Medicni perspektivi, 2018;23(4)
2018 Vol. XXIII N 4
Key words: white laboratory mice, bentonite gel
Abstract. Influence of gel bentonite on physiological indicators of the white laboratory mice. Shyrobokov V.P., Poniatovskyi V.A., Yavorovskyi О.Р., Jankowskyi D.S., Dyment G.S., Bobyr V.V. The evaluation of the effect of lifelong usage of sodium form of gel bentonite on some physiological parameters of mice (body weight, feed and water intake, general condition, change in coordination of movements, state of wool, fertility and mortality) was performed on 110 white laboratory mice (BALB / c line). This experimental study was carried out in two replicates. To accomplish this task, the mice were divided into two groups: control – the animals were on a standard diet, and experimental – they used water with the addition of sodium form of bentonite gel (0.5-1%). It was found that prolonged intake of bentonite gel by laboratory animals neither led to an excessive increase in their weight (the weight gain of the experimental group did not differ statistically significantly from the control group, p≤0.05), nor did it cause acute or chronic intoxication. It is also shown that the constant use of bentonite has a positive effect on the organism of experimental mice, which is expressed in the decrease of animal mortality, increase of life expectancy and pronounced positive effect on fertility functions (increase in the number of offspring). Based on the obtained data it can be assumed that the continuous intake of bentonite by the animal organism is one of the factors of their microbiome improvement, which affects on a plenty of physiological functions, including animals reproduction. It is possible that smectite sorbents also enrich the body of mice by certain essential mineral elements (silgrey, etc.) and has cytomucoprotective properties concerning the mucous membranes of the macroorganism.
Key words: psychophysiological state, higher medical education, exam, pathological physiology
Abstract. Influence of psychophysiological features of the 3-d course students on their training at the department of pathological physiology SE "DMA". Koldunov V.V., Klopotskyi G.A., Kozlova Ju.V., Kaniuka G.S., Starushkevych G.F. The article presents the results of the individual psychophysiological features analysis of the 3-d course students of the Dentistry Faculty, who have completed studying pathological physiology. The obtained data were compared with the results of the complex exam and the results of the licensing exam STEP-1. As a result, it was found that the psychophysiological indicators of students affect on learning performance. The main psychological differences between successful and unsuccessful students are in the intellectual and emotional-will spheres. Therefore, conducting psychophysiological testing among students and familiarizing them with the results obtained makes it possible for future doctors to take into account their personal and psychophysiological characteristics not only during the training period, but also in their professional activities. Such information, on the one hand, may induce many students to work on themselves, and on the other - not to fall into illusions. Further research in this direction and carrying out correlations of the obtained results will allow to find and eliminate the causes of unsatisfactory students’ studying. Work in this direction will contribute to the development of fundamentally new teaching methods in accordance with the requirements of time and scientific-technical progress.
Key words: hypertension, gout, urat-lowering therapy, antihypertensive drugs
Abstract. Evaluation of the state of medical care in patients with arterial hypertension in combination with gout by retrospective analysis data. Kuzmina A.P., Lazarenko O.M. The prevalence of cardiovascular diseases, especially arterial hypertension, continues to increase. An important problem is the management of the patient with a comorbid pathology in the primary link by the family physician. The purpose of this study was to assess the state of medical care in patients with arterial hypertension combined with gout, using a retrospective analysis of ambulatory cards, diagnostic and treatment data. There were analyzed 105 outpatient cards that met the inclusion criteria. The mean age of patients was 53.5±10.2 years. Among the examined patients there were 99 males (94.3%), and 6 (5.7%) females. Аrterial hypertension stage II has been reported in 100 (95.2%) patients, stage III – 5 (4.8%) patients. Аrterial hypertension 1 degree is established in 74 (70,5%) patients, 2 degrees – 21 (20%), 3 degrees – 10 (9,5%). The average duration of the gout was 4.4 [4; 2] years, arterial hypertension – 5.3 [3; 1] years. Acute gouty arthritis was present in 11 (10.5%) patients, chronic gouty arthritis – 85 (81%), and chronic tofi arthritis – 9 (8.5%). Patients seek medical help from their family doctor too late. Examination of patients with hypertension in combination with gout is not complete, this contributes to underestimation of total cardiovascular risk. In a number of cases, titration of the dose of allopurinol higher than 300 mg is not, performed so only a third of patients reach the target uric acid level.
