Assuntos
Anticoagulantes/uso terapêutico , Neoplasias/tratamento farmacológico , Embolia Pulmonar/prevenção & controle , Rivaroxabana/uso terapêutico , Acidente Vascular Cerebral/tratamento farmacológico , Tromboembolia Venosa/prevenção & controle , Trombose Venosa/tratamento farmacológico , Consenso , Gerenciamento Clínico , Esquema de Medicação , Cálculos da Dosagem de Medicamento , Humanos , Neoplasias/sangue , Neoplasias/complicações , Neoplasias/patologia , Guias de Prática Clínica como Assunto , Embolia Pulmonar/sangue , Embolia Pulmonar/complicações , Embolia Pulmonar/patologia , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/patologia , Tromboembolia Venosa/sangue , Tromboembolia Venosa/complicações , Tromboembolia Venosa/patologia , Trombose Venosa/sangue , Trombose Venosa/complicações , Trombose Venosa/patologiaRESUMO
The study was organized to provide additional characteristic of chronic dysfunction of renal allo-transplant using such biomarkers of serum and urine as enzymes (alanine aminotransferase), aspartate aminotransferase, gamma- glutamiltransferase, alkaline phosphatase, N-acetyl-ß-D-glucosaminidase, interleukins (IL-2, IL-8, IL-10), beta-2- microglobulin. The chronic dysfunction of renal allo-transplant is characterized by increasing of concentration of IL-10 and beta-2-microglobulin in serum and increasing of concentration of beta-2-microglobulin, IL-2, IL-8 in urine and increasing of activity of N-acetyl-ß-D-glucosaminidase, alkaline phosphatase, aspartate aminotransferase, gamma-glutamiltransferase as compared with patients with satisfactory function of renal allo-transplant. The multivariant logistic regression analysis established that only activity of N-acetyl-ß-D-glucosaminidase in urine was reliably independently related to chronic dysfunction of renal allo-transplant. It is assumed that increasing of concentration of beta-2-microglobulin in serum testifies glomerular dysfunction and in urine--tubular dysfunction of renal allo-transplant. The enzymeuria indicates continuing damage of epithelium of proximal tubules of nephron. The classification of patients with satisfactory function and chronic dysfunction of renal allo-transplant established that the highest indicators of square under ROC-curves had concentration of beta-2-microglobulin in serum (0.858 ± 0.061) and urine (0.733 ± 0.079) and activity of N-acetyl-ß-D-glucosaminidase in urine (0.701 ± 0.061). To specify diagnosis of chronic dysfunction of renal allo-transplant the most useful (ratio of likelihood of positive result 10 and 11 correspondingly) are tests of beta-2- microglobulin in serum (more than 8.55 mkg/ml) and N-acetyl-ß-D-glucosaminidase/creatinine in urine (more than 34 nmol/(sl)/ mmol/l). These discoveries require further validation and confirmation by implementation of morphological analysis of bioptat of renal allo-transplant.
