Vol 15, No 5-6 (2015)

The results of conservative and surgical treatment of patients diagnosed with dysplastic diseases of ectocervix, living in the environmentally polluted area of the city and in the region with more favorable environmental conditions, were examined. The conclusions on the effectiveness of various methods and the need to implement the prevention programs for cervical dysplasia were drawn. The detection of abnormality of enzyme activity and content of chemicals in the cell, observed in the absence of clinical manifestation of the disease, will allow correcting the pathological conditions in the subclinical stage.

The main goal of this research was to evaluate if there is an impact of obesity on pregnancy outcomes, particularly on weight of newborn infants. 308 delivery cases were reviewed, followed by investigation of placental histology after deliveries in women with normal weight, increased body mass index and obesity. We compared placenta’s morphology findings, biochemical blood parameters and risks for hyportrophic infants born in preterm and normal deliveries of women with different body mass indices. This study shows that obesity increases the risk of hypotrophy of newborn in preterm deliveries on 28-36 weeks of gestation by 4,4, but the highest level (by 6) was noted on 28-32 weeks of gestation, and only 3,4 on 33-36 weeks of gestation.

This paper covers the results of research of reaction of ischemic test of the humeral artery and dynamics of the level of endothelin-1 in blood serum in women with pregnancy complicated by preeclampsia.

The nature of vaginal fluid and its microbiocenosis in residents of environmentally disadvantaged areas and areas with more favorable environmental conditions was examined for the purpose of determining the role of microbial factors in the etiology and pathogenesis of ectocervix dysplasia. The study showed that the cervical dysplasia causes a significant abnormality of the microecological system, especially noticeable in women from the main group, which is reflected in a significant increase in the number of different species of microorganisms with a predominance of strict anaerobic bacteria. A direct moderate correlation between duration of patients’ habitation in environmentally disadvantaged areas and the growth of microbial and fungal flora in smears was found.

The article evaluates the prognostic significance of the predictor indices that reflect the state of the major biological systems involved in the formation of the embryo(feto)placental disorders and major obstetrical syndromes. As a result of the conducted study of predicting major obstetrical syndromes (PN, PE, PERP, ETC) using tests of clinical epidemiology - the sensitivity, specificity, predictive values of positive and negative results, diagnostic accuracy, the informative predictor indices were selected (PI= FER/TNF x 100; PI= PAMG/FER x 100; PI= L CD95+/PSF x 100), reflecting the degree of impairment of various compensatory and protective-adaptive processes in FPC and system dysfunction. High prognostic value of the proposed predictor index can be recommended for widespread practical use.

Iron deficiency anemia has a significant negative impact on various aspects of children’s health. Wide variety of risk factors and com plicity of risk groups are hampering the timely prevention of the disease. The aim of the study was the assessment of the dynamics of known risk factors of iron deficiency anemia in toddlers. A retrospective study of known risk factors frequency in 184 children born in the period from 01.07.1998 to 31.06.1999 (101 with iron deficiency anemia and 83 healthy) and 228 children born in the period from 01.07.2008 to 31.06.2009 (135 with iron deficiency anemia and 93 healthy) was held. We found the change of significance of most antenatal risk factors. Mother’s chronic pathology of gastrointestinal tract and atopic diseases are significant risk factors of IDA. We found increased impact of mother’s endocrine disease on the development of IDA in toddlers. Antenatal risk factors that directly disrupt placental transportation of iron from mother to the fetus such as premature birth and placenta pathology also became more important. Low birth weight (more than -3SD) and length at birth less then median (more than -1SD) are risk factors of IDA. The duration of breast-feeding for more than 9 months of life is a new risk factor of IDA in toddlers.

The frequency of iron deficiency and iron deficiency anemia (IDA) remains high in the pediatric population, but due to possible adverse effects of iron supplementation, routine prophylaxis is limited. In this regard, it is important to detect risk groups of iron deficiency anemia. After exclusion of antenatal risk factors, one of the most significant risk factors is the low socioeconomic level. The aim of the study was the assessment of IDA socio-economic risk factors dynamics. A retrospective study of known socio-economical risk factors frequency in 184 children born in the period from 01.07.1998 to 31.06.1999 (101 with iron deficiency anemia and 83 healthy) and 228 children born in the period from 01.07.2008 to 31.06.2009 (135 with iron deficiency anemia and 93 healthy) was held. Socio-economic factors in modern conditions have little effect on IDA in toddlers. Protective effect against IDA has mother’s status of a housewife. At the greatest risk of IDA are toddlers who are brought up in large families (3 children or more).

