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1314 Романцов, ГорячеваUDC 615.27-053.2/.6 © M.G. Romantsov, L.G. Goryacheva, A.L. Kovalenko, 2010 Romantsov M.G., Goryacheva L.G., Kovalenko A.L. Cycloferon for treatment and prevention of children diseases // Preventive and clinical medicine. – 2010. - № 1 (34). – Р.78-90. 1State Educational Establishment of Higher Professional Training «Mechnikov Saint-Petersburg State Medical Academy of the Federal Agency for Public Health and Social Development of the Russian Federation», 195067, St.-Petersburg, K-67, Piskarevsky prospect, 47, tel. (812) 543-96-09, fax: (812) 740-15-24, e-mail: mechnik@westcall.net; www.mechnik.spb.ru 2Research Institute for сhildren infections Научно-исследовательский институт детских инфекций, Russia, 197022, Saint-Petersburg, Prof. Popov str., 9. Теl.: (812) 234-60-04, 234-18-62. Fax: (812) 234-52-83. E-mail: childinf@soros.spb.ru 3Scientific-Technological Pharmaceutical Firm “POLYSAN”, Russia, 191119, Saint-Petersburg, Ligovsky prospect, 112, tel.: 8(812)110-82-25,112-13-79, е-mail: sales@polysan.ru, STPF “POLYSAN” www.polysan.ru Summary. The article presents authors’ own material and literary data on cycloferon pharmacotherapeutic efficiency. Cycloferon belongs to a group of interferon inducers, immunomodulators. The effect of the preparation at various children socially-significant diseases is described. These include ARVI, bronchial asthma, allergic conditions accompanied by the disorder of antiinfectious protection, mycoplasmic infection, broncho-pulmonary complications in ARVI with low intensity of free-radical oxidation. Suppression of autoimmune processes, which are the cause of postvaccinal complications in often ill children, is shown with the use of cycloferon on the background of planned vaccination. Results of cycloferon use in case of gastrointestinal tract diseases, intestinal infections both of viral and bacterial genesis are described. Cycloferon use for intestinal dysbiosis correction is suggested, microflora restoration to normal level is noted in 95 % of children. Preparation use for surgical pathology, particularly in appendicular peritonitis, with the aim of decreasing postoperative complications, and also for the correction of immune disorders in chronic viral hepatitis C and B in children treated with the combined therapy is described. Cycloferon safety and efficiency is proved by the postmarketing randomized studies of its efficiency. Key words: Cycloferon; treatment; disease prevention; often ill children. References 1. Агаева С.Г. Клинико-лабораторная характеристика хронического гепатита В на фоне лямблиоза у детей в условиях Дагестана //Автореф. дисс. …..к.м.н.-СПб.-2009.-21с. 2. Белякова А.В. Нарушения иммунитета и их коррекция у детей с распространенным апендикулярным перитонитом // Автореф. дисс. ….к.м.н.-Челябинск.-2006.-21с.. 3. Балаболкин И.И., Рылеева И.В., Булгакова В.А., Ляпунов А.В. и др. Терапевтическая эффективность индукторов синтеза интерферона при бронхиальной астме у детей, страдающих частыми острыми респираторными вирусными инфекциями // Материалы IV конгресса педиатров-инфекционистов России «Актуальные вопросы инфекционной патологии у детей (диагностика и лечение)», Москва, 2005 г. - С. 28. 4. Ботвиньев О.К., Орехова С.Б.Романцов М.Г. Циклоферон в терапии детей, больных пиелонефритом, ассоциированным с герпесвирусами //Антибиотики и химиотерапия.-2009.-№5-6.-С.48-54. 5. Вершинина Е.Н., Иванова В. В., Говорова Л.В. Терапевтическая коррекция иммунных расстройств при респираторных заболеваниях у детей с герпесвирусным инфицированием //Информационно-методическое письмо для врачей.-Санкт-Петербург.-2007.-26с. 6. Гаращенко М.В. Новые технологии в медикаментозной профилактике острых респираторных заболеваний у детей школьного возраста в условиях мегаполиса //Автореф. дисс. …к.м.н.-Москва.-2007.-21с. 7. Горячева Л.Г. Современные медицинские технологии в лечении хронических вирусных гепатитов //Романцов М.Г.,Горячева Л.Г.,Коваленко А.А. //Противовирусные и иммунотропные препараты в детской практике.-Санкт-Петербург.-2008.-С.100-112. 8. Горячева Л.Г. Терапия вирусных гепатитов у детей раннего возраста //Врач.