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RESULTS OF RADICAL SURGICAL TREATMENT OF CHOLANGIOCARCINOMA
Get PDFRadical operations of cholangiocarcinomas are connected with the great number of post-operative complications, and lethality reaches 15-30 %. The most debatable questions remain the choice of the operation type depending on localization and spreading of a tumor and also the expedience of using mini-invasive technologies as a preoperational preparation to the radical surgical treatment. We would like to share the little experience of the radical surgical treatment of cholangiocarcinomas.
The research aim is to analyze results of radical surgical treatment of patients with cholangiocarcinoma.
Matherials and methods. We have analyzed the outcomes of surgical treatment in 18 patients with cholangiocarcinomas. Tumor localization was determined according to the Bismuth-Corlett classification. Type 1 tumors were found in 2 (11.1 %), type 2 in 4 (22.2 %), type 3А in 5 (27.8 %), type 3B in 4 (22.2 %), type 4 in 1 (5.6 %), and distal localization in 2 (11.1 %) patients. As biliary decompression, 9 (50 %) patients underwent percutaneous transhepatic biliary duct drainage (PTBD), and another 9 (50 %) patients were operated without preoperative biliary decompression Pre-operative embolization of portal vein branches with the aim to increase the low volume of liver after anticipated resection was performed in 4 (22.2 %) patients.
Results. After the embolization of portal vein branches, the estimated residual volume of hepatic parenchyma increased from 33.4 % to 45.7 %. Patients with cholagiocarcinomas of different localization performed the radical operations: isolated hepaticocholedochus resection in 5 (27.8 %) patients, hepaticocholedochus resection combined with Taj Mahal hepatic resection in 1 (5.6 %), right hemihepatectomy in 5 (27.8 %), left hemihepatectomy in 4 (22.2 %), extended right hemihepatectomy in 1 (5.6 %), and pancreoduodenal resection in 2 (11.1 %) patients. Complications of radical surgeries were observed in 4 (22.2 %) patients. Lethal outcomes occurred in 3 (16.7 %) patients.
Conclusions. Radical operations are attended with complications in 22,2 % and lethality in 16,7 %. As a preoperative preparation it is possible to use mini-invasive interventions for the biliary decompression and increase of hepatic parenchyma volume
PREDICTION OF THE DURATION OF HOSPITAL TREATMENT OF PATIENTS WITH CATARACT
Get PDFThe aim of the paper was to evaluate and determine the duration of the hospital treatment of patients with cataract.
Materials and methods of the investigation. 629 case histories were analyzed and 60 patients’ forms were also analyzed. The assessment of case histories was done according to the scheme: sex, age, the stage of cataract, the duration of hospital treatment, the cause of treatment which lasts more than 1 day (postoperative complication, treatment of concomitant eye diseases, patient’s desire), the type of complication. 60 surveyed patients with cataract required surgical treatment in order to work out the model of the duration of hospital treatment. The questionnaire contained several questions, which answers allow evaluating the social status of patients, somatic and optic status, peculiarities of the main disease and also the duration at the hospital after the operation.
Results. It has been demonstrated that patient’s age, his or her financial status, the number of concomitant somatic and eye diseases are the main peculiarities for the prognosis for long-lasting stay at hospital after surgical treatment. Undetermined logics was used to create the model of prognosis of the duration of hospital treatment based on еру results of patients’ questionnaire, the method of clustering was used to receive undetermined rules.
Conclusions. Ophthalmologic status of the patient, the presence of concomitant eye diseases, such as myopia alta, glaucoma, diseases of retina, and optic nerve and concomitant somatic disease play an important role in the choice of the type of treatment. The most informative indices for hospital treatment of patients with cataract after surgery are patient’s age, his/her financial status, the number of concomitant somatic and eye diseases
CONTROL LEVEL AND ASSESSMENT OF THE CLINICAL COURSE IN PATIENTS WITH THE ASSOCIATED PATHOLOGY OF BRONCHIAL ASTHMA AND COPD
Get PDFThe notion “asthma-COPD cross” (ACC) for patients with clinical signs of bronchial asthma and COPD was introduced. From 15 to 45 % of population with bronchial obstructive diseases suffer from ACC and its prevalence increases with age.
According to the data of epidemiological studies, in average a half of patients with BA in the world cannot reach a control of BA or keep it for a long time.
The aim of our research was the determination of the control level and also assessment of symptoms of the disease of patients with BA and COPD.
Patients. The study included patients with ACC, older than 30 years. The control included patients with the bronchial asthma and COPD without any signs of these pathologies combination.
Methods. All patients underwent the spirography with the analysis of the curve “flow-volume” of a force exhalation and also bodypletizmography (“MasterScreenPneumo”, "CardinalHealth" (Germany)). Al patients were interrogated by the questionnaires: questionnaire for BA symptoms control (ACQ-7), test for BA control (ACT), test for COPD assessment CAT).
