The review describes the skin microcirculation disorders with essential arterial hypertension by the capillaroscopy and laser Doppler flowmetry. The methods are complementary to each other and provide information about the structural and functional state of arteriolar, capillary and venular vessels in the microvasculature. The most common disorders in the skin microvasculature attending the arterial hypertension are vasomotor dysfunction of the microvascular endothelium, a decreasing of the dilator reserve, and capillary rarefaction. The bulk information was obtained in non-acral areas of the skin, where the tissue perfusion is has mainly nutritional pattern. The blood flow pattern in of the skin acral areas, where the sympathetic adrenergic system of regulation dominates, is still unexplored, and tissue perfusion is characterized by a thermoregulatory shunt orientation.

The aim of the work is to evaluate microcirculation, innervation and intercellular interactions depending on the severity and timing of cold tissue lesions. Materials and methods. 50 patients with III–IV degree of lower extremities local cold injury, as well as their blood were explored. Patients were divided into two groups depending on the period of clinical course: 5 and 30 days of cold injury. At the same time, the patients were divided into 3 groups according to the level of the lesion. The 1 group patients had only fingers frostbitten. Group 2 – patients had lesion boundary extended to the metatarsals and metatarsals. Patients with cold trauma of the proximal segments of the lower extremities belonged to group 3, had the damage level limited by the lower third of the low leg in the most cases. Studies in these groups were carried out on the 5th day after the injury. The phenomenon of lymphocytic-platelet rosette formation and the amplitude of M-response were evaluated. Results. In patients with frostbite, the increased adhesive ability of blood platelets to lymphocytes, was significantly decreased by 30 days. By the day 5, the number of lymphocyte-platelet rosettes increased 2.2 times, and the degree of adhesion 1.7 times. By the day 5 of the injury, the value of the M-response was reduced by 1.7, and the detected changes were preserved for day 30. In patients with fingers frostbitten, the percentage of LTA increased by 1.3 times, and the degree of adhesion by 1.5 times. Registered ENMG potentials decreased by 1.7 times. In group 2, the ability of platelets to adhere to lymphocytes increased by 1.6 times, and the average number of plates participated in rosette formation increased by 2.1. The registered ENMG potentials decreased by 2.5 times. In patients with the maximum level of cold tissue damage, the adhesive ability of lymphocytes and platelets increased by 3 times, and the degree of adhesion increased by 3.5 times, the amplitude of the M-response decreased by 2.6 times. Conclusions. The patients with local cold injury have been demonstrated the increasing of the platelets ability to adhesion to lymphocytes. The increasing of the number and degree of LTA was proportional to the level of tissues damaged by cold. Also, patients with frostbite had a sharp decreasing of in the amplitude of the M-response (motor response), which was getting worse with the increasing of severity of tissue damage. In the case of local cold injury, the maximum activity deviations in the activity of lymphocytic-lamellar interactions and the m-response amplitude of the electroneuromyography were recorded in the early period of cold injury, with a tendency to restore the wound process on the 30th day.

Introduction. About 0.2 % of the adult population all over the world suffers from hypertrophic cardiomyopathy. Early and timely diagnosis of the apical form of hypertrophic cardiomyopathy remains an urgent medical problem, since the disease has a wide variability of clinical manifestations and often occurs asymptomatic or with symptoms of other heart diseases. Magnetic resonance imaging is an informative method of radiation diagnosis of hypertrophic cardiomyopathy. The aim is improving of radiology diagnostics in applying to the apical form of hypertrophic cardiomyopathy. Materials and methods. 98 patients with apical hypertrophic cardiomyopathy aged 19 to 76 years were еxamined. There were 48 men and 50 women. All subjects were examined by a cardiologist, all patients underwent electrocardiography and echocardiography, 45 patients underwent magnetic resonance imaging (MRI) of the heart. Results. In our study 13 patients had MRI determined the isolated form of apical form of hypertrophic cardiomyopathy, 32 had combined one. 42.2% of the patients with symmetrical hypertrophy of all apical segments had sawtoothed configuration of the LV revealed by MRI. The symptom of left ventricular cavity obliteration was determined in 19 patients. The symptom of LV cavity sequestration was determined in 5 subjects. 5 patients had an aneurysm on the top of the left ventricle, 1 – on the top of the right ventricle. Signs of left ventricular outflow tract obstruction were visualized in 2 patients, intraventricular obstruction at the level of the middle segments of the left ventricle was determined in 5 cases. Akinesis and hypokinesis were detected in areas of fibrous changes (n=21) or in areas of cardiosclerosis (n=2). In 17.8 % of subjects identified non-compacted myocardium, in 3 cases it was combined with apical form of hypertrophic cardiomyopathy. With contrast enhancement in 29 patients, foci (n=22) or zones (n=7) of pathological accumulation of contrast agent were determined, which indicated the replacement of myocardium with fibrous tissue.

