Medical perspectives (Medicni perspektivi)

10-15

Authors: Dzyak G.V., Nekhanevich O.B.

The purpose of our research was studying of cardiovascular system overexertion symptoms by dynamic of diastolic function of left ventricle during exercises of different power in athletes with small abnormalities of heart development. We surveyed 70 athletes aged 12-27 years. The diastolic function dynamics of left ventricular is showed in the work. The main indexes of myocardium relaxation disorders during diastole are defined. It is proved that in athletes with small abnormalities of heart development (mitral valve prolapse, open oval window) during submaximal physical loadings, signs of left ventricular diastolic dysfunction developed.

21-26

Authors: Stepanov Yu.M., Kovalenko A.N., Salenko А.V.

Among the diseases of the gastroduodenal zone chronic gastritis (CG) occupies one of the leading positions. One of the main forms of CG is reflux gastritis (RG) based on long-term location of duodenal content in the gastric antrum, so-called duodenal reflux (DR). It is well known that stable inflammatory response of the gastric mucosa (GM) appears under the influence of bile acid and gastric juice, leading to chronic antral gastritis followed by gradual development of atrophy, metaplasia and dysplasia appearance. Therefore the aim of our work was to investigate the influence of the DR on the course of chronic hepatitis and morphological changes in the gastric mucosa. We observed 70 patients with chronic RG, aged from 22 to 59 years, average age – 43,5±1,2 years. The control group consisted of 25 healthy individuals of both sexes aged from 19 to 39 years. As a result it was found out that pain and dyspeptic syndromes caused problems most of all. While studying the content of bile acids in gastric juice of all patients examined it was higher (1,42±0,05 g/L) in comparison with the control group (0,65±0,04 g/L). Content of bile acids in groups of RG patients with atrophy and without it was analyzed. The role of DR as an independent factor of recomposing changes in GM in chronic RG was proved.

32-37

Authors: Sebov D.M.

. The article analyzes data of 3234 coronary angiographies with established coronary X syndrome (CXS) in 217 cases, herewith expressed tortuosity of coronary arteries (ETCA) was found out in 148 (more than 2/3) of cases. A 5-years’ analysis of cardio-vascular events (CVE) in patients with CXS in comparison with the group of IHD patients and initial atherosclerosis of coronary arteries was made. Absence of reliable difference of developing severe cardio-vascular events (SCVE) bet¬ween patients with initial atherosclerosis and CXS was proved. Risk of CVE development was significantey higher in patients with ETCA, OR=4,93; 95% (0,62; 3929). Patients with CXS had higher risk of severe arrhythmias development as compared with IHD patients with initial atherosclerosis: OR=2,36 (1,01; 5,56). There was no reliable difference between lethality of any causes and number of coronary interventions in all groups.

42-48

Authors: Voronin K,V., Alale A.M., Alale I.I., Chervonyi S.I.

In the structure of inflammatory di¬seases postpartum endometritis (PE) retains its leading position. The likelihood of postpartum endometritis deve¬lopment after cesarean section increases by 5-10 times compared with spontaneous labor and its frequency has no tendency to decrease. The urgency of PE problem is determined not only by its high prevalence, economic losses, but its possible complications (uterine suture failure and generalization of infection as well). Clinical picture of PE currently is characterized by late manifastation, presence of atypical and asymptomatic forms with mismatched general reaction of the organism and severity of the local pathological process. The leading role in the etiology of PE belongs to conditionaly pathogenic microflora, in the most cases (90%) presence of strict anaerobic nonsporeforming mic¬roorganisms, composing part of the normal flora of the genital tract in women. The aim of the study was the development of the principles of active prevention of postpartum endometritis in women with severe vaginal anaerobic dysbiosis while planning cesarean section.

56-60

Authors: Yakovlieva V.H.

