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№4' 2019


State Institution "V. T. Zaitsev Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine", Kharkiv
Kharkiv National Medical University
Kharkiv Medical Academy of Postgraduate Education, Ukraine
Study of activating effect of surfactant drugs on pulmonary macrophages in vitro in patients with bronchiectasis
5 - 8
The state of surfactant system of lungs in chronic inflammation is known to disrupt their structural organization, causes shifts in the system itself, the severity of which depends on alveolar parenchyma injury rate. The cell destruction of aerohematical barrier is accompanied by changes in pulmonary surfactant system, its deficiency, development of dis− and atelectases, which increases the severity of lung injury and promotes the progression of bronchiectasis. Exogenously introduced surfactant restores local immunity and serves as a substrate for synthesis of its own surfactant. To determine the stimulatory effect of natural surfactant on receptors of the lung macrophages and its influence on activation of phagocytosis a comparative study of direct effect of infasurf on cell surface and formation of phagocytic vacuoles in macrophage elements of individuals with bronchodectic disease at an acute stage was performed . In bronchoalveolar lavage of patients the percentage and viability of pulmonary macrophages were determined. Other lavage material was investigated both as a baseline control and with infasurf. The electron microscopic examination of bronchoalveolar lavage macrophage elements in patients show that after incubation of cells with infasurf, there is a pronounced cell surface activation, formation of phagocytic vacuoles containing membranes of exogenous surfactant. Its small and large clusters were often observed lying freely between pulmonary macrophages, whereas in the control group (without infasurf) small fragments of tubular myelin or osmiophilous lamellar bodies were noted. Thus, the specific pharmacological action of surfactant drugs directly contributes to differentiation and maturation of pulmonary macrophages, their phagocytic function activation.
Key words: bronchiectasis, surfactant, pulmonary macrophages.
State Institution "V. T. Zaitsev Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine", Kharkiv, Ukraine
Prediction and prevention of purulent−inflammatory complications of post−surgery wounds
9 - 12
Improvement of the methods for prognosis and prevention of the post−surgery wound complications based on the use of new technologies in microbiology and surgery is of a great importance today. In order to develop and improve such methods, a study has been performed and it involved 230 patients who received a surgical treatment. Clinical and laboratory, biochemical, histological and microbiological methods have been applied. An automatic microbiological analyzer has been applied to identify and determine the sensitivity of the isolated microorganisms to antibacterial agents. The admission of the patient to a hospital assessed the degree of risk of purulent−inflammatory complications in the post−surgery wound on clinical grounds, namely they are: age (over 50 years old), disease duration (longer than 18 hours), accompanying pathology, unpredictable amount of surgical intervention. In the presence of these factors, the patients were assigned to the group of risk of purulent−inflammatory complications in the post−surgery period. To determine a more reliable prognosis, the bactericidal value of the patient's serum was evaluated for detecting the intensity of inhibition of anti−infective defense mechanisms. This allows during the preoperative period the prediction of not only purulent−inflammatory complications, but also identifying the microflora that contributes to their occurrence. As a result of this research, an algorithm for predicting and preventing the purulent−inflammatory complications of the post−surgery wounds was developed. In the case of establishing the fact of a suppression of protective anti−infective mechanisms of the organism in the preoperative period, the patients were given antibacterial prophylaxis with selection of the most effective drug.
Key words: surgical interventions, purulent-inflammatory complications, mechanism of anti-infective resistance.
