Saratov JOURNAL of Medical and Scientific Research

Original article

The study of surgical activity dynamics at patients with hypertensive intracerebral haematoma using simulation analysis in the Chuvash Republic

Summary:

Objective: improving the efciency of treatment for patients with hypertensive intracranial hematomas by means of planning optimization, epidemiological evidences simulation analysis and dynamics of surgical treatment indices. Material and Methods. 225 patient charts with hypertensive intracerebral hematomas have been analyzed. All patients were examined and treated in Cheboksary Republican Clinical Hospital January 2008 to December 2017 Results. The retrospective analysis revealed decrease in the number of surgeries for hypertensive intracerebral hematomas from 35 to 19 From 2011 to 2017 mortality in the group of patients with 30 to 60 ml hematomas decreased as well. Surgeries in the group of patients aged 50–70 who had strokes most frequently in 2010–2017 got fewer. Conclusion. Introduction of decision-making system at diagnosis stage enables applying diferentiated approach for choosing surgical treatment approach.

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Experience of endovideosurgical hemithyroidectomy use for patients with benign thyroid diseases

Year: 2019, volume 15 Issue: №2 Pages: 290-295
Heading: Surgery Article type: Original article
Authors: Vertyankin S.V., Turlykova I.A., Meshcheryakov V.L., Grekov V.V., Chupakhin N.V., Vanzha Ya.E., Ivanova V.A., Zhurkin K.I..
Organization: Saratov State Medical University
Summary:

Objective: development and assessment of the way of an endoscopic hemithyroidectomy improving visualization of anatomical structures and excluding «the confict of tools». Material and Methods. Results of treatment of 103 patients who transferred hemithyroidectomy from endoscopic and traditional approaches to the period from 2014 to 2018 on the basis of the Hospital of S. R. Mirotvortsev (Saratov) are analyzed. According to access option patients were divided into 2 groups. The compression syndrome, functional autonomy of a thyroid gland and results of a puncture biopsy were indications to operation. Results. Unilateral paresis of a throat is diagnosed for 1 patient after traditional intervention, stopped within 1.5 months, after an endovideosurgical hemithyroidectomy — for 3 patients, and was stopped in terms from 7 days up to 1.5 months. Signs of hypoparathyrosis were not found in the groups of patients. The complications connected with administration of carbon dioxide did not arise. Conversionwas not required in any case. Conclusion. Development and assessment of a new way of an endoscopic hemithyroidectomy which is feasible, safe and provides high degree of esthetic result.

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Experimental substantiation of the results of combined techniques in treatment of soft tissue abscess

Year: 2019, volume 15 Issue: №2 Pages: 287-290
Heading: Surgery Article type: Original article
Authors: Alipov V.V., Kulikova A.N., Musaelyan A.G., Mustafayeva D.R.
Organization: Saratov State Medical University
Summary:

Objective: to develop a model of purulent abscess of soft tissues and experimentally substantiate the efectiveness of the use of nanoparticles of zinc oxide (ZОN) and a drug based on lanthanum nitrate in the combined treatment of purulent abscess of soft tissues. Material and Methods. The purulent abscess of soft tissues modeling was performed using a modifed Fogarty catheter using a culture of Staphylococcus aureus in an experiment on 80 white laboratory rats of males weighing 190±25 g. Four groups of animals (20 each) were selected, which, after surgical dissection and laser rehabilitation of the cavity, carried out local therapy. In the frst (control) group, standard treatment was used, in the second group a drug based on lanthanum nitrate was used, in the third — ZОN, in the fourth — a combination of the drug with lanthanum nitrate + ZОN. Results. By the 10th day, 87±4.9 % of animals of the fourth group showed activation of the processes of collagenosis and epithelialization and complete obliteration of the abscess cavity. Conclusion. The developed purulent abscess of soft tissues modeling method is low-impact and allows optimizing the time of abscess formation with specifed characteristics. The combined treatment of animals of the fourth group due to the synergism of action creates optimal conditions for the accelerated obliteration of the purulent abscess of soft tissues cavity, shortening the treatment time by two times compared with the standard techniques.

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Clinical and laboratory indices of periprosthetic infection in patients with knee endoprosthesis instability

Year: 2019, volume 15 Issue: №2 Pages: 283-286
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Shpinyak S.P., Galashina E.A., Babushkina I.V., Girkalo M.V., Kauts O.A., Grazhdanov K.A.
Organization:
Summary:

 Objective: to make assessment of clinical and laboratory indices in patients with deep periprosthetic infection and knee endoprosthesises aseptic instability. Material and Methods. 80 patients with septic and aseptic instability of knee endoprosthesises have been surveyed. All patients were subjected to comprehensive clinical and laboratory examination (intra-articular fuid cytology and microbiology testing, joint tissue histology testing, ELISA was employed for determining the levels of skeletal tissue remodeling markers). Results. The complete combination of several examination criteria specifc for knee periprosthetic infection was