Key words: coronary heart disease, elderly patients, features of treatment
Abstract. Features of the treatment of elderly patients with coronary heart disease at the stages of 1990, 2010 and 2017 examinations. Shapovalenko I.S. The purpose of the work is to determine the characteristics of prescription, adherence to treatment and the effect of certain classes of drugs used for the treatment of cardiovascular diseases on the life expectancy of elderly patients with ischemic heart disease (IHD). 517 case histories of patients aged 60-87 (–91) years old, born in 1925-1957 with IHD were analyzed. All the examined were first hospitalized in the hospital and later were observed with the main diagnosis of coronary artery disease: stable exertional angina I-IV FC. Further observation of the patients lasted from 3 to 25 years (average observation period 10 years), until reaching the endpoint or until the last observation in 2017. The patient’s death was chosen as the endpoint, on the basis of which the life expectancy index (determined by the year / age of death) was studied. It has been shown, that therapeutic regimens for the elderly patients with coronary artery disease meet current standards for the treatment of coronary artery disease at the stages of 1990, 2010 and 2017. Patients' adherence to therapy was 82.4%. According to the data obtained, the association of taking certain classes of drugs with the life expectancy of patients was: ACE inhibitors increase life expectancy by 7 years, acetylsalicylic acid (ASA) - by 4 years, statins and β-blockers - by 2 years. The most effective combinations for treating people with IHD that affect life expectancy are: combinations of ASC, statins and ACE inhibitors - survival up to 80.14±3.16 years, ASA, statins and Ca-channel blockers - survival up to 80±1.71 years, ASC, statins and β-blockers - survival to 79.3±4.24 years, ASA and ACE inhibitors - survival to 79.59±3.83 years.
Key words: diabetes mellitus type 1, diastolic dysfunction, left ventricular hypertrophy
Abstract. Influence of the course of type 1 diabetes on the left ventricular myocardial geometry and intracardiac hemodynamic. Moshenets K.I. The aim of the study was to examine changes in left ventricle (LV) geometry and to evaluate the systolic and diastolic function of LV in patients with type 1 diabetes mellitus (T1DM) depending on the course of the disease. Materials and methods. 63 patients with T1DM were examined. The mean age was 31.5 (24.0, 39.0) years, the duration of the disease was 11.0 (5.0, 18.0) years. Laboratory tests: C-peptide, HbA1c, blood creatinine, first morning urinary albumin excretion (UAE), glomerular filtration rate (GFR) according to the formula CKD-EPI were made. Long-term monitoring of blood glucose levels during 6 days was conducted by using the CGMS system. Transthoracic echocardiography and tissue Doppler imaging were used. Patients were divided into groups: Group 1 – HbA1c≤7.0% (n = 21), Group 2 – HbA1c> 7.0% (n = 42). 10 sex- and age-matched healthy controls were included. Results. Patients with DM 1 had significantly higher indices of the LV mass index (LVMI), LV posterior wall thickness, interventricular septal excursion and left ventricular posterior wall excursion (p <0.05). Hypoglycemic episodes lead to thickening of the interventricular septum and LV posterior wall thickness, increase of LV end-systolic volume, decrease of ejection fraction, and prolongation of isovolumteric relaxation time (p <0.05). Diastolic dysfunction with impaired relaxation (grade I) was 18 in patients with DM 1 (28.57%) without significant differences between the 1-st and 2-nd groups. Concentric remodeling of LV occurs in 16 (76.2%) patients of group 1 and in 27 (64.29%) of group 2. Eccentric hypertrophy of LV is determined in 1 (4.76%) patient of group 1 and in 5 (11.9%) of group 2, respectively, and only in 9.52% patients with T1DM. Conclusions. Patients with DM 1 have signs of structural and geometric reconstruction and diastolic dysfunction. Hypoglycemia is a significant factor leading to the formation of LV hypertrophy, as well as to decrease both of diastolic and systolic function of the myocardium.
