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

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.

scholarly journals Portosystemic shunting procedures for complicated portal hypertension: modern opportunities of mini-invasive technique

2021 ◽  
Vol 26 (3) ◽  
pp. 34-45
Author(s):  
Yu. V. Khoronko ◽  
E. V. Kosovtsev ◽  
M. A. Kozyrevskiy ◽  
E. Yu. Khoronko ◽  
N. A. Krivorotov ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Varicose Veins ◽  
Sharp Decrease ◽  
Portosystemic Shunt ◽  
Long Term Results ◽  
Invasive Technique ◽  
Recurrent Bleeding ◽  
Clinical Group ◽  
Shunt Thrombosis ◽  
Group I

Aim. To improve the results of treatment for patients with complicated portal hypertension of cirrhotic genesis using the transjugular intahepatic portosystemic shunt with endovascular obliteration of the inflow pathways to the esophageal-gastric varicose veins.Material and methods. Transjugular intahepatic portosystemic shunt was performed in 172 patients with gastroesophageal variceal bleeding. The patients were divided into 3 clinical groups. The shunting procedure was applied to 62 patients. Another 110 patients underwent transjugular intahepatic portosystemic shunt and selective obliteration of the esophageal-gastric vein inflow pathways. The short-term and long-term results (up to 140 months), the incidence of thrombosis, recurrent bleeding and mortality, as well as their relationship with the established risk factors for complications were traced.Results. All patients achieved an effective reduction in the portosystemic pressure gradient and a reduction in the manifestations of portal hypertension. Recurrence of bleeding caused by shunt thrombosis occurred in 23 (13.3%) patients. In clinical group I (n = 62), this complication was noted in 9 (14.5%) patients, in II (n = 54) – 11 (20.4%) cases, in III (n = 56) – only in 3 (5.4%) cases. Bleeding-free survival decreased from 1.0 to 0.82 in 83.9 months, then plateaued. A sharp decrease in the Kaplan–Meier curve from 1.0 to 0.88 was observed within 24.5 months after the intervention. The largest number of deaths was in group I (30.6%), the smallest in group III (7.1%).Conclusion. Transjugular intahepatic portosystemic shunt supplemented by obliteration the inflows of the esophagealgastric varicose veins provides complete eradication of varicose veins, helps to reduce the frequency of recurrent bleeding and death.

scholarly journals Treatment and prevention of bleeding from varicose veins of the esophagus

2021 ◽  
Vol 1 (215) ◽  
pp. 80-83
Author(s):  
Eduard Mogilevets ◽  
Keyword(s):  
Liver Cirrhosis ◽  
Portal Hypertension ◽  
High Efficiency ◽  
Varicose Veins ◽  
Mortality Rates ◽  
Long Term Results ◽  
Recurrent Bleeding ◽  
Chronic Liver Diseases ◽  
Treatment And Prevention

Liver cirrhosis is the result of various chronic liver diseases. Portal hypertension is a serious complication of cirrhosis. Its consequences, in turn, along with other complications are gastroesophageal varicose bleeding, which cause high mortality rates. The article contains analysis of the results of laparoscopic esophagogastric devascularization without esophageal transsection and splenectomy in a patient with liver cirrhosis portal hypertension and recurrent bleeding from varicose veins of the esophagus. First successful surgery according to this method was introduced in the Grodno Municipal Clinical Hospital No. 4 in November 2011. Immediate and long-term results show a rather high efficiency of using this operation in the treatment and prevention of bleeding from varicose veins of the esophagus with cirrhosis. It is advisable to conduct further studies of the effectiveness of using this operation, despite the encouraging results of the use of this modification of laparoscopic esophagogastric devascularization.

