Медицина сьогодні і завтра最新文献

{"title":"Optimization of the treatment of polyomaviruse infection in patients after kidney transplantation","authors":"M. Zheleznikova","doi":"10.35339/msz.2019.84.03.15","DOIUrl":"https://doi.org/10.35339/msz.2019.84.03.15","url":null,"abstract":"Immunosuppressive therapy is considered to be one of the main risk factors for replication of BK and JC polyomaviruses after kidney transplantation. The effective treatment regimens for dysfunction of the kidney transplantation have been studied in patients with chronic kidney disease V stage with polyomavirus infection. 97 patients with transplanted kidneys during the first year after transplantation were examined. The frequency of detection of BK and JC viruria, JC viruria and viremia was 5 (16.13 %). The frequency of BK viruria was 10 (32.26 %), isolated JC viruria – 2 (6.45 %) and ВК viruria – 1 (3.23 %), simultaneous detection of the JC і ВК viruses was observed in 3 (9.68 %). There are 12 patients with persistant ВК viruria and viremia who need to change immunosuppressive therapy. The median time to detection of persistant BK-viruria and viremia after transplantation in patients with tacrolimus was (12.29±7.16) weeks, in patients with cyclosporine was (12.29±7.16) weeks. The period for elimination of polyomavirus in patients with cyclosporine and mycophenolates included (13.00±5.13) weeks, and in patients with cyclosporine and everolimus included (7.00±2.58) weeks. This investigation revealed different patterns of the treatment of kidney transplant dysfunction caused by BK-polyomavirus infection. The first step in the treatment of BKV infection is reduction in immunosuppression. In this study, we did conversion from tacrolimus to cyclosporine or conversion from mycophenolates to everolimus with restriction of cyclosporine doses. The last strategy showed better results because period for elimination of polyomavirus was shorter.","PeriodicalId":404961,"journal":{"name":"Медицина сьогодні і завтра","volume":"115 3","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114000885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dynamic study of concentrations of inflammatory and anti-inflammatory interleukins in patients with neck injuries","authors":"M. Sizyi","doi":"10.35339/msz.2019.84.03.01","DOIUrl":"https://doi.org/10.35339/msz.2019.84.03.01","url":null,"abstract":"The cytokine status was studied in 64 patients with neck injuries and damage to internal structures. Severe trauma causes damage to the protective barriers of the organism and activates immunological reaction. Among substances secreted during this process pro-inflammatory cytokines are of high importance. It is shown, that monitoring of cytokine status (IL-6, IL-8, IL-10, TNFα) in the acute period of trauma had been having important clinical, prognostic and diagnostic values. A dynamic study of the concentrations of pro-inflammatory and anti-inflammatory interleukins during the first ten days in patients, together with clinical data, made it possible to change the routine treatment tactics and optimize the terms and scope of surgical care. The TNFα is a reliable indicator of a developing infectious complication and takes a chance to change antibacterial or anti-inflammatory therapy and improve effects of therapy.","PeriodicalId":404961,"journal":{"name":"Медицина сьогодні і завтра","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133829606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of family anxiety in women with depressive disorders of different genesis and macrosocial, mesosocial and microsocial maladaptation of different expression","authors":"R. Isakov","doi":"10.35339/MSZ.2019.84.03.10","DOIUrl":"https://doi.org/10.35339/MSZ.2019.84.03.10","url":null,"abstract":"252 women with depressive disorders were examined: 94 people were with psychogenic (prolonged depressive reaction caused by adjustment disorder), 83 women were with endogenous (depressive episode; recurrent depressive disorder; bipolar disorder, current episode of depression) and 75 patients were with organic depression (organic affective disorders). 