UDC: 618.19-091.8-06:616-089.843
One of the current vectors of modern reconstructive and cosmetic surgery is augmentation mammoplasty - an operation to enlarge the mammary glands. The breast implant is well tolerated by the body, as the immunogenicity of its material is extremely low. At the same time, the silicone gel of the implant is a foreign object and the surrounding breast tissues give a stereotypical response in the form of growth of the connective tissue stroma with the formation of a capsule around the implant and the appearance of focal cellular infiltrates. Modern breast implants, unlike implants of previous decades, are more sophisticated in their structure, and the level of protection against damage is much higher. A complication associated with the long-term use (up to 20 years) of implants, where low-quality silicone or industrial silicone was used as a filler, is the penetration of low-molecular-weight particles of the implant through its shell to the surrounding tissues with the subsequent formation of silicone granules. In the vast majority, such changes develop after mechanical traumatization of the implant. The purpose of the study is to establish the morphological criteria of the reaction of breast tissue after silicone implant damage. The material for research was histological micropreparations of breast tissue from the archive of the "Grace Clinic" (Kyiv), with the mutual consent of patients who applied for repeated mammoplasty. The duration of the implants in the breast gland was from 6 to 20 years. The age range of the women was from 36 to 53 years. On preparations stained with hematoxylin and eosin, tissue biopsies of the glands of 9 patients with a diagnosis of deformation of silicone implants and violation of the integrity of their wall were presented. The micropreparations were visualized using a UlabXSP-137TLED light microscope at various magnifications and photographed with an XCAM 1080P camera. The study of histological preparations of soft tissues of the breast glands, from which silicone implants were removed, established changes in stromal-cellular elements, namely: decorated fibrous structures accumulated in the form of dense capsules with elements of local contractures; from the side of cellular elements, the most demonstrative were cellular infiltrates, which included macrophages, lymphocytes, and plasma cells, which indicated a high probability of a chronic inflammatory process. A large number of giant multinucleated cells of foreign bodies were present in practically all examined sections, which indicated the impossibility of macrophages to complete phagocytosis with lysis of the phagocytosed material, which by its chemical composition is the silicone of the implant. All the described phenomena can be interpreted as a natural reaction of the tissues to the implant, the contents of which got into the soft tissues of the breast. Thus, the presence of numerous giant multinucleated cells of foreign bodies, dense capsules with elements of local contractures, and a significant predominance of macrophages, lymphocytes, and plasma cells in cellular infiltrates over other cellular elements can be considered a morphological criterion for the reaction of breast tissue to silicone implant damage. Keywords: mammary/breast gland, breast implant, breast silicone implant damage, aesthetic surgery, microscopy, histopathological diagnosis, implant-associated fibrotic changes.

Pericardial effusion (PE) can occur in inflammatory and infectious diseases; postoperatively, in pulmonary arterial hypertension, renal failure, as well as in malignant diseases that can affect the pericardium and manifest as a paraneoplastic syndrome (1). On the other hand, the presence of blood in the pericardial cavity – hemopericardium – is more commonly seen in aortic dissection, cardiac rupture, trauma, or after invasive procedures (2) and less frequently in malignant cardiac tumors. The late diagnosis of content in the pericardial cavity, often due to the absence of specific symptoms, can lead to delayed detection and preclude radical treatment in the case of tumors or neoplastic heart lesions. However, early diagnosis and tumor resection can significantly improve patients' condition and allow for life-extending chemotherapy (3). This case highlights the critical importance of early detection in pericardial effusion. The purpose of presenting this clinical case is to increase awareness and alertness among family doctors, therapists, cardiologists, cardiothoracic surgeons, and radiologists to exclude neoplastic involvement of the heart when hydro- or hemopericardium is detected.

