Vol 97, No 3 (2016)

Aim. To evaluate the effectiveness of different management regimens in patients with sarcoidosis in clinical practice settings.

Methods. A retrospective analysis of condition of 530 patients with sarcoidosis at baseline and at the end of follow-up (at least 6 months) was conducted. The patients were divided into subgroups according to the treatment received by them: prednisolone, methotrexate, pentoxifylline, vitamin E. The fifth group consisted of patients who were under active surveillance without treatment. The dynamics of the disease clinical and laboratory manifestations, radiographic changes, and lungs forced vital capacity were evaluated.

Results.. Improvement rate was the highest and amounted to 74.3% in patients with mild forms of sarcoidosis treated with vitamin E. The spirometric parameters have most commonly positive dynamics among patients treated with prednisone (56.2%). When comparing patients with equal radiographic stages and close spirometry data, methotrexate improved radiographic pattern in 70% of cases. Pentoxifylline effect was associated with the initial radiographic stages of sarcoidosis (p=0.003), its influence was insufficient in preventing of the fibrosis development and the lungs vital capacity reduction in patients with initially severe and widespread forms of sarcoidosis. After completion of treatment with methotrexate, relapse occurred in 37.2% of patients, and after pentoxifylline treatment in 31% of cases subsequent systemic glucocorticoid therapy was needed.

Conclusion. In mild sarcoidosis vitamin E is quite effective and active surveillance without treatment is acceptable, in case of severe course, prednisolone and methotrexate efficacy is comparable, while pentoxifylline did not allow to prevent fibrosis development and the lungs ventilatory capacity reduction; choice of regimen is determined by the clinical presentation severity and lesion size according to the X-ray.

Aim. To present the treatment results of patients with liver echinococcosis using abdominisation method to eliminate the fibrous capsule cavity.

Methods. Method of fibrous capsule abdominisation was used in 73 patients with liver echinococcosis. Primary echinococcosis was diagnosed in 68 patients, relapse - in 5. An important condition for the surgery success is a thorough examination of the residual capsule to detect biliary fistulas and in case of their presense - a reliable suturing of the fistula with the subsequent control of their hermeticity and drainage. The fibrous capsule cavity and subphrenic space were drained using fascines drainage through which the fibrous capsule cavity was irrigated with ozonated sodium chloride solution and 0.02% dekasan solution.

Results.. Postoperative complications occurred in 4 patients, and were presented with bile leakage, pleuritis and wound infection. There were no fatal cases. During the course of treatment biochemical tests results of patients who underwent fibrous capsule abdominisation, and patients in whom the fibrous capsule elimination was performed by capitonnage and intussusception were compared. The best results were found in patients with fibrous capsule abdominisation. Abdominisation method is reasonable for cysts of medium and large sizes (up to 15 cm in diameter), and in cases when the cavity elimination has a risk of blood vessels and bile ducts damage.

Conclusion. Our research showed the possibility to perform fibrous capsule cavity abdominisation in liver echinococcosis, this method does not worsen liver functional state compared with capitonnage and intussusception.

Aim. To analyze the results of the application and to study the effectiveness of ultrasound shear wave elastography and elastometry in the endometrial pathology diagnosis in secondary infertility.

Methods. Multiparameter ultrasound with shear wave elastography and elastometry modes (Shear Wave Elastography) was performed in 146 women of reproductive age (Aixplorer scanner, Supersonic Imagine, France). The main group (N1) included 101 women with secondary infertility: 43 patients with tuberculous lesions of the uterus, 58 - with chronic endometritis without concomitant tuberculosis. The control group (N2) included 45 healthy women: 22 nulliparous women, 23 - parous women. Age of examined women ranged from 24 to 48 years, mean age in N1 group was 34.4±2.6 years, in N2 group - 33.9±2.9 years.

Results.. Depending on the nature of the pathology elastographic cards of examined women in the main group differed in color. Elastographic cards of blue-green range of low intensity dominated in patients with chronic endometritis. In patients with tuberculous lesions of the uterus unevenly colored, non-homogeneous, high intensity, from green to yellow and red in color-grade elastographic cards were determined. Endometrial stiffness values in patients with chronic endometritis and in tuberculous lesions of the endometrium (31.7±4.3 and 89.7±5.7 kPa, respectively) were significantly higher than that in healthy women (16.5±1.0 kPa, p

Conclusion. The presented analysis indicates the feasibility of the shear wave elastography and elastometry application in multiparameter ultrasound study of the uterus and adnexa in the diagnostic algorithm of patients with secondary infertility.

