Vol 93, No 6 (2012)

In many countries of the world mean life expectancy has lately significantly increased from 50 to 70-80 years. Twin studies have shown that genetic differences account for about 25% of the variance in adult human lifespan. However, the association with the life expectancy was proven for the only candidate gene - apolipoprotein gene, playing a great role in regulating lipoproteins metabolism. E2 allele of this gene is much more prevalent compared to E4 allele in people over 100. In animal models, single-gene mutations in genes involved in insulin/insulin-like growth factor-1 abnormal activation pathway and target of rapamycin signaling pathway have considerably extended the lifespan. The key link in regulating the insulin/insulin-like growth factor-1 abnormal activation pathway is the human forkhead box O3A transcription factor. A clear rel ationship between the lifespan and GG genotype of this gene in Japanese, German and French population was found. However, although candidate longevity genes are defined, their effects on the lifespan are still to be confirmed. Questions of gene products’ mutual influence and gene penetration are still undecided. Ethnical and geographical associations of different polymorphic alleles with aging and longevity are not completely clear. Therefore, further search and genetic and phenogenetic markers examination determining the lifespan is needed. Na+-Li+-сountertransport speed in the erythrocyte membrane, which is a genetically determined intermediate phenotype, may be one of those markers.

Aim. To perform a comparative analysis of multispiral computed tomography, echocardiography and myocardial perfusion scintigraphy in the evaluation of left ventricular mass. Methods. The study included 44 patients (15 female, 29 male) aged of 21 to 73 years (mean age was 55±11 years). Left ventricular mass was assessed by noninvasive multispiral computed tomography coronary angiography using the 64-slice «Aquillon 64» (Toshiba, Japan) scanner. Echocardiographic evaluation was performed on the «Vivid-7» (GE, USA) ultrasound system. Scintigraphic analysis of left ventricular mass was performed on the single-detector gamma camera «Millenium-MPR» (GE, USA) using the «4-D MSPECT» (University of Michigan Medical Center) software. Results. A comparative analysis of left ventricular mass showed that the differences in median values were statistically significant between all the methods presented. The differences in left ventricular mass calculated using the Bland-Altman method were as follows: between multispiral computed tomography and echocardiography -32±41 gr, between multispiral computed tomography and myocardial perfusion scintigraphy «4-D MSPECT» 34±48 gr. Conclusion. Multispiral computed tomography, echocardiography, myocardial perfusion scintigraphy assess left ventricular mass differently, with myocardial perfusion scintigraphy giving the lowest and echocardiography giving the highest mass. Results gained at multispiral computed tomography lies in between the myocardial perfusion scintigraphy and echocardiography.

Aim. To develop diagnostic algorithm to predict the risk of community-acquired pneumonia development. Methods. 2000 patients with community-acquired pneumonia (male conscripts aged 18 to 22 years, mean age 19.2±0.19). A comparative analysis of two groups of patients to assess the algorithm for toxic shock syndrome, acute respiratory failure and acute kidney injury prediction was performed. In the comparison group (n=782, 1998 to 2003), prediction of complications was based on doctors’ personal knowledge and experience without using the prediction algorithms. In the main group (n=1218, 2003 to 2008), the established prediction algorithm was used. Results. The introduction of community-acquired pneumonia complications prediction algorithm allowed to decrease the incidence of such complications significantly. Toxic shock syndrome was diagnosed in 8.8% of patients in the comparison group and in 3.7% of patients of the main group (р <0.05), acute respiratory failure - in 43.1% of patients of the comparison group and in 19.5% of patients of the main group (р <0.05). The effectiveness of the algorithm for toxic shock syndrome prognosis was 90.8%, sensitivity - 91.8%, specificity - 89.7%, accuracy - 94.5%. The effectiveness of the algorithm for acute kidney injury prognosis was 90.7%, sensitivity - 90.7%, specificity - 90.8%, accuracy - 95.1%. Conclusion. Offered prediction algorithms can help a physician to suspect a possibility of potentially dangerous and lethal complications development in patients with community-acquired pneumonia at the early stages of the disease. It allows to adjust the treatment, to simplify the estimate for transportation need, to detect the indications for patients admission, including the admission to intensive care unit, and improve the results of treatment.

