The slopes of the slurry and two-fingered intestines. Causes, symptoms and treatment of creeping ailments

- the process of getting sick of the slunk of a chronic recurrent nature, which leads to a defect in the mucous membrane of the slunk and the tissue that has been removed from it. The main symptom є bіl in the epigastric region in the heart, or when іzhі, is not often seen in the back and breast tissue... Often blues, bridging, baking, tediousness are considered. Naybіlsh nebezpechnі accelerated - bleeding, burrowing of the shlunka, stenosis of the pylorus іddіlu, malignant degeneration of the worms. Diagnose the data of gastroscopy and X-ray of the slunk, analyzes for helikobakternu infection. The slope of the slurry is not folded, it should be conservative, in accelerated drops it should go down to the surgical procedure.

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medications

Virazkova ailment of a slunk can be made with a mechanism for development, scho and a virazkova ailment two-fingered intestines and also classified.

Symptoms of the creeper slope

On the way from the twist of the twelve-fingered intestine, the twist of the slunk is characterized by a bile, which is determined at once and at once the reception is received. Bluvot during virazts_ of the slunk bring lulling. A frequent symptom is the furnace, as well as the heaviness in the shlunk (tied to the damage of the viporozhnennya), flatulence. Appetite, as a rule, decreases. However, some and localization in the antral sections of the slunk can be manifested by hungry or uncomfortable pains.

Likewise, the twisting of the twelve-fingered intestine, the twisting of the slunker is not without such acceleration, such as bleeding, perforation of the slunk. With localization of the fold in the area of ​​the collar, there is a possibility of development of stenosis of the pyloroduodenal viddil. LOCALIZED INTO THE SLUNK high risik malignancy, in the form of a pathway of the 12th intestine.

diagnostics

The main information for an accurate diagnosis of the incision of the slunk is given by gastroscopy - endoscopic diagnostics of the slunk. The same bend can be seen in contrast radiography of the slunk. When the slurry is reached, the bacteriological sowing is carried out for the development of helikobacteria. At the same time, I will freeze the dichny test, detecting Helicobacter by the PLR ​​and IFA method. A general and biochemical analysis of blood can show signs of anemia, when there is a shortage of bleeding from the bloodstream, specific signs twists and turns at laboratory tests viyaviti is not possible. Feces can also be checked for bleeding (analysis of feces on a covered roof).

Lіkuvannya vyrazki slunk

At lіkuvannі swirling ailments slunk is great value maє suvore dotrimannya dієti - vidmova from products, how to grind a slurry wall and wipe out shlunk juice... We are sick, so we are hungry for the vigorous slunk, and then we turn to gostr, salty, sour, greased and smoked food, products, bagati with coarse cellulose. It is recommended to live the varena or steam it. Lykarska therapy including:

• Ingibitorium proton pump (omeprazole, rebeprazole, esomeprazole and analogs) or blockers of H2-histamine receptors for smothering the slurry secretion (preparations of the group ranitidine);
• gastroprotective (bismuth, sucralfate) and antacid;
• antibacterial drugs for the strangulation of helicobacter infections (metronidazole). Lykarska therapy, tailored to the treatment of H. pylori, as a rule, is carried out for 10-14 days, in order to continue the therapy with lowering acidity drugs.

The twist of the slurry of the operative lykuvannya not vimagє is not folded. The surgical part of the shlunk (resection) indicates only in the development of important problems: perforation, imperfections, malignancy of the twist with the development of the shlunk cancer. Ridko to surgical treatment vdajutsya in case of persistent often recurrent illness, not to accept conservative therapy.

Lіkuvannya symptomatic vyrazok slunk vimagaє, the first for everything, having seen the vyrazka factor. As a rule, there is enough for a positive effect. In the capacity of pre-treatment therapy, it is necessary to stagnate, to reduce the secretion of hydrochloric acid (proton pump ingibitorium, H2-gastroprotector). Reduction of secretory activity in case of viraztsi of the slunk can be fully tightened in a surgical way- Carrying out the vagotomy by way.

Forecast and prevention

Prevention of creeping ailments of the slunk, as well as creeping ailments of the DPK, є timely detection and treatment of heliobacterial infections shlunkovo-intestinal tract, unique stressful situations, Uncontrolled reception drugsі Regularly balancing food. The inconsistency of the slope of the shlunka will be thrown safely in the case of a quick and adequate therapy. Unwelcome prognosis for accelerated development.

For a quote: Loginov A.S., Kalinin A.V. promptly i conservatively gigantic slings of the shlunks // RMZ. 1997. No. 5. Z 1

The statistic presents the results of a comprehensive treatment of 223 ailments with gigantic corkscrews (GYZH), which were tested in special gastroenterological cases of the GVKG im. MM. Burdenko in 1985-1994 rr. It is indicated that it is shown before the operative and conservative treatment of HYZH. The results of the trivial outpatient care for the ailments (stretching 2-9 times for a whiskey from the hospital) are more conservatively more beautiful. brutalization by medical aid and the frequency of hospitalizations of ailments operated on the HYL drive, boules in 2 times, not for conservative treatment. The paper presents the results of comprehensive examination of 223 patients with giant gastric ulcers (GGUs) treated at the specialized gastroenterological units of the Academician N.N. Burdenko State Military Clinical Hospital in 1985-1994. Indications for the surgical and conservative treatments of GGUs were defined. The conservative treatment based on the long-term outpatient of patients for 2-9 years after hospital discharge was ascertained to be more preferable. The referrals and hospitalization of the patients operated on for GGUs were twice higher than those after conservative treatment.

