Vol 10, No 3 (2017)

Objective. To analyze the survival of patients with liver cirrhosis and to assess the effectiveness of endoscopic interventions in the prevention of portal genesis bleedings.

Materials and methods. To assess the effectiveness of endoscopic interventions, our study included 449 liver cirrhotic patients with portal hypertension who was admitted with bleeding from varicose veins or the threat of its recurrence for the period from 1996 to 2015. All patients were divided into 2 groups of the study. The main group included 239 patients treated between 2010 and 2015 and the control group consisted of 210 patients in the period from 1996 to 2010.

Results. The analysis showed that the percentage of patients without recurrence of bleeding from varicose veins was 27% (33 patients) in the control group and 54.2% (64) in the main group when performing only endoscopic interventions. With the phased tactics of portosystemic shunt performance after endoscopic interventions this figure amounted to 32.4% (45) and 109 (61.6%). In the structure of mortality of patients without cirrhosis in the long-term period (81 patients) with endoscopic interventions recurrence of bleeding were observed in 40.7% (33) cases in the control group and 68.1% (64 of 94) in the main group. In turn, when combined endoscopy and portosystemic shunting in the structure of the patients, without counting deaths from progressive liver cirrhosis, the proportion of absence of recurrence was 45.9% (in 45 of 98 patients) and 71.2% (in 102 out of 153 tracked in the remote period excluding deaths from cirrhosis). In the group of patients that do not carry out any endoscopic intervention and the patients received only conservative therapy only in 3 (10.7%) cases it was possible to avoid recurrence of bleeding, which determines the therapeutic ineffectiveness isolated attempts to reduce the risk of recurrence of hemorrhagic syndrome.

Conclusion. Modern possibilities of endoscopic technologies have significantly improved the results of treatment and prevention of varicose bleeding or the threat of its recurrence, and the commitment to the phased tactics, with a combination of minimally invasive and traditional decompressive surgery, allowed to increase the survival rates of patients with 80% to 88% - up to 1 year and from 42% to 64% - to 3 years of follow-up.

Introduction: Pheochromocytoma is one of representative of neuroendocrine tumors. According this fact, pheochromocytoma remains to evaluation for multiply endocrine neoplasia, especially if disease is bilateral. In this case, it is necessary to additionally carry out a genetic screening test.

The aim of the study is to Improve diagnosis and treatment outcomes for patients with MEN syndrome.

Materials and methods: The authors present a clinical case of a 37-year-old man diagnosed and treated for a bilateral pheochromocytoma.

Results: The patient was diagnosed medullary thyroid cancer after successful bilateral adrenalectomy. The patient underwent thyroidectomy. A genetic research showed the T1900 mutation in the codon of 634 RET gene, which confirmed the presence of the patient MEN 2 syndrome. According to the high concordance of the mutated gene, patient's son was carried out to genetic examinations, which confirmed the presence of this mutation. The boy underwent thyroidectomy opportunely.

Discussion: Due to primary oncological observation if the patient has pheochromacytoma, it is necessary to exclude MAN 2 syndrome both in the patient himself and his relatives. The safest and informative method is genetic research.

Conclusion: presently a comprehensive examination of both the patient himself and his relatives is necessary for timely diagnosis and correct management of treatment patients with MEN 2 syndrome.

Relevance. Despite of a specific prophylaxis, the thromboembolic complications occur in 20-25% of patients after orthopedic surgeries. In those who do not receive the prophylaxis the complications rate is even higher taking up to 45-70% thereby putting the complications into second place after infection complications.

Objective. To compare the efficacy and safety of dabigatran etaxilate and rivaroxaban in prophylaxis and treatment of the venous thromboembolism after hip and knee arthroplasty.

Materials and methods. An analysis of prophylaxis and treatment of venous thromboembolism in 104 patients who had had hip and knee arthroplasty has been accomplished. All patients were randomized into two groups. 51 patients were enrolled into the first (control) group where 220 mg per day dabigatran etexilat therapy was used. The second (investigated) group included 53 patients who received 10 mg per day rivaroxabane therapy. A year after surgery the quality of life of patients was assessed using CIVIQ-20 and SF-36 questioners.

