The Journal of V. N. Karazin Kharkiv National University, series "Medicine"

Peculiarities of immunore resistance changes in the experiment of induced peritonitis in animals of different ages

Marina Ivanenko — 2019-06-13

The article describes some peculiarities of changes in the indicators of adaptive humoral immunity, levels of immunoglobulin A and circulating immune complexes, phagocytic activity of neutrophils and the disruption of enzymes activity, which provide the phagocyte function in the NST test on the model of induced peritonitis in animals of different ages. The results of the study indicate certain violation of the primary cellular and secondary humoral immunity during the aging of the body and decrease in the adaptive responses of the immune system during inflammation due to an increase in antigenic effects. The levels of immunoglobulin A in the blood serum of 3 and 22-month-old rats with the inflammation model were reduced in comparison with this index in control group animals. The content of the CIC in the rats blood serum of both age groups was significantly higher in comparison with the control group. All the studied indices of neutrophils phagocytic activity in the 22-month-old animals with the inflammation model were lower than in the control rats of this age. In the 3-month-old rats with the inflammation model, the index of phagocytosis completeness was significantly lower in comparison with the control group. The reduction in the reserve capacity of phagocytic cells was higher in the 22-month-old animals. An increase in the neutrophils metabolic activity and a decrease in their metabolic reserve in 3 and 22-month-old rats with the inflammation model were revealed in comparison with the parameters of the control groups.

The functional state of the system of immunological protection in traumatic disease in patients with an increased body mass index

Valeriy Kucheryavchenko — 2019-06-13

The purpose of this study was to analyze the functional state of the system of immunological protection in traumatic disease in patients with an increased body mass index (IВMІ). Using systemic multivariate analysis, the integral indicators of immunogenesis were determined on the basis of a dynamic study of 1344 complex immunograms in 224 patients with IВMІ with polytrauma and different starting figures оf BMI. The patients were divided into 3 groups: group I included patients with a BMI to 29.9; group II – patients with a BMI 30.0 –39.9; group III – patients with a BMI > 40.0. The study was conducted on the 1, 3, 7, 14, 30 and 360 days from the moment of receiving polytrauma. Our analysis allowed us to prove objectively on mathematical models that traumatic disease is a long process. Clinical and pathogenetic aspects of immune disorders do not cause doubts and provide grounds for the application of the proposed treatment algorithms and changes in stereotypes regarding the approach to treatment in general.

Biomechanical analysis of tension-compression asymmetry, anisotropy and heterogeneity of bone reconstruction in response to periprosthetic fracture repair

Olexander Zolochevsky — 2019-06-13

Bone repair after periprosthetic fracture is a critical issue in orthopedics. Biomechanical analysis given in this review has been concerned with understanding on how mechanical signals and molecular mechanisms affect the healing of Vancouver periprosthetic femoral fracture of B1 and C-type with the use of internal fixation through a less invasive stabilization system (LISS)-plate, which is screwed into the artificial hip joint. The outcome of this analysis will be how the implant/biomaterial interface with bone, translation of mechanical to biological signals and treatment of periprosthetic femoral fractures after total hip arthroplasty with the use of LISS-plates and screws for internal fixation may be controlled in order to improve the fracture healing rate and shorten treatment duration.

Severe multiple trauma: analysis of multistage tactic of treatment

Mariia Matvieienko — 2019-06-13

The research was conducted to analyze the results of the diagnosis, treatment, surgical correction stages, deadlines final stabilization of bone fragments. Clinical and laboratory parameters, stages according to Damage сontrol (DC) tactic, results of treatment were analyzed. A total of 140 operations were performed in several stages. Оn the first day were performed 114 operations in order to stop the bleeding and temporary immobilization of the limbs. On the 2–14 days were performed 26 operations due to deferred indicators. Thirty patients (93.7 %) developed posthemorrhagic anemia, 14 (43.75 %) patients - pneumonia. The local infectious complications (abscesses, festering wounds) occurred in 5 (15.6 %) patients, and urinary tract infection in 3 (9.3 %) patients. This question need to further study of intensive care and development of criteria for the sequence and timing of multistage surgical correction in order to optimize treatment and reduce complications.

Features of manifestations, treatment and prevention of nsaids – induced gastroduodenopathy in patients of different profile departments