Relevance. An active study of ischemic mitral regurgitation and a modern aggressive approach to its surgical treatment in combination with continuous improvement of plastic valve-retaining methods make the surgical treatment of ischemic mitral regurgitation the most promising, however, the choice of optimal surgical tactics for this pathology continues to be discussed. Objective. The clinical case of combined surgical treatment of severe ischemic mitral regurgitation (plication of the anterolateral commissure by pulling the prolapsing segment of AML (А1), suturing and reimplantation of the ruptured marginal chordae and annuloplasty with the rigid complete annuloplasty ring), formed on the background of progressive ischemic heart disease after myocardial infarction, in combination with CABG (autovenous coronary artery bypass grafting of right coronary artery, posterolateral branch and obtuse marginal branch and mammary coronary artery bypass grafting of diagonal branch). Conclusion. The presence of a «classic» dilatation of the fibrous ring of the mitral valve and an ischemic damage of the leaflets and
subvalvular structures (tearing of the chords with impaired coaptation of the leaflets, malfunctioning of the papillary muscles) requires plastic correction of these defects in addition to «classic» annuloplasty of the fibrous ring of the mitral valve, which results to the absence of residual and recurrent mitral regurgitation in the immediate postoperative period.

Aim. Study of heart function in the patients with CVD. Materials and methods. 46 patients with varicosity (VD) and 34 patients with post-thrombotic disease (PTD) were examined; the control group was represented by 15 healthy volunteers. The diagnosis was established using the CEAP basic classification. The study did not include patients with a diagnosed arterial hypertension, diabetes mellitus, chronic lung disease, significant hemodynamic heart defects, coronary heart disease. Ultrasound examination of the heart and veins of the lower extremities was performed on a Saote My Lab Alpha, Acuson Sequoia 512 apparatus. In addition to the standard protocol of heart ultrasound examination, the parameters of the right heart were calculated: sizes of the right ventricle (RV), right atrium, thickness of the anterior wall of the pancreas; to assess the ejection fraction (EF) of the pancreas the mobility of the lateral edge of the tricuspid ring was calculated, and the pressure on the tricuspid valve (TV) was measured. Diastolic ventricular function was studied by spectrograms of tricuspid and mitral blood flow. Results. Most of the indicators of cardiac activity in patients with VD were within normal limits, but a tendency to increase increasing of the right heart size was noted. In addition, the thickness of the interventricular septum and the right ventricle (RV) anterior wall was found to increase from 0.8 to 1.1 cm and from 0.3 to 0.5 cm, respectively, according clinical classes from C2 to C6 (CEAP). Eject fraction (EF) of both the RV and the left ventricle (LV) were also within normal limits, but with a tendency to decrease (67.8 % – C2, to 62 % – C6). The growth of the clinical class is followed by the increasing of percentage of non-restrictive blood flow through the tricuspid valve (TV). The restrictive type of blood flow in patients with VD had not been identified. Patients with PTD also showed a tendency to increase the right heart. However, whereas the size of the RV, as a rule, did not exceed 3.0 cm, the size of the right atrium was slightly higher than normal one in the clinical class C4 and C5.6. All the patients had EF of LV within normal limits, but it slightly decreased by the growth of class. Only patient classes C3 and C4 had EF of RV within the normal range. The 18 % of patient class C5.6 had EF lower than normal with value 48%. Diastolic dysfunction (DD) of the RV was detected in 73.3% of patients with class C3 and 100% with classes C4 and C5.6. Moreover, a restrictive type of blood flow through TV appeared from class C4 and the percentage increased up to 27.2% (class C5,6). Conclusions. DD of the RV was the main hemodynamic disorder.

