Vol 94, No 1 (2013)

Aim. To define the prognostic factors for puncture drain interventions efficiency and of an optimal time point for the open surgeries. Methods. Surgical treatment results in 56 patients with acute pancreatic necrosis are described. The first group (28 patients) included the patients treated only by. The second group (28 patients) included the patients who underwent puncture drain interventions with further open surgery. Puncture drain surgery efficiency was evaluated using laboratory data and results of instrumental examinations. Results. Body temperature, leukocytosis and a «left shift» on a white blood cell count performed not later than 7 days after the surgery were the key factors for assessing the puncture drain surgery efficiency. During the first 7 days after surgery the body temperature has come to normal in 100% of patients from the first group and in 30% of patients from the second group (c2=15,83, р <0,0005), in other 70% of patients from the second group the body temperature has come to normal later than 7 days after surgery. White blood cell count has come to normal during the first 7 days after surgery in 75% of patients from the first group and in 0% of patients from the second group (c2=11,14, р <0,0016), in 25% of patients from the first group and in all patients from the second group it has only came to normal range at least 7 days after surgery. A marked «left shift» during the first 7 days after surgery was registered in 50% of patients from the first group and in 0% of patients from the second group (c2=6,12, р <0,05), in 50% of patients from the first group and in all patients from the second group it has only came to normal range at least 7 days after surgery. A conservative approach should be preferred if these parameters improve over time and no significant changes in pancreas are seen on computed tomography, otherwise, especially when there are the signs of incomplete debridement on the computed tomography, an open-access surgery should be performed. Conclusions. Puncture drain intervention may be an independent and final method of surgical treatment or may become the first stage of combined surgical treatment in patients with acute pancreatic necrosis. Indications for an open-access surgery should be assessed 7-8 days after the puncture drain surgery was performed if no positive change of laboratory data is seen.

Aim. To study the role of nitroxidergic reactions of the circulatory system in the development of ischemic stroke. Methods. 51 patients (both males and females) with the diagnosis of ischemic stroke were examined. All patients were distributed to 3 groups according to the severity of neurological deficit. All patients underwent brain computed tomography or magnetic resonance imaging. Cerebral blood flow was examined by extra and transcranial ultrasonic dopplerography. Central hemodynamics was evaluated by echocardiography. General clinical examination, neurological and neuroophthalmological examinations were also performed. Vasomotor endothelial function was assessed using a 7 MHz linear transducer on the ultrasound unit «Medison SonoAce X8». The level of nitric oxide was assessed using its stable metabolites, nitrite and nitrate definition in serum. Neurological status was assessed according to the USA National Institutes of Health Stroke Scale. Results. Disorders of nitroxidergic mechanisms of blood vessels regulation were observed in patients with ischemic stroke. Endothelium-dependent brachial artery dilation disorders and nitric oxide persistent metabolites level decrease were related to the severity of the disease and the neurological deficit degree. Conclusion. The study of endothelium-dependent vascular tone regulation mechanisms revealed that these mechanisms are involved in the pathogenesis of ischemic stroke; the study of these mechanisms can be used to clarify the severity of neurological deficit, and possible prognosis.

Aim. To define the indications and to evaluate the effectiveness of various surgical treatment methods in patients with arterial stenosis and occlusion due to atherosclerotic vascular disease of lower extremities as a complication of diabetes mellitus. Methods. Results of surgical treatment of 52 randomly assigned patients who underwent surgeries due to peripheral vascular disease as a complication of diabetes mellitus (type 2 - 51 patients, type 1 - 1 patient) were analyzed. The following surgeries were performed: arterial reconstructive surgery - 24 (46.2%) patients (group 1), balloon catheter angioplasty and stenting - 12 (23.1%) patients (group 2), indirect revascularization surgery (revascularising osteotrepanation, endovascular prostaglandin E therapy) - 16 (30.7%) patients (group 3). Following parameters were assessed: decrease of ischemic rest pain, arterial insufficiency stage, hospitalization terms, healing of foot ulcers, mortality rate, and amputation rate. The longest foot ulcers healing terms [only in 5 patients (31.2%) at first year] were registered in the third group. 1 death was registered each in the first and in second groups (mortality rate 4.2 and 8.3% respectively), no deaths were registered in group 3. The results of trophic ulcers treatment in the patients from the third group were poor. It is tactically appropriate to prefer endovascular surgeries to open surgeries as far as in this case there is no need for local and general anesthesia allowing to decrease the number of complications and the length of rehabilitation together with comparable results. Primary open arterial reconstructive surgeries are possible in patients with diabetes mellitus as a next step after endovascular surgery or when endovascular surgery can not be done. Conclusion. Similar instant and long-term results were found after direct comparison of bypass and endovascular surgeries, allowing to recommend these surgeries in patients with peripheral vascular disease as a complication of diabetes mellitus.