-2006.-№8. 9. Горячева Л.Г. Терапия вирусных гепатитов у детей с использованием препаратов различного механизма действия // Вестник Санкт-Петербургской государственной медицинской академии им. И. И. Мечникова.-2006.-№4. 10. Григорян С.С. Индукторы интерферона: итоги и перспективы //Интерферону – 50 лет. Материалы конференции.-М.,19-20 ноября 2007г.).-С.66-72. 11. Дерюшева А.В., Львова И.И. Влияние инфекции, вызванной вирусами простого герпеса на соматическую патологию у детей школьного возраста.-Санкт-Петербург.-2008.-24с. 12. Железникова Г.Ф., Иванова В.В., Монахова Н.Е. Варианты иммунопатогенеза острых инфекций у детей.-Санкт-петербург.-2007.-С.45-80. 13. Ершов Ф.И., Романцов М.Г. Антивирусные средства в педиатрии.-Москва.-2005.-С.112-132. 14. Ершов Ф.И., Киселев О.И. Интерфероны и их индукторы (от молекул до лекарств).-Москва.-2005.-С.211-219. 15. Иммуномодуляторы с противовирусной активностью /Учебное пособие с грифом УМО-639-2004 под ред.М.Г.Романцова.-Москва.-2005.-74с. 16. Кетлинский С.А., Симбирцев А.С. Цитокины.-Санкт-Петербург.-2008.-С.23-46. 17. Кондратьева Е.И. Экстренная неспецифическая профилактика ОРВИ и гриппа препаратом циклоферон у детей в эпидемический период // Вестник Санкт-Петербургской государственной медицинской академии им. И.И.Мечникова.-2005.-№1.-С.72-76. 18. Краснова Е.И. Особенности иммунного ответа при инфекционном мононуклеозе и подходы к иммуномодулирующей терапии // Вестник Санкт-Петербургской государственной медицинской академии им. И.И.Мечникова.-2005.-№1.-С.76-82. 19. Краснов В.В. Эффективность применения циклоферона у часто болеющих детей, имеющих маркеры активности герпетических инфекций //Вестник Санкт-петербургской государственной медицинской академии им.И.И.мечникова.-2009.-№1.-С.148-153. 20. Королева Е.Г. Терапия респираторной микоплазменной инфекции у детей с отягощенным преморбидным фоном.-Санкт-Петербург.-2007.-14c. 21. Минаева Н.В. Особенности аллергической патологии у детей с синдромом нарушения противоинфекционной защиты //Автореф. дисс. …д.м.н.-Пермь.-2006.-44с. 22. Михайлова Е.В. Применение препарата циклоферон в комплексной терапии кишечных инфекций ротавирусной этиологии у детей /Е.В. Михайлова, Д.Ю. Левин // Мат. III конгр. педиатров-инфекционистов «Актуальные вопросы инфекционной патологии у детей». М., 2004.- С. 154-156. 23. Москалева Е.В., Смирнова С.В.,Петрова А.Г. Циклоферон при ВИЧ-инфекции у детей с перинатальным инфицированием.-Санкт-Петербург.-2008.-24с. 24. Назарочкина О.В.,Харченко Г.А. Вирусные менингиты у детей. Коррекция циклофероном нарушений в системе иммунитета //Информационно-методическое письмо для врачей. -Санкт-Петербург.-2008.-22с. 25. Ошева Т.М. Воспалительные заболевания верхних отделов пищеварительного тракта у детей // Информационно-методическое письмо для врачей.-Санкт-Петербург.-2007.-24с. 26. Применение циклоферона для экстренной профилактики ОРВИ в организованных детских и подростковых коллективах. Методические рекомендации №23 Департамента здравоохранения Москвы под редакцией Е.А.Дегтяревой.-М.,-2008.-24с. 27. Противовирусная терапия инфекционных болезней детского возраста //Сборник научных статей.-М.,-2006.-79с. 28. Применение циклоферона в педиатрической практике //Сборник научных статей.-Санкт-Петербург.-2005.-96с. 29. Романцов М.Г., Ботвиньева. Практика педиатра. Циклоферон.-Санкт-Петербург.-2005.-14с. 30. Рациональная фармакотерапия часто болеющих детей /Романцов М.Г., Ботвиньева В.В.,Шульдякова О.Г.-Санкт-Петербург.-2006.-115с. 31. Романцов М.Г., Ершов Ф.И. Часто болеющие дети. Современная фармакотерапия. Москва.-2009.-349с. 32. Романцов М.Г. Сологуб Т.В. Экстренная неспецифическая профилактика и лечение гриппа и ОРВИ. Лекция для врачей.-Санкт-Петербург.-2008.—42с.. 33. Романцов М.Г., Горячева Л.Г., Коваленко А.Л. Противовирусные и иммунотропные препараты в детской практике.-Санкт-Петербург.-120с. 34.Романцов М.Г.,Зарубаев В.В.,Коваленко А.Л., Сологуб Т.В. Грипп А/H1N1-типичная эмерджентная инфекця. Вопросы терапии и экстренной профилактики /\Вестник Санкт-Петербургской государственной медицинской академии им.И.И.Мечникова.-2009.-№2.-С.168-172. 35. Селькова Е.П. Профилактика респираторных заболеваний в период эпидемического подъема.