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№1' 2016


Kuban State Medical University, Ministry of Health of RF, Krasnodar, Russian Federation
European Clinical Practice Guidelines for Cardiology 2015
5 - 10
The review presents the main provisions of 5 clinical practice guidelines of the European Society of Cardiology published in 2015. The focus is on the changes introduced in the new version of the guidelines. For example, in acute coronary syndromes in patients without persistent ST−segment elevation main changes relate to the diagnosis, heart rate monitoring, risk stratification and treatment strategies. New criteria for risk stratification in these patients, which allow choosing treatment and timing of invasive intervention, were defined. It is recommended to switch from the use of femoral approach at coronary angiography and percutaneous coronary intervention to radial approach. Patients with ventricular arrhythmias are recommended apparatus therapies including implantable and wearable cardioverter defibrillators, subcutaneous defibrillators to prevent sudden cardiac death. Diagnostic criteria and recommendations for treatment of hereditary primary arrhythmic syndromes were updated. The recommendations for diagnosis and treatment of pericardium diseases contain etiologic classification, according to which they are divided into infectious and non−infectious. The main causes of pericardial diseases are viruses and bacteria (most commonly Mycobacterium tuberculosis). In−patient treatment of acute and recurrent pericarditis in high−risk patients should be administered. The recommendations on diagnosis and treatment of pulmonary hypertension propose clinical classification, which includes the new state, the newly identified gene mutations and several other changes. The guidelines for treatment of infective endocarditis emphasize the key role of general prevention, not only antibiotic one. Early surgical intervention for treatment of this disease is approved. The new European guidelines summarize all contemporary scientific data on these topics and are a valuable educational resource for practitioners.
Key words: clinical practice guidelines, acute coronary syndrome, sudden cardiac death, pericarditis, pulmonary hypertension, infectious endocarditis.
Penza State University, Russian Federation|N. N. Burdenko Penza Region Clinical Hospital, Russian Federation
Silent myocardium ischemia: contemporary view on the problem
11 - 16
This review presents the updated understanding of the pathophysiology of silent myocardial ischemia, modern methods of its diagnosis, prognosis both in patients with stable angina and with exacerbations of coronary artery disease. Silent myocardial ischemia may be due to a defect in perception and transmission of the pain impulse (nociceptive system), increase in antinociceptive system activity, or both mechanisms simultaneously. The disease may also be caused by suppression or impaired perception of pain impulses at the thalamus level. The questions of diagnosis, clinical and prognostic significance of silent myocardial ischemia in selected groups of patients (patients with diabetes, those with the history myocardial infarction, left ventricular hypertrophy, syringomyelia, and patients taking certain medications such as cytotoxic agents, antiviral, antibacterial, in which this pathological condition develops due to autonomic neuropathy and blocked stimuli transmission at nerve fibers). Particular attention is paid to this issue in acute coronary syndrome, its possible causes and modern detection methods (intracardiac monitoring, spiral computed tomography, myocardial scan) are discussed. However, in the majority of health facilities the most common method of diagnosis of transient ischemia is various modifications of monitoring ECG and stress tests. The need for 12−lead ECG telemonitoring in the intensive care unit in patients with acute coronary syndrome for the surgical correction of the tactics of their management and treatment is emphasized.
Key words: silent myocardial ischemia, acute coronary syndrome, ECG telemetry.
