Lviv Clinical Bulletin

12-16

Authors: Radchenko O., Pylypiv L.

Introduction. Arterial hypertension (AH) is one of the most urgent medical and social problems of the present time due to the considerable prevalence, high risk of complications, and lack of treatment efficacy. Assessing the status of the autonomic nervous system (ANS) is one of the perspectives for the further study and understanding of the disease, which is due to the active participation of the ANS in the processes of adaptation and pathogenesis of a large number of lesions. Vegetative dysfunctions are considered to be a key in the emergence of neurocirculatory dystonia, heart rate abnormalities and cardiac rhythm disorders, myocardial ischemia, hypertensive crises, and increased activity of the sympathetic part of the ANS for a long time is investigated in the course of the onset and progression of AH, including drug-resistant coronary heart disease, congestive heart failure, and metabolic syndrome. Aim. To determine the tone of the ANS and describe the features of the AH course depending on the vegetative status. Materials and methods. 70 patients with AH aged 33 to 81 years (mean age 61.1 ± 1.4 years) were examined, including 47 women (67.1%) and 23 men (32.9%). The average duration of AH was 9.6 ± 0.7 years. In addition to the standard laboratory and instrumental examination, the status of the ANS was assessed by the S. M. Pukhlik questionnaire (1998). The control group included 18 healthy volunteers with an average age of 33.4 ± 3.3 years. Results. It has been found out that 81.4 % of patients with hypertension have sympathicotonia accompanied with higher indices of the systolic and diastolic blood pressure, cardiac rate, more often abdominal obesity (especially obesity classes II and III) as well as hyperlipidemia which conversely are additional risk factors for cardiovascular complications and potential indicators for further prognosis. So, the use of non-medicated (body weight normalization, physical activity, stress reduction) methods and medications (β-blockers, α1-adrenergic blockers, imidazolin receptor blockers, β-stabilizers, sedative preparations) to provide a positive balanceof the ANS should be the subject of further research to normalize blood pressure and reducing the risk of cardiovascular complications. Conclusions. Increasing the sympathetic tone in patients with AH leads to an increase in cardiovascular risk, which should be taken into account when assessing the total cardiovascular risk, identifying a program of treatment and prevention.

23-26

Authors: Tomashevskiy Ya., Vendzylovych Yu., Tomashevska N., Hrupovych L., Danylevych N., Hrupovych M., Sulyga I., Firchuk M.

Introduction. Considering the urgent need to optimize the methods for preventing diabetes mellitus, it is important to find the methods of early diagnosis of carbohydrate metabolism disorders that precede the manifestation of type 2 diabetes mellitus and to promote the method of self-monitoring of carbohydrate metabolism available in Ukraine and abroad for each family. In connection with the peculiarities of energy metabolism, the expediency of studying the pyruvate dehydrogenase activity of blood for the purpose of early diagnosis of diabetes mellitus is obvious. Aim. To identify the persons with a hereditary predisposition to type 2 diabetes mellitus (with mitochondrial diabetes) in the population of the Prykarpattya region using the assessment of carbohydrate metabolism. To recommend the use of a bloodless visual method of studying the total content of α-ketoacids in the urine. Materials and methods. Into the study there were involved 292 practically healthy residents of the Prykarpattya region (166 men and 126 women aged 6 to 80 years) in which the blood glucose level did not exceed 5.6 mmol (100.8 mg%). The state of carbohydrate metabolism was evaluated using pyruvate dehydrogenase and α-ketoglutarate dehydrogenase tests. The monitoring was performed by indicators of pyruvate dehydrogenase activity in blood of healthy persons in the range of 8.01-16.30 μcat/l, as well as the 2-hour α-ketoneuria (6.4-11.4 mg, p <0,01), which was accepted as normal. Results Hereditary predisposition to type 2 diabetes mellitus (mitochondrial diabetes) was detected in 40.76% of the subjects. Of these, 7.88% is due to pyruvate dehydrogenase deficiency and 32.88% of α-ketoglutarate dehydrogenase deficiency. It let us determine a genetic predisposition to type 2 diabetes mellitus (mitochondrial diabetes) in 40.76 % of the patients, in particular, in 7.88 % – due to pyruvate dehydrogenase deficiency and in 32.88 % – due to α-ketoglutarate dehydrogenase deficiency. Conclusions. So, it is recommended to use at home a bloodless visual research method of α-keto acids total amount detection in the urine available to every family, as an effective way of self-control of carbohydrate metabolism, which will facilitate the identification of the individuals with inherited predisposition to the disorders of carbohydrate metabolism (mitochondrial diabetes), followed by the manifestation of type 2 diabetes mellitus and will allow to take the necessary measures to prevent its occurrence.

31-35

Authors: Barna O., Getman O., Korost Ya.

Introduction. Aging is a general property of all living and non-living systems, which represents the accumulation of violations of the structure and reduction of the function of the system. These changes develop over time. One of the important reasons for the aging of a living system is the inadequacy of its renewal. Theoretically, two main mechanisms of aging are distinguished. The first is the genetically determined non-renewal of a number of structures, which with age are gradually destroyed or lose their ability to function. This process is random, it is called stochastic aging. The second mechanism of aging develops due to a decrease in the rate of self-renewal. It is caused by the changes in the effect of programs regulating processes in a living organism and is called regulatory aging. In modern conditions, there is the possibility of using various diagnostic techniques to determine the individual aging profile of an organism and to select on the basis of the obtained results an aging prevention program. Aim. To make an overview of contemporary literature on the issue of anti-aging medicine, its main principles and tasks. Materials and methods. The content analysis, the method of system and comparative analysis, the bibliosemantic method of studying the current scientific research on the issue of anti-aging medicine, its main principles and tasks were used. Results. The emergence of anti-aging medicine is associated with an increase of life expectancy in economically developed countries. People live longer and, for understandable reasons, tend to be active even at a respectable age. The methods of laboratory and functional diagnostics have already reached the level when it is possible to speak about the possibility of accurately predicting the state of health of each person in old age. Prediction algorithm of aging includes an assessment of anamnestic data, physical examination, diagnosis of menopause, assessment of the functional state of various organs and systems using the methods of functional diagnostics, laboratory tests, evaluation of hormonal functions, immunological studies. Conclusions. Anti-aging medicine, its main principles are based on the application of advanced scientific and medical technologies for the early detection, prevention, treatment and reduction of the number of age-related diseases. The slowing down of aging processes aims not only to increase the number of years spent, but also to improve the quality of life in old age.

