ASSESSMENT OF THE ENDOTHELIAL FUNCTION IN PATIENTS WITH RHEUMATOID ARTHRITIS AND NSAID-GASTROPATHY

D.I. ABDULGANIEVA

Kazan State Medical University, Kazan, RUSSIA

Heterogeneity of the pathogenesis of NSAID-gastropathy is known. Given the insufficient data about features of NSAID-gastropathy in rheumatoid arthritis (RA), the purpose of study was to study variants of response of brachial artery to the test with reactive hyperemia in patients with RA with NSAID-induced gastropathy.

Materials and methods 51 patients with RA with NSAID-induced gastropathy (average age 41,6 ± 4,4 years) were involved into study, diagnosis of RA was set according to criteria of American Association of Rheumatology. Endoscopic changes characteristic for NSAID-gastropathy and assessed according to the classification ofLanza F., were observed in all patients. The control group consisted of 33 healthy volunteers aged between 22 to 50 years (mean age 32 ± 2 years). Function of endothelium was studied by means of ultrasonic method of D.S.Celermajer, K.E. Sorenson (1992) in our modification.

Results In patients with RA with NSAID-gastropathy there was observed increase in the thickness of itima-media complex as compared to the control group - 0,053 ± 0,002 and 0,036 ± 0,001, respectively (p <0,05), opening of the brachial artery both into diastole (0,400 ± 0,008), and in systole (0,396 ± 0,009) was significantly greater than in the control group (0,31 ± 0,009 and 0,33 ± 0,01, respectively (p <0,05); relative systolic increase, characterizing the rigidity of brachial artery wall was significantly reduced as compared to the control 0,033 ± 0,003 and 0,063 ± 0,004 (p <0,05). During the test with reactive hyperemia in patients withRA with NSAID-gastropathythere was observed less maximum vasodilation for 15 sec as compared to the control group 2,27±0.66% (from -7 to 12.5%%) and 11,6 ± 1,2% (p <0,05) and 60 sec. 3,56 ± 0,83% (from -13.1 to 18.7%%) and 12,8 ± 1,14, respectively (p <0,05), which shows dysfunctionof endothelium.

Conclusion: In patients with RA with NSAID-gastropathy ofgastroduodenalUD, there was revealed endothelial dysfunction.

ABOUT THE PROBLEM OF TREATMENT OF PERIAMPULARY TUMORS

G.A.ABDURASHIDOV, A.Z.ABDULLAYEV, E.M.MAMEDOVA, A.G.GASANOV

Department of General Surgery, DSMA, Makhachkala, RUSSIA

The aim of the study.Evaluation of the results of two-stage approach to treatment of obstructive jaundice on the basis of periampular tumor.

Materials and methods. The analysis of staged treatment of 116 patients with periampular tumors treated at the clinic of general surgery. Comparison group consisted of 112 patients with one-stage interventions in the same period. In 90 (78.4%) observation the first phase included cholecystostomy from mini access with laparoscopic assisting, in 23 (19.0%) percutaneous external cholangiostomy under the control ofradiotelevision and ultrasound, in 3 (2.6%), endoscopic retrograde stenting of the biliary tract. In the second stage of radical surgery was performed in 43 (37.1%) patients, palliative in 51 (43.9%). In 22 (19.0%) cases, the second stage of surgery was not performed because of the prevalence of cancer. In the control group of patients radical surgery was performed in 17 (15.2%) patients, palliative interventions (biliodigestiveanastamoses) in 95 (84.8%) patients.

Results and discussion. In the control group there were observed 18 (16.1%) complications: syndrome of “rapid decompression” of the biliary tract - 5, the progression of liver-kidney failure - 8, biliary peritonitis - 4, pancreatic fistula - 1. Six fatal outcomes due to the progression of liver-kidney failure and peritonitis (postoperative mortality 5.4%) were observed. In the study group there were5 (4.3%) complications: syndrome of "rapid decompression" in the first phase - 1, the progression of liver disease - 2, local choleperitonitis - 2. There was recorded one fatal outcome (postoperative mortality rate 0.9%).

Comparative analysis of main and control groups shows propriety of a two-step patient management with periampular tumor, complicated by obstructive jaundice. Sparing decompression of biliary tract in the first phase and the implementation of radical or palliative surgery for a patient already prepared for surgery does not lead to the disturbance in the function of hepatocytes, insolvency and bilio-pancreatodigestive anastomoses and violation of the internal media of the organism.

Conclusions. Given the obtained results, staged treatment of periampular tumor, complicated by obstructive jaundice is the most preferable for this category of patients. It may significantly reduce the number of complications and fatal outcomes.

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FEATURES OF THE ANGIOGRAPHIC PICTURES OF PATIENTS WITH LOWER LIMB OBLITERATING THROMBOANGITIS

N.S.ABISHOV, G.T.TAGHIZADEH, Z.M.ALIYEV, E.J.ZAKIRJAYEV, R.A. GULIYEV

Scientific Centre of Surgery named after M.A. Topchubashev, Baku, AZERBAIJAN

Introduction. Valuable method of the assessment of the lesion of distal arterial bed is a selective contrast radiographic angiography, made through transfemoral (contralateral limb) or transaxillary accesses. Objective: to estimate characteristics of the angiographic picture of patients with obliterating thromboangitis (OT) with critical lower limb ischemia.

Materials and methods. This work shows analysis of the results of angiographic study 42 patients with OT critical lower limb ischemia (III-IV stage by R.Fontaine-AV. Pokrovsky), aged between 22 - 57 years (average age was 40,9 ± 0, 52 years). The examined patients were hospitalized at the department of Vascular Surgery of Scinetific Center of Surgery named after acad. M.A. Topchubashev for the period from 1997 to 2008., that constituted 24.8% of the total number of patients (169) with OT of lower extremities at the stage of critical ischemia.

Results. According to our data, OT characterize multiple occlusions of distal arteria of extremities, one of two signs is characteristic for each occlusion: conicity or abruptness of the shadow. The wall of the artery proximal to the occlusion is usually flat. “Wrinkled” appearance is typical mainly for femoral artery, or tibial arteries, characterizes lesion of vessels in OT. Usually there is an intense net of collateral vessels around each vascular occlusion. Simatimes it is developed so that the arterial circulation in the extremities is supported. These collateral vessels have a characteristic spiral or rootlike appearance characteristic for patients with OT. Unlike the obliterating atherosclerosis, in OT no calcification of the vascular wall, no visible mosaic defects in the contour of arteries is seen.

Conclusions: According to our data there is a certain relationship between the nature, location, prevalence of vascular lesions and degree of development of limb ischemia. Evaluation of the data allows successful prediction of the effectiveness of surgical treatment of patients with OT and critical lower limb ischemia.

Date: 2014-12-28; view: 727