The Journal of V. N. Karazin Kharkiv National University. Series «Medicine»

5-8

Authors: V.I. Zaljubovsky

The historical aspects of development of department of surgery of one of the eldest now operating Institutes – Kharkov University – from the moment of foundation to our days are presented in the article. Some not popular episodes of activity of prominent domestic surgeons are marked: P.M. Shumlyansky, T.L. Vancetti, V.F. Grube, A.G. Podrez et al, putting began becoming of Kharkov surgical school. Basic directions of pedagogical, scientific and medical activity of present collective of department of surgical diseases of the Kharkov National University by V.N. Karazin are lighted up.

13-17

Authors: Yu.V. Nikitchenko, V.N. Dzyuba, Т.N. Оvsyannikova, О.Ye. Bityutskaya, V.V. Bondar, А.А. Sheremet, А.S. Popovich

The peculiarities of change of prooxidant-antioxidant balance in rat hepatocytes and blood serum under unbalanced nutrition and possibilities of its correction by means of supplement of ration by food addition (biopolymer from rapana tissues (BR)) were investigated. It was found out that the used food addition in conditions in vitro had revealed significant antiradical activity. It is shown that the use of BR against the background of unbalanced ration led to normalization of lipid hydroperoxides content in blood and significant decrease of the level of these LPO products in rat hepatocytes, to the slowing of glutathione peroxidase activity decrease in hepatocytes and normalization of superoxide dismutase activity in blood of experimental animals.

21-26

Authors: T.A. Ryzhkova

The adhesive properties of pathogenic Corynebacteria under aerobic and microaerophilic conditions of incubation were studied. It was determined that decreasing of oxygen concentration during cultivation resulted no changes in C.d.gravis tox+ NCTC reference strains adhesiveness. For museum and circulating Corynebacteria under microaerophilic cultivation’s conditions it was typifying the initial adhesiveness depression with next following return to benchmark and posterior adhesive activity increase after fifth-eighth and tenth passages. The C.d.gravis tox+ PW-8 v. Massachusetts strain adhesiveness changed in different directions during cultivation in microaerophilic conditions.

33-36

Authors: E.D. Khvorostov, N.V. Cherkova

The reparative processes in hepar's parenchyma were explored on 84 rabbits breed of Chinhilla in the mass 3-3,5 kg by influence of electrocoagulation and ultrasound after operation on 1, 3, 7, 14, 30 days using the method of electron microscopy. Animalr were operated behind introvenosus tiopental narcosis. The holecystectomy was made with using electrocoagulation influence (the first group) and ultrasound influence (the second group). The control group included 6 rabbits without surgical operation. The pepth and degree of intensity of dystrophic process are less after ultrasound influence than after using of electrocoagulation.

41-45

Authors: N.N. Voloshina, T.P. Yabluchanskaya

Influence of constitutions features of structure of body of man is studied on the linear indexes of heart at dilatational cardiomyopathy (DKMP) by an ultrasonic method. A basic group was made by 123 patients with dilatational cardiomyopathy (DKMP), and group of comparison – 69 practically healthy persons. Age inspected in the first and second groups – 57,7±16,4 and 56±17,4 years. Konstitutions types: asthenic, normosthenik, hypersthensk determined on the basis of indexes of relative length of trunk and relative width of shoulders. The put tasks decided with the use of echocardiography research in Mcode and In on a vehicle («Siеmens»). A heart was probed by a scan-out from different acoustic accesses. The geometrical indexes of the left auricle, left and right ventricles and pulmonary artery were determined (LA). Exactness of measurings made 0,5 mm. The got results processed the methods of mathematical statistics. Settled accounts mean (M) and middle quadratic deviation (sd). Authenticity of distinctions was estimated with the use of t- criterion of St'yudenta at the level of meaningfulness of p≤0,01, and in small selections by the non-parametric criterion of Vilkoksona. Results rotined that at DKMP the sizes of chambers of heart on the average on 50% exceed characteristic healthy persons, here is an increase of all of linear sizes of heart, in a greater measure, ventricles and auricles and, in a less measure, aortas. With a transition from an asthenic to the hypersthensk type build most linear indexes of heart increase both at healthy and patients with DKMP. In ultrasonic diagnosis hearts at DKMP it is necessary to take into account the type of build of inspected.

