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Tbilisis saxelmwifo samedicino universiteti


TBILISI STATE MEDICAL UNIVERSITY

saqarTvelos samedicino Jurnali


samecniero-praqtikuli, meTodologiuri Jurnali. daarsda 1922 wels


-, . 1922

Medical Journal of Georgia


Scientific-practical methodological journal. Was established in 1922

4
oqtomberi-dekemberi 2008

Sinaarsi
mimoxilviTi statia i. kirvaliZe, T.jorbenaZe, r.xecuriani, a.SukakiZe, n.xviCia, m. arabuli _ kardiomiopaTia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 alergologia, meanoba b. maWavariani, c. sakandeliZe, n. rurua _ bronquli asTma da orsuloba . . . . . . . . . . . . 8 dermatologia, alergologia n. mgelaZe, r. qarselaZe, l. JorJoliani _ atopiuri dermatitis ganviTarebis riskis faqtorebi Tbilisis saskolo asakis bavSvTa populaciaSi . . . . . . . . . . . . . . . 12 profpaTologia r. javaxaZe, m.wereTeli, x.CigogiZe, n.ruxaZe, n.xatiaSvili, x.SublaZe _ Sromis medicinis Tanamedrove problemebi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17 ONCOSURGERY A.R. Aliyev - The results of treatment of the gastric cancer after expanded and expanded-combined operations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 yel-yur-cxvirisa da nevrologiuri daavadebebi g. buaZe, s. xeCinaSvili, m. beriZe, i. xundaZe, m. alfaiZe - smenaClungobis gamomwvevi paTologiis zegavlena Tavis tkivilze . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

.. e - (in vitro) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 neiromorfologia t. mermaniSvili, g. WaWia, e. xiTariSvili, T. jorbenaZe - intrakraniuli meningiomis recidivis ganviTarebis vadebi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 eqsperimentuli medicina S. tukvaZe, g. grigoraSvili - kunelis flavonoidebis moqmedeba eqsperimentuli aTerosklerozisas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .39 werili redaqcias sruliad saqarTvelos kaTolikos-patriarqs, uwmindessa da unetaress, ilia meores . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 m. xoferia, z. kaxabriSvili, m. ruxaZe, r. svaniSvili sprotuli medicinis satkivari . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 saiubileo TariRi v. gaCeCilaZe Rirsebuli mecnieri da mamuliSvili (z. Telias dabadebidan 85 wlisTavis gamo) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 vad. saakaZe Cemi Taobis sasiqadulo mamuliSvili (d. kvaWaZis dabadebidan 80 wlisTavis gamo) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 gaxseneba merab janeliZe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 nekrologi zezva RuRuniSvili . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 daviT gocaZe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 nana Wabukiani . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 saZiebeli . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55

mimoxilviTi statia

kardiomiopaTia
i. kirvaliZe, T.jorbenaZe, r.xecuriani, a.SukakiZe, n.xviCia, m. arabuli
klinikuri paTologiis samecniero-praqtikuli centri

(recenzenti _ profesori r. kapanaZe)

naxevari saukune (1957 w.) gavida mas Semdeg, rac ingliselma mecnierma Brigden-ma miokardiumis ucnobi etiologiis, arakoronaruli warmoSobis daavadebaTa dasaxasiaTeblad Semoitana cneba ,,kardiomiopaTia. miuxedavad imisa, rom am xnis ganmavlobaSi msoflios mraval qveyanaSi Catarebulia fundamenturi gamokvlevebi, sadReisod ar arsebobs erTiani azri kardiomiopaTiebis etiologiis, paTogenezis, morfogenezis, klasifikaciisa da mkurnalobis Sesaxeb. jandacvis msoflio organizaciis mier miRebuli adrindeli (1980 w.) klasifikaciis mixedviT, arsebobs kardiomiopaTiebis ori jgufi: pirveladi da meoradi. pirvelad kardiomiopaTiebs miekuTvneba: hipertrofiuli (konstriqciuli), dilataciuri (kongesciuri) da restriqciuli (endomiokardiuli fibrozi) kardiomiopaTiebi. meoradi kardiomiopaTiebi gvxvdeba intoqsikaciebis, infeqciebis, memkvidreobiTi da saWmlis momnelebeli sistemis daavadebebis dros (22). aqve unda aRiniSnos, rom konstriqciuli kardiomiopaTia SesaZloa amoRebul iqnas kardiomiopaTiebis klasifikaciidan, rogorc endokardiumis amiloidiT infiltraciis Sedegi (19). kardiomiopaTiebis mniSvnelovnad srulyofili klasifikacia SemuSavda 1996 wels jandacvis msoflio organizaciis kardiologTa samuSao jgufis mier. am klasifikaciaSi dilataciur, hipertrofiul da restriqciul kardiomiopaTiebTan erTad Setanilia marjvena parkuWis ariTmogenuli kardiomiopaTia, araklasificirebadi kardiomiopaTiebi da specifikuri kardiomiopaTiebi. am ukanasknelTa Soris gamoyofilia iSemiuri, sarqvlovani, hipertenziuli da anTebiTi kardio-

miopaTiebi. arainfeqciuri, anTebiTi, dilataciuri kardiomiopaTiebis jgufSi gaerTianebulia autoimunuri, peripartuli, alergiuli da transplantaciis Semdgomi kardiomiopaTiebi. kardiomiopaTiebis dros aRiniSneba damaxasiaTebeli, magram araspecifikuri paTologanatomiuri cvlilebebi. n. muxarliamovma TanaavtorebTan erTad (1984), Seiswavla ra 63 gvamis gakveTis Sedegad miRebuli masala, yvela SemTxvevaSi aRniSnavs kardiomegaliis arsebobas gulis yvela saknis kargad gamoxatuli dilataciiTa da maTi kedlebis hipertrofiiT. sayuradReboa, rom gulis masa meryeobda 520-dan 1350 gramamde. mikroskopulad, SemTxvevaTa 61%-Si gamovlinda upiratesad subendokardiuli wvrili nawiburebi, xolo 33%-Si adgili hqonda endokardiumis gasqelebas. autoimunuri kardiomiopaTiis dros aRiniSneba kardiomiocitebis araTanabari hipertrofia, parenqimaSi cilovani da cximovani distrofia, hiperemia da stazi. SeiniSneba agreTve, kunTovan boWkoebs Soris SemaerTebeli qsovilis gamravleba, sarkoplazmaSi ribonukleoproteidebisa da glikogenis Semcireba. mniSvnelovani cvlilebebi vlindeba fermentebis aqtivobis mxrivac. kerZod, mkveTrad Semcirebulia suqcinat-dehidrogenezas, citoqromoqsidazas, nadda nadf _ diaforazebis, atf-azas aqtivoba. xazgasmiT unda aRiniSnos, rom miokardiumis subujreduli struqturebidan gansakuTrebiT ziandeba mitoqondriebi, rac, bunebrivia, ganapirobebs energodeficitis warmoqmnas. miokardiumis hipoqsiisa da hemodinamikis moSlis mniSvnelovani paTogenezuri faqtoria sisxlis reomorfologiuri cvlilebebi. niSandoblivia, rom eqsperimentuli au-

toimunuri kardiomiopaTiis dros da kardiomiopaTiiT daavadebul avadmyofebSi sisxlis reomorfologiuri cvlilebebi identuria da miuTiTebs formiani elementebis daberebis procesis daCqarebaze, maT naadrev ganlevaze (5, 17, 21, 26 ). literaturaSi sakmaod farTod gamoiyeneba termini `iSemiuri kardiomiopaTia~, rac ganpirobebulia klinikur praqtikaSi SegubebiTi kardiomiopaTiisa da gulis iSemiuri daavadebis diferenciuli diagnostikis sirTuliT. xSirad gulis iSemiuri daavadebiTa da SegubebiTi kardiomiopaTiiT avadmyofebs aReniSnebaT identuri klinikur_angiokardiografiuli simptomkompleqsi, rac Tavis mxriv ganpirobebulia gulis kunTis dazianebis generalizebuli xasiaTiT. aRniSnul SemTxvevaSi ZiriTad klinikur simptomebs warmoadgens gulis ukmarisoba da kardiomegalia (13, 27). friad sagulisxmoa, rom miokarditis klinikuri simptomebis arseboba, xSirad endomiokardiuli biofsiiT ar vlindeba anTebis materialuri substrati. eqsperimentuli gamokvlevebiT dadgenilia, rom TagvebSi koksaki-virusiT gamowveuli miokarditis dros, gulSi virusis titrebi piks aRwevs inficirebidan me-3 dRes, mcirdeba me-7 dRes, xolo me-14 dRes virusebi aRar vlindeba. rac Seexeba miokardiumis anTebas, igi minimalurad aris gamoxatuli. praqtikuli TvalsazrisiT metad mniSvnelovania, rom aRniSnul SemTxvevebSi Sratis troponinis T (cTnT) izoformebis done, romelic miokardiumis travmis metad mgrZnobiare markeria, korelaciaSi aRmoCnda virusis titrebTan, xolo anTebis xarisxTan ki piriqiT _ ar korelirdeba. es monacemebi miuTiTebs, rom miokardiumis dazianeba anTebis Camoyalibebamde viTardeba, rac uTuod gasaTvaliswinebelia kardiomiopaTiebis etio-paTogenezze msjelobisas (4, 7, 14). bolodroindeli monacemebis Tanaxmad, miokarditis mZime formebiT mimdinareobisas adgili aqvs kardiomiocitebis apoptozs. autofsiuri masalis gamokvleviT dadginda, rom miokarditis dros mraval kardiomiocitSi vlindeba dnm-is apoptozuri fragmentacia, xolo sakontrolo jgufSi _ mxolod ramdenimeSi. yvelaze meti apoptozuri kardiomiociti aRmoCnda miokarditiT daavadebul im avadmyofebSi, romlebic gardaicvalnen gulis ukmarisobiT, gulis uecari gaCerebis gamo gardacvlilebSi ki, naklebi raodenobiT. aRniSnulidan gamomdinare, naTelia, rom mZimed mimdinare

mwvave miokarditis dros kardiomiocitebis apoptozi miokardiumis dazianebis saerTo meqanizms warmoadgens. amasTanave, kardiomiocitebis apoptozis maRali maCvenebeli dakavSirebulia gulis fataluri ukmarisobis ganviTarebasTan (11, 12, 24). apoptozi sadReisod klinikis ,,samizned iqca. Sesabamisad gulis ukmarisobis prevenciisa Tu koreqciis mizniT gamokvlevebi mimarTuli unda iyos kardiomiocitebis apoptozis sawinaaRmdego saSualebebis gamosavlenad da Sesaqmnelad (9). Seswavlilia eqsperimentuli autoimunuri miokarditis dros anTebiTi infiltratis Semadgenloba da imunuri ujredebis sxvadasxva tipisa da qvetipis, agreTve, maTi produqtebis mediatoruli roli gulis funqciis moSlis inducirebaSi. gamoirkva, rom miokarditis iniciaciisaTvis aucilebelia CD 4+T ujredebi, romelTa raodenoba infiltratSi, daavadebis progresiis procesSi, korelirebs sistoluri funqciis moSlasTan, xolo CD 8+T ujredebs, granulocitebsa da mastocitebs pirdapir SeuZliaT kardiomiocitebis funqciis darRveva. maregulebeli meqanizmebis ukmarisobis pirobebSi, adgilobrivi dazianeba kardiomiocitebis nekrozs, fibrozuli SemaerTebeli qsoviliT Canacvlebasa da gulis srul disfunqcias iwvevs. mkvlevarTa azriT, eqsperimentuli autoimunuri miokarditi saSualebas iZleva Sefasdes imunuri sistemis roli dilataciuri kardiomiopaTiisa da gulis ukmarisobis ganviTarebaSi, amasTanave, SesaZlebelia igi gamoviyenoT rogorc organospecifikuri, qsovilis autoimunuri dazianebis zogadi nimuSi (1, 6, 8, 16). cnobilia, rom fibrinolizuri sistema mniSvnelovan rols asrulebs miokardiumis struqturuli mTlianobis dacvaSi, Sesabamisad, gulis funqciis ganxorcielebaSi. I. Hosgor da Tanaavtorebma (2005) Seiswavles transheqsamJavas (TXA) mier fibrinolizuri sistemis inhibirebis gavlena miokardiumsa da kolagenze. eqsperimentebi Catarebulia katebze. sakontrolo jgufis cxovelebis venaSi SeyavdaT izotonuri marilxsnari, xolo sacdeli jgufis cxovelebSi _ izotonur marilxsnarSi gaxsnili TXA (200 mg/kg). orive jgufis cxovelebidan aRebul sisxlSi sazRvravdnen fibrinolizur aqtivobas euglobulinis lizisis xangrZlivobis, fibrinogenis degradaciis produqtebisa da fibrinis firfitis lizirebuli farTobis di-

ametris mixedviT. sacdeli jgufis cxovelebis miokardiumis morfologiuri gamokvleviT gamovlinda intermiofibriluri SeSupeba, glikogenis raodenobis mkveTri Semcireba, mitoqondriebis gajirjveba da pinocitozuri buStukebis Semcireba kapilarebis endoTelur ujredebSi. bioqimiuri kvlevis monacemebiT, adgili hqonda kolagenis mniSvnelovan akumulacias miokardiumSi. aRniSnulidan gamomdinare, avtorebi gamoTqvamen varauds, rom fibrinolizuri sistemis inhibirebis pirobebSi kolagenis akumulacia miokardiumSi SesaZloa ganapirobebdes mis struqturul cvlilebebs, rac Tavis mxriv, kardiomipaTiasa da gulis funqciis darRvevas iwvevs. eqsperimentuli kardiomiopaTiis dros ultrastruqturul cvlilebebs axasiaTeben maTi garkveuli kombinaciiT, romelsac ganixilaven rogorc regeneraciuli da plastikuri ukmarisobis ganviTarebis markerebs. es markerebi moicavs birTvis deformacias, miofibrilebis fokalur liziss, gluvi sarkoplazmuri retikulumis da perinukleuri sivrceebis gafarToebas. aRniSnuli cvlilebebis saboloo stadiaa zogierTi kardiomiocitis degeneracia da mononukleuri ujredebis rezorbcia (15,25). H.H.Berra da Tanaavtorebis (2005) monacemebiT, kardiomiopaTiis dros kerovani dazianebebi SeiZleba aixsnas mikrocirkulaciis cvlilebebiT. Trypanosoma cruzi-iT inficirebisas imatebs saeqsperimento cxovelebis (virTagvebis) sisxlis siblante, rac, Tavis mxriv, iSemiis riskis faqtoria da SeiZleba gavlena iqonios kapilarebSi sisxlis dinebaze. sagulisxmoa, rom plazmis momatebuli siblante korelaciaSia parazitis maRal donesTan sisxlSi inficirebidan meSvide dRes da gamaglobulinis fraqciis koncentraciasTan meToTxmete dRes. amave periodebSi aRiniSneba poikilocitebisa da stomatocitebis raodenobis momateba. aRniSnuli parazitiT inficirebis pirobebSi gulis SekumSvis Zalis mniSvnelovan Semcirebaze miuTiTebs T.G.Melo TanaavtorebiT (2004). igi amtkicebs, rom Trypanosoma cruzi-iT xangrZlivi inficirebis Sedegi aris kardiomiopaTiis Camoyalibeba. sagulisxmoa, rom arakoronaruli dazianebis SemTxvevaTa 70 %-Si adgili aqvs kujredebis momatebul aqtivobas, leikoc-

itebis indeqsis Semcirebas, limfocitebis mometebul mgrZnobelobas miokardiumis mimarT, xolo 60%-Si _ miokardiumis sawinaaRmdego antisxeulebis arsebobas (23). sainteresoa l.aleqsandrovisa da Tanaavtorebis (1987) monacemebi. maTi azriT, wvrili intrakardiuli arteriebisa da nervebis dazianeba demielinizaciis saxiT, cvlis ra miokardiumis struqturasa da funqcias, did rols TamaSobs kardiomiopaTiis CamoyalibebaSi. am procesSi gansakuTrebuli roli ekuTvnis demielinizaciis Sedegad gamoTavisuflebul cilovan komponents. maTi zemoqmedebiT klebulobs limfocitebis supresoruli aqtivoba da qveiTdeba K ujredebis funqciac. aRsaniSnavia, rom dilataciuri kardiomiopaTiiT daavadebulTa 50%-s aRmoaCnda periferiuli sisxlis limfocitebis sensibilizacia mielinis ZiriTadi cilis mimarT, rac iwvevs limfocitebis supresoruli aqtivobis daqveiTebas da imunoregulaciuri meqanizmebis moSlas, B limfocitebis poliklonur aqtivacias, e.i. supresoruli aqtivobis deficiti da periferiul sisxlSi mielinis ZiriTadi cilis mimarT sensibilizebuli citotoqsikuri limfocitebis xazis arseboba gulis ritmis momdevno darRveviT miuTiTebs gulis gamtari gzebis nervuli boWkoebis demielinizaciaze. dadgenilia rom dilataciuri kardiomiopaTiis Camoyalibebis sawyis etapze ziandeba gulis marcxena parkuWi, rasac Semdgom erTvis marjvena parkuWis ukmarisobac. zogierT SemTxvevaSi orive parkuWi erTdroulad ziandeba. amasTanave, SesaZloa marjvena parkuWis upiratesi dazianebac. dilataciuri kardiomiopaTiiT gardacvlilTa gvamebis paTologanatomiuri gamokvlevis safuZvelze dadginda, rom dilatacia Seexeba gulis orive parkuWs. marcxena parkuWis mniSvnelovani dazianebis fonze 40 %-Si aRiniSneba marjvena parkuWis dazianebac (20). yovelive zemoaRniSnulidan naTlad Cans, rom kardiomiopaTia, morfogenezis TvalsazrisiT, jer kidev bolomde Seucnobeli paTologiaa, rac Semdgomi gamokvlevebis aucileblobaze miuTiTebs. gulis kumSvadi funqciis darRvevis ganmapirobebeli materialuri safuZvlebis gamovlena da, Sesabamisad, efeqturi samkurnalwamlo saSualebebis SerCeva ZiriTad problemad rCeba.

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(1957.) , Brigden . , , , , , . , . . , . , , ; , . , . , . - - , . , . , , .

CARDIOMYOPATHY
I. Kirvalidze, T. Jorbenadze, R . Khetsuriani, A. Shukakidze, N. Khvichia, M. Arabuli
Almost half a century has passed since English scientist Bridgen has first introduced the definition of cardiomyopathy for the characterization of myocardium pathologies of unknown etiology and non coronary origin. Regardless of the fact that many early days fundamental investigations are devoted to cardiomyopathy problem, still there is no common consideration concerning the etiology, pathogenesis, morphogenesis, classification and therapy of cardiomyopathy as well. According to present day literature data experimental autoimmune myocarditis elucidate the role of immune system in the evolution of dilatational cardiomyopathy and cardiac decompensation. During experimental cardiomyopathy damage almost of all cardiac hystiocytes organelles is detected. Ultrastructural changes are characterized by certain combinations accepted as markers in the initiation of regeneration and plastic insufficiency. On behalf of World Public Health Services recommendation the term cardiomyopathy encloses patients with myocarditis of unknown origin with well defined characteristic features megalocardia and cardiac decompesation. However, heart valve, coronary and lung vessels injuries are excluded. Note worthily, concept secondary cardiomyopathy is not well interpreted, especially as in this case etiology is well understood. Due to the complexity of differential diagnostics for congestive cardiomyopathy and myocardial ischemia in present day literature the term ischemic cardiomyopathy is widely applicable. Frequently, patients with congestive cardiomyopathy and myocardial ischemia reveal identical clinical-angiocardiographic set of symptoms determined by generalized injury of cardiac muscle. Taking into account all the above mentioned data it is evident that regarding etio pathogenesis and morphogenesis cardiomyopathy is not completely explored pathology and needs further investigation. The goal here is revelation of factors affecting cardiac contractile function. Besides, elaboration of new, effective pharmaceutical means seems of great importance.

literatura :
1. Afanasyeva M., et al. Autoimmune myocarditis cellular mediators of cardiac disfunction // Autoimmune Rev. 2004.- 3 (7-8). p. 476- 86. 2. .., .., .. ., . // . . 1986, 10, . 62-66. 3. Berra H. H., Piaggio E., Revelli SS., Luquita A., Blood viscosity changes in experimentally Trypanosoma cruzi-infected rats. // Clin Hemorheol Microcirc. 2005; 32(3): 175-82. 4. Burian J., Buser P. et al., Myocarditis: the immunologist; s view on pathogenesis and treatment. // Swiss Med Wkly. 2005 Jun 25: 135 (25-26): 359-64. 5. . . , // . .-1992.- .- 64, 9.-. 3-8. 6. Currie S., Quinn FR. Et al., Selective down-regulation of subendocardial ryanodine receptor expression in a rabbit model of left ventricular dysfunction. // J Mol Cell Cardiol. 2005 Aug; 39(2): 309- 17. 7. Dalla Libera L., Paulletto P., Piccolo D. et al. The indiopathic dilated cardiomyopathy in man. A Biochemical and molecular study on myosin // Bosic. Res. Cardiol. -1991. -vol. 86., 1P. 70-78. 8. Esrefoglu M., Gul M. et al. Effects of melatonin and caffeic acid phenethyl ester on testicular injury induced by myocardial ischemia / reperfusion in rats. // fundam Clin pharmacol. 2005 Jun; N19(3): 365-72. 9. Garg S., Narula J. et al. Apoptosis and heart failure: clinical relevance and therapeutic targer. // J Mol Cell Cardiol. 2005 Jan; N38(1): 73-9. Epub 2004 Dec. 13. 10. Hosgor I., Yarat A. et al. Collagen deposition in myocardium after inhibition of fibrinolytic activity. // Blood Coagul Fibrinolysis, 2005 Jan; 16 (1): 25-30. 11. Kyto V., Lapatto R. et al. Glutathione depbetion and cardiomyocyte apoptosis in viral myocarditis. // Eur J Clin Invest. 2004 Mar; 34(3): 167-75. 12. Lancel S., Petillot P. et al. Expression of apoptosis regulatory factors during myocardial dysfunction in endotoxemic rats. // Crit Care Med. 2005 Mar; 33 (3): 492-6. 13. Laude K., Richard V. et al. Coronary endothelial cells : a target of ischemia reperfusion and its treatment ? // Arch Mal Coeur Vaiss. 2004 Mar; 97 (3) : 250-4. 14. Lim BK., Shin JO. et al. Myocardial injury occurs earlier than myocardial inflammation in acute experimental viral myocarditis. // Exp Mol Med. 2005 Feb 28; 37(1): 51-7. 15. lushnikova EL; Klinnikova MG. et al. Ultrastructural criteria of cardiomyocyte regeneratory and plastic insu-fficienc in anthracycline cardiomyopathy. // Bull Exp Biol Med. 2005 Apr; 139(4): 472-6. 16. Maeda K., Shioi T. et al. Rapamycin ameliorates experimental autoimmune myocarditis. // Int Heart J 2005, May; 46(3) : 513-30. 17. Melo TG., Almeida DS. et al. Trypanosoma cruzi infection disrupts vinculin costameres in cardiomyocytes. // Eur J Cell Biol. 2004 Oct; 83(10): 531-40. 18. . ., // . . . . -.: , - 1992.-.2. . 7.-.199.- 249. 19. ninoSvili l., miokardiumis morfologiur-funqciuri cvlilebebi autoimunuri kardio- miopaTiis dros. sakandidato disertacia, Tbilisi, 1998. 20. . ., . ., . ., .// . - 1998- 11, C.3-5. 21. Satoh M., Nakamura M. et al., Myocardial osteopontin expression in associated with collagen fibrillogenesis in human dilated cardiomyopathy. // Eur J Heart Fail. 2005 Aug; 7(5): 755-62. 22. . ., . ., ., .: . 1995. 23. . ., . ., . ., ., // . .- 1987.- 6.- .117.-119. 24. Syed F., Odley A. et al., Physiological growth synergizes with pathological genes in experimental cardiomyopathy. // Circ Res. 2004 Dec 10; 95(12): 1200-6. Epub 2004 Nov 11. 25. . ., . ., , : // . . -1991.-9.- . 128.-133. 26. Wakisaka Y., Niwano S. et al., Structural and electrical ventricular remodeling in rat acute myocarditis and subsequent heart failure.//Cardiovasc Res.2004 Sep 1; 63(4); 689-99. 27. Werner L., Deutsch V. et al., Transfer of endothelial progenitor cells improves myocardial performance in rats with dilated cardiomyopathy induced following experimental myocarditis. // J Mol Cell Cardiol. 2005 Aug 23; [Epub ahead of print ].