State Institution "V. T. Zaitsev Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine", Kharkiv, Ukraine
Influence of right ventricular lead implantation site choice on pacing efficiency
13 - 17
Currently the electrophysiological treatment options have been considered to be the most effective for many patients with arrhythmogenic cardiomyopathies, as well as in those with arrhythmias on the background of heart failure. Currently, the dependence of efficiency of the pacemakers on the location of the electrodes has been proven. In order to study the effect of a myocardial dysynchrony on the effectiveness of pacing depending on the location of the right ventricular electrode, an investigation has been performed. This study comprised the patients with a complete atrioventricular block, preserved ejection fraction of the left ventricle (more than 50 %), with no history of myocardial infarction, who were implanted with the two−chamber pacemaker. It has been established that the best results were achieved with a stimulation of the middle and lower septal zone of the right ventricle, the worst ones were obtained with a stimulation of its apex. It has been found that the dynamics of the magnitude of segmental strains and a global longitudinal strain coincided with the dynamics of other parameters of the pacemaker effectiveness, which indicated the pathogenetic value of myocardial dysynchrony in the progression of heart failure after implantation of the pacemaker. Therefore it could be concluded that the studying of myocardial mobility by determining a longitudinal strain for assessing the functional state of the myocardium and the effectiveness of pacing is highly advisable. It is emphasized that the use of the latest strains−dependent techniques for cardiac performance evaluation in the patients with bradyarrhythmia have a great potential to predict the development of chronic heart failure and to choose the optimal method of physiological stimulation of the heart.
Key words: right ventricular lead, cardiac stimulation, myocardial dyssynchrony.
State Institution "V. T. Zaitsev Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine", Kharkiv, Ukraine
Tactics of surgical treatment for isolated duodenal injury
17 - 19
Currently the diagnosis and surgical treatment of isolated duodenal injury is one of the most rare and, consequently, a complicated and completely unsolved problem in emergency surgery. In order to analyze the results of surgical treatment and to justify the optimal amount of intervention in the patients with isolated duodenal injury we have performed a study, wherein the cases of an open injury of the cut−stab character, the effects of a blow on the anterior abdominal wall have been considered. The admission time of patients generally made 6 hours. Examination radiography of abdominal organs with DeBakey − Henelt test, phagogastroduodenoscopy was performed. In cases of unexplained clinical picture the diagnostic video laparoscopy was urgently used. The factors, affecting an outcome of treating the isolated duodenal injury were as follows: the time of hospitalization of patients, size and localization of the bowel defect, timely diagnosis and choice of the surgery volume as well as the post−surgery complications. A thorough revision of a retroperitoneal space, being the one of the symptoms of the Winiwarter−Laffite triad, was accomplished. In injuries of the first and second degree, duration of an injury of no longer than 6 hours, it is necessary to close the defect of the duodenum by two−row sutures with a nasogastroduodenal intubation. At admission of the patients at later terms or with the injuries of the third degree it is expedient to exclude a passage of food on a gut by imposing a gastroenteroanastomosis with Brownian complicity and a decompression of bilious ways. On the basis of our findings the diagnostic and surgical algorithms, depending on admission time of patients to a hospital, size and localization of duodenum wall defect were designed.
Key words: duodenal injury, tactics of surgical treatment, results of surgical treatment.
Public Non&minus
Profit Organization of Kharkiv City Council "Regional Clinical Perinatal Center", Ukraine
Antiphospholipid syndrome and pregnancy
20 - 22
The main issues of etiopathogenesis, clinical manifestations, diagnosis of antiphospholipid syndrome are considered. This syndrome is a state of the body whereat a thrombosis can occur, especially during pregnancy. This syndrome pathogenesis is characterized with an interaction of antiphospholipid antibodies with negatively charged phospholipids. They are the part of membranes of platelets, endotheliocytes, prothrombin−activating complex, beta−2−glycoprotein and nerve cells with impaired functions. Joining to phospholipids, the antiphospholipid antibodies lead to a sharp decrease in platelet count and impaired endothelial cell function. In nerve tissue disorders according to the structural and functional type occur, the formation and function of the humoral agents responsible for hemostasis are disrupted. The antiphospholipid syndrome in obstetrics and gynecology often manifests as spontaneous miscarriages, the effect of the "empty fetal egg", fetal growth retardation and even its antenatal death, as well as preeclampsia. In the treatment of pregnant women with antiphospholipid syndrome, mainly several protocols have been used, i.e. anticoagulants and antiplatelet agents in combination with glucocorticoids; combination of glucocorticoids with acetylsalicylic acid; monotherapy with sodium heparin or acetylsalicylic acid; anticoagulants and antiplatelet agents for hemostasis correction. The treatment protocols during pregnancy, childbirth and postpartum period have been presented. It is emphasized that the patients with antiphospholipid syndrome and vascular thrombosis should be monitored by rheumatologist, surgeon, obstetrician and gynecologist after successful child delivery. Duration of receiving antiplatelet and anticoagulant therapy has to be solved individually.