Assuntos
Acetilglucosaminidase/urina , Interleucina-10/sangue , Interleucina-2/urina , Interleucina-8/urina , Transplante de Rim , Insuficiência Renal Crônica/diagnóstico , Microglobulina beta-2 , Acetilglucosaminidase/sangue , Adolescente , Adulto , Alanina Transaminase/sangue , Alanina Transaminase/urina , Fosfatase Alcalina/sangue , Fosfatase Alcalina/urina , Aspartato Aminotransferases/sangue , Aspartato Aminotransferases/urina , Biomarcadores/sangue , Biomarcadores/urina , Humanos , Interleucina-10/urina , Interleucina-2/sangue , Interleucina-8/sangue , Rim/metabolismo , Rim/patologia , Masculino , Pessoa de Meia-Idade , Curva ROC , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/patologia , Insuficiência Renal Crônica/urina , Estudos Retrospectivos , Transplante Homólogo , Microglobulina beta-2/sangue , Microglobulina beta-2/urina , gama-Glutamiltransferase/sangue , gama-Glutamiltransferase/urinaRESUMO
In a structure of the cardio-vascular system diseases in Ukraine the part of chronical ischemia of the lower extremities tissues constitutes more than 20%. Due to diffuse affection of the distal parts of arterial bed it is impossible to succeed in performance of a direct" revascularization in 40% of patients. In 60-87% of such patients a severe ischemia of the lower extremities tissues occurs, causing the necessity of their high amputation performance on the hip level. The results of surgical treatment of 36 patients, suffering inoperable types of the peripheral arteries occlusion were analyzed. In 18 patients the algorithm of intraoperative ultrasound duplex scanning was applied, surgical interventions were performed using optimized procedures. As a second stage the PRP-therapy was conducted, since the second post-operative day all the patients have had performed the elaborated complex of physical exercises, directed on the shin and hip muscles strengthening. Optimization of the lower extremities indirect revascularization methods have permitted to increase the rate of the treatment positive results from 55.6 to 88.9%, to reduce the unsatisfactory results rate--from 44.4 to 11.1%. The PRP-therapy and complex of regular physical exercises conduction have promoted the VEGF content enhancement in the blood serum by 15.6%. malleolar-brachial index--by 28.9% in the patients, suffering occlusion of femoro-popliteo-tibial segment. PRP-concentrate constitutes a potent cell biological activator of the VEGF, improves metabolism and microcirculation in muscles and cells of the skin.
Assuntos
Arteriopatias Oclusivas/terapia , Terapia por Exercício/métodos , Extremidade Inferior/irrigação sanguínea , Plasma Rico em Plaquetas , Procedimentos Cirúrgicos Vasculares/métodos , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/fisiopatologia , Arteriopatias Oclusivas/cirurgia , Velocidade do Fluxo Sanguíneo/fisiologia , Terapia Combinada , Feminino , Humanos , Extremidade Inferior/diagnóstico por imagem , Extremidade Inferior/fisiopatologia , Extremidade Inferior/cirurgia , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , UltrassonografiaRESUMO
On the basis of their experience with 530 kidney transplantations and literature data the authors argue the necessity of careful assessment of the kidney allograft state at all stages of its life. An accent is thus done on the necessity of the complex diagnostics with using noninvasive and invasive methods that will facilitate the kidney allograft dysfunction prediction and prevention, and longer time of the kidney allograft survival.
Assuntos
Transplante de Rim , Rim , Monitorização Fisiológica/métodos , Assistência Perioperatória/métodos , Complicações Pós-Operatórias , Sobrevivência de Tecidos , Biópsia , Humanos , Rim/patologia , Rim/fisiopatologia , Rim/cirurgia , Transplante de Rim/efeitos adversos , Transplante de Rim/métodos , Transplante de Rim/normas , Assistência Perioperatória/normas , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/prevenção & controle , Prognóstico , Medição de Risco , Fatores de Risco , Doadores de Tecidos , Coleta de Tecidos e Órgãos/métodos , Coleta de Tecidos e Órgãos/normas , Transplante Homólogo/patologia , Transplante Homólogo/normasRESUMO
The peroxidal oxidation of lipids (POL) and antioxidant defense (AOD) system state in the patients blood before renal transplantation performing and on the fourth day after it were studied, depending on kind of familial or potential agonal with beating (DBH) or nonbeating (DNBH) heart donor applied and the presence of complications--delayed renal autotransplant (RAT) function and acute reaction of rejection (ARR). In chronic renal insufficiency, RAT transplantation from cadaver, DNBH and ARR the POL processes intensification and AOD system activity lowering were noted.
