Vol 25, No 3 (2017)

Morphology and pathological anatomy
Diagnostic value of microvessel structure in brain glial tumors
Shpon’ka I.S., Shynkarenko T.V.

Abstract

Diffuse gliomas are the most common primary brain tumors with a disproportionately high mortality rate. Characteristics of microvessels are of high diagnostic and prognostic significance, however, the results of previous studies are controversial. The aim of the work is to evaluate the features of angiogenesis in diffuse gliomas on the basis of determining the qualitative and quantitative microvascular characteristics. Also important is their relationship with the histological type of tumor. Microvascular density (μm-1), total vascular area (%), total lumen area (%) and the mean diameter of microvessels (μm) were measured and calculated in diffuse brain gliomas (n=76) using GFAP-negative status of endothelium in the presence of exclusively GFAP-positive tumor cells. Proliferation of microvessels was evaluated using proliferation index of vascular epithelium (Ki-67). The possibility of routine evaluation of the angiogenesis in diffuse gliomas using GFAP and Ki-67 markers was defined. We revealed significant correlation between features of the neoplastic microvasculature and WHO Grade.

I.P. Pavlov Russian Medical Biological Herald. 2017;25(3):350-361
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Biochemistry, physiology, biophysics, pathological physiology
Typology of the human organism system adaptation
Shatyr Y.A., Bulatetsky S.V., Ulesikova I.V., Mulik I.G., Nazarova E.V.

Abstract

Transition to personalized medicine requires the systematization of possible scenarios of the human organism individual adaptation to exogenous shocks.

Objective: To identify and typology sustainable adaptation options to extreme environmental factors, taking into account individual, genetically determined functional properties of the human organism. As the object of the study, 146 people of both sexes were involved, 18-23 years of age. The work was performed in accordance with Articles 5, 6 and 7 of "The Universal Declaration on Bioethics and Human Rights" with the informed consent registration. As a result of complex theoretical and experimental researches the typology of the human organism system adaptation to extreme exogenous influences is designed. At the same time, stable combinations of functional properties phenotypic manifestations for individuals with high, medium and low level of general non-specific reactivity are systematized. Revealed expressed specific manifestations of the variation pulsometry main indicators depending on the individual level of general non-specific reactivity of an organism, where the prevalence of the sympathetic component of the autonomic nervous system is characteristic for people with high reactivity level and parasympathetic – for individuals with a low reactivity level. It was determined that an emergency exercise stress in individuals with a high level of general non-specific reactivity is a risk factor for sympathicotonia that gives them increased stress reactivity. Taken studies have proved the feasibility of separation of three types of the adaptation process. 1. The syntoxic process, which is typical for low level of general non-specific reactivity. 2. An integrated process inherent to the medium level of reactivity. 3. Catatoxic process, which is typical for a high level of general non-specific reactivity of an organism. The proposed typology is based on the account: the background level of general non-specific reactivity; specificity and speed of adaptation development; vegetative balance; dynamics of nociceptive sensitivity; psycho-emotional state of a person. Using the developed typology allows to individualize an assessment, forecasting and correction of the functional organism state that will provide personalization of health-support a person in high ambient load.

I.P. Pavlov Russian Medical Biological Herald. 2017;25(3):362-372
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Anniversury
Emel'janov Nikolaj Fedorovich: by the 125-anniversary
Kiryushin V.A., Kozeevskaya N.A.

Abstract

The article describes the stages of the life path and scientific work of the famous hygienist Nikolai Fedorovich Emelyanov.

I.P. Pavlov Russian Medical Biological Herald. 2017;25(3):373-377
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Internal medicine
Polymorphism of nitric oxide synthase genes (NOS1 84G/A AND NOS3 786C/T) in patients with bronchial asthma and essential hypertension
Shakhanov A.V., Nikiforov A.A., Uryasyev O.M.

Abstract

There exists an interest in studying polymorphism of nitric oxide synthase genes in patients with bronchial asthma and essential hypertension.

Aim: to study clinical and pathogenetic significance of polymorphism of nitric oxide synthase genes (NOS1 84G/A and NOS3 786C/T) in formation of comorbid pathology of bronchial asthma and essential hypertension.

Materials and methods: in the study 71 patients participated who were treated for bronchial asthma or essential hypertension. The main group consisted of 24 patients with comorbid pathology of bronchial asthma and essential hypertension. The group of patients with isolated bronchial asthma included 23 individuals. The group of patients with isolated essential hypertension included 24 individuals. In all patients polymorphism of nitric oxide synthase genes NOS1 84G/A and NOS3 786C/T was determined.

