Vol 33, No 1 (2016)

Aim. The aim of the study was to improve the quality of diagnosis and treatment of extratesticular lipomas (EL). Materials and methods. Retrospective analysis of 4 EL cases observed at Moscow City Clinical Urological Hospital № 47 and City Clinical Hospital № 57 over the period from 1995 to 2015 was carried out. Among the X-ray methods for EL diagnosis, high resolution ultrasound investigation (> 7,5 MHz) and high pole magnetic resonance tomography (MRT) (1,5T) were used. Results. The patients’ mean age was 41,3 ± 30,6 years. EL was placed in the spermatic cord and the testicle membranes (2 cases), in the epididymis head and tail (2 cases). A single localization of EL was observed in 3 cases, combination of EL with multiple lipomatosis - in 1 case. The sizes of EL averaged 25,8 ± 17,2 mm (11,1 ± 12,7 cm3). EL caused pain and discomfort in the groin and scrotum in 2 cases, lateral course - in the rest cases. Spermatic cord and testicle membrane El were self-revealed, epididymis EL - with US. When palpating, EL was detected in the form of a tumor mass of the soft-elastic consistence, when carrying out US and MRT with suppression of signal from fat - in the form of an encapsulated mass of fatty density. EL diagnosis was verified in 3 cases after the surgery. The outcome of diseases was favorable in all patients. Differential diagnosis of EL with different surgical and urological diseases of the groin-scrotum region is discussed in the paper. Clinical case of spermatic cord membrane EL is reported. Conclusions. Despite typical radiation signs of EL, a reliable differentiation between EL and the other tumors of groin-scrotum region using clinical and radiation methods is not always possible. In such cases, taking into account patients’ complaints (pain, discomfort, cosmetic defect), the method of choice for treatment of EL is a surgical one - enucleation of EL followed by pathomorphological verification.

Aim. The aim of the study was to optimize the diagnosis and prognosis of developing arrhythmias in this cohort and to reveal the possible role of fibrous matrix disturbance in development of arrhythmia. Materials and methods. The main group included 43 patients with premature ventricular excitation syndromes (WPW phenomenon, WPW syndrome), the comparison group - 15 practically healthy persons of the similar age. The mean age of patients belonging to the main group was 25,3 ± 9,15 years. All the groups were comparable by gender distribution ( p = 0,45, Fisher criterion) and age ( p = 0,27, U-criterion). Results. The greatest matrix metalloproteinase-9 (MMP-9) indices were assessed in patients with WPW syndrome - 96,1 ± 33,2 ng/ml, with WPW phenomenon - 54,3 ± 21,8 ng/ml; p = 0,0003). Practically healthy persons had minimum MMP-9 values - 27,4 ± 10,9 ng/ml ( p = 0,00014; p = 0,000002). Maximum values of tissue inhibitor of matrix metalloproteinases (TI MP-1) are presented in WPW phenomenon group and practically healthy persons (418,5 ± 69,8 ng/ml and 461,7 ± 72,2 ng/ml; p = 0,27). In patients with WPW syndrome, TIMP-1 was reliably lower - 341,1 ± 90,1 ng/ml ( p = 0,002; p = 0,00012). Procollagen type 1 carboxyterminal propeptide (PICP) level in patients with WPW syndrome was 179,9 ± 76,2 ng/ml, with WPW phenomenon - 97,8 ± 31,7 ng/ml ( p = 0,00014). All patients, included into the study, significantly differed from practically healthy persons by PICP level - 69,4 ± 23,9 ng/ml ( p < 0,05, U -criterion). Statistical processing of material showed reliable differences between extracellular matrix status indices depending on WPW syndrome and phenomenon, as well as presence or absence of AF paroxysms against the background of ventricular preexcitation. Conclusions. Changes in fibrous matrix, namely, increase in MMP-9, PICP concentrations and decrease in TIMP-1was registered. WPW syndrome is characterized by significant dysbalance of collagen synthesis and degradation seromarkers than WPW phenomenon. The studied seromarkers of fibrosis, probably, participate in formation of rhythm disturbance of the heart with actual syndromes available.

Aim. The aim of the study was to estimate the informative level of changes in blood platelet serotonin and neuronspecific enolase among patients with different forms of tick-borne encephalitis in its acute period. Materials and methods. Forty four patients with acute course of tick-borne encephalitis were examined in dynamics of disease: 35 patients with nonparalytic and 9 - with paralytic forms. All patients experienced determination of blood platelet serotonin and enolase concentrations using the method of immune-enzyme analysis. The control group consisted of 15 healthy persons. Results. During the peak of infection, the platelet serotonin level in paralytic form was reliably lower than in nonparalytic one ( p < 0,05) and it has not been restored in the period of early reconvalescence. On the contrary, in nonparalytic form, by the end of infectious process its value increased. During the first days of disease, the elonase concentration in all the cases of tick-borne encephalitis was within the norm. In the period of early reconvalescence, no changes in enolase content among patients with nonparalytic form were established, whereas its index ( p < 0,05) increased in paralytic form. Conclusions. The study of platelet serotonin concentration in the acute period of tick-borne encephalitis is more informative than determination of blood enolase level and can serve as an early prognostic marker of the development of paralytic form.

