Medical perspectives (Medicni perspektivi)

4-9

Authors: Rodinsky A.G., Tkachenko S.S., Guz L.V.

The aim of our work was analysis of the bioelectrical activity of efferent fibers of the sciatic nerve in experimental menopause condition. Experiments were performed on 25 female white rats, divided into experimental and control groups. Menopause was modeled by total ovariohysterectomy. In 120 days after modeling we had recorded evoked action potentials of fibers of isolated ventral root L5 induced by stimulation of sciatic nerve with rectangular pulses. Threshold, chronaxia, latency, amplitude and duration of the action potential (AP) were analysed. Refractory phenomenon was investigated by applying paired stimuli at intervals of 2 to 20 ms. In the context of long-term hypoestrogenemy threshold of AP appearance was 55,32±7,69%, chronaxy – 115,09±2,67%, latent period – 112,62±1,74% as compared with the control animals (p<0.01). In conditions of paired stimuli applying the amplitude of response to the testing stimulus in animals with ovariohysterectomy at intervals 3 and 4 ms was 61,25±36,45% and 53,48±18,64% (p<0.05) respectively.

19-23

Authors: Pertseva T.O., Konopkina L.I., Huba Iu.V.

Chronic obstructive pulmonary disease (COPD) has a significant impact on various aspects of life of patients due to of daily symptoms, frequent exacerbations, comorbid conditions, including anxiety and depression. In the scientific literature there are different data on the relationship between the frequency of occurrence and severity of exacerbations of COPD on the one hand and concomitant depression and increased anxiety on the other hand. The aim of our study – to examine frequency and se­verity of depression and anxiety in patients with COPD exacerbation and in stable phase of the disease in patients with varying terms of remission. We examined 108 patients with COPD, which were divided into two groups. The main group – 16 patients with COPD were examined in two visits: in exacerbation and after two months of its completion. A comparison group – 92 patients with COPD in stable phase of the disease for at least three months. Examination of pa­tients included general clinical methods, evaluation of clinical symptoms of COPD, evaluation of mental status using Hospital Anxiety and Depression Scale. It was found that symptoms of depression and anxiety are more expressied in pa­tients with COPD exacerbation than in the stable phase. It was determined that the frequency of depression and anxiety in patients with COPD tends to decrease in two months after the exacerbation. It was also shown that mild depression and anxiety prevail in COPD patients with impaired mental state. In addition, there was found correlation between severity of dyspnea and depression severity in COPD patients with concomitant depression in the stable phase of the disease.

27-34

Authors: Pysarevska K.О.

Atrial fibrillation (AF) - one of the most common cardiac arrhythmia, which leads to increased mortality, increased risk of stroke, heart failure, worsening of quality of life. The aim of the study was to examine the clinical condition and hemodynamic performance of the heart in patients with non-valvular persistent AF before and 6 months after the restoration of sinus rhythm by electrical cardioversion (ECV). According to the study, it was found that the major diseases against which persistent AF is diagnosed: hypertension (87.7%), obesity (60.5%) and a combination of these diseases (33%). Hold of sinus rhythm within 6 months after ECV is accompanied by a significant improvement in clinical condition: the number of patients with significant dyspnea (scale MRC=3) has decreased (12% of patients versus 34% at the time of the ECV) (p <0.01), dyspnea (scale MRC=1) - 22% of the patients (p <0.05). Heart failure III FC remained only in 10% of patients versus 28% t the time of the ECV (p <0.05). Long-term preservation of sinus rhythm improved atrial function: ejection fraction LA increased by 25.8% (p <0.01), RA by 18% (p <0.05), decreased volume of indexed parameters in systole (LA - 21.3 %, RA - 26.4%) and diastolic (LA - 12.4%, RA - 21.6%) (p <0.001). Contractile function of the left ventricle improved: ejection fraction increased by 14.3%, SV - 13.7% (p <0.001), diastolic volume decreased by 20.7% (p <0.01). Despite optimal medical therapy, clinical status and cardiac hemodynamic parameters in patients with recurrent AF have not improved.

40-46

Authors: Kytovyi A.B., Pymakhov V.V.

Results of treatment of 71 victims with combined blunt thoracic and brain trauma were analysed. In the main group (n=35) there was used algorithm, envisaging videothoracoscopic interventions and widening indications for chest stabilization. Mentioned above technique enabled to increase efficiency of diagnostic and treatment in patients with mild and moderately severe brain trauma; this was reflected both in acceleration of restoration of respiratory index by 5,8 days, consciousness – by 4,3-4,9 days depending on trauma severity and decrease of postoperative complications and lethality number.

52-63

Authors: Cherednichenko Yu.V.

