2019, volume 15

Objective: based on retrospective outcome review of surgical rehabilitation perform assessment of possible usage for intramedullary locking rod structures meant to treat comminuted fractures of humeral shafts. Material and Methods. The intramedullary cross-locking rods were used to fix the fragments. The structures were inserted into humeral shafts by antegrade or retrograde techniques. In most cases surgical interventions were conducted as fracture closed reductions, at that the length and the axis of the limbs were restored without any additional fixation of separate fragments. Results. The review of outcomes for 33 patients with complicated traumatic destructions of humeral shafts showed high efficiency of intramedullary locking rod structures at managing patients with this type of injuries. Conclusion. Small surgical trauma and solid fixation provide for early functional rehabilitation of injured extremities as well as patients» quick return to everyday routine and activity before the fracture heals completely.

The case report for Hallux rigidus surgical management with endoprosthesis total replacement using zirconia ceramics has been presented.

The analysis of studies on pedicle screw fixation in the cervical spine has been carried out. Mathematical data on the accuracy of freehand placement of cervical pedicle screws, the frequency of screw malposition, the frequency of clinically significant complications are presented. The article describes the causes of perforation of pedicle of vertebra, the causes of complications of this technique, as well as recommendations to increase the accuracy of insertion the screws and reduce postoperative complications.

Ceramic cleavage on fixed orthopedic structures is a very common complication of occlusive trauma. Attempts intraoral repair of such defects have been undertaken since the 90s of the last century. The existing technique, including the treatment of the prosthesis with hydrofluoric acid and the subsequent application of silanes, quite successfully coped with the task at the boundary of the chip within the ceramics. When chipping to metal, this technique does not provide adhesion of the composite to the metal. The situation has changed dramatically with the appearance unsilane primers containing MDP monomer and providing reliable chemical adhesion of the metal to the composite. As follows from the presented clinical case, even after 1 year after the repair of the ceramic prosthesis, the anatomical, functional and aesthetic characteristics of the dentition are fully preserved.

Objective: to assess the parameters of microcirculation in the pulp vessels in the immediate and remote periods of observation in the treatment of dentin caries, depending on the depth of destruction of hard tooth tissues, the type of restoration material and methods of filling. Material and Methods. Registration of microcirculation parameters in the vessels of the tooth pulp was carried out by laser specie-optical devices «Speclometer». The study of the state of hemodynamics in the pulp of the tooth was conducted in 233 patients, a total of 286 teeth were sealed. For dental treatment used designed glass ionomer cement light-cured composite materials import manufacture and restoration complex. Results. The reasons leading to a change in blood flow in the pulp of the tooth are due to a violation of the marginal fit of the material to the hard tissues of the tooth, interocclusal and interdental relationships, the influence of both the adhesive system and the restoration material. The restoration of blood flow in the vessels of the tooth pulp in the treatment of dentin caries (cavity of average depth) reaches control values from 14 days to 1 month, with a deep carious cavity from 1 month to 3 months. Restoration of blood flow in the vessels of the tooth pulp in the treatment of deep caries with the modified «sandwich method» reaches control values after 14 days, with the «sandwich method» from 1 to 3 months (p <0.05). Conclusion. The parameters of hemodynamics (blood flow level and intensity) are important predictive criteria assess the status of microcirculation.

Objective: to study the incidence of buccal epithelial cells with nuclear abnormalities in women aged 50- 60 years, suffering from lichen planus; identification of the spectrum of nuclear aberrations and analysis of diagnostic information content of the studied indicators in assessing the risk of complications. Material and Methods. The incidence of nuclear aberrations in buccal epithelial cells was studied in 20 women aged 50 to 60, patients with lichen planus. 10 women of the same age group without the disease were selected for the control group. The use of ROC-analysis allowed to determine the most informative cytogenetic criteria, allowing to establish the diagnosis of «lichen planus», calculating their critical values, sensitivity and specificity for their use as diagnostic tests. Results. A change in the number of cells with micronuclei and signs of destruction of the nucleus, and cells with nuclear aberrations in patients in the area of disease was revealed. Indicators of nuclear destruction in cells outside the affected area in the group of patients differed from those in the control sample. Conclusion. The increase in the number of cells with micronuclei in the area of lesion with lichen planus is a sign of genetic instability, which can start the process of their malignancy. Recognition of nuclear aberrations against the background of nuclear destruction makes it possible to diagnose lichen planus. Determination of the frequencies revealed perinuclear vacuoles and karyopyknosis in the affected cells of the oral mucosa and lips may serve as a confirmation of diagnosis.