Chronic venous insufficiency is often accompanied by trophic changes in soft tissues. The treatment of such patients is long and often, ineffective. Relapse of a trophic ulcer is about 30% and leads to deterioration of life quality and dissatisfaction with conservative and even surgical treatment. Goal. Objectification of changes in the microvasculature and compensatory the possibilities of collateral circulation in the lower extremities with complicated forms of chronic venous insufficiency. Materials and methods. The studies were carried out on the Linsor installation characterizing the biological tissue by the change of scattered light intensity and on the thermal imager making possible to determine the temperature of a point with an accuracy of 0,001 degrees, followed by software image processing. The examination was performed 3-4 times in the dynamics of the treatment process and before the patient discharge, from a standard distance of 1,5 meters. The soft tissues in 23 patients with chronic venous insufficiency of the lower extremities and the presence of open trophic ulcers was studied. There were 21 women, 2 men, the average age was 45,2±3,6 years. The area of the ulcer defect varied from 5,7 cm² to 15,3 cm². Patients with extensive trophic ulcers (circular) were excluded from the examination, because of absence of ulcer defect epithelization during the period of hospitalization and its visualization by the thermographic method. Results. As a result of the study, we obtained a reduced intensity of infrared radiation of the ulcer surface in all patients. To clearly isolate ulcerative defect from the surrounding tissues, we set the temperature range 35,0–37,5 °C and recalculated the resulting area in cm² (conversion factor 22,73). We studied the microcirculatory changes occurring in the trophic ulcer and surrounding tissues, confirming the need to continue conservative treatment after complete ulcer defect epithelization for at least 7 days, and only after that period the normalized level of infrared radiation was detected and subsequently relapsed trophic ulcers did not occur for a long time. Conclusion. Based on the obtained data, we confirmed the thermal imaging method sensitivity is suitable for assess of microcirculation in the trophic ulcer area; the method provides the possibility to apply it for the dynamics of conservative treatment in patients with complicated forms of chronic venous insufficiency.

Relevance. In this article, the authors draw the attention of readers to the modern possibilities of using the biomicroscopy of the bulbar conjunctiva (BMBC) method in the diagnosis of microcirculatory (MC) disorders in systemic sclerosis (SS). Comparison of BMBC results of patients with SS with a control group allowed us to identify microcirculatory signs of this disease, and comparison the changes detected during nail capillaroscopy (NC) showed additional diagnostic capabilities of the BMBC method. The aim of the study was to identify new MC signs in SS using the BMBC-method, which can be further used to assess the dynamics and search for patterns with the clinical picture. Materials and methods. 48 patients with SS, the average age was 51±1.7 years were examined by BMBC, the ratio of women to men was 46:2, respectively. The control group consisted of healthy individuals without any diseases that could affect to the microcirculatory bed (MCB); the average age was 47.4±2.3 years, and the ratio of women to men was 20:10. The results showed statistically significant changes in angioarchitectonics among patients with SS compared with the control. A significant decrease in the average diameter of arterioles (14.1±0.7 μm) and capillaries (6.6±0.2 μm) was observed in the group of patients with SS compared with the control (16.6±0.6 μm, p=0.0165 and 7.3±0.2 μm, p=0.0356, respectively, for arterioles and capillaries). The decrease in capillaries during SS in four regions of the temporal section of the bulbar conjunctiva was incremental and amounted to: 15.3% in the area of the angle of the eye, 23.3% in the transitional region, 28.1% in the central and 37.9% in the perilimbal in comparison with the control. Conclusions. The BMBC-method is highly informative in the diagnosis of MC-disorders in SS. The main BMBC changes in the MC disorders caused by SS are the disturbance of MCB by the increasing tortuosity of microvessels, the contour discontinuity and the presence of local wall extensions. A peculiarity is the reduction of the capillary bed in all four regions of the temporal section of the bulbar conjunctiva with a maximum in the perilymb area.

Introduction. The actuality of children allergic respiratory diseases problem is due to the steady increase oftheir occurrence all over the world. Computerized capillaroscopy (ССS) of the nail bed is a non-invasive and highly informative method for assessing the structural and functional parameters of capillaries in real time and physiological conditions, and so it is effectively applied in pediatric practice. However, studies in this promising direction are rare. Aim. Was to determine the microcirculation peculiarities in children suffering from respiratory allergic diseases with prolonged cough, using the method of computerized capillaroscopy of the nail bed. Materials and methods. 238 children aged from 2 to 17 years with acute and chronic respiratory diseases, accompanied by prolonged (more than 4 weeks) cough, were examined and divided into 4 groups (Gr): Gr1 (n=68) – patients with acute or exacerbation of the chronic upper respiratory tract diseases of the infectious genesis; Gr2 (n=53) – patients with lower respiratory tract infection; Gr3 (n=39) – patients with allergic rhinitis; Gr4 (n=78) – patients with bronchial asthma (BA). All patients underwent history, examination and ССS of the nail bed. Results. Patients with allergic diseases of the respiratory tract, especially with BA, were found to have structural and functional disorders of the capillary bed and a pronounced increase in the length of the perivascular zone indicating an increase in the hydration degree of the interstitial space due to chronic allergic inflammation, in contrast to children with respiratory tract infection getting changed microcirculation parameters mainly in the venous part of capillaries. Conclusion. CСS of the nail bed is a highly informative method to identify functional features of the capillaries in allergic and infectious pathologies of the respiratory system, which can be successfully used as additional criteria for their differential diagnosis.

