Lviv Clinical Bulletin

Number 4(16), 2016

8-14
The Peculiarities of the Endothelial Function, Blood Lipid Spectrum and Heart Rate Variability in Patients with Stable Angina, Depending on the Heart Rate Frequency

Authors: Bilous Z., Аbrahamovych О.

Abstract

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The survey studies the impact of heart rate on the development of endothelial dysfunction and disorders of heart rate variability in patients with stable angina. Introduction. Endothelium plays an important role in the adaptation of coronary blood ﬂow to myocardial oxygen demand in case of angina pectoris. In case of damage there is an imbalance between the level of endothelium synthesized substances – imbalance between vasodilators and vasoconstrictors towards increased synthesis of vasoconstrictors, which plays a signiﬁ cant role in causing stenosis of coronary arteries, affected by atherosclerosis. The loss of endothelial anti-inﬂammatory, antioxidant and antithrombotic capacity causes disorders of perfusion, tissue hypoxia. Episodes of transient coronary artery vasoconstriction deepen inadequate coronary blood ﬂow, further limiting it. Increased heart rate mechanically damages the vascular wall, causing endothelial dysfunction. High heart rate can affect hemostasis, promote destabilization and rupture of an atherosclerotic plaque. Purpose of the study. To evaluate the peculiarities of the endothelial function, blood lipid spectrum and heart rate variability in patients with stable angina, depending on the heart rate frequency. Materials and research methods. The study involved 125 patients with stable angina, which were divided into groups, depending on the magnitude of heart rate. The control group consisted of 34 practically healthy persons surveyed comparable according to age and sex. The average heart rate in patients of groups 1, 2 and 3 was, on average, 89.9 ± 6.57 bpm, 70.26 ± 4.37 bpm and 58,0 ± 1,12 bpm respectively, in the control group – 70.7 ± 5.4 bpm (p1.4 < 0.05, p2,4 > 0.05, p3,4 < 0.05). Serum ELISA determined endothelin-1; method for determining the activity of vWF is based on its ability to induce platelet aggregation in the presence of aggregation inducer ristozitine; the study of blood lipid spectrum was carried out by using spectrophotometric method; studying heart rate variability, we analysed the temporal and spectral characteristics. Statistical analysis of the results of research was carried out by the variation statistics method using Statistica 6.0 and Microsoft Ofﬁ ce Excel 2007. Results of the investigation and their discussion. In patients with stable angina endothelial dysfunction was pronounced. In patients with stable angina with a heart rate >80 bpm endothelial dysfunction was more pronounced (increased content of endothelin-1 – 5.85 ± 0.31 fmol/ml (р1,2 < 0.01, р1,3 < 0.01) and von Willebrand factor – 186.3 ± 11.0 % (р1,2 < 0.01, р1,3 < 0.01), and more signiﬁcant pro-atherogenic changes of blood lipid spectrum (increased LDL-C, TG). Between HR end E-1, vW direct relationship. LDL-Cin 1 group 4.27 ± 0.34 mmol/l and 4.12 ± 0.18 and 3.04 ± 0.25 mmol/lin 2 and 3 (р1,2 > 0.05, р1,3 < 0.01). TGin 1 group 2.19 ± 0.08 mmol/l, in 2 group – 1.98 ± 0.06, and in 1 group – 1.90 ± 0.04 (р1,2 < 0.05, р1,3 < 0.01). In patients with stable angina pro-atherogenic changes in lipid spectrum was pronounced. Between HR, LDL-C and TG established a direct relationship. Based on the study of spectral and temporal characteristics of heart rate variability there was found an autonomic imbalance in these patients with a predominance of sympathetic nervous system activity. Between HR and heart rate variability the temporal and spectral characteristics direct relationship. In patients with a heart rate of 60-80 and <60 beats per min. endothelial dysfunction was less pronounced, however, decrease of the level of parasympathetic ANS impact in the regulation of cardiac activity was found. Platelets and index of aggregation does not indicate the existence of substantial differences in surveyed groups. Conclusions. Patients with stable angina have features of endothelial function, lipid spectrum of the blood and heart rate variability depending on heart rate, which are in the most signiﬁcant signs of endothelial dysfunction, violation of lipid spectrum of the blood and the imbalance of autonomic nervous system dominated symptomatic level in patients with the frequency of heart rate over 80 beats / minute, and it can be used as a criterion for assessing the severity of the pathogenic mechanisms of stable angina.