Aim. To study vascular endothelial growth factor (VEGF), tumor necrosis factor alpha (TNF-α), interleukin-1β (IL-1β) and interleukin-1 receptor antagonist (IL-1RA) blood and vitreous humor levels in patients with proliferative diabetic retinopathy (PDRP) and post-vitrectomy hemophthalmia. Methods. 82 patients (82 eyes) with PDRP and post-vitrectomy hemophthalmia present 2 months (from 55 to 78 days) after performed vitrectomy were examined. Results. In patients with proliferative diabetic retinopathy (PDRP) and post-vitrectomy hemophthalmia VEGF blood level remained normal in 92.7% of cases, TNF-α blood level was normal at all times, blood level of IL-1β was within normal ranges in 93.8% of cases, and IL-1RA blood level was decreased in 74.4% of cases. Vitreous humor level was above normal ranges for VEGF - in 84% of cases, for TNF-α - in 9,9% of cases, IL-1β vitreous humor level was within reference ranges at all times, and IL-1RA vitreous humor level was decreased in 84.1% of cases. Conclusion. The gained data indicates further vascular proliferation in the eye cavity as a leading factor for hemorrhage relapses, despite the vitrectomy performed.

Aim. To assess the changes in intestinal microbiota in patients with HIV. Methods. The cultures of stool samples of 317 patients with different stages of HIV [13 (4.1%) patients - with the acute infection stage (2A, 2B, 2C), 217 (68.5%) - with the stage III, 87 (27.4%) - with the stages IVA-B according to classification by Pokrovsky V.I., 2001] were examined by plating on the growth medium and further microbiologic examination. Results. Changes in intestinal microbiota were found in 94% of the patients. The decrease in the obligatory microorganisms quantity, especially in bifidobacteria (lower than reference ranges in 70.3% of patients) was the most frequent finding. Bacterial overgrowth of conditionally pathogenic biota (mainly S. aureus and Candida) was registered in 57.1% of patients. The intestinal microbiota composition did not depend on the clinical stage of HIV infection and presence of opportunistic infections, with only CD-4 count associated with the degree of intestinal microbiota changes. Conclusion. Intestinal microbiota changes are typical for patients with HIV infection at all stages of the disease regardless of opportunistic infections presence. Low CD-4 count is associated with higher severity of intestinal microbiota changes.

Aim. To examine an opportunity of sinus rhythm recovery in patients with mitral valve disease and atrial fibrillation (AF) by the means of surgery and concomitant procedures. Methods. 180 patients with AF who underwent mitral valve surgery using cardiopulmonary bypass in 2007-2011 were examined. Patients’ mean age was 52.5±0.5 years, 71 (39.4%) were male, 109 (60.6%) - female. Patients were divided into 3 groups: 22 patients with paroxysmal AF were included in Group I. 109 patients with persistent AF who underwent mitral valve surgery only were allocated to the Group II. 49 patients with persistent AF who underwent additional pulmonary vein isolation (radiofrequency ablation) were included in the Group III. Results. 83 (46.1%) of patients had single mitral valve disease, 62 (34.4%) of patients had multiple valve disease with involvement of tricuspid valve, 21 (11.7%) of patients had multiple valve disease with involvement of aortic valve, 21 (11.7%) of patients had all abovementioned valves involved. Mean arrhythmia duration was 36.3±3.8 months. Sinus rhythm was restored during the surgery in 16 (72.7%) patients of the Group I, in 60 (55.0%) patients of the Group II, in 41 (83.7%) patients of the Group III. Sinus rhythm was still registered at the discharge in 14 (63.6%), 19 (17.4%) and 13 (26.5%) respectively. Conclusion. It is possible to recover and hold regular rhythm in early postoperative period in more than 60% of cases in patients who underwent surgery for mitral valve disease and concomitant paroxysmal AF. Simultaneous radiofrequency ablation performed in patients with persistent AF increases sinus rhythm recovery rate in first day after surgery.

