P115 LAPAROSCOPIC TRANSABDOMINAL PREPERITONEAL (TAPP) HERNIA REPAIR IN DECOMPENSATED CIRRHOSIS

Abstract Aim To evaluate the possibilities, benefits and safety of laparoscopic treatment of inguinal hernias in patients with cirrhosis of the liver and ascites, in particular to evaluate the TAPP approach for the treatment of inguinal hernias in patients with cirrhosis of the liver and ascites. Material and Methods Group I - TAPP repair in 16 patients with liver cirrhosis and ascites. Group II - Lichtenstein type hernioplasty in 15 patients with liver cirrhosis and ascites. All patients underwent planned surgery after dosing preoperative laparocentesis and correction of liver function indices. Results In the first group of patients no complications developed, no suppurative complications were observed, no edema, no leakage of ascites fluid. Postoperatively, all patients recovered well, noticed less pain. Only 25 percent of patients required analgesics. Patients were discharged at home 3-5 days postoperatively. In group II - minor complications were observed: 1 local hematoma, 1 seroma. Postoperative pain syndrome was more pronounced. All patients required analgesics. Duration of hospitalization 4-6 days. During a 10-month follow-up, no patients had recurrence and chronic pain. Conclusions TAPP repair provided the opportunity to assess macroscopic changes in the liver and possibly to perform liver biopsies, if necessary. TAPP repair reduces days of hospitalization and postoperative recovery by reducing pain syndrome with a low percentage of analgesics. TAPP repair can be a useful treatment option for patients with liver cirrhosis accompanied by ascites.

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The Effectiveness Of Quadriceps Strengthening Exercises Combined With Neuromuscular Electrical Stimulation on Patellofemoral Pain Syndrome

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967117s00107 ◽

2017 ◽

Vol 5 (2_suppl2) ◽

pp. 2325967117S0010

Author(s):

Sezen Karabörklü Argut ◽

Nilgün Türker ◽

Derya Çelik ◽

Önder İsmet Kılıçoğlu

Keyword(s):

Electrical Stimulation ◽

Muscle Strength ◽

Neuromuscular Electrical Stimulation ◽

Pain Syndrome ◽

Quadriceps Strength ◽

Patellofemoral Pain ◽

Group I ◽

Strengthening Exercises ◽

Group Ii ◽

And Function

Objective: The weakness of the quadriceps strength in patellofemoral pain syndrome (PFPS) is very evident. Therefore, quadriceps strengthening exercises are very important part of the rehabilitation program. Neuromuscular Electrical Stimulation (NMES) is considered one of the methods for increasing quadriceps muscle strength. To evaluate the effectiveness of combined NMES and strengthening exercises to improve the recovery of quadriceps strength and function in patients with PFPS. Methods: This study was planned as a randomized controlled pilot study. A total of 27 patients (mean age=38.9±10.8 years, range=20-60 years; 16 females) with PFPS were assessed and randomly assigned into 2 groups. Group I received a standard program (quadriceps strengthening, hip strengthening and hamstring stretching) and NMES combined with quadriceps strengthening exercises simultaneously. Group II received the same standard program without NMES. Both groups were enrolled 3 times per week for 40 minutes per day in 6 weeks. Patients were assessed at the baseline, 3 rd, 6th, and 12th weeks of treatment. Quadriceps strength was evaluated by isokinetic dynamometer. The range of motion at testing was set between 0 for extension to 90 for flexion. The test was performed at 60 degrees/sn and concentric maximum peak torque value was recorded. Kujala and Lysholm scores were used for functional assessments. The data were analyzed using the SPSS 20.0. Shapiro-Wilk test was used to assess the distribution of data. The changes in dependent variables before treatment, 3 rd, 6th, and 12th weeks were analyzed using a 2 by 4 mixed-model analysis of variance (ANOVA). Pairwise comparisons with paired t test were used to determine whether the Group I or Group II, has changed over time. An intention- to- treat analysis was performed to impute values for missing data. An alpha level of 0.05 was established. Results: The study was completed with 20 patients. Group I (n=10; mean age=39.4±8.5 years; 7 females) and group II (n=10; mean age=43.2±11.7 years; 5 females) had no differences in pre-operative measures (p>.05). There was significant improvements in within groups statistics of all parameters for both groups (p<.05). No differences in quadriceps strength, Kujala and Lysholm scores between groups were found at the different time points (F= 0.86; p = 0.12, F=0,001; p =0.97, F=0.12; p=0.73, respectively) Conclusion: NMES combined with quadriceps strengthening exercises has no additional effect on PFPS patients’ on muscle strength and function. When considering these results, we believe that there is no need to continue the study in progress. [Table: see text]

