Secondary care organization

 AVAILABILITY OF SPECIALIZED MEDICAL AID FOR NEUROTRAUMA IN THE METROPOLIS AND THE REGION WITH LOW POPULATION DENSITY

Moguchaya O.V., Simonova I.A., Shchedrenok V.V., Anikeev N.V.

Moguchaya O.V., Simonova I.A., Shchedrenok V.V., Anikeev N.V.

 Russian Polenov Neurosurgical Institute,

Saint Petersburg, Russia

Rendering medical assistance for neurotrauma is a very important problem owing to its significant incidence and high level of persistent disability.

Objective – to study the availability of neurosurgical aid in the metropolis and the region with low population density.

Materials and methods. Content analysis was used for investigation of the documents, which regulate medical aid. The classification of Russian regions according to population density was offered: with low – up to 4.0 persons per km², moderate – from 4.1 to 16, high – above 16.1. The point system for assessment of neurosurgical assistance availability for neurotrauma was developed. It is based on the separation of the factors, which limit assistance in view of emergency.  

Results. The content analysis revealed only 14.3 % of the documents with the phrase “availability of medical assistance”, without regard to population density and features of settlement. The availability of neurosurgical aid for neurotrauma in the region with low population density (Komi Republic) was unsatisfactory based on the results of the offered technique, average availability is 10.5 points. In the metropolis (St. Petersburg) the rate is satisfactory (8.9 points).Two groups of the measures for increasing availability of specialized neurosurgical aid were proposed: for medical and non-medical facilities.

Conclusion. The content analysis of the documents regulating the provision of medical assistance testifies insufficient attention to the issues of its availability. The availability of specialized neurosurgical aid for neurotrauma in the region with low population density is unsatisfactory. In the metropolis the availability is satisfactory. Measures for increasing the availability of specialized neurosurgical assistance for neurotrauma should be realized by medical and non-medical facilities.

Key words: neurotrauma; availability of medical assistance; specialized medical assistance; neurosurgical assistance; metropolis; region with low population density.  

Information about authors:

Moguchaya O.V., MD, PhD, professor, head of quality sector of medical assistance, Polenov Russian Scientific Research Neurosurgery Institute, Saint Petersburg, Russia.

Simonova I.A., candidate of medical science, head physician, Polenov Russian Scientific Research Neurosurgery Institute, Saint Petersburg, Russia.

Shchedrenok V.V., MD, PhD, professor, senior researcher, Polenov Russian Scientific Research Neurosurgery Institute, Saint Petersburg, Russia.

Anikeev N.V., candidate of medical science, head of neurosurgery  department, Saint Martyr Elizaveta City Hospital, Saint Petersburg, Russia.

Address for correspondence:

Moguchaya O.V., Volodarskogo St., 11-6, Sestroretsk, Saint Petersburg, 197706

Tel: +7 (921) 656-14-47

E-mail: ovm55@yandex.ru

REFERENCES:

1. Agadzhanyan VV, Ustyantseva IM, Pronskikh AA, Kravtsov SA, Novokshonov AV, Agalaryan AKh, et al. Polytrauma. Emergency care and transportation. Novosibirsk : Nauka, 2008. 320 p. Russian

2. Peleganchuk VA. Scientific substantiation of the organization of specialized medical aid at multiple and combined injuries in the subject of the Russian Federation. Dr. med. sci. abstracts diss. Novosibirsk, 2010. 45 p. Russian

3. Sakharov AV. Medical and social aspects of road traffic injuries. Cand. med. sci. abstracts diss. St. Petersburg, 2011. 18 p. Russian

4. Konovalov AN, Potapov AA, Likhterman LB, Kornienko VN, Kravchuk AD, Okhlopkov VA, et al. Reconstructive and minimally invasive surgery of the consequences of traumatic brain injury. Moscow : IP “T.A. Alexeeva”, 2012. 320 p. Russian

5. Shchedrenok VV, Dorovskikh GN, Moguchaya OV, Anikeev NV, Sebelev KI, Iakovenko IV. Clinic and beam diagnosis of isolated and combined traumatic brain injury. St. Petersburg : RNHI im. prof. AL. Polenova, 2012. 456 p. Russian

6. Ishchenko AN. Regional features of contemporary Russia's demographic development. Dr. econ. sci. abstracts dis. Moscow, 2008. 44 p. Russian

7. Whole world. Wordstat info. Available at: http://worldstat.info (accessed 10.05.2014) Russian

8. Gazetteer “About countries”. Available at: http://ostranah.ru (accessed 10.05.2014) Russian

9. Gumanenko EK, Samokhvalov IM. Field surgery of local wars and armed conflicts. Moscow : GEOTAR-Media Publ., 2011. 672 p. Russian

10. Glazkov RV, Iakovenko IV, Vereshchako AV. Point Grading Scale of assessing the severity of injuries of the spine and spinal cord. In: Medical emergencies in vertebrology : the materials of All-Russian scientific and practical conference with the international participation. St. Petersburg, 2013. p. 35–36. Russian

11. Pape HC, Peitzman AB, Schwab CW, Giannoudis PV. Damage control management in the polytrauma patient. NY; Dordrecht; Heidelberg; London : Springer Verlag, 2010. 463 p.

PERIODICAL HEALTH EXAMINATION FOR COAL MINING WORKERS AS THE BASE OF OCCUPATIONAL DISEASE PREVENTION

Piktushanskaya T.E.

Piktushanskaya T.E.

 Treating rehabilitation Center # 2,

Shakhty, Russia

There was a system of prevention of occupational diseases and staged health examination from health post to occupation pathology center in Rostov region in 70-80s of the previous century.

Objective – to evaluate the effectiveness of the system of staged examinations for miners, to develop the measures for its improvement.

Materials and methods. Research subject – occupational assistance and periodical health examination for miners. The different schemes of periodical health examination for miners of Rostov region were investigated. The bibliographic method and the data of the register of patients with diseases of the Rostov Center of Occupational Pathology were used. The effectiveness of prophylactic medical examination was analyzed for the period from 1970 till 2013.      

Results. The study of twenty years of experience with staged treatment and preventive medical examination of workers of the coal industry has proved the expediency and high efficiency of used methods of medical prevention of occupational diseases. At the present time the role of employers in providing medical assistance for the working population reduced to zero. The regulations of obligatory medical examination are extremely unsatisfactory.

Conclusion. For preservation of health of workers of the coal industry it is necessary to implement a number of activities: to supplement the labour code with periodical health examinations for employees in the center of occupational pathology, to develop and implement the regulations for procedures of regular medical examination, medical rehabilitation, recovery and the standards of activity of medical health units, to resume radiation therapy rooms, inhalatoriums, sanatorium-preventorium and medical workshop service. It is necessary to implement the systems for assessing individual professional risk in coal industry enterprises, to develop mechanisms for financing treatment of employees of high risk in the occupational pathology centers.

Key words: periodical health examination; obligatory medical examination; prevention of occupational diseases; medical rehabilitation; staged treatment.

Information about author:

Piktushanskaya T.E., candidate of medical science, head of mobile diagnostics department, Medical Rehabilitation Center #2, Shakhty, Russia.

Address for correspondence:

Piktushanskaya T.E., Dubinina pereulok, 4, Shakhty, Rostov region, Russia, 346510.