Assuntos
Antioxidantes/metabolismo , Função Retardada do Enxerto/metabolismo , Rejeição de Enxerto/metabolismo , Falência Renal Crônica/metabolismo , Transplante de Rim , Peroxidação de Lipídeos , Catalase/sangue , Ceruloplasmina/metabolismo , Função Retardada do Enxerto/sangue , Função Retardada do Enxerto/enzimologia , Rejeição de Enxerto/sangue , Rejeição de Enxerto/enzimologia , Humanos , Falência Renal Crônica/sangue , Falência Renal Crônica/enzimologia , Falência Renal Crônica/cirurgia , Transplante de Rim/métodos , Peróxidos Lipídicos/sangue , Estudos Retrospectivos , Doadores de Tecidos , Vitamina A/sangue , Vitamina E/sangueRESUMO
There were examined 825 patients, in whom affection of extracranial arteries was revealed, including 340 (41.2%) men and 485 (58.8%) women, 27 to 73 years old. Atherosclerotic stenosis and occlusion of extracranial arteries was diagnosed in 305 (40.0%), pathologic kinking of vessels on atherosclerosis and hypertonic disease background--in 196 (23.8%), pathological kinking, caused by aortoarteriitis and fibrose--muscular displasia--in 197 (23.9%), hypoplasia of arteries--in 54 (6.5%), aortoarteriitis--in 73 (8.8%) patients. Stages I-IV ischemia together with proven affection of extracranial arteries served as indication for surgical treatment of chronic cerebro-vascular insufficiency. Depending on character of the arteries affection 11 kinds of operative interventions were conducted, using complex intraoperative program of the brain defense. Total number of reconstructive operations performed was 967. In 752 (91.2%) patients immediate good and satisfactory results were noted. In the late period 450 patients were examined: good results were achieved in 64.9%, satisfactory--in 22%, in 30 (6.7%) improvement did not occur and 28 (6.2%) died. Introduction of the proposed complex examination and surgical treatment program have permitted to improve the results of treatment of the patients, suffering chronic brain ischemia.
Assuntos
Arteriosclerose/cirurgia , Isquemia Encefálica/cirurgia , Encéfalo/irrigação sanguínea , Estenose das Carótidas/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos , Adulto , Idoso , Angiografia , Artérias/diagnóstico por imagem , Artérias/patologia , Artérias/cirurgia , Arteriosclerose/complicações , Arteriosclerose/diagnóstico , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/etiologia , Isquemia Encefálica/fisiopatologia , Estenose das Carótidas/complicações , Estenose das Carótidas/diagnóstico , Circulação Cerebrovascular , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Ultrassonografia Doppler TranscranianaRESUMO
Surgical complications were studied, which occurred in 55 (20.37%) of 244 patients, to whom 270 renal allotransplantation (RAT) operations were performed. In 19 (34.6%) of recipients the urological complications were noted, in 20 (34.4%)--spontaneous rupture of the transplant, in 11 (20%)--lymphocele, in 5 (9.1%)--arrosive hemorrhage from the renal transplant artery. The methods of surgical correction of the RAT complications were optimized. Urological complications and spontaneous rupture of the renal allotransplant were revealed most frequently. An acute rejection reaction constitutes the most frequent cause of spontaneous rupture of the renal allotransplant. While the RAT surgical complications occurrence an active surgical tactics is adopted.
Assuntos
Transplante de Rim , Complicações Pós-Operatórias/cirurgia , Procedimentos Cirúrgicos Operatórios/métodos , Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transplante HomólogoRESUMO
The results of 92 elective operative interventions, performed in 71 patients with chronic renal insufficiency (CRI) in terminal stage, were studied. Performance of elective operative interventions in patients with CRI in terminal stage, to whom the treatment, using chronic hemodialysis, was conducted, allows to increase quality of their medical and social rehabilitation considerably and the efficacy of kidney transplantation (KT). They constitute effective and safety method of treatment in complex surgical program of patients preparation to KT performance.
Assuntos
Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Falência Renal Crônica/cirurgia , Adulto , Feminino , Humanos , Transplante de Rim/estatística & dados numéricos , Masculino , Pessoa de Meia-IdadeRESUMO
The causes of the renal allotransplant (RAT) removal during first year after the kidney transplantation performance were studied. Of 270 renal allotransplantations performed in 56 (20.5%) of recipients the transplant was removed during first year after the operation. In 36 (64.3%) of patients transplantnephrectomy was performed for immune conflict presented, in 12 (21.4%) of observations purulent-septic complications have become the cause of RAT removal and in 8 (14.3%)--the vascular causes (thrombosis of RAT artery, vein).
