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Hypertension leads to the myocardium and cardiac interstitium remodeling, causing a number of pathological changes: left ventricular myocardial hypertrophy, myocardial fibrosis, potentiation of ischemia, structural rearrangement and apoptosis of cardiomyocytes. Its other consequences are endothelial dysfunction and an increased stiffness of the main arteries. The whole complex of these changes forms a vicious circle and reflects the essence of change, i.e. the so−called "hypertensive heart". To assess the heart structural and functional state in hypertension, we examined 58 patients with stage III disease in the long term after ischemic stroke. In all patients the blood pressure was daily monitored and they were examined with Doppler cardiography. Left ventricular hypertrophy occurred in 51.8 % of cases: eccentric and concentric hypertrophy predominated, as well as concentric remodeling was recorded in only 6.9 % of the studied cases. Among the individuals without left ventricular hypertrophy, the daily non−dipper blood pressure profile was determined in 24.0 %, the night−peaker one was found in 12.0 %, dipper one was revealed in 56.0 %, and over−dipper was noticed in 8.0 % surveyed; while in the presence of hypertrophy, the prevalence of night−peaker increased significantly up to 14.3 % and non−dipper did to 33.9 %. In the patients with eccentric and concentric hypertrophy and persons with concentric remodeling, the daily non−dipper blood pressure profile was diagnosed in 32.0, respectively; 30.0 and 45.5 %, night−peaker − in 20.0; 10.0 and 9.1 %, dipper − in 48.0; 60.0 and 45.5 % of cases. The results show that the patients with stage III hypertension who have suffered an ischemic stroke undergo remodeling of the myocardium and cardiac interstitium, resulting in the formation of "hypertensive heart", that is an early clinically significant sign of the pathophysiological state of the cardiovascular system.

The combination of chronic heart failure and metabolic syndrome is a common clinical case. Patients with this pathology belong to the group of a high cardiovascular risk, which is explained by the higher frequency and severity of traditional cardiovascular factors. Of particular interest is the use of "L−BIOCOMPLEX (liposomal)" dietary supplement of "Biolik" company (Kharkiv, Ukraine), available in liposomal form as a set of L−carnitine + thioctic acid in cardiovascular pathology. To study its effect on treatment efficiency, 40 patients with chronic heart failure in combination with metabolic syndrome were examined. The treatment result for the patients whose complex treatment included "L−BIOCOMPLEX" at a dose of 5 ml of L−carnitine and 10 ml of thioctic acid once a day 30 minutes before meals for four weeks, and those receiving only basic therapy. It has been shown that L−BIOCOMPLEX as an additive to standard therapy improves the clinical and functional state of patients: reduces the functional class of chronic heart failure, increases exercise tolerance, enhances diastolic heart function and boosts the left ventricular ejection fraction in the left ventricle. The inclusion of "L−BIOCOMPLEX" in the traditional scheme of therapy helped to improve the quality of life of patients. As part of the combination therapy of the patients with chronic heart failure the "L−BIOCOMPLEX" positively affects lipid and carbohydrate metabolism, reduces atherogenic lipids, diminishes the severity of insulin resistance. Thus, "L−BIOCOMPLEX" has a positive influence on additional risk factors, affecting the cardiovascular prognosis and playing a significant role in the mechanisms of development and progression of heart failure.

Esophageal cancer remains one of the most common cancers with a high mortality rate worldwide. A certain problem when treating the esophageal cancer is the highly traumatic surgery, a significant number of post−surgery complications from esophagogastroanastomosis and severe postoperative pain. Therefore, there is a need for new developments and techniques for the formation of esophagogastroanastomosis to minimize post−surgery complications. To reduce the number of postoperative anastomotic complications and improve the pain control in patients after esophageal resection, a study was conducted that included 60 patients with esophageal cancer and cardioesophageal transition. We compared two methods of esophagogastroanastomosis formation: intussusception mechanical and circular mechanical, as well as those of postoperative anesthesia, namely, a combination of thoracic paravertebral blockade and thoracic epidural anesthesia using only thoracic epidural anesthesia. Due to our findings the effectiveness of the proposed intussusception mechanical anastomosis was proven, which allowed to significantly reduce the frequency of endoscopically detected reflux esophagitis by 1.5 times at the end of the one year follow−up observation. It is established that anesthesiological support of postoperative anesthesia during surgery for malignant diseases of the esophagus using combined postoperative analgesia (thoracic paravertebral blockade and thoracic epidural anesthesia) reduces the endocrine−metabolic response in men, generally makes it possible to prevent the development of post−surgery complications.

