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№2' 2015

ABSTRACTS

Russian Cardiology Research&minus
and&minus
Production Center, Ministry of Health, Moscow, Russian Federation
The role of palmitic fatty acid in initiation of hypertriglyceridemia, hypercholesterolemia, atherosclerosis, and atheromatosis
5 - 14
Phylogenetically, at early stages high density lipoproteins (HDL) are initial transporters of all fatty acids (FA) to cells, later unsaturated and polyenic FA (PFA) are transported by low density lipoproteins (LDL). Insulin−dependent cells absorb palmitic saturated acid (SFA), oleic monounsaturated FA (MFA) and oleic triglycerides (TG) in very low density lipoproteins (VLDL). Hepatocytes separately secrete palmitic, oleic and linolenic VLDL. After hydrolysis of TG in the circulation, cells uptake ligand palmitic and oleic VLDL by apoЕ/В−100 endocytosis, i.e., these TG are not converted into LDL. Under the effect of cholesteryl ester transfer protein, PFA from HDL are transported to linoleic VLDL as cholesterol (CL) polyesters and convert VLDL into linolenic LDL which are taken up by cells via apoВ−100 endocytosis. Physiologically, the amount of oleic VLDL is always greater than that of palmitic VLDL. In insulin resistance (IR) syndrome, palmitic SFA produced de novo from glucose is not converted into oleic MFA. Hepatocyte secrete predominantly palmitic VLDL, the amount of which is greater than that of oleic VLDL. As a result of slow hydrolysis in the blood the major proportion of palmitic VLDL is converted into palmitic LDL. These LDL initiate hyperlipidemia, lower HDL−CL, reduce bioavailability of PFA, and trigger atherosclerosis with formation of atheromatosis in arterial intima. Nonphysiological effect of excessive palmitic acid and palmitic TG in vivo cannot be abolished by statins and increased dietary ?−3 PFA content, which can be effective only in prevention of hyperlipidemia, atherosclerosis, coronary atheromatosis, coronary heart disease and myocardial infarction.
Key words: palmitic fatty acid, hypertriglyceridemia, low density lipoprotein cholesterol, atherosclerosis, atheromatosis.
Kharkiv Medical Academy of Postgraduate Education, Ukraine
Resistant arterial hypertension: diagnosis and treatment
15 - 23
Resistant arterial hypertension is diagnosed when three antihypertensives administration does not result in achieving target blood pressure, which for most patients is the level below 140/90 mm Hg, wherein one of the drugs must be diuretic and all drugs must be administered to optimal or maximum tolerated doses. Although arbitrary number required to control blood pressure drugs, determination is very useful from the point of view of both the clinician and researcher, since it helps to identify the phenotype of resistance to a wide antihypertensive treatment and diagnostic determining tactics, such as testing or causes of secondary hypertension selection treatment. Thus the patients with resistant arterial hypertension have a higher probability of detection of diseases, leading to the development of secondary hypertension. These include sleep apnea, kidney disease, renal artery stenosis, primary aldosteronism. Much more rare causes include Cushing's syndrome, pheochromocytoma, hyperparathyroidism, coarctation of the aorta, intracranial tumors. Referral and specific treatment of these diseases can improve blood pressure control and long−term prognosis. Despite the high prevalence of resistant arterial hypertension, the lack of blood pressure control is often associated with an inadequate selection of antihypertensive therapy, blood pressure misjudgment or failure of patients to medical recommendations. Therefore, before carrying out diagnostic measures it is necessary to assess consistently adequacy of patients receiving therapy that inherent in the definition of resistant arterial hypertension and exclude pseudoresistance.
Key words: resistant arterial hypertension, diagnosis, treatment.
