No 3 (2013)
EDITORIALS
REVIEWS
8-11 197
Abstract
Summary - The paper reviews bibliography related to early diagnostics and differential di-agnostics of Parkinson's disease and discusses characteristics of tremor, non-motor disorders and other neurological symptoms and responses to dopaminergic medications prescribed to treat Parkinson>s disease. Considering the issues of differential diagnostics of Parkinson’s disease and parkinsonian syndrome associated with hepatolenticular disease, progressive supranuclear palsy, corticobasal degeneration, multiple system atrophy, and some other diseases, the authors discuss the role and share of neuroimaging techniques in diagnosing the Parkinson’s disease.
ORIGINAL RESEARCHES
16-18 282
Abstract
The hyperdynamic response of cardiocirculatory system is known to incur danger for patients with deficiency in systemic and coronary circulation waiting for reparative surgeries on abdominal aorta. 38 aortobifemoral bypass surgery case follow-ups have allowed to assess efficiency of prevention of hyperdynamic response of cardiocirculatory system to laryn-goscopy and intubation of trachea with infusion of ultra-short acting beta-blocker esmolol (at calculated dose of 1.5 mg/kg infused 5 minutes before the anaesthetic induction). As reported, esmolol has prevented tachycardia at the moment of laryngoscopy and intubation of trachea that is indicative of its priority compared to the traditional methods of induction of anaesthesia.
A. A. Silaev,
E. P. Turmova,
E. V. Markelova,
R. M. Gromovoy,
I. E. Golub,
E. V. Shkorik,
A. A. Khelimskiy
18-21 238
Abstract
The authors have examined 80 patients with ischemic heart disease before and after coronary artery bypass surgery. Before surgery, the cases associated with further post-operative inflammatory complications were characterised by low level of T-lymphocytes, in-creased content of cells with receptor to interleukine-2, and decreased IgG concentration in blood. The application of recombinant interleukine-2 has normalised the content of leucocytes, increased the absolute level of lymphocytes, and normalised the quantity of T- and B-cells, increased IgA level and decreased IgM level. The cytokine therapy allows reducing the number of postoperative inflammation and infection-related complications and reducing the hospital length of stay.
E. A. Rozhnova,
M. F. Kinyaikin,
M. A. Shapoval,
G. I. Sukhanova,
A. V. Danilets,
I. V. Naumova,
T. A. Khairzamanova
22-24 300
Abstract
The paper reviews polysomnography of 83 patients with chronic obstructive lung disease associated with obstructive sleep apnoea syndrome/hypopnoea. The obstructive sleep apnoea syndrome was diagnosed in 62 patients (75 %): there were mild (26 patients), moderate (17 patients), and severe (19 patients) forms of the disease. As reported, there was a reliable correlation between the body mass index, the number of apnoea episodes and the haemoglobin oxygen saturation in arterial blood. There was no correlation related to the forced expiratory volume in one second. Therefore, it could be supposed that the pathogenesis of obstructive sleep apnoea syndrome in case of chronic obstructive lung disease depends on the degree of adiposity rather than the intensity of lower respiratory airway obstruction.
25-28 210
Abstract
The experimental model has been used to detect that the non-alcoholic steato-hepatitis (NASH) is characterised by an increase of heme oxygenase-1 expression, number of apoptotic hepatocytes, and concentration of tumour necrosis factor beta in rat liver. The increasing apoptosis level positively correlates with TNF-β (that is indicative of cytokine-dependent activation) and negatively correlates with heme oxygenase-1 activity. In case of NASH the heme oxygenase-1 activity is likely to compensate TNF-β-mediated hepatocyte apoptosis.
29-32 196
Abstract
The paper summarises results of comprehensive clinical encephalographic examination of 101 older patients with cerebrovascular diseases. The authors have detected paroxysmal symptoms of epileptic nature in 78 patients. The integrated drug treatment included antiepileptic agents. Two-year treatment with neuroprotectors combined with antiepileptic agents has demonstrated a high efficiency of this therapy: there were 85.9 % of cases of regression in clinical features of paroxysms and positive dynamics observed on the encephalograms. The encephalographic changes in case of epileptic paroxysms being specific of old age were characterised by dissociation between non-response to rhythmic photic stimulation and evident response to hyperventilation.
