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Dynamics of changes of the membrane-bound enzymes activity in blood of 67 patients with multiple sclerosis depending on the variety and duration of the disease was investigated. Enzymes activity was studied using enzymatic kinetic method on biochemical analyzer Screen aster lab (Hospitex Diagnostics). The analysis of indicators of enzymatic activity in multiple sclerosis in the examined patients showed a significant reduction of creatine phosphokinase level by 56.5%, increased by 38.9% level of alanine aminotransferase vs. the controls, and a tendency to reduction of the levels of aspartate aminotransferase (by 12.5%), alkaline phosphatase (by 10.6%) and increase of gamma-glutamyl transpeptidase level (by 23.9 %). Direction and intensity of enzymatic dysbalance depended on the disease variety and duration. The most expressed changes of enzyme activity were observed in patients with cerebrospinal multiple sclerosis. Increased disease duration was accompanied by progressive reduction of enzyme activity (significant reduction of levels of alkaline phosphatase by 23.2 %, creatine phosphokinase by 73.0 %, alanine aminotransferase by 26.2 % and lactate dehydrogenase by 16.3 %). The revealed enzymatic changes suggested disorders of various intracellular metabolic processes occurring in patients with multiple sclerosis. The most pronounced enzyme activity reduction was observed in patients with cerebrospinal multiple sclerosis and in patients with the disease duration over 10 years, which is a marker of the condition severity, pathological process generalization and depletion of the organism reserve capacity. Decreased level of creatine phosphokinase in patients with all varieties of the disease, regardless of the duration of multiple sclerosis, reflects the degree of reduction of metabolic and energy processes rate in the cells of muscular and nervous tissues, possibly due to increased catabolism and, as a consequence, development of movement disorders.

Atrial fibrillation is the most common type of arrhythmia in the clinical practice. It is responsible for one third of admissions for heart rhythm disorders and is associated with increased risk of death, stroke, and other thromboembolic complications. The authors review non-valve atrial fibrillation in which thromboembolic complications occur due to thrombosis of the left atrium, mainly its auricle. Antiaggregants and anticoagulants are used among the other drugs to prevent these complications. In the patients with intermediate and high risk, antiaggregants have some advantages over aspirin or aspirin/clopidogrel. Anticoagulant therapy with adjusted doses of warfarin is the most accessible strategy to prevent stroke in patients with atrial fibrillation. The search for new oral anticoagulants, which are effective, safe and easy to use, is aimed at direct thrombin inhibitors and factor Xa inhibitors (apixaban, rivaroxaban). Introduction of a new generation of anticoagulants is a step forward and can allow increase in the number of patients receiving an adequate prevention of thromboembolic complications.

Correction of arterial hypertension in patients with diabetes mellitus is as important as compensation of metabolic disorders. The majority of researchers consider hyperinsulinemia, insulin resistance, and arterial hypertension associated states. Primary functional disorders responsible for association of salt intake and increased blood pressure are located in the kidneys. Therefore, one of important factors influencing arterial hypertension therapy efficacy in patients with renal diseases is salt-sensitive character of arterial hypertension. With this purpose we analyzed the results of combination antihypertensive therapy in patients with diabetic nephropathy based on investigation of hemodynamic and metabolic parameters. As excessive salt amount is caused by decreased taste sensitivity of the tongue receptors to sodium chloride, which results in its increased in the food, daily urine excretion of electrolytes and salt sensitivity of arterial hypertension as well as their association with the indices of daily arterial pressure monitoring were determined. Therapy with Noliprel A and combination of Valsartan and Indapamide was the most effective in patients with salt-sensitive arterial hypertension. The patients who took Noliprel, normalization of circadian profile of antihypertensive therapy occurred more often.

Complicated structure of the esophgogastric junction mucosa is one of the causes of appearance of esophagus areas prone to malignant regeneration. There are several hypotheses of association of duodenogastroesophageal reflux containing acid, fatty acids, pancreatic enzymes, with development of metaplasia in the epithelium of the mucous membrane of the terminal esophagus, resembling the structure of the gastric cardia. According to one of them the epithelium of the cardia is always pathologically associated with gastroesophageal reflux disease, according to the other, this is a normal structure of the gastrointestinal tract epithelium. It is hypothesized that non-acid area in the region of the cardia is a barrier between the mucous membrane of the stomach and esophagus. Adenocarcinoma revealed endoscopically in the area of esophagogastric junction is a complex malignant tumor developed in the distal portion of the esophagus, cardia or proximal portion of the stomach. Cardial and noncardial cancers of the stomach having different etiology are distinguished. Increase of frequency of cancer of cardia and esophagogastric junction is influenced by increased acidity of the stomach. It is noted that common chronic atrophic gastritis with decreased acid formation in the stomach somewhat protects the organism from gastroesophageal reflux disease which can be an etiological factor in development of gastroesophageal junction cancer.

