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№3' 2019

ABSTRACTS

Sumy State University
Kharkiv Medical Academy of Postgraduate Education
V. N. Karazin Kharkiv National University, Ukraine
Effectiveness of antihypertensive therapy in comorbidity of arterial hypertension and obesity depending on physical activity
5 - 9
In order to assess the effectiveness of antihypertensive therapy in comorbidity of hypertension and obesity, depending on physical activity of patients, a study was performed in 200 persons, They were prescribed with a diet therapy as non−drug treatment and an increased physical activity was recommended. The patients received a combination of an angiotensin converting enzyme inhibitor and a calcium antagonist. Primary blood pressure levels of the patients were evaluated 3 months after initiation of treatment: only 102 among 200 had reached the target levels in dual antihypertensive therapy, and the rest required an additional antihypertensive medication. As a result of the study, it has been found that physical activity positively affected the dynamics of cardiovascular remodeling, anthropometric and biochemical data as part of a comprehensive 6−month treatment of hypertensive patients with obesity (including dual antihypertensive therapy). With the similar drug treatment the patients with sufficient physical activity differed from those with low physical activity by the significantly lower body mass index, better dynamics of cardiovascular remodeling, higher levels of antiatherogenic lipoprotein, high inflammatory disease, and less pronounced adipokine imbalance.
Key words: arterial hypertension, obesity, antihypertensive therapy, physical activity.
Grodno State Medical University, Grodno, Belarus
Improvement of efficiency of primary hemostasis using Sengstaken − Blakemore tube in patients with portal hypertension
10 - 19
Nowadays the efficient use of an obturator probe has remained not high enough, and is also accompanied with a number of particular complications. A study was performed to increase the effectiveness of primary hemostasis using the Sengstaken − Blackmore probe with a coating having hemostatic, antibacterial and regenerative properties in an acute episode of bleeding from varicose veins of the esophagus and stomach in the patients with liver cirrhosis and portal hypertension. A prospective, controlled, randomized study of the treatment results for the patients with an acute episode of bleeding from varicose veins of the esophagus and stomach on the background of liver cirrhosis complicated by portal hypertension was carried out. In the main group of patients, an ointment of a combined composition (antibacterial component, proline, oxidized cellulose) was preliminarily applied to the balloons of the obturator probe, which contributed to quite an effective hemostasis. In the patients using the standard methodology, the changes identified in laboratory and instrumental studies indicated unstable hemostasis. Thus, the use of an ointment of a combined composition to treat the balloons of the obturator probe prevents the damaging effect on a mucous membrane of the esophagus and accelerates its regeneration, prevents the aggravation of liver functional state by reducing the frequency of relapses and can be used as an independent method for treating the patients with bleeding from varicose veins of esophagus on the background of portal hypertension, and after performing an endoscopic sclerotherapy.
Key words: portal hypertension, liver cirrhosis, bleeding, esophageal and gastric varices, proline, obturator probe.
SI "V. T. Zaytsev Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine", Kharkiv, Ukraine
Protection of central and peripheral organs in aortic surgery
19 - 23
The introduction into clinical practice of hypothermic circulatory arrest, both in the non−perfusion version and with an artificial circulation, was the beginning of active use of systemic hypothermia as an effective element of cerebral and visceral protection during combined cardiac surgeries, including in aorta pathology. To evaluate ways of protecting visceral organs and spinal cord, namely the "no perfusion" technique with drainage of cerebrospinal fluid, lateral aortic compression, left−atrial−femoral bypass, deep hypothermia with cardiac arrest, i.e. hypothermic circulatory arest, bypass grafting, artificial blood circulation and moderate hypothermia in surgery for acute aortic syndrome the results of treatment of the patients with acute bundle aortic aortic abdominal localization were analyzed. There was characterized the proposed and implemented in practice original method of protection, consisting in an access to aorta, which is pressed above the aneurysm at the level of bifurcation, and selective perfusion into the mouth of vessels supplying the internal organs with a custodiol solution with a temperature of 3−4°. All the patients with combined occlusion−stenotic lesions of different arterial pools have aortic prostheses with the inclusion of visceral arteries into bloodstream in different variants. The tendency of the more favorable post−surgery period in the patients to whom the implemented methods of protection were applied.
