Vol 20, No 2 (2014)

Articles
The life quality of patients after electropulse therapy under singlestage correction of mitral valve failure and fi brillation of atriums
Gorbunova E.V., Romanova M.P., Maksimov S.A., Mamtchur S.E.
Abstract
The sampling of study included patients after single-stage surgical correction of mitral valve failure and fibrillation of atriums using radio-frequency procedure "Labyrinth". The indicators of quality of life had been evaluated threefold with questionnaire SF-36 (initially, before application of electropulse therapy and after restoration of sinus rhythm) namely in three months after cardiac surgery intervention. The examined patients with fibrillation of atriums had low indicators of physical and psychological health. After restoration of sinus rhythm physical component of health increased up to 15.8% in patients with mechanical prostheses and up to 17.4% in patients with biological prostheses (p<0.05). At that, indicator of psychological component of health turned out to be twice higher in patients with biological valves than in patients with mechanical valves (p<0.01). The higher values of psychological component of health are related to withdrawal of warfarin in patients with biological prostheses of heart valves.
Medical Journal of the Russian Federation. 2014;20(2):4-7
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The indicators of activity of enzymes and parameters of lipid spectrum in cells of liver in children under chronic viral hepatitis C
Bulygin V.G., Bulygin G.V.
Abstract
The determination of indicators of activity of NAD (F)-dependent enzymes and lipid composition in biopsy material of liver from 21 children aged 12-16 years and suffering from chronic hepatitis C demonstrated that under stage III of process of chronic transformation of disease in comparison with stage II in cells of liver the synthetic processes are activated, the final stages of Krebs cycle are intensified and simultaneously protection of cells from processes of lipid peroxidation is reduced. The study also established that cholesterol level is increased and level of cholesterol ethers is decreased and lipid metabolism is shifted aside lipolysis. Therefore, it is established that indicators of activity of enzymes and lipid composition in cells of liver in children with chronic hepatitis C depend on the stage of chronic transformation of disease. The study demonstrated that under stage III as compared to stage II the more profound rearrangements of metabolic fates are occurring seemingly due to increase of severity of course of the given infectious process.
Medical Journal of the Russian Federation. 2014;20(2):7-9
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The concept of improvement of quality of skilled medical care to victims of road accidents in conditions of multitype hospital
Skorogliyadov A.V., Liyadova M.V., Ratiyev A.P.
Abstract
The road traumatism continues to be the most serious problem at the territory of the Russian Federation. The article uses as an example the first-rate Moscow clinic to consider particular aspects of optimization of specialized medical care to victims of road accidents in conditions of multitype hospital. The results of functioning of traumatology service are analyzed. The main principles of emergency medical traumatological care are determined.
Medical Journal of the Russian Federation. 2014;20(2):10-12
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The arterial hypertension in women of reproductive age
Gamzayev M.A.
Abstract
The prospective medical social study was implemented to research the characteristics of formation and prevalence of arterial hypertension and its significance if decreasing reproductive potential of women. The analysis of results of questionnaire survey established that 28.7±0.9% of women suffered from arterial hypertension. At that, the older were women the more frequently the more severe forms of arterial hypertension were diagnosed. In women, against the background of arterial hypertension, various reproduction losses were observed 1.91 times more often. The family relationship stress, insufficient physical activity, surplus body mass and excessive consumption of curring (salt) are among major risk factors of formation of arterial hypertension. The elimination of these risk factors can both limit prevalence of arterial hypertension among women and decrease reproduction losses conditioned by this disease.
Medical Journal of the Russian Federation. 2014;20(2):12-14
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The effectiveness of biofeedback therapy of headache of tension in patients with various characteristics of autonomous nervous system
Sorokina N.D., Selitskiy G.V., Terementseva E.S.
Abstract
The article considers the results of the study of comparative effectiveness of the biofeedback therapy of patients with headache of tension. The respiratory training and EEG-biofeedback therapy were applied as a therapy to reduce pain syndrome and amelioration of psycho-physiological conditions of patients. The study covered four groups of human subjects with different indicators of autonomous nervous system according R.M. Bayevskiy under Holter monitoring of variability of cardiac rhythm for all period of awaking condition and availability or absence of vegetative dysfunction reflecting development of chronic condition of headache. The difference of effectiveness of therapy of headache of tension with biofeedback of various types (respiratory or EEG) in patients with different characteristics of autonomous nervous system and presence of syndrome of vegetative dysfunction is statistically approved.
Medical Journal of the Russian Federation. 2014;20(2):15-18
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The analysis of terms of onset of recurrences and survival without recurrences of patients with cancer of vulva
Nerodo E.A., Nerodo G.A., Ivanova V.A.
