Lviv Medical Journal (Львівський медичний часопис / Acta Medica Leopoliensia)

P.9-17

Authors: A.V. KOPCHAK

Aim. To perform a comparative assessment of different methods of condylar process osteosynthesis and to determine their clinical efficacy by analyzing immediate and long-term treatment results. Methods. Results of 146 mandibular condyle osteosynthesis with the use of different types of fixators were analyzed. Kirschner needles were used in 18.5% of cases, strait plates - in 13%, L and Y-shaped plates - in 32.2%, a combination of needles with others types of fixators - in 4.8%, 2 plates located at an angle to each other - in 9%, lag screws - in 1.5%. In 9.5% of cases with high condyle fractures and medial dislocation, osteoplastic reposition of the condylar head was performed. In 10.2% of cases, fragments of the condylar head were removed followed by mandibular ramus osteoplasty or artificial titanium endoprosthesis arthroplasty (1.5%). Quality of fragments reposition and fixation was assessed based on the clinical data and control radiography; duration of the intervention, incidence of complications, and character of occlusal and articulation disorders in the long term postoperative period were also considered. Results. The effectiveness of surgical treatment for condylar fractures depended on the type and location of the fracture, the applied method of fixation, and functional loading conditions in the postoperative period. Immediate and longterm outcomes were significantly better (p <0,05) in low subcondylar fractures. No significant differences in the clinical effectiveness of different methods of fixation were found in biomechanically-favorable linear fractures. Instead, in biomechanically-unfavorable oblique and comminuted fractures the most appropriate method was the usage of 2 miniplates, while the other methods of fixation were insufficient. In cases of intra-articular fractures the best results were achieved using treatment methods allowing to preserve the viability of the condylar head and to ensure its correct reposition. Conclusions. The effectiveness of surgical treatment for mandibular condyle fractures depends on type, location of fracture, and applied method of fixation. In biomechanicallyfavorable linear fractures, adequate fixation can be achieved using different fixator types, while in oblique or comminuted fractures the method of choice is to use 2 miniplates located at an angle to each other. Keywords: mandibular fractures, condylar process, osteosynthesis, miniplates

P.25-33

Authors: M.A. BYCHKOV, M.M. MRYHLOTSKYY, Y.A. BYCHKOV

Aim. To analyze the effectiveness of breast cancer treatment by means of mathematical modeling. Methods. The results of 5-year survival (5YS) of 331 female patients with second stage breast cancer (T1 -3N0-1M0), who were treated at Lviv regional oncological center in 2006, were analyzed. Study groups were formed by randomization stratification: according to clinical staging; by histological variants of the tumor; by treatment; by age. Approximation of the data was performed in MatLab 7.10.0 software environment for algorithm Polynomial Curve Fitting (PolyFit). The significance of prognostic factors in their combination and correlation were assessed by Pearson and Student criteria. The magnitude of the error for the approximated data was evaluated by integrated methods used in the software environment. Results. Mean 5-year survival for both the whole sample and for individual groups can only be statistical in nature and does not reflect the actual connection between the studied traits. Certain methods of mathematical modeling allow us to establish the nature and extent of interaction between different parameters and their combinations. Thus, an approximation algorithm for PolyFit brings out the advantages and disadvantages of methods of treatment in each case. Compared with the Kaplan-Meier procedure, a current "gold standard" in cancer research, methods of mathematical modeling with cubic regression (including the method we used) can predict the course of the disease more accurately as a whole and in terms of efficiency treatment. However, the presence of Runge phenomenon (large error at the "end" of the approximated graph) can be regarded as a drawback of this technique, which can be avoided by increasing research sample and the degree of approximation, and taking into account only a certain method was used in our study). The accuracy of predicted data ranged from 75% to 95%. Data analysis showed that the unified approach to treatment of patients with breast cancer is not justified. For each combination of parameters we have studied, different methods of treatment yielded different distributions of the main features (5YS). While in some cases (for patients with ductal type tumors in stage IIB) mono method offers better results when used at the age of 50-80 years, in others it is not sufficiently effective; besides, the results are the best in the mean in ductal tumors in stages IIA and IIB, and slightly worse than in the combined treatment for lobular tumors in stage IIA. Combined treatment usually offers better results than using only surgical method or complex method, but the peak 5RV in this method differs in various combinations of histological types and stages; thus, considering only the mean values, combined treatment is a priority for lobular tumors in stages IIA and IIB and with undifferentiated tumors in stage IIA. Combined treatment produces better results in patients with undifferentiated tumor type over the age of 60 years. However, in each case, physicians need to bear in mind that the risk of recurrence after using only surgical treatment is quite high (according to our research). Conclusions. A common approach to treatment of breast cancer does not provide the best results in terms of the fiveyear survival and recurrence. Mathematical modeling allows to study the problem profoundly and to develop a personal approach to selection of treatment techniques for the patients that provide high efficiency of treatment and good prognosis for the patients. Keywords: breast cancer, mathematical modeling

