Vol 24, No 3 (2018)

Articles
THE CHARACTERISTICS OF MORBIDITY OF PATIENTS SURVIVED A TRANSITORY ISCHEMIC ATTACK
Kostenko E.V., Kravchenko V.G., Polunina V.V.
Abstract
The actuality. The transitory ischemic attacks very often are considered as precursors of the stroke. The individual prognosis of risk of development of stroke after transitory ischemic attacks is unequal and is determined by differences in causes and risk factors of patients. The important place in establishing individual approach to treatment of patients with transitory ischemic attacks belongs to analysis of corresponding concomitant pathology. The analysis of morbidity is conditioned by necessity of differentiated analysis of characteristics of morbidity for development of personalized approach to treatment and restoration of health of this category of patients. The purpose of study is to investigate and analyze characteristics of morbidity of patients survived transitory ischemic attacks. Material and methods. The analysis was applied to morbidity of 351 patients survived transitory ischemic attacks, including 227 females (average age 59,6 ± 3,6 years) and 124 males (average age 57,6 ± 2,2 years). Results and discussion. It is demonstrated that level of morbidity increases with age from 233,9 до 605,9 cases of diseases per 100 examined. The analysis of rank distribution of diseases according classes of diseases demonstrated that teh first place belongs to diseases of blood circulation system (32.6%), the second place - to mental disorders (31.5%) and the third place - to diseases of endocrine system (15.5%). The positive correlation is established between availability of teo and more diseases of blood circulation system and development of recurrent transitory ischemic attacks (r = 0,688, p < 0,05). Conclusion. The availability of combined pathology in patients with transitory ischemic attacks dictates necessity of its registration at complex evaluation of health state of the given category of patients and development of multi-disciplinary approach to diagnostic and treatment of patients.
Medical Journal of the Russian Federation. 2018;24(3):116-119
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THE HEMOFILTRATION AT INFUSION THERAPY OF SEVERE ACUTE PANCREATITIS
Ganert A.N., Kokorev E.V., Zhbannikov P.S., Zabusov A.V.
Abstract
The 64 patients with severe acute pancreatitis at admission in hospital arterial hypertension, low venous saturation of oxygen (ScvO2), hyperlactemia, oligoanuria and hypercreatininemia were observed. This occurrence became an indication for infusion therapy to recover and optimize hemodynamics. After 6 hours of therapy, 30 patients were lacked increasing of diuresis related to infusion load and hypercreatininemia increased and also significantly increased positive fluid balance s compared to other patients. These 30 patients were additionally applied hemofiltration during 66 hours. The infusion therapy was characterized by difficulty of restoration and optimization of hemodynamic, large volumes of infusion mediums та frequent application of sympathomimetics. In patients without hemofiltration a significant increasing of cumulative fluid balance was added. The hemofiltration permitted to normalize diuresis, to prevent surplus cumulation of fluid and to support blood circulation at the optimal level.
Medical Journal of the Russian Federation. 2018;24(3):120-123
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THE PROBLEMS OF ANGIOGENESIS IN THE EYE OF PREMATURE CHILD
Sidorenko E.I.
Abstract
The purpose of study is to investigate pathogenesis of the first pre-clinical stage of retinopathy in premature children. Materials and methods. The sampling for examination included 642 premature born children. At the moment of birth, the gestation age was uз to 30 weeks, body mass up to 1500 g (very low body mass). The study included: indirect ophthalmoscopy; digital retinoscopy using wild-field retinal pediatric camera; calibermetry of retinal vessels. The intravital analysis of biochemical composition of vitreous body in 74 children with retinopathy and 45 animals (young rabbits chinchilla). The intra-vitreous injection of inhibitors VEGF was applied to more than 300 premature born children. The results. The retinopathy of premature born children is a leading cause of blindness. The article is devoted to mainly studying pathogenesis of only pre-clinical phase I of retinopathy of premature born children that is factually explored insufficiently. It is established that pathological angiogenesis of retina triggers an area of retina with vessels that stimulates functioning of system of struggle with hyper oxygenation and delays a normal development of angiogenesis. The immature auto-regulation of vessels of retina inadequately reacts to oxygen causing expressed angiospasm and developed circulatory disorders in vascularized retina aggravating total hypoxia. These processes delay angiogenesis almost for a month. The hypoxia-induced factors HIF1.2,3 began with significant delay both to be cumulated and to stimulate production of vascular endothelial growth factor. Conclusion. The study of pathogenesis phase I of retinopathy of premature born children open opportunity to effect pathogenic sections of disease and to prevent blindness and visual impairedness in premature born children.
Medical Journal of the Russian Federation. 2018;24(3):124-128
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THE TRANSPLANTATION OF DESCEMET’S MEMBRANE WITH ENDOTHELIUM IN COMPLICATED CLINICAL SITUATIONS
Oganesyan O.G., Makarov P.V., Grdikanyan A.A., Getadaryan V.R.
