Medical perspectives (Medicni perspektivi)

4-11

Authors: Shyrobokov V.P., Poniatovskyi V.A., Yavorovskyi О.Р., Jankowskyi D.S., Dyment G.S., Bobyr V.V.

The evaluation of the effect of lifelong usage of sodium form of gel bentonite on some physiological parameters of mice (body weight, feed and water intake, general condition, change in coordination of movements, state of wool, fertility and mortality) was performed on 110 white laboratory mice (BALB / c line). This experimental study was carried out in two replicates. To accomplish this task, the mice were divided into two groups: control – the animals were on a standard diet, and experimental – they used water with the addition of sodium form of bentonite gel (0.5-1%). It was found that prolonged intake of bentonite gel by laboratory animals neither led to an excessive increase in their weight (the weight gain of the experimental group did not differ statistically significantly from the control group, p≤0.05), nor did it cause acute or chronic intoxication. It is also shown that the constant use of bentonite has a positive effect on the organism of experimental mice, which is expressed in the decrease of animal mortality, increase of life expectancy and pronounced positive effect on fertility functions (increase in the number of offspring). Based on the obtained data it can be assumed that the continuous intake of bentonite by the animal organism is one of the factors of their microbiome improvement, which affects on a plenty of physiological functions, including animals reproduction. It is possible that smectite sorbents also enrich the body of mice by certain essential mineral elements (silicon, etc.) and has cytomucoprotective properties concerning the mucous membranes of the macroorganism.

16-19

Authors: Kuzmina A.P., Lazarenko O.M.

The prevalence of cardiovascular diseases, especially arterial hypertension, continues to increase. An important problem is the management of the patient with a comorbid pathology in the primary link by the family physician. The purpose of this study was to assess the state of medical care in patients with arterial hypertension combined with gout, using a retrospective analysis of ambulatory cards, diagnostic and treatment data. There were analyzed 105 outpatient cards that met the inclusion criteria. The mean age of patients was 53.5±10.2 years. Among the examined patients there were 99 males (94.3%), and 6 (5.7%) females. Аrterial hypertension stage II has been reported in 100 (95.2%) patients, stage III – 5 (4.8%) patients. Аrterial hypertension 1 degree is established in 74 (70,5%) patients, 2 degrees – 21 (20%), 3 degrees – 10 (9,5%). The average duration of the gout was 4.4 [4; 2] years, arterial hypertension – 5.3 [3; 1] years. Acute gouty arthritis was present in 11 (10.5%) patients, chronic gouty arthritis – 85 (81%), and chronic tofi arthritis – 9 (8.5%). Patients seek medical help from their family doctor too late. Examination of patients with hypertension in combination with gout is not complete, this contributes to underestimation of total cardiovascular risk. In a number of cases, titration of the dose of allopurinol higher than 300 mg is not, performed so only a third of patients reach the target uric acid level.

31-40

Authors: Moshenets K.I.

The aim of the study was to examine changes in left ventricle (LV) geometry and to evaluate the systolic and diastolic function of LV in patients with type 1 diabetes mellitus (T1DM) depending on the course of the disease. Materials and methods. 63 patients with T1DM were examined. The mean age was 31.5 (24.0, 39.0) years, the duration of the disease was 11.0 (5.0, 18.0) years. Laboratory tests: C-peptide, HbA1c, blood creatinine, first morning urinary albumin excretion (UAE), glomerular filtration rate (GFR) according to the formula CKD-EPI were made. Long-term monitoring of blood glucose levels during 6 days was conducted by using the CGMS system. Transthoracic echocardiography and tissue Doppler imaging were used. Patients were divided into groups: Group 1 – HbA1c≤7.0% (n = 21), Group 2 – HbA1c> 7.0% (n = 42). 10 sex- and age-matched healthy controls were included. Results. Patients with DM 1 had significantly higher indices of the LV mass index (LVMI), LV posterior wall thickness, interventricular septal excursion and left ventricular posterior wall excursion (p <0.05). Hypoglycemic episodes lead to thickening of the interventricular septum and LV posterior wall thickness, increase of LV end-systolic volume, decrease of ejection fraction, and prolongation of isovolumteric relaxation time (p <0.05). Diastolic dysfunction with impaired relaxation (grade I) was 18 in patients with DM 1 (28.57%) without significant differences between the 1-st and 2-nd groups. Concentric remodeling of LV occurs in 16 (76.2%) patients of group 1 and in 27 (64.29%) of group 2. Eccentric hypertrophy of LV is determined in 1 (4.76%) patient of group 1 and in 5 (11.9%) of group 2, respectively, and only in 9.52% patients with T1DM. Conclusions. Patients with DM 1 have signs of structural and geometric reconstruction and diastolic dysfunction. Hypoglycemia is a significant factor leading to the formation of LV hypertrophy, as well as to decrease both of diastolic and systolic function of the myocardium.