Key words: pulmonary arterial hypertension, systemic scleroderma, pharmacological treatment of pulmonary hypertension
Abstract. Management of patients with pulmonary arterial hypertension against systemic sclerodermia (part 2). Khaniukov O.O., Yehudina Ye.D., Kalashnykova O.S. Pulmonary arterial hypertension (PAH) is a serious condition caused by the damage of the small pulmonary vessels, leading to the increase of pulmonary artery pressure, pulmonary vascular resistance, development of right ventricular failure and death. PAH is one of the actual problems of modern medicine due to low survival rate, rapid disability of the patients and a high cost of treatment. PAH is one of the leading causes of death in systemic sclerodermia (SSD). PAH associated with scleroderma is a unique phenotype combining the manifestations of both SSD and PAH, the pathogenetic mechanisms of which modify the clinical picture and the course of these conditions. Timely diagnosis and treatment of PAH show significant effect on survival rates, however, early detection of PAH is still difficult in SSD due to several factors. The main causes are restriction of modern screening methods and polyorganic involvement in SSD. In comparison with other subgroups of PAH the patients with SSD-PAH poorly answer to the specific PAH therapy. SSD-PAH, along with idiopathic pulmonary hypertension (IPAH), belongs to group I of pulmonary hypertension classification and according to modern consensus has a similar pathogenesis and clinical picture, however, differences in the response to therapy are observed in these groups, that indicates the role of other pathobiological mechanisms. Recent investigations explain these differences by such factors as autoimmune and inflammatory responses, more severe vascular remodeling and direct myocardial damage in the SSD. Drug therapy of PH in SSD is similar to that in IPAH and includes prostaglandins, endothelin receptor antagonists, calcium channel blockers, which are prescribed in cases of a positive vasoreactive test, PDE-5 inhibitors. In this literature review we showed traditional and new methods of PAH treatment and their relevance to SSD-PAH in accordance with randomized clinical trials.
Key words: collagen, phrenoesophageal ligament, hiatal hernia, gastroesophageal reflux disease, platelet-rich plasma
Abstract. Ways to improve the results of laparoscopic antireflux operations in patients with big hiatal hernias. Hrubnik V.V., Iliashenko V.V., Hrubnik V.V., Paraniak M.R. The purpose of our study is to evaluate expediency of Platelet-Rich Plasma with self-fixated ProgripTM mesh use in hiatal hernia repair. The study was performed on 144 patients with gastroesophageal reflux with large hiatal hernias (the size of hernias 10-20 cm2 ), who underwent Nissen fundoplication and crurarrhaphia. All patients were divided into two groups: I group (71 patients) - we used non-absorbable self-fixating ProgripTM mesh for reinforcement of crurarrhaphia, II group (73 patients) – crurarrhaphia was done without mesh. In the patients of I group pieces of mesh were infiltrated by 2-4 ml of autologous PRP. Follow-up was completed in 128 (88,9%) patients with a mean follow-up duration of 39 months (range 12-60 months). There were no serious complications in the patients of both groups. During the 60 months of follow-up, 2 recurrences occurred in the mesh group and 14 recurrences appeared in the non-mesh group (p<0.05). Patient satisfaction was significantly higher in the mesh group (p<0.05). Our study has shown that the collagen content is reduced in patients with large HH. Thus, in such patients it is advisable to use mesh for crural reinforcement. The use of PRP provides a fast ingrowth of mesh, acts as catalyst to increase collagen synthesis and deposition, which promote to reduce the risk of recurrences.