48 women had no signs of psychosocial maladaptation, the remaining 204 had manifestations of macrosocial, mesosocial and microsocial maladaptation of varying severity. The features of family anxiety in women with depression of various origins and different severity of macrosocial, mesosocial and microsocial maladaptation were investigated in order to determine the target targets of differentiated psychosocial rehabilitation of patients in this contingent. Clinical-psychopathological and psychodiagnostic methods were used. There was revealed a general tendency towards an increase in the indicators of family guilt, family anxiety and family tension as the degree of macrosocial, mesosocial and microsocial maladaptation increased. At the same time, the greatest differences in indicators were observed between the groups with moderate and severe maladaptation, and the smallest differences were observed between the groups without signs of disadaptation and with signs of mild maladaptation. The data obtained should be taken into account when developing treatment and rehabilitation measures for patients of this contingent.","PeriodicalId":404961,"journal":{"name":"Медицина сьогодні і завтра","volume":"53 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128484231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiac masks of hypothyroidism","authors":"N. Piriatinska, L. Saprichova, V. Y. Vdovichenko, N. Klochko","doi":"10.35339/msz.2019.84.03.06","DOIUrl":"https://doi.org/10.35339/msz.2019.84.03.06","url":null,"abstract":"Hypothyroidism is a common condition of thyroid hormone deficiency that is easily diagnosed and corrected. But often the symptoms of thyroid insufficiency are nonspecific and similar to other somatic diseases, especially in older patients, which causes difficulties in timely diagnosis and treatment. Monosymptomatics often leads to an erroneous diagnosis, these are the so-called therapeutic «masks» of hypothyroidism. The article discusses a clinical case of late diagnosed hypothyroidism occurring under a cardiological mask was reviewed. Patient treatment for cardiovascular failure did not bring the expected result. Additional diagnostics revealed autoimmune thyroiditis, primary hypothyroidism, severe course. To correct thyroid function, the patient was prescribed L-thyroxine, which led to the disappearance of symptoms from the cardiovascular system.","PeriodicalId":404961,"journal":{"name":"Медицина сьогодні і завтра","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126018931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biliary system functional condition in patients with chronic cholecystitis against the background of diabetes mellitus type 2","authors":"L. Zhuravlyova, G. Tymoshenko","doi":"10.35339/msz.2019.84.03.05","DOIUrl":"https://doi.org/10.35339/msz.2019.84.03.05","url":null,"abstract":"Overlay of diseases of the biliary system to diabetes mellitus type 2 can contribute to the enhancement of disorders of protein, lipid and carbohydrate metabolism and affect the mechanisms of regulation at the cellular molecular level. Therefore, the need for early diagnosis and study of the features of the course of chronic cholecystitis against the background of diabetes mellitus type 2 is a pressing issue of internal medicine. The motor-evacuation and cholecretory functions of the biliary system and the features of the course of chronic cholecystitis on the background of diabetes mellitus type 2 were studied. 93 patients were examined, of which 62 were patients with combined diabetes mellitus type 2 and chronic cholecystitis and 31 patients with isolated chronic cholecystitis. The control group was represented by 20 apparantly healthy individuals, who were representative of the age and number of male and female probands. The course of chronic cholecystitis was found to be accompanied by impaired gallbladder motor (evacuation) function, which was manifested by an increase in the latency period, the volume of the cavity of the gallbladder, the emptying coefficients in the dynamics and a decrease in the index of contraction of the gallbladder. In the presence of diabetes mellitus type 2, an atypical course of chronic cholecystitis may be formed, characterized by motor-evacuation disorders of the biliary tract and physico-chemical changes in bile, the severity of which exceeds those of isolated chronic cholecystitis. The peculiarities of the course of chronic cholecystitis in patients with diabetes mellitus type 2 are manifested by insignificant clinical symptoms and distinct changes at both stages of cholecystosonography, which may be the result of the development of autonomic neuropathy. In diabetes mellitus type 2, it is advisable to determine the status of the gallbladder (cholecystosonography) in order to prevent the risk of complications (cholelithiasis) and timely administration of antimicrobial therapy in the presence of an additional inflammation.","PeriodicalId":404961,"journal":{"name":"Медицина сьогодні і завтра","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130560468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Structure and severity of pathological anxiety response in the