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Sumy State University, Department of General Surgery
DPL was introduced by Root in 1965 as a rapid and accurate method to identify the presence of intra abdominal hemorrhage following trauma. Subsequent studies have confirmed the efficacy of DPL in diagnosing abdominal hemorrhage as well as its superiority over physical examination alone.
The accuracy of DPL has been reported between 92% and 98%. The high sensitivity of DPL is due to the significant false positive rate of the technique. Several authors have highlighted the importance of interpreting DPL results in the context of the overall clinical condition of the patient. A positive DPL does not necessarily mandate immediate laparatomy in the hemo-dynamically stable patient. DPL has been shown to be more efficient than CT scan in identifying patients that require surgical exploration.
The complication rate associated with DPL is quite low. The incidence for complication is quite lower for open DPL compared with the closed technique. However, closed DPL can be performed more rapidly. Studies designed to examine the ability of physicians to estimate the red blood cell (RBC) count in DPL fluid have demonstrated the poor sensitivity of visual inspection. A positive DPL, based on microscopic analysis of lavage fluid, has been defined as >1000000 RBC/mm3. It has been recommended that patients with RBC counts in the equivocal range (i.e, 25,000-75,000 RBC/mm3) undergo additional diagnostic testing, such as CT scanning. The false positive rate for DPL is increased in patients with pelvic fracture. In other to avoid sampling the retroperitoneal hematoma, a supra- umbilical approach has been recommended, theoretically reducing the chances of a false positive result. The advantages of DPL for detection of hollow visceral injuries have been clearly demonstrated. By investigations of fluid for amylase and alkaline phosphatase, consistent with enteric injuries. Similarly, the utility of the DPL white blood cell (WBC) count has been questioned. DPL is sensitive for mesenteric injuries and, in fact, has been shown to be more superior than CT for the diagnosis of this injury.
Thus, DPL is a safe, rapid and accurate method for determining the presence of intra peritoneal blood in victims of BAT. It is more accurate than CT for the early diagnosis of hollow visceral and mesenteric injuries, but it does not reliably exclude significant injuries to retro peritoneal structures. False positive results may occur in the presence of pelvic fractures. Hemo- dynamically stable patients with equivocal results are best managed by additional diagnostic testing to avoid unnecessary laparatomies.
TUBERCULOMA OF THE LUNGS
Obwaigwa E.B., student of 4th course
Scientific Supervisor - V.V. Madiar
Sumy State University, Department of General Surgery
The term tuberculoma of the lungs is used here to describe a rounded, homogeneous radiographic opacity, with well-defined borders, one centimetre or more in diameter, of a tuberculous nature; no histological pattern is inferred. In the past such shadows have been called Assmann's foci, solitary or round foci, coin lesions, nodular tuberculosis, and localized caseous pneumonias, but none of these terms has come into general use.
PATHOLOGY When the bronchus is blocked, caseous material can no longer drain, the contained air is absorbed, and on the radiograph a rounded homogeneous tuberculoma replaces cavitation. A further seldom-appreciated possibility is that a primary tuberculous lung focus may occur in rounded form and come within the radiological definition. Two cases in this series and possibly a third were primary lesions. Clinically, when a patient presents with a tuberculoma, there is no means of determining whether it is a post-primary pneumonic focus or an inspissated cavity. Even recognition of a primary lesion may be impossible in the absence of evidence of hilar gland enlargement, lung calcification, or recent Mantoux conversion. The only points on which reliance can be placed are: (1) a caseous pneumonic focus before liquefaction has a homogeneous centre firmly adherent to its wall, and this cannot be washed away with water; (2) microscopic examination of a caseous pneumonic focus stained for elastic fibres may show large portions of intact elastic structure, while in an inspissated cavity only disorganized elastic elements may be seen; (3) cartilaginous remnants may traverse a pre-cavitary focus.
CLINICAL ASPECTS Lung tuberculomata are easily confused with other conditions of similar appearance, but they have many distinctive features. The silent nature of many of these lesions is well known, routine radiography being the reason for their reference. Haemoptysis and pleural pain are the most frequent presenting symptoms, and may occur alone or together with other complaints commonly associated with an early tuberculous infection. The duration of symptoms is always of importance and may help in differentiating from malignant and acute inflammatory conditions. A careful search of the sputum for tubercle bacilli should be made with liberal use of cultures and, where necessary, the examination of laryngeal swabs or gastric contents. The erythrocyte sedimentation rate (E.S.R.) rarely rises above normal except in a proportion of active cases.