The violation of blood coagulation properties is observed in many diseases of the respiratory system, including chronic obstructive pulmonary disease (COPD). It is known that in a stable COPD phase release of proinflammatory cytokines in blood is observed, it leads to disturbance of hemostasis parameters toward hypercoagulation. The aim of our study was to determine possibility of coagulation disorders formation in patients with COPD in a stable phase of pathological process at different stages of disease course and identify relationship between coagulation parameters levels and degree of violation of ventilation lung function. Materials and methods. We examined 30 patients with COPD in a stable disease phase, included in the main group (FEV1 =49,5±15,5% of the due, there were 27 men (90.0%), 3 (30.0%) women, mean age was 61,8±7,9 years, level of pack /years index - 34,2±15,3). The control group consisted of 10 healthy subjects matched with the patients of the main group by age and sex. All patients were divided into 2 subgroups. Subgroup 1 included 16 patients with moderate COPD, that is the level of FEV1>50% (61,8±7,4% of predicted), and subgroup 2 - 14 COPD patients with severe COPD, that is the level of FEV1 <50% (35,3±8,2% of predicted). Patients received standard treatment according to the disease stage. Main indicators of coagulation levels: prothrombin index (PI), prothrombin ratio (PR), international normalized ratio (INR), activated partial thromboplastin time (APTT), thrombin time (TT) and antithrombin III (AT III) were identified in all patients. Results. The levels of PI, PR and INR in the subgroup 1 differed significantly from those of in the subgroup 2, control group (p<0,05) and pointed at hypercoagulation, whereas in the subgroup 2 all indicators were absolutely identical with control group. Correlation link between the level of INR levels and FEV1 (r=-0,73; p<0.01) in patients of the main group was determined. Levels of APTT, TT and AT III in the main group and in subgroups 1 and 2 were identical to those of the control group. There were no significant differences of these parameters between subgroups 1 and 2. Conclusions. In patients with COPD already at early stage of the disease abnormalities of coagulation hemostasis link mainly on external coagulation pathway toward hypercoagulation develop.

67-73

Authors: Kotlyarchuk K.B., Maslyak Z.V., Lukianova A.C., Tsyapka O.M., Selina I.O., Usenko H.V.

Aim of this study was to analyze molecular genetic and cytogenetic reasons for disease resistance to tyrosine kinase inhibitors (TKI) imatinib (IM) and nilotinib (NI) in patients with chronic myeloid leukemia (CML). Material and methods. A group of 32 CML patients with primary or acquired resistance to TKI treatment was investigated. Cytogenetic response was determined by conventional karyotyping with differential banding. Presence of BCR-ABL kinase domain mutations was investigated by direct sequencing. Results and discussion. The frequency of mutations was 37% (12 patients) with prevailing occurrence of mutations with low sensitivity to nilotinib – E255K/V; Т315I; F359V; Y253H. In 47% of the cases (15 patients) additional chromosome aberrations (ACA) were revealed which could also be the reason for TKI resistance in patients without BCR/ABL mutations. Patients with detected mutations of BCR/ABL gene were either switched to nilotinib or treated with increased dose of IM. Cytogenetic response was achieved in only 2 patients with mutations and in 12 patients without them. Frequency of blast crisis development did not differ significantly in both groups. Conclusions. Among the investigated patients with CML resistant to IM BCR/ABL gene mutations were detected in more than third of the cases whereas ACA were found in almost half of the group. Taking into account revealed prevalence of mutations not sensitive to the 2nd generation TKI nilotinib, investigation of mutational status has to be obligatory in all patients for whom treatment correction is considered. Presence of ACA should also be taken into account in patients requiring administration of the second line TKI since they can adversely influence expected treatment response as well.

80-84

Authors: Kutovoy A.B., Petrashenko I.I.

