Perm Medical Journal

”Perm Medical Journal” (ISSN Key title: Permskiĭ medit︠s︡inskiĭ zhurnal) is a referred scientific and practical journal. It was founded in 1923 by Medical Society of Perm University. Since 2001 the founders of “Perm Medical Journal” are Perm State Academy of Medicine and Perm Research Center of Russian Academy of Medicl Sciences and Administration of Perm Region. Since 2017, the founder is Academician E.A. Vagner Perm State Medical University.

The journal is registered by the Roskomnadzor agency (licensee ЭЛ № ФС 77-75489 on 05.04.2019).

“Perm Medical Journal” is included into the list of the leading scientific journals and editions of the Russian Federation intended for publication of basic scientific results of theses for a degree of Doctor of Science.

01.14.01 - Obstetrics and gynecology (medical sciences)
01.14.02 - Endocrinology (medical sciences)
01.14.08 - Pediatrics (medical sciences)
01.14.12 - Oncology (medical sciences)
01.14.17 - Surgery (medical sciences)
01.14.25 - Pulmonology (medical sciences)
02.14.02 - Epidemiology (medical sciences)
03.14.09 - Clinical immunology, allergology (medical sciences)
03.14.10 - Clinical laboratory diagnostics (medical sciences)

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Current Issue

Vol 37, No 3 (2020)

Cover Page
Original studies
Enterolithiasis
Davidov M.I., Nikonova O.E.
Abstract

Objective. To study the prevalence, etiopathogenesis, clinical features, diagnosis and treatment of enterolithiasis.

Materials and methods. For 26 years, 30 patients (16 men, 14 women) with intestinal calculi were observed. Elderly and senile patients prevailed (18 persons). Six patients had enterolites, 24 – coprolites. In general, 41 calculi measuring from 2.5 to 22 cm (31 concrement was 6 cm and larger) were diagnosed in patients. Calculi were most often formed in the sigmoid and rectum. Fibrocolonoscopy, proctosigmoidoscopy, ultrasound, computed tomography were used.

Results. It was established that chronic colonic stasis, congenital and acquired intestinal diseases, intake of indigestible and extraneous for the intestine substances (chalk, barium, magnesium and aluminum salts) played a leading role in the formation of intestinal calculi. In 25 patients, calculi caused complications, of which the most severe were perforation of the intestine and acute intestinal obstruction.

Conclusions. Improvement of diagnostics and the developed differentiated treatment tactics permitted to improve treatment results better and achieve recovery in all 30 patients.

Perm Medical Journal. 2020;37(3):5-11
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Correlation between adipocytokine profile and heart rate variability in patients with obesity
Shulkina S.G., Smirnova E.N., Laurent E.A., Kolomeets N.Y., Konovalov V.V., Kozmenko O.A., Chernukha T.A.
Abstract

Objective. The high prevalence of obesity in employable population dictates the necessity for preclinical diagnosis of diseases associated with it, including the study of the autonomic regulation of heart rhythm. The objective was to study the correlations between the adipocytokine profile and heart rate variability in patients with obesity.

Materials and methods. 300 persons were examined, the average age was 46.2 ± 6.4 years; Group 1 was metabolically unhealthy obesity phenotype (MUHOP) – 90 patients; group 2 was obesity without metabolic disorders [Ob(+)MD(-)] (MHOP) – 50 persons; the control group consisted of 100 healthy respondents. We studied the following indices: blood serum adipocytokines: leptin, insulin, resistin, adiponectin. Heart rate variability was studied using Poly-Spectrum Rhythm 2012 computer electrocardiograph.

Results. In the course of the study, decrease in the total heart rate variability and reactivity of the parasympathetic part of the autonomic nervous system in patients from MUHOP group was found, while there were no differences with the control in the MHOP group. It was established that a decrease in the parasympathetic effect on the regulation of heart rhythm is associated with the presence of abdominal obesity, insulin resistance, and an increase in the level of TG, glucose, resistin, and uric acid.

Conclusions. The received relationships between indicators of carbohydrate and lipid metabolism, the level of uric acid and adipocytokines with temporal and spectral characteristics of the autonomic nervous system confirm their contribution to the development of autonomic dysfunction in obese persons.

Perm Medical Journal. 2020;37(3):12-17
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Clinicoepidemiological features of tick-borne encephalitis course in Perm krai
Nikolenko V.V., Vorobyova N.N., Merkuryeva E.V., Nikolenko A.V., Suslina O.A., Okishev M.A., Rozhkova D.K.
Abstract

Objective. The incidence rate of tick-borne encephalitis in Perm Krai annually exceeds that in the Russian Federation by several times, and therefore, the aim of the study was to reveal the clinical and epidemiological characteristics of the course of infection.

