Vol 96, No 6 (2015)

The main stages of development and formation of the cardiovascular surgery in the Republic of Tatarstan and the role of the department of surgical diseases №2, on the basis of which this branch of surgery engendered in the 60s of XX century, are represented. The first demonstrational cardiac surgeries (closed mitral commissurotomy) were performed in Kazan at the premises of the 3d city hospital by academician A.A. Vishnevsky in 1958. In 1963 the 6th city hospital became the main base of the department of surgical diseases №2 in Kazan, and the first cardiac surgery intervention was performed on April 15, 1963 on 26 years old patient with mitral stenosis of rheumatic etiology. In the 70s of XX century cardiac surgery service at the premises of 6th city clinical hospital got the status of Interregional cardiac surgery center. From the beginning of the 1990s, cardiopulmonary bypass surgery became leading in the department of cardiac surgery. In 1992 the cardiac surgery department of the 6th city clinical hospital was reorganized and became the Kazan Center of Cardiovascular Surgery with 75 beds, since 1995 bearing the name of professor N.P. Medvedev. In 2000 the department was headed by associate professor R.K. Dzhordzhikiya (doctoral thesis «Minimally invasive surgery of acquired heart valve disease», 2004). In 2005 more than 300 cardiopulmonary bypass surgeries has been performed in the clinic. In 2006 employees of the center in almost full strength moved to the Interregional clinical diagnostic center, the first cardiac surgery at the center was performed in September 2006. Annually the number of high-tech operations increases. At the same time scientific research work is carrying out. The generalizing research studing the results of the preservation of annulo-papillary continuity when replacing valve in the mitral position with mechanical prosthesis in patients with rheumatic disease conducted at the center was one of the first in Russia. The past 80 years of the history of the Department of Cardiovascular Surgery and the stable foundation laid by previous generations of researchers and clinicians, the glorious representatives of the Kazan school of cardiovascular surgery, serve as a guarantee of successive development of scientific and clinical work of the department and the whole cardiac surgery service in the Republic of Tatarstan.

Aim. Evaluation of the global systolic function of the right ventricle according to multislice computed tomography in patients with pulmonary embolism.

Methods. 37 people aged 31 to 75 years (20 women and 17 men, mean age 55±12 years) were examined. The study group included 15 patients without clinical or instrumental signs of congenital heart disease and myocardial infarction of the left and right ventricles, with signs of pulmonary embolism according to multislice computed tomography. The control group included 22 patients. Tomographic analysis of end-diastolic volume, ejection fraction of the left and right ventricles was performed during noninvasive multislice computed tomography - coronary angiography, angiopulmonography. The study was conducted on a 64-helical computed tomography Aquillon 64 (Toshiba, Japan).

Results. Analyzing group medians in patients with pulmonary embolism there was a decrease of the right ventricular ejection fraction and end-diastolic volume of the left ventricle (р <0.05). There was no statistically significant difference in left ventricular ejection fraction and end-diastolic volume of the right ventricle. An increase of the end-diastolic volumes of right and left ventricles ratio in group of patients with pulmonary embolism compared to control (р <0.05) was found.

Conclusion. Multislice computed tomography (angiopulmonography with electrocardiographic synchronization) allows to diagnose pulmonary embolism and evaluate global contractility of the right ventricle; in patients with pulmonary embolism a decrease of the right ventricular ejection fraction, increase of the end-diastolic volume of the right and left ventricles ratio was observed.

Aim. To develop a method for determination of the differentiated types of hemodynamics based on the data analysis of integral circulation indicators.

Methods. The method for determination of the differentiated hemodynamics types was developed based on the data analysis of integral circulation indicators - cardiac output, heart rate, total peripheral vascular resistance and modulus of volume elasticity. The types of hemodynamics - hyperkinetic, eukinetic, hypokinetic - were determined by cardiac output. Tachy-, normo- and bradisistolic subtypes were determined by the heart rate, subtypes with a predominance of vascular resistance and arterial stiffness were determined by the modulus of volume elasticity and total peripheral vascular resistance ratio. Four groups of patients were examined. The first group included 63 patients with I-III degree of arterial hypertension aged 18 to 77 years, mean age 48.9±12.38 (M±σ). The second group - 82 patients with primary hypothyroidism and I-III degree of arterial hypertension aged of 41 to 75 years, 59.8±7.9 years (M±σ). The third group - 33 patients with rheumatoid arthritis and I-III degree of arterial hypertension aged 17 to 67 years, 47.2±8.12 years (M±σ). The control group included 32 healthy volunteers aged 21 to 37 years, 24.7±5.34 years (M±σ).