Radiographic Features -Tuberculomata may be single or multiple, from 1 to 5 cm. or more in diameter, and appear in any part of the lung. Their density is variable; occasionally the presence of an enveloping capsule can be inferred. When a tuberculoma cavitates, the typical picture is that of single or multiple translucencies, rarely circular but of smooth outline and often eccentric in situation, within the homogeneous mass of the lesion.
Diagnosis and Differential Diagnosis - The following are some of the many diseases which produce rounded shadows in chest radiographs and may have to be considered in the differential diagnosis: bronchogenic carcinoma, neoplastic metastases, lung ,abscess, pneumonia, encapsulated pleural effusion or empyema, congenital and acquired cysts, pulmonary hydatid cysts, coccidioidomycosis, gumma, adenoma, haemangioma, lipoma, hamartoma, pleural fibroma, and neurofibroma.
Course and Prognosis - The processes by which the lesions heal are similar to those of other forms of tuberculosis; namely, by resolution, fibrosis, and calcification. Radiographically a tuberculoma may demonstrate activity by enlargement, cavitation, or the appearance of tuberculosis elsewhere in the lungs or pleura. Enlargement, which may take place slowly over many months or rapidly, is commonly followed by cavitation, a positive sputum, or the spread of disease.
Energy sUPPLY of the Kidneys IN Children WITH Pyelonephritis
A. Loboda
Sumy State University, Department of Pediatrics with Medical Genetics
The study is devoted the estimation of the energetic providing of the kidneys after the index of activity of lactatdehydrogenase (LDH) in the serum of blood and urine of children with a pyelonephritis (PN).
Activity of LDH was probed by a kinetic method after speed of decrease of absorbency of NADH2.
There were inspected 60 children with acute PN, 30 patients with chronic PN in the period of exacerbation and 15 - with chronic PN in the period of remission. Comparison group included 30 children without kidney pathology.
LDH activity in serum of healthy children was in the standard definition of parameters for this method (225-450 Units/l). It is set that in children with acute PN the concentration of LDH in the serum of blood grew almost in 4,5 times, at exacerbation of chronic PN increased in 2,6 times in relation to healthy children.
LDH activity in urine of healthy children was 2,59±0,71 Units/l. Activity of LDH in urine of patients with acute and exacerbation of chronic PN almost in 5 times exceeded the index of comparison group. Contents of the enzyme in the serum and urine in the period of remission did not differ from a value specific for healthy children.
In the case of pyelonephritis occur significant violation of the energy supply of the kidneys, as evidenced by the high level of LDH in serum and urine.
THE IMPORTANCE OF HEAVY METALS IN INTRAUTERINE FETAL GROWTH
L. Turova, E. Mohova, 5-year student., T. Yaschenko, 5-year student
Scientific chief – M.D., prof. V. Markevich
Sumy State University, Department of Pediatrics with Medical Genetics
Among the factors that cause perinatal morbidity and mortality, intrauterine growth retardation of the fetus (IGR) is a priority. However, despite of numerical studies of the etiology and pathogenesis of IGR, damaged factors that act on the fetus finally not established.
Metabolic microelements (ME) significantly affect the growth and development of the placenta and fetus. Toxic effect of heavy metals on the fetoplacental system is considered by many authors as one factor in violation of children's health.
So, it’s necessary to examine the role of the placenta in ensuring the microelement balance of the fetus. We investigated the features transplacental migration to the fetus ME in the case of IGR.
Determination of ME (nickel, chromium and lead) carried out in samples of placenta 30 women who gave children with signs of IGR. Group comparisons were placenta samples from 30 healthy women who gave children without clinical manifestations of IGR.
Was calculated as the ratio ME in the placenta, the index of penetration of metals in umbilical cord blood (the ratio of ME content in the serum of umbilical cord blood to its concentration in maternal blood serum, expressed in a percentage) and the index of accumulation in the placenta (the ratio of ME content in the erythrocytes of the child to its content in the placenta, expressed in a percentage).
