Замонавий тиббиёт радиацион тасвирлаш усулларининг сезиларли даражада ривожланиши ва дсярли барча анатомии сохаларни бахолаш учуй мослаштириши мумкин булган турли режимларнинг пайдо булиши билан ажралиб туради. Ушбу тадкикот натижаларига кура, COV1D-19 билан боглик булган кавсрноз синус тромбозини эрта аниклаш учун тасвирлаш методологиясини таклиф килади. Тромбнинг борлигини аниклаш имкон бсрадиган махсус рсжимларда МРТ тасвирларини тавсифлаш ва изохлаш амалга оширилди. Тадкикот шуни курсатдики, тавсия этилган тасвирлаш усули узига хос аломатлар пайдо булишидан олдин бсморларда тромбозни эрта аниклашга имкон бсради.
A clinical case of EYE MANIFESTATIONS of complications is presented in a teenager who has had COVID-19. The studies were carried out in the intensive care unit and intensive care unit (ICU) of the clinic of the Tashkent Pediatric Medical institute. The patient underwent standard laboratory and instrumental studies, as well as an ophthalmological examination, including visometry, biomicroscopy, ophthalmoscopy. This clinical case showed that COVID-19 infection was complicated polymorphic ophthalmic symptoms indicating involvement in the process lacrimal gland, mucous membranes of the eyeball and eyelids, cornea of the lacrimal sac, retrobulbar tissue, while from the side of the eyes these complications are expressed in dry keratoconjunctivitis (Sjögren's syndrome).
Relevance of the problem.Despite the great successes of angiosurgery, the problem of surgical treatment of abdominal aortic aneurysms does not lose its relevance. World health statistics records a steady increase in the incidence of abdominal aortic aneurysm (ABA). According to L.J. Melton et al. (1984) and L.K. Bickerstaff et al. (1984) in the USA the number of patients with abdominal aortic aneurysm has increased 7 times in 30 years since 1951. In England and Wales, according to F.G. Fowkers et al. (1989) for the same period revealed a 20-fold increase in abdominal aortic aneurysms in men and 11-fold in women. According to the results of multicentre screening studies ABA was detected in 8% of the examined (E.S. Vourvouri, 2001), and in the age group of 64-69 years ABA was detected in 5.7% of the examined, and in the age group of 75-81 years - in 8.9% (R.A.P. Skott et al., 2001). A similar trend is observed in other countries. Accordingly, mortality from ABA is also increasing - aneurysm rupture in a number of countries is one of the ten most frequent causes of death among elderly and senile people (F.A. Lederle et al., 1990)
Currently, planned aneurysm resection has become a recognised standard of radical treatment of ABA patients and the number of these operations is steadily increasing. For example, about 40,000 ABA resections are performed annually in the USA (J.J. Grange et al., 1997). In Sweden during the period from 1987-89 to 1993-95 the number of ABA operations increased 5 times and currently 10 operations per 100,000 population are performed (A.Hallin et al., 2001), although this is 1.5 - 2 times less than the required number. However, postoperative lethality is still quite high and makes 5-7% (A.V.Pokrovskiy et al., 1992; Y.V.Belov et al., 1992; V.V.Vakhidov et al., 1992; A.W. Bradbury et al. Bradbury et al., 1997; A.Hallin et al., 2001).
E.W. Steyeberg et al. (1995) summarised the data of literature on 17238 ABA resection operations and gave an average mortality of 6.8%.
Multicentre studies in five major hospitals in the Netherlands found that only 74% of patients underwent ABA resection without complications; 26% had some complications, 9% of which were severe and 4.1% of which were fatal (G.J. Akkersdijk et al., 1998). Similar results were obtained in the Canadian Cooperative Study (K.W. Johnston et al., 1990). It was established that the peculiarity of complications in the majority of patients was their systemic character (L.L. Lau et al, 2001) The course of the postoperative period is most often complicated by cardiac, respiratory, renal, cerebrovascular, as well as complications associated with thrombosis and bleeding (W.E. Lloyd et al., 1996; R.D. Sayers et al., 1997; J.D. Blankenstein et al., 1998; R. Ayari et al., 1998). Ayari et al., 2001)
The undisputed leadership, without doubt, belongs to cardiac complications, the incidence of which varies from 10% to 20%. Moreover, cardiac complications account for 50-70% of total mortality. Cerebrovascular complications, although not uncommon, account for no more than 1-1.5%, but their mortality reaches 40%. Complications associated with thromboses and haemorrhages in the perioperative period reach 2-5% (M.M.Reigel et al., 1987; K.W.Johnson et al., 1990; N.Franklin et al., 1993; A.A.Milne et al., 1994).
