[000:00:00;00] it is easy to explore belarus only from the report of our trip. baranovichi station. not just a house. he raised not even chekhov's cherry, and i'm not ashamed of this word, a real paradise apple garden. landscapes full of thoughtfulness and sadness enchant even the most fastidious

travelers. and if there is no such opportunity, the city of belarus is what you need, but for now the whole world in the photographs does not let you fall in the leaning tower of pisa. i will support you in every way. watch the finnish project on our tv channel and travel online hello on the air program health, the quality of our life depends on it, but in the modern world it is not enough to know about it , you need to work on it with your advice in our studio experienced experts share. today, the program of endovascular technologies includes surgical treatment of atherosclerosis of the lower extremities it is possible to introduce tools to crush the plaque with

a high-pressure balloon and install a metal structure at the site of the lesion, which will maintain the artery in an expanded state. to whom adaptive physical education is recommended, even if people with the same diagnoses come to us often, their program differs depending on their state of health, physical fitness, and concomitant diseases. cucumber is not just water. and, by the way , columbus took on his long voyages, cucumbers, both fresh and pickled, in order to so that his sailors do not have these and other topics in our program, we begin. the defeat of the vessels of the legs in a very dangerous state is accompanied by various

complications. how to diagnose a disease in time and treat it in detail, answer all questions with an x-ray by a devascular surgeon. yan igorevich kirnozhitsky. jan igorevich hello we are glad to see you in our studio. hello, today we will talk about obliterating atherosclerosis of the lower extremities, a very serious and severe diagnosis, because there are a lot of complications. that's what this disease is. and in general, why suddenly the vessels of the lower extremities begin to suffer is a systemic disease that affects all the vessels in the human body. this is a multifactorial disease; there are a lot of factors that cause the development of atherosclerosis. this is an increase in the level of lipids in the blood. hyperemia due to an increase in total

cholesterol due to an increase in bad cholesterol, the so-called or low-density proteins. this is an increase in blood sugar levels in the background. diabetes mellitus sedentary lifestyle. and, of course, bad habits 90% of the division of our department of vascular surgery, these are courses. patients who smoke and chronic stress for quite a long period of time are also an important reason for the development of diseases. but what i have listed are factors that we can somehow correct, there are factors that we do not correct and cannot influence them in any way. well, of course , age patients over 60 get sick much more often than a younger patient . this is gender, because according to some studies, men get sick many times more often,

than women. the ratio is 4:1 and the third factor is a genetic predisposition. uh, if a patient has relatives with atherosclerosis with a heart attack, well, that is, as a consequence of atherosclerotic disease, then with some degree of probability it can be assumed that this patient also has a high risk of getting sick and having some complications. well, probably, arterial hypertension is also correct. this is a disease that, let's say, hits the blood vessels. and if there are any other concomitant predisposing factors and genetic breakdowns, then here you just know all the bad things converge in one place. yes, on the wall of blood vessels or endothelium, those very harmful and bad atherosclerotic plaques begin to form and grow. now let's take a closer look at the factors that we have listed, and they cause damage to

the internal e, the layer of the wall of the artery, the so -called insummy, which line the artery from the inside, this month there is a focus of inflammation and in this place there are lumps of water-soluble lipids, that is, cholesterol, uh, attached to the wall of an artery thus, a small atherosclerographic plaque begins to form, which grows over the years, increases in size and causes narrowing of the artery, but subsequently complete blockage of the lumen. the most interesting thing is that lipids are not bad, as we think correctly. this, when there are a lot of them, there is a violation, not bad, but normal. our bodies need them for their own purposes, right for cell renewal and energy. so it turns out, as there is a defect in lipids, they enter there. there they become alien. this is where the immune system speaks. hey, something is wrong here, special cells come there, which also begin to fight these lipids. and now

such a process arises. a languid invisible one, so i would like you to pay attention, there are plaques that we always see on angiography, growing into the gaps. actually, clogging. and there are plaques that do not grow into the lumen of the vessel, but grow into the wall of the vessel, yes, and this is not always visible, but they are the most critical because of them, heart attacks, and because of them , strokes. because of them, thrombosis. the so-called eccentric plaques, or flat. uh, a fairly large percentage of the total volume, say, atherosclerotic plaques in the vessels and, indeed, in the angelographic room, performing standard angiography in one projection. we may not see it. this is a flat plaque that is in two dimensions. it may not be visible. yes, in this case, of course, the methods of computed angiography help us. we will be able to make 3d models after the computed tomography.

