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ADVANTAGES OF PORT-SYSTEMS COMPARED WITH VARIOUS METHODS OF LONG-TERM VENOUS ACCESS IN ONCOLOGY

Аuthors: A. P. Kolesnik, A. V. Kadzhoian, S. M. Machuskhiy, K. O. Bolshakova, D. Ye. Cherniavskiy

Pages: 346-358

Abstract

         

The issue of providing reliable, safe and at the same time least invasive venous access remains one of the topical issues of oncology. Installation of venous access for patients with oncological pathology is necessary for chemotherapy, blood sampling for analysis, as well as for palliative and symptomatic care for patients which has advanced stages of malignant process. Therapeutic agents can be administered in various ways: intra-arterially, intravenously, intraperitoneally. In the world of modern medicine, intravenous administration of drugs is most often used, since it provides a high rate of spread, as well as systemic action in the human body. However, not all medicinal substances are amenable to easy and safe delivery by parenteral route and, first of all, it concerns cytostatic agents. Chemotherapy has an irritating and sometimes damaging effect on the walls of peripheral vessels, and frequent blood fetuses and the introduction of parenteral chemotherapeutic agents entail complications in the form of phlebitis, thrombophlebitis and other septic processes that can lead to death. Despite the fact that the port system was invented more than 50 years ago, this device is increasingly used in the daily clinical practice of an oncologist and doctors of other specialties, including anesthesiology and pediatrics. So the port system is a small device which is placed under the skin under local anesthesia to perform certain medical manipulations related to the treatment and diagnosis of diseases. This article provides arguments on the appropriateness of using the subcutaneous venous port system, its advantages, disadvantages, as well as the features of its installation, exploitation and also their importance in the modern clinical medicine.

Keywords: access, port-system, catheter, implantation.

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References

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The issue of providing reliable, safe and at the same time least invasive venous access remains one of the topical issues of oncology. Installation of venous access for patients with oncological pathology is necessary for chemotherapy, blood sampling for analysis, as well as for palliative and symptomatic care for patients which has advanced stages of malignant process. Therapeutic agents can be administered in various ways: intra-arterially, intravenously, intraperitoneally. In the world of modern medicine, intravenous administration of drugs is most often used, since it provides a high rate of spread, as well as systemic action in the human body. However, not all medicinal substances are amenable to easy and safe delivery by parenteral route and, first of all, it concerns cytostatic agents. Chemotherapy has an irritating and sometimes damaging effect on the walls of peripheral vessels, and frequent blood fetuses and the introduction of parenteral chemotherapeutic agents entail complications in the form of phlebitis, thrombophlebitis and other septic processes that can lead to death. Despite the fact that the port system was invented more than 50 years ago, this device is increasingly used in the daily clinical practice of an oncologist and doctors of other specialties, including anesthesiology and pediatrics. So the port system is a small device which is placed under the skin under local anesthesia to perform certain medical manipulations related to the treatment and diagnosis of diseases. This article provides arguments on the appropriateness of using the subcutaneous venous port system, its advantages, disadvantages, as well as the features of its installation, exploitation and also their importance in the modern clinical medicine

DEVELOPMENT MECHANISMS AND CLINICAL SIGNIFICANCE OF ANEMIA IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Аuthors: A. V. Kovchun, V. V. Kmyta, A. N. Bondarkova, L. N. Prystupa

Pages: 359–370

Abstract

         

For a long time, chronic obstructive pulmonary disease (COPD) was associated with polycythemia with chronic hypoxia. Epidemiological studies of recent years show that 17 to 24 % of patients with COPD have anemia and only 6 to 10 % have polycythemia.

Anemia in patients with COPD can be caused by concomitant pathology or pathogenetically related to the underlying disease and may be referred to anemia of chronic disease (ACD). Anemia is an independent factor in the severity of dyspnea, reduced tolerance to stress and survival of patients. A high level of hepcidin in the serum of blood, which occurs as a result of systemic inflammation, impairs absorption of iron, and also leads to sequestering of iron in macrophages, plays a key role in the development of ACD. Investigating the mechanisms of occurrence of this anemia and determining the optimal ways of it`s correction can improve the quality of life, reduce the overall cost of treatment and disability.

The results of a self-study show that 6.5 % of patients with COPD have iron deficiency anemia and 16.3 % of ACD. Patients with iron deficiency anemia have serum iron and ferritin level probably lower in comparison with patients without anemia, with erythrocytosis and ACD. In the group of patients with COPD and ACD, low serum levels were detected in comparison with patients without anemia and erythrocytosis, at the same time as with high levels of ferritin, which was significantly higher compared to patients in other groups.

Keywords: anemia, erythrocytosis, hepcidin, chronic obstructive pulmonary disease.

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KIDNEY FUNCTIONAL RESERVE IN PATIENTS WITH CHRONIC RENAL DISEASE AND NONALCOHOLIC STEATOHEPATITIS IN THE BACKGROUND OF OBESITY, THERAPEUTIC CORRECTION OPPORTUNITIES

Аuthors: A. A. Antoniv

Pages: 371–381

Abstract

         

Introduction. The increase in the frequency of nonalcoholic steatohepatitis (NASH) comorbid course on the background of obesity and chronic kidney disease (CKD) cases in people of working age in Ukraine and in the world necessitates conducting research on mechanisms of mutual burden and finding new factors for the progression pathogenesis of this comorbidity.

