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Кісти яєчників. Аналіз структури патології у жінок репродуктивного віку
Get PDFThe problem of treatment of patients with ovarian cysts is the one of main problems in the modern gynecological practice. The use of the results of the different modern methods of diagnostics can essentially shorten the time for setting the clinical diagnosis that is to choose the correct treating tactics in proper time.The aim of work was to analyze the structure of tumor-like formations of ovaries in women of reproductive age.Methods of research. There was carried out the retrospective analysis of 3555 medical histories of patients of reproductive age, who were hospitalized in gynecological department during 2009–2014 and underwent surgical and conservative treatment. The endoscopic optics, made by “Wing” (Russia) was used at laparoscopy. Laparoscopy and histological study of the samples of tissue were carried out according to the standard methods. The data were processed using the statistical program packageSTATISTICA (StatSoft statistica v.6.0).Results. It was established, that the frequency of ovarian pathology in women of reproductive age in the structure of gynecological pathology is 7,48 %. In the structure of ovarian pathology the frequency of functional cysts is 77,82 %, endometriosis and dermoid cysts – 8,27 %, ovarian cystomas – 4,89 %. Ultrasound examination allows diagnose endometrial ovarian cysts with 100 % exactness, dermoid ovarian cysts – up to 90 %, and in 47.01 % of cases it allows determine the character of functional cysts. In 31 % of patients the ovarian cystomas were endoscopically diagnosed with the further morphological confirmation of diagnosis.As far as the benignant ovarian pathology is in most cases diagnosed just in the active fertile period of women life, all efforts of obstetrician-gynecologist must be directed on timely diagnostics (using invasive methods if necessary) and the treatment of disease that would help to reduce the frequency of cancer and preserve the reproductive potentialПроблема конкретизації характеру кіст яєчників та тактика їх подальшого ведення займає одне з провідних місць в гінекологічній практиці. Частота об’ємних утворень яєчників у жінок репродуктивного віку в структурі гінекологічної патології складає 7,48 %. В структурі доброякісної патології яєчників частота функціональних кіст складає 77,82 %, ендометріоїдних та дермоїдних – 8,27 %, кістом яєчника – 4,89
Діагностична цінність різних режимів визначення домашнього артеріального тиску для оцінки ефективності алгоритмізованої антигіертензивної терапії при тривалому спостереженні за пацієнтами з артеріальной гіпертензією
Get PDFAim. The assessment of diagnostic possibilities of the protocols of the home arterial pressure (AP) measurement for the control of efficacy of anti-hypertensive therapy.Methods. The data of home AP of 236 patients as to its value, frequency of attainment of recommended level and determination of phenotype of arterial hypertension (AH), received for 3-5-7 of measurement taking into account of the results of 1 day or without it, were compared. The coefficients: Cohen’s kappa and Lin’s coordination of correlation were determined.Results. Taking into account of the data of the 1 day of measurement worsened the coordination of the mean AP values in 7 days of treatment not depending on the duration of measurement and did not influence in further. The coordination of data as to attainment of recommended level of home AT and AH phenotypes in the case of 7-days and 5-days measurement did not depend on taking into account of the data of 1 day, but worsened at 3-days one.Concision. Taking into account of the data of 1 day of home AT measurement influences the diagnostic possibilities of the measurement protocols of the different term as to the control of efficacy of the long-term anti-hypertensive therapy at the beginning of treatment and in the case of 3-days period of measurement and is less essential at the long-term observationЗіставлення даних різних за тривалістю протоколів вимірювання домашнього АТ (3, 5, 7 днів) довело, що врахування результатів, отриманих у 1-й день вимірювання, найбільше впливає на їхні діагностичні можливості щодо контролю ефективності антигіпертензивної терапії на початку лікування та у разі триденного періоду вимірювання, однак, є менш суттєвим при тривалому спостереженн
Особливості вегетативних порушеньта ішемічних змін міокарда у хворих на стабільну стенокардію, асоційовану з неалкогольною жировою хворобою печінки