39-42

Authors: Grishchenko O., Lakhno I.

Introduction. Uterine bleeding in gynecological practice is a vast group of nosological forms, accompanied by increased blood loss during menstruation or acyclic metrorrhagia. Quite often, bleeding is not associated with the presence of structural-anatomical changes in the organs of the reproductive system. At the basis of the dysfunctional uterine bleeding (DUB) is the imbalance of regulatory mechanisms of the hypothalamic-pituitary-ovarian axis. Application of the empirical approach in their treatment from the standpoint of: “Endocrine disorders require hormonal therapy”, – not always, nevertheless, achieves the desired goal. Aim. To study the effectiveness of the drug Tranexam (Nizhpharm, Russia) in patients with uterine myoma and DUB. Materials and methods. We examined 138 patients of the reproductive age. The I group includes 24 practically healthy women. In the II group there were 58 patients with menstrual bleeding, 28 of them were diagnosed with DUB (IIA subgroup) and 30 had small uterine myoma (IIB subgroup). In group III, 56 subjects were monitored. In the III A subgroup there were 26 women with DUB, in IIIB – 30 patients with small fibroids. The diagnosis of menorrhagia was established on the basis of the following criteria: the use of more than 20 pads or tampons per cycle, the need to replace hygiene products during the night, the presence of clots in menstrual blood more than 1.0 cm in size, the duration of bleeding is 7 days or more. Patients of group II received oral contraceptives with 30.0 μg ethinylestradiol according to the contraceptive scheme once a day, and in the bleeding period 1 tablet twice a day. In group III, Ttanexam (in tablets of 250.0 mg) was administered 1.0 g four times a day to patients with menorrhagia. Patient monitoring was performed over three menstrual cycles. In addition to general clinical examination, all 138 patients underwent ultrasound examination of pelvic organs and mammary glands, colposcopy, oncocytology. Patients were consulted by a therapist, an endocrinologist and, if necessary, a hematologist. The effectiveness of the treatment was determined based on the number of hygiene products used, the duration of menstrual bleeding, and the hemoglobin (Hb) level in the blood. The level of adverse reactions under the influence of the treatment with oral contraceptives and tranexamic acid was recorded. Results. No pronounced deviations of endocrinological status have been detected in these patients. It was found out that in women with uterine bleeding the application of the combined oral contraceptives was accompanied by higher rates of side effects such as headache, breast tenderness, nausea and vomiting compared with the application of tranexamic acid. The prescription of tranexamic acid («Tranexam») in pills in patients with menorragia had higher effectiveness than the combined oral contraceptives that was reflected in a significant decrease in a number of required sanitary facilities, duration of menstrual bleeding and a higher level of hemoglobin. The application of tranexamic acid in pills provides the confidentiality of use that increases compliance of therapy and patients’ adherence to treatment. Conclusions. The administration of tranexamic acid (Tranexam) in tablets for the patients with menorrhagia surpassed the effectiveness of combined oral contraceptives, and therefore is recommended for use in such patients in routine practice.

52-55

Authors: Sklyarov E., Maksymets T.

Introduction. Ischemic heart disease takes a leading place in morbidity and mortality structure among the Ukrainians and in the world. There are certain peculiarities of the onset, course and prognosis of the ischemic heart disease in women. For example, in women, there is a later age of coronary artery disease. At the same time, the prevalence of coronary heart disease in women with coronary heart disease is worse than in men. Infant mortality rates in the female population are 19.0%, whereas in males – 12.0%. Mortality among women in the first year after the myocardial infarction reaches 36.0%, which is 10.0% higher than in men. Aim. To make an overview of modern literature on the risk factors and predictors of coronary heart disease in women. Materials and methods. The content analysis, method of system and comparative analysis, the bibliosemantic method of study of the actual scientific researches concerning risk factors and predictors of coronary artery disease in women have been used. Results. Traditional risk factors for coronary heart disease include burdened hereditary history, age, dyslipidemia, arterial hypertension, diabetes mellitus, metabolic syndrome, abdominal obesity, smoking, hypodynamia, inappropriate nutrition, hypoestrogenemia. The following new risk factors have been identified: C-reactive protein, homocysteine, lipoprotein (a), microalbuminuria, uric acid, leptin, adiponectin, fibrinogen, tumor necrosis factor, interleukin-6, gamma-glutamyltranspeptidase, non-alcoholic fatty liver disease, subclinical atherosclerosis. The presence of early coronary artery disease in close relatives of women under 65, men up to 55 years of age is an independent risk factor, although its significance is lower than that of men. An early myocardial infarction in one of the parents increases the risk of coronary heart disease in women by 2.8 times. It is traditionally believed that the risk factor of corobary heart disease for women is over 55 years of age (in men over 45). The incidence of coronary heart disease in women increases with age: women under 30 years of age suffer every twentieth person, while in the age group of 50-59 years, signs of coronary heart disease are in one of five women, after 60 years the overall incidence of coronary artery disease is 41.3%. Conclusions. The isolation of risk factors in stratifying the risk of cardiovascular disease and determining the markers of subclinical atherosclerosis in women will help to prevent the emergence of early complications of cardiovascular damage, reduce their morbidity and mortality.

14-17

Authors: Shevaga V., Payenok A., Zadorozhnyj A., Zadorozhna B.

Introduction. Today, doctors in general practice observe the steady growth of chronic diseases of the internal organs, which lead to violations of the normal functioning of the central nervous system with the gradual emergence of encephalopathy. Metabolic encephalopathies include brain damage due to homeostasis disorders in organs in the case of chronic kidney disease. However, the appearance of renal encephalopathy provokes not only toxic and metabolic disorders, but also arterial hypertension, which is a companion of chronic kidney disease. Aim. To study the psycho-emotional changes in patients with renal encephalopathy by the standardized multivariate personality examination (SMPE). Materials and methods. 20 patients with renal encephalopathy were examined, among them 8 men (40.0%) and 12 women (60.0%) aged from 24 to 43 years (serum age 38.73 ± 0.76). According to ICD-10, chronic kidney disease stage I was in 5 (25.0%) of the examined patients with renal encephalopathy, stage II – in 8 (40.0%), III – in 4 (20.0%), and IV – in 3 (15.0%). The control group was made of 22 practically healthy persons of the corresponding age. For a quantitative and qualitative assessment of changes of the psycho-emotional sphere of patients with renal encephalopathy, the SMPE method, being the Minnesota Multiphasic Personality Inventory (MMPI) and adapted by L. N. Sobchik to our conditions, was used. Results. A floating profile of Minnesota Multiphasic Personality Inventory was found in the examined patients in which most scales were above the upper limit of standard. The studied profile signifies the state of general stress which involves different mechanisms and compensatory functions of psychic activity which are under the tension. These are directed for the discrimination of dysadaptation. Although with this profile mental tension increases, this prognostic profile is promising in terms of normalization, as in this case a psychogenic borderline conditions caused by chronic somatic diseases are observed. In particular, the increased level of anxiety, uncertainty in oneself, the concentration of negative experiences, the presence of affective perversity of manifestations of inhibition and psychoasthenic response to external stimuli within the limits of neurotic disorders in the surveyed testify the high level of scores on the scale 6 and 7 in comparison with the control group (p <0.05). The presence of health problems in the patients with nephrotic encephalopathy and the absence of significant co-participation and help from others causes their autisation, the separation from reality (scale 8) (p <0.05 comparatively with a control group). Conclusions. Patients with renal encephalopathy often have anxiety-asthenic syndrome, and therefore such patients need the social support, which will facilitate their return to normal, active daily life.