P.40-46

Authors: Y. KORZHYNSKYY ,N. KAMUT O. SHEVCHUK , L. YEVTUSHOK

Increasing rate of infants with large birth weight is currently the issue in Ukraine as well as worldwide. The main causes of this situation are genetic factors, mother comorbidities, poor diet and a non-active way of life. The term "infant macrosomia" is defined as a birth weight greater than 4000 g or birth weight relative to gestational age greater than the 97th percentile (or more than two standard deviations from the mean). In today's clinical obstetrics and neonatology the term "large for gestational age" - "great to gestational age" is used as well. Esakoff T.F., Cheng YW., and others have shown that high birth weight is closely associated with perinatal morbidity and mortality. Aim. To study the epidemiology of children born with a big weight on the example of the Rivne region for the years 2003-2012 in order to optimize the provision of perinatal care in the future. Methods. Analysis of non-personified raw data on the number of babies born with a large body weight (> 4000g) in Rivne region in 2003-2012. The data were obtained by the copy of the "Register of newborns." The sample size included 18 527 newborns - 12151 males and 6376 females. The frequency of newborns of more than 4000 g in the general population of births was determined. For the designated period, gender differences were analyzed in children born with great weight and the proportion of weight classes: 4000 - 4249 g, 4250 - 4499 g, 4500 - 4749g, 4750 - 4999 g, and over 5000 g. Results. It was established that the absolute number of children born with a large body weight (> 4000 g) in Rivne region for ten years (2003-2012) has increased by 512 children, and the overall growth rate was 32.99 %. The greatest positive increase in the number of children born with a large mass was recorded in 2006 when its value was 320 children, and the growth rate was +19.95 %. At the same time it has been found that the proportion of babies born with a large weight in the overall structure of newborns in Rivne region for ten years (2003-2012 years) is decreasing. The largest decrease in the proportion of children born with a large weight in the overall structure of newborns was recorded in 2009, when its value was negative 0.54 %, while the growth rate was minus 4.41 %. By defining gender differences in various weight classes of children with large birth weight over a generalized 10-year period, it was found that the incidence of boys with a high body mass in all weight classes is significantly higher (p<0,01), than the incidence of girls. Conclusion. Our analysis revealed that in Rivne region over the period of ten years (2003-2012) there was observed a decreasing trend in the proportion of children born with a high birth weight in an environment of an increase in the total number of newborns in Rivne region. Frequency of males with high body mass in all weight classes is significantly higher (p<0,05), than the frequency of newborn females with great body weight during the ten-year period of observation. The analysis of birth rate of children is important for developing a network of schools, offices, staff offices, and medical care for children with high birth weight. Keywords: high birth weight of newborns, epidemiology

P.51-56

Authors: R.I. BILOBRYVKA, V.I. POPOV, O.P. KALITCHUK

Aim. To examine chronic recurrent forms of balanoposthitis resistant to conventional local antifungal or antiinflammatory treatment, to determine etiologic factors of balanoposthitis, and to classify balanoposthitis. Methods. The study involved 98 patients aged from 18 to 80 years with diagnosis of balanoposthitis resistant to treatment with medications for topical application. All patients underwent standard investigations, including general clinical examination, biochemical, bacteriological, serological, immunological methods, and tissue biopsy. Results. 42(42.8%) bacteriological seedings were conducted, among them were isolated Enterobacteria, S. aureus, Klebsiella, Gardnerella vaginali in 18 (18,3%) Candida albicans, E.coli and others in 6 (6.12% ), and in 16 (16.3%) 2-3 types of microorganisms. It has been confirmed that the effectiveness of treatment of bacterial and mycosis balanoposthitis depends on the overall immunity of the patient. The simultaneous treatment of sexual partners is also important. Other factors causing the disease were the human papillomavirus infection in 17 (17.3%)), complications of balanoposthitis (phimosis, paraphimosis, excessive foreskin) that need surgical treatment (circumcision) in 11 (11.1%) patients, allergic reactions, drugs and latex intolerance (20.04% ), cream base intolerance in 13 (13.2%). All patients with recurrent balanoposthitis visited a doctor 2-3 times or more within 6 months and underwent local therapy. It was determined that the greatest difficulty in the treatment of recurrent form of balanoposthitis is treatment of balanoposthitis with erosions regardless of its etiology. The most effective treatment for patients with cream base intolerance involves water-based creams and bath with KMnO4, Burov fluid (with weeping, erosions) with saline (for dry forms of balanoposthitis, and allergic reactions). For Candida balanoposthitis we used treatment of infection, sources, strengthening of body immunity, examination and treatment of sexual partners by systemic and local drugs: cream ketoconazol 2%, bifonazoli 1%, clotrimasoli 1%, econasoli nitrati 1%, miconasoli nitrati 2%, terbinafini 1%), probiotics, vitamins. Creams of broad-spectrum antibiotics (gentamicin, neomycin , tetracycline, fuzyd acid, mupirocin, bacitracin) with the addition of 10-15% zinc oxide were also effective in the treatment. Too careful and frequent hygiene of genitals is impractical for treatment because it leads to disruption of the natural microenvironment. The main factors of prevention of chronic balanoposthitis are: personal hygiene and hygiene of genitals; prevention of sexually transmitted diseases; treatment of diabetes and other chronic diseases (including male sex organs), weight loss in patients with metabolic syndrome (obesity), sex hygiene: condoms; prevention creams and lubricants for avoiding abrasions; irritation reduction; abstinence from sexual intercourse at the first symptoms of inflammation or during treatment, examination, and treatment of sexual partners. Conclusions. The isolated skin damage of prepuce and/or head of the penis can be symptoms of systemic skin disease. Balanoposthitis is a widespread disease, with a tendency to increase in different age groups. Balanoposthitis has polymicrobial etiology; sometimes it is caused by mono infection. Physicians should pay particular attention to erosions and ulcerations that do not heal during long time on prepuce and head of the penis and require differential diagnosis with other diseases, precancerous conditions or carcinoma. Parents should monitor childhood hygiene of boys' genitals. It is necessary to separate synechias and concretion of prepuce from the head of the penis. Keywords: balanoposthitis, recurrent forms, etiology, clinical symptoms, treatment, prevention

