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7metastases in the liver and pleura. Forecast disease at recurrence of ovarian cancer is also a measure of sensitivity to chemotherapy. All patients had platinum-sensitive patients in the combined treatment with survival greater than the survival of patients who only received chemotherapy. This is probably determined the effectiveness of chemotherapy in patients with recurrent ovarian cancer with a "high" survival during the combined treatment.
Conclusions Repeated cytoreductive surgery increases the survival of patients with recurrent ovarian cancer stage I-IIIb, while platinum tumors in the absence of multiple metastases in the liver and in the pleura, with a residual tumor less than 1 cm and the objective tumor response to chemotherapy.
DOI: 10.22448/AMJ.2016.15-16.46-47
UDC 616-099
THE MORPHOLOGY OF SOME ORGANS IN CASE OF COMBINED INTOXICATION OF ALCOHOL AND
DRUGS Gigolyan M. O., Cheryomkin M. I.
Amur State Medical Academy, Blagoveshchensk, Russia
In forensic practice there is observed increase in mortality from poisoning by narcotic substances and alcohol. One of the most actual problems of forensic medicine is the development and improvement of methods of diagnosis of acute and chronic drug intoxication (ANI, CNI) [4]. In the literature there is not enough study of morphological changes in ANI and CNI [2, 3]. However, data on morphology of combined intoxication with alcohol and drugs are controversial and insufficient. According to the literature, 79-82,6% of drug addicts with chronic hepatitis and 100% with cirrhosis of the liver abused alcohol [5,6,7].
The aim of our study was to investigate morphological changes in concomitant chronic intoxication with alcohol and drugs.
Materials and methods We studied 38 corpses of persons of both sexes suffering from chronic narcotic intoxication aged 18 up to 45 years old. CNI diagnosis was confirmed on the basis of forensic-chemical studies in the internal organs and biological fluids of corpses with the identification of narcotic substances from the group of opiates (morphine, heroin, codeine) as well as the diagnosis of CNI was confirmed by the data of cat-amnesis, the presence of multiple traces, at different stages of injection injuries. In 22 cases of investigated corpses (60%) in blood it was found the ethyl alcohol in a concentration from 0,9% up to 2,2% and identified narcotic substances from the group of opiates (morphine, heroin, codeine). To study the relationships between alcohol consumption and morphological changes of internal organs with the drug, we allocated 2 groups: 1) the dead from isolated acute poisoning by opiates (16 people), which served as the comparison group; 2) the combined deaths from acute poisoning by alcohol and opiates (22 people). In the control group in 15 cases it was used individuals aged 20-35 years old (12 men and 3 women) never used drugs and died from mechanical asphyxia. Evaluation of morphological changes of internal organs was performed by comparing on Student's criterion. There was produced macroscopic examination according to the Shore method. For microscopic examination the taken tissue were fixed in 10% neutral formalin and subjected to standard paraffin conducting. The preparations were stained with hematoxylin and eosin, Mallory and Perlsu, picrofucsin by Van Gieson with subsequent morphometric studies.
The results of the study
Morphologic study of the majority of drug usersidentified a range of changes, whichaccording to the literature was common in alcoholic disease [1]. Puffiness of the face, muciform, gelatinous mass covering the wall of the stomach, enlarged liver with a yellowish tinge, the increase in the fat layer of the heart, enlargement of heart chambers, the consolidation of the pancreas.
Microscopic examination revealed hepatic steatosis, diffuse fibrosis and lipomatosis of the stroma of the pancreas, diffuse cardiosclerosis, irregular hypertrophy of the myocardium, marked lipomatosis of the stroma of the myocardium, fragmentation of cardiomyocytes. Basal inlay ofnephrothelium, thinning of the adrenal cortex occurred from 40% up to 90% of cases.
Morphologic changes in the main group (the combined toxicity of by alcohol and opiates) were significantly more frequently than in the comparison group (isolated opiate toxicity): 1) in the heart - a significant increase in the fat layer (70 and 32% of cases), uneven myocardial hypertrophy (in 100 and 70% of cases), the extension chambers of the heart (in 56% of cases in the main group and 31% in the comparison group), fragmentation of cardiomyocytes (in 88 and 56% of cases); 2) in the lungs -hemosiderosis of the lungs (45-25% of cases); 3) in the brain there is marked fibrosis of the meninges (in 76-36% of cases), vascular changes with impaired permeability (in 56-22%); 4) in the liver - diffuse fatty infiltration, steatosis of the liver.(in 69-29%); 5) in the adrenal glands - the thinning of the crust, the accumulation of brown pigment(in 71-35% of cases); 6) in the kidneys - basal inlay ofnephrothelium (67-27% of cases); 7) in the pancreas - the consolidation of the pancreas (62 and 26% of cases), marked fibrosis and lipomatosis of the stroma of the pancreas (in 85 and 58% of cases), (p > 0.05 for all the listed signs).
