Irkutsk Regional Clinical Hospital
Irkutsk Regional Clinical Hospital
Borodashkina S.Y.,Irkutsk Regional Clinical Hospital |
Protasov K.V.,Irkutsk State Medical Academy of Continuing Education |
Podkamennyi V.A.,Irkutsk State Medical Academy of Continuing Education
Kardiologiya | Year: 2017
Aim: to determine risk factors of early cardiovascular complications after beating-heart coronary artery bypass grafting (CABG) in patients with ischemic coronary disease (IHD) and type two diabetes (D2). Materials and methods. We included into this study 188 patients (mean age 59 years, 85.1% men) with IHD and D2 who underwent off-pump CABG. The following cardiovascular complications (CVQ registered within 7 days after surgery were analyzed: myocardial infarction (MI), stroke/transient ischemic attack (S/TIA), atrial fibrillation (AF). The control group of patients without CVC was formed by case-control method. In the study groups we compared IHD severity, coronary angiography, brachiocephalic and peripheral arteries duplex ultrasonography data, blood pressure level, glomerular filtration rate, EuroSCORE II risk, preoperative glycemic parameters and hypoglycemic therapy, as well as CABG volume and severity. Factors associated with postoperative CVC were determined by multiple stepwise logistic regression. Results and conclusions. CVC were registered in 47 patients (MI - in 18, S/TIA - in 2, AF - in 27). As compared with the control group patients with CVC had higher Canadian Cardiovascular Society angina class and EuroSCORE II risk, lower left ventricular ejection fraction and glomerular filtration rate; they more frequently had left main coronary artery involvement, total coronary artery occlusions, carotid and peripheral artery disease. Group of patients with CVC had higher levels of glycosylated hemoglobin, serum glucose and its diurnal variability, as well as higher proportion of patients switched preoperative from oral hypoglycemic agents to rapid-acting insulin. According to logistic regression most informative predictors of CVC were peripheral artery disease (odds ratio [OR] 3.4, 95% confidence interval [CI] 1.7-7.1), diurnal serum glucose variability on admission day (OR 13.2, 95% CI 5.9-30.0 per 0.1 mmol/l) and the day before surgery (OR 1.3, 95%C11.2-2.4 per 0.1 mmol/l), and switching from oral hypoglycemic agents to insulin (OR 2.5, 95%CI 1.2-5.5).
Panasyuk A.I.,Irkutsk Regional Clinical Hospital |
Grigoryev E.G.,Irkutsk State Medical University
Novosti Khirurgii | Year: 2017
Atypical variants of the acute appendicitis course occur in 20-30% of patients. Indistinctive clinical picture is explained by the location variety of the vermiform appendix in the abdomen. The paper presents the peculiarities of clinical manifestations of acute appendicitis. Particular attention is given to the atypical clinical signs depending on the localization of the vermiform appendix in the abdominal cavity. Posibilities of diagnostic visualization methods (ultrasound, multislice computed tomography) for the differential diagnosis of the "acute abdomen" syndrome are under discussion, as well as the reasons of possible misdiagnosis. This case report demonstrates one of the multiple "masks" of acute appendicitis - the "chameleon of the abdominal cavity" and the difficulties of clinical diagnosis in case of mesoceliac appendix. Atypical onset of the disease, which the patient associated with a large meal, intolerable pains, frequen vomiting, not typical for acute appendicitis forced position, physical findings served as a basis for working diagnosis - acute intestinal obstruction. This version of small bowel invagination was supported by means of diagnostic visualization. The erroneous conclusion was obviously associated with the location of the vermiform appendix, its size (D=1,2 cm) and severe inflammatory changes. Videolaparoscopy turned out to be a comprehensive method of diagnosis and treatment.
Makhutov V.N.,Irkutsk Regional Clinical Hospital |
Aldaranov G.Yu.,Irkutsk Regional Clinical Hospital |
Ovakimyan G.A.,Irkutsk Regional Clinical Hospital |
Boyko T.N.,Irkutsk Regional Clinical Hospital
Polytrauma | Year: 2017
Objective - to present the experience of restoration of chest structure in the patients with polytrauma with use of the device SRKCH-22. Materials and methods. The presented experience is based on a retrospective analysis of treatment of 40 patients with chest structure disarrangement. The patients underwent intrapleural osteosynthesis using the stapling instrument for ribs, clavicles and the lower jaw (SRKCH-22). Results. The main results of using this method of chest structure restoration were early activation of the patients, the feasibility of performing operation in any surgery unit during providing emergency care, the absence of infectious complications and low postoperative mortality (2.5 %). Conclusion. The efficiency of the method is associated with early patient activation on the background of chest structure restoration, effective pain relief and normalization of respiratory function in the patients with polytrauma.
