a lethal outcome, among them. Neurotrauma frequency among inhabitants of RT and the related mortality have considerable reserves for their decrease when comparing with results in other countries.

Key words: head trauma, I. C.D.-10, mortality due to head trauma, spinal cord trauma.

 

References

1. Mustafin, I.R. Kliniko-epidemiologicheskie aspekty i mediko-social’nye posledstviya tyazheloi izolirovannoi ochagovoi cherepno-mozgovoi travmy v regional’nyh usloviyah: avtoref. dis. ... kand. med. nauk / I.R. Mustafin. — M., 2009.
2. Potapova, N.A. K izucheniyu social’no-ekonomicheskih posledstvii neirotravmy / N.A. Potapova, A A. Potapov, L.B. Lihterman // Voprosy neirohirurgii. — 2009. — № 4. — S.61—64.
3. Potapov, A.A. Sovremennye rekomendacii po diagnostike i lecheniyu tyazheloi cherepno-mozgovoi travmy / A.A. Potapov, V.V. Krylov, L.B. Lihterman [i dr.] // Voprosy neirohirurgii. — 2006. — № 1. — S.3—8.
4. Barker-Collo, S.L. Trends in head injury incidence in New Zealand: a hospital-based study from 1997/1998 to 2003/2004 / S.L. Barker-Collo, N.J. Wilde, V.L. Feigin // Neuroepidemiology. — 2009. — Vol. 32 (1). — P.32—39.
5. Bellner, J. Diagnostic criteria and the use of ICD-10 codes to define and classify minor head injury / J. Bellner, S.M. Jensen, J. Lexell, B.J. Romner // Neurol Neurosurg Psychiatry. — 2003. —Vol. 74 (3). — P.351—352.
6. Cortbus, F. Epidemiology of Head Injuries in Germany / F. Cortbus, W.I. Steubel // Neurotrauma. Proceedings of the 6th EMN Congress Moscow, Russia, 14—17 May, 2001 — М., 2001.
7. Deb, S.7. ICD-10 codes detect only a proportion of all head injury admissions / S. Deb // Brain Inj. — 1999. —Vol. 13 (5). — P.369—373.
8. Hartman, M. Pediatric traumatic brain injury is inconsistently regionalized in the United States / M. Hartman, R.S. Watson, W.P. Linde-Zwirble [et al.] // Pediatrics. — 2008. —Vol. 122 (1). — P.172—180.
9. Langlois, J.A. Traumatic Brain injuri-Related Hospital Discharges / Resuits from a 14- Stait. Survilans System, 1997 / J.A. Langlois, R. Scott, Ph. Kegler [et al.] // MMWR Morb Mortal Wkly. — 2003. — Vol. 52(SS04). — P.1—18.
10. Mauritz, W. Epidemiology, treatment and outcome of patients after severe traumatic brain injury in European regions with different economic status / W. Mauritz, I. Wilbacher [et al.] // European Journal of Public Health. — Vol. 18, № 6. — Р.575—558.
11. Management and Prognosis of Severe Traumatic Brain Injury (Part I and II). ICD-10 Rates of Hospitalization Related to Traumatic Brain.
12. Peloso, P.M. МКБ-10 Mild traumatic brain injuries presenting to Swedish hospitals in 1987—2000 / P.M. Peloso, H. Holst, J. Borg // Rehabil. Med — 2004. — Suppl. 43. — P.22—27.
13. Steudel, W.I. Epidemiology and prevention of fatal head injuries in Germany--trends and the impact of the reunification / W.I. Steudel, F. Cortbus, K. Schwerdtfeger // Acta Neurochir. — 2005 — Vol. 147 (3). — 231—242.
14. Thurman, D. Trends in hospitalization associated with traumatic brain injury / D. Thurman // JAMA. — 1999. — Vol. 282 (10). — P.954—957.

 

Analysis of the epidemiological situation in a multidisciplinary hospital

Natalia D.Shaykhraziyeva, the candidate of medical sciences, the associate professor of epidemiology and a dezinfektologiya GBOU DPO «Kazan State Medical Academy» managing epidemiological department of GAUZ «City Clinical Hospital № 7», Kazan, Russia, tel. 89872969342, e-mail: epid-gkb7@mail.ru

Abstract. The article provides a comprehensive description of the epidemiological situation in the surgical wards of a multidisciplinary hospital in the long-term dynamics and identified the epidemiological features of nosocomial infections. Set the average annual incidence rate of hospital-acquired infections is purulent-septic 18,03 100 operated, the incidence of GD according to official statistics for the reporting period was 0,11 per 100 operated patients. Established dominance in the structure of nosocomial urinary tract lesion (50,2%), generalized forms of septic hospital infections were not recorded. Presented etiological structure infections in surgical wards, set the prevailing role S. aureus, S. epidermidis, P. aeruginosa, E. Coli, Enterococcus. This change of the leading agents in the etiological structure infections in 2008 by S. Epidermidis (26%) in 2010 to K. Pneumonia (28%). High prevalence of resistance to antibiotics (amoxicillin, erythromycin, clindamycin, cephalosporins) and chlorine-containing disinfectants («Javel Clayden», «Zhavelion», «Pyurzhavel»), especially in the leading types S. epidermidis, Kl. Pneumonia (16,3±3,7%), while remaining sensitive to only to imipenem and meropenem (98%) and to action «Septustin M». According to the research substantiated ways to improve surveillance, including monitoring and microbiological monitoring of microbial resistance to disinfectants.

Key words: hospital-acquired infections, purulent-septic infections in surgical wards multidisciplinary hospitals, antibiotic resistance, microbial resistance to disinfectants.

 

References

1. Brusina, E.B. Epidemiologiya vnutribol’nichnyh gnoino-septicheskih infekcii v hirurgii / E.B. Brusina, I.P. Rychagov. — Novosibirsk: Nauka, 2006. — 176 s.
2. Pokrovskii, V.I. Osnovy sovremennoi klassifikacii infekcii, svyazannyh s okazaniem medicinskoi pomoschi / V.I. Pokrovskii [i dr.] // Epidemiologiya i profilaktika. — 2011. — № 6 (61). — S.55—61.
3. Pokrovskii, V.I. Vnutribol'nichnye infekcii: novye gorizonty profilaktiki / V.I. Pokrovskii [i dr.] // Epidemiologiya i infekcionnye bolezni. — 2011. — № 1. —S.4—7.
4. Nacional'naya koncepciya profilaktiki infekcii, svyazannyh s 4. okazaniem medicinskoi pomoschi. — M., 2011.
5. Shkarin, V.V. Regional'nyi monitoring ustoichivosti mikroorganizmov k dezinfektantam: itogi, perspektivy / V.V. Shkarin [i dr.] // Medicinskii al'manah. — 2012. — № 3 (22). — S.122—126.
6. Nazhim, A.G. Rekomendacii po vyboru dezinficiruyuschih preparatov / A.G. Nazhim // Medicinskii al'manah. — 2012. — № 3 (22). — S.133—134.
7. Uskorennoe opredelenie ustoichivosti bakterii k dezinfekcionnym sredstvam: metod. rekomendacii № 1100-26-0-117 ot 10.01.2000 g. — M.: Moskovskii gorodskoi centr, 2000.
8. European Centre for Disease Prevention and Control. Antimicrobial resistance surveillance in Europe 2009. Annual Report of the European Antimicrobial. Resistance Surveil- lance Network (EARS-Net). — Stockhom: ECDC, 2010. — 208 р.