Tel: +7 (8636) 23-10-63

E-mail: centreab@yandex.ru

REFERENCES:

1. Shabalkin AI, Piktushanskaya IN, Yakovleva EP. Actual problems of occupational pathology and medical rehabilitation of occupational diseases. In: Prophylaxis of health breach and expert examination of occupational sutableness of workers in modern conditions : the materials of reports of All–Russian conference. Rostov-on-Don, 2012. p. 280-287. Russian
2. Piktushanskaya IN, Shabalkin AI. Experience of occupational diseases prophylaxis of eastern Donbass miners. In: Scientific-methodical providing of occupational pathology centres activity in modern conditions : the materials of reports of All–Russian conference. Shakhty, 2013. p. 179-185. Russian
3. Bykovskaya TY, Piktushanskaya IN, Shabalkin AI. Regional experience of occupational diseases prophylaxis of coal mining workers. In: Sanatorium-Resort Recovery, Treatment and Rehabilitation of Patients with Social Significant and Occupational Diseases : the Materials of Reports of the Fourth International Congress. Sochi, 2012. p. 162-165. Russian
4. Bykovskaya TY, Piktushanskaya IN, Shabalkin AI. Occupational diseases, actual problems of prophylaxis and medical rehabilitation. Bulletin of Eastern-Siberian Scientific Centre of SDRAMS. 2012; (5): 123-126. Russian
5. Piktushanskaya IN, Shabalkin AI. About the necessity of changing the normative legal base regulating occupational pathological help organization. In: Actual problems of ecology-associated and occupational respiratory diseases : the materials of reports of All-Russian conference. Rostov-on-Don, 2014. p. 92-97. Russian
6. About confirmation of the list of harmful and (or) dangerous productional factors and works for fulfiling of which obligatory preliminary and periodical medical examination (investigation) are carried out and the order of carrying out preliminary and periodical medical examination (investigation) of workers who are engaged in hard works and works with harmful and (or) dangerous conditions of labour : the order of Ministry of Health Care and Social Development of RF N 302n from 12.04.2011. Russian
7. About confirmation of order of rendering medical assistance in acute and chronical occupational diseases : the order of the Ministry of Health Care of RF N 911n from 13.11.2012. Russian (Об утверждении порядка оказания медицинской помощи при острых и хронических профессиональных заболеваниях : приказ Минздрава России № 911н от 13.11.2012 г.)

Original researches

PREDICTIVE SIGNIFICANCE OF MARKERS OF INFLAMMATION, Lipopolysaccharide-Binding Protein AND LACTATE IN DEVELOPMENT OF SEPSIS IN PATIENTS WITH POLYTRAUMA

Ustyantseva I.M., Khokhlova O.I., Petukhova O.V., Zhevlakova Y.A., Agalaryan A. Kh.  

Ustyantseva I.M., Khokhlova O.I., Petukhova O.V., Zhevlakova Y.A., Agalaryan A. Kh.  

Federal Scientific Clinical Center of Miners’ Health Protection,

Leninsk-Kuznetsky, Russia

Objective – to assess the clinical and predictive significance of the criteria for systemic inflammatory response syndrome (SIRS), levels of markers of inflammation, LPS-BP and lactate in the blood of critically ill patients with polytrauma.

Materials and methods. The analysis included the results of examination of the patients with polytrauma (n = 1565) in critical state (APACHE III > 80, ISS > 30), supposed blood loss > 20 % of total circulating blood) who were retrospectively classified in concordance with ACCP/SCCM criteria (1992): SIRS (n = 575), local infection (n = 360), sepsis (n = 270), severe sepsis (n = 120) and septic shock (n = 60). A case was considered as infection after confirmation of infection source and microbiologic confirmation.

Identification of microorganisms was performed with Vitek 2 bacteriologic analyzer (Bimm, France). Serum procalcitonin (PCT) and C-reactive protein (CRP) were assessed with Cobas 6000 SWA (Switzerland). The levels of lipopolysaccharide-binding protein (LPS-BP), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) in the blood serum were measured with IMMULITE ONE immunochemiluminiscent analyzer (USA). Venous blood lactate was measured with Roche Omni S analyzer (Germany).

The statistical analysis of the data was performed with IBM SPSS Statistics 20. The description of qualitative signs was performed through calculation of absolute and relative frequencies. Fisher’s exact test and χ² test were used for comparison of the qualitative values. Identification of relationships was realized with multiple logistic regression. For estimation of diagnostic information capacity of the tests ROC-curve was analyzed. The differences were considered as statistically significant with p < 0.05.

Results. In 72 % of the patients with polytrauma development of infectious complications was noted; in 4.7 % of the cases sepsis was diagnosed at 8-10 days, and its severe course was characterized with connection of multiple resistant gram-negative microflora. The hyperproduction of LPS-BP, PCT, CRP and IL-6 was found. Its degree was related to severity of developing sepsis and increase of frequency of LPS-BP diagnostic levels before microbiologic confirmation of an infection. The strong direct correlation between the levels of lactate and LPS-BP was demonstrated.

Conclusion. The received results confirm the high diagnostic and predictive significance of LPS-BP, CRP and lactate, and possibility for using these values as early markers of purulent septic complications. The measurement of blood lactate is an independent predictive factor of mortality in polytrauma.

Key words: polytrauma; systemic inflammatory response syndrome; sepsis; lipopolyssacharide-binding protein; lactate; C-reactive protein; procalcitonin.   

Information about authors:

Ustyantseva I.M., PhD, professor, deputy director of clinical laboratory diagnostics, Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Khokhlova O.I., MD, PhD, physician of clinical laboratory diagnostics, Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Petukhova O.V., candidate of medical science, physician of clinical laboratory diagnostics, Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Zhevlakova Yu. A., candidate of medical science, bacteriologist, clinical diagnostic laboratory, Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Agalaryan A. Kh., candidate of medical science, head of surgery department, Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Address for correspondence:

Ustyantseva I.M., 7^th district, 9, Leninsk-Kuznetsky, Kemerovo region, Russia, 652509

Federal Scientific Clinical Center of Miners’ Health Protection

Tel: + 7(384-56) 2-38-88; 2-39-90; 9-55-13

E-mail: irmaust@gnkc.kuzbass.net

references:

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2.        Erbay H, Yalcin AN, Serin S, Turgut H, Tomatir E, Cetin B, Zencir M. Nosocomial infections in intensive care unit in a Turkish University hospital: a 2 year survey. Intens. Care Med. 2003; 29: 1482-1488.

3.        Agadzhanyan VV. Septic complications in polytrauma. Polytrauma. 2006; (1): 9-17. Russian

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6.        Csóka B, Németh ZH, Mukhopadhyay P, Spolarics Z, Rajesh M, Federici S, Deitch EA, et al. CB2 cannabinoid receptors contribute to bacterial invasion and mortality in polymicrobial sepsis. PLoS One. 2009; 4 (7): e6409.

7.        Rankin JA. Biological mediators of acute inflammation. AACN Clin. Issues. 2004; 15 (1): 3-17.

8.        Bone RC, Fisher CJ Jr, Clemmer TP, Slotman GJ, Metz CA, Balk RA. Sepsis syndrome: A valid clinical entity. Crit. Care Med. 1989; 17: 389-393.

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11.    Meisner M, Adina H, Schmidt J. Correlation of procalcitonin and C-reactive protein to inflammation, complication, and outcome during the intensive care unit course of multiple-trauma patients. Crit. Care. 2006; 10 (1): R.1.

12.    Ustyantseva IM, Khokhlova OI, Petukhova OV, Zhevlakova YuA, Agadzhanyan VV. Criterions of the systemic inflammatory reaction syndrome in early diagnosis of the sepsis and patients with polytrauma. Polytrauma. 2010; (1): 13-16. Russian

13.    Gutierrez G, Wulf ME. Lactic acidosis in sepsis: another commentary. Crit. Care Med. 2005; 33: 2420-2422.

14.    Levy B, Gibot S, Franck P, Cravoisy A, Bollaert PE. Relation between muscle Na+K+ATPase activity and raised lactate concentrations in septic shock: a prospective study. Lancet. 2005; 365: 871-875.

