STAGES OF REHABILITATION OF PATIENTS WITH ACUTE CEREBROVASCULAR ACCIDENT

One of the urgent tasks of modern medicine is organizing the rehabilitation for patients who have suffered a stroke at different stages of rehabilitation. Restoration of impaired functions in such patients occurs in the first 3−5 months from the onset of the disease, that is influenced by a number of factors: duration of the stroke, size of the lesion and pool of lesions, active participation in the process of a patient him−/herself. The main principles of rehabilitation include its early onset in an acute period of stroke; regularity and duration; complexity and multidisciplinarity (formation of multidisciplinary teams); adequacy of rehabilitation measures, i.e. creation of individual programs taking into account the severity of neurological deficit and dysfunction; stages. Different methods of recovery are applied to each patient individually or in combination, or sequentially according to the rehabilitation program, which is based on the analysis of the patient's condition by all members of the multidisciplinary team, taking into account the results of functional testing and objective examination. Medical support, postural correction, kinesitherapy, mechanotherapy (including robotic), field therapy, hardware physiotherapy, massage, acupuncture according to the indications, functional neurotraining and cardiotraining, neuropsychological training are used. The results of research confirm that the integrated use of kinesitherapy, physical factors, balneotherapy, the methods of psychological rehabilitation of patients after stroke provides a faster recovery of neurological deficit, activates non−specific brain systems, restores mental and somatic functions of the body. Therefore, in addition to health, the patient needs to renew his ability to work and social status. Key words: acute cerebrovascular accident, medical rehabilitation, stages of rehabilitation.

DACRYOCYSTITIS AS AN OTOLARYNGOLOGICAL PROBLEM: OWN TREATMENT EXPERIENCE

The urgency of improving the effectiveness of dacryocystitis treatment is determined by: their stable proportion among eye diseases, a high percentage of post−traumatic, iatrogenic and chronic forms, ability to be a source of dangerous complications and social significance. Existing anatomical and physiological relations and values of rhinogenic factors determine the involvement of otolaryngologists in dacryocystitis treatment. In order to determine the characteristics of the contingent of patients with dacryocystitis, structure of rhinogenic factors, methods of examination, surgical treatment and principles of postoperative management of patients, a study was conducted with 107 patients with chronic disease. The clinical effectiveness in diagnosis and planning of surgical intervention of the combination of endonasal optical rhinoscopy, probing and contrast of the nasolacrimal pathway with triombrast with subsequent radiological and (or) CT examination was determined. It is shown that the correction of endonasal structures should be performed simultaneously with dacryocystorhinostomy. The efficiency of the classical West−Bokstein surgery has been determined, the necessity of an individual approach to its planning has been shown. The main tasks of each stage of the surgery, which significantly affect its outcome, are established. When performed correctly, the effectiveness of "plastic" and "simple" rhinostomy, management of patients with and without stenting is almost the same. It has been proven that the use of radio wave and shaver techniques can greatly simplify the stages of the surgery and improve healing. Based on the obtained results, a conclusion was made about the expediency of involving an otolaryngologist in the consultation of patients with chronic dacryocystitis in each case. The criterion for choosing treatment tactics in favor of endonasal endoscopic dacryocystorhinostomy is the presence of rhinogenic factors of dacryocystitis. Key words: dacryocystitis, endonasal endoscopic dacryocystorhinostomy, rhinogenic factors, stenting, surgical treatment, epiphora, lacrimation.

