scholarly journals SURGICAL TACTICS FOR OBSTRUCTIVE JAUNDICE OF NON-TUMOR ORIGIN AND STRICTURE OF THE DISTAL CHOLEDOCHUS

2020 ◽  
pp. 38-38
Author(s):  
A.G. Khasanov ◽  
S.K. Bakirov ◽  
R.E. Shamsiev ◽  
D.G. Shaybakov ◽  
A.F. Badretdinov
Keyword(s):  
Obstructive Jaundice ◽  
Tumor Origin ◽  
Surgical Tactics

Analysis of neutrophils functional activity in men with mechanical jaundice of various genesis

2020 ◽  
Vol 65 (9) ◽  
pp. 547-551
Author(s):  
M. A. Darenskaya ◽  
O. V. Smirnova ◽  
B. G. Gubanov ◽  
E. V. Kasparov ◽  
L. A. Grebenkina ◽  
...  
Keyword(s):  
Obstructive Jaundice ◽  
Functional Activity ◽  
Area Under The Curve ◽  
Sharp Decrease ◽  
Pathological Process ◽  
Maximum Intensity ◽  
Special Role ◽  
Intensity Maximum ◽  
Effector Cells ◽  
Tumor Origin

Obstructive jaundice (OJ) or blockage of the bile duct code K83.1 (according to ICD 10), occurs in approximately 45-50% of cases of all varieties of jaundice, it can be both non-tumor and tumor genesis. The functional pathway plays a special role in the genesis of complications of breast the activity of neutrophils as key effector cells responsible for the development of the inflammatory process in the breast. Investigation of the metabolic mechanisms of the functioning of neutrophils allows us to identify intracellular targets, when exposed to It was possible to modulate the level of cell reactivity.The study used data from 47 men with obstructive jaundice of non-tumor origin and 45 men with obstructive jaundice of tumor origin (stage I-II of the tumor process). As a control, data from 100 practically healthy men were used. A pronounced change in the kinetics of the chemiluminescent response of neutrophils in men with obstructive jaundice was found, consisting in an increase in the time to reach the maximum intensity, maximum intensity, area under the curve and activation index for both spontaneous and luminol-dependent induced chemiluminescence. The development of the tumor process in this category of patients was accompanied by a decrease in the area parameter under the curve during spontaneous and induced reactions, time to maximum, intensity maximum and activation index during spontaneous chemiluminescence. The data obtained indicate a marked increase in the values of the functional activity of neutrophils in patients with obstructive jaundice of benign origin, as well as a sharp decrease in their values in the presence of a pathological process of malignant origin.

scholarly journals Application of fuzzy mathematical model of decision-making for the selection of optimal surgical tactics in patients with non-tumor obstructive jaundice

2018 ◽  
Vol 99 (3) ◽  
pp. 439-445
Author(s):  
Dzh N Gadzhiev ◽  
E G Tagiev ◽  
N Dzh Gadzhiev ◽  
R Yu Shikhlinskaya
Keyword(s):  
Mathematical Model ◽  
Postoperative Complications ◽  
Obstructive Jaundice ◽  
Fuzzy Inference ◽  
Interleukin 2 ◽  
Optimal Choice ◽  
Rule Base ◽  
Inference System ◽  
Surgical Tactics ◽  
Level Of Risk