The aim of the study: to establish changes in the functional status of the kidneys and the functional reserve of the kidneys depending on the stage of chronic kidney disease (pyelonephritis) for comorbidity with nonalcoholic steatohepatitis and obesity.

Material and methods of research. 240 patients with CKD (chronic bilateral pyelonephritis) of I–III stage were examined, 145 of them had comorbid NASH and obesity of the 1st degree (1 group), 95 patients were diagnosed with CKD І–ІІІ stage without comorbid pathology. Depending on the stage of the CKD, the groups of patients was distributed as follows: 1st group – into 3 subgroups: CKD I stage – 51 patients, CKD II stage – 53 patients, CKD III stage – 41 patients. The 2nd group was divided into 3 subgroups: CKD I stage – 32 patients, CKD II stage – 35 patients, CKD III stage – 28 patients. The control group consisted of 30 practically healthy persons (PHPs). The average age of patients was (49.8 ± 5.8) years. The diagnosis of CKD was made according to the recommendations of the clinical guidelines of the Institute of Nephrology of the National Academy of Medical Sciences of Ukraine (2012). The study included patients with CKD І–ІІІ stage without a nephrotic syndrome with chronic uncomplicated pyelonephritis in the phase of exacerbation. The glomerular filtration rate (GFR) was investigated by creatinine clearance, calculated using the Cockroft-Gaulta formula, as well as by the universal automatic calculator CKD-EPI. In addition to standard research methods (blood creatinine, urea, proteinograms, ionograms, urinalysis, urine analysis by Nechyporenko, Zimnytsky, urine culture with the identification of the pathogen, its amount and sensitivity to antibiotics, etc.), the kidney function was studied after water-salt loading. For aqueous salt loading 0.5 % sodium chloride solution was used in the volume of 0.5 % of the body weight of the patient, and the urine was collected after one hour, the research was conducted as follows: at 7 am, the patient completely cleared the bladder, after which he was offered to drink 0.5 % sodium chloride solution at a rate of 0.5 % of body weight, then for an hour the patient was in a state of rest, after an hour, urine was collected, the volume measured and the creatinine concentration determined according to the standard procedure. Creatinine excretion was calculated by water-salt loading, urine output per minute, GFR by creatinine clearance (CC). The increase in excretion of creatinine after aqueous-salt loading relative to the excretion of creatinine at daily diuresis was the magnitude of functional renal reserve (FRR). For the determination of FRR, the presence and magnitude of growth of GFR after saline loading was determined by the Cockroft-Gaul formula.

Research results. Features of the functional state of the kidneys for the comorbidity of chronic kidney disease (CKD): chronic pyelonephritis with obesity and nonalcoholic steatohepatitis (NASH), depending on the stage of CKD, is characterized by a higher degree of reduction of glomerular filtration rate (GFR), degree of hypoalbuminemia, proteinuria than in isolated course. Patients with CKD in І–ІІ stages without comorbid conditions have established a significantly higher functional renal reserve (FRR) in response to water-electrolyte stimulation, which is sufficient in both categories of patients (GFR increase in the range of 28–37 % versus 19–31 % for comorbidity with NASH). Patients with CKD in stage III with nonalcoholic steatohepatitis have significantly reduced FRR, and 4.9 % of patients with comorbidity FRR is absent, which proves the syndrome of the interconnection of NASH with CKD, which is the interdependence of the decrease in GFR with increasing intensity of oxidative stress, decrease in the potential of antioxidant factors protection and hyperproduction of the components of the connective tissue: collagen, hexosamines, sialic acids, cytokeratin-18 against the background of decreased activity of collagenolysis (p < 0.05).

Conclusions: Non-alcoholic steatohepatitis significantly aggravates the course of CKD I–III stages with a possible decrease in nitrogen function, glomerular filtration rate, hypopalbuminemia than in the isolated course of CKD only. Patients with CKD of the I–II stages without comorbid conditions have established a significantly higher functional reserve of the kidneys in response to water-saline stimulation, which, at the same time, is sufficient in both categories of patients (GFR increase in the range of 28–37 % versus 19–31 % for comorbidity with NASH) regarding the possibility of improving the function of the kidneys by developing appropriate therapeutic and rehabilitation programs. Patients with CKD stage III with nonalcoholic steatohepatitis have significantly reduced the FRR (growth of GFR by 8.9 % versus 17.5 % in patients without NASH), and 4.9 % of patients with comorbidity had no functional renal reserve (an increase of 3,2 %), which proves the syndrome of the interaction of NASH with the CKD of stage III in the form of almost irreversible changes in the functional state of the kidneys and the need for constant monitoring and prevention of its progression. Correlation analysis of the indices obtained in patients with comorbidity of CKD І–ІІІ stage and NASH indicates significant interdependence of reduction of GFR with increasing intensity of oxidative stress, decrease in the potential of antioxidant defense factors (content of reduced glutathione), hyperproduction of connective tissue components (collagen (protein-bound oxyproline), hexosamines, sialic acids), cytokeratin-18 against the background of collagenolysis decrease (p < 0.05), which correlate with the intermediate and high power interactions with the index of GFR (p < 0.05).

