Transcarpathian Regional Research Articles

Interpretative Models and Modern Design Concepts of the Palace Building of Uzhhorod Castle

The purpose of the article is to investigate the current state of the interior of the palace building of the Uzhhorod Castle of the Transcarpathian Regional Museum of Local Lore (TRMLL) named after T. Legotskyi and to analyze the newest interpretation design models of expositional space. The obtained results, interpret them through philosophical models of interior design, take into account stylistic features; needs of society, trends and advanced technologies in the field of environment design. Research methods. The research is based on ideology, imagery, philosophical interpretation, art history and source studies. As well as modern methods of three-dimensional modeling, texturing, rendering and post-production of the obtained visualizations. The scientific novelty. The article suggests and theoretically substantiates design concepts, philosophical interpretation of interior design and technological equipment. New ideas dealing with exhibitional space and museum exhibition arrangement were put forward. It was successfully managed to combine medieval, Renaissance and baroque fortification architecture, historical design of residential palace interior with modern technologies and plastics. Conclusions. Nowadays interior of palace building of T.Legoskyi TRMLL Uzhhorod Castle is in the state of emergency condition, needs capital repair and restoration. Having analyzed academic works of Transcarpathian historians and having studied the modern condition of Uzhhorod Castle, it appeared to be possible to reveal problems pertaining expositional space arrangement of T.Legoskyi TRMLL- old equipment, the necessity to heat premises and their repair, and the main issue- the need to renovate, create new interior design, which is to be based on sources and at the same time on rethinking of stylistic layers. The achieved interpretation models demonstrare possible ways to renovate exhibition space of the palace building, fully open author ambitions and ideas. The imsges found symbolize continuity of time, rethink medieval, Renaissance and baroque aesthetics-combine the new technologies, modern art trends and authentic paintings and reliefs. Museum T.Legotskyi TRMLL archive exhibits do not fall out from the context, they emphasize specificity of premises and architectural complex in general. Historic continuity and strong stylistic onnection in suggested interpretation models is observed.

The choice of surgical correction method depending on the etiology of decompensated chronic venous insufficiency

Aim. To evaluate the immediate and distant results of treatment depending on the etiology of chronic venous insufficiency in the stage of decompensation. Materials and methods. This work presents an analysis of the results of treatment of 342 patients of CEAP 6 with manifestations of chronic vein insufficiency on the background of varicose disease (VD) and post-thrombotic syndrome (PTS) in the surgical clinic of the Transcarpathian Regional Clinical Hospital named after A. Novak (Uzhhorod) for the last 10 years. At least 169 patients had VD (CEAP 6). Post-thrombotic syndrome (occlusive form) was observed in 173 patients (CEAP 6). The ratio of women to men in VD was 3:1, and in PTS was 3:2. Results. In patients of group I (crossectomy + short stripping + distal scleroobliteration), postoperative complications developed in only 2 (4.3 %) patients in the form of suppuration of the operative wound on the thigh and lymphorrhea. With extended venectomy + SEPS, early postoperative complications were observed in 5 (6 %) patients: three patients had suppuration of the postoperative wound on the thigh, and two patients had lymphorrhea. In classical venectomy + Linton’s operation, inguinal wound suppuration occurred in 2 (5.3 %), lymphorrhea in 3 (7.9 %) patients. Suppuration of the postoperative wound on the lower leg was observed in another 3 (7.9 %) patients. The long-term outcomes in the patients of the group I were: 9 (19.1 %) patients had partial recanalization of the perforated veins of the group of great saphenous vein (GSV) on the lower leg, and one (2.1 %) had complete recanalization. Trophic ulcer (TU) did not heal in one patient after conservative treatment, relapse of TU occurred in 7 (4.1 %) patients. In patients of the group II thrombosis of the cross autovenous shunt (during Palma’s operation) in the early postoperative period was observed in 5 (8.5 %) patients, during autovenous shunting and Husni’s operation (transposition of the GSV into the popliteal vein) in no case. During Linton’s operation, suppuration of the postoperative wound was observed in 7 (15.9 %) cases. TU did not heal with conservative treatment in 5 (56 %) patients. Conclusions. In the stage of decompensation of VD, pathogenetically justified treatment is crossectomy, venectomy with elimination of horizontal reflux in the zone of trophic ulcer. Trophic ulcers <5 cm and >2 cm deep I–II degrees are treated conservatively after surgery and heal independently within a year. Phlebectomy and CE of the affected limb are contraindicated in PTS. Pathogenetically justified method of treatment is reconstructive and restorative surgery to restore main blood flow with elimination of horizontal reflux in the zone of trophic ulcer.

