№1, 2017, volume 13

The problems concerning the study at clinical departments, ethics and deontology in communication between students and patients are discussed in the article. Special attention is paid to uprising of the cultural level of students.

The aim of the work is to analyze the attitude of employers to health preserving practices among agricultural workers with occupational diseases. Material and methods. Applying qualitative research strategy — focus-group interview (research period: 2015-2016). The basis of the study is opinion of peasant farm enterprise employers from Saratov region (n=8). Results. The article reveals formal character of health preserving actions aimed at agricultural workers with occupational diseases who are involved in work associated with occupational hazards at peasant farm enterprises. Breach of employment requirements and norms, conditions of work, sanitary and medical protection on the part of employers has also been stated. Failure of working career alternative adequate to somatic state of employees and absence of formed value system among agricultural workers aimed at health preserving practices have been detected as well. Conclusion. On the basis of employers opinion it is possible to state weakening of responsibility on the part of an employer as an active agent of health preserving process and its transfer to employees.

In modern neurorehabilitation practice there is a trend of common approach to the content of rehabilitation of patients with various etiopathogenic features of brain damage. The urgency of the problem of medical and social rehabilitation of patients with brain injury is associated with a high prevalence of this pathology and medical and social uncertainty of the prognosis. The authors of the publications cited in the survey have considered the rehabilitation prognosis and predictors of disability in patients with traumatic brain injury. According to most authors' opinions, the effects of traumatic brain injury even of mild degree can be shown for the first time some years later, while at the same time it is not always adequate to the severity of the acute period of craniocerebral trauma and often having a progradi-ent course. The review presents the results of studies showing that significant progress in the recovery of patients with traumatic brain injury is possible by using an integrated approach, a coordinated multidisciplinary action aimed at the patient and his family, as well as the rehabilitation period of the sequence, starting with early intensive and ending late recovery period. Medical and Social Rehabilitation of patients after traumatic brain injury, in the current context — a multidisciplinary challenge, the effectiveness of regulation is determined by the coordination and solution of medical, social, psychological and organizational tasks.

The article deals with theoretical basis of studying socio-professional groups in the field of sociology of medicine. The analysis of current domestic studies of socio-professional group of surgeons is presented. The specificity of medical training of this socio-professional group is determined in the context of its professional activity.

The aim of the article: evaluation of the results of treatment of patients with nephrolithiasis by distance shock-wave lithotripsy on the basis of the data on kidneys received from multispiral computed tomography. Material and Methods. The study involved 46 patients who were hospitalized in the clinic of urology with diagnosed urolithiasis with the pres- ence of a renal calculus from 10 to 17 mm in size. A complex of laboratory analyses including multispiral computed tomography was used. The concrement elimination was carried out by distance shock-wave lithotripsy Results. Correlation analysis and ROC-analysis did not show the efficacy of distance shock-wave lithotripsy comparing scanning procedures and distance shock-wave lithotripsy. Conclusion. The size and average density of a concrement according to multispiral computed tomography should not be served as a basis for prognosis of effective fragmentation of concre-ments by distance shock-wave lithotripsy in patients with urolithiasis caused by stones of 10-17 mm in size.

Objective: to assess the possibility of using the markers of acute kidney injury to predict the preoperative risk for the subsequent decline in glomerular filtration rate in different types of surgical treatment of renal cell carcinoma (RCC). Material and methods. 60 patients with histologically confirmed RCC T1-3M0N0 operated in the clinic of urology of Saratov State Medical University n.a. V. I. Razumovsky in the volume of nephrectomy or partial nephrectomy. Before surgery all patients underwent standard examination intended for patients with kidney tumors: ultrasound, MRI, excretory urography and dynamic renoscintigraphy, the perioperative values of serum creatinine and glomerular filtration rate were determined. Using the method of immuno-enzymatic analysis the concentrations of excreted with the urine NGAL and IL-18 in serum samples at the preoperative stage, after 5 days and after 1 month of postoperative follow-up were investigated. Differences in clinical data and clinical variables were compared by using Spearman rank correlations and t-test. Results. The determined parameters of acute kidney injury markers IL-18 and NGAL in the early postoperative period were increased in patients after open nephrectomy. Moreover, the correlation analysis according to the Spearman method revealed a strong significant correlation between the preoperative levels of IL-18 and GFR after surgery (r=1; p<0.05). Conclusion. Laparoscopic resection of RCC is the method of choice for surgical treatment of RCC. As a predictor of adverse prognosis, the level of IL-18 in serum may be used. Its increase correlates with a decline in renal function in the postoperative period, and according to some reports, IL-18 also is an independent predictor of adverse prognosis in patients with a localized RCC.