Keywords: chronic kidney disease, nonalcoholic steatohepatitis, glomerular filtration rate, functional renal reserve.

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THE EFFICACY OF OBSTETRIC PESSARIES IN MULTIPLE PREGNANCY DEPENDING ON THE LENGTH OF CERVIX

Аuthors: A. Sukharev, T. Kopitsa

Pages: 382–388

Abstract

         

The study was conducted in the city maternity hospital of Sumy (Ukraine) at the Department of obstetrics and gynecology of Sumy State University. Information was collected by interviewing and examining pregnant women using special research methods. In addition, the medical records of children born from multiple pregnancies were analyzed. All pregnant women used transvaginal ultrasound scanning.

The aim of our study is to evaluate the effectiveness of pessarium in multiple pregnancy in women with miscarriage risk depending on the length of the cervix.

We used Simurg pessarium (Belarus). The pessaries were applied in 15-17 weeks.

Pregnancy, delivery and perinatal outcomes were analyzed in 45 women with diamnionic dichorionic pregnancy. All pregnant women were divided into 3 groups according to Dunne cervicometry.

20 pregnant women with cervical length of more than 38 mm did not use diaphragm and tocolytic therapy. Pregnancy proceeded without complications and ended with labor in time.

In 13 women with a cervical length of 26-38 mm, pessarium was applied in connection with the threat of miscarriages. Tocolytic therapy was not used. Term labor was observed in 92.3% of cases. The average weight of the fetuses was 2875+375 g.

In 12 women with a cervical length of 16-25 mm pessarium was installed in connection with threatened miscarriages, and tocolytic therapy was used. Spontaneous vaginal delivery was observed in 75.0% of the women. Premature break of amniotic fluid was observed in 40.0%. The average weight of the fetuses was 2750 + 335 g. Newborns had the lowest score at birth.

Comparative analysis helped to conclude that the results of uncomplicated pregnancy gestation and with the obstetric pessarium in women with the cervix length 26-38 mm did not differ significantly.

Based on the findings, practical recommendations are proposed. The recommendations that were made as a result of the study were implemented in the work of the maternity hospital.

The prospect of further research requires further study of the problems of antenatal care in multiple pregnancies, prevention of gestational complications, optimization of labor, prevention of perinatal losses.

Keywords: multiple pregnancy, miscarriage, pessarium.

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CHARACTERISTICS OF CHANGES IN THE CELLULAR COMPOSITION OF GUMS IN CLINICAL OBSERVATIONS WITH TIME DEPENDING ON THE TYPE OF ODONTOPREPARATION FOR CERMET STRUCTURES

Аuthors: V. B. Radchuk, N. V. Hasiuk, P. A. Hasiuk, R. А. Levandovskyi

Pages: 389–395

Abstract

         

Introduction. The study of the effect of odontopreparation under the cermet structures on the morphofunctional changes in the tooth tissues makes it possible to characterize the features of the preparation of the teeth for this type of structures in order to maintain the viability and functioning of the pulp. The issues of reactive changes in the gums depending on the type of odontopreparation and the predictability of the long-term results of prosthetics, taking into account the individualized approach in the age aspect, remain insufficiently studied.

Purpose. Optimize approaches to odontopreparation under full cermet structures with the creation of a ledge and without it, proceeding from the patterns of morphological changes in the cellular composition of the gums in conditions of various types of odontopreparation.

Materials and Methods. The material was collected from patients from the surface of the marginal part of the gum by scraping, using a crescent trowel on day 45 of clinical observations. The collected material was applied to a sterile objective glass, fixed by dry fixation at room temperature, under open-air conditions, followed by Romanovsky-Gimsa staining.

Discussion. The study of cellular gum composition in the area of the prepared teeth of patients of both clinical groups of observations on the 45th day after odontopreparation, based on scientific data on the renewal of the epithelium of the oral mucosa, which for gums is 41–57 days, according to V. L. Bykov.

In the cellular composition of the gums of patients of the first group, intermediate epithelial cells predominated, if surface cells and horny scales are present. Intermediate cells had a centrally located rounded nucleus, an azure-positive cytoplasm and an elongated form, implanted plasmolemma. Intermediate cells with the phenomena of cytopathology. Segmented nucleated leukocytes with clearly segmented nuclei and their individual young forms. The heterogeneity of myeloid cells, as a response to the high activity of the inflammatory process, indicates the differentiation of leukocytes. A powerful microbial composition subsequently initiates necrobiotic processes in epithelial cells, and segmented neutrophils. Along with this, due to phagocytosis, the cytoplasm of segmented neutrophilic leukocytes is destroyed, the so-called incomplete phagocytosis.

Cellular gum composition in the region of the prepared vital teeth of patients of the second group, represented by multilayered flat epithelium. Interim epithelial cells predominated, provided that surface cells and horny scales were present. Available single representatives of rod-like flora and intermediate basophilic epithelial cells are predominantly cubic or polygonal, with azur-positive granules in the cytoplasm. The nucleus is round, sometimes oval.