Results: the studied groups did not differ in distribution of the genotypes (χ2=2.13, p=0.712) of NOS1 84G/A polymorphism. The studied groups reliably differed in distribution of alleles (χ2=10.55, p=0.005) and of separate genotypes (χ2=10.49, p=0.03) of NOS3 786C/T polymorphism which evidences the relationship between the given polymorphism and development of bronchial asthma and essential hypertension. In patients with comorbid pathology of bronchial asthma and essential hypertension the frequency of occurrence of T-allele is higher and that of C-allele is lower (χ2=4.24, p=0.04) than in patients with isolated bronchial asthma. T-allele of NOS3 786C/T polymorphism 2.4 times increases the probability for comorbid pathology of bronchial asthma and essential hypertension in comparison with isolated bronchial asthma (OR=2.40, 95% CI: 1.04-5.56).

Conclusion: evaluation of NOS3 786C/T polymorphism can be used for identification of patients with bronchial asthma with a high risk for development of essential hypertension.

I.P. Pavlov Russian Medical Biological Herald. 2017;25(3):378-390
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Clinical and molecular interrelations of dislipidemia and metabolic phenotype of osteoarthritis
Kabalyk M.A., Sunyaykin A.B.

Abstract

The work purpose: analysis of lipid parameters and inflammation markers in metabolic phenotype (MPh) osteoarthritis (OA) in correlation with the clinical manifestations of the disease. The study involved 90 patients with OA of the knee (average age of 64.66±8.43 year), of which 37 patients were with Diabetes mellitus type 2 (group MPh OA). 25 comparable volunteers were a control group. Lipid levels, interleukin-1β (IL-1β), tumor necrosis factor α (TNF-α), vasculo-endothelial growth factor A (VEGF-A), atherosclerotic changes of the common carotid artery by ultrasound were determined for all patients. It is shown that when MPh OA patients have a higher atherogenic index (as compared with the control group and patients with OA without the MPh), a greater thickness of the intima-media complex of the common carotid artery and the imbalance of cytokines in favor of increased pro-inflammatory molecules. In MPh OA group there was correlation of atherogenic lipids with proinflammatory cytokines (IL-1β, TNF-α), a marker of endothelial damage (VEGF-A) and clinical manifestations of OA. Thus, the results of the analysis confirm the important role of dyslipidemia and atherosclerosis in the pathogenesis of MPh OA, in particular indicate the possibility of integrating factors of cardiovascular comorbidity via molecular patterns IL-1β, TNF-α, VEGF-A.

I.P. Pavlov Russian Medical Biological Herald. 2017;25(3):391-398
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Psychology, clinical psychology, neurology, psychiatry, narcology
Peculiarities of organization of bioelectric brain activity in subclinical stage of epilepsy
Sychev V.V., Sychev V.N., Shatrova N.V.

Abstract

According to some authors, changes in the electroencephalogram (EEG) in the absence of clinical paroxysmal manifestations should be considered as subclinical epileptic manifestations. Verification of this hypothesis on the basis of the auto-spectral Fourier analysis of the EEG was the purpose of this work. Were examined in 27 women, mean age of 35.4±2.48 years, right-handed, without paroxysmal clinical and EEG manifestations (first group) and 25 women, mean age of 36.2±2.17 years, right-handed, without paroxysmal clinical manifestations, but with epileptiform activity on EEG (second group). In the second group were registered the increase in faverage of the brain EEG (p<0.001), while was increased faverage both of the left and right hemisphere (p<0.01). Zonal peculiarities of bioelectric activity of a brain of the second group surveyed was a significant increase in faverage EEG in all investigated leads (p<0.01), resulting in total liquidation of zonal differences (p>0.05). The results of the analysis allowed to conclude that the registration of the EEG epileptiform paroxysmal phenomena without clinical manifestations should be considered as a subclinical stage of epilepsy.

I.P. Pavlov Russian Medical Biological Herald. 2017;25(3):399-403
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Surgery
Immediate results of carotid endarterectomy in patients receiving statin therapy
Zybin A.V., Timina I.E., Pokrovsky A.V., Harazov A.F.

