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The investigation was performed to evaluate the peculiarities of the dynamics of peripheral and central hemodynamic parameters in patients with arterial hypertension and obesity under the influence of antihypertensive therapy, depending on the presence of bariatric treatment of morbid obesity. The study included 56 patients with obesity and uncontrolled arterial hypertension (main group (36 individuals) with medications for arterial hypertension + surgical treatment for obesity; the control group (20 individuals) made only the patients with medication for arterial hypertension). The study design consisted of 4 stages. The value of the body mass index in main group was 47.30 (42.90; 56.10) kg/m2, in the control it did 33.80 (31.40; 36.80) kg/m2 and was reliably lower than in the main one (p < 0.05). The office peripheral and central systolic blood pressure, diastolic blood pressure, pulse arterial pressure and amplification blood pressure were measured with oscillometric arteriography using the Arteriograph device (Tensiomed, Hungary). The dynamics of changes in peripheral and central hemodynamic parameters in the patients with arterial hypertension and morbid obesity under the influence of prolonged antihypertensive therapy depending on the performed bariatric surgery has been studied. The peculiarities of the influence of bariatric treatment of obesity on the course of arterial hypertension and the level of peripheral and central arterial pressure have been determined. At the end of the 6−month follow−up period, all the patients achieved the target counts of "office" peripheral and central systolic as well as diastolic blood pressure. Only in the patients of main group we managed to normalize the level of peripheral pulse blood pressure. At the same time, immediately after bariatric surgery, in 6 months, the level of brachial systolic blood pressure and central diastolic blood pressure in the main group was significantly lower than that in the comparison group.

Considering that the majority of those suffering from an increased body mass index with traumatic injuries at the moment of admission to the hospital have a concomitant pathology, it is very important to study the readiness of such patients for a stressful release of systemic inflammatory response markers. By means of system multivariate analysis, as a result of studying the dynamics of seven leading indices (adiponectin, leptin, resistin, interleukin−6 and 8, tumor necrosis factor alpha−2, C−reactive protein), the functional state of markers of the systemic inflammatory response as the products of secretory function of adipose tissue, which were calculated on the basis of 1,344 assay sheets in 224 patients with an increased body mass index during polytrauma, that characterized this functional system in the intervals from one day to one year from the time of damages, the integral indices were determined and mathematical model of the state of fatty tissue biomarkers activity was developed. Mathematical modeling allowed the revealing of an expressed deviation of the integral index compared with the control both at the early period and in the long term, i.e. one year after polytrauma getting for all the patients examined. The leading role of disorders in the system of fatty tissue biomarkers in the pathogenesis of trauma diseases in the patients with an increased body mass index with traumatic injuries was emphasized, which is a prerequisite for prescribing the appropriate therapies.

The first experience of using the Rotarex endovascular device (Straub Medical AG, Switherland) for percutaneous mechanical thrombectomy in patients with acute lower limb ischemia, resulted from the thrombosis and embolism of the infraingual arteries, is presented. All the interventions on lower limb revascularization with an acute ischemia using this device proved to be technically and clinically successful. All the patients managed to achieve rechanneling of occluded segments and restoration of antegrade blood flow down the lower arterial segments to the foot. After rechanneling of the occluded arteries, in the majority of patients in arterial lumen there were pronounced stenosis lesions caused by residual thrombi and hemodynamically significant stenoses, therefore, they were additionally performed with balloon angioplasty or stenting. This allowed eliminating the residual stenosis and reaching the main blood flow of the foot. Thus, percutaneous mechanical thrombectomy with the help of the thrombectomy system Rotarex is an effective method of treating acute ischemia of lower limbs resulted from acute thrombosis and embolism. This procedure demonstrates the results comparable to traditional surgical thromboembolectomy and is accompanied with a much lower risk of perioperative complications, amputations and mortality. By reducing the need for thrombolysis, the mechanical thrombectomy thereby significantly reduces the risk of hemorrhagic complications.

The treatment results for the patients with portal hypertension, complicated by esophageal and gastric variceal bleeding, using endoscopic hemostasis methods, namely ligation and sclerotherapy, were analyzed. Endoscopic sclerotherapy was performed with ongoing bleeding, under conditions of stopped bleeding, some patients were introduced with probe obturator. In the groups of patients who received sclerotherapy, the persistent hemostatic effect was 86.2 %; recurrent bleeding with a favorable outcome did 9.2 %; total mortality made 6.1 %. Thus, the basis of successful treatment is a differentiated approach to the choice of the endoscopic hemostasis method. When choosing a treatment one should take into account the localization, extent of varices and the severity of the underlying disease. Endoscopic methods of hemostasis and prevention of complications are effective and should remain on the first line of treatment for these patients. The most optimal is the achievement of temporary hemostasis during drug therapy, balloon tamponade and correction of homeostasis functions, followed by the final choice of the method and endoscopic hemostasis in the delayed period.