To the provision of reconstructive surgical care for lesions of large joints in the Transcarpathian Regional Clinical Hospital named after Andriy Novak of the Transcarpathian Regional Council

To the provision of reconstructive surgical care for lesions of large joints in the Transcarpathian Regional Clinical Hospital named after Andriy Novak of the Transcarpathian Regional Council

Analysis of changes in the organ of vision in patients with long-term diabetes mellitus based on the endocrinology department of the A. Novak Transcarpathian Regional Clinical Hospital (Transcarpathian Regional Council)

Analysis of changes in the organ of vision in patients with long-term diabetes mellitus based on the endocrinology department of the A. Novak Transcarpathian Regional Clinical Hospital (Transcarpathian Regional Council)

ECHOES OF THE «PRAGUE SPRING» OF 1968 IN TRANSCARPATHIA: ACCORDING TO THE MATERIALS OF THE STATE ARCHIVE OF THE TRANSCARPATHIAN REGION

The article highlights the question of the reaction of the party and Soviet leadership, as well as the population of the Transcarpathian region to the events in Czechoslovakia in 1968. The study is based on the materials of the State Archive of the Transcarpathian Region, which were not previously published. We note that the archive did not include the main documents - the materials of the 3rd plenum of the regional committee of the Communist Party of Ukraine, which considered the issue of events in Czechoslovakia. This happened at the level of acquisition of the fund in October 1990. In total, 25 cases P-1 have been withdrawn from the description of 6 funds. Some materials are preserved in the «Soviet» fund R-195. We are talking about the certificates and information that the party and Soviet leadership sent to the republican center, as well as letters from the chairman of the regional executive committee of the Transcarpathian regional council V. Rusin and the head of the culture department of the Transcarpathian regional executive committee V. Kerechanin to the first secretary of the Transcarpathian regional committee of the Communist Party of Ukraine Yu. Ilnitsky. The Soviet leadership saw the events in Czechoslovakia as a direct threat to the socialist system. Therefore, the propagandists were entrusted with the task of «correctly» conveying the party's policy for members of the CPSU, as well as broad segments of the population. For this, special information letters were sent in the region of the Ukrainian SSR. Researchers have identified at least two propaganda campaigns to interpret the «Prague Spring»: the first (summer 1968) – aimed at supporting the official position of the USSR on the events in Czechoslovakia; the second – in August 1968 – from the «popular» discussion of the TASS message about «fraternal assistance» – the introduction of troops of the Warsaw Pact Organization into Czechoslovakia. Under special supervision was the Transcarpathian region – the territory that in 1920-1930. was an integral part of Czechoslovakia. Here, state security agencies especially closely monitored the reaction of the population to events in Czechoslovakia. A significant number of the recorded 1,182 cases of critical statements and assessments of the situation from «anti-Soviet positions», were in Transcarpathia. The leadership of the region was entrusted with a number of tasks: through the exchange of delegations through party, Soviet, Komsomol, trade union bodies, public organizations, cultural and sports societies, journalists to communicate with the leadership of the East Slovak region, to receive the necessary information from them regarding the development of events in Czechoslovakia; inform the senior republican leadership; restrict access to information that came from Czechoslovakia through radio, television, the press; propaganda processing of ordinary members of the CPSU and the population of the Transcarpathian region.

DETERMINATION OF THE FORM OF VENOUS HYPERTENSION IN PATIENTS WITH DECOMPENSATED CHRONIC VENOUS INSUFFICIENCY WITH VARICOSE DISEASE AND POSTTHROMBOTIC SYNDROME

