Innovative Medicine of Kuban #2 (2017)

InnovativeMedicineofKuban#2 (2017)

CONTENTS

CELL THERAPY ADVANCES IN COMBUSTIOLOGY

I.V. Gilevich, T.V. Fedorenko, E.A. Kolomytseva,

S.B. Bogdanov, A.A. Senenchenko, Y.V. Ivaschuk

Scientific research institution – Ochapovsky Regional clinic hospital #1, Krasnodar Region

Severe burns are life-threatening condition both local and general inflammatory disease, frequently with serious complications, despite significant progress in healing.

The golden standard is a surgical incision of necrotising skin areas with further autoplasty with perforated graft. But in cases with large and deep burns we observe deficit of skin resources and cell techniques are demanded.

In the present article we discuss development of cell technologies modern tendencies in cell therapy treatment for burns. In Scientific Research Institution – Ochapovsky Regional Clinic #1 a clinical study on autologous fibroblasts application for burn wounds is being performed. We described results of cell therapy treatment with complex of various autoplasty methods performed in two patients.

Key words: Cell therapy, fibroblasts, burn, keratinocytes.

EXPERIENCE OF ANKLE JOINT REPLACEMENT

D.L. Miroshnikov 1, O.V.Sabodashevsky 1, A.A. Afaunov 1,2,

I.I. Zamyatin 1, H.H. Matar 1, Y.V. Napakh 1

Background Study immediate and long-term results following ankle joint endoprosthesis.

Materials and Methods During the period from 2013 to 2016, we performed 26 ankle joint endoprostheses in patients aged from 19 up to 78 years with arthroses of various etiology. The average operative time was 1,6 hours. Average blood loss was 200 ml. There were 3 cases with an intraoperative fracture of an internal anklebone and they required additional synthesis by one or two screws. In the postoperative period one patient developed some regional necrosis in the postoperative wound area. Developed complications had no impact on observed positive results.

Results In 24 cases of 26 (92,3%) patients were satisfied with surgery results. In 18 of those (69,2%) the volume of postoperative movements significantly increased, but remained less normal. In 3 cases (11.5%0 the volume of movements remained at the preoperative limited level, however the pain syndrome while walking was completely stopped. In 3 patients (11,5%) who had no restrictions in movement amplitude neither prior to nor after the operation, the pain syndrome was also stopped. In 92,3% cases the positive results of ankle joint replacement were received. In 2 cases (7,7%) the received results were estimated as unsatisfactory because of deformation and the remaining pain syndrome. We continue observing patients.

Conclusions Ankle joint replacement with modern implants allows to achieve the positive immediate and longterm results in 92,3% cases and it is a hi-tech alternative to arthrodesis procedures.

Key words: ankle joint endoprosthesis, coxarthrosis, endoprosthesis complications.

SUCCESSFUL ENDOVASCULAR TREATMENT

FOR LCA TRUNK TRIFURCATION LESION

A.S. Nekrasov, A.A. Grechishkin, S.V. Mayngart

Scientific Research Institute – Ochapovsky Regional Clinic Hospital # 1, Krasnodar, Russia

Left coronary artery (LCA) supplies blood to 75% – 100% of myocardial volume of the left ventricle (LV). The atherosclerotic lesion of LCA trunk causes an ischemia in the sufficient area of the myocardium that often results in LV dysfunction, heart failure, and arrhythmia. The risk of death in cases with this pathology reaches 50% at drug treatment. Several decades, coronary artery bypass graft surgery (CABG) was considered as «the golden standard» of treatment for LCA trunk stenosis. Due to the skills and experience in treatment for coronary pathology, new technologies development and stenting techniques, percutaneous transluminal coronary angioplasty (PTCA) for LCA trunk stenosis became more effective and safe treatment. Despite this, trifurcation of LCA trunk remains extremely difficult pathology for endovascular treatment, for a lack of sufficient experience.In the present paper we described successful endovascular treatment for trifurcation lesion of LCA trunk in a case with acute coronary syndrome (ACS).

Key words: trifurcation of LCA trunk, PTCA, ACS, stenting.