vessels of the patient and already on this 3d model you can clearly see that yes, this is a plaque, it is. it really slows down the blood flow, or accelerates it and prevents blood flow below the level of vascular damage. but let's tell you in more detail. we are so obliterating atherosclerosis of the lower extremities or enderteria, they even call it that, because the process of inflammation cannot be stopped. yes, that is, the process of vascular damage has already been started. but what are the symptoms telling about the symptoms of the disease. well, it probably matters to remember, after all, the stages of the development of the disease. there are only three of them, these are the three main stages. the first stage is a symptomatic section, when the patient has no symptoms, but the arteries are already affected by atherosclerotic plaques. it's just that this defeat is the initial stage. it still does not clog the lumen to some critical

values ​​and the patient does not experience. no, you can’t call him healthy in this situation any discomfort. you can say it's not a survey, right? well poorly examined, most likely the second reason for the disease - this is already intermittent claudication. this is a phenomenon that occurs in a patient during physical exertion while walking, starting from aching muscles. uh, if we're talking about legs , it's most often the calf muscles. with higher lesions of the pelvic artery, all the femoral gluteal muscles can hurt, but the main symptom is intermittent chromate. the patient cannot walk a certain distance at a calm, unhurried pace. he has to stop to stand to rest for two or three minutes, in order for the pain in the muscles to go away, feelings of at least a feeling of coldness in the legs in the feet, association of the hairline

, thinning of the skin, pale. pokrovov, this significant enough symptoms, which also need to pay attention. and the third stage is already the stage of critical critical limb ischemia. these are already severe skin lesions - these are necrosis. these are trophic ulcers. well, gangrene, as the final steel for the disease, that is, people who bring themselves to the third stage of obliterating enderritis. it's just such here are those contenders for the fact that they were to lose a limb, right because, unfortunately, at this stage. when already, as you said, there is gangrene, when already with necrotic changes due to the fact that the supply of important arteries is blocked, yes, that is, unfortunately, nothing can be done, of course, at an early stage, it was a disaster. please tell us what modern diagnostic technologies exist today, there is a belt following the american european, and people in

the age group over 60 years old have 20% without symptomatic obliterating sclerosis, out of these twenty percent, only two 2% complain of some kind of complaints, but this is not intermittent lameness by talking with patient. it can be suspected, the second is a biochemical blood test. increasing cholesterol levels is an indexogenicity absolutely true and blood glucose levels are important at the moment. in common world practice, research is to determine the ankle brachial index measurement from historical ankle pressure on the arteries of the ankle and on the arteries of the shoulder. here, let's explain why yes , because many now, uh, viewers do not understand, and when the vessels are affected by atherosclerosis, the speed of the pulse wave, she after all accelerates correctly elasticity is lost. these are simple laws of physics. that is, if we had a pipe of large diameter, and it

goes into another pipe of small diameter, but it is natural that the speed of pressure, let's say, is at first. significant, of course, in a tube of a narrow diameter, the velocity of the fluid will be much higher than in a vessel of a larger diameter, therefore, of course, we see , first of all, the acceleration of blood flow according to the ultrasound data of the leg artery. this is clearly visible, and this is also quite such an informative informative method. ct scan. mri allows you to see and eccentric plaques, flat and the extent of the lesion, the extent of the lesion, but still the gold standard is angeography. this is a method that has some let's say inconvenience. this is an invasive method in the first place, that is, in order to perform this study. you need to go to the hospital. you need to come to the

operating room. yes, that is, a study is being done under intravenous anesthesia, so, of course, it is not entirely convenient, but it is very informative and sometimes allows you to solve serious problems. you're doing an angiogram. you see the place of narrowing is critical there 70-75%. here is your algorithm further through the catheter that we have already installed. a special metal conductor is brought into the service area. it acts as a rail for delivering already heavy artillery, let’s say, tools that really heal, so a special balloon is brought into the service area for the guide. which is inflated to about nine ten atmospheres, atmospheres, and the plaque is crushed, it is pressed against the walls of the artery. after this is the so-called balloon angioplasty, then the balloon is removed to this

