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Pacific Medical Journal

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No 4 (2004)
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EDITORIALS

5-10 256
Abstract
Based on the literature data and his own findings, the author provides an analysis of central nitroxide mechanisms of pain sensitivity regulation. In anti-pain system a nitroxide signal serves as integrating element, producing an effect on the activity of serotonergic, noradrenergic and opiate components of endog-enous analgesia. Changes in nitrogen oxide production within "analgetic" centers of brain that occur due to the nociceptive stimulation are capable of determining the course of descending pain-modulating processes. Depending on the pain process, stage nitroxide mechanisms intensify effectiveness of either anti-pain or pronociceptive systems, thus, changing threshold of pain sensitivity.

LECTURES

11-15 300
Abstract
Acute massive loss of blood is up to now one of the states having the highest lethality rates. Increased interest in this problem is accounted for by the fact that almost all surgeons deal with it quite often. Results of infusion-transfu-sion therapy depend on its timeliness and adequacy, while the approach, demand for transfusion mediums, as well as their quantity and structure are determined by clinical picture, blood loss volume, its rate and duration, and patient's age and concomitant diseases. The major problem of haemorrhage therapy that is blood replacement is now solved by using whole donor blood and its components, as well as by means of infu-sions of fresh frozen plasma, saline, colloidal solutions, and perftoran.
16-17 269
Abstract
According to the authors' opinion, intracardial ra-dio-frequency ablation was efficacious at 92.2% of cases. The best results, when this procedure was applied, were observed un-der supraventricular rhythm disturbances (100%) and WPW-syndrome (93%). Ablation did not result in deterioration of basic indexes of intracardial hemodynamics both immediately after the operation and within six-month period after it, and made for intraventricular asynchronicity abatement.

REVIEW

18-20 208
Abstract
The paper describes technique of oesophagus stent-ing under strictures of neoplastic or nonneoplastic origin, focus-ing special attention on features of different devices, indications and contra-indications to their application. Based on the litera-ture, the author provides grounds for high effectiveness of oe-sophagus stents. Application of this procedure allows suppressing severe symptoms and improving quality of life for the patients who suffer from progressive oncological process.
21-25 454
Abstract
First "epilepsia partialis (corticalis) continua" was described by the progenitor of Russian neurology A.Ya. Ko-zhevnikov. Although this disease has been studied for a century, issues of its origin and mechanisms of onset still remain unspeci-fied. The paper as a literature review of main stages of the re-search into epilepsia partialis continua, places this disease be-tween different forms of tick-borne vernal encephalitis, gives in-formation about some components of its pathogenesis and pro-vides grounds for the participation of extrapyramidal deep structural defects in the developing of this pathology.
26-29 215
Abstract
The paper provides a literature review on modern methods of pacing. Biventricular pacing, in authors' opinion, improves treatment results of patients suffering from congestive cardiac insufficiency. Ongoing researches into the efficiency of biventricular pacing associated with defibrillation are intended for showing the effect produced by electrotherapy on subjective esthesiophysiology of well-being and survival indexes.