Cellular gum composition in the region of the prepared endodonticaly treated teeth in the patients of both groups is represented by multilayered flat epithelium with intermediate surface cells and horny scales. Single lymphocytes and segmental leukocytes were visualized. One of the definite differences in the qualitative rearrangement of the cells of both groups’ individuals was the appearance of epithelial cells in the cellular structure, with signs of irritation in the form of a sharp basophilia, homogenization and vacuolization of the cytoplasm as a manifestation of a dystrophic process. Taking into account the fact that in the scraping cells of the inflammatory reaction are rare gingival changes in this term of observations should be stated as those that arose because of epithelium differentiation violation accordingly as a compensatory adaptive response to periodontal fibrosis and, to a lesser extent, as a response to odontopreparation.

Conclusions. The results of a complex cytological study indicate that the above tinctorial features of gingival epitheliocytes in the cellular composition of patients in both groups of clinical observations reflect the functioning of the protective mechanisms of gum tissue in norm and provide their homeostasis.

Keywords: morphological changes in the cellular composition of gums, cermet structures, intermediate epitheliocytes, segmented leukocytes, cytoplasmic vacuolization, compensatory adaptive response, periodontal fibrosis.

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ASSESSMENT OF CARDONAT EFFICIENCY IN CARDIOMYOPATHY TREATMENT AFTER PHYSICAL OVERLOAD IN ATHLETES

Аuthors: V. Klapchuk, V. Bezugla, Yu. Vinnichuk

Pages: 396–408

Abstract

         

Introduction. Modern sport of higher achievements is inextricably linked with constant physical activity of high intensity, which ultimately leads to the formation of overstrain phenomena in the first place of the cardiovascular system. The problems of drug correction remain virtually unresolved which emphasizes the urgency of the creation and clinical implementation of non-prohibited metabolic drugs aimed for the athletes of high qualification.

The purpose. Determination of the role of Cardonat in the cardiomyopathy, treatment caused by chronic physical overload (CMPCPO) in athletes.

Materials and methods. The study involved 48 athletes (representatives of cyclic sports) with a diagnosis of CMPCPO who were randomized into 2 equivalent (n = 24) groups: the main group and the control group. Athletes of both groups from the moment of diagnosis reduced. The volume and intensity of training loads was reduced in athletes of both groups by 75%. Control group participants received only basic therapy (Panangin, Triovite in therapeutic doses) and placebo (capsule with starch). Athletes of the main group in addition to basic therapy used Cardonat, one capsule three times a day for 4 weeks. Comprehensive study of athletes before and after the course of treatment included the determination of anthropometric data, anamnesis, physical examination, blood pressure measurements, 12-channel electrocardiography (ECG), echocardiography (Echo) in a state of relative rest, determination of overall physical disability

Results. The results of a study of the effectiveness of Сardonat treatment in representatives of cyclic sports with cardiomyopathy due to chronic physical overload are presented. It was shown that the addition of the drug to the complex therapy of this category of athletes is accompanied by positive clinical and instrumental changes in the activity of the cardiovascular system. Consequently, under the influence of Cardonat, the percentage of athletes who had complaints of heart pain, heart palpitations, manifestations of asthenic syndrome, significantly decreased. Frequency of recording systolic murmur in the apex of the heart significantly reduced in 38% of the athletes in auscultation. According to the ECG in the dynamics of treatment, there is a significant improvement in the repolarization processes of the left ventricle (normalization of the ST segment and T-wave), a decrease of rhythm disturbance and athletes percentage with a tendency to tachycardia. On echocardiography more significant reverse remodeling of the left ventricle, regression of myocardial hypertrophy and improvement of diastolic function were observed compared with the results of the control group. According to the PWC170 test the level of physical performance is significantly increased.

Conclusions. The additional use of Cardonat in therapy is safe, expedient, pathogenetically justified and can be considered as an important reserve for providing pharmacological assistance to athletes with CMPCPO.

The use of Cardonat in complex therapy is safe, expedient, pathogenetically justified and can be considered as an important reserve for providing pharmacological assistance to athletes with CMPCPO.

Keywords: sport, Cardonat, cardiovascular system of athletes, cardiomyopathy, chronic overstrain, electrocardiography, echocardiography, physical capacity.

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References

  1. Belotserkovsky ZB, Lyubina BG. Serdechnaya deyatel'nost' i funkcional'naya podgotovlennost' u sportsmenov. Norma i atipichnye izmeneniya [Cardiac activity and functional preparedness of athletes. Norm and atypical changes]. Moskva: Sov. sport, 2012. 548 p.
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MODERN KHARKIV TEENAGERS’ ATTITUDE TO HEALTH AND HEALTHY LIFESTYLE

Аuthors: A. N. Shvets, Yu. N. Shvets, A. V. Korobkova-Arzhannikova

Pages: 409–415

Abstract

         

The article reveals the problem of that modern youth is characterized by negligence in relation to their health. In many aspects this is determined by the absence for a long period of time of the state's social policy in promoting of healthy lifestyle, sufficient medical care for the population, which leads to the spread of chronic pathology among children and adolescents, a decrease of the birth rate and an increase of mortality among working-age people. The characteristics of adolescents' health and the risk factors of the disorders among adolescents aged 14–18 in 2017 are presented.

