Endobiliary antegrade stenting by self-expanding stents was performed in 32 patients with unresectable tumors of pancreatobiliary area. Uncoated stents were used in 15 patients with the proximal obstruction of the biliary tree. Uncoated stents prevent the blockade of lobar, segmental and cystic duct. Covered self-expanding stents were used in 17 cases of distal occlusion and obstruction of the peripapillary area. Antegrade stenting drainages of 8Fr were performed in a stepwise manner, consistently performing outside, then outward-internal drainage of the biliary tree, which was transformed into endobiliary stenting. Hybrid endobiliary antegrade stenting, which involves maintaining outward-internal drainage in lumen installed endobiliary stent, was performed in 14 patients. Hybrid antegrade stenting endobiliary allowed to keep endobiliary access to palliative care for all the time, monitor and correct the patency of the stent, by releasing from intraluminal sludge, to carry out a successful reparative stenting “stent to stent” in case of the invasion of tumor or scar tissue in to the lumen of the stent or around of its proximal end.
The research was performed at the Loginov Moscow Clinical Scientific Center. It is based on Russian obstructive jaundice (OJ) consensus results, considered at the 45th annual Central Research Institute of Gastroenterology Scientific session Oncological issues in the gastroenterologist practice (1 March 2019). The article objective is to note the diagnostic and conservative treatment current issues in patients with OJ. The increase in the number of patients with OJ of different etiology provides problem actuality. In a large number of cases, medical treatment is delayed due to inadequate diagnostic and management, while correct patients routing today can be provided regardless of medical institution level. In this article the examination steps and conservative treatment role in patients with biliary obstruction management are presented.
Arterial hypertension in the metabolic syndrome in the elderly contributes to the formation of cognitive disorders and anxiety-depressive disorders. It is shown that the severity of these deviations of the psychological continuum significantly decreases after 1 year, under the influence of an antihypertensive fixed combination of amlodipine, mesinopril and rosuvastatin in the chronotherapy mode (evening reception), than in the traditional application (morning reception in the equivalent dosage of 5/10/10 mg per day in both cases. The dynamics of cognitive impairment in chronotherapeutical approach in patients 6074 flights from arterial hypertension with metabolic syndrome is characterized by a significant increase in the average score on a scale MMSE, f source 17.8 0.3 to 23.5 0.4 points (р 0.001), against 16.9 0.3 to 20.4 0.4 points (р 0.001) in the morning taking the drug. Situational anxiety decreased from 40.8 2.2 to 30.6 1.8 points (р 0.05) and from 40.0 2.5 to 32.1 2.0 points (р 0.05), personal anxiety from 48.8 2.0 to 25.4 1.9 (р 0.001) and from 44.9 1.9 to 30.7 1.7 (р 0.01) points in the evening and morning the reception, respectively. Depressive disorders decreased slightly more significantly in chronotherapy (14.1% vs. 7.7%) than in the traditional scheme, but despite this, both cases with (groups) corresponded to depressive spectrum disorders. The results obtained indicate that chronotherapy is more effective than the traditional use of a fixed combination of amlodipine, lisinopril and rosuvastatin in arterial hypertension with metabolic syndrome.
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