Study of the development level of risk factors in dangerous tumors causing lonely arterial thromboembolia

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Авезов A., Каттаходжаева M., Болтоева F., & Юлдашева S. (2020). Study of the development level of risk factors in dangerous tumors causing lonely arterial thromboembolia. in Library, 20(4), 1751–1760. извлечено от https://inlibrary.uz/index.php/archive/article/view/14778
Абаджон Авезов, Ташкентская медицинская академия

Ургенчский филиал

Феруза Болтоева, Ташкентская медицинская академия

Ургенчский филиал

Сайёра Юлдашева, Ташкентская медицинская академия

Ургенчский филиал

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Аннотация

Our study showed that VTE is one of the most serious complications in patients with oncopathology and determines  the  course  of  the  disease,  requires  dynamic  monitoring  of  hemodynamic  parameters  and timely  administration  of  both  pharmacological  and  mechanical  means  of  preventing  thrombosis. Preventing  the  development  of  VTE  is  one  of  the  important  steps  to  increase  the  survival  of  cancer patients


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International Journal of Advanced Science and Technology

Vol. 29, No. 5, (2020), pp. 1751-1760

1751

ISSN: 2005-4238 IJAST
Copyright ⓒ 2020 SERSC

STUDY OF THE DEVELOPMENT LEVEL OF RISK FACTORS IN

DANGEROUS TUMORS CAUSING LONELY ARTERIAL

THROMBOEMBOLIA

Abadjon Avezov, -

Urgench branch of Tashkent Medical Academy Republic of Uzbekistan

Mahmuda Kattahodjaeva, -

Tashkent State Institute of Dentistry, Republic of Uzbekistan

Feruza Boltoeva, -

Urgench branch of Tashkent Medical Academy Republic of Uzbekistan

Sayyora Yuldasheva -

Urgench branch of Tashkent Medical Academy Republic of Uzbekistan

Abstract

Our study showed that VTE is one of the most serious complications in patients with oncopathology and
determines the course of the disease, requires dynamic monitoring of hemodynamic parameters and
timely administration of both pharmacological and mechanical means of preventing thrombosis.
Preventing the development of VTE is one of the important steps to increase the survival of cancer
patients

Keywords:

TELA, pathological changes of thromboembolism, pulmonary artery thromboembolism,

venous thrombosis, pathomorphological changes of TELA in malignant tumors

Introduction
The actuality of the problem.

The practical significance of the problem of pulmonary artery

thromboembolism is currently determined by the apparent increase in the frequency of pulmonary artery
thromboembolism in various diseases, a significant increase in the frequency of postoperative and
posttraumatic embolisms common during complex surgical interventions; moreover, deaths from
pulmonary artery thromboembolism in highly developed countries are the third leading cause of death
after ischemic heart disease and stroke (P.V. Ipatov et al., 2005).
To look for a possible source of the development of pulmonary artery thromboembolism, several risk
factors for this disease have been evaluated and a number of additional studies have been conducted to
identify dangerous areas where embolism may develop. Varicose veins of the legs in 27 (21.9%) patients,
surgical procedures in 76 (59.4%) patients, history of pulmonary artery thromboembolism in 12 (9.3%)
patients, injuries of various etiologies in 13 (10.1%) patients observed. Furthermore, when other cases are
analyzed, most of them are independent risk factors, according to the literature. Among them, obesity was
observed in 16 subjects (12.5%), UIC (post-infarction cardiosclerosis) - 22 (17.2%) and UIC-13 (10.1%)
with arrhythmias. Particular attention is paid to chronic heart failure as a risk factor in the development of
pulmonary artery thromboembolism. Chronic heart failure (CHF) was reported in 98 (76.6%) patients. In
the analysis of etiological factors, taking into account gender and age, varicose veins of the legs are the
most common risk factor in both groups.
Women underwent more surgeries than men. However, symptoms and injuries of ischemic heart disease
(post-infarction cardiosclerosis) were more common in men (n <0.05). In the group over 60 years of age,
symptoms of systolic dysfunction and ischemic heart disease (ischemic heart disease (IHD) complicated
by post-infarction cardiosclerosis and atrial fibrillation) were more common (p <0.05). More than half of
the patients (52.2%) were found to have multiple risk factors combined. Distribution by risk groups helps
clinicians to make the correct diagnosis, make the right decisions in case of doubt obtained as a result of
examinations (T.A. Batyraliev and co-authors, 2006; Vyortkin A.L. and co-authors, 2007).
Isolation of patients with venous diseases of the legs in the postoperative period, prolonged
immobilization for various reasons in heart failure, obesity and some congenital coagulopathies allows
not only to reduce the time of diagnosis, but also to take timely preventive measures.
According to the literature, the most typical symptoms of pulmonary artery thromboembolism are
shortness of breath, tachypnoea, chest pain, tachycardia, cough, spitting up blood, and leg vein
thrombosis. (Ipatov P.V. et al., 2006; Korovina N.P. et al., 2005). Shortness of breath is one of the most
common symptoms.The results of research prove this fact. In patients with pulmonary artery