Aim. To improve the results of surgery on patients with hiatus hernia. Methods. Case histories of patients who underwent surgeries at the department of gastric and esophageal surgery from 1996 to 2011 were analyzed. 626 laparoscopic fundoplications in patients aged form 15 to 78 years were performed, among them - 57 using transillumination with fiber optic sensor tube. All patients were present with signs typical for hiatus hernia and gastroesophageal reflux disease (heartburn, belching, early satiety, epigastric discomfort etc.). Pre-surgical examination included X-ray and esophagogastroduodenoscopy. Most patients underwent Nissen fundoplication. The surgery duration varied from 30 to 180 minutes (mean time 65 minutes). Results. Surgical complications such as hollow organs perforation were registered in 4,3% of cases (27 cases out of 626 surgeries). No such complications were registered in group where surgery was performed using transillumination with fiber optic sensor tube. In 12 cases laparotomy for perforation closure was required, in other 15 cases perforation was closed using laparoscopy. No serious events were registered in early post-surgical period, with all patients discharged from the hospital at days 5-7. Such complications as dysphagia and gas-bloat syndrome were predominant in early post-surgical period after laparoscopic fundoplication. The incidence of the early post-surgical complications in patients who underwent surgery without transillumination with fiber optic sensor tube was: dysphagia - 28,8% (164 out of 569 patients), gas-bloat syndrome - 23,7% (135 patients). In cases when transillumination with fiber optic sensor tube was used, dysphagia was diagnosed in 1 case (1,8%), gas-bloat syndrome - in 9 (15,8%) cases. The incidence of late post-surgical complications including dysphagia, relapses and situations when fundoplication becomes undone over time: without transillumination with fiber optic sensor tube - 10,2% (58 out of 569 patients), using transillumination with fiber optic sensor tube - 3,5% (2 out of 57 patients). Conclusion. Preliminary results show that using transillumination with fiber optic sensor tube in laparoscopic fundoplication in patients with hiatus hernia reduces the incidence of post-surgical complications.

Aim. To investigate the possible relationship between content of selenium in environmental objects (soil and foods) and prevalence of tumors in the Republic of Azerbaijan. Methods. Atomic absorption spectroscopy was used for quantitative determination of selenium in soil of some economical regions of the country and in foods of every day’s local diet that are the natural nutritional sources of selenium. Serum selenium level in patients with tumors was assessed using X-ray fluorescence spectroscopy. Results. Soil and food analysis revealed low contents of selenium in them. Difference in selenium concentrations in soils from studied economic regions and in food products farmed in these regions was discovered. The serum selenium level of patients with malignancies was 37.3 μg/l (38.6 μg/l - females, 34.3 μg/l - males). There was a reverse relationship found between selenium concentrations in soils and food of the region and prevalence of tumors, as well as with serum selenium level in patients with tumors and tumor stage and malignant potential. Conclusion. The territory of Azerbaijan Republic may be considered as the region with selenium deficiency. Our research supposes that selenium deficiency can be associated with increased prevalence of malignancies in the region.

Aim. To increase the quality and access of children with a congenital pathology of maxillofacial area living in the Kemerovo region to the dental aid in the specialized center. Methods. Actions for reorganization of structure and activity of the Kemerovo Regional Center of maxillofacial area congenital pathology prevention and treatment in children were developed and an estimation of the efficiency of their introduction was performed using the most relevant indicators of medical, social and economic activity by the comparison of these indicators in two periods: 1999-2003 and 2005-2009. Also the quality of life of over than fifty 15-18 year old patients who have completed the treatment course in the centre was assessed using standard questionnaires. Physical, mental, social and economical well-being was assessed. Results. The structure of the Kemerovo Regional Center of maxillofacial area congenital pathology prevention and treatment in children was improved and the objectives of the Centre were corrected. The system for the patients’ account and monitoring was created, adequate diagnostic, medical and rehabilitation technologies were developed and introduced. Up to 95% of the disabled children are registered in a center’s database within the first months of life, the age of children in whom corrective surgeries (cheiloplasty and palatoplasty) are performed decreased, corrective surgeries in patients 15-18 years of age are completely over in 84.5% of the cases, 2.2% of patients still have physical disability at the age of fifteen, 48.0% of children are completely satisfied by a treatment course, their appearance and social adaptation. Conclusion. The introduction of the proposed measures allowed to provide a high quality healthcare for children with a congenital pathology of maxillofacial area, their early rehabilitation, decrease of physical disability and reduction of the state payments.