Key words: aortic aneurysm, surgical treatment, organ protection.
SI "V. T. Zaytsev Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine", Kharkiv, Ukraine
Efficiency of necrotomy and continuous drainage of burn zone with subfascial lesions
24 - 28
Thermal injuries occupy the 3rd−4th places in the structure of injuries, being an urgent problem of modern clinical medicine. A critical increase in intra−tissue pressure in various injuries leads to an irreversible necrobiotic process in the tissues. In these cases an emergency fasciotomy, helping to normalize intra−tissue pressure is indicated. In order to evaluate the clinical effectiveness of the necrotomy in a tissue compartment syndrome, providing an optimal drainage of the affected tissues and an active effect on the near−wound zone by lymphotropic therapy, a survey of patients with deep subfascial burns was performed. It has been found that necrotomy and flow drainage of the burn zone in case of subfascial lesions by improving microcirculation and lowering the level of intoxication reduce the readiness of burn wounds for primary necrectomy and accelerate the complete cleansing of the lesion area from necrotic tissues. The quality of the granulation cover made it possible to perform operations aimed at restoring the skin in optimal terms with a sufficiently high engraftment of autografts.
Key words: burns, tissue compartment syndrome, necrofasciotomy, ozone therapy.
SI "Dnipropertovsk Medical Academy of the Ministry of Health of Ukraine", Dnipro, Ukraine
Features of fluid redistribution during goal−directed infusion therapy of high surgical risk patients in urgent surgery
29 - 32
One of the basic components of intensive treatment of patients with an urgent abdominal pathology is perioperative infusion therapy. To analyze the perioperative dynamics of the water sectors of a body in the patients with a high surgical risk with acute abdominal pathology, a targeted regimen of infusion therapy was used to examine 35 patients. Perioperative targeted infusion therapy was carried out with balanced crystalloid solutions. With the non−invasive bioelectric rheography, the indices of water sectors of a body were studied. On the first day, the extracellular sector volume overflow was established due to an increase in interstitial volume. From the second day, the excess volumes of intravascular fluid and plasma were determined. On the third day there was a deficit of all the studied indices. On the fifth day of the post−surgery period, volumetric depletion of mild degree was noted. From the seventh to the tenth days, all the studied parameters to normal were reliably restored. A targeted regimen of infusion therapy in such patients was concluded to correct a moderate volume depletion on the tenth day after surgery by an excessive increase in plasma volume after six hours of treatment, the development of interstitial edema in the first two days, and the formation of mild volumetric depletion from third to seventh day.
Key words: water sectors, goal-direct infusion therapy, depletion, urgent surgery, high surgical risk.
Kharkiv National Medical University, Ukraine
Role of gestational endothelialopathy in development of intrauterine growth restriction in pregnant women with placental dysfunction
33 - 37
To determine the role of gestational endotheliopathy in development of intrauterine growth restriction in pregnant women with placental dysfunction and introduction of the methods for its predictive diagnosis, a retrospective analysis of 200 histories of pregnant women was performed and 70 women with gestational endotheliopathy, intrauterine growth restriction syndrome were examined. The study used ultrasonic, Doppler, biochemical, enzyme−linked immunosorbent, morphological and statistical methods. As a result of the carried out study, the changes in endothelium−dependent vasodilation of vessels, vascular−endothelial growth factor, thrombospondin, thrombomodulin, vascular and platelet−endothelial molecules of cell adhesion were determined, that indicated a crucial role of gestational endothelium in pathogenesis and can be used as early predictors of intrauterine growth restriction. Thus, the presented study, based on a comprehensive evaluation of the endothelial component in genesis of early placental dysfunction, showed that the presence of gestational endotheliopathy is an independent prognostic factor associated with adverse effects of pregnancy. In pregnant women with placental dysfunction there were revealed the disorders of vasoregulatory, atrombogenic functions, intercellular integration, changes in the parameters of uterine−placental−fetal hemodynamics, histomorphometric disorders, enabling to better understand the pathogenesis of various forms of placental dysfunction, to propose the ways to forecast the complications at early stages and to develop the optimal tactics of monitoring this category of patients.
Key words: gestational endothelialopathy, placental dysfunction, intrauterine growth restriction.