The purpose of the study was to identify trends and factors of the state of health of the younger generation aiming to develop scientifically grounded recommendations for early detection and correction of violations in their health state in order to choose the optimal solution for introduction of health saving technologies in life.

Monitoring of detection of health state was performed during a comprehensive survey of adolescents in the process of their education. The study involved 387 Kharkiv pupils aged 14–18 (195 boys and 192 girls).

As a result of the study, 16 % of them have some chronic pathology of varying severity, and 52 % have functional disorders. Among adolescents aged 14–18, prevalence rates increased: diseases of the musculoskeletal system – by 10 times; pathology of the organs of vision – by 2.8 times, and neuropsychic diseases – by 6.3 times.

The study revealed that today the common trends in the health state of the younger generation are increasing chronic pathology, underestimation of own health and growing popularity of bad habits among children and adolescents. The formation of violation of the health of young people is mainly due to: deviant and self-destructive forms of behavior; problems with the socialization of studied contingent; high aggressiveness of the social environment. It is well known that along with factors of heredity, the formation of adolescent health is strongly influenced by factors of the habits and living conditions: anthropogenic, educational, family-household, ideological and cultural. For the development of health and prevention strategies it is important to know what factors play a major role in shaping the health disorders of adolescents and young people at the present stage of development of Ukrainian society.

Keywords: adolescents, health, healthy lifestyle, risk factors, medical-prophylactic measures.

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PATHOMORPHOLOGICAL FEATURES OF BRAIN ASSOCIATED WITH SUICIDAL RISK IN PATIENTS WITH DEMENTIA

Аuthors: I. H. Mudrenko

Pages: 416–423

Abstract

         

Purpose: definition of pathomorphological predictors regarding suicide in patients with dementia on the basis of neuroimaging analysis.

Materials and methods: 213 people with different clinical forms of dementia (vascular, due to Alzheimer's disease, mixed type) were examined. The СT scan method and the statistical processing method of results were used.

Research results: The article elucidates the relationship between the pathomorphological features in patients with various types of dementia and the risk of suicide. Thus, in Alzheimer's disease, the majority of patients in the groups compared had atrophic changes in the brain due to the neurodegenerative process such as atrophy of brain and cerebellum gyruses, expansion of subarachnoid spaces, deepening of the brain fissures. However, it has been determined that the existence of such X-ray changes as the decrease in brain matter density on the render of basal ganglia and white matter was observed in patients with low SR. That is, it can be assumed that joining vascular pathology as a chronic ischemia is a factor in the anti-risk of suicidal behavior in patients with Alzheimer’s disease.

In the vascular form of dementia process, the risk factor of suicide is the subcortical impression of brain white matter (leukoencephalopathy); mixed dementia – expansion of subarachnoid spaces, periventricular leukoareosis, expansion of brain bases , reduction of brain matter density on the render of basal ganglia, acute cerebrovascular event by hemorrhagic and ischemic types (rupture of aneurysms, cerebral infarction).

We assume that the existence of a more expressed organic impression of brain substance by the pathological neurodegenerative process and joining the vascular impression prevents the formation and implementation of SR.

The obtained data should be taken into account by clinicians for timely diagnosis and prevention of SR in patients with dementia.

Keywords: vascular dementia, mixed, with Alzheimer's disease, suicidal behavior, pathomorphological brain’s features, X-ray signs, computed tomography.

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THE RESULTS OF AUTOTRANSFUSION WITH PLATELET RICH PLASMA IN SPINAL NEUROSURGERY

Аuthors: E. G. Pedachenko, M. V. Khyzhnyak, O. O. Potapov, Yu. E. Pedachenko, O. F. Tanasiichuk, O. P. Krasylenko, A. M. Furman, I. G. Vasylieva, N. G. Chopyk, N. P. Oleksenko

Pages: 424–431

Abstract

         

Introduction. Рlatelet-rich plasma (PRP), a blood plasma separated by centrifugation with highly abundant platelets, has multiple applications in many healthcare fields for the improvement of soft and bone tissues regeneration. The studies of PRP implementation results in spine neurosurgery are of high demand in case of pathologies related to the degeneration or injury of living bone and cartilaginous elements of vertebral column, which require the installation of vertebral interbody fusion system.

Purpose. Improvement of surgical treatment outcomes by means of improving postoperative wound healing and reducing pain severity after the installation of transpedicular fixation systems in the lumbar spine using a biotechnological method which has a multimodal effect on regeneration processes and is simple and cost-effective

Materials and Methods. The results of transpedicular stabilization in lumbar spine vertebral column were assessed within the early post-operational period in two groups of patients comparable in age and health status with spondylolisthesis and spinal motion segment instability. Patients from the main group (n = 20, average age 47.8 ± 6.6 years) received PRP during the operation as compared to the control one (n = 30, average age 46.9 ± 5.6 years) without PRP injections.

