Vol 9, No 1 (2018)

Method of prevention of postoperative gray allohernioplasty in laparoscopic ventral hernia
Ivanov Y.V., Panchenkov D.N., Chaikin R.S., Zinovsky M.V., Avdeev A.S.

The authors have developed a new method of seroma formation prevention after laparoscopic allohernioplasty in patients with postoperative ventral hernias. The results of the study showed that trans- position of hernia sac into the abdominal cavity and fixation to the unmodified abdominal wall around the perimeter of the hernial orifice can reliably eliminate Grajewo cavity and thereby to eliminate the possibility of seroma formation in the postoperative period. Federal service for intellectual property (Rospatent) decided to grant a patent for this method of seroma formation prevention at the surgery of postoperative ventral hernias as for the invention “Method of laparoscopic plasty of ventral hernias” (№2017120227/14(035085) from 17.01.2018).

Journal of Clinical Practice. 2018;9(1):3-9
Original Research
The effectiveness of using modern technologies in early recovery period treatment of post-stroke patients
Mizieva Z.M., Shirshova E.V.

This study presents the results of investigation «Amadeo», «Armeo» effectiveness in treatment of 61 post-stroke patients during early recovery period with upper limbs motor dysfunction. Comparative characteristics of treatment effectiveness in patients with ischemic and hemorrhage stroke are given. The results of investigation represent positive effect of using robotic technologies in post stroke patients rehabilitation therapy.

Journal of Clinical Practice. 2018;9(1):10-17
Internal fixation of instability pelvic fracture
Khapilin A.P., Solod E.I., Snetkov D.A., Kotova M.N., Simonov A.B., Eremin I.K., Shaikhutdinov R.S., Beltikov K.S., Postnikov S.D., Gorelov I.V.

Over the past 3 years, an analysis of surgical treatment of 48 patients with unstable fractures of pelvic bones has been performed. The study group included patients with type B3, C2, and C3 fractures according to AO classification. The average follow-up period after the operation was 1 year.

Evaluation of the results of treatment was carried out on the basis of clinical examination, the analysis of radiographs and Mattis evaluation scale. Good results (76%) were obtained in patients with pelvic fractures type B3, C2, according to the AO classification. The number of satisfactory and unsatisfactory results of 15% and 9%, respectively, was obtained in patients in the group with the heaviest damage type C3. Complications of festering, impaired stability of fixation with loss of reposition were observed in 5 people (9%), two patients from the 3rd group died.

The obtained data allows to draw a conclusion that submersible osteosynthesis using various designs performed at the earliest possible time (damage control) remains the gold standard for today in the treatment of unstable fractures of the pelvis. The greatest number of complications was observed in the group of vertically unstable fractures of the pelvis C3. The data obtained correlates to a certain extent with the data of domestic and foreign literature.

Journal of Clinical Practice. 2018;9(1):18-22
Ceramic crown inlays as alternative to substitute defects of side teeth with light-conforming composites
Olesov E.E., Novozemtseva T.N., Tikhonov V.E., Olesova V.N., Kaganova O.S.

A clinical and functional examination of the maxillofacial area was performed in 280 patients with the defects of the lateral teeth being replaced with ceramic crown inlays or light-cured composites three years ago. Computer methods were used to assess the articulation, occlusion and tone of the masticatory muscles on the T-Scan III and Bio EMG III devices. In a third of the lateral teeth, an unreasonable increase in indications to composite fillings has been established – when more than 50.0% of the occlusal surface is destroyed. Indicators of dental status are significantly better when using ceram- ic inlays compared with fillings made of composite material in the long term after treatment of multiple caries. Ceramic crown inlays prevent occlusal-articulatory disorders and dysfunction of the masticatory apparatus, characteristic in long-term periods for patients with multiple caries when replacement of lateral teeth defects with fillings made of composite.

Journal of Clinical Practice. 2018;9(1):23-27
Experimental comparison of constructions «spondylosyndesis-270» and «spondylosyndesis-360»
Abakirov М.D., Nourmukhametov R.М., Borisov Y.A.

Objective: The purpose of our study was to compare the biomechanical properties of the «spondylosyndesis-270» and «spondylosyndesis-360» fusion methods and make a conclusion about the possibility of the clinical use of «spondylosyndesis-270».

