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Incidence of Small Bounded Edentulous Spaces in Children and Adolescents Living in Lviv
Get PDFAccording to the researches by national authors, the variability in the number of children and adolescents with small bounded edentulous spaces is noted. It depends on geographical area of residence, level of the region urbanization, the state of dental care. The latter determines the need to study the prevalence of small bounded edentulous spaces in school age individuals in a particular region in order to plan and optimize their prosthetic rehabilitation. The foregoing justifies the objective of our research.Materials and methods of the research. Small bounded edentulous spaces in 2360 individuals of school age living in Lviv were the study subject. Study object involved determination of their incidence depending on age and gender, and main reasons for their occurrence.Results of the research and their discussion. The incidenceofsmall bounded edentulous spaces among school children in Lviv was found to range on average from 8.90% in girls to 10.53% in boys. The increase in the number of patients with the studied pathology in the age range from 9 to 17 years of age in both gender groups was proven. Moreover, these indices were higher in boys in all age groups in comparison with girls. Small bounded edentulous spaces were found to be diagnosed in the lateral areas of both jaws by 2.5 times more often than in the frontal ones in all examined patients. The main reason for premature loss of permanent teeth was the ineffectiveness of conservative treatment or its absence.Conclusions. The results of the research indicated that the incidence of small bounded edentulous spaces among school children in Lviv was significant, in the range of 10%. It had a tendency to increase with age substantiating the need for prosthetic rehabilitation of school age individuals
The method of diagnosis and classification of the gingival line defects of the teeth hard tissues
Get PDFFor solving the problem of diagnosis and treatment of hard tissue defects the significant role belongs to the choice of tactics for dental treatment of hard tissue defects located in the gingival line of any tooth.This work aims to study the problems of diagnosis and classification of gingival line defects of the teeth hard tissues. That will contribute to the objectification of differentiated diagnostic and therapeutic approaches in the dental treatment of various clinical variants of these defects localization.The objective of the study – is to develop the anatomical-functional classification for differentiated estimation of hard tissue defects in the gingival part, as the basis for the application of differential diagnostic-therapeutic approaches to the dental treatment of hard tissue defects disposed in the gingival part of any tooth.Materials and methods of investigation: There was conducted the examination of 48 patients with hard tissue defects located in the gingival part of any tooth. To assess the magnitude of gingival line destruction the periodontal probe and X-ray examination were used.Results. The result of the performed research the classification of the gingival line defects of the hard tissues was offered using exponent power. The value of this indicator is equal to an integer number expressed in millimeters of distance from the epithelial attachment to the cavity’s bottom of defect.Conclusions. The proposed classification fills an obvious gap in academic representations about hard tissue defects located in the gingival part of any tooth. Also it offers the prospects of consensus on differentiated diagnostic-therapeutic approaches in different clinical variants of location. This classification builds methodological “bridge of continuity” between therapeutic and prosthetic dentistry in the field of treatment of the gingival line defects of dental hard tissues
Frequency and Spectrum of Chromosomal Aberrations, Acrocentric Chromosome Associations Among Long Livers with Arterial Hypertension and Osteoarthritis Residing in the Carpathian Region
Get PDFThe frequency and spectrum of chromosomal aberrations, acrocentric chromosome associations among 264 long livers with arterial hypertension and osteoarthritis residing in the Carpathian region were analyzed. The obtained results were compared between patients with arterial hypertension and osteoarthritis, patients with arterial hypertension only, patients with osteoarthritis only and healthy individuals. The indices of the average frequency of chromosomal aberrations in all long livers was as follows: (2.82±0.27) in long livers with arterial hypertension and osteoarthritis and (2.17±0.47) in healthy individuals. In long livers with arterial hypertension and those with osteoarthritis, the frequency of chromosomal aberrations was 1.38 times higher compared to the control group (healthy long livers). The frequency of chromosomal abnormalities in long livers with arterial hypertension and those with osteoarthritis was (2.93±0.09) and (2.64±0.37), respectively.At the same time, there was observed