Vol 20, No 2 (2014)

The sampling of study included patients after single-stage surgical correction of mitral valve failure and fibrillation of atriums using radio-frequency procedure "Labyrinth". The indicators of quality of life had been evaluated threefold with questionnaire SF-36 (initially, before application of electropulse therapy and after restoration of sinus rhythm) namely in three months after cardiac surgery intervention. The examined patients with fibrillation of atriums had low indicators of physical and psychological health. After restoration of sinus rhythm physical component of health increased up to 15.8% in patients with mechanical prostheses and up to 17.4% in patients with biological prostheses (p<0.05). At that, indicator of psychological component of health turned out to be twice higher in patients with biological valves than in patients with mechanical valves (p<0.01). The higher values of psychological component of health are related to withdrawal of warfarin in patients with biological prostheses of heart valves.

The road traumatism continues to be the most serious problem at the territory of the Russian Federation. The article uses as an example the first-rate Moscow clinic to consider particular aspects of optimization of specialized medical care to victims of road accidents in conditions of multitype hospital. The results of functioning of traumatology service are analyzed. The main principles of emergency medical traumatological care are determined.

The article considers the results of the study of comparative effectiveness of the biofeedback therapy of patients with headache of tension. The respiratory training and EEG-biofeedback therapy were applied as a therapy to reduce pain syndrome and amelioration of psycho-physiological conditions of patients. The study covered four groups of human subjects with different indicators of autonomous nervous system according R.M. Bayevskiy under Holter monitoring of variability of cardiac rhythm for all period of awaking condition and availability or absence of vegetative dysfunction reflecting development of chronic condition of headache. The difference of effectiveness of therapy of headache of tension with biofeedback of various types (respiratory or EEG) in patients with different characteristics of autonomous nervous system and presence of syndrome of vegetative dysfunction is statistically approved.

The article presents the three step surgery technique of laporoscopy inter-sphincter resection of rectum because of cancer of its inferior ampullar section. The distinguishing characteristic of this technique is compliance of “no-touch” principle (without touching the tumor). This approach consists of primary isolation of segment of intestine with tumor at the expense of ligation of feeding vessels and blocking lumen of intestine more distal towards the tumor. Then mobilization of rectum is made with implementation of total mesorectumectomy. This approach can promote improvement of long-term oncological results of surgery.

The article presents the results of biochemical study of mixed saliva of children of adolescent age. The indicators of phosphoric calcium metabolism (levels of osteocalcin, vitamin D, parathyroid hormone and activity of bone iso-enzyme of alkaline phosphatase) are investigated. The significant differences of investigated parameters in adolescents with different degree of caries intensity are established. The study data reflects the characteristics of pathogenesis of caries in children of adolescent age. The diagnostic and prognostic informativity of laboratory indicators for dynamic monitoring of children of given age is demonstrated.

The main causes of hepatic pathology related to pregnancy are pre-eclampsia, HELLP syndrome, acute fatty hepatosis of pregnant women, and cholestatic hepatosis of pregnant woman. This pathology needs a multidisciplinary approach. The medical care to female patients with hepatic dysfunction/pathology is to be provided in multitype hospitals of high-top level. It is ultimately important that not only obstetrician-gynecologist are aware about the characteristics of this pathology but also anesthetist, resuscitation specialist, surgeon, therapist, gastroenterologist, infectiologist, transfusiologist and physician of department of hemodialysis. This level of awareness will promote early diagnostic and timely emergency care support. All variants of hepatic pathology related to pregnancy have both genetic determination and many common in etiology and pathogenesis. They are extremely difficult for early detection and differentiate diagnosis. The results of pathomorphology analysis testify the severity of affection of liver from causes related to pregnancy and make it possible to exactly differentiate them intravital biopsy included. In the case of manifestation of obvious clinical picture of hepatic pathology and its complications the only etio-pathogenic method of treatment remains timely delivery though in certain cases no amelioration of condition occurs. As a rule, the choice of method of delivery totally depends on obstetric situation. The advantages of operative or conservative method are not determined yet. The effectiveness of methods of pharmaceutical therapy and methods of detoxification (plasmapheresis, MAPS) has no proof nowadays. The transplantation of liver under HELLP-syndrome and acute fatty hepatosis of pregnant women factually has no development in Russia. Just that is why it is so important to detect and to take into account the slightest clinical and laboratory manifestations of hepatic dysfunction during pregnancy. No less important it is to determine the tactics of treatment and delivery as well.

The anemia originating under infectious inflammatory processes, non-infectious inflammatory diseases, tumors is called “anemia under chronic diseases” to emphasize the role of main disease in its pathogenesis. The rate of occurrence of anemia under certain diseases reaches 100%. But, in these situations, for all that diversity of pathogenic mechanisms of anemia, one of the main mechanisms is considered the redistribution of iron into cells of macrophage system activating under various inflammatory (infectious and non-infectious) or neoplastic processes. The anemia under chronic diseases by their prevalence takes second place after iron-deficiency anemia. The prevalence of anemia under chronic diseases in old and senile age varies from 2.9% to 61% in males and from 3.3% to 41% in females. In young and mature age, anemia under chronic diseases is more often detected in females. In hospitalized patients of old age its rate goes up to 36-80% whereas in out-patients it goes to5-14%. Among patients with systemic diseases of connective tissue anemia occurs almost in half of patients and at that anemia under chronic diseases is prevailing. The diagnostic criteria of anemia under chronic diseases are indicated in details. The main mode of correction of anemia in this category of patients is the treatment of active inflammatory process. This treatment includes antibacterial therapy considering character of supposed of verified infection agent, basic and antiinflammatory therapy of rheumatoid diseases, surgery treatment under corresponding indications (abscess of abdominal cavity, purulent pyelonephritis, etc.). In these situations, prescription of iron preparations, vitamin B12 as usually is inefficient and only delaying timely detection of main cause of anemia and onset of corresponding therapy. The picking out of anemia under chronic diseases as a separate pathogenic alternative and awareness about it both have important value in view of matching of this alternative to iron-deficiency anemia and certain sideroblastic anemias although essence and therapeutic approaches under these anemias are different.