Key words: antiphospholipid syndrome, antiphospholipid antibodies, cardiolipin antibodies, lupus anticoagulant, pregnancy, postpartum period.
Kharkiv National Medical University, Ukraine
State of the art of discoordinated labor problem
23 - 30
The course and result of childbirth for mother and fetus was evaluated by comparing different ways of correction of discoordinated delivery (clinical protocols, using of epidural anesthesia, combined method with phosphatidylcholine). Among the abnormalities of labors, the frequency of those makes 18−20 %, a discoordination of labor has taken an important place. The discoordination means a disorder in coordinated contractions of different parts of an uterus. It is known that this pathology may result in a high incidence of operative delivery, birth injury, pathological blood losses, postpartum septic complications, maternal and perinatal morbidity. In order to assess the course and outcome of labor for the mother and the fetus, by comparing various methods of correction of discoordinated labor, 120 women in labor were examined, they were divided into clinical groups depending on the correction method described above. We have analyzed the indices of the partograms of women in childbirth, the results of hysterography and cardiotocography, levels of adrenaline, norepinephrine, prostaglandin F2α, endogenous oxytocin in the mother's blood. Hemodynamics in the uterine vessels and the ones of the fetoplacental complex was determined using dopplerometric investiagtions. The condition of the newborns was evaluated. Based on the investigation results of the birth outcome, it has been concluded that the application of phosphatidylcholine in the combined treatment of the discoordinated labor can significantly reduce the frequency of cesarean section surgeries, improve the condition of the fetus and newborn by normalizing the biologically active substances in blood of the mother and fetus, blood flow in the fetoplacental complex, and eliminate the occurrence of abnormal labor.
Key words: labor discoordination, phosphatidylcholine.
Kharkiv Medical Academy of Postgraduate Education, Ukraine
Current approaches to treat gestational period complications in women with Graves’ disease
31 - 34
The most common cause of hyperthyroidism in pregnant women is recognized by Graves' disease. Because it leads to serious complications in the mother and fetus, timely correction of disorders of homeostasis provides a successful outcome of pregnancy. In order to study the effectiveness of the drug with the active substance sulodexide in pregnant women with Graves' disease, 28 women were examined for the possibility of reducing obstetric and perinatal complications. They performed general clinical examinations, performed an extensive hemostasis, determined the fetal fetal condition. It has been found that the development of chronic syndrome of disseminated intravascular coagulation is characteristic for pregnant women and as a result this aggravates the gestational period for the mother and fetus. Supplementation of the standard protocol of treatment with anticoagulant sulodexide has led to an improvement in the parameters of the coagulation unit of hemostasis, and was also characterized by anti−adhesive and antithrombotic action. Clinically, the effectiveness of this therapy was manifested by the elimination of symptoms of placental insufficiency, the threat of pregnancy termination, preeclampsia, delayed fetal fetal development, thrombotic complications. The results obtained in this study indicate that the use of sulodexide anticoagulant has contributed to a reliable normalization of the hemostatic index, improved blood supply to the placental and fetal complex, which reduced an obstetric pathology occurrence and perinatal mortality. Thus, we can recommend to include natural anticoagulant sulodexide into standard protocol of treatment for patients with Graves' disease, because it has no side effects, unlike other anticoagulant drugs and can be safe for pregnant women.
Key words: hemostasis, pregnancy, Graves' disease, sulodexide.
