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Inflammation plays the key role in pathogenesis of myocardial infarction and is a necessary stage for healing. High−sensitivity C−reactive protein is the laboratory marker that can reflect the input of inflammation during the disease course. Six hours after the disease onset high−sensitivity CRP concentration rises sharply, which reflects the degree of the inflammatory process due to myocardial necrosis. The aim of the work was to evaluate the factors which affect the degree of inflammation in patients with myocardial infarction and possible relationship between high−sensitivity C−reactive protein level and intracardiac hemodynamic parameters. All patients underwent intravenous fibrinolysis. Cardiac ultrasound was performed on day 3−14 of the disease. Blood sampling for high−sensitivity C−reactive protein was performed on admission, during the first 6 hours of the disease onset. The level of CRP was determined using increased latex immunoturbodimetric analysis. Strong positive correlation between high−sensitivity C−reactive protein level and the history of type 2 diabetes mellitus and with the time to fiblinolysis; weak positive correlation between high−sensitivity C−reactive protein level and LV end−diastolic diameter were revealed. Patients from the highest quartile had higher mean end−diastolic and end−systolic LV diameter than the patients in groups 1 and 2. Valid regression model in which high−sensitivity C−reactive protein level accounted for 7.3 % of end−systolic LV diameter increase and for 8.9 % of end−diastolic LV diameter increase was obtained. High−sensitivity C−reactive protein level is an independent factor related to end−diastolic and end−systolic LV diameters in patients with ST elevation myocardial infarction.

The knowledge of the genetic factors predisposing to the disease and its complications can have important prognostic significance and be used both before the appearance of any clinical or biochemical signs of the disease and when choosing the drugs and treatments modalities. The study of allelic polymorphism of the hemostatic system genes in patients with coronary artery disease (CAD) as well as in healthy individuals in the general population allowed to find alleles that are in varying degrees associated with predisposition to development of this disease in different ethnic groups. To determine the frequency of allelic variants of C50T PTGS1 gene polymorphism and relation of polymorphism with clinical, biochemical and functional aspirin resistance in patients with coronary artery disease, patients with chronic forms of CAD (stable angina, myocardial infarction) were examined against a background of standard therapy. The patients were divided into aspirin resistant whose cardiovascular adverse events and those clinically sensitive to ACK without complications. As a criterion of the level of biochemical aspirin resistance 11−dehydro−thromboxane B2, functional AR −− total arachidonate index and ADP−induced platelet aggregation was determined. Genotyping of a polymorphic site of S50T gene PTGS1 (rs3842787) was performed by polymerase chain reaction followed by analysis of restriction fragment length. The probability of ACVE development for mutant T−allele COG−1 polymorphism patients was significantly higher (Odds ratio =3.39; 95 % CI [1.39−8,77], p = 0.019), than for C−allele patients. A significant relationship of mutant T−allele C50T polymorphism gene COX−1 with the index of arachidonate−induced platelet aggregation (p = 0.0007), with the malonic dialdehyde (MDA) (p = 0.024) and low density lipoprotein cholesterol (LDL) cholesterol levels (p = 0.049) was revealed. The presence of the mutant C−allele of the gene polymorphism T1565S was significantly associated with LDL level, urine 11−dehydro TxB2 levels and the level of (NO2 + NO3). The findings demonstrate that the presence of mutant alleles of polymorphism C50T PTGS1 gene and polymorphism T1565S ITGB3 gene is significantly associated with coronary artery disease pathogenetic factors that can contribute to a more severe course of the disease and increase the risk of adverse cardiovascular events.

The article reports the original experience of treatment of patients with choledocholithiasis, who were performed percutaneous transhepatic endobiliary interventions at the so−called "endoscopically complex forms" of choledocholithiasis. The classical surgical interventions performed in the conditions of obstructive jaundice and purulent cholangitis significantly aggravate surgical results and are accompanied by a high level of mortality. Percutaneous transhepatic endobiliary interventions were used in patients to prepare them for reconstructive operations and in a small number of patients after decompression of the biliary tract (mechanical lithotripsy, balloon dilation of the major duodenal papilla and bringing down the stones into the duodenum). If suppurative cholangitis was present, percutaneous transhepatic endobiliary drainage allowed carrying out treatment of the biliary tract with antiseptic solutions. After reconstructive operations, endobiliary drainage was not removed thus preventing the development of biliary hypertension. Percutaneous transhepatic endobiliary interventions can eliminate the obstructive jaundice syndrome, suppurative cholangitis, and prepare the patients to reconstructive surgery and in some cases become the sole method of treatment of patients with high operational and anesthetic risk.

