1 Харківська медична академія післядипломної освіти, м. Харків, Україна 2 Вінницький національний медичний університет ім. М. І. Пирогова, м. Вінниця, Україна 3 Державна наукова установа «Науково-практичний центр профілактичної та клінічної медицини» Державного управління справами, м. Київ, Україна РезюмеМета роботи -з'ясувати основні особливості клінічної характеристики пацієнток, хворих на зовнішній генітальний ендометріоз в періопераційному періоді. Для досягнення поставленої мети були визначені наступні задачі: 1) вивчити локалізацію розподілу ендометріоїдних гетеротопій у пацієнток, хворих на зовнішній генітальний ендометріоз на тлі гіпотиреозу; 2) вивчити структуру хірургічних втручаннь у пацієнток з поєднаною патологією (зовнішній генітальний ендометріоз на тлі гіпотиреозу); 3) вивчити частоту рецидивування ендометріозу у пацієнток з поєднаною патологією після хірургічного лікування. Матеріали і методи. Нами було обстежено 100 пацієнток: 40 -з поєднаною патологією (І основна група); 60 з ендометріозом, без патології щитовидної залози (ІІ група порівняння). Загально-клінічні, лабораторно-інструментальні та променеві методи дослідження (УЗД, КТ, Ro-графія). Діагноз у всіх пацієнтів підтверджений результатами гістопатологічного дослідження. Всі оперативні втручання виконані ендовідео-хірургічним методом. Результати дослідження та їх обговорення. За результатами дослідження локалізації та ступеня поширення ендометріоїдних гетеротопій у пацієнток з поєднаною патологією були отримали наступні результати: I ступінь -38,0% жінок з ендометріоїдними кістами яєчників та аденоміозом; II ступінь -27,0% пацієнток з ендометріоїдним ураженням очеревини і аденоміозом; III ступінь -23,0% хворих з ендометріоїдними кістами яєчників, аденоміозом, з ендометріоїдним ураженням очеревини і сечовивідних органів; IV ступінь -12,0% пацієнток з ендометріоїдними кістами яєчників, аденоміозом, з ендометріоїдним ураженням очеревини і ретроцервікальної області. Структура ендохірургічних втручань у обстеженного контингенту представлена наступним чином: у 80,0% клінічних випадків були проведені органозберігаючі операції; у 20,0% -радикальна операція; у 56,0% -комбінація лапароскопії та гістероскопії; у 42,0% -лапароскопічнийвагінальний доступ і тільки в 2,0% була здійснена конверсія на лапаротомію. Частота випадків рецидиву ендометріозу після хірургічного лікування, у пацієнток, хворих на ендометріоз на тлі гіпотиреозу, склала: через 6 місяців -4,0%; через 9 місяців -6,0%, через 12 місяців -10,0% відповідно. Повне полегшення симптомів досліджуємого захворювання після операції спостерігалося у 80,0% жінок, а у 24,0% жінок відновлена репродуктивна функція. Висновки. Хірургічне лікування пацієнтів з ендометріозом, асоційованим з гіпотиреозом, має базуватися на принципі радикального видалення ендометріоїдних вогнищ, особливо за допомогою комбінованих симультанних операцій у разі тяжкого екстрагенітального ендометріозу. Додатково слід ураховувати цілий ряд аспектів, а саме: локалізацію ендометріоїдної гетеротопії та тяжкість ендометріозу; вік па...
