CONTENTS
PROBLEM OF D-DEFICIENT RICKETS: MYTHS AND REALITYÒhe provision with vitamin D and the state of phosphate-calcium metabolism in women in labor, newborns and children of early age getting various schemes of feeding and rickets prophylaxis are studied. 279 children aged from one month to 3 years are examined. Children fed only by breast milk obtain enough protein, but inadequate amount of lipids, lactose and mineral elements - calcium and nonorgantic phosphate resulting in osteopenia. This enhances the risk of development of rickets syndrome. Along with study of the clinical and X-Ray picture and changes of phosphate - calcium metabolism indices, the diagnostic "gold" standard should include evaluation of content of 25 OHD. Only in case of its reduction D-deficient rickets can be diagnosed. ESTIMATION OF PREVALENCE OF BRONCHIAL ASTHMA SYMPTOMS IN CHILDRENAccording to the data of epidemiologic examination of schoolchidren performed in 2000 and in 2003 by "ISAAC" program the growth of rate of bronchial asthma symptoms by 53,3% is revealed especially in elder age group comparing with younger group, as well as among boys both in younger and elder age groups. The amount of such symptoms as postload bronchospasm and dry night cough not connected with acute respiratory disease increased by 74%. Mild course of the diseases prevails in all age groups. COURSE OF CHRONIC VIRAL HEPATITIS C IN PATIENTS WITH HIV-INFECTION105 patients with HIV aged 19 to 40 years were examined in order to study clinical cause of co-infection (VG C+HIV) and to predict further course of the disease. Clinical manifes-tations of hepatobiliary zone involvement were more frequent in the presense of co-infection. Chronic HIV-infection was accompanied by active replication of virus of hepatitis C with high and average level, reverse correlation between the number of CD4 cells and RNA-HIV level was revealed among the most of co-infected patients. Changes of biochemical indices of blood, frequency of detecting of RNA-HIV correlated with duration of infection. SURGICAL TREATMENT OF COMBINED DISEASES OF ABDOMINAL CAVITY ORGANSThe experience of surgical treatment of 600 patients with combined abdominal pathology is studied. It is established that immediate and remote results of combined abdominal operations and rate of complications are not different from standard treatment. Planned combined intrerventions are appropriate, but such operations in urgent surgery are often considered as tactical error. Only simultaneous presence of two acute surgical diseases can be considered as exception but such variants in medical practice are rare. LOW HORIZONTAL ELECTROSURGICAL GASTROENTERIC ANASTOMOSESThe original aseptic electrosurgical gastroentero-anastomosis after stomach resection is suggested. Anastomosis is formed on greater curvature of stomach stump without opening of anastomosed organs lumen. The advantages of anastomosis are the simplicity of performance, asepticity absence of prerequisites for development of anastomosites and bleeding from anastomosis. The suggested anastomosis was used in 51 patients during stomach resection performed for various indications with good immediate and longterm results. COMPLEX CONSERVATIVE TREATMENT OF NEPHROPTOSISThe efficiency of the developed complex of conservative methods of treatment of patients with nephroptosis as well as indications to the given treatment method are determined. Conservative treatment of 106 patients with nephroptosis included 10 procedures of treatment massage with manual reposition of kidneys, wearing supporting bandage and following recommendations on regime. Safety and high efficiency of this method are established: recovery came immediately after treatment in 80, 31 and 7% in I, II and III stages respectively, being retained within 12 mounths after onset in 67 and 22% of cases in I and II stages. PREVENTION OF ADHESIVE DISEASE OF PERITONEUM IN PATIENTS WITH POSTOPERATIVE VENTRAL HERNIASNew intraoperative methods and devices for prevention of adhesive process in peritoneum not causing significant increase of intraabdominal pressure, increasing the choice of hernioplasty methods under tensometric control of tension of hernia defect edges, using transplants and surgical suture tissue with antiadhesive and antibacterial effect are developed.Using above-mentioned methods during last 9 years 374 patients with postoperative ventral hernias were operated: the rate of unsatisfactory results of the treatment estimated by hernia relapse rate and manifestations of