-Москва.-2003.-30с. 36. Серозные менингиты у детей //Сборник статей.-Санкт-Петербург.-2007.-30с. 37. Тихомирова О.В. Ротавирусная инфекция.Особенности клинического течения и тактика терапии //Учебное пособие.-Санкт-Петербург.-2005.-80с. 38. Часто болеющие дети: современная фармакотерапия // М.Г.Романцов, Ф.И.Ершов.- Издательская группа «ГЭОТАР-Медиа», Москва.-2006.-192с. 39. Эффективность циклоферона при проведении экстренной профилактики ОРВИ в организованных коллективах. Методические рекомендации для врачей./Шульдяков А.А., Петленко С.В., Романцов М.Г., Сологуб Т.В.).-Санкт-Петербург.-2007.-16 с. Information about the authors: Romantsov Mikhail Grigorievich – Doctor of Medicine, Professor of the department of Infectious Diseases of SEEHPT «Saint-Petersburg State Medical Academy named after I.I.Mechnikov of Roszdrav». Тel.: 8-812-710-82-25. E-mail: RomantsovGCP@polysan.ru Kovalenko Alexsandr Leonidovith - Scientific-Technological Pharmaceutical Firm “POLYSAN”, Russia, 191119, Saint-Petersburg, Ligovsky prospect, 112, tel.: 8(812)110-82-25,112-13-79, е-mail: sales@polysan.ru, STPF “POLYSAN” www.polysan.ru Accepted 14.09.2009 г. 1291 Сайганов UDC 616.12-008.46-08 © S.A. Sayganov, O.G. Khurtsilava, 2010 Sayganov S.A., Khurtsilava O.G. Acute cardiac insufficiency treatment in myocardium infarction of the right ventricle // Preventive and clinical medicine. – 2010. - № 1 (34). – Р.90-95. State Educational Establishment for Additional Professional Training «Saint-Petersburg Medical Academy for Post-Diploma Training of the Federal Agency for Public Health and Social Development of the Russian Federation». Russia, 191015, St.-Petersburg, Kirochnaya str., 41. Тel.: 8 (812) 272-52-06, fax: 8 (812) 273-00-39. Е-mail: admin@maps.spb.ru Summary: Correction of hemodynamic disorders in acute right ventricle insufficiency (ARVI) due to myocardium infarction (MI) of the right ventricle usually consists of treatment by inotropic maintaining drugs and preload increase on the right ventricle (RV) for increased output into pulmonary artery. However at present, there are no precise recommendations on fluid introduction in ARVI treatment. To determine optimum criteria of infusion therapy 42 patients with MI of the lower localization and MIRV were included into the study. MIRV was complicated with ARVI. All patients were prescribed dobutamin and reopolyglukin (300 ml/hour) was introduced intravenously under pulmonary artery pressure (PAP) control, jamming pulmonary artery pressure (JPAP), central venous pressure (CVP). Perfusion cardiac index (CI) was determined by thermodelution method. Echocardiographic examination was performed before treatment and at optimum JPAP values. It was found that in ARVI patients at initially low APP and JPAP (16.2±0.21 and 7.0±0.18 mm hg) CVP is increased (11.2±0.25 mm hg). On the background of reopolyglukin introduction CI increased from 1.82±0.03 to 2.51±0.04 l/min/m2 (p <0.001) at JPAP of 18 mm hg. At the same time no marked CVP increase was observed. Further fluid introduction with JPAP up to 20 mm hg did not result in further CI increase and was followed by substantial CVP increase (from 13.7±0.23 to 16.2±0.24 mm hg; p <0.001). On the background of treatment LV size increased (from 52.3±0.57 to 54.4±0.60 mm increased; p <0.05) and fraction output also increased (from 37.5±0.87 to 41.9±0.99 %; p <0.05) in the absence of significant dynamics on the right cardiac chambers. The obtained data show expediency of preload increase on the right ventricle for ARVI treatment. Fluid should be introduced together with inotropic maintaining drug therapy. Target JPAP in IRVI treatment is 18 mm hg at which FV volume LV increases thus showing the improvement of its filling. Fluid infusion is not expedient at CVP increase higher than that of JPAP. In this case final increase of diastolic pressure in LV is leveled by higher rates of RV filling pressure and no increase LV filling is observed. Key words: right ventricle myocardium infarction; acute right ventricle insufficiency; treatment; right ventricle preload increase. References 1. Ганелина И.Е. Атеросклероз коронарных артерий и ишемическая болезни сердца / И.