Hemodinamikos pokyčiai kepenų operacijų metu yra svarbūs perioperacinėms išeitims. Tyrimo tikslas: išsiaiškinus hemodinaminių pokyčių pobūdį bei priežastis parinkti optimalią pacientų monitoravimo metodiką darant kepenų rezekci¬nes operacijas. Tikslui pasiekti iškelti šie uždaviniai: palyginti širdies minutinio tūrio monitoravimo neinvaziniu impe¬dan¬so kardiografijos būdu vertę su invaziniu intermituojančios termodiliucijos būdu pacientams, kuriems daromos kepenų rezek¬cijos, nustatyti dažniausiai kintančius hemodinaminius parametrus kepe¬nų operacijų metu, nustatyti hemodinaminių rodiklių pokyčių priežastis, rasti hemodinaminius veiksnius, įtakojančius didesnį kraujo nete¬kimą operacijos metu. Remiantis tyrimo rezultatais, daromos šios išvados: siekiant sumažinti perioperacinį sergamumą ir mirštamumą darant kepenų rezekcijas būtina monitoruoti centrinės hemodinamikos ro¬dik¬lius. Širdies minutinio tūrio monitoravimui tinka saugus, nebrangus ir tikslus neinvazinis impedanso kardiografijos metodas. Kepenų rezekcinių operacijų metu stebimi hemodinaminiai pokyčiai yra vidurinio arterinio kraujo spaudimo sumažėjimas (hipotenzija), susijęs su širdies indekso su¬ma¬žėjimu, ir slėgio apatinėje tuščiojoje venoje padidėjimas. Hipotenzijos bei širdies indekso sumažėjimo priežastis dažniau yra apatinės tuščiosios venos perspaudimas, pasireiškiantis didėjančiu slėgiu šlaunies venoje, kurį sąlygoja chirurginės manipuliacijos. Hipotenzijos priežastį kepenų rezekcinių operacijų metu galima... [toliau žr. visą tekstą] / Aim of the study: select optimal methods for patient’s monitoring du¬ring hepatic resection after evaluation the character, causes and rate of hemodynamic changes. Main goals: to compare the value of non-invasive impedance cardiography for moni¬toring of cardiac output to invasive intermittent thermodilution method in patients undergoing hepatic resection, to determine mostly changing hemodynamic parameters during the hepatic surgery, to determine the causes of hemodynamic changes, to determine hemodynamic factors, influencing increase in blood loss during the surgery. Conclusions: non-invasive ICG method may be used to monitor cardiac output during the hepatic resection surgery, most common hemodynamic changes during hepatic resection surgery include the reduction in mean arterial blood pressure (hypotension), decreased cardiac index, and elevated pressure in the inferior vena cava, more common cause of hypotension is clamping of the inferior vena cava, which is caused by surgical manipulations; less common – blood loss. Cause of hypotension during hepatic resection surgery may be determined by pressure monitoring in the superior and inferior vena cava, blood loss is related to the number of clamping of the inferior vena cava and increasing pressure in the superior vena cava. Practical recommendations: in order to reduce the number of hemodynamic changes during the surgery, it is essential to monitor arterial blood pressure, cardiac output and pressures in the superior and... [to full text]

<p>Uvod-Kardiovaskularne bolesti su vodeći uzrok smrti i radne nesposobnosti u Evropi, predstavljaju<br />veliko socijalno i ekonomsko opterećenje. Bolesti periferne arterijske cirkulacije se mogu podeliti u<br />dve celine i to na okluzivne i neokluzivne bolesti, odnosno funkcionalne smetnje. Učestalost<br />arterijske bolesti donjih ekstremiteta snažno je povezana sa godinama starosti. Faktori rizika za<br />perifernu arterijsku bolest su slični onima koji su važni u etiologiji koronarne arterijske bolesti:<br />gojaznost, pu&scaron;enje, dislipidemija, &scaron;ećerna bolest, hipertenzija. Najtipičnija prezentacija periferne<br />arterijske bolesti je intermitentna klaudikacija koja se karakteri&scaron;e bolom u listovima koji se<br />pojačava pri hodanju; bol obično nestaje u miru. Svi gojazni pacijenti sa perifernom arterijskom<br />bole&scaron;ću donjih ekstremiteta imaju povećan rizik od budućih kardiovaskularnih događaja, te je kod<br />njih obavezna op&scaron;ta sekundarna prevencija u cilju pobolj&scaron;anja prognoze. Fizičko vežbanje<br />predstavlja metodu izbora kod obolelih od periferne arterijske bolesti donjih ekstremiteta.