A. S. Loginov,
A. V. Kalinin.

A.S. Loginov,
A.V. Kalinin.

Academician N.N. Burdenko State Military Clinical Hospital, Moscow.

materials and methods

I will use the development of tactics for testing and predicting the effectiveness of young advances up to 10 years (1985-1994). MM. Burdenko was comprehensively treated and prevented 223 ailments from this pathology. The presence of HYJ in all ailments was diagnosed with fibrogastroscopy, the malignant nature of the failures in case of presentation of the results of bagatoraz biopsies and trivial spasms (stretching for 2-9 rockets). All the children took part in the retreat of the weekends of the clinics, instrumental and laboratory methods, Including fractional dosage of slurry in addition to pH-meter. The control fibrogastroscope was carried out through 2-4-6 lateral views of the cob during the course and after 1, 6 and 12 months during the start of the turn. Spіvіdnoshennja cholovіkіvі women bulo 27: 1, sick people older than 60 years became 47%.

results

In 187 (83.8%) ailments of the creeper of a bullet with a diameter of up to 5.1 cm, in 25 (11.2%) patients - a drop of 6.1 cm. 1. Most of the HYZH were localized in the shlunk - in 149 (66.8%) ailments.
For the analysis of the period 32 we have a problem with the operation of the HYZH drive. Indicated before the operation, the last round and the term of the operative treatment at the moment of the diagnosis of the HYZH are presented in Table. 2. To navigate with the necessary surgical assistance in case of non-emergency indications (development of not safe for life accelerated - bleeding, perforation) - the operation should be carried out great (from the resection of the slunk before the resection of the slunk). All resections of the shlunk according to Bilrot I also boules with urgent camps. Posting lines surgical treatment From the drive, the acceleration was increased from 1 to 4 dB.
The main shows before the Victory Day prompt engagement in 56.3% of respondents, there was an accelerated rate of improvement, which prompted the respondents to complete the volume and calibrate promptly. When choosing the tactics of surgical treatment, the results of endoscopic and morphological dosages biopsy, it was not allowed to unambiguously judge about the appearance of a malignant swelling in the first instance of a patient. The average triviality of ailments from HYZH took 43.8 ± 9.6 days for an operative engagement.
Conservative treatment of HYL during the day was carried out more quickly to our principles: merciful physical design, Interchangeable mechanically and cheeky dramatically for 2 years. Have the first days of the day when it is obvious pain syndrome zastosovuvali selective blockers M1-holinoreceptors (gastrocepins) or in'n'ktsiyni forms of H2-blockers (quamethol and neutron) until the pain subsides and antacids are used (almagel and maalox).
For painful symptoms (call up on the 2-3rd day), or if the intensity was low, if the illnesses were needed, they were treated with pills with secretion blockers. So, since 1992, H2-blockers of other and third generations (ranitidin, zantak, ranisan and famotidine) were used, likuvalny effect... The first control gastroscopy was performed 10-14 days after the first day. When an unambiguous definition of morphologies about the good nature of the HNL was rejected, the Chergov control gastroscopy was performed at an interval of 2 times. At the conclusion of fibrogastroscopy (ascertaining the start of the bend), a biopsy was also taken from the scar on the muscle of the bend defect. Basically, lіkuvannya supplemented by physiotherapeutic procedures only when discarding the results of repeated histological pre-examination biopsy. The middle term for the aging of the HYL was stored for 38.6 ± 4.3 days.
In 99 patients, HYZH had ailments that accelerated bleeding, 84 of them were treated for intensive therapy and reanimation. Table. 3 presented data about showing up to the admission of ailments to the intensive therapy ward.
For zupinka bleeding vikoristovuvali go in - a postal regimen, hunger, cold on the abdomen, take in the middle of the crushed ice (in 100% of patients); come in intensive therapy - intravenous injection of 5% dose of aminocaproic acid, 200 ml per infusion, drop-by-drop, oral treatment up to 400-550 ml / day, introduction of fresh frozen plasmas, 2 doses per infusion, 1-2 times per infusion, 1-2 times per infusion circulating blood (BCC) before normalization (in 79.8% of patients); blood loss to transfusions of one-group erythrocyte mass in 47 (55.9%) ailments; medical endoscopic methods for stopping bleeding - infestation, or aplication on the area of ​​adhesion of adhesive compositions, or pluralistic aerosols (MK-6, MK-7, gastrozol and in.) in 17 bleeding ailments, coagulation , tinned shlunkovy vm_stu. Until 1987 we went to the spotted introduction of sodium bicarbonate through a gum or polydimensional probe, injections into the empty slunk before controlling the pH of the slurry vmistu. In a given hour, a drop of the introduced suspension of wild antacids (Almagel, gel-lacquer, maalox), diluted with a rostrum, 100 ml of suspension for 50-70 ml physiological... Vikoristannya of the given method of elimination of HYZH in the development of bleeding allowed 81 (96.4%) patients to reach the stiffness of bleeding in terms of 2 to 5 dB.

