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Vol 7, No 3 (2015)

Reviews

IMPROVED NEUROLOGICAL ASSESSMENT OF SEVERE INTRAVENTRICULARHEMORRHAGE IN NEWBORNS WITH VERY LOW AND EXTREMELY BIRTH WEIGHT

Schugareva L.M., Iova A.S., Kryukov E.Y., Sotnikov S.A.

Abstract

Neurological outcomes in severe intraventricular hemorrhage in infants with very prematurity de- termined by correctable and uncorrectable factors of bleeding. The aim of the study was to develop an optimal clinical diagnostic algorithm in selection of treatment of severe intraventricular hemorrhage in infants born with critical immaturity. During the period 2005-2010. He received treatment at the hospi- tal in 1150 infants with very low birth weight (VLBW), and extremely low birth weight (ELBW). We used clinical methods of evaluation: neurological examination, pediatric Glasgow Coma Scale / Saint Petersburg (Iova A.S. et al., 1999). Diagnostic methods: ulrasonografiya (US), computed tomography (CT), magnetic resonance imaging (MRI).Ways of improving diagnostic tactics depending on the risk factors and the dynamic clinical and ultrasonographic evaluation. Adoption subgaleal drainage when post-hemorrhagic ventriculodilatation improves early neurological outcomes in children.
HERALD of North-Western State Medical University named after I.I. Mechnikov. 2015;7(3):7-11
pages 7-11 views

THE VALUE OF THORACOSCOPY IN IMPROVING THE RESULTS OF EXAMINATION AND TREATMENT OF PATIENTS UNDERGOINGCHEST TRAUMA

Zaycev D.A., Movchan K.N., Lishenko V.V., Velikorechin A.S.

Abstract

This paper describes a system of therapeutic and diagnostic measures in patients with chest trauma of various kinds. The basis of the system included the use of primary thoracoscopy under local anesthesia during drainage of the pleural cavity and the feasibility of building a medical-diagnostic help for syndromic basis.The aim of the study was to improve the results of examination and treatment of patients with chest injury on the basis of the development of optimal therapeutic - diagnostic algorithm using different types of thoracoscopy.Materials and Methods: Among the clinical findings (330 patients) identified 2 groups: control and research. In the control group (175 victims) were used traditional methods of examination (175 victims) and treatment in the study group medical-diagnostic program included the implementation of the various options thoracoscopy.Comparing the results and effectiveness of treatment in the two groups can be stated that diagnostic and treatment algorithm (using primary thoracoscopy during the regular drainage of the pleural cavity), used in patients at the study, reduces the number of thoracotomies 2 times. In the control group, thoracoscopy was performed in vain 4 (14.3%) among the 28 victims, and thoracotomy 3 (9.4%) of the 32 victims. When the primary TC contraindications for its implementation were not in any case that suggests TC necessary «elements» during the drainage of the pleural cavity in cases of medical care to patients with chest trauma. The time spent on diagnosis and definition of further tactics in the study group was 5 - 10 min., While in the control group required 20 to 60 minutes.Use of a complex diagnostic and treatment activities providing hour emergency surgical care for patients with chest injury, admitted to the health facility, where the state does not provide separation of Thoracic and thoracic surgeon on duty, justified because it is based on reasonable use of both traditional methods of examination of patients and survivors, and the broad introduction into clinical practice of innovative technology diagnostic and treatment process (US pleural cavity and pericardium, the rational use of thoracoscopy in the implementation of the drainage of the pleural cavity, and others.).
HERALD of North-Western State Medical University named after I.I. Mechnikov. 2015;7(3):12-22
pages 12-22 views

SURGICAL ANATOMY OF PARATHYROID GLANDS IN PATIENTS WITH SECONDARY HYPERPARATHYROIDISM

Novokshonov K.Y., Fedotov Y.N., Karelin V.Y., Pridvizhkin T.S., Chernikov R.A., Sleptsov V.I., Sour P.N., Timofeeva N.A., Sinchuk I.K., Uspensky A.A., Semenov A.A., Makarin V.A., Fedorov E.A., Malugov J.N., Bubnov A.N., Nikulin M.O.