<br />Cilj istraživanja: Uporediti efekte programirane fizičke aktivnosti i medikamentozne terapije na<br />hemodinamiku i riziko faktore za kardiovaskularna obolenja kod gojaznih osoba obolelih od<br />periferne arterijske bolesti donjih ekstremiteta.<br />Ispitanici i metode istraživanja: Obavila se retrospektivna-prospektivna, klinički deskriptivna,<br />kontrolisana studija, na ispitanicima Javne Ustanove Domovi Zdravlja Kantona Sarajevo -<br />Specijalističko konsultativna delatnost. OJ Specijalističko konsultativna delatnost predstavlja<br />sekundarni vanbolnički nivo zdravstvene za&scaron;tite. Ovom studijom se evaluirao period od 20 nedelja<br />(140 dana). U studiju je uključeno 75 ispitanika. Na početku istraživanja, na osnovu nalaza kolor<br />Doppler sonografije pedalnih arterija, nalaza ejekcione frakcije leve komore, spirometrijskog<br />nalaza, vrednosti pulsnog aortalnog pritiska te utvrđivanja preterane uhranjosti &ndash; gojaznosti<br />ispitanici su uključeni u istraživanje. Osim ultrazvučnog nalaza i nalaza spirometrije, pacijenti su<br />dali i iscrpnu anamnezu o prethodnim obolenjima. Uradilo se merenje indeksa telesne težine, obim<br />struka i klaudikacione distance. Lipidogram kao i jutarnji &scaron;ećer su bili urađeni za svakog pacijenta.<br />Pacijentima je prepisana ili produžena medikamentozna terapija, te data detaljna upustva za<br />svakodnevni program vazoaktivne &scaron;etnje.<br />Rezultati istraživanja: Na početku istraživanja prosečna vrednost obima struka ispitanika je<br />iznosila 87,94&plusmn;3,07cm, nakon dve sedmice prosečan obim struka je iznosio 87,10&plusmn;2,0 cm, a na<br />kraju istraživanja 84,96&plusmn;1,98cm. Na početku istraživanja ispitanici ispitivane grupe su imali indeks<br />telesne mase od 28,93&plusmn;2,10 kg/m2. Nakon dve sedmice istraživanja i provedene terapije indeks<br />telesne mase se smanjio i iznosio 28,36&plusmn;1,99 kg/m2, da bi na kraju istraživanja prosečna vrednost<br />indeksa telesne mase u ispitivanoj grupi iznosio 27,26&plusmn;1,87 kg/m2. Prosečna vrednost glukoze u<br />krvi na početku istraživanja je iznosila 5,77&plusmn;0,96 mmol/L, tokom istraživanja ta vrednost je bila<br />5,42&plusmn;0,88 mmol/L, a na kraju istraživanja 5,30&plusmn;0,92 mmol/L. Postprandijalna vrednost glukoze u<br />krvi je na početku istraživanja iznosila7,48&plusmn;0,85 mmol/L, tokom istraživanja ta vrednost je bila<br />6,82&plusmn;0,62 mmol/L, a na kraju istraživanja 6,44&plusmn;0,64 mmol/L. Na početku istraživanja vrednost<br />HbA1c je iznosila 5,52&plusmn;0,91%, tokom istraživanja 5,32&plusmn;0,97%, a na kraju istraživanja<br />5,09&plusmn;0,73%.Prosečna vrednost CRP-a na početku istraživanja je iznosila 3,77&plusmn;1,12mg/L, tokom<br />istraživanja vrednost je iznosila 3,66&plusmn;1,36mg/L, da bi na kraju istraživanja ta vrednost iznosila<br />3,61&plusmn;1,21mg/L. Uparenim t-testom nije ustanovljeno statistički značajno smanjenje ili povečanje<br />CRP-a tokom istraživanja. Prosečna vrednost holestarola u krvi ispitanika na početku istraživanja<br />je bila iznad referentnih vrednosti i iznosila 6,58&plusmn;0,90 mmol/L. Nakon dve sedmice istraživanja i<br />provedene terapije vrednost je iznosila 4,96&plusmn;0,46 mmol/L, da bi na kraju istraživanja vrednost<br />iznosila 4,15&plusmn;0,54 mmol/L. Prosečne vrednosti triglicerida na početku i tokom istraživanja su bile<br />povi&scaron;ene, da bi na kraju istraživanja bile u okvirima referentnih vrednosti. Razlika između<br />VI<br />vrednosti leptina kod mu&scaron;karaca na početku i kraju istraživanja je iznosila 2,66&plusmn;1,52 ng/ml<br />(t=3,024; p=0,094) dok kod ispitanica ženskog pola nije do&scaron;lo do statistički značajne razlike.