Vol 99, No 6 (2018)

Aim. To study the clinical and functional features of patients with colorectal cancer complicated by acute intestinal obstruction.

Methods. A retrospective analysis of the data of 147 patients with colorectal cancer operated on from 2014 to 2016 for urgent indications for acute intestinal obstruction was performed. The study of lethality during the period from 1993 to 2016 was carried out separately. The study was performed in the clinic of urgent oncologic surgery of the State Autonomous Healthcare Institution “Republican Clinical Oncologic Dispensary” MH RT.

Results. Among patients with acute intestinal obstruction in colorectal cancer, a constant increase of the ration of elderly and senile patients is observed, as well as high anesthesia risk. Statistically significant indices of decrease of nutritional status in the group of patients of elderly and senile age and subtle manifestations of hypovolemia were revealed. In the elderly and senile patient group, polypragmasia was registered in 50.5 %.

Conclusion. Patients with colorectal cancer complicated by acute intestinal obstruction, have their own characteristics, different from patients operated on in clinics of urgent abdominal surgery with other diagnoses, the main ratio of which is made up of acute inflammatory diseases. This category of patients should be operated on in institutions where it is possible to provide specific highly skilled surgical and anesthesia-resuscitation care for malignant neoplasms.

Aim. Comparative study of clinical effectiveness of doxazosin, tamsulosin and silodosin as monotherapy for patients with chronic non-inflammatory prostatitis.

Methods. Outpatient medical records (OMR) of patients with the diagnosis of chronic non-inflammatory prostatitis who were treated in “The clinic of ambulatory urology” (Kazan) in 2012-2017, were analyzed: all 173 OMR of patients receiving doxazosin 1 mg QD for 30 days as monotherapy; all 150 OMR of patients receiving doxazosin 2 mg per day BID for 30 days as monotherapy; all 54 OMR of patients receiving doxazosin 4 mg per day BID for 30 days as monotherapy; all 77 OMR of patients receiving tamsulosin 0.4 mg QD for 30 days as monotherapy; all 36 OMR of patients receiving silodosin 8 mg QD for 30 days as monotherapy. Based on these OMR the “Clinical index of chronic prostatitis” (CI CP) was analyzed before the start of pharmacotherapy and 30 days after the beginning. According to the clinical index, the discrete sample was ordered containing the values of CI from 0 points (no complaints) to 50 points (maximal score - the most marked symptoms).

Results. Before the beginning of the treatment every sample of patients is homogeneous and after 30-day treatment they lose homogeneity and tend to divide into several homogeneous samples.

Conclusion. Clinical effectiveness of doxazosin, tamsulosin and silodosin in men with CNP varies in wide range, is poorly predictable, poorly explainable and needs further studies according to the principles of modern evidence-based medicine.

Aim. To evaluate the character of the course and to determine the features of biochemical manifestations in patients with atrial fibrillation and arterial hypertension combined with extracardiac diseases.

Methods. To study the features of the course of persisting form of atrial fibrillation (AF) in patients with arterial hypertension (AH) stage 3 combined with extracardiac diseases. 374 patients aged 45 to 65 years were examined. Among them chronic obstructive pulmonary disease (COPD; n = 37), diffuse toxic goiter (DTG; n = 33), hypothyroidism (HT; n = 69), diabetes mellitus (DM; n = 49) and abdominal obesity (AO; n = 64) of mild and moderate degree were detected. 5 groups were formed: group 1 - AH + AF + COPD, group 2 - AH + AF + HT, group 3 - AH + AF + DTG, group 4 - AH + AF + DM, group 5 - AH + AF + AO. The control group included 56 patients with AH and AF without concomitant diseases, and the comparison group included 36 patients with AF without AH and 30 patients with AH without AF. The study evaluated clinical, anthropometric and laboratory parameters, the results of instrumental diagnostic investigation. The level of galectin-3 was determined in the serum by ELISA. The concentration of brain natriuretic peptide (NT-proBNP) was measured with a panel “NT-proBNP - ELISA - Best”. Multiple comparisons of the groups were performed with Kruskal - Wallis test. To compare binary and categorical parameters, exact two-tail Fisher’s test was used. Optimal multivariate regression models were developed directly and reversely. Verification of statistical hypotheses was carried out with critical value of significance p = 0.05 i.e. the difference was considered statistically significant if p < 0.05. All statistical calculations were performed with the use of R-Studio soft.

