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CYSTOMANOMETRY – ONE OF THE ASSESSMENT METHODS OF THE URODYNAMIC INDEXES IN PATIENTS WITH INFILTRATIVE CERVICAL CANCER
Get PDFAim: To evaluate contractile function of urinary bladder in patients with infiltrative cervical cancer after nerve-sparing radical hysterectomy (NSRH).
Patients and Methods: Ninety patients with infiltrative cervical cancer were treated with nerve-sparing radical hysterectomy (n=45, NSRH group), or radical hysterectomy (RHE III) without preservation of pelvic autonomic plexuses (n=45, RHE group). Cystomanometry was carried out using urodynamic apparatus “Uro-Pro” by standard method.
Results: Using cystomanometry, we have evaluated the main urodynamic indexes such as pressure upon bladder filling (P1), first vesical tenesmus pressure (P2); change of detrusor pressure upon change of bladder volume (P), volume of urinary bladder (V), and complience of urinary bladder wall (C) at preoperative period and postoperative period in both groups of patients. While at preoperative period P1 indexes did not differ significantly between the groups, after NSRH performance, P1 values were significantly higher than P1 values in the group of patients treated with RHE III (8,29±1,1 cm H2O versus 3,51±0,8 cm H2O (р<0,05)). P2 indexes in patients from both groups before and after surgical treatment differed significantly and were 6,82±0,4 cm H2O and 12,27±1,2 cm H2O (р<0,05) in NSRH group, and 5,44±0,6 cm H2O and 10,62±1,1 cm H2O (р<0,05) in RHE III group. The P value in both patients groups before and after the surgical treatments was significantly different, and demonstrated a gradual elevation of urinary bladder pressure, especially in the patients from RHE III treated group. Urinary bladder volume at preoperative and postoperative periods in NSRH-treated group remained practically unaltered (209,78±14,2 ml and 216,86±14,9 ml (р>0,5) respectively), while in the patients from RHE III-treated group after surgical treatment an urinary bladder volume significantly decreased from 188,4±10,5 ml to 161,9±9,8 ml (р<0,05). An analysis of compliance of urinary bladder wall (C) has shown that after surgical treatment in RHE group C value decreased by 75% while in NSE group this index decreased just by 25%.
Conclusions: The data of urodynamic study evidence the better preservation of urinary bladder functions in patients with infiltrative cervical cancer after NSRH than in the patients treated with RHE III
EVALUATION OF RECURRENT HOSPITALIZATION PROBABILITY IN PATIENTS WITH DUODENAL AND GASTRIC ULCER DEPENDENT UPON REHABILITATION INPUT
Get PDFBackground: notoriously known worldwide cause of morbidity and disability duodenal (DU) and gastric ulcer (GU) experience their rise in Ukraine, demonstrating formidable increase by 38,4 % in last decade with the prevalence of 2299 per 100 000 population. Every second patient is treated in-patiently, every third experiences disability spell annually. Reduction in related risks confined not so much by absence of effective therapy but rather shortcomings in patient management and patient devotion. By WHO data 50 % of patients fail to follow physician prescriptions, 60 % can’t recollect physician recommendations in first 20 minutes. Ubiquitous belated timing of rehabilitation initiation in post hospital stage appeared to be cardinal obstacle of its efficiency with low (up to 20 %) coverage, and ensuring clinical effect in 8 % cases only.Aim: to evaluate efficacy of rehabilitation program detailed at first episode of in-patient treatment at gastroenterological department.Data: organized by cohort design. Control cohort comprised 180 patients with first episode of hospitalization due to DU or GU in gastroenterological Vinnitsa city department in 2009–2010 years. Experimental cohort consisted of 220 alike patients who enter rehabilitation program (RP). RP was administered randomly. Randomness was statistically verified on principal confounders. Cases were traced 4 years.Methods: we applied three modifications of semi-parametric frailty model to study effect of program on the risk of recurrent hospitalization.Results: all three modifications coincided in that program secured typically at least 39 days to recurrent hospitalization per patient with drop in risk at least at RR=0,774
CLINICAL CASE – SCLEREDEMA ADULTORUM
Get PDFScleredema of Buschke is a rare dermal disease of unknown etiology which is characterized by a dense diffuse swelling of the derm and subcutaneous adipose tissue. It characterized by induration of the skin which includes a non-pitting hardening of the skin around the neck, shoulders, and trunk sometimes the face. Three basic forms are distinguished: classical, idiopathic, diabetic or metabolic.
The histopathological features of scleredema are characterized by sharply thickened derma, edema and structural impairment of collagenous fascicles metachromasia appears in the foci of the damage as a result of accumulation of glycosaminoglycans. Differential diagnostics was carried out at the other diseases similar to scleredema such as systemic scleroderma, eosinophilic fasciitis, porphyria cutanea tarda hereditaria, porphyria cutanea scleroderma-like form, Werner's syndrome, scleromyxedema, amyloidosis. Several treatments are suggested in the literature.
