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CHRONIC HEPATITIS B AND C COINFECTIONA. UYANİKOGLU, F. AKYUZ, B. PİNARBASİ, F. ERMİS, K. DEMİR, M. GULLUOGLU, D. ONEL, M. BOZACI, S. BADUR , Z. MUNGAN, S. KAYMAKOGLU Medical Faculty of Istanbul University, Istanbul, TURKEY Objectıve: Chronic hepatitis B and hepatitis C coinfection is uncommon. In this study we investigated the features of the patients with chronic hepatitis B + C coinfection, followed in our clinic. Materıal-method: Chronic hepatitis B + C patients with positive HBsAg and HCV RNA, followed between 1996 and 2009, were evaluated retrospectively regarding their epidemiologic and clinical features in terms of treatment and follow up. Results: 38 patients (28 males, mean age 50.97 + 12.47, distribution 31 – 76 years) positive for HBsAg and HCVRNA were evaluated. 26 patients (68.4%) were chronic hepatitis, and 12 (31.6%) were cirrhotic. The most frequent comorbid disease was chronic renal failure (5 patients) and 2 patients underwent renal transplantation, 3 patients had hepatocellular carcinoma (HCC). The mean known disease period of the patients was 7.07 ± 5.04 years (1-20 years). In 26 patients (68.4%) HCVRNA was positive, and HBVDNA was negative, in 12 patients they were (31.6%) both were positive. The HCV genotypes of the 19 patients that could be investigated were; 78.8% 1b, 15.8% 1a, and 5.2% genotype 4. The sustained virologic response (SVR) (negative HCVRNA in the 6 th month without treatment) established in all patients was 30%. 30 of the patients had been treated with interferon, and while 8 of the 20 patients (40%) treated with interferon + ribavirin had achieved SVR; 2 of the 10 patients (20%) treated with only interferon had achieved SVR. In a HCV active patient treated with pegilated interferon and ribavirin, acute hepatic attack developed due to HBV reactivation.Conclusıon: In patients with Hepatitis B and C coinfection, the dominant infection is usually hepatitis C. Interferon + ribavirin (most commonly) or else interferon alone used in the treatment of patients with dominant HCV infection, can result in sustained virologic response in one third of the patients. During treatment, exacerbation of hepatitis B may be seen due to the supression of HCV.
CHARACTERISTICS OF SURGICAL TREATMENT OF “FRESH” IATROGENIC INJURY EXTRAHEPATIC BILE DUCTS
S.A. NOVODVORSKIY, A.P. BATISHEV
The frequency of iatrogenic bile duct injury during cholecystectomy ranges between 0.22 - 0.7% (Russia) and 0,66 - 0,86% (Belgium, Holland) and forecasting of the improvement in the results of cholecystectomy is impossible. The aim of the study - to develop practical recommendations for surgeons during the diagnosis of “fresh” bile ducts injuries. Materials and methods. Analyzed the results of diagnosis and treatment of 107 patients with iatrogenic bile duct injuries in 1989-2010. In 89.7% of patients the injury occured during cholecystectomy, of them in 61.7% - in traditional and 28% - in laparoscopic. In 29% of patients, bile duct damage was diagnosed during operation, in 50.5% - in the early postoperative period. 107 patients were performed 116 rehabilitation and reconstructive operations. 37 (34.6%) patients were operated with a “fresh” injury of hepaticocholedoch, restorative operations were performed in 19, 9 patients underwent plastic of the anterior wall of the choledoch, and 5 – were removed the clips, 5 were inserted biliobiliary anastomosis on the Cara drainage. With the diastase of crossed ends of the duct up to 2 cm or more, 7 patients were inserted choledochoduodenostomy, 11 were performed hepaticojejunostomy on the isolated loop of small intestine (by Ru- 6 and by Brown - 5). Results. 33 (30.8%) of 107 patients had postoperative complications - 8 (21.6%) with a “fresh” injury and 25 (35.7%) operated in the late periods after bile duct injury. Mortality in the postoperative period was 7.5%, 2.7% with “fresh” injuries and 8.5% with the bile duct strictures. Conclusions. 1. Continuation of the operation by a surgeon, that damaged bile ducts, is not reasonable because of frequent poor results. 2 Restorative and reconstructive operations in the intraoperative diagnosis of bile duct injury and diagnosis of damage in the early postoperative period, performed by specialized surgeons allow to achieve good results in 76.5% of the operated, as in these cases after the injury there are no expressed inflammation, adhesive-cicatrical processes in the zone of intervention and complications of biliary duct strictures developing at a later stages. . Date: 2014-12-28; view: 781
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