15.    Jansen TC, van Boomel J, Woodward R, Mulder PG, Bakker J. Association between blood lactate levels, Sequential Organ Failure Assessment subscores, and 28-day mortality during early and late intensive care unit stay: a retrospective observation study. Crit. Care Med. 2009; 37 (8): 2369-2374.

16.    Baker SP, O’Neill B, Haddon W, Long WB. The injury severity score: A method for describing patients with multiple injuries and evaluating emergency care. J. Trauma. 1974; 14 (3): 187-196.

17.    Chapman SJr, Iredell JR. Gram-negative sepsis in the intensive care unit: avoiding the therapeutic failure. Curr. Opin. Infect Dis. 2008; 21 (6): 604-609.

18.    Thuong M, Arvaniti K, Ruimy R, de la Salmonière P, Scanvic-Hameg A, Lucet JC, et al. Epidemiology of Pseudomonas aeruginosa and risk factors for carriages acquisition in an intensive care unit. J. Hosp. Infect. 2003; 53 (4): 274-282.

19.    Bertrand X, Thouverez M, Talon D, Boillot A, Capellier G, Floriot C, et al. Endemicity molecular diversity and colonization routs of Pseudomonas aeruginosa in intensive care unit. J. Intens. Care Med. 2001; 27: 1263-1268.

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Anesthesiology and critical care medicine

ANALYSIS OF HOSPITAL MORTALITY AND CLINICAL DIAGNOSTICS QUALITY IN PATIENTS WITH POLYTRAUMA

Levchenko T.V., Kravtsov S.A., Kornev A.N., Shatalin A.V., Dzuban G.G.

Levchenko T.V., Kravtsov S.A., Kornev A.N., Shatalin A.V., Dzuban G.G.

Federal Scientific Clinical Center of Miners’ Health Protection,

Kemerovo Regional Office of Forensic Medicine, Leninsk-Kuznetsky, Russia

Objective – to examine the level and structure of hospital mortality in polytrauma, and thanatological profile in dependence on dominating injury and terms of in-hospital stay. To assess the quality of clinical diagnostics in different terms of traumatic disease, to perform expert estimate for identified defects in rendering medical assistance.

Materials and methods. There was a retrospective monitoring for 636 case histories of patients with polytrauma who received treatment in the specialized traumatology center on the basis of Scientific Clinical Center of Miners’ Health Protection from 2008 till 2012. 102 patients died. The mortality was 16 %. The clinical structural analysis of hospital mortality was performed, and the quality of clinical diagnostics was assessed.

Results. The hospital mortality for the examined period was 16 % as mean. The decrease in mortality in acute period of traumatic disease up to 23.5 % was noted, including during the first 24 hours – 9.8 %, with relative increase after 10 days (39.2 %). The maximal number of lethal outcomes (79.4 %) related to road traffic accidents. Severe traumatic brain injury was the dominating injury in polytrauma (37.3 %). The competing dominating injuries were noted in 26.5 %.

Defects in clinical diagnostics quality were noted in 54 (52.9 %) of deceased patients; in 2 patients (1.9 %) they were with thanatological significant characteristics. The highest number of diagnostic errors (80.2 %) was noted in the acute period of traumatic disease as result of objective causes – extremely severe state of patients, necessity of resuscitation measures, surgical procedures and short terms of in-hospital stay. The individual defects in clinical diagnostics are conditioned by subjective factors: insufficient examination of patients, low professional level of specialists and non-qualitative execution of medical documentation.

Conclusion. It is necessary to continue investigation of hospital mortality in polytrauma, its structure, causes and cases with defects. It will allow to perform scientific substantiation for organizational measures for improvement of medical assistance in severe injuries with aim of improvements in results of diagnostics and treatment.

Key words: hospital mortality; traumatic disease (TD); diagnostic defects.

Information about authors:

Levchenko T.V., head of anatomic pathology department, Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Kravtsov S.A., MD, PhD, head of center of resuscitation, intensive care and anesthesiology, Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Kornev A.N., candidate of medical science, head of treatment quality department, Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Shatalin A.V., MD, PhD, head of resuscitation and intensive care department, Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Dzuban G.G., head of Leninsk-Kuznetsky interdistrict department, Kemerovo Regional Office of Forensic Medicine, Leninsk-Kuznetsky, Russia.

Address for correspondence:

Levchenko T.A., 7^th district, 9, Leninsk-Kuznetsky, Kemerovo region, Russia, 652509

Federal Scientific Clinical Center of Miners’ Health Protection

Тел.: +7 (384-56) 2-40-11

E-mail: info@gnkc.kuzbass.net 

REFERENCES:

1.      Zayratyants OV, Kaktursky LV, Avtandilov GG. Formulation and comparison of clinical and pathologicoanatomic diagnosis. Moscow, 2003. 45 p. Russian

2.      Agadzhanyan VV, Pronskikh AA, Ustyantseva IM, Agalaryan AK, Kravtsov SA, Krylov YM, et al. Polytrauma. Novosibirsk : Nauka Publ., 2003. 494 p. Russian

3.      Ankin LN. Polytrauma (organizational, tactical and methodologic problems). Мoscow : Medicine Publ., 2004. 204 p.

4.      Ermolov AS, Abakumov MM, Sokolov VA, Kartavenko VI, Galankina IE, Garaev DA.  Structure of hospital mortality in concomitant injury and the ways of its decrease. Surgery. 2006; (9): 16-20. Russian

5.      Korolev VM. Epidemiologic aspects of concomitant injury. Far Eastern Medical Journal. 2011; (3): 124-128. Russian

6.      Maksimov AV. Systemic analysis of defects in rendering medical assistance for patients with injuries after falling from different height according to expert practice of medical examiner. Chief physician: Economy and law. 2013; (1): 42-46. Russian

7.      International statistic classification of diseases and problems associated with health. 1^0th revision. Volume 3. Zheneva : World Health Organization, 1994. 924 p. Russian

8.      Puras YV, Talypov AE, Krylov VV. Mortality in patients with severe concomitant traumatic brain injury. Neurosurgery. 2010; (1): 31-39. Russian

9.      Singaevsky AB, Karnasevich YA, Malykh IY. Reasons of lethal outcomes in severe concomitant injury. Bulletin of surgery by the name of I.I. Grekov. 2002; 161 (2): 62-64. Russian

10.  Shatalin AV, Kravtsov SA, Agadzhanyan VV. Main factors influencing on mortality in patients with polytrauma admitted into specialized trauma center. Polytrauma. 2012; (3): 17-21.

11.  Shchedrenok VV, Moguchaya OV, Yakovenko IV, Grigoryan  GA, Anikeev NV, Fedorov AV, et al. Analysis of hospital mortality in patients with concomitant traumatic brain injury in Saint Petersburg and issues of medical aid quality. Bulletin of surgery by thename of I.I. Grekov. 2007; 166 (5): 82-85. Russian

12.  Dutton RP, Stansbury LG, Leone S, Kramer E, Hess JR, Scalea TM. Trauma mortality in mature trauma systems: are we doing better? An analysis of trauma mortality patterns? 1997-2008. J. Trauma. 2010; 69 (3): 620-626.

CHRONOLOGY AND STRUCTURE OF ORGAN DYSFUNCTIONS AT PATIENTS WITH TRAUMATIC SHOCK

Iudakova T.N., Girsh A.O., Macsimishin S.V., Shchetina A.V.

Yudakova T.N., Girsh A.O., Maksimishin S.V., Shchetina A.V.

Kabanov City Clinical Hospital #1,

Omsk State Medical Academy,

Omsk, Russia

Objective – to define the chronology and the structure of system and organ dysfunctions in patients with traumatic shock, and to perform comparative assessment of regress during administration of different options of infusion therapy.

