Purpose of the study: to study the effect of the combination of valsartan and sacubitril on the indices of central hemodynamics in patients with coronary heart disease (CHD) within 2 years after revascularization. Material and research methods. The study included 320 patients with coronary artery disease who underwent coronary revascularization. All patients were divided into 2 groups: patients who received valsartan (group B, 160 people), patients who received ARNI - a combination of valsartan and sacubitrile molecules (group C, 160 people). At baseline and in dynamics after three months, at the end of the first and second years of follow-up after revascularization in patients with coronary artery disease systolic the blood pressure (SBP, mm Hg), diastolic blood pressure (DBP, mm Hg), heart rate in minute, the concentration of brain natriuretic peptide (BNP) in the blood were determined. Also, during echocardiography, the stroke volume of the heart, indexed to the body surface area (SI, ml / m2), the minute index (MI, ml / m2), the mean pressure in the pulmonary artery (PA, mm Hg) were determined. Research results. In the group of patients taking valsartan (group B), the relative dynamics of BNP concentration was -10.69 ± 0.55% by the 3rd month of observation, -21.24 ± 1.03% by the end of the 1st year, and -34, 39 ± 1.64% by the end of the 2nd year of observation. The inclusion of sacubitril in the therapy scheme contributed to a greater positive effect in reducing the BNP concentration: the relative dynamics of the BNP concentration was -10.30 ± 0.52% by the 3rd month of observation, - 21.91 ± 1.00% by the end of the first year of observation, and -39.28 ± 1.67% (p <0.05 significant difference with group B). By the end of the 1st and 2nd years of observation, the use of a combination of valsartan and sacubitril contributed to a more pronounced decrease in blood pressure (p <0.01), a more pronounced dynamics of MI (p <0.05) and a decrease in pressure in РA (significantly lower baseline indicators, p <0.05 and indicator in group B, p <0.01). Conclusion. The present study revealed a positive effect of revascularization and subsequent therapy of coronary artery disease with the inclusion of sacubitrile on the BNP concentration, blood pressure and mean pressure of pulmonary artery.
The most important stage of anesthetic management is the period of induction into anesthesia, which requires control and regulation of central hemodynamics and vegetative changes, which creates conditions for ensuring a smooth course of subsequent stages of anesthesia without increasing intraocular pressure during surgical correction of congenital glaucoma in children.
Известно, что при наследственных формах заболевания часто наблюдается сочетание врожденной глаукомы с другими аномалиями глаза - аномалией Аксенфельда - Ригера, синдромом Франка - Каменецкого, аномалией Петерса, склерокорнеа (Bremond-Gignac D. 2007). Считается, что при глаукоме, сочетающейся с аномалиями глаза и синдромами, в отличие от гидрофтальма внутриглазное давление (ВГД) чаще повышается в более старшем возрасте, а именно во втором десятилетии жизни (юношеская глаукома), реже - после 5-6 лет и еще реже - в младенчестве (Катаргина Л.А., Хватова А.В., Коголева Л.В., и др.2010).
The importance of ophthalmotonometry in the diagnosis of ocular pathology cannot be overestimated. Not you- There are doubts about the need for this study in patients of all age groups [1]. For example tonometry data in eyes with a cornea having a thickness in the center of more than 580 microns need to be corrected lowering (real IOP is lower than the obtained data) [2].
Analysis of risk factors and clinical-hemodynamic parameters of patients with ischemic heart disease and arterial hypertension. Among the risk factors encountered in the examined IHD +AH patients, smoking + obesity + alcohol coexistence was 50%, obesity + hypodynamics 23.6%, alcohol + smoking 17%, heredity + alcohol + smoking 9.44%. Patients experienced headache in 75% of cases, tinnitus in 64%, weakness in 59%, tachycardia in 45%, and dizziness in 41%. The VEM test was performed in both groups of patients, with a threshold of (99.8 ± 2.3) Wt in patients with IHD + AH and 10.9% in patients with IHD without AH (109 ± 3.8) Wt. was At the same time (load) the duration of stress was equal to the initial value in the group with IHD + AH (8.3 ± 1.8), while in patients with IHD without AH was 9.2 ± 2.3 and 10.8%.