Get PDFThe aim of the work was in the establishing of the features of autonomic disorders and ischemic changes of myocardium in patients with stable angina pectoris, associated with non-alcoholic fatty liver disease.Methods of research: the open prospective cohort study in parallel groups included 54 patients with IHD, among which were 30 patients with non-alcoholic fatty disease of the liver. All patients underwent the general clinical anthropometric examination, daily monitoring of ECG by Holter with determination of myocardium ischemia manifestations, study of the heart rhythm variability using the portable system Cardiosense K. (city Kharkov).Conclusions: at the stable effort angina, associated with non-alcoholic fatty liver disease, the reliable decrease of SDNNi, RMSSD and pNN50 parameters in active and passive periods and more LF/HF values in both periods are observed that proves the ANS imbalance with predominance of the sympathetic link activity on the background of inhibition of parasympathetic influences. Patients with the stable angina pectoris with NAFLD are characterized with more expressed ischemic changes of myocardium such as prolongation of the general duration of ST segment depression during a day, depth of ST segment depression and the duration of maximal episode of ST segment depression and also the increase of the registration frequency of ventricle extrasystole comparing with patients without NAFLDМета роботи полягала у встановленні особливостей вегетативних порушень та ішемічних змін міокарда у хворих на стабільну стенокардію, асоційовану з неалкогольною жировою хворобою печінки. У даної категорії хворих виявлений дисбаланс вегетативної нервової системи з переважанням активності симпатичної ланки на тлі пригнічення парасимпатичних впливів, більш виражені ішемічні зміни міокарда та збільшення частоти реєстрації шлуночкової екстрасистолі
Аналгетична та антиеметична ефективність білатеральної блокади поверхневого шийного сплетіння при тиреоїдектоміях у пацієнтів з тиреотоксикозом.
Get PDF Aim: the evaluation of antiemetic effect of bilateral blockage of superficial cervical plexus at the background of general anesthesia by sevoflurane or propofol in the complex of anesthesiology management of patients, who undergo thyroidectomy under conditions of specialized endocrinology center.Materials and methods. Patients are divided in 2 groups: the group of balanced analgesia (BA) -88 patients, control group 87 ones. Depending on the type of general anesthesia – inhalational by sevoflurane (S) or TIVA by propofol (P) patients were divided in subgroups BA –S-44 patients, BA-P – 44, C-S – 46 patients and C-P – 41 patients. In subgroups BA-S and BA-P was used the complex of balanced multimodal analgesia (BMMA) that included administration of dexamethasone, dekxketropofen and bilateral blockage of superficial cervical plexus (BBSCP) by 0,5 % solution of bupicavaine. The assessment of pain was carried out according to VAS, consumption of narcotic and non-narcotic analgetics, frequency and expressiveness of PONV during the first 24 hours of p/o period.Results and discussion. BMMA as BBSCP on the background of basic anesthesia by sevoflurane lowers the need and consumption of opioids, especially intraoperative consumption of fentanyl. Due to the high effectiveness of bilateral BSCP in subgroups of BA-S and BA-P it was not expedient to use the narcotic analgetics in p/o period as opposite to the groups C-S and C-P where they were used in 94,9 % and 93,7 % of patients respectively. According to VAS the pain in subgroups of BA-S and BA-P was weak and reliably (p<0,05) lower than in C-S and C-P. The use of BMMA on the background of basic anesthesia by sevoflurane in subgroup of BA-S provides intraoperative opioid-preserving action: the reliable (p<0,05) decrease of fentanyl consumption to 283,4±12,4 mcg for operation comparing with other subgroups. BMMA complex allowed reliably (p<0,05) raise the level of patients without PONV to 72,7 % and 77,3 % in subgroups of BA-S and BA-P respectively. The reliable decrease of the total sum of points according to PONV scale was attained in subgroup of BA-P to 0,36±0,11, that was by 60,6 % and 55,2 % less than in subgroups of C-S and C-P. For the subgroup of BA-S this index was 0,41±0,11 and was by 55,4 % and 49,4 % reliably (p<0,05) less than in subgroups of C-S and C-P.Conclusions. The best antiemetic system is the use of BMMA with BBSCP on the background of basic anesthesia by propofol with addition of metoplocramide before the induction of general anesthesia: the index of patients without PONV– 77,3 %, frequency of appearance of clinically significant PONV– 9,1 %, index of general sum of points according to PONV scale -0,36±0,11 (all indices are reliably less than in subgroups of C-S and C-P) Проведено оцінку ефективності збалансованої мультимодальної аналгезії (ЗММА): дексаметазон, декскетопрофен та білатеральна блокада поверхневого шийного сплетіння (ББПШС) та вплив ЗММА на частоту розвитку післяопераційної нудоти та блювання (ПОНБ). Продемонстровано високу аналгетичну ефективність комплексу ЗММА, оптимальна антиеметична схема є використання ЗММА із ББПШС на тлі базової анестезії пропофолом із додаванням метоклопраміду перед індукцією загальної анестезі