 

Analysis of hospital stage of giving emergency medical services to patients died during

Marat N. Sadykov, the candidate of medical sciences, the chief physician of GAUZ «GKB № 7», Kazan, tel. 8-960-048-26-54

Vladimir G. Beljakov, the candidate of medical sciences, the deputy chief physician of GAUZ «GKB № 7», Kazan, tel. 8-987-290-47-97, e-mail: belikov70@mail.ru

Zufar G. Valeyev, the manager of kliniko-expert office of GAUZ GKB No. 7 Kazan, tel. 960-078-58-98, e-mail: valeevzg@mail.ru

Abstract. Article is devoted to the comparative analysis of the causes of death, come in profile offices and offices of reanimation of a hospital of ambulance, to identification of the reasons of emergence of intrahospital complications. In this regard all cases of a lethal outcome were divided into two groups: a) the dead in the first three days; b) the dead in later terms. Losses among the second group of patients most precisely characterize problems as rendering medical care in ambulance clinic. At a complex expert assessment of cases of death each of them was carried to one of three categories of outcomes: preventable, conditionally preventable and impreventable as the first two groups are an essential reserve in decrease in a hospital lethality. The experts who were carrying out an assessment of quality of treatment in profile offices, using the card of the expert developed and offered by us, referred to category impreventable 48 (57,1%) a case, the Others 34 (42,9%) a case, according to experts, are conditionally preventable and in case of timely transfer to resuscitation unit other outcome of a disease is possible. In reanimation offices 89,5% of cases are referred to category of the impreventable, conditionally preventable 8,6%, preventable 1,9%, among which 4 cases of yatrogenny complications.

Key words: hospital lethality, quality medical.

 

References

1. Vertkin, A.L. Organizacionnye i klinicheskie aspekty dosutochnoi letal’nosti v mnogoprofil’noi bol’nice skoroi medicinskoi pomoschi / A.L. Vertkin, E.N. Arinina // Terapevt. — 2006. — № 6. — S.9—13.
2. Vorob’eva, S.L. Nauchnoe obosnovanie sovershenstvovaniya sistemy analiza letal’nyh ishodov: avtoref. dis. ... kand med. nauk / S.L. Vorob’eva. — SPb., 2009.
3. Guzeev, A.I. Puti snizheniya posleoperacionnoi letal’nosti pri ostryh hirurgicheskih zabolevaniyah organov zhivota v usloviyah gorodskoi bol’nicy / A.I. Guzeev // Vestnik hirurgii im. Grekova. — 2000. — T. 159, № 3. — S.21—24.
4. Ermolov, A.S. Struktura gospital’noi letal’nosti pri sochetannoi travme i puti ee snizheniya / A.S. Ermolov // Hirurgiya. — 2006. — № 9. — S.16—20.
5. Zheleznyak, E.S. Analiz pokazatelei bol’nichnoi letal’nosti i ih znachenie v usloviyah medicinskogo strahovaniya / E.S. Zheleznyak, N.G. Petrova, V.Z. Klechikov // Zdravo- ohranenie Rossiiskoi Federacii. — 1995. — № 5. — S.14—21.
6. Krylov, A.A. Analiz letal’nyh ishodov i puti uluchsheniya diagnostiki i lecheniya ostryh pnevmonii / A.A. Krylov, E.G. Shackaya // Klinicheskaya medicina. — 1995. — № 2. — S.26—29.
7. Kuldashev, D. Ekspertnaya ocenka prichin letal’nosti postradavshih s cherepno-mozgovoi travmoi / D. Kuldashev, S. Toshboev // Materialy IV s’ezda neirohirurgov. — 2006. — S.343—344.
8. Neupokoeva, L.A. Analiz sostoyaniya letal’nosti v tera- pevticheskom otdelenii BSMP / L.A. Neupokoeva, L.N. Ga- sanenko // Voprosy organizacii okazaniya neotlozhnoi pomoschi v usloviyah promyshlennogo centra: tez. nauch.-prakt. konf. — Omsk, 1994. — S.35—38.
9. Pankin, O.A. Dogospital’nye faktory bol’nichnoi letal’nosti pri infarkte miokarda / O.A. Pankin // Klinicheskaya medicina. — 2004. — № 4. — S.36-39.
10. Petrova, N.G. O nekotoryh podhodah k analizu smertnosti naseleniya / N.G. Petrova. — М., 2000. — S.19—22.
11. Svetlichnaya, T.G. Analiz letal’nyh ishodov v stacionarah goroda i sela / T.G. Svetlichnaya // Zdravoohranenie Rossiiskoi Federacii. — 1999. — № 3. — S.42—44.
12. Farrahov, A.Z. Statistika zdorov’ya naseleniya i zdravo- ohraneniya (po materialam Respubliki Tatarstan za 2005—2009 gody): ucheb.-metod. posobie / A.Z. Farrahov, A.A. Gil’manov, V.G. SHerputovskii [i dr.]. — Kazan’, 2010. — 267 s.
13. Tarakanova, L.I. Sovershenstvovanie sistemy okazaniya i ocenki effektivnosti raboty skoroi medicinskoi pomoschi na malonaselennyh territoriyah Severo-Zapada Rossii: avtoref. dis. ... d-ra med. nauk / L.I. Tarakanova. — M., 2007.
14. Tischuk, E.A. Osobennosti obraschaemosti za medicinskoi pomosch’yu v sovremennyh usloviyah / E.A. Tischuk // Zdravoohranenie Rossiiskoi Federacii. — 2002. — № 1. — S.25—26.
15. Shevchenko, I.I. Analiz vyzhivaemosti pacientov s ostrym infarktom miokarda, oslozhnennym kardiogennym shokom / I.I. Shevchenko // Rossiiskii kardiologicheskii zhurnal. — 2004. — № 3. — S.5—9.
16. Bechien, U.Wu. Hospital Infections Negatively Impact Pancretitis / U.Wu. Bechien // Gastroenterology. — 2008. — Sept. 26 (Health Day News).

 

WHEN THE ISSUE  WAS IN PRINT

Matrices of interattractor distances in assessment of autonomic nervous system residents of Yugra

Raice N. Zhivoglyad, mD, professor, Surgut State university, Yugra, Surgut, Russia, tel. 8-922-42-00-777, e-mail: severnatasha@rambler.ru

Natalia V. Zhivaeva, graduate student Surgut State University, Yugra, Surgut, Russia, tel. 8-922-42-00-777, e-mail: severnatasha@rambler.ru

Olga A. Bondarenko, graduate student Surgut State University, Yugra, Surgut, Russia, tel. 8-922-42-00-777, e-mail: severnatasha@rambler.ru

Abstract. Aim. To establish a quasiattractors of the behavior of the autonomic nervous system Ugra residents living in the North of Russia. Matherial and method. We examined 235 patients aged 23 to 55 who went into 8 groups: two groups by gender, each of which was divided by age at 21—35 years and 36—55 years, in turn, each group was divided by the time of residence in the North to 10 years and more than 10 years. The studies used the technique of pulse oximetry, pulseoximeter based ELOKS01SZ designed and manufactured by JSC IMC «New Devices», Samara. We have performed a comparative analysis of the parameters of quasi-attractors of the state vector in 13-dimensional FPS of the subjects. Results. Calculation of matrix mezhattraktornyh distances for quasiattractors functional status (FSO) of the subjects showed an increase in the distance between the centers of the chaotic quasi-attractors in the phase space of states, reflecting the stabilizing ability of the autonomic nervous system, and consequently increased adaptability of the subjects. Conclusion. New methods for the study of mechanisms of state FSO can be used to assess the adequacy and effectiveness of the system of longterm homeostasis of the population living in the North of Russia, using the methods of system analysis and synthesis.

Key words: the functional state of the organism, the matrix interattractor distances quasiattractor, systems analysis.