The present case record describes scleredema adultorum Buschke in a 52- years-old male with stiffness and density of the skin of trunk. He had suffered from diabetes mellitus type-1 for more than 30 years. The patient was treated with antibiotics, corticosteroids, polyenzyme agent, hepatoprotector, cytoflavin, polyvitamins. There was improvement with slightly decrease infiltration in foci lesions, skin color in the area of rash brightened.
Skin diseases are common in diabetes mellitus. This clinical case will enable to expand knowledge of general practitioners about the rare dermal disease – Buschke's scleredema giving the possibility to reveal such patients at early stages of the disease in proper time
THE SERUMAL CONCENTRATION OF HBsAg IN PATIETS WITH CHB/HIV CO-INFECTION COMPARING WITH CHB MONO-INFECTION IN THE DIFFERENT PHASES OF NATURAL COURSE OF CHRONIC HEPATITIS Ð’
Get PDFThe prevalence and inclination to chronization of viral hepatitis B is 3 – 5 times higher in patients with HIV-infection than in HIV-negative ones. The natural clinical course of chronic hepatitis B (CHB) in patients with HIV has the features, connected with immune suppression and mutual influence of viruses. The quantitative determination of HBsAg allows the more precise monitoring of the natural course and the dynamics of treatment of patients with CHB but these features are little studied in patients with co-infection CHB/HIV.
In the work was presented the comparative analysis of the results of quantitative determination of the serumal HBsAg in 59 Patients with co-infection CHB/HIV and 60 ones with chronic hepatitis. At the study it was established, that in patients with CHB/HIV co-infection were observed the reliably higher qHBsAg levels than in HIV-negative ones both in whole and in each CHB phase that depends on the immune suppression degree and DNA level of hepatitis B virus
LIPOFILLING OPPORTUNITIES IN BREAST CANCER SURGERY
Get PDFIn this article the authors described the experience of lipofilling usage at the National Cancer Institute.
Aim of this work was to improve the aesthetic results of surgical treatment of breast cancer patients by the usage of lipofilling in patients after breast reconstruction. The description of methods of lipofilling and their application in cancer patients, the benefits of usage of LipiVage® system was performed.
Materials and methods. The study included 42 women with breast cancer, who received special treatment in 2012–2016. The main group included 21 patients that have received special treatment and undergone lipofilling. The control group included 21 patients, who received only special treatment, (with no lipofilling). Different objective and subjective criteria for evaluating the effectiveness of lipofilling in achieving a satisfactory aesthetic result in patients, who underwent radical and reconstructive surgery for breast cancer, were used in this investigation.
The results shows that the implementation of lipofilling improves the aesthetic perception after breast reconstruction in 20 % of patients, decreases the number of complications after reconstructive operations and are not accompanied by a worsening of results of special treatment in breast cancer patients.
In conclusion it can be noted that our results show a high efficiency of lipofilling after special treatment, its safety and advisability for further usage
USING OF BINOMINAL METHOD FOR THE PURPOSE OF DETERMINATION OF CONFIDENCE INTERVALS FOR PREDICTION OF INVASIVE DUCTAL BREAST CARCINOMA METASTASES
Get PDFThe study was performed using surgical and biopsy material based on histopathological study, which was conducted at the Chernivtsy Regional Clinical Oncology Centre. In the cases of verified diagnosis of ductal breast carcinoma was studied the size of the primary tumour node and metastasis in lymphogenous features of regional lymph node according to classification system TNM. All cases were divided by categories T and N. Using statistical data was conducted the analysis in patients of verified diagnosis of ductal breast carcinoma in Chernivtsy region. We determined the features of metastasis to regional lymph nodes under according to the classification pTNM and confidence intervals calculated according to percent binomial method with p=0.05. After receiving the results the data were compared to predict metastasis. Using statistical data were conducted the analysis in women of Chernivtsi region with verified diagnosis of ductal breast cancer. We determined the features of metastasis classification according pTNM and confidence intervals of percent according to binominal method with p=0.05. All observations of histopathological conclusions were conducted on the basis of Chernivtsy Regional Clinical Oncology Centre
CHARACTERISTIC OF INDIVIDUAL INDICATORS OF ENDOGENOUS INTOXICATION IN THE EXPERIMENTAL ASTHMA DYNAMICS AND THEIR CORRECTION BY THIOTRIASOLIN
Get PDFThe aim of this work was to find out the specifics of changes in endogenous intoxication, middle mass molecules (MMM) and erythrocyte intoxication index (EII) in the blood of animals for experimental asthma in different periods of its development and to correct them by thiotriazolin.
Material and methods. Researches were carried out on 72 guinea-pigs (males), which were divided into 6 groups for 12 animals in each of them. The last sixth group included animals that were treated by thiotriazolin. The drug thiotriazolin rate of 100 mg / kg intramuscularly since 23rd day of the experiment for 10 days was administered in the animals of sixth group.
Experimental model of bronchial asthma was restored on guinea-pigs by the V.I. Babych method (1979). In all groups of animals there were determined the middle mass molecules concentration in blood in the wave of 254 nm by I.A.Volchehorskiy, D.A.Dyatlova, E.I. Lvovska and others methods and EII by V.K. Kazymyrko V.I. Maltsev methods. Numerical results were adapted with static method using Student’s criteria.
