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Морфо-функциональное состояние сердца и давление в легочной артерии у пациентов пожилого возраста с гипертонической болезнью и фибрилляцией предсердий
Get PDFThe aim: To carry out a comparative study of the structural and functional state of the heart in patients with essential hypertension (EH) depending on the form of atrial fibrillation (AF) - persistent or permanentMethods: Doppler echocardiography, EHRA scale and CHA2DS2VASc. 95 patients aged 60-74 were included in the study, 20 of which with uncomplicated essential hypertension (EH), 39 – with persistent (PersAF) and 36 – permanent (PermAF) atrial fibrillation (AF).Results: as compared with uncomplicated EH, the increase in a degree of left ventricular hypertrophy (LVH) and left atrial size (LA) was found out to be a marker of a diastolic dysfunction of the left ventricle (LV) in AF patients. The highest values of LVH and LA were registered in PermAF. The characteristic PermAF heart rate acceleration appeared to be a significant factor of the heart structure and function changes, notably the increase of LVH and LA dilatation. LV systolic function demonstrated the deterioration in PermAF: along with reduces LV ejection fraction there were 10 % patients with systolic dysfunction. In the majority of AF patients pulmonary hypertension was found: I stage – 51 % in PersAF and 67 % in PermAF; II stage in 5 % and 14 %, respectively. The increase in systolic blood pressure in the pulmonary artery in AF is associated with an increase of right ventricle.Conclusions: Patients with AF have had more apparent structural and functional state of the heart. OP GB further contributes to the disturbance of systolic and diastolic LV function in patients. The increase in diastolic LV dysfunction is associated with increased pressure in the pulmonary artery.При изучении морфо-функционального состояния сердца у больных пожилого возраста с гипертонической болезнью и фибрилляцией предсердий установлено нарастание гипертрофии левого желудочка, размеров левого предсердия и правого желудочка. Нарастание диастолической дисфункции левого желудочка сопряжено с повышением давления в легочной артерии. Нарастание массы миокарда левого желудочка, дилатация левого предсердия ассоциирует с учащением частоты сердечных сокращений при постоянной форме Ф
Изучение состояния реактивности мембраны Шнайдера при некоторых формах стоматогенного верхнечелюстного синусита
Get PDFThe one of causes of the high prevalence rates of the chronic maxillary sinusitis is an absence of differentiated approach to the treatment of the different forms of this pathology. The spread of infection on the mucous tunic of maxillary sinus takes place already after extraction of tooth with gangrenous pulp as a result of suppuration of the maxilla root cyst, at osteomyelitis of alveolar process, after operations of sinus-lifting at implantation of maxillary teeth. Standardization of treatment of inflammatory pathological states in maxillary sinus that have different causes and mechanisms of development leads to the temporal extinction of expressed clinical symptoms only, favoring the chronization of disease.Aim of research: To study morphological changes of Schneiderian membrane at odontogenic and iatrogenic (traumatic form) maxillary sinusitis of stomatogenic origin.Material and methodsThere were studied intraoperational biopsy materials of 14 (19,7 %) patients with odontogenic maxillary sinusitis (control group) and 57 (80,3 %) patients with traumatic form of iatrogenic maxillary sinusitis (main group). For the survey microscopy histological sections were colored with hematoxylin and eosin, where the height of mucous tunic epithelium, absolute area of leuko-lymphocytic and hemorrhagic infiltrates were defined, the state of vessels of microcirculatory channel was assessed. For analysis of the process of fiber-creation in studied samples, the sections were colored with Weigert hematoxylin according to Van Gieson. For qualitative and quantitative study of cells distribution in mucous tunic of maxillary sinus the morphometric net of S.B. Stephanov was used. Manasse pathomorphological classification was used for differentiation of the revealed changes in mucous tunic. For revelation of the natural killer cells, the sections were colored with alcian blue (critical concentration of magnesium chloride 0,6 Mol) with additional coloration of kernels with hematocylin. The reactions with СD 8, CD 56, CD 68, CD 138, CD 43 monoclonal antibodies were carried out. Streptavidin-biotin system of visualization of LSAB2 antibodies (peroxidate mark + benzidine) (LabVision, USA) was