15-19
The Employment of Orthodontic Bracket System as Method of Intermaxillary Fixation in Cases of Traumatic Mandibular Fractures: Retrospective Literary Review and Own Experience

Authors: Vares Ya., Chegrynec N.

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Introduction. Intermaxillary ﬁxation is an important and inseparable constituent part of treatment of trauma patients which provides an adequate interocclusal relationship. It can be employed as a solely conservative moda lity for fracture treatment as well as obligatory assistance of jaw osteosynthesis in case of its traumatic injury. The essential drawbacks of the existing methods of intermaxillary ﬁxation, particularly dental arch bars and ligatures, are negative inﬂ uence on periodontium, complicated hygiene, non-balanced muscular loading, pain and psychological discomfort to the patient etc, which requires a search for alternative methods. A stream development and inculcation to the clinical practice of various orthodontic systems in recent decades allow extrapolating the indications for their employment from orthodontics to other dental directions, especially maxillofacial traumatology. The purpose of the study is a retrospective analysis with clariﬁcation of historical aspects and generalization of own experience of employment of non-removable orthodontic technique (bracket system) for ﬁxation of bone fragments in cases of traumatic mandibular fractures. Materials and research methods. Since 2012 in the Department of Surgical Dentistry and Maxillofacial Surgery of The Danylo Galytsky LNMU 57 patients (men – 45, women – 12; age 18 – 45) with traumatic mandibular fractures were examined and treated surgically (control group, 35 patients) and conservatively (main group, 22 patients). In all patients of the main group the intermaxillary ﬁxation was carried out using the elements of non-removable orthodontic technique – brackets VictoryÒ with hooks (speciﬁcation 0° TQ, 0° ANG, 022) (3М Unitek, USA), which were ﬁxed on teeth according to standard protocol, including acid enamel etching, employment of adhesive, ﬁxation of brackets with light-curing composite). Later the hooks of opposite brackets were joined together by elastic rubber rings in proper occlusal relationship. Control inspection of patients was carried out on 1, 3, 7, 14, 21, 30, 60 and 90 days post-operatively. Results. The obtained results of employment of non-removable orthodontic elements (brackets) for bone fragments ﬁxation in 22 patients with traumatic mandibular fractures were evaluated by us as satisfactory. The mean period of intermaxillary ﬁxation was 19 ± 2 days. On that time clinical and roentgenological signs of fracture consolidation were observed in all patients and there were no occlusal disturbances in any case as well as other complications except of unglue of brackets from the teeth surface. There were no patients’ complaints regarding laboured oral hygiene and service of orthodontic appliance. Positive results of investigation are conﬁrmed by the demonstration and description of a clinical case. Conclusions. Summarizing the results of a brief retrospective literary analysis as well as our own clinical experience it could be asserted that employment of elements of non-removable orthodontic technique (bracket system) for ﬁxation of bone fragments in cases of traumatic mandibular fractures creates a serious alternative to the existing methods of an intermaxillary ﬁxation. The proposed method allows to reestablish an adequate anatomical and functional status of the mandible in short terms, facilitates oral hygienic maintenance, requires no local anaesthesia and is suitable for both balanced occlusal loading distribution and, oppositely, correction of occlusal relationship by means of directed elastic pull.

20-26
The Сontent of Some Humoral and Metabolic Vasoactive Factors in the Blood of the Cirrhotic Patients and Their Dependence on the Hepatopulmonary Syndrome Severity Degree

Authors: Abrahamovych M., Tolopko S., Fayura O.

