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Variants of Localization and Extension of Hypo- and Aplasia of the Great Saphenous Vein in Patients with Primary Varicose Great Saphenous Veins
Get PDFThe objective of the research was to improve the diagnostics and treatment of patients with primary varicose great saphenous veins by studying their frequency and systematizing the variants of localization and extension of great saphenous vein hypoplasia and aplasia in its trunk.
Materials and Methods. The study included 560 patients with varicose veins of the lower limbs and pathological refluxes in different segments of the great saphenous vein. All the patients underwent triplex ultrasound scan of the lower limb venous system.
Results. Among the patients with pathological reflux in a certain GSV segment, hypo- and aplasia of its segments were observed in 32.5% of the cases (95% CI 28.6-36.6%). Aplasia of this vein was observed twice as less frequently than hypoplasia (p<0.05). In 2.3% of the cases (95% CI 1.2-3.9%), hypoplasia of a certain GSV segment evolved to aplasia, or vice versa. It was found that the GSV trunk may have several hypo- or aplastic regions separated by its normal or varicose segment – bi-level hypo- or aplasia that was observed in 3.8% of the patients with hypo- or aplasia (95% CI 1.6-7.8%). In bi-level hypo- or aplasia, 2 hypoplastic regions were detected in 85.7% of the cases (95% CI 42.1-99.6%) and 2 aplastic regions were found in 14.3% of the cases (95% CI 0.4-57.9%). There were proposed to distinguish the following variants of GSV hypo- and aplasia: 1) simple: total, proximal, segmental and distal; 2) bi-level: proximal segmental, distal segmental and bi-segmental. In addition, for every dysplastic vein segment, the type of malformation should be indicated, namely hypoplasia, aplasia, or hypo/aplasia.
Conclusions. The study conducted allowed assessing the relationship between the variants of GSV hypo- and aplastic segment localization and extension and different variations of pathological refluxes of the GSV in its trunk for further choice of surgical tactics
Optimization of the Prediction of Arterial Hypertension Development in the Patients with Type 2 Diabetes Mellitus on the Background of Undifferentiated Connective Tissue Dysplasia
Get PDFIn recent years, disorders of connective tissue metabolism that are involved in the pathogenesis of many diseases have attracted increasing attention. They are of particular importance in the presence of connective tissue dysplasia. Undifferentiated forms, being a frequent component of comorbid pathology, are quite widespread among the general population. Among comorbidities, arterial hypertension, diabetes mellitus and undifferentiated connective tissue dysplasia in various combinations are more often observed.
The objective of the research was to determine the prognostic significance of undifferentiated connective tissue dysplasia in the development of arterial hypertension in the patients with type 2 diabetes mellitus.
Materials and methods. To determine the prognostic significance of undifferentiated connective tissue dysplasia in the development of arterial hypertension, there was conducted an analysis of hospital discharge reports received by the patients with type 2 diabetes mellitus duration of at least 2 years who were treated two to five years ago. The predictive significance of the factors selected for the analysis was determined through applying the regression analysis using a logistic regression model, the Wald test.
Results. The test for coincidence of the predicted and observed values revealed that the specificity of the regression model was 87.2%, while its sensitivity was 89.7%. The overall predictability was 88.5%.
Conclusions. These are quite high indicators that allow us to apply the proposed model to detect the patients with type 2 diabetes mellitus being at high risk of arterial hypertension
Mastering the Central Line Placement Techniques Through Effective Resident Training Environment
Get PDFCatheterization of the central vein is one of the fundamental procedures in anesthesiology. Mastering different methods of central venous access is an important part of resident training. At the initial stage residents should master the way of high medial access to the right internal jugular vein that is one of the simplest techniques with the lowest risk of complications for a patient. The operating room can be an optimal training environment where first independent puncture attempts are performed in a stable patient undergoing surgical intervention under general anesthesia. The next stage of training should involve access to other central veins as well performing the procedure in a conscious patient
The Use of Rentgenological Methods of Diagnostics in Surgical Treatment of Atrophy of the Alveolar Process of the Upper Jaw and Part of the Lower Jaw in Women of Postmenopausal Age
Get PDFThe objective of the study is to evaluate the condition of the alveolar part of the upper jaw and the part of the mandible according to X-ray studies in postmenopausal women before and after surgical treatment of the atrophy of jaw bone tissue using osteoplastic material and an ossein-hydroxyapatite compound.
