Vol 8, No 2 (2017)

Articles
SERUM OSTEOPONTIN LEVEL IS ASSOCIATED WITH PRESENCE OF ATRIAL FIBRILLATION IN CALCIFIC AORTIC VALVE STENOSIS
Tipteva T.A., Chumakova O.S., Reznichenko N.E., Safaryan V.I., Baklanova T.N., Voloshina N.M., Zateyshchikov D.A.
Abstract
Identification of risk factors associated with presence of atrial fibrillation (AF) in patients with aortic valve stenosis (AS) remains to be unraveled.The aim of the study was to investigate relationship between profibrotic biomarkers and presence of AF in AS patientsMethods. 191 patients (29,8% male, 77,7±0,59 years) with AS (defined as aortic valve area (AVA) ≤ 2,0 sm2) were enrolled in the study. Clinical, echocardiographic and biochemical variables, including serum TGFβ1 and osteopontin levels were compared between 2 groups of patients: with and without AF. Results. 83(36,5%) of AS patients had AF. In logistic regression models independent associations between AVA index (p=0,040), left atrial volume (p=0,021), OPN (р=0,009) and presence of AF were found. Patients with serum OPN level > 10,05 ng/ml had twice more higher AF incidence comparedto patients with serum OPN level ≤ 10,05 ng/ml (53,8% and 29,2%, respectively, p=0,020).Conclusion. Serum OPN level was independently associated with presence of AF in AS patients, thus we speculate on it’s predominant profibrotic role in the left atrium.
Journal of Clinical Practice. 2017;8(2):3-13
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THE RELATIONSHIP OF KIDNEY FUNCTION WITH ARTERIAL WALL CONDITION IN INDIVIDUALS WITHOUT CHRONIC KIDNEY DISEASE AND CARDIOVASCULAR DISEASES
Pykhtina V.S., Strazhesko I.D., Tkacheva O.N., Sharashkina N.V., Vygodin V.A., Plokhova E.V., Boytsov S.A.
Abstract
Background: Chronic kidney disease (CKD) is a known risk factor for cardiovascular disease (CVD). However, there is a small information about increased risk of CVD already with a slight decrease in kidney function. Substrate for CVD development is subclinical changes in the arterial wall, which can be accelerated by known risk factorsHypothesis: We have assumed that even an initial impairment of kidney function were capable of adversely affecting on the arterial wall.Objective: To examine the association of kidney function with the condition of the arterial wall in persons without CKD and CVD in different age groups.Materials and methods: The study group included 253 subjects free of known CVD and CKD. The average age of the subjects was 51.5 ± 13.3 g. There were 172 women and 81 men. The group of conditionally “older” (women> 55 years, men> 45 years) was 117 people, conditionally “younger” (women ≤ 55 years, men ≤ 45 years) - 136. 55 subjects had arterial hypertension 1-2 st. All subjects had a glomerular filtration rate (GFR) ≥60 ml / min / 1.73 m2, albuminuria <30 mg /24h. When assessing the condition of the arterial wall, the pulse wave velocity (PWV)> 10 m / s had 93 people, the complex intima-media thickness (CIMT)> 0.9 mm had 42 people, the presence of atherosclerotic plaques (AP) had 106 people, and a decrease in endothelium-dependent vasodilation (EDVD) <10% in 86 people. An elevated urea level> 8.3 mmol / l in the blood was detected in 10 people. Determination of creatinine, urea in the blood serum was carried out by routine methods. Measurement of PWV with the help of applanation tonometry. Measurement of CIMT and determination of AP was carried out by means of duplex scanning of carotid arteries. Measurement of EDVD - using a test with reactive hyperemia.Results: Statistical analysis of the results of this study was carried out using the SAS application statistical software package (StatisticalAnalysisSystem, SAS InstituteInc., USA). In the course of multivariate linear regression analysis, a statistically significant independent association of the urea level with CIMT (β = 0.023, p = 0.023) was detected in the “older” group taking into account the correction for sex, systolic blood pressure level, smoking, body mass index, fasting glucose level and albuminuria. Independent relationships of levels of GFR, creatinine and albuminuria with parameters of the vascular wall were not revealed.Conclusions: The level of urea had a direct independent relationship with CIMT in the older age group, which is more likely due to the ability of urea to enhance oxidative stress. Interrelations of the level of GFR, albuminuria, creatinine with the condition of the arterial wall were not obtained in the study group
Journal of Clinical Practice. 2017;8(2):14-21
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CLINICAL ASPECTS OF SLEEP DISORDERS IN PATIENTS WITH PARKINSON’S DISEASE
Andrienko O.A.