Objective: to identify risk factors that adversely affect the development of fetus and child small for gestational age; to assess the incidence of the intrauterine development of fetus and newborn; to analyze the health indicators of these children. Material and Methods. Cases of 226 children (6.6%) with diagnosed intrauterine growth restriction of the fetus were examined, including 134 of prematurity (59%). Results. The most common risk factors for the intrauterine development of the fetus were: violation of the utero-placental circulation — 196 cases, the uterine scar — 78 women, urinary tract infection — 94. Extragenital pathology was found in all women, the threat of termination of pregnancy in 109 cases, medical history of abortions in 106 women and 83 anaemia in women. Birth asphyxia was observed in 102 children (45%), prematurity in 71 cases (31.4%). Asphyxia of severe degree accounted 1 (0.5%) premature and 1 (0.45%) full-term baby. Asphyxia of moderate severity (4-6 points) accounted 70 (30.9%) preterm and 31 (13.7%) full-term infants. The most common form of the intrauterine development of the fetus asymmetrical revealed 178 cases (79.1%). Conclusion: Perinatal factors such as medical abortion, urinary tract infection, extragenital pathology are preventable. The predominant form of the intrauterine development of the fetus is asymmetric form, symmetric and dysplastic revealed to a greater degree in premature infants. Children with low weight for gestational age should be adequately provided with the necessary nutrients, fortifiers, vitamins and in the process of rehabilitation — cerebropro-tective therapy.

The damage of the peripheral nervous system often acts as a complication of extensive surgical interventions on the removal of malignant breast tumors. The research goal is to evaluate the criteria for the effectiveness of early rehabilitation treatment of postoperative upper plexopathies. Material and Methods. The analyzed results of complex diagnosis and treatment of 162 women undergoing radical mastectomy for breast cancer, aged 33 to 79 years were presented. The examination included neurological examination, analysis of the psychological state using the HADS scales, Janet Taylor and HDRS, holding electroneuromyography Results. 98.76% of cases of patients after radical mastectomy for malignant breast tumors were diagnosed with unilateral shoulder complex. At 1.24% it established a bilateral lesion of the brachial plexus. The presence of pain is not a leading complaint in all cases. Among patients with classical mastectomy performed significantly prevailed damage of the intercostal nerves III and IV. In post-operative patients with the retrofit radical mastectomy neuro- and plexopathy were often diagnosed. Consent to one-stage reconstructive surgery is directly correlated with the level of education and marital status. Indicators of depression and anxiety were lower after reconstructive plastic surgery. Conclusion. The criteria for the effectiveness of early rehabilitation treatment of postoperative upper plexopathies were obtained. The decisions on the nature and scope of reconstructive and plastic surgery were established to be in conjunction with the social components of life of patients.

The aim of the work is to evaluate the quality of life, cognitive deficits, the development of anxiety and depression of patients in rehabilitative period of mild and medium-severe hemispheric ischemic stroke during the year at the background of complex rehabilitation. Materials and Methods. We examined 123 patients at the age of 40 to 80 with ischemic stroke in the acute and rehabilitation periods (up to 1 year). Quality of life (overall life questionnaire SF-36, overall performance), the state of cognitive functions (the MMSE scale), the level of anxiety and depression (the HADS and the MADRS scale) during the acute phase and after a course of rehabilitation treatment have been assessed. Re-sults. After rehabilitation in the sanatorium positive dynamics of physical and psychological well-being was noted with patients, cognitive function was improved as well as emotional regression of personality disorders in the first 3 months after ischemic stroke. These effects are related with individual program of rehabilitation on an outpatient phase, including cognitive and neuropsychological correction leading to a clear positive dynamics of the main indicators of cognitive status, reduction of anxiety and depressive disorders, improving physical and mental health components of the SF-36 questionnaire in the course of the year. Conclusion. The findings proved that during the complex rehabilitation after an ischemic stroke during a year the marked high levels of "quality of life" including reducing anxiety and depression and regression of cognitive impairment were revealed.

The goal was to carry out the comparative analysis of ultrasonic Doppler indices and data of morphometric methods of uterine cervix examination of women with prenatal moving of amniotic fluid depending on presence or absence of uterine cervix trauma in labor. Material and methods. 148 pregnant women with prenatal moving of amniotic fluid were examined. The main group included 64 pregnant women with uterine cervix ruptures; the comparison group consisted of 84 patients without any labor trauma. Ultrasonic and morphological examinations of uterine cervix were carried out. Results. Cavernous transformation of venous cervical bloodstream closely correlated (r = 0,67, p <0.001) with the index of vascularization degree and labortrauma degree. Conclusion. The revealed echomorphological relationship in uterine cervix of pregnant women with various labor outcomes allowed using these data to predict uterine cervix rupture in labor process.