Изв. Нац. академии наук Беларуси. Сер. мед. наук, 2004, No.1

Изв. Нац. академии наук Беларуси. Сер. мед. наук, 2004, No.1

Известия Национальной академии наук Беларуси
СЕРИЯ МЕДИЦИНСКИХ НАУК
Издатель Беларуская навука, Минск, Республика Беларусь

Номер 1, 2004

СОДЕРЖАНИЕ

КЛИНИЧЕСКАЯ И ЭКСПЕРИМЕНТАЛЬНАЯ МЕДИЦИНА

Skrahina E. M., Borstchevsky V. V., Zalutskaya O. M., Hurevich H. L., Surkova L. K.
Drug-resistant pulmonary tuberculosis at present time. pp. 5--9

Summary: Multidrug-resistant (MDR) tuberculosis is becoming a global problem. Research in basic directions of microbial changeability, monitoring and study of clinical aspects of MDR tuberculosis (TB) are needed to improve MDR tuberculosis control measures. The purposes of the study were: to investigate levels and spectrum of MDR TB in various regions of Belarus; to find out biological properties of Mycobacterium tuberculosis (Mb.t) with different susceptibility to antituberculosis drugs (ATD); to analyze the treatment results of 60 TB patients, including patients with drug resistant TB. Results. In Belarus MDR TB among newly diagnosed patients in 2002 was 3.8%, MDR TB percentage from all newly diagnosed culture positive patients was 7.9%. Mb.t strains were resistant to 3 and more ATD in 63.8%. Median time of appearing cultures containing Mb.t strains susceptible to ATD was 23.8 days, and 31.6 days for cultures with MDR Mb.t. strains. After 7 month treatment, positive X-ray changing has been observed in all patients with susceptible to ATD and monoresistant TB, in 83% patients with polyresistant TB and only in 40% patients with MDR TB. Sputum conversion has been observed in all patients with susceptible to ATD and monoresistant TB, in 92% patients with polyresistant TB and only in 50% patients with MDR TB. Conclusions. There is a high level of MDR TB among newly diagnosed patients in Belarus. Drug susceptibility testing method used in Belarus is characterized by long time to get results. Treatment results of MDR TB patients are extremely poor. Our study demonstrates the need of special measures introduction to improve diagnosis, treatment and prophylaxis of MDR TB.

Danilova L. L, Murashko N. V.
Dehydroepiandrosterone sulfate, testosterone, and sex hormone-binding blood globulin in men of various ages with complete and incomplete variants of metabolic syndrome. pp. 10--14

Summary: The aim of our research was the learning of DHEAS, testosterone, SHBG possible contribution in creation of clinical insulin resistance manifestations in various age periods in men with "complete" and "incomplete" variants of metabolic syndrome. DHEAS levels were lowering in each considered age period (15 years) for the patients with manifestations of metabolic syndrome, but not for healthy ones. In the same age groups of the persons with metabolic syndrome, DHEAS level was significantly lower than in healthy men. For the men of one age with various manifestations of metabolic syndrome, the lower values of DHEAS corresponded to complete syndrome variant with the presence of obesity, hypertension, T2DM. Serum total testosterone levels were decreasing progressively with age in observed men with metabolic syndrome, aggravated with the development of T2DM and development of complete variant of metabolic syndrome.

Sidorovich R. R., Smeyanovich A. F.
Problems of surgery of traumatic brachial plexus injury. pp. 15--19

Summary: The results of 2 types of surgery interventions for injured brachial plexus are presented. -- surgery on injured tissue (98 patients) and the transplant pf functionally intact muscles (57 patients). It is shown that choice of the type of intervention should largely depend on the brachial plexus' damage type and degree. Surgery on nerve structures is recommended early after the injury. Positive results of restoring the function of the upper limb have been obtained in 67.4% patients. The most successful have been the neurorrhaphia and neurolysis methods (have accounted for 84.2 and 80.0% of the positive results, respectively). Transposition surgery is recommended when the injury is expansive and treatment is started later in the post-traumatic period. Positive results have been reported in 94.7% patients. The transposition of the Latissimus dorsi and Pectoralis major is found to have generated the most of the positive results.