Results. At comparing parameters of BA control was revealed the reliably worse control in the group of patients with the associated pathology by data of the questionnaire ACQ-7 comparing with patients with BA. The influence of COPD symptoms was also more essential in patients with ACC comparing with one with COPD.
At the more expressed degree of the bronchial obstruction, BA control was reliably weaker, whereas the influence of COPD symptoms was more essential.
In patients with ACC with the unsatisfactory control of BA (АСQ-7 ≥1,5 points) the mortality prognosis, expressed by BODE index, grows almost in 3 times; inpatients with the severe and very severe influence of the disease effect (САТ > 20 points), the mortality prognosis grows more than in 2 times.
The reliable positive correlation was revealed between the results of CAT and ratio of the internal thoracic volume of gases to the total capacity of lungs (ITGV/TLС), that reflects the degree of lungs hyperinflation - (r=0,35; p<0,05).
Conclusions. At BA and COPD combination the indices of the disease control are worse than at the bronchial asthma and a bit similar to ones at COPD.
Indices of BA control and influence of COPD symptoms on the condition of patients with the associated pathology were mainly negatively changed at the increase of the bronchial obstruction degree.
The essential negative influence of the insufficient BA control and the high influence of COPD symptoms on the disease prognosis in patients with associated pathology (BA+COPD) were revealed
DIAGNOSTICS OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE IN REAL CLINICAL PRACTICE: HYPODIAGNISTICS OR HYPERDIAGNOSTICS
Get PDFAccording to the data of the world statistics there is observed the continuous growth of chronic obstructive pulmonary disease (COPD). According to the last data of the World health organization (WHO), for today there is near 250 mln persons with chronic obstructive pulmonary disease (COPD), and this disease becomes as cause of death of near 3 mln persons annually.
Aim: to establish the prevalence of undiagnosed chronic pulmonary disease (COPD) among persons, who consider themselves as healthy ones and regularly undergo medical check-ups; to estimate the frequency of chronic obstructive pulmonary disease (COPD) according to the data of medical documentation.
Methods and materials: 525 persons, older than 35, who did not have in an anamnesis any chronic diseases of respiratory tract, were interrogated. At the following stage, persons, who had taken 18 points or more underwent a spirography with bronchodilatation test, using 400 mcg of salbutamol and were interrogated by the modified questionnaire of short breath by the medical research council (MRC) and test of the chronic obstructive pulmonary disease estimation (COPD) (TEC). There were examined 136 patients, mean age (51,5±0,8), men were 81(59,5 %) mean age (52,2±1,1) and women – 55(40,4 %) mean age (50,7±0,9).
There were analyzed 56 medical stories of patients, treated at therapeutic departments of the city clinic because of internal organs diseases with the concomitant diagnosis of chronic obstructive pulmonary disease (COPD).
Among persons with first revealed chronic obstructive pulmonary disease у 21 (26,6 %) was reveled І severity degree according to GOLD, in 26 persons (32,9 %) – GOLD ІІ, in 28 (35,4 %) – GOLD ІІІ, in 4 (5,1 %) – GOLD ІV severity degree, so 32 patients did not receive basic treatment at all.
At the same time among patients with COPD diagnosis in medical documentation only in 38,4 % this diagnosis was spirographically verified, the hyperdiagnostics of disease on the base of complaints and age characteristic took place in other cases
36 MONTHS SURVIVABILITY AND ITS PREDICTORS IN PATIENTS WITH CHRONIC HEART FAILURE AND DECREASED FRACTION OF LEFT VENTRICULAR EJECTION DEPENDING ON SEX
Get PDFAim of the work: to compare survivability parameters during 36 months and their predictors among men and women with chronic heart failure and decreased fraction of left ventricular ejection.
Materials and methods: the research included 356 patients with CHF (NYHA ІІ –ІV) with decreased LVEF<40 %, 18–75 years old. Using Kaplan-Meier method, there was analyzed the survivability in men and women during 36 months, then there were analyzed independent factors that influenced survivability terms depending on sex using the multiple logistic regression.
Results. Our analysis of the survivability of patients with CHF with decreased LVEF demonstrated that the cumulative survival after 3 years of observation was 49 and 51 % for men and women, respectively. The curves of 36 months survivability didn’t reliably differ. At the analysis of factors, associated with the bad prognosis, there were observed differences between groups of men and women with CHF. Thus, in men the predictors of 36 month survival were: the thickness of the right ventricle wall, size of the right atrium, end-diastolic volume and end-systolic volume of LV, indices of EDV and ESV of LV, urinary acid level, value of LVEF. In women the predictors of survivability during 3 years were the following parameters: BMI, DM type 2 in an anamnesis, end-diastolic size of LV, end-systolic size of LV, blood glucose level, LVEF.