Negotiation

Yak can be seen їkh hovering tributes, conservatively lіkuvannya ГЯЖ trivialishe, nіzh operatively. However, unimpressed on the tse, we are still able to pass the conservative taste. The correctness of such an approach is confirmed by the results and in the long run (stretching 2-9 rocky) for the ailments of the HYZH, written from the stationary for the treatment. The withers, after the operative involvement of the ailments, went to the medical aid 2 times more often, below the conservative treatment. The number of hospitalizations for an operative treatment is also significant, but not for a conservative one, which can be explained by the development in patients with ailments of an operated slunk due to the disabling nature of gastrointestinal operations, a great deal of emergency
Okremі authori with conservative treatment of HYZH to fight back the trophism of the mucous membrane of the shlunk. In 79 ailments of the HYZH, in those with a provincial ulceration of the bul, the lack of trophism of the mucous membrane of the shlunk, to the main treatment, they were given hyperbaric oxygenation in courses of 10 sessions every other day, which allowed to change the term for 7 days by the end of the day.

visnovka

1. Shown before the operative treatment of HYZH є development is not safe for life accelerated - perforation and bleeding, as opposed to intensive hemostatic therapy in the minds of a special hospital; Withdrawal indications - non-healing of a bend for more than 3 m / s from the cob of therapy.
2. When there are absolute indications before the operation, conservative treatment of HL should be carried out according to the principles of treatment of malignant ailments with the urahuvannya of the clinical and morphological variant of the surrender and the obviousness of the concomitant ailments.

literature :

1. Bagmet І.І. Giant slurry curves: the reasons for the establishment of that particularity key manifestations... Quarter All-Union Z'yzd of gastroenterologists. M.; L., 1990.Vol. 1; P. 363.

2. Grebeniv A.L. Certification of gastroenterology. M .: Medicine. 1996. Vol.2.; 710 s.

3. Spesivtsev V.N. Evaluation of the effectiveness of specific anti-inflammatory drugs. Pratsi of the conference "Clinical aspects of pharmacotherapy and presentation of new things in gastroenterology". Smolensk; M., 1992. 170-3.

Table 1. ROSPODIL AND LOCALIZATION OF WL

Table 2. Views about the operative treatment of HYZH in 32 ailments

Systemic scleroderma is a process of getting sick, as a result of developing organisms, in the basis of which lies the change from the whole tissue of the overgrowth of fibrosis and the reduction of blood-bearing vessels according to the type of obliterating endarteries.

The frequency of the population of systemic scleroderma becomes approximately 12 per 1 million population. Women who are sick in most cases, not among the people. The envy is the most widespread in the group of 30-50 years.

Causes of systemic scleroderma

Often, aversion to such factors, such as infections, hypothermia, stress, tooth decay, tonsillectomy, hormonal changes in the woman's body (vaginism, abortion, climax), contact with toxic chemicals, vaccines.

The exact reason for the diagnosis of the disease has not been established. In Danish hour, one of the main ones is the theory of genetic schism. Installed with the same type of disease. In addition, the relatives of the ailment have a higher frequency of development of rheumatic ailments (rheumatoid arthritis, systemic chervony vovchak) in the outward population. On the corny of the theory about viral injections, it is said that there is a change in immunity, it is connected with the dialect of viruses (especially retro-viruses and herpes-viruses). Alle a specific stamp virus, wiklikє systemic scleroderma, as long as there is no knowledge.

Symptoms of systemic scleroderma

The main familiarity with the disease is the strengthening of the function of fibroblasts. Fibroblasts are the main cells of tissue, which synthesize collagen and elastin, for which tissue is produced to become a great performance and elasticity at the same time. When the function of fibroblast is adjusted, it is possible to repair the colagen from a great number of fibroblasts, to adapt to fibroblast formation. At the finale in the organs and tissues of the tissues, there is usually sclerosis. In addition, it’s easy to grab a lot of money, like to feast on it. There is a transition to blood flow, and as a legacy, to pretend to be a blood clot. Such changes of the court should lead to the destruction of the normal blood flow of tissue and the development of ischemic processes.

Spoluchna tissue is widely represented in organism, therefore, with systemic scleroderma, practically all organisms and textiles can be used. To that the symptoms of an illness are even worse.
With the state of the art progression of the disease, the development of sclerotic changes in the school and the fibrosis of the internal organs is characteristic of one thing - two rocks from the ear of the disease. With a wide variety of options, the temperature of the til, the inlet of the mass, appears permanently. Mortality of ailments in case of a state of the art, progression of visoka.

For chronic interruption of systemic scleroderma, the characteristic cob is indicative of a fall in Raynaud's syndrome, a reduction in a scleroderma. Dani can be manifested with an isolated stretch of baguettes of rock. In the course of the year, symptoms of internal organ damage appear in the clinical picture.

smacking shkiriє Find out more about the characteristics of systemic scleroderma and develop in more patients. A handful of ways to fight. In typical types of scleroderma, they pass the stages of the reduction of the shkiri for the rakhunok nabryak, then they see the indigestion (deprivation of the pupils in the case of fibrosis) and the part of the atrophy of the tissue. With a whole shkіra on the face of an old school and unruly, for a rakhunok її tightness, a kit-like zmorshka is formed near the company, revealing a similarity with a mask.

Sclerodactylia is also a characteristic sign of illness. At the same time, the wrinkle of the wrist with the development of the deformation of the fingers ("sausage" fingers) is formed.

The order of the damage to the skin also shows trophic damage to the viglyadas of the curves, suppurations, deformation of the discs and the appearance of the areas of the region.

ruinє the most frequent cob acquaintances with the disease. Nibilsh with widening є vasospastic crises (Raynaud's syndrome). When there is a lot of cold weather, it’s bad, or when it’s out of the blue, there’s a ringing of the bugs, as a rule, of the hands. The price of supervising oniminnyy, oniminnyam or to see the bluesinny fingers. When progresuvannya zhvoryuvannya for the rakhunok ishemia fabrics on the fingers of the fingers set themselves up to the last non-grievous virazki ("scurvy bite"). In important cases, necrosis of the remaining phalanges of the fingers develops.

pounding of slopes manifested by pain in them, wounds, tendency to initial deformities for rakhunok deformity and tissue atrophy near the slope. When obmatsuvannyh urazhennyh slopes above them, you can notice the noise of rubbing the tendon. Systemic scleroderma is characterized by a loss of mucous membranes, as well as atrophy. The infection of the cysts is manifested by osteolysis (ruptured) of the cysts of the fingers from the shortened phalanx.