representatives of the command staff of the merchant and passenger navy","authors":"K. Kosenko","doi":"10.35339/msz.2019.84.03.11","DOIUrl":"https://doi.org/10.35339/msz.2019.84.03.11","url":null,"abstract":"During 2016–2019, 180 navy commanders of Ukraine were surveyed: 110 members of the merchant navy command staff and 70 members of command staff of the passenger navy. All surveyed were male, citizens of Ukraine. Clinical-psychopathological and psychodiagnostic methods were used for studying the specific manifestations of anxiety response of the command staff of the merchant and passenger navy, to determine the need to create system-specific measures for the protection of their mental health. It is shown that more than half of the representatives of the command staff of the merchant (69,1 %) and passenger (57,1 %) navy have signs of mental maladaptation, which in most cases do not reach clinically outlined severity. A significant number of command personnel of both the merchant and passenger navy have manifestations of pathological alarming responses and alarming symptoms, predominantly of moderate intensity. In the commanders of the merchant navy more intense manifestations of alarming symptoms are observed, the average severity of which is approaching the upper limit of subclinical values, in representatives of the passenger navy the average severity of alarming symptoms is approaching to the upper limit of the standard indicators. A lower indicator of alarming symptoms among commanders of the passenger navy is due to a significantly larger number of persons without signs of mental maladaptation, while a significantly increased level of alarming response of merchant navy captains is due to a large number of respondents with preclinical maladaptive manifestations. The data obtained should be taken into account in the development of specific measures of psychotherapy and psychoprophylaxis for this contingent, which is the perspective of this study.","PeriodicalId":404961,"journal":{"name":"Медицина сьогодні і завтра","volume":"98 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116642026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Topographic and anatomical features of the sulci structure of the brain's occipital lobe medial surface","authors":"O.O. Trach, D. Shyian, А.О. Tereshchenko, I.V. Ladna","doi":"10.35339/msz.2019.84.03.02","DOIUrl":"https://doi.org/10.35339/msz.2019.84.03.02","url":null,"abstract":"The complex of macromicroscopic methods has revealed the features of the sulci structure of the brain’s occipital lobe medial surface. Macromicroscopic, morphometric, topographic and anatomical, statistical and mathematical analysis were used. The sulci of the medial surface of the brain's occipital lobe are classified into permanent, typical and non-permanent. The complex of anatomical structures of the medial surface of the brain's occipital lobe includes the parietooccipital sulcus, calcarine sulcus, cuneus, calcarine spur, additional sulci. The parietooccipital and calcarine sulci are divided into segments: posterior (distal process), anterior (proximal process), common (common area). The parietooccipital sulcus is connected to the anterior end of the calcarine sulcus at 98,5 %. The length of the parietooccipital sulcus is min 16,0 mm and max 58 mm, M=35,8 mm, depth is min 9,0 mm and max 43,0 mm, M=24,3 mm. It was found that in 35 % of cases, the posterior end of the calcarine sulcus does not reach the apex (angle) of the occipital lobe of the brain by min 2,0 mm and max 14,0 mm, M=7,8 mm. In 43 % the posterior end of the calcarine sulcus bifurcates. The distance between the posterior end of the calcarine sulcus and the upper end of the parietooccipital sulcus is min 18,0 mm and max 64,0 mm, M=39,8 mm. The length of the calcarine sulcus is min 37 mm and max 79 mm, M=54 mm. The depth of the anterior part of the calcarine sulcus is min 8,0 mm and max 36,0 mm, M=20,7 mm; the depth of the posterior part is min 5,0 mm and max 22,0 mm, M=12,8 mm.","PeriodicalId":404961,"journal":{"name":"Медицина сьогодні і завтра","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121755135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Morphological changes in the walls of varicose veins of the lower extremities during minimally invasive surgical treatment","authors":"E.G. Cherkasheninov","doi":"10.35339/msz.2019.84.03.03","DOIUrl":"https://doi.org/10.35339/msz.2019.84.03.03","url":null,"abstract":"The vein wall was investigated in the treatment of patients with varicose veins by endovenous laser and radiofrequency ablation. Fragments of removed veins with varicose veins served as material