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Results of Surgical Treatment of Primary Hyperparathyroidism
Get PDFThe article presents a retrospective and prospective analysis of treatment results in 76 patients with typical clinical manifestations of primary hyperparathyroidism being treated as inpatients in Ivano-Frankivsk Regional Clinical Hospital from 2010 to 2015. There were 24 (77.0%) females and 7 (23.0%) males. Various forms of hyperparathyroidism were diagnosed in 31 (40.7%) patients. Surgery was performed in all patients under general anesthesia with cervical access. Bilateral exploration of the parathyroid glands with the removal of modified adenomatous and hyperplastic glands were performed. One parathyroid gland was removed in 22 (73.0%) patients; two parathyroid glands were removed in 9 (17.0%) patients. 14 (45.2%) patients were diagnosed with renal form of primary hyperparathyroidism, 8 (25.8%) patients were diagnosed with mixed form of primary hyperparathyroidism; 6 (19.4%) patients were diagnosed with osseous form of primary hyperparathyroidism and asymptomatic form was diagnosed in 3 (9.7%) patients. After surgery 2 (6.4%) patients developed severe transient hypoparathyroidism including paresthesia and spasms which required intravenous injection of calcium for 4-5 days with further administration of its tablet form for 2-3 months. All operated patients with renal form of primary hyperparathyroidism shortly before parathyroidectomy or immediately after it underwent extracorporeal lithotripsy or kidney surgery. In 10 patients of this group the indicators of phosphorous-calcium metabolism were normalized. In one patient two months after parathyroidectomy a slight increase in the level of parathyroid hormone was preserved - by 72.4 pg/ml. Thus, 2 months after surgery the level of parathyroid hormone exceeded the normal values in one patient (4.2%) only
Teaching Diagnosis and Treatment of Acute Viral Hepatitis in Children to Interns
Get PDFThe objective of the research was to improve interns’ knowledge of the etiopathogenesis, clinical and paraclinical diagnosis, current methods of treatment and prevention of viral hepatitis in children. Infectious diseases are unfortunately very dangerous due to their severe clinical course, often unpredictable clinical symptoms and treatment results. This pathology remains one of the most common causes of death among children. Pathology of the liver and biliary tract in childhood is quite common; it is characterized by prolonged clinical course continuing into adulthood. The article describes the experience of teaching problems of diagnosis, treatment and prevention of viral hepatitis in children to pediatric interns during the cycle of lectures “Children’s Infectious Diseases”. During practical training of interns special attention is paid to etiology, clinical and laboratory diagnosis, treatment and prevention of various types of viral hepatitis. In particular, significant attention is given to the prevention of viral hepatitis in childhood. For this purpose educational learning material was developed at the Department.
The Influence of Combined Pharmacotherapy with the Use of Trimetazidine and Potassium and Magnesium Salts of Gluconic Acid in Patients with Chronic Heart Failure of Ischemic Origin
Get PDFThe objective of the research was to improve the efficiency of treatment of patients with chronic heart failure (CHF) of ischemic genesis by adding potassium and magnesium salts of gluconic acid and trimetazidine to the background therapy (BT). Materials and methods. Registration of electrocardiogram (ECG) and ECG Holter Monitoring (ECG HM) was performed in order to achieve the aim. The study involved 84 patients with postinfarction cardiosclerosis with CHF. Patients were randomized into four groups depending on treatment characteristics. The first group included patients with heart failure of ischemic genesis treated with BT; the second group consisted of patients with CHF, who were treated with BT and potassium and magnesium salts of gluconic acid; the third group included patients with CHF who were prescribed trimetazidine on the background of BT; the fourth group consisted of patients treated with BT in combination with potassium and magnesium salts of gluconic acid and trimetazidine.Results of the research. The proposed treatment regimens were proved to be effective in reducing ischemic parameters after 6 and 12 months of treatment. Anti-ischemic treatment using a combination of potassium and magnesium salts of gluconic acid and trimetazidine on the background of BT led to the most significant change in the average number of myocardial ischemia episodes in examined patients. Indicator of the average daily number of ischemic episodes before the research in the first group decreased after treatment by 29.21 %. The average number of myocardial ischemia episodes during the day in the second group decreased by 38.50 % and constituted (2.78±0.10) after treatment. The addition of trimetazidine to BT in patients of III group was accompanied by significant anti-ischemic effect reducing the average daily number of ischemic episodes by 43.8 % (p<0.001). It should be noted that the anti-ischemic treatment of group IV patients using a combination of BT, potassium and magnesium salts of gluconic acid and trimetazidine resulted in the most statistically significant change in this indicator in examined patients, namely by 48.90 % (p<0.001).Conclusions. Thus, a more significant anti-ischemic effect was observed when using combined treatment with potassium and magnesium salts of gluconic acid and trimetazidine compared with BT in a separate combination with each of these drugs
Antenatal and Genealogical Risk Factors for Bronchopulmonary Dysplasia and Dysplastic Dependent Pathology of Bronchopulmonary System in Children