Certainly, a large number of complications after resection of abdominal aortic aneurysms is caused by the initial severity of patients' condition, however, many unresolved tactical and technical issues of patients' preparation for the operation, stage of performance in case of combined lesions of several vascular basins play a practically significant role. Adequate management of the operation itself and the immediate postoperative period is no less important, taking into account the possibility of such dreadful complications as thrombosis and embolism, cerebral and cardiac death. Until now there is no unified complex analysis of the results of treatment of uncomplicated abdominal aortic aneurysms and, accordingly, recommendations for the prevention of possible complications.
All this determined our aim and objectives of the study.
The aim of the study is to improve the results of surgical treatment of ABA by developing an effective system for determining the main risk factors of surgical treatment and optimal surgical tactics to prevent possible complications.
Scientific novelty.For the first time a complex analysis of indications and contraindications to surgical treatment of abdominal aortic aneurysms was carried out
The most significant concomitant pathology capable to lead to formidable complications and lethality during the intervention and in the nearest postoperative period was revealed. Adequate measures of their prevention and treatment were proposed.
The algorithm of surgical treatment tactics for patients with combined pathology of coronary arteries and aortic arch branch lesions was developed
The state of haemostasis system at all stages of reconstructive surgery on abdominal aorta, starting from skin incision to wound closure, was studied for the first time.
Conclusions:
1. The proposed original classification of ABA, based on mutual dependence on the etiology of the disease, localisation, concomitant diseases, clinic and its course, allows to determine the strategy of early diagnosis, to estimate the most significant risk factors, the stage of intervention in combined lesions of adjacent and distant vascular basins and, ultimately, to determine the ways to reduce complications and mortality in patients with ABA.
2. The most informative methods of ABA diagnostics are duplex scanning and computed tomography. Non-invasive diagnostics capabilities are enough to determine the aneurysm size, its relation to the renal arteries, as well as to find out the state of visceral branches and aortic bifurcation. Abdominal aortography is indicated in patients with concomitant arterial hypertension to identify the state of the renal arteries.
3. Significant risk factors in these patients are ischaemic heart disease (44.1%), arterial hypertension (49%), haemostasis disorders (almost 100%).
4. The leading concomitant disease in the development of postoperative complications is ischaemic heart disease. Its share in abdominal aortic aneurysms is 40%. Postoperative cardiac complications reach 14.9%. Diagnostics of ischaemic heart disease should be based on the stage-by-stage detection of coronary lesions and its functional-compensatory abilities.
5. The main complications of the postoperative period after ABA resections are acute heart failure (14,9%), cerebral circulatory disorders (1,5%), acute renal failure (3,33%).
6. When significant coronary vascular channel lesions are detected in patients with ABA, it is fundamental to solve the issue of intervention staging. At 3-4 functional classes of circulatory insufficiency, appearance of new zones of hypo- or akinesia, decrease of ejection fraction below 40%, the first stage should be myocardial revascularisation surgery
7. In patients with combined lesions of brachiocephalic vessels in patients with ABA it is reasonable to assess the cerebral blood flow. In the presence of 70% or more stenosis of VCA, presence of embologenic plaque, bilateral haemodynamically significant stenosis it is necessary to perform carotid artery intervention as the first stage.
8. One of the most difficult problems of reconstructive operations in ABA is the contiguous lesion of renal and visceral branches of the abdominal aorta. The principle is their one-stage reconstruction. The types of reconstruction of these branches should be variable depending on the volume and extent of the pathological process.
