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KoHrpecu, cuMno3ÍyMU, wkoam / Congresses, Symposiums, Schools
Materials and methods. 31 patients with AS complicated by GER were examined (main group). GER manifests a few years after the debut of the AS in all patients. Proton pump inhibitors (PPI) used to treat GER in the patients of main group. 20 patients with AS without GER have formed comparison group. Bone mineral density was studied by ultrasound densitometer Ahilles Express. Statistical analysis was performed by parametric statistics. Reliability of differences was assessed by Student t-test. The relations between the qualitative attributes were investigated by calculating of the coefficient of association Yule — Q.
Results and discussion. OPS was detected in 25 (80.6 %) patients of the main group and in 14 (70.0 %) persons of the comparison group. Reliable differences in frequency of OPS between patients from main group and patients from comparison group have not been revealed. On the second stage of the study the main group of patients was divided into two subgroups (A and B) depending on the duration of PPI therapy. 20 patients received PPI less than 3 years (mean duration of using — 1.1 ± 0.6 years) were included in subgroup A. 11
patients received PPI more than 3 years (mean duration reception 4.1 ± 1.0 years) and they formed subgroup B. OPS was detected in 17 (85.0 %) patients from subgroups A and in 8 (72.7 %) patients from subgroup B. Index Z in patients of the subgroup A was —0.610 ± 0.088, index Z in patients of the subgroup B was —0.850 ± 0.113. Reliable differences in the index Z between the two groups of examined patients were absent (p > 0.05). However, the index T in the subgroup B (-2.700 ± 0.205) was significantly (t = 4.080, p < 0.001) lower than in the subgroup A (-1.720 ± 0.120). Analysis of relations between the prolonged use of PPI in patients with AS complicated by GER, on the one hand, and OPS, on the other hand, revealed medium strength association (Q = +0.360, p < 0.05).
Conclusion. Prolonged use of PPI in the treatment of GERD in patients with central form of AS enhances the expressivity of OPS. In my opinion, this situation is a result of occurrence of the calcium malabsorption phenomenon in hypoacid conditions. Thus, doctor should prescribe an additional antiosteoporotic drugs in the treatment of GER by PPI in patients with AS.
ZHULKEVYCH I., UGLYAR T.
Ternopil State Medical University named after
I.Ya. Gorbachevsky, Ternopil, Ukraine
Fractal Analysis of the Bone Tissue Status in Patients with Non-Hodgkin Lymphoma
Introduction. The change in mineral bone tissue (BT) density in patients with solid tumors, acute and chronic leukemias is a known fact. However, very few studies are devoted to monitoring the dynamics of mineral density changes of BT in patients with non-Hodgkin lymphoma (NHL). According to research rare mineral density BT changes are observed in 30—35 % of patients, and the average age of patients is over 60 years.
Aim of the research is to explore the dynamic changes of BT in patients undergoing NHL chemotherapy stage of treatment using the method of virtual bone biopsy.
Materials and methods. The analysis of changes of mineral density by direct measurement of BT density (in Haunsfild units) in trabecular parts of vertebrae of thoracic and lumbar spine on computer axial tomograms at stages of diagnosis and after chemotherapy (4—6 courses of chemotherapy CHOP protocol) treatment. In order to standardize and stabilize images of trabecular vertebrae we used universal digital filter — «Mexican hat» wavelet. Densitometry of trabecular vertebrae layer in thoracic and lumbar spine was performed in the applications of mathematical analysis of medical images DICOM — ClearCanvas Workstation and ImageJ with the BoneJ extension, freely distributed by the National Institute of Health (USA). Fractal dimension was observed by map-counting and box-counting algorithms.
Number of the patients was 30. 11 men and 19 women were among them. Average age was 64.51 ± 2.84 years. The diagnosis was established by the NHL world
(NCCN, ESMO) and national criteria for the diagnosis of compulsory morphological and immunohistochemical verification. In all patients there was B-macrocell, CD20 positive lymphoma.
Results. Based on the analysis of axial slices BT scans and measurements of vertebral trabecular density of thoracic and lumbar spine in the above terms we found negative trend changes in patients' BT. Changes in density of BT at diagnosis of disease stage were seen in a decrease in trabecular density of the vertebrae in 7 (63.6 %) men and 16 (84.2 %) women. Registered changes were mostly found in women and the depth decrease of vertebral BT density in women was significantly higher than in men. After completing chemotherapy in all patients there was further decline in the density of BT, but the rate of decrease was detected in different gender groups. Densi-tometric and fractal analysis (according to map-counting and box-counting algorithms) of the state of vertebral trabecular BT showed direct positive and reliable connection between the above parameters.
Conclusions. 1. The reduce of vertebral BT density of thoracic and lumbar spine of patients with NHL requires monitoring BT at all stages of the management of patients with NHL. 2. The reduce of density of tra-becular vertebrae in patients with NHL occurs at different rates for men and women at chemotherapy treatment stage. 3. There is a direct and reliable connection between densitometric characteristics and fractal dimensions (according to map-counting and box-counting algorithms) of state of trabecular vertebrae in patients with NHL. 4. The perspective for further research is to identify the causes of changes in BT density in patients with NHL and the main factors that lead to it, as well as inclusion of the modifiers of BT into the maintenance and correction therapy.
№ 2 (18), 2015
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