Get PDFThe incidence of certain risk factors for bronchopulmonary dysplasia and dysplastic dependent pathology of bronchopulmonary system was studied and their informative and prognostic values were determined. Such factors as complicated pregnancy course, maternal age at childbirth, previous termination of pregnancy were proven to be the most significant. Dysembryogenic stigmas from previous pregnancies in children as well as manifestations of gestosis were found to be informative regarding the formation of dysplastic dependent pathology in case of the birth of a premature baby or a baby with low birth weight. According to studied factors their pathometric and sanological values were calculated making it possible to include these factors to the structure of regional prevention programs in the future
Prognostic Value of Polymorphism of G-308A Gene of the Tumor Necrosis Factor-α in the Progression of Chronic Heart Failure in Patients with Ischemic Heart Disease and Obesity
Get PDFOne of the widespread and prognostically unfavorable complications of cardiovascular diseases is chronic heart failure, where an important role is given to proinflammatory cytokines in the pathogenesis of the disease. Polymorphic variants of the gene of tumor necrosis factor-α are determinants of increased risk in the development of chronic heart failure in patients with ischemic heart disease. Presence of allelic gene A and genotype A/A of polymorphic locus G-308A, the gene of tumor necrosis factor-α in patients with ischemic heart disease and concomitant obesity was associated with chronic heart failure progressing and development of systolic dysfunction of the left ventricle
Imbalance of the Humoral Component of the Immune System as a Basis for the Progression of Non-Alcoholic Fatty Liver Disease in Patients with Obesity and Concomitant Biliary Tract Pathology
Get PDFThe objective of the research was to study the features of the indicators of the humoral component of the immune system depending on the body mass index in patients with non-alcoholic hepatic steatosis, non-alcoholic steatohepatitis, concomitant obesity and biliary tract pathology.Material and methods. 200 patients with non-alcoholic fatty liver disease, concomitant obesity and biliary tract pathology including 100 patients with non-alcoholic hepatic steatosis and 100 with non-alcoholic steatohepatitis were examined. 70 out of 100 patients with non-alcoholic steatohepatitis had the minimum level of alanine transaminase activity and 30 patients had a moderate alanine transaminase activity. The control group included 30 apparently healthy persons. The body mass index was determined using the Quetelet formula. All the patients with non-alcoholic hepatic steatosis and non-alcoholic steatohepatitis were divided into three groups depending on the increase in the body mass index and the presence of biliary tract pathology. The humoral immune system state was evaluated by the levels of immunoglobulins A, M and G and the content of circulating immune complexes. Results. In patients with non-alcoholic hepatic steatosis and non-alcoholic steatohepatitis, concomitant obesity and biliary tract pathology, there were observed abnormalities in the humoral component of the immune system with possible increase in the levels of major immunoglobulin classes as well as in the content of circulating immune complexes being more pronounced in patients with non-alcoholic steatohepatitis compared to patients with non-alcoholic hepatic steatosis (p<0.05) and apparently healthy persons (p<0.001). The increase in the body mass index led to a significant increase in the levels of Ig A, M, G and the activation of circulating immune complexes.More significant changes in humoral indices were observed in patients with chronic non-calculous and calculous cholecystitis in the presence of inflammatory biliary tract changes during the exacerbation of the pathology compared to patients who underwent cholecystectomy on the background of the aggravation of postcholecystectomy syndrome.Conclusions. The obtained data indicated that one of the elements in the pathogenesis of non-alcoholic fatty liver disease with concomitant obesity and biliary tract pathology is a significant change in the indicators of humoral immunity, namely the increase in the levels of Ig (A, M, G) and circulating immune complexes which depend on the clinical form (non-alcoholic hepatic steatosis or non-alcoholic steatohepatitis), increase in the body mass index and the presence of biliary tract comorbidity
Structural-Functional Peculiarities of the Urinary Bladder in Postnatal Ontogenesis
Get PDFIt is known about the high incidence of the urinary bladder lesions in the structure of urological pathology regardless of age; however, according to the analysis of world literature sources, data on postnatal ontogenetic transformations of its wall constituents are poorly studied. Therefore, the purpose of our work was to study the morphofunctional peculiarities of the urinary bladder during sexual formation and puberty in parallel with research of pro- and antioxidant systems, as these processes are interrelated and interdependent.In compliance with bioethical principles, in the experiment on 20 immature and 20 mature white outbred male rats using a complex research methods (injection, histological, immune-histochemical, electronic-microscopic and biochemical) the structural changes in the wall of the urinary bladder and pro- and antioxidant systems in stages of postnatal ontogenesis were studied.Vascular transformations in investigated age periods occur in parallel with the transformations of cellular and non-cellular elements of the urinary bladder wall, ensuring adequacy of tissue homeostasis in ontogenesis. All this is associated with the processes of peroxidation and antioxidant systems operation, indicating their interrelationship and interdependence and strict control of the whole hierarchical system of regulation.Taking into account the peculiarities of the structural elements of the urinary bladder wall at these stages of postnatal ontogenesis, clarification of the dynamics in other age groups and under the influence of various factors is promising