Results. Eukinetic and hyperkinetic circulation types with predominance of peripheral vascular resistance were mostly identified in healthy volunteers. Eukinetic type of hemodynamic with predominance of peripheral vascular resistance is typical for patients with hypothyroidism and arterial hypertension, and for patients with rheumatoid arthritis and arterial hypertension hyperkinetic and eukinetic types with predominance of the arterial system rigidity are characteristic. Eukinetic and hypokinetic circulation types with predominance of both peripheral resistance and arterial stiffness are mostly present in essential hypertension.

Conclusion. Developed method of distinguishing the differentiated types of hemodynamics allows determining the hemodynamic heterogeneity in both healthy people and patients with hypertension.

Aim. To evaluate the diagnostic approaches to viral hepatitis B and immune response on hepatitis B vaccination among clinical dispensary of dermatology and sexually transmitted diseases medical staff.

Methods. The study included 92 serum samples of healthcare facility staff who underwent hepatitis B vaccination more than 7 years before. To assess the post-vaccination immunity, levels of antibodies to surface antigen of hepatitis B (anti-HBS) were determined by ELISA. Published data on the duration of post-vaccination immunity and annual reporting forms of clinical dispensary of dermatology and sexually transmitted diseases of Kazan in 2013 were analyzed.

Results. Patients with human immunodeficiency virus, viral hepatitis B and C are often seeking for medical aid, retaining the risk for medical staff and other patients to be infected. Diagnosis of hepatitis B virus in medical settings is based on the detection of hepatitis B surface antigen (HBSAg), while revealing hepatitis B core antigen (HBCAg), anti-HBC (summary levels), extra-Dane particle antigen (HBEAg) and other markers of viral hepatitis B would allow to diagnose a latent form of hepatitis B. In 56.5% (n=92) of cases, anti-HBs levels were below the protective titer, suggesting higher risk for infection and requiring an additional revaccination. In the remaining 43.5% of cases, protective antibodies titers were revealed, confirming the effectiveness of specific prevention measures.

Conclusion. Despite the mass vaccination for hepatitis B, owing to post-vaccination immunity weakening over time, revaccination of medical staff remains important.

Aim. Explore the effectiveness of the double-barreled drainage tube «tube in tube», mounted by the developed technique after rectum sphincter-sparing abdominoperitoneal resection due to cancer.

Methods. The data of 52 patients with rectal tumors who underwent rectum sphincter-sparing abdominoperitoneal resection in two surgical wards over the past 4 years were analyzed. At the surgery, the colon was brought down together with anal channel mucosa excision and bringing down the colon mucosa to the anal channel. Rectum sphincter-sparing abdominoperitoneal resection was finished in all patients by placing a double-barreled drainage tube of the original construction to the retroperitoneal part of the cavity of the true pelvis by an original method via the anterior abdominal wall incision. No one-step intestinal stoma was exteriorized in any of the patients.

Results. The average duration of postoperative hospital stay was 17 days; in patients who underwent non-hybrid operation (50 of 52 patients) - 15.3 bed-days. Postoperative complications occurred in a total of 11 (21.1%) patients, and the rate of septic complications was 1.9%, which is lower compared to published data. It is worth noticing that the use of our original method of pelvic cavity draining totally excludes peritoneal fistula formation and facilitates post-operative care.

Conclusion. The proposed method of pelvic cavity draining at rectum sphincter-sparing abdominoperitoneal resections might be effective, as is associated with lower chance of purulent and septic complications. It excludes the possibility of perineal fistula formation, facilitates the post-operative period management.

Aim. To specify the indications for in situ femoropopliteal (tibial) bypass, to study complications rate immediately after, within 1 and 2 years of the surgery.

Methods. The study group included 33 patients with symptoms of critical lower limb ischemia, who underwent femoral-popliteal or femoral-tibial bypass. 4 (12.1%) cases of type C and 29 (87.9%) cases of type D arterial bed lesions according to TASC II classification were revealed after investigation. Patients were followed up for 2 years period. Shunt thrombosis rate, condition of the trophic ulcers, chronic arterial ischemia stage before and after the surgery, mortality, lower limb amputation were measured outcomes.