Abstract
The article presents the results of monitoring and analyzes of group of patients with cancer of vulva (809 female patients) during last 30 years. The recurrence occurred in 203 patients (25.09%). Accordingly, recurrence occurred in 18.2% at stage I, in 20.5% at stage II, in 26.68% at stage III and in 46.25% at stage IV of disease. The duration of period without recurrence significantly depends on stage of disease. The higher is stage of disease the shorter is duration of period without recurrence (from 59.3 to 7.24 months). The more is tumor invasion the shorter period without recurrence is. Mostly, recurrence manifests during first three years of monitoring after termination of treatment (in 73.19%). This occurrence testifies the necessity of frequent and dynamic dispensary monitoring of patients using instrumental laboratory techniques of examination for earlier detection of recurrence of tumor with following immediate treatment. In patients with stage II and IV the reliable increase of period without recurrence is noted after application of chemotherapy in complex treatment of cancer of vulva. The detection of survival of patients without recurrence depending on stage of disease provided following data. The five-year survival without recurrence amounted to 46.7% at stage I, 22.4% at stage II. The three-year survival amounted to 2.5% at stage III. The one-year survival amounted to 2.7% at stage IV. Therefore, decrease of survival without recurrence obviously depends on increase of stage of disease. The next factor impacting longevity of patient is a depth of invasion of tumor. Meaning, the more invasion of tumor is the less survival without recurrence is. The detection of effect of primary treatment on survival without recurrence confirmed the positive impact of introduction of chemotherapy into complex treatment of patients with stage III-IV of disease. Hence, the rate of recurrence of cancer of vulva and survival without recurrence depend on the stage of disease, depth of invasion of tumor and applied treatment.
Medical Journal of the Russian Federation. 2014;20(2):18-21
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The new view at inter-sphincter resection in case of cancer of inferior ampullar section of rectum
Tulina I.A., Kravtchenko A.Y., Tananiyan A.O., Bredikhin M.I., Tsarkov P.V.
Abstract
The article presents the three step surgery technique of laporoscopy inter-sphincter resection of rectum because of cancer of its inferior ampullar section. The distinguishing characteristic of this technique is compliance of “no-touch” principle (without touching the tumor). This approach consists of primary isolation of segment of intestine with tumor at the expense of ligation of feeding vessels and blocking lumen of intestine more distal towards the tumor. Then mobilization of rectum is made with implementation of total mesorectumectomy. This approach can promote improvement of long-term oncological results of surgery.
Medical Journal of the Russian Federation. 2014;20(2):22-23
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The evaluation of effectiveness of application of extremely high frequencies and extremely high frequencieslaser combined effect in complex treatment of patients with pyoinfl ammatory diseases of maxillo-facial area
Vagina I.L., Khelminskaya N.M., Istomina I.S., Grubova L.V., Glazkov J.B.
Abstract
The inclusion of physical factors into complex treatment of pyo-inflammatory diseases of maxillo-facial area makes it possible to optimize course of treatment process by force of effect on mechanisms of sanogenesis. The article, on the basis of clinical characteristics and Doppler graphical studies of common carotid and facial arteries, demonstrates that extremely high frequencies and extremely high frequencies-laser combined effect is able to reestablish indicators of regional hemodynamics altered by pyo-inflammatory diseases of maxillo-facial area. This process promotes enhancement of effectiveness of complex treatment. The differential application of extremely high frequencies and extremely high frequencies-laser therapy depending on course of pyo-inflammatory process is substantiated.
Medical Journal of the Russian Federation. 2014;20(2):23-26
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The analysis of characteristics of phosphoric calcium metabolism in pathogenesis of caries in children of adolescent age
Kiselnikova L.P., Alekseyeva I.A., Danilova I.G., Gette I.F., Ojgikhina N.V.
Abstract
The article presents the results of biochemical study of mixed saliva of children of adolescent age. The indicators of phosphoric calcium metabolism (levels of osteocalcin, vitamin D, parathyroid hormone and activity of bone iso-enzyme of alkaline phosphatase) are investigated. The significant differences of investigated parameters in adolescents with different degree of caries intensity are established. The study data reflects the characteristics of pathogenesis of caries in children of adolescent age. The diagnostic and prognostic informativity of laboratory indicators for dynamic monitoring of children of given age is demonstrated.
Medical Journal of the Russian Federation. 2014;20(2):27-30
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Rivaroxaban: the risk of development of undesirable reactions of interaction
Kazakov A.S., Astakhova A.V., Lepakhin V.K.
Abstract
The anticoagulants in peroral form are generally applied under various diseases with increased susceptibility to thrombus formation. Nowadays, the selective anticoagulants influencing in a inhibition way only one of factors of blood coagulation system are used more extensively in the clinical practice. Rivaroxaban is one of such pharmaceuticals. Rivaroxaban regulates formation of thrombin at the expense of blocking of factor Xa action without direct impact on thrombin. The combined application of Rivaroxaban with inhibitors - CYP3A4 and P-glycoprotein increases concentration of pharmaceutical in blood plasma. This occurrence significantly intensifies its pharmacodynamic effect and considerably increases risk of development of massive bleedings and other possible side-effects. Rivaroxaban is metabolized with CYP3A4 and P-glycoprotein hence the most obvious manifestations of interaction reactions were detected under combined application with pharmaceuticals affecting both of these structures.
Medical Journal of the Russian Federation. 2014;20(2):31-36
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The hepatic pathology in obstetrics
Kulikov A.V., Shifman E.M., Spirin A.V.