alergologia, meanoba

bronquli asTma da orsuloba


b. maWavariani, c. sakandeliZe, n. rurua
Tbilisis saxelmwifo samedicino universitetis medicinis fakulteti

(recenzenti _ profesori a. Telia)


bronquli asTma orsulobaSi farTod gavrcelebuli daavadebaa da gvxvdeba 0.4-4%-is farglebSi (3,9). yoveli 500 SemTxvevidan erTs aReniSneba sicocxlisTvis saSiSi garTuleba (3). orsulobis periodSi Jangbadze moTxovnileba matulobs, rogorc TviT orsulebis, ise ganviTarebadi nayofis mxridanac, rac iwvevs momavali dedis sasunTqi gzebis cvlilebebs. im cvlilebebs aqvs anatomiuri, hormonuli, metabolituri (mJave-tutovani Tanafardobis) darRvevis xasiaTi. orsulobis periodSi filtvebis funqcia sakmaod kargad aris Seswavlili. cnobilia, rom am periodSi filtvebis ventilacia matulobs daaxloebiT 42%-iT, sxva monacemiT ki, kerZod, filtvebis sasicocxlo moculoba (VC), pirvel wamSi forsirebuli amosunTqva (FEV1) da filtvebis forsirebuli sasicocxlo moculoba (FVC) rCeba ucvleli (1,3). garegani sunTqvis parametrebi SesamCnevad matulobs, kerZod, alveoluri ventilacia - 70%-iT, sasunTqi gzebis rezistentoba ki, piriqiT, klebulobs 50%-iT, izrdeba sasunTqi gzebis specifikuri ganmavloba, xolo Jangbadis moxmareba matulobs daaxloebiT 20%-iT (4,7) sunTqvis gaZliereba iwvevs CO2 gamoyofis matebas da sisxlSi misi koncentraciis Semcirebas, magram radgan imavdroulad xdeba Tirkmlebis mier bikarbonatebis gamoyofis gaZliereba, plazmis PH rCeba normis farglebSi. orsulebSi hiperventilacias xsnian centraluri stimulaciiT da progesteronis moqmedebiT, romelic amcirebs sunTqvis centris mgrZnobelobis zRvars da iwvevs sunTqvis stimulacias, rac ganapirobebs filtvebis ventilaciis gaZlierebas da CO2-is Semcirebas (3). orsulobis gavlena bronquli asTmis mimdinareobaze sxvadasxvagvaria: daaxloebiT 30%-Si aRiniSneba mdgomareobis gaumjobeseba, 30%-Si pacientTa mdgomareoba ar icvleba, xolo danarCen SemTxvevaSi pacientTa mdgomareoba mZimdeba (1,3). mZime (arakontrolirebuli) bronqul asTmian pacientTa mdgomareoba orsulobis dros, iSviaTad ki - mSobiarobis Semdgom periodSi, Cveulebriv, uaresdeba. ramdenadme momatebulia naadrevi mSobiarobis da uneblie abortebis sixSire (1,3), magram bavSvebs TiTqmis ar aReniSnebaT Tandayolili anomaliebi (3). bronquli asTmis msubuqi (kontrolirebuli) da saSualo (nawilobriv kontrolirebuli) persistebuli mimdinareobis bronquli asTma iSviaTad aris Cveneba abortis gakeTebis an sakeisro kveTis (3). bronquli asTmis mqone pacientebi, yoveli momdevno orsulobisas iseve reagireben, rogorc pirvelze. savaldebuloa vicodeT, rom bronquli asTmis pirveli Seteva SesaZlebelia pacients ganuviTardes orsulobis periodSi. arsebobs mravali Sroma, romelSic aRniSnulia, rom mZime (arakontrolirebuli) asTmis dros matulobs mSobiareTa sikvdilianoba. gordonis monacemebiT, 30861 orsulobidan 277 hqonda bronquli asTma, xolo aseT pacientebSi 5.7 %-Si aRiniSneboda asTmis mZime forma da sikvdilianobis 2/3 swored am jgufis pacientebze modioda. mZime mimdinareobis asTmian pacientebs 35%Si bavSvi uCndebaT mcire wonis, 28%-Si viTardeba perinataluri sikvdiloba, xolo 12.5%-Si cxovrebis pirvelive wels viTardeba nevrologiuri darRvevebi (3,6,6). orsulobis periodSi bronquli asTmiT daavadebul pacientebs, 2-jer ufro xSirad uviTardebaT iseTi garTulebebi, rogoricaa Rebineba, gestozi, saSodan sisxldena, hipertenzia, preklamfsia (3,4), asTma maqsimalurad mZimdeba orsulobis 24-32 kviris periodSi, Semdeg asTmis simptomebi iklebs, gansakuTrebiT bolo oTx kviraSi, xolo SemTxvevaTa 90%-Si mSobiarobisas sulxuTvis Setevebi ar aRiniSneba (10). bronquli asTmis mkurnaloba orsulTa

Soris tardeba Cveulebrivi standartuli sqemiT. gansakuTrebuli yuradReba eTmoba profilaqtikur RonisZiebebs: orsulTa damokidebulebas garemos uaryofiT faqtorebTan (Tambaqos boli, samuSaoze qimiuri gamRizianeblebis zegavlena da a.S.) da alergenebTan (oTaxis mtvris, xaliCebis, rbili avejis tkipebi, taraknebi da a.S.) kontaqtis acileba (eliminaciuri Terapia). pacientma unda Seiswavlos da gamoiyenos sunTqviTi varjiSebi (2). persistiuli mimdinareobis bronquli asTmiani pacientebis mdgomareobis Sefaseba unda xdebodes TveSi erTxel. spirometria rekomendebulia Catardes eqimTan pirveli vizitisas , xolo Semdeg mdgomareobis Sefaseba SeiZleba pikflous monitorirebiT. Tu pacients FEV1 60-80%_is farglebSia, is riskis jgufs miekuTvneba, xolo, Tu 60%-ze dabalia aris saSiSroeba asTmis gamwvavebisa da saWiroa Catardes profilaqtikuri RonisZiebebi. asTmian orsul pacientTa marTvaSi upirvelesi amocanaa gamoiricxos hipoqsia da misi arasaxarbielo moqmedeba nayofze. im SemTxvevaSi, Tu dedis PO2 < 60 mm/v.w.s. an hemoglobinis done naklebia 90gr/mlze, SesaZlebelia nayofs ganuviTardes hipoqsia da saWiroa pacients droulad Cautardes agresiuli Terapia(10). ucilebelia sasunTqi gzebis infeqciebis gamovlena da mkurnaloba, Tumca unda gvaxsovdes rom tetraciklinis rigis preparatebis

daniSvna am SemTxvevaSi ar aris sasurveli, vinaidan isini uaryofiTad moqmedebs nayofis kbilebis Casaxvaze. aseve araa rekomendebuli iodis preparatebis miReba, romlebic Tavisuflad gaivlis ra placentur bariers, SeuZlia gamoiwvios farisebri jirkvlis Tandayolili daavadebebi. mizanSeuwonelia sulfanilamidebis, aminoglikozidebis, ciprofloqsacilinis, hidroqsizinis (ataraqsis) daniSvna. am ukanasknels gaaCnia terategenuri efeqti (3). aspirinuli asTmis (aspirinis autanlobis) SemTxvevaSi pacients ekrZaleba yvela im samkurnalo saSualebis miReba, romelsac gaaCnia aspirinisaTvis damaxasiaTebeli Tvisebebi (araqidonis mJavaze moqmedebis saerTo meqanizmi). esenia: pirazolonis (metamizolis) rigis preparatebi (analgini, baralgini, citramoni, amidopirini da a.S.), arasteroiduli antianTebiTi saSualebebi (indometacini, brufeni da a.S.). agreTve, im sakvebi produqtebis miReba, romlebic Seicavs salicilis mJavas (vaSli, atami, Rvino, ludi da a.S.) bronquli asTmis sawinaaRmdego saSualebebi Tavisuflad gadis placentas, amitom maTi daniSvna unda xdebodes mkacri Cvenebebis mixedviT. amasTan, aucilebelia gaTvaliswinebuli iqnas aSS-is sakvebi produqtebisa da samkurnalo saSualebebis xarisxis kontrolis sammarTvelos (FDA) mier mowodebuli asTmis sawinaaRmdego preparatebis saSiSroebis reitingi (4,5,7)

bronqdilatatorebi

kategoria

qolinergiuli preparatrebi

kategoria

1. adrenalini 2. efedrini 3. eTilnorepinefrini 4. izoprenelini (izadrini, novodrini,euspirani) 5. izoetarini 6. orciprenalini (asTmopenti, alupenti) 7. terbutalini (brikalini) 8. salbutamoli (ventolini) 9. salmeteroli (sereventi) 10. Teofilini 11. aminofilini 12. diprofilini

D C C C D C B C C C D C

1. atropini C 2. ipratropia bromidi (atroventi) B citostatikebi 1. metotreqsati X 2. ciklosporini C antileikotrienebi 1. montelukasti (vanseari) B 2. zifirlukasti (akolati) B 3. zileutoni C membranstabilizatorebi 1. kromilini (intali) B 2. nedokromili B sainhalacio steroidebi 1. beklametazoni D 2. budesonidi C 3. flunizolidi C 4. flutikazoni C 5. sistemuri moqmedebis kortikosteroidebi (prednizoni, triamcinoloni) D

10

A-klinikurma gamokvlevebma nayofisaTvis saxifaTo Sedegebi ar gamoavlina; BadamianisTvis saxifaTo ar aris, C- xifaTi gamoricxuli ar aris, Tumca am mimarTulebebiT klinikuri gamokvlevebi ar Catarebula, teratogenuri moqmedeba gamovlenilia mxolod cxovelebSi, D- am preparatebis daniSvna saxifaToa, Tumca misi klinikuri efeqti Warbobs gverdiT movlenebs; X- kategoriulad akrZalulia orsulebisTvis. sayuradReboa, rom mZime (arakontrolirebuli) asTmis gamo, nayofze gamowveuli ziani aRemateba asTmis sawinaaRmdego saSualebebiT miyenebul zians. bronquli asTmis Setevebis mosaxsnelad gamoiyeneba sainhalacio B2 stimulatorebi, Teofilini (saTanado monitorirebis pirobebSi), m-qolinergiuli blokatorebi (ipratropia bromidiatroventi), Jangbadi sveli wesiT sainhalaciod, xolo SemanarCunebeli (bazisuri TerapiisTvis) natriumis qromglikati (intali), nedokromili, sainhalacio hormonebi dabali doziT, iSviaT SemTxvevaSi mZime (arakontrolirebuli) persistiuli asTmis dros dasaSvebia sainhalacio hormonebis maRali doza an sistemuri kortikosteroidebis (D kategoria) mcire doziT gamoyeneba. H1 blokatorebi (antihistaminuri saSualebebi) upiratesad gamoiyeneba, rode-

sac, bronqul asTmasTan erTad, pacients aReniSneba zemo sasunTqi gzebis alergozebi. orsulobis periodSi antihistaminuri preparatebidan umjobesia gamoviyenoT pirveli Taobidan difenhidramini (dimedroli) da qlorfeniramini maleati (koldaqti heqsapevmini, kontak 400), romlebic miekuTvneba B kategorias (FDA klasifikaciiT). amave kategorias miekuTvneba meore Taobis preparatebi: loratidini da cetirozini, xolo feqsofenadini (telfasti) C kategorias (5). Tu bolo 4 kviris ganmavlobaSi orsuli iRebda kortikosteroidebs, saWiroa antistresuli steroiduli dozis (100mg hidrokortizonis yovel 8 saaTSi intravenurad) daniSvna mSobiarobisas da Semdeg 24 saaTis ganmavlobaSi, dedis adrenaluri krizisidan Tavis acilebis mizniT. specifikuri Terapia orsulobis periodSi, Cveulebriv, ar tardeba. gamonaklisia iseTi SemTxvevebi, rodesac mkurnalobis kursi dawyebulia orsulobis win. mSobiaroba ukeTesia Catardes regionuli (epiduruli) anesTeziis qveS, romlis dros mcirdeba filtvebis ventilacia da Jangbadze moTxovnileba (10), xolo, Tu aucilebelia zogadi narkoziT anesTeziis Catareba, ukeTesia ftorotanis gamoyeneba, romelsac gaaCnia bronqodilataturi efeqti.


. , . , .

- 0,4 4% (3.10). 30% , 30% - , - . () , - , , , , , 12,5% , ; 2 , , , , (3,8) , , (3). , F (4,5) 2- ( ), ( ), - ( - ) , , .

11

( ) (1,2,3). , () , . , , , .

BRONCHIAL ASTHMA AND PREGNANCY


B. Machavariani, Ts. Sakandelidze, N. Rurua
TBILISI STATE MEDICAL INSTITUTE

Bronchial Asthma is one of the most widespread diseases among pregnants and is seen in 0.4-4% cases (3.10). The condition is improved among 30% of diseased, is not changed among 30 % and is complicated among others (4). At the time of long-lasting bronchial asthma of heavy form, sometimes in the period of after delivery, the condition of diseased is complicated, frequency of premature birth is increased, frequency of perinatal death of fetus is increased as well, in 12.5% of cases the infants with different neurological complications are born. Vomiting of pregnant, toxicosis, vaginal hemorrhage, hypertension, preeclampsia happens twice often among mothers (3.8). The key problem among the pregnants diseased with bronchial asthma is to avoid a hypoxia and its fatal influence on the fetus. We should avoid using of the medicaments having damaging influence on the fetus (3). We know that medicines can freely penetrate over the placental barrier, so they will be prescribed according to life-saving indication and the recommendations of FDA should be taken into consideration (4.5.). In order to arrest an attack of bronchial asthma among pregnants we can use 2 stimulators, medicines of theofilin, M-cholinergic medicines (Atrovent), for basic therapy Natrium chromoglikat, Nedocromil, Inhalation hormones. We should take into consideration that the influence of heavy asthma on the fetus is more fatal then the side-action of anty-asthma medicines. As for specific hyposensitization, it is not performed to pregnants, excluding the cases when the course of hyposensitization started before pregnancy.

literatura
1. gurgeniZe g. gurgeniZe g. JorJolaZe n. alergia da alergiuli daavadebebi, Tbilisi.: 2001w. gv. 355-356 2. GINA asTmis mkurnalobisa da prevenciis globaluri strategia. ZiriTadi cvlilebebis mokle mimoxilva, 2007w. 3. . - . . . .-1984.- . 403-410. 4. . , . , - . (. .) .- 2000.- . 232-234. 5. . - (. .) a.- 2000-. 99-100; 288-289. 6. Bhana S.L. et al. The course and outcome of pregnancy in women with bronchial asthma. Acta allergol 1972, 27, 397-406. 7. British Thoracic society Scottish intercollegiate Guidelines Network. British Guideline on the Management of Asthma 2008. 8. Gordon Met al Fatal morbidity following potentially an oxygenic conditions VII bronchial asthma. Am Sornal obstet Gynecol. 1970, 106 (3), 421-429 9. National asthma Education and Prevention Program. Managing asthma during pregnancy recommendation for pharmacologic treatment Bethesia (). National Heart, Lung and Blood Institute 2005. 10. National Heart, Lung and Blood Institute. National Asthma Education and Prevention Program Expert Panel Report. Guidelines for the diagnosis and Management of asthma 2007.

12

dermatologia, alergologia

atopiuri dermatitis ganviTarebis riskis faqtorebi Tbilisis saskolo asakis bavSvTa populaciaSi
n. mgelaZe, r. qarselaZe, l. JorJoliani
iv. javaxiSvilis saxelobis Tbilisis saxelmwifo universiteti

(recenzenti - medicinis doqtori l. saginaZe)

atopiuri dermatiti qronikuli alergiuli daavadebaa, romelsac safuZvlad udevs kanis Ig-E damokidebuli anTeba da misi hiperreaqtiuloba, rac arRvevs kanis bunebriv reaqcias egzo- da endogenur gamRizianeblebze da xSirad uviTardebaT atopiisadmi genetikurad ganwyobil pirebs [3,7,8,10]. atopiuri dermatiti globaluri problemaa. ekonomikurad ganviTarebul qveynebSi atopiuri dermatitis prevalentoba 10-28%-ia, alergiul daavadebaTa struqturaSi daavadebis xvedriTi wili 50-75%s aRwevs. igi adreul asakSi manifestirdeba da `alergiuli marSis~ pirveli gamovlinebaa, romelic progresirebs bronquli asTmisa da alergiuli rinitis ganviTarebiT, amasTan, warmaodgens ekonomikur tvirTs [5,13,14]. oficialuri statistikuri monacemebiT, saqarTveloSi, oTxmocian wlebSi, sxvadasxva alergiuli daavadebis epidemiologiuri kvlevis monacemebi dabalia im SedegebTan SedarebiT, romlebic miRebul iqna 1995 wels ISAAC-is kiTxvaris gamoyenebiT Catarebuli gamokvlevebiT [11,12]. alergiuli daavadebebis prevalensi da struqtura 1999 wels Tbilisis bavSvTa mosaxleobaSi Semdegnairad gadanawilda: atopiuri dermatiti - 7.5%; urtikaria da kvinkes SeSupeba- 4.4%; polinozi 3.8%; bronquli asTma 3.1%; janmrTeli kontingenti 81.2 [2]. ISAAC-programis II faza 2004 wels Catarda msoflios 22 qveynis 30 klinikur centrSi. kiTxvaris meSveobiT gamoikvlies 9-11 wlis bavSvebi. saqarTveloSi, alergiuli daavadebis gavrcelebam daaxloebiT 5% Seadgina [12]. 2000-2005 wlebSi kanisa da veneriul sneulebaTa samecnie-

ro-kvleviT institutSi registrirebul kanis daavadebis mqone avadmyobTa Soris atopiurma dermatitima Seadgina 8.2% [1]. Cven mier, atopiuri dermatitis gavrcelebis Seswavlis mizniT, drois fiqsirebul monakveTSi Catarda erTmomentiani klinikuri kvleva [4,6]. Tbilisis 5 raionSi ganTavsebuli 5 skola SeirCa klasteruli randomizaciis meTodiT. reprezentatuli populaciis aucilebeli minimaluri moculoba ganisazRvra TbilisSi (2006w.) mcxovrebi 6-dan 10 wlamde umcrosi saskolo asakis bavSvTa saerTo raodenobis mixedviT. am mizniT gamoyenebul iqna mtkicebiTi medicinis specialistTa saerTaSoriso sazogadoebis kalkulatori. SerCeul skolebSi arsebuli siebis gamoyenebiT Seiqmna 6-dan 10 wlamde asakis bavSvTa erTiani reestri (2543 bavSvi), saidanac randomizaciis meTodiT (SemTxveviTi cifrebis cxrili) formirebul iqna fokus populacia (2454 bavSvi). kvlevis procesSi gamoyenebul iqna epidemiologiuri kvlevisa da satelefono kvlevisaTvis SemuSavebuli anketa-kiTxvari, romelic moicavda: demografiul maCveneblebs, alergiuli daavadebebiT memkvidrul datvirTvas, wlamde kvebis xasiaTs, avadobas, atopiuri dermatitis skrining diagnostikas da sxva. didi britaneTis samuSao jgufis mier SemuSavebuli atopiuri dermatitis diagnostikuri kriteriumi (1994) gamoyenebul iqna am daavadebis diagnostikisTvis: aucilebeli niSani _ qavili, sami an meti Semdegi niSnebidan: dermatitis arseboba (an anamnezSi) kidurebis momxrel zedapirze; alergiuli datvirTva (asTma an WinWris cieba), kanis nakecebis daintereseba, kanis difuzuri simSrale, debiuti or wlamde asakSi [9].