Kharkiv Medical Academy of Postgraduate Education, Ukraine
Adipokines of adipose tissue and their role in progression of renal disease
24 - 28
This review analyzes modern scientific data on the role of some factors produced by adipocytes in renal tissue damage. The most significant, active substances of adipose tissue include leptin, adiponectin, visfatin, TNF−alpha, IL−6, resistin. Leptin is synthesized by adipocytes in proportion to the mass of adipose tissue. In the kidney, leptin receptors are found in the cells of tubular epithelium. In obesity, leptin can induce production of type I collagen by mesangial cells and fibrogenesis in renal tissue, stimulate proliferation of endothelial cells and vascular smooth muscle cells, causing glomerular hypertrophy. Adipose tissue is the site of synthesis of another hormone, adiponectin. Serum adiponectin is increased in CKD. Visfatin is adipocytokine that is considered as a new pro−inflammatory cytokine. A hormone associated with energy metabolism, immunity, insulin action, it affects cellular energy metabolism. Resistin is another hormone of adipose tissue, the level of which increases with progression of renal disease and inversely correlated with glomerular filtration. Tumor necrosis factor−? (TNF−?) stimulates production of endothelin−1 in renal mesangial cells, indirectly involved in the regulation of vascular tone and proliferative activation and sclerotic processes in the kidney tissue. Another pro−inflammatory cytokine is IL−6. The concentration of IL−6 in the blood is usually considered as a reliable predictor of mortality in patients with end−stage renal failure. Thus the discussed in the review adipose tissue adipokines have both direct and indirect impact on renal function, renal damage progression processes and structures of vascular complications in CKD of different origin. The end result of the impact on this stage kidney disorders is development of glomerulosclerosis and tubulointerstitial fibrosis of the kidney tissue.
Key words: adipokines, obesity, chronic kidney diseases, leptin, visfatin, adiponectin, resistin, interlekin-6, tumor necrosis factor-α.
Kharkiv Medical Academy of Postgraduate Education, Ukraine
Relationship between daily blood pressure profile and a marker of chronic systemic inflammation in patients with stage 2 essential hypertension with microalbuminuria
29 - 33
Сhronic systemic inflammation (CSI) with immune damage of the vessels plays an important role in development and progression of essential hypertension. Immunocompetent cells have the ability to direct the damage and activation of endothelial cells by contact interaction and secretion of cytokines in the intercellular medium, which play a special role in the induction of vascular injury. The kidneys are involved in regulation of blood pressure and the long time they remained an asymptomatic lesion in the form of microalbuminuria (MAU). The method of ambulatory blood pressure monitoring provides important information about the mechanisms of cardiovascular regulation of blood pressure, allowing determination of the circadian rhythm and dynamics over time. The purpose of this study was to investigate the association between CSI markers TFN−?, C−reactive protein, IL−6, IL−10 with the types of circadian blood pressure profile in patients with stage II essential hypertension depending on the levels of MAU. The type of circadian blood pressure was dominated in patients with insufficient degree of nocturnal blood pressure reduction and a significant increase in the number of patients with «dipper» and «night−peaker» profile with an increase of MAU in the considered population. A significant increase in the all CSI markers was observed compared with the reference group, with the difference in the content of TNF−?, IL−6 and the ratio of IL−6/IL−10 by increasing the degree of MAU. The presence of circadian blood pressure type «dipper» had a negative correlation with the content of IL−6, TFN−? and C−reactive protein, such as blood pressure type «non−dipper» positively correlated with the content of IL−6, TFN−? and C−reactive protein. The blood pressure type «night−peaker» had a moderate positive relationship with the content of IL−6, TFN−? and C−reactive protein. It is concluded that elevated levels of CSI markers are an important determinant of formation and progression of arterial hypertension in patients with hypertensive nephropathy. Chronic systemic inflammation markers IL−6, TFN−? and C−reactive protein may serve as indicators of target organ damage in patients with essential hypertension.
Key words: hypertension, chronic systemic inflammation, cytokines, circadian blood pressure monitoring.
Kharkiv National Medical University, Ukraine
The effect of intrauterine fetal infection on calcium and magnesium exchange in pregnant with urogenital infection
34 - 38
Mineral insufficiency is currently considered one of obstetric and perinatal problems. Balanced supply of both mother and fetus with necessary amount of biogenic elements is essential for a normal course of pregnancy. Calcium and magnesium belong to mineral substances of paramount importance. Their contents in mother's body can be influenced by various pathologic factors, including infectious agents. The aim of the study was to determine a possible impact of intrauterine infection on the state of calcium and magnesium exchange in pregnant patients with urogenital infections of various etiology and their newborns. To achieve this aim the authors assessed blood serum of 254 pregnant patients with viral, bacterial and viral−bacterial infections and umbilical blood of newborns to determine the contents of calcium and magnesium by spectrophotometry with the use of diagnostic kits. The control group included 50 women with physiological course of pregnancy. The presence of any of the above mentioned infections was found to induce the development of moderate, but significant in comparison to the control group, hypocalcemia. Besides, intrauterine infection not only induced hypocalcemia in mother, but also reduced the intake of calcium by the fetus regardless of the type of infectious agent. Central trend of serum magnesium level alteration in the groups under study was almost similar to calcium level alterations. The presence of hypomagnesemia in mother to a certain extent also resulted in a reduction of magnesium intake by the fetus, as evidenced by its decreased amount in umbilical blood. It can be concluded that this group of pregnant patients with intrauterine fetal infection requires not only administration of the corresponding antiviral and antibacterial therapy but also mineral status correction.
