Modern approaches to management of cardiovascular risk factors at patients with diabetes mellitus type 2.

Diabetes mellitus (DM) type 2 is the serious progressing chronic disease representing independent risk factor of development of cardiovascular complications. The mortality from cardiovascular diseases at the persons suffering from DM type 2 continues to grow around the world, despite constant augmentation of expenses on treatment and prophylaxis. In this article factors of cardiovascular risk at DM are analyzed and possible ways of their correction are surveyed.

[Ultrasound duplex scanning in the assessment of the effectiveness of gravitation therapy and conservative treatment of patients with atherosclerosis obliterans of the lower extremities]. / Pokazateli ul'trazvukovogo dupleksnogo skanirovaniia v otsenke éffektivnosti gravitatsionnoi terapii i konservativnogo lecheniia bol'nykh obliteriruiushchim aterosklerozom arterii nizhnikh konechnostei.

Ultrasound duplex scanning was used to compare the results of the treatment of 162 patients suffering from atherosclerosis obliterans of the lower extremities. It is to be noted that 50 patients were administered only gravitation therapy, 72 patients underwent a complex of treatment measures including, in addition to gravitation therapy, physiotherapy and drug treatment, and 40 patients received conservative treatment alone. The assessment criteria were the maximal systolic velocity of blood flow (V(max)), end diastolic mean, velocity (V(min)), mean maximal velocity (V(mean)), volume velocity of blood flow (V(vol)), ankle/brachial index (ABI), and index of regional perfusion (IRP), proposed by us and representing the percent ratio of the volume velocity of blood flow to the minute heart volume (MHV). It has been revealed in the course of the treatment that the best clinical outcome was recorded in patients who received a complex of treatment measures. The use of gravitation therapy alone provided better treatment results as compared to those obtained in patients administered standard conservative therapy. Of all the indicators used, only V(mean), V(vol), ABI and IRP are of the clinical significance. However, the most significant information on the segmental blood flow was obtained on the assessment of the IRP whose values did not depend on the changes in central hemodynamics. In contrast to the ABI, the advantage of the IRP lies in the possibility of blood flow assessment in different segments and arteries of the extremities. So, the use of the quantitative indicators of ultrasound duplex scanning and, first of all, of the IRP, allows an objective evaluation of the segmental blood flow and may serve one of the significant criteria of the treatment effectiveness.

[The use of gravitation overloading in the treatment of obliterative atherosclerosis of lower extremity arteries]. / Primenenie gravitatsionnykh peregruzok v terapii obliteriruiushchego ateroskleroza arterii nizhnikh konechnostei.

The article sums up results of treatment of 152 patients with obliterating atherosclerosis of the lower extremity arteries which were exposed to 2-3 G gravitation overloading made in a centrifuge of a short radius in direction head--pelvis. The gravitation overloading in the regimen followed were not found to have negative effects of central hemodynamics. Peripheral circulation was noted to considerably improve which is confirmed: 1) by clinical data showing 2-5 times longer distance of painless walking; 2) by the data of ultrasound dopplerography manifested as larger volume rate of blood flow and regional perfusion index; 3) by thermographic explorations evidencing the recovery of the thermoprophile of the legs and feet. Thus, the application of gravitation overloading is a new effective method of conservative treatment of patients with the pathology in question.

[International cooperation in implementation of the program of reproductive health protection in the Samara region]. / Mezhdunarodnoe sotrudnichestvo v realizatsii programmy okhrany reproduktivnogo zdorov'ia naseleniia Samarskoi oblasti.

A concept of strategic development of territorial service of maternity and childhood protection has been developed in the Samara region making use of international experience. The results indicate improvement of qualitative parameters of the service activities after introduction of international programs.

[Marriage in old age groups (medico-social aspects)]. / Braki, zakliuchaemye v starshikh vozrastnykh gruppakh (mediko-sotsial'nye aspekty).

Recently married elderly people change attitude to hospital treatment and living in asylums; they prefer care rendered at home and hospital-substituting forms of care; hospitalization and ambulance care are less needed and permanent social workers are required less. All this promotes rational utilization of the potentialities of therapeutic institutions and saving of public health and social protection resources.

[Development of hospital-substituting forms of medical care in the Samara region]. / Razvitie statsionarzameshchaiushchikh form meditsinskoi pomoshchi naseleniiu Samarskoi oblasti.

Development of hospital-substituting forms of medical care in the Samara region is discussed, 13% of patients treated at hospitals were rendered medical care through hospital-substituting institutions, which resulted in economy of 137 million roubles. The authors make their suggestions on optimizing statistical forms of files and records to be used in registration of medical care at day-time hospitals.

[The outpatient forms of the organization of social medical care for older persons in Russia]. / Vnebol'nichnye formy organizatsii mediko-sotsial'noi pomoshchi litsam starshikh vozrastov v Rossii.