Objective — to evaluate the efficacy of endovascular techniques in the treatment of occlusion and stenotic lesions of the brachiocephalic and cerebral arteries, to define the ways of complications prevention. Materials and methods. 594 patients with occlusion and stenotic lesions of the brachiocephalic and cerebral arteries were operated by endovascular methods in endovascular center of Dnipropetrovsk Regional Clinical Hospital named after I.I. Mechnikov. 688 endovascular operations were carried out. Most part of the operations are carotid stenting (423 operations). All of these operations were carried out with the usage of different types of antiembolic protection systems: distal, proximal or their combination. Intracranial segments of cerebral arteries were operated in 43 cases. 169 operations of stenting of vertebral arteries in extracranial segments were performed. Subclavian arteries and brachiocephal truncus were operated in 53 cases. Results. Total removal of stenosis was achieved in 588 cases (98.99%). 509 patients (85.69% of cases) had improvement in neurological status (on a scale NIHHS, Mrs., MoCA). 77 (12.96%) patients had no deterioration of neurological status. Postoperative mortality was 1.01%. Common level of other complications was 4.3 %: cerebral complications - 2.7%. Discussion. The results of the endovascular treatment of occlusion and stenotic lesions of the cerebral arteries show high efficacy and low complication level. The ways of reduction complications level are identified. They are in a differentiated selection of antiembolic protection method, endovascular treatment planning, based on monitoring of changes in the brain hemoperfusion, the emphasis is on the use of the special neurologic deviсes. Conclusions. Endovascular treatment of occlusion and stenotic lesions of the cerebral arteries is effective with a small risk of complications. Risk can be reduced further by the differential choice of antiembolic protection methods, with the help of wide use of special cerebral balloon-catheters and stents for the treatment of stenotic pathology of intracranial arteries, by planning stages of endovascular treatment, based on the clinical data, data of cerebral hemoperfusion in various areas of the brain, and cerebral angiography.

70-79

Authors: Filippova A.Yu.

Nonalcoholic fatty liver disease is now considered as a part of comorbidity pathology. About third part of general population suffers from hepatic steatosis and non-alcoholic steatohepatitis (NASH), which is a serious problem of the XXI century, considering the growth of prevalence of obesity, which leads to fat accumulation in the liver. The aim of our study was to investigate the clinical and functional manifestations of hepatic steatosis and NASH in patients with obesity and disorders of the biliary tract (BT), depending on the body mass index. The study involved 200 patients with nonalcoholic fatty liver disease (NAFLD) (100 patients with hepatic steatosis and 100 NASH) in combination with obesity and BT disorders. Middle age of those examined was 42,1±2,02 years (range from 24 to 73 years). The control group consisted of 30 healthy persons. Each group was divided into subgroups according to body mass index (BMI): overweight (BMI 25-29.9 kg/m2), first degree of obesity (BMI 30-34,9 kg/m2), second degree of obesity (BMI 35-39,9 kg/m2). We evaluated the main clinical and biochemical syndromes (pain, dyspeptic, asthenia, cholestatic, cytolytic, mesenchymal-inflammatory, liver-cell deficiency). It is found, that the most reliable clinical and functional parameters were observed already at the first stage of NAFLD, at the stage of steatosis with fat deposition in the liver. It indicates that the majority of clinical parameters could be considered as early markers of hepatic steatosis formation and its further progression up to the level of steatohepatitis in patients with NAFLD in combination with obesity and BT disorders. Thus, in patients with NAFLD in combination with obesity and BT pathology an active clinical picture of the disease was observed, the severity of which was increasing together with BMI increasing.

86-90

Authors: Kondratiev V.A., Reznik A.V.

By the data of clinical-instrumental examination there was performed comparative assessment of gender differences in cardiac performance of 54 patients aged 5-15 years with persisting form of partially controlled atopic bronchial asthma in inter-attack period of disease. Children were divided in two groups depending on gender - 28 boys and 26 girls. Group of comparison included 52 healthy children - 26 girls and 26 boys. In the girls in the inter-attack period of asthma reliably more often than in the boys there were revealed ventilation disturbance in the lungs by obstructive type; this promoted rise of pressure in the pulmonary artery. Herewith only in girls in 15,4% of cases there was revealed arterial pulmonary hypertension of a mild form. By the data of echocardiography in girls with bronchial asthma as compared with boys more expressed dilatation both of the right and left ventricles of the heart was observed. Average means of left ventricle contractility both in girls and boys in the inter-attack period of bronchial asthma were reliably decreased (р<0,01) as compared with healthy children, but in girl-patients as compared with boys these deviations were more significant. In the majority of such cases (in girls – 73,9%, in boys – 53,8%) decrease of contractile myocardium function was caused by presence of metabolic disorders in the form of repolarization changes of ventricular complex ob electrocardiogram. Investigations performed showed presence of some gender differences in cardiac performance in bronchial asthma children which should be considered in the course of treatment.