The study of the prognostic value of different methods in the treatment of bladder cancer was carried out, covering approaches to the treatment of bladder cancer. A review of Russian and foreign sources of literature on the treatment of bladder cancer and predicting outcomes was performed, including the study of articles and papers on the problems of this disease.

This study presents the results of the treatment of 168 patients with the diagnosis of colorectal cancer stage 4 with bilobar liver metastases. In the control group (78 patients), cytoreductive surgery was carried out with atypical liver resection. In the study group (90 patients), removal of the tumor was followed by radiofrequency thermal ablation of liver metastases.

The study of aethiopathogenesis of bladder cancer and the prognosis of the disease occurrence, as well as the possibility of prevention is presented in the article. The review of Russian and foreign literature sources, considering the development of bladder cancer incidence and prognosis was carried out. Forecasting the development of malignancies is currently a priority in terms of modern oncology.

The aim of this study is to explore the possibilities of intraoperative ultrasonography (IOUS) in patients with VATS resections of lung lesions. The article presents practical results of this imaging technique in 391 patients who were treated from 2011 to 2014. The effectiveness of IOUS is compared with classical methods of searching intraparenchymal lesions with subsequent video-assisted thoracic surgery (VATS).

This article proposes a method for diagnosing inconsistency of fundoplication cuffs with the help of x-ray examination of the organs of the abdominal cavity.

The article is devoted to modern concepts of pathogenesis, clinic, treatment strategies for thrombosis of the trunk and main branches of the portal vein. The article presents developed in the clinic tactics algorithms for the progression of bleeding from esophageal varices and the use of reconstructive interventions.

The article is devoted to the history of Samara herniological school from its foundation to the present time. The paper presents the most important research works of scientists of Samara devoted to the problems of treatment of patients with abdominal hernias of various localization.

Purpose: improving outcomes in patients with primary and tertiary hyperparathyroidism by the study of techniques and the volume of intervention in the thyroid and parathyroid glands. Materials and methods. The analysis of treatment of 52 patients with hyperparathyroidism was carried out: 21 patients with primary and 31 patients with tertiary hyperparathyroidism. Among them there were 15 men (28.8%) and 37 women (71.2%). The age of patients ranged from 20 to 80 years. In 71.4% of patients with primary and 77.4% with tertiary hyperparathyroidism the parathyroid gland pathology was combined with pathology of the thyroid gland. In patients with primary hyperparathyroidism, the operation was aimed at the removal of adenomas with high activity and maintenance of unaltered parathyroid glands. In patients with tertiary hyperparathyroidism, it was aimed at total parathyroidectomy. In case of combined pathology in organs, subtotal resection of the thyroid or thyroidectomy was performed. The operation technique is described in detail. Results. In addition to the removal of adenomas in 21 patients with primary hyperparathyroidism, subtotal resection of the thyroid gland was performed in 3 patients, and 12 patients underwent thyroidectomy. Among 31 patients with tertiary hyperparathyroidism, 17 patients had a multi-colloid goiter, which required performing thyroidectomy. Also while searching for parathyroid adenomas, 7 patients required mobilization of the thyroid gland, which was completed by its resection. Conclusion. 55.7% of patients with hyperparathyroidism have a combination of parathyroid and thyroid diseases, which requires implementation of thyroidectomy and removal of adenomas of parathyroid glands. In 19.2% of patients with hyperparathyroidism, the peculiarities of parathyroid adenoma location requires mobilization of the thyroid gland, which causes resection of the thyroid gland and removal of parathyroid adenomas.

