[Tuberculous abdominal cocoon as a rare variant of peritonitis]. / Osumkovyvayushchii tuberkuleznyi perivistserit kak redkii variant peritonita.

OBJECTIVE: To study and systematize clinical symptoms of tuberculous perivisceritis, to clarify diagnostic value of laboratory and instrumental survey in these patients and to identify the features of surgical treatment. MATERIAL AND METHODS: There were 8 patients with tuberculous perivisceritis. Examination included computed tomography of the abdominal cavity and chest, ultrasound, laparoscopy. All patients underwent surgical treatment with histological, cytological, microbiological and molecular genetic analysis of peritoneal exudate and biopsy of peritoneal specimens. RESULTS: Clinical picture of tuberculous perivisceritis is variable and non-specific. Periods of exacerbation are replaced by periods of prolonged remission. The complex of radiological survey used in verification of perivisceritis does not allow accurate determining the nature of disease. However, peritoneal tuberculosis may be suspected as a rule considering signs of thickening of the peritoneum. Objective confirmation of perivisceritis is possible only during surgical intervention. In this case, etiological factor can be established only after a thorough histological examination of resected fibrous capsule. CONCLUSION: Clinical picture of tuberculous perivisceritis does not have specific symptoms. The disease is characterized by prolonged and undulating course. Acute peritonitis and acute intestinal obstruction may be suspected during exacerbation of the pathological process. Laparotomy followed by complete excision of fibrous capsule and adhesiolysis is preferred.

[Gallstone ileus: diagnosis and treatment]. / Zhelchnokamennaia kishechnaia neprokhodimost': voprosy diagnostiki i lecheniia.

AIM: To analyze informative value of radiological diagnosis of acute gallstone ileus. MATERIAL AND METHODS: There were 7 patients with acute gallstone ileus who underwent diagnostic abdominal X-ray examination, ultrasonography and computed tomography. RESULTS: There was high informative value of CT for acute gallstone ileus if it was applied within the first hours after admission. At the same time other diagnostic approaches were less informative. CONCLUSION: CT within emergency diagnostic algorithm is able to optimize diagnostic process, to clarify the cause of acute ileus and to promptly determine the indications for video-assisted surgery.

[Tuberculous peritonitis. 'Forgotten' disease]. / Tuberkuleznyi peritonit. 'Zabytaia' bolezn'.

AIM: To analyze diagnosis and treatment of patients with tuberculous peritonitis, to develop the algorithms for instrumental examination and differential diagnosis. MATERIAL AND METHODS: There were 48 patients with tuberculous peritonitis. The examination included radiography, abdominal and thoracic computed tomography, ultrasound, and laparoscopy. All patients underwent histological, cytological, microbiological and molecular-genetic analysis of abdominal exudate and peritoneal biopsy. Exclusion criterion was signs of secondary peritonitis. RESULTS: Clinical picture of tuberculous peritonitis was accompanied by nonspecific symptoms. Previously identified pulmonary tuberculosis and HIV-infection were present in 93.8 and 70.8% of patients. Diagnostic laparoscopy of abdominal cavity as the main method of instrumental diagnosis together with cytological, molecular-genetic and microbiological research of peritoneal exudate and tissue specimens were useful to determine diagnosis in 87.2-95.8% of cases. CONCLUSION: Tuberculous peritonitis may be assumed in patients with previous tuberculosis of lungs or other localizations, HIV-infection. Computed tomography is the most informative method to diagnose tuberculous peritonitis. Diagnostic laparoscopy is indicated for suspected tuberculous peritonitis. This procedure is supplemented by peritoneal biopsy, cytological, molecular-genetic and microbiological examination of peritoneal exudate and tissue specimens.

[Diagnosis and treatment of gallstone intestinal obstruction]. / Diagnostika i lechenie zhelchnokamennoi tonkokishechnoi neprokhodimosti (s kommentariem).

AIM: To analyze informative value of radiological examination in diagnosis of acute gallstone intestinal obstruction. MATERIAL AND METHODS: Diagnosis and treatment of 7 patients with acute gallstone intestinal obstruction have been analyzed. Diagnostic protocol included radiography of abdominal cavity, sonography and computed tomography. RESULTS: Computed tomography within the first hours after hospitalization is highly informative to diagnose gallstone intestinal obstruction if other methods are ineffective. CONCLUSION: Inclusion of computed tomography into survey algorithm optimizes diagnostic process, clarifies the cause of acute intestinal obstruction and promptly determines the indications for video-assisted surgery.