31-35

Authors: Nyankovskyy S., Iatsula M., Senkevich O., Pasichnuk I., Kulik I.

Introduction. The health of the nation is determined primarily by the health of children. The results of numerous studies show that the source of the differences in adult health should be sought in their childhood. Children’s health is an integral indicator of the general well-being of society, as well as a subtle indicator of all social and environmental problems. Recently, the situation with the health of children has come close to the critical one: the general level of morbidity and the prevalence of diseases of organs and systems is increasing. Aim. To evaluate the medical and social features of the health status of schoolchildren in Lviv and Lviv region, to determine their dependence on age and place of residence. Materials and methods. The analysis of the results of the surveys made in 2002 (about 20,000 schoolchildren in Lviv) and in 2012 (about 32 000 children of Lviv and 16 000 children of four districts of Lviv region) were considered. The main risk factors of the formation of functional disorders, syndrome of school maladaptation, neurotic reactions, age prevalence of major complaints were discussed. Results. The study of the state of children’s health, taking into account their individual age characteristics at all stages of their development, with the simultaneous determination of the influence on the children’s organism of the various factors of micro- and macrosocium plays an important role in the optimization and complex principles of the organization of scientific research of such an important direction of pediatrics as preserving the health of the child. It is impossible to create an effective system of preventive, organizational and other technologies aimed at improving and preserving the health of children without taking into account the complexity of the main risk and protection factors. Analyzing the results of questionnaires, we can conclude that in recent decades, the state of health of schoolchildren in the Lviv region has no tendency to improve. Among the factors that lead to a decrease of the level of child health, the most important role belongs to the school workload, due to the stressful action of which there is a maladaptive syndrome with neurotic reactions of varying degrees of severity. A screening survey of schoolchildren, conducted on a large sample, enables us to identify the main medical and social features of schoolchildren’s life, to assess the age-old prevalence of major complaints and threatening symptoms, the main trends in their habits, to distinguish risk groups for further in-depth review and survey. Comprehensive assessment of the health of children, the introduction of new health-improving technologies, the unification of efforts of health workers, pedagogues and parents will help to prevent the growth of functional disorders and organ lesions in schoolchildren, their chronization, reduce the symptoms of school maladaptation, and increase their health. Conclusions. Among the factors that assist the decline of child’s health level the educational loading plays an important role. Its stress making effect results in fast development of the disadaptation syndrome with the neurotic reactions of different degree of expressiveness. The complex estimation of the children’s health state and introduction of new health promotion technologies give an opportunity to prevent the increase of functional disorders and organic pathologies in schoolchildren.

41-44

Authors: Markin L., Medvjedjeva O.

Introduction. Anomalies of the heart and major vessels of the fetus take the first place in the structure of mortality from the abnormalities developed in the early neonatal period, they occur with a frequency of 7 to 17 per 1000 newborns and cause about 40.0% of perinatal losses. Given the fact that preventative measures for the prevention of congenital heart diseases are not successful, their prenatal ultrasound diagnosis is relevant. There are cardiological abnormalities that are incompatible with life – in these cases, it is proposed to interrupt pregnancy. There are heart defects that can serve as markers for chromosomal abnormalities. Some variants of the congenital heart diseases can be adjusted by surgical intervention immediately after birth (such patients must be born in specialized centers). In addition, modern medicine is at such a stage of development that some structural anomalies of the heart can be eliminated even during the intrauterine period of the life of the fetus with the best pathway. Aim. To improve the diagnosis of fetal heart abnormalities during the routine screening ultrasound. Materials and methods. Recommendations for the improvement of the diagnosis of fetal heart anomalies by the routine screening ultrasound examination in the second trimester of pregnancy by the additional visualization of the major vessels with an assessment of the average diameter, the location of the heart axis, the ratio of the chambers of the heart and the size of the pulmonary artery, aorta and upper vena cava. Results. It is believed that the results of prenatal research is mainly influenced by the technical reasons (resolution of the device, pregnancy period, thickness of the anterior abdominal wall of the mother, position and size of the fetus). In our opinion, the prenatal detection of congenital heart defects strongly depends on the algorithm of conducting a fetal heart study in the screening regimen. All screening ultrasounds should be performed according to a single protocol, which is the main for the standardization of echographic research. In the case of suspicion of airborne disease in the fetus, the patient is referred for medico-genetic counseling with karyotyping and verifying the diagnosis. The main screening examination of the heart is based on a four-chamber cut. To obtain this image, the sensor should be installed perpendicularly to the fetal ridge at the level of atrioventricular valves. During the adequate withdrawal of this section, the right and left ventricles, right and left atrium, interventricular and interatrial septum, mitral valve and tricuspid valve openings are clearly visualized (the level of the tricuspid valve is normally slightly lower than mitral), an oval window can also be seen. Conclusions. During the additional visualization of the major vessels more than 90.0% of congenital heart defects can be diagnosed, indicating the need to optimize the protocol for the providing of the assistance of such patients, and the basic specific criteria for evaluating the anatomy of the heart and the fetal heart. So, the study of fetal heart is one of the most important stages of screening ultrasound in the second trimester of pregnancy.

49-51

Authors: Katerenchuk O.

