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The purpose of the work was to analyze the characteristics of ambulatory blood pressure monitoring (ABPM) in hypertensive patients with overweight and obesity. A total of 76 patients (35 men and 41 women) with essential hypertension (EH) aged 38−76 who received antihypertensive therapy with groups 1−3 of drugs were observed. Depending on the body mass index, the patients were divided into 4 groups: group 1 −− patients with normal body weight, group 2 −− patients with overweight; group 3 −− patients with hypertension and grade 1obesity, group −− 4 patients with hypertension and grade 2−3 obesity. Analysis of ABPM parameters in hypertensive patients with obesity and overweight revealed significantly higher index area and normalized load index area of diastolic pressure, as well as the value of the daytime and nighttime variation in diastolic blood pressure. The analysis of indicators reflecting the dynamics of the blood pressure in the morning revealed statistically significant increase in «adverse» morning hours index values in groups of hypertensive patients with grade 1−3 obesity compared to the patients with normal weight and overweight. Hypertension in overweight and obesity was associated with changes in the biological circadian rhythm of blood pressure to «non−dipper» type with lack of its adequate reduction at night. The revealed features of the ambulatory blood pressure monitoring parameters indicate an increased risk of early target organ damage and development of cerebral vascular events in these patients.

The aim of the work was to estimate the value of the polymorphic locus G−308A gene of tumor necrosis factor−α in development of obesity in patients with coronary artery disease. Complex examination of 222 patients with coronary artery disease, who were treated at cardiology department of Kharkiv City Clinical Hospital № 27, was performed. All patients with coronary artery disease and obesity were divided into three groups. Group 1 included patients with grade 1 obesity (n = 80), group 2 −− patients with grade 2 obesity (n = 71), and group 3 patients with grade 3 obesity (n = 71). Thirty−five healthy persons saved as controls. Statistical analysis of the results was performed using software Statistica (StaSoftInc, USA). Mean, standard deviation and significance level by Pearson at p < 0.05 were calculated. Reducing the frequency of detection of the genotype G/G polymorphic locus G−308A gene of tumor necrosis factor−α is associated with development of obesity in patients with coronary artery disease. In patients with coronary artery disease and obesity, increase in the detection rate of A allele and genotype A/A polymorphic locus G−308A gene of tumor necrosis factor−α and decrease in G allele was associated with an increase in the body weight.

For most patients with gout the physicians of the first contact are general practitioners, family doctors. However, research results indicate a lack of awareness among primary care physicians of the criteria of diagnosis and modern approaches to treatment of gout. The majority of family physicians traditionally consider gout primarily as the disease of the joints. Joint syndrome is a striking clinical manifestation of the disease; it affects the quality of life of the patient and, acquiring a chronic course, leads to disability. However, gout may inflict different organs and systems, especially the kidneys, often preceding the typical gouty arthritis and determine the prognosis of the patient. Awareness of family physicians on modern principles of management of patients with gout can improve early diagnosis of the disease and ensure the timely and optimal treatment. Knowledge of risk of purine metabolism disorders underlying gout, and ways of their correction, as well as patient education in healthy lifestyle can provide a basis for effective prevention programs.

The authors present the analysis of results of surgical treatment of 78 patients with locally advanced tumors of the pelvic organs complicated by involvement of the adjacent organs. The tumors were complicated by invasion of the urinary tract with formation of enteric−vesical, intestinal−vaginal or vaginal−vesical fistula (45 patients) and unilateral (8 patients) or bilateral ureterohydronephrosis (4 patients). The primary tumor location was as follows: 45 patients −− adenocarcinoma of the rectum and sigmoid colon, 15 −− squamous cervical cancer, 12 −− ovarian cancer, 6 −−− pelvic sarcoma. Of 78 cases of tumor invasion into the adjacent pelvic organs, posterior pelvic exenteration (intestine resection with hysterectomy) was performed in 34 cases, resection of the bladder and ureters was performed in 34 cases. Five cases underwent total pelvic exenteration, 2 −− colostomy. Two−stage operation was performed in 18 cases, one−stage in 58. Histological examination of removed tumors in 67 of 76 patients (88.1 %) indicated the true invasion of the adjacent organs, while inflammatory infiltration of the body wall occurred in 9 (11.9 %) patients. In 92.2 % of patients, resection margins investigation indicated radically performed partial exenteration (absence of cancer cells in the resection margin). Surgical treatment of this disease with a high degree of radical removal of the primary tumor can be achieved by combined surgical interventions in cases of staged surgical tactics and syndrome approach.