Odessa National Medical University, Ukraine
Features of external rod−controlled fixation in calcaneal fractures
35 - 39
A device for transosseous osteosynthesis of rod type and a technique of external fixation have been developed, which will allow to provide with high degree of efficiency a positive clinical result of reposition of all types of intra−articular calcaneus fractures. The proposed device, based on the apparatus Ilizarov details, as well as technique of osteosynthesis have their own peculiarities, namely the technical ability to use a removable repotent node to perform the reposition of all types of calcaneus fractures. We have used the modified method of closed one−moment instrumental reposition. Own practical experience and observations allowed us, depending on the nature of the destruction of posterior articular facet and types of its displacement, to assert the possibility of using a closed one−time instrumental reposition. The essence consists in distraction surgery, where the main mechanism of indirect reposition is the effect of tensile forces in a certain sequence on surrounding fracture of damaged ligaments, i.e. so−called the effect of ligamentotaxis. According to this method, 6 surgical procedures were performed. In all cases, the use of the proposed device intraoperative repositioning of the posterior articular surface of the heel bone and restoration of the Böhler's angle were considered satisfactory, even with significant destruction. Technical capabilities enables the conclusion about recommending this for surgical treatment of intra−articular fractures of a heel bone. It is advisable to continue research in the specified patient category to confirm the effectiveness of new, minimally invasive surgical intervention. Further improvement and implementation of surgery of intra−articular fractures of calcaneus will improve both the medium and long−term results.
Key words: calcaneus, fractures, transosseous osteosynthesis.
Danylo Halytsky Lviv National Medical University, Ukraine
Treatment advantages of patients with ureterolithiasis by lithotripsy contact methods in comparison with open surgery
40 - 43
One of the most effective methods of treatment of ureteral concretions is ureteroscopy with contact lithotripsy. The study analyzed the results of treatment of 96 patients with urolithiasis they were as follows: 44 patients underwent laser ureterolithotripsy, 52 persons had an open ureterolithotomy. When comparing different treatments for patients with ureterolithiasis, it has been found that the average duration of surgery when performing laser ureterolithotripsy was shorter and averaged 53 minutes. As for open ureterolithotomy it lasted in average 102 minutes. The average length of patients staying in clinic when performing laser ureterolithotripsy in average was 2.5 days, during open ureterolithotomy that index was 20 days. This is a significant advantage of endoscopic treatment of ureterolithiasis versus an open surgery (especially when a holmium laser is used in lithotripsy). By using endoscopic methods of treatment of ureteral concretions instead of an open surgery (ureterolithotomy), it has been possible to reduce the in−patient staying 8 times. Lithotripsy with a holmium laser occurred to be an effective method of destroying the ureteral concretions of any mineral composition, if the dimensions of these calculi did not exceed 2 cm. It should be emphasized that under these conditions, the localization of a stone and the duration of its stay in the ureter are also not important. In addition, the use of a holmium laser minimizes an injury to the ureter wall. The advantages of lithotripsy when it used with a holmium laser consist in its high efficiency in destruction of solid fixed and the ingrown stones. In case of combination of both a stone and ureteral stricture and in the presence of ligature calculi, the treatment with a holmium laser is also prescribed.
Key words: ureterolithiasis, laser ureterolithotripsy, open ureterolithotomy, holmium laser.
Kharkiv National Medical University, Ukraine
Non−standard approaches to upper urinary tract reconstruction
44 - 49
The main alternatives to a standard ureteral reconstruction at the expense of urothelial−containing tissues are an autotransplantation of the kidney, replacement of the ureter, and interposition of autologous tissues that do not contain urothelium. This compares the tissues that have a similar histological structure, system of blood supply and innervation. Although the general trend in the assessment of the role of renal autological transplantation in the correction of ureteral defects is quite optimistic, there is a likelihood of severe complications, including severe transplant infection and its loss, complications from vascular anastomoses. At the same time the tissues having similar histological structure, system of blood supply and innervation have been compared. However, in some clinical situations it is not possible to replace the upper urinary tract with such a surgical approach, which forces the surgeon to use alternative and non−standard methods of ureteral reconstruction. Among the various types of ureteral reconstruction with enteral tissues, the leading role is the interposition of segments of the small intestine. Most authors point to the favorable results of this technique in terms of minimal lethality, low incidence of complications and stabilization of renal function after surgery. However, the problem of intestinal interposition is complications associated with enterotomy, electrolyte balance disorders, reabsorption into the blood of metabolism products and active secretion of mucus into the lumen of the urinary tract. The published reports have mostly described the positive results after ureteral plasticity of the buccal mucosa flap, but the length of the stricture in the implementation of such a treatment method should not exceed 5−6 cm ureter.