Kharkiv National Medical University, Ukraine
Peculiarities of pinopods formation in endometrium depending on luteal phase support in cycles of in vitro fertilization
38 - 43
The formation of pinopods occurring in the middle of the luteal phase is a major indicator of the quality of the endometrium. The study is aimed at studying the peculiarities of pinopod formation in the endometrium, depending on the method of maintaining the luteal phase in the treatment of infertility by means of in vitro fertilization. To this end, 50 women being the oocyte donors were examined. They were subdivided into five subgroups depending on the luteal phase support scheme. On the 5th day after receiving oocytes, women underwent endometrial tube biopsy to scan electron microscopy and determine foam events in the endometrium. It has been proven that in patients receiving highly purified progesterone for subcutaneous administration of 25 mg (1 ml) once a day and 90 mg of intra−vaginal progesterone as a gel, normal development of pinopods was observed in 60.0 % of cases. This scheme proved to be the most effective. Therefore, for the success of extracorporeal fertilization, the process of forming pinopods, which depends on the scheme of maintaining the luteal phase of the cycle, is important. It is noted that the common negative features in the formation of pinopods in women during the period of "implantation windows" is a decrease in the number of pinopod events, an increase in the number of foam events, the presence of areas of pinopod absence, mosaicism of their sizes, forms and stages of development.
Key words: pinopods, luteal phase support, endometrium, in vitro fertilization.
Grigoriev Institute for Medical Radiology, National Academy of Medical Sciences of Ukraine, Kharkiv
V. N. Karazin Kharkiv National University, Ukraine
Relationship between malignant tumor metabolism and tumor−bearing organism
44 - 48
For a long time, the attention of researchers has primarily focused to the molecular−genetic aspects of the oncogenesis regulation, while quite a logical question remained unclear: where does the cancer cell get an energy for accelerated division? Today the studies have emerged and they prove that specific oncogenes control many other genes, including those responsible for metabolism, which not only maintain high energy levels of their own metabolism, but also alter the supply of glucose and amino acids from healthy microenvironment cells to their advantage. Metabolic disorders are accompanied with a progressive protein−energy deficiency. A feature of this process is the discrepancy between the amount of energy received and that required. There is a sharp rise in energy needs and a pronounced breakdown of body proteins, a decrease in the rate of glucose oxidation with a simultaneous increase in lipid oxidation. Nutrient deficiency leads to a release of its own reserves as a result of the destruction of body tissues. In this regard, the development of ways to block the energy sources and plastic material to enter a cancer cell is being actively discussed in order to improve the effectiveness of treatment of cancer patients.
Key words: malignant tumor, metabolism, tumor carrier.
Kharkiv National Medical University, Ukraine
A rare clinical case of Wilson’s disease manifestation in early childhood
49 - 54
Wilson's disease is a rare autosomal recessive inherited disease, the pathogenesis of which is associated with impaired copper metabolism in the body, that leads to its excessive accumulation in various organs and tissues, mainly in the liver and central nervous system. Typically the Wilson's disease manifests mainly at a young age. The history of studying this pathology has been described, wherein the important milestones were mentioned as the determination of the role of impaired copper metabolism in pathogenesis of the disease, the establishment of an autosomal recessive inheritance of Wilson's disease. A mandatory clinical manifestation of Wilson's disease is the formation of neurological symptoms as an akinetic−rigid syndrome, hyperkinesis, ataxia, tremor, muscle dystonia, which is associated with a predominant lesion of basal ganglia, the dentate of the cerebellum and substantia nigra. However, the Wilson's disease can be finally diagnosed only on the basis of a combination of clinical data, the results of an ophthalmic (presence of the Kayser − Fleischer ring) laboratory test and molecular genetic analysis. Treatment for Wilson's disease includes a diet that restricts the intake of foods high in copper, and prolonged use of D−penicillamine (cuprenyl). Zinc preparations and antioxidants are also used. Here we present a clinical case from our own practice of atypically early manifestation of Wilson's disease in a child of the first year of life.
Key words: Wilson’s disease, impaired copper metabolism, early childhood, extrapyramidal disorders, molecular genetic testing.
