Vol 19, No 5 (2013)

Articles
THE ROLE OF INFORMED VOLUNTARY CONSENT FOR APPLICATION OF AMNIOSCOPY IN ENHANCEMENT OF QUALITY OF MEDICAL CARE SUPPORT IN OBSTETRICS PERMANENT ESTABLISHMENTS
Dobrokhotova Y.E., Polunina N.V., Danelyan S.J., Djobava E.M., Panaiyotidi D.A., Nekrasova K.R.
Abstract
The article analyzes the results of implementation of informed voluntary consent of women for application of amnioscopy. It is demonstrated that timely applied examination facilitates the early identification of unfavorable course of pregnancy. This approach makes it possible to timely apply the complex of treatment measures and hence to better the perinatal outcomes.
Medical Journal of the Russian Federation. 2013;19(5):4-6
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THE LEGISLATIVE REQUIREMENTS AND LEGAL REASONS APPLIED AT ORGANIZATION OF RENDERING WORKS (SERVICES) BY SPECIALTY OF "THERAPY" IN AMBULATORY SECTOR
Goncharov N.G., Boiytchenko Y.Y.
Abstract
Nowadays, the alterations in normative legislative acts occur headily, especially in the field of regulation of procedure of rendering of medical types of works (services). The article presents the review of legislative normative acts. The actual requirements to organization of provision of medical care concerning out-patient therapy in the primary medical sanitary care system are discussed. The review is done concerning main requirements to organization of therapist work, order of medical district, justification of fee-for-service medicine, etc. The article targets both public health professionals and therapeutists of primary medical sanitary care system to enhance the knowledge level.
Medical Journal of the Russian Federation. 2013;19(5):7-11
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THE RATIONALIZATION OF DIAGNOSTIC OF NON-SPECIFIC SALPINGOOPHORITIS ON THE BASIS OF ANALYSIS OF INFORMATIVITY AND MODELING OF CLINICAL LABORATORY PARAMETERS
Agarkov N.M., Budnik I.V., Ivanov V.A., Yakovlev A.P., Shulga L.V.
Abstract
The article analyzes the clinical symptoms and laboratory indicators applied in diagnostic of salpingoophoritis. The sample included 65 female patients with non-specific salpingoophoritis and in 32 healthy women. To rationalize the diagnostic process in these groups the informativity of main symptoms, total analysis of blood, levels of cytokines in blood, immunoglobulins in cervical vaginal mucus and products of lipids oxygenation in blood was analyzed. The most informative diagnostic parameters of salpingoophoritis are established. The net model of rational diagnostic of non-specific salpingoophoritis is developed using computer modeling. This model makes it possible to significantly diminish number of analyzed parameters without damage to diagnostic.
Medical Journal of the Russian Federation. 2013;19(5):12-15
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THE LIMITATION OF METABOLIC AND INFLAMMATORY ALTERATIONS IN POST-SURGERY PERIOD: THE ROLE OF FIELD BLOCK ANESTHESIA AND ANALGESIA
Lyuboshevskiy P.A., Zabusov A.V., Timoshenko A.L., Korovkin D.V.
Abstract
The limitation of surgery stress-response is considered as one the main tasks of anesthesia and post-surgery intensive therapy. The article deals with evaluation of intensity of neuro-endocrinal, metabolic and inflammatory alterations after abdominal operations depending on type of anesthesia. The sample of 260 patients was divided on groups depending on type of anesthesia (total intravenous anesthesia as is, combined with epidural or spinal anesthesia). The analysis was applied to concentration of cortisol, glucose, lactate, cytokines, nitrogen excretion with urine and intensity of post-surgery pain syndrome. During post-surgery period significant increase of concentration of cortisol, glucose and lactate and pro inflammatory and antiinflammatory cytokines was established. The application of both spinal and epidural anesthesia during operation significantly decreased intensity of these alterations and limited nitrogen excretion. Besides, the epidural analgesia provided more adequate post-surgery pain relief.
