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BACKGROUND: The function of the thyroid gland effects on obesity and comorbidities. It has been proven for bariatric surgery to be the most effective in obesity treatment. AIM: to evaluate the dynamics of body weight, thyroid status, leptin and insulin resistance in obese patients after bariatric surgery. MATERIALS AND METHODS: 74 obese patients were observed after bariatric surgery (sleeve gastrectomy – 42, gastric bypass - 32); initial body mass index (BMI), thyroid stimulating hormone, free T4, fasting plasma leptin, insulin and glucose were estimated; the insulin resistance index HOMA-IR was calculated. The dynamics of body weight was estimated by BMI and the excess BMI loss (% EBMIL). After 3 years of follow-up, 48 patients were examined. RESULTS: Subclinical hypothyroidism (SH) was detected in 36.5% of patients with high degrees of obesity. A correlation was found between BMI and TSH level (R=0.5; p=0.01). HOMA-IR was increased in most patients with obesity of the II and III degree (4.8±1.9 ng / ml). In the SH group, the leptin level was significantly higher than in the group with a normal TSH level of 43.0±7.3 ng / ml and 33.2±4.6 ng / ml (p=0.004). Among patients with initial SH, spontaneous reduction of TSH levels occurred in 45% patients 3 years after surgery. CONCLUSIONS: Postoperatively, the BMI decrease was associated with the decrease of TSH, leptin and HOMA-IR. The data obtained may reflect the effect of adipose tissue on the functional state of the thyroid gland in patients with high degrees of obesity after bariatric surgery. This seems to be extremely important for maintaining body weight.

Background: Bariatric surgery methods have proven to be most effective in treating obesity. Weight regain (WR) is often found after various types of bariatric surgery. The clinical significance of WR is not clearly defined. Aims: to assess the dynamics of body weight and determine the amount of clinically significant WR based on the study of carbohydrate metabolism and blood pressure in patients with obesity after performing sleeve gastrectomy (SG) and gastric bypass (GB). Materials and methods: 68 patients with obesity after SG (40) and GB (28) were observed for 3 years. Body mass index (BMI), percentage of excess BMI lost (% EBMIL), WR, glycated hemoglobin, blood pressure were evaluated. Results: A comparable efficiency (EBMIL more than 50%) of the SG and the GB was at the nadir point. %EBMIL over 50% was achieved in 78.8% of patients after SG and 80.0% of patients after GB. WR more than 15% was associated with a significant increase in systolic blood pressure. Clinically significant WR in the SG group was detected in 32.5% of patients, in the GB group in 17.2% of patients (p 0.05). Conclusion: WR of more than 15% was associated with a significant increase in systolic blood pressure in patients with obesity after SG and GB, which makes it possible to consider WR of more than 15% clinically significant. A clinically significant WR 36 months after surgery was detected in 32.5% of patients after SG and 17.2% of patients after GB.

The article analyzed the results of surgery using tree gastric restriction laparoscopic operations which led to high possibility of the development of gastroesophageal reflux disease (GERD). Laparoscopic stomach length resection was performed in 327 (68,1%) out of 480 (62,1%) patients. Laparoscopic gastric bypass surgery took place in 142 (29,5%) cases and laparoscopic biliary-pancreatic bypass surgery - in 11 (2,3%). The diagnosis of GERD was established in 193 (40,2%) patients before the operation and it was usually accompanied by hernia of the esophageal opening (HEO). The patients were arranged in 4 groups. The first group had operations using the standard method and it included 287 (59,8%) patients without any signs of GERD or HEO. The patients of the second group (84 (17,5%) had signs of GERD and HEO and standard operations with a hernia removal and cruroraphy were carried out. The patients of the third group 109 (22,7%) had initial signs of GERD and the standard method was used for them. The developed method was applied for patients of the fourth group (132 (27,5%). All the operations were completed by antireflux valve formation, but in the cases of GERD and HEO presence, they accomplished by hernia removal, cruroraphy. After performing standard operations, the signs of GERD were noted in 51,5% of cases. Thus, patients of the first group (148 (51,5%) had the signs of GERD. It was noted, that the signs of GERD were presented in patients of the second group (79 (94%) and it numbered 97 (89%) patients of the third group. In the case of the fourth group, signs of GERD were in 14 (10,6%) patients.