Kharkiv National Medical University, Ukraine
Diagnostic approaches to gluсometabolic categories verification: views evolution
17 - 20
According to the International Diabetes Federation, in 2011 about 52 million of Europeans aged 20−79 had diabetes, and by 2030 it forecasts the growth to 64 million. In addition to these statistical data of diabetes prevalence, in 2011 the experts found impaired glucose tolerance (IGT) in 63 million Europeans. Given the almost comparable epidemiological data on the prevalence of both diabetes and IGT, the subject of intense scientific discussion is diagnostic and prognostic approach to identifying violations of carbohydrate metabolism prior to the development and clinical manifestation of type 2 diabetes. Based on clinical studies, fasting hyperglycemia > 7.0 mmol/l and plasma glucose level after 2 hrs. of glucose tolerance test (OGTT) > 11.1 mmol/l are considered pre−clinical manifestations of diabetes. These disorders can be termed «prediabetes» to focus on the clinical sense of the state, and emphasize the high risk of developing diabetes in the future. The importance of prediabetes is defined by the fact that it is not only a predictor of diabetes, but also a predictor of cardiovascular and cerebrovascular disease. This group of patients with prediabetes should be a major contingent for preventing both type 2 diabetes and the risk of cardiovascular and cerebrovascular diseases. Classically diagnosis of diabetes is based on determining plasma fasting glucose or 2 hrs. after OGTT. It should be noted that a significant disadvantage of determining glucose to diagnose diabetes is the high variability of this parameter depending on the diet, particularly relevant for determining the level of glucose. In 2009 the International Expert Committee, comprising representatives of the American Diabetes Association (ADA), the International Diabetes Federation (IDF) and the European Association for the Study of Diabetes (EASD), recommended the use of the most objective test for type 2 diabetes mellitus diagnosis to determine the level of glycosylated hemoglobin (HbA1c) with its growth ? 6.5 %. Epidemiological data indicate relationship between elevated HbA1c, fasting and post OGTT hyperglycemia and development of diabetic retinopathy. However, determining HbA1c has several advantages, namely, it is independent of the power supply and does not require fasting; it is a reflection of carbohydrate homeostasis in the recent 6−8 weeks. HbA1c is most objective parameter, since it does not affect the level of short−term limitations and errors in diet. At the same time normal level HbA1c not exclude the diagnosis of diabetes and impaired carbohydrate tolerance.
Key words: prediabetes, diabetes, diagnostic criteria, plasma glucose, glucose tolerance disorders, glyco-sylated hemoglobin.
Kharkiv National Medical University, Ukraine
Structural and functional state of the myocardium in patients with hypertension and chronic obstructive pulmonary disease
21 - 26
The left ventricle (LV) is one of the main target organs of hypertension. echocardiography plays a prognostic role in this case. Assessment of LV hypertrophy and LV systolic and diastolic function is based on measurement of LV mass, geometry, and function. The value of echocardiography as a research tool in cardiology is uncontested. Quantification of cardiac chamber size and function is the corner stone of cardiac imaging. Echocardiography has a unique ability to provide noninvasive real−time images of the beating heart. Morbidity and mortality in patients with chronic obstructive pulmonary disease (COPD) is associated with cardiovascular diseases and often complicated by right−sided heart failure. However, RV assessment can be challenging. Doppler echocardiography cannot measure hemodynamic parameters but only provide an estimate of them. Therefore, the main limitation of this study is the lack of true hemodynamic data. Doppler echocardiography allows measurement of pulmonary artery systolic pressure, this modality is often problematic in patients with COPD because of lung hyperinflation and difficulty in obtaining clear acoustic windows. Although transthoracic echocardiography is an excellent noninvasive screening test for chronic heart failure (CHF), a high clinical index of suspicion is necessary to detect the disease before irreversible pathophysiologic changes occur. Despite multiple studies, many issues of the LV and RV structure and function remain open. In conclusion, noninvasive assessment of LV and RV systolic and diastolic function by strain and strain rate independently predicts future heart failure. New ultrasound technologies such as speckle−strain may play an important role in predicting prognosis and detecting preclinical stages of disease in CHF.
Key words: echocardiography, hypertension, chronic obstructive pulmonary disease.
