The Journal of V. N. Karazin Kharkiv National University. Series «Medicine»

1-96

Authors: HEART RATE VARIABILITY: FROM THE MOST DARING IDEAS TO THE MOST PRACTICAL IMPLEMENTATION

HEART RATE VARIABILITY: FROM THE MOST DARING IDEAS TO THE MOST PRACTICAL IMPLEMENTATION

6-11

Authors: N.I. Yabluchansky, L.A. Martimyanova

A clinical classification of orientated on practical doctor atrial fibrillation offered. The classification comprised both well-known and completely new points. It consist of eight parts: nature, mechanisms, flow, clinical picture and its meaning, accompanying syndromes, important in decisions making, complications, reactions to medical interferences and drugs in acute pharmacologic tests, prognosis. Each part consists of subdivision. The classification is explained in details.

14-17

Authors: O.V. Ignatkina, M.I. Yabluchansky

The connection of efficiency of therapy by metoprolol (MT) with type of reactions of neurogumoral regulation on this drug in acute farm test (AFT) was investigated in 106 patients with a chronic heart failure. The type of reaction was determined by a heart rate variability method by change of sympathovagal balance (SVB) in AFT. Clinic and haemodinamic parameters and parameters of ultrasonic scanning of heart were studied prior to the beginning and upon termination of a stage of therapy by MT. By more significant the outcomes of therapy have appeared among the patients with decreasing of SVB.

20-23

Authors: E.T. Advienko, V.P. Maliy

The presentation of Siberian Anthrax as a biological weapon. Particularly started is the pathogenesis of the Inhalation form of the diseases, the modern way of therapy.

26-29

Authors: E.I. Bodnya, O.I. Povgorodnaya, N.A. Mikulinsky, A.A. Golovachev

The level of most registered parasitic diseases in Ukraine is reducing. From this point of view the parasitiosis, caused by the pathogenic proteus and helminths, have the most importance.

32-36

Authors: A.M. Broshtein, N.A. Malishev, V.E. Luchshev

Malaria remains one of the most important problems of health organizations for 100 countries in Asia, Africa and South America. Every year in the world about 300 to 500 million clinical conditions of Malaria and from 1.5 to 2.7 million people especially children up to 5 years, every year die from it. Not minding the success in the area of biology epidemiological study and clinical problems of the disease. In the present people die from malaria compared to 30 years ago. The highest level of the disease and death rates comes from the region on the territories that have been eliminated earlier, the number of increase malaria delivery and the second condition of delivery continues to increase. In the article is been presented modern ways in the areas of synthesis of new drugs for the treatment and prophylaxis of malaria and also new methods of diagnosis. The most important perspective for treatment and prophylaxis of malaria is taking different drug forms Artemizin, combination of Mefloxin and Artemizin, Alovakvon with Proguanium and other combination.

38-42

Authors: M.A. Georgiyantz, V.A. Korsunov

The article shows modern ways of conducting intensive therapy in patients with difficult forms of meningoccocal infection. Presented is the basic use of antibacterial therapy, intensive shock therapy, DVC-syndrome, respiratory support, enteral and parenteral feeding. More attention is paid to the condition and problems of taking steroids, extracorporal methods of detoxication.

46-49

Authors: V.N. Kozko, A.E. Bondar, A.O. Solomennic

The total number of lymphocytes and expression of superficial antigens CD3, CD4, CD8, CD20, CD56 were studied in the lymphocytes of peripheral blood among 40 patients with chronic HCH. The first group consists of 16 patients with normal level of AlAT, the second one-24 patients with high level of AlAT. Discovered the true (p<0,05) decrease of OCHL, percent cell, expressing antigens CD3+, CD56+ and index CD4/CD8 among the patients of the first group and the true (p<0,05) decreasing OCHL percent cells CD3+, CD4+, CD8+ and CD56+, increasing CD20+ among patients of the second group compare to control. The comparing of immune indexes in patients in group 1 and 2 turned out the true (p<0,05) difference in the type of decreasing OCHL, expression of antigen CD3+ and increasing of the percent of cells, expressing antigens CD4+ and CD8+ among patients with normal level of AlAT.

53-56

Authors: V.S. Kopcha, M.A. Andreitchin

The effectiveness of different methods of therapy in patients with acute shigellosis is compared. It is detected the one-time pollination of mucous membrane of colon (colon-sorbtion) with oxide aerosol of sillard-P contributes to quick clinical recovery, normalization of reologic blood characteristics and rectum microcirculation and prevent reconvalescensive bacterial-carrier. The combination of colon-sorbtion and ethiotropal therapy per os hasn’t got the advantages in usage of the same kind of enteralsorbtion without ethiotropal preparations.