32-34 236
Abstract
The paper analyses results of surgical treatment of 112 patients with tumours in pancreatoduodenal area. The tumour most often concentrated in the head of pancreas. When admitted to hospital, 101 patients had obstructive jaundice. The radical surgery - pancreatoduodenal resection - had been proved feasible in 23 case follow-ups. The other patients underwent salvaging procedures. 39 patients had complications. The overall mortality was 11.6 %, 8.7 % - after pancreatoduodenal resection.
35-37 259
Abstract
The authors have examined cerebral hemodynamics in 43 patients aged 45 to 77 with chronic disturbances of cerebral blood circulation caused by arterial hypertension and hemodynamically insignificant atherosclerosis, and performed Doppler ultrasonography of extra- and intracranial areas of major cerebral arteries using multifunctional Angiodin system. All patients had complaints of cerebrostenic and neurological symptoms. Initially, the depressed blood circulation was recorded in the arteries of vertebrobasilar basin, and then the blood flow velocity changes in carotid channels came up to the level of vertebral arteries. A Doppler ultrasound test allowed detecting changes that preceded worsening of symptoms of organic lesions of the central nervous system. The overwhelming majority of cases confirmed correlations of the localisation of neurological symptoms and the basin of reduced blood flow parameters.
38-40 281
Abstract
The paper provides data for substantiating the possibility of intra-articular therapy with calcitonin (Miacalcic) on the basis of experimental simulation of rheumatoid arthritis. The author offers a new method of preventing inflammatory destruction in the knee joint connective tissues (Russian Federation patent No. 2269355).
41-44 333
Abstract
The paper provides results of surgical treatment of 158 adult patients operated in 1999-2011. The follow-up period lasted from 2 to 130 months. The actuarial survival rate reached 99±7 % by the end of the 1st year of the follow-up, 93±3 % - by the end of the 5th year of the follow-up, and 93±3 % - by the end of the 11th year of the follow-up. In 87 % of case follow-ups the surgery results were found to be good. In the general group, by the end of the 1st, 5th and 11th years of the follow-up, the rates of freedom from structural dysfunction were 99.5±0.5 %, 95±3 %, and 64±13 %, respectively. By the 11th year of the follow-up, this parameter came up to 100 % in patients aged 60 and older, 71 % - in patients aged 45-59, and 60 % - in patients younger than 50. The rates of freedom from non-structural dysfunction were 98.5±0.9 % by the end of the 1st year after surgery, 95±2.5 % - by the end of the 5th year after the surgery, and 91±5.8 % - by the end of the 11th year after surgery.
44-46 224
Abstract
The paper provides analysis of tracheal sounds of forced expiration carried out on the basis of 78 cases of bronchial asthma in men aged 16-25 with normal spirographic values using authors’ technique (the control group comprised of 77 healthy non-smoking men of comparable age). The increasing duration of tracheal sounds of forced expiration observed in 41 case follow-ups (32 patients) confirms that the acoustic method is likely to be promising to diagnose bronchial obstruction in patients with bronchial asthma and normal spirographic values.
47-48 229
Abstract
The paper studies lipid spectrum, levels of tumour necrosis factor beta and in-terleukins-1b and 10 in women with rheumatoid arthritis with hypercholesterolemia. The authors have examined 98 patients, including 72 women with rheumatoid arthritis associated with mild and moderate forms of hypercholesterolemia, without clinical manifestations of cardiovascular pathology, and 26 almost healthy women (control group). In all cases of rheumatoid arthritis the authors detected increased levels of atherogenic blood lipid fractions (low-density lipoproteins and triglycerides) and considerably increased content of tumour necrosis factor-beta and inter-leukin-1b in blood serum that confirmed high activity of chronic immune inflammation and risk for cardiovascular complications.
K. V. Stegniy,
E. A. Fefelov,
A. Ya. Cherkashin,
A. V. Kulkov,
A. I. Suprun,
A. A. Shkarbanov,
M. V. Marchuk,
K. A. Birukov
49-52 294
Abstract
The paper discusses results of endoscopic dissection of perforating veins in 154 patients with chronic venous insufficiency (98 cases of varicose vein disease and 56 cases of postthrombophlebitic disease). The endoscopic dissection of perforating veins was in all cases combined with a single-stage phlebectomy or crossectomy. The control group was comprised of 26 patients who underwent classic Linton procedure. The complications related to the endoscopic vein surgery were observed in 2.6 % of cases. In 34.5 % of cases, the complications were caused by Linton procedure. The average length of hospital stay was 7.3±0.5 bed-days after endoscopic dissection of perforating veins and 21.2±0.7 bed-days after Linton procedure. The cost of treatment of one patient amounted to 10392.0±31.6 roubles in the major group, and 18263.8±46.2 roubles in the control group.