Materials and methods. The research included 75 patients with traumatic shock of degree 3 with distribution into three groups depending on an option of infusion therapy. Severity of general state, expressiveness of organ dysfunctions and efficiency of therapeutic influences were estimated with SOFA scale.

Results. In the patients with traumatic shock of degree 3 the following chronology and structure of development of organ and system dysfunctions were noted: acute cardiovascular, renal, cerebral, hemostasiological, respiratory and hepatic insufficiency.

Conclusion. In patients with traumatic shock of degree 3 organ and system dysfunctions should be estimated by means of SOFA and plasma hemostasis parameters.

Key words: traumatic shock; multiple organ insufficiency.

Information about authors:

Yudakova T.N., candidate of medical science, head of resuscitation and intensive care department, Kabanov City Clinical Hospital #1, Omsk, Russia.

Girsh A.O., MD, PhD, professor, chair of anesthesiology and resuscitation, Omsk State Medical Academy, Omsk, Russia.

Maksimishin S.V., candidate of medical science, deputy head physician of anesthesiology and resuscitation, City Clinical Hospital of Emergency Medical Aid #1, Omsk, Russia.

Shchetina A.V., physician of resuscitation and intensive care department #1, Kabanov City Clinical Hospital #1, Omsk, Russia.

Address for correspondence:

Girsh A.O., 24 Severnaya St., 204, building 1, 143, Omsk, Russia, 644052

Tel: +7 (3812) 66-69-95; +7 (923) 681-40- 60

E-mail: agirsh@mail.ru

REFERENCES:

1.                  Stukanov MM, Mamontov VV, Maksimishin SV, Girsh AO, Chugulev IA, Ivanov KA. Influence of the balanced and unbalanced infusion therapy on parameters of system haemodynamics, electrolytic and acid-base balances in patients with traumatic shock. Bulletin of Ural Medical Academic Science. 2011; (2): 26-30. Russian

2.                  Stukanov MM, Mamontov VV, Maksimishin SV, Girsh AO. Hemostasis parameters in patients with traumatic shock. Bulletin of Ural Medical Academic Science. 2012; (1): 50-55. Russian

3.                  Brohi K, Cohen MJ, Canter MT. Acute traumatic coagulopathy initiated by hypoperfusion: modulated through the protein c pathway? J. Trauma. 2008; 64: 1211-1217.

4.                  Intensive therapy : national guidelines. Gelfand BR, editors. Moscow : Medicine Publ., 2009. 954 р. Russian

5.                  Yudakova TN, Girsh AO, Maksimishin SV, Malkov OA. Associativity of indicators of cardiovascular system and endothelial dysfunction in patients with hemorrhagic shock. Anesthesiology and resuscitation. 2013; (6): 11-14. Russian

6.                  Malkov AO, Yudakova TN, Maksimishin SV, Girsh AO. Dynamics of development of endothelial dysfunction in patients with hemorrhagic and traumatic shock. Omsk Scientific Bulletin. 2013; (2): 37-40. Russian

7.                  Ait-Oufella H, Maury E, Lehoux S, Guidet B, Offenstadt G. The endothelium: physiological functions and role in microcirculatory failure during severe sepsis. Intensive Care Med. 2010; 36 (8): 1286-1298.

8.                  Khaykin IV, Rozanov IE, Maylova GE. Some mechanisms of development of multiple organ insufficiency in patients with severe concomitant injury. Military Medical Journal. 2007; (3): 55-57. Russian

9.                  Davydov MI, Zaridze DG, Lazarev AF. Analysis of the causes of mortality in the population of Russia. Bulletins of Russian Academy of Medical Science. 2007; (7): 17-27. Russian

10.              Stukanov MM, Mamontov VV, Girsh AO, Yudakova TN. Associativity of infusion therapy and state severity in patients with traumatic shock. Polytrauma. 2011; (46): 41-46. Russian

11.              Girsh AO, Stukanov MM, Yudakova TN, Maksimishin SV. Modern methodology of infusion therapy in patients with shock. STM. 2012; (3): 73-77. Russian

12.              About the approval of rules of clinical use of donor blood and (or) its components : the order Russian Federation Ministry of Health from 02.04.2013 183n. 29 p. Russian

13.              Carlino W. Demage control resuscitation from major haemorrhage in polytrauma. Eur. J. Orthop. Surg. Traumatol. 2013; 31: 1012-1019.

14.              Ustyantseva IM, Khokhlova OI. Features of laboratory diagnostics of critical conditions in patients with polytrauma. Polytrauma. 2013; (3): 81-90. Russian

15.              Rebrova OY. Statistic analysis of medical data: application of STATISTICA applied software package. Moscow : Medicine Publ., 2006. 305 р. Russian.

Clinical aspects of surgery

COMPREHENSIVE  ASSESSMENT OF HEMODIALYSIS PATIENTS AFTER TOTAL  PARATHYROIDECTOMY

Evmenova T.D., Lyamina L.G.

Evmenova T.D., Lyamina L.G.

 Kemerovo Regional Clinical Hospital,

Kemerovo, Russia

Objective – to show the effectiveness of total parathyroidectomy based on the comprehensive assessment of hemodialysis patients before and after the intervention.

Materials and methods. The effectiveness of total parathyroidectomy in 47 patients with renal hyperparathyroidism is shown on the basis of complex estimation of their condition before and after surgery by calculating of an integrated parameter using the Wilcoxon test, carrying out the one-way analysis of variance and application of Harrington’s psychophysical scale.

Results. 47 patients were followed up from 10 months to 11 years.  Clinically, all patients reported significant improvements already in the early postoperative period, and it persisted throughout the period of observation. Integrated indicator summarizing the main symptoms of renal hyperparathyroidism was 0.787 in each patient before the operation, in the early postoperative period – 0.143 (p = 0.0000001).

Using psychophysical scale by Harrington and distribution of values of comprehensive assessment before and after parathyroidectomy we found that the vast majority of the patients evaluated their presurgical state as poor and very bad and, on the contrary, after it – as good and very good.

In all patients in the long-term period after the operation itchy skin removed, gait improved, no pathological fractures were found. In most patients the pain in bones, joints and muscles disappeared completely, as well as blood pressure normalized.

Conclusions. The study showed that good and very good condition of the patients maintained throughout the period of observation. This suggests that total parathyroidectomy is most effective treatment for renal hyperparathyroidism.

Key words: parathyroid glands; secondary hyperparathyroidism; parathyroidectomy.

Information about authors:

Evmenova T. D., MD, PhD, professor, head of endocrine surgery department, Kemerovo Regional Clinical Hospital, Kemerovo, Russia.

Lyamina L. G., surgeon, oncologist, surgery department, City Clinical Hospital # 2, Kemerovo, Russia.

Address for correspondence:

Lyamina L.G., Shakhterov prospect, 62b-171, Kemerovo, Russia, 650002

Tel.: +7 (3842) 46-33-96; +7 (913) 287-75-47

E-mail: dr-onсolog2006@rambler.ru

REFERENCES:

1.      Egshatyan LV. Efficiency of therapeutic and surgical treatment of secondary hyperparathyroidism in patients receiving renal replacement therapy with program hemodialysis. International journal of endocrinology. 2012; (3): 25-34. Russian

2.      Evmenova TD, Lyamina LG, Moshneguts SV. About the issue of surgical treatment of secondary (renal) hyperparathyroidism. In: Modern aspects of surgical endocrinology : the materials from XXth Russian symposium with international participation. Kazan, 2012. p. 101-105. Russian

3.      Samokhvalova NA, Maystrenko NA. Surgical correction of secondary hyperparathyroidism in patients receiving renal replacement therapy. In: Modern aspects of surgical endocrinology : the materials from IId Ukrainian-Russian symposium. Kharkov, 2011. p. 385-388. Russian

4.      Falvo L, Catania A, Sorrenti S, D'Andrea V, Santulli M, De Antoni E. Relapsing secondary hyperparathyroidism due to multiple nodular formations after total parathyroidectomy with autograft. Surgery. 2003; 69 (11): 998-1002.