Aim. To study the features of the clinical course of rosacea in combination with demodicosis. Methods. The study included patients aged 19 to 59 years with rosacea (n=71), in whom Demodex mite were identified. Gender and age-comparable patients with rosacea and without demodicosis (n=68) were examined as comparison group. The disease duration in both groups ranged from 2-3 weeks to 7 years. Clinical examination, Demodex folliculorum identification were performed. Diagnostic criteria for clinical forms of rosacea were used for diagnosis and staging of the disease. Results. The pustular form of the disease was more prevalent in patients with rosacea, complicated by demodicosis. The combination of erythema with skin edema was found in all patients with a pustular form of the disease, bigger grouped skin rash elements having an infiltration bed were revealed in a greater degree. In patients with papular form of rosacea, complicated by demodicosis, skin rash elements were localized all over the face in 33.3% of cases, in comparison group similar rash was noted in 12.5% of cases. In patients with rosacea, complicated by demodicosis, most of the patients suffered relapses at least twice a year and more. In cases of rosacea without demodicosis relapses were significantly less frequent. Conclusion. In patients with rosacea, complicated by demodicosis more severe clinical course of the disease was observed with a prevalence of pustular forms and the greater skin area involved.

Aim. To study influence of temperature of local anesthetics solutions on effectiveness of brachial plexus block using axillary access. Methods. Patients who underwent arm and hand surgeries were randomized either to the main group (n=25) or to the control group (n=25). In the main group, 1% lidocaine (20 ml) and 0.25% ropivacaine (40 ml - males, 30 ml - females) at 38 °C were used for brachial plexus block using axillary access. In the control group, anesthetics at room temperature were used. Brachial plexus block was performed using the axillary access at m. pectoralis major margin above the a. axillaris pulsation point. To register provoked muscular action potentials, a portative neurodiagnostic system «Nicolet One» was used. The percentage of provoked muscular action potential amplitude decrease was counted with results of a measurement before the block as a baseline. For additional analgesia and sedation phentanylum 0.005% was used until Ramsay sedation score II was achieved. «EZSAT-E» software package was used for data analysis. Results. In the main group brachial plexus block was achieved 14.2±3.4 minutes earlier than in the control group. Phentanylum dose required to provide psychic and emotional comfort was 45.4% lower in the main group (3.0±0.9 μg/kg per hour) compared to the control group (5.5±1.7 μg/kg per hour). Conclusion. The use of local anesthetics solutions at body temperature increases the efficiency of brachial plexus block and reduces the time of it’s achievement, increases it’s analgesic potential and decreases the need for narcotic analgesics to provide psychic and emotional comfort for the patient.

The article surveys the data from domestic and international studies regarding the evolution of thoughts and contemporary point of view at epileptic seizure predictors, considering data from experimental and laboratory studies as well as from clinical studies. The provisional epileptic seizure predictors classification is proposed. The characteristics of the included predictors is given, the need for direct comparison considering results of laboratory studies on biological models as well as clinical trials on biologic objects is underlined.

The article is addressed to attract the attention of the physicians mainly dealing with out-patients to the actual problem - sleep apnea. This condition is commonly masked by widespread internal diseases and other conditions, like cardiovascular and respiratory diseases, obesity, diseases of pharynx and larynx. At the same time, its’ timely diagnosis and treatment are extremely important, because it may lead to non-responsiveness to arterial hypertension treatment, increases the risk of arrhythmias and other fatal complications. The article presents the case report of primary diagnosis of sleep apnea (from author’s practice) and its possible treatment options.

The history of the department of ophthalmology of the Kazan State Medical Academy for the 90-year period was analyzed. The department was founded in September, 1922. The reason for the foundation of the department was the trachoma that was rampant at that time in the Volga region. Academician V.V. Chirkovskiy (1874-1956), who headed the department from 1922 to 1928, was the founder and the first director of the first in USSR Trachoma Institution based in Kazan. From 1929 to 1932 professor Valentin Yemel’yanovich Adamyuk (1877-1950), the honoured Scientific researcher of the republic of Tatarstan was the head of the eye clinics of the medical academy and of the Scientific and Research Trachoma Institution. In 1932 professor, the honoured Scientific researcher of the republic of Tatarstan Alexandr Nikolaevich Murzin (1885-1954) has won the elections and headed the department. He secured the merging of the Scientific and Research Trachoma Institution and the eye clinics of the medical academy into the one institution. Thanks to the proper healthcare management and treatment and prevention measures trachoma was eliminated in republic of Tatarstan in 1964. Later, the department was chaired by Alexandr Nikiforovich Kruglov (1952-1964), Kamilya Islamovna Gafarova (1964-1967), Moisey Bencionovich Wufgart (1967-1987), Liyuda Bakhtigareevna Galiaskarova (1987-1996), Marina Vladimirovna Kuznetsova (1996-2012). Since March 2012 the department is headed by PhD, Principal out-of-staff ophthalmologist of the Ministry of Health of the Republic of Tatarstan Aidar Nailevich Amirov. Nowadays the department staff completes over 5000 complicated eye microsurgeries yearly, and also consults the patients form Republic of Tatarstan and nearby regions with complicated cases of different eye diseases at the out-patients clinic and departments of the hospital.

