Vol 2, No 1 (2011)

Articles
YuZhNYY OKRUZhNOY MEDITsINSKIY TsENTR FMBA ROSSII –PRIORITETY I PERSPEKTIVY
Krishtopin V.S.

Abstract

Journal of Clinical Practice. 2011;2(1):3-7
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CYSTIC KIDNEY DYSPLASIA IN INFANTS
Todorov S.S.

Abstract

Cystic kidney dysplasia (CKD) in infants is a rare congenital pathology, associated with connective tissue dysplasia. Three autopsy cases of CKD reveals disturbance proportions of connective, fat, chondroid tissue with dominance cells and fibers of connective tissue. Kidney cysts formation with CKD, under our opinion, is secondary process due to compression few kidney tubules by undeveloped mesenchymal tissue.
Journal of Clinical Practice. 2011;2(1):8-10
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APPLICATION OF LARYNGEAL MASK IN PATIENTS WITH ANKYLOSING SPONDILYTIS
Machno U.E., Kutsevolova N.V.

Abstract

The use of laryngeal mask (LM) instead of nasotracheal intubation is justified in patients with injuries and congenital abnormalities of the cervical spine, diseases with limited mobility of the cervical spine, such as ankylosing spondylitis (Bechterew's disease). Intubation in this group of patients is usually carried out using fibrobronchoscopy. Application of laryngeal mask in these patients requires not only haemodynamics monitoring , but also permanent monitoring of gas exchange parameters (SpO 2, ЕТCO 2) and the tightness of breathing circuit. In a clinical case of a 47old patient suffering from ankylosing spondylitis for 10 years LM with muscle relaxants and mechanical ventilation was used successfully during routine general anesthesia in his knee arthroplasty.
Journal of Clinical Practice. 2011;2(1):11-13
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A CASE OF TREATMENT OF PRIMARY HIP REPLACEMENT COMPLICATION
Chesnikov S.G., Dedyaev S.I., Timoshenko M.E., Borondzhiyan T.S.

Abstract

Authors described a case of postoperative complications after total hip replacement. Joint replacement and reconstruction of the defect at the bottom of the acetabulum allowed to recover the architecture of the joint.
Journal of Clinical Practice. 2011;2(1):14-17
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INVERSION OF ORTHOTOPIC ILEAL NEOBLADDER TO PREVENT TENSION IN ANASTOMOSIS
Perepechay V.A.

Abstract

Orthotopic ileal neobladder is the standard alternative after cystectomy, ensuring the recovery of selfurination, a full social and psychological rehabilitation of patients. From 1993 to 2010 cystectomy were performed to 209 patients, 119 (57,0%) of which underwent orthotopic bladder reconstruction in various forms: colonic plastics – 48 (40,3%) patients, intestinal plastics – 71 (59,7%) patients. In cases when short mesentery occured, a special method for bladder reconstruction was developed. The method consists in the longitudinal, not transversal crosslinking of the tank, as in the Studer orthotopic ileal neobladder, and inverting its positioning in the pelvis maximally closer to the tank wall, and overlapping tensionfree urethroreservoir anastomosis. We operated on 21 patients using this method of bladder reconstruction. All cases with insufficient length of the mesentery were compensated by the offset technique of inverting of orthotopic ileal neobladder. Cases of leak of the tank or anastomosis were not observed. Medium capacity of neobladder after removal of urethral catheter – 110 ml., in 3 months – 350 ml, in 12 months – 490.0 ml. Maximum pressure in the tank does not exceed 40 cm water column (average 30 cm H 2O). Day retention – 94,7%, night confinement at a forced night miction – 79.0%. The proposed method of inverting orthotopic ileal neobladder can be recommended when overlapping of orthotopic urinary reservoir is impossible or associated with leaks of the anastomosis due to the insufficient length of the mesentery using known techniques of orthotopic ileal bladder reconstruction.
Journal of Clinical Practice. 2011;2(1):18-25
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CHANGING APPROACH TO THE PROSTATE AS THE WAY OF NERVE-SPARING EFFECT IMPROVEMENT IN PATIENTS WITH LAPAROSCOPIC PROSTATECTOMY
Perepechay V.A., Medvedev V.L., Dmitriady S.N., Zozulya A.V., Skorikov I.I., Kelina I.N., Gornostaev V.N.