Е. Ганелина. – СПб.: «Наука», 2004. – 260 c. 2. Денисенко Б.А. Инфаркт миокарда правого и левого желудочков / Б.А. Денисенко, Г.А. Гольдберг, Ю.П. Дробышев. – Новосибирск, 1987. – 225 c. 3. Диагностика и лечение инфаркта правого желудочка / Г.А. Газарян, И.В. Захаров, Д.А. Чепкий, Н.М. Бикбова // Клиническая медицина. – 2007. – Т. 85. – № 6. – С. 67-70. 4. Показатели центральной гемодинамики у больных инфарктом миокарда обеих желудочков / А.В. Соплевенко [и др.] // Южно-Российский медицинский журнал. – 2000. – № 5-6. – С. 34-37. 5. Сыркин А.Л. Инфаркт миокарда. – 3-е изд., перераб. и доп. / А.Л. Сыркин. - М.: Мед. информ. агентство, 2003. – 466 с. 6. Comparative effects of volume loading, dobutamine, and nitroprusside in patients with predominant right ventricular infarction./ L.J. Dell'Italia, M.R. Starling, R. Blumhardt [et al.] // Circulation. – 1985. – Vol. 72. – P. 1327-1335. 7. Determinants of hemodynamic compromise with severe right ventricular infarction / J.A. Goldstein, B. Barzilai, T.L. Rosamond [et al.] // Circulation. – 1990. – Vol. 82. – P. 359-368. 8. Gandy W.E. Recognition and treatment of right ventricular myocardial infarction / W.E. Gandy // EMS Magazine. – 2008. – Vol. 37. – № 3. – P. 69-73. 9. Goldstein J.A. Pathophysiology and management of right heart ischemia / J.A. Goldstein // J Am Coll Cardiol. – 2002. – Vol. 40. – P. 841-853. 10. Goldstein J.A. Right versus left ventricular shock. A tale of two ventricles / J.A. Goldstein // J Am Coll Cardiol. – 2003. – Vol. 41. – P. 1280-1282. 11. Hemodynamics of volume loading compared with dobutamine in severe right ventricular infarction / M. Ferrario, A. Poli, M. Previtali, L. Lanzarini // Am J Cardiol. – 1994. – Vol. 74. – № 4. – P. 329-333. 12. Initial report of percutaneous right ventricular assist for right ventricular shock secondary to right ventricular infarction. / G.M. Giesler, J.S. Gomez, G. Letsou [et al.] // Catheter Cardiovasc Interv. – 2006. – Vol. 68. – № 2. – P. 263-266. 13. Piazza G. The acutely decompensated right ventricle: pathways for diagnosis and management / G. Piazza, S.Z. Goldhaber // Chest. – 2005. – Vol. 28. – № 3. – P. 1836 – 1852. 14. Romand J.A. Acute right ventricular failure, pathophysiology and treatment / J.A. Romand, F.A. Donald, P.M. Suter // Monaldi Arch Chest Dis. – 1995. – Vol. 50. – № 2. – P. 129-133. 15. Siniorakis E.E. Volume loading in predominant right ventricular infarction: bedside haemodynamics using rapid response thermistors / E.E. Siniorakis, N.I. Nikolaou, C.D. Sarantopoulos // European Heart Journal. – 1994. – Vol. 15. – № 10. – P. 1340-1347. 16. Wellens H.J.J. Right ventricular infarction / H.J.J. Wellens // N Engl J Med. – 1993. – Vol. 328. – № 8. – P. 1036-1038. Information about the authors: Sayganov Sergey Anatolievich – Assistant Professor of M.S.Kushakovsky Cardiology department of the St.-Petersburg Medical Academy for Post-Diploma Training of the Federal Agency on Public Health Services and Social Development. Теl.: 8(921) 948-40-93. E-mail: Sergey.Sayganov@spbmapo.ru; ssayganov@peterstar.ru Hurtsilava Otari Givievich – M.D., Professor, Rector of the St.-Petersburg Medical Academy for Post-Diploma Training of the Federal Agency on Public Health Services and Social Development. Accepted 17.09.2009 г. 1293 Шустер UDC 616.62-003.7-089:[616.69:616.153.49]-085.357 © P.I. Shuster, O.N. Tselebrovskaya, F.A. Sagidullin, 2010 Shuster P.I.1, Tselebrovskaya O.N.2, Sagidullin F.A.2 Hypogonadism androgen therapy efficacy and safety in patients with hyperuricemy and radically eliminated urolithiasis // Preventive and clinical medicine. – 2010. - № 1 (34). – Р.95-99. 1 State Educational Establishment of Higher Professional Training «Omsk State Medical academy of the Federal Agency for Public Health and Social Development of the Russian Federation», 644099, Omsk, Lenina str., 12, tel.: 8(381) 223-32-89. 2 State Educational Institution of the Higher Professional Education «Bashkir State Medical University», 450000, Ufa, Lenina str., 3, tеl/fax: 8(347) 272-37-51, е-mail: info@bgmy.ru Summary: As a result of research it has been revealed that androgenic therapy of elimination hypogonadism, improves not only the general condition and the sexual status of patients, but also reduces Lesch-Nyhan syndrome that is preventive maintenance urate urolithiasis. Kеy words:hypogonadism; urolithiasis. References 1. Аляев Ю.