The application of preoperative magnetic resonance angiography in the treatment of critical leg ischemia in patients with diabetes ABBREVIATIONS ABPI -ankle brachial pressure index AI - ankle index ARO - arterial runoff CLI - critical limb ischemia DM – diabetes mellitus DSA- digital subtraction angiography DU - duplex ultrasonography GSV- great saphenous vein HKUM - Hospital of Kaunas University of Medicine IHD - ischemic heart disease IS - ischaemic stroke MRA - magnetic resonance angiography NAV – not reversed autovein PAOD - peripheral artery disease PATE - pulmonary artery tromboembolia SD - standard deviation χ2 - Chi-square 1. INTRODUCTION Complications of atherosclerosis and diabetes mellitus rank among the greatest “scourges” of the aging population. In the majority of developed countries, mortality from complications of atherosclerosis occupies the 1st – the 2nd places, and mortality from complications of DM – the 3rd – the 4th places [Šulcaitė R., 2002]. One of the main risk factors for the development of atherosclerosis is diabetes mellitus (DM)[Eskelinen, E., 2003; Kozek, E., 2003; Yokoyama, H., 2003]. Clinical manifestations of atherosclerosis are ischemic heart disease (IHD), cerebral ischemia (CI), and obliterative atherosclerosis, or peripheral artery occlusive disease (PAOD). At present, diabetologists used the term diabetes lipidus, thus combining these two diseases into one. Up to 70% of amputations of non-traumatic origin... [to full text]

Coronary arteries stenosis causes ischemic heart disease which is the main fatality reason all over the world. For diagnosis arteries stenosis invasive and noninvasive methods are used. These methods are quite expensive and not all medical institutions can carry out such tests. Analysis of electrocardiogram could be one of the cheapest and current methods to diagnose arteries stenosis. Despite the fact, that in some cases such analysis is not very informative, medics look for the informative ECG parameters and their combinations in order to predict stenosis. The goal of this work is to create statistical methods and software for prognosis of coronary arteries stenosis using digital ECG parameters. Data was colecet and prepared for this reseach in Clinic of Cardiology of Kaunas Medical University. In this work are presented: 1.Statistical analysis models for prognosis of coronary arteries stenosis. 2.Software for uses. 3.Comparative analysis of statistical analysis models. 4.Results of real data analysis, which were obtained by using, developed statistical models and software. Obtained results will be used to improve methods of diagnosis ischemic heart disease and arteries stenosis in Clinic of Cardiology of Kaunas Medical University.

Tyrimo objektas. 27–90 metų asmenys, sergantys pirmojo ir antrojo tipo diabetu ir periferinių arterijų liga, gydyti Vilniaus universiteto kraujagyslių chirurgijos centre Vilniaus miesto universitetinėje ligoninėje 1997–2011 m. Tyrimo tikslas. Nustatyti Vilniaus universiteto kraujagyslių chirurgijos centre Vilniaus miesto universitetinėje ligoninėje gydytų pacientų, sergančių diabetu, periferinių arterijų ligos ypatumus, PAL padarinius ir PAL padarinių rizikos veiksnius. Tyrimo medžiaga ir metodai. Išanalizuotos 925 pacientų, sergančių 1 ir 2 tipo diabetu ir 1997–2011 metais gydytų Vilniaus universiteto kraujagyslių chirurgijos centre Vilniaus miesto universitetinėje ligoninėje nuo periferinių arterijų ligos istorijos. Statistinė analizė atlikta SPSS 19.0 for Windows programų paketu. Pasirinktas statistinio reikšmingumo lygmuo α=0,05. Rezultatai. Ištyrėme 387 moterų ir 538 vyrų, duomenis. Vidutinis tiriamųjų amžius buvo 67,99±9,47 metų. 95,6 proc. tiriamųjų sirgo 2 tipo diabetu. Vidutinė sirgimo diabetu trukmė buvo 12,95±9,91 metų. Diabetinę angiopatiją turėjo 47,8 proc. tiriamųjų, nefropatiją – 34,9 proc., retinopatiją – 14,6 proc., polineuropatiją – 33,7 proc.. Statistiškai reikšmingai dažniau nefropatija, retinopatija ir polineuropatija buvo nustatyta pacientams, sergantiems 1 tipo diabetu. Pacientai dažniausiai sirgo širdies ir kraujagyslių sistemos ligomis. 21,2 proc. tiriamųjų jau buvo patyrę galūnių amputacijas. Vidutinė hospitalizacijos trukmė buvo 17,3±10,80... [toliau žr. visą tekstą] / Object of the research. 27–90 years old patients having the type 1 and type 2 diabetes mellitus and peripheral artery disease, who were treated at the Vilnius University Vascular Surgery Center in the Vilnius town University Hospital in the year 1997–2011. The aim of our research was. To analyse aspects of peripheral artery disease in patients with diabetes mellitus, who were cured at Vilnius University Vascular Surgery Center in the Vilnius town University Hospital as well as to determine the consequenses of PAD and the risk factors PAD. Material and methods of the research. 925 cases of the type 1 and type 2 diabetes mellitus were explored at the Vilnius University Vascular Surgery center in the Vilnius town University hospital in the year 1997–2011, who received treatment for the peripheral artery disease. The statistic survey has been done using the program pack SPSS 19.0 for Windows. Statistic importance level α=0.05. Results. Data about 378 women and 538 men have been explored. An average age of all the patients was 67.99±9.47 years. 95.6% of patients had the type 2 diabetes mellitus. An average duration of having disease was 12.95±9.91 years, 47.8% of cases had diabetic angiopathy, 34.9% of patients had nephropaty, 14.6% of cases had retinopathy, 33.7% of all the cases had polyneuropathy. According to the statistic importance rates retinopathy, nephropathy, polyneuropathy are more often among patients with the type 1 diabetes mellitus. Cardiovascular diseases were... [to full text]

