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№1' 2014


Kharkiv Medical Academy of Postgraduate Education
Emotional disturbances on panic disorder patients and their psychotherapy correction
5 - 7
A considerable growth of anxiety disorders is observed in Ukraine at present. According to epidemiological research up to 80% of the population suffer from paroxysmal and permanent vegetative symptoms that clinically manifest as vegetative dysfunction syndromes. Panic disorder (PD) and agoraphobia (AP) prevail in their structure. PD usually occurs against a background of psychogenic (highpoint of the conflict, under influence of severe stress) and biological (hormonal changes, onset of sexual activity) disorders. At the same time, diagnostic criteria of PD have demonstrated that AP develops without any connection with current psychological factors. The research was performed to investigate the state of the emotional sphere of patients with panic disorder. The emotional disorders of 40 PD patients and 20 AP patients were investigated using clinical and pathopsychological methods. The high level of anxiety was shown. Pathopsychological investigation identified a high level of trait anxiety and low level of neurotism and depression. Clinical and psychopathological research of patients with PD showed that paroxysmal clinical manifestations fit into the pattern of PA symptoms complex. Permanent manifestations were detected mainly in the controls (A) and were characterized by asthenic, anxious and subdepressive symptoms submitted in a variety of syndromes: anxious-phobic -- 31%, asthenic-depressive 16%, asthenic-hypochondriac -- 16%, asthenic, anxiety -- 21%, asthenic -- 14%. Among patients with PD leading psychopathological syndromes were asthenia (20% patients), anxiety and depression (33% of patients) and hypochondriac (46,66% of patients). According to Eyzenk scale, the patients with PD in 55% of cases noted high level of neurotism, while patients with agoraphobia in 47% of cases had domination of an average level. The average level of depression according to Hamilton scale in patients with PD was 16 points. According to Spielberger scale in PD patients mean anxiety level score was 39, and in patients with agoraphobia -- 42 points. Indicators of reactive anxiety were significantly different. In patients with PD mean level was 33 points, and in patients with agoraphobia -- 54 points. Patients with agoraphobia had hyperthymia -- mean rate 19, dysthymia -- mean rate 18, anxiety -- mean rate 21. The system of psychotherapy correction was established with high efficacy in 68% cases. Complete reduction of PD symptoms achieved in 68% of patients, significant improvement -- in 20% of cases, no significant changes were detected in 12% of patients. The system of psychotherapy correction was established with high efficacy in 68% cases.
Key words: еmotional disturbances, panic disorder, psychotherapy correction.
Kharkiv Medical Academy of Postgraduate Education
Modern concepts of psychotherapeutic process from the perspective of personalized medicine
8 - 12
This paper features the current situation of psychotherapy from the perspective of major psychotherapeutic paradigms (neurodynamic, psychodynamic, cognitive-behavioral, rational, psychomethodological) in the framework of the dominant concept of personalized medicine. Comprehensive integral strategy in a definite clinical case considering genetic, macro- and microenvironmental factors, optimization and individualizing of therapeuric and diagnostic process is meant. The role of psychophenomenological approach in psychiatry as a fully functional instrument of personalization in medicine is emphasized. Introduction of such profile is especially important within the framework of the search for personalized therapeutic strategy as psychotherapy is associated with medically oriented intervention promoting treatment efficacy, compliance forming, improvement of the quality of the life of the patients with various types of somatic, neurological, surgical pathology. Efficient application of this sanogenic instrument in specialized and general medical practice together with improvement of theoretical and therapeutic-diagnostic capabilities can improve the quality of medical aid, social and labor adaptation and population health.
Key words: psychotherapy, personalized medicine, psychotherapeutic profile, ontogenetic model, the psychotherapeutic process.