Aim. Creation of a model of fuzzy logic for predicting the risk of postoperative complications and the choice of individual optimal surgical tactics in obstructive jaundice caused by choledocholithiasis. Methods. At the first stage, we determined the most prognostically significant factors affecting the risk of postoperative complications. In accordance with these factors, linguistic variables were introduced: X1 - patient’s age; X2 - duration of jaundice; X3 - temperature; X4 - comorbidities; X5 - the level of liver dysfunction; X6 - CD4+ in the blood; X7 - interleukin-2 in the serum; Y - level of risk. The intervals of their changes were determined. Fuzzi Logic Toolbox Matlab soft was used to achieve the determined aim. The values of input variables were introduced into the model, transformed in the «Phaser» block and then the rule base of the fuzzy inference system was formed by the expert method. As a result, the level of risk is determined and the choice of surgical tactics is made: (1) risk is absent or low (A); (2) doubtful risk (B) - if the risk assessment in the dynamics after preoperative therapy decreases, then tactics A, if the score does not decrease or increases, then tactics C; (3) high and very high risk (C) - an unequivocal choice of stage tactics. Results. According to the defined level of risk, in 92 patients a one-stage procedure was used, while 58 underwent a two-stage intervention. Due to the developed fuzzy mathematical model, forecasting of the optimal choice of surgical tactics is achieved, which significantly improves the results of treatment. Conclusion. The developed fuzzy mathematical model makes it possible to differentiate the choice of surgical tactics for a particular patient and thereby reduce the incidence of postoperative complications from 29.0 to 4.7% and mortality from 11.0 to 1.3%.

scholarly journals Low-intensive Laser Therapy for Management of Cerebral Dysfunction in Patients with Obstructive Jaundice of Non-tumor Origin

2019 ◽  
Vol 8 (1) ◽  
pp. 53-59
Author(s):  
A. P. Vlasov ◽  
I. A. Chigakova ◽  
D. E. Timoshkin ◽  
M. A. Spirina ◽  
V. S. Kuznetsov ◽  
...  
Keyword(s):  
Obstructive Jaundice ◽  
Laser Therapy ◽  
Total Bilirubin ◽  
Low Intensity ◽  
Endogenous Intoxication ◽  
Cerebral Dysfunction ◽  
Tumor Origin ◽  
Low Intensity Laser Therapy ◽  
Intensity Laser ◽  
The Brain

 BACKGROUND The liver’s function is impaired above all others in the mechanical jaundice, which leads to the progression of endogenous intoxication and the damage of different organs and systems, including the brain. The development of hepatic encephalopathy undoubtedly aggravates the course of the disease, which requires its timely management.AIM OF STuDy: to evaluate the effcacy of the low-intensity laser therapy when managing the cerebral dysfunction in mechanical jaundice of non-tumor origin.MATERIAL AND METHODS A comprehensive study of 60 patients with obstructive jaundice of non-tumor origin was performed. The patients were divided into 2 groups: I (comparison) — the standard therapy (n=30); II (studied) group — inclusion of low-intensity laser irradiation of blood (n=30). On check dates (day 1 and 7), the severity of cerebral dysfunction was assessed in all patients using the psychometric tests (“Point in Circle, “Labyrinth”). The microcirculation was assessed with LACC 02 device (Russia). The coagulation/lysis system of blood was studied with TEG 5000 thrombelastograph (USA).RESULTS In patients with obstructive jaundice, disorders of the functional state of the liver were noted, which resulted in the growth of total bilirubin, alanine and aspartic aminotransferases, and toxic products. All this was accompanied by cerebral dysfunction, which was shown by results of the psychometric study and extended performance of tests, in particular (“Point in Circle”, “Labyrinth”). Signifcant changes and disorders of the hemostatic system were revealed in patients. The complex treatment of obstructive jaundice, which included laser therapy, allowed a relatively rapid recovery of the functional state of the brain to be observed, as evidenced by the shortening of the test time for the tests being studied. The positive effect of this kind of therapy was accompanied by a decrease in the severity of the syndrome of endogenous intoxication, improved microcirculation and hemostasis.CONCLUSION The presence of pancreatic obstructive jaundice lead to the development of florid syndrome of endogenous intoxication, which was reflected in the growth of ALT, AST, amylase, and total bilirubin. During the entire period of the study, a decrease in studied blood parameters was observed in patients who had underwent low-intensity laser therapy sessions. Conducting a psychometric study in the initial periods revealed some violations, such as extended performance of tests (“Point in Circle”, “Labyrinth”).

