The objective of the present study was to compare levels of homocysteine (HC), total cholesterol (TC), triglycerides, high and low density lipoproteins (HDLP and LDLP respectively), and C-reactive protein (CRP) and to evaluate their role in the development of atherosclerosis in patients with type 2 diabetes mellitus (DM2) or without it in the late postoperative period following aortofemoral reconstructive (AFR) operations. A total of 79 patients (40 with DM2 and 39 without it) examined after AFR surgery had the above parameters enhanced compared with the respective baseline values. In the majority of the cases, hyperhomocysteinemia (HHC) was associated with the increased levels of CRP, fibrinogen, and LDLP. However, they were higher in patients with DM2 than without it and correlated with the HbA1c level (r=0.32-0.45; p<0.05). In DM2 patients with HHC, simultaneous hyperlipidemia and elevated CRP levels, the thickness of the intima-media complex in aorta, popliteal artery, anterior and posterior tibial arteries significantly increased. Moreover, these patients experienced more apparent stenosis of these arteries (>50%). Patients with DM2 more frequently exhibited a combination of several markers of the atherosclerotic process especially in the presence of the smouldering inflammatory process in the vascular wall.
56 patients with cancer of major duodenal papilla were examined before and after pylorus-saving pancreaticoduodenal resection. Carbohydrate metabolism was estimated before and after the operation, impact of the operation on diabetes mellitus progression was detected. If there were no carbohydrate metabolism abnormalities in 75% before the operation, then there were 55% of such patients after the operation. After the pylorus-saving pancreaticoduodenal resection the impaired glucose tolerance was detected in 4 (7%) of patients whose carbohydrate metabolism had corresponded to norms before the operation. 7 (13%) Of 17 (31%) patients had diabetes mellitus of mild severity after the pylorus-saving pancreaticoduodenal resection, the rest 10 (18%) had diabetes mellitus of moderate severity. In 7 (13%) patients after the pylorus-saving pancreaticoduodenal resection the diabetes mellitus of moderate severity was detected for the first time, at that in 4 patients diabetes mellitus of mild severity was detected, and in 3 patients — diabetes mellitus of moderate severity (everyone received insulin therapy in the long-term postoperative period) was detected. Checking protocol of the patients’ carbohydrate metabolism in the perioperative period was described in detail. The possibility of prognostication of carbohydrate metabolism abnormalities in the long-term postoperative period by indications of carbohydrate metabolism before the operation and in early postoperative period was studied. Middle blood glucose level in early postoperative period is an informative indication for prognostication of carbohydrate metabolism state in the long-term postoperative period. An algorithm of patients’ examination with cancer of major duodenal papilla before the operation and after it was offered; also checking protocol of carbohydrate metabolism indices and correction of the detected abnormalities in the early postoperative period were offered.
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