COGNITIVE FUNCTION ASSESSMENT IN PATIENTS WITH UNSTABLE ANGINA

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

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

Key words: cognitive functions, unstable angina, compliance.

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

 FUNCTIONAL CLASSIFICATION OF THE DIABETIC FOOT SYNDROME AND ITS APPLICATION VALUE

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

1. Chichkova MA, Kozlova OS, Orlov FV. Osobennosti sochetaniya infarkta miokarda i ostrogo narusheniya mozgovogo krovoobrashcheniya [Features of the combination of myocardial infarction and acute cerebrovascular accident]. Astrakhanskiy meditsinskiy zhurnal [Astrakhan Medical Journal]. 2016; 1: 55–60.

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4. Gusev YeI, Konovalov AN, Skvortsova VI. Nevrologiya i neyrokhirurgiya: uchebnik v 2 tomah [Neurology and neurosurgery: a textbook: in 2 toms]. Moskva: GEOTAR-Media [Moscow: GEOTAR-Media]. 2013; 2: 419 p.

5. Danilova VI, Khasanovoy DR ed. Insul’t; Sovremennyye podkhody diagnostiki, lecheniya i profilaktiki: metodicheskiye rekomendatsii [Stroke; Modern approaches to diagnosis, treatment and prevention: guidelines]. Moskva: GEOTAR- Media [Moscow: GEOTAR-Media]. 2014; 248 p.

6. Prikaz ministerstva zdravookhraneniya RF ot 15 noyabrya 2015 goda No928n «Ob utverzhdenii poryadka okazaniya meditsinskoy pomoshchi bol’nym s ostrym narusheniye mozgovogo krovoobrashcheniya» [Order of the Ministry of Health of the Russian Federation dated November 15, 2015 No 928n “On approval of the procedure for rendering medical care to patients with acute cerebrovascular accident”]. 2015.

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

8. Yavelova IS, Khokhlunova SM, Duplyakova DV ed. Ostryy koronarnyy sindrom [Acute coronary syndrome]. Moskva: GEOTAR-Media [Moscow: GEOTAR-Media]. 2017; 384 p.

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10. Rekomendatsii amerikanskoy kollegii kardiologov, ameri- kanskoy assotsiatsii serdtsa i Obshchestva serdechno – sosudistoy angiografii i interventsiy [The recommendations of the American College of Cardiology, the American Heart Association and the Society of Cardiovascular Angiography and Interventions]. Cherezkozhnoye koronarnoye vmeshatel’stvo [Percutaneous coronary intervention]. Dallas, TX: American Heart Association [Dallas, TX: American Heart Association]. 2005.

11. Savchenko AP, Cherkavskaya OV, Rudenko BA, Bolotov PA. Interventsionnaya kardiologiya; Koronarnaya angiografiya i stentirovaniye; Interventsionnaya kardiologiya; Koronarnaya angiografiya i stentirovaniye: rukovodstvo [Interventional cardiology; Coronary angiography and stenting; Interventional Cardiology; Coronary angiography and stenting: manual]. Moskva: GEOTAR Media [Moscow: GEOTAR Media]. 2010; 448 p.

12. Bokeriya LA, Bukharin VA et al. Serdechno-sosudistaya khirurgiya: rukovodstvo [Cardiovascular Surgery: guide]. Moskva: Meditsina [Moscow: Medicine]. 1996; 768 p.

13. Surzhko GV. Ostroye narusheniye mozgovogo krovoobra- shcheniya kak faktor v vozniknovenii kliniko-psikhologicheskikh rasstroystv [Acute cerebrovascular accident as a factor in the occurrence of clinical and psychological disorders]. Molodoy uchenyy [Young scientist]. 2015; 10: 462-464.

UDC 616.831.94-005.1-073.432.19

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

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

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

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

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

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

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

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

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

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

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

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

UDC 616.831-001.34-06:616.133.33

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

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

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

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

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

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

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

UDC 616.832-001-083.2

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 MANAGED INFUSION THERAPY FOR UNSPECIFIED SUBSTANCE TOXIC EFFECTS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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UDC 617.586-002.44-06:616.379-008.64

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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 INFORMATIVE VALUE OF VISUAL ANALYSIS OF RADIOLOGIC GRAY-SCALE IMAGES

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 SMOKING AMONG MEDICAL PROFESSIONALS: PERSPECTIVES OF PRESENT DAY

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 ARTERIAL HYPERTENSION ACUTE MANAGEMENT IN INTERNAL DISEASES

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

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

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

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

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

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

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

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

 ACUTE ADVERSE REACTIONS FOR CONTRAST MEDIUM INFILTRATION IN MEDICAL PRACTICE

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

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

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

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

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

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

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

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

Key words: iodinated intravascular contrast media, adverse reactions.

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

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

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

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

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

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

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

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

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

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

UDC 616.12-073.756.8(048.8)

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

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

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

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

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

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

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

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

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3. Liu Y, Li C, Guo S, Song Y, Zhao Y. A novel level set method for segmentation of left and right ventricles from cardiac MR images. Conf Proc IEEE Eng Med Biol Soc. 2014; 2014: 4719-4722.

4. Frick M, Paetsch I, den Harder C, et al. Fully automatic geometry planning for cardiac MR imaging and reproducibility of functional cardiac parameters. J Magn Reson Imaging. 2011; 34 (2): 457-456.

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

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

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

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

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

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

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

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

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

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

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

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UDC 616-008.9(048.8)

 METABOLIC SYNDROME AS A CAUSATIVE FACTOR OF MEDICAL EMERGENCIES

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 ASSOCIATION OF CARDIOVASCULAR RISK AND DISPROPORTIONATELY HIGH LEFT VENTRICULAR MYOCARDIAL MASS

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

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

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

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

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

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UDC 616.891.6-039.31-079.4(048.8)

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

 THE FEATURES OF PANIC ATTACK DIFFERENTAL DIAGNOSIS IN ADMISSION DEPARTMENT

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Key words: patient, damage, diaphragm, peritonitis.

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

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UDC 616.342-002.44:616.37-006

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

UDC 616.329-007.251-089

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

 SPONTANEOUS ESOPHAGUS RUPTURE TREATMENT BY ENDOSCOPIC STENTING (clinical case)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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