bluuebunny/crossref_metadata_2025 huggingface dataset:
The risk of development of multiple primary malignant tumors involving the thyroid gland
Authors: Afanas’eva Z A , Bakunin S F
Published: November 2019

Aim. To determine the relative risk of developing other malignant tumors in patients with thyroid cancer and and the risk of developing thyroid cancer in patients with other malignancies. Methods. A retrospective analysis of 116 patients with multiple neoplasia including thyroid gland involvement was conducted for the period from 1973 to 2010. In order to estimate the relative risk of development of multiple neoplasias including thyroid gland lesions used was the following formula: relative risk = [a / (a + b)] / [c / (c + d)], where a is the number of patients with thyroid cancer with a second malignancy; b is the number of patients with thyroid cancer without a second malignancy; c is the number of patients in the population affected by the same malignant disease, as patients in group a; d is the number of people in the population without any cancer-related pathology. Results. In patients with carcinomas of the thyroid gland the relative risk is higher than in the general population for developing metachronous lymphoma (41.8 for men, 31.7 for women), renal cell carcinoma (55.6 for men, 18.5 for women), prostate cancer (35.7), lung and bronchus cancer (18.8 for women), melanoma (17.1 for women), colon cancer (16.7 for women), cervical cancer (15.8), uterine cancer (11.8), breast cancer (11.5 for women), skin cancer (9.5 in women) and the simultaneous development of renal cell carcinoma (33.8 for men and 46.3 for women), prostate cancer (24.4), melanoma (20.6 for women), cancer of the esophagus (19.4 for men, 17.8 for women), colon cancer (19.0 for men), lymphomas (12.8 for men), cervical cancer (11.3), breast cancer (11.0 for women), skin cancer (8.5 for women). The relative risk of developing metachronous cancer of the thyroid gland is higher than that in the population in patients with melanoma (108.0 in men, 50.4 for women), with malignant neoplasms of the lymphoid tissue (40.2 for men, 40.8 for women), uterine cancer (11.8), skin cancer (8.7 in women), breast cancer (8.0 for women). Conclusion. During preventive medical examinations of patients with thyroid cancer the relative risk of developing subsequent cancers must be taken into account for early diagnosis of multiple neoplasias.
Prediction of atrial fibrillation according to levels of serum markers of inflammation during arterial hypertension
Authors: Vasilets L M , Agafonov A V , Khlynova O V , Ratanova E A , Grigoriadi N E , Krivaya A A , Trenogina K V
Published: November 2019

Aim. To study the parameters of inflammation during atrial fibrillation in patients with arterial hypertension and to determine the possibility of their predictive significance in relation to development of the arrhythmia. Methods. Examined were 97 individuals with arterial hypertension, mean age 50.53±8.10 years. Formed were two groups: patients with arterial hypertension without the arrhythmia and patients with atrial fibrillation on the background of arterial hypertension. Among the examined patients with atrial fibrillation revealed were patients with persistent or recurrent persistent forms of atrial fibrillation, the latter were examined both without and during the paroxysm of arrhythmia. The comparison group was comprised of 21 practically healthy individuals. In all patients determined was the content of C-reactive protein, tumor necrosis factor-alpha, and fibrinogen. Results. Paroxysms of atrial fibrillation were accompanied by a significant increase in the concentration of the tumor necrosis factor-alpha. The level of C-reactive protein had an inverse correlation with the severity of atrial fibrillation, that is, in cases of persistent atrial fibrillation it was lower than in cases of paroxysmal forms of atrial fibrillation, as well as in patients with arterial hypertension without the arrhythmia. Conclusion. Variation in the levels of inflammation markers is an independent predictor of atrial fibrillation in patients with arterial hypertension.
The use of double catheter epidural anesthesia in the lumbar segment of the spine during surgical correction of funnel chest deformity
Authors: Safin R R , Anisimov O G
Published: November 2019

Aim. To provide clinically effective epidural anesthesia during corrective thoracoplasty in children with congenital deformity of the chest with the use of an access, which makes it possible to minimize the probability of accidental spinal cord injury during the procedure. Methods. Conducted was a prospective study of 40 adolescents randomized to the main group (thoracic epidural anesthesia combined with general anesthesia) and the comparison group (general anesthesia), 20 observations in each group. In order to evaluate the effectiveness of the method at the time of surgery determined was the level of cortisol and glucose, and after the operation recorded were the times of resolution of the pneumothorax and of the intensity of pain. Results. In the main group a slight decrease in the biochemical markers of stress was noted in contrast to their moderate increase by the end of the operation in the comparison group. Associated complications and pain in the postoperative period in the main group were expressed to a lesser extent than in the comparison group. Conclusion. Thoracic epidural anesthesia combined with general anesthesia may be the method of choice during surgical correction of the funnel chest deformity.
Emotional burnout syndrome among dentists
Authors: Petrov P I , Mingazov G G
Published: November 2019