Aim. Improve the results of treatment of patients with decompensated forms of chronic venous insufficiency by determining the main forms of venous hypertension inherent in varicose veins and postthrombotic syndrome.
 Materials and methods. From 2018 to 2022, 147 patients with chronic venous insufficiency (CVI) C6 according to CEAP, aged from 38 to 69 years (on average, 55±5.3 years), were treated in the surgical clinic of the Communal non-commercial enterprise «Transcarpathian Regional Hospital» of the Transcarpathian Regional Council from 2018 to 2022. According to the etiopathogenesis of decompensated CVI, 76 (51.7%) patients were diagnosed with varicose veins of the lower extremities, and 71 (48.3%) patients with postthrombotic syndrome (PTS). Research of venous hemodynamics began with the determination of vertical reflux in the system of the large saphenous vein, then in the system of the small saphenous vein, then the presence of vertical reflux in the system of deep veins of the lower extremities and horizontal reflux in the thigh and lower leg. At the same time, isolated and combined forms of horizontal and vertical refluxes were distinguished.
 Research results. Based on the complex ultrasonographic examination (USG) and the etiopathogenesis of chronic venous insufficiency, 76 (51.7%) patients with varicose veins (VC) had superficial venous hypertension. In decompensated forms of PTPS, 71 (48.3%) in 68 (95.8%) patients had deep venous hypertension, and in 3 (4.2%) a mixed form of venous hypertension. According to USG studies, the diameter of the large saphenous vein (LSV) in patients of the 1st group was on average 10.3±0.2 mm, the small saphenous vein (SSV) was 5.3±0.1 mm. In patients of the second group, the diameter of the LSV was 11.1±0.5 mm, the SSV was 6.5±0.2 mm. Failure of penetrating veins in the first group was found in 14 (18.4%), and only in 12 (15.8%) cases horizontal reflux was single. The average diameter of penetrating veins was 5.1±0.5 mm
 In the second group of patients, horizontal reflux in penetrating veins was found in all patients, and in 56 (78.9%) of them, it was multiple. At the same time, the average diameter of penetrating veins was 5.8±0.9 mm.
 The size of trophic ulcers was larger in the second group of patients. With a diameter of a trophic ulcer up to 10 cm in patients with superficial hypertension, 42.1% had the IIst depth of the lesion, and with deep venous hypertension, the IIIst depth of the lesion was observed in 51.4% of cases. 34.2% of patients with superficial hypertension had trophic ulcers with a diameter of up to 5 cm and a depth of lesions of the IIst, then patients with deep venous hypertension had trophic ulcers of up to 5 cm in diameter with a depth of lesions of the IIst in only 5.8% of cases. IV st. of lesion depth was observed only in three patients with a mixed form of venous hypertension.
 Conclusions. In decompensated forms of varicose veins, superficial venous hypertension is observed in almost all patients. With PTS in the stage of decompensation, 95.8% of patients have a deep form of venous hypertension, and 4.2% of patients have a mixed form of hypertension. In 68 (95.8%) patients of the second group, blood refluxes in deep, penetrating and superficial veins were interconnected with each other, where their pathological effect was mutually reinforcing. In 61 (81.5%) patients with a superficial form of venous hypertension, each of the refluxes had an independent character and was hemodynamically unrelated to each other.

Early electrophysiological predictors of progression of hydrocephalus in children with epilepsy

Hydrocephalus is a severe disease in children of all age groups. Failure to treat hydrocephalus in a timely manner can lead to progressive neurological deficits and death. Instead, early diagnosis and treatment of progressive hydrocephalus can completely recover the child. The term «early diagnosis» of hydrocephalus is the most difficult task for a pediatric neurologist. There are no pathognomonic clinical signs of this disease. Detection of electrophysiological signs of hydrocephalus progression in the early stages of the disease could significantly affect on treatment outcomes. The aim of our work is to establish early electrophysiological predictors of the progression of hydrocephalus in children with epilepsy. Materials and methods. 28 children with epilepsy were examined at the Transcarpathian Regional Children’s Hospital and the Medical Center «Diamed» in Uzhhorod from 2018 to 2022. All children were examined prospectively using video-EEG monitoring with sleep fixation, magnetic resonance imaging (MRI), multispiral computer tomography (MSCT). Results. The electrical status epilepticus during slow-wave sleep (ESES) was registered in 35 % of examined patients (8 children). The average duration from detection of the electrical status of sleep to the establishment of shunt system in the brain is 37 days (from 15 to 60 days). The ESES disappeared in 6 children during the first month after the implantation of the shunt system in the brain, in 2 children during the next 3 and 6 months of observation. We have developed our own algorithm for examining children with hydrocephalus and epilepsy up to 1 year and older than 1 year. Conclusion. An intense increase of epileptiform activity and appearance of electrical status of slow-wave sleep may be one of the predictors of the progression and decompensation of hydrocephalus and requires dynamic control. Further randomized trials are needed to assess the significance of these changes. The developed algorithm will increase the effectiveness of the use of additional examination methods for early detection of the progression of hydrocephalus in children with epilepsy.

EARLY DIAGNOSIS OF ASYMPTOMIC CHRONIC ISCHEMIA OF THE LOWER EXTREMITIES.

The aim: To assess the possibility of using a questionnaire and determining the Ankle Brachial Index(ABI) for early diagnosis of asymptomatic ischemia of the lower extremities in patients with various somatic diseases. Materials and methods: The study involved 294 patients who were receiving inpatient treatment at Communal Non-Profit Enterprise «Uzhgorod Central City Clinical Hospital»,Communal Non-Profit Enterprise «Transcarpathian Regional Clinical Hospital» and Communal Non-Profit Enterprise «Uzhgorod District Clinical Hospital». The study was conducted in 36 patients of pulmonological, 52 - neurological, 22 - endocrinological, 28 - rheumatological, 67 - general therapeutic and 89 - surgical patients. In order to detect hidden ischemia, the patients were surveyed according to the Edinburg questionnaire, regional systolic pressure was measured on the tibial arteries of the lower extremities and calculation of the Bone-humerus index (ABI)at rest and after physical exertion (walking), also non-contact skin temperature was measured on the lower leg and thigh. Results: During the study, (ABI) less than 0.9 was found in 108 (36.7%) patients, while in 47 (43.5%) cases, (ABI) decreased only after exercise.In the majority of cases, 98 (90.7%) a decrease in (ABI) was observed on one lower limb. A decrease in the skin temperature of the lower extremities was observed in 141 (48%) patients, 134 (95.1%) of which were diagnosed with diabetes.Symptoms of hidden ischemia, according to the questionnaire, were found in 99 (33.7%) patients.Smoking was observed in 61 (56.5%) patients with symptoms of hidden ischemia. Conclusions: As a result of our study, it was found that the specificity of the Edinburg questionnaire in detecting the preclinical stage of ischemia of the lower extremities reaches 88.2%, and the sensitivity - 91.6%. The obtained results indicate the expediency of using the questionnaire in the complex of diagnostics of vascular pathology in patients of various profiles. False-negative results of(ABI)in people with diabetes are associated with mediacalcinosis. In such cases, it is necessary to assess the state of blood flow by measuring the pressure on the back of the foot after physical exertion.

