Lviv Clinical Bulletin

14-17

Authors: Markin L., Shatylovytch K.

Introduction. The pathological changes of the venous system in pregnant women and the mothers are manifested in the occurrence of varicose veins of the lower extremities, venous thrombosis and thromboembolism. Varicose veins of the lower extremities are observed in 20.0-40.0% of pregnant women, in more than 70.0 % of women, manifestation of this disease occurs in the third trimester of the gestational process. The structural changes and a further decrease in the elasticity of the walls of the venous vessels are systemic, but the most affected are the veins that are least covered by muscles – the surface veins of the lower limbs, rectum, small pelvis, and also the fetoplacental complex. Actually, one of the gestating complications of chronic venous insufficiency is the formation of secondary placental dysfunction with clinical implementation in the form of fetal distress, fetal growth retardation syndrome (FGRS), preeclampsia (PE). Aim. To evaluate the effectiveness of the treatment of varicose veins of the lower extremities and prevention of its gestational complications using venotonic drug Normoven. Materials and methods. There were examined 60 women aged 21-45 (gestational age 28 weeks or more) who suffered from the varicose veins of the lower extremities. In all patients, the severity of the disease corresponded to the clinical class C1-C3 according to the international classification (CEAР). Observations included the all standard clinical and laboratory examination, antenatal cardiotocography (after 30 weeks), determination of fetal biophysical profile (BPP), and ultrasound doplerometric examination determining the state of blood flow in the arteries of the uterus, placental bed (spiral artery (SA)), umbilical (UA) and middle cerebral artery (MCA), renal artery (RA), venous duct (VD)). The effectiveness of the proposed treatment was evaluated by measuring the diameter of the lower leg at the ankles once a week and subjectively. Were evaluated the following symptoms: pain and feeling of heaviness in the lower extremities at the end of the day, reduced tolerance to static loads, and the presence of a vessel in the fluid muscle. Results. The first, yet preclinical, response of the mother-placenta-fetal system to any disease of the maternal organism is the violation of hemodynamics in its utero-placental contour. It was found that the progress of the gestational process in pregnant women with the varicose veins of the lower extremities in 6.7% was complicated by fetal distress, 13.3% – FGRS, 36.7% – PE. In view of the pathogenetic commonality of the varicose veins of the lower extremities and PE as the realization of endothelial dysfunction, intravenous systemic measures can be considered as one of the measures to prevent the onset of gestation in the second half of pregnancy in such patients. Thus, 23 pregnant women (76.7%) after the treatment using Normoven noted no leg pain at the end of the day and after walking or prolonged standing. The reduction of the pain syndrome to “slight discomfort” was in 12 (40.0%) patients. In 7 out of 23 pregnant females, edema of the legs and trunk disappeared, due to the improvement of microcirculation, lymph drainage and the elimination of tissue hypoxia as a result of the combined administration of diosmin and hesperidine. The average diameter of the legs in this subgroup was 24.5 ± 2.8 cm. Comprehensive treatment interrupted the progression of the varicose process, shin-like protrusions did not look over the surface of the legs Conclusions. The efficacy of the venotonic drug of systemic action Normoven in the treatment of varicose veins disease and positive effect on the intensity of the uterine–placental blood flow have been established. The possibility of applying of Normoven in preventing the development of preeclampsia in pregnant women with varicose veins of the lower extremities has been proved.

23-34

Authors: Abrahamovych L., Abrahamovych-Stasenko O.