Среди анестезиологических проблем, связанных с лапароскопией у детей, выделяют главным образом, влияние на организм ребенка внутрибрюшной гипертензии. При лапароскопических вмешательствах существенное повышение внутрибрюшного давления вызывает разнообразные патологические эффекты на органы и системы, в особенности, на гемодинамику и дыхание, а также на функцию печени, почек и кровоснабжение органов брюшной полости. Повышение ВБД приводит и к росту внутригрудного давления за счет смещения диафрагмы вверх, что уменьшает объём грудной клетки и дыхательный объём. При этом повышается пиковое давление в дыхательных путях, растет сопротивление легочных сосудов с нарушением соотношения вентиляция-кровоток.
Проблема первичной открытоугольной глаукомы является одной из важнейших в современной офтальмологии. Распространенность заболевания находится в прямой зависимости от возраста: до 60 лет - 0,8, от 61 до 70 лет - 6,4, 71 год и старше - 7,4 на 1000 населения. Исторически, глаукому описывали как болезнь, одним из главных признаков которой является повышенное внутриглазное давление (ВГД), и только недавно ее стали считать основой оптической нейропатии, нейродегенеративным заболеванием. Уровень ВГД является очень важным, но не определяющим фактором сохранности зрительных функций. В связи с этим актуальность приобретают комплексные схемы лечения, сочетающие лекарственные, хирургические и физиотерапевтические методы, а также диктующие необходимость постоянной нейропротекторной терапии. Среди нейропротекторов прямого действия большого внимания заслуживает препарат «Гистохром».
Purpose of the study. To study risk factors for the development of complications in pseudophakic eyes. Material and methods. We carried out a retrospective and prospective analysis of the case histories of 65 children (65 eyes) diagnosed with pseudophakia, who were in the hospital in the eye department of the clinic of the Tashkent Pediatric Medical Institute over the past 5 years. The results of the study showed that the most significant risk factors for the development of intra- and postoperative complications are the following factors: FAI, neutrophil- leukocyte index (0.94±0.5), true intraocular pressure 20.5±1.2 mm Hg. Art., thickness of the choroid 1.02 ± 0.33 mm, protein in the CV above 3.5 ± 0.09 g/l, and in the blood below 62 ± 1.3 g/l
In the surgical treatment of glaucoma in children under anesthesia protection, the maximum reduction in intraocular pressure (IOP) is required. Otherwise, there is a possibility of a dangerous complication - vitreous prolapse. In this article the combined use of inhalation anesthetic sevoflurane in the surgical treatment of glaucoma in children is discussed as a method of improving the anesthetic protection of children.
Aim of research. To study the dynamics of the FBS of the eyes in children with congenital glaucoma by age. The studies were carried out in the clinic of TashPMI, on 132 eyes with congenital glaucoma. By age, patients were distributed according to the classification of E.S. Avetisova 2003. At the advanced stage of FBS, the eye exceeded the average statistical norm by 2.9 mm, 2.3 mm, 2.3 mm, at the advanced stage by 4.7 mm, 4.8 mm, 6.3 mm, and at the terminal stage by 7.5 mm, respectively, in each age group of eyes. An increase in the size of the anterior-posterior axis of the eye in congenital glaucoma depends not only on the violation of the hemo hydrodynamic processes of the eye with the accumulation of intraocular fluid, but also depends on the age-related dynamics of eye growth.
Purpose — to determine the values of central corneal thickness (CCT) in children depending on the level of intraocular pressure
(IOP) and the stage of congenital glaucoma (CG).
Material and methods. Clinical studies were carried out in the eye department of the clinic at the Tashkent Pediatric Medical In-
stitute. The study involved 18 patients (36 eyes) aged 9 to 11 years (mean age 9.3±1.6 years) with confirmed diagnosis of CG.
All patients underwent basic ophthalmologic examination prior to surgical and conservative treatment. In addition to basic meth-
ods, axial eye length and CCT were determined using an automatic non-contact tonometer/pachymeter manufactured by NIDEK
(USA).
Results. Analysis of the obtained data showed that in initial, moderate and advanced stages of glaucoma, the CCT values were sig-
nificantly lower than the age norm values. This indicates stretching of the fibrous capsule and thinning of the cornea in glaucoma.
