Vol 10, No 2 (2018)

Differential diagnosis of patients with cubital tunnel syndrome and concurrent diseases
Orlov A.Y., Jigania R., Nasarov A.S., Bersnev V.P., Butovskaya D.A.

The main groups of peripheral nerve disorders — cubital tunnel neuropathy, peripheral nerve sheath tumors and cervical degenerative disc disease are reviewed in this article. The main clinical courses of these disorders are presented in this article. We met some problems during the treatment of these disorders. The differential diagnosis of these disorders is associated with some difficulties. Basing on these problems, we attempt to describe advances and limitations of diagnostic methods used for differential diagnostic of abovementioned disorders in this article.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2018;10(2):5-11
Efficacy and safety of new oral anticoagulants: Position of gastroenterologist
Bakulin I.G., Belousova L.N., Pakhomova I.G., Chizhova O.Y.

The prevention of thromboembolism is the leading goal in the management of atrial fibrillation (AF) patients. Oral anticoagulants (OAC) has been using in the treatment of AF patients for a long time according the modern clinical recommendations. Recently, new direct oral anticoagulants (NOAC) have been increasingly used in the treatment and prevention of thrombo-embolism in AF patients. However, the problem of bleeding prevention in anticoagulated patients (primarily for gastrointestinal tract) is still unresolved. The authors analyzed the results of evidence-based medicine for assessing the risk of gastrointestinal bleeding in anticoagulated patients with NOACs.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2018;10(2):12-18
Anemias in elderly and old
Bogdanov A.N., Shcherbak S.G., Pavlovic D.

Recent information about frequency, etiology and pathogenesis, diagnostics and treatment different anemias in elderly and old patients are revelealed in this review.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2018;10(2):19-26
Endothelial dysfunction and circulating endothelial cells in patients with chronic ischemic heart disease
Sayganov S.A., Kuzmina-Krutetskaya A.M.

Aim. To evaluate endothelial function in patients with chronic ischemic heart disease by determining the number of circulating endothelial cells in peripheral blood.

Material and methods. 71 patient with typical angina class I–III and presence of obstructive coronary artery disease according to coronary angiography were assessed, coronary anatomy was assessed on the SYNTAX Score scale and the number of CEC was determined by flow cytofluorimetry. Depending on the chosen treatment strategy patients were divided into the following groups: a group of medical therapy (group 1) — 22 patients; a group of patients requiring percutaneous coronary intervention (group 2) — 25 patients; a group of patients requiring surgical revascularization by coronary artery bypass surgery (group 3) — 24 patients. The control group consisted of 20 patients without atherosclerotic lesions of the coronary arteries.

Results. Study groups do not differ by sex, age, history of smoking, the presence of hypertension, MI history (р > 0.05). In the group of patients who are scheduled to perform CABG significantly more patients with diabetes mellitus (р < 0.05) (group 1 — 3 patients (13.6%), group 2 — 4 patients (16.0%), group 3 — 7 patients (29.1%), control group — 2 patients (11.8%)). Study groups reliably differ in the anatomy of coronary lesions (SYNTAX Score in group 1 — 9.4 ± 2.7, in group 2 — 19.7 ± 5.7, in group 3 — 23.5 ± 6.0), р < 0.05. The number of CECs in the study groups is significantly higher than the generally accepted norm (р < 0.05), (group 1 — 12 (10÷16), group 2 — 14 (10÷17), group 3 — 14 (11÷17), control group — 12 (10÷16)). There are no significant differences between the groups with coronary artery disease (р > 0.05).

Conclusion. Study of endothelial function by flow cytometry using monoclonal fluorescently labeled antibodies to CD146 and CD45 can be considered as a criterion for noninvasive assessment of the severity of atherosclerotic lesion of the coronary bed.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2018;10(2):27-32
Evaluation of cardiovascular risk factors in women with left breast cancer of middle-aged and elderly age at the stage of chemotherapy and radiotherapy
Vologdina I.V., Zhabina R.M., Poroshina E.G., Stanzhevsky A.A., Savelieva A.V., Krasilnikova L.A., Maslyukova E.A.