Abstract

Ectopic or supernumerary parathyroid glands (PTg) can be the reason of surgical failure in treat- ment of secondary hyperparathyroidism in patients, who underwent dialysis. The aim of this study is to estimate the number and localization of PTgs in patients with secondary hyperparathyroidism. We included 165 patients, who underwent total parathyroidectomy with heterotopic autotransplantation of parathyroid gland tissue or subtotal parathyroidectomy. All identified PTgs were separated in two groups: eutopic and ectopic. Preoperative localization was performed by multispiral computed tomog- raphy of neck and mediastinum, neck ultrasonography, two-isotope Tc99 MIBI of PTgs. In postopera- tive period, we estimated the level of parathyroid hormone in the serum and performed morphological verification. There were found 659 PTgs. 12 (7,2%) patients had 3 parathyroid glands, and 11 (6.7%)had 5 PTgs. 4 Ptgs were found in 142 (86,1%) patients. 520 (78,9%) PTgs were eutopic, 139 (21,1%) - ectopic. The most common ectopic place for upper PTgs were paraesophageal and retrotracheal spaces, carotid sheath. Ectopic lower PTgs were most commonly located in the horns of the thymus. All super- numerary PTg were ectopic and often located in area between lower pole of the thyroid lobe and the thymus.Conclusion. During the operation in case when ectopy is suspected, upper PTgs should be located in in paraesophageal and paratracheal areas or in carotid sheath, if it necessary. If lower PTgs is absence, surgery should be completed cervical thymectomy.
HERALD of North-Western State Medical University named after I.I. Mechnikov. 2015;7(3):23-28
pages 23-28 views

THE INTENSITY OF THE FORMATION OF ADHESIONS IN THE PROCESSOF INRA-POMINALNOM STRENGTHENING OF THE ABDOMINAL WALL IN THE EXPERIMENT SYN-THETIC MESH IMPLANTS, DIFFERENT PHYSICAL-TO-CHEMICAL BASISOF THE STRUCTURE

Chistyakov D.B., Movchan K.N., Yaschenko A.C.

Abstract

In the experiments 60 rabbits explored intra-abdominal implantation in the abdominal wall with synthetic prostheses with different physico-chemical basis of the structure. Results of implantation of the prosthesis was assessed primarily in relation to the development or absence of adhesions. In experiments (6 groups of animals were evaluated 4 types of implants made of polypropylene, polyvinylideneftuoride, polyvinylideneftuoride layer with a collagen coating and PVDF coated carboximetilcelulosa. The pronounced formation of adhesions (worst results) marked with the strengthening of the abdominal wall implants created from polypropylene. Best of all (rare formation of adhesions in the peritoneal cavity) were the results when implanted in the abdominal wall prostheses, consisting of PVDF materials.
HERALD of North-Western State Medical University named after I.I. Mechnikov. 2015;7(3):29-37
pages 29-37 views

BONE DENSITY PARAMETERS CHANGING IN POSTMENOPAUSAL WOMEN WITH DIFFUSE SITES NONTOXIC GOITER AND AUTOIMMUNE THYROIDITIS IN TREATMENTLOW-DOSE ESTROGEN-PROGESTOGENS MEDICATION

Gromova V.A., Vorokhobina N.V., Malygina O.F., Kuznetsova A.V.

Abstract

Postmenopausal osteoporosis - multifactorial disease, on the pathogenesis of which affect not only the estrogen deficiency, but functional state of other endocrine glands, particularly the thyroid gland. The article presents the results of a research 74 women with autoimmune thyroiditis and diffuse nodular nontoxic goiter, which during perimenopause and menopause for 12 months received low-dose estrogen-progestin preparation containing 2 mg drospirenone and 1 mg of 17-estradiol. The control group consisted of 40 women of similar age without thyroid disease who were not receiving drugs hormone replacement therapy (HRT). To study the effect of HRT on bone metabolism all women at baseline and after 12 months of follow-conducted study of bone mineral density (BMD) with dual en ergy X-ray absorptiometry (DXA). As a result of the treatment received reliable increase in BMD in the lumbar spine L1-L4 9-10% (p <0.001) in the proximal femur - by 2.8-3.5% (p <0.01) in the bones forearm - by 1.8-2.1% (p <0.01).Conclusion: The use of low-dose estrogen-progestin drugs for 12 months in women with autoimmune thyroiditis and diffuse nodular nontoxic goiter in peri- and postmenopausal period helped gain in BMD in both trabecular and cortical bone structure.
HERALD of North-Western State Medical University named after I.I. Mechnikov. 2015;7(3):38-43
pages 38-43 views

SOME FEATURES OF THE DEVELOPMENT OF URGENT COMPLICATIONSAFTER CHEMOTHERAPY IN PATIENTS WITH MALIGNANT LYMPHOMA

Yurkin A.K., Maximov A.G., Shegolev A.V., Yurkina E.A.

