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Contents  2017-3


  1. Evaluating the past, planning the furure

N.S. Bashketova, R.К. Fridman, Е.I. Smirnova, I.А. Zabotina, Т.V. Кryukova

  1. Impact assessment of influenza on pregnancy

Z.P. Kalinina, A.A. Dolgiy, O.V. Parkov, A.N. Mikhaylov, V.P. Chashhin              8

  1. Physical development of newborns of female radiation workers

S.F. Sosnina, P.V. Okatenko               14

  1. The prevalence of markers of viral hepatitis B and C in certain contingents in the Voronezh region

T.N. Sitnik, J.V. Chemodurova, T.A. Mamchik, N.P Mamchik, Matsaeva E.A.          21

  1. Carriage epidemiological characteristics of streprococcus pneumoniae among preschool children in St. Petersburg

 D.S Kolesnik, A.S. Mokhov, E.A. Lebedeva, V.V Kolodzhieva, A.E Goncharov, V.Yu. Khoroshilov, A.A. Shishmakov, S.V. Sidorenko, L.P.Zueva          28

  1. Characteristic of patients with tb and HIV co-infections in the day patient facility of the tuberculosis dispensary

A.K. Ivanov, E.V. Shevyreva, N.A. Skrynnik, N.A. Tursunova, V.V. Manina               34

  1. Molecular epidemiology of intestinal protozoan invasions caused by cryptosporidium spp. and giardia duodenalis.

D.V. Azarov, A.E. Goncharov              41

  1. Сomparison of coronary artery stenting using conventional and bifurcation stents

G.G. Khubulava, K.L. Kozlov, A.N. Shishkevich, S.S. Mikhailov, V.N. Kravchuk, Z.M. Abdullaev  47

  1. Prospects of enchanced rehabilitation of patients with esophageal cancer after simultaneous esophageal-gastric surgery

K. V. Pavelets, K.V. Medvedev, M.A. Protchenkov, D.S. Rusanov, A.A. Sokolova, M.K. Pavelets, U.A. Drozd         53

  1. Technique and standardization development of сomplete mesocolic excision to prevent intraoperative and postoperative complications

 A.A. Saharov, L.D. Roman, K.G. SHostka, A.N. Pavlenko, K.V. Arutyunyan, K.S. Il'in, K.V. Privalova, A.A. Gradusov, G.I. Sinenchenko                  59

  1. Dental care to patients with hereditary coagulopathies

A.V.Kim, A.V.Silin, A.L. Rubegov, N.A. Gureva, L.V. Zalevskaia, T.M. Koloskova               66
5. Features of the pancreas and liver condition in overweight and obese children
M.М. Gurova, A.А.Guseva, V.P. Novikova            72
6. Arrosive bleeding prevention after pancreatoduodenectomy
M.Ju. Kabanov, K.V. Semencov, D.M. Jakovleva, A.A. Tarmaev          79




Z.P. Kalinina1, 2, A.A. Dolgiy1, O.V. Parkov2, A.N. Mikhaylov3, V.P. Chashhin1
1North-Western State Medical University named after I.I. Mechnikov, Russia, 191015, Saint-Petersburg, Kirochnaya street, 41.
2S.P. Botkin Clinical Infectious Diseases Hospital, Russia, 191167, St. Petersburg, Mirgorodskaya street, 3.
3Pavlov First Saint Petersburg State Medical University, Russia, 197022,St. Petersburg, Leo Tolstoy street, 6 / 8.

Introduction. Pregnant women are in a high-risk group of exposure to influenza and its complications.  During 2015-2016 were registered 257 cases of influenza in pregnant women in St. Petersburg which comprise 8.6% from hospitalized adults among them were 2 fatal cases.
Purpose. The aim of the study is to evaluate the risk impact assessment of severe influenza on the course and outcome of pregnancy.
Materials and methods. Retrospective analytical cohort study was conducted in maternity hospitals of St. Petersburg.  The study included 306 pregnant women, the main group is 102 women diagnosed with influenza (PCR) during 2015-2016, comparison group include 204 pregnant women without influenza at the same period of time. The study materials were data from the official reporting documentation. Statistical analysis was carried out using computer software Statistica and WinPepi, as well as relative risk (RR) was calculated.
Results. According to the results of the data analysis on diseases before and during pregnancy, it is stated that cardiovascular pathology and respiratory diseases are more common in women recovered again influenza than in women without influenza during pregnancy (RR = 1,62; 95% CI = 2.6-1.0, p <0.05). The impact of influenza on the birth outcomes was not marked: in both groups more than 71,0% of childbirth were without complications.
.  There were no statistical differences in the state of health of newborn children in groups: more than 92.0% of children were healthy.
Conclusion. It was shown that cardiovascular pathology and respiratory diseases are more common in women recovered again influenza than in women without influenza during pregnancy (RR = 1,62).
Key words: pregnancy, influenza, comorbidity, complications.

