ARCHIVE

Abstract. A clinical psychological and psychodiagnostic investigation of 339 families with children with the diagnosis of cancer revealed main psychological problems of interrelation of the parents and child as well as sick children and medical staff, volunteers. The parameters of psychoemotional state, personality and behavior peculiarities of the sick children and their parents, their family function associated with the reaction to cancer were studied. The factors of professional distress of the medical staff and volunteers were determined. Based on the generalization of the obtained findings short- and long-term tasks and purposes of the system of medical psychological aid were determined. The targets of medical psychological treatment were distinguished for all participants of the treatment process. An algorithm of psychological aid including a differentiated use of psychoeducation and psychocorrection measures was worked out.

Abstract. Coping strategies were investigated in patients with chronic obstructive disease of the lungs (CODL) aged 54.6+-1.2 with the disease duration 14.4+-0.9 years. Psychological protective mechanisms were assessed using life style index and technique of psychological diagnosis of methods of coping with stress and problem situations adapted by L.I. Wasserman. Personality peculiarities were determined using MMPI modified by F.B. Beresin, emotional state using Freiburg multidimentional personality questionnaire. Among constructive coping strategies the most prevalent were search of social support, decision planning, self control, though their significance was less pronounced among all copings. Relatively constructive coping strategies included responsibility taking, more seldom - positive reassessment. Distance, confrontation coping and escape prevailed among unconstructive copings. Thus, personality and emotional peculiarities, passive and active psychological protection, formation of inner picture of the disease in patients and disabled with CODL should be investigated and assessed at all stages of restorative treatment which will serve the basis for creation of individual rehabilitation programs.

Abstract. Ninety-three patients with alcohol addiction (IDC-10 F10.2) were investigated with the purpose to study the peculiarities of the clinical states prone to relapses (CSPR) at various stages of forming remission (1-96 months) using clinical and statistical methods. It was determined that at danger of remission breakdown of any duration by the generalized clinical factor of CSPR, the patients with alcohol addiction made a uniform group due to actualization of syndrome of pathological addiction to alcohol (PAA) at biopsychological levels. Target therapy in parsons with alcohol addiction in remission should be differentiated with the account of the leading level of PAA manifestation, classification foundation and polymodality of risk factors of alcohol disease relapses.

Abstract. The purpose of the study was to investigate the role of nitrous oxide and cholinergic system in the pathogenesis of ischemic stroke. The findings of clinical biochemical investigation at various subtypes and degree of ischemic stroke showed that an important role in its pathogenesis was played by dysfunction of the vascular endothelium, manifesting by reduction of endothelial nitrous oxide and deficiency of cholinergic neuromediation represented by reduction in the level of acetylcholine esterase in the blood serum in the most acute and acute periods of the disease, especially against a background of arterial hypertension and cardiac pathology. Based on the available literature and the original findings the author suggested a scheme of pathobiochemical cascade of ischemic stroke allowing to expand the ideas about the pathogenesis, neurochemical nature of ischemic stroke as well as to develop new directions in diagnosis and more effective treatment.

Abstract. In dementing diseases excessive activation of glutamatergic system disturbs the process of consolidation of memory trace while its reduction against a background of Memantin administration promotes restoration of the normal pattern of new information digestion. In this regard we performed investigation of the clinical efficacy of Memantin in treatment of non-dementia cognitive disorders and asthenic disorders in patients with dyscirculatory encephalopathy after stroke because they demonstrated more pronounced cognitive disorders. The findings of cognitive tests by the correlation analysis data were not associated with the parameters of scales of depression and anxiety. Marked asthenic disorders were demonstrated by asthenia tests. The data that cognitive disorders are due to not only vascular disorders but also neurodegenerative process activated by ischemic stroke were also obtained.

Abstract. The current literature on the impact of renin-angiotensin system blockers on the prognosis in patients with cardiovascular disease was analyzed. It is shown that according to new randomized trials and meta-analysis, angiotensin II receptor blockers and direct renin inhibitor aliskiren do not reduce the risk of cardiovascular complications and mortality in a wide range of clinical conditions, besides may worsen renal outcomes. Angiotensin-converting enzyme inhibitors, in particular perindopril (10 mg) and its combination with indapamide (2.5 mg) capable of reducing the mortality of patients with hypertension should be preferred to angiotensin receptor blockers II.

Abstract. The purpose of the study was to investigate the relation of insertion-deletion (I/D) polymorphism of the angiotensin-converting enzyme (ACE) gene with the parameters determining exercise tolerance (ET) in patients with coronary artery disease (IHD). The study involved 152 male patients with CAD with hemodynamically significant (according to selective coronary angioventriculography) stenoses of the coronary arteries. The examination of patients included a load test by modified Bruce protocol. The study of the ACE gene I/D polymorphism in the buccal epithelium was performed by polymerase chain reaction. It was established that in the group of patients with CAD low tolerance to physical exercise is independently associated with diffuse type of coronary artery damage, obesity, smoking and the presence of D allele of ACE gene insertion-deletion polymorphism.