Osteolysis of the distal phalanges of the fingers

Naybilsh ugly organs of the herbal system in systemic sclerodemia є stravohid and intestines... In stravohods, a sclerotic deformity deforms due to damage to normal passage. Patsinti skarzhitsya at the sight of a ball behind the breastbone, nudota, stove, positive for blues. In case of significant deformation, a surgical operation can be used to expand the education of the stravohode. The intestines are more severe, but the symptoms of their illness significantly reduce the quality of the life of the patients. In classic paintings, pain, diarrhea, and decreased weight are overwhelmed. Constipation is characteristic of the intestines.

training leg in Danish hour to go to the first plan among the causes of mortality of ailments with systemic scleroderma. There are two types of lesions characteristic: interstitial disease - fibrosing alveolitis and diffuse pneumosclerosis, as well as Legeneva hypertension. Significant manifestations of nonspecific interstitial deterioration include in themselves a weakness, dry cough, abnormal weakness, stomatism. Legenev's hypertension is manifested by a progressive backwardness, the form of stagnation of blood in legends and heart failure. Thrombosis of Legeny Sudin and Gostra Pravoshlunochkova is not common;

Scleroderma is characterized by the defeat of all balls of the heart. In case of fibrosis of the myocardium, the heart grows in size, forms a congestion of blood in the empty ones with the development of heart failure. Even more often, through the deterioration of the innervations of the sick heart, the patients experience arrhythmias. Arrhythmias are the main cause of raptor death in scleroderma ailments. With sclerosis of the valves of the heart, defects of the stenotic type are formed. And with fibrosis of the pericardium, adhesive pericarditis develops.

Basically nirok battle to lie sclerosis of other blood-bearing vertebrates with development of ischemia and bend of clinin nirok. With a progressive variant of scleroderma, a nirkovy crisis often develops, for which a characteristic raptor cob is characteristic, a sharp development of a nirkova deficiency and malignant hypertension. For a chronic variant of scleroderma, it is powerfully swirled around the world, as it will become asymptomatic for the next hour.

Diagnostics of systemic scleroderma

Diagnosis of systemic scleroderma is reliable if one "great" or two "malikh" criteria are present (American College of Rheumatology).

"Great" criterion:
- proximal scleroderma: symmetrically draining of the skin in the area of ​​the fingers, with the extensions proximally from the metatarsophalangeal and metatarsophalangeal lobes. The snakes of the shkiri can be promoted on the face, shia, chest, belly.
"Mali" criteria:
- Sclerodactylia: pererakhovanі іshkіrnі vyshkіnі, interlaced with fingers.
- digital scars-dilyanki zapadannya shkіri on the distal phalanges of the fingers, or the loss of speech in the pads of the fingers.
- bilateral basal pneumofibrosis; most of the line-of-the-school nodes, the most rapid changes in the lower portions of the lungs with a standard radiological condition; You can express yourself behind the type of "stylistic legend".

In Russia, bully proponated the onset of signs of systemic scleroderma.

Treatment of systemic scleroderma

We are averse to scleroderma, it is recommended to use a singing mode: a unique psychomotional shock, trickling into the cold and vibrations. It is necessary to wear clothes that are warm enough to reduce the frequency of occurrence and increase in the rate of attacks of vasospasm. It is recommended to throw palsy, formulated in coffee-containing drinks, and also in form of drugs that are used to induce irritation of sudin: sympathomimetics (ephedrine), beta-adrenergic blockers (metoprolol).

The main steps of treatment for scleroderma є:

Sudden therapy for treatment of Raynaud's syndrome with signs of ischemia tissue, legacy hypertension and nephrogenic hypertension. Stagnate ingibitorium of angiotensin converting enzyme (enalapril), blockers of calcium channels (verapamil) and prostaglandin E. Moreover, for the prevention of thrombus formation, antiaggreganti stagnates (qurantil).

Protisapalny drugs docitolno indicate already at the early stages of development of the disease. Recommended non-steroidal antiapaline drugs (ibuprofen), hormonal drugs (prednisolone) and cytostatics (cyclophosphamide) for the singing regimen.

To suppress excess fibro-formation, penicillamine stagnates.

Surgical treatment of systemic scleroderma of polyagus in the asserted defects in plastic surgery, as well as in defect in the stratohode, amputation of dead fingers.

Reduced systemic scleroderma and prognosis

With shvidkoprogressive forms of scleroderma, the prognosis of unpleasantness, becoming ill will end with a lethal result after 1-2 times when the manifestation is to be found with a quick cob of liking. In case of chronic form, in case of fast and complex treatment, the level of vision becomes up to 70%.

Lykar therapist S.V. Sirotkina

01.10.2017

Systemic scleroderma (SSc) is a systemic closure of tissue, which is characterized by fibrosis, malignant disease and immunological diseases with a growing degree of internal organ damage. Unimportant to those often, the SSDs are usually divided into two stages after the level of protection of the school - diffusion and intercourse (limitation), the Raynaud phenomenon and its acceleration and universal signs of getting overwhelmed by 95%. Good see, angioopathy in SSD is a vicious destruction of microcirculation from ischemic organs, activation of fibroblasts and a further development of the great fibrosis. At the same time, the Raynaud's phenomenon is a potentially not safe symptom, the splinters often progress up to the ravages (in 50% of patients), leading to gangrene of the symptoms.

