Relevance: Patients with critical lower limb ischemia and diabetes mellitus are the most difficult group of patients in terms of a favorable outcome of the disease. The number of such patients increases annually. When treating these patients, it is necessary to take into account many different pathological conditions that can lead to fatal complications in the perioperative period. The purpose of the work: The aim of the work was to study methods of prevention of gastrointestinal bleeding in patients after endovascular surgery on the arteries of the lower extremities for critical ischemia in diabetes mellitus. Material and methods: The prospective study included 220 patients who were treated in the vascular surgery department of the A. A. Polyantsev General Surgery Clinic of the Volgograd State Medical University for obliterating atherosclerosis of the arteries of the lower extremities and diabetes mellitus in the period from 2017 to 2021 inclusive. All patients were diagnosed with critical ischemia of the lower extremities stage IIIIV ischemia according to the Fontaine-Pokrovsky classification. Results and discussion. The relationship between the number of painkillers taken per day to reduce pain syndrome and erosive and ulcerative lesions of the gastric mucosa and duodenum in both groups was noted. Conclusion: All patients with peripheral artery diseases accompanied by critical ischemia had endoscopic changes from gastritis to ulcerative lesions, including those complicated by bleeding, by the time they sought specialized medical care. The group at increased risk of gastrointestinal bleeding is patients with repeated reconstructions, surgical corrections of complications or amputations at various levels (from finger to hip), as well as taking anticoagulants in therapeutic dosage. Routine prevention of gastrointestinal bleeding with proton pump inhibitors is not acceptable for this group of patients.
The purpose of the study. To determine the frequency of occurrence and prevention measures of erosive and ulcerative lesions of the proximal gastrointestinal tract in patients operated for critical ischemia with a diagnosis of obliterating atherosclerosis of the arteries of the lower extremities. Materials and methods. The examination included patients with lower limb ischemia - III-IV stage of ischemia according to the Fontaine-Pokrovsky classification. The patients were divided into 2 groups: the control group, where treatment was carried out according to the recommendations: HP diagnosis (express test) was carried out only with an endoscopic picture of gastric ulcer and duodenal ulcer, as well as the main group, in which HP diagnosis was carried out totally with fibrogastroduodenoscopy and a standard three-component eradication scheme was prescribed for at least 14 days when bacterial contamination of the gastric mucosa was detected. Results. In all cases, endoscopic changes characteristic of gastritis were registered in patients of the first group. Of the eight patients (100%), two (25%) were diagnosed with single erosions in the distal parts of the stomach, one patient (12.5%) had atrophic gastritis, and the remaining 5 (62.5%) patients had hyperemia of the antral and prepiloric mucosa. In patients of the second group, there were no changes in FGDS in one patient (25%), foci of mucosal atrophy were diagnosed in two patients (50%), and single erosions in one (25%). Conclusion. Among patients with peripheral artery diseases accompanied by critical ischemia, by the time they seek specialized medical care, there are no healthy or close to such persons with unchanged mucous membrane of the proximal parts. In the high-risk groups for the occurrence of gastrointestinal bleeding, a complex effect on aggression factors is necessary
Bariatric surgery is the main method of treating obesity and associated pathological conditions despite a large number of complications, relapses of obesity, side effects, lifelong monitoring and taking various medications that correct emerging metabolic disorders. The article analyzes the results of modern bariatric operations, considers an alternative view of the causes of obesity and possibLe soLutions to this chronic progressive disease.
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