Introduction: The attention of scientists from many countries is focused on hormonal substances - adipokines at the present time. Lowering the level of the hormone adiponectin plays a central role in the development of obesity and cardiovascular disease in humans. The aim of the work is to determine the effect of complex therapy of thiotriazolin and L-lysine escinate on adipocyte secretion indices in patients with non-alcoholic fatty liver disease (NAFLD) with overweight and obesity. Materials and methods: 135 patients with overweight and obesity were examined, 46 of which were overweight (BMI-25-29.9 kg / m2), 34 were obesity grade I (BMI-30-34.9 kg / m2), 20 - Obesity II degree (BMI-35-39.9 kg / m2). 35 patients had normal body mass (BMI 18-24.9 kg / m2). We also examined 20 practically healthy persons. The age of the examinees varied, the median age was 55 years (intercourt scale Q1-Q3 from 40 to 61 years). The verification of the diagnosis of NAFLD was conducted in accordance withthe recommendations of the Unified Clinical Protocol. Results: The additional use of thiotriazolin and L-lysine escinate significantly influenced the adiponectin concentration level. Compared with the period before treatment, the adiponectin level increased in patients with overweight and obesity in 1,6 times (p <0.05). Compared to baseline, the adiponectin content in patients with NAFLD increased by 24.6-27.6% (p <0.05). Also, the level of leptin decreases significantly in patients with overweight and obesity (p <0.05). Conclusions: Integrated therapy with thiotriazolin and L-lysine escinate is an effective way to normalize the level of adipokines in patients with NAFLD with overweight and obesity.

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Laryngeal and hypopharyngeal cancer accounts for 1.5–3.8% of all malignant neoplasms, accounting for more than half of all ENT-cancer patients in the structure of oncological morbidity in Ukraine. Among them more than 60% are found in III–IV stages. Locally diffused larynx and hypopharynx cancer are indications for laryngectomy and resection of the hypopharynx, depending on the extent of the lesion that, in the presence of regional metastases, can be combined with one-or two-way radical or functional neck dissection. Failure to suture the hypopharynx after laryngectomy further leads to the formation of pharyngeal fistulas, suppurations of postoperative wounds, necrosis of the skin and the formation of pharyngostomas. In the plastic closure of the pharyngostomes, regional skin, and facial, and skin-muscle flaps are used, among which the most common is the large chest muscle. The advantages of the flap are the ease of fence, the large volume of plastic material, stability of a “vascular leg”, reliability and short operating time. Our experience with the use of free and regional flap suggests that the musculo-skeletal system of the large chest muscle can be used not only as a “rescue swaddle”, but also, as a first choice in certain clinical situations. 72 patients with laryngeal and hypopharyngeal cancer were included to the study. The age of patients ranged from 41 to 74 years. All patients (100%) had histologically confirmed flat-cell carcinoma of varying degrees of differentiation. Depending on the spread of the cancer process, stage III (T3N0-1M0) was diagnosed in 47 (65.2%), stage IV (T3N2-3M0, T4N0-3M0) in 25 (34.8%) patients. Laryngeal cancer is found in 52 (72.2%), hypopharyngeal — in 20 (27.8%) patients. Plastic closure of pharyngostomas was carried out after 2–3 months after larynectomy, after reduction of inflammation in postoperative wound and clear formation of pharyngostoma edges. The surgical intervention was carried out by two brigades — one brigade carried out the excision of the skin muscle flap, while the other one carried out the removal of the throat wall in the soft tissues of the neck, and then the sheathing of the skin part of the flap was carried out to the edges of the pharyngostomas, and the stitching of the edges of the skin at the point of excision of the flap on the chest wall. The evaluation of the function was performed on the scale of functioning for head and neck cancer patients, PSS-HN (Performance Status Scale for Head and Neck Cancer Patients). The total necrosis of the flap was observed in 2 patients (2.7%) among 72, that were operated as one of the first, at the stage of development of the surgical technique. Partial flap necrosis was observed in 6 (8.3%) patients. Thus, the plastic closure of pharyngostomas with the help of the skin-mimetic flap of the big chest muscle was successful in the vast majority of patients (70 out of 72). The investigation of the functional status of patients on the PSS-HN scale showed a significant improvement and expansion of the diet from 30 to 90-100 points due to the transfer of patients from probe to usual food intake. The public eating habits improved from 25 to 100 points. The operation of the plastic closure of pharyngostomas did not increase the clarity of the language of patients, but created the anatomical conditions for the development of pseudo-voice and vocal prosthesis. So, the using of the skin-muscular flap of major pectoralis muscle in pharyngostomas plastic closure allows achieving satisfactory surgical and functional results.