Results. Repeated reconstructions rate for primary shunt thrombosis immediately after surgery was 30.3±8.0%. Shunt thrombosis (secondary) occurred in only three (9.1±5.0%) patients. The main causes which led to the shunt thrombosis during or at the 1st day after the surgery, were absence of intraoperative valvulotomy quality control and presence of unligated great saphenous vein tributaries. Trophic defects healing was observed in 3 (30.0±14.5%) of 10 patients with ulcers immediately after surgery and in all cases (100.0%) by the end of 1 year follow-up. The total number of high-level amputations within 2 years was 25.8±7.9%, the overall mortality rate within 2 years was 6.1±4.2%. Femoral-popliteal or femoral-tibial bypass surgery allowed to preserve the limb in 74.2% of patients within 2 years of follow-up. Bypass patency was preserved in 41.7% of patients out of 24 in situ bypass surgeries for the follow-up time. In our opinion critical limb ischemia with significant and extended arterial bed lesions of D and C types (according to TASC II score) is one of the indications for in situ femoropopliteal (tibial) bypass as for the surgery of the first choice. Endovascular treatment is also impossible for this type of lesion, as alternative surgeries using reversed autovein and synthetic explant do not meet all the requirements for an extended bypass.

Conclusion. The lack of adequate intraoperative valvulotomy quality control and presence of unligated great saphenous vein tributaries may be the causes of early postoperative shunt thrombosis; despite the low femoropopliteal (tibial) bypass patency rate in patients with critical ischemia, the surgery was recognized as efficient as it allowed to preserve the limbs in 74.2% of patients.

Aim. To study clinical course of atopic dermatitis and improve dermatosis therapeutic tactics in vitamin D deficiency. Study design - comparative observational open-label study.

Methods. 67 patients with a verified «atopic dermatitis» diagnosis were selected to study. Serum calcidol level below 75 nmol/l was observed in 32 patients what was the basis to division of the observed patients into two groups. Conventional therapy (local glucocorticoids and moistening agents, systemic administration of non-specific anti-inflammatory and desensitizing agents) was administered to all patients. Vitamin D active form - alfacalcidol (Alpha D3-Teva) was administered to patients of the second group as a part of complex therapy.

Results. Good clinical results have been achieved amid the treatment, in 21 days SCORAD index decreased by 86.56% in the first group, in the second - by 93.63%, with the clinical remission achievement in over 75% of patients in both groups. Atopic dermatitis complex therapy using alfacalcidol contributed to the normalization of the vitamin D concentration (from 42.92±2.87 to 79.26±4.92 nmol/l) and total calcium level (from 1.97±0.4 to 2, 21±0,8 mmol/l), reduced TEWL measurement and increased corneometry results. The therapy did not contribute to the sebometry data change in both groups.

Conclusion. Vitamin D deficiency leads to more severe atopic dermatitis course; complex treatment of this disease with alfacalcidol facilitated normalization of serum vitamin D level and tendency to the epidermal barrier recovery, what opens new possibilities in the treatment of atopic dermatitis.

Aim. To analyze the injection anesthesia use frequency in the treatment of primary and permanent teeth pulpitis by paediatric dentists of Republic of Tatarstan, Mari El and Chuvashia according to survey results.

Methods. 202 pediatric dentists participated in questionnaire survey.

Results. 89.55±2.64% of specialists use devital amputation method in Tatarstan, 94.12±2.85% - in other regions. Significantly more doctors use vital extirpation (85.29%) and vital amputation (41.17%) in the permanent teeth treatment in regions than in Tatarstan (69.40 and 25.37%, respectively). 76.47% of doctors in regions and 54.47% in Tatarstan (p <0.01) use injection anesthesia in the treatment of permanent teeth pulpitis in their daily practice. Injection anesthesia is used by 20.15% of dentists in Tatarstan and 26.47% in regions when treating primary teeth. Percentage of specialists who do not use anesthesia in their practice is greater In Tatarstan - 29.10% (8.82% in other regions). Less than 10% of physicians use infiltration anesthesia, conduction and periodontal methods. The main reasons of doctors refusal from the use of injection anesthesia in children - a child’s behavior, which does not allow to perform the procedure, fear of complications and paediatric dentists belief in the absence of its necessity.