<br />Prosečne vrednosti viskoznosti plazme su na početku i tokom istraživanja bile iznad referentnih<br />vrednosti da bi na kraju istraživanja ta vrednost bila u granicama fiziolo&scaron;kih vrednosti. Prosečne<br />vrednosti PSV na početku i tokom istraživanja su bile u granicama patolo&scaron;kih vrednosti da bi na<br />kraju istraživanja vrednost bila u granicma fiziolo&scaron;kih vrednosti. Na početku istraživanja prosečna<br />vrednost PSV-a je bila 25,64&plusmn;5,38 cm/s, tokom istraživanja 26,94&plusmn;5,31 cm/s, da bi na kraju<br />istraživanja iznosila 35,84&plusmn;5,73 cm/s. Tokom sva tri merenja do&scaron;lo je do statistički značajnog<br />pobolj&scaron;anja. Na početku i tokom istraživanja ispitanici ispitivane grupe su imali patolo&scaron;ke<br />vrednosti klaudikacione distance, da bi na kraju istraživanja ta vrednost bila u fiziolo&scaron;kim<br />granicama. Ustanovljeno je statistički značajno smanjenje pulsa tokom istraživanja i to u<br />fiziolo&scaron;kim okvirima. Iako je do&scaron;lo do statistički značajnog pobolj&scaron;anja EFLV ipak su vrednosti na<br />kraju istraživanja bile na donjim granicama fiziolo&scaron;kih vrednosti. U toku istraživanja dobilo se i<br />statistički značajno pobolj&scaron;anje vrednosti pulsnog aortalnog pritiska. Iako je do&scaron;lo do statistički<br />značajnog pobolj&scaron;anja FEV1 ipak su vrednosti na kraju istraživanja bile na donjim granicama<br />fiziolo&scaron;kih vrednosti.<br />Zaključak - Vrednosti indeksa telesne mase ispitanika na kraju istraživanja su se statistički<br />značajno smanjile. Prosečna vrednost holesterola i triglicerida, kao i prosečna vrednost PSV-a,<br />BMI, EFLV, FEV1, kao i svih ostali poređenih parametara značajno se smanjila nakon oba<br />tretmana. Na osnovu dobijenih rezultata ustanovljeno je da je klaudikaciona distanca statistički<br />značajno manja u odnosu na početne vrednosti. Poredeći efekte medikamentoznog tretmana sa<br />efektima kombinovanog terapijskog pristupa dolazi se do zaključka da su svi poređeni parametri,<br />izuzev C-reaktivnog proteina u krvi, statistički značajno pobolj&scaron;ani na kraju kombinovanog<br />tretmana u odnosu na vrednosti na kraju medikamentoznog tretmana.</p> / <p>they represent a large social and economic burden. Diseases of peripheral arterial circulation can be<br />divided into two groups - the occlusive and non-occlusive disease, or functional impairment.<br />Incidence of arterial disease of the lower extremities is strongly associated with age. Risk factors<br />for peripheral arterial disease are similar to those that are important in the etiology of coronary<br />artery disease: obesity, smoking, dyslipidaemia, diabetes and hypertension. The most typical<br />presentation of peripheral arterial disease is intermittent claudication, which is characterized with<br />pain in the leaves, which increases during walking; the pain usually goes away in peace. All obese<br />patients with peripheral arterial disease of the lower extremities have an increased risk of future<br />cardiovascular incidents, and they require general secondary prevention in order to improve their<br />health forecasts. Physical activity represents the method of choice in patients with peripheral<br />arterial disease of the lower extremities.<br />Aim of the research: Compare the effects of programmed physical activity and medical therapy on<br />hemodynamic and risk factors for cardiovascular diseases in patients with peripheral arterial<br />diseases of the lower extremities.<br />Subjects and methods of research: A retrospective-prospective, clinically descriptive, controlled<br />study was conducted on subjects of the Public Institution Health Care Centre of Sarajevo Canton&ndash;<br />Specialist-consultative unit. Specialist-consultative unit represents secondary outpatient level of<br />health care. This study evaluated a period of 20 weeks (140 days). The study involved 75 subjects.