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BILATERAL BREAST SARCOMA IN WOMEN WITH MACROMASTIA
Get PDFBilateral breast sarcomas are rare malignancies of unknown etiology. Most common histological subtypes of breast sarcoma are angiosarcoma, fibrosarcoma and malignant fibrous histiocytoma. Phyllodes tumors have a predisposition to transform into sarcoma.
The present clinical case describes bilateral breast fibrosarcomas in a 39 years-old female with macromastia. This peculiarity gave possibilities to do wide local excision of both tumors within 3.0 cmresection margins and preserve both breasts. Histological and immunohistochemical (ERG, CK-AE1/AE3) examination confirmed fibrosarcomas in both breast (in right – stage IIB, in left – stage IIA). Patient carried on postoperative treatment with radiation therapy (36.1 Gy for both breasts) and four cycles of adjuvant chemotherapy (doxorubicin, cisplatin, cyclophosphamide).
For the first year patient had clinical and ultrasound examination every three months, then every 6 months. CT scan of chest and abdomen was every year. In seven post-op years there was no evidence of disease recurrence.
Thus, macromastia gives an exceptional chance to carry out organ-sparing radical surgery in women with advanced breast malignancies
FERTILITY-SPARING HYSTEROTOMY IN MALIGNANT TROPHOBLASTIC TUMOURS TREATMENT
Get PDFThe aim is to improve treatment efficacy and life quality of patients with malignant trophoblastic tumours.
Fertility-sparing hysterotomy with uterine reconstruction was carried in 16 patients aged of 17 to 32 years: 2 cases due to urgent and 13 – due to planned indications.
On the basis of research, the indications for the urgent and planned fertility-sparing hysterotomy with uterine reconstruction in patients with malignant trophoblastic tumours were formulated. No postoperative complications. Steady remission in all cases. Follow up from 1 to 17 years (averaged 9.2 years).
1. Localized uterine resection with uterine reconstruction – the method of choice in malignant trophoblastic tumours surgical treatment;
2. Fertility-sparing hysterotomy with uterine reconstruction is only possible in centers which are experienced in the complex multimodality treatment of gestational trophoblastic neoplasms;
3. Basic requirement of fertility-sparing surgery is beginning adjuvant chemotherapy as soon as possible
PSYCHOHYGIENIC ASPECTS OF TRAINING OF DISABLED ADOLESCENTS WITH PATHOLOGY OF THE VISION
Get PDFThe objective of this article is to undertake a literature review to familiarize ourselves with the knowledge base; to summarize information about some psycho-hygienic aspects of teaching and visually impaired adolescents, including features of communication, learning environment, psycho-emotional stress in specialized educational institutions, as well as individual psychological characteristics of personality, emotional and volitional state of visually impaired and general patterns of physiological and psychological characteristics and health of adolescents with vision pathology. To examine the system of security measures in order to optimize the learning environment for the promotion of mental health of the studied contingent and the nature and impact of the learning environment on functional status and health of adolescents with vision pathology. To investigate the impact of current patterns of complex sanitary and regime-organizational factors of training on functional status and health of adolescents with vision pathology. A thorough literature review helps to lay the foundation for a study, and can inspires new research ideas
POLYPROPYLENE MESH IMPLANT AND A-PRF MEMBRANE FOR RECONSTRUCTION OF THE TRAUMATIC DEFECTS OF THE LATERAL AND BACK WALL OF THE MAXILLARY SINUS
Get PDFAbstract. Background: The aim of this study was to investigate the possible use of Polypropylene mesh implant and A-PRF membrane for covering the defects of the lateral and back wall of the maxillary sinus after its traumatic damages.
Materials: non-resorbable Polypropylene mesh implant was used in 10 patients as a barrier membrane for prevention of adipose tissue herniation into maxillary sinus.
Method: 3 D CT was used for assessment of bone fragments position and volumetric parameters of the maxillary sinus before and after surgical repair.
Result: Postoperative 3-D CT after 2 months demonstrated effective reestablishment of anatomical configuration of sinus and its volume, absence of pathological inflammatory changes of the sinus mucosa.