place already along the same rails, the stand is started and the stand is implanted. and there are different ones, some balloons are inflated , some straighten themselves. please show so that everyone understands how hmm jewelry work is. it is an alloy of nickel and titanium. in some cases, antal. the material is absolutely not so valuable, hypoallergenic. this stand is exactly in my hands. this is the most expanding walls, that is , the manufacturer. betrayed him a certain diameter a certain length and packed a special system. the delivery system diameter of the delivery system is several times smaller than the diameter of the stand itself. and having approached the affected area, we simply lower the cover with it, pull off the cover of the delivery system and the stand straightens itself out. yes, completely fulfilling the contours of the artery from the inside, the material turns out to be such that it remains there, yes, the endel grows into it

, and it already performs. actually , the function of such a foundation or frame, that is, in this critical place, the narrowing is no longer will be. but if we talk about the situation, when you came in and looked, and there is the most terrible atherosclerosis. yes, even with calcifications, that is, the vessel wall is so fragile that it is not something like a balloon? yes, even this net cannot be touched, because it will crumble, then. i understand you're already doing bypass surgery. we are now dividing the leg arteries into several floors. uh, the first floor is the pelvic arteries. that is, inside the pelvic location, then the next floor. these are the arteries of the thigh, third floor. these are arteries below the level knee joint. well, at the moment, modern angiosurgery is already highlighting the fourth floor. these are the arteries below the level of the ankle joint in our hospital. we

try to fit. uh, in such a way as to simultaneously perform a reconstructive recanalization operation on all floors on which we can intervene, if a person has a narrowing in the pelvic arteries, then a stand will be installed there, if there is a lesion on the hip plus everything, as you described calcified massive and extended defeat, of course, it is better to perform a bypass operation more efficiently in this place, that is, take a synthetic tube or the patient's own vein and bypass the affected area, and already below the knee joint was pumped. connected again, x-ray vascular surgery, balloon angioplasty, stenting is rarely used below the knee gap. well, in some situations too, perhaps the most important stage is done on the foot. that is, we

must open the arterial arches, in order for there to be a good exchange, good uh, outflow blood venous bed, if it is not. this will all end badly. that's how these operations have become so. here are streaming and outpatient operations, if we are talking about balloons , angioplasty, or prostatitis of an artery performed operations. after 12 hours, a person can get up and go, but still, let's scare everyone. let's highlight. how defeat. arteries are dangerously trophic ulcers, uh, which cause terrible discomfort, this is a patient, uh, with chronic constant pain in the area of ​​​​the trophic ulcer, which reduces quality of life standard of living drops significantly. well, as a result

of gangrene, amputation and amputation is not just an operation. that is, we made a putiller for them, amputated his leg. the patient healed well, everything was fine, the person was discharged home. it doesn't end there. after all, international studies show that the frequency of surviving after amputation after 5 years is 50%, that is, 40% of patients under five years of age die after amputation. we spoke transliros. this is a systemic disease and development. cardiovascular complications it is very the high risk just goes off scale colossal, so, of course, this disease is very serious and to be treated. she needs to be taken very seriously. what is the prevention of atherosclerosis and how can the development of atherosclerosis of the lower extremities be prevented, including everything simply everything is based on

risk factors, that is, the rejection of bad habits. this is tobacco smoking alcohol. the control of blood sugar levels is important, that is, for patients with diabetes mellitus, there are certain values ​​​​of the range of indicators that you need try to stick to. control of the level of cholesterol and lipids in the blood, an active lifestyle , walking, cycling, if the physical condition allows, exercise therapy is very effective in terms of helping the patient, that is, physiotherapy increases the walking distance with intermittent chromate, increases the speed and against the background of this entire patient. self-esteem rises. he believes that, in principle, he is recovering, that is, in 4 weeks the effect is very colossal, good, then timely, of course, an appeal to the doctor