WAYS TO IMPROVE DIAGNOSIS OF PATIENTS WITH POSTCHOLECYSTECTOMY SYNDROME

Postcholecystectomy syndrome is a symptom complex that occurs or worsens after cholecystectomy and is a functional and / or organic disorder. It often complicates the post−surgery course of gallstone disease. The presence of symptoms of the disease indicates a deterioration in the quality of life of patients, but the diagnostic examination is not always possible to detect morphological or functional changes. Thus, at present the syndrome is an urgent problem of gastroenterology and biliary surgery. Diagnostic issues with a differentiated approach to the functional or organic nature of postcholecystectomy syndrome are important for the choice of further treatment tactics. In order to improve the diagnostic algorithm taking into account the changes in the area of the major duodenal papilla, a study was conducted in 137 patients. To determine the functional disorders of the sphincter of Oddi there was used the method of ultrasound investigation of hepatobiliary area and Vater's papilla with choleretic loading on Boyden as well as the Grigoriev's methods in the absence of organic obstruction of the terminal choledochus at previous stages of examination. Morphological changes in the major duodenal papilla area were evaluated using the technique of parietal ph−impedancemetry, which was performed on the background of benign mechanical jaundice in the patients after cholecystectomy during endoscopic retrograde cholangiopancreatography prior to endoscopic papillosphincterotomy. The obtained results help to perform a differentiated approach to the patients who underwent cholecystectomy, taking into account morphofunctional changes in the area of the major duodenal papilla and allow the implementation of the selected methods to the research algorithm of patients with postcholecystectomy syndrome. Key words: postcholecystectomy syndrome, functional and organic changes of major duodenal papilla, patency of the terminal choledochus, treatment tactics.

COMPARATIVE ANALYSIS OF NEUROPHYSIOLOGICAL FEATURES IN YOUNG WOMEN AND MEN SUFFERING FROM EPILEPSY

The definition of epilepsy via the concept of neuronal discharge indicates the crucial importance of electroencephalography (EEG) in epileptology. This pathology is a certain problem for each sex, that requires gender−specific approaches when managing and treating such patients. To investigate them, 30 men and 30 women aged 18−44 years with a reliable diagnosis of epilepsy were examined. A comprehensive clinical, neurological and neurophysiological study of patients was performed, taking into account the data of clinical case and life history. Each patient was assessed for neurological status according to traditional methods, electrophysiological method of examination (routine EEG) was used. On the results of electroencephalography in individuals of both sexes with epilepsy, there was a decrease in the amplitude of the α−rhythm, but a significant slowdown in this rhythm was not detected. Most patients had high−amplitude (> 20 μV) and low−frequency β1−rhythm. Low−frequency high−amplitude slow−wave activity was regarded as an EEG reflection of degenerative−dystrophic processes in brain. Photostimulation caused paroxysms of bilaterally synchronous sharp and slow waves, complexes of "acute−slow" wave. Hyperventilation led to an increase in the θ−rhythm amplitude, appearance of δ−waves, higher expression of true epileptiform phenomena: adhesions, "acute wave−slow wave" complexes, "spike−slow wave" complexes. A comparative analysis of the obtained results allowed to conclude that the changes in bioelectrical activity in epilepsy occur according to the general mechanisms of epileptogenesis, regardless of gender. Key words: epilepsy, electroencephalogram, comparative analysis, young men and women.

MAIN ISSUES OF CHILDREN'S INCIDENCE OF ACUTE OTITIS MEDIA AND PROSPECTS TO SOLVE THEM

The problem of acute otitis media in children is relevant because of the prevalence, social significance, possibility of rapid development of both life−threatening intracranial and intralabyrinthine, mastoid complications, as well as acute or prolonged dysfunction of adjacent cranial nerves, especially auditory, vestibular ones. In order to determine the frequency of various forms of acute otitis media, the nature and extent of its complications in children of different ages there was conducted a retrospective analysis of medical histories of patients treated at the City Clinical Hospital № 30 Kharkiv within 2015−2019. There was stated that the biggest group was composed by the patients with a purulent form of the disease, a slightly smaller number of patients had secretory and viral processes. But when analyzing the data over the years, of interest is the fact that during the period when the number of purulent forms decreased, the number of viral ones increased. Complications include mastoiditis, acute sensorineural hearing loss, cerebrospinal fluid and hypertension and intoxication syndromes. It is important that in acute purulent and viral otitis there is an intoxication syndrome along with the manifestations of acute sensorineural hearing loss. Signs of vestibular dysfunction in children can be disguised as symptoms of intoxication, they are much more difficult to detect. Considering the fact that the snail and the labyrinth are washed by the same liquid, it is logical to assume that in this situation the vestibular analyzer suffers together with the auditory one. Therefore, along with otoneurological research it is necessary to apply instrumental methods for establishment of latent disturbances of function of the vestibular analyzer. According to the research results it was concluded that a more detailed study of vestibular analyzer dysfunction in children with acute otitis media, as they are disguised as symptoms of intoxication. Key words: acute otitis media, frequency, complications, vestibular disorders, children.

