Method of diagnostics of undifferentiated connective tissue dysplasia

Objective – to develop a method for diagnosing undifferentiated connective tissue dysplasia (UCTD) in patients with surgical pathology.Material and methods. The object of the study comprises 96 patients with surgical pathology who were treated in the department of thoracoabdominal surgery of the Shalimov National Institute of Surgery and Transplantology during 2017-2020 and 20 practically healthy people (comparison group). Laboratory, instrumental, histological, immunohistochemical studies and statistical analysis were performed.Results. The developed method contains an assessment of the most informative phenotypic and visceral signs of connective tissue pathology. The main attention is paid to the features that characterize the visceral manifestations of UDCT, especially functional and morphological changes of the digestive organs, which is extremely important in abdominal surgery. Ultrasonography is used to analyze the width of the white line of the abdomen and the condition of the abdominal and retroperitoneal organs, determining the presence of diastase of the rectus abdominis and splanchnoptosis. Studies of the effectiveness of the proposed method have shown that it can be used to diagnose UDCT in patients with surgical pathology, which is necessary to select effective treatment tactics and prevent complications in such patients.Conclusions. A method for diagnosing undifferentiated connective tissue dysplasia has been developed, which evaluates the most informative phenotypic signs of connective tissue pathology and considers the peculiarities of pathology in patients of a surgical hospital.

POLYMORPHISM OF TISSUE INHIBITORS OF METALLOPROTEINASE-2 (G303 → A) GENE IN PATIENTS WITH INTESTINAL ANASTOMOTIC LEAK IN UKRAINIAN POPULATION

Purpose - to analyze the frequency of polymorphic variants of tissue inhibitors ofmetalloproteinase-2 (G303 → A) gene in patients with intestinal anastomotic leak.Material and methods. The object of the study comprises 61 patients with anastomotic leakand connective tissue pathology, who were treated in the department of thoracoabdominalsurgery of Shalimov National Institute of Surgery and Transplantology during 2017-2020. Laboratory, genetic, histological studies and statistical analysis were performed.Results. As a result of genetic and statistical analysis of the tissue inhibitors ofmetalloproteinase-2 (G303 → A) gene polymorphisms, genotype variants have beenidentified that are associated with the risk of anastomotic leak in the hollow digestiveorgans. Significant differences in the distribution of genotypes in the studied groupswere revealed. Analysis of the multiplicative model of inheritance of tissue inhibitors ofmetalloproteinase-2 (G303 → A) gene showed compliance of genotype distribution withHardy-Weinberg's law. All models of inheritance were analyzed and the best model withthe lowest Akaike Information Criterion, which turned out to be a recessive model, hasbeen determined.Conclusions. It is statistically significant that in the group of patients with intestinalanastomotic leak the GG variant of the TIMP-2 gene was detected in 1,6 times moreoften. Carriers of minor homozygotes of AA genotype in the group with suture failurewere not detected, while a similar genotype in the control group was found in 10%(p <0,05).

FEATURES OF APONEUROSIS PATHOMORPHOLOGICAL CHANGES IN PATIENTS WITH EVENTRATION

Objective – to improve the treatment results of patients with eventration by determiningthe role of undifferentiated connective tissue dysplasia in the development of thiscomplication.Material and methods. The object of the study comprises 33 patients with eventrationwho were treated in the department of thoracoabdominal surgery of Shalimov NationalInstitute of Surgery and Transplantology during 2017-2020.Results. At complex pathomorphological research of aponeurosis fragments similarmorphological changes have been revealed in groups of patients with phenotypic signsof undifferentiated connective tissue dysplasia and eventration. Immunohistochemicalexamination of tissues with monoclonal antibodies to α-SMA revealed uneven, focalexpression in smooth muscle differentiation cells and fibroblasts in both groups. In thestudies with monoclonal antibodies to Collagen IV, moderate positive expression in thebasement membrane of the blood vessels, in smooth muscle cells of the muscular layerof the vascular wall, in areas of the connective tissue was observed, that is a sign ofpathological remodeling of the connective tissue.Conclusions. Similar pathomorphological changes of the aponeurosis in groups withphenotypic signs of undifferentiated connective tissue dysplasia and post-operativeeventration confirm the role of the connective tissue pathology in the development of thiscomplication.

ANALYSIS OF POLYMORPHISM OF MATRIX METALLOPROTEINASE-2 (C-1306 → T) AND TISSUE INHIBITORS OF METALLOPROTEINASE-2 (G1303→ A) GENES IN PATIENTS WITH EVENTRATION

Summary. The aim. To analyze the frequency of polymorphic variants of matrix metalloproteinase-2 (C-1306→T) (MMP-2) and tissue matrix metalloproteinase-2 (G303→A) (TIMP-2) genes in patients with eventration. Materials and methods. The study included 11 patients with eventration and 44 patients with connective tissue pathology. Laboratory, genetic and statistical studies were performed. Results and discussion. All models of inheritance are analyzed and the best model with the lowest information criterion Aikaike, which turned out to be a recessive model, is determined. Conclusions. As a result of genetic and statistical analysis of polymorphism of MMP-2 (C-1306→T) and TIMP-2 (G303→A) genes, it was found that polymorphic variants of these genes are not reliably associated with the development of eventration.

Stroke at a young age.A clinical case of dissection of the vertebral artery

The article presents a description of a clinical case of ischemic stroke in a 32 year old patient as a consequence of dissection of the vertebral artery against the background of congenital connective tissue pathology, provoked by a sports load.