Kharkiv National Medical University, Ukraine
The use of alpha−lipoic acid in patients with chronic acalculous cholecystitis in combination with coronary artery disease
27 - 29
Increase in the level of GSH and cytosolic enzymes (MPO and GT) in plasma is observed in CAC in combination with coronary artery disease as a result of oxidative stress contributing to increased permeability of plasma membranes and cytolysis of hepatocytes. The study of glutathione system in the examined patients before treatment demonstrated an increase in the concentration of GSH in plasma (0.016±0.01 mmol/g and 0.03±0.02 mg/g; p < 0.05), levels of GR (0.39±0.05 ?mol/min per mg of protein to 0.45±0.03 µmol/min per mg of protein; p < 0.05), MPO (0.98±0.03 µmol/min per mg of protein to 1.59±0.02 µmol/min per mg of protein; p < 0.05) and GT (p < 0.05). The increase in the content of GR in erythrocytes may be due to not only activation of the enzyme by oxidative stress induced by inflammation and its absorption to the precursors of erythrocytes. The GT level in erythrocytes in patients of both groups before the treatment was reduced compared to the controls (5.57 to 3.76; p < 0.01). Treatment with additional application of Espa−lipon in patients of the main group decreased the concentration of GSH in plasma (0.018 mmol/l; p < 0.05) and increased G (p < 0.01), indicating stabilization of hepatocyte membranes. In the comparison group, receiving conventional treatment, significant differences in glutathione system in erythrocytes and plasma was observed (p > 0.5). Administration of Espa−lipon in patients with chronic acalculous cholecystitis in combination with coronary artery disease contributes to decrease in activity of lipid peroxidation and increased activity of antioxidative protection system.
Key words: chronic acalculous cholecystitis, coronary artery disease, Espa-lipon.
V. T. Zaytsev Institute of General and Emergency Surgery, Ukraine|National Academy of Medical Science of Ukraine, Ukraine
Minimally invasive techniques in surgical treatment for varicose veins of lower extremities
30 - 34
Despite significant advances made in treatment of varicose veins of the lower extremities and chronic venous insufficiency, a problem of diagnosis and treatment of this disease is important. This is due to the high prevalence and high rate of relapse, increasing its frequency and the presence of complicated forms of the disease, leading to long−term disability. In addition, varicose disease is characterized by a decrease in the quality of life of patients resulting from cosmetic and functional changes. Various forms of the disease occur in 26−38 % of women and 10−20 % of men of working age. Its annual growth in industrialized countries is 2.6 % among women and 1.9 % among men. At present a promising methods of treatment of varicose veins is compression sclerotherapy. In recent years, «foam−form» sclerotherapy has become the main method of vein sclerosis, i.e. sclerosis using the foamed drug. The information about it appeared in English literature at the beginning of the century. Its undeniable advantage is its close contact with the walls of the veins sclerotherapy with displacement from the latter the blood injected with the foam. Minimally invasive and high efficiency techniques have allowed many phlebologists to put it to the forefront of treatment of varicose veins. However, development of international criteria for application of «foam−form» sclerotherapy contributes to its highly efficient use in certain ways and at certain stages of development of varicose veins. Not all patients can be carried out stripping of the varices. Elderly patients or those with concomitant diseases such as diabetes, obesity, the history of deep−vein thrombosis, the presence of venous ulcers are indicated an alternative method. The indications for «foam−form» techniques were determined by the recent consensus on sclerotherapy, and can be recommended for widespread use in treatment of varicose veins. Today is a full sclerotherapy treatment of varicose veins. Though surgical correction of hemodynamics at certain stages of chronic venous insufficiency of the lower limbs is the main method, this technique can be used in the complex of measures at various manifestations of this disease.
Key words: varicose veins, sclerotherapy, ultrasound duplex scanning.