Abstract. The purpose of the research was to study progression of cardiohemodynamics indices and their correlation with adipocytokines and neopterin in patients with stable angina and obesity. Adipokines and neopterin levels were assessed by immunoenzyme methods using immunoenzyme analyzer "LabLine-90" (Austria). Echo-CG and Doppler echocardiographic investigation of structural and functional state of myocardium was carried out using "Radmir" unit in �-mode and two-dimensional mode in standard echocardiographic positions. The research demonstrated that obesity played a major role in the development of structural and functional changes in myocardium of the left ventricle in patients with stable angina, contributed to the development of left ventricular myocardial hypertrophy on the account of increase in left ventricular posterior wall thickness by 6.3% and left ventricular myocardium mass by 29.6% in this cohort of patients; Patients with stable angina and associated obesity were found to have evident diastolic dysfunction by the type of relaxation, which was observed in 57% of patients.

Abstract. Main information about modern classification of metabolic syndrome is presented. The questions of lipid metabolism disorders in metabolic syndrome are featured, it is emphasized that atherogenic dyslipidemia is considered a trigger mechanism of a cascade of metabolic disorders at metabolic syndrome. Biochemical and pathophysiological aspects of influence on the syndrome pathogenesis of main classes of lipoproteids are presented. The findings of the clinical investigation allowed to compare and classify main groups of hypolipidemic drugs. Based on the data of evidence based medicine in the context of cardiovascular risk main indications, contraindications and efficacy of main groups of hypolipidemic drugs at metabolic syndrome are discussed. Preliminary findings about clinical efficacy of new groups and prospects of development of hypolipidemic drugs combinations are reported.

Abstract. The role of lipid peroxidation (LP) in the pathogenesis of infectious inflammatory diseases of the urogenital system and possibility of its correction by means of stimulation of combinations of antioxidation protective system (AOPS) were investigated. Indicators of LP and AOPS were investigated in blood plasma before treatment of 99 patients with associated protozoal-urogenital viral infection. A considerable aggravation of all LP and AOPS parameters was established statistically significantly in all patients before the treatment. After the treatment by traditional therapy, improvement of indicators without achievement of their normalization was noted which suggested proceeding oxidizing damage of the tissues. The use of the original methods of ozonotherapy led to authentic improvement and normalization of practically all indicators of LP and AOPS which in complex with clinico-laboratory indicators suggested clearance of the organism from the infection agents and restoration of physical and chemical properties of cellular membranes.

Abstract. The authors analyzed the literature data on the variants of delivery management after cesarean section. As the frequency of cesarean section (CS) increased during the recent twenty years, vaginal delivery after CS is suggested as a method to reduce it. A decision about delivery after CS includes determining the balance between the risk and benefit of each type of delivery. An attempt of vaginal delivery in any woman with a low transverse section on the uterus is desirable but the recent investigations warn the doctors and patients about potential unfavorable consequences. Comprehensive counseling considering the "passport of the operated uterus" from the very beginning of the pregnancy can give the best conditions for the attempt to perform vaginal delivery associated with lower number of complications, is less expensive and allow shorter rehabilitation period (about 40-60% of attempts are successful in patients meeting all requirements of the choice). A great attention should be paid to prognostic criteria to obtain safe treatment and successful outcome at vaginal delivery.

Abstract. Intrauterine fetus hypoxia and asphyxia of the newborn during the delivery in its acute and chronic variants are diagnosed in every fifth newborn weighing 1000 g and more, in particular, in Kharkiv Region this number varied from 16.6 to 21.4% in 2008-2012. The analysis of clinical anatomical peculiarities of lethal cases with perinatal hypoxia vs. histological picture of the adrenals in the newborns showed that in dead fetuses and newborns acute hypoxia (asphyxia) against a background of chronic hypoxia or without was associated with pathological changes in the structure of the adrenals, reflecting development of functional insufficiency. The obtained findings allow to conclude about the necessity of control of adrenals functional state in the mother, fetus and newborn at intrauterine hypoxia and postnatal asphyxia and development of the methods of prevention of adrenal insufficiency development.

Abstract. The work covers an urgent issue of contemporary coloproctology, i.e. saving the life of the patient by means of elimination of the disease and return of the patient to the society physically and socially rehabilitated. The authors present the original tactics of restorative and reconstructive-restorative operations on the large intestine based on the use of absolute and relative contraindications to it. It was performed in 1394 patients at Ukrainian Centre for Coloproctology. The use of this tactics, methods of prognosis and purposeful prevention of the complications allowed to increase the number of restorative operations from 64.6 to 71.2 %, reconstructive-restorative from 16.8 to 25.7%, improve the functional results after reconstructive-restorative operations, diminish the frequency of complications of healing interintestinal anastomoses and anatomical functional constructions from 14.1 to 5.6%, reduce post-operative death rate from 2.6 to 0.9%. Successful performing of the above operations is possible in specialized institutions with the experience of improvement of new technologies of restoration and reconstruction of the intestine.