13

2454 gamokiTxuli bavSvidan atopiuri dermatitis diagnozi daudginda 278-s (11.3%). miRebuli Sedegebis statistikuri damuSaveba ganxorcielda programuli paketis SPSS V.13-is meSveobiT. daavadebulTa ganawileba klasisa da sqesisi mixedviT mocemulia pirvel diagramaSi: pirvel klasSi Warbobda davaadebulTa ricxvi 110 (39.6%) (p<=0.01) (diagrama 1), mamrobiT sqesis ki 146 (52.5%) (p>0.05) (diagrama 2).

li bavSvi. ZiriTadi da sakontrolo jgufis formirebis dros gaTvaliswinebuli iyo homogenurobis principi. SemTxveva_kontrolis kvlevis Catarebis safuZvelze, gansazaRvrul iqna atopiuri dermatitis formirebis socialuri, biologiuri da samedicino riskis faqtorebis raodenobrivi maCvenebeli: Sansebis Sefardeba (OR), absoluturi riski eqsponirebulTaTvis (Re), absoluturi riski

diagrama 1
klasi

diagrama 2
sqesi

I klasi 39.6%

II klasi 16.5%

mamrobiTi 52.5%

IV klasi 19.1%

III klasi 24.8%

mdedrobiTi 47.5%

diagrama 3
raioni

diagrama 4
daavadebis sezoni

vakesaburTalo 28%

zafxuli 35%

didubeCuRureTi 36%

Semodgoma 215

gldaninaZaladevi 17%

isani-samgori 5%

mTawmindakrwanisi 14%

gazafxuli 36%

zamTari 8%

Tbilisis xuTi raionidan atopiuri dermatiti upiratesad gamovlinda didube-CuRureTis raionSi 96 (36%) (p<=0.01) (diagrama 3). gazafxulze daavadebis sezonuri upiratesoba ki aReniSneboda daavadebulTa mniSvnelovan nawils - 96 (35%) (p<=0.01) (diagrama 4). atopiuri dermatitis riskis faqtorebis gamovlenis mizniT, Catarda observaciuli, analizuri retrospeqtuli kvleva SemTxveva-kontroli. am mizniT Seswavlili populaciidan gamoyofil iqna ori jgufi: ZiriTad, anu SemTxvevaTa jgufSi gaerTianda atopiuri dermatitiT daavadebuli 278 pacienti, xolo sakontrolo jgufSi _ 300 pirobiTad janmrTe-

araeqsponirebulTaTvis (Re), absoluturi riski araeqsponirebulTaTvis (Rne) da atributuli riski (AR). socialur-higienuri riskis faqtorebidan upiratesad gamovlinda katis arseboba ojaxSi (OR 3.95, 95% CI: 2.61-5.98), xSiri konfliqti (OR- 1.81; 95% CI -1.22-2.69) da arasruli ojaxi (OR- 1.54; 95% CI -1.08-2.20, aseve Tambaqos mweveli orive mSobeli (OR- 1.30; 95% CI -0.91-1.86) (diagrama 5). orsulobis Taviseburebebi, romelic warmoadgens atopiuri dermatitis maxasiaTebel riskis faqtors aris kvebiTi alergia (OR- 7.99; 95% CI -3.17-21.38), medikamenturi alergia (OR9.09; 95% CI -1.98-57.94), stresi (OR- 1.45; 95% CI 0.98-2.15), Tambaqos mweveli orsuli (OR- 1.89;

14

95% CI -1.28-2.81) da virusuli daavadeba (OR2.08; CI -0.81-5.45) (diagrama 6). wlamde asakis bavSvTa Taviseburebebi, romelic warmoadgens atopiuri dermatitis ganviTarebis riskis faqtors, aris bavSvis xelovnuri kveba (OR- 5.29; 95% CI 3.30-8.51), wlamde avadoba kvebiTi alergiiT (OR- 10.27; 95% CI -6.17-17.24) da medikamenturi alergiiT (OR- 3.03; 95% CI -1.546.06), aseve vaqcinaciis Cautarebloba (OR4.98; 95% CI -0.99-33.65) (diagrama 7). diagrama 5
4.5 4 3.5 3 2.5 2 1.5 1 0.5 0 kata binaSi konfliqtebi arasruli ojaxi Tambaqos mweveli mSoblebi

citrusi (OR- 14.97; 95% CI - 7.09-32.66), antibiotiki (OR- 5.82; 95% CI -3.0-11.46), vitaminebi (OR- 4.42; 95% CI 1.67-12.31). (diagrama 8). atopiuri dermatitis ganviTarebas xSirad win uswrebs helminTozis (OR- 10.78; 95% CI - 7.17 - 16.24), gaRizianebuli nawlavis sindromis (OR- 12.74; 95% CI - 8.41 - 19.35) an kariesis (OR- 3.37; 95% CI -2.30-4.94) arseboba anamnezSi. memkvidreobiTi Taviseburebebi, rogorc atopiuri dermatitis riskis faqtori ganawilda Semdegnairad: deda alergiuli diagrama 6

10

5
OR AR Re Rne

kveb i Ti al er gi a

st r esi

vi r usui i n feqc i a

OR

AR

Re

Rne

medikamenturi alergia

Tambaqo

diagrama 7
16 12 10 8 6 4 2 0 OR AR
medikameturi alergia vaqcinaciis dagvianeba an arCatereba xelovnuri kveba wlamde kvebiTi alrgia

diagrama 8
14 12 10 8 6 4 2 OR AR Re Rne

Re

0 Rne rZe nigozi citrusi vitaminebi

kvercxi

citrusi

antibiotiki

anamnezis mixedviT kvebiTi da medikamenturi alergenebi, romelic qarTveli populaciisaTvis upiratesad gamovlinda aris: rZe (OR- 4.04; 95% CI -2.24-7.39), kvercxi (ORdiagrama 9
OR 4.63 5.12 13.69

1.9 5.56

deda

mama

da-Zma

sndm*

snmm*

7.41; 95% CI -4.01-13.55), nigozi (OR- 10.64; 95% CI -3.03-44.53), Tafli (OR- 6.04; 95% CI -1.93-21.08),

daavadebis anamneziT (OR- 13.69; 95% CI - 7.0827.04), mama alergiuli daavadebis anamneziT (OR- 5.56; 95% CI -2.87-10.99), da-Zma alergiuli daavadebis anamneziT (OR- 1.90; 95% CI 0.96-3.80), dedis mxriv sisxliT naTesavebi alergiuli daavadebis anamneziT (OR- 5.12; 95% CI -1.60-18.13), mamis mxriv sisxliT naTesavebi alergiuli daavadebis anamneziT (OR4.63; 95% CI -1.76-12.84) (diagrama 9). amrigad, Cven mier miRebuli monacemiT mravali sxvadasxva socialur - higienuri Tu medikur-biologiuri faqtori warmoadgens atopiuri dermatitis ganviTarebis riskis faqtors. mniSvnelovania, agreTve, Cveni qveynis bavSvTa populaciisTvis damaxasiaTebeli riskis fatorebis kidev ufro detaluri analizi, raTa Tavidan acilebul iqnes am progresirebadi daavadebis prevalensi.

15


. , . , .
. .

() , IgE- , . , , , , . - , , - -. 5 . 5 , 2454 . 278 (11.3 %) . SPSS: 2 : ( , 278 ), 300 . , (, ), ( , , ) . (OR- 13.69; 95% CI - 7.08-27.04). (OR- 7.99; 95% CI -3.17-21.38) , , (OR- 5.29; 95% CI -3.30-8.51). , (OR- 7.41; 95% CI -4.01-13.55), (OR- 4.04; 95% CI -2.24-7.39). , , ( , ), , . , .

RISK FACTORS FOR ATOPIC DERMATITIS IN JUNIOR CHILDREN POPULATION IN TBILISI


Natia Mgeldze, Rusudan Karseladze PhD, Prof; Liana Zhorzholiani PhD, Prof.
IV.JAVAKHISHVILI TBILISI STATE UNIVERSITY

Atopic dermatitis is a chronic inflammatory skin disease at the core of which lie IgE-dependent sensitization and hyperreactivity, violating natural reaction of skin barrier on external and internal irritation. Atopic dermatitis, as a rule, is often introduced in the form of atopic march among young children, but the case can also appear later on in adults. Seeking for revelation of atopic dermatitis risk factors, observative, analytical retrospective survey case-control was conducted. With the mentioned aim in five districts of city Tbilisi, five schools were chosen by method of claster randomization in which 2454 children were interviewed according to beforehand produced epidemiological questioner. Atopic dermatitis was diagnosed in cases of 278 (11.8%) children. Statistical treatment of resulted outcomes was prepared according to program package SPSS the residents were divided into two groups: primary or sample group with 278 patients suffering from atopic dermatitis and control group with 300 conditionally healthy children. Conducted analysis proves that exogenous (physical, chemical and biological) and endogenous (the role of nerve system, gastro-intestinal system, genetic predisposition) factors partake in development of atopic dermatitis. The main part in the formation of atopic dermatitis belongs to hereditary predisposition (OR- 13.69; 95% CI - 7.08-27.04). The risk of food allergy evolution (OR- 7.99; 95% CI -3.17-21.38) increases with nutritional

16

non-observance during women pregnancy and among infants, being on artificial rearing (OR- 5.29; 95% CI 3.30-8.51). Notably the history of food allergy among children in terms of maternal atopic history was more predictive than paternal history.Thus, hen eggs (OR- 7.41; 95% CI -4.01-13.55), proteins of cows milk (OR- 4.04; 95% CI -2.24-7.39) are most common causes of AD development in children within the first year of their birth. Development of dysbacteriosis intensifies the tendency of AD, the trend associated with uncontrolled, frequently, receipt of antibiotics, allergic disease(bronchial asthma and allergic rinit), helminthiasis, caries. In the final analysis, many exogenous and endogenous factors contribute to the development of atopic dermatitis.

literatura:
1. buCukuri i. qituaSvili T. atopiuri dermatitis epidemiologia da klinikuri maxasiaTeblebi. saqarTvelos samedicino moambe. #1, 2006w, gv.102-105 2. JorJoliani l. alergiuli daavadebis klinikur-epidemiologiuri Taviseburebani bavSvTa populaciSi. med. mecn. doqt. disertacia, 1998, 98 gv. 3. .., .. . .: .- 1999. 238 . 4. . . // . 2003. 4. .52-57. 5. .. . STATISTICA .: .- 2003.- 312 . 6. . . : , // Materia Medica. 2000.- 1 (25).- . 41-49. 7. ., ., . . 2000. 8. Akdis CA, Akdis M, Bieber T, et al.Diagnosis and treatment of atopic dermatitis in children and adults: European Academy of Allergology and Clinical Immunology/ American Academy of Allergy, Asthma and Immunology/PRACTALL Consensus Report. J Allergy Clin Immunol 2006;118:152-69. 9. Brenninkmeijer E.E.A.; Schram M.E.;. Leeflang M.M.G; Bos J.D.;. Spuls Ph.I -Diagnostic Criteria for Atopic Dermatitis: A Systematic Review Br J Dermatol. 2008;158(4):754-765 10. Hanifin JM, Cooper KD, Ho VC, Kang S, Krafchik BR, Margolis DJ, et al. Guidelines of care for atopic dermatitis, developed in accordance with the American Academy of Dermatology (AAD)/American Academy of Dermatology Association Administrative regulations for evidence-based clinical practice guidelines. J Am Acad Dermatol 2004;50:391-404. 11. Hoffjan S, Epplen JT. The genetics of atopic dermatitis: recent findings and future options. J Mol Med 2005;83:682-92. Novak N, Kruse S, Potreck J, et al. Single nucleotide polymorphisms of the IL18 gene are associated with atopic eczema. J Allergy Clin Immunol 2005;115: 828-33. [Erratum, J Allergy Clin Immunol 2006;118:1319.] 12. ISAAC Steering Committee. Worldwide variations in the prevalence of asthma symptoms: the International Study of Asthma and Allergies in Childhood (ISAAC). Eur Respir J 1998;12: 315335. 13. Weiland S.K., Bjrkstn B., Brunekreef B., Cookson W.O.C., von Mutius E.,. Strachan D.P and the International Study of Asthma and Allergies in Childhood Phase II Study Group. Phase II of the International Study of Asthma and Allergies in Childhood (ISAAC II): rationale and methods Eur Respir J 2004; 24:406-412 14. Williams H, Flohr C. How epidemiology has challenged 3 prevailing concepts about atopic dermatitis. J Allergy Clin Immunol 2006;118:209-13. 15. Williams HC, Robertson CF, Stewart AW, et al.Worldwide variations in the prevalence of symptomsof atopic eczema in the International Study of Asthma and Allergies in Childhood. J Allergy Clin Immunol. 1999;103:125138.

17

profpaTologia

Sromis medicinis Tanamedrove problemebi


r. javaxaZe, m.wereTeli, x.CigogiZe, n.ruxaZe, n.xatiaSvili, x.SublaZe
n.maxvilaZis saxelobis Sromis medicinis da ekologiis s/k instituti

(recenzenti - profesori vad. saakaZe)

1991 wels, pekinSi jandacvis saerTaSoriso organizaciis mier miRebul deklaraciaSi dasaqmebuli mosaxleobis janmrTelobis dacvis Sesaxeb, xazgasmiT aRiniSna, rom Sroma ekonomikuri da materialuri faseulobis safuZvels warmoadgens, yvela saxis socialuri moRvaweobis sayrdenia da uzrunvelyofs qveynebis socialur-ekonomikur ganviTarebas. garemo, sadac adamians uxdeba cxovreba da moRvaweoba, zegavlenas axdens ara marto mis fizikur mdgomareobaze, aramed mis fsiqo-fiziologiur monacemebze. amitom ar SeiZleba adamianis ganxilva ganyenebulad, garemodan mowyvetiT. aseve ar SeiZleba calkeul daavadebaze msjeloba garemomcveli situaciis gaTvaliswinebis gareSe. es gansakuTrebiT exeba im pirebs, romlebic Tavisi muSaobis xasiaTiT dakavSirebuli arian sawarmoo mavne faqtorebTan. dasaqmebulTa janmrTelobis SenarCuneba saxelmwifos erT-erTi umniSvnelovanesi funqciaa, romelic saxelmwifos socialuri politikis safuZvels warmoadgens. dRes msoflioSi adamianis janmrTelobas RirebulebiTi mniSvneloba eniWeba. jansaRi eri upirveles yovlisa janmrTeli adamiania, amdenad sazogadoebis sijansaRis mniSvnelovan indikators warmoadgens dasaqmebulTa janmrTelobis mdgomareoba. calkeuli adamianis janmrTeloba gansazRvravs saxelmwifos SromiTi resursebis xarisxs, Sromisnayofierebas, warmoebuli mTliani Sida produqciis sidides. Sromis saerTaSoriso organizaciis monacemebiT evropaSi Sromis aradamakmayofilebeli pirobebiTa da sawarmoo garemoTi gamowveuli daavadebebiT ganpirobebuli danakargi yovelwliurad Seadgens 66 miliard dolars.

ukanasknel wlebSi SeiniSneba Sromisunariani asakis pirTa Soris gul-sisxlZarRvTa, kuW-nawlavis, neiroendokrinuli sistemebis, sayrden-mamoZravebeli aparatis dazianebiT mimdinare avadobis zrda; dasaqmebulTa reproduqtiuli janmrTelobis gauareseba. Sromisunariani mosaxleobis janmrTelobis formirebaSi mniSvnelovani roli eniWeba profesiul riskebs. Sromis saerTaSoriso organizaciisa da janmrTelobis saerTaSoriso organizaciis specialistebis SefasebiT arsebobs 150-ze meti profesiuli riski da daaxloebiT 100 maTgani warmoadgens mudmiv safrTxes 2000 sxvadasxva profesiis adamianisTvis (4.5). janmo-s monacemebis Tanaxmad, mavne faqtorTa CamonaTvali dReisaTvis moicavs 100 000-ze met qimiur nivTierebas, 50 fizikur da 200 biologiur faqtors, 20mde arakeTilsaimedo ergonomikul pirobebs, amdenive sxvadasxva saxis fizikur datvirTvas, uamrav fsiqologiur da socialur problemas, romelTa moqmedeba saboloo jamSi iwvevs rogorc profesiuli, aseve zogadi daavadebebis gaxSirebas, invalidobas, Sromisunarian asakSi naadrev sikvdils. es ki mZime tvirTad awveba nebismieri qveynis erovnul ekonomikas (2). msoflioSi, yovelwliurad, sawarmoo ubeduri SemTxvevebisa da profesiuli daavadebebis gamo, 2,2 mln. adamiani iRupeba; 250 mln. adamiani sawarmoo ubeduri SemTxvevis msxverpli xdeba, xolo 160 mln.-mde adamiani avaddeba profesiuli daavadebiT. zarali profesiuli faqtorebiT gamowveuli Sromisunariani mosaxleobis sikvdilianobisa da invalidobis Sedegad sxvadasxva qveynis magaliTze saerTo erovnuli Semosavlis 10-

2. saqarTvelos samedicino Jurnali, 4, 2008 w.

18

15%-s Seadgens (9). aqedan gamomdinare, socialuri pasuxismgeblobis udidesi tvirTi qveyanaSi unda gadanawildes saxelmwifos, biznessa da Sromisunarian mosaxleobaze. am procesSi mTavaria socialuri xarjebis balansireba, raTa ar moxdes sazogadoebis polarizacia, Tumca amis tendencia SeimCneva. dRes saxezea qveynis mosaxleobis janmrTelobis mdgomareobaze sxvadasxva faqtoris, maT Soris sawarmoo, intensiuri zemoqmedebis integraluri maCveneblebis gauareseba (maRali sikvdilianoba, gansakuTrebiT bavSvebSi, bunebrivi matebis stabilurad dabali maCvenebeli, gul-sisxlZarRvTa sistemis, avTvisebiani simsivneebis, endokrinuli daavadebebis zrda, sicocxlis xangrZlivobis Semcireba, Tandayolili anomaliebis, alergiuli da respiratoruli sistemis daavadebebis mkveTri mateba da sxva). mosaxleobis dasaqmebuli nawilis profesiuli usafrTxoebisa da garemos dacvis mizniT, bolo aTwleulSi gansakuTrebiT gaaqtiurebulia saerTaSoriso organizaciebi: janmo, iunepi, Sso, evrosabWo da sxva. Seqmnilia mravali dokumenti, konvencia, rekomendacia, direqtiva, qartia. am dokumentebSi asaxulia Sromis medicinis samsaxuris ganviTarebis ZiriTadi principebi; mowodebulia sabazo infrastruqturis modelebi (3.9). 1994 wlis jso-s mier miRebul deklaraciaSi dasaqmebuli mosaxleobis janmrTelobis dacvis Sesaxeb aRniSnulia: samuSao adgilis usafrTxoeba da sijansaRe umniSvnelovanesi sakiTxia, romelic dakavSirebulia zogadad janmrTelobasTan da dasaqmebulTa keTildReobasTan; maTi ganxilva aucilebelia yvela doneze politikis gansazRvrisas (calkeul kompaniaSi, nacionalur da saerTaSoriso doneze). ganviTarebul qveynebSi dasaqmebulTa janmrTeloba ganixileba rogorc warmoebuli produqciis xarisxis ganmsazRvreli ucilobeli piroba: `daavadebul mwarmoebels ar ZaluZs xarisxiani produqciis Seqmna~. mraval evropul qveyanaSi Sromis medicinis sferoSi sakanonmdeblo da praqtikuli saqmianobis Semdgomi cvlilebebis orientirs warmoadgens saerTaSoriso organizaciis konvenciebi: Sromis usafrTxoebisa da janmrTelobis Sesaxeb #155/1981; Sromis medicinis samsaxurebis Sesaxeb #161/1985, evrokavSiris direqtiva 89/39 EEC (1989w.); janmo-s global-

uri strategia `dasaqmebulTa janmrTeloba 2000 wlisaTvis~ (1996w) da sxva. 1995 wels janmos da Sso-s komitetebis gaerTianebul meTormete sesiaze Camoyalibda Sromis medicinis 3 ZiriTadi amocana: 1. dasaqmebulTa janmrTelobis mdgomareobis gamyareba da Sromisunarianobis SenarCuneba; 2. sawarmoo garemosa da Sromis procesis gaumjobeseba dasaqmebulTa janmrTelobis SesanarCuneblad, raTa maqsimalurad uzrunvelyofil iqnes usafrTxoeba samuSao adgilebze; 3. samuSao adgilebze Sromis organizaciisa da kulturis srulyofa usafrTxoebisa da janmrTelobis SesanarCuneblad, rac xels Seuwyobs pozitiuri socialuri klimatis Seqmnas, gazrdis Sromis nayofierebas da aseve gaaumjobesebs gamoSvebuli produqciis xarisxs (10). Sromis medicinis nacionaluri sistemis konceptualuri safuZvlebis fesvebi 1978 wels alma-ataSi miRebul jso-s deklaraciaSia, romelic Sromis medicinas ganixilavs rogorc dasaqmebulTa da nacionaluri jandacvis sistemebs Soris kontaqtis pirvel doned ganTavsebuls adamianTa sacxovrebel da samuSao adgilis siaxloves. evrokomisiam 2002-2006 wlebisTvis samuSao adgilebze janmrTelobis dacvisa da usafrTxoebis strategiis SemuSavebisas gaiTvaliswina XXI saukuneSi sazogadoebaSi momxdari cvlilebebi: Sromisunariani mosaxleobis dabereba da mis struqturaSi qalebis wilis mateba; marTvisa da momsaxurebis sferoSi profesiaTa ricxvis zrda (socialuri izolireba, samuSaoTa erTferovani, monotonuri xasiaTi); dasaqmebis formis cvlileba (xanmokle da nawilobrivi dasaqmeba); mcire da saSualo sawarmoebSi dasaqmebulTa ricxvis zrda (mcire da saSualo biznesi); axali riskebis, gansakuTrebiT fsiqo-socialuri xasiaTis riskebis, warmoSoba. strezSi (italia, 2006 weli, ivnisi), janmos Sromis medicinis sferos centrebis meSvide Sekrebaze, romelSic monawileobda 45 centris warmomadgeneli 32 qveynidan, ganxilul iqna janmos strategiis CarCoebSi Semdgomi kvlevebi da miRebul iqna dasaqmebulTa janmrTelobis deklaracia, romelSic aRniSnulia TaTbiris monawileTa SeSfoTeba imis gamo, rom, miuxedavad Sromis medicinis efeq-

19

turi Carevisa, dasaqmebulTa didi nawili jer kidev ganicdis Sromis riskebis dauSvebeli donis zemoqmedebas da xdebian profesiul daavadebebisa da sawarmoo travmebis msxverplni. isini kargaven Sromis unars, potenciur gamomuSavebas da maT Zalian mcire nawils SeuZlia isargeblos Sromis medicinis samsaxuriT. 2006 wlis agvistoSi janmom SeimuSava moqmedebebis globaluri gegmis proeqti dasaqmebulTa janmrTeloba 2008-2017 ww, romelSic aRniSnulia, rom dasaqmebulebi warmoadgenen msoflios mosaxleobis naxevars da gvevlinebian Tanamedrove msoflio sazogadoebis ekonomikuri da socialuri ganviTarebis fuZemdemlebad; maTi janmrTeloba damokidebulia sawarmoo garemos mravalricxovan risk-faqtorze, socialur da yofiT faqtorebze, aseve samedicino momsaxurebis xelmisawvdomobaze. globaluri gegmis miznebi: 1. Sromis medicinaSi nacionaluri politikis, moqmedebis gegmebisa da programebis SemuSaveba da ganxorcieleba; 2. janmrTelobis dacva samuSao adgilze; 3. profesiuli samedicino momsaxurebis xarisxisa da misawvdomobis gaumjobeseba; 4. profilaqtikuri RonisZiebebis gasatarebeli winadadebebis dasabuTeba da gavrceleba; 5. dasaqmebulTa gacnobiereba mdgradi ganviTarebis arasamedicino RonisZiebebis Sesaxeb. janmom globaluri gegmis miRebiT mouwoda masSi gaerTianebul qveynebs Sromis medicinis nacionaluri sistemebis Seqmnisaken. evrokavSiris qveynebSi Sromis medicinis sfero sakmarisad ganviTarebulia da maTi Sesabamisi struqturebi didi xania integrirebulia rogorc evropul, ise evroatlantikur sivrceSi. rTuli socialuri mdgomareobis miuxedavad, dsT-s ZiriTad qveynebSi _ ruseTi, ukraina, belorusia, moldaveTi, somxeTi da baltiispireTi - SeZles Sromis medicinis samsaxuris reformireba, erovnul Taviseburebebze morgebuli Sromis medicinis samsaxuris Seqmna da integrireba saerTaSoriso moTxovnebis Sesabamisad. dRevandeli mdgomareobiT, Sromisa da dasaqmebulTa jnmrTelobis dacvis xaziT, saqarTvelo aRiarebs saerTaSoriso samarTlis principebs da normebs qveynis kanonmdeblobiT dadgenili moTxovnebis dacviT. saqarTvelo 1993 wlidan iTvleba Sromis saerTaSoriso organizaciis wevrad da parlamentis mier ratificirebulia

sxvadasxva dokumenti; qveyana gawevrianebulia vaWrobis msoflio organizaciaSi da misi valdebulebebi gansazRvrulia 1996 wlis 22 aprils luqsemburgSi dadgenili SeTanxmebiT partniorobisa da TanamSromlobis Sesaxeb, Tumca aRniSnuli SeTanxmebebi da valdebulebebi jerjerobiT ar aris gaaqtiurebuli (6.7). bolo periodSi saqarTveloSi ukana planze moeqca dasaqmebuli mosaxleobis janmrTelobis dacvis mwyobri sistema, ramac ganapiroba qveynis mosaxleobis janmrTelobisaTvis usafrTxo garemos Seqmnis problemebis gaaqtiureba. Sromis dacvis da higienis biuletenSi saqarTvelos Sesaxeb aRniSnulia, rom qveynis politikuri xelmZRvaneloba samuSao adgilebis Seqmnis realizacias awarmoebs ise, rom ar iTvaliswinebs dasaqmebulTa socialuri dacvis, usafrTxo samuSao adgilebis Seqmnis aucileblobas. saqarTveloSi Sromis inspeqciis samsaxuri gauqmebul iqna swored im dros, rodesac, magaliTad somxeTSi, formirebul iqna ganaxlebuli inspeqcia 120 kaciani StatiT. saerTaSoriso gamocdileba ki gviCvenebs, rom amgvari ugulisyuro damokidebuleba Sromis dacvis sferosadmi saboloo jamSi iwvevs uzamazar humanitarul da ekonomikur danakargebs. amgvari politikis gatarebas ar eTanxmeba Sromis saerTaSoriso organizaciasTan TanamSromlobaSi myofi struqturebi. Sromis dacvis specialistebis, damsaqmeblebis da profkavSirebis SeTanxmebiT miRweul iqna Sromis higienis dacvis sferos Semdgomi rRvevis SeCereba. damsaqmebelTa organizaciebma uzrunvelyves Sromis higienis dacvis xaziT seminarebis Catareba, daiwyo Sromis higienis dacvis nacionaluri profilis Seqmna, Sesabamisi kadrebis momzadeba da maT mier kontrolirebadi sawarmoebis informaciuli uzrunvelyofa (1). dasaqmebuli mosaxleobis janmrTelobisaTvis usafrTxo garemos uzrunvelyofis mizniT pirveli rigis amocanaa maT organizmze moqmedi riskis faqtorebis gamovlena, sistematizacia da unificireba qveynis erovnuli meurneobis ganviTarebis perspeqtivebis, warmoeba-dawesebulebis specifikis, Sromisa da cxovrebis wesis, klimatur-geografiuli pirobebis da sxva faqtorebis gaTvaliswinebiT. cvalebadi socialuri da teqnologiuri garemos pirobebSi mosaxleobaze moqmedi riskis faqtorebis Tavidan acileba da prevenciuli RonisZ-

20

iebebis SemuSaveba saTanado efeqtiT sasicocxlo mniSvnelobas iZens saqarTvelos dRevandel pirobebSi. aRniSnuli amocanebis gadaWras emsaxureba profilaqtikuri medicinis specifikuri dargi _ Sromis medicina. Sromis medicina mowodebulia daicvas dasaqmebuli mosaxleoba garemos mavne faqtorebisagan, SeinarCunos maTi janmrTeloba qveynis ekonomikuri winsvlisaTvis. yovelive es unda ganxorcieldes dasaqmebuli mosaxleobis janmrTelobis dacvis xangrZlivi erovnuli programis safuZvelze, romelic garantirebuli

unda iyos qveynis konstituciiT, mosaxleobis Sromisa da janmrTelobis dacvis kanonebiT, Sromis medicinis erovnuli konvenciis SeqmniT. am sakiTxis gadasaWrelad aucilebelia samTavrobo iniciativa qveynis mier aRebuli saerTaSoriso valdebulebebis SeTanxmebis gasaaqtiureblad; saWiroa Sromisa da janmrTelobis dacvis aspeqtSi kanonmdeblobis mizanmimarTuli srulyofa da misi harmonizeba saerTaSoriso da evrokavSiris moTxovnebTan, TanamSromloba evropul samezoblo politikis ( ENP) farglebSi.