Aim. To study the prevalence of atopic dermatitis symptoms and its relation to bronchial asthma symptoms in children of 7-8 years of age. Methods. 8880 children aged 7-8 years were examined (3000 children - in 2002, 2865 children - in 2006, 3015 children - in 2010). A questionnaire survey for atopic dermatitis symptoms was conducted as a part of international unified program «International Study of Asthma and Allergy in childhood». Results. Significant differences in prevalence of atopic dermatitis symptoms according to the questionnaire survey and as documented in medical charts were determined. The prevalence of atopic dermatitis symptoms has raised from 12.5±0.4% in 2002 to 20.4±1.5% in 2010 (р <0.001). The prevalence of atopic dermatitis symptoms early onset (younger than 2 years of age) decreased from 7.6±1.0 to 4.9±0.8% (p <0.05). The prevalence of atopic dermatitis relapses during the past calendar year increased from 3.2±0.6 to 4.8±0.8% (p <0.05). Meanwhile, the diagnosis of atopic dermatitis was set up in preadolescent children 7-8 years of age fore frequently: to 4.0±0.7% in 2002 compared to 13.8±1.3% in 2010 (p <0.001). The prevalence of atopic dermatitis and bronchial asthma combination increased from 3.4±0.4 to 7.8±1.0% (p <0.001). A strong relation between presence of atopic dermatitis symptoms and bronchial asthma symptoms was discovered (from 0.76 to 1.00, p <0.05). Conclusion. The prevalence of atopic dermatitis symptoms and bronchial asthma symptoms is still growing in preadolescent children 7-8 years of age, a relation between presence of abovementioned diseases symptoms was discovered.

Aim. To assess the influence of epilepsy and anticonvulsants on central control of hormone release and ovarian function in women of reproductive age. Methods. The reproductive and endocrine functions were assessed in 82 female patients with epilepsy, of whom 37 did not receive anticonvulsants (first group), 45 patients were on anticonvulsant treatment (second group). 17 healthy females (control group) were also assessed. Serum levels of estradiol, progesterone, prolactin, luteinizing hormone, follicle-stimulating hormone and dehydroepiandrosterone were estimated during follicular (n=48) and luteal (n=34) stages of menstrual cycle. Results. Estradiol serum level was below normal ranges, and prolactin serum level - above normal limits at follicular stage of menstrual cycle in female patients not treated with anticonvulsants. In luteal phase serum levels of estradiol, progesterone, dehydroepiandrosterone exceeded the reference ranges, and testosterone levels were lower than normal in both patients treated and not treated with anticonvulsants. Comparison of two groups showed that estradiol serum level was lower in untreated patients in both stages of menstrual cycle compared to patients treated with anticonvulsants. There was a marked difference in endocrine function at all levels of reproductive neuroendocrine regulation in untreated female patients compared to female patients treated with anticonvulsants with major transformations in female patients with epilepsy not treated with anticonvulsants. Conclision. Epilepsy and treatment with anticonvulsants can influence the central regulation of hormone release in females.

