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№1' 2013

ABSTRACTS

Crimean State Medical University named after S.I. Georgievsky, Simferopol, Ukraine
The influence of combination magnetolaser therapy on quality of life in patients with bronchial asthma at the state of restorative treatment
6 - 10
Abstract. The authors analyze the dynamics of the parameters of quality of life in 158 patients with bronchial asthma using MOS SF-36 questionnaire before and after the treatment. The efficacy of standard resort therapeutic complex, additional administration of non-invasive magnetolaser therapy and combination of non-invasive megentolaser therapy with endonasal laser irradiation was compared. It was determined that combined application of non-invasive magnetolaser therapy and endonasal laser irradiation improved the quality of life of the majority of patients with bronchia asthma even when pronounced signs of allergic rhinitis are absent vs. separate administration of non-invasive magentolaser therapy and basic resort therapy.
Key words: bronchial asthma, quality of life, non-invasive magnetolaser therapy, endonasal laser irradiation.
Kharkiv National Medical University, Kharkiv, Ukraine
The peculiarities of therapy with atypical antipsychotics for complications of paranoid schizophrenia in women
11 - 14
Abstract. Symptom specificity of the most common atypical antipsychotic drugs, nosomorphosis and pharmaceutical pathomorphosis of schizophrenia clinical picture were investigated. The study involved 60 women with paranoid schizophrenia with continuous course aged 18-50 treated at Kharkiv Rregion Clinical Psychiatry Hospital No. 1 who were administered second generation antipsychotics (risperidone, amisulpride, olansapin, clozapine) depending on the main psychopathological symptom complex. Clinical psychopathological methods and history investigation as well as PANSS technique were used to confirm predominance of symptom specificity of the effect (influence on positive and negative signs) of common atypical antipsychotics depending on dominating in the clinical picture of a definite sign, with that some cases required combination treatment or its change.
Key words: schizophrenia, atypical antipsychotic, symptom-specificity.
Kharkiv National Medical University, Kharkiv, Ukraine
Neurological complications of primary hypothyroidism of various origin
15 - 19
Abstract. The purpose of the work was to determine pathogenetic metabolic bioenergetic regularities of forming neurological syndromes at primary hypothyroidism (PH) of various origins. The study involved 154 patients with PH against a background of autoimmune thyroiditis (AIT) and 127 patients with PH after thyroidectomy aged 36-59. The investigation included clinical neurological, instrumental, biochemical and statistical study. The clinical biochemical investigation demonstrated that PH against a background of AIT was more frequently accompanied by combined variants, i.e. encephalopolyneuropathy (55.8%) and encephalomyelopolyneuropathy (25.3%) and more pronounced increase in the level of atherogenic fractions of lipid metabolism and hormone-mediator dysbalance of the sympathoadrenal system with the shift towards activation of its mediator link. In patients with post-operative PH, encephalopathy (45.7%) and neuromuscular syndromes (46.5%) were noted more frequently with more pronounced activation of oxidant antioxidant system and shift of the sympathoadrenal system towards activation of the hormonal link. Disorders in energy production at PH did not depend on the disease origin but correlated with severity of thyroid dysbalance and metabolic dysorders. The revealed peculiarities of forming neurological signs at PH of various origin should be taken into account when administering the treatment.
Key words: primary hypothyroidism, autoimmune thyroidism, thyroidectomy, neurological complications, metabolic disorders.
Samarkand State Medical Institute, Republic of Uzbekistan
Optimizing treatment tactics in infants with sepsis
27 - 29
Abstract. The purpose of the work was to assess the efficacy of combination decontamination of the intestine in treatment of sepsis in infants. Clinical observation was performed on 53 infants (aged 1 month - 1 year) with sepsis. The method of combination intestine decontamination included enterosorption and selective intestine decontamination using oral antibiotic therapy with antibiotics influencing only conventionally pathogenic flora preserving bifido- and lactoflora (gentamicin, canamicin, ercefuril, funistatin). It was shown that the use of combination of decontamination with basic therapy yielded significant reduction of laboratory indices of non-specific endogenous intoxication already on day 10 of treatment and reduced the period of treatment by one week when compared with basic therapy.
Key words: infants, sepsis, combination intestine decontamination.
