The aim: Is to determine the tactics and methods of treatment of bezoars of the gastrointestinal tract. Materials and methods: From 2001 to 2019, 17 patients were diagnosed with “bezoar”. Results: Due to the “weariness” of the clinic, the diagnosis was made in the first 3 days only for 3 (17,6 %) patients. On the basis of the obtained average pH values for 4 (23,5 %) patients established moderate hypoacid, for 4 (23,5 %) - pronounced hypoacid, for 6 (35,3 %) - anacid. For 5 (29,4 %) patients, the bezoars were withdrawn on the first attempt, while the other 5 (29,4 %) were “lumped”. In the course of fibrogastroscopic examination, all patients were diagnosed with impaired motor-evacuation function of the stomach: gastroesophageal and duodenogastric refluxes, presence of passive discharge of the contents of the stomach into the esophagus. Conclusions: Therefore, the preconditions for the development of bezoars may be: hypo- and anacid, impaired motor-evacuation function of the stomach, chronic gastric ulcer,cognitive impairment. Endoscopic method should be preferred in the treatment, on condition of its failure - laparoscopic gastrotomy with bezoar extraction.

Introduction: Cardiac arrhythmia often occurs in the gestational period of pregnant women, contributing to the development of complications of pregnancy, childbirth and perinatal pathology, which requires a more thorough examination of pregnant women and antiarrhythmic treatment, which in turn increases the risk of complications pregnancy and childbirth. Many types of arrhythmias occur in women without structural damage to the cardiovascular system. The aim is to study the occurrence of cardiac rhythm disturbances in healthy pregnant women, depending on the gestational age, the number of previous pregnancies, infectious diseases during pregnancy, and arrhythmia analysis, which required antiarrhythmic treatment. Materials and methods: Retrospectively 60 individual cards of pregnant women were studied. An ECG monitoring was performed to identify the arrhythmia. Results: Among the arrhythmia were: supraventricular and ventricular extrasystoles, unstable paroxysmal tachycardia. All cases of arrhythmia were without lengthening QT interval. Sinus tachycardia was significantly more common in combination with anemia. Heart rhythm disorders are associated with emotional excitement. Conclusions: Most violations of the heart rate occurred in the second trimester of pregnancy. With concomitant anemia, sinus tachycardia is significantly more common, and sinus bradycardia is associated with an enlarged uterus in compression of the inferior vena cava. With the increase in the number of pregnancies, the risk of heart rhythm disturbances increases. However, the past infectious diseases of the bronchopulmonary system during pregnancy did not significantly affect the occurrence of rhythm disturbances. The appointment of antiarrhythmic drugs was observed in all pregnant women whose cards were included in the study.

Introduction. This review is devoted to the current state of knowledge regarding the clinical value of Holter electrocardiogram monitoring to identify predictors of predicting future adverse cardiovascular events. The aim of the study. Based on the study of modern sources and the results of own research, analyze scientific studies on the criteria for predicting cardiovascular events with Holter electrocardiogram monitoring in patients with heart disease. Materials and methods. 52 sources of literature and the results of own research were analyzed, in which the role of Holter electrocardiogram monitoring in predicting adverse cardiovascular events was highlighted. Results. The analysis of the literature and the results of our own research prove that the indisputable advantage of Holter electrocardiogram monitoring is the detection of prognostic and unfavorable indicators of the risk of sudden cardiac death, which, of course, is extremely important in modern society. Conclusions. The high informativeness of Holter electrocardiogram monitoring for predicting future adverse cardiovascular events has been proven and the criteria for their prediction have been clarified.

Annotation. The purpose of the work is to demonstrate the peculiarities of its course, modern methods of diagnosis and treatment on the example of a clinical case of borreliosis myocarditis. According to the results of the patient's ECG, a transient atrio-ventricular block of the first degree was established. The results of general clinical methods of examination of the patient generally corresponded to the reference values. According to the results of Holter ECG monitoring, a diagnosis of mild myocarditis, heart failure I, functional class I, with preserved ejection fraction (50 %) of the left ventricle was made. Ventricular arrhythmia – 4th grade according to Laun. Competitive atrial rhythm, transient atrioventricular block. Because specific cardiovascular lesions occurred for no apparent reason and symptoms occurred during peak tick activity, the patient was re-interviewed for migratory erythema and tick bites. The patient confirmed being in the forest during the disease season and sucking the mite without specific skin lesions. To further search for the etiological factor that led to the identified changes, the patient was tested for antibodies to Burrelia burgdorferi by ELISA. The obtained positive result (Ig G – 3.89 IU/ml, Ig M – 33.74 IU/ml) indicated an acute period of Lyme disease. Thus, the final diagnosis was: Lyme disease, stage II (early disseminal). Subacute infectious (borreliosis) myocarditis, mild course, heart failure I, functional class I, with preserved ejection fraction (50 %) of the left ventricle. Ventricular arrhythmia – 4th grade according to Laun. Competitive atrial rhythm, transient atrioventricular block of the I degree. Treatment is prescribed: doxycycline 100 mg x 2 times/day, metoprolol 25 mg x 2 times/day, metabolic therapy and serological tests are recommended after 3, 6, 12 months and 2 years. Thus, the clinical case shows the difficulties of diagnosing “borreliosis myocarditis”, emphasizes the prospects for the development of algorithms for the diagnosis and treatment of borreliosis myocarditis.

No abstract