59-62

Authors: N.F. Merkulova, E.A. Belkina, V.V. Nikitina, N.A. Ekimova

Clinics of 124 patients of different ages were presented. Clinical polymorphism was found in adults in comparison with adolescents. Mononucleosis is more often characterized by gradual onset of disease, later appearance of atypical mononuclear in blood samples, slow regression of symptoms. Septic forms were found more often in adolescents.

66-68

Authors: A.K. Polykchi

141 Patients with diphteria have been examined. Monocyte-complementavy index of blood determined. Close relation between monocyte-complementary index and form, severity, development of myocarditis, duration of the disease have been established.

73-75

Authors: T.M. Popova

Altan application efficiency for patients suffered from salmonellosis has been proved. The medicine actively normalizes lipid peroxidation level and antioxidant activity in blood serum. The results have been obtained allow to recommend to use altan antioxidant preparation for alongside treatment of salmonellosis.

78-81

Authors: G.P. Somov, Isaak Salmover, V.P. Maliy

The pseudotuberculous infection contamination is widespread everywhere, clinic is characterized by a considerable polymorphism. More often disease shows representative (94,3 %) flow with a lesion of different organs and systems. The pseudotuberculosis called by serovar III of Y. pseudotuberculosis, flows past rougherly as contrasted to by forms called by serovar I of the agent.

84-85

Authors: D.B. Penkov, V.P. Malyi

The facts of expressed interferon indace function of cycloferon in the therapy of acute viral hepatitis C are presents in acticle. The prescription of preparation in dose form 4,0 ml is predominate.

90-93

Authors: E.V. Kobolev

In acute experiments on Wistar rats it was shown that transcranial magnetic stimulation (TMS) (1,5 Тl, 20 impulses, 30 min from the moment of cessation of TMS) is followed by the decreasing of those indices which were determined in «open field» test. Namely, the number of crossed squares as well as the number of rearings were substantially reduced. Naloxon (1,0 and 10,0 mg/kg, i.p.) induced dosage-depended protective action with regard to TMS-induced effects upon animal's behaviour. The enlargement of opiate-induced components of posture-tonic reactions- explozivness, exophtalm, adduction of extremities, decreasing of pain-induced reactions, increasing of tail tonus, loosing of the ability to hold on the rode and grasping of the pencil were seen. Mentioned behavioral reactions were blocked by naloxon (10,0 mg/kg, i.p.). The conclusion was made on the activation fo kapa-opiate receptors in the course of TMS.

98-103

Authors: I.V. Lakhno, S.G. Sobol, A.E. Tkachyov, E.A. Danilenko

It was investigated clinical effects of “Diovenor 600” administration in patients with fetoplacental insufficiency. It was shown the optimization of haemodinamics in uterine cord and cerebral media fetal arteries due to such a method of treatment. Total biophysical profile score and its separate parameters were improved in patients with fetal distress.

106-111

Authors: A.V. Martynenkо, A.S. Antonova, A.M. Yegorenkov

The article is devoted to statistical approach that based on method of splitting registered composite rhythmogramm to its independent components, each formed by corresponding regulating units of an organism. Formal mathematical procedure of independent component analysis (ICA) of heart rate variability (HRV) allows to obtain no more than three components forming the rhythmogramm of health person. This fact rationally represents physiological hypotheses about regulation systems taking part in forming HRV phenomenon. ApplyingICAto HRV approves itself on timing intervals form 4 to 15 minutes. Вreaking the limit of this timing interval causes essential worsening of quality of components forming the rhythmogramm. Optimal application ofICAfor splitting initial registered HRV signal into components, according to quality, is usingICAwith five-minute HRV registering protocol.

115-120

Authors: J. C. Tantchou Tchoumi

Myocardial infarction is one of the basical cause of population invalidisation and death that determinate the necessity of deepning pathogenetical researches in its development peculiarities and the new method elaboration of the manyfactorial disease effective treatment. The aim of the investigation was to explore the proinflammatory cytokine: tumor necrosis factor-α (TNF-α) expression dynamics and C- reactive protein (CRP) in patients with acute myocardial infarction. 70 patients were involved in thе study and divided in 2 groups: in the 1 st group were 40 patients with Q- wave myocardial infarction were recruited, in the 2 nd group 30 patients with non Q – wave myocardial infarction. Serum levels of TNF-α and CRP were measured on the first day and twice on the 7 th and the 28 th day by ELISA. The results of the investigation showed that the inflammatory reaction caused mainly by TNF-α and lesser than CRP was high on the 1 st day, gradually decreased to the 7 th , 28 th day and was more significant in patients with Q- wave myocardial infarction.