Особливості соціального і родинного функціонування жінок, хворих на параноїдну шизофренію, з точки зору їх впливу на стан материнсько-дитячої взаємодії
Get PDFAim. To analyze the social and family functioning features of women with PS, with regard to their influence on mother-child interaction status.Contingent and methods. During 2014–2016, 100 women with PS and 112 children of them (12 women had two children) were examined at psychiatric department of Zakarpattya oblast narcological dispensary. The women were aged from 25 to 40 years, duration of the disease was from 2 to 15 years. The children were aged from 3 to 14 years, 65 girls and 47 boys were among them.The women were examined by clinical-psychopathological and psycho diagnostic methods; the children – by the “Kinetic family drawing” projection test.Results. The signs of the social and family disfunctioning of mothers were found in the children’s pictures, in particular, actual family composition concealment in drawings, the absence of sick mother on drawings, the image of sick mother at the periphery of the picture, often by the real or assumed barriers, and "Virtual" mothers images, the absence of family members cooperative activities images, dominance of items, but not people in the drawings, too small images of themselves and family members, as a rule, at the bottom of a paper. These signs show a significant emotional discomfort, loneliness, depressed mood, inferiority feelings in the child, the lack of unity sense with the family, alienation feelings, an unsatisfied need to affiliate.Conclusion. The obtained data were used as a basis for development of the system of medical and psychological optimization of mother-child interaction in women with PSЗ метою аналізу особливостей соціального і родинного функціонування жінок, хворих на ПШ з точки зору їх впливу на стан материнсько-дитячої взаємодії, обстежено 100 жінок, хворих на ПШ, та 112 їх дітей. Встановлено, що порушення материнсько-дитячої взаємодії у родинах, де мати хворіє на ПШ, виявляють тісний зв'язок з соціальною і родинною дисфункцією у матері, важкість яких визначає особливості психологічного стану дитини та викривлення її сприйняття сімейної ситуації та материнсько-дитячих стосункі
Обсессивно-компульсивные явления в патоморфозе простой формы шизофрении
Get PDFAim of the work – To establish the special features of obsessive-compulsive phenomena within pathomorphosis of the simple form of schizophrenia.Materials and methods of research. On the base of MI “Regional clinic psychiatric hospital” of ZRC under condition of the informed consent were examined 58 patients with diagnosis – schizophrenia, simple form (F20.6), among them 31 men and 27 women. The mean age of patients were 42,4±0,82 years old. The duration of disease was 2–25 years.Clinical-anamnestic, clinical-psychopathological, catamnestic and statistic methods were used in the research.In the result of research was observed pathomorphosis of the simple form of schizophrenia. The analysis detected in the clinical picture not only classic manifestations such as autism, decline of energetic potential, emotional deficits and drifting, but also several pathologic syndromes that were earlier considered as not typical for this form of disease.The classic picture of the simple form of schizophrenia realized with especially deficit symptomatology was present in 15,5 % of cases only. In more than ½ of observations in the structure of disease was present the productive symptomatology, the share of obsessive-compulsive inclusions within it was 10,3 %.At the same time obsessive-compulsive phenomena often formed the clinical continuum in the debut of disease, in several cases they were kept during the whole disease and were reliably more often among the patients of male sex.Conclusions. The results of research demonstrate the need for the further study of pathomorphosis of the psychic diseases for elaborating the more qualitative diagnostic criteria of comparing the obsessive-compulsive symptomatology with the different nosological unitsРабота посвящена выявлению и анализу обсессивно-компульсивных явлений в рамках патоморфоза простой формы шизофрении. Установлена доля обсессивно-компульсивных включений в структуре простой формы шизофрении. Рассмотрены особенности динамики обсессивно-компульсивных включений на протяжении развития заболевания. Выделен основной содержательный компонент обсессивных и компульсивных включений в рамках простой формы шизофрени
