Vol 97, No 2 (2016)

Aim. To assess the effectiveness of the original puncture transvenous temporary endocardial springy electrode use in patients with myocardial infarction complicated by bradyarrhythmias.

Methods. The study included 126 patients with myocardial infarction complicated by acute bradyarrhythmias. The original endocardial electrode was used in 38 patients (main group). Temporary artificial heart rhythm control was performed using endocardial springy temporary puncture electrode in 88 cases of bradyarrhythmias (control group). Written informed consent was taken from all patients who underwent the procedure, and in the absence of contact with the patient decision to perform temporary cardiac pacing was made by a council of physicians.

Results.. Spontaneous pacing interruption occurred in 13 patients of the main group and 32 control group patients at various times of the artificial pacing. Thanks to the used original electrode constructional features, fatal cases were prevented in 11 (84.6%) patients of the main group. In 9 of 32 patients of the control group with impaired pacemaker, cardiac pacing was restored by the electrode re-fixation to the heart right ventricular endocardium. In 23 patients of the control group artificial rhythm was restored by the method of endocardial electrode reposition. The number of patients with a spontaneous interruption of temporary artificial heart rhythm control had a strong correlation with the number of patients with the identified new changes in the electrocardiogram (ST segment elevation with acute recurrent myocardial infarction; r=0.84, p

Conclusion. In case of spontaneous interruption of temporary cardiac pacing caused by the loss of myocardial electrical conduction function in the area of the contact with the electrode, for effective and safe fatal cases prevention endocardial electrodes of the original design use is recommended.

Aim. To assess the endothelial dysfunction degree in patients with ulcerative colitis, depending on the disease attack severity, the pathological process spread, the presence of systemic manifestations, complications, and endoscopic activity of the process.

Methods. 45 patients with an established diagnosis of «ulcerative colitis» in the exacerbation phase and with newly diagnosed disease forms were examined. The control group included 11 apparently healthy people. As endothelial dysfunction markers vascular endothelial growth factor levels in serum and blood plasma desquamated endothelial cells amount were studied.

Results.In the group of patients with ulcerative colitis a statistically significant increase in levels of endothelial dysfunction markers (the vascular endothelial growth factor content was 506.40±287.00 pg/ml, the plasma desquamated endothelial cells number - 6.47±4.22×104/L) was found compared with the control group (p

Conclusion. In patients with ulcerative colitis endothelial dysfunction, correlated with disease activity and severity markers, was revealed; vascular endothelial growth factor levels and plasma desquamated endothelial cells number can serve as the ulcerative colitis severity criteria, as well as a sign of unfavorable disease course.

Aim. To approbate method of endoscopic removal of esophagus and stomach polyps using a ligation device.

Methods. During the period from 2013 to 2015, 37 endoscopic polyps removal using the variceal band ligation device «G-Flex» (Belgium) were performed to 34 patients (26 women and 8 men) aged 17 to 68 years. Removed polyps size ranged from 5 to 11 mm. Polyps localization was as follows: esophagus abdominal part and stomach cardia - 7 (19%), stomach subcardial part - 2 (5%), stomach body - 19 (52%), antrum - 9 (24%). Before polyps removal, lesions biopsy and gastric juice acidity determination were performed to all patients, in 45% of cases endosonography was performed. According to the histological study results, hyperplastic polyps were detected in 5 (15%) patients, adenomatous polyps - in 29 (85%). In 2 patients the endosonography results revealed submucosal lesion, coming from the mucous membrane muscular layer.

Results. Technical possibilities of the esophagus and stomach polyps endoscopic removal using variceal band ligation device, depending on the lesion location and size, were evaluated. In all cases, regardless of the focus localization and the comorbidity severity, a successful technical surgery performance was achieved in the absence of complications and symptoms recurrence in the early and late postoperative periods. Method advantages and disadvantages, indications for its performance in the inpatient and outpatient settings are revealed.

