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№4' 2013


Kuban State Medical University (Ministry of Health of RF), Krasnodar, Russian Federation
Congress of European Society of Cardiology: new Guidelines and important clinical trials (Amsterdam, 2013)
5 - 11
The article highlights the most important events of Congress of European Society of Cardiology 2013 (Amsterdam, Netherlands). The new European Guidelines for treatment of hypertension, stable coronary artery disease, cardiac pacing and resynchronization therapy, diabetes, pre-diabetes and cardiovascular diseases are described briefly. The findings of large clinical trials reported at all sessions of Hot Line and Clinical Trial Update are presented. New data on the efficacy and safety of a number of studied treatments for cardiovascular disease will have an impact on the daily clinical practice.
Key words: cardiovascular diseases, clinical trials, guidelines in treatment.
Kharkiv Medical Academy of Postgraduate Education, Kharkiv City Clinical Hospital No. 8
Clinical instrumental and genetic factors affecting the long−term prognosis in patients with coronary artery disease who underwent coronary artery stenting
12 - 15
Seventy-five patients were investigated to study clinical instrumental and genetic factors affecting the long-term prognosis at coronary artery disease. The complex examination of the patients included physical, clinical methods, a 6-minute walk test and genotype CYP2C19 study. Comparative analysis of the groups of patients was performed using Student's t-test for quantitative parameters. Depending on the disease course the patients were divided into groups with favorable and unfavorable prognosis. During the examination 33.3% of patients developed various complications necessitating hospital treatment. It was established that the factors associated with unfavorable course were low functional class of stable angina, high functional class of heart failure established prior to the intervention, the presence of genotype CYP2C19, and frequent alcohol intake in a dose exceeding 4 drink/day. The obtained findings should be considered when treating this group of patients.
Key words: stenting, prognosis, genotype CYP2C19, coronary artery disease.
Kharkiv National Medical University
Endothelial dysfunction at hypertension
16 - 21
As far as functional and structural remodeling of the vessels is considered to be one of important mechanisms for manifestation of arterial hypertension, pathogenetic mechanisms of interaction of biologically active substances produced by vascular endothelium and affecting formation of balance in the system of pressor and depressor factors in the conditions of hemodynamic stress are discussed. Disorders of this system contribute to the risk of arterial hypertension formation and progression, endothelial cells providing the basic functional response. Blood flow in the arterial vessels creates shear stress which is directly proportional to the blood flow rate and blood viscosity indices, and with the changes in pressure in the vessel and disorders of shear stress, endothelium provides regulation of the processes of vasoconstriction and vasodilatation. The basic mechanisms and conditions of forming thromboresistance and thrombogenicity of the endothelium in arterial hypertension are demonstrated.
Key words: hypertension, endothelial dysfunction, endotheliocytes, thrombocytes, nitric oxide, endothelins.
Kharkiv National Medical University
The changes in indicators of congenital immunity in patients with mixed urogenital protozoan viral infection when ozone therapy is applied
22 - 29
One hundred and sixty-six patients, of them 141 with combined protozoan viral urogenital infection, were investigated to analyze the changes of main factors of humoral and cellular non-specific immunity depending on the methods of treatment. The dynamics of typical indices was studied by the scope and character of the administered therapy at the traditional standard treatment, pharmacological immunotherapy with antiprotozoan therapy boosters, with the use of the original methods of ozone therapy. It was revealed that treatment according to the requirements of the World Health Organization and Ministry of Health of Ukraine failed to achieve any significant improvement of nonspecific immunity factors, resulting in chronization of inflammation and dissemination of mixed infections. The most favorable indices were achieved in cases of general pharmacoimmune correction with the original antiprotozoan therapy boosters. The most evident and stable positive clinical laboratory result with normalization of the majority of humoral and cellular factors of congenital immunity was achieved with combination treatment including original diverse ozonotherapy methods.
Key words: mixed urogenital protozoan viral infection, complex treatment, indicators of congenital immunity, ozone therapy.
Kharkiv Regional Clinical Perinatal Centre
Kharkiv National Medical University
Is herpes simplex virus dangerous for pregnancy?
