Vol 9, No 2 (2018)

Original Research

Possibilities of modern neuroimaging techniques in the diagnostics and neuromonitoring of the recovery process in patients after ischemic stroke

Ekusheva E.V., Kiparisova E.S., Kurzanceva O.O., Smirnova O.A.


Ischemic stroke is still leading in terms of primary disability caused by residual neurologic de-fect in the majority of patients. Persistent motor disorders are observed even after timely and ade-quately carried out rehabilitation measures. The article discusses the possibilities of modern instru-mental technologies for diagnostics and further monitoring of the process of restoration of post-stroke deficit, which is based on the phenomenon of neuroplasticity.

Journal of Clinical Practice. 2018;9(2):4-11
pages 4-11 views

The left atrium remodeling is associated with adverse outcomes in unoperated degenerative aortic stenosis

Safaryan V.I., Zotova I.V., Tipteva T.A., Koroleva O.S., Zateyshchikov D.A.


Degenerative aortic stenosis (DAS) may be accompanied by remodeling of the left atrium (LA). The aim of the study was to assess the effect of the morpho-functional parameters of the LA remodeling on the prognosis of patients with DAS. The prospective study included 383 patients (men – 33.9% of patients), aged 78.9 ± 0.40 years, with DAS (mild – 18.3%, moderate – 30.8%, severe – 50.9%). The patients did not undergo a surgical correction of the defect. The LA morpho-functional state was estimated by the LA size/volume and the ratio of the rate of the transmitral flow to the rate of the early diastolic movement of the fibrous mitral valve ring (E/e ratio). The average follow-up period was 603.9 ± 24.57 days. The general mortality was assessed. The information on the outcomes was collected by telephone contacts. Multivariate Сox-regression analyses showed that the LA remodeling was independently associated with the death risk: an increase in the LA size ≥45 mm (ОR 1.6, CI 1.06-2.37, р=0.026) and an increase in the Е/е ratio >15 (ОR 1.6, CI 1.08-2.39, р=0.021). Another risk factor was a decrease in the creatinine clearance <45 ml/min (ОR 1.7, CI 1.10-2.60, р=0.016), area of the aortic valve (ОR 0.4, CI 0.26-0.74, р=0.002) and a decrease in the left ventricular ejection fraction <40% (ОR 1.7, CI 1.02-2.71, р=0.042). The Kaplan-Meier survival analysis showed that the E/e ratio>15 and the LА size ≥45 mm were statistically significantly associated with an increased risk of the general mortality (р<0.0001, LogRank=14.5 and р<0.0001, LogRank=18.2, respectively). The areas under the ROC curves for the increased LA size ≥45 mm and the E/e ratio>15 were 0.62 and 0.61, respectively. Thus, the indices of the LA remodeling – the LA size ≥45 mm and the E/e ratio > 15 – are associated with a poor outcome in patients with DAS.

Journal of Clinical Practice. 2018;9(2):12-19
pages 12-19 views

Development of a new algorithm for treatment of primary angle closure glaucoma

Kurysheva N.I., Trubilin V.N., Kapkova S.G., Lepeshkina L.V.


Purpose – to develop a new algorithm for treatment of primary angle closure glaucoma (PACG) based on laser peripheral iridotomy (PI) and selective laser trabeculoplasty (SLT) and to determine its indications and contraindications. 68 eyes with PACG were observed for 6 years. These patients had undergone PI and then SLT. The control group included 74 POAG eyes of the same age and stage of glaucoma. The effectiveness of SLT was assessed using the Kaplan-Meier survival analysis. The risk factors for SLT failure in the long-term period were studied to determine the indications and contraindications for this treatment algorithm, and the condition of corneal endothelium in dynamics was investigated using confocal microscopy. The hypotensive effect of SLT in PACG was worse than in POAG: 90 and 93% respectively one year after SLT, and 16 and 21% six years after SLT (log rank test, p=0.195). The following factors of SLT failure were common for both forms of glaucoma: IOP >24 mm Hg, corneal thickness ≤540 µm, corneal hysteresis <7 mm Hg and age of patients >68 years. The extension of laser action <1800 and lens thickness >4.8 mm were additional predictors of SLT failure in PACG. In both forms of glaucoma, diabetes mellitus, age of patients and duration of the disease before SLT had a negative effect on the condition of corneal endothelium. The anterior-posterior axis and the presence of pigment deposition on the endothelium were significant in PACG. The proposed algorithm for PACG treatment, including the initial performance of PI and then SLT, is an effective method of treating this form of glaucoma, provided that the opening of the anterior chamber angle is sufficient (at least half) and the lens thickness is no more than 4.8 mm. The initially high IOP, the age of patients over 68 and a thin cornea (<540 μm) worsen the SLT prognosis. Moreover, diabetes mellitus and the presence of pigment deposition on the endothelium along with long-term glaucoma history increase the risk of corneal endothelium damage after SLT.

Journal of Clinical Practice. 2018;9(2):20-29
pages 20-29 views

Patterns of activation of vanilloid and purinergic receptors of the bladder urothelium in elderly with hyperfunction of urothelium, atherosclerosis and their combination

Prashchaev K.I., Ilnitski A.N., Pranovich A.A., Gurko G.I., Selivanov A.N.


This article describes the patterns of activation of vanilloid and purinergic receptors in the bladder tissue in males of different ages. Based on the obtained data, the conclusions are made about the prospects of using activation of these receptors as predictors of certain diseases of the male urinary tract, such as idiopathic increased activity of the bladder (overactive bladder) and as biological markers for evaluating the effectiveness of treatment in the combination of idiopathic overactive bladder and atherosclerotic changes of general nature.

