Реферат: При изучении влияния нервной системы на физиологические и патофизиологические процессы возникает необходимость определения вклада каждого из отделов вегетативной нервной системы. Для оценки влияния парасимпатического звена на вариабельность сердечного ритма разработан криохирургический метод деструкции nervus vagus в шейном отделе, в грудной и брюшной полостях. Показано, что на шеи в области «сонного» треугольника криохирургическим способом можно провести деструкцию n. vagus, а также криоденервацию arteria carotis и таким образом «выключить» из регуляторного звена расположенные на интиме сосуда барорецепторы. Установлено, что с использованием эндоскопической установки и криохирургического способа денервации сосудов можно осуществить деструкцию барорецепторов дуги аорты с сохранением анатомической целостности сосуда. Относительная доступность выделения ветвей брюшного отдела n. vagus у крысы по латеральным краям пищевода позволяет провести криоденервацию как отдельных, так и обеих ветвей нерва вместе с пищеводом. Ключевые слова: криодеструкция, nervus vagus, аорта, эксперимент, денервация, барорецепторы, эндоскопия. Реферат: При вивченні впливу нервової системи на фізіологічні і патофізіологічні процеси виникає необхідність визначення вкладу кожного з відділів вегетативної нервової системи. Для оцінки впливу парасимпатичної ланки на варіабельність серцевого ритму розроблено кріохірургічний метод деструкції nervus vagus у шийному відділі, в грудній і черевній порожнинах. Показано, що на шиї у ділянці «сонного» трикутника кріохірургічним способом можна провести деструкцію n. vagus, а також кріоденервацію arteria carotis і таким чином «вимкнути» з регуляторної ланки розташовані на інтимі судини барорецептори. Встановлено, що з використанням ендоскопічної установки і кріохірургічного способу денервації судин можна здійснити деструкцію барорецепторів дуги аорти зі збереженням анатомічної цілісності судини. Відносна доступність виділення гілок черевного відділу n. vagus у щура по латеральних краях стравоходу дозволяє провести кріоденервацію як окремих, так і обох гілок нерва разом зі стравоходом.
Treatment of patients with polytrauma is a difficult problem for surgeons and physicians of intensive care units due to the fact that a multiple and complex lesion often serves as a trigger for the development of a number of life-threatening complications, such as pulmonary embolism (PE). Despite the existing methods of prevention and treatment of pulmonary embolism, the development of this complication in patients with polytrauma accompanied by massive hemorrhageisstill remains an unsolved problem. This article presents a clinical case of the development of isolated PE during performing osteosynthesis of the patient with polytrauma and in stable condition achieved after the intensive therapy within the week. The analize of studies considering the problem of thrombus formation in various parts of the vascular bed and considering of pathophysioliogycal mechanisms of the systemicinflammatory response has been performed. Riskfactors forpulmonary embolism and methods of prophylaxis are studied. Taking into consideration the currently available research data dedicated to this issue, the idea about the generalized nature of the pathological process which can be manifested as deep vein thrombosis such as PE or their combination has been expressed. In respect the insufficient effectiveness of thromboprophylaxis, the need to work out the other or additional laboratory and diagnostic methods of blood coagulation system assessment and responsively therapeutic methods is being considered.
BACKGROUND: Ichthyosis vulgaris is the most common type of Mendelian disorders of cornification, caused by loss-of-function mutations in the gene encoding epidermal protein filaggrin (FLG), namely R501X and 2282del4. FLG 2282del4 mutation in heterozygotes is incompletely penetrant. Polymorphisms in one-carbon metabolism genes could be associated with clinical manifestation of ichthyosis vulgaris. AIM: The purpose of the present study was to analyze the effects of MTHFR, MTR and MTRR polymorphisms in patients with ichthyosis vulgaris. METHODS: 31 patients with ichthyosis vulgaris, 7 their FLG heterozygous relatives without symptoms of disorder, and 150 healthy controls were enrolled in study. FLG null mutations —R501X (rs61816761) and 2282del4 (rs558269137) — and one-carbon metabolism gene polymorphisms — MTHFR C677T (rs1801133), MTHFR A1298C (rs1801131), MTR A2756G (rs1805087) and MTRR A66G (rs1801394) — were analyzed by a polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) assay. RESULTS: Among patients with ichthyosis, heterozygous for FLG 2282del4 mutation, the distributions of genotypes for folate metabolism genes were: MTHFR C677T CC:CT:TT —29.4%:70.6%:0.0%; MTHFR A1298C AA:AC:CC — 52.9%:47.1%:0.0%; MTR A2756G AA:AG:GG — 70.3%:23.5%:5.9%; MTRR A66G AA:AG:GG — 23.4%:52.9%:23.5%. The frequencies of MTR 2756AA and MTRR 66GG genotypes were 1.4–1.6 times higher in affected individuals heterozygous for 2282del4 than in patients with other FLG genotypes. In affected 2282del4 heterozygotes, the frequency of MTR 2756AA genotype was 1.6 times greater than in healthy controls (p<0.01). The strongest association was found between MTHFR 677CT/MTHFR 1298AA/MTR 2756AA/MTRR 66AG genotype and ichthyosis — OR=11.23 (95% CI 2.51−50.21, p=0.002). CONCLUSIONS: Various genotypes of one-carbon metabolism genes increase the risk of ichthyosis in heterozygotes for the FLG 2282del4 mutation (OR 2.799‑11.231). The most probable predisposing genotype is 677CT/1298AA/2756AA+AG/66AG.