The seriousness of the situation is associated with the formation of structural damage and functional herbal anomalies in case of Raynaud's phenomenon in the framework of SJS on the basis of the primary (idiopathic) forms of this phenomenon, if there is no evidence of damage to the tissue. Thus, digital vasculopathy is one of the factors leading to chronic ischemic pain and disability in patients with SS.

Primordial Raynaud's phenomenon є clockwork werewolves Vasospastic a phenomenon. Raynaud's phenomenon - an episode of short-term ischemia in cases of vasospasm of arteries, precapular arterioles and cerebral arteriovenous anastomoses in the presence of cold and emotional stress. Most of the time it’s hard to catch fingers and nig, knicks vuh, nis and nipples. As a rule, snakes to the color of shkiri recognize three phases: cobble, cyanosis and erythema as a result of compensatory vasodilatation. Klinichnі manifest the phenomenon of Raynaud can be zagrupuvati with an offensive rank:

• most often the changes of the barn are spared on the fingers of the hands;
• Zones can be repaired on one finger, widened on one finger, and symmetrical on both hands;
• most often get lost II-IV fingers of the hands;
• The change of the barrage of the shkiri can be seen on the other dilyankas - in the shells, the nose of the nose, revealing, above the colons;
• before the hour of Raynaud's attacks, you can see a frequent livedo at the end of the day, as you pass when the vasospasm is complete;
• in the vicinity of vipadkas, there is a need to improve the language, to manifest itself in the same oniminnym and passing destructed movi (mova becomes inviolable, wicked);
• signifies a part of ailments to skarzhannya on sensory damage (oniminnya, pokolyuvannya, bil) before the hour of the attack.

The breadth of the Raynaud's phenomenon becomes less than 10% in the foreign population. N.A. Flavahan (2015), in a recent look at the emphasis on thermoregulatory mechanisms and the basis for the understanding of Raynaud's phenomenon, the role of arteriovenous anastomoses and increased activity of α2-adrenoceptor blockers in decreased blood circulation.

Raynaud's phenomenon in SJS inherited structural and functional vertebral lesions with rotated proliferation of distal arteries (digital arteries). Sudinny snakes may be twofold. On one side, the proliferation and fibrosis of antihypertensives, endothelial activity, is meant to produce up to the strength of the development of the vessel sound mediators and the one-hour reduction of the levels of the vessel-expanding molecules. On the other hand, part of the episode of vasospasm should be produced in the residual bag until the progressive tissue formation, the production of high superoxide radicals and even more pathological changes in the tissues. The pathophysiology of Raynaud's phenomenon is tied with folding mechanisms and transmission between modality and vascular, internal vascular factors and mechanisms of nervous control.

The diagnosis of Raynaud's phenomenon is established in the first place on the presentation of scarg and clinical symptoms, and it becomes reliable with a positive response on three days of nutrition:

1. Do you mean why the sensitivity of your fingers to the cold is unprecedented?
2. How do you change the color of your fingers in the cold?
3. Why does the stench become blue and / or bluish?

With a positive response to all three nutrition, the diagnosis of Raynaud's phenomenon is reliable.

The second Raynaud's phenomenon is often observed with systemic congestion of the full tissue and with the greatest broadening with SJS (up to 95% of cases), as well as with systemic cervonia (close to 40%), dermatomyositis within the framework of antithyroid syndrome, 25% %). Diagnostic criteria of primary and secondary Raynaud's phenomenon are presented in Table 1.

It is accepted respectfully, that the twisting of the fingers (pads) of the fingers є the inherited ischemia, while the twisting of the original surfaces of the fingers is of a "traumatic" character. Until today, we have not had enough proofs of the theory. However, a message from B. Ruaro і spіvavt. (2015), which included 20 patients with STD and finger twisting, demonstrated a significant decrease in blood flow in the moment of finger twisting and finger twisting during activation. The ischemia of the tissue can also be the basis for the development of osteolysis, especially the nigth phalanges.

The ability to predict the development of digital paths may be of great importance, but it is not very important to allow a group of patients to see, as they require highly direct, professional injections. For the last hour in the course of the decile dull boules, the predictor of the incidences in SSD and the predictive factor were described. In the great prospective prescient (n = 623), for the participation of patients with the SDS, it was established that before the most powerful factors in the development of new digital virazoks in the course of 6 months, the abnormalities in the number of fingers and the manifestation of any critical ischemia. Priority predictors of antibodies to topoisomerase (anti-Scl-70), antibodies to type A receptor endothelin-1 (ET-1), increased blood pressure A systematic survey of PRISMA I. Silva and spivavt. (2015) considered factors of the development of digital pathways, such as є: type of diffuse reduction in patients with SS, early debut of Raynaud's phenomenon, the presence of antibodies to topoisomerase (anti-Scal-70), abnormalities growth of endothelium sudin (VEGF).

One hour to see, how the manifestation of digital twists and turns is tied with an important interruption of ailments and to bring about an increased mortality. In the large-factor analysis of 3196 patients from the EUSTAR base, the history of digital changes was a reliable prognostic factor of death.

