Vol 30, No 4 (2013)

Aim. To study the methods for improving estimation of treatment efficiency in patients with disseminated peritonitis (DP), in particular, to detect the necessity of relaparotomy for abdominal sanation. Material and methods. 132 patients with disseminated peritonitis were examined: prospectively – 92 cases, retrospectively – 40. To analyze the degree and dynamics of polyorgan insufficiency, “Dynamic Organ Dysfunction Assessment Scale” (DODAS) was used. Determination of 7 and more scores by this scale reliably proves the presence of polyorgan insufficiency syndrome (POIS). The scale permits to estimate patients’ status by 6 systems and organs with a maximum sum of 24 scores. The number of scores of the 1 st, 2 nd and 3 rd days after the operation was subjected to trend analysis using the program Microsoft Office Excel. The trend score analysis of polyorgan insufficiency allows to determine its stage and efficiency of treatment. As a result, we managed to determine the indications to relaparotomy at the earlier terms than when using prognostic relaparotomy index. Results. The predicted lethality in the main group was established to coincide with the real one (27,3%). In the group of comparison, the real number of lethal outcomes (85,7%) occurred to be higher than the prognosticated ones (72,0%). Sensitivity and specificity of the suggested method of relaparotomy indications determination was 0,9 and 0,8, respectively. Thus, determination of polyorgan insufficiency stage makes it possible to correct treatment and determine relaparotomy indications in time. Conclusion. The course of polyorgan insufficiency in disseminated peritonitis during the adjacent three days is subjected to the laws of polynomial function and is different by development rate and regression. Prognosis for life in disseminated peritonitis depends on the stage of polyorgan insufficiency. Efficiency of DP treatment in the postoperative period is to be estimated by means of trend analysis of polyorgan insufficiency assessment scale scores.

Aim. To clarify the peculiarities of postnatal reduction of weight in patients with different levels of gestational body weight growth (GBWG). Materials and methods. Prospective cohort study included 118 patients: 25 with insufficient GBWG, 43 – with recommended GBMG and 5 – with excessive GBWG. Anthropometric measures (body weight, cutaneous adipose fold thickness) were fulfilled when registering pregnant women in the first trimester of gestation, on the 3 rd day and 3, 6, 9, 12 months after the delivery. GBWG level was assessed according to “The Guidelines on Pregnancy Weight Growth” depending on the initial body weight index (BWI). Results. While carrying out a multifactorial analysis with exclusion of BWI influence, reliable correlation between GBWG and the postnatal body weight reduction ( p =0,000, p =0,000, p =0,000 and p =0,011 – 3, 6, 9 months and a year after the delivery, respectively) was revealed. With the recommended GBWG, the initial weight is restored by the 9 th month after the delivery and with the insufficient one – immediately after the delivery. With the excessive GBMG, the weight is reduced slower and in a year after the childbirth 22% of women have > 5 kg and 14,0% – > 10 kg. Excessive GBMG promotes additional accumulation of fatty tissue in pregnancy and its incomplete reduction after the delivery. In a year after the delivery, percentage of a fatty body weight with excessive weight growth is significantly higher than with the recommended one ( p =0,018). Conclusion. GBWG within the recommended values is accompanied by an adequate restoration of weight by the 9 th month after the delivery irrespective of woman’s pregravid status. Insufficient weight growth leads to faster (just immediately after delivery) return to the initial weight. Excessive body weight growth in pregnancy is a risk factor for delayed postnatal reduction.