Materials and methods. A continuous retrospective clinical and laboratory survey including 314 adult patients admitted to the Perm Regional Clinical Infectious Diseases Hospital in 2014-2019 was carried out.

Results. The following features were revealed: the disease is diagnosed more often in persons over 41 years old, infection mainly occurs when visiting the forest and park areas. That is why, it is necessary to reduce the number of infection carriers. In every fifth patient, the disease is characterized by the development of an inapparent form, as well as mixed infection in association with pathogens circulating in ticks in the territory of Western Ural ticks.

Conclusions. In 45.9 % of cases, the infection has a moderate and severe course, involving not only meninges but also the brain substances into the pathological process that requires early diagnosis and timely adequate therapy.

Perm Medical Journal. 2020;37(3):18-25
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Chromosomal microarray analysis of ovum material in tubal pregnancy
Olina A.A., Sadykova G.K.
Abstract

Objective. To determine the significance of chromosomal aberrations in ectopic pregnancy. An ectopic pregnancy is a complication that occurs in approximately 1–2 % of all pregnancies and can cause morbidity and mortality in women of childbearing age. Identification of potential risk factors for the diagnosis of ectopic pregnancy remains an urgent, incompletely studied question.

Materials and methods. A descriptive exploratory study was conducted on the basis of the City Clinical Hospital named after M.A. Tverie, Perm. The objects of the study were 20 women with tubal pregnancy. All patients were admitted to the gynecological unit of the clinic with a diagnosis of “progressing tubal pregnancy”, for which tubotomy with laparoscopic access was performed that allowed to preserve the integrity of the material. Besides traditional histological study, in all cases a chromosome microarray analysis of the fetal egg was performed.

Results. In addition to routine histological study, in all cases of the analyzed group, a chromosome microarray analysis of the ovum material was carried out. It turned out that in one case, in a 28-year-old patient with a five-week tubal frozen pregnancy a complex chromosome imbalance was found: three copies of 1–6, 8–22 and X chromosomes and four copies of chromosome 7, molecular karyotype (according to ISCN 2016): arr (1–6. 8–22, X) x3, (7) x4.

Conclusions. Despite the fact that genetic breakdowns are uncontrollable factors and it is not possible to directly influence them, the search for possible mechanisms leading to them is promising.

Perm Medical Journal. 2020;37(3):26-32
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Disturbances of carbohydrate metabolism and postoperative complications after distal pancreatic resection
Barykov V.N., Istomin A.G., Markina N.V., Tyulganova V.L.
Abstract

Objective. To study the state of carbohydrate metabolism in patients after distal pancreatic resection and its effect on the development of postoperative complications.

Materials and methods. Over 10 years, 47 patients have been operated on with various tumors of the body/tail of the pancreas and complications of chronic pancreatitis. In 16 of them, concomitant diabetes mellitus was diagnosed before surgery, and in 31 patients, carbohydrate metabolism was normal.

Results. After surgery, from a group of patients with unchanged carbohydrate metabolism, 8 (25.8 %) developed diabetes mellitus. The following postoperative complications – pancreatic fistula, inflammatory infiltrates and "fluid leakages” in the abdominal cavity – occurred in 68 % of cases. Out of 24 patients with diabetes mellitus, complications were registered in 21 (87.5 %) and of 23 diabetes-free patients – in 11 (47.8 %).

Conclusions. The total risk for the development of the postoperative abdominal complications after the distal resection in patients with diabetes mellitus, diagnosed before and after the intervention, is 7.6 times higher than in patients without diabetes.

Perm Medical Journal. 2020;37(3):33-39
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Review of literature
On the question of osteomyelitis and its consequences in children: literature review
., Schepalov A.V., Antonov D.V., Belokrylov A.N., Zhuzhgov E.A.
Abstract

According to the literature data, the article considers the occurrence and development of acute and chronic osteomyelitis. The basic principles of classification and terminology are presented. The authors paid special attention to the features of the clinical manifestations of osteomyelitis and its spread, identified clinically important focal changes in osteomyelitis. The etiology, pathogenesis and features of pathophysiology with a different mechanism for the development of osteomyelitis are considered. The moments, affecting the formation of orthopedic outcomes in the form of deformations, shortening of limbs are noted. The authors examined the complications and tactical features in the treatment of the effects of osteomyelitis. The importance of a systematic approach to treatment, the determination of the stages and their contents, taking into account the main process and the anatomical and functional expediency, are accentuated.