Kharkiv Medical Academy of Post-graduate Education, Kharkiv, Ukraine
The peculiarities of peripheral hemodynamics in children with reactive arthropathy with knee joint involvement
30 - 33
Abstract. The work deals with investigation of the functional state of peripheral hemodynamics in children with reactive arthropathy. The purpose of the work was to investigate rheographic indices in children aged 2-17 with reactive arthropathy involving knee joints. Peripheral hemodynamics was assessed at analysis of rheovasography data which was done using diagnostic computer complex "Reo-Spectr+". The indices of pulse blood supply, the state of vascular tone of large, medium, small arteries, interaction of arterial and venous levels of blood circulation, venous outflow were investigated. Total blood filling of organs and tissues was assessed. It was revealed that homodynamic disorders (deficiency of compensation of peripheral hemodynamics in the area of the foot, compensation of hemodynamic disorders in the area of the shin exceeding 2 times hemodynamic changes in the area of the foot) were formed in the proximal and distal from the involved knee joint regions.
Key words: reactive arthropathy, peripheral hemodynamics, children.
Kharkiv Medical Academy of Post-graduate Education, Kharkiv, Ukraine
The level of post−vaccination antidiphtheria immunity in children depending of the duration of type 1 diabetes mellitus
34 - 38
Abstract. The indices of artificial active antitoxic antidiphtheria immunity in children and teen-agers with type 1 diabetes mellitus (DM1) were investigated depending on the disease duration (from 1 year to 10 years). Laboratory methods were used to determine the level of specific antibodies to diphtheria using immunoenzyme assay. The most negative influence of DM1 on diphtheria antibodies level was noted in children with primarily revealed disease with duration < 1 year. This requires the changes to the choice of immunization tactics in children and teenagers with DM1 with the consideration of the clinical parameters of the disease namely possibility of planned vaccinations, in particular to the children with medical contraindications, on the day of scheduled vaccinations. The obtained findings suggest that DM1 negatively influenced active artificial immunity against diphtheria depending not only the duration of the main disease (DM1) but also its complications.
Key words: duration of type 1 diabetes mellitus, post-vaccination antidiphtheria immunity, children.
Kharkiv National Medical University, Kharkiv, Ukraine
The influence of inhibitor of activator of plasminogen−1 on cardiometabolic markers in patients with combined arterial hypertension and obesity
39 - 43
Abstract. Investigation of the role of apokines in arterial hypertension development is an important field of investigation. The authors analyzed the influence of various levels of plasminogen-1 activator inhibitor (PAI) on formation of clinical metabolic disorders in patients with arterial hypertension and obesity. The levels of lipids and carbohydrates were determined using biochemical techniques, adipokines concentration using immunoenzyme techniques. The study involved 82 patients with arterial hypertension associated with obesity, men (25.61%) and women (74.39%), mean age 59.03+-1.47. The patients were divided into tretiles by PAI level (low, medium, high). In patients with arterial hypertension associated with obesity, increased PAI activity was associated with abdominal obesity, increased arterial pressure, glycometabolic and lipid disorders with formation of adipikine dysfunction manifesting by increased activity of tumor necrosis factor- α and hypoadiponectinemia.
Key words: arterial hypertension, obesity, inhibitor of activator of plasminogen-1, carbohydrates, lipids, adipokines.
Kharkiv National Medical University
SI Institute of Therapy named by L.T. Malaya NAMS of Ukraine, Kharkiv, Ukraine
The influence of cardioprotection on the state of hemodyncmics at treatment of cardiorenal syndrome in patients with chronic heart failure and chronic kidney disease
44 - 49
Abstract. Cardioprotectors play an important role in treatment of myocardial dysfunction at chronic heart failure (CHF). The purpose of the work was to investigate the influence of quercetin on the parameters of structural functional characteristics of the myocardium, the functional state of the kidneys at treatment of CHF and CHF accompanied with chronic kidney disease (CKD). The parameters were investigated using echocardiography and Doppler echocardiography, the kidney function was determined by Jaffe technique and immunoenzyme assay. Administration of quercetin in patients with CHF and CHF associated with CKD resulted in additional improvement of the markers of kidney dysfunction, immune inflammation, structural and functional parameters of the myocardium. Thus, introduction of quercetin to the standard therapy of these patients was accompanied by additional immunomodulating, cardioprotective and nephroprotective effect, which manifested by improvement of the activity of the heart and kidneys. The findings of the research allow the physicians to improve the therapeutic tactics in patients with CHF and CKD.