Results of the research. The highest level of endogenous intoxication in the blood was in the fifth group of guinea pigs with asthma (33rd day), indicating the direct dependence of the antigenic effect on their severity. Using of the thiotriazolin within 10 days (from 23rd to 33rd day) caused the decrease of the MMM254 concentration and EII in serum compared with a group of guinea pigs, that were not entered the medicine. It approved its treating effect.
Conclusions. So, the research of middle mass molecules and erythrocyte intoxication index indicators in different periods of experimental asthma showed their gradual increase in serum of guinea pigs with the greatest severity in 33rd day of the experiment. It might indicate the development of endogenous intoxication animals. But the using of thiotriazolin caused the decreasing of these indicators. That gives a reason to state its positive effect on some markers of endogenous intoxication and feasibility of further researches
VITAMIN D AS ONE OF PREDICATORS OF THE STABLE VIRAL RESPONSE TO ANTIVIRAL THERAPY IN PATIENTS WITH CHRONIS HEPATITIS С
Get PDFChronic hepatitis C (CHC) it is not exceptionally medical problem but a significant social and economic threat, taking into account the unfavorable consequences of this disease: cirrhosis and hepatocellular carcinoma. And as a result - the high level of disability. In the article are presented the results of examination of 41 patients with chronic hepatitis C, with 1 genotype, who received the antiviral therapy (AVT). All patients underwent determination of the level of 5-hydroxycholeсalсeferol (25-OH vit D3), vitamin D and also the study of IL-28B polymorphism as the one of predicators of response to AVT. It was demonstrated, that in patients with hepatitis was observed the deficit of 25-OH vit D3 and general vitamin D. It was established, that in patients with the normal 25-OH vit D3 level SVR (stable viral response) was observed in 1,4 times more often than in patients with deficit of 25-OH vit D3. That is the level of 25-OH vit D3 can be considered as a predicator of SVR to AVT
MARKERS OF ATOPIC REACTIVITY IN THE PUPILS WITH SEVERE BRONCHIAL ASTHMA
Get PDFThe aim of the work was to increase the effectiveness of treatment of the severe asthma phenotype in school-age children, taking into account the diagnostic value of atopic reactivity indicators. The study involved 30 pupils with severe asthma and 30 children with moderate-heavy version of it. Amid severe asthma increases risk of higher concentrations of IL-4 and IL-5 in the serum, and almost in every second child was observed the increased concentrations of Ig E (more than 545,3 IU/mL, odds ratio was 1,9 (95 % CI 1,1-3,4). In the group of patients with severe asthma were significantly more frequent cases of the skin hypersensitivity to household allergens with respect to the members of the second group. There were separated the indices of clinical and epidemiological risk and diagnostic value of some markers of atopic reactivity for verification of the severe asthma phenotype. It was established that the development of severe asthma in children marked tendency to reduce the metabolic activity of eosinophilic granulocytes in blood (in terms of intracellular content of cationic proteins and peroxidase) and phagocytic ability of these effector cells of allergic inflammation. For the phenotype of severe asthma the risk of high concentration of IL-4 and IL-5 in serum increased in 3,1 times, but this paraclinical test is rather suitable for verification of this phenotype (SP – 84,6% (95 % Sp 75,9–91,1)) than for its detection (Se – 36,4 % (95 % CI 26,9–46,6))
THE USE OF PLASMAPHERESIS IN TREATMENT OF PATIENTS WITH INFERTILITY, PERITONEAL ENDOMETRIOSIS AND NAT2 GENE POLYMORPHISM
Get PDFIt is known that 30–40 % of patients with peritoneal endometriosis suffer from infertility. Half of the patients with endometriosis are identified point mutation in NAT2 – gene, which plays an important role in the acetylation of aromatic and heterocyclic amines, in the accumulation of endotoxins, activation of free radical oxidation, impaired microcirculation. These factors involve the use of methods of gemapheresis which have detoxification, the blood rheology corrective and immune corrective effects.The purpose of this study was to evaluate the efficacy of therapeutic plasma exchange in treatment of patients with peritoneal form of endometriosis, infertility and point mutations in the gene NAT2.The study included 140 patients with infertility, peritoneal form of endometriosis and point mutations in the gene NAT2. All patients are performed laparoscopy, coagulation foci of endometriosis. In the following 93 (66.4 %) patients were treated with a the course of therapeutic plasmapheresis using the apparatus «PCS-2» with the removal of 20–25 % the volume of circulating plasma with replacement plasma of crystalloid and colloid solutions. Before treatment were shown the signs of endotoxemia, activation of oxidative stress. After treatment with the use of plasmapheresis was revealed the significant reduction of endogenous intoxication parameters and oxidative stress. Also is noted the increase in the pregnancy rate, both independently and in IVF programs, especially during the first 3 months after treatment. The findings suggest that the efficiency of the proposed comprehensive treatment techniques (laparoscopy and subsequent course of therapeutic plasmapheresis) of patients with peritoneal endometriosis and infertility and with point mutations in the gene NAT2. The use of plasmapheresis is pathogenetically justified in patients of the studied group