Introduction. According to the World Health Organization (WHO) Report currently more than 350 million people in the world suffer from clinically significant anxiety and depressive disorders and this number is expected to grow. Depression is the leading cause of disability worldwide. The special attention should be given to the category of patients with the cardiovascular diseases, because the existence of depression greatly deteriorates the disease course. It is well-known that depression and anxiety are the risk-factors for the development of cardiovascular diseases. Also depression is usually observed in patients in early post-myocardial infarction period, in patients with hypertension, especially with the heart failure syndrome. Aim. To analyze the literature sources and to propose own thoughts on the topic of the depression and cardiovascular diseases, their causes, consequence or comorbidity. Materials and methods. Content analysis, method of system and comparative analysis, bibliosemantic method of research of actual scientific researches on the topic of the depression and cardiovascular diseases, their causes, consequence or comorbidity was made. Results and discussion. The combination of depression and cardiovascular diseases is a well-known clinical fact, supported by the results of many clinical studies. Since the 90’s more than 100 descriptive studies in this field assessing the relationship of depression with cardiovascular morbidity and mortality have been performed. Also more than 60 prospective studies were conducted to establish the connection between the presence of depression and coronary heart disease. It is important to note that the negative impact on the prognosis has not only the so-called major depression, but also its mild form. Women are 1.7 times more likely to experience a significant depression than men. The majority of clinical studies of depression in patients with heart failure do not provide a separate data for men and women. One study analyzed the prevalence of depression in patients with heart failure only in out-of-hospital settings. The symptoms of depression were observed in 64 % of the women and 44 % of the men. Interestingly, the hospitalization for treatment of acute heart failure usually exacerbates the symptoms of depression. Once the heart failure is under control, the depressive signs and symptoms may abate. There are different pathological mechanisms of depression in cardiovascular diseases. The first is the psychological aspect associated with the development of life-threatening condition. The feeling of fear of death, anxiety about the future course of the disease, restrictions of physical activity, necessity of the invasive procedures usually cause anxiety and\or depression in patients in the acute phase of the disease. For the early post-myocardial infarction patients’ depression substrate more often is due to the impossibility of returning to normal physically active life, reduced work capacity, social adjustment difficulties and the impact of myocardial infarction on sexual activity. At the same time, despite the psychological mechanisms of depression, the dysfunction of the heart muscle also attributes to the development of depression. Myocardial dysfunction is usually observed in cardiovascular diseases (coronary heart disease, arterial hypertension, cardiomyopathy, inflammatory heart diseases, valvular lesions). Also the myocardial dysfunction in the form of heart failure is the final link in the chain of cardiovascular continuum. Any damage to the heart muscle leads to the increasing of the filling pressure in the heart chambers and thereby stimulates the increased activity of neurohumoral systems: the rennin-aldosterone-angiotensin, sympathetic nervous system, vasopressin and natriuretic peptides systems. Activation of neurohumoral systems aims to support the adaptation processes and homeostasis in heart failure syndrome but often causes harm. In the settings of the heart failure syndrome we should also mention the endogenous cannabinoid system, which as a system of the immediate response to stress, after the period of overstimulation becomes depleted causing a paradoxical effects. At the same time, depressive disorders are often accompanied by the hyperactivity of the hypothalamic- pituitary-adrenal axis, followed by increased excretion of cortisol in the bloodstream. Increased cortisol in this situation has a protective effect by mobilizing the body’s reserves. Interestingly, the higher levels of blood coagulation are observed in patients with cardiovascular disease and depression in comparison with patients without depression. Conclusions. The depression in terms of cardiovascular diseases may act as a risk factor for their development, it can be a cause of the heart muscle dysfunction, as well as be caused by psychological problems in consequence of the disease.

57-60

Authors: Ilnyckyу G., Bilozir L., Bojko O., Chulovska U., Nevzhoda O.

Introduction. At the stage of the unceasing progress of science and technology, the quality of education, and hence the use of innovative technologies, makes it possible to improve it. In the educational sector of Ukraine, the Concept for the training of the physicians is being developed, elaborated in accordance with the requirements of the World Federation of Medical Education and the main provisions of the Bologna Process. The educational sector, like medical education in particular, has entered the path of radical reforms and entry into the European educational space, requires the bringing of all of itscomponents to the generally accepted international standards. One of the initiators of the implementation of reforms and innovations into the medical and educational sector of Ukraine is the Danylo Halytsky Lviv National Medical University, the oldest medical institution of the country’s education, founded in 1784. Aim. To highlight the teaching methodology of the discipline “tuberculosis” for the students of the English-speaking form of education using computer-information technologies. Materials and methods. The experience of the Department of Phthisiology and Pulmonology in conducting the educational process among the students of the English-speaking form of education is described. The achievements, problems and ways of their improvement in conditions of joining the European educational space are considered. Results. The work of the staff of the Department of Phthisiology and Pulmonology of the Danylo Halytsky Lviv National Medical University in a complex with modern equipment of educational rooms and lecture rooms, dynamic provision of pedagogical process is provided taking into account the latest information technologies, systematic updating and replenishment of materials, including bench and test tasks, as well as comprehensive publishing of the activities and not only improve the quality of the educational process, but also the growth of students’ interest in the subject “Tuberculosis” highlighting the problems of tuberculosis, which positively affects the prospects of the further professional orientation of future doctors. Conclusions. Achievements in the field of obtaining modern medical education in higher educational institutions of Ukraine will facilitate the attraction of new foreign citizens to study. High professionalism and spirituality, the achievements of the Ukrainian, in particular, Lviv medical school, can serve outside of our country. Ukraine, in keeping with the global educational trends, will have a worthy place in the modern information world.

11-17

Authors: Abrahamovych O., Dudar I., Abrahamovych K.