Medical Journal of the Russian Federation. 2013;19(5):15-19
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THE DYNAMICS OF CLINICAL METABOLIC INDICATORS IN PATIENTS AFTER GASTRECTOMY DURING THE PROCESS OF PERSONALIZED DIET THERAPY WITH ENTERAL FEEDING INCLUDED
Khomitchuk A.L.
Abstract
The article presents evaluation of dynamics of clinical metabolic indicators in patients after gastrectomy on account of cancer during two-year period of monitoring against the background of personalized diet with enteral feeding included. The monitoring was applied to 128 patients: 57 males and 71 females aged from 20 to 82 years and mean age 60.7±12.2 years. The analysis was applied to blood biochemistry, factual diet in domestic conditions, body composition, basal metabolism and quality of life during treatment process. Every patient received a prescription of personalized diet therapy based on the results of examination of corresponding dietary status. In case of indication needed a medicament therapy was prescribed too. The erosive reflux esophagitis, hypoferric anemia was revealed in 34% of patients and damping-syndrome in 40% of patients. Against the background of diet recommendations in most patients the mentioned post-surgery complications were leveled and decrease of body mass was prevented. It was achieved to increase the body mass up to 3-5 kg in 12% of patients. The positive dynamics was established concerning normalization of bowels evacuation and decrease of dyspepsia occurrences and weakness. The concentration of whole protein increased up to 70 g/l (p<0.05), iron - up to 16 mkmol/l, hemoglobin - up to 126±3.2 g/l, and hematocrit - up to 0.374±0.07 (p<0.05). The evaluation of dynamics of body composition the increase of all basic components was established. The analysis of basal metabolism established normal protein oxidation, increased fat oxidation, and decrease of velocity of carbohydrates oxidation. The results of survey using a focused questionnaire of the European Organization for Research and Treatment of Cancer (QLQ-C30 version 3.0) demonstrated in patients amelioration of general health conditions. The patients became more robust physically and mentally and their major complaints diminished. The personalized diet therapy with enteral feeding included promotes support of body mass, amelioration of clinical metabolic and quality of life in patients after gastrectomy.
Medical Journal of the Russian Federation. 2013;19(5):19-23
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THE APPLICATION OF CONSTRUCTION UNBLOCKING BACKBONE GROWTH IN SURGERY TREATMENT OF INFANTILE AND ADOLESCENT SCOLIOSIS
Sampiyev M.T., Laka A.A., Zagorodniy N.V., Balashov S.P., Malkov V.S., Ramlugon K.
Abstract
The application of LSZ constructions to cure scoliosis in children makes it possible to achieve an effective correction in all planes of deformation without any limitation of skeleton growth. The characteristics of LSZ make it possible to decrease traumatism of operation; to prevent development of certain complications related to child growth and practically put no limitations of physical activity during post-surgery period. These conditions have an important role in social adaptation of patients. When patient attains the age of completion of active growth of backbone LSZ construction is dismantled due to absence of spondylosyndesis and enacted intervertebral joints. The installation of helical system is made at the unaltered anatomy of backbone. Considering the previous achieved correction further application of helical systems makes it possible to achieve factually 100% result in correction even in case of 80-100 degrees of scoliosis. The article presents the results of surgical correction of infantile and adolescent scoliosis using the construction unblocking backbone growth.
Medical Journal of the Russian Federation. 2013;19(5):24-28
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THE FOREIGN BODIES OF BRONCHI IN PATHOGENESIS OF LINGERING AND CHRONIC BRONCHOPULMONARY DISEASES IN CHILDREN
Sosyura V.K., Bayandina G.N., Shershevskaya A.Y.
Abstract
The article presents the results of diagnostic and treatment of unrecognized lingering carriage of foreign bodies in bronchi of children hospitalized for examination with symptomatic of prolonged and chronic bronchopulmonary disease. The key position in diagnostic is bronchoscopy. This technique made it possible to extract foreign bodies of different origin from depth of airway. The sample consisted of 79 examined patients including 53 children were aged up to 3 years old (67%) and 14 children were aged from 4 to 6 years old (17.7%). The technique of rigid bronchoscopy is rationally applied under general anesthesia with oxygen artificial lung ventilation in injection mode.