5-10

Authors: J. Brožaitienė, J. Juškėnas

The aim of this study is to assess the peculiarities of heart rate variability (HRV), hemodynamics and oxygen uptake data during functional testing procedures in post - MI patients at various risk groups and to use the infor­mative values for optimisation the intensity of exercise training programme. The peculiarities and significance of heart rate variability, hemodynamics and O2 uptake data were assessed in 558 post - myocardial infarction patients, subdivided into low (group 1, 44 pts), intermediate (group 2, 221 pts) and high (group 3, 293 pts) risk groups. Clinical investigation, followed by typical instrumental (ECG, echocardiography etc.) was performed for every patient at the beginning of search. A computerised analysis of heart rate variability (SDNN, respiratory sinus arh­ythmia – RA, HR power - spectrum components: very low frequency (VLFC), low frequency (LFC), and high fre­quency (HFC), maximum HR values in response to the AOT (RRB), the extent of response (DRRB) as well as hemodynamics (method rheografy) and oxygen uptake parameters (VE, VO2, VE/VO2, VE/VCO2) during an ac­tive orthostatic test (AOT), bicycle exercise or spiroergometric test was estimated. On the ground of the informa­tive parameters of autonomic HR control, hemodynamics and O2 uptake responses to the workload, an algorithm for the optimisation of an exercise-training programme was proposed and used for training patients with coronary artery disease.

35-40

Authors: A.R. Galeev, L.N. Igisheva, E.M. Kazin

The cardiorategrams of 5400 children from6to 16 years was analyzed for studying of age features of heart rate variability. It was revealed, that those children's values of parameters of heart rate (M, SDNN, RMSSD, TP, VLF, HF) was increased with age. It was accompanied by sinuosity fluctuations of parameters from year to year. Gender differences were observed on parameter of M since 9th years old, on parameters TP, VLF, LF since 11th years old, on parameters SDNN, RMSSD, HF since 12th years old. It was not revealed gender differences at the age of 16 years on all parameters of heart rate variability. It was shown, that parameter VLF received on the record of the electrocardiogram with duration less than five minutes was suitable for a physiological and clinical evaluate. The received values of parameters can be used in practice as normative.

45-50

Authors: Ye.G. Tsoy, L.N. Igisheva, A.R. Galeev

The aim of this study was to clear up the peculiarities of adaptation in early neonatal period. Comparative analysis of clinical and rythmographic data was made in 122 full-term newborns at the age of 1-6 days. Undulating course of adaptation process characterized by increasing of life activity in the first two days and on the 6-th day and relative of functional activity on 3-5-th days was estimated. Dimension of measurement of heart rate variability (HRV) allows us to characterize course of adaptation in early neonatal period.

54-58

Authors: Ye.M. Gurjanova, L.N. Igisheva, A.R. Galeev

Heart rate data of 244 healthy and ill children were analyzed for studying features of heart rate variability (HRV) at a bronchial asthma in view of an initial autonomic tone. It is revealed, that bronchial asthma patients are characterized by the parasympathetic initial autonomic tone with hypercholinergic effect of influence on HRV. It is stablished, that spectral characteristics of HRV (HF, MLF) are markers of pathological autonomic regulation. At loading regulation at bronchial asthma patients was characterized by the increased activation of the sympathetic branch of ANS not depending on an initial autonomic tone. Efficiency of HRVgrathy for diagnostics of autonomic disturbances is shown at a bronchial asthma.