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thromboembolism, this condition was reported in 89.5%. In rare cases, signs of myocardial infarction
were detected: pleurisy pain - 49.9%, cough - 30.7%, fever - 11.9%, hemorrhage - 15%.

Frequency of occurrence of clinical signs in patients

with pulmonary artery thromboembolism.

Dyspnea

Chest pain

Сough

Fever

Spitting blood

Figure

1

Frequency of occurrence of clinical signs in patients with pulmonary artery

thromboembolism.

The aim of the study:

To study the morphological changes and causes of death in malignant neoplasms

complicated by pulmonary artery thromboembolism, to study the correlation between morphological
changes and hemodynamic parameters.

Scientific novelty:

The relationship between morphological changes and death resulting from pulmonary

artery thromboembolism in malignant neoplasms has been studied based on the results of a study. For the
first time, morphological and hemodynamic changes in the lungs, the interrelationships between the levels
of ischemia are thoroughly analyzed, compared, studied on the basis of the relevant data obtained, and
appropriate conclusions are drawn.


Methods and materials

Patients who died during treatment in the surgical and other treatment departments of the Republican
Specialized Scientific-Practical Medical Center of Oncology and Radiology are widely used data obtained
through retrospective study of autopsy statements and medical history data. A total of 128 selected patient
data will be studied. The selected patients were mainly divided into 2 groups: 1. The main group
included: autopsy and medical history data from 98 (76.6%) corpses who died of pulmonary artery
thromboembolism; 2. In the control group: 30 (23.4%) corpses with other causes of death other than
pulmonary artery thromboembolism were first analyzed in detail by autopsy and retrospective study of
disease histories, and appropriate conclusions were drawn and studied.
Research studies are evaluated using autopsy data from corpses and data from medical histories. 76
(59.4%) women with an average age of 56.6 ± 3.5 years, 52 (40.6%) men. Of the 128 cases, 13 (10.1%)
were under the age of 30-40, 33 (25.8%) were under the age of 41-50, 45 (35.1%) were under the age of
51-65, and 37 (29.0%) Over the age of 66”, of which 58 (45.3%) were urban residents and 70 (54.7%)
were rural residents. Statistically analyzed and studied.





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Table 1. The results of the general analysis of the selected population in terms of age and living
conditions in the population.

Age


30-40 age
n-13

41-50 age
n-33

51-65 age
n-36

66 age and older
n-46

Total number
n-128

Average
age
living
condition

35,7 ± 3,2

45,5 ± 3,6

57,8 ± 3,5

69,6 ± 3,5

56,6 ± 3,5

Urban

7(5,4%)

14(11,0%)

17(13,3%)

20(15,6%)

58(45,3%)

Rural

6(4,7%)

19(14,8%)

19(14,8%)

26(20,4%)

70(54,7%)

Total

13(10,1%)

33(25,8%)

36(28,1%)

46(36,0%)

128(100%)




Figure1. Frequency of total indicators as a percentage of the total studied population

0

5

10

15

20

25

30

35

40

45

Between 30-

40 years

41-50

51-65

66 and older

Number of patients studied

Percentage of patients studied

Figure 2. Frequency of total indicators as a percentage of the total studied population


To confirm the pathological diagnosis, thrombus samples were sent for microscopic examination in the
histological laboratory. Injury of the pulmonary artery was assessed in accordance with the
recommendations (Paltsev M.A., Kaktursky L.V., Zaratyants OV Pathological anatomy: Nats.
Rukovodstvo. M .: GEOTAR - Media; 2011. 375-378).