Burn injuries and their treatment is an important medical and social problem. Compartment syndrome is a serious complication of deep circular burns, which causes increased subfascial pressure and local tissue ischemia with the development of intercellular interstitial edema and a significant rise of intra−tissue pressure, which exacerbates tissue blood supply, enhancing the tissue hypoxicity. Treatment is performed by necrotomy, which due to decompression helps to reduce intra−tissue pressure and reduce the scale of necrobiotic processes in damaged tissues. To develop a method to treat deep subfascial burns, a study was conducted in 15 patients. Dynamic monitoring of tissue pressure in the fascial sheaths of each muscle allowed to determine the direction and degree of degenerative−destructive changes caused by zonal microcirculation disorders, increasing edema, hypoxia, ischemia and necrosis of individual muscle fibers, which helped to determine the need for surgery. The method of treatment included decompression necrofasciotomies with opening of zonal fascial−aponeurotic muscular bed−cases of the first order in the paranecrosis areas; general anti−shock and detoxification therapy; local ozone therapy with a complex of cytoprotectants and antioxidants; necrectomy and autodermoplasty. According to the results of the study, it is concluded that an important place in treatment of the compartment syndrome in the patients with deep burns is the objectification of intra−tissue pressure. The method of determining the dynamics of compartment syndrome and surgical tactics will allow preserving the viability of a significant part of the damaged muscle mass, reduce the volume of tissues that underwent necrectomy, restore the skin timely.

Dysmenorrhea is a cyclic pathology, characterized with the appearance of pain on the menstruation eve or in its first days. This condition affects the quality of life of women on a daily basis, causes absences at study and work, and restricts participation in sports competitions or social events. In addition, many women experience constant emotional stress associated with dysmenorrhea. However, if the treatment is chosen correctly, general prognosis is good. Complications depend primarily on the intensity of pain, which affects a woman's quality of life and daily activities. If the primary dysmenorrhea is not associated with any pathology or disease and does not have any serious complications, then the secondary one, depending on the etiology, the complications may indicate infertility, pelvic prolapse, severe bleeding and anemia. Nonsteroidal anti−inflammatory drugs have been shown to be the first line of treatment for dysmenorrhea. In severe cases, higher doses of these drugs or combination / adjuvant therapy are prescribed. If their use does not provide sufficient improvement of the patient's condition, hormonal drugs are prescribed in a cyclic mode, i.e. progestogens or combined oral contraceptives. All oral hormonal contraceptives are considered effective in reducing the pain of dysmenorrhea in girls, but in adult women, especially in secondary amenorrhea, data on the effectiveness of hormonal contraception are poor and contradictory. A balanced, healthy diet improves the dysmenorrhea course, so it is important that women are aware of its need. Vitamins and dietary herbal supplements have also been quite effective in dysmenorrhea treatment. Further investigations of modern methods of hormonal contraception, the possibility of their long−term and safe use in dysmenorrhea in women of different ages is promising.

External genital endometriosis is one of the most common gynecological proliferative diseases. The disease development is based on molecular and genetic disorders that occur in women and are the result of the cell response to oxidative stress. In endometriosis the polymorphism of genes of detoxification systems, depletion of antioxidant defense mechanisms due to hormonal imbalance and activity of pro−inflammatory processes are called the causes of oxidative stress. Currently, much attention is paid to aspects of the immune system and local peritoneal factors. To develop diagnostic criteria for the stages of external genital endometriosis by determining the activity of enzymes of the antioxidant system and catalase in serum and peritoneal fluid, a study was performed in 86 patients. The research results showed that in external genital endometriosis of stages I−II in the serum of women the catalase activity increased, and that of superoxide dismutase remained at the physiological level. Determination of the studied enzymes in peritoneal fluid indicates that their parameters correspond to the control values in women without endometriosis. Thus, the study showed that the patients experience multidirectional changes in antioxidant system, which are manifested in increased catalase activity at the systemic level at the disease stages I−II and local one at stages III−IV. At the same time, the activity of superoxide dismutases at all stages of the disease in both serum and peritoneal fluid is normal. The state of the antioxidant system is concluded to depend on the peculiarities of micronutrient metabolism. Further study and correction of its possible disorders may positively affect in preventing and treatment of external genital endometriosis in women.