Key words: pregnancy, urogenital infection, intrauterine infection of the fetus, calcium and magnesium exchange.
D. Halitski Lviv National Medical University, Ukraine
Vitamin D deficiency in women with threatened miscarriage and bacterial vaginitis
39 - 42
The purpose of the work was to study D−status of pregnant women with threatened miscarriage, and bacterial vaginosis. The study involved 58 pregnant women with 30−34−week gestation with the threat of premature birth and 15 with uncomplicated pregnancy. Ultrasound investigation was performed using ultrasound diagnostic system HDI 5000 Sono CT (Philips Ultrasound, United States). 25(OH)D level in the venous blood was determined with immunochemical method with electrochemiluminescent detection (ECLIA) (Cobas analyzer 6000, test system Roche Diagnostics, Switzerland). D−status assessment was carried out according to of the recommendations of the experts of Central Europe: the norm −− the level of 25 (OH) D 30−50 ng/ml, insufficiency −− 20−29 ng/ml, D−deficiency −− less than 19 ng/ml, expressed deficiency −− less than 10 ng/ml. The diagnosis of BV was made by R. Amsel criteria; qualitative and quantitative assessment of vaginal biocenosis was done using real−time PCR. In over a half of pregnant with the danger of miscarriage (60.3 %) vitamin D deficiency was revealed (14.60±3.14 ng/ml). 25(ОН)D (20.32±0.57 ng/ml) deficiency was characteristic for 18.97% of the pregnant and only 6.9 % had normal vitamin D level (30.69±0.41 ng/ml). Bacterial vaginosis was diagnosed in 32.8 % of the pregnant with the threat of miscarriage and in 13/3 % with uncomplicated pregnancy. The patients with pronounced vitamin D deficiency (11.78±296 ng/ml prevailed among BV patients. Our findings suggest that the reproductive history of pregnant women with vitamin D deficiency is characterized by frequent inflammation of the mucous membranes of the genital tract and problems in the reproductive history. BV in pregnant women with threatened miscarriage is detected in a third of patients (32.8 %). At vitamin D deficiency, detection rate of BV in this category of pregnant increases from 9.1 % in the vitamin D deficiency to 50.0 % in expressed D−deficiency.
Key words: bacterial vaginosis, premature labor, vitamin D, D-deficiency.
Kharkiv National Medical University, Ukraine
Assessment of the effectiveness of isthmic cervical incompetence correction with laser Doppler flowmetry
43 - 46
Cervical incompetence (CIN) is due to a pathological condition of the cervix. We developed a new method of correction of pregravid CIN consisting in the use of fillers, the main component of which is hyaluronic acid. To evaluate the effectiveness of various methods of correction of CIN we used a new method, Laser Doppler Flowmetry (LDF) technique based on non−invasive determination of blood perfusion of the tissue by measuring the Doppler shift that occurs when probing with the laser beam of red blood cells moving in the microvasculature. The study involved 90 patients who were divided into study and control groups. The control group consisted of 30 healthy women without abnormalities in the female reproductive system and history of miscarriage. The main group consisted of 60 women with the history of CIN. The analysis of the microvasculature with LDF in group 1 showed significant deterioration of microcirculation, possibly due to vasospastic effect in the area of the cervix. Group 2 also showed an increase in microcirculatory blood flow after the initial microvascular spasm. Obviously, these effects can be explained by the irritating action of the vaginal pessary on the cervical mucosa. In patients of group 3, after use of fillers based on hyaluronic acid, the microvasculature changes (expressed vasospasm) quickly returned to a normal level, corresponding the control group of patients. Thus, LDF allows to evaluate the processes of tissue perfusion by the blood, which is especially important in assessing the effectiveness and differentiated selection of therapy. Therapy using fillers does not violate the functional state of the microvasculature of the cervix, reduces the risk of complications after correction of CIN.
Key words: laser Doppler flowmetry, isthmic cervical incompetence, diagnosis of effectiveness of therapy, fillers.