Introduction. The problem of the quality of life of patients with the chronic kidney disease stage VD treated by hemodialysis is becoming more and more urgent in medicine. One of the most common factors that worsen in patients with chronic kidney disease (CKD) that are treated by hemodialysis – skin itching occurs in 50.0-60.0% of these patients. Itching affects sleep, working capacity, causes depression, sometimes suicidal thoughts. Aim. To increase the efficiency of treatment of patients with CKD and skin itching, which are treated by hemodialysis, with the use of ultraviolet irradiation on the basis of the study of the effect of skin itching on the quality of their life, the state of decomposing cells and proinflammatory cytokines. Materials and methods. The study involved 109 patients with CKD of the VD stage who were undergoing hemodialysis at the Lviv Regional Clinical Hospital and Kyiv City Scientific and Practical Center of Nephrology and Dialysis. The control group was made up of 20 healthy individuals who, according to age and gender, corresponded to the patients of the examined group. There were studied the parameters of the pruritus, the quality of life, the levels of proinflammatory cytokines (IL-1β, IL-17, MCP-1), the presence and activity of the skin mast cells, depending on the presence / absence of the itching skin. Was carried out the ultraviolet radiation treatment and was examined its effect on the itching, the levels of cytokines and the quality of life in 109 hemodialysis patients. Results. In 56.0 % of patients with the chronic kidney disease stage VD was revealed the skin itching which is inversely correlated with the most indicators of the life quality. Proinflammatory cytokines potentially reflect the activity of pruritus in 58.3 % of patients. Was noted a higher number and activity of mast cells in patients with the pruritus compared to patients without it. As a result of the comparisons between proinflammatory cytokines and mast cells was found a direct connection of both in patients with the pruritus. In 100.0 % of patients the ultraviolet radiation treatment helped to eliminate the skin itching. The positive influence of the ultraviolet radiation retained in 45.8 % of patients within one year. The levels of the proinflammatory cytokines in patients with the pruritus decreased in two weeks after the ultraviolet radiation course. Conclusions. It was found that in patients with the CKD stage VD treated by the hemodialysis the itching of the skin significantly impairs the quality of life. It was also found that the ultraviolet radiation treatment reduced the itching of the skin in these patients, resulting in the improvement of the quality of life by 14.8 %.

18-22

Authors: Barnett O., Kyyak Y., Kyyak H., Kovalyshyn V., Besh D.

Introduction. Myocardial hibernation refers to “new ischemic syndromes,” which in recent years have increasingly attracted the attention of cardiologists and cardiac surgeons. Hibernation includes a number of adaptive responses: inhibition of metabolic processes to more complex and lengthy pathophysiological changes that lead to myocardial contractile weakness, and their degeneration of cardiomyocytes and their apoptosis. Aim. To find out the pathophysiological mechanisms of occurrence and ultrastructural signs of cardiomyocyte hibernation in patients with arterial hypertension (AH) and myocardial infarction (MI), as well as the role of hibernation in the occurrence of heart failure (HF). To determine the dependence of segmental disorders of the left ventricular myocardial contractility (hypokinesia, akinesia, dyskinesia) on the presence of hybridized cardiomyocytes and to reveal the duration of their life. Materials and methods. For 36 patients with hypertension and coronary artery disease were examined, were examined the ultrastructure of myocardial biopsy material (n = 10) obtained during coronary artery bypass graft (CABG) and aneurysmectomy, as well as express neoplastic lesions (n​​= 26) in those who died of heart attack. Myocardial biopsies were obtained during the execution of the CABG for angina pectoris (n = 10) or ventriculoplasty in combination with CABG (n = 6). Ultra-structured study of 10 myocardial biopsies during CABG and ventriculoplasty, as well as 26 express-necropsies of the myocardium of those died due to the MI who were ill with hypertension were made. Results. It has been determined that hypertrophy and cardiomyocyte hybridization correlate with the severity of hypertension, MI, besides necrosis, causes stunning, hypertension, apoptosis, and necrosis of cardiomyocytes, mainly in the parainfarction and intact regions of the left venticle. The hepatized cardiomyocytes (irreversibly altered, hybridized cardiomyocytes containing α-glucogens) were first detected. The correlation between the percentage of remodulated cells (from 50.0 to > 75.0%) and the emergence of segmental lesions of the contractility of left ventricle (hypo-, aki-, dyskinesia), which leads to acute and chronic HF was found. Conclusions. Myocardial hibernation is a clinically important syndrome, which is often accompanied, under certain circumstances, by the transient left ventricle dysfunction. It is important to consider it in clinical practice, since hibernation is present in patients with almost all forms of coronary heart disease and requires both medical and surgical treatment.

27-31

Authors: Rudnyk T., Nadashkevіch O., Parashchuk B., Zaychenko Y.

Introduction. It is known that in 15.0-20.0% of the world’s population there is at least one episode of urticaria throughout the life, and therefore it belongs to the group of dermatoses of a social nature. Significant prevalence, absence of unified diagnostic algorithms, multifactorial etiology, often resistance to treatment and rehabilitation measures with a significant decrease in the quality of life of patients is the cause of a careful attention to its study. However, despite the fact that it would be possible to assume the commonality of the pathogenetic mechanisms of allergic dermatitis and damage to the glands of the internal secretion, in particular, thyroid gland, today the insufficient attention is paid to the research of the role of the latter in the occurrence of urticaria, the information about the informativeness of the individual criteria for assessing its condition, the influence of pathological changes of the thyroid gland on the clinical course of urticaria is not outlined. Aim. To investigate the functional state of the thyroid gland in patients with urticaria and to determine its dependence on the severity of the urticaria, its duration, and the long-term duration of the last clinical remission. Materials and methods. 86 patients with chronic idiopathic urticaria (34 men and 52 women) aged 15-67 years were examined. Control group consisted of 20 healthy people. The duration of the disease varied from 5 months to 29 years. The mild course of dermatosis was diagnosed in 31 (36.0%) patients, the moderate – in 24 (28.0%), and the severe course – in 31 (36.0%). The function of the thyroid gland was evaluated by the determining the level of thyroxin, triiodothyronine and tyroglobulin in the blood serum. Results. In patients with urticaria, there is a dependence of the function of the thyroid gland on the presence and duration of the last remission – significant increase of the thyroxine levels and reduction of triiodothyronine level in the blood serum of patients with the continuous course of urticaria and duration of the last remission up to 3 months, and a possible increase of thyroglobulin level in serum in the patients without remission. Conclusions. It was found that urticaria is accompanied by the dysfunction of the thyroid gland which lies in a certain growth of thyroxine and thyroglobulin and in the reduction of triiodothyronine level in the blood serum. The intensity of the changes mentioned above depends on the clinical course of the pathological process, specifically on the presence and progression of the last clinical remission, in this connection it is expedient to further study the involvement of the thyroid gland into the autoimmune processes in patients with dermatosis.

37-45

Authors: Abrahamovych M., Farmaha M.

