Важливим досягненням у вирішенні патогенезу генералізованого пародонтиту стало вивчення дисфункцій ендотелію судин мікроциркуляторного русла пародонта, яка характеризується порушеною ендотелій залежною релаксацією судин і підвищеною адгезивністю ендотелію [2, 3, 4, 11]. Особлива увага приділяється вивченню гемомікроциркуляторних порушень, які ведуть до розвитку в пародонті метаболічних порушень, дистрофічних, дегенеративних змін, ініціюють запальні реакції [1, 5, 6, 7, 9, 12]. Оцінка ендотеліальної дисфункції є новим і перспективним напрямком сучасної медицини і розглядається не тільки як маркер судинних порушень. Встановлено її важливе значення в ініціюванні, прогресуванні і клінічних проявах чисельних захворювань [2, 4, 8, 10, 11]. В пародонтології механізми розвитку ендотеліальної дисфункції вивчені недостатньо, що вказує на необхідність глибокого вивчення цієї проблеми на сучасному медичному рівні.
Двостулковий клапан аорти – це вроджена вада серця, поширеність якої складає 0,9-1,37 у загальній популяції, і, можливо, вона є найчастішою серцево-судинною дисплазією. Дана вада втричі частіше зустрічається у чоловіків ніж у жінок [1]. Двостулковий клапан складається з двох стулок (передньоі і задньоі чи правої та лівої), зазвичай неоднакових за розміром, можливо, внаслідок неадекватної продукції фібриліну-1 в період пренатального онтогенезу. Стулки клапана з’єднані двома спайками, які можуть бути частково зрощеними [2]. Безсимптомний перебіг двостулкового клапана аорти впродовж багатьох років істотно підвищує ризик виникнення його ускладнень: аортального стенозу, недостатності аортального клапана, дилатації висхідної аорти, утворення аневризми аорти. Основним методом діагностики даної вади є ехокардіографія, яка може визначити остаточний діагноз у більшості пацієнтів
Abstract. The mechanisms of formation of male infertility are increasingly becoming immune-dependent. Immunological isolation of the testes is provided by the anatomical blood-testis barrier and the special tolerance of the immune system to antigens expressed on male gametes. For a better understanding of the immunopathogenetic mechanisms of infertility, a study of the role of various immune factors is required.
The aim: to study the role of pro-inflammatory and anti-inflammatory cytokines in blood serum to clarify their role in spermatogenesis.
Materials and Methods: 45 infertile men aged 22-48 were examined. They were divided into 2 groups: first group – 22 men with a systemic autoimmune disease - rheumatoid arthritis; second group – 23 somatically healthy patients
with idiopathic infertility. The control group included 27 fertile healthy men aged 22-48 years. Determination of the
cytokines concentration in blood serum was carried out by the immunoenzymatic method. Student's t-test was used to compare the significant difference in mean values between groups. P < 0.05 was considered significant.
Results. Patients with autoimmune diseases (rheumatoid arthritis) had the highest rate of leukocytospermia, indicating a possible long-term inflammatory process. In patients with idiopathic infertility, oligozoospermia was diagnosed in 3 patients (13.04%), oligoasthenozoospermia in 7 patients (30.36%), asthenozoospermia in 8 patients (34.78%) and leucocytospermia in 5 patients (21.82%). In patients with rheumatoid arthritis, the concentration of IL-18 (cytokine of the IL-1 family) in the blood serum of infertile men was 1.36 times higher than that of fertile men. The level of IL-6 was 6 times higher, and the concentration of IFN-γ exceeded the norm by more than three times. The level of IL-10 was 9,4 times higher than in control group. Significant changes in the serum cytokine profile were recorded in men with idiopathic infertility. The level of pro-inflammatory cytokines increased statistically significantly: IL-18 – 1.45 times, IL6 – 2.85 times, IFN-γ – 2.65 times. Simultaneously, the level of anti-inflammatory cytokines increased: IL-10 – 3.0 times.
We also analyzed the ratio of serum levels of pro- and anti-inflammatory cytokines. Significant increase in ІL10/TNF-α ratio was recorded in men with idiopathic infertility and infertile men with rheumatoid arthritis. Specifically, in men with idiopathic infertility the ІL-10/TNF-α ratio was 3.3 times higher and in patients with rheumatoid arthritis the ІL-10/TNF-α ratio was 4.1 times higher than in control group. In patients with rheumatoid arthritis the ІL-10/ІFN-γ ratio
was in 3 times higher than in control group. Significant positive correlations were found in healthy fertile men: TGF-β1 – IFN-γ, IL-10 – IL-18 and IL-10 – TNF-α. In men of the control group, the synthesis of IL-18 and TNF-α was balanced by the production of IL-10. The synthesis of IFN-γ was by balanced by the production of TGF-β1.
Conclusions. The development of infertility associated with various accompanying pathologies is related with by changes in both systemic and local immune reactivity. The pro-inflammatory cytokine profile of blood serum and a decrease in the concentration of IL-1β are observed in patients with idiopathic infertility. The largest number of deviations of immune reactivity was found in infertile men with concomitant autoimmune diseases
The aim: To provide clinical evaluation of the effectiveness of anesthesia for cystectomy of radicular cysts that have grown into the maxillary si-nus or nasal cavity using different techniques of endonasal block-ade of the nasopalatine nerve.
Materials and methods: Clinical observations were conducted on 52 patients of different age and sex. These patients were diagnosed with large radicular cysts (more than 3.0 cm in diameter) that had grown into the maxillary sinus (33 cases) or into the nasal cavity (19 cases). The surgical excisions of cysts (oroantral cystectomies) were performed un-der local potentiated anesthesia. Patients were divided into two clinical groups, depending on the methods used for endonasal blockade of the nasopalatine nerve: the main and the control group. Patients in the main group underwent endonasal blockade of the nasopalatine nerve at the point of its emergence from the pterygopalatine ganglion.
In the control group, the neural blockade was performed at the entry of this nerve into the incisive canal. Pain sensitivity and perception in patients were studied using subjective and objective methods. The data was analyzed by means of the Pearson’s chi – square tests.
Results: During the enucleation of radicular cysts that grew into the inferior nasal meatus and maxillary sinus in patients of the main group there was no pain observed. There were no manifestations of pain-induced stress neither from the side of autonomic system, nor physical or emotional manifestations of pain, which confrmed the effectiveness of nasopalatine nerve anesthesia. In patients of the control group during similar operation the full effect of local anesthesia was achieved in 56.0% of cases (χ2 – 9,270, р = 0,003). The rest of the patients during cystectomies showed some signs of pain-induced stress from the side of autonomic system or in the form of physical or emotional manifestations.
Conclusions: Endonasal blockade of the nasopalatine nerve at the point of its emergence from the pterygopalatine ganglion invariably provided a complete analgesia during enucleation of radicular cysts that have grown into the maxillary sinus or nasal cavity. Anesthesia of the nasopalatine nerve at its entry into the incisive canal allows pain-less cystectomy of radicular cysts that have spread to the front of the inferior nasal meatus from the front teeth.