Vol 5, No 3 (2014)

Articles
THE SAFETY OF MESENCHIMAL STROMAL CELLS THERAPY
Knyazev O.V., Konoplyannikov A.G., Parfenov A.I., Ruchkina I.N., Churikova A.A., Albulova E.A., Bykova S.V., Boldyreva O.N., Fadeeva N.A., Lishinskaya A.A., Bondarenko E.Y., Kagramanova A.V.
Abstract
There is a large amount of literature data that shows the effectiveness of cell therapy using mesenchymal stromal cells (MSCs), as on preclinical models and in some clinical studies in small groups of patients.Currently the use of MSC in clinical practice is limited by security considerations. Potential risks associated with their proliferative capacity, the risk of infectious complications, as well as the possible immunogenicity of the cells themselves.Foreign researchers analyzed on the basis of a literature review, the results of which evaluated the clinical safety of MSCs. The article presents the results of our monitoring of patients with inflammatory bowel disease (IBD), which received MSCs in the Department of pathology bowel. The results of our study, and the results, given in the review, should provide scientists and policy-makers the confidence that according to available scientific data an innovative method of cell therapy is safe for clinical use.
Journal of Clinical Practice. 2014;5(3):5-14
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MORPHOMETRIC ASSESSMENT FOR THE PROGNOSIS OF CURRENT IN APLASTIC ANEMIA PATIENTS AFTER SPLENECTOMY
Fedorovskaya N.S., Diakonov D.A., Fedorovskaya N.A., Pankov V.N.
Abstract
The article presents the method of definition of the forecast of current in aplastic anemia patients after splenectomy, based on morphometric analysis of functional zones of a spleen in histologic cuts at painting by hematoxylin and eosine. At an estimation of a preparation in a light microscope by means of the computer program calculated the average area of a white pulp, further calculated its weight. Reduction in weight of a white pulp of a spleen below 10,0 g testifies to the favorable forecast of current aplastic anemia, increase - more than 10,0 g specifies adverse current of disease. This method is allows to solve differently the indications for immunosuppressive treatment of patients with given pathology after splenectomy.
Journal of Clinical Practice. 2014;5(3):15-19
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THE ROLE OF THE PRIMARY-OUTPATIENT CARE PHYSICIAN IN TREATMENT OF PATIENTS WITH METABOLIC SYNDROME
Kirichenko L.L., Ovsyannikov K.V., Korolev A.P., Fedoseev A.N., Tochilkina S.A., Dvoryanchikova Z.Y., Ulyanova E.A.
Abstract
Metabolic syndrome is attracting more and more attention of physicians because of the increasing prevalence and poor prognosis for patients. The main target in treatment of any chronic disease is to achieve a satisfactory compliance status that depends on the motivational status of a patient and a physician. Communication between some aspects such as the motivation to conduct long-term therapy, the level of knowledge and readiness to use both of these parts on practice is interest to explore.The aim of the present study was to analyse the readiness of primary care physicians to assist patients with the metabolic syndrome. Tasks that the authors set for themselves, was to assess the knowledge, skills and willingness of primary care physicians to help patients with metabolic syndrome. The object of study were physicians and local therapists working in Moscow hospitals and clinics, who were training at the Department of Therapy №2 FPGE MSMSU from 2011 to 2013. Surveys were conducted on the basics of the available methodologies for assessing the knowledge and skills that are using in teaching nowadays. Analysis of the results suggests very low willingness of physicians to assist patients of this category.
Journal of Clinical Practice. 2014;5(3):20-24
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ULTRASOUND CRITERIA FOR DIAGNOSIS AND MONITORING OF DRUG THERAPY OF COMBINED PROLIFERATIVE DISEASES OF THE UTERUS
AG K.G., SA L.A., OE N.E., RH T.K., NN C.N.
Abstract
The aim of the paper was to evaluate the diagnostic accuracy of transvaginal tenderness-guided ultrasonography in the identification of location of genital endometriosis, endometrial hyperplasia and uterine fibroids before and after treatment dienogest. It is a selective progestin for the treatment of endometriosis. Adenomyosis was diagnosed when a poorly defined area of abnormal echo-texture (decreased or increased echogenicity, heterogeneous echotexture, myometrial cysts) presented in myometrium. Typical ultrasonic changes of efficacy were: homogeneity of myometrium; clear and intense contours of uterine fibroid with increased echogenicity; reduction of the echogenic endometrial stripe with the average echogenicity and clear lines of myo- and endometrium with a reduction in local blood. These criteria can be used to select non-surgical management of patients. In cases where a poorly defined area of abnormal echotexture (decreased or increased echogenicity, heterogeneous echotexture, myometrial cysts) did not change the surgery or the embolization of artery uterine is required. The preferred imaging modality for the evaluation of uterine on therapeutic alternatives to hysterectomy and myomectomy is transvaginal ultrasonography.
Journal of Clinical Practice. 2014;5(3):25-34
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THE POSSIBILITY OF MINIMALLY INVASIVE ROENTGEN-SURGICAL TECHNIQUES IN ABDOMINAL SURGERY
Ivanov Y.V., Lebedev D.P., Alekhnovich A.V.