The results of surgical treatment of 139 patients with metabolic syndrome, obesity and dislipodemia were analyzed. Modern bariatric operations (4 types) were performed by using laparoscopic method. There were regulated bandages of the stomach (RBS), lengthwise gastric resections (LGR), biliopancreatic and stomach bypass surgeries (BBS, SBS). Results of five-year follow-up indicated that restrictive operations on the stomach (RBS, LGR) aimed to correct overweight and dislipodemia had some limitations to application in a varying degree. The RBS operation should be appropriate to use for women of the young age group, when an initial body-weight index wasn’t more than 43 kg/m². The LGR operation was effective for men of the young age group and women in case of moderately expressed dislipodemia and in case when the initial body-weight index didn’t exceed more than 45 kg/m². Combined bariatric operations (BBS, SBS) were most likely effective on body weight and dislipodemia.

Nowadays, according to data of WHO, the diabetes mellitus was diagnosed in more than 280 million people. The diabetes mellitus type II had 90% patients. The applied methods of conservative therapy seldom lead to euglycemia condition of patients. Last years the treatment of diabetes mellitus was carried out by the method of different bariatic interventions. Good results was obtained, they should be analyzed and investigate. The results of treatment of 142 patients from 628 patients (with type II) were estimated. The patients were undergone by different bariatic interventions. Modern laparoscopic operations were performed on all the patients. Controlled bandage of stomach had 81 of patients. Gastric resection was performed in 28. Gastric bypass surgery was carried out in 22 of patients and biliopancreatic diversion — in 11. The improvement of control of leukemia level was obtained. Diabetes type II could be treated by surgical methods. The best results were obtained after combined operations, which potentially could present an alternative method of treatment of type II diabetes.

OBJECTIVE. The study assessed an efficacy of laparoscopic gastric bypass (LRGB) in correction of main components of metabolic syndrome (MS). The authors revealed the possible reasons of insufficient efficacy of operation. MATERIAL AND METHODS. Results of LRGB were estimated in 228 patients who underwent operation during 5 years. Index of body mass, % EBMIL, lipid spectrum, level of glycemia, content of leptin and ghrelin were considered. RESULTS. The high efficacy of operation influence on MS was found in young age groups. Other groups had lower efficacy of operation. The reason was in gastrointestinal tract reconstruction that resulted in decrease of body mass, regress of associated diseases, change of key hormones which regulated energy metabolism, homeostasis of glucose and lipids. The ghrelin level didn’t have a determining value and didn’t influence on decrease of MT after operation. CONCLUSIONS. The operation effectively influenced on all possible components of MS, but the ghrelin content wasn’t determinative for long-term regulation of body mass loss and reduced the efficacy of operation.

Obesity has negative impact on female reproductive health. Various medical conservative and surgical interventions have been used to improve the reproductive function in obese women. In this literature review, we featurethe main modern methods of treating obesity in order to restore reproductive function in women.

OBJECTIVE. The study aimed to improve the results of gastric bypass surgery. MATERIALS AND METHODS. The article analyzed the results of surgical treatment of 342 patients with metabolic syndrome who underwent operation at the period from 2008 to 2016.The patients were divided into 2 groups according to the type of operation. The first group included 224 (65,4 %) patients who underwent standard surgery LGB using Lontron procedure. The second group numbered 118 (34,5 %) patients whom LGB operation with ARC (the original method) were performed. The efficacy of operation was evaluated in different terms (after 3-month, one year and 3 years). The article described in detail and showed the technique of proposed modified operation of gastric bypass surgery. RESULTS. The proposed method of operative treatment was validated by researches performed. There was demonstrated higher efficacy of operations compared with the standard gastric bypass surgery. CONCLUSIONS. The operation of modified laparoscopic gastric bypass with formation of antireflux valve allowed clinicians to improve the results, decrease the number of complications and have a strong influence on main components of metabolic syndrome.

Obesity has a negative impact on female reproductive health. The review presents literature data on current views on the etiology, pathogenesis of obesity and its impact on the reproductive health of women. Particular attention is paid to problems arising in women of reproductive age who are obese.