S.F. Sosnina, P.V. Okatenko
Southern Urals Biophysics Institute of the FMBA of Russia, Russia, 456780, Ozyorsk, Chelyabinsk Region, Ozyorskoe av., 19. 
            Introduction. Physical development of newborns is a key indicator of children’s health status. Previous studies on anthropometric status of newborns from mothers being exposed to ionizing radiation are ambiguous. In this case the assessment of the impact various risk factors including radiation on physical development of newborns from nuclear enterprises employees is still topical.     The aim of the study was to estimate the physical development of newborns of female workers of factory «Mayak» with accumulated preconceptive doses of external gamma-radiation.
Methods. It was conducted a retrospective analysis of anthropometric data of 650 newborns including 130 newborns of female workers of factory «Mayak» as well as nonparametric statistical methods were used.
 Results. Among newborns exposed to radiation was marked a large percentage of newborns with high weight in the whole group and in the girl’s subgroup. The doses of external gamma-radiation on female gonads were higher in newborns with low and high birth weight than in newborns with normal weight. An average radiation absorbed dose of external gamma-radiation on ovary before fertilization was 423, 2 mGy. Within the factor analysis were determined 4 factors described radiation preconceptive doses in female workers (15,3% -dispersion), antenatal life (13,8%- dispersion ), obstetric-gynecologic anamnesis(13,5%- dispersion) and mothers’ substance abuse (9,7%- dispersion).
Conclusion. Determined aspects of newborns physical development confirm the significance of the further studies on health of newborns from female radiation workers.
y words: newborns, physical development, factory "Mayak", preconceptional exposure


T.N. Sitnik 1, 2, J.V. Chemodurova 1,2, T.A Mamchik.1, N.P. Mamchik 2, E.A.Matsaeva 1
1Voronezh Regional Clinical for Prevention and Control of AIDS, Russia, 394065 Voronezh, Patriotov pr., 29b
2Voronezh State Medical University named after N.N. Burdenko, Russia, 394036, Voronezh, Studencheskaya st., 10

Introduction. Despite the significant achievements in the prevention and treatment of diseases caused by hepatotropic viruses, hepatitis are still a serious medical and social problem.
The aim of study was to reveal the trends of detecting markers of viral hepatitis B and C in different groups of patients during laboratory examinations in medical organizations of the Voronezh region.
Materials and methods.  During 2001-2016 was conducted a retrospective analysis of   prevalence of markers for hepatitis B and C in different groups of patients. The study was based on laboratory data obtained from regional medical organizations reports. It was analyzed primary infection of viral hepatitis by medical workers, patients with chronic, narcological, dermatology and venereal diseases, as well as examination of almost healthy people (donors) and pregnant women.
Results and conclusions. According to the results of laboratory researches of risk groups, after 2008 it was a statistically significant reduction in the detection of HBsAg in all patients due to wide population immunization against HBV. The high prevalence of hepatitis B was marked in patients with chronic diseases, whereas hepatitis C prevails in narcological patients. Donors experienced a tenfold decrease in the detection of HBsAg and anti-HCV due to the vaccination and improved donor selection   in automatic database. The prevalence of markers of hepatitis B in pregnant women was 2 times lower with the stable anti-HCV detection. The results of screening test for markers of hepatitis B and C in medical workers reveal the tendency to infection reduction but with the high prevalence of hepatitis C infection in all groups of patients.

