PREVALENCE OF NUTRITIONAL DEFICIENCY IN PATIENTS OF THE GENERAL THERAPY DEPARTMENT AND SPECIALIZED GASTROENTEROLOGIC DEPARTMENT

Y.N. BUTOVA, A.A. YAKOVLEV

Rostov State Medical University, Rostov-on-Don, RUSSIA

Objective: To study the prevalence and structure of malnutrition in patients with chronic diseases treated at the general therapy and specialized (gastroenterologic) hospital.

Materials and methods: One-time screening of patients, sent to therapeutic and gastroenterologic hospitals for the treatment of somatic pathology was conducted. Screening included the use of validated questionnaires based on the Nottingham method, as well as the MUST and NRS scale [Melchior JC, 1995; Jeejeebhoy KN, 2000], providing identification of signs of nutritional deficiency (ND). 3936 patients were screened: 1229 (31.2%) patients were sent for examination and treatment in the Department of General Therapy of the Central District Hospital and 2707 (68.8%) patients - to the gastroenterologic hospital of clinic of the Rostov State Medical University within the period from 2006 to 2008.

Results: At the stage of screening there were revealed 2276 (57.8%) patients with signs of disturbance of nutritional status: 402 (17.7%) patients of the general therapeutic group and 1874 (82.3%) patients in the gastroenterological cohort of patients. In the intragroup analysis, according to nosologic forms of the disease, all 2276 patients with nutritional deficiency were divided into 3 groups: 285 patients with pathologies of cardio - vascular system, 1914 - patients with diseases of the digestive system and 77 patients with broncho-pulmonary diseases. Quite large number of patients with chronic pancreatitis draws special attention. Among 1378 (35%) of patients with verified diagnosis of CP, 779 (56.5%) had sigs of ND.

Conclusions: Among patients with chronic disorders of internal organs treated in the hospital, there is a high level of nutritive disorders. The use of screening questionnaires and scales (MUST, NRS) in the general therapeutic practice suggests the possibility and objectivity of the diagnosis of nutritional deficiency at its initial manifestations. In patients with chronic pancreatitis at the exacerbation stage, high percentage of nutritional deficiency is recorded.

.

SURGICAL TREATMENT OF PATHOLOGICAL TORTUOSITY OF THE INTERNAL CAROTID ARTERY

S.A. DADASHOV, A.V. LAVRENTYEV, O.A. VINOGRADOV, K.A. ANTSUPOV,

A.N. DUNDZYA

I.M. Sechenov First Moscow State Medical University, University Clinical Hospital No 1, Moscow, RUSSIA

Introduction: Stroke is one of the main causes of stable disability and mortality in the world. In the structure of cerebrovascular insufficiency, pathological tortuosity of the internal carotid artery (ICA) take the second place after atherosclerotic lesions. According to statistical data of various authors tortuosity of carotid arteries occurs in 25-30% of the adult population, but the clinical significance of this pathology is observed only in 10-15% of cases.

Purpose: To determine the tactics of surgical treatment, to analyze and evaluate the results of different methods of surgical treatment in pathological tortuosity of the internal carotid artery.

Materials and methods: The study included 90 patients operated for pathological tortuosity of the ICA in the period from 2006 to 2011. The total number of operation - 94. Age of the examined - 32 - 81 years, including 48 men (53.3%) and 42 women (46.7%). All patients had clinical manifestations of cerebrovascular insufficiency. The main methods of diagnosis, based on which indications for surgery and dinamic follow-ups are determined, are transcranial Doppler and monitoring, triplex canning of carotid arteries, multispiral computed angiography, magnetic resonance angiography. Subject to the expressiveness of intimal proliferation in the area of maximum tortuosity (“septa”), the patients were divided into 2 groups: I group - patients without intimal proliferation, II group - patients with a intima proliferation.