Increase in the incidence of nonalcoholic fatty liver disease (NAFLD), which can be a component of the diseases associated with insulin resistance (metabolic syndrome, type 2 diabetes mellitus, obesity). has been noted recently. The problems of diagnosis and treatment of NAFLD are urgent. Main tasks of treatment of the patients with NAFLD are reduction of steatosis and steatohepatitis, prevention of liver fibrosis and liver cell failure. To investigate dynamically the influence of Hepadif in complex therapy on the metabolic indices, the levels of proinflammatory cytokines and LP we investigated 40 patients with nonalcoholic steatohepatitis. In all patents the diagnosis was verified with ultrasonography and clinical laboratory methods (ALT, AST, lipid profile, TBA active metabolites, NO, TNF-α and IL-6). Positive dynamics (significant reduction of liver cytolytic enzymes activity, p<0.001, normalization of lipid metabolism levels, p<0.001) was noted against a background of the administered treatment. Investigation of cytokine profile parameters after the treatment revealed significant reduction of proinflammtory cytokines level: TNF-α (p<0.001) and Il-6 (p<0.001). The analysis of LP indices demonstrated significant reduction of TBA active metabolites (p<0.001) and nitrogen oxide (p<0.001). After the course of treatment asthenovegetative syndrome was observed in 2 (5,0%) of patients, discomfort and heaviness in the right hypochondrium in 3 (7.5%), liver enlargement in 4 (10,0%) patients. The obtained findings suggest the influence of combination treatment with L-carnitine, antihypoxants and folic acid on the pathological chains in nonalcoholic steatohepatitis development. Administration of Hepadif, Actovegin and folic acid in combination therapy improved the general condition of the patients, normalized biochemical parameters, and prevented the disease progress.

The problem of increased body weight and obesity, manifesting by generalization of gastroenterological pathology, in particular gastroesophageal reflux disease and nonalcoholic fatty liver disease, has became noninfection pandemic recently. Main factor causing obesity is energy balance disorder, therefore reduction of excessive body mass, correction of nutrition behavior, hypocaloric diet, individual exercise programs are necessary. A new molecular target (a system of endocannabioids) playing an important role in energy balance regulation was revealed when working out the drugs for excessive weight correction. The drug influencing this target is Distressa, the efficacy and sefety of which was investigated in patients with comorbid gastroenterological pathology. Administration of the drug was accompanied by appetite reduction, quick saturation but did not inhibited the central nervous system. After the three-month course of therapy with Distressa the patients demonstrated positive dynamics of the main symptoms and signs of gastroesophageal reflux disease and nonalcoholic fatty liver disease. The endocannoid dependent receptors CB1 in the composition of Dietressa drug stabilized nutritional behavior of the patients and reduced their body weight.

The problem of treatment for complicated cancer of the stomach is urgent as the majority of the patients (80%) are admitted with stage III or IV disease. The leading radical method of treatment is gastrectomy, its long-term results largely depend on the method of the gastrointestinal tract reconstruction. The authors analyze the experience of treatment of the patients with locally advanced gastric cancer in whom combined gastrectomy was followed by gastroplasty with ileocecal segment of the intestine. The results of this method were compared with those of combined gastrectomy with end loop esophagojejunoanastomosis. Gastroplasty with ileocecal segment was not accompanied by marked aggravation of the injury, time of the operation, post-operative complications. In case of invasion to the transverse colon it can be recommended as a method of choice. Gastroplasty with ileocecal segment reconstructs the upper portions of the gastrointestinal tract after combined gastrectomy with forming a reservoir containing a natural valve mechanism and allows participation in the process of digestion of the duodenum. Gastroplasty with ileocecal segment of the intestine promotes reduction of the number of long-term post-gastrectomy syndromes and improves the quality of life of the patients.

