[A clinical case of piloleiomyoma]. / Klinicheskii sluchai piloleiomiomy.

The article describes a clinical case of a benign tumor from smooth muscle cells - piloleiomyoma. The incidence of leiomyoma in the skin is 3-5% of all leiomyomas. A 27-year-old patient applied to a medical institution with complaints about an intradermal formation in the ear region that occurred repeatedly within 5 months after surgical treatment. After the first surgical intervention, the patient was consulted in various medical organizations, where the following diagnoses were made: «nodular fasciitis¼, «smooth muscle tumor without signs of malignancy¼ and «non-epithelial spindle cell neoplasm¼. According to ultrasound examination, the formation with dimensions of 11×9×5 mm reached the mastoid process of the temporal bone and was characterized by increased internal blood flow. After surgical removal of the neoplasm, taking into account the difficulties of differential diagnosis, an immunohistochemical study was conducted. An accumulation of smooth muscle cells was detected in the surface layers of the dermis under the epidermis by the immunohistochemical study with the use of the marker SMA. A study on CD34 protein revealed a high density of blood capillaries and the absence of its expression in smooth muscle cells. The proliferative index (Ki-67) and mitotic activity (PHH-3) of cells was also studied. The index of proliferative activity was less than 2%, mitoses were isolated. Thus, the results of immunohistochemical study proved the conclusion of piloleiomyoma.

[Physiotherapy treatment of vegetative disorders in patients with voice disorders]. / Fizioterapevticheskaya korrektsiya vegetativnykh rasstroistv u bol'nykh s narusheniyami golosa.

OBJECTIVE: To increase the effectiveness of treatment of hypotonic functional dysphonia using physiotherapy in patients with neurovegetative disorders. MATERIAL AND METHODS: The study included 42 patients, aged from 25 to 64 years, with disturbed vocal function, which included anamnestic analysis, an objective study of ENT organs by conventional methods, a video stroboscopy of the larynx, a cytological study of smears from the laryngeal mucosa, and the determination of the functional state of the autonomic nervous system (ANS). RESULTS: The clinical-physiological study of VNS shows neurovegetative dysfunction (inadequate autonomic support of activity) in 10 patients. In these patients, the traditional conservative treatment was ineffective. Acupuncture used for treatment of neurovegetative disorders in these patients significantly improves the results of traditional treatment. CONCLUSION: The results indicate an increase in the effectiveness of physiotherapy treatment (reflexotherapy using magnetic-infrared laser radiation and acupuncture) of ANS condition. These measures can be carried out in conjunction with traditional methods of treatment or in the case of their low efficiency.

[Treatment of metabolic syndrome in young patients with vitamin D deficiency].

AIM: The purpose of the study is to increase the effectiveness of treatment of metabolic syndrome (MS) in young patients with vitamin D deficiency. MATERIALS AND METHODS: The study involved 54 patients with MS and vitamin D deficiency (50% of women, 50% of men), aged 2044years. To assess the concentration of melatonin at a young age, a control group of 42 practically healthy volunteers with comparable demographic characteristics with no signs of MS was formed. RESULTS: In patients with MS and vitamin D deficiency, there was a significant decrease in the average daily level of 6-sulfatoxymelatonin in the urine by 3.7 times, compared with the group of individuals without MS. Patients with MS and vitamin D deficiency (n=54) were randomly assigned to two groups with comparable clinical and demographic characteristics. Patients of the 1st group (n=27) observed dietary recommendations and took the drug Metformin at a dose of 1700 mg/day for 12 months. In the 2nd group (n=27), in addition to the one indicated in the 1st treatment group, correction of vitamin D deficiency was performed (a micelled preparation of cholecalciferol at a dose of 4000 IU/day, for 6 months, then 2000 IU/day for another 6 months) and the level of melatonin (melatonin preparation at a dose of 3 mg/day for 6 months). After treatment in young patients with MS, there was a significant change in the median of the studied parameters in all therapeutic groups, but more pronounced dynamics was observed in group 2 in terms of: WC in women, BMI, insulin resistance index, LDL cholesterol, TG, hs-CRP, hs-TNF-, IL-6, leptin. CONCLUSION: To increase the effectiveness of MS treatment in young patients with vitamin D deficiency, it is necessary to determine the level of melatonin (urinary 6-sulfatoxymelatonin) and, if it decreases, carry out correction of melatonin and 25 (OH) vitamin D in addition to the standard therapy of this syndrome.

[A crosscorrelation analysis of fluctuations in heart rate and breathing when diagnosing the autonomic disorders in patients with hypotonic type of functional dysphonia]. / Krosskorrelyatsionnyi analiz svyazi kolebanii serdechnogo ritma i dykhaniya v diagnostike vegetativnykh rasstroistv u bol'nykh s funktsional'noi disfoniei po gipotonusnomu tipu.

