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Документ Acute myocardial infarction in a puerpera: a case report(Полтавський державний медичний університет, 2023) Fylenko, B. M.; Roiko, N. V.; Khazanov, O. P.; Romaniuk, A. М.; Cherniak, V. V.; Филенко, Борис Миколайович; Ройко, Наталія Віталіївна; Хазанов, Олександр Павлович; Романюк, Анатолій Миколайович; Черняк, Валентина ВолодимирівнаWe report a lethal case of acute myocardial infarction in a puerpera. Cardiovascular diseases rank as the leading causes of mortality during pregnancy and the postpartum period, with myocardial infarction (MI) being a rare yet frequently fatal occurrence. Research indicates that MI typically manifests between 6 to 12 weeks postpartum, though instances may also occur at later stages. The reported case is interesting in terms of the mismatch between the timing of clinical symptoms of acute coronary syndrome (less than 24 hours) in the puerpera and alterations in myocardial infarction (2-3 days), which was diagnosed morphologically. Therefore, we searched for possible causes that led to the clinical and morphological changes described above. At first glance, the main cause of myocardial infarction development is coronary artery dissection with the formation of hematoma in the wall of the blood vessel, which narrows its lumen and leads to necrosis of the heart muscle. A brief analysis of the case has established that ischemic damage to the myocardium preceded the development of spontaneous coronary artery dissection and could be caused by one of the factors or a combination of them: coronary artery spasm caused by ergometrine and anemia due to uterine atony-related postpartum hemorrhage. The formation of intramural hematoma of the vascular wall, which narrowed the lumen of the coronary artery, could be the result of the prescription of antithrombotic therapy, which complicated the health status of the woman and led to death. When providing medical care to puerperas with postpartum hemorrhage, it is necessary to take into account the risk for cardiovascular complications that could develop due to anemia or administration of ergometrine.Документ Gastric cancer with multiple metastases in pregnancy: a case report(2019) Filenko, B. M.; Starchenko, I. I.; Roiko, N. V.; Sovhyria, S. M.; Cherniak, V. V.; Khazanov, O. P.; Филенко, Борис Миколайович; Старченко, Іван Іванович; Ройко, Наталія Віталіївна; Совгиря, Світлана Миколаївна; Черняк, Валентина Володимирівна; Хазанов, Олександр ПавловичThe mortality rate in gastric cancer during pregnancy is very high, which dictates the need to research and improve the methods of early diagnosis of malignancies, as well as studying the pathogenesis of malignant tumors in pregnant women. We report a lethal case of gastric cancer in a pregnant woman. The findings of the autopsy, histological, histochemical and immunohistochemical examinations verified gastric signet ring cells carcinoma with multiple metastases and infiltration of the placental intervillous space. The possible pathogenesis of cancer with changes in the hormonal background occurring in pregnant women is discussed. Understanding the endocrine mechanisms of carcinoma pathogenesis will be useful for developing new therapies for gastric cancer.Документ Клініко-морфологічні прояви гангрени Фурньє: літературний огляд та власне спостереження(Івано-Франківський національний медичний університет, 2018) Хазанов, Олександр Павлович; Филенко, Борис Миколайович; Старченко, Іван Іванович; Ройко, Наталія Віталіївна; Проскурня, Сергій Анатолійович; Хазанов, Александр Павлович; Филенко, Борис Николаевич; Старченко, Иван Иванович; Ройко, Наталия Виталиевна; Проскурня, Сергей Анатольевич; Khazanov, O. P.; Filenko, B. M.; Starchenko, I.; Roiko, N. V.; Proskumia, S. A.