The mechanism of the development of digital pathways in case of SS is explained by decilcoma factors, which include repeated microtraumas, vitality of shkiri, dryness and manifestation of calcification. It is important that 8-12% of cases are found on the basis of calcification of the skin and pediatric cells. However, the trivial ischemia after the Raynaud phenomenon is the most important mechanism. The digital curves grow in size and between the fringes, the obvious bare tissues (knuckle, tendons), calcification of the tissues. Virazki vvazhayutsya gostry up to 3 m / s, chronic - up to 6 m / s. Clinical results and turns lie in the number of factors. The loss of soft tissues and cells is more likely to occur in about 30% of patients with SSD and digitally. In the course of the 7-course monitoring, the disease was accelerated in 11% of cases with gangrene; in case of ineffectiveness, for the duration of the disease, the manifestation of recurrent ischemic attacks of the development of gangrene, which was diagnosed in 100% of the ailments; 12% of patients with digital trips received hospitalization and surgical assistance.

Critical is the ischemia of symptoms in case of SSD є urgent mills and non-emergency visits. Oscillations in the development of critical ischemia lie non-reversible ischemia (on the view of Raynaud's phenomenon), then the process can quickly lead to gangrene of the picture and the loss of fingers. For baby 1 (a, b, c), there are photographs of patients with digital twists and turns and developed as a critical ischemia on the SSD.

Critical ischemia is diagnosed with severe pain when one is getting sick of narcotic analgesics. Naymenshі dotsіkі rukh viklikayut bіl. Appear critical ischemia change the wrinkles of the fingers, the style of beating, the color of the blues, the differences between the "blue" and the "blue" zones of the fingers. It’s important to keep your hands on the table not to spoil any positive things (more, more likely, more efficiently earlier). Critical ischemia develop in II-IV fingers. It is unimportant for those that at the basis of vasculopathy in SSD lie vaso-occlusive ailment, swelling and dying of reversible potential and helping to overcome the loss of soft tissues and tighten the fingers.

Patient management with Raynaud's phenomenon, with digital changes / necrosis in SS, including nonpharmacological, pharmacological, and surgical treatment (Table 2). Vikoristovuvany non-pharmacological modalities include the unique triggers, anti-inflammatory drugs, including cold contact, emotional stress, and the use of acute sudin, including β-adrenergic antagonists, anti-inflammatory drugs such as cisplatin, vinblastin, targeted tyrosine kinase blockers, in.) and amphetamines. The pinching of kurinnya is absolutely necessary for the prodding of a given court's ear with already sprinkling ischemic fabric.

Vasoactive therapy methods are central to the pharmacological treatment of Sudden SJS acceleration. E. Hachulla і spіvavt. (2007), as a rule, vasodilatation therapy will significantly overshadow the development of distal pathways (development of distal pathways, RR 0.17; 95% predominant interval, DI 0.09-0.32).

Calcium channel blockers (CCBs) are few in the treatment / prophylaxis of digital virazoks, there is a wish for a large number of clinicians in the vicious group of drugs (most often nifedipin) in the treatment of important phenom ena. In a randomized sublingual blind, oral nifedipin was administered (30 mg daily for 4 times, and at the same time 60 mg daily for 12 times) and intravenously administered Iloprost for phenomogenesis important. According to the recognized results, the average number of digital trips was changed from 4.3 to 1.4 in 16 cases of treatment with nifedipin. With the stasis of iloprost, the number of digital signs changed from 3.5 to 0.6. Adjustment of hand temperature and microcirculation is indicated only in case of stagnation of iloprost.

Nezvazhayuchi those scho іsnuє dosit stronger is therapeutic obgruntuvannya rolі іngіbіtorіv angіotenzinperetvoryuyuchogo enzyme (ACE) in SS i sudinnih uskladnennyah in yakostі agentіv remodelyuvannya sudin (yak i y patsієntіv of іshemіchnoyu hvoroboyu sericite) in danii hour vіdsutnya dokazova base yak pіdtverdzhuє efektivnіst tsogo vtruchannya. At bagatotsentrovomu podvіynomu slіpomu randomіzovanomu klіnіchnomu viprobuvannі, yaky consisting of 210 patsієntіv lіmіtovanoї MICs abo autoіmunnim Raynaud's phenomenon (s nayavnіstyu spetsifіchnih sklerodermіchnih autoantitіl) trirіchne lіkuvannya kvіnaprilom not asotsіyuvati Zi digit number zmenshennyam novih digіtalnih virazok (OR 0.08; 95% od DІ - 0.23 to 0.06).

Ingibitories of phosphodiesterase type 5 (PDE5) develop degradation (and, moreover, increase the bioavailability) of cyclic guanosine monophosphate (HMP) with further vasodilation. In the metaanalysis of the effectiveness of the therapy of digital tests, which included 31 randomized control tests for the duration of the test, the rate of testing of the inhibitors of phosphodiesterase-5 (on the basis of three randomized classroom tests, n = 85)

In a recent highly centered sublingual blind, randomized controlled patient, 84 patients were included in the yak; Protect the hour of the start of the tsikh virazok (the main point of the end of the day) did not change. Three commercially available FDE5 Ingibitors include Sildenafil, Vardenafil and Tadalafil. Sildenafil and vardenafil may last for a longer short period in the West - close to 4 years, at that time the period when Tadalafil Nabagato started to last longer - lasting 18 years. Doses of oral vasodilating drugs, which are most often used in the therapy of Raynaud's phenomenon and on the second, are presented in Table 3.

Prostanoid є by straining vasodilators, and also inhibit the aggregation of platelets and proliferation of cells of smooth ointments of sudin. Iloprost, contractions in Europe for the treatment of digital virazoks, tied with SJS, is a chemically stable analogue of prostacyclin with a subordinate vasodilator and platelet effects. Iloprost is a synthetic analogue of prostacyclin, viciousness of aggregation and activation of thrombocytes; activates endogenous fibrinolysis, without the anti-fatigue effect, causing leukocyte adhesion and migration to the ear endothelium, as well as the accumulation of leukocytes in the ischemic tissues.