80-85

Authors: J. Srinivasa, M. Ramesh Bha, M.R. Prabha Adhikari

Introduction: Respiratory sinus arrhythmia is a valuable tool for determining autonomic nervous system control of cardiovascular function and an important index of autonomic nervous system pathology Objectives: The present study was conducted to compare the amplitude of respiratory sinus arrhythmia (expressed as Heart rate variability) in normotensive individuals and freshly diagnosed hypertensive subjects and to detect any influence of abdominal breathing in freshly diagnosed hypertensives Materials and Methods: 50 Normotensive and 50 age matched hypertensive subjects were selected for the study.The subjects were instructed to breathe normally for first minute then during the second minute , subjects were requested to do conventional deep breathing using chest muscles (Intercostals chiefly). The subjects then performed abdominal breathing during the third minute, while electrocardiogram(ECG)in limb lead was being recorded and changes in heart rate was manually measured. Results: The mean heart rate variability of newly diagnosed hypertensives was 6.30±1.11 for normal breathing, 12.48±1.64 for conventional deep breathing and 15.56±2.54 for abdominal breathing and mean heart rate variability of normotensive subjects was 8.10±2.25 (P<0.0001) for normal breathing,18.08±5.12 (P<0.0001) for deep breathing using chest muscles and 20.68±6.28 (P<0.0001) for abdominal breathing. Discussion and Conclusion: The newly diagnosed hypertensive subjects had significantly reduced heart rate variability ( amplitude of RSA) compared to age matched controls, which improved with abdominal breathing Thus the deleterious effect of reduced HRV can be revered to an extent through proper abdominal breathing in the hypertensive subjects as well as in controls as shown in our study.

90-94

Authors: A.S. Isaeva, N.I. Yabluchansky

There is a description of historical and social aspects of using “Quality of life” tests. In the article rules of application “Quality of life” in practical medicine are summarized, in particular, in cardiology, the examples of tests are included. Using of “Quality of life” allows to make unbiased data of patients health status.

98-102

Authors: O.P. Bilozorov

Clinical investigations have shown that atopic dermatitis is characterized with high concentration of IgE and increased level of circulating immune complexes due to antigenic load, which is partially connected with skin microorganisms. Literature data are reviewed about atopy genetic and localization of genes connected with this pathology.

104-112

Authors: Y.F. Kutasevych

The modern approaches to systemic and topical therapy of atopic dermatitis and scientific support for the use of classic and new medications are reviewed in this article.

115-126

Authors: N.N. Popov, E.G. Kurinna

Mainstages of formation and developing of allergic reactions of I type were analysed. Properties and the role of each components of the immune reaction: allergens, reagines, must cells and basofils were described. Basis principles of diagnostics and therapy were demonstrated.

5-12

Authors: N.I. Yabluchansky

The work was focused on problems of clinical application of ejection fraction. It was proved that ejection fraction may be used in diagnostics only within a complex of other indices of circulation system.

16-23

Authors: A.D. Vizir, V.A. Vizir, A.E. Berezin, A.V. Demidenko

180 people were examined, among them there were 30 healthy persons and 150 persons who were ill with arterial hypertension at the age of 39-63. We found out that 58 of them had essential hypertension , 44 – arterial hypertension with endothelial dysfunction and 48 – cerebroischemic arterial hypertension. The brain blood flow was determined by B-mode and pulse color Doppler. The plasma catecholamin levels were determined by RIA. The evaluation of erythrocyte catecholamin level in red blood cells was performed with the help of a digital image analysis system . The analysis of the obtained results showed that the endothelial dysfunction of extracranial arteries and their structural remodelling of hypertensive patients depended more on the activity of tissue component of simpatho-adrenal system than on catecholamin level in blood plasma. Cerebroischemic arterial hypertension forming is accompanied by damaging mechanisms of interrelation between the plasma catecholamin activity and processes of their transmembrane transportation and intracellular deposition. At the same time the decrease of plasma catecholamins influence on mechanical properties of endothelium is associated with the decrease of endothelium-dependent vasodilation contribution to ensuring adequate cerebral perfusion even under significant hyper sumpathicotonia.

29-34

Authors: G.V. Dzyak, T.V. Kolesnik

The aim of the research was to study clinical effects and acceptability of a new AT1-recepotor blocker – irbesartan (aprovel, Sanofi/BMS). 30 patients with soft and moderate arterial hypertension were examined, the average age of the examined persons is 52,66,1 years old, duration of disease - 9,7 years. The prescribed dose of aprovel was 150 mg per day for 12 weeks, the dose was corrected after 4 weeks of therapy. All the patients passed 24 hours’ blood pressure monitoring ( device of MEDITEX, ABPM, Hungary) before the start of treat-ment and on 4, 8, 12after it. The following indices were analyzed: middle systolic and diastolic blood pressure (24-hours, day, night), variability of blood pressure, hypertension time and square indices. This study showed the efficacy of aprovel monotherapy (the dose made up 150 – 300 mg per day). The preparation causes a stable hypotensive effect, decreasing systolic and diastolic blood pressure after 6 – 8 week of treat- ment. The hypotensive effect of aprovel depends on the dose of the preparation. Aprovel does not influence nor-mal circadian low daily blood pressure rhythm and corrects pathologicone.