 

References

1. Es'kov, V.M. Sinergetika — zavershayuschaya stadiya razvitiya obschei teorii sistem / V.M. Es'kov, Yu.M. Popov, Yu.V. Vohmina // Slozhnost'. Razum. Postneoklassika. — 2013. — № 2. — S.29—41.
2. Es’kov, V.M. Predstavlenie attraktora povedeniya vektora sostoyaniya dinamicheskih sistem, v t-mernom fazovom prostranstve / V.M. Es’kov, M.Ya. Braginskii [i dr.] // Svidetel’stvo ob oficial’noi registracii programmy dlya EVM № 2009616012. — Rospatent, 2009.
3. Karpin, V.A. Magnitobiologicheskie effekty v kompleksnom biotropnom vozdeistvii na organizm cheloveka ekstremal'nyh ekologicheskih faktorov vysokih shirot: bioinformacionnyi analiz / V.A. Karpin, O.E. Filatova // Vestnik novyh medicinskih tehnologii. — 2013. — T. XX, № 1. — S.14—16.
4. Es'kov, V.M. Sposob korrektirovki lechebnogo ili lechebno-ozdorovitel'nogo vozdeistviya na pacienta / V.M. Es'kov, V.V. Es'kov, O.E. Filatova // Patent № 2433788 (13)S2 ot 20.11.2011.
5. Eskov, V.M. Chaotic approach in biomedicine: Individualized medical treatment / V.M. Eskov, A.A. Khadartsev, V.V. Eskov [et al.] // J. Biomedical Science and Engineering. — 2013. — Vol. 6. — P.847—853.
6. Filatov, M.A. Matrixes of Quasiattractor Distances at Identification of Human Psychophysiology Function / M.A. Filatov, D.Y. Filatova, O.I. Himikova, J.V. Romanova // Complexity Mind Postnonclassic. — 2012. — Vol. 1. — P.19—24.

 

Local thrombolysis in thrombosis of bypass grafts and prosthesis of lower extremity arteries

Askar K. Gadeev, a cardiovascular surgeon of department of Vascular Surgery UAIPH «City clinical hospital number 7», Kazan, a competitor of the department of radiology SEI APE «Kazan State Medical Academy», тel: 89172481121, е-mail: snowrider607@rambler.ru

Roin K. Dzhordzhikia, mD, prof., Head of cathedra of surgical diseases № 2 SEI HPE «Kazan State medical university», Kazan

Vladimir A. Lukanikhin, Head of the department of vascular surgery UAIPH «City emergency hospital number 2», Kazan

Lenar G. Mindubaev, cardiovascular surgeon of the department of vascular surgery UAIPH «City emergency hospital number 2», Kazan

Roman A. Bredikhin, mD, assistant of cathedra of surgical diseases № 2 SEI HPE «Kazan State medical university», the doctor cardiovascular surgeon of the department of vascular surgery UAIPH «Interregional Clinical Diagnostic Center», Kazan

Mars K. Mikhailov, MD, prof., Head of Radiology SEI APE «Kazan State Medical Academy», Kazan

Abstract. The results of treatment of 16 patients with thrombotic occlusion of shunts and prosthesis of abdominal aorta and arteries of the lower extremitiesto examine.Diagnosis of occlusive lesions and monitor the effectiveness of treatment were carried out with the use of ultrasound and angiographic studies. The indications to thrombolysis were no distal arterial bed and the severity of the patients who did not allow a user to arterial reconstruction.Local thrombolysis was performed with the preparation «Urokinase Medak» from 1 to 3 days access through the axillary or femoral artery. Blood flow recovery was obtained in all 16 patients.In 2 cases the hard hematomaof shoulder there was. After the development of preventive measures such complications were observed.After thrombolysis 2 patients died (from myocardial reinfarction and gastrointestinal bleeding).The study found that local thrombolysis is highly effective and low-invasive method of treatment of patients with severe comorbidities, as well as the absence of the distal arterial bed.

Key words: local thrombolysis, acute ischemia of lower extremity arteries, «Urokinase Medak».

 

References

1. Lebedev, L.V. Sosudistaya hirurgiya na ishode HH stoletiya: perspektivy i real’nost’ / L.V. Lebedev // Mir mediciny. — 1997. — № 5. — S.25—27.
2. Petrovskii, B.V. Progress sovremennoi angiohirurgii / B.V. Petrovskii // Hirurgiya. — 1991. — № 1. — S.9--14.
3. Savel’ev, V.S. Ostraya neprohodimost’ bifurkacii aorty i magistral’nyh arterii konechnostei / V.S. Savel’ev, I.I. Zatevahin, N.V. Stepanov. — M.: Medicina, 1987. — S.54.
4. McNamara, T.O. Thrombolysis of peripheral arterial and graft occlussions: Improved results using high-dose urokinase / T.O. McNamara, J.R. Fischer // Am. J. Rentgenol. — 1985. — Vol. 144. — P.769—775.
5. Ouriel, K. A comparison of recombinant urokinase with vascular surgery as initial treatment for acute arterial occlusion of the legs. Thrombolysis or peripheral arterial surgery (TOPAS) investigators / K. Ouriel, F.J. Veith, A.A. Sasahara // N. Engl. I. Med. — 1998. — Vol. 338. — P.1105—1111.
6. Rajan, D.K. Recommendations to improve the quality of endovascular interventions for acute limb ischemia / D.K. Rajan, N.H. Patel, K. Valji [et al.] // J. Vasc. Interv. Radiol. — 2009. — Vol. 20. — P.208—218.

 

The forecasting and treatment of a suppuration of a bone wound at traumatic damage of the bottom jaw

Tafkil T. Faizov, mD, Professor, Head of the Department of maxillofacial Surgery GBou VPo «Kazan State medical university» Russian Ministry of Health, Kazan city, Russia, tel. 8-843-273-17-75

Larissa N. Mubarakova, MD, Assistant Professor, Department of Maxillofacial Surgery GBOU VPO «Kazan State medical university» Russian ministry of Health, Kazan city, Russia, tel. 8-960-038-10-36, mubarakova@yandex.ru

Abstract. Aim. The purpose of work was to estimate the importance of the analysis of an oral liquid at traumatic crisis of the bottom jaw, and also at its complication by a suppuration of a bone wound, at addition to complex treatment of preparations «VINIBIS», «COMPLIVIT», «POLYVIT», «DIMEFOSFON». Material and method. Actual there is still a problem of development of new, more effective methods of diagnostics with use of noninvasive researches of an oral liquid and new strategy of complex treatment of inflammatory complications of crisis of the bottom jaw with inclusion of methods of correction of immunity. Results. It was revealed, that normalization of parameters leukocytes in dynamics of recover of patients occurs irrespective of character of spent treatment. At the same time definition of parity Ca/Si has been revealed, that the analysis of the maintenance of calcium, silicon and zinc in an oral liquid, and also, allows to judge a condition of the center of an inflammation and to spend differential diagnostics at the given forms of a pathology. Conclusion. Thus, the general clinical research of blood does not bear the information on character and fabric specificity of the center of an inflammation unlike parameters macro- and microelement in an oral liquid. At patients with traumatic crisis of the bottom jaw, the complicated suppuration of a bone wound, at complex treatment without application of the preparations stimulating immunity, gradual involving in inflammatory process of the trailer broken fragments of the bottom jaw was observed. Inclusion in complex treatment of the offered preparations promoted knocking over of an inflammation in a place of primary damage and strengthened process of regeneration of a bone fabric in the pathological center.

Key words: traumatic crisis bottom, a suppuration of a bone wound, an oral liquid.

 