9. Patients with aneurysmal lesion of abdominal aorta initially always have significant disorders of haemostasis system. In 30% of patients with occlusive diseases of aorta and its branches in the preoperative period the activity of thrombocytic-vascular link of hemostasis is increased, antithrombotic ability of vascular wall endothelium is decreased and blood rheological properties are disturbed. Activation of fibrinolysis was noted in patients with aneurysmal lesion of abdominal aorta.
10. During the operation for abdominal aortic aneurysmal lesion, after starting the blood flow the level of plasminogen increases additionally by 30%, which is a risk factor for haemorrhagic complications in the perioperative period. On the 1-3 day after the operation there is a significant decrease of blood anticoagulant potential - antithrombin-Sh by 25-27%, protein C by 23-25%. This period is the most dangerous in terms of thrombohemorrhagic complications development.
11. When using standard heparin during the operation there is a consumption of antithrombin-Sh by 30-45% and increase of platelet aggregation by 10%, which is a threatening condition for the occurrence of thrombosis of deep veins of the lower extremities with subsequent TELA. When using fraxiparin during reconstructive vascular surgeries the consumption of antithrombin-Sh and increase in platelet aggregation do not occur, prothrombin time, activated partial thromboplastin time, thrombin time are lengthened insignificantly that testifies to expediency of its use for prevention of thrombohemorrhagic complications.
12. Application of the diagnostic methods proposed by us to detect the main risk factors during the operation and in the nearest postoperative period, use of the algorithm of stage and volume of intervention allowed to reduce significantly the number of threatening complications, thus the lethality decreased 4 times, and the number of non-fatal complications - 4 times non-fatal complications - 1.5 times.
The treatment of obliterative diseases of the lower limb vessels remains a significant challenge in modern vascular surgery. The high frequency of postoperative complications, high mortality, and progression of atherosclerotic processes after reconstructive interventions on the vessels of the lower limbs have led to a search for pathogenetically justified ways and means of preventing complications of reconstructive surgeries.
The author employed hypolipidemic agents, namely glyrofam and colestid, to develop a conservative prophylaxis regimen for postoperative complications of obliterating atherosclerosis. The regimen was based on the study of platelet aggregation activity indices and lipid metabolism state. It consisted of a course of treatment with hypolipidemic drugs, administered in 1-month cycles with a 3-month periodicity.
The clinical material comprises the examination and treatment of 138 patients. The control group included 61 patients. The main group comprised 77 patients, 39 of whom took colestid and 38 patients used glyrofam.
The study of long-term outcomes demonstrated a reduction in the incidence of postoperative thrombosis from 8.1% to 1.3% and a decrease in mortality from 13% to 2.6% in patients undergoing hypolipidemic therapy.
These findings suggest that hypolipidemic drugs that affect lipid metabolism may prevent the progression of atherosclerotic processes and that drugs that affect the rheological properties of blood may reduce the incidence of postoperative thrombosis.
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.
Пандемия коронавирусного заболевания 2019 года (Covid-19), вызванная тяжелым острым респираторным синдромом коронавирусом 2 (SARS-CoV-2), стимулировала разработку высокоэффективных вакцин, которые производились с беспрецедентной скоростью с использованием разнообразных технологий. Однако неудивительно, что появились новые сообщения о побочных эффектах, так как еще много людей вакцинированы, а период наблюдения продлен.
Atherosclerosis, the morphological correlates of vascular disease, is characterized by early endonthelial dysfunction, vascular inflammation together with build-up of lipids, cholesterol, calcium and cellular debris within the intima of the vessel wall. This build-up leads to the formation of advanced atherosclerotic plaque (Hans A.R.Bluyssen,et al., 2012). Despite the fact that better treatments have relieved the number of deaths from atherosclerosis-related diseases, and have improved the quality of life for people who have these diseases, atherosclerosis remains the underlying cause of about 50% of all death in westernized society.
COVID-19 сопровождается массивным воспалением, гипоксией, диффузной внутрисосудистой коагуляцией, что может стать предпосылкой к развитию артериального и венозного тромбозов.