Endovenous laser ablation (EVLA) as mini−invasive analogue of saphenous stripping is one of priority methods of surgical treatment of varicose disease. It can be performed for the interfascial segments of veins (saphenous veins). But recommendation for treatment of tributaries are still debated. In all described cases, tunnel anesthesia of tributaries (own technique), aimed at reduction of vein diameter, and as a result to free location of the tributary in the with liquid tunnel. No significant difference was found between groups of combination of EVLA with phlebectomies and EVLA with sclerotherapy. No significant complications were found in both groups. Few small esthetic complications without significant difference between groups were observed except pigmentations which had significantly higher incidence in EVLA plus sclerotherapy group. The study showed that one or another supplementing method can be more suitable in different patients depending on configuration of tributaries, severity of chronic venous insufficiency etc. As a result the algorithm of supplementing treatment of venous tributaries was created. Finally the study showed that in 94.7±1.6 % of cases of EVLA performance supplementing treatment of venous tributaries is needed. Tunnel anesthesia eases and optimizes treatment of tributaries. The choice of supplementing treatment can be made based on clinical manifestations of varicose disease, results of duplex investigations (tributaries number, configuration, location data). Efficacy of EVLA is 98.4±0.9 % and does not depend on kind of supplementing treatment of tributaries.

Modern surgery treatment of chondromalacia of the knee joint are aimed at creation of optimal conditions for repair of the cartilage, similar to hyaline cartilage. However, the scientific task of surgery for local cartilage defects of the knee joint is still far from being solved, as clinical and functional outcomes are not always satisfactory. The purpose of the work was to make a comparative analysis of the results of treatment of patients with chondromalacia of the articular cartilage of the knee joint using various reparative techniques. The surgical interventions were performed arthroscopically, microfracturization technique and subchondral tunneling were standard. The method of deep tunneling, the distinctive feature of which is to form the tunnel to the medullary canal is described in detail. The methods of physical rehabilitation in the postoperative period were similar in all patients. Clinical functional results of the treatment were assessed in dynamics according to Tegner−Lysholm procedure. The best treatment results were observed in the clinical group with reparative therapy technique (deep tunneling). The same results of treatment were in clinical groups, which underwent microfracturization and subchondral tunneling technique.

Identification of the pathophysiological mechanisms of infertility and unsuccessful attempts of in vitro fertilization is an important issue of modern reproductology. The aim of this study was to determine the risk factors of thrombosis formation in patients with thrombophilia, leading to unsuccessful attempts at IVF. All patients were examined for the presence of antiphospholipid syndrome and hereditary gene polymorphism predisposition to thrombophilia. The study revealed that the presence of genetic thrombophilia, especially their combination with antiphospholipid syndrome (APLS), may be the cause of clinically diagnosed early pre−embryonic losses. It revealed a significantly higher incidence of various structural forms of thrombophilia in patients with failed IVF. Etiopatogenetic risk factors for failed attempts of IVF in women with thrombophilia are the presence of APLS and the genetic thrombophilia (FV Leiden mutation, prothrombin G20210A mutation, MTHFRS677T polymorphism gene PAI−1 or other thrombogenic defects in fibrinolysis, and platelets count), the combination of which greatly increases the risk of thrombotic complications and leads to a lack of embryo implantation into the uterine cavity; the prevalence in the structure of multigenic thrombophilia, gene polymorphism, and endogenous hypofibrinolysis of synchronization processes of fibrinolysis and fibrin, as well as a high concentration of circulating APL antibodies in conjunction with hyperhomocysteinemia cofactors and antibodies to APL antibodies.