References

1. Babkov, A.V. Stroncii / A.V. Babkov, Yu.I. Moskalev // BME. — 3-e izd. — M., 1985. — T. 24. — S.322—324.
2. Liflyandskii, V.G. Vitaminy i mineraly. Ot A do YA / V.G. Liflyandskii. — SPb.: Izdat. dom “Neva”, 2006. — 640 s.
3. Mashkovskii, M.D. Lekarstvennye sredstva: v 2 t. / M.D. Mashkovskii. — 14-e izd., pererab., ispr. i dop. — M.: OOO «Izdatel’stvo «Novaya volna»; izdatel’ S.B. Divov, 2002. — T. 2. — 608 s.: 8 s. il.
4. Mubarakova, L.N. Morfofunkcional’naya ocenka sostoyaniya ochaga ostryh odontogennyh gnoino-vospalitel’nyh zabolevanii metodom luchevoi diagnostiki: avtoref. dis. ... kand. med. nauk / L.N. Mubarakova. — Kazan’, 1999. — 20 s.
5. Mubarakova, L.N. Sposob ocenki sostoyaniya ochaga ostrogo odontogennogo vospaleniya / L.N. Mubarakova, R.F. Baikeev, S.S. Ksembaev [i dr.]. — Patent na izobretenie № 2132068 ot 20.06.1999.
6. Mubarakova, L.N. Sposob diagnostiki odontogennyh osteoflegmony i adenoflegmony / L.N. Mubarakova, Yu.A. Zaharov. — Patent na izobretenie № 2230327 ot 10.06.2004.
7. Nikolaeva, N.B. Spravochnik VIDAL’ / N.B. Nikolaeva, B.R. Al’perovich, V.N. Sozinov // Lekarstvennye preparaty v Rossii: spravochnik. — M.: AstraFarmServis, 1996. — 1296 s.
8. Ostrovskii, V.K. Leikocitarnyi indeks intoksikacii pri ostryh gnoinyh i vospalitel’nyh zabolevaniyah legkih / V.K. Ostrovskii, Yu.M. Svitich, V.R. Veber // Vestnik hirurgii im. I.I. Grekova. — 1983. — T. 131, № 11. — S.21—24.
9. Pohoden’ko-Chudakova, I.O. Sravnitel’naya ocenka dinamiki mikrokristallizacii rotovoi zhidkosti u pacientov s travmaticheskimi perelomami nizhnei chelyusti pri standartnom lechenii i lechebno-reabilitacionnyh meropriyatiyah s ispol’zovaniem akupunktury / I.O. Pohoden’ko-Chudakova // Stomatologiya dlya vseh. — 2005. — № 2. — S.10—13.
10. Barceloux Dg. Zinc // J. Toxicol. Clin. Toxicol. — 1999. — Vol. 37(2). — P.279—292.

 

Intercellular ratio of blood cells as indicator of effiiciency therapy of massive blood loss

Dmitry V. Sadchikov, Professor, Doctor of medical Science, Head of Department of Emergency, Anesthetic and Reanimation Aid, Saratov State Medical University n.a. V. I. Razumovsky, Saratov, Russia

Andrey O. Khozhenko, Assistant, Department of Emergency, Anesthetic and Reanimation Aid, Saratov State Medical University n.a. V. I. Razumovsky, Saratov, Russia

Aleksander V. Kuligin, Professor, Doctor of medical Science, Department of Emergency, Abstract. Anesthetic and Reanimation Aid, Saratov State medical university n.a. V.I. Razumovsky, Russia

Yana A. Osyko, Department of Emergency, Abstract. Anesthetic and Reanimation Aid, Saratov State medical university n.a. V.I. Razumovsky, Russia

Abstract. We have carried out a research aiming to study the relations of quantitative and qualitative parameters of blood cells in patients with massive blood loss. We have analyzed 93 patients with severe blood loss due to hemorrhage from upper parts of gastrointestinal tract. We have analyzed the number of blood cells and the number of anisocytes, poekilocytes and reticulocytes as well as criteria of effectiveness of treatment and outcomes. After the statistical processing of obtained data we came to conclusion that there are a typical reaction of system of blood to the acute blood loss. It manifests by interrelated changes of erythrocyte-leukocyte ratio and quantitative parameters of red blood cells.

Key words: massive blood loss, interrelations of blood cells.

 

References

1. Vorob’ev, A.I. Ostraya massivnaya krovopoterya / A.I. Vorob’ev, V.M. Gorodeckii, E.M. SHulutko, S.A. Vasil’ev. — M.: GEOTAR-MED, 2001. — 176 c.
2. Gel’fand, B.R. Intensivnaya terapiya: nacional’noe rukovodstvo: v 2 t. / B.R. Gel’fand; pod red. B.R. Gel’fanda, A.I. Saltanova. — M.: GEOTAR-Media, 2009. — T. I. — 960 s.
3. Corwin, H.L. Anemia and red blood cell transfusion in the critically ill / H.L. Corwin // Semin. Dial. — 2006. — Vol. 19, № 6. — Р.513—516.
4. Ribeiro, M.A. Jr. Volume Replacement in Trauma / M.A. Ribeiro Jr., M.G. Epstein, L.D. Alves // Ulus. Travma Acil. Cerrahi Derg. — 2009. — Vol. 15, № 4. — Р.311—316.
5. Shander, A. Financial and clinical outcomes associated with surgical bleeding complications / A. Shander // Surgery. — 2007. — Vol. 142, № 4. — Р.20—25.

 

Results of the ultrasonic method of research in the choice of the way of therapy of the syndrome of diabetic foot for complication prevention in the form of gangrene of the bottom extremity

Ruslan I. Fatykhov, candidate of medical sciences, assistant to chair of the general surgery, GBou VPo «Kazan State medical university» of ministry of Health of Russia, Kazan, 8-927-4-000-295, 74ruslan@rambler.ru

Ivan V. Klyushkin, professor, doctor of medical sciences, professor of chair of the general surgery, GBou VPo «Kazan State medical university» of ministry of Health of Russia, Kazan, 8-919-624-96-40, hirurgivan@rambler.ru

Konstantin A. Koreyba, candidate of medical sciences, associate professor of the general surgery, GBou VPo «Kazan State medical university» of ministry of Health of Russia, Kazan, 8-9274-128-703, korejba_k@mail.ru

Magomed N. Nasrullayev, doctor of medical sciences, professor of chair of clinical anatomy and out-patient and polyclinic surgery of GBOU DPO «Kazan State Medical Academy» of the Ministry of Health and Social Development of the Russian Federation, Kazan, Russia, (843) 272-47-71, msh-oao-kap@yandex.ru

Abstract. Aim — to estimate possibilities of identification of level of trophic disturbances in soft tissues of the bottom extremity that will allow to create medical and preventive programs objectively. Material and methods. To carry out the detailed literary analysis of existing diagnostic receptions at a syndrome of diabetic foot. Results and their discussion. Absence of diagnostic algorithm at diabetes mellitus complication — a syndrome of diabetic foot promotes low efficiency of medical process and the high frequency of performance of mutilating surgical interventions. The new diagnostic receptions which realization is possible at all stages of treatment are necessary for the solution of this problem: from level of out-patient and polyclinic links before hospitalization. Conclusion. One of the perspective directions to the answering specified demands is ultrasonic diagnostics. In article opportunities and restrictions of the application, existing methods of ultrasonic diagnostics are shown at a syndrome of diabetic foot. The comparative analysis of available diagnostic receptions with definition of the key characteristics allowing qualitatively is carried out and quantitatively to estimate a pathological condition.

Key words: ultrasonic diagnostics, syndrome of «diabetic foot», border apoptosis—necrosis.

 