adhesive peritoneal disease decreased from 42,9% to 7,5%. OPTIMIZATION OF REPARATIVE REGENERATION OF BONE TISSUE IN TREATMENT OF FALSE JOINTS WITH DEFECTS OF THE TIBIAEfficiency of the use of the developed method of reparative regeneration stimulation of bone tissue in patients with false joints with defects of tibia is studied. The method is based on brephoplasty of bone defect and the use of the low intensive laser radiation or "Dona" peroral medication in postoperative period. It was shown that the use of the laser radiation or the "Dona" in postoperative period reduced the duration of treatment in the main group in comparison with the control group by 1,4, the fixation index - by 2,7 due to accelerating adhesion of bone fragments. PHYCHOTHERAPY IN PATIENTS WITH ARTERIAL HYPERTENSIONEffect of the original integrative psychotherapeutic program on psychic state of patients with arterial hypertension and level of arterial pressure is studied. The psychotherapeutic program included the use of Ericson hypnosis, methods of visualization, therapeutic metaphora, neurolinguistic programming. Besides patients were taught to selfhypnosis. Psychotherapeutic work with psychologic defenses was performed. High efficiency of original integrative psychotherapeutic method is shown. Along with psychotherapy in patients with arterial hypertension it is necessary to correct nonadaptive psychologic defenses mechanisms what makes psychotherapy effect persistant. MELATONIN IN TREATMENT OF CLIMACTERIC AND PSYCHIC DISORDERSSeverity of climacteric mental disorders correlates with hormonal profile of patients - the more severe are mental disorders, the lower is melatonin level and the higher FSH and LH levels. The treatment of mental disorders in menopause with synthetic analog of melatonin promotes full reduction or positive dynamics of psychopathologic manifestations. Combination of melatonin with amitriptilin shows better results than an isolated prescription of antidepressants and tranquilizers. Melatonin has antianxiety and antidepressant effect in patients. CLINICAL MANIFESTATIONS AND TREATMENT OF SACRALGIASThe results of examinations of patients with pains in sacrum are given. The most frequent causes of sacralgias are: periarthrosis of sacroileal joints, aseptic epiduritis, diseases of pelvis, true spondylolisthesis of the lumbar part of vertebral column, sacrum tumors. Periarthrosis of sacroiliac joints can present as independent clinical syndrome or as a symptom in osteochondrosis of the lumbar part of vertebral column and diseases of pelvis organs. Peridural temperature is usually 34,4°C and in aseptic epiduritis it decreases by 2,2°C, what is probably due to venous congestion in epidural fat tissue. Peridural laserotherapy reduces duration of treatment, decreases amount of medications. COMPARATIVE ESTIMATION OF EFFICIENCY OF VARIOUS CHEMOTHERAPY PROGRAMS OF CHRONIC LYMPHOLEUKOSISComparative analysis of efficiency of the treatment of 214 patients with chronic lympholeukosis on standard therapy with chlorambucil or CHOP and various therapy programs including fludarabin are presented. Interval between courses was 28 days, number of courses was 6. Fludarabin containing regimes are highly effective methods of treatment of chronic lympholeukosis. FCM and FC treatment gives better results than monotherapy with purin analogs. Good tolerance of the treatment, low general and hemotologic toxicity are observed. ENDOTHELIAL DYSFUNCTION IN PATIENTS WITH RHEUMATOID ARTHRITISEndothelium-dependent regulation of vascular tension in patients with rheumatoid arthritis is studied. It is shown that endothelium function test with reactive hyperemia should be estimated not by quantitative but by qualitative change of vessel lumen starting from 15 th second after removal of occlusion. Endothelium dysfunction during reactive hyperemia on 15 th second is accompanied by the increase of rigidity. Reactivity of brachial artery in rheumatoid arthritis depends on clinical picture of the disease. The extreme degree of endothelium dysfunction - vasospasm is found in prolonged course of the disease and appears to be a sign of unfavourable prognosis. EFFECT OF RILMENIDINE, METOPROLOL AND HYDROCHLOROTHIAZIDE ON FUNCTION OF LEFT VENTRICLE AND ENDOTHELIUM DEPENDENT VASODILATATION IN WOMEN WITH ARTERIAL HYPERTENSION IN POSTMENOPAUSEEstimation the effect of selective agonist of 11-imidasolin receptors rilmenidine (albarel), b1-adrenoblocker metoprolol (egilok) and hydrochlorothiazide on parameters of central hemodynamics, diastolic