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

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.

scholarly journals Renal involvement in prolonged salmonella bacteremia: the role of schistosomal glomerulopathy

1992 ◽  
Vol 34 (3) ◽  
pp. 193-198 ◽  
Author(s):  
Reinaldo Martinelli ◽  
Luis Jose Cardoso Pereira ◽  
Edilson Brito ◽  
Heonir Rocha
Keyword(s):  
Nephrotic Syndrome ◽  
Renal Involvement ◽  
Clinical Manifestations ◽  
Renal Lesion ◽  
Steroid Resistant ◽  
Group I ◽  
The Mean ◽  
Group Ii ◽  
Hepatosplenic Schistosomiasis

Renal involvement has been well documented in patients with hepatosplenic schistosomiasis and in patients with prolonged salmonella bacteremia (PSB). Whether there is a specific renal lesion related to PSB or the chronic bacterial infection aggravates a pre-existing schistosomal glomerulopathy has been a matter of controversy. To analyze the clinical manifestations and histopathological findings of the renal involvement, 8 patients with hepatosplenic schistosomiasis and PSB (group I) were compared with 8 patients with schistosomal glomerulopathy (group II) matched by sex and glomerular disease. The mean age in group I was 17.7 years. All patients presented with hematuria, in 4 cases associated with non-nephrotic proteinuria. In group II the mean age was 23 years; nephrotic syndrome was the clinical presentation in 7 of the 8 patients in the group. All patients in group I experienced remission of the clinical and laboratory abnormalities as the salmonella infection was cured; in group II the patients had persistent, steroid-resistant, nephrotic syndrome. On histological examination, no difference was noted between the two groups, except for pronounced glomerular hypercellularity and interstitial mononuclear cell infiltration in group I. These observations strongly suggest that PSB exacerbates a pre-existing sub-clinical schistosomal glomerulopathy by the addition of active lesions directly related to the prolonged bacteremia

scholarly journals An integrated approach to the treatment of pelvic pain associated with adenomyosis

2021 ◽  
pp. 53-60
Author(s):  
T.F. Tatarchuk ◽  
L.V. Kalugina ◽  
A.О. Danylova ◽  
K.S. Pavlova
Keyword(s):  
Nitric Oxide ◽  
Therapeutic Effect ◽  
Pelvic Pain ◽  
Clinical Manifestations ◽  
Well Being ◽  
Nitric Oxide Donor ◽  
Pelvic Pain Syndrome ◽  
Mcgill Pain Questionnaire ◽  
Group I ◽  
Group Ii

Dysmenorrhoea and intermenstrual pelvic pain are the most common symptoms of clinical manifestations of adenomyosis, which significantly impair the quality of women’s life. Adequate and long-term pain correction and alternative therapeutic approaches became extremely important for patients with adenomyosis during the COVID-19 pandemic. Research objective: to examine the clinical efficacy of nitric oxide donor (L-arginine) in the complex treatment of pelvic pain syndrome associated with adenomyosis.Materials and methods. The study included 63 women diagnosed with adenomyosis. Patients were divided into 2 groups by simple randomization: I (D) group (n = 31) received dydrogesterone 30 mg from 5 to 25 days of the menstrual cycle, II (D+T) group (n = 32) in addition to dydrogesterone received a nitric oxide donor L-arginine (Тivortin) according to the scheme. Pelvic pain was assessed before treatment with a Visual Analogue Scale and a McGill Pain Questionnaire, and an assessment of the overall pain impact on women's well-being was based on the SF-36 Health Status Survey. The effectiveness of pelvic pain therapy was assessed after the first and third months of treatment, as well as three months after the end of therapy with the above methods.Results. Researchers achieved a therapeutic effect in the treatment of chronic pelvic pain in both study groups, but in group II (D + T) after 3 months of treatment there was a significant reduction in pelvic pain, while patients of the standard therapy group have prolonged progestogen intake. There was a further improvement in the clinical condition in group I (D) after 6 months of follow-up, as well as no recurrence of pain in group II (D + T).Conclusions. The results of study demonstrate a significant effect of Tivortin as part of complex therapy on the rate of achievement and duration of therapeutic effect in the treatment of pelvic pain associated with adenomyosis.