5.      Gagne ER, Urena P, Drueke TB. Short- and long-term efficacy of total parathyroidectomy with immediate, a autograftying with subtotal parathyroidectomy in hemodialysis patients. J. Am. Soc. Neph. 1992; 3 (4): 1008-1017.

6.      Jimeno J, Pérez M, Pereira JA, Sancho JJ, Sitges-Serra A. Surgical treatment of recurrent secondary hyperparathyroidism. Cir. Esp. 2006; 79 (1): 70-71.

7.      Levin A, Bakris GL, Molitch M. Prevalence of abnormal serum vitamin D, PTH, calcium, and phosphorus in patients with chronic kidney disease: results of the study to evaluate early kidney disease. Kidney International. 2007; 71 (1): 31-38.

8.      National Kidney Foundation. K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am. J. Kidney Dis. 2003; 42 (4, Suppl. 3): S1-S201.

9.      Slatopolsky E, Delmez JА. Pathogenesis of secondary hyperparathyroidism. Neprol Dial Transplant. 1996; 11 (3): 130-136.

Clinical aspects of traumatology and orthopedics 

FEATURES OF TREATMENT OF PELVIC INJURIES IN POLYTRAUMA

Bondarenko A.V., Kruglykhin I.V., Plotnikov I.A., Voytenko N.A., Zhmurkov O.A.

Bondarenko A.V., Kruglykhin I.V., Plotnikov I.A., Voytenko N.A., Zhmurkov O.A.

Altay State Medical University,

 Regional Clinical Hospital of Emergency Medical Aid,

Barnaul, Russia

Pelvic ring injuries include fractures of bones, disruptions of pelvic ring joints and acetabular fractures. Pelvic injuries are most common in polytrauma.

Objective – to find out the specifics of the pelvic ring and acetabular injuries in patients with polytrauma, characteristics of complications and treatment options.

Materials and methods. The study included the composition and the structure of injuries, mortality, and features of rendering assistance for patients with pelvic injuries in polytrauma treated in Regional Clinical Hospital of Emergency Medical Aid during 2000-2013.

Results. Most patients died in the first three days after injury at the intensive care phase of treatment. The most frequent causes of death were acute massive blood loss and traumatic (hemorrhagic) shock. The highest in-hospital mortality in patients with pelvic fractures was observed for polytrauma with ISS > 40 and unstable injuries (61-C) to the pelvic ring. Surgical interventions for the pelvic bones or associated complications were not the direct causes of death. Most complications can be attributed to the general (somatic) ones, the cause of which was forced physical inactivity. Local complications associated with operative treatment of pelvic injuries were 3.3 %.

Conclusion. Three of four patients with pelvic trauma had the injuries to other organs and systems. In polytrauma pelvic injuries occur in each fifth patient. The unstable pelvic ring injuries are the most common in polytrauma. Hospital mortality among patients with pelvic injuries in polytrauma reaches 17.2 %. Most patients died on the first day after injury. The main causes of death were acute massive blood loss and traumatic (hemorrhagic) shock. The vast majority of died patients received conservative treatment. Most complications were associated with forced physical inactivity due to severity of an initial injury and using conservative treatment techniques.

Key words: acetabulum; osteosynthesis; polytrauma; pelvis.

Information about authors:

Bondarenko A.V., MD, PhD, professor, head of traumatology department #2, Regional Clinical Hospital of Emergency Medical Aid, Barnaul, Russia.

Kruglykhin I.V., physician of traumatology department #2, Regional Clinical Hospital of Emergency Medical Aid, Barnaul, Russia.

Plotnikov I.A., physician of traumatology department #2, Regional Clinical Hospital of Emergency Medical Aid, Barnaul, Russia.

Voytenko N.A., physician of traumatology department #2, Regional Clinical Hospital of Emergency Medical Aid, Barnaul, Russia.

Zhmurkov O.A., physician of traumatology department #2, Regional Clinical Hospital of Emergency Medical Aid, Barnaul, Russia.

Address for correspondence:

Kruglykhin I.V., Regional Clinical Hospital of Emergency Medical Aid, traumatology department #2, Komsomolsky prospect, 73, Barnaul, Altay region, Russia, 656038

Tel: +7 (913) 272-71-01

E-mail: nova107@yandex.ru

REFERENCES:

1. Maurice E. Müller Foundation in cooperation with documentation center AO-ASIF. UCF. Universal classification of fractures. Moscow, 1996. Booklet number 2. 32 p. Russian
2. Milyukov AY. Formation of tactics of treatment of patients with pelvic injuries. Polytrauma. 2013; (3): 22-29. Russian
3. Agadzhanyan VV, Pronskikh AA, Ustyantseva IM, Agalaryan AK, Kravtsov SA, Krylov YM, et al. Polytrauma. Novosibirsk : Nauka Publ., 2003. 492 p. Russian

4.      Sokolov VA. Multiple and associated injuries. Moscow : GEOTAR-Media Publ., 2006. 512 p. Russian

5.      Tile M, Halfet DL, Kellam JF. Fractures of the pelvis and acetabulum. Philadelphia : Lippincott Willams & Wilkins, 2003. 830 p.

6.      Smith WR, Ziran BH, Morgan SJ. Fractures of the pelvis and acetabulum. New York : Informa Healthcare USA. Inc., 2007. 359 p.

7.      Baker SP, O'Neill B, Haddon W Jr, Long WB. The Injury Severity Score: a method for describing patients with multiple injuries and evaluating emergency care. J. Trauma 1974; 14: 187–196.

8.      Glants S. Biomedical Statistics : per. s angl. Moscow : Praktika Publ., 1998. 459 p. Russian

9.     Sokolov VA. Prevention and treatment of complications of polytrauma in the the postresuscitation period. Vestnik travmatologii i ortopedii im. N.N. Priorova. 2002; (1): 78–84. Russian

SHORT TERM OUTCOMES AFTER ANKLE ENDOPROSTHETICS

Kuchiev A.Y.

Kuchiev A.Y.

Chaklin Ural Scientific Research Institute of Traumatology and Orthopedics,

Ekaterinburg, Russia

At the present time, ankle endoprosthetics for osteoarthritis is not widespread, and arthrodesis is the gold standard of surgical treatment for these patients.

Objective – to evaluate the short-term results of ankle endoprosthetics.

Materials and methods.  The results of total ankle endoprosthetics in 31 patients in the period from 3 months to 3 years were analyzed. The clinical examination method and X-ray investigation data were used. 

Results. In all patients the pain syndrome stopped in a short time after intervention, range of joint motion maintained or increased, support ability of extremity recovered that improved the patients’ quality of life.

Conclusions. Ankle endoprosthetics is recommended in cases of restoration of limb function in patients with osteoarthritis regardless of etiology. This technology can be used as a method of choice in treating these patients

Key words: total endoprosthetics; arthropathy deformans; ankle.

Information about author:

Kuchiev A. Y., candidate of medical science, senior  researcher, Chaklin Ural Scientific Research Institute of Traumatology and Orthopedics, Ekaterinburg, Russia.