Abstract
The transplantation of Descemet's membrane with endothelium (DMEK) is the most efficient method of treatment of endothelium pathology. However, it is considered that at certain clinical situations DMEK is inappropriate. The purpose of study is to analyze the results of DMEK in complicated clinical situations. Materials and methods. The sampling included 14 patients (16 eyes) with pathology of endothelium of primary (19%) and secondary (81%) genesis and with concomitant alterations, including: total lack of vitreous (19%), non-posterior chamber pseudophakia (25%), presence of Ahmed drainage (25%), artificial lensiris diaphragm (12%), corneal ectasia combined with toric artiphakia (12%), penetrating scar of cornea (6%). Prior to operation, average visual acuity amounted to 0,04±0,05. The subtotal DMEK was applied to 15 eyes and in one case ¼ DMEK was implemented. In 2 cases cornea of donor had keratotomic incisions and in one case Descemetotransplant was formed from residual back layers of cornea after formation of front layer wise transplant using femtosecond laser. The results. No intra-operational complications were established. In 19% of cases a partial mismatch of transplant took place. The repeated DMEK was implemented in 1 case. The recovery of transparency of cornea and increasing of vision acuity were achieved in 94% of cases. In 6 months after operation an average central thickness of cornea amounted to 522±46 μm and density of endothelium cells in average amounted to 1541±486 kl/mm2. Conclusion. The application of DMEK in complicated situations ensures high biological and functional results and is accompanied with minimal number of complications. The procurement of expertise in endothelium surgery, it is appropriate to apply DMEK in all cases of pathology of endothelium.
Medical Journal of the Russian Federation. 2018;24(3):129-134
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THE ROLE OF MRI SCAN WITH CONTRAST AMPLIFICATION AT MULTI-PARAMETRIC MRI IN OPTIMIZATION OF X-RAY THERAPY OF RECURRENT CANCER OF PROSTATE
Kossov F.A., Bulychkin P.V., Olimov B.P., Panov V.O., Tkachev S.I., Buydenok Y.V., Tyurin I.E., Dolgushin B.I., Shimanovsky N.L.
Abstract
The purpose of study is to evaluate the role of dynamic contrast intensification as a constituent of multi-parametric MR-therapy in diagnostic of clinical recurrence of prostate cancer and optimization of salutary X-ray therapy. Materials and method. The sampling consisted of 89 patients with marker (prostate specific antigen) prostate cancer recurrence after radical prostate ectomy. The preliminary examination established no distant metastases. The multi-parametric MR-imaging of pelvis minor was applied both before salutary X-ray therapy and 6 months later after with purpose of applied treatment control. In 44 patients’ analysis was applied to data of dynamic MR-imaging with contrast intensification constituent to multi-parametric MR-imaging with intravenous injection of various MR-mediums (1M Gadobutrol, ½M Gadodiamid and ½M Gadoversetamid). The results. The model of multiple linear regression was applied to demonstrate that square of substrate of clinical recurrence statistically reliably correlates with level of marker of prostate specific antigen (R = 0,74; p < 0,0008) independently of type of injected various MR-mediums. The sensitivity of multi-parametric MR-imaging in detection of clinical recurrence of prostate cancer was evaluated by comparison with levels of prostate specific antigen and amounted to 92%, specificity - to 82%, accuracy - to 88%. The application of technique of hypo-fractionating of radiation dose on area of clinical recurrence of prostate cancer detected by multi-parametric MR-imaging demonstrated more progressive decreasing of marker of prostate specific antigen as compared with standard scheme of salutary X-ray therapy (according McNemarre criterion p < 0,03). The statistically reliable dependence (Mann-Whitney criterion p < 0,018) of alteration of signal in case of dynamic MR-imaging with contrast intensification after intravenous injection of various MR-mediums from square of substrate of clinical recurrence of prostate cancer and initial concentration of injected various MR-mediums between 1M Gadobutrol and ½M Gadodiamid and ½M Gadoversetamid. Conclusion. The multi-parametric MR-imaging has high sensitivity, specificity and accuracy in detection of substrate of clinical recurrence of prostate cancer. The application of in initial concentration of 1M (Gadobutrol) reliably increase validity of detection of local clinical relapse of prostate cancer especially in case of detection of substrate of recurrence of enough little and extra-little sizes. The application of multi-parametric MR-imaging using various MR-mediums marker in initial concentration of 1M (Gadobutrol) prior to course of salutary X-ray therapy enables to plan a supposed zone of X-ray impact with the purpose of more personalized brining of of high tumorocide dose of radiation at the area of clinical recurrence of prostate cancer needed for full resorption of recurrent tumor.