used. The number of CD 8+, CD 68+ cells in sight was counted. All prescriptions of solutions were taken from instructions.Photodocumentation was carried out using Axiolab binocular microscope, Axiocam digital camera with 8 megapixel matrix, personal computer, connected with digital camera by interface, video cable and «AxioVision 4.8» software. Statistical processing of the received results was carried out using tables of R.B. Strelkov, by accelerated method of quantitative comparison of morphological preparations. The reliability of the received results were assessed according to the method of Student-Fisher for reliability level no less than 95 %,that is conventional for biological and medical studies (р<0,05).Results of research. Odontogenic maxillary sinusitis is characterized with diffuse and focal mainly macrophagic-lymphocytic and hemorrhagic infiltration of the proper plate of the mucous tunic (35,7±12,8 %, р>0,05); fibrosis of the proper plate of the mucous tunic of maxillary sinus, in several cases more expressed proliferation of collagenous fibers of the proper plate (21,4±10,9 %, р>0,05); expressed edema of the proper plate tissue with effusion in extracellular matrix (14,3±9,3 %, р>0,05); cysts (7,2 %, р>0,05). CD 8+ (8,48±0,25 %), were found in infiltrate, CD 68+ macrophages prevail (21,5±0,4 %), CD56+ cytotoxic lymphocytes (singular), CD 43+ complexes, CD 138+ cells (in insignificant number). In Schneiderian membrane epithelium were revealed desquamation (64,3±12,8 %), necrosis (57,1±13,2 %), focal planocellular metaplasia (42,9±13,2 %), vacuole dystrophy of epithelial cells (42,9±13,2 %), intraepithelial lymphocytic infiltration (35,7±10,2 %). In average epithelium height is 44,6±1,5 mcm.Traumatic form of iatrogenic maxillary sinusitis is characterized with expressed diffuse and focal mainly macrophagic-lymphocytic and hemorrhagic infiltration of the proper plate of the mucous tunic (36,8±6,3 %, р<0,05); fibrosis of the proper plate of the mucous tunic of maxillary sinus, uneven thickening of basal epithelium membrane (31,6±6,1 %, р<0,05); expressed proliferation of collagenous fibers of the proper plate, expressed edema of the proper plate and polyps (10,5±4,0 %, р<0,05). Cysts were not observed. CD8+ in infiltrate (perivascular), CD 68+ (15,53±0,18 %) macrophages, CD56+ cytotoxic lymphocytes (16,7±4,9 %), CD 43+ (are situated diffusely), CD 138+ prevailing cells (100 %). In Schneiderian membrane epithelium were revealed necrosis (57,9±6,5 %), metaplasia (47,4±6,6 %), loss of ciliary cover (63,2±6,3 %), intraepithelial lymphocytic infiltration (42,1±6,5 %). In average epithelium height is 62,9±2,28 mcm.Conclusions. Patients with odontogenic injury of sinus are characterized with expressed vascular reaction, aseptic inflammation. The moderate proliferation of collagenous fibers, especially around vessels, glands, along basal epithelium membrane, disorders of epithelium lane, necrosis nidi, desquamation, planocellular metaplasia. The loss of ciliary cover on the background of necrosis, planocellular metaplasia and intraepithelial lymphocytic infiltration prevail in patients with traumatic form of iatrogenic maxillary sinusitis of stomatogenic origin. Restoration of epithelium cover that provides mucous-ciliary clearance is possible because of absence of brightly expressed fibrosis of the proper plate of mucous tunicПри одонтогенном синусите, отмечена выраженная сосудистая реакция, асептическое воспаление слизистой, умеренное разрастание коллагеновых волокон, нарушение рядности эпителия, очаги некроза, десквамации, плоскоклеточной метаплазии. При травматической форме ятрогенного синусита –, некроз, метаплазия и внутриэпителиальная лимфоцитарная инфильтрация. Выраженный фиброз собственной пластинки слизистой оболочки отсутствует. Возможно восстановление эпителиального покрова, обеспечивающего муко-цилиарный клирен
Клинико-гемостазиологические аспекты синдрома привычной потери плода и возможности его профилактики