With the purpose to evaluate diagnostic efficacy of some clinical symptoms of acute appendicitis 75 women in different terms of pregnancy were examined. Informative content of such symptoms as Kocher- Volkovich, Rovsing, Bartomje - Michelson, Sitkovsky, Gabay, Brendo, Michelson, Ivanov was studied. Pain syndrome was fixed in all examined women. Pain localization was various and depended on the pregnancy term. During the I trimester of pregnancy the most often pain was manifestated in epigastrium and right lower quadrant, rarely in other abdomen regions. In the II trimester in majority of cases pain occurred in right lower quadrant. During III trimester pain prevailed in right upper quadrant of abdomen. Analyzing informative component of researching symptoms there was noted significant decrease (р<0,05; р<0,01; р<0,001) of their diagnostic value with growth of pregnancy term. Therefore Kocher – Volkovich and Rovsing symptoms were the most informative in the I trimester of pregnancy. Diagnostic efficacy of Brendo(67,3%), Michelson(55,7%), Ivanov(59,6%) symptoms was higher than that of Kocher – Volkovich (36,5%), Rovsing (28,8%), Sitkovsky (51,9%), Bartomje – Michelson (55,7%) symptoms, their value was diminishing together with increase of pregnancy terms.

95-100

Authors: Grizodub D.V.

To improve prevention and treatment of intolerance to fixed denture materials by studying the impact of status of microbial contamination of the oral cavity on the pathogenesis of its development. The clinical study was performed in 62 patients, 22 of them came to the clinic for prosthetics and with clinical symptoms of intolerance to fixed dentures. The comparison group consisted of patients without clinical manifestations of intolerance. Healthy individuals without prosthesis were used as a control group. The results of clinical studies convincingly demonstrate that in the oral mucosa of patients of the main group level of Gram-negative bacteria was higher and that of Gram-positive was lower than in the comparison groups. Indicators in the study group testify to the increase in the total number of microorganisms, especially Gram-negative bacteria and decrease of gram-positive ones. Con¬ta¬mination with fungi of the genus Candida of the oral mucosa of patients with intolerance to materials of fixed dentures was higher by 67,3% in the main group than in the comparison group.

106-112

Authors: Besedin O.M.

Vacuum Therapy (Vacuum-assisted closure, VAC) - a method of complex therapy which is used to improve the healing of both acute chronic wounds in patients with diabetic foot syndrome. Due to widespread introduction of this technique, unique cell, extracellular and general effects of its use in the treatment of patients with purulent-necrotic complications of diabetic foot syndrome, a technique of vacuum wound therapy has been successfully used in many surgical departments of Ukraine. Despite the diversity of the clinical effects of VAC-therapy and appearance of number of publications, in the domestic and foreign literature physiological basis of this method have not been studied completely. The effectiveness of vacuum therapy explain: the reduction of the size of the wound, the stabilization of the wound environment (due to the removal of inflammatory mediators and cytokines), microdeformation and remodeling of cell, rows reduction of edema, reduction of bacterial contamination, etc. At the same time, mechanisms of blood flow enhancement at different duration of VAC-therapy use, remain unclear its effect on the third phase of wound healing process as well.

120-127

Authors: Shydlovska T.A., Basanets A.V., Gvozdetskiy V.A., Shevtsova T.V.