Background Sepsis and septic shock are formidable and complications in surgery with mortality 20–50%. In the pathogenesis of sepsis, a significant role belongs to bacterial endotoxin (LPS - liposaccharide).Aim of study Assessment of the efficacy of selective lipopolysaccharides hemosorption (SLH) in treatment of sepsis.Material and methods We examined 65 patients with developed sepsis or suspected presence of gram-negative infection. Patients were retrospectively divided into two groups. In Group 1, 27 patients received Polymyxin B hemoperfusion using Toraymyxin cartridges. In Group 2 (38 patients), adsorber Alteco (LPSA) was used.Results It was established that 28-day mortality was 11.1% in Polymyxin group and 28.9% in LPS group A, p = 0.091, 60-day mortality was 33.3 and 55.3%, respectively (p=0.065). The use of SLH contributed to a decrease in the activity of endotoxin (EAA) from 0.52 (0.39; 0.65) to 0.40 (0.36; 0.57) EU (p=0.330) in Polymyxin group and from 0.59 ( 0.42; 0.72) to 0.54 (0.40; 0.81) EU ( p = 0.981) in the LPS-A group. At the same time, the level of procalcitonin (PCT) in the blood statistically significantly decreased from 8.4 (3.6; 29.0) to 4.8 (1.9; 36.3) ng/ml (p=0.0117) only in the LPS-A group. The level of C-reactive protein (CRB) in the blood statistically significantly decreased only in the Polymyxin group, from 205 (154; 264) to 162 (106; 202) mg/L (p<0.001). After SPH procedures, there was a tendency to a decrease in the level of blood cytokines in both groups. Conclusion 1. The trend of better survival among patients was noted during hemoperfusion when using Polymyxin B in comparison with the results of adsorption of lipopolysaccharide with Alteco cartridges: so, 28-day mortality was 11.1 and 28.9%, respectively (statistically not significant).2. As a result, the procedure of selective lipopolysaccharides hemosorbtion on hemosorbents with Polymyxin B in blood significantly decreased level of C-reactive protein (21%), there was statistically insignificant decrease in the level of endotoxin activity (23.1%), lipopolysaccharide binding protein (21.6%), procalcitonin (2.4 times), presepsin (20%), as well as the level of interleukin-6 (3.4 times) and interleukin-10 (1.6 times) . Adsorption of lipopolysaccharide with Alteco cartridges leads to a statistically significant reduction of procalcitonin in blood (1.8 times), and statistically insignificant decrease of: endotoxin activity (9.3%), lipopolysaccharide binding protein (28.6%), interleukin-6 (3.8 times), interleukin-10 (7.1 times) and soluble receptor to interleukin-2 (2.2 times).
Introduction. Extracorporeal membrane oxygenation has found wide application in clinical practice during the COVID-19 pandemic. Oxidative stress, endothelial dysfunction, and systemic inflammatory response syndrome play an important role in the pathogenesis of COVID-19. Our research was designed to study correlations in-between those factors and the impact of extracorporeal membrane oxygenation on them.Aim. The study of systemic inflammatory response and endothelial function in patients with COVID-19 during extracorporeal membrane oxygenation.Material and methods. In the course of a prospective study, we examined 100 COVID-19 patients aged 26 to 75 years, median 55 years [47;60], who were treated at the N.V. Sklifosovsky Research Institute for Emergency Medicine, using extracorporeal membrane oxygenation. As a control group (normal), 25 practically healthy people whose median age was 32 years [25;39] were examined. The function of the vascular endothelium was assessed by the content of nitric oxide stable metabolites in the blood serum and the level of angiotensin-converting enzyme. Next, the ratio of nitric oxide metabolite to angiotensin-converting enzyme level was calculated, reflecting the imbalance between endotheliumdependent vasodilation and vasoconstriction. To assess the severity of oxidative stress in blood serum, malondialdehyde was determined as a marker of lipid peroxidation. The state of the antioxidant system was assessed in terms of total antioxidant status of blood serum. The presence of an imbalance in the system of lipid peroxidation and the antioxidant system total antioxidant status was judged by the oxidative stress coefficient, i.e. the ratio of malondialdehyde to the total antioxidant activity.Results. The analysis showed the presence and progression of endothelial dysfunction, impaired vascular regulation, activation of free radical processes, the presence of an imbalance in the prooxidant/antioxidant system, as well as the progression of the inflammatory process with a decrease in the level of markers of the COVID-19 severity.Conclusion. Further studies of the correlation between endothelial damage and the severity of the systemic inflammatory response syndrome may be of fundamental importance for explaining the pathophysiological mechanisms of COVID-19 course and developing new treatments for such patients.