Genoprotective role of vitamin E and selenium in rabbits anaesthetized with sevoflurane

2004 ◽  
Vol 23 (8) ◽  
pp. 413-419 ◽  
Author(s):  
Cetin Kaymak ◽  
Ela Kadioglu ◽  
Hulya Basar ◽  
Semra Sardas
Keyword(s):  
Dna Damage ◽  
Vitamin E ◽  
Comet Assay ◽  
Antioxidant Supplementation ◽  
Group Iii ◽  
Sevoflurane Anaesthesia ◽  
Group I ◽  
The Mean ◽  
Group Ii

In this study, genotoxic effects of repeated sevoflurane anaesthesia were investigated in rabbits with or without antioxidant supplementation. Twenty-one New Zealand male rabbits were included in the study and randomized into three groups as: placebo treated (Group I), vitamin E supplemented (Group II) and selenium supplemented (Group III). Vitamin E and selenium were given intraperitoneally for 15 days before anaesthesia treatment. Anaesthesia was administered using 3% sevoflurane in 4 L/min oxygen for a 3-hour period and continued for 3 days. Blood samples were collected before anaesthesia (Sample 1), after the first, second and third days of sevoflurane administration (Sample 2, Sample 3 and Sample 4 respectively) and the last samples were taken 5 days after the last sevoflurane administration (Sample 5). Genotoxic damage was examined using the comet assay. The degree of damage is assessed by grading the cells into three categories of no migration (NM), low migration (LM) and high migration (HM) depending on the fraction of DNA pulled out into the tail under the influence of the electric field. The number of comets in each sample was calculated (1 × number of comets in category NM + 2 × number of comets in category LM + 3 ×number of comets in category HM) and expressed as the total comet score (TCS), which summarizes the damage frequencies. In Group I, a significant increase in the mean TCSs was observed for Samples 3 and 4 as compared with Sample 1. However, there were no significant differences between Samples 1, 2 and 5. The mean TCS of Sample 4 was significantly higher than Sample 1, 2 and 3 in Group II. Group III demonstrated no significant mean TCSs for any experimental conditions. Statistical differences were also observed between the groups with significant P values. This experimental study points out the presence of DNA damage with repeated sevoflurane anaesthesia and the genoprotective role of antioxidant supplementation on DNA damage in mononuclear leukocytes of rabbits by highly sensitive comet assay.

Evaluation of Recurrent Pediatric Syncope: Role of Tilt Table Testing

PEDIATRICS ◽  
1994 ◽  
Vol 93 (4) ◽  
pp. 660-662
Author(s):  
Margaret J. Strieper ◽  
Debbie O. Auld ◽  
J. Edward Hulse ◽  
Robert M. Campbell
Keyword(s):  
Pediatric Patients ◽  
Neurocardiogenic Syncope ◽  
Tilt Table ◽  
Conversion Reaction ◽  
Cell Counts ◽  
Group I ◽  
Tilt Table Testing ◽  
Group Ii ◽  
Made In

Objective. To determine the current practice and effectiveness of evaluating recurrent syncope in pediatric patients, and to establish the role of tilt table testing in the evaluation. Design. Retrospective analysis of 54 pediatric patients with the history of syncope referred to cardiologists. Group I consisted of 27 patients examined without tilt table testing group II consisted of 27 patients whose examination included tilt table testing. Results. Group I had an average of 5.4 studies and group II, 6.6 studies performed per patient. Studies included chest radiograph (16 vs 13), electrocardiogram (24 vs 27), echocardiography (21 vs 27), 24-hour electrocardiogram (14 vs 16), transtelephonic monitor (7 vs 8), electrophysiology study (1 vs 3), complete blood cell counts (11 vs 12), chemistries (10 vs 11), thyroid function test (3 vs 3), neurology consult (12 vs 6), electroencephalogram (12 vs 5), and head computed tomographic scan (5 vs 3). Of the 298 non-tilt studies, the results of only 5 (1.6%) were abnormal. Diagnoses were made in 5 (18.5%) of 27 group I patients (Wolff-Parkinson-White syndrome, 1; conversion reaction, 2; hyperventilation, 1; migraines, 1), whereas diagnosis was made in 27 (100%) of 27 group II patients (neurocardiogenic syncope, 25; conversion reaction, 2). Conclusion. An extensive workup is not routinely indicated in syncopal patients with a history consistent with neurocardiogenic syncope. Tilt table testing performed early in the evaluation will increase the probability of a diagnosis, and will often prevent the need for further extensive, expensive anxiety-producing tests.