Г. Метафилактика мочекаменной болезни / Ю.Г. Аляев, А.В. Амосов, В.С. Саенко. - М., 2007. - 350 с. 2. Лопаткин Н.А. Пятнадцатилетний опыт применения ДЛТ в лечении МКБ / Н.А. Лопаткин, И.К. Дзеранов // Пленум правления Российского общества урологов. Материалы. - М., 2003. - С.5. 3. Назаров Т.Н. Метаболические нарушения при андрогеном дефиците у мужчин, страдающих уролитиазом / Т.Н. Назаров, В.В. Михайличенко, В.П. Александров // Материалы Российско-Кубинского андрологического Форума. 1-11 апреля 2008. -М., 2008. - С. 103. 4. Пытель Ю.А. Уратный нефролитиаз / Ю.А. Пытель, И.И. Золотарев. – М., 1995. - 176 с. 5. Реброва О.Ю. Статистический анализ медицинских данных. Применение пакета прикладных программ STATISTICA / О.Ю. Реброва. - М., 2002. - 312 с. Information about the authors: Shuster P.I. - Ph.D. (Medicine), senior lecturer of faculty surgery with an urology course, Omsk State Medical Academy, tel. 8(913)972-02-72, е-mail: ship-uro@yandex.ru Tselebrovskaya O.N. - competitor of a scientific degree of faculty of biological and bioorganic chemistry, Bashkir State Medical University, tel. 8(898)995-50-81, е-mail: eagletdinov@yandex.ru Sagidullin F.A. - Ph.D. (Medicine), senior lecturer of faculty of biological and bioorganic chemistry, Bashkir State Medical University, tel. 8(347)273-61-71, е-mail: eagletdinov@yandex.ru Accepted 16.10.2009 г. 1296 Ишинова UDC 616.89-008.441:612.843.3 © V.A. Ishinova, 2010 DYNAMIC OF TACTILE SENSITIYITY IN PATIENTS WITH PSYCHOGENIC PAIN DURING THE PSYCHICAL RELAXATION V. A. Ishinova The Institution of special psychology and pedagogy, Saint-Petersburg Ishinova V.A. Dynamics of tactile sensitivity in patients with psychogenic pain in the course of mental relaxation // Preventive and clinical medicine. – 2010. - № 1 (34). – Р.99-102. Non-state educational institution of higher vocational level «The Institution of special psychology and pedagogy» (NOY ISPiP), 194356, Saint-Petersburg, B. Ozernaia, 92 А, phone : 8-(812) 596-24-42, E-mail: vaishinova@yandex.ru Summary: In the present work there was conducted the research of dynamic of thresholds of tactile sensation during the psychical relaxation with psychogenic pain as exemplified by patients with anxiety phobic diseases versus patients, affected somatogenic pain, and healthy people. Assessment of patients’s psychophysiological state of both groups was being carried out in the beginning and at the end of psychological correction course. There was used the empatho-technique as method of psychical relaxation. Key words: anxiety phobic diseases, psychogenic pain, somatogenic pain, thresholds of tactile sensation, focused ultrasound, psychical relaxation, empatho-technique. The pain is one of the most popular and relevant complaint in clinic practice of the therapeutist. The problem of her control is important practical task. In order to choose adequate methods of therapy it is necessary to comprehend particularities of pathogenesis of pains disorders, of which general groups are somatogenic, psychogenic and neurogenic pain [5, 6, 1, 9]. Psychogenic pain is of the most interest, of which progression mechanism supposes the leading significance of negative emotional state, which initiate the pain in the absence of serious somatic diseases [4, 7, 1]. Therefore, determination of the leading pathogenetic mechanism, that is at the root of occurrence of pain syndrome, contributes the improvement of effectiveness of rendering assistance. In view of this the present work describes studying of changes of tactile sensitivity in patients with psychogenic pain as exemplified by anxiety phobic diseases during the psychological correction versus the patients with somatogenic pain. We have assumed that threshold of tactile sensation depend on sustained by the time of research feeling of internal and external irritants, that can change under the influence of stress factors. It was also expected that instability of excitative process, that is