Oksana Moskal — 2019-06-13

Nonsteroidal anti-inflammatory drugs are the most commonly used medicines in medical practice. As literary sources show, they often cause unwanted side-effects. Among them, the most dangerous and terrible are the consequences of NSAIDs – induced gastro-, enteropathy, which sometimes inherently and negatively prevail over the primary disease, significantly lengthening the recovery time. The purpose of our work was to evaluate the frequency, clinical manifestations and morphological features of lesions of the gastroduodenal zone that arise in patients of rheumatologic, neurological profiles and angiosurgery department during the course of treatment with nonsteroidal anti-inflammatory drugs of different groups, to trace the dependence of the frequency of manifestations of the pathology of the stomach and duodenum from simultaneous receiving two nonsteroidal anti-inflammatory drugs and their combination with glucocorticosteroids and anticoagulants. Asymptomatic clinical picture of NSAID-gastropathy was found, which did not coincide with the available endoscopic changes in the gastroduodenal tube: in 63 % of cases, erosive changes in the mucous membrane were present, and stomach and duodenal ulcers were revealed in 11 %. It was also found that in the group of patients receiving proton pump inselective non-steroidal anti-inflammatory drugs can significantly reduce the probability of developing the pathology of the gastroduodenal zone, compared with non-selective.
The course of treatment with nonsteroidal anti-inflammatory drugs should be as short as possible and should be carried out with minimal but effective doses. Parallel prophylactic administration of proton pump inhibitors, usually a half dose, is appropriate in patients at high risk of developing erosions and ulcers in the background of treatment with these drugs.hibitors, the incidence of gastroduodenopathy was reliably lower (34.2 %) than in patients who did not receive them (53.4 %). During this study, it was found that the use of

Two-stage surgical treatment of subarachnoid and paryhymatous blood effects with the use of endovascular embolization of damaged aneurysm

Oleksii Polkovnikov — 2019-06-13

The aim of the study was the optimization of treatment of aneurysmatic subarachnoid haemorrhage complicated by the formation of intracerebral hematoma. The analysis of the results of surgical treatment of 101 patients in the acute period of cerebral aneurysm rupture was performed. The first group of observations in which the surgical treatment was limited to endovascular occlusion of cerebral aneurysms. In the second group of observations, multi-stage surgical treatment was performed - endovascular embolization of cerebral aneurysm with subsequent removal of parenchymal hematoma for 24–48 hours.In most cases, surgical treatment was limited to endovascular embolization of the ruptured aneurysm. In 3 observations, multistage surgical treatment was performed - endovascular embolization of cerebral aneurysm with subsequent removal of intracerebral hematoma. In two cases, positive dynamics with a regression of neurological deficits in the postoperative period was noted. In one observation, partial regression of motor deficit.Two-stage surgical treatment of subarachnoid haemorrhage with intracerebral hematoma the use of endovascular embolization of the ruptured aneurysm and subsequent evacuation of hematoma is effective and can be used in cases where there is a technical possibility of occlusion of the aneurysms and the compensated state of the patient.

Condition of the gastrointestinal tract motor function in abdominal injury

Danila Safronov — 2019-06-13

The work is devoted to the study of the motor-evacuation function (MEF) of the gastrointestinal tract (GIT) in patients with closed abdominal injury of varying severity. The investigation was carried out on the basis of the Polytrauma Department at the Kharkov Municipal Emergency Aid Hospital named after A.I. Meshchaninov. 125 patients with isolated or combined blunt abdominal trauma were under observation. The main criterion for the inclusion of patients in the study was the presence of injury to the abdomen and / or retroperitoneal space, confirmed while surgery or using instrumental methods of examination. The structure of injuries was dominated by a combined trauma, which was observed in 104 (83.2 %) victims; in 21 (16.8 %) patients abdominal injury was isolated or multiple. Evaluation of the MEF of the gastrointestinal tract was carried out using a technique developed with the participation of the author on the basis of the available indicators widely used in practice. The severity of the injury was determined on an ISS scale. The results showed that the predominant part of patients with abdominal trauma (62.4 %) had a violation of gastrointestinal MEF upon admission; in 21 % of patients, the state of function at the border of functional compensation was noted, and only in 16 % of persons, the MEF of the gastrointestinal tract was rated as moderately and completely compensated. By severity of injury, a group of patients with moderate severity (47.2 %) prevailed; a mild injury was observed in 35.2 % of patients, severe injury was diagnosed in 16 %, and a super-severe one was in 1.6 % of injured people. The possibility of using the MEF indicators of the gastrointestinal tract as one of diagnostic criteria for the severity of a blunt abdominal injury is assumed.

Neurodynamic compensatory mechanisms of visual impairment and biomechanical indicators of running in an elite athlete in the paralympic sprint

Danila Safronov — 2019-06-13

The purpose of our work was to identify potential compensatory mechanisms of visual impairment in an elite athlete in the Paralympic sprint based on an analysis of the biomechanical characteristics of running and neurodynamic indicators. A highly qualified athlete with visual impairment (category T12) participated in the study. The individual characteristics of the psychophysiological state and the results in running for 60, 80,100, 120, 200 m, biomechanical characteristics of the run for 100 m were analyzed within 5 months. In total, 36 series of measurements of each indicator were carried out for 5 months. The athlete being examined is an atypical sprinter, as she is a representative of a mobile and strong type of nervous system, which allows her to maintain a higher speed at a distance for a longer time compared to other athletes, which can be considered as a potential reserve. The role of the auditory analyzer was not identified as a compensatory mechanism of visual dysfunction. A high reliable relationship between the neurodynamic and biomechanical characteristics was revealed of the examined female athlete. According to the study, improving the biomechanics of running by focusing on the work of a kinestatic analyzer can give an increase in speed at a distance while maintaining it almost to the finish.