FACTORS OF PERIOPERATIVE MORTALITY IN PATIENTS WITH GROWING RENAL CELL CARCINOMA IN INFERIOR VENA CAVA LUMEN

Difficult surgical cases of tumors of the inferior vena cava occur very often, because this intervention is characterized with technical difficulties and severe intraoperative complications. The most dangerous of these include massive bleeding, acute heart failure, and pulmonary embolism by tumor masses, which are the most common causes of perioperative mortality. Vena cava trombectomy is a special operation that can be accompanied by heavy bleeding at virtually any stage. The causes and frequency of mortality in 108 patients operated for renal cell carcinoma with growing to the inferior vena cava were retrospectively analyzed. Reliable factors for the prognosis of perioperative mortality in this pathology have been identified. Factors that characterize the tumor thrombus features, as well as parameters related to general condition of a patient, have been found to be of the greatest importance. The results of the study showed that the level of perioperative mortality in caval tumor thrombi is 8.3 % when using surgical methods without artificial circulation. The presented patient population contained a significant proportion of so−called "high" thrombi of III−IV levels, thrombi invading the wall of the inferior vena cava, as well as retrograde spread of intraluminal tumor. The main causes of death were acute heart failure, intraoperative bleeding, pulmonary embolism with tumor masses and acute renal failure. The prognostic value of perioperative mortality was demonstrated by the following thrombus factors: its "high" level, invasion of intraluminal tumor into the caval wall, signs of complete obstruction of caval blood flow. The mortality rate was objectively affected by severe heart failure, signs of pulmonary embolism before surgery. Key words: inferior vena cava, tumor thrombus, renal cell carcinoma, vena cava trombectomy, lethality.

ISTHMOCELE: ETIOLOGY, CLINIC, DIAGNOSIS AND TREATMENT (Literature review)

Modern obstetrics is characterized with a loyal approach to surgical delivery, which has significantly affected the activity of maternity hospitals: the number of complications in childbirth from both the mother and fetus has decreased. The formed scar on the uterus is determined differently when examining the women in the postoperative period. Isthmocele is a hypogenic area in the myometrium within the site of postoperative scar in the form of a "niche", diverticulum or sac after cesarean section. It can lead to the development of diseases: abnormal uterine bleeding, dysmenorrhea, chronic pelvic pain, dyspareunia, infertility, adenomyosis, bladder dysfunction, as well as be the cause of ectopic pregnancy, uterine rupture, abnormalities in the placenta attachment of. Risk factors for isthmocele include low uterine incisions, a history of cervical removal, cervical dilatation of more than 5 cm, more than five hours of delivery, etc. For the first time the diagnosis of "isthmocele" is made at ultrasonic research, more often transvaginal one. The diagnosis is confirmed by hysteroscopy or constructive surgery. An important criterion for ismocele is the degree of deficiency, i.e. the ratio between the the biometry thickness on the scar and adjacent to the scar the myometrium area. Depending on the woman's reproductive plans, conservative or surgical treatment of isthmocele is recommended, using autologous stem cells to regenerate muscle tissue. Conservative treatment involves taking oral contraceptives. Surgical treatment includes the imposition of a two−row single−wing suture. The use of stem cells in the postoperative period allows a rise in the frequency of pregnancies in women with a scar on the uterus in the case of the isthmocele formation. Key words: isthmocele, cesarean section, myometrium, autocells.