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COMPARATIVE EVALUATION OF THE RESULTS OF SURGICAL TREATMENT OF ACUTE ASCENDING THROMBOPHLEBITIS OF THE GREAT SAPHENOUS VEIN USING THE ENDOVASCULAR HIGH-FREQUENCY WELDING TECHNIQUE AND TRADITIONAL TECHNIQUE

Wiadomości Lekarskie ◽

10.36740/wlek202004103 ◽

2020 ◽

Vol 73 (4) ◽

pp. 638-641

Author(s):

Serhiy I. Savolyuk ◽

Valentyn A. Khodos ◽

Roman A. Herashchenko ◽

Vladyslav S. Horbovets

Keyword(s):

Saphenous Vein ◽

High Frequency ◽

Comparative Evaluation ◽

Great Saphenous Vein ◽

Pain Syndrome ◽

Surgical Operation ◽

Electric Welding ◽

Group I ◽

Group Ii ◽

Welding Technique

The aim of the study was to conduct a comparative evaluation of the effectiveness of surgical treatment of acute ascending thrombophlebitis of the great saphenous vein using the endovascular high-frequency welding technique and traditional phlebectomy. Materials and methods: Two groups were formed in the conducted study. Group I included patients (n=42) with the acute ascending thrombophlebitis of the great saphenous vein, in whom their thrombosed great saphenous vein was removed using the endovascular high-frequency welding technique. As a source of current, an EK300M1 Svarmed electric welding machine (Ukraine) was used. Electric welding of a thrombosed vein segment was carried out using the endovenous electric welding catheter. Group II included patients (n=31) with the acute ascending thrombophlebitis of the great saphenous vein, who underwent the traditional phlebectomy of the thrombosed great saphenous vein according to Babcock’s technique. Results: In group I no patient revealed presence of pain syndrome with significant intensity during the postoperative period. An infiltrate along the coagulated segments of the great saphenous vein, postoperative oedema and paresthesiae were observed in considerably fewer cases from group I versus group II (р=0.0005, р=0.0001, р=0.0018). During their follow-up for more than 12 months, 2 (4.76 %) of 42 patients from group I revealed partial recanalization of the great saphenous vein (р=0.632). In group I the postoperative inpatient period was 1.3±0.1 days. In group II the above period averaged 4.8±0.8 days (p<0.001). Absence of an intense pain syndrome in group I was caused by a gentle effect of high-frequency electric current itself on the venous wall and paravasal structures. A significant reduction of side effects and complications with a shorter stay of patients in hospital versus the traditional phlebectomy was achieved owing to reduction in the extent of injury of the surgical operation itself with the use of endovascular high-frequency welding. Conclusions: The technique of endovascular high-frequency welding in treatment of acute ascending thrombophlebitis of the great saphenous vein makes it possible to reduce the extent of injury of the surgical operation versus the traditional phlebectomy, results in a significant decrease in the number of side effects and complications and shortens the period of the patient’s stay in hospital.

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Evaluation of Effectiveness of Immunomodulatory Therapy in Combined Treatment of Patients with Chronic Nonbacterial Prostatitis

Health of Man ◽

10.30841/2307-5090.1.2021.232324 ◽

2021 ◽

pp. 27-32

Author(s):

Volodymyr Trishch ◽

Andrii Mysak

Keyword(s):