49-53

Authors: Yu.B. Zakharchenko, V.S. Shevchenko

The acute cholangitis development rules in residual choledocholithiasis were studied. The task was set to identify dependence of acute cholangitis expression on bile ducts pathological lesions degree in residual choledocho-lithiasis. 23 patients with residual choledocholithiasis, 6 (26,1%) men and 18 (73,9%) women aged 37 to 69. 8 (34,8%) patients delivered to the hospital had external drainage of choledoch. Diagnostic program included clinical laboratory methods of investigation, ultrasound scanning, fistulocholangiography and retrograde cholangiography, endoscopic investigation of the upper portion of gastro-intestinal tract with Vater’s papilla visualization, bacteriological examination of bile, histological investigation, choledochomanometry. In all cases of residual choledocholithiasis there were revealed evidence of acute cholangitis, in 14 (60,9%) cases – fibrinous cholangitis, acute purulent cholangitis – in 9 (39,1%) cases. The bacteriological investigation of bile revealed colon bacillus, Proteus, Klebsiella, enterococcus, anaerobes non-sporeformers. Thus, residual choledocholithiasis was attended by acute cholangitis of various degree of manifestation. It should be considered in planning of treatment program for patients with residual choledocholithiasis.

61-64

Authors: I.S. Lebez, G.V. Letyago

The state of vascular sector of the microcirculatory system was studied by capillaroscopy of the nail matrix in 106 adolescents, aged 15-18, with OA. It was established that degenerative lesions of joints were characterized by development of various vascular changes in the microcirculatory system. The most frequent disorders were twisting of capillary branches, moderate spasm of arterial sector, a decrease in the quantity of capillary rows, and in the number of functioning capillaries in them. Besides, there was determined irregular arrangement of capillaries in the row and contraction of capillary loops. All that testified to the development of capillarotrophic insufficiency which contributes to development and progression of degenerative changes in the articular cartilage.

68-72

Authors: N.N. Popov, E.V. Ognivenko, E.A. Romanova

The efficiency of administration of chlorophylliptum as an immunomodulator as well as that of applica-tion of essentiale and potassium orotatum for compensation of the pathogenetic immunity link malfunctions in purulent rhinosinusitis patients suffering from insular diabetes has been investigated in our work. Under the influence of introduced therapy considerable reduction of superoxide radical exoproduction by cells, red-uction of proinflammatory cytokine content in blood serum (interleucin-1β, interleucin-6, tumor necrosis fac-tor-α) and dynamic reduction of tissue-aggressive factor content in blood serum (average and small molecular circulating immune complexes, autoantibodies to collagen and elastin) have been observed.

76-80

Authors: M.A. Tymkovich, V.P. Maliy

The conducted immunological researches in the patients with CHB gave the opportunity to establish two types of immunological body reaction at HBV: dysociative and hyporeactive, which are found in close correlation with the degree of activity, biochemical violations and clinical symptoms of disease. The influence of immunological body reaction on the clinical course of the chronic HBV-infection was studied. At patients with CHB with the set hyporeactive type the significant of basic clinical symptoms of disease differed by less duration on comparison with similar significant at patients with a dysociative type.

85-91

Authors: E.D. Khvorostov, M.S. Tomin

The results of experimental and clinical application of ultrasonic scalpel are analysed at implementation of operations on a stomach. In an experiment there were 70 rabits of breed Chinchilla. An ultrasonic scalpel was utillized in the basic group of animals (n=35), in control (n=35) is a monoarctic electro-knife (MEN). In clinical part patients with the surgical diseases of stomach (n=111) parted on two groups. In a basic group (n=46) operative interferences were executed by USS, in control (n=65) – with MEN. Morphological changes, what be going on under the action of physical types of energy, are studied. It is set that ultrasonic dissection does not render the serious damaging affecting gastric wall, and a section takes a place quickly and bloodless. On the basis of findings an ultrasonic scalpel is recommended for forming of gastroenteroanastomosis in clinical terms.

95-104

Authors: L.A. Martimyanova, N.V. Makienko, N.Yu. Usan

Clinical pharmacology of beta-adrenoblockers within the framework of ATC classification system is described. Clinical classification, pharmacokinetics and pharmacodynamics features of this drug group are given. Clinical application and principles of beta-adrenoblockers use at basic diseases in a therapeutic clinic are examined. Accents on beta-adrenoblockers use in patients with arterial hypertension, ischemic heart diseases and chronic heart failure are made. The main side effects of drugs, absolute and relative contraindications, and interaction with other medications are described.

5-9

Authors: S.О. Bychkov, R.М. Grynyov, L.N. Duchik

After the carried out experimental researches authors submit experience of performance 101 laparoscopic operation on organs of hepatobilear system with application of low temperatures influences. For cryoinfluences it was used the own designed cryoapplicator. The analysis of the received results allows to recommend more wide using of low temperatures at laparoscopic operations.

12-15

Authors: A.V. Martynenkо, M.I. Yabluchansky, S.V. Ostropolec

The method extending spectral analysis of heart rate variability (HRV) application for patients with sinus arrhythmia was proposed. The method is based on rhythmogram physiological clusterization that generalized as empirical smooth of time series. Рroposed method exactly split mixed signal on true independent sources: we obtain stochastic and harmonic sources when we split real HRV records and TP of harmonic source good correlated with expected TP value for patients’ age group. Thus method extends HRV technology for medical practice.

