Vol 7, No 3 (2016)

Articles
GRAFT LIGAMENTIZATION OF ANTERIOR CRUCIATE LIGAMENT
Akhpashev A.A., Dzhambinova E.A., Zvezdkina E.A., Kanaev A.S., Tkalin A.N.

Abstract

The article presents an analysis of surgical treatment results of 71 patients, operated on for rupture of the anterior cruciate ligament (ACL) in the department of traumatology and orthopedics FSСС FMBA of Russia in 2013-2016. All patients underwent primary arthroscopic ACL reconstruction with autograft from tendons gracilis and semitendinosus. We assessed the condition of the operated knee joint on MRI after 3 - 6 - 12 - 24 months after surgery. Based on the criteria of MR studies, we concluded that the non-uniform diffuse change of MR signal from the graft on T2, PD FS can be traced in the first 2 years after surgery, reflecting process of ligamentization. In the first three months we also observed an increase in the diameter of the graft, which further regressed. Process of ligamentization ends within two years after the operation, whereby the signal from the MR-graft should be similar to the native ACL.
Journal of Clinical Practice. 2016;7(3):3-7
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PECULIARITIES OF STRUCTURAL-FUNCTIONAL STATE OF THE KIDNEYS ACCORDING ELASTOGRAPHY SHEARWAVE IN CHILDREN WITH ARTERIAL HYPERTENSION ON THE BACKGROUND OF OBESITY
Borsukov A.V., Bekezin V.V., Kozlova E.U., Zuy V.S.

Abstract

Introduction. Metabolic and hemodynamic consequences of obesity (insulin resistance and hyperglycemia, hypertension, dyslipidemia) rofm metabolic syndrome in adolescence and an accordingly high risk of cardiovascular morbidity and mortality in adulthood. In recent years, studies have shown that obesity and metabolic syndrome are independent risk factors for chronic kidney disease (CKD). Ultrasonography is the most commonly used noninvasive method for research of the kidneys in pediatric patients.Aim of the study: to assess new features of shear wave elastography for the diagnosis of structural-functional state of the kidneys in children with arterial hypertension and obesity. Materials and methods. Ultrasound examination of kidneys was performed using a digital portable ultrasound system ANGIODIN - sono / P - Ultra (NPF “BIOS” Russia). Was examined 83 children who underwent elastography shear wave parenchymal layer of the kidney definition of renal parenchymal stiffness in kPa.Results. In patients with arterial hypertension and obesity the results of elastography, shear waves we found significant differences in the elasticity of the renal parenchyma between those with arterial hypertension (group 1, n=37) and children with uncomplicated obesity (group 2, n=26). The elasticity of the renal parenchyma in patients of the control group (n=20) was significantly lower than in patients of the 1st and 2nd groups. The results show that in children of the 1st group with stable hypertension high values of the elasticity of the renal parenchyma were detected in 3,2 times more often in comparison with children of the 1st group were diagnosed with labile hypertension. Conclusion. The shear wave elastography is an informative noninvasive method of evaluation of the kidneys in children with arterial hypertension with obesity. This diagnostic approach can be used in pediatric patients as a screening method (before ABPM) to assess the risk of developing hypertension, degree of hypertension and the adequacy of current anti-hypertensive therapy.
Journal of Clinical Practice. 2016;7(3):8-15
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ZENKER’S DIVERTICULUM: MODERN APPROACHES TO SURGICAL TREATMENT
Ivanov Y.V., Sazonov D.V., Panchenkov D.N., Shablovsky O.R., Istomin N.P.

Abstract

The study is devoted to the peculiarities of surgical treatment of Zenker diverticulum. For convenience and for safety we propose the use of intraoperative video endoscopic transillumination of the diverticulum. The method significantly increases the safety of operation, shortens its duration and results to a better cosmetic effect. To avoid relapse, diverticulectomy should be supplemented by cricopharyngeal myotomy.
Journal of Clinical Practice. 2016;7(3):17-23
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TECHNICAL DETAILS AND RESULTS OF CRYOABLATION IN PANCREATIC CANCER
Ionkin D.A., Stepanova Y.A., Shurakova A.B., Chzhao A.V.