With intravenous injection of prostanoids, the frequency of side effects and disgusting tolerance of the drug, including systemic hypotension, spoilage, flushing, gut-intestinal problems, is determined to be as high as 92 percent of the percentage

Internal therapy of prostate people should be seen in case of refractory interruption of Raynaud's phenomenon, especially in patients with generalized form of SSD and in cold weather. Most often it is used for internal prostate (3-5 days of treatment with 0.5-2 ng / kg / h in a stretch of 6 hours, repeated courses of skin 4/6/8 in a stretch of 52 types) and epoprostenol.

I also talked about internal therapy of prostate problems for the improvement of the start of digital flights and the rapid number of new ones. In bi-centered sublinear, randomized, early intravenous therapy of prostanoids (iprost 0.5-2.0 ng / kg / h for 6 years for 5 days after sleep), the bullet was tied with significantly larger patients.

In important cases, vasculopathies are overrun, with recurrent problems, patients are guilty of repetitive courses of prostanoids; without interruption or extension of the course of internal therapy to be seen in clinically dead-end situations.

It is essential that oral preparations of prostanoids (iprost, and also new drugs - beraprost, cisaprost, treprostinil) did not demonstrate any kind of polyphenia in registered digital virazoks. The other prostaglandin analogs, alprostadil, are more likely to become stagnant in the development of Raynaud's phenomenon and in digital virazoks.

Prazosin yak antagonist of the α1-adrenergic receptor in two randomized dosages, demonstrating a friendly inflow to overcome the Raynaud's phenomenon. Apparently, prazosin was consumed in a dose of 1 mg 3 times and the dose was increased to the prediction in terms of placebo and due to fewer failures in the test. It is a pity that the published tributes about the second flow on the digital curves are not enough.

Miscellaneous nitrates were used for the improvement of local blood flow, which led to a more rapid reduction and potential side effects, which reduced the entusiasm of regular blood flow.

ET-1 є does not deprive us of vasoconstrictors by straining, but the proliferative effect on cells of smooth mucous membranes and fibroblasts is increased, acting through two receptors (cya and ETB). In general, ETB, appear in the cells of smooth mucous membranes, take vasoconstriction and hyperplasia, at that time as ETB, which is also found on endothelial cells, spriyas vasodilatation.

Bosentan is a subline antagonist of ET-1 receptors, and is licensed in Europe for the treatment of legacy arterial hypertension (PAH) and the prevention of recurrent digital viral infections. Two great sublinear sublinear, randomized controllers who have been tested have shown that bosentan treatment has significantly accelerated the number of new flights. In a randomized sub-baseline, placebo-controlled, pre-infusion of bosentan, 125 mg for starting and prophylaxis of ischemic digital events in patients with SSS, which included 188 patients with 24-day SJS, which included 188 patients with 24 to add) the association with a 30% reduction in the number of new digital paths. Bosentan contractions in Europe for the prevention of digital infections in case of scleroderma, protest Controls for the control of the quality of products in the United States (FDA) for the analysis of painful contractions is not used. Bosentan can be an important method of drug use, it is possible to use it orally and potentially uniquely in order to acquire new digital transmissions.

In patients with incurable, easy-to-use digital virazoks, refractory to therapy with phosphodiesterase-5 and internal infusion prostanoids, antagonists of ET-1 receptors can be especially brown.

On the current day for PAH testing in Europe, two new ET-1 receptor antagonists have been hardened: macentan and ammbrizentan, which underwent further testing in digital virazoks with SSS.

Calcification of the tissue, how to feel the twist, you can squeeze the surgical treatment, if you come in on the fire, you didn’t succeed. Digital (dolonnaya) sympathectomy can bring significant corrosiveness to patients who have not been taken to conservative methods of therapy. Insane intercourse є those who are given a methodology to visit in the surrounding special surgical centers.

On babies 2, 3 and 4, there are adapted recommendations on the management of patients with the Raynaud's phenomenon, on a digital basis and critical ischemia. Smells represent a step-by-step option for improving therapy in terms of the prevalence of efficiency or ineffectiveness of earlier visits, based on the advanced clinical practice.

In such a rank, SSA-associated vasculopathy is a serious and urgent problem, which significantly accelerates the transition of SSA. It’s easy to carry, inexpensive, affordable therapeutic options for dealing with Raynaud’s phenomenon, and it’s faster for people to see digital turns to be a direct priority. Victory of a well-known therapeutic approach to optimize the treatment of patients with the Raynaud phenomenon and digitally allow adequate supervision of such patients and to prepare for the adoption of new children for forgetting

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Fibrillation of the atrium (FP) is associated with the risk of death, the disease and other thromboembolic acceleration, heart failure and hospitalization, malfunctioning of the quality of life dysfunction, AF on the basis of the transferred Gostr coronary syndrome (GCS) є Expansion of the folding in a clinical situation that requires the correction of anticoagulant and antithrombotic therapy (Kirchhof et al., 2016; Steffel et al., 2018) ....

13.01.2020 Cardiology Rheumatology Myocardial infarction at university polyarthritis

Unimportant on Significance The perfect strategy for the treatment of patients from the State Gostra with myocardial infarction (IM) for the last ten years, the whole ailment still needs to be deprived of one of the provincial causes of illness in the whole world. More than 80% of cases of IM are severely stenotic coronary arteries (CA) atherosclerosis, and in 5% of cases the cause of fatal IM is non-atherosclerotic CA. However, according to the data of J. Saw et al., In women with IM VICOM ≤50 years with the help of coronary angiography (CG) in 28.8% of patients with no signs of artery disease, in 36.4% - atherosclerotic, in 30.3% - non-atherosclerotic lesions. CA is the same in 4.5% - etiology is not established. ...

gastroduodenal fold - late chronic recurrent illness, when, as a result of the breakdown of the neuroendocrine regulation by the secretory, evacuation and trophic processes in the gastroduodenal zone, in the twelve-finger intestines and the slurry, there is a breakdown. The main sign of the sharpening is the establishment of a defect (bend) in the stage of the slunk and the twelve-fingered intestine, which penetrates into the mind of the superficial ear of the mucous membrane (erosy), into the pidlizial ball.