Abstract

Given the retrospective analysis of the immediate result of carotid endarterectomy in patients with atherosclerotic hemodynamically significant unilateral lesion of the internal carotid artery on statins therapy. 262 carotid endarterectomy in 262 patients are executed. The postoperative period averaged 7.8 days, survival after surgical treatment of 98.86%. The initial condition of the carotid arteries was determined data by duplex scanning, the presence of risk factors and level of lipid profile that have a statistically significant influence on the development of complications in patients receiving statins therapy (p<0.05). Each risk factor did not have a statistically significant impact, however the presence of three or more factors reliably more often aggravated the course of atherosclerosis and increased the incidence of complications (p=0.04). Defined the reliable interrelation of dependence of a lipid profile level (a cholesterol and low density lipoproteins (LDL)) and weight of a course of initial atherosclerotic changes. The maximal values of cholesterol level 5.39±1.13 mmol/l were determined in patients with stenosis of internal carotid artery from 70 to 89% (р=0.05). In all cases of a stenosis of 90% there was increase in level of triglycerides to 1.75±1.05 mmol/l (р=0.05). LDL in all patients registered above the recommended values of 3.45±1.19 mmol/l. However, it is worth noting against the background of statin therapy, the level of high density lipoproteins in the average values did not decrease below 1.46±0.46 mmol/l (p=0.05). Statin therapy has a different degree of influence on the achievement of recommended values of lipid metabolism and the development of complications. In one case (0.38%) there were recorded stroke, transient ischemic attack and myocardial infarction. So effective is the use of synthetic statins III and IV generations: atorvastatin and rosuvastatin. Statin therapy in the preoperative period and continued after surgical important for achieve the surgery to prevent complications. Correction risk factors, such as hypertension, diabetes, smoking, dyslipidemia and other, helps to improve treatment outcomes.

I.P. Pavlov Russian Medical Biological Herald. 2017;25(3):404-414
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Assessment of lipid profile of peritoneal fluid for differential ascites diagnostics
Ivanusa S.Y., Onnitsev I.E., Yankovsky A.V., Deev R.V.

Abstract

The problem of differential ascites diagnostics in different patients remains urgent for modern surgery. Apart from well known methods, authors propose an original algorithm for assessment of ascetic fluid. The main element of such studies is the determination of a lipid spectrum of ascetic fluid and content of lipid components in cell structures. 260 samples were examined which were obtained from patients having examination and treatment in the General Surgery Clinic of the Kirov Military Medical Academy (St. Petersburg). For examination of ascetic fluid, the methods of cytological analysis of ascitic fluid centrifugate were used, its cytochemical examination, as well a complex of biochemical methods: determination of the total protein, amylase, chylomicrons, triglycerides; bacterial inoculation was made. It has been shown that the ratio of chylomicrons, lipoproteins and cytosis permits a more precise differentiation of ascites type which influences the selection of further treatment program especially in chyloperitoneum and lymphatic ascites.

I.P. Pavlov Russian Medical Biological Herald. 2017;25(3):415-433
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Application of surgical instruments in liver echinococcectomy
Amonov S.S., Prudkov M.I., Fayziev Z.S.

Abstract

The paper present results of diagnostics and surgical treatment of 39 patients (24 men, 15 women; age from 21 to 59 years; 29 people of working age) with liver echinococcosis. In 21 cases of these echinococcectomy was completed from traditional accesses, in 18 cases – from reduced incision with the use of a set “Mini-Assistant” and developed by the authors surgical instruments (cannula-aspirator and tweezers-spoon) and destruction of the cyst fibrous capsule 33% solution of hydrogen peroxide (perhydrol). Within 12 months after surgery in 21 of 39 patients there was not any lesions in the projection of the former cyst of the liver, in 12 patients we revealed a residual cavity of irregular form, in 6 patients – foci of fibrosis. Suppuration of the remaining cavities of the cysts, the indications for re-surgery, recurrence of disease were not revealed in any case. Thus, the proposed methodology can be used effectively for echinococcectomy from the liver with the aim of quality evacuation hydatid cysts and prevention of complications and relapse. The article gives full specifications and features of use designed surgical instruments, which allows to reproduce and widely apply them in surgical practice.

I.P. Pavlov Russian Medical Biological Herald. 2017;25(3):434-442
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Morpho-functional assessment of different methods of separation of the abdominal wall at increasing abdominal cavity
Shapovalyants S.G., Mikhalev A.I., Mikhaleva L.M., Dzavaryan T.G., Pulatov M.M.