30 - 32
Genital herpes simplex virus (HSV) is one of the most common sexually transmitted viral diseases. The infected with HSV woman infects her child in 40% of cases, of them 85% intranatally. The highest probability of HSV infection in the neonatal period is observed at primary infection of the mother the day before the delivery. Neonatal death rate makes 50-70%. The majority of survived have neurological complications, deafness, herpetic lesions of the skin, viral sepsis, encephalitis. The diagnosis is based on the clinical presentation but to prevent transmission early laboratory diagnosis is necessary. Typospecific serological reaction and DNA diagnosis are used. The treatment of primary episode of genital herpes includes systemic antiviral drugs (Acyclovir, Valtrex, Lavomax (Tilirone)), immunomodulators (Cycloferon, Alpharekin, Panavir, Allokin-Alfa), analgesics, antioxidants, vitamins. Acyclovir is also used topically. The pregnant with active eruptions or prodrome signs are performed caesarian section. Breastfeeding is allowed if the breasts are not involved.
Key words: herpes, pregnancy, childbirth, prevention.
Kharkiv Regional Clinical Oncology Center
Basic aspects of pathogenesis fibrocystic mastopathy
33 - 37
The literature on the problems of the pathogenesis of fibrocystic mastopathy is reviewed. It was noted that the presence of proliferative processes in the breast tissue increased the risk of cancer development. The information accumulated in the literature shows that formation of firboadenomatous changes in the breast tissue is a hormone-dependent process. The principles of pathogenetic treatment of the patients with fibrocystic mastopathy have been worked out by many researchers. The study of mastopathy causes and development can allow complex pathogenetic therapy in treatment of dyshormonal processes in the breast tissue. Conservative treatment of the patients should be performed individually considering the revealed psychosomatic, hormonal and somatic disorders. Pathogenetically substantiated therapy for fibrocystic mastopathy, correction of metabolic disorders can promote breast cancer prevention.
Key words: fibrocystic mastopathy, pathogenesis, psychosocial, hormonal and somatic disorders.
City Maternity Hospital No. 5, Kyiv
Clinical diagnostic value of antiphospholipid antibodies in prognosis of fetal growth retardation
38 - 40
Complex clinical examination of 130 pregnant with fetal growth retardation syndrome of various degrees of severity and 30 healthy pregnant (controls) was performed to establish clinical diagnostic value of antiphospholipid antibodies in development of fetal growth retardation syndrome. The performed investigation demonstrated that antiphospholipid antibodies concentration over 0.6 U/ml was prognostically unfavorable, associated with increased frequency of severe fetal growth retardation syndrome against a background of prolonged gestosis, marked hemodynamic disorders in the placental complex and low efficacy of the administered therapy. Pregnancy in these women was complicated by placental insufficiency in 100% of cases, severe pre-eclampsia in 70.0% of cases and eclampsia in 2.5% of cases. Considering these data, antiphospholipid antibodies concentration over 0.6 U/ml was determined a threshold in development of severe fetal growth retardation syndrome.
Key words: antiphospholipid antibodies, fetal growth retardation, prognosis.
Main Military Medical Clinical Centre "GVKG" (Ministry of defense of Ukraine), Kyiv
Anaerobic nonclostridial cellulitis of the pelvis: a modern view on the problems of surgical treatment
41 - 46
Contemporary literature on the problem of surgical treatment of anaerobic nonclostridial cellulitis of the pelvis region was analyzed. Owing to introduction to the clinical practice of modern surgical technologies and antibacterial drugs, the problem of treatment of anaerobic nonclostridial cellulitis received a new solution. When anaerobic nonclostridial cellulitis is diagnosed, urgent surgery based on the principles of active surgical tactics (including surgical treatment of the purulent necrotic focus with adequate drainage, programmed repeated surgical treatment) is indicated. The used reparative interventions are divided into full-layer skin autodermoplasty and wound autodermoplasty with a free split-skin grafting. Nanodisperse dioxide, polymetisiloxan are promising drugs. The literature data suggest that treatment of anaerobic nonclostridial cellulitis is still disputable, which requires new methods of treatment of the pathological process.