Pelvic Pain ◽

Standard Therapy ◽

Chronic Pelvic Pain ◽

Chronic Pelvic Pain Syndrome ◽

Pain Syndrome ◽

Pelvic Pain Syndrome ◽

Group I ◽

Chronic Nonbacterial Prostatitis ◽

Nonbacterial Prostatitis ◽

Group Ii

Among men of working age, chronic prostatitis is the most common urological disease, and its inherent symptoms are a common reason for seeking urological care. To date, there is no single universal successful therapy for chronic prostatitis. Therefore, it justifies the further search for new methods of treatment of patients with this pathology. The objective: the aim of the study was to evaluate the effectiveness of immunomodulatory therapy in treatment of patients with chronic nonbacterial prostatitis with inflammatory chronic pelvic pain syndrome (CP/CPPS (NIH IIIA)). Materials and methods. Under observation there were 78 patients with chronic nonbacterial prostatitis, with inflammatory chronic pelvic pain syndrome (NIH IIIA), with a disease duration of more than 2 years and low effectiveness of treatment on the background of standard therapy. All patients received standard therapy according to the clinical protocol. Some patients (group 58-II) on the background of standard therapy were additionally prescribed Overin (cridanimod sodium salt 250 mg/2 ml in 1 amp.) From the pharmaceutical company “Geolik Pharm Marketing Group” 2 ml intramuscularly once a day every 48 h, 10 injections, followed by a comparative evaluation of clinical results relative to the control group of patients (group 20 – I) who received only standard therapy, immediately after treatment and 6 months after treatment. Results. It was found that the use of standard therapy, Overin, in patients with chronic nonbacterial prostatitis with inflammatory chronic pelvic pain syndrome (CP/CPPS – NIHIII A), contributed to a longer and lasting clinical effect, in contrast to the results in the group of patients who received only standard therapy. According to the assessment of the general condition (S+QoL) in group I of patients after treatment and 6 months after the standard course of treatment, the indicator improved by 38.5 and 30.9 %, respectively (p<0.05). Whereas in group II of patients, the score (S+QoL) after treatment after 6 months was 52.8 % and 49.1 % lower than before treatment (p<0.05). Overin has also been shown to be more effective in terms of the severity of the inflammatory process according to the results of prostate secretion microscopy. Lack of inflammatory activity in the prostate, in the presence of less than 10 leukocytes in the field of view at microscopy of its secretion in patients of group I after treatment was observed in 55 %, after 6 months in 45 % of patients, respectively in group II was in 77.3 % after treatment and in 75 % of patients 6 months after treatment. A more visible positive dynamics of immune status in the second group of patients was obtained. Namely, after treatment, there was a probable increase in IFN-γ in the blood by 29.9 % and a decrease in IL-6 by 2.7 times (in ejaculate by 3.2) while maintaining the visible dynamics compared to input data before treatment after 6 months (p<0.05). Whereas in the blood of patients of group I IFN-γ increased after treatment by only 5.5 % and IL-6 decreased by 24.0 % (ejaculate by 22.9 %). The level of sІgA in the ejaculate of patients of group I after treatment increased by 15.7 %, while in group II by 30.2 % (p<0.05). After 6 months, the studied indicators of immune status in the blood and ejaculate of patients of group I, visibly did not differ from the data in this group before treatment (p>0.05). Conclusions. The use of Overin on the background of standard therapy in patients with inflammatory form of CP/CPPS, contributes to a stable and long-lasting clinical effect, which is confirmed by the dynamics of the obtained clinical and laboratory data.

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A Comparative Study of the Diagnostic and Prognostic Value of Squamous Cell Carcinoma Antigen and Alfa-foeto Protien in Hepatocellular Carcinoma Before and After Therapeutic Intervention

QJM ◽

10.1093/qjmed/hcaa052.028 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

S Abdelhamid ◽

T M Alsakty ◽

H H Radwan ◽

M E Abouelmaaty ◽

A S Allam ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Squamous Cell Carcinoma ◽

Liver Cirrhosis ◽

Cell Carcinoma ◽

Squamous Cell ◽

Prognostic Value ◽

Control Group ◽

Squamous Cell Carcinoma Antigen ◽

Group I ◽

Group Ii

Abstract Background hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide and it is one of the major causes of death, because of its high frequency and poor prognosis. Hepatocellular carcinoma is now a common malignancy in Egypt which usually develops on top of liver cirrhosis secondary to viral infection, as hepatitis C viruses increased the risk of HCC in the Egyptian patients. Aim of the Work was to verify the possibility of using the plasma squamous cell carcinoma antigen level as a tumor marker for hepatocellular carcinoma and to evaluate its prognostic value in management of HCC. Patients and Methods the study included 60 subjects divided into three groups: group I was 30 patients with hepatocellular carcinomas, group II was 15 patients with liver cirrhosis and group III was 15 normal subjects serving as a control group. Follow up of the patients who had HCC and undergone either RFA or TACE will be done after 1 month by measuring serum level of alfa feto protein & SCCA. Results the plasma SCCA level was significantly higher in group I patients (with HCC), than in the group II patients (cirrhosis) and control group. SCCA showed direct significant correlation with the most of laboratory data specially AST, INR, number and size of lesion and its values were decreased after intervention. Conclusion plasma SCCA is a sensitive and specific serum marker for the diagnosis and prognosis of HCC and combination of AFP and SCCA in screening and diagnosis of HCC yielded a better sensitivity in diagnosis of HCC.

