Vol 9, No 3 (2018)

Original Research
Recurrent croup in children: problems and ways of their solution
Abaeva N.G., Vernigora N.D., Safronenko L.A., Karpov V.V., Lukashevich M.G., Disenbaeva L.G., Shapranova N.L., Golovina E.M.
Abstract

In this review, we analyse morbidity, anamnesis, clinical features, immunological status, catamnesis, treatment options and ways of prevention of acute and recurrent croup in children studied over the past four decades. Based on the accomplished analysis, we stipulate the need for conducting a scientific research on the recurrent croup problem, development of preventive methods and guidelines.

Journal of Clinical Practice. 2018;9(3):4-9
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Quality of life dynamics in patients with ischemic heart disease after percutaneous coronary intervention with stent implantation
Dorofeeva N.P., Orekhova Y.N., Ter-Akopyan A.O., Ivanchenko D.N., Shlyk S.V., Mashtalova O.G., Kulikova I.E., Chibineva S.A., Sklyarov F.V., Pleskachev А.S.
Abstract

Percutaneous coronary intervention (PCI) with stenting in patients with stable ischemic heart disease (IHD) is not always accompanied by a significant improvement of clinical symptoms and quality of life (QOL), because of the presence of affective disorders. The aim of this study was to investigate the dynamics of QOL in patients with stable IHD after PCI and conservative treatment, depending on the presence of symptoms of anxiety and depression. In the group of patients with comorbid symptoms of anxiety-depressive disorders, the initial values of GH, VT, SF, RE, MH according to the SF-36 scale were low during PCI. After PCI, QOL of patients in this group improved, and the studied parameters became comparable to those in the group without affective symptoms. In the group of conservative treatment with concomitant symptoms of anxiety and depression, RP, GH, VT, SF and MH values were initially low. A significant dynamics of QOL in patients of this group was not observed after the conservative treatment. In patients without affective symptoms, there was an improvement in SF and RE after the conservative treatment at the 3 months follow-up.

Journal of Clinical Practice. 2018;9(3):10-15
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Association of the hormonal status parameters with the results of the cardiorespiratory exertion test in athletes
Megeryan S.D.
Abstract

The aim of this study was to identify the specifics of the endocrine system functioning in males professionally involved in sports. We have observed 70 sportsmen and 70 students of the Maritime Academy. The check-up included the following procedures: the ultrasound examination of the thyroid gland, assessment of the hormonal status (measuring concentrations of prolactin, cortisol, thyroid stimulating hormone, free thyroxin, antibodies to thyroid peroxidase in the blood serum), complete blood count (assessment of the hemoglobin level), assessment of microelements in the blood serum (calcium and magnesium levels). The study has established that athletes have significantly higher concentrations of thyroid-stimulating hormone and lower concentrations of cortisol and free thyroxin, as compared to people not involved in sports. A positive correlation between the levels of cortisol, thyroid-stimulating hormone, free thyroxin and prolactin in the blood serum has been found in athletes. The high levels of thyroid-stimulating hormone and relatively low values of cortisol may be considered as indicators of a better athlete’s performance and a reflection of the optimal adaptation of the pituitary-thyroid and pituitary-adrenal systems to systematic high physical loads.

Journal of Clinical Practice. 2018;9(3):16-21
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Experience of the prp-therapy application in the treatment of patients with gonarthrosis
Chesnikov S.G., Rosenberg D.V., Timoshenko M.E., Dediaev S.I.
Abstract

Our experience of trauma and orthopedic department shows a high efficiency of using PRP-therapy in the treatment of gonarthrosis. The use of PRP therapy significantly reduces the intensity of the pain syndrome and substantially improves the quality of life of patients with gonarthrosis, and allows acceleration of patients’ rehabilitation.