Grakovich A. A., Kozlov I. D., Plashchinskaya L. I.
Comparative analysis of arterial hypertension rate in men in particular regions of Belarus. pp. 20--26

Summary: Evaluation of the dynamics in the epidemiological situation on arterial hypertension (AH) among men at the age of 20 -- 69 and 40 -- 59 years from non-organized populations of some regions of the Republic of Belarus is presented in this paper. It is shown that despite significant progress in AH control, for many years, the problem of the AH control will be one of the priorities for the Ministry of Health. The data presented in this article testify to the fact that the purposeful actions at the individual and population level allow to control the AH rate even when there are factors which potentially can influence negatively upon the AH epidemiological situation. The ambulatory and polyclinic institutions of the Ministry of Health of Belarus as well as the Centers for primary prevention of cardiovascular diseases, established at present, should be the key unit in the ensuring the adequate AH control. It is concluded that the development of organizational technologies targeted at the ambulatory and polyclinic institutions of the Ministry of Health as well as at the Centers for primary prophylaxis of cardiovascular diseases, is needed.

Tropnikova G. K., Mironova G. P., Roznova L. E.
Features of nociceptive reflexes and activity of serotonergic brain structures during endotoxemia after destruction of nucleus raphe magnus. pp. 27--29

Summary: Experiments on mongrel male rats demonstrated involvement of bulbar nucleus raphe magnus in formation of hypoalgesic response after intraperitoneal injection of lipopolysaccharide E. coli.

Pesotskaya Y. A., Netukova N. I., Koulchitsky S. V., Korik E. O., Naumova M. V., Semak I. V., Pashkevich S. G., Kulchitsky V. A.
Transsynaptic degeneration in the dorsal vagal complex after subdiaphragmatic vagotomy. pp. 30--36

Summary: In experiments on ketamine-xylazine-acepromazine-anestetized rats, bilateral subdiafragmatic vagotomy was performed. Four weeks after the operation, there appeared granule-containing microglial cells in the neuronal pericaryon and defragmentation of the nuclei in nervous and glial cells in the rostral and caudal solitary tract nucleus. Neuronal cell bodies of the commissural area in the solitary tract nucleus showed invaginations of the nuclear membrane with signs of condensation of chromatin fragments nearby the nuclear membrane or other signs of apoptosis with characteristic formation of membrane "apoptotic bodies." In the dorsal motor nucleus of the vagus nerve, processes of nerve cells with signs of degeneration by "dark" and "light" types were observed. The findings are indicative of induction of destructive processes both in motor (by retrograde degeneration) and sensory (apoptosis) nuclei of the dorsal vagal complex in response to the injury of peripheral parts of the nervous system. Four weeks after vagotomy, in the ventrolateral medulla where arcs of vagosympathetic reflexes are relayed, there was a decrease in the activity of glutathione reductase by 35--40%, glutathione S-transferase by 20--25%, superoxide dismutase by 55--60%, and catalase by 85--90% (which is a sign of inhibition of antioxidant protective mechanisms). Seven weeks after vagotomy, the motor and sensory nuclei of the dorsal vagal complex demonstrated not only destructive but also repair processes.

Smeyanovich A. F., Shanko Y. G.
Peculiarities of clinical picture, diagnosis, and treatment of meningiomas of the region of great occipital foramen. pp. 37--40

Summary: The review of literature presented and analysis of 10 cases of great occipital foramen region meningiomas is performed. All of patients are operated on through suboccipital approach. Total removal of tumor was made in 7 cases, subtotal -- in 2 cases, tumor biopsy with decompression of brain stem -- in 1 case (anterior localization of tumor). Lethal outcome was in 1 case because of brain stem infarction. In our opinion, transcondyllar approach is not necessary because of the risk of instability in occipito-cervical junction. There were no cases of tumor recurrence during long-term observation.