УДК 616.33/.34-02:616.988:578.834]-053.2

Пандемія коронавірусної інфекції 2019–2021 рр. об’єднала людство в пошуку ефективних методів діагностики, лікування та профілактики цієї інфекції. За даними Всесвітньої організації охорони здоров’я, в Європі станом на 19.07.2021 р. зафіксовано 58 558 098 випадків інфекції, спричиненої коронавірусом SARS-Cov-2 (SARS-Cov-2) [1], а згідно з повідомленнями ЮНІСЕФ, понад 8700 дітей і підлітків померли від COVID-19, що становить 0,3 % від 2,7 мільйона смертей від COVID-19 у 78 країнах [2]. У квітні 2020 р. з’явилися повідомлення про асоційований із SARS-Cov-2 мультисистемний запальний синдром у дітей (MIS-C), який характеризується гарячкою та поліорганним ураженням, часто з порушенням гемодинаміки [3]. За клінічними проявами MIS-C подібний до хвороби Кавасакі, однак встановлено, що це окрема нозологічна одиниця. З-поміж найбільш характерних клінічних проявів цього синдрому відзначимо ураження легень, міокарда, шлунково-кишкового тракту (ШКТ), шкірні та неврологічні симптоми. За даними деяких авторів, найпоширенішими при MIS-C є гастроінтестинальні прояви, їх виявляють у 50–87 % дітей [4,5]. Абдомінальний синдром часто імітує гострий живіт, становлячи серйозну діагностичну проблему для педіатрів і дитячих хірургів, коли пацієнт не має катаральних симптомів.

UDC 611.132.2–055.1–071.3

The size of the coronary arteries is an essential parameter in assessing coronary anatomy, which depends on age and anthropometric indicators. However, there is limited data on the correlation between biometric indicators and coronary arteries’ size among Ukrainian residents. The purpose of the study is to evaluate the size of the coronary ostia and study their correlation with age, height, weight, body mass index, and body surface area in men with and without coronary artery disease using coronary angiography. The study group consisted of 98 patients: 64 patients with and 34 patients without lesions of the coronary arteries (treated as healthy or within the norm). In patients with no coronary artery disease, the ostium of the left coronary artery is higher than that of the right coronary artery: 5.94±1.41 mm versus 5.09±1.36 mm, p=0.013. In men with coronary artery disease, the average parameters of the height of the left coronary artery (5.45±1.10 mm) are significantly more extensive than the height of the right coronary artery 4.91±1.05 mm (p=0.005). In the healthy group, a direct relationship of medium strength between the data of the height of the right coronary artery ostium and height was proven (r=+0.34, p=0.049), as well as an inverse relationship of medium strength between the value of the height of the right coronary artery ostium and age (r= -0.35, p=0.041). No correlation of age-anthropometric parameters with the value of the height of the ostium of the left coronary artery has been found. Relationships between the left coronary artery index and age, weight, and height have been established in men with coronary artery disease.

UDC 611.132.2:616.12-005.4]-055.2-073.756.4

Angiographic examination of the coronary arteries – coronary angiography allows for intravital evaluation of the coronary arteries. Structural lesions of the coronary arteries are a prerequisite for developing coronary heart disease, the most common form of cardiovascular disease among women. The work aimed to carry out a morphometric analysis of coronary artery valves in women in normal conditions and under coronary artery damage, with an assessment of the relationship between age and anthropometric indicators. Angiographic images of the coronary arteries of 56 normal women and those with structural lesions of the coronary arteries served as materials and methods. Used methods: coronary angiography, mathematical and statistical calculations. In women with lesions of the coronary arteries, the height of the left coronary artery ostia (4.78±1.16 mm) exceeded the height of the right coronary artery ostia (3.94±0.98 mm) (p=0.003). Similar differences were found in women without lesions of the coronary arteries, in particular, the height of the left coronary artery ostia was 5.96±0.91 mm, the height of the right coronary artery ostia was 4.58±1.10 mm (p<0.0001). The height of the ostia of the left (p=0.0001) and right (p=0.027) coronary arteries prevailed in healthy patients, compared to the group with coronary artery lesions. According to the analysis of the combined effect of several factors on the height of the coronary artery valves, it was established that with increasing age, height (r=-0.35, р=0.047) and body surface area (r=-0.37, р=0.035) decreased. Height was directly correlated with body weight (r=+0.36, p=0.043). According to the results of the paired correlation, a direct correlation of average strength between height and body weight (r=+0.49, p=0.014) and body surface area (r=+0.63, p=0.001) was proved. Thus, with the help of the angiographic method of research, various relationships between the height of the coronary artery ostia and the age-anthropometric parameters in women with coronary artery lesions and under normal conditions were established.