[The application of the system of «reminder stickers¼ for the rehabilitation programs with the use of behavioural therapy for the patients presenting with anxiety disorders]. / Sistema stikernykh napominanii v programmakh reabilitatsii s primeneniem povedencheskoi terapii u patsientov s trevozhnymi rasstroistvami.

UNLABELLED: This article was designed to report the results of research on the effectiveness of the new original «reminder stickers¼ technique proposed by the authors for the management of the patients undergoing rehabilitation based on behavioral therapy. The essence of this technique consists of providing the patients with systematic reminders of the need to implement skills aimed at coping with maladaptive sensations that accompany anxiety disorders. AIM: The objective of the present study was to evaluate the effectiveness of using the «reminder stickers¼ technique for the formation of stable responses to the correction of the target clinical symptoms. PATIENTS AND METHODS: The study involved 118 patients suffering from anxiety disorders allocated to two groups for comparison. Group 1 was comprised of the patients (n=76) given the reminders while group 2 contained those (n=42) not included in the system of «reminder stickers¼. The difference between the parameters of interest in the two groups was estimated with the use of Mann-Whitney and Kolmogorov-Smirnov tests. RESULTS: The analysis of diary records of the patients was used to evaluate the frequency of occurrence of maladaptive sensations that required the application of the appropriate behavioural skills and the frequency of the missed or delayed responses as well as the level of subjective satisfaction of the patients with the stability of the acquired skills. It was shown that the patients given «reminder stickers¼ significantly more frequently reported situations that required the application of the appropriate skills within the first week after the initiation of monitoring than the patients of group 2 (р<0,0001). The frequency of the missed or delayed responses in these patients was significantly lower than in group 2 (р<0,0001) whereas the degree of subjective satisfaction with the stability of the acquired skills was much higher (р<0,0001). These differences persisted during week 2 after the onset of monitoring when the frequency of maladaptive sensations that required the application of the previously formed behavioural skills of therapeutic significance in the patients given «reminder stickers¼ remained lower than in the patients to whom no such «remainders¼ were provided (р=0,001). The frequency of the missed or delayed responses in these patients decreased significantly in comparison with that in group 2 (р<0,0001),) while the degree of subjective satisfaction of the patients with the stability of the acquired skills further increased (р<0,0001). CONCLUSION: The results of the study indicate that inclusion of «reminder stickers¼ in the structure of cognitive-behavioral therapy at the stages of formation of the skills needed to cope with maladaptive sensations enhances the ability of the patients presenting with anxiety disorders to much more often timely identify situations that require the use of the appropriate behavioural skills and to apply them. It is concluded that the application of the original «reminder stickers¼ technique ensures an adequate response of the patients to maladaptive sensations that accompany anxiety disorders.

[Polyclinic of the Branch N 6 of the 3rd Vishnevskiy Central Military Hospital celebrates the 40 years anniversary].

Polyclinic of the Branch N 6 of the 3rd Vishnevskiy Central Military Hospital celebrates the 40 years anniversary. The history of development^of the policlinic of the branch N 6 of the Federal Government Budgetary Institution <> of the Ministry of Defence, which dates back to 1976, when the 9th clinic of the Moscow garrison was formed. Over the years, repeatedly changed the organizational and staff structure and the name of the clinic (9" consultative-diagnostic polyclinic, polyclinic of the 52,d Consultative Diagnostic Centre MF), continuously improved patient care technology. Currently, the clinic deployed 26 medical-diagnostic branches and offices, with more than 200 employees. Among them, 1 Honoured doctor, 5 candidates of medical sciences, 50% of doctors and 65% of nurses have the highest qualification category. To health care is more than 22 thousand people.

Wild bird surveillance around outbreaks of highly pathogenic avian influenza A(H5N8) virus in the Netherlands, 2014, within the context of global flyways.