The study was conducted to identify risk factors for cardiovascular complications in 38 women with HER2neu negative left breast cancer without severe cardiovascular pathology, related both to the clinical features of the patients and the treatmenbeing performed. Patients after radical mastectomy were hospitalized for chemotherapy (doxorubicin in a cumulative dose not exceeding 360 mg/m2) and 3D conformal radiation therapy on the left breast breast of chest radiation doses 39 Gy (equivalent to 48 Gy of normal functioning). Separation into groups was carried out depending on the age: from 20 to 59 years — 20 patients, from 60 to 74 years — 18 patients. It was revealed that the risk of cardiovascular complications in the Score Scale was significantly higher in elderly patients due to age, increased systolic blood pressure and hypercholesterolemia. These patients showed higher rates of BMI and abdominal obesity. The study of psychosocial factors has shown great importance of the transferred stress in the past. The patients of the second group showed high personal anxiety (55.4 ± 3.4, 95% CI 49,6–56,4). In 70% of middle-aged patients and 89% of elderly patients after chemotherapy and radiotherapy cardiotoxicity in the form of cardiac insufficiency of systolic and diastolic dysfunction and asymptomatic cardiac arrhythmias was revealed.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2018;10(2):33-38
Association of polimorphism rs1801282 with different components of the metabolic syndrome
Eremenko T.V., Kotova S.M., Matezius I.Y., Khetagurova F.K., Radugin F.M.

Objective. To study the association of polymorphism rs1801282 of the PPARγ gene with different components of metabolic syndrome (MS).

Materials and methods. 145 subjects with newly diagnosed MS were examined. All subjects underwent a clinical examination, including general clinical, laboratory and instrumental methods; presence of polymorphism rs1801282 of the PPARγ gene was also determined.

Results. In the group of subjects with rs1801282 polymorphism, hyperglycemia was observed less frequently compared with the rest of subjects the incidence was 53.8% and 79.8% cases respectively (p = 0.005). A decrease in the risk of arterial hypertension was also observed in subjects with polymorphic allele: an increase in blood pressure was noted in 70.6% of rs1801282 group and 96.2% for wild type PPARγ (p < 0.001) When analyzing levels of triglycerides and high-density lipoproteins, an increase in these parameters was noted in the group of subjects with rs1801282 polymorphism.

Conclusion. The results of the study indicate the association of rs1801282 polymorphism in subjects with metabolic syndrome with a number of clinical features of the disease, dyslipidemia and a reduction of the risk of hyperglycemia and hypertension.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2018;10(2):39-43
Diagnostic algorithm for detecting chronic obstructive pulmonary disease in primary care
Ovakimyan K.V., Pokhaznikova M.A., Andreeva E.A., Kutznetsova O.Y., Plavinskij S.L.

Background. This article aims to implement an adaptation of the international standardized questionnaires, to assess the diagnostic value of their Russian-language version for diagnostics of chronic obstructive pulmonary disease (COPD), to develop the diagnostic algorithm based on questionnaires and spirometry results in order to form COPD high risk group in primary care.

Materials and methods. The main results were based on the RESPECT study (RESearch on the PrEvalence and the diagnosis of COPD and its Tobacco-related etiology) population of St. Petersburg.

Results. The repeatability of Russian-language version of investigated questionnaires was significantly high.

Conclusion. A new diagnostic algorithm was developed to identify individuals at high risk of COPD and could be recommended for primary health care.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2018;10(2):44-51
Prevention of embolism in patients with atrial fibrillation after resection of left atrium appendage during open heart surgery (pilot study)
Sotnikov A.V., Melnikov M.V., Marinin V.A., Kisil Y.V., Samko K.V.

Aim. To assess the potential of prevention cardiogenic embolism by resection of left atrium appendage (LAA) during open heart surgery in patients with atrial fibrillation (AFib).

Materials and methods. Study design — cohort prospective. Study group consisted of 19 patients with AFib whom during open heart surgery for coronary and/or valvular disease additional radical resection of LAA was made. After removal of the appendage two-layer linear suture to left atrium was performed without leaving a stump. Control group consisted of 20 patients with AFib, in whom during open heart surgery LAA remained intact. Long-term results were studied using CROQ telephone questionnaire.

Results. There was no hospital mortality in both groups. Long-term results in control group were followed up to 6 years, in study group up to 2 years. Radical resection of LAA in patients with AFib reduced the risk of thromboembolic events in long-term period. In control group there were 4 strokes (2 of them were fatal), but no strokes in study group (p < 0,05).

Conclusion. Radical resection of LAA in patients with AFib during open heart surgery for coronary and/or valvular disease prevents cardiogenic arterial embolism.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2018;10(2):52-57
Transcutaneous oxegen measurement in the area of soft tissue radiation-induced fibrosis in patients with breast cancer
Topuzov E.E., Agishev T.T., Fedorov K.A., Krasnozhon D.A., Vats A.B., Romanovsky D.V., Dashyan G.A., Sidikov A.A., Ovsyannikov A.A., Sadygova S.N., Prikhod’ko E.V., Kasyanova M.H.