Baranov A.A.,Moscow State University |
Ivanov D.O.,North State Medical University |
Alyamovskaya G.A.,Russian National Research Medical University |
Amirova V.R.,Bashkir State Medical University |
And 36 more authors.
Vestnik Rossiiskoi Akademii Meditsinskikh Nauk | Year: 2014
In 2010, the Russian Federation (RF) registered palivizumab - innovative drug, based on monoclonal antibodies for passive immunization of seasonal respiratory syncytial virus (RSV) infection in children of disease severe progress risk group, which include primarily premature infants, children with bronchopulmonary dysplasia and hemodynamically significant congenital heart disease. Currently, palivizumab is included in the list of recommended medicines and medical care standards of different countries, including Russia. In the review the results of Russian research on the progress of RSV infection, its epidemiology and immunization experience gained over the 2010-2014 period are summarized in relation to the foreign data. During the four epidemic seasons palivizumab immunization covered more than 3,200 children of severe RSV infection risk group with a progressive annual increase in the number of patients who received the drug. Geography of palivizumab immunization is also greatly expanded in our country during this time. If during the first two seasons measures of immunization were taken mainly in Moscow and St. Petersburg, at the present time, thirty one territorial entities of the Russian Federation have the experience in the drug application. Analysis of the results of RSV infection immunization (made in several regions) confirms the high clinical efficacy and palivizumab safety already demonstrated in international studies. In addition, the analysis presents the potential to improve the efficiency of the integrated RSV infection immunization programs, realizing in the establishment of high-risk child group register, adequate counseling for parents, as well as the development of the routing of patients and coordination of interaction between different health institutions during the immunization. © 2014, Izdatel'stvo Meditsina. All rights reserved.
Lepekhova S.A.,Irkutsk State Medical University |
Koryakina L.B.,Irkutsk Regional Clinical Hospital |
Kurganskii I.S.,Irkutsk State Medical University
Vestnik Rossiiskoi Akademii Meditsinskikh Nauk | Year: 2015
Background: One of the main difficulties in assessing the effectiveness of etiologic treatment of hypoparathyroidism is absence of its standardized model. Objective: The aim of the study was to develop a method of hypoparathyroidism modeling. Methods: Controlled nonrandomized study was performed on female Wistar rats aged 10 month. Group 1 (n =14) was performed with destruction of parathyroid glands with electrocoagulation; group 2 (n =12) - parathyroidectomy by the developed method. In 3 and 14 days after the surgery the levels of ionized calcium, parathyroid hormone, number of white blood cells, blood leukocyte formula, indicators of immunological tests, histological examination of organs in the area of operations were performed. Statistical analysis was performed using the nonparametric Mann-Whitney-Wilcoxon test. Results: Selection of animals by sex and age criteria, angular skin incision, use of the operating microscope, microsurgical techniques. Extirpation of parathyroid glands via resection of thyroid gland with the closure of the wound defect glue appeared to be the distinctive features of the developed method. In 14 days the group 2 showed decrease in ionized calcium (p =0.016), PTH (p =0.094), leucocytes (p =0.004), PI (p =0.003), spontaneous NBT test (p =0.004), induced NBT test (p =0.003) compared with group 1. Histological examination in the group 2 revealed no changes in thyroid gland, thin connective tissue capsule, cavity with a small amount of glue, however, there were determined foci of necrosis with perifocal inflammation in the group 1. Conclusion: Combination of several techniques allowed to simulate metabolic disorders with persistent hypocalcemia as well as lack of mortality in early postoperative period.