. ,.,.,. ,. , .
, . . - , , . . , , , 66 . . . , , .

ACTUAL PROBLEMS OF LABOR MEDICINE UP TODAY


R. Javakhadze, M. Tsereteli, Kh. Chigogidze, N. Rukhadze, N. Khatiashvili, Kh. Shubladze
Preservation and maintenance of workers health is one of the main states function ,which forms the basis for states social policy. Up today the health of nation is, first of all, the health of a man, thats why one of the main public health indicator is the workers health condition. Accordingly to ILO data, in Europe annually casualties, connected with unsatisfactory work conditions and causing occupational diseases, involve 66 milliard dollars US. During last years in Georgia the system of workers health defense doesnt work. Thats why it is the state initiatives on introduction of this obligationic, reasonable which are intaken by our country in the sphere of workers health and labor defense, set labor legislation in conformity with international requirements and collaboration with other EU countries.

21

literatura: 1. . . 2008. 11. 1. C. 25. 2. . . . . V . 2006. 3. . . , 2006., 79 . 4. . . . . . . . .- .: , 2001. 5. . (ILO/OSH 2001) 6. EUROPIAN FOUNDATION FOR THE IMPROVEMENT OF LIVING AND WORKING CONDITIONS. Working conditions in the European Union. Second European Survey on the Working Conditions January 1996. Luxemburg, office for official Publications of the European Communities, 1997. 7. EUROPEAN COMMISION. Guidance on risk assessment at work. Health and Safety. Luxemburg, Office for Official Publications of the European Communities, 1996 (ISBN 92-827-4278-4). 8. ILO. Convention 161 concerning occupational health services. Geneva, International Labour Organization, 1985. 9. Occupational health. In: WHO European centre for Environment and Health. Concern for Europes tomorrow. Health and the environment in the WHO European region.Stuttgart, Wissenschaftliche Verlagsgesellschaft, 1995. 10. Report of the Joint ILO/WHO Committee on occupational health services. Geneva, International Labour Organization, 1985.

22

ONCOSURGERY

THE RESULTS OF TREATMENT OF THE GASTRIC CANCER AFTER EXPANDED AND EXPANDED-COMBINED OPERATIONS
A.R.ALIYEV The national centre of oncology, Baku, Azerbaijan Republic (Reviewer - professor R. Japarov)

In last ten years there was an essential progress in the surgical treatment of the gastric cancer (1, 4). According to the literature the majority of researchers show authentic improvement of the follow-ups in the patients with gastric cancer after the expanded operations, followed by removal of the target affected organ with lymphodissection (2, 6). Besides, it was determined that five-year survival rate of the patients with gastric cancer with metastases in the regional lymph nodes after performing simple gastrectomy makes 18%, and in the operations followed by lymphodissection - 39%. Last years the researches have been conducted the application of expanded lymphodissection in the gastric cancer in the leading clinics of the world, consisting of the application of mobilization and removal of the lymph nodes located on the way of the inferior vena cava, abdominal region of aorta, root of mesentery (2, 5). Performing given operation has been recommended to the patients with locally extensive gastric cancer in the absence of generalized manifestations of malignant process. It is significant that there are many opponents of expanded and expanded-combined operations with the gastric cancer, who consider that the given operative interventions lead to a sharp increase in the quantity of postoperational complications without improvement of the follow-ups of treatment Lawrence W., Roucos D.H. (8, 10). The given complications have both a local and a general somatic character. The number of cases of postoperational pancreatitis and intraabdominal abscess are most often registered among local manifestations of postoperational complications. Other important kind of the treatment of gastric cancer is the provision of patients quality of life. Since the first successfully performed gastrectomy in 1887 (Shlatter), surgeons look for the best reconstruction method. Each of the offered methods have its advan-

tages and disadvantages (3, 7, 9, 11). Some surgeons followed the way of the creation of areflex anastomosis; others began applying the reconstruction on Roux method. Considering that, none of the reconstruction methods completely resolve the problem of postoperational disease manifested by reflux-esophagitis and jejunal syndrome, it can be attempted to compensate the deprivation of reserve function of the stomach after gastrectomy in the given group of patients by forming of artificial ileal reservoir. However, few randomized researches, absence of impartial estimation parameters of various techniques complicate the choice of optimum reconstruction method after gastrectomy. Material and methods: Expanded and expandedcombined operations had been performed on 81 patients with GC, who were included in the research. The ages of the patients fluctuated from 35 till 67. The majority of patients were in the age group from 40 till 50 (83, 3%). In 56 cases lymphodissection corresponded to the level D2, and in 25 cases - D3. In 20 cases the operation had a combined character including the resection of adjacent organs. There were 15 men and 5 women among operated patients. Apart from the stomach removal, one organ was additionally resected in 12 patients. The partial pancreas resection was performed to 4 of the patients, a transverse colon resection to 2 of them, to 5 atypical pancreas resection and to 1- atypical hepatic resection. The resection of 2 organs was performed additionally to 3 patients. The resection of pancreas and transverse colon was performed to 2 of the patients, to 1 of them a transverse colon resection and an atypical resection of II and III segments of liver, and to the fourth distal resection of pancreas and bisegmentectomy (II and III) of liver. Resection of the following 3 organs was performed additionally to 3 patients: pancreas, transverse colon

23

and small intestine. Along with gastrectomy a multivisceral resection was performed to one patient which included four organs: a liver, a pancreas, a large and small intestine. It is important to note that splenectomy enters into a standard volume of operation in gastrectomy in the gastric cancer, and the lymphodissection was an integral component of the operative treatment. For studying of the immediate results of surgical treatment of gastric cancer the following researches have been done: clinicolaboratory examination of blood, ultrasonic, and if necessary, C of abdominal cavity organs, X-ray- examination of the thorax and X-ray contrasting study of the continuity of esophageal-jejunal anastomosis. The reconstruction method by loop of jejunal with the application of Braun anastomosis was basically applied in NCO. In the patients with early gastric cancer, expanded gastrectomy was accompanied with the formation of two reservoirs in the reconstructive stage and at the same time the use of areflex esophagogastric anastomosis by the method of M.I.Davydov. Operations were performed to 20 patients with a plastic component, i.e. with application of reservoirs in the reconstructive stage.

lowing patient after expanded-combined gastrectomy the insolvency of oesophageal-intestinal anastomosis with opening of the fistula in the pleural cavity was recorded. The patient died of the subsequent pleural empyema. In five cases the postoperational pancreatitis (D2 - 2, D3 - 3) was ascertained. Left-side subdiaphragmatic abscess (D2 - 1, D3 - 2) was clinically, ultrasonographically and computer- tomographically determined in three patients after performing drainage under ultrasound examination. In one patient after the expanded-combined operation of the relaparotomy necrosis of intestines as a result of thrombosis of mesenteric vessels was recorded, subsequently the patient died of peritonitis. The following patient after gastrectomy with lymphodissection level D2 died of sepsis on the 22nd day. Altogether the lethality has made 6,17%. Average duration of the postoperational period was 18,1 days. Early manifestations of postoperational disease have been determined in 13 (21,31%) patients after the standard loop reconstruction manifested by reflux-esophagitis. Presence of a postoperational pathology was recorded in 2 (10%) patients where interintestinal reservoirs have been imposed after gastrectomy in the reconstructive stage.

Distribution of the patients depending on the volume of operation and a postoperative course
Postoperative examination Postoperational complications R-operations Postoperational lethality Staying in hospital (days) Lymphodissection D2 (56) D2 (52) 3 (5,36%) 2 (3,57%) 2 (3,57%) 16 D2 comb.(4) 5 (8,93%) 1 (1,78%) Lymphodissection D3 (25) D3 (9) 4 (16%) 1 (4%) 23 D3 comb.(16) 6 (24%) 1 (4%) 2 (8%)

Results and discussion: Postoperative complications were observed in 18 (22,22%) cases. On the 7th postoperational day the postoperational hypostatic pneumonia was clinically and rentgenologically determined in 5 patients after combined gastrectomy with lymphodissection levels D2 and D3 and it was resolved in two cases on the 18-21st day, and in three others - on the 21-23rd days. On the third postoperational day the acute bilateral pleuropneumonia was clinically and rentgenologically determined in the sixth patient with lymphodissection D2. The patient died of the respiratory failure on the 5th postoperational day. In the seventh patient the insolvency of oesophageal-intestinal anastomosis after gastrectomy with lymphodissection level D2 was determined. Despite carrying out relaparotomy, application of the jejunostomy, sanation and drainage of abdominal cavity, the patient died. In the fol-

The carried out research has shown that in spite of the fact that the number of postoperational complications in the patients with gastric cancer after expanded and expanded-combined gastrectomy is rather great, at the same time the difference in the lethality and number of days spent in a hospital is statistically doubtful in comparison with the standard operations. It is significant that the received preliminary results show the advantage of application of reservoirs in the reconstructive stage after gastrectomy, statistically authentically showing the decrease of early manifestations of a postoperational reflux-pathology. Thus, modern operative treatment principles of the gastric cancer consist of the maintenance of oncological adequacy and the choice of most functionally proved reconstruction method for improvement of life quality in postoperational periods.

24

kuWis kibos mkurnalobis Sedegebi gafarToebuli da gafarToebul-kombinirebuli operaciebis Semdgom


a. alievi
onkologiis erovnuli centri, baqo, azerbaijanis respublika

kuWis kiboTi dasnebovnebul 81 avadmyofs Cautarda gafarToebuli da gafarToebul-kombinirebuli operaciebi. letalobam Seadgina 6,17%, xolo postoperaciuli periodis xangrZlivobam - 18,1 dRe-Rame. Catarebuli kvlevis Sedegebis analizma gviCvena, rom operaciuli mkurnalobis Sedegad postoperaciuli garTulebebis SedarebiT maRali maCvenebeli, romelic gamovlinda kuWis kiboTi dasnebovnebul avadmyofTa Soris gafarToebuli da gafarToebul-kombinirebuli operaciis Semdgom, letalobisa da stacionarSi gatarebuli sawol-dReebis ricxobrivi maCveneblebis sxvaoba, analogiur maCveneblebTan SedarebiT, standartuli meTodebiT Catarebul operaciebTan Sedarebisas, statistikurad ara sarwmunoa. winaswari SedegebiT irkveva, rom rezervuarebis gamoyeneba gastreqtomiis Semdgom rekonstruqciul etapze upiratesobiT gamoirCeva, razec metyvelebs statistikurad sarwmuno Semcireba postoperaciuli refluqs-paTologiis naadrevi gamovlinebis sixSiris maCveneblis. migvaCnia, rom kuWis kibos operaciuli mkurnalobis Tanamedrove principebi unda emyarebodes onkologiuri uzrunvelyofis adekvaturobas da rekonstruqciis funqciurad dasabuTebul meTods cxovrebis xarisxis gasaumjobeseblad postoperaciul periodSi.

-
..
, ,

81 - . 6,17%. 18,1 . , , -, , . , -. , .

25

literatura:
1. .., .., - . : . .2003 2. - 49. -.209-216. 2. .., - .., .. . . , -.- 2001.- .402-404. 3.Adachi S., Takeda T., Fukao K Evaluation of esophageal bile reflux after total gastrectomy by gastrointestinal and hepatobiliary dual scintigraphy. \\Jpn J Surg (1999 29: 301-306. 4. Bonenkamp J.J., Sasako M., Hermans J. et al. Extended lymph-node dissection for gastric cancer. N. Engl. J. Med. 1999; 340: 908-914. 5.Bostanci E.B., Yol S., Kayaalp C. et al. Comparison of complications after D2 and D3 dissection for gastric cancer. The journal of cancer surgery V. 30, !1, 2004 febrary, s.20-25. 6.Chua C.L. Total gastectomy for gastric cancer: the rationale for J-pouch reservoir. \\J R Coll. Surg. Edinb., 43, june 1998, 169-173. 7.Hartring H.H., Bonenkamp J.J., van de Velde C.J.H. Influence of surgery on outcomes in gastric cancer. ESMO-EONS Educ. Symp., Budapest. 2001; 97-117. 8.Lawrence W., Horsley J.S.//J. Surgery Oncology - 1996. - Vol. 61. - P. 85-89. 9.Oh St., Kim B.S., Park K.C. A new reconstruction technique following total gastectomy: jejunal pouch uncut double anastomosis. \\Materials of 2nd International Gastric Cancer Congress. 1997, Munich (Germany). 2:895-898. 10.Roucos D.H., Hottenrott C., Lorens M. et al.//J. Cancer Res. Clinical Oncology. - 1990. - Vol. 116. - P. 307-313. 11.Shwartz A., Beger H.G. Gastric substitute after total GASTECTOMY - clinical reveleance for reconstruction techniques. \\Langenbecks Arch Surg (1998 383: 485-491.

26

yel-yur-cxviris da nevrologiuri daavadebebi

smenaClungobis gamomwvevi paTologiis zegavlena Tavis tkivilze


g. buaZe, s. xeCinaSvili, m. beriZe, i. xundaZe, m. alfaiZe,
s. xeCinaSvilis saxelobis Tssu sauniversiteto klinika

(recenzenti - medicinis mecnierebaTa doqtori f. xoxaSvili)

kvlevis mizani iyo konduqtiuri da Sereuli xasiaTis smenaClungobis gamomwvevi sxvadasxva paTologiis operaciuli da konservatiuli mkurnalobis zegavlena smenis funqciasa da TandarTuli cefalgiebis klinikur mimdinareobaze. kvleva Catarda s. xeCinaSvilis saxelobis Tssu klinikaSi 1999-2007 wlebSi. gamokvleul iqna 6-75 wlis 106 pacienti, 63 mamakaci da 43 qali. paTologiis mixedviT gamoyofil iqna Semdegi jgufebi: I jgufi _ adenoidebi (30 avadmyofi), I jgufi _ alergiuli da vazomotoruli riniti (22 avadmyofi), III jgufi _ cxviris polipozi (16 avadmyofi), IV jgufi _ cxviris Zgidis gamrudeba (20 avadmyofi), V jgufi _ qronikuli hipertrofuli riniti (18 avadmyofi) sakontrolo jgufi Seadgina Sesatyvisi asakis 30-ma janmrTelma pirma. gamoyofil jgufebSi smenis simaxvilis gansazRvra da smenis daqveiTebis tipis (konduqtiuri an neirosensoruli) dadgena xdeboda zRurblovani tonaluri audiometriiT. Sua yurSi mimdinare procesebis xasiaTis dazusteba xdeboda timpanometriiT. TandarTuli Tavis tkivilis xasiaTis gansazRvrisaTvis tardeboda nevrologiuri gamokvleva da transkraniuli doplerografia. dgindeboda smenis daqveiTebis tipi da xarisxi. daavadebidan gamomdinare gamoyenebul iqna mkurnalobis konservatiuli da qirurgiuli meTodi. konservatiuli meTodidan gamoviyeneT: cxviris wveTebi, hiposensibilizacia, yurebis daberva (policerizacia), kortikosteroiduli malamoebiT fonoforezi. qirurgiuli meTodidan viyenebdiT adenotomias, cxviris polipotomias, niJarebis ultrabgeriT dezintegracias, kolxotomiasa da septoplastikas. mkurnalobis Semdgom kvlav tardeboda smenis ganmeorebiTi gamokvleva

zRurblovani, tonaluri audiometriiT da timpanometriiT. ganmeorebiT dgindeboda smenis simaxvile. gamoyofil jgufebSi vadarebdiT smenis simaxviles mkurnalobamde da mkurnalobis Semdeg. vafasebdiT Catarebuli mkurnalobis efeqturobas smenis gaumjobesebis TvalsazrisiT. cefalgiebze dakvirveba xdeboda mkurnalobidan 6 Tvis manZilze pacientebis sam asakobriv jgufSi, 6-15 wlis, 16-65 wlis, >65 welze. 6 Tvis Tavze tardeboda Tavis tvinis sisxlZarRvebis ganmeorebiTi doplerografia. kvlevis monacemebis gadamuSaveba moxda kompiutruli statistikuri paketiT SPSS-11,0. gamoyenebul iqna parametruli da araparametruli statistikis meTodebi. saSualo monacemis gamosaTvlelad viyenebdiT stiudensis Sewyvilebul ttests. saSuloebis Sedareba xdeboda erTfaziani ANOVA-Ti. kvlevis Sedegebi: klinikur jgufSi avadmyofTa 60% -s (18 avadmyofi SedarebiT didi zomis adenoidebiT) audiometriuli gamokvleviT daudginda konduqtiuri smenaClungoba, xolo Sereuli xasiaTis smenaClungoba aReniSna avadmyofTa 10%-s (3 pacienti). smenis saSualo simaxvile dadgenil iqna decibelebSi (cxrili 1). neirosensoruli smenaClungoba am pacientebSi savaraudod gamowveuli iyo sisxlZarRvovani mizezebiT (qronikuli arteriuli hipertenzia- 2 avadmyofi) avadmyofTa 47%-s (14 avadmyofi) awuxebda sxvadasxva intensivobisa da sixSiris Tavis tkivili. maTgan 12 pacients doplerografiuli gamokvleviT datvirTuli hqonda venuri sistema da aReniSnebda viliziis wris arteriebSi sisxlnakadis xazovani siCqaris mateba, xolo 2 avadmyofs daudginda cerebruli arteriebis sxvadasxva xarisxis angiospazmi (cxrili 2).

27

I klinikur jgufSi pacientebis 75%-s (16 pacienti) daudginda konduqtiuri smenaClungoba, xolo pacientTa 10%-s (2 pacienti) -Sereuli xasiaTis (neirosensoruli da konduqtiuri) smenaClungoba. neirogenuri mizezebidan erT SemTxvevaSi savarau-

normis Sesatyvisi doplerografiuli monacemebi da mocemul kvlevamde, 1 wliT adre, nevrologis diagnoziT, rogorc daZabulobis Tavis tkivili. I I klinikur jgufSi konduqtiuri smenaClungoba dadginda 75% -Si (12 pacienti),

cxrili 1 konduqtiuri da Sereuli smenaClungobis saSualo maCveneblebis Sedareba cxvir-xaxis limfadenoiduri qsovilis sxvadasxva paTologiis dros
paTologiis tipi adenoidebi (I) alergiuli da vazomotoruli riniti (II) cxviris polipozi (III) cxviris Zgidis gamrudeba (IV) qronikuli hipertrofuli riniti (V) Ppacientebis raodenoba 30 22 16 20 18 Akonduqtiuri smenaClungoba % 60% 75% 75% 90% 65% smenis simaxvile (decibeli) 40 8.4 55 4,5 65 6.6 78 7.9 59 11.2 Sereuli smenaClungoba % 20% 10% 6% 0 35% smenis simaxvile *58 7.5 * 67 6,5 *72 8,5 *67 4.7

cxrilSi moyvanilia saSualo maCveneblebi (SD) * p<0.05 cxrili 2 smenis simaxvilis Sedareba klinikur jgufebSi (decibelebi) konduqtiuri da Sereuli smenaClungobis dros mkurnalobamde da mkurnalobis Semdeg
paTologiis tipi Aauditoruli smenaClungoba, smenis simaxvile mkurnalobamde Aadenoidebi (I) alergiuli da vazomotorul riniti (II) cxviris polipozi (III) cxviris Zgidis gamrudeba (IV) Qqronikuli hipertrofuli riniti (V) Aadenotomia lokaluri da zogadi antialergiuli saSualebebi polipotomia septoplastika cxviris qveda niJarebis ultabgeriTi dezintegracia, konxotomia 40 8.4 55 4,5 65 6.6 78 7.9 66 11.2 Mmkurnlobis Semdeg 28 7.2** 38 6.2** 34 4.7** 32 5.4** 41 9.3* Sereuli smenaClungoba, smenis simaxvile mkurnalobamde 58 7.5 67 6,5 72 8,5 67 4.7 *48 8.4 Mmkurnlobis Semdeg 51 9.6 59 11,5 *44 12,6

Mmkurnalobis meTodi

cxrilSi moyvanilia saSualo monacemebi (SD) * P<0.05 ** <0.01 Sereuli xasiaTis smenaClungoba ki- 6%do iyo aminoglikozidebis jgufis antibiSi (erTi pacienti), cefalgiiT datvirTuotikebis xangrZlivi xmareba mwvave pnevmoli anamnezi hqonda 8 pacients, romelTac niis gamo, xolo meore SemTxvevaSi aRiniSdoplerografiulad daudgindaT monebida migrenozuli Tavis tkivili da bamatebuli xazovani siCqareebi intracerezilaruli arteriis spazmi. pacientebis brul arteriebSi da datvirTuli hqon60% (12 avadmyofi) uCioda Tavis tkivils, daT viliziis wre. romelTagan 11 pacients aRmoaCnda intracIV klinikur jgufSi konduqtiuri smenaerebrul arteriebSi xazovani siCqareebis Clungoba aRiniSna 90%-Si (18 avadmyofi). mniSvnelovani mateba da rozentalis venebsxvadasxva intensivobis TandarTuli is datvirTva. erT avadmyofs aRmoaCnda