The technique to protect the nervous system and internal organs against ischemic injuries during surgical interventions for acute aortic syndrome is assessed. There was performed the analysis of 92 cases of patients treated for acute aortic syndrome. In each case, a complex of measures was used in their various combinations: hypothermia with additional local cooling of the patient's head, systemic and separate perfusion (selective perfusion of the brain, separate corporal perfusion). When performing a surgery in a simple compression of the aorta without perfusion, the surgeon is limited in time. The top of the left ventricle or arch of the aorta is used for taking blood, sending it to the femoral artery. As a shunt, it is convenient to use the aortic line of the artificial blood circulation apparatus, i.e. a passive bypass of the clamped site. The left atrial femoral shunting with centrifugal pump during surgeries in thoracoabdominal aorta makes it possible to perform them in an open heart. Hypothermic perfusion was performed with cooling of a patient until the brain bioelectric activity disappeared and oxygen consumption was minimal, which corresponds to the saturation of venous blood in internal jugular vein at the level of 95−98 %. The temperature in patient's oropharynx and rectum was 14−15 ° C. The main advantage of the proposed technique consists in the surgery safety for a patient.

Emergency pathology of abdominal organs causes a disordered fluid metabolism. The pathophysiological manifestations of the latter in acute abdominal pathology are a decrease in extracellular space. Volume depletion leads to hemodynamic disturbances and causes a decrease in tissue perfusion, which forms multiorgan dysfunction or failure. In order to assess the effectiveness of the liberal and restrictive regimens of infusion therapy with crystalloid solutions, a comparative analysis of the state of central and peripheral hemodynamics in patients with urgent abdominal organs pathology operated on in the volume of laparotomy was performed. The parameters of central and peripheral hemodynamics were investigated using the method of non−invasive bioelectric rheography. The influence of the infusion therapy volume on the formation of hemodynamic response in patients with urgent abdominal pathology was established. The results of the study enabled to draw the conclusions that the liberal regimen of infusion therapy did not allow a qualitative correction of volume depletion in patients of moderate surgical risk with urgent pathology of abdominal organs due to the formation of hypodynamic type of blood circulation and a disordered tissue perfusion throughout the entire observation period, while restrictive mode, on the contrary, contributes to the correction of volume depletion, supporting the normodynamic type of blood circulation and tissue perfusion during the entire post−surgery period.

In order to develop a differentiated approach to the choice of treatment tactics and methods for optimizing the management of patients with endometrial hyperplastic processes, 80 women with glandular and adenomatous forms of the disease were examined. A differentiated approach to the treatment of endometrial hyperplasia is based on the clinical and morphological features of its course and suggests a systemic effect on the endocrine and metabolic processes in the body. The approach to the tactics of treating the women's disease was carried out taking into account the ultrasound scan of the pelvic organs, determining the proliferation markers Ki−67 and p−53, the level of sex steroids and the expression of progesterone and estrogen receptors. With low expression of progesterone receptors, preserved expression level of estrogen receptors and low proliferative activity of the endometrium after the performed fractional curettage of uterus, the patients with unexpressed glandular endometrial hyperplasia are recommended to be treated with indol−3−carbinol. Patients with a pronounced glandular hyperplasia of the endometrium, but with a preserved level of expression of estrogen and progesterone receptors, and a moderate increase in the level of proliferation markers, the hormone therapy with synthetic progestins is needed for 3−6 months according to the standard technique. Patients with non−acute adenomatous hyperplasia of endometrium and decreased expression of estrogen and progesterone receptors, against the background of a moderate level of proliferation markers after curettage, the cryotreatment of the uterine cavity with liquid nitrogen is recommended. With a significant decrease in the expression of estrogen and progesterone receptors in patients with a pronounced adenomatous hyperplasia of the endometrium, and a high proliferative activity of proliferation markers, a surgical treatment is carried out. It was concluded that a differentiated approach to the treatment of hyperplastic processes of uterus, taking into account the receptor profile of the endometrium, the expression level of proliferation markers is important for a positive dynamics of the disease symptoms and the therapy results.

