Vol 11, No 1 (2019)

Original researches
Dynamics of endothelian function in different treatment strategies in stable ischemic heart disease
Sayganov S.A., Kuzmina-Krutetskaia A.M.

Aim. To assess the dynamics of endothelial function by determining circulating endothelial cells in peripheral blood in patients with stable ischemic heart disease within various treatment approaches.

Material and methods. The study involved 98 patients with stable ischemic heart disease and 30 patients in the control group without coronary atherosclerosis. Endothelial function was assessed by determining the number of circulating endothelial cells in peripheral blood using flow cytofluorimetry with antibodies to cell surface markers: CD146+CD45 at the baseline. Depending on the treatment tactics, the study participants were divided into 3 groups: the medicamental therapy group, the group of coronary stenting, and the group of coronary bypass surgery. After 3 months from the baseline, dinamics assessment of endothelial dysfunction was performed.

Results. Endothelial dysfunction was observed in all patients with obstructive lesions of the coronary blood flow and associated with effort angina class and anatomical severity of coronary disease. Improvement of endothelial function was facilitated by lipid-lowering therapy. Revascularization by coronary stenting impaired endothelial function in three months after the intervention. Mycoardial revascularization by coronary bypass did not impair endothelial function.

Conclusion. Examination of endothelial dysfunction by determining the number of circulating endothelial cells in peripheral blood can be used to assess the severity of endothelial dysfunction in patients with IHD receiving lipid-lowering therapy and undergoing surgical revascularization.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2019;11(1):5-12
Medicamentous and non-medicamentous treatment of hip osteoarthritis in pregnant women
Trofimov E.A., Mazurov V.I., Melnikov E.C., Trofimova A.C., Samigullina R.R., Gaydukova I.Z.

The management of pregnant women with severe pain caused by primary or secondary osteoarthritis (OA) of the hip joint (HJ) has not been developed. The aim of the article was to evaluate the influence of NSAIDs, glucocorticoids (GC), analgesics and non-drug treatment methods on pregnancy outcomes in patients with primary and secondary OA HJ.

Methods. The study included 99 pregnant women aged 35 to 49 with an intensive pain (≥4.0 points according to visual analog scale (VAS)) due to primary or secondary OA HJ. Depending on the form of OA, the severity of pain and the patient’s opinion, the following therapy was adminestered: ibuprofen up to 800 mg per day orally (n = 31) or paracetamol up to 1000 mg per day orally (n = 20) or methylprednisolone up to 12 mg per day orally (n = 27) or non-medicamentous methods (n = 21), including educational programs, systematic physical therapy, body mass index correction, instep support, orthosis, etc.). The efficacy of the treatment was evaluated within a month from the beginning of the therapy, pregnancy outcomes for the mother and the fetus and pathology of the child after 12 months after the birth. The factors, associated with low efficacy of treatment, were evaluated.

Results. In 50 (51%) women primary OA HJ was diagnosed, in 49 (49%) — secondary OA HJ. A decrease of pain in HJ in patients of all treatment groups (p > 0.05 for comparison with baseline) was observed. The patients with secondary OA who receiving Methylprednisolone showed a statistically significant (p < 0.05) pain relief compared to the patients in other clinical groups. A correlation was found between the intensity of pain syndrome (VAS) and BMI. 85 (85%) patients had urgent deliveries, 14 (14%) had premature, natural delivery in 82 (82%) women, and a caesarean section was performed in 29 (29%) cases. The cases of ante- and perinatal fetal death were not recorded. Pathological conditions were absent in 28 (84.85%) of newborns, whose mothers refused medical treatment, in 28 (90.32%) newborns, who received ibuprofen, in 15 (75%) — paracetamol, and in 23 (85.19%), who were on methylprednisolone therapy (differences between the goups are unreliable, p ≥ 0.05). In 12 months after birth in the group of newborns receiving antenatal ibuprofen, pathological conditions were observed in 3 children, paracetamol — in 5, metiprednisolone — in 4 children and in 5 children in the group not receiving medicamentous therapy.