To assess cytotoxicity of dressings and biopolymer gels used for wound treatment, the influence of some of them on the growth and viability of human skin fibroblasts (FB) in culture was studied. Human skin FB were innoculated in 12−well culture plates and cultured for 72 hours in CO2 incubator. Seven variants were investigated experimentally: 1 −− FB in the culture medium (control); 2 −− FB + dressing Grassolind (Hartmann); 3 −− FB + washed dressing Grassolind; 4 −− FB + mesh Arma−tura (Ukrtechmed); 5 −− FB + hydrogel dressing "Arma−gel+" (Ukrtechmed); 6 −− FB + fibrin gel; 7 −− FB + collagen gel. Fibrin gel was prepared from human plasma and collagen gel from human collagen (type I), serum, and thrombin. After 72 hours of incubation with the studied samples FB number and viability in each case was evaluated. Adhesive properties of Arma−gel+, fibrin and collagen gels were studied. It was shown that dressing Grassolind neutral (Hartmann) and hydrogel dressing Arma−gel+ (Ukrtechmed) have a strong cytotoxic action on human skin FB in culture. Unlike fibrin and collagen gels, Arma−gel+ does not have adhesive properties even after saturation with culture medium. It was found that propylene mesh Arma−tura (Ukrtechmed) and washed from the ointment mass dressing Grassolind (Hartmann) were non−toxic to cells and in combination with fibrin or collagen gel were promising matrices for FB culture preparation for cytoplasty in wound treatment. Fibrin gel accelerates the growth of skin fibroblasts in culture by 2.5 times compared to the control. Thus, in the complex treatment of wounds and burns, including transplantation of dermal equivalents based on the fibroblasts, cytotoxic properties of some dressings and gels should be considered. Their use simultaneously with cytoplasty is not recommended.

To evaluate the dynamics of venous ulcers healing under influence of platelet rich plasma (PRP), the results of treatment of patients with trophic venous ulcers who were performed hemodynamic correction were analyzed. Biopsies were taken from different parts of the wound surface on days 7 and 28 of treatment. Modern immunohistochemical methods with monoclonal antibodies. According to the received data pathogenetically directed surgical treatment with combined use of PRP accelerate maturation of granulation tissue and accelerate re−epithelialization of the ulcer. The samples demonstrate the appearance of the signs of physiological regeneration (adequate angiogenesis, fibrillogenesis with the correct orientation of collagen fibrils and complete re−epithelialization). This promotes healing venous ulcers and reduces the possibility of relapse. Our findings suggest that the use of surgical treatment with elimination of veno−venous reflux in conjunction with the methods of regenerative medicine in patients with severe varicose veins are pathogenetically justified. Complex treatment with topical application of platelet−rich plasma reduces the healing time of venous trophic ulcers, activates synthesis of the connective tissue without changing its structure, which is manifested by normalization of the ratio of fibrillar collagen types, absence of foci of atypical localization of collagen, adequate angiogenesis.

Prevention of perinatal morbidity and mortality are one of the most urgent problems of modern obstetrics. Placental dysfunction (PD) is a leading cause of perinatal morbidity and mortality and one of the most common complications of pregnancy. Pregnant women with hemodynamic disorders of the fetoplacental system, who were divided into 3 groups depending on the degree of hemodynamic disorder, were investigated. The investigation showed that increase in the total activity of coagulation blood factors, thrombinemia markers, decreased anticoagulant and fibrinolytic activity of the blood suggest a form of compensated chronic disseminated intravascular coagulation (DIC) in pregnant women with disorders of the hemostatic system. These results allow us to conclude that coagulation disorders of homeostasis are important in the pathogenesis of placental dysfunction. This is one of the causes of hemodynamic disorders in placental system accompanied by the changes in the structure of the spiral arteries.