the individual variability in chromosomal aberration frequency from 0.2 to 5%. In the spectrum of chromosomal aberrations, unstable chromosomal aberrations (dicentrics, rings, fragments) predominated in all long livers. When studying the index of acrocentric chromosome associations there was revealed that the difference in the indices between studied groups was identical to that when studying the frequency of chromosomal aberrations. In long livers with arterial hypertension and osteoarthritis, the index of the average number of acrocentric chromosome associations per cell was 1.07 times higher than that in long livers with arterial hypertension only, 1.32 times higher compared to that in long livers with osteoarthritis only and 1.75 times higher compared to healthy individuals (p<0.05)
Predictors of Kidney Damage in Patients with Metabolic Syndrome
Get PDFMetabolic syndrome is an epidemic of XXI century. Each of the components of metabolic syndrome (arterial hypertension, hyperglycemia or dyslipidemia) can be a risk factor for chronic kidney disease. However, it remains unknown what plays a key role in the progression of the disease.The objective of the research was to identify early detectors of kidney damage in patients with metabolic syndrome.Materials and methods. The study involved 70 patients with metabolic syndrome. In addition to standard examination methods, markers of endothelial disfunction (hydrogen sulfide and nitrogen monooxide) were measured in venous blood samples and the urine was tested for microalbuminuria. All the patients were divided into 3 groups according to the degree of albuminuria: normoalbuminuria, microalbuminuria and macroalbuminuria. To compare the indices between the groups, the Student’s t-test was used; to determine the relationship between the individual values, the Pearson correlation coefficient (r) was applied.Results. The indicator of systolic blood pressure was higher in patients with microalbuminuria compared to those with normoalbuminuria (163.4±14.4 mmHg, versus 153.0±17.7 mmHg; p<0.01). Hydrogen sulfide level was higher in patients with normoalbuminuria (66.8±7.2 µmol). There was a moderate positive correlation between systolic blood pressure and microalbuminuria (r=0.3804; p<0.01) and a moderate negative correlation between hydrogen sulfide and microalbuminuria (r=0.3404; p<0.01).Conclusions. We revealed a decrease in hydrogen sulfide level to 57.4±7.9 µmol in patients with metabolic syndrome. This may be an early predictor of kidney damage.
Use of Noninvasive Cerclage in Combination of Micronized Progesterone in Miscarriage Of Multifetal Pregnancy
Get PDFWe represent the results of the combined method of treatment and prevention of miscarriage in women with a multiple pregnancy and a high risk of the threat of termination the pregnancy because of using the obstetric unloading pessaries, combined with micronized progesterone. The efficiency of this method of treatment is evidenced by the rapid elimination of clinical symptoms of threatened abortion, accelerating the regression of ultrasound markers, reducing the number of complications in of pregnant women and reducing the time of their stay in hospital.Goal: To evaluate the effectiveness of the handling the obstetric pessary in combination with micronized progesterone at women with multifetal pregnancy and a high risk of miscarriage.Materials and methods. We analyzed 120 cases of multifetal pregnancies with signs of miscarriage within the terms from 16 to 28 weeks. The first group of the examined women was: 40 pregnant women with twins and signs of miscarriage, who in the scheme of treatment and prophylactic measures were offered to use the unloading obstetric pessaries in combination with continuous therapy by natural micronized progesterone until 36 weeks of pregnancy. The second group included 40 pregnant women with twins, who were laid seam on the cervix because of istmicocervical insufficiency and were applied short-term courses of therapy by gestagens. The control group comprised 40 pregnant women with twins at the age of 16-28 weeks of pregnancy who were conducted the therapy about the threat of miscarriage according to the current clinical protocols (Order of the Ministry of Health of Ukraine No. 624). It was carried out the analysis of the course of pregnancy, childbirth, the postpartum period and the state of neonatal adaptation in the surveyed groups.Results of the research and their discussion. In the first group, urgent childbirth occurred in 34 (85%) cases, in group II in 29 (72.5%) cases, in control group – in 25 (62.5%) cases. Cesarean delivery was performed in 7 (17.5%) patients of group I pregnant women, in 9 (22.5%) of group II patients and in 11 (27.5%) in the pregnant group. When studying the state of neonatal adaptation of newborns in the examined groups, the following results were obtained. The average weight of the newborns in group I was 3245 ±280 g, in group II 2865 ±365 g, in the control group - 2975 ±325 g (p>0.05). The evaluation of the state of newborns on the Apgar scale, respectively at the 1st and 5th minutes, was respectively: in newborns of the I group, 7.5 ± 1.4 and 8.4 ± 1.3 points, in group II - 7.3 ± 1.6 and 8.2 ± 1.1 points, in the control group – 7.2 ± 1.6 and 8.6 ± 1.2 (р 1-р 2> 0.05).Conclusions. Comprehensive prophylaxis of non-pregnancy in multiple pregnancies, combining the use of a traumatic cardiac cervix with the help of unloading obstetric pussies with progesterone preparations, allows prolonging pregnancy, preventing the development of prematurity, contributes to the improvement of perinatal indicators