Highly pathogenic avian influenza (HPAI) A(H5N8) viruses that emerged in poultry in east Asia since 2010 spread to Europe and North America by late 2014. Despite detections in migrating birds, the role of free-living wild birds in the global dispersal of H5N8 virus is unclear. Here, wild bird sampling activities in response to the H5N8 virus outbreaks in poultry in the Netherlands are summarised along with a review on ring recoveries. HPAI H5N8 virus was detected exclusively in two samples from ducks of the Eurasian wigeon species, among 4,018 birds sampled within a three months period from mid-November 2014. The H5N8 viruses isolated from wild birds in the Netherlands were genetically closely related to and had the same gene constellation as H5N8 viruses detected elsewhere in Europe, in Asia and in North America, suggesting a common origin. Ring recoveries of migratory duck species from which H5N8 viruses have been isolated overall provide evidence for indirect migratory connections between East Asia and Western Europe and between East Asia and North America. This study is useful for better understanding the role of wild birds in the global epidemiology of H5N8 viruses. The need for sampling large numbers of wild birds for the detection of H5N8 virus and H5N8-virus-specific antibodies in a variety of species globally is highlighted, with specific emphasis in north-eastern Europe, Russia and northern China.

[Molecular-genetic methods for diagnostics of tumour growth].

Considerable progress has recently been achieved in understanding molecular medicine in general and vell molecular biology in particular. Molecular medicine is a scientific discipline studying man under normal condition and pathological changes at the cellular-molecular level with reference to gene activity and function of protein mediators responsible for delivery of information to various organs or systems of the body and cell-to-cell interaction.

[Brent goose colonies near snowy owls: internest distances in relation to breeding Arctic fox densities].

This study was conducted in 2005 near Medusa Bay (73 degrees 21' N, 80 degrees 32' E) and the delta of the Pyasina River (74 degrees 10' N, 86 degrees 45' E), northwest of the Taimyr Peninsula. It was shown that in the years when the numbers of the Arctic foxes are high, even though the lemming numbers are high as well, Brent geese nest considerably closer to owls' nests than in the years with low Arctic fox numbers. At values of the Arctic fox densities greater than one breeding pair per 20 km2, the factor of lemming numbers ceases to affect the distance between owl and geese nests. This distance becomes dependent on the Arctic fox density (numbers). When the Arctic fox density is greater than the pronounced threshold, the owl-Brent internest distance is inversely and linearly related to the Arctic fox density.

[Mechanisms of the uncomplicated wound healing in patients with ventral hernia].

84 patients operated on middle ventral hernia with the use of different methots of implantation and types of mesh implants were included in the study. All patients received the thoriugh US-investigation after the operation. The sublay hernia plasty proved to be the best reconstruction method, demonstrating lesser tissue exudation. The onlay plasty should be preserved only for cases of hernioplasty when the use of sublay technique is impossible.

[The ultrasound semiotics of uncomplicated wound healing after inguinal mesh plastics].

Dynamic ultrasound (US) investigation was performed in 89 patients operated on inguinal hernia with the use of meshes of various type. The US scanning proved to be a highly informative means of visualization, allowing the objective postoperative assessment of muscular and aponeurotic structures as well as the implant form and position. The study showed, that the mesh implantation was always accompanied by the exudative tissue reaction, which was determined by the physico-chemical characteristics of the implant.

[Red-breasted goose colonies on the Taimyr Peninsula: factors responsible for the proximity of goose nests to nests of peregrine falcons, rough-legged buzzards, and snowy owls].

Red-breasted goose colonies have been studied near Medusa Bay (73 degrees 21' N, 80 degrees 32' E), on the northwestern Taimyr Peninsula, and along the Agapa River (70 degrees 11' N, 86 degrees 15' E) down to its mouth (70 degrees 26' N, 89 degrees 13' E), in the central Taimyr Peninsula. Red-breasted geese nesting near peregrine falcons are protected by the falcons from arctic foxes; however, they are sometimes attacked by the falcons themselves. In the colonies near peregrine falcon nests, the vast majority of goose nests were situated no farther than 100 m from the falcon nest. When food is abundant, falcons protect a larger area around their nest. The distance between the falcon nest and the surrounding goose nests is inversely related to the falcon's activity. In years of higher falcon activity, falcons prevent red-breasted geese from nesting as close to their nest as in years of lower falcon activity. Additional stimuli are required for red-breasted geese to form colonies near rough-legged buzzard nests. The distance between snowy owl nests and red-breasted goose nests was smaller when arctic foxes were abundant than when they were scarce.

