Ulcerative colitis (K51), adults

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STAGED METHOD OF SURGICAL TREATMENT OF LIVER ECHINOCOCCOSIS

The purpose of the study is to present and evaluate the results of treatment of patients with parasitic liver damage using a modern diagnostic algorithm, various methods and stages of surgical treatment.

Material and methods. The results of treatment of 81 patients (34 men (42%), 47 women (58%)) who underwent 104 surgical interventions for liver echinococcosis in the surgical department No. from 2015 to 2021. The difference in the number of operations performed and actual patients is explained by the use of a staged method of surgical treatment in some cases.

Results. Of the total number of operated patients, one-stage surgical interventions were applied in 64 (79%) cases. In 17 (21%) patients, various staged methods of surgical treatment were applied, which made it possible to exclude some of them from the category of "non-resectable" and perform surgical treatment with good results. An unsatisfactory result of treatment with a fatal outcome was noted in one case from the total array of patients.

Conclusion. The use of a modern diagnostic algorithm, various surgical techniques, including staged minimally invasive and laparoscopic ones, makes it possible to achieve good treatment results in a specialized surgical center.

Important problems in the diagnosis and treatment of primary sclerosing cholangitis (based on the Russian consensus on diagnosis and treatment autoimmune hepatitis. Moscow, 2018)

The article is published based on the results of the Russian Consensus on the diagnosis and treatment of primary sclerosing cholangitis (PSC), discussed at the 44th annual Scientific Session of the CNIIG "Personalized Medicine in the Era of Standards" (March 1, 2018). The aim of the review is to highlight the current issues of classification of diagnosis and treatment of patients with PSC, which causes the greatest interest of specialists. The urgency of the problem is determined by the multivariate nature of the clinical manifestations, by often asymptomatic flow, severe prognosis, complexity of diagnosis and insufficient study of PSC, the natural course of which in some cases can be considered as a function with many variables in terms of the nature and speed of progression with numerous possible clinical outcomes. In addition to progression to portal hypertension, cirrhosis and its complications, PSC can be accompanied by clinical manifestations of obstructive jaundice, bacterial cholangitis, cholangiocarcinoma and colorectal cancer. Magnetic resonance cholangiography is the main method of radial diagnostics of PSC, which allows to obtain an image of bile ducts in an un-invasive way. The use of liver biopsy is best justified when there is a suspicion of small-diameter PSC, autoimmune cross-syndrome PSC-AIG, IgG4-sclerosing cholangitis. Currently, a drug registered to treat primary sclerosing cholangitis which can significantly change the course and prognosis of the disease does not exist. There is no unified view on the effectiveness and usefulness of ursodeoxycholic acid and its dosage in PSC. Early diagnosis and determination of the phenotype of PSC is of clinical importance. It allows to determine the tactics of treatment, detection and prevention of complications.

[Cholecystitis as a complication of typhoid fever]

The problems of chronic infection, pertaining to typhoid fever, with main complication as an acute and chronic cholecystitis, were addressed. The main method of chronic cholecystitis treatment, pertaining to typhoid fever, is cholecystectomy with consequent speciphic treatment using various routes of the drug introduction.

[Experimental and clinical grounds for using 30% solution of ethyl alcohol for chemical denervation of the gastric acid-producing zone]

Experiments were performed in 18 male rats followed by a histological investigation of the obtained material. The application of the 30% solution of ethyl alcohol was proved to cause irreversible dystrophic alterations of nerve fibers in the gastric wall when injected subserously and there were no irreversible destructive alterations in other organ tissues. Results of treatment of 82 patients with perforated pyloro-duodenal ulcers after suturing the perforated opening in combination with chemical denervation of the gastric acid-producing zone with 30% solution of ethyl alcohol injected subserously were analyzed. Reliably decreased acid-proteolytic activity of the gastric body was found to result in stable remission and low percentage of recurrent diseases. The method can be recommended for wide practical use due to its simplicity and low percentage of recurrences of ulcer disease of the duodenum against the background of preserved helicobacteriosis of the stomach.

[Synthesis of eicosanoids in the colonic mucosa in patients with ulcerative colitis]

The synthesis of cyclooxygenase (CO) and lipoxygenase (LO) metabolites of arachidonic acids, such as prostaglandins (PG) E2, F2 alpha, 6-keto-P1 alpha, thromboxane B2 (TB2), leukotriene B4 (LTB4) and hydroxyeicosatetraenic acids (HETEA) in the biopsy specimens of the colonic mucosa (CM) was studied in vitro in 30 patients aged 17-66 years who had ulcerative colitis (UC) of various severity and extent. The biopsy specimens of CM from 10 patients with the irritable bowel syndrome were used for comparison. A proportional severity of the disease and increased synthesis of CO and LO metabolites in CM was ascertained in a phase of UC. In the early phase of clinical remission (on the average, following 4 weeks of therapy), there was a comparative reduction in the level of eicosanoids with the preserved high production of TB2 and LO derivatives (LTB4 and HETEA). At the same time, in patients with severe UC, a higher synthesis of LTB4 and HETEA and PG was preserved. The predominance of CM production of eicosanoids having aggregative, vasoconstrictor, and proinflammatory effects (less coefficients of 6-keto-PGF1 alpha/TB2 and PG/LTB4 + ETEA), which had been detected in a phase of UC exacerbation, was preserved in a phase of remission development, by forming the metabolic basis for recurrence of the process.

[Microhemodynamics and energy metabolism in schizophrenia patients]

An apparent disturbance was revealed in microhaemodynamics of patients diagnosed as having schizophrenia (n = 210) which was more pronounced in continuously progredient form of the above medical condition. An increase in conjunctival indexes, polymorphic character of capillaries, decrease in numbers of capillary loops were revealed by biomicroscopy of the bulbar conjunctiva and capillaroscopy respectively. The patients showed lowering of ATP level and rise in the content of cathodic LDG4-LDG5 fractions, accumulation in blood of lactic and pyruvic acids.

[Antioxidants in the treatment of schizophrenia (the correction of lipid peroxidation processes)]

It was established in the course of 185 schizophrenic patients' examination that intensification of lipid peroxidation (LP) took place in relapses of the disease. It was manifested either in increase of blood serum levels of both malonic dialdehyde and diene conjugates, or in decrease of erythrocytes' resistance to LP mediated hemolysis. Alterations in indices of either spontaneous or induced chemoluminescence were revealed too. LP indices were lower by the end of the treatment in hospital, but remained significantly higher than normal values. Application of antioxidants in combined treatment of schizophrenic patients promoted decrease of LP activity as well as improvement in mental state of patients. LP activity was high in the remission too. Determination of LP indices may have prognostic importance.