Introduction. In all countries of the world, in particular in Ukraine, there is a significant increase in the incidence rate of the tumors of the skin, the prevention and treatment of which has a significant medical, social and economic significance. In clinical practice, different methods of treatment of benign and malignant neoplasms of the skin are used, among which surgical method, laser and electrocoagulation, cryodestruction using liquid nitrogen, ointment based on concentrated alkali and acids, etc., have been widely used. The statistical indicators of evaluating their efficacy indicate that good, long-term results of the treatment of malignant neoplasms of the skin are achieved only in 15.0-25.0% of patients. The search for new, more effective methods of treating this category of patients deserves special attention. The aim of this work is to find out the effectiveness of the treatment with herbal liniment “Antineoderm C-A” in patients with benign and malignant neoplasms of the skin. Material and methods. For 28 years we have examined and cured 20221 patients with different benign and malignant neoplasms (8 214 (40.62%) men, 12007 (59.38%) of women), aged 3 to 93 years. Of these, 329 (1.63%) patients with early melanoma and 118 (0.58%) patients with squamous cell carcinoma of the skin, which until now have not been treated, 1024 (5.06%) patients with a diagnosis of “basal cell carcinoma of the skin” , In which there was a relapse of the disease after the traditional methods of “removal” in other clinics. Of the 16335 patients (80.78%) with benign neoplasms, 7350 (45.00%) were not helped by other methods of treatment. The following survey methods have been used: visual inspection with dandruff, dermatoscopy, biopsy in cases of benign tumors of the skin (to clarify the diagnosis) with subsequent histological and pathomorphological studies of biopsy. In patients with early stages of melanoma (a biopsy is categorically banned because it can lead to traumatic metastasis of the tumor), a specific oncologic marker, S-100 melanoma protein, has been identified that can detect the presence of metastases. For the patients with melanomas in the early stages it was performed a comprehensive clinical-laboratory and instrumental examination of the internal organs for detecting the presence of metastases in accordance with approved protocols of the Ministry of Public Health of Ukraine. Results. In the vast majority of the treated patients there were no unsatisfactory direct results of supervision. The treatment proceeded without complications, except for the patients with plantar warts, which failed to complete the curia because of their refusal from the necessary in this case numerous medical sessions. Among 2349 (100.00%) of patients with different types of warts in 2344 (99.78%) the treatment was good, and unsatisfactory result was observed in 5 (0.22%) patients with plantar warts due to reluctance to continue treatment. And the among the total number of treated patients (20221-100.00%) poor results were observed in 0.02% of patients. Patients with good results of treatment include those 1024 patients with basal cell carcinoma of the skin and 7350 patients with benign neoplasms, who had signs of relapse after applying other methods (surgical, laser and electrocoagulation, cryodestruction using liquid nitrogen, using an ointment based on concentrated alkalis and acids, etc.). Conclusions. Treatment of benign and malignant tumors and melanoma in early stages using “Antyneoderm C-A” is safe and effective, and therefore, regardless of gender and age can be recommended for use in dermatooncology.

39-41

Authors: Markin L., Kunynets H.

Introduction. The presence in the history of two spontaneous miscarriages and more in the first trimester is treated as the usual miscarriage of pregnancy. Endocrine factors, genital infections, extragenital diseases play a significant role in the etiology of habitual miscarriage of pregnancy. It is noteworthy that the frequency of idiopathic (unclear etiology) of the usual miscarriage of pregnancy reaches 50.0-75.0%. Aim. To evaluate the effectiveness of preventive measures with the use of “Pregnaca” by people with idiopathic habitual miscarriage of pregnancy. Materials and methods. The group of observation was 50 women with idiopathic habitual miscarriage of pregnancy, who had been prevented from involuntary miscarriage from a 7-8 week pregnancy. The pregnant first subgroup (25 women) prescribed dydrogesteron (10.0 mg twice daily), the second (25 women) diddgesterone and “Pregnachea” (1 capsule a day). The peculiarities of the course of the gestation process were judged on the basis of the results of ultrasound biometrics, the determination of the internal diameter of the fetal egg and the caudal-parietal size of the fetus. The results of the measurements were compared with the indicators of T. V. Khodareva, A. M. Stigar (1989), obtained during the dynamic monitoring of pregnancy with normal course. With the help of silicicular echography, the degree of myometrium hypertonum, the ratio of the length of the uterus cavity to its anterior posterior size, and the ratio of the length of the cervix to its diameter at the level of the inner eye were determined. Results and discussion. All women in the surveillance group during the previous abortion failed to demonstrate the role of endocrine and immunologic factors, genital infections, chromosomal disorders, extragenital diseases, isthmic-cervical insufficiency. In the 7-8-week period of pregnancy signs of hypertonic myometrium were absent. Local thickening of myometrium during ultrasound examination was not detected. The ratio of the length of the uterine cavity to its forebrain size was 1.32 ± 0.03, and the ratio of the length of the cervix to its diameter at the inner eye level was 1.56 ± 0.04. Clinical signs of the threat of involuntary abortion were not observed. The dimensions of the uterus and the biometric indices of the fetal egg and fetus corresponded to the period of gestation. In the course of the uncomplicated pregnancy, the growth rate of the fetal egg was an average of 0.63 cm, and an increase in the caudal-parietal size of the fetus – 0.84 cm per week. Preventive measures were ineffective in 32.0% of the first subgroup of pregnant women and in 24.0% of women from the second subgroup. In the case of an involuntary miscarriage, the study of fetal heart rate revealed bradycardia (103.7 ± 5.8 beats/min). There was a lag behind the size of the internal diameter of the fetal egg and the coccyx-parietal fetal size for 7-9 days from the date of gestation. The hypertonic myometrium of II-III degree was characterized predominantly. The ultrasound examination then showed several thickening of the myometrium, including in the placental area, which caused a decrease in the anterior-posterior size of the uterus. The ratio of the length of the uterus to its anterior posterior size was 1.70 ± 0.05 (p <0.05). Increasing the activity of the uterus led to a shortening and opening of the cervix. The ratio of the length of the cervix to its diameter at the internal eye level was reduced to 1.20 ± 0.04 (p<0.05). Сonclusions. It was proved that using Pregnacare increases the effectiveness of the preventive measures in case of the idiopathic habitual miscarriage to 25.0 %.