V. T. Zaytsev Institute of General and Emergency Surgery, Ukraine
Surgical treatment of pelvic tumors with invasion of the vascular formations
35 - 37
The purpose of the work was to assess the effectiveness of combined extensive operations in locally advanced cancers of pelvis organs. The results of surgical treatment of 21 patients (9 men, 12 women), aged 44−69 with locally advanced malignant tumors of the small pelvis treated at V. T. Zaytsev Institute of General and Emergency Surgery, National Academy of Medical Science of Ukraine were analyzed. Sixteen cases (76.2 %) had colon cancer with invasion to adjacent organs (the posterior wall of the bladder −− 5 cases, the uterus −− 4 cases, and in the prostate and vagina −− 4 cases, ureters −− cases), 3 cases (14.3 %) had multiple primary malignant tumors (in combination with bladder cancer in two cases, in combination with endometrial cancer in 1 case), 2 cases (9.5 %) had sarcoma of the pelvis. To clarify the diagnosis, the following methods were used: ultrasound, multislice computed tomography, MRI, pelvic videocolonoscopy, cystoscopy, angiography, histologic and clinical tests. All patients were performed advanced surgery for absolute indications. Postoperatively standard therapy was administered: antibiotic prevention, correction of fluid and electrolyte content and protein metabolism (infusion−transfusion therapy), anticoagulant therapy, pain relief. Postoperative surgical complications occurred in 7 cases (33.3 %), which required reoperation in 4 cases (19.0 %). Overall and disease−free 2−year survival rate in cases of tumor spread to adjacent organs was 75 % and 56.3 %, respectively; in cases of multiple primary tumors at time of observation > 24 months relapses and deaths were not observed; in the case of extraorgan sarcomas local recurrences occurred within 1 year, with the mortality rate of disease progression at 6 and 15 months after the operation. Active surgical tactics aimed at curative treatment, allows even at the tumor invasion to the great vessels, to prevent further progression of the disease, thus, extend the life of patients. Treating common pelvic tumors requires major surgery with multidisciplinary team of surgeons. Despite the trauma, interventions with adequate provision of the perioperative period give satisfactory results. Long−term results allow considering these operations a method of choice for locally advanced pelvic tumors. Further study of the long−term results of surgical treatment will allow understanding the possibility of cure in these patients.
Key words: small pelvis tumors, vessels, surgical treatment.
Russian Research Institute of Reindeer Antlers, Barnaul, Russian Federation
Altai State Medical University, Barnaul, Russian Federation
Dynamics of reparative processes in planar skin wounds at local application of ointments based on a concentrate of canned antlers
38 - 41
Wound healing is one of the most ancient, but not aging problems of practical medicine. In recent years, pharmacological agents of animal origin, which are active biological stimulants, have been increasingly applied in clinical practice. The aim of the work was to study the wound healing activity of ointments on the basis of a concentrate of canned deer antlers. To accomplish the objectives an experiment in rabbits was carried out. Each animal was inflicted a planar wound to the skin. Fifteen rabbits were divided into 3 groups depending on the method of local treatment: the controls healed in a natural way; groups 1 and 2 were applied daily ointment made of a concentrate of canned antlers. The effect of drugs on wound healing was assessed using planimetry method with the wound area and percentage of area reduction of the wound surface per day. Statistical processing was performed using Statistica 7.0 software. Two independent groups were compared using Mann−Whitney U−test, three or more using rank analysis of variance with Kruskal−Wallis test followed by pairwise comparisons of groups Mann−Whitney test with Bonferroni correction when assessing the value of p. In the course of the following results: the rate of wound healing in experimental animals is 1.5 times higher than the rate of healing of wounds of the control group. Complete healing of wounds in the first experimental group occurred on average at day 21 in the second experimental group −− 23 e. Complete healing of wounds in the control group, the topical treatment of wounds which are not carried out, came only a 26 day. The following results were obtained: 1) according to the pilot study the ointment has a wound−healing effect, which is evidenced by the dynamics of indicators of wound healing (higher rate of wound area reduction and shortening of wound epithelialization by 3−5 days in the experimental groups; more rapid rejection of scab in the experimental groups of animals); 2) these findings can be used for further study of the possibility of using the concentrate from deer antlers as part of formulations for topical application at treatment of wounds of different origin in humans.
Key words: wound, regeneration, concentrate of canned antlers.
Kharkiv Regional Clinical Perinatal Center, Ukraine
Effects of infectious factors and citokines on perinatal morbidity and mortality in preterm infants
42 - 48
Pregnancy in women with infectious pathology develops in specific environment and has a large number of perinatal complications, reduction of which is an urgent obstetric problem. Appearance of new diagnostic capabilities allows to study the etiological factors in detail and provides a new approach to definition of the pathogenetic mechanisms of perinatal complications, especially in the premature newborns and preterm rupture of the membranes. The aim of the work was to develop pathogenetic methods of treatment and prevention of infectious lesions in the fetus and premature newborns. It was found that perinatal complications, which are usually caused by infectious, immunological disorders, formation of endothelial dysfunction. The complex of measures aimed at optimizing the management of pregnancy, which can improve the course of the gestation period, reduce the number of perinatal complications for both the mother and the newborn, by normalizing the disturbed parts of the regulatory mechanisms, endothelial system and immunological homeostasis, which is achieved by carrying out ozone therapy and immune correction, was suggested.