A clinical case of sarcoidosis of the orbit as the first manifestation of systemic sarcoidosis is presented. A patient (born 1961) was referred with diplopia, gradual visual acuity of both eyes decrease during the last 8 years. The objective status at the ophthalmologist examination in 2009: temporal deviation of both eyes (10° right, 15° left), I degree left-side ptosis. Refraction -2,5 dioptre. Eye convergence and abduction impairment. Oculus Uterque - cornea is transparent, conjunctive appears normal, the anterior chamber is of medium depth, aqueous humor is transparent, iris is structured, the pupil is round, light reaction is normal, nuclear sclerosis. «String of pearls» opacity of vitreous body. The fundus of the eye: optic disc is pale pink with temporal discoloration, temporal border is not sharp, arteries are contracted, twisted, veins are of different caliber, macular reflex is fuzzy. Consolidation locus 0.9 mm with an acoustic above the optic nerve projection and posterior acoustic enhancement were found on the B-scan ocular ultrasonography. No signs of a mass were observed. Retroocular tissues are of normal density, with hyperintense 0.5-0.9 mm focuses in the internal segment (ultrasonographic signs of fibrosis). A diagnosis of orbital granulomas was proposed, the preliminary diagnosis: «Eye sarcoidosis, orbit sarcoidosis, sarcoid angiopathy». In June 2009 patient developed a nodular erythema on lower limbs, reported the joint pain, fever. Lung dissemination was determined on the chest X-ray, the patient was referred to phtysiologist and pulmonologist. The Mantoux test of 2 TU was negative, the diagnosis of tuberculosis was ruled out. The adequate therapy was administered. Thus, the eye involvement can be the first and only clinical feature of sarcoidosis and make the physician think about the systemic disorder debut.

In 2012 it will be 205 years since the teaching of ophthalmology was started in Kazan. Since that time the teaching methodic has passed different stages starting from simple passive teaching to complex interactive teaching using the curricula modules. The method was introduced at the department in 2010 according to the latest state educational standard. The curricula is formed by several modules (practical skills, emergencies in ophthalmology, terminology) that are scored separately. The approach allows to increase the students’ activity at the classes, motivates for advanced reading and out-of-class studying and helps to acquire all the skills and knowledge better.

Aim. To assess the efficacy of complex treatment of retinal veins occlusion with anti-angiogenic - ranibizumab, and laser retinal photocoagulation. Methods. 36 patients (36 eyes) with occlusion of central retinal vein and its branches were included. Patients with central retinal vein occlusion (n=17) were included in the first group, patients with retinal vein branch occlusion (n=19) were included in the second group. All the patients underwent visual acuity testing, ocular tonometry, ophthalmoscopy, biomicroscopy, spectral optical coherence tomography, intravenous fluorescein angiography at the baseline, 1 and 3 months after treatment. Treatment included intravitreal ranibizumab injection (0.5 mg) and laser retinal photocoagulation 1 month after intravitreal injection. Results. In 94.4% of cases good treatment effect was observed. Visual acuity improved from 0.06±0.03 at baseline to 0.22±0.08 (p <0.05) at the end of treatment in the first group and from 0.31±0.06 to 0.64±0.05 (p <0.05) in the second group. Central retinal thickness reduced from 752.2±98.4 μm to 309.21±45.57 μm (p <0.05) in the first and from 689.12±64.08 μm to 235.37±46.07 μm (p <0.05) in the second group. Conclusion. The results indicate high effectiveness of suggested complex treatment of retinal vein occlusion with anti-angiogenic - ranibizumab and laser retinal photocoagulation.