Results. It was found that during the first day post-operation the pain severity in the main group was significantly reduced (1.6 ± 0.7 points according to the visual analogous scale) as compared to the control (3.8 ± 0.9 points). Moreover, these characteristics before the discharge of the patients were 0.3 ± 0.3 and 2.0 ± 0.4 points respectively. It is noteworthy that the swelling and wound edges hyperemia were remarkably reduced after the PRP use. Finally, no complications, side-effect or systemic consequences of PRP were observed.

Conclusions. Therefore, the local injections of PRP during the installment of transpedicular stabilization system in lumbar spine is easy-to-handle and safe approach favoring the quick recovery in early post-operational period.

Keywords: lumbar spine; transpedicular interbody fusion; platelet-rich plasma.

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PECULIARITIES OF TREATMENT OF CERVICAL SPINAL NERVE TUMORS WITH PARAVERTEBRAL EXTENSION

Аuthors: Ye. I. Slynko, T. A. Malysheva, O. O. Potapov, Yu. V. Derkach

Pages: 432–438

Abstract

         

Introduction. To evaluate the results of surgical treatment of patients with malignant peripheral nerve sheath tumors (MNST) with specification of the peculiarities of their structure and extension pattern, and to determine prognostically unfavorable morphological features in malignant tumors of peripheral nerves.

Materials and methods. The study is based on a retrospective analysis of the medical records of 48 patients. The indication for the operation was worsening neurological symptoms as a result of the tumor process in the cervical spine, verified by methods of neuroimaging (spondylography, CT, SCT, MRI).

Results. he expected response to surgical treatment in patients with MPNST depends on many factors: localization, directions of neoplasm extension, radical nature of the treatment and the histological variant of the tumor. In most cases, MNST is diagnosed in patients aged 27 to 56 years. The time from the onset of neurological symptoms to diagnosis varies from several weeks to one year.

Conclusions. Determining the tactics of surgery and the choice of surgical access is an important component for achieving long remission. The choice of an adequate approach makes it possible to totally remove the tumor, reduces the time of intervention, blood loss, injuries to the nervous structures during removal of the tumor.

Keywords: malignant tumors of the spinal nerves; peculiarities of surgical treatment; cervical spine.

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References

  1. Shamaev MI, Malysheva TA. [The modern approaches to classificationn of the central nervous system tumours. ]Ukrainian Neurosurgical Journal. 2005;(3):111-122. http://theunj.org/article/view/129825.
  2. Louis DN, Perry A, Reifenberger G, von Deimling A, Figarella-Branger D, Cavenee WK, Ohgaki H, Wiestler OD, Kleihues P, Ellison DW. The 2016 World Health Organization Classification of Tumors of the Central Nervous System: a summary. Acta Neuropathol. 2016 Jun;131(6):803-20. doi: 10.1007/s00401-016-1545-1. PubMed PMID: 27157931.
  3. Asano K, Yoshida G, Morita D, Ito T, Shido Y, Kouyama A, Iwase T, Matsuyama Y. Malignant peripheral nerve sheath tumor in the cervical spine with multiple nevus cell nevi. J Orthop Sci. 2016 Mar;21(2):250-4. doi: 10.1016/j.jos.2015.06.015. PubMed PMID: 26740424.
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DIAGNOSTIC SIGNIFICANCE OF MAGNETIC RESONANCE IMAGING IN PROSTATE INTRAEPITHELIAL NEOPLASIA

Аuthors: M. P. Мelnychuk

Pages: 439–446

Abstract

         

Introduction. Multiparametric magnetic resonance imaging (mpMRI) is routinely used in prostate cancer diagnostics. In order to improve sensitiveness of MRI such additional parameters were developed as T2 weighted images, diffuse weighted images, dynamic contrast enhancement. In last decade a lot of investigations are directed at studying MRI role in prostate intraepithelial neoplasia (PIN) diagnostics. Previous investigations had controversial results due to different approaches and the number of patients.

The article is about prostate intraepithelial neoplasia (PIN) diagnostics through PSA test.

Purpose. To determine role and significance of mpMRI in prostate intraepithelial neoplasia diagnostics.

Materials and methods. The results of examination of 52 patients with PIN were assessed using PIRADS criteria. The total number of samples with PIN amounted 166. According to PIRADS MRI assessment of central and peripherial zones was made separately. The use of T2WI, DWI, DCE in patients with high grade and low grade PIN was studied. PIN was diagnosed through prostate biopsy guided by transrectal ultrasound. MRI was performed before prostate biopsy (MRI cognitive fusion biopsy).

Discussion. There was a difference in values of PIRADS characteristics between PIN and benign prostatic tissue. The mean of PIRADS gradation in samples with PIN was 2.1. Among them 47 (28.3 %) PIN samples had gradation 3 (the presence of clinically significant cancer is equivocal), in 8 (4.8 %) cases – gradation 4 (clinically significant cancer is likely to be present). Compared with low grade PIN, high grade PIN had 30.4 % larger mean PIRADS value, 2,3. This is an evidence of high diagnostic value of MRI parameters in PIN detection.

MRI parameters in high grade PIN cases differ a lot from those of low grade PIN and normal prostate. It was determined that high grade PIN has similar properties on MRI as prostate cancer.