One of the trends in infertility treatment is the use of auxiliary reproductive technologies, including in vitro fertilization (IVF). Improvement of its effectiveness is related to the study of immune regulation of female reproductive function. Women with thrombophilia demonstrate a significant reduction in sensitivity of the receptor apparatus of the endometrium due to the large doses of drugs during IVF. To study the immunological status and cytokines during IVF, the patients with thrombophilia and infertility of tubal origin were investigated. Based on the obtained findings it was revealed that stimulation of superovulation in IVF programs in women with thrombophilia significantly effects the condition of the humoral immunity. The negative result of IVF consists in increased immunoreactivity and significant increase in the content of ІL−1α, ІL−8 and TNFα. The humoral immune system is originally activated in the women with pregnancies due to IVF programs, and in women with ineffective IVF programs, cellular link is activated. It can be assumed that stimulation of superovulation reduces IL−8 level women in group IVF+ and thus to a certain extent, controls the manifestations of the humoral immunity and hardly effects cellular immunity.

At present urolithiasis is one of the most common diseases. When selecting the optimal method of treatment of ureteral stones, many factors, such as the size, localization of the stone, clinical characteristics, anatomical features, technical capabilities of the intervention, should be considered. The decision on the choice of treatment modality should be based on the balance between the cost and invasiveness of the procedure, the need for complete removal of the calculus and timely recovery of the patient. Comparative analysis of the results of ultrasound and laser contact lithotripsy in the treatment of complicated ureteral calculi was performed. The concept of a complex stone was introduced at analysis of the causes and the structure of complications and failures during contact ureterolithotripsy using ultrasonic lithotripter. Data analysis showed that the use of laser contact lithotripsy improves the results of complex treatment of ureteral stones, reduces the number of intraoperative and postoperative complications. This method contributes to a smoother course of the post−operative period, which reduces the cost of treatment, the length of the hospital stay and rehabilitation period of the patients.

At present, prostate cancer is one of the most socially significant oncological diseases in the world. An equally important problem is the high incidence of obesity and metabolic syndrome in the majority of economically advanced countries. According to the concept of metabolic syndrome, obesity, mainly of android type, hypertension, dyslipidemia, impaired glucose tolerance are the links in a chain of metabolic disorders, and the leading ones are insulin resistance and compensatory hyperinsulinemia. In the recent foreign literature, clinical features of prostate cancer in men with excessive body weight have been fearured. The study of such aspects of metabolic syndrome as blood pressure, increased body weight, increased levels of uric acid and insulin resistance allowed to regard them as risk factors for the development of prostate cancer. However, additional factors of medically controlled hypertension, increased levels of high−density lipid and triglyceride levels significantly affect the development of aggressive prostate cancer and mortality. Changes in the lifestyle and dietary recommendations, along with the control of the body weight, can help to stabilize the severity of metabolic syndrome and prevent development of prostate cancer.

The authors present a retrospective study to evaluate perioperative complications of surgical treatment of RCC with tumor thrombi, as well as to study oncological properties including overall survival and progression−free survival of patients. One hundred and thirty−two patients with intravenous proliferation of renal cell carcinoma were included into the study. The whole population was stratified into two groups: 1 −− tumor thrombi restricted to the renal vein only (n = 63), and 2 −− tumor thrombi of the inferior vena cava (n = 63). All patients underwent surgery with the use of Chevron incision without cardiopulmonary bypass. In cases of retrohepatic thrombi or higher, the classic and piggyback techniques of liver mobilization were applied. The access to the right atrium was performed through the diaphragm from the abdomen. The average follow−up period of all the patients that were included into the survival analysis was 30.6±5.6 months. The overall level of perioperative complications in patients with macroscopic tumor thrombi reached 56.8 %. The frequency of complications was statistically significantly higher in cases of the tumor extending into the IVC (p < 0.05). The overall survival median in the whole group was 48.0 months (Me = 48; Q25−75 = 30−60), and progression−free survival median was 30.0 months (Me = 30; Q25−75 = 18−48). Total 2− and 5−year metastasis−free survival rate did not exceed 83.8 %, and 36.9 %, respectively, with relapse−free survival rate of 73.3 %, and 13.5 %. Survival rates did not differ significantly in the renal vein thrombi groups, and the IVC thrombi groups (p > 0.759 for overall survival, and p > 0.062 for progression−free survival). Univariant analysis results demonstrated the predictive value of the factors such as the ECOG scale status, histological grading of the tumor, tumor invasion into the wall of the IVC, and the level of thrombus in the IVC. However, in the multivariant analysis the statistical significance of the IVC level thrombi only (retrohepatic segment of the IVC, and the segment above/below the retrohepatic IVC) (р < 0.0474) was presented.

