Vol 20, No 5 (2014)

Articles
The problem of premature delivery in modern obstetrics
Saveliyeva G.M., Shalina R.I., Panina O.B., Astrakhantseva M.M., Spiridonov D.S.
Abstract
In obstetrics, one the most discussed issue is premature delivery followed by morbidity and mortality of newborns increased up to 1.5-2 times as compared with case of full-term pregnancy. Despite valuable achievements on diagnostics, prevention, treatment of menace of premature delivery and organization of departments of intensive therapy of premature newborns, no country can significantly decrease rate of premature delivery and its aftermaths. The article summarizes the results of original studies and international achievements relating issues of premature delivery. The ways of perspective studies of prevention of premature miscarriage.
Medical Journal of the Russian Federation. 2014;20(5):4-8
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The social hygienic aspects of diet of women of reproductive age
Gamzayev M.A.
Abstract
The results of sociological survey demonstrate that in current social economic conditions and in particular in Baku women are peculiar to irrational and highly caloric diet with mean energetic capacity 2923.7±10.3 kcal/m 3. Consequently, growth of body mass in women and body mass index comes up to mean of 25.7±0.14 kg/m 2. The combined effect of both factors increases rate of various reproductive disorders in women. Hence explanatory activities among women are implemented concerning modifications of their diet habits and body mass control to enhance effectiveness of protection of reproductive female health.
Medical Journal of the Russian Federation. 2014;20(5):9-12
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The comparative analysis of attitude of consumers from different segments of target auditorium to the fee-for-service in state multi-profile curative institution of Moscow
Pushkova S.I.
Abstract
The article presents the results of sociological survey of two segments of target auditorium of consumers of fee-for-service in state multi-profile curative institution of Moscow. The comparative analysis of attitude to fee-for-services of consumers with policies of voluntary medical insurance and patients receiving fee-for-cervices according individual contracts. The statistical analysis of questionnaires made it possible to make up group portraits of consumers from every segment and to evaluate the degree of their satisfaction with level of medical fee-for-service.
Medical Journal of the Russian Federation. 2014;20(5):13-15
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The transplantation of heart of reconstruction of left ventricle in female patient with ischemic heart disease complicated by cardiac insufficiency and electric storm: the role of tomoscintigraphy with phase images
Ostroumov E.N., Shumakov D.V., Golitsyn S.P., Kotina E.D., Gupalo E.M., Slobodiyanik V.V., Tatiyevskaya Z.V., Babin A.V.
Abstract
Nowadays, the treatment of cardiac insufficiency of ischemic genesis still is an actual problem. The conclusions of competent controlled and randomized studies such as for example STICH are still ambiguous. In case of absence of success of modern therapeutic methods of treatment of cardiac insufficiency of ischemic genesis the cardiosurgery interference becomes an inevitable occurrence. Its last and radical stage is transplantation of heart. Another choice for patients with cardiac insufficiency of ischemic genesis formally liable to transplantation of heart can be extension of of traditional methods of cardiosurgery. The discussion of role of single-photon emission computed tomography in decision making concerning tactics of treatment is the purpose of study. To discuss such kind of decision a specific case is proposed to attention of reader. The female patient with cardiac insufficiency of ischemic genesis with implanted cardioverter defibrillator suffered from continuing everyday episodes of ventricular tachycardia - electric storm. The patient received anti-arrhythmia therapy, permanent intravenous infusion of lidocaine that correspond Status 1 according UNOS. Then patient was hospitalized as a recipient for transplantation of heart. However, the results of evaluation of myocardium applying technique of single-photon emission computed tomography synchronized with ECG and using phase images resulted in changing decision about carrying out of organ-preserving operation. The application of single-photon emission computed tomography made it possible to determine size and topography of transmural scar. This task could be achieved either by technique of single-photon emission computed tomography or by MRI. But implanted cardioverter defibrillator was a contra-indication to MRI. The single-photon emission computed tomography revealed volume of affection equal to 48%. The task to evaluate viable myocardium outside scar also could be achieved either by technique of single-photon emission computed tomography or by MRI. The task to determine topography of sources of pathological rhythm in ventricles could be implemented through visualization using phase images obtained under evaluation of results of gated SPECT. The preventive installation of intra-aortic balloon counterpulsation, resection of aneurysm of left ventricle and endoventriculoplastic by Dor was applied to patient. The follow-up months of monitoring detected no program triggering of implanted cardioverter defibrillator. The stable sinus rhythm was observed under standard extra systole and therapy with amiodarone. According data of single-photon emission computed tomography end-systolic volume of left ventricle decreased from 215 to 103 ml and ejection fraction of left ventricle increased from 23% to 34%. The six minute stepwise probe (6 minutes test) made up to 460 m. The application of single-photon emission computed tomography synchronized with ECG and using phase images makes it possible to make an adequate decision in choosing tactics of treatment of patients with implanted cardioverter defibrillator for whom conclusions of competent controlled and randomized studies still are ambiguous.