Abstract. The literature on the urgent questions of surgical removal of tumor thrombi of the inferior vena cava, i.e. approach to the right atrium through the diaphragm from the abdominal cavity, liver mobilization and causes of hemorrhage from the isolated segment of the inferior vena cava at thrombectomy, is reviewed. A considerable progress in surgical technique of venocavothrombectomy, primarily in development of extraction methods of high tumor thrombi without the use of artificial circulation, is emphasized. It is shown that this surgical protocol requires further improvement by means of investigation of the anatomy of the cavoatrial segment of the inferior vena cava, liver and lumbar veins.

Abstract. The peculiarities of utrastructural rearrangement of the blood cellular elements interacting with venous endothelium was done using the method of electron microscopy for which endothelial vein wall in the area of the thrombus formation was taken during the operation. The study of ultrastructure of venous blood leucocytes contacting with the pathologically changed vein at chronic diseases of the lower extremities showed that the majority of leucocytes were in metabolically active state. It was established that disorders of cytoplasmic membrane of the leucocytes promoted their fixation on the endothelial surface of the venous wall, separate erythrocytes were destroyed by turbulent motion of the blood. The whole complex of the revealed submicroscopical disorders of leucocytes and erythrocytes in the area of turbulent blood flow at high activity of thrombocytes may promote thrombi formation.

Abstract. A method of cryonecrectomy of purulent wounds is reported. Its capabilities in improving the processes of wound healing, preparation of the tissues of purulent wounds, long-healing wounds and ulcers to surgical treatment is assessed. A method of cryonecrotectomy of the wounds using cryoapplications resulting in adhesions, freezing on and fixation on the effective part of the cryoapplicator of the pathological structures, which together with it are detached or resected from the wound surface with the purpose to clean it from necrotic tissues, fibrin, purulent discharge, pathologically changed granulations or reduction of pain, was developed. The experience of the application of this method using cryoapplicator with a cotton workpiece in 17 patients with long healing wounds and ulcers of the extremities is presented. Application of cryonecrotectomy of the wounds promoted removal of thin-layer (from 0.1 mm and more) pathologically changed tissues and foreign bodies without drug anesthesia. Positive results of preparation of the wounds to plastic reconstruction were obtained.

Abstract. The role of pro-inflammatory cytokines in development of the most common psychoneurological signs in cancer patients is discussed. Elevation of the levels of inflammation mediators, cytokines and their receptors was noted in cancer patients with localized and metastatic forms of the disease. Activation of cytokine production was observed at radio- and chemotherapy. Cytokines released at the periphery transfer the information about inflammation to the brain starting numerous signal cascades involved in development of behavior disorders. Association of cytokine gene polymorphism and development of these signs is featured. The necessity of further investigation of mechanisms of cytokines influence on the behavior with the purpose of development of effective strategies for treatment of psychoneurological disorders in cancer patients is emphasized.

Abstract. Morphological characteristics of gastric cancer complicated by perforation were investigated in 44 patients. All patients underwent urgent surgery. The biopsy samples obtained at FGDS, laparoscopy of the patients as well as operation material were investigated. The findings demonstrated prevalence of the following histological signs of the tumors: nondifferentiated cancer, poorly differentiated carcinomas and cricoic cell cancer. It was established that poorly differentiated tumors were accompanied by intravascular invasion promoting development of emboli and destruction of the tumor tissue and gastric wall. The urgency of the problem of perforated gastric cancer requires its further investigation.

Abstract. The capabilities of helical x-ray computed tomography in assessment of tumor process generalization in patients with cancer of the upper portion of the stomach are presented. Its main x-ray signs (thickening of the wall of various degree (0.7 - 4.5 cm), elasticity disturbance (rigidity) in the place of the tumor infiltration) were distinguished and systematized. The expediency of x-ray CT on the first stage of examination of the patients with suspected gastric cancer was shown. The obtained information allows more reasonable planning of diagnostic procedures during pre-operative preparation of the patient. The method allows to solve the most important tasks of possible generalization of the process to the adjacent organs and tissues as well as to revel metastatic involvement of parenchyma organs and lymph nodes.

Abstract. The purpose of the work was to study the efficacy of phytogenic drugs of Biphyton® and Women's Health series in the form of phytosuppositories and phytotablets at nonspecific endocervicitis in 90 women of reproductive age. The patients were performed clinical, bacteriological, cytomorphological investigation, colposcopy, transvaginal echography and color Dopller mapping using the original technique. The findings demonstrated that combined use of the drugs of Biphyton® series produced marked bactericide effect and did not promoted selection and formation of reservoirs of resistant strains of microorganisms, considerably reduced the terms of treatment. Absence of side-effects, high clinical efficacy allow to recommend these phytoselective drugs for complex treatment for nonspecific endocerviscitis in women of reproductive age.