Key words: ureteral reconstruction, kidney autotransplantation, intestinal ureteroplasty, ureteral reconstruction with buccal mucosa flap.
State Institution "Grigoriev Institute for Medical Radiology of the National Academy of Medical Sciences of Ukraine", Kharkiv
V. N. Karazin Kharkiv National University, Ukraine
Secondary edematous breast cancer: when to be operated on background of neo−adjuvant chemotherapy?
50 - 54
Current methods of diagnosis and treatment of breast cancer patients should be closely linked to the advances in molecular biology The ways of increasing the effectiveness of combined treatment of the patients with secondary−edema of breast cancer, namely the tactics of personalized treatment on the basis of evaluation of molecular−biological tumor markers and the data of magnetic resonance imaging have been presented in this paper. Here it has been emphasized that the proposed method of assessing the prevalence of the tumor process in the patients with secondary edematous breast cancer allowed the determination of the tumor size and edema, as well as to optimization of the treatment protocols. This research was performed in 54 patients aged of 37−75 years and these patients comprised the main group. All of them underwent the sessions of neoadjuvant polychemotherapy, surgical treatment, remote radiotherapy in the presence of affected lymph nodes in terms of sequential comprehensive treatment. The immediate results of the effectiveness of combined treatment were evaluated by one− and two−year overall and relapse−ree survival of the patients with secondary edematous breast cancer. The findings (follow−up period of 1−2 years) have indicated that the personalized treatment of patients with secondary−edema of breast cancer depending on the molecular−biological marker clusters with determination of the degree of aggressiveness and choice of treatment tactics is a highly effective method. Owing to the use of the personalized treatment, a complete or partial regression was achieved by more than by 30 % in 83.3 % of patients in the main group versus 50 % of the control, that jointly with the data on therapeutic pathomorphosis confirms the effectiveness of this method.
Key words: secondary edematous breast cancer, molecular biological markers, pathomorphosis.
State Institution "Grigoriev Institute for Medical Radiology of the National Academy of Medical Sciences of Ukraine", Kharkiv
Kharkiv Medical Academy of Postgraduate Education, Ukraine
Determination of expression rate of molecular biological markers in tumor of patients with stage I−IV endometrial cancer to predict the disease relapse
54 - 58
In order to study the molecular biological markers of the tumor in patients with endometrial cancer stages I−IV, the patients who received a combined treatment at the Department of Oncological Gynecology at the State Institution "Grigoriev Institute for Medical Radiology" were surveyed. The study has demonstrated that in the patients with advanced endometrial cancer, the expression rate of molecular biological markers and ER and PR receptors depends on the histological shape of the tumor. In adenocarcinomas with a high degree of differentiation, the value of both positive and negative VEGF was observed in equal percentages, against the background of high Bcl−2 expression, negative mt p53 expression, and negative or moderate proliferative activity. In patients with adenocarcinoma with moderate degree of differentiation, the value of positive VEGF was observed three times more often than negative one, against the background of a high Bcl−2 expression, negative mt p53 expression and moderate proliferative activity (Ki67). In the patients with low−grade adenocarcinoma endometrium, both positive and negative VEGF were equal in percentage, against the background of high Bcl−2 expression, negative mt p53 expression, and positive proliferative activity. In adenocarcinomas with high and moderate degree of differentiation, the positive status of ER and PR is more often observed, and, conversely, in the patients with low−differentiated adenocarcinoma their negative status was found. It has been revealed that the level of expression of the investigated molecular biological markers and ER and PR receptors in tumors of the patients with endometrial cancer differed depending on the occurrence of relapse. This fact can be used to determine the risk of endometrial cancer recurrence.
Key words: endometrial cancer, molecular biological markers, relapse, expression.