At present a new direction, the use of molecular biological markers (MBM) to predict the course of the malignant process and choose optimal therapy, have been actively developed in oncology. Determining MBM can provide additional information on the biological behavior of the tumor: the rate of its growth, its ability of invasion and metastasis, resistance to chemotherapy. Most attention is paid to the study of MBM, which characterize apoptosis, cell proliferation and angiogenesis, which include p53, Bcl−2, Ki 67 and VEGF. Molecular biological markers of ovarian tumors were studied in patients with stage 3−4 ovarian cancer (T3cNxM0−1). In the majority of patients the treatment was started with neoadjuvant chemotherapy (NHT) followed by surgery. The rest had surgical treatment followed by adjuvant chemotherapy was performed. The investigation revealed that expression of mt p53 depended on the extent of malignancy, it increased with the degree of mutation process. The majority of patients with recurrent ovarian cancer showed a high expression of mt p53 in combination with the absence of Bcl−2 expression. This was particularly evident in the patients over 50 years. NCT affected expression of Ki−67 and Bcl−2 in ovarian cancer patients, which can be used to assess sensitivity of the individual tumors to chemotherapy. The relationship between VEGF expression and a high level of tumor marker CA 125 indicates a high metastatic tumor activity, which is a negative factor in ovarian cancer prognosis. The findings of the investigation can be used to form the groups of patients at higher risk of recurrence and metastases.

The presented review paper covers one of the major problems in the field of oncourology, combination treatment of patients with castrate−naive metastatic prostate cancer that includes the combination of androgen deprivation therapy and chemotherapy. The results of the early 15 studies on the use of various chemotherapeutic agents in this group of patients, which were carried out over the past 30 years are reported. Chemotherapeutic treatment regimens, their success rate and side effects are described. The above mentioned facts formed the basis for conclusions that there is no practicability in applying hormone therapy and chemotherapy for metastatic prostate cancer as the first−line treatment. However, recent studies of GETUG−AFU 15, CHAARTED−E3805 and STAMPEDE demonstrated the rationality of treatment with docetaxel in combination with ADT for hormone−naive patients with metastatic disease. These studies have captured a significant improvement in progression−free survival favoring patients who received docetaxel in addition to ADT compared to those who only received ADT. A significant improvement in overall survival was also noted during CHAARTED−E3805 study favoring patients from the group of chemo−hormonal therapy. The effective use of mitoxantrone in patients with castrate−resistant prostate cancer is of great interest, as well as fair advantage of such approach in terms of pain relief and for improving patients' quality of life. However, there are currently no results for clinical trials with the use of mitoxantrone in addition to standard ADT. Therefore, combination therapy including hormonal therapy concurrent with docetaxel drugs has demonstrated during recent studies certain advantages for patients with castrate−naive prostate cancer. However, their results were not totally unambiguous, considering data given by the overall and progression free survival. The role of mitoxantrone in combination with hormonal deprivation for patients' treatment of this group has not been studied yet.

Chronic occlusive cerebral vasculopathy (Moya−Moya disease) refers to a group of rare diseases. The mechanism of its occurrence is based on slowly progressive stenosis and obliteration of the large vessels as well as development of broadened collateral network of basal cerebral arteries. Idiopathic (congenital) and symptomatic (acquired) form of the disease are distinguished. The first symptoms manifest in the age groups from 10 to 20 years, from 30 to 40 years. The diagnosis of the disease is difficult due to the lack of pathognomonic symptoms. Its gold standard is endovascular cerebral selective angiography, a highly informative and accessible method. The clinical manifestations of this disease were investigated on a practical example to optimize diagnostic criteria. Two clinical cases of the disease are featured. These young patients presented in a state of moderate severity and in serious condition. Typical changes in the form of severe stenosis/occlusion of M1 segment of the both middle cerebral arteries with formation of multiple collaterals were found during angiography, which is typical for this disease. The patients were observed for 6 months, both on the outpatient and inpatient basis. Stable clinical effect was achieved in the patients as a result of conservative treatment.