Reorienting Library Space and Services of Book Depositories under the Conditions of Martial Law in Ukraine: The Case of the Largest Libraries of Zakarpattia

Objective. The research aims to explore the practical experience of the activity transformation of Ukrainian libraries during the military invasion of the russian federation on the territory of Ukraine. Methods. The analysis of world publications allowed: to attempt identifying the specific methods of library work during extreme events; to conduct an analysis of the services of educational and public libraries; to prove the effectiveness of psychological and moral library support to the population; and to identify its most effective forms. Results. The substantiation of the obtained results is based on the characteristics of the library of the Uzhhorod National University and the Transcarpathian Regional Universal Scientific Library named after F. Potushniak, aimed at supporting victims of war. The most active methods of library work during the first months of the war between russia and Ukraine were revealed. Analysis of the provision of library services confirms the importance of book depositories as an important centre for uniting people for mutual support. The paper outlines practical recommendations regarding the active participation of libraries in the lives of people forced to flee from places of active hostilities. There is a burst of creative library changes associated with the reorientation of the library space and services according to the social challenge posed by russia's military aggression. Conclusions. The ability of the largest library institutions in Zakarpattia to provide moral support to people affected by the war has been revealed. The role of library support as an important factor in practical assistance to people has been confirmed.

Обрання обласного уповноваженого від Закарпатської реформатської церкви та наслідки цього процесу

Метою статті є реконструювати процес налагодження контактів між Закарпатською реформатською церквою та органом нової радянської влади – Радою у справах релігійних культів (РСРК), визначення так званої контактної особи між державою та конфесією, а також наслідки безуспішних виборів такої особи. Методологія дослідження базується на аналізі маловідомих і невідомих архівних джерел Синодського архіву Реформатської церкви Угорщини, Державного архіву Закарпатської області та Центрального державного архіву вищих органів влади та управління України. Наукова новизна роботи полягає в тому, що в українських дослідженнях історії церков проблематика реформатів Закарпаття досліджувалася лише частково і не в хронологічній послідовності, хоча загалом історії протестантів приділялася широка увага. Висновки. Авторка дійшла висновку, що після приходу радянських військ на Закарпаття церковна структура реформатів (кальвіністів) зазнала значних втрат, оскільки з трьох пробстів (благочинних) місце служби залишили двоє, а зі 113 священників – 25. Орієнтовно 20–25 % членів релігійних громад (чоловіків) депортували, повідомляючи, що нібито ведуть їх на триденні відновлювальні роботи. Хаотичність ситуації посилило й те, що Рада у справах релігійних культів не дозволила в 1946 році державну реєстрацію реформатів, поки вони не мають так званого обласного уповноваженого. Очевидно, що РСРК не володіло інформацією ні стосовно структурної побудови реформатів, ні стосовно їх адміністративно-територіального поділу, ні стосовно кількості вірян. Коли ж відбулися вибори обласного уповноваженого, проблема виникла через те, що його особу не узгодили з уповноваженим у справах релігій у Закарпатській області. У відсутності погоджувальних консультацій органи влади вбачали удар по своєму авторитету, тож РСРК вирішила відновити його так, що визнала недійсними результати виборів й одночасно доручила КДБ організувати стеження за обраним Іштваном Дьорке та близькою до нього організацією «Коло східних братів». КДБ кваліфікував діяльність І. Дьорке як антидержавну. Рада у справах релігійних культів бажала бачити обласним уповноваженим Дюлу Барі, оскільки вбачала в ньому не просто компромісну фігуру, а й людину, яка буде служити інтересам влади. Зрештою, РСРК також визнала, що не має достатньо інформації стосовно реформатів, тож розпочала процес їх повного перепису, не виключаючи і можливості злиття реформатської церкви із Всесоюзною радою Євангельських християн-баптистів.