Key words: viral hepatitis B, viral hepatitis C, anti-HCV, HbsAg, viral hepatitis markers


A.K. Ivanov, E.V. Shevyreva, N.A. Skrynnik, N.A. Tursunova,
V.V. Manina
St. Petersburg State Budget Healthcare Establishment "Tuberculosis dispensary № 12", Russia, 190103, St. Petersburg, nab. reki Fontanki,152-A.
Introduction.  The set up of day patient facilities in TB dispensaries is a promising way to control TB patient’s treatment.
Purpose. The study was aimed at analyzing of 10-years work of outpatient facilities in TB dispensary.
Materials and methods. It was analyzed treatment outcomes in 774 patients with active TB with the division into two groups of patients: patient with TB and HIV co-infections (200 patients) and HIV-negative TB patients (574 patients).
Results and discussion.
In the Admiralteysky District of St.Petersburg the number of HIV patients with newly diagnosed tuberculosis increased 6 times. Patients with co-infections have intrathoracic lymph node lesions 3.9 times often than HIV-negative TB patients. In turn the disseminated and focal lungs tuberculosis were frequently observed in patients without HIV infection (17,3% vs 9.0%). The destructive changes in the lungs were marked only in the fourth part of the patients in both groups.  Release of mycobacterium tuberculosis in patients with co-infectious was marked in 46,0% cases and in patients without HIV infection was marked in 35,7% cases which is 1.2 time less. It was stated a multidrug resistance in 18,4% patients  with co-infections which is 1,4 time less in comparison with HIV patients. The viral hepatitis was diagnosed accurately in patients with co-infection rather than in HIV-negative TB patients (82.5% vs 11.7%; p<0.001). The treatment effectiveness of patients with co-infections was similar both in hospitals and day patient facilities in TB dispensaries where were just achieved the prolongation of controlled therapy in patients with co-infections (p<0.01).
Conclusion. Patients with co-infections (TB and HIV) in day patient facilities were observed with the lymphatic system disorders caused by TB and frequent serous membranes reactions. Controlled anti-TB therapy in day patient facilities is an important component in TB patient’s treatment and its effectiveness is almost similar to hospital treatment.

Key words: tuberculosis, HIV infection, day patient facilities.


D.S. Kolesnik 1,4, A.S. Mokhov1,3, E.A., Lebedeva1, V. V Kolodzhieva1,2, A. E Goncharov1,2, V. Y., Khoroshilov1,4, A. A. Shishmakov1, S. V. Sidorenko3,1, L. P.Zueva1
1North-Western State Medical University named after I.I Mechnikov, Saint-Petersburg, Russia, 191015, Kirochnaya street, 41
2 Institute of Experimental Medicine, Saint-Petersburg, Russia, Akademika Pavlova street, 12
3 Children's Research of Infectious Diseases of the Federal Medical-Biological Agency, St. Petersburg, Russia, 197022, Professora Popova street, 9
4Territorial Department of management of Federal service for supervision of consumer rights protection and human wellbeing across St. Petersburg in the Nevsky and Krasnogvardeisky districts, St. Petersburg, Russia, 191025,Obukhovskoy Oborony propect,123

Introduction. The investigation of the characteristics of Streptococcus pneumoniae carriage strains circulating in children's groups is essential to assess the impact of vaccination on the epidemic process of pneumococcal infection.
The aim of the study is to assess the carriage epidemiological characteristics of S. pneumoniae among preschool children at the beginning of vaccination.
Material and methods. It was examined 1574 children aged 2 -7 years. Serotypes of isolated pneumococci cultures were determined by multiplex PCR as well as virulence genes ftsW, pezT, the npl, and pblB. The case-control study was conducted to determine risk factors for invasive S. pneumoniae carriage.
Results. The strains proportion of Streptococcus pneumoniae serotypes under the 13-valent vaccine, was 36.03 per 100 isolates [95 % CI = 27,1 – 44,96] in our study. The colonization of pneumococci strains with the pathogens factors was associated with the previous otitis (OR= 4,44 [95% CI= 1,77 - 11,16]).
Conclusion. It was determined the active circulation of potentially invasive strains of S. pneumoniae among preschool children suggesting the necessity of timely detection and debridement of its carriers.
Key words: Streptococcus pneumoniae, vaccine, carriers, pathogens factors, preschools


