Currently, molecular-genetic studies attract attention of many scientists; there are contradictory and ambiguous data on some genes and their role in chronic inflammations of pelviс organs. Some immunogenetic aspects of pathogenesis of chronic endometritis are presented in this review; the role of mutual effect of gene dysregulation and immune system is indicated, the data on possible link between functional endometrium status and pathological polymorphism of some genes are cited.
Aim. To study the dependence of antioxidant status (AOS) on the age, sex, localization and size of the damage focus in patients during the most acute period of the development of atherothrombotic variant of ischemic stroke.
Materials and methods. Seventy four patients (main group) in the most acute period of atherothrombotic variant of ischemic stroke were examined. The group of comparison, comparable by age and sex, included 15 healthy persons. The total blood serum antioxidant status was investigated using an assay kit of “Vector-Best” Company B-7501 (“Vector-Best”, Russia).
Results. AOS value in the comparison group was 1,69 ± 0,17 mmol/l (median 1,72; interquartile range 1,53-1,83 mmol/l) that corresponded to the standard interval, indicated in the assay kit guidelines (1,3-1,8 mmol/l). OAS did not differ in men and women (criterion U = 26,0; p = 0,816). In patients of the main group, AOS was reduced ( p = 0,000034); AOS value was 1,14 ± 0,4 mmol/l (median 1,12 mmol/l, interquartile range 0,81-1,45 mmol/l). Age, sex and localization of stroke focus did not reliably influence the degree of AOS fall. Moderate reverse correlation between the focal sizes and decreased AOS value was established. Spearman’s rank correlation coefficient was -0,79 ( p < 0,001).
Conclusions. Decrease in AOS during the most acute period of developing atherothrombotic stroke does not depend on sex, age, ischemic focus localization, but it depends on sizes of the focus, subjected to ischemization.
Aim. To carry out dynamic assessment of the structural and functional indices of cardiovascular system in young men with arterial hypertension (AH) associated with excess body mass (Ebm) against the background of therapy.
Materials and methods. Examination of 86 young men aged 18-27 years, including the group of comparison with practically healthy persons ( n = 24) and the group of observation ( n = 62) was performed. The group of observation joined patients with AH without EBM and AH+EBM. The study was conducted initially and 6 months later. Patients with AH+EBM ( n = 25) were divided into 2 subgroups: group 1 (12 persons) without therapy and group 2 (13 persons) against the background of antihypertensive therapy.
Results. Six months later, in group 1 there was observed a growth of “office” systolic arterial pressure (SAP) by 3,8 % (145,0 ± 2,88 and 150,54 ± 2,99 Hg mm), p = 0,001, but in the group with antihypertensive therapy, SAP decreased by 12,7 % (145,75 ± 2,80 and 129,33 ± 1,5 Hg mm), p = 0,01 and DAP - by 12,1 % (86,5 ± 1,95 and 77,16 ± 2,41 Hg mm), p = 0,02. Pulse wave propagation velocity (PWPV) along the vessels of muscular and elastic types among patients without therapy was found to grow in dynamics by 12,2 and 16,2 %, respectively. Against the background of therapy, there was a tendency to a reliable reduction in PWPV indices.
Conclusions. Antihypertensive therapy in patients with AH+EBM, while decreasing AP, leads to reduction of LVMM, LVMMI, PWPV and IMCV. The early diagnosed lesion of target organs among young men with AH+EBM and timely antihypertensive therapy can improve structural and functional characteristics of cardiovascular complications.
Aim. To characterize the remodeling of brachiocephalic arteries in patients with instable angina, taking into account morphological type.
Materials and methods. Duplex scanning of brachiocephalic arteries was performed in 66 patients with instable angina and 59 practically healthy persons, comparable by sex and age.
Results. It was established that in patients with instable angina remodeling of the vessels of brachiocephalic region occurs earlier, than in healthy persons, and diameter of the vessels of elastic type is changed to a greater degree. Remodeling of diameters is associated with the elevation of pumping ability of the heart. IMC of the vessels of combined and muscular types of brachiocephalic region in patients is essentially larger already by the age of 40 and grows with age.
Conclusions. Hardness of the wall of brachiocephalic arteries of all types is higher in patients, than in healthy persons and grows with aging, with increase in pulse and systolic pressure, dyslipidemia.