ВОДОКОРИСТУВАННЯ У БАСЕЙНІ РІЧКИ ЛАТОРИЦЯ: СТАН ТА ОПТИМІЗАЦІЯ

The urgency of constructive-geographical analysis of water use within the upper part of the basin of the river Latorytsia is substantiated. In the materials of the article the water-resource and morphometric characteristics of the rivers of the upper part of the Latorytsia river basin are analyzed. The main works of domestic scientists and practitioners in the field of hydrology, hydromorphology and hydroecology, which relate to rivers within the Latoritsa basin in the Transcarpathian region, are considered. The stock materials of the Transcarpathian Center for Hydrometeorology, the Tisza River Basin Department and the Department of Ecology and Natural Resources of the Transcarpathian Regional State Administration were collected and processed. A brief description of the hydrological parameters of Upper Latorytsia is given. Based on a statistical series of data, the structure and dynamics of water use within the Latorytsia river basin from its source to Mukachevo for the period from 1990 to 2020 were studied in detail. Statistical samples of such water use indicators as total water users, intake use of water in general and for individual water management purposes, volumes of discharged water in general and by certain categories, water losses during transportation, etc. The state and performance of sewage treatment plants of the largest water users within the studied part of the Latoritsa basin are considered separately: volumes of water discharge by different categories and types of treatment. The main trends, characteristics, changes in the structure, needs and dynamics of water use indicators within the upper part of the Latorytsia river basin over a 30-year period have been identified. The impact of the main surface water pollutants in the Latoritsa basin, including utilities and recreational facilities, was analyzed. Initial data from the Tisza River Basin Management were used to build a map of the river network of the Latorytsia river basin within the Transcarpathian region and a map of the location of the main water users within the upper part of the Latorytsia river basin. Based on the study, including a detailed analysis of 2-TP water management reports, a number of water management problems were identified and ways to solve them, as well as measures to optimize water use within the Latoritsa basin system to reduce anthropogenic pressure on surface water bodies and improve their environmental state.

Сучасна динаміка сніголавинних процесів на території гірського масиву Полонина Боржава

The article analyzes the current dynamics of avalanche processes in the territory of the Polonyna Borzhava mountain massif, as one of the most avalanche-prone zones of the Ukrainian Carpathians. The studied area is visited by thousands of tourists every year, especially in winter, as ski tourism is quite well developed here. Accordingly, hundreds of tourists face a direct threat to life and health - avalanches. Therefore, first of all, it is worth showing the current dynamics of avalanche processes on Polonyna Borzhava from the point of view of rational management of recreation and tourism. Almost every year, people, both professionals and beginners, are killed or injured in avalanches on Polonyna Borzhava. Knowledge the basics of handling during avalanche danger, obtaining information about the onset of such periods and evaluating changes in the multi-year dynamics of avalanches can minimize risky situations in the mountains. An analysis of avalanche seasons in Polonyna Borzhava during 2011-2020, based on the materials of the Plai avalanche station, the Transcarpathian Regional Center for Hydrometeorology and the Main Department of the State Emergency Service of Ukraine in the Transcarpathian Region, showed that the most avalanche-dangerous month is February, when 40,7% of all avalanches occurred. During the studied period, the most avalanches with a volume of 1001-5000 m3 occurred, which do not cause significant damage to the environment, but can lead to the death or injury of people and animals. The number of avalanches varies greatly from year to year, because in the short term it directly depends on weather conditions (amount of solid precipitation, air temperature of the cold half of the year, wind activity, etc.), and in the long term it depends on climatic changes. During 2011-2020, the most avalanches occurred in 2012 (25), and in 2014 and 2020 they were not recorded at all. Clarification of the average multi-year dates for the formation of stable snow cover showed that it falls on November 21. Taking into account the trends of global warming, shifting of seasons, greater transition of precipitation to the liquid phase, etc., avalanches in Polonyna Borzhava will become a rarer phenomenon with very large annual variability in number and volume. The work uses descriptive and literary research methods, as well as elementary means of mathematical statistics.

Effects of Metformin, Insulin on Hematological Parameters of COVID-19 Patients with Type 2 Diabetes.

COVID-19 infection caused by SARS-COV-2 can result in multi-organ injuries and significant mortality in severe and critical patients, particularly those with type 2 diabetes as a comorbidity. Metformin and insulin are the main diabetes medications that affect the outcome of patients with COVID-19. The purpose of our study was to find out the features of the hematological indicators of patients with COVID-19 patients and type 2 diabetes. This is a retrospective study of the hospital confirmed COVID-19 patients between January to March 2022, who were admitted to Transcarpathian Regional Clinical Infectious Diseases Hospital (Uzhhorod, Ukraine). The effect of type 2 diabetes, metformin, and insulin on COVID-19 were analyzed, respectively. Demographics and blood laboratory indices were collected. In patients who took metformin, the level of CRP was significantly lower than in patients who did not take metformin (24 mg/L [IQR 15 - 58] vs 52 mg/L, [IQR 22-121], P = 0.046). Our findings suggest that pre-admission metformin use may benefit COVID-19 patients with type 2 diabetes.