Aim. To study the emotional burnout syndrome among dentists in relation to age, gender, work experience and specialization. Methods. Examined were 200 dentists enrolled for training at the Department of Dentistry and Maxillofacial Surgery of the Institute of Postgraduate Education of Bashkir State Medical University in 2010/2011 academic year. The test of V.V. Boiko «Methods of diagnosing the level of emotional burnout» was used. Results. Symptoms of emotional burnout were found in 53.8% of respondents. The magnitude of the phases of emotional burnout was independent of age, gender, length of service as a dentist (p 0.05). When accounting for occupational specialization differences were found in the entry «driven into a cage» (p=0.019). This symptom was most pronounced in dental therapists, followed by dental surgeons. Among dentists-orthopedists the symptom of «emotional detachment» was predominant (p=0.027). Conclusion. Emotional burnout syndrome develops in the course of professional activities of a dentist, professional specialization of the dentist affects the development of this syndrome.
Epidemiology of post-traumatic epilepsy in the Republic of Tatarstan
Authors: Yarmukhametova M R
Published: November 2019

Aim. To conduct a comprehensive study of epidemiological and clinical characteristics of patients with post-traumatic epilepsy among the adult population of three districts of the Republic of Tatarstan. Methods. The study was conducted in 2009 in three districts: Arskiy, and Baltasinskiy Tetyushskiy. Cases of active epilepsy were recorded according to the results of household walkovers, continuous investigation of medical outpatient records in healthcare institutions, registration cards of the calls of the ambulance station. Clinical and neurological examinations, including examination of a neurologist, EEG, and in addition - magnetic resonance and computed tomography were performed in cases of newly diagnosed epilepsy, as well as to confirm the diagnosis. Results. Of the established causes of symptomatic epilepsy the most common one was traumatic brain injury (25.09%), notably in males (n=52, 19.47%) on average three times more frequently than in females (n=15, 5.61%). Most commonly the injuries were seen in the age group 30-49 years (5-6 times more common in men). In 23.88% (n=16) of patients with post-traumatic epilepsy more than 12 attacks per year were registered, in 73,14% (n=49) - 1-12 attacks per year, 2.98% (n=2) patients were in medical remission. 83.58% of patients received monotherapy. The most commonly prescribed medications - valproic acid salt, carbamazepine, topiramate, both as monotherapy and as part of polytherapy. Conclusion. A high prevalence of post-traumatic epilepsy (25.09%) was revealed; an insufficient degree of control of epileptic seizures was noted, which was often due to irrational drug therapy.
Pediatric health care modernization in the Republic of Tatarstan: first results
Authors: Farrakhov A Z
Published: November 2019

Aim. To summarize the first results of pediatric healthcare modernization in the Republic of Tatarstan. Methods. Analytical, expert, comparison and systematic approaches were used as a research methods. Results. The obtained results vividly depict the main goal of the modernization performed - to improve the pediatric healthcare on the basis of the innovative medical and management technologies. Modernization is understood as a process of current healthcare facilities enhancement and renovation, bringing them in line with new requirements, norms, technical regulations, healthcare quality measurement tools and qualification of healthcare professionals. The main attention is devoted to healthcare management, computerization of healthcare facilities, modern training technologies, interdepartmental integration. Modernization priorities are shared by the whole country, however, their implementation depends on intra- and off-system healthcare features in subjects of Russian Federation. It is useful to unite the efforts of the healthcare system in the process of modernization in terms of healthcare management based on territorial responsibility of high medical technologies centers and development of governmental-private partnerships. Conclusion. One of the priority trends of prevention service of pediatric healthcare in the Republic of Tatarstan is to form the prevention policies by introduction of a new functional structure - pediatric healthcare centers. The important role should be given to quality assessment of the introduced innovations by statistical, quantitative and qualitative assessments, showing the effectiveness of the healthcare.
Role of endothelial dysfunction and metabolic syndrome in interventional treatment complications development in patients with coronary heart disease
Authors: Arsenitcheva O V , Omeljanenko M G
Published: November 2019

Aim. To assess the influence of endothelial dysfunction and metabolic syndrome on interventional treatment coronary complications development in patients with coronary heart disease. Methods. 57 patients with coronary heart disease and concomitant metabolic syndrome (the main group) and 64 patients with coronary heart disease alone (the comparison group) were included in the study. Control group for endothelial function parameters included 33 healthy blood donors. Endothelial function was assessed by plasma and erythrocyte nitrate level, plasma L-arginine level and desquamated endothelial cell blood count before the interventional treatment and after its completion. Results. Initial signs of endothelial dysfunction were observed in both groups of patients compared to the controls. Desquamated endothelial cell blood count was significantly higher in patients with metabolic syndrome than in the comparison group. Only the desquamated endothelial cell blood count increased significantly after the interventional treatment, the difference was more pronounced (р 0.05) in patients with metabolic syndrome. Complications of interventional treatment in patients with and without symptoms of metabolic syndrome were observed in 29.8 and 14.1% respectively (р 0.05). The number of coronary artery restenoses was significantly higher in the main group than in the comparison group (12.2 and 3.1% respectively). Conclusion. Initially endothelial dysfunction was more pronounced in patients with metabolic syndrome. A significant increase of endothelial dysfunction was observed in patients of the main group after the interventional treatment. The number of interventional treatment complications and coronary arteries restenoses was significantly higher in patients with coronary heart disease and concomitant metabolic syndrome.
Echocardiographic features of congestive heart failure in patients with chronic obstructive pulmonary disease
Authors: Akramova E G
Published: November 2019