Abstract

The use of prostatespecific antigen screening made it possible to detect an earlystage prostate cancer in young men in which nervesparing radical prostatectomy with preservation of erectile function could be performed. Laparoscopic radical prostatectomy (LRPE) is preferred as a nervesparing technique in the treatment of prostate cancer. During the last 2 years 19 patients underwent the modified Brussels technique transperitoneal LRPE, (extrafascial prostatectomy – 17, interfascial – 2). The average period of observation was 10.3 months. 13 of 14 patients were observated more than 6 months. In this group all patients achieved a complete continence, one of the patients remained urine leak with no more than 1 strip a day. Brussels technique provides better control of neurovascular fibers in the seminal vesicles during radical prostatectomy. Posterior approach to the prostate gland should be avoided in the nervesparing LRPE.
Journal of Clinical Practice. 2011;2(1):26-30
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COMPARATIVE EFFICACY OF COMBINATION CONTACT AND TRANSURETHRAL PERCUTANEOUS LITHOTRIPSY WITH REMOTE LITHOTRIPSY IN CORALLOID NEPHROLITHIASIS TREATMENT
Perepechai V.A., Zozulya A.V., Skorikov I.I., Dimitriadi S.N., Gornostaev V.N.

Abstract

A retrospective analysis of results of percutaneous nephrolithotripsy (PNLT) for corallike nephrolithiasis in lithotripter "Swiss LithoClast ® Master" and transurethral nephrolithotripsy (TUNLT). In the period 20072010 167 PNLT and 11 TUNLT were performed. Complete elimination at PNLL was achieved in 83.2% of patients, residual concretions – in 16,8% of cases, with complete elimination TUNLT – 36,4%, residual concretions – 63,6%. In 3% of patients needed for the complete elimination of the implementation of additional percutaneous accesses, while 12.6% of the patients was necessary to repeat PNLT. Complications from PNLT + DLT developed in 30,2% of cases, and when the TUNLT + DLT – in 18,2%. Percutaneous technology in comparison to open surgery with corallike nephrolithiasis can significantly shorten the postoperative rehabilitation period and be choice method of the treatment due to its high efficiency and less traumatic.
Journal of Clinical Practice. 2011;2(1):31-34
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EARLY CONTINENCE RECOVERY IN PATIENTS WITH RADICAL PROSTATECTOMY
Perepechay V.A., Dmitriadi S.N., Alekseev B.Y.

Abstract

From 2008 to July 2010 95 patients underwent radical prostatectomy (RP) – 12 of them – laparoscopic prostatectomy, 83 – retropubic prostatectomy. In 43 patients suspension of urethral anastomosis was not performed. 11 patients underwent the Noguchi's front suspension (11,6%), 22 patients – Tewari's complete reconstruction of the fascial structures (23,1%) and 19 – complete reconstruction of the fascial structures with a modified technique of the rear suspension with a deficit of length of aponeurosis Denonvile (20%). Monitoring of continence was conducted on the third day of the removal of the catheter, in 1 month, 3 months, 6 months and 1 year. 74.7% of patients evaluated in a period of 6 months and only 54,7% of patients – in a year after surgery. On third day of removal of the catheter continence in a group without complete suspension was 20,9%, with front suspension – 27,3% in the group with Tewari's reconstruction – 49,9%, with Denonvile suspension – 36,8% respectively. 1month continence was 36,6%, 54,5%, 76,2% 78,9% respectively. Through threemonth observation full time continence was achieved in 63,8%, 60%, 85,7% and 73,3% respectively. Through 6 months and 12 months observation there was no significant difference in continence in all groups.
Journal of Clinical Practice. 2011;2(1):35-40
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ENDOTHELIAL FUNCTION AND MORPHOFUNCTIONAL STATE OF BLOOD CELLS IN THE BASINS OF THE ISCHEMIC LIMBS IN THE DIFFERENT TYPES OF SURGICAL TREATMENT OF ATHEROSCLEROSIS OBLITERANS
Katelnitsky I.I., Pleskachev S.A., Burikov M.A., Matsionis A.S., Povilaytite P.E.

Abstract

The aim of the investigation was to study the morphological condition of blood cells in the basins of the ischemic limbs and their dynamics as a result of various types of surgical treatment. Implementation of combined surgical treatment has a more normalizing effect in comparison with isolated reconstructive surgical treatment. The use of lumbar sympathectomy in patients with occlusive lesions of arteries of lower limbs and varying degrees of ischemia reduces endothelial dysfunction and normalizes a number of parameters describing the morphology and functioning of red blood cells and platelets. There was detected the deformation of red blood cells indicating that the restoration of the plasticity of red blood cell membranes significally reduced the degree of agglutination of red blood cells. According to obtained data the influence of sympathectomy depends on the severity of the disease in general the highest efficiency is observed at the II and III degree of ischemia.
Journal of Clinical Practice. 2011;2(1):41-46
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IMMUNOTROPIC AGENTS IN COMPLEX TREATMENT OF CHILDREN WITH INTERMITTENT ALLERGIC RHINITIS AND RECURRENT RESPIRATORY INFECTIONS
Chigaeva E.V., Grankina N.E.