Results and their discussion. Venous thromboembolic complications had occurred in 18 (17,3%) of patients equally in the first and second group. Isolated common femoral vein thrombosis was found in 8 (7,7%), and in 3 (2,9%) patients it was associated with pulmonary embolism. Popliteal and tibial vein thrombosis was detected in 7 (6,7%) patients. Internal bleeding complications were found in 9 (8,6%) patients with venous thrombosis. The complications were more common in a second group (higher by 1,7%). In 7 (6,7%) cases the complications had no clinical significance. Only in 2 (1,9%) patients (one case in each group) were documented severe hemorrhages, that needed hemostatic therapy. A year after surgery the quality of life of patients was assessed using specifically oriented CIVIQ-20 and SF-36 international questioners for chronic venous insufficiency. The evidence based differences between two groups were not discovered.

Conclusion. Dabigatran etexilate as well as rivaroxaban can be used for prophylaxis of the venous thromboembolism after orthopedic surgeries.

Summery. Introduction. The research devoted to the study of pathogenetic, immunological, and biophysical aspects of the tissue regeneration process with wound defects of various etiologies is gaining in popularity in the "world" of medical science, at present this problem remains topical [1, 2, 6, 8, 9]

Purpose of the study. A comparative analysis of the dynamics of morphological manifestations of tissue regeneration occurring when recombinant interferon α2b, is used in the healing of an acute experimental wound is carried out.

Materials and methods. Depending on the nature of the wound treatment, the experimental animals were divided into two groups: 1) a comparison group in which the edges of the wound were struck with a 0.9% NaCl solution; 2) the main group, where a similar edge of the wound defect was cut off with recombinant interferon α2b at a dose of 1000 ME / 1ml diluted with 0.9% NaCl solution. The rats were removed from the experiment on the 4th, 8th and 20th day of the study, while a full-thickness skin flap was taken in the area of the scar (defect), which was examined by light microscopy. At the same time, the intensity of formation of the granulation tissue, its "maturation", and also in the margins and on the bottom of the wound was estimated in the absolute values, the cellular populations realizing the process of inflammation were determined.

As a result of the study, the character of the complex effect of recombinant interferon α2b was established, which included reduction of the negative effect of secondary alteration, differentiation of the intravascular immune response, formation of conditions for natural regeneration with activation of angiogenesis and synthesis of a valuable scar, decrease in propensity to keloidosis.

Conclusions. The obtained results testify to the morphological validity of the use of recombinant leukocyte interferon α2β as a stimulant of the inflammation phase, as against the background of the use of this substance, its ability to enhance phagocytosis was noted.

Relevance. The number of elderly patients with acute cholecystitis is constantly increasing, in spite of the success achieved in the diagnosis and treatment of this pathology. The possibilities for radical treatment of patients with high operational anesthesia risk are substantially limited.

The aim of the study was to conduct comparative analysis of the quality of life of patients after transcutaneous-transhepaticmicrocholecystostomy and traditional cholecystostomy with thermal mucoclasia of the gallbladder.

Materials and methods. The quality of life of 31 patients with high operational anesthesia risk following transcutaneous-transhepaticmicrocholecystostomy (TTMC) and traditional cholecystostomy with thermal mucoclasia of the gallbladder (TCTMG), was studied. All patients were divided into two groups: the first group consisted of 20 (64.5%) patients who underwent TTMC, the second one included 11 (35.5%) patients who underwent TCTMG. Quality of life of patients was studied with the help of the questionnaire using the SF-36 Health Status Survey 4 months after TTMC or TCTMG. Statistical processing of the results was carried out using the program Microsoft Office Excel -2013.

Results and its discussion. The physical component of health (physical functioning, role functioning due to physical condition, pain intensity, general health) was 64.25% higher in patients of Group II than in patients of Group I (p = 0.001), and the psychological Health component (mental health, role functioning due to emotional state, social functioning, vital activity) was also (68.05%) higher in Group II (p = 0.004).

Conclusions. The use of the method of thermal mucoclasia of the gallbladder in patients with high operational anesthesia risk allows to achieve higher quality indices compared to patients who underwent TTMC, since after demucotization of the gallbladder cavity it is obliterated due to hyperplasia of the connective tissue of the lamina propria or submucosa, thereby finally solving the problem of acute cholecystitis in this category of patients.