Get PDFAim of the work: to determine the changes in hemostasis system and the features of polymorphism of genes, responsible for the state of coagulation system and endothelium in women with habitual fetal loss syndrome for substantiation and elaboration of the treatment-prophylactic complex for them.Methods of research. The main group included 58 pregnant with habitual fetal loss syndrome (HFLS). The control group included 34 somatically healthy women with physiological course of pregnancy and non-complicated obstetrical anamnesis. Polymorphisms in genes of factor V Leiden 1691 G → A, prothrombin 20210 G → A, fibrinogen β 455 G → A, methylenetetrahydrofolatereductase (MTHFR) 677 C → T were defined by the method of allele-specific polymerase chain reaction. The main parameters of hemostasis system were defined on automatic coagulometer, the level of D-dimer by immune-enzyme method.Reults. The pregnant with pathologic genotypes and alleles: 1691 G→A FVL, 20210 G→A FII and 677 C→T MTHFR must be related to the risk group of miscarriage development. For these pregnant the hypercoagulation is typical already at the early terms of pregnancy. The assessment of effectiveness of treating arrangements demonstrated, that in the main group in 56 (96,6 %) women pregnancy was finished with delivery (рК>0,05). The term of delivery did not reliably differ in the main group comparing with the control one (рК>0,05) and was 38,0 [36,0–39,0] weeks (C=39,0 [38,0–40,0] weeks).Conclusions. The study of hemostasis system and the thrombophilia markers allows reveal pregnant with hypercoagulation syndrome that form the group of risk of miscarriage and the use of treating-prophylactic complex significantly improves the results of pregnancyВ представленной работе было проведено определение изменений в системе гемостаза, а также особенности распределения полиморфизма генов, ответственных за состояние свертывающей системы и эндотелия, у женщин с привычным невынашиванием плода. Предложенный лечебно-профилактический комплекс позволяет улучшить исходы беременности у женщин с привычным невынашиванием плод
Оцінка обміну речовин та трофологічного статусу хворих на рак шлунка після гастректомії та субтотальної проксимальної резекціїї шлунка
Get PDFAim. The indices of DT functional state and some indices of metabolism were studied and also trophological status of patients with gastric cancer after gastrectomy (GE) by the new technology of esophageal anastomosis formation was evaluated in the work. Methods. The research included 150 patients with gastric cancer. In the main group was applied the new technology of esophageal anastomosis formation. In 1, 12 and 24 months after gastroectomy (GE) the test on tolerance to glucose, carbohydrate load and, scatological study were carried out and the body mass index of patients was measured. The clinical data were analyzed using the program software for personal computer: Microsoft Excel et Statistica 6.0. Statictical processing was carried out using Student criterion. The differences were considered as reliable ones at p <0,05. The analysis of clinical data was carried out using the program software for personal computer: Microsoft Excel et Statistica 6.0.Result. It was established, that in patients of the main group during 2 years after resection of stomach was observed the decrease of number of complaints after carbohydrate load and manifestations of damping syndrome decreased in 2 times. With increase of postoperative term the creatorrhoea manifestations decreased in the main group. Patients with the new variant of reconstruction had better trophological status that is proved by the increase of body mass index. Conclusions. Thus, the use of the new method of reconstruction of digestive tract at GE significantly increases the trophological state, indices of carbohydrate metabolism and DT functional state in both postoperative and remote terms after GEОцінювали трофологічний статус пацієнтів після оптимізації процесу резекції шлунка за показниками: вміст глюкози і стан хворих після вуглеводного навантаження, частота креатореї, індекс маси тіла через 1, 12 і 24 місяці після оперативного втручання. Нова технологія реконструкції травного тракту після гастректомії сприяє зниженню демпінг-синдрому, підвищенню маси тіла, поліпшує трофологічний статус хвори
Профілактика та лікування гастроінтестинальних проявів харчової алергії у дітей першого року життя, алергія до білків корв’ячого молока
Get PDFGastrointestinal manifestation (GM) of food allergy (FA) in infants are non-specific, e.g.: frequent throwing up, colic, abdominal pain, vomiting, food refusal, which significantly complicates the differential diagnosis and selection of treatment direction.Materials and methods. 311 infants with atopic dermatitis symptoms were examined. 