Aim. To optimize echocardiographic diagnosis of congestive heart failure in patients with chronic obstructive pulmonary disease (COPD). Methods. Several modes of echocardiography using HD 11XE (Philips, USA) ultrasound scanner, 24-hour ECG monitoring using Microvit MT-101 (Schiller, Switzerland) 3-channel recorder and spirometry using АFD-02-«МFP» (Russia) machine were performed in 157 patients aged 39-76 years (male - 114, female - 43) who were divided into the following subgroups: (1) patients with COPD alone, (2) patients with COPD and concomitant arterial hypertension, (3) patients with COPD and concomitant ischemic heart disease, (4) patients with ischemic heart disease, (5) healthy controls. Results. 55.4% of patients with COPD had clinical signs of congestive heart failure (with signs of isolated diastolic dysfunction in 85.7% of patients with congestive heart failure). Diastolic dysfunction was associated with increase of peak isovolumic velocity (IVV) and even more significant decrease of peak early (Ea) and late (Aa) diastolic annular tricuspid vale velocities ratio at pulsed Doppler tissue imaging compared to patients without congestive heart failure. In patients with isolated COPD and isolated diastolic dysfunction echo signs of right ventricle dilatation, and in patients with COPD and concomitant ischemic heart disease - also of pulmonary artery trunk dilatation and hypertrophy of both ventricles were significantly more frequent. Systolic dysfunction was found only in patients with COPD and concomitant ischemic heart disease, causing longitudinal systolic dysfunction of the right ventricle seen as a reduction of systolic excursion and peak systolic (Sa) annular velocity, increased Myocardial Performance Index (Tei Index) and corrected isovolumic relaxation time, as well as hypertrophy of both ventricles and left ventricular dilatation. Conclusion. Echocardiography (Doppler tissue imaging) can be used for congestive heart failure diagnosis verification in patients with COPD.
Left ventricle remodeling electrocardiography criteria of survival assessment in Q-wave myocardial infarction patients
Authors: Khayrutdinova G M
Published: November 2019

Aim. To study the survival in patients with Q-wave myocardial infarction depending on features of left ventricle remodeling on electrocardiography. Methods. 10-year overall survival and heart diseases associated survival rates depending on features of left ventricle remodeling on electrocardiography were studied in 87 patients who had survived an acute myocardial infarction with Q wave. The first group included 45 patients who fulfilled electrocardiographic criteria for left ventricle adaptive remodeling, the second group included 42 patients with electrocardiographic features of left ventricle maladaptive remodeling. The survival in both groups was estimated using the Kaplan-Meier’s curves. Results. There was a highly significant inverse relationship between age and survival rate of the patients with Q-positive myocardial infarction. 40 patients succumbed by the end of the observation period, among them - 20 (50%) due to heart diseases. 20 (50%) patients died from non-cardiac events, among them - ischaemic stroke, neoplasms and accidents (most common - alcohol intoxication, 5,8% each). Chronic heart failure was most common reason of death in both groups, and it prevailed in the group of patients with left ventricle maladaptive remodeling electrocardiographic features. According to the gained data, there were no significant differences observed in overall survival in both groups during the whole follow-up period. In assessment of survival associated with heart diseases, the differences close to the statistically significant were found. Conclusion. The comparison of the overall survival depending on left ventricle remodeling electrocardiographic features did not detect any reliable differences, while in case of heart diseases associated survival assessment differences close to the statistically significant were found.
Comorbidities in chronic «overcrowded posterior cranial fossa» syndrome
Authors: Zabbarova A T , Bogdanov E I , Khusainova D K , Fatkheeva L S
Published: November 2019

Aim. To analyze the prevalence and role of comorbidities in variety of clinical manifestations in patients with congenital occipital hypoplasia - «overcroded posterior cranial fossa» syndrome. Methods. Clinical history and physical examination of 200 patients (aged 16-74 years, males 108, females 92) with «overcrowded posterior cranial fossa» syndrome, including 134 with cerebellar ectopia, 92 with syringomyelia, 24 with hydrocephalus, were analyzed. Results. The diseases identified in patients with «overcrowded posterior cranial fossa» syndrome were combined into six groups: cardiovascular diseases (n=120; 60.0%), infectious and inflammatory diseases (n=39; 19.5%), gastrointestinal diseases (n=37; 18.5%), metabolic and endocrine diseases (n=31; 15.5%), diseases of the musculoskeletal system and connective tissue (including cervical vertebral stenosis (n=53; 26.5%), scoliosis (n=50; 25.0%), arthropathies (n=21; 10.5%), other diseases and pathological conditions (including mild traumatic brain injury (n=74; 37.0%), seizures (n=13; 6.5%). In patients with «overcrowded posterior cranial fossa» syndrome the prevalence of cardiovascular, gastrointestinal diseases, traumatic brain injury, obesity, primary or secondary cervical vertebral stenosis was significantly higher (p 0.05) compared to general population. In patients with syringomyelia a higher rate (p0.05) of scoliosis and traumatic brain injury was revealed. Conclusion. The prevalence of comorbidities in patients with «overcrowded posterior cranial fossa» syndrome was higher compared to general population. The differences of the type and rate of the concomitant diseases in patients with various forms of the syndrome may contribute to the variety of clinical manifestations of «overcrowded posterior cranial fossa» syndrome.
The role of antioxidant system genes in the formation of coronary heart disease clinical phenotypes
Authors: Podolskaya A A , Galyavich A S , Maikova E V , Kravtsova O A , Alimova F K
Published: November 2019