Key words: nonclostridial anaerobic pelvic cellulitis, surgical treatment, topical treatment of wounds.
Kharkiv National Medical University
Surgical tactics in patients with complications of local gastric cancer
47 - 50
The results of surgical treatment of 418 patients with local gastric cancer complicated with bleeding, stenosis, perforation, and their combination were analyzed. The original two-stage surgical tactics with a wide use of low-invasive interventions was used on the first stage of the treatment. Radical surgery was done in 168 (40.2%) of patients, 250 (59.8%) underwent palliative and symptomatic surgery. The results of the surgery depended on the choice of adequate surgical tactics and the volume of the primary surgery. Post-operative complications occurred in 36/3% (152 patients). Post-operative and general death rate made 17.5% and 21.3% (73 and 89 patients), respectively. The expediency of application of two-stage surgical approach using minimally invasive methods of hemostasis, palliative and symptomatic surgery on the first stage followed by early delayed or planned radical surgery (stage 2) allowing reduction of the operation duration and increase of reliability, improvement of the quality of life, was substantiated.
Key words: local gastric cancer, complications, surgical tactics.
Donetsk National Medical University named after M. Gorky, Donetsk Regional Antitumor Center
Paraneoplastic syndrome in hepatocellular cancer
51 - 56
Paraneoplastic syndrome is an important component of neoplastic process, it can affect the diagnosis, treatment and prognosis of the disease. This syndrome in patients with hepatocellular cancer is more frequent with the larger tumor mass, high level of alpha-fetoprotein, disseminated process and late stages. The most frequent paraneoplastic syndromes at hepatocellular carcinoma are hypercholisterinemia, hypoglycemia, hypercalcemia, erythrocytosis. In addition to erythrocytosis, the patients with paraneoplastic syndrome show poorer survival and prognosis vs. the patients without this syndrome. The cases of successful treatment of paraneoplastic syndrome are rare, but they reflect efficacy of the basic disease treatment, therefore, paraneoplastic syndrome can be used as a peculiar tumor marker.
Key words: hepatocellular cancer, primary liver cancer, paraneoplasia, paraneoplastic syndrome.
Donetsk Regional Antitumor Center
Donetsk National Medical University named after M. Gorky
The variants of surgical treatment for esophageal cancer and gastric cancer involving the esophagus
57 - 60
Immediate and functional results of surgical treatment of 363 patients with esophageal cancer and gastric cancer involving the esophagus treated at Donetsk Regional Antitumor Center from 2005 to 2012 are presented. Lewis', Garlock', abdominomediastenal, abdominothoracocervical approaches were used most frequently. They allowed adequate lymphadenectomy and tumor removal within the limits of the healthy tissue. In 77 patients (21.2%) the operation was of a combination character (splenectomy - 42 cases, pancreatic tail resection - 24, subtotal pancreatectomy - 6, resection of the diaphragm and its pedicles -16, liver resection - 8, large intestine resection - 6, lung resection - 5. The variants of developed and used in the clinic esophagoentero- and esophagogastrostomy are shown. Reliability of the techniques (anastomosis failure - 0%), and their functionality (reflux esophagitis - 8%, scar stenosis - 6%) was shown.
Key words: esophageal cancer, gastric cancer involving the esophagus, surgical treatment.
Kharkiv Medical Academy of Postgraduate Education
Contact dermatitis in clinical practice
61 - 64
The literature data on the causes and mechanisms of contact dermatitis, the methods of diagnosis and treatment are reported. Prevalence of simple contact dermatitis over allergic (80 and 20 % , respectively) was noted. Skin lesion caused by physical, chemical and biological factors play a role in simple contact dermatitis developing non-immunologically, while allergic contact dermatitis is a classical form of delayed-type hypersensitivity reaction mediated by sensitized lymphocytes. The diagnosis is based on clinical and history data, findings of in vitro immunological responses to specific allergens, and skin tests.
