AIM To determine the influence of the time gap between acute myocardial infarction with ST-segment elevation and intracoronary intervention performed later than 2.5 hours on myocardium, we studied indicators of perfusion over time with an aid of SPECT, including intraventricular asynchrony (2-4 days and 6-8 months after stent installation). MATERIALS AND METhOD We observed 22 patients with multivessel coronary lesion. The Russian program with the analysis of perfusion, function and the phase images was used in SPECT synchronized with ECG. RESuLTS Showed that the time gap prior to coronary intervention in the acute phase of myocardial infarction may be directly connected with the increase in impaired perfusion during the end-systole and the severity of pathological intraventricular asynchrony without ECG signs. All patients had significantly decreased wall mobility and intraventricular asynchrony together with increased R-R interval in the late period (after 6-8 months) independently from the coronary intervention time. In patients of group 1 (coronary intervention within 6 hours), focal transmural lesions of myocardium significantly decreased. CONCLuSION Late revascularization help decrease intraventricular asynchrony reducing the risk of heart failure in future.
Relevance The problem of diagnosing and treating patients with acute ischemia of the extremities against the background of thrombosis and atherosclerotic lesions of the main arteries remains very complex task and requires the use of various diagnostic methods, and the leading one is radiation diagnostics.The aim of the study . The development of radionuclide patterns of acute lower limb ischemia and assessment of the treatment efficacy in angiosurgical patients using three-phase scintigraphy. Material and methods The radionuclide method was performed to examine 264 patients with acute thrombosis of the main arteries against the background of atherosclerotic lesions of the lower extremities arteries and clinical signs of acute ischemia of the lower extremities of I-III degree according to the classification of I.I. Zatevakhin.Results We defined quantitative and visual signs of acute ischemia, designed radionuclide semiotics, which allowed to detail the damaged tissue of lower extremities and evaluate the efficacy of the conservative or surgical treatment. The study contains clinical examples of patients with varying degrees of acute limb ischemia.Conclusion The developed radionuclide patterns of acute ischemia in thrombosis of main arteries of the lower extremities allowed to determine the level of arterial occlusion and the degree of acute ischemia, identify the areas of lack of blood supply and necrosis with no clinical signs at an early stage of formation and optimize the treatment strategy.
Background.Perfusion scintigraphy reveals perfusion defects in the occlusion of pulmonary vessels of any caliber and makes it possible to quantify pulmonary blood flow disorders, which allows the method to be used for the comparison of the thrombolytic and anticoagulant therapy efficacy in patients with acute pulmonary embolism.Aim of study .To compare the efficacy of thrombolytic and anticoagulant therapy in the treatment of acute pulmonary embolism in the dynamics of pulmonary perfusion disorders.Study Design.A prospective non-randomized study. The quantitative result of pulmonary perfusion deficiency obtained during perfusion scintigraphy was compared in patients with pulmonary embolism treated with thrombolytics or anticoagulants before treatment and in dynamics. The dynamics was evaluated the next day after administration of thrombolytics and on day 4–5 after initiating anticoagulant therapy. Preliminary analysis of these parameters in the group with anticoagulant therapy a day after the start of administration (by analogy with TLT) revealed no statistically significant differences.Description of the method.Radionuclide and CT studies were performed on a hybrid system SPECT/CT “Discovery NM/CT 670” (GE, USA): perfusion was evaluated with 80–120 MBq of Macrotech 99mTc radiopharmaceutical (RP), CT angiography was performed with 70-100 ml of radiopaque substance “Visipaque.” To determine the total perfusion deficiency, each defect of accumulation with an area equal to the segment was taken as a perfusion deficiency of 5% (subsegmental — 2.5%), equal to the lower lobe — 25%, an area equal to the right lung — 55%, the left lung — 45%. Characteristics of the sample.The perfusion scintigraphy was performed in 381 cases out of 503 patients with a diagnosis of pulmonary embolism of high/intermediate risk of early death, treated in the Intensive Care Unit for Surgical Patients from 2011 to 2016. In 166 cases out of 381, thrombolysis was performed; in 215 cases, an anticoagulant was prescribed. The groups did not differ in age and gender composition: 60±16 years; Me 61 (50; 71) and 62±15 years; Me 63 (53; 74); p=0.22, Mann-Whitney test; men/women: 73/93 and 89/126; p=0.68, the Fisher test.Results of the study.In 96.1% (366/381), perfusion disorders were observed in both lungs; in 3.9% (15/381) there was a unilateral lesion. The comparison of the treatment efficacy was conducted in 169 patients: in 127 cases the next day after introduction of a thrombolytic and in 42 cases on day 4–5 of anticoagulant therapy. In the group with thrombolysis, the initial perfusion deficiency was statistically significantly higher than in the anticoagulant group: 50±10%; Me 50 (40; 60) vs. 39±10; Me 40 (30; 45); p<0.00001, the Mann–Whitney test. The level of pulmonary hypertension was also higher: the systolic pressure in the pulmonary artery was 56±17 Me 54 (45, 68) versus 40±24 Me 40 (22; 56); p<0.00001, the Mann–Whitney test. As a result of treatment, the perfusion deficiency statistically significantly decreased in both groups: in the group with TLT from 50±10%, Me 50 (40; 60) to 26±14%; Me 25 (15; 35); p<0.00000.1, Wilcoxon test; and in the treatment with anticoagulant it decreased from 39±10%, Me 40 (30; 45) to 23±15%; Me 15 (15; 30); p<0.0001, Wilcoxon test. In the TLT group, the perfusion disorders regression was stronger compared to ACT and was registered the next day after administration of a thrombolytic: the standardized effect Es=2.0 and Es=1.2. In the treatment with anticoagulants, statistically significant differences were detected only on day 4–5 from the beginning of its administration. The study power for both groups was 1.00. After thrombolysis the systolic pressure in the pulmonary artery decreased statistically significantly within the next 24 hours: from 56±17 mmHg, Me 54 (45, 68) to 36±14 mmHg, Me 35 (25; 43); p=0.0002, Wilcoxon test; Es=1.3; P=1.00. With anticoagulant treatment, no statistically significant changes in pulmonary arterial pressure occurred 4-5 days after the initiation of treatment: 40±24 mmHg, Me 40 (22; 56) and 50±31 mm Hg, Me 48 (30; 58) ); p=0.72, Wilcoxon test.Conclusion.The advantage of thrombolysis over anticoagulant therapy was the ability to improve pulmonary blood flow, reduce pulmonary hypertension, and stabilize the patients’ condition quickly. Anticoagulant therapy did not allow this effect to be achieved in a short time: the statistically significant reduction in pulmonary perfusion deficiency occurred only on day 4–5 of treatment and was less significant; the statistically significant regression of pulmonary hypertension did not occur at that time.
Научно-исследовательский институт скорой помощи им. Н.В. Склифосовского, г. Москва Сочетанная трансплантация почки и поджелудочной железы (ТП и ПЖ)метод выбора в лечении пациентов, страдающих сахарным диабетом 1-го типа, осложненным терминальной диабетической нефропатией, которая позволяет достигнуть инсулинонезависимости, остановить или существенно замедлить развитие вторичных осложнений сахарного диабета. Одним из важнейших условий успешной трансплантации является адекватное дренирование экзокринного секрета поджелудочной железы. В статье описан первый отечественный опыт забрюшинной сочетанной ТП и ПЖ с ретроперитонеальным формированием дуодено-дуоденоанастомоза. Ключевые слова: сочетанная забрюшинная трансплантация почки и поджелудочной железы, дуодено-дуоденоанастомоз, дренирование экзокринного секрета.
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