2017, volume 13

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.

Purpose of the study: to evaluate the prognostic value of brain natriuretic peptide (BNP) as a predictor of cardiovascular events in patients with acute coronary syndrome (ACS) within one year after hospitalization. Material and Methods. The study included 201 patients, including 150 men and 51 women, who were treated in the emergency department of cardiology with ACS including 96 patients without symptoms of CHF and/or AHF. Results. All patients were divided into groups depending on the presence signs of heart failure of CHF and/or AHF at the time of admission: patients with no signs of heart failure were divided into 2 groups: those with BNP levels >101 pg/mL (group 1; n=37) and <100 pg/mL (group 2; n=59); the third group consisted of patients with symptomatic HF (n=105). In patients without clinical signs of CHF and/or AHF with elevated level of the BNP at the time of hospitalization was observed significantly increased risk of unstable angina during the year compared to patients with normal levels (OR 2.83 [95% Cl: 1.1—7.24], p=0.04). In patients without clinical signs of CHF and/or AHF with elevated BNP levels at the time of hospitalization compared to patients with AHF and/or CHF, had no statistically significant differences in the long-term prognosis. Conclusion. Patients with ACS in the absence of CHF and/or AHF but with elevated levels of BNP at admission should be attributed to the group of high risk for cardiovascular complications. Increasing the level of BNP in ACS patients at admission has an adverse value for long-term outcome and can be used as an additional risk marker.

Measurement of the central aortic pressure and the augmentation may have additional benefits for characterizing the state of the cardiovascular system than the only stiffness of the vascular wall. The purpose of the study is to assess the changes of indicators of central aortic pressure and arterial stiffness in women of early postmenopausal period, against the background of the prolonged use of menopausal hormone therapy 1 mg E2 / 2mg DRSP. Material and Methods. The study included 162 women in early postmenopause. The subjects were divided into 2 groups: primary — 84 patients, which was appointed menopausal hormone therapy 1 mg E2 / 2mg of DRSP (drug "Angelique", Bayer), control group — 78 women who did not receive menopausal hormone therapy. The duration of observation is 5.2 years. ABPM was performed with the evaluation indicators of arterial stiffness (RWTT, Alx, ASI, AASI, (dP/dt) max.), central aortic pressure, aoPW. Results. Initial aoPW increase was detected in 15 (21.4%) women of the main group and in 19 (24.3%) control group patients (p=0,4). The women in both groups showed an increase to the end of the study aoPW more pronounced in women of control group. Increasing falls detected in 25 (29.7%) women of the main group and in 25 (32%) women of control group (p=0.84). It was noted that in women in both groups a significant decrease of central aortic pressure has been matched. In women of the main group to the end of the study there was a reduction in pulse pressure from 38,4±6,2 to 35,3±4,19mm Hg (p<0,001) and the absence of changes in women drops the control group. It is noted a significant increase of Alxao in patients of control group and no change in women of the main group. ASI revealed a decrease in women of the main group with 132.0 (121.0; 142.0) to 127.0 (115.5; 137.0) to the end of the study, and an increase from 133.0 (111.0; 155.0) to 148.0 (134.2; 171.0) in women in the control group (p<0.01). Decrease of AASI in women of the main group to 0.379 (0.320; 0.463) to 0.264 (0.203; 0.329), (p<0.001)and no change in the control group of women has been detected. Conclusion. The measurement of the central aortic pressure and the augmentation may have additional benefits for characterizing the state of the cardiovascular system. The positive changes in arterial stiffness and reflected waves, determining the value of central aortic pressure, on the background of long-term menopausal hormone therapy combined 1 mg E2 / 2 mg DRSP.

The literature review is devoted to the universal molecular markers and predictors of forming non-alcoholic fatty liver disease and pathology of the colon, the role of insulin resistance as one of the factors of the pathogenesis of non-alcoholic fatty liver disease in the development of colorectal cancer. The mechanisms of diseases of the colon (colorectal cancer) are found out to be due to non-alcoholic fatty liver disease.