ANTIBACTERIAL THERAPY IN PATIENTS AFTER SURGERY ON ACUTE DESTRUCTIVE CHOLECYSTITIS

R.A.MAMEDOV, K.M.MAMEDOV, E.M.GASIMOV

Azerbaijan Medical University, Baku, AZERBAIJAN,

Central Distric Hospital, Goychay, AZERBAIJAN

At present, cholecystectomy from mini-access, and an operation of choice in the treatment of patients with acute calculous cholecystitis. The methodology of cholecystectomy from a mini access (according to M.I. Prudkov) has established well in the hospital No. 1 of Baku and CRH of Goychay, where it is applied since 2010. Its less traumatic effect as compared to standard laparotomic operation and easier tolerance as compared with the laparoscopic method (due to the absence of gas insufflated into the abdominal cavity) made it preferable for acute calculous cholecystitis. We consider it especially suitable for elderly patients with a serious comorbidity.

In postoperative period, we consider it optimal to conducting antibiotic therapy through the round ligament of the liver, by means of its cannulation. This provides maximum pharmacokinetics of antibacterial drug to the site of inflammation, decrease of sensation of pain, and quicker restoration of clinical and laboratory parameters of the patient.

We perform cannulation by the end of the operational method (cholecystectomy) before suturing the transrectal operative access. Without removing the fixing ring with a lighter and retractors, round ligament catheterization is performed as close to the liver as possible. To carry antibacterial therapy, 14 patients operated for acute destructive cholecystitis at age of 45-65, were injected through the cannula set in the round hepatic ligament 1000 mg of sefadim dissolved in 5 ml of 0.5% novocaine solution, once daily, as well as mixture of 1 ml of 50% solution of Analgin, 1 ml of 1% Dimedrol solution and 2 ml of 0.5% novocaine solution for the purpose of anesthesia in the postsurgical period. Injection was carried out slowly, the duration of treatment was 4-5 days. Such a method of antibacterial therapy allowed to avoid multiple intramuscular injections and reduced the number of injected drugs (daily dose of sefadim 2000 mg), and accelerated the rehabilitation of patients.

DIAGNOSTIC CRITERIA AND OPERATIONS TACTIC

AT PATIENTS WITH LIVER LIVER ECHINOCOCCOSUS COMPLICATED WITH OBSTRUCTIVE JAUNDICE

A.A. MAMMADOV, E.A. ISKANDAROV, R.Z. EMINOV, R.E. JAFARLI

Scientific Center of Surgery named after M.A.Topchubashov, Baku, AZERBAIJAN

One of the etiological reasons of obstructive jaundice is the rupture the of echinococcus cyst into the biliary tract. The fragments of chitinous lamina and daughter vesicles of the small sizes can pass to the main bile ducts through bilious fistulas in the cyst walls, breaks normal bile flow, that in some cases lead to the further obstructive jaundice. Sometimes, surgeons incorrectly estimate the development of jaundice, thinking about that it may be the toxic influence of parasites to liver tissue. The mistakes in the diagnostic tactics, proceeds during the operation, when the surgical intervention limited with only echinococectomy. In these cases, it will be appear the symptoms of the cholestasis and cholangitis in the postoperative time.

Aim: with analyzing the results of the clinical investigations to develop the diagnostic criteria, which can indicate to the rupture of cysts to the bile tract and to prepare the adequate surgical interventional tactic.

Material and methods: 26 patients with liver echinococcus, which operated in Scientific Center of Surgery, were under observations. Most of patients, first time were operated in another clinics and after with postoperative complications came to our center. Diagnosis was confirmed with ultrasound investigation (USI). Fast in all patients the symptoms of rupture of hydatid cyst into the biliary tract, such as intermittent jaundice, fever, increase of body temperature and others. In preoperative time the patients which have suspicion of the cystobiliar fistula have undergone to magneto resonance tomography (MRT). The MRT results show the symptoms of daughter vesicles in common bile duct. In patients with external bile fistula fistulacholangiography was performed, which indicate the dilatation of biliary ducts upper the obstruction. The blood tests show the increasing of enzymes, such as ALT, AST, Alkaline phosphates and others. In all patients operation were performed. On an occasion of the basic diagnosis Echinococcectomy, sanation and drainage cyst cavity was made. In all patients choledochotomy, revision of the bile ducts, remove of fragments of chitinous lamina and daughter vesicles were performed. In one case we observed, migration of the parasites scolex in to the bile gall bladder and cholecystectomy also was made. The patients in satisfied condition were written out of the clinic without any complains and complication.

Conclusion: on our supervision the cyst which placed in 4. 5. 6 and 8-th liver segments, have higher risk to invasion to the biliary tract. In cases, that after USI we show cysts in 4, 5, 6 and 8 segments and patients which have had in history jaundice, fever, increase of body temperature and others, obligatory will undergone to the MRT. Operation intervention will content the revision of biliary ducts and finished with bilio-digestive anastomose. The anastomose excludes the risk of repeated obstruction of biliary tract, if the hydatid vesicles migrated into the bile ducts small sizes, adequate revision of which is impossibly.

CASCADE PLASMA-FILTRATION AS AN ALTERNATIVE OF TRIPLE THERAPY OF HEPATITIS C

E.N. MAMMADBAYOV, V.D. RZAYEV

Biomed Spectrum, Baku, AZERBAIJAN

The use of efferent methods of treatment in various areas of medicine are well known. They are also relevant in the treatment of hepatic diseases. We tested the method of cascade plasma filtration in two groups of patients. The first group consisted of patients with chronic hepatitis C that started antiviral therapy according to a common pattern: pegylated interferon + ribaverin, the so-called “gold standard”. The second group consisted of patients with absolute medical contraindications to antiviral therapy and patients that who flatly refused to acceptPVT.

In the first group, sessions of cascade plasma-filtration were conducted according to the protocol accepted in Japan, which was drawn up in 2007. In the second group,cascade plasma-filtration was conducted on the background of antifibrotic treatment.

It should be noted that the both groups of patients had expressed viral load, genotype 1, fibrosis of the 3^rd and 4^thdegree, high histologic activity of A2-AZprocess, unfavorable genotypic binding of 28Binterleukin: TT and ST.

All the patients of the 1^stgroup, RNAseronegativation was observed after 4 weeks of treatment with preservation of a subsequent stable viral response.

Almost all patients of the 2^ndgroup had up to 75% decrease in viral load, the level of severity of fibrosis and histological activity of the process also decreased.

Based on the obtained results, it seems reasonable to continue research in this direction, which will allow to comparecascade plasma-filtration – equally effective method of improving response to antiviral therapy – with expensive method of trial therapy, which also has side effects. In patients that have contraindications to antiviral therapy, combination of antifibrotictherapy with the method of cascade plasma-filtration significantly improves the forecasts of life span without the reduction of its quality.

Date: 2014-12-28; view: 999