Aim. To elaborate a mathematical model of individual myopia development and progression risk in school students who study using innovative programs. Methods. 372 students of №19 gymnasium, Kazan, Russia, were examined. Students were divided into two groups: the first group - students with emmetropia (180 subjects) and the second group - students with myopia (192 subjects). Age distribution (junior students aged 7-9 years - 111 subjects, middle school students aged 12-14 years - 147 subjects, senior students aged 16-17 years - 114 subjects) was taken into account. Results. Factors influencing the visual acuity deterioration in school students were combined into five groups: medical and biological, social and hygienic, visual load, behavioral and alimentary. The visual load had the highest impact (52.8% - for male students, 51.7% - for female students), with behavioral factors on the second place (39.0% - for male students, 41.61% - for female students), alimentary factors on the third place (36.46 and 41.38% accordingly), medical and biological factors on the fourth place (24.80 and 29.09%) and with social and hygienic factors at the bottom (20.69 and 27.74%). Conclusion. The overall sum of the prognostic coefficients allows to define the risk of myopia on case-to-case basis and to distribute the student to a prognosis group. Basing on this approach. it is possible to develop personalized recommendations for myopia prevention targeting on the most important unfavorable prognostic factors.

Aim. To assess the tear fluid level of vascular endothelial growth factor in patients with proliferative diabetic retinopathy in case of panretinal photocoagulation and intravitreal ranibizumab treatment. Methods. Panretinal photocoagulation was performed in 20 patients (40 eyes) with proliferative diabetic retinopathy (first group). In the second group, which included 20 patients (40 eyes) with the same stage of diabetic retinopathy, panretinal photocoagulation was combined with intravitreal ranibizumab treatment. 20 healthy subjects (40 eyes) were examined as a contol group. There were no adverse events registered during the treatment. At the follow-up, 4 patients from the first group were diagnosed with partial intraocular hemorrhage; a posterior vitrectomy was required in 1 eye, in 3 eyes intraocular hemorrhage has resolved spontaneously. A complex of clinical and laboratory examinations included visual acuity testing, biomicroscopy, indirect ophthalmoscopy using Mainster wide field lens, fluorescein angiography, optical coherence tomography, tear fluid ELISA. Results. There was a complete regression of retinal neovascularization (no blood flow in newly grown blood vessels) in 14 (35%) eyes of patients from the first group after the first procedure. In the second group a complete regression of retinal neovascularization was observed in 100% of cases after the first procedure. The tear fluid level of vascular endothelial growth factor increased from 398.6±112.2 to 668.2±102.2 pg/ml (p <0.05) in 40 (100%) eyes of patients from the first group, in the second group the level of vascular endothelial growth factor decreased after the angiogenesis inhibitor injections in 40 eyes (100%) from 332.1±98.2 до 314.6±44.4 pg/ml (p <0.05). 1 month after treatment the visual acuity in the first group the visual acuity improved in 40% of cases (16 eyes), was stable in 45% (18 eyes), decreased in 15% (6 eyes) with the mean value changed from 0.22±0.12 to 0.24±0.08 (p <0.05); in the second group the visual acuity improved in 40% of cases (16 eyes), was stable in 45% (18 eyes), decreased in 15% (6 eyes) with the mean value changed from 0.22±0.12 to 0.24±0.08 (p <0.05). Conclusion. The use of panretinal photocoagulation combined with intravitreal ranibizumab treatment in patients with proliferative diabetic retinopathy decreases the tear fluid vascular endothelial growth factor level, improves the visual acuity and thickness of the retina. There was a marked and prolonged effect after the combined treatment, that allows to recommend this treatment method to all patients with proliferative diabetic retinopathy.

Aim. To study the features of microcirculation in bulbar conjunctiva of patients with chronic hepatitis C depending on the duration of the infection. Methods. 40 patients (80 eyes) with chronic hepatitis C were observed: the first group consisted of 11 patients, chronic hepatitis C duration up to 3 years, second group - 10 patients, chronic hepatitis C duration 5 to 3 years, third group - 19 patients, chronic hepatitis C duration over 5 years. The control group consisted of 20 healthy subjects (40 eyes). The microcirculation in bulbar conjunctiva was assessed using biomicroscopy. Arterioles, veins and capillaries were distinguished by the direction and speed of the blood flow, the vessel diameter, configuration and branching, observed changes were scored. Liver enzymes levels were assessed, as well as levels of immunoglobulins M and G to hepatitis C virus, polymerase chain reaction was performed to define the presence of viral RNA. Results. Microcirculation disorders (perivascular, vascular and intravascular changes) in bulbar conjunctiva were found in all of the patients with chronic hepatitis C compared to the control group. There was a link between total conjunctiva index and the duration of the infection as well as liver enzymes levels. In the first group total conjunctiva index was scored as 11,52±0,7, 14,0±1,18 - in the second group, 19,3±0,84 - in the third group. Conclusion. Microcirculation disorders are present in all patients with chronic hepatitis C, that should be considered while monitoring and choosing the optimal treatment.