Key words: chronic heart failure, chronic kidney disease, systolic function of the myocardium, diasctolic function of the myocardium, kidney dysfunction markers.
Kharkiv National Medical University, Kharkiv, Ukraine
Renal dysfunction and peculiarities of iron metabolism in patients with chronic heart failure of various functional classes and chronic kidney disease
50 - 52
Abstract. Anemia and renal dysfunction are the most common comorbid states at chronic heart failure. The purpose of the work was to assess the functional state of the kidneys and iron metabolism in patients with anemia developing against a background of chronic heart failure of various functional classes and chronic kidney disease. Iron concentration, total serum iron-binding capacity was determined by colorimetry, urine albumin was determined by immunoenzyme assay. It was revealed that reduction of glomerular filtration rate simultaneously with the increase of the functional class of chronic heart failure were accompanied by the signs of iron deficiency due to the loss of iron with urine at microalbuminuria. Increase of renal dysfunction proportional to the severity of heart decompensation negatively influenced the functioning, accessible to erythropoiesis, iron pool, which manifested by reduction of serum iron level and coefficient of transferrin saturation.
Key words: chronic heart failure, chronic kidney disease, anemia, iron metabolism.
A.A. Bogomolets National Medical University, Kyiv, Ukraine
The role of metabolic link of nitrogen oxide in the mechanism of development of glaucoma optic neuropathy and neuroprotection prospects in glaucoma: contemporary aspects
53 - 59
Abstract. Recently, major progress has been made in the pathophysiology, clinical approach and treatment of primary glaucoma. It has been established that to coordinate inter- and intracellular activity, living organisms have developed complex chemical signaling systems. Intracellular signals are generally mediated by chemical messengers known as neurotransmitters. In the context of biochemical communication nitric oxide (NO) identified and act primarily as neurotransmitter. This review article provides overview of some biochemical aspects of NO in the eye. In this regard, NO appears to play a major role in the pathogenesis of open angle glaucoma. Nitric oxide as mediator that play a key role in the regulation of several ocular functions which are of major importance in glaucoma, particularly regulation of the intraocular pressure, control of ocular blood flow, and retinal ganglion cell death by apoptosis. This offers new perspectives in the understanding of the pathogenesis of glaucoma and, as a consequence, opens new potential therapeutic approaches to the disease that is still a leading cause of blindness.
Key words: nitrous oxide, NO-synthases, glaucoma, optic neuropathy, apoptosis, neuroprotection.
Kharkiv Medical Academy of Post-graduate Education, Kharkiv, Ukraine
Contemporary tendencies of cellular technologies development in treatment of neuroretinopathy
60 - 62
Abstract. Clinical application of stem cells, the restorative potential of which is associated with the prospects of treatment of some eye diseases, can become an important filed of ophthalmology. The author reports the most important direction of research in the filed of cellular therapy. It is noted that at the contemporary stage of ophthalmology development the authors of the majority of works concentrate on replacement of ganglious cells of the retina because their death is the end sage of the pathogenesis of various types of neuroretinopathy. Discovery of the method to differentiate stem cells to ganglionar cells of the retina and connection of the latter with their potential targets will be the main step in repopulation of neurons at their death. The accumulated material requires profound analysis and generalization. Cellular therapy is a powerful therapeutic factor actively introduced to the treatment of neuroretinopathy.
Key words: cellular therapy, neuroretinopathy, stem cells.
Kharkiv Medical Academy of Post-graduate Education, Kharkiv, Ukraine
The experience of toric intraocular lenses implantation in patents with corneal astigmatism
63 - 66
Abstract. The results of the performed operations of facoemulcification of cataract with implanting toric intraocular lenses (IOL) in patents with cornea astigmatism of various degrees by means of facoemulcification of the cataract of various density with grafting of toric aspherical IOL AcrySof* IQ Toric of different models (T2-T9) are analyzed. Considerable increase of the vision acuity and improvement of the quality of life was achieved in all patients. In patients who were implanted different models of AcrySofIQ Toric post-operative vision acuity was -0.78+-0.2, post-operative corneal astigmatism was 0.9+-0.21. The most pronounced visual functions were obtained in patients without accompanying eye pathology, visual acuity in them was 1.0 with almost complete neutralizing of corneal astigmatism. It was shown that grafting of toric IOL is a highly effective method of treatment for cataract with accompanying corneal astigmatism allowing the patients to avoid spectacle correction at length using only one stage of surgery.