Kharkiv Medical Academy of Postgraduate Education, Ukraine
Modern approaches to clinical diagnosis and treatment of static disorders of the spine and joints
47 - 51
Modern data of leg length discrepancies diagnosis and structure in patients with hip asymmetry are presented in the article. Musculoskeletal diseases (MSВ) are as a rule caused by a number of factors. In studying the pathogenesis of MSD derivatives of the factors are of great interest, they create unfavorable background and underlay in the development of the pathology. The study of pathological states connected with the so−called short leg syndrome or leg length inequality −− LLI−syndrome, also known as leg length discrepancies −− LLD−syndrome is important. Static musculoskeletal disorders are diagnostically rather difficult because visual estimation is used, which is difficult to objectify, analyze biochemically as well as define the role of these violations in pain syndromes appearance. Computer optical topography (COT) is the most perspective estimation procedure of static musculoskeletal disorders. Noninvasiveness, absolute safety, precise dimensional analysis, possibility of functional research are positive properties of this method. According to various researchers 4 mm leg length discrepancy is found in 81.2 % patients with lower lumbar pain, 10 mm and more −− in 43.5 %, from 15 mm and more in 17.8 %. In this case all patients demonstrated warps of various intensity and hip asymmetries. The most widespread effects of LLI−syndrome are hip rotations in sagittal and frontal planes. Hip warps to 22 mm are most common compensation reactions of leg length discrepancy. Irrespective of the cause, rotation moment in hip bones appears while walking in patients with this syndrome, which gradually leads to twisted hip and lateral curvature in the lumbar part of the vertebra on the side of longer leg. Under 4−6 mm leg length discrepancy S−shaped thoracolumbar scoliosis is formed. The article comprises the results of clinical studies and perspective analysis of the results of examination of 251 patients presented with chronic pain in the lower lumbar area and/or lower extremities, in which asymmetries of lower extremities and hip were found with the help of clinical tests and instrumental methods. The parameters allowing to exclude vertebra pathology which can be cause of hip warp were studied additionally. For this purpose the angle of the arc of curvature lateral asymmetry (LA) similar to Cobb angle diagnosed under x−ray study and rotation angle in the arc of curvature apex (RA) were investigated. Besides general clinical examination all patients underwent segment measurement of lower extremities length with the help of a measuring tape. All patients were additionally done hip symmetry estimation with the help of COT method of human body relief worked out in Novosibirsk SRITO. Leg length discrepancy was found in 176 (70.1 %) patients with hip asymmetry including 125 (49.8 %) where it was due to anatomic lower extremity shortening; 13 (5.2 %) had the history of the hip or shank fractures; in 56 (22.3 %) it was connected with knee joint and/or foot deformations. In other 83 cases (33 %) hip asymmetries can be connected with functional leg shortening due to hypertone of hip and/or over−hip muscles which was proved by presence of various myofascial pain syndromes. Treatment of patients with chronic pain syndromes in the back, hip and lower extremities was directed to pain syndrome elimination by muscular spasm decrease and injured area trophic improvement. Besides traditional ways of pain syndrome treatment, methods of static musculoskeletal asymmetries with orthopedic correction with the help of orthopedic girdles, posture correctors, bandages, insoles and socks were used. Decrease of specific weight of medications for pain syndrome elimination is an important principle of the treatment. With this purpose we preferred the use of local therapy with the help of modern methods including extracorporeal shock wave therapy (ESWT). This method allowed in short terms to decrease or absolutely eliminate pain sense and restore the function of the injured segment.
Key words: leg length inequality syndrome, myofascial pain syndrome, pelvic asymmetry, computer optical topography of the body, extracorporal shock-wave therapy.
