DIAGNOSTICS AND INTENSIVE CARE OF HEART FAILURE IN PATIENTS WHO UNDERWENT CORONARY ARTERY BYPASS GRAFT SURGERY WITH ARTIFICIAL CIRCULATION

Introduction. Coronary heart disease, the complexity of the surgery conducted, inflammatory reaction to extracorporeal circulation and the need for perioperative anticoagulation influence perioperative state of hemodynamics during the surgical revascularization of a myocardium in patients with coronary heart disease. The aim. To improve the results of treatment of cardiac surgery patients with heart failure who underwent surgery, namely, coronary artery bypass grafting using extracorporeal circulation by improving methods of diagnosing heart failure. Materials and methods. 100 cardiac surgery patients with coronary heart disease were operated on at State Institution of Science “Research and Practical Center of Preventive and Clinical Medicine” State Administrative Department. In all the cases, coronary artery bypass grafting was performed using artificial circulation. In patients of group 1 (40 patients) in the postoperative period, the correction of hemodynamic disorders was performed according to the standard protocol. In group 2 (60 patients) - a differentiated approach to the correction of hemodynamic disorders was used. Results. It was found that in group 2 for stabilization of hemodynamics, oxygen status, microcirculation, smaller doses of sympathomimetics and shorter duration of their use, P <0.05 than in 1 were applied. Conclusions. The results of the studies indicate the possibility of using the method of phasography, in particular, the analysis of symmetry of the T wave, as a marker of ischemic changes in the myocardium in cardiac patients who underwent coronary artery bypass grafting using artificial circulation. The obtained data show that the developed algorithm of perioperative management of cardiac surgery patients with heart failure makes it possible to significantly accelerate the rehabilitation of cardiac surgery patients, increase patient comfort and reduce the length of their hospitalization. The possibility of using phasography for monitoring of myocardial condition in patients undergoing coronary artery bypass surgery has been investigated.

SURGICAL TREATMENT OF ACUTE THROMBOSIS ARTERIES OF INFRAPOPLITEAL SEGMENT

Aim of the study. Aim of the study was to analyze the outcomes of surgical treatment of acute thrombosis of the popliteal-tibial segment arteries with various etiological factors of its occurrence. The analysis of the surgical treatment of 40 patients with acute thrombosis of the popliteal-tibial segment arteries was carried out for the period from 2014 to 2020. Depending on the pathogenesis of acute thrombosis of the popliteal-tibial segment arteries, the patients were divided into three groups: Group 1 – 17 (42.5%) patients with acute arterial thrombosis of the popliteal-tibial segment caused by embolism or thrombosis in the background of stenotic-occlusive diseases of the lower extremitiesvessels; Group 2 – 15 (37.5%) patients with acute arterial thrombosis of the popliteal-tibial segment in the background of thromboangiitisobliterans of the lower extremities (Buerger's disease); Group 3 – 8 (20%) patients with acute arterial thrombosis of the popliteal-tibial segment in the background of popliteal artery aneurysm. During the follow-up period of 2 months, the incidence of rethrombosis and amputation of the lower limb in the patients of Group A was 5.9% and 5.9%, respectively. In Group B, the incidence of rethrombosis and amputation of the lower limb was 73.3% and 40.0%, respectively. In group C, the incidence of rethrombosis and amputation of the lower limb was 12.5% and 12.5%, respectively. Conclusions. In patients with acute arterial thrombosis of the popliteal-tibial segment in the background of embolism or stenotic-occlusive diseases, combined endovascular or hybrid surgical interventions showed better results compared to open thrombectomy, in which rethrombosis was diagnosed in 14.3% of cases. In patients with thromboangiitis obliterans of the lower extremities, regional catheter-directed thrombolysis showed better (p=0,04) results compared to open thrombectomy and endovascular interventions, in which rethrombosis was diagnosed in 90% and 100% of cases, respectively. In patients with popliteal artery aneurysm, open surgical interventions or regional catheter-directed thrombolysis showed better results compared to endovascular interventions, in which rethrombosis was diagnosed in 50% of cases.

