Vol 96, No 1 (2015)

Aim. Prevention of purulent and septic complications in females after planned caesarean section.

Methods. Out of 60 pregnant women, who underwent comprehensive examination during the trial, 35 (58.3%) were included in the study group and were delivered off by planned cesarean section; 25 (41.7%) pregnant women, included in the control group, were delivered off by urgent cesarean section. Considering the goal of the study, bacteriology of vaginal discharge, amniotic fluid and placental tissues, DNA detection of vaginal discharge bacterial flora before and after treatment (using «Femoflor-16» test system) according to classification by M.N. Boldyreva (2010), uterine cavity aspirate cytology according to classification by M.A. Kupert (2003), sonography of the uterus and uterine adnexa on the 4-5 day after the surgery according to classification of A.P. Milovanov were added to the training program for pregnant women. In the study group, pregnant patients with severe anaerobic vaginal dysbiosis at the 36-38 weeks of gestation were administered causal treatment of severe anaerobic vaginal dysbiosis, pregnant patients of the control group were not treated if severe anaerobic vaginal dysbiosis was diagnosed.

Results. Performed correction of vaginal microbiota in the study group has significantly improved the course of postoperative period, reduced the incidence of uterine subinvolution, signs of chorioamnionitis as a manifestation of ascending infection compared to the control group. Postpartum endometritis has developed in 1 (2.8%) patient of the study group and in 5 (20.0%) cases in the control group. Offered method for preparing the patients with vaginal dysbiosis to cesarean section reduced the risk for postpartum endometritis by 6.8 times.

Conclusion. Strategy of preparation for planned Caesarean section should include vaginal discharge bacteriology and treatment of severe anaerobic vaginal dysbiosis, which reduces the risk for postpartum endometritis by 6.8 times.

Aim. To decrease the one-year mortality rate in out-patients with malignancies undergoing periodic health examination.

Methods. The study included 270 patients, who were examined and followed up. The main group included 140 patients, who monthly underwent ultrasonography of inferior vena cava branches during the first year of follow-up. The control group included 130 patients, in whom ultrasonography of inferior vena cava branches was performed only if clinical manifestations of venous thrombosis were registered.

Results. Venous thrombosis was diagnosed in 35 patients of the main group, including 21 cases of venous thrombosis at very high risk for embolism. In control group, ultrasonography of inferior vena cava branches was performed in 13 patients who developed clinical manifestations of venous thromboembolic events, in whom 6 patients were diagnosed with deep vein thrombosis of the lower limbs, in 3 patients venous thrombosis was assessed as at very high risk for embolism. In 24 patients (21 in the main group and 3 in the control group), targeted measures to prevent pulmonary embolism were administered, including cava filter implantation, vein ligation above the venous thrombosis at very high risk for embolism site, and crossectomy. The rest of the patients were administered conservative prevention of thromboembolism. In the main group, no deaths associated with pulmonary embolism were registered. In the control group, 19 patients died due to developing pulmonary embolism.

Conclusion. Preventive measures for pulmonary embolism, selected according to the results of timely ultrasound diagnosis of venous thrombosis, may reduce the one-year mortality rate in patients with cancer.

Aim. To reason the strategy of staged surgical treatment in patients with acute abdomen.

Methods. The study included 72 patients, of them 32 were included in the main group, in which the staged surgical treatment strategy was implemented. To assess the effect of such approach, control group including 40 patients who were treated using the early total care strategy, was formed retrospectively. The decision on the certain strategy use (early total care strategy or staged treatment strategy («aborted operation») was made in every included patient by operating surgeon during the operation.

Results. The modern method of surgical treatment («aborted operation» strategy) was introduced into the clinical practice for treating acute surgical abdominal diseases. A new method for patient’s condition severity assessment and operative risk prognosis based on the physical signs, as well as the scale of the indications for the «aborted operation» approach were developed. An original method for laparotomy wound closure was proposed. Device for laparostomy consists of two details - frame, which is stitched to the edges of surgical wound, and replaceable cap, which can be fixed to the frame. The device is made of soft elastic organic material, which is transparent and non-reactive. The key advantage of the device is the transparency of the cap material, allowing to review the condition of abdominal organs at any moment after the surgery without additional analgesia. The device act as a «viewport», allowing to clearly visualize the changes of abdominal organs, to diagnose the possible complications and to timely recognize the indications for programmed abdominal cavity debridement. The mortality in the control group was 100%, in the intervention group - 59%.