At present, cardiovascular diseases cause ca. 30 of deaths worldwide, and are the most common cause of death and disability (The World Health Report 2002; Pearson 1999). Coronary artery disease (CAD) accounts for nearly 50 of all deaths caused by cardiovascular diseases. In 2002, 7.2 million people died of CAD worldwide, and 5.8 million new cases were diagnosed. In 2000, the number of people with CAD around the world amounted to ca. 40 millions (Mackay 2004). The modern understanding of the pathophysiology of atherosclerosis and the concept of “cardiovascular risk factors” started forming in 1950s, when the first findings of the Framingham study were published (Wilson et al. 1998, D’Agostino et al. 2000). Information accumulated during scientific research on atherosclerosis allowed for a significant reduction of CAD-related mortality in the developed countries during the last 20 years, but a more profound analysis showed that the mortality mostly decreased in males, whereas in females it continues to grow. Nearly two-thirds of suddenly deceased women previously showed no clinical symptoms of CAD (AHA 2002). This most probably was influenced by a still predominant erroneous opinion that women, especially of younger age, very rarely have CAD and atherosclerosis of peripheral arteries. Epidemiological studies showed that cardiovascular diseases induced by atherosclerosis are equally frequent cause of death in both males and females. Of all patients who in 2000 in the U.S. died... [to full text]

Aptikus minimalius PAL simptomus, yra labai svarbūs diagnostiniai, greitai atliekami neinvaziniai tyrimo metodai (kulkšnies-žasto indeksas, nykščio indeksas, ėjimo testas, segmentinių slėgio gradientų matavimas ir kt.). Ambulatorinėje grandyje retai matuojamas kulkšnies-žasto indeksas riboja galimybę nustatyti PAL kiek galima anksčiau, numatyti galimas gyvybiškai svarbių organų kraujagyslines komplikacijas, laiku siųsti pacientą konsultuoti angiochirurgui. Mažai tyrinėtu alternatyvaus neinvazinio impedanso pletizmografijos tyrimu galima nustatyti ne tik periferinių arterijų ligos simptomus, bet vienu metu įvertinti eilę kitų parametrų. Darbo tikslas buvo nustatyti neinvazinio impedanso pletizmografijos metodo efektyvumą kojų arterinei kraujotakai įvertinti ir šį metodą palyginti su kitais neinvaziniais bei invaziniais diagnostikos metodais. Tyrimo metu nustatyta statistiškai reikšminga kulkšnies-žasto indekso bei impedanso pletizmografijos parametrų sąsaja pacientams, sergantiems lėtiniu prieširdžių virpėjimu, lyginant su pacientais neturinčiais šio ritmo sutrikimo, nustatyta impedanso pletizmografijos - bangos viršūnės laiko parametro sąsaja su angiografiškai aptikta kraujagyslės okliuzijos vieta. Pagrindinio impedanso pletizmografijos parametro (bangos viršūnės laiko) specifiškumas yra 96 proc., jautrumas – 73 proc. atsižvelgiant į KŽI pokyčius, o lyginant su angiografija – jautrumas 100 proc., specifiškumas – 50 proc. Taigi, neinvazinis impedanso pletizmografijos... [toliau žr. visą tekstą] / In cases of observing even the slightest PAD symptoms, rapid non-invasive diagnostic test methods become extremely important (the ankle-brachial index, thumb index, walking test, measurement of segmental pressure gradients, etc.). in an outpatient setting , the ankle-brachial index (ABI) is rarely measured, thus limiting the opportu¬nities for the earliest possible detection of PAD, prediction of vascular com¬plications of vital organs, and timely referral of the patient for a con¬sultation with an angiosurgeon. An alternative non-invasive test method of impedance plethysmo¬graphy, which has been little investigated so far, allows both detection of symptoms of peripheral arterial disease and concurrent assessment of a number of other parameters. The aim of the study is to assess the efficiency of a non-invasive method of impedance plethysmography in diagnosing arterial circulation disorders in the legs, and to compare this method with other non-invasive and invasive diagnostic methods of peripheral arterial disease. A significant correlation between the Ankle-Brachial Index and the im¬pedance plethysmography parameters was established in subjects with permanent atrial fibrillation, but not in subjects without this rhythm disorder. During the study, an obvious correlation between the Crest Time in¬ter¬val measured by the impedance plethysmography method and the vas¬¬cular occlusion site shown on angiography was established. Specificity of the impedance plethysmography... [to full text]