43 % of children (n=134) (studied group hereinafter) aged to 6 months had durable, resistant to conventional therapy pathological manifestations from the gastrointestinal tract. Laboratory tests were carried out for all of the children: determination of total venous blood serum levels of immunoglobulin, specific immunoglobulin E to cow's milk fractions (boiled milk, α – Lactalbumin, β – Lactalbumin, casein), to soya and goat's milk, eosinophil cationic protein levels (ECP). Guided by the ESPGHAN algorithm, diagnostic elimination diet was suggested to all of the infants during 4 weeks with the following lactose cow's milk (0.33% fat) provocative test for mother, in case of breast-feeding, or return to lactose-free formula, characterized by lower hydrolysis degree, in the case of artificial feeding. In the case of clinical symptoms restoration, the elimination diet was extended for three months, and then, after three months, provocative re-test was suggested. Laboratory parameters were monitored regularly 4 weeks and 3 months later, the additional ECP determination in blood serum was carried out in infants having positive provocative test.Research results. Positive clinical dynamics of symptoms was observed during the first week of the treatment in 127 infants, and it significantly correlated with ECP level reduction in blood serum. 51 children on the 4th week of observation, and 4 children on the 3rd month of observation had positive provocative test. The tendency to general and specific IgE decrease in relation to cow's milk fractions was slower (15–20 % on the 3rd month of treatment) and did not correlated with clinical symptoms dynamics.Conclusion. In infants, stable GM can be connected with allergic pathology. Direct and indirect provocation tests can be used by pediatricians for the allergy to cow's milk proteins diagnosis. The use of hypoallergenic nutrition formulas as basic and dairy-free diet for mother can significantly decrease GM of FA. Eosinophil cationic protein is advisable to use for the severity of the allergic process estimation in infantsDuring the first week of the treatment, ECP level decreased and it correlates with clinical symptoms dynamics.The tendency to general and specific IgE decrease in relation to cow's milk fractions was slower (15–20 % on the 3rd month of treatment) and does not correlate with clinical symptoms dynamicsГастроінтестинальні прояви харчової алергії (ХА) у дітей перших місяців життя є неспецифічними, що значно ускладнює диференційну діагностику та вибір напрямку терапії. Метою роботи було удосконалення алгоритму диференційної діагностики гастроінтестинальних проявів проявів ХА у дітей перших місяців життя та демонстрація ролі раціонального вигодовування, як профілактики даних стані
Психоемоційний профіль і рівень професійних знань слухачів передатестаційного циклу «неврологія» в умовах реформування післядипломної освіти
Get PDFIn order to investigate psycho-emotional profile of neurologists, studying on pre-cycle "Neurology", in circumstances of constant reforms of both medical field, and postgraduate education, their test in writing (51 person) was carried out by standardized multifactor personality test. The given method allowed determining quantitatively and qualitatively (in points) existing psycho-emotional problems of this category of neurologists independently of age, sex and work experience, e.g.: the presence of emotional lability with psycho-astenisation and autisation, as well as reserve mechanisms of adaptation increasing (communicability and expansion of social desirability).Materials and methods. The additional test of the level of special professional skills in the given group at the beginning and in the end of studying on the 30-day pre-cycle showed a probable improvement of the knowledge level, according to the complex theses data, therefore, it can be argued about the presence of motivational factors in students to expand and to improve their knowledge in specialty during postgraduate training.Results of the conducted research of neurologists’ psycho-emotional profile have shown the presence of emotional lability with psycho-astenisation and autisation under constant reforms of medical field conditions. Nevertheless, in contrast to the specified profile changes, the adaptive desire of both special knowledge expanding, and active participation in the mentioned changes are formed in modern students.Conclusion. In order to reduce psychological disadaptation problems manifestation in modern pre-curses students, it should more widely publicize and discuss the advisability of medical field reforms, both in available informational sources for doctors (social and medical publications, journals, associations and specialty societies meetings), and during studying at postgraduate education department. Understanding and appropriate positive perception of the necessity of changes in medical field will reduce effectively anxiety and pessimism among doctorsПроведене тестування 52 слухачів передатестаційного циклу «Неврологія» методом стандартизованого багатофакторного опитування особистості виявило наявність емоційної лабільності з психоастенізацією та аутизацією в умовах реформування системи післядипломної освіти та медичної галузі. Також виявлений ріст резервних механізмів адаптації до подій, що відбуваються з бажанням розширити рівень спеціальних знань та вмін