Aim. To study the clinicofunctional peculiarities of children with deformed pelvis and slight asymmetry of the lower extremities length, to develop the program of differentiated treatment. Materials and methods. 140 children aged 3 to 15 years with distorted pelvis and slight asymmetry of the lower extremities length of primary (idiopathic) genesis and pathology of locomotor system of the known etiology (secondary) were examined. There were 78 girls (55,7%) and 62 boys (44,3%). Orthopedic disorders, topographic and electromyographic changes, pain syndrome and vegetative dysfunction peculiarities were studied. Efficiency of conservative orthopedic treatment was assessed in 100 children. Results. Different degrees of severity of clinicofunctional disorders were determined. Impairment of bearing was increasing in process of child growing. In case of organic orthopedic pathology, vertebral column deformity was growing progressively worse against the background of marked pelvic distortion. Neuromuscular dysfunction was detected in all the examined patients. Rehabilitation program was worked out individually taking into account the degree of manifestation of vegetative and muscular dysfunction, orthopedic and somatic pathology. Conclusion. 1. Functional orthopedic disorders are progressing while child growing and lead to the secondary changes in pelvis and vertebral column. 2. Vegetative dysfunction and asymmetry of bioelectric paravertebral muscles activity are additional means for an early diagnosis of the degree of severity and compensation state.

Aim. To determine the pathogenetic significance of nonspecific inflammation factors in atherogenesis and lipid-releasing leukocyte ability (LRLA) in patients with obliterating arterial lower extremities atherosclerosis in combined course of atherosclerosis of different vascular pools (coronary, branchiocephalic arteries) and diabetic foot syndrome. Materials and methods. The study included 83 patients: 72 patients with obliterating atherosclerosis of lower extremities vessels, 11 – with diabetic foot syndrome. The control group consisted of 20 practically healthy persons. All patients were investigated with instrumental and laboratory methods. Lipid-releasing leukocyte ability was assessed using Professor A.V. Tuev, Professor V.Yu. Mishlanov method. Patients underwent operative treatment including prosthetics, shunting, endarterectomy, thrombectomy, sympathectomy, stenting, balloon dilatation depending on the course of disease, level of arterial bed lesion, degree of extremities ischemia and associated pathology. Results. Comparative analysis of the results of laboratory LRLA values was carried out in patients with isolated associated lesion of lower extremities arteries and diabetic foot syndrome. In the groups of patients with isolated and associated atherosclerosis there are reliable differences. After operative treatment, LRLA is decreased that causes reduction of atherogenesis risk. No differences were detected in case of association with diabetic foot syndrome. Ambulatory treatment in the postoperative period included angioprotectors, disaggregants, statins (simvastatin – 20–40 mg or atorvastatin – 10 mg, constantly). Conclusion. LRLA is a risk factor for developing obliterating atherosclerosis of lower extremities and associated lesion of arterial bed. Maximum LRLA values were revealed in the group of patients with diabetic foot syndrome and associated lesion of different arterial pools. Effective operative treatment of patients with OLEA is accompanied by significant decrease in LRLA value. No LRLA dynamics in the postoperative period among patients with DF syndrome was de

Aim. To study the blood serum inflammatory markers and Chlamidophila pneumoniae and Mycoplasma pneumoniae antibody titer concentrations in patients with chronic respiratory diseases (CRD) depending on presence of ischemic heart diseases (IHD) and risk factors of cardiovascular diseases. Materials and methods. 58 patients with CRD were examined. Group 1 included 20 patients with CRD associated with IHD, group 2 – 38 CRD patients without IHD. Blood serum Chlamidophila pneumoniae and Mycoplasma pneumoniae antibodies (Ig Aand Ig G) as well as inflammatory marker concentrations were determined. Results. High rate of positive Chlamidophila pneumoniae and Mycoplasma pneumoniae antibody titers was revealed in both groups. Optical density ratio coefficient > 1,1 was detected in 16 persons (80%) of group 1 and in 25 persons (66%) of group 2. In both groups, CRP concentrations were increased. In group 1, rise in IL-6 (mean value 7,2±9,04) and IFNγ (13,6±5,19) concentrations was observed, in group 2 – rise in IL-4 (10,4+8,68) concentration was fixed. Conclusion. Chlamidophila pneumoniae and Mycoplasma pneumoniae antibodies occur equally frequently both in patients with associated CRD and IHD and CRD patients without IHD. Differences between two groups in IL-6, INFγ and IL-4 content were found.