To determine the contents of ME in biosubstrates used atomic absorptive spectrophotometer C-115MI manufacturing by joint-stock company “Selmi” (Ukraine).
We found that the level of toxic ME in the placenta of women from IGR had higher values than women who gave healthy newborns (HN).
Placental content of nickel in women who gave children with the manifestations of IGR was 5 times higher (p <0,001) than in healthy parturients, and the index of penetration - lower, while the index of the accumulation - much higher. Index of penetration was 56,6% against 83,3%, and the accumulation of 766,7% against 275,8%, respectively.
The content of chromium was greater (p <0,001) in 2,5 times in the placenta of women who gave children with IGR. The index entry for chromium was 94,1% versus 78,7%, and the index of accumulation - 113,2% against 100% of comparison group.
The concentration of lead in the placenta of women who gave children with manifestations IGR, had a tendency to increase, in comparison with the placenta of women who gave HN. Index of lead penetration through the placenta was lower than in physiological pregnancy and was 107,7% versus 125%, the index of accumulation also decreased in the case of IGR- 163,7% against 204%.
The effectiveness of the placental barrier against such toxic ME as nickel and chromium, is low, which leads to the accumulation of heavy metals in the body and causes development of IGR.
STUDYING OF THE INTESTINAL MICROBIOCOENOSIS IN CASE OF ACUTE ENTERIC INFECTION
Dytko V., 5-th year student
Scientific adviser - candidate of medical science V.V. Zahlebaeva
Sumy State University, chair of infectious diseases and epidemiology with course of microbiology, virology, immunology
Nowadays the acute enteric infections (AEI) are one of the most urgent medical problems, caused by the aggregate of ecological and social-economic factors that influenced on the general health of population. Every year morbidity of the AEI increases in the all age groups. The question of reasonable etyotropic AEI therapy is one of pressing problems. The purposely usage of antibiotics does not reach the necessary result, while the new biological bacterial preparations and enterosorbents invokes an undoubted interest.
According this, the purpose of this scientific research was to study the intestinal microbiocoenosis condition at the patients with AEI before the treatment and at 5-6th day after hospitalization on the background of the usage of “Bifi- form” by 1 capsule 2 times a day and the influence of antibacterial preparations.
116 patients with AEI were examined. The first group (40 patients) got synbiotic “Bifi-form” and the basic therapy. Second group – 18 patients, got norfloxacyne, “Bifi-form” and basic therapy. The groups of comparison were made by patients which did not get “Bifi-form”. The third group of 37 patients got only basic therapy. The fourth group of 21 patients got norfloxacyne and the basic therapy.
In comparison of the patients of the 1st and 3rd groups with the patients of the 2nd and 4th groups disappearance of the stomach-ache, diarrhea, fever was faster in case of the 1st and 3rd groups. So the use of the antibacterial preparations in the AEI treatment prolongs duration of fever, pain and diarrhea symptom, that’s why it is necessary to narrow their prescription indications maximally.
The opportunistic AEI origin can be the reason of different levels of difficulty of the violation of the colon microflora even at the persons without accompanying gastrointestinal tract pathology or it can appear on a background of the compensated dysbiotic changes. The study of intestinal microbiocoenosis state before the treatment proves the necessity of combined probiotics (“Bifi-form”) introduction to the complex AEI therapy beginning from the acute desease period.
“Bifi-form” can become the recommended preparation for intestinal microflora normalization, especially on the background of usage of the antibacterial preparations.
Clinical and epidemiological features of diphtheria
Khilko A.S., Chemych O.M., 5-th year student
Supervisor of studies – D.M., prof. the Head of infectious diseases and epidemiology department M.D. Chemych
Sumy State University, chair of infectious diseases and epidemiology with course of microbiology, virology, immunology
Actuality. Gradual decline of morbidity on diphtheria in ХХ century it was it is interrupted in 1991-1992 sharp getting up, that put under a doubt efficiency specific prophylaxis this disease. It became actual study of modern clinical and epidemiological features of given infections.
Purpose of work - study clinical and epidemiological features of modern to diphtheria in terms North-eastern, boundary region of Ukraine (Sumy region).