28

Tavis tkivili hqonda pacientebis 75%-s (15 avadmyofi). doplerografiulad 12 avadmyofs daudginda intracerebruli sixlZarRvebis sxvadasxva xarisxis angiospazmi, erTi avadmyofi diagnostirebuli iyo klasteruli Tavis tkiviliT, 2 pacients datvirTuli aRmoaCnda swori da ganivi sinusebi. sxva pacientebSi datvirTuli iyo sauRle venebi. V klinikur jgufSi konduqtiuri siyrue aRiniSna 65%-Si (11 avadmyofi), 35%-Si smenaClungoba Sereuli xasiaTis iyo (6 avadmyofi), unilateraluri neirosensoruli smenaClungobis mizezad erT SemTxvevaSi savaraudo iyo gadatanili limfomatozuri meningiti, xolo danarCen 5 SemTxvevaSi, xandazmul pacientebSi neirodegeneracia (spiraluri kvanZis neironebis progresuli kargva). TandarTuli perioduli Tavis tkivili hqonda pacientebis 80%-s (14 avadmyofi). doplerografiulad, erT pacientis daudginda marjvena wina cerebruli

gaumjobeseba (p<0.05), xolo Sereuli smenaClungobis SemTxvevaSi I da I klinikur jgufSi smenis simaxvile imatebda, Tumca arasarwmunod (p<0.5) (cxrili 2). Catarebuli mkurnalobidan 6 Tvis Semdeg TandarTuli cefalgiebi sruliad gaqra pacientebis 75%-Si, xolo 25%-Si aRiniSna Tavis tkivilis intensivobisa da sixSiris mniSvnelovani Semcireba, rac dasturdeboda ganmeorebiTi doplerografiiTac. Semcirebuli iyo xazovano siCqareebi intrakraniul sisxlZarRvebSi da met-naklebad gantvirTuli aRmoCnda venuri sistema. Sedegebis ganxilva: cxvirisa da cxvir-xaxis lorwovani garsisa da limfadenoiduri qsovilis qronikuli paTologia, sasmeni lulis obstruqciis garda, xSirad sasunTqi gzebis gamavlobas aferxebs [1-4], ris Sedegadac sisxlSi Jangbadis parcialuri wneva ecema, xolo naxSirorJangis (CO 2 ) parcialuri wneva matulobs,

cxrili 3 intrakraniuli doplerografiiT cerebruli sisxlnakadis xazovani siCqareebis Sedareba cefalgiebiT datvirTuli pacientebis sxvadasxva asakobriv jgufSi da sakontrolo pirebSi mkurnalobamde da mkurnalobis Semdeg
pacientebis asakobrivi jgufebi 6-15weli 16-65weli >65welze 6-15weli 16-65weli >65welze sisxlnakadis xazovani siCqareebi (mm/sek) mkurnalobamde Sua wina kontroli cerebruli kontroli cerebruli kontroli arteria arteria 76 12 *91 1.8 65 11 *82 0.8 54 10 61 9 *78 1.2 50 11 *63 0.6 41 10 45 12 *60 0.4 39 11 *51 0.3 35 10 sisxlnakadis xazovani siCqareebi (mm/sek) mkurnalobis Semdeg 76 12 80 4.8 65 11 67 2.4 54 10 61 9 66 4.9 50 11 51 1.7 41 10 45 12 47 2.6 39 11 43 5.1 35 10

baziluri arteria *65 0.9 *52 0.7 *46 0.9 57 2.6 44 1.8 35 2.7

maCveneblebi asaxavs saSualoebs (SD) * p<0.05

arteriis angiospazmi, xolo danarCen avadmyofebs maRali xazovani siCqare intracerebrul arteriebSi da datvirTuli venuri sistema. VI klinikur jgufSi auditoruli smenaClungoba aRiniSna 100%-Si. am jgufis yvela pacients hqonda TandarTuli cefalgia da intrakraniuli hipertenziis niSnebi (cxrili 3). konduqtiuri da Sereuli smenaClungobis maCveneblebi klinikuri jgufebSi mocemulia pirvel cxrilSi. Catarebuli operaciuli da konservatiuli mkurnalobis Sedegad klinikur jgufis pacientebSi konduqtiuri smenaClungobiT aRiniSna smenis sarwmuno

rasac dauyovnebliv aRiqvams sisxlZarRvovani receptoruli sistema [5-6]. Jangbadis optimaluri miwodeba cerebruli sisxlZarRvebiT komprometebulia da tvinis qsovili qronikul hipoqsias ganicdis. metaboluri procesebiT ganpirobebuli hipoqsiis sakompensaciod CairTveba cerebruli sisxlZarRvebis autoregulaciuri meqanizmebi, rodesac adekvaturi sisxlis nakadis mobilizaciis mizniT da mikrocirkulaciis gasaZliereblad arteriolebsa da kapilarul qselSi viTardeba mniSvnelovani vazodilatacia, xolo arteriebSi izrdeba sisxlnakadis siCqare. doplerografiulad,

29

arteriolebisa da kapilarebis vazodilataciaze migviTiTebs dabali pulsuri indeqsi (PI), romlis saSualo maCveneblebi aRwevda 0.6 0.11. arasakmarisi vazoregulaciuri kompensaciis pirobebSi, tvinis qsovilSi eqstravaskuluri wneva yovelTvis momatebulia da mikrovaskuluri kompensatoruli dilatacia gawonasworebulia. itvirTeba viliziis wris arteriebi, radgan izrdeba sisxlis nakadis moculoba da rTuldeba sisxlis venozur sistemaSi gatana [7]. hipoqsiis gamo, tvinis qsovilSi Jangbadisa da glukozis utilizacia Seferxebulia, viTardeba venuri stazi. sauRle venebisa da venuri sinusebis datvirTva iwvevs intrakraniul hipertenzias, ramac SesaZloa Tavis intensiuri tkivilebi gamoiwvios. toqsikuri produqtebiT tvinis garsebis gaRizianeba kidev ufro amZimebs cefalgiebis intensivobas. Tavis tvinis parkuWovani sistemidan cerebrospinaluri siTxis evakuacia ferxdeba. Tavis tvinis liqvoruli sivrceebi lokokinas wyalgamyvani arxis meSveobiT ukavSirdeba SigniTa yuris labirinTis sivrceebs, rac parkuWovani sistemis gadatvirTvis dros

SesaZlebelia neirosensoruli siyruis mizezad iqces. cxvir-xaxis lorwovanas limfadenoiduri paTologiis moxsnis SemTxvevaSi sasmeni lulis gamavloba aRdgeba da konduqtiuri smenaClungoba iklebs. Sereuli xasiaTis smenaClungobis dros smenis simaxvile matulobs, Tumca zogierT gamoyofil jgufSi mateba arasarwmunoa, rac, savaraudod, ganpirobebulia neirosensoruli smenaClungobis SedarebiT rTuli etiopaTogeneziT. sasunTqi gzebis gamavlobis aRdgena iwvevs sisxlSi Jangbadis parcialuri wnevis matebas. ixsneba hipoqsia da misi paTologiuri Sedegi, aRdgeba stabilurcerebruli sisxlnakadi da xdeba venuri sistemis gantvirTva, rac xels uwyobs cerebrospinaluri siTxis evakuaciasa da intrakraniuli hipertenziis Semcirebas. aRniSnuli amcirebs cefalgiebis intensivobas an saerTod xsnis Tavis tkivils. amgvarad, konduqtiuri da Sereuli smenClungobisas operaciuli da konservatuli mkurnaloba zrdis smenis simaxviles da amcirebs an zogierT SemTxvevaSi sruliad aqrobs TandarTul Tavis tkivils.

,
. , . , . , . , .
. .

, , . : 106 6 75 . 5 3 . . . . (DWL Multi-Dop T with pulse-wave transducer 2-MHz ). : . ( < 0,05 ). ; (< 0,01 ), . . : , , , , - .

30

INFLUENCE OF LYMPHADENOIDAL TISSUE PATHOLOGY ON HEADACHES ACCOMPANYING THE HEARING LOSS OF CONDUCTIVE AND MIXED CHARACTER
G. Buadze, M. Alpaidze, M.Beridze, N. Metreveli, S. Khechinashvili
Study was aimed at investigation of surgical and conservatory treatment results in various pathologies causing the conductive and neurosensoral hearing loss and on clinical course of accompaning cephalgia. Patients and methods: 106 patients, aged 6-75 years have been investigated. According to the character of lymphadenoidal pathology patients were divided in 5 clinical groups and three age categories. Patients were researched by tonal audiometry and character of pathology was assartained by tympanometry. The mean decrease of hearing function was studied in clinical groups before and after treatment. The clinial course of accompaning headaches was studied and mean velosity of cerebral blood flow in intracerebral vessels was defined by doplerography (DWL Multi-Dop T with pulse-wave transducer 2- MHz). Results: The hearing loss of various degree was detected in clinical groups that was significantly improved after surgical and conservative teratment (p<0.05). The significant increase of cerebral bood flow velocity was detected in different intracerebral arteries in patients with headaches. The pulse Index was significantly decreased (p<0.01) indicating to the dilatation of cerebral arteriols and cappilares. After treatment, the cerebral bood flow velocity found to be decreased in intracerebral arteries and the Pulse Index was elevated. Conclusion: After treatment of lymphadenoidal pathology not only the hearing function improves, but also the intensity of accompaning headackes signifcantly decreases and in several cases complitely dissapears.

literatura:
1. Chopra H. ,Munjal V., Gupta S.N. Defness in pedoatric age group, Indian Journal of Otology&Rinology and Head-NecK injury-1999, Vol.51:3:7-10; 2. Ander JK., Roper AH. Seld audible venous bruits and high jugular bulb, Arch. Neurol.-1999. 43:157, 1096; 3. Tetterman BL, Huxpord W.M.,Sanders J.E. Sudden bilateral sensorineural hearing loss, Layngoscope1996:106:1347; 4. Baloch RW., Jacobson K., Wilson T. Dropp attack with Maniers syndrome, Ann Neurol.-1990:28:384:1990; 5. Mutot DE. Natural history of sensorineural hearing loss, Ann Otol. -1997:86:463. 6. Nadol JB. Hearing loss, N. Eng.J Med -1993:329:1092; 7. Fisher M. The anatomy and pathology of cerebral vasculature , Modern concept of cerebrovascular disease-1975, New Yourk, Spectrum, p.1-4.

31

(IN VITRO)
.. E
, ,

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, , , , , . , , , , , , . . , [1,3] . , (), , . ( ), . 1- : -3,0 ., -1,0 ., -4,0 ., 0,25 ., -2,0 ., -0,5 ., -0,3 ., -400-3,0 ., 70 %- 0,5 ., -0,0825 ., -0,0225 ., -82,0 ; 2- : -3,0 ., -1,0 ., -4,0 ., 0,25 ., -2,0 ., -0,5 .,

-0,3 ., -3,0 ., 70 %- 0,5 ., -0,0825 ., -0,0225 ., -82,0 . ; 3- : -3,0 ., -1,0 ., -4,0 ., 0,25 ., -2,0 ., -0,5 ., -0,3 ., -80-3,0 ., 70 %- 0,5 ., -0,0825 ., -0,0225 ., -82,0 . : 800C (62 ) 2 . . 4,0 . (I ). , 50 ., , 3,0 . , 3,0 ., 3,0 . -400( ( -80) 20 (II ). 1 , 0,5 70%- 0,25 . (III ). (I ) II III . 0,5 . , . 2- 3- . , , in vitro . in vitro : , - . . 4 , 3 .

32

5%- 45 , . . , , 2 . , . , , , , 25 (370C), , . 370. 30 5 , , . , 5

( ) 18 . , , . . , [1]. , , : m 100 = ------------------, pB - (); - , (); m- , (); - (); - , (%).

. 1.
C, % 70 60 50 40 30 20 10 0 1
, % 25 20 15 10 5 0 2 3 4 5 6 t, 1 2 3

1 2 3

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t,

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33

, 3% -80, 5 (57.54%), . , , -400 - , 5 42,98 34,56%. , (.2), , , , 5 , ,

1,2 3, 16, 14 % , 14,91 % 23, 5 %. , . ( ), , , . . , , . , , . -

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, % 15 10 5 0 2 ,% 20 15 10 5 0 2 3 4 5 6 t, 1 2 3 3 4 5 6 t, 1 2 3

a) ) (2 % )

(20,8%). -400 1 2 , , , 15,08 12,63%. 60 . , 60 . , , . , 5 . ,

. , , 5 , 9,42% 11,2% (1- ), 8,07 9,82% (2 ), 12,63% 15,08% (3- ). 3- , -80, . , , 3 % -8, , , - 400 , , - :

3. saqarTvelos samedicino Jurnali, 4, 2008 w.

34

. 5% , , , , , , , , ,

. , , . , , . , , , , ( 1., - 1.5 -2 .).

`glisotrikalis~ biofarmacevtuli Tvisebebis Seswavla eqsperimentSi


s. mexralieva
baqos samedicino universitetis farmacevtuli teqnologiis, organizaciisa da ekonomikis kaTedra

in-vitro Catarebuli kvlevebis Sedegad aRmoCnda, rom gelis wonidan gamoiyofa biologiurad aqtiuri nivTierebebi, romlebic ar grovdeba arc kanis zedapirze da arc kanze, magram drois ganmavlobaSi qmnis difuzias xelovnuri sisxlSi dializis dros. yvelaferi es miuTiTebs, rom gelis Semadgeneli aris kinetikurad aqtiuri.

STUDY OF BIOPHARMACEUTICAL FUNCTIONS OF GEL GLISOSTRICAL BY THE EXPERIMENTS 0N V0TRO


S.J. MEHRALIYEVA
As a result of experiences in vitro it was found out that biologically active substances liberated from weight of gel, not only do not gather on surfaces of a skin and pleated a skin, but during the time make diffusion in artificial blood in dialysis environment. All it shows that compositions of gel are kinetically active, but among them there is gel containing compositions foundation, such as the twin-80 and in 3 compositions of gel activity is higher.

literatura:
1. e .. , Glysocal, , 2008.- 1.- .105-108. 2. e .., .., .. AZ 2008 0067 . 3. e .., .., .. AZ 2007 0246 .

35

neiromorfologia

intrakraniuli meningiomis recidivis ganviTarebis vadebi


t. mermaniSvili, g. WaWia, e. xiTariSvili, T. jorbenaZe
p. sarajiSvilis saxelobis nevrologiisa da neiroqirurgiis instituti, i. javaxiSvilis saxelobis Tbilisis saxelmwifo universiteti

(recenzenti - profesori z. Tofuria)

simsivnis biologiuri `qcevis~ gansazRvra praqtikuli onkologiis umniSvlovanes sakiTxebs miekuTvneba. am problemis axsna simsivnuri procesis etiopaTogenezis dadgenasTan aris dakavSirebeli, romelic mravalmxrivi kvlevis sagans warmoadgens. Tanamedrove etapze grZeldeba im kriteriumis Zieba, romelic maqsimalurad sarwmunod dagvexmareba simsivnuri procesebis sxvadasxva aspeqtis prognozirebis sakiTxSi. zemoxsenebuli, intrakraniul meningiomebTan mimarTebaSi, recidivis ganviTarebis gansazRvis obieqturi kriteriumebis ZiebaSi gamoixateba. meningiomebis biologiuri `qcevis~ da prognozirebis sakiTxi farTo diskusiis sagans warmoadgens (3,10,14). avadmyofobis gamosavals mniSvnelovnad gansazRvravs simsivnis lokalizacia, intrakraniul struqturebTan kavSiri da operaciuli Carevis moculoba (11,16). ukanasknel wlebSi did yuradRebas aqceven, agreTve, molekulur doneze meningiomebis paTogenezisa da genetikuri anomaliebis Seswavlas (6,8,12,17). sayovelTao azriT, prognozis ZiriTad faqtorad operaciuli Carevis moculoba iTvleba (7,15), magram avtorTa umravlesoba simsivnis diferenciaciis xarisxs miiCnevs mniSvnelovan damoukidebel, mkurnalobis ganmsazRvrel damatebiT kriteriumad (5,13). recidivis ganviTarebis sixSire pirveladi simsivnis diferenciaciis xarisxzea damokidebuli, Tumca es maCvenebeli, sxvadasxva avtoris monacemidan gamomdinare, sagrZnoblad gansxvavebulia,

rac, albaT, unda aixsnas simsivnis diferenciaciis xarisxis gansazRvris subieqturi faqtoriT (16,18). meningiomebis diferenciaciis xarisxis gansazRvraSi prioriteti eniWeba histologiur parametrebs sxvadasxva kombinaciiT. avtorTa umravlesobas miaCnia, rom simsivnis mitozur aqtivobas aqvs didi mniSvneloba, rac dadasturda rogorc univariaciuli, ise multivariaciuli analiziT (4,9). simsivnis anaplaziis xarisxis obieqtur kriteriumad Tvlian mitozis mdgomareobaSi myofi ujredebis raodenobriv gansazRvras, rac asaxulia janmrTelobis dacvis msoflio organizaciis mier 2000 da 2007 wels mowodebul klasifikaciaSi, magram am sakiTxTan mimarTebaSi sxvadasxva avtoris mosazreba erTmaneTs yovelTvis ar emTxveva. isini araerTgvarovnebiT xasiaTdeba (16,18), rac, rogorc Cans, unda aixsnas daTvlis teqnikuri mxaris, mxedvelobis velis zomebis, raodenobisa da, SesaZlebelia, mkvlevarTa kompentenciis doneebs Soris gansxvavebiT (20.). meningiomis diferenciaciis xarisxis gansazRvris mizniT, Cven gamoviyeneT i. alovis mier mowodebuli mitozuri indeqsis gansazRvris meTodis sakuTari modifikacia (1,2), romelic saSualebas iZleva obieqturad Sefasdes meningiomis diferenciaciis xarisxi, ganisazvros misi klinikuri mimdinareoba, risi codnac aucilebelia mkurnalobis racionaluri meTodebis SemuSavebisaTvis. Sromis mizans warmoadgenda meningiomebis recidivis ganviTarebis vadebis

36

mitozis mdgomareobaSi myofi ujredebis raodenobasa da mitozur indeqsTan damokidebulebis Seswavla. gamovikvlieT p. sarajiSvilis saxelobis nevrologiis institutSi 1987-90 ww. warmoebuli intrakraniuli meningiomebis totaluri rezeqciis SemTxvevebi, gavaanalizeT avadmyofobis istoriaSi arsebuli onkologiuri TvalsazrisiT saintereso monacemebi, SevkribeT naoperaciebi avadmyofebis katamnezi zemoxsenebuli simsivneebis recidivebis gamosavlenad. Cven mier Seswavlilia morecidive meningiomebis 46 SemTxveva.avadmyofebs Soris 25 (54,3%) iyo mamakaci da 21 (45,7%) qali. morecidive meningiomebi pirveladi simsivnis diferenciaciis xarisxis mixedviT ganawilda Semdegnairad: keTilTvisebiani da atipuri - 15-15 SemTxveva (32,6%), anaplaziuri - 16 SemTxveva (34,8%). morecidive keTilTvisebiani meningiomebiT daavadebuli 15 avadmyofidan 6 (40,0%) iyo mamakaci, 9 (60,0%) qali, atipuri meningiomiT - 15 SemTxvevidan 7 (46,7%) mamakaci, 8 (53,3%) qali, xolo anaplaziuri meningiomiT - 16 SemTxvevidan 12 (75,0%) mamakaci, 4 (25,0%) - qali. meningiomebis diferenciaciis xarisxis sqesTan damokidebulebis SeswavliT gamovlinda, rom keTilTvisebiani meningiomebiT avadmyofebidan 27,5% iyo mamakaci, xolo 72,5% _ qali. atipuri meningiomebi 36,7%-Si aReniSneboda mamakacebs, 63,3%-Si ki _ qalebs, xolo anaplaziuri meningiomebi 48,6%-Si _ mamakacebs da 51,4%-Si _ qalebs. operaciuli masalis Seswavlis safuZvelze meningiomebis diferenciaciis xarisxi isazRvreboda janmo-s mier mowodebuli klasifikaciis mixedviT, romelSic gamoyofilia meningiomebis 3 jgufi: keTilTvisebiani (klasikuri), atipuri da anaplaziuri. intrakraniuli meningiomis TiToeul SemTxvevaSi mitozuri figurebis daTvla warmoebda SemTxveviTi naWrebis, Warbujreduli anaTlebis 10 SemTxveviT mxedvelobis velSi. viTvlidiT ujredebis saerTo raodenobas da mitozis ama Tu im fazaSi myofi ujredebis ricxvs. miRebuli monacemebis safuZvelze vsazRvravdiT mitozur indeqss (mitozis mdgomareobaSi myofi ujredebis raodenoba 1000 simsivnur ujredze) Semdegi formulis gamoyenebiT: MI = 1000 M/ N (%), sadac MI - mitozuri indeqsia, M - mitozis mdgomareobaSi myofi ujredebis raodenoba, xolo

N - imave 10 velSi ujredebis saerTo raodenoba. morecidive simsivneebisaTvis mitozuri aqtivobis damaxasiaTebeli sidideebis maCveneblebi sakmaod did farglebSi meryeobs: M meningiomebisaTvis, romelTa recidivis ganviTareba Cven mier iyo gamovlenili, meryeobda 3-dan 28-mde da saSualod Seadgina 7,484,89; imave 10 velSi N meryeobda 600-dan 3600 ujredamde (saSualod 1166544 ujredi); MI meryeobda 3,22dan 21,87-mde (saSualod 6,553,25). morecidive meningiomebis Cven mier Seswavlil SemTxvevebSi mitozis mdgomareobaSi myofi ujredebis raodenoba Warbi ujredulobis mqone 10 SemTxveviT mxedvelobis velSi keTilTvisebian meningiomebisaTvis meryeobda 3-dan 5-mde da saSualod Seadgina 3,870,50, imave 10 velSi ujredebis saerTo raodenoba meyeobda 617-dan 1240 ujredamde - saSualod 878210 ujredi, xolo mitozuri indeqsi meryeobda 3,22-dan 7,03-mde da saSualod Seadgina 4,591,01. morecidive simsivneebis atipur formebSi mitozis mdgomareobaSi myofi ujredebis raodenoba momatebuli ujredulobis mqone 10 SemTxveviT mxedvelobis velSi meryeobda 5-dan 11-mde da saSualod Seadgina 6,872,19. imave 10 velSi ujredebis saerTo raodenoba meryeobda 600-dan 1970 ujredamde - saSualod 1109408 ujredi, mitozuri indeqsi meryeobda 4,0- dan 10,78-mde da saSualod Seadgina 6,652,13, xolo morecidive anaplaziur meningiomebSi mitozis mdgomareobaSi myofi ujredebis raodenoba momatebuli ujredulobis mqone 10 SemTxveviT mxedvelobis velSi meryeobda 5-dan 28-mde da saSualod Seadgina 11,445,99. imave 10 velSi ujredebis saerTo raodenoba meyeobda 698-dan 3600 ujredamde - saSualod 1490660 ujredi, xolo mitozuri indeqsi meryeobda 3,5-dan 21,87-mde da saSualod Seadgina 8,294,30. morecidive meningiomebiT mamakacebSic M da MI (9,125,97 da 7,473,88) ufro maRalia, vidre qalebSi (5,521,74 da 5,461,72). amasTan, Cvens masalaze morecidive simsivneebSi rogorc mitozis mdgomareobaSi myofi ujredebis raodenoba, ise mitozuri indeqsi farTo farglebSi meryeobs da qveda zRvari warmoadgens 3 mitozis mdgomareobaSi myof ujreds (mitozuri indeqsi 4,86) da mitozur indeqss 3,22 (mitozis mdgomareobaSi myofi ujredebis raodenoba _ 4). Cveni gamocdilebidan gamomdinare, simsivnis diferenciaciis xarisxis gansazRvrisas, rodesac momatebuli ujredulobis 10

37

mxedvelobis velSi mitozis mdgomareobaSi myofi ujredebis raodenoba 3 da metia, gaTvaliswinebuli unda iyos mitozuri indeqsic. Tu es ukanaskneli 3,22 an ufro metia, recidivis ganviTareba aris mosalodneli. morecidive meningiomebs Soris umetesoba (27 SemTxveva) iyo dorzaluri lokalizaciis (morecidive meningiomebis saerTo raodenobis 58,7%), napralis meningiomebma (13 SemTxveva) Seadgina morecidive meningiomebis saerTo raodenobis 28,3%, xolo bazaluri lokalizaciis (6 SemTxveva) - morecidive meningiomebis saerTo raodenobis 13,0%. morecidive meningiomebi recidivis ganviTarebis vadebis mixedviT ganawilda Semdegnairad: operaciis Semdeg 1 wlamde - 15 SemTxveva, maT Soris 7 mamakacia, 8 qali; 2 wlamde - 6 SemTxveva, yvela mamaka-

cia; 3 wlamde - 4 SemTxveva, maT Soris 1 mamakacia, 3 qali; 4 wlamde - 2 SemTxveva, mamakaci da qali; 5 wlamde - 5 SemTxveva, yvela qali; 5 welze met vadaSi (20 wlamde) - 14 SemTxveva, maT Soris 8 mamakacia, 6 - qali. miRebuli monacemebis statistikuri damuSavebiT gamovlinda, rom recidivis ganviTarebis vada ukuproporciulad sarwmunod aris damokidebuli mitozis mdgomareobaSi myofi ujredebis raodenobasa da mitozur indeqsze. amrigad, intrakraniuli meningiomis totaluri rezeqciis SemTxvevaSi, recidivis ganviTarebis prognozis gansazRvrisas, aucileblad unda iqnas gaTvaliswinebuli simsivnis mitozuri aqtivobis maCveneblebi, rac, Tavis mxriv, unda gaxdes operaciis Semdgomi optimaluri mkurnalobis safuZveli.