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Bacterial DNA and its consequences in patients with cirrhosis and culture-negative, non-neutrocytic ascites

Journal of Medical Microbiology ◽

10.1099/jmm.0.2008/001867-0 ◽

2008 ◽

Vol 57 (12) ◽

pp. 1533-1538 ◽

Cited By ~ 24

Author(s):

Mohammed Mahmoud El-Naggar ◽

El-Sayed Abdul-Maksoud Khalil ◽

Medhat Abdul Massih El-Daker ◽

Mona Fouda Salama

Keyword(s):

Liver Cirrhosis ◽

Molecular Evidence ◽

Necrosis Factor Alpha ◽

Bacterial Dna ◽

Risk Of Death ◽

Group I ◽

Group Ii ◽

Culture Negative ◽

First Admission

The detection of bacterial DNA in serum and ascitic fluid (AF) from patients with liver cirrhosis and ascites is interpreted as molecular evidence of intestinal bacterial translocation (BT) and considered sufficient to activate the cellular immune response leading to greater cytokine synthesis. We studied 34 patients with liver cirrhosis and culture-negative, non-neutrocytic ascites [22 patients without bacterial DNA (group I) and 12 patients with bacterial DNA (group II)]. History and clinical examination were done with the following investigations at first admission and followed up for 24 weeks: serum and AF tumour necrosis factor-alpha (TNF-α), AF polymorphonuclear leukocytes, AF cultivation and detection of blood and AF bacterial DNA. Serum and AF TNF-α were significantly higher in patients with bacterial DNA compared to those without bacterial DNA at first admission [54.5±22.56 vs 35.2±17.97 pg ml−1 (P=0.02) and 123.2±49.32 vs 82.6±29.58 pg ml−1 (P <0.005), respectively]. These changes became highly significant at the end of follow-up of both groups [119.3±27.19 vs 40.2±16.08 pg ml−1 (P <0.001) and 518.8±91.11 vs 97.6±17.81 pg ml−1 (P <0.001), respectively]. In group II, there was a significant increase in serum and AF TNF-α at the end of follow-up compared to at first admission (P <0.001). The relative risk of death, hepatorenal syndrome (HRS) and spontaneous bacterial peritonitis (SBP) was higher in patients with bacterial DNA compared to those without bacterial DNA. We conclude that cirrhotic patients with culture-negative, non-neutrocytic ascites and bacterial DNA have a significantly higher level of serum and AF TNF-α and higher risk of HRS, SBP and mortality compared to those without bacterial DNA, suggesting that bacterial DNA and TNF-α are implicated in these complications of liver cirrhosis.

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AB0797 THE ROLE OF ULTRASOUND CRITERIA IN ASSESSING PAIN SYNDROME IN THE KNEE JOINT IN PATIENTS WITH RHEUMATOID ARTHRITIS AND OSTEOARTHRITIS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.3224 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 1423.1-1423

Author(s):

N. Aleksandrova ◽

A. Aleksandrov

Keyword(s):