Aim. To analyze severe traumatic injuries of visual organs in children of Perm Krai.
Materials and methods. Retrospective analysis was fulfilled according to the data of case registers of emergency ophthalmologic stations of Perm Regional Clinical Hospital and “City Clinical Hospital № 2 named after F.Kh. Gral” as well as case histories of children with visual organs injuries hospitalized to ophthalmological units of the same institutions for 2 years (2014-2015).
Results. During 2 years, 39 801 persons, including 4078 (10,2 %) children, addressed to two emergency ophthalmological stations in connection with visual organs injuries; 41 children were hospitalized: 30 (73 %) boys and 11 (27 %) girls aged 1-17 years. Most children had eye injuries, received at home - 23 persons (56,1 %), in the street - 17 (41,5 %), at school (manual training) - 1. Injured visual organ - 43 eyes: wounds - 31 (72 %) eyes, contusions - 8 (19 %), burns - 4 (9 %).
Conclusions. Injuries of visual organs, which require hospitalization to specialized units and rendering emergency surgical and conservative care, are registered in children of Perm Krai. A part of injured patients after hospital treatment preserved low visual acuity or had no object vision. Thus, it is necessary to take active measures for prevention of eye injuries and their consequences.
Aim. To study the influence of benzimidazole derivatives on the formation of oxidative stress under the impact of physical load.
Materials and methods. Physical load (PL) was induced on intact outbred male rats by daily swimming for 21 days. Physical load, induced by swimming, is a convenient model of muscular work and it can be dosed. It, as a forced for rats procedure, caused stress, the development of which was controlled by changes in adrenal mass indices and blood leucocyte number in the animals.
Results. The impaired behavioral reactions, decreased antioxidant activity in the liver and brain homogenates, elevated peroxidation product content, raised hemiluminescence intensity was detected.
Conclusions. Negative manifestations of the developed psychoemotional and oxidative stress were restrained by the introduction of dibazol and synthesized potassium salt 2-[1-(1,1-dioxothietanyl-3)benzimidazolyl-2-thio] acetic acid.
Aim. To assess the opportunities and advantages of the method of transillumination pulsooptometry and ultrasound visualization in differential diagnosis of benign and malignant mammary neoplasms.
Materials and methods. The study material of 532 persons aged 30-50 years was analyzed. All patients underwent ultrasound diagnosis of the mammary gland, pulsooptometry according to Z.M. Sigal (1981), computed and magnetic resonance imaging, ductography, mammography. To varify the nature of growth, biopsy material was subjected to histological analysis.
Results. Out of 532 patients examined, mammary cancer was revealed in 130 women, non-cancerous neoplasms of various etiology - in 402.
Conclusions. In spite of all achievements in modern medicine and development of new diagnostic and treatment methods, US combined with transillumination pulsooptometry is most available and reliable.
Aim. The aim of this study was to detect the predictors of the postoperative herniation in midline laparotomy as the most frequent type of approach in urgent surgery. The study included retro-and-prospective analysis of 398 case histories. Analysis was performed according to 45 signs.
Materials and methods. The following parameters were taken into account: Kettle index, anterior abdominal wall status, presence of the signs of undifferentiated connective tissue dysplasia, hard physical labour, use of bandage in the postoperative period as well as blood erythrocyte and hemoglobin indices, bilirubin and creatinine levels. Separately, the following parameters were assessed: presence of aponeurosis defects (physically and by US data) and presence of hernia outpouching.
Results. According to the obtained data, the indications to preventive endoprosthetic replacement of the anterior abdominal wall were formed.
Conclusions. Combination of some factors, not connected with surgical treatment, raises the risk for herniation, being the indication to preventive endoprosthesis replacement of the abdominal wall.
Aim. To study the correlation between the blood serum brain-derived neurotrophic factor (BDNF) level and the manifestation of anxious-depressive symptomatology in patients with tension headache.
Materials and methods. The study involved 82 patients with tension headache. The method of immune-enzyme assay with test-system ELISA kit was used to measure the blood serum BDNF concentration.
Results. The BDNF level in patients with episodic infrequent and frequent tension headaches was comparable with the group of control. Among patients with chronic tension headache, decrease in BDNF level as compared to group 1, group 2 and the control was revealed. The BDNF level is changed, depending on the duration and intensiveness of tension headache.