Noise influence takes one of the leading roles in the development of sensorineural hearing loss (SHL). At the same time professional deafness steadily occupies the 5th place in the structure of occupational diseases in Ukraine over the past few years. Of special importance is the problem of pre-clinical and early diagnosis of occupational hearing deterioration, in sense of timely prophylactic and rehabilitation measures in “risk group” workers. The objective research methods play an important role in the diagnosis of auditory analyzer state. Many scientific studies have shown the diagnostic effectiveness of method of otoacoustic emissions recording in the early diagnosis of lesions of receptor part of auditory analyzer. It is known that SHL of noise genesis largely affects the receptor part of the auditory analyzer, for which the OAE method has great practical diagnostic significance. Objective: to study informativity indicators of otoacoustic emission for the diagnosis of sensorineural hearing loss in various occupational groups of coal workers in Ukrainian mines. Materials and Methods: Auditory function of 87 workers of the coal industry (drifters, miners and longwall miners) with different levels of industrial noise and hygienic conditions in their workplaces was: 28 studied drifters (group 1), 25 miners (group 2) and 34 longwall miners (group 3). Work experience in noise in these groups was 17,9±1,0; 23,1±1,0 and 22,2±2,0 accordingly. Noise ratio in drifters was 93,6±4,9 dBA, in miners – 92,9±5,5 dBA and in longwall miners – 86,5±6,04 dBA accordingly, while the maximum permitted level is 80 dBA. The research was conducted on the analyzing system "Eclipse" "Interacoustics" (Denmark). All patients underwent registratiov of the caused OAE at frequency distortion product (DPOAE) at frequencies 1-6 kHz. The results were rated using variation statistics Student's test. Results: The most prominent violation of the receptor part of the auditory analyzer according to the OAE among all the examined workers of different professional groups of the coal industry was found in drifters, miners had less pronounced violations and the least significant ones were in longwall miners. At the same time in 42,9% drifters caused OAE at frequency distortion products was not recorded on any of the investigated frequencies. Received averages of OAE amplitude in the studied frequencies differed significantly in drifters not only from the norm, but also from that in the group of longwall miners in the 4-6 kHz region. The most prominent disorders according to the speech and above-threshold audiometry were found in drifters and miners, testifying to violations in the receptor part of the auditory analyzer. Conclusions: In all occupational groups of coal industry workers according to OAE data, more pronounced violations were found in the frequency distortion products in the 4-6 kHz. This is evidenced by significant decrease of OAE amplitudes averages, especially pronounced in 4 and 6 kHz, where they significantly differ from the norm and from the indicators in the group of longwall miners; and OAE registration was absent in the drifters. The identified differences in OAE indicators and dysfunction severity in the receptor structures of the auditory analyzer, obviously, could be explained by the nature of industrial noise and hygienic working conditions in the workplaces of the studied workers of coal industry.

133-138

Authors: Vіtovska O.P., Savіna O.M.

The purpose of the work is to estimate sickness rate and patterns of eye and adnexa diseases. The data of departmental statistical reports of Ministry of Health of Ukraine (form 12) for 2005-2014 years, period were used. The specific weight, prevalence and sickness rate were determined for the following diseases: conjunctivitis and other diseases of the conjunctiva, cataract, myopia - among children aged 0-17 years; strabismus - among children aged 0-14 years; glaucoma and optic nerve atrophy - among adolescents aged 15-17 years. Results. Among children's eye and adnexa diseases the following diseases were identified the most often: myopia (28,26 ± 0,02)%, conjunctivitis (20,12±0,01)% and strabismus (7,87±0,01)%; particularly among new cases of eye diseases their proportions were 13,89±0,02%, 44,06±0,03% and 2,24±0,01% correspondingly. The prevalence of eye and adnexa diseases among children in Ukraine was 102,05±0,03%, and 45,90±0,02% especially for newly diagnosed diseases.

144-147

Authors: Nikolayenko-Kamyshova T.P.

Disturbances in the system of he¬mostasis and vascular complications is the topical clinical problem, requiring profound study with the development of treatment and prophylaxis algorithm. Thrombus-hemorrhagic complications in patients with chronic myeloproliferative (CMPN) neoplasias are caused by the presence of plethoric and myeloproliferative syndromes, findings of hemogram (level of erythrocytes, thrombocytes, leukocytes, hematocrit index) and hemostasiogram testify to this. A case of thrombus-hemorrhagic complication in a female patient with chronic myeloproliferative neoplasia was considered. Carrying out differential diagnostics requires performing additional investigations: USI, CT with defining of hemostasiogram, hemogram findings, their thorough monitoring when surgical intervention is needed. This diagnosis for the first time was made in conditions of surgical in – patient unit. In pre- and postoperative periods as well as for prevention of vascular complicatients in the patient with CMPN it is necessary to mandarory administer agents which correct hematologic status and rheologic indices. This clinical case was analyzed with the aim to draw doctors’ aftention to complexities in diagnostics and defining treatment tactics for patients with thrombus-hemorrhagic complications: necessity to establish all possible risk factors of vascular events development and to carry out constant hemostasiologic menitoring for preventing lethal outcomes.