Abstract

The aim of the study was to investigate the effect of different methods of anterior abdominal wall separation on the increasion of the abdominal cavity volume (ACV) for the prevention of compartment sindrome. The effect of Novitsky posterior separation (Transversus Abdominis Release – TAR), Ramirez anterior separation and Ramirez anterior separation with the mobilization of posterior wall rectus sheath (R+MPRS) on increase ACV was studied. The study was conducted on autopsy materials of 30 non-fixed corpses. In the first part of investigation the results of Novitsky operation have been studied (n=10), in the second part – of Ramirez operation (n=10) and in the third part – R+MPRS (n=10). The ACV have been determined before and after surgery and the degree of it’s increasion after each operation have been counted. In Ramiraz's separation the average of ACV before the operation was 3.2±0.2 L, after the operation – 4.06±0.2 L with an average increasion in volume of 27.8±2.6%. In Novitsky operation the average of ACV before the operation was 3.1±0.1 L, after the operation – 3.9±0.1 L, with an average increasion of 24.2±1.7%. In Ramiraz + MPRS the average of ACV before the operation was 3.1±0.08 L, after the operation – 4.7±0.22 L with an average increasion of 49.8±4.6%. The study revealed different effects of the three types seperation of the abdominal wall on increasion the ACV. The operation of Ramiraz+ MPRS has the greatest effect on the increasion the ACV (49.8±4.6). The results were successfully used in the choice of the type of operation in 8 patients with large ventral hernias.

I.P. Pavlov Russian Medical Biological Herald. 2017;25(3):443-452
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Comparative analysis of the efficiency of methods of operative intervention in patients with pilonidal sinus
Katorkin S.E., Lichman L.A., Andreev P.S., Davidova O.E.

Abstract

Pilonidal sinus is a disease which occupies an important place in Coloproctology profile and constituting 15% of all purulent diseases of the anus. The aim of this work is the analysis of the results of surgical treatment of patients with pilonidal sinus: by closing the wound with a continuous suture with the catch of the bottom of the wound (modified method) in comparison with excision of Pilonidal sinus and suturing wounds seams Moshkovich. All patients (n=82) were divided into 2 groups (30 and 52 patients), respectively completed the operational manual. We performed the analysis of the results of treatment according to operative time, early postoperative complications, disease relapses, the severity of pain, timing of rehabilitation, and identified the differences between the groups for the development of early postoperative complications (χ2=21.72; p=0.05). Thus, the obtained statistically significant data on the advantage of the method of wound closure with a continuous suture with the catch of the bottom of the wound over the method of suturing wounds seams Moshkovich.

I.P. Pavlov Russian Medical Biological Herald. 2017;25(3):453-459
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Diagnosis and treatment of male infertility in patients with common pathology of genitals and inguinal region
Sobennikov I.S., Zhiborev B.N., Kotans S.Y., Cherenkov A.A.

Abstract

The article presents a study of reproductive function and fertility prognosis in 27 male patients of reproductive age with common diseases of genitals and inguinal region. These patients were under observation in the outpatient clinics with the diagnosis of male infertility. Blood levels of sex hormones and spermograms were evaluated in dynamics before and after surgical treatment of the main disease. In the research it was found that surgical removal of the probable cause of infertility in marriage resulted in normalization of spermogram parameters in 15% of cases and to the onset of pregnancy in 22.2% of cases. No significant changes in the dynamics of sex hormones were found. Besides, in the course of research a positive clinical effect of conservative treatment for the connective tissue dysplasia associated with the main disease and infertility in marriage, was obtained. This effect was confirmed by the onset of pregnancy in 29.4% of patients who underwent drug therapy.

I.P. Pavlov Russian Medical Biological Herald. 2017;25(3):460-468
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Comparative analysis of the results of computerized phonoenterography in patients with acute destructive appendicitis before surgery and in the postoperative period
Philippova K.V., Zaitsev O.V.

Abstract

Using the method of computerized phonoenterography we made an analysis of motor-evacuation function of the gastrointestinal tract in 35 patients with acute destructive appendicitis before surgery and in the postoperative period and in 30 patients without abdominal pain syndrome and concomitant pathology of the organs of the abdominal cavity. The obtained results of computerized phonoenterography different in the group of patients with acute appendicitis before appendectomy in comparison with group of patients without acute abdominal pathology (control group). For patients after appendectomy statistically significant differences with the control group in the vast majority of bands wasn’t obtained. Given the fact that the densities of the spectral power of acoustic signals of the abdominal cavity to assess the motor-evacuation function of the intestine in these groups of patients, we showed a reduction of motor-evacuation function of the intestine in patients with acute destructive appendicitis before surgery in comparison with patients of control group and recover in the postoperative period. Thus, the method of computerized phonoenterography is advisable to apply for the diagnosis of lower motor function of the intestine in patients with acute appendicitis, and in the early postoperative period in patients with acute destructive appendicitis for monitoring recovery of intestinal motility.