[White-fronted and bean geese breeding near snowy owls, peregrine falcons, and rough-legged buzzards at the Taimyr Peninsula].

Studies were carried out in 2000-2007 near Medusa Bay (73.21' N, 80.32' E) and along the Agapa River (from 70 degrees 11', 86 degrees 15' E. down to the mouth 71 degrees 26' N, 89 degrees 13' E), in the northwestern and central parts of the Taimyr Peninsula. White-fronted goose nests are usually spread in the tundra or placed in 1-3 nest colonies near nests or staging points of snowy owls, peregrine falcons, or rough-legged buzzards. The intent of white-fronted geese to breed near birds of prey or owls increases sharply when arctic fox numbers are high. In the area near Medusa Bay, white-fronted geese nest much closer to peregrine falcon nests than in the area along the Agapa River. At the latter location, white-fronted geese lose the competition to red-breasted geese, which are more numerous here. Bean geese, in spite of their greater size and ability to protect their nests against arctic foxes, really tend to breed near peregrine falcons or buzzards, where they manage to compete with red-breasted geese.

[Interpretation of the epizootic outbreak among wild and domestic birds in the south of the European part of Russia in December 2007].

The paper presents the results of interpreting the epizootic outbreak etiologically associated with high-virulent influenza virus A/H5N1 among domestic and wild birds in the Zernogradsky and Tselinsky districts of the Rostov Region. Epizooty was characterized by a high infection rate in the synanthropic birds of a ground-based complex. RT-PCT revealed influenza virus A/H5 in 60% of pigeons and crows and in around 20% of starlings, and in 10% of tree sparrows. Fifteen viral strains from chickens (Gallus gallus domesticus), Indian ducks (Cairina moschata), rooks (Corvus frugilegus), rock pigeons (Columba livia), tree sparrows (Passer montanus), common starlings (Sturnus vulgaris), and great white herons (Egretta alba) were isolated and deposited in the State Collection of Viruses of the Russian Federation. Full-sized genomes of 5 strains were sequenced and deposited in the international database GenBank. The isolated strains belong to the Quinhai-Siberian (2.2) genotype, an Iranian-Northern Caucasian subgroup, they are phylogenetically closest to the strain A/chicken/Moscow/2/2007 (inducing epizooty among poultry in the near-Moscow Region in February 2007) and have 13 unique amino acid replacements as the consensus of the Quinhai-Siberian genotypes in the proteins PB2, PA, HA, NP, NA, and M2, by preserving thereby 4 unique replacements first describes for the strain A/chicken/Moscow/2/2007. The findings are indicative of a different mechanism that is responsible for bringing the virus into the northeastern part of the Azov Sea area in September 2007 (during the fall migration of wild birds) and in December 2007 in the south-western Rostov Region where a human factor cannot be excluded. Mass infection of synanthropic birds endangers the further spread of epizooty, including that in the central regions of the Russian Federation in spring after near migrants return after wintering.

Feasibility and interpretation of FE(NO) measurements in asthma patients in general practice.

BACKGROUND: Exhaled NO (FE(NO)) is a useful biomarker for the monitoring of asthma control and response to therapy. However, there is a lack of data on FE(NO) levels and their interpretation in Primary Care asthma population depending on their treatment and smoking habit. Besides, the majority of current FE(NO) tests have been done by stationary chemiluminescence analysers whose use is limited to research laboratories. METHODS: FE(NO) measurements by the novel hand-held NO monitoring device (NIOX MINO) were made in 96 asthma patients (32 males, mean age 53+/-12) at five local General Practices during their scheduled 15-20 min visits for lung function assessment. RESULTS: Success rate was 78% and the intra-subject coefficient of variation was 8.7%. Inhaled corticosteroid treatment had an overall reducing effect on the FE(NO) value (30.5 [19.8-49.8]) vs. patients not on the ICS (26.5 [19-94]) (p<0.044). FE(NO) levels in the ICS treated current or ex-smokers group of patients were still significantly above the normal values (p<0.0001). FE(NO) levels were similar in patients receiving ICS whether there were current, ex-smokers or non-smokers. The highest FE(NO) levels (94 [15.8-151]) were found in asthmatic current smokers and not receiving treatment with ICS. The most "normalised" FE(NO) levels (35.3 [13.5-35.3]) were seen in ex-smokers. CONCLUSIONS: FE(NO) measurements performed with a new hand-held monitoring device are reproducible and feasible in General Practice in the majority of patients of different ages and asthma severities. A high percentage of patients with different severities of asthma and regardless of their treatment with ICS and current smoking habit (current and/or ex-smokers) had highly elevated FE(NO) values, suggesting that their current therapy was possibly insufficient to control the underlying degree of airway inflammation and asthma symptoms.