Rheumatoid Arthritis ◽

Knee Joint ◽

Synovial Membrane ◽

Pain Syndrome ◽

Synovial Proliferation ◽

Group Iii ◽

Joint Cavity ◽

Group I ◽

Number Of Patients ◽

Group Ii

Background:Pain syndrome and pathological changes in the synovium detected by ultrasound can be early signs of various diseases of the joints [1].Objectives:the use of ultrasound criteria for changes in the synovial membrane of the joint cavity to assess the severity of pain in patients with rheumatoid arthritis (RA) and osteoarthritis (OA).Methods:The study included 36 patients with RA (32 women and 4 men aged 22 to 55 years old) and 38 patients with OA (30 women and 8 men aged 30 to 50 years old) with lesions of the knee joints. A visual analogue scale (VAS) was used to determine the severity of pain. The severity of pain in the knee when walking was at least 40 mm according to the VAS in all examined patients. Joint ultrasound examination was carried out according to the standard technique using a linear transducer with a frequency of 5–12 MHz on an Accuvix V10 ultrasound diagnostic system (Samsung Medison, South Korea). The evaluation of ultrasound changes in the upper inversion of a knee joint was carried out according to the following criteria: the severity of intra-articular effusion (1), synovial proliferation (2), local vascularization of the synovial membrane using power Doppler (3) (Table 1).Table 1.Parameters of ultrasound criteria for assessing changes in the synovial membrane of the joint cavityNormal indicators1 - width of the suprapatellar turn is 6 mm2 - thickness of the synovial membrane is 3 mm (from the anterior approach)3 - lack of vascularization lociMinimum changes1 - delamination of the suprapatellar curl leaves from 7 to 9 mm2 - thickness of the synovial membrane 3.1–4.5 mm3 - appearance of single loci of vascularization (1-2 in the Doppler field)Moderate changes1 - delamination of the leaves of the suprapatellar twist 10-14 mm2 - thickness of the synovial membrane is 4.6–6.4 mm3 - appearance of moderate (> 5) vascularization lociSevere changes1 - delamination of suprapatellar folds of more than 15 mm2 - thickness of the synovial membrane is more than 6.5 mm3 - multiple foci of vascularization (> 5, merging in places)Results:Correlations of various severity were found between pain indices according to VAS and the thickness of the synovial membrane of the knee joint (r = 0.33, p = 0.019) and the number of vascularization foci (rS = 0.29, p = 0.04) in RA patients, as well as between pain according to VAS and the severity of intra-articular effusion (r = 0.28, p <0.002) in patients with OA.The patients were divided into three groups according to the severity of pain in the knee joint: group I - 41-59 mm (12 patients with OA and 9 patients with RA), group II - 60-79 mm (16 patients with OA and 12 patients with RA), group III - 80–100 mm on the VAS scale (10 patients with OA and 15 patients with RA). Group I was dominated by OA patients with minimal changes in intra-articular effusion and local vascularization of the synovial membrane, with moderate synovial proliferation (28.6% of the total number of patients in the group). In group II patients with OA with moderate severity of intra-articular effusion and local vascularization (21.4%) and patients with RA with moderate changes in the thickness of the synovium and local vascularization (25%) were equally common. Group III was dominated by RA patients with severe synovial proliferation and moderate local vascularization (28%), as well as patients with OA with moderate intra-articular effusion (20%).Significant differences in the thickness of the synovium in patients with RA in the first and third groups were noted (H-test = 5.9, p = 0.025).Conclusion:The additional use of ultrasound criteria for changes observed in the synovial membrane of the joint cavity in patients with RA and OA can help predict pain in the knee joint. The manifestation of pain syndrome in patients with OA is most associated with the severity of synovitis in the joint, and in patients with RA - with the severity of synovial proliferation.References:[1]Sarmanova A et al. Arthritis Res Ther. 2017;19(1):281.Disclosure of Interests:None declared

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A randomized controlled study of transinguinal pre peritoneal repair vs Lichtenstein repair for inguinal hernia

International Surgery Journal ◽

10.18203/2349-2902.isj20193350 ◽

2019 ◽

Vol 6 (8) ◽

pp. 2757

Author(s):

Santosh M. Patil ◽

Augusty Dharmapuri

Keyword(s):

Chronic Pain ◽

Inguinal Hernia ◽

Hernia Repair ◽

Controlled Study ◽

Chronic Groin Pain ◽

Inguinal Hernias ◽

Group I ◽

History Of ◽

Study Population ◽

Group Ii

Background: Inguinal hernia repairs are one of most common surgeries performed world-wide. Inguinal hernias are present in 1.7% of the world population.Methods: Total of 100 patients was included in this study with 50 patients in each group. Group I (n=50): patients in this group underwent hernia repair using open preperitoneal mesh procedure. Group II (n=50): patients in this group underwent hernia repair using Lichtenstein procedure.Results: The proportion of patients with left inguinal hernia was higher in group I (48.00%) as compared to group II (46.00%), but this difference was not statistically significant. In overall study population (81.25%) as well as in group I (82.50%) and group II (80.00%) of the study, no history of straining was observed in the majority of the cases. Though the proportion of straining was higher in group I (32.00%) as compared to group II (26.00%), but this difference was not statistically significant (p=0.775). Chronic pain (see Table 4) was found in 28.75% of total patients, though the chronic pain was found in higher proportion of patients of group II (32.0%) as compared to group I (22.0%).Conclusions:In conclusion, this study shows that the TPT provides significant advantages over the Lichtenstein technique in case of repair of unilateral inguinal hernias. Patients in TPT group had less incidence of wound induration and chronic groin pain. They were also able to return to their jobs earlier.