Management of patient with famil ial combined hyperlipoproteinemia: a case study

Olha Babii — 2019-06-13

Familial combined hyperlipoproteinemia is considered one of the most common genetic hyperlipidemias in the general population with estimated prevalence 0.5 %–2.0 % of all inherited dyslipidemias. This disorder frequently coexists with other metabolic diseases such as obesity, insulin resistance, hypertension, non-alcoholic fatty liver disease. Association of hyperlipoproteinemia and type 2 diabetes mellitus can be explained due to the fact, that familial combined hyperlipoproteinemia is caused by genetic variability, including genes encoding the upstream transcription factor 1. The last regulates nearly 40 genes implicated in lipid, lipoprotein and carbohydrate metabolism, as well as immune response. Polymorphism in the upstream transcription factor 1 is strongly associated with dyslipidemia, impaired glucose tolerance, insulin resistance, and type 2 diabetes mellitus. In this report on example of clinical case we want to pay attention of practitioners to the problem of familial causes of hyperlipidemias, which leads to early onset of atherosclerosis, cardiovascular disease, and, finally, to premature disability of the affected person. Because of the frequent overlapping with the features of metabolic syndrome, this serious disorder is often not recognized and treated timely. Our patient was a 43 year old male, who was referred to the clinic with complaints of angina pain and dyspnoea provoked by minimal physical exertion, palpitations, irregular heartbeats, lower extremities and face oedema. At the age of thirty in the patient have developed type 2 diabetes mellitus, during last 7 years it was insulin dependent, the course was severe, glycaemia was poorly controlled by the therapy. Also he had essential hypertension III grade. At the age of 37 years the patient suffered from ST-elevated myocardial infarction, one year later occurred recurrent myocardial infarction. His family history was strongly positive for atherosclerosis and cardiovascular disease, as well as type 2 diabetes mellitus. In laboratory testing the fasting blood sample revealed a grossly lipemic serum, with total cholesterol level 17.75 mmol/L, very low density lipoproteins 3.41 mmol/L, low density lipoproteins 13.64 mmol/L, high density lipoproteins 0.7 mmol/L. Diagnosis: «Familial combined hyperlipoproteinemia (Fredrickson type 2B). Acute coronary syndrome: Unstable angina IIB. Postinfarction (STEMI 2014, 2015) cardiosclerosis. Essential hypertension III degree III stage. Heart failure with left ventricular systolic and diastolic dysfunction, EF 36 %. III functional class NYHA. Stage D AHA. Risk score 4 (very high).Type 2 diabetes mellitus, insulin dependent, severe course. Non-alcoholic fatty liver, 2 degree. Nodular goitre I degree, euthyroid state» was established. Management of this patient includes lifestyle modification and combined lipid lowering therapy in high doses: rosuvastatin and choline fenofibrate. Unfortunately, in this case target levels of cholesterol and triglycerides were not achieved: minimal level of total cholesterol was 12.29 mmol/L, and level of triglycerides was 41.48 mmol/L. Risk estimates based on risk charts, scores, or functions used in the general population, probably grossly underestimate the real risk of this patient with familial combined hyperlipoproteinemia. Coexistence of extremely high level of cholesterol and type 2 diabetes mellitus significantly aggravates and advances each other's course, comparing with the isolated disorders.

Stant restenosis in a patient with vazorenal arterial hypertension

Tatyana Hlavatskikh — 2019-06-13

The fact that there is an increased risk of cardiovascular complications in patients with arterial hypertension remains undeniable. In 10–20 % of cases, the cause of high blood pressure can be determined. These are the so-called secondary forms of hypertension, among which up to 20 % are associated with vascular pathology of the kidneys (renovascular hypertension). The lack of effectiveness of drug therapy of this form of hypertension determined the invasive treatment tactics using metal and plastic structures that expand the lumen of the narrowed portion of the vessel. The purpose of this article was to observe the clinical course of renovascular hypertension and determine the tactics of treatment in the long-term period after a previous stenting of the renal arteries.

Difficulties in systemic sclerosis diagnosis on the example of clinical case

Eugenia Golubkina — 2019-06-13

A clinical case of middle-age female patient diagnosed with systemic sclerosis with lesions of skin, joints, vessels, gastrointestinal and respiratory systems. The disease manifested with Raynaud phenomenon, due to this patient was consulted by different specialists but the diagnosis of systemic sclerosis was made 5 years after its onset. This clinical case illustrates the features of the clinical course of systemic sclerosis and difficulties in timely diagnosis of this disease.

Pulmonary embolism in young age

Vladislava Kulminska — 2019-06-13

One of the risk factors for pulmonary embolism is age (> 40 years). Lately, more and more cases of thromboembolism occur at a young age that requires special attention in diagnosis and treatment. This clinical case presents an example of thromboembolism at a young age, and also shows that prolonged immobilization in young patients can be only one risk factor for the formation of pulmonary embolism. In order to predict possible complications in patients with pulmonary thromboembolism, it is necessary to take into account the initial state of the patient and associated diseases in each case.