Vol 10, No 1 (2019)

Original Research
Improved methods of the contrast-enhanced ultrasound in patient with chronic viral hepatitis
Tikhankova A.V., Borsukov A.V., Buyeverov A.O., Ivanov V.V., Ivanov Y.V.

Rationale. The article presents the data obtained by an improved method of contrast-enhanced ultrasound (CEUS) in patients with chronic viral hepatitis.

Methods. We compared the quantitative and qualitative CEUS parameters in 2 groups of patients: the 1st group was administered 2.5 ml of the contrast agent, and the 2nd group was administered 1.0 ml of the contrast agent.

Results. The results showed that the quantitative parameters had no statistical differences in the arterial and portal phases.

Conclusion. The parameters of the late venous phase were not clinically significant, since the study objective included the assessment of diffuse liver disease, not focal liver lesions.

Journal of Clinical Practice. 2019;10(1):4-9
The results of staged endovascular revascularization with use of stents with third generations of drug-eluting and biodegradable polymer in patients with acute coronary syndrome and multivessel coronary artery disease
Bocharov A.V., Popov L.V.

Background. Acute coronary syndrome (ACS) is currently the leading cause of people’s death worldwide.

Objective. Based on the analysis of a combined end point, MACCE, to estimate the efficacy and safety of the strategy of staged endovascular revascularization in comparison with heart bypass surgery in patients with ACS and multivessel involvement in a distant time period.

Methods. We have performed an analysis of the long-term results of staged endovascular revascularization of the myocardium using 3d generation drug-eluting stents with a biodegradable polymer coating in patients with ACS and multivessel involvement, in comparison with the results of heart bypass surgery.

Results. According to the non-inferiority hypothesis test, the non-inferior efficacy of staged endovascular revascularization in comparison with heart bypass surgery has not been proven, using the MACCE combined point of emerging major cardiovascular events, the frequency of repeated revascularization in the groups does not exhibit statistically significant differences.

Conclusion. Heart bypass surgery is comparable to endovascular revascularization with the use of 3d generation drug-eluting stents in the frequency of repeated revascularizations.

Journal of Clinical Practice. 2019;10(1):10-15
Disorders of fine motor skills after a stroke: the processes of neuroplasticity and sensorimotor integration
Ekusheva E.V., Komazov A.A.

Background. Impairment of fine motor skills in the hand is one of the most frequent causes of the persistent loss of professional skills, social maladjustment, and the impossibility of self-care in patients after a stroke, which ultimately leads to a significant reduction in the quality of their life. The article discusses the features of the fine motor skills’ impairment in the hand in patients after a stroke, in the context of a lateralized hemispheric lesion.

Methods. We have studied 26 patients after a primary ischemic stroke in the pool of middle cerebral artery of the right (n=12) or left (n=14) brain hemisphere. The average age of patients was 55.7±7.3 years. Patients with a right-sided ischemic stroke were comparable to those with a left-sided stroke in their age, disease duration, size of the lesion and the gender ratio.

Results. All the patients after an ischemic stroke had motor impairment in the form of a hemiparesis of a mild or moderate degree.

Discussion. We suggest the existence of differentiated mechanisms for the development of fine and highly coordinated voluntary movements in the hand of patients after an ischemic stroke, depending on the lateralization of the supratentorial lesion: diffuse deficit of the afferent support in a right-sided ischemic stroke vs. bilateral efferent deficit for a left hemisphere lesion.

Conclusion. The obtained data on the differentiated mechanisms for the development of fine and highly coordinated voluntary movements in the hand of patients after an ischemic stroke warrant the necessity of a further, more targeted research on those disorders in the post-stroke period, on order to optimize the existing rehabilitation approaches and improve the functional potential and quality of life of such patients.

Journal of Clinical Practice. 2019;10(1):16-22
Ultrasound steatometry in patients with non-alcoholic fatty liver disease: pilot results
Venidiktova D.Y., Borsukov A.V., Alipenkova A.V., Eremkina A.V., Tagil A.O., Trushova V.A.