FORMATION OF OUTFLOW PATHWAYS IN PATIENTS WITH COMBINED STENOTIC-OCCLUSIVE LESIONS OF THE FEMORAL AND TIBIAL ARTERIAL SEGMENTS

The aim of the study. To prevent the development of postoperative thrombosis of the reconstruction segment after endovascular and hybrid revascularization of the femoral-distal arterial portion in the conditions of stenotic-occlusive process of the tibial arteries by forming functionally capable pathways in the tibial segment. Materials and methods. The results of treatment 135 patients with atherosclerotic occlusive-stenotic lesions of the infrainguinal arterial segment of the lower extremities were analyzed. According to the severity violation of chronic arterial insufficiency of the lower extremities, grade IIB was detected in 50 (37.04%) patients, grade III - in 63 (46.66%) examinee, grade IV- in 22 (16.30%) examinee. Patients were divided into 2 groups. Group I included 61 (45.19%) patients with occlusal-stenotic lesions at the level of the infrainguinal segment, who underwent only endovascular correction of the peripheral arterial portion, the second group consisted of 74 (54.81%) patients with multilevel occlusive-stenotic lesions of the infrainguinal arterial segment which was performed hybrid arterial reconstruction. Results and discussion. The proposed tactic involves endovascular angioplasty of at least two tibial arteries. During revascularization of 135 patients by endovascular (61 supervision) and hybrid (74 supervision) methods of a femoral-distal arterial blood flow under conditions of arterial sclerotic disease of tibial arteries carried out in 115 (85,18%) patients endovascular dilatation of two arteries. Thrombosis of the reconstruction segment in the postoperative period was finding in 9 (6.67%) cases: when using endovascular and hybrid revascularization methods, respectively - in 4 (6.56%) and 5 (6.76%) cases. Thrombosis of the reconstruction segment in the early postoperative period in 8 cases developed after endovascular angioplasty of one of the tibial arteries and only in 1 observation after endovascular angioplasty of 2 tibial arteries. Conclusion. Reconstruction of outflow pathways at the tibial arterial segment with occlusive-stenotic lesions of the infranguinal arterial portion during endovascular and hybrid techniques of revascularization by performing angioplasty of the two tibial arteries of the tibia can provide a positive result of revascularization in the early postoperative period, respectively in 95.08% and 95.95% of cases.

ECONOMIC INDICATORS OF SURGICAL TREATMENT OF ATHEROSCLEROSIS OF THE FEMORAL-POPLITEAL SEGMENT IN PATIENTS FOR CRITICAL LIMB ISHEMIA

Introduction: is to analyze the economic indicators of different types of surgical treatment of atherosclerosis of the femoral-popliteal segment of the lower extremity in patients for сritacal limb ishemia. Materials and methods. were analyzed 173 cases of atherosclerosis of the femoral-popliteal segment of the lower extremity in patients for сritacal limb ishemia, of which 93 underwent arterial percutaneous transluminal angioplasty and 80 bypass surgery of the affected vessels. For this an original model of determining the value of medical care was used. It included the determination of costs that was given as a payment for medical workers, material and technical costs, the surgical interventions costs, the drugs that were used, additional examinations, and etc. Results. Economic analysis of costs per average patient that underwent PTA was UAH 5025.85, and bypass surgery UAH 4351.1. However,analyzing the results of treatment showed that there are small differences between the two methods, in particular a larger number of patients with diabetes. Conclusions. Both methods of treatment gave almost the same result in terms of the cost of treatment, which requires consideration of other factors, especially the clinical course of the disease.