Abstract

The article investigates the features of urgent complications in patients with malignant lymphoma after chemotherapy. The study included 151 patients. Indolent lymphomas diagnosed in 68 people aggressive lymphomas - in 83 people. The study identified the most important urgent conditions af fecting patients and mortality. In patients with aggressive lymphoma we revealed the following lifethreatening condition (i.e. critical condition under which the patient can die without treatment in the anytime soon): acute heart failure, pulmonary edema, hemorrhagic stroke.The most common urgent conditions in patients with indolent lymphomas are following: ischemic stroke, acute renal failure and DIC syndrome. There were significant predictors of urgent complications that allow to predict their development and define the scope and order of pre-emptive intensive care, as well as to create a matrix of information for the development of learning mathematical matrix for model urgent complications after chemotherapy in patients with malignant lymphoma during neutropenia.
HERALD of North-Western State Medical University named after I.I. Mechnikov. 2015;7(3):44-48
pages 44-48 views

EFFECT OF DIFFERENT TYPES OF LEUKOCYTE FILTERSON ERYTHROCYTE DONOR BLOOD PRODUCTS AT THEY PRODUCTIONSTAGE LEUKODEPLETION

Belyaev A.E., Mironenko A.N., Platonov S.M.

Abstract

To evaluate the side effects of “production” leukofilters (LF) on filtering blood components, in particular - determine the degree of loss of hemoglobin at leykodepletion (LD) of erythrocyte blood components with various types of LF. The study of this parameter is necessary for determining reasonable criteria for selecting the type LF for everyday work in the production of red blood cell suspension (RBC’S), which would be most consistent with the concept of the “ideal”. Materials and Methods: Blood systems «Leukotrap RCPL» (production of «Pall Medical», USA) with integrated LF and «Demotec» (production of «Demophorius», Cyprus), which fluster LF “Leykosep» (production Company NLP «Interoko», Russia) were used for collection of donor blood. Results and discussion: 22 samples of leukodepleted RBC’S with LF “Leykosep” and 20 samples of RBC’S after LF «Pall» were examined for. Prior to the LD groups were quite comparable. The process of executing the LD leads to a significant reduction in the volume of the container contents and, accordingly, the loss of hemoglobin in the system with a reduction of its content in a dose of RBC’S. However, indicators of volume loss and reduction of hemoglobin in the “Interoko” group were significantly greater than in the group «Pall», which appear to be associated with the design of the LF. Accordingly, in the group “Interoko” amount of hemoglobin per dose of RBC’S was significantly less than in the group «Pall». At the same time revealed the difference between the groups in hemoglobin concentration after LD was on the damage trend without reaching statistical significance (p = 0.053), which may indicate an insufficient value of groups. However, indicators of hemoglobin concentration were within adequate values (N > 40 g / dose) to meet the requirements of Technical regulations. Conclusions: Given the increasing number of proposals on the market LF existing assessment criteria (subjective convenience for staff, the producer price) becomes clearly insufficient, moreover it turns out that the use of different types of systems at least makes it necessary to clarify the accounting for losses of erythrocyte blood products in the LF. The study makes it clear that the manufacturer’s instructions to the LF and work instructions for the LD of erythrocyte blood components should include additional criteria - a loss of volume in the LF, which entails a significant reduction in hemoglobin content.
HERALD of North-Western State Medical University named after I.I. Mechnikov. 2015;7(3):49-53
pages 49-53 views

THE BILATERAL EPICUTANEOUS ELECTROSTIMULATION OF THE LOWERLIMB MUSCLES CONTRIBUTES TO INTRADIALYTIC HYPOTENSION PREVENTIONAND HEMODIALYSIS EFFICIENCY IMPROVEMENT

Vishnevskii K.A., Belyaev A.E., Mironenko A.N.