Conclusion: Polypropylene mesh implant provides effective barrier between soft tissues and maxillary sinus, due to its strength characteristic and biocompatibility
GENETIC FEATURES OF RESISTANCE TO ANTITHROMBOCYTIC DRUGS IN PATIENTS WITH ISCHEMIC HEART DISEASE AFTER CONDUCTED PERCUTANEOUS CORONARY INTERVENTION
Get PDFThe aim of the study: To study and evaluate platelets aggregation activity as primary phase of haemostasis and anti-platelet therapy in IHD patients after PCI, depending on the polymorphism of the gene ITGA 2 - C 807T.
Materials and methods: 54 patients who were on a treatment at the clinical hospital "Feofaniya" (Kyiv) and at the Kyiv Clinical Hospital on railway transport №2 were examined: 20 women and 34 men (mean age - 67.8 ± 7.46 years). The study involved patients with stable forms of coronary artery disease (stable angina pectoris II-III) and acute coronary syndrome, with a history of percutaneous coronary intervention (PCI). All patients received antiplatelet therapy: acetylsalicylic acid (3.7%), clopidogrel (9.3%) or a combination of them (87%).
Functional activity of the platelets was studied on a Biola Aggregation Analyzer laser agrometer. The response to antiplatelet therapy was confirmed by the Aggredyne test. The polymorphism of the C807T of the ITGA2 gene was determined by polymerase chain reaction (PCR).
Based on the results of the aggregation ability, antiplatelet therapy sensitivity, the patients were divided into two groups: group I - individuals with varying degrees of insensitivity to antiplatelet drugs (35 patients), group II - susceptible to treatment (19 patients). In each group was analyzed the polymorphism of the gene ITGA2 and features of the functional activity of the platelets, depending on the genotype.
Results: In 50% of patients receiving ASA there was a different degree of non-sensitivity, with respect to thienopyridines - this figure was 20%. Among patients who received dual antiplatelet therapy did not match at least one of the drugs - 83.3%. Among the "non responders" 78.9% had a mutated T-allele, and a homozygous variant for the T allele was recorded in 53.15% of patients, while "respondents" - 15.8%. Most in the group of "respondents" was the group of the native genotype - C / C. The most pronounced tendency to influence the genotype on spontaneous aggregation was observed in relation to the T-allele, in particular in the homozygote (genotype T / T). The significant difference between the groups was obtained from the platelet response to ADP. Thus, the reaction of carriers in the T-allele, as homo- and heterozygotes, was significantly different.
Conclusions: In 64.8% of patients with coronary heart disease after PCI was observed a decrease in antiplatelet sensitivity, which has a clear link with the polymorphism of the gene ITGA 2. The presence of the T-allele in the genotype of patients with IHD is associated with a less adequate platelet response in patients receiving dual antiplatelet therapy for ASA and thienopyridines on ADP, which may have an effect on the sensitivity to thienopyridines
QUALITY OF LIFE OF PATIENTS WITH OVARIAN CANCER OF THE THIRD STAGE USING DIFFERENTIATED TREATMENT
Get PDFThe aim of this research was to assess the quality of life in patients with stage III ovarian cancer during the treatment period, depending on the applied therapeutic approaches.