Conclusion. The survivability of men and women with CHF with decreased LVEF during 36 months didn’t reliably differ and was 49 and 51 % respectively. But predictors of the lethal outcome in men and women essentially differed during 36 months, and their number is essentially higher in men. 
MICROBIOLOGICAL SPECTRE OF TERTIARY PERITONITIS AS A COMPONENT OF ITS DIAGNOSTICS AND TREATMENT
Get PDFThe aim of the research was to investigate the microbial spectre of tertiary peritonits (TP) and its antibiotic resistance as the way to improve the diagnostics and treatment of TP.
Materials and methods. Prospective research enrolled 109 patients with secondary peritonitis. Tertiary peritonitis developed in 18,3 % of cases. Samples of peritoneal exudate had been drawn upon index operation, relaparotomy and on the day of diagnosis of TP. Blood sampling was performed in patients with persistent fever, impaired consciousness, prolonged (>4 days) discharge from drainage tubes and on the 1st day of diagnosis of TP. Antibacterial susceptibility was evaluated using Hinton-Müller media.
Results and discussion. Patients were divided into 2 groups: with secondary peritonitis (89) and with TP (20). In TP group, cultivation of 76,2 % of primary specimens resulted in replantable and identifiable growth, presenting a shift towards Gram-negative flora and higher incidence of Candida albicans. Following the development of TP, hemocultures were positive in 15,1 %, presented mainly by Proteus spp. and non-albicans Candida spp. Second-group carbapenems, tigecycline and piperacillin-tazobactam had shown the highest activity in pathogens of TP. Caspofungin proved to be the most potent antifungal agent, especially towards non-albicans Candida spp. Antibiotic resistance in TP group was marked in 63,8 %.
Conclusions. Tertiary peritonitis is one of the most severe forms of abdominal sepsis with highest mortality. Causing pathogenic flora in case of TP is mainly Gram-negative and coccal with high rates of antibiotic resistance both in vitro and in vivo. Fungi, presented predominantly by Candida non-albicans substrains, show an increasing content in peritoneal exudate and major effect upon mortality in TP. In case of TP, a significant percent of peritoneal specimens do not provide any culture growth despite of observing stringent sampling, transportation and cultivation rules. Antimicrobial therapy of TP can never be standardized and should always be thoroughly based upon regular and proper peritoneal and blood sampling
THE USE OF INTERMITTENT NORMOBARIC HYPOXIA IN CHILDREN'S NEUROLOGY (REVIEW)
Get PDFThe present review summarizes the data about the use of intermittent normobaric hypoxia (INH) in the treatment and prevention of both acute and chronic diseases of the nervous system in children. The INH method is used in pregnant women with fetoplacental insufficiency, anemia and for mental disorders correction. The INH efficiency in relation to such pathology as cerebral palsy, epilepsy, enuresis, sleep disturbances, autonomic dysfunction is proved. The age dependence of bioelectric activity of the brain in practically healthy persons (age from 8 to 21 years) on hypoxic factor and the most sensitive period of age from 13 to 16 years is shown. The results the own studies have shown that the children which are born and live in radioactive contaminated areas (RCA), the course of INH sessions led to the restoration of somatovegetative status: activation of higher vegetative centers, optimization of sympathetic and parasympathetic links; positive influence on the activity of the cardiovascular system; ventilatory capacity of lungs; blood parameters
THE ANALYSIS OF RELATIONSHIP BETWEEN LESION OF FUNCTIONAL SYSTEMS OF NERVOUS SYSTEM AND SEVERITY OF FATIGUE IN PATIENTS WITH MULTIPLE SCLEROSIS
Get PDFDespite numerous investigations, fatigue remains one of the least studied manifestations of MS. However, significant prevalence of this symptom proves importance of its study. The aim of the study was to define a prognostic assessment of fatigue development accompanying lesions of certain functional systems and degree of disability. Material and methods. 96 patients, aged 15 to 58 years with a diagnosis of MS have been examined. MS patients were examined with the same protocol, using formalized scales. To detect fatigue and determine the degree of its severity was used Fatigue Severity Scale (FSS). The degree of disability in patients was assessed by Kurtzke EDSS (Expanded Disability Status Scale). Statistical methods for the data analysis were also used, including methods of descriptive statistics, probability assessment and prognostic significance of obtained data using odds ratio (OR). Results. Fatigue was detected in 49.1% of patients with a degree of disability lower than 4 EDSS scores and in 90.4% of patients with disability higher than 4 EDSS scores (p=0.0027). The assessment of functional systems at the time of observation has statistically significant prognostic values according to the following parameters: pyramidal system lesion (OR=7.43 (2.43–22.76)), coordination disorders (OR=4.60 (1.05–20.25)), cranial nerve lesion (OR=4.33 (1.40–13.39)), (p<0.05). Lesion of the pyramidal and coordination systems at the onset of the disease may increase risk for detection of fatigue higher than 4 scores in the follow-up observation (lesion of pyramidal system – OR=1.62 (0.5–5.25), coordination disorders OR=1.41 (0.58–5.16)). Conclusion. The results of our investigation showed that symptom of fatigue is observed in almost 90 % of MS patients. The study showed that fatigue in MS patients depends on the degree of disability and lesions of certain functional systems
THE STRUCTURAL FEATURES OF VASCULAR ENDOTHELIUM IN ACUTE CEREBRAL ISCHEMIA
Get PDFThe aim of the research was to study the number and structural properties of desquamated endothelial cells (DECs) in the peripheral blood in carotid ischemic stroke (CIS) and carotid transient ischemic attacks (TIAs) and its connection with the marker of endothelial dysfunction - endothelin-1.