[Brant goose colonies near snowy owls: internest distances in relation to lemming and arctic fox abundance].

Brant goose colonies around snowy owl nests have been studied near Meduza Bay (73 degrees 21' N, 80 degrees 32' E) and in the lower reaches of the Uboinaya River (73 degrees 37' N, 82 degrees 10' E), the northwestern Taimyr Peninsula, from 1999 to 2006. All brant nests within 680 m from an owl nest have been regarded as an individual colony. The results show that the area of the colony is always larger than the guarded area around the owl nest. In years of high abundance of lemmings, brant geese nest generally closer to the owl nest than in years of high abundance. When arctic foxes are abundant, however, brant geese nest significantly closer to owls than when the foxes are scarce, irrespective of lemming abundance. The mechanism of brant colony formation around owl nests is based on a number of stimuli.

Real-time measurement of particulate matter deposition in the lung.

Air pollution and cigarette smoke are recognized health risks. A method was developed for the measurement of the deposition fraction (DF) of polydisperse particulate matter (PM) in human airways. Ten normal volunteers [three females, age range 18-67 years, mean age (SD) 43.9 (14)] made single breath exhalations after inhalation to total lung capacity. The exhaled breath was diverted to a multichannel laser diffraction chamber where the particulate profiler measured 0.3 - 1.0-microm particles. DF was inversely related to expiration flow-rate, 0.69 (0.02) at 4 l min-1 and 0.5 (0.01) at 13 l min-1, respectively (p<0.05), and was influenced by the inhalation flow-rate [0.70 (0.02) at 3 l min-1 and 0.59 (0.02) at 13 l min-1, respectively (p<0.05)], while no differences were found between nasal and oral inhalation (0.68 (0.05) versus 0.67 (0.06), p>0.05). Higher breath holding times were associated with elevated DF [0.74 (0.02) at 20 s, and 0.62 (0.05) without breath holding (p<0.01)]. When the expiratory flow was controlled and the breath hold time standardized, DF was reproducible (CV = 4.85%). PM can be measured in the exhaled breath and its DF can be quantified using a portable device. These methods may be useful in studies investigating the health effects of air pollution and tobacco smoke.

Effects of cyclo-oxygenase inhibition on exhaled eicosanoids in patients with COPD.

BACKGROUND: Leukotriene (LT) B4 concentrations are increased and prostaglandin (PG) E2 concentrations are decreased in exhaled breath condensate (EBC) in patients with chronic obstructive pulmonary disease (COPD). A study was undertaken to investigate the short term effects of cyclo-oxygenase (COX) inhibition on exhaled LTB4 and PGE2 concentrations in patients with COPD and to identify the COX isoform responsible for exhaled PGE2 production. METHODS: Two studies were performed. A double blind, crossover, randomised, placebo controlled study with ibuprofen (400 mg qid for 2 days), a non-selective COX inhibitor, was undertaken in 14 patients with stable COPD, and an open label study with oral rofecoxib (25 mg once a day for 5 days), a selective COX-2 inhibitor, was undertaken in a different group of 16 COPD patients. EBC was collected before and after drug treatment. Exhaled LTB4 and PGE2 concentrations were measured with specific immunoassays. RESULTS: All patients complied with treatment as indicated by a reduction in ex vivo serum thromboxane B2 concentrations (ibuprofen) and a reduction in lipopolysaccharide induced increase in ex vivo plasma PGE2 values (rofecoxib) of more than 80%. Exhaled LTB4 was increased after ibuprofen (median 175.5 (interquartile range 128.8-231.5) pg/ml v 84.0 (70.0-98.5) pg/ml, p < 0.001) and exhaled PGE2 was reduced (93.5 (84.0-105-5) pg/ml v 22.0 (15.0-25.5) pg/ml, p < 0.0001). Rofecoxib had no effect on exhaled LTB4 (p = 0.53) or PGE2 (p = 0.23). CONCLUSIONS: Non-selective COX inhibition decreases PGE2 and increases LTB4 in EBC, whereas selective COX-2 inhibition has no effect on these eicosanoids. PGE2 in EBC is primarily derived from COX-1 activity, and COX inhibition may redirect arachidonic acid metabolism towards the 5-lipoxygenase pathway.