References

1. Avdovenko, A.L. Differencirovannyi podhod k lecheniyu diabeticheskoi stopy / A.L. Avdovenko, V.P. Sazhin, V.N. Emkuzhev // Standarty diagnostiki i lecheniya v gnoinoi hirurgii: tez. dokl. — M., 2001. — S.72—73.
2. Akulova, F.D. Reografiya. Instrumental’nye metody issledovaniya serdechno-sosudistoi sistemy / 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 / E.P. Burleeva, M.F. Bahtin, M.Yu. Shutov // Standarty diagnostiki i lecheniya v gnoinoi hirurgii: tez. dokl. — M., 2001. — S.100—101.
4. Davydenko, V.V. Stimulirovannyi angiogenez — novoe napravlenie v lechenie pri ishemicheskih sostoyaniyah / V.V. Davydenko, V.M. Maks // Vestnik hirurgii. — 2000. — № 1. — S.117—119.
5. Klyushkin, I.V. Adekvatnoe provedenie konservativnoi terapii — garant effektivnogo lecheniya sindroma diabeticheskoi stopy / I.V. Klyushkin, R.I. Fatyhov // Fundamental’nye issledovaniya. — M., 2011. — S.79—83.
6. Kozlov, V.I. Issledovanie kolebanii krovotoka v sisteme mikrocirkulyacii / V.I. Kozlov, V.G. Sokolov // Primenenie lazernoi dopplerovskoi floumetrii v medicinskoi praktike: materialy II Vseros. simp. — M., 1998. — S.8—12.
7. Lelyuk, V.G. Ul’trazvukovaya angiologiya / V.G. Lelyuk, S.E. Lelyuk. — M.: Real’noe vremya, 2003. — 322 s.
8. Fatyhov, R.I. Kombinirovannaya ul’trasonografiya v oprede- lenii stadii techeniya i lechebnoi taktiki pri ostryh gnoinyh zabolevaniyah pal’cev kisti / R.I. Fatyhov // Kazanskii medicinskii zhurnal. — 2008. — № 5. — S.671—673.
9. Fatyhov, R.I. Analiz rezul’tatov konservativnogo lecheniya sindroma diabeticheskoi stopy / R.I. Fatyhov, I.V. Klyushkin // Aktual’nye voprosy diagnostiki, lecheniya i profilaktiki sindroma diabeticheskoi stopy: III Vseros. nauch.-prakt. konf. s mezhdunar. uchastiem. — Kazan’, 2011. — S.28—31.
10. Yakushina, T.N. Konservativnaya terapiya troficheskih yazv goleni / T.N. Yakushina, V.G. Kupeev, L.M. Vaslavskii // Sovremennye aspekty klinicheskoi mediciny: sb. nauch. tr. — Tula, 2002. — S.55—57.
11. Abbott, С.А. The North-West Diabetes Foot Care Study: incidence of, and risk factors for, new diabetic foot ulceration in a community-based patient cohort / С.А. Abbott, A.L. Carrington, H.S. Ashe // Diabet. Med. — 2002. — № 19(5). — P.377—384.
12. Karnafel, W. Microcirculation in the diabetic foot as measured by a multichannel laser doppler instrument / W. Karnafel, J. Juskowa, R. Maniewski // Med. Sci. Monit. — 2002. — № 8(7). — P.37—44.

 

Unsolved problems of emergency vascular surgery

Askar K. Gadeev, a cardiovascular surgeon of department of Vascular Surgery UAIPH «City clinical hospital number 7», Kazan, a competitor of the department of radiology SEI APE «Kazan State Medical Academy», тel. 89172481121, е-mail: snowrider607@rambler.ru

Roin K. Dzhordzhikiia, mD, prof., Head of cathedra of surgical diseases № 2 SEI HPE «Kazan State medical university», Kazan

Vladimir A. Lukanikhin, Head of the department of vascular surgery UAIPH «City emergency hospital number 2», Kazan

Igor M. Ignatiev, mD, prof. of the cathedra of surgical diseases № 2 SEI HPE «Kazan State medical university», the head of the department of vascular surgery UAIPH «Interregional Clinical Diagnostic Center», Kazan

Roman A. Bredikhin, mD, assistant of cathedra of surgical diseases № 2 SEI HPE “Kazan State medical university”, the doctor cardiovascular surgeon of the department of vascular surgery UAIPH «Interregional Clinical Diagnostic Center», Kazan

Vladimir A. Damotsev, Head of the department of nephrology and hemodialysis UAIPH «City emergency hospital number 2», Kazan

Abstract. The work of two departments that provide emergency care to patients with urgent vascular pathology in Kazanwas analyzed.Routine methods of diagnosis of diseases main and peripheral vessels are ultrasound examinationand less angiography.The disadvantages of these methods necessitate the introduction of methods of magnetic resonance imaging and computed tomography in vascular regime as the most sensitive, safe methods, with a minimum percentage of false negative results in the work of the department of vascular surgery. The acute deep vein thrombosis of the lower limbs take the main place of the number of emergency hospitalization.This category of patients needs in long-term treatment and instrumental monitoring that leads to great material and moral costs.Solution of this problem may be the availability of a day hospital.Thrombosis of peripheral arteries take the second place.The presence of these patients with severe comorbidities require the use of combined ‘open’ and endovascular interventions in a hybrid operating room. Modern state of vascular surgery dictates the need for retraining angiosurgeons on a specialty «endovascular diagnosis and treatment». There is an urgent need to develop a screening program for early detection of the most common diseases of blood vessels, technical equipment of modern facilities department of vascular surgery, the functioning of consulting cabinets and the day hospitals, the organization of care for patients who need the formation of permanent vascular access, as well as patients with chronic critical ischemia of the lower limbs.

Key words: acute care, vascular surgery, acute vascular pathology.

 

References

1. Pokrovskii, A.V. Sostoyanie sosudistoi hirurgii v Rossii v 2011 godu / A.V. Pokrovskii, V.N. Gontarenko. — M., 2012. — S.4—51.
2. Pokrovskii, A.V. Sostoyanie sosudistoi hirurgii v Rossii v 2012 godu / A.V. Pokrovskii, V.N. Gontarenko. — M., 2013. — S.4—89.
3. Conway, K.P. Prognosis of patients turned down for conventional abdominal aortic aneurysm repair in the endovascular and sonographic era / K.P. Conway, J. Byrne, M. Townsend, I.F. Lane // J. Vasc. Surg. — 2001. — Vol. 33. — P.752—757.
4. Lindholt, J.S. Screening for abdominal aortic aneurysms: single center randomized controlled trial / J.S. Lindholt, S. Juul, H. Fasting, E.W. Henneberg // B.M.J. — 2005. — Vol. 330. — P.750—753.
5. Multicenter Aneurysm Screening Study Group. The Multicenter Aneurysm Screening Study (MASS) into the effect of abdominal aortic aneurysm screening on mortality in men: a randomized controlled trial // Lancet. — 2002. — Vol. 360. — P.1531—1539.
6. Norman, P.E. Population based randomized controlled trial on impact of screening on mortality from abdominal aortic aneyrysm / P.E. Norman, K. Jamrozic, M.M. Lawrence-Brown [et al.] // B.M.J. — 2004. — Vol. 329. — P.1259—1262.
7. Reed, W.W. Learning from the last ultrasound. A population-based study of patients with abdominal aortic aneurysm / W.W. Reed, Jr.Jw. Hallett, M.A. Damiano, D.J. Ballard // Arch. Itern. Med. — 1997. — Vol. 157. — P.2064—2068.
8. Scott, R.A. Influence of screening on the incidence of ruptured abdominal aortic aneurysm: 5-year results of a randomized controlled study / R.A. Scott, N.M. Wilson, H.A. Ashton, D.N. Kay // Br. J. Surg. — 1995. — Vol. 82. — P.1066—1070.
9. The AGREE collaboration. Development and validation of an international appraisal instrument for assessing the quality of clinical practice guidelines: the AGREE project // Qual. Saf. Health Care. — 2003. — Vol. 12. — P.18—23.

 

Features of diagnosis and treatment of deep vein thrombosis

Roin K. Dzhordzhiki, MD, Head of the Department of Surgical Diseases № 2, Kazan State Medical University , Kazan, Russia

Ayrat R. Belyaev, Chief of the City Emergency Hospital № 2, Kazan, Russia

Vladimir A. Lukanikhin, Head of the Department of Vascular Surgery, City Emergency Hospital № 2, Kazan, Russia , tel. 89872904004, e-mail: luka.kzn @ mail.ru

Eduard A. Vergasov, Aidar M. Akhmetzyanov, Lenar G. Mindubaev, Askar K. Gadeev, Rustem K. Khaziev, Timur I. Mavlyudov, Laysan S. Ismagilova, Lilia R. Nasybullina, Ramil R. Kadyrov, Sergey V. Ibragimov, doctors of the departments of vascular surgery and diagnostics City Emergency Hospital № 2, Kazan, Russia

Abstract. The article is dedicated to a retrospective analysis of the treatment of patients with deep vein thrombosis (DVT). From 2007 to 2012 were treated 704 patients with DVT. 590 received conservative therapy. In the 114 cases used active endovascular or surgical treatment. The main and determining treatment strategy research method was compression ultrasound duplex scanning of veins. The study showed a trend of growth in detection of patients with DVT. In the group of patients with conservative therapy 5 patients died, 4 of them from pulmonary embolism (PE) and 1 from venous gangrene. All died of pulmonary embolism had occlusive form of DVT. Analysis of the causes of mortality casts doubt on the mobilization of patients with occlusive forms of venous thrombosis and to recommend «active» bed rest with a constant physiotherapy.