Key words: perinatal pathology, premature birth, immunotherapy, medical ozone.
Kharkiv National Medical University, Ukraine
The condition of immune factors and cytokines at placental insufficiency
48 - 51
The immune system plays a major role in maintaining normal biological relationship between the mother and fetus. The aim of the study was to examine the state of immunological factors and cytokines in pregnant women with placenta insufficiency (PIN). The study involved 162 pregnant women in the period of gestation 17−38 weeks, who were divided into 3 groups: group 1 −− 62 pregnant women with PIN against a background of extragenital pathology, group 2 −− 65 pregnant women with PIN against a background of obstetric pathology, group 3, control group −− 35 healthy women with uncomplicated gestational period. Autoantibodies to tissue factor, the content of immunoglobulins G, M and A in maternal and umbilical cord blood and the concentration of cytokines were determined. The study revealed that PIN disturbed the single integrated cellular−humoral system of protection, including immunity, hemostasis and nonspecific resistance of the mother and fetus. PIN is characterized by a fivefold increase in antibody production compared to the controls: blood concentration of IgM, IL−8, the indicators of mean cytochemical coefficient (MCC), increased concentration of IL−1? and TNF?. High levels of IL−1 ? in the cord blood at PIN reflect the degree of increased antigenic load, which leads to increased permeability of the blood brain barrier and may play a role in the pathogenesis of perinatal involvement of the central nervous system of the newborn.
Key words: placental insufficiency, cytokines, antibodies.
Kharkiv Medical Academy of Postgraduate Education, Ukraine
The characteristics of postoperative adhesion formation in patients with tubal pregnancy
51 - 55
The frequency of abdominal pregnancy in Europe amounts to 1 % of all pregnancies, and in Ukraine it amounts to 15.4 per 1,000 pregnancies. The ratio of uterine and ectopic pregnancies is 1: 100. 25−47 % of all patients admitted to the hospital are patients with tubal pregnancy. The main etiological factors of ectopic pregnancy are structural changes in the fallopian tubes (sexually transmitted genital infections, tubal sterilization, operations on the fallopian tubes including surgical treatment of tubal pregnancy); hormonal (IVF, ovulation induction, delay of ovulation, hormonal contraceptives), intrauterine contraceptives; other factors (hypoplasia of the corpus luteum, endometriosis, congenital anomalies of the uterus, cross−migration of ovule, oxidative stress). Etiological factors of the adhesion formation which patients with tubal pregnancy suffer from in the postoperative period consist of the urgency of surgery, the presence of blood in the abdominal cavity, the use of carboxyperitoneum during laparoscopic surgery, mechanical, chemical, physical, infectious effect on the peritoneum. The traumatic effects caused by the above factors lead to peritoneum ischemia resulting in deterioration of the local fibrinolytic activity of the tissue (inhibition of fibrinolysis by inhibitors of plasminogen activator PAI1, PAI2, which are formed as a result of a surgical trauma), followed by an inflammatory reaction and endothelial dysfunction. During re−laparoscopy 94−100 % of patients have adhesion formation after laparotomy surgeries and 81 % of patients after laparoscopic surgeries, which leads to repeated tubal pregnancy that have 7−27 % of patients. Application of Ringer's lactate, seprafilm, adept, mesogel, SprayGel, sodium hyaluronate, SURGIFLO matrix for prevention of adhesion formation intraoperatively and Distreptaza in the early postoperative period without affecting all parts of the pathogenesis does not provide 100 % anti−commissural effect but reduces the frequency of development of postoperative adhesions in 31.3 % −− 40 % of cases and restores reproductive function in 51−67.5 % of patients, due to which reproductive function of 32.5−49 % of patients can be restored using TAA, which efficiency does not exceed 30 %. The research of new approaches to the prevention of adhesion which have patients with tubal pregnancy in the postoperative period should include the use of minimally invasive methods of surgical treatment and modern anti−commissural medicines with antioxidant effect, which will help to reduce adhesion development, to enhance the demographic measures in Ukraine and the quality of life of patients.