THERMAL AND NON-THERMAL METHODS OF TREATMENT OF PATIENTS WITH PRIMARY VARICOSЕ DISEASES OF THE LOWER LIMBS OF STAGE C2

Treatment results of primary varicose disorders has been shown. The experience of using of thermal (endovenous laser ablation) and non-thermal methods (endovenous mechanochemical ablation, echo-controlled introduction of bioglue) in treatment of stage C2 chronic venous is shown. The purpose of this work is to evaluate the efficiency of endovenous ablation techniques. The treatment of 58 patients was analyzed. In the group of patients who underwent endovenous laser obliteration, reflux was not detected. In the group of patients with mechanochemical obliteration, reflux was determined in 3 patients (27.2%) at follow-up after 3 months required supplementation with foam sclerobliteration. In the group of patients with the introduction of bio glue, reflux was determined in 1 patient (20%) at the examination after 3 months. The received results lead to conclusion, that endovenous laser coagulation of affected veins is a reliable method of threatment, the gold standard. The advantage of non-thermal methods is the absence of thermal effects on the paravenous structures, respectively, patients have no pain during the procedure, increases comfort, and there is no risk of damage to the paravenous nerves. Another advantage of non-thermal techniques is no need to use of tumescent anesthesia, since only one puncture is required for the operation, which is comfortable for patients. The use of adhesive vein obliteration is justified in patients with signs of a short reflux duration and has an advantage for the patient due to the absence of the need for compression in the postoperative period. Non-thermal methods require further research and widespread implementation in practice.

CHOICE OF REVASCULARIZATION TECHNIQUE IN PATIENTS WITH ISCHEMIC DIABETIC FOOT

Background Ischemic diabetic foot is determined by trophic disorders of the foot due to a combination of atherosclerosis of the arteries and diabetic lesions. In the United States and some European countries, among major non-traumatic amputations, amputations in patients with diabetes are 45-70%. The use of revascularization can significantly improve the results of treatment of patients with diabetic foot. Features of ischemic diabetic foot require a separate approach to revascularization. There are no generally accepted guidelines for revascularization in diabetic foot in the world today. The choice of revascularization technique remains an open question. The aim of the study. To analyze the effectiveness of differentiated application of intervention techniques of revascularization for the treatment of ischemic diabetic foot. Steps of differentiated choice of revascularization We identified seven steps: determination of indications for revascularization, determination of the critical arterial segment. the level of hemodynamic compensation, determination of the feasibility of revascularization, the choice of revascularization technique, the perform revascularization, the active postoperative monitoring. Materials and methods Diabetic ischemic foot was diagnosed in 133 observations. 123 revascularizations of 94 lower extremities were performed in 91 patients with ischemic diabetic foot. Patients underwent angioplasty, surgical revascularization or hybrid intervention. Results Revascularization was performed in revascularization was performed in 92,4% of patients with ischemic diabetic foot. Amputation-free survival was noted in 85.4% of cases, wound-healing in 62.6%, preservation of foot support function in 79.7%, avoidance of repeated interventions in 78.9%. 5 (5.5%) patients died, 2 of them (2.2:%) within 30 days after revascularization. Conclusions: Differentiated choice of revascularization technique allows to increase the number of patients to be revascularized 92,4%, to reach of the level amputation-free survival to 85,4%, to reach of the level wound-healing to 62,6%, to salvage of foot support function to 79,7%, to perform revascularizations in patients with a high probability of limb amputation.

HYBRID SURGERY IN MULTI-FLOOR ATHEROSCLEROTIC INFLAMMATION OF THE MAIN ARTERIES OF THE LOWER LIMBS

Cardiovascular diseases occupy one of the main groups in the structure of morbidity in most countries. A significant part of this group is affected by the main arteries of the lower extremities. Atherosclerotic diseases of the terminal aorta are combined with stenotic-occlusive lesions of the iliac-femoral, femoral-popliteal and popliteal-tibial arterial segments. Timely diagnosis and choice of treatment to maintain a full life remains one of the most pressing medical problems today. Comprehensive drug therapy used in the treatment of this pathology is ineffective and leads to limb loss, which leads to limited mobility, ability to self-care, contributes to social maladaptation and requires the involvement of the working population to care for the patient. All of the above has led to an expansion of readings to restorative operations aimed at preserving the limbs. However, reconstructive surgery of stenotic-occlusive diseases of the arteries of the lower extremities today is a complex and far from unresolved problem, which contributes to the development of new research to select the optimal method of surgical treatment. The article presents data on hybrid surgical interventions (open surgery and stenting) in 59 patients with chronic ischemia of the lower extremities. The early postoperative period in 4 (6.8%) patients was complicated by hematoma and in 5 patients (8.5%) by postoperative wound lymphorrhea. Hybrid surgeries, in chronic lower extremity ischemia in patients with multilevel lesions of the main arteries, are effective and minimally invasive, especially in patients at high risk of complications. Such technologies allow to save the limb and life of the patient with the minimum trauma, to reduce duration of stay in a hospital.