Aim. To investigate the effects of phosphocreatine and ethylmethylhydroxypyridine succinate on cardiomyocyte apoptosis intensity and degree of ventricular cardiomyocytes hypertrophy in rabbits with vasorenal hypertension (VH) model. Methods. VH was modeled on rabbits by artificial abdominal aortic stenosis by one-third of the diameter just above the renal arteries arising. Rabbits were divided to 4 groups: rabbits with 4-week VH without treatment, rabbits with 4-week VH treated with phosphocreatine, rabbits with 4-week VH treated with ethylmethylhydroxypyridine succinate, and healthy rabbits (control group). Cardiomyocyte apoptosis intensity and degree of ventricular cardiomyocytes hypertrophy was assessed in all of the rabbits by evaluation of nuclear-cytoplasmic ratio. Results. Use of phosphocreatine or ethylmethylhydroxypyridine succinate led to a significant reduction of the apoptotic index in the left ventricular myocardium, whereas the similar effect on the right ventricle was only typical for phosphocreatine. None of these drugs had an effect on myocardial hypertrophy degree, which remained on the same level as in the untreated hypertensive animals. Conclusions. Energy deficiency is one of the factors inducing cardiomyocyte apoptosis, so administration of phosphocreatine or ethylmethylhydroxypyridine succinate might be an important component of heart failure prevention and treatment in hypertension. Myocardial hypertrophy has no effect on the cardiomyocyte apoptosis intensity in case of proper energy supply.

Aim. To investigate the relationship between PML expression and poly(ADP-ribose)-polymerase (PARP) activity in physiological conditions and at genotoxic stress induced by chemotherapy and ionizing radiation. Methods. The study was conducted on BJ fibroblasts cultured in DMEM/199 medium supplemented with fetal bovine serum, L-glutamine and antibiotics. PML down-regulation was achieved by short interfering ribonucleic acid transfection. To induce deoxyribonucleic acid (DNA) damage in BJ fibroblasts, doxorubicin and hydroxyurea or ionizing radiation were used. PARP activity, formation of DNA double-strand breaks and DNA damage response were examined by Western blotting and immunofluorescence microscopy. Results. PML knockdown was accomplished with an increased PARP activity, confirmed by an increased expression of poly-ADP-ribose (PAR) polymers. At PML knockdown ant DNA damage caused by chemotherapy and ionizing radiation, there is a significant increase in PAR polymers expression as well as increase in the number of cells containing PAR foci. Conclusion. Increased activity of poly(ADP-ribose)-polymerase at PML knockdown and DNA damaging conditions indicates the compensatory response due to insufficiency of the homologous recombination mechanisms. The phenomenon found widens the spectrum of malignancies that might be potentially sensitive to the therapy with poly(ADP-ribose)-polymerase inhibitors.

At present, the problem of concomitant diseases still remains very important for medical science as well as for medical practice. Arterial hypertension is one of the most actual global healthcare problems, holding the leading place among cardiovascular diseases. Acid-related diseases, including gastroesophageal reflux disease and duodenal ulcer are also widely-spread with the tendency of prevalence growth, and are having the leading place among gastrointestinal diseases. The combination of arterial hypertension and acid-related diseases is a new state of an organism regulation. Their synchronism is not accidental, as both diseases share links of the general etiology and pathogenesis. The daily arterial pressure profile and heart rhythm variability has a number of distinctive features when the diseases collide. The presence and progression of esophageal and duodenal mucous membranes inflammation in these patients promotes the certain arterial blood pressure profile formation. The data concerning the prevalence, common etiology and pathogenesis, features of hemodynamics and clinical manifestations in patients with arterial hypertension associated with peptic ulcer disease and gastroesophageal reflux disease are reviewed. Data of autonomic regulation features, 24-hour blood pressure profile and central hemodynamics condition in patients the combination with the mentioned diseases are also covered.