Conclusion. In certain indications and performance technique adherence, the esophagus and stomach polyps endoscopic removal using variceal band ligation device is a safe and radical method of upper gastrointestinal tract benign epithelial lesions treatment.

Aim. To analyze the relationship of osteoporosis in reproductive age patients with breast cancer with the pain severity and osteoporosis diagnosis improvement in these patients to improve their quality of life.

Methods. The study included 63 women aged 30 to 50 years. The studied group consisted of 33 women with confirmed diagnosis of breast cancer, control group - 30 healthy, same age women of comparison group. The examination included a blood test for osteocalcin, calcitonin, alkaline phosphatase, parathyroid hormone, thyroid stimulating hormone, calcium and phosphorus. The pain severity was evaluated by McGill pain questionnaire and pain syndrome classification. Osteodensitometry was performed to all patients of studied and control groups. All patients with «breast cancer» diagnosis were examined prior to specific treatment administration and 6 months after treatment course completion. 12 patients were examined also after neoadjuvant chemotherapy.

Results.Osteopenia (initial changes of bone tissue) was revealed in 3 (10%) cases in the control group. There was no cases of osteoporosis in the control group. Clinical manifestations in the form of the 1st level pain syndrome in healthy women was registered in 6 (20%) cases. Osteoporosis develops more often in patients who underwent complex treatment with ovarian function blocking, i.e. the artificial menopause advent. Osteoporosis in breast cancer patients after combined treatment was detected in 69.7% of cases, and pain - in 75.8% of cases. Bone mineral density indicators during treatment and after it were significantly different compared to those before treatment (p

Conclusion. In breast cancer in reproductive age patients after the complex treatment, osteoporosis and pain often develop, therefore such patients need to undergo osteodensitometry for timely osteoporosis diagnosis and treatment correction.

Aim. To conduct a comparative analysis of used anesthesia methods in patients with acute pancreatitis in intensive care units settings using pain scales.

Methods. Depending on the anesthesia type, 44 patients with acute pancreatitis were divided into three groups: the first group received intramuscular injections of nonsteroidal anti-inflammatory drugs and spasmolytics, the second group - intramuscular injections of non-steroidal anti-inflammatory drugs and opioid analgesics, the third group - epidural anesthesia with local anesthetics. Comparative analysis of pain character, intensity was conducted, its dynamics in patients of all groups amid anesthesia was evaluated using a visual analogue scale, verbal rating scale, verbal descriptor scale, McGill pain questionnaire.

Results. Baseline pain intensity in patients of all groups was high. Patients estimated this pain as «very strong». The time and the level of pain intensity reduction for various anesthesia types had differences. Pain syndrome was eliminated slower in patients of the second group. By the end of the 1st day, patients of this group continued to complain of «strong» pain. Pain intensity decreased only on the 2nd day - patients reported «moderate» pain. Pain syndrome was not completely eliminated in these patients for 2 days of anesthesia. 97.7% of patients reported that the visual analogue scale is the most acceptable pain assessment scale for them.

Conclusion. In patients with acute pancreatitis, the most optimal anesthesia types are intramuscular nonsteroidal anti-inflammatory drugs with spasmolytics and prolonged epidural anesthesia with local anesthetics; intramuscular administration of opioid analgesics with non-steroidal anti-inflammatory drugs is less effective in relieving pain.

Aim. To study immune system state, hemostasis system, the neuropeptide level (substance P) and their interrelation in respiratory diseases in frequently ill children.

Methods. 340 frequently ill children, 125 rarely ill children and 30 apparently healthy children aged 6 months to 6 years were studied in the acute period of the disease, and in the period of clinical remission. Diagnosis was made on the basis of medical history, clinical signs, instrumental and laboratory assessment results. CD3+, CD4+, CD8+, CD19+ lymphocytes count, serum immunoglobulin classes A, G, M, E levels, interleukin-1β, -2, -6, -8, tumor necrosis factor α, substance P were determined.