Kharkiv National Medical University, Ukraine
Reparative methods of surgical treatment for defects in knee cartilage
52 - 55
Local damage of the cartilage knee is violation of the integrity of cartilage covering mainly in one department, which arise as a result of injuries and illnesses. The methods of reparative treatment of local cartilage knee defects are abrasive сhondroplastiс, microfracturization of the defect bed, subchondral tunneling aimed to stimulate chondrogenesis due to the release of pluripotent bone marrow stem cells of mesenchymal origin. The purpose of the work was to substantiate experimentally and clinically the optimal reparative surgical method of treatment of hyaline cartilage defects. To study the mechanisms of reparative chondrogenesis against a background of chondromalacia of the articular cartilage immunohistochemical study of 45 adult male rats was performed. Clinical material included 20 patients with chondromalacia of the articular cartilage of the knee joint of grade 3−4 by R. Outerbridge (1961), which were performed subchondral tunneling of the defect bed, clinical group 1. Twenty−one patients underwent a deep tunneling of the cartilage defect, clinical group 2. Bone marrow stem cells with subchondral tunneling of the zone of chondromalacia produce a few clones of proliferating chondroblasts, which migrate into the deeper layer of cartilage plates, dividing and differentiating into chondrocytes. Formation of through «tunnel» in the medullary cavity provides a mass migration to the cartilage of dividing cells, bone marrow−derived stem cells. The outcomes in clinical group 2 was significantly better. Reparative surgical technique for treatment of local cartilage defects of the knee (deep tunneling to the medullary cavity) is promising.
Key words: knee, chondromalacia, articular cartilage.
Kharkiv Medical Academy of Postgraduate Education, Ukraine
The use of medication and physiotherapy in cephalgic syndrome in patients with sequellae of brain injury
56 - 60
The patients with mild traumatic injuries (70−80 %) amount the largest group among patients with head injuries. One of the main long term symptoms of mild traumatic brain injury is headache. The aim of the study was to investigate the influence of the complex medical and physical therapy on hemodynamics in patients with sequellae of mild traumatic brain injury and evaluation of efficiency of the treatment and definition quality of life in the patients. The study involved 65 patients with sequellae of mild traumatic brain injury. The patients were divided into two groups: group 1 consisted of patients who received medical therapy. Group 2 included the patients who were administered a similar drug therapy and physical therapy in addition to using the method of magnetic therapy and darsonvalization. Control of the treatment was carried out using the method of Doppler ultrasonography of carotid arteries as well as testing of patients by questionnaire MOS SF−36 quality of life, which was carried out before and after the treatment. The result of the study showed that patients with sequellae of traumatic brain injury had disorders of hemodynamics and liquorodynamics. Decreased quality of life on all scales of the questionnaire MOS SF−36 was revealed. Combined treatment using physiotherapy and medical treatment leads to subjective and objective improvement of the state of patients. A fairly significant increase of cerebral blood flow and decrease in the indices of resistance vessels were observed. A significant increase in the quality of life on the scale of pain intensity, life activity, emotional and social functioning, physical functioning was found.
Key words: brain injury, sequellae of brain injury, darsonvalization, magnetotherapy, hemodynamics, qua-lity of life.
Kharkiv National Medical University, Ukraine
Antiphospholipid syndrome and acute сerebrovascular pathology in infants
61 - 65
Nowadays, the frequency of acute cerebrovascular diseases among children population ranges from 2.5 to 4.2 cases per 100 thousand. The leading causes of acute cerebral ischemia in children are congenital vascular abnormalities, blood pathology, autoimmune angiopathy, and hereditary metabolic disorders, including antiphospholipid syndrome (APS), which is considered a unique model of autoimmune thrombotic vasculopathy. Primary, secondary, catastrophic and neonatal APS are allocated. Clinical signs of APS vary and depend on the localization of noninflammatory thrombotic vasculopathy. APS signs in children are thrombocytopenia, migraine, nosebleeds, livedo reticularis, epilepsy, chorea (hyperkinesis), transient ischemic attacks and strokes, ocular neuropathy, sudden hearing loss, and others. The main serological markers of APS are increase of blood antibodies to phospholipids, cardiolipin, the presence of lupus anticoagulant in two or more studies, received with an interval of at least 6 weeks. An important criteria for the diagnosis of APS in children are the presence in relatives of rheumatic diseases; recurrent stroke and/or heart attack (especially before the age of 50 years); recurrent thrombophlebitis; miscarriage, eclampsia and pre−eclampsia. As an example, a clinical case of ischemic stroke against a background of antiphospholipid syndrome in a child aged 10 months was described in this article.
Key words: ischemic stroke, antiphospholipid syndrome, childhood, antiplatelet agents.