scholarly journals Effect of Aging on the Cornea of Male Albino Rat and Possible Therapeutic Role of Royal Jelly

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
H R Elareny ◽  
A I Ahmed ◽  
A F Alneklawy ◽  
M K Tawfik
Keyword(s):  
Royal Jelly ◽  
Male Rats ◽  
Distilled Water ◽  
Oral Gavage ◽  
Albino Rat ◽  
Therapeutic Role ◽  
Once Daily ◽  
Group I ◽  
Group Ii

Abstract Introduction Nowadays interest in aging has greatly increased, Aging is a complex natural process involving every molecule, cell, and organ in the body that is associated with tissue dysfunction in many organs. Aging of the cornea causes major eye effects and leads to substantial cost in medical and social terms. These effects include the highly prevalent dry eye disease (DED) that affects both visual function and quality of life in elderly. Symptoms of (DED) include, ocular pain, visual disturbances, and increase lacrimation. Functional foods such as Royal jelly (RJ) have a growing attention because of consumers increasing concerns about their health. Its importance not only for its nutritional properties but also for its functional and biological properties such as antioxidant, anti-inflammatory, antibacterial, antiviral, and anti-ulcerous activities. It is used as a cheap natural source in daily life and medicine. (RJ) is a complex substance composed of proteins, sugars, lipids, amino acids, vitamins, and minerals. Aim The present study aimed to investigate the histological effect of aging on the cornea of male albino rat and possible therapeutic role of (RJ) on senile group. Materials and Methods Twenty-four male albino rats were used in this study divided into Group I: consisted of 6 adult male rats aged 3- 6 months. Group II: consisted of 18 senile male rats aged 18-24 months, were further subdivided into three subgroups as follows: Group II A: (n = 6) negative control senile rats, not subjected to any procedure for 4 weeks. Group II B: (n = 6) control senile rats and were given distilled water by oral gavage once daily for 4 weeks. Group II C: (n = 6) senile rats were given (RJ) by oral gavage dissolved in distilled water once daily for 4 weeks. At the end of the experiment, rats were sacrificed after being deeply anesthetized with ether according to the protocol of the Committee of Animal Research Ethics (CARE). The cornea of each animal was carefully dissected out after death and immediately fixed in 10% formalin for preparation of paraffin blocks 5 micrometer thickness. Sections were stained with hematoxylin and eosin (I-I&E), Masson's trichrome and periodic acid-Schiff (PAS). Statistical analysis and quantitative morphometric study were done. Results Light microscopic examination of corneas of senile rats revealed different pathological changes included irregularity in the surface epithelium as well as surface erosions and cytoplasmic vacuolations. The stroma showed widely separated collagen fibers with decreased keratocyte density. It was concluded that (RJ) supplementation to senile rats obviously unproved all layers of the cornea histologically.

Endothelin effects in isolated, perfused lamb lungs: role of cyclooxygenase inhibition and vasomotor tone

1991 ◽  
Vol 261 (2) ◽  
pp. H443-H450 ◽  
Author(s):  
H. Toga ◽  
J. Usha Raj ◽  
R. Hillyard ◽  
B. Ku ◽  
J. Anderson
Keyword(s):  
Vasomotor Tone ◽  
Cyclooxygenase Inhibition ◽  
Group Iii ◽  
Group I ◽  
Before And After ◽  
Pulmonary Arterial ◽  
Group Ii ◽  
Sites Of Action ◽  
Arteries And Veins