Mаteriаls аnd Methods. Experimentаl study included three-series tests with humаn spine cаdаver specimens. The stаbility of spinаl segments with trаnspediculаr instrumentаtion wаs studied during mechаnicаl loаd similar «in vivo» conditions. We used a torsion and tensile load on cadaver discs and investigated the stability of screw fixation in both methods.

Results: the monolateral fixation with the banana-shaped cage provides a sufficiently level of stability

under compression and torsion load. However, the outcomes of the monolateral method of fusion was better. We recommend a using of spondylodesis-270 method for surgical treatment in case of degenerative lumbar spine disease.

Journal of Clinical Practice. 2018;9(1):28-34
Efficacy of combined use of anti-VEGF (Aflibercept) and lasercoagulation for corneal neovascularisation before keratoplasty
Mamikonyan V.R., Malozhen S.A., Krakhmaleva D.A., Trufanov S.V., Pivin E.A.

It is known that both pre- and postkeratoplasty neovascularization of the cornea can significantly increase the risk of graft rejection reaction.

The article presents preliminary results of the use of a VEGF inhibitor combined with laser coagulation in the treatment of corneal neovascularization before keratoplasty in order to increase corneal transplant survival.

Journal of Clinical Practice. 2018;9(1):35-38
Modern methods of fixation of rear-camera intraocular lenses after facoemulsification of the cataract complicated by the violation of capsule support of the lumber
Kozhukhov A.A., Kapranov D.O.

The review of domestic and foreign literature sources examining different methods of fixation of posterior chamber intraocular lenses after phacoemulsification of cataract, complicated capsular support of the lens is presented. There is a sufficiently widespread of transscleral suturing of the IOL and the prospect of developing IOL fixation in corneal layers.

Journal of Clinical Practice. 2018;9(1):39-43
Duplex scanning as an alternative to computer tomography with contrast enhancement for the control of complications after endovascular aneurysm repair
Korshunov D.I., Khabazov R.I., Ustiantseva N.V., Chupin A.V., Deryabin S.V.

EVAR (endovascular aneurism repair) is the preferred method for the surgical treatment of ananeurysm. The advantage of this type of surgical intervention is that a smaller number of postoperative complications will occur.

The main diagnostic tasks for patients after EVAR are to determine the size of the aneurysmal sac, detection of an endoleak, detection of the endoprosthesis migration and the deformation of the stent graft itself.

Conclusion: early detection of complications in the postoperative period remains the main problem for monitoring patients after EVAR. Duplex scanning is a safe, non-invasive and effective method of measuring the size of an aneurysmal sac and detecting possible complications after EVAR.

Journal of Clinical Practice. 2018;9(1):44-49
Methods of diagnosis in cardio-oncology
Plokhova E.V., Sorokin A.V., Staferov A.V., Dundua D.P.

Early diagnosis and advances in treatment have led to improved survival of patients with cancer, but have also increased morbidity and mortality due to treatment side effects. Cardiovascular diseases (CVDs) are one of the most frequent of these side effects. As a result of the direct effects of radiation therapy and chemotherapy on heart and vessels сan be: acceleration of atherosclerosis, damage of cardiomyocytes and endothelium, and arterial and venous thrombosis. The direct effect of the cancer treatment on the heart is called cardiotoxicity. Early diagnosis and identification of patients at high risk of cardiotoxicity is the first step towards successful prevention of CVD in cancer patients without compromising cancer care, which ultimately leads to a reduction in mortality. Echocardiography is the method of choice for the detection of myocardial dysfunction during and after cancer therapy. New methods of imaging like three-dimensional echocardiography, speckle-tracking echocardiography, cardiac magnetic resonance show a higher sensitivity in detecting of early myocardial dysfunction during cancer therapy. This review outlines the main diagnostic algorithms and approaches used in cardiooncology.

Journal of Clinical Practice. 2018;9(1):50-62
Boerhaave’s syndrome: case report and review
Andreychenko S.A., Bychinin M.V., Klypa T.V., Ivanov Y.V., Sazonov D.V., Dyminov R.M., Shablovskiy O.R.