Вивчення рідкісних захворювань різного ґенезу дає можливість удосконалити їх діагностику, лікування, прогноз та попередити виникнення ускладнень. Гангрена Фурньє – це специфічна форма некротизуючого фасциїту з прогресуючим некрозом тканин статевих органів і промежини внаслідок синергічної полімікробної інфекції. Патоморфологічні зміни при ГФ описані в незначній кількості публікацій, що відображають дані біопсій або післяопераційного матеріалу з наявністю патогномонічних та неспецифічних проявів. Наведено випадок летального випадку гангрени Фуріньє з патоморфологічною верифікацією. ГФ навіть у сучасних умовах при ранньому виявленні хвороби залишається захворюванням з високим рівнем летальності. Прогноз при ГФ, в першу чергу, залежить від поширеності процесу, етіології та термінів надання медичної допомоги. При діагностиці даного захворювання на ранній стадії необхідно звертати увагу на патогномонічні макроскопічні та мікроскопічні прояви хвороби, що допоможе вчасно постановити діагноз та, відповідно, надати невідкладну хірургічну допомогу.; The study of rare diseases of various geneses enables to improve their diagnosis, treatment and prognosis, preventing its complications. One of such disease is Fournier’s gangrene, which mortality rate is accounted for 31% to 80% depending on the area, localization of lesions and development of complications. Fournier’s gangrene (FG, Fournier’s disease, spontaneous gangrene of the scrotum, subfascial phlegmon and gangrene of the genitalia, epifascial necrosis, gangrenous inflammation of the scrotum, fulminant gangrene of the scrotum) is a specific form of necrotizing fasciitis with progressive necrosis of the tissues of genitalia and perineum as a result of synergistic polymicrobial infection. The etiology of the FG is unknown. The pathogen of the disease and the site of entry is managed to be identified in 95-97% of cases. If the cause of the disease is non-identifiable, then Fournier’s gangrene is considered idiopathic. There is a dearth of publication describing pathomorphological changes in FG, reporting about the findings of biopsy or postoperative material study. Early and late pathomorphological changes are distinguished according to the clinical course of the disease. We report a lethal case of Fournier's gangrene with pathomorphologic verification. The 54-year-old patient L. presented to the Surgical Unit of Central Clinical Hospital with the admission diagnosis of Fournier’s phlegmon, bedsore of the upper third of the femur, SIRS, intoxication. Based on the physical examination and results of the laboratory test a clinical diagnosis of Fournier's gangrene, fast-progressive form with the lesions of the scrotum and putrid lesions of soft tissue, intoxication, was made. The patient underwent urgent surgery on life indications: necrectomy of scrotum tissues and penis, sanation and drainage of abscess, necrectomy, sanation and drainage of bedsore. Epicystostomy was made with regard to the defect of the urethra. The bacteriological study of the postoperative material revealed Еscherichia coli and hemolytic Acinetobacter. Despite the surgery and conservative treatment the overall state of the patient was critical and he died within 24 days. Pathomorphological study of the autopsy material confirmed the clinical diagnosis: the underlying disease is phlegmon of the perineum, scrotum and penis. The underlying disease was complicated with marked parenchymal dystrophy of internal organs, pulmonary edema, brain edema, bedsores of the lumbosacral area, bacteriemia. Consequently, intoxication was the direct cause of death. Therefore, Fournier's gangrene remains a potentially life-threatening disease that is accompanied by toxemia and bacteremia with a high mortality rate. A widespread form of FG with fulminant and fast progressive clinical course, significant lesions of the scrotum and penis, was revealed in the deceased. The close relationship of the fascial spaces of the scrotum, penis, medial surfaces of the femur contribute to the rapid spread of infection to the adjacent anatomical areas. The patient was hospitalized in the full-scaled clinical stage of the FG, which corresponded to the advanced stage of pathomorphological manifestations, thus, with no difficulties in the diagnosis. However, apparently, combination of pathogens causing the disease and its antibiotic resistance played a key role in lethal outcome. To sum it up, to date, Fournier's gangrene is considered a disease with high level of lethality even at early detection of the disease. The prognosis for FG primarily depends on the prevalence of the process, etiology and terms of providing medical care. Noteworthy, pathognomonic macroscopic and microscopic manifestations are crucial in the early diagnosis of the disease, providing with prompt diagnosis and surgical care.