Lazarev V.V.,Irkutsk Regional Clinical Hospital |
Chirik A.A.,Irkutsk Regional Clinical Hospital |
Lazareva A.A.,Polyclinic No 8 |
Glotov S.D.,Russian Academy of Medical Sciences
Vestnik otorinolaringologii | Year: 2015
The present paper reports a clinical case of local syphilitic meningoencephalitis known as Argyll-Robertson syndrome and manifested in the form of acute sensorineural loss of hearing. The patient was a 46 year old resident of the city of Irkutsk. He experienced the sharp impairment of hearing involving both ears with the accompanying feeling of dizziness, disturbed orientation of the locomotorbehaviour, the lurching gate, subfebrility, the loss of the ability to speak and write. The diagnosis was based on the presence of anisocoria, the absence of consensual pupillary reaction to the light, weak atropine action on the pupils, well expressed positive results of the VRDL (blood) and RW (liquor) tests, an enhanced signal from the left temporal region in the T-2 regime during MRI, positive hearing dynamics within 12 hours after the onset of anti-inflammatory, antibacterial and infusion therapy. The specific feature of the clinical case being considered is differential diagnostics was performed with the purpose of distinguishing it from otogenic brain abscess associated with chronic left-hand mesotympanitis.Abstract available from the publisher.
PubMed | Irkutsk Regional Clinical Hospital, Polyclinic No 8 and Russian Academy of Medical Sciences
Type: Case Reports | Journal: Vestnik otorinolaringologii | Year: 2015
The present paper reports a clinical case of local syphilitic meningoencephalitis known as Argyll-Robertson syndrome and manifested in the form of acute sensorineural loss of hearing. The patient was a 46 year old resident of the city of Irkutsk. He experienced the sharp impairment of hearing involving both ears with the accompanying feeling of dizziness, disturbed orientation of the locomotorbehaviour, the lurching gate, subfebrility, the loss of the ability to speak and write. The diagnosis was based on the presence of anisocoria, the absence of consensual pupillary reaction to the light, weak atropine action on the pupils, well expressed positive results of the VRDL (blood) and RW (liquor) tests, an enhanced signal from the left temporal region in the T-2 regime during MRI, positive hearing dynamics within 12 hours after the onset of anti-inflammatory, antibacterial and infusion therapy. The specific feature of the clinical case being considered is differential diagnostics was performed with the purpose of distinguishing it from otogenic brain abscess associated with chronic left-hand mesotympanitis.
Andreeva E.O.,Irkutsk Regional Clinical Hospital |
Koryakina L.B.,Irkutsk Regional Clinical Hospital |
Pivovarov Yu.I.,Irkutsk Regional Clinical Hospital |
Kurilskaya T.E.,Irkutsk Regional Clinical Hospital
Cardiovascular Therapy and Prevention (Russian Federation) | Year: 2014
Aim: To estimate the role of endogenous metabolic factors in formation of vascular endothelium reactivity in patients with different genesis cardiovascular regulation disorders. Materials and methods. The research included 30 patients with ischemic heart disease (IHD) with stable form of exertional angina (EA) of II-III severity class, 30 patients with I-II stage and 1st-2nd degree essential hypertension (EH), and 15 clinically healthy volunteers. We researched the signs of functional state of vascular endothelium before and after occlusion test. The parameters investigated included: adhesion of thrombocytes, spontaneous aggregation, prostacyclin activity of blood plasma, levels of antithrombine-III, of von Willebrand factor, contents of malonic aldehyde, of nitrites, of endothelin-1, of membrane-connected haemoglobin, of methaemoglobin in erythrocytes, activity of angiotensine-converting enzyme, level of sorption on the membrane of erythrocytes of nucleotides. Research of hemorheology was performed by viscosimetry method. Results: In healthy volunteers high probability of endothelium sensitivity to transverse strain decrease (in 82%) was determined and 25% increase of activity of peroxide oxidation of lipids. In patients with exertional angina influence of dynamic changes of blood flow on endothelium occurred by 2% decrease of viscosity and more than 120% increase of production von Willebrand factor (in 87%). It was concluded that as higher the production of prostacyclin in response to mechanic stimuli (more than 50%) is, the higher is probability of blood flow dynamic changes influence on endothelium. In patients with essential hypertension 30% increase of level of antithrombine-III in 100% of cases caused increase of sensibility of vascular endothelium to transverse strain. Conclusion: The most significant factors linked with sensibility of endothelium of vascular wall to dynamic blood flow changes in examined groups of patients were determined. In patients with exertional angina vascular reaction was mostly linked with rheological qualities and adhesive-aggregation characteristics of blood. In patients with essential hypertension the sensitivity of vascular endothelium was implied to be concordant with anticoagulant activity of blood plasma.