Key words: Liver abscesses, diagnostics, surgical treatment
Abstract. Experience in the treatment of liver abscesses. Kutovoy A., Klishyn A., Kosulnikov S., Kravchenko K., Tarnopolskiy S. The paper presents the results of diagnosis and treatment of patients with liver abscesses. In the surgery of Dnipropetrovsk Regional Hospital named after І.І. Mechnikov 183 patients diagnosed with liver abscess aged 18 to 81 years were treated. In 118 (64.5%) patients the period from the first complaints to the diagnosis was up to 1 month, in 48 (26,2%) from 1 to 3 months, in 15 (8,2%) from 3 to 6 months, in 2 (1.1%) from 6 to 12. To diagnose abscesses of the liver ultrasound of abdominal cavity, computer tomography, laparoscopy were used. Treatment of liver abscesses included both conservative therapy and surgical intervention. Only 14 (7.6%) patients received conservative treatment. Surgical treatment included minimally invasive interventions under U.S. control, laparoscopic, open drainage and resection techniques. The method of choice of surgical treatment for patients with uncomplicated liver abscesses with a diameter of 3 cm or more was echocontrolled peritoneal pelvic drainage, performed in 146 (79.8%) patients. Complications of surgical treatment were found in 15 (8.2%) cases: drainage dislocation – in 12 (6.6%) patients, purulent fistula – in 1 (0.5%), intestinal obstruction – in 1 (0.5%), peritonitis – in 1 (0.5%).
Key words: in vitro fertilization, psychosomatic disorders, antiphospholipid syndrome, hemostasis system
Abstract. Prothrombotic states as risk factor of in vitro fertilization failures in women with infertility and psychosomatic disorders. Kaminskyi A.V., Boychuk O.G., Kolomiichchenko T.V. Failures of in vitro fertilization (IVF) may be associated with prothrombotic states, the circulation of antiphospholipid antibodies (APA). 93 women with infertility were screened: 1 group - 32 women without severe psychosomatic disorders; 2 group - 61 women with psychosomatic disorders. The control group consisted of 30 fertile women. The level of AFA to membrane phospholipids (phosphatidylethanolamine, phosphatidylserine, cardiolipinum), antibodies to β2-glycoprotein (β2-GPI), hemostasis (platelet count, ADP-induced platelet aggregation index, fibrinogen concentration, prothrombin index, activated partial thromboplastin time - APTT, test for soluble fibrin-monomeric complexes, D-dimer), homocysteine in the blood serum was defined. The frequency of significant AFA titres in the group of women without psychosomatic disorders was 18.9%, and if they were present - 44.3%, the rate of β2-GPI 9.6% versus 24.5%, respectively. Only in 11.5% of women in 2 groups, elevated levels of APA were associated with β2-GPI and/or one or more clinical criteria for antiphospholipid syndrome (APS). In patients with infertility and psychosomatic disorders, increased platelet aggregation in the context of relative thrombocytopenia, higher fibrinogen levels, soluble fibrin-monomeric complexes, and prolonged APTT with elevated D-dimer levels was revealed. Some patients have hyperhomocysteinemia. Factors that adversely affect the efficiency of IVF in the patients with psychosomatic disorders were noted: elevation of APA; reduction in the number of platelets; growth of the ADP-induced aggregation index; extension of APTT; increase of fibrinogen, D-dimer; homocysteine. The presence of prothrombotic states associated with APS should be taken into account when preparing for IVF and perform their appropriate correction.
Key words: chronic pelvic pain, inflammatory diseases of the pelvic organs, interleukins, personalized therapy
Abstract. Possibilities of personalized therapy in patients with chronic pelvic pain and inflammatory diseases of the pelvic organs. Grek L.Р. The aim of our study was to create a pathogenetically determined systemic approach to improve the treatment and the psycho-emotional state of a woman with chronic pelvic pain and inflammatory diseases of the pelvic organs through the individualization of therapeutic and rehabilitation tactics on the basis of the study of immune-hormonal relations, and psychopersonal characteristics of thematic patients. A comparative evaluation of the cytokine (IL-10, IL-6, TNF-α) and hormonal profile (luteinizing hormone (LH), follicle-stimulating hormone (FSH), estradiol, progesterone, prolactin, cortisol) was carried out as well as; monitoring of pain and psycho-emotional disorders of the dynamics of observation. In the dynamics of observation after the treatment for 6 months it was noted: a decrease in the pro-inflammatory activity of the cytokine profile: IL-6 by 43.28%, TNF-α by 63.27%; recovery of hormonal ratios – in 76% of women; 88% of patients identified a significant improvement in general and psychoemotional state; reduction of reactive anxiety and depressive disorders to normal values was determined in 84% of patients; regression of pain syndrome to the minimum indices according to the VAS scale was determined in 96% of patients. This demonstrates the effectiveness of personalized therapy and the possibility of expanding the therapeutic - diagnostic algorithm in patients with chronic pelvic pain.