function of left ventricle and endothelium - dependent vasodilatation was performed. Acute medicinal tests are performed in 36 women with arterial hypertension of I and II degree in combination with metabolic syndrome in postmenopause. It is established that all three medications decreased systolic, diastolic and average arterial pressure and had effect on both periods of diastolic filling of left ventricle. At the same time singnificant differences in their action are revealed: rilmenidine had more effect on isovolumetric relaxation, metoprolol had effect on DTe parameters reflecting passive extension of left ventricle, hydrochlorothiazide had effect on diastolic transmitral blood flow in fast filling phase. DYNAMICS OF RENAL CARCINOMA MORBIDITY IN POPULATION OF THE SAMARA REGIONDynamics of specified morbidity of renal carcinoma in population of large industrial region of the Middle Volga (Samara) from 1963 to 1987 and from 1989 to 1998 is studied. 4292 initial notices on patients with morphologic verification of 85% cases are analysed. During 25 years (1963-1987) morbidity increased by 3,4 times with maximum in age group from 50 to 59 years old. In group of patients up to 39 years old it was low and stable. From 1989 to 1998 morbidty increased by 2,1 times with maximum in the same age group as in previous period. Morbidity in age group up to 39 years old increased by 2 times. PROSTATE CANCER MORBIDITY IN THE SAMARA REGIONMorbidity of prostate cancer in large industrial region of the Middle Volga - the Samara region in 1989-2001 is studied. Intensive and standardized indices of the disease are calculated, the analytical leveling of indices by the least squares method is performed. Basic tendencies of change of the morbidity in various age groups is established separately for urban and rural men. Reliable growth of the morbidity is revealed in urban men over 60 years of age. Territorial differences in incidence of prostate cancer can not be explained only by the effect of exogenous factors (ecology, industrial production etc.), obviously endogenic factors and different quality of the disease diagnostics are important. ON QUALITY OF MEDICAL CARE TO PATIENTS WITH SEXUALLY TRANSMITTED DISEASESQuality of medical care to patients with sexually transmitted diseases is studied. Retrospective analysis of ambulatory charts of patients (100 men and 107 women aged 18 to 45 years) is performed. Material and technical equipment and treatment and prophylactic base of dermatovenerologic dispensaries and female clinics are estimated. Drawbacks in organization of treatment and diagnostic process in 48,3% cases were caused by low fullfilment of current demands to resource base of Health care institutions and in 17,3% were caused by work of physicians. PROBLEMS OF MEDICAL LEGISLATION IN NARCOLOGYThe level of knowledge by medical workers and their patients of legislation problems of narcology is presented. 182 physicians, 184 students of Kazan and 124 patients with drug addiction admitted for treatment to narcologic institutions of Tatarstan Republic took part in the study. Both medical workers and their patients on a whole are satisfatorily informed on problems of rights of patients with drug addiction. At the same time there are significant problems in knowledge of medical legislation in narcology. Most of respondents support the necessity of anonymous narcologic offices and charging payment narcologic structures. MEDICAL AND STATISTIC FEATURES OF YOUTH MORTALITY IN TATARSTAN REPUBLICDynamics, structure of causes and sex - age peculiarities of mortality of population aged 15 to 29 yearsold during 1993-2002 are studied. General index of youth mortality increased by 8,3% because of infections and parasitogenic diseases, cardiovascular and respiratory diseases, traumas, poisoning etc. Mortality rate in rural areas was higher than in towns nearly in all classes of causes except of infectious and parasitogenic diseases and urogenital diseases. The high increase of mortality level was noted in 20-24 age old group. Average annual index of male mortality as a whole was 8 times higher than in females. ACYUAL STATE OF MEDICINAL SELFTREATMENT IN KYRGYZSTANQuality of medical care is determined by quality of pharmacotherapy, its rationality, safety aud validity. Problem of medicinal selftreatment is additional burden for health of patients and Health care as a whole. Results of studies performed in Kyrgyzstan can serve a stimulating factor for solution of this problem in Russia and Tatarstan Republic. |