Peculiarities of surgical tactics of patients with thymus tumors

The aim of the study: to study retrospective analysis results of the surgical treatment of thymus tumours for predicting long-time results. Methods. Study included 35 patients who were treated at the Department of Thoraco-abdominal Surgery from September 2019 to May 2021. The control group included 20 patients with SVCS were treated with conventional techniques, while the experimental group included 15 patients who underwent a novel bypass surgery developed by us. Results. The venous bypass was mandatorily complemented with cytoreduction. Complications in the post-operative period were reported from the experimental group and included auriculo-subclavian bypass thrombosis, post-operative complications were reported in the control group including haemorrhage from the sternotomy wound in 1 (3.3 %) case, superior vena cava thrombosis in 2 (6.6 %) cases, pneumonia in 2 (6.6 %). The relative risk of complications and lethal outcome was calculated for patients from both groups. It was found that the risk of complications was twice as high in the control group as in the experimental group (standard error of relative risk equals 0.64). Conclusion. The first mandatory step of the radical surgery in patients with thymomas with SVC invasion should be the auriculo-jugular and auriculo-subclavian bypasses, which can reduce the relative risk of post-operative complications by a factor of the risk of lethal by a factor of 3.

EXPERIENCE OF SURGICAL TREATMENT OF THE CAROTID BODY TUMOR AND TUMORS WITH INVASION AT THE CAROTID VESSELS

The analysis of the structure and results of surgical treatment of 72 patients who were hospitalized in the department of vascular surgery Lviv regional hospital for the period 1995 to 2017. Among the 42 cases was diagnosed carotid body tumors (1-st study group) and at 30 patients was (2-nd control group) other tumors of the neck. In first group structure of surgery operation was: tumor removal and suturing the vascular wall defects - 76%, resection and shortening of the common carotid artery - 21%, expansion of the internal carotid artery - 3%, ligation of the external carotid artery - 10%, lymphadenectomy - 28%, prosthetic vascular wall - 3%, the tumor resection - 3%, internal jugular vein ligation - 7%, excision of fragment muscle - 3%, nerve resection - 14%. In the second group, the following surgical operations were performed: removal of the tumor and suturing of the defects of the vascular wall - 96%, lymphadenectomy - 48% tumor resection - 30%, ligation of the internal jugular vein - 14%, removal of the muscle fragment - 4% , resection of nerves - 13%. In group 1, intraoperative complications were observed in 1 (3.4%) cases, which were manifested by massive bleeding from the tumor, requiring a repeated surgical intervention to stop the bleeding. Postoperative complications were observed in 1 (3.4%) cases when acute cerebral ischemia developed. In 1 (3.4%) cases, tumor recurrence was observed after 9 years. Clinic experience shows that surgery is an effective treatment for carotid body tumor and tumors with invasion into vessels of the neck, providing a low rate of complications, a full recovery or long-term remissio

The role of tumoral stroma in determining the forecast of recurrence and fatal consequence of stage IIA-IIIB colorectal cancer

Colorectal cancer (CRC) ranks 2nd in the structure of mortality from malignant neoplasms (MN). One of the criteria for the prognosis of CRC may be a tumor stroma, which has not been widely used in clinical practice. The aim was to determine the main morphological features of the stroma CRC T3N0-2M0 and search for prognostic criteria for their recurrence and lethal outcome according to the operating material and autopsy. Materials and methods. Group I included primary CRC without recurrence. The average recurrence-free period was 5 years (62.5±16.5 months). Group II – primary CRC with recurrence; IIA – with recurrences within 5 years from the date of tumor removal that did not lead to death; IIB – with the appearance of recurrence and lethal consequence of the generalization of the tumor process within 5 years from the moment of removal of the primary tumor. CRC micropreparations made according to the standard method with G + E staining were studied; immunohistochemical study was performed using monoclonal antibodies to smooth muscle actin alpha. Results. Stromal-parenchymal ratio >50 % is a prognostic criterion for recurrence (p<0.05) and shorter recurrence-free survival (p<0.001) of patients with stage IIA-IIIB CRC. Immature stroma type CRC stage IIA-IIIB is associated with the presence of tumor budding (p<0.001), G3 differentiation (p<0.01), shorter recurrence-free survival (p<0.001); among recurrent CRCs, the immature type of stroma is associated with the lethal outcome of patients (p<0.05). Expressed levels of tumor-activated fibroblasts are one of the criteria for immature CRC stroma (p<0.003), but as an independent prognostic criterion has limited prognostic value. Conclusions. TSR and immature type of stroma are prognostic criteria for recurrence and recurrence period of CRC pT3N0-2M0, more typical of tumors of patients with recurrence and lethal outcome with the same ratio of tumors by differentiation