Particular attention is paid to contact dermatitis associated with nickel, widely used in everyday life and in industries. Recommendations to the patients with allergy to nickel and other irritants are given.
Key words: simple and allergic contact dermatitis, etiology, pathogenesis, diagnosis, treatment.
Kharkiv Medical Academy of Postgraduate Education
Vascular endothelial growth factor in psoriasis: pathogenetic and therapeutic aspects
65 - 68
Recent studies have shown that one of the most important parts of the pathogenesis is unbalanced vascularization. Angiogenesis in psoriasis is characterized by the presence of enhanced proliferation of endothelial cells lining the inner surface of the blood vessels. It is known that epidermal keratinocytes in psoriasis patients are the major source of pro-angiogenic factors, interleukin-1, 6 , 8, tumor necrosis factor α, vascular endothelial growth factor (VEGF). VEGF is recognized the key proangiogenic factor responsible for formation of new blood vessels in psoriatic plaques. This factor plays an important role in inflammation initiation, as a factor enhancing vascular permeability. Our studies revealed a significant increase of VEGF content in the serum of patients with common psoriasis. Treatment of psoriasis with topical corticosteroids, drugs of biological therapy has a positive effect on the level of VEGF. The application of anti-VEGF drugs to psoriasis treatment in future is discussed.
Key words: psoriasis, angiogenesis, vascular endothelial growth factor, pathogenesis, therapy.
Kharkiv National Medical University
Clinical and epidemiological features of chronic hepatitis C at present
69 - 72
The findings of investigation of the epidemiological features and clinical presentation of chronic hepatitis C are reported by the example of 206 patients treated at Kharkiv Regional Clinical Hospital for Infectious Diseases within the period of 2007-2011. General clinical and traditional statistical methods were used. It is shown that most vulnerable for HCV infection and development of chronic disease is a socially active group of persons aged 24-45, men prevailed women 2.5 times. It was established that the major risk factors of HCV infection were drug use (24.27 %), surgery or blood transfusion (22.32 %), tattoo or body piercing (10.2%) and contact with extraneous blood (7.77 %). Manifestations of hepatomegalic (100 %) , asthenovegetative (75.24 %) and dyspeptic (69.9 %) syndromes prevailed in the clinical picture of chronic hepatitis C. The obtained information should be considered when treating this group of patients.
Key words: chronic hepatitis C, HCV infection, epidemiology, clinical picture.
Kharkiv Medical Academy of Postgraduate Education
Comparison of clinical effect of various kinds of complex therapy for chronic acquired toxoplasmosis in the stage of acceleration
73 - 77
The clinical effect of different types of complex therapy for chronic acquired toxoplasmosis was compared based on the clinical laboratory and electrophysiological data of the state of the immune system of the patients. The efficacy of complex treatment of 143 patients was determined in three groups: group 1 (n = 45) was treated with antiprotozoal therapy with a combination of pyrimethamine+sulphadoxine; group 2 (n = 48) was administered combination therapy with an antiprotozoal drug and specific anti-toxoplasmosis immunoglobulin; group 3 (n = 50) was treated with specific immunoglobulin against human Toxoplasma gondii. Tolerability and efficacy of the drugs was assessed with the use of complex (clinical, laboratory and immune) examination of the patients before the preparation administration, 1 month, and 5 - 6 months after the beginning of the treatment. The best clinical immunological effect at treatment of the patients with chronic acquired toxoplasmosis on the stage of exacerbation was achieved at treatment with combination therapy. Therapy with specific immunoglobulin against human Toxoplasma gondii took the interim position, and therapy with pyrimethamine+sulphadoxine appeared to be least effective. The obtained findings should be considered when treating this group of patients.
Key words: chronic acquired toxoplasmosis, antiprotozoal therapy, immunotherapy, immunoglobulin, human Toxoplasma gondii, combination therapy, T- and B-immunity.