Kharkiv Medical Academy of Postgraduate Education, Ukraine
Treatment of cerebral venous dyscirculatory encephalopathy in patients in the late period of closed craniocerebral injury
66 - 70
The frequency and occurrence of traumatic brain injury in Ukraine ranges from 2.8 to 5.4 cases per 1000. After 2−4 years in 80 % of them different in structure and degree posttraumatic cerebral pathology, especially venous discirculatory is observed. Clinicians are searching for medical and drug−free methods of treating this pathology. It is of interest to study the effectiveness of Diosmin series drug on clinical manifestations of cerebral venous encephalopathy in patients in the late period of closed craniocerebral trauma and treatment of patients with the same pathology by complex method −− Diosmin and magnetophoresis with 10 % solution of bromine at the level of C8−Th2. The study was conducted on 72 patients with cerebral discirculatory venous pathology in late period of closed craniocerebral injury (CCI). The patients were divided into two groups. Group 1 (controls) consisted of 34 patients (47.2 %), who were administered Diosmin 600 mg a day, in the morning 30 minutes before breakfast for 30 days. Group 2 (main) included 38 patients (52.8 %), who had medical treatment, consisting of Diosmin 600 mg, and methods of physiotherapy magnetophoresis with 10 % solution of bromine at the level of C8−Th2. All patients with CCI underwent a common scheme of clinical and neurological examination. To verify the violations of cerebral hemodynamics extra and transcranial Doppler method was used. The indices of central hemodynamics and cardiopulmonary reserve were calculated by the original non−invasive method. The results obtained demonstrate a positive therapeutic effect of magnetophoresis with 10 % solution of bromine and Diomin at a dose of 600 mg on hemodynamics of the pulmonary circulation and blood circulation on the whole, indicate a rather pronounced compensatory potential of central and cerebral vascular system of the patient. Unlike the patients with initial manifestations of cerebral venous pathology, the patients with venous dystonia and examined patients with severe venous disorders (group 3) did not have any improvement in aerobic performance after pathogenetic treatment performed with 600 mg of Diosmin with magnetophoresis, which indicates significant violations of compensatory opportunities of vascular system and organic changes both in cerebral vessels and pulmonary circulation.
Key words: brain injury, venous circulatory encephalopathy, diosmin, magnetophoresis with 10 % solution of bromine.
Republican Specialized Scientific and Practical Medical Center of Dermatology and Venereology of Ministry of Health of Uzbekistan, Tashkent, Uzbekistan
Investigation of biological molecules in the rhythm of hair follicles in patients with alopecia areata
71 - 74
The problem of hair loss in working−age population is not only of medical but also social significance. The trend to growth of the rate of torpidly occurring forms of the disease that are resistant to therapy has been observed. The study of fibroblast growth factor bFGF, and FasL apoptosis factor in patients with alopecia areata can help to improve the treatment of this disease. Fibroblast growth factor bFGF, and apoptosis FasL factor were investigated in the blood of patients with alopecia areata and healthy individuals by ELISA using test systems Sigma (Germany). The results showed that the concentration of basic fibroblast growth factor bFGF in the blood of patients with alopecia areata was significantly reduced compared with those in healthy subjects and the concentration of apoptosis FasL factor was significantly increased. The changes in the indices of growth factors and apoptosis correlated with the severity of alopecia areata. The study suggests that the proteins of the FGF family and FasL are responsible for the fine adjustment of the phases of the life cycle of the hair follicles. Further studies aimed at regulating the concentration of these proteins in the hair follicles may become the basis for the improvement of treatment of alopecia areata.
Key words: alopecia, cytokines, dermatoscopy.
Kharkiv Medical Academy of Postgraduate Education, Ukraine
A case of syphilitic aortitis complicated with aortic aneurysm
75 - 78
Syphilis of the cardiovascular system is a late form of syphilis and usually occurs 5−40 years after the infection. Syphilitic aortitis occurs in 70−80 % of untreated patients after primary infection, while 10 % of these patients have serious cardiovascular complications such as aortic aneurysm, aortic stenosis of coronary and aortic valves. Syphilitic aortitis may manifest by symptomatic chest pain or symptoms of compression of the surrounding organs, but asymptomatic variant is also possible. Syphilitic aortitis complicated by aortic aneurysm is often found on chest x−ray or rupture of the aorta, and as a consequence, death (2−6). We present a case of syphilitic aortitis complicated by aortic aneurism in a 55 year−old woman, resident of Kharkov, pensioner, a former athlete identified by cardiosurgeouns. For 16 years the patient did not seek medical help, was ill only with ARVI. She complained of chest pain, inability to sleep on the back. CT revealed the signs of fusiform aneurysmal expansion with parietal thrombosis. The serological screening for syphilis PB 1:20, RPGA, ELISA for syphilis, RMP 1:8 were positive. The patient received 2 courses of antisyphilis specific treatment, she was discharged with improvement (chest pain disappeared), and with recommendations for further observation and treatment in cardiac surgery.