Results. When assessing the lipid profile in the studied groups, significant differences were detected for HDL (high density lipoprotein) the values of which were the highest in the control group; TC (total cholesterol) was significantly lower in group 1 and 2; LDL (low density lipoprotein) and TG (triglycerides) - in group 3. The level of uric acid in the serum in all clinical groups was higher compared to those of the control group but significance was reached only in group 3. The concentration of K+ in the blood was significantly higher in all groups compared to the control group. The study of NT-proBNP and galectin-3 as markers reflecting the processes of remodeling and myocardial fibrosis in patients with atrial fibrillation combined with arterial hypertension, demonstrated that the average level of NT-proBNP in all groups was higher than in the control group but the difference was significant only in group 5. The level of galectin-3 in the serum of patients with arterial hypertension and atrial fibrillation combined with comorbid extracardiac pathology was significantly higher in the groups compared to the control group (except for group 3 where the number of patients was the lowest) and significantly lower in the comparison group of patients with atrial fibrillation without arterial hypertension.

Conclusion. The course of arterial hypertension and atrial fibrillation with concomitant extracardiac diseases is characterized by the changes of biochemistry, which manifest as the changes of lipid profile, electrolyte content and factors inducing fibrosis. The obtained data confirm the possible role of galectin-3 as a biological marker of fibrosis and myocardial remodeling in patients with AF and AH and comorbid extracardiac pathology.

Aim. Study of the fnctional state of left ventricular myocardium and determination of diagnostic criteria of poor prognosis of mitral valve prolapse.

Methods. 151 patients (116 males and 35 females) with mitral valve prolapse (MVP) were examined. The average age was 34.8 ± 0.79 years. Division by the groups was performed depending on the severity of structural changes of the valve and width of the cusps: group 1 included 54 patients with classic form of MVP (cusp width ≥5 mm), group 2 included 55 patients with cusp width ≥3 mm, group 3 included 42 patients with MV cusp width less than 3 mm. All patients underwent complex clinical functional examination of cardiovascular system. The state of systolic and diastolic cardiac function was assessed using stationary high-tech ultrasound scanner «Philips iE-33» (Philips, Holland) according to conventional technique with determination of standard heart parameters and calculation of intracardiac hemodynamic parameters. Echocardiography was performed on admission and 12 to 18 month later.

Results. The study revealed that the most prominent changes of cardiohemodynamics and unfavorable disease course were observed in 72.2 % of patients with classic form of MVP (group 1). Patients with non-classic form of MVP (group 2) also had poor prognosis in 27.8 % of cases. Diagnostic criteria of poor prognosis of MVP according to echocardiography were determined: severe mitral regurgitation (degree ≥III), mitral valve cusp thickness during diastole over 6 mm, left ventricle dilation (EDS ≥ 60 mm; ESS ≥ 36 mm), left atrial dilation (anterior posterior size of LA ≥ 40 mm, LA volume ≥ 80 ml), mitral annulus dilation (diameter of MA ≥ 35 mm).

Conclusion. Differences of functional state of the myocardium of left ventricle were revealed depending on the type of mitral valve prolapse caused by the severity of connective tissue dysplasia. In classic form of MVP more severe disorders of intracardiac hemodynamics were observed as well as more severe mitral insufficiency.

Aim. Study of the features of changes of antioxidant protection in patients with mechanical jaundice of benign and malignant origin in dynamics.

Methods. The author studied the role of antioxidant system in the progression of mechanical jaundice of various origins in 104 patients. Groups of patients with a syndrome of mechanical jaundice of benign (62 patients) and malignant origin (42 patients) were isolated. The material of the study was blood from the ulnar vein, which was taken in the morning on an empty stomach before surgery. In the dynamics (on the 7th day after the operation), 53 patients were examined. To assess the state of antioxidant protection, a spectrophotometric method of investigation was used.

Results. A high level of malonic dialdehyde, the product of lipid peroxidation, was determined in all patients regardless of origin. There was also a depression of the enzymatic link of antioxidant protection (a decrease in the activity of superoxide dismutase and catalase). After surgical intervention in patients with mechanical jaundice of benign origin, correction of the level of reduced glutathione was observed. In patients with mechanical jaundice of malignant origin in dynamics, the activity of antioxidant enzymes did not differ significantly from the norm (p1-3 = 0,23; p1-3 = 311).