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Number of views: 397

Introduction. The attempts of the different scientists to diagnose and describe dangerous pulmonary complications of chronic liver diseases were more than 100 years ago. So, in 1884, an Austrian doctor M. Fluckiger found a link between the liver diseases and lungs watching a patient with cirrhosis, cyanosis and symptom of “drumsticks.” The term “hepatopulmonary syndrome” (HPS) was ﬁrst proposed only in 1977 by a group of Swedish researchers to display the arterial hypoxemia that occurs in about 1/3 of the patients with liver cirrhosis (LC) without concomitant diseases of the cardiovascular and respiratory systems. The elucidation of the pathogenic mechanisms of HPS, taking into account its unfavorable course, small amount of symptoms, high mortality is an important task of modern hepatology and would help to diagnose it at early stages, to prevent the severity increase, using adequate pathogenetically justiﬁ ed drugs. The aim of our study was to determine the content of some humoral and metabolic vasoactive factors, namely the endothelium-dependent (cyclic guanosine monophosphate, endothelin-1, tumor necrosis factor α), indices of the renin-aldosterone system (renin, aldosterone), natriuretic hormone in the blood of the cirrhotic patients and determine their dependence on the hepatopulmonary syndrome severity degree. Materials and methods. Into the study there were involved 80 patients [23 women (28.75 %) and 57 men (71.25 %) aged 27 to 67 years old] with LC, in a randomized manner with preliminary stratiﬁ cation by the presence of HPS to achieve the aim. All of them were treated in Lviv Regional Hepatological Center for the period 2012-2015 years. Taking into account the expert assessments of the chosen characteristic features of HPS in the assessing of its severity degree (concordance coefﬁcient = 0.81; signiﬁcance was deﬁned due to R. Fischer’s criteria), we found: in case of the values from 6 to 21 points – I degree HPS, 22-43 points – II degree HPS, 44-103 points – III degree HPS. Created by us computer program “Hepatopulmonary syndrome”, which provides the selection of indices, followed by the calculation of points, helped to optimize the work with minimal time. According to this principle all the patients were stratiﬁed into three groups: the 1st group (I degree HPS) included 28 patients (35.0 %), the 2nd (I degree HPS) – 31 (38.8 %), the 3rd (I degree HPS) – 21 patients (26.3 %). The levels of some endothelium-dependent vasoactive substances in the blood plasma, indices of renin-aldosterone system and natriuretic peptide contentwere identiﬁed in all these patients. According to the results of our study there can be seen the tendency of the certain dynamics of vasoactive humoral and metabolic factors content changes in the blood of the patients with LC depending on the severity degree of HPS. The received results showed that the levels of cyclic guanosine monophosphate, tumor necrosis factor α, endothelin-1, renin, aldosterone, natriuretic peptide in the patients of the study group were signiﬁcantly higher (p < 0.05) compared with the reference rates, and the growth of their content directly proportional depends on the severity degree of lung lesions, reﬂecting endothelial dysfunction and violations of renin-aldosterone system state with the appearance of intrapulmonary vasodilation and paradoxical response of the receptors of the pulmonary vessels to the inﬂuence of vasoconstrictors that allows us to consider them as one of the pathogenic mechanisms of the HPS. Conclusions. In the patients with HPS the levels of cyclic guanosine monophosphate, tumor necrosis factor α, endothelin-1, renin, aldosterone, natriuretic peptide were signiﬁcantly (p < 0.05) higher compared with the reference values which allows us to consider them as parts of the pathogenetic mechanisms of its appearance with the activation of cascade reactions resulting in the hyperproduction of nitric oxide or direct vasorelaxation inﬂuence through the relaxation of smooth muscle cells of the vascular wall of pulmonary vessels. The value of these vasoactive humoral and metabolic factors directly proportional depends on the HPS severity degree, contributing to pre-capillary-capillary pulmonary vasodilation with the paradoxical response of the receptors of the pulmonary vessels to the inﬂuence of vasoconstrictors, and therefore can be considered as markers of lung injury severity in patients with LC.

27-35
Ultrastructural Organization of Microcirculatory Bed in Clear Cell Renal Cell Carcinoma of Different Grades of Differentiation

Authors: Fedevych S.

