Фактори, які кондиціонують поліваріантність ефектів бальнеотерапевтичного комплексу курорту Трускавець на інтракардіальну та центральну гемодинаміку

Показано что, разнообразие эффектов курса бальнеотерапии на курорте Трускавець на гемодинамику может быть сведено методом кластерного анализа к четырем вариантам. Методом дискриминантного анализа выявлены 15 исходных параметров гемодинамики, вегетативной регуляции и обмена электролитов и липидов, закономерно обуславливающих тот или иной вариант бальнеоэффекта.The method of an echocardiography studies reactings intracardial and central hemodynamics of the man on a course balneotherapy on a spa Truskavets'. Outgoing from shifts of main parameters: an index of contractility (IC), frequency of a rhythm (FR), middledynamic pressure (Pm), general peripheral resistance of vessels (GPRV), expulsion time (ET), enddyastolic (EDV), shock (SV) volumes of heart and cardiac output (CО) - is selected 4 types of reacting. Hypotensive bradycardiо-antikinetic reacting registered for 34,8% of persons, is characterized reduce of Pm, rhythm, ET and CО associated with absence of changes SV, EDV, GPRV and IC. For antiresistive tachycardiо-prokinetic type (30,3% of cases) is characteristic combination of increase of a FR, ET and CО with a considerable decrease GPRV. At proresistive antiinotropic tachycardiо-antikinetic type (19,7% of faces) is essentially increased GPRV and FR, reduced IC, ET, EDV, SV and CО. For 15,2% of faces is established antiresistive proinotropic prokinetic type described by a increase of IC, EDV, SV, FR and CО and decrease of GPRV. The type of effects are conditionized by constellation of 15 initial parameters of haemodynamic, vegetative regulation and exchange of lipides and electrolytes and are prognozed by method of disccriminant analysis (correctly 83,3%)

Do synovial biopsies help to support evidence for involvement of innate immunity in the immunopathology of Behçet's disease?

Behçet's disease is a complex vasculitis of unknown etiology. Abundant neutrophils suggest the involvement of innate immunity. Cytokines are skewed to the T-helper-1 pattern. Few sterile organs are easily accessible for analysis in Behçet's disease. Cañete and coworkers identify inflamed joints as a feasible model and suggest the involvement of innate immunity in Behçet's disease

Staged Mucosal Advancement Flap versus Staged Fibrin Sealant in the Treatment of Complex Perianal Fistulas

Background. In this prospective randomised study, the staged mucosal advancement flap is compared with staged fibrin sealant application in the treatment of perianal fistulas. Methods. All patients with high complex cryptoglandular fistulas were randomised to closure of the internal opening by a mucosal advancement flap (MF) or injection with fibrin sealant (FS) after treatment with setons. Recurrence rate and incontinence disorders were explored. Results. The MF group (5 females and 10 males) with a median age of 51 years and a median followup of 52 months. The FS group (4 females and 11 males) with a median age of 45 years and a median followup of 49 months. Three (20%) patients of the MF group had a recurrent fistula compared to 9 (60%) of the FS group (P = 0.03). No new continence disorders developed. Conclusion. Staged FS injection has a much lower success rate compared to MF

Use of TNF blockers and other targeted therapies in rare refractory immune-mediated inflammatory diseases: evidence-based or rational?

Evidence-based medicine implies that clinical decision making should be based on external research evidence when available. This external evidence includes, but is certainly not restricted to, randomised controlled trials (RCTs). The development of powerful but often expensive targeted therapies for immune-mediated inflammatory diseases (IMIDs) is one of the major successes of evidence-based medicine but, paradoxically, also threatens the traditional RCT-based approach. Indeed, the increasing availability of these drugs decreases the number of patients available for RCTs, questions the ethical basis for the use of placebo groups and raises the issue of cost-efficacy. These considerations become even more important in rare phenotypically diverse and potentially life-or organ-threatening IMIDs such as sarcoidosis, Behcet's disease and uveitis. Using the successful application of tumour necrosis factor blockade in these diseases as an example, this review defends the concept that pathophysiological insights in cellular and molecular disease pathways as well as limited case series are valid sources of external evidence for the rational use of targeted therapies in these rare refractory conditions. If authors fail to redefine their concept of rational therapy along the lines of not only evidence-based but also pathophysiology-based and practice-based medicine, they may underestimate the potential of novel drugs in rare refractory IMIDs and thereby jeopardise the health of their patient