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Optimization of transpedicular spondylosynthesis application for type A3 lesions of the thoracolumbar transition: clinical experimental study

Year: 2019, volume 15 Issue: №2 Pages: 275-283
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Likhachev S.V., Zaretskov V.V., Arsenievich V.B., Shchanitsyn I.N., Shulga A.E., Zaretskov A.V., Ivanov D.V.
Organization: Saratov National Research University n.a. N. G. Chernyshevsky
Summary:

Objective: the optimization of transpedicular systems application for type A3 lesions of the thoracolumbar transition using computer simulation based on the fnite elements method. Material and Methods. The examination data (post-traumatic kyphotic deformation, intensity of pain syndrome, length of operation and extent of blood loss) of 81 prospec-tively enrolled male patients who in 2017–2018 had been operated for Th11-L2 vertebrae simple fractures of А3N0M1 type (AOSpine classifcation). The patients were divided into 3 groups in accordance with the type of intervention performed on them: short-segment (n=42), 8-screws polysegment (n=25) and 6-screws polysegment (n=14). Biome-chanical simulation based on the computer tomography data was performed for each variant of the metal construction arrangement. Results. In the process of biomechanical simulation with all the variants of the instrumented spine 3D- models loading 8-screws construction proved to be the most consistent one, at that the stability of polysegmental constructions exceeds that of bisegmental one by an order. The results of surgical management were evaluated in terms of up to a year following the intervention. The loss was less and the correction worked better with polysegmental fxation despite more complicated initial conditions for the correction compared to those of group 1 Conclusion. Biomechanical simulation shows prerequisites for the development of bisegmental systems instability as the equivalent stresses and peak displacements are higher compared to those of polysegmental fxation. The efciency analysis of application of various transpedicular fxations for type A3 thoracolumbar transition lesions attests to the advantage of polysegmental arrangements of transpedicular systems, at that the implantation of the 6- screws polysegmental system should be considered the frst choice on the number of indices.

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Quality of life in children with fat feet (planovalgus foot, longitudinal platypodia)

Year: 2019, volume 15 Issue: №2 Pages: 271-274
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Dokhov M.M., Sertakova A.V., Rubashkin S.A., Timaev M.Kh.
Organization:
Summary:

Objective: to evaluate the quality of life in children with fat feet using standard quality of life questionnaire technique. Material and Methods. 97 children with fat feet (mean age 9.7±1.2 y. o.) and 32 children with neutral position of the feet (control group) participated in the research. Both the fat foot and neutral position of the foot diagnoses were based on patients» clinical examination and instrumental methods of diagnosis. The questionnaire survey was conducted using the Oxford Ankle Foot Questionnaire (OAFQ) for children (7–17 y. o.) designed for evaluation of potential cost for treatment of children with foot and ankle joint pathologies. It is made up of 15 questions showing the quality of life (physical development, school life and exercise, emotional development) as well as problems with shoes selection. General central module of the Kiddy-KINDL Questionnaire covers various aspects of children»s life providing a fexible modular psychologically applicable method. The structure of the questionnaire scales consists of 24 questions united in evaluation groups. Results. In the group of fatfoot children the quality of life is reliably lower in terms of physical development and shoes selection. Flat feel has almost no impact on children»s emotional development as well as their social function; it doesn»t usually lead to fxation on disfguration. Conclusion. To evaluate every individual clinical case of decline in physical development quality and worsening of the emotional state in pediatric patients trauma orthopedists are recommended to employ various questionnaires that allow for detailed defning of lesions degree and quality for individual selection of the treatment method.

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Hemostasis test parameters in patients requiring revision knee arthroplasty

Year: 2018, volume 14 Issue: №2 Pages: 266-271
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Girkalo M.V., Shakhmartova S.G., Shpinyak S.P., Mandrov A.V., Kozadaev M.N., Puchinyan D.M.
Organization:
Summary:

Objective: comparative analysis of the blood coagulation system in patients requiring revision arthroplasty of the knee joint in connection with the developed infectious and aseptic complications after total arthroplasty. Material and Methods. 37 patients with complications of total knee replacement were examined. Patients were divided into 2 groups: 1st — with signs of suppuration (n=19); 2nd — withsigns of aseptic instability of the endoprosthesis components (n=18). The control group consisted of 22 conditionally healthy people. Studied screening coagulation: activated partial thromboplastin time, prothrombin time, fbrinogen concentration, thrombin time, antithrombin III, protein C, the content of soluble fbrin-monomer complexes and D-dimers. Results. There was an increase in activated partial thromboplastin time in patients of group 2, prothrombin time — in patients of groups 1 and 2 compared with the data obtained in the control group (p<0.001). An increase in the content of soluble fbrin- monomer complexes and D-dimers was recorded in the blood plasma of patients of the 1st and 2nd groups compared to their level in the control group (p<0.001). Conclusion. The data of local coagulogram tests in patients requiring revision arthroplasty of the knee joint refect the signs of maladaptation in the hemostatic system at the preoperative stage of examination. It is worth noting the lack of information content of the screening coagulogram, as its basic tests do not refect changes in the whole system of homeostasis, the search for new informative research methods remains relevant today.