linked with psychoemotional stress, must be in the picture of alteration of wavering of threshold of tactile sensation during the psychological correction with psychic relaxation’s application. T h e p u r p o s e o f s t u d y. Study of the interrelationship between the intensity of painful, the intensity of negative emotional state and tactile sensitivity of patients with anxiety phobic diseases. Materials and methods of research. Research was carried out for 42 patients with anxiety phobic diseases (11 men and 31 woman ) with cephalagia, abdominal, vertebra pains, which had psychogenic nature (Group 1). Patients with anxiety phobic diseases had complaints on high anxiety, obsession fears, anxiety, sleep disturbance. As a control group there was researched: - 30 persons (22 women and 8 men) with somatogenic pain (group 2). They had complaints about cephalgia (craniocerebral trauma in parity), abdominal (there was educed cholelithiasis) and vertebragenous pain (there was found thoracic and cervical spine osteochondrosis). Patients was examined in the clinic № 45 of SPb, where were made relevant diagnoses. - 54 healthy subjects (40 women and 14 men), who didn’t have neurosal and somatic complaints and presented the group «conditionally healthy persons». An average age of researched persons was 34, 07±1,41. Psychological testing was conducted at the beginning and end of the course of psychological correction. There were used the anxiety scale of Spielberg-Chanin and scales of enquirer of psychopathologic symptomatic SCL-90-R [10] for assessment of emotional state. Pain intensity was identified by the scale «pain» from an enquirer of life quality MOS SF-36 [8]. Therewith the factor was the better, the higher. All enquirers are validated. There was used the plant consisted of the generator and focalizing ultrasonic source (frequency of focused ultrasound 1,7MHz) for tactile sensitivity research [4]. Thresholds of tactile sensitivity ware determined on the skin of terminal phalange of right arm forefinger. For that end the finger was placed on the room-temperature water surface in such way that the medium of phalange of forefinger was in the center of focalizing source. Impulse intensity was taken as the threshold of tactile sensation, that conveyed a tactile sensation not less than 2 times during 3 presentation. The tactile sensitivity was researched with persons of all groups: 1. healthy people – before and after one psychical relaxation session; 2. patients with ТФР and persons with somatogenic pain – before and after every psychical relaxation session during the whole course of psychological correction. There were taken measures for analysis that was got before and after the first empatho-techniques session and also before and after lat session. There was used psychical relaxation method (empatho-techniques) for management of psychogenic pain and leveling of negative emotional state, that presented in detail in the previous work [2, 11]. Statistical processing of the data obtained was carried out using the STATISTICA v 5.5 computer program. R e s u l t s a n d d i s c u s s i o n At the beginning of the course of psychological correction patients with APD had the pronounced pain (56,86±4,12), whose factor was credibly (p < 0.01) lower than in the group of healthy subjects (77.57±2,56) and credibly (p < 0.05) higher than in the group of subjects with somatogenic pain (41,3±3,59). Pain senses of the patients with APD were accompanied by excessive values of the questionnaire SCL-90-R on all scales and high level of ЛТ (Table 1). In most cases all found factors were credibly (р < 0,01) higher that for the patients with somatogenic pain (Table 1). Empatho-techniques use permitted to improve the emotional state of the patients of both groups, that conduced to decrease of the intensity of the pain. Thus at the end of psychological correction course there was the credible (p<0,001) decrease of pain intensity (78,21±2,93) in the group of patients with the APD, whose factor didn’t have credible difference from healthy subjects factor versus patients of group 2 (50,27±2,62). Patients with somatogenic pain had continued to feel pain against the end of course, that can be linked with the particularities of mechanisms of psychogenic and somatogenic pain formation. Table 1 Average values of checklist factors SCL-90-R, trait (ЛТ) and reactive (РТ) anxiety in the group of patients with the anxiety phobic disorders (group 1), patients with somatogenic pain (group 2) before and at the end of psychological correction course and group of healthy subjects.