Genetic predisposition alongside with environmental factors play a major role in the pathogenesis of coronary heart disease, causing the deregulation of various biochemical processes leading to the disease onset. Antioxidant system deregulation, marked mainly by lipid peroxidation products and a number of enzymes, is known to be one of the risk factors for coronary heart disease. A genetic defect might lead to a change in enzyme activity and inhibition of antioxidant protection. However, the pathogenic factors and antioxidant system deregulation mechanisms in different clinical courses of coronary heart disease are not studied enough as phenotypic expression of genetic polymorphism is largely dependent on the gene pool and the living conditions of a particular population, explaining the controversial data on the association of polymorphisms candidate genes with the risk of coronary heart disease. Currently, the role of genes encoding antioxidant system enzymes in predisposition to coronary heart disease development is not sufficiently studied, and research results are contradictory. The review summarizes the current data on the antioxidant system genes (superoxide dismutase enzymes, glutathione peroxidase and catalase) genetic polymorphisms association with the risk of coronary heart disease (as an acute myocardial infarction, angina рectoris).
An innovative technology of transumbiliсal laparoscopy in gynecology
Authors: Mazitova M I , Kibardina N A , Fatykhov K Kh , Khairullina E A
Published: November 2019

Aim. To analyze the advantages and weaknesses of single-port transumbiliсal laparoscopy in treatment of disorders of female genital tract. Methods. Transumbiliсal laparoscopy was performed using the first Russian toolkit for single-port laparoscopy surgery. 70 female patients with different disorders of female genital tract (ectopic pregnancy - 41, benign ovarian tumors - 8, ovarian apoplexy - 16, leiomyoma of uterus - 5) who needed a surgery were randomized to 2 groups 35 patients each. Patients from the first group underwent single-port transumbiliсal laparoscopy surgery through a single puncture of the abdominal wall, patients from the second group underwent a surgery with ports introduced into the abdomen by several trocars. Results. In patients treated by conventional laparoscopy the surgery duration was 29.2±2.3 minutes, compared to 46.1±3.3 minutes in patients treated with single-port transumbiliсal laparoscopy. However, the duration of single-port transumbiliсal laparoscopy has decreased significantly after the first 6 surgeries were performed, and if these surgeries were excluded from the analysis, the average single-port transumbiliсal laparoscopy duration was 35.3±0.6 minutes. Postoperative pain level assessed by visual analogue scale was somewhat lower in patients after single-port transumbiliсal laparoscopy, though, the difference was not significant. An assessment of the abdominal wall and suture visual assessment were performed. Transumbiliсal suture was completely concealed in the umbilicus, thus, single-port transumbiliсal laparoscopy provides a good cosmetic effect. There were some technical difficulties associated with the single-port introduction of all medical instruments, which were overcome by medical instruments length and curvature modification and revised position of surgeons in the operating theatre. Conclusion. The advantages of the new technology were reduction of abdominal wall trauma, reduction of complications associated with the introduction of the trocar, a slight reduction of postoperative pain, good cosmetic results after surgery. Further research is needed to determine the differential approach to the choice of operation technique.
Clinical case of successful left coronary artery stenting in patient with acute myocardial infarction and acute decompensated left-sided heart failure
Authors: Galyavich A S , Ivanov A G , Yakupov I F , Khakimzyanov A A , Soboleva E A
Published: November 2019

Patients with major coronary artery involvement are a very tough group to treat in terms of emergent revascularization possibility by percutaneous coronary intervention. Concomitant myocardial infarction and pulmonary edema makes the treatment even more complicated and requires proper anesthetic approach. A patient who had underwent a coronary artery bypass graft surgery for a late stage coronary artery disease 5 years before was admitted to the cardiac intensive care unit with myocardial infarction and acute decompensated left-sided heart failure. Considering the life-threatening angina leading to a serious complications (acute pulmonary edema) and the results of the latest coronary angiography, an urgent coronary angiography with the revision of coronary arteries condition and further possible percutaneous coronary intervention due to life-threatening emergency was offered. Mechanical ventilation was started, the patient’s condition stabilized. Left coronary artery trunk stenting, a difficult approach considering the risk for complications, was performed as the second stage intervention, saving patient’s life.
Assessing current state of nursing in Mari El Republic and developing approaches for its improvement
Authors: Paybaktova T A , Zlobina G M
Published: November 2019