Municipal Non&minus
Profit Enterprise of Kharkiv City Council "Kharkiv City Children's Hospital N 5", Ukraine
Features of cerebral circulatory dynamics and cerebral bioelectric activity in children with craniocerebral injury
55 - 59
In order to study the state of cerebral hemodynamics and to investigate the electroencephalographic characteristics in children with closed traumatic brain injury, 114 patients were examined. The children were examined in 6.1±0.8 months after a traumatic brain injury. To determine cerebral hemodynamics, transcranial dopplerography was performed, the functional state of brain was evaluated according to electroencephalography. In the course of the study, it was noted that a disordered cerebral hemodynamics in children with moderate and severe brain contusion and its foci presence was accompanied by a rise in a linear velocity of blood flow, while its decrease was found at the same contusion, but that was severe and with the presence of subdural, subarachnoid and epidural hemorrhage. Signs of diffuse changes in bioelectrical activity of the brain were represented by a significant increase in an amplitude of the alpha rhythm in children with closed traumatic brain injury of moderate and serious severities compared to mild one.
Key words: children, craniocerebral injury, electroencephalography, transcranial Doppler sonography, paroxysmal activity.
Kharkiv Medical Academy of Postgraduate Education, Ukraine
Immune status of Epstein − Barr virus−infected children with secretory middle otitis
60 - 64
Recently the role of herpes viruses in an aggravation of inflammatory diseases of the upper respiratory tract, in particular, herpes simplex virus and Epstein − Barr virus, has become increasingly evident in otorhynolaryngology practice. To determine the extent of infection with Epstein − Barr virus and to study the immunogram of the first level for the children with secretory otitis media, 48 patients aged 3−9 years were examined for the purpose of an adequate treatment. Infection was revealed by serological diagnosis (enzyme immunoassay) with the determination of IgM to capsid complex (VCA) and IgG to early antigen (EA). Level 1 immunograms were also determined by immune enzyme analysis. Children with secretive middle otitis (22.9 %) were infected with Epstein − Barr virus, corresponding to an acute phase of the disease, as well as they had a reduce cell immunity. All children received comprehensive treatment for secretory middle otitis. It was concluded about the need for children with middle otitis to be screened for an infection with the Epstein−Barr virus and treated conservatively by an immunologist.
Key words: secretory middle otitis media, etiology of Epstein - Barr virus, immune status of children, treatment.
Petro Mohyla Black Sea National University, Mykolaiv, Ukraine
Kharkiv Medical Academy of Postgraduate Education, Ukraine
Results of polarized light use for study of stress−strain state of cornea in pathology of extraocular muscles
65 - 69
The parameters of interference patterns observed on the cornea in a polarized light in pathology of extraocular muscles were quantitatively evaluated. A study of the shape of 147 interference patterns observed on the cornea in a polarized light showed that the horizontal deviation of an eye in 56 % of cases was caused by the displacement of the attachment of the upper rectus muscle towards the inner rectus muscle. During illumination of the cornea of a live eye with polarized light, a specific interference pattern in the form of a rhombus formed by rainbow stripes (isochromes) is observed. It is established that such an interference pattern is the result of the influence of extraocular muscles on the cornea. The findings showed that the weakening of the force of one of muscles leads to asymmetric distortion of the shape of the interference rhombus, which is manifested with a reduced length of the corresponding section of the diagonal. On the contrary, as the force of the muscle increases, the corresponding section of the diagonal enhances. The displacement of the attachment site of direct extraocular muscle along the line of action is equivalent to a change in effort on its part, indicated appropriately by the shape of the interference rhombus. As the muscle moves away from the line of action, the angle of the interference rhombus is shifted away from the corresponding meridian.
Key words: polarized light, optical anisotropy, cornea, extra-ocular muscles, interference picture.