52-55 226
Abstract
29 patients with malign tumours of right side of colon undergone treatment in coloproctologic centre of the Primorsky Krai Regional Clinical Hospital No. 1 have been administered liquid balanced mixture Nutrizon Energy during 7 days before and 7 days after the surgery in addition to basic nutrition. The control group was comprised of 28 patients with colorectal cancer administered standard diet (1st table). As reported, the perioperative drug intake has appeared to inhibit the production of proinflammatory cytokines and cytotoxic lymphocytes and normalise the relation of T-helper cells and T-suppressor cells by the 8th day after the surgery. The recovery of intestinal motility in patients taken the feeding mixture was observed 2-3 days earlier than that of patients in the control group and allowed to avoid massive infusions and proceed with enteral feeding in 3 days after surgery.
56-58 278
Abstract
The paper provides prospective controlled randomised examination of 57 men undergone aortobifemoral bypass surgery on chronic occlusive arterial disease of limbs associated with widespread atherosclerosis. Urapidil was used to correct pre- and intraoperative resistant hypertension in 29 patients of the impact group. Enalaprilat was used to treat patients in the control group. The target values of arterial pressure were achieved in 92 % of cases in the impact group and in 74 % of cases in the control group.
59-61 253
Abstract
Summary - Research objective - the analysis of risk factors of development of acute disturbance of brain cyrculation in dynamics of 2000-2009 in industrially developed region of the Republic of Kazakhstan. The analysis was carried out with 2789 patients. As risk factors arterial hypertension, cerebral atherosclerosis, diabetes, obesity, tobacco smoking, alcohol abuse and existence of psychoemotional stresses against an inactive way of life are analysed. Among modified risk factors prevalence of an arterial hypertension, cerebral atherosclerosis, smoking and the loudspeaker of the two first to the advancing growth is revealed.
61-64 299
Abstract
The paper provides data about the incidence rate of cerebrovascular diseases in Primorsky Krai during four years (2009-2012). As reported, the cerebrovascular pathology remains the single source of incidence and death rates in the region. It accounts for over 36.5 % of first diagnosed disease cases of all the blood circulation system diseases that exceeds the Russian Federation and the Far Eastern Federal District indices. This unfavourable situation arises from the deficit of skilled personnel (neurologists, neurosurgeons, and angioneurologists), weak material and technical resources of public health services and defects of vascular centre management.
65-69 263
Abstract
The paper reviews the study of functional states and health risks of personnel that service the underground trunk railways (railway tunnels) of the East Siberian railways. As reported, the quarter part of workers engaged in the underground works prove to have satisfactory adaptive potential, over 70 % - deconditioning of the cardiovascular system, over 50 % - low index of physical state and high degree of neuropsychic stress. The risk assessment of major general pathological syndromes reveals maximal prevalence of risks for functional disorders of cardiovascular, digestive, and endocrine systems. The authors have detected positive correlation between the risk values of border psychic disorders, nervous system disturbances and frustrations because of social and living conditions and way of life. The functional status assessment appears to serve as a basis for developing adaptive processes and occupational health programs.
70-71 245
Abstract
The best practices demonstrate that the uterine artery embolisation is justified in case of symptomatic myoma, unrealised reproductive function and severe extragenital pathology. The paper describes 85 cases of uterine artery embolisation on uterine myoma of different location and size in women aged 33 to 48. In 94.2 % of cases the immediate postoperative period was characterised by rather specific clinical manifestations of ‘post-embolisation syndrome’ success-fully treated using conservative methods. The mean length of stay was 3.6±0.2 bed-days. The uterine artery embolisation was a uterus-preserving surgery in 84 cases. In 4 % of cases a pregnancy occurred.
LECTURES
12-15 256
Abstract
Summary - The paper discusses distinctive aspects of introduction of modern information technologies into the health care practice and highlights that implementing the telecommunications will require not only the introduction of new techniques but also structural changes related to both procedural institutional background and interpersonal relationships. As indicated, in such conditions a medical specialist will need to modify judgment and knowledge to keep a traditional ‘patient-doctor’ relationship based on patient’s trust to doctor’s experience and skills, on the one side, and allow improving diagnostics and correctly selecting treatment strategies, on the other side, as soon as possible. If otherwise, this will result in the loss of a definition of ‘attending physician’ related with uncontrolled self-medication and medicinal drug trading, thus causing reduction of total population health and unreasonable depletion of healthcare system resources.