Key words: deep vein thrombosis, pulmonary embolism.

 

References

1. Zubarev, A.R. Ul’trazvukovaya diagnostika zabolevanii ven nizhnih konechnostei / A.R. Zubarev, V.Yu. Bogachev, V.V. Mit’kov. — M.: Vidar,1999. —104 s.
2. Rossiiskie rekomendacii po diagnostike i lecheniyu venoznyh tromboembolicheskih oslozhnenii // Flebologiya. — 2010. — № 1, vyp. 2. — S.1—37.
3. Savel’ev, V.S. Flebologiya. Rukovodstvo dlya vrachei / V.S. Savel’ev, V.A. Gologorskii, A.I. Kirienko [i dr.]: pod red. V.S. Savel'eva. — M.: Medicina, 2001. — 664 s.

 

The role of blood cells in a syndrome of endogenous intoxication

Marina M. Dmitrenko, anesthesiologist-reanimatologist, Saratov regional perinatal centre, tel. 8-927-110-50-93, e-mail: marina198809@mail.ru

Yana A. Osyko, ordinator, Department of emergency and anesthesiology-resuscitation help, Saratov medical university V.I. Razumovsky ministry of health of Russia; Saratov, tel. 8-905-324-34-53, e-mail: yana_osyko@mail.ru

Alexander V. Kuligin, doctor of medical science, Professor, Department of emergency and anesthesiology-resuscitation help, Saratov medical university V.I. Razumovsky ministry of health of Russia, Saratov, tel 8-903-328-79-37, e-mail: avkuligin@yandex.ru

Abstract. For the purpose of increase of efficiency of diagnostics of weight of intoxication at patients with pankreonekrozy we studied a ratio of uniform elements of blood at the developed syndrome of endogenous intoxication. On the basis of Regional clinical hospital of Saratov 80 clinical records of patients with the established diagnosis pancreonecrosis» are retrospectively studied. Quantitative indices of a cellular element of system of blood, both red and white sprouts were considered. Indicators of efficiency carried out both conservative and expeditious treatment were estimated at different terms of pathological process: in the first days at the receipt of, in the first, fifth and seventh days after surgery. The obtained data were processed by us by means of methods of nonparametric statistics. Existence of the stereotypic answer of a cellular element of system of blood on influence of endotoxins, being shown in the form of the interfaced quantitative changes is authentically confirmed. The most informative is as a result revealed, rational and applicable in practical activities from the uniform elements of the blood considered a ratio, allowing to predict further development of pathology. Such expression is the relation of work of quantity of erythrocytes and platelets to quantity of leukocytes. This formula is applicable generally for the fifth or seventh days, generally when carrying out conservative treatment. For achievement of the greatest efficiency and positive results of therapy it is necessary to keep normal ratio of uniform elements of blood, and not just correct the separate links of the system.

Key words: endogenous intoxication, intercellular ratio, pancreonecrosis.

 

References

1. Gel’fand, B.R. Intensivnaya terapiya: nacional’noe rukovodstvo: v 2 t. / B.R. Gel’fand; pod red. B.R. Gel’fanda, A.I. Saltanova. — M.: GEOTAR-Media, 2009. — T. I. — 960 s.
2. Peritonit. Sindrom ostroi polisistemnoi disfunkcii. Endogennaya intoksikaciya / D.V. Sadchikov, A.S. Mil’cyn, O.V. Osipova, I.V. Arhipov. — Saratov: Izd-vo SGMU. — 2001. — Ch. I.
3. Mavrodii, V.M. Anemiya: sindromnyi podhod / V.M. Mavrodii. — Doneck: Zaslavskii A.Yu., 2010. — 48 s.
4. Roslyi, I.M. Pravila chteniya biohimicheskogo analiza / I.M. Roslyi, M.G. Vodolazhskaya. — M.: MIA, 2010. — 96 s.
5. Bein, B. Prakticheskaya i laboratornaya gematologiya / B. Bein, S.M. L’yuis, I. Beits. — M.: GEOTAR-MED, 2009. — 720 s.

 

Diagnostic and treatment features in patients with concomitant abdominal injuries

Viacheslav F. Chikaev, PhD, Professor, Department of traumotology, ortopedy and emergency surgery GBOU VPO «Kazan State medical university», Russian ministry of Health, Kazan city, prof.chikaev@gmail.com, 89274344829

Rinat A. Ibragimov, mD, surgeon № 2, GAuz «GKB № 7, Kazan city, rinatibr@mail.ru

Gleb I. Mikusev, Head of the Traumotology GAuz «GKB № 7» Kazan city, g.mikusew@mail.ru

Jurii V. Bondarev, Head of the Department of surgery № 3 GAuz «GKB № 7» Kazan city

Azat R. Aidarov, surgeon of the Department of surgery№ 3 GAuz «GKB № 7» Kazan city, azat041@yandex.ru

Abstraсt. We analyzed and established diagnostic tactics in patients with concomitant abdominal injuries. In most cases there were combined injuries of two anatomical regions. Combination of injuries of three anatomical regions was in 11,7%. In the total count of concomitant injuries, percentage of abdominal injuries was 11,2%, that included 6,6% combination with limb traumas, 4,6% — with neurotraumas. In case of concomitant trauma the structure of severity was: severe trauma (42%) and extremely severe (30%), mild in 21%, the middle severity was at 7%. Using the nosological approach, we mentioned that most patients had damage of the urinary tract (49,8%). In these injuries there were 35% of kidney contusions, ruptures of the urinary bladder and urethra 13,7%, 1,1% — kidney ruptures. Intraperitoneal bleeding was discovered in 40,3%, in 25,2% it was were liver and spleen trauma, in 15,1% — the mesentery and omentum ruptures. In case of concomitant trauma the range of diagnostics depends on patients’ actual status, and in presence of abdominal injuries, surgical treatment is prior to others.

Key words: concomitant trauma, abdominal injuries, injured patient.

 

References

1. Bryusov, P.G. Zaprogrammirovannoe mnogoetapnoe hirurgicheskoe lechenie pri politravme / P.G. Bryusov // Hirurgiya. — 2009. — № 10. — S.42—46.
2. Gumanenko, E.K. Voenno-polevaya hirurgiya lokal'nyh voin i vooruzhennyh konfliktov: rukovodstvo dlya vrachei / E.K. Gumanenko, I.M. Samohvalov. — M.: GEOTAR-Mediya, 2011. — 672 s.
3. Gumanenko, E.K. Politravma. Aktual'nye problemy i novyetehnologii lecheniya / E.K. Gumanenko // Novye tehnologii lecheniya v voenno-polevoi hirurgii i hirurgii povrezhdenii mirnogo vremeni. — SPb., 2006. — S.2—12.
4. Zubarev, P.N. Hirurgicheskaya taktika pri ognestrel’nyh raneniyah grudi i zhivota / P.N. Zubarev, E.V. CHernov // Trudy Voenno-medicinskoi akademii. — SPb., 1992. — T. 231. — S.90—110.
5. Giannoudis, P.V. Surgical priorities in damage control in polytrauma / P.V. Giannoudis // J. Bone. Joint. Surg. Br. — 2003. — Vol. 85. — Р.478—483.
6. Bochicchio, G.V. The management of complex liver injuries / G.V. Bochicchio // Trauma Quart. — 2002. — Vol. 15. — Р.55—76.
7. Kouraklis, G.7. Damage control surger y/ G. Kouraklis, C. Vagianos // Arch. Hellenic. Med. — 2002. — Vol. 19. — Р.216—257.