PREMATURE AGING INDICES IN PATIENTS WITH MODERATE CARDIOVASCULAR RISK

Aging is characterized with a gradual aggravation of organ function throughout life and can occur both physiologically and prematurely. With premature aging there is an early decrease in the adaptive mechanisms of all physiological systems of the body, there is a significant reduction in physical and mental activities, that contributes to the early development of age−related pathology. Genetic and epigenetic factors, as well as environmental ones can be the causes of different rates of aging. It is not possible to accurately determine the onset of old age by biological characteristics, because people with the same calendar age are not always the same as for biological one. To establish the association of age−related disease factors with the markers of premature aging and biological age in the patients of various age groups, a study was performed in the patients aged 25−44 and 45−59 years with moderate cardiovascular risk in accordance with the SCORE scale. The primary task for predicting and preventing the age−associated diseases is to identify genetic, molecular and cellular factors that determine the rate of aging and increase the risk of age−associated diseases. The role of cardiovascular risk factors in premature aging has been determined. It is established that the most important factors that lead to an increase in biological age and formation of age−associated diseases are the disorders of lipid and carbohydrate metabolism and level of oxidative stress, importance of which progresses with age. The relationship between cardiovascular risk factors and biological age, estimated with different methods, their influence on telomere length, that allows the designing of an algorithm to determine the markers of premature aging in different age groups for early and effective prevention of metabolic−associated diseases, has been established. Key words: biological age, cardiovascular risk, premature aging, telomere length.

ROLE OF ADIPOSE TISSUE AND ADIPOKINES IN CHRONIC INFLAMMATION DEVELOPMENT ON METABOLIC SYNDROME BACKGROUND

The most pressing issue that combines obesity and insulin resistance is chronic subclinical inflammation, which affects the metabolic and secretory functions of adipose tissue, and is important for the development of pathological processes. The morphological basis of inflammation is the infiltration of adipose tissue by immune competent cells. Biologically active substances specific for adipose tissue are considered to be the collagen−like protein adiponectin and the protein hormone leptin, which are secreted in adipocytes. Leptin stimulates the cellular immune response and increases the production of pro−inflammatory cytokines, and adiponectin is thought to have anti−inflammatory properties. With the development of metabolic syndrome, the concentration of adiponectin in blood decreases, and that of leptin increases. To establish the relationship between serum leptin levels with markers of systemic inflammation and spontaneous production of proinflammatory cytokines as well as mononuclear blood leukocytes, an experimental study was conducted, i.e. modeling the metabolic syndrome in white female rats WAG / GSto aged 5−6 months. The predominance of proinflammatory cytokines: interleukins − 1β, −6, −8, −10, TNF−α in supernatants of mononuclear leukocytes with increasing leptin concentration, which is consistent with the view of its ability to stimulate cell immunity and affect the production of proinflammatory cytokines. It is proven that an increase in leptin levels in metabolic syndrome is not only a symptom that characterizes the functional state of adipose tissue, but also causes spontaneous production of proinflammatory cytokines and mononuclear leukocytes in blood, that is pathogenetically interrelated with the systemic inflammatory response. It is established that the change in the cytokine profile in the serum becomes a forecast of the formation and effectiveness of treatment of metabolic syndrome on the background of obesity. Key words: obesity, metabolic syndrome, undifferentiated chronic inflammation, cytokines.

SONOGRAPHIC MARKERS OF ASSOCIATION OF FOLATE CYCLE POLYMORPHIC GENES AND EPIGENETIC FACTORS

Reproductive losses in Ukraine are about twice the European average, but have the same causes: miscarriage, abortion, malformations, parental infertility, death of women of childbearing age and children under six days of age. The study focuses on genetically determined reproductive losses associated with folate cycle polymorphism, some other polymorphisms, and epigenetic factors that increase the risk of adverse pregnancy outcomes. Methods of systematic and demographic analysis studied the indices of medical and statistical observation of the population of the Kharkiv region within the period of 2008−2018 with an emphasis on the results of biochemical, molecular genetic and sonographic examinations of pregnant women. Data on the number of examined pregnant women were analyzed using ultrasonographic and biochemical studies at the level of alpha−fetoprotein, chorionic gonadotropin and free estriol in the framework of selective screening programs for pregnant women. Statistical data on the number of fetuses and newborns who died during the first − sixth day after birth, with a distribution on the basis of full−term have been studied. The data are compared with similar national indices. The directions of reducing the reproductive losses are offered, including complex inspection of pregnant women with use of ultrasonography, biochemical and molecular−genetic methods of diagnostics of genetic diseases and defects of fetus development. Among the epigenetic factors we have identified obesity and old age of pregnant women, among the types of abortions we did medical abortions associated with stillborn pregnancies, as well as miscarriages. The findings of the study can be used to minimize the effects of risk factors for reproductive loss in the activity of general practitioners. Key words: polymorphism of folate cycle genes, reproductive losses, miscarriage, congenital malformations of fetus, ultrasonography.