Conclusion. Low percentage of injecting anesthesia use in pediatric dentistry was revealed, especially in the primary teeth treatment; there is a need for dentists motivation to wider use of injection techniques of analgesia in the pulpitis treatment by raising awareness, what will allow to use more advanced methods of pulpitis treatment, reduce number of visits and treat more efficiently and painlessly.

Aim. To perform quantitative analysis and immunohistochemical phenotyping of regional lymph nodes structural and cellular elements in gastric cancer in the absence and the presence of metastases.

Methods. The regional lymph nodes obtained during surgery for gastric cancer from 48 patients (31 men and 17 women, mean age 60.9 years) were studied. Histological sections were stained with haematoxylin and eosin, van Gieson stain, azure-II-eosin, pyronin by Brashe. Then morphometric analysis of lymph nodes structural and cellular elements was performed. A set of monoclonal antibodies against CD45, CD3, CD4, CD8, CD10, CD20, CD30, BLA-36, immunoglobulin (Ig) λ- and κ-chains, CD56, myeloperoxidase, CD68, lysozyme, α1-antichymotrypsin, CD35, S100, Ki-67, CD31, collagen type IV, vimentin, desmin was used for immunohistochemical reactions. Comparative study was performed in the following groups: (1) control group; (2) lymph nodes without metastases; (3) lymph nodes with metastases of different size.

Results. Paracortical and follicular hyperplasia, sinus histiocytosis, microcirculatory disorders and fibroplastic processes were found in regional lymph nodes in gastric cancer development. Paracortical hyperplasia was characterized by following immunohistochemical phenotype: CD 45, CD 3, CD 4, CD 8, CD 10, CD 30, CD 56, S 100, CD 31, Ki-67. CD45, CD20, BLA-36, CD10, CD30, CD35, Ig λ- and κ-chains, Ki-67 were mainly expressed in follicular hyperplastic reaction. The sinus reaction was accompanied by total cellularity increase with a predominance of CD68(+), α1-antichymotrypsin(+) and lysozyme(+) cells. Expression of CD3, CD4, CD8, CD10, CD56, Ki-67 decreased amid the paracortical zone area reduce in metastases development. Sinuses were devastated and poor with cellular elements, often with lymphostasis or sclerosis signs. Imunohistochemically there was moderate reaction with monoclonal antibodies against α1-antichymotrypsin, low - against lysozyme, myeloperoxidase, and high - against vimentin. Wherein follicular hyperplasia with high levels of CD20(+) B-cells, BLA-36(+) activated lymphocytes and Ig(+) antibody producing plasma cells persisted. At the same time microcirculatory disorders and fibroplastic processes progressed.

Conclusion. Structural components area ratio, cellular composition and immunohistochemical phenotype change in the regional lymph nodes in gastric cancer development, with significant differences between intact and affected lymph nodes; paracortical zone and sinuses area reduction with T-, NK-cells and macrophage markers expression decrease amid the preservation of follicular hyperplasia with high level of activated B lymphocytes and antibody producing plasma cells can promote metastases engrafment in lymph nodes and further cancer generalization.

Aim. To evaluate knowledge about contraception and the harms of abortion, and the young students’ attitude to a family creation.

Methods. The study object was students of colleges and secondary technical schools in Samara. The study method was questionnaire survey. 754 questionnaires were analyzed using SPSS 21 package.

Results. About 80% of students are aware of the getting pregnant possibility as a result of a single sexual encounter and that the condom is a reliable mean of protection against both unintented pregnancy and the human immunodeficiency virus and other sexually transmitted diseases. A little more than half of respondents (55%) know about emergency contraception, the awareness level increases with age - from 42% in 15-year-olds to 73% in 19-year-olds. In total 36% of students are aware of the high reliability of combined oral contraceptives: 22% - among 15-year-olds, 47% - among 19-year-olds. Only 40% of students are aware that coitus interruptus is unreliable method of contraception, and the informed students proportion increases with age from 36 to 52%. Understanding that protection according to the menstrual cycle is an inefficient mean of contraception increases with age from 22% among 15-year-olds to 44% among students aged 19 years and older, accounting for 31% of all respondents. 7% of sexually active students have undergone abortion, and 3% - more than once. Contraceptive awareness analysis showed that the knowledge level among students who denied sex increases with age not as essentially as in the general group.