Key words: syphilitic aortitis, aortic aneurysm, syphilis.
N. I. Pirogov Russian National Research Medical University, Moscow, Russian Federation
Pressing issues of angioprotector administration
79 - 85
Modern classification of angiotropic drugs from the group of targeted, affecting target cells and organs is presented. The effectiveness and safety of pharmacotherapy with angioprotectors is influenced by two main factors: the chemical structure of the active substance (selectivity of angioproteguoe effect) and the concentration of the active substance in the vicinity of the target (value of angioproteguoe effect). Pharmacokinetics and pharmacodynamics of these drugs are described in sequential stages. The antioxidant and antiradical properties of the active substances of natural flavonoids comprising the angioprotectors (particularly quercetin and its metabolites) are discussed. Venotonic action of flavonoids in the treatment of chronic venous insufficiency is emphasized. Particular attention is paid to safety of pharmacotherapy with systemic phleboprotectors, because the literature reports prooxidant action of flavonoids, which is expressed in the damage of biological structures, general decline in the viability of cells. This stresses the necessity of further research in order to expand the clinical use of quercetin and its derivatives.
Key words: angioprotectors, bioflavonoids, quercetin, water-soluble fraction of flavonoids, efficacy and safety of therapy.
Kharkiv Medical Academy of Postgraduate Education, Ukraine
Pressing issues of malaria prevention
86 - 89
Two main ways for how antimalarial prophylactic measures are held, i.e. early diagnosis and sanitation of patients with malaria or parasitemia (the most important part of the measures), and the fight against pathogen's vector mosquitos are presented. The aim of malaria prophylaxis is to prevent infecting people and (or) to prevent the disease itself. Therefore, prevention is the destruction of vectors (mosquitoes) and the malarial parasites (Plasmodium). In terms of vector control entomological surveillance is provided in the infection nidus, hydrotechnical measurements, processing mosquito breeding sites by larvicides and processing the facilities by imagicydes. In endemic regions precautions against mosquito bites should be taken. It is important to provide information about the correct individual malarial chemoprophylaxis to the people traveling to endemic areas. As an individual chemoprophylaxis to malaria caused by resistant to chloroquine plasmodium falciparum, Fansidar, atovaquone/proguanil, Malarone, mefloquine and artemisinin are used. Chloroquine is used in nidus whithout chloroquine−resistant P. falciparum. In areas with high infection risk, chloroquine is combined with pyrimethamine. Chloroquine is also used as a chemoprophylaxis to other types of malaria. In some regions Savarin (chloroquine + proguanil) is also used. For the relapse caused by vivax and ovale−parasites, primaquine additionally is administered for 14 weeks. Vaccine prevention is not performed due to the absence of vaccine.
Key words: malaria prevention, mechanical protection, chemical protection, drugs.
P. L. Shupik National Medical Academy of Postgraduate Education, Ukraine
Type 1 bocavirus detection in children with clinical manifestations of acute respiratory viral infection
90 - 94
Acute respiratory infections are one of the most pressing problems of Ukrainian pediatrics, as they make over 90 % of all infectious diseases in children population. The studies conducted in 2011−2014 revealed a significant spread of infection with bocavirus (NBoV1) in Ukraine. It was noted that the peak of incidence in the country is in December. Virological studies to identify HBoV were conducted in a scientific laboratory of P. L. Shupik National Medical Academy of Postgraduate Education. Real−time polymerase chain reaction was used to analyze 458 samples of biological material taken from hospitalized children with acute respiratory viral infection. The results showed the presence of DNA bocavirus in 23.5 % of cases in patients aged 1−7 years. The patients with bocavirus infection most commonly present with cough, corisa, fever, difficult breathing, edema. It was established that bocavirus can affect the upper and lower airways, which is manifested by acute otitis, tonsillitis, pharyngitis, laryngotracheitis, obstructive bronchitis, pneumonia. Today one of the main methods of bocavirus detection is real−time polymerase chain reaction, which allows to quickly obtain accurate information about the etiological cause of acute respiratory viral disease and prescribe treatment.
Key words: human bocavirus, diagnosis, acute respiratory viral infections.
