THE PERSPECTIVE DIRECTIONS TREATMENT’S OF NONSPECIFIC ULCERATIVE COLITIS
Scientific Center of Surgery after named akad. M,A,Topchubashev, Baku, AZERBAIJAN
The nonspecific ulcerative colitis (NUC) — one of the most urgent problems of the modern gastroenterology. NUC – chronic disease of a colon of the inflammatory nature, characterized serious diffusive ulcerative-destructive changes of a mucosa of direct and colonic intestines, with a relapsing or continuous current, a lesion of its mucosa accompanied by development of hemorrhages, ulcers, pyogenic in a colon, usually characterized by a progressing current and complication. NUC it is extended mainly among the population of industrially developed countries. In the USA and Canada, the European Union countries prevalence of disease in adult population makes from 40 to 117 on 100 000 population. Across the CIS countries prevalence NUC makes 70-150 diseased on 100 000 population. The youth at the age of 15-40 years falls ill and older persons are more senior 60 years. At children NUC develops rather seldom, making only 8-15 % from disease of adults. The urgency of a problem of NUC isn't subject for today to doubt, considering variety of mechanisms of development of disease, and also insufficient efficiency of used agents of medicament’s correction that leads frequently to development of serious complications and proof physical inability of the patient. The question on causes of illness remains till now opened. There are various theories of occurrence NUC: virus, genetic, and also influence of various allergic reactions owing to which there are antibodies to elements of a mucosa of a colon; defect of protection of a mucosa – disturbances of its integrity owing to slime destruction by bacterial sulfatases; appendix communication (appendectomy till 20 years is considered the protective factor for NUC). The genetic predisposition role is unequivocally proved. Psychological factors can play a role in occurrence of an exacerbation of disease. The definitive diagnosis is put only on the basis of a colonoscopy with the subsequent histological research a bioptates mucosa and clinical disease, biochemical analyses of a blood also. The basic preparations used for treatment NUC, there are preparations of 5-ASA, corticosteroids and cytostatics. Salazomedicines are used at all forms and types of current NUC. Considering that sulfonilamid’s the component is regarded as the main source of collateral affects, and also that wide application 5-aminosalicylic acids is interfered by its instability, now are developed the form of release of a preparation with the special sheeting is developed, capable to be blasted at certain pH-medium, there by promoting achievement of a preparation of certain departments of an intestine ("Asakol" containing 400 mg 5-ASA, is supplied by an acrylic covering which is blasted at ðÍ from above 7, i.e. the preparation can reach an ascending intestine; "Salofalk" containing 250 mg of active substance, is protected, besides an acrylic covering, a semiimpenetrable cover from ethylcelluloses. They are blasted at ðÍ above 5,6, i.e. their action is limited to distal departments of a small bowel; "Pentasa", bagged in a cover from ethylcelluloses, is dissolved in a colon). Antibiotics prescribe in case of joining of a secondary infection, presence of purulent complications. Especially antibacterial therapy is shown at suspicion on a toxic megacolon. Ciprofloxacin, metronidazole, ornidazole, cephalosporins of a wide spectrum of action, Amikacinum are thus most effective. At obvious unsuccessful therapy by all other preparations, immunosuppresses, such as 6-merkaptopurin or Azathioprinum can be used. Some authors recommend to apply at NUC a recombinant preparation infleximab, representing humeral monoclonal IgG-antibodies to the TNF – α. In particular there is data about revealing that people who are in long remission at NUC have the raised level of prostaglandin D2 which has been taped earlier for recover and maintenance of remission at laboratory rats at NUC. The given opening can lead to a new direction in treatment NUC. Surgical treatment can be demanded in case of rupture of a wall of an intestine, a massive bleeding, narrowing of a lumen of an intestine with the phenomena of intestinal impassability, occurrence of a colorectal cancer. NUC is a serious illness with difficult, in many cases the mechanism of development. Some directions of medicine are engaged in studying of the true reasons of occurrence of this disease and search of new perspective methods of its treatment at once: gastroenterology, immunology, molecular biology, genetics, surgery, pharmacology.
GENETIC CHANGES IN COLORECTAL CANCER AND PRETUMOR DISEASES OF THE COLON
Moscow State Medical and Dental University, SRI of Physico-chemical medicine, CCH No 2. named after N.A.Semashko “Russian Railways” JSC, Moscow, RUSSIA
Purpose: Identification of more informative somatic mutations leading to the development of sporadic colorectal cancer (CRC) and determination of their significance for differential diagnosis of tumor process.
Materials and methods: The analysis of somatic mutations of APC, K-ras and p53 genes in biopsies of the colon (C) in patients with colonic adenocarcinoma (n = 24), patients with adenomatous polyps of colon (n = 37), hyperplastic polyps of C (n = 17), inflammatory intestinal diseases (n = 69) and patients of the control group (n = 25) by methods of sequencing and MALDI-TOF minisequencing.
Results: 50 pathogenic variants of somatic mutations were characterized, 13 of them were not previously described. Potential diagnostic sensitivity for the identification of colonic tumors in the identification of mutations in all three genes constituted 58% [95% confidence interval, 47% -69%], with 100% specificity of the method. It was shown that combination of APC and K-ras genes, is optimal for revealing the fact of a tumour (56%sensitivity [95% CI, 45% -68%]). At the same time, there was demonstrated a statistically significant difference in the frequency of p53 gene mutations in patients with adenocarcinomas and patients with benign colonic tumors (p = 0,02).