Aim. To study the effectiveness and safety of pentahydroxyethylnaphtoquinone (Hystochrome) in patients with active and fibrous stages of retinopathy of prematurity. Methods. 281 prematurely born babies: first group - 63 patients with retinopathy of prematurity stages I-II and vast non-vascular area; second group - 201 baby with stage III retinopathy of prematurity and posterior aggressive form of retinopathy after the performed retinal laser photocoagulation; third group - 17 babies with subtotal intraocular hemorrhage - were followed up. In addition, 29 children with fibrous stage of retinopathy of prematurity were observed. Pentahydroxyethylnaphtoquinone (Hystochrome) was used as epibulbar instillations and peribulbar injections. To assess the treatment results, examination using the «RETCAM-120» system, B-scan ultrasonography using the «AVISO» scanner and visual evoked potentials examination with flash light stimulus using the «Neuro-MVP» device were performed. Results. In babies from the first group the improvement of electrophysiological parameters was observed in 20% of cases after treatment with pentahydroxyethylnaphtoquinone, compared to 4% in control group. In the second group pentahydroxyethylnaphtoquinone improved the electrophysiological parameters in 39% of cases. In the third group (17 babies with subtotal intraocular hemorrhage) the hemorrhage degradation was twice more rapid compared to controls. There was no effect from pentahydroxyethylnaphtoquinone treatment at the late stages of the disease. No adverse effects were registered. Conclusion. Pentahydroxyethylnaphtoquinone (Hystochrome) has shown good effectiveness and safety while treating patients with non-proliferative stages of retinopathy of prematurity and vitreous hemorrhage.

Aim. To study the properties of eye vessels Doppler sonography and retinal optical coherence tomography in assessing the treatment effectiveness in patients with diabetic retinopathy. Methods. 122 patients (244 eyes) with type 2 diabetes mellitus and nonproliferative diabetic retinopathy aged 41 to 55 years were examined. The disease duration ranged from 2 to 15 years. All patients were treated with glibenclamide and supportive therapy: eye drops of 1% methylethylpiridinol - 1 drop 3 times a day, 20% pyracetam solution - 5 ml intravenously for 14 days. Patients were divided into 4 groups: 1st group included 30 patients who were administered with Hirudo powder, 2nd group consisted of 32 patients treated with Hirudo powder in combination with laser photocoagulation, 3rd group included 30 patients treated by laser photocoagulation and 4th group consisted of 30 patients who were treated with glibenclamide and supportive therapy only. All patients were examined before and 4 days after treatment, examination included standard ophthalmic examination, retinal optical coherence tomography and eye vessels pulsed color Doppler sonography. Results. Improvement of circulation parameters resulting in increased blood flow speed and decrease of vascular resistance index, as well as visual acuity improvement, reduction of macular edema were registered in the first group after the treatment. In the 2nd group, significant improvement of circulation parameters as increased blood flow speed and decrease of vascular resistance index, visual acuity increase, reducing of the area and height of macular edema were observed. In the 3rd group, deterioration of circulation parameters as decreased blood flow speed and increase of vascular resistance index, slight visual acuity increase and reducing of the area and macular edema height were observed. In the 4th group improvement of circulation parameters was non-significant as well as visual acuity change and retinal condition. Thus, combination of Hirudo powder and retinal laser photocoagulation was the most effective method, leading to improvement of circulation parameters, visual acuity increase, reduction of macular edema. Conclusion. Quantitative analysis of retinal optical coherence tomography and eye vessels Doppler sonography parameters and their link to visual acuity testing allows to assess completely the effectiveness of conducted treatment.