39-43

Authors: O.V. Ignatkina, M.I. Yabluchansky

The important condition of treatment of the patients with a heart failure (HF) is the normalization of a neu-rogumoral regulation (NGR) under action of medicinal therapy, and first of all, by ACE-inhibitors. Heart rate vari-ability (HRV) is a technique qualitatively estimating work of NGR. The efficiency of enalapril maleat (EM) thera-py of the patients with HF on its influence on clinical parameters and HRV was estimated depending on reaction LF/HF HRV in acute pharmacological assay (APA) with this preparation. Prior to the beginning treatment to the patients was spent APA with EM with registration of parameters HRV before reception and at height of action of a preparation. By its results of the patients have shared into two groups: group 1 with increase LF/HF, and group 2 with decrease LF/HF in APA. Within 3 months all patients received EM, nitroglycerinum and hydrochlorthia-zidum, then estimated changes in a clinical-functional condition of the patients and parameters HRV. The results show, that the clinical efficiency of EM is more effective at of decrease reaction of sympathovagal balance on APA with this preparation, is especial at the persons with III NYHA class. At rising LF/HF on APA results of treatment are less essential. The reaction of ТР in reply to therapy is higher in group of the patients with decrease LF/HF in APA, that reduces risk of development of fatal complications.

48-54

Authors: V.M. Kovalenko

On the basis of the data of clinical examination and echocardiography was studied the functional significance of compensatory myocardial hypertrophy under conditions of physical load test of sportsmen with myocardial hy-pertrophy of the left ventricle or without it and patients with different stages of arterial hypertension. The usage of compensatory myocardial hypertrophy indices for diagnostics of the heart failure was grounded.

61-67

Authors: S.N. Panchuk, V.B. Zhukova, I.A. Bondarenko, H.N. Pasko, I.V. Solovjova

Neurohumoral effects of metoclopramidum on 18 healthy volunteers were studied with the help of heart rate variability technology (HRV) under acute pharmacological test conditions. The obtained results indicated that metoclopramidum decreases the total power of neurohumoral regulation (NHR) mostly by depressing sympathetic activity and least - parasympathetic one. The degree of the preparation effect on HRV indexes was determined by the initial sympathovagal balance of the volunteers. Metoclopramidum did not show the ability to modify the directions of HRV parameter changes in conditions of active tilt test. The preparation effect was limited by more significant deposit decrease of a parasympathetic component with a shift of autonomic balance towards sympathetic influences. The above effect was not determined by the initial values of sympathovagal balance. The determined individuality of the neuroregulatory systems response to metoclopramidum intake requires its preliminary testing in acute pharmacological test. The optimal management of a patient requires planning of the dose and regimen of a medication intake.

73-80

Authors: H. Hutten

Purpose of work: Assessment of the potential of intramyocardial electrograms (IMEGs) for longterm cardiac telemonitoring that is not possible by surface ECG due to the poor reproducibility of these signals. Materials and methods: With the availability of cardiac pacemakers with broad-bandwidth telemetry (0,3-200 Hz) and fractally coated electrodes the monitoring of IMEGs both from the spontaneously beating and the paced heart became possible. These signals have first been utilized to monitor rejection in transplanted hearts. Protocols for standardized clinical examinations have been set up that allow to eliminate errors (e.g. time of day, changes in posture, and stimulation parameters). Tailored software has been developed for signal processing based on event classification, averaging, and parameter extraction. Individual features like anatomy of the heart and respective position of the electrode require that each patient is considered for its own reference. Results: IMEGs can be acquired with excellent longterm reproducibility of signal morphology. In most cases the transitory effects during the post-implant period can appropriately be considered. Regarding reproducibility the IMEGs are superior to surface electrograms. Careful signal processing of the structured morphology of IMEGs supplies information of clinical relevance that can not be obtained from surface electrograms. Ventricular evoked responses (VERs) can be obtained with the same electrode that is used for stimulation. VERs in transplanted hearts do indicate not only acute rejection and infection episodes, but have a high prognostic potential for recipient monitoring. Furthermore, IMEGs monitor information on the hemodynamic situation of the heart, e.g. end-diastolic filling volume, and they can be utilized for AV-setting in patients with cardiomyopathies. Conclusion: Surface electrograms are well established for cardiac routine diagnosis and longterm monitoring, e.g. Holter monitoring. However, thanks to progress in pacemaker technology IMEGs offer another challenging potential for cardiac monitoring including therapy management and risk surveillance that is not accessible with surface electrograms. Computerized evaluation of IMEGs is possible, however requires tailored software that is made available by specialized centers.