Key words: cataract, astigmatism, phacoemulcification, toric intraocular lenses.
Kharkiv National Medical University, Kharkiv, Ukraine
Contemporary aspects of ovarian hyperstimulation syndrome prevention
67 - 73
Abstract. The review on ovarian hyperstimulation syndrome (OHSS) prevention is presented. OHSS is an iatrogenic complication related exclusively to ovarian stimulation when assisted reproductive technologies are applied. The number of measures has been introduced by now to identify high risk patients and to prevent OHSS development. The most sophisticated strategies are highly demanding to the personnel qualifications, as well as to the equipment of ART clinics. The proposed strategy of total oocytes/embryos cryopreservation is the only available now that guarantees the prevention of both primary and secondary OHSS development. Any other kind of strategy may decrease the risk of primary OHSS occurrence, however, significantly less imply on secondary OHSS development once the pregnancy achieved in ART cycles
Key words: ovarian hyperstimulation syndrome, additional reproductive technologies, cryopreservation of oocytes/embryos, prevention.
Kharkiv Medical Academy of Post-graduate Education, Kharkiv, Ukraine
Etiopathogenetic approaches to differential diagnosis and restoration of reproductive function at polycystic ovary syndrome
74 - 77
Abstract. The work covers the state of reproductive function in women with polycystic ovary syndrome. Etiopathogenetic approaches to treatment of these patients are presented. Up-to-date approaches to surgery and post-operative management of the patients with polycystic ovary syndrome and tuboperitoneal infertility are analyzed. The use of concervative and surgical methods of treatment for polycystic ovary syndrome was analyzed. The indications to laparoscopic surgery and extracorporal fertilization were determined. 82% of patients with polycystic ovary syndrome have tuboperitoneal infertility associated with endometriosis which reduces the treatment efficacy from 60% to 19.5% and requires development of new methods of treatment including intraoperative application of anti-adhesion barriers.
Key words: polycystic ovary syndrome, infertility, treatment, endometriosis.
Kharkiv National Medical University, Kharkiv, Ukraine
The role of thrombophilia in the structure of female infertility etiopathogenesis
78 - 81
Abstract. Diagnosis and treatment of infertility of married couples is an urgent issue of contemporary gynecology. Introduction of the programs of assisted reproductive technologies to the practice requires investigation of new pathogenetic aspects of their efficacy improvement. Therefore, it is reasonable to reveal possible causes of inefficacy of assisted reproductive technology programs. The amount of homocystein and markers of antiphospholipid syndrome was determined using immunoenzyme method in a group of women with unsuccessful attempts of assisted reproductive technologies. A high level of hyperhomocysteimemia and antiphospholipid antibodies was revealed in the patients with infertility of unknown origin and repeated unsuccessful attempts of assisted reproductive technologies which suggested their negative influence on the results of the programs. The obtained findings allow to choose the tactics of management of this group of women participating in the programs of assisted reproductive technologies.
Key words: hereditary thrombophilia, antiphospholipid syndrome, infertility, in vitro fertilization.
SI Institute of General and Urgent Surgery of AMS of Ukraine, Kharkiv, Ukraine
Kharkiv National Medical University, Kharkiv, Ukraine
The peculiarities of lymphodissection at combined gastrectomy at surgical treatment for local cancer of the stomach
82 - 91
Abstract. Treatment of complicated gastric cancer is an urgent issue. About 80% of patients are admitted with stage III and IV disease. Long-term surgery results depend on the volume of lymphodissection. The authors report the results of surgery of 338 patients with complicated local cancer of the stomach. Gastrectomy with lymphodissection D2 was performed in 131 patients, 207 underwent palliative and symptomatic surgery. The variants of vasal lymphodissection with bandaging the branches of abdominal trunk were developed. Removal of hepatoduodenal ligament with portal plastic surgery was applied. Post-operative complications developed in 128 patients, post-operative and general death rate parameters were 62 and 77, respectively. The results can be used in surgical treatment for gastric cancer with lymphadenopathy. Thus, gastric tumor invasion to the adjacent organs with lymphademnopathy are not the sign of inoperability even with life threatening complications.