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THE USE OF VARIOUS TECHNOLOGIES IN THE SURGICAL TREATMENT OF DECOMPENSATED FORMS OF VARICOSE VEINS OF THE LOWER EXTREMITIES WITH UNILATERAL VALVULAR INCOMPETENCE OF THE GREAT SAPHENOUS AND ANTERIOR ACCESSORY SAPHENOUS VEIN

Modern medical technologies ◽

10.34287/mmt.1(48).2021.10 ◽

2021 ◽

Vol 48 (1) ◽

Author(s):

O. V. Sokolov

Keyword(s):

Surgical Treatment ◽

Radiofrequency Ablation ◽

Varicose Veins ◽

Pain Syndrome ◽

Ulcer Recurrence ◽

Average Area ◽

Results Of Treatment ◽

Group I ◽

Group Ii ◽

One Year

Abstract Purpose of the study. Comparative evaluation of the results of treatment of patients with varicose veins (VVs) in stage C6, with the valve incompetence of the trunks of GSV and ASSV in one lower limb, by traditional venectomy and radiofrequency ablation (RFA). Materials and methods. The study was conducted on the basis of MI «RCH n.a. І.І. Mechnikov», MNE «CCH №16» DCC and MC «JMC Menorah» from 2010 to 2020 yy. Included 43 patients: women – 29 (67,4%), men – 14 (32,6%). Age - from 29 to 74 years (average – 52,7 ± 10,8 years). Patients are divided into 2 groups. The I group (n = 22) included patients who underwent traditional venectomy of GSV and ASSV, the II group (n = 21) – patients who underwent RFA under local anestesia. The observation lasted 12 months. Results. The average area of ulcers ranged from 1 to 12 cm2. The average area of ulcers in group I was 6,3 ± 3,1 cm2, in group II – 6,2 ± 2,7 cm2. Complete epithelialization of ulcers occurred faster with the use of RFA (group II) – 38,1 ± 5,7 days against 44,7 ± 6,2 days in group I. After 3 months. the number of healed ulcers in group I. was 20 (83,3%), in II – 24 (96,0%). Ulcer recurrence one year after surgery occurred in 4 (5,6%) patients of group I, in group II there were no recurrences. After 6 months the difference between the severity of CVI (VSS) was 10,5 ± 2,8 points in group I and 13,9 ± 2,2 points in group II. Conclusions. 1. Surgical treatment of VVs at unilateral defeat of GSV and ASSV with use of RFA differs in the better profile of a postoperative pain syndrome, less traumatism, has the best indicators of recovery in comparison with a traditional venectomy. 2. Treatment with RFA in comparison with traditional phlebectomy one year after surgery had an advantage in the number of recurrences of trophic ulcers Keywords: varicose veins, venectomy, radiofrequency ablation, trophic ulcers.

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Differential diagnostics and correction of metabolic and immunological disorders in patients with hepatic cirrhosis, complicated hepatosplenomegalia and portal hypertension

Actual problems of modern medicine ◽

10.26565/2617-409x-2019-4-04 ◽

2019 ◽

Keyword(s):