The aim of the research is to determine the epidemiological situation of acute intestinal infections that are particularly relevant for the republic. Material and Methods. In this study reporting form No. 2 «Information on infectious and parasitic morbidity» for 2015-2018, regulatory documents and data on the epidemiological situation of acute intestinal infections in the world. Results. A retrospective analysis of the epidemiological situation of acute intestinal infections in the country showed that these infections take second place in the structure of infectious morbidity after acute respiratory diseases, while the fact of an increase in the incidence rate of OKI of unidentified etiology in 2018 is of particular importance. The decoding figure did not decrease and amounted to 42% (41.3% in 2017; 37.7% in 2016; 33.9% in 2015), and in cities 38% (37.2% in 2017; 31.4% in 2016; 29.1 % in 2015). Conclusion. In the structure of acute intestinal infections, infections with an unidentified etiology predominate, which requires an increase in the health literacy of the population, as well as an improvement in the system of epidemiological surveillance of this pathology.

The literature review is devoted to a rare variant of hypoventilation, sleep-dependent, in children — central hypoventilation with a late onset and hypothalamic dysfunction, ROHHAD syndrome (Rapid-onset Obesity, Hypothalamic dysregulation, Hypoventilation, Autonomic Dysregulation). Diagnosis and management of patients with this syndrome requires a multidisciplinary approach of a team of specialists. On the basis of modern data, the issues of clinical and laboratory-instrumental diagnosis of the disease, possible etiological factors, diagnostic criteria and frequency of symptoms, approaches to therapy and prognosis are presented.

Purpose: to study the features of the course of atrial fibrillation (AF) in patients with arterial hypertension (AH) and chronic heart failure (CHF) in combination with concomitant extracardial pathology and to assess the effect of AF on the progression of chronic heart failure. Material and Methods. In an observational cohort study was observed in 308 patients 45-60 years with AF in hypertension and CHF in combination with noncardiac pathology: diabetes mel-litus (DM) (n=40); diffuse toxic goiter (DTG) (n=42); hypothyroidism (GT) (n=59); abdominal obesity (АО) (n=64); and chronic obstructive pulmonary disease (COPD) (n=47). The comparison group consisted of 56 patients with AF and CHF hypertension, without concomitant noncardiac disease. When comparing groups, the unpaired Mann — Whitney U- test for numerical variables and the exact two-way Fisher test for categorical variables were used. Differences were considered significant at a level of p <0.05. The calculations were carried out in the program Rstudio. Results. In all the presented clinical groups there were no differences in the frequency of the permanent form of AF, paroxysmal form was more often recorded in thyroid and АО pathology, and persistent form in COPD, DTZ and DM. Transformation of paroxysmal AF into chronic AF occurred in groups of patients with DTZ (p<0.001), DM (p=0.041) and АО (p=0.004). Progression of CHF was revealed in groups of patients with DTZ (p<0.004), DM (p<0.008), АО (p<0.001) and COPD (p=0.05). Conclusion. Significant progression of AF and CHF is observed in patients with SSD, COPD, АО and DTZ. The most pronounced indicators of left ventricular diastolic dysfunction were found in patients with DM, GT and АО.

The updated classification of heart failure ESC 2016 highlights new problems of understanding epidemiology and treatment of the syndrome. In particular, today there is a lack of prognostically advantageous management of patients with heart failure with preserved or midrange left ventricular ejection fraction (HFpEF/HFmrEF). Even less information exists regarding long-term outcomes after the application of percutaneous coronary intervention (PCI) in these patients. There is only a small amount of studies about the long-term prognosis after PCI with stratification on values of LVEF Their results are analyzed in this article and make it possible to indirectly judge the effectiveness of this method in the group of patients with HFmrEF