Key words: complicated local cancer of the stomach, surgery, lymphodissection.
Kharkiv City Clinical Emergency Hospital, Kharkiv, Ukraine
Fasceocutaneous shin flaps with double axial blood supply for shin and foot repair
92 - 96
Abstract. Decreasing rate of complication after restoration of shin and foot by way of application of fasciocutaneus flaps is of current interest. The article covers the improvement of shin and foot reconstruction results by way of application of the fasciocutaneus flaps on the shin surface with double axial vascular supply. Anatomical foundations, surgical techniques for the flap separation, measures to increase viability of flaps as well as first experience of plastic surgery by way of application of the distally based fasciocutaneus flaps on the shin surface with double axial vascular supply: medial (r. saphenus a. descendens genicularis and rr. perforantes a. tibialis posterior), posterior-medial (a. superficialis sure medialis and rr. perforantes a. tibialis posterior), posterior-lateral (a. superficialis sure medialis and rr. perforantes arteria peronea (fibularis)), anterior-lateral (rr. perforantes arteria peronea (fibularis) and rr. perforantes arteria a. tibialis anterior) are reported. These flaps were successfully used in 23 different cases of treatment of intricate wounds in the shin and foot region. One flap underwent partial, boundary necrosis (4.3%).
Key words: fasceocutaneous flaps, wounds, foot, shin, revascularization, plastic surgery.
Kharkiv National Medical University, Kharkiv, Ukraine
Surgical tactics at treatment of patients with perforated cancer of the stomach
97 - 100
Abstract. The purpose of the study was to improve the results of surgical treatment of patients with the perforated stomach cancer. The article presents the comparative analysis of the results of surgical treatment of 65 patients with perforated stomach cancer, 35 of them were treated with application of individualized approach to the choice of method and volume of operative intervention. The major surgical complications in postoperative period were anastomosis leakage, suppuration of laparotomic wound, eventration. Application of the individualized approach to examination and operative treatment of patients with the perforated stomach cancer allowed to reduce the amount of postoperative complications and mortality.
Key words: perforated cancer of the stomach, surgical intervention, individual approach.
Kharkiv Medical Academy of Post-graduate Education, Kharkiv, Ukraine
The results of water−cure cement application in endodontic defects treatment
101 - 104
Abstract. The work deals with investigation of clinical efficacy of a new Ukrainian water-cure cement Restapeks produced by La Tus Company (Kharkiv, Ukraine). in treatment of various endodontic defects. The purpose of the work was to assess the clinical efficacy of water-cure cement Restapeks in treatment of endodontic defects and to compare it with the results of application of its analogue MTA-cement Pro-Root (Dentsply). The results of treatment were assessed using clinical and x-ray criteria immediately after the treatment and a year later. A year later all patients demonstrated a satisfactory clinical result of the treatment. No one stated complaints. Percussion in all patients was painless, crown restorations were preserved, x-ray demonstrated improvement of the destructive processes in the involved focus and complete preservation of the crown restoration. High clinical efficacy of Ukrainian water-cure cement was shown. The results of treatment using Restapeks can be compared with those of MTA-cement Pro Root in similar situations.
Key words: endodontic defects, root canals, MTA-cements.
Kharkiv Medical Academy of Post-graduate Education, Kharkiv, Ukraine
Blood biochemical parameters and assessment of the state of connective−tissue structures metabolism in children with bone destructive diseases of the temporomandibular joint in planning of reconstructive surgery
105 - 109
Abstract. This work determines the possibility to perform reconstructive operations in children with bone destructive diseases. The purpose of the work was to investigate the indices of acute-phase inflammation and connective-tissue metabolism to predict the course of post-operative period and correct the general state of the patients. Laboratory indices of the peripheral blood (echogram integral indices) and biochemical indices of the patients with secondary deforming osteoarthritis and bone ankylosis were investigated. The obtained findings suggest that chronic secondary deforming oateorrthrosis and ankylosis of the temporomandibular joint developed against a background of metabolic processes disorders in the main substance of the connective tissue; these manifestations were noted in early age. The revealed disorders at secondary deforming osteoarthritis and ankylosis of temporomandibular joint require correction of these states both before the surgery and after it. Investigation of the laboratory parameters can be used to assess the efficacy of treatment of the patients with secondary deforming osteoarthrosis and ankylosis of temporomandibular joint and in retrospective analysis.