A Disorder of Menstrual Function Regularization and its Influence on a Female Reproductive Potential
Get PDFObstetric complications in women of reproductive age are often the result of puberty disorders which remain underestimated and not taken into account in pregnancy monitoring programs in such patients, leading to an increase of habitual non-carrying of pregnancy and negative obstetric effects.The objective of the research is to carry out a comprehensive multivariate assessment of the disturbances of the body adaptive processes in teenage girls, taking into account the data of anamnesis regarding the specifics of menstrual function regularization during puberty, and to determine the main factors of complicated pregnancy in this category of patients.Materials and methods. To carry out the task, 110 pregnant women with a disorder of menstrual function regularizationhave been prospectively examined (the main group); the examination was performed at the preconception stage and in the periods of 6-12, 22-24 and 32-36 weeks of pregnancy. The comparison group consisted of 30 patients with a normal menstrual cycle. In order to identify risk factors and predict complications, the odds ratio (OR) and its 95% confidence interval were used.Results. Extragenital pathology plays a significant role in the formation of pathological course of puberty and obstetric complications; 87.27% ofsuch cases were demonstrated in our study. Among the disorders of the ovarian-menstrual cycle, the structural significance is characteristic to the failure of the luteal phase and anovulatory disorders (78.18% of cases). Gynaecologic pathology includes inflammatory diseases of the pelvic organs (35.45%), cervical background processes (41.66%), ovarian tumour lesions (21.81), and primary infertility(14.54%). The obtained results of the structure of pregnancy complications in patients of the main group show reproductive losses in early pregnancy (11.8%), subchorionic hematoma (28.18%) and the threat of late spontaneous abortion; these data are notedthree times more often than in the comparison group. Many cases of preeclampsia (28.18%), gestational anaemia in more than half of the observations, fetal distress during pregnancy (32.72%) and birth of children with a low weight (17.27%) are associated with the development of the primary placental dysfunction and pathology of vascular and thrombocytic component of haemostasis.Conclusions. Analysis of the obtained data confirmed that pregnant women with a disorder of menstrual function regularization in puberty are characterized by a significant number of complications during pregnancy and delivery, high rates of spontaneous abortions and missed miscarriages; all these factsshould be considered as potential risk factors. The key factors are the following: endocrine imbalance by type of oligomenorrhea and luteal phase deficiency (OR – 9.16; 2.21-23.24), inflammatory diseases of the genital tract, such as asymptomatic bacteriuria and bacterial vaginosis (OR – 14.26; 3.26-32.12), premature deliveryin past medical history, the risk of spontaneous miscarriages and subchorionic hematoma
Juvenile Idiopathic Arthritis in Adults: Long-Term Observation of Ukrainian Patients
Get PDFThe assessment of long-term outcome of functional disability and disease activeness in adult patients with juvenile idiopathic arthritis appears to be complicated due to the absence of a unified approach to the classification and estimation of disease activeness, as well as the loss of supervision over a patient because of remission or his/her transition from pediatric to adult rheumatic service. The objective of the research was to determine how adults with the history of juvenile idiopathic arthritis fulfill the classification criteria for adult rheumatic diseases, as well as to assess activeness of these diseases, the degree of functional disorders, and social activeness of patients in Ukraine. Materials and methods. Patients with juvenile idiopathic arthritis older than 18 years and with more than 3 years of disease duration living in different parts of Ukraine were included into the study. Data regarding sociodemographic features, fulfillment of adult classification criteria, Health Assessment Questionnaire, articular and extra-articular Juvenile Arthritis Damage Index and disease activity were analyzed.Results. We observed 122 adult patients with the history of juvenile idiopathic arthritis irrespective of the presence of active inflammation at the moment of the examination. This group included patients from different regions of Ukraine diagnosed with juvenile