Perm Medical Journal. 2020;37(3):40-57
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Role of leptin in pathogenesis of hepatic steatosis, steatohepatitis and endothelial dysfunction in obesity: literature review
Miftakhova A.M., Pestrenin L.D., Gulyaeva I.L.
Abstract

According to the latest WHO data, in the world there are 2 billion adults and 381 million children and adolescents from 0 to 19 years old, who are overweight or obese. This is due to the presence of many factors affecting the occurrence and development of this disease. One of the important links in the pathogenesis of obesity is hyperleptinemia in combination with leptin resistance.

In this article, we attempted to summarize the information on the role of leptin in the pathogenesis of obesity complications such as liver steatosis, steatohepatitis and endothelial dysfunction. Parallels have been drawn between insulin resistance and leptin resistance. The relationship of leptin and insulin was analyzed, and data on the effect of these hormones on carbohydrate and fat metabolism are also presented.

Perm Medical Journal. 2020;37(3):58-65
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Methods of diagnosis and technologies
Analysis of results of cytological screening of cervix in persons living in Perm territory
Schekotova A.P., Bulatova I.A., Paducheva S.V., Shabieva O.R., Pogrebnova L.S., Bezmaternykh S.P., Saprykina I.A.
Abstract

Objective. To analyze the results of cytological screening for cervical cancer in women, living in the Perm Territory.

Materials and methods. The work is based on the results of a cytological study of 4670 women aged 29 to 70 years who underwent additional medical examinations in medical institutions of Perm and the Perm Territory for the period from 2017 to 2019.

Results. It was established that regardless of the place of residence, normal cytograms prevail. Inflammatory changes were more often observed in the urban population than among women living in the village. As age increased, the number of neoplastic changes in the cervix increased with a peak incidence at the age of 50. Detection of cervical cancer in the Perm Territory was 0.03 % that corresponds to the average statistical indicators in Russia, although this apparently reflects the problems of hypodiagnosis in cytological screening, since in the country in recent years the incidence of cervical cancer and mortality from it has been increasing.

Conclusions. The cytological method is a key step in cervical cancer screening, since it allows you to identify early pathological changes in case of adequate collection of material, correct staining of preparations, and a highly qualified cytologist.

Perm Medical Journal. 2020;37(3):66-74
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Thoracoscopy and chemical pleurodesis in treatment of pancreatogenic pleural effusion
Plaksin S.A., Kotelnikova L.P., Farshatova L.I.
Abstract

Objective. To determine the opportunities of thoracoscopy and the effectiveness of induction of chemical pleurodesis by intrapleural administration of drugs for pancreatogenic pleurisy.

Material and methods. We analyzed the results of surgical treatment of 17 patients with acute pancreatitis and 14 – with pancreatic cysts after necrosis complicated by pancreatogenic pleural effusions, accounting for 3,7 % of all effusions.

Results. Mild and moderate pleurisy was successfully suppressed in 4 cases (12.9 %) by pleural punctures. Six patients (19.4 %) with pancreatic necrosis and huge pleural effusion in case of severe conditions underwent pleural drainage. In 20 cases (64.5 %), fragmented pleurisy was treated using thoracoscopy. Pleurodesis was performed by means of insufflation of talcum powder in five cases that permitted to reduce the drainage time from 7.14 ± 2.96 days without pleurodesis to 4.2 ± 1.1 days (p = 0.026). Pleurodesis using application of trichloroacetic acid had no effect in three patients. Five patients received 200–300 μg of octreotide diluted with 40 ml of isotonic sodium chloride solution into the pleural cavity through the drainage. The drainage period reduced to 3.5 ± 1.0 days (p = 0.018). The effect was maximally expressed in the cases with high amylase level in the pleural exudate. After that, 20 patients underwent various operations on the pancreas.

Conclusions. Thoracoscopy is indicated to patients with pancreatogenic pleurisy for removal of fragments and sanation of the pleural cavity. Intraoperative pleurodesis with talcum effectively suppresses pleurisy and reduces the drainage period while application of trichloroacetic acid has no essential influence. Intrapleural administration of octreotide allows rapid reducing exudation when amylase index is high. Our study supports the effectiveness of mini-invasive procedures (videothoracoscopy combined with talcum powder pleurodesis and intrapleural administration of octreotide) to sanitize the pleural cavity, suppress pleurisy and shorten drainage periods.

Perm Medical Journal. 2020;37(3):75-83
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Experience of performing organ-preserving surgeries in patients with true ingrowth of placenta in perinatal center of Samara Regional Clinical Hospital named after V.D. Seredavin
Kalinkina O.B., Nechaeva M.V., Tezikov Y.V., Lipatov I.S., Aravina O.R., Tezikova T.A., Mikheeva E.M., Konovalova Y.I.
Abstract

In modern obstetrics, an abnormal placental invasion is a serious problem associated with the following high perinatal losses: massive obstetric bleeding that leads to the death of both the mother and the fetus.