The aim of the work was to determine the role of the cytokine profile in reducing fertility and etiopathogenesis of non−developing pregnancy (NDP). The study involved 124 women, of which 64 women with confirmed NDP were selected as a core group. The comparison group was formed by 30 healthy women referred for the operation of medical abortion. The control group consisted of 30 healthy women planning pregnancy. All patients were examined to assess the viability of the luteal phase of the menstrual cycle. The dynamics of follicle growth and transformation of midline structures of the uterus were controlled by ultrasound. The content of estradiol and progesterone in the blood serum, local immunological status were investigated by detection TNF−alpha in in swabs of the uterus, interleukins IL−1, IL−6, IL−10, FAMG. Endometrial biopsies were subjected to histological examination to evaluate its functional activity and expression of estrogen and progesterone receptors. The findings showed that a large role in reducing fertility in women is played by malfunction of microenvironment genital cells as a result of persistent inflammatory process. In the future, the process of restoring fertility (even after treatment of the focus of infection) may be hindered by problematic restoration of hormone−cytokine relationships that define a complete menstrual cycle with adequate functional activity of the endometrium, reflected by the proper production of FAMG. Thus, hormone−cytokine balance provides a full menstrual cycle in women with normal endometrium, which depends on the secretion of fertility alpha−microglobulin (glycodelin). Non−developing pregnancy is a result of disorders of the immune−endocrine−tissue relations in the genital tract, which can lead to permanent reduction of female fertility.

Differentiated use of organ operations in gynecological patients with uterine leiomyoma (UL) allows saving generative function of patients. In this context, the aim of our study was to evaluate the effectiveness of the combined treatment and various types of hormonal therapy in patients with UL. The study involved 48 women with UL, who were divided into two clinical groups: 1 (n = 20) treated with combination therapy: stage 1 −− hormone therapy with Gn−RG agonists for 3 months. In the absence of the effect of the therapy, stage 2 (operation) was performed: laparotomy, myomectomy with histological examination of the removed tissue. Group 2 consisted of 28 patients who received preoperative selective modulators of receptors by estrogen for 3 months. Treatment efficacy was assessed by the change in the size of fibroids, normalization of the general condition and uterine bleeding intensity. The investigation demonstrated that the use of hormone therapy in some cases allows avoiding surgical treatment to stabilize the growth of fibroids and significant reduce their size. In case of ineffective hormonal therapy, surgery was performed. The use of hormone replacement therapy in the preoperative stage allowed to increase the percentage of organ−preserving operations, to reduce blood loss during surgery and to reduce the size of the scar on the uterus.

Main clinical variants of kidneys impairment against a background of purine exchange disorders: acute urate (gout) nephropathy, urate tubular−interstitial nephritis, urate nephrolithiasis as well as the details of medication, used in modern nephrology for therapy of such diseases are described in this article. Basic medication for treatment of gout nephropathy is Allopurinol, highly effective in urate tubular−interstitial nephritis, acute uric acid nephropathy, urate nephrolithiasis in combination with hyperuricemia, and is the medication of choice for prevention of acute uric acid nephropathy development in cancer patients. Allopurinol frequently causes side effects, such as dyspepsia and dermatitis, that limit its usage. Alternative inhibitors of xanthy−oxidase is Febuxostat, that has a more favorable profile of safety. Uricosuric medications are rarely used at present due to their hepatotoxicity and high risk of recurrent urate nephrolithiasis. In cases of combination of gout and arterial hypertension in patients with preserved renal function and absence of nephrolithiasis, Losartan could be used, that is characterized by hypotensive and clinically meaningful uricosuric effect. Citrates are the drugs of choice for dissolution of renal calculi, consisting from uric acid and its derivates, and also for metaphylaxis of urate nephrolythiasis. Citrate therapy should be performed under a thorough urine pH control because its excessive alkalization could be followed by phosphate crystallization. Layering of phosphate film on the urate calculus makes ineffective the further treatment with citrate mixture.

