The research objective is to study the effectiveness of different methods of immunostimulation in surgical patients with peritonitis and thrombohaemorrhagic syndrome.
Materials and methods. Immunological researches were conducted on 100 patients with diffuse peritonitis and developed THS: at entry - stage I, 3rd -5th days - stage II and the 7th -10th days - stage III. On 30 patients out of the above aimed at immunostimulation preparation immunofan (50 micrograms intramuscularly, once a day within 7-10 days), on 20 patients helium neon low-intensity laser irradiation (LILI) of blood, and on 30 patients immunofan + blood LILI was included in peritonitis intensive therapy complex. The control group consisted of 20 patients at whom immunostimulation was not peformed. LILI with a wavelength of 0.63 micrometer was carried by intravascular light conductor, using Alok-1, just 10 days, at the beginning for 5 minutes duration and then daily increasing the exposure for 1-2-minutes and bringing it up to 10 minutes. Indicators characterising cellular and humoral links of immunity and also phagocytosis were defined to assess the immune system condition. Results and discussion. Condition of preoperative immune status of patients with peritonitis and THS was determined by weakening of cellular immunity and compensatory rise in humoral activity of the immune system. It was found that in patients with peritonitis and THS there develops combined secondary immunodeficiency, characterized by pathological changes in phagocytosis system, humoral and cellular links of immunity, which requires the introduction of immunostimulants in the complex therapy. For 5-10 days of monoimmunostimulation both by immunofan and LILI there was observed activation of factors of nonspecific resistance; and the relative number of lymphocytes, cells with the phenotype CD3 +, CD4+ increased . However, the use or immunofan or LILI separately though helped to reduce the activity of the marker CD95 +, but this indicator did not get even to the upper limit of the norm. Also, further growth in the number of cytotoxic CD8 + cells which may contribute to cell apoptosis with the formation of multiple organ failure was not prevented. In view of the slowness and insufficient marked effect of both monoimmunostimulation methods it was decided to perform a combined (LILI + immunofan) immunostimulation in a separate group of patients. Combined immunostimulation comprising intramuscular introduction of immunofan + intravascular irradiation by helium neon laser was found to be more effective in comparison with monoimmunostimulation only by immunofan or laser irradiation and led to earlier immune correction starting from 5th day, which was confirmed by increase in number of lymphocytes, CD3 +, CD4 +-cells, the level of phagocytosis and CD19 + in 1.2 - 1.3 times (p<0.05).
CLINICAL AND MORPHOLOGIC PROPERTIES OF IN SITU THYROID CARCINOMA (C-R IN SITY, G0)
İ. HASANOV, R. ZAMANOV, N. ALIYEVA
Scientific Surgical Center named after M.Topchubashov, Azerbaijan Medical University, Baku, AZERBAIJAN
Introduction.Despite that in-situ thyroid carcinoma is found in 6.0–18.0% of the materials of surgical intervention, it was not sufficiently studied from clinical, ultrasonographic and morphologic points of view, and certain diagnostic criteria were not systemized.
The aim of the investigation.To improve diagnostic algorithm of the occurrences of in-situ thyroid carcinoma (c-r in situ, G0) by means of retrospective analysis.
Materials and methods.Data of 96 patients postoperatively examined in 1999-2009 for “in-situ thyroid carcinoma, G0” were exposed to systematic statistical correlation analyses (p; r; c², P=0,95).
Results.Specific diagnostic criteria were not revealed at the preoperative stage. The following are approximate (tentative) parameters: the age under 14; the age higher than 50; with insulin-dependent diabetes, cysts of ovary, endometriosis, oncopathology of mammary glands in the anamnesis; and ultrasonographically detected –mixed type venous unclear hypoechoic area or node; cytological detected –hyperchromatic, polymorph epithelial cell masses and higher than 4,0‰mitosis activity of thyroid epithelium.There is no statistically reliable relation between previously conducted conservative treatment based on the blood group, rhesus-factor, number, sizes of nodules in the organ, ultrasonographi chyperechogenicity (calcified focuses), “thyroid panel” figures of blood, thyroid pathology of patients and opinion of postoperative morphologic analysis. “Follicular adenoma with severe dysplasia and restricted atypia” was mostly given postoperative opinion (72 patients; 75,0%). Signs of “follicular hystoarchitectonic diffuse enlargement and nodular mass of the organ ” are in statistically valid correlation with “in-situ cancer; G0” (r=0,59; p<0,04; c2=66,9). Strumectomy was carried out inin 52 patients (54,2%), partial resection of the organ – 20 (20,8%), hemithyreodectomy together with throat part – 12 (12,5%), subtotal resection because of multinodular goiter and diffuse-nodular enlargement – 10(10,4%) and total thyreodectomy without lymphodissection – 2 patients (2,1%). Manifestative cancer was observed in 11 patients (11,7%) within 3.0–14.0 months after 94 surgical operations carried out without removing a part of the organ. The fact may be connected with both inadequacy of the diagnosis, and unstudied mechanisms of thyroid carcinogenesis.
Conclusion.Thus, it is necessary to improve preoperative diagnostics of in-situ thyroid carcinoma (C-r in-situ, G0) and to study preoperative strokes of thyroid carcinogenesis with cancer in situ by means of more informative methods.