Conclusions. Chronic tension headache causes exhaustion of not only mediator, but of neurotrophic systems of the brain as well. Blood serum BDNF concentration measured permits to assess activity of cerebral neuroplastic processes and to choose neurotrophic therapy for a more rapid triggering of serotoninergic system and arresting of anxious-depressive syndrome.
Aim. To estimate an opportunity and advantages of a method of a transillyuminatsionny pulsooptometriya and ultrasound in differential diagnostics of benign formations and malignant neoplasm of a mammary gland.
Materials and methods. Research of 532 people aged 30 to 50 years. To all patients carried out ultrasound of a mammary gland. Scanning was carried out by the linear sensor 5-7 Mhz. Estimated echogenicity, structure, the sizes and vascularization of educations with measurement of high-speed indexes, indexes of peripheral resistance and the pulsation index. Measurements of hemodynamics and optical density were carried out using the device and the method of Z.M. Sigal. Carried out a computer tomography, magnetic resonance tomography, a ductography, a mammography. For verification of the nature of education carried out the histologic analysis of the bioptat received at a puncture of mammary glands and during operation. Analyzed structure of tissue, existence of various pathological inclusions, their quantity and the sizes.
Results. Despite all achievements in the modern medicine and creation of new methods of diagnostics and treatment, ultrasound in combination with transillyuminatsionny pulsooptometriya is the most available and reliable.
Conclusions. 1. At ultrasound fibroadenomas of education had mainly ovoidny form (85%), with the lowered echogenicity (87%), the homogeneous structure and smooth, legible contours. A cyst in turn in 99% of a round form, anekhogenny, the homogeneous structure and with smooth contours, at 80% located on the course of ductus lactiferi. By means of ultrasound on our way allows to carry out noninvasively and efficiently a puncture biopsy.
Aim. To detect the mechanisms of maintaining static equilibrium in old patients with complaints for vertigo, depending on disorders in emotional sphere.
Materials and methods. Eighty two patients of old age (75-89) with complaints for vertigo were examined. On the basis of clinical data and results of psychometric testing, 2 groups of patients were formed: patients with emotional disorders and those free of them. Functional stabilometric study (open eyes test, Romberg test, optokinetic test) in European standard was performed using stabilometer (MBN-Biomechanics Company).
Results. Disturbances of static equilibrium among old patients with emotional disorders are reflected in changed stabilometric parameters of functional tests and are represented by instablity of low-variable parameter - center-of-pressure displacement velocity, improvement of parameters in repeated studies with short exposition and in complicated functional tests.
Conclusions. Emotional disorders influence the strategy of maintaining static equilibrium in patients of old age. It effects postural activity and can be measured quantitatively using computer stabilometry. Functional character of ataxia in patients with emotional disorders is manifested by variability of stabilometric parameters and improvement of parameters, as functional tests are complicated. The most sensible is the parameter of center-of-pressure displacement velocity.
Aim. To study the possibility of using MELD scale for determining the degree of severity of hepatic cirrhosis (HC) and determine its diagnostic characteristics.
Materials and methods. Thirty patients with HC, including 15 patients with compensated HC stage (class A+B) by Child-Pugh scale and 15 persons with decompensated HC (class C), were examined. Total blood bilirubin and creatinine concentrations were assessed, INR and MELD index were calculated.
Results. Meld index with use of total bilirubin, creatinine indices and INR is increasing as HC is progressing from 5 at the compensated stage to 26 at the decompensated stage ( p < 0,001) and directly correlates with the degree of severity of cirrhosis, estimated by Child-Pugh scale ( r = 0,64; p = 0,005). The threshold value of MELD index to differentiate the compensated HC stage from the decompensated one was 11.
Conclusions. Design parameter of MELD permits to differentiate the degrees of HC severity with sensitivity equal to 73,3 % and specificity - 84,6 %. When MELD index is less than or equal to 11, the compensated stage of HC is diagnosed, when it exceeds 11, the decompensated cirrhosis is specified.
Aim. To study the response of peripheral vessels hemodynamics to apnea in young women with idiopathic arterial hypotension.