Materials and methods: There were observed 24 women in the postmenopausal period, aged from 51 to 58 years, with atrophy of the alveolar process of the upper jaw and the part of the lower jaw who were surgically treated.
Results of the study. On the basis of the obtained results of the X-ray examination, we can assume that the developed by us technique of surgical treatment of atrophy of the alveolar process of the upper jaw and the part of the lower jaw by the use of bone material of animal origin in combination with the ossein-hydroxyapatite compound allows us to intensify bone tissue regeneration processes, which further will contribute to the increase of the volume of bone tissue.
Conclusions. The use of modern X-ray methods, in particular orthopantomography and cone-beam computerized tomography in the diagnosis and surgical treatment of atrophy of the alveolar process of the upper jaw and the part of the lower jaw, are highly informative, and also provide the possibility of work with a roentgenographic image in a digital format that allows a more detailed assessment of the area of surgical intervention before and after the treatment
State Regulation of Public Health in the Precarpathian Region during the Period of the Austro-Hungarian Empire (1772-1918)
Get PDFOn the basis of archival documents, published historical documents and other available information sources, there was clarified the state of state regulation of public health (preventive medicine) in the Precarpathian region during the period of the Austro-Hungarian Empire, that is a relevant experience for building a modern health care system in Ukraine.
Frequent changes in various socio-economic formations and the transition of the Precarpathian region from one state to another were found to significantly influence the nature of social relations in the region. Medical and sanitary care in this region was organized according to and influenced by the laws of the state that included the Precarpathian region in the relevant historical period.
Trying to expand medical care and educational work among the population in order to prevent illness and increase life expectancy during the period of the Austro-Hungarian Empire (1772-1918), the authorities and public institutions in the field of health care initiated systematic and purposeful work on the formation of the basis for preventive medicine and, in fact, broke grounds in the field of public health. Their experience and practice are not only of scientific interest, but also of practical significance for the construction of a modern health system
Questionnaire of Third-Year Medical Students of the Ivano-Frankivsk National Medical University Undergoing Shortened Course of Study About Delivered Lecture in Clinical Anatomy and Operative Surgery
Get PDFThe educational process in Ukraine, that is undergoing reform due to the introduction of the European Credit Transfer System, requires the improvement of the basic forms of education, namely lectures. This is due to the dynamic development of scientific advances in medicine, the appearance of innovative technologies, the growth of requirements for the formation of a competitive specialist, a doctor who constantly needs to improve his/her knowledge and practical skills in particular. The questionnaire of student audience helps clarify the advantages and disadvantages of the teaching material presented during the lecture and the level of mastering the key moments of the lecture by students. We present the results of a questionnaire of students about the lecture delivered at the Department of Cinical Anatomy and Operative Surgery
Substantiation, Development and Implementation of Person-Centered Assessment of Psychosocial Significance of Chronic Dermatosis at the Stage of Primary Healthcare
Get PDFHigh prevalence and incidence of chronic dermatoses among different age groups of Ukrainian population in combination with their multifactorial etiology and the progredient clinical course determine the need for the provision of general family medicine physicians with simple and accessible at the stage of primary healthcare technologies of medical care delivery to such patients. Patients with chronic dermatoses are known to be characterized by certain metabolic features, clinicopathologic cutaneous manifestations, as well as the development of special mental state associated with psychological trauma due to chronic dermatoses.
The objective of the research was to substantiate, develop and implement person-centered assessment of psychosocial significance of chronic dermatoses at the stage of primary healthcare delivery by general family medicine physicians.