Traumatic brain injury is a major health and social problem. At the present stage mild traumatic brain injuries, which account for 80 % of the total number of victims dominate in its structure. Currently mild brain injuries include cerebral concussion and mild brain contusion. To determine the pathogenesis of the damaging cascade and methods improving neuroplasticity and neurotrophicity, the patients with a 1−5 year history of mild brain injury were examined. Focal neurological, asthenic, cephalgic, dissomniac, vegetative, neuroendocrine, vestibular, anxious and depressed, apathetic syndromes and behavioral, mental and emotional disorders were revealed. Psychodiagnostic tests MMSE and MoCa scale revealed disorder of attention, memory, orientation, praxis, gnosis also identified when using the test to memorize 10 words, Schulte tables, proofreading test. Anxiety and depressive symptoms were revealed using Spielberg−Hanin and Beck scales. The analysis of biochemical indices suggested disorders of neuroplasticity processes that manifested by decrease in the content of BDNF and BNGF and simultaneous increase in the serum levels of apoptosis products of protein from subfamilies Bax and Bcl−2 in the blood serum of the patients after mild traumatic brain injury. Such patients should be administered: decongestants, vegetostabilizing, nootropic, antiepileptic drugs, symptomatic therapy, if necessary −− antidepressants, as well as the medicines that improve the neurotrophic (polypeptides), energy, metabolic and neuroplastic functions.

The efficacy of complex treatment, which includes manual therapy, reflexology and physiotherapy exercises for the correction of vestibular disorders in patients with vertebrogenic vertebral artery syndrome was investigated by means of comparison of non−drug and drug treatment of the patients with vertebral artery syndrome. The study involved patients with vertebral artery syndrome aged 18−44 years. All patients underwent clinical and neurological examination, visual diagnosis of disorders of statics and dynamics of the musculoskeletal system, manual diagnosis by the classical method of K. Lewit (1998), functional X−rays of the cervical spine in the frontal and lateral projections, functional transcranial Doppler ultrasonography of the neck vessels, magnetic resonance imaging of the brain. Vertebral−basilar insufficiency was assessed according to Hoffenberth's scale (1990), vestibular disorders with the help of the European Evaluation of Vertigo scale, to quantify the impact of dizziness on the daily routine DHI was used. The test was performed before treatment and 3 weeks after the beginning. Positive dynamics was observed in both groups as reduction of severity and frequency of vertigo attacks, headache, tinnitus, regression of ataxic disorders. The patients receiving combination treatment demonstrated significant reduction or complete disappearance of pain, muscle tension in the neck and shoulder area, reduction of the number of active and latent trigger points. Our study suggests that the combination treatment of vestibular disorders in patients with vertebral artery syndrome, including medication, manual therapy, reflexology and physiotherapy exercises, is pathogenetically justified and has advantages over standard drug therapy.

At present the incidence of acute epiglottitis in adults and severity of its complications increase. Besides visualization techniques, objective methods of diagnosis of inflammation stage of epiglottitis are lacking. To improve the effectiveness of early diagnosis of abscess formation at acute epiglottitis in adults on the basis of the clinical course, modern instrumental, laboratory and ultrasound methods were compared. Clinical diagnosis of acute epiglottitis is not difficult, but determining its type, whether it is infiltrative or abscessed, to identify indications for opening the abscess of the epiglottis are problematic. Nowadays a wide range of diagnostic methods is used in the diagnosis of acute epiglottitis, ultrasonography being the most effective. This method allows real−time obtaining the information about the state of the larynx tissues, in particular the epiglottis, on the architectonic tissue level. A complete coincidence of diagnoses according the echosonography findings of the larynx and clinical examination (including the findings of indirect laryngoscopy) is observed. The patients' condition improved and they were discharged from the hospital in healthy condition after a timely surgical intervention as well as on the background of causal and pathogenetic therapy. The effectiveness of treatment of patients with epiglottitis and its complications depends on accurate and timely topical diagnosis of the purulent−inflammatory focus, resulting in the adequate surgery. Thus, the proposed method of diagnosis using ultrasound reveals abscesses of the epiglottis at an early stage and allowed removal of the purulent content, prevention of severe complications of epiglottitis (purulent parapharyngitis, deep cellulitis of the neck and mediastinitis).