D.V. Azarov1, 2, A.E. Goncharov1,3
1North-Western State Medical University named after I.I Mechnikov, St. Petersburg, Russia, 191015, Kirochnaya street, 41
2 St. Petersburg City for Hygiene and Epidemiology, Saint-Petersburg, Russia, Malaya Sadovaya street, 1
3 Institute of Experimental Medicine, Saint-Petersburg, Russia, Akademika Pavlova street, 12

Cryptosporidiosis and giardiasis are the most common invasions globally. Despite them being found years ago, the epidemiology of these diseases is quite questionable. This study presents the attempt to summarize the data concerning molecular identification and epidemiology of protozoal invasions caused by Cryptosporidium spp. and Giardia duodenalis.
Key words: Cryptosporidium spp., Cryptosporidiosis, Giardia duodenalis, giardiasis, intestinal protozoal invasions, molecular epidemiology, parasitology.



G.G. Khubulava 1, K.L. Kozlov 2, A.N. Shishkevich 1,
S.S. Mikhailov 1, V.N. Kravchuk 1, Z.M. Abdullaev 1
1 Military Medical Academy named after S.M.Kirov, Russia, 194044, Saint- Petersburg, Akademika Lebedeva street, 6.
2    Saint- Petersburg Institute of Bioregulationand Gerontology of the North-Western Branch of the Russian Academy of Medical Sciences, Russia, 197110, Saint- Petersburg, Dinamo prospect, 2

Introduction: There are a number of techniques for stenting bifurcations aimed at minimal bifurcation metallization that is the use of one stent. One way to reduce complications after coronary artery stenting is the use of bifurcation stents.
Materials and methods: Endovascular treatment of bifurcation lesions of the coronary arteries was based on the study of 116 patients with the comparison of coronary artery stenting techniques using conventional and bifurcation stents.
Results: Among the study group were 3 patients with implanted stent BIOSS having more than 50% of the stenosis of the lateral branch. In addition, the occlusion of the lateral branch during the operation was not observed. Thus, out of 53 performed stenting, only one patient had more than 50% of residual stenosis of the lateral branch.
Conclusions: The study analysis revealed the advantage of the last stent, particularly, in the frequency of occlusion and significant residual stenosis in the lateral branch.
Keywords: Stenting of the coronary arteries, bifurcation lesion, provisional T-stenting, bifurcation stent Bioss.


K.V. Pavelets 1, 2, 3, K.V. Medvedev1, M.A. Protchenkov1, 2, D.S. Rusanov1, 2, A.A.Sokolova1, M. K. Pavelets1, 2, U.A. Drozd2
1Saint-Petersburg Mariinsky hospital, Russia, 194104, Saint-Petersburg, Liteiny pr., 56
2Saint-Petersburg State Pediatric Medical University, Russia, 194100, Saint-Petersburg, Litovskaya str., 2
3North-Western State Medical University named after I.I. Mechnikov, Russia, 191015, Saint-Petersburg, Piskareyvskiy pr., 47.
Introduction: Esophageal cancer surgery is frequently associated with the predicted severity of the postoperative period (total duration of the postoperative period is 11-26 days).
Aim of this study was to demonstrate a complex approach to the prediction and prevention of postoperative complications, the justification of enhanced rehabilitation protocol  of patients after surgical interventions in particular (Fast-track surgery or ERAS-Enhanced Recovery After Surgery)  after esophageal resection.
Materials and methods: The study is based on the experience in surgical treatment of 271 patients with esophageal cancer, who during postoperative period undergone complex assessment of neoplastic process and physical status.
Results: Due to preoperative staging optimization, preoperative preparation, surgical planning and scientific based monitoring of rehabilitation period was achieved satisfactory results in surgical treatment with mortality 5,2% and average inpatient day 8±1,6 days
Conclusion: Complex approach of patients managing allowed to approximate the implementation of ERAS-program.
Key words: esophageal cancer, surgical treatment, preoperative preparation, preoperative staging

