BILE-EXCRETING SYSTEM

L.S. ASLANOVA, M.P. RUSTAMOVA, V.A. HIDAYATOVA, KH.N. GASANOVA

Scientific Surgical Center named after M.A.Topchubashov, Baku, AZERBAIJAN

Biliary tract pathology is an urgent problem of modern medicine. The clinical course of diseases of the biliary system are often accompanied by various functional disorders of the colon.

Objective of the investigation: to study the state of the colon during the diseases of the biliary system.

Materials and methods: radiologic, endoscopic, morphologic and laboratory studies were conducted in 162 patients with diseases of the biliary system of which 80 patients were with - chronic non-stone cholecystitis, 27 - calculous cholecystitis, 36 - biliary dyskinesia, and 19 – had cholecystectomy.

Results of the investigation allowed to find various violations of the morphofunctional state of the colon in 119 (73.7%) patients. The changes occurred in movement disorders of the colon - 35 patients, proctosigmoiditis of various degrees of manifestation - 71 patients. 13 patients had changes in the type of erosive and ulcerative proctosigmoiditis. 1^st group - 85 persons - 71.4% - symptoms of intestinal lesion: pains in the intestinal tract, constipations or diarrheas, flatulence, pathological colonic secretions. 2^nd group - 34 people - 28% - no clinical disorders of the colon were detected. 2^nd group patients mainly had changes in the type of chronic proctosigmoiditis (64.7%). Irritable colon syndrome, without morphological changes generally in whole group was observed in 22.4% of patients, and often accompanied functional disorders of the biliary system. Erosive proctosigmoiditis was found in 12.9% of patients whose underlying disease was calculous cholecystitis. Accompanying changes of the colon in 2^nd group patients were usually expressed by hyperkinetic and hypotonic type dyskinetic disorders - 47%, in the majority of cases with the presence of similar changes in bile ducts, chronic proctosigmoiditis was observed in 46.8% of patients, and was equally often observed in patients with chronic non-stone and calculous cholecystitis and biliary dyskinesia. Latently erosive proctosigmoiditis found in 6.2% of patients with calculous cholecystitis is of particular interest.

A CASE OF APPLICATION OF PROLONGED COURSE OF EXCHANGE PLASMAPHERESIS IN A PATIENT WITH DYSFUNCTION OF THE LIVER TRANSPLANT

I.E. BAYRAMALIBEYLI, I.N. SOLOVYEVA, A.A. RAHIMOV

First Moscow State Medical University n.a. I.M. Sechenov, Moscow, RUSSIA

The aim of the study was to determine the effectiveness of plasma exchange in patients after liver transplantation, development of optimal treatment of plasmapheresis, adequate replacement therapy. Patient K., 47, suffering from Wilson-Konovalov's disease at the terminal stage, were conducted orthotopic transplantation of the right lobe of the liver. The postoperative period was uneventful, there was a satisfactory functional recovery of the transplanted organ. Immunesuppression was carried out in the mode of standard three-component therapy (sandimmun, glucocorticoids and azathioprine). 5 months after the operation, there were observed clinical and laboratory signs of transplant dysfunction: an increase of total bilirubin content up to 667 micromol/l, direct bilirubin to 484 micromol/L, AST up to 127 u/L, ALT 162 u/L, AP - 1712 u/l, GGT - 333, hypoglycemia up to 2.8 mmol/l. There was observed decrease in the protein- synthetic function of transplanted organ: content of total protein - 5.3 g/l, albumin - 2.8 g/l. Clinical and instrumental examinations confirmed the presence of cell-hepatic dysfunction with symptoms of cholestasis. There was started treatment aimed at restoration of transplant function and detoxification. Within 3 months the treatment program included prolonged course of exchange plasmapheresis (PA) - 17 PA procedures, which were held at intervals 1-3 times per week. The volume of plasma exfusion per session -1000-1300ml (1120 ± 53) - 50-65% of the estimated VPC. Totally amount of given plasma constituted 19 890 ml of plasma (about 10 estimated VPC amounts) with mandatory replacement during each session of donor FFP (2-3 doses), 10% albumin solution 200-400 ml, 10% glucose solution. There was observed good tolerance of procedures and achieved positive dynamics of clinical manifestations (skin itching and phenomena of hepatic encephalopathy decreased), laboratory parameters. The selected mode of infusion-substitution therapy allowed to normalize the total protein content / albumin in the plasma of the patient. Thus a course PA in extended mode allows to arrest symptoms of transplant dysfunction, improve the clinical course and thereby increase the period of waiting of retransplantation of liver.

Date: 2014-12-28; view: 984