Aim. To study cell-mediated and humoral immunity in bronchopulmonary dysplasia in children.

Methods. The inpatient and outpatient medical records of 103 children from the 1st day of life up to 3 years of age: 58 boys and 45 girls, were analyzed. T-lymphocytes helper and suppressor activity markers, the immunoregulatory index, B-lymphocytes markers, concentration of the three main immunoglobulins classes, pro- and anti-inflammatory interleukins, circulating immune complexes were determined.

Results.. The helper activity in exacerbation phase was at the lower limit of normal (42.1±0.9) and significantly increased in remission phase (52.6±0.8), without exceeding the reference values. CD8 lymphocytes percentage in the blood remained within the reference ranges both in exacerbation of inflammation and in remission phase. Immunoregulatory index was above normal both in the exacerbation and in the remission phases, reducing in remission phase. Pro-inflammatory interleukin-4 concentration in the exacerbation period exceeded reference values by 1.5 times and amounted to 21.0±0.6 pg/ml. In the remission phase its normalization (11.1±0.4 pg/ml) appeared. Interleukin-8 and interferon-γ levels in the exacerbation stage were significantly higher than normal and amounted to 70.3±1.2 and 15.1±0.4 pg/ml, respectively. The tumor necrosis factor concentration was at the upper limit of normal (19.54±0.29 pg/ml). The humoral immune response was characterized by a slight decrease in the immunoglobulin A level, some increase in immunoglobulin G and a significant increase in the circulating immune complexes concentration (109.5±6.6 units) in the exacerbation phase.

Conclusion. Pronounced immunosuppression is uncharacteristic for bronchopulmonary dysplasia; identified changes are an adequate immune response to viral and bacterial infection in the acute phase of disease.

Aim. To establish the influence of controlled oral hygiene by optimizing the pressure on the toothbrush when brushing teeth in adolescents on their dental health.

Methods. The study involved 183 adolescents aged 15 to 18 years with the same dental status. The force applied onto toothbrush when cleaning teeth was determined in 95 adolescents who were examined at the beginning of follow-up. 88 adolescents, who were divided into two main groups, were further followed-up. The first group consisted of 51 adolescent who were trained to the rules of tooth brushing using the standard method, and the pressure force on toothbrush when brushing was monitored clinically (according to gingival mucosa reaction) and by using a measuring device. The control of force was performed every 3 months during one year. The data obtained during the preliminary examination of 95 adolescents (the first group) before the beginning of follow-up were the reference points of optimal pressure on the gingiva and teeth. The second group included 37 adolescents who were trained to the rules of the standard tooth brushing once at the beginning of the follow-up.

Results.. It was found that in prolonged control of hygiene habits with particular reference to the pressure power applied by toothbrush on the gingiva and teeth when brushing, clinical indicators characterizing the hygiene indicators and periodontal condition, change in the favorable direction.

Conclusion. Favorable pressure force on the gingiva and teeth when brushing teeth in adolescents is from 140 to 200 g/cm2.

Aim. To study the state of local immunity of the oral cavity in patients with fixed aesthetic dental prostheses and inflammatory periodontal diseases.

Methods. 90 patients with fixed aesthetic dental prostheses and inflammatory periodontal diseases (main group) and 21 patients without dental prostheses and inflammatory periodontal disease (control group) were examined. Immunoglobulin A, sA, G, M, E classes, interleukin-4, -6 and -1β, interferon α contents in oral liquid were determined using enzyme immunoassay.

Results.. As a result of our study of immunoglobulins level in saliva in patients of the main and control groups an increase in the immunoglobulin A level, compared with the normal value, statistically significant increase in secretory immunoglobulin A were revealed; difference in the immunoglobulin G level was not determined. The increase in immunoglobulin E level in patients of the main group was determined. When studying the interleukins content in the oral fluid a statistically significant decrease in the concentration of IL-4 and increase in interleukin-6 and -1β content in patients of the main group were determined. The tendency to decrease in the interferon α content in the main group compared to the control group was registered.