Adhesive peritoneal disease is an important question of abdominal surgery. 55-70% of the patients develop adhesions, which can cause acute ileus, after abdominal surgery. The questions of prognosis and prevention of adhesions is one of main tasks of surgery, but the criteria of risk of adhesion development are still not clear. The ultrastructure of mesothelial cells of the peritoneum was investigated using the tissue samples taken during the operation for electron microscopy. The study demonstrated the presence of dystrophic, destructive and often degenerative disorders of organelles and intercellular membrane structures. These patients also demonstrated the course of catabolic intracellular processes which are structurally proven by the presence of secondary lysosomes and lipid inclusions in the mesothelial cell cytoplasm. A large number of free ribosomes and polysomic was seen in the cytoplasm of these cells. Thus, the presence of metabolically active mesotheliocytes indicates the action of reserve intracellular repair mechanisms.

Teratogenesis is development of fetal anomaly at unfavorable influence of the environment or as a result of diseases, which leads to abortions in 60% of cases in the 1st trimester of pregnancy. And birth of children with pathology. The influence of teratogenic factors has its peculiarities: dose dependence, differences associated with metabolism, changes in the sensitivity of the fetus to the influence depending on the term of gestation. Main defects of intrauterine development are anomalies of the central nervous, cardiovascular, digestive, locomotor systems. Teratogenic factors are chemical, biological, physical components and their combinations. The most common are drugs (the WHO recommendations distinguish 5 categories of drugs by their teratogenicity), chemicals, infections, metabolic disorders and harmful habits of the pregnant. They meet the following criteria: association between the effect of the factor and formation of development defect must be proven; epidemiological factors prove this association; the effect of the damaging factor coincides with the critical development periods of the embryo and fetus; characteristic development defects are formed rarely, if the damaging factor effect is not frequent. In all cases of intrauterine defects development, consultations of a pediatric surgeon, pediatric neurologist, genetic, neonatologist, pediatrician and anesthesiologist are necessary to solve the question of management of pregnancy, delivery and possible treatment of the newborn (including surgery).

Fetal growth retardation syndrome, resulting from morphological and functional changes in the placenta, is an urgent problem of modern obstetrics. The villi of the placenta due to compensatory adaptation mechanisms can change forming of the villus tree with the purpose of stimulation of vascular growth and normalization of placenta blood flow. With the purpose of investigation of the state of fetoplacental complex at different variants of disorders in forming villous tree at fetal growth retardation syndrome, morphological examination of the placenta in pregnant as well as ultrasonography, Doppler study, cardiotomography were performed. The obtained findings after ultrasound assessment of the degree of the placenta maturity proved that this method does not allow to assess the villous tree maturity but reflects the placenta maturity in the whole. At investigation of fetal growth retardation syndrome it is necessary to pay attention to the factors determining supply of the placenta with the maternal blood, the most characteristic of them is disturbance of the blood flow in the umbilical artery. New diagnostic ultrasound signs, reflecting the state of the villous tree at fetal growth retardation syndrome should be searched for purposefully.

Reproductive health of the women is an urgent medical social problem. Due to the high incidence of cervical pathology the authors characterize the peculiarities of the clinical manifestations of cervical ectopia. It was found that patients with cervical ectopia are characterized by multiple symptoms (profuse genital discharge, genital itching, hyperemia, contact bleeding, etc.), early sexual debut, low frequency of using barrier methods of contraception, existence of 2 or more partners.They more often had various gynecological diseases: colpitis, salpingoophoritis, ovarian cysts, and every second patient with cervical ectopia had an average of 2-3 gynecological diseases simultaneously. Various somatic diseases were significantly more frequently recorded among these patients. Disorders of the gastrointestinal tract (gastritis, colitis, cholecystitis), pathology of the urinary system were registered more frequently. The results obtained studying microcirculation in patients using laser Doppler flowmetry demonstrated disturbances in the basal circulation in all patients with cervical ectopba, manifested by the decrease in microcirculation parameters. Combination of radiosurgical treatment and ozone procedures lead to the improvement in the microcirculation positively effecting subsequent process of healing as well as improving the treatment results as a whole.

Inflammatory diseases of the pelvic organs are an urgent problem of gynecology. The diseases are caused by complex microbial groups, the treatment requires antibacterial therapy. Treatment with antibiotics in women with chronic diseases of the hepatobiliary system (acalculous cholecystitis, cholangitis, hepatitis) is problematic due to unfavorable effects. Clinical efficacy of an antibacterial drug Zoxicef was investigated in the patients with acute and chronic salpyngooophoritis, pelvioperitonitis, toboovarial inflammatory tumors, and hepatobiliary system pathology. At tuboovarial inflammatory tumors the treatment efficacy is achieved by combination of medication with Zoxicef and laparoscopic surgery in the focus of the inflammation. Side effects were not observed at treatment with Zoxicef (ceftizoxime) did not produce any side effects, allergic reactions. No cases of refusal from treatment were observed. The drug was well tolerated. Three-month follow up did not register any period of exacerbation of hepatobiliary pathology including dyspeptic signs.