A.A. Saharov1, 2, L.D. Roman1, 2, K.G. Shostka1, 2, A.N. Pavlenko3,
K.V. Arutyunyan1, K.S. Ilin1, K.V. Privalova4, A.A. Gradusov2,
G.I. Sinenchenko2
1Leningrad Regional Oncology Dispensary, Russia, 191014, St Petersburg, Liteyny pr., 37.
2Military Medical Academy named after S.M.Kirov, Russia, 194044, St. Petersburg, Akademika Lebedeva st., 6.
3Saint-Petersburg multifaceted medical , Russia, 198103, Saint-Petersburg, Fontanka emb., 154
4Ryazan higher airborne command school. named after V. F. Margelov. Russia, 390031, Ryazan, Margelov Square, 1.
Introduction. Colorectal cancer is the third most common malignant tumor in the world among men and the second in women. The popularization of the embryonic surgery principles in oncology resulted in the attempt to use the concept of complete mesocolic excision in surgeries on colon to increase the total patients’ survival. Currently, it is necessary to develop the common understanding of end points of lymphadenectomy, morphological research standards for further investigations.
The aim of the study was to assess the reliability and direct results of complete mesocolic excision in right hemicolectomy.
Materials and methods. From 2010 to 2012 a method of complete mesocolic excision in right hemicolectomy was developed, standardized and implemented into clinical practice of Leningrad Regional Oncology Dispensary. Patients operated in this very period weren’t included in the study. During 2012-2015 were conducted 67 right hemicolectomy using complete mesocolic excision techniques. The procedure of surgery was developed due to medical literature, reviews found out in  PubMed, Embase, UpToDate, Google Scholar with the search query “complete mesocolic exision, high-tie ligation, ligation of Central vessels, D3 dissection, extended lymphadenectomy, right hemicolectomy, no-touch isolation technique, colon cancer”.
Results. Thedeveloped technique of right hemicolectomy with complete mesocolic excision is general and applicable for both open and laparoscopic surgeries. The reliability of the developed technique allows to recommend it as being standard for performing the right hemicolectomy.
Conclusions. 1. Oncologic efficacy of complete mesocolic excision in right hemicolectomy requires examination in randomized researches.
2. The use of standardized complete mesocolic excision technique is not accompanied with the increase of intraoperative and postoperative complications.
Keywords: complete mesocolic excision, D3 lymph node dissection, right hemicolectomy, colon cancer.


A.V.Kim1, A.V.Silin2, A.L. Rubegov1, N.A. Gureva1, L.V. Zalevskaia3,
T.M. Koloskova 3
1 Saint- Petersburg State Pediatric Medical University,Russia, 194100, Saint-Petersburg, Litovskaya str., 2.
2 North-Western State Medical University named after I. I. Mechnikov, Russia, 195067, Saint-Petersburg, Piskarevsky pr., 47.
 3 Dental clinic № 9, Russia, 191028, St.-Petersburg, Tchaikovsky str., 27.

Introduction: Blood disorders are a large and heterogeneous group of diseases characterized by various impairment of the blood cells structure or functions where within the group is divided hereditary coagulopathies disorders: hemophilia A and B, Von Willebrand disease associated with the violation of blood coagulation. Dental care issues are of high importance in patents with blood disorders due to severe organ and tissue lesions of oral cavity.
Aim of the study was to formulate the basic principles of the treatment and prevention of hereditary coagulopathies according to the literature review and studies on dental care.
Results: There is a lack of studiesonfeatures and correction methods of dental status abnormalities in patients with hemophilia, but all the same there is a high prevalence of oral diseases in patients with hereditary coagulopathies:  patients with mild hemophilia have cavities in 94% of cases, patients with moderate hemophilia – 96%, patients with severe hemophilia-100%; patients with mild hemophilia have periodontal pathology in 75% of cases  and 100% of cases in patients with severe hemophilia correspondingly; TMJ functional disorder are observed in 38,5% of patients with hemophilia.
Conclusions: The complex dental treatment, development of interaction mechanisms between dentist and hematologist as well as dental care standards are necessary for the reduction of the prevalence of the major oral diseases and their complications in patients with hereditary coagulopathies.
Key words: dentistry, hematology, coagulopathy, hemostasis.