Key words: leiomyoma, submucosal tumor, esophagus, benign tumors
Abstract. Rationale for the choice of operations in esophageal leiomyoma. Vasylkivskyi V.V., Getman V.G. Operations on the esophagus occupy an important place in the surgery of the gastrointestinal tract, since this organ passes through three anatomical regions: the neck, thoracic and abdominal cavity. The main pathologies for surgical interventions are congenital malformations, injuries, foreign bodies, burns and scarry strictures, neuromuscular diseases of the esophagus, hernia of the esophagus and reflux esophagitis, diverticula, acquired fistula, esophageal cancer, benign tumors and cysts. For the majority of these conditions clear recommendations on diagnosis and treatment have been developed. In the literature, there is no consensus on indications for conservative or surgical treatment of patients with esophageal leiomyoma and the type of surgical intervention: 1) resection of the esophagus 2) removal of the tumor with part of the wall; 3) enucleation of the tumor; 4) endoscopic removal. Mortality after resection of the esophagus or its wall with plastic is 13%, and after enucleation of leiomyoma – 2%. In our clinical study, the analysis of the performed operations on patients with leiomyoma of the esophagus was performed. The aim – to make a retrospective analysis of different types of surgical interventions in patients with esophageal leiomyoma performed in the thoracic departments of the National Cancer Institute, Kiev City Clinical Cancer Center, Kiev Clinical Hospital N 17, Zhytomyr Regional Hospital, Vinnitsa Regional Hospital. Retrospective evaluation of 66 patients with morphologically confirmed esophageal leiomyoma was made. The following types of imagining were performed in patients: radiological examination of esophagus with solution of barium sulphate and radiography, computed tomography of the chest (CTc), computed tomography angiography (CTA), magnetic resonance contrast-enhanced imaging (MRI TO). Instrumental methods: esophagogastroduodenoscopy (EGD) with biopsy, endoscopic ultrasound, endoscopic ultrasound-guided fine needle aspiration biopsy (EUS-FNA). The type of surgical interventions: proximal gastrectomy (n=3); Garlock operation (n=2); Lewis operation (n=3), resection of the tumor with part of the esophageal wall (n=6); tumor enucleation (n=52). Complications after operations in the early period: postoperative bleeding - the source is not identified, failure of the esophageal wall seam. In the late postoperative period – esophageal pleural fistula in two patients and esophageal stenosis in one patient. Indication for removal of leiomyomas: severity of symptoms, tumor size more than 5 cm, multiple leiomyomas, transition onto the stomach, patient's persistent desire, increase of volume in dynamics, changes in mucosa over the mass. Indications for resection options for surgery: adhesion of the tumor with the mucosa for more than three centimeters, the inability to exclude the malignant process, the giant esophageal leiomyoma with the transition onto the stomach. Patients who underwent non-surgical operations had a shorter postoperative hospital stay, fewer complications and a better quality of life. According to our results, preoperative biopsy with intact mucosa is not informative, but also does not increase the number of perforations.
Key words: arterial hypertension, atrial fibrillation, ischemic heart disease
Abstract. Features of the arterial hypertension clinical course in patients with ischemic heart disease and atrial fibrillation. Yalovenko M.I., Khaniukov O.O. More than 30% of the world's population suffer from arterial hypertension (AH). AH is one of the important cardiovascular risk factors. AH is associated with a 1.5-fold increase in the risk of atrial fibrillation (AF). AF is the most common cardiac arrhythmias in the population. Nowadays, AF is regarded as potentially lethal arrhythmia, in consideration of the broad range of its negative consequences not only due to significant deterioration in the quality of the patients’ life but also due to related significant increase in the incidence of serious complications and death. Objective: to study the features of the AH clinical course, the nature of the target organs lesion in patients with ischemic heart disease with and without permanent form of atrial fibrillation. The study included 78 patients, average age was 66,3±1,0, men – 43 (55,1%). Patients were divided into 2 groups: group 1 (n=42) consisted of patients with AH, IHD and permanent AF; group 2 (n=36) included patients with AH and IHD without heart rhythm disturbances. The analysis of the frequency of lesions of target organs in groups 1 and 2 showed that the III degree of hypertension was detected in 25 (59,5%) patients in group 1 and in 8 (22,2%) patients in group 2. Degree III was diagnosed in 17 (40,5%) and 24 (66,6%) patients of 1-st and 2-nd groups, respectively. Absence of targets organ damage in group 2 was documented in 4 (11,1%) patients. AF presence is associated with a severe course of hypertension and more frequent lesion of target organs. Based on the research results, it was established a direct relation between the duration of AH and the duration of the permanent form of AF. It is expedient for patients with AF arisen against the background of AH to achieve target levels of BP for prevention disease progression and improving the prognosis.
