Prognosis criteria for remission of hypercorticism after transsphenoidal endoscopic adenomectomy in patients with Cushing’s disease

The aim of the study. To assess the role of early postoperative examination in the prognosis of cd remission 1 year after TSS.Patients and methods. 101 Patients (12 men, 89 women, mean age 41,2 years (15-72) with confirmed cd were included. Midnight and morning serum cortisol and plasma ACTH, late night salivary cortisol, 24-h urinary free cortisol (ufc) excretion were performed at the days 2-3 and 12-14 after the TSS. Hypercortisolism remission status was estimated one year after surgery. The optimal threshold values of ACTH and cortisol parameters at 2-3 and 12-14 days after surgery to prediction of cd remission after TSS were calculated by roc-analysis.Results. One year after surgery cd remission was confirmed in 63 patients, whereas in 38 patients hypercortisolism persisted. Postoperative parameters of cortisol and ACTH secretion had comparable high specificity and sensitivity at 2-3 and 12-14 days after surgery for prediction cd remission.Conclusion. According to our data, morning serum cortisol ≤388 nmol/l and plasma ACTH ≤20 pg/ml at 2-3 d after TSS may be used as a prognostic criterion for cd remission 1 year after surgery with sensitivity and specificity 94,9%, 75,9% and 83,3%, 95,8%, respectively

ANTIPLATELET DRUGS RESISTANCE IN PATIENTS WITH ISCHEMIC HEART DISEASE AND OBLITERATIVE ATHEROSCLEROSIS OF LOWER LIMB ARTERIES ASSOCIATED WITH DIABETES MELLITUS TYPE 2

Aim. To study a rate of resistance to acetylsalicylic acid (ASA) and clopidogrel and clinical outcomes in patients with atherosclerosis and diabetes mellitus type 2 (DM2).Material and methods. 154 patients were involved in the study and split into two groups. 100 patients (47 men, 53 women; aged 66,4±7,8 y.o.) with ischemic heart disease (IHD) (which was presented by angina pectoris, class I-III, or myocardial infarction history) were included into the first group (G1). Other 54 patients (38 men, 16 women; aged 64,1±10,2 y.o.) with IHD associated with obliterative atherosclerosis of lower limb were included into the 2nd group (G2). Platelet aggregation was evaluated by Born's method (inducers of platelet aggregation were arachidonic acid and ADP). Reduction of platelet aggregation ≥20% after arachidonic acid induction was considered as criterion of resistance to ASA. Patients were considered as resistant, partly resistant and sensitive to clopidogrel if platelet aggregation reduced on <10%, 10-29%, and ≥30% respectively.Results. Rate of ASA and clopidogrel resistance in patients with DM2 was significantly higher than these in patients without DM2 (48% vs 16% respectively, р=0,003 in G1; 42% vs 7% respectively, р=0,007 in G2).Conclusion. Resistance to antiplatelet drugs is observed more often in patients with DM2 and can result in increased risk of cardiovascular complications

ANTIPLATELET DRUGS RESISTANCE IN PATIENTS WITH ISCHEMIC HEART DISEASE AND OBLITERATIVE ATHEROSCLEROSIS OF LOWER LIMB ARTERIES ASSOCIATED WITH DIABETES MELLITUS TYPE 2

Aim. To study a rate of resistance to acetylsalicylic acid (ASA) and clopidogrel and clinical outcomes in patients with atherosclerosis and diabetes mellitus type 2 (DM2).Material and methods. 154 patients were involved in the study and split into two groups. 100 patients (47 men, 53 women; aged 66,4±7,8 y.o.) with ischemic heart disease (IHD) (which was presented by angina pectoris, class I-III, or myocardial infarction history) were included into the first group (G1). Other 54 patients (38 men, 16 women; aged 64,1±10,2 y.o.) with IHD associated with obliterative atherosclerosis of lower limb were included into the 2nd group (G2). Platelet aggregation was evaluated by Born's method (inducers of platelet aggregation were arachidonic acid and ADP). Reduction of platelet aggregation ≥20% after arachidonic acid induction was considered as criterion of resistance to ASA. Patients were considered as resistant, partly resistant and sensitive to clopidogrel if platelet aggregation reduced on &lt;10%, 10-29%, and ≥30% respectively.Results. Rate of ASA and clopidogrel resistance in patients with DM2 was significantly higher than these in patients without DM2 (48% vs 16% respectively, р=0,003 in G1; 42% vs 7% respectively, р=0,007 in G2).Conclusion. Resistance to antiplatelet drugs is observed more often in patients with DM2 and can result in increased risk of cardiovascular complications.</p