GIANT CELL TUMOT OF THORACIC SPINE. A CLINICAL CASE OF EFFICIENT RADICAL SPONDYLECTOMY OF THREE VERTEBRAL BODIES

I.V. Basankin, V.A Porhanov, K.K. Takhmazyan, V.B. Kononenko, V.V. Shtraub, S.D. Sitnik, E.I. Zyablova, I.A. Pashkova, A.N. Fedorchenko, A.Y. Bukhtoyarov

Scientific Research Institute – Ochapovsky Regional Clinic Hospital # 1 Krasnodar, Russia

We present a clinical case of surgery performed for giant cell tumor of thoracic spine. This surgery was aimed to perform total en-bloc spondylectomy for three vertebral bodies invaded by tumor to follow principles of radicality and prevent local recurrence. We applied complex multidisciplinary approach when a team of thoracic surgeons, vertebrologists and x-ray experts was involved. We performed an operation of necessary volume for 420 minutes with 800 ml of blood loss. Postoperatively this patient showed no neurologic disorders. Spinal cord functions were completely preserved. The patient has been observing for 4 postoperative years and demonstrated no tumor recurrence and stability of the placed metal construction.

Key words: acute coronary syndrome, myocardial infarction, acute heart failure, levosimendan.

«CLASS OF EVIDENCE IIB» FOR ACUTE HEART FAILURE: WHEN, WHO, WHY?

A.M. Namitokov 1, F.R.Achmiz 1, A.S.Shimko 2, E.S. Dumanyan 1,

A.A. Skopets 1, P.V. Sukhoruchkin 1, O.A. Pozdnyakova 1, E.D. Kosmacheva 1, V.A. Porhanov 1

1 Scientific Research Institute – Ochapovsky Regional Clinic Hospital #1, Krasnodar, Russia

2 Kuban State Medical University, Krasnodar, Russia

Despite a high level of standartization of principal approaches for acute coronary syndrome treatment, in acute cardiac care department there often occur cases when therapy is not to be included in present recommendations as they are non-effective and impossible for application. Myocardial infarction is one of those situations especially when it is complicated by cardiogenic shock and ventricular arrhythmia.

For overwhelming majority of ‘standard’ situations we apply recommendations with a high level of evidence I or IIa. Below we present a clinical case of treatment for acute coronary syndrome with ST-segment elevation, when non-routine used recommendations with class of evidence IIb were of great importance.

Key words: acute coronary syndrome, myocardial infarction, acute heart failure, levosimendan.

SURGERY FOR LATE RADIATION NECROSIS FOCI

IN THE FUNCTIONALLY IMPORTANT CEREBRAL AREAS

Kovalev G.I. 1, Blumenau I.S. 1, Muzlaev G.G. 1,2

1 Scientific Research Institute – Ochapovsky Regional Clinic Hospital #1, Krasnodar, Russia

2 Kuban State Medical University, Krasnodar, Russia

Background Appearance and development of new radiotherapy methods for primary and secondary cerebral tumors resulted in more frequent diagnosis of post radiosurgical complications. A common sequel of treatment with linear accelerators is radiolesions of brain tissue.

Aim Study outcomes of surgical treatment for cerebral radiation necrosis foci.

Materials and Methods We included 3 patients with late radiolesion foci of brain tissue with progredient course, operated on in Scientific Research Institute – Ochapovsky Regional Clinic Hospital # 1, for the period since January 1, 2015 to April 30, 2017. Age rate was 61 – 65 years and mean age was 63 years. Below we present a clinical case of surgical treatment for post radiation surgery necrosis.

Results and discussion Increased focal volume in the late radiotherapy period with simultaneously expressed rise of local hypostasis in brain tissue could indicate development of a late post-radiation perifocal necrosis

Conclusions Our observations showed surgical efficiency for post radiosurgery complications treatment.

Key words: radiation necrosis, radiosurgery complications, cerebral metastases.

A CLINICAL CASE OF IDIOPATHIC PAROXYSMAL

LOWER JAW MYOCLONUS

L.I. Bonzuk, D.K. Sichinava, E.A. Kurinnaya, M.A. Barabanova

Scientific Research Institute – Ochapovsky Regional Clinic Hospital # 1,

Krasnodar, Russia

Idiopathic paroxysmal lower jaw myoclonus is a rare condition of movement and characterized with unexpected violent myoclonias of masticatory muscles that cause vertical movements of the lower jaw bone isolated or in cluster types.

In the paper we presented a clinical case of idiopathic paroxysmal lower jaw myoclonus. We described peculiarities of diagnosis, treatment and clinical findings.

Key words: paroxysmal myoclonus of lower jaw bone, epilepsy, masticatory muscles, antiepileptic agents.