Address for correspondence:

Kuchiev A. Y., Bankovskiy pereulok, 7, Ekaterinburg, Russia, 620014

Tel: +7 (343) 383-24-60

E-mail: kalan77@mail.ru

REFERENCES:

1.      Hintermann B. Total ankle arthroplasty. New York : SpringerWein, 2005. 196 p.

2.      Traumatology and orthopaedics. Kornilov NV, editor. 3^th ed., supplementary and rev. Moscow : GEOTAR-Media Publ., 2011. 592 p. Russian

3.      Akhmetzhan AD. Criteria for diagnostics and evaluation of complex treatment in patients with posttraumatic kruzarthritis. Cand. med. sci. abstracts diss. Novosibirsk, 2009. 25 p. Russian

4.      Alekseeva LI, Tsvetkova ES. Osteoarthritis: from past to future. Nauchno-prakticheskaya revmatologiya. 2009;

5.      Daniels TR, Younger AS, Penner M, Wing K, Dryden PJ, Wong H et al. Intermediate-Term Results of Total Ankle Replacement and Ankle Arthrodesis: A COFAS Multicenter Study. J. Bone Joint Surg. Am. 2014; 96 (2): 135-142.

6.      Claridge RJ, Sagherian BH. Intermediate term outcome of the agility total ankle arthroplasty. Foot Ankle Int. 2009; 30 (9): 824-835.

7.      Hintermann B, Barg A, Knupp M, Valderrabano V. Conversion of painful ankle arthrodesis to total ankle arthroplasty. Surgical technique. J. Bone Joint Surg. Am. 2010; 92 (Suppl. 1, Pt. 1): 55-66.

8.      Van den Heuvel A, Van Bouwel S, Dereymaeker G. Total ankle replacement. Design evolution and results. Acta Orthop. Belg. 2010; 76 (2): 150-161.

9.      Stoyanov AV, Emelyanov VG, Pliev DG, Mikhaylov KS. Total ankle replacement (literature review). Traumatology and orthopaedics in Russia. 2011; (1): 144-152. Russian

10.  Gougoulias N., Khanna A., Maffulli N. How Successful are Current Ankle Replacements: A Systematic Review of the Literature. Clin. Orthop. Relat. Res. 2010; 468 (1): 199-208.

11.  Karantana A, Hobson S, Dhar S. The scandinavian total ankle replacement: survivorship at 5 and 8 years comparable to other series. Clin. Orthop. Relat. Res. 2010; 68 (4): 951-957.

Functional, instrumental and laboratory diagnostics

REFERENTIAL INDICES OF BONE MINERAL DENSITY OF LUMBAR VERTEBRAE FOR WOMEN OF KUZBASS

Zakharov I.S., Kolpinsky G.I., Ushakova G.A.

Zakharov I.S., Kolpinsky G.I., Ushakova G.A.

Kemerovo State Medical Academy, Kemerovo, Russia

Osteoporosis is one of the leading non-infectious diseases according to its medical, social and economic consequences. The prevalence of this disease in women is significantly higher than in men.  Dual-energy X-ray absorptiometry takes a leading part in osteoporosis diagnostics. During bone densitometry obtained indices of bone mineral density (BMD) are compared with a reference database that is originally put into densitometric system, which often differs from the indices in the particular region particular region.

Objective – to develop the reference database of bone mineral density indices in the lumbar vertebrae of Kemerovo region women.
Materials and methods. There was processing of 1504 results of dual-energy X-ray absorptiometry for the lumbar vertebrae of the Kuzbass women of different age groups. The study included the women living in Kemerovo region at least 10 years, without diseases resulting in osteoporosis formation. The area of ​​diagnostic interest included the first-fourth lumbar vertebrae.

Results and discussion. During the study the reference database of bone mineral density indices for the lumbar vertebrae for the women of Kemerovo region of different age groups was developed. The peak values of bone mineral density in the lumbar vertebrae in the women of Kemerovo region are associated with the age period of 20-29 years, with the following 10-year stability of indices. After age of 40 the statistically significant reduction of BMD values is observed. There were statistically significant differences during comparison of the reference values of lumbar BMD in the women of Kemerovo region and the values in National Health and Nutrition Examination Survey database for the age periods of 16-19 and 20-29 years. However, at the age of 30-39 and older BMD values in the women of Kuzbass were lower.

Conclusions. Therefore, use of the developed reference database of bone mineral density indices of the lumbar vertebrae for Kuzbass women will allow performing dual-energy X-ray absorptiometry with consideration of regional differences, and it will result in diagnostics quality increase for osteopenia and osteoporosis.

Key words: osteoporosis; bone mineral density; dual energy X-ray absorptiometry; reference indicators.

Information about the authors:

Zakharov I.S., candidate of medical science, docent of obstetrics and gynecology department #1, Kemerovo State Medical Academy, Kemerovo, Russia.

Kolpinsky G.I., MD, PhD, professor, chair of X-ray diagnostics, radiotherapy and oncology, Kemerovo State Medical Academy, Kemerovo, Russia.

Ushakova G.A., MD, PhD, professor, head of obstetrics and gynecology department #1, Kemerovo State Medical Academy, Kemerovo, Russia.

Address for correspondence:

Zakharov I.S., Voroshilova St., 22a, Kemerovo, Russia, 650029  

Tel: +7-(3842)-46-51-62

E-mail: isza@mail.ru

REFERENCES:

1. Hernlund E, Svedbom A, Ivergard M, Compston J, Cooper C, Stenmark J, et. al. Osteoporosis in the European Union: Medical Management, Epidemiology and Economic Burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch. Osteoporos. 2013; 8: 136.
2. Lesnyak OM. Audit of osteoporosis problem in Russian Federation. Preventive Medicine. 2011; (2): 7-10. Russian
3. Looker AC, Borrud LG, Hughes JP, Fan B, Shepherd JA, Melton III LJ. Lumbar spine and proximal femur bone mineral density, bone mineral content, and bone area: United States, 2005–2008: data from the National Health and Nutrition Examination Survey (NHANES). Hyattsville, Md. : Dept. of Health and Human Services, Public Health Service, National Center for Health Statistics, 2012. 132 p. (Vital and Health Statistics, Series 11, No. 251. Data From the National Health and Nutrition Examination Survey).
4. Kaptoge S, Reid DM, Scheidt-Nave C, Poor G, Pols HA, Khaw KT, et al. Geographic and other determinants of BMD change in European men and women at the hip and spine. A population-based study from the Network in Europe for Male Osteoporosis (NEMO). Bone. 2007; 40 (3): 662-673.
5. The report of the status and protection of environment in Kemerovo region in 2013. Kemerovo, 2014. 279 p.
6. Koskina EV, Ivoylov VM, Glebova LA, Brusina EB, Rynza OP. Social hygienic monitoring of pediatric health in Kemerovo. Mother and Child in Kuzbass. 2012; (2): 18-22. Russian
7. Mihayluts MF. The disease incidence in children living in a city with developed chemical industry with complex influence of contaminated air and soil. Ecologic Hygienic Problems in Kuzbass, Kemerovo, 1990. p. 27–28. Russian
8. Osteoporosis. Lesnyak OM, Benevolenskoy LI, editors. 2^nd edition, revised and supplemented. Moscow : GEOTAR-Media Publ., 2009. 272 p.
9. Zhang Z-Q, Ho SC, Chen Z-Q, Zhang C-X, Chen Y-M. Reference values of bone mineral density and prevalence of osteoporosis in Chinese adults. Osteoporos Int. 2014; 25(2): 497-507.
10. Hui SL, Gao S, Zhou XH, Johnston CC Jr, Lu Y, Gluer CC, et al. Universal standardization of bone density measurements: a method with optimal properties for calibration among several instruments. J. Bone Miner. Res. 1997; 12:1463–1470.

ALGORITHM FOR LABORATORY DIAGNOSTICS OF HYPOCHROMIC ANEMIA

Surzhikova G.S., Klochkova-Abelyants S.A.

Surzhikova G.S., Klochkova-Abelyants S.A.

Novokuznetsk  Institute of Postgraduate Training,

Novokuznetsk, Russia

Objective – to explore the parameters of iron metabolism to create a diagnostic algorithm of iron deficiency and functional iron deficiency.