Conclusions. High specificity and sensitivity in the identification of somatic mutations in the k-Ras, p53 and APC genes. The role of each gene in the development of systems of early detection of CRC was determined. Relation of identification of mutations in TP53 with more late stages of oncologic process in the colon was shown.
INFLUENCE OF USE OF ANSP DURING ABDOMINAL OPERATIONS ON THE FUNCTIONAL ACTIVITY OF THE HYPOPHYSIS – ADRENAL GLAND
F.E.ABBASOV, H.F.HUSEYNOV, F.J.HASANOV, S.RAHMANI
Scientific Center of Surgery named after acad. M.A. Topchubashov, Central Hospital of SCC, Baku, AZERBAIJAN
Introduction. Although the use of anti-inflammatory nonsteroid preparations (ANSP) in the process of surgical treatment, their anti-stressor effect, is a widely discussed subject in the literature, there are still serious differences in relation to a number of aspects of the issue. As the settlement of the problem is of great scientific and practical importance, we set a goal to study the influence of the use of ANSP during abdominal operations on the intensity of hormonal response to surgical aggression of the organism.
Materials and methods. 25 patients that underwent open and laparoscopic surgery because of abdominal surgical diseases were before the intervention intravenously injected 100 mg of Ketonal solution, and on the 1st and 2nd post-surgical days, rectal suppositories(Voltaren 50 mg) were used each 8 hours (main group). The influence of the use of ANSP during abdominal operations on the intensity of hormonal response to surgical aggression of the organism was assessed based on changes in the level of ACTH and cortisol in blood (in 16 patients) and in the content of 17-OKS excreted with daily urine (in 9 patients). Obtained results were compared with the control group (in 22 patients).
Results. It was observed under the influence of surgical aggression, the content of ACTH and cortisol in the blood of patients of the control group increased from 30,3±2,18 to 57,4±3,55 nq/l (89,4%) and from 551,5±36,8 to 1185,6±65,8 mmol/l (2.1 times), respectively, whereas, in patients in which ANSP was used, the increase had more soft character - from 34,8±2,16 to 49,3±2,86 nq/l (41,7%) and from 568,3±38,5 to 967,2±42,9 mmol/l (70,2%) respectively (P<0,001). As a logic result of this, immediately after surgical invervention and in the 1-2nd and 3-5th post-surgical days low content of ACTH in the blood of patients entering the main group in comparison with the indicator same stage of the control group, 16,4%, 15,0% and 21,2% (P<0,02), respectively, and low content of cortisol in the blood of patients entering the main group in comparison with the indicator of same stage of the control group - 22,5%, 17,7% and 22,8% (P<0,01), receptively, and low content of 17-OKS excreted with daily urine, allows to state that the use of ANSP has powerful anti-stressor effect.
Conclusion. Use of ANSP during abdominal operations decreases intensity of hormonal response of organism to surgical aggression and significantly weakens functional tension on hypophysis – adrenal gland system.
OCCURRENCE RATE OF ANOMALIES OF OUTLET OF CORONARY ARTERIES FROM THE AORTA
E.F. ABBASOV, S.S. MANAFOV, B. SOHRABI, F.Z. ABDULLAYEV
Scientific and Surgical Center named after M.Topchubashov, Baku, AZERBAIJAN
Heart Center named after Shehid Medeni, Tebriz, IRAN
Introduction. Anomalies of outlet of coronary arteries (CA) from the aorta, usually do not create clinical symptomatology and are detected as accidental diagnostic finding. However, in extreme cases, especially, during “open heart” surgeries, the study of the problem is paid special attention.
Materials and methods. In 2007-2009, at Shehid Medeni and Imam Rza hospitals of Tebriz University there was carried out retrospective analysis of archive materials about 6065 persons that passed coronary angiographic examination, in 74 persons (1,22%) there were detected up to 10 various variants of anomalies of outlet or coronary arteries (CA) from the aorta. Patients, in which at the same time with congenital heart diseases there were detected coronary anomalies, were not included into clinical materials.
Results. In more than half of 74 patients (53,2%) in which anomaly of outlet of CA from aorta was revealed there was observed outlet of LAD and LCX from left coronary sinus through free hole (42 persons), in 11 patients (13,9%) – outlet of LCX from right aortal sinus, in 6 persons (7,6%) - outlet of LCX from right coronary artery, and other 6 persons (7,6%) outlet of RCA from left aortal sinus, and in 3 patients (3,8%) – outlet of left coronary artery from right aortal sinus. Among relatively less occurring coronary anomalies, I and II type single coronary arteries were observed in 2 (2,54%) and 1 (1,27%) patients, respectively, outlet of all the three coronary arteries from right coronary sinus was observed in 1 (1,27%) patient, in 1 (1,27%) - double LAD, and in other 1 (1,27%) patient double LCX was revealed. In cardiosurgical patients, early detection of anomalies of outlet of CA from aorta is of great clinical importance. Although during aortal-coronary bypass operations, presence of such anomalies does not create serious problems, during closing operating of aortal defects they may lead to dangerous complications. Thus, if in case of unawareness of a surgeon about starting of LAD and LCX from left aortal sinus or of LCX from right coronary sinus with free hole during selective antegrade cardioplegia or suturing of fibrous band, the surgeon misses such holes, this may lead to critical ischemic damage of the zone fed by the veseel.
Conclusion. Before the operations planned for aortic closure defects, it is recommended to carry out coronary angiography of all the patients for early detection of anomalies of outlet of CA from aorta or other coronary pathologies.