CLINICAL AND MORPHOLOGICAL FEATURES OF GASTROINTESTINAL LEIOMYOMAS WHICH ARE COMPLICATED BY BLEEDING

Aim: Investigation of the morphological structure of gastrointestinal leiomyomas which complicated by bleeding, and also reveal the reasons of such complications. Material and methods: There are 36 patients in the study group. All patients were hospitalized in Vinnitsa Regional Clinical Hospital during 2010-2021years with the features of acute gastrointestinal bleeding from the upper gastrointestinal tract. The verification of the tumor was carried out using histopathological and immunohistochemical studies in the postoperative period. According to the results of these studies, all patients were diagnosed with leiomyoma. Results: Among all patients hospitalized with an acute GI bleeding during 2010 - 2021, GI leiomyomas were diagnosed in 0.41%. Men accounted for 56.4%, women - 43.6%. Most of all there were patients aged 50-70 years. The size of the smallest tumor witch removed was 2.5 × 2 cm, the largest - 10 × 8 cm. In our study, leiomyomas that were complicated by bleeding were most often localized in the stomach (88.9%) and duodenum (8.3%), and only in one case (2.8%) in the esophagus. Most of the complicated leiomyomas became leiomyomas of such pathomorphological types as cellular, epitheloid and weird leiomyomas. Their histological structure has its own characteristics. The manifestations of neoangiogenesis and destruction of the blood vessels are clearly visible. There is a thin, it is extensions, all vessels are lacunars and sinusoidal. Also it has sings of angiomatosis. Immunohistochemical analysis of all leiomyomas in the study group showed a positive reaction to smooth muscle actin and desmin, and was negative for CD117 and CD34. In all complicated leiomyomas, the intensity of expression of the immunohistochemical marker of endothelial vessels CD31, which is responsible for the level of vascularization, was high, which confirms the results obtained in histopathological examination. The proliferation index of all complicated leiomyomas was below 5%, which confirms the benign nature of these tumors. But the mean expression level of Ki-67 was statistically higher for complicated leiomyomas. Conclusions: During the histopathological examination it was found that leiomyomas of the proliferative pathomorphological subspecies, which include cellular, epitheloid, and weird leiomyomas, were most often complicated by bleeding. Factors that affect the growth rate of gastrointestinal leiomyomas include the level of proliferative activity of the tumor and the level of its vascularization. Determination of the level of tumor proliferation is performed using the immunohistochemical marker Ki-67, and to determine the level of vascularization is responsible for the immunohistochemical marker CD31. Upper gastrointestinal leiomyomas, which complicated by bleeding were characterized by high levels of Ki-67 and CD31 expression. The obtained research data can be used in the selection of diagnostic and treatment management for patients with leiomyomas of the upper gastrointestinal tract.