CONTENT OF DIENE KOH'UGATIVES AND MALONIC DIALDEHYDE IN BLOOD FOR RATS IN DYNAMICS OF FORMATION OF IMMOBILIZATIONAL STRESS

Nowadays, one of the most important problems are stressful reaction of human and animal systems. The purpose of our study was to find out the peculiarities of the dynamics of changes in the indices of diene conjugates and malonic dialdehyde in blood in rats under the conditions of development of immobilization stress. Material and methods of research. The experiments were carried out on white male rats of the Vistar line weighing 180–200 g which were divided into 3 groups for 10 animals (one control and three tested). The control group of rats was injected with 1 mg physiological saline per kg body weight intraperitoneally. The animals were decapitated under anes the siaca used by sodium thiopental (intraperitoneal injection of 1 % solution of 50 mg / kg) and withdrawn from the experiment after 1, 3, and 5 days. In blood plasma was determined the content of diene conjugates and malonic dialdehyde in stress-induced rats, the groups were compared with the control group rats. Results. The state of the processes (POFs) was assessed by the content of blood vessels detected in different periods (1 st, 3 rd, and 5 th day) after conducting of IS in rats. Under the conditions of the development of the IS, an increase in the content of DK was observed at 116.96 % (p<0.05) in the experimental group1 accordingly on the 1st day after the IS compared with the control. For the 3rd day of the study, the level of DK increased by 44.24 % (p<0.05) in experimental group 2, against the intact group of animals. Experimental group 3, in which animals were withdrawn from the IS for the 5th day, was characterized by an increase in the content of DK by 41.84 % (p<0.05) compared with the control group. Another indicator of MDA in the blood for 1 day of the experiment in experimental group 1 increased by 104.15 % (p<0.05) in the case of IS in relation to the intact group. On the 3rd day of the experiment under the conditions of development of IP, the level of MDA increased by 83.9 % (p<0.05), against control. At the 5th day of the experiment, MDA level was 30.1 % (p<0.05) for IS, when compared with control Conclusion. Consequently, the experiment made it possible to establish the significant activation of the LP processes, which we determined with increasing levels of DC and MDA in animals under IS conditions, the most of it was on the 1th day of the experiment

STUDY OF AMINO ACID COMPOSITION IN A THALICTRUM FOETIDUM L. HERB

Submitted article is concerned with the study of amino acid composition in a Thalictrum foetidum L. herb. Investigations have been performed by the high performance liquid chromatography method based on the extraction of free amino acids from the herbal raw material and on the acid hydrolysis of the herbal medicinal products followed by analysis of hydrolizates using the HPLC with precolumn derivatization with 9-fluorenylmethoxycarbonyl chloride  (FMOC) and o-phthaldialdehyde (OPA) attended by the detection with fluorescence detector. Amino acid identification has been performed by the comparison of retention times with the mixture of standard amino acids (Agilent 5061-3334). The content of bound amino acids has been determined by the subtraction of free amino acids composition from their total composition. As a result of study 15 essential and non-essential amino acids have been found. It is important to note that L-Serine, L-Histidine, Glycine and L-Phenylalanine are not in a free state in Thalictrum foetidum L. herb. The quantity of  L-Glutamic and L-Aspartic acids is 17.47 and 13.41 µg/mg, respectively (common amino acids). The content of abovementioned acids in a bound state is 15.66 and 9.84 µg/mg, respectively. As for content of other amino acids which were found in Thalictrum foetidum L. herb, it has to be said about their practically the same composition which is in the range from 4 to 5 µg/mg. Content of L-Histidine (1.80 µg/mg in general and bound state) and L-Tyrosine (1.76 µg/mg in general state and 0.08 µg/mg in bound state) is minimum in this herb. It has been established that amino acids are in a free and bound state in the investigated herbal raw material. Content of bound amino acids is higher than general content. Among the amino acids, which are in the overwhelming majority in the studied herb,  it stands to mention L-Glutamic and L-Aspartic. These amino acids play an important role in supporting the physiological processes of the body, especially nervous system. In consideration of experimental data to be noticed is that Thalictrum foetidum L. is a promising plant for creation of phytotherapeutic medications with neurally mediated action

MOLECULAR MARKERS OF ENDOGENOUS NEUROPROTECTION IN THE BRAIN OF RATS WITH EXPERIMENTAL PARKINSON'S DISEASE AND ON THE BACKGROUND OF USING NEW PHARMACOTHERAPY SCHEMES