46-49

Authors: Nyankovskyy S., Ivakhnenko O., Iatsula M.

Introduction. Today, despite the already significant experience of implementation of the main provisions of the Bologna Declaration in the domestic educational space, many students and faculty of higher educational institutions (universities) quite often express themselves quite ambiguously, due to the lack of integrity, completeness, thoughtfulness and proper resource provision. It is difficult to expect a brilliant final result if you introduce something in parts. This approach often leads to a negative or distorted result. Aim. To discuss the issues of the implementation of the Bologna process into the medical education of Ukraine. Materials and methods. In this article the debatable questions about the Bologna process implementation into the Ukrainian medical education are studied including thequestions about the students and teachers mobility, teaching load standards, students’ knowledge evaluation system, peculiarities of students’ training in clinical departments. Our own experience of the Bologna Declaration statements implementation into the pedagogical activities of pediatric department of Lviv National Medical University is described. Results. The Bologna process in Ukraine has dramatically increased the time, duration and frequency of formal control of students’ knowledge and skills. And if the number of students in the group who came to the clinic reaches 13-15 people, then the teacher turns into a machine for formal assessment of students’ knowledge. The reduction of classroom hours and an increase in self-learning are often interpreted by the students as a way to get rid of the latter. Practice shows that students themselves learn not only through laziness, but also through inability. This form of work requires a significant increase in the library stock, modern literature, mass free Internet access, virtual educational programs, telemedicine resources, distance learning. Conclusions. To optimize the educational process in Ukraine, the pedagogical load of the teaching staff and the number of students in the academic staff should be fixed as soon as possible. There must be created the modern university clinics with proper funding, students and teachers have to focus on the training of a wiser physician who needs the health care system most, and to improve the equipment of the departments of higher educational institutions and postgraduate education institutions with modern diagnostic and therapeutic equipment and materials, to motivate students to study.

54-57

Authors: Yuzych І.

Introduction. Dilated Cardiomyopathy (DCM) is a chronic disease caused by various conditions which lead to the ventricular dilatation, which decreases their contractile ability of the myocardium. DCM occurs more frequently in men than in women, and is the most common in the age 20-60 years. About one in three cases of congestive heart failure is due to the dilated cardiomyopathy. Symptoms of DCM can occur at any age and may include shortness of breath, swelling of the lower extremities and feeling of fatigue. This article contains a literature review concerning this disease. Aim. To make an overview of modern literature on the issue of DCM. Materials and methods. The content analysis, method of system and comparative analysis, the bibliosemantic method of studying the actual research in relation to the problem of DCM was used. Results. Clinical feature of DCM – increasing heart failure severity refractory to the treatment. In the early stages of the disease, the clinical symptoms are quite small. Patients can only complain of weakness and moderate shortness of breath but do not attach importance to this. Laboratory indices in patients with DCM generally are not informative. Echocardiography, which today is the most important method of the diagnosis of DCM helps to see the increasing of the heart chambers sizes, namely the increase of the end-diastolic sizes of the left and right ventricules, diffuse nature of the lesions, reducing of its contractility and in accordance with this the ejection fraction decreasing, relative mitral and tricuspid valves insufficiency signs. In this case the hypertrophy of the left ventricle walls may be missing, or its size is not commensurate with the sizes of dilatation. With the decrease of the contractile ability of the myocardium the likelihood of detecting the mural clots in heart chambers increases, and this can then become a source of thromboembolism. Regardless of etiology, the treatment of DCM is symptomatic and is based on the correction and prevention of the major clinical manifestations and complications – congestive heart failure, rhythm disorders and thromboembolism. Surgical treatment of DCM is used in case of the resistancy to intensive medical treatment of heart failure and provides heart transplantation followed by immunosuppressive treatment. If there is a risk of the patient’s life-threatening arrhythmia, it is advisable cardioverter defibrillator implantation. Conclusions. DCM is determined predominantly by the degree of congestive heart failure, the risk of sudden death increases with its increase. The main causes of death of patients are ventricular fibrillation, decompensation of congestive heart failure, thromboembolism. The diagnosis of the disease in the early stages allows the appointment of appropriate treatment, and, therefore, preventing the occurrence of fatal complications.