Introduction. Cirrhosis of the liver is a frequent chronic polyethyologic disease of the internal organs with polymorphous syntropic lesions, which often causes early disability and death of patients – that is why it is necessary to improve the principles of complex differentiated treatment taking into account extrahepatic manifestations of the disease. Aim. To improve the algorithm and to improve the efficiency of treatment of patients with cirrhosis of the liver by taking into account detected extrahepatic co- and polymorbid syntropic lesions of other organs and systems. Materials and methods. The study included 1713 patients with cirrhosis (75.7% of men, 24.3% of women, age 18-86), who performed a comprehensive examination of all organs and systems in accordance with the requirements of modern medicine. Subsequently, patients were divided according to the criteria for classification of C. G. Child – R. N. Pugh by severity at A (38.1%), B (52.3%) and C (9.6%) classes, and a comprehensive differential treatment was performed for 4-6 weeks. The control group consisted of 302 patients, representative of gender, age and severity of liver cirrhosis, which were treated according to the generally accepted method. Results. Among patients with cirrhosis of the liver, 74.3% had varicose veins of the esophagus, 61.3% had gastropathy, 48.2% had varicose hemorrhoidal veins, 19.2% had arterial hypertension, 56.4% arterial hypotension, 57,3% – secondary cardiomyopathy, 27.5% – rhythm disorders, 65,3% – disorders of conduction, 82,9% – signs of hepatopulmonary syndrome, 8,9% – portopulmonal hypertension, 0.8% – signs of hepatolateral syndrome type І, and 3.3% – type II, 56.0% – secondary encephalopathy, 73.1% – signs of the disorders of the autonomic nervous system, 60.5% – osteopenia and 39.5% – osteoporosis, 42.3% – anemia, 29.8% – coagulopathy and 94.2% – signs of skin lesions. In 64.2% of the patients treated using the system we had modified, good results were obtained, in 28.7% the results were satisfactory and 7.1% – were not satisfactory. 73.1% had a good result in patients with class A of liver cirrhosis, 63.9% – class B and 61.8% – class C. The number of patients with satisfactory results was roughly the same in all groups (26.5% -30.4%). In group A, there were no patients with poor treatment outcomes, in group B – 5.7%, and in group C they were 11.7%. The presented actual material allows us to assert that the complex treatment we have modified is effective in 92.9% of the patients with liver cirrhosis. In the significantly lower number of patients treated using the usual method compared to the experimental group (47.4%), good results were obtained, and this was due to a significant increase in the number of patients with only a satisfactory result of treatment (46.7%). In 5.6% of the patients, the results of treatment were not satisfactory, and 0.3% the results were poor. 51.3% of the patients with a good result were patients of class A of liver cirrhosis, 49.4% – class B and 20.7% – class C. The number of patients with satisfactory results, as in the experimental group, was approximately identical in quantity in groups A, B and C (from 46.2% to 48.3%). In group A, 1.7% of the patients had a poor outcome, in group B they were 4.4%, and in group C – 27.6%. Consequently, the generally accepted comprehensive treatment is effective in 94.1% of patients with liver cirrhosis, but for qualitative indices, it is significantly lower than the medical complex we have modified. Conclusions. Modified by the authors, the complex differential treatment of patients with liver cirrhosis, taking into account the presence of polymorbid syntropic lesions, as well as the traditional one gives a positive result, but the effectiveness of conventional treatment is lower compared to the complex we modified.

49-51

Authors: Zinchuk О.

Introduction. Lyme borreliosis (LB) is a polysystemic infectious disease caused by a bacterium Borrelia burgdorferi and transmitted through the suction of ixodic ticks. In the last decade, the incidence of LB in Ukraine has risen steadily; it is officially classified as a group of particularly dangerous infectious diseases. LB often runs syntopetically in the pathologic process of various organs and systems. Heart failure is often found in case of LB, but it is poorly investigated. Aim. To find out the clinical-electrocardiogram signs of heart disease in patients with LB in the western region of Ukraine. Materials and methods. There were 352 patients with LB who were inpatient and outpatient care in the Lviv Regional Infectious Diseases Hospital in 2000-2008. Among the patients, there were 129 men and 223 women. The average age was 45.61 ± 0.81 years. Diagnosis of LB was based on the results of epidemiological, clinical and laboratory and instrumental studies. A clinical case of severe heart failure in a patient with a chronic course of Lyme borreliosis was described. Results. Symptoms of heart function abnormalities were detected in 72 patients (21.6%) out of 333 who were diagnosed with early-onset LB. In 55 of them (16.5%) there were clinical signs of heart disease. Changes in EG were detected in 46 (18.2%) out of 253 surveyed. The most frequent clinical signs that indicated a disorder of the function of the heart were a feeling of discomfort or pain in the area of ​​the heart. Sternal discomfort was seen in18 patients of 333 (5.4%), in 16 (4.8%) – pain in the heart region. 22 patients (6.6%) showed the weakening of the heart tones, 13 (3.9%) – systolic murmur on the apex. An echo study showed that some patients combine several echogenic signs – most often bradycardia with ventricular extrasystoles or conduction disorders of varying degrees. These changes were usually short-lived and disappeared after the treatment with antibiotics. Antimicrobial treatment in common doses (Uniodox – 4 patients, Ceftriaxone – 3 patients, Amoxicillin – 1 patient) contributed to the gradual normalization of the condition of the patients. Clinical and ECG-changes in patients with myocarditis normalized within 3-4 weeks – in 6 out of 8. In 2 patients after discharge from the clinic, the relaxation of cardiac tones, ventricular repolarization disorders in the form of tinnitus reduction, which required the additional treatment, was maintained. Despite the benign course of myocarditis in most patients with LB, the lack of early specific antimicrobial treatment due to the inadequate diagnosis can be a reason for the progression of the pathologic process in heart tissue with severe consequences. Conclusions. It was found that the clinical symptoms of heart disorders were present in 16.5 % of patients in early period of Lyme borreliosis and electrocardiographic changes – in 18.2 %. These symptoms were present more often in the group of the patients without erythema migrans. There were 2.4 % of patients in early period of the disease with the symptoms of myocarditis. These patients need a permanent detailed monitoring of the cardiac activity during all periods of the disease for the prescription of an adequate treatment.

56-60

Authors: Smoljar N., Bezvushko E.