Kharkiv Medical Academy of Postgraduate Education
State Institution "SP Grigoriev Institute for Medical Radiology of the National Academy of Medical Sciences of Ukraine", Kharkiv
Molekula Pre&minus
Tumor Medical Center, Kharkiv, Ukraine
Direct results of surgical treatment of three−negative breast cancer
59 - 62
Three−negative breast cancer is characterized by aggressive clinical course, early metastasis and poor prognosis, leading to more active oncosurgical tactics and systemic treatment. Due to the aggressive clinical course of this oncopathology with increasing risk of locoregional and distant metastases, the most common surgical treatment tactics are modified variants of radical mastectomy with wide dissection of lymph nodes in areas of potential metastasis. Radicalism of the operation is the cause of the increase in the incidence of wound and lymphoenosis, the development of which depends on many factors, the determination of which is important for the development of methods of prevention of complications. In recent years, in the early stages of the disease, a radical breast resection after a course of adjuvant radiotherapy has been considered as an alternative. To study the immediate post−surgery results of three−negative breast cancer, depending on the initial clinical and pathological parameters and features of therapeutic tactics, a study was conducted in which 66 patients participated. Patients underwent radical mastectomy and breast resection, as well as lymph node dissection. Nine patients underwent aloplastic reconstruction. The results of the analysis showed that most often after radical surgeries, irrespective of their volume, there are lymphovenous complications, the development of which is affected by an increase in body mass index and lesions of lymph nodes. Aloplastic breast reconstruction contributes to a reduced incidence of lymphoid complications, and neoadjuvant chemotherapy is associated with an increased incidence of wound complications. These factors should be considered when planning the surgery protocols of patients with three negative breast cancer.
Key words: three-negative breast cancer, surgical treatment, postoperative complications, risk factors.
National Centre of Oncology, Azerbaijan, Baku
Radiotherapy in combined treatment of recurrent stage 3 laryngeal cancer
63 - 66
The paper presents the treatment results performed in 250 patients with a laryngeal tumor of the third stage. The average life expectancy of these patients generally does not exceed 3−6 months. Chemotherapy is usually considered the standard treatment for the recurrence of head and neck squamous cell cancer patients, previously received radiotherapy. When prescribing the chemotherapy, a tumor regression is observed only in 10−40 % and does not virtually affect the life. Average life expectancy of these patients often varies from 5 to 9 months. The optimal total dose of radiotherapy for the treatment of inoperable recurrent and metastatic cancer was found in this reserach for imroving treatment results. The surgical protocols and techniques under discussion in this paper are certainly of a practical significance. The method for preoperative radiotherapy for larynx cancers was developed and the guidelines have been proven. Also there was proven that preoperative radiotherapy in a combined treatment of recurrent operable laryngeal cancer increases its effectiveness and does not affect postoperative period. Repeated radiotherapy for recurrent inoperable laryngeal cancer is possible only if the changes after previous radio− or combination therapy do not exceed 2 degrees. In addition, a repeated radiotherapy at a total source dose of 40−60 Gy is an effective method of palliative treatment and significantly improves the life expectancy and quality in the patients if compared with palliative chemotherapy. The method used in combination with intratumoral chemo− and radiotherapy significantly improves the efficiency of palliative treatment in the patients with recurrent regional metastasis for inoperable laryngeal cancer, in the primary tumor area, no signs of recurrence were found.
Key words: laryngeal cancer, combined cancer treatment, radiotherapy.