Conclusion. Knowledge about the particular mean of contraception reliability do not depend on age, but on the intimate contacts experience; there is a need in additional education of secondary specialized educational institutions students by medical professionals on safe sex and the prevention of unintended pregnancy before sex life onset.

Aim. To evaluate the significance of risk factors correction for treatment effectiveness improvement and prevention of arterial hypertension in outpatient conditions.

Methods. The study was conducted in two phases over the period of 2011-2015 in Baku outpatient clinics. At the beginning of the first part of work 547 patients with controlled hypertension were followed up, by the end of study 437 patients remained followed up, 196 men and 241 women, aged from 23 to 68 years, disease duration was from 4 months to 14 years. At the beginning of the second part of the study measures for hypertension prevention were taken in 916 patients with normal blood pressure (788 patients completed the study).

Results. In patients with long-term course of the disease, maintaining a stable target blood pressure (<130/80 mm Hg) was possible with great difficulty, despite the antihypertensive therapy. The main reasons were occasional visits to the doctor, and low compliance to treatment, lack of risk factors awareness and their correction necessity. The antihypertensive therapy combined with risk factors correction resulted in the blood pressure normalization during the entire follow-up period. In the second part of the study, it was shown that the motivation to the risk factors correction prevented the formation of hypertension new cases (in the first group - only 5.1±1.6% of new clinically not apparent hypertension cases which were effectively cured). In the group with a partial motivation of the major risk factors modification 11.4±1.7% of new cases of clinically not apparent hypertension (χ2=6.08; p <0.02) and 2.4±0.8% cases of symptomatic hypertension occurred over the 3 years. In the group of patients, who were not motivated to correct risk factors 18.9±2.4% of new cases of clinically not apparent hypertension (χ2=6.47; p <0.02) and 6.6±1.5% of severe arterial hypertension cases (χ2=6.51; p <0.02) were formed over the 3 years. The lack of motivation reduced the hypertension treatment effectiveness: in the clinically not apparent forms it was 61.2±7.0% (χ2=5.92; p <0.02), and in clinically apparent forms - 29.4±11.4% (χ2=4.81; p <0.02).

Conclusion. Approach to secondary prevention of hypertension at the population level was evaluated, the basis of which consisted of the outpatient network readiness to the continuous blood pressure monitoring, scientific rationale of the dominant risk factors, explanatory work on the risk factors modification and health status self-control among the population; significance of risk factors correction was found.

Aim. To provide the experimental rationale for technology of autologous modification of dental implants based on non-woven titanium material with a through porosity considering the indicators of peg-spacer primary stability.

Methods. Randomised study included 20 preparations of mandible of pigs aged form 9 to 13 months. Periotest method was used for comparative assessment of stability indicators of dental implants models based on non-tissue titanium material with a through porosity that were installed using the conventional technology and by autologous modification using pin spacer diameters of 1.8, 2.0 and 2.3 mm.

Results. Increasing the pin spacer diameter from 2.0 to 2.2 mm increases the indicators of stability by 13.33 PT in models of dental implants with sleeve of nonwoven titanium material with a through porosity, by 2.7 PT - with sleeve of nonwoven titanium material modified by autologous bone. Modification of nonwoven titanium material with a through porosity by autologous bone increases implant stability by 13.49 PT with pin spacer diameter of 2.0 mm, by 2.86 PT - with pin spacer diameter of 2.3 mm.

Conclusion. The stability of the dental implant model depends on the pin spacer diameter of the intraosseous part and the density of nonwoven titanium material with a through porosity, which is regulated by autologous bone modification. Study results suggest using the technology of autologous modification of dental implants based on nonwoven titanium material with a through porosity widely in clinical practice.