1Kharkiv National Medical University
2Municipal Clinical Hospital № 27, Kharkiv
Cerebrovascular insufficiency and diabetic encephalopathy in patients with type 2 diabetes mellitus
13 - 17
Diabetic encephalopathy is resistant cerebral pathology that occurs in patients with type 2 DM. To establish the association between impaired cerebral hemodynamics and formation of cognitive disorders, 87 patients with type 2 diabetes mellitus and stage 2 diabetic encephalopathy aged 56.3±5.9 were investigated. Mean disease duration was 9.3±4.5 years. Glycosylated hemoglobin level in the patients ranged from 7.2 to 8.8%. The examination included cognitive function assessment using Mini-mental State Examination (MMSE) and Addenbrooke's Cognitive Examination-R (ACE-R), Doppler ultrasound, electroencephalography, MRI, statistical processing of the findings. Mild and moderate cognitive disorders were reveled. Memory function, speech fluency, attention and orientation were deteriorated more significantly (p<0.01) which reflected disorders of frontosubcortical brain portions and neurodynamics of trunk and subcortical structures in type 2 diabetes mellitus. These disorders were accompanied by deorganization of main bioelectric brain rhythms, increase in P300 peak latency of endogenic evoked potentials, reduction of brain blood flow velocity, disorders of cerebral vascular reactivity. The findings of the research demonstrated efficacy of Addenbrooke's Cognitive Examination in screening and diagnosis of cognitive disorders in type 2 diabetes mellitus. Early detection of cognitive decline and administration of adequate therapy considering the state of cerebrovascular reserve allowed preventing its decline in patients with type 2 diabetes mellitus, improving their quality of life and social adaptation.
Key words: type 2 diabetes mellitus, diabetic encephalopathy, cognitive disorders, cerebrovascular insufficiency, cerebrovascular reserve.
Kharkiv Medical Academy of Postgraduate Education
Dynamics of emotional and autonomic parameters in patients with myofascial pain syndrome of cervicobrachial localization under the influence of non−pharmacological treatment
17 - 20
The capabilities of non-pharmacological therapy influence on vegetative functional of the patients with cervicobrachial myofascial pain syndromes were determined. The study involved 87 patients with cervicobrachial myofascial pain syndromes presented with disorders of biomechanical pattern as well as vegetative dysfunction syndrome and emotional disorders. The degree of the pain syndrome was determined using visual analogue scale, vegetative signs were objectified using A.M. Wein questionnaire as well as by mean of investigation of the state of vegetative tone, reactivity and life support. To assess the level of trait anxiety Spilberberg-Khanin scale as well as HAM (health, activity, mood) test were used. Group 1 (49 patients) was administered a complex of manual therapy (5 sessions every other day). Group 2 (38 patients) was administered a specially developed therapeutic program including corporal and auricular acupuncture in addition to manual therapy. Correction of myofascial pain syndromes with manual therapy resulted in reduction of the degree of the pain syndrome and emotional vegetative disorders. Treatment of vegetative disorders using acupuncture improved the efficacy of treatment for myofascial pain syndrome. Thus, the results of the treatment proved the efficacy of non-pharmacological therapy in patients with cervicobrachial myofascial pain syndromes and demonstrated the necessity to combine manual therapy and acupuncture in this group of patients.
Key words: myofascial pain syndromes of cervicobrachial location, vegetative dysfunction, non-medica-mnetal therapy.
1V.I. Razumovsky Saratov State Medical University, Ministry of Health of RF
2Medical Center Di
Analysis of genetic factors in patients with chronic heart failure
21 - 29
This review deals with investigation of polymorphism of genes encoding proteins of the major neurohumoral systems involved in development and progression of chronic heart failure and other heart diseases.. The data on the relationship of polymorphic variants of these genes encoding the proteins of renin-angiotensin-aldosterone and sympathoadrenal systems as well as about polymorphism of genes encoding pre-inflammatory cytokines are featured. The findings of the research proving the association of polymorphic variants of genes encoding angiotensin-converting enzyme, angiotensinogen, angiotensin and beta-adrenerergic receptors with development and the character of course of arterial hypertension, coronary artery disease, chronic heart failure are presented. The data about the association of polymorphic variants of the above genes and efficacy of the administered therapy and incidence of some side effects at administration of angiotensin-converting enzyme inhibitors and beta-adrenoblockers are reported. The problems of practical use of the results of genetic testing, in particular, in prognosis of the reaction in patients with chronic heart failure to the treatment means and prevention according to personalized medicine are analyzed.