84-90

Authors: I. G. Zakharov, O.F. Tyrnov

The task of quantitative verification of untraditional diagnostics methods that use simple indexes (colour and nail form, structure peculiarity of eye iris and etc.) is formulated. The nail lunulae length as a simple index was used to accomplish the task. The conclusion of diagnostic meaningfulness of simple indices is drawn. The nonrandom nature of weekly rhythm in change of nails lunulae length is shown, the presence of weekly rhythm of human functional asymmetry is determined. The present approach allows, in principle, to study other methods of untraditional diagnostics and can be used as an independent research method of organism functioning peculiarities that require long-term regular measuring.

93-97

Authors: I.G. Lesovaya

The information on frequency of chronic non-tumoral sialaden diseases of various groups of the population of the Kharkov region, according to the archive data of the specialized clinic of the Kharkov Medical Postgraduate Academy is submitted in this work.

105-108

Authors: V.P. Maly, O.K. Polukchy, P.V. Nartov

90 patients with diphtheria of stomatopharynx were examined. It was determined that activation of prekal-likreine-kallikreine system took place during the course of disease. Patients with severe forms of the disease, for whose therapy it is necessary to use ingibitors of proteolysis, had the most significant changes.

112-116

Authors: E.D. Khvorostov, I.A. Semenenko

The results of surgical treatment of 14 patients (12 – with blood system diseases, 2 patients with nonparasitic cysts of spleen) were analyzed in the article. The questions of indications to surgical treatment of blood system disease patients and principles of rational transfusion tactics were considered. The methods of laparoscopic spleenectomy, which had been used in the surgical department of Railway clinical hospital of Kharkov since July, 2000, were described and applied in practice. A comparative evaluation of advantages and usage advisability of laparoscopic method use is carried out. Special consideration was given to establishment of indications to splenectomy, preoperative preparation and conducting of postoperative period of. Authors showed, that spleenectomy of blood system disease patients related to operation with increased risk, though laparoscopic spleenectomy that required corresponding experience of a surgeon and technical equipment, was an alternative to open spleenectomy.

6-11

Authors: M.I. Yabluchansky

The medical education activity of the Karazin Kharkiv National University was renewed with the Ukraine becoming an independent state. Historical roots and the actuality of the University medical education is the topic of the article. The main idea is that medical education in the Ukraine should turn toward the educational sphere. In this way the conflict of the interests caused by concentration in one place both the medical education and health care will disappear. This is going to be profit for everyone and for ordinary citizen in the first place. This means that whole country will be benefited.

16-21

Authors: V.G. Babijchuk

It has been shown that under hypothermia conditions the interactions between central and autonomous contours of cardiac activity regulation can be significantly changed, therefore the probability of paradoxical reactions of an organism to application of cardiotropic preparations increases. The change of a sign of chronotropic effect of cathecholamines (CA) and acethylcholine (AC) under hypothermia in a great extent is substantiated by an increase of blood brain barrier (BBB) permeability, that should be taken for consideration in practical medicine. Besides therapeutic cooling regimens contribute to a recovery of impaired rhythmicity of functioning of nerve and cardiovascular systems, in particular under conditions of emotional stress, that is one main causes of human disease appearing.

25-29

Authors: V.N. Dzuba, Yu.V. Nikitchenko, T.A. Shmonina

ATPase activity alterations in rats of different age groups during the total myocardial ischemia were studied. It was determined that only mitochondrial oligomycin-sensitive ATPase was sensitive to effect of the total myocardial ischemia. The fact that addition of magnesium ions in the incubation medium eliminated ischemic effect in 3-months old rats and weakened it in 24-months old rats pointed to important role of magnesium ions in structure-functional reconstruction of mitochondria under myocardial ischemia. Young 3months old rats were established to be more tolerant to myocardial ischemic damage thanold animals.