Kharkov Medical Academy of Postgraduate Education, Ukraine
Etiopathogenic aspects and complex ultrasonography of endometrial hyperplastic processes
95 - 97
Endometrial hyperplasia (EH) is a heterogeneous group of pathological processes, ranging from benign estrogen−dependent proliferation of the glands to monoclonal growth of altered tissue of the uterus membrane. Endometrial hyperplastic processes deserve special attention because of the risk of malignancy such as atypical hyperplasia, endometrial adenomatosis (diffuse and focal form). According to modern ideas, there are two main pathogenetic mechanism of endometrial hyperplasia. The first mechanism results from development of long−term estrogen stimulation of the endometrium in the absence of anti−proliferative effect of progesterone with anovulatory dysfunction against a background of absolute or relative hyperestrogenemia. The second mechanism of EH is due to the lack of hormonal effects, and the important role played by metabolic disorders, systemic and local changes in the endometrium at the cellular and intracellular levels as well as hyperinsulinemia and insulin resistance. The aim of the work was to study the ultrasonographic criteria of EHy in women of reproductive age using color Doppler mapping (CDM). The study involved 54 women of reproductive age with histologically verified diagnosis of endometrial hyperplasia who underwent ultrasonography integrated with the CDM in the first phase (day 5−7) of menstrual cycle with assessment of the thickness and structure of the endometrium, endometrial−uterine coefficient (EUC), resistance index (IR) and the character of the blood flow in the investigated area. Ultrasonography with CDM in 48 (88.9 %) patients with endometrial hyperplasia, revealed endometrial thickness averaging 13.6±2.4 mm, increase in echogenicity ranging from 0.9 to 1.2, anehogennoe inclusions to 2.5−3 mm, increased vascularization of the endometrium, peripheral blood flow type; IR was 0.58±0.06, the rate of blood flow amounted 8.3 cm/s. In 17 (31.4 %) patients, both endometrial polyps measuring 0.2−0.4 cm, increased echogenicity, homogeneous structure, presence of a small amount of fluid around the formation, presence of deformation of the site of joining of the frontal and posterior walls of the uterus and irregular thickening of the endometrium circulation were visualized. The presence of the pedicle of the polyp was found in 9 (16.6 %) women, IR was 0.67±0.03. To clarify the pathogenic mechanisms of development of endometrial hyperplasia in women of reproductive age, it is appropriate to study the metabolism of sex steroid hormones, the functional state of the endometrium at the cellular and intracellular levels. The use of complex ultrasonography with CDM allows to determine the structural changes in the endometrium, to assess the extent of its vascularization, assess the blood flow in the study area, which greatly improves the accuracy of diagnosis of endometrial hyperplasia in women of reproductive age.
Key words: endometrial hyperplasia, endometrial polyps, hormonal profile, receptor apparatus, complex ultrasonography.
Stakhanov Maternity Hospital, Lugansk region, Ukraine
The capabilities of transvaginal ultrasonography in the diagnosis of background cervical diseases
98 - 102
The paper presents the literature and the original data on the capabilities of transvaginal sonography in the diagnosis of background diseases of the cervix (endocervical hyperplasia, polyps, pseudoerosions, chronic endocervicitis). It is shown that endocervical hyperplasia is characterized by thickening, increased echogenicity in the proliferative phase of the menstrual cycle. In severe hyperplasia of the total thickness of sheets of endocervical is 12.1±1.1 mm. The polyps located in the external os are hardly differentiated from the surrounding tissue, and polyps of the cervical canal can be seen better, especially on a short stem with a clear, smooth contour, surrounded by the liquid on three sides. Pseudoerosions were diagnosed in 73 (96.1 %) women of 76 colposcopically identified. They were characterized by the presence of small slit−like inclusions and cystic cavities of irregular shape measuring less than 3 mm in the external os. Ultrasound picture of endocervicitis was studied in 60 women. It was found that it the possible ultrasonic endocervicitis criteria were thickening of M−echo over 5 mm (78.3 %); heterogeneous structure of the endocervix (96.6 %); endocervical hyperechoic inclusions (38.3 %); rough boundary between the mucosa and muscle layer (76.6 %); multiple small cysts (41.6 %); expansion of the cervical canal in the ovulatory period (63.3 %); small hyperechoic inclusions with an acoustic path (23.3 %); increased vascularization of the endocervix (68 %).
Key words: transvaginal ultrasonography, uterine cervix, background diseases.
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