Objective - to work out tactics and techniques of operation in patients with tertiary hyperparathyroidism associated with uremic tumoral calcinosis. Materials. Tactics and methods of treatment of uremic tumoral calcinosis are not well-described because of the rarity of the pathology. The article presents clinical observation of the patient A. born in 1954. Diagnosis: chronic renal failure, tertiary hyperparathyroidism, parathyroid adenoma, osteo-articular form; uremic tumor calcification in the right shoulder and arm. Ca = 2,4-2,55 mmol / l, P = 1,7-1,8 mmol / l iPTH = 800 pg / ml. Result. Treatment of patient was carried out in two stages. The first step was removal of 6 parathyroid adenomas, the second - opening three calcification cysts in the right upper limb - 750 ml in total volume, containing white exudate resembling lime solution. The postoperative period was uneventful. IPTH = 60 pg / ml. Conclusion. 0.09% of patients with chronic renal failure on hemodialysis may develop uremic tumoral calcinosis, the treatment of which is aimed at excision of the parathyroid gland adenomas, opening and drainage of para-articular pathologic cysts.

The article deals with analysis of urgent situations in parathyroid surgery. Six patients out of 214, who underwent surgery in 2000-2013, were operated urgently. Three patients out of five, who underwent surgery associated with hypercalcemic crisis, died in immediate postoperative period. Surgery was indicated to one patient with compression of organs located in the neck region.

The disease von Hippel-Lindau (VHL) is an autosomal dominant inherited disease characterized by predisposition to various cancers. It is caused by a mutation of the 3rd chromosome at the site 3p25/26, where suppression gene of tumor growth is localized. The clinical course of the disease is divided into two types: type 1 - without development of pheochromocytoma (an affection of the retina, tumors of the brain and spinal cord, pancreatic, renal, and splenic cysts, solid pancreatic tumors), type 2 - with the development of pheochromocytoma (subdivided into subtype 2A with a low risk of development of kidney cancer, 2B - high risk of developing kidney cancer, 2C - development of only pheochromocytomas). The paper presents authors’ own observation of the family in two generations with type 2C VHL syndrome.

We present a clinical case of endogenous hypercortisolism. After examination, 18-year-old patient was diagnosed with Cushing's syndrome, presumably caused by corticosteroma of left adrenal gland. Left laparoscopic adrenalectomy was performed. Pathologohystological conclusion was adrenal pigmented nodular dysplasia. In postoperative period hypercortisolism symptoms regressed. During the 2-year lasting observation of patient no relapse was found. In retrospect, the patient revealed symptoms of a rare hereditary disease - Carney complex. The interest of submitted observation lies in its exceptional rarity. Unilateral adrenalectomy was effective, but the probability of recurrence of Cushing’s syndrome and other manifestations of Carney complex still exists.

The article presents long-term results of treatment of 58 patients with diffuse toxic goiter after surgical subtotal resection of the thyroid gland. The analysis of risk factors for recurrence of hyperthyroidism was performed. It was concluded that the volume of thyroid remnant is not prognostically significant factor in the risk of recurrence of hyperthyroidism.

The study examines bone mineral density characteristics in postmenopausal women and in the type II diabetes at different ages, which will optimize the diagnosis, prevention and treatment in these patient categories.

We analyzed possible predictors of recurrence of atrial fibrillation after catheter ablation with the subsequent formation of a mathematical model predicting the efficacy of interventional treatment. This approach makes it possible to optimize the selection of patients with atrial fibrillation for radiofrequency ablation and increase its effectiveness.

The article is devoted to the peculiarities of the disease in patients with primary immunodeficiency (PID) in the Samara region. We studied the anamnestic and clinical features of the PID according to the patients’ medical histories. It was revealed that infectious respiratory diseases prevail among manifestations of PID. In addition, we came to the conclusion that PID is underdiagnosed.

Objective: study of the influence of intradermal auto-serum therapy on the level of IgE-antibodies in children with atopic BA (bronchial asthma). Methods. A course of intradermal auto-serum therapy was conducted in 44 children with atopic BA with sensitization to house dust mite allergens. The quantitative analysis of IgE-antibodies to the mixed of mites D. pteronyssinus and D. farinae in serum was performed before the course of auto-serum therapy and afterwards. Results. There was a statistically significant decrease of the levels of IgE-antibodies to the mixed of mites D. pteronyssinus and D. farinae (p=0,0000001) after the course of auto-serum therapy. Conclusion. Intradermal auto-serum therapy leads to the decrease of the level of IgE-antibodies in children with atopic BA.