ANALYSIS OF RELATIONSHIPS OF EMOTIONAL BURN OUT FEATURES AND INDICATORS OF EMOTIONAL INTELLIGENCE AMONG MEDICAL WORKERS

Purpose - the aim of this article is to present the results of a statistical analysis of the relationship between the features of emotional burnout and indicators of emotional intelligence among medical workers. Material and methods - 4 groups of respondents (110 medical workers) took part in the study: surgical doctors, therapeutic doctors, surgical nurses, therapeutic nurses. Evaluation of the features of emotional burnout and emotional intelligence was carried out using diagnostic methods of emotional burnout (V.Boyko), the questionnaire of emotional burnout by K. Maslach and S. Jackson (adaptation by N. Vodopyanova) and the method of emotional intelligence (N. Hall). The study consisted of two stages. The purpose of the first stage was to determine the level and characteristics of the manifestation of emotional burnout of medical workers according to the following symptoms: (emotional exhaustion; depersonalization; reduction of personal achievements; "stress" (experiencing traumatic circumstances, dissatisfaction with oneself, caged, anxiety and depression); "resistance" (inadequate selective emotional response, emotional and moral disorientation, expansion of the sphere of saving emotions, reduction of professional duties); "exhaustion" (emotional deficit, emotional detachment, psychosomatic and psychovegetative disorders). The level of manifestation of emotional intelligence of medical workers was also assessed according to the following indicators: emotional awareness, emotion management, self-motivation, empathy, recognition of other people's emotions The second stage of the study was aimed at determining the characteristics of the relationship of individual indicators of emotional benefit screaming with specific indicators of the emotional intelligence of health care workers. Mathematical processing of the research results was carried out using Spearman's correlation coefficient by means of the SPSS 17 computer program. Results and discussion. The results of our research have shown that: 1) the overwhelming majority of the test subjects have high and medium levels of reduction of personal achievements, and such a phase of emotional burnout as resistance” (inadequate selective emotional response, emotional and moral disorientation, expansion of the sphere of economy of emotions, reduction of professional duties); 2) half of respondents have high and medium levels of emotional exhaustion, depersonalization; 3) a quarter of the respondents formed such a phase of emotional burnout as “exhaustion” (emotional deficit, emotional and personal detachment, psychosomatic and psychovegetative disorders). The following levels of development of emotional intelligence were revealed in different groups of medical workers: a) high and medium - among doctors of a surgical profile and doctors of a therapeutic profile; medium - for surgical nurses; low - for therapeutic nurses. Conclusion. Medical workers with high and medium levels of emotional intelligence have a low level of manifestation of symptoms of emotional burnout (dissatisfaction with oneself; feelings of being caged; anxiety and depression; reduction of professional duties; emotional deficit; personal detachment; psychosomatic and psychovegetative disorders), as well as a low level of development phases of tension, resistance, exhaustion, depersonalization and reduction of personal achievements.

PREDICTORS AND PREMORBID CONDITIONS OF THE DEVELOPMENT OF FEMALE GENITAL CANCER, IN PARTICULAR ENDOMETRY CANCER AND BREAST CANCER

Objective: to review a new potential diagnostic criteria for predictors and premorbid conditions of female genital cancer, including endometrial cancer and breast cancer. Materials and methods. Bibliographic, information-analytical methods were used in the work. Sources of information were data from the scientific literature on the topic of the study, modern gadleins, a review of randomized controlled trials. Results. The results of epidemiological studies suggest that the increased risk of cancer of the female reproductive system is the presence of obesity and type 2 diabetes. Potential mechanisms of their association are hyperinsulinemia, hyperglycemia, chronic inflammation, and insulin resistance. Because insulin is a major regulator of cell metabolism and is a tissue growth factor, hyperinsulinemia increases the risk of cancer. Hyperinsulinemia is associated with increased secretion of androgens by the ovaries and decreased levels of the protein that binds sex hormones, leading to higher concentrations of biologically active estrogens, which are also known to be risk factors for female genital cancer. In recent years, PFAA profiles have been found to be significantly altered in cancer and type 2 diabetes. Because cancer cells require certain amino acids to synthesize DNA, tumor growth factors, build new blood vessels, and duplicate all of their protein content, changes in PFAA profiles can be used as biomarkers of disease and different types of cancer at different stages. Conclusions. With the growing incidence of cancer, the issue of early diagnosis and detection of cancer in the pre-clinical stages remains relevant. Protein metabolism in cancer remains unclear and requires further research using a larger sample size. In addition, the biological mechanisms by which amino acids may contribute to the risk and progression of cancer or other premorbid conditions need to be elucidated. Determining the exact mechanism underlying changes in PFAA profiles has great potential for cancer diagnosis and treatment.