Introduction. The problem of dental caries is one of the most urgent because of its significant prevalence and intensity in many countries all around the world. At the same time, the information statistics of the WHO shows a decrease in the rate of dental caries in most developed countries, as well as the stabilization of the incidence or the slowdown of its growth in some developing countries. Studying the frequency of dental diseases with the analysis of their causes is the basis of primary prevention. An epidemiologic examination of children is considered essential in assessing the dental morbidity and conducting the optimal preventive measures, taking into account information about their residence in specific natural and social conditions. The analysis of literature is showing a significant variability in the spread of dental caries not only in different regions of Ukraine, but also among the children living within the same city. Aim. To estimate the prevalence and intensity of caries of teeth in children of Lviv and Lviv region and to find out their dependence on the age of the surveyed. Materials and methods. 2387 children were surveyed in 20 towns of Lviv region and 454 children in Lviv. The survey was conducted in key groups of 7, 12, 15 years in accordance with WHO guidelines for epidemiological studies. The defeat of teeth by caries was estimated by the following indices: prevalence of caries of teeth (%), caries intensity by index CSR (C – caries, S – sealed, R – removed tooth). Results. It was determined that the average prevalence of caries is 81.44 % with 3.68 harmed teeth. The affection of teeth by caries is growing with age. The prevalence of caries in 7-years- old children is a 63.56 %, with the intensity of 1.20 harmed teeth. In 12- years-old children, accordingly – 91.60 % and 3.84 teeth and in 15-years-old children – 90.66 % and 6.09 teeth per one child. The considerable differences in the indexes of teeth affection by caries were established depending on the territory of residence of the children, as well as the age – a considerable increase of the intensity of teeth caries was observed in 12- to 15- years-old children. The analysis of the results of the examination of children made it possible to reveal a different level of prevalence and intensity of dental caries, as well as an insufficient level of providing the metamorphosed dental care. This testifies to the need for further examination of children in other populated areas, the study of the nature and impact of the ecological, natural, geochemical and other factors of the environment in which the children live, not only on the development and formation of solid dental tissues, but also on the state of their dental health. Conclusions. The prevalence and intensity of caries of teeth in children of the Lviv region according to the criteria of the wound are high. It is necessary to develop the preventive measures for the preservation of the health of children, as well as efficiently organize dental care for children.

13-16

Authors: Radchenko O., Pylypiv L.

Introduction. Arterial hypertension (AH) keeps the leading position in the list of the most common diseases of the cardiovascular system. AH often is accompanied by psycho-emotional disorders of different expression level. Aim. Determination of the psycho-emotional status of the patients with AH and the characteristics of AH course in patients with a high level of anxiety. Materials and methods. The study involved 70 patients with essential hypertension aged 33-81 years (mean age 61.1 ± 1.4 years), including 47 women (67.1%) and 23 men (32.9%). The average duration of AH was 9.6 ± 0.7 years. In addition to the standard questionnaire the survey for the self assessment was conducted using the Spielberger-Hanin scale to assess reactive (RA) and personal (PA) anxiety, which was assessed as low (less than 30 points), moderate (31-45 points) or high (46 points and more). The control group was composed of 18 healthy volunteers with an average age of 33.4 ± 3.3 years. Results. It was determined that the additional risk factors of cardiovascular complications in the patients with high levels of PA include: high blood pressure, abdominal obesity, elevated glucose levels, frequent hypo- or hypercholesterolemia, more frequent detection of diabetes mellitus. These include the more frequent concentric left ventricular hypertrophy, which is now recognized as the cause of an adverse prognosis and the least survival. Determining the level of PA, which is simple and informative, allows you to predict the nature of the course of the AH. Patients with AH with a high level of PA are more likely to experience AH crisis, higher systolic and diastolic blood pressure, complaints of high sweating and palpitations during the exercises, obesity of the III degree, in peripheral blood analysis – leukocytosis and anemia, higher glucose levels, very low and very high total cholesterol levels. In high PA ​​conditions, a larger Sokolow-Lyon index on ECG, a smaller diastolic diameter, but a larger relative thickness of the left ventricular wall on the echocardiography, is more likely to result in concentric remodeling and concentric left ventricular hypertrophy. Conclusions. It has been found out that 70,0 % of patients have a high level of anxiety and have significantly more risk factors for cardiovascular complications (higher levels of systolic and diastolic blood pressure, often detection of hyperglycemia, hypo- and hypercholesterolemia, more often deveopment of concentric left ventricular hypertrophy) than patients with moderate level of anxiety.

20-22

Authors: Radchenko О., Slaba О.

Introduction. Epidemiological studies have shown that bronchial asthma (BA) in different countries has 3.0-12.0% of the able-bodied population. It is believed that by 2025 the BA will have another 100-150 million people. Another trend is the health of the population – the increase of the number of people with excessive body weight and obesity. The increase in the prevalence of asthma and obesity among the population leads to a high probability of their combination. Obesity has been shown to lead to respiratory symptoms based on the results of epidemiological studies back in the 80’s of the twentieth century. A special role in the pathogenesis of BA associated with obesity is given to visceral adipose tissue, which produces a number of hormone-active substances – adipokines (leptin, adiponectin, resistin, tumor necrosis factor, alpha interleukin (IL) 6, etc.) involved in hydrocarbon and lipid metabolism, regulation of inflammation and immune homeostasis. Aim. To determine the level of leptin in the blood of patients with asthma with varying body mass and analyze the changes of the parameters of external respiration in patients depending on its level. Materials and methods. A comprehensive clinical and laboratory-instrumental examination of 20 patients with asthma (12 men aged 18 to 59 years old and 8 women aged from 24 to 80 years old) on the basis of the allergological department of the 1-st Clinical Hospital of Lviv, was conducted, according to the order of the Ministry of Health of Ukraine N 128 from March 19, 2007, the level of leptin plasma was determined by the method of enzyme-linked immunosorbent assay. Results. In all the patients with normal body mass, the level of leptin was normal, and in 60.0% ± 11.0 patients with overweight and obesity – elevated. Among the patients with normal body mass (n = 5), leptin level was 5.4 ± 1.7 ng/ml, which significantly differed from that in patients with excess body weight (n = 10) and obesity (n = 5) – 17.61 ± 4.1 ng/ml and 50.6 ± 12.04 respectively. Comparison of leptin levels in men and women showed the significant gender differences: in men the mean value was 12.13 ± 3.6 ng/ml, and in women – 28.8 ± 1.2 ng/ml (p <0.05). With the increase of the level of leptin in the blood, all indicators of the function of external respiration progressively decreased. In patients with hyperluptinemia, the actual lung capacity of the lungs was significantly lower than in the group of patients with normal leptin levels, which was accompanied by a significant decrease of the lung capacity at inhalation, etc. Conclusions. The level of leptin in blood plasma in patients with excessive body weight was found. Patients with hyperleptinemia have a natural decrease in all indicators of the function of external respiration.

29-32

Authors: Frayt V., Fedoriv Ya.-R.