Objective. To evaluate the effectiveness of the ultrasound steatometry technique in patients with non-alcoholic fatty liver disease.

Materials and methods. 68 patients aged 19–62 years (median age 40.5 years) were examined, 30 men (44.1%) and 38 women (55.9%), who underwent a single diagnostic algorithm of 7 (8) stages: questioning, clinical examination, noninvasive bioimpedance, biochemical blood test, liver ultrasound in B-mode, determination of hepatorenal index, ultrasound steatometry, liver biopsy.

Results. In 4 patients (5.88%), a remote clinical picture of the metabolic syndrome, fatty liver infiltration was diagnosed. Signs of steatohepatitis were present in 19 (27.9%) patients, signs of cirrhosis — in 2 (2.9%). The sensitivity and specificity were 60.3% and 72.6%, respectively, for the B-mode, 44.3% and 51.9%, respectively, for the ultrasound measurement of the hepatorenal index, 90.6% and 92.2%, respectively, for ultrasonic steatometry.

Conclusion. Ultrasound steatometry is an informative method for screening of patients with non-alcoholic fatty liver disease. Correlation (r) of the ultrasound diagnosis of steatosis with biopsy at the stage S0 corresponds to 0.81, at the stage S1 — to 0.68, at the stage S2 — to 0.74, at the stage S3 — to 0.88, that indicates a high information value of this method.

Journal of Clinical Practice. 2019;10(1):23-29
Cardiooncology. Basic principles of prevention and treatment of cardiotoxicity in cancer patients
Plokhova E.V., Doundoua D.P.

Advances in the diagnostics and treatment of cancer have led to improved survival of patients and decreased mortality. Cardiovascular complications (CVC) however, are among the most frequent side effects of anticancer treatment, which can have an adverse effect on the prognosis. This may be the result of cardiotoxicity, which involves direct effects of the radiation therapy and /or chemotherapy on the heart function and structure. Heart failure with cancer therapy was associated with a 3.5-fold increase in the risk of mortality compared with idiopathic cardiomyopathy. The cardiotoxicity risk assessment is often difficult, due to the different susceptibility of patients to drugs and their combinations, and coadministration of radiation therapy. Therefore, the likelihood of development and the time of occurrence of cardiotoxicity may vary and not always depend on the initial risk. Strategies for managing such patients are in most cases based on the expert opinion. This article provides recommendations for the prevention and therapy of cardiotoxicity, set out in the consensus of the European Society of Cardiology 2016.

Journal of Clinical Practice. 2019;10(1):30-40
Efficacy and safety of carvedilol in combination with bronchodilators in patients with CHF of ischemic origin and COPD.
Evdokimov V.V., Evdokimova A.G., Yushchuk E.N.

Objective. To study the effectiveness of carvedilol, tiotropium bromide and indacaterol in complex therapy on clinical and functional parameters in patients with CHF of ischemic origin in combination with COPD.

Material and methods. The study included 98 patients aged 45–75 years, suffering from CHF II–III FC with post-infarction cardiosclerosis, LV ejection fraction less than 45% and COPD of 2–3 degrees (GOLD). In addition to basic therapy all patients received carvedilol and were divided into 3 groups: tiotropium was administered in the 1st (36 people), indacaterol in the 2nd (32 people), and a combination of tiotropium and indacaterol in the 3rd (30 people). At baseline and after 6 months of follow-up, the clinical condition, exercise tolerance were assessed, the quality of life was assessed using the clinical state rating scale (SHOX) and MRC dyspnea scale, questionnaires of University of Minnesota (MLHFQ) and St. George’s Hospital (SGRQ). EchoCG, 24-hour blood pressure monitoring with simultaneous ECG recording, and spirometry test were performed.

Results. The use of carvedilol in combination with tiotropium and indacaterol (both in mono and in combination) as part of complex therapy of CHF II–III FC of ischemic genesis with COPD is safe and effective: the clinical condition of patients improved, quality of life, frequency and duration of ischemia episodes decreased significantly, significantly increased LVEF, decreased pulmonary hypertension, improved condition of the bronchopulmonary system.