Medical Journal of the Russian Federation. 2013;19(5):28-30
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THE HEMODYNAMIC GRADATIONS IN CASE OF JOINT APPLICATION OF TECHNIQUES OF EXTRACORPOREAL DETOXICATION IN CHILDREN WITH RENAL INSUFFICIENCY
Agzamkhodjayev T.C., Sharipov I.L., Nurmukhamedov K.K.
Abstract
The study of complex therapy effect on hemodynamic disorders was carried out using detoxication techniques on the sample of 215 patients (63 patients with acute renal insufficiency and 152 patients with chronic renal insufficiency). The analysis of results established that depending on severity of patients’ condition the complex treatment can have alternatives involving into hemodialysis joint application of hemosorption and plasmapheresis. The mentioned technique made it possible to decrease the level of intoxication, to ameliorate metabolism processes and to correct peripheral and central hemodynamics. The obtained positive results support enhancement of total conditions of patients. The effective life prognosis is established in the category of the most severe category of patients.
Medical Journal of the Russian Federation. 2013;19(5):30-33
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THE CONDITION OF PROCESSES OF PEROXIDATION OF LIPIDS AND ANTIOXIDANT SYSTEM AND CLINICAL CHARACTERISTICS OF CHILDREN BORN IN PARENTS SUFFERING OF DIABETES MELLITUS TYPE I
Mikayeliyan N.P., Gurinova A.E., Mikayeliyan A.V., Novikova S.V.
Abstract
The article deals with results of study of processes of peroxidation of lipids and antioxidant defense in 29 children born in parents suffering of diabetes mellitus type I. It is demonstrated that in these children antiradical defense is stronger than in children with diabetes mellitus type I. The reinforcement of antioxidant defense in children born in parents suffering of diabetes mellitus type Ican promote the activation of defense factors with the development of reactions of adaptive character. The foundation of human health is developed in childhood. The processes of formation of morphologic functional status of child, growth and differentiation of tissues mainly depend on presence of diseases and conditions and effect of metabolic processes.
Medical Journal of the Russian Federation. 2013;19(5):33-36
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TREATMENT OF VENOUS LEG TROPHIC ULCERS USING LOW INTENSIVE LASER RADIATION
Sergeev N.A., Shestakov M.S.
Abstract
The treatment of venous leg trophic ulcers was done in 120 patients. In 42 patients of comparison group the traditional conservative treatment was applied. In 78 patients of the main group the traditional treatment was combined with original techniques of laser therapy. It was shown that low intensive laser radiation promotes the improvement of next and remote results of venous trophic ulcers treatment. The best results are received in patients (21) of main group who after the complete ulcer epithelization due to laser radiation the operative correction of a venous blood flow was applied.
Medical Journal of the Russian Federation. 2013;19(5):36-37
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THE DETERMINATION OF CONFIDENCE OF CAUSE-AND-EFFECT RELATION "UNTOWARD REACTION-MEDICINAL AGENTS' INTERACTION”
Kazakov A.S.