Late radiation injury in the form of radiation-induced fibrosis is one of the many complications of radiation therapy. In current literature, pathogenesis of radiation-induced fibrosis is considered from several angles. According to one of the hypotheses, the main cause of pathogenesis of radiation-induced fibrosis is damage of the blood vessels caused by radiation. Another hypothesis insists that radiation causes depletion of specific cell populations in the irradiated area, reducing the number of stem cells (mostly, fibroblasts).

Based on our first-hand experience in treating late radiation injures of soft tissues in patients with breast cancer, we measured oxygen perfusion of the skin (TсPО2) in the area of late radiation injury using a transcutaneous monitor TCM 400 (Radiometer, Denmark). The obtained results may give a new insight into pathogenesis of late radiation injures.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2018;10(2):58-63
What factors need to be considered when assessing the financial costs of medicines
Fedorenko A.S., Burbello A.T., Pokladova M.V., Ivanova M.A.

The article presents possible approaches to assessing the financial costs of medicines. The results of the ABC/VEN and ATC DDD analyzes recommended by the Ministry of Health of the Russian Federation and the World Health Organization (WHO) in assessing the financial costs of medicines in a large multidisciplinary hospital are described. The evaluation of ABC/VEN and ATC/DDD analyzes, their advantages and disadvantages is given. It is shown that the ABC/VEN analysis gives only a general idea of planning financial expenditures and ATC/DDD about real drug consumption in the treatment of one patient. The financial costs of treating one patient vary significantly and depend on many factors: disease nosology, severity, division profile, etc. It was determined which factors should be taken into account both in estimating the cost of medicines and in planning financial expenditures for the next year.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2018;10(2):64-72
Gender peculiarities of nutrition in students and their relationship with quality of life
Gonchar N.V., Kalinicheva E.O., Mustafaev E.H., Dobrenko V.A., Sokolova M.I.

Objective. Nutritional peculiarities and their relationship with the quality of life’s (QoL) values were estimated in 38 students.

Materials and methods. We evaluated the dietary peculiarities according to the results of our special questionnaire. The students used ten-point scale for answer questions. We have formed the two subgroups of the respondents according to the results of their answers: subgroup A (students whose answers were 5 points or less) and subgroup B (students whose answers were more than 5). We estimated QoL according to the SF-36 questionnaire.

Results.Most of the respondents eat regularly the food containing plant fibers (76.3%) and the food with animal proteins (81.6%). Above mentioned dietary peculiarities correlates reliably with such QoL values as SF and BP in men and VT in women. 36,8% of respondents have breakfast irregularly, this nutritional peculiarity reduces reliably such QoL values as PF, GH and VT. The regularity of breakfasts correlates reliably with VT in men, and PF and GH in women. Dietary restriction of spicy, fatty, fried, smoked foods is observed in 36.8% of respondents; a negative reliable correlation of this nutritional peculiarity with RP has been revealed in women; possible positive effect of such kind of food on the QoL can be suggested.

Conclusion. It is shown that there is a correlation between students’ eating habits and the quality of life.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2018;10(2):73-78
Diagnostics and surgical tactics in case of combined complications of colon cancer in elderly and senile patients
Glushkov N.I., Gorshenin T.L., Dulaeva S.K.

The results of diagnostics and surgical treatment of the combined complications of colon cancer in elderly and senile patients are presented. It is established that modern ray methods of research, along with traditional methods, allow to improve the quality of diagnostics of combined complications. The introduction of endovideosurgical technologies helps to reduce the number of postoperative complications and lethality.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2018;10(2):79-86
Portrait of the patient with intermediate ejection fraction of the left ventricle on the background of acute decompencation of heart failure
Skorodumova E.G., Kostenko V.A., Skorodumova E.A., Siverina A.V., Rysev A.V., Povzun A.S.

Background. Medico-statistical portrait of patient are a fairly new concept.

Materials and methods. 71 patients with intermediate ejection fraction of left ventricle (ILVEF) under acute decompensation of chronic heart failure were examined, 51 of them were male (71.8%) and 20 female (28.2%). Main cause of cronic heart failure was ischemic heart disease and arterial hypertension. The Charlson comorbidity index and Stevenson’s hemodynamic profile of patients. The average age of the individuals is 65.6 ± 12.1 years. Statistical processing of the data was carried out using the method of multifactor analysis using SPSS 23 and the Microsoft Office Excel 10.0 package.

Results. Main features of portrait of a patient with ILVEF with acute decompensation of heart failure, which has an high risk of death, is a male aged 64 to 71 years, with a Charlson’s comorbidity index equal to 5 points and higher, as well as a hemodynamic profile of B or C. Portrait of a patient with ILVEF who has a low risk of death — a male / female aged 55 to 64 with a Charlson’s index from 1 to 4 points, as well as hemodynamic profile A and L.

