STUDY OF PROGNOSIS OF SURVIVAL RATE IN PATIENTS WITH HEART FAILURE AND PEACEMAKER EXPOSEED TO LONG-TERM TREATMENT. 

Bakhshiev M. , Golitsin S. , Belenkov Yu.

 Azerbaijan State Medical University named after N.Narimanov, Baku,

 Azerbaijan, Scientific Institute of Surgery, Baku, Azerbaijan Institute of Clinic Cardiology, Moskow, Russia. 

      With the object of study of prognostic aspects and survival rate in differential cases of long term treatment of CHD patients with heart failure of 1-3 FC (NIHA), being in the different regiment of electrocardiostimulation, the special research was conducted with 25 patients (1st group) average 62.7+_2.4 years old, 27 patients (2nd group) average 64.2+_ 3.1, 30 patients (3rd group) average 65.3+_2.7years old, 30 patients (4th group) average 64.5+_2.1years old. 

      All 112 patients were taking long term, more than 5 years treatment with: 1 group - corvaton+ diurethics 2 group - nifedipin+ diurethics 3 group - digoxin+ diurethics 4 group - capoten+ diurethics. In case of need digoxin was added to the 1 and 2 group patients. All the patients were under control after implantation of peacemaker during 1, 3, 6 and 12 month of treatment and then after   6 and 12 months within 5 years and more. 

     Methods of control of a condition of patients were evaluation     of central hemodynamics during all stages on noninvasive methods (veloergometry, spiroergometry, echocardiografhy) On 1st and 12th months after implantation of the peasemaker and further annual - invasive methods of right-hand catheterization of the heart with application of isometric hand exercise. Analysis of a survival rate  was made by a method Kaplan-Meier. 

       The results of the conducted research indicated that patients  with CHD and pacemaker with heart failure had the combination of considerable increase of size of left ventricle and left atrium higher level of diastolic blood pressure in pulmonary artery, and extreme increase of left ventricular work index, and particularly right ventricle of hearts, the low index of PCWP and combination of dP/dt max in short period after implantation of peacemaker under control in rest, its necessary to concider as prognostic unfavorable in this aspect is the dynamics of change of hemodynamics in conditions of isometric load according to the information right-side catheterization, where the predictors of bad prognostic and survival rate were: 

1.combination of evident increase of TPVR with very low growth of PCWP and even its decreasing the up-limit of load; 

2.abrupt increase of index growth in striking work of right ventricle in comparition with relatively low index growth of left ventricular striking work under load; 

3.relatively high-growth of diastolic blood pressure in the column pulmonary artery short after implantation of peacemaker. 

       The most favorable and statistically reliable in terms of survival rate, about 5 years and more, results were those of 4 and first  groups.

For more information about this article please contact with following address: 

Bakhshiev Murad, 

Doctor of medical science, professor, Chair of internal diseases of Azerbaijan State Medical University named after N.Narimanov Adress: 38/35 Tabibli Str, 370122 Baku, Azerbaijan 

Тel.: + 99412 94 18 23 Fax: +99412 97 37 84 

E-mail: tamc@azeuro.net muradali@mail.ru 

CAUSES OF POST OPERATION MORTALITY FROM STENOSING COLON CANCER COMPLICATED BY OBSTRUCTION 

Aliyev S.A. 

Azerbaijan Medical University named after N.Narimanov, Baku, Azerbaijan 

      The results of surgical treatment of patients with cancer-caused large-intestine obstruction cannot be stated as satisfactory because  of high rate of post-operation complications and high mortality rate (fluctuating between 31,3% and 43,5%). 

     In the base of the work are putted results obtained from treatment of 522 patients at age from 22 to 88 years who suffered from obstruc- tion caused by colon cancer. 307 patients were female and 215 patients were male persons. 282 patients (54%) were from senior age group. 

    The investigation program included complex use of routine and modern instrumental diagnostic methods (roentgenography, endoscopy and ects.). 

    Occlusive intestine obstruction (OIO) was caused by : cancer of right part of ascending colon in 118 (22,6%) patients, transversal colon cancer in 35 patients (6,1%) and descending colon cancer in 369 patients (70,1%). OIO was in it's compensated stage in 242 patients (46,4%), subcompensated in 131 patients (25.1%) and decom- pensated in 149 patients (28.5%). In 34 (6,5%) patients OIO was complicated: by tumor perforation in 24 patients and diastatical rupture of colon in10 patients. Cancer stage was found in as 3 A in 207 (39,7%) patients, 3б in 118 (22,6%), 4 - in 161 (30,8%). In 36 (6,9%) patients the cancer stage was not established. 486 patients (91,1% from all investigated) were operated. In 306 (63%) patients one stage radical operations with application of primary large-intestinal anostomosis in 204 of them (66,6%) were performed. 48,7% of patients were elderly and old. In 39,2% of patients the operations performed by palliative method because tumor extraction applied in presence of regional and distant cancer metastases. In 4 (0,8%) patients with non-operable cancer in different colon parts trial relaparotomia was used as surgical supply. 

