Vol 35, No 3 (2018)

Aim. To carry out the qualitative analysis of metal implant, inserted into the bone, determine tactics for treatment of inflammatory process in the postoperative period of metallosteosynthesis.

Materials and methods. The treatment of 1325 patients with the developing posttraumatic osteomyelitis of the upper and lower extremities in the Department of Complicated Traumatology of City Clinical Hospital № 6 and traumatology departments of Perm for 10 years (2004–2014) was analyzed.

Results. Metallosis was observed in 227 (17.2 %) persons. Matallosis was manifested by suppuration and fistula formation in the region of screw 2–3 months after operative treatment of fracture in 177 (76.3 %) patients, and in 50 (27.7 %) patients – by acute purulent inflammatory process immediately after the surgery. In 34 (15 %) patients, computed tomography and MRI demonstrated metal bone impregnations. All these 227 (17.2 %) patients underwent elimination of metal constructions. The postoperative wounds after elimination of metal constructions healed primarily in 152 (66 %) patients. Secondary healing of the postoperative wounds was noted in 75 (44 %) persons. The long-term results were studied during 3 years in 189 (83 %) patients. The development of the postoperative osteomyelitic process, connected with late removal of metal construction, was registered in 8 (4.4 %) persons. False joint was formed in 1 (0.5 %) patient with tibial fracture. Positive long-term result was reached in 180 (95.2 %) persons.

Conclusions. Timely diagnosis, correctly chosen technique of treatment permit to provide full restoration of the structure and function, and obtain positive medical and social rehabilitation in this category of patients.

Aim. To estimate the opportunities of proton density-weighed magnetic resonance tomograms in diagnosis of microstructural changes of articular cartilage (AC) in osteoarthritis (OA) on the basis of proton density (PD) variability analyzed.

Materials and methods. Sixty two patients with OA and 8 volunteers without OA were examined. All the patients underwent MRI of the knee joints, using tomograph with magnetic field intensity equal to 1.5 tesla. To assess MR images, semiquantitative measurements of articular tissues on the basis of WORMS protocols were used. To estimate the proton density, manual segmentation of PDFS-weighed images of the knee joint medial condyle was implemented. The proton density was estimated, applying 3-D histogram (0–255).

Results. At stage I of osteoarthritis, fall in density H⁺ in the peripheral zone of AC was observed, but it was preserved in the contact part, exposed to maximum statodynamic loadings. At stage II, significant progressing decrease in H⁺ density peaks in the AC regions, subjected to lesser loads, with preservation of high spectral peaks in the region of elevated friction was stated. Stage III of gonarthrosis was characterized by decrease in H⁺-spectra as a whole, especially in the loading regions of AC. At stage IV of OA, global reduction in PD intensity was observed along the whole cartilaginous plate surface.

Conclusions. The detected patterns of changes in proton density spectra reflect the known degenerative process in AC with osteoarthritis. This property of proton-weight MR-images can be used for assessment of microstructural changes in the articular cartilage with OA.

Aim. To improve the reparative tissue regeneration, applying oxymethyluracil in surgical patients.

Materials and methods. The impact of 5-oxymethyluracil-2,4-dioxo-5-hydroxy-6-methyl-1,2,3,4-tetrahydropirimidine (5-OMU) on the processes of regeneration stimulation in the tissues was studied in 4 groups, including different organs and systems of the body. The analysis of the results of using 5-OMU for torpid wounds in general surgery included 145 patients, erosive-ulcerous lesion of the upper parts of gastrointestinal tract – 126, reparative surgeries on GIT – 105 and revasculizing interventions on the heart – 63. To develop experimental models, mature rats, aged 11–12 months, with the body mass 2.9 ± 1.7 kg were used. Two sets of experiments with cut and burn wounds were implemented.

Results. The experimental studies, aimed at investigation of histological and histochemical preparations, demonstrated positive influence of oxymethyluracil on the healing of skin wounds.

Conclusions. On the basis of the studies carried out, the preparation is also recommended for use in other fields of surgery for the treatment of erosive-ulcerous lesions of the upper part of gastrointestinal tract, for intestinal anastomoses and when performing revasculizing surgeries on the heart. Different drug forms of this preparation were developed to reach its maximum concentration in the tissues, clinical trials were conducted and its efficient use in clinical practice was confirmed.