OBJECTIVE: To conduct a cross-correlation analysis of the frequency of breathing and heart rhythm variability (HRV) in the diagnosis of autonomic disorders in patients with hypotonic type of functional dysphonia. MATERIAL AND METHODS: Twenty-eight women, aged between 21 and 63 years, with hypotonic type of functional dysphonia were examined. The examination of patients included an analysis of anamnesis, an objective ENT study by common methods, videostroboscopy of the larynx, and determination of the functional state of the autonomic nervous system (ANS). RESULTS: It was shown that in such patients, HRV contains alternating RR-intervals, which reduce the correlation coefficient between breathing fluctuations and sinus respiratory arrhythmia. In the majority of patients, ANS dysfunction is detected in the form of insufficient autonomic activity support, while the correlation coefficients (Rc) provide additional information about the autonomic tone. At high values of the correlation coefficient, the autonomic tone is optimal or reduced, at low values (below 0,5) it is optimal or elevated. At the same time, the correlation coefficient, which tends to zero at normal indicators of the total HRV power, indicates the state of ANS tension, which is associated with increased autonomic tone and can be one of the causes of sinus respiratory arrhythmia. CONCLUSION: The crosscorrelation analysis of HRV and breathing in patients with hypotonic type of functional dysphonia is one of the quantitative methods of the diagnosis of vegetative dystonia.

[Diagnostics of olfactory disorders in the patients with Parkinson's disease and polypous sinusitis with the use of the Sniffin' Sticks test].

The objective of the present study was the characteristic of the sense of smell and comparison of its peculiarities in the patients presenting with Parkinson's disease and polypous sinusitis based on the results of otorhinolaryngological examination with the use of the Sniffin' Sticks test. A total of 31 patients with polypous rhinosinusitis (PRS) (18 men and 17 women at the age of 44-58 years ) and 97 patients with Parkinson's disease (PD) (47 men and 50 women at the age of 50-56 years) were enrolled in the study. It was shown that 85% of the patients with PRS and PD suffered from olfactory disorders. The evaluation of selected parameters determined by the Sniffin' Sticks test demonstrated the impairment of the sense of smell in 48% of the patients with PRS and in 54% of those having PD. The main difference between the two groups was in the odour threshold that was reduced in 97% of the patients with PRS and in 72% of the cases with PD and in the ability to distinguish between odours that was compromised in 37% and 78% of these patients respectively.

[Ontogenetic aspects of changing lysozyme activity under acute somatic pain].

OBJECTIVE: Ouraim was to study influence of acute somatic pain on lysozyme activity of rats of different age: newborn, rats after eye opening, rats at the age of a month, adult and old rats. METHODS: Lysozyme activity was checked before pain irritation and 2, 30, 60, 120, 180min afterwards using Dorofeychuk's method in our modification. Pain effect was modeling by electrical stimulation. RESULTS: activity of lysozyme was 0. 434±0. 01 units in intact newborn rats, It was higher than in adult rats - 0.260 ±0.01 units (p <0.001) and it was unchanged during the experiment. We found low lysozyme activity in rats after eye opening - 0.015±0.003 units and it was stable during the experiment. Rats at the age ofa month had diphasic reaction: lysozyme activity was 0.191±0.01 units in intact rats, it increased up to 0.378±0.01 units (p <0.001) in 2 min after painful irritation and it decreased up to 0.113±0.02 units (p <0.001) in 30 min. Lysozyme activity was 0.260±0.01 units. Single-phase reaction was determined after acute painful irritation: increase of lysozyme activity after acute somatic pain up to 0,450±0,014 units (p <0.001). Lysozyme activity was 0.246±0.02 units in blood plasma of old rats. It decreased up to 0.1701±0.01 units (p <0.01) after painful irritation and it was 0.387±0.01 (p <0.001) in the end of the experiment. CONCLUSION: Response on pain irritation has differences in different groups. The common vector of pain response was the increase of lysozyme activity in rats at the age of a month, adult rats, rats after eye opening and old rats. Reaction of increasing lysozyme activity was strongly detected in adult rats. The results demonstrate preventive lasozyme resistance to potential tissue damage or contamination.

[The medical care to patients with diet behavior disorders in case of obesity].

The article deals with the results of the study applied to 304 patients with exogenic constitutional obesity during their reception. The Danish questionnaire DEBQ related to the issues of diet behavior was applied. The study revealed significant motivations of women to visit their physician with the purpose of weight adjustment: health problems (75%), need to obtain quick promotion (37%), self-affirmation (26%), to keep girlfriend, mother, colleague company (4%), curiosity (3%). The programs of prevention and rehabilitation are developed for patients with overweight and obesity to take into account the type of diet behavior and factors to increase the patients.