for pathomorphological research. The following histological staining methods were used: hematoxylin and eosin, van Gieson’s picrofuchsin with additional staining on elastica, according to Mallory. It has been shown, that with varicose veins of the lower extremities, pronounced irreversible morphological changes develop in the vein wall in the form of damage to endothelial cells, hypertrophy of all layers of the vein wall, total development of connective tissue in it with impaired collagen structure both in the basement membrane of endothelial cells and in muscle and elastic layers. Changes in the structure of collagen in the vein wall can be traced in all studied groups, which seems possible, since the treatment with minimally invasive methods is carried out against the background of already altered venous trunks. At the same time, injuries in the vein wall are most pronounced when using endovenous laser coagulation of veins and are accompanied by frequent pain in the postoperative period. The latter is confirmed by morphological changes in the form of total necrosis of the vein wall with necrosis and complete desquamation of the endothelium into the lumen of the vessel. Damage to the wall of the vein of the lower extremities, altered by a chronic current process with varicose veins, including its endothelium and all layers, is minimized when using radiofrequency ablation. Accordingly, cicatrization of surrounding fabrics in the zone of action of radiofrequency ablation will pass in more short spaces and with a favourable end for a patient, that it is confirmed by the less number of paresthesias and sickliness on motion a vein in a postoperative period.","PeriodicalId":404961,"journal":{"name":"Медицина сьогодні і завтра","volume":"152 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116913429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anticoagulant therapy in patients with stenosis of the carotid arteries with rhythm disturbance","authors":"I. Pulyaeva","doi":"10.35339/msz.2019.84.03.14","DOIUrl":"https://doi.org/10.35339/msz.2019.84.03.14","url":null,"abstract":"The results of examination and treatment by carotid endarterectomy method in 23 patients with atrial fibrillation and lesions of the carotid arteries in the State Institution «V.T. Zaitsev IGES NAMSU» from 2017 to 2019. Antiplatelet agents (aspirin were prescribed in 20 patients, clopidogrel were prescribed in 3 patients) were prescribed due to the presence of cardiovascular disease and previous myocardial infarction. No patient was found to have impaired cerebral circulation in the postoperative period. Tension hematoma was diagnosed in two patients and bleeding from soft tissues, which required revision of the postoperative wound with hemostasis, in one. It has been shown that patients with hemodynamically significant stenosis and unstable plaque of the carotid arteries most often develop atherothrombotic stroke. Patients with stenosis of the carotid arteries and rhythm disturbances should receive antiplatelet and anticoagulant therapy with blood pressure correction in the absence of bleeding.","PeriodicalId":404961,"journal":{"name":"Медицина сьогодні і завтра","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115320709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complications of intramedullar blocking osteosynthesis","authors":"A. Mansyrov, V. Litovchenko, N. Berezka, Yevgenеy Gariachy","doi":"10.35339/msz.2019.84.03.16","DOIUrl":"https://doi.org/10.35339/msz.2019.84.03.16","url":null,"abstract":"The complications of intramedullary blocking osteosynthesis of diaphyseal fractures of the limb bones due to tactical errors, as well as ways of preventing them, have been identified and summarized. Typical tactical errors of intramedullary blocking osteosynthesis were: application of the method against indications, violation of the osteosynthesis technology and the use of inadequate «author’s» techniques, introduction of own intraoperative “corrections” and change of course of the surgical intervention, excessive reaming of the medullary canal, significant intraoperative trauma of bone fragments and soft tissues, the wrong type of blocking or untimely dynamization, lack of continuity in medical rehabilitation. The most negative impact on the anatomical restoration of the bone and the functional restoration of the limb has the reaming of the medullary canal, performed without appropriate indications and with technical errors.","PeriodicalId":404961,"journal":{"name":"Медицина сьогодні і завтра","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129614750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}