Aim. Improving the nursing management based on a comprehensive socio-hygienic assessment. Methods. Analytical, statistical, retrospective and prospective analysis, data copying, opinion poll. Results. Positive changes in nursing service development in Mari El Republic were revealed during the period from 2000 to 2011. By January, 1, 2012, 7458 nurses with secondary medical education were employed in 50 medical institutions run by Ministry of Healthcare and in 306 village first-aid stations. The majority were certified and had a qualifying category - 97% and 67% respectively. The average value of nursing provision was 107.1 nurses per 10 000 of population, staffing - 95.5%, staffing based of the number of employed nurses - 72%. Ratio of job combining among nursing staff was 1.3, the «doctor-nurse» ratio was 1:3.6. Recently a tendency of nursing personnel outflow from nursing practice was revealed in the region. Since 2000 the number of working nursing specialists decreased by 380. The share of «young» specialists was only 7.9% of all the employed nurses, the share of nursing staff of pre-retirement and retirement age was 19%. Conclusion. According to the forecast data for the near-term outlook it is possible to expect decrease of nursing staff rates in the region. The creation of «nursing service management school» may solve the problem.
Experimental ground for high-intensity laser wavelength choice for chronic hemorrhoids low-invasive surgical treatment
Authors: Shakhrai S V , Gain Y M , Gain M Y , Ryabtseva S N
Published: November 2019

Aim. To assess the morphological changes of rectal wall after the exposure to 970 and 1560 nm wavelength laser radiation and to choose the optimal wavelength for laser cauterization of hemorrhoids. Methods. Experiments to assess the effect of the exposure to 970 and 1560 nm wavelength laser radiation on rectal tissues were performed. Laser cauterization was modeled on white rats (two groups 18 animals each). «Mediola-Compact» semiconductor laser (manufactured by «Fotek» ldt, Belarus) was used. Animals of the first group were exposed to laser radiation with wavelength of 970 nm, 1560 nm wavelength was used in the second group. Animals were withdrawn from the experiment on day 1, 7 and 14 after the beginning of experiment to assess the morphologic features of the tissue fragments with destructive lesions after laser cauterization. Results. Less pronounced destructions and quicker healing were noted after the exposure to laser radiation with wavelength of 1560 nm compared to 970 nm. Statistically significant differences were revealed in general damage (U=3.5, р=0.00) and necrosis (U=0.0, р=0.00) areas depth both on day 7 and day 14 after the exposure. On day 14 no necrotic lesions were found in the second group, and general damage area was formed by granulations (U=0.00, р=0.00) compared to the first group where necrotic and inflammatory lesions persisted. Conclusion. In choosing the laser wavelength while developing rectal laser cauterization techniques for hemorrhoids, water-absorbed 1560 nm infra-red laser radiation should be preferred.
Kazan medical nurses community structure and activities at the end of XIX century
Authors: Naumova O A
Published: November 2019

The Kazan branch of the Red Cross medical nurses was established in 1886. Its’ purpose was to professionally train women for further care for wounded soldiers at wartime, and for civil population care in hospitals at peace-time. The Kazan branch of medical nurses had started with a six students living in a shared flat. It was reported to the local Red Cross branch and was funded by it. All theoretical and practical classes were held according to the studying plan approved by the Russian National Federation of Red Cross on February 19th, 1882. After graduation all nurses were obliged to work as a nurse for at least two years, and to arrive to the Red Cross branch in case of war to be sent for military service. Nurses could also care for patients in private houses for a pay. Nurses were patient and zealous caring for ill and wounded, which wasn’t an easy job, indicating a true love and willingness for care among medical nurses. A selfless activity of medical nurses during a wartime, starvation and epidemics improved the image of a medical nurse and attracted community’s attention. During the plague and cholera epidemics in 1889-1892 15 nurses of the Kazan branch of the Red Cross were granted the medal for diligence. By the beginning of the XX century a skilled service of nursing care has been formed in the Kazan Province, becoming a prototype of modern nursery practice.
Vladimir Leonidovich Borman - the first pediatric surgeon of the Imperial Kazan University
Authors: Akhunzyanov A A
Published: November 2019

Vladimir Leonidovich Borman was the first pediatric surgeon of the Imperial Kazan University, participated in the Russo-Japanese War, World War I and the Civil War. In 1900 a novel course of pediatric surgical diseases was started at the university. A new pediatric clinic was launched among other new clinics, and Vladimir Leonidovich Borman, a surgeon and a doctor of medicine, was invited to head one of the departments there. Since then the teaching of pediatric surgical diseases for Imperial Kazan University medical faculty students has been performed at the pediatric ward of the faculty surgery clinic. Then Vladimir Leonidovich participated in surgical service foundation in many parts of the country both at peace and wartime, he became the founder of the Omsk State Medical University department of hospital surgery. The contribution of that amazing, energetic, talented doctor and teacher to Russian medicine can not be overestimated.
Aspiration drainage in the prevention of postoperative septic complications in rectum sphincter-sparing abdominoperitoneal resection
Authors: Akhmetzyanov F Sh , Shaykhutdinov N T , Valiev N A , Shemeunova Z N , Egorov V I
Published: November 2019

Aim. Explore the effectiveness of the double-barreled drainage tube «tube in tube», mounted by the developed technique after rectum sphincter-sparing abdominoperitoneal resection due to cancer.

Methods. The data of 52 patients with rectal tumors who underwent rectum sphincter-sparing abdominoperitoneal resection in two surgical wards over the past 4 years were analyzed. At the surgery, the colon was brought down together with anal channel mucosa excision and bringing down the colon mucosa to the anal channel. Rectum sphincter-sparing abdominoperitoneal resection was finished in all patients by placing a double-barreled drainage tube of the original construction to the retroperitoneal part of the cavity of the true pelvis by an original method via the anterior abdominal wall incision. No one-step intestinal stoma was exteriorized in any of the patients.