Результаты использования эндопротезирования в реконструктивно-пластической хирургии рака молочной железы
Get PDFAim of research: the study of the remote results of breast reconstruction using endoprosthesis simultaneously with the surgical stage of combined and complex treatment of patients with BC. Materials and methods. 32 patients with BC who underwent the complex and combined treatment in the period 2012–2015 on the base of MIHP “Kharkiv regional clinical oncologic center” were under observation. At this study the given group of patients underwent hypodermic mastectomy with NAC kept and using silicone endoprosthesis as breast reconstruction. The largest group included women at the social active age 30–49 years old (66,7 %). The mean age of patients was 39,3 years old. The number of patients at the age of 60–69 years old was significantly less – 6,2 % (2 patients) of cases. The menstrual function on the whole was kept in 21 (65,6 %) patients and was absent for up to 5 years in 7 (21,8 %) patients and for more than 5 years in 4 (12,6 %) patients with BC.Results of research. At analysis of the results of research was established that the studied variant of reconstructive-plastic operative intervention in combination with hypodermic mastectomy with NAC kept as the surgical stage of combined and complex treatment of patients with BC has no essential effect on its remote results. The indices of both general survivability and the one without relapse depended only on the prognostic factors commonly acknowledged for this disease.Conclusions1. The reconstructive-plastic operative intervention using endoprostheses simultaneously with hypodermic mastectomy with NAC kept does not worsen the remote results of neither combined nor complex treatment of patients with BC.2. On the base of research was established the absence of influence of breast reconstruction on the increase of local relapses and remote metastases: 9,4 % and 6,2 % respectivelyВ статье рассматриваются результаты применения эндопротезирования в реконструктивно-пластической хирургии рака молочной железы. Показано, что при проведении подкожной мастэктомии с сохранением сосково-ареолярного комплекса одномоментное эндопротезирование не ухудшает результаты комбинированного и комплексного лечения больных раком молочной железы. Приведены данные, полученные при изучении отдалённых результатов и эффективности применения данного вида реконструкции: местные рецидивы установлены в 9,4 % случаев, 5-летняя выживаемость составила 84,3
Порівняння традиційних та нетрадиційних факторів ризику серцево-судинних захворювань у жінок в перименопаузі
Get PDFAim of the work: to compare the frequency of occurrence and correspondence of the traditional risk factors of the cardiovascular disease to the nontraditional ones in women during perimenopause.Materials and methods: there were examined 115 women with HD of II stage, 1-2 degree and obesity of I-II degree 50±3,5 years old. Depending on menopause status they were divided: 45 women in perimenopause, 50 women in menopause with 3 years period and 20 practically healthy women in perimenopause as a control group. VEGF concentration was determined by the method of immune-enzyme analysis.Results: it was revealed that in the group of women in menopause was observed the reliable increase of the rate of risk factors of cardiovascular events. Combination of obesity, dyslipidemia, hyperglycemia and the high AP complicates the course of perimenipause period in women. The level of VEGF factor had not the reliable influence on indices of the lipid metabolism (general CS, triglycerides, CS LPLD, CS LPVLD) and BMI in women (p >0,05) in perimenopause period but had the influence of hyperglycemia in premenopause and early menopause periods except CS LPHD and BMI increase and also had the influence on the hyperglycemia level in women in perimenopause.Conclusions: it was established that combination of such RF of CVD as obesity and dyslipidemia essentially complicate the clinical manifestations of climacteric syndrome in women in perimenopause that is proved by the high menopause indices. It was established that at combination of hyperglycemia, dyslipidemia, obesity and high VEGF level the risk of CVD on the SCORE scale increases in women in perimenopause. There was demonstrated the reliable influence of VEGF level on the hyperglycemia and CS LPHD indices in menopause (р<0,05), that gives grounds to consider VEGF as an additional nontraditional RF of CVD in these womenМетою роботи було порівняти частоту зустрічальності та відповідність традиційних факторів ризику серцево-судинних захворювань до нетрадиційних у жінок в перименопаузі. Обстежено 115 жінок з гіпертонічною хворобою II стадії, 1-2 ступеня і ожирінням I-II ст., у віці від 45 до 60 років. Виявлено, що поєднання ожиріння, дисліпідемії, гіперглікемії та високого АТ обтяжували перебіг перименопаузального періоду у жінок. Рівень фактору VEGF не мав достовірного впливу на показники ліпідного обміну та ІМТ у жінок в пременопаузальний та ранній менопаузальний період