The article reviews chronic constipation diagnostics and treatment issues. According to the russian and foreign authors data, chronic constipation is a common pathology, which requires an individual approach to the patient and a spacious approach to a diagnostics and treatment problem. Chronic constipation syndrome feature is the delicacy of the problem which makes patients do not seek medical help for a long time, abuse laxatives, trying to eliminate the consequence but not the cause of a latent disease which leads to constipation. The article gives constipation syndrome definition from modern positions and its main classifications, considers the commonest risk factors for chronic constipation in clinical practice. It presents the different pathogenesis theories of the constipation syndrome. Various methods of the intestine anatomical and functional features instrumental diagnostics, as well as anorectal function assessment tests are described. Chronic constipation medicamental treatment results are given. Views on the colostasis resistant forms surgical treatment and different approaches to the selection of surgery type are covered. It is concluded that the chronic constipation problem remains relevant in abdominal surgery due to its wide prevalence, pathophysiological heterogeneity and low efficiency of therapy. At this stage, there are no evidence-based recommendations on the treatment choice for chronic constipation, made on the therapy effectiveness analysis. Rational use of the known diagnostics methods, new directions in diagnostics and therapy, for example, the determination of intestinal microbiota metabolites and designing metabolite-type drugs offers the prospects in solving this problem. The main causes of failure in chronic constipation surgery are inadequate selection of the surgery extent and marked disturbance of the colon evacuation function. Evaluation of the chronic constipation new surgical treatment methods value in the arsenal of modern coloproctology requires the accumulation of more meaningful experience. In addition, surgical interventions methods should be individual and based on understanding of the disease etiopathogenetic aspects. The review is of interest for general practitioners, gastroenterologists, coloproctologists and surgeons.

The aim of work was to compile information on current international approaches to children and adolescents physical development assessment. Physical development is an important health indicator of children and adolescents, which reflects individual sexual and constitutional features, different climatic and socio-economic living conditions. Currently different of methods are used to assess children physical development. In 2006, the World Health Organization introduced a reference growth rates of children under 5 years («Child Growth Standards for children»), which show how children should grow while ensuring proper care, feeding and healthy environment. These standards make it possible to assess the physical development of children all over the world, regardless of ethnicity, feeding type and socioeconomic status. «WHO Growth Reference 2007» standards are developed for children from 5 to 19 years. It is recommended to evaluate nutritional status from 2 years of age by calculating the body mass index standard deviation score (SDS) on the standard for the corresponding age and sex. The program for personal computers «WHO Anthro» was developed for individual assessment of children under 5 years anthropometric indicators using both parametric (sigma - Z-score determination) and nonparametric (centile - percentile determination) methods, and the program «WHO AnthroPLUS» - for children and adolescents over 5 years. The programs allow to asses physical development easily and conveniently in practical application and to visualize the results. The World Health Organization international reference standards allow to evaluate physical development pathology, including nutritional status, according to international criteria for malnutrition, overweight and obesity, short and tall stature diagnosis. Adoption of the World Health Organization standards unifies the methodology for assessing the children and adolescents physical development, will make comparable the results obtained at different time, in different countries and regions of the world.

Guillain-Barre syndrome is an acute inflammatory demyelinating polyradiculoneuropathy of autoimmune etiology, which is characterized by peripheral paralysis and protein-cell dissociation in the cerebrospinal fluid in most cases. The Guillain-Barre syndrome prevalence is 0.6-2.4 cases per 100 thousand population. In Moscow, about 200 people are taken ill with Guillain-Barre syndrome each year. Currently, four main clinical variants of Guillain-Barre syndrome are described: acute inflammatory demyelinating polyradiculoneuropathy, axonal form, acute motor axonal neuropathy, and Miller-Fisher syndrome. Disease development is preceded by contact with the viral or bacterial infections causative agent such as Campylobacter jejuni, Mycoplasma pneumonia, cytomegalovirus, Epstein-Barr virus and influenza virus. Guillain-Barre syndrome pathogenesis is «molecular mimicry» between infectious agents surfaces and the peripheral nerves structures. High titer of antibodies to the GM1, GD1a, GD1b and GQ1b gangliosides is found in patients blood serum. Diagnostic criteria for the Guillain-Barre syndrome diagnosis are the physical examination results, cerebrospinal fluid analysis and electroneuromyographic study. The North American motor deficit severity scale is used to assess the neurological status. This scale allows to evaluate the patient’s condition and movement abilities. Currently plasmapheresis and immunoglobulin G therapy are the main treatment options for patients with Guillain-Barre syndrome. The favorable prognosis in the form of disease clinical manifestations regression reaches 60-80%. Mortality in Guillain-Barre syndrome is 5% in average and may reach 20% in patients on mechanical ventilation. The most common death causes of patients with Guillain-Barre syndrome are respiratory failure, aspiration pneumonia, sepsis, and pulmonary embolism. Early treatment initiation can reduce serious complications risk, including respiratory failure, what ultimately leads to decrease in mortality and patients disablement.