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Number of views: 654

Introduction. Implementing into medical practice target therapy in cancer patients including the conventional (clear cell) renal cell carcinoma (CCRCC) provides the delivery of anti-angiogenic and conventional cytoreductive agents through “normalized” ways of the vascular network of tumors to cancer cells. We also know that microcirculatory bed and its microenvironment in tumors are formed by vasculogenesis and angiogenesis, unlike normal tissues, are characterized by the presence of primitive vessels and abnormal microenvironment. However, no stu dies were conducted, which would have characterized in comparative plan the ultrastructural organization of tumor microvessels in CCRCC of different grades of differentiation. The aim is to examine ultrastructural organization of microcirculatory bed in conventional (clear cell) renal cell carcinoma of different grades of differentiation. Materials and methods. Material for conducting transmission electron microscopic researches was postoperative biopsies of peripheral and central parts of tumors in CCRCC at high differentiated cancer (G 1) – three cases: one man (61-years-old) and two women (49- and 61-years-old); with an average grade of differentiation (G 2) – three cases: two men (43- and 66-years-old) and one woman (69-years-old); with a low grade of differentiation (G 3) – six cases, all were men (48-, 52-, 56-, 70-, 71-, 75-year-old). Material for conducting of сontrol studies in transmission electron microscopy was postoperative biopsies of renal cortex of eliminated parts of the kidney with tumor and the whole kidney with tumor in these patients with CCRCC. The technique is common in transmission electron microscopy. Results and discussion. At the ultrastructural level, vascular buds, primordial endothelial cells, optimally developed capillaries, forming capillaries, already formed capillaries, small venules, primitive capillaries, hematopoietic cells, mesenchymal cells, ﬁ bers of collagen studied in peripheral stroma of tumors with high differentiated (G 1) CCRCC. In the central part of the tumors there are small numbers of cells that are in the process of apoptosis, decomposition and necrosis. Gaps of disorganized capillaries are rich in accumulations of erythrocytes, platelets and ﬁ brin monomer bundles of ﬁ bers, gaps of small venules with wrinkled walls are rich in a homogenous blood plasma. The sclerotized stroma of tumors with an average grade of differentiation (G 2) CCRCC contains mesenchymal cells, disorganized bands of primordial endothelial cells, hypertrophic capillaries and small venules. The luminal surfaces of endothelial cells of the vessels are formed by a large number of microvilli. Their gaps contain hyperaggregates of erythrocytes, polymorphonuclear granulocytes, monocytes, platelets with high electron density, ﬁbrin polymer bundles of ﬁ bers, the large drops of lipoprotein. At the low grade of differentiation (G 3) CCRCC, the considerable areas of epithelium- and endothelium-containing formations of peripheral and more central parts of the tumor are disorganized, and are in a state of apoptosis and necrosis. It was observed that the modiﬁed tumor apoptotic epithelial cells with surrounding ﬁbrin polymer bundles of ﬁbers and adjacent the remodulated stroma were rich in mononuclear cells, monocytes, hematopoietic cells, mesenchymal cells, primordial endothelial cells, vascular buds, capillaries of sinusoidal type, primitive capillaries, newly formed capillaries and small venules. The control studies made it possible to establish that the ultrastructural organization of optimally developed capillaries of peripheral part of tumors with high differentiated grade CCRCC is close to that of peritubular capillaries of renal cortex of patients with high differentiated (G 1) CCRCC and kidney of mammals. Conclusions. The ultrastructure of microcirculatory bed of tumors with a high grade of differentiation (G 1) is a more “normalized” than the average one (G 2) and the low (G 3) grade of differentiation CCRCC.

36-41
The Study of the Effectiveness of Meloxicam “Movalis” Application in Postoperative Patients with Planovalgus Foot Deformity

Authors: Yatskevych A., Trutyak I., Abrahamovych U., Yatskevych O.