Clinical manifestation of acute renal failure, its pathogenetic relationship with biochemical reactions in the kidney tissue, their functional activity and processes of self−regulation are featured. Regardless of the cause of acute renal failure, renal disease is characterized by common mechanisms, among which oxygen deprivation, disorders of acid balance and water−electrolyte shifts are of primary importance. Their pathogenetic interdependence leads to nephron damage. Under these conditions, the optimum is replacement therapy including dialysis or kidney transplant surgery. To achieve drug protection of the kidney in accordance with the clinical severity of the disease, the drugs of different pharmacological groups or combinations, providing symptomatic effect, are administered. Herewith, the means of pathogenetic therapy, which providing nonspecific metabolic effects, can protect the kidney under pathological conditions, are absent. The rational combination of these properties is possible in drugs with antihypoxic activity based on the antioxidant mechanism, which allows polytropic pharmacodynamics. This is confirmed by the literature and the results of the original research of the effectiveness of synthetic (sodium salt of poly−(2,5−dihydroxyphenylene)−4−thiosulfate acid) and plant (hofitol) antihypoxants in a model of renal pathology. Against this background, improving the tissue respiration of the renal parenchyma and restoration of blood supply to the kidneys due to the direct antihypoxic action of the drugs protects their excretory function and its sensitivity to the processes of self−regulation.

Parkinson's disease is one of the most common diseases of the nervous system. In addition to the motor symptoms, the clinical presentation of the disease includes non−motor symptoms, appearing 5−10 years before the clinical manifestation of motor disorders. Among the non−motor manifestations of Parkinson's disease are neuropsychic, autonomic, sensory, sleep disorders, pain being the most common. The purpose of the work was to prove feasibility of inclusion in the comprehensive treatment of pain in patients with early stage of Parkinson's disease, of physical factors, such as sinusoidal modulated currents, balneotherapy and low−frequency variable magnetic field. Our findings suggest that in patients treated with the proposed complex of therapeutic physical factors, pain reduction, as well as subjective improvement and, ultimately, improved quality of life developed earlier compared to the control group. The combination of neuroprotective pathogenetic therapy and treatment with physical factors is effective and helps to keep the motor activity of the patients with early stages of Parkinson's disease.

Development of new trends in modern operative surgery and elaboration of new surgical interventions require their deep anatomical study using modern research methods. In recent years, the leading hospitals have demonstrated the principle of carrying out operations with the use of 3D graphics. The purpose of the work was to develop a three−dimensional model of the cerebellum, its nuclei and pathways. The study was performed on 430 specimens of the cerebellum of people who died at the age of 20−99 due to the diseases not associated with the involvement of the vascular and central nervous system. Macromicroscopic, stereotactic, morphometric, graphic methods and statistical analysis were used. Final fixation was performed in a special solution consisting of glycerin, water, alcohol, pepsin, ammonium chloride and NaCl. Human anatomy department of KNMU has developed a 3D model of the cerebellum, its nuclei and pathways, based on their macromicroscopic specimens, taking into account their individual variability and topographoanatomical features. Our 3D model is a highly accurate copy of natural macromicroscopic anatomical specimen. A three−dimensional model allows creation of a synthetic model using a 3D printer fully corresponding the original macromicroscopic specimen. The data obtained can be used in the practice of neurosurgery, neurophysiology, neurology and neuromorphology with the purpose of detailing cerebellar areas, optimization of operations on the cerebellum. They can be used in a number of scientific works and implemented in the educational process. They complement the existing concepts about common patterns of the structure of the cerebellum, its nuclei and pathways.