ORIGINAL RESEARCHES

29-31 291
Abstract
Left posterior block of bundle of His occurs under posterodiaphragmatic myocardial infarction. Based on the anal-ysis of 14 observations the authors make up conclusion that ap-plication of computer electrocardiotopography with registration of 260 unipolar leads allows to specify necrosis size under myo-cardial infarction complicated by left posterior block of bundle of His, and in some cases to detect the block itself.
32-33 237
Abstract
The paper describes two clinical cases of transplan-tation of allogenic fibroblast-like mesenchymal stem cells under third-degree burns. Wound healing features studied by the au-thors point to a high regeneration rate due to marked angiogen-esis. Prior pilot researches and clinical observations point out a high effectiveness of cellular transplantation applied in the course of severe burns treatment.
34-35 217
Abstract
Based on the analysis of 55 cases of abdominal sepsis associated with complicated acute respiratory distress syndrome, the authors have shown intensification of free-radical lipid oxi-dation processes and reduction in antioxidant cell protection. As standard intensive therapy was of no effect, the authors have concluded that intensification of antioxidant protection is expe-dient as integrated intensive care when dealing with acute respi-ratory distress syndrome observed at patients with abdominal sepsis.
35-37 240
Abstract
Modelling of pain syndrome and giving of intramus-cular injection of Ketonal as for laboratory rats have allowed studying changes in the activity of nitric oxide-forming neurons of cerebrospinal ganglions and posterior horns, which are con-sidered to be "pain gates", from the standpoint of the modern science. Intramuscular injection of Ketonal resulted in suppress-ing of nitric oxide generation by nociceptive neurons of spinal ganglions and spinal cord. Mechanism of analgesic action of Ke-tonal has both peripheral and central components.
37-38 238
Abstract
Based on 493 clinical observations, the authors have analysed the results of traditional and integrated (using videoim-age laparoscopy) treatment of postoperative abdominal complica-tions. When the therapy was integrated, total lethality amounted to 16.9% when both diagnostics of complications and relaparoto-my were only performed by applying traditional methods, the le-thality was much higher coming up to 29.7%. Among the patents over 60 the lethality under traditional surgeries amounted to 56.4%, while applying integrated methods -24.7%. These findings allowed the authors to draw conclusion that videoimage laparos-copy is very promising for diagnostics and treatment of postopera-tive complications, especially for patients of elderly and old ages.
39-42 229
Abstract
The authors present analysis of treatment results of 137 patients suffering from complicated colorectal cancer. Among them, patients of elderly and old ages amounted to 71%. 119 pa-tients were operated on. Based on the findings, the authors show advantages of delayed and radical surgery, as well as conditionally radical operations to be performed on this patient population. The paper also touches upon a subject of the quality of diagnostics of colorectal cancer, especially at patients of elderly age.
42-44 211
Abstract
At the comparative analysis of the changes arising in examined ovaries the following features have been determined. In group of the fetus which have been born in pelvic presentation in 82% it was marked morphological features of hemodynamic disorders of a various degree of expressiveness. In group of the fruits which have been born in cranial presentation, similar mor-phological changes were determined only in 15% of cases. Con-clusion. Results of researches testify to pathological influence on gonadal hemodynamic in case on pelvic presentanion not only intranatal as was considered earlier, but also antenatal.
44-46 232
Abstract
The authors have examined patients with chronic renal insufficiency that underwent conservative treatment (71 persons) and programmed hemodialysis (31 persons). X-ray densitometry of lungs developed in Amur Clinical Hospital was used. In the course of examination the authors revealed increase in regional and integral disturbances of pulmonary ventilation, as the renal insufficiency progressed when giving conservative treatment. With length of dialysis there was a tendency towards decrease in X-ray densitometry indexes that could be accounted for by subclinical uremic pulmonary affection.
47-48 245
Abstract
In authors' opinion, basic tendency in clinical re-searches that has become apparent over the last years in the do-main of perioperative analgesia consists in the use of multimodal principle of anti-pain protection, and preemptive analgesia, first and foremost. Having examined the patients aged 12-78 on whom surgical operations for abdominal and thoracic cavities organs were performed, the authors ascertained that using of pre-emptive analgesia by Ketonal and postoperative analgesia by means of epidural introduction of both morphine and Ketonal intramuscularly is clinically efficacious and pathogenetically well-founded.
49-52 270
Abstract