M.М. Gurova 1, A.А. Guseva 2, V.P. Novikova 3

  1. Belgorod State National Research University (BelSU), 308015, Belgorod, Pobeda str., 85, Russia
  2. Regional children clinical hospital, 305035, Kursk, Koltsova str., 11а, Russia
  3. V.A. Almazov Federal North-West Medical Research Centre, 197341, Sankt Petersburg, Akkuratova str., 2, Russia

Introduction. It is known that obesity in children is accompanied by the liver affection in the form of steatosis or non-alcoholic fatty liver disease (NAFLD). However, the frequency of occurrence and wide range of specific pancreatic symptoms in overweight children compared to obese children has not yet been systematically investigated.
Objective: We aimed to assess the frequency of detection of ectopic fat deposition in the pancreas and liver, and characterize peculiarities of exo- and endocrine function of the pancreas in overweight compare to obese children.
Methods. Were investigated 150 children (the average age – 13 years): 60 overweight children, 60 children with obesity and 30 healthy children with normal body weight. Diagnostics of the pancreatic and liver steatosis were based on the data of abdominal sonography. We determined the blood lipids, insulin, insulinresistancy index - HOMA, elastase-1 in stool.
Results. Pancreatic steatosis occurred with equal frequency in overweight and obese – in 51/85,0% and 52/86,7% of cases accordingly (p=0,88), whereas steatosis of the liver was found in 38/63,3% of cases in children with obesity and in 17/28,3% of cases in overweight children (р=0,001). Most common ultrasound characteristics of pancreatic steatosis were the following: increased sizes of the pancreas, increased density and presence of hyperechogenic inclusions in 53/88,3% children with obesity and in 26/43,3% in overweight children (р=0, 023). Activity of the elastaze-1 in children of both groups was significantly lower than in comparison group (265,1±38,18 and 314,8±16,2 mkg/g vs 354,2 ± 41,15 mkg/g, p < 0,05).
Conclusions. We found very high incidence of pancreatic steatosis, which was compatible in obese and overweight children. Steatosis of the liver was found more often in children with obesity. Combinations of the steatosis of the pancreas and liver were found in about 1/3 cases of overweight children and ½ cases of obese patients.
Key words: non-alcoholic fatty pancreas disease, non-alcoholic fatty liver disease, children, obesity, overweight


M.Y. Kabanov1, 2, K.V. Semecov1, 2, D.M. Yakovleva1, 2, A.A. Tarmaev1.
1North-Western State Medical University named after I. I. Mechnikov, Russia, 191015, Saint-Petersburg, Kirochnaya st.41
2Hospital for war veterans, Russia, 193079, Saint-Petersburg, Narodnaya st.21, 2

Introduction: Recently, there is an increasing tendency of malignant tumors of biliopancreatoduodenal zone. The only effective treatment is pancreatoduodenectomy allowing to increase the life expectancy and patients life quality, however, some complications may be fatal for patients. One of the complications of pancreatic fistula is the arrosive bleeding. In this regard, the study of postoperative complications causes, preventive and treatment methods development is a current problem for pancreas surgery.
The aim of the study is to propose the arrosive bleeding prevention method after pancreatoduodenectomy and estimate its efficiency.
Methods: During 2012 to 2016 were performed 84 pancreatoduodenectomies for cancer of the different biliary-pancreaticoduodenal areas. To compare the effectiveness of the proposed method were identified 2 groups. From 2012 to 2014 were carried out 35 operations without arrosive bleeding prevention (the control group), and from 2014 to 2016 were carried out 49 operations with the creation of protective «cuff» by wrapping the common hepatic artery by the round ligament of the liver (the main group).
Results: In the control group, two patients had arrosive bleeding from the common hepatic artery and the gastroduodenal artery stump requiring re-operative intervention. Of the two re-operated patients in the control group died from vast blood loss consequences and massive hemotransfusion syndrome. The reason of arrosive bleeding was the pancreatic fistula formation diagnosed in 10 (28.6%) patients.
In the main group pancreatic fistula was diagnosed in 11 (22.4%) patients. In the main group arrosive bleeding and fatal outcomes was not observed.
Conclusion: The analysis of the modern literature and our own research reveals that the main reason of postoperative complications after pancreatoduodenectomy is pancreatic fistula formation.
Pancreatic fistula accompanied by arrosive bleeding is a severe postoperative complication, which is hard treatable. Intraoperative prevention of arrosive bleeding from the common hepatic artery and its branches as a  protective «cuff» made from round ligament of the liver, can reduce the risk of bleeding in the postoperative period, and improve the treatment outcomes.
Keywords: pancreatoduodenectomy, arrosive bleeding, the protective «cuff».



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