Shishkova M. K., Semeneya I. N., Ponomarev V. V., Lyah S. V.
Cation composition of cerebrospinal fluid and blood serum in patients with central subfebnility. pp. 41--43

Summary: The results of the study of cation composition of cerebrospinal fluid (CSF) and blood serum in patients with central subfebrility are presented in this paper. An increase in ratio K⁺/Ca⁺⁺ in CSF and decrease in Na⁺ and K⁺ concentrations and K⁺/Ca⁺⁺ index in blood serum were found out, which can be important in subfebrility mechanisms.

ИММУНОЛОГИЯ И ВИРУСОЛОГИЯ

Mohammadi M. T., Cherstvoy E. D., Melnikov I. A.
Peculiarities of Ki-67 and PCNA expression in papillary and medullary thyroid carcinomas. pp. 44--50

Summary: Proliferative activity of tumor cells was studied in surgery material from 18 cases of medullary and 17 cases of papillary thyroid carcinomas by immunohistochemical staining using monoclonal antibody to Ki-67 and PCNA. Antigen Ki-67 expresses during all phases (G₁, S, G₂ and M) of the cell cycle but not in quiescent G₀ cells, and PCNA -- in G₁, S and G₂ phases. The mean proliferative activity of medullary thyroid carcinomas with PCNA were 7.26±.10% (0.89--18.97%), and with Ki-67 -- 1.35±.48% (0.19%--9.23%). The mean proliferative activity of papillary thyroid carcinomas with PCNA were 3.47۪.46% (1.60--7.83%), and with Ki-67 -- 1.29۪.20% (0.40--3.31%). PCNA showed a higher proliferative activity than Ki-67 in all cases. Ki-67 is a more specific proliferation marker than PCNA.

МЕДИЦИНСКИЕ БИОТЕХНОЛОГИИ

Ilyasevich I. A., Beloenko E. D., Kulchitsky V. A., Soshnikova E. V., Tesakov D. K.
Diagnostic possibilities of transcranial magnetic stimulation (by example of analysis of motor responses of the diaphragm in patients with spinal column and chest deformity). pp. 51--59

Summary: 10 healthy control subjects (age 12--16), 10 children with funnel chest and 8 children with scoliosis have been studied by transcranial magnetic stimulation. The analysis of motor responses was compared to the data of the electromyogram mm. intercostales in forced respiration. In the control group the latency of motor responses of the mm. thenar was 21.1± 0.3 ms; diaphragm -- 15.1± 0.9 ms. Some changes in motor conduction of the n. phrenicus in patients with chest and spinal deformity have been revealed. The character of the changes revealed allows to determine pathophysiological mechanisms of the respiratory insufficiency in patients with funnel chest and scoliosis.

Olenskaya T. L., Kozlovski V. I., Konevalova N. Y.
Active orthostatic test in prediction of arterial hypertension complications. pp. 60--66

Summary: 208 patients with arterial hypertension of degree II were studied for evaluation of effects of orthostatic reactions on development crisis, acute disorders of cerebral blood flow, acute coronary syndromes and mortality cases. The following methods were used: examination of patients, laboratory and instrumental, active orthostatic test, classic statistical techniques, such as logistic regression, classification trees. During 3.1± 0.3 years a certain number of TIA, strokes, acute coronary syndromes and mortality cases was registered. Using the program Classification Trees, we revealed most important factors associated with development of the events in patients with hypertension of degree II. The diagnostic sensitivity of predictive model for crises was 98%, specificity was 98%. The diagnostic sensitivity of predictive model for acute disorders of cerebral blood flow was 95%, specificity was 98%. The diagnostic sensitivity of model for acute coronary syndromes was 81%, specificity was 90%. The diagnostic sensitivity of model for mortality cases was 94%, specificity was 98%. Active orthostatic test and complex examinations increase diagnostic sensitivity and specificity of predictive models of outcomes of complications in patients with hypertension of degree II.