Abstract

The study researches the effectiveness of bilateral epicutaneous electrostimulation of the lower limbs muscles (BEEM) for purification intensification and improvement of the hemodynamic stability during the procedure in patients receiving hemodialysis (HD). The study included 71 patients (test group N=37; control group N=34). BEEM performed during hemodialysis three times per week for 30 minutes in the first 3 hours of each hemodialysis session for 3 months. The control group received standard HD therapy. The BEEM group in contrast to the control group showed a significant increase in the efficiency of dialysis (spKt/V), as well as lower levels of predialysis uremia. Also, the BEEM contributed to reduce the frequency of intradialytic hypotension episodes in patients who had a history of such episodes.
HERALD of North-Western State Medical University named after I.I. Mechnikov. 2015;7(3):54-59
pages 54-59 views

MELATONIN EXCHANGE AT MULTIMORBID CARDIOVASCULAR PATHOLOGYWITH ANXIETY AND DEPRESSIVE DISORDERS IN YOUNG AND MIDDLE-AGED MEN

Aflitonov M.A., Partsernyak S.A., Mironenko A.N., Partsernyak A.S., Topanova A.A.

Abstract

Evaluate melatonin (MT) patterns excretion at multimorbid cardiovascular pathology (MCVP) (coronary artery disease (CAD), hypertension, metabolic syndrome (MS)) with non-psychot- ic mental disorders (NPMD) anxiety/ depressive type. Identify the effectiveness of visual-auditory ef- fects in the treatment of these pathologies. Design and methods: The study included 70 men (mean age 37,46±6,74) with MCVP divided into 4 groups by simple random sampling, and 20 healthy men (mean age 38,3±6,73 g). Patients in Group 1 (n = 22) received standard therapy CAD, hypertension and NPMD, in group 2 (n = 25) standard therapy CAD, hypertension, NPMD and visual-auditory correction. Patients of group 3 (n = 23) received standard therapy CAD, hypertension, NPMD, visual-auditory correction and psychotherapy. Used in the study: complex psychological test methods and laboratory-instrumental evaluation of the cardiovascular system. Definition of 6-sulfatoxymelatonin (6-SMT) performed by ELI- SA using kits BÜHLMANNEK-M6S. Results: Identified change normal «dipper» pattern to «non- dip- per» and «night-peaker» (daily index blood pressure and 0-10% <0% (p <0,001) in all treatment groups. Patients 3 group observed achievement reference values of the night excretion after treatment 458±64-» 798±32 (before and after treatment, respectively) (p <0,001). In all groups after treatment was observed significantly change the type of NDP «severe depression», «clinical anxiety» to «mild depression»; «sub- clinical anxiety» (p <0,001). Conclusions: Patients with MCVP have abnormalities of MT content char- acterized by a decrease in nocturnal excretion of 6-SMT. Night pattern of 6-SMT excretion significantly correlated with severity of anxiety/ depression before and after treatment. Results of patients treated with visual auditory correction significantly better than patients of other groups (obtained reference intervals MT excretion, biochemical indices and normalization of psychological tests).
HERALD of North-Western State Medical University named after I.I. Mechnikov. 2015;7(3):60-65
pages 60-65 views

PROVIDING THE POPULATION WITH PRIMARY CARE PHYSICIANS:FACTS, TRENDS AND PROGNOSIS

Hurtsilava O.G., Luchkevich V.S., Avdeeva M.V., Logunov D.L.