Exhaled nitric oxide from lung periphery is increased in COPD.

Single constant flow exhaled nitric oxide (eNO) cannot distinguish between the sources of NO. The present study measured eNO at multiple expired flows (MEFeNO) to partition NO into alveolar (Calv,NO) and bronchial (Jaw,NO) fractions to investigate peripheral lung contribution to eNO in chronic obstructive lung disease (COPD). MEFeNO were made in 81 subjects including 18 nonsmokers, 16 smokers and 47 COPD patients of different severity by the classification of the Global Initiative for Chronic Obstructive Lung Disease (GOLD): 0 (n = 14), 1 (n = 7), 2 (n = 11), 3 (n = 8) and 4 (n = 7). COPD severity was correlated with an increased Calv,NO regardless of the patient's smoking habit or current treatment. The levels of Calv,NO (in ppb) were 1.4+/-0.09 in nonsmokers, 2.1+/-0.1 in smokers categorised as GOLD stage 0 (smokers-GOLD0), 3.3+/-0.18 in GOLD1-2 and 3.4+/-0.1 in GOLD3-4. Jaw,NO levels (pL x s(-1)) were higher in nonsmokers than smokers-GOLD0 (716.2+/-33.3 versus 464.7+/-41.8), GOLD3-4 (609.4+/-71). Diffusion of NO in the airways (Daw,NO pL x ppb(-1) s(-1)) was higher (p<0.05) in GOLD3-4 than in nonsmokers (15+/-1.2 versus 11+/-0.5) and smokers-GOLD0 (11.6+/-0.5). MEFeNO measurements were reproducible, free from day-to-day and diurnal variation and were not affected by bronchodilators. In conclusion, chronic obstructive pulmonary disease is associated with elevated alveolar nitric oxide. Measurements of nitric oxide at multiple expired flows may be useful in monitoring inflammation and progression of chronic obstructive pulmonary disease, and the response to anti-inflammatory treatment.

Supplementary oxygen in healthy subjects and those with COPD increases oxidative stress and airway inflammation.

BACKGROUND: Hyperoxia increases oxidative stress through the generation of reactive oxygen species and may therefore enhance inflammation in the lungs. The aim of this study was to investigate whether short term supplementary oxygen (28%) increases oxidative stress and inflammation in the airways by measuring 8-isoprostane and interleukin 6 (IL-6) concentrations in exhaled breath condensate. METHODS: Twenty three healthy subjects (12 men, mean (SD) age 48 (7) years) and 23 patients with chronic obstructive pulmonary disease (COPD; 15 men, mean (SD) age 56 (5) years) were studied. 8-isoprostane and IL-6 concentrations were measured by immunoassay. RESULTS: Increased concentrations of 8-isoprostane and IL-6 were found in all subjects after breathing 28% oxygen for 1 hour. In healthy subjects the concentrations of 8-isoprostane and IL-6 were 10.9 (2.9) pg/ml and 4.9 (0.8) pg/ml, respectively, compared with baseline concentrations of 6.1 (1.3) pg/ml and 2.9 (0.6) pg/ml, and in patients with COPD the concentrations were 27.9 (3.1) pg/ml and 8.3 (1.2) pg/ml), respectively, compared with baseline concentrations of 18.9 (3.6) pg/ml and 6.3 (0.6) pg/ml. By contrast, breathing air through the same face mask for 1 hour had no significant effects on 8-isoprostane or IL-6 concentrations in normal subjects or those with COPD. CONCLUSIONS: These findings suggest that short term supplementary oxygen may enhance oxidative stress and inflammation in the airways. Whether this happens with long term oxygen therapy needs to be determined.