To study neuropsychological peculiarities and autonomic nervous system state of the NMU students for early diagnosing of autonomic dysfunctions, 1379 students) were examined. At first they were tested using ЕРІ (Eysenck Personality Inventory). The type of temperament was determined according to I. P. Pavlov. The second stage consisted of evaluation of autonomic tone with calculating of Kerdo index (BI). Autonomic reactivity was assessed according to G. Dagnini−B. Aschner reflex. Increased excitability of the higher nervous activity was revealed in the majority of students, the average score of the women was significantly increased. Extraverted types dominated. Autonomic tone testing revealed sympathicotonia suggesting adaptive reaction strain. The blood pressure (total 93 %) and the history of vegetovascular disorder (88 %) confirm the correlation of the findings of psychological investigations with the present autonomic dysfunctions.

A clinical and morphological study of 108 middle−aged women with arterial hypertension who referred to the clinic for plastic surgery was performed to assess the clinical morphological characteristics of the skin. Morphological examination of skin biopsy specimens from behind the ear using staining with hematoxylin−eosin, picro fuchsin (Van Gieson), fuchselin (Weigert) for elastics, revealed in these patients the changes, particularly expressed in the microvasculature in the form of dystonia: uneven lumens in the arterioles due to spasms and ectasia, destructive changes of the walls (mucoid and fibrinoid swelling up to necrosis), plasma impregnation, formation of blood clots and microaneurysms, hyalinosis, endothelium discomplexity. Marked degenerative changes in the elastic and collagen fibers with violation of their relationship, uneven thickness and tortuosity of the basement membrane, variability in different layers of epidermis cells with uneven accumulation of melanin and hemosiderin were revealed in the dermis. More pronounced manifestations of vascular and degenerative changes were present in older individuals, which confirms the validity of the clinical and morphological patterns and causal relationship of vascular changes and parenchymal cells. This should be considered by clinicians at all stages of patient management, i.e. pre−, post−operative and rehabilitation.

This review features the questions of disorders of immunoinflammatory response regulation leading to various pathological conditions (tumor growth, chronic inflammatory and autoimmune diseases, etc.). In this case, formation of immunological tolerance, triggered by unaccomplishing immunological process can be important. The ability of inflammatory mediators to induce tolerance is used in normal conditions (during pregnancy, tolerance to dietary antigens). The mechanisms linking development of tumors, tolerance and chronic inflammatory response and possible regulatory role of a number of drugs in these processes were determined. One of the most important stimulators of apoptosis is PD−L1, its binding to the corresponding receptor on the surface of T−cells leads to anergy. In the tumor microenvironment, T−lymphocytes are characterized by expression of a large number of inhibitory receptors therefore promising means of cancer immunotherapy is the use of antibodies to it. Thus, ipilimumab (antibody drug for CTLA−4) indicates a relatively high efficiency in treatment of late−stage melanoma. The effects of cytokines are discussed. The state of immunological response is connected with regulation of metabolism of some amino acids; their deficiency allows reduction of inflammatory response and induce immunological tolerance. Taking into account the importance of maintaining balance in the immune regulation, compounds that can suppress chronic inflammation and does not have severe side effects after prolonged use are searched. Among such substances are flavonoids, retinoic acid and its metabolites, as well as non−steroidal anti−inflammatory drugs. Thus, there are prospects for effective pharmacologic effects on the regulation of immune processes with the purpose to eliminate chronic inflammation and its negative consequences.