36-40

Authors: L.A. Grebeniuk, A.V. Popkov, V.A. Shchurov

The aim of this work is to analyze the influence of some factors on biomechanical behavior of the human skin in natural growth and in graduated lengthening with application of the Ilizarov fixator. 45 healthy individuals of various age and 104 patients suffering from congenital shortening of one lower limb or osteomyelitic sequelae have been examined. The limb discrepancy was eliminated by mono- and bilocal osteosynthesis with application of the Ilizarov fixator. The amount of lengthening comprised 3 - 14 cm, its relative value achieved 6 - 30%. Distraction started in 5 days following fixator placement. Biomechanical parametres were determined with the help of the device designed by A.A. Utenkin. The method allows for studying skin deformation properties - shift stiffness (S, kg/mm2) by minimal in time loading but constant in value moment, as well as for calculation of the amount of relative deformation (stretching,., %). The work reports on the effect of different factors – structural and age ones, conditions of reparative lengthening and processes of regeneration – on the mechanical behavior of the limb skin in shortening of different etiology and gradual traction for equalizing limb length. There is a number of factors having influence on the skin biomechanics of the human extremity: 1 structural peculiarities of the collagen bundles and elastic fibres in the papillary and reticular dermis layers (collagenous fibres make up 98% of the connective dermis tissue and provide its high stiffness). The conformation principle of the collagenous and elastic fibrillas and fibres is their spiral character. 2 - the type of the collagen viscosity in the dermis, especially in its deep layers; 3 - age factor; 4 - an amount and etiology of limb shortening in patients with the locomotor system orthopaedic pathology; 5 - the method of limb shape modeling (lengthening and deformity correction) in the conditions of the guided transosseous osteosynthesis (mono- and bilocal osteosynthesis); 6 - skin regeneration (Ilizarov effect) as a consequence of the formogenetic effect appearing in the conditions of tension stress.

44-47

Authors: E.G. Maksimenko, V.N. Savchenko

It was determined that the serotonin level in hypothalamus, brain stem, cerebellum and brain hemispheres lowers in rats with high audiogenic spasmodic activity as compared to rats with low excitability level, and the serotonin content in rats decreases in cerebellum and hypothalamus.

52-55

Authors: V.A. Moroz, V.P. Starenkiy

The purpose of the work based upon the treatment results of 29 patients with radiation injuries received in accidents are to determine optimum his treatment tactics. Special attention was focused on surgical rehabilitation and mistakes and inaccuracies, made during its carrying out. The calculation of the received dozes was carried out of the basis of the calculated simulation method of an accident in consideration of the source’s activity, geometry of the exposure and time of contact with it. The observation of the patient under considerations enables us to assert that in the acute period of the radiation injury (prior to 3 months after the accident) the reconstructive surgical treatment is expedient only in conditions of x-ray overexposure, with only surface injure of tissues, especially when there is their inflammatory response. For better remote results of treatment surgical rehabilitation of the consequences of a radiation trauma, including determination of the coretraction scope and the type of an operation, should be postponed for 6 months, which will enable to do it more precisely.

63-67

Authors: N.G. Strygelchyk

The potential mutagenic effects of new auxilary farmaceutical substancies (emulgators) was investigated. Under per os injection the substancies not induced the chromosomal aberrations in the narrow cells and dominant lethal mutations in male gametes of mouse. The results are discussed in connection to using at investigated substancies in pharmacology.

72-76

Authors: G.I. Taran

Morphometrical comparison of duplex kidney and ureter structural elements in children was done taking in account the gravity of the pathological process and methods of treatment. Morphological objects giving the possibility to prognose the method of surgical treatment and it’s outcome depending on the quality and quantity of changes of the duplex kidney structure were determined. The principal difference of quantitative changes of structural elements of a duplex kidney without the violation of urodynamics in moderate violation of the outflow of urine and also in a steadfast loss of the function because of the violation of urodynamics of a grave degree was confirmed.

81-84

Authors: Yu.B. Zakharchenko

The results of treatment the 34 patients with the acute purulent cholangitis was analysed. There were 9 men (26,4%) and 25 women (73,6%) in the age for 43 to 87. On the entrance those patients to the clinic their general condition were heavy, but some of them had middle weight condition. The possibility violation of the gall-ducts on the level of common bile ductwere conditioned with: the big stones have 18 patients (52,9%), which defied to endoscopiccholedocholithotraction; strictures of the ducts have 8 patients (24,7%); combination ofcholedocholithiasis with the strictures have 5 patients (14,7%); combination of the choledocholithiasis with parapapillar diverticulum have 3 patients (8,8%). The diagnostic program conclude of the clinical and laboratories methods investigations, ultrasound scanning, endofibroscopic investigation the top past of the gastro-intestinal tract, endoscopic retrograde cholangiopancreatography, cholangiomanometry, bacteriological cheek up of the bile. The treatment program included: the standard infussional therapy of acute cholangitis and the obstructive jaundice; the endoscopic sphincterotomy with following nasobiliar drainage; thelandmark endocholangial leading the complex antibacterial medicine Levosin. As the resultsof the treatment all patients with acute obstructive purulent cholangitis in all cases weremixed in the period of 4-9 days after the treatment starting, with were definite by the clinicalflowing and verified by the dates of laboratorical cheek up methods. All of these allowed tofulfil the radical surgical intervention on the common bile duct with the least risk for the patient. There was no lethal outcome.