Abstract

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Number of views: 406

Introduction. Today the main method of complex treatment of severe foot deformities in adults is a surgery. Every surgery beneﬁ cial to a patient is accompanied by iatrogenic and inﬂammatory tissue damage of different degrees and related complications of wounds. No exception is made for corrective surgery on foot. After a corrective intervention, and also after postoperative changes of anatomical relationships in segments, there occurs inﬂammatory reaction which is accompanied by a prolonged swelling and foot pain. It is believed that meloxicam has not the least analegtic and anti-inﬂammatory activity as traditional anti-inﬂammatory drugs and speciﬁc (highly selective) inhibitors COX-2, dominating them on the degree of safety and the least number of side effects. Moreover, for the orthopedic patients very important is their positive impact on the components of the musculoskeletal system, in particular promoting the normalization of metabolism in cartilage. Evaluation of the efﬁcacy of meloxicam (“Movalis”) in patients after surgery on ﬂat foot deformity has not been investigated. The aim of the study is to determine the efﬁcacy of meloxicam (“Movalis”) in patients after ﬂatfoot surgery. Materials and methods. The results of efﬁ cacy determining of meloxicam treatment were analyzed (“Movalis” ﬁrm Boehringer Ingelheim GmbH) in 107 patients (27 men and 80 women, average age 48.4 years), operated with ﬂatfoot (research groups). All patients were performed a corrective osteotomy of foot and various options of arthroplasty and miotenoplasty operations. All operations were performed according to McBride, SCARF osteotomy, Weil, Akin, Chevrone. “Movalis” was prescribed in injection (15.0 mg daily). On the sixth day after the operation patients were prescribed a single oral use of “Movalis” with daily dose of 15.0 mg or twice a day 7.5 mg for another 10 days. The control group totaled 104 patients, similar by age, sex and foot surgery, which did not use NSAIDs, and (if necessary) performed anesthesia using Metamizole (50.0 mg for patients with moderate pain) and narcotic drug (Tramadol 50.0 mg) in cases of pronounced and signiﬁcant pain. In all patients of experimental and control groups in the postoperative period were observed: 1) the severity and dynamics of pain according to the VAS scale; 2) the severity of aseptic inﬂammation by the severity of local swelling of the foot before the operation, evaluation of its dynamics every day in the morning after waking and before the load measurment with a measuring tape on the level of the ﬁ fth tuberous metatarsal bone, which can be easily determined during the palpation in all patients; 3) the dynamics of the wound healing with an assessments of the postoperative wound healing results, for which we used and modiﬁed for speciﬁcanatomical location clinical system developed by prof. H. T. Nishanovym with co-authors. Results and discussion. Thus, the proposed scheme of treatment can achieve not only an adequate analgesic effect, but also provides a strong anti-inﬂammatory effect. In the ﬁ rst days of treatment it can not only prevent the growth of inﬂammatory syndrome (unlike the patients in the control groups), but to reduce it to 44.7 % compared with control group of patients that have not been treated with “Movalis”. By the end of the ﬁ rst week inﬂammatory syndrome, as a result of a treatment by the proposed scheme, is expressed in 4.2 times less than in control group of patients. The scheme of treatment has a positive effect on the components of the syndrome of inﬂammation, but the anti swelling effect is expressed the most. There were no vesicles in patients of the research group, while they were detected in 2.3 % of patients in the control group. In general, treatment of patients with ‘Movalis’ helped to reduce the rate of postoperative inﬂammatory and wound’s complications in 2.9 times – from 14.8 to 5.1%. Total tolerance to meloxicam (“Movalis”) was seen as very good in 77 patients (71.9 %), good – in 27 (25.2 %), satisfactory – in 2 (1.8 %), and in one patient (0.9 %) as poor (allergic reaction). In 2 patients were detected gastrointestinal side effects (heartburn, discomfort in epigastric area), but they did not require discontinuation of “Movalis”. Conclusions. The use of meloxicam (“Movalis”) in patients after ﬂ at foot surgery is effective, achieves good analgesic effect, and provides a strong anti-inﬂammatory effect. “Movalis”is well tolerated and signiﬁcantly reduces the incidence of wound complications.

42-54
Treatment of the Cirrhotic Patients Considering Portal Hypertension Severity Degree and Comorbid Syntropic Extrahepatic Lesions, their Complications: Modified Algorithm, its Effectiveness

Authors: Ferko M.

