Vol 23, No 5 (2017)

Articles
THE ORGANIZATION OF MEDICAL CARE OF PATIENTS WITH BRONCHOPULMONARY PATHOLOGY COMPLICATED WITH CHRONIC HYPOXEMIC RESPIRATORY INSUFFICIENCY IN ST. PETERSBURG
Titova O.N., Kuzubova N.A., Volchkov V.A., Kozyrev A.G., Haritonenko E.Y.
Abstract
The article considers issues of organization of medical care of patients with chronic hypoxemic respiratory insufficiency and such the most grounded method of its treatment as long-term oxygen therapy in home conditions. The methodological aspects of functioning of the municipal pulmonological center organized in St. Petersburg are expounded, including scheme of routing and observation of patients with chronic hypoxemic respiratory insufficiency. The efficiency of two-yers functioning of the center is analyzed.
Medical Journal of the Russian Federation. 2017;23(5):228-232
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THE HYBRID SURGICAL INTERVENTIONS IN PATIENTS WITH CRITICAL ISCHEMIA OF LOWER EXTREMITIES
Temrezov M.B., Kovalenko V.I., Bulgarov R.S., Bakhmetev A.S., Temrezov T.K., Botashev R.N.
Abstract
The purpose of study is to evaluate efficiency of hybrid surgical interventions under critical anemia of lower extremities in patients with multi-level atherosclerosis affection of arterial bed.The material and methods. The results of surgical treatment using hybrid technology are analyzed. The sampling consisted of 38 patients (33 males and 5 females) suffering from critical anemia of lower extremities because of multi-level atherosclerosis affection of main arteries. The average age was 69,6±2,5 years. The 21 patients (group 1) underwent balloon angioplasty with stenting of iliac arteries through direct access in femoral artery using balloon enlarging stents Asssurant and at the same time instant femoral popliteal stenting. The 17 patients (group 2) underwent stenting of iliac arteries combined with endarterectomy from common and deep arteries of thigh with profundoplastics.The results. The immediate and distant results of treatment in both groups had no differences. After endovascular interventions at iliac segment a primary technical success was achieved in 92.1% of cases and a clinical success - at 81.1% of cases. In the zone of open vascular interventions in femoral popliteal segment primary and secondary patency made up to 89.5% and 97.4% correspondingly. The rate of keeping of extremity in general made up to 92.1% and lethality - 7.9%. The distant results up to three years were monitored in 35 patients. The primary patency in the zone of endovascular intervention after 1, 2 and 3 years made up to 89,8, 76,2 and 68,5% correspondingly. In 5 patients (13.2%) repeated operations were implemented. The level of keeping of extremity after 1,2 and 3 years made up to 77.4%, 74.1% и 72.5%. The survival after 1,2 and 3 years made up to 94,3%, 88,6% and 85,7% correspondingly.The conclusion. The hybrid interventions (stenting of iliac arteries combined with surgical adjustment of femoral popliteal segment) under critical ischemia of lower extremities in the first place are effective and expedient for patients in severe condition and high surgical risk.
Medical Journal of the Russian Federation. 2017;23(5):233-236
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THE OPTIMAL EXTENT OF INTRA-OPERATIONAL MONITORING UNDER LAPAROSCOPIC OPERATIONS BECAUSE OF ESOPHAGEAL ACHALASIA AND GASTROESOPHAGEAL HERNIA
Anipchenko N.N., Ovezov A.M., Allakhverdyan A.S.
Abstract
The combination of pneumoperitoneum and pneumomediastinum are the main pathophysiological characteristics of laparoscopic operations because of achalasia cardia and hernia of esophageal opening. Their impact on hemodynamics and biomechanics of breathing requires control and timely adjustment. Within the framework of prospective randomized clinical study 66 patients were examined, including execution of laparoscopic operations because laparoscopic operations because of esophageal achalasia and hernia of esophageal opening. The patients were divided in two groups and both consisted of two subgroups: with standard and extended monitoring. The study resulted in establishment of optimal scope of indices monitoring necessary for safe anesthetic support of the given operations.
Medical Journal of the Russian Federation. 2017;23(5):237-241
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THE ACUTE DISORDERS OF CEREBRAL BLOOD CIRCULATION OF ISCHEMIC TYPE DURING PREGNANCY, DELIVERY AND POST-DELIVERY PERIOD
Arustamyan R.R., Adamyan L.V., Shifman E.M., Konysheva O.V., Doroshenko D.A., Lukina N.N., Golonzko V.A., Lapochkina O.B.