Abstract
The main causes of hepatic pathology related to pregnancy are pre-eclampsia, HELLP syndrome, acute fatty hepatosis of pregnant women, and cholestatic hepatosis of pregnant woman. This pathology needs a multidisciplinary approach. The medical care to female patients with hepatic dysfunction/pathology is to be provided in multitype hospitals of high-top level. It is ultimately important that not only obstetrician-gynecologist are aware about the characteristics of this pathology but also anesthetist, resuscitation specialist, surgeon, therapist, gastroenterologist, infectiologist, transfusiologist and physician of department of hemodialysis. This level of awareness will promote early diagnostic and timely emergency care support. All variants of hepatic pathology related to pregnancy have both genetic determination and many common in etiology and pathogenesis. They are extremely difficult for early detection and differentiate diagnosis. The results of pathomorphology analysis testify the severity of affection of liver from causes related to pregnancy and make it possible to exactly differentiate them intravital biopsy included. In the case of manifestation of obvious clinical picture of hepatic pathology and its complications the only etio-pathogenic method of treatment remains timely delivery though in certain cases no amelioration of condition occurs. As a rule, the choice of method of delivery totally depends on obstetric situation. The advantages of operative or conservative method are not determined yet. The effectiveness of methods of pharmaceutical therapy and methods of detoxification (plasmapheresis, MAPS) has no proof nowadays. The transplantation of liver under HELLP-syndrome and acute fatty hepatosis of pregnant women factually has no development in Russia. Just that is why it is so important to detect and to take into account the slightest clinical and laboratory manifestations of hepatic dysfunction during pregnancy. No less important it is to determine the tactics of treatment and delivery as well.
Medical Journal of the Russian Federation. 2014;20(2):37-44
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Dementia: the diagnostic and therapeutic aspects
Mokhova O.I., Damulin I.V.
Abstract
The article considers actual concepts concerning clinical manifestations, diagnostic and treatment of dementia as a widespread syndrome in neuro-geriatric practice. It is pointed out that the most frequent causes of dementia in old age are Alzheimer's disease, vascular lesions of brain along with combination of these etiologic factors as well dementia with Lewy bodies. The approaches are analyzed concerning diagnostic of cognitive, emotional and behavioral disorders in such patients on the basis of application of neuro-psychological and psychometric scales. The possibilities of modern techniques of neuro-visualization are characterized. The actual approaches to treatment of cognitive disorders are considered. In particular, the characteristics of application of inhibitors of acetylcholinesterase, invertible blocker of post-synaptic glutamatergic NMDA-receptors and pharmaceuticals with vasoactive and metabolic action are examined. The application of non-pharmaceutical methods of treatment and prevention of cognitive abnormalities is discussed. The conclusion is made about necessity of further study of effects of various pharmaceuticals in the case of cognitive abnormalities, behavioral disorders and everyday activities. The practicability is substantiated to include these pharmaceuticals into scheme of treatment activities in patients with dementia with the purpose to correct cognitive and behavioral defects.
Medical Journal of the Russian Federation. 2014;20(2):45-49
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Anemia of chronic diseases
Andreitchev N.A., Baleyeva L.V.
Abstract
The anemia originating under infectious inflammatory processes, non-infectious inflammatory diseases, tumors is called “anemia under chronic diseases” to emphasize the role of main disease in its pathogenesis. The rate of occurrence of anemia under certain diseases reaches 100%. But, in these situations, for all that diversity of pathogenic mechanisms of anemia, one of the main mechanisms is considered the redistribution of iron into cells of macrophage system activating under various inflammatory (infectious and non-infectious) or neoplastic processes. The anemia under chronic diseases by their prevalence takes second place after iron-deficiency anemia. The prevalence of anemia under chronic diseases in old and senile age varies from 2.9% to 61% in males and from 3.3% to 41% in females. In young and mature age, anemia under chronic diseases is more often detected in females. In hospitalized patients of old age its rate goes up to 36-80% whereas in out-patients it goes to5-14%. Among patients with systemic diseases of connective tissue anemia occurs almost in half of patients and at that anemia under chronic diseases is prevailing. The diagnostic criteria of anemia under chronic diseases are indicated in details. The main mode of correction of anemia in this category of patients is the treatment of active inflammatory process. This treatment includes antibacterial therapy considering character of supposed of verified infection agent, basic and antiinflammatory therapy of rheumatoid diseases, surgery treatment under corresponding indications (abscess of abdominal cavity, purulent pyelonephritis, etc.). In these situations, prescription of iron preparations, vitamin B12 as usually is inefficient and only delaying timely detection of main cause of anemia and onset of corresponding therapy. The picking out of anemia under chronic diseases as a separate pathogenic alternative and awareness about it both have important value in view of matching of this alternative to iron-deficiency anemia and certain sideroblastic anemias although essence and therapeutic approaches under these anemias are different.
Medical Journal of the Russian Federation. 2014;20(2):50-55
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In memoriam of Yuriy Pavlovitch Lisitsyn
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Medical Journal of the Russian Federation. 2014;20(2):56-56
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