., ., ., .
. . , . .

. . , , , , .

DEPENDENCE OF INTRACRANIAL MENINGEOMAS RELAPSES TERMS FROM MITOTIC ACTIVITY OF THE TUMOR
T. Mermanishvili, G. Chachia, E. Khitarishvili, T. Jorbenadze
Determination of biological behavior of tumors is one of the most important questions in practical oncology. As regards to intracranial meningeoma it presumes the search of objective criterions of tumor relapses prognosis. The results of conducted trial testify, that the terms of intracranial meningeomas relapses in the case of their total resection are statistically reliable in inversely proportional dependence to the mitotic activity of the tumor (p<0,05), that should be taken into consideration with determination of post-operative period tactics.

38

literatura:
1. mermaniSvili t., SaqariSvili r. - mitozuri indeqsis mniSvneloba Tavis tvinis meningiomebis diferenciaciis xarisxisa da recidivebis prognozis gansazRvraSi// quTaisis samedicino Jurnali.- 1999.- N1-2, 122-6. 2. jorbenaZe T., mermaniSvili t. - intrakraniuli meningiomebis warmoSobisa da recidivis ganviTarebis damokidebuleba simsivnis diferenciaciis xarisxze. saqarTvelos samxedro samedicino akademiis macne, 2:12-14, 2000. 3. Analysis of the influens of the variable size on the characteristics and behaviour of meningiomas/ Mascarenhas L., et al.// Neurocirurqia (Astur).-2005- N16(6).-P.486-91. 4. Boker D.-K., Meurer H., Gullotta F. Recurring intracranial meningiomas. Evaluation of some factors predisposing for tumor recurrence. // J.Neurosurg. Sci.- 1985.- N29.- P.11-17. 5. Central nervous system meningiomas in the first two decades of life: a clinicapathological analysis of 87 patients/ Rushing EJ, Olsen C., Mena H., et al.// J Neurosurg.- 2005.- N103(6).- P.489-95. 6. Diagnostic and prognostic significans of genetic regional heterogenelity in meningiomas/ Pfisterer WK et al.// Neuro-oncol .- 2004 - N6(4) .- P.290-0. 7. Factors affecting operative and excess long-term mortality in 935 patients with intracranial meningioma./ Kallio M., Sankila R., Hakulinen T., Jaaskelainen J.// J. Neurosurg.-1992.- N31.- P.2-12. 8. Genetic and epigenetic alterations of the NF2 gene in sporadic meningiomas/ Lomas J., Bello MJ, Arjona D., et al.// Genes Chromosomes Cancer.- 2005.- N42(3).- P.314-9. 9. Histopathologic indicators of recurrence in meningiomas: correlation with clinical and genetic parameters/ Kim YJ, Ketter R., Henn W., et al.// Virchov Arch.- 2006.- N449(5).- P.529-38. 10. Histological pattern of central nervous system neoplasms / Ahmed Z., Muzaffar S., Kajani N., et.al.// J. Pak Med assoc -2001 N 51(4) P.154-7. 11. Jellinger K., Slowik F. Histological subtypes and prognostic problems in meningiomas. // J. Neurol. 1975.- N208.- P.279-98. 12. Intracranial meningiomas of Chilhood and adolescence/Tufan K, Doguli F, Kurt G, et al.// Pediatr Neurosurg.- 2005.- N41(1).- P.1-7. 13. Lohmann CM, Brat DJ. A conceptual shift in the grading of meningiomas// Adv anat Pathol.- 2000.N7(3).- P.153-7. 14. Long-term survival of 1986 patients with intracranial meningioma diagnosed from 1953 to 1984 in Finland./ Sankila R., Kallio M., Jaaskelainen J., Hakulinen T.// Cancer.- 1992.- N70.-P.1568-75. 15. Loss of tumor suppressor in lung cancer-1 (TSLC1) expression in meningioma correlates with increased malignancy grade and reduced patient survival/ Surace EI, Lusis E., Murakami Y., et al.// J Neuropathol Exp Neurol.- 2004.-N63(10).- P.1015-27. 16. Louis D.N., Budka H., von Deimling A. Meningiomas // Tumors of the nervous system. Eds. by P. Kleihues, W.Cavenee .- Lyon, 1997.- P.134-141. 17. Microarray-based gene expression profiling of benign, atypical and anaplastic meningiomas identifies novel genes associated with meningioma progression/ Wrobel G., Roerig P., Kokocinski F., et al.// Int J Cancer.2005.- N114(2).- P.249-56. 18. Pathology and genetics of tumours of the nervous system. World Health Organization classification of tumours /Kleihues P, Cavenee WK, eds// Lyon, France: IARC Press, 2000. 19. Perry A., Gutman DN, Reifenberg G. Molecular pathogenesis of meningiomas./ J Neurooncol.- 2004.N70(2).-P.183-202. 20. The mitosis-specific antibody anti-phospho-histone-H3 (pHH) facilitates rapid relable grading of meningiomas according to WHO 2000 criteria/ Ribalta T, et al.// Am J Surg Pathol, 2004.-N28(11). P.1532-6.

39

eqsperimentuli medicina

kunelis flavonoidebis moqmedeba eqsperimentuli aTerosklerozisas


S. tukvaZe, g. grigoraSvili
Tbilisis saxelmwifo samedicino universiteti, g. naTaZis saxelobis sanitariisa da higienis samecniero-kvleviTi instituti

(recenzenti profesori m. fircxalava)

gul-sisxlZarRvTa daavadebebi _ aTerosklerozi, gulis iSemiuri daavadeba, farTod gavrcelebulia da kvlav rCeba erT-erT mniSvnelovan problemad saxelmwifo, socialuri da samedicino struqturebis sferoSi (1-2,11). am daavadebebis paTologiuri meqanizmebis Seswavla, maTTan arsebuli ZiriTadi metaboluri darRvevebis koreqciis axali gzebis moZieba medicinaSi prioritetul mimarTulebad iTvleba. ukanasknel wlebSi klinikis pirobebSi mravali farmakologiuri saSualeba gamoiyeneba, rac SesaZleblobas iZleva arsebiTad gaizardos aTerosklerozis mkurnalobis efeqturoba. maT xangrZliv gamoyenebas, gansakuTrebiT qronikuli daavadebebisas, xSiri gamwvavebebiT, xSirad Tan axlavs Tanmdevi movlenebi, romlebic ara marto amcirebs Terapiul efeqts, aramed zogjer axali paTologiuri mdgomareobis warmoqmnas iwvevs. am garemoebam specialistebis mkurnalobis aramedikamenturi xerxebis mimarT gazrdili interesi ganapiroba, romlebic dafuZnebulia bunebrivi faqtorebis gamoyenebaze da arsebiTad gamoricxavs arasasurvel Semdgom movlenebs (8). sadReisod gul-sisxlZarRvTa sistemis daavadebebis mkurnaloba da profilaqtika did interess iwvevs flavonoidebis moqmedebis SeswavlaSi (6, 12). flavonoidebi _ bunebrivi, biologiurad aqtiuri fenoluri naerTebis jgufia. amJamad, dadgenilia rom flavonoidebi farmakologiuri moqmedebis farTo diapazoniT xasiaTdeba.

flavonoidebisadmi miZRvnili mravali naSromidan Cans, rom es nivTierebebi warmatebiT SeiZleba gamoyenebuli iyos aTerosklerozis, spazmolituri anTebis sawinaaRmdego, diuretuli, antimikrobuli da sxva samkurnalo saSualebebis saxiT. flavonoidebi mcenareuli qsovilebis aucilebeli komponentia da mudmivad Sedis adamianis organizmSi sakvebidan. mcenareuli qsovilebis Semcveli flavonoiduri naerTebi endogenuri antioqsidantebis rols asrulebs (5). flavonoidebis kardioproteqtoruli efeqti lipidur speqtrze aixsneba maTi keTilsasurveli gavleniT, sisxlis Sededebasa da vazomotorul tonusze. zog eqsperimentSi naCvenebia, rom flavonoidebi pasuxs agebs maT hipoqolesterinemul efeqtze (10, 13). mraval avtors miaCnia, rom flavonoidebis antiaTerogenuli moqmedeba dakavSirebulia lipidebis zeJanguri Jangvis procesebis inaqtivaciiT, maTi inhibitorebis saxiT, rogorc uSualo monawileobiT, aseve rkinis SeboWviT, ris Sedegad rkinis monawileoba lipidebis JangviT procesebSi mcirdeba. flavonoidebis maRali SemcvelobiT xasiaTdeba samkurnalo mcenare _ kuneli, romlis nayofi mSral wonaze gadaangariSebiT 200-350 mg % flavonoidebs Seicavs (10). samuSaos mizans warmoadgenda _ kunelis nayofidan misi gadamuSavebis Sedegad miRebul flavonoidebis jamur preparatSi ZiriTadi nivTierebis gansazRvra da am

40

preparatis moqmedebis Seswavla eqsperimentuli aTerosklerozisas. masala da meTodebi _ kunelidan flavonoidebis jamuri preparatis miRebas vawarmoebdiT Cven mier damuSavebuli meTodiT. miRebul preparatSi ganvsazRvreT flavonoidebis raodenobrivi Semcveloba maRalefeqturi Txevadi qromatografiis meTodiT (9). kunelis flavonoidebis danamatis moqmedebis Seswavlis mizniT, eqperimenti CavatareT laboratoriul cxovelebze aTerosklerozis eqsperimentuli modelis SeqmniT. eqsperimenti CavatareT 60 ujiSo TeTr virTgvaze sawyisi masiT 100,0 5,0 g. cxovelebi dayofili iyvnen 6 jgufad (TiTeoulSi 10 virTagva). virTagvebis I-jgufi (sakontrolo) ikvebeboda vivariumis saerTo racioniT, romelic Seicavda yvela ZiriTad sakveb ingredients im raodenobiT da SefardebiT, romelic aRiarebulia optimalurad mocemuli saxeobis cxovelisaTvis (7). I -jgufi ikvebeboda imave racioniT da amasTan, yoveldRiurad zondis meSveobiT cxovelebSi Segvyavda qolesterinis 10%-iani xsnari mzesumziris zeTSi 0,25 g-is raodenobiT cxovelis 1 kg masaze gaangariSebiT cxovelebis IV, V da VI-jgufebSi. cxovelebSi Segvyavda qolesterinis xsnari mzesumziris zeTSi imave raodenobiT da damatebiT kunelidan gamoyofili flavonoidebis preparati Sesabamisad 10,20 da 30 mg cxovelis 1 kg masaze gadangariSebiT. cdis xangrZlivoba Seadgenda 120 dRes. dinamikaSi cdis dasawyisSi da dasasruls (120 dRis Semdeg) virTagvebis sisxlSi vsazRvravdiT saerTo qolesterinis raodenobas (4). miRebuli Sedegebi da maTi ganxilva kunelis nayofidan Cven mier gamoyofil preparatSi flavonoidebis gansazRvris Sedegad dadgenilia, rom igi Seicavs 250 mg % am nivTierebas, rac sawyis nedleulSi Semcveli flavonoidebis saerTo raodenobis 80%-s Seadgens. miRebuli preparatis biologiuri aqtivobis Seswavlas vawarmoebdiT eqsperimentiT TeTr virTagvebze. cdis Sedegebi warmodgenilia cxrilSi. rogorc cxrilis monacemebidan Cans, sakontrolo jgufis cxovelebis sisxlSi cdis periodSi saerTo qolesterinis raodenoba statistikurad sarwmunod ar icvleboda, maSin rodesac me-II jgufSi am maCveneblis raodenoba izrdeboda

(13,4%-iT), rac mzesumziris zeTSi qolesterinis SemcvelobiTaa gamowveuli. cxovelebis IV-jgufSi, romlebic cdis periodSi iRebdnen qolesterinis xsnars mzesumziris zeTSi es maCvenebeli arsebiTad izrdeboda da Seadgenda 14,3 0,58 mmol/ l-ze. cxovelebis im jgufebSi, sadac qolesterinTan erTad damatebiT Segvyavda kunelis nayofidan miRebuli flavonoidebis preparati, cdis bolos saerTo qolesterinis Semcveloba sisxlSi mniSvnelovnad mcirdeboda da igi Sesabamisad 33,0; 50,0 da 58%-s Seadgenda. I -jgufSi gansazRvruli am maCveneblis mimarT. aRniSnuli monacemebi kunelis flavonoidebis preparatis mkveTrad gamoxatul hipoqolesterinemul (qolesterindamwev) moqmedebaze miuTiTebs. cxrilis monacemebidan gamomdinare dadgenilia pirdapirproporciuli damokidebuleba kunelis flavonoidebis preparatis koncentraciasa da cxovelebis sisxlis SratSi saerTo qolesterinis Semcvelobas Soris. kunelis flavonoidebis preparatis yoveldRiurad maqsimaluri koncentraciiT (30 mg/kg-ze) miRebisas Sesabamisad adgili hqonda cxovelebis sisxlis SratSi saerTo qolessaerTo qolesterinis Semcveloba (mmoli/l) TeTri virTagvebis sisxlSi kunelis flavonoidebis miRebisas (eqsperimentSi) _ (M m)
cxovelebis jgufi I-(sakontrolo) IIIIIIV V VI saerTo qolesterinis raodenoba sawyisi 120 dRis monacemebi Semdeg

4,0 0,6 3,96 0,1 4,1 0,33 3,8 0,5 3,9 0,6 4,0 0,3

4,4 0,4 4,99 0,69 14,3 0,58 9,59 0,62 7,2 1,29 6,04 0,27

terinis koncentraciis maqsimalur Semcirebas (58,0%-iT). Catarebuli gamokvlevebis Sedegad miRebuli monacemebi saSualebas gvaZlevs davaskvnaT, rom kunelis nayofSi Semcveli flavonoidebi zemoqmedebas axdens cxovelebis lipidur cvlaze da mis arsebiT koreqcias ganapirobebs.

41


. , .
. . . ,

, . - 250,0 %. 60 . , ( 33,0; 50,0 58%). . , .

STUDY OF HAWTHORN FLAVONOIDS IN EXPERIMENTAL ATHEROSCLEROSIS


SH. TUKVADZE, G. GRIGORASHVILI
The medicine containing flavonoids is extracted from the how fruit. The amount of flavonoids (25,0 mg%) in the medicine is determined by ,,High performance liquid chromatography. The effect of the medicine is studied during the experiment performed on 60 outbreed rats. It has been estimated and statistically proven that hawthorn causes general cholesterol level decrease in blood serum. (33,0; 50,0 and 58% respectively). No valid changes of given indicators have been revealed in the controlled group of animals. The results of study testify the fact that hawthorn flavonoids substantially improve the lipid spectrum of the body, and reveal hypocholesterinemic effect.

literatura:
1. . . , 1996.- 3.- . 18 -22. 2 . . ., . . .- 1995.- 2.- . 20-26. 3. . . , 1991. .: , 80 . 4. . ., . . . . .: . -1995. - 188 . 5. .., .., .. .-1996.- 2.- . 33-38. 6. .., . ., . . .- 2000.-5.- . 43-51. 7. .. // .-1982.-4.-. 63-67. 8. . ., . ., . . .- 2000.- 9.- . 40-46. 9. ., ., . . .: , 1997. 10. Christofer D. Farndner a A, Katrin A. effect of soi protein and phitoestrogen intake of plasma lipids in hypercholesterinemic postmenopausal women. third international symposium on the role Preventing and Treating Disease. Washington, 1999, p. 16.18. 11. Thomas B., Clarson A. Isoflavones the hypocholesterinemic componenetes. third international Symposium in the role preventing and treating Disease. Washington, 1999,p.120-122. 12. Federal a register. Pt2. Department of Healthand Human. Services, Food and drug Administration. 1999, v 64, p. 122-127. 13. Rob S, Tailer D. nutr. Res. int. 1998, v.30, p. 719-729.

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werili redaqcias

sruliad saqarTvelos kaTolikos-patriarqs, uwmindessa da unetaress, ilia meores

Tqveno uwmindesobav! didi mowiwebiTa da pativiscemiT mogaxsenebT, rom Cveni TanamSromlebis ZalisxmeviT, unikaluri saarqivo masalebis moZiebiT dadginda, rom Cveni saavadmyofo dafuZnebulia rogorc wminda andria pirvelwodebulis saxelobis monasteri-lazareTis kompleqsis ganuyofeli nawili da aSenebulia ruseTis ukanaskneli mefis nikoloz meoris dedis, maria feodorovnas mier. amis wyalobiT, Cveni saavadmyofo, eklesiasTan erTad, gadaurCa auqcionze gayidvas, gadaeca saqarTvelos sapatriarqos da dRes igi funqcionirebs Tavisi pirvandeli daniSnulebisamebr, rogorc wminda andria pirvelwodebulis saxelobis metad popularuli eklesia da sakmaod warmatebuli saavadmyofo eqimTa daxelovnebis erT-erTi mZlavri kera saqarTveloSi. umorCilesad gTxovT, bolomde aRsruldes istoriuli samarTlianoba da sapatriarqos mfarvelobis qveS, Cveni SromiT, mrevlis mxardaWeriTa da SemowirulobebiT movawyoT, ganvaaxloT, ganvaviTaroT igi da vaqcioT sanimuSosaCvenebel saeklesio (wminda andria pirvelwodebulis saxelobis) saavadmyofod, rac metad gavrcelebuli simbiozia mTel msoflioSi da yvelasTvis iqneba sasurveli: uflisTvis, eklesiisTvis, mrevlisTvis, avadmyofebisTvis, eqimebisTvis, mTeli saqarTvelosTvis. gfaravdeT RmerTi! yofili me-9 saavadmyofos TanamSromelTa saxeliT, profesori Tamaz SioSvili

redaqciisagan: pativi gvaqvs redaqciis TanamSromelTa da Cveni qveynis mravalricxovan qarTvel medikosTa saxeliT mokrZalebiT SevuerTdeT werilSi moyvanil Txovnas mimarTuls qarTveli xalxis sulieri mamis, misi uwmindesisa da unetaresis, ilia meorisadmi. Cveni qveynis mravalsaukunovani istoriis manZilze eklesiis msaxurTa mier xalxis sulieri da fizikuri janmrTelobis sasargeblod gaweuli humanuri tradiciebi kvlavac saxelovnad grZeldeba da imeds gamovTqvamT, rom miRebuli gadawyvetileba xels Seuwyobs farTod gavrcelebuli daavadebebis Semcirebas da saSualebas miscems maT daubrundnen sasargeblo sazogadoebriv saqmianobas.

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sportuli medicinis satkivari


masobrivi sporti erT-erTi mTavari saSualebaa, romelic ganapirobebs mosaxleobis gajansaRebas. sporti da fizikuri aRzrda uzrunvelyofs adamianis fizikur ganviTarebas, Sromisunarianobis amaRlebasa da sicocxlis gaxangrZlivebas. sportis ganviTareba gulisxmobs sportis sxvadasxva saxeobis maRali klasis sportsmenebiT dakompleqtebas da adgilobriv da saerTaSoriso sportul RonisZiebebSi monawileobis miRebas, rasac saxelmwifoebrivi mniSvneloba aqvs. Cvens qveyanaSi sportis ganviTarebis mniSvnelovan xelSemwyob RonisZiebad iTvleba sxvadasxva tipis sportuli bazebis masobrivi mSenebloba. sadReisod, bevri sxvadasxva asakis adamiani organizebulad Tu individurad eweva fizikur varjiSs, wvrTnas, rac, samwuxarod, yovelgvari samedicino meTvalyureobis gareSe xdeba. xangrZlivad daZabuli kunTuri muSaoba organizmis saTanado fizikur mdgomareobas saWiroebs, romlis dadgenac mxolod specialuri samedicino gamokvlevebiT xorcieldeba. evropis qveynebSi uamravi fitnes klubi funqcionirebs (rac CvenSic mravladaa), sadac, Cvengan gansxvavebiT, winaswari saeqimo Semowmebis gareSe savarjiSod aravin daiSveba. marTalia, zogierTi nakrebi gundis wevrebi Tanamedrove doneze gadian samedicino Semowmebas, magram zogjer dabali klasifikaciisa da damwyeb sportsmenebs saeqimo kontrolis gareSe uxdebaT varjiSi. saqarTvelos sportis medicinis samsaxuri mTel msoflioSi erT-erTi mravalprofiliani iyo Tavisi centrebiT (maSin respublikaSi 10 saeqimo fizkulturis dispanseri funqcionirebda). axla aseT dawesebulebas mxolod Tbilisis z. Telias saxelobis sprotuli medicinisa da reabilitaciis centri warmoadgens. marTalia, centrs gaaCnia Senoba, aqvs saTanado kabinetebi, hyavs sportis medicinaSi licenzirebuli eqimebi, laboratoria da reabilitaciis ganyofileba, magram aRar aqvs saxelmwifos mier damtkicebuli programebi. centri, mZime ekonomikuri krizisis gamo, ver uzrunvelyofs sportsmenTa im masStabis samedicino momsaxurebas, risi potencialic sinamdvileSi gaaCnia. programebis dafinansebis da axali debulebis damtkicebis SemTxvevaSi an, Tu es dawesebuleba saxelmwifo biujetze iqneba gadayvanili, centri mTlianad ganaxorcielebda rogorc Tbilisis sportsmenTa, ise regionebidan Camosuli nakrebi gundebis wevrebis samedicino momsaxurebas. sportsmenebi savaldebulo wesiT unda isinjebodnen weliwadSi erTxel mainc (sasurvelia orjer), xolo kvalificiuri sportsmenebi unda imyofebodnen dinamikuri samedicino meTvalyureobis qveS. Secdoma iyo, rodesac sprotsmenTa Semowmeba xdeboda poliklinikaSi, radgan iq ar arian sportul medicinaSi licenzirebuli eqimebi. sportis eqimebs ki SeuZliaT gamoavlinon sportuli paTologiebi, romelic xSirad farulad mimdinareobs. misi gamovlena ki xdeba specialuri funqciuri sinjebisa da datvirTvis gamoyenebis Sedegad. sportuli paTologiebis drouli gamovlineba Tavidan agvacilebs sportsmenTa sikvdilianobas, rasac, samwuxarod Cvens sinamdvileSi araerTxel hqonda adgili. mizanSewonilad migvaCnia, rom janmrTelobis dacvisa da sportis xelmZRvanelma organoebma gaiTvaliswinon yovelive zemoaRniSnuli da droulad aRmouCinon daxmareba Tbilisis sportuli medicinisa da reabilitaciis centrs.

m. xoferia Tbilisis sportuli medicinisa da reabilitaciis centris direqtori, z. kaxabriSvili saqarTvelos sportuli medicinis asociaciis prezidenti, medicinis mecnierebaTa doqtori, m. ruxaZe profesori, r. svaniSvili profesori.