Parkinson's disease (PD) is one of the most common neurodegenerative diseases in the elderly. The aim of the study. To study apoptotic processes and their role in the formation of dopaminergic neurodegeneration and to develop new treatment regimens with a specific neuroprotective effect on the dopaminergic system. Materials and methods. The study was carried out on 90 Wistar rats at the age of 6 months weighing 220–290 grams. Parkinsonism was induced by the administration of the neurotoxin MPTP (N-methyl-4-phenyl-1,2,3,6-tetrahydropyridine) to experimental rats with neuroprotective treatment: I – Intact (passive control); II – animals with experimental Parkinson's disease (PD, active control); III – PD + Amantadine (AM) IV – PD + AM + Cerebrocurin; V – PD + AM + Pramistar; VI – PD + AM + Gliatilin; VII – PD + AM + Noofen; VIII – PD + AM + Pronoran; IX – PD + AM + Melatonin. Results. The obtained data indicate that neuroprotective therapy of PD with drugs such as melatonin, cerebrocurin, pronoran and gliatilin in combination with amantadine leads to an increase in the expression of the HIF-1α, HIF-3α, HSP70 genes, bcl-2 proteins and decrease c-fos proteins with caspase-3 as markers of apoptosis and can also serve as a molecular marker for the activation of endogenous neuroprotection mechanisms under the conditions of an experimental PD. Conclusions. The study experimentally demonstrated a new target of neuroprotection in PD conditions – apoptosis of dopamine-producing neurons and substantiated modulators of this process – drugs for combined therapy with amantadine (melatonin, cerebrocurin, pronoran and gliatilin) ​​as promising drugs for the treatment of PD

MODERN ASPECTS OF PATHOGENETIC TREATMENT WITH ZINC SALTS OF PATIENTS WITH WILSON'S DISEASE IN UKRAINE

The aim – to study the effectiveness of zinc salts in the treatment of patients with neurological forms of Wilson's disease (WD). Materials and methods. The analysis of the treatment results of 128 patients with hepatocerebral degeneration (71 men and 57 women) in the State Institution “Institute of Neurology, Psychiatry and Narcology of the National Academy of Medical Sciences of Ukraine” was carried out. At the time of hospitalization, the age of patients ranged from 5 to 55 years, an average of 27.3 years, and at the time of debut of the disease - from 1 year to 40 years, an average of 21.3 years. 33 patients underwent monotherapy with zinc salts, 63 – combined therapy with small doses of penicillamine and zinc salts, 32 – monotherapy with penicillamine. Results. Because of the treatment, 67.1 % of patients showed an improvement in neuropsychiatric status: speech improved significantly, tremor of the extremities and the amplitude of hyperkinesis decreased, muscle tone decreased, and cognitive functions improved. According to the international two-level rating scale (UWDRS), the total pathology index decreased by 21 points. Zinc salts are effective and low-toxic and can be the drug of choice in the treatment of patients with hepatocerebral degeneration in the pre-symptomatic stage of the disease, as well as at the stage of maintenance treatment, both as monotherapy and in combination with penicillamine. However, zinc salts and penicillamine are not enough for the treatment and rehabilitation of patients with hepatocerebral degeneration. Therefore, taking into account the clinical picture and the data of additional research methods, it is necessary to conduct courses of symptomatic treatment at least 1-2 times a year. Conclusions. Thus, it can be noted that zinc salts are very effective and low toxic, and, therefore, can be the drug of choice in the treatment of patients with HCD in the pre-symptomatic stage of the disease, as well as at the stage of maintenance therapy as a single drug, and in combination with penicillamine or other chelate drugs

THE ASPECTS OF DEVELOPMENT AND STANDARDIZATION OF CHILDREN’S SUPPOSITORIES WITH EXTRACT OF LICORICE ROOT

The aim of this work was the development of technology of rectal suppositories of immunomodulatory action for children and their standardization. To obtain suppositories, a licorice root extract, chamomile and tea tree essential oils were used. Given that the introduction of ingredients in a dissolved form is preferable, we studied the possibility of using emulsion suppository bases. To evaluate the compositions, the homogeneity and colloidal stability of the suppositories obtained were studied. Estimation of homogeneity, melting temperature, decay time, average mass was carried out according to the State Pharmacopoeia. To confirm the authenticity of the active ingredients, a chromatography method was used. The quantitative determination of glycyrrhizin acid was carried out by spectrophotometric method. Suppositories were prepared by the pouring method. The licorice root extract was added to the suppository when dissolved in the hydrophilic phase of the base. Essential oils of chamomile and tea tree were introduced when a solid fat of type A dissolved in a melt, at a temperature of (42.0±2.0) ºC. Optimum indices for the criteria of “homogeneity” and “colloidal stability” were noted for the samples of the composition: purified water, polysorbate-80, lecithin, solid fat type A. To prove the authenticity of the licorice root extract in suppositories, the chloroform-methanol-water system was optimal (26:14:3). Identification of essential oils on a gas chromatograph showed that on the chromatogram the peaks and retention times of the solution under study coincide with the peaks and retention times of the reference solutions. The conducted studies of quantitative determination of glycyrrhizin acid have shown that its content in one suppository is not less than 0.035 g in terms of glycyram