idiopathic arthritis during 1984-2013. An adult rheumatologist examined all patients and the diagnosis was revised according to the adult classification of rheumatic diseases. Typical diagnostic criteria for rheumatoid arthritis were estimated in 32.8% of patients, ankylosing spondylitis – in 31.1% of patients, undifferentiated arthritis – in 13.9% of patients, Still’s disease – in 4.9% of patients, psoriatic arthritis – in 0.8% of patients, steady clinical laboratory remission – in 16.5% of patients. Most patients (81.8%) with rheumatoid factor positive polyarticular juvenile idiopathic arthritis fell under rheumatoid arthritis criteria in adulthood, and in 85% of patients with enthesitis-related arthritis as well as 53.8% of patients with extended oligoarthritis ankylosing spondylitis developed in adulthood. 68.8% of patients with systemic juvenile idiopathic arthritis, 68% of patients with rheumatoid factor negative polyarthritic subtype and 55% of patients with enthesitis-related arthritis had disability and incapacitation. Minimal disorders of the patients’ general condition according to the Health Assessment Questionnaire in adult age were found in most subtypes of juvenile idiopathic arthritis classified according to the International League of Associations for Rheumatology (extended and persistent oligoarthritis, rheumatoid factor positive polyarthritis, systemic subtype); moderate disorders of the general condition were found in enthesitis-related arthritis and rheumatoid factor negative polyarthritis. Side effects of juvenile idiopathic arthritis according to the articular Juvenile Arthritis Damage Index included severe articular damage being most frequently found in systemic and rheumatoid factor positive polyarthritis subtypes of juvenile idiopathic arthritis, while side effects of juvenile idiopathic arthritis according to the extra-articular Juvenile Arthritis Damage Index included extra-articular damage being found in systemic and rheumatoid factor negative polyarthritis subtypes of juvenile idiopathic arthritis, that was confirmed by the assessment of physical health according to the Short Form Health Survey-36, which was the worst in patients with systemic (40.3±12.6) and rheumatoid factor negative polyarthritis (38.9±9.4) subtypes of juvenile idiopathic arthritis.Conclusions. Further research of remote consequences of juvenile idiopathic arthritis in adult age and long-term observation of such patients require a detailed study to improve diagnostics and provide adequate treatment of rheumatic diseases with juvenile onset in adult age
Features of Histological Forms of Tumor Growth in Patients Who Underwent Combined Surgery for Stomach Cancer
Get PDFThe morphological type of tumor is a crucial factor in selecting the type and volume of surgery.The objective of the research was to determine the effect of tumor histological type on survival rates in patients with locally advanced stomach cancer after combined surgery.Materials and methods. The study included 990 patients; there were 714 men and 276 women. All patients underwent combined surgery: distal subtotal gastric resection was performed in 222 cases; proximal subtotal gastric resection was used in 129 cases; gastrectomy was applied in 639 cases. Statistical analysis of the obtained data was performed using the SPSS 13.0 software program. The results were considered statistically significant at p<0.05.Results. The study of certain morphological types of tumor depending on the patients’ age and sex, as well as clinical and morphological features revealed a significant predominance of adenocarcinoma (77.1%) over other types and a significantly smaller number of undifferentiated tumors – 20.6%; squamous cell cancer and small-cell cancer constituted 1.3% and 1.0%, respectively. The average life expectancy after surgery was 37.51±2.69 months (p=0.021); in women, it was slightly higher compared to men – 43.75±5.70 months vs. 35.13±3.02 months (p=0.057). The overall 5-year survival rate for all patients was 17.32±1.49%; for men – 16.11±1.72% (p=0.005), for women – 20.46±2.99% (p=0.399); however, these differences were not statistically significant (p=0.087).Conclusions. After surgery, there were no significant differences in the average life expectancy of patients with the same histological forms of gastric adenocarcinoma between men and women (p>0.05), while significant differences were observed between patients (both men and women) with adenocarcinoma and undifferentiated adenogenic stomach cancer (p<0.05)
Evaluation of Cardiovascular Risk and Blood Pressure Parameters in Patients with Bronchial Asthma and Co-Existent Chronic Obstructive Pulmonary Disease