Обґрунтування методики розрахунку ліжкового фонду для надання вторинної стаціонарної допомоги
No full textIntroduction: The aim of optimization of the system of stationary and specialized medical help must be the shortening of the bed fund. The problem is the absence of the grounded approach to determination of the profiles and number of beds that must be kept that is why the elaboration of available methods of the bed fund optimization is needed.Aim: Elaboration of the approaches to optimization of the existing bed fund of the health protection institutions depending on the intensity of medical help in the context of the hospital districts creation.Methods: For calculation of the bed fund were used indices of the population morbidity, actual use of the bed fund (mean number of days of using bed, bed circulation, mean duration of patient’s stay in bed and the general bed downtime), the results of expert assessments of the grounding of hospitalization and possibility to shorten the stay in all-day hospital. The research was carried out on the base of three neighboring districts of Zhytomyr region where the creation of hospital district was planned.Results: After using the coefficients of inexpedient hospitalization and decreasing the treatment duration was calculated the number of beds and their profile for the medical help to the population of the hospital district of 182 thousands of citizens for the health protection institutions with the different treatment intensity. The possibility to shorten the existing bed fund by 22% without worsening the quality of medical help that gives a possibility to create the additional hospital of rehabilitation and institutions for palliative help was scientifically grounded.Conclusions: It was established, that the optimal indices of bed fund for the secondary specialized help must be 35,4 for 10 thousands of dwellers, among them: 27,3 beds for specialized treatment, 4,2 beds for planned treatment, 2,2 beds for rehabilitation, 1,7 beds for palliative treatmentНаведено підходи до розрахунку ліжкового фонду закладів охорони здоров’я вторинного рівня залежно від інтенсивності надання медичної допомоги з використанням коефіцієнтів необґрунтованої госпіталізації та зменшення тривалості лікування. Визначено, що при створенні госпітального округу з населенням 182 тисячі громадян ліжковий фонд повинен становити 35,4 ліжка на 10 тисяч жителів, з них для спеціалізованого лікування 27,3 ліжка, планового лікування – 4,2 ліжка, відновного лікування – 2,2 ліжка та паліативного лікування – 1,7 ліжк
Объёмная абсорбирующая повязка-дренаж для лечения огнестрельных ран мягких тканей
Get PDFThe volume absorbent bandage-drainage was elaborated and clinically tested for the treatment of the gunshot wounds of the soft tissues. The aim of research was in elaboration of absorbent bandage-drainage for wounds with the small surface sizes (less than 30 cm) and analysis of its use for the treatment of the gunshot wounds of soft tissues.Methods. The volume absorbent bandage-drainage was use in 37 wounded with gunshot wounds of soft tissues with different localization. The control group included 42 wounded with the gunshot wounds of soft tissues who underwent the treatment by the wet-drying bandages with antiseptic solutions with further use of the gause bandage with ointment “Levomicol”. There were assessed the change of the local status of the wound, intensity of the pain syndrome on the visual analogous scale (VAS), the number of surgical processings, duration of hyperthermia, number of bandagings.Results. The use of the volume absorbent bandage-drainage in the treatment program for patients with the gunshot wounds of soft tissues allowed reliably reduce the term of the wound purification, diminish the terms of primarily-delayed suturing, diminish the term of the wound healing.Conclusions. The results of elaborated bandage-drainage indicate the effectiveness of its use at the treatment of the gunshot wounds of soft tissues with the size of surface holes less than 3,0 cm. The use of the volume absorbent bandage-drainage allows speed up the process of the gunshot wounds purification, diminish the number of complications and surgical interventionsДля лечения огнестрельных ран мягких тканей разработана и клинически апробирована объёмная абсорбирующая повязка-дренаж. Повязка предназначена для активного отведения раневого экссудата из раневого канала и лечебного воздействия на раневую поверхность. Полученные результаты применения объёмной абсорбирующей повязки-дренажа показали её эффективность при лечении огнестрельных ран мягких ткане