Abstract

To ensure the availability of primary health care compliance with regulatory requirements, taking into account population density, and personnel stability are very important. Methods. According to the reporting form №30 analyzed accordance staffing table one of the polyclinic of St. Petersburg regulatory and target indicators, presented in the Orders of medical care. Analyzed frequency of layoffs of doctors from polyclinic throughout the year, taking into account the duration of the employment relationship. Results. The population living in the polyclinic area of health care, is extremely insufficient provided by dentists, rheumatologists, urologists, oncologists and psychotherapists, as their numbers on 57,5-80,8% below the regulatory and target indicators. Insignificant shortage of staff identified among allergist, cardiologists, gastroenterologists, infectious disease specialists, general practitioners and otolaryngologists precinct because the lack of individuals working in these fields, is 10-30%. There is no shortage of such specialists as endocrinologists, ophthalmologists and neurologists. Over the last year 20,5% of doctors quit from a polyclinic and the newly employed at 1,5% less than retired from work. Conclusion. The current staffing table does not fully meet the regulatory requirements on the number of posts and the number of actually working doctors on 10 thousand of population. Another problem is the turnover of medical staff, which exacerbates the staffing imbalance.
HERALD of North-Western State Medical University named after I.I. Mechnikov. 2015;7(3):66-72
pages 66-72 views

CICATRIZATION AND REGENERATION

Pechersky A.V., Pechersky V.I., Shpilenya E.S., Gaziev A.H., Semiglazov V.F.

Abstract

Introduction. The cicatrix as the local site of a sclerosis, replaces wound defect or focus of a necrosis. Lead to cicatrization various type of a trauma, including operational, and also some of diseases. Cicatrization quite often leads to stricture and other complications.Materials and methods. The methodology of stimulation of regeneration for reduction of intensity of cicatrization of the damaged tissues is shown on the example of the patient from a stricture urethra.Results. In 5 months after an endoscopic urethrotomy of a stricture of bulbous part of urethra of 3 mm and the developed recurrence - the stricture of bigger length - 5 mm the repeated endoscopic urethrotomy was carried out. In 5 months after carrying out a repeated endoscopic urethrotomy and the beginning of the complex treatment directed on stimulation of regeneration and prevention of formation of cicatricial tissue according to a control urethrography the bulbous part of urethra was passable.Conclusion. Complex stimulation of regeneration taking into account a role of immune system in this process, on an equal basis with purpose of proteolytic ferment preparations, can be used for reduction of expressiveness of sclerosis of the damaged tissues.
HERALD of North-Western State Medical University named after I.I. Mechnikov. 2015;7(3):73-82
pages 73-82 views

HEPATIC OSTEODYSTROPHY IN AUTOIMMUNE LIVER DISEASES

Prashnova M.K., Raikhelson K.L., Kharitonov A.G., Baranovskiy A.Y.

Abstract

Несмотря на несомненные успехи, достигнутые в понимании этиологии и патогенеза аутоиммунных заболеваний печени, остается еще множество нерешенных вопросов. Актуальной проблемой современной медицины являются нарушения костного обмена у данной категории больных. Поздняя диагностика этих осложнений, часто на стадии тяжелого остеопороза с развитием инвалидизирующих переломов, определяет отсутствие своевременного начала терапии, потерю трудоспособности и сложность социальной реабилитации больных, ухудшая прогноз выживаемости.
HERALD of North-Western State Medical University named after I.I. Mechnikov. 2015;7(3):83-92
pages 83-92 views

FEATURES OF DIAGNOSTICS AND PLASTY OF LARGE LEFT-SIDED POSTTRAUMATIC DIAPHRAGMATIC HERNIA

Zemlyanoy V.P., Sigua B.V., Nikiforenko A.V., Kotkov P.A.

Abstract

Post-traumatic diaphragmatic hernia often develop as a result of an open or closed chest and abdomen injury, thoracoabdominal and iatrogenic. A clinical observation of successful diagnosis and treatment of patient with major post-traumatic diaphragmatic hernia, developed after laparoscopic splenectomy, accompanied by technical features, is exampled. Operative treatment of large post-traumatic diaphragmatic hernia is a complex reconstructive operation and requires the use of alloplastic materials for adequate correction.
HERALD of North-Western State Medical University named after I.I. Mechnikov. 2015;7(3):93-96
pages 93-96 views

POST-INFARCTION CARDIAC RUPTURE

Kovalchuk E.Y., Rysev A.V.