СOM – Comatization; O-C – Obsessive-Compulsive disorders; INТ – Interpersonal Sensitivity; DEP – Depression; ANX – Anxiety; HOS – Hostility; PHOB – Phobic Anxiety. Against the end of the psychological correction course there was noted credible (р < 0,01) decrease of all researched factors in the group of patients with psychogenic and somatogenic pain. However their average values at the group of patients with APD and subjects with somatogenic pain didn’t have credible differences but were credibly different from healthy subjects factors (Table 1). The research of thresholds of tactile sensitivity indicates that their average values didn’t have credible differences in all researched groups before and after the empatho-technic session in the beginning and at the end of the psychological correction course (Diagram 1).  D   iagram 1. Average values of absolute thresholds tactile sensitivity before(   ) and after ( ) empatho-techniques session for healthy subjects (1), for patients with anxiety phobic diseases before and after first session of psychological correction (2 a), before and after last session of psychological correction (2 b); for patients with somatogenic pain before and after first session (3 а), before and after last session of psychological correction (3 b) . dB – measurement units of the thresholds of tactile sensitivity in dB for patients; . – before empatho-techniques session; - after empatho-techniques session.However by comparison with group of healthy people there were revealed credibly (p < 0,05) higher values in the subjects with psychogenic and somatogenic pain in the beginning of the psychological correction course, and in subjects only with somatogenic pain at the end of the course, that can be determined by differences in mechanisms of psychogenic and somatogenic pain formation (Diagram 1). For research of the intensity of the thresholds of tactile sensation changes we were defining the difference between factors of absolute thresholds of tactile sensation got before the empatho-technic session and after that for every studied subject, and specified that difference as delta (│∆│, dB). ∆1 complied with 2,56±0,33 dB in patients with APD before psychological correction that was credibly higher than in subjects with somatogenic pain (1,37±0,18 dB) and healthy people (1,23±0,12 dB). ∆2 complied with 1,57±0,21 dB in patients with APD at the end of the course that was credibly higher than in subjects with somatogenic pain (0,90±0,15 dB) but came around to delta value of healthy people (Diagram 2).  Diagram 2. Delta average values in the healthy subjects (1), in patients with anxiety phobic diseases before psychological correction (2а), after psychological correction (2b), in patients with somatogenic pain before psychological correction (3a), after psychological correction (3b). dB - measurement units of the thresholds of tactile sensation in dB. Conclusion. Therefore, according to received results, there was found that pain of high intensity in the patients of both groups was accompanied by negative emotional states and expressed increase of tactile sensation delta before psychological correction. Negative emotional states leveling contributed to psychogenic pain management and credible decrease of tactile sensation delta at the end of the course that can argue about recovery of regulatory processes and correlation of the central and peripheral tactile sensation links and reflect the optimization of the CNS functional status indirectly. Thus, according to earlier researches there was noted the reduction of the neurodynamic processes fluctuation in terms of brain bioelectrical activity (BEA) and the reduction of excitative processes expression according to the data from driving rhythm of the photostimulation in the patients with APD [2]. Correlation relationships analysis showed that the pain of subjects with APD was interrelated with the scale «somatization» factor as corporal equivalent of anxiety, and tactile sensation delta – with the aggression factor. The pain factor of subjects with somatogenic pain was correlated with interindividual sensation factor, the pain factor of healthy subjects – with depression. Conclusions