DELAYED UNION OF MANDIBULAR FRACTURES: ANALYSIS OF 74 CLINICAL CASES

Delayed union of bone tissue in patients with mandibular fractures is observed in 2.4 – 26 % of clinical cases. Solution of this problem yet very much far from the final solutio and there is an urgent requirement in the comprehensive analysis of role of general and local factors of origin of delayed union MF. Methods. Modern clinical, laboratory and microbiological research methods were used in the work. Densitometry conducted on computed tomograph Planmeca Promax 3d (Finland) (85 kV 5–7 mA). The basal values of immunoglobulins of the main classes and interleukins IL-1β, FNT-α, IL-4, MDA, SOD and catalase activity, POL, β-Cross Laps and osteocalcin in peripheral blood were determined in 74 patients with delayed consolidation of the mandibular fractures. Correlation analysis of local and general (concomitant somatic pathology) factors, and clinic-laboratorial parameters in patients with delayed consolidation of the mandibular fractures is conducted. Results. There is a high correlation between β-Cross Laps (negative) and osteocalcin (positive) and bone mineral density. The mean inverse correlation relationship was established between the MDA and catalase activity and BMD (r=–0.57), and the high correlation of these indices with markers of bone remodeling (positive to β-Cross Laps (r=0.80 and r=0.87, respectively) and negative to osteocalcin (r=–0.80 and r=–0.84, respectively). High direct correlation between FNT-α indices and POL, MDA, and catalase indices, as well as very strong with β-Cross Laps (positive) and osteocalcin (negative), and also with high-correlation ligaments of sIgA and IL-1β. Discussion. Convincing clinical and laboratory data were obtained that the combined effect of local and general (concomitant somatic pathology) factors on the basis of the activation of inflammation processes, which increase the indirect influence on immune factors, processes of radical oxidation and bone metabolism, is resulted to delayed union. It was also found that clinical signs of the development of consolidation complications in patients with MF include increased signs of inflammation (oedema, exudation, etc.) up to the 3rd day and preservation of even moderate signs of inflammation (inflation, local hyperemia, and others) after the 7th day, BMD below 600 HU. Among the local factors that increase the infectious risk and inflammatory reaction, the following clinical situations should be distinguished: comminuted fracture; the presence of a tooth in the line of fractures; partially edentulous with loss of antagonist teeth (according to Eichner); complete adentia with mandible atrophy

VIOLATION OF MICROBIAL AND ENDOGENOUS METABOLISM IN CELIAC DISEASE

Aim: to investigate a fecal microbiota composition and to identify candidate biomarkers of celiac disease (CD) by serum metabolomics analysis. Methods: the quantitative real-time polymerase chain reaction was used for fecal microbiota assessment. Serum metabolomic assays were conducted using the GC–MS. Results: serum of CD patients showed significant increases in stearic acid, 2-HIVA, succinate, fumarate and benzoate compared to HC. A decrease in the level of eicosadiene and an increase in AA in blood were determined. The ratio of AA to EDA was statistically significant (4.84 vs. 3.28, p=0.033). The elongase activity index in patients with celiac disease tended to increase (p=0.067). The colon microbiome in CD was characterized by decreasing in the level of butyrate-producing Faecalibacterium prausnitzii (F.p.) and Bifidobacterium spp.. Significant negative correlations were observed; between the levels of Bifidobacterium spp. and F.p. and the concentration of succinic acid (rs=–0.343 [p=0.026] and rs=–0.430 [p=0.005], respectively); the F.p. and the fumaric acid (r=–0.429, p=0.005); the benzoic acid and the amount of Bifidobacterium spp. (r=–0.341, p=0.025). Conclusion: significant changes in serum levels of microbial and endogenous metabolites, reflecting some metabolic pathways disturbances were observed in CD. Metabolites and metabolomic index reflecting the balance between pro-inflammatory and anti-inflammatory components, may be considered as candidate biomarkers of chronic inflammation and metabolic dysbiosis in CD. An increased B. fragilis/F.p. ratio can serve as available biomarker for intestinal pro-inflammatory dysbiosis in CD