SURGICAL TECHNIQUE IN LEIOMYOSARCOMA OF THE INFERIOR VENA CAVA DEPENDING ON ITS LOCATION

The aim: To improve the outcomes of inferior vena cava (IVC) leiomyosarcoma, propose own classification of IVC segments, which correlates with surgical access, methodology, sequence and amount of surgery. Materials and methods: In the period from 1991 to 2021 in the Transcarpathian Regional Clinical Hospital named after A. Novak and in the Transcarpathian Antitumor Center 8 patients with IVC leiomyosarcoma were operated. The prevalence of leiomyosarcoma in IVC was determined according to the division of IVC into 7 segments. Defeat of one segment of IVC was in 50% of cases, two - in 37.5%, three - in 12.5%. In 5 (62.5%) cases circular resection and alloprosthesis of IVC were performed; in 2 (25%) – circular resection, alloprosthesis of IVC and implantation of the right and left renal veins in the prosthesis; in 1 (12.5%) - circular resection, alloprosthesis of IVC and implantation of the left renal vein in the prosthesis. All surgeries were performed with laparotomy access (87.5% by Chevron type). Results: The average operation time was 215 (160-320) minutes, the average blood loss was 305 (250-500) ml. Postoperative complications were recorded in 2 (25%) cases. There were no cases of pulmonary embolism, venous thrombosis, prosthesis thrombosis, perioperative mortality. In 7 (87.5%) cases, surgery was radical. The overall 1-year, 2-year and 3-year survival rates were 87.5%, 71.4% and 57.7%. Conclusions: The division of IVC into 7 segments characterizes the detailed definition of the cranial limit of leiomyosarcoma and segmental involvement of IVC in the tumor process, which allows to choose the right surgical tactics, perform radical resection of IVC and maintain laminar blood flow to IVC and its tributaries.

COMPREHENSIVE TREATMENT OF COMPLICATED COURSE OF LIVER CIRRHOSIS IN CASE OF BLEEDING FROM THE VARICOS VEINS OF ESOPHAGUS, ENCEPHALOPATHY AND ASCITES

Aim: To develop a complex treatment for patients with decompensated cirrhosis in case of bleeding from the varicose veins of the esophagus. Material and methods: With bleeding from varicose veins of the esophagus for the period 2015–2020. in the clinic of the Transcarpathian Regional Clinical Hospital. A. Novak examined and treated 64 patients with C-class liver cirrhosis according to the Child-Turcotte-Pugh criteria. Results: In 17 patients they used extracorporeal ultrafiltration of ascitic fluid with it’s subsequent intravenous reinfusion. In the subgroup of 39 patients with effective sclerotherapy the mortality rate was 23.1%. In the subgroup of 25 patients where the ES was ineffective and the Blackmore tube was applied, the mortality rate was 32%. Among the 20 patients after laparocentesis with ascitic fluid evacuation 8 (40%) died. In the 17 patients after extracorporeal ultrafiltration of ascitic fluid with its subsequent intravenous reinfusion 2 (11.8%). In the subgroup where albumin peritoneal dialysis was applied 7 patients died (25.9%). Conclusions: The prognostic factors for the lethal outcome of bleeding from varicose veins of the esophagus in patients with decompensated liver cirrhosis are: the ineffectiveness of endoscopic sclerotherapy as a means of primary hemostasis, bleeding recurrence in the first 5 days. The use of staged treatment using extracorporeal methods can significantly improve the results of treatment, reduce mortality.

PECULIARITIES OF REHABILITATION CARE FOR PATIENTS ON THE BASIS OF A MULTIDISCIPLINARY HEALTH CARE INSTITUTION OF THE THIRD LEVEL OF MEDICAL CARE (ON THE EXAMPLE OF TRANSCARPATHIAN REGION)

Objective: to determine the structure and organizational features of rehabilitation care for patients on the basis of the regional multidisciplinary health care institution of the third level of medical care.Methods. Research methods: bibliosemantic, statistical, structural-logical analysis and generalization. The materials of the research were the official reporting and accounting forms of medical documentation of the health care institution.Results. Rehabilitation services at the Transcarpathian Regional Clinical Hospital Named After Andriy Novak are focused on providing rehabilitation care mainly to patients with diseases and disorders of the two systems, between which there are fundamental differences in the preferred modes of rehabilitation care (inpatient or outpatient). In March 2022, in the structure of inpatient and outpatient rehabilitation services, the vast majority were services to patients with disorders of the musculoskeletal system and connective tissue (78.4% of the total) and patients with diseases of the nervous system (11.1% of the total). The vast majority (97.5%) of patients with musculoskeletal and connective tissue disorders received outpatient rehabilitation services, while 70.6% of patients with nervous system diseases received inpatient rehabilitation services.Conclusions. Opportunities for the provision of inpatient rehabilitation services on the principle of early rehabilitation in the institution are not fully used. The involvement of patients with other groups of diseases or pathological changes in other organs and systems in rehabilitation care is low.

