[The relationship of vascular complications with cerebrovascular reactivity and endothelial dysfunction in patients with obstructive sleep apnea]. / Svyaz' sosudistykh oslozhnenii s tserebrovaskulyarnoi reaktivnost'yu i endotelial'noi disfunktsiei u patsientov s obstruktivnym apnoe sna.

OBJECTIVE: To assess the relationship of vascular complications with cerebrovascular reactivity (CVR) and endothelial dysfunction in patients with obstructive sleep apnea (OSA). MATERIAL AND METHODS: One hundred and twelve patients were examined. The patients were stratified into the main group with moderate and severe OSA and the control group without apnea. All patients underwent anthropometry, polysomnography, transcranial dopplerography and duplex scanning of the brachial artery. RESULTS: Patients with OSA showed a more frequent decrease in post-occlusive vascular dilatation. The CVR indices in the hypercapnic test in the main group were in the range of 0.91-0.97 and significantly lower after 1 minute on the left, after 5 minutes on both sides and after 10 minutes on the left. A positive correlation during a hypercapnic test between the CVR on the left after 10 minutes and the desaturation index (r=0.287, p=0.021), between the CVR on the left after 5 and 10 minutes and acute cerebrovascular accident (r=0.248, p=0.048 and r=0.285, p=0.022, respectively), as well as a negative correlation between the indicators of the middle cerebral artery and chronic cerebral ischemia were established in patients with apnea. CONCLUSION: Timely assessment of pathological changes in central and peripheral hemodynamics in patients with OSA will allow diagnosing early signs of vascular complications, which will further improve the personalized strategy for the prevention of stroke and chronic cerebral ischemia.

[Laparoscopic decompression of celiac trunk in children]. / Laparoskopicheskaia dekompressiia chrevnogo stvola pri kompressionnom stenoze u detei.

MATERIAL AND METHODS: For the period 2013-2016 four patients were treated at the Filatov Children's City Clinical Hospital #13. There were 2 children aged 14 years and 2 children aged 17 years. All patients have been diagnosed via anamnesis, complaints, pulse-wave doppler sonography, contrast-enhanced MDCT and angiography. After comprehensive examination 3 patients underwent laparoscopic decompression of celiac trunk. In all cases celiac trunk compression was predominantly caused by median arcuate ligament of the diaphragm combined with neurofibrotic tissue of celiac plexus. RESULTS: All patients were discharged after laparoscopic decompression of celiac trunk. Intra- and postoperative complications, as well as cases of conversion were absent. Mean time of surgery was 65 minutes. In all cases postoperative period was smooth (4 days on the average). Two patients underwent follow-up examination in long-term postoperative period: pulse-wave doppler sonography, contrast-enhanced MDCT and angiography. In both cases reduced severity, incidence and duration of pain syndrome were observed. CONCLUSION: Clinical examples show some problems in diagnosis and treatment of compressive stenosis of celiac trunk due to rarity of pathology especially in childhood. Nevertheless, combination of abdominal ischemia and celiac trunk stenosis confirmed by instrumental diagnosis is indication for surgical treatment.