20-23

Authors: A.V. Skripchenko, M.V. Smelyanskaya, S.D. Peremot, A.V.Martinov

Associations of intracellular infections and trichomonadis in etiology of chronic inflammatory diseases of urogenitalis organs for men exposed in 97% cases. Thus the associations of three infectious agents come to light more frequent than all (more than 60%), one of which – richomonadis. A presence in the association of viral agent (HSV or CMV) stipulates more heavy clinical flow of disease of urogenitalis system.

31-36

Authors: A.I. Tsivenko, N.V. Cherkova, I.S. Panchenko, S.I. Zabroda

3879 medical cases of various gallstone disease types with laparoscopic cholecystectomy were analyzed. As a result it was found that more mild currency of the post operation period with less reaction of organism on operation trauma and less percent of postoperation complications is seen in patients undergone operation with ultrasound. Usage of ultrasonic influence is multifunctional: it allows to carry out simultaneously cavitation, coagulation, dissection of tissues in the field of intervention that warns billing, a bleeding, damage extrahe-patic bilious channels, necrosis of tissue and promotes decrease in- and postoperative complications

43-48

Authors: I.A. Bondarenko, N.I. Yabluchanskіy

The clinical parameters, indices of external respiration function (ERF) and heart rate variability (HRV) in patients with chronic obstructive pulmonary disease (COPD) against a background of the basic therapy were investigated. The study involved 105 patients with COPD in the stage of remission (36 female and 69 male) aged 60.49.6 with COPD lasting 10,1±5,3 years. The complex investigation demonstrated efficacy of the long-term basic therapy for COPD. Initial variations in the clinical state, degree of ERF and HRV parameters in patients with COPD depending on the gender, age, duration of the disease, term of smoking and initial level of total power of HRV spectrum and their different reactions against a background of basic therapy were revealed. The importance of HRV technology for control of the state of regulatory systems in patients with chronic obstructive pulmonary disease on the stages of basic therapy was proven.

53-58

Authors: K.V. Vovk, N.A. Bruev

The mutually aggravating influences of one disease on the clinical course of the other one are observed in the combination of ischemic heart-disease (IHD) and peptic ulcer (PU). The purpose of the present work is to determine the course features of the concomitant PU in the patients with IHD and possibilities of its drug correction. Examination of 114 patients was carried out under conditions of cardiological department of the Kharkov Regional Hospital; during the FGDS, PU (33,3%) was discovered in 38 of the patients with the IHD at the age of 30-65 (47,4±4,9). The course feature of the PU in combination with IHD is change of clinicolaboratory criteria, that shows up in 50% cases with pain syndrome with moderate monotonous intensity; presence of dyspeptic syndrome (in 34% cases) in the form of meteorism and diarrhea (in 27% cases) and constipation (in 42% cases); increase of secretory and acid-forming gastric function (17,1% cases); semination of mucous coat of stomach with helicobacterium infection (in 50% cases). Abnormality of the cardiovascular fitness with PU and IHD was accompanied by tachycardia, moderate increase of blood pressure and ST segment depression, that was predisposing to the rise of aggression factor in the mucous coat of stomach with impaired microcirculation, trophic disturbances and development of the PU (in 33%). The complex therapy in PU with IHD, including the use of clacid, ammoxicillin, pariet in combination with actovegin, results in improving of therapeutic effects and contributes to acceleration of healing of ulcerous defect of the mucous coat of stomach.

66-73

Authors: P.А. Garkaviy

265 AH patients investigated. 98 patients were taking CA, 85 – BB, 82 – ACE. Hydrochlorothiazide was added to one of the drugs if hypotensive effect was insufficient. BP was measured before, within 1, 2 weeks, 1,3 and 6 months after treatment. Two groups were identified during the tilt test: group 1 – normotensive orthostatic reaction (NOR), BP changes from -5 mmHg to +20 mmHg, and group 2 – hypotensive orthostatic reaction (HOR) – 20 mmHg and more SBP decrease and/or 10 mmHg and more DBP decrease. According to our data all three drugs effectively decreased BP, but the dynamics and grade of decrease varied. CA had the most powerful hypotensive effect, decreasing SBP and DBP already on the 1-st week of drug intake, especially in patients with HOR, both in clinostasis and orthostasis. CA therapy increased frequency of HOR on DBP on 5%. BB had less powerful hypotensive effect and in patients with HOR gradually decreased both SBP and DBP in clinostasis, and markedly in orthostasis. Within 6 months of treatment BB decreased SBP and DBP in patients with HOR in clinostasis in the lowest extent, and in larger extent in orthostasis. BB therapy increased frequency of HOR on SBP on 5%, and on DBP on 8%. ACE inhibitors had smooth hypotensive effect, seen after 1-st week of intake. Maximal temps of SBP and DBP decrease was seen in patients with HOR during 1-st – 2-nd weeks of treatment, both in clinostasis and orthostasis. During the first-second week period of treatment with ACE frequency of HOR increased on SBP from 17% to 24% and on DBP from 14% to 17% with further tendency of HOR frequency decrease to 21% on SBP and to 16% on DBP within 6 months. Out of three groups of hypotensive drugs (CA, BB, ACE) probability of HOR progressively increased when using CA and BB, and only when using ACE inhibitors increased temporarily.