Research object - medical maps of patients with diphtheria from 1987 to 2008 years. Epidemiology maps of patients for the same period.
Cardinal the feature of epidemic was predominance adult population among patients on diphtheria. Amount of adults presented 488 (81,33 %) from 600 diseased, children it was in 4,35 time less than are 112 cases (18,67 %). For adults illness ran across heavier - for period a supervision was it is registered 19,88 % heavy to the flow of disease adult population and only 3,74 % - for children. Patients, instilled, have illness against diphtheria ran across in to the easy form; happened although cases middling-heavy and heavy flow of illness, that can testify to the defects inoculation or inopportuneness revaccination.
Thus, these researches show that on modern diphtheria are ill more frequent adults, illness has thus more heavy motion in patients of this group. Vaccination of population against diphtheria high enough but development is in instilled medium severity and heavy forms testifies to violation inoculation or absence timely revaccination. Data of researches shows that at proper prophylactic measures, it is possible not only to stop distribution diphtheria infection, but also to stop her.
STUDY OF INCIDENCE ON ASCARIASIS IN THE SUMY REGION IN 2000-2009 YEARS
Darwich Muhammad, Menon Gowri Kalyani, 5-th year student
Scientific adviser – assist. K.S. Polov’yan
Sumy State University, chair of infectious diseases and epidemiology with course of microbiology, virology, immunology
Changing social-economic situation in Ukraine, the migration processes in the past 10 years have affected the health of the population, the nature of supply and sanitary living conditions. In turn, these changes could have an impact on the level of helminthic invasion of children and adults.
The aim of this study was the analysis of the incidence of the population of Sumy region on ascaridiasis for 2000-2009 years.
A study of morbidity ascaridiasis according to accounting reports of urban and regional sanitary-epidemiological stations for the 2000-2009 years. Among the registered cases in the rural population constituted 40,7 - 44,6 %. In the dynamics of the maximum number identifying ascariasis was in 2001 (1435 cases) in 2002 began reducing morbidity (1349), which reached a minimum (862) in 2009.
Proportion of children up to 14 years in relation to the adult population in different years varied from 50,1 % to 70,6 %. Among rural residents, this indicator ranged from 50,1 - 77,3 %. The dynamics for 10 years, a tendency to reduce child morbidity with lift in 2008 (564 persons) compared with 2007 (519 people). In the study of age-grading of the child population for the entire analyzed period revealed the prevalence of children aged 7 to 14 years inclusive among the registered cases. In the group of 0 to 2 years including a minimum level of cases of ascariasis was in 2005-2006 (53), the maximum - in 2002 (106). Among children aged 3 to 6 years the minimum number of cases was in 2009 (143), and the maximum - in 2000 (317). Among children aged 7 to 14 years, in 2009 fixed the minimum number of identified ascariasis - 241 cases, the maximum observed in 2000 (586).
In Sumy in the past 10 years, the maximum number of ascariasis was identified in 2001 (61 cases), minimal - in 2009 (21). About half were children under 14 years inclusive. In 2007, children accounted for 52% of children from 0 to 2 years in the period from 2001 to 2006 and in 2009 the number of reported cases of ascariasis among children 0-2 years and 3-6 years was the same. Among children aged 7-14 years, an increase in reported cases of ascariasis in 2002, retaining a high level until 2005 (12 and 18, respectively), declining from 2006 (3). In 2009, registered 2 cases of ascariasis in this group.
Based on this analysis it is possible to conclude the feasibility study of different age groups on ascariasis, routine deworming in children, improving health and preventive work among the population, especially in rural areas.