PRIMARY PATIENT ASSESSMENT IS A BASIC

DIFFERENTIAL DIAGNOSIS FOR INTERMITTENT APSYCHIA

G. A. Golovina

Scientific Research Institute – Ochapovsky Regional Clinic Hospital #1, Krasnodar, Russia

We assess differential diagnosis for intermittent apsychia considering primarily examinations. Special attention is paid to anamnestic criteria, active orthostatic trial, ECG tracing.

Key words: neutrally mediated syncopes, orthostatic hypotony, cardial syncopes, epilepsy.

STATE-OF-THE-ART: DIAGNOSIS AND TREATMENT

FOR LARGE INTESTINE DIVERTICULAR DISEASE

(APPROACHES AND TECHNIQUES REVIEW)

D.P. Puzanov, V.V. Polovinkin, I.A. Puzanova, N.A. Zebelyan

Scientific Research Institute – Ochapovsky Regional Clinic Hospital #1, Krasnodar, Russia

For the last decade approaches to epidemiology and treatment for diverticular disease have changed significantly. Many principles used earlier lost their current relevance. At the same time we should carefully study etiological factors, pathophysiological mechanisms and cause and effect relationships for this pathology development. Diagnostic methods improvement, early prophylaxis and new approaches to treatment are capable to reduce risks of lethal outcomes in cases with this disease. The main aspects of an etiology, diagnostics and treatment of diverticular disease and its complications are presented in the present review.

Key words: diverticular disease, diverticulosis, diverticulitis.

CHANGES IN VALUES OF MEAN AGE IN PATIENTS WITH PRIMARY

DIAGNOSED MALIGNANCIES IN KRASNODAR REGION IN 2001–2015

(according to data of Population-Based Cancer Registries of Krasnodar Region)

R.A. Murashko, L.G. Teslenko, L.L. Stepanova, O.M. Golub, S.V. Sharov

Clinical Oncological Dispensary #1, Krasnodar, Russia

Stages of Formation and functioning of population-based cancer registries (PBCR) in Krasnodar Region are presented now in this article. Introduction of this registries in Krasnodar Region had great impact on reliability of statistical information. We presented dynamic research results of mean age values in patients with malignancies in the region (according to PBCR). All indicators are considered regarding localization of malignant neoplasms, sex, rank places in dynamics for 15 years (2001–2015). We revealed authentic increase (p < 0,05) of average age in patients in general regarding all localizations (for 2,6 years). In female patients it has increased more (for 2,3 years) than in male patients (for 1,6 years). In the majority of localizations we observed authentic (р < 0,05) increase in middle age both in men (in 49% cases), and women (in 53,9%). Direct high correlation link of mean age and such indicators of health in the population as mean age and average life expectancy of the population in Krasnodar Region, with oncological incidence is noted.

Key words: population-based cancer registries, malignancies, mean age of среднийвозраст primary diagnosed patients.

PSYCHOLOGICAL SELECTION CRITERIA

OF THE PERSONNEL POOL OF MANAGERS FOR NURSING CARE

L.A. Syzova

Scientific Research Institute – Ochapovsky Regional Clinic Hospital #1, Krasnodar, Russia

We considered modern vision of psychological aspects to form personnel reserve including middle managers – senior nurses in a multi-type healthcare institution. Possible application of an indicator for social and psychological adaptation of a person as a main selection criterion for a personnel reserve was checked. The research hypothesis has been defined: level of social and psychological adaptation of a nurse is a key professional and psychological competence which is closely connected with such organizational, professional and personal qualities of a subject as professional identity; organizational loyalty; career aspirations.

It is shown that the workers reaching the medium-to-high level of social adaptation have created professional identity, demonstrate organizational loyalty, they are focused on professional growth and career advance. Three factors connecting set of psychological competences of the manager in nursing care are allocated. We made a conclusion regarding a possible use of the marked-out social and psychological qualities as key psychological competences in selection experts for a group of linear management. Results of the conducted study allowed to distinguish three factors connecting set of psychological competences of the manager in nursing care that in general confirms the suggested hypothesis. It is shown that in each of the factors the leading role is carried out by the medium-to-high level of social adaptation.

The accounting of specifics in the personal and psychological qualities connected among themselves in each of factors allows to define focus of the educational and developing work with subjects of a personnel reserve. At the same time the increased level of social adaptation can be considered with the sufficient basis as key selection criterion of nurses in reserve pool.

Set of the social and psychological, organizational and psychological markers defining an indicator for social adaptation, undoubtedly is a component of professional competences of a middle manager that is to be considered in the course of occupational standards development in the field of nursing care.

Key words: nursing staff, personnel pool, social integration, occupational standards for nursing care.