In terminal stage CG, the CCT values practically did not differ from the age norm, but were higher than in initial, moderate and ad-
vanced stages of the disease. The noted thickening of the corneal membrane in terminal stage may be explained by edema of the cor-
neal tissue as a result of elevated IOP.
Conclusion. The age norm values of CCT should be taken into account when characterizing the severity of glaucomatous process
in children. Compared to the age norm, the cornea is significantly thinner in children aged 9 to 11 years with initial, moderate
and advanced stages of CG, and becomes significantly thicker in terminal stage, which is associated with edema caused by ele-
vated IOP.
Prevention and elimination of increased intraocular pressure is one of the most important tasks of an anesthesiologist during ophthalmic operations, therefore, the search for optimal anesthesia schemes is an urgent problem of modern anesthesiology. The aim of the work was to evaluate the effectiveness of combined methods of anesthesia in intraocular surgery in children by analyzing hemodynamic parameters. We examined 46 children who needed ophthalmological operations. The following anesthesia schemes were used: sevoflurane + fentanyl (group 1), propofol + fentanyl (group 2). Anesthesia effectiveness was assessed on the basis of clinical data with monitoring of the main hemodynamic and respiratory parameters. The results showed that the anesthesia regimens used were characterized by a smooth clinical course, while maintaining the stability of the main hemodynamic parameters.
In patients with opened angle with slight pigmentation or without pigmentation and subatrophy of iris root Travatan turned out to be the most efficient treatment choice. In patients with opened angle with evident endo- and exopigmentationDuotrav was most effective antiglaucomatous drug. In patients with rostral profile of angle Fotil Forte combined with Travatan was the most effective choice. In most evident pigmentation of angle laser trabeculoplasty is recommended as additional method of glaucoma treatment.
Childhood glaucoma is a chronic vision threatening condition that may significantly impact an individual’s psychosocial well-being. The prognosis of glaucoma largely depends on early and accurate diagnosis and successful treatment, including control of increased. The purpose is to determine the effectiveness of modified tonometers (Maklakova) NGm2-"OF TP" in performing tonometry and tonography in infants and children with microphthalmos and blepharophimosis. We have proposed modified models of Maklakoff tonometers weighing 5, 10, and 15 g, made of silver, the weights on both sides have contact plates, which are made of medical plastic and have a diameter of the applanation area d=8 mm. Methods: Tonometry and tonography using the simplified method of Nesterov A.P. were carried out in 30 (60 eyes) children aged from birth (0) to 16 years. Results: Our recommended design of weights showed results that do not differ from those obtained using standard Maklakov tonometers. At the same time, modified weights provide the opportunity to determine tonometric IOP and eye hydrodynamics in newborns and patients with microphthalmia and/or blepharophimosis, which greatly facilitates the work of pediatric ophthalmologists and reduces examination time.
Determine the indicators of intraocular pressure (IOP) tonometry, taking into account the parameters of the central thickness of the cornea (CTC) in children with congenital infantile glaucoma (CIG). Clinical studies were conducted in the eye department of the Tashkent Pediatric Medical Institute's clinic. A total of 14 patients (26 eyes) aged 3 to 10 years with a diagnosis of CG were examined. All patients underwent basic ophthalmologic examination prior to surgical and conservative treatment. In addition to basic methods, the axial length of the eyeball was determined, and the CTC was determined on an automatic non-contact tonometer - Reichert pachymeter (USA). An analysis of the data showed: IOP in 39% of cases was considered subnormal, after correction taking into account the CTC in 11% of cases, the IOP was high. This group (11% of cases) was composed of children with a “thin” cornea at the terminal stage of CIG and high myopia. The correct interpretation of IOP indicators will help in choosing an adequate treatment and monitoring the glaucoma process. The used indicator of the central nervous system has practical significance in the interpretation of tonometry according to Maklakov 5 gr.
Surgery is the main treatment for congenital glaucoma. At the present stage, inhalation anesthetics (IAs) continue to meet all the necessary requirements, but combined methods of anesthesia based on sevoflurane remain controversial. In ophthalmic practice, this method has the following advantages: controllability of anesthesia, less effect on intraocular pressure, ensuring a smooth course of anesthesia.