P.62-68

Authors: I.S. SOROKIVSKY, I.M. GOT'

Aim. To summarize and highlight the results of implementation of modern techniques and materials used to prevent postextraction atrophy of the alveolar processes of the jaws. Methods. Modern English, Russian and Ukrainian professional literature was overviewed. 47 review articles and original studies devoted to problems of postextraction atrophy of the alveolar processes of the jaws were selected. Results. Atrophy of the alveolar processes of the jaws is an inevitable process which accompanies the removal of teeth. Reduction of surgical trauma during tooth extraction and further plastic manipulation is the key to reducing the activity of bone resorption processes that result in worsening of geometric characteristics of the alveolar process. The use of modern osteo-plastic materials and principles of guided tissue regeneration can significantly reduce the level of postextraction atrophy and substantially improve conditions for placement of dental implants or other prosthetic structures. The opportunities related to the introduction into clinical practice of morphogenetic proteins and growth factors allow accelerating and increasing the volume of mature bone formation of appropriate quality for subsequent prosthetic rehabilitation in postextraction areas. Conclusions. Minimizing of postextraction atrophy in order to increase opportunities for further prosthetic rehabilitation and reduce the need for additional intervention is an important task for today. A number of modern materials and comparatively simple techniques allow achieving substantial results in preservation of the height and width of the alveolar process and reducing the need for future interventions aimed at restoring the alveolar process morphology. Keywords: tooth extraction, postextraction atrophy of the alveolar process, osteoplastic material, dental implantation

P.77-81

Authors: V.S. KOZOPAS

Aim. To highlight the modern state of the ways and methods of treatment for pelvic bones fractures on prehospital stage in cases of multiple and combined traumas. Methods. Current literature sources were used in the article, whereways and methods of treatment of pelvic bones fractures on prehospital stage were described, studied, and analyzed. Results. Fractures of the pelvis are the most severe injuries, especially when they are combined with damages of internal organs. In addition to surgical treatment of lesions of the pelvic organs, operative techniques of stabilization of fractures of the pelvis are becoming more popular; this allows to reduce the blood loss and pain syndrome, to create favourable conditions for the consolidation of the fracture, and to mobilize the patient in early periods after injury. However, presently there is no optimal treatment strategy for damage of the pelvic bones and organs, which would determine the volume, timing and way of performing surgical intervention. The performed review of literature revealed that the best method of treatment and emergency rehabilitation of patients with unstable pelvic ring injuries is an early external fixation of the pelvis, which is a component of antishock therapy and allows to mobilize affected areas quickly. Advantages of osteosynthesis by apparatus of external fixation are: less invasive intervention; reduction of the time of operation; stability of fixation; and a low number of complications. Conclusions. Complexity of choosing methods and treatment strategy for patients with fractures of pelvic bones is due to the difficulty in determining predominant damage, which influences the order of medical aid. Mini invasive operative treatment allows carrying out osteosynthesis of pelvic bones as soon as possible, which helps to avoid shock. Early fixation of pelvic damages by means of rod apparatuses is an optimal method of treatment and quick rehabilitation of patients with unstable damages of the pelvic circle. Keywords: polytrauma, pelvis fractures, extraneous, extracutaneus osteosynthesis, hospital treatment

P.88-96

Authors: Ya.V. HANITKEVYCH

Evidence of the presence of professors of medicine with local Ukrainian background at the medical faculty of the University in Lviv under the Austro-Hungarian and Polish rule is presented; the issue of their obtaining the rank of Professor in the Soviet period is regarded.