A comparative analysis of the results of treatment of 350 patients with adenocarcinoma of the ovaries of III-IV stage, which have undergone suboptimal or non-optimal cytomelective surgery, was conducted. To assess the quality of life and to examine the relationship between changes in physical health and quality of life, patients in both groups were asked to complete the questionnaires EORTC QLQ-C30 and SF-36. According to the questionnaire of the EORTC QLQ-C30, the indicators of physical activity, the ability to do everyday affairs, were higher in the second group of patients who received differentiated treatment. The indicator of "social functioning" was also higher in the II group of patients. When evaluating the patients' liver on the scale of the questionnaire SF-36, it was found that the positive effect of differentiated therapy is maintained for 3 years. Life quality is an important criterion for evaluating the results of antitumor therapy, and when it is continuously monitored in patients with ovarian cancer the safety of treatment for patients could be improved, including at an advanced stag
IODINE DEFICIENCY AND PATHOLOGY OF THYROID GLAND AS A BACKGROUND STATE OF CANDIDIASIS OF MUCOSA OF THE UPPER PART OF DIGESTIVE TRACT
Get PDFThere were examined 119 patients of gastroenterological profile, who, according to the results of microbiological examination of scraping from tongue and biopsy material of digestive tract and stomach, were divided into three groups: 1 group – patients with oropharyngeal candidiasis and surface candidiasis of mucous tunic, 2 group – patients with invasion of Candida fungi in mucous tunic, 3 group – patients without oropharyngeal candidiasis and without growth of fungi in biopsy material. The status of iodine provision was studied in 78 persons. The results of research revealed that at structural changes of thyroid gland the dominating position in patients with candidiasis of mucous tunic occupies the nodular goiter– 29,31% and 36,36% for 1 and 2 group respectively, whereas in 3 group the frequency of nodular goiter was 11,76%, at that hyperplasia and nodular goiter in patients with fungi invasion in mucous tunic was revealed 2,6 times more often comparing with patients without candidiasis (χ2=4,01; р<0,05). In patients with oropharyngeal and surface candidiasis and invasive candidiasis of mucous tunic of the upper part of digestive tract the hard degree of iodine nutrition deficiency with thyroglobulin level higher than 40 ng/ml was revealed in more than half of cases. At that the frequency of hard iodine deficiency at fungi invasion in mucous tunic 4,2 times higher comparing with patients without candidiasis of mucous tunic (F=0,024; р<0,05).
So, the concomitant comorbid state with pathology of thyroid gland and iodine deficiency is an aggravating factor in the course of candida infection that is necessary to be taken into account at clinical monitoring of patients with candidiasis of mucous tunic of the upper part of gastrointestinal tract. 
THE INFLUENCE OF TRANSRECTAL MULTIFOCAL PROSTATE BIOPSY UNDER ULTRASOUND CONTROL ON THE DEGREE OF INFRAVESICAL OBSTRUCTION IN DIFFERENT GROUPS OF PATIENTS
Get PDF. Prostate cancer - is a malignant neoplasm arising from prostatic epithelium. [1] It is well known, that prostate cancer is the most common cancer in men population. Most patients, who underwent a biopsy of prostate, have expressed varying degrees of benign prostatic hyperplasia and, accordingly, symptoms, specific to the disease, including symptoms of the lower urinary (LUTS). [2], Uroflowmetry is a method widely used around the world to assess the degree of severity of infravesical obstruction [3].
The aim was to determine the degree of influence of transrectal multifocal biopsy of the prostate under ultrasound control on the degree of infravesical obstruction [4].
The study included patients with elevated serum PSA over 4 ng/ml with the volume (Vpr) of prostate from 20 cm³ to 90 cm³, volume of residual urine no more than 50 cm ³. Uroflowmetry was performed with the determination of the volume of residual urine at the primary treatment. At 21 day after transrectal multifocal prostate biopsy under Ultrasound control all patients underwent uroflowmetry. The age of patients ranged from 40 to 70 years. Patients were divided into 3 groups depending on the volume of the prostate gland. The first group consisted of 28 people where prostate volume ranged from 20 cm³ to 40 cm³, in the second group, consisted of 25 persons, prostate volume ranged from 41 cm³ to 60 cm³, and in the third group, consisted of 30 people, prostate volume ranged from 61 cm³ to 90 cm³. The following indicators of urofloumetry were determined as the following: voided volume, max flow rate, average flow, voiding time, flow time, time to max flow, and the volume of residual urine.
This study has demonstrated a high risk of complications in patients with prostate volume of more than 60 cm3 caused by infravesical obstruction after prostate biopsy
OPTIMIZATION OF PROPHYLACTIC ARRANGEMENTS IN CHILDREN WITH HYPOPLASIA OF DENTAL ENAMEL
Get PDFAim of research. To raise the effectiveness of anticarious properties of oral cavity in children with enamel hypoplasia by introduction of the complex of arrangements, directed on optimization of the oral cavity hygiene, level of secretory immunoglobulin А (sIgA) and the content of mineral components of oral liquid (calcium and orthophosphates).