Introduction. Despite the significant successes of tuberculosis treatment, the epidemiological situation, which practically does not show a probable improvement ща the main epidemiological parameters, remains anxious. Aim. To increase the efficiency of treatment of patients with primary and recurrent pulmonary tuberculosis, as well as to prevent simultaneously the onset and progressing of chronic pulmonary heart (PH) on the basis of the complex of peculiarities of their pathogenic mechanisms, ascertained by us. Materials and methods. The relationships between tuberculosis and the average temperature in January, July, and during the whole year, respectively in 69 countries of the world, as well as the dependence of the morbidity on the average temperature in 23 countries in America, Africa and Europe were studied. The coefficient of correlation r between the incidence of tuberculosis and the average temperature of the enviroment and the degree of its probability p is calculated. The study of the course and manifestations of the disease with the simultaneous analysis of the important functional indicators in the process of antibiotic treatment of 717 patients aged from 15 to 78 years (average age 35.8 years), of which 452 men (63.0%) and 265 women (37.0%). Results. Hypotonia and hypovolemia are the main factors that not only lead to the onset of pulmonary tuberculosis and the formation of PH, but also lead to poor treatment efficiency. PH is formed, mainly due to hypotension and hypovolaemia, which are additionally induced by the reduced vascular tone and increased fluid loss. Correlation of the regional disorders of the main functions of the cardiopulmonary system, especially in conditions of increased blood supply, which was provided by the appointment of a gentle bed regimen in an anti-rheostatic position during the first 1.5-2.0 months of stay in the hospital, and an additional (up to 1.5-2.0 l per day), in combination with modern antibacterial drugs, not only prevents the formation of PH, but also significantly increases the effectiveness of treatment of the patients with primary and recurrent pulmonary tuberculosis. Conclusions. Chemotherapy in the patients with primary or recurrent pulmonary tuberculosis on the background of the advancing correction of the disorders of the main regional functions of the lungs (ventilation and perfusion) not only increases the efficacy of treatment but also prevents the recurrences of the disease and formation of chronic PH.

36-39

Authors: Abrahamovych O., Abrahamovych U., Synenkyi O., Holovach T., Kushyna A.

Introduction. The problem of the diagnosis and treatment of the patients with cancer, in particular, with localization of it in the stomach, is one of the most pressing problems of today, both in Ukraine and throughout the world. The incidence of cancer is traditionally high in many countries, with males being twice as high as women. Annually in the world about 750 thousand new cases of gastric cancer are registered. Ukraine ranks eighth among the 48 countries in the world, which account the oncological diseases, by the indices of cancer. In the structure of mortality from malignant tumors, stomach cancer takes second place as in men (after malignant neoplasms of the lungs) and women (after breast cancer). In 2006, the incidence of stomach cancer in Ukraine was 27.4 per 100 thousand people, which significantly exceeds the world population – 15.6 per 100 thousand population. Aim. To make an overview of modern literature on the complications of gastric cancer in the practice of a doctor-rheumatologist and describe a clinical case. Materials and methods. The content analysis, the method of system and comparative analysis, the bibliosemantic method of study of the actual scientific researches concerning complications of gastric cancer in the practice of the doctor-rheumatologist, and the clinical case have been described. Results. It is presented the clinical case of arthralgic syndrome caused by the remote bone stomach cancer metastases in the practice of the doctor-rheumatologist. Diagnostic algorithm for the patient’s examination, directed by a family doctor with a suspicion of reactive arthritis, in the conditions of a rheumatologic hospital presupposes the use of a number of laboratory tests, most of which are performed in private laboratories. These tests were performed, signs of rheumatologic disease were not detected, but an increase of alkaline phosphatase level in serum by almost 12 times became the reason for reversing the search for the cause of bone tissue damage. X-ray examination of bone: focal changes has not been detected, chest x-ray has suspected metastasis in the lungs. Scintigraphic studies have revealed multiple metastatic bone defects. The ways of optimizing of the diagnosis search in patients with bone pain, elevated levels of alkaline phosphatase and burdened oncological history are outlined. It is noted that the optimal and most rational method of diarrhea in these situations is to study the level of alkaline phosphatase in the serum of the patient and make the scintigraphy with 99mTc-MDP. Conclusions. Taking into account the practical rheumatology, the article focuses on the optimal diagnosis of the patients experiencing pain in the bones, having the elevated levels of alkaline phosphatase, and the patients burdened with a cancer anamnesis. The studies on the problem show that the most effective and rational diagnostic method of gastric cancer is 99mTc-MDP scintigraphy.

47-53

Authors: Svintsitskyi A.

Introduction. Functional dyspepsia (FD) is common in the worldwide population. In developed countries, dyspeptic disorders occur in 30.0-40.0% of the population and is responsible for 4,0-5,0% of all appeals to general practitioners. In this case, the lion’s share (60.0-65.0%) refers to FD. Women are more likely to suffer after mental injuries. In Ukraine, the prevalence of FD is 30.0-40.0%, but in reality the number of patients may be higher, as many individuals with similar complaints do not visit a doctor. Aim. To make an overview of modern literature on the problem of FD, the current principles of its diagnosis and treatment. Materials and methods. During the study the content analysis, method of system and comparative analysis, bibliosemantic method of study of the actual scientific research were used. Results. According to the recommendations of the conciliation meeting of the International Working Group on the improvement of the diagnostic criteria of the functional diseases of the gastrointestinal tract diseases (Roman criteria III), the diagnosis of FD may be posed if, for at least three last months (not necessarily in succession), there is one of the following symptoms for the last six months: a feeling of gravity after eating; feeling of early saturation; epileurial pain; heartburn in epigastrium, as well as the absence of organic diseases (including those based on the results of esophagogastroduodenal fibroscopy that would explain these symptoms. Treatment of patients with FD syndrome should be comprehensive and include the measures to normalize the lifestyle, diet, labor, psychotherapeutic methods, and, if necessary, medication. Examination and treatment of the patients with FD usually occurs in outpatient conditions until the disappearance of its manifestations. During remission, patients maintain their ability to work. Dispensary assumes the implementation of recommendations for normalization of lifestyle and medical nutrition, periodic examination of patients (once or twice a year) and timely treatment of relapses of the disease. The prognosis in patients with FD is considered rather favorable. With time, there is a decrease in the severity of complaints, which is caused both by a decrease in stressful effects and by the adaptation of patients to factors that have led to the appearance of clinical symptoms. Spontaneous disappearance of symptoms is noted in about one third of patients. It is believed that the risk of peptic ulcer in patients with FD does not differ from the asymptomatic population. Conclusions. FD is one of the most pressing problems of modern gastroenterology, but many issues are still unresolved and need further study.