To date, the basis of surgical tactics for chest injuries is the primary surgical treatment of the wound and drainage of the pleural cavity with dynamic monitoring and determination of indications for surgery, based on the amount of blood released by drainage, without any attempts to actively verify the nature of injuries.Treatment of patients on the basis of the so-called "individual approach" and active-waiting tactics, taking into account clinical, radiological and laboratory data, mainly meets the recommendations of the middle of the last century.From the standpoint of evidence-based medicine, thoracoscopy is the most effective method of topical diagnosis of traumatic hemothorax. Videothoracoscopic technologies significantly reduce the incidence of purulent intrapulmonary and pleural complications in penetrating lung injuries. Undoubted advantages of thoracoscopy are: full-fledged revision; accurate diagnosis, which eliminates doubts about the diagnosis and waiting period; determination of indications for drainage, operative thoracoscopy or thoracotomy.
The aim of this study was to evaluate changes in the level of erythrocyte metabolism under conditions of hypoxia in patients with traumatic disease in polytrauma depending on the components of intensive care (IC). Materials and methods. A prospective study was carried out in 88 patients suffering from polytrauma in the period from 2015 to 2017. All the patients were divided into 2 groups, comparable by severity of trauma and condition. A special feature of the examined patients was the staged surgical correction in all cases according to the Damage Control concept. Patients from the Control group received an intensive care according to the standard local clinical protocol in polytrauma. Patients randomized to the FDP group were treated with infusion of D-fructose-1,6-diphosphate sodium hydrate in addition to the standard care. Hemodynamic parameters and cellular metabolism indicators were monitored: on admission to the operating room, after 24 hours, on day 3, 5 and 14. Results. The signs of hypovolemia were equally severe in both groups on admission to the operating room. The FDP group demonstrated more rapid stabilization of hemodynamics and improved myocardial contractility at the 3rd day of IC. The monitoring of acid-base balance and carbohydrate metabolism showed the presence of compensated metabolic acidosis and energy deficiency. High indexes of lactate/pyruvate indicated a sharp imbalance in the ratio of aerobic/anaerobic metabolic processes. The analysis of ATP dynamics displayed impaired mitochondrial ATP production and inhibition of the glycolytic pathway of energy release. Conclusions. Complementary systemic inflammatory response with the elevation of lactate level by the 5th day occurred in patients with traumatic disease who underwent staged surgical correction. Optimization of intensive care resulted in a faster restoration of the balance between aerobic and anaerobic metabolic processes, an increase in the level of ATP and the rate of 2,3-DPG production in erythrocytes contributing to adequate oxygen supply to the tissues, supporting cellular respiration and preventing the development of oxidative tissue damage, as well as helped to maintain compensatory mechanisms and reduce cellular hypoxia ensuring adequate metabolism of vital organs.
Summary. Aim. To evaluate the features of acute alimentary pancreatitis and the risk of complications in patients with a combination of PRSS1 and SPINKI1 gene mutations. Materials and methods. 70 patients with acute alimentary pancreatitis were examined. The mean age was 45.4±13.87 years. The study group included 48 (68.57 %) men and 22 (31.43 %) women. In 34 (48.57 %) patients there was a severe course of acute pancreatitis, in 25 (35.72 %) – moderate severity, in 11 (15.71 %) – mild. Complicated disease was diagnosed in 59 (84.29 %) patients, 11 (15.71 %) – uncomplicated. The severity of the course and the presence of complications were evaluated using the Atlanta Classification, 2012. The polymorphism of the PRSS1 and SPINKI1 genes was determined by all subjects. Statistica 13 was used for statistical analysis. Results and discussion. The combined effect of the PRSS1 and SPINKI1 gene mutation is associated with a higher risk of severe alimentary pancreatitis. The presence of a combined mutational status increases the chances of developing peritonitis, pleurisy, pancreatic accumulation, pseudocysts and pancreatogenic diabetes mellitus. In addition, these patients have proven significantly higher chances of formation of purulent peritonitis, phlegmon, suppuration of pseudocysts, development of systemic complications – systemic inflammatory response syndrome and multiple organ failure syndrome. Conclusions. The reliable connection between the presence of a combination of mutations of the studied genes and the development of severe course of acute alimentary pancreatitis and the formation of complications have been proved.
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