Вплив факторів ризику на довгострокові результати лікування пародонтиту
Get PDFThe aim of research was to review original articles devoted to the given topic to study the connection between tooth loss prognosis and risk indicators, and to analyze the influence of the specific risk factors on periodontal prognosis and its accuracy.Methods. Structural and logical analysis method, semantic bibliography method.Results. The references analysis has shown that determination of a positive prognosis is more predictable than doubtful prognosis determination. Some risk factors have major practical value and are discussed by many authors. Nevertheless, doubtful prognosis determination remains practically unchanged. A furcation involvement, deep residual pockets, significant bone loss, and\or at least the second degree of mobility in the presence of active inflammation are rather important to determine periodontal prognosis.Conclusion. The importance of determination of the accurate periodontal prognosis prior to treatment is crucial to build trust relationship between peridontist and patient, as well as to prevent legal liability. Next research should be focused on simplifying of prognostic models with high predictabilityПародонтальний прогноз має важливе значення при лікуванні хворих на генералізований пародонтит, оскільки допомагає розробити обґрунтований план лікування та спрогнозувати його результати. Саме тому на початкових етапах лікування захворювань пародонту клініцисти зазвичай потребують чітких критеріїв як для прогнозу окремих зубів, так і загального прогноз
Вплив сумісного застосування під час кардіохірургічних операцій ультрафільтрації крові та різних варіантів первинного заповнення апарату штучного кровообігу на маркери запалення у дорослих пацієнтів
Get PDFAim of the given research is to evaluate the influence of blood ultrafiltation during cardiopulmonary bypass (CPB) with primary circuit filling by various colloidal solutions on systemic inflammatory response markers in adult patients after heart valve replacement.Materials and methods. The study included 115 patients after heart valve replacement. They were randomly assigned into four groups depending on the type of fluid to fill the cardiopulmonary bypass (CPB) and blood ultrafiltration use. The first group (п=37) received modified gelatine 4 % solution for CPB filling. Hydroxyethylstarch 130/0,4 was administered in the original volume filling for the third group of patients (п=35). Blood ultrafiltration prior to CPB finishing was carried out in patients of second group (n=21) and fourth group (n=22). The inflammatory markers concentration (IL-1α, IL-6, TNF-a, IL-10) were studied in serum samples before intubation (1), after CPB finishing (2) and on the first day after surgery (3). The levels measurement (IL-1α, IL-6, TNF-a, IL-10) was carried out using commercially available enzyme-linked immunosorbent assay (Diaclone). Statistical data analysis was carried out using Statistica 6.0 with Schapiro, Wilkie, Wilcoxon, Kruskal-Wallis criteria (ANOVA by rank test). The value of p <0.05 was considered as reliable.Results. Any significant differences between groups in distribution according to age, male and female ratio, patients preoperative clinical status, CPB duration, and aortic clamp were not detected. Results have shown, that the TNF α and IL 6 levels in serum after CBP finishing and on the first day after surgery were considerably lower in the fourth group of patients. The IL-10 concentration in the fourth group was considerably higher after CBP and during the first day after surgery. The number of leukocytes increased in all groups, but it was considerably lower in the fourth group after CBP and during the first day after surgery. Besides, this group required shorter time of ventilation (р=0,0000), inotropic agents administration (р=0,02), intensive therapy unit (р=0,0018) and hospitalization (р=0,016,) comparing with the other groups.Conclusion. It has been fouond, that ultrafiltration removes from the circulating inflammatory cytokines and increases anti-inflammatory IL 10 level. It reduces the treatment duration and the number of complicationsУ 115 хворих, яким проводили операції на серці в умовах штучного кровообігу, досліджено вплив первинного заповнення контуру апарату штучного кровообігу різними синтетичними колоїдами та ультрафільтрації крові на маркери запалення. Встановлено, що ультрафільтрація крові підвищує видалення з циркуляції прозапальних цитокінів та забезпечує зростання протизапального IL 10. Це зменшує кількість ускладнень та тривалість лікуванн