Conclusion. In patients with fixed aesthetic dental prostheses and inflammatory periodontal diseases humoral immunity imbalance was identified, manifesting in changes of the immunoglobulin classes A, sA and E, interleukin-4, -6 and -1β contents in oral fluid.

Aim. To assess motor evoked potentials parameters in a complex of intraoperative neurophysiological monitoring at the time of discectomy for a herniated intervertebral disc under general anesthesia, to determine their dependence on age, sex, height.

Methods. Intraoperative motor evoked potentials monitoring during microdiscectomy under inhalational anesthesia was conducted in 43 patients for the herniated disc at L4-L5 or L5-S1 levels. In all patients, the herniated disc diagnosis was confirmed by the magnetic resonance imaging data. Monitoring was performed using the «Neuro-IOM» device («Neurosoft», Russia). Latency and amplitude of muscle response for m. abductor hallucis and m. tibialis anterior were analyzed.

Results.. The obtained data suggest that the motor evoked potentials allow to objectify the presence of motor disorders, which persist at the end of microdiscectomy. The data on the relationship between latency of muscles responses on the side of radiculopathy and the healthy side with patients’ age, body height and weight are obtained. The motor evoked potentials amplitude had a direct correlation with the patients’ body weight. Increase in latency of transcranial motor evoked potentials on the side of the clinical motor fall-out compared with the healthy limb was defined. Due to the expressed variability of motor evoked potentials responses amplitude under general anesthesia, significant differences for a given parameter were not obtained.

Conclusion. There is relationship between latency of motor evoked potentials and patients’ age, body height and weight; an increase in the latency of transcranial motor evoked potentials on the side of the clinical motor fall-out compared with the healthy limb was revealed.

Aim. To study spectrum of viral proteins secreted into the culture medium by the healthy donor peripheral blood lymphocytes infected by HIV-1 NL4-3 strain in vitro.

Methods. We used a primary lymphocytes culture obtained from healthy donors. For synchronous infection of primary lymphocytes culture in vitro NL4-3 strain of human immunodeficiency virus (HIV) (NIH AIDS Research & Reference Reagents Program, USA) was used. The HIV-1 titer in the supernatants was determined by enzyme immunoassay (EIA p24gag Coulter). In addition, electrophoresis of clarified culture medium proteins in 12.5% polyacrylamide gel under denaturing conditions followed by electron transport onto a nitrocellulose membrane; immunoblotting for detection of virus-specific proteins using positive control serum to HIV-1 («Bio-Rad») were performed; protein markers kits LMW 94-14.4 kD, HMW 212-53 kD («Pharmacia Biotech») were used to determine the seroactive fractions molecular weight.

Results.. HIV antigens spectrum in the culture medium was studied on the 4th, 9th and 13th days after lymphocyte culture infection with HIV. Within 13 days of virus reproduction both non-structural and structural proteins of HIV-1 gag gene are detected in the culture medium, spectrum and quantitative range of which varies with time. After 4 hours of HIV reproduction in primary lymphocytes culture in vitro large number of gag gene nonstructural proteins (p40, p55) are exported from cells into culture medium. Further, gag gene non-structural proteins may be cleaved into the structural proteins (p24/25, R18) under the cellular proteases action, which is caused by the proteolytic enzymes accumulation in the culture medium.

Conclusion. In HIV reproduction in primary lymphocytes cultures soluble forms of the HIV-1 gag gene proteins are secreted into culture medium; in the initial stages of the infection HIV proteins spectrum in the culture medium of lymphocytes activated with phytohemagglutinin in vitro consists of only the HIV-1 precursor proteins (p55, p40) and at a later stages - also of the gag gene viral capsid proteins (p24/25, R18).