<br />At the beginning of the study, based on the findings of colour Doppler sonography of the pedal<br />arteries, the findings of ejection fraction of the left ventricle, spirometry findings, values of<br />pulmonary aortic pressure and the determination of overweight - obesity subjects were included in<br />the research. In addition to ultrasound findings and spirometry findings, patients provided an<br />exhaustive history of previous illnesses. Measurement of the body weight index, waist<br />circumference and claudication distance were performed. Lipid status and morning blood glucose<br />level were performed for each patient. Prescribed or prolonged medicinal therapy was performed<br />for patients, and detailed instructions for everyday vasoactive walking program were given.<br />Research resultsAt the beginning of the study, the average volume of the subjects&#39; waist<br />circumference was 87.94 &plusmn; 3.07cm, after two weeks the average volume of the waist was 87.10 &plusmn;<br />2.0 cm, and at the end of the study 84.96 &plusmn; 1.98cm. At the beginning of the study, subjects of the<br />tested group had a body mass index of 28.93 &plusmn; 2.10 kg / m2. After two weeks of research and<br />performed therapy, the body mass index decreased and amounted to 28.36 &plusmn; 1.99 kg / m2, so that at<br />the end of the study, the average body mass index in the tested group was 27.26 &plusmn; 1.87 kg / m2.<br />The mean blood glucose level at the beginning of the study was 5.77 &plusmn; 0.96 mmol / L, during the<br />study this value was 5.42 &plusmn; 0.88 mmol / L, and at the end of the study, 5.30 &plusmn; 0.92 mmol / L. The<br />postprandial blood glucose level at the beginning of the study was 7,48 &plusmn; 0,85 mmol / L, during the<br />study, this value was 6.82 &plusmn; 0.62 mmol / L, and at the end of the study, 6.44 &plusmn; 0.64 mmol / L. At<br />the beginning of the study, the HbA1c value was 5.52 &plusmn; 0.91%, during the study 5.32 &plusmn; 0.97%, and<br />at the end of the study, 5.09 &plusmn; 0.73%. The C-reactive protein (CRP) mean at the beginning of the<br />study was 3.77 &plusmn; 1.12mg / L, during the study, the value was 3.66 &plusmn; 1.36mg / L, and at the end of<br />the study, this value was 3.61 &plusmn; 1.21mg / L. Paired t-test did not show a statistically significant<br />reduction or an increase in CRP during the study. The average blood cholesterol of the subjects at<br />the beginning of the study was above the reference values and amounted to 6.58 &plusmn; 0.90 mmol / L.<br />After two weeks of research and therapy, the value was 4.96 &plusmn; 0.46 mmol / L, and at the end of the<br />study the value was 4.15 &plusmn; 0.54 mmol / L. The average triglyceride values at the beginning and<br />during the study were elevated so that at the end of the study they were within the reference values.<br />VIII<br />The difference between the values of leptin in male subjects at the beginning and at the end of the<br />study were 2.66 &plusmn; 1.52 ng / ml (t = 3.024; p = 0.094) while there was no statistically significant<br />difference in female subjects. The average values of plasma viscosity were initially and during the<br />study above the reference values, and at the end of the study this value was within the limits of<br />physiological values. The mean values of PSV at the beginning and during the study were within<br />the limits of pathological values, and at the end of the study the value was within the physiological<br />limits. At the beginning of the study, the mean PSV value was 25.64 &plusmn; 5.38 cm / s, during the study<br />26.94 &plusmn; 5.31 cm / s, and at the end of the study it was 35.84 &plusmn; 5.73 cm / s. During all three<br />measurements statistically significant improvement was observed. At the beginning and during the<br />study, the subjects of the tested group had pathological values of claudication distance, and at the<br />end of the study this value was within the physiological limits. A statistically significant reduction<br />in pulse was observed during the study, in physiological frameworks. Although there was<br />statistically significant improvement in EFLV, however, the values at the end of the study were at<br />the lower limits of physiological values. During the study, statistically significant improvement in<br />the value of pulmonary aortic pressure was obtained. Although there was statistically significant<br />improvement in FEV1, the values at the end of the study were at the lower limits of physiological<br />values.<br />Conclusion - The values of the body mass index of subjects involved at the end of the study were<br />statistically significantly reduced. The average value of cholesterol and triglycerides, as well as the<br />average value of PSV, BMI, EFLV, FEV1 as well as all other comparable parameters, decreased<br />significantly after both treatments. Based on the obtained results it was found that the claudication<br />distance was statistically significantly lower than the baseline values. Comparing the effects of<br />medicinal treatment with the effects of the combined therapeutic approach, it is concluded that all<br />the compared parameters, other than C-reactive protein in the blood, were statistically significantly<br />improved at the end of the combined treatment compared to the values at the end of the medicinal<br />treatment.</p>

Kepenų arterijų anatominiai variantai yra dažni. Viena dažniausių aberantinių (netipiškai atsišakojančių) kepenų arterijų atsišakojimo vietų yra viršutinė pasaito arterija. Pastarosios arterijos kraujotaka yra įtakojama daugybės fiziologinių ir patologinių veiksnių. Literatūroje taip pat aprašyti pavieniai atvejai apie iš viršutinės pasaito arterijos atsišakojančios aberantinės kepenų arterijos įtaką viršutinės pasaito arterijos hemodinamikai, tačiau didesnės apimties įrodymais pagrįstų tyrimų šioje srityje iki šiol nebuvo atlikta. Todėl šio tyrimo tikslas buvo įvertinti, ar aberantinė kepenų arterija, atsišakojanti iš viršutinės pasaito arterijos, reikšmingai įtakoja pastarosios kraujagyslės hemodinamiką. Šiame tyrime kompiuterinės tomografijos angiografijos pagalba įvertinti kepenų arterijų anatominiai variantai, atrinkti pacientai doplerio ultragarso tyrimams. Pastaruoju metodu tirta viršutinės pasaito arterijos kraujotaka pacientams, kurių vieni turėjo aberantinę kepenų arteriją, atsišakojančią iš viršutinės pasaito arterijos, o kiti turėjo įprastą kepenų arterijų anatomiją. Vertinta aberantinės kepenų arterijos, atsišakojančios iš viršutinės pasaito arterijos, įtaka pastarosios arterijos hemodinamikai (rezistentiškumui). Remiantis tyrimo duomenimis nustatyta, kad kepenų arterijų anatominiai variantai yra dažni. Aberantinė kepenų arterija, atsišakojanti iš viršutinės pasaito arterijos, reikšmingai mažina pastarosios arterijos rezistentiškumą. Pateiktos praktinės... [toliau žr. visą tekstą] / Anatomical variants of hepatic arteries are frequent. One of the most common origins of aberrant (atypically branching) hepatic arteries is superior mesenteric artery. Many physiologic and pathologic features influence hemodynamics of the latter artery. There were some sporadic cases in literature about the influence of aberrant hepatic artery arising from superior mesenteric artery to the hemodynamics of the latter artery, but no evidence based large extent studies were performed. Therefore the aim of this study was to evaluate how significant the aberrant hepatic artery branching from the superior mesenteric artery influences the hemodynamics