Well-timed diagnostics of a spontaneous nontraumatic rupture of esophagus or Boerhaave’s syndrome, presents great difficulties because of his rarity and a variety of clinical implications. Esophagus ruptures may feign various organs pathology [2] that most often demands differential diagnostics with a stomach ulcer perforation, acute myocardial infarction, pulmonary artery embolism, aortic dissection and pancreatitis [16, 17]. The treatment can include conservative and surgical tools, but still accompanied by high mortality (up to 35%) [7]; results largely defined by the time between the moment of a rupture and start of the treatment. In addition to the review, described the experience of successful treatment of a patient with Boerhaave’s syndrome in the light of the generalized today data of world medical literature on this problem.

Journal of Clinical Practice. 2018;9(1):63-70
Clinical case
Clinical case: aortic valve replacement with aortic root reconstruction and coronary artery bypass grafting in 73-yo obese female patient
Borisov D.V., Zotov A.S., Vachev S.A., Troitskiy A.V., Khabazov R.I.

Aortic valve replacement is the second most common cardiac surgery procedure. Prosthesis-patient size mismatch can increase the incidence of adverse events postoperatively, it also leads to increased left ventricular load. Some studies describe the higher mortality in this group of patients. It is also proved that patients with severe aortic stenosis usually have impaired platelet aggregation and low von Willebrand factor causing bleeding disorders.

We report a case of successful aortic valve replacement and aortic root enlargement (Nicks technique) combined with coronary artery bypass grafting (left internal mammary artery to the left anterior descending artery) and left atrial appendage resection in 73-y.o. obese female patient. Postoperative course was uneventful.

Journal of Clinical Practice. 2018;9(1):71-75
Clinical case: severe course of adenoviral conjunctivitis with a hemorrhagic component complicated by a toxic-allergic reaction against a pregnancy
Trubilin V.N., Poluninа E.G., Andzhelova D.V., Kasparova E.A., Evstigneeva Y.V.

One of the manifestations of adenovirus keratoconjunctivitis – extensive subconjunctival hemorrhages – is the characteristic of rather rare hemorrhagic form of conjunctivitis of severe course. Patients, especially pregnant women, with clinical manifestations of adenoviral conjunctivitis of severe course with a hemorrhagic component complicated by a toxic-allergic reaction, require close attention not only from ophthalmologists. It is necessary to conduct a comprehensive examination, including: general blood test, coagulogram, consultation of the therapist. Clinical signs of deterioration, in the early days of the disease, against the backdrop of treatment, is a clinical feature of the course of adenovirus infection, which should be informed to the patient. The use of a complex approach using the domestic non-toxic inducer of interferon formation of Poludan (polyA:polyU complex) in instillations and injections, supplemented by scraping-massage with a glass rod of the tarsal conjunctiva, facilitating the elimination of adenovirus from conjunctival follicles, quickly and effectively reversed the phenomenon of severe AVC. The appointment of corticosteroid therapy, regardless of the severity of the toxic-allergic reaction, is shown no earlier than 7 days after the manifestation of the disease.

Journal of Clinical Practice. 2018;9(1):76-81
Healthcare system administration
Principles of the approximate program construction for professional retraining in specialty "Health care management and public health"
Kochoubey A.V., Konanykhina A.K., Komarov S.G.

The principles of building an approximate educational program for professional retraining in the specialty of “Health care management and public health” were determined on the basis of the results of the analysis of regulatory legal documents, educational programs of domestic and foreign medical universities, a survey of students of additional professional education courses. Principles include the availability of basic and variable part in the form of separate modules for each competence, the possibility of internship, the compulsory of distance learning, of the control, of interactive forms of training, of freedoms for the educational organization in relation to the length and the content of training modules, forms of study and control, duration of distance learning.

Journal of Clinical Practice. 2018;9(1):84-88
Information note on the work of the multi-republican medical center at the Federal Research and Clinical Center of the Federal Medical and Biological Agency of Russia (Yalta, Republic of Crimea)
Khabazov R.I.

Information note on the work of the multi-republican medical center at the Federal Research and Clinical Center of the Federal Medical and Biological Agency of Russia (Yalta, Republic of Crimea)

Journal of Clinical Practice. 2018;9(1):89-91

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