У статті аналізуються сучасні підходи до видалення каменів сечової системи у єдиній нирці. Результати дослідження показали, що функціональний стан нирки найбільш збережений при застосуванні малоінвазивних лапароскопічних і ретроперитонеальних доступів для операцій з приводу каменів верхніх сечових шляхів. Перевагою ретроперитонеальних доступів була відсутність ускладнень механічного та термічного ураження очеревини з наступним виникненням спайкового процесу. Ефективність фіксації нирки у фізіологічному положенні як профілактика рецидиву нефролітіазу хворих з коралоподібними каменями єдиної нирки полягає у зменшені травматичності та тривалості операції, прискорює соціальну реабілітацію хворого, дає хороші віддалені результати.

One of the most current problems in surgical treatment of the head and neck malignant neoplasms is the necessity for plastic replacement of defects that occur after tumor removal. The management of a submental flap in 34 patients with squamous cell cancer of the oral cavity and skin cancer of the face has been analyzed. There were 29 males and 5 females. The average age of patients was 56.9±5.23 years. The squamous cell cancer of the tongue was diagnosed in 18 patients, the floor of mouth — 7, the mucous of the cheek — 5, the retromolar triangle — 1 and skin basaloma of face in 3 patients. Single-stage reconstruction of postoperative defects after removal of the primary tumor was carried out simultaneously with the neck dissection. The submental flap with orthograde blood supply was used for reconstruction of the oral cavity defects in 31 patients and submental flap with the retrograde variant of blood supply was used to replace skin defects of face in 3 patients. The flap, which included skin, subcutaneous fat and the anterior belly of digastric muscle was used in 25 patients. A submental flap that included skin, subcutaneous fat, anterior belly of digastric muscle, and the fragment of the mylohyoid muscle was used in 9 patients. Total flap failure was observed in 2 patients and partial flap failure was observed in 3 patients. To replace the defect the supraclavicular artery skin and fascial flap were used in patients with total flap failure. Completion of primary plastics was 94%. Salivary fistula was observed in 2 patients and orostoma was not observed. Oral nutrition was restored for all 33 patients with oral cancer after surgery on 7–8 day. The hematoma in the donor’s site was diagnosed in 1 patient and partial sutures failure was observed in 4 patients. The obtained results allow us to recommend the submental flap as an effective way to reconstruct the defects of the oral cavity and the skin of the face after the removal of malignant tumors.

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The aim: Identify differences in indexes of body fat and muscle masses, as well as blood adipokines in patients with nonalcoholic fatty liver disease, from gender-appropriate healthy men and women. Materials and methods: 135 patients with non-alcoholic fatty liver disease with normal, overweight and obesity and 20 almost healthy individuals for the control group were examined. Verification of the diagnosis was performed in accordance with the recommendations of the unified clinical protocol. An anthropometric examination of patients was performed according to the method, which included the determination of 48 anthropometric parameters. The formulas determined the absolute amount of adipose and muscle tissue. Levels of adipokines (leptin and adiponectin) were determined by enzyme-linked immunosorbent assay. Results: According to Matiegka, body fat was 30.2-35.2% higher, and muscle body weight was 17.4-29.1% lower in patients with non-alcoholic fatty liver disease compared to healthy people. The concentration of leptin in the serum of patients with nonalcoholic fatty liver disease was statistically significantly higher (2.05-3.78 times) compared with almost healthy individuals. At the same time, the indicators of adiponectin concentration (1.54-1.92 times) and log A / L index (1.16-1.32 times) were lower. Correlations between changes in muscle mass and adipokines concentration have been established. Conclusions: In addition to the known increase in body fat in non-alcoholic fatty liver disease, there has been established a significant decrease in muscle mass. A direct correlation between adiponectin concentration and an inverse correlation between leptin levels and muscle mass in patients with nonalcoholic fatty liver disease was found.

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