Liver Cirrhosis ◽

Portal Hypertension ◽

Varicose Veins ◽

Clinical Manifestations ◽

Well Being ◽

Differential Diagnostics ◽

Recurrent Bleeding ◽

Group I ◽

Group Ii

The study of the role of the spleen in the pathogenesis of liver cirrhosis is important for treatment. Currently available literature data indicate the role of altered spleen functions in the pathogenesis of liver cirrhosis. The aim of this study was to clarify the features of the etiology and pathogenetic disorders in patients with hepatosplenomegaly. Materials and methods. We investigated the uniform elements of blood and blood serum from 58 patients with hepatosplenomegaly amid cirrhosis, portal hypertension complicated. Patients were divided into two groups depending on the antigenic load: I - patients with liver cirrhosis against the background of hepatitis viruses HBV/HCV and II - patients with autoimmune hepatitis against the background of herpes viruses CMV/VEB. Treatment of patients included the use of antiherpetic immunoglobulins and hematopoietic cord blood progenitor cells. Results. In patients of group I was detected an increase in the spontaneous oxidative activity of neutrophils and depletion of the oxidative reserve in oxygen-dependent phagocytosis. It activated the signaling pathways of pro-inflammatory cytokines IL-6 (an increase of 60 times). We found an increased content of CD22+ -plasma B-lymphocyte that elevated synthesized concentrations of IgA. In patients of group II were found an increase in the activity of C3 and a decrease in the C4-components of complement; thrombocytopenia due to the presence of platelet autoantibodies; increased synthesis of immunoglobulins IgM, IgG, increased synthesis of IFN-. All patients showed disturbances in the metabolism of amino acids in various metabolic cycles - ornithine, which disrupted the formation of urea and indicates the accumulation of ammonia, which can enhance the cytotoxic effect in group I; methionine with a violation of the formation of cystine from cysteine and the accumulation of homocysteine, which enhances the synthesis of IFN-γ, which was increased in group II by 4 times. Conclusions. Some etiological and pathogenetic features of the formation of liver cirrhosis complicated by portal hypertension and recurrent bleeding from varicose veins of the esophagus were revealed. The immunological and metabolic changes verified by us correlated with the disappearance of the clinical manifestations of the disease, improved well-being, and the absence of recurrence of bleeding.

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Hepatosplenomegaly in liver cirrhosis is caused by reactive oxygen species formation, an increase in apoptosis and autophagy, and pronounced autoimmune reactions

Regulatory Mechanisms in Biosystems ◽

10.15421/022156 ◽

2021 ◽

Vol 12 (3) ◽

pp. 408-418

Author(s):

E. M. Klimova ◽

L. A. Drozdova ◽

O. V. Lavinska ◽

E. A. Bychenko ◽

Y. H. Kot ◽

...

Keyword(s):

Liver Cirrhosis ◽

Absorption Capacity ◽

Phagocytic Index ◽

Recurrent Bleeding ◽

Barr Virus ◽

Group I ◽

Tnf Α ◽

Group Ii ◽

Light Fluorescence ◽

High Level

Various factors of infectious and toxic genesis can lead to the liver cirrhosis, often accompanied by complications such as recurrent bleeding due to portal hypertension against the background of hepatosplenomegaly. Metabolic changes and disturbances in immunoreactivity occur in the liver and spleen. To substantiate the choice of personalized treatment tactics for patients with hepatosplenomegaly, we investigated individual metabolic predictors and immunopathological processes in patients with: liver cirrhosis and hepatitis B (HBV) and/or hepatitis C (HCV) viruses (I group, n = 52); with herpes viruses CMV (cytomegalovirus) and EBV (Epstein-Barr virus) (II group, n = 48), and with splenomegaly and frequent recurrent bleeding associated with hereditary enzymopathies (III group, n = 15). We used the methods of immunoturbidimetry; enzyme immunoassay; light, fluorescence and confocal microscopy. In group I (HBV/HCV), we revealed a decrease in the C4 component; a significant increase in the phagocytic index and phagocytic number, a reduced number of active phagocytes and the digestion index; a decrease in the IL-1β content and an increase in IL-18 and IL-6. In group II (CMV/EBV), we revealed a high activity of the C3 and a low activity of the C4 component against the background of a high level of ROS in neutrophils; the antineutrophil antibodies (ANCA) formation in 85.7% of patients (71.4% –perinuclear antibodies (pANCA) to myeloperoxidase; 14.3% – cytoplasmic antibodies (CANCA) to proteinase 3). Also, in group II, an increased level of pro-inflammatory cytokines IFN-γ, IL-1β, TNF-α, IL-18 and anti-inflammatory IL-6 was detected. Changes in links of immunity in II group led to the formation of autoimmune reactions in 64.7% of patients, which was expressed in the development of a broad range of antinuclear antibodies ANA (11 specificities, including ANA to chromatin and chromatin-associated proteins, to proteins cytoskeleton, enzymes and enzyme complexes). In group III, we revealed a low absorption capacity of neutrophils, a high frequency of antineutrophil antibodies pANCA occurrence and cANCA (in 67.2% of the examined), and low concentration of TNF-α. The developed model of the stepwise change of immunological markers makes it possible to substantiate the choice of a complex targeted treatment, including antiviral and immunotropic therapy.

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