Aim. To study the options to correct vision in athletes with myopia. Methods. 100 athletes with myopia, going in for different sports, (male - 49, female - 51, aged 14 to 35 years) were examined and questioned. The questionnaire contained questions regarding following issues: sports type, myopia degree, type of vision correction, type of contacts, wear schedule of contact lenses, adverse effects. Ophthalmic examination included visual acuity testing, eye examination with automated refractor and anterior biomicroscopy. Results. Low myopia was diagnosed in all of the athletes examined. 49% of them did not used any vision correction because of the low degree of myopia - less than 0.75 dpt, the rest 51% used glasses in 18% of cases and contacts in 33% of cases. Athletes participating in injury-prone sports or sports requiring good long distance vision and good peripheral vision such as ice hockey, volleyball, football, used the contact lenses. Hence, the contact lens type did not complied with recommended for use in sports by their replacement schedule. 81% of questioned athletes wore lenses with 4-week replacement period or of longer use instead of daily disposable lenses that are preferable. In 18% of athletes wearing contacts a chronic conjunctivitis was diagnosed. Conclusion. For external eye complications prevention in athletes going in for injury-prone sports not only type of vision correction but the contact lenses replacement schedule matters.

Aim. To assess the effectiveness of combined non-penetrating surgery: non-penetrating deep sclerectomy and ab externo trabeculectomy in patients with primary open-angle glaucoma depending on type of aqueous humor retention. Methods. Results of surgeries on 72 patients (83 eyes) with primary open-angle glaucoma were analyzed. Patients were divided into 2 groups. Standard ophthalmic examination was added by fluorescein lymphography of the anterior eye to determine the surgery type as well as for hypotensive effect long-term prognosis. Non-penetrating deep sclerectomy and ab externo trabeculectomy were conducted in the first group (67 eyes). In the control group (16 eyes) standard non-penetrating deep sclerectomy was performed. A cytostatic was used as a subconjunctival injections in the post-surgical period. Results. Intraocular pressure was fully compensated in 52 eyes out of 67 (77.6%) in the long-term period after non-penetrating deep sclerectomy and ab externo trabeculectomy in the first group. In 15 eyes (22.4%) topical hypotensive drugs were required for complete compensation of intraocular pressure. Complete compensation of intraocular pressure was registered in patients with moderate aqueous humor flow reduction (trabecular and mixed with prevalence of trabecular forms). Topical hypotensive drugs were required in severe aqueous humor flow reduction (mixed form with prevalence of intrascleral). In the second group, compensation of intraocular pressure was achieved only in early post-surgical period in 12 eyes (75%) with further decrease of hypotensive effect after 4-6 months. There was no complete compensation of intraocular pressure at late post-surgical period. To normalize the intraocular pressure, topical hypotensive drugs were required in 15 eyes (93.8%), surgery was repeated in 1 (6.2%) case. Conclusion. Combined surgery (non-penetrating deep sclerectomy and ab externo trabeculectomy) is more effective compared to non-penetrating deep sclerectomy and is indicated in patients with open-angle glaucoma and moderate aqueous humor flow reduction.

Neonatal hepatitis is one of the most actual problems of children under 6 months of age. The term «neonatal hepatitis» includes infectious liver injury which develops in antenatal period or occurrs during first 3 months of life. The most common causes of liver damage in newborns are viral infections including cytomegalovirus, herpes simplex virus, enteroviruses, parvoviruses, hepatitis B and C viruses. Nowadays the most frequent perinatal infection is cytomegalovirus (1-2% of all newborns). It manifests clinically in 10-15% of cases, with liver involved in 40-63,3% of cases. Mother-to-infant transmission of hepatitis B and C viruses is usually intranatal, transplacental transmission is rare. Mother-to-infant transmission of other hepatotropic viruses (A, D and E) is very rare. A number of hereditary diseases associated with metabolic disorders (amino acids, carbohydrates, lipids, bile acids) and enzyme deficiencies (arginase deficiency, hemochromatosis), etc. can mimicry the clinical picture of neonatal hepatitis. Liver damage can be the only manifestation of perinatal infection (hepatitis B and C, herpes viruses) or come along with other organ damage (generalized herpes virus infection, bacterial infections, toxoplasmosis). Perinatal hepatitis B and C are usually chronic. Neonatal hepatitis caused by herpes simplex virus is usually an acute, possibly fulminant infection. Neonatal hepatitis caused by cytomegalovirus has a variety of clinical subtypes: from a non-jaundice type (with a good prognosis) to a cholestatic form (with possible formation of biliary atresia and liver cirrhosis). Thus, different neonatal hepatitises have their particular features. Wide spectrum of laboratory tests available nowadays allows to define the exact reason for neonatal hepatitis and its clinical course.