Abstract
According to the scientific literature of sleep disturbance in patients with Parkinson’s disease meet from 51 to 85 %. In this study, PD patients with sleep disturbances were found in 50.1% (348 of 694 patients) were included in the registry (it surveyed patients with PD, aged from 21 to 90 years with different stages of BP living in different cities and districts of the Rostov region), noted sleep disorders during the disease, as well as to verify the diagnosis of PD. In the future, EEG-somnography were selected 48 patients with BP stage 2 on the Hoehn-Yahr, aged 52 to 71 years, and 50 healthy volunteers aged 49 to 67 years. It is established that in patients with PD stage of sleep you go faster - less time awake, and time of stage 1 non-REM sleep and the stage of paradoxical sleep (PS) in comparison with healthy volunteers. Chronic dyssomnia may occur due to ingestion of antiparkinson medications. Sleep duration decreases, but the psychological need remains the same. Structural changes are observed in sleep are significantly reduced slow-wave stage of sleep, some to a lesser extent, REM-phase and total sleep time.
Journal of Clinical Practice. 2017;8(2):22-27
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INNOVATIVE APPROACHES TO REHABILITATION OF PATIENTS AFTER ISCHEMIC HEMISPHERIC STROkE
Ekusheva E.V., Kiparisova E.S., Shirshova E.V.
Abstract
Our aim was to study efficacy of pathogenetically substantiated rehabilitation of sensorimotor disorders in patients after ischemic stroke. Methods. A total of 119 patients were studied all with hemiparesis following ishemic stroke. There were 35 controls. All patients underwent rehabilitation which included robotized mechanotherapy, stabilography, neuro-muscular stimulation, physical therapy, ergotherapy, massage etc. Before and after the rehabilitation therapy TMS and SSEP parameters were evaluated in all patients. Results. Rehabilitation with the use of a personified, pathogenetically grounded approach contributed to a better recovery of the neurological deficit. In those patients who received personalized therapy significant changes of TMS parameters (central motor conduction time at rest and in facilitation probe), but not SSEP ones were registered. Conclusions. The effectiveness of the pathogenetically substantiated rehabilitation of patients after ischemic stroke was demonstrated. Were demonstrated more effective in restorative treatment of motor deficits. Somatosensory functions were restored worse, which implies the identification and takes into the account of the sensory deficit, as well as neurophysiological monitoring of the recovery process with the use of TMS and SSEP to improve the effectiveness of ongoing rehabilitation in this category of patients.
Journal of Clinical Practice. 2017;8(2):28-33
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EFFICIENCY AND SAFETY OF RADIOFREQUENCY CATHETER ABLATION OF ATRIAL FIBRILLATION IN ELDERLY PATIENTS
Fedorova M.H., Chapurnykh A.V., Nizhnichenko V.B., Lakomkin S.V., Doshicin V.L.
Abstract
Atrial fibrillation is one of the most frequent and significant rhythm disturbances. The effectiveness and expediency of using one of the most effective methods of treatment of this arrhythmia (radiofrequency ablation in elderly patients) remains a controversial and insufficiently studied issue. The article compares the results of the treatment of 63 patients of mature age (up to 75 years) and senile age (from 75 years). Patients underwent 78 operations of radiofrequency catheter ablation of atrial fibrillation and atypical atrial flutter, which was resistant to drug therapy. In the groups of patients of mature and senile age, there were no statistically significant differences in the effectiveness of treatment. In elderly people group, a higher incidence of complications was found mainly due to hydrothorax, but these complications did not increase the risk of death and were stopped during treatment. This allows to conclude that the senile age of patients should not be the reason for refusing to conduct radiofrequency catheter ablation.
Journal of Clinical Practice. 2017;8(2):34-41
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FEATURES OF SENSORIMOTOR DISTURBANCES IN DIFFERENT PERIODS AFTER ISCHEMIC STROKE
Ekusheva E.V., Kiparisova E.S., Shirshova E.V.
Abstract
The aim of the study was to investigate the clinical and neurophysiological features of sensorimotor disturbances in patients at different time periods after ischemic stroke. Methods. The study involved 133 patients with ischemic stroke in the right and left cerebral hemispheres in the late recovery (58) and residual (75) periods. There were 35 controls. Were performed transcranial magnetic stimulation, evoked abdominal reflexes and somatosensory evoked potentials. Results. It was shown that functional recovery processes are continuing with varying degrees of severity in patients and in a year after stroke. Conclusions. Persistence and severity of sensorimotor disturbances, as well as compensatory opportunities, defined afferent component of poststroke deficit, which implies an additional impact in this area to expand the possibilities of neurorehabilitation in patients after stroke.
Journal of Clinical Practice. 2017;8(2):42-48
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CERVICAL SPINE INSOLVENT FIXATION IN THE CASES OF ITS TRAUMAS AND DISEASES
Grin A.A., Kasatkin D.S.