Medical Journal of the Russian Federation. 2018;24(3):135-141
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THE EVALUATION OF RISKS AT APPLICATION OF CARDIO-VASCULAR MEDICATIONS
Bolsunovskaya Y.R., Olefir Y.V., Romanov B.K.
Abstract
The article presents the results of evaluation of risk of development of undesirable reactions in case of application of cardiovascular medications out of listing of vitally needed and most important pharmaceuticals and Standard of medical care under stable angina pectoris from 01.01.2014 to 01.06.2017 out of 21 639 registered in the Federal database information sources. The data analysis was implemented using techniques of evaluation of degree of reliability of cause-and-effect relationship and also evaluation of ratio benefit and risk. The evaluation of manifestations of side-effects was applied and rating of greatest number of arriving messages in Federal okrugs was established. The higher level of arrival of messages concerning cases of serious undesirable reactions with high degree of reliability of cause-and-effect relationship is marked. The wide-spread application of cardiovascular medications and availability of risk of development of undesirable reactions requires continuity of monitoring of their safety.
Medical Journal of the Russian Federation. 2018;24(3):142-145
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THE ANTITUMORAL MEDICATIONS
Romanov B.K., Dmitrieva N.B., Zatsepilova T.A.
Abstract
The article presents the review of antitumoral medications for treatment registered in Russia nowadays and being at the final stage of their development - clinical studies in authorized testing centers for subsequent registration. The summarized information is presented by official sources - the State register of medications of the Ministry of Health of the Russian Federation, the Electronic Subject Heading List of Clinical Recommendations and Clinical Handbooks and prepared on their basis Orders on Standards of Medical Care. The place and role of chemotherapeutic remedies are demonstrated in relation to therapy of oncologic patients and typical schemes of application of anti-blastoma remedies in case of the most prevalent and most severe nosological forms of neoplastic diseases.
Medical Journal of the Russian Federation. 2018;24(3):146-150
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THE COMPARATIVE ASPECTS OF TWO MODIFICATIONS OF GASTRIC RESECTION ACCORDING T. BILLROTH TECHNIQUE IN ONCOLOGIC PRACTICE
Morgoshia T.S.
Abstract
The surgical intervention implying total ablation of tumor, continues to be the only method giving hope for recovery of patient despite a significant number of combined and complex methods of treatment of the given disease. However, many positions of the given conception underwent cardinal changes. Nowadays, most of authors recommend after gastric resection to restore to the extent possible natural anatomic relationships that provides best functional results. At the same time, certain researchers give preference to Billroth-II mode and at that some of them are devoted opponents of gastric resection by Billroth-I mode in case of cancer. This opinion is based on supposition that gastric resection by Billroth-II mode provides in greater extent radicalism in case of treatment of malignant neoplasms of given localization. The main factor restraining application of this most physiological operation is established opinion alleging its oncologic non-efficacy. The thesis is substantiated that intervention into modification of operation according Billroth method does not result in increasing of number of post-operative complications and that there is no differences also in distant results of surgical treatment of gastric cancer in case of application of both modes of restoration of continuity of digestive tract after sub-total distal resection. At the same time, quality of life of patients becomes better after reconstruction of digestive tract using gastroduodenal anastomosis. Most of researchers, studying indications to sub-total gastric resection using method Billroth-I, assume that it is reasonable to apply this particular mode of restoration of continuity of gastrointestinal tract only in case of early cancer, its exophytic forms (stage I and II) located in area of stomach angle or its low one third of its body and absence of metastases into regional lymphatic nodes.
Medical Journal of the Russian Federation. 2018;24(3):151-156
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THE BIPOLAR AFFECTIVE DISORDER TYPE II
Bardenshteyn L.M., Osipova N.N., Slavgorodsky Y.M., Beglyankin N.I., Aleshkina G.A., Turansky M.M.
Abstract
The article presents review of modern publications concerning studies of bipolar affective disorder type II. The materials are summing up concerning national and international studies of characteristics of clinical course of depressions and hypo-maniacal states within the framework of bipolar affective disorder type II, problems of differential diagnostic of bipolar affective disorder within spectrum of affective pathology. The significance of studying of pre-morbid background in case of bipolar affective disorder type II, co-morbid states for prognosis of course of disease is demonstrated. The screening, diagnostic and estimated scales and questionnaires are considered including principles of their application as an add-on to actual international diagnostic systems ICD-10, DSM-IV-TR, DSM-V.
Medical Journal of the Russian Federation. 2018;24(3):157-162
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LEONID MIKhAYLOVICh ROShAL' (K 85-LETIYu SO DNYa ROZhDENIYa)
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Medical Journal of the Russian Federation. 2018;24(3):163-164
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OBShchEROSSIYSKOE OBShchESTVENNOE DVIZhENIE «NARODNYY FRONT «ZA ROSSIYu» PRESS-RELIZY
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Medical Journal of the Russian Federation. 2018;24(3):165-168
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