Diabetes mellitus in women is a serious problem due to the unfavorable prognosis for the child's life. The urgency of the issue of disordered carbohydrate metabolism during pregnancy is associated with the complications that may occur in the mother and her fetus at different stages of gestation. The issue of reproductive health in diabetes is very important for modern medicine, because fertility disorders lead to a complicated pregnancy and its adverse consequences. To establish the probable risk factors for perinatal pathology in patients with Diabetes mellitus, a retrospective study was conducted, which included pregnant women aged 18 to 42 years living in the Lviv region. Somatic, reproductive anamnesis and complications of pregnancy were studied. The results suggest that diabetes can occur in women of any reproductive age. Its factors may be the mother's endocrine pathology and medication, risks associated with chronic somatic disease, namely, the urinary system and its combination with endocrine pathology, history of reproductive loss (miscarriage, stillbirth, children with congenital malformations), complications of pregnancy, most often these are polyhydramnios in combination with preeclampsia and impaired uterine and fetal blood flow; premature birth, mostly by cesarean section, the birth of premature babies. Identification of risk factors for perinatal pathology in women with diabetes is necessary to determine its new informative markers in this population. This will allow the establishing of a database for further research, which will facilitate the timely identification of pregnant women at risk, improve pregnancy prognosis, reduce perinatal pathology and also will be of medical and social effect.

Radiation and polychemotherapy significantly affect the immune system of a cancer patient, unabling to adequately respond to infectious agents and provide effective antitumor protection. Rehabilitation of immune disorders is an urgent task, the solution of which will contribute to the generalization of experience when suing the immune modulators in cancer patients. To summarize the existing data on the use of concomitant immune therapy in antitumor treatment, the reports published within 30 years in Pubmed, Cochrane Library, ScienceDirect and the Vernadsky National Library of Ukraine were analyzed. It is expedient to use immune correction at different stages of antitumor treatment in the case of compliance with certain criteria for the prescribing the immune modulatory drugs. Their use is most justified after the primary tumor removal, even in the presence of metastases, because the increase in antitumor resistance is achieved in the absence of tumor cells in the patient's body or their presence in minimal quantities. Possibilities and goals of concomitant immune therapy in cancer patients should be considered taking into account the stage of treatment. Immune modulators with additional properties (detoxification, antioxidant) can serve as universal drugs. In the early post−surgery period, it is advisable to use the drugs, affecting the cells of the mononuclear phagocyte system for the prevention of postoperative infectious complications. During radiation and chemotherapy, preference should be given to the drugs with antitoxic effects and capable of preventing the leukopenia development. Thus, the prescribing of concomitant immune therapy in the combined treatment of cancer patients is an important task, demanding a balanced approach.

The problem of adrenal metastases and the need for ipsilateral adrenalectomy during nephrectomy in the patients with renal cell carcinoma has not yet been resolved. To study the clinical and morphological features of adrenal metastases of renal cell carcinoma and to identify a group of patients with a high probability of their development, pathological findings and case histories of 108 patients who underwent surgery included adrenalectomy or adrenal resection were retrospectively examined. Characteristics of patients and tumors in the groups of adrenal metastases and adrenal bulk formations not being cancer metastases were comparatively analyzed. When analyzing the tumors from the group of benign formations of the ipsilateral adrenal gland, it was found that in most cases they were represented by cortical adrenal adenomas without signs of hormonal activity. The histological structure of benign neoplasms was most often represented by clear cell and mixed−cell adenomas, dark−cell adenoma was observed in one case. The patients of this group complained mostly of common a persistent or intermittent rise of blood pressure. Patients with synchronous adrenal metastases of cancer are characterized by large kidney tumors, signs of local spread. According to the study results, it was concluded that the prognostic value in terms of differential diagnosis of adrenal metastases and adenomas in the patients with renal cell carcinoma there was demonstrated only by macroscopic intravenous cancer. The characteristics of the adrenal glands themselves were not objective prognostic parameters for the differential diagnosis between benign and malignant pathology. Ipsilateral adrenalectomy is indicated in the patients with intravenous renal cell carcinoma.

