Клинические случаи успешного эндоскопического стентирования бронхов

Introduction. A comprehensive approach to restore the patency of the trachea and bronchi in stenoses of various origin consists in their endoscopic stenting, which can be both temporary and maximum continuous.Materials and methods. The study presents two clinical cases of successful endoscopic stenting of the lower lobar bronchi of the lungs with relief of respiratory failure. In the first case, the left inferior lobar bronchus was compressed from the outside by a hematoma from a ruptured false aortic aneurysm. Thus, the aneurysm was stented first, and the compressed bronchus — second. In the second case, the right inferior lobar bronchus was stented due to lung metastases. In both cases, bronchial stenosis was accompanied by pulmonary atelectasis.Results and discussion. In both cases, stenting was effective in restoring the patency of stenosed bronchi and expanding the lungs, which enabled respiratory failure to be stopped. In the first case, 3 months after the stenting, its outward migration was revealed, but no recurrence of bronchial narrowing was observed during further dynamic observation. In the second case, the follow-up of the patient for 6 months after stenting showed adequate functioning of the stent.Conclusion. The presented clinical cases demonstrate high efficacy and reliability of endoscopic stenting in bronchial stenoses of various origin to cope with the respiratory failure and thereby improve the quality of life.Введение. Современным способом восстановления проходимости трахеи и бронхов при стенозах различной этиологии является их эндоскопическое стентирование, которое может быть как временным, так и максимально возможно продолжительным.Материалы и методы. Представлены два клинических случая успешного эндоскопического стентирования нижнедолевых бронхов легких с купированием дыхательной недостаточности. В первом случае причиной сдавления извне левого нижнедолевого бронха явилась гематома в результате разрыва ложной аневризмы аорты, в связи с чем первым этапом была стентирована аневризма, а вторым — сдавленный бронх. Во втором случае был стентирован правый нижнедолевой бронх по причине метастатического поражения легкого. В обоих случаях стенозирование бронхов сопровождалось ателектазом легких.Результаты и обсуждение. В обоих случаях стентирование было эффективным с восстановлением проходимости стенозированных бронхов и расправлением легких, что позволило купировать дыхательную недостаточность. В первом случае через 3 месяца после установки стента выявлена миграция его наружу, однако при дальнейшем динамическом наблюдении рецидива сужения бронха не отмечалось. Во втором случае наблюдение за пациентом в течение 6 месяцев после стентирования показало адекватное его функционирование.Заключение. Представленные клинические случаи показывают высокую эффективность и надежность эндоскопического стентирования стенозов бронхов различной этиологии, что позволяет справиться с дыхательной недостаточностью и тем самым улучшить качество жизни

Динамика маркеров острого повреждения почек при использовании эпидуральной блокады во время резекции в условиях тепловой ишемии

Objective: to investigate the time course of changes in the early biomarkers of acute kidney injury in patients with clinically localized cancer during partial nephrectomy, as electively indicated, under thermal ischemia with prior epidural block.Materials and methods. To analyze the nephroprotective effect of an epidural block in kidney resection with warm ischemia, markers of acute kidney injury (cystatin C, interleukin 18, NGAL, L-FABP and KIM-1) were studied by ELISA in the blood and urine of 35 patients with local cancer with an epidural block (main group) and 37 patients with local cancer without an epidural block (control group) before surgery and 40 min after its beginning and on days 1 and 3 of the postoperative period. All patients were divided into 2 groups by the levels of cystatin C in the blood serum: 1000 ng/ml and lower, and over 1000 ng/ml.Results. Epidural block during the perioperative period in kidney resection with warm ischemia for patients with local cancer had an obvious nephroprotective effect allowing maintaining the initial renal functional parameters, in contrast to the standard disease management.Цель исследования – изучение динамики ранних биомаркеров острого повреждения почек у больных клинически локализованным раком при резекции почки по элективным показаниям в условиях тепловой ишемии с предварительным проведением эпидуральной блокады.Материалы и методы. Для изучения нефропротективного влияния эпидуральной блокады при резекции почки и тепловой ишемии в крови и моче 35 больных локализованным раком с проведением эпидуральной блокады (основная группа) и 37 пациентов с локализованным раком без проведения эпидуральной блокады (контрольная группа) до вмешательства и через 40 мин после начала операции, а также на 1-е и 3-и сутки послеоперационного периода методом иммуноферментного анализа были исследованы 5 маркеров острого повреждения почек: цистатин С, интерлейкин 18, NGAL, L-FABP и КIМ-1. По фоновому уровню цистатина С в сыворотке крови все больные были разделены на 2 группы: с уровнем показателя ≤1000 нг/мл и >1000 нг/мл.Результаты. Применение эпидуральной блокады в периоперационном периоде у больных локализованным раком при резекции почки в условиях тепловой ишемии оказывает нефропротективный эффект, позволяя сохранить функциональные показатели почек на исходном уровне в отличие от стандартного ведения больных

