2017, volume 13

The aim: to analyze locomotor function of lower limbs in patients with dysplastic coxarthrosis Crowe IV type before and after single-step hip joint endoprosthesis and femoral bone osteotomy conducted by our own technology. Material and Methods. 42 patients with one-side dysplastic coxarthrosis Crowe IV type were examined and operated. The mean age at the time of admission in men was 47.3±1.2 years, women — 46.1 ±1.1 years. Static and kinematic function of lower limbs was evaluated with the help of stabilometrics and podometry before and one year after the operation. Results. Before treatment, the patients had deviations of static and dynamic function of locomotor system stabilometri-cally seen as instability in upright position and podographically as a compromised gait. One year postsurgically we indicated static balance between the limbs within the normal range, expanded motoring mode, which was supported by significant improvement in the biomechanical characteristics of locomotor function of the patients. Conclusion. Total hip replacement in combination with modifying osteotomy of the hip conducted by a unique technique restores static and kinematic function of lower limbs in patients with high congenital hip dislocation (dysplastic coxarthrosis Crowe type IV) which is proved by stabilographic and podographic indices one year after operation.

The research goal of the review is to present data on etiology, prevalence, classification of different types TEN/ in children. Mechanisms of pathological foot type, indications for conservative and surgical methods of treatment have been analyzed.

Aim: development of an integrated biomechanical index that reflects the state of kinematic and static function in patients who need replacement of large joints as well as evaluation of the myoneural complex of lower extremities activity of category of patients. Material and Methods. 103 patients with osteoarthrosis of the hip and knee joints. A biomechanical survey included podography, stabilometry and dynamometry. An electrophysiological study of the peripheral nerves of the lower extremities with the determination of the amplitude of the muscle response and late neuronal responses was carried out. The level of activity of the gluteal muscles was determined. Results. The most sensitive indicators reflecting the state of biomechanical status were identified, specialized software for the integral biomechanical index calculation was developed. Conclusion. Methods of clinical biomechanics allow specialists to assess the state of kinematic and static function of the musculoskeletal system, matching of the integral biomechanical index with the data of neurophysiological monitoring makes possible to select individual tactics of treatment.

Aim: to determine the concentration of MMP-9, TNF-a and IL-6 in blood serum of patients with benign and malignant bone tumors and feasibility of cytokine data use for differential diagnostics of the neoplastic process nature. Material and Methods. Levels of matrix metalloproteinase-9 (MMP-9), tumor necrosis factor-a (TNF-a) and interleukin-6 (IL-6) in blood serum were determined by the immunoenzyme method in 64 patients with bone tissue neoplasms (fibrous dysplasia, osteocystoma, giant-cell tumor, osteosarcoma, chondrosarcoma, bone metastases, multiple myeloma). Re-sults. MMP-9 level was heightened in patients suffered from chondrosarcoma and multiple myeloma. TNF-a and IL-6 expression was increased in cases with bone metastases. MMP-9, TNF-a and IL-6 levels were higher in cases with malignant bone neoplasms than in cases with benign bone tumors. Conclusion. MMP-9, TNF-a and IL-6 participate in the neoplastic process pathogenesis directly. Nevertheless it is too early to speak about the diagnostic value of the cytokines in cases with tumorous bone affection.

Aseptic acetabular loosening is one of the most common complications of primary hip arthroplasty Its treatment is possible in the volume of replacement of only the endoprosthesis cup with the preservation of a stable correctly oriented femoral component. The sequence of actions consists of provision of access to the acetabulum component and its replacement, after which the necessary offset is selected by changing the size of the head and installing a new pair of friction. Currently, the vast majority of the installed heads during the primary and revision hip replacement have a standard size forthe cone of the femoral component 12/14mm. According to the observations, in 3% of cases, there are femoral components with non-standard cone sizes 11/13 mm, usually established 7-8 years ago. The absence of heads forthe necessary cone leads to the need to replace the stable correctly oriented femoral component, which is accompanied by an increase in the time of intervention, the volume of intraoperative blood loss and the risk of intraopera-tive peri-prosthetic fracture. We represent the clinical case of a 75-year-old patient with a dislocation of the acetabular component and a stable correctly oriented femoral component, which during the audit intervention due to the lack of heads for an irregular cone size, total replacement of the components was made.

