Cardiovascular system diseases (CSD)-is one of the most acute medical and social problems of modern society. Ischemic heart disease (IHD) and acute disturbance of cerebral circulation were and remain the leading cause of death and disability. At present, it has been established that in the progression of IHD and its complications, an increase in the level of homocysteine and deficiency of vitamin D are essential. Purpose of the study: to study the effect of hyperhomocysteinemia and deficiency of vitamin D on the course of atherosclerosis and ischemic heart disease. Materials and methods. The study analyzed laboratory data from 58 patients with atherosclerosis. Depending on the prevalence of atherosclerosis patients were divided into 2 groups. All those examined had vitamin D deficiency, as well as hyperhomocysteinemia. These changes were more pronounced in patients with multifocal atherosclerosis, which required a more thorough medication correction after surgical intervention on the coronary and carotid arteries. Results: Of practical interest is the analysis of blood plasma homocysteine concentration values depending on the localization of atherosclerotic lesion. In our study, in the first group, the median plasma homocysteine concentration was significantly higher. Moreover, there was a strong correlation between high concentrations of homocysteine and advanced atherosclerotic lesions. These results may indicate a possible destabilization of atherosclerosis course with hyperhomocysteinemia in combination with vitamin D deficiency. Patients of the first group with multifocal atherosclerosis had significantly higher homocysteine indices and a more pronounced vitamin D deficiency. No less important is the fact that in the examined patients both in one group and in the other group a significant vitamin D deficiency was detected. Conclusions. Hyperhomocysteinemia and vitamin D deficiency-are risk factors for the development of coronary heart disease and are associated with an unfavorable course of coronary pathology. All patients with ischemic heart disease had vitamin D deficiency and hyperhomocysteinemia, more pronounced with multifocal atherosclerosis, which should be considered when prescribing medication after myocardial revascularization.

In addition to the positive effect of weight loosing after bariatric surgery, the post-operative period is often associated with signifi cant changes in bone metabolism.Aim. The aim of this study was to examine changes in bone turnover markers and indicators of dual-energy X-ray absorptiometry (DXA) within 12 months after laparoscopic greater curvature plication (LGCP).Materials and methods. We studied 54 patients from class III obesity who underwent LGCP. The average preoperative weight of the patients was 125.5±19.1 kg, and BMI of 43.0±4.9 kg/m 2 . The gender distribution of the cohort was 35.2% man and 64.8% women. At three time points after the operation (at 3, 6 and 12 months) control examination was conducted that included DXA and markers of bone metabolism.Results. After the surgical treatment we registered signifi cant reduction of all the anthropometric indicators (ρ<0.05; EWL 12 45.8±18.8%; EBL 12 55.1±23.4%). According to the controlled studies on the 12th months, a signifi cant increase in bone turnover markers was revealed (ρ<0.05; CTX, P1NP, OC, OPG, VTD) and reducing of PTH (ρ<0.05). The measure of DXA on the 12th month of observation showed no signifi cant changes in bone metabolism. Strong positive correlation was uncovered between markers of bone metabolism: CTX / P1NP (r=0.790, p=0.000), CTX/ OC, P1NP/OC (r=0.7, p=0.000), minor correlation between PTH/OC (r=0.249, p=0.027). We also report a minor and weak negative correlation between the markers of bone metabolism (CTX, P1NP, OC and VTD) and anthropometric data.Conclusions. Twelve months post LGCP markers of bone turnover (CTX, P1NP, OC, OPG, VTD) were signifi cantly increased. The increased level of VTD is associated with the loss of FAT. Also the change in DXA was detected. Зміни кісткового метаболізму після лапароскопічної плікації великої кривизни шлунка. Річне дослідження А. О. Никоненко, Є. І. Гайдаржі, М. БужґаНезважаючи на позитивний ефект втрати ваги після баріатричних операцій, післяопераційний період часто пов'язаний зі значними змінами в метаболізмі кісткової тканини.Мета роботи -вивчення динаміки маркерів ремоделювання кістки та показників її двоенергетичної рентгенівської абсорбціометрії протягом 12 місяців після лапароскопічної плікації великої кривизни шлунка.Матеріали та методи. Досліджували 54 пацієнти з ожирінням III ступеня, які перенесли лапароскопічну плікацію великої кри-визни шлунка. Середня передопераційна вага пацієнтів була 125,5±19,1 кг і ІМТ 43,0±4,9 кг/м 2 . Поділ за статтю був такий: 35,2% чоловіків і 64,8% жінок. Контрольне обстеження здійснили на 3, 6 і 12 місяці після операції. Обстеження включало вимір показників двоенергетичної рентгенівської абсорбціометрії та визначення маркерів кісткового метаболізму.Результати. Після хірургічного лікування зареєстрували значне зниження всіх антропометричних показників (ρ<0,05; EWL 12 45,8±18,8%; EBL 12 55,1±23,4%). Згідно з результатами досліджень через 12 місяців виявили значне збільшення маркерів ремоделювання кістки (ρ<0,05; CTX, P1NP, OC, OPG, VTD) та зниження PTH (ρ...

