[The effect of cytokine therapy on the results of surgical treatment of patients with acute ulcerative gastroduodenal bleeding].

AIM: To improve the results of surgical treatment of patients with acute ulcerative gastroduodenal bleeding using immune correction with ß-leukin. MATERIAL AND METHODS: Urgent and elective operations were performed in 120 patients with gastroduodenal ulcers. Patients of the main group (n=63) received systemic cytokine therapy with ß-leukin in addition to conventional treatment. Pre- and postoperative immune correction was absent in the comparison group. RESULTS AND DISCUSSION: There was preoperative imbalance of antiphlogistic and proinflammatory cytokines in comparison group. Severity of this process depended on blood loss. Therapy with interleukin decreased severity of cytokine imbalance.

[State of immune and cytokine status in acute ulcerative gastroduodenal bleeding].

The paper analyzes the results of a survey of 37 patients with acute ulcerative gastroduodenal hemorrhage. During endoscopy found that 7 patients the cause of bleeding was gastric ulcer, duodenal ulcer in 27 and 3 concomitant ulcer. Hemostasis was evaluated by J. Forrest and the severity of blood loss was assessed by the A.A. Shalimov: with blood loss was mild in 11 patients, the average degree--12 and with severe--14. In all patients on admission in the peripheral blood were studied state of cellular, humoral and cytokine profile: CD3+, CD4+, CD8+, CD4+/CD8 + and CD19+, FI, FF, CEC, IgA, M, G, TNF-α, IFN-γ, IL-1, IL-2, IL-4, IL-6, IL-8 and IL-10. In general patients with on admission revealed significant changes in the immune and cytokine status. In cellular immunity occurs immunosuppression. Disturbances in humoral immunity manifests itself in increased levels of lymphocytes in blood loss and hardships of all multi-directional changes in the concentration of immunoglobulins depending on the amount of blood loss. When there is an imbalance in cytokine status, the depth of which depends on the degree of blood loss.

[IMPACT OF OPERATIVE INTERVENTION ON DYNAMICS OF THE IMMUNITY INDICES IN AN ACUTE GASTRODUODENAL HEMORRHAGE].

The results of surgical treatment of 39 patients, suffering an acute gastroduodenal ulcer hemorrhage, were analyzed. Gastric ulcer disease was diagnosed in 9 patients, duodenal ulcer disease--in 29, combined ulcer--in 1. A light degree blood loss was noted in 13 patients, while a middle degree--in 12, and severe--in 14. In accordance to J. Forrest classification in 6 patients an active bleeding was revealed (FIa, FIb), in 11--nonstable hemostasis (FIIa, FIIb, FIIc), and in 22--FIII. Preoperatively in patients on the third, seventh and fourteenth day the contents of CD3+, CD4+, CD8+, CD19, calculation of a CD4+/CD8+ ratio, the level of immunoglobulins (IgA, IgM, IgG) and circulating immune complexes were determined in peripheral blood. Phagocytic activity of neutrophils was estimated, using determination of phagocytic index and phagocytic number. In an acute gastroduodenal ulcer hemorrhage immunosuppression was noted, and severity of disorders in T- and B-chains of immunity have depended upon a blood loss severity. Conduction of a routine basic conservative therapy in postoperative period did not guarantee elimination of immunosuppression.

[Dynamics of the main immunological indices in patients, suffering gastroduodenal ulcers, complicated by hemorrhage].

A deep clinical, immunological, microbiological analysis was performed in patients, suffering gastroduodenal ulcer, complicated by hemorrhage. Immunodeficiency state with the signs of autoimmunization was noted in the patients. These changes were most severe in a severe blood loss, the local endoscopic hemostasis instability, high risk of the hemorrhage recurrence occurrence, presence in a periulcer zone mucosa of a conditionally pathogenic and pathogenic microflora with a Klebsiella pneumoniae and Streptococcus beta-haemoliticus predominance. The analysis of the data obtained permits to prognosticate the pathologic process severity course and to improve the program of treatment.

[The use of ozone and low-intensive laser irradiation in complex treatment of complicated duodenal ulcer].

The study is based on the examination of 12 patients with perforative duodenal ulcer and 24 patients operated on recurrent bleeding duodenal ulcer. Some component of the immune system, such as T- and B-lymphocytes rates, immunoglobulin rate and macrophagal activity, were decreased prior the beginning of the complex treatment. Normalisation of humoral and cell immunity was registered on 10-12 days after the beginning of the ozone and low-intensive laser irradiation.