Journal of Clinical Practice. 2019;10(1):41-47
Adaptation of the method of pulse wave velocity measurement for screening examinations in outpatient practice
Tkachenko Y.V., Strazhesko I.D., Borisov E.N., Plisiuk A.G., Orlova I.A.

Background. Estimation of the parameters of arterial stiffness allows one to make conclusions about the development of CVD long before clinical manifestations of the target organ damage. The determination of the pulse wave velocity (PWV) is the «gold standard» for the arterial wall stiffness assessment. The oscillometric method of PWV measurement has a number of advantages (convenience and high speed) over the most common «two-point» techniques.

Objective. The purpose of this work was to adapt the PWV measurement using the oscillometric method for screening outpatient examinations. Using a BPLab Vasotens diagnostic oscillometric system (Russia), PWV was measured in 152 patients, and a formula was obtained for recalculating PWV values in the supine position on the basis of PWV values in the sitting position.

Methods. Using a BPLab Vasotens diagnostic system, PWV was measured in 152 patients, and a formula was derived for recalculating PWV values in the supine position on the basis of PWV values in the sitting position.

Results. Measuring aortal PWV in the sitting position gave an opportunity of a simultaneous study of the central and peripheral BP parameters and the arterial wall stiffness. The obtained data may be used during patients’ screening in the outpatient setting.

Conclusion. The use of the screening procedure for the PWV measurement in the outpatient practice will allow concluding on the CVD development long before clinical manifestations of the target organs damage and will rid the patient of a possibility of a wrong estimation of their cardiovascular risk.

Journal of Clinical Practice. 2019;10(1):48-56
Review of methodology and materials using for building of gum soft tissues
Tarasenko S.V., Zagorskij S.V.

In the review we analyze the basic surgical techniques applied to increase the volume of a keratinized gum and materials used for this procedure, such as dermal and collagen matrices. The results of clinical trials are presented on the effectiveness of collagen matrices, including Mucograft. The analysis of the literature highlights the main advantages and disadvantages of these methods and materials, as well as the most significant and promising areas for the further clinical research.

Journal of Clinical Practice. 2019;10(1):57-62
Deep stimulation in neurosurgery
Kalinkin A.A., Vinokurov A.G., Kalinkina O.N., Ilinykh A.S., Bocharov A.A., Durov O.V., Isaev E.N., Chupalenkov S.M.

The technique of deep brain stimulation is used to treat patients with various diseases of the central nervous system who are not amenable to conservative therapy, while open interventions in them are associated with a high risk of complications. In the review, we evaluate the efficiency of the deep stimulation of different regions of the brain in some pharmacoresistant forms of diseases.

Journal of Clinical Practice. 2019;10(1):63-71
Anterolateral ligament as a main stabilizing structure оf rotational stability оf the knee joint
Epshtein A.A., Prizov A.P., Lazko F.L., Zagorodniy N.V., Akhpashev A.A.

Currently, anterior cruciate ligament grafting is one of the most popular operations on the knee joint, but despite the fact that the technique has been used for years, there is a high percentage of unsatisfactory long-term postoperative results, reaching 25%, according to various authors. The concern over this problem has led to an increase in the number of studies aimed at the understanding of the causes of these failures. Most researchers have concluded that the unsatisfactory results are associated with instability in the knee joint, which is caused by the damage of a ligamentous structure found in many dissections, namely, anterolateral ligament (ALL). In this literature review, we have analyzed the articles dedicated to the ALL, its anatomical and histological structure, its biomechanics, as well as its role in the anterolateral stability of the joint. Also in this review we consider the existing surgical methods for the correction of anterolateral instability associated with the ALL damage.

Journal of Clinical Practice. 2019;10(1):72-80
Clinical significance of ureaplasmas in urogenital pathology
Kovalyk V.P., Vladimirova E.V., Rubasheva T.V., Sirmays N.S.