Abstract

The purpose of the research was to develop a prescribing of immunomodulators Imudon, Viferon, Superlymph in the complex treatment of frequently ill children (FIC) with a frequency of ARI 6 or more times a year, foci of chronic infection in oro and nasopharynx, and intermittent (seasonal) AR mild or moderate severity (SAR). Methods: 120 FIC from 5 to 7 years old (56 boys and 64 girls) were followedup during 2 years. Investigation revealed pollen and household allergens predomination in the spectrum of causesignificant allergens. Microbial landscape of chronic infection foci in the oro and nasopharynx was characterized by a predominance of Staphylococcus aureus in 71,2%, Candida albicans in 28,8%, Streptococcus haemolyticus in 50% of patients. In 67.4% of patients microbial associations of 2 and 3 pathogens predominated. Immune system abnormalities were characterized by reduction in T cells, the level of serum IgA in 62.5%, gammaIFN – in 80%, alphainterferon – a 60% increase in serum IgG – at 62,5%, TNFα – 80,0%, and IgE – in 100% of the children. Supplementation of Imudon, Superlymph and Viferon as a component of complex treatment of this category of children reduces the mucous contamination with active forms of Candida albicans by 24 times, with bacterial flora ( Staphylococcus aureus, Streptococcus spp. ) in 2 3,4 times, reduces inflammation of the mucous membranes of oro and nasopharynx, adenoid hypertrophy, reduces the frequency of ARI in 1,9, 2,5 and 3,1 times respectively. In 16,6% of FIC with SAR who did not receive immunomodulators in complex treatment, persistent AR developed in a year of observation. Cases of persistent AR in groups of children receiving Superlymph or Viferon were not revealed.
Journal of Clinical Practice. 2011;2(1):47-53
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SOME ASPECTS OF CT ASSESSMENT OF SUPRAVESICAL URINARY TRACT IN PATIENTS AFTER CYSTILEOPLASTICS
Sukhanova O.P., Borondzhiyan T.S., Minasyan E.V.

Abstract

The purpose of the research was to determine morphological and urodynamic changes of supravesical urinary tract in patients after cystileoplastics. Methods. CT studies in the late postoperative period in 19 patients after radical cystectomy, combined with vesiculoprostatectomy and cystoileoplastics and malignant lesions of the bladder were performed. Results. None of cases revealed signs of continued growth. In 57% of the cases it was evidence of lymphadenopathy in the absence of negative dynamics of the underlying disease. No dependence of the state of anastomoses of the volume formed by the reservoir and the degree of shortening of the ureter was found. In assessing the state of supravesical urinary tract 11 from 19 (57,8%) patients were registered varying degrees of severity gidroureteronephrosis, and in 4 patients, pelvic ureteric reflux. All patients with urodynamic disorders identified "new bladder" had less volume than patients who did not have these disorders. Conclusion. CT study is the method of choice in the evaluation of supravesical urinary tract after cystoileoplastics for timely prevention of complications of an inflammatory process. It was revealed that the degree of changes in the urinary tract depending of the volume of the reservoir formed, requires further analysis.
Journal of Clinical Practice. 2011;2(1):54-56
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EFFECT OF METABOLIC DISORDERS IN THE COURSE OF OSTEOARTHRITIS
Artemenko N.A., Ter-Ananyants E.A., Mashtalova O.G.

Abstract

The aim of this study was to examine the influence of obesity on the course of osteoarthritis (OA) in women. Material and methods: 83 women diagnosed with OA were divided into 2 groups. Group 1 (51 patients) with BMI ≥ 30 kg/m 2; Group 2 (32 patients) with BMI <30 kg/m 2. Objectification of symptoms was achieved by using a VAS (visual analogue scale) and index WOMAC. Blood levels of Creactive protein (CRP) and interleukin6 (IL6) also determined. Results: moderate direct relationship between BMI and severity of pain by VAS (r = 356, p = 0,027) was revealed. Excessive body weight (group 2) was established a very close relationship between the change in the index of pain by VAS and difficulties in performing daily activities (B WOMAC) (r = 0,971, p = 0.28). In both groups of patients with OA, regardless of BMI, there was the high level of CRP and IL6. Women with a degenerativedestructive joint disease obtained a very close relationship between IL6 and severity of pain by VAS (r = 0,99; p = 0,23). In patients with OA 2 groups revealed a strong relationship (r = 0,84, p = 0.002) between the rates of CRP and IL6 and significant relationship (r = 0,67, p = 0.006) between these same indicators in women with BMI <30 kg/m 2. Conclusions: The course of OA in women with excessive body weight is accompanied by more marked pain syndrome, increased levels of biomarkers of systemic inflammation, significant functional impairment and frequent development of synoviitis of the knee.
Journal of Clinical Practice. 2011;2(1):57-62
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METHOD OF SURGICAL GENTLE TREATMENT OF PATIENTS WITH CHRONIC HYPERTROPHIC RHINITIS
Selyutina E.A., Beysova W.R., Yuriev S.I., Radchenko E.J.