The adequacy of blood supply in the allograft is one of the main factors of kidney transplant vitality and function and the effectiveness of transplantation itself.The aim of the study was to investigate the effectiveness and variants of arterial reconstructions of kidney allograft. Material and Methods.The results of kidney transplantation were analyzed among 66 patients. During the period from 2012 to 2016, all of them were done kidney transplantation in the department of transplantology. There were 37 (56.1 %) men, 29 women (43.9 %), the average age at the time of surgery was 33.2 ± 12.0 years. According to the aim of the study all the patients were divided into two groups: the first group included 12 (18.2 %) recipients, who received an arterial reconstruction. The age of the patients was 30.8 ± 6.5 years, there were 6 (50 %) men, other -women. Another group involved 54 (81.8 %) patients without arterial reconstruction. The average age of recipients was 33.7 ± 12.9 years, there were 31 (57.4 %) men, 23 women (42.6 %). We analyzed duplex examination of kidney allograft on the 7.6 ± 1.9 day after kidney transplantation. Results.According to the analysis of duplex examination the features of blood disorder in kidney allografts were not determined. The differences between groups were non-significant (p > 0.05). There were not identified any stenosis, thrombosis or bleeding in any cases of arterial reconstructions of kidney allograft; function of kidney allograft has preserved for the period of 2.2 ± 1.4 years. Conclusions.Adequate arterial reconstruction of kidney allograft is effective and safe method of kidney preparation for transplantation. Одним із принципових факторів життєздатності та функції пересадженої нирки, а отже й ефективності трансплантації, є адекватність кровотоку в аллотрансплантаті.Мета роботи -вивчити ефективність і варіанти артеріальних реконструкцій ниркового аллотрансплантату.Матеріали та методи. Проаналізовані результати трансплантації нирки 66 хворим. З 2012 по 2016 р. їм виконана пересадка нирки у відділенні трансплантації. Чоловіків було 37 (56,1 %), жінок -29 (43,9 %), середній вік пацієнтів -33,2 ± 12,0 року. Згідно з метою роботи пацієнтів поділили на групи: першу становили 12 (18,2 %) реципієнтів, яким виконане хірургічне втручання на артеріях трансплантату. Середній вік пацієнтів -30,8 ± 6,5 року, чоловіків було 6 (50 %), інші -жінки; друга група -54 (81,8 %) пацієнти, в яких не було необхідності в артеріальних реконструкціях аллонирки. Середній вік реципієнтів -33,7 ± 12,9 року, чоловіків було 31 (57,4 %), жінок -23 (42,6 %). Аналізували дуплексне сканування ниркового аллотрансплантату в середньому на 7,6 ± 1,9 доби після пересадки нирки.Результати. Під час дуплексного ультразвукового сканування ознак порушення кровотоку в ниркових аллотрансплантатах не виявили. Відмінності між групами статистично невірогідні (p > 0,05). У жодному випадку не зареєстровано стенозів, тромбозів або кровотеч; за період спостереження 2,2 ± 1,4 року функція аллонирок збережена.Висновки. Адекватна артер...