The review of the literature on anesthesia in pregnant women with subarachnoid hemorrhage is presented. Physiological changes of pregnancy should by undoubtedly taken into consideration while performing anesthesia and surgery because of the comorbidities. Particularly, the oxygen intake is higher in pregnant. Adequate systolic pressure is also a very important parameter maintaining the intrauterine blood flow and fetus perfusion during the whole term of pregnancy. Medications used in pregnant women can also influence the fetus. From the clinical point of view, the selection of anesthetics and other medications allowed for use in pregnant women should be limited to medications that are proven to be safe. Pharmacological effects of the medications, used for anesthesia and treatment of pregnant women with subarachnoid hemorrhage are covered in the review, including their influence on fetus. Surgical treatment options for pregnant women at different pregnancy terms with different conditions requiring neurosurgery are surveyed. Post-surgical rehabilitation of pregnant women with subarachnoid hemorrhage is reviewed. In each particular clinical case an individual anesthesia plan should be created considering the pregnancy term and features of the disease.

Chronic alcoholism is a disease affecting all the vital organs, including development of functional and organic eye disorders in 2-70% of cases. Alcoholic (ethanol) amblyopia with such features as slow gradient visual acuity decrease in both eyes (although visual acuity can decrease down do a very low grade, the complete blindness is rare) is among the disorders in patients with chronic alcoholism. Fundus of the eye at the beginning of the disease is normal in most of the cases, sometimes an optic nerve congestion and mild features of optic neuritis can be observed. Sometimes optic nerve hyperemia or anemia can be observed. Simple optic nerve atrophy seen as the temporal parts or the entire disc blanching can be seen at the late stages. Alcohol toxicity can also result as peripheral vision decrease, with degree of it increasing depending on the clinical manifestations of the alcoholism. Generally, eye disorders in patients with chronic alcoholism in most of the cases manifest as central retinal area damage and combination of retinal and optic nerve involvement.

Aim. To reveal the management defects of timely and sufficient emergency care provision at emergency patient admission. Methods. The mortality among the adult Kazan city inhabitants who were urgently admitted to Municipal Emergency Hospital was examined in a retrospective cohort study. The retrospective analysis of in-patients medical charts, ambulance accompanying talons and autopsy protocols of 543 patients who has succumbed during the first 24 hours after being admitted to Municipal Emergency Hospital №1 Kazan, Russia since January 1st, 2009 to December 31, 2011, was performed, emergency medical care on the pre-hospital stage was analysed. Results. The number of patients who got the out-patient care in the admission department of the emergency hospital has increased during the last several years, distracting admission department staff form their primary job and causing errors in medical care. The number of errors due to the medical care mismanagement can be estimated as 23.3%. Low staff qualification, lack of subspecialty consultations or councils and lack of case monitoring are among the reasons. Conclusion. Providing high quality medical aid in out-patients clinics would allow Emergency hospitals to focus on admitting and treating patients with life-threatening emergencies.

Aim. To detect the weak points of the existing system of blood donors’ draw in, to define the paths of blood donorship development in the Republic of Mari El. Methods. The analysis of the existing system of donorship at the period from 2002 to 2011 was conducted according to the data of combined yearly reports, data of united blood transfusion center of the Republic of Mari El database, data of Russia’s blood transfusion system facilities activity analysis. The changes in the number of blood donors, activity of blood donors, and detection of blood-transmitted diseases markers were evaluated. Results. No need for further significant increase in the number of active donors was detected, since the modern methods of blood and blood components preparation allows to increase the amounts of required blood components by other ways. The decrease in donors’ mean age was registered, the share of donors younger than 30 increased 2.8-fold compared to 2002 and 1.46-fold compared to 2007. The mean age of donors is 33,94±0,14 years, gender distribution (females - 39.2%, males - 60.8%) do not collide with the gender distribution of the general population. The share of plasma donors has significantly increased (4.8-fold in 2011). Since 2009 the share of first-time donors has increased to 42.9%, indicating the instability of the group of people ready to donate blood. Electronic database introduction and active use allows to exclude people with blood-transmitted diseases and other absolute contraindications from donating blood. The share of people willing to donate blood with registered blood-transmitted diseases has relatively dropped from 4.18% in 2007 to 1.42% in 2011. Conclusion. The main goal of blood transfusion services of Mari El Republic is still to increase the number of permanent donors, donating blood regularly, it will allow to increase the safety of blood components produced and provide the blood transfusion services stability.