Key words: generalized periodontitis, occlusive diagnosis, bone tissue
Abstract. Dependence of the clinical course of generalized periodontitis on the quality of occlusal balance after complex treatment. Malynovskyi V.G. The purpose of this research was to study the features of the clinical course of generalized periodontitis, depending on the quality of occlusal balance after complex treatment. 128 patients with generalized periodontitis of the I-II degree, chronic course, aged 35-55 years, were examined. All of them underwent a clinical examination, computed tomography of the jaw bones, and occlusive diagnostics by means of the “T-scan III” device. As a result of the conducted studies, it was found that only in 34,4±4,2% of patients occlusal relationships were restored, whereas in the remaining 65,6±4,2% occlusion balance disorders were registered. The presence of occlusal imbalance was accompanied by a worsening of the clinical condition of periodontal tissues. It was shown that the greatest correlation is observed for the degree of occlusive imbalance with the index of osteoporosis activity (r=0.42, p<0.05), less significant – with Ramfjord indices (r=0.40, p<0.05), PI (r=0.38, p<0.05) and CPITN (r=0.35, p<0.05). Also, with disorders of occlusal balance, there was a decrease in bone mineral density, most pronounced in areas of hyperocclusion. At the same time, the revealed changes were not reliable (р˃0.05), which was explained by the focal nature of the appearance of resorptive phenomena in areas of increased occlusal load. According to obtained results, the qualitative restoration of occlusal ratios, in particular with the help of modern computer equipment, in the complex treatment of generalized periodontitis is the key to long-term clinical and X-ray stabilization of the disease.
Key words: professional agrarian lyceum, professionally conditioned functions, donosological diagnostics of mental states, computer program «Agrotest»
Abstract. Donosological diagnostics of pre-pathological mental states in students of Professional Agrarian Lyceum using the «Agrotest» computer program. Bogachova O.S., Korobchanskiy V.O. Modern ideas about the role of psycho-physiological functions in the formation of personality indicate that the prognostic value of the main properties of the central nervous system (CNS) is the physiological basis of the formal-dynamic side of the behavior of each individual person. Against the background of inconsistencies of psycho-physiological functions with professionally significant requirements, pre-pathological conditions associated with impaired psycho-physiological adaptation of adolescents arise, which affects the functional state of their body, and, above all, has negative consequences in relation to the central nervous system. The purpose of the study is to identify and correct the development of donosological mental states in order to prevent possible disorders in students of professional agrarian lyceum (PAL) using a computer program on determining the leading professionally significant functions by the "Test program of professional suitability for agrarian professions "Agrotest"”. 100 students aged 15-18 studying agrarian specialties at the Odnorobovsky Professional Agrarian Lyceum were under supervision. We divided them into 3 groups. The study was conducted using our developed computer program "Test program of professional suitability for agrarian professions «Agrotest» and "psycho diagnostic questionnaire for high school pupils”. The students who mastered agrarian specialties at PAL suffered from the disturbance in the process of psychophysiological adaptation, this directly affects their functional state by the development of fatigue in the 2-nd year of study, resulting in a high percentage of donosological pathology in this group of students with significant increase in the 3-rd course of study (p <0.05). It has been established that the propagation of donosological mental states in students of professional agrarian lyceum (PAL) affects the background disorders of the functional state of the central nervous system, which requires immediate introduction of psychohygienic measures.