Key words: tubal pregnancy, pathogenesis of postoperative adhesions, anticommissural remedies.
Ulianovsk State University, Russian Federation
Recurrent pulmonary edema in patients with renal artery stenosis (Pickering syndrome)
56 - 60
Renovascular hypertension due to atherosclerotic renal artery stenosis (ARAS) is one of the most common forms of secondary hypertension. Every five patients with renovascular hypertension have bilateral renal artery stenosis. Development of pulmonary edema in patients with bilateral renal artery stenosis is the most dangerous complication. The aim of this study was to review the literature which discusses the pathogenesis, diagnosis and treatment of patients with ARAS and Pickering syndrome over the recent 20 years. T. G. Pickering et al. (1988) described development of pulmonary edema in patients with bilateral renal artery stenosis. The development of pulmonary edema in patients with ARAS depends on the degree of hypertension and renal function. The pathogenesis of pulmonary edema in patients with ARAS has not been studied, and includes three basic mechanisms: impaired sodium excretion, development of diastolic dysfunction and impaired pulmonary alveolar−capillary barrier. Clinical features of Pickering syndrome is a rapidly increasing shortness of breath, passing in gasps. Duplex scanning with color Doppler mapping of the renal arteries is the screening test for detection of renal artery stenosis, renal angiography is a «gold standard». The first place of treatment of renovascular hypertension is occupied by an optimal drug therapy; recurrent pulmonary edema in patients with hemodynamically significant renal artery stenosis is indication for renal artery stenting. The question of renal artery stenting in patients with resistant hypertension and rapid decrease of kidney function is being discussed.
Key words: pulmonary edema, renovascular hypertension, Pickering syndrome, renal artery stenosis.
Kharkiv National Medical University, Ukraine
The experience of complex treatment for pain syndrome against a background of dysphagia
61 - 67
Pain syndrome is present in numerous cases in neurology and maxillofacial surgery. One of the universal kinds of medication, relating to the group of symptom−modifying drugs that treat pain syndrome, are nonsteroid anti−inflammatory drugs in various doses. However, the patients with acute impairments and chronic dysfunctions of brain blood circulation often acquire bulbar and pseudobulbar dysfunction, characterized by development of dysphagia, various inflammatory infectious processes, traumas requiring immobilization and resulting in pain syndrome in the maxillofacial area, which makes the operation of muscles involved in chewing and swallowing more difficult. A powerful drug with anti−inflammatory, analgesic, and antipyretic effects is meloxicam in the form of orally disintegrating tablets (Movixicam® ODT), which dissolve in the patient's mouth and do not require active involvement of the muscles. The research showed high efficiency of Movixicam® ODT while treating patients with pain syndrome of varying etiology caused by dysphagia. Positive therapeutic effects of varying degrees could be observed in 98 per cent of cases, which meant a considerable decrease in the intensity of pain syndrome, which meant a higher degree of the freedom of movement of the patients' muscles. The convenience of applying the orally disintegrating form of meloxicam widens its range of application and allows its administration even in the cases of dysphagia.
Key words: pain syndrome, dysphagia, Movixicam(r) ODT.
Kharkiv National Medical University, Ukraine
Heritary polyneuropathy as a factor of statokinetic disorders in early−age children
68 - 72
Pathology of the peripheral nervous system is quite frequent in the structure of pathology early childhood, affecting child statokinetic state, however not always promptly diagnosed, adequately assessed and taken into account while adminestering therapy and rehabilitation of children. The most frequent form of peripheral nervous system lesions in all age groups is polyneuropathy, which at the present stage is treated as a disease of the whole organism caused by the pathological process at the level of the peripheral nerves. Genetic heterogeneity of hereditary motor sensory polyneuropathies was determined. The form with autosomal dominant, autosomal recessive, and X−recessive concatenated inheritance types was described. Every group of hereditary motor sensory polyneuropathies is characterized by the triad of main clinical symptoms: atrophy of distal sections of the hands and feet with their deformation, disorders of sensation in the area of the atrophied muscles, Hypo− or areflexia of upper and lower limb muscles. On the basis of electrophysiological data hereditary motor−sensory polyneuropathy are divided into two basic types: demyelinating (type 1) and axonal (type 2). Type 1 motor−sensory neuropathy is characterized by reduced impulse conduction velocity in the peripheral nerves, more pronounced in small and tibial nerves (on the feet), less in the median and ulnar nerves (in the arms). Type 2 disease is characterized by slightly reduced or normal values of impulse conduction velocity (more than 45 MPs to the median nerve). In early childhood the most common hereditary motor−sensory polyneuropathy types are 1, 2, and 3.