The problem of studying the structure, diagnosis and treatment of mental disorders in Ukrainian servicemen has been acute since the beginning of the Anti−Terrorist Operation in 2014 and later with the change of its format to Operation of Joint Forces with a large number of troops to participate in hostilities. To establish the features of the debut and clinical manifestations of dissociative disorders in servicemen, 34 combatants were examined. Research methods were as follows: anamnestic, psychopathological, psychodiagnostic, statistical. The following dissociative manifestations were noted: motor disorders in the form of tremor of the upper extremities or the whole body, pseudoparesis and pseudoparalysis, motor tics, globus hystericus, seizures in the form of pseudoepileptic seizures, speech disorders, stupor, short−term amnesia, partial vision loss etc. In servicemen, such manifestations were found at symptom and syndrome levels in 55.88 % of cases; those reached the nosological level were observed in 44.12 % and were part of the structure of such disorders as isolated dissociative disorder, maladaptation, post−traumatic stress disorder. The clinical picture and severity of dissociative manifestations depend on the stressor, age and personality traits of the serviceman. Their immediate causes were recognized as: the state of anticipation of an inevitable event, the occurrence of which the patient subconsciously wanted to avoid; the state of being in the middle of a psychologically uncomfortable environment; state of being in a short−term, acute life−threatening situation; condition after the last acute or a number of acute psycho−traumatic situations of a life−threatening nature; in the structure of flashbacks; a condition after or on the background of an acute or chronic psycho−traumatic situation of a life−threatening origin or a state of chronic psycho−emotional and physical fatigue, which was accompanied by sleep deprivation.

The main manifestation of epilepsy is a seizure, the clinical embodiments of which depend on the location of the epileptic focus in brain, the pathways of excitation, brain maturity, and so on. Many neurological diseases, including epilepsy, are myoclonus, i.e. short−term involuntary contractions of single or groups of muscles in the torso and limbs. The prevalence of myoclonus in radically different options for predicting the diseases not only of the nervous system, but also of other organs and systems determines the relevance of this problem. In order to study, analyze and generalize modern approaches to epileptic myoclonus, its diagnosis as well as differential diagnoses, and also treatment at different ages for implementation into practical medicine, 62 children with epilepsy were examined. The results of the study show that myoclonic epileptic seizures are more common in young children. Such conditions were observed in most patients in the structure of idiopathic generalized epilepsy. In children of early age there are very frequent serial attacks which are combined with several other types of attacks: infantile spasms, tonic, clonic, atonic. Most patients had a drug−resistant type of disease. In adolescents the idiopathic forms prevailed. Myoclonic seizures could be combined with other generalized types of seizures. In this study, more than half of the patients had a drug−resistant course due to the encephalitic type of epilepsy. Almost half of the children managed to achieve stable remission for more than a year. Patients received levetiracetam, clonazepam in age doses as mono− and polytherapies. According to the results of the study, it was concluded that the correct diagnosis, timely treatment are the basic principles of management of the patients with myoclonic seizures.

Radiation therapy is a mandatory treatment tactic in almost 70 % of cancer patients, including those of head and neck, accounting for about 15−20 %. The radiotherapy prescribing causes certain complications in patients, so its need increases the level of anxiety and stress, forms a pessimistic perception of the prospects of anticancer treatment. An additional stressor is also the myths about radiation therapy, which can provoke the refusal of treatment. Therefore, an important task of medical care at the stage of radiation treatment is not only psychocorrection of the emotional sphere, but also correction of cognitive distortions, psychoeducation, the formation of a satisfactory therapeutic alliance and commitment to therapy. To study the features of psycho−emotional adaptation in preparation for radiation therapy in the patients with head and neck cancer, 60 patients were examined. To determine the psycho−emotional status of cancer patients there were used a clinical method (survey, collection of complaints and anamnestic data), a test of differentiated self−assessment of the functional state "Feeling, activity, mood", the method of "Distress Thermometer". It was found that during the procedures of radiation therapy in 90 % of patients the rate of distress increased and positively correlated with the test "Feeling, activity, and mood". The average indices of psycho−emotional state according to all scales of the test "Feeling, activity, mood" decreased. Criteria for adaptation to radiation therapy were identified: compliance with the basic rules and requirements related to nutrition, hygiene, keeping the regimen; timely and qualitatively informing the doctor about changes in the patient's condition; quality of relationships with staff. It is concluded that the need for psychocorrectional work at the stage of the course of radiation therapy with the selection of the main targets for psychotherapeutic interventions.