Medical Journal of the Russian Federation. 2014;20(5):16-21
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The evaluation of security of application of endobronchial valve in patients with infiltrative tuberculosis of lungs in phase of decay and with failure in treatment
Skluyev S.V., Petrenko T.I., Myshkova E.P.
Abstract
The article analyzes the results of treatment of 102 patients with infiltrative destructive tuberculosis of lungs with failure in treatment. In treatment of 49 patients endobronchial valve was applied and 53 patients were treated according standards and constituted comparison group. The application of endobronchial valve results in no development of endobronchial complications and in 14.3% cases cause complications during course of disease demanding alterations of tactic of treatment. After implantation of endobronchial valve in 40.8% of patients occurred clinical manifestations of presence of endobronchial valve in bronchus and all symptoms were arrested with pharmaceuticals during three weeks. The implantation of endobronchial valve results both in growth of granular tissue of various degree in zone of blocking and in development of scar stenosis of blocking bronchi in remote period.
Medical Journal of the Russian Federation. 2014;20(5):22-25
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The dynamics of biochemical markers of re-modulating of myocardium in children with dilation cardiomyopathy against the background of complex therapy
Bershova T.V., Bakanov M.I., Basargina E.N., Gasanov A.G., Ivanov A.P., Monaenkova S.V.
Abstract
The development of methods of treatment of chronic cardiac insufficiency under dilation cardiomyopathy in children is an actual issue of children cardiology. The article presents complex clinical biochemical results of examination of children with chronic cardiac insufficiency under dilation cardiomyopathy. the complex therapy included inhibitors of angiotensin converting enzyme and P-adrenoceptor antagonists. On the basis of analysis in blood serum concentrations of matrix metalloproteinase, matrix metalloproteinase tissue inhibitor-1, content of single components of apoptosis, superoxide dismutase and total nitrogen oxide the alterations of these biologically active agents in blood serum of children with different stage of circulatory disturbance prior and after application of cardio-protection therapy. It is demonstrated that amelioration of clinical conditions of patients with circulatory disturbance stage I-IIA is followed by tendency to normalization of content of matrix metalloproteinase, matrix metalloproteinase tissue inhibitor-1 and decreasing of degree of apoptosis cell destruction. This trend can be caused by capacity of inhibitors of angiotensin converting enzyme and P-adrenoceptor antagonist to suppress increased synthesis of matrix metalloproteinase and processes of apoptosis due to decreasing of degree of hypoxic damage of cardiac hystiocytes. In children with circulatory disturbance stage IIB-III resistance to the applied therapy can be a consequence of increased endogenous production of nitrogen oxide.
Medical Journal of the Russian Federation. 2014;20(5):25-29
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The manifestations of polymorphic exudative erythema in oral cavity
Khelminskaya N.M., Kravetz V.I., Gontcharova A.V.
Abstract
The article considers clinical experience of diagnostic and treatment of such severe and allergic symptom complex as polymorphic exudative erythema in conditions of maxillo-facial hospital. In stomatological practice, this disease applies to category of rare ones. The irregularity of its clinical manifestations on face and in oral cavity and severity of course of disease deserve consideration of stomatologists in out-patient section and maxillofacial surgeons in hospital.