Presents data on the non-hospital forms of medicosocial care of elderly and senile subjects in the Russian Federation, which proved to be the most effective as regards the economy and staff under conditions of the population aging.

[Role of teaching practices in the training of nurses for primary health care centers]. / Rol' obuchaiushchikh praktik v podgotovke sestrinskogo personala pervichnoi mediko-sanitarnoi pomoshchi.

The role of "training practice" in the formation of teams of specialists of the reformed primary health care is discussed. Innovation models of a "general practitioner" ("family doctor"), "family office manager", "general practice nurse" are mastered at "experimental" sites of an organization experiment. The philosophy of a tutor in general practice, individual requirements of students, and regulations of training are defined. Scheme of information of all interested persons and organizations on the alterations is presented. Prospects in development of primary health and social care of the family are outlined on the basis of general practices in the Samara region.

[Organization of medical and social hospital care of elderly persons in Russia]. / Organizatsiia statsionarnoi mediko-sotsial'noi pomoshchi litsam starshikh vozrastov v Rossii.

Hospital forms of medicosocial care of elderly and senile subjects in Russia are reviewed on the basis of published reports and authors' data. Together with outpatient forms, hospital forms of care of the elderly have been widely used of late and are functioning within the framework of public health and social protection systems. Integration of medical and social services in the sphere of health protection of the elderly is emphasized.

[Organization and effectiveness of the functioning of the cardiologic obstetric day hospital]. / Organizatsiia i éffektivnost' raboty kardiologicheskogo akusherskogo dnevnogo statsionara.

Organization of a cardiological obstetrical daytime hospital, contribution of physicians of many profiles, and use of a wide spectrum of methods for examination improved the quality of follow-up of women of fertile age with cardiovascular diseases and promoted timely cardial, cardiosurgical, and obstetrical care of this patient population. Improvement of follow-up of adolescent girls with cardiovascular diseases permits detection of disease before gestation, timely surgical correction, and preparation to gestation. Follow-up of pregnant patients with cardiovascular diseases resulted in decrease of perinatal and maternal mortality.

[The use of a microsurgical precision technic for applying a gastroduodenal anastomosis in a Billroth-I gastric resection]. / Ispol'zovanie mikrokhirurgicheskoi pretsizionnoi tekhniki nalozheniia gastroduodenoanastomoza pri rezektsii zheluka po Bil'rot-I.

Advantages of the formation of gastroduodenal anastomosis using the microsurgical precision technique as compared to the two-row interrupted Albert-Lembert suture and the one-row suture of Pirogov-Mateshuk were established in an experimental investigation in 63 dogs. The article describes the precision suture technique proposed by the authors which was used in Billroth-I resection of the stomach in 15 patients. It was shown that the use of the precision suture resulted in healing by the first intention type, without motor evacuatory disorders and with shorter time of hospital treatment.

[Development of obstetric and pediatric care in the Samara region]. / Razvitie sluzhby rodovspomozheniia i detstva v Samarskom regione.

The strategic concept of territorial service of maternity and childhood health protection developed in the Samara Region with consideration for obligatory medical insurance can improve the health status of women and children, ameliorate the demographic situation, and decrease the reproductive loss in the Region.

[Role of the general practitioner in the organization of the primary component of medical care]. / Rol' vracha obshchei praktika v organizatsii pervichnogo zvena meditsinskoi pomoshchi.

A program "Introduction of General Practitioners (Family Doctors) in the Primary Health Care System" has been developed in the Samara region. The first results are presented.

[Organization of geriatric care in the Samara region under conditions of obligatory medical insurance]. / Organizatsiia geriatricheskoi pomoshchi v Samarskoi oblasti v usloviiakh obiazatel'nogo meditsinoskogo strakhovaniia.

The authors share the experience they gained in rendering medical care to elderly and senile patients and describe the specific features of such care under conditions of obligatory medical insurance. The study was carried out in the Samara region.

[Efficient accomplishment of anastomosis in gastrointestinal operations]. / Pretsizionnoe formirovanie anastomozov pri operatsiiakh na zheludke i kishechnike.

In experimental study (40 dogs) variant of precisional (microsurgical) suture and anastomosis was developed, which was successfully carried out in clinical practice in 72 patients with various diseases of gastro-intestinal tract. For precisional formation of gastro-intestinal and bowel anastomoses magnifying optics, atraumatic suturing material and microsurgical instruments were used. Separately were sutured by knot sutures gastric or bowel serosa (external layer) and musculosubcutaneos layer of these organs together with mucous membrane tangentially, without its penetrating puncture (internal layer). The developed precisional method of formation of the anastomoses promotes healing of gastro-intestinal wound by primary intention and may be recommended for wider practical application.