References
Information about the author: Ishinova Vera Alexandrovna – candidate of psychology science, senior lecturer of the Institute of special pedagogy and psychology, work phone: (8-812) 752-67-14, home telephone: (8-812) 534-2018, e-mail: vaishinova687@yandex.ru signature Accepted 02.10.2009 г. 1302 Галеев UDC 616.37-002-07 © Sh.I. Galeev, M.E. Topuzov, M.A. Rubtsov, 2010 Galeev Sh.I.1, Topuzov M.E.1, Rubtsov M.A.2 Prognosis of severe acute pancreatitis // Preventive and clinical medicine. – 2010. - № 1 (34). – Р.102-105. 1State Educational Establishment of Higher Professional Training «Mechnikov Saint-Petersburg State Medical Academy of the Federal Agency for Public Health and Social Development of the Russian Federation», 195067, St.- Petersburg, K-67, Piskarevsky prospect, 47, tel. (812) 543-96-09, fax: (812) 140-15-24, e-mail: mechnik@gmail.com; mechnik@westcall.net; www.mechnik.spb.ru 2State administration on Public Health Services “Clinical Hospital of Prelate Luka (Prof. of Medicine Voyno-Yasenetsky)", St.-Petersburg, Chugunnaya str., 46, tel.: 8(812) 328-99-58, fax: 8(812) 540-12-38. Summary: The clinically based Atlanta Classification was formulated in 1992, but in recent years it has been increasingly criticized. No formal evaluation of the use of the Atlanta definitions of predicted severe pancreatitis in the literature has ever been performed. We have performed such analysis and concluded: complex evaluation of different laboratory and instrumental data is more reliable instrument than conventional APACHE II ≥ 8. Key words: acute pancreatitis; severe pancreatitis; Atlanta criteria of severity. References 1. Савельев В.С. Деструктивный панкреатит: алгоритм диагностики и лечения (проект, составленный по материалам IX Всероссийского съезда хирургов, 20-22 сентября, Волгоград) / В.С. Савельев, М.И. Филимонов, Б.Р. Гельфанд // Consilium medicum. – 2000. – №2. – 5 с. 2. Данилов М.В. Дискуссионные вопросы хирургии острого деструктивного панкреатита / М.В. Данилов // Анналы хирургической гепатологии. – 2001. – Т.6. – С. 125-130. 3. Balthazar E.J. Acute pancreatitis: Assessment of severity with clinical and CT evaluation / E.J. Balthazar // Radiol. – 2002. – Vol. 223. – P. 603-613. 4. Beger H.G., Rau B.M. Severe acute pancreatitis: clinical course and management / H.G. Beger, B.M. Rau // World J. Gastroenterol. – 2007. – Vol. 13. – P. 5043-5051. 5. McKay C.J. Natural history of organ failure in acute pancreatitis / C.J. McKay, A. Buter // Pancreatol. – 2003. – Vol. 3. – P. 111-114. 6. Neoptolemos J.P. Early prediction of severity in acute pancreatitis by urinary trypsinogen activation peptide: a multicentre study / J.P. Neoptolemos, J.M. Mayer, E.A. Kemppainen // Lancet. – 2000. – Vol. 355. – P. 1955-1960. 7. Rau B.M. Outcome determinants in acute pancreatitis / B.M. Rau // Am. J. Surg. – 2007. – Suppl. to October. – P. S39-S44. 8. Uhl W. IAP guidelines for the surgical management of acute pancreatitis / W. Uhl, A. Warshaw, C. Imrie // Pancreatol. – 2002. – Vol. 2. – P. 565-573. Information about the authors: Galeyev Shamil Ibragimovich - Assistant, the department of Surgical Diseases with the course of Children Surgery of I.I.Mechnikov St.-Petersburg State Medical Academy, tel.: 8(921) 915-70-10, e-mail: shamilgaleev@yandex.ru Topuzov Marlen Eskenderovich – M.D., department of Urology of I.I.Mechnikov St.-Petersburg State Medical Academy, tel.: 8(921) 915-70-10, e-mail: martop@mail.ru Rubtsov Michail Aleksandrovich – head of the Surgical department of the clinical hospital of Prelate Luka (Prof. of Medicine Voyno-Yasenetsky), tel.: 8(812) 328-99-58, e-mail: rubtsovmich@yandex.ru Accepted 16.10.2009 г. |
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