if you have any symptoms. refusal of fast food seems to me the trouble of the modern age, 21. and, of course, a good mood, because you are doctors of the angel-surgeons. say that a very large number of diseases associated with damage to the cardiovascular system is associated with stress and we have a damaging effect of stress hormones. she needs to forget about it. thank you so much for saving lives every day not only thanks to modern technologies, but also thanks to your professionalism. i will remind you that today our guest was an english surgeon, head of the angiography room of the tenth city clinical hospital. jan igorevich ignadsky do not switch, we continue to take care of your health. stay with us. this is

a rubric of food with a plus sign. the quality of our life depends on what we eat victoria today there are a lot of cucumbers on our table from the point of view of nutrition, why cucumbers are still useful. it seems to me nikolai, we are so used to the fact that this vegetable is always on our table , the one that we hardly even think about how important and useful it is for our body, by the way, and cucumber is a relative of pumpkin, zucchini and melon. and this is the same vegetable that we eat unripe. so a cucumber is a vegetable, but any person will say that, in fact, it may even be a useless vegetable, because almost 90% of it consists of water, nikolai more. oh, i would say that cucumbers are about 55% water, but this

does not mean at all that there is no benefit from it, uh, not at all, because in dietology and in our nutrition, but, unfortunately, or fortunately, no, no magic. there are no magical products, there are no useless products, a and our health is determined by how much our food consists of natural healthy a and good products, and if 80% of our diet is represented by natural products, then most likely our body will have resources for in order to cope with twenty percent of some errors of some junk food. so if 95% water, then as i understand it, 5%, that's just the same. perfect benefit yes, let's talk about this five percent basis, which gives that minimum calorie content from a cucumber is carbohydrates, that is,

about three to four carbohydrates. e grams of cucumber and we can say that a cucumber - this is truly a product of almost negative calorie content, because our body will spend much more energy on digesting this product than the powers of water. yes, yes, exactly, than it will receive from this very cucumber, but, besides , in the cucumber, and hmm, there is a sufficient amount of fiber, relative to the mass of the cucumber. it seems that it is not so much and it is up to one gram per 100 g of fiber, but nevertheless less, given that there are still many dissolved vitamins and minerals. we will get a cucumber from a cucumber, it can definitely be considered a superfood. and by the way, the main nutrients are sosre. it is in the peel and directly under the peel, therefore, by cutting the peel, we practically deprive the cucumber of all the most useful and important. now, if we talk about vitamins and minerals, i understand that there is a standard

set for all vegetables of vitamin c and vitamin b and vitamin. e some antioxidants properly zinc selenium e, calcium a little bit of phosphorus, manganese, yes, that's right, but i would like, but separately, but hmm, pay attention to the fact that there is a lot of vitamin c a in the cucumber and, by the way, saying columbus took it on his long voyages, cucumbers are both fresh and pickled for that so that his sailors do not have scurvy, but a disease associated with vitamin deficiency vitamin c and cucumbers - this is an excellent source of potassium of the very element that is important for the functioning of the heart for the normal functioning of blood vessels. and for excellent absorption of calcium in the bones. well, now it 's time for victoria to turn to cyril karmanova and ask what our wonderful chef will surprise us with today. well, for example, uh, what i know, you can

eat a cucumber raw, you can eat it with honey, you can eat it with salt, you can pickle it. uh, you can ferment, then prepare a salad with other vegetables. here kirill and you today than us? surprise nikolai today i will cook a traditional old vietnamese dish called name or, as many of us call it e, rice paper springle of fresh red fish, vegetables, fruits in the form of cucumber and avocado. so cyril you continue, but we victoria let's get back to the cucumber, but the green color. there are antioxidants in there. after all , it is also very beneficial for our body. right. remember that vegetables are fruits. it is the main source of antioxidants for our body. dioxidants are substances that prevent peroxidation, thereby preventing premature cell aging. a and the more varied colors of vegetables in our diet, the more

different antioxidants. we will get. but the cucumber is such a green component. and by the way, but very important to the cucumber treat the same way as greens for people who take anti-clotting drugs. and this does not mean that green vegetables are not allowed - this means that you need to determine some daily norm of green vegetables, or greens every day and stick to it while choosing, and doses of anticoagulants to drugs. well, if we talk about cucumbers in terms of combination with other products, here, if there are any rules in dietology, about which we should know, but in general a combination of products. this direction is rather such folk dietology. a la you can’t eat herring, but with milk, when we cook fish or herring, we add