SURGICAL TECHNIQUE IN LEIOMYOSARCOMA OF THE INFERIOR VENA CAVA DEPENDING ON ITS LOCATION.

The aim: To improve the outcomes of inferior vena cava (IVC) leiomyosarcoma, propose own classification of IVC segments, which correlates with surgical access, methodology, sequence and amount of surgery. Materials and methods: In the period from 1991 to 2021 in the Transcarpathian Regional Clinical Hospital named after A. Novak and in the Transcarpathian Antitumor Center 8 patients with IVC leiomyosarcoma were operated. The prevalence of leiomyosarcoma in IVC was determined according to the division of IVC into 7 segments. Defeat of one segment of IVC was in 50% of cases, two - in 37.5%, three - in 12.5%. In 5 (62.5%) cases circular resection and alloprosthesis of IVC were performed; in 2 (25%) - circular resection, alloprosthesis of IVC and implantation of the right and left renal veins in the prosthesis; in 1 (12.5%) - circular resection, alloprosthesis of IVC and implantation of the left renal vein in the prosthesis. All surgeries were performed with laparotomy access (87.5% by Chevron type). Results: The average operation time was 215 (160-320) minutes, the average blood loss was 305 (250-500) ml. Postoperative complications were recorded in 2 (25%) cases. There were no cases of pulmonary embolism, venous thrombosis, prosthesis thrombosis, perioperative mortality. In 7 (87.5%) cases, surgery was radical. The overall 1-year, 2-year and 3-year survival rates were 87.5%, 71.4% and 57.7%. Conclusions: The division of IVC into 7 segments characterizes the detailed definition of the cranial limit of leiomyosarcoma and segmental involvement of IVC in the tumor process, which allows to choose the right surgical tactics, perform radical resection of IVC and maintain laminar blood flow to IVC and its tributaries.

Етапність хірургічних маніпуляцій при раку лівої нирки з імплантаційним венозним тромбом

Introduction. Defeat of the left kidney by cancer and left-sided tumor venous invasion are diagnosed almost half as often as the right one. Only radical treatment for renal cancer (RC) complicated by a tumor thrombus of the inferior vena cava (IVC) is considered to be surgical. The use of aggressive surgery, which involves the implementation of radical nephrectomy and thrombectomy with IVC, leads to a number of complications that can be prevented by improving surgical techniques. Insufficiently covered issues of surgical tactics in left kidney cancer with implantation venous thrombus lead to their detailed discussion. Objective. To improve the results of surgical treatment of left renal cancer complicated by implantation thrombus of IVC by developing a differentiated approach to access and stages of surgical procedures. Materials and methods. The study included 147 patients with RC complicated by IVC tumor thrombosis, of which 96 (65.3%) – with right renal cancer, 51 (34.7%) – with left renal cancer. All patients underwent surgical treatment at the Transcarpathian Regional Clinical Hospital named after Andriy Novak or the Transcarpathian Antitumor Center in the period from 2005 to 2020. The level of spreading of tumor thrombus by IVC was determined according to the classification of the Mayo clinic. At defeat of the left kidney by a tumor 0 the level of a thrombus was diagnosed in 17 (33,3%) patients, I level – in 17 (33,3%), II level – in 10 (19,6%), III level – in 5 (9,8%), IV level – in 2 (3,4%). In 6 (11,8%) cases, the implantation thrombus of the IVC was combined with retrograde spread to the left adrenal and left gonadal veins, and in 12 (23,5%) – with descending phlebothrombosis of the IVC and the common iliac vein. All patients underwent surgery with a «chevron» or «mercedes» transabdominal approach using the en block organ mobilization technique in the right and left abdominal and retroperitoneal regions. Results. The average time of the operation was 196 minutes, the average volume of blood loss was 400 ml. The spleen was injured during surgery in 2 (3.9%) patients. Tumor IVC thrombus was removed in all (100%) cases. Postoperative complications of I-II degrees according to the Clavien-Dindo classification were recorded in 12 (23,5%) cases. Overall 1, 3, 5 year survival was 98,0%; 70,6%; 47,1% respectively. The use of the presented stages in the surgical treatment of left kidney tumors with implantation IVC thrombus made it possible to perform radical intervention in all cases: cavatrombectomy and nephrectomy, without episodes of pulmonary embolism, without significant bleeding and without repeated thrombosis. Conclusion. Transabdominal «chevron» or «mercedes» access with the use of the «en block» organ mobilization technique in the right and left sides of the abdominal cavity and retroperitoneal space, priority complete control of IVC and renal veins with priority performance of the venous stage of the operation and transfer of the stump of the left renal vein through the mesenteric window of the small intestine to the left provide successful radical surgical treatment of patients with left renal cancer with implantation venous thrombus.