We examined 35 patients with the first CIS, on days 1st and 10th, and also 34 patients with symptomatic carotid TIAs, on days 1st and 10th of the observation. Middle age of the examined patients with a CIS was 63,7±1,0. Middle age of the examined patients with the ТIАs was 54,7±1,0. 25 practically healthy persons were examined as a group of control. Neurologic deficit was assessed with the National Institutes of Health Stroke Scale (NIHSS). DECs were estimated by CD34 immunobead capture in the peripheral venous blood of patients and persons of control group. We studied the level of endothelin-1 in the peripheral venous blood of patients and persons of control group using the enzyme immunoassay using the Biomedica (Austria) during the first 24 hrs and on day 10. Statistical processing of the obtained results was carried out using statistical analysis package Statistica. In this case, the mean value, the standard error and the correlation analysis were determined. Samples were compared using the Student's criterion (t) and the correlation coefficient (r).
During an examination of 35 patients in the acute period of CIS and 34 patients with carotid TIAs using the immunocytochemical method the number of DECs was studied in venous blood. The quantitative analysis of vascular endothelium in acute cerebral ischemias showed its statistically unreliable differences in CIS and TIAs.
A conclusion is drawn about the general mechanisms of endothelial dysfunction in CIS and TIAs. The number of DECs significantly correlates with the terms of disease. Regress of this indicator is noted in patients by the end of follow-up in both observation groups. During the first 24 hrs in patients with CIS and TIAs density of DECs of blood directly correlates with the level of endothelin-1 blood. The endothelin-1 level tends to decrease by the 10th day of observation and the correlation force with the DECs level is correspondingly reduced
THE CLINICAL FEATURES OF ATRIOVENTRICULAR CANAL DEFECT
Get PDFAtrioventricular canal defect (AVCD) is a congenital heart defect, which occurs in 2.9 % of all congenital heart defects (CHD) and is characterized by a wide variety of anatomical forms and often don’t have clear cardiac manifestation. Untreated AVCD may lead to the development of pulmonary hypertension.
Aim. To determine clinical features of AVCD in children, considering variable anatomical forms of the pathology and its association with genetic pathology.
Materials and methods. Patients history and outpatient statistic records of children with AVCD, who were admitted to Lviv Regional Children’s Hospital from September 1999 till January 2016 have been analyzed (n=84).
The aspects of clinical manifestation of AVCD without associated pathology have been identified (n=48). Clinical manifestation of complete (n=36) and incomplete (n=12) AVCD and clinical manifestation with and without Down syndrome have been discussed.
Children with AVCD were divided into two groups: A – children with complete (n=36) and B – with incomplete (n=12) form of AVCD. Group A was divided into A1 – with trisomy 21 (n=14), A2 – without genetic pathology (n=22).
Results. In group А2 – 36,36±10,26 % and in group В – 50±14,4 % children were asymptomatic. Dyspnea, increased sweating during feeds, growth retardation and frequent respiratory viral infections during early childhood period were leading symptoms. Most frequent auscultation findings were accent of II heart sound over the pulmonary artery and 2-3/6 systolic murmur over left sternal border. According to echocardiographic examination mitral valve insufficiency was predominantly of mild grade, tricuspid insufficiency and pulmonary hypertension was diagnosed in group А2 with the frequency of 9,09±6,13 %).
Conclusions: The absence of clinical features in group A2 and B 36,36±10,26 and 50,00±14,40 respectively, saturation levels 92,36±0,49 % in patients without genetic pathology and 95,25±0,40 % with incomplete AVCD provide a need to adopt protocol of children examination with saturation level under 95 % and compulsory echocardiographic diagnosis within the first month of life