scholarly journals Biliary decompression in patients with obstructive jaundice

2019 ◽  
pp. 24-31
Author(s):  
V. L. Korobka ◽  
S. V. Tolstopyatov ◽  
R. O. Dabliz ◽  
A. M. Shapovalov
Keyword(s):  
Surgical Treatment ◽  
Mortality Rate ◽  
Obstructive Jaundice ◽  
Biliary Tract ◽  
Palliative Treatment ◽  
Biliary Decompression ◽  
Surgical Access ◽  
Final Treatment ◽  
Tumor Origin ◽  
Overall Mortality

Aim. Evaluation of the biliary tract decompression methods and their use results, in patients with obstructive jaundice of various etiologies on the basis of our own clinical material.Material and Methods. A retrospective analysis of the biliary tract drain results in 6935 patients with obstructive jaundice with benign and tumor etiology. In 87% cases there was B Class of obstructive jaundice. In 93% we observed mild (A Class) obstructive jaundice. For the biliary tract drainage we used laparoscopic or open surgical access. The retrograde drain we used in sixty-seven percent cases with obstructive jaundice B Class. In sixty-six percent cases of obstructive jaundice C Class, we used antegrade drain.Results. The biliary decompression was effective in 98%. Regarding the rate and timing of bilirubin reduction, all the applied methods showed a similar result, however, the greatest number of complications and fatalities we recorded in patients after antegrade percutaneous drain of the biliary tract and transabdominal access. In 36% the performed interventions became the final treatment option, and the sixty-one percent of patients underwent two-stage treatment. The overall mortality rate was 3%.Conclusion. The use of percutaneous drainage is justified for obstructive jaundice with tumor origin, and possible radical surgical treatment. Transabdominal access drainage for benign etiology of obstructive jaundice in compensated patients can be safely used. Transduodenal endoscopic drain is an alternative to other methods biliary tract drain in severe and medium obstructive jaundice of benign etiology. The same drain method can be used for drainage of biliary tract in patients with tumors of the hepatopancreatobiliary zone organs, as a palliative treatment. 

scholarly journals Stage surgical tactics in patients with obstructive jaundice complicated of the acute cholangitis and biliary sepsis

2019 ◽  
Vol 41 part 3 (2) ◽  
pp. 51-55
Author(s):  
O. Ye. Kanikovskiy ◽  
Ya. V. Karyi ◽  
Yu. V. Babiichuk
Keyword(s):  
Alkaline Phosphatase ◽  
Obstructive Jaundice ◽  
Acute Cholangitis ◽  
Transaminase Level ◽  
Biliary Decompression ◽  
Group Iii ◽  
Group I ◽  
Biliary Sepsis ◽  
Group Ii ◽  
Surgical Tactics

Purpose of the study. Improve treatment results of the patients with obstructive jaundice complicated of the acute cholangitis and biliary sepsis.Materials and methods. We analyzed the outcomes of surgical treatment of 200 patients with obstructive jaundice of the non-tumor genesis. The acute cholangitis was observed in 35 patients, which was caused of the biliary sepsis in 10 cases. The patients were divided into three groups: group I (n = 95), where endoscopic methods of biliary decompression were used; group II (n = 48), where biliodigestive anastomoses were formed; and group III (n = 57), where the external drainage of bile ducts was conducted.Results. The patients of the group I demonstrated a gradual decrease of bilirubin and alkaline phosphatase levels, which reached the normal readings on Day 7. The patients of the group II demonstrated normal levels of bilirubin and alkaline phosphataseon Day 14. The patients of the group III demonstrated rapid decrease of bilirubin and alkaline phosphatase levels, which reached the normal readings on Day 28. The transaminase level in each group of patients had reached the norm earlier.Conclusions. Priority is given to stage surgical tactics in patients with obstructive jaundice complicated of the acute cholangitis and biliary sepsis. Single-stage correction is recommended for patients with hyperbilirubinemia of less than 200 mcmol/l and duration of jaundice for less than 14 days, in the presence of compensated or subcompensated co-occurring pathology as well as in the absence of acute cholangitis.Keywords:obstructive jaundice, acute cholangitis, biliary sepsis, biliary decompression.

scholarly journals Difficulties in assessing the severity of liver dysfunction for obstructive jaundice