The authors have studied variability of blood pres-sure and heart rate at 45 patients suffering from metabolic syn-drome associated with arterial hypertension, depending on type of lipid and carbohydrate metabolic disturbances. As is stated, patients suffering from pancreatic diabetes of the second type had the least level of high-density lipoproteins and unfavorable type of abdominal obesity. Results of daily monitoring of electro-cardiogram and blood pressure confirmed adverse effect of early carbohydrate metabolism disturbances on prognosis for meta-bolic syndrome course. In conclusion authors point out the ex-pediency to perform 24 hours' monitoring of electrocardiogram and blood pressure together with heart rate variability wave struc-ture analysis as to patients suffering from metabolic syndrome and blood hypertension.
53-54 271
Abstract
140 women being in an in-patient obstetric-gynae-cologic department were operated on as per proposed technique by using antireflux endotracheal tube (patent of the Russian Fed-eration for invention No. 2150300 - 2000). Application of this device allows conducting surgery at a more qualitative and safe level. Among other advantages are both reductions in dosage of drugs having systemic action and good tolerance to anaesthesia and surgery that is especially important in obstetric practice un-der very complex interrelations between mother's organism and foetus.
54-55 272
Abstract
On carrying out the analysis of nuclear DNA content in foetus retina, the author describes retina thickness time, fea-tures of chromatin distribution in neuron nuclei and shows that starting from I up to III trimester of pregnancy a number of poly-ploids reduces, while neuron concentration per unit area de-creases.
56-58 204
Abstract
Based on the experience of 190 laparoscopic cholecys-tectomies, the authors make a comparison of the cardiovascular sys-tem state when applying epidural anaesthesia and endotracheal nar-cosis. They show that changes in hemodynamics indexes when ap-plying endotracheal narcosis are well-marked, as against the epidu-ral anesthesia, thus implying that maintenance of spontaneous breathing during the whole operation makes for more adequate compensation of negative effects of carbon-dioxide peritoneum.
58-61 183
Abstract
We investigated 45 adolescences with carriage disor-ders. Condition of calcii-phosphorum exchange was estimated on blood calcium (Ca) and phosphorus concentration and also its level morning urinary excretion in relation creatinine. Level of CrossLaps (is marker of bone resorbtion) and level of osteocal-cini (is marker of bone formation) in blood mere measured by enzyme immunoassay analysis (Hoffman la Roshe). PTH secre-tion in the serum blood was estimated. Control group was con-sisted by 40 health adolescences similar ages and sex. The adoles-cences with carriage disorders have expressed decrease of OC in comparison with control (p<0,01). The adolescences with car-riage disorders had dysfunction of calcii-phosphorum exchange in compare control group; it illustrated of hypocalcaemia and hypercalciuria. The boys had more low concentration of Ca in comparison girls (p<0,01). PTH level was lower in adolescences with carriage disorders than control group (p<0,05). We didn't establish any correlation relationship between calcium exchange and PTH concentration.
61-62 220
Abstract
Every day women working as medical personnel contact with aggressive occupational environment. Based on 315 leukograms, the author has studied cell-phagocytic protec-tion indexes, lymphocytic-monocytic potential, and allergic susceptibility of the organism. As is shown in the paper, up to 35% of patients were in acute stress being very unfavorable prognostic sign.
63-65 232
Abstract
The authors studied regularities of prolactin synthe-sis under metoclopramide test conducted on 155 women suffer-ing from galactorrhea syndrome and on 22 patients with no ga-lactorrhea syndrome signs. The tests revealed that, if any, there was reliable increase in level of prolactin secretion. Type of re-sponse to metoclopramide introduction entirely depended on initial value of prolactin.
65-67 248
Abstract
Forensic medical examination of cases of infection with venereal diseases and HIV infection is rather rare type of medical examination. Persons went through sexual violence are a group of risk of being infected with sexually-transmitted infec-tions, diagnostics of which should be performed as soon as pos-sible. Therefore, in all cases of sexual crimes victims must be examined by venereologist. The authors also cite an instance from their practice.
67-68 383
Abstract
The paper provides discussion about nosologic place of miliary disseminated lupus of face and diagnostic potential of polymerase chain reaction. The author has made an attempt to detect DNA of Mycobacterium tuberculosis by using polymerase chain reaction in patients' skin, but it failed. Tuberculous ethiol-ogy of miliary disseminated lupus of face still raises doubts.
69-71 237
Abstract
Based on 106 observations of coronary heart disease, the authors estimate longitudinal segmental systolic and diastolic functions of left ventricle and its global diastolic function. The maximum dysfunctional segments are detected at patients with two- or three-vascular affection of coronary channel. The more myocardium segments of diastolic function are registered, so much the global diastolic function of the left ventricle is involved. Though some criteria are nondiagnostic as for one-vessel affec-tions, the authors incline to believe that application of tissue Doppler cardiography, which is used under coronary heart dis-ease even if there are normal indexes of transmitral blood flow, is well-grounded.
72-75 257
Abstract