Zmatchinski V. A., Uss A. L., Milanovich N. F., Dzuba E. V., Morozova O. M., Mitskevich P. B., Zavgorodnyaya I. L., Solovieva N. S., Batan Z. E.
Autologous hemopoietic stem cell transplantation in treatment of patients with breast cancer. pp. 67--71

Summary: High-dose chemotherapy with autologous hematopoietic stem cell transplantation is effective in the adjuvant setting for patients with breast cancer at high risk for relapse. Patients who received bone marrow transplantation had significantly higher regimen-related toxicity than patients receiving blood stem cell transplantation. Engraftment with using G-CSF after blood stem cell transplantation was significantly faster in patients who received mitoxantrone/cyclophosphamide/melphalan (CMM) as conditioning regime than in patients without using G-CSF. Engraftment in patients received cyclophos-phamide/BCNU/cisplatin (CPB) regimen was independent from using G-CSF. Patients who received CPB regimen had significantly higher mucositis and hepatic toxicity than patients receiving CMM regimen.

Raevneva T. G., Halabarodzka N. V., Askirka A. N., Goregliad N. S., Gusina N. B., Shavlov N. M., Shurpo N. N., Kletski S. K., Kupriyanov A. B., Klyuchareva A. A.
Diagnosis and prognosis of liver cirrhosis in children. pp. 72--78

Summary: Etiological pattern of liver cirrhosis in 45 children observed in the Republic Center for Pediatric Hepatology has been shown. Some infectious pathology, metabolic disorders and bile duct atresia have been diagnosed. In 42.6% of patients, etiology hasn't been determined. In 51.1% of children, liver cirrhosis resulted from congenital hepatitis. In 25 patients, liver biopsy has been performed and morphological data has been described. Clinical, biochemical and Doppler ultrasonological criteria of bad prognosis and late features of portal hypertension (based on analysis of clinical course of liver cirrhosis in 29 children) have been revealed. The most significant ones were portal-systemic anastomosis visualization (r = 0.57; P < 0.05) and presence of retrograde blood flow in portal vein (r = 0.59; P < 0.05). In prospective study, survival rates in patients with these symptoms have been established.

Smeyanovich A. F., Baranovsky A. E.
Results of microsurgery on olfactory meningiomas with application of en-doscopy. pp. 79--81

Summary: Application of assisting endoscopy while removing new formations in the olfactory area made it possible in 53.5% of operative cases to perform total removal of the tumor while preserving minor blood vessels in the front parts of the circle of Willis, which feed the chiasmocellar area (optic nerves, chiasm, upper "floors" of the Turkish saddle area), supraclinoid segments of the internal carotid artery, as well as the front sections of the third ventricle. These patients in the postoperative period did not have neurological deficit; 15% of patients had signs of recovering eyesight functions in early postoperative period. In the remote postoperative period (5 years and more), there were no tumour relapses in the group of patients who were operated on with application of assisting endoscopy.

Lutskaya I. K., Marchenko E. I., Chukhrai I. G.
Influence of low intensity laser irradiation on adhesion strength of filing-tooth junction. pp. 82--88

Summary: Low level helium-neon laser radiation with the intensity flow of 16--20 mVt/cm² and 40 sec exposure to a filling (or a part of a filling) from "Charisma" with 2 mm diameter produces a beneficial effect on the state of the "filling-tooth" border. A significant increase in the adhesive "Charisma" strength to dense tooth tissues was established at all technological stages while using the photopolymer. As a result of using the neon-helium laser, the adhesive strength of "Charisma" -dentin" border reaches the following values: after the cavity preparation -- 10.71 + 0.59 MPa, after etching with phosphoric acid -- 10.66 + 0.45 MPa, after application of adhesive system -- 15.47 + 0.32 MPa, after filling -- 11.49 + 0.32 MPa (against 7.90 + 0.18 MPa in the group of comparison). The most acceptable practical method is the use of helium-neon laser radiation after tooth filling, which is accounted by simple working conditions. Moreover, an increase in the adhesive strength at this stage approximates in its value to the analogous one after application of the adhesive system.