Kharkiv National Medical University
City Out&minus
Patient Clinic N3, Mariupil, Ukraine
Pathogenetic predictor of endothelial dysfunction in patients with cardioembolic and atherothrombotic transient ischemic attacks
67 - 71
To establish criteria for the severity of pathogenetic disorders in the most common forms of transient ischemic attacks, i.e. cardioembolic and atherothrombotic, a differentiated approach to the treatment and primary prevention of vascular disorders of the cerebral ischemia and dysfunction of ischemia was substantiated. To objectify endothelial dysfunction, endothelin−1 was studied with its principal antagonist − a sodium oxide vasodilator and the major pro−inflammatory cytokine TNF−α. The blood was collected from the patients 12 hours after the first neurological symptoms appeared, the purpose of which was to determine the peak values of the disturbance of biochemical parameters. The data obtained indicate that with a transient ischemic cardioembolic attack, a milder clinical manifestations is caused by less pronounced pathogenetic changes in endothelial dysfunction. At the same time, in atherothrombotic form, the neurological symptoms grow more slowly and have a more pronounced character, which is also confirmed by the study of endothelial dysfunction. Thus, the study of endothelial dysfunction severity in patients with transient ischemic attacks can justify a differentiated pathogenetic approach to treatment and improve the prevention of vascular disorders. Primary prevention in a transient ischemic attack should be directed to causes that are extravasal in nature, and at atherothrombotic treatment to atherosclerosis, mainly reduction of atherosclerotic plaques. Despite quite similar correlation of major vasoconstrictor and vasodilator disorders, a mild and moderate clinical severity due to various occlusion factors is observed. To further determine the occlusion mechanisms, it is necessary to study rheological, coagulation and dynamic parameters of patients' blood.
Key words: cardioembolic transient ischemic attack, atherothrombotic transient ischemic attack, endothelial dysfunction, endothelin-1.
Kharkiv National Medical University, Ukraine
Features of autonomic nervous system and cerebral neurodynamics state in young patients with chronic vertebrogenic pain syndromes
72 - 76
The origin of vertebrogenic pain syndrome is associated with the irritation of the receptor apparatus in the area of affected vertebral−motor segments with the responses of the corresponding muscle groups. Taking into account the neurophysiological interrelation of emotional, autonomic functions, as well as the dependence of the threshold of perception of pain sensations on the functional state of nonspecific brain systems, we have assumed about the interrelation of vertebrogenic pain syndrome with a state of nonspecific one. In order to determine the features of vegetative regulation and cerebral neurodynamics, 128 young patients suffering from chronic vertebrogenic syndromes have been examined. Vegetative tone, reactivity and physical, mental and emotional activity, as well as a protocol based on the expert evaluation of autonomic disorders have been investigated in this study. All the patients have reported about the manifestations of autonomic dysfunction, manifested by psycho−vegetative syndrome, clinical signs of which were permanent disorders in the cardiovascular and muscular systems, as well as respiratory, thermoregulatory, gastrointestinal spheres, against which they developed and vestibular crises, syncopal states and lipotimia. Subjective autonomic−emotional manifestations in patients predominated the objective ones, that testified to the significant role of emotional disorders in the structure of the syndrome of autonomic dysfunction. Psychophysiological activation in young patients with chronic vertebrogenic pain syndromes in the vegetative sphere was manifested by the sympathetic orientation of autonomic functions according to the results of vegetative tests, and in the neurophysiological one the predominance of desynchronizing brain system was noted.
Key words: autonomic dysfunction, chronic vertebrogenic pain syndromes, non-specific brain structures.
State Institution "Institute of Neurology, Psychiatry and Addiction of the National Academy of Medical Sciences of Ukraine", Kharkiv
VN Kharkiv National University Karazina, Ukraine
Cognitive impairment in neurodegenerative pathology as index of neuroplasticity in psychoneurological model of adaptation of patients
77 - 83
Today, cognitive function and their impairment in patients with neurodegenerative diseases is an urgent problem of modern neurology. The study of the neuropsychological profile makes it possible to more accurately present the picture of involvement in the pathological process of different brain structures and thereby facilitate differential diagnosis. In order to study the cognitive features of patients with neurodegenerative (demyelinating) pathology and the possibility of their psychoneurological adaptation, 104 patients with remitting type of multiple sclerosis were examined. To investigate verbal memory disorders, we used the method of "Remembering 10 words", which allows to evaluate such parameters as the amount of direct memory and the strength of delayed memory (ie indicators of short and long−term memory). The Schulte Tables technique was used to investigate arbitrary attention disorders, enabling the evaluation of arbitrary attention as volume, concentration distribution functions, and attention switching. It is concluded that the assessment of cognitive deficits as for personal characteristics and emotional, volitional disorders significantly reduces the informativeness and the ability to correct cognitive dysfunction. Thus, in severe remission multipple slerosis in women was more pronounced than in men, as well as a lack of ability to work and attention deficit.The revealed neurodynamic and operative disorders make it possible to draw conclusions about the severity of the neurodegenerative process and its prognosis.Timely detection of cognitive and emotional−personality changes can not only improve the life quality of patients with neurodegenerative diseases, but also act as an independent link in psychoneurological model of adaptation of these patients.