Abstract
The article discusses the actual issue of safety of patients during application of medicinal agents related to unpractical combination of medicinal agents which can result in decrease of effectiveness and safety of pharmacological therapy. The application of medicinal agents in potentially dangerous combinations is a serious clinical issue. According various researchers, the combinations of medicinal agents prescribed by physicians are potentially dangerous in 17-23%. The untoward reactions induced by interaction of prescribed medicinal agents are developed in 6-8% of patients. The detection and analysis of complications of medicinal therapy related to pharmaceutical interaction is the most actual and complicated task of pharmaceutical control. In case of analysis of information about untoward reactions the most important is the evaluation of degree of confidence of cause-and-effect relationship "untoward reactions-medicinal agents’ interaction". The evaluation of degree of confidence of cause-and-effect relationship "untoward reactions-medicinal agents interaction" is ultimately important stage of evaluation of information about untoward reactions organized in national and regional centers of monitoring of safety of pharmaceuticals in many countries and WHO center. In practice of Russian pharmaceuticals control the mentioned technique hitherto was not applied to evaluate interdependence between complications related to medicinal agents. As a result of this, the present study was targeted to assess the significance of standardized evaluation of degree of confidence of cause-and-effect relationship "untoward reactions-medicinal agents interaction" in the process of analysis of information from national database concerning untoward reactions. The scale of determination of evaluation of degree of confidence of cause-and-effect relationship "untoward reactions-medicinal agents’ interaction" was developed using modification of the Horn-Hamsen scale in accordance with study demands. The application of the scale of determination of evaluation of degree of confidence of cause-and-effect relationship "untoward reactions-medicinal agents’ interaction" makes it possible to receive more reliable data concerning interaction of preparations and to detect these interactions. The application of given scale can be useful in preparation of evidential publications about cases of medicinal agents interactions resulting in complications. This scale can be useful in assessment of already published cases especially the ones which did not passed thorough verification.
Medical Journal of the Russian Federation. 2013;19(5):38-42
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THE PRIMARY EXPERIENCE AND SHORT-TERM RESULTS OF FEMTOLASER POSTERIOR KERATOPLASTY (DSEK) WITH FORMATION OF TRANSPLANT FROM ENDOTHELIUM SIDE
Neroyev V.V., Gundorova R.A., Stepanov A.V., Bykov V.P., Penkina A.V., Oganesiyan O.G.
Abstract
The most often applied operation in case of pathology of endothelium of cornea is the automated keratoma endothelial transplantation with descemetorexis. At the same time, surplus amount of stroma and uneven thickness of transplant limit the achievement of potential visual acuity. The development of laser femtosecond technologies made it possible to form transplants of symmetric profiles and desired thickness. Besides, the proofs exit concerning damage of epithelium under effect of femtolaser near the object. The article presents the primary experience and short-term results of endothelial keratoplasty using transplant formed with femtosecond laser LDV Z6 (Ziemer, Switzerland) from endothelium side. The surgery was applied to 6 patients including cases of end-to-end keratoplasty, with primary and secondary dystrophy, artiiridofaction, avitria and other concomitant pathology. The period of monitoring consisted 6 months. The effectiveness evaluated according presence of intra- and post-surgery complications, recovery of transparence of cornea, evenness and thickness of transplant and density of endothelium cells. The recovery of transparency of cornea was achieved in all patients. During post-surgery period both full and partial separation of transplant occurred. The mean minimal thickness of transplants made up 76.6 mkm and mean maximal thickness — 93.3 mkm. The difference in thickness within the limits of single transplant among all grafts consisted 1720±162 kl/mm 2. It was first demonstration of clinical possibility and effectiveness of implementation of laser femtosecond endothelium kerartoplasty with formation of graft from endothelium side.
Medical Journal of the Russian Federation. 2013;19(5):43-46
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DIOXINS: A HIGH ECOLOGICAL DANGER
Vasenova V.Y., Butov Y.S., Izmerova N.I., Selysskiy G.D.
Abstract
The article presents the literature review cocnerning a serious danger of propagation of dioxin compounds for human organism. In case of their ingress on skin a serious pathology occurs in form of chloracne involving into pathologic process the hepatobiliary system. The humoral immunity suppression is marked. The increment of activity of anti-inflammatory cytokines is noted. The development of embryo-toxic and mutagenic effects is increased. All these processes condition the formation of malignant neoplasms.
Medical Journal of the Russian Federation. 2013;19(5):47-49
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The oldest chair of endocrinology and diabetology: eighteenth anniversary
Doskina E.V., Kotchergina I.I.
Medical Journal of the Russian Federation. 2013;19(5):50-54
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