Abstract
The clinical observations showing the diagnostic and therapeutic capacities of minimally invasive percutaneous roentgen-surgical techniques in the diagnosis and treatment of hepatopancreatoduodenal zone diseases are presented. In these cases, the use of minimally invasive surgical techniques on various stages of diagnosis and treatment have helped to correct diagnosis, and effective treatment, discarding traditional traumatic surgery. In the first clinical observation percutaneous radiosurgical method drainage of an abscess of the liver allowed to reveal chronic form of fascioliasis and conduct specific treatment. In the second - to establish the cause of recurrent subhepatic abscess, in the third-to remove concrements of common bile duct, if unable to perform open surgery or endoscopic papillosfinkterotomiya and remove concrements. Common to all three clinical observations is the fact that up to minimally invasive roentgen-surgical methods of treatment were carried out public activities, which for various reasons proved ineffective. The latest minimally invasive radiosurgical methods allow not only to establish an accurate diagnosis, but may be intermediate or final treatment.This is especially important in severe patients at impossibility of the surgery and if necessary, stabilization of the general status and improving metabolic and functional parameters of the upcoming radical operation. In most cases, a variety of minimally invasive surgical techniques are not competing among themselves, but only complement or substitute one another in every concrete clinical situation.
Journal of Clinical Practice. 2014;5(3):35-42
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MODERN POLICY OF CANCER IN PREGNANCY TO OVERCOME A HARDSHIP
Kedrova A.G., Levakov S.A.
Abstract
The natural tissue remodeling that occurs in reproductive organs of women following pregnancy and lactation promotes cancer progression, accounting for 'the dual effect' of pregnancy. There are the tumor promoting activity of physiologic regression is due to an inflammation-like microenvironment that is present during reproductive organs regression. The hypothesis that hormone-stroma from an actively involuting reproductive organs promotes tumor progression is being evaluated using both in vivo and in vitro model systems. ECM proteins that activate tumor cells invasion are being identified using proteomic approaches. We have carried out our analysis of 16 patients with pregnancy-associated cancer. The most common cases of cancer were: cervical cancer, breast cancer, ovarian cancer and lymphoproliferative disorders. In each case, the decision about the tactics of pregnancy and treatment of cancer were taken individually together with oncologists, obstetricians, pediatricians and patients. The difficulties for the adoption of an optimal solution can be attributed insufficient evidentiary basis for tactical decisions, which are often the main cause of health in favor of abortion, although the woman, in almost all cases was strongly tuned to its prolongation. Our analysis also showed a low awareness of physicians about this issue, the need for its wider discussion, both among health professionals and women who have to get up on the pregnancy as soon as possible and be tested in compliance with the principles of oncological alertness.
Journal of Clinical Practice. 2014;5(3):43-50
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THE СOMBINATION OF SPINAL SUBARACHNOID HEMORRHAGE AND MIELOISHEMIA: DIFFICULTIES OF DIAGNOSIS AND PECULIARITIES OF NEUROREHABILITATION
Bobrovskaja A.N., Lobanov S.A.
Abstract
The article contains the description of the clinical case of rare combination of spinal subarachnoid hemorrhage end mieloishemia in 50-year-old patient, with discussion of difficulties of diagnosis and peculiarities of neurorehabilitation.
Journal of Clinical Practice. 2014;5(3):51-58
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POLYSEROSITIS AS A MASK OF PARAPROTEINEMIC HEMOBLASTOSIS
Novikova O.N., Alekseeva N.V., Rudenko E.A.
Abstract
The article describes the rare clinical case of Waldenstr`m's macroglobulinemia in combination with primary amyloidosis which main clinical symptom is polyserositis. The diagnostic difficulties of this case are described.
Journal of Clinical Practice. 2014;5(3):59-65
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ACROMEGALY. Case report
Soyustova E.L.
Abstract
Acromegaly - a neuroendocrine pathology, caused by chronic overproduction of growth hormone. Chronic overproduction of somatotropin and insulin growth factor (IGF) is clinically expressed in gigantism or acromegaly. Acromegaly is accompanied by various metabolic disorders, lesions of cardiovascular and respiratory systems.
Journal of Clinical Practice. 2014;5(3):66-70
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CLASSIFICATION, DIAGNOSIS, AND APPROACH TO TREATMENT FOR ANGIOEDEMA
Borisova T.V., Sokurenko S.I.
Abstract
Angioedema is defined as localized and self-limiting edema of the subcutaneous and submucosal tissue, due to a temporary increase in vascular permeability caused by the release of vasoactive mediators. When angioedema recurs without significant wheals, the patient should be diagnosed to have angioedema as distinct disease. In the absence of the accepted classification, different types of angioedema are not uniquely identified. Four types of accuired and three types of hereditary angioedema were identified as separate forms from the analysis of literature. Here, we summarize the data and the resulting classification and treatment of angioedema.
Journal of Clinical Practice. 2014;5(3):71-82
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IMMUNOLOGICAL DISODERS IN PATIENTS WITH CHRONIC RENAL INSUFFICIENCY AND POSSIBILITY OF IMMUNE THERAPY
Sokurenko S.I., Fedoseev A.N., Borisova T.V.
Abstract
The main evidence of the participation of immune responses in the pathogenesis of chronic renal failure (CRF) is an undoubted effect of treatment with corticosteroids, alkylating agents and cyclosporine A. This is supported by the relationship of nephrotic syndrome (NS) with atopy, Hodgkin's disease, certain HLA-types: DRw7, B12.This article presents a review of the literature, focused on the immunological changes in patients with impaired renal function, including сhroniс hemodialysis. Various aspects of immunocorrection in patients with chronic kidney disease are analyzed.
Journal of Clinical Practice. 2014;5(3):83-88
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