TREATMENT AND DIAGNOSTIC APPROACH IN SMALL HEPATIC CYSTS
İ.G. AHMEDOV, A.M. ABDULLAYEV, A.I. GURBANOVA
Dagestan State Medical Academy, Makhachkala, RUSSIA
The diagnostic and treatment approach applied in relatively big echinococcus and nonparasitic hepatic cyst is not always used in cysts of 3-4 cm being significantly frequent discovery in examination of patients.
The aim of held examination was generation of an optimal approach of management of patients having small hepatic cysts.
The examination was based on the material on observation and treatment of 71 patients suffering from echinococcus hepatic cysts of CE1type (upon the classification of WHO) at the size no more than 4 mm from the number of the people at the age of 10-75 appealed because of parasitic and nonparasitic cysts detected in ultrasound examination: 47 patients that were undergone to medication therapy independently either in the combination with transcutaneous paracentetic method and 24 hours – traditional echinococcectomy after reaching the cysts of the sizes applicable for implementation of such intervention. Optimal parameters of utilization expectant management were elaborated using the method of modeling on the basis of retrospective data of the surgical treatment of echinococcus with hepatic localization of cysts at 877 patients.
Results and conclusion An algorithm of treatment and diagnostic measures was suggested in exposure of small (less than 4 cm) hepatic cysts taking into account complexity of differential diagnosis of the cysts and the possibilities of modern methods of treatment for obtaining optimal results in treatment in minimum costs. Echinococcosis with high-performance differential-diagnostic test was implementation of a trial course of treatment with Albendazol at 1.5-3.5 cm size of the hepatic cyst and in doubtful results of verification. Risen titres of RIFA antibodies and (or) peeling of cuticular covers is predicted in ultrasonic scanning after trial treatment course in echinococcosis. The size of the cyst of 5.-7 sm is presented as the most optimal for implementation of traditional operative intervention in selection of expectant management. Development of presurgical complications is within the framework of statistic errors at these sizes and the term of stationary treatment, specific and non-specific complications and frequency of recurrences doesn’t concede to the indicators of interventions at the big sizes of cysts.
INFORMATION CAPABILITY ON METHODS OF ELASTOMETER AND BIOPSY OF LIVER AT THE PATIENTS SUFFERING FROM CHRONIC VIRAL HEPATITIS
E.V. ALEYNIKOVA, O.G. POLUSHIN
Medical University, Vladivostok, RUSSIA
The indicators of elastometer of liver at the patients suffering from viral hepatitis vary from 2.0 to 76,6 kPa (Glushenkov 2010). Wide spacing of the data of the method impedes their clinic interpretation. Diagnostic exactness of the identification of hepatic fibrosis in the elasticity value more than 14 kPa is 82.6% (Fontana, 2002; Friedvan, 2003).
The aim of real work was studying of interconnection of data of elastometer and the results of morphologic examination of hepatic biopsy materials at the patients suffering from chronicle viral hepatitis (CVH).
Materials and methods: 18 patients suffering from CVH have been examined in the stage of virus replication (12 men and women, mean age 35±11), eleven patients out of them suffered from hepatitis C and 7 out of them suffered from chronicle viral hepatitis B. The diagnose was made on the basis of a complex clinic-laboratory and instrumental examinations including examination of patients by the apparatus «FibroScan» and morphological examination of hepatic biopsy materials obtained by the method of percutaneous hepatic aspiration.
Results: According to the results the elastometer of the indicator of elasticity of liver varied from 3.8 to 14.3 kPa. Fibrous changes were registered at 15 patients, initial fibrous changes of hepatic parenchyma (F1) were detected at 9 cases, fibrous changes were characterized as moderately apparent (F2) at 4 patients and severe hepatic fibrosis was revealed at two patients (F3-4). According to the results of hepatic biopsy, fibrous changes of liver were registered at 11 patients, 10 out of them had morphologic symptoms of the initial fibrosis (F1), fibrous changes of one patient had a moderately apparent character (F2) at one patient. Thereby, sensitivity of elastometer method in diagnostic of hepatic fibrosis at patients suffering from chronic viral hepatitis was 72.2%. Maximum number of divergence of data of elastometer and hepatic biopsy was observed at the patients having biochemical activity to the pathological processes.
Conclusion: Elastometer at the patients suffering from CVH allows to implement noninvasive diagnostics of hepatic fibrosis, it may be applied as a screening test, as well as for monitoring in the process of antiviral therapy and at the stage of regular medical check-up of the patients, but “golden standard” of diagnostics of CVH is the method of morphologic examination of hepatic tissues.