cream there correctly for weight. in fact, intolerance to certain combinations usually has a very individual character. that is, and i, for example, may have an individual intolerance, if i eat a cucumber along with cottage cheese, and you have nikolai, for example, these two components combined cucumbers will be perfectly combined. e with cow's milk and melodies. i remember in the village. it was such a super dish from grandparents, so it is very important to focus on your own feelings. if somewhere you feel that some kind of discomfort has appeared. keep track of what you ate the day before and try to replace this one next time. food for something else and track down, maybe next time. you will already feel better cucumbers with red fish. that's how much this combination is right for our gastrointestinal tract - an excellent combination, in general, it

seems to me, again, if not, individual intolerance, then cucumbers are combined with absolutely all products. and we remember that in order for our food to be balanced during the day, there must be proteins, that is, fish, and there must be vegetables, that is, cucumbers, so the combination is wonderful. ok then. now. let's still remember that a cucumber is 95% liquid, but there is potassium there, which also has a nasty effect, but still we decide to whom cucumbers in large quantities will still be contraindicated. yes, excellent question nikolai a i want to note that we often cut off the dark one. cucumber because it is usually bitter, it is bitter due to a special substance called cucurbitacin. this is a substance that gives bitterness, but it is not at all harmful. but

just the same, it contributes to a better functioning of the gastrointestinal tract, in principle, cucumber juice contributes to activation. e, all the glands of the gastrointestinal tract and increase the acidity of gastric juice, and on the one hand it can increase appetite improve digestion, but if you have chronic diseases, and the gastrointestinal tract in the acute stage, for example, exacerbation of ulcers, exacerbation of gastritis. exacerbation of duodenal ulcers, and exacerbation of various inflammatory bowel diseases , in this case fresh cucumbers, should be limited and again focus on your own tolerance. cyril, i see the dish is ready, we will have it. try it with sesame sauce, well victoria please rate this dish. i want to

remember, but a very interesting fact is the women of the eastern countries and-and eurasia and japan and china is considered the most slender due to the presence of a large amount of fish in their diet, so dear girls, dear women are highly recommended to eat fish. uh, at least twice a week to stock up, and polina with saturated fatty acids, and also in our dish, protein is represented by fish and cream cheese, vegetables are represented by avocado and cucumber, and carbohydrates are represented in a very small amount in the form of rice paper . the dishes are balanced very healthy and i'm sure very tasty. i think this is the food plus sign, eat right and be

healthy. what is the role of youth in the religious life of

the country, but in fact, when you enter the temple among people of respectable age, our youth, it is especially noticeable in the temple and is also especially noticeable. and in general, in church life , what kind of experience is necessary to go through in order to realize the deep meaning of the faith, you are the roof and the way of the skin more here and understanding pull it was paid for us sinners. what should a believer do in order to get closer to god on the way, our chan better they ride a companion to be him with a true thought word and christian torment awaits, and yes, freedom is already for us. and we are already deciding whether to invite him into our hearts or not. look, spiritual and educational projects on

belarus 24 tv channel. we can conditionally divide our work into two such main conceptual areas. the first is procurement, public procurement and procurement from own funds, and the second direction is exactly what we are talking about, now these are the sadists of foreign economic activity. here we punish a full complex system set of services in our exporters, starting from the organization of a business mission. exhibition activity means, uh, establishing direct contacts, but if we are the national center for marketing, naturally, we also carry out a full range of marketing research, both for our exporters, our companies, and for foreign partners. we also have an image of our educational center, yes, which we use here to explain. uh, how to work in foreign markets. yes, what

tools? does each market have its own specifics? yes, here we are recently we did, uh, a series of webinars, yes, for how to work in the african market? that is, we invited, among other things, our e, where are the representative offices, yes, and so it is focused on explaining to our exporters in a normal accessible language how to enter the market. yes, where to start, what are the barriers, what are the problems, if the tariffs are not tariff issues, yes, that is, the whole range of issues, the same work is being done in another region. we are similar. ah, webinars. these various webinars can be online conferences, that is the chinese in the chinese in the asian market with pakistan with egypt yes, that means, uh, we have the russian market, uh, there is such a resource as an information resource export. uh, very interesting very useful very effective information resources. uh, let's say. so,