The conclusion. This article describes a creation of mathematical model for patients with ILVEF and acute decompensation of chronic heart failure under background of comorbidity and hemodynamics with a check of the obtained models using ROC-analysis

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2018;10(2):87-91
Intraoperative neuromonitoring as an element of neurophysiological support system high-tech neurosurgical care
Alexandrov M.V., Ulitin A.Y., Chernyi V.S., Toporkova O.A.

Intraoperative neurophysiological monitoring (IONM) is comprised of a complex of electrophysiological methods allowing continuous monitoring of the functional state of the nervous system in order to minimize its damage. IONM is a part of an integrated system of high-tech medical care in neurosurgery. Experience gathered at Polenov Russian. Neurosurgery Research Institute infers that the ultimate solution for effective intraoperative monitoring is to develop a specialized structure within the department of functional diagnostics.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2018;10(2):92-98
Biological tissue reaction to the intracorporeally-polymerising implant used in a minimally invasive “puncture-infusion-seal” method of the inguinal canal
Trunin E.M., Mowlabucus M.J., Murt L.L., Smirnov A.A., Tatarkin V.V., Rybakov V.A.

The article focuses on the study of the biological properties of a synthetic intracorporeally-polymerising implant, designed to be used in a minimally invasive “puncture-infusion-seal” technique under experimental study for the treatment of reducible inguinal hernias. The method is innovative in the field of herniology and surgery in general for its minimal invasiveness. Two types of experiments were conducted to investigate the response of live tissues of the body to the implant as a foreign body (on rats) and the impact of the implant on the male reproductive system of rabbits.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2018;10(2):99-106
Effect of systemic enzyme therapy on clinical manifestations of inflammation in gonarthrosis
Mazurov V.I., Dorovskikh A.G., Trofimov E.A.

Summary. Despite a significant number of studies on various schemes of OA therapy, there are only some studies with the use of systemic enzyme therapy (ETS) in combination with NSAIDs and / or SYSADOA. The aim was to study the effect of different groups of drugs (NSAIDs, ETS, SYSADOA) on the clinical course of gonarthrosis, as well as to develop an algorithm for the choice of treatment tactics depending on the clinical and sonographic manifestations of this disease.

Methods. The data of 46 patients with stage I and stage II OA of Kellgren-Lawrence were analyzed. Patients of the first group received combined oral therapy with chondroitin sulfate (HS) 500 mg 2 times a day and glucosamine sulfate (GS) 750 mg 2 times a day in combination with selective NSAIDs. The second group of patients received combined therapy of HS 500 mg 2 times a day with the GS 750 mg 2 times daily together with Phlogenzym (PL), 2 tablets 3 times a day. All patients included in the study were examined initially, after 8 and 12 weeks. Procedures included clinical (VAS, WOMAC) and instrumental methods with the use of ultrasound of joints to evaluate the pathology of soft tissues and detect synovitis..

Results. Comparing groups 1 (HS, GS and NSAIDs) and 2 (HS and GS together with PL) on the effect on the structural state of cartilage and the dynamics of the main ultrasonic manifestations of OA knee joint, it should be noted that the effectiveness of drugs HS and GS in combination with enzyme therapy was higher, because in this group of treatment of synovitis decreased, whereas in the group of HS and GS, together with NSAIDs, these parameters either increased or remained unchanged.

Conclusions. The use of polyenzyme drugs significantly increases the effectiveness of complex therapy in patients with osteoarthritis of the knee joints.

In patients with gonarthrosis treated with a combination of chondroitin sulfate, glucosamine sulfate and phlogenzym was observed a significant reduction in the severity of synovitis, as well as more frequent lower daily dose of the selective NSAID or their full cancellation, compared with a control group of patients treated with symptomatic drugs retardation in combination with NSAIDs.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2018;10(2):107-112
Hemophagocytic syndrome and ankylosing spondylitis
Belogurov A.R., Mazurov V.I., Tcigan E.N., Tyrenko V.V., Toporkov M.M., Buryak I.S., Voronin S.V., Sobolev A.V.

Hemophagocytic syndrome is a consequence of excessive activation of the immune system that develops as a rule in response to infection, neoplasm or as a result of an autoimmune disease leading to uncontrolled hyperinflammatory syndrome, internal injuries, cytopenia and death. The diagnosis of the syndrome is complex and is based on the criteria accepted by the society for the study of hemophagocytosis syndrome in 2004. Therapy involves the use of a combination of cytostatics and glucocorticoids and is carried out for a long time. The article describes the clinical case of hemophagocytic syndrome in a patient with ankylosing spondylitis.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2018;10(2):113-120

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