Abstract

The field of post-infarction myocardial ruptures is still a nearly blind spot of cardiology; there are many facts about it which are ambiguous and simply too vague. For example, the dispersion in frequency rate is quite self-explanatory: from 0 to 30 or even 35 per cent. A number of clinical studies concerning the 30 days mortality due to acute myocardial infarctions just ignores myocardial ruptures as being the cause of death. This probably comes from a certain confusion as the post-infarction myocardial ruptures and the cardiogenic shock have almost similar manifestations. However pathologists participating in those not so numerous clinical studies concerning the 30 days mortality due to acute MIs presume that the real frequency rate of myocardial ruptures is much higher and stands at 20 to 36 per cent among all cases.
HERALD of North-Western State Medical University named after I.I. Mechnikov. 2015;7(3):97-101
pages 97-101 views

CLINICAL AND NEUROLOGICAL CRITERIA FOR THE DIAGNOSISOF MYASTHENIA GRAVIS

Kosachev V.D., Lobzin S.V., Alekseeva T.M., Kreis O.A.

Abstract

927 patients suffering from myasthenia gravis have been examined. A long-term follow-up analysis of the various forms of myasthenia in its clinical and neurological development has been conducted. Systematization and evaluation of the results have revealed major and frequent diagnostics criteria appropriate of myasthenia gravis. There are fatigable muscular weakness (92,3%), formula motor dis- turbances (91,9%), test with neostigmine (77,5%), generalized muscular weakness (76,3%), “flutter” and «migration» of the symptoms (71,1%), preservation of eye movements downward while it restricts in other directions (68,3%), combination ptosis and lagophthalmos on one side (50,1%). A diagram of clinical diagnostic, which help us to review a patient diagnosis of myasthenia gravis or suspect this exact disease has been developed.
HERALD of North-Western State Medical University named after I.I. Mechnikov. 2015;7(3):102-107
pages 102-107 views

PREVALENCE OF DEPRESSION IN PATIONTS WITH HYPOTHYROIDISM

Sinitsina Y.V., Kotova S.M., Tochilov V.A.

Abstract

Examination of 125 women with primary hypothyroidism was conducted to specify a prevalence of a depression and its severity and also to reveal change of indicators under therapy of levothyroxiny. The percent of persons without depression before treatment was the least. More expressed depression was revealed in the group of a manifest hypothyroidism at women of middle age. Direct dependence between the TSH level and indicators of a depression is noted. Against treatment there was an improvement of indicators, however symptoms of a depression were eliminated not at all patients.
HERALD of North-Western State Medical University named after I.I. Mechnikov. 2015;7(3):108-112
pages 108-112 views

THE RELATIONSHIP OF CLINICAL AND SOCIO-PSYCHOLOGICAL CHARACTERISTICSOF HOSTILITY AND AGGRESSION IN PATIENTS WITH PSORIASIS

Solovjeva S.L., Ruzhinskikh A.G.

Abstract

The article presents the current idea of the relationship between negative emotions and severity of psoriasis. It concludes investigations of the relationship between such negative feelings as hostility, ag- gressiveness and severity of chronic dermatosis; consideration of various variants of aggressive behavior and their relation to hostility. The article gives recommendations for enhancing the quality of care in hospitals for patients with psoriasis with a hostile, aggressive behavior.
HERALD of North-Western State Medical University named after I.I. Mechnikov. 2015;7(3):113-117
pages 113-117 views

CLINICAL AND IMMUNOLOGICAL INTERACTIONS IN THE RECURRENT MISCARRIAGEAND THEIR CORRECTION METHODS

Belyaeva M.A., Bobrov S.A., Lapin S.V.

Abstract

The review is devoted to the problem of reproductive losses associated with impairment of the immune mechanisms which ensure the normal pregnancy progression. Increased expression of cytokines by T-helper type 1 cells underlies the immune etiology of reproductive losses. Decrease in regulatory T- cells activity leads to the development of recurrent spontanious abortion . The most important mechanisms of pregnancy progression cytokine regulation are presented. The main autoimmune conditions leading to fetal death are: antiphospholipid syndrome, increased activity of natural killer cells, compatibility in the HLA system, the presence of antinuclear, antigiston, sperm antibodies and Human chorionic gonadotropin antibodies. The modern methods of pathogenetic therapy of recurrent spontanious abortion are reviewed.
HERALD of North-Western State Medical University named after I.I. Mechnikov. 2015;7(3):118-123
pages 118-123 views

PRAVILA DLYa AVTOROV

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HERALD of North-Western State Medical University named after I.I. Mechnikov. 2015;7(3):124-125
pages 124-125 views


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