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Дослідження особливостей серцево-судинного ремоделювання та зміни маркерів метаболізму кісткової тканини у жінок з ішемічною хворобою серця, асоційованою з постменопаузальним остеопорозом
Get PDFThe coronary artery disease is the one of most urgent problems of modern cardiology as well as the problem of osteoporosis. The aim of research was to study the features of cardiovascular remodeling and bone tissue metabolism markers changes in women with coronary artery disease, associated with postmenopause osteoporosis.Methods of research. There were examined 78 women in postmenopause period with coronary artery disease (CAD): 1 group (comparison) – 19 women with CAD and normal indices of the bone tissue mineral density (BTMD); 2 group – 27 women with CAD and osteopenia; 3 group – 32 women with CAD and osteoporosis; the control group – 12 conventionally healthy women of corresponding age. With the help of ultrasound densitometry, echocardioscopy and immune-enzyme analysis the state of bone tissue mineral density, structural-functional state of heart and level of bone remodeling biomarkers were studied.Results. It was revealed, that CAD clinical course on the background of osteopenic syndrome is characterized with rise of bone remodeling markers level, increase of carotid arteries intima-media thickness, more often development of diastolic dysfunction, calcification of heart valves and big vessels, the correlations between the osteoprotegerin, osteocalcin, homocysteine levels and cardiovascular remodeling parameters were established.Conclusions. For women in postmenopause period with coronary artery disease, comorbid with osteoporosis is typical the rise of bone metabolism markers (osteoprotegerin, osteocalcin) levels and endothelial dysfunction (homocysteine) that not only reflect the state of bone tissue but also take part in cardiovascular remodelingДосліджено стан серцево-судинного ремоделювання та зміни маркерів метаболізму кісткової тканини у жінок з ішемічною хворобою серця та остеопенічним синдромом. Встановлено зростання рівня кісткових біомаркерів та їх взаємозв’язок з параметрами кардіо-васкулярного ремоделювання, збільшення товщини комплексу інтима-медія сонних артерій, більш частий розвиток діастолічної дисфункції лівого шлуночка, кальцинозу клапанів серця і великих суди
Результати застосування двох етапної схеми лікування у хворих на волосистоклітинну лейкемію
Get PDFThe analogues of purine nucleosides (pentostatin, cladribine) stay the first line preparations for today. But their use can cause the deep leucopenia and thrombocytopenia that in its turn increases the risk of bacterial, viral and fungal infections, dangerous for the patients’ life. The use of ITF α before 2-СdA course favors the renewal of marrow function and decrease of cytopenia that in its turn allows raise the treatment efficacy and avoid the heavy complications at с 2-СdA therapy.Aim: To analyze the efficacy of two-stage way of treatment in patients with HCL.Methods: The two-stage scheme of HCL treatment was used in 22 patients (14 men and 8 women), whose age median was 49,5 years. At the first stage the ITF α treatment was carried out during 2-4 months. At the second stage of treatment at the improvement of the general patient’s state and hemogram indices, the 2-СdA course was prescribed. Statistical analysis of material was carried out using the packages of applied programs STATISTICA for Windows 5,0. The dynamics of parametric parameters was assessed with the help of Wilcoxon pair criterion. The value р<0,05was considered as a reliable difference.Results: In the result of treatment the full clinical-hematological remission was fixed in 95,5 % of patients, in 4,5 % the partial response to the therapy was fixed. The relapse of disease appeared in 18,2 % of patients during 6-87 months. The analysis of event-free survival (EFS) of patients with HCL after two-stage treatment demonstrated that it is impossible to take into account the median of event-free life of these patients, because the relapse of disease was fixed in less than 50 % of patients, at the same time 25 % of studied persons lived 43,87 months (low quartile).Conclusions: The two-stage method of treatment of patients with HCL allows receive result without heavy complications of the therapy. Such treatment tactics is expedient in patients at the later stages of disease and at significant cytopeniaПроведено аналіз ефективності лікування 22 хворих на волосистоклітинну лейкемію двохетапним методом (ІФН α+2-CdA). Повну ремісію досягнуто у 95,5 %, а часткову у 4,5 % пролікованих. Рецидив хвороби констатовано у 18,2 % хворих. Двохетапний спосіб лікування дозволяє уникнути тяжких (загрозливих життю) ускладнень та підвищити ефективність терапії. Така тактика лікування доцільна у хворих на пізніх стадіях хвороби та при значній цитопені
Дослідження місцевого імунітету порожнини рота у пацієнтів із первинним гіпотиреозом поєднаним із захворюванями тканин пародонта