Introduction. Ischemic postconditioning (IPostC) is a new concept in the brain protection strategy. Almost all researches in this area focus on the functioning and survival of neurons, while non-neuronal cells affected by IPostC remain unexplored. The aim is to study the IPostC effect on changes in microglia in the neocortex of Wistar rats after global brain ischemia during various periods of reperfusion. Materials and methods. Male Wistar rats were used as a model of a 10-minute global brain ischemia with a subsequent IPostC; the reperfusion-ischemia cycle was 15 s/15 s. In the early (2 days) and late (7 days) reperfusion periods, the number of morphologically unchanged neurons and Iba-1-positive nucleated microglyocytes in the occipital cortex was estimated. Results. It has been shown that global brain ischemia in rats leads to 25.9% (P<0.05) neuron death and an increase of 30.9% (P<0.05) in the number of Iba-1-positive microglia cells by the 2nd day of the reperfusion period in the occipital neocortex; by the 7th day of reperfusion, there was observed a neuron death significant increasing by 34.5% (P<0.05) and the number of Iba-1-positive microglia cells increasing of 65.2% (P<0.05) compared to similar indicators in sham-operated groups. The IPostC by 2 days of reperfusion was found to increase the number of unchanged neurons in the occipital region of the cerebral cortex by 18.3% (P<0.05), which is not accompanied by a significant change in the number of Iba-1-positive microglial cells; by 7 days of reperfusion the increase number of unchanged neurons was found to be 23.5% (P<0.05) in the analysed brain region , which is accompanied by a decrease in the number of Iba-1-positive microgliosis by 32.5% (P<0.05) comparing with similar indicators in groups without IPostC. Conlusions. The results of this work suggest that the cytoprotective effect of IPostC for neurons of the occipital neocortex of Wistar rats in the long-term reperfusion period is caused by blocking the infiltration of the ischemic brain region by both resident and recruited cells of the immune system.

Purpose. Modern medical standards do not contain information about the urgent bleaching of nail hematomas and bruises. The aim of this work is developing of new ways and means for blood bleaching of the bruising and subungual hematomas for its immediate discoloration. Materials and methods. The peculiarities of hydrogen peroxide effect on blood color alteration in different environment have been studied in laboratory, by experiment and in clinical conditions. We studied the peroxide effect on liquid and dry venous blood in a Petri dishes, in bloody gauze bandages, on the surface of the skin, in hematoma under the nail in humans and in the skin over the bruise created by intradermal injection of pig blood. The studies take into account the role of local interaction such factors as the duration of interaction, the concentration of ingredients, local temperature, the value of alkaline and osmotic activity of the studied solutions. The results were recorded by color photo and video. Results. In laboratory and experimental conditions the red and blue blood as well as red, brown and/or blue stained tissues were shown to be urgently bleached by alkaline solutions of hydrogen peroxide. Hemoglobin was found to be the «dye» of blood-stained tissues. We listed the inventions to the intradermal bruising discoloration, subungual hematomas, and fresh and dried blood. The main ingredients of the inventions for intradermal and subungual hematomas bleaching are reported. The essence of the invented methods of skin and nail hematomas discoloration is presented. Conclusion. The alkaline solution of hydrogen peroxide can be used for emergency discoloration subungual hematoma, the skin in the area of bruise and the bandage stained with blood.

The lecture presents contemporary view on the human cardiovascular system organization. The mechanisms determining the systemic blood pressure level are shown; the factors regulating minute volume of blood circulation and peripheral resistance to blood flow are described. The mechanisms of neurogenic and basal vascular tone are noted, the role of humoral and endothelial regulation mechanisms of the artery lumen s is indicated. Based on the recent evidences of the circulatory system functioning, we gave a description of the main medicinal compounds used in clinical practice to decrease blood pressure. The pharmacological drugs decreasing neurogenic vascular tone and inhibiting basal vascular tone are indicated. The data of drug action, its pharmacodynamics and basic principles of combined use for the rational treatment of hypertension are presented. The lecture may be interesting to physiologists, pharmacologists, cardiologists, therapists, medical students and clinical residents.