Materials and methods. The studies were conducted for 375 women aged 16 to 60. 79 of them were apparently healthy and were included into the control group, 296 – with diagnosed anemic syndrome, of whom 103 women suffered from iron deficiency anemia, 193 - anemia of chronic diseases. Among women with anemia of chronic diseases 121 patients had diagnosed anemia, which developed against the background of autoimmune connective tissue diseases (rheumatoid arthritis). In 72 patients infectious and inflammatory diseases were presented with chronic tonsillitis, bacterial endocarditis and chronic pyelonephritis. A study of iron metabolism indices in the blood serum of women was performed. During diagnostics the clinical data and hematological parameters were considered.

Results. Anemia in women with diagnosed iron deficiency anemia had hypochromic and microcytic characteristics. Anemia in patients with rheumatoid arthritis and with infectious and inflammatory processes was characterized by anemia of chronic diseases and was hypochromic, rarely normochromic and microcytic. Violation of iron metabolism in anemia of chronic diseases on the background of infectious and inflammatory diseases and rheumatoid arthritis is characterized by functional iron deficiency and changes in the synthesis of transferrin receptors on the erythroid cells.

Conclusions. Iron deficiency anemia and anemia of chronic diseases differentiate depending on parameters reflecting iron metabolism. It is necessary to consider the impact of chronic diseases on the results of an examination of deposited iron in iron-deficient erythropoiesis. Determination of the amount of soluble transferrin receptors greatly increases the accuracy of the laboratory diagnostics of iron deficiency anemia and anemia of chronic diseases, and the index of rTFR / log ferritin > 1.5 is an adequate indicator of iron deficiency in the body and should be used in the algorithm of differential diagnosis of hypochromic anemia. 

Key words: hypochromic anemia; iron deficiency anemia; anemia of chronic disease; ferritin; soluble transferrin receptor.

Information about authors:

Surzhikova G.S., candidate of medical science, docent, head of chair of clinical laboratory diagnostics, Novokuznetsk Institute of Postgraduate Training, Novokuznetsk, Russia.

Klochkova-Abelyants S.A., candidate of medical science, docent of chair of clinical laboratory diagnostics, Novokuznetsk Institute of Postgraduate Training, Novokuznetsk, Russia.

Address for correspondence:

Klochkova-Abelyants S.A., Glinki St., 3, 67, Novokuznetsk, Kemerovo region, Russia, 654000

Tel: +7 (3843) 79-62-19; +7 (906) 934-59-09

E-mail: satenikka@mail.ru

REFERENCES:

1. Pavlov AD, Morshchakova EF, Rumyantsev AG. Erythropoiesis, erythropoetin, iron. Moscow : GEOTAR-Media Publ., 2011. 304 p. Russian

2. Kazyukova TV. The ferrokinetics indices in infectious inflammation diseases in younger children. Pediatrics. 2004; (3): 42-48. Russian

3. Surzhikova GS, Klochkova-Abelyants SA. Soluble transferrin receptors in differential diagnostics of hypochromic anemia. Polytrauma. 2013; (3): 62-65. Russian

4. Baranovskaya IB, Onishchuk SA. Reticulocyte hemoglobin in differential diagnostics of anemia. Bulletin of Orenburg State University. 2008; (2): 129-134. Russian

5. Graziadei I, Gaggl S, Kaserbacher R, Braunsteiner H, Vogel W. The acute-phase protein al-antitrypsin inhibits growth and proliferation of human early erythroid progenitor cells (burst-forming units-erythroid) and of human erythroleukemic cells in vitro by interfering with transferring iron uptake. Blood. 1994; 83: 260-268.

Researches of young scientists

MORPHOMETRIC FEATURES OF FEMUR HEAD BONE TISSUE IN COXARTHROSIS 

 Davydov D.A., Ustyantseva I.M.

Davydov D.A., Ustyantseva I.M.

 Federal Scientific Clinical Center of Miners’ Health Protection,

Leninsk-Kuznetsky, Russia 

Objective – to perform comparative evaluation of morphometric indices of structure of femur head bone tissue in coxarthrosis and without such pathology.   

Materials and methods. The study included 16 patients with clinical diagnosis of coxarthrosis of degrees III-IV (patients’ mean age of 53.0 ± 3) who were admitted for hip joint endoprosthesis to the department of traumatology and orthopedics in Clinical Center of Miners’ Health Protection. The disease period was 9.5 ± 3.94 years. In the comparison group the objects for morphologic study were 10 femur heads, which were taken as result of autopsy in died patients. The mean age of the diseased patients was 57 ± 5.6. This group included the materials with macroscopic unchanged articular surface and absent bone deformation. The morphologic examination was performed with the specialized software and measurement of bone rod thickness and square in the histological sections. The statistical analysis was performed with Statistica 6.0 applied software package.

Results. After the morphologic study of the femur head samples the histological picture did not contradict the previous investigations, and it testified the degenerative dystrophic changes in bony and cartilage tissue in coxarthrosis. During histological examination of the samples the comparison group showed the uniform thickness of cartilaginous tissue of articular surface with all regions saved: cell-free, superficial, transitional regions, region of isogenous groups, region of columns, region of hypertrophic cells and calcification region. In all three examined parts of the femur head the spongy substance consisted of continuously connected bone rods, which form the closed cavities – lacunes. Despite of lower thickness and decreased square of bony rods in the deep part of a healthy femur head, the mechanical strength is not sufficient for supporting normal functioning, and it is possibly related to its qualitative composition by the means of saved remodeling processes. The morphologic studies showed no statistically significant differences in bony rod thickness for all three examined parts of bone tissue of the femur head. The bony rod square in the region III was 34 % lower than in the region I, and 17 % lower than in the region II. It testified the shortening as result of domination of the resorption processes over synthesis in this region. According to the results of comparative characteristics of morphometric indices of the structure of femur head bone tissue in coxarthrosis and without this pathology it was found that articular surface thickness in arthrosis femur head was 37.5 % lower than in the comparison group. In coxarthrosis the bony rod thickness was 14 % higher in the region II of the femur head, and 31 % higher in the region III compared to the comparison group. The bony rod square was 20 % lower in the region II and 15 % lower in the region III compared to the comparison group.

Conclusion. In coxarthrosis the morphometric indices of bone tissue are characterized with decreased square of the bony rods, despite of increase in the thickness. It gives evidence of predomination of resorption processes over synthesis in the bone tissue. The predomination of resorption processes is also supported by disarrangement of integrity of the bone lacunes resulting in decreasing mechanical strength in the femur head with arthrosis. For assessment of bone tissue remodeling one can use such morphometric indices as bony rod thickness and square in different parts of the femur head in coxarthrosis.

Key words: coxarthrosis; morphometry; structure; bone tissue resorption and synthesis.                           

Information about authors:

Davydov D.A., anatomic pathologist, anatomic pathology department, Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia. 

Ustyantseva I.M., PhD, professor, deputy director of clinical laboratory diagnostics, Federal Scientific Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia.

Address for correspondence:

Ustyantseva I.M., 7^th district, 9, Leninsk-Kuznetsky, Kemerovo region, Russia, 652509

Tel: +7 (384-56) 9-55-11

E-mail: irmaust@gnkc.kuzbass.net

REFERENCES:

1.            Gayvoronsky IV. Human general anatomy. Т. 1 : textbook for medical schools. 3d revised edition. Saint-Petersburg : SpetsLit Publ., 2003. p. 107. Russian

2.            Milyukov AY. Surgical tactics and organization of specialized medical assistance for patients with isolated, multiple and concomitant pelvic injuries. Dr. med. sci. diss. Новосибирск, 2013. 354 p. Russian

3.            Nekachalov VV. Bone and joint pathology : manual. Saint-Petersburg : Sotis, 2000. p. 36-39. Russian

4.            Histology atlas. Velsh U, editor. Moscow : GEOTAR-Media Publ., 2011. p. 76. Russian

5.            Clanton ThO, De Lee JS. Osteochondritis dissecans. History, pathophysiologic and current treatment concepts. Clin. Orthop. 1982; 167: 50-64.