This research is organized to investigate if the thermal gradient (Tgrad) (difference between temperature maximum and minimum in the region of interest over thyroid gland on neck thermogramm) could be a marker of normal/ abnormal thyroid function and, if so, find out the cut-off value and check it screening validity.Materials and methods. Thermography examination was performed using a TVS-300 med (S-Petersburg, Russia) thermal imaging camera with a resolution of 384 × 288 pixels and sensitivity was <0.04 °C according to European Association of Thermology standards. Anterior neck thermografic images were performed and collected in cloud database, where, by mean of program tools, region of interest were marked and Tgrad calculated. Totally 1025 pts with different thyroid pathology (group 1: female 944, age 15–90 (55,4±15,8), male 81, age 14–86 (53,6±18,8)), and 395 healthy persons (group 2: male 324 age 17–26 (21,8±4,4), female 71 age 16–70т (34,6±12,7)) were investigated. To check the quality of the model another 314 persons (18 male and 296 female) were studied in screening mode.Results. Calculated Tgrad value was 1,65±0,53 °C, Ме 1,53(1,24; 1,90) and 0,98±0,23 °C, Me 1,01(0,82; 1,15) for group 1 and 2 accordingly. By mean of binary logistic regression analysis we found good correlation between Tgrad value and presence/absence of thyroid pathology: significance level р<0,0001, χ² = 838,84, df = 1, β 0 = 9,984, β 1 = –9,033. Area under curve in ROC analysis was 0,922 (95 % CI 0,908; 0,935), р<0,001; optimal cut off value for Tgrad was 1,21 °C for maximal sensitivity (79,8 %) and specificity (83,3 %). In screening evaluation, according to optimal cut-off value 1,2 °C for Tgrad , 82,2 % of cases were classified correctly: true-positive and true-negative results were achieved in 258 from 314 pts.Conclusion. Thermography test, based on Tgrad value calculation, could help to distinguish persons with normal and abnormal function of thyroid gland.
Introduction. The paper presents the results of X-ray examination of patients with lung lesions caused by diseases and computed tomography (CT) of patients with COVID-19 of varying degrees of infiltration according to the categorical CT scheme from CO-RADS 1 to CO-RADS 6, developed by the Dutch Radiological Society (NVvR). Good results can be achieved by detecting the early stage of the disease in COVID-19. The work considers indications, contraindications, methodology and interpretation, at different phases of infil-tration in COVID-19. Objective. To review the dynamic models of CT imaging of lungs affected by COVID-19, to define CT character of primary and post-primary infection and discuss the role of imaging in differential diagnostics and monitoring of the pathology. Materials and research methods. 85 patients (the median of 48 y.o. to the 17 to 84 y.o. range) were examined. All patients un-derwent CT procedure («Toshiba Corp.» 64-sl. CT). Results. At an early stage bilateral basal peripheral changes of the «ground glass» type opacity, generally of minuscule area, pre-dominate which precurse development of viral pneumonia in COVID-19. As the disease progresses areas of change in the tissue appear patterned according to the type of «patchwork», consolidation areas form resembling OP «reverse halo». Complete resorption of changes in lungs is likely. Resolution of pathological changes could be observed after a month and longer with a successful outcome. Conclusion. At the stage of the outbreak progression the role of CT imaging methods in assessing the condition of lungs could not be overestimated. They provide means to identify changes at the subclinical stage, to assess the severity of the course and conduct differential diagnostics, but also to inform about the likelihood of COVID-19 when PCR testing results are lacking. The role of CT is in-deed prevailing in clinical conditions of limited resources and while coping with a large patient cohort with acute respiratory diseases of undefined aetiology. Key words: Differential diagnosis; CT examination; COVID-19; CO-RADS scheme.
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