Abstract
The work represents the analysis of surgery treatment of 552 patients with traumas and degenerative diseases of cervical spine subaks level (CSSL) who were treated in Scientific Research Insnitute of Emergency Care n.a. N.V. Sklifosofsky neurosurgery department since 01.01.2001 to 31.12.2013 and who underwent 554 surgeries. 19 (3.4%) patients had complications connected with the incorrect installation of a stabilizing system and insolvent fixation of a spine. 5 other patients were moved from other hospitals with instrumental confirmed dislocation of ventral plate fragments and damages of the esophagus. The aim of this work is to define risk factors, frequency and causes of complications connected with unsatisfactory fixation of CSSL of patients with trauma and degenerative diseases of cervical spine subaks level.
Journal of Clinical Practice. 2017;8(2):49-55
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COMPLICATIONS OF CERVICAL SPINE SURGERY. RISK FACTORS AND PREVENTIVE STRATEGIES
Grin A.A., Kasatkin D.S.
Abstract
According to numerous studies, the percentage of complications after operations on the cervical spine is up to 27.0%, the number of patients requiring re-intervention - to 10.7%. Postoperative mortality is 0.26% [1-10]. The identification and study of the effect of the most important risk factors and their combinations on the frequency and severity of postoperative complications, an analysis of the causes of errors made during surgery or at the stage of planning, and the formation of a unified approach to solving the problem of timely diagnosis, treatment and prevention will reduce the number of complications and improve the quality of surgical treatment of patients with diseases and trauma of the cervical spine on subaxial level.
Journal of Clinical Practice. 2017;8(2):56-60
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PARTICULARITIES IN TREATMENT OF ESOPHAGEAL PERFORATION AFTER CERVICAL SPINE FUSION EXPERIENCE OF TREATMENT OF 24 PATIENTS
Pogodina A.N., Green A.A., Kasatkin D.S., Kaikov A.K., Lvov A.S., Kordonskii A.U., Shibaev E.Y.
Abstract
The aim of the study is to specify the causes, peculiarities of the damage and the tactics of treating patients with clinically significant damages to the esophagus after the anterior cervical fusion or in combination with it.Material and methods: medical treatment of 24 patients in Sklifosovsky Emergency Research Institute with the damage to the esophagus after the front access surgery of the cervical spine during the period of 2003-2016 was analyzed.Results: we succeeded to restore or save the support ability of the spine for all patients and at the same time to take away the infected transplants, and, if necessary, to make adequate decompression of neurovascular entities of the spine column and fixation of the verbal-motor segment. 21 patients underwent conserving surgery in the cervical esophagus with its suturing with the double-row suture. 2 patients had failure of seams in the esophagus and they underwent a repeated surgery of suturing its defect. 2 patients underwent organodetrital surgeries. One patient died. Conclusion: damages to the esophagus after anterior cervical fusion or in combination with it are rare complications. That is why it is impossible to gain much experience in treating of such patients in only one clinic. In this case all publications on this topic are of great interest. Due to unsatisfactory results of the conservative therapy we should consider surgical treatment in general hospitals with the participation of a multidisciplinary brigade the golden standard.
Journal of Clinical Practice. 2017;8(2):61-71
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EXPERIENCE OF REHABILITATION THE ATHLETES AFTER SURGICAL INTERVENTION ON THE ACHILLES TENDON
Belyakova A.M., Sereda A.P., Samoilov A.S.
Abstract
Achilles tendon injury frequency increases. The lack of standardized methods of rehabilitation after surgery on the Achilles tendon leading to increased risk of repeat injury tendon and reduces the possibility return to physical activity. Recovery of function the main task of rehabilitation programs, especially when working with athletes. We have a program of rehabilitation of 147 patients was per- formed after surgery on the Achilles tendon, which began from the first day after the operation and was as much as possible early onset of axial load.
Journal of Clinical Practice. 2017;8(2):72-80
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MODERN APPROACHES FOR SURgICAL TREATMENT OF PATIENTS WITH ABDOMINAL HERNIAS
Terekhin A.A.
Abstract
Операция по поводу грыжи живота является распространенной в хирургической практике. Результаты плановых операций намного лучше операций выполняемых при ущемлении. Увеличение числа плановых оперативных вмешательств ведет к уменьшению экстренных, что положительно влияет на результаты, поэтому своевременная операция является залогом успешного лечения пациента с грыжей.С развитием технологий хирургия и ее сложный раздел герниология - учение о грыжах делают огромные скачки в своем развитии. Еще каких-то десять - двадцать лет назад среди хирургов обсуждался вопрос, как оперировать грыжу - с сеткой или без сетки. Сегодня круг вопросов значительно расширился, какой способ операции предпочтительный у пациента с данным видом грыжи - открытый или лапароскопический, какая их модификация, какой трансплантат выбрать. В настоящее время предъявляются очень высокие требования к качеству операций по поводу грыж, поэтому от хирурга требуется отдельная специализация в этой области хирургии. Сегодня мы обратились к эксперту - врачу-хирургу Федерального научно-клинического центра ФМБА России к.м.н. Терехину А.А.
Journal of Clinical Practice. 2017;8(2):81-82
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