Materials and methods. The study was carried out according to a specially developed program for collecting, accumulating and analyzing the results and included 114 patients with chronic dermatoses at the age of 29-58 years. Patients were divided into 2 groups: Group I included patients with chronic dermatosis duration of <10 years and Group II comprised patients with chronic dermatosis duration of over 10 years. Medical and psychological examination of patients with chronic dermatoses was performed using the method of differentiated self-assessment of the functional state - the WAM (well-being, activity, mood), the Spielberger State Anxiety Scale modified by Khanin Yu.L., the personality questionnaire of the Bekhterev Institute (LOBI) etc.
Conclusions. The prognostic value of the decrease in strength and energy is an adverse effect on a relatively long clinical course of the disease. The diagnostic value of work/study limitations is 0.896 bit, and the prognostic value of this factor is a psychological limit of psychosocial functioning of an individual due to long-term clinical course of the disease. The presence of chronic skin disease was found to affect the patients’ daily lives; taking (physical, aesthetic, intellectual, etc.). The diagnostic value of work/study limitations is 0.896 bit, and the prognostic value of this factor is a psychological limit of psychosocial functioning of an individual due to long-term clinical course of the disease. The presence of chronic skin disease was found to affect the patients’ daily lives; taking (physical, aesthetic, intellectual, etc.). This indicated greater (p<0.050) psychosocial limitation in individuals with long-term clinical course of chronic dermatoses being an indicator of the need for psycho-educational activities at the stages of clinical manifestations of chronic dermatoses
Alexithymia and Quality of Life in Adult Patients with Juvenile Idiopathic Arthritis
Get PDFPatients with chronic pain disturb not only quality of life (QL) but also develop difficulties in describing their feelings. Prolonged pain, stress, pathological conditions and related emotions can alter the perceived sensation of pain. The aim of our study was to study the QL and the level of alexithymia in adult patients with different types of juvenile idiopathic arthritis (JIA).Materials and methods. 173 young people aged 18-40 years old were examined: 118 adult patients with different ILAR variants of JIA, 30 patients with ankylosing spondylitis (AS) and 25 healthy young people. The QL was assessed using the Short-Form-36 questionnaire (SF36) with further assessing the level of alexithymia by Toronto alexithymia scale (TAS-20).Results. The analysis of QL shows that PCS (44.8±9.9) was significantly lower (p=0.001) in patients with JIA than in healthy subjects (55.7±6.9) of the corresponding age and sex, but did not differ from patients with AS (42.3±7.5). Patients with JIA had lower physical (p=0.001), role functioning (p=0.001) and bodily pain (p=0.001) compared with healthy, with no difference from patients with AS. In the distribution of patients with JIA in groups by the level of alexithymia, differences in QL were not revealed by MCS or PCS and scales related with them. The relationship analysis between the alexithymia and QL in patients with JIA shows, that elevated and high levels of alexithymia were related with low levels of MCS (p<0.05), role functioning (p<0.05), mental health (p<0.05). PCS and physical functioning did not affect the level of alexithymia in adult patients with JIA. PCS, role functioning, bodily pain, and general health were the lowest in patients with poly-articular JIA. However patients with oligo-, poly-articular, enthesyte-related JIA had no differences on scales related to PCS. Patients with poly-JIA with elevated and high levels of alexithymia revealed significantly lower social (p<0.05) and role (p<0.05) functioning, mental health (p<0.05) compared to patients without alexithymia. The presence of low bodily pain in alexithymic patients was found. Signs of alexithymia were found in 90% and 85% of adult patients with the oligo-arthritis and enthesyte-related JIA, respectively. The comparison of the QL in patients with oligo-arthritis and enthesitis-related JIA with different levels of the alexithymia shows no significant differences.Conclusions. 85.2% of adult patients with different variants of JIA have elevated and high levels of alexithymia. Adult patients with JIA have lower physical functioning than healthy individuals of the same age and sex, although they do not differ from the control group and AS group on psychological functioning and related vitality, social and role functioning, and mental health. The presence of alexithymia is related with a low level of psychological functioning, role functioning, mental health. However, physical functioning did not affect the level of alexithymia in adult patients with JIA. Patients with poly-JIA have the lowest physical, role function, bodily pain and general health, but according to the psychological functioning there were no differences between different variants of JIA in adulthood. Patients with poly-JIA with elevated and high levels of alexithymia have significantly lower social (p<0.05), role (p<0.05) functioning and mental health (p<0.05) compared to patients without signs of alexithymia.