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saiubileo TariRi

Rirseuli mecnieri da mamuliSvili

dabadebidan 85 weli Seusrulda saqarTveloSi sportuli medicinis erT-erT damfuZnebels, cnobil mkvlevars, pedagogs, sazogado moRvawes, warsulSi saqarTveloSi sportis medicinis federaciis sapatio Tavmjdomaresa da Tbilisis saxelmwifo sportuli akademiis medicinis kaTedris gamges, fizkulturisa da sportis damsaxurebul moRvawes, saqarTvelos damsaxurebul eqims, medicinis mecnierebaTa doqtors, profesor zaqaria Telias. cxovrebisa da mecnieruli SemoqmedebiTi saqmianobis samagaliTo gza ganvlo batonma zaqariam. mTeli cxovrebis manZilze iRvwoda saqarTveloSi sportuli medicinis ganviTarebis, sportsmenTa janmrTelobis ganmtkicebis, am dargSi Rirseuli samedicino kadrebis aRzrdisa da daxelovnebisaTvis. batoni zaqaria daibada 1923 wels samtrediaSi cnobili pedagogebis ojaxSi. saSualo skolis warCinebiT damTavrebis Semdeg, swavla ganagrZo Tbilisis saxelmwifo samedicino institutSi. axalgazrda niWierma, energiulma studentma Tavi gamoiCina swavlasa da organizaciul saqmianobaSi. is gaxda samedicino institutis axalgazrdobis Tavkaci, xolo Semdgom 1946-50 wlebSi Tbilisis erT-erTi raionis komkavSiris raionuli komitetis pirveli mdivani. 1950 wlidan moyolebuli sicocxlis bolomde man mTeli Tavisi codna, siaxlisadmi Ziebis daucxromeli unari, SemoqmedebiTad daukavSira saqarTveloSi sportuli medicinis samsaxuris Camoyalibebasa da mis Semdgom ganviTarebas.

1952 wlidan is yofili sabWoTa kavSiris kalaTburTel vaJTa nakrebis, xolo 1953 wlidan Tbilisis `dinamos~ fexburTelTa gundis samedicino samsaxurs xelmZRvanelobda. batonma zaqariam Tavis sadisertacio naSromSi, pirvelma saqarTveloSi, warmoadgina muxlis saxsris travmuli dazianebebis kompleqsuri mkurnalobis originaluri meTodi, romelic farTod dainerga da dResac ar daukargavs Tavisi mniSvneloba saerTaSoriso masStabiT. is mravali samecniero-praqtikuli naSromisa da 5 monografiis avtoria. 2001 wels mas mieniWa XX saukunis #1 sportuli eqimis sapatio wodeba, dajildoebuli iyo Rirsebis ordeniT, flobda umaRlesi ligis sportuli fexburTis jildoebs. kerZod: 2 oqros medals, orgzis ssrk Tasis da evropis Tasis mflobelTa Tass, miRebuli hqonda mravali saerTaSoriso da respublikuri jildo. Tbilisis meriis gadawyvetilebiT, misi saxelis ukvdavsayofad, saxls, romelSic is cxovrobda, gaukeTda memorialuri dafa, Tbilisis sportuli medicinisa da reabilitaciis centrs mieniWa misi saxeli, xolo friadosani sportsmeni studentebisaTvis dawesda zaqaria Telias saxelobiTi stipendia. batoni zaqaria iyo keTilSobili pirovneba da WeSmariti mamuliSvili, maRali zneobis matarebeli moqalaqe da patrioti, romelic sicocxlis bolomde erTgulad emsaxura qarTul sportul medicinas. vaxtang gaCeCilaZe

45

saiubileo TariRi

Cemi Taobis sasiqadulo mamuliSvili

TbilisSi, saburTalos sasaflaos centraluri gzis dasawyisSive, asiode nabijSi, marjvena mxris meore mwkrivSi labradoris granitiT mopirkeTebul myudro samarxs SeniSnavT, sadac Cveni Taobis saamayo mamuliSvili daviT kvaWaZe ganisvenebs. mxolod 54 weli dahyo amqveynad... cota icocxla, Tumca mainc bevri ram sasikeTo moaswro da waruSleli kvali datova samamulo medicinisa da kulturis istoriaSi. wels mas 80 weli Seusruldeboda... misi naTeli xsovnis aRsaniSnavad, mimdinare wlis 20 seqtembers, profesor daviT kvaWaZis dabadebidan 80 wlisTavis aRsaniSnavad Tbilisis saxelmwifo samedicino universitetis, saqarTvelos farmakologTa sazogadoebisa da iv.beritaSvilis saqarTvelos fiziologTa sazogadoebis erToblivi iniciativiT moewyo samecniero konferencia `eqsperimentuli da klinikuri medicinis miRwevebi~. konferenciaze iv.beritaSvilis saxelobis fiziologTa sazogadoebis prezidentis, akademikos vaJa okujavas, saqarTvelos farmakologTa sazogadoebis Tavmjdomaris, profesor givi Turmanaulis, amave sazogadoebis gamoCenili wevrebis prof. neli anTelavas, prof. niko gongaZis, prof. guram

beqaias mogonebebSi saxierad warmodgenil iqna am cxovrebidan udrood wasuli SesaniSnavi pirovnebis, gamorCeuli mkvlevarisa da pedagogis, mravali Taobis medikosTa aRmzrdelis, iSviaTi adamianuri da moqalaqeobrivi niSan-TvisebebiT dajildoebuli erisSvilis, baton daviT kvaWaZis damsaxureba erisa da qveynis winaSe. batonma daviTma, warCinebiT daamTavra a/k rkinigzis Tbilisis #1 saSualo skola, imave wels Cairicxa Tbilisis saxelmwifo samedicino institutis samkurnalo fakultetze, Semdeg ki institutSi moRvaweoba gaagrZela aspiranturaSi farmakologiis specialobiT. aspiranturis damTavrebisTanave, cnobili qarTveli mecnierisa da sazogado moRvawis, Tbilisis saxelmwifo samedicino institutis kaTedris gamgis, profesor grigol cqimanauris xelmZRvanelobiT daicva sakandidato disertacia, romelic mieZRvna metad seriozul da mniSvnelovan problemas - hemoragiuli Sokis farmakologiuri koreqciis meqanizmebis dadgenasa da praqtikul medicinaSi mis gamoyenebas. samecniero xarisxis miniWebisTanave, daiwyo axalgazrda mecnieris ganuxreli aRmasvla did mecnierebasa da pedagogikaSi. daviT kvaWaZis samecniero kvlevebis diapazoni metad farTo, xolo speqtri

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friad nairferovani gaxldaT, Tumca, misi originaluri da gansakuTrebiT araordinaruli kvlevebis mTavari mimarTuleba mainc, gul-sisxlZarRvTa sistemis funqciuri mdgomareobis paTologiuri gadaxrebis mowesrigebis gzebisa da prevenciuli kompleqsebis Ziebas mieZRvna. iSviaTi mecnieruli intuiciiT dajildovebuls, baton daviTs, ar akmayofilebda Sesaswavli problemebis mxolod ZiriTadi - farmakologiuri safuZvlebi, aramed, rogorc wesi, mkvlevari siRrmiseuli midgomiT azustebda paTologiis momijnave fundamentur aspeqtebsac paTofiziologiurs, bioqimiurs, biofizikursa da sxv. misi iSviaTi adamianuri Tvisebebi, uzomo kacTmoyvareoba aSkarad aisaxa mecnieris kvlevebis mimarTulebaSi: man gansakuTrebuli yuradReba miapyro adamianis sicocxlis gaxangrZlivebas, mizanmimarTulad azustebda farmakologiuri saSualebebis moqmedebas sisxlis mimoqcevis regulaciis centralur da periferiul struqturebze. metic, mecnierma Seqmna farmakologiaSi friadmniSvnelovani mimarTulebebis - gerontologiuri da geriatriuli farmakologiis safuZvlebi, mkvlevarma eqsperimentSi gansazRvra antiariTmiuli saSualebebis moqmedebis meqanizmebi asakis gaTvaliswinebiT. daviT kvaWaZem, pirvelad msoflio farmakologiaSi, miagno gansxvavebuli asakis cxovelebSi sagule glikozidebiT inducirebuli ariTmiebis mimdinareobebis Taviseburebebsa da maTi efeqturi mkurnalobis gzebs. mecnierma gamoavlina, rom xandazmuli asakis cxovelebTan SedarebiT, iuveniluri da axalgazrda asakis cxovelebSi glikozidebis moqmedebis Sedegad ganviTarebuli intoqsikaciis dros transmisiuli ariTmiebi Warbobs, xolo xandazmul asakSi ariTmiebs eqstrasistoluri da paroqsizmuli taqikardiis xasiaTi aqvT. mecnierma varaudi gamoTqva, rom zogierTi antiariTmiuli saSualeba (meqsiletini, tokainidi), SesaZlebelia, proariTmiuli Tvisebebisa iyos. parkuWTa eleqtruli sistolis xangrZlivobaze moqmedebis gziT. mecnieri ver moeswro am ideis brwyinvale dadasturebas, romelic mogvianebiT aRiarebuli iqna kardiologiaSi `torse da pointes~ saxelwodebiT, rac xSirad letalobis mizezs warmoadgens. friad mniSvnelovania, agreTve, mecnieris gamogoneba - `gulis ariTmiebis modelirebis meTodi~, ris gamoc mas 1979 wels

sakavSiro saavtoro mowmoba gadaeca, rac naTxemis dazianebis klinikamdeli diagnostikis meTods warmoadgens, igi win uswrebs specifikuri klinikuri niSnebis gamovlinebas da amiT xels uwyobs adreuli diagnostikisa da mkurnalobis dadebiT efeqts. sicocxlis bolomde batoni daviTi aqtiurad da dauRalavad eZiebda axal efeqtur gzebs adamianis yvelaze xSir da mZime daavadebasTan - gul-sisxlZarRvTa sistemis paTologiaTa prevenciisa da Terapiis speqtris gafarTovebisa da Sevsebis mizniT. xanmokle, magram ukiduresad gajerebuli cxovrebiT icxovra. moaswro sayovelTao siyvarulis, pativiscemisa da aRiarebis mopoveba. konferenciaze prof. guram beqaiam pirvelad amcno msmenelebs didi ivane beritaSvilis Canaweri-Sefaseba student daviT kvaWaZis gamocdis Semdeg, sadac axalgazrda ymawvili akademikosma gamorCeulad mcodne, niWier da perspeqtiul pirovnebad aRiara. am striqonebis avtors, maxsovs daviT kvaWaZis studenturi wlebi: moZravi, gulRia, metad kontaqturi. is pirvelive sityvebidan ipyrobda mosaubris guls. gamoirCeoda ubraloebiT da gulisxmierebiT, gansakuTrebuli kacTmoyvareobiTa da keTilsaimedoobiT. es SesaniSnavi adamianuri Tvisebebi ganpirobebuli iyo misi gamorCeuli Tandayolili bunebiT, Tumca, amis Sesaxeb, samwuxarod, mogvianebiT Sevityve sasuliero pirebisgan - maSin, rodesac batonma daviTma aqauroba miatova. Telavis RvTismSoblis taZris dekanozma mama anTimozma (anzor CageliSvilma) CemTan kerZo saubarSi gansakuTrebuli siTboTi, Tu rogori sayovelTao siyvaruliT iyo aRiarebuli daviT kvaWaZe Tavis mSobliur kuTxeSi - did jixaiSSi, sadac CasvlisTanave dauRalavad da gansakuTrebuli taqtiT mkurnalobda yvela Tanasoflels da daimsaxura `uvercxlo eqimis~ maRali wodeba. Semdgom ki daviT kvaWaZis iSviaT humanur da profesiul Tvisebebze saqarTvelos mitropolitisgan - meufe nikolozisgan (nikoloz maxaraZe) Sevityve, romelic, agreTve, icnobda baton daviTs axalgazrdobidanve da axlaxan davkrZaleT TbilisSi - wminda nikolozis saydarSi. meufe nikolozi gansakuTrebuli siTboTi axasiaTebda daviT kvaWaZis Tavmdablobasa da kacTmoyvareobas, sulierebasa da mokrZalebulobas.

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Rrmad mwams, rom swored am sulierebam ganapiroba Cvens madlier mexsierebaSi daviT kvaWaZis ukvdaveba misi pirovnuli, gamorCeuli TvisebebiT: profesiuli daucxromlobiT, dauRalavi mecnieruli ZiebiT, iSviaTi saTnoebiT, keTilmosurneobiTa da keTilsindisierebiT. rarig sasixaruloa da saamayo, rom misi erTaderTi memkvidre - profesori irine kvaWaZe saamayo erisSvilad dautova batonma daviTma uzomod sayvarel samSoblos. qalbatoni irine mamamisis kvalobaze fundamenturi medicinis wamyvan mimarTulebas - adamianis fiziologias Caudga saTaveSi. dRes igi xelmZRvanelobs Tbilisis saxelmwifo samedicino universitetSi adamianis fiziologiis departamentsa da sauniversiteto magistraturisa da doqtoranturis samsaxurs, Seadgina da gamosca ori gamocemiT `adamianis fiziologiis~ fundamenturi saxelmZRv-

anelo, sargeblobs sauniversiteto koleqtivis sayovelTao pativiscemiTa da siyvaruliT. ... iq ki - saburTalos sasaflaoze, batoni daviTi Tavisi SesaniSnavi winaprebis, ded-mamisa da maTi mSoblebis garemocvaSi ganisvenebs - adamianTa gverdiT, romlebmac memkvidreobiT gadasces TavianT sasiqadulo memkvidres uiSviaTesi adamianuri niSan-Tvisebebi. guli gvwydeba, rom esoden adre mogvatova, Tumca, `vinc uyvars, imas wvrTnis ufali~ (ebr. 12,6). metic, wminda mociquli pavle brZanebs: `marTali icocxlebs rwmeniT~ (ebr. 10,38). amitomacaa, rom dResac batoni daviTi CvenTvis kvlav cocxalicaa da marTalic. ... da uneblied am wminda, asketurad mokrZalebul saflavTan meufleba locva-vedreba: `Seiwyale, ufalo, suli monaTa da mxevalTa SenTa!..~

vadim saakaZe, profesori, saqarTvelos medicinis mecnierebaTa, medikur-biologiur mecnierebaTa, profilaqtikuri medicinis mecnierebaTa da afxazeTis mecnierebaTa akademiebis akademikosi

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gaxseneba

merab janeliZe

saqarTvelos samedicino sazogadoebrioba didi gulistkiviliT gamoeTxova cnobil medikos-mecniers, mTargmnels, moRvawes, pedagogs merab janeliZes. merab janeliZem 1960 wels daamTavra Tbilisis saxelmwifo samedicino instituti. damTavrebisTanave muSaoba daiwyo afxazeTSi gulrifSis tuberkulozis sawinaaRmdego sanatoriumSi qirurg-ordinatorad. 1963 wels man warmatebiT Caabara sakonkurso gamocdebi da miRebul iqna onkologiis samecniero-kvleviT institutSi onkoginekologis Tanamdebobaze. batonma merabma, profesor l. CarkvianTan da v. adamiasTan erTad, saSvilosnos yelis eroziebis, xolo r. CiqovanTan erTad, kibos gavrcelebis axali epidemiologiuri klasifikacia Seadgina. istoriul monacemebis safuZvelze, aRsaniSnavia baton merabis mier Sedgenili medicinis tipobrivi klasifikacia, romelic dayofilia racionalur zepir,

weriT, iracionalur, komplementur da alternatiul medicinad. mcenareTa fiziologiis dargSi, TanaavtorebTan erTad, man daamtkica iseTi receptorebis arseboba, romlebic moqmedebis gamomJRavnebiT cxoveluri receptorebis msgavsi an analogiuria. batonma merabma filtvebis tuberkulozis dros gulis paTologiis ori axali forma aRwera tuberkulozuri (toqsikuri) da iSemiuri (hipoqsiuri). i. quTaTelaZis saxelobis farmakologiis institutSi, akademikos v. asaTianTan erTad, man, eqsperimentSi, kibos ujredebSi gamoavlina birTvuli membranis paradoqsuli dajirjvebis fenomeni, aseve akademikos v. asaTianis monacemebze dayrdnobiT, man gamoavlina mTis zomieri simaRleebis dadebiTi efeqti dRegrZelobis statusze. profesor mixeil Sengelias TanadgomiT batonma merabma rusul enaze Targmna z. fanaskertel-ciciSvilis `samkurna-

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lo wigni karabadini~, romlis gamocemac mniSvnelovani movlena iyo erovnuli medicinis popularizaciis saqmeSi. sayurdReboa mis mier Seqmnili qarTveli eqimebis fici (hipokrates ficidan gamomdinare). baton merabs mravali narkvevi aqvs gamoqveynebuli gamoCenil adamianTa cxovrebisa da moRvaweobis Sesaxeb. batoni merabi, S. gogoxiasa da s. dalaqiSvilTan erTad, aqtiurad monawileobda afxazeTis dRegrZelTa fenomenis Semswavlel mravalwlian eqspediciaSi. man gamoaqveyna masalebi im medikosebis Sesaxeb, romlebic afxazeTidan sisxlismRvreli konfliqtis dros daiRupnen da im pirebis siebic, vinc, samxedro SenaerTeb-

Si separatistTa, imperiis mier waqezebul bandebs ebrZodndn. batonma merabma Seiswavla da Taviseburi interpretacia misca uZvelesi civilizaciebis lingvisturi sakiTxebisa da qarTveluri enebis urTierTobis rTul problematikas. mis mier rusul enaze Targmnili da gaSifrulia meaTe saukunis nawarmoebi `qebai da didebai qarTulisa enisai~. man mravali gamokvleva miuZRvna, agreTve, Sumeruli damwerlobis sakiTxebs. batonma merabma mravali sasikeTo saqme gaakeTa erovnuli medicinis sakeTildReod. Canafiqric bevri hqonda, magram aRar dascalda ganxorcieleba. misi mecnieruli memkvidreoba Rirsebul adgils daimkvidrebs qarTuli medicinis istoriaSi.

saqarTvelos medicinis istorikosTa samecniero sazogadoeba

4. saqarTvelos samedicino Jurnali, 4, 2008 w.

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nekrologi

zezva RuRuniSvili

Cveni qveynis samedicino sazogadoebrioba, qarTuli inteligencia gulistkiviliT gamoeTxova saqarTveloSi janmrTelobis dacvis TvalsaCino organizators, saxelmwifo da sazogado moRvawes, baton zezva RuRuniSvils. mravalmxriv saintereso da SemoqmedebiTad Sinaarsiani cxovrebis gza ganvlo batonma zezvam. daibada 1940 wels TbilisSi, cnobil qarTul tradiciul ojaxSi. dedaqalaqis rkinigzis #1 saSualo skolis warmatebiT damTavrebis Semdeg Cairicxa Tbilisis saxelmwifo samedicino institutis samkurnalo fakultetze. niWierma, moazrovne studentma institutSive gamoiCina Tavi samedicino ganaTlebis safuZvlianad aTvisebaSi, TanatolebTan megobrul Tanadgomasa da keTil urTierTobaSi. yovelive amis gamo, samedicino institutis studentobam is erTxmad airCia Tavis liderad da wlebis manZilze xelmZRvanelobda axalgazrdul organizacias. axlgazrda asakSive masSi gamovlinda pedagogiuri moRvaweobis Cinebuli unari. ZiriTadi saqmianobis paralelurad, samedicino institutis biologiis kaTedraze arCul iqna asistentis Tanamdebobaze, sadac mravali weli momaval eqimebs gadascemda genetikis mecnierul safuZvlebs.

yvelgan, sadac ki umoRvawia baton zezvas, mkveTrad vlindeboda misi rogorc niWieri xelmZRvanelis pirovnuli Tvisebebi: TanamSromlebTan obieqturi da mzrunveli ganwyoba, saqmianobaSi - Tanamedrove formebisa da meTodebis danergvisadmi mudmivi swrafva, axalgazrda, niWieri kadrebis mimarT permanentuli yuradReba, profesiuli daxelovnebisadmi momTxovni damokidebuleba da sxva. gansakuTrebiT gamovlinda batoni zezvas organiztoriuli niWiereba da novatoruli unari saqarTveloSi sakuroroto dargis aRmSeneblobis procesSi. am mxriv aRsaniSnavia Cveni qveynis sarekreacio zonebSi misi TaosnobiT Tanamedrove donis sanatoriumebis, dasasvenebeli saxlebis, gamajansaRebeli kerebis mSeneblobebis gafarToeba, am obieqtebze uaxlesi samkurnalo-sareabilitacio siaxleTa danergva, maTi aRWurva samedicino teqnikiT da sxva mravali. gamorCeuli iyo batoni zezvas moRvaweoba saqarTvelos parlamentSi. wlebis ganmavlobaSi is saTaveSi edga janmrTelobisa da socialuri sakiTxebis komitets. misi iniciativiT qveynis sakanonmdeblo organom miiRo mravali sagulisxmo gadawyvetileba avadmyofTa da medicinis dargis muSakTa uflebebis, samkurnalo saqmis ganviTarebis, samkurnalwamlo saSualebebis uzrunvelyofis, mosaxleo-

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bis socialuri dacvis, ltolvilTa janmrTelobis mdgomareobis gaumjobesebis, saqarTveloSi demografiuli procesebis mogvarebis Taobaze da sxva mravali sagulisxmo problemis Sesaxeb. yovelive aRniSnulis gamo, am saxelmwifoebrivi mniSvnelobis sakiTxebisaTvis iuridiuli kanonis statusis miniWeba moiTxovda mudmiv SemoqmedebiT Ziebasa da politikur midgomas. maTi srulyofa sakanonmdeblo dokumentad batoni zezvas didi gamocdilebisa da daZabuli Sromis Sedegi iyo. dRes saqarTvelos samedicino sazogadoeba aRWurvilia im umaRlesi sakanonmdeblo debulebebiT, romlebic ganapirobeben qveynis mosaxleobis janmrTelbis dacvis uflebaTa kanonierebas. gamorCeulad STambeWdavi iyo batoni zezvas pirovnuli xibli, misi uxvi maragi da zedmiwevniT Rrma codna istoriis, xelovnebis, prozis, poeziis, misTvis Cveuli keTili iumori, adamianTa mimarT

mokrZaleba, pativiscema da Tanadgoma. mis garSemo Tavs iyrida megobarTa, keTilis msurvelTa da TanamoazreTa didi armia. mas yvelgan RimiliTa da gulRiad xvdebodnen. aseTive iyo batoni zezvas ganwyoba yvelasadmi. aRtacebas iwvevs misi sajaro Tu kerZo gamosvlebisa da saubrebis mravalferovneba, leqsikis siuxve, azrTa mWermetyveleba. swored yovelive amis gamo is yvela Taobis warmomadgenelTa Soris sasurveli pirovneba iyo. Cveni qveynis umaRlesma xelisuflebam, baton zezvas eris, qveynisa da profesiisadmi mravalmxriv erovnul moRvaweobas maRali Sefaseba misca da daajildova Rirsebis ordeniT. cxovrebidan wavida samSoblos moWirnaxule patrioti, erovnuli suliskveTebiT damuxtuli mamuliSvili, romlis danatovari is didi memkvidreobaa, rac momaval Taobebs amqveyniuri cxovrebisa da moRvaweobis naTel magaliTad gamoadgebaT.