Key words: gene, polymorphism, chronic heart failure, angiotensin-converting enzyme.
Kharkiv National Medical University
History and clinical significance of electrocardiography: from sources to contemporaneity
30 - 34
Historical stages of electrocardiography are described. In 1791 an Italian physician L.Galvani was the first to investigate electrical phenomena in muscular contraction, which gave rise to experimental physiology. In 1856 R.Kölliker and H. Müller determined the presence of weak current occurring at myocardium contractions. In 1887 an English physiologist A.Waller using capillary electrometer was the first to obtain a record of electrical activity in the human myocardium. In 1893 a Dutch physiologist W.Einthoven suggested the term electrocardiography for the new method. In 1903 the first electrocardiograph was made and in 1905 W. Einthoven carried out transmission of an electrocardiogram via telephone, which opened the way to ECG-telemetry. The system of electrocardiographic leads was elaborated during the period from 1913 to 1943. In 1947 N. Holter invented the first remote ECG monitor. Since 1961 Holter monitoring (HM) has been widely used in clinical practice. The American Association of Cardiology distinguishes three classes of clinical indications for Holter monitoring. In Ukraine physicians usually use B. Laun and M. Wolf classification when interpreting ECG in patients with ventricular arrhythmias. Diagnostic capabilities of Holter monitoring can be expanded by telemetry which has been used in Ukraine since 1935. Transesophageal electrocardiography and transesophageal electrocardiostimulation have been used in clinical practice since the 1980th. These methods help to diagnose abnormal changes in the myocardium which are difficult to assess on a plain ECG or which are not detected by Holter monitoring.
Key words: history of electrocardiography development, Holter monitoring, ECG-telemetry, transesophageal electrocardiography.
Kharkiv National Medical University
Etiology, pathogenesis and diagnosis of chronic obstructive pulmonary disease at present
35 - 39
Chronic obstructive pulmonary disease is one of the major problems of health due to its high frequency, association with other lung diseases, constant progress. This is an example of a multifactorial disease, the development of which is involved by environment pollution, harmful industrial factors, smoking, genetic predisposition. . The definition of chronic obstructive pulmonary disease has been revised recently as an acute condition characterized by deterioration of respiratory symptoms beyond normal variability and requiring therapy changes. Chronic obstructive pulmonary disease is characterized by a relatively large preclinical period of the disease followed by formation of complications. Most studies demonstrating the inability to influence the progression of chronic obstructive pulmonary disease were conducted in patients with clinical manifestations of the disease. Under these conditions early diagnosis of chronic obstructive pulmonary disease with early use of therapies aimed at key stages of chronic obstructive pulmonary disease pathogenesis is important. With regard to the pathogenesis of lung injury, the most recognized is deficiency of alpha-1- antitrypsin. galectin-3 may be considered a stimulant of fibrosis. Adhesion molecules actively participate in development of bronchial remodeling in chronic obstructive pulmonary disease. One of the systemic manifestations of chronic obstructive pulmonary disease is osteoporosis developing in patients with chronic obstructive pulmonary disease despite administration of glucocorticoids. Therefore, investigation of the level of osteopontin in chronic obstructive pulmonary disease can be considered a factor of development of complications such as osteoporosis. Prospective chronic obstructive pulmonary disease investigations should be aimed at solution of the questions of new ways of treatment and prevention of chronic obstructive pulmonary disease and its complications.
Key words: chronic obstructive pulmonary disease, alpha-1-antitrypsin, galectin-3, adhesion molecules, osteo-pontin, SAT scale, mMRC.