96-103

Authors: Drogomiretskaya M.S., Ahmad Saleh Khalyaf Salama

Anomalies and deformation of dental system in children and adolescents contribute not only to the deterioration of dental health, bat quite often this is the cause of a wide range of somatic pathology. The aim of our study was to determine risk factors of dental system myofunctional disorders in children with impaired course of the antenatal period using morphological and morphometric studies. The changes that have been defined in the organs examined were dystrophic and dyscirculatory and differed in degrees of severity in all parts of the oral cavity. Dystrophic changes were detected in the gums and tongue epithelium. Dyscirculatory disorders were characterized by formation of submucosal edema, development of the vascular bed hyperemia and presence of hemorrhage under the basement membrane of the epithelium and salivary gland stroma. Pronounced changes were recorded in the nerve cells of the oral cavity.

109-116

Authors: Serdyuk A.M., Beletskaya E.N., Stus V.P., Onul N.M.

Deterioration of the environment in the XX-XXI century under the influence of chemical, physical, radiological and other factors is not only and not just an ecological catastrophe of modern times, but a direct threat to the health and life of human society as a whole. Among the most important factors influencing people's health occupy chemical the leading place, because since 1957 more than 50 million chemical substances were synthesized, but only 15% of them have a toxicological evaluation, and 30% of the diseases in Europe are associated with chemical factor (ECHA-EXA). Chemical "pressing" determines a significant reduction in the reproduction of the population of Europe, and for Ukraine it means a large-scale depopulation, among possible reasons of which a significant role belongs to the deterioration of the reproductive capacity of population, men in particular, and this work is devoted to this problem. On the basis of profound analysis of literature data, complex ecologic-hygienic researches we identified markers of exposure, prognosticaly significant markers of impact for the early diagnostics of disorders of male generative system in conditions of low-dose impact of xenobiotics. We achieved convincing evidence of ecologically determined character of unogenital diseases and fertility decrease, we developed scientifically-justified principles of management of risk of development of ecologically-determined reproductive pathology in men.

123-129

Authors: Berdnyk O.V., Rudnytska O.P., Dobrianska O.V.

Spatial-temporal characteristics of the population’s morbidity and prognosis of the situation are the main conditions for substantiation of the management decisions directed at the optimization of public health formation. Determination of the tendencies of morbidity 6-years children of during 1972 – 2014 years and their prognosis levels was the aim of the study. The analysis of morbidity based on the preschool institution’s health documents involved both temporal (42-years period of time) and spatial (different ecological districts) assessments. The negative changes in older preschool age children’s health have been revealed: growth of total morbidity, prevalence of respiratory diseases, inflammatory diseases of the eye. The higher levels of morbidity are registered in the districts located near the highways of the city. It testifies to the negative influence of transport-related air pollution on the children’s health formation. The estimation of prognostic levels (till 2020 year) showed future growth of diseases prevalence etiologically linked with air pollution.

134-139

Authors: Duzhiy I.D., Muntyan S.O., Dubnitskiy V.Yu., Kharchenko S.V., Smianov V.A.

Until 2030 the ulcer mortality will have a growing trend as estimated by the World Health Organization. Detection of countries and population groups with high risks for the ulcer mortality is possible using forecast method. The authors made a forecast of mortality rate from complicated ulcer disease in males and females and their age groups (15-24, 25-34, 35-54, 55-74, over 75, 15 - over 75) in our country. The study included data of the World Health Organization Database from 1991 to 2012. The work analyzed absolute all-Ukrainian numbers of persons of both genders died from the ulcer causes (К25-К27 coded by the 10th International Diseases Classification). The relative mortality per 100 000 of alive persons of the same age was calculated de novo. The analysis of distribution laws and their estimation presents a trend of growth of the relative mortality. A remarkable increase of deaths from the ulcer disease is observed in males and females of the age after 55 years old. After the age of 75 years this trend is more expressed.

144-148

Authors: Karpenko S.I., Shponka I.S., Zavizion V.F., Zavizion E.M., Skoryk V.R., Snisar A.V.

Solid pseudopapillary tumor of the pancreas (Frantz's tumor) is a very rare disease with uncertain malignant potential. This tumor occurs in young women at the age before 35 years. Asymptomatic disease course leads to growth of tumor up to the huge size. Surgery is the only treatment method applied. Histological diagnostic is complicated with similarity of tumor with neuroendocrine tumor of the pancreas. Disease is characterized with favorable prognosis. Paper shows our own clinical observation of Frantz’s tumor. During control ultrasound examination of woman aged 34 years, echo-signs of mass lesion in extraperitoneal area near the lower pole of the left kidney were diagnosed. During physical examination in the left hypochondrium a soft, atropic mass lesion 5.5x5 cm in size was diagnosed. Lesion presence is confirmed by CT assessment. Distal resection of the pancreas and splenectomy was performed. Diagnosis was verified histologically and immunohistochemically. Postoperative period is complications free. The results of CT assessment, detailed description of gross specimen and the results of histological and immunohistochemical examination are presented.