Aim. To study the dynamics of lung cancer (LC) morbidity among the population of five cities of the Republic of Bashkortostan over the period from 2010 to 2016 and the structure of industrial emissions for grounding of adequate integral index, connected with LC morbidity and development of preventive measures to decrease malignant neoplasms.

Materials and methods. The structure of gross emissions of industrial enterprises and ecologohygienic assessment of atmospheric air was conducted according to the materials of the Department of Rospotrebnadzor in Bashkortostan for 2010–2016. Lung cancer morbidity in the above mentioned territories was studied by the materials of Republican Clinical Oncological Dispensary. To estimate the influence of gross emissions on LC morbidity, modeling technique, adequate to panel analysis of spatially dynamic structural data, was applied.

Results. The assessment of carcinogenic risk of atmospheric air emissions, taking into account not separate carcinogens, but their combined effect as substances with similarly directed impact, detected accurate correlation of dependence of high LC morbidity on the resultant carcinogens action.

Conclusions. High LC morbidity in the cities of Bashkortostan is connected with high gross emission of carcinogens into the atmospheric air. Information on gross emissions of carcinogens and their structure can serve as an integral criterion of atmospheric pollution impact on lung cancer morbidity.

Aim. To estimate the dynamics of the main demographic indices (population, gender and age composition of population, number of born and dead, natural population increase (loss), migration growth of population) in Perm and Perm Krai (PK) over the period of 1990–2016.

Materials and methods. The data, presented by the department of population census and demographic statistics of Territorial Board of the Federal Service for State Statistics in PK (Permstat) were analyzed.

Results. In Perm Krai – in 2013 and in Perm – in 2012, there was registered increase in the population, confirming the end of depopulation period, observed since the nineties of the XX century. The analyzed period is characterized by growth in birth rate and fall in death rate in Perm and Perm Krai. However, the natural population increase remains insignificant. The detailed characteristic of gender and age structure is presented in the paper; it permits to assess the reproductive potential of the region.

Conclusions. The detected tendencies make it possible to determine the strategic directions for improvement of medicodemographic situation in Perm Krai.

Aim. To establish the structural changes in the prostate of reproductive experimental animals in conditions of long immunosuppression.

Materials and methods. Sixty white rats of reproductive age were studied. The state of immunosuppression was modeled with intramuscular introduction of cyclophosphamide in the dose of 1.5 mg/kg of the body mass during 10 days. Linear sizes and volume of the organ were determined. At the microscopic level, height and width of epithelial cells, their volume as well as large and small diameters and cell nuclei volumes were determined.

Results. In response to long immunosuppressive impact, organometric indices of the prostate both in the early (on days 7, 15) and late (on day 30) observation periods decreased owing to indirect cytotoxic impact of cyclophosphamide on the glandular and stromal components of the organ.

Conclusions. The decreased values of linear-volumetric micromorphometric indices within the same observation periods confirm the dynamics of organometric parameters of the gland and prove intensive response of the organ at micro-and-submicroscopic level.

The paper presents a case of the outcome of the left atrium myxoma of large sizes, complicated by syncopal states in an elderly woman, which was followed by myxoma removal.

The presented review gives the main stages of speleotherapy formation in West Ural, the knowledge of which is necessary for improvement of the system of professional training of physicians – experts in sanitary service.

The analysis of demographic indicators (population size, sex, age composition of the population, number of births and deaths, natural increase (decrease) in the population, migration growth of the population) in Perm and Perm Region (PR) for the period 1990 - 2016 Department of Population Censuses and Demographic Statistics of the Territorial Body of the Federal Service of State Statistics for PR (PERMSTAT).
In the Perm Region in 2013, and in Perm in 2012, an increase in the population was recorded, which indicates the end of the depopulation period that has been observed since the 1990s. XX century. The analyzed period in Perm and the PR is characterized by an increase in the birth rate and a decrease in mortality. However, the natural increase in the population remains insignificant.
The article gives a detailed description of the gender and age structure of the female population, which makes it possible to assess the reproductive potential of the region.
The revealed regularities and trends allow defining strategic directions for improving the medical and demographic situation in the Perm Region.