Conclusions. 1) The use of non-medicamentous and medicamentous (non-selective NSAIDs or GC in small doses or analgesics) treatment in pregnant women with hip osteoarthritis has equal efficiency and safety for the health of both the mother and the fetus; 2) сhildren born to mothers with primary or secondary hip osteoarthritis treated with NSAIDs or analgesics or GC in age of 12th month do not differ from children born to mothers with osteoarthritis of hip joints receiving non-medicamentous therapy; 3) an increase of the body mass index of a pregnant woman with osteoarthritis of the hip joints is a predictor of refractoriness to any form of drug and non-drug therapy.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2019;11(1):13-20
Ways to improve the immediate results of treating complicated colon cancer in elderly and senile patients
Glushkov N.I., Pavelets K.V., Gorshenin T.L., Lobanov M.Y., Shishlikova Y.S.

The article analyzes the results of treating 545 elderly and senile patients with complicated forms of colon cancer and severe concomitant pathology. Depending on the method of surgical treatment, the patients were divided into two groups. The control group consisted of 408 patients, who were performed traditional surgery without investigating the Tei index. The patients of the main group were operated using endovideosurgical technologies. In addition, the calculation of systolic-diastolic ratio by means of Doppler echocardiography was carried out. Measuring the Tei index allowed correcting cardiovascular risk in the perioperative period, thereby increasing operability and reducing the number of postoperative cardiac complications. The use of minimally invasive methods of surgical treatment for colon cancer contributed to a decrease in the frequency of postoperative complications. Thus, it contributed to reducing hospital mortality from 29.9% to 2.2%.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2019;11(1):21-26
Photochromotherapy using narrow-band optical radiation of 530 nm wavelength in cognitive rehabilitation of patients with focal brain lesions
Tereshin A.Е., Kiryanova V.V., Reshetnik D.A., Efimova M.Y., Savelyeva E.K.

The objective of the research was to study the nootropic effects of photochromotherapy using narrow-band optical radiation (PCT NBOR) of 530 nm wavelength in combination with the standard medical and psychological therapy in cognitive impairments rehabilitation in patients with focal brain lesions.

Materials and methods. The rehabilitation outcomes in 141 patients with cognitive impairments due to focal brain lesions were studied. Patients were subdivided into two groups: 90 patients of the control group were treated with the standard nootropic medications and neuropsychological procedures; 51 patients of the main group were additionally treated with PCT NBOR of 530 nm wavelength transorbitally and in the neck-collar zone. The dynamics of the score increase according to Rivermid, Karnovsky, Roshina, MMSE, mRS, HDRS, SF-36 scales were analyzed.

Conclusion. PCT NBOR of 530 nm wavelength has advantages in restoring the functional state, attention, counting, reading, and speech intrinsic to the ischemic brain damage compared to the standard cognitive rehabilitation program. In the patients with hemorrhagic stroke PCT NBOR of 530 nm wavelength has no significant effect on cognitive functions; however it improves the general functional state.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2019;11(1):27-38
Healthcare system development
Economic aspects and managing the work of express laboratory while using portable gas analyzers in resuscitation units
Gaikovaya L.B., Saiganov S.A., Lataria E.L., Gramatovich O.V., Fedorenko A.S., Ermakov A.I.

The economic rationale for the choice of a portable analyzer of gases and electrolytes for their use in the resuscitation and intensive care units, as well as implementing the “point of care testing” principle allowed us to optimize the work of the express laboratory, reduce the number of tests, their costs, and increase the quality of research.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2019;11(1):39-46
Difficulties in interpreting the criteria for assessing medical care provision in acute appendicitis
Movchan K.N., Demko A.E., Tatarkin V.V., Batirshin I.M.

Some patients experiencing health problems unreasonably bring charges against medical specialists because of inadequate medical care providing. It occurs in cases of acute appendicitis as well as in cases of its complications. This article presents data about clinical observation of the patient suffering from acute appendicitis with diagnosis pecularities, unusual tactic of treatment with the subsequent dissatisfaction in this regard with the quality of health care provision. Compliance with the deiontological principles showing mutual respect on the part of both the medical staff and patients may prevent bringing charges against organizations because of inadequate medical care provision.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2019;11(1):47-54
Case report
Endovideosurgery in treating large nonparasitic hepatic cysts
Sigua B.V., Zemlyanoy V.P., Kachiuri A.S., Gurjii D.V., Abdulaeva R.M., Vinnichuk S.A., Zakharov E.A.

Background. Liver cysts despite their low prevalence are an important issue in surgical hepatology. Among the indicatiors of the problem are often on the one hand, an asymptomatic course and on the other hand, possible complications such as compression of vessels and bile ducts, suppuration with abscesses and their rupture leading to peritonitis.

