NEUROPSYCHIC POLYMORPHISM OF JUVENILE SYSTEMIC LUPUS ERYTHEMATOSUS

Damage to the nervous system (neurolupus) is one of the most common clinical manifestations of systemic lupus erythematosus (SLE) in childhood, and is also considered as an unfavorable prognostic criterion for the course of this disease. Neurolupus is characterized by a wide range of clinical manifestations in both children and adult patients, which is due in most cases to a common pathogenetic mechanism - the formation of systemic microvasculitis. The non-specificity and variability of neuropsychiatric symptoms, which may appear already at the onset of the disease, significantly complicate the early diagnosis of SLE and necessitate a close acquaintance of the pediatrician with neurolupus polymorphism in children.

Tumor budding as a prognostic criterion of colorectal cancer

Colorectal cancer (CRC) is the second leading cause of mortality among cancers after malignant tumors of respiratory system. One of the most significant prognostic features of CRC is tumor budding (TB), which isn’t widely implemented in clinical practice. The aim of this research: to find the prognostic criteria of recurrence and lethal outcome of CRR IIA and IIIB stages (рТ3N0-2M0), the ratio of tumors with certain differentiation in groups of research was taken equal. Material and methods. The group I was formed from primary CRC without recurrences. The main relapse-free survival time was 5 years (62.5 ± 16.5 months). The ІІ group – primary CRC with recurrences; ІІА – with recurrences during 5 years from the moment when the tumor was removed, without fatal outcome; ІІВ – with recurrences and lethal outcome from genera­lization of tumor process during 5 years from the moment when the tumor was removed. The microslides of CRC were made by using the standard methods. Results. TB was identified in 46.66 % (28/60) of CRC рТ3N0-2M0. The direct relationship between tumor grade and presence of TB was found (Р < 0.05), but TB didn’t define differentiation of the CRC. There was a statistically significant relationship between TB and metastatic spreading of CRC to regional lymph nodes (Р < 0.001). Metastasis was associated with 3 stage of TB, absence of metastasis was typical for CRC without TB. The tendency was found in a larger number of cases of the CRC with TB 3 stage among recurring CRC compared with CRC without recurrence, mainly due to the ІІВ group of the research. Inverse correlation between TB stage and time of recurrence appearance was found (Р < 0.05). TB in central tumor sites was followed by presence and higher stage of TB in peripheral tumor sites (Р < 0.05), that can be taken into account during biopsies of CRC. Conclusions. TB is a prognostic criterion of metastasis and time of recurrence appearance for CRC рТ3N0-2M0, which is mostly typical for tumors in patients with recurrences and lethal outcome at the taken equal ratio of tumors by differen­tiation.

The role of tumoral stroma in determining the forecast of recurrence and fatal consequence of stage IIA-IIIB colorectal cancer

Colorectal cancer (CRC) ranks 2nd in the structure of mortality from malignant neoplasms (MN). One of the criteria for the prognosis of CRC may be a tumor stroma, which has not been widely used in clinical practice. The aim was to determine the main morphological features of the stroma CRC T3N0-2M0 and search for prognostic criteria for their recurrence and lethal outcome according to the operating material and autopsy. Materials and methods. Group I included primary CRC without recurrence. The average recurrence-free period was 5 years (62.5±16.5 months). Group II – primary CRC with recurrence; IIA – with recurrences within 5 years from the date of tumor removal that did not lead to death; IIB – with the appearance of recurrence and lethal consequence of the generalization of the tumor process within 5 years from the moment of removal of the primary tumor. CRC micropreparations made according to the standard method with G + E staining were studied; immunohistochemical study was performed using monoclonal antibodies to smooth muscle actin alpha. Results. Stromal-parenchymal ratio >50 % is a prognostic criterion for recurrence (p<0.05) and shorter recurrence-free survival (p<0.001) of patients with stage IIA-IIIB CRC. Immature stroma type CRC stage IIA-IIIB is associated with the presence of tumor budding (p<0.001), G3 differentiation (p<0.01), shorter recurrence-free survival (p<0.001); among recurrent CRCs, the immature type of stroma is associated with the lethal outcome of patients (p<0.05). Expressed levels of tumor-activated fibroblasts are one of the criteria for immature CRC stroma (p<0.003), but as an independent prognostic criterion has limited prognostic value. Conclusions. TSR and immature type of stroma are prognostic criteria for recurrence and recurrence period of CRC pT3N0-2M0, more typical of tumors of patients with recurrence and lethal outcome with the same ratio of tumors by differentiation.