[The sociological evaluation of quality of medical care rendered to the patients with body overweight and obesity].

The evaluation of quality of medical care rendered to the patients with body overweight and obesity was carried out in the conditions of curative preventive institution and private medical clinics on the municipal level. The study revealed the problems related to the organization of medical care provision to this category of patients addressing to the public medical institutions. The conclusion is made about the need of enhancing the actual system of medical care of patients with body overweight and obesity. It is rational to consider patients' opinion during the optimization of the available high quality medical care.

Pathophysiological aspects of the formation of neurological deficit in multiple sclerosis.

The results of complex studies were used to formulate a concept of the development of neurological impairments in multiple sclerosis (MS). Acutely developing impairments to spike propagation, reaching the level of conduction blockade, due to the active pathological process with demyelinating and axonal damage to the CNS lead to the formation of neurological impairments in exacerbations of MS, while complete or partial reversion (regression) of these symptoms in the stage of remission results from compensatory changes in the nature of conduction, which were not, however, accompanied by recovery of electrophysiological measures. The development of stable neurological deficit in secondary-progressive MS is determined by impairments to spike conduction processes associated with significant levels of demyelination and atrophic changes in the CNS, with myelin loss and axon death. Finally, the severity of cognitive changes is determined by differences in the severities of both the focal demyelinating process and diffuse damage to brain substance in MS, including the neurodegenerative component. The main factor in transient increases in symptoms is the universal lability of electrophysiological parameters, including those developing on the background of ion and neurotransmitter imbalance.

[The medical care to the patients with body overweight].

The issues of medical care to the patients with obesity are discussed. The social satisfaction level of patients undergoing medical treatment in various curative institutions is considered as one of indicators reflecting the medical service effectiveness. The characteristics of functioning of a private medical clinic and a municipal medioprophilactic institutions are revealed. The lower appealability and treatment effectiveness in the public medical institutions is exposed. The need in the optimization of the public health functioning and the enhancement of the actual medical care provision to the patients with body overweight and obesity is determined.

[Vestibular cochlear disturbances in multiple sclerosis].

To specify the character of vestibular cochlear disturbances in multiple sclerosis (MS) and mechanisms of their formation, the objective quantitative evaluation of experimental caloric nystagmus using the computer electronystagmographic method and a comparison of hearing impairment with asymmetry of vestibular reactions were conducted in 48 patients with MS. The peculiarities of vestibular disturbance found in the study suggest a predominance of central vestibular syndrome with both subtentorial and supratentorial traits. The influence of the heat stimulus of vestibular analyzer (hot water caloric test) in multiple sclerosis revealed during computer electronystagmography may have diagnostic value.

[Vertigo and peripheral ischemic cochleovestibular syndrome caused by circulatory insufficiency in the vertebrobasilar system].

We studied characteristics of vestibular and acoustic disorders in patients with arterial hypertension, atherosclerosis and vascular dystonia; correlation between peripheral cochleovestibular syndromes (PCVS) and circulation in the major and intracranial arteries, central hemodynamics, organic changes in the brain. We discovered that anomalies and asymmetry in vertebral arteries diameters, stenoses, reduced stroke and minute blood volumes play an essential role in development of PCVS. The latter are rarely accompanied with ischemic foci in the brain. Medication of vascular vertigo consists in administration of an adequate drug. We believe that betaserk is most effective.

[The role of neurovisualization methods in diagnosis and verification of vertigo etiology].

Roentgen computed tomography (RCT) and MR-imaging (MRI) were used in investigation of vertigo etiology and affection of the cochleovestibular analyzer in 130 patients aged 28 to 74 years with recurrent systemic rotatory vertigo or its other symptoms. All the patients have undergone comprehensive otoneurological examination, RCT and MRI which showed that peripheral cochleovestibular syndromes (PCVS) caused by arterial hypertension (AH), atherosclerosis (AS), vascular dystonia (VD) are rarely characterized by focal alterations in the brain. PCVS comparison with blood flow in the vertebral arteries (VA) detected most frequently anomalies and asymmetries of the diameters. MR-angiography plays an important role in verification of pathology of intracranial VA. In central cochleovestibular syndrome (CCVS) with AH, AS, VD, principal pathological changes were registered in the brain trunk and cerebellum by MRI. Vestibulometry and otoneurological method detect not only vascular cochleovestibular peripheral and central syndromes but also to make differential diagnosis. RCT and MRI verify cochleovestibular syndromes in patients with multiple encephalomyelitis, VIII nerve neurinoma and tumors of the posterior cranial fossa.

[The role of the otoneurological method in early diagnosis of multiple sclerosis].