PUBLIC HEALTH ORGANIZATION
O. A. Sobolevskaya,
A. F. Ponomarev,
S. E. Gavrina,
L. S. Denisenko,
O. K. Shkuratova,
E. S. Rogatkina,
S. P. Ivanov
80-82 272
Abstract
The paper summarises data about colorectal cancer detected in the Coloproctol-ogy Centre of the Primorsky Krai Regional Clinical Hospital No. 1 over 15 years (1977-2011). The colorectal cancer occupies the 5th position among the malign tumour incidence rate in Primorsky Krai. Each third case of this disease (35 %) is diagnosed in the advanced stage of a disease (stage III-IV). Of 1366 patients over 15 years 1134 were operated, radical surgeries were performed in 73.1 % of cases. The complications were observed in 6.4 % of cases. The lethality rate reached 2.6 %. The paper emphasises the role of preventive measures intended to improve diagnostics and quality of treatment for patients with malign tumours of large intestine.
83-85 291
Abstract
To establish interrelationship with working environment and changes in the state of health in railway security force, complex of indicators of temporary disability morbidity (TDM) has been investigated. The materials of the study were sick lists over period of 2009-2011. TDM levels in regular direct labour employees (shots, canine handlers) have been proved to be significantly more increased than those in managerial personnel. The influence of age, occupation, and professional length of service on morbidity has been analyzed and it was confirmed that length of service exerted an impact on shots and canine handlers’ morbidity. Respiratory diseases have been occupationally dependent in shots and canine handlers, while cardiovascular diseases have predominated in managerial personnel.
86-89 297
Abstract
The demand for control of access to health care and use of medical resources stipulates the creation of systems for automation of health care facilities. The paper summarises the best practices regarding introduction of information technologies in medicine and discusses the efficiency of introduction of clinical information system DOKA+ in the Primorsky Krai Regional Clinical Hospital No. 1.
PRACTICE OBSERVATIONS
90-91 305
Abstract
The paper reviews the case from practical experience with estimation of effi-ciency and safety of liraglutide (victose) in patient after kidney transplantation with diabetes mellitus type II and chronic viral hepatitis C administered immune-suppressive therapy (Prograf, Myfortic, and Prednisolone). During the first visit, against the insulin therapy the doctors have managed to compensate diabetes and normalise transaminases. The episodes of hy-poglycaemia and excessive weight remained. Liraglutide allowed decreasing the glycated haemoglobin con-tent by 19 %, removing the episodes of hypoglycaemia, and regulating the body mass index. The 9-month case follow-up did not reveal increasing levels of transaminases and creatinine. The content of Prograf in blood serum remained stable.
91-94 228
Abstract
The paper provides analysis of values of videoelectroencephalographic monitoring during sleep of patient with idiopathic generalised tonic-clonic seizures. The electroencephalogram of the second stage of deep sleep demonstrates generalised epileptiform activity that occurs independently of the ‘sleep spindles’ and detects that the structure of ‘sleep spindles’ is kept even when the epileptiform pattern is being recorded. These facts prove to be inconsistent with the key thalamocortical relationship theory postulate, which is a transformation of ‘sleep spindles’ into ‘spike-wave’ and ‘sharp-slow wave’ complexes. The case follow-up reliably confirms that the rhythms of high amplitude ‘spike-wave’ and ‘sharp-slow wave’ complexes known to occur in the electroencephalograms of patients with idiopathic generalised epilepsy are only a cortical phenomenon likely to be caused by ‘sleep spindles’ activity. The incitation spreads by cortical structures, only.
A. A. Sinenko,
E. B. Abramochkina,
E. M. Fizenger,
O. I. Syusina,
N. M. Lupach,
N. N. Glazkova,
N. S. Komendantova
95-96 250
Abstract
The paper describes clinical case of gout in man aged 61 who has suffered from gouty arthritis since he was 18 years old. The patient has not been administered adequate treatment. The disease caused severe joint deformations and removal of two toes. The paper summarises patient complaints, medical history information and objective evidence, results of laboratory tests, X-ray examination, ultrasound scanning, and endoscopy.