The aim of the review is to summarize the modern views on etiopathogenesis and treatment of ovarian cancer, as well as to search for ways for a more personalized approach to the management of patients with this oncological disease. Despite the limited number of patients participating in clinical trials of ovarian cancer, there are obvious results of gradual evolution in its diagnosis and treatment. Studies of etiopathogenesis led to a better understanding of the ovarian cancer genesis mechanisms, whereas evolution in treatment was marked by combination of secondary cytoreductive surgery with the most effective chemotherapeutic drugs and biological agents. The introduction of biomarkers, particularly CA125 (cancer antigen 125), in the diagnostic algorithm for both primary and recurrent ovarian cancer has opened up new horizons for the application of effective methods of treatment at the disease earliest stages. However, in the landmark study of G.J. Rustin et al. there was no a statistically significant difference in disease-free and overall survival among female patients with immediate treatment of recurrent ovarian cancer based only on elevated CA125 and female patients in whom chemotherapy was initiated after the clinical symptoms manifestation. Conducting clinical trials in small cohorts of patients with certain ovarian cancer histotype will help to select one or another effective combination of chemotherapy and/or biological agents administered not only intravenously, but also intraperitoneally, and thereby provide the personalized approach to the treatment of this disease.

Chronic pulmonary heart disease is a common pathology and has become one of the leading causes of disability and death in recent years [15]. According to the literature, two-thirds of patients with chronic obstructive pulmonary disease die during the period from 15 months to 5 years after the circulatory decompensation onset, which occupies the third place after hypertension and coronary heart disease among causes of death in the age group older than 50 years [14]. Pulmonary hypertension is considered to be the main pathogenetic mechanism of chronic pulmonary heart disease [11]. The mortality rate in patients with chronic pulmonary heart disease is directly related to the level of pulmonary artery systolic blood pressure. Thus, according to literature data, at the pulmonary artery systolic pressure from 30 to 50 mm Hg 4-5-year survival rate is 30%, and at the level of more than 50 mm Hg 5-year survival rate is zero [1]. Thus, pulmonary hypertension is a poor prognostic factor. Furthermore, it is known that the changes identified in the right ventricle amid the pulmonary hypertension are survival predictors in patients with chronic obstructive pulmonary disease [18]. Literature review showed that the hemodynamics feature in patients with chronic pulmonary heart disease is increased pressure in the pulmonary artery, which leads to both ventricles remodeling and in particular to the right heart enlargement, rise of both right and left ventricles diastolic dysfunction, reduced stroke volume and cardiac output. Furthermore, the review describes that such drug classes as angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, calcium channel blockers and selective β-blockers are successfully used for the revealed disorders correction in patients with chronic pulmonary heart disease.

The works of different authors on the role of riboflavin in the oxidative stress suppression in tissues and organs were analyzed. Experimental and clinical studies showed that the riboflavin (vitamin B2) has antioxidant properties and acts as a coenzyme for redox enzymes affecting the glutathione reduction. Russian scientists studies established a significant negative linear correlation between the level of malondialdehyde in blood serum and riboflavin consumption. Several studies showed that riboflavin deficiency affects the activity of antioxidant enzymes, including glucose peroxidase, superoxide dismutase and catalase, which leads to a reduction in tissue cells antioxidant potential. The riboflavin feasibility in laser refractive surgery is due to the development of oxidative stress in the cornea in response to the intervention and the need for its correction. In photorefractive corneal surgery, it is worsened by secondary ablation induced by ultraviolet radiation. Works of the last few years show that the oxidative effect of the radiation is attenuated when performing the excimer laser refractive ablation after presaturation of the stroma with riboflavin solution. Experimental studies showed that both drip and aerosol corneal saturation with 0.25% isotonic riboflavin solution does not affect the accuracy of excimer laser ablation of the corneal stroma. In the clinic, performing transepithelial photorefractive keratectomy with riboflavin photoprotection for myopia with astigmatism of varying degrees and without astigmatism minimized corneal syndrome, sterile inflammatory response. It accelerated epithelialization and was accompanied by early optometric indicators stabilization, which confirmed the feasibility of riboflavin use as photoprotector in laser corneal refractive surgery.