One of the most severe dysfunctions of reproductive system in puberty are abnormal uterine bleeding, often resulting in persistent menstrual and generative function disorders and hormonally caused diseases. In order to study the clinical and paraclinical characteristics of pubertal abnormal uterine bleeding, a comprehensive examination of girls aged 11−18 years was conducted, which included an analysis of complaints and clinical course of the disease, anamnesis, the course of pregnancy and childbirth in mothers, degree of physical and sexual development, as well as the nature of menstrual function, gynecological status, ultrasound of the pelvic organs. Laboratory examination included a study of indices of clinical blood tests, urine, bacteriological vaginal seeding, coagulogram, hormonal profile (gonadotropic and sex hormones). As a result of the study, one of the etiological factors of abnormal uterine bleeding during the puberty period was the changes in physical and sexual development, an unfavorable perinatal period and premorbid background, the presence of extragenital pathology, acute or chronic stress, as well as hereditary susceptibility to impaired functioning of reproductive system.

A systematic analysis of available currently published data on the use of hormone therapy in treatment of breast cancer in premenopausal women has been carried out. The review includes the data of foreign authors published over the past 20 years. The statistics on breast cancer is provided. Its subtypes were determined with basis on the expression of specific cytokeratins, the relationship of various biological types with age and the disease course, as well as brief recommendations were given on treatment of biological subtypes of breast carcinoma and a new trend in the treatment of triple−negative tumors is specified. The stages of the milestones of breast cancer hormone therapy are presented. The findings of large randomized studies, comparing the results of different combinations of hormone therapy, as well as the role of luteinizing hormone agonists, i.e. releasing hormone in fertility preservation, the significance of the suppression of ovarian function are shown. The issues of patient management after completion of chemotherapy and the difficulty of differentiating between "true" and "temporary" (women who can recover the menstrual cycle) menopause are discussed, since the assessment of ovarian function markers will show the same results, that makes it difficult to choose the drugs for hormone therapy. The modern approaches to the use of hormone therapy in breast cancer in premenopausal women according to the latest recommendations of the international associations of medical oncologists are considered.

The problem of treating the injuries of distal metaepiphysis of the long bones has remained relevant due to a large number of complications, both infectious−necrotic and associated with impaired regeneration. Analysis of the treatment results for such patients suggests that at the planning stage of the treatment process, it is necessary to take into account not only the classification features and individual characteristics of each specific damage, but also the degree of patient motivation, his/her readiness for productive cooperation. In order to substantiate the tactics of treatment of injuries to distal metaepiphysis of the long bones with a decrease in the share of plate osteosynthesis and, accordingly, an increase in the one of minimally invasive technologies, 210 patients were treated with damage to the humerus, forearm, hip, and tibia. In the case when it is possible to avoid a traumatic surgery with the guaranteed result, one should use minimally invasive, biologically justified, and therefore less dangerous techniques (extrafocal osteosynthesis, fixed method, skeletal traction). Comparative evaluation of the results of treatment of patients with injuries to the distal long−bone metaepiphysis entitles to speak about the effectiveness and expediency of applying the proposed treatment tactics.

The "golden standard" for restoration of cerebrospinal fluid flow during ischemic stroke is systemic thrombolysis, based on its understanding as a dynamic process dependent on the volume of blood supply, which, according to the patient's compliance with its criteria, is performed in accordance with the methodological recommendations of the Ministry of Health Care of Ukraine. To determine the dynamics of neurological status, to obtain neuroimaging and blood parameters in elderly patients after thrombolytic therapy, there was performed a study wherein before, during and after systemic thrombolysis, the patients were assessed using the NIHSS stroke scale and neuroimaging. Functional capabilities were ranked on the Rankin scale and the Barthel index. During the admission to hospital the patients were examined with: duplex scan of blood vessels, electrocardiogram, Echo−cardiogram, general blood test, blood glucose analysis, coagulogram, International normalized ratio, blood biochemistry. After systemic thrombolysis in patients, four of whom were severe and one with moderate neurological deficiency, there was a significant regression of focal neurological symptoms (NIHSS 0−1 points), which resulted in four of them, who had undergone a full course of treatment and were discharged on days 12−19, to a significant functional restoration of impaired neurological functions with a lack or mild impairment of vital and full self−service capacity. It is concluded that the elderly age of patients makes it necessary to choose the optimal effective protocol for the treatment of ischemic stroke against the background of atherosclerotic encephalopathy and concomitant diseases in order to avoid polypragmasia. The prevalence of stroke among the elderly persons and the aging of population of developed countries necessitates the use of thrombolytic therapy, since this reduces post−neonatal neurological deficits, increases functional recovery and, thereby, improves the life quality in these patients.