Incisions are taken from the tissue obtained at autopsy on the same day. The materials were

processed in accordance with the guidelines for the unification of methods of biopsy and histological and
histochemical examination of surgical materials.
Ischemic infarctions are observed in the lungs. The main reason for this was found to be cases of vascular
thromboembolism, and in rare cases, cases of thrombosis in vasculitis. The infarct is clearly demarcated
from the periphery and is conical in shape, with the base facing the pleura. Fibrin deposits form in the
pleura at the site of infarction (reactive pleurisy).


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A thrombus or embolus is detected in the branches of the pulmonary arteries at the end of the cone facing
the root of the lung. Dead lung tissue is dense, granular, dark red in color. Pulmonary ischemic infarction
is a hemorrhagic coronary white infarction and usually develops against the background of venous
stagnation, the occurrence of which is to some extent explained by the specificity of pulmonary vascular
architecture, the presence of anastomoses between the pulmonary and bronchial arteries.
Of the 98 (main group) corpses who died of pulmonary artery thromboembolism as a complication of
malignant neoplasms, 3 (3.9%) were 30-40 years old, 23 (17.1%) were 41-50 years old, and 30 (31.6%)
were ) were 51-65 years old, 42 (47.3%) were 66 years old and older, of which 42 (42.8%) were urban
residents and 56 (57.2%) were rural residents. (Table 2)

Table 2. The prevalence of mortality from pulmonary artery thromboembolism among urban and
rural populations.

Age

Address

30-40age
n-3

41-50 age
n-23

51-65 age
n-30

66 age and older
n-42

Total
number
n-98

Urban

2(2,0%)

10(10,2%)

12(12,2%)

18(18,4%)

42(42,8%)

Rural

1(1,0%)

13(13,3%)

18(18,4%)

24(24,5%)

56(57,2%)

Total

3(3,0%)

23(23,5%)

30(30,6%)

42(42,9%)

98(100%)


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Figure 2. The frequency of deaths from pulmonary artery thromboembolism among urban and

rural populations

Of the 30 (control group) corpses that died from other complications of malignant neoplasms, not from
PATE, which developed as a complication in malignant neoplasms, 10 (7.8%) were 30-40 years old, 10
(7.8%) were 41-50 years old, 6 ( 4.7%) are 51-65 years old, 4 (3.1%) are 66 years old and older, of which
16 (53.3%) are urban and 14 (46.7%) are rural. detected. (Table 3)

Table 3. The prevalence of mortality rates among urban and rural populations from other
complications of malignant neoplasms

.

Age

Address

30-40age
n-10

41-50 age
n-10

51-65 age
n-6

66 age and older
n-4

Total number
n-30

Urban

5(16,7%)

4(13,3%)

5(16,7%)

2(6,7%)

16(53,3%)

Rural

5(16,7%)

6(20,0%)

1(3,3%)

2(6,7%)

14(46,7%)

Total

10(33,3%)

10(33,3%)

6(20,0%)

4(13,4%)

30(100%)


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Figure 3. The frequency of encounters between urban and rural populations in mortality rates from

other complications of malignant neoplasms

According to the results of autopsy reports from the Department of Pathomorphology of the Republican
Specialized Scientific-Practical Medical Center of Oncology and Radiology, the results of the study of
corpses in patients with pulmonary artery thromboembolism, the main cause of death, were as follows:

0

5

10

15

20

30-40

41-50

51-65

66 and

older

city

vilage

Figure 4. The frequency of encounters between urban and rural populations in mortality rates from

other complications of malignant neoplasms

According to the results of autopsy reports from the Department of Pathomorphology of the Republican
Specialized Scientific-Practical Medical Center of Oncology and Radiology, the results of the study of
corpses in patients with pulmonary artery thromboembolism, the main cause of death, were as follows:


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0

1

2

3

4

5

31-40 age

41-50 age

51-65 age

66 and older

Ovarian cancer

bowel cancer

Pancreatic cancer

Cervical cancer

Liver and gallbladder cancer

Mammary cancer

Cardioesophageal sphere

Sigmoideum bowel cancer

Cervical cancer

Tumors of the bladder

Cancer of the middle part of the esophagus

Stomach cancer

Colorectal cancer

Lung cancer

Figure 5. Frequency of deaths from pulmonary artery thromboembolism in the population

depending on age and type of malignant tumor

Analyzing the data obtained, after surgery, in most cases, deaths from colorectal, gastric, lung, liver,
uterine, ovarian, and bladder cancers were observed in people over 51 years of age.
Among the cancers that pose a risk of developing direct pulmonary artery thromboembolism, the most
common are adenocarcinomas, squamous cell carcinomas, and variable cell tumors. These tumors are
most often observed in the lungs, stomach, rectum, uterus, anal canals. The most common causes of
pulmonary artery thromboembolism after cancer in these organs are their anatomical and histological
features, arterial and venous angioarchitectonics, postoperative immobilization conditions, inactivity, as
well as changes in blood rheological properties in the above-mentioned cancers. Disorders of the
anticoagulant system, including changes in the formation of vitamin K, Ca ions from the factors involved
in blood clotting, especially the liver The disease leads to chronic hepatitis, obesity of II-III degree.
Autopsy examination revealed the presence of a thrombus in one of the pulmonary arteries, often on the
right side, in 27.2% (35) corpses, regardless of gender and age. In 78.5% (77) corpses, thrombi were
detected in the small and segmental branches of the pulmonary artery. In 73.5% (72) corpses,
simultaneous thrombus occlusion of the arteries of both lungs was noted; In 16.3% (16 corpses) - only
cases of occlusion of the small branches of the right pulmonary artery were detected, in 10.2 (10 corpses)
cases - only cases of occlusion of the small branches of the left pulmonary artery were detected.
In each follow-up of pulmonary artery thromboembolism, the task is to determine its source. However,
the source of pulmonary embolism was not identified at autopsy in 7.9% of patients (10 corpses).


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According to the data obtained at the autopsy, from 2001 to 2018, 98 deaths from pulmonary artery
thromboembolism were observed, regardless of gender, and it was found that thromboembolism was
located in different parts of the pulmonary arteries.
Pulmonary artery thromboembolism has been observed more frequently in the postoperative period for
malignant neoplasms of the stomach and rectum, as well as liver and lung cancers. Pulmonary artery
thromboembolism resulting from blood clot embolism formed in the right ventricular cavity at varying
degrees of heart failure was detected in 16.3% (16 corpses).
Among the causes of pulmonary artery thromboembolism in 6.1% of cases are hematologic
paraneoplastic processes in malignant tumors of various localizations.
Table 5. Distribution of hematologic paraneoplastic processes in various localized risk factors.

Gemotokrit indicators



Risk factors

П

ТИ

R

ec

ove

ry t

im

e

(

m

inu

t)

Fibr

inog

en A

(g/

l)

Fibr

inog

en B

Throm

bot

es

t

H

em

at

oc

ri

t

1

Chronic hepatitis

86-95%

70-78

3,15-4,5

(-)

V

36%

2

Obesity

84-95%

72-75

3,20-4,5

(-)

V

34-36%

3

Chronic bronchitis

86-108%

68-72

3,6-6.3

(+)

VI

35%

4

Diabetes mellitus

95-98%

70-72

4,5-4,8

(-)

IV

31%

5

Varicose expansion of the leg veins

86-90%

71-76

3,15-3,26

(-)

IV

43%

6

Coronary heart disease

95-98%

75-78

3,6-4,5

(-)

VI

42%

7

UKI

95-90%

75-78

3,5-4,5

(-)

VI

42%

8

Arterial hypertension

95-108%

70-78

3,2-4,5

(-)

V

36%

9

Atherosclerosis

86-98%

75-78

3,6-4,5

(-)