Diseases comorbidity issues are of concern of many researchers, in recent decades, there are attempts to understand the hierarchy of diseases cause-and-effect relationships. Integrative approach to the patient’s condition assessment, whose comorbidity index increases with aging, is of great practical importance, since it allows the practitioner to choose the best drug therapy strategy and to objectively assess the risk of adverse cardiovascular events. Cardiovascular diseases, including those associated with bronchopulmonary system diseases, occupy leading position in mortality rate. One of the most common combinations in clinical practice is a combination of heart failure and chronic obstructive pulmonary disease. Their pathogenetic relationship may be due to common for diseases neurohumoral imbalance. The review presents data on the prevalence and mortality of patients with congestive heart failure and chronic obstructive pulmonary disease, describes the importance of autonomic nervous system dysfunction assessment in cardiovascular and bronchopulmonary diseases combination. Data on the heart rate variability assessment informativeness from the perspective of the clinical characteristics determination relevance and prognosis in patients with congestive heart failure and chronic obstructive pulmonary disease are presented. The main assessed time-domain and spectral parameters are narrated. The results of the heart rate variability parameters study in multicenter clinical trials in patients groups with heart failure and bronchopulmonary obstruction, which define the clinical and prognostic predictors among the heart rate variability parameters, are presented. In general, information on heart rate variability in congestive heart failure in comorbidity with chronic obstructive pulmonary disease is scantily presented in the available literature.

A review of publications in scientific medical literature devoted to the study of factors affecting medical professionals health is presented. They reflect the diversity of physical, chemical, biological harmful to health effects faced by medical professionals when delivering care to patients. Often there is a simultaneous exposure to several factors, bearing the risk to human health. Reliable data on occupational diseases of medical professionals do not actually exist. This caused, above all, by socio-economic reasons, a tendency to self-medication, low medical aid appealability, imperfection of prenosological diagnostics and restricted list of reportable occupational diseases. When performing their professional responsibilities medical professionals are exposed to many factors harmful to health, their work is associated with significant psychological and physical stress. Occupational diseases and morbidity with temporary disability depend on the medical professional specialty and affecting them work-related factors, as well as on the existing environmental situation. As an analysis of the specialized domestic and foreign literature showed, a unified approach to study the medical professionals’ morbidity has not yet been produced. An effective information-analytical system for the medical professionals health control, which would ensure full objective timely information on the number of medical workers exposed to harmful work environment factors, their existing diseases (somatic and occupational), the nature of the disorder course, remission duration, disability, rehabilitation measures effectiveness, is still not developed in Russia.

A clinical case of a patient G., 30 years old, who choked on a fish bone on the last day of being in prison, is described. The prison doctor and then the local doctor did not conduct special investigations and esophagus damage by the fish bone was virtually dismissed. Then, the patient presented with fever (39 °C) and chills. Diagnosis of «influenza» was made. A few days later, tonic-clonic seizures with loss of consciousness appeared. Diagnosis of «Epilepsy?» was made. The patient was admitted to the therapeutic hospital via ambulance on the 7th day of the disease. In 60 minutes after admission the patient died of profuse arterial esophageal bleeding. At autopsy there was purulent lesion of the thoracic esophagus posterior wall, purulent mediastinitis, purulent fusion of the anterior wall of the aorta, aortoesophageal fistula. Tonic-clonic seizures with the syncope development in a patient G. emerged as a manifestation of the condition such as the Morgagni-Adams-Stokes syndrome due to hemodynamically induced cerebral ischemia, which occurred because of the blood leakage from the aorta into the esophagus through the festering aortoesophageal fistula. Fatal case could be avoided, when following deontological principles of treating and the presence of doctors’ professionalism.

The variety of cholelithiasis clinical manifestations, seriously impeding the timely diagnosis, are well known. This is determined by multiple impairment of interorgan communication in cholelithiasis. The most difficult form of cholelithiasis both for identification, and for treatment is choledocholithiasis. Diagnosis of stones in the common bile duct is based on a complex of clinical, laboratory and instrumental data. The appearance of jaundice amid the abdominal pain and revealing signs of biliary hypertension during instrumental examination are considered typical for choledocholithiasis. Particular difficulties for the diagnosis are choledocholithiasis cases with atypical pain syndrome, the absence of jaundice and non-dilated bile ducts. One of the reasons for the variability of pain syndrome in cholelithiasis is polymorbidity of these patients. Relatively frequently, bile duct stones are combined with a hiatal hernia, which is pathogenetically interdependent. Clinical manifestations in such cases depends on what syndrome is the dominant. Non-dilated bile ducts in patients with proven choledocholithiasis was detected in 5.8% of patients. In this situation, the presence of cholestasis and cytolysis biochemical markers in the absence of instrumental signs of biliary hypertension can simulate intrahepatic cholestasis. Clinical case demonstrating the difficulty of choledocholithiasis diagnosis is presented. In a given clinical observation the patient with a history of cholecystectomy for cholelithiasis; with intense abdominal pain, primarily appraised as a manifestation fixed hiatal hernia; pronounced anicteric cholestatic syndrome, was presented. No signs of biliary hypertension in the standard transabdominal ultrasound examination of the abdomen required exclusion of intrahepatic causes of cholestasis. In-depth instrumental and laboratory examination allowed to diagnose in patient choledocholithiasis. It is proposed to mark out variant of the cholelithiasis course with the stones localization in the common bile duct under the guise of cholestatic hepatitis.