Get PDFDeficiency disorders in biogeochemical parameters, are a major medical and social problem on the most territory Ukraine, and are characterized by the low iodine in the environment, which is a cause of hypothyroidism. Therefore, the study of the breach features of cellular and humoral immunity in patients with primary hypothyroidism combined with diseases of the periodontal tissues is of considerable practical interest. This will allow you to develop the best approaches to differentiated pharmacotherapy of comorbid conditions.Objective: to study the state of local immunity of the oral cavity in patients with primary hypothyroidism combined with diseases of the periodontal tissues.Materials and methods: The study of local immunity protection in patients with periodontitis on the background of primary hypothyroidism conducted on the basis of a comparative analysis of the immunological data in the core group of 89 people, 15 people of comparison group and the control group of 30 people. The first group included patients with periodontal disease and hypothyroidism, the second one - those with periodontal disease without thyroid disease. The control group consisted of 30 volunteers without clinical signs of disease.Research results. Results of the studied factors of cellular and humoral local immunity in the oral fluid, suggest lowering of the ysozyme activity and increased secretory immunoglobulin sIgA in patients with hypothyroidism combined with periodontal disease, while in patients with periodontal pathology without thyroid disease there is the increasing activity levels of lysozyme and increased secretory immunoglobulin sIgA.Сonclusion. The people with periodontal disease on the background of primary hypothyroidism found significant irregularities in the immune defense of the mouth. The nature and severity of these changes has a close relationship with the clinical course of inflammatory and dystrophic-inflammatory process in surround tissues, indicating the feasibility of such pathology at immunocorrective meansВ статі представленні результати дослідження місцевого імунітету порожнини рота у пацієнтів із первинним гіпотиреозом поєднаним із захворюваннями тканин пародонта. Встановлено, що у пацієнтів із первинним гіпотиреозом поєднаним із захворюваннями тканин пародонта виявлено достовірні порушення у імунному захисті ротової порожнини, які проявляються зниженням рівня активності лізоциму та підвищенням рівня sIg
Дослідження соціальних та клініко-динамічних факторів предиспозиції до розвитку депресивної симптоматики у хворих на параноїдну форму шизофренії
Get PDFBackground. The raise of the quality of diagnostics of depressive symptomatology in patients with paranoid schizophrenia by revelation of the factors of predisposition to its development.Materials and methods. 82 хворих patients (studied group) were examined for paranoid schizophrenia with depressive syndrome and 47 – without the syndrome of depression (group of comparison). For this aim the clinical-anamnestic, socio-demographic, clinico-psychopathological and pathopsychological methods of research were used. The scales PANSS, CDSS, HARS, HDRS, questionnaire for the assessment of social functioning and the life quality of psychic patients were also used. On the base of received results the prognostic importance of the separate factors of predisposition to the development of depressive symptomatology in patients with paranoid schizophrenia was assessed.Results of research. Social predisposing factors: absence of own family; inability to use the existent educational and professional potential; absence of work and short employment history. The age and gender belonging had not essential influence on the development of depressive symptomatology. The clinico-dynamic factors of predisposition were determined as: depressive-paranoid syndrome in the period of exacerbation; duration of exacerbation period more than 40 days; development of depressive symptomatology at the beginning of disease and its further conservation; raise of the frequency of rehospitalizations with the course of disease; short dose of supporting therapy and short-term remissions without rehabilitation support; continuous-progredient course of disease with development of apathetic-abulic defect.Conclusions. Depressive symptomatology can develop at any stage of schizophrenia disease. Being associated with depressive symptomatology, disease fast acquires the unfavorable, malignant course with reduction of the quality and duration of emissions and raise of rehospitalization level already in first 5 years of disease. It is proved by the low level of compliance, development of hospitalism, decrease of social functioning and level of life quality. The revealed social and clinico-dynamic predisposition factors will allow raise the level of diagnostics of depressive symptomatology in patients with paranoid schizophrenia. Elaboration of the complex socio-medical rehabilitation of patients with depressive symptomatology at paranoid schizophrenia that takes into account the revealed factors of predisposition will favor the increase of the level of social functioning and life quality of this contingent of patientsОбстежено 129 хворих на параноїдну шизофренію та виявлено ряд соціальних та клініко-динамічних факторів предиспозиції до розвитку депресивної симптоматики. Також визначено, що депресивна симптоматика може розвинутись на будь-якому етапі захворювання в результаті чого шизофренія швидко набуває несприятливого перебігу. Виявлені особливості дозволять підвищити якість діагностики депресії та медико-соціальної реабілітації даного контингенту хвори