Conclusion. After surgical intervention, partial improvement of the condition of patients with mechanical jaundice of benign origin was observed, and dysfunction of antioxidant protection persisted in patients with mechanical jaundice of malignant origin.

Aim. To evaluate the effectiveness of correction of the ovarian hyperandrogenism (OHA) in girls in puberty.

Methods. 38 girls with OHA syndrome were examined. The average age of the girls was 14.39 ± 0.27 years. Ferriman-Gallwey hirsutism score was 19.7 ± 0.47, the hormonal score 18.14 ± 2.43, the indifferent score 2.34 ± 0.13. The comparison group included 20 girls matched by age (14.74 ± 0.15 years) with physiological course of puberty. The study included the evaluation of hirsutism severity by Ferriman-Gallway score, determination of the hormones of hypothalamus-pituitary-adrenal-ovarian system in early follicular phase on day 5-7 of menstrual cycle.

Results. The causes of OHA syndrome in the pubertal period were found to be polycystic ovary syndrome in 68.42 % and tumor-like formations (follicular cysts) in 31.58 % of girls. Compared to healthy girls, the girls with OHA syndrome had statistically significantly higher values of luteinizing hormone (LH) - 9.19 ± 0.96 mME/ml, LH/FSH ratio - 1.8 ± 0.15, total testosteron (Ttotal) - 1.3 ± 0.11 ng/ml, estrone (E1) - 109.5 ± 4.88 ng/ml, androstenedione (An) - 4.01 ± 0.12 ng/ml as well as low values of estradiol (E2) - 49.1 ± 2.6 pg/ml and sex hormone-binding globulin (SHBG) - 45.7 ± 2.14 nmol/l. The study demonstrated that correction of ovarian hyperandrogenism, promotes an increase in the level of E2, SHBG and decrease of the level of LH, LH/FSH ratio, Ttotal, An.

Conclusion. Complex pathogenetic therapy of OHA syndrome in girls in puberty leads to significant improvement of hormonal status in this group of patients.

Aim. To study the reaction of hemostasis system to a single effect of hypercapnic hypoxia of maximum intensity in rats and possibility of correcting hemostasis disorders by means of a preliminary course of an antihypoxant - mexidol.

Methods. The study involved sexually mature male rats (48 specimens) of the Wistar line with an average mass of 274.0 ± 32.0 g. The rats were kept on a standard diet, food and water were fed once a day between 10 and 11 hours. In the evening, animals underwent a single hypercapnic hypoxia in a special flow chamber. The state of hypercapnic hypoxia of maximum intensity was modeled at O2 content of 5.0 %, CO2 - 5.0 % during a single 20-minute exposure. As a training regimen, a 30-fold course of mexidol was used, the drug was administered intraperitoneally to rats at a dose of 50 mg/kg for 1.5 hours prior to exposure to hypercapnic hypoxia.

Results. After a single exposure to hypercapnic hypoxia of maximum intensity, shortening of the onset of clot formation, an increase of alpha angle, and maximum clot density were recorded. Also, the clot formation time shortened and the maximum clot lysis index increased. With a single exposure to hypercapnic hypoxia of maximum intensity after the course of mexidol, a decrease in the maximum clot density was recorded.

Conclusion. A single exposure to hypercapnic hypoxia of maximum intensity was characterized by a shift of hemostatic potential toward hypercoagulability along with fibrinolytic system activation. The course use of antihypoxant mexidol, preceding hypercapnic hypoxia of maximum intensity, significantly reduces the risk of clot formation.

Aim. Study of effects of titanium dioxide nanoparticles administered orally on the rodent thymus morphological and functional state.

Methods. The study used classical morphological approaches and specific markers of proliferation - Ki-67, apoptosis - p53 protein and macrophages - CD68, which allow adequately identifying not only the cells themselves, but also their functional state. The rodent thymus was analyzed after oral administration (10 mg/kg of body weight of the animal, 28 days) of the TiO2 nanoparticles (rutile form, 40-60 nm) obtained by diluting the TiO2 powder in distilled water. Aggregation of the nanoparticles was prevented by processing a suspension of nanodispersed TiO2 in an ultrasonic bath. The rats of the control group were orally injected with distilled water in the same volume. Serial paraffin sections of the thymus were stained with hematoxylin-eosin, picrofuxin according to Van Gieson, immunohistochemical staining was performed with antibodies to Ki-67, CD68, p53.