 

Rendering the urgent help to patients with ischemic and neuroischemic forms of the syndrome of diabetic foot on «Diabetic foot» center experience

Konstantin A. Koreyba, candidate of medical sciences, associate professor of the general surgery, GBou VPo «Kazan State medical university» of ministry of Health of Russia, Kazan, 8-9274-128-703, korejba_k@mail.ru

Ivan V. klyushkin, professor, doctor of medical sciences, professor of chair of the general surgery, GBou VPo «Kazan State » of of Health of Russia, Kazan, 8-919-624-96-40, hirurgivan@rambler.ru

Alexander V. Maksimov, manager. office of vascular surgery No. 1 GAuz «mz Republican Clinical Hospital of the Republic of Tatarstan», mD, associate professor of cardiology and angiologiya of GBOU DPO «Kazan medical Academy» of Ministry of Health of Russia, Kazan

Ruslan I. Fatykhov, candidate of medical sciences, assistant to chair of the general surgery, GBou VPo «Kazan State medical university» of of Health of Russia, Kazan, 8-927-4-000-295, 74ruslan@rambler.ru

Magomed N. Nasrullayev, doctor of medical sciences, professor of chair of clinical anatomy and out-patient and polyclinic surgery of GBou DPo «Kazan State medical Academy» of the ministry of Health and Social Development of the Russian Federation, Kazan, Russia, (843) 272-47-71, e-mail: msh-oao-kap@yandex.ru

Abstract. Aim. Research objective — to describe work of the specialized center on rendering the qualified medical care to patients with a syndrome of «diabetic foot». Material and methods. Statistical material of work of the medical center from 2007 for 2012. Results and their discussion. The syndrome of diabetic foot – is one of terrible and late complications of a diabetes mellitus, often an outcome of pathology is performance of an injuring surgical grant. For high-quality rendering a medical care by the perspective direction creation of the specialized centers including necessary experts, the diagnostic equipment and application of modern medicamental agents is. Experience of the Diabetic Foot Center of Kazan is presented in article on rendering the acute angiosurgery management to patients with is purulent-necrotic complications of a syndrome of diabetic foot. Possibilities of the center, percent of rendering the qualified medical care, and also the combined work of two clinics are shown: Diabetic Foot center and angiosurgery unit of the Republican hospital of Kazan. Conclusion. For realization of an adequate medical care key stages, prospects on their improvement and optimization both on the example of the specified clinics, and at the level of a polyclinic link, unit of the general surgery are allocated.

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

 

References

1. Briskin, B.S. Oslozhneniya sindroma diabeticheskoi stopy: patogenez, diagnostika i lechenie v pozhilom i starcheskom vozraste / B.S. Briskin, A.V. Proshin // Klinicheskaya gerontologiya. — 2004. — T. 10, № 1. — S.33—40.
2. Gracheva, T.V. Kachestvo zhizni pacientov v otdalennye sroki posle hirurgicheskogo lecheniya oslozhnennyh form sindroma diabeticheskoi stopy / T.V. Gracheva, E.YU. Levchik // Vestnik hirurgii im. I.I. Grekova. — 2010. — T. 169, № 3. — S.29—33.
3. Dedov, I.I. Endokrinologiya: nacional’noe rukovodstvo / I.I. Dedov, G.A. Mel’nichenko. — M.: GEOTAR, 2008. — 1072 s.
4. Lisin, S.V. Diabeticheskaya stopa / S.V. Lisin, A.D. Pryamikov, V.V. Latonov // Rossiiskii medicinskii zhurnal. — 2003. — № 2. — S.48—53.
5. Mezhdunarodnoe soglashenie po diabeticheskoi stope. — M., 2000. — 97 s.
6. Pavlov, Yu.I. Uroven’ klinicheskih metabolitov oksida azota u pozhilyh bol’nyh s gnoino-nekroticheskimi oslozhneniyami sindroma diabeticheskoi stopy / YU.I. Pavlov, I.A. Svetlakova, E.A. Davydova // Klinicheskaya gerontologiya. — 2006. — T. 12, № 8. — S.65—67.
7. Chiglashvili, D.S. Predotvraschenie amputacii konechnostei u bol’nyh v sluchae «diabeticheskoi stopy» / D.S. CHiglashvili //Vestnik novyh medicinskih tehnologii. — 2001. — T. 8, № 2. — S.70—71.
8. Shagazatova, B.H. Osobennosti pervichnoi invalidnosti pri saharnom diabete / B.H. SHagazatova, I.G. Avenova // Mediko—social’naya ekspertiza i reabilitaciya. — 2003. — № 2. — S.45—47.
9. Shestakova, M.V. Mnogokomponentnyi podhod k lecheniyu saharnogo diabeta i ego oslozhnenii / M.V. SHestakova // Terapevticheskii arhiv. — 2006. — T. 78, № 10. — S.33—36.
10. Fagrell, B. Critical limb ischemia: coments on consensus document / B. Fagrell // J. Intern. Med. — 1992. — Vol. 231, № 3. — Р.195—198.

 

Stages of creation of the program of emergency medical service to patients with the syndrome of diabetic foot

Ruslan I. Fatykhov, candidate of medical sciences, assistant to chair of the general surgery, GBou VPo «Kazan State medical university» of ministry of Health of Russia, Kazan, 8-927-4-000-295, 74ruslan@rambler.ru

Ivan V. Klyushkin, professor, doctor of medical sciences, professor of chair of the general surgery, GBou VPo «Kazan State » of of Health of Russia, Kazan, 8-919-624-96-40, hirurgivan@rambler.ru

Konstantin A. Koreyba, candidate of medical sciences, associate professor of the general surgery, GBou VPo «Kazan State medical university» of ministry of Health of Russia, Kazan, 8-9274-128-703, korejba_k@mail.ru

Abstract. Aim. Research objective – to develop and survey possibilities of new positions in syndrome diagnostics diabetic foot — an ultrasonic elastometriya and an electrothermometry, allowing to construct the adequate medical program. Material and methods. Based on parameters of the methods of an ultrasonic elastometriya developed by authors and an electrothermometry to develop the pathogenetic program of correction of pathology. Results and their discussion. Existing provisions of correction of metabolic disturbances at a syndrome of diabetic foot don’t allow to achieve cupping of pathological process. Often this fact is bound to lack of the accurate and adequately constructed stage of a kuration of the patient from diagnostic before medical process. For exercise of the adequate treatment-and-prophylactic program it is necessary use of diagnostic receptions and the grants allowing in due time to estimate a course of pathological process. Existing methods of diagnostics, don’t allow to solve this problem. Authors of article show application of the new methods of diagnostics developed by them at a syndrome of diabetic foot — an ultrasonic elastometriya and an electrothermometry, the patents confirmed with receiving. Conclusion. Being based on result of new methods of diagnostics, the stage-by-stage, step-by-step program of correction of a disease is provided. Keeping of the presented references stops clinical a picture and disease advance, minimizing need of performance of a surgical intervention, and in case of its performance is maximum having more distally arranged level of a rendered intervention.

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

 

References

1. Myskina, N.A. Process reparacii troficheskih yazv u bol’nyh saharnym diabetom / N.A. Myskina, A.Yu. Tokmanova, M.B. Anciferov // Problemy endokrinologii. — 2004. — № 2. — S.34—38.
2. Pavelkin, A.G. Ocenka effektivnosti tromboliticheskoi terapii pri oslozhnennyh formah diabeticheskoi stopy / A.G. Pavelkin, A.N. Belyaev // Med. al’manah. — N.Novgorod: OOO «YUnion Print». — 2012. — № 4 (23). — S.88—91.
3. Pavlova, M.G. Sindrom diabeticheskoi stopy / M.G. Pavlova, T.V. Gusov, N.V. Lavrischeva // Trudnyi pacient. — 2006. — № 1. — S.25—28.
4. Sergeeva-Kondrachenko, M.Yu4. . Diabeticheskaya neiropatiya / M.YU. Sergeeva-Kondrachenko // Remedium. Povolzh’e. — 2012. — S.17—25.
5. Fatyhov, R.I. Osnovnye faktory postroeniya konservativnoi terapii s ocenkoi ee effektivnosti metodom elektrotermometrii pri sindrome diabeticheskoi stopy / R.I. Fatyhov, I.V. Klyushkin // Fundamental’nye issledovaniya. — 2012. — № 5 (2). — S.355—358.
6. Fatyhov, R.I. Sovremennyi vzglyad na problemu oslozhnenii saharnogo diabeta / R.I. Fatyhov, I.V. Klyushkin, Yu.A. Klyushkina // Fundamental’nye issledovaniya. — 2013. — № 3(1). — S.206—210.
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8. 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.
9. 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.