Abstract

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Number of views: 594

Intraduction. Liver cirrhosis is one of the most difficult diseases in the world to the diagnosis and treatment of which special attention is paid. The prevalence of liver cirrhosis and mortality caused by it is very different across countries and tends to increase. The incidence of liver cirrhosis increased over the past 10 years in developed countries in 10.0-15.0 %. Information on mortality due to the liver cirrhosis is ambiguous – from 8 to 80 per 100 thousand population. It was learned that liver cirrhosis is not limited by the injury of hepatobiliary system, but also extends to other organs and systems that can be considered as cirrhotic disease of the whole organism with involvement into the pathological process of various organs and systems of the human body, interpreted as syntropic comorbid lesions, which in most of the cases cause temporary, and in the future – sustainable abnormal function, disability, often – death of the patient. Today it is premature to assume that the problem of treatment of the cirrhotic patients is solved due to the fragmentary information, obtained using a variety of different models in experimental and clinical conditions, ignoring the severity of portal hypertension and syntropic comorbid extrahepatic lesions and their complications, does not allow to affect substantially on the treatment effectiveness of these patients, improve their quality of life. This determines the relevance, medical, social and economic significance, and also the need for the improvement of the principles and increase the efficiency of complex differential treatment of the cirrhotic patients considering the severity degree of portal hypertension and comorbid syntropic extrahepatic lesions and their complications that are still not performed. The aim of our study was to improve the algorithm and increase the treatment effectiveness of patients with liver cirrhosis taking into account the severity degree of portal hypertension and comorbid syntropic extrahepatic lesions and their complications. Materials and methods. After obtaining written consent in accordance with the principles of the Helsinki Declaration of Human Rights, the European Convention on Human Rights and Biomedicine and Legislation of Ukraine into the study in randomized manner with the preliminary stratification by the presence of liver cirrhosis were involved 240 patients who were hospitalized with the aim of the examination and treatment into created on the basis of the Internal Medicine Department N 1 of Lviv National Medical University and Gastroenterological Department of Lviv Regional Clinical Hospital, Lviv Regional Hepatological Center. According to the results of an ultrasound dopplerfloumetric examination of the abdominal cavity vessels, all the patients were stratified into three groups: the first – patients with I degree portal hypertension – 122 persons [33 women (27.0 %) and 89 men (73.0 %), aged 21 to 78 years (average age 46,4 ± 1,0 years), including 78 patients (57.4 %), for whicha comprehensive differentiated treatment with the help of modified by us algorithm was conducted (experimental group) and 44 patients (42.3 %), for which there was conducted a comprehensive treatment due to the conventional method (Order of the MPH of Ukraine from 13.06.2005, N 271 – the control group), the second patients with II degree portal hypertension – 57 patients [14 women (24.6 %) and 43 men (75.4 %) aged 27 to 66 years (average age 48,2 ± 1,3 years), including 26 persons (19.1 %) – experimental group and 31 patients (29.8 %) – control group], the third group – patients with III degree portal hypertension – 61 patients [18 women (29.5 %) and 43 men (70.5 %) aged 29 to 73 years (average age 50,2 ± 1,3 years), including 32 patients (23.5 %) – experimental group and 29 patients (27.9 %) – the control group]. The criteria for evaluating the treatment results were as follows: excellent result – recovery; good result – a significant improvement, most values of the indices returned to normal; satisfactory result – a slight improvement, some values of indices have improved; bad result – no improvement and a very bad result – deterioration or transformation into cancer. For the direct assessment of the life quality of the patients with cirrhosis, we used a questionnaire MOS 36-Item Short-Form Healh Survey, created by J. E. Ware in 1992. Results and discussion. In accordance with the aim, we have developed a comprehensive differentiated pathogenetically grounded individualized landmark treatment algorithm for the patients with liver cirrhosis taking into account the severity degree of portal hypertension, syntropic comorbid extrahepatic lesions and their complications. It was found that it is effective in 93.6% of the patients, as well as in 9.5 % (p < 0.05) for the value exceeds the conventional method (Order of the MPH of Ukraine from 13.06.2005, N 271). According to the results of our study, we can say that the improved algorithm for the treatment of patients with liver cirrhosis and a common methodology gives a positive result, but in terms of qualitative and quantitative indices, generally accepted medical complex is significantly inferior to modified by us algorithm. Conclusions. Treatment of the patients with liver cirrhosis according to the modified by us algorithm is effective for the results of evaluation of physical parameters and quality of life. It must be comprehensive, that, except of the impact on the etiological factor, its main pathogenetic links, commits to take into account the severity of portal hypertension and the presence of syntropic comorbid extrahepatic lesions and their complications.

55-58
Coronary Artery Anomalies: the Efficiency in Diagnosis by the Improved Method in Autopsy Material

Authors: Boiko O., Maksymchuk E.