Results. Significant changes of the tissue of thymus gland under the influence of TiO2 nanoparticles were revealed. In the thymus of experimental animals, a decrease in the proportion of cortex was found to be 17.6 %, a significant decrease in the density of the cell population due to decrease in the number of thymocytes was demonstrated. Immunohistochemical typing revealed that under the influence of TiO2 nanoparticles, a decrease in the number of Ki-67-positive cells in the cortex of the lobule of the thymus gland was observed, which indicates the inhibition of proliferation in these conditions. Under the influence of TiO2 nanoparticles, an increase of the amount of cells entering apoptosis in the cortex of the thymus segment of the experimental group by 5.18 times was observed, as evidenced by the results of immunohistochemical study of the expression of apoptosis marker p53 protein. Perhaps, as a compensatory mechanism there is a pronounced increase in the number of macrophages, as indicated by an increase in the average number of CD68 immunopositive cells in the cortex of the thymus of the test group by 2.61, and in the brain substance by 1.35.

Conclusion. The revealed morphological and functional changes of the thymus with oral administration of TiO2 nanoparticles indicate their immunosuppressive effect.

Uterine cervix undergoes various changes throughout the pregnancy, which are characterized by the general term “remodeling”. In particular, this process includes changes of the length (shortening) and consistency (softening) of uterine cervix. The latter from the clinical point of view is important not only for observation of pregnant women with normal course of pregnancy but also for predicting such states as an outcome of labor induction or preterm delivery. Traditionally, cervical elasticity has been estimated through digital examination and Bishop score, however, currently there are available imaging techniques, which are more objective and precise. Amongst these methods, elastography plays a special role. Elastography allows measuring the capacity of tissues to deform. The softer the tissues, the higher mentioned capacity under the applied pressure. Currently there are various methods of elastography, starting from real-time elastography, when the capacity to be deformed is registered under the influence of physiologic movements or minimal manual pressure, to shear wave elastography, when the velocity of propagation of shear waves is measured. Although there are number of methods of elastography and perspectives of their use in obstetric practice, at the present time there is no consensus on standardization of these methods. In the cervical elastography this task is even more complicated, because there is no reference tissue to be compared with, especially this is true for strain elastography. The aim of this study was comparative analysis of methods estimating cervical elasticity and underlining current problems from the clinical point of view.

Coronary artery bypass grafting techniques have been unchangeable for many years, whereas development and enhancement of myocardial protection methods in coronary bypass grafting for patients with ischemic heart disease are still actual issues of current coronary surgery. Coronary artery bypass grafting techniques include the traditional/conventional technique with cardiopulmonary bypass, aortic cross-clamping and cardioplegia, off-pump and on-pump beating heart coronary artery bypass grafting. Coronary artery bypass grafting with cardiopulmonary bypass and cardioplegia remains the most common method of coronary revascularization. However the cardiac arrest inevitably leads to global cardiac ischemia, and current cardioplegias do not prevent ischemic damage to the myocardium in all cases, especially in high-risk surgical patients. Off-pump coronary artery bypass grafting allows preventing global myocardial ischemia (due to the constant native coronary blood-flow) and avoiding possible negative consequences of cardiopulmonary bypass use. The main limitations of this technique are associated with high risk of hemodynamic instability due to low cardiac output and systolic output caused by target arteries exposition. On-pump beating heart technique is a reasonable compromise between conventional on-pump coronary artery bypass grafting, cardioplegia and off-pump procedure. It is a safe and effective technique with outcomes that are equivalent or superior to the outcomes reported for conventional coronary artery bypass grafting in patients with unstable hemodynamics, low left ventricular ejection fraction and in high-risk patients. The literature review presents the results of on-pump beating heart coronary artery bypass grafting.

Aim. To compare the diagnostic capabilities of indirect laboratory markers of alcohol consumption - alanine aminotransferase, aspartate aminotransferase, gamma-glutamyltranspeptidase and carbohydrate-deficient transferrin, depending on the social status and age group of the subjects.