Calcium Metabolism Indicators in Patients with Generalized Periodontitis and Hypertension
Get PDFThe objective of the study is to determine the level of calcium in patients with hypertension of the II degree and generalized periodontitis of the II degree.There were examined 30 patients with hypertension of the II degree with generalized periodontitis of the II degree. Patients’ age ranged from 35 to 54 years. These patients were in the main group. Treatment of patients included taking the medicine “Ca-D3 NIKOMED”.The control group included 10 patients without general somathic pathology and with healthy periodontitis of the same age. The results obtained were subject to variational and statistical processing.The analyses were carried out before and 3 months after the treatment. The level of general Ca in patients with generalized periodontitis of the II degree and hypertension of the II degree before the treatment was 1.66±0.03 mmol/l (p<0.001) (norm 2.15-2.5 mmol/l). In the patients of control group this figure was 2.33±0.04 mmol/l (p<0.001).After 3 months the level of general Ca in patients with generalized periodontitis of the II degree and hypertension of the II degree was 1.87±0.03 mmol/l (p<0.001).The level of ionized Ca in patients with generalized periodontitis of the II degree and hypertension of the II degree before the treatment was 0.36± 0.01 mmol/l (p<0.001); after the treatment the level of ionized Ca was 0.41±0.01 mmol/l (p<0.001). The level of ionized Ca in control group patients was 1.03±0.02 mmol/l (p<0.001).We can conclude: according to the analysis of levels of general and ionized calcium in serum of patients with generalized periodontitis of the II degree and hypertension of the II degree we can conclude that these indexes are lower than normal; patients with generalized periodontitis of the II degree and hypertension of the II degree have increased levels of general calcium and ionized calcium in serum after taking the drug “Ca-D3 NIKOMED”during 3 months
Differentiated Antiplatelet and Hepatoprotective Therapy in Patients with Stable Coronary Heart Disease on the Background of Nonalcoholic Fatty Liver Disease in Stage of Steatosis
Get PDFThe objective of the research was to evaluate the effectiveness of long-term antiplatelet and hepatoprotective differentiation therapy in patients with postinfarction cardiosclerosis and co-existent non-alcoholic fatty liver disease in stage of steatosis.Materials and methods. There were examined 72 patients with stable coronary heart disease functional classes II-III and co-existent non-alcoholic fatty liver disease in stage of steatosis. All the patients underwent a complete clinical examination; the functional state of their liver and platelet haemostasis were assessed. All patients received standard therapy the effectiveness of which was assessed 3 and 6 months after treatment.Results. The effectiveness of antiplatelet therapy was found to depend on treatment duration, the functional state of the liver and the scheme of antiplatelet and hepatoprotective differentiation therapy. In particular, 6 months after treatment, a positive dynamics of platelet haemostasis was observed in all the patients of Group I. However, the target value of its indicators was achieved in 60.5% of patients. In Group II, the target level of platelet aggregation activity was achieved in 38.3% of patients. The level of liver enzymes was within the control limits in 52.8% of patients. In 47.2% of patients, however, an increase in their level was observed, which necessitated the administration of appropriate hepatoprotective therapy.Conclusions. The developed concept of differentiation treatment of patients with coronary heart disease and co-existent non-alcoholic fatty liver disease in stage of steatosis envisages the need for monitoring the indicators of platelet haemostasis and liver function every three months after the administration of antiplatelet therapy with the possibility of its intensification and the inclusion of hepatoprotective drugs