Medical Journal of the Russian Federation. 2014;20(5):29-31
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The mathematical modeling of interleukins for rational diagnostic of acute salpingo-oophoritis
Afasnasiyeva E.P., Shumga L.V., Yakovlev A.P., Ivanov A.V.
Abstract
The sampling included 65 female patients with acute salpingo-oophoritis and 32 healthy women. The detection of interleukins of peripheral blood was made using the technique of solid-phase immune-enzyme assay. The diagnostic significance, according indicators of shift, disintegration, coefficients of correlation and informativeness were established. The study revealed that to detect this disease priority is to be given to level of interleukins-2 higher than 45 pg/ml, of interleukins-8 higher than 25 pg/ml, of interleukins-18 lower than 100 pg/ml and of IFN-a higher than 15 pg/ml. The mentioned cytokines were considered in development of mathematical model supporting classification of patients with acute salpingo-oophoritis and healthy women. The network model of diagnostic of required pathology was developed too.
Medical Journal of the Russian Federation. 2014;20(5):31-35
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The modern view on etiology, pathogenesis and modes of treatment of hysteromyoma
Kondratovitch L.M.
Abstract
The article presents actual data concerning possible pathology and pathogenesis of hysteromyoma. The various views and theories related to origin of this disease are presented. The modern classifications of this pathology are expounded. The alternatives of conservative and operative treatment depending on age of patients, clinical manifestations of disease, presence of complaints and concern of preservation and realization of reproductive function. The approaches to treatment of given pathology from the position of endocrinology and organ-preserving and reconstructive surgery are exposed. The issues of surgical and hormonal therapy in female patients of reproductive and premenopause age. The operational approaches depending on size, type of growth, localization of myoma nodes and technical possibilities of hospital are described in details. The article enumerates innovative modes of treatment of hysteromyoma using ultrasound, high temperature, embolization of vessels supplying blood to myoma node.
Medical Journal of the Russian Federation. 2014;20(5):36-40
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The safety of application of laxatives
Luzina E.V.
Abstract
The constipation occurs in 16-27% of population and only one third of patients seek medical care. The laxatives are traditionally applied for stool regulation. At the same time, 4.18% of patients make excessive use of these pharmaceuticals. The article characterizes the main groups of laxatives and presents the results of meta-analysis of effectiveness of preparations including description of unfavorable effects with formation of laxative disease. The original clinical case of female patient with severe form of laxative disease is presented. The treatment of this complication is described. It is emphasize that key role is played by withdrawal of pharmaceutical caused laxative disease and correction of electrolyte disorders and recovery of functioning of stomach. The good results of treatment is ensured by lactulose due to safety, good tolerance and additional effects, in particular normalization of composition of gut organisms.
Medical Journal of the Russian Federation. 2014;20(5):41-44
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The actual approaches to therapy of refractory migraine
Ekusheva E.V., Damulin I.V.
Abstract
The refractory migraine is a severe version of migraine with many unclear and contradictory related issues. The main problem of such patients is in absent or minimal effect of standard anti-migraine therapy both in prevention of attack and rapid relief of symptoms. Hence the most difficulties are related to tactics of management of hard-curable patients with refractory migraine. The therapy is more often selected in empirical way and individually for every patient. This process takes much more than one month and the main purpose of treatment is to decrease level of deadaptation. In this connection, during management of this category of patients the most justified is multidisciplinary approach coupled with rational combined pharmacological therapy with large specter of non-pharmaceutical methods of exposure.
Medical Journal of the Russian Federation. 2014;20(5):45-52
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The asymptomatic pancreatic hyper-fermentation
Krasnovskiy A.L., Grigoriyev S.P., Zolkina I.V., Loshkareva E.O., Brutskaya L.A., Bykova E.A.
Abstract
The asymptomatic increase of level of enzymes of pancreas often results in such incorrect diagnosis as chronic pancreatitis and in prescription of unnecessary treatment. Meanwhile, in many similar cases hyperenzymemia has a benevolent nature. The article discusses possible causes of pancreatic hyperenzymemia in healthy persons. The algorithm of diagnostic search in this clinical situation is proposed.
Medical Journal of the Russian Federation. 2014;20(5):52-56
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