Abstract

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Number of views: 466

Introduction. Coronary arteries anomalies can only be found during the pathomorphololgical detailed study because clinical symptoms are often absent. The coronary artery anomalies are classified as anomalies of origination, course, quantity, permeability and communication. However, these variants of coronary artery anomalies can be missed unless a careful search with macro and microscopic examinations and preparation. Purpose of the research. To find out the efficiency of an improved method in diagnosis of coronary artery anomalies in autopsy material. Materials and research methods. The improved method of diagnosis of coronary artery anomalies in autopsy material was taken to get the quality image of angioarchitectonics of coronary arteries by correcting the components of pouring mass which does not damage the vascular wall, to use the angiography, to improve the histological tissue techniques for histopathological study of coronary arteries, to establish the diagnosis. The autopsies were performed by the improved method at Lviv Regional Pathology Bureau. The pouring mass contained “Triombrastum” (manufacturer Farmak JSC, Ukraine), methylene blue and gelatine and was injected into the coronary arteries. Thereafter the angiographic studies of coronary arteries were performed. The histological specimens of vascular wall were examined by the light microscopy. Results of the investigation and their discussion. The improved method of diagnosis of the coronary artery anomalies in autopsy material was carried out in the following stages. In the first stage the heart was removed during the autopsy. The coronary arteries were injected by the pouring mass. In the second stage the heart was carried to a standard dental x-ray film in size of 305×405 mm. Angiographic studies were performed on the high-frequency dental X-ray unit “PLANMECA Intra” (manufacturer PLANMECA OY, Finland). In the third stage the sections of vascular wall were completed, followed by the painting of them according to standard histological and histochemical methods. The proposed method allows tincturing the sections of vessel wall with the help of standard histological and histochemical techniques after angiographic studies, to explore the postmortem changes of the coronary arteries, to detect the coronary arteries anomalies that is extremely important for the pathomorphological diagnosis and explains the cause of myocardial ischemia. Conclusions. The improved method of diagnosis of coronary artery anomalies in autopsy material is effective and can be used in the practice of pathology.

59-64
Association of the Fractalkine Level with Non-modiﬁable and Modiﬁable Factors of Cardiovascular Risk, the Severity of the Atherosclerotic Lesions of the Coronary Vessels

Authors: Lopina N.

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Number of views: 410

The purpose of research is to evaluate the association of fractalkine level with non-modiﬁable and modiﬁable factors of cardiovascular risk, and the severity of the atherosclerotic lesions of the coronary arteries. Materials and Methods. 131 patients with coronary artery disease (CAD) were examined. Depending on the presence of type 2 diabetes mellitus (T2DM), patients with CAD were divided into 2 groups: 1st group (n = 70) – patients with concomitant T2DM, 2nd group (n = 61) – patients with CAD without T2DM. All patients were performed coronary angiography to verify the diagnosis of CAD. Also in all patients were evaluated anthropometric indicators, the levels of fractalkine, indexes of lipid and carbohydrate metabolism. Results. The study found that patients with CAD both with concomitant T2DM and without had increased levels of fractalkine signiﬁ cantly compared with the control group. In patients with hemodynamically signiﬁcant stenosis, diffuse coronary lesions with concomitant T2DM and without had signiﬁcantly higher fractalkine levels. In assessing the relationship fractalkine with non-modiﬁable risk factors there were established the presence of a weak correlation with age, unreliable weak correlation with experience of T2DM, no statistically signiﬁcant average correlation with experience of CAD. In assessing the relationship fractalkine with anthropometric indices there were established the presence of a weak correlation with weight, the volume of the thighs, the ratio of waist size and hip and average positive correlation with a volume of waist, which conﬁ rms the fact that the abdominal obesity increases the synthesis of fractalkine adipocytes. In assessing the relationship fractalkine with lipid metabolism, it was found the presence of a weak correlation with total cholesterol, triglycerides, VLDL, the level of LDL cholesterol. In assessing fractalkine relationships with indicators of carbohydrate metabolism, has been established the presence of a weak correlation with the index of a short-term glycemic control – glucose and secondary with an indicator of a long-term glucose control – HbA1c. The analysis of correlations between the level of fractalkine and severity of CAD has been established the existence of signiﬁcant correlations: strong – between the amount of atherosclerotic plaques of coronary vessels, the middle – between the number of affected vessels, the number of diseased coronary artery segments, weak – the number of lesions of the proximal middle and distal segments, the number of hemodynamically signiﬁcant stenosis of the coronary arteries. Conclusions. Results of the study demonstrate the impact on the level of fractalkine age, duration of CAD, metabolic status and indicators of glycemic control, abdominal obesity. Increasing fractalkine level is associated with more severe atherosclerotic process. The study shows the impact on the development and progression of atherosclerosis, endothelial dysfunction, especially in patients with concomitant T2DM and abdominal obesity.