Methods. The activity of enzymes were assessed in the blood serum of socially adapted young subjects (18-25 years, 201 people) and adults (35-50 years, 121 people) by standard biochemical methods, and the level of carbohydrate-deficient transferrin was determined by capillary electrophoresis. With the use of questionnaires, the subjects were tested for alcohol abuse. Non-parametric criteria of statistical significance were used to evaluate the difference.

Results. No differences in the activity of enzymes associated with the level of alcohol consumption were found in the youth group (p = 0.911 for alanine aminotransferase, p = 0.669 for aspartate aminotransferase, p = 0.303 for gamma-glutamyltranspeptidase). Activity of gamma-glutamyltranspeptidase was significantly higher in adult group of alcohol abuse (p = 0.021), but individual values of enzyme activity of some subjects from this group fit into the population reference interval. Differences in the level of carbohydrate-deficient transferrin in the youth group, associated with the volume and frequency of alcohol consumption, were not revealed (p = 0.348), and all individual values were within the reference interval. In the adult group, values of this parameter were higher in high-dose alcohol drinkers (p = 0.019) but the diagnostic threshold of alcohol abuse was reached only in 2 subjects.

Conclusion. Indirect laboratory markers do not have sufficient diagnostic significance for screening of alcohol abuse among socially adapted young people and adults. Informativeness of carbohydrate-deficient transferrin may be sufficient if the diagnostic threshold corresponding to a definite social and age group replaces the standard population-established concentration limit.

Aim. To determine epidemiological features of acute and chronic viral hepatitis B in the Kyrgyz Republic over the period 1997-2017. Меthоds. Analysis was performed on data bases of the National accounting forms on treated cases of acute and chronic hepatitis B cumulated by the Medical Information Centre of the Ministry of Health of Kyrgyz Republic for the period of 1997 to 2017 as well as 384 medical records of patients with chronic hepatitis B treated in the Hepatologic Centre “Tsadmir”.

Results. In the Kyrgyz Republic among all acute cases of acute viral hepatitides, hepatitis A comprises 60.5 %, hepatitis B - 16.9 %, the ratio of unverified non-A non-C viral hepatitis - 15.2%. With the introduction of HBV vaccination of children (2000) and improvement of infectious control in healthcare settings, a decline of acute HBV incidence is observed - from 26.7 0/0000 to 5.3 0/0000 due to the decrease of acute hepatitis B among children and adolescents to isolated cases, adults from risk groups. The highest incidence of acute hepatitis B is recorded in Osh and Bishkek, in Jalal-Abad and Chuy Regions. This can be explained by that in the southern and northern capitals of the Kyrgyz Republic and in the near lying areas with high population density, access to laboratory and instrumental methods of diagnosis of viral hepatitides is better, along with the higher awareness of its inhabitants regarding the prevention compared to other regions. At the same time an increase of chronic hepatitis B incidence is observed. Predominant modes of transmission are medical-parenteral exposure and household contact (60.9 %), with frequent formation of family clusters (23.8 %). Imperfections were found in the early detection, reporting and accounting of cases of chronic viral hepatitides as well as in examination of hepatitis B virus carriers.

Conclusion. The performed analysis of the incidence and prevalence of acute and chronic hepatitis B in the Kyrgyz Republic allowed assessing the dynamics of the epidemiologic situation in the country regarding this disease, revealed shortcomings in the detection and examination of viral hepatitis B carriers, contributed to development of a new guide for epidemiological surveillance of viral hepatitides.

Aim. To describe a case of arterial thrombosis with a thrombus that had atypical composition due to profound pathological changes in the cellular and protein composition of the blood.

Methods. Scanning electron microscopy of an ex vivo thrombus extracted from the common femoral artery.

Results. In the absence of platelets and leukocytes there was a significant prevalence of fibrin over other blood components in all layers of the arterial thrombus. There were no morphological signs of intravital contraction (retraction) characteristic for thrombi: single erythrocytes were not exposed compressive deformation, redistribution of fibrin and platelets within the thrombus toward the periphery. Formation of the atypical arterial thrombus in the vessel with atherosclerotic vessel damage is probably due to association with severe hyperfibrinogenemia and thrombocytopenia.

Conclusion. The structure of a thrombus depends not only on its vascular location (arterial or venous), but also on the cellular and protein composition of the blood. These factors support diversification of antithrombotic therapy, considering composition and properties of thrombi irrespective of the place and hemodynamic conditions of their formation.