Aim. To examine the problems of implementing patients’ rights for information by medical assistants in providing medical care of a minor under 16 years of age.

Methods. The study was conducted as a poll using anonymous questionnaires and semi-standardized interviews using specially designed questionnaires and the method of expert evaluations. The study involved 407 medical assistants providing medical care for children’s population, and 427 parents of minor patients (under 15 years of age). The department of health management and public health of institute of postgraduate education of Ivanovo State Medical Academy conducted the study at the medical settings of the Vladimir and Ivanovo regions.

Results. The study revealed low awareness of the medical assistants in patient’s rights for information, in particular, to have access to medical documents. Execution of the right of minor patients and their legal representatives to obtain information on the health status was shown to be inadequate, with medical assistants often ignoring the parents’ request to provide information about the health status of the child and access to medical charts and results of diagnostic procedures. A significant part of medical assistants do not consider mandatory to explain to minor patients parents the diagnostic data within their competence.

Conclusion. The currents state of affairs in implementing patients’ rights for information requires development and implementation of medical and organizational measures for better awareness of medical assistants about patients’ rights, in particular, right to be informed, as well as optimizing execution of this right.

An overview of the literature of domestic and foreign authors concerning the prisoners incarceration conditions and the health status, the most important disease groups and the medical support organization is presented. The prisoners health status significantly differs from the nationwide values, what is related to the maladgusted population stratum concentration, the prison conditions that facilitate some infectious diseases spread, and other factors. These problems are not isolated, as the majority of persons who are in prison, sooner or later return to the community. In the second half of the 1990s in Russia the leading in morbidity structure of convicted were respiratory diseases - 23.5% (respiratory viral infections, chronic non-specific lung disease, pneumonia, etc.); mental disorders - 19.6% (alcoholism, drug addiction), infectious and parasitic diseases - 17.3% (tuberculosis, sexually transmitted infections) diseases of the skin and subcutaneous tissue - 10.9% (scabies, pediculosis). In Russia during the 1990s, the death rate of prisoners increased by 3.2 times (from 323.0 to 1027.3 per 100 thousand of convicts). However, since the late 1990s, there is a steady decline in mortality, which is determined primarily by a decrease in prisoners mortality from tuberculosis. Doctors availability (excluding dentists) for persons who are in prisons in republic of Tatarstan is 45.4 per 10 thousand, nurses availability - 109.1. These values are higher than in the institutions of the Ministry of Health, in terms of doctors - by 3.2%, and nurses - 18.1%. Prisons represent an important public healthcare resources, allowing to identify, treat, and prevent a large group of diseases in complicated target group which is often difficult to get by civilian health services. Existing problems in the prisoners health, poor material and technical resources of medical services are due to inadequate funding of the Department of the correctional system. Lack of legal framework does not allow the administration to take into account features of the most vulnerable categories of prisoners.

The problem of securing and protecting the citizens rights for the medical care delivery in the existing legislation is one of the most relevant in the modern Russian law. In domestic legislation the right to health and medical care is primarily enshrined in the Constitution of the Russian Federation. For example, the article 41 establishes the right to get free medical care in accordance with the state guarantees program of free medical care delivery to citizens, and to receive paid medical and other services. However, there are some peculiarities and problems of these rights implementation in minor patients. This article is devoted to the analysis of this problem certain aspects. In particular, it raises questions on the patient’s right to get information about his/her health status, enshrined in the Fundamentals (article 19) and the Law of the Russian Federation «On Protection of Consumers’ Rights of 07.02.1992». Quite controversial is the situation when the legal representatives of a minor under the age of 15 years strongly refuse medical intervention and hospital insists on it. Considering the features of the right ofminors to confidentiality, it should be noted that providing the information constituting patient’s confidentiality to legal representatives is not stipulated by the national medical legislation standards in case of minors over 15 years old. However, it should be taken into account that in case of harm infliction to a minor or unlawful interference with the minor’s health, the latters not having full legal capacity, are not able to protect themselves. Also in the current legislation in the field of donation and transplantation the problem of the minors lifetime donation regulation remains unsolved. In summary, it should be noted that, despite the relative development of the legislation on the minor patients rights, in reality unusual situations that create psychological, moral and ethical problems for doctors occur quite often.