6.            Akulich YV, Bryukhanov PA, Merzlyakov MV, Sotin AV. Estimation of relation of bone tissue structural adaptation. News of Saratov University. New series. 2011; Vol. II. Mathematics. Mechanics. Informatics Series. (2): 54-61. Russian

7.            Nikonova TA, Ustyantseva IM, Khokhlova OI. Mineral density indices and features of bone remodeling in coxarthrosis. In: Multiprofile hospital: problems and solutions : the collection of works from  XVIth All-Russian scientific practical conference. Leninsk-Kuznetsky, 2012. С. 88. Russian

8.            Davydov DA, Nikonova TA, Ustyantseva IM. Relationship between pathomorphological parameters of femoral head structure and bone remodeling markers in coxarthrosis. Polytrauma. 2013; (1): 61-66. Russian

9.            Gerk SA, Golovanova OA. Human bone apatite – features of chemical structure in pathology. Butlerov’s messages. 2011; (24): 123-132. Russian

10.       Semenova LA, Radenska-Lopovok SG, Alekseeva LI. Morphologic characteristics of osteoarthrosis. Archive of pathology. 2010; (2): 47-51. Russian

11.       Shostak NA, Klimenko AA, Nikolenko MV. Osteoarthrosis: the issues of pathogenesis and treatment. Clinicist. 2010. (1): 47-53. Russian

12.       Golovanova OA, Lemesheva SA. Composition and structure of human bone tissues as reflection of pathogenic mineralization processes in coxarthrosis. Bulletin of Omsk University. 2010; (2): 106–112.

13.       Histologic and microscopic techniques : manual. Sapozhnikov AG, Dorosevich AE, editors. Smolensk : SAU Publ., 2000. 476 p. Russian

14.       Glants S. Biomedical Statistics : translated from English. Moscow : Praktika Publ., 1998. 459 p. Russian

15.       Goldberg OA, Grishina LP, Kanya OV, Koryak VA, Lebedev VF. About the issue of femoral head pathomorthology in coxarthrosis of stages III-IV. Bulletin of East Siberian Scientific Center. 2012; (4-2): 175-178. Russian

Rehabilitation

THE INNOVATIVE MODEL OF REHABILITATION IN KEMEROVO REGION

Korbanova T.N.

Korbanova T.N.

Kemerovo Institute of Socioeconomic Problems of Healthcare,

Kemerovo, Russia

Studying and the analysis of domestic and foreign references testify that indices of public health in many countries of the world including Russia promote increase in population’s need for medical aid, and it is mainly conditioned by increase of demand for recovery methods of treatment.

Objective – to develop effective technologies for medical rehabilitation.

The technique was developed which allows estimating need for technologies of recovery treatment.  There was an analysis of health in the population of Kemerovo region in 2009-2011. The requirement of recovery technologies was calculated on the basis of incidence.

Conclusion. The study of rehabilitation assistance in Kemerovo region allowed developing the innovative model of medical rehabilitation.

Key words: medical rehabilitation; recovery treatment; technology of rehabilitation; innovative model of rehabilitation.

Information about author:

Korbanova T.N., leading specialist, Department of Population Health Protection of Kemerovo region, Kemerovo, Russia.

Address for correspondence:

Korbanova T.N., Serebryanny Bor St., 15a – 188, Kemerovo, Russia, 650070

Tel: +7 (923) 601-89-99

E-mail: hott811@hotmail.ru

REFERENCES:

1.      Agranovich NV, Androsova TA, Yermolaeva NY. The issues of organization of rendering medical care for elderly patient with cardiovascular pathology at out-patient stage. Deputy Chief Physician. 2013; (2): 14-21. Russian

2.      Boytsov SA, Linchak RM. Prevention in system of rendering medical care. What is done and what will be done? Archive of Internal Medicine. 2012; (6): 15-19. Russian

3.      Britten N. Qualitative research: qualitative interviews in medical research. B.M.J. 1995; 311: S251-S253.

4.      Campbell J. Inappropriate admissions: thoughts of patients and referring doctors. J. R. Soc. Med. 2001; 9: 628-631.

5.      DeCoster C, Peterson S, Carriere KC. Assessing the extent to which hospitals are used for acute care purposes. Medical Care. 1999; 37 (6 Suppl.): 151-166.

6.      Eight main objectives of development of domestic health care: editorial article. Chief Physician. 2012; (2): 3-6. Russian

7.      Lisitsin VI, Fedchenko PYu. Regional tendencies and features of mortality of working age population (on the example of Novgorod region). Health Care of the Russian Federation. 2013; (2): 43-47. Russian

8.      Mikhaleva TS, Tarasov AA. Bases of medico-professional examination and rehabilitation in occupational pathology. Medicosocial Examination and Rehabilitation. 2013; (1): 8-11. Russian

9.      Potapov AI, Novichkova NI, Chistyakova TV. Prevention and rehabilitation – the effective directions for increasing level of health of the population. Health Care of the Russian Federation. 2012; (1): 3-5. Russian

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THE PROBLEMS OF DISABILITY AND REHABILITATION OF DISABLED PEOPLE ФАЕУК LABOUR INJURY IN KUZBASS

Sytin L.V., Zhestikova M.G.

Sytin L.V., Zhestikova M.G.

  Novokuznetsk State Institute of Postgraduate Medicine,

Novokuznetsk, Russia

Objective - to carry out the analysis of industrial injury and disability from 2002 to 2012; to find out the peculiarities of disability from labour injury and problems of rehabilitation in Kemerovo region.

Materials and methods. To carry out this investigation we used the methods of sociological, statistic and comparative analysis. Statistical data of disability of adult population in the Russian Federation and in Kemerovo region were taken from 2002 to 2012 from the publications and information of Kuzbass regional department of the Fund of Social insurance of the Russian Federation. The standard documents for assessing industrial injury severity and loss of professional ability were also used.

Results and discussion. From 1992 to 2010 the natural decrease of the population of the Russia was more than 13 million people. The distinguished feature of demographical crisis is high injury rates and high mortality of working age individuals from violent causes. The rate of industrial injuries and associated disability in Kuzbass is among the highest in the country. The analysis of statistical data of rehabilitation of disabled people has shown that in spite of the additional finance support by the Found of Social Insurance the results are worse compared to home accidents. The main problems limiting effectiveness of rehabilitation measures have been determined.

Conclusion. The present regulatory framework for evaluation of health damage and working ability loss impedes timely and qualitative rendering rehabilitation services and is to be revised. Many disabled persons with consequences of industrial injures have dependency mentality and the absence of desire to continue work activity. It is necessary to develop and introduce an algorithm of complex rehabilitation of injured people suffered at work in Kuzbass.

Key words: industrial injury; disability; rehabilitation. 

Information about authors:

Sytin L.V., candidate of medical science, docent of medical rehabilitation and reflexotherapy chair, Novokuznetsk State Institute of Postgraduate Medicine, Novokuznetsk, Russia. 

Zhestikova M.G., candidate of medical science, head of medical rehabilitation and reflexotherapy chair, Novokuznetsk State Institute of Postgraduate Medicine, Novokuznetsk, Russia.

Address for correspondence:

Sytin L.V., Bardina prospect, 28, Novokuznetsk, Russia, 654059

City Clinical Hospital #1, medical rehabilitation chair

Tel: +7 (3843) 79-61-94; +7 (952) 168-53-01

Е-mail: mr796194@yandex.ru

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