Aim. To improve the results of treatment of patients with chronic lymphovenous failure of the lower extremities by introducing new methods for diagnosis of peripheral and central lymphodynamics. Materials and methods. Peripheral and central lymphodynamics (thoracic lymphatic channel – TLC) was studied in 40 patients with chronic lymphovenous failure (CLVF) of the lower extremities of different severity. The other 40 patients without vascular pathology signs underwent the same investigations. Lymphodynamics was studied with USI-scanner (Aloka SSD – 4000; Acuson X-300). Results. In CLVF patients, TLC orifice diameter was up to 3,24±1,32 mm. TLC arch diameter was 6,19±1,48 mm that is significantly larger than in comparison group ( p <0,01). Linear lymph flow velocity (LLFV) in the main group was 11,47±4,31 cm/s, PLFV – 117,93±69,54 ml/min. Both indices are reliably ( p <0,01) higher than in comparison group that confirms dynamic failure of TLC orifice in CLVF patients. Some peripheral lymphodynamics indices were studied. The obtained data show lymph hyperproduction, prove presence of lymphatic hypertension in patients with CLVF both at the periphery and at the TLC level as well as development of dynamic TLC orifice failure. Conclusion. The results of the study demonstrate efficiency of USI with colour duplex scanning of lymph nodes in CLVF patients for detecting lymphatic hypertension at different levels and what is especially important – at the neck TLC level.

Aim. To compare the possibilities of using blood hyaluronic acid (HA), de Ritis coefficient and vasculoendothelial growth factor (VEGF) determination for diagnosis of hepatic fibrosis in chronic hepatitis and hepatic cirrhosis. Materials and methods. Blood serum HA, aspartic transaminase/ alanine transaminase (AST/ALT) ratio, VEGF were determined in 100 patients with chronic hepatits C and 50 patients with hepatic cirrhosis at the outcome of hepatitis C. The control group included 34 persons. Results. While carrying out correlation analysis, reliable correlations between both direct fibrosis marker – HA and indirect test – de Ritis coefficient and VEGF were revealed. The sensitivity of HA determination for diagnosis of cirrhosis with the concentration higher than 100 ng/ml is 100%, specificity – 80%, negative prognostic value for exclusion of HC – 1,0. The AST/ALT ratio demonstrates 96% sensitivity with the point of division 1,5, specificity – 69%, negative prognostic value – 0,76. The test sensitivity of VEGF determination for differential diagnosis of cirrhosis and hepatitis with the point of division 312,3 pg/ml is 90%, specificity – 80%, efficiency – 84%, negative prognostic value for exclusion of HC – 0,89. Conclusion. Determination of VEGF concentration can be used for differential diagnosis of hepatic cirrhosis and chronic hepatitis as an indirect hepatic fibrosis marker since efficiency of this test somewhat yields to HA and exceeds AST/ALT ratio.

Aim. To improve the results of surgical treatment of patients with thyroid gland pathology by means of developing electronic computer (EC) program allowing to optimize diagnosis, observation and prognosis of the disease course. Materials and methods. Together with the Chair of Computer Engineering and Information Security of Ufa State Aviation and Technical University the program “Intellectual System for Diagnosis of Thyroid Pathology Based on Neuronet Technologies” was developed. Results. The authors worked out and registered EC program “Intellectual System for Diagnosis of Thyroid Pathology Based on Neuronet Technologies” permitting to collect, store and analyze information on patients. The program is also capable of presenting the supposed diagnosis and result of treatment on the basis of the introduced information. Analysis of 148 case histories and ambulatory records of patients with diffuse toxic goiter was carried out; accuracy of diagnosis was > 90%; accuracy of disease outcome prediction was >75%. Conclusion. The applied modern methods of diagnosis and processing of the obtained data by means of biomedical statistics as well as neuronet information processing and analysis system make it possible to optimize patients’ management, storage and processing of medical information and permits to conduct differential diagnosis of diseases.

