ENTEROSORBENTS APPLICATION PRACTICE AT INTESTINAL INFECTIOUS DISEASE

S.M. KASUMOVA

Azerbaijan Medical University, Baku, AZERBAIJAN

Growth of polyresistance of microorganisms to antibiotics and chemical medicines makes actual search of the alternative effective ways of therapy of the acute enteric infections (AEI). In respectable clinical researches it is defined that at AEI of the invasive type of diarrhea (a salmonellosis, shigellosis, etc.), in pathogenesis of which adhesion, cytotoxic action of activators and endotoxicoses have special importance enterosorbents unlike antibacterial preparations, render fast and bright desintaxicational hypothermal and anti-diarrhea clinical effect. Thus, because of sorption and elimination of competitive pathogenic and conditionally pathogenic microflora (CPM) from intestines enterosorbents have no negative impact on intestines microbiocenosis. It is possible to assume that use of enterosorbents in AEI treatment since first days of disease for the account of sorption of exotoxin pathogenic bacteria can prevent development of heavy complications. We held research with inclusion in complex AEI therapy of the invasive type of diarrhea enterodes enterosorbent - low-molecular colloid solution for enteral administration. The preparation is capable to connect the toxins formed in an organism and the toxic substances from out as well as to deduce them throughout intestines. The medical effect is obvious in 15-30 minutes after reception. Before use 5 g of powder should be dissolved in 100 ml of boiled water and one should drink 30-100 ml of the prepared solution 1-3 times a day during 2-7 days (before disappearance of symptoms of an intoxication). We observed 60 sick persons – 22 of them with light and 48 with middle complicated forms of AEI aged from 3 month up to 3 year; 40 patients of them as a part of complex therapy received enterodes as means for monotherapy (20) or in combination with İnterix (20). Etiological diagnosis has been deciphered at 19 (31,7 %) patients: 2 – with shigellosis of Sonne and Flexner, 6 – with salmonellosis and 11 - with etiological the factor caused by CPM representatives (blue pus pin, campylobacter and proteas). It is defined that “etiotropic” monotherapy by enterosorbents is more effective than treatment by İntetrix only, and it raises essentially at their joint utilization in treatment of middle complicated forms of AEI of a bacterial etiology of the invasive type of diarrhea. The held researches revealed higher antibacterial activity of enterosorbents which promotes sanitation of stomach intestines tract from pathogens and also can render mediated immune modeling action for the account of detoxication and prevention of an antigene overload of immune system. All above mentioned create favorable conditions for knocking over infectious process. In the conclusion it is possible to confirm that at infectious intestinal diseases enter-sorption is pathogenetically proven way of therapy.

A PATIENT WITH ACUTE LIVER DAMAGE DUE TO PERICARDIAL TAMPONADE CAUSED BY PERICARDIAL MEZOTHELIOMA

O. KESKİN, M. BEKTAŞ, D. MENEKŞE GEREDE, A. TÜZÜN, G. KUMRU, G. KILIÇ, G. PAÇACI, B.ÖZTÜRK, Ö. GERÇİK, A. REŞİT BEYLER, K. BAHAR

Introduction: A wide variety of conditions may result in acute liver injury. Acute pericardial tamponade which is caused by fluid accumulation in pericardial sac can cause rapid deterioration in liver function. Pericardial mezothelioma is a very rare tumor and very few cases have been reported in the literature so far. Pericardial mezothelioma causes pericardial thickening and fluid accumulation between pericardial layers. In our case a patient with acute liver failure due to pericardial tamponade caused by pericardial mezothelioma will be notified.

Case: 55 year old male patient was admitted to the emergency department with complaints of nausea, dizziness and weakness. At admission, there was no pathologic findings except cyanotic appearance on his physical examination. The patient did not have any predisposing factors or chronic liver disease and denied consumption of any medication, alcohol, operation, blood transfusion or substance of abuse. Blood tests showed ALT:1924 (referance values:<45 U/L), AST: 1714 (<41 U/L) and total bilirubin:3.3 mg/dl, direct bilirubin: 1.5 mg/dl, INR:1.92 and PT:20.4 second. On the second day of his admission, the patient developed respiratory distress, hypotension and agitation. Hepatic veins and inferior vena cava was widened on abdominal USG which were totally normal on first day. IVC diameter was measured as 31 mm. Massive pericardial effusion was reported on echocardiographic examination. Emergent pericardiosyntesis and subtotal pericardiectomy was performed. After pericardiosynthesis, the patient’s clinical condition improved dramaticilly and cyanotic appearance disappeared. 10 days after pericardiosyntesis liver damage tests returned to normal. Pericardial biopsy was consistent with pericardial mesothelioma. On post-operative period, patient had no complication and his clinical condition resolved completely.

Discussion: Acute liver damage is characterized by sudden elevation in liver damage tests in individuals without any known liver disease. Etiologic factors vary between countries but this clinical picture often develops due to viral and toxic causes. Acute pericardial tamponade is a rare cause of acute liver injury. In our case, acute liver damage was due to acute pericardial tamponade and liver damage tests and patient’s clinical status returned to normal by appropriate treatment of pericardial tamponade. Primary malignant pericardial mesothelioma is an extremely rare tumor. Although cardiac tamponade is a well-known complication of this malignancy, it is uncommon as the initial manifestation.

Date: 2014-12-28; view: 1286