At early stages of demyelinating and degenerative diseases of the central nervous system, degenerative changes are partly reversible, requiring improvements in diagnostic measures, the emergence of alertness among neurology doctors and general practitioners. An analysis of the current state of the study of the central nervous system degenerative and inflammatory diseases revealed a pressing problem of an adequate comprehensive medical care for these patients. The new therapeutic strategy should be aimed at "neuroprotection", which will trigger stimulation of neurogenesis, angiogenesis, restoration of structures and functions of synaptic apparatus, formation of dendritic networks. It has been shown that the autoimmune inflammatory disease of multiple sclerosis also has a degenerative component. In the system of therapeutic measures of the disease of Wilson−Konovalov, in addition to the obvious toxic effects of the copper itself, it is advisable to consider the vascular factor as one of the components of adaptive counteraction to the degenerative process. Taking into account the knowledge about the inflammatory factor negative effect on neurogenesis and adaptive possibilities of the nervous system, even the minimal signs of active inflammation in the central nervous system (as well as the situation of radiologically isolated syndrome) require the prescribing of pulse therapy with glucocosteroids. A hypothesis is made that glucocorticosteroids, although having a direct negative effect on neurogenesis, can indirectly positively influence the inhibition of inflammation and decrease in edema. Addition of therapy based on the concept of "guided neuroplasticity" can be a significant contribution to the system of therapeutic measures of neuro−inflammatory and neurodegenerative diseases of the central nervous system.

Vegetative dysfunction that occurred in childhood is an unfavorable background if the child has a concomitant pathology. As a rule, autonomic disorders are secondary, against the background of many mental, neurological and somatic diseases. In order to study the features of the clinical manifestations of autonomic disorders in children who suffered a closed head injury of varying severities, 80 patients aged from 3 to 17 years were examined. The study used the following methods: clinical and anamnestic using the inpatient card; clinical and neurological examination with the application of the Vein questionnaire; vegetative indices were evaluated by calculating the Kerdo index. The results of the study showed that in children who suffered a traumatic brain injury, autonomic disorders most often manifested themselves as headaches, less often as a fatigue, more rarely as dizziness, memory and sleep disorders. Loss of consciousness is more often observed in severe forms of closed head injuries, and subfebrile condition, as well as disorder of the gastrointestinal tract are single observations. Autonomic dysfunction syndrome is one of the frequent manifestations of the effects of traumatic brain injury, is characterized by polymorphism of clinical manifestations, may be relatively permanent or permanent with recurring paroxysms. Vegetative tone in children with trauma was more often characterized with parasympathicotonia. Vegetative dysfunction increased under the influence of meteorological factors, physical and emotional stress.

The problem of stabilization of visual functions of patients with various forms of retinal abiotrophy remains relevant and not fully resolved. To study the effectiveness of the use of the drug "Encad−Biolik" in the combined therapy of retinal pigment abiotrophy, a study of the results of treatment of 30 (60 eyes) patients with this pathology was conducted. The drug "Encad−Biolik" was used in a combined therapy in the form of intramuscular injections of 5.0 ml 1 time per day and subconjunctivally with 10.5 mg for 10−15 days. Treatment efficacy was assessed at 6, 12, and 18 months. According to the results of observations after the use of the drug "Encad−Biolik" in a combined therapy in patients of the main group, in contrast to the control group, the fields of vision and stability of light sensitivity were increased. There was a significant difference (p < 0.05) in the stabilization of peripheral vision too. It should be noted that there were no adverse reactions when using this drug. Four patients after subconjunctival injections had painful sensations, probably related to the peculiarities of the pain threshold. In these cases, in addition to instillation anesthesia with proparacaine, the application with a cotton swab with the same preparation for three minutes was successfully used. The results of the study lead to the following conclusions: the use of the drug "Encad−Biolik" in patients with retinal pigment abiotrophy makes it possible to stabilize the pathological process and visual functions; the drug helps to reduce the frequency of such complications of retinitis pigmentosa, such as the development of atrophic changes in the macular area of retina; the use of this drug is safe, its effectiveness is noted after the second course of treatment, and the most pronounced positive changes occur since the third course.