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Bioflm formation by Staphylococcus strains isolated from various biological materials at infectious complications following total knee replacement

Year: 2019, volume 15 Issue: №2 Pages: 261-266
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Babushkina I.V., Bondarenko A.S., Mamonova I.A., Ulyanov V.Yu.
Organization: Saratov State Medical University
Summary:

Objective: to study Staphylococcus spp. Strains bioflm forming ability in vitro. These strains are infectious agents for implant-associated infection in patients following total knee replacement depending on the biomaterial under study. Material and Methods. Bioflm forming ability in vitro of 275 Staphylococcus spp. strains has been studied. Bioflm formation was performed using modiefed method of G. D. Christensen. Results. Bioflm forming ability was discovered in 51.2 % of the studied strains, at that it was reliably (p<0.05) higher forcoagulase-positive staphylococci compared to coagulase-negative ones. Staphylococcus strains isolated from sonication fuid obtained after removed prothesiscom- ponents ultrasonication and soft tissue bioptates were chatracterised with high ability for bioflm forming. This ability was reliably (p<0.05) higher than in strains isolated from wounds and aspirate. Interspecies diferences were observed in a group of strains isolated from bioptates: optical density of the S. epidermidis stains extracts was reliably (p<0.05) higher than that of S. aureus strains. Conclusion.Bioflm forming ability of Staphylococcus spp. strains isolated from patients with implant-associated infection depends on the biomaterial under study thus defning the most informative methods of microbiological study.

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Evaluation of the efectiveness of psychopharmaco-therapy correction with an anxiolytic drug for patients with a periodontal disease and a dentopatiya.

Year: 2019, volume 15 Issue: №2 Pages: 256-260
Heading: Stomatology Article type: Original article
Authors: Savina E.A., Kobzeva Yu.A., Aslanyan M.A., Eremin O.V., Nelovko T.V.
Organization: Saratov State Medical University
Summary:

Objective: to assess the impact of behavioral psychotherapy and psychopharmacocorrection with an anxiolytic drug on the level of anxiety and dentophobia, compliance, and the efectiveness of therapy in patients with infamma-tory periodontal diseases. Material and Methods. Comprehensive examination of 40 patients aged 27–57 years with a diagnosis of refractory periodontitis. The clinical assessment of the periodontal tissues was taken into account and the psycho-emotional status of the patient was assessed using the characterological questionnaire H. Smishek, the hospital anxiety and depression scale and a specially designed questionnaire for determining the level of dentophobia and the dynamics of the doctor-patient relationship. Results. Since the frst visit and till the 26th week consecutive decrease in level of uneasiness, then slight increase by the 52nd week is noted. Conclusion. The use of the developed algorithm for personalized treatment of patients with infammatory periodontal diseases with the inclusion of behavioral psychotherapy and psychopharmacocorrection may reduce the level of anxiety and dental fear, increase compliance and the efectiveness of therapy.

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Features of dental prosthetics at patients with chronic periodontitis and coronary heart disease

Year: 2019, volume 15 Issue: №2 Pages: 251-256
Heading: Stomatology Article type: Original article
Authors: Lepilin A.V., Eremin A.V., Lipatova T.E.
Organization: I.M. Sechenov First Moscow State Medical University, Saratov State Medical University
Summary:

Objective: at patients with chronic generalized periodontitis in combination with chronic ischemic heart disease to study the change of cytokines, biomarkers of osteoproliferation and osteoresorption in comparison with the character- istics of endothelial functions and the determine rational approaches to prosthetics. Material and Methods. 90 patients with periodontitis and coronary heart disease, who use metal, metal-ceramic and removable partial dentures using thermoplastic resin were survey. We studied of cytokines, markers of bone metabolism in the oral fuid, evaluated va-sodilating, vasoconstrictor and adhesive endothelial function. Results. The coronary heart disease in combination with chronic periodontitis is characterized by the endothelial dysfunction, which associated with the activity of periodontitis. Biochemical manifestations of periodontitis, bone resorption and endothelial dysfunction are more pronounced by the use patients metal dentures compared to metal-ceramic and removable partial dentures using thermoplastic resin. Conclusion. The use of patients at periodontitis and coronary heart disease metal dentures, in contrast to patients using metal-ceramic and removable partial dentures using thermoplastic resin, is accompanied the increase of biochemical markers of infammation and bone resorption in the oral fuid and the endothelial dysfunction.

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