Adequate ventilating maintenance of long operations of liver transplantation is one of conditions of successful realization of this complex, difficult and long operations. Experience of realization 16 related ортотопических transplantations of liver at adult patients in the age of from 16 up to 61 years (compare 29,6±12,5) was analyzed. Average duration of anaesthesia has made 15,4±1,58 hour. Ventilating maintenance was carried out in a mode of traditional artificial ventilation easy with use of a technique minimal-flow. Key parameters of ventilation are determined by stages of operation, i.e. a dynamic condition of cardiovascular system, productivity of heart, blood volume, value of preload and after load and many other parameters. The basic condition of successful realization of similar anaesthesia is the knowledge of features minimal-flow anaesthesia, presence of informative ventilating and gas monitoring. The use of isoflurane in a regime of minimal-flow allows essentially lowering the charge anaesthetic to provide reliable, controlled and safe anesthesia during all operation. Time of postoperative artificial and support ventilation easy has made 4,2±1,1 hour.

METHODS

76-77 224
Abstract

Low- and minimal-flow anesthesia are modern technologies of inhalation anesthesia for which realization modern anaesthesiological respiratory devices both constant informative ventilating and gas monitoring are necessary. Realization of minimal-flow anesthesia is connected to some physiological features of gas exchange in lungs, having a place at small streams of inhalation gases. Observance of simple rules of realization low-flow anesthesia with modern inhalation anesthetics allows providing reliable, well controlled and practically safe anesthesia at the most difficult and long operations.

78-80 221
Abstract

Modern chemotherapy is impracticable without due maintenance of oncological patients' life quality. New modes of cytostatic drug introduction allow undergoing almost any courses of medical treatment on an outpatient basis, while long-term chemotherapy and anaesthesia are performed by using specially developed infusion systems. Subcutaneous implantation of ports that are devices for multiple infusions makes for easier introducing of medicinal agents, thus avoiding extravasation and phlebitis. The authors share their own experience in using outpatient infusion pumps and ports.

PRACTICE OBSERVATIONS

81-82 237
Abstract

The paper presents a follow-up of a defect of interventricular septum arisen from a child's chest blunt injury diagnosed on the basis of auscultatory data, radiography, and ultrasound study. When acute consequences of the injury were suppressed, the child underwent alloplasty of interventricular septum in parallel with artificial circulation and chemical cold cardioplegia. As per control examination made in a year, hemodynamic indices were normal.

82-83 252
Abstract

The paper provides a follow-up of a child aged thirteen when the authors have diagnosed bilateral renal artery stenosis, most evident on the right. The patient underwent left balloon angioplasty and renal arterial transposition of the right renal artery in four months. The repeated examination showed normal arterial pressure without any correction of antihypertensive drugs. Based on the results, the authors concluded that combination therapy of renal angioplasty in cases of vasorenal hypertension is advisable.