Key words: neuroplasticity, adaptation, neurodegenerative pathology, demyelination, cognitive dysfunction.
Kharkiv National Medical University
Petro Mohyla Black Sea National University, Mykolaiv
Kharkiv Medical Academy of Postgraduate Education, Ukraine
Features of ophthalmic care for patients with complicated cataracts
84 - 89
Today, around 50 million people worldwide suffer from cataracts, more than a half of them need surgical treatment. High prevalence of this pathology in Ukraine, the need to improve the provision of ophthalmic care to patients, and the reform of the health care system have made the research relevant. Concomitant diseases and special conditions of the eye increase the risk of intra− and postoperative complications, worsen the functional parameters of patients after surgery. In order to develop a unified approach to the treatment of complicated cataracts based on diagnostically related groups of patients, a retrospective analysis of case histories of patients with different variants of complications related to the condition of the lens itself, its ligament apparatus and other structures of the eye was conducted. In each case, the surgeon has to choose the appropriate modification of cataract phacoemulsification surgery. The study proposed the classification of cataract phacoemulsification modifications on the basis of the techniques and the sequence of operation stages, taking into account the classification of the degrees of turbidity of the lens, proposed by L. Buratto. It has been noted that in complicated cases, according to the indications of the patient, surgery may be performed on several modifications of cataract phacoemulsification. The developed classification made it possible to generalize the various variants of pathology and greatly facilitate the choice of tactics of surgical treatment in complicated cataracts. It can be used not only for practical application, but also for improving the qualification of trained professionals. The prospect of further research is to identify contraindications for outpatient treatment of the patients with complicated cataracts.
Key words: cataract complication, classification of phacoemulsification modifications, diagnostically related groups.
Kharkiv Medical Academy of Postgraduate Education
Kharkiv National Medical University
Medical Center for Outpatient Ophthalmic Surgery "OKO", Kharkiv, Ukraine
Experience of aflibercept application in patients with exudative age−related macular degeneration
90 - 96
Age−related macular degeneration is a threatening pathology, gradually leading to a complete loss of central vision, which adversely affects an individual physically and emotionally as well as socially, reducing the life quality of such patients. To analyze the anatomical and functional results of intravitreal injections of aflibercept in the patients with exudative age−related macular degeneration, 47 patients a were prospectively studied. Intravitreal injections of aflibercept were performed by the same surgeon under aseptic operating conditions at a dosage of 2 mg, which was 0.05 ml of the drug. All patients underwent a comprehensive ophthalmic examination, which included visometry, autoceratorefractometry, tonometry, biomicroscopy, and ophthalmoscopy under medical mydriasis, as well as optical coherence tomography. The study took place before the intravitreal administration of aflibercept, one month after each of the three loading injections, 4, 8, and 12 weeks, respectively, after the start of treatment, and 4 weeks after the fourth injection, which was performed 8 weeks after the third loading. The total follow−up period was 24 weeks. For assessing the anatomical and functional efficiency of the treatment the changes in visual acuity, which were adjusted as well as those in the central retinal thickness according to optical coherence tomography were accepted as the criteria. The treatment results showed a significant increase in visual acuity of patients with the most significant increase in the index at week 12 from the beginning of therapy, as well as to a statistically significant decrease in the central retinal thickness within six months of observation. It is obvious that a consistent use of this drug is necessary to achieve stable treatment results.
Key words: exudative age-related macular degeneration, visual acuity, central retinal thickness, intravitreal antiangiogenic therapy.
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