Materials and methods. Object of research – enamel hypoplasia of the permanent teeth. Subject of research – hygienic status of the oral cavity, level of general calcium, orthophosphates, sIgA in the oral liquid. Methods of research: vital coloration of enamel, transillumination, photometric, immune-enzyme method, indices of hygienic status of the oral cavity (Green–Vermillion (1964) index, Silness–Loe (1964, 1967) index).
There was carried out an assessment of hygienic status of the oral cavity, determination of the level of calcium, orthophosphates and sIgA in the oral liquid of 45 children, 6–14 years old (group № 1 – 21 persons, group № 2 – 24 persons). Group №1 – children, who underwent the complex of prophylactic arrangements that included recommendations as to the choice of means and subjects for the oral cavity care and teaching the standard method of teeth brushing. Group № 2 – children, who additionally used remineralizing cream on the water base with casein phosphopeptide – amorphous calcium phosphate (СРР-АСР) (Certificate on the state registration №10014/2010 of 03.12.2010).
Results. Hygienic status of the oral cavity of children from the both groups was assessed as “unsatisfactory” one according to Green–Vermillion index and as “bad” one according to Silness–Loe index. After prophylactic arrangements the oral cavity status was improved in children of the group № 1: Green–Vermillion (p=0,0013) and Silness–Loe (p=0,0002) indices essentially decreased. In children of the group №2 after prophylactic arrangements hygienic status of the oral cavity was improved more essentially: Green–Vermillion (p=0,0002) and Silness–Loe (p=0,0002) indices reliably decreased. Prescription of remineralizing cream to the children of group № 2 reliably raised the content of calcium (р=0,0051) and sIgA in the oral liquid (р=0,001). Orthophosphates level did not essentially change in both groups.
Conclusions. Introduction of the complex of prophylactic arrangements with additional use of remineralizing preparation favored the more essential improvement of the oral cavity hygiene, raise of calcium and sIgA in the oral liquid
IATROGENIC AND ODONTOGENIC FORMS OF STOMATOGENIC MAXILLARY SINUSITIS. ULTRASOUND CHARACTERISTIC
Get PDFThe special features of transfer of information of the cone-beam computed tomography allows make conclusions about the character of pathological changes in maxillary sinuses only by the features of form and outlines of shadow of changed mucous tunic of sinus at its equal intensity that often leads to the incorrect interpretation of the results of research.
The high sensitivity of two-dimensional ultrasonography as for thickening (sclerosis) of mucous tunic, its edema (effusion) and exudation (purulent or serous) allows the more widen use of this method in addition to the cone-beam tomography at examination of maxillary sinuses. The other important moment is an absence of harmful influence of ultrasound on organism that makes it ideal for assessment of the dynamics of clinical course and allows prescribe it for pregnant and children.
The two-dimensional ultrasound examination of 86 patients with stomatogenic maxillary sinusitis (iatrogenic – 79,1 % odontogenic – 20,9 % forms) was carried out using ultrasound diagnostic apparatus АCUSON X 500, ATSmod.539 (SIEMENS, USA) in В-mode by the method of V.V. Shilenkova.
In the result of research was found out that sonographic picture of the maxillary sinuses at stomatogenic maxillary sinusitis depends on etio-pathogenetic form of disease. For iatrogenic form of maxillary sinusitis of stomatogenic origin are typical the ultrasound signs of chronic inflammation with many inflammatory inclusions in sinus, sclerosis of mucous tunic and serous effusion. By frequency prevailed: hyperechogenicity of membrane (30,8 %), its heterogenous echostructure (52,9 %), hyperechogenic character of content (39,7 %), arched outline of the back wall (36,8 %).
For odontogenic form of maxillary sinusitis of stomatogenic origin are typical the ultrasound signs of acute catarrhal inflammation with predomination of exudation in the mucous tunic and absence of contents in the lumen of sinus. By frequency prevailed: hypoechogenicity of membrane (27,8 %), its homogenous echostructure (45,6 %); acoustic shadow in sinus (72,2 %), arched outline of the back wall (27,8 %)