Kharkiv Medical Academy of Postgraduate Education, Ukraine
New approaches to treatment of age−related macular degeneration
70 - 72
Age−related macular degeneration is a leading cause of central vision loss in people over 50 years of age. The rising incidence and significant risk of disability of the working population make this pathology a serious medical and social problem. With an early diagnosis of this condition and timely treatment, it is possible to avoid a loss of visual functions, to achieve a long−term remission or its reverse development. But there is no specific treatment for this disease. One of the drugs, affecting the functional state of retina in the patients with macular dystrophy is the "Visiloton Complex". To show its efficiency, a study was conducted in which 70 patients (70 eyes) with age−related macular degeneration of "dry form" participated. All the patients underwent a complete ophthalmic examination: visometry, biomicroscopy, computer static perimetry (Humphrey). The eye retinas were investigated using optical coherence tomography. The results of the study showed the feasibility of using "Visiloton Complex", as evidenced by a significant increase in visual functions in 65 % of patients. Under the influence of the drug the performance of the central and peripheral vision was improved, which was due to its strong antioxidant and vasoconstrictive action. Optical coherence tomography data confirm the positive effect of "Visiloton Complex" on neuroepithelial cells, as indicated by a decrease in retinal thickness under the drug influence. The use of "Visiloton Complex", comprising vitamins and minerals that normalize metabolism, possessing antioxidant action, protect the body against the effect of adverse environmental factors, contributes to an improvement of general state and well−being of patients with age−related macular degeneration.
Key words: macular degeneration, visual acuity, "Visiloton Complex" drug.
Kharkiv Medical Academy of Postgraduate Education, Ukraine
Markers of angiogenesis in patients with alopecia areata
73 - 78
This study was aimed to evaluate the level of production of angiogenesis markers, namely VEGF, sVEGFR1, EGF and NO system in 67 patients with alopecia areata, depending on the pathology severity and activity. The content of stable metabolites of NO (NO2 and NO3) and NOS was studied in blood plasma using a spectrophotometric method. Growth factors and sVEGFR1 were investigated in serum by solid enzyme−linked immunosorbent assay. At an active stage with a moderate to serious severity of alopecia areata, the VEGF value was significantly higher. In chronic course, the VEGF level was significantly decreased at all severity levels, but the minimum was observed in the patients with a severe stage. The most significant decrease in the concentration of sVEGFR1, an increase in the content of EGF was diagnosed at an active stage with a severe alopecia areata. With signs of disease progression to severe stage, the level of NO, NO3, iNOS was as high as possible. At a chronic stage, their significance was significantly reduced relative to secretion in active manifestations of the disease (p < 0.01). In patients at an active stage with moderate and severe course of alopecia areata, the content of NO2 and cNOS was significantly lower than the level of indices at chronic disease. Correlation analysis revealed the existence of complex relationships between angiogenic factors, features of the disease course. Identified disorders can create conditions for the development of endothelial dysfunction and indicate a direct involvement of them into the mechanisms of formation of alopecia areata.
Key words: alopecia areata, angiogenesis, endothelial dysfunction.
Kharkiv Medical Academy of Postgraduate Education, Ukraine
Chronic HCV−infection as a predictor of disease severity (case study)
79 - 82
A global problem for humanity is the wide spread of HCV carriers worldwide. To address this, the WHO has developed a global strategy for the health sector to eliminate viral hepatitis and has set the following goals: to reduce the number of new cases of chronic hepatitis B and C by 90 % by 2030 as well as to reduce the quantity of death from these infections by 65 %. It is emphasized that the development of infectious or somatic disease on the background of chronic viral hepatitis requires a more careful approach and thorough medical correction, as their course and prognosis can be significantly aggravated. The case of viral hepatitis A, which occurred on a background of previously undiagnosed HCV infection and resulted in a death, has been described. Thus, previously undiagnosed HCV infection exacerbated the course of a self−eliminating disease, such as hepatitis A, and resulted in a death. Therefore, expanding the screening for viral hepatitis will allow identifying infected individuals and conducting antiviral therapy and preventive measures, which will reduce the incidence and mortality rates.
Key words: viral hepatitis A, viral hepatitis C, chronic HCV-infection, diagnosis, treatment, outcome.