Key words: hereditary motor-sensory polyneuropathy, statokinetic disorders, demyelination, axonal damage.
Kharkiv Medical academy of Postgraduate Education, Ukraine
Medico−psychological management of persons with acute disorders of mental state and behavior
73 - 80
The article presents modern variants of medical and psychological help to persons with acute mental and behavior disorders. The purpose of the work was to feature the clinical presentation of acute mental and behavior disorders, which result from the influence of extraordinary situation (ЕS), during or directly after it. The psychotherapy techniques of medical and psychological management are also described. Mental and behavioral disorders in the conditions of ES have a lot in common with clinical disorders which develop in ordinary terms. However there are also substantial differences. In the conditions of ES mental disorders develop simultaneously in a big group of people. The clinical presentation in these cases is typical ranging from the state of maladjustment and neurotic reactions to the reactive psychoses. Mental and behavioral disorders can be divided into 4 groups: non−pathological (physiological) reactions, pathological reactions, neurotic and reactive psychotic states. In a remote period mental disorders develop as a posttraumatic stress disorders (PTSD) −− F 43.1 or chronic personality changes due to a catastrophe (F 62.0). Urgent medical and psychological service execute the followings basic functions: rapid medical and psychological and (if necessity) first medical aid to the population; connections and co−operation with specialized psychological and psychiatric services. urgent medical and psychological aid at ES is rendered as of crisis interventions.
Key words: urgent medical-psychological care, psychotherapy, stress reaction, neurotic states, psychotic states.
Kharkiv Medical Academy of Postgraduate Education, Ukraine|N. E. Zhukovsky National Aerodynamic University, Ukraine
Local hypothermia in treatment of vasomotor rhinitis
81 - 86
Modern standard of conservative therapy for vasomotor rhinitis provides successful treatment in 30−40 % of cases. The effectiveness of conservative therapy increases at its combined use with the methods of physical therapy. Management of local hypothermia provides complex effect on the cooled tissues, i.e. analgesic, spasmolytic, anti−inflammatory and reparative−regenerative, providing suppression of vasomotor reactions underlying vasomotor rhinitis. To improve the results in treatment of vasomotor rhinitis, combined method of standard conservative therapy and local hypothermia method of the nasal cavity was used. The results of treatment of 62 patients with vasomotor rhinitis were studied in the comparative aspect. The comparison group consisted of 30 patients with vasomotor rhinitis, in whom conservative therapy included nasal steroids and antihistamines according to the protocol. The main group consisted of 32 patients in whom similar conservative therapy was supplemented by local hypothermia of the nasal cavity. The original device, equipped with automatic regulation of the temperature, which fully controls the process of entering the preset cooling mode, strictly maintaining this temperature level during the entire period of operation, was used for local hypothermia. The main criterion for evaluating the results of treatment was the degree of improvement in nasal breathing function by the method of active rhinomanometry. The investigation showed that immediately after the treatment the function of nasal breathing in the majority patients with vasomotor rhinitis was significantly improved, but the degree of improvement was more pronounced in patients from the main group: the level of the index of summary flow significantly increased in patients from the comparison group to 64 %, in patients from the main group − 86 % and the rate of total resistance decreased by 57 % and 65 %, respectively, although the patients subjectively evaluated this improvement in a relatively lesser extent.
Key words: local hypothermia device, vasomotor rhinitis, nasal breathing, anterior rhinomanometry.