Material and methods. The article presents the experience of treating the patient with a large nonparasitic liver cyst, as well as the technical aspects of surgery and the immediate results of the treatment.

Results. The use of endovideosurgical technologies in treating patients with large nonparasitic liver cysts reduces the length of hospital stays, minimizing postoperative complications, as well as the period of rehabilitation.

Conclusion. The use of external drainage of nonparasitic liver cysts under the control of medical imaging methods is preferable in the presence of infectious complications of cysts as a preparatory stage for radical treatment. Laparoscopic treatment of patients with large nonparasitic liver cysts is characterized by the lowest complication and recurrence rates and for repeated surgical interventions.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2019;11(1):55-60
Modern opportunities of early diagnostics and minimally invasive surgical treatment of intestinal perforation by a foreign body
Sinenchenko G.I., Verbitsky V.G., Demko A.E., Parfenov A.O., Osipov A.V., Tereshichev A.A., Novozhilov V.N., Kosachev A.V.

The article presents two cases of intestinal perforation by a foreign body rarely being the cause for “acute abdomen”. In both cases the disease resembled acute appendicitis. The introduction of endovideosurgical technologies into surgical practice contributes to early diagnostics of a gut wall perforation by a foreign body and allows performing only low-invasive surgical treatment.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2019;11(1):61-64
Clinical and laboratory profile of hereditary spherocytosis
Asatryan T.T., Zenina M.N., Chernysh N.Y., Gaikovaya L.B.

Diagnostics of hereditary spherocytosis is usually based on clinical picture, family history and laboratory tests. The list of laboratory tests includes osmotic fragility test, a glycerol lysis test, an eosin-5-maleimide binding test and others. None of the following methods identify all cases of hereditary spherocytosis.

The article discusses the problems of diagnosing congenital microspherocytic anemia and provides the detailed analysis of informational value of various research methods and their significance.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2019;11(1):65-72
History of the surgical treatment of cubital tunnel syndrome
Jigania R., Korotkevich M.M., Orlov A.Y., Bersnev V.P.

Cubital tunnel syndrome is a widespread form of peripheral neuropathy. This article presents chronological overview of the surgical treatment methods of cubital tunnel syndrome along with authors who described them for the first time.

The historical review provides for better understanding of existent surgical methods und for development new surgical approaches of treatment cubital tunnel syndrome

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2019;11(1):73-78
The effect of warfarin, heparin, and modern directly acting oral anticoagulants (dabigatran etexilate, rivaroxaban, apixaban) on the level of coagulation factors: V, VII, VIII, IX, XII, WF
Gulyaikhina D.E.

Heparin is common initial therapy administered to subjects with acute venous thromboembolism. Routine clinical practice in this case consists of immediate heparin therapy initiation and administration of warfarin sodium within 24 hours; administration of heparin is usually finished in 5 days. Patients with CF-LVAD (continuous flow left ventricular assist device) are also administered intravenous unfractionated heparin. Heparin mainly serves as anticoagulant via catalyzing antithrombin, which leads to factor II (thrombin), factor X inhibition, with smaller effect on IX, XI, XII.

During the last 50 years warfarin has been the most common anticoagulant from vitamin K antagonists group which is used to treat patients with high risk of developing arterial and venous thrombosis. It has narrow therapeutic window due to unfavorable pharmacokinetics, thus requiring frequent monitoring, and it’s affected by interaction with concomitant medications and foods. Apart from this, effect of warfarin is not limited to the influence on hemostasis; it also has impact on all vitamin K-related proteins. Warfarin shows its anticoagulant effect through decreasing functional levels of vitamin K-related factors II, VII, IX and X. Synthesis of two physiologic anticoagulants — C and S proteins — is blocked at the same time. Warfarin competes with vitamin K, thus blocking vitamin K effects.

Modern directly acting oral anticoagulants: direct thrombin inhibitor dabigatran and Xa factor inhibitors — rivaroxaban and apixaban, were developed as an alternative to warfarin. They also show non-hemostatic vascular effects via protease activated receptors (PARs).

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2019;11(1):79-92
Non-infectious complications of peritoneal dialysis in children
Schebenkov M.V., Dobroserdov D.A., Shavkin A.L.

The article discusses non-infectious complications of peritoneal dialysis. Attention is focused on the causes of non-infection complications, diagnostics, treatment and prevention. Both common and rather rare complications are described.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2019;11(1):93-98

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