Results: All patients were performed triplex scanning of carotid arteries and monitoring of transcranial Doppler middle cerebral artery. In patients of the 1^st group (70) no significant asymmetries of blood flow in the middle cerebral artery in the contralateral side (the difference of the indices below 25%) were found, but in 21.4% there was observed microembolization. In patients of the 2 group(20) in 50% of cases there was revealed significant asymmetry of blood flow in the middle cerebral artery in the contralateral side and in 85% there was observed microembolization into the pool of middle cerebral artery. In this case, all patients of the 2^nd group were performed resection of twisting area in order to eliminate septal site. In triplex scanning the spectrum of blood flow in the ICA before the operation was a turbulent, after - laminar, the local blood flow velocity in the ICA in the zone of tortuosity before the operation constituted 1,9 ± 0,1 m/s, after the operation - 0,70 ± 0,1 m/s (p <0,05); resistance index in the ICA bend was 0,82±0,08, after the operation - 0,64±0,04 (p<0,05). Postoperative strokes and deaths were not observed. Analysis of clinical outcomes of operations showed positive dynamics of neurological status, both in the near and in the late postoperative period.

Conclusions: The surgical treatment of pathological tortuosity of the carotid arteries is the prevention of ischemic stroke, as well as tortuosity of the internal carotid with intimal proliferation in the area of maximum tortuosity is similar with atherosclerotic stenosis of the internal carotid artery according to hemodynamic and embologenus significance.

ASSESSMENT MOTOR-EVACUATION FUNCTION OF THE GALL BLADDER IN PATIENTS WITH TYPE 2 DIABETES MELLITUS ACCORDING TO ULTRASOUND DATA

M.L. DANILOVA, V.V. TRUSOV

Department of Internal diseases with courses of radiation method of diagnosis and treatment of military-field therapy, SEI of HPE, Izhevsk, RUSSIA

Recognition and treatment of lesions of the biliary system is a prerequisite for successful compensation of diabetes mellitus (DM), as clinical experience shows a significant effect of diseases of the gallbladder and bile ducts in the course of diabetes and effectiveness of glucose-lowering efficacy. In connection with, the assessment of the functional state of biliary system in patients with DM by an integrated method of ultrasound was of particular scientific interest.

Materials and methods. Conducted purposeful survey of 82 patients with verified diagnosis of chronic acalculous cholecystitis (CAC) and 2 type DM was conducted. The comparison group consisted of 47 patients with CAC without concomitant diabetes. All patients were carried out dynamic cholecystosonography with the use of food stimulus (2 egg yolks). During the analysis of the contractile ability of the gall bladder the following parameters were considered: basal gallbladder volume (Vo, cm³), the volume of discharge at the end of evacuation (V_k, cm³), the amount of bile ejected into the duodenum (ΔV, cm³), also there was calculated the effectiveness of the coefficient of evacuation function C_ef% = ΔV × 100 / V_o.

Results. According to the data of dynamic cholecystosonography in patients with type 2 DM with CAC, the motility of the gallbladder naturally low, as compared with patients of the comparison group. In the majority of cases there was revealed hypokinetic type of bile excretion, characterized by significant, as compared to CAC patients without concomitant DM, increase in the initial volume of the gallbladder (V_O = 34,04 ± 0,13 cm³ and V_O = 32,24 ± 0,15 cm³, respectively, p < 0.001). In the calculation of the effectiveness coefficient of evacuation function of the gallbladder there were obtained data, showing marked decrease of this indicator in patients with CAC, associated with type 2 DM and moderate indicators - in the comparison group (C_ef. = 42,42 ± 0,31% and K_ef. = 46,41 ± 0,54% respectively, p <0,01).

Conclusion. Thus, in patients with type 2 diabetes with chronic acalculous cholecystitis motility of gallbladder was naturally low as compared with patients of the comparison group. In most cases there was revealed a hypokinetic type of bile excretion. Echographic ultrasound method allows to specify the nature of the biliary tract lesions in patients with diabetes, which makes it possible to specify the type of disorder of the biliary system and thus justify the pathogenetic treatment.

Date: 2014-12-28; view: 992