79-84

Authors: E.I. Zalyubovskaya

91 patients have been examined to study the effectiveness of (ACE inhibitor) lysinoprile in various doses including its combination with carvedilol β-blocker as a complex treatment in ischemic heart disease patients with hert failure symptoms, diabetes mellitus 2 type (D) and metabolic syndrome (MS). The conclusion has been made that doses of lysinopril and carvedilol as a complex therapy in ischemic heart disease patients with hert failure symptoms, diabetes mellitus 2 type (D) and metabolic syndrome (MS) has a definitely positive effect concerning normalization of general cholesterol level (CH), triglycerids (TG), cholesterol lipoproteid of low density (CH-LPLD). Increasing lysinoprile dose allows to improve the level of CH-LPLD and lipoproteids of very low density (CH-LPVLD), and carvedilol promotes the reduction of CH, TG, CH-LPLD, CH -LPVLD levels. Combination of lysinoprile 2,5-5,0 mg with carvedilol 37,5-50,0 mg permits to increase the level of CH lipoproteids of high density.

88-93

Authors: N.M. Korenev , G.A. Borisko., T.A. Kostenko , O.A. Aphanasyeva

The adaptation capabilities (reaction to physical stress load) of 98 children, aged 16-18, born from fathers, who took part in liquidation of the Chernobyl nuclear disaster, as compared with adaptability of 53 children from the families with no radiation risk have been studied. Heart rate, blood pressure and echocardiogemo-ynamic indices were registrated at rest, on the first, the third and the fifth minutes after physical stress load. The adolescents born from the father-liquidators revealed a reduced reaction level to physical load. We recommend careful organization of physical training for such children.

98-105

Authors: T.I. Lyadova

At patient with acute viral hepatitis B three types of immune reactions were established, determined by the character of answer of principal regulators cytokines: normally reactive, dissociative, and hyporeactive, which are found in close correlation with the severity degree of weight, clinical signs and outcomes of disease. The got results allow to recommend the necessity of complex investigation of patients with acute viral hepatitis B with determination of markers of active viral replikation (DNA HBV) and level of principal regulators cytokine.

110-114

Authors: E.V. Ognivenko, N.N. Popov, E.A. Romanova

Antimicrobial immunity condition has been examined in 29 patients with purulent maxillary sinusitis in the exacerbation phase under insulin-dependent diabetes mellitus (group 1) and 29 chronic purulent maxillary sinusitis patients not suffering from endocrinopathies of any kind (group 2)/ Development of purulent maxillary sinusitis in persons insulin-dependent diabetes mellitus progresses against the background of the significant decrease of the main antimicrobial immunity factors aktivity, affinity of the produced antibodies, opsonizing properties of serum, and phagocytic biocidal activity of neutrophils. Neutrophil biocidity decrease is associated with malfunctions occurring in both oxygen-dependent and oxygen-independent ntimicrobial mechanisms.

119-124

Authors: P.I. Rynchak

120 patients with CHF and anemia were exemained. CHF of II FC was found in 49 patients, III FC – in 42 and IV FC in 29 patients. All patients had standart treatment. The level of hemoglobin, MKV, MCH, MCHC, hematocrite, serum iron, ferritine, erythropoetin, tumor necrosis factor α, interleukin 1β. It was found that the level of hemoglobin and serum iron in patients with CHF of ischemic genesis was decreased and it has direct relation to increased level of proinflammatory cytokins, which increases in parallel to incerasement of erythropoetin, which reflects cytokininducted appearance of anemia in patients with CHF as a result of erythropoesis inhibition.

129-140

Authors: Е.Е. Tоmina, N.I. Yabluchanskіy

Peptic ulcer etiology, pathogenesis and therapy literature review is offered. With the reoccurrence of interest to the meaning of autonomous nervous system in the genesis of ulceration, the research of regulatory processes using heart rate variability (HRV) analysis becomes strongly actual. Latest publication that contain separate HRV investigations in peptic ulcer patients are given.

150-167

Authors: V.P. Maliy, O.V. Volobueva, T.I. Lyadova

In a lecture are presented etiologic, epidemiology, patogenetic and clinical description of shigellosis. Basic approaches to diagnostics, medical treatment and prophylaxis of disease are represented.