The concept of "metabolic syndrome" in ophthalmology can include the entire set of interrelated metabolic abnormalities predisposing to the development of vitreoretinal complications of type 2 diabetes and coronary heart disease (CHD). Based on the definition, the researches of local changes in markers of metabolic processes, particularly in complicated cataract, are relevant for the prediction of the results of surgical treatment. Such a method for detecting marker proteins in tear was introduced by us in clinical practice for the differential diagnosis of local changes in metabolism in complicated (cataract caused by changes of the lens in response to background disturbances of metabolism) and age-related cataract. The mechanism of development of complicated cataracts is similar to cataractogenesis with age-related cataracts, but in complicated cataract processes of change in the lens is more intensive and faster under the influence of a violation of the immunological balance, oxidative processes and biochemical changes that occur in the body and locally on a background of concomitant diseases and diseases of the eye.

At the present stage it is believed that one of the triggers is cataractogenesis depletion of the antioxidant capacity of the lens and the development of oxidative stress. This manifests itself in the early stages cataractogenesis fluctuations in the level of glutathione in the lens and the accumulation of free radical oxidation products. Following this, a reduction in the number of negative charges on the main protein of lens fiber - crystallin. This fact is interpreted as a violation of protein phosphorylation within the fibers of the lens due to discoordination cascade regulation systems due to their free radical damage. In turn, decrease the water solubility of proteins leads to the adsorption of proteins on the uncharged cell membranes, resulting in increasing lens violation regular stacking membranes. Light scattering by surfaces of folded membranes lens fiber is considered as the main cause of lens opacity with cataract.

We examined 136 patients with cataracts of various origins (272 eyes) aged 62 ± 3,2 years. Among those surveyed were women (74 people). All patients underwent detailed clinical, ophthalmological examination of the complex and as a result were divided into groups with a diagnosis of cataracts of

various origins. We have developed an algorithm for determining the prognosis of outcome of surgical intervention in the oxidative stress on the content of antioxidant enzymes tears justified selective choice of preparations of local and systemic antioxidant action to prevent and stabilize the clouding of the lens.

The greatest number of complications arise in the extraction of complicated cataract, because its development is already associated with the presence of an underlying disease (a disorder of metabolism, endocrine disorders), additional ocular pathology (uveitis syndrome Fuchs, secondary glaucoma), the influence of external factors. This kind of state characterized by the presence of pathological changes in the immune, circulatory system, metabolic disorders, entailing and cause various postoperative complications (hyphema, postoperative iridocyclitis, exudative inflammatory response (EVR), epithelial-endothelial corneal dystrophy, macular edema with the outcome in macular degeneration). It becomes apparent that the creation of methods of forecasting and prevention of post-operative complications, as well as specific algorithm scheme of preoperative preparation, at various kinds of complicated cataract, is an important and urgent problem of modern ophthalmology.

Barnard (Barnard) Christian Nettling South African surgeon, performed the first successful heart transplant man, he was born in 1922 in Beaufort West in South Africa. In 1940 he graduated from school in 1946, the medical faculty of the University of Cape town. In 1953 he received the degree of doctor of medicine at the medical school of the University of Cape town. In 1956, he studied cardiac surgery in the US, where in 1958 he received the degree of doctor of medicine. After returning to South Africa K. Barnard was appointed cardiothoracic surgeon, and soon the head of surgical research, Department of cardiothoracic surgery at the clinic of the University of Cape town. In the October 1959 Christian Bernard is the first in Africa performed a successful kidney transplant. In 1962 he held the post of assistant Professor in the Department of surgery of the University of Cape town. December 3, 1967 K. Barnard and his colleagues have performed the first successful orthotopic transplantation of the human heart. In 1972 he was appointed Professor of surgical Sciences at the University of Cape town. In 1974 K. Barnard produced the world's first heterotopic heart transplant man. In 1981 he developed the patronage system of the heart by conducting hypothermic perfusion. In 1983, K. Barnard, resigned. He is the author of the autobiographical book "One life" (1970), published in co-authorship with Z. Stander anti-racist novel "Undesirable elements" (1974). Christian Barnard died on 2 September 2001, Paphos, Cyprus.