Introduction. Nowadays hemodialysis is the most widespread way of treatment concerning the end-stage renal disease. The variant of choice as for permanent vascular access for hemodialysis is arteriovenous fistula. An actual problem is the deterioration of the patency of arteriovenous fistula. According to the research, most patients do not know about the risks associated with intradialytic hypotension. Under these conditions, research with determining the level of critical intradialytic hypotension is particularly relevant. Purpose of the work is to study and evaluate intradialytic hypotension as a risk factor for thrombosis of arteriovenous fistulas. Materials and methods. 60 patients were examined with end-stage renal disease, receiving of hemodialysis. Among these patients a thrombosis of arteriovenous fistula appeared in the long term (7.5 (3.0–17.6) months) after the surgery. The average age of patients was (54.1 ± 11.8) years; there were 30 (50%) men, 30 (50%) women. Results. According to the results of our study, 38 (63 %) patients had hypotension at the end of the hemodialysis session. Conclusions. Blood hypotension is one of the main predictors of thrombosis of arteriovenous fistula in the late postoperative period. A decrease in systolic blood pressure on 35.0 (25.0–50.0) mm Hg to 100.0 (90.0–110.0) mm Hg is critical for the patency of arteriovenous fistula. Adequate control and correction of blood pressure (in particular, during a hemodialysis session) can prevent thrombosis of arteriovenous fistula.

Introduction. Thanks to the use of renal replacement therapy at the current stage of medical development, complete medical and social rehabilitation of patients with end-stage chronic renal failure is possible. The key to effective programmed hemodialysis is the formation of adequate permanent vascular access. Ensuring the optimal use and functioning of permanent vascular access is a multidisciplinary challenge. Currently, none of the known options for permanent vascular access is ideal, but a native arteriovenous fistula meets the requirements to a greater extent. Complications from vascular access for hemodialysis remain relevant for their solution today. The most common complication of vascular access is thrombosis of an arteriovenous fistula. For patients with chronic renal failure who are on programmed hemodialysis, thrombosis of vascular access is a great danger, which ultimately can lead to the impossibility of further hemodialysis and is the main reason for hospitalization and high mortality of this contingent of patients and needs an urgent solution. Clinical cases. 17 patients underwent thrombectomy from the subcutaneous "fistula". vein of the upper extremity. The age of the patients was 49.0 (44.0-61.0) years. By gender, the studied patients were distributed as follows: women - 9 (53%), men - 8 (47%). Among 17 (100%) operated patients, 12 (71%) had late thrombosis, 5 (29%) had early thrombosis of arteriovenous fistula,. Of 5 (100%) patients with early thrombosis of arteriovenous fistula, thrombectomy was effective in 2 (40%) patients (p=0.038). On the other hand, in 12 (100%) patients with late thrombosis of arteriovenous fistula, thrombectomy was successful in only 4 (33%) cases. Discussion. The cause of thrombosis of any vascular anastomosis is primarily hyperplasia of the neointima due to the proliferation of smooth muscle cells of the vascular wall. This circumstance leads to the formation of stenosis of the anastomosis, and as soon as the stenosis values become hemodynamically significant (> 50% of the lumen of the vessel), the risk of developing thrombosis increases by more than 50%. Thrombectomy alone is insufficient to restore patency of the permanent vascular access in the long term, as flow-limiting stenosis is present in more than 85% of cases. Conclusions. Neointimal hyperplasia is the main cause of progressive stenosis of arteriovenous fistula and subsequent thrombosis. Thrombectomy is indicated for thrombosis of arteriovenous fistula in the early postoperative period (up to 30 days after arteriovenous fistula formation). Thrombectomy alone is not enough to restore the patency of the permanent vascular access in the long term, and the final treatment requires its reconstruction at an early stage or the creation of a new arteriovenous fistula.