SHORT REVIEWS
103-103 277
Abstract
The paper summarises five-year experience in applying the X-ray endoscopy-based approach to restoring oesophageal patency in 119 patients aged 21-63 in case of strictures of different origin. The doctors have succeeded in performing complete restoration of oesophageal patency in most cases. In 3.4 % of cases (4 patients), the oesophageal stricture dilation failed even in case of maximum balloon pressure due to high density of scar tissue in the area of stricture and longer disease duration. There have been no lethal outcomes.
104-104 203
Abstract
The paper provides data obtained from the obstetric department of the Primorsky Krai Regional Clinical Hospital No. 1 that specialises in the endocrine pathology. As reported, over the past 10 years there has been a six-fold increase in the number of deliveries in pregnant women with diabetes mellitus: from 0.9 % in 2003 up to 5.3 % in 2012. The paper reviews 70 labour and delivery medical records of women with diabetes mellitus. The gestational diabetes mellitus was diagnosed in most of pregnant women (60 %), the diabetes type 1 was diagnosed in 30 % of cases, and the diabetes type 2 - in 10 % of cases. The preterm deliveries were recorded in 21 % of cases. 69 % of cases required operative delivery. All babies were born alive. One in three baby was born with signs of diabetic fetopathy (macrosomia).
METHODS
M. F. Kinyaikin,
A. V. Mashkova,
S. G. Zavalnyuk,
T. Yu. Voronevskaya,
O. G. Polushin,
I. V. Naumova,
N. N. Udaltsova
72-74 275
Abstract
The paper summarises the pioneer experience of ultrasound bronchoscopy in the Primorsky Krai regional pulmonological centre in 35 patients with mediastinal lymphadenopathy. In 12 cases the authors have performed ultrasound-guided directed transbronchial lymph node biopsy that allowed verifying diagnosis made for 4 patients (1 - sarcoidosis, 3 - lung cancer). The paper provides a clinical example of efficient morphological diagnostics of lung cancer with EBUS-TBNA method.
75-76 248
Abstract
The paper describes experience of 67 cases of endoscopic treatment for oesophageal achalasia: X-ray-guided balloon dilatation. The authors used a high pressure balloon of 30-35 mm in diameter to mount in cardia and fill with radiographic contrast medium for 15-30 minutes. Depending on the degree of oesophageal achalasia, 2 to 5 procedures were required to achieve stable positive effects kept during 1-2 years and more. The authors did not observe any complications and lethal outcomes.
E. Yu. Evdokimova,
O. V. Chesnokova,
I. L. Mukhina,
T. V. Andreeva,
S. V. Gavrina,
A. S. Moskalenko,
A. I. Gordeeva,
O. V. Sayk
76-78 203
Abstract
The paper provides analysis of 63 cases of ulcerative colitis and Crohn’s disease. The peak incidence fell within the age of 20 to 40. The authors have noticed the prevalence of extraintestinal manifestations, pathology found to be resistant to basic therapy, high rates of invalidisation with respect to the patients of active working age. The paper reports a successful experience of anti-cytokine therapy administered in severe cases of inflammatory bowel diseases.
79-80 270
Abstract
The paper describes authors’ method of treatment of vasomotor rhinitis with high-energy diffused laser device used to perform vasotomy of lower and middle turbinated bones in the outpatient settings under regional anaesthesia. The different contact laser vasotomy procedures have been performed for 1620 patients with neurovegetative and in 154 patients with allergic forms of chronic vasomotor rhinitis. The efficiency of treatment assessed in one month after the procedure fluctuated between 92 and 97 %. The stable recovery of nasal breathing in case of allergic-related form of the disease was observed in 126 patients.
PEDAGOGY
97-99 276
Abstract
The article deals with modern educational technology forming physician to be key competences: general cultural and professional. This paper proposes an introduction of the project and modular-based learning activity approach to the process and content of education. The authors present the educational project based on a module educational technology in foreign language teaching at a medical university. The offered project positively affects the quality of students’ theoretical and practical training.
MEDICAL HISTORY
99-102 282
Abstract
The paper reviews the history of medicine in Primorsky Krai and presents the pioneer doctors organised surgical services in Vladivostok: first - small hospital, then - naval hospital, later - hospital centre of regional significance. A combination of clinical care and research work has given rise to medical education in Vladivostok. The medical institute departments settled in the regional hospital have stimulated intensive research activity. Today, improving the quality of both treatment and diagnostics in parallel with the research and development results serves as foundation for the next step forward for Primorsky Krai medicine.
ISSN 1609-1175 (Print)