Tbilisis saxelmwifo samedicino universiteti, `saqarTvelos samedicino Jurnalis~ saredaqcio kolegia da sabWo

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daviT gocaZe

saqarTvelos samedicino sazogadoeba da onkologiis nacionaluri centri Rrma mwuxarebiT iuwyeba, rom gardaicvala amave centris generaluri direqtoris moadgile, medicinis mecnierebaTa doqtori, saxelmwifo premiis laureati, evropis urologTa asociaciis wevri, profesori daviT gocaZe. daviT gocaZe daibada 1953 wlis 16 oqtombers quTaisSi. 1969 wels warCinebiT daamTavara quTaisis saSualo skola da swavla gaagrZela moskovSi. 1970-76 wlebSi warCinebiT daamTavra moskovis pirogovis saxelobis II samedicino institutis samkurnalo fakulteti. 1976-78 wlebSi gaiara klinikuri ordinatura moskovis onkologiis samecniero centrSi specialobiT qirurgia-onkologia. 1978-81 wlebSi daamTavra aspirantura imave samecniero centrSi specialobiT qirurgia-onkologia (urologia). 1981 wels daicva sakandidato disertacia da muSaobda sakavSiro onkologiis samecniero centris onkourologiuri ganyofilebis mecnierTanamSromlad. 1986 wels saqarTvelos ministrTa sabWos dadgenilebiT gadmoyvanil iqna saqarTvelos jandacvis onkologiis

samecniero centris urologiuri ganyofilebis samecniero xelmZRvanelad. misi xelmZRvanelobiT ganyofilebaSi klinikuri saqmianobis paralelurad farTod gaiSala intensiuri samecniero-kvleviTi muSaoba. drois mcire monakveTSi onkourologiuri ganyofileba gaxda respublikaSi erT-erTi mZlavri samecniero da praqtikuli saqmianobis kera. klinikaSi damuSavda wvrilnawlavovani rezervuaris formirebis originaluri meTodika, romelic cnobilia `goce-fauCis~ saxelwodebiT, da romelmac farTo aRiareba moipova rogorc Cvens qveyanaSi, aseve mis farglebs gareT. 1982 wels daicva sadoqtoro disertacia Temaze: `cisteqtomia Sardis buStis kombinirebul da kompleqsur mkurnalobaSi~. misi TaosnobiT onkourologiuri ganyofileba gaxda egzenteraciebis warmoebis pioneri saqarTveloSi; misi xelmZRvanelobiT damuSavebul iqna mcire menjis organoebis evisceracia da aRdgeniT-rekonstruqciuli operaciebis qirurgiuli da meTodologiuri aspeqtebi, da adre araoperabelurad miCneul avadmyofebs gadarCenis da komfortulad cxovrebis gza dausaxa. am tipis operaciebi xor-

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cieldeba msoflios mxolod erTeul klinikebSi. mis saxels ukavSirdeba, agreTve, onkologiis nacionaluri centris urologiuri da mcire menjis recidiuli da adgilobrivad gavrcelebuli simsivneebis ganyofilebis Camoyalibeba. misive xelmZRvanelobiT daculia 6 sadoqtoro da sakandidato disertacia, avtoria 100-mde samecniero naSromis. 1993 wels naSromisaTvis `Sardis derivaciis meTodebis srulyofa cisteqtomiis Semdeg~ mieniWa profesor a. RvamiCavas saxelobis premia, xolo 2004 wels _ saxelmwifo premiis laureatis wodeba, 2007 wels naSromTa ciklisaTvis `modificirebuli cisteqtomiebis adgili da roli Sardis buStis kibos mkurnalobaSi~ mieniWa profesor l. SaraSiZis

saxelobis premia. mecnierebaSi Setanili wvlilisaTvis dajildoebulia zaza fanaskertel-ciciSvilisa da gr. muxaZis saxelobis medlebiT. batoni daviTi iyo al. wulukiZis saxelobis Tbilisis urologTa da profesor k. vefxvaZis saxelobis saqarTvelosa da Tbilisis onkologTa samecniero sazogadoebaTa wevri da Jurnal `onkourologiis~ (moskovi) mTavari redaqtoris moadgile. misi udroo gardacvaleba udavod didi danaklisia, rogorc onkologiis nacionaluri centris koleqtivisa da samedicino sazogadoebisaTvis, aseve TiToeuli adamianisaTvis, visTanac baton daviTs hqonia kolegialuri, megobruli urTierTobebi.

saqarTvelos Sromis, janmrTelobisa da socialuri dacvis saministri, a. RvamiCavas saxelobis onkologiis nacionaluri centri, saqarTvelos onkologTa samecniero sazogadoeba da asociacia, saqarTvelos urologTa da qirurgTa asociacia.

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nana Wabukiani

qarTulma inteligenciam, umaRlesma skolam didi danaklisi ganicada. gardaicvala filosofiur mecnierebaTa kandidati, wlebis manZilze Tbilisis saxelmwifo samedicino universitetis filosofiis kaTedris docenti, nana Wabukiani. daibada 1936 wels, sorbonis universitetis doqtoris aleqsandre Wabukianis ojaxSi. mxolod erTi wlis iyo nana, rodesac saqarTveloSi `kaenis sulis aRzevebis gamo aTi wliT darCa umamod da dedas daawva misi da ori ufrosi vaJis aRzrda. gaWirvebam nanas da mis Zmebs avTandilsa da oTars ara marto Sroma da moTmena aswavla, aramed erTmaneTis mimarT usazRvro siyvarulic STaunerga. ase daebeda nana Wabukians: didi tkivili da didi siyvaruli mudam Tanamgzavrobdnen misi cxovrebis gzas. universitetSi swavlis wlebSi nana colad gahyva momavalSi cnobil filosofoss, mweralsa da mecniers, jansuR korZaias, romelTanac 50 wlis manZilze erTgulad da rudunebiT emsaxureboda ojaxs da qveyanas, erovnuli cnobierebis damkvidrebasa da da momaval medikosTa aRzrdis saqmes. momxiblavi garegnobisa da da faqizi sulis pedagogs dResac siyvaruliTa da

xazgasmuli pativiscemiT ixseneben yofil studentTa Taobebi. n. Wabukianis erudicia da oratoruli xelovneba friad STambeWdavs xdida mis leqcia-seminarebs. is ara marto filosofias aswavlida, aramed sazogadod adamianTa siyvaruls, samSoblos siyvaruls, sikeTes, uangarobas. da ara marto aswavlida, TviT iyo yovelive amis unaTlesi magaliTi. ukanasknel wlebSi, avadmyofobis gamo, iSviaTad gamodioda saxlidan. meuRlesa da wamozrdil SviliSvilebze zrunvas cdilobda. samSoblos bedze, mis momavalze fiqri ar asvenebda. ver davbrundebiT afxazeTsa da samaCabloSi?! aucileblad kiTxavda mosaubres da iqve rwmeniT daamatebda: aucileblad davbrundebiT! bolos isev avadmyofobam imZlavra. mainc moulodneli iyo misi cxovrebis wignis tragikulad daxurva missave dabadebis dRes 5 oqtombers. TiTqos sayvareli meuRlis poeturi xilva gaacxada: `erTad atotebs miriad argans, awydeba xeebs oqtombris qari, da foTlebs rCebaT, sul erTi, magram usazRvrobaSi gafrenis wami. naTelSi amyofos misi suli!

kolegebi, megobrebi

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saZiebeli

2008 wels `saqarTvelos samedicino JurnalSi~ gamoqveynebuli masalebis saZiebeli

mimoxilviTi statiebi i. kirvaliZe, T.jorbenaZe, r.xecuriani, a.SukakiZe, n.xviCia, m. arabuli _ kardiomiopaTia, 4, 3-7 a. paWkoria, v. paWkoria, o. mindiaSvili, a. gvalia, v. beraia, g. kvaWaZe, n. zariZe _ kranio-abdominaluri Serwymuli travmebi, 1, 7-9 a. rexviaSvili, m. vaSakiZe, s. gvaramia, m. gogiSvili _ arteriuli wnevis 24-saaTiani ambulatoriuli monitoringis prediqtoruli mniSvneloba,1, 4-6 kardiologia g. tabiZe, m. iakobaSvili, d. baRaTuria, T. cibaZe - marcxena parkuWis remodelirebis Taviseburebebi diastoluri disfunqciiT mimdinare gulis qronikuli ukmarisobisas, 3,15-17

T. WavWaniZe, g. tabiZe, n. burkaZe, m. iakobaSvili, l. mWedliSvili, a. kobaiZe, n. rostiaSvili, g. baqraZe _ nebivololis klinikuri efeqturoba gulis qronikuli ukmarisobis dros, 1, 10-11
pulmonologia, fizioTerapia n. saakaSvili, m. tabiZe, n. kakulia, m. afxazi, i. kvinikaZe - vanadiumis eleqtroforezis gavlena gaxangrZlivebuli pnevmoniis mqone avadmyofTa kardiohemodinamikaze, 3, 18-21 alergologia l. uCava, m. janjRava, a. xmeliZe, m. danelia, n. baramiZe, s. rodonaia _ bronquli asTma, rogorc globaluri problema , 1,12-14 alergologia, fizioTerapia n. saakaSvili, i. Tarxan-mouravi, n. jakobia - santimetruli diapazonis mikrotalRebis eleqtromagnituri velis gavlena bronquli asTmis dros, 3, 25-27 alergologia, meanoba b. maWavariani, c. sakandeliZe, n. rurua _ bronquli asTma da orsuloba, 4, 8-11 infeqciuri daavadebebi i. mWedliSvili, d. gelovani, T. mWedliSvili - zogierTi infeqciuri daavadebis gavrceleba saqarTveloSi, 2, 3-7 infeqciuri sneulebani, epidemiologia i. mWedliSvili, T. mWedliSvili, m. eloSvili - saqarTveloSi meningokokuri infeqciisa da baqteriuli meningitebis epidemiologiuri zedamxedvelobis gaumjobesebis gzebi, 3, 22-24 diabetologia, fsiqologia a. cibaZe, l. cucqiriZe, r. yuraSvili, m. korkelia, d. cibaZe -sensomotoruli da fsiqoemociuri produqtiuloba araproliferaciuli retinopaTiiT garTulebuli Saqriani diabetis dros, 3, 33-36

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endokrinologia S. janjRava, q. asaTiani, l. uCava, a. xmeliZe, m. janjRava, e. xmeliZe, n. baramiZe, m. danelia - hiperprolaqtinemia mamakacebSi, 2, 11-17 kurortologia n. saakaSvili, i. WabaSvili - biliaruli sistemis paTologiisas saxarbedios mineraluri wyliT organizmSi mimdinare koreqcia, 2, 8-10 profesiuli daavadebebi r. baraTaSvili, v. saakaZe _ cementismieri profesiuli dermatozebis prevenciis safuZvlebi, 1, 25-27 n. CxaiZe, n. ruxaZe, e. lifonova, x. SublaZe _ kaspis cementis qarxnis muSamosamsaxureTa Soris daavadebebis gamomwvevi riskis faqtorebi, 1, 28-30 r. javaxaZe, m. wereTeli, x. CigogiZe, n. xatiaSvili, n. xaWapuriZe, m. gviSiani _ profesiuli daavadebebis ganviTarebis dinamika da Sromis pirobebi manganumis warmoebaSi, 1, 21-24 profpaTologia r. kverenCxilaZe, m. cimakuriZe, l. baqraZe, n. xunaSvili - Tbilisis metropolitenis muSakTa Sromis pirobebi, janmrTelobis mdgomareoba da misi gaumjobesebis RonisZiebebi, 3, 28-32 r. javaxaZe, m.wereTeli, x.CigogiZe, n.ruxaZe, n.xatiaSvili, x.SublaZe _ Sromis medicinis Tanamedrove problemebi, 4, 17-21 andrologia g. galdava, g. durgliSvili _ pirveladi hipogonadizmis CanacvlebiTi hormonuli Terapia, 1, 31-33 dermatologia, alergologia n. mgelaZe, r. qarselaZe, l. JorJoliani _ atopiuri dermatitis ganviTarebis riskis faqtorebi Tbilisis saskolo asakis bavSvTa populaciaSi, 4, 12-16

ONCOSURGERY
A.R. Aliyev - The results of treatment of the gastric cancer after expanded and expanded-combined operations, 4, 22-25 yel-yur-cxvirisa da nevrologiuri daavadebebi g. buaZe, s. xeCinaSvili, m. beriZe, i. xundaZe, m. alfaiZe - smenaClungobis gamomwvevi paTologiis zegavlena Tavis tkivilze, 4, 26-30 profilaqtikuri medicina k. gelaSvili, r. kverenCxilaZe, n. vefxvaZe, i. mWedliSvili, i. faRava, r. javaxaZe, l. ziraqiSvili - profilaqtikuri medicinis warsuli, awmyo da momavali, 3, 9-14 r. kverenCxilaZe, vad. saakaZe, m. cimakuriZe, l. baqraZe - saqarTvelos samrewvelo obieqtebis garemos dacvis profilaqtikis ZiriTadi principebi, 2, 15-17 komunaluri farmacia a. bakuriZe, v. eriaSvili, T. WumburiZe, n. nemsiwveriZe, i. wurwumia - komunaluri farmaciis problemebi saqarTveloSi, 3, 41-43

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.. e - (in vitro), 4, 31-34 neiromorfologia t. mermaniSvili, g. WaWia, e. xiTariSvili, T. jorbenaZe - intrakraniuli meningiomis recidivis ganviTarebis vadebi, 4, 35-38 eqsperimentuli medicina S. tukvaZe, g. grigoraSvili - kunelis flavonoidebis moqmedeba eqsperimentuli aTerosklerozisas, 4, 39-41 eqsperimentuli medicina, paTomorfologia g. pataraia - eqsperimentSi tyviis (Pb) eqspoziciiT organizmSi ganpirobebuli morfologiur-funqciuri cvlilebebi da misi prevencia, 2, 20-24 Tanamedrove teqnologiebi medicinaSi T. cecxlaZe - eleqtroqimiuri danadgariTa da teqnologiuri sistemiT warmoebuli sadezinfeqcio da sasterilizacio xsnarebis efeqturoba da usafrTxoeba, 2, 25-35 tradiciuli medicina T. alaSvili, T. Wanturia _ sindromologiuri diagnostika homeopaTiaSi, 1, 40-43 kritikuli medicina a. falavandiSvili, z. xelaZe, T. sanikiZe, n. CubiniZe, zv. xelaZe _ Zvlis tvinis mdgomareoba sicocxlisaTvis saSiS periodSi, 1, 15-17 . , . , . , . , . - - , 1, 18-20 sportuli medicina . , . , . - , 1, 37-39 d. qobelaSvili _ Tavis tvinis naxevarsferoebis dominantoba sportuli daostatebis TvalsazrisiT, 1, 34-36 jandacvis organizacia e. mirvelaSvili - Saqriani diabetiT daavadebulTa ganaTlebis zogierTi sakiTxi saqarTveloSi, 3, 18-19 jandacvis organizacia, nevrologia m. Savdia, e. darbaiseli, n. Savdia. a. vaCeiSvili -ojaxis eqimis rolo asTeniis gamovlenasa da mkurnalobaSi, 3, 44-49 profesiuli ganaTleba, profpaTologia m. cimakuriZe, vad. saakaZe, r. kverenCxilaZe-mosazrebani umaRles samedicino skolaSi profesiuli paTologiis swavlebis Sesaxeb, 3, 37-40

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medicinis istoria m. Tvauri _ borjomis mineraluri wylebis sabadoebis aRmoCenis Sesaxeb, 1, 44-48 r. iakobiZe, i. CinCalaZe - robert kupcisis gamocdileba da Rvawli saqarTvelos wylis resursebis sistemuri Seswavlis saqmeSi, 1, 36-40 werili redaqcias T. SioSvili - sruliad saqarTvelos kaTolikos - patriarqs, uwmindessa da unetaress, ilia meores, 4, 42 m. xoferia, z. kaxabriSvili, m. ruxaZe, r. svaniSvili sprotuli medicinis satkivari, 4, 43 iubilari g. CafiZe, j. mamalaZe - sasiqadulo mamuliSvili (simon (soso) kapanaZis dabadebidan 70 wlisTavis gamo), 3, 50-52 redaqtoris gverdi rCeuli (irakli faRava), 2, 46-47 tradicia (irakli da daviT ciciSvilebi), 2, 44-45 Cveni mizani, 1, 3 saiubileo TariRi v. gaCeCilaZe Rirsebuli mecnieri da mamuliSvili (z. Telias dabadebidan 85 wlisTavis gamo), 4, 44 vad. saakaZe Cemi Taobis sasiqadulo mamuliSvili (daviT kvaWaZis dabadebidan 80 wlisTavis gamo), 4, 45-47 gamosaTxovari Tamar dekanosiZe, 3, 3-8 kote barqaia, 2, 48 gaxseneba T. kaWaxiZe, j. mamalaZe - megobris xsovnas (guram baqraZe), 3, 53 giorgi kereseliZe, 2, 43 j. mamalaZe _ WeSmaritebis ZiebaSi, 1, 49-51 j. mamalaZe, m. kutubiZe - icxovra sikeTiT sxvaTa mimarT (jemal mgalobliSvili), 3, 54-55 vad. saakaZe naTeli pirovneba, WeSmariti moqalaqe (oTar SalamberiZe), 2, 41-42 merab janeliZe, 4, 48-49 nekrologi gulnara gersamia, 3, 56-57 daviT gocaZe, 4, 52-53 zezva RuRuniSvili, 4, 50-51 levan Carkviani, 3, 58-59 nana Wabukiani, 4, 54

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avtorTa

sayuradRebod!

ukanasknel wlebSi `saqarTvelos samedicino JurnaliT~ dainteresdnen kievis, xarkovis samedicino universitetebis biblioTekebi, sadac igzavneba Cveni Jurnalis yoveli nomeri. aqve gvinda aRvniSnoT Jurnalis saredaqcio sabWos wevris, yofili Cveni Tanamemamulis m. mixailis damsaxureba, romelic Cvens Jurnals avrcelebs israelis samedicino dawesebulebebSi. ramdenime Jurnali gagzavnil iqna amerikis SeerTebuli Statebis biblioTekaSi. Cven TxovniT mivmarTeT maTi dawesebulebebis xelmZRvanelebs aqtiuri urTierTTanamSromlobis Taobaze. vimedovnebT, rom sasurvel Sedegs miviRebT. `saqarTvelos samedicino Jurnali~ 2002 wlidan referirebulia sruliad ruseTis mecnierul da teqnikur institutSi (B) da yoveli nomeri Tavsdeba internetis veb-gverdze www.medportal.ge (samedicino biblioTeka). is ganTavsebulia, agreTve, Cveni qveynis erovnuli biblioTekis sacnobaro katalogSi. Cveni Jurnalis furclebze aqtiurad TanamSromloben mezobeli saxelmwifoebis azerbaijanisa da somxeTis medikosebi. Cveni samomavlo gegmebia: aqtiuri TanamSromloba msoflios wamyvan samedicino centrebTan, gamomcemlobebTan, specialistebTan, erovnuli samedicino azrovnebis farTo popularizacia ucxoeTis samedicino wreebSi da maTi citireba ucxoeli avtorebis SromebSi, SemoqmedebiTi kontaqtebi Cveni qveynis samecniero-kvleviT da saswavlo dawesebulebaTa wamyvan specialistebTan; poligrafiuli donis srulyofa da Jurnalis iersaxis mimzidveloba.

`saqarTvelos samedicino Jurnalis~ redaqcia

redaqciis misamarTi: Tbilisi, vaJa-fSavelas gamz. 33

: ,

- 33

xelmowerilia dasabeWdad: 24.12.08 w., formati 70 X 108 1/16 fizikuri nabeWdi Tabaxi 5.0 saaRricxvo-sagamomcemlo Tabaxi 3,5, tiraJi 300, fasi saxelSekrulebo

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saredaqcio kolegiisa da sabWos Tavmjdomare giorgi menabde mTavari redaqtori jangir mamalaZe

.. ..

THE CHAIRMAN OF EDITORIAL BOARD AND COUNCIL G. MENABDE CHIEF EDITOR J. MAMALADZE

saredaqcio kolegia:
nodar baqraZe, zaza beriSvili, klara gelaSvili, oTar gerzmava, SoTa gogoxia, fridon Todua, paliko kintraia, dimitri korZaia, gia lobJaniZe, vadim saakaZe (mTavari redaqtoris moadgile), irakli favleniSvili, merab qavTaraZe, eTer qemerteliZe, levan qurcikaSvili, nodar yifSiZe, roman SaqariSvili, ramaz Sengelia (mTavari redaqtoris moadgile), gulnara CafiZe, aleqsandre cibaZe, daviT WavWaniZe, simon xeCinaSvili, ramaz xecuriani

: .. , .. , .. , .., .. , .. , .. , .. , .. , .. , .. , .. , .. , .. (. ), .. , .. , .. , .. , .. , .. , .. , .. (. )

EDITORIAL BOARD:
N. Bakradze Z. Berishvili, D. Chavchanidze, G. Chapidze, K. Gelashvili, O. Gerzmava, Sh. Gogokhia, M. Kavtaradze, E. Kemertelidze, S. Khechinashvili, R. Khetsuriani, P. Kintraia, N. Kipshidze, D. Kordzaia, L. Kurtsikashvili, G. Lobjanidze, I. Pavlenishvili, V. Saakadze, R. Shakarishvili, R. Shengelia, P. Todua, A. Tsibadze

saredaqcio sabWo:
a. aladaSvili m. apostolovi i. beraZe m. boxua r. gagua g. gegeSiZe l. gujabiZe j. gujabiZe a. diamandopulosi i. eliaSvili n. emuxvari g. vasaZe g. vekua n. vefxvaZe o. zurabiSvili o. ToiZe z. Tofuria s. kapanaZe i. kvaWaZe a. kvezereli-kopaZe r. kverenCxilaZe v. kiknaZe n. kintraia z. kirtava (Tbilisi) (bulgareTi) (Tbilisi) (Tbilisi) (Tbilisi) (samtredia) (Tbilisi) (Tbilisi) (saberZneTi) (tyibuli) (Tbilisi) (Tbilisi) (Tbilisi) (Tbilisi) (parizi) (Tbilisi) (Tbilisi) (Tbilisi) (Tbilisi) (Tbilisi) (Tbilisi) (Tbilisi) (Tbilisi) (Tbilisi) a. koWlamazaSvili l. managaZe v. margvelaSvili i. megrelaZe m. mixaili g. muxaSavria i. mWedliSvili q. nemsaZe n. saakaSvili T. sanebliZe r. surmaniZe m. tatiSvili a. tuveidi i. faRava e. qarTveliSvili b. qobulia v. yifiani r. yuraSvili a. CarTolani T. CxikvaZe l. WeliZe n. xatiaSvili a. xomasuriZe n. javaxiSvili (Tbilisi) (Tbilisi) (Tbilisi) (Tbilisi) (israeli) (Tbilisi) (Tbilisi) (Tbilisi) (Tbilisi) (marneuli) (baTumi) (Tbilisi) (vaSingtoni) (Tbilisi) (Tbilisi) (Tbilisi) (Tbilisi) (Tbilisi) (mestia) (Tbilisi) (Tbilisi) (Tbilisi) (Tbilisi) (Tbilisi)

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