Aim. To study the clinical features, disability degree and expert examination results in patients with peptic ulcer disease. Methods. Acts of expertise of patients with peptic ulcer disease (gastric ulcer - 44 patients, duodenal ulcer - 47 patients) performed in medical and social expertise bureau on internal diseases of Saint-Petersburg, Russia from 2009 to 2011 were examined. Results. The most frequent peptic ulcer disease risk factors found in both of the groups were: predisposing diet and dietary habits (65.9% of patients with gastric ulcer, 78.7% of patients with duodenal ulcer), smoking (53.2 and 63.6% respectively), stress (70.5 и 87.2% respectively). In 10 (22.7%) patients with gastric ulcer and in 38 (80.9%) patients with duodenal ulcer peptic ulcer disease was associated with presence of Helicobacter pylori. There was a combination of predisposing factors in a majority of patients. In most of the cases a moderate activity and a long term of the disease was registered. Complications were diagnosed in 30 (68.2%) patients with gastric ulcer and in 27 (57.4%) patients with duodenal ulcer, most frequently: gastrointestinal bleeding - 19 (43.2%) and 12 (25.5%) patients respectively, gastric outlet obstruction - 10 (22.7%) and 9 (19.2%) patients respectively. According to the medical and social expertise algorithm 19 (43.2%) patients with gastric ulcer and 17 (36.2%) patients with duodenal ulcer were primarily rated as disability degree III, 3 (6.8%) and 2 (4.3%) patients respectively - as disability degree II. Contraindicated jobs and labor conditions, low labor, functional and social status were the reasons of setting up the status of disabled. Conclusion. The preliminary data show that peptic ulcer disease is not only a medical, but a major social problem, requiring novel treatment and prevention methods, as well as personal rehabilitation programs development and improvement.

Aim. To improve the graphic method of analysis of the upper dental arch and its segments, to increase the accuracy of upper dental arch abnormalities detection and to minimize orthodontist’s man-hours. Methods. The plaster models of 32 maxillae with dentoalveolar abnormalities were studied before and after treatment. The graphs of individual normal dental arches and its sizes were created by using the geometric and graphic method by Hawley-Herber-Herbst. The regularities were found based on the gained data; graphs of individual normal dental arches (stereotyped patterns) were created using the Adobe Photoshop CS3 software. Dentoalveolar abnormalities were visually examined by directed applying the stereotyped patterns and pictured before and after treatment. 64 models were examined overall. Results. A relation was found: incisors and canines dental crowns half-sum relates to the length and width of Hawley-Herber-Herbst individual normal dental arch graph as 1:2,3:1,3. Considering the relation found, the set of stereotyped patterns was created. The pattern was chosen for the studied model according to the patient incisors and canines dental crowns width. The visual examination allows to recognize and to record (take a picture) teeth malposition, abnormalities of the upper dental arch and its segments in transverse and sagittal planes for correction control. The photos of the models at different stages of orthodontic treatment with stereotyped patterns applied can be added to the patients’ medical chart, indicating the present occlusal rehabilitation success. Conclusion. The offered way of detection of upper dental arch and its segments abnormalities does not require significant time to be performed, is informative and can be implied to clarify the dentoalveolar abnormalities treatment plan.

Intestinal obstruction (ileus) due to bezoar is a rare condition. Its combined prevalence among all cases of intestinal obstruction varies from 0.5 to 1%. An observed case is reported. A patient was admitted at the emergency ward with abdominal pain,nausea, bloating, and constipation. At examination - bloating, abdominal distention, moderate abdominal muscular defense at palpation, paraumbilical tenderness. Colon cleansing was started with a good effect. Gastrointestinal fluoroscopy: at 4 and 8 hours after introduction of barium contrast it is located in the dilated loops of small bowel with persisting air fluid levels. The diagnosis of unresolved intestinal obstruction was set up. The midline laparotomy, small bowel decompression by Abbott-Miller, peritoneal drainage with two tubes were performed. Final diagnosis: «Intestinal obstruction (phytobezoar), non-infected peritonitis».