Objective: to study the outcome of labor and neonatal status after obstetric operations of vacuum extraction method KIWI. Material and Methods. The research and treatment of 58 newborns after the operation method KIWI were carried out. Conducted survey and evaluation of neurological status of newborn, analysis of medical documents (medical card of the pregnant, findings of ultrasound screening of the fetus, birth history and development of the newborn) were performed. Results. Indications for obstetrics KIWI included: narrow pelvis (17.2%), uterine inertia and discoordination (25.9%), fetal distress — 33 (56.9%). The KIWI application was a complete opening of the uterine mouth, the absence of membranes, a living fetus, clinical according to the size of the fetal head and pelvis of mother. The results of the assessment of children by Apgar scale: 1-3 points from 1.7%; 3-6 points of 25.9%; 7 or more points 72.4% of children. Cerebral ischemia 1 degree was diagnosed in 63.8%; of the 2 degree of 34.5%, grade 3 in 1.7% of children. The average stay of children in the Department of physiology was 6.5 days, the 2nd stage is 11.6 days. Generic tumor from the apparatus KIWI was observed in 36.2%, cephalohematoma in 31,0%; no serious complications have to 32.7% of children. All patients were discharged from hospital. Examination of 29 children at the Department of Catamnesis showed that 13.7% of them noted a neurological deficit in the form of small brain dysfunctions. Conclusion. The introduction of new models of vacuum extraction, enhance the delivery through natural patrimonial ways. No significant impact on the course of the neonatal period, which allows us to recommend the method for more widespread use. However, the vacuum extraction of the fetus may be effective and safe only if indications, conditions and technique are strictly followed.

The goal is to analyze the various risk factors for necrotizing enterocolitis (NEC) in newborn infants of different gestational age. Material and Methods. A retrospective analysis of medical records (forms 096/y, 097/y)for2011-2015 was conducted. 20 pairs "mother— newborn". The criterion for inclusion in the analysis was the presence in the diagnosis of necrotizing enterocolitis. A method of descriptive statistics was used to interpret the data. The calculation of intensive and extensive indicators is carried out. Results. When analyzing the results, it was found that all patients had a combination of processes leading to spasm of the vessels of the intestinal wall, which led to mucosal ischemia and necrosis, as well as intestinal contamination with pathogenic microflora, which caused damage to the intestinal mucosa. Conclusion. To prevent the development of NEC, it is necessary to take into account the presence of newborn risk factors for the development of the disease, this requires an analysis of the current course of pregnancy, childbirth and the early neonatal period.

Objective: to perform analysis of HIV-infection epidemic in the Saratov region in the period from 1996 to 2015. Material and Methods. Epidemiological and static methods have been used, retrospective epidemiological analysis of HIV-infection progression on the territory of the region has been performed. Results. Excess incidence and prevalence of HIV-infection in the region has been noticed. The main virus routes are injections of narcotic drugs and sexual transmission. From 2009 the persons over 30 years old have been involved in the epidemical process to a greater extent. The increase in the number of women of fertile age among incident cases of HIV-infection has been registered. Increasing incidence rate of HIV-infection among rural people occurred. Conclusion. In the Saratov region, as well as in the Russian Federation, high burden of HIV-infection continues to persist, that imposes more detailed study of the problem.

Objective: to evaluate the practical possibility of automated calculation of glomerular filtration rate (GFR) in patients with type 2 diabetes mellitus (DM) on the basis of the developed computer program «Chronic_Kidney_Disease_Di-agnostics». Material and Methods. The study included 233 patients (78 men and 155 women) with type 2 diabetes who were hospitalized in the Neuroendocrinological Department of Nizhny Novgorod Regional Clinical Hospital n.a. O. N. Semashko during the period from 2013 to 2016. The average age of patients was 57.75 years [52; 64]. According to the history the mean duration of type 2 diabetes was of 5.3 years [0.3; 8.0]. The average level of glycosylated hemoglobin (HbA1c) was 9.53% [7.0; 10.2]. All patients underwent clinical and laboratory an3 instrumental studies. The data obtained were entered into the program «Chronic_Kidney_Disease_Diagnostics» (authors: N.A. Yarkova, N.N. Borovkov, D.A. Terekhova). Statistical analysis of the results of research carried out by Statistica 7.0. Results. According to the study in patients with type 2 diabetes, chronic kidney disease has been identified in the pre-clinical stages C2 and C1 (56.2 and 25.8%, respectively). Conclusion. The program «Chronic_Kidney_Disease_Diagnostics» is intended for nephrologists, endocrinologists and therapists. It allows specialists to diagnose kidney CKD in patients in the therapeutic profile of the early preclinical stage. It is designed for quick calculation of glomerular filtration rate.

Aim: to study the effectiveness of in-depth preventive counseling as one of the forms of information and training technologies for prevention of hypertension. Material and Methods. On the basis of the district hospitals of the Saratov region the analysis of volume and quality of preventive work in the group of persons with risk factors under investigation in the study of prevention and patients with arterial hypertension trained in Health School. Results. Analysis of the effectiveness of Schools for patients with arterial hypertension showed an increase in the number of people achieving the target blood pressure level from 32 to 42% and reducing the number of patients hospitalized for hypertensive crises, in comparison with the previous year by 22%. Conclusion. Schools for patients with arterial hypertension teach patients to correct risk factors and to control their disease.