I.P. Pavlov Russian Medical Biological Herald. 2017;25(3):469-475
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Clinical and experimental oncology
A comparative analysis of the treatment of patients with acute colonic obstruction obstructive tumor genesis
Shabunin A.V., Grekov D.N., Gugnin A.V., Korsheva I.Y.

Abstract

In a retrospective study, a comparative analysis of treatment of 509 patients with acute obstructive colonic obstruction, tumor genesis, which are made of different kinds of surgery (n=384) and stenting of the tumor stricture self-expanding metal stents (n=79). For statistical comparison of results concluded that the endoscopic stenting accompanied by fewer complications, a low mortality, reduces hospitalization time as compared to conventional operations. Stenting may be applicable for continuous decompression in patients with malignant strictures as the final treatment, as well as to the time of decompression in potentially resectable patients as the first stage of treatment («bridge to surgery»). In a retrospective study evaluated the results of clinical observation 509 patients from 2010 to October 2016 were carried out surgery for malignant obstruction of the colon. The first group included 79 patients who performed endoscopic stenting. These patients are the main group. A control group, consisting of two sub-groups, made up of 384 patients whom underwent surgery were performed. First subset patients (330 patients) performed a resection of the left colon departments to form a single-barrel colostomy (Hartmann type of operation), right-sided hemicolectomy with the formation ileotransverzoanastomosis; the second subgroup (54 patients) were formed colonies or ileostomy due to hemodynamic instability and/or the presence of unresectable tumors. We describe the results of the comparison of colorectal stenting and colostomy. The conclusion about the prospects of the use of colorectal stenting in patients with acute colonic obstruction obstructive tumor genesis.

I.P. Pavlov Russian Medical Biological Herald. 2017;25(3):476-483
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Reviews
History of phlebology (Part II)
Nebylitsyn Y.S., Nazaruk A.A.

Abstract

The article presents data about the history of phlebology development in the period from XV to XX centuries – the key time of the establishment of medicine, the most important discoveries and breakthroughs. In the Middle ages the development of surgery, particularly in Europe, slowed considerably, due to the dominance of the Church and the introduction of various restrictions. However, the stagnation of the Middle ages gave way to the flowering of the Renaissance – a time of rapid development of art, science and technology. Gradually surgery were included in University education, and this marked the beginning of further improvement. XVII-XVIII centuries can be considered the time of completion of the empirical approach in surgery. In this period the development of phlebology has had a huge impact discoveries in physiology, histology, pathological anatomy and clinical medicine. A crucial period in medicine began XIX-XX centuries – asepsis and antisepsis, general and local anaesthesia, techniques of blood transfusion etc. was opened. The development of phlebology in this period was influenced by such scholars as Jerome Fabrizi, Ambroise Paré, Max Schede, Alexei Trojans, Friedrich Trendelenburg, Georg, Perthes, Albert Narath, William Wayne Babcock, Otto Wilhelm Madelung, Emil Theodor Kocher, etc. The article describes their contribution to the history of phlebology.

I.P. Pavlov Russian Medical Biological Herald. 2017;25(3):484-500
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Short communication
The formation of medical students` competence in the process of studing the discipline «Physical culture and sports»
Proshlykov V.D., Tolstova T.I.

Abstract

The article considers the successful formation of medical students cultural competence for school-classes on physical culture. Formation of competences is a complex pedagogical process in connection with the fact that physical education classes are conducted with a large number of simultaneously engaged in sports halls, which makes it difficult to study the theoretical sections of curricula. Most of today's students has a low level of physical fitness. Students wishing to become doctors, do not understand the value of physical activity role in life of the doctor. It is noted that students' interest in independent studies increases when they study self-assessment of their physical development and compare it with normative indicators, then together with the teacher develop recommendations for correcting lagging indicators of physical development and after a certain training period evaluate the results achieved during training. This allows you to more intelligently approach the choice of physical activity and understanding its positive effects. Formation of competences is possible subject to simultaneous solution of two tasks – increasing the level of physical preparedness of students and their acquisition of specific knowledge about the influence of regular physical loads on the functional state of the organism.

I.P. Pavlov Russian Medical Biological Herald. 2017;25(3):501-506
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