Exercise

When Ofa form right reovazogrammy in a quiet position was changed in 14 out of 21 patients: in 8 it was presented in the form of an arch (a slow systolic rise, round top and sloping down), 6 - had the shape of the burst (rapid ascent and descent, jag ). The left curve shape has not changed. After exercise the right reovazogramma all patients has changed: in 13 cases it had the appearance of the dome, and in 8 - a form of burst.

On the left tibia in 7 patients form reovazogrammy also been changed. When RSA form reovazogrammy right leg in all patients at rest was flattened. The left reovazogramma changed their shape in 8 patients out of 12 similar changes in the right lower limb. After exercise, both right and left reovazogrammy were flattened, smooth dicrotic notch in all patients with RSA.

Consequently, qualitative analysis reovazogrammy proves that with the growth of the inflammatory and destructive processes in CHO increases and the number of cases with different forms rheogram changes in the first place - with the right lower limb. After exercise, these changes occur in the TAC more than half of patients, with Ofa and governors - all patients, and for governors - and in a quiet position.

In patients with acute catarrhal appendicitis quantitative analysis indicates that the propagation time rheographic wave in seconds and percentage of the cardiac cycle, both right and left alike, and at rest and after exercise (tabl.15). There was a significant lengthening anakroticheskoy phase right after the functional test to 15,28 ± 1,39% vs. 14,80 ± 0,86% in the control group (P <0,05) 13,98 ± 1,048% in a patient in a quiet position ( P <0,05).

Bandwidth anakroty and vascular tone are directly proportional, and with brand viagra an increase in tonic tension vessels anakroty expectancy increases and blood flow, respectively, slowed down - write HH Yarullin (1967), O. Korkushko (1983), VP Bisyarina. (1986). Consequently, patients with TAC after the functional test comes peripheral vasospasm right lower limb.

From literature review it is clear that those responsible for vascular tone is sympathetic nervous system, rendering vasoconstrictor effect (VZ Parin. 1965; GP Konradi, 1971; AM Chernukha. 1971; VA Negovsky , 1977; BI Tkachenko, 1984; Folikov AB and O. Neill, 1976; P. Johnson, 1982). Consequently, peripheral spasm indicates an increase in SNS tone, due likely to increased stimulation of peripheral pain fibers after exercise. Blood flow index and the amplitude of the wave rheographic in ohms was significantly decreased after exercise and on the right lower limb.

accuracy when comparing performance reovazogrammy before and after exercise; x - reliability when compared with the control group

When Ofa (Table 2) vascular tone at rest, according to anakroticheskoy phase as a percentage, is elevated on the right by 20.4% (P> 0.05), and after exercise, this figure rises even further, and noted an increase in the indicator and the left on average - by 20.2% from baseline (P <0.05). Peripheral blood on admission was significantly reduced only on the right (by 10,2%), and after physical activity - by 40% compared with the control group (P <0.05 and P <0.05).

Thus, as a result of vasoconstriction on the right, the degree of which increases after exercise, there comes a corresponding decrease in blood flow.

At RSA (Table 3) wave propagation time rheographic a percentage relative to the cardiac cycle increased and the right of the deceased, whereas the left is significantly increased just after exercise (P <0.05). A similar change is undergoing anakroticheskaya phase in seconds and percentages. Judging by them, vascular tone in a quiet elevated position on the right by 42.2%, and after the functional test - increased by 60% compared to the norm, and by 17,8% - from the initial level.

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Spontaneous

Of oxygen activity of neutrophils was determined by the reaction of reduction of nitro blue tetrazolium. NBT-test is based on the absorption of phagocytes Nitroblue Tetrazolium from the medium and its subsequent recovery within the cell to diformazana. Reaction with intact neutrophils characterizes the degree of "functional stimulation" of these cells in vivo (NST-test spontaneous) rates of NBT-test in neutrophils stimulated in vitro with zymosan, opsonized and neopsonizirovannym can be considered as a criterion of activity at the voltage of the functions of oxygen (NST- test-stimulated n / c and a / h). Index of stimulation of neutrophils in all kinds of zymosan (Kao, Kan, CA): The ratio diformazan-positive cells in stimulated reaction to diformazan-positive cells in the spontaneous reaction of NBT-test [5].