1 Kharkiv National Medical University
2 Kharkiv Medical Academy of Postgraduate Education
The role of immunotherapy in treatment of patients with community−acquired pneumonia
40 - 43
A considerable growth of pneumonia incidence has been noted in the world. A large group of patients with early destructive changes in the lungs, unfavorable prognosis is forming. The changes in the immunity state and host reactivity leads to more frequent cases of atypical pneumonia, cases with poor signs, prolonged treatment of the disease.. Immunotherapy becomes a logical therapeutic strategy promoting more efficient conventional pathogenetic treatment and genetic stability of the immune cells. To study the efficacy and safety of immunocorrecting drug Glutoxim in conjunction with antibacterial therapy in treatment of community-acquired pneumonia 36 patients with group 3 pneumonia aged 27-67 were included in the study. One group of the patients (18 patients) was treated with standard therapy and Glutoxim. The basic mechanism of Glutoxim effect is stimulation of proliferation and differentiation of normal cells and activation of the processes of death of transformed cells. The group of the patients who were administered immunomodulating therapy demonstrated a positive effect of the third day (reduction of temperature and intoxication, control of cough, increase in the parameters of nonspecific immune protection). Mean bed-day was 12.7±1.8. The received clinical and laboratory data prove that Glutoxim enhances antibacterial therapy, promotes more rapid recovery of the patients with inflammatory diseases of bacterial origin.
Key words: pneumonia, prolonged duration, immunodeficiency states, immunocorrection.
1Kharkiv National Medical University
2Kharkiv Regional Clinical Perinatal Centre
Prevention of perinatal pathologies in pregnant women following auxiliary reproductive technologies
44 - 50
Pregnancy resulting from auxiliary reproductive technologies develops in specific conditions, has a large number of perinatal complications, reduction of which is an important issue of obstetrics. New diagnostic capabilities allow to specify the etiology and work out new approaches to definition of pathogenetic mechanisms of perinatal complications, especially after auxiliary reproductive technologies. To specify the pathogenesis and work out effective methods of prevention of perinatal complications of pregnancy resulting form auxiliary reproductive technologies 120 women were investigated, of them 90 in whom pregnancy resulted from application of auxiliary reproductive technologies and 30 with spontaneous pregnancy. It was revealed that one of main mechanisms of perinatal complication development which are usually due to hemodynamic disorders in the system mother-placenta-fetus, is forming endothelial dysfunction. A complex of measures aimed at optimizing of pregnancy management after auxiliary reproductive technologies which allows improvement of the course of gestation period reduce the number of perinatal complications both in the mother and the fetus by means of normalizing the disorders in the regulation mechanisms of the endothelial system and immunological homeostasis, which is achieved by the use of ozone therapy and immunocorrection before implantation.
Key words: perinatal pathologies, reproductive technologies, endothelial dysfunction.
1Kharkiv National Medical University
2Kharkiv Regional Clinical Perinatal Centre
Modern aspects of complex therapy to be recurrent papillomatous viral infection
51 - 55
Papillomavirus infection is extraordinarily difficult for diagnosis and therapy and requires protracted examination and treatment. The relapses are observed in 20-30% of the patients. The most typical manifestations of the infection are pointed anogenital condylomas. As a natural substance indol-3-carbinol (I3C) is the only pathogenetic means for the disease treatment associated with papillomavirus infection, efficiency of Indol-F® including I3C was investigated in complex treatment of anogenital condylomas. The investigation was conducted on 120 women with pointed condylomas of external genital organs, caused by human papillomavirus infection. all patients were treated using cryodestruction of condylomas with liquid nitrogen in combination with immunotropic therapy. In 45% cases relapses occurred. The women with the disease relapses, depending on the clinical form of PVI were divided into 2 groups: group 1 (26 women) with clinically expressed course of the disease; group 2 (28 women) with symptom-free virus carrier state. Every group was divided into sub-groups, in one of which the patients were given complex therapy including combination of local destruction of condylomas (by the method of cryotherapy) and administration of antiviral and immunomodulatory agents. In the other sub-group Indol-F® was administered. The findings of the research show that the use of Indol-F® is a promising and necessary to solve the problem of dissemination and consequences of viral urogenital infections. Complex use of Indol-F® in combination with antiviral agents, immunomodulators and destructive therapy can guarantee recovery of the patients and absence of the disease relapses..
Key words: papillomatous viral infection, pointed condylomas, therapy.