The article presents the clinical case of a 28-year-old female patient who was diagnosed with a noncompact myocardium of the left ventricle. The disease debuted with clinical signs of cardiac rhythm disturbance, according to long-term monitoring of electrocardiogram results a ventricular extrasystole equivalent to Lown 4b was detected. On echocardiography, a sharp decrease in the ejection fraction of the left ventricle was of particular significance .A diagnosis was made after magnetic resonance imaging of the heart, the presence of two layers of myocardium was detected: compact and noncompact layer, the latter exceeding the former in thickness greater than two times. The patient was recommended slow titration of  a dose of angiotensin-converting enzyme inhibitors up to the maximum tolerable dose under the control of blood pressure; addition  of anticoagulants on the basis of primary prevention of thromboembolic complications; elective implantation of a bi-chamber artificial cardioverter-defibrillator for the primary prevention of sudden cardiac death.

The article presents the clinical case of a 28-year-old female patient who was diagnosed with a noncompact myocardium of the left ventricle. The disease debuted with clinical signs of cardiac rhythm disturbance, according to long-term monitoring of electrocardiogram results a ventricular extrasystole equivalent to Lown 4b was detected. On echocardiography, a sharp decrease in the ejection fraction of the left ventricle was of particular significance .A diagnosis was made after magnetic resonance imaging of the heart, the presence of two layers of myocardium was detected: compact and noncompact layer, the latter exceeding the former in thickness greater than two times. The patient was recommended slow titration of  a dose of angiotensin-converting enzyme inhibitors up to the maximum tolerable dose under the control of blood pressure; addition  of anticoagulants on the basis of primary prevention of thromboembolic complications; elective implantation of a bi-chamber artificial cardioverter-defibrillator for the primary prevention of sudden cardiac death.

AIMS: to assess the effect of changes in the body in men and women with type 1 and 2 diabetes on the state of markers of bone metabolism.. Determination of the directionality of changes in serum markers of bone remodeling and bone mineral density in both sexes in this disease.

METHODS: A cross-sectional study was conducted of patients diagnosed with T1DM (n = 98) and T2DM (n = 137); control group, consisted of 82 persons. Calcitropic homons, serum markers of bone remodeling were studied in all patients.

RESULTS: the results of the evaluation of the content of markers of serum bone metabolism in patients with DM1and DM2 in comparison with the control group indicate the presence of pathological changes in the processes of bone remodeling in the form of a decrease in the bone formation marker PINP in patients with DM1 by 16%, with DM2 by 12% compared with the control and enhancement of the marker of bone resorption of b-CTx in 32% of patients with DM1 and 25% of patients with DM2; as well as inconsistency of changes in bone remodeling processes in patients with DM1, with a predominant change in bone resorption, determined in 28% of cases. Patients with DM1 had lower levels of P1NP and b-CTx, which reflects a lower bone metabolism compared to patients with DM1, regardless of age and duration of the disease.

CONCLUSIONS: the loss of bone mass in the majority of the examined patients with diabetes, is associated with the suppression of bone formation and, to a much lesser extent, of bone resorption. In this case, the values ​​of bone remodeling markers in patients with DM2 are lower than in patients with DM1. Factors such as the compensation of the glycemic profile, the duration of diabetes and the presence of diabetic nephropathy can affect bone metabolism.

The aim of the study was to establish a change in the structure of the prostate gland of experimental animals of reproductive age under conditions of prolonged immunosuppression. The study was carried out on 60 white rats of reproductive age. The state of immunosuppression was modeled using cyclophosphamide at a dosage of 1.5 mg/kg body weight intramuscularly for 10 days. The linear dimensions and volume of the organ were determined. At the microscopic level, the height and width of the epithelial cells, their volume, as well as the larger and smaller diameters and the volume of the cell nuclei were measured. In response to long-term immunosuppressive effects, the organometric parameters of the prostate are decreased both at the early (7, 15 days) and late (30 days) observations due to the direct cytotoxic effect of cyclophosphamide on the glandular-stromal components of the organ. The decrease in the values ​​of linear-volume micromorphometric parameters at the same time of observation confirms the dynamics of the organometric parameters of the gland and indicates an intensive organ response at the micro- and submicroscopic level.