Assuntos
Abscesso/complicações , Glomerulonefrite/etiologia , Rejeição de Enxerto/etiologia , Nefropatias/complicações , Transplante de Rim , Feminino , Rejeição de Enxerto/epidemiologia , Humanos , Masculino , Estudos Retrospectivos , Transplante HomólogoRESUMO
The methods of surgical treatment of spontaneous rupture of renal allotransplant (RAT) were studied up in 21 patients. In 17 (80.9%) of patients the RAT rupture was caused by an acute reaction of rejection (ARR), in 14.3% of observations--by an acute necrosis of tubules, in 2 (9.5%)--by renal vein thrombosis and in 2 (9.5%)--by an ischemic damage of the transplant. Surgical treatment of the RAT spontaneous rupture (except the cases with rupture due to renal vein thrombosis) must be managed by the hemorrhage stoppage, the RAT tissues strain reduction (decapsulation and the cross-like capsulotomy), conduction of its intraoperative anticrisis and antiischemic defense with subsequent complex therapy for ARR and the transplant dysfunction. Application of such a tactics of treatment have permitted to secure the RAT and its functions in spontaneous rupture in 82.4% of observations. The transplant survival was registered in terms up to one year in 64.7% of observations.
Assuntos
Nefropatias/cirurgia , Transplante de Rim , Complicações Pós-Operatórias , Procedimentos Cirúrgicos Operatórios/métodos , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ruptura Espontânea/etiologia , Ruptura Espontânea/cirurgiaRESUMO
Results of treatment of 28 patients with polycystic kidney were presented. In 12 (42.9%) patients with terminal stage of chronic renal insufficiency transplantation of kidney (TK) was performed without preliminary nephrectomy or nephrectomy was done simultaneously with TK. In 16(57.1%) patients nephrectomy was performed in stage of preparation to allotransplantation. Were established advantages of preliminary performance of nephrectomy in patients with polycystosis on stage of preparation to TK: in one-year follow-up the settle down of renal allotransplant was noted in all patients.
Assuntos
Transplante de Rim , Doenças Renais Policísticas/cirurgia , Cuidados Pré-Operatórios , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
There were analyzed the results of treatment of 1514 patients, to whom different reconstructive operations on vessels were performed. In 88 (5.8%) of them infectious-inflammatory complications occurred. Three groups of complications were assigned: superficial (in 43.2% observations), deep (in 44.3%) and common infectious (in 12.5%). To all the patients treatment was conducted, in 93.2% of observations positive result was noted, mortality had constituted 2.3%, amputation of lower extremity was performed in 4.5% of patients. There were assigned predisposing factors for the infectious complications occurrence. Complex of curative and prophylactic measures for application in reconstructive vascular surgery was elaborated.
Assuntos
Complicações Pós-Operatórias/prevenção & controle , Infecção da Ferida Cirúrgica/prevenção & controle , Procedimentos Cirúrgicos Vasculares , Adulto , Fatores Etários , Humanos , Pessoa de Meia-Idade , Fatores de TempoRESUMO
There was the technique elaborated for the revascularized transplantation of the omentum majus flap on myocardium, upper extremity and brain. There were performed 26 operations of nondirect revascularization of myocardium, 3--of microsurgical transplantation on upper extremity and 3--on the brain.
Assuntos
Braço/irrigação sanguínea , Braço/cirurgia , Procedimentos Cirúrgicos Cardíacos/métodos , Artérias Carótidas/cirurgia , Neovascularização Fisiológica/fisiologia , Procedimentos Neurocirúrgicos/métodos , Omento/transplante , Humanos , Microcirurgia/métodosRESUMO
Anatomo--morphological peculiarities of greater omentum (GO) in 63 patients, in whom its flap was applied for revascularization of ischemized tissues of extremities, myocardium and the brain, were studied up. Microsurgical transplantation of the GO free flap was performed in 41 patient, omentocardiopexy without the break of the GO vascular pedicle--in 22. Possibilities of the GO application for the ischemized organs revascularization were estimated.