Key words: laboratory findings, osteoarthrosis, ankylosis, temporomandibular joint, children.
Kharkiv Medical Academy of Post-graduate Education, Kharkiv, Ukraine
Ultrasound signs of mastopathy in women with hyperplastic processes of the endometrium
110 - 112
Abstract. The issue of diffuse fibrous cystic mastopathy is urgent due to the fact that some proliferative forms are markers of breast cancer (BC) development. The purpose of the work was to investigate the peculiarities of the structural changes of the breast parenchyma and to determine ultrasound criteria (peak blood flow velocity, peripheral resistance index) in women with mastopathy accompanied by hyperplastic processes of the endometrium. Our study allowed to note a number of features and to determine ultrasound criteria of the structural changes in the breast in women of fertile age with mastopathy accompanied by hyperplastic processes of the endometrium using Doppler ultrasound and elastography. This permitted a complex assessment of the structural changes of the breast parenchyma, blood flow peculiarities and to obtain information about rigidity of the hyperplastic tissue which allows to improve the efficacy of differential diagnosis of dyshormaonal mastopathy in women of reproductive age.
Key words: mastopathy, hyperplastic endometrium processes, ultrasonography, Doppler ultrasound, elastography.
Order red Star Main Military Clinical Hospital, Kyiv
Kharkiv Medical Academy of Post-graduate Education, Kharkiv, Ukraine
Transvaginal ultrasonography and magnetic resonance imaging in diagnosis of hyperplastic processes of the endometrium
113 - 117
Abstract. The authors present the review of literature on the role of transvaginal ultrasound diagnosis (TUD) and magnetic resonance imaging (MRI) in improvement of diagnostic approaches to assessment of endometrium in the uterus cavity in patients with hyperplasic processes of the endometrium (HPE). Significance of the issue of the diagnosis efficacy improvement and differential diagnosis of HPE is due to the tendency to increased incidence of small pelvis malignancy, which, according to various authors, makes 15-47%. A common instrumental method of HPE diagnosis is TUD allowing noninvasive assessment of the small pelvis organs macrosctrucutre in women. In radiology practice high diagnostic informativity at endometrium investigation is achieved with combination of different methods of radiation diagnosis, i.e. TUD with color Doppler mapping (for visualization of the blood flow including neoplasms) and MRI with high contrast soft tissue visualization, which are successfully used in differential diagnosis in case of ambiguous ultrasonography findings. The further progress of diagnostic screening will improve the informativity of radiation diagnosis, as well as efficacy of combined use of TUD and color Doppler mapping, Doppler ultrasound and MRI at benign HPE.
Key words: transvaginal ultrasound diagnosis, magnetic resonance imaging, endometrium, uterus cavity, endometrium hyperplasia.
Sumy Central District Clinical Hospital, Sumy, Ukraine
Investigation of indices of efficacy of work of family medicine establishments
118 - 120
Abstract. Significance of the study is due to the task to improve the efficacy of the national health system in Ukraine. The purpose of the work was to determine the influence of the introduced principles of general practice - family medicine (GPFM) on the efficacy of the work of primary care hospitals. The indices of frequency of illness and primary disability were investigated within the period of 2002-2010 in the network of the institutions of general proactive - family medicine of rural areas of Kharkiv region. Dispersion analysis was used to investigate the association between these indices and the state of follow-up work, the volume of working time of the physician, introduction of new technologies (algorithms) of forming healthy life style of the population. It was shown that organization of primary medical care of the population of rural areas in the form of general practice - family medicine promoted improvement of efficacy of medical care owing to task-oriented measures of the physicians. The most pronounced changes were noted in the health localities which were previously served by medical and obstetric stations.
Key words: family medicine, morbidity, prevalence, disability, efficacy.
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