Нейростимуляційний контроль блокад медіальних гілочок задніх гілок спинномозкових нервів у лікуванні больового “фасет-синдрому” поперекового спондилоартрозу та плануванні денервації дуговідросткових суглобів
Get PDFThe aim of research is an improvement of blocks of medial branches of posterior rami of spinal nerves (MB PR SN) in treatment of the “pain facet syndrome” of lumbar spondyloarthritis and planning of denervation of zygapophysial joints by the additional identification of target nerves by neurostimulator.Material and methods. 96 patients with lumbar “facet syndrome” (40 men and 56 women) 18 -75 years old. All patients underwent blocks of MB PR SN under “С-arm” control and electrostimulation by “B BRAUN Stimuplex Dig RC Nerve Stimulator”. The effectiveness of MB PR SN blocks was evaluated during a week, in 1, 3, 6 and 12 months by VAS and questionnaire Roland-Morris.Results of research. At the beginning 524 blocks were done at the level L3-S1 in 96 (100 %) patients. 420 blocks in 70 patients at the levels L3-L4, L4-L5, L5-S1, and 104 ones in 26 patients at the levels L4-L5, L5-S1. The positive dynamics was observed during 3 months with decease of pain syndrome from 50 % to 72 %, and improvement of living activity from 50 % to 67 %. In 54 patients (56 %), the blocks were repeated at 7 day. That is 270 blocks in 45 patients at the levels L3-L4, L4-L5, L5-S1, and 36 blocks in 9 patients at the levels L4-L5, L5-S1. The positive dynamics was observed during 6 months with decrease of pain syndrome from 50 % to 58 %, and improvement of living activity from 38 % to 63 %. MB PR SN neurotomy was done in 18 patients (18,7 %) after two blocks under endoscopic control with decrease of pain syndrome by 63 %-86 % depending on age and improvement of living activity by 50 % - 75 % more than 1 year.Conclusion. Electric stimulation of multi-sectional muscles during MB PR SN blocks allows reliably identify the necessary nerve rami, decrease the falsely positive and falsely negative results at anatomic variation of nerves location that gives a reason for using this method for both treatment of pain facet-syndrome and planning of ZJ denervation in patients with lumbar spondyloarthritisУ статті обговорюється проблема лікувально- діагностичних блокад у разі больового “фасет-синдрому” поперекового спондилоартрозу та плануванні денервації дуговідросткових суглобів. Наведено досвід ефективності виконання блокад медіальних гілочок задніх гілок спинномозкових (МГ ЗГ СМН) нервів під контролем нейростимуляції у 96 пацієнтiв, протягом 3, 6 та 12 місяців. Встановлено переваги даного методу і рекомендації до широкого застосуванн
Анализ поздних послеоперационных осложнений при лечении камней мочеточника с использованием уретероскопии и контактной ультразвуковой литотрипсии
Get PDFUreteroscopy is a highly effective and minimally invasive diagnostic and treatment technology. In association with intracorporeal lithotripsy, ureteroscopy is in the first line of distal ureteral stones treatment strategy.Methods. In 1034 patients with ureterolithiasis ureteroscopy with contact lithotripsy and (or) lithoextraction was carried out against different ureteral stones. The patients were examined after discharge in dynamics from 8 weeks to 1,5 years, and on the testimony - to the complications liquidation.All testimonies were divided according to their severity levels using Satava classification.Results. 90 patients with late postoperative complications were found. In 78 (86,7 %) of them transient vesicoureteral reflux, and in 12 (13,3 %) ureterostegnosis were found.In case of postoperative complications development, their clear dependence on stone density is noted in patients with stones size to 1 cm. The dependence is leveled with an increase in the stone size, and complications may occur at any concrement density. At concrement localization in the middle and upper third, the probability of the late postoperative complications development does not depend on stone size, but the complications significantly more often occur at stone size to 1 cm and more when it is localized in the lower ureter. The probability of the late postoperative complications increases when concrement density is 1000 HU and more regardless its localizationВ статье проанализированы причины и характер поздних послеоперационных осложнений у пациентов с уретеролитиазом при выполнении уретероскопии и контактной литотрипсии с использованием семиригидного уретероскопа и ультразвукового литотриптора. Основными причинами осложнений ультразвуковой контактной уретеролитотрипсии является локализация камней в верхних отделах мочеточника, размеры их свыше 1 см и плотность больше 1200 H