New facts about the importance of the JAK−STAT signaling system in development of a number of inflammatory and autoimmune diseases are now emerging. The JAK−STAT system, or pathway consisting of Janus kinase (JAK) and signal transducer protein as well as transcription activator (STAT), transmits information from extracellular polypeptide signals through transmembrane receptors directly to target gene promoters in the nucleus without the involvement of secondary messengers. The JAK−STAT system plays an important role in the implementation of immunological processes and is considered a therapeutic target in immune−mediated inflammatory diseases. JAK inhibitors are so−called yakinibs, low molecular weight chemically synthesized targeted drugs that inhibit intracellular JAK signaling molecules and interrupt the effect of interleukins on the cell. Drugs have an acceptable benefit−risk ratio. The most common side effects are infections of the upper respiratory tract, urinary tract and gastrointestinal tract. The safety profile of topical JAK inhibitors is better than that of oral drugs due to their minimal systemic absorption. For the first time, JAK inhibitors have been shown to be effective in rheumatoid arthritis and myelofibrosis. Disordered regulation of the JAK−STAT signaling pathway is observed in various inflammatory and autoimmune skin diseases. JAK molecules are overexpressed in epidermis, dermis in psoriasis, atopic dermatitis, alopecia areata and vitiligo. Decoding the new mechanisms of pathogenesis of psoriasis, atopic dermatitis, alopecia areata, vitiligo created the preconditions for improving their pharmacotherapy with the use of inhibitors of Janus kinases. Today, JAK inhibitors are the most promising specific target agents when treating the immune−mediated dermatoses.

To determine the levels of personal and situational (reactive) anxiety in adolescents with psoriasis, depending on the clinical and epidemiological characteristics of dermatosis as well as the indices of pathology severity, we examined 30 patients aged 13−17 years. The study used Spielberger's method in Yu. Khanin modification depending on sex, age biological periodization, duration of course and exacerbation of psoriasis, the cause of dermatosis and indices of pathology severity in adolescents. The research results revealed a high level of personal anxiety, increasing with age, in most individuals examined. It has been suggested that high levels of personal anxiety in patients with psoriasis as a genetic trait that is prone to excessive anxiety provoke the appearance of psoriasis after a stressful situation. A high level of situational anxiety was detected in only 30.0 % of cases. Girls have a significantly higher level of personal anxiety and a 1.5−fold predominance of situational anxiety over boys. There is also an increase in the level of personal anxiety with a rise in intensity of cutaneous manifestations of psoriasis: the more hyperemia, peeling and infiltration of psoriatic lesions in girls, the stronger the stress and anxiety. Because adolescence, which is intermediate between childhood and adulthood and is characterized by new psychological phenomena (personal self−affirmation, the young person's need to communicate, increase contacts, formation of a new worldview, review and change previously established beliefs, values and norms of life), therefore it is likely that the data obtained during the study on anxiety levels in adolescents with psoriasis are related to the disease specifics and course.

The spine is a complex biomechanical system with dual support and protection function that can adapt to different loads. The vertebromotor segment function depends on the structure of the vertebrae and intervertebral disc, mechanical strength of the structures that provide stability in this department. In a stable segment, the normal relationship between the vertebrae is maintained, which prevents their deformation and pain under normal physiological stress. It is also important to protect the spinal cord, nerve roots and minimize energy expenditure. Instability of the vertebromotor segment is manifested in its pathological mobility, among the causes of which are degenerative changes in the discs, intervertebral joints and musculoskeletal system, recurrent microtraumas, inflammatory processes, developmental abnormalities, genetic diseases. There is a relationship between the degree of spinal motor segment instability and the degeneration severity in the discs. The most common method of radiological diagnosis of instability of the spinal motor segment is functional radiography, which is performed either in projection with flexion and extension, or with passive axial traction and compression. Multislice computed tomography and magnetic resonance imaging are also used to diagnose this condition. Magnetic resonance imaging is considered the most accurate method of diagnosing degenerative pathologies of the spine. The range of use of ultrasound in the diagnosis of pathologies of the musculoskeletal system, in particular the spinal motor segment, is expanding. In the study of instability of the cervical and lumbar spine, it is appropriate to use all methods of radiological diagnosis. X−rays, in addition to detecting vertebral displacement, can assess other changes in them, and magnetic resonance imaging and ultrasound better detect degenerative changes in the discs.