Results. The average duration of postoperative hospital stay was 17 days; in patients who underwent non-hybrid operation (50 of 52 patients) - 15.3 bed-days. Postoperative complications occurred in a total of 11 (21.1%) patients, and the rate of septic complications was 1.9%, which is lower compared to published data. It is worth noticing that the use of our original method of pelvic cavity draining totally excludes peritoneal fistula formation and facilitates post-operative care.

Conclusion. The proposed method of pelvic cavity draining at rectum sphincter-sparing abdominoperitoneal resections might be effective, as is associated with lower chance of purulent and septic complications. It excludes the possibility of perineal fistula formation, facilitates the post-operative period management.
Prevention of paracolostomal complications following abdominoperineal extirpation of the rectum
Authors: Toychuev Z M , Gataullin I G , Aglullin I R , Khamitov M R , Kaji M R
Published: November 2019

Aim. To find an optimal way of end colostoma formation in patients with colorectal cancer following abdominoperineal extirpation of the rectum. Methods. Results of surgical treatment (rectum extirpation ended with sigmoidostomy) of 142 patients with malignant tumors of lower part of rectal ampulla treated from 2005 to 2012 are presented. Data of 101 patients (comparison group) were retrospectively analyzed, in whom the same approach of choosing the colostomy technique was applied. The main group consisted of 41 patients in whom the efficacy of authors-introduced technique of colostomy with alloplasty for colostomal wound consolidation from the abdominal cavity side was prospectively defined. Results. The prevalence of early post-operative stomal complications was 18,8% (in 19 out of 109 patients) in comparison group. Ileum volvulus around the stoma causing bowel obstruction was diagnosed in 2 cases, necrosis of stoma wall - in 2 patients, evisceration around stoma site - in 3 patients, perforation of sigmoid stoma - in 1 patient, stoma retraction - in 1 patient, bleeding at stoma site - in 3 patients, paracolostomal mass - in 1 patient. 14 patients from comparison group developed late post-operative stomal complications, including parastomal hernia - 8 patients, stoma prolapse - 3 patients, colostomal fistula - 1 patient, stomal stenosis - 2 patients. Treatment results in the patients from the main group were satisfactory. Early complications included 1 case of bleeding from stoma site, 1 case of partial necrosis of stoma wall. No late complications were registered. The gained data allows to provide successful rehabilitation to patients who underwent colorectal cancer surgery. The described technique is contraindicated in case of infected peritoneal effusion. Conclusion. The use of the method proposed by authors not only significantly improves colostomy results, but significantly decreases the rate of both early and late post-operative complications of stomas compared to standard methods.
Ultrasonography in assessing the cervical cancer extent
Authors: Smirnov Y A , Bogacheva T M , Valeev R G
Published: November 2019

Aim. To study the potentials of complex ultrasonography in assessing the extent of cervical cancer, defining typical ultrasonographic features of cervical cancer. Methods. 75 patients with the diagnosis of morphologically confirmed cervical cancer were examined. Continuous sampling method was used to recruit the patients. Patients underwent transabdominal, transvaginal and transrectal ultrasonography with the use of color Doppler and power Doppler modes. Results. 57 (76,5%) patients were diagnosed with squamous cell non-keratinous carcinoma, 12 (16%) - with squamous cell keratinous carcinoma, 6 (8%) - with adenocarcinoma. 43 (57,3%) patients had cancer stages I-II, 32 (42,7%) - cancer stages III-IV. The certain features of ultrasonographic images were found at different stages of cervical cancer. At cancer stage I the most typical findings were: low echogenicity area, diffuse heterogeneity of stroma, area of hypervascularity at the place of cervical cancer. Increased blood flow at the cancer site is typical for cervical cancer because of tumor vasculature hyperplasia and neoangiogenesis, the increase in number of blood vessels is proportional to tumor size. Cervix hypertrophy, fuzzy and irregular contouring, no flexion angle between the fundus and cervix were characteristic for cervical cancer stages II-III. Corpus uteri echo-structure at the tumor site portrays the tumor structure. Infiltrates in parametrium can be seen. At stage IV tumor spreads to urine bladder and rectum walls. In advanced stages uretеrs can be involved, pyelectasis and ureterectasis can develop. Conclusion. Complex ultrasonography allows to diagnose cervical cancer quite reliably and to estimate the extent of cervical cancer.
Model of specific diagnostics of ovarian cancer stages
Authors: Antoneeva I I , Abakumova T V , Gening T P , Gening S O , Pirmamedova S S
Published: November 2019