Results. Strong negative correlation was revealed between the CD4+-cells level, interleukin-2, interferon γ and hemostasis system parameters. Substance P, interacting mainly with interleukin-1β and -2, CD4+-cells, interferon γ, indirectly interacts with the hemostasis system. In recurrent obstructive bronchitis and complicated acute pneumonia course substance P content increase was higher (4.6-fold compared with healthy children). The fact that the immune system indicators, including cytokine status, substance P and hemostasis system do not normalize during respiratory disease clinical remission in frequently ill children indicates the infection persistence, the inflammatory process continuation during clinical remission.

Conclusion. Along with the immune system, the nervous system and hemostasis system play an important role in respiratory diseases severity in frequently ill children, their complications, prolonged duration, recurrence and transition into a chronic condition.

Aim. To determine the effectiveness of indirect antibiotics and lymphotropic therapy for the systemic inflammatory response syndrome correction in patients who underwent abdominal surgery.

Methods. There were two groups with systemic inflammatory response syndrome in the postoperative period: 212 patients with various diseases of the abdominal cavity, who received conventional systemic complex therapy, and 146 patients whose complex treatment included antibiotics and lymphotropic therapy (administration of the cephalosporin antibiotics with lymphotropic mixture into the tibia subcutaneous tissue with the prior venous stasis creation). In both groups, patients with destructive forms of cholecystitis and appendicitis complicated by local or general peritonitis dominated. The dynamics of systemic inflammatory response syndrome clinical indicators, as well as laboratory parameters were assessed: the white blood cells count, leukocyte intoxication index, C-reactive protein and blood albumin. The data obtained on the 1st, 3rd and 5-6 days after surgery were analyzed.

Results. In both groups clinical and laboratory symptoms positive dynamics was noted, which was more pronounced in the main group. In the control group leukocyte intoxication index increased on the third day and then decreased, but did not reach normal values on 10th day, while in the main group leukocyte intoxication index decreased already on the third day with its full normalization to 10th day. A faster normalization of white blood cell count, albumin level and C-reactive protein concentration decrease are also observed in the main group. Using indirect lymphotropic therapy was associated with reduction of postoperative complications and lethality rates.

Conclusion. Lymphotropic therapy is an effective method of the systemic inflammatory response syndrome correction and can be recommended for the postoperative management of patients with abdominal surgery.

Aim. To study the effect of L-arginine and its analogue N-nitro-L-arginine methyl ester (L-NAME) alone and in combination on lysosomal cysteine proteolysis and lysosomal membranes state in rat aorta.

Methods. The study was performed on male Wistar rats kept under standard vivarium conditions and divided into three control and three experimental groups of 8 animals each. The experimental samples included groups with L-arginine and/or L-NAME administration. The indicators were studied in the rat aorta homogenate precipitating and non precipitating fractions. Acid phosphatase activity was determined by a standardized method of «end point», the cathepsins B, L and H activity was studied by spectrofluorimetric method.

Results. When simulating the changes of nitric oxide synthesis level using L-arginine, the increase of the total cathepsins activity was detected, acid phosphatase lability coefficient was reduced, what is characterized by general lysosomal membranes stabilization. L-NAME group, in contrast, is characterized by a decrease in the cathepsin B and H activity indicators, differences from arginine group were observed in the cathepsin H in lysosomal and general fractions, lysosomal membrane is labile. Combined drugs administration reduces the total cathepsins activity, while there is an increase of the acid phosphatase total activity, all indicators suggest lysosomal membranes labilization.

Conclusion. L-arginine at a dose of 500 mg/kg causes increase in the total cathepsins B, L and H activity in rat aorta due to lysosomal fraction; L-arginine action leads to lysosomal membranes stabilization; L-NAME group in cathepsin H shows a decrease in the cathepsins secretion level with decreased total activity due to both factions; combined administration of arginine + L-NAME group in cathepsin B is characterized by an increase in secretion due to lysosomes membrane labilization.