51-58

Authors: Hrubnik V.V., Iliashenko V.V., Hrubnik V.V., Paraniak M.R.

The purpose of our study is to evaluate expediency of Platelet-Rich Plasma with self-fixated ProgripTM mesh use in hiatal hernia repair. The study was performed on 144 patients with gastroesophageal reflux with large hiatal hernias (the size of hernias 10-20 cm2 ), who underwent Nissen fundoplication and crurarrhaphia. All patients were divided into two groups: I group (71 patients) - we used non-absorbable self-fixating ProgripTM mesh for reinforcement of crurarrhaphia, II group (73 patients) – crurarrhaphia was done without mesh. In the patients of I group pieces of mesh were infiltrated by 2-4 ml of autologous PRP. Follow-up was completed in 128 (88,9%) patients with a mean follow-up duration of 39 months (range 12-60 months). There were no serious complications in the patients of both groups. During the 60 months of follow-up, 2 recurrences occurred in the mesh group and 14 recurrences appeared in the non-mesh group (p<0.05). Patient satisfaction was significantly higher in the mesh group (p<0.05). Our study has shown that the collagen content is reduced in patients with large HH. Thus, in such patients it is advisable to use mesh for crural reinforcement. The use of PRP provides a fast ingrowth of mesh, acts as catalyst to increase collagen synthesis and deposition, which promote to reduce the risk of recurrences.

63-68

Authors: Kaminskyi A.V., Boychuk O.G., Kolomiichchenko T.V.

Failures of in vitro fertilization (IVF) may be associated with prothrombotic states, the circulation of antiphospholipid antibodies (APA). 93 women with infertility were screened: 1 group - 32 women without severe psychosomatic disorders; 2 group - 61 women with psychosomatic disorders. The control group consisted of 30 fertile women. The level of AFA to membrane phospholipids (phosphatidylethanolamine, phosphatidylserine, cardiolipinum), antibodies to β2-glycoprotein (β2-GPI), hemostasis (platelet count, ADP-induced platelet aggregation index, fibrinogen concentration, prothrombin index, activated partial thromboplastin time - APTT, test for soluble fibrin-monomeric complexes, D-dimer), homocysteine in the blood serum was defined. The frequency of significant AFA titres in the group of women without psychosomatic disorders was 18.9%, and if they were present - 44.3%, the rate of β2-GPI 9.6% versus 24.5%, respectively. Only in 11.5% of women in 2 groups, elevated levels of APA were associated with β2-GPI and/or one or more clinical criteria for antiphospholipid syndrome (APS). In patients with infertility and psychosomatic disorders, increased platelet aggregation in the context of relative thrombocytopenia, higher fibrinogen levels, soluble fibrin-monomeric complexes, and prolonged APTT with elevated D-dimer levels was revealed. Some patients have hyperhomocysteinemia. Factors that adversely affect the efficiency of IVF in the patients with psychosomatic disorders were noted: elevation of APA; reduction in the number of platelets; growth of the ADP-induced aggregation index; extension of APTT; increase of fibrinogen, D-dimer; homocysteine. The presence of prothrombotic states associated with APS should be taken into account when preparing for IVF and perform their appropriate correction.

75-81

Authors: Vasylkivskyi V.V., Getman V.G.