In all cases at all stages of a deformed cecum was fixed planar soldering to the ventral wall in the place of its deserozirovaniya. In some animals in SPBP involved bowel loops, omentum and other mobile abdominal organs. Severity SPBP on day 3 was 2,35 ± 0,22 points, at day 7 there was a slight but statistically significant decrease in its severity (p <0,05) to 2,09 ± 0,14 points. By day 14 the severity of adhesions brand name levitra also tended to decrease (1,87 ± 0,16 points), but it is not of a statistically significant nature. Histological examination revealed the dynamic changes of maturing fibrous connective tissue with signs of decay infiltrative processes and progressive angiogenesis.

On the third day after playing SPBP there was a decrease of spontaneous NBT-test, which indirectly indicated the presence of a peripheral vein of a small absolute number of cells, which caused a massive migration to the inflammatory focus. By day 7 was observed stihaniya inflammation, respectively, reduction in migration of neutrophils. In addition, as a result of compensatory mobilization of bone marrow, peripheral vein increased number of polymorphonuclear leukocytes, in connection with which there was an increase of oxygen activity in the spontaneous NBT-test, the normalization of which proishodlo to 14 day after the simulation SPBP.

In the stimulated NBT-test neopsonizirovannym zymosan brand viagra online on the third day after operation was observed to decrease. By 7 the day of the experiment - it did not differ from that of healthy animals, and by day 14, again declined. Despite such momentum, attention is drawn to the fact that at 7 and 14 day reserve of cellular activity (RNA) in response to zymosan neopsonizirovanny progressively decreased. This is explained by the presence in the blood of young, functionally immature polymorphonuclear leukocytes are not able to adequately respond to stimulation.

A formal study of NBT test stimulated by opsonized zymosan showed its decrease at 3, 7 and 14 days after modeling SPBP, but the analysis of reserve cell activity in opsonized zymosan (CAR), it was found that the changes were the same as when stimulated neopsonizirovannym zymosan.

Discrete cells' ability to respond to various stimuli (CA) changed natural: the third day after the simulation - has not changed, as in the bloodstream was attended by mature neutrophils, to the 7 day experiment, a marked "dip" due to the presence of immature white blood cells, and to day 14 - again stabilized.

Reliable correlation between the severity of SPBP and the change of oxygen dependent functions we have not been identified.

Thus, on the third day after the simulation SPBP in peripheral blood of a marked reduction of oxygen activity of neutrophils, with the exception of the activation coefficient, which rose or were the same as in healthy animals, probably due to the massive migration of inflammatory cells, the presence cialis without prescription of bloodstream of mature neutrophils, increased provision of cellular activity. By the seventh day is observed reserve of oxygen depletion of cellular activity, which is due to compensatory activation of the bone marrow and the appearance in the blood of young, functionally immature neutrophils. On the fourteenth day a partial normalization of oxygen activity of polymorphonuclear leukocytes, which is associated with stihaniya inflammatory processes in the abdominal cavity.

Consequently, when SPBP at different stages after the simulation observed dynamic changes in the indices of immunological reactivity, in particular oxygen dependent neutrophil function. In this regard, a promising direction in the development antiadgezivnyh prophylactic drugs can be considered the use of local and resorptive immunocorrecting therapy, as well as in-depth study of the patterns of immunopathogenesis SBB.

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Metabolic syndrome
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Pulmonary embolism

The most accurate diagnostic information provides angioscanning ultrasound duplex color-coded blood flow primarily due to the possibility of direct visualization of blood vessels. This study allows to assess the condition of the walls and lumen of the vein, the presence of thrombotic masses, the nature of the thrombus (occlusive, neokklyuzivny) and even tentatively judged on its "age", ie degree of organization. Ultrasound scanning of saphenous veins allows to identify with absolute precision the true extent of thrombosis. In the case of his transfer to the deep veins with a simple scan can determine whether a thrombus is fixed to the wall of the deep veins or freely floating (floated) in the lumen (Fig. 1). Simultaneous use of Doppler ultrasound and color coding significantly improves the reliability of the information received.

Compulsory stage angioscaning is to investigate any and all deep veins of both lower extremities since 10% of the possible simultaneous development of thrombosis in them. Most often it is asymptomatic or masked by the clinic of acute varikotromboflebita.

X-ray contrast venography is of limited value in brand viagra diagnosing this disease. Its use is advisable only for distributing safeno-femoral thrombosis in the iliac and inferior vena cava. In such situations, it may go on direct or indirect (Endovasal) interventions on the inferior vena cava.