Assuntos
Encéfalo/irrigação sanguínea , Encéfalo/cirurgia , Vasos Coronários/cirurgia , Extremidades/irrigação sanguínea , Extremidades/cirurgia , Isquemia/cirurgia , Omento/transplante , Humanos , Neovascularização Fisiológica/fisiologiaRESUMO
The state of cerebral blood flow was studied in 81 patients with chronic disorder of cerebral blood circulation using angiographic investigation. Various kinds of pathological kinking of the vessels, originated from the aortic arch, the reducing of their contrasting, the lowering of the blood flow velocity were disclosed. Enhancement of the capacity reserve of vascular channel while conducting the probe with sodium nitroprusside more than by 10% gave evidence about possibility of the blood flow restoration after reconstruction of the affected artery.
Assuntos
Aorta Torácica/anormalidades , Aorta Torácica/diagnóstico por imagem , Isquemia Encefálica/diagnóstico , Encéfalo/irrigação sanguínea , Encéfalo/fisiologia , Artéria Carótida Interna/anormalidades , Artéria Carótida Interna/diagnóstico por imagem , Adulto , Tempo de Circulação Sanguínea , Angiografia Cerebral/métodos , Circulação Cerebrovascular/fisiologia , Processamento Eletrônico de Dados , Feminino , Hemodinâmica/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de DoençaRESUMO
Of 230 patients, examined by coronarography, in 219 the signs of the ischemic heart disease were revealed. The criterions were elaborated for differentiated choice of the myocardial revascularization method.
Assuntos
Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/cirurgia , Revascularização Miocárdica/métodos , Angiografia/métodos , Feminino , Humanos , MasculinoRESUMO
During ten years 57 patients with symptomatic arterial hypertension were examined. The suprarenal gland disease was diagnosed in 31 patient, the renal arteries disease--in 16, the thoracic aorta coarctation--in 10; 35 patients were operated on. The radical intervention conduction have promoted the arterial pressure normalization in early postoperative period.
Assuntos
Hipertensão/diagnóstico , Hipertensão/cirurgia , Artéria Renal/cirurgia , Adolescente , Adulto , Feminino , Humanos , Hipertensão/etiologia , Nefropatias/complicações , Nefropatias/diagnóstico , Masculino , Pessoa de Meia-Idade , Cuidados Pré-OperatóriosRESUMO
Results of surgical treatment of 368 patients with atherosclerotic occlusions of popliteal-tibial segment are analyzed. The operation method choice was based on classification, discerning five types of lesion: I type--isolated a. femoris superficialis (AFS) occlusion; II type--AFS occlusion, a. femoris profunda stenosis; III type--extended occlusions of superficial, popliteal, deep arteries and shin arteries; IV type--the lesion of distal part of a. femoris communis and a. poplitea; V type--the popliteal artery occlusion with the process transient on shin arteries.
Assuntos
Arteriosclerose/patologia , Artéria Femoral/patologia , Artéria Poplítea/patologia , Artérias da Tíbia/patologia , Adulto , Arteriosclerose/cirurgia , Artéria Femoral/cirurgia , Humanos , Pessoa de Meia-Idade , Artéria Poplítea/cirurgia , Índice de Gravidade de Doença , Artérias da Tíbia/cirurgiaRESUMO
The experience of treatment of 303 patients with the operated stomach diseases (OSD) is summarized. It was established that to reduce the frequency of their occurrence it is necessary: to perform vagotomy especially selective proximal (SPV) thoroughly for complete acid producing zone denervation achievement; to examine gastric cardia and pyloroduodenal zone before and intraoperatively thoroughly to select an optimal method of its drainage; to conduct conservative therapy of ulcer disease after vagotomy conduction up to the ulcer defect healing according to endoscopic control data.
Assuntos
Síndromes Pós-Gastrectomia/cirurgia , Drenagem , Síndrome de Esvaziamento Rápido/cirurgia , Gastrectomia , Humanos , Recidiva , Vagotomia Gástrica Proximal , Vagotomia TroncularRESUMO
No ischemic insult, myocardial infarction, death due to cardiovascular pathology was observed in 138 patients, to whom after the operation on the arteries of truncus brachiocephalicus the ticlid was administered. At a comparison group (120 patients) in 3 the myocardial infarction have occurred (one patient died), in 2--an ischemic insult. After the ticlid application the positive late follow-up result was noted in 93.1% patients, without it--in 70.5%. The preparation compliance is good.