Complete vestibulometric, audiological and otoneurological examinations were made in 48 patients with multiple sclerosis (MS). Central cochlear-vestibular syndrome was diagnosed in all the examinees. The otoneurological examination and comparison of changes in the acoustic and vestibular functions revealed specific symptoms characteristic for demyelinating disease of the central parts of the cochleovestibular analyzer. MR-tomography visualization of the demyelination foci in the brain confirmed affection of the cochleovestibular analyzer.

[Vertigo and a role of neurovisual methods in it etiology and diagnosis].

Investigation of vestibular system using a standard method of electro-nystagmography in complex otoneurologic examination does not provide enough information on the etiology of vestibular analyzer lesion, location and diffusion of the pathological process. Neurovisual methods, in particular MRI and CT, have demonstrated high diagnostic validity in such pathological states as tumors of pons cerebellum and posterior focca; infarctions in the stem and cerebellum regions. The study revealed a role of MRI and CT in etiology of vertigo and lesions of cochleovestibular analyzer. One hundred thirty patients aged 28-74 years with recurrent attacks of systemic rotary vertigo and other its appearances have been examined. In 14 (11%) patients such an attack was accompanied by loss of consciousness, falls, double-vision and other neurological symptoms. All the patients underwent otoneurological examination, computer electronystagmography, auditory evoked potentials registration, CT and MRI. It is shown that peripheral cochleovestibular syndromes caused by arterial hypertension, atherosclerosis and autonomic vascular dystonia are rarely characterized by focal cerebral changes (11 patients by CT data and 17 by MRI).

[Epidemiology, clinical features and betaserc therapy of vertigo in initial and reversible cerebrovascular pathology].

The study comprised two sections: epidemiologic and clinical. The aim of the epidemiologic investigation was to determine prevalence of vertigo, including its mild cases, in patients with initial and reversible forms of cerebrovascular pathology. While screening an open population, 726 men and women aged 35-60 years have been examined using uniform program. Vertigo was detected in 30%, frequent and long-lasting one in 14.6% cases (8.1% men and 21.9% women, p < 0.001). A clinical section included a profound examination of 40 patients. Along with duplex scanning of major brain arteries, neurologic and otoneurologic examination of the patients, aucoustic stem evoked potentials have been registered. Marked dysfunctions of autonomic nervous system and changes in functioning of different vestibular analyzer regions were revealed. High efficacy of betaserk used during 2 months in dosage 16 mg three times a day was demonstrated by improvement of the patient's state in 97% cases.

[Cochleovestibular syndromes in vertebrobasilar insufficiency]. / Kokhlevestibuliarnye sindromy pri vertebral'no-baziliarnoi nedostatochnosti.

The study aimed at (1) identification of the main vestibulometric characteristics of peripheral cochleovestibular syndrome caused by arterial hypertension, atherosclerosis and vegetative vascular dysfunction, (2) elucidation of the pathogenic peculiarities of its formation and (3) evaluation of therapeutic efficacy of betaserc in peripheral vertigo. Eighty-five patients with peripheral cochleovestibular syndrome (PCVS) were studied. On the base of the data of ultrasonic examination of major cranial arteries, arterial blood pressure, central hemodynamics and structural cerebral changes, it is shown that abnormalities of vertebrobasilar system play an important role in PCVS development. Stenosis of spinal and internal carotid arteries was found in a limited number of cases. A conclusion is made on involvment of hemodynamic mechanism of blood circulation insufficiency in the inner ear at microcirculating level in ischemic PCVS pathogenesis. A study of the structural cerebral changes revealed that PCVS were not accompanied by the ischemic foci in the brain. Pharmacotherapy of peripheral vertigo of vascular etiology is based on the right choice of the drugs optimizing blood circulation in combination with vestibulolytics. Therapeutic efficacy of 2-month betaserc course in peripheral vertigo has been proved.

[The status of cerebral hemodynamics in patients with vertebro-basilar insufficiency syndrome]. / Sostoianie tserebral'noi gemodinamiki u bol'nykh s sindromom vertebral'no-basiliarnoi nedostatochnosti.

The state of venous and arterial cerebral hemodynamics was studied using ultrasonic dopplerography with application of hypo- and hypercapnia, angioencephaloscintigraphy with pertecnetate Tc-99m in 48 patients with syndrome of vertebrobasilar insufficiency. Estimation was performed in patients by the results of neurological and otoneurologic evidence, the data of nistagmography and registration of the truncal evoked potentials. It was found that at early stages of the development of vertebrobasilar insufficiency's syndrome disorders of vasomotor reactivity and disturbances in venous hemodynamics play a leading role in its pathogenesis. Stenosis damages of extra- and intracranial arteries become dominating in subsequent clinical picture.