PUBLIC HEALTH ORGANIZATION

84-86 206
Abstract

The paper provides a report of the chief specialist of the Public Health Department of the Sakhalin Oblast Administration that contains information about regional anesthesiology and reanimation service. The author points out the low level of hospital facilities, provision with narcosis apparatus, follow-up devices, and expendables, as well as highlights the necessity to modernize equipment of resuscitation and intensive care departments, to purchase modern equipment, and to train personnel. In conclusion, the author places emphasis on creation and reinforcement of specialized reanimation centers and equipping of air medical service in order to provide timely transportation of patients from remote districts.

86-87 233
Abstract

The paper provides analysis of results of invasive prenatal diagnostics (696 cases) performed in Regional Clinical Center of Maternity and Childhood Protection (Vladivostok) over 2001-2003. Chromosomal anomalies were detected at 4.2% of cases. The most frequent pathologies were Down's syndrome and balanced translocations. Based on the findings, the authors pointed out the necessity of wider application of invasive prenatal diagnostics in the region.

88-89 231
Abstract

Neoplasms are one of the most important medical and social problems. In Primorye 24060 oncological patients have been registered in oncological dispensaries. In 2003 6268 patients were for the first time registered as persons having malignant tumors. In 2003 oncopathology structure comprised tumors of reproductive system (38.5%) and genital organs (18.5%). Breast cancer prevailed, and then followed carcinoma of uterine cervix, uterus and ovaries. Among all malignant tumors resulting in Region's woman mortality the highest death rate was registered, if women suffered from neoplasms of breast, uterine cervix, ovaries, and uterus. Putting the screening system into practice will allow to reduce a portion of advanced tumors of reproductive system and to decrease death rate among Region's women.

HISTORY

90-92 336
Abstract

The paper provides a profile of P. I. Fedotov who is a head of the department of propedeutics of internal diseases in Vladivostok State Medical University. His course of life includes work in the regional hospitals on graduating from the institute, participation in the military operations during the Great Patriotic War, presentation of two theses for Doctor's degree, guidance for the department for 13 years, establishment of pulmonologists' school in Primorsky Region, and development of a series of basic works on the problems of clinical picture and medical treatment of lungs diseases

PEDAGOGY

92-93 211
Abstract

Depending on general goals and objectives of postmortem examination, post-graduate training of forensic experts is provided by departments of pathologic anatomy and forensic medicine conjointly. It consists of four stages that include postmortem diagnostics of the most important somatic diseases (stage I), work with macrobiological specimens (stage II), microscopical diagnostics (stage III), and making out of a diagnosis and thanatological conclusion, based on the attainments (stage IV). Four-stage training system shows up an adequacy of this approach to didactic process of forensic pathologists' advanced training.

94-95 225
Abstract

Some interactive methods have been introduced at the department of human anatomy to develop creative virtues, analytical potentiality and manual skills of students studying there in hours of self-instruction. These methods imply preparation of different systems of human organism and the follow-up analysis of the results, as well as work on term papers.

96-97 279
Abstract

Specialists working at therapeutic departments of Vladivostok State Medical University are engaged in constant, purposeful and concerted activities to form professional skills of students, as provided by the requirements of State Educational Standard for the year 2000. The main line of students' activity is work at clinic, using state-of-the-art technologies included. A special attention is focused on the students' self-instruction under teacher's control that allows providing training of the future doctors for mastering the profession during post-graduate courses in intership.

INFORMATION

98-99 260
Abstract

Medicina-DV Publishing House established two years ago in Vladivostok State Medical University specializes in publishing scientific literature and teacher's manuals. Besides, this publishing house is engaged in preparing and issuing "Pacific Medical Journal" being far-famed both in Russia and in Asia-Pacific Region. By inviting well-qualified specialists, in a short space of time it has succeeded in achieving impressive results. At the latest Far-Eastern exhibition "Publishing court2004" this journal and two books issued by "Medicina-DV" were rewarded with certificates of quality for editing and design. From 2005 electronic issues of the "Pacific Medical Journal" are going to be available for Internet users at http://www. elibrary.ru.



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ISSN 1609-1175 (Print)