The clinical significance of Ureaplasmas in urogenital pathology is reviewed. Ureaplasmas belong to the class Mollicutes. Asymptomatic carriage of these bacteria is common, and most individuals do not develop disease. Ureaplasma urealyticum and Ureaplasma parvum are sexually transmitted bacteria among humans implicated in a variety of disease states including but not limited to: nongonococcal urethritis, adverse pregnancy outcomes, chorioamnionitis, and bronchopulmonary dysplasia in neonates. U. urealyticum has been associated with urethritis in men and is revealed in a high concentration that confirms its etiological role in the disease. Men with a high U. urealyticum load are considered for treatment, however, the data on the therapy efficiency have been insufficient so far. In symptomatic women, bacterial vaginosis should always be tested for, and the corresponding therapy should be prescribed in case of positive results.

Journal of Clinical Practice. 2019;10(1):81-87
Case report
Harlequin’s face — a rare form of autonomic dysfunction during dissection of the internal carotid artery
Belopasov V.V., Gubanova M.V., Belopasova A.V., Kalashnikova L.A., Dobrinina L.A.

A comprehensive examination and dynamic observation of a patient with clinical manifestations of connective tissue dysplasia and dissection of the internal carotid arteries revealed a symptom complex characteristic of Harlequin syndrome. The description of this form of pathology is given for the first time in the national literature. A brief review presents the diagnostic criteria and mechanisms for the development of this rare autonomic dysfunction.

Journal of Clinical Practice. 2019;10(1):88-93
Spinal muscular atrophy. Clinical and genetic examination and risk assessments in pregnancy planning (SMA) woman
Mitkovsky V.G., Ponomareva N.Y., Makarova V.V., Milagina V.S., Yampol’skaya E.N., Kochetkov A.V.

The resulted clinical example of genetic diagnostics of the causes of spinal muscular atrophy in a patient planning fertility. The revealed mutation made it possible to clarify the etiology and pathogenesis of the development of neuromuscular disorders, determine the prognosis of inheritance and prenatal diagnosis, and evaluate the possibilities of adequate treatment.

Journal of Clinical Practice. 2019;10(1):94-100
Familial mediterranean fever: clinical case
Saykovskiy R.S., Sadovnikova S.V.

Background. Familial Mediterranean fever (FMF) is the brightest exponent of autoinflammatory diseases. FMF usually occurs to people of Mediterranean origin (Jews, Armenians, Azerbaijanis, Arabs, Kurds, Greeks, Turks and Italians). This is a hereditary disease with the autosomal recessive inheritance. Includes history of research, epidemiology FMF, variants of the disease course, methods of treatment.

Clinical case description. A 61-year-old woman arrived complaining of weakness, fever, joint pain. First sign of disease showed at 20-years-old. When she came in: WBC 20.1–109/l, HGB 6.7 g/ml, ESR 60 mm/h, CRP 100 mg/l, CRP 202 μmol/L, UREA 19.7 mmol/L. Quantity of protein in one liter of urine 0.160 g. Ultrasonic signs of pyelectasis in both kidneys. The diagnosis was made on the basis of characteristic attacks of fever, polyarthritis, thoracalgia of Armenian nationality patient. The diagnosis was confirmed by the detection of amyloidosis and genetic data.

Conclusion. Knowledge of the FMF clinical profile is important for differential diagnosis with many acute conditions, e.g. acute abdomen, myocardial infarction, pneumothorax, rheumatic diseases. It is important to remember that untimely diagnosis and improper treatment lead to the development of AA-amyloidosis (30–40%) with the outcome of renal failure.

Journal of Clinical Practice. 2019;10(1):101-107
Healthcare system administration
The influence of the media on the formation of cognitive dissonance in the doctor-to-patient interaction
Baglyuk S.B., Kasatkina N.S.

The purpose of the article is to discuss the specifics of communication between a doctor and a patient, complicated by the influence of the media. A survey of pseudoscientific ideas challenging a specialized medical knowledge together with the method of content-analysis indicate a cognitive dissonance in the doctor-patient interaction. Conclusions: the dissonance factor and the minimum necessary mutual understanding between a doctor and a patient are regulated by situationally relevant communicative models.

Journal of Clinical Practice. 2019;10(1):108-113

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