Ukrainian Research Institute of Transport Medicine, Odessa
Medication and physiotherapy for inflammatory cervical pathology of in women of reproductive age
56 - 60
Complex medication and physiotherapy for inflammatory diseases of the uterine cervix (exo- and endocerviscitis, erosion, stage 1 dysplasia) was performed in 80 women of reproductive age (main group) using the original treatment protocol. The controls were 40 women who were given standard treatment for this pathology. All patients were performed microscopic, cytomorphological, bacteriological investigations of urogenical secretion, polymerase chain reaction for urogental infections, colposcopy. The investigation revealed grade 3 and 4 of cleanliness of the vaginal flora, the existence of microbe association in 80 patients (88.89%), association with virus infection (herpes or human papillomavirus) in 30 (30.0 %). Colposcopy demonstrated prevailing benign (70%) and pretumour (10%) zone of epithelium transformation, papillary dysplasia (35 %), dysplasia fields (43 %), simple (46 %) and proliferative (546%) leukoplakia. The proposed complex medication and physiotherapy treatment of cervix pathology included staged treatment of vaginal and cervical mucosa with 3 % solution of hydrogen peroxide and solution of cyteal followed by introduction into the canal of tampon with octenisept, influence of magnetolaser ray (amplitude -- 4-5 µm, frequency of modulation 37.5Hz, time of exposition from 5 to 10 min), introduction of vaginal tampons with buckthorn oil and antifungal ointment (7-10 sessions). Clinical effect of the recommended therapy was observed in 45 patients of the main group, which was proved by disappearance of complaints, improved colposcopy findings and normalization of vagina microbiocenosis on day 7 after the beginning of the treatment. Thirty percent of the controls had subjective and objective signs of the pathological process. The proposed protocol seems promising and needs more thorough investigation.
Key words: vagina dysbiosis, cervix, magnetolaser, exo- and endocervicitis, cervical erosion.
Kharkiv National Medical University
V.I. Shapoval Regional Center of Urology and Nephrology, Kharkiv
Control of renal artery at removal of tumor thrombi from the lumen of the inferior vena cava: surgical strategy options
61 - 64
The author analyzes various methods of control of renal artery at caval thrombectomy. Based on research findings on this problem and own surgical experience he discusses the advantages and disadvantages of preliminary bandaging of the renal artery, pre-operative renal artery embolization and artery bandage after thrombectomy. The priorities of thrombectomy before the renal artery ligation including high safety in respect of the thrombus fragmentation and embolism with the tumor of the pulmonary artery as well as massive bleeding from renal venous collaterals are presented. Nevertheless this surgical approach can increase venous hypertension inside the kidney and its influence on cancer results require further clinical investigation. An ideal method of renal artery control at venocavothrombectomy does not exist at present. This stage of the operation considerably depends on the experience and individual preferences of the surgeon. Further investigation is necessary to determine the role of the existing surgical techniques.
Key words: ligation of the renal artery, renal artery embolization, tumor thrombus, inferior vena cava.
A.I. Meshaninov Kharkiv City Clinical Emergency Hospital
Improvement of preliminary ischemic preparation of tissues for composite flaps plastic surgery of the extremities
65 - 69
Preparation of tissues for staged flap plastic surgery on the extremities was improved. Delay method promotes creation of alternating ischemia-reperfusion up to 4-5 days after the first stage of the operation, distant training is performed by means of interval interruption of the blood flow in a healthy extremity using a blood pressure cuff applied three times for 10 minutes per session with 2-3-minute intervals. Starting from day 6-7 and to the second stage of surgery, training is performed by means of a systematic cross clamping of vessels in the extremity at Italian plastics -- recipient, at Indian -- the extremity with the isolated flap followed by clamping of vessels in the temporary feeding pedicle of the flap or the tissue bridge at the top of the flap when preparing with delay method. Everyday clamping time is increased by 5 minutes (from 5 to 30 minutes) per each training session. After compensation of the blood flow in the flap, this tissue bridge may be conclusively forced by application of suture. A prognostic test of flap viability based on evaluation of intensity of postischemic hyperemia was suggested. Sufficient blood flow in the tissues is determined with the appearance of homogeneous post-ischemic hyperemia of the flap tissues (including its distant areas) and white spot sign for less then 3 seconds. Insufficient blood flow is determined by absence or decrease in intensity of post-ischemic hyperemia and white spit sign time over 4-5 seconds. This flap viability prognostic test and method of ischemic recipient wound and flap tissues preparation were successfully used in treatment of 8 patients.