Aim. To develop the model of specific diagnostics of III-IV stages of ovarian cancer. Methods. 404 patients with I-IV stages of primary ovarian cancer according to International Federation of Gynecology and Obstetrics classification were examined. Ultrasonography of genitalia and internal organs, chest X-ray in order to detect possible remote metastases, cytological, histological and immunohistological examination of tumor mass, as well as «lipid peroxidation - antioxidants» system condition of tumor tissue and patients’ serum were examined. Results. Elevated level of a lipid peroxidation product, malondialdehyde, was found in tumor tissue of patients with ovarian cancer, with levels of malondialdehyde growing from clinical stage I to clinical stage III of the disease. Leukocyte counts of peripheral blood statistically significantly decreased at stages I-III and elevated at stage IV. However, aerobic and anaerobic cytotoxicity of neutrophils decreases. An algorithm of supplementary diagnostic tools use to define the stage of ovarian cancer was developed, as well as differentiation coefficient calculation formula. Conclusion. Defining the serum levels of malondialdehyde, catalase and glutathione reductase activity allows to calculate the coefficient for differentiation between stages III and IV of ovarian cancer, and detection of cation proteins level, myeloperoxidase activity and phagocytic index allows to calculate the coefficient for differentiation between stages II and III of ovarian cancer.
Causes of non-effectiveness of secondary prophylaxis of ischemic stroke
Authors: Vasilevskaya O V , Safina D D , Silant’eva I V
Published: November 2019

Aim. To study the aspects of prevention and risk factors of a recurrent ischemic stroke. Methods. 50 patients who suffered a recurrent ischemic stroke in the period from October 2010 to February 2011 participated in the study. Past medical history information was obtained according to a specially designed questionnaire. Information on the regularity of medication administration (antihypertensive, antithrombotic, lipid lowering), maintenance of a diet, and modes of physical activity was collected. Results. The main measure of prevention of thrombosis in patients after an ischemic stroke was acetylsalicylic acid, 11% of patients took it regularly. The patients did not use the modern and more effective drug clopidogrel. In the group of patients with a cardioembolic ischemic stroke the recommended anticoagulation therapy with warfarin was not conducted. 89% of the patients were compliant with antihypertensive medications before the development of a recurrent stroke, however only 15 (30%) patients took the drugs regularly under blood pressure control. The majority of patients (70%) at first administered the antihypertensive medications according to the prescription instructions, but then in accordance to well-being. None of the patients knew and controled their cholesterol level. Statin therapy was not conducted in any patient. The recommended hypolipidemic diet was maintained by 44% of patients, 25% of them - routinely. The number of smokers up to the recurrence of the ischemic stroke was 66%, of which only 15.2% reduced the number of cigarettes. 10% of patients stopped drinking alcohol, 34% - decreased its use, 22% did not change the level of alcohol consumption, 34% of patients noted that they did not consume alcoholic beverages. Only 44% of patients altered their physical activity, started going for a walk in the fresh air. A decrease in adherence to therapy after an average of 2 months after initiating treatment was established. A direct relationship between the quality of prophylaxis and the time of recurrent ischemic stroke occurrence was revealed according to the following parameters: normalization of the blood pressure levels, antithrombotic therapy, control of blood glucose levels, termination of smoking, cessation of alcohol abuse. Conclusion. The majority of the patients did not take the necessary measures for the prevention of ischemic stroke; organization of educational activities is necessary to raise awareness among the patients about this disease.
Functional status of maxillofacial area in children with asymmetric congenital abnormalities and acquired maxillofacial deformities
Authors: Silin A V , Satygo E A , Semenov M G , Semeleva E I , Kondrateva N A , Trushko M B
Published: November 2019

Aim. To determine the masticatory muscles functional activity change in children with congenital abnormalities of maxillofacial area and acquired maxillofacial deformities at the stages of reconstructive plastic surgery. Methods. 10 children at the age from 10 to 14 years with acquired (1st group - 5 patients with secondary temporomandibular joint osteoarthritis, asymmetric micrognathia) and unilateral congenital maxillofacial deformities (2nd group - 5 patients with I-II branchial arches syndrome, asymmetric micrognathia) were examined. Occlusion parameters and electromyographic features of masticatory muscles were analyzed. Results. Occlusal contact estimation did not reveal any significant differences between the groups. The symmetry of masticatory muscles at teeth clenching was higher in children with acquired asymmetric micrognathia (the index of asymmetry at electromyography 1.95±2.1%) compared to children with congenital asymmetric micrognathia (the index of asymmetry at electromyography 23.06±18.8%), p=0.005. Total activation index of masticatory muscles at electromyography ranged from 143 to 64% in patients with temporomandibular joint osteoarthritis and from 127 to 75% in children with I-II branchial arches syndrome. None of the patients included in the study had any complaints of temporomandibular joint and masticatory muscles condition. This was confirmed by no difference in muscular balance static index in two groups. Nevertheless, in patients with I-II branchial arches syndrome a much more sufficient asymmetry was observed. Orthodontic treatment and reconstructive surgery did not succeed in asymmetry index restoration to normal ranges. Conclusion. In children with symmetric abnormalities and acquired deformities functional status of maxillofacial area can be rapidly restored after reconstructive treatment at well-planned orthodontic rehabilitation; maxillofacial area functional status in patients with unilateral abnormalities can not be fully restored, since muscle asymmetry persists for a long time.
Clinical and instrumental criteria in predicting the clinical course of chronic posttraumatic uveitis after penetrating ocular trauma
Authors: Maracheva N M , Panova I E
Published: November 2019