ACUTE COMPLICATED PANCREATITIS AND DIABETES MELLITUS: THE ROLE AND SIGNIFICANCE OF THE BIOCHEMICAL INDICATORS OF CARBOHYDRATE AND LIPID METABOLISM AS A PROGNOSTIC CRITERION FOR THE SEVERITY OF THE DISEASE CLINICAL COURSE

The aim: A clinical evaluation of biochemical parameters especially carbohydrate and lipid metabolism, their effect on the treatment program in patients with acute complicated pancreatitis. Material and methods: The results of complex treatment of a sample group of 127 patients with acute pancreatitis were studied. A moderately severe clinical course of the disease was found in 42 patients (33.1%) and severe in 85 patients (66.9%), the ethanol genesis of the disease was stated in 73 (57.5%), biliary genesis – in 54 (42.5%) patients. The evaluation of the treatment effectiveness was based on the analysis of the dynamics of disease clinical manifestations and the monitoring of laboratory biochemical parameters and glucose levels Results: It was stated, that the clinical course of the disease, severity, and prognosis of the patient’s condition correlate with the dynamics of markers of endotoxicosis and hepatic insufficiency, and glucose level is one of the most sensitive criteria. The carbohydrate metabolism dynamics analysis in the blood of patients has shown that in most patients glucose levels increase notably with the increase in pancreatic swelling and reaches a peak by its destruction Conclusions: The incidence of diabetes mellitus due to primary inflammation of the pancreatic parenchyma in ACP has a linear dependence on the frequency and duration of the disease; with the probability of developing diabetes with an exacerbation of the process during 5-8 years is 17.5%. The level of blood glucose in patients with ACP can be a reliable indicator of the severity of the disease course and correlates with other indicators of metabolism

ASSESSMENT OF THE IMMUNE RESPONSE PHENOTYPE IN PATIENTS WITH SURGICAL SEPSIS DEPENDING ON THE COURSE AND OUTCOMES OF THE DISEASE

Sepsis remains one of the biggest problems of modern medicine throughout the world. Timely determination of the phenotype of the patient’s immune response will be critical to making early therapeutic decisions. Analysis of the content of Treg and TNF-α, IL-6, IL10, TGF-β in patients with sepsis, depending on the severity of organ dysfunction in the dynamics of the disease was carried out. There was a direct correlation of moderate strength between the blood levels of IL-10 and Treg (R = 0.54, p<0.05). High levels of Treg, IL-10 content reflect the immunosuppressive phenotype of the immune response in the late stages and is a prognostic criterion for an unfavorable outcome in sepsis.

The role of diagnosis of respiratory dysfunction in patients with thoracic trauma with polytrauma

Annotation. Combined thoracic trauma is one of the most unfavorable in determining the prognosis in patients with polytrauma. The aim of the study was to evaluate the informativeness of the spirography method in patients with concomitant thoracic trauma as a prognostic criterion for the severity of the course of traumatic disease and the effect of the proposed modifications of the intensive care algorithm on treatment results. A study of the state of indicators of the function of external respiration was carried out using the method of spirography in 92 patients with concomitant thoracic trauma. The patients were divided into 3 groups depending on the foreseen leading pathogenetic mechanism of respiratory failure in all periods of traumatic illness. The effect of additional administration of ceruloplasmin solution, solution of D-fructose-1,6-diphosphate sodium salt hydrate solution was compared with the classical algorithm of intensive therapy. The effect of the proposed treatment was assessed 30 days after receiving polytrauma and the parameters of the external respiration function were compared with the data obtained in conditionally healthy volunteers. It was determined that the addition of a solution of ceruloplasmin to the algorithm of intensive therapy, the leading mechanism of action of which is the effect on oxidative stress, is the most pathogenetically determined in patients with concomitant thoracic trauma in polytrauma, which is confirmed by the most restored indicators of the function of external respiration in them, determined using spirography on the 30th day of observation. The data obtained are important in determining the prognosis of the course of traumatic illness and planning a rehabilitation program in patients with concomitant thoracic trauma.