Conclusion. Staged treatment strategy may significantly reduce the postoperative mortality, being an alternative to standard tactical and technical approaches used in emergency abdominal surgery.

Aim. To explore the features of insulin resistance variations in overweight and obese patients with metabolic syndrome treated with moxonidine and combination of moxonidine and ivabradine.

Methods. The study included 30 patients with metabolic syndrome, who were overweight (body mass index 26.9±0.2 kg/m2) and 30 patients with metabolic syndrome and obesity (BMI 34.2±0.3). Control group included 17 healthy volunteers matched with patients by age and sex. Patients with metabolic syndrome and excessive body weight received moxonidine twice daily in average daily dose of 0.58±0.07 mg. Patients with metabolic syndrome and obesity received moxonidine twice daily in average daily dose of 0.52±0.04 mg and ivabradine twice daily in average daily dose of 13.7±1.1 mg. Biochemical blood tests (insulin, C-peptide, glucose, glycated hemoglobin serum levels) were performed in all patients.

Results.Patients with metabolic syndrome and obesity tended to increase insulin resistance, compared to individuals with metabolic syndrome and excessive body weight. In overweight patients with metabolic syndrome treated with moxonidine, a trend for lower insulin resistance, accompanied by a decrease of insulin, C-peptide, glycosylated hemoglobin, glucose levels and homeostasis model assessment-estimated insulin resistance (HOMA-IR) index by 7.1, 2.0, 5.0, 7.3 and 12.2% respectively was discovered. Combination therapy with moxonidine and ivabradine in patients with metabolic syndrome and obesity leaded to a statistically significant improvement of insulin resistance, accompanied by a decrease of insulin levels, glucose, C-peptide, and glycated hemoglobin by 16.7%, 12.3% (p

Conclusion. In patients with metabolic syndrome, deepening of insulin resistance on the background of increased sympathetic activity is associated with higher grades of obesity. Combination therapy with moxonidine and ivabradine in patients with metabolic syndrome and obesity leads to a significant improvement in insulin resistance due to the additional sympatholytic effect.

Aim. To identify the pecularities of clinical, functional features and morphological characteristics in children with subatrophic gastroduodenitis after eradication treatment.

Methods. Gastrointestinal tract condition was examined in 26 children with subatrophic gastroduodenitis. Esophagogastroduodenoscopy with morphological analysis of biopsy specimens, esophageal pH test and urea breath test were performed.

Results. 16 (60.7%) children reported low-grade pain, severe pain occurred in 3 (11.5%) patients, no abdominal pain was reported in 7 (27.6%) patients. A biopsy specimen was gained in 22 patients; moderate contamination with H. pylori was detected in 13 (59%) patients, severe - in 9 (41%) patients. Breath test was positive in all patients (n=26). Morphological study revealed fibrotic changes in 14 (63.6%) patients, atrophy and sclerosis lesions - in 7 (31.8%) and 17 (77.3%) patients, respectively, in addition to clear signs of inflammation. Intestinal metaplasia of the gastric mucosa was discovered in 4 (18.2%) children. Candidiasis of the stomach and duodenum was diagnosed in 7 (31.8%) children. All patients were administered standard eradication treatment. Repeated breath test after 4 weeks was positive in 9 (41%) patients, including 7 (31.8%) who were diagnosed with candidiasis by biopsy test. At 12 months, the control endoscopy performed in 19 patients: 5 patients, who failed to follow the recommendation, had marked clinical and endoscopic signs of relapse, no patients with good treatment compliance (n=14, 73.6%) had any clinical manifestations, although endoscopic signs of inflammation preserved in 9 (47.4%) children. Biopsy with histological examination was repeated in 9 patients. Signs of inflammation were significantly reduced in 6 (66.7%) patients, while the foci of atrophy, sclerosis and intestinal metaplasia retained in 2 out of 9 children. Contamination with H. pylori had significantly decreased.