Вміст есенціальних мікроелементів в організмі дітей з відставанням у зрості в залежності від ступеня низькорослості
Get PDFChildren and teenagers short stature is associated with significant imbalance of essential microelements, in particular, Zinc, Selenium, Manganese, Chromium, and Copper.Aim of research: a complex study of essential microelements content in children organism suffering from short stature, determination of the possible influence of essential microelements deficits on growth retardation degree.Materials and methods. 240 patients were examined: 166 boys (69.2 %) and 74 girls (30.8 %) aged 3 to 18 years (the average age was 9.65±0.17 years). 206 children and teenagers with different forms of short stature were among them: 144 boys (69.9 %) and 62 girls (30.1 %) with the average age 10.06±0.2 years. All short statured patients were divided into three groups depending on growth retardation degree. The content of microelements in hair was determined by X-Ray fluorescence method using «ElvaX–med» (Ukraine) spectrometer and method for determination of chemical elements mass fraction in hair (МВВ 081/12–450200 method), certified by Ukrainian State Committee of Standardization, Metrology and Certification (Certificate from June, 14, 2007) and proved by the State Sanitary and Epidemiological Service of Ukraine (Resolution №19 from December, 09, 2008). The content of microelements (Zinc, Selenium, Manganese, Chromium, and Copper) in blood plasma was determined by X-Ray fluorescence method using «ElvaX–med» (Ukraine) spectrometer using method of chemical elements measurement in plasma (МВВ 081/12-0468-07), certified by Ukrainian State Committee of Standardization, Metrology and Certification (Certificate from October, 12, 2007) and proved by the State Sanitary and Epidemiological Service of Ukraine (Resolution №8 from October, 05, 2000).Results. A clear correlation between the growth retardation degree and Zinc content in hair of growth retarded children – with an increase of growth retardation the average level of Zinc in hair of growth retarded children significantly decreases. Any significant difference between the Selenium content in both hair and blood plasma in patients with short stature and different degrees of growth retardation wasn’t found. Considerable reduction of Chromium level in hair and plasma of all patients with short stature comparing with the control group independently of growth retardation degree was found, but any difference between Chromium level indexes in hair of patients with different degrees of growth retardation wasn’t determined. Considerable reduction of Copper level in plasma comparing with the control indexes was determined in children with growth retardation ≥2 SD; any significant difference between indexes depending on growth retardation degree wasn’t determined; the lowest indexes of the Copper content in hair were found at growth retardation ≥3 SD. Manganese level in plasma significantly (but not considerably) is reduced in patients with growth retardation ≥2 SD comparing with patients with growth retardation less than 2 SD, and significantly reduced in relation to the control indexes.Conclusion. Essential microelements imbalance was determined in most short statured patients. The most significant misbalance of was found in Zinc indexes in hair of patientsВивчали вміст есенціальних мікроелементів (цинк, селен, марганець, хром, мідь) в організмі дітей з відставанням у зрості в залежності від ступеня низькорослості. Виявлено чіткий взаємозв’язок між ступенем відставання в зрості та вмістом цинку в волоссі дітей з низькоросліст
Характеристика взаємозв’язку післяінсультної спастичності із клінічними та параклінічними факторами
Get PDFThe aim of research was to study the correlation between the intense of post-stroke spasticity and certain clinical (severity of stroke in most acute period, pathogenetic subtype of stroke, localization of ischemia zone) and paraclinical )sex, smoking in anamnesis, content of exciting and braking neurotransmitters) factors.Methods. The research included 97 patients with the first ischemic stroke. During the 6th month patients were divided in 2 groups: the ones with post-stroke spasticity and without it. For determination of reliable correlation between the intensity of spasticity and clinical and paraclinical factors the non-parametric correlation coefficient of Kendall range (τ) was used.Results. In the research we observed the reliable positive correlation between spasticity after stroke and the severity degree of ischemic stroke, smoking in anamnesis, localization of stroke in carotid basin and the level of glutamate and aspartate in the most acute period of stroke. It was also revealed the negative correlation of the middle force between the spasticity intensity and glycine and taurine content in the most acute period of ischemic stroke.Conclusions. The revealed correlations between the spasticity degree and clinical and paraclinical parameters can be further used for elaborations of development predicators of spastics and the study of preventive treatmentДосліджено кореляційні взаємозв’язки післяінсультної спастичності з деякими клінічними та параклінічними факторами. Виявлена достовірна позитивна кореляція спастичності із ступенем важкості інсульту, курінням в анамнезі, локалізацією інсульту у каротидному басейні та рівнем глутамату й аспарату у найгострішому періоді. Також виявлено негативну середньої сили кореляцію ступеня вираженості спастичності та вмістом гліцину й таурину в найгострішому періоді ішемічного інсульт