Journal of Clinical Practice. 2018;9(2):30-35
pages 30-35 views

Chronic endometritis is an indication for the pregravid preparation

Savelyeva G.M., Mikhalev S.A., Konoplyannikov A.G., Mikhaleva L.M., Babichenko I.I., Boltovskaya M.N.


The crucial role of chronic endometritis in the genesis of endometrial dysfunction has been currently established. The inflammatory process serves as a co-factor and leads to a decrease in the receptivity of the sex hormones of the endometrium due to impaired blood circulation of the tissue and fibrosis in the stroma of the endometrium.

This article is devoted to the study of the morpho-functional state of the endometrium in women of the reproductive age with abnormal uterine bleeding, in whom endometritis was diagnosed pathomorphologically, which is important for clarifying indications for the pregravid preparation in the future. A comprehensive examination of patients with abnormal uterine bleeding includes: bacterial culture (PCR) of the cervical canal and uterine cavity, hormonal profile, ultrasound examination of the pelvic organs and a complex histological examination of the uterine biopsy at the 7–10th and 19–21st days of the menstrual cycle, followed by immunohistochemical examination with the use of antibodies to the receptors of estrogens and progesterone, glycodelin, CD138, CD4, CD8, CD20.

Journal of Clinical Practice. 2018;9(2):36-41
pages 36-41 views

Clinical observation of fatal bilateral spontaneous pneumothorax in wegener granulomatosis, which simulated lung cancer

Khaydukova N.B., Khabarov Y.A., Stepanov V.A., Zvyezdkhina E.A., Ivanov Y.V.


We present a clinical observation of a 77 year-old patient admitted to the hospital with a sharp deterioration in the course of chronic obstructive pulmonary disease. The results of computed tomography of the chest read in favor of a newly detected malignant neoplasm of the upper lobe of the right lung with invasion into the mediastinum and secondary disseminations in the lower lobe of the left lung and liver. The performed fiber-optic bronchoscopy with a transbronchial lung biopsy did not verify the cancer diagnosis. The patient developed a bilateral spontaneous pneumothorax with the formation of bilateral bronchial-pleural fistulae with a massive air discharge through the pleural drainage. The presence of bilateral large bronchopleural fistulae did not allow a surgical intervention which required a separate intubation of the main bronchi. Minimally invasive techniques were ineffective. The patient died on the third day from the moment of the bilateral pneumothorax development due to severe respiratory failure. The autopsy established the diagnosis of Wegener’s granulomatosis affecting the lungs and kidneys.

Journal of Clinical Practice. 2018;9(2):42-49
pages 42-49 views

Hybrid one-stage reconstruction of the right subclavian artery occlusion and critical stenosis of the brachiocephalic trunk

Orekhov P.Y., Chupin A.V., Deryabin S.V., Lebedev D.P., Titovich A.S., Maksimenko D.M.


The aim of this study was to introduce a clinical example of a one-time hybrid reconstruction of symptomatic occlusion of the right subclavian artery with subclavian steal syndrome and critical stenosis of the brachiocephalic trunk in a patient after an aorto-femoral bifurcation bypass surgery and multiple reconstructions of distal anastomoses.

Journal of Clinical Practice. 2018;9(2):50-53
pages 50-53 views

Methods for prevention of intraoperative rupture during surgical interventions of intracranial aneurysm clipping

Kim S.V., Shin A.R., Vinokurov A.G., Klypa T.V., Baklaushev V.P., Troitsky A.V.


Intraoperative aneurysmal rupture (IAR) is one of the most dramatic complications of intracranial intervention. Its frequency, depending on the aneurysm’s localization and anatomical features, may reach 50%. IAR leads to the increase of unfavorable outcomes by 1.5–3 times. There exists a variety of techniques aimed to reduce the frequency of this complication, however, all of them have essential limitations.

The review presents analyses of the basic risk factors for IAR and techniques of its prevention, as well as modern approaches directed at the alleviation of this complication’s consequences.

Journal of Clinical Practice. 2018;9(2):54-67
pages 54-67 views

Superelastic nickel-free titanium alloys as materials for dental implants (experimental study)

Olesova V.N., Uzunyan N.A., Khafizov R.G., Ivanov A.S., Olesov E.E., Shumakov F.G.


Superelastic alloys of titanium (titanium-niobium-zirconium and titanium-niobium-tantalum) are more favorable in comparison with titanium for dental implants due to their physico-mechanical properties closer to those of bone tissue. Animal morphological studies of the biocompatibility of these alloys in comparison with titanium have been carried out. The control of the titanium alloy samples’ interaction with bone tissue was performed at the time points of 30 and 90 days; scanning electron microscopy and microprobe element analysis of tissue along the boundary with titanium alloys were used as the methods of investigation. The proximity of the morphological pattern and elemental composition of bone tissue along the border with titanium and superelastic alloys of titanium is shown, both at the control period of 30 days (in contact with alloys, a poorly mineralized connective tissue is found) and at 90 days (the border with titanium alloys is covered with mineralized bone tissue, similar in its composition to the surrounding bone tissue).

Journal of Clinical Practice. 2018;9(2):68-73
pages 68-73 views

Healthcare system administration

The normative regulation of dispensary observation of the adult population of Moscow

Sandakov Y.P.


The review presents an analysis of the normative legal documents regulating the dispensary observation of the adult population of Moscow. There are contradictions in the normative documents that make it difficult to organize a dispensary observation in a medical organization.

Journal of Clinical Practice. 2018;9(2):74-79
pages 74-79 views

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