ABSTRACT
Results of surgical treatment for an acute ulcer gastroduodenal bleeding in 120 patients, ageing 16-75 yrs old, were analyzed. In 20 of them a gastric ulcer was a cause of bleeding, while in 84--a duodenal ulcer, and in 16--a coexistent gastroduodenal ulcer. The bleeding activity was estimated in accordance to J. Forrest classification. In 57 patients (a comparison group) preoperatively and postoperatively a complex of a standard basal conservative therapy without immunocorrection was conducted, and in 63 (the main group)--a systemic cytokinotherapy (SCKTH), using betaleukin, was applied postoperatively additionally in a complex of therapy. A content of CD3+, CD4+, CD8+, CD19+, IgA, IgM, IgG was estimated in dynamics, as well as circulating immune complexes, phagocytic index, phagocytic number. There was established, that a dysbalance depth in the immune status have had depended upon the blood loss severity. The SCKTH application is pathogenetically substantiated, it promotes the immune status normalization, as well as a more favorable course of postoperative period and the results of treatment improvement.
Subject(s)
Gastrointestinal Hemorrhage/drug therapy , Immunologic Factors/therapeutic use , Interleukin-1beta/therapeutic use , Peptic Ulcer/drug therapy , Stomach Ulcer/drug therapy , Adolescent , Adult , Aged , Antigen-Antibody Complex/blood , Antigens, CD/immunology , Case-Control Studies , Female , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/immunology , Gastrointestinal Hemorrhage/surgery , Humans , Immunoglobulin A/blood , Immunoglobulin G/blood , Immunoglobulin M/blood , Immunophenotyping , Lymphocytes/drug effects , Lymphocytes/immunology , Lymphocytes/pathology , Male , Middle Aged , Peptic Ulcer/complications , Peptic Ulcer/immunology , Peptic Ulcer/surgery , Recombinant Proteins/therapeutic use , Severity of Illness Index , Stomach Ulcer/complications , Stomach Ulcer/immunology , Stomach Ulcer/surgery , Treatment OutcomeABSTRACT
The results of surgical treatment of 137 patients, suffering obturation jaundice of non-tumoral etiology, were analyzed. In all the patients the cause of obturation jaundice was choledocholithiasis. Roncoleukin was infused intravenously additionally in a complex of therapy. A degree of hepatic dysfunction was determined, taking into account the cholestasis markers. In 23 patients purulent cholangitis have occurred on background of obturation jaundice. Concentration of cytokins TNF-α, IFN-γ, IL-1, IL-2, IL-4, IL-6, IL-10 in sera were determined, using immunoassay analysis. The cytokins dysbalance severity preoperatively and dynamics of its changes have depended upon the hepatic dysbalance degree and presence of purulent cholangitis; a dysbalance is deeper, when the hepatic dysfunction is higher. Application of pathogenetically substantiated purposeful cytokinotherapy, including roncoleukin, have promoted the cytokins dysbalance elimination and improvement of the patients treatment results.
Subject(s)
Cholangitis/drug therapy , Choledocholithiasis/drug therapy , Cholestasis/drug therapy , Immunologic Factors/therapeutic use , Interleukin-2/therapeutic use , Jaundice, Obstructive/drug therapy , Adolescent , Adult , Aged , Aged, 80 and over , Biomarkers/blood , Cholangitis/immunology , Cholangitis/pathology , Cholangitis/surgery , Choledocholithiasis/immunology , Choledocholithiasis/pathology , Choledocholithiasis/surgery , Cholestasis/immunology , Cholestasis/pathology , Cholestasis/surgery , Common Bile Duct/drug effects , Common Bile Duct/immunology , Common Bile Duct/pathology , Common Bile Duct/surgery , Female , Humans , Injections, Intravenous , Jaundice, Obstructive/immunology , Jaundice, Obstructive/pathology , Jaundice, Obstructive/surgery , Liver/drug effects , Liver/immunology , Liver/pathology , Liver/surgery , Male , Middle Aged , Recombinant Proteins/therapeutic use , Th1-Th2 Balance/drug effectsABSTRACT
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.