Aim. To identify the prognostic criteria for the recovery or transformation to chronic form in patients with prolonged clinical course of uveitis associated with penetrating ocular trauma basing on the results of clinical examination and instrumental methods. Methods. 120 patients with chronic clinical course of post-traumatic uveitis were examined 2-3 months after the penetrating ocular trauma using clinical examination and ultrasonography of eye and orbita. 1st group consisted of 60 convalescents, 2nd included 60 patients with chronic disease. The control group consisted of 40 healthy volunteers. Ultrasonography included measurement of innermost eye coat thickness and the retrobulbar part of the optic nerve thickness measured 10 mm behind the eyeball bilaterally. Results were statistically analyzed. Results. Prognostic criteria for recovery or chronic inflammation development in chronic post-traumatic uveitis were found. They are: G-index and interocular asymmetry coefficient of innermost eye coat and optic nerve thickness. At calculation of G-index, which characterizes inflammatory consequences of trauma, presence of cornea imbibition, rubeosis iridis, cataract, vitreous body fibrosis, pulled-in cornea and sclera scars, retinal and choroidal detachment, the eyeball subatrophy, decreased eye fluid pressure, optic nerve thickening. The value of all the parameters equaled 1. An interocular thickness asymmetry coefficient characterized innermost eye coat thickness or optic nerve thickness ratio in injured eye compared to other eye. 2-3 weeks after the trauma characteristic G-index value of G ≥4, an interocular asymmetry coefficient value of ≥1,3 for innermost eye coat thickness and ≥1,1 for optic nerve thickness are the indicators of a high risk of chronic development. Lesser values predict recovery. Conclusion. Use of the set of found prognostic criteria in patients with prolonged clinical course of uveitis provides high prognosis accuracy of 93,3% at predicting recovery or chronic uveitis development.
Prospective analysis of lipid profile parameters, inflammatory response and endothelial function markers before and after percutaneus coronary intervention in patients with stable angina
Authors: Petelina T I , Musikhina N A , Gapon L I , Dementjeva N V
Published: November 2019

Aim. To conduct the prospective study assessing the biochemical laboratory parameters in patients with stable angina and hemodynamically significant coronary artery stenosis before and 12 months after transluminal balloon-catheter angioplasty. Methods. 40 patients (males and females), mean age 57,3±9,6 years with stable angina and chronic coronary artery disease were examined. Patients were divided into 2 groups based on the absence (1st group, 14 patients) or presence (2st group, 26 patients) of hemodynamically significant coronary artery stenosis on selective coronary angiography. Patients with hemodynamically significant coronary artery stenosis underwent percutaneous transluminal coronary angioplasty (PTCA) with stenting (drug-coated stents). Blood lipid profile, inflammatory markers and endothelial dysfunction markers were measured before the surgery and 12 months after treatment. Results. In patients with hemodynamically significant coronary artery stenosis statistically significant association of hemodynamically significant coronary artery stenosis presence with atherogenic lipid fractions levels, inflammatory markers (high-sensitivity C-reactive protein, tumor necrosis factor-alpha) and an endothelial function parameter (endothelin-1) were revealed. Long-term results of PTCA with stenting included the significant decrease of atherogenic and increase of anti-atherogenic fractions in lipid profile. There also was a prolonged inflammatory response characterized by high-sensitivity C-reactive protein (hs-CRP) level elevation, and the endothelin system dysfunction retaining. Conclusion. Persistent hs-CRP level increase as well as endothelin-1 level increase suggest a high risk of late stent thrombosis, it should be taken into account while following-up patients at the late stages after PTCA.
The influence of thrombolytic therapy on clinical and instrumental parameters of left ventricular remodeling in the late post-infarction period of myocardial infarction with Q-wave
Authors: Khairutdinova G M
Published: November 2019

Aim. To evaluate clinical and instrumental parameters of late left ventricular remodeling in patients with myocardial infarction with Q-wave depending on use of thrombolysis. Methods. 87 patients with myocardial infarction with Q-wave on electrocardiography (ECG) were included. First group consisted of 34 patients in whom thrombolytic therapy was performed, second group consisted of 53 patients in whom thrombolysis was not used due to late referral (over 12 hours from initial symptom onset, 88,7%), concomitant hemorrhagic stroke (3,8%), previously reported uncontrolled arterial hypertension (7,6%). All patients were followed up at 3-4 weeks, 60 and 120 months after the onset of myocardial infarction, examination included ECG, echocardiography, clinical examination. Results. In patients of both groups increase of total R-wave amplitude on repetitive ECGs was associated with relative left ventricle wall thickening, increase of left ventricular mass index, decrease of systolic and diastolic wall stresses caused by compensatory hypertrophy of intact cardiomyocytes according to results of correlation analysis. Increase of total amplitude of QS-waves on repetitive ECGs was associated with left ventricular cavity dilatation and spherification with wall thickening, increase of systolic and diastolic wall stresses. Patients in whom thrombolysis was not used had significantly higher rates of angina at post-infarction period. No statistically significant differences of ECG and echocardiography parameters between two groups of patients were found during the whole follow-up period. Non-significant increase of total R-wave amplitude and QS-waves amplitude was registered in patients in whom thrombolysis was started not later than 90 minutes from initial symptom onset compared to patients in whom thrombolysis was started later. Conclusion. Comparison of ECG and echocardiography parameters over time did not reveal any statistically significant differences between the groups with and without thrombolysis.