Аналіз особливості кольорових виборів за тестом МКВ емігрантів та реемігрантів, хворих на депресивні розлади
Get PDFAim of research – the study of characterological features of emigrants and re-emigrants by the analysis of color choices according to Lusher’s test.Methods. Examination was carried out using the method of colored choices (modified eight-color test of М. Lusher). Statistical analysis of the results was carried out using the distinct Fisher criterion.Results. We examined 196 emigrants, 191 re-emigrants and 198 persons that were not emigrants. The new data as to the influence of emigration and re-emigration factor on characterological features of patients with depressive disorders of psychogenic, endogenous and organic character are given in the work. There was demonstrated the formation of pathocharacterological features by hypothymic (dysthymic) type with the predomination of anxious-depressive features in emigrants and astheno-depressive ones in re-emigrants with the most expressed differences in the group of psychogenic depressions and the least expressed ones – in the group of depressive disorders.Conclusions. The results of research allow talk about the presence of pathocharacterological features by hypothymic (dysthymic) type in studied patients that must be considered within the main syndrome – depressive or anxious-depressive one in the context of influence of socio-psychological factors on the peculiarities of personal transformations. Emigration as a whole must be considered as the factor that favors pathocharacterological development in direction of the anxious-depressive changes and re-emigration – as the factor of astheno-depressive and apatho-depressive personal transformations. The influence of emigration and re-emigration factor on the personal features is mostly manifested in the group of psychogenic depressions and it is the least the group of organic depressive disordersСтаття присвячена дослідженню характерологічних особливостей емігрантів та реемігрантів, хворих на депресивні розлади через аналіз результатів за методом кольорових виборів. Наведено нові дані щодо впливу фактору еміграції та рееміграції на характерологічні особливості хворих з депресивними розладами психогенного, ендогенного та органічного характеру та формування відповідних патохарактерологічних рис у даних групах пацієнті
Обґрунтування тактики вибору при лікуванні множинних та поєднаних переломів довгих кісток в залежності від тяжкості травми та стану постраждалих
Get PDFThe aim of the article is substantiation of the optimal tactics and volume of osteosynthesis of patients with multiple and combined fractures of the long bones, which polytrauma severity was 25–40 points according to ISS scale and condition severity according to MFS-IC, added with age indices, 21–32 points.Methods. The clinical base of research included 104 patients of this category, divided in 2 groups by the sign of one-stage (main) or two-stage (group of comparison) operative treatment. The system of objective medical and social criteria of treatment efficacy, offered by the authors, allowed rather reliably determine the optimal character, volume and terms of operative interventions.Results. The terms of main stages of fractures consolidation in patents with two-stage technique of osteosynthesis exceeded the analogous ones in patients with one-stage technique in 1,3–1,6 times; the severity of complications in patients, who underwent the two-stage treatment of multiple and combined fracture of the long bones were more than in victims with analogous traumas, who underwent the one-stage technique of osteoporosis; the terms of staying on the stationary treatment of patients, who underwent the one-stage treatment were 1,7times less than in ones, who underwent the two-state tactics of osteosynthesis; the mean terms of fractures consolidations in patients, who underwent the one-stage surgical treatment were 1,3–1,4 less by the all types of fractures and their combinations than in patients, who underwent the two-stage surgical treatment.Conclusions. The one-stage realization of the all types of extrafocal and closed intramedullary blocking osteosynthesis is optimal for this category of patientsВ статті на основі порівняльного аналізу 104 історій хвороб пацієнтів з множинними та поєднаними переломами довгих кісток, тяжкість травми яких за шкалою ISS складає 25–40 балів, проведеного із застосуванням авторської системи об’єктивних медичних та соціальних критеріїв оцінки ефективності лікування, доводиться, що тактикою вибору для таких постраждалих може вважатися одноетапне виконання всіх видів позаосередкового та закритого інтрамедулярного блокуючого остеосинтез