[CD25-positivity and efficacy of roncoleukin in complex treatment of patients with gastroduodenal ulcers complicated by hemorrhage].

In 72 patients, suffering gastroduodenal ulcer disease recombinant interleukin-2 (LL-2) Roncoleukin ("Biotech", Russia) was applied in complex of treatment. The main populations of immunocytes, containing cellular-tissue receptor IL-2 CD25, were investigated in specimen from various zones of gastroduodenal mucosa and peripheral blood. There was established the trustworthy hyperexpression of CD25 in patients while gastrointestinal hemorrhage. Roncoleukin inclusion into the complex of treatment of patients have promoted more effective normalization of affinity of various immunocytes type towards IL-2 receptors, clinical signs occurrence of the disease elimination and the ulcer defect epithelization acceleration.

Lymphocytes from patients with chronic duodenal ulcer disease show enhanced proliferative response to beta-endorphin.

We investigated the effect of phytohemagglutinin and the neuropeptide beta-endorphin on the in vitro lymphocyte proliferative response in patients with chronic ulcer disease and upper gastrointestinal bleeding or in remission, acute ulcer or hemorrhagic gastritis, and in healthy persons without upper gastrointestinal disease. We found that the addition of beta-endorphin produced a strongly enhanced proliferative response to phytohemagglutinin in lymphocytes from patients with chronic ulcer disease, and in particular from those with recent bleeding.

[Type I hypersensitivity reactions and etiopathogenesis of hemorrhagic rectocolitis]. / Réactions d'hypersensibilité de type I et étiopathogénie de la rectocolite hémorragique.

There is a body of clinical, epidemiological, biologic, histological and therapeutic data suggesting that type I hypersensitivity plays a role in the pathogenesis and maintenance of ulcerative colitis. Contradictory evidence from different studies on the pathogenic mechanisms may simply mean that there is not one but several types of ulcerative colitis. Chronic inflammation of the intestine would cover a heterogeneous group of conditions. Genetic susceptibility controlling one of more anomalies of the immune system would be triggered by external factors such as respiratory or food allergies, viral or bacterial infections or other factors including smoking or stress. The wide range of factors involved would explain the variety of findings reported by different groups searching for a single pathogenic mechanism. Finally, as emphasized by other authors, screening for subgroups of patients with allergy among the ulcerative colitis population would be useful in adapting treatment and developing a more specific therapeutic strategy not only for acute phases but perhaps also for preventive treatment.

[Prognosis of bleeding from duodenal ulcers]. / Prognozirovanie razvitiia krovotechenii iz iazv dvenadtsatipestnoi kishki.

Clinical and pathogenetic findings on 147 patients with duodenal ulcer (DU) and 29 patients with DU complicated by ulcerogenic bleeding were compared. This allowed to single out significant criteria for prediction of development of bleeding in such patients: male sex freguent seasonal exacerbations, hereditary load, location of the ulcer at the back wall of the duodenal bulb, negative atropine test, HLA-phenotype B35, A2 A3, A2 AX. High acidity and large sixe of DU were hot prognostically independent. The importance of complex approach in solution of prognostic problems is emphasized.

[The significance of gastric helicobacteriosis in the genesis hemorrhage from duodenal peptic ulcer]. / Znachenie khelikobakterioza zheludka v geneze krovotecheniia iz iazvy dvenadtsatiperstnoi kishki.

Based on a comprehensive analysis of findings from examination and surgical treatment of 196 patients with bleeding pyloroduodenal ulcers, it was found out that patients with concurrent helicobacteriosis of the stomach are prone to more unfavourable course of their illness, which fact is evidenced by a greater loss of blood and higher risk for bleeding recurrences. A classification is proposed by the authors, taking advantage of the data from endoscopic, microscopic and immunoenzymatic techniques, with the purpose of providing an assessment of degree of severity of helicobacteriosis of the stomach.

[Nonspecific immunity indices in acute gastrointestinal hemorrhage of peptic etiology]. / Sostoianie pokazatelei nespetsificheskogo immuniteta u bol'nykh s ostrym zheludochno-kishechnym krovotechenium iazvennoi étiologii.