of superior mesenteric artery. Anatomical variants of the hepatic arteries were evaluated by computed tomography angiography also the candidates for Doppler ultrasound were selected. Doppler ultrasound was used to evaluate the hemodynamics of the superior mesenteric artery in patients with aberrant hepatic artery arising from the superior mesenteric artery and in those with typical hepatic artery anatomy. The influence of the aberrant hepatic artery arising from superior mesenteric artery to the hemodynamics (resistance) of the superior mesenteric artery was assessed. The results of the investigation show that anatomical variants of the hepatic arteries are frequent. The aberrant hepatic artery arising from superior mesenteric artery significantly lowers resistance of the superior mesenteric artery. Practical recommendations were set... [to full text]

Anatomical variants of hepatic arteries are frequent. One of the most common origins of aberrant (atypically branching) hepatic arteries is superior mesenteric artery. Many physiologic and pathologic features influence hemodynamics of the latter artery. There were some sporadic cases in literature about the influence of aberrant hepatic artery arising from superior mesenteric artery to the hemodynamics of the latter artery, but no evidence based large extent studies were performed. Therefore the aim of this study was to evaluate how significant the aberrant hepatic artery branching from the superior mesenteric artery influences the hemodynamics of superior mesenteric artery. Anatomical variants of the hepatic arteries were evaluated by computed tomography angiography also the candidates for Doppler ultrasound were selected. Doppler ultrasound was used to evaluate the hemodynamics of the superior mesenteric artery in patients with aberrant hepatic artery arising from the superior mesenteric artery and in those with typical hepatic artery anatomy. The influence of the aberrant hepatic artery arising from superior mesenteric artery to the hemodynamics (resistance) of the superior mesenteric artery was assessed. The results of the investigation show that anatomical variants of the hepatic arteries are frequent. The aberrant hepatic artery arising from superior mesenteric artery significantly lowers resistance of the superior mesenteric artery. Practical recommendations were set... [to full text] / Kepenų arterijų anatominiai variantai yra dažni. Viena dažniausių aberantinių (netipiškai atsišakojančių) kepenų arterijų atsišakojimo vietų yra viršutinė pasaito arterija. Pastarosios arterijos kraujotaka yra įtakojama daugybės fiziologinių ir patologinių veiksnių. Literatūroje taip pat aprašyti pavieniai atvejai apie iš viršutinės pasaito arterijos atsišakojančios aberantinės kepenų arterijos įtaką viršutinės pasaito arterijos hemodinamikai, tačiau didesnės apimties įrodymais pagrįstų tyrimų šioje srityje iki šiol nebuvo atlikta. Todėl šio tyrimo tikslas buvo įvertinti, ar aberantinė kepenų arterija, atsišakojanti iš viršutinės pasaito arterijos, reikšmingai įtakoja pastarosios kraujagyslės hemodinamiką. Šiame tyrime kompiuterinės tomografijos angiografijos pagalba įvertinti kepenų arterijų anatominiai variantai, atrinkti pacientai doplerio ultragarso tyrimams. Pastaruoju metodu tirta viršutinės pasaito arterijos kraujotaka pacientams, kurių vieni turėjo aberantinę kepenų arteriją, atsišakojančią iš viršutinės pasaito arterijos, o kiti turėjo įprastą kepenų arterijų anatomiją. Vertinta aberantinės kepenų arterijos, atsišakojančios iš viršutinės pasaito arterijos, įtaka pastarosios arterijos hemodinamikai (rezistentiškumui). Remiantis tyrimo duomenimis nustatyta, kad kepenų arterijų anatominiai variantai yra dažni. Aberantinė kepenų arterija, atsišakojanti iš viršutinės pasaito arterijos, reikšmingai mažina pastarosios arterijos rezistentiškumą. Pateiktos praktinės... [toliau žr. visą tekstą]