2021 ◽  
Vol 26 (2) ◽  
pp. 129-136
Author(s):  
M. Yu. Kabanov ◽  
K. V. Sementsov ◽  
D. Yu. Boyarinov ◽  
M. N. Myanzelin ◽  
M. Ya. Belikova ◽  
...  
Keyword(s):  
Obstructive Jaundice ◽  
Liver Failure ◽  
Disease Model ◽  
Model Assessment ◽  
Compensatory Mechanisms ◽  
Extrahepatic Cholestasis ◽  
Modern Methods ◽  
Surgical Tactics ◽  
Common Understanding

A literature review is devoted to the current classifications of liver failure that occurs in obstructive jaundice. Modern methods of diagnosis and criteria for determining the time of development and assessing the severity of this disease, model assessment and prognosis of acute liver failure are also considered. Attention is paid to assessing the severity and determining the timing of the development of liver failure in extrahepatic cholestasis. In addition, there is no common understanding of the role of liver compensatory mechanisms involved in the development of this condition. There are no generally accepted views on the surgical tactics of treatment of patients with obstructive jaundice complicated by liver failure. The limits of application of step-by-step treatment of patients with neoplastic obstructive jaundice have not been reliably determined. All these issues require further research, search for universal tools for assessing liver failure, predicting postoperative complications for choosing the optimal surgical treatment tactics.

Indications for Surgical Exploration in the Diagnosis of Intrahepatic Obstructive Jaundice

1952 ◽  
Vol 22 (2) ◽  
pp. 232-243
Author(s):  
Leonard A. Stine ◽  
Richard M. Bendix ◽  
Jerome M. Swarts
Keyword(s):  
Obstructive Jaundice ◽  
Surgical Exploration

Impaired Fibrinolysis in Obstructive Jaundice - Evidence from Clinical and Experimental Studies

1988 ◽  
Vol 60 (01) ◽  
pp. 025-029 ◽  
Author(s):  
M Colucci ◽  
D F Altomare ◽  
G Chetta ◽  
R Triggiani ◽  
L G Cavallo ◽  
...  
Keyword(s):  
Renal Failure ◽  
Bile Duct ◽  
Obstructive Jaundice ◽  
Plasminogen Activator ◽  
Fibrinolytic Activity ◽  
Experimental Studies ◽  
Plasminogen Activator Inhibitor ◽  
Venous Stasis ◽  
Microvascular Thrombosis ◽  
Duct Ligation

SummaryMicrovascular thrombosis is considered an important pathogenetic factor in renal failure associated with obstructive jaundice but the mechanisms leading to fibrin deposition are still unknown. The plasma levels of plasminogen activator inhibitor (PAI) in 29 patients with obstructive jaundice were found significantly increased as compared to 20 nonjaundiced patients. Fibrin autography of plasma supplemented with tissue plasminogen activator (t-PA) revealed that in icteric samples most of the added activator migrated with an apparent Mr of 100 kDa, corresponding to t-PA-PAI complex, whereas in control samples virtually all t-PA migrated as free enzyme. PAI activity detected in icteric samples is similar to the endothelial type PAI since it is neutralized by a monoclonal antibody against PAI-1.Venous stasis in jaundiced patients was neither associated with an increase in blood fibrinolytic activity nor with a decrease in PAI activity. Immunologic assay showed that t-PA release was impaired in 3 out of 4 patients. In controls, venous occlusion induced an increase in both fibrinolytic activity and t-PA antigen and a reduction in PAI activity. Bile duct recanalization in jaundiced patients subjected to surgery was accompanied by a decrease in plasma PAI activity which paralleled the decrease in serum bilirubin levels. In nonjaundiced patients, surgical treatment did not cause significant changes in either parameter. Rabbits made icteric by bile duct ligation showed an early and progressive increase in plasma PAI activity indicating that obstructive jaundice itself causes the elevation of circulating PAI. It is concluded that obstructive jaundice is associated with a severe impairment of fibrinolysis which might contribute to microvascular thrombosis and renal failure.

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