Abstract

The technique of intramucosal vacuumresection of the inferior nasal concha in patients with chronic hypertrophic rhinitis. Provides evidence of the efficacy of obtaining histologic material data by the method, the functional parameters, evidenced a feasibility of the successful treatment of the discussed technology.
Journal of Clinical Practice. 2011;2(1):63-66
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CLINICAL AND PATHOGENETIC ASPECTS OF ISCHAEMIC HEART DISEASE COMPLICATED BY CHTONIC HEART FAILURE
Dorofeeva N.P., Pleskachev S.A., Shlyk S.V., Tchigaeva E.V., TherAnanyanz E.A., Mashtalova O.G., Koulikova I.E., Pleskachev A.S., Todorov S.S.

Abstract

Objectives: To investigate genetic and neurohumoral determinants of chronic heart failure (CHF) development and progression in ischaemic heart disease (IHD) patients. Methods: Serum neurohormone level analysis (angiotensin II, aldosterone, endotheline1, NTproBNP, TNFα) and genotyping (genes encoding ACE, angiotensinogen, and type1 angiotensin II receptors ) were implemented in 100 patients Results: Activation of endotheline and NTproBNP is characteristic of early CHF stages while decompensation of chronic heart failure shows elevation in aldosterone and TNFα . Structural polymorphism of renineangiotensine system genes is not significant in CHF development and progression in IHD patients.
Journal of Clinical Practice. 2011;2(1):67-73
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EPIDEMIOLOGICAL CHARACTERISTICS OF CHRONIC HEART FAILURE PATIENTS IN ROSTOV REGION
Dorofeeva N.P., Pleskachev S.A., Shlyk S.V., Tchigaeva E.V., TherAnanyanz E.A., Mashtalova O.G., Koulikova I.E., Pleskachev A.S.

Abstract

Objective. Assesment of chronic heart failure (CHF) prevalence and differential treatment in Rostov Region based on retrospective and prospective evaluation. Materials and methods. Retrospective analysis of 3059 casehistories of CHF patients hospitalized in cardiology departments of Rostov Region in 2008. 745 patients prospective followup. Results. Inpatients demonstrate a 52% CHF prevalence with a mortality rate of 3%. Major CHF development factors (in 82% cases) were determined to be ischaemic heart disease and arterial hypertension. Optimal medical treatment with basic pharmacological groups of drugs was conducted in 82% of inpatients the number decreasing to 53% during a year after discharge.
Journal of Clinical Practice. 2011;2(1):74-78
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CANCER PATIENTS THYROID AND GLUCOCORTICOID HOMEOSTASIS IN METASTATIC BRAIN DISEASE
Airapetov K.G.

Abstract

Blood concentration of hormones – stress indicators has been studied in patients with metastatic brain disease at pretreatment stage. Pronounced deviations of glucocorticoid and thyroid homeostasis have been observed in these patients. Dependence of hormonal parameters dynamics on extension of cerebral and extracranial metastasizing has been revealed.
Journal of Clinical Practice. 2011;2(1):79-83
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ISSUES OF RESPIRATORY INFECTIONS PREVENTION IN OUTPATIENT CHILDREN
Petrov V.A.

Abstract

The article analyzes the literature and the author's own research on prevention and treatment of influenza and ARTI primarily in outpatient children. Systematic analysis of the main domestic sources and trends in the treatment of ARTI in children showed that the gains in treatment and prevention of acute respiratory infections can hope for substantial improvement of clinical and costeffectiveness of an integrated system of prevention of ARTI in children population.
Journal of Clinical Practice. 2011;2(1):84-89
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ChEKhOV I MY
Skorikov I.I., Artemenko N.A.

Abstract

В заключение выпуска журнала Федерального медико-биологического агентства «Клиническая практика», отражающего работу ФГУ «Южный окружной медицинский центр ФМБА России», публикуем небольшое эссе об Антоне Павловиче Чехове. В минувшем 2010 г. нашего именитого земляка особенно часто вспоминали в связи со 150-летием со дня рождения.
Journal of Clinical Practice. 2011;2(1):90-93
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