V. N. Karazin Kharkiv National University, Ukraine
Measles virus elimination: resolved issues and future challenges
83 - 88
Measles is a highly contagious infectious disease caused by an RNA−containing virus of the family Paramyxoviridae and Morbillivirus genus. The most proper way to stop it is a total vaccination. At the moment, live attenuated strains of the Enders − Schwartz measles virus are used to conduct it. Although they were developed more than 50 years ago, the vaccines in use today are effective enough to create a proper immune protection that can defend against an infection for decades, if the vaccination schedule is followed. The vast majority of measles outbreaks that have been reported in Europe over the last seven years have been caused by a lack of an immune response resulting from the unprecedented coverage of the population with vaccination. The measles outbreak observed in the adult and child population of Ukraine since December 2018 indicates the need and urgency of additional efforts to curb the spread and complete elimination of the measles virus. It has been determined that more than 95 % of the population should be vaccinated to ensure an elimination of measles virus and prevent the disease outbreaks after the virus has been imported from the countries that are still endemic to measles. It is noted that as a result of successful implementation of vaccination programs, the public's attention to measles is diminished even among physicians who sometimes have a rather dubious understanding of the disease symptoms. Ensuring a complete elimination of the measles virus requires the development and implementation of additional laboratory tests for immunity, development and realization of new, more polyvalent vaccines that are more readily accepted by population, increased awareness on safety and necessity of vaccination, as well as regulation.
Key words: measles, immunity, elimination, epidemiological control, vaccination.
Kharkiv Medical Academy of Postgraduate Education, Ukraine
Role of dopplerography in diagnosis of hemodynamic disorders in vertebral arteries with instability and arthrosis of atlanto−axial joints
89 - 92
Biomechanical dysfunction of the cervical vertebral motor segment is one of the most common causes of cervicogenic headache. Cervical pain syndrome of vertebrogenic genesis is often observed against the background of congenital anomalies of bone and soft tissue structures. It has been established that anatomical variation of the place of junction, the level of entry into the bone canal, as well as doubling of the vertebral arteries create prerequisites for pathological changes of hemodynamics in them at different functional loads, therefore, timely diagnosis is important to prevent these disorders. Due to the fact that the vertebral arteries are contained in the vertebral canal, which is formed by the transverse processes of the cervical vertebrae, they are normally protected against rotational movements. The development of osteoarthritis with the appearance of osteophytes leads to compression of the vertebral artery or irritation of the cervical nerve plexuses located on the walls of blood vessels. This, in turn, leads to a spasm of the vertebral arteries during rotational movements. To develop informative hemodynamic parameters in the vertebral and basal arteries in case of pathologies of the cervical spine, an analysis of the Doppler sonography results was performed in patients with instability and arthrosis of the atlanto−axial junction. The maximum systolic velocity (Vs), end diastolic velocity (Vd), resistance index (RI) in the second and third segments of the vertebral arteries in neutral position of the head and during rotational movements were determined. Thus, hemodynamic disturbances in the vertebral arteries in patients with instability and arthrosis of the atlanto−axial articulation are manifested by a decrease in Vs, an increase in RI. These changes are most pronounced with functional loads in the form of rotational movements of the head.
Key words: dopplerography, atlanto-axial joints, third segment of the vertebral artery.
Kharkiv Medical Academy of Postgraduate Education, Ukraine
Diagnostic radiology methods of degenerative changes in lumbar intervertebral discs in young people
93 - 96
In recent years, the number of scientific studies investigating the prevalence of low back pain among schoolchildren has been significantly increased. Degenerative disease of the discs is often accompanied by a low back pain with irradiation into the legs in representatives of different age groups, in particular, in older children. The main factors of its development are genetic predisposition, trauma, obesity, lack of exercise. Most of the components of the vertebral motor segment have the nerve endings and reflex influences, accompanied by inflammation, microcirculatory disorders, and their combination contributes to an appearance of back pain. Diagnosis of degenerative disc disease includes the study of the patient's medical history, analysis of clinical symptoms, use of functional tests and various types of imaging to clarify the degree of macrostructural changes in disks, among which the main place is taken by the magnetic resonance imaging. The development of degenerative changes in intervertebral discs as early as childhood, which requires a further study using non−invasive, accessible and informative methods, especially ultrasound ones. The results of ultrasonography of lumbar intervertebral discs were analyzed in 36 adolescents aged 16−18 years, diagnosed for the protrusion when the MRI was applied. Paramedian protrusion was found to be significantly more frequent than posterolateral, median, and circular ones. Due to its non−invasiveness, low price and information value, the ultrasound can be the most popular method not only as a screening one but also for the expert evaluation of lumbar intervertebral disc protrusion in schoolchildren.
Key words: diagnostic radiology, lumbar intervertebral discs, adolescents.
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