Abstract
The actuality. The acute disorders of cerebral blood circulation of ischemic type is a rare but dangerous complication of pregnancy. The etiology of ischemic disorders is different. The rate of strokes increases during pregnancy. The pre-eclampsia and eclampsia can become a cause of ischemic stroke.The purpose of study. To analyze structure, etiology, rate of ischemic disorders of cerebral blood circulation in pregnant women, women in labor and puerperia for optimization of tactics of obstetrics care support.The materials and methods. The analysis of 76 cases of acute disorder of cerebral blood circulation of ischemic type in anamnesis and during gestation. The conclusions. The rate of ischemic disorders of cerebral blood circulation is reliably higher in pregnant women as compared with women of reproductive age without pregnancy. The pre-eclampsia and eclampsia became a cause of development of ischemic stroke in 18.3% of cases.
Medical Journal of the Russian Federation. 2017;23(5):242-247
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THE PARTIAL DESCEMET'S STRIPPING WITH TRANSPLANTATION OF DESCEMET'S TRANSPLANT UNDER ENDOTHELIAL DYSTROPHY OF CORNEA
Oganesyan O.G., Grdikanyan A.A., Yakovleva S.S., Getadaryan V.R.
Abstract
The DMEK technique is applied five times more rarely than DS(A)EK despite that DMEK provides higher functional result. The main causes are technical "convolution" of implementation, long period of training, accompanied by prolonged operations, higher reject control of donor's tissue, increased rate of dependency of endothelium and mismatch of transplant. Therefore, an efficient technique is needed similar to DMEK though simpler than DMEK.The purpose of study. To analyze the results of implantation of Descemet's transplant (DMET) in patients with endothelium dystrophy of cornea (Fuchs) on the basis of limited clinical observations.Material of study. In two years, DMET was implemented to 12 patients. The study included 6 patients with average age of 60±18 years (from 29 to 80 years). All female patients had primary endothelial dystrophy and one male patient had secondary endothelial dystrophy. The visual acuity prior to DMET in average made up to 0,2±0,2 (from 0,01 to 0,5). The average CTR according optical coherent eye tomography made up to 685±53 µm (from 622 to 749 µm). Results. Within available periods of observation, resorption of edema of cornea takes place in 4 patients (67%) and visual acuity increased from average 0,2±0,1 to 0,45±0,3. In various periods density of endothelium cells varied from 549 to 689 kl per mm2. The indices of optical coherent eye tomography decreased from pre-operational 685±53 µm to 553±15 µm. Conclusion. The results testify efficiency of DMET. The period of restoration of transparency of cornea can vary from 1 to 6 months. The indices of density of endothelium cells are inferior to indices after DMEK. Also, DMET is ineffective in case of secondary dystrophy and at most efficient on previously non-operated eyes.
Medical Journal of the Russian Federation. 2017;23(5):248-253
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THE EVALUATION OF RISK FACTORS RELATED TO PREVALENCE OF HIV-INFECTION AT DENTIST'S VISIT
Khelminskaya N.M., Goncharova A.V., Kravets V.I., Shen P.A.
Abstract
The article considers issues of necessity of studying risk factors of spreading of IV-infection at dentist's visit in sate medical institutions and commercial stomatological structures. The data from publications concerning morbidity is presented. The clinical manifestations in oral cavity of patients with HIV-infection are studied. The analysis of efficiency of medical activities is presented. The recommendations concerning prevention of HIV-infection are given.
Medical Journal of the Russian Federation. 2017;23(5):254-257
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THE MOLECULAR BIOLOGICAL AND IMMUNE PATHOLOGIC CHARACTERISTICS UNDER AUTO-IMMUNE DISEASES OF SKIN
Makhneva N.V., Butov Y.S., Vasenova V.Y.