Abstract

Aim: To improve the results of treatment of terminal stage pancreatic cancer. Materials and methods. Since 2012 cryosurgery was performed in 45 patients - 20 men (44.4%) and 25 women (55.6%) with pancreatic cancer. With mean age of 59 ± 3 years. The head of the pancreas was struck in 20 (44.4%) cases, a head-body - in 13 (28.9%), the body - in 12 (26.7%). The following distribution of patients depending on pacreatic cancer stages were noted: stage IV- 34 patients, stage III- 11. In 8 patients with pancreatic cancer and liver metastases simultaneous cryodestruction of tumorsof the pancreas and liver malformations were performed. Local cryodestruction has been supplemented by bypass in 29 cases (64.4%). In one case, cryosurgery was performed on segment of the portal vein after the pankreatoduoenal resection. All patients subsequently were underwent adjuvant chemotherapy, supplemented by regional chemoembolization in 10 cases.Results. We proposed indications and contraindications for cryoablation. Intraperitoneal bleeding was diagnosed in 2 (4.4%) cases. Acute pancreatitis - in 5 (11.1%) cases. Suppuration manipulation area was noted in 2 (4.4%) cases. Ascites was detected in 9 (20.0%) patients (docked within 5-8 days therapeutically). Wound supporation was observed in 2 (4.4%) cases. Complete pain relief atchieved after cryoablation was reached in 38% of cases or significant reduction of its intensity in 41%. Kaplan-Meier survival in patients with pancreatic cancer for 6 months was 56%, for 12 months - 28%, for 24 months -15% and for 28 months - 4.3%.Conclusion. Сryodestruction for cancer of the pancreas in patients with unrespectable tumors improves the quality of life of cancer patients, primarily due to decrease pain intensity. Application of chemotherapy improves quality of life and can prolong survival rates.
Journal of Clinical Practice. 2016;7(3):24-35
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ASSESSMENT OF AGE-RELATED CHANGES OF MYOCARDIAL CONTRACTILITY OF THE LEFT VENTRICULAR BY SPECKLE-TRACKING ECHOCARDIOGRAPHY AND DETERMINING THEIR RELATIONSHIP WITH TELOMERE LENGTH
Plokhova E.V., Akasheva D.U., Tkacheva O.N., Strazhesko I.D., Dudinskaya E.N., Kruglikova A.S., Pykhtina V.S., Streltsova V.I., Boitsov S.A.

Abstract

Purpose: The aim of this cross-sectional study was to explore a profile of left ventricular (LV) strain parameters in healthy older and to examine their association with telomere length - accepted marker of cellular senescence.Methods: Echocardiography and 2-D speckle tracking analysis was performed on 303 healthy volunteers aged 23 to 91 years without history of cardiovascular diseases (CVD). LV myocardial deformations were obtained using off-line analysis program QLAB (Philips). Telomere length was measured in peripheralblood mononuclear cells by a real-time quantitative polymerase chain reaction method.Results: Global longitudinal LV strain was reduced in older people without CVD. Radial strain of LV, apical and basal rotation, LV systolic twist were increased (p<0,001). There are no association with circulation LV strain. Telomere length was not associated with the longitudinal LV strain (β=-0.117, p=0.5). However, a significant relation was obtained with LV twist (β=-0.518, p=0.03). Short telomeres enhances the risk of increasing LV twist in 2 times (χ2=3,99, p=0,05; OR=1,96; 95% CI 1,01-3,79).Conclusion: Longitudinal strain decreases in older people. Radial strain and LV twist increases with aging. These changes indicate the age-related disorders of myocardial contractility and may be considered as a markers of biological age of heart. Increase in LV twist is significantly associates with telomere length, allowing use these parameters as markers of biological age. Cellular senescence has an independent contribution to the age-associated changes in the contractile function of the LV myocardium.
Journal of Clinical Practice. 2016;7(3):36-45
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ON-PUMP BEATING HEART MYOCARDIAL REVASCULARIZATION FOR HIGH RISK PATIENTS
Zotov A.S., Klypa T.V., Borisov D.V., Ilyin M.V.

Abstract

107 patients with mean ejection fraction 40,6±7,4% underwent on-pump-beating heart coronary revascularization and associated procedures. There were 76 men and 31 women, with a mean age of 68,9±7,8 years. Five patients required carotid endarterectomy and twelve patients required left ventricular aneurysm repair. 5 patients underwent carotid endarterectomy and 12 patients - left ventricular aneurysm repair. The mean number of graft/patient was 2,9±0,8. Postoperatively occurred the following complications: acute ischemic stroke - 1 (0.9%), acute heart failure - 1 (0.9%), respiratory failure - 2 (1.9%) and bleeding required surgical revision - 1 (0.9%). Hospital mortality rate was 0,9% (1 of the 107 patients). On-pump beating heart technique is a safe and efficient method for coronary artery bypass grafting and associated procedures (carotid endarterectomy, left ventricular aneurysm repair).
Journal of Clinical Practice. 2016;7(3):46-52
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STUDY OF THE PLATELET-RICH PLASMA CLINICAL EFFICACY IN THE TREATMENT OF KNEE OSTEOARTHRITIS
Lazishvili G.D., Egiazaryan К.A., Akhpashev A.A., Danilov M.A., Strakhov M.A., Gaev T.G.