Conclusion. Endoscopic signs of gastroduodenal chronic inflammation correspond to the severity of morphological characteristics in the acute stage of gastroduodenitis. Children with preserved signs of intestinal metaplasia of gastric and duodenal mucosa require intensive treatment and prolonged follow-up.

Aim. Study is aimed to investigate contractility impairments and receptor mechanisms of adrenergic regulation of myocardium inotropic function in Alzheimer’s disease model on transgenic mice.

Methods. Experiments were performed on isolated preparations of atria and ventricles myocardium of mice. Transgenic mice of B6C3-Tg(APP695)85Dbo Tg(PSENI)85Dbo genotype were used as animal model of Alzheimer’s disease. Contractile responses of myocardium were registered by conventional myographic technique in isometric conditions. To evaluate the expression of adrenergic receptors, immunofluorescence staining of myocardium with specific antibodies was performed.

Results. Transgenic mice showed not only a decreased effect of norepinephrine on myocardium inotropic function but also the inversion of the effect of norepinephrine - the use of 10-5-10-4 M of norepinephrine decreased myocardium inotropic function. Immunofluorescent staining showed decrease of expression of β1- and especially β2-adrenergic receptors ventricular myocardium of transgenic mice comparing to wild type mice. Adrenergic deregulation was registered in ventricles, but not in atria. The features of adrenergic regulatory mechanisms of myocardial contractility in transgenic APP/PS1 mice aged 8-10 months are specific, although somewhat similar to wild type mice aged 8-10 months, and are evidently due to Alzheimer’s disease. The inversion of norepinephrine inotropic effect (from positive to negative) may be explained by switching the intracellular cascade pathway of β2-adrenergic receptors effects to another type of G-protein.

Conclusion. The results indicate that peripheral adrenergic mechanisms of myocardial contractility regulation are impaired in studied transgenic mice model of Alzheimer’s disease. Obtained data widen our understanding of Alzheimer’s disease pathogenesis, as well as our conception of relations between cardiovascular diseases and neurodegeneration.

Aim. To summarize the results of 19-year activity in laboratory of immunohistochemical tumor diagnosis of Tatarstan Regional Cancer Centre of Ministry of Health, Republic of Tatarstan.

Methods. Advantages and limitations of modern molecular techniques for the diagnosis of human tumors are discussed based on our own experience and the literature data.

Results. A number of tumor cells molecular targets (e.g., growth factor receptors, differentiation antigens) are being determined in Tatarstan Regional Cancer Centre since 1996 on the daily basis for creating a «molecular portrait of tumor» and customized therapy adjustment. The total number of tumors investigated using immunohistochemistry, systematically increased from 150 in 1996 to 5910 in 2014, and for each tumor 1 to 12 (usually 4-5) or more antigens expression is evaluated. Since 2007, molecular cytogenetic studies of potential targets for the treatment of breast cancer, stomach and lung are investigated. To identify HER2 oncogene amplification performed 894 assays were performed in 2007-2011 using chromogenic in situ hybridization and 1064 assays using fluorescence in situ hybridization were performed in 2011-2014. Since November 2014 we are using fluorescence in situ hybridization to detect ALK-EML4 translocation in lung adenocarcinomas, during the last month of the 2014 38 tests were performed. For two decades, the laboratory, which has a reference status in the Volga region of Russian Federation, has verified the diagnosis in 32 thousand patients, among them 55% cases of breast cancer (prognostic markers), 18% - lymphoproliferative processes, 15% - anaplastic tumors and metastatic cancers of unknown primary source, 12% were soft tissue tumors. Error rate for immunohistochemical diagnosis was 2.6%, mainly involving central nervous system tumors, lymphomas, and metastatic cancers of unknown primary source.

Conclusion. Modern morphological tumor verification provides high quality diagnosis and treatment of cancer patients in the Republic of Tatarstan for many years.