In patients with cervical spine injuries Doppler ultrasound is one of the most informative methods of diagnosis reveling structural functional disorders in the large vessels, vertebrobasiar basin. Hemodynamic disorders in the vertebral artery were analyzed with Doppler ultrasound in patients with traumatic deformation of the cervical spine with the aim of identifying its correlation with the nature of the initial damage, the amount of deformation and the terms of its existence. It was revealed that the most significant early criteria of hemodynamic disorders in the vertebrobasilar basin is changing of in the symmetry of maximum flow velocity and increase of resistance indexin the vertebrqal arteryat absence of the clinical signs of vertebrobasilar insufficiency. In 53.6 % of cases of Doppler ultrasound revealed hemodynamic instability in the form of the asymmetry of the maximum systolic flow velocity, clinical manifestations of vascular disorders in the vertebrobasilar basin were manifested only in 7.17% of patients with subtype DF3 and CF3, and the rest these disorders were compensated and subclinical. Negative influence of deformation of the terms of existence on increase of blood flow asymmetry in the vertebral arteries was revealed. The magnitude of angular deformity was not statistically significant for the manifestation of vascular disorders in patients with traumatic cervical spine deformation.

Degenerative diseases of the lumbar spine against a background of osteoporosis are frequently accompanied by pain, neurological disorders, disorders of the pelvic organs, changes in the locomotor function of the spine affecting the quality of life of the patients. Surgery for this pathology uses various devices for introduction of the bone cement, which have both advantages and disadvantages. The authors analyze the results of surgical treatment of the patients with various types of spine pathology (degenerative lumbar scoliosis, spondylolistesis, spinal canal stenosis, uncomplicated compression fractures of the vertebral bodies against osteoporosis and aggressive hemangiomas using a universal device for introduction of bone cement and cannulated screws produced by Vostok-N (Kharkiv). In spite of a small instrument kit, this device allows to perform two types of surgical operations: transpedicular stabilization and vertebroplasty both separately and in combination. The use of cannulated screws with bone cement in diseases of the spine against a background of osteoporosis promoted stabilizing tranpedicular constructions, prevented resorption zones development near the screws and created favorable conditions for spondylodesis. The state of the patients was assessed 3, 6, 9 months after the surgery using visual analog scale and Oswestry index of stabilization. Positive dynamics of the neurological state (regression of the pain syndrome, transitory neurological deficiency, disappearing of sensitive and reflectory disorders) was observed.

Ovarian cancer ranks third among oncogynecological diseases and is the leading cause of death among cancer patients. Combination treatment (surgery and chemotherapy) is considered to be the main method of treatment. One of the directions of its efficacy improvement is development of new regimens of chemotherapy and improvement of the techniques of chemotherapy administration. In order to increase the effectiveness of combined treatment of patients with stage III-IV ovarian cancer the results of the treatment were compared with those of the patients treated with traditional methods. Median and mean relapse-free survival were the criteria of assessment depending on the disease stage and the tumor histology. The findings of the research demonstrated that 3-4 cycles of neoadjuvant therapy promoted transition of advanced tumors to the operable ones with the increase of the volume of optimal surgery and reduction of the residual tumors. The use of this method helped to reduce the frequency of tumor recurrence and increased the period of remission in the first two years, compared with patients who received surgery at the first stage, but under the observation of up to 60 months the difference between the first and the control group disappeared.

The percentage of renal tumors equals 2 % among all malignant tumors in adults. The treatment tactics in renal cell cancer patients (60-80 % of all histology types) not long ago included only surgical treatment with further cytokine prescription. Patients with metastatic renal cell cancer make 30 % of all the patients with this pathology. This is the most complicated contingent that requires individual approach. Prescription of distant gamma therapy and polychemotherapy had no success because of tumor resistance towards those methods. The usage of interferon-2? in combination with interleukin-2 had little effectiveness with great number of side effects. Remissions with immunotherapy were observed only in 7-8 %. The effectiveness of metastatic renal cell cancer treatment enhanced greatly since introduction of targeted agents in clinical application. As the first-line therapy the patients are offered cytoreductive nephrectomy with further interferon or targeted therapy, which is more acceptable. As the first-line therapy we choose sunitinib, sorafenib or pazopanib. The second-line therapy is represented with everolimus or temsirolimus. Thus, when ineffective, one targeted agent could be changed to another, or prescribed with interferon for better effect. The choice of the drug is based on MSKCC criteria and the factors of the tumor process visualization (CT, MRI, US). Additional selection criteria for a target drug as well as treatment control are under development.