Objective. The purpose of the study was to analyze the methods of delivery in patients with placenta accreta.

Materials and methods. The study group consisted of 31 patients aged 25 to 42 years with placenta ingrowth, who underwent metroplasty in the Perinatal Center of V. D. Seredavin Samara Regional Clinical Hospital in the period from May 2018 to December 2019. Most often, placental ingrowth was detected in the second trimester of pregnancy (41.94 %). In 5 cases, placental ingrowth was diagnosed in the operating room (16.3 %). On average, the time of detection of ingrowth is 24.96 weeks of gestation.

Results. Out of 31 patients we observed, 27 underwent metroplasty using complex compression hemostasis, and 1 patient underwent temporary balloon occlusion of the internal iliac arteries. The total volume of blood loss was 1625 ± 485 ml, and the median was 1455 ml. Only 5 (17.24 %) patients had a blood loss of more than 2000 ml, and there was no blood loss of more than 3000 ml.

Conclusions. Introduction of organ-preserving operations allows maintaining a woman's reproductive health, avoiding massive blood loss, and improving perinatal outcomes. Patients with a scar on the uterus after cesarean section, with placentation on the anterior wall and in the area of the scar on the uterus should be immediately sent to the third level of rendering specialized medical care.

Perm Medical Journal. 2020;37(3):84-96
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Preventive and social medicine
Role of air ambulance in evacuation of pregnant women from arctic regions of the republic of Sakha (Yakutia): efficieny indices
Burtseva T.E., Gogolev N.M., Sotnikov V.A., Douglas N.I., Ushnitskaya E.K., Borisova E.A., Bulshy I.S.
Abstract

Цель. Анализ деятельности работы санитарной авиации по оказанию медицинской помощи беременным в Республике Саха (Якутия).

Материалы и методы. Представлен анализ работы санитарной авиации по эвакуации и оказанию неотложной и экстренной медицинской помощи беременным по отчетным данным Республиканского центра медицины катастроф за 2014–2019 гг.

Результаты. За период 2014–2019 гг. эвакуация беременных санитарной авиацией занимает ежегодно 3-е место среди всех вызовов. Около 30 % вызовов обслуживается санитарной авиацией из арктических районов Республики Саха (Якутия). Эффективность данной работы в арктических районах неоспорима: за последние годы значительно снижена младенческая смертность и не допущено случаев материнской смертности.

Выводы. Маршрутизация и эвакуация беременных из арктических районов Республики Саха (Якутия) привела к значительному снижению младенческой смертности и отсутствию случаев материнской смертности.

Perm Medical Journal. 2020;37(3):97-102
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Prevention of scoliotic spinal deformity in children with mild neuro-orthopedic pathology
Schekolova N.B., Ladeischikov V.M., Nenakhova Y.V., Likhacheva L.V.
Abstract

Objective. To describe in details the prevention of scoliotic spinal deformity in children with mild neuro-orthopedic pathology.

Materials and methods. The health status of 125 children aged 3 to 15 years was studied. To investigate in details the neuro-orthopedic pathology and estimate the efficiency of treatment, the method of computed optic topography and electroneuromyography was used.

Results. Clinical and functional features in children with mild neuro-orthopedic disorders were characterized by the combination of vegetative, topographic and electromyographic changes. Scoliosis and spinal deformity progressed in children, who were not treated. Computer-topographic method of diagnosis determines the degree of severity of spinal state. Electroneuromyographic study is the method that permits to assess and predict the muscular dysfunction degree. All the children had conservative complex treatment at ambulatory-polyclinic rehabilitation institutions. The total efficiency of treatment was 95 %.

Conclusions. 1. Mild neuro-orthopedic pathology is formed and progresses against the background of neuro-muscular and vegetative disorders while a child is growing and developing. 2. Computed optic topography is a reliable early diagnostic and prognostic criterion for estimation of scoliosis in the therapeutic program. 3. Purposeful conservative treatment and follow-up of children and adolescents prevent the progression of neuro-orthopedic pathology.

Perm Medical Journal. 2020;37(3):103-109
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Anniversaries and information on events
Military pages of history: department of pathological anatomy of Molotov medical institute during the Great Patriotic War of 1941–1945 – to the 75th anniversary of victory devoted*
Friend G.G., Ponomareva T.B., Shilova F.A.
Abstract

The history of the Department of Pathological Anatomy of Molotov Medical Institute during the Great Patriotic War of 1941–1945 is presented. The working conditions of the department, the formation of pathological anatomy service in Perm and region, the active work of the department in training personnel for pathology departments, the creation of the society of pathologists, the scientific work of the department are shown.

Perm Medical Journal. 2020;37(3):110-117
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