     Post-operation complications requiring the necessity of relaparo- thomia operation were performed in 12 patients (4,5%). Mortality rate after radical operations composed 16,3% and 42% after palliative operations. General post-operation mortality rate composed 25,7%. The death was caused by: peritonitis as a result of tumor perforation and diastatical rupture of colon and large intestine anastomosis insolvency in 42 patients (33,6%), severe endogenous intocsication caused by the basic disease and obstruction in 37 patients (29,6%), thromboembolism of lung artery in 18 patients (14,4%) acute cardiovascular failure in 16 patients (12,8%), acute respiratory failure in 8 patients (6,4%) and liver failure in 4 patients (3,2%). 

      Primary tumor removal without one stage recovering of intestinal continuum is alternative to surgical tactics in patient of all age groups independently of the tumor localization level.

     Obstructive variations of radical operations are specially indicated to patients with high operation risk during the acute obstruction of descending colon. 

For more information please contact with following address: 

Aliyev Saday Agalar oglu, Azerbaijan Medical University named after N.Narimanov

Tel.: 99412 95 30 82 (work) 

PRIMARY RADICAL OPERATIONS DURING TUMOR-CASED ACUTE LARGE-INTESTINAL OBSTRUCTION IN ELDERLY AND SENILE PATIENTS. RISK OR ALTERNATIVE? 

Aliyev S. A. 

Azerbaijan State Medical University named by N.Narimanov 

      The growth of morbidity from colorectal cancer among patients of senior age group, difficulty of gerontologic and geriatric aspects of stenosing colon cancer are evidence of problem actuality for nearest occlusive intestine obstruction treatment results. 

      Base of the present work is composed from results obtained from the investigation and treatment of 293 senior age group patients who were hospitalized to Surgical Diseases Clinic of AzMU named by N. Narimanov on the occasion of occlusive large intestine obstruction (the mentioned patients composed 54,3% from the all patients hospitalized due to stenosing colon).225 patients (41,7%) were in elderly and 68 (12,6%) mode patients. 

     Diagnostic program included wage of laboratory, roentgenology, enoscopy and ultrasound, investigation methods and unclear magnetic- resonance tomography of abdominal cavity. 

      Intestine obstruction was caused by stenosing ascending colon cancer in 13 patients (4,4%), by descending colon (including sigmoid colon and retosigmoid part) cancer in 215 patients (73,4%) and by transverse colon cancer in 215 patients (73,4%). In 78 patients (26,6%) intestine obstruction was compensated, in 118 (40,3%)subcompensated and in 9 (33,1%) decompensated. IIIa cancer stage was established in 136 patients, (46,4%) IV stage in 146 patients (49,8%). In 27 patients (9,2%) clinical course of malignant process was complicated by tumor perforation in 18 patients and by diastatical rupture in suprastenotic colon segments in 9 patients.

       Pre-operation preparing and post-operation treatment included detocsication therapy, directed to correction of volemic and metabolic misbalance prophylaxis and treatment of suppurative-septic complications. 260 patients (88,7%) undergone surgical operations. Urgent operations performed in 102 patients (39,2%), radical operations - in 158, palliative -in 100 patients .Tumor rezectability composed 60,8%. Explorative laparatomia was performed in 2 patients. In 33 patients with late stages of malignant process conservative events promoted more firm recovering from acute effects of 10 condition severity, high risk of symptoms become a reason of surgical events the rejection from operation performance in above mentioned patients. 29 patients (18,3%) died after radical operations and 52 patients (32%) after palliative operations. General post-operation mortality composed 31,5%. 

    Llow post-operation mortality after primary extraction of tumor independently of stenosing cancer level makes us consider that the risk of radical operations in senior age group is exaggerated. During the acute obturation of descending colon in patients of this category obstructive methods of radical operations (with rezection of affected segments of colon and creating colostomas) are for choice. 

For more information please contact with following address: 

Aliyev Saday Agalar oglu, 

Azerbaijan Medical University named after N.Narimanov 

Tel.: 99412 95 30 82 (work)

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