Materials and methods. Comparative analysis of the results of ultrasonic scanning of peripheral arteries and veins using apnea test between 19 women with idiopathic arterial hypotension - SAP 98 (92-98) mm Hg and 11 women with normal arterial pressure - SAP 124 (121-126) mm Hg was carried out. Women’s age in both groups was 18-25 years. Arterial pressure and peripheral oxygen saturation were measured. Angioscanning in lying position and at rest as well as angioscanning prior to and 20 seconds after breath-holding was fulfilled. Diameter and blood velocity were estimated in the brachial, radial and posterior tibial arteries and veins.
Results. Apnea in young hypotensive women was found to induce increase in the diameter of a larger number of arteries than in the control group and fall in arterial blood velocity with the absence of venous blood velocity dynamics.
Conclusions. The abovementioned changes in the peripheral blood flow among women with hypotension are to be considered as manifestation of deadaptation, expressed by extreme endothelium-dependent dilatation of resistive vessels and inhibition of vasotonic response, probably, associated with excessive nitric oxide endothelial production.
The review of native and foreign special literature on chronic duodenal patency abnormalities is presented; their association with cholelithiasis is indicated. Variants of surgical correction of motor duodenal pathology are assessed. The published results confirm perspective value of the development of the methods of low-invasive simultaneous laparoscopic treatment of chronic duodenal patency abnormalities in patients with chronic calculous cholecystitis.
The data on the etiology and pathogenesis of cerebellar cognitive affective syndrome (CCAS) as well as clinical observations are presented in the paper. Schmahmann J.D. and Sherman J.C. described the spectrum of behavioral and cognitive disorders, which are the results of cerebellum stroke and are called CCAS. This syndrome includes disturbances of executive functions and is characterized by perseverations, absent-mindedness or disatractibility, visual-spatial disorders, speech production difficulties and personality changes. The authors considered the historical description of this syndrome, its etiology, pathogenesis and presented their own clinical observation of CCAS in a 70-year-old woman.
Aim. To assess the dynamics of reproductive losses in Perm during the period of 2006 to 2016.
Materials and methods. The following statistical forms were analyzed: 13 “Data on abortion”; 32 “Data on medical care rendered to pregnant, parturient women and puerperas”; 14 “Data on hospital activity” in Perm over the period from 2006 to 2016, taking into account changes in live birth criteria, registered in 2012.
Results. Decrease in reproductive losses is an important reserve for improving demographic situation. Reproductive losses are the losses of conception product at all the stages of fetus development, caused by spontaneous and stimulated abortion, dead birth as well as death of first-year of life children. For the analyzed period, increase in the number of labors by 8 times and reduction in the number of medical abortions (losses - 71 %) was noted. In the structure of pregnancies with abortive outcome, the share of extrauterine pregnancy remains at the same level. A threefold decrease in dead births is observed.
Conclusions. Reproductive losses in Perm are the following: I place - early miscarriage; II - extrauterine pregnancy; III - late miscarriage; IV - mortinatality. The place, occupied by the losses of desired pregnancies, becomes more and more significant. That is why we need to accentuate specialists’ attention on the problems of family planning, pregravid preparation and management of pregnancy at early terms.
Aim. To analyze the causes of iatrogenic damages of esophagus, estimate the surgical tactics depending on the type and localization of perforation and terms of hospitalization.
Materials and methods. Medical documentation of 89 patients with esophageal damages of various etiology was analyzed. Iatrogenic damages of esophagus were diagnosed in 37 (41,6%) patients.
Results. The most frequent cause of esophageal perforation during treatment and diagnostic manipulations was gullet bougienage for cicatrical strictures and cardiospasm. This diagnosis was based on pains, occurring after treatment and diagnostic manipulations, which critically increased after taking liquid or food, appearance of soft tissue emphyzema of the neck and mediastinal emphysema. Presence of contrast substance leakage in roentgenoscopy permitted to determine the localization and size of esophageal defect. During the recent years, in case of diagnostic difficulties or late admission to hospital, computed tomography was used. The terms of starting treatment and complications developed substantially determined its volume and surgical tactics. Accordingly, different medical techniques were undertaken.
Conclusions. Along with traditional interventions, stenting, clipping of esophageal wounds and vacuum therapy can be used to treat iatrogenic damages, indications to which need further study.