91-96

Authors: A.V. Stepanov

Prior trials detected benefits from hyperbaric oxygenation therapy (HBOT) for patients with coronary artery diseases (CAD) and acute myocardial infarction. The aim of this study was to assess the changes in ANS in patients with CAD during session of HBOT by using the technique of HRV. The patients with CAD were subdivided into three groups in dependence of atmosphere pressure and contents of oxygen. We measured the total power (TP), low frequency component (LF) reflecting sympathetic and high frequency (HF) reflecting vagal activity, autonomic balance (LF/HF ratio) and LF and HF in normalized units (LFn, HFn). We observed significant increase under HBOT of TP, decreased LF/HF ratio because of changing in both branch of AHS and parasympathetic activity increased more significant than decreased sympathetic activity. In our point of view the changes in ANS depend of proportionally from oxygen tension in tissues coursed by HBOT. Our preliminary results showed that measurement of HRV is helpful in monitoring not only the circulation but also the common status of patients during the sessions of HBOT and it will be possible in the future to modulate the protocols of HBOT individually for certain patient. Increasing of vagal activity and total power with decreasing of sympathetic tone during of HBOT is the evidence of "relaxation" of circulation and ANS which less stressed by monitoring the body oxygenation. Adjunctive HBOT can improve prognosis in patients with CAD in various ways: the positive modifying of HRV is a sign of favorable changing in ANS; increasing of cardiac electrical stability; prevention of left ventricular dysfunction, progressing in Killip class and ventricular ectopic activity and presence of late potentials; restores of sinus nodal cells to neural modulations.

101-103

Authors: E.D. Khvorostov, A.I. Tsivenko, S.A. Bychkov

For the period from 1994 year 1486 patients with chronic and acute calculosus cholecystitis aged from 18 to 78 years old were operated in the hospital. 312 patients of them were subjected to operations on organs of the abdominal cavity in the earlier period. Peculiarities of the operative treatment in this group of patients are elucidated in the article, particularly carrying out of the videolaparoscopic cholecystectomy. Au thors based possibility and expedientness of fulfilment of videolaparoscopic cholecystectomy in patients subjected to operations on organs of the abdominal cavity earlier.

108-112

Authors: N.I. Yabluchansky, E.P. Kamenskaya

The object of the present study was to evaluate the clinical effectiveness of the beta-blockers and ACE- inhibitors treatment of hypertension patients. The group of patients included 72 persons aged from 27 to 68 (47±6,97) with a moderate hypertension remaining for 7,4±5,2 years. All patients were divided into 3 groups. The first group (27 patients) received monotherapy of the conjunctive from of enalapril and hydrochlorothiazide (2 tablets twice a day), the second group (10 patient) was getting metaprolol (100 mg/daytwice a day). The third group of patients received both medications simultaneously once a day. Heart ratevariability was obtained by using “Cardiolab 2000“ device. The total power of spectrum (TP, ms2) wasevaluated as a measure of the total neuro-humoral regulation. Power of spectrum in the very low (VLF, ms2), low (LF, ms2) and high (HF, ms2) frequency areas reflected the humoral, sympathetic and parasympatheticinfluences correspondently. The low and high frequency areas ratio was obtained as an index of the sympatho-vagal balance (LF\HF). According to the ТР value obtained in the baseline the patients were divided into the sub-groups with a satisfactory (ТР>1000 мс2) and low (ТР<1000 мс2) power of the total regulation. The treatment effectiveness in each group was evaluated by comparing its results in sub-groups withdifferent basal regulation status. The reliability of the discrepancies was obtained by using the Studentcriterion for 95% confiding interval. Positive influence of the ACE inhibitors and beta-blockers was observednot only in the arterial pressure dynamics but also in the neuro-humoral regulation status. The optimisinginfluence on the regulation systems became apparent not only as a growth of the total regulation but also asnormalization of its branch balance (first of all the sympatho-vagal balance). The combined therapy providedmore pronounced clinical result with smaller doses then the regular therapy. It also made the treatment lessexpensive.