Journal of Clinical Practice. 2018;9(3):22-24
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Long-term outcome of the laparoscopic repair of hiatus hernia
Burikov M.A., Skazkin I.V., Shulgin O.V., Kinyakin A.I., Sokirenko I.A.
Abstract

Presently, the improvement in the quality of life of patients who underwent a laparoscopic surgical repair of hiatus hernia and the absence of the gastroesophageal reflux disease (GERD) recurrence are the basic characteristics of the surgical treatment. In this connection, further perfection of the tactics and techniques of the surgical GERD treatment becomes an important problem of modern surgery.

Here, we present a comparative analysis of the remote results of the surgical treatment of 159 patients with GERD-complicated hiatus hernia. The patients were divided into two groups, depending on the technique of the performed endosurgical treatment. The first group consisted of patients operated via the standard laparoscopic Nissen fundoplication. In the second group, we included those patients who underwent surgical treatment using a modified procedure of Nissen fundoplication with the formation of a non-tension cuff (RF patent No. 2529415 of 27.09.2014).

Evaluation of the results, based on the survey questionnaires Gerd-Q, GSRS, SF-36 and the data of instrumental research methods, was performed 1 to 5 years post-treatment.

The treatment of the GERD-complicated hiatus hernia patients with application of the technique of forming a non-hanging fundoplication cuff shows the best long-term results: the incidence of the reflux syndrome and signs of hyperfunction of the fundoplication cuff is lower. The revealed differences coincide with the data of the Gerd-Q and GSRS questionnaires, as well as the life quality estimation by the SF-36 questionnaire. The developed techniques do not require application of sophisticated technical skills and re-equipment and may be recommended for the practical use in the everyday practice in surgical hospitals of all levels.

Journal of Clinical Practice. 2018;9(3):26-33
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Inhalation anesthetics in a comprehensive enhanced recovery after surgery program
Kutsevolova N.V., Makhno Y.E., Anoshin A.S., Lepikhov E.V., Sanchenko M.A., Dorofeeva E.M., Moshenkova N.A., Kuklenko A.E., Naklonnaya N.V.
Abstract

Over the recent years, an increasing attention has been paid in the Russian healthcare to the concept of a‘fast-track surgery’ also known as ‘enhanced recovery after surgery (ERAS)’. This article presents the advantage of inhalation anesthetic agents from the perspective of the ERAS concept. A special attention is paid to drugs belonging to halogen-containing inhalation anesthetic class (Sevoflurane and Desflurane). It is emphasized that, despite a number of differences in the clinical effect of these anesthetics, they are drugs of choice in the fast-track surgery.

Journal of Clinical Practice. 2018;9(3):34-36
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Algorithm for the management of patients with incompetence of postoperative uterine scar after a cesarean section, our clinical experience
Kogan O.M., Voytenko N.B., Zosimova E.A., Martynova E.N., Nersesayn D.M., Bubnikovich A.A.
Abstract

The growth of the cesarean section frequency has created a new healthcare problem – follow up of pregnancy in women with a uterine scar. The pregnancy course in the case of an incompetent uterine scar poses risks of not only a premature labor, but also of a uterine rupture during the entire gestation. Currently, the issues of the diagnostics and reconstructive surgery for an incompetent uterine scar after a cesarean section when planning a pregnancy remain understudied.

Journal of Clinical Practice. 2018;9(3):38-43
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Prevention of thromboembolic complications in the laparoscopic treatment of obese patients
Burikov M.A., Skazkin I.V., Shulgin O.V., Kinyakin A.I., Sokirenko I.A., Volkova N.V.
Abstract

Obesity is an additional high-risk factor in the development of thromboembolic complications (TEC) in the surgical treatment. 110 cases of obese patients who underwent a treatment at the Surgical Department from January, 2015 to March, 2018. Prior to the operation, all the patients received a medication to prevent thromboembolic complications, while intermittent pneumocompression was applied during the surgery. The use of intermittent pneumocompression of the lower extremities in the laparoscopic surgical treatment of obese patients reduces the amount of venous thromboembolic complications via normalization of the intravenous haemodynamics

