Обследовали 100 больных с ожирением. Регулируемое бандажирование желудка (РБЖ) было выполнено 20 пациентам, рукавная резекция желудка (РРЖ)-40 больным и гастрошунтирование (ГШ)-40 больным. Контрольную группу составили 10 практически здоровых людей. В сыворотке крови иммуноферментным методом определяли концентрацию витаминов В 1 , В 2 , В 5 , В 6 , В 9 , В 12 , С, D, ниацина, биотина и ретинол-связывающего белка (РСБ) до операции и через 1 год после хирургического лечения. Выявлено значительное снижение витаминов С, В 6 , В 5 , D и РСБ как до, так и после бариатрических операций (БО). Более половины больных, перенесших РРЖ, имели также исходное снижение уровня ниацина. Через год после проведения БО (РБЖ, РРЖ, ГШ) число больных с дефицитом этих витаминов сохранялось прежним либо увеличивалось. ГШ не оказало существенного влияния на концентрацию фолиевой кислоты, витаминов В 2 , В 12 , В 1 и биотина. У un-ta.-Bulletin of North Caucasian federal university. 2014;1(40):83-85. 4. Luk'janenko E. V. Ispol'zovanie NO-soderzhashhikh vozdushno-plazmennykh potokov v kompleksnom lechenii peritonita: avtoref. dis. … kand. med.nauk. M. 2006. 24 p. 5. Marakhonich L. A., Pekshev A. V. Infekcija v khirurgii-problema sovremennojj mediciny: sb. tez. 3-jj Vsearmejj. konf. s mezhdunar. uchastiem.-Infection in surgery-problem of modern medicine: collection of theses of third army conference.
This paper presents two rare case reports with one common feature. Patients with thyroid nodules, who had undergone a comprehensive clinical evaluation based on standard algorithms according to their preoperative diagnosis of "Multinodular goiter, grade II", were scheduled for surgical treatment (thyroidectomy). Postoperative morphological examination revealed, however, the extremely rare neuroendocrine tumor-paraganglioma-that simulated multinodular goiter with tracheal compression. Our analysis of these clinical cases showed common systematic mistakes that were committed during conventional, standardized preoperative examination, resulting in certain difficulties in the treatment of these patients.
Introduction
Spontaneous bleeding into the soft tissues of the abdominal and thoracic wall is described as complication of anticoagulant therapy. Computed tomography (CT) allows to detect the presence of extravasation of the contrast agent into a hematoma, which is indicated as a sign of ongoing bleeding. Other specific CT signs of such coagulopathic bleeding have been described earlier.
Aim of the study
To evaluate the significance of specific coagulopathic CT signs for predicting the dynamics of spontaneous bleeding into soft tissues in patients with COVID-19.
Materials and methods
A retrospective study included 60 patients with COVID-19 with spontaneous bleeding into soft tissues and extravasation of a contrast agent on CT. In addition to extravasation, a “hematocrit effect” was detected in 43 patients on CT. Of these, 39 had extravasation in the form of a “signal flare.” All patients underwent transarterial catheter angiography (TCA). To assess the prognostic value of CT signs, the results of CT and TCA compared. The absence of extravasation on the TCA more often corresponded to stopped bleeding.
Results
Extravasation on TCA found in 27 (45%) patients. The presence of the “hematocrit effect” or the combination of this sign with the phenomenon of a “signal flare” on CT (
n
= 43) led to more frequent confirmation of extravasation on TCA than in their absence (
n
= 17): 23.5% vs. 53.4% (
p
= 0.028).
Conclusion
The presence of a fluid level and the phenomenon of a “signal flare” on CT in the structure of spontaneous hematomas of the soft tissues of the abdominal and thoracic wall in COVID-19 patients more often corresponded to ongoing bleeding on the TCA. The absence of coagulopathic CT signs more often corresponded to stopped bleeding.
Graphical abstract
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