In the recent years infectious mononucleosis has been frequently diagnosed in adults. This is caused by Epstein-Barr virus of herpes virus subfamily. This virus is a lymphotropic agent causing syndromes of lymphoproliferation and immune insufficiency associated with the damage of the heart, central and peripheral nervous system, kidneys, glands. 186 patients with immune mononucleosis and diagnosed acute myocarditis were examined to study the frequency of development, peculiarities of clinical course and treatment of acute myocarditis in adults. It was established that myocarditis in this group of patients can be symptom-free, the clinical presentation can be masked by the primary infection process. Clinical, laboratory (increased lactate dehydrogenase-1, asparagin transamylase, MB creatinphosphategenase and troponin-1), electrocardiography, echocardiography, x-ray methods play a great role in the diagnosis of myocarditis in this group of patients. Within the period of active virus replication it is necessary to perform virology and laboratory investigations with the purpose to control the changes in the infection process and reverse development of complications. Medication for myocarditis in patients with infectious mononucleosis must include antiviral drugs (Acyclovir or Gancyclovir), drugs influencing inflammatory, autoimmune, allergic reactions, restoration and maintenance of hemodynamics, effect on metabolism of the myocardium, symptomatic complications therapy.

Medical professionals are susceptible to infectious diseases, namely hemocontact hepatitis, due to their professional activity. To establish clinical laboratory and diagnostic peculiarities of chronic viral hepatitis C in medical professionals we compared two age and sex matched groups of patients: 112 health professionals and 112 residents of Kharkiv aged 18-72. Verification of the diagnosis was based on detection of viral RNA, its genotypes, anti-HCVcore/NS3,4,5, and anti -HCV Ig classes G/M in the blood. Analysis of the findings shows that hepatitis C in health professional is registered in the prime of their working activities (30-60 years of age) already in the chronic stage of the disease with signs of hepatic fibrosis. This disease is predominantly registered in health professionals who are directly connected with the blood of the patients, mostly nurses. The course of chronic hepatitis C in health professionals is frequently accompanied by constant or periodic exacerbations with intoxication, cytolytic and mesenchymal inflammatory G/M syndrome, significant morphological liver damage and decrease in its functional capacity. One of the causes for late diagnosis and more severe course of chronic hepatitis C in health professionals is a careless attitude towards their health, as evidenced by their low adherence to testing. The findings of the research can promote improvement of hepatitis C diagnosis in health professionals.

The number of thalassemia carriers amounts to 80-90 million in the world. This disease is common in Azerbaijan and is diagnosed in 7-8% of the population of the lowlands. Considering that the data on the level of secretion of endogenous antimicrobial peptides at thalassemia are not numerous we compared the amount of defensin (HNP), protein increasing membrane permeability (BPI), endotoxin as well as association between biochemical indices, the amount of iron and level of secretion of antimicrobial peptides. The findings of biochemical and immunological investigation of the venous blood in children and adolescents with different forms of thalassemia were analyzed. It is concluded that 1) homozygote form of beta-thalassemia against a background of reduced phagocyte activity of leucocytes and functional state of the liver is characterized by increase secretion of defensin before splenectomy in 5 times, after it in 15 times; 2) the patients with frequent transfusions demonstrate accumulation of iron with increase in blood plasma endotoxin concentration against this background; 3) frequent infectious complications result in increase in BPI secretion; 4) increased level of endogenous peptides is a marker of infection process development and reflects the dynamics of changes of the biochemical parameters and immune status of the organism.

The problem of artificial reproduction methods is urgent for Russia as the number of infertile couples exceeds 15%, which is critical of the demographic situation in the country. The effectiveness of IVF was assessed as the ratio of successful attempts to the total number of attempts. Strictly coordinated hormonal control of the functions of immune-competent cells is vital for successful implantation. The process of the embryo implantation depends adequate work of female sex hormones (estradiol and progesterone), at that receptivity is more important than their absolute amount. Estradiol increases synthesis of the proper receptors as well as progesterone, androgen receptors, while progesterone inhibits. An important role in prevention of abortions and pregnancy maintenance at the early stages is played by influence of progesterone on the receptors, therefore this hormone is administered with a preventive purpose. The findings of the clinical trial are controversial therefore it is important to determine practicability and efficacy of hormonal therapy to prepare the patients to in vitro fertilization.