Journal of Clinical Practice. 2018;9(3):44-47
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Dexmedetomidine as a part of multimodal analgesia in postoperative period in trauma patients
Kutsevolova N.V., Makhno Y.E., Kuklenko A.E., Vasiliauskiene E.V., Andronova I.V., Sanchenko M.A., Dorofeeva E.M., Magomedova D.A., Pavlovsky A.S., Semenikhina E.V.
Abstract

Despite the large arsenal of analgetics acting through different pharmacological mechanisms and the development of various anesthesia methods, the problem of postoperative pain treatment still remains urgent. Providing a complete pain relief after a surgery remains a desired, but not always a reachable goal. According to the literature, 30 to 75% of patients undergoing surgery suffer from the severe pain syndrome in the postoperative period. This article presents the experience with the use of a prolonged intravenous infusion of Dexmedetomidine as a part of multimodal analgesia in patients who underwent endoprosthetic replacement of large joints.

Journal of Clinical Practice. 2018;9(3):50-53
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Adipokine status in patients with stable ischemic heart disease associated with affective disorders
Dorofeeva N.P., Ter-Akopyan A.O., Оrekhova Y.N., Ivanchenko D.N., Shlyk S.V., Mashtalova O.G., Kulikova I.E., Chibineva S.A., Sklyarov F.V., Pleskachev А.S.
Abstract

One of the factors negatively affecting the cardiac prognosis of coronary heart disease (CHD) is affective disorders of the depressive spectrum. Symptoms of depression may increase the level of systemic inflammation and promote disorders of carbohydrate metabolism by altering the synthesis and secretion of adipokines: leptin, resistin, adiponectin. The aim of this study was to assess the adipokin status in patients with stable coronary artery disease in the conditions of conservative therapy and during percutaneous coronary interventions (PCI) with stenting, including patients with depressive symptoms. The presence of depressive symptoms was accompanied by an increase in the level of resistin in the blood plasma in patients with stable ischemic heart disease. PCI with coronary artery stenting resulted in an increase in the concentration of all the adipokines: adiponectin, leptin, resistin. Stenting of coronary arteries in people with depressive symptoms led to an increase in the level of resistin, adiponectin with a decrease in the concentration of leptin in the blood plasma on the third day after the operative intervention.

Journal of Clinical Practice. 2018;9(3):54-59
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Potential of the neurosurgical treatment of symptomatic temporal epilepsy
Airapetov K.G., Glazkov A.A., Al-Khammadi A.H., Prinsovskaya E.V., Nikolaenko M.V.
Abstract

A combination of the appropriate epilepsy service and modern methods of microneurosurgery allow realization of an effective high technology medical care to patients with symptomatic temporal epilepsy.

Journal of Clinical Practice. 2018;9(3):60-65
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Potential of high-tech microneurosurgery in the treatment of pineal tumors
Airapetov K.G., Glazkov A.A., Al-Khammadi A.H., Mahno Y.E., Moshenkova N.A.
Abstract

A combination of modern methods of high-tech microneurosurgery, neuroanesthesia and neuroreanimation allows a successful realization of the program for the surgical treatment of pineal tumors. Such operations belong to the highest difficulty category and carry a high surgical risk.

Journal of Clinical Practice. 2018;9(3):66-69
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Healthcare system administration
A room for mistake:views of patients and physicians on medical errors
Konanykhina A.K., Komarov G.A., Kochoubey A.V.
Abstract

The article is devoted to the problem of medical errors and responsibility for them. The study was conducted by interviewing physicians and patients. 98% of physicians have encountered medical errors in their practice. The most common causes of medical errors are: insufficient knowledge and experience, lack of attention to a patient. The results indicate a loyal attitude of patients towards medical errors. More than 30% of patients believe that a physician should not be punished for an error.

Journal of Clinical Practice. 2018;9(3):70-73
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