Abstract
The skin and mucous membranes are the min barrier organs providing systemic defense from environmental effects. They actively participate in deliverance of organism from antigens of various origin due to availability of one's own elements of immune system. The failure in chain of immune defense causes deceleration of process of elimination of antigen damaging structure of one's own tissue. The article presents mechanism of elimination of immune complexes and examples of therapeutic procedures accelerating and normalizing this process. The maintenance and recovery of excretory function of skin ensure positive dynamics of clinical manifestations of various diseases, including ones of autoimmune genesis. In case of fixation of immunoglobulins in tissues, skin acts as a target-organ. At that, detected specific antibodies are diagnostic markers for a wide circle of autoimmune dermatoses. Furthermore, immunopathologic processes occurring in skin are associated with disorders of synthesis of various molecular compounds of its tissue structures. This is testified by the results of immune morphologic picture of expression of a number of molecules of adhesion, protein components of desmosomal apparatus and basal membrane of epidermis, antigens of HLA-system. Therefore, skin is a complex organized structure capable to actively participate in development of inflammatory and autoimmune reactions. The analysis of these reactions at molecular biological level permits to evaluate intensity of occurring processes, to implement testing of efficacy of applied curative activities and in a number of cases to serve as an additional diagnostic marker. Undoubtedly, implementation of molecular biological methods as a tool of cognition favors continuous broadening of information about a number of aspects of pathogenesis of skin diseases and brings to development of new methods of their treatment at the molecular genetic level.
Medical Journal of the Russian Federation. 2017;23(5):258-262
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THE SYSTEMIC PSYCHO-NEUROLOGY: MAIN FACTORS EFFECTING CONNECTOME
Damulin I.V.
Abstract
The review considers actual aspects of structural and functional functioning of central nervous system. The significance of concept of connectome is emphasized. The constructing of connectome is based on the results of functional magnetic resonance imaging and consists in selecting of particular cerebral regions (areas), evaluating relationships between these regions and minute analysis of network of these relationships. At that, nowadays in neurosciences even more significance is attached not to functional segregation (specialization of one or another areas of brain) but functional integration, including synaptic level. The global principle of functioning of the brain is emphasized - goal achievement (information transfer) with minimal energy spending. The factors impacting on functioning of connectome are considered. The alteration of this structure during aging is analyzed. The data concerning individual and gender differences in organization of connectome are presented. The conclusion is made that obtained actual data permits to establish such a separate direction of neurosciences as systemic psycho-neurology combining clinical disciplines, methods of neurovisualization and mathematical methods. Exactly such a comprehensive approach opens new possibilities in studying functioning of so complicated organized system as brain is.
Medical Journal of the Russian Federation. 2017;23(5):263-269
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THE CLINICAL DEVELOPMENT OF BIO-SIMILAR PRODUCTS OF INSULIN AND ITS ANALOGUES: MODERN STAGE OF PROGRESSING
Philippova A.V., Chzhao V., Kolbin A.S.
Abstract
The article presents a review of data concerning clinical development of bio-similar products of recombinant human insulin and its analogues according beginning of 2017. The review is implemented concerning regulative requirements. The analysis is implemented concerning registries of registered medications and registries of clinical studies at the territory of the Russian Federation, European Union and USA. The review of articles in the information database MEDLINE (PubMed) is implemented too. It is established that in whole in the world regulative approaches are developed related to implementation of clinical studies of bio-similar products of insulin. However, this direction represents a new field of knowledge. The requirements to clinical studies of this type pass a stage of formation and adaptation. In the beginning of 2017 at the mentioned territories only two bio-similar insulin glargin were registered. At the same time, certain clinical studies at the present moment wait for completion. This situation testifies that the considered problem is one of the most actual and perspective fields of medical science.
Medical Journal of the Russian Federation. 2017;23(5):269-274
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THE CLINICAL CASE OF DETECTION OF TICKS GENUS DEMODEX OF ATYPICAL LOCALIZATION
Kuleshova S.V., Altaeva A.A., Aysina N.K., Tarasov A.A., Dvoretskaya E.V., Minushkina L.O.
Abstract
The role of the tick Demodex in pathogenesis of different diseases of skin until now suffer from ambiguous evaluation. The article presents examples of detection of the tick Demodex in diverse material with and without clinical manifestations. The clinical case is presented concerning detection of the tick in secretion from nipple of mammary gland. The issue of various approaches to diagnostic both in our country and abroad is brought up.
Medical Journal of the Russian Federation. 2017;23(5):275-278
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KhRONIKA
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Medical Journal of the Russian Federation. 2017;23(5):279-280
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