 

Videoendoscopic surgical treatment of perforated gastric and duodenum ulcers

Mansur K. Yagudin, PhD, mD, surgeon, CRH of Almetyevsk city, Russia, е-mail: mansur.yagudin@mail.ru

Ruslan F. Gubayev, surgeon, head of surgery department № 1 of CH № 7, Kazan city, Russia

Ildus R. Mukhametov, surgeon, CRH of Almetyevsk city, Russia

Radiy F. Gumarov, PhD, mD, surgeon, CRH of Almetyevsk city, Russia

Vladislav G. Davydov, PhD, surgeon, moscow city, Russia

Ildar G. Hisamiev, surgeon of surgery department № 1 of CH № 7, Kazan city, Russia

Omar T. Alishev, MD, surgeon of surgery department № 1 of CH № 7, Kazan city, Russia

Eldar B. Bagautdinov, surgeon of surgery department № 1 of CH № 7, Kazan city, Russia

Abstract. Perforated (perforated) ulcer, severe complication of gastric ulcer and duodenal ulcers, which leads, as a rule, to the development of peritonitis. Therefore, improving the results of surgical treatment of perforated ulcers of the stomach and duodenum through the development and implementation of modern videoendoscopic interventions is an important issue. We present the experience of endoscopic and traditional treatment of 130 patients with perforated ulcers of the stomach and duodenum. In the study group, 63 patients underwent videoendoscopic surgical treatment. In the control group, 67 patients had the classic methods of surgery by laparotomy. Minimally invasive treatment of perforated gastric and duodenal ulcers are an alternative to traditional methods. Laparoscopic suturing technique was carried out in the localization of ulcers on the anterior wall of the stomach or duodenum and perforated hole sizes up to 10 mm using a mobile strands of large or small omentum. Perforated hole sutured by plumbing loop seam (Malkov—Tagirov, 2003) with absorbable atraumatic needle thread on the formation of intracorporeal knot. Our suturing technique of ulcers is reliable, low trauma surgical approach allows patients to intensify before and shorten hospitalization. All of this allows us to recommend minimally invasive methods of repair of perforated ulcers for widespread use.

Key words: videoendoscopy, perforated ulcers of the stomach and duodenum.

 

References

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2. Lobankov, V.M. Perforativnye yazvy v postsovetskih stranah / V.M. Lobankov [i dr.] // Vestnik hirurugicheskoi gastroenterologii. — 2006. — № 1. — S.75.
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5. Timerbulatov, F.B. Maloinvazivnye tehnologii v hirurgii yazvennoi bolezni dvenadcatiperstnoi kishki / F.B. Timerbulatov [i dr.] // Hirurgiya. — 1999. — № 5. — S.42—43.
6. Uteshev, N.S. Lechenie bol’nyh s perforativnymi piloroduodenal’nymi yazvami / N.S. Uteshev [i dr.] // Hirurgiya. — 2003. — № 12. — S.48—51.
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8. Shurkalin, B.K. Laparoskopicheskaya hirurgiya v lechenii perforativnyh gastroduodenal’nyh yazv / B.K. Shurkalin [i dr.] // Vestnik hirurgii. — 1999. — T. 158, № 3. — S.100—101.
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10. Khoursheed, M. Laparoscopic closure of perforated duodenal ulcer / M. Khoursheed, M. Fuad, H. Safar [et al.] // Surg. Endosc. — 2000. — Vol. 14. — P.56—58.
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13. Lee, K.H. Endoscope-assisted laparoscopic repair of perforated peptic ulcers / K.H. Lee, H.C. Chang, C.J. Lo // Am. Surg. — 2004. — Vol. 70. — P.352—356.
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15. Mehendale, V.C. Laparoscopic versus open surgical closure of perforated duodenal ulcers: a comparative study / V.C. Mehendale, S.N. Shenoy, A.M. Joshi [et al.] // Indian. I. Gastroenterol. — 2002. — Vol. 21. — P.222—224.
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20. Svanes, C. Perforated peptic ulcer: main factors of morbidity and mortality / C. Svanes [et al.] // World. J. Surgery. — 2003. — Vol. 34. — P.1666—1671.

 

Options laparoscopic treatment of perforated duodenal ulcers

Marat R. Tagirov, kandidat of medical sciences, assistant to chair of surgery of GBou DPo «Kazan State medical Academy» of ministry of Health of the Russian Federation, doctor-surgeon of GAuz «City Clinical Hospital No. 7» of Kazan, tagirov72@yandex.ru

Khalil M. Кhalilov, the candidate of medical sciences, the manager of surgical office № 2 GAuz «City Clinical Hospital № 7» of Kazan, halilov.7@yandex.ru

Azat M. Zakirov, doctor-surgeon of GAuz «City Clinical Hospital № 7» of Kazan, 8-905-020-00-46, zakirov19771@mail.ru

Mansur I. Shakirov, the candidate of medical sciences, doctor-surgeon of GAuz «City Clinical Hospital № 7» of Kazan

Abstract. Article is devoted to the analysis of feature of diagnostics and surgical treatment of perforative duodenal ulcers at 510 patients. New ways of an ushivaniye of a perforative opening with use of laparoscopic technologies which were successfully applied at 83 patients— an ushivaniye of a perforative ulcer by a loopback sealing-up seam, with a removable ligature are offered. Introduction points троакаров, equipment of carrying out surgeries are defined. Indications to different types of laparoscopic methods of an ushivaniye of perforative duodenal ulcers depending on their sizes, an arrangement, disease terms are defined. Contraindications to laparoscopic interventions are defined at perforative duodenal ulcers. Postoperative maintaining patients is described, postoperative results are analysed. The offered options of treatment allowed to reduce considerably painful reaction in the early postoperative period, to reduce treatment terms in a surgical hospital twice and to accelerate postoperative rehabilitation of patients.

Key words: ruptured ulcer, methods of closure, laparoscopic.

 

References

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4. Kriger, A.G. Opasnosti, oshibki i oslozhneniya pri laparoskopicheskom ushivanii perforativnyh gastroduodenal’nyh yazv / A.G. Kriger, K.E. Rzhebaev // Vestnik hirurgii. — 1999. — № 3. — S.7—10.
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Problems in diagnosis of ectopic pregnancy

Rushanya I. Gabidullina, of mD, professor kafedry akusherstva i ginekologiya № 2 GBou VPo KGmu mz RF, tel. 8 (917) 289-93-10, ru.gabidullina@yandex.ru

Lyaysan I. Sirmatova, the manager. gynecologic office of GAuz GKB № 7 of Kazan, tel. (843) 237-72-48

Elza M. Kislitsina, the doctor of gynecologic office of GAuz GKB № 7 of Kazan, tel. 8(905)026-10-43

Stanislav E. Savelyev, the doctor of gynecologic office of GAuz GKB № 7 of Kazan, tel. 8(917) 253-81-10

Abstract. Retrospective analysis of 390 women case histories, that admitted to the gynecological department with ectopic pregnancy suspicion is carried out. In case of 358 patients (91.8%) proper diagnosis was made during first hours after hospital admission and operative treatment was carried out. 32 case of ectopic pregnancy diagnosis verification troubles andincreasing terms of preoperative hospital staying were analyzed. We find out that in case of 71.9% of expectant tactic were interstitial location and progressive tubal pregnancy. In case of ectopic pregnancy before 4 week (menstruation delay till 10—14 day) proper diagnosis criterion is dynamic increase of beta-subunit of human chorionic gonadotropin. In case of menstrual delay more than 14 day, determine of positive value beta-subunit of human chorionic gonadotropin in blood serum or positive urine pregnancy test in combination with qualified transvaginal ultrasound examination is enough.

Key words: ectopic pregnancy, diagnosis, chorionic gonadotropin, transvaginal ultrasound examination.

 

References

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