7 research outputs found
The effect of single and dual antiplatelet therapy on the activity of pro-inflammatory cytokines in patients with coronary artery disease and obstructive sleep apnea
No full textAim. To study the activity of pro-inflammatory cytokines in patients with coronary artery disease (CAD) associated with obstructive sleep apnea (OSA), depending on the type of antiplatelet therapy. Material and methods. The study included 148 patients with stable CAD, 30% (n=44) of whom had mild OSA, 10% (n=14) - moderate and severe OSA. There were 60% (n=90) of patients without OSA. Proinflammatory activity of cytokines was assessed by the level of interleukins (IL): IL-1β, IL-6, IL-10. Results. Using dual antiplatelet therapy, there were no differences in aggregation activity of platelets (spontaneous and induced by 0,1 μM ADP) in patients with and without OSA. This indicates the synergism and potentiation of the antiplatelet effect of clopidogrel and acetylsalicylic acid (ASA). Patients with moderate and severe OSA and stable CAD had higher levels of IL-1β and IL-6 compared with patients without OSA. Antiplatelet therapy, especially dual one, had an anti-inflammatory effect, which was reflected in lower values of pro-inflammatory IL both in patients with and without OSA. Conclusion. Patients with moderate and severe OSA and stable CAD had higher levels of pro-inflammatory IL (IL-1β, IL-6) compared with patients without OSA. The combined use of clopidogrel and ASA potentiates antiplatelet and anti-inflammatory effects. This is reflected in lower values of pro-inflammatory IL and lower aggregation activity of platelets in patients with stable CAD, regardless of OSA
Improvement of surgical treatment of an acute biliary pancreatitis at elderly and senile patients
No full textAim of investigation. To estimate various variants of surgical treatment of acute biliary pancreatitis at patients of over 60 years old, to develop a method of cholecystectomy at the large Hartmann pouch adherent to biliary tracts, to decrease such complications, as bleeding, bile leakage, damage (intersection) of common bile or common hepatic duct.Material and methods. Patients separated into 3 groups in relation to operative access. The first group – (67 patients) was operated by traditional surgical access. The second group (54 patients) was operated through miniaccess with the help of «Generalpurpose frame wound retractor», of them 34 patients with large Hartmann pouch adherent to biliary tracts, were operated by the proposed method (patent of the Russian Federation #2358663 under application #2008103639, priority 30.01.08; registered on 20.06.2009; bulletin #17). The third group (61 patients) was operated by laparoscopic method. The mean age of patients in groups was 73,1 years. In 100% of cases patients had two and more concomitant diseases. The main type of surgical intervention in groups – was cholecystectomy, drainage of common bile duct by Pikovsky, drainage of abdominal cavity.Results. At traditional cholecystectomy postoperative complications develop at 44,8% of patients: eventration – 7,5%, subphrenic abscess – 6%, suppuration of postoperative wound – 11,9%, pneumonias – 8,9%, pancreatonecrosis – 10,4%. After minilaparotomy in postoperative period at 9,3% of patients following complications developed: incompetence of cystic duct stump and bile leakage – 3,7%, suppurations of postoperative wounds – 3,7%, pneumonia – 1,9%. Conversions were registered in the main group at 5,6 % of patients. After videolaparoscopy complication were observed at 14,8 % of patients: damage of common bile duct, postoperative bile leakage – 3,3%, incompetence of stump of cystic duct – 1,6%, residual choledocholithiasis with accompanying obstructive jaundice – 3,3%, pancreatonecrosis – 6,6%.Conclusions. The proposed method of cholecystectomy at large Hartmann pouch adherent to biliary tracts, allows to decrease such complications as bleeding, bile leakage, excludes damage of common bile duct
Modern approaches to surgical treatment of acute pancreatitis (literature review)
No full textAcute pancreatitis, according to different authors, occupies up to 25 % in the structure of emergency surgical pathology of the abdominal organs. Remains quite high postoperative mortality. At present, the search for more effective approaches to determining the tactics of treating such patients and new effective, least traumatic surgical technologies continues. This review has been prepared in order to summarize information of modern approaches to the surgical treatment of acute pancreatitis. The review is based on the study and analysis of sources included in the electronic databases elibrary.ru, cyberleninka.ru and electronic versions of specialized publications that are freely available on the Internet. All authors state the need, along with general clinical studies, to use various methods of abdominal cavity imaging as early as possible. The use of ultrasound, magnetic resonance imaging and computed tomography, including with contrast, is recommended. The use of visualization allows to quickly clarify the diagnosis and choose the best tactics. Currently, most authors prefer percutaneous minimally invasive interventions performed under the control of various imaging methods. A combination of percutaneous and endoscopic technologies is also offered. These techniques allow, in most cases, with high efficiency to reduce the number of complications. Laparotomy has become much less commonly used, however, this access cannot always be refused. The tactics of treatment, including the choice of the method of operation, is carried out depending on the phase of the disease, the location of the focus, its delimitation from the surrounding tissues, the presence of concomitant pathology and complications. Staged surgical treatment with the initial use of minimally invasive techniques is preferred
Value of N-terminal pro brain natriuretic peptide in predicting acute kidney injury in patients with acute decompensated chronic heart failure