Key words: method of ischemic preparation of tissue of recipient injury and flap, prognostic test of viability of skin flap, wounds, extremity revascularization, plastic surgery.
Volgograd State Medical University, Ministry of Health, Russian Federation
Main approaches to etiotropic treatment of viral hepatitis
70 - 74
Viral hepatitis caused by A,B,C,D,E,F,G,TTV, SenV viruses is a highly important medical and social issue. Widespread use of hepatitis B and C diagnosis has shown that every tenth inhabitant of the earth is infected by one of these viruses. Successive treatment of these diseases is determined by both creation of new drugs and development of combinations of these drugs used in clinical practice. Various approaches to etiotropic therapy of chronic viral hepatitis, the leading of which is the use of pharmacological agents, interfetrons (natural, recombinant, short-range and long-acting), are featured. Promising is the use of combination protocols of therapy, i.e. simultaneous administration of interferon and its inductor (for example, interferon and cycloferon) with the purpose to prevent remission escape. As a means of viral hepatitis therapy inhibitors of reverse transcriptase (nucleoside analogues) are used. Plasmid DNA-vaccines are of special concern. The fact that there are patients recovered from acute hepatitis C is reassuring. Understanding the mechanism of clearance can allow to tale a step towards the vaccine creation. At large, viral hepatitis therapy is a difficult task. Drug combinations are the thing of the future, which was proven by the use of such protocol in viral (HIV infection) and nonviral (tuberculosis) diseases.
Key words: viral hepatitis, pharmacotherapy, drug combination.
1 Kharkiv Medical Academy of Postgraduate Education
2 V.N. Karazin Kharkiv National University
Clinical characteristics of the course of viral hepatitis A depending on the genotype of HAV and type of immune response
75 - 80
One hundred and fifty-six patients of specialized in-patients hospitals (Kharkiv, Sumy, Donetsk, Poltava, Zakarpatia regions) were examined to investigate the frequency of HAV genotypes in various regions of Ukraine, clinical peculiarities of hepatitis A depending on the determined genotypes of the virus and production of immune response mediators. The diagnosis of hepatitis A was made using clinical, epidemiology, immunogenetic and biochemical data determining anti-HAV IgM in the blood serum with IEA and HAV RNA with polymerase chain reaction. Virus genotyping was done using restriction analysis by M. Mizokami et al (1999) modified by Central Research Institute of Epidemiology (Moscow). Two genotypes were revealed on the territory of Ukraine 1A and 3A, with 1A prevalence (75%). The patients with 3A genotype demonstrated more severe course of the disease with longer reconvalescence period when compared with the patients with 1A HAV genotype. Similar immune reactions resulting from the character of the response of main cytokine regulators was noted at different stages of the infection process. The necessity of complex examination of the patients with hepatitis A with determining the markers of active viral replication (RNA) as well as TNF-alpha, IL-4, IL-2 was proven.
Key words: hepatitis A, genotype, regulatory cytokines, immune response types.
N.I. Pirogov Russian Research Medical University, Moscow, Russian Federation
Original and generic drugs: myths and realities
81 - 88
A wide use of generics is a world-wide tendency at present. This raises important questions to the producers of reproduced drugs, in particular, if it is possible to obtain a copy of the original of high quality, if it is guaranteed that the generic will have similar to the basic drug therapeutic efficacy and safety, etc. Permission to produce generics is based on the assumption that it will be equivalent to the original by its pharmaceutical and pharmacokinetic features (absorption, distribution, metabolism and excretion of the active component). Therapeutically equivalent are the generics meeting FDA criteria, which annually publishes the lists of permitted drugs in the Orange Book. A high-quality copy of the original drug can be obtained if pharmacologically active substances making up the generic will have a simple chemical nature, its pharmacokinetics will be linear, the production standard will correspond to high quality and control (GMP), producer transparency (open access to the primary data on bioequivalence, correspondence to specifications). It is also important to compare and assess the composition and quality of adjuvants in various reproduced drugs as to their correspondence to international pharmacopeia and the composition of then original drug. This question at the Russian and European market requires further analysis.