Abstract

The study of platelet-rich plasma efficacy in the treatment of patients with knee osteoarthritis (OA) was performed. 188 patients were included and divided into three groups. Group 1 - 82 patients with OA, where hyaluronic acid was used for treatment, Group 2 - 36 patients, and Platelet Rich Plasma (PRP) and hyaluronic acid were used, Group 3 - 70 patients, only PRP was used. It`s been found that the use of PRP for treatment is characterized by a pronounced clinical efficacy compared with use of hyaluronic acid, which manifests in reduced detection rate of edema, hyperthermia and hyperemia. The use of PRP leads to pain reduction in the knee joint and increase the functionality of patients, that confirmed by more pronounced declining of visual analog scale indicators, Leken index and the WOMAC index values increase. The presented results of study are consistent with authors who believe that the lack of side effects and complications when using PRP indicates the safety of its use in clinical practice.
Journal of Clinical Practice. 2016;7(3):54-60
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VASCULAR WALL CONDITION, GUT MICROBIOTA COMPOSITION, AND DIET IN PATIENTS WITHOUTCARDIOVASCULAR DISEASES
Kashtanova D.A., Tkacheva O.N., Egshatyan L.V., Plokhova E.V., Popenko A.S., Tyakht A.V., Alexeev D.G., Kotovskaya Y.V., Boytsov S.А.

Abstract

Purpose of the study. To study the relationship between the gut microbiota composition, the state of the vascular wall and nutrient intake in patients without clinical manifestation of cardiovascular disease.Materials and methods. The study included 92 residents from Moscow and the Moscow region, men and women aged 25 to 76 y.o., without clinical manifestations of chronic diseases, with no medical treatment but with possible presence of cardiovascular risk factors. All the participants were examined with duplex scanning of the carotid arteries with the definition of the thickness of the intima-media complex (IMC), the presence of atherosclerotic plaques, measuring carotid-femoral pulse wave velocity (PWV), the measurement of interleukin-6 (IL-6) and C-reactive protein (C-RP) and sequencing of the V3-V4 variable regions of 16S rRNA genes of the gut microbiota.Diet was studied by quantitative assessment of consumer products using a standardized computer program «Analysis of Human Nutrition states» (version 1.2.4 Research Institute of Nutrition 2003-2006).Results. The study revealed that in the investigated cohort IMC thickness was greater in those with a large number of bacterial genera Serratia and Blautia. Bifidobacterium representation was increased and Blautia representation was decreased in those who consumed a lot of starch.Conclusion. The composition of the gut microbiota is associated with both vascular wall stiffness and atherosclerosis. In addition, the bacteria associated with subclinical atherosclerosis were more represented among those who consumed smaller amounts of complex carbohydrates.
Journal of Clinical Practice. 2016;7(3):62-72
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FROM IDIOPATHIC FIBROSING ALVEOLITIS TO IDIOPATIC LUNGS FIBROSIS
Averyanov A.V.

Abstract

In this paper we try to present the current state of knowledge of the diagnosis and treatment of idiopathic pulmonary fibrosis (IPF), and to express our view on the problems and their solution, without which it is very difficult to improve the quality of medical care for IPF-patients in Russia.
Journal of Clinical Practice. 2016;7(3):73-76
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THE ORGANIZATION OF TUBERCULOSIS CHEMOPREVENTION OF HIV INFECTED PEOPLE IN MODERN CONDITIONS
Sinitsyn M.V., Ausheeva L.B., Bogorodskaya E.M.

Abstract

In connection with the growing number of patients with combined HIV/ TB infection the legal framework and organization of treatment for such cases need some modernization. We investigated the legal documents regulating the provision of TB care in the Russian Federation, and medical care for HIV-infected persons. The results have shown that there is no comprehensive program for the reception, inspection and simultaneous antiretroviral therapy, tuberculosis chemoprevention and timely tracking the development of unwanted side reactions in patients with combined HIV/ TB infection. Therefore, for effective work on the prevention and early detection of tuberculosis the integration of TB and AIDS Service Center is required. Chemoprevention schemes, including optimally two medicines in complex, especially if patients on antiretroviral therapy, are also considered.
Journal of Clinical Practice. 2016;7(3):78-83
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THE MODERN PROGRAMS OF COMPLEX EXAMINATION (CHECK-UP)
Motrich O.G.

Abstract

In June 2015, in Federal research and clinical centre of FMBA of Russia was organized a new division: Check-up Clinic (complex diagnostic centre) the goal of which was to provide full medical examination in a short time and in a comfortable environment. About the specific features and future plans - our intervew with Head of Check-up Clinic.
Journal of Clinical Practice. 2016;7(3):85-86
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