Aim. The aim of the study was to determine the functional activity of endothelium in patients with Crohn’s disease (CD), and to assess its dependence on the severity of disease attack. Materials and methods. Sixteen patients diagnosed CD in the exacerbation phase and those with first diagnosed forms of disease were examined. The control group enclosed 11 practically healthy persons. The blood serum vasculoendothelial growth factor (VEGF) level, plasma desquamated endotheliocytes (DEC) number, as well as microalbuminuria (MAU) level were studied as the markers of endothelial dysfunction (ED). Results. Among CD patients, increased concentrations of ED markers as compared with the control group were revealed. A reliable correlation between the ED indices and the degree of severity of the disease was obtained. Positive correlation between the VEGF, DEC and MAU levels and the systemic inflammation markers (ESR, SRP, fibrinogen and alpha-2-globulin) was found. A mathematical model allowing to predict the degree of severity of CD attack was developed. Conclusions. Endothelial dysfunction, which is expressed by the increased VEGF, DEC and MAU levels, was detected in CD patients. ED indices directly depend on the serum markers of systemic inflammation. Thus, VEGF, DEC and MAU values can serve as a criterion for CD attack severity.

Aim. The aim of the study was to estimate the efficiency of the drugs splenopid and roncoleukin for the treatment of a severe purulo-necrotic pathology in patients of Izhevsk Regional Clinical Hospital № 1. Materials and methods. The results of treatment of 125 patients with severe purulo-septic pathology of the abdominal cavity and retroperitoneal space are presented in the paper. All patients were divided into 2 groups: group 1 (50 persons) took “Splenopid”, group 2 (60 persons) - “Roncoleukin”. The control group included 15 persons, who experienced traditional methods of treatment. The patients’ status was assessed by toxicological, immunological and biochemical indices. Results. Among the patients taking splenopid, positive dynamics in immunological status was detected at the days 4-7. In the control group, all cellular immunity indices were below the norm. The patients receiving roncoleukin had positive immunological dynamics at the days 3-5, which was accompanied by the activation of initially decreased cellular component of the immune system. Conclusions. A high activity of these drugs was stated in different degrees of immunological deficiency, in treatment of pyoinflammatory diseases of the abdominal cavity, small pelvis organs, septic states. The cellular and humoral immunity indices in the group of patients receiving ronkoleukin are higher that can prove its greater efficiency.

Aim. The aim of the study was to assess the effect of a new nonnarcotic analgesic, compound G-104, on the motor activity, coordination of movements, muscular tonus and respiratory function of white rats, when introduced in a wide range of doses comparing to the registered analgesics. Materials and methods. The effect on mice tonus was evaluated using the horizontally tightened wire, coordination of movements was studied with the device Rotarod, graphic registration of respiratory movements - by means of the system PowerLab 4/35 and the computer program LabChart 8. The number of respiratory movements per minute was calculated, the cases of pathological respiratory forms were taken into account. The motor activity was studied using the device “Open field”. Results. A new native analgesic G-104 does not influence the muscular tonus of white rats in the dose of UN50 unlike Tramadol and Ketorolac causing irreversible hypotonus in 50-100 % of experimental animals. The compound G-104, as well as the comparison drugs Tramadol and Ketorolac, has no effect on coordination of movements. No changes in spontaneous motor activity after chronic introduction of G-104 in the device “Open field” were revealed. A new analgesic G-104 does not alter the frequency and amplitude of white rats’ respiratory movements when introduced in the dose of UN50 as compared with the background indices. Conclusions. The compound G-104, when introduced in the dose of UN50, does not influence the muscular tonus and coordination of movements in white rats unlike the analgesics Tramadol and Ketorolac causing hypotonus in therapeutic doses. The compound G-104 does not alter the spontaneous motor activity in the device “Open field”. A new analgesic G-104 does not depress respiration in white rats when introduced in the dose of UN50.

Aim. The aim of the study was to investigate the drugs used by emergency teams for arresting pain syndrome in elderly patients. Materials and methods. The study was conducted on the basis of State Budgetary Institution of the Republic Mari El “Republican Clinical Hospital for War Veterans” using the method of content-analysis of emergency cards. Emergency cards of 153 patients over sixty were studied. Results. It was established that 41,8 % of men and 58,2 % of women addressed for acute care. The mean age of patients was 84,3 ± 4,26 years. For all kinds of pain, there were administered 51alalgetics, 26 adjuvants and 76 other drugs. It was stated during the study that 9,2 % of drugs were administered with violation of application instructions. It was detected that out of 40 cases of ketorolac administration, 10 (25 %) were irrational. The most common error is combined administration with acetylsalicytic acid (6 cases). Conclusions. It is necessary to increase the level of knowledge of emergency team specialists regarding the problems of rational administration of drugs for pain syndrome arrest taking into account patients’ old age and possible medicamentous interactions.

Clinical picture of myocarditis is nonspecific, in some cases it is difficult to diagnose and induces a large number of errors. Therefore, differential diagnosis is of great importance for management of inflammatory myocardial damages.

Resistant arterial hypertension (RAH) occurs with frequency of 10 % to 30 % of cases depending on RAH definition and arterial hypertension (AH) population. To a certain extent, RAH prevalence depends on inclusion into the group of pseudoresistant or real RAH. In the present paper the problems of real RAH are under consideration. Modern definition of RAH is attributed mainly to ambulatory patients, treated by three-or four component program including diuretic. Spironolactone was established to be of great significance in RAH treatment, much more exceeding bisoprolol and doxazosin. Recently, clinical studies regarding the procedure of renal arteries denervation and carotid arteries stimulation were carried out. The uncontrolled studies showed high efficiency of these procedures during three years, whereas the controlled studies are doubtful in respect of their effect.