The article is devoted to optimization of the respiratory support of patients with acute respiratory distress in the first hours of hospitalization in the intensive care unit and intensive pulmonary therapy profile for gas composition of arterial blood. The study presents two groups of patients: in the first group the respiratory support was administered by standard pulseoximetry (SatO2), and in the second group it was administered only after the analysis of gas composition of arterial blood. The results of own study confirmed that pulseoximetry (SatO2) is not sufficiently informative when choosing a method of respiratory support, and analysis of gas composition of arterial blood will help to optimize the treatment of acute respiratory failure in conditions of resuscitation and intensive therapy.

The purpose of the research is to give description of patients with CVH observed in the Samara regional hepatological centre of Samara State Medical University and to identify groups for antiviral therapy based on its potential effectiveness for known predictors: gender, age, presence of HBeAg, viral load, genotype of the virus. 336 of CVH patients aged 18 to 78 years with disease duration from 3 to 12 years were observed. Examination of patients by the standard criteria for patients with chronic viral hepatitis showed that among patients with chronic viral hepatitis В in Samara region the main group of patients is HBV DNA «+», HBeAg-negative, genotype D. Among 336 patients 65.5% of the observed patients are subject to antiviral therapy, 18.4% of which have high probability of achieving SVR. In the rest 47.1% of patients it is necessary to consider the ratio of cost of treatment, its effectiveness, motivation of the patient that requires an individual approach in each case.

The article presents the results of phacoemulsification with the use of the proposed method of rigid extension of the pupil, which allows the surgeons to reduce the operating injury, to protect pupillary edge of the iris, to achieve mydriasis of predetermined value, to reduce the likelihood of intra- and postoperative complications in patients with pseudoexfoliation syndrome.

In the article, the peculiarities and options of the clinical course of asymptomatic vitreo-macular adhesion are studied; possible outcomes and complications of macular area are analyzed. Monitoring of patients allowed us to identify three options of the clinical course of asymptomatic vitreo-macular adhesion: stable, camaraderie with the formation of a complete posterior vitreous detachment, and transition of asymptomatic vitreo-macular adhesion into symptomatic one with severe macular complications.

The article is devoted to assessing the state of the central corneal thickness in different forms of primary glaucoma. The results of the study of the central corneal thickness in patients with primary open-angel (POAG) and angel closure (PACG) glaucoma compared with the control group of healthy individuals. According to the study, in the POAG central corneal thickness was significantly smaller than in PACG and in the control group. In the PACG «thin» and «ultrathin» corneas occurred twice rarer and “thick” and “ultrathick” ones occurred almost twice more frequently in comparison with POAG. The research also revealed an inverse relationship of the central corneal thickness values depending on the stage of glaucomatous process.

Cone-beam computed tomography (CBCT) was applied in diagnostics and planning of treatment in 73 patients with noncarious lesions. For the first time, the density of hard tissues was estimated by the Hounsfield scale, which allowed accurate identification of areas of hypermineralization and demineralization. Presented data were used for determination of invasion areas at preparation for the operation. 3-D model and estimate indicators of the lesion area size helped to specify the type, form and rate of the noncarious lesion.

The article discusses the biomechanical aspects of the choice of dental implant at the bone deficit in the area of the proposed implant. The analysis of stresses in the bone tissue when using intraosseous and external-intraosseous implants is carried out.

The study of vertical movements of the lower jaw with a random selection of research objects for the purpose of identifying the early signs of TMJ dysfunction showed the prevalence of the curvature of the vertical movements of the lower jaw up to 87.5%, among which bilateral S-shaped curvature occurs in 15.6% of cases.

The article presents data of the study of indicators of oral fluid in patients with wedge-shaped defects of teeth in the pathology of the gallbladder and bile ducts.