Aim. To show the benefits of performing mini-access restorative phase on the colon in patients with colostomy.

Methods. A retrospective analysis of the results of closure stomy operations in 2011-2017 in two emergency cancer departments of Republican Clinical Oncology Center MH RT was conducted. The inclusion criteria of the study were: 1) surgical intervention for acute intestinal obstruction in colorectal cancer performed in RCOC; 2) mandatory removal of the primary tumor during the first surgery; 3) the presence of a functioning intestinal stoma formed during the first surgery; 4) fixation of both stumps in one stoma. The exclusion criteria were refusal to restore the continuity of the colon for medical indications and the patient's refusal to undergo the surgery.

Results. The study included 11 males (44 %) and 14 females (56 %). The age interval was 49 to 81 years, of which 12 patients were over 70 years old (48 %), the average age was 67.7 ± 5.4 years. The tumor removed at the first stage was localized in the right parts of the colon in 5 patients (20 %), and in the left in 20 patients (80 %). By the stages of the malignant process, the patients were distributed as follows: stage B - 14 cases (56 %), stage C - 10 (40 %), stage D - 1 (4 %). The average duration of the surgery was 53 ± 14.38 minutes (40 to 123). The postoperative period was 10.8 ± 1.92 days on average (5 to 18).

Conclusion. Restoration of intestinal continuity through mini-paracolostomy access is technically rational, as due to the mini-access the patient undergoes minor surgical trauma; the anatomical proximity of the anastomosed bowel stumps excludes the difficulties associated with the search for the distal stump in the traditional method of recovery; the duration of the postoperative hospital stay decreases significantly.

Aim of the study is to evaluate efficacy of different methods of minimally invasive treatment of pancreatic pseudocysts (PPC).

Methods. A single center retrospective study of patients with pancreatic pseudocysts (n = 17): 90 males (76.9 %), 27 females (23.1 %) aged 25 to 72 years. The patients underwent external percutaneous drainage (group 1, n = 96) or internal drainage (group 2, n = 21). The diagnosis of pseudocysts included clinical, laboratory (biochemical and bacteriological) and special investigation methods: radiological, endoscopic, ultrasound examination of hepatobiliary zone, computer tomography.

Results. Complications in the early postoperative period were observed in patients from both groups 1 and 2. They were related to inefficacy of cystodigestive anastomosis, which required percutaneous drainage in 2 cases (9.5 %), or to formation of pancreatic fistula. Lethal outcomes were not observed. Readmission to surgical department for removal of the drainage was required in 28 (23.9 %) patients from group 1. Internal drainage is considered more advantageous for PPC decompression compared to external one due to persistence of pancreatic fluid passage through gastrointestinal tract. External drainage is associated with frequent external pancreatic fistulae formation as well as prolonged hospital stay and treatment in an outpatient setting worsening the quality of life, but it is an intervention of choice in somatically severely ill patients, in fast growing cyst, imperfectly formed wall and threatening cyst rupture into abdominal cavity or abscess. These aspects prevent from refusal from external drainage for PPC treatment.

Conclusion. When choosing the optimal time and type of surgical intervention in PPC, the surgeon should evaluate localization, sizes, maturation of PC wall and its relation to pancreatic duct, somatic state and patient’s individual features.

Вопрос обзора. Каковы эффекты немедикаментозных видов лечения у мужчин с продолжительной болью, дискомфортом в области предстательной железы (простаты) и таза (хроническим простатитом / синдромом хронической тазовой боли (ХП / СХТБ)?

Трансуретральная резекция простаты (ТУРП) считается лучшим лечением симптоматической ОДУП. ТУРП улучшает симптомы и мочеиспускание путем хирургического удаления ткани предстательной железы через мочеиспускательный канал. Однако побочные эффекты, появляющиеся примерно в 20 % всех ТУРП, включают в себя потерю крови, что требует переливаний, инфекции, стриктуры, нарушение половой функции, недержание мочи и задержку мочеиспускания. Лазерная простатэктомия, использующая лазер для разрушения ткани увеличенной простаты, приводящей к СНМП, является малоинвазивной процедурой, которая в настоящее время используется в качестве альтернативы ТУРП.