The article presents the results of treatment of 68 patients who underwent laparoscopic sleeve gastric resection (LSG) and laparoscopic gastric bypass (LGB) at the period from 2014 to 2015. The efficacy of operations on the course of nonalcoholic fatty liver disease (NAFLD) was estimated. There were performed a liver biopsy and histological studies with determination of histological activity index, the rate of severity of fibrosis according R. G. Knodell scale and METAVIR system, nature and degree of manifestation of steatosis of hepatocytes and intrahepatic cholestasis. NAS activity scale was used to evaluate morphological changes. The results of 1,5-year follow-up study were assessed in dynamics. Fibro Test results were in the range from 0 to 1 depending of fibrosis severity using METAVIR system (from F0 to F4), Knodell and Ishak scales. It was stated that there was an improvement of histological and functional findings in cases of hepatic steatosis, inflammation and fibrosis. All the patients (100%) initially had the signs of NAFLD and 12 patients (22,6%) - fibrosis. The complete regression of NAFLD was noted in 43(81,1%) cases and signs of previous fibrosis were smoothed over in 6 patients (41%). Liver function tests have deteriorated at 6-month period, but tests improved to normal rates at the end of 1-year period. The bariatric surgeries are effective methods of NAFLD treatment and Fibro Test is non-invasive and reliable method of liver state assessment.

Laparoscopic sleeve gastrectomy (LSG) was performed in 522 patients at the period from 2007 to 2015. The operation was carried out by different methods. It was stated that «the ideal candidates» for choosing LSG operation were the patients without metabolic syndrome (MS) and body-weight index, which wasn’t higher than 48 kg/m². The operation could be performed on patients younger than 40 years old in order to correct disorders of insulinic and cholesterol metabolism. Patients with MS have limitations for LSG application, because of this reason, the operation is advisable for younger age group without severe accompanying pathology. The operation could be applied in older age group in order to stabilize general condition in case of high risks as the first (sometimes the last) stage of treatment for the patients whom more effective operation couldn’t be recommended.

This work analyzed the results of surgical treatment of 380 patients who underwent the laparoscopic adjustable gastric banding (LAGB) at the period from 2004 to 2015. The patients were initially divided into 2 groups with metabolic syndrome (MS) and without MS according to the sex, age (up to 40 years old or older). As the result of performed analysis, there was stated that LAGB operation wasn’t effective and couldn’t be recommended for an application on the patients with MS. The patients have to follow necessary advice for life. Otherwise, the probability of complication development and recurrent operation would be really high and because of this, the more effective surgical treatment should be initially used. LAGB operation didn’t influence on pathogenetic mechanisms of main components of MS and couldn’t be regarded as effective. This LAGB operation is reasonable to apply in women without MS of young age group with initial body mass index lower than 43 kg/m². These women have to be able strictly follow doctor’s advice for life.

The article presents the assessment results of efficacy of modern bariatric laparoscopic operation during 10 years of practice. This work analyzed the treatment results of 1018 operated patients at the period from 2007 to 2014. The laparoscopic regulated gastric bandage operation was performed in 275 (28, 8%) cases. The lapa roscopic longitudinal gastric resection (LLGR) was applied in 411 (43,1%) (231 operation used the developed modification and 180 used standard method). The laparoscopic gastric bypass surgery (LGBS) was carried out in 253 (26,5%) cases (56 used the developed modification and 197 used the Lontron modification). The laparoscopic biliopancreatic bypass surgery (LBBS) was made in 14 (1,4%) cases (11 used Hess Marceau Baltasar modifications and 2 - Fobi modification, 1 - Scopinaro operation). BIB was implanted in 65 (6,3%) cases. The diagnosis of metabolic syndrome had initially been established for 321 (31,5%) patients. The rest of the patients 697 (68,4%) have been operated for obesity of different degree. An initial body mass index (BMI)

Aim. To study the effect of the antidepressant paroxetine on the compliance to antihypertensive therapy in patients with arterial hypertension (HT) and post-stroke depression.Material and methods. Patients (n=24) aged 55-73 with controlled HT (blood pressure, BP140/80 mmHg after 16 weeks was found in 10 (41.6%) patients. Clinical post-stroke depression was found in 7 (30.4%) patients, 5 (41.6%) of them were from group 2 (OR=0.35, 95% CI 0.12-0.78). High treatment compliance was in 15 (65.2%) patients, and 9 (81.8%) of them were from group 1. Nine (39.1%) patients did not receive an adequate antihypertensive therapy, 5 (41.6%) of them were from group 2 and could not explain their refusal from medication. General index of intellectual function was higher in patients of group 1 (p=0.034) than this in group 2; index of motor function did not change significantly (p>0.05).Conclusion. Reduction of compliance to antihypertensive therapy and rehabilitation in hypertensive patients after stroke is associated with unmotivated refusal from treatment because of clinical post-stroke depression.