No full textAim. To investigate the prognostic value of serum N-terminal pro-brain natriuretic peptide (NT-proBNP) in the development of acute kidney injury (AKI) in patients with acute decompensated chronic heart failure (ADCHF). Subjects and methods. Eighty-three patients (55 (66%) men and 28 (34%) women; mean age, 65±11 years) with ADCHF were examined. AKI was diagnosed and classified according to the 2012 Kidney Disease Improving Global Outcomes Clinical Practice guidelines. To rule out contrast-induced AKI, the investigation enrolled only patients in whom radiopague agents had not been injected 7 days before and during hospitalization. Enzyme immunoassay was used to determine serum NT-proBNP concentrations in all the patients upon hospital admission. Results. AKI was diagnosed in 18 (22%) patients, 13 (16%) had Stage I, 4 (5%) had Stage II, and 1 (1%) had Stage III. The serum concentration of NT-proBNP was significantly higher in patients with AKI than that in the other patients [1512.1 (981.0; 2246.2) and 861.8 (499.0; 1383.6) pg/ml (p=0.008). The rise in NT-proBNP concentrations of more than 942 pg/ml was established to be associated with a considerable increase in the risk of AKI (relative risk (RR) was 4.3; 95% confidence interval (CI), 1.27—14.90; p=0.02). RОС analysis indicated that a NT-proBNP level of >942 pg/ml allows prediction of AKI with a sensitivity of 78% (52; 94) and a specificity of 55% (44; 69) (AUC=0.70; p=0.006). Four (5%) patients died in hospital. NT-proBNP levels in all the dead were greater than 942 pg/ml. Two of the 4 deceased patients had AKI. Conclusion. A high level of NT-proBNP in a patient with ADCHF during hospitalization can serve as a biomarker for high risk of AKI and for high mortality rates.</jats:p
Specific course of tuberculosis in elderly and senile patients
No full textThe objective: to identify specific features of the clinical course of tuberculosis in elderly and senile patients under the current epidemic situation.The specific clinical course of tuberculosis was analyzed in 54 patients at the age of 61 years and older and compared with the course of 234 patients at the age from 18 to 39 years selected by the continuous sampling of all 472 patients discharged from hospital in 2018. The following features were found to be typical of patients of 61 years and older: more frequent chronic forms of the disease (37.0%) and complications (35.2%), the major complication was chronic cor pulmonale (33.3%); more frequent concurrent chronic nonspecific lung diseases (13.0%) and coronary heart disease/arterial hypertension (14.8%); more frequent deaths (31.5%), mainly due to pulmonary heart disease; less frequent generalization of tuberculosis (5.5%) and concurrent HIV infection (7.4%)
The effect of single and dual antiplatelet therapy on the activity of pro-inflammatory cytokines in patients with coronary artery disease and obstructive sleep apnea
No full textAim. To study the activity of pro-inflammatory cytokines in patients with coronary artery disease (CAD) associated with obstructive sleep apnea (OSA), depending on the type of antiplatelet therapy.Material and methods. The study included 148 patients with stable CAD, 30% (n=44) of whom had mild OSA, 10% (n=14) — moderate and severe OSA. There were 60% (n=90) of patients without OSA. Pro-inflammatory activity of cytokines was assessed by the level of interleukins (IL): IL- 1β, IL-6, IL-10.Results. Using dual antiplatelet therapy, there were no differences in aggregation activity of platelets (spontaneous and induced by 0,1 pM ADP) in patients with and without OSA. This indicates the synergism and potentiation of the antiplatelet effect of clopidogrel and acetylsalicylic acid (ASA). Patients with moderate and severe OSA and stable CAD had higher levels of IL- 1β and IL-6 compared with patients without OSA. Antiplatelet therapy, especially dual one, had an anti-inflammatory effect, which was reflected in lower values of pro-inflammatory IL both in patients with and without OSA.Conclusion. Patients with moderate and severe OSA and stable CAD had higher levels of pro-inflammatory IL (IL- 1β, IL-6) compared with patients without OSA. The combined use of clopidogrel and ASA potentiates antiplatelet and anti-inflammatory effects. This is reflected in lower values of pro-inflammatory IL and lower aggregation activity of platelets in patients with stable CAD, regardless of OSA
Особенности течения туберкулеза у лиц пожилого и старческого возраста
No full textThe objective: to identify specific features of the clinical course of tuberculosis in elderly and senile patients under the current epidemic situation.The specific clinical course of tuberculosis was analyzed in 54 patients at the age of 61 years and older and compared with the course of 234 patients at the age from 18 to 39 years selected by the continuous sampling of all 472 patients discharged from hospital in 2018. The following features were found to be typical of patients of 61 years and older: more frequent chronic forms of the disease (37.0%) and complications (35.2%), the major complication was chronic cor pulmonale (33.3%); more frequent concurrent chronic nonspecific lung diseases (13.0%) and coronary heart disease/arterial hypertension (14.8%); more frequent deaths (31.5%), mainly due to pulmonary heart disease; less frequent generalization of tuberculosis (5.5%) and concurrent HIV infection (7.4%).Цель исследования: выявить особенности клинического течения туберкулеза у лиц пожилого и старческого возраста в современных эпидемических условиях.Проанализированы особенности клинического течения туберкулеза ‒ у 54 больных в возрасте 61 года и старше в сравнении с 234 пациентами 18-39 лет, отобранных сплошной выборкой из всех 472 больных, выписанных в 2018 г. Выявлено, что у лиц в возрасте 61 года и старше: более частая хронизация процесса (37,0%) и осложненное (35,2%), в основном хроническим легочным сердцем (33,3%), течение; более частые сопутствующие хронические неспецифические заболевания легких (13,0%) и ишемическая болезнь сердца/артериальная гипертония (14,8%); более частые летальные исходы (31,5%), преимущественно за счет легочно-сердечной недостаточности; более редки генерализация туберкулеза (5,5%) и сопутствующая ВИЧ-инфекция (7,4%)