Предиктори геморагічної трансформації при кардіоемболічному ішемічному інсульті
Get PDFAim. To specify the role of certain clinical factors, active forms of oxygen (AFO) and Cathepsin D as predictors of hemorrhagic transformation occurring at cardioembolic ischemic stroke (CEIS).Methods. Clinical and neurological examination of 125 patients with CEIS in the acute stage was carried out. The number of leukocytes in the stage of apoptosis (АNV+-cells) and necrosis (PI+-cells), the number of leukocytes with high AFO intracellular content (AFO+-cells) and low mitochondrial membrane potential (MMP) (Mito+-cells), and Cathepsin D activity were determined.Results. Clinical and laboratory characteristics of CEIS in patients with hemorrhagic transformation (HT) were determined. Both severe stroke, and disorders of consciousness, and large stroke volume-heart size, and SBP is over than 170 mm Hg refer to clinical factors associated with HT. The number of AFO+-leukocytes and Cathepsin D activity in blood serum during the first day of the disease should be used as additional markers to predict cardioembolic ischemic stroke hemorrhagic transformation. When the count of AFO+-leukocytes is over than 40 %, along with Cathepsin D total activity, higher than 4.5, and Cathepsin D free activity, higher than 3.5 nmol of tyrosine.Conclusion. The number of leukocytes with high AFO intracellular content and Cathepsin D activity in blood serum during the first day of cardioembolic ischemic stroke can be predictors of hemorrhagic transformation progress. Determination of hemorrhagic transformation predictors should be carried out before the thrombolytic and anticoagulant therapyОбстежено 125 хворих з кардіоемболічним ішемічним інсультом (КЕІ). Встановлено, що для прогнозування геморагічної трансформації при КЕІ в якості додаткових маркерів доцільно використовувати вміст АФК+-лейкоцитів та активність катепсину D у сироватці крові на першу добу захворювання. Вміст АФК+-лейкоцитів у периферичній крові, вищий, ніж 40 % від загальної кількості лейкоцитів, зростання загальної активності катепсину D, вище, ніж 4,5 та вільної активності катепсину D, більше, ніж 3,5 нмоль тирозину /(хв.*мг білка) можуть бути предикторами розвитку геморагічних ускладнен
Влияние вакуум-терапии на репаративную регенерацию тканей перираневой области
Get PDFAim of research was to study the influence of a low-dose vacuum therapy, as the most effective method for local wound treatment, on reparative tissue regeneration, compared with the traditional treatment methods. The object of research was patients with purulent surgical diseases of soft tissues. The subject of study was changes in dynamics of tissues proliferative activity.Methods: the control group consisted of patients with purulent surgical diseases (16 patients), being examined comprehensively and treated by the traditional scheme. The main group consisted of patients with purulent surgical diseases (16 patients), in which a low-dose vacuum therapy method was used for local wound treatment.Results. The obtained results show high reparative effect of a low-dose vacuum on wound area tissues, due to proliferative processes activation in wound. The effect of the negative pressure on wound area tissues leads to increasing the amount of cells in high proliferative activity, which activates reparative processes in wound defect area.Conclusion. The use of immunohistochemistry method for determination of the reparative regeneration level in tissues at KI 67 antigen expression study allows evaluating objectively the level of proliferative activity and give guidelines for wound closure this or that wayЦель работы – изучение влияния низкодозированного вакуума на регенерацию тканей перираневой области. Проанализированы результаты лечения больных гнойными хирургическими заболеваниями, которым в качестве способа местного лечения был применён метод вакуум-терапии. Для изучения влияния вакуум-терапии на репаративную регенерацию тканей перираневой области использован метод определения индекса пролиферации при исследовании экспрессии атигена KI 6