Further study is required to stratify all PIN patients into groups of high malignization risk in order to perform detailed examination and treatment. MpMRI gives an opportunity to assess the peculiarities of precancerous diseases in order to perform precise biopsy with minimal amount of samples.

Keywords: high grade and low grade prostate intraepithelial neoplasia, multiparametric MRI, prostate cancer.

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References

  1. Heidenreich A, Abrahamsson P, Artibani W, Catto J. Early detection of prostate cancer: European Association of Urology recommendation. Eur Urol. 2013; 64(3):347-354.
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  5. Dwivedi D, Kumar R, Bora G. Multiparametric MR can identify high grade prostatic intraepithelial neoplasia (HGPIN) lesions and predict future detection of prostate cancer in men with a negative initial prostate biopsy. Magn Reson Imaging. 2016; 34(8):1081–1086.
  6. Woodrum D, Gorny K, Greenwood B. MRI-Guided Prostate Biopsy of Native and Recurrent Prostate Cancer. Semin Intervent Radiol. 2016; 33:196–205.
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INFLUENCE OF METABOLIC SYNDROME ON KIDNEY FUNCTION IN PATIENTS WITH CHRONIC GOUT

Аuthors: M. Hrytsenko

Pages: 447–452

Abstract

         

The purpose of the study was to evaluate the influence of the metabolic syndrome on the features of clinical course, parameters of kidney function and severity of the inflammatory process in patients with long-term course of gout.

Materials and methods. We examined 30 patients with long-term gout and metabolic syndrome and 30 patients with gout without metabolic syndrome. All patients underwent anamnesis collection, physical examination, blood pressure measurements, anthropometric indices, laboratory tests: determination of uric acid level, creatinine, fasting plasma glucose, total cholesterol, triglycerides, cholesterol of high and low density lipoprotein, C-reactive protein, fibrinogen, erythrocyte sedimentation rate, calculation of glomerular filtration rate, general urine test, instrumental studies (ultrasound of the kidneys).

It was established that in gout associated with metabolic syndrome there was a more severe course of the disease, according to laboratory data, there was a significant difference in the rates of inflammation, which indicates the contribution of the metabolic syndrome to the intensity of the inflammatory process. The combination of gout and metabolic syndrome also had a negative effect on the function of the kidneys. Reduced renal function was detected in 63.3 % of patients in the main group and only in 36.7 % – in the group without metabolic syndrome which is reflected in changes in biochemical parameters and in the general analysis of urine. According to the ultrasonography of the kidneys, the concrements are found 23.4 % more often in patients with gout in the presence of metabolic syndrome.

Keywords: gout, metabolic syndrome, gouty nephropathy.

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References

  1. Dalbeth N, Merriman TR, Stamp LK. Gout. The Lancet. 2016;388(10055):2039–2052. doi:10.1016/s0140-6736(16)00346-9
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  8. González-Senac NM, Bailen R, Torres RJ, de Miguel E, Puig JG. Metabolic syndrome in primary gout. Nucleosides, Nucleotides and Nucleic Acids. 2014:33(4-6);185-191. doi: 10.1080/15257770.2013.853785 PMID: 24940668
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  11. Billiet L, Doaty S, Katz JD, Velasquez MT. Review of hyperuricemia as new marker for metabolic syndrome. ISRN rheumatology. 2014. doi: 10.1155/2014/852954 PMID:24693449 PMCID:PMC3945178
  12. Wei CY, Sun CC, Wei JC, Tai HC, Sun CA, Chung CF, Chou YC, Lin PL, Yang T. Association between hyperuricemia and metabolic syndrome: an epidemiological study of a labor force population in Taiwan. BioMed research international. 2015. doi: 10.1155/2015/369179 PMID: 26273611 PMCID: PMC4529909
  13. Pol'skaya II, Marusenko IM, Vezikova NN. [Characteristic features of gout development in presence of metabolic syndrome]. Uchenyye zapiski Petrozavodskogo gosudarstvennogo universiteta. Biologicheskiye nauki. 2014;2 (139):52-58.
  14. Krishnan E, Baker JF, Furst DE. Gout and the risk of acute myocardial infarction. Arthritis Rheum. 2006;54:2688–2696.

RELATIONSHIP OF OXIDATIVE STRESS WITH THE INDICATORS OF BONE METABOLISM IN PATIENTS WITH TYPE 2 DIABETES MELLITUS AND OSTEOPOROSIS

Аuthors: V. I. Kryvenko, O. I. Borodavko

Pages: 453–459

Abstract

         

The literature data indicate that there is a close relationship between carbohydrate metabolism and bone metabolism in patients with type 2 diabetes mellitus (DM). It is important to find the factors that lead to changes in bone turnover in patients with type 2 DM. One of these factors may be oxidative stress (OS).

The purpose of the study analysis of the relationship between the parameters of bone metabolism and oxidative stress in patients with a combined course of diabetes mellitus type 2 and osteoporosis (OP).