We have determined the sites of action of endothelin-1 (ET) in the lamb pulmonary circulation. The influence of cyclooxygenase inhibition and baseline vasomotor tone on ET effects was also studied. Lungs of 14 lambs (6-9 wk of age, 12.1 +/- 0.6 kg body wt) were isolated and perfused with blood. Group I lungs (n = 5) were untreated, group II lungs (n = 5) were treated with indomethacin to inhibit cyclooxygenase, and group III lungs (n = 4) were treated with indomethacin and a thromboxane A2 analogue, U-46619, to elevate vasomotor tone. All lungs were perfused with constant flow in zone 3, with left atrial and airway pressures being 8 and 6 cmH2O, respectively. We measured pulmonary arterial pressure and, by the micropuncture servo-null method, pressures in 20- to 50-microns diameter subpleural venules, both before and after each dose of ET was infused (50, 100, 250, and 500 ng/kg). Group I lungs, with high baseline vasomotor tone, exhibited a biphasic response to ET; 50-100 ng/kg of ET dilated both arteries and veins, whereas 500 ng/kg of ET constricted both arteries and veins. In group II lungs with low vasomotor tone, all doses of ET caused constriction of arteries only. In group III lungs (indomethacin treated with elevated vasomotor tone), 50-100 ng/kg of ET caused dilation of arteries and veins, whereas 500 ng/kg of ET induced constriction, this time only in arteries. We conclude that ET has both dilator and constrictor effects in arteries and veins of isolated, perfused lamb lungs. ET-induced arterial and venous dilation is dependent on initial vasomotor tone but not on cyclooxygenase metabolites.(ABSTRACT TRUNCATED AT 250 WORDS)

scholarly journals The prognostic role of inflammatory markers in COVID 19 patients – A retrospective analysis.

2021 ◽  
Author(s):  
Shivkumar Gopalakrishnan ◽  
sangeetha kandasamy ◽  
S.Malini ◽  
S.Peer Mohamed ◽  
k.velmurugan
Keyword(s):  
Inflammatory Markers ◽  
Severe Disease ◽  
Radiation Hazard ◽  
P Value ◽  
Binary Logistic Regression Analysis ◽  
Group Iii ◽  
Group I ◽  
Group Ii ◽  
D Dimer

Abstract Background. Approximately 5% of COVID-19 patients suffer near fatal disease. Clinical and radiologic features may predict severe disease albeit with limited specificity and radiation hazard. Laboratory biomarkers are eyed as simple, specific and point of care triage tools to optimize management decisions.This study aimed to study the role of inflammatory markers in prognosticating COVID-19 patients.Methodology. A hospital based retrospective study was conducted on COVID-19 adult inpatients classified into three groups as mild disease-recovered [Group I], severe disease-recovered [Group II] and dead [Group III]. Categorical outcomes were compared using Chi square test. Univariate binary logistic regression analysis was performed to test the association between the explanatory and outcome variables. Unadjusted OR along with 95% CI was calculated. The utility of lab parameters (Ferritin, LDH, D dimer, N/L ratio and PLT/L ratio) in predicting severity of COVID-19 was assessed by Receiver Operative Curve (ROC) analysis. P value < 0.05 was considered statistically significant.Results. The mean age was 49.32 +/- 17.1 years. Among study population, 378 were Group I, 66 Group II, and 56 Group III. Median levels of Ferritin among the 3 groups were 62ng/mL, 388.50 ng/mL and 1199.50 ng/mL. Median value of LDH were 95U/L, 720 and 982.50(p <0.001). D-dimer values of 3 groups were 23.20ng/mL, 104.30 ng/mL and 197.10 ng/mL (p <0.001). CRP done qualitatively was positive in 2 (0.53%), 30 (45.45%) and 53 (94.64%) of patients. The odds of patients suffering severe COVID-19 rose with rising values of ferritin, LDH and D-dimer [unadjusted OR 1.007, 1.004 &1.020]Conclusion. One time measurement of serum ferritin, LDH, D-dimer and CRP is promising to predict outcomes for COVID 19 inpatients. Single qualitative CRP was equally good but more cost effective than quantitative CRP. The most specific combination was NLR, Lymphocyte percentage and D-dimer levels done between 7th – 10th day of symptoms.

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