Institute of Medicobiological Problems, PFUR, Moscow, Russian Federation,|MedFarmOtkrytie LTD, Moscow, Russian Federation, N. I. Pirogov Russian National Research Medical University, Moscow, Russian Federation
Pharmacogenomics of antiretroviral drugs, genetic therapy against HIV infection and genome edition
87 - 97
The use of highly active antiretroviral therapy has transformed HIV infection into a chronic controlled, although incurable disease. This continuous life−long and expensive therapy is associated with long−term side effects and emergence of resistant strains of the virus. Three drugs are commonly prescribed: two nucleoside reverse transcriptase inhibitors in combination with a protease inhibitor drug or a drug with a non−nucleoside reverse transcriptase inhibitor. Such schemes can effectively suppress the virus, but there are some drawbacks. Two ways of using antiretroviral drugs pharmacogenomics were investigated to optimize the treatment of HIV infection. Anti−HIV agents based on any type of RNA (ribozyme, antisense RNA, RNA aptamers, RNA decoys, small interfering RNA) and protein agents −− RevM10, intracellular antibodies and intrakines were described. Recombinant protein inhibitors can be expressed using the retroviral or lentiviral vectors providing a convenient target for development of drugs based on gene therapy, which allows entrance of transgenes expressing anti−HIV agents in the cells of the patient affecting the life cycle of the virus. Gene therapy for HIV infection has attracted many scientists, pharmacists and pharmacologists, as the potential to provide effective treatment and even cure of this disease.
Key words: phramocogenomics, anti-HIV agents, genetic therapy, HIV infections.
Kharkiv Region Clinical Oncology Center, Ukraine
The capabilities of computed tomography and ultrasonography in diagnosis of pancreatic invasion in gastric cancer
98 - 100
Capabilities of ultrasonography and computed tomography in evaluation of tumor pancrease invasion by gastric cancer were investigated. The main x−ray tomography and ultrasound signs of pancreas invasion were distinguished and systematized. Main CT symptoms of gastric cancer invasion to the pancreas are: absence of parapancreatic fiber between the posterior wall of the stomach and the pancreas, irregular boundary between the tumor tissue of the stomach and pancreas. The main ultrasonic symptoms of stomach cancer with invasion of the pancreas are concave contour of the gland in the area of stomach tumor ingrowth, rough boundary between the gland and the affected wall of the stomach, absence of stomach displacement relatively the pancreas. The analysis showed the feasibility of transabdominal ultrasound examination of the stomach and spiral computed tomography in the diagnosis of pancreatic invasion by gastric cancer.
Key words: cancer of the stomach, computed tomography, ultrasonography, prevalence, pancreas.
City Children's Hospital No. 12, Kharkiv, Ukraine
The capabilities of radiodisgnosis in cervical osteochondrosis in adolescents
100 - 104
The paper presents the pathogenetic mechanisms of degenerative disc disease of the cervical spine in adolescence. A comparative assessment of X−rays, magnetic resonance imaging and ultrasound imaging in visualization of the structures, intervertebral disk protrusion and herniation of various localization, spinal canal stenosis was done. It was found that decrease in the height of X−ray disc hernia was observed in all and protrusion in 23 (65.7 %) cases, central spinal canal stenosis in 7 (43.8 %) and in 17 (48.6 %) cases, respectively. MRI changes within the disk were detected in 24 (68.6 %) and hernia in 15 (93.4 %) cases, respectively. Stenosis SC was diagnosed by MRI in 15 (93.4 %) cases of hernia and in 31 (88.6 %) of protrusion. Ultrasonography detected the changes within the disk in the form of increased echogenicity, heterogeneity of the disc in all cases. The incidence of stenosis of the central SC revealed by US coincided with the results of MRI. Protrusion of IVD was median in 16 (45.7 %) cases, paramedian in 12 (34.3 %) circular in 4 (11.4 %), and posterolateral in 3 (8.6 %) cases. Hernia of IVD was median in 7 (43.8 %) cases, paramedian in 6 (37.5 %), circular in 2 (12.5 %), and posterolateral in 1 (6.2 %) case.
Key words: cervical osteochondrosis, adolescents, intervertebral discs, radiodiagnosis.
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