Materials and methods. Study of 94 patients, of which 1-st group – 22 patients with OP, 2-nd group – 22 patients with type 2 DM, 3-rd group – 50 patients with combined course of these diseases. An ultrasound densitometry on an Omnisense 7000 ultrasound densitometer (BeamMedLtd, Israel) was performed for all patients. The bone tissue assessment been performed according to the WHO criteria. The levels of osteocalcin (OK), parathyroid hormone, calcitonin in blood serum, the level deoxypyridinoline (DPD) was determined in morning urine for all patients. The OS intensity was assessed by the nitrotyrosine level in the serum.

Results. In patients with a combined course of type 2 diabetes and OP bone metabolism, there is a significant reduction in the levels of OC and DPD by 44 % and 24 % compared to patients who did not have type 2 DM (p < 0.05). In patients with a combined course of type 2 DM and OP, the severity of the OS increases, which is confirmed by a significant increase in the level of nitrotyrosine in 2.8 times compared with patients with OP and 2.1 times – with type 2 DM (p < 0,05). In patients with combined course of type 2 DM and OP recorded negative relationship between bone metabolism and OS, as evidenced by the presence of significant association between levels nitrotyrosine, OC, DPD, parathyroid hormone and calcitonin.

Conclusion. The relationship between nitrotyrosine and indicators of bone metabolism may indicate the significant role of reactive oxygen species in decreasing bone turnover in patients with combined course of type 2 DM and OP.

Keywords: oxidative stress, bone metabolism, type 2 diabetes mellitus, osteoporosis.

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References

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ESTIMATION OF PBL TECHNOLOGY BY MEDICAL STUDENTS DEPENDING ON THEIR LEARNING STYLE

Аuthors: L. I. Hrebenyk, O. Yu. Smirnov, O. O. Prykhodko, L. O. Primova

Pages: 460–470

Abstract

         

The article presents the results of an empirical study in which a search was made for the correlation between learning styles of students and their attitude to two types of learning: traditional for Medical institutions of Ukraine and problem-based learning (PBL). This study was conducted among second-year students of Medical Institute of Sumy State University by using questionnaires. For comparative estimation of learning systems, authors developed special questionnaire that estimates psycho-emotional comfort, organization of learning process, student’s role in the learning process, students’ vision of the teacher’s role, and the choice of the teaching system as optimal. Students of different learning styles (“activists”, “theorists”, “reflectors”, and mixed styles) have been established to perceive different teaching methods (traditional versus PBL) differently. Reflectors and Activists (as leading learning styles, 45.1 % and 19.6 %, respectively) give more positive estimation of learning process organization in PBL system compared to traditional system than Theorists (11.8 % of students). In general, students of all learning styles appreciated PBL as an additional educational innovation that improves the practical component of higher medical education based on traditional approaches to teaching. This can be explained by the fact that organization of PBL lessons meets the demands of all learning styles. The possibility to introduce 50 % of PBL study lessons into the curriculum of students’ training in Medical Institute has been supported by the majority of students.

Keywords: problem-based learning, learning styles, higher medical education.

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  1. Bokey L, Chapuis PH, Dent OF. Problem-based learning in medical education: one of many learning paradigms. Med. J. Aust. 2014;201(3):134–136.
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CHEMICAL VAGOTOMY IN EXPERIMENTAL ACUTE PANCREATITIS

Аuthors: V. M. Chumakov, O. L. Sytnik, M. S. Lyndin

Pages: 471–477

Abstract

         

According to modern conceptions, acute pancreatitis is a multifactorial disease with complex multicomponent pathogenesis. Regardless of the improvement of surgical treatment, mortality in complicated forms of acute pancreatitis is from 25 to 85 % according to different studies without a significant downward trend.

The purpose of the research is to investigate the dynamic of morphological changes in the pancreas after chemical vagotomy at acute experimental pancreatitis in rabbits.

Materials and Methods. The experiment was carried out with 55 rabbits – males with a weight of at least 3.0 kg. Induction of acute pancreatitis was provided by laparotomy, ligating of the pancreatic duct and 5 injections of solution with pharmaceutical bile and trypsin to the parenchyma of all parts of the pancreas in dose 0.4–0.5 ml/kg [9, 10]. For the purpose of performing chemical vagotomy in amimals of the main group paraesophageal space was infiltrated with a 30 % solution of ethyl alcohol in dose 1.5–2 ml. After 14 days of the experiment, the animals from both groups underwent a programmated relaparotomy with autopsy of material from pancreas for the further morphological investigation.

Results. The pathomorphological changes in pancreas in the modeling of the acute pancreatitis demonstrate significant inflammatory changes with the development of subtotal and total pancreatic necrosis. Based on the morphological investigation, it was found, that in the comparison group the pathomorphological picture of subtotal and total pancreatic necrosis with destruction > 50 % of parenchyma is significantly more frequent than in the main group (p < 0.05).

Conclusion. As a result of the experiment, it allows to consider that chemical vagotomy as an additional method that can improve the efficacy of treatment of acute pancreatitis. Further study is required to develop the minimally invasive technique of chemical vagotomy with subsequent introduction into clinical practice in order to improve the direct results of treatment of patients with acute pancreatitis.

Keywords: acute pancreatitis, pathomorphology, chemical vagotomy, modeling, experiment.

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