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CYTOKINE STATUS IN PATIENTS WITH ACUTE CALCULOUS CHOLECYSTITIS

 

J.N. HAJIYEV, E.G.TAGHIYEV, A.G.GUSEYNALIEV, N.J.HAJIYEV

Azerbaijan Medical University, Baku, AZERBAIJAN

 

Taking into consideration that the study of the concentration of cytokines in various pathological conditions is at present of great importance, the aim of out work was to study the condition of pro-inflammatory TNFa, IFNg, IL-2, IL-6 cytokines and anti-inflammatory IL-10 cytokines in acute calculous cholecystitis (ACC) . The investigation results of 60 patients with ACC at the age of 18-74 were analysed. 18 patients had catarrhal, 14 - phlemonic - and 15 gangrenous form of the disease, and in 13 patients ACC was complicated by mechanical jaundice and cholangitis (CG). The concentration of cytokines was determined by IFA method before the operation. As a control measure, cytokine levels in the blood serum of 12 actually healthy individuals were studied. A comparative study showed that, as a whole, before the operation in all patients as compared to control the level of TNFa increased - 2.6 times (ð<0,001), IL-6 –by 52,7% (ð<0,05), IL-10 – by 19,5%, and IFNg - reduced by 34,7% (ð<0,001), IL-2 – by 44,0% (ð<0,001). Indexes of pro-and anti-inflammatory cytokines ratio TNFa/IL-10 were 2.6 times (ð<0,01) above normal, and the general IL-2/IL-10 ratio of the group was reduced by 95.4% (p 0,001) as compared to control indicators. It shall be noted that the level of TNFa among all the forms of ACC was the highest in patients with catarrhal cholecystitis – 3.1 times (ð<0,001), and lowest in patients with MJ and CG - 2.1-times (ð<0,001). The analysis of the content of anti-inflammatory IFNg cytokine showed that against the background of MJ and CG its level decreased by 18,0% (ð<0,05) as compared to the control. In other forms of ACC concentration of IFNg in blood was significantly lower than in controls. In all the forms of the disease there was observed a decrease of the level of IL-2 in blood serum, however the lowest level of the neurotransmitter was observed in gangrenous form. In all the forms of ACC there was observed increased concentration of IL-6, but highest content (2.6 times ð<0,001) was observed in the phlegmonic form of the disease. Comparative assessment of the level of anti-inflammatory IL-10 cytokine showed that in catarrhal and phlegmonic form of ACC, as well as in patients with MJ and CG there was observed increase in its content as compared to the control. On the contrary, in the gangrenous form of the disease its content decreased by 52.5% (ð<0,001) as compared with healthy individuals.

Thus, the ACC developed against the background of an imbalanced cytokine regulation, and the depth of the imbalance depends on the form of cholecystitis, presence of MJ and CG.

 

CHARACTERISTICS OF INTENSIVE THERAPY IN ACUTE HEPATIC FAILURE AND ACTIVATION OF CIRRHOTIC PROCESS

 

R.A. IBADOV, N.R. GIZATULINA, A.S. ARIFJANOV,

M.M. ABSALOV, N.A. STRIJKOV

 

Republican Specialized Centre of Surgery named after acad. V. Vakhidov, Tashkent,



UZBEKISTAN

 

Purpose of the study: to develop a standard of intensive management of patients with hepatic cirrhosis (HC) after the insertion of a proximal splenorenal anastomosis with the development of acute hepatic failure (AHF).

Materials and methods: Management of 36 patients with AHF in the early postoperative period failure that were performed insertion of proximal splenorenal anastomosis within the period of 2005-2009 in the RSCS named after acad were studied. After the insertion of selective SRA activation of HC was observed in 14% of patients. In 8.77% of cases cholemia and fermentemia reached high figures (bilirubin: total - 101.3+2.3 mmol/L, direct - 52.4+1.9 mmol/L, aspartate aminotransferase -298.3+11.3 nmol/s.l., ALT - 902.0+40.3 nmol /s.l). Causes of AHF included: esophageal bleeding-40.9%, ascites-peritonitis - 40,9%, of which in 68.1% the reason of acute renal failure was the initial functional hepatic failure, the scope of surgical intervention and great amount of blood loss during the operation. In 46% of patients therapy was included HBO.

Results: four-line standard of intensive care was developed:

The first line - treatment of hepatic (mixed) encephalopathy: elimination of “resolving factors”; reduction of formation, absorption of neurotoxic metabolites; influence on activity of inhibitory neurotransmitters. The second line - treatment of syndromes of acute hepatic injury: treatment of syndromes of cholestasis and cytolysis; correction of the hypoglycemic syndrome; correction water-electrolytic disorders; replacement hepatotropic therapy. The third line - prevention and treatment of vital complications of other organs and systems: respiratory failure and broncho-pulmonary complications, cerebral edema, hepato-renal syndrome; coagulopatic bleedings. The fourth line - rehabilitation of patients under the conditions of intensive therapy: treatment of postshunting encephalopathy and edematous-ascitic syndrome.

Conclusions: The use of four-line treatment tactics in all patients with the activation of cirrhotic process and acute hepatic failure significantly revealed considerable improbements of the clinical status of patients with expressed positive dynamics of clinical and biochemical parameters.

 


Date: 2014-12-28; view: 992


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