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It was noted the frequency signs of chronic alcoholism in the main group: increase of the mass of the heart is more in the group with combined ANI (375g and 325g, respectively), the average weight of the liver (i770g and 2i50g, respectively), frequencyof fatty liver (72 and 56%, respectively), follicular hyperplasia with the formation of light areas in the spleen (89-54% of cases), the drain erosion of the gastric mucosa (45-34%).
Conclusions The study noted that in persons died from acute combined poisoning with alcohol and opiates, signs of chronic alcohol intoxication are occurred significantly more often than in isolated deaths from acute poisoning by opiates. This explains ethanol's role in the development of these morphological changes. Morphometrically determined higher intensity of fatty dystrophy in combined poisonings is one of the results of the frequent propensity of addicts to use drugs in combination with alcohol.
The differences may have practical importance in their use for differential diagnosis of isolated opium addiction and its combination with alcoholic disease.
Our research has shown the advisability of use of microscopic and morphometric studies with the use of quantitative assessment for the development of morphological methods for diagnosis of CNI.
Literature
1. Paukov V.S., Ugryumov A.I. // VINITI. News of science and technology. Ser.: Medicine. Vol. Alcoholic disease. 1997. No. 5. Pp 1-4.
2. PigolkinYu.I., Sherstiuk B.V.// Forensic expert. 1996. Vol. 39, No. 4. Pp. 26-28.
3. PigolkinYu.I.,Bogomolov D.V., DolzhanskyO.V., Ozdamirova Y. M. // Actual aspects of forensic medicine. Izhevsk, 1999. Vol. 5. Pp. 171-173.
4. Harabet K.V. // Problems narcol. 1994. No. 3. Pp. 72-76.
5. Novick D.M., GelbA.M., StengerR.J. et al. // Ibid. 1981. Vol.75, N 2. Pp. 111 - 115.
6. Novick D.M., Reagan K.J., Croxson T.S. et al. // Addiction. 1997. Vol. 92, N 2. Pp. 167-171.
7. Gelb A. M., Mildvan D., Stenger R. J. // Am. J. Gastroenterol. 1977. Vol. 67, N 4. Pp. 314-318.
DOI: 10.22448/AMJ.2016.15-16.47-49
UDC 37.026-378.61
TRENDS IN MODERN MEDICAL SCHOOL IN THE ASPECT OF THE EDUCATIONAL COMPETENCIES OF A PHYSICIAN
Gordienko E. N., Vakhnenko J.V.
Amur State Medical Academy, Blagoveshchensk, Russia
The problem of Life at all times was leading in three manifestations of the consciousness of Humanity: culture, science, education. The main discipline that studies it in education and Science is Biology. Historically it has formed the system of knowledge about Nature in all its kingdoms, levels of life, the universality and diversity. Modern international level of formation of educational services, including graduate medical school, defines training specialist "in terms of development of personal qualities, abilities, skills for professional activity in accordance with Federal state educational standard (fgos), and taking into account the requirements to the quality of human capital in the modern labour market" (GEF, 2015). Latin logo <competens - awareness, experience) in any field of higher education, speaking in an embodiment, shape (matrix>.), aims: to develop a leading educational motivation for students - future doctors and for the one who gives refuge - high school teacher. The content of the matrix reflects a complex path last on the formation of the moral outlook of the Russian doctor of the XXI century, prepares the student to creative assimilation of the basic aspects of the natural and human sciences and clinical disciplines in higher medical schools in compliance with state goals and objectives for the protection of health of citizens of Russia. These standards are consistent with the objectives and define the rules of the graduate of a medical school of all civilized Nations of the world.
Logic of formation of the matrix global competence in the discipline "Biology" dictates it difficult fundamental areas and levels, the integration of teaching with other theoretical and clinical Sciences of the medical school, a significant body of applied knowledge and skills, their prospects. For the teacher - developer of the matrix of competency or educational forms that have an informal professional work. It allows him to give maximum exposure to the role of the subject: Biology - 1 course, or "Cardiology" - 5-6's courses in the system of modern bio-medical knowledge, to define your own functions by editing the training system and implementing it in accordance with the standards of education and Curriculum.
The primary imperative and problem in working with the students of 1st year for a teacher is the formation of readiness of the novice student to follow the requirements of the Amur state medical Academy to the study and assimilation of fundamental biological and ecological information in the system "Nature - Consciousness of Man". For freshmen - high school graduates, medical colleges this is the most important task! It is supplemented by the claim on the ability and willingness of the student to the analysis not only of specific material modules of discipline and ideological biosocial and personally important for future doctors aspects, the con-
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