Serum Level of Neuron-Specific Enolase in Patients with Past Ischemic Stroke
Get PDFThe article presents the results of the examination of 128 patients with past ischemic stroke (on the 4th -5th months after acute cerebrovascular disease).Enzyme immunoassay for the determination of NSE concentration in blood serum of patients included into the study showed that the median of the distribution of enzyme was 14.3 (5.7; 57.8) ng/ml (р<0.05) compared to 3.8 (3.2; 7.5) in patients of the control group.On the basis of the comparison of serum levels of NSE with the value of total NIHSS, MMSE and МоСА score more significant increase in this parameter was detected in patients with profound neurologic deficit and MCI. The analysis of serum NSE is an informative diagnostic criterion for the evaluation of neuronal damage in the brain leading to the inclusion of detection of NSE in clinical practice to optimize diagnostic procedures in patients with past ischemic stroke
Duration of Clinical Stages of Implant-Supported Fixed Dentures Manufacture with Screw-Retained Solid Abutments
Get PDFThe article indicates that implant-supported fixed restoration with screw-retained solid abutments is the way of prosthetic rehabilitation of patients with different dentition defects. One of the uncertain legal status reasons for this kind of orthopedic surgery is the lack of institutional regulations of time for their performing.The objective of research was to establish time standards for an orthopedist for manufacturing of implant-supported fixed structures with screw-retained solid abutments.Materials and methods of the researchThe object of research was a clinical process of dental orthopedic care in case of implant-supported fixed structures with screw-retained solid abutments manufacturing.Scope of research involved the structure, sequence, duration and scope of the appropriate orthopedic care.The standard time for the manufacturing of such structures by dentist-orthopedist is determined after appropriate time and motion research as the sum of duration of each prosthetic unit manufacturing in the structure of the prosthesis according to the nature of the working time spent on its production using the formula ST = Tc + K x Tcc.Results of the research9 orthopedists made prosthetic appliances to 9 patients to whom 7 bridgeworks and 8 single crowns using screwed solid abutments were manufactured on 22 implants. Time and motion observations and the subsequent mathematical calculations of their work showed that the clinical process of implant-supported fixed dentures with screw-retained solid abutments manufacturing consists of 6 clinical stages during which constant time expenditure (Tc) of orthopedist constitute 165.73 minutes on any construction, and changeable-constant time expenditure (Tcc) comprises 31.24 minutes for a single crown and 47.47 minutes on bridgework with 2 foundations, therefore Tcc on 1 foundation in the prosthesis is 23.74 minute.Thus, the time standard for the manufacture of a single crown TS = Tc + K x (Tcc) = 165.73 min + 1 x 31.24 min = 196.97 min, where K is the number of single crowns. The time standard for the manufacture of a bridgework is TS = Tc + K x Tcc of 1 foundation = 165.73 min + 2 x 23.74 min = 213.20 min, where K is the number of bridge supports.Conclusions. Time standard of orthopedist for implant-supported single crown with a screw-retained solid abutment manufacture for a particular patient is 196.97 min, and for the manufacture of bridge with two such foundations is 213.20 min.When manufacturing such single crown or bridgework with a different number of structural elements for one patient several, the appropriate correction coefficient (K) corresponding either to a number of single crowns or to the number of bridge foundations is required to be used
Peculiarities of Anamnesis and Life Quality in Patients with Atrial Fibrillation
Get PDFAtrial fibrillation is a common rhythm disturbance. One of the main parameters being crucial for the choice of tactics of treatment and prevention of complications is the life quality of patients. The objective of our study was to evaluate this indicator in patients with atrial fibrillation depending on different approaches to treatment. The study involved 254 patients with paroxysmal and persistent forms of atrial fibrillation and 42 practically healthy persons. The main features of anamnesis, presence of comorbidities, aggravating risk factors were studied as well as a survey using “AFEQT Questionnaire” was conducted. When studying the anamnesis it was revealed that patients treated by medications only (the first experimental group) had arterial hypertension as a main presumable cause of atrial fibrillation (92.4%); in one third of cases different forms of coronary artery disease and heart failure were diagnosed (38.6% and 33.3%, respectively). In the fourth group (after left ventricular revascularization) a prevailing cause of atrial fibrillation was coronary heart disease (100%). In the second group (after cardioversion) as well as in the third group (after ablation) the largest proportion of patients was also diagnosed with arterial hypertension – 62.0% and 40.9%, respectively. The mean total AFEQT score among the control group was 82.3±3.1 points. Patients of the first group scored the minimum value among interviewed patients -53.4±4.6 - that was significantly less compared to the control group, р<0.05. The total average value of the third group was significantly higher than that in the first group, 69.3±4.6 points against 53.4±4.6 points, respectively, р<0.05. Thus, it was found that the lowest life quality is typical for patients treated with medications only. The patients after ablation have the highest life quality. Left ventricle revascularization slightly improves life quality, but this trend is not statistically significant