Razrіznyayut hospitality erozії, hosprі virazki, chronic virazki, cicatricial ulcer deformity.

In ethology and pathogenesis, there are several types of basic and friendly factors.

Main officials.

• a special role is introduced to the infectious factor;
• damage of nerve-hormonal mechanisms, which regulates etching;
• dislocation of the muscle mechanisms of etching due to the wrinkle structure of the mucous slurry and the twelve-fingered intestine;
• in the central place, lay a porch on the side of the central nervous system.

Friendly factors:

• spadkova slenderness;
• wash out the last middle class, the middle factor of the borrowing of money for a long time;
• the destruction of the regime of eating, rearing in the races of easily consumed in carbohydrates, overwhelmingly saving important and overly overtraveling products;
• irregular reception of їzhі and "shvidke kharchuvannya".

A provincial symptom, especially "hungry" pain, is characterized by periodicity, seasonality, growing character, dull ringing with the reception of a yyzh, or a change in the blues, and a lingering warmth. Early more types for the localization of the hopper, small, no, hungry - for the hoop, roasted at the gate and in the twelve-fingered intestines. It is determined by the regularity of the ligaments of the pains from the heart and the bitch. Ryasna, gostra, sour, salty, rude and rude wake up to wiklik, when there are intense pains.

The seasonality of the pain (spring and main pain) is typical for the gastroduodenal infestation, which allows the perception of pain in the case of others. Period of sharpening changes by periods of remission. The reason is connected with the seasonal changes in the external reactivity of the organism, and the attachment in such a world can play the role and destruction of the vitamin balance in the organism.

Vinnik's blues chill out without any boredom, in pain, bringing relief. Bluvotn_ masi may smell sour. Vidіlennya active shlunkovy juice in the past is also uncommon for bloating.

The ovens are spontaneous not only in the period of sharpening, or perhaps overwhelming a number of rockets and be of a seasonal nature. Frequent symptoms є haircut, zriguvannya.

Appetite for changes. The natural connection of pain with the reception of їzhі viklikє іnodі the ailments have fear of їzhey.

Folding gastroduodenal curve:

1. Bleeding can be manifested by a crooked vomit and a black styloid. With a twisted lesion of the two-fingered intestine, blues can be seen, and the first sign of bleeding є rapid symptoms of weakness, zaporochennya, before the tarry style appears.

Persha help:

• strict postal mode і absolute calm (mikhur with ice - 30 min, interruption 30 min, again - mikhur with ice);
• hunger;
• the introduction of coagulants (in the hospital).
• 2. Perforation (piercing) of the bend - more often than not at the localization of the bend on the anterior wall of the duodenal gut. Characterized by severe "dagger" pain in the abdomen, symptoms of collapse, bloating from the house of blood, or "kava thick", stilettos (melena).

Persha help:

• ovnezhennya physical decay (spokiy);
• Extraction of transport in surgery;
• it is not possible to catch a sick person і to make a slunk;
• michur with ice on the abdomen.
• 3. Stenosis of the pyloric viddil of the shlunk (collar stenosis). As a result of starting the twisting process in the low, pyloric form of the slunk, a scar is established. This can be done to make it difficult to evacuate instead of a slurry in a twelve-fingered intestine. Harchovі masi zatryuyutsya in the shlunka more, scho to produce to niggle and wandering.

In addition to the pain of a permanent character, it is meant to be cut with a rotten smell, the blues are bright, and in the forefront, constipation and carry, and the sick.

From the last slowing down, it means penetration - the germination of a twist in one organ (partly in a podshlunkovy zalozu) - the appearance of symptoms characteristic of pancreatitis. An important acceleration is the malignancy of the twist - the transformation into cancer. Malignancy of the turnover is often counter to the decrease, and sometimes or zero acidity of the slurry juice in the patient.

lykuvannya gastroduodenal changes in the transfer of physical nutrition, psychological (emotional stress), food in alcohol, wine in alcohol, food in hospitality, food in the winter

Conservative treatment is carried out with persistent gastroduodenal infections. Vono includes: regimen, drug addiction, drug addiction, physiology, sa-

11atorpo-kurortpoe lykuvannya.

In the Danish hour for the treatment of gastroduodenal virazka, the following preparations will be stuck:

• a) basic preparations:
  • antisecretory zasobi - omeprazole, lansonrazole, pantoprazole, rabeprazole; cimetidin, ranitidine, famotidine, npzotidin, roxatidin; antacid;
  • gastrocytoprotectors - misoprostol, enprostil;
  • anti-chelikobacternu koshty - amoxicilin, clarithromicin, levofloxacin, etc.;
• b) additional auxiliary equipment, which is injected into the motor function of the slunk:
  • cerucal, motilium, cisapride;
  • antispasmodics - buscoian papaverine, drotaverine and іn.;
  • most of the central regulatory activity - tranquilizers, sleepworms, antipsychotics, antidepressants, analogs of regulatory peptides;
  • to regulate reparative processes - solcoseryl, actovegin, etaden, gastrofarm and in.