Nose injury occupies the leading place among the damages of the ear, nose and throat and facial bones. The growth of injuries, lack of a unified approach to the treatment leads to a dramatic increase in the number of patients with post−traumatic deformities and defects of the facial bones. Recently, this problem has taken on particular importance due to the large number of victims in war zones. Severe multiple fractures of the middle zone of the facial skeleton, accompanied by brain injury of varying degrees, bleeding and liquorrhea are determined only using targeted special examination. At the same time, there are no uniform requirements as to the volume of research, resulting in underestimation of the spread of the depth and scope of the injury to the nose and adjacent areas, the nervous system, as well as development of a number of complications and cosmetic defects of the face. On the basis of in−depth investigation of the patients with fractures of the nose and adjacent areas we propose the working classification of isolated and combined injuries of the nose for clinical diagnosis and adequate medical care.

A retrospective study of 172 case histories of patients who received gunshot wounds to the extremities while participating in anti−terrorist operation in the east of Ukraine in 2014−2015 was performed. Gray−scale ultrasound, Doppler ultrasonography and sonoelastography were used to estimate anatomic integrity, acuity of contours, structure, the condition of the surrounding tissues. Wound channels, hematomas of the surrounding tissues, foreign bodies (shells, bullets, metal fragments), and hemodynamics of the vessels were determined. Gunshot wounds were found in 27.9 % of the patients, gunshot shell fragment wounds in 63.9 %, mine and explosive wounds in 8.1 %. According to the nature of the wound channel, blunt gunshot wounds were found in 60,4 %, penetrating wounds in 34.4 %, gutter wounds in 5.2 %. 77.9 % had single bodily injuries; 22.1 % patients had multiple injuries. The greatest amount of damage was at the level of the tibia and femur. The damage to major vessels and nerves were noted, these rates were higher in patients with penetrating gunshot wounds. Ultrasound examination as a screening method should be comprehensive and integrated, involving gray−scale, color Doppler ultrasound, sonoelastography of wounded extremities and adjacent anatomical and topographic zones.

At present, headache is the most frequent complaint appearing at various conditions. Migraine (M), tension−type headache (TTH) and vertebrocogenic headache (VH) are best−known and most common neurological diseases occurring in the adult population. Cerebral hemodynamics and CVR were investigated using transcranial Doppler sonography (TDS) in patients with different types of the headache. The diagnosis was made according to the criteria of the International Classification of HD, 2nd revision (2003). The parameters of the linear blood flow velocity (BFV) in the cerebral arteries were investigated using TDS. The state of cerebrovascular reactivity was assessed using the following functional loads: hypercapnic load (coefficient of reactivity CrCO2), hyperventilation load (CrO2), orthostatic load (CrOL), antiorthostatic load (CrAOL), functional nitroglycerin test (CrFNT), functional metabolic test (CrFMT). Hemodynamic disturbances in the studied persons often manifested by increased BFV in the medial cerebral arteries and posterior cerebral arteries, and asymmetry of BFV in the MCA and VA. The CrFNT parameters CrCO2 and CrO2 were significantly increased in patients with migraine. The patients with TTH demonstrated hyperreactivity at FMT, hyperreactivity to CO2−load and hyporeactivity to O2−load. The patients with VH revealed hyperreactivity at FMT and hyporeactivity to O2−load. All clinical groups showed hyperreactivity at orthostatic load. These figures demonstrate hyperreactivity to FNT, CO2 and O2−load, probably associated with a shift in the humoral metabolic regulation. Cerebral hemodynamics in patients with headache is characterized by angiodystonic phenomena.