Postural violations (PV) is a topical issue for people of advanced age. Studying of features of postural control in elderly people by means of computer stabilometrics (CS) was the research objective. This technique also can serve as control of efficiency of performed therapy of PN. In literature, there are only single researches of change of the main rack in persons older than 60 years. Materials and methods. 138 patients, whose age fluctuated from 60 to 102 years (average 77.8+2.3 years) were examined and divided into three age groups with 46 people in each one: elderly, seniors and long-livers. Results of research testify to marked decrease in compensatory opportunities of maintenance of balance in people over 60; the growth in postural instability was also noted according to the increase in age. Prior to therapy, a significant increase in the area and length of statokineziograms, as well as in the speed of movement of the center of pressure was revealed; average value of the “average position of the center of pressure” parameter in the frontal and sagittal planes considerably differed from normal indicators. After carrying out a standard course of treatment, the average values of the Deviation, Way and Speed parameters decreased in comparison with similar values before treatment. The average value of the Area parameter proved to be the most sensitive to medical manipulations. Conclusion. The CS method allows specialists to carry out rather objective early diagnostics of PN in elderly patients and to evaluate their condition in dynamics.

The article described foundation for new approaches to the analysis of herbal materials and preparations of Calendula officinalis L. by use of complex methods such as the TLC analysis, spectrophotometric and high performance liquid chromatography (HPLC). Discovery of narcissin as a dominant and active flavonoid has diagnostic value that is beneficial for the purpose of standardization of herbal materials and phytopharmaceuticals of Calendula officinalis L. For the purpose of objective quality evaluation of herbal materials and phytochemicals new methods were developed that allow analysis of the main groups of biologically active substances - flavonoids.

The review contains data of the research of some oxidoreductases in medicinal plants according to vegetation stages, the relationship of their activity and isozyme spectrum with accumulation of phenolic biologically active compounds (flavonoids), the possibility of using the above mentioned oxidoreductase characteristics as markers of plant harvesting period.

This paper presents an analysis of the human resource capacity of the pharmaceutical market of the Volga Federal District. It was found out that the problem of staff shortages is one of the urgent problems. The proportion of persons of retirement and pre-retirement age in the retail sector of the pharmaceutical market is about 30%. At the same time, the number of budget places in universities during the last five years has decreased by 37%. In five years about 10 500 pharmacy professionals will come to the pharmaceutical companies of the Volga region. Thus, the shortage of personnel will continue.

The paper presents a study of the fractional composition and structure of the set of molecular forms of malate dehydrogenase in fresh and dried medicinal plants - herbs of meadowsweet - in humid environment.

The article presents the peculiarities of the clinical course of allergic skin diseases. The changes in humoral immunity and in the cytokines in the peripheral blood are revealed. Major changes in quality of life for allergic contact dermatitis, eczema and atopic dermatitis were identified.

This article is devoted to the analysis of the microflora spectrum that was isolated from patients of resuscitation and intensive care unit. The resistance of the main predominant microorganisms to the antimicrobial agents is described. The results of own studies have confirmed the need for the dynamic monitoring of the microbial scene in the hospital. The basic directions for prophylaxis and management of organizational work in the workplace in a laboratory are proposed.

The article presents the analysis of working time of nursing staff on the example of ward nurses in the resuscitation and intensive care department for major and minor works by method of photochronometry of working day in the General hospital.

The article is devoted to one of the current trends in the development of information technologies in medical practice of development and implementation of workstation. The introduction of a unified information system and the formation of information space will significantly reduce the time, increase productivity and the level of professional qualification of senior nurses.

The paper presents the scientific assessment of mortality in the Volga rural district of Samara region for the period 2009-2013. There is a decrease in total mortality of the population against the background of stable fertility rates, resulting in a small natural population loss. The mortality rate from diseases of the circulatory system is decreasing, and mortality from neoplasms and injuries is increasing. For purpose of further mortality reduction, a set of measures, including preventive measures aimed at eliminating the risk of premature mortality, is required.

In order to improve the quality of medical care in a City Hospital, we studied the system of organization of expertise of temporary disability, which has a two-level structure that includes attending doctors and medical commission under the supervision of the heads of departments and deputy chief physician of the hospital. Despite the problems in health care system, the majority of patients and physicians are satisfied with the quality of care and solution of issues during the examination of temporary disability. Based on the survey and testing of physicians, organizational and management problems were identified, as well as difficulties in the organization of information support services during the examination of temporary disability.