The role of laboratory diagnosis is low. CBC reveals a moderately pronounced signs of inflammation (slight leukocytosis, increased ESR, positive reaction to CRP). Study of various components of the hemostatic system has no independent diagnostic importance. Meanwhile, many doctors are somehow considered a high level of prothrombin index marker of venous thrombosis. If a patient with varicose this figure exceeds 100%, then they expose the diagnosis of acute thrombosis and sent him to the hospital even in the absence of any clinical symptoms. Such an approach does not hold, can not replace viagra to prevent impotence physical and instrumental examination and must be reserved in the past.

Faced with patients varikotromboflebitom should necessarily exclude its paraneoplastic nature. So, we know that 1 / 3 of patients with cancer of the body of the pancreas initially go to the doctor with symptoms of thrombophlebitis. Therefore, with respect to patients with acute thrombophlebitis of the very important oncological alertness doctor. Then at the slightest doubt, in addition to general clinical examination must be carefully ultrasound examination of abdominal organs, retroperitoneum and pelvis, thyroid, gastro-and colonoscopy, X-rays of the chest.

Treatment

Therapeutic measures in acute varikotromboflebite should:

1) prevent the spread of thrombosis in deep veins;

2) quickly arrest the inflammation in the walls of veins and surrounding tissues;

3) to exclude recurrence of thrombosis varicose veins.

Priority and ways of solving these problems are determined by location and prevalence of thrombophlebitis, the nature of the underlying disease (varicose and postthrombotic disease), as well as the general condition of the patient: presence or absence of his severe concomitant diseases.

Most patients with varikotromboflebitom can be treated conservatively on an outpatient basis. Emergency hospitalization in the surgical hospital (preferably in a specialized vascular or phlebological department) is required when the ascending forms of thrombophlebitis trunks of large and small saphenous veins when there is a threat to go deep vein thrombosis on. Such patients should be treated in the emergency procedure after an ultrasound scan.

Operative treatment

Surgical treatment may be palliative or radical. The aim of palliative operations is to prevent the transition to deep vein thrombosis after safeno-femoral and safeno-poplitealnoe anastomosis. To do this, make the dressing estuarine subcutaneous routes. Most often affects the thrombotic process of the great saphenous vein, so the most famous operation Troyanov - Trendelenburg - high ligation v. saphena magna with compulsory ligation of all estuarine tributaries. Postoperatively, the patients underwent conservative treatment aimed at relief of thrombotic and inflammatory processes.

Radical surgery is possible for varicose veins, it provides not only eliminate the threat of deep vein thrombosis and pulmonary embolism, and removal of all varicose (thrombosed and netrombirovannyh) veins with ligation of incompetent perforators mandatory.

The advantage of such operations is to accelerate the timing of medical rehabilitation at the expense of the radical elimination of the pathological focus. Therefore, the somatically not burdened patients preferred combination of radical Venectomy. Such intervention should be performed in the first 2 weeks. disease. In the later periods dense inflammatory infiltrate in the area varikotromboflebita make the removal of diseased veins is very traumatic. That is why, if a radical operation because of any cause could not be performed during this period of time, its implementation should be deferred until the full relief of inflammation (for a period of 4 - 6 months).

Emergency surgical intervention was also shown in patients with safeno-femoral and safeno-poplitealnym thrombosis, ie, the transition of the pathological process in the deep veins. In these cases, along with ligation of the main superficial veins carry thrombectomy of the femoral or popliteal veins. Such intervention should be performed in specialized viagra enhancing orgasm departments of vascular surgery.

Its features have surgery on the varikotromboflebita with postthrombotic disease. Superficial veins in these patients often carry active collateral function. Since in most cases a blood clot in the saphenous veins exposed to recanalization, the removal of these additional routes of outflow of blood from the limb is inappropriate. The volume of transactions should be limited to ligation of surface wellhead main veins. The essential difference between this operation from interfering with varicose veins is mandatory retention of all the tributaries near the anastomosis. That it is blood flow in the contralateral limb or in the system of the superior vena cava in the defeat of the iliac veins. Therefore, at the mouth of the saphenous vein wall in a deep ligate without crossing the highway surface and its tributaries. After recanalization of thrombus collateral blood flow in the subcutaneous veins of resumes.

In cases of post-thrombotic occlusion of deep veins carry out surgery for patients with varikotromboflebitom no need, regardless of its level. Occlusion of the iliac and femoral veins in itself an obstacle to the spread of thrombosis of the great saphenous vein in the proximal direction. Risk of pulmonary embolism, while absent, so these patients is sufficient for conservative therapy.