Operations on the esophagus occupy an important place in the surgery of the gastrointestinal tract, since this organ passes through three anatomical regions: the neck, thoracic and abdominal cavity. The main pathologies for surgical interventions are congenital malformations, injuries, foreign bodies, burns and scarry strictures, neuromuscular diseases of the esophagus, hernia of the esophagus and reflux esophagitis, diverticula, acquired fistula, esophageal cancer, benign tumors and cysts. For the majority of these conditions clear recommendations on diagnosis and treatment have been developed. In the literature, there is no consensus on indications for conservative or surgical treatment of patients with esophageal leiomyoma and the type of surgical intervention: 1) resection of the esophagus 2) removal of the tumor with part of the wall; 3) enucleation of the tumor; 4) endoscopic removal. Mortality after resection of the esophagus or its wall with plastic is 13%, and after enucleation of leiomyoma – 2%. In our clinical study, the analysis of the performed operations on patients with leiomyoma of the esophagus was performed. The aim – to make a retrospective analysis of different types of surgical interventions in patients with esophageal leiomyoma performed in the thoracic departments of the National Cancer Institute, Kiev City Clinical Cancer Center, Kiev Clinical Hospital N 17, Zhytomyr Regional Hospital, Vinnitsa Regional Hospital. Retrospective evaluation of 66 patients with morphologically confirmed esophageal leiomyoma was made. The following types of imagining were performed in patients: radiological examination of esophagus with solution of barium sulphate and radiography, computed tomography of the chest (CTc), computed tomography angiography (CTA), magnetic resonance contrast-enhanced imaging (MRI TO). Instrumental methods: esophagogastroduodenoscopy (EGD) with biopsy, endoscopic ultrasound, endoscopic ultrasound-guided fine needle aspiration biopsy (EUS-FNA). The type of surgical interventions: proximal gastrectomy (n=3); Garlock operation (n=2); Lewis operation (n=3), resection of the tumor with part of the esophageal wall (n=6); tumor enucleation (n=52). Complications after operations in the early period: postoperative bleeding - the source is not identified, failure of the esophageal wall seam. In the late postoperative period – esophageal pleural fistula in two patients and esophageal stenosis in one patient. Indication for removal of leiomyomas: severity of symptoms, tumor size more than 5 cm, multiple leiomyomas, transition onto the stomach, patient's persistent desire, increase of volume in dynamics, changes in mucosa over the mass. Indications for resection options for surgery: adhesion of the tumor with the mucosa for more than three centimeters, the inability to exclude the malignant process, the giant esophageal leiomyoma with the transition onto the stomach. Patients who underwent non-surgical operations had a shorter postoperative hospital stay, fewer complications and a better quality of life. According to our results, preoperative biopsy with intact mucosa is not informative, but also does not increase the number of perforations.

88-94

Authors: Malynovskyi V.G.

The purpose of this research was to study the features of the clinical course of generalized periodontitis, depending on the quality of occlusal balance after complex treatment. 128 patients with generalized periodontitis of the I-II degree, chronic course, aged 35-55 years, were examined. All of them underwent a clinical examination, computed tomography of the jaw bones, and occlusive diagnostics by means of the “T-scan III” device. As a result of the conducted studies, it was found that only in 34,4±4,2% of patients occlusal relationships were restored, whereas in the remaining 65,6±4,2% occlusion balance disorders were registered. The presence of occlusal imbalance was accompanied by a worsening of the clinical condition of periodontal tissues. It was shown that the greatest correlation is observed for the degree of occlusive imbalance with the index of osteoporosis activity (r=0.42, p<0.05), less significant – with Ramfjord indices (r=0.40, p<0.05), PI (r=0.38, p<0.05) and CPITN (r=0.35, p<0.05). Also, with disorders of occlusal balance, there was a decrease in bone mineral density, most pronounced in areas of hyperocclusion. At the same time, the revealed changes were not reliable (р˃0.05), which was explained by the focal nature of the appearance of resorptive phenomena in areas of increased occlusal load. According to obtained results, the qualitative restoration of occlusal ratios, in particular with the help of modern computer equipment, in the complex treatment of generalized periodontitis is the key to long-term clinical and X-ray stabilization of the disease.

101-102

Authors: Shevtsova A.I., Hordiienko Yu.A.

Review on the manual “Functional biochemistry”