Get PDFThe combination of arterial hypertension, asthma and COPD has a significant prevalence in clinical practice. The presence of hypertension contributes to the growth of severity of asthma-COPD overlap (ACO), the worst prognosis and a high risk of cardiovascular complications. Coexistence of diseases changes the course of each of them, contributes to the early formation of complications and creates certain difficulties for therapy.The aim of work was to investigate the factors of cardiovascular risk, as well as the arterial pressure indicators of patients with ACO.Patients. 140 patients with ACO with an average forced expiratory volume for the first second (FEV1) (59.0 ± 1.4)% and the ratio of forced expiratory volume in the first second to the forced vital capacity of the lungs (FEV1 / FVC) (53.6 ± 0.8)%. Methods. All the patients underwent measurement of body weight and height, measurement of office systolic blood pressure (SBP), diastolic blood pressure (DBP), 24-hour ambulatory blood pressure monitoring (ABPM), biochemical blood test, coagulogram, assessment of total cardiovascular risk on a SCORE scale, the risk of cardiovascular complications on QRISK2 scale, the risk of developing diabetes mellitus (DM) on QDiabetes scale.Results. Patients with ACO had some pathological changes in blood pressure. Also, these patients had a significant overload with arterial pressure. Also, in these patients, the diurnal index (DI) of SBP and DI DBP were significantly reduced relatively to normal values.Patients with ACO predominantly belonged to the group of moderate risk of fatal cardiovascular events in 10 years (3.83%). The QRISK2 is quite significant, and is more than 15%. There is also a fairly significant risk of developing DM (more than 13%).A higher concentration of inflammational markers was revealed in ACO patients with more severe bronchial obstruction (significant increase in C-reactive protein and fibrinogen with increased bronchial obstruction).ACO patients from subgroups GOLD 1 and GOLD 2 predominantly belonged to the group of moderate risk, and patients from the GOLD 3.4 subgroup predominantly had a high risk of developing fatal cardiovascular events over the next 10 years (according to the SCORE scale). The QRISK2 scale risk was also moderate in the first two subgroups and high in patients with severe bronchial obstruction (GOLD 3,4).Conclusions. In patients with a combination of asthma and COPD, significant cardiovascular comorbid pathology, a high prevalence of arterial hypertension, a high degree of overload with arterial pressure were found. Significant violations of the variability of blood pressure were also revealed. In this category of patients, a moderate risk of developing fatal cardiovascular events, as well as the development of diabetes within the next 10 years is also determined. Even more significant violations of blood pressure and high rates of cardiovascular risk were detected in patients with a combined pathology with a higher degree of bronchial obstruction
Recurrent Ovarian Cancer with the Involvement of Urinary Organs: is There Place for Secondary Cytoreductive Surgery?
Get PDFThe objective of the research was to estimate early and long-term results of secondary cytoreductive surgery performed for recurrent ovarian cancer with involvement of urinary organs. Materials and methods. The study included 62 patients with recurrent ovarian cancer treated in the Institute of General and Emergency Surgery named after V.T. Zaitsev of the Academy of Medical Sciences of Ukraine during January 2009 – September 2015. Selection criteria for secondary cytoreductive surgery were the following: recurrent ovarian cancer with involvement of the bladder and/or the ureter, no urologic surgery during primary cytoreductive surgery, the ECOG performance status of 0-2. Urological surgery that had been a subject to the analysis was the following: cystoscopy with or without intraoperative urethral stenting, bladder resection, ureterectomy, ureteral reimplantation, cystectomy with further reconstruction. Evaluation criteria included the presence and the level of surgical and postoperative urological complications within 30 days after surgery, relaparatomy rates, postoperative mortality, type of cytoreduction. Long-term results were evaluated through recurrence rates after secondary cytoreductive surgery, median survival, disease-free survival and overall survival.Results. Volumes of performed surgery (excluding urological one) were the following: lymphadenectomy (n=29; 46.7%), bowel resection (n=17; 27.4%), vascular resection (n=4; 6.5%) and others. Minimally invasive urological surgery included urethral stenting (n=6; 9.7%) and cystoscopy (n=13; 20.9%). Bladder resection was performed in 26 (41.9%) cases, cystectomy – in 17 (27.4%) cases. R0 resections were performed in all the cases. Postoperative non-urological complications were observed in 7 (11.2%) patients. Urological complications were found in 9 (14.5%) patients. Postoperative mortality was 3.2%. Recurrence was documented in 7 (11.3%) cases. Median survival was 24 months. Follow-up mortality was 30% (n=18).Conclusions. The results of combined secondary cytoreductive surgery performed for recurrent ovarian cancer with involvement of urinary organs indicate the possibility of en bloc resection of tumor and surrounding organs at acceptable rates of postoperative complications and mortality. Extended combined surgery and even pelvic exenteration are effective in treatment of patients with recurrent ovarian cancer