Aim. To investigate morphological, functional and immunophenotypic features of the immune response using mucosal and parenteral methods of administration of the complex of opportunistic microorganism antigens. Materials and methods. Functional, morphological and immunophenotypic characteristics of immunocompetent cells and organs of mice (80, SWA line) in intact animals (control), as well as the above characteristics in intranasal (3-fold in the dose of 500 ug / mouse), peroral (3-fold in the dose of 2 mg / mouse) and subcutaneous (2-fold in the dose of 200 mg / mouse), methods of administration of multicomponent vaccine Immunovac VP-4 containing the complex of opportunistic microorganism antigens were investigated. Mononuclear leukocytes of spleen, lymph nodes and lymphoid tissue of the small intestine were used to evaluate the expression level of markers (CD3, NK 1.1, CD3/NK, CD4, CD25, CD4/CD25, CD8, CD19, MHC II, CD5.2 (B1), TCR (Tγδ) with the help of monoclonal antibodies («Caltag Laboratories», USA) by means of a flow cytometer FacsCalibur («Beckman Coulter F-500", USA). Cytotoxic activity of natural killers against neoplastic K562 line in MTT assay was revealed. Morphological studies were performed on serial paraffin sections stained with histological and histochemical methods. Statistical processing of the data was performed using statistical package StatSoft 8.0. Results. It was revealed that the investigated complex of opportunistic bacteria antigens causes significant activation of effectors of innate immunity both in parenteral and mucosal immunization. It is displayed in increased levels of expression of differentiation, co-stimulating, adhesive molecules on the surface of mononuclear leukocytes, in proliferation of key effectors of mucosal immunity (Tγδ-B 1 and B- lymphocytes, NK cells), increase in their functional activity, changes in the pattern, cellular composition of immunocompetent organs and lymphoid tissue, regional to the site of administration and distant from it that indicates formation of not only local, but systemic immunity as well. Conclusion. The obtained data allow us to extend the strategy for using vaccines and immunomodulators of bacterial origin by means of non-parenteral immunization methods to create protection from a broad spectrum of pathogens.

Aim. To study the correlation between progress in studies and coping-behaviour of academic students in stress situations. Materials and methods. The study included students of the Stomatological Faculty of Perm State Academy of Medicine named after Academician E.A. Wagner (81 persons) as well as students of the Faculty of Law and Economic Faculty of PSNRU (52 persons) who were divided into 3 groups by their results in studies. To assess their psychological health, the method of “Coping-behaviour in Stress Situations” (S. Normann et al., 2002) adapted by T.A. Kryukova (2004) was used. It can be applied for teacher’s activity. Results. Correlation between students’ results and indices of their psychological health in the period of training at higher school was established. For this purpose, the questionnaire consisting of 48 statements which reflect frequency of using the intended types of personal reactions in stress situations by 5 forms of behavioral strategies (problem-oriented, emotionally-oriented, emotionally-oriented for avoidance, abstraction, search for social support) was used. Conclusion. The obtained results of the study permit to recommend teachers of higher schools to realize an individual approach to students while carrying out an individual teaching and educational work.

The problems of epidemiology and prevention of infections connected with rendering medical care (ICMC) in the framework of The National Prophylaxis Conception approved in November 2011 by Chief Sanitary Inspector of the Russian Federation are discussed in the lecture. This group of infections is defined, changes in terminology and classification of ICMC indicated in the conception for harmonization of native normative documents with international requirements are presented. Mechanisms of developing epidemic ICMC process at medical institutions of various profile, systems of preventive and antiepidemic measures and epidemiological inspection are considered from the point of view of the latest scientific achievements. Contribution of the Department of Epidemiology of PSAM named after Academician E. A. Wagner to development of theoretical and practical aspects of ICMC prevention is shown in the lecture.