The state of phagocytic activity of neutrophils, phagocytic index, opsonic coefficient, activity of blood serum lysozyme were studied with acute gastro-intestinal hemorrhages (ulcerous etiology in 116 patients, non-ulcerous etiology in 76 patients). The dependence of reduction of indices of phagocytosis and blood serum lysozyme on the degree of blood loss and duration of the posthemorrhagic period was revealed which may be used in clinical practice.

[Status of the immune system in acute gastrointestinal hemorrhages from chronic gastroduodenal ulcers]. / Sostoianie immunnoi sistemy pri ostrykh zheludochno-kishechnykh krovotecheniiakh iz khronicheskikh gastroduodenal'nykh iazv.

Based on a comparative study of indices of the cell and humoral immunity in patients with different degree of blood loss in the posthemorrhagic and postoperative periods the author has established that they are characterized by a stable proportion of different populations of lymphocytes with the deficiency of immune competent cells and increased content of lymphocytes without T and B lymphocyte specific markers. The concentration of 3 main classes of immunoglobulins G, A and M is maintained within normal limits even at severe blood loss which discloses great compensatory abilities of the immune system.

[Status of the cellular immune system in acutely developing complications of peptic ulcer before and after surgical treatment]. / Sostoianie kletochnoi immunnoi sistemy pri ostro razvivshikhsia oslozhneniiakh iazvennoi bolezni do i posle operativnogo lecheniia.

The ulcer perforation of bleeding can arize against the background of immunodeficiency characterized by decreased T- and B-lymphocytes in the peripheral blood. The immunodeficiency retains after operation and can facilitate a recurrent disease. In the postoperative period it is necessary to control the immune system in order to correct immunodeficiency.

[Nonspecific reactive state of the body in gastroduodenal hemorrhages]. / Sostoianie nespetsificheskoi reaktivnosti organizma pri gastroduodenal'nykh krovotecheniiakh.

The clinico-immunological investigation of 99 patients with gastroduodenal hemorrhages has shown pronounced changes in the humoral defensive system of the organism to develop due to hemorrhage which are dependent mainly on the degree and duration of the hemorrhage. The complement system is the first to suffer. The authors believe that the indices of the antiinfectional immune reactivity might be one of the criteria in determining the optimal terms of surgery in the posthemorrhagic period.

[The HLA phenotype and duodenal ulcers in patients following kidney transplantation]. / HLA-fenotip i duodenal'nye iazvy u bol'nykh posle transplantatsii pochki.

The authors have performed an investigation of the association between ulcer disease of the duodenum and bleedings from the ulcers in 204 patients after transplantations of the kidney with the antigen of HLA system histocompatibility. Duodenal ulcers were found in 25 patients (12.9%), in 11 of them the ulcers were complicated by bleedings which was 5.4% of the total number of the patients with the transplanted kidney. The evaluation of the HLA antigen distribution has revealed an association of duodenal ulcers with A2 and B13 antigens which took place significantly more often than in a group of practically healthy people (RR = 1.85 and 1.9 correspondingly). In patients with the transplanted kidney and following ulcerous bleedings this association was more obvious (RR = 2.32 and 3.74 correspondingly). According to the calculated etiological fraction 40% of the patients can be supposed to have the etiological association of the disease with A2 antigen and 20% of the patients with B13 antigen. A typical feature was the presence of possible "protective" A9 antigen which was found in the group under study two times more seldom than in the control group (RR = 0.25). A comparison of the distribution of HLA antigens in the patients in whom there developed bleeding duodenal ulcers with those who had no such complications has also established the association of the disease with HLA A2 and B13 antigens. The probable "protective" A9 antigen was also found. Since the kidney transplantation is preceded by determination of the recipient's HLA phenotype, these data can be used as prognostic criteria as well as the indications to performing preventive antiulcerous therapy in patients with high risk of the development of ulcerous lesions of the gastrointestinal tract.

[Changes in immunologic reactivity in patients with gastrointestinal bleeding]. / Izmenenie immunologicheskoi reaktivnosti u bol'nykh s zheludochno- kishechnym krovotecheniem.

The disorders in immunologic reactivity in acute gastrointestinal bleeding were studied in dynamics in 160 patients. Pronouncement of disorders in the T-system of immunity, activation of the reactions of specific sensibilization and autoallergic phenomena depend on severity of the blood loss. In ulcer location in the duodenum, the performance of an organ-preserving operation with vagotomy and elimination of the ulcer which is a source of antigen stimulation is preferable.