Melatonin is neurohormone, which is involved in regulation of many functions of an organism, including the digestive system. Therefore the authors offered to include this hormone as a preconditioner factor in surgical treatment of colon tumors using laparotomy and laparoscopy. Preoperative application of melatonin allowed shortening the terms of postoperative period and hospital stay.

Aim. To study an interrelation of anxiety and depression with arterial hypertension (HT) of various degrees taking into account gender distinctions.Material and methods. One-stage (cardiology and psychometric screening) epidemiology study was carried out in 1% sample of the Novgorod Region adult population. The program of screening included the standard epidemiological record of HT detection and psychometric testing in 1607 respondents with the Hospital anxiety and depression scale (HADS). Risk calculation was performed by logistical regress model using disagreement criterion (odds ratio).Results. HT prevalence rate was 52.1% among men and 49.8% among women of Novgorod Region. The highest prevalence rate of HT was observed at the age ≥70 years: 88.9% among women and 83.6% among men. Relationship between subclinical and clinical types of the anxiety, depression and HT degrees 2-3 was revealed with some gender peculiar properties. Patients with isolated systolic HT had high association with anxiety and depression irrespective of gender.Conclusion. Revealed relationship between anxiety, depression and HT, especially in patients with HT degree 3, required an interdisciplinary approach to the therapy of this group of patients.

Since the widespread introduction of minimally invasive laparoscopic techniques in abdominal surgery there was a question - what are their physiological differences from operations withapproach by laparotomy. The study of these differences, mechanisms and their correction allows you to bring the results of operations with open approach to the laparoscopic. However, the possibility of an effective systemic exposure, allowing adapting body reaction to surgical procedures remains unresolved. To date, the use of melatonin in surgical practice is based on its functions as a neurotransmitter that can potentiate some natural protective reaction of the body. The paper analyzes the effects of melatonin, you can use as a biological adaptogenic control which generally acts as a trigger to launch a diver-seprocesses, including reparative ones in the body. The use of adaptive mechanisms initiated by melatonin in response to surgical trauma and tumor processes can be successfully applied to improve the results of surgical treatment of patients with surgical diseases operated as open and laparoscopic access.

It was shown by the authors that changes of the level of cytokines reflected the degree of invasiveness of operative intervention. The endovideosurgical approach was less traumatic and provided a rapid rehabilitation of the patients in postoperative period. It is possible to consider the high levels of IL-10 as a predictor of development of local inflammatory process and as an indicator of probable infectious complications in postoperative period.

Aim. To study extra- and intracranial hemodynamics in patients with chronic hepatitis of different activity.Material and methods. Ultrasonography of the cerebral blood flow was performed in 576 patients with chronic hepatitis.Results. Contralateral hemyspherical asymmetry (more than 30 %) of the maximum linear rate of blood flow in the medium cerebral arteries and decrease in resistance index (0,55±0,09) and pulsativity index (1,34±0,66) were found in 33,8 % of patients with chronic hepatitis of high activity. Collateral blood flow reduction through connecting arteries of Willis circle was revealed in 13,8 % of patients. The tortuosity of arteries and thickening of intima-media complex was found in patients with chronic hepatitis (mainly of high activity). It leads to decline of cerebral blood flow.Conclusion. Symptomatic and asymptomatic cerebral blood flow disturbances were observed in 23,2% and 38,8% of patients with active chronic hepatitis respectively.

Aim. To investigate sex- and age-specific characteristics of arterial hypertension prevalence in type 2 diabetics with obesity. Material and methods. Sex- and age-specific features of hypertension prevalence were studied in 6177 (1345 males and 4832 females) type 2 diabetic obese citizens of the Novgorod region. Results. The highest incidence of mild hypertension was found in obesity degrees I and II (50-68%). Prevalence of moderate and severe hypertension reached 20-31 and 4-5%, respectively, in obesity of degree I and II, 15% in males and 11% in females in obesity degree III. Conclusion. In type 2 DM obese patients mild hypertension occurs most frequently. Severe hypertension develops often in males with obesity degree II and III in age groups 50-59 and 60-69 years, in females - in any obesity at the age of 70 and older.

Statistically confident (р < 0,05) change of blood flow parameters in segmentary and parenchymal arteries in the form of increase of resistance and pulsativity indices has been found that in patients with high-activity chronic hepatite with hyperbilirubinemia. The highest increase of the resistance and pulsativity indices of 0,88 ± 0,05 and 1,24 ± 0,07, respectively, was observed only in segmentary arteries. No statistically confident (р > 0,05) changes were found in maximal and minimal linear parameters of blood flow in these arteries.