USE OF THE OZONIZED SOLUTIONS IN COMPLEX THERAPY OF PATIENTS WITH SHARP|bitingly| VIRAL HEPATITIS A AND B
Ponor O.B., 5-th yeor student
Scientific adviser - candidate of medical science V.V. Zahlebaeva
Sumy State University, chair of infectious diseases and epidemiology with course of microbiology, virology, immunology
Presently morbidity is on viral hepatitis is one of the most actuality medical problems.Every year morbidity of the viral gepatitis increases in all age groups.Application of medicinal facilities which on the nature are|appear| xenobiotic| strengthens|aggravates| loading on the microsomal| systems of liver. In the conditions of hepatocellular| insufficiency the selection of adequate therapeutic doses of medications (at a cirrhosis biotavailability of preparations is increased with a high hepatic hovergap) is complicated.|complicates| All of it becomes|stands| precondition|pre-requisite| for consideration unmedicinal methods of treatment|treating| of,one of it| is a |what| оzonotherapy. |Purpose of work – to probe influence of the ozonized solutions on clinical motion of viral hepatitis, іntegrative indexes of endogenous intoxication, haematological indexes. For achievement of purpose patients with sharp|bitingly| viral hepatitis A and B, which|what| a complex clinical-еpidemiologic| and laboratory|laboratory-scale| inspection was conducted, were inspected .It was inspected 102 patients which|what| passed|reeve| treatment|treating| in Sumy regional clinical infectious hospital of Z.Y. Krasovizkogo| from October 2004 for September, 2006. It is discovered|exposes| that for patients which|what| got|receive| ozonized solution |, quick there was an improvement of general|common| feel, diminishing|tickle-off| of level|Y-level| of icterus|spleenwort|, and normalization|standartization| of biochemical and general clinical| laboratory|laboratory-scale| indexes|metric| of blood. The received results |according to| the results by conducted a research recommend| introduction|input| of ozonized solution| |endovenous| for the complex therapy of a sharp|bitingly| viral hepatitis A|but| and B.
STUDY OF INCIDENCE ON MUMPS IN THE SUMY REGION IN 2000-2009 YEARS
Omolade Apata Ester, Odigo Ubani Patrick, 5-th year student
Scientific adviser – assist. K.S. Polov’yan
Sumy State University, chair of infectious diseases and epidemiology with course of microbiology, virology, immunology
Infectious diseases remain to this day one of the major causes of morbidity, disability and mortality of the planet. According to WHO 24,7 % lethal cases among the population due to infectious diseases and their consequences, while among children the figure reaches 63,0 %. Carrying out mass vaccination in Ukraine from 1982, and the introduction of vaccinations against mumps vaccine on the calendar in 2000 helped to reduce the incidence among children and adolescents. Monitoring the incidence of mumps epidemic in Ukraine shows typical cyclical disease with periodic ups every 4-5 years.
The purpose of this study was the analysis of the incidence of mumps in the Sumy region in the 2000-2009 years.
A study of morbidity on mumps according to accounting reports of urban and regional sanitary-epidemiological stations for the 2000-2009 years. Maximum patients with mumps in the Sumy region was in 2002 and amounted to 256 persons (19,5 per 100 thousand population), by children aged 10-14 years (92,0 per 100 thousand) and 15-19 years (85,8 to 100 thousand). Since 2003 the incidence has decreased significantly - 131 persons (10,4 per 100 thousand), progressively decreased to a minimum in 2009 - 25 people (2,15 per 100 thousand). During the period studied in children under 1 year only in 2000, 2001 and 2006 recorded diseases: under 2 (23,7 per 100 thousand), 1 (8,5 per 100 thousand) 2 persons (22,07 per 100 thousand). Analyzing the incidence of mumps in the Sumy region among children of different age groups observed increased incidence approximately doubled from 10-14 years compared with a group of 7-9 years. Maximum disease incidence among persons 20 years and over was in 2007 - 41 persons (4,28 per 100 thousand).
In Sumy maximum incidence of mumps was in 2001 - 90 persons (30,7 per 100 thousand), including 23 people (10,3 per 100 thousand) age 20 years and older. Illness decline began in 2002 and reached a minimum in 2009 - 6 persons (2,2 per 100 thousand). Over the entire period were 1 case of mumps (40,48 per 100 thousand) in children under 1 year in 2006. In 2007 also happened to increase the number of cases of mumps in children aged 10-14 years. Since 2002 the group aged 20 years and older was a progressive decline from the peak increase in 2007 - 28 people (12,19 per 100 thousand) compared with 2006 (2,61 per 100 thousand).
The results indicate the need for epidemiological control of mumps vaccination according to the plan of preventive vaccinations, the study of post-level immunity after vaccine. Necessary to investigate the incidence of epidemic mumps among vaccinated persons of all ages.