Key words: original drug, generic, bioequivalence, therapeutic equivalence.
1Kharkiv Regional Clinical Cancer Center
2Kharkiv Medical Academy of Postgraduate Education
The capabilities of computed tomography and ultrasound diagnosis in preoperative evaluation of intramural gastric cancer invasion
89 - 92
The capabilities of x-ray computed tomography and ultrasonography in determining the stage of intramural invasion of gastric cancer are presented. Main features of intramural invasion were distinguished and systematized (various degrees of the wall thickening, impaired differentiation of its layers, complete or partial, depending on T stage). Investigation of 36 patients with different stages of gastric cancer (according to TNM) showed that transabdominal ultrasonography was more accurate and specific method vs. x-ray computed tomography in diagnosis intramural gastric cancer invasion, preferably at earlier stages of development, although it a number of cases differentiation of T3 and T4 stages was difficult. Computed tomography allowed more distinct vs. ultrasonography visualization of the anatomical structures lying outside the gastric wall. The analysis showed the advisability of complex application of methods of x-ray computed tomography and ultrasonography at pre-operative evaluation of patients with suspected cancer of the stomach.
Key words: ultrasonography, gastric cancer, computed tomography.
Kharkiv Medical Academy of Postgraduate Education
Нemodynamic patterns of acute period hemispheric ischemic stroke according to transcranial triplex scanning
93 - 96
At present ischemic stroke accounts for the majority (80%) of cases of acute cerebrovascular accidents, therefore the search for possibilities of early non-invasive diagnosis of ischemic stroke remains relevant. The purpose of our research was to develop hemodynamic patterns during acute hemispheric ischemic stroke (the first day of the disease) using transcranial triplex scanning of Willis artery. Complex Doppler ultrasonography of the brain vessels was done in 197 patients (134 with ischemic stroke and 64 with transitory ischemic attack). The following hemodynamic parameters were studied: peak systolic blood flow velocity (PSBFV), diastolic blood flow velocity (DBFV), peripheral resistance index (RI), pulsatility index (PI), time-averaged maximum flow velocity (TAMV), cerebral hemispheric asymmetry coefficient (CАs). It was noted that acute hemispheric ischemic stroke can occur with decreased, normal and elevated PSBFV on the side of the stroke. There variants of hemodynamic indices (patterns) were distinguished for these patients. Group 1 showed a significant decline in velocity indices: PSBFV -- 50.7 ±2.7 сm/s; PDBFV -- 15.8 ±1.2 cm/s; TAMV -- 26.4 ±2.7 cm/s; increased peripheral resistance: PI -- 1.39 ±0.06; RI -- 0.71 ±0.04; KAs -- 0.56-0.58. In group 2 velocity indices in the middle cerebral artery on the side of the stroke remained almost unchanged: PSBFV -- 98.8±4.1сm/s; PDBFV -- 29.0±2.4 сm/s; TAMV -- 52. 2±3.5 сm/s. Peripheral resistance indices deviated from the norm and showed increase: PI -- 1.34±0.07; RI -- 0.71±0.04; KAs was close to 1. In group 3 velocity indices and those of peripheral resistance were significantly higher than normal ones: PSBFV -- 146.4±2.9 сm/s; PDBFV -- 23.3±1.9 cm/s; TAMV -- 81.8±3.5 сm/s; PI -- 1.51±0.13; RI -- 0.84±0.04; KAs was between 1.42-1.51. Triplex scanning demonstrated significant reduction in the signal on the side of the stroke in 68 cases (76%), which was consistent with the literature data. Our findings allowed to work out hemodynamic patterns for acute hemispheric ischemic stroke in the acute phase which can be used in practical neurology.
Key words: transcranial triplex scanning, ischemic stroke, hemodynamic patterns.
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