Dermatovenereology Hospital, Belgorod-Dnesterovsky, Odessa region
Bukovinsky State Medical University, Chernivtsi
Adaptation compensatory capabilities of the human body at demodecosis
78 - 81
Cortisone and insulin level, basal level of hypophyseal hormones and those of peripheral endocrine glands in the blood plasma of the patients as well as the degree of interrelation of immune and hormone parameters with calculation of the respective correlation coefficients of cortisone and insulin and immunity parameters were investigated to study the state of human adaptation compensation capabilities at demodecosis. Generally accepted clinical and laboratory methods of investigation were used: parasitology, immunology (the parameters of cellular and humoral immunity), hormonal, instrumental and statistical. It was shown that various changes in the concentration of cortisone and insulin occurred at chronic action of invasion as stress, which suggested different types of adaptation reaction, the changes of the regulating influence of adaptive hormones on the factors of immunity in patients with demodecosis, reduction of the strength of correlation and, in a number of cases, changes of its vector. To improve the efficacy of rehabilitation, complex therapy aimed at normalizing hormone level and immunity stimulation is necessary.
Key words: demodecosis, acariosis, invasive dermatozoonosis, diagnosis, prevention.
Kharkiv Medical Academy of Postgraduate Education
Antenatal sonographic features and perinatal outcomes of various disorders of fetal cardiac rhythm
82 - 88
M-mode echocardiography of 26 fetuses with assessment of atrioventricular conduction and simultaneous arteriovenous pulsed Doppler ultrasound was performed to determine ultrasound diagnostic criteria and improve prognosis of perinatal outcome in fetuses with different types of cardiac arrhythmias. Comparative analysis of perinatal outcomes was made, antenatal echo- and Doppler images were presented. Favorable perinatal outcome was observed in isolated atrial extrasystoles, atrial bigeminy or trigeminy, supraventricular tachycardia up to 205-215 beats/min with 1:1 antrioventricular conduction. Supraventricular tachycardia (200-220 beats/min) was accompanied by universal edema and required transplacental treatment. Sinus bradicardia, grade 2-3 atrioventricular block, supraventricular tachycardia with atrial flutter and 2:1 atrioventricular conduction, as well as ventricular tachycardia were associated with fetal distress or universal edema, perinatal loss, hemodynamic disorders. The majority of fetal arrhythmias are observed in the second half of pregnancy, which proves the necessity of the third ultrasound scanning. Upon detection of fetal arrhythmia with adverse or uneven perinatal prognosis delivery in a perinatal centre is preferable.
Key words: fetus, arrhythmia, antenatal ultrasound diagnosis, perinatal outcome.
Kharkiv Medical Academy of Postgraduate Education
Ultrasound features of cyclic changes in the breast depending on hormonal parameters in women with diffuse mastopathy
89 - 92
This study was undertaken to examine the ultrasonic features of cyclic changes in the breasts in women with various forms of mastopathy, depending on the hormonal status by determining the qualitative and quantitative parameters of fibroglandular tissue.
The study involved 134 women with various forms of diffuse mastopathy (prevalence of glandular, fibrous, cystic components and mixed type) aged 21-45 and 28 women aged 19-43 without structural changes in the breast parenchyma.
All women underwent ultrasound study of the breast using high-frequency linear transducers in the 1st and 2nd phases of the menstrual cycle, as well as the study of hormone levels.
Based on the findings of ultrasonography, hormone investigation in women of reproductive age with diffuse mastopathy, enlargement of the breast parenchyma, increase of its echogenicity, uneven structure, enlargement of the ducts diameter were noted.
The obtained findings suggest of a link between the nature of the changes in the breast parenchyma and cyclic changes in hormone levels in women with diffuse mastopathy.
Key words: breast, hormonal status, ultrasonography.
Kharkiv Medical Academy of Postgraduate Education
Nine decades of state postgraduate medical education in Kharkov
93 - 95
Historical facts, which served the creation, establishment and subsequent reorganization and development of Postgraduate Medical Institute in a wide range of areas, from infectious diseases and health concerns, surgical pathology and internal medicine questions to organization of medical institutions in the conditions of economic development of the country are analyzed. Marked achievements of education science and teaching methods and introduction of intensive techniques and training facilities, fruitful cooperation with leading medical universities in Ukraine, CIS and oversees countries are described.
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