Aim. To assess clinical effectiveness of axillary region myoplasty using pectoralis minor muscle flap as an achievable and easy in technical performance method for seroma prevention after radical mastectomy.

Methods. 545 patients aged 45 to 65 years (mean age 42.34±0.62 years) with stage I-II breast cancer, who were followed up from 2006 to 2014, were examined. Patients were divided into two groups: the main group included 256 women who underwent Patey’s mastectomy combined with axillary region myoplasty using pectoralis minor muscle flap (using the method developed by the authors in 2005-2006, and patented in 2010) and the control group consisted of 289 patients with Patey’s mastectomy.

Results.The total seroma volume for 14 days in patients of the main group was 76.3% less than that in patients without myoplasty (p

Conclusion. Axillary region myoplasty with pectoralis minor muscle is an effective method of prevention, leading to a decrease in the seromas volume and duration in the postoperative period, as well as hospitalization period reduction.

Aim. This article proposes a roentgen-endosurgical method of performing intracranial arteries revascularization in acute tandem occlusion of the internal carotid artery with the distal embolism development in the middle cerebral artery.

Methods. In the period from 2007 to 2014 endovascular revascularization in the internal carotid artery acute thrombosis was performed in 18 patients. Tandem occlusion of the cervical, petrous, cavernous and terminal segments of the internal carotid artery (53.3%) was the most commonly diagnosed. Isolated occlusion of the internal carotid artery cervical segment was determined in 5 (33.3%) patients, of the terminal segment - in 3 (20%) cases. L- and T-types occlusion of the internal carotid artery terminal segment thrombosis frequency were comparable and amounted to 20%. In 5 patients the internal carotid artery tandem occlusion with the distal embolism development in the middle cerebral artery occurred. In this type of injury a method for blood flow restoration in middle cerebral artery without restoring antegrade blood flow in the internal carotid artery was developed and applied.

Results. Full blood flow restoration in the middle cerebral artery using this method was achieved in these patients in all cases. Complications associated with the intervention were not registered.

Conclusion. The proposed method can be used in patients with the internal carotid artery acute tandem occlusion and the distal embolism development in the middle cerebral artery; the use of this type of revascularization is possible in patients with well-developed communicating arteries that can provide an adequate perfusion volume in the middle cerebral artery.

2015 marks the 120th anniversary of the birth of Nikolay Fedorovich Poryvaev - the outstanding Russian physician-pathologist and scientist. After graduation from the Penza boys gymnasium Nikolay Fedorovich entered the Medical Faculty of Kharkov University, graduating in 1923. He first worked as a therapist in the Mokshan village of Penza region. Then he moved to Penza, where he continued to work as a therapist in the provincial hospital (currently SBIH «Penza Regional Clinical Hospital named after N.N. Burdenko»). From 1929 to 1936 he was in charge of the provincial hospital prosectorium. He became interested in scientific and pedagogical activity, which he began to be engaged in further by moving to the Department of Pathological Anatomy of Kazan State Medical Institute. In 1950 N.F. Poryvaev defended his PhD thesis on «Pathology». For a time, from 1955 to 1959 and from 1966 to 1968 he headed the department. The article presents a brief biography of the associate professor N.F. Poryvaev, his activities in Penza and Kazan are described. Nikolay Fedorovich was World War II veteran, he was awarded the Order of the Red Star and three medals for his services to the country. In the literature devoted to the history of medicine of Penza and Kazan, there are only fragmentary information about associate professor N.F. Poryvayev. This work is presented to fill this gap.