SOCIO-ECONOMIC POTENTIAL FOR THE DEVELOPMENT OF RURAL GREEN TOURISM IN THE TRANSCARPATHIAN REGION

The article examines the activities of households that provide services in the field of rural green tourism in Transcarpathian region. The main prerequisites which helped rural residents to start their own business in the sphere of rural green tourism are analyzed; the main indicators of rural tourism homesteads activity according to COVID-19 and in the pre-crisis period are reviewed; the main factors influencing the realization of social and economic potential of households in rural green tourism and its effective use in crisis situations are revealed. The purpose of the article is to conduct socio-economic analysis and assessment of impact of the main generating and destructive factors affecting the functioning of rural tourist estates in Transcarpathian region, which form the basis for the development of anti-crisis measures to improve their socio-economic potential, which can be used by the owners of rural green estates. Methodology. The study was conducted on the basis of the results of sociological monitoring of owners of rural estates in the Transcarpathian region, conducted by the Transcarpathian Regional Center for Socio-Economic and Humanitarian Studies of the National Academy of Sciences of Ukraine in 2021. The monitoring covered 95 respondents, of whom 51.6% were women and 48.4% were men. 74% of the respondents were economically active people between the ages of 35 and 56. The monitoring was conducted on the basis of the method of personal structured interviews according to a stochastic sample, which is representative for the population of the region at the age of 18 and older. The results of the study confirm that the functioning of the majority of rural tourist estates in the Transcarpathian region, in addition to objectively negative consequences of the crisis COVID-19 is affected by many destructive factors at the micro- and macro level, the elimination of which ensures their functioning in case of recurrence of crisis situations. The results of the study showed that only 4% of entrepreneurs were able to increase the potential and profitability of their own business during the crisis period. Also 23.7% of entrepreneurs, despite the crisis, plan to diversify and expand their business in the future. According to the results of sociological research anti-crisis measures to improve the effectiveness of rural tourist estates were developed, such as increasing the level of education and qualifications of owners of rural tourist estates, business diversification and expanding the range of services, reorientation to a new category of consumers, the development of e-tourism, strengthening of integration and cooperation between different economic actors in the region.

Маркери імунного запалення у хворих на неалкогольну жирову хворобу печінки коморбідну із хронічним обструктивним захворюванням легень

The purpose of the study was to determine markers of immune inflammation in patients with nonalcoholic fatty liver disease combined with chronic obstructive pulmonary disease. Materials and methods. The observation revealed 82 patients who were treated in the pulmonology and gastroenterology department of the Andriy Novak Transcarpathian Regional Clinical Hospital during 2018-2020 with a diagnosis of nonalcoholic fatty liver disease and chronic obstructive pulmonary disease II group B and C. Among the examined there were 61.0% (50) men and 40.0% (32) women. The average age was 57.8±1.5 years old. Results and discussion. As a result of the conducted research it is established that increased levels of chronic immune inflammation markers were observed in all examined with significant increase in patients with a comorbid condition. The highest concentrations of C-reactive protein were found in patients with nonalcoholic fatty liver disease combined with chronic obstructive pulmonary disease with frequent exacerbations and hospitalization, and exceeded the normal values by 8.3 times. The levels of tumor necrosis factor-α and neopterin in patients with frequent exacerbations of chronic obstructive pulmonary disease and hospitalization were by 2.7 times and 1.9 times higher than in patients with a small number of exacerbations and by 3.2 and 3.9 times higher than in patients with nonalcoholic fatty liver disease without chronic obstructive pulmonary disease. The indexes of interleukin-6, transforming growth factor-β, the number of IgG antibodies to neutrophil elastase and the level of tissue inhibitor of matrix proteinases-1 remain consistently high in all patients with combined pathology of nonalcoholic fatty liver disease and chronic obstructive pulmonary disease regardless of the frequency of exacerbations, thus supporting inflammation even in remission. Elastase antibody levels correlate directly with the levels of the tissue metalloproteinase-1 inhibitor and increase with the degree of severety of fibrosis, which may indicate a high level of serum neutrophil elastase activity in patients with nonalcoholic fatty liver disease in combination with chronic obstructive pulmonary disease and its participation in fibrosis. Conclusion. Patients with nonalcoholic fatty liver disease in combination with chronic obstructive pulmonary disease showed an increased level of chronic systemic inflammation of low intensity based on the analysis of C-reactive protein, tumor necrosis factor-α, neopterin and interleukin-6 compared with nonalcoholic fatty liver disease without chronic obstructive pulmonary disease even in remission, which indicates an aggravating course of the disease in combination of two pathologies. Stably high concentration of IgG antibodies to neutrophil elastase may indirectly indicate the maintenance of the activity of this enzyme in the serum of patients with nonalcoholic fatty liver disease in chronic obstructive pulmonary disease and confirms its participation in liver fibrogenesis