OXIDATION OF 2-PICOLINE OF OZONE IN THE LIQUID PHASE

Study of the reactions of 2-picoline with ozone in acetic acid solution. It is established that ozone reacts with 2-picoline in three ways: by heteroaromatic ring, a free pair of electrons on the nitrogen atom and the methyl group. The main products of destructive oxidation of heteroaromatic rings are peroxide compounds. Among the products of aromatic character identified 2-picoline-N-oxide and 2-picolinic acid. Reaction of 2-picoline with ozone in acetic acid solution is first order in each of the initial reagents

Randomized «FARVATER» study. Atorvastatin (10 and 20 mg/d) in treating patients with coronary heart disease and dyslipidemia: effects on lipids, C-reactive protein and fibrinogen levels

Aim. To compare effects of atorvastatin in the doses of 10 and 20 mg/d on lipid profile, C-reactive protein (hsCRP), fibrinogen levels, as well as vascular wall structure and function in patients with coronary heart disease (CHD) and primary hyperlipidemia (PHL). Material and methods. Fifty CHD and PHL patients were randomized to 10 or 20 mg/d atorvastatin doses (no titration), for 24-week period. Atorvastatin effects on lipids, treatment tolerability (symptoms ± increased hepatic enzymes), as well as on endothelial function, vessel elasticity and stiffness, were examined. Results. After 24 weeks of 10 mg/d atorvastatin treatment, levels of total cholesterol (TCH), triglycerides (TG), and low-density lipoprotein CH (LDL-CH) significantly decreased – by 25,4%, 21,7%, 34,9%, respectively. In 20 mg/d group, these figures were 27%, 15,2%, and 43,9%, respectively. No significant inter-group difference in LDL-CH levels was registered. No substantial CRP and fibrinogen level reduction was observed. During 24 weeks, 7 adverse events were registered, only 2 (4%) being related to atorvastatin therapy. Conclusion. In patients with CHD and PHL, atorvastatin (10-20 mg/d) decreased LDL-CH levels by 35-44%, and was well-tolerated. The therapy did not affect hsCRP and fibrinogen levels

Randomized study FARVATER: Part II. Atorvastatin effects on endothelial function, vascular wall distensibility and stiffness

Aim. To study atorvastatin (10 and 20 mg/d) effects on lipid, C-reactive protein, and fibrinogen levels, vascular wall structure and function in patients with coronary heart disease (CHD) and primary hyperlipidemia (PHL). Material and methods. In total, 50 CHD and PHL patients were randomized into two stable-dose atorvastatin groups (10 or 20 mg/d) for 24 weeks. Atorvastatin effects on lipid levels, endothelial function, vascular wall distensibility and stiffness, as well as treatment tolerability, were examined. Results. Twenty-four-week atorvastatin therapy (10 or 20 mg/d) reduced low-density lipoprotein cholesterol (LDL-CH) level by 34,9% and 43,9%, respectively (p<0,001). At baseline, vascular wall functional parameters did not differ significantly, reaching 7,2% and 6,4% for endothelium-dependent vasodilatation (EDVD), 21,3 and 18,7 10-3/kPa for vascular wall distensibility (DC) of common carotid artery (CCA); 8,0 and 9,1 Units for vascular wall stiffness (beta-index), respectively. Three-month therapy was associated with significant increase in EDVD – by 40,2% in 10 mg/d group, and by 51,3% in 20 mg/d group. After 24 weeks of the treatment, CCA distensibility increased by 45,3% (p<0,01) and 43,6% (p<0,01) in 10 and 20 mg/d groups, respectively. Vascular wall stiffness decreased by 23,4% (p=0,008) and 25,7% (p=0,002), respectively. There was no significant association between LDL-CH decrease and EDVD, distensibility or stiffness dynamics. During 24-week follow-up, 2 adverse events (4%), linked to atorvastatin therapy, were registered. Conclusion. In CHD and PHL patients, atorvastatin (10-20 mg/d) increased EDVD by 40-51%, CCA distensibility by 43-45%, reduced vascular wall stiffness by 23-26%, and was well tolerated

Dynamics of markers of markers of acute kidney injury when using epidural block during resection under warm ischemia

Objective: to investigate the time course of changes in the early biomarkers of acute kidney injury in patients with clinically localized cancer during partial nephrectomy, as electively indicated, under thermal ischemia with prior epidural block.Materials and methods. To analyze the nephroprotective effect of an epidural block in kidney resection with warm ischemia, markers of acute kidney injury (cystatin C, interleukin 18, NGAL, L-FABP and KIM-1) were studied by ELISA in the blood and urine of 35 patients with local cancer with an epidural block (main group) and 37 patients with local cancer without an epidural block (control group) before surgery and 40 min after its beginning and on days 1 and 3 of the postoperative period. All patients were divided into 2 groups by the levels of cystatin C in the blood serum: 1000 ng/ml and lower, and over 1000 ng/ml.Results. Epidural block during the perioperative period in kidney resection with warm ischemia for patients with local cancer had an obvious nephroprotective effect allowing maintaining the initial renal functional parameters, in contrast to the standard disease management