Aim. Assess the changes of neurological and psychological status in patients with acute stage of the first ischemic stroke.

Methods. The study included 25 patients with ischemic stroke, the average age was 65.72±12.49 years. Neuropsychological examination was performed using a Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment scale (MoCA), Beck Depression Inventory, Spielberger State-Trait Anxiety Inventory, Lazarus Ways of Coping Questionnaire. All studies were performed twice on day 1-3 and on day 19-21 after the stroke.

Results. Mild motor dysfunction by National Institute of Health Stroke Scale (NIHHS) was registered at admission. By the end of the acute period, positive changes were registered: NIHSS score decreased by 66.4%, significant improvement in patient’s cognitive status was seen. The average depression score by Beck Depression Inventory was 15.6 points, with severe depression diagnosed in 2 patients. By the end of the acute period, depressive symptoms regressed to the average level of 11.1 points. Reactive anxiety at admission was low, personal anxiety - high. By the end of the acute period anxiety remained at the same level or slightly reduced. Direct correlations of the neurological deficit degree by NIHSS and depression score by Beck Depression Inventory, as well as the later with personal anxiety level were revealed. Inverse correlation between the MMSE cognitive status and depression levels was discovered.

Conclusion. By the end of the acute period, the severity of emotional disorders decreases and cognitive function improves together with restoring motor activity.

Congenital heart diseases are third most prevalent congenital disorders right after congenital musculoskeletal and central nervous system disorders. Up to 30-35 thousand of children with congenital heart disease are born annually in USA, 20-22 thousand - in Russia, 320-350 children - in the Republic of Tatarstan. Univentricular heart is among rare and unique congenital heart disorders. The natural course of the disease is poor, with two thirds of patients passing away within the first year due to severe pulmonary hypertension, progressing heart failure, and severe hypoxia and heart arrhythmias. Prenatal influence of the disorder on hemodynamics is not significant, and babies are born with normal body weight and length. In most of the children, the disease is diagnosed within the first months after birth. If combined with pulmonary artery stenosis and transposition of the great vessels, clinical manifestations are associated with serous hypoxia and cyanosis. Intensive cyanosis is observed since birth, peripheral signs of hypoxia - phalangeal and nail deformities are seen early. Such children do not frequently have respiratory diseases, despite shortness of breath; there is no crackles in lungs. In the absence of pulmonary artery stenosis, the clinical picture reminds congenital heart disorder with big ventricular septal defect and left to right shunt with the expressed hypervolemia and moderate cyanosis, which becomes more severe while crying and at feeding. Children often have recurrent pneumonia and bronchitis, lag behind in physical development, they constantly have a shortness of breath and tachycardia, hepatomegaly occurs early. A clinical case of the patient with congenital heart disease (univentricular heart) and severe congestive heart failure is presented. The peculiarity of this case is the presence of the single atrium communicating through a common atrioventricular valve with a single ventricle, from which two main vessels begins with the aortic and pulmonary valves, as well as atypical long clinical course associated with heart arrhythmia and extensive cardiac remodeling.

The article describes Romanov dynasty representatives work as the Sisters of Mercy: the sister of Emperor Nicholas II Grand Duchess Olga Alexandrovna, and cousin of the Emperor Grand Duchess Maria Pavlovna, in the Russian military hospitals from the very first days of the First World War. Realizing that sick and wounded need care, they gave all their energy to service to them. Complying with hospitals everyday life order where they held the service, not distinguishing themselves, they lived everyday hospital life. August sisters seemed humane and kindred because they aspired to alleviate the suffering of the paternalized wounded, console them, show them kindness. The Romanov dynasty representatives personified for the wounded all near and dear to their hearts. They constituted that higher female creature which embodies the virtues of mother and wife, and at the same time the Christian service paragon, what was always much valued among Russian people. Both Grand Duchess Olga Alexandrovna and Grand Duchess Maria Pavlovna, Jr., the Red Cross Evgenevskiy community nurse, activities flowed in the tense daily work, difficult military life conditions and hardships. Sisters of Mercy of the Romanov dynasty - Grand Duchess Olga Alexandrovna and Grand Duchess Maria Pavlovna - became exemplary models for all young sisters, who joined the road of charity in the grim days of First World War.