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Liver disease

Liver disease

Hematologic changes in acute liver disease will be discussed below. They are mainly represented by hemolytic or hypoplastic anemia.

Many years ago, Wintrobe (1936), studying the frequency of the various types of anemia in chronic liver disease, found signs of macrocytosis in 32,6% of patients normotsitoza - at 30,3%, the absence of anemia - a 22.7% and microcytic anemia - 14 , 4%.

Macrocytic anemia may be due to folic acid brand name viagra deficiency, associated with alcoholism, or even simultaneously existing pernicious anemia, but is usually not associated with deficiency of any vitamin, source macrocytes are bone marrow makronormoblasty. Macrocytes much more uniform in shape than similar cells in megaloblastic anemia similar severity. The volume of these macrocytes slightly increased compared to the norm, but they are thinner and have larger than normal red blood cells in diameter. Such cells are known as leptotsity [Binghan, 1961; Werre et al., 1970] and are of two types, one of which is mishenevidnymi cells. Mishenevidnost was influenced by serum factors - normal cells are introduced into the bloodstream of patients with circulating leptotsitami, capture an excess amount of cholesterol and acquire relevant leptotsitam properties, including resistance to salt solutions. Such changes are characteristic of severe hepatocellular lesions, in which certain cells take the form akantotsitov observed in a-b-lipoproteinemii. The presence of these cells poor prognosis, and those patients in whom they are found, usually die within 1-2 months.

Very often, especially if it is accompanied by chronic hepatitis or cirrhosis, anemia is moderate - hemoglobin levels rarely fall below 100 grams per liter. In such cases, the United neoslozh-normotsitarny and normochromic red blood cells.

If red blood cells in the peripheral blood normotsitarny or slightly megalocytic, the bone marrow hypoplasia exhibit the phenomenon, and erythroblasts become makronormoblasticheskimi [Nunally, Levine, 1961]. In makronormoblastov large nucleus, chromatin network more open and contains blocks or wedges of chromatin, rather than dense "blob" cores as the most recent normoblasts. There are giant metamyelocytes, but sometimes found the picture plazmotsitoza. Megaloblastic changes are observed only when the deficiency of folic acid.

Sometimes, as in the blood and bone marrow revealed changes characteristic of true iron deficiency. They arise due to blood loss, such as bleeding from esophageal varices, which may be complicated by hemorrhagic diathesis as a consequence of liver disease.

In anemia, concomitant liver disease, shortened life time of erythrocytes [Chaplin, Mollison, 1953; Cooksley et al., 1973]. Erythrocytes of these patients live less healthy and being transfused recipients; red blood cells of healthy individuals transfused to patients with liver disease, are short-lived. This demonstrates Viagra Is it possible Viagra will help you clearly the existence of intra-and extracellular hemolytic factor. The role of the spleen is unclear, and there is no direct correlation between the latter and the severity of hemolysis [Cooksley et al., 1973]. Splenectomy rarely improves the condition of patients and does not lead to an increase in red blood cell. It has been suggested that red blood cells are damaged during the passage through the liver [Dacie, 1967], but Cooksley et al. (1973) concluded that the passage of erythrocytes through the liver is not the primary cause of hemolysis and that this body is carried out only phagocytosis already altered cells. Kinetics of iron have shown that bone marrow is not able in the usual way to compensate for the increased destruction of red blood cells. Erythropoiesis is really growing, but not to such an extent as to prevent the development of moderate anemia. Evidence of ineffective erythropoiesis no [Kimber et al., 1965].

Lifespan of red blood cells can be reduced and in acute liver disease, but, except for the above-mentioned rare aplasia, any shortening of the red blood cell reliably compensated, so anemia is rare.

Sometimes severe hemolytic anemia may occur in patients with chronic liver disease at the time of exacerbations. One of these diseases, Tsive syndrome was first described in 1958 It occurs after a single dose of alcohol dose and is manifested in the form of severe hemolytic anemia following the hyperlipidemia and hypercholesterolemia. The syndrome is usually accompanied by weakness, vomiting, fever and pain in the epigastric region or in the lower chest. Severe hemolytic anemia may occur against the backdrop of attacks of acute viral hepatitis or developed after the Coombs-positive hemolytic anemia that accompanies chronic active hepatitis.

It should be remembered that drinking large amounts of alcohol can lead to megaloblastic or sideroblastic changes that will be imposed on the manifestations of anemia, a characteristic of chronic liver disease.

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