RETROPERITONEAL ABSCESS IN INFECTED PANCREATITIS

V.I. BONDAREV, R.V. BONDAREV, KHOSHAL GUL MOHAMMAD, AL-RIAN SHAHID ASLAM

Lugansk State Medical University, Lugansk, UKRAINE

Introduction: The high frequency of infected forms of acute destructive pancreatitis (ADP), which leads to local and general purulent complications, as well as not declining mortality rates force us to look for new ways of surgical correction of the problem.

Materials and methods: 27 patients with purulent complications of ADP were under observation. Males- 17, females -10 in the average age of 48. Verification of infection was determined by fine-needle puncture (FNP), which was conducted under the USG-guide with Madayag 18-20G needles (Balton), the drainage (FND) of purulent foci was carried out by Pig tail 6F and 9F drainage systems (Balton). In the presence of large sequesters minimal accesses (MA) in the lumbar and iliac areas were carried out.

Results: The indication for their implementation was the presence of fluid accumulations (FA), and in the absence of the latter - the clinical and laboratory signs of infection. We believed that indications for FND were the high rate of re-formation of FA after two or three FNP, the presence of thick, cloudy discharge over the needle. In the presence of FA in two or more affected areas of retroperitoneum (RP) two, three and in one case four drainage systems for a flow lavage were installed.

Conclusions: Fine-needle drainage led to regression of the inflammatory process in RP in about 45% of cases. In the remaining 55% of observations minimal accesses into the lumbar and iliac regions allowed to remove large pieces of detritus and to conduct an adequate drainage of RP. An arrosive hemorrhage from the splenic artery, which required splenectomy, has developed in a patient with the presence of lumbotomic access. Lethal outcomes were not observed.

INDICATORS OF METABOLISM HEPATIC CELLS IN CHILDREN WITH DIFFERENT STAGES OF CHRONIC VIRAL HEPATITIS B

V.G.BULYGIN

SRI of Medical Issues of the North Problems, Siberian Department of RAMS, Krasnoyarsk, Russia

Given the leading role of liver in the metabolism of the body and a very significant reduction in many of its functions in chronic viral hepatitis B, information about metabolic changes directly in the hepatic tissue of patients with different stages of chronicity of the disease is of great interest. The aim of our studies is the identification of lipid composition and activity of enzymes in the hepatic tissues of children with chronic hepatitis B, and the study of metabolic mechanisms of its chronicity.

24 children at the age of 12 and 16 years, with chronic hepatitis B: 14 with the 2nd stage of the process of chronicity and 10 - with the third stage, were examined. In the hepatic tissue, obtained by targeted biopsy (under ultrasound control) there was identified lipid spectrum of cells (phospholipids (PL), cholesterol (CHOL), free fat acids (FFA), triacil glycerides (TAG) and cholesterol esters (CE)) and activity of intracellular enzymes (glucose-6-phosphate dehydrogenase (G6FDG), glycerol-3-phosphate dehydrogenase (G3FDG), lactate dehydrogenase (LDH), NAD-and NADP-dependent isocitrate dehydrogenase (NADICDG and NADFICDG), NAD-and NADP-dependent glutamate dehydrogenase ( NADGDG and NADFGDG), NAD-and NADP-dependent malate dehydrogenase (NADMDG and NADFMDG) and glutathione reductase (GR)).

It is known that changes in hepatic metabolism, caused by increasing severity of chronization of the pathologic process, consist in the following: reduction of the main structural lipids of cells - CHOL and PL, shift of lipid exchange towards accumulation in TAG cells, reducing of enzyme activity and, consequently, reduced synthetic capacity of intracellular metabolism and proliferative capacity of liver cells, as well as decrease in their production of ATP due to the inhibition of reactions of tricarboxylic acid and glycolysis cycle.

Thus, the intensity of metabolic reactions in the liver of children aged between 12 to 16 years, with chronic viral hepatitis B, depends on the stage of chronization of the infection process and at its 3^rd phase deeper injuries of liver cells expressed in the inhibition of the activity of intracellular enzymes and changes of lipid exchange with accumulation of cells in triacilglycerides are observed as compared to the 2^nd stage of injury.

Date: 2014-12-28; view: 866