ОБЗОРЫ

Semenenya I. N.
Space human ecology. Role of cosmogeophysical factors in formation of constitutional peculiarities in developing organisms. pp. 89--96

Summary: A comparatively new and very promising interdisciplinary direction in modern science known as space human ecology with origins from distant past is presented in this paper. Evidences of vital importance of natural cosmoplanetary fields in formation of constitutional peculiarities in developing organisms during early ontogenesis are summarized. Topicality of development of studies in this field is emphasized.

Titovets E. P., Antonov I. P.
Role of aquaporins in development of cerebrovascular pathology. pp. 97--100

Summary: Brain ischemia and edema -- pathogenic mechanisms involved in cerebrovascular diseases -- are considered from the point of view of the aquaporin presence and functioning in the brain structures. Inadequacy of the orthodox oxygen diffusion theory is stressed and, as an alternative, the aqua-microcirculatory theory of brain oxygenation involving aquaporins is given some prominence. It is pointed out that the aquaporin theory presents a more realistic theoretical approach and gives better insight into the problems of brain oxygenation, ischemia and edema.

Fedorovich S. V., Arsent'eva N. L., Maksimenko A. A., Kazakova T. M.
Modern concepts of etymology and pathogenesis and treatment of allergic diseases. pp. 101--108

Summary: The allergic diseases are wide-spread antropogenic influence of the unfavorable factors of environment, dysregulatory changes in the immune status promote formation of immunodeficiency of a state with accumulation of immunotoxical complexes and damage to histic frames of the skin and liver. The following laws were established: the highest hazard of development of asthma is found in the farmers, artists, cabors at factories producing plastics, cleaners and agricultural workers. The most common "guilty" allergens are alimentary -- 63.7%, medicinal -- 35.4%, household -- 40.6% etc. There are two kinds of approaches to therapy of bronchial asthma (BA): by principle "steps upwards" and "steps downwards". The important achievement in range of therapy building of combinations seretid and simbicort. As alternative to low doses inhalational glucocorticoids and cromolyns at treatment of mild persistent asthma in the patients at age of more than 12 years, antileukotrienal drugs car be considered. Leukeferon, isophon, phenspired, polyoxidony promote enriching of the immune status in complex therapy. Rusam -- perspective drug with antiallergic activity. The therapy esthifan + triovit raises function of cellular link of immunodefence due to drop of activity of a humoral link. The specific immunotherapy is the most effective method of treatment of atopical conditions, now registered in every fifth European. Procedure of autoserotherapy in treatment of the leading forms of the ecologically caused allergoses has recommended itself well. The peroral and hypodermic methods of allergovaccination prevent relapses of asthmatic BA and atopical dermatitis, and the peroral method is more effective.

Davidovsky A. G.
Functional role of prooxidant and antioxidant processes in the liver during bacterial endotoxemia. pp. 109--117

Summary: Functional role of free-radical oxidation processes and products in molecular and cellular mechanisms of proinflammatory cytokine expression and signal transduction in liver cells during bacterial endotoxemia was considered. The hypothesis of liver-localized physico-chemical system of redox-control of physiological functions was proposed.

Sidorenko G. I., Zolotukhina S. F., Kovkova A. V.
Metabolic risk factors of cardiovascular diseases. pp. 118--122

Summary: A concept of risk factors, which allons not only to explain the origin of common cardiovascular diseases but also to outline ways of prevention, is described. The role of dyslipoproteinemia and so far unresolved questions of "target" cholesterol level, which must be achieved as a result of treatment, is highlighted. Data concerning the role of hyperhomocysteinemia as universal metabolic risk factor are presented. Data concerning the role of asymmetric dimethylarginin are presented. The results of target-oriented vitamin prevention of cardiovascular diseases and their complications are indicated.

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Разработана и поддерживается Николаем Н. Костюковичем. Последнее обновление: 5 августа 2004 г.
Создана при участии Игнатия И. Корсака
Копирайт © 2004 Национальная академия наук Беларуси
Копирайт © 2004 Издательство "Беларуская навука"