The syndrome of the biologically inactive growth hormone is a new nosological unit, which in 1999 was introduced into the International Classification of the Congenital Growth Hormone Deficiency (KIGS Aetiology Classifi cation System). There is currently no reliable data on the prevalence, peculiarities of anamnesis and clinical course of this pathology. In this study, the clinical features of patients with a biologically inactive growth hormone syndrome were studied based on anamnesis, phenotype, physical and sexual development. The degree of puberty was estimated on the Tanner scale (1962). To confirm the syndrome of a biologically inactive growth hormone, a sensitivity test to the growth hormone, which was positive in all studies, was applied. The bone age of patients was studied using the atlas W. W. Greulich, S. P. Pyle (1993). There is an evidence that patients with the biologically inactive growth hormone syndrome are 12.38 % of patients with low fertility. Pathology in boys is three times more likely than girls. One third of children had cases of low birth rate among the relatives of the first and second lines. The pathological course of pregnancy in mothers was determined in 41.2 % of cases. Most of the surveyed individuals had timely sexual development with an inclination to the early, which began at 10−11 years. Early puberty was recorded in 23.53 % of children aged 8−9. The optimal physiological puberty at the age of 12−14 years was at 24.18 %. Thus, patients with the syndrome of a biologically inactive growth hormone account for the ninth part of the low−grade children who underwent a survey. The frequency of pathology in male children was significantly higher than in females. Such patients have a proportional structure of the body and a typical phenotype, the main manifestations of which are the protruding forehead, saddle−shaped nose, deep−set eyes and hypoplasia of the mandible. During the activation of pubescence, the facial features of patients change, and their phenotype loses its character.

In order to study in dynamics the state of lipid peroxidation and antioxidant system in patients with varicella, depending on the disease severity, their complex examination was carried out, which included clinical, biochemical and instrumental methods. The state of lipid peroxidation in varicella patients was judged by the examining of serum diene conjugates, malonic dialdehyde and total oxidative activity of blood plasma. The state of antioxidant system was found by the total antioxidant activity of blood plasma and erythrocytes, activity of catalase, superoxide dismutase, glutathione peroxidase, glutathione reductase of erythrocytes, glutathione peroxidase, glutathione reductase of blood plasma, total glutathione content, oxidative and restorative glutathione of blood plasma. The results of the study of indices of oxidative and antioxidant systems in patients with chicken pox indicated that as the severity of the disease enhances, the content of primary diene conjugates and secondary malonic dialdehydes of lipid peroxides and the total oxidative activity of blood plasma increases, indicating the activation of lipid peroxidation. The data obtained confirm the advisability of using antioxidants in the treatment of chicken pox. Patients who received in addition to the combined therapy the antioxidants, i.e. mexidol and tocopherol at earlier terms oxidative activity of blood plasma, the blood levels of conjugated dienes and malondialdehyde, there was decreased the oxidative activity of blood plasma, content of diene conjugates and malone aldehyde, antioxidant activity of blood plasma and erythrocytes, activity of catalase, superoxide dismutase, glutathione peroxidase, glutathione reductase and the concentration of reduced glutathione were increased, that was accompanied with by a decrease in intoxication and clinical improvement.

Owing to the scientific achievements of recent decades it has been possible to significantly expand the idea of the pathogenesis of chronic hepatitis B, which made it possible to develop effective methods for the disease diagnosis, to identify the main therapeutic directions in its treatment and significantly improve the prognosis. The direct results of treatment with nucleotide / nucleoside analogues in viral hepatitis B were analyzed. The study included patients with HBsAg−positive viral hepatitis B who received lamivudine 100 mg/day and patients prescrivbed with tenofovir 300 mg/day. The duration of prospective observation was 48−52 weeks. The laboratory (alanine aminotransferase content) and virologic (HBsAg, qualitative and quantitative determination of HBV DNA by polymerase chain reaction) were performed in local laboratories. The indices of viral load and virological response were considered as the endpoints. A complete virologic response was considered to be the level of HBV DNA < 300 copies/ml and the normalization of the level of alanine aminotransferase at the end of treatment. The results of this study showed that the total number of patients with complete virological response (HBV DNA < 300 copies/ml) did not differ after 4 weeks in the lamivudine and tenofovir groups; after 24 weeks of prospective observation, the frequency of complete virological response in the tenofovir group was 25.2 % more, and the overall level of complete virological response in 48−52 weeks after initiation of antiviral therapy was 46.4 % in the lamivudine group and 74.2 % in the tenofovir group.