VI

43%


Autopsy and retrospective analysis of the majority of patients helped identify risk factors for
thromboembolic complications in 106 (82.6%) corpses. More than half of the patients were found to have
multiple risk factors in 72 (73.5%) corpses.
Including chronic hepatitis 18 (18.3%); arterial hypertension 8 (8.2%); diabetes mellitus 5 (5.1%); obesity
9 (9.2%); chronic bronchitis 6 (6.1%); varicose veins of the legs 7 (7.1%); coronary cardiosclerosis 9
(9.2%); ischemic heart disease 4 (4.1%); atherosclerosis was 6 (6.1%). These data are reflected in the
table below
Table 6. Distribution of advanced deaths by age and frequency of occurrence according to the cause of
death, depending on the identified risk factors

The main cause of
death PATE (n -
98)

Deaths from other causes
(n-30)


Age

Average
(SD)

57,8 ± 3,5

56,6 ± 3,5

30-40 age

n ( %)

3(3,0%)

10(33,3%)

41-50 age

n ( %)

23(23,5%)

10(33,3%)

51-65 age

n (%)

30 (30,6%)

6(20,0%)

66 age and older

n (%)

42 (42,9%)

4(13,4%)

Chronic hepatitis

n (%)

18 (18,3%)

7(23,3%)


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Arterial hypertension

n (%)

8 (8,2%)

5(16,7%)

Diabetes mellitus

n (%)

5 (5,1%)

3(10,0%)

Obesity

n (%)

9 (9,2%)

5(16,7%)

Chronic bronchitis

n (%)

6 (6,1%)

2(6,7%)

Varicose expansion of the leg
veins

n (%)

7 (7,1%)

2(6,7%)

Coronary heart disease

n (%)

9 (9,2%)

5(16,7) %)

Ischemic heart disease

(%)

4 (4,1%)

5(16,7%)

Atherosclerosis

(%)

6 (6,1%)

4(13,3%)


The study found that as the risk of developing pulmonary artery thromboembolism increased with age, the
analysis of autopsy materials from 98 corpses who died of PATE showed that risk factors were found to
be different in 72 (73.5%) corpses.


CONCLUSION

Thus, autopsy and retrospective analysis of the corpses revealed that more than half of the patients had
multiple risk factors in 72 (73.5%) corpses. Including chronic hepatitis 18 (18.3%); arterial hypertension
8 (8.2%); diabetes mellitus 5 (5.1%); obesity 9 (9.2%); chronic bronchitis 6 (6.1%); varicose veins of the
legs 7 (7.1%); coronary cardiosclerosis 9 (9.2%); ischemic heart disease 4 (4.1%); atherosclerosis was 6
(6.1%) and a combination of two or more risk factors was found.
Other concomitant diseases that occur in tumors with high risk factors; it is necessary to pay more
attention to hepatitis, obesity, arterial hypertension, coronary heart disease, varicose veins, chronic
bronchitis, diabetes, atherosclerosis, ischemic heart disease.


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Библиографические ссылки

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Alekhin M.N., Sidorenko B.A. Modern approaches to echocardiographic evaluation of systolic function of the heart. // Cardiology. - 2007. No. 7.-S. 4-12.

Alyokhin M.N. Tissue doppler in clinical echocardiography // Cardiology. 2006. - T. 46, No. 5. -S. 68-70.

Barkagan Z.S., Mamot A.P. The basics of prolonged prophylaxis of thromboembolism therapy with indirect anticoagulants (indications, dose selection, laboratory monitoring). M .: Medicine, 2004 .- 143 p.

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Boychevskaya E.I. Functional evaluation of treatment results for massive pulmonary embolism: Abstract. Diss. Candidate of Medical Scicncc-M, 1991 - 147 p.

Vcnchikov A.I., Vcnchikov V.A. The main methods of statistical processing of observation results in the field of physiology. M .: Medicine, 1974, - 148 p.

Vertkin A.L., Baratashvili V.L., Belyaeva S.A. Pulmonary thromboembolism // Handbook of a polyclinic physician. 2007. - No. 5. - S. 11-13.

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Kozlovskaya X-ZH. Thrombophilic conditions // Clinical Pharmacology and Therapy. 2003. - No. 12.-S.74-85.

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Azimjon Naziijonovich Tursunkulov, Erectile dysfunction in patients with prostate cancer after radical prostatectomy by various methods. Journal of Biomedicine and Practice 2019, vol. 2, issue 5, pp. 17-22 http://dx.doi.org/10.26739/2181-9300-2019-5-2

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