Varicella morbidity in adults has increased 2 times recently. This disease causes a number of complications, including, myocarditis. The incidence, clinical features and treatment of acute myocarditis in adults with chicken pox were investigated. The study involved general clinical, biochemical and instrumental methods. Our findings show that acute myocarditis is caused by type 3 herpes virus; the disease may be asymptomatic as the clinical picture is veiled by the infectious process. High correlation between severity of varicella and incidence of acute myocarditis in adults was revealed. Drug treatment should be early and include antiviral drugs (acyclovir), drugs affecting the inflammatory, autoimmune and allergic reactions, restoration of hemodynamics, effects on the metabolic processes in the myocardium, symptomatic therapy for the complications.

Research aimed at improving the diagnosis of acute neuroinfections for early correction of complex treatment considering the etiology of the disease can increase its effectiveness and is relevant today. The aim of our study was to evaluate the diagnostic value of PCR in the diagnosis of acute neuroinfections in adults. To achieve this, we analyzed all clinical cases of acute neuroinfections in adults in Kharkiv and Kharkiv region for 2011−2013. To establish the etiology of the disease, in addition to bacteriological studies of CSF and blood, PCR was used to detect enteroviruses, types 1,2 herpes virus, herpes zoster virus, Epstein−Barr virus, type 6 human herpesvirus and cytomegalovirus in CSF of patients with serous neuroinfections. HIV−positive patients also underwent investigation for T. gondii. In purulent lesions, CSF PCR was performed to identify Meningitidis N., S. Pneumonia, H. Influenza, which, according to the literature, are among the most frequent pathogens of neuroinfections in adults. The analysis of the findings allows the conclusion that only using only generally accepted bacteriological and serological methods is insufficient. PCR greatly increases the etiological decoding of acute neuroinfections in HIV−negative and HIV−positive patients. In HIV− patients with CNS symptoms, normal CSF indices do not preclude neuroinfections. In such cases, all possible methods of pathogen identification, including PCR, should be used.

Martial injuries of the spinal cord, peripheral nerves evoke persistent disability and account for about 5 % of neurotrauma. During the period of antiterrorist operation in the eastern Ukraine, gunshot wounds a of the spine and spinal cord made 2−37 % of nerve trunks injuries and were combined with the wounds of the vessels of the extremities. Ultrasound examination of the peripheral nerves was performed in 39 victims with gunshot and mine−explosive wounds to the extremities and spine. The wound channel, the presence of hematoma surrounding the tissue, foreign bodies (injuring shells, bullets, their plating, metal fragments) were assessed. Ultrasonography allows to specify the type, location and the cause of the nerve trunks damage. Ultrasonography of the peripheral nerves may be carried out in the conditions of a mobile hospital and plaster mobilization of the wounded and injured. In combined injury with extensive lesions of the long bones, the neurovascular bundles and tendons limits evaluation of the proper nerve structure violation and making a differential diagnosis.

Tension headache (TH) and cervicogenic headache (CH) are the best−known and most common neurological diseases occurring in adults. To study was performed to assess cerebral hemodynamics using transcranial duplex scanning in patients with different types of TH and CH. The parameters of the linear blood flow velocity (BFV) in the cerebral arteries and maximal blood flow velocity (Vmax) in vertebral veins (VV), Rosenthal basal veins (RBV) and straight sinus (SS) were investigated using transcranial Doppler sonography at rest and under functional loads. Hemodynamic disturbances in the studied persons with TH often manifested in the form of strengthened BFV in the middle cerebral arteries and asymmetry of the BFV. Patients with CH manifested vasospasm in both vertebral arteries (VA), vasospasm in one VA and/or basilar arteries (BA), blood flow asymmetry through VA. The majority of patients with TH had increased Vmax in the SS and BVR, and the vast number of patients with CH had increased Vmax in the VV and SS, and hyperreactivity in VV and SS compared to the control set. Cerebral hemodynamics in patients with tension headache is characterized by angiodystonic phenomena, venous disgemia in the form of increased outflow from SS and BVR and hyperreactivity during ortho− and antiorthostatic loads in SS and BVR. In patients with cervicogenic headache vasospastic reactions in VA and BA, venous discirculation in VV and TS dominate.