[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.

[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.

[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.

Lack of accuracy of the noninvasive Helicobacter pylori stool antigen test in patients with gastroduodenal ulcer bleeding.

OBJECTIVE: Oral presentation at Digestive Diseases Week, San Francisco, California, May 2002. The antigen-based stool assay has proven to be accurate in diagnosing Helicobacter pylori infection in dyspeptic patients. We evaluated the H. pylori antigen-based stool assay (HpSA) in patients with peptic ulcer bleeding (PUB). METHODS: Thirty-six patients with PUB were endoscoped, and antral and corpus biopsy specimens were taken for rapid urease test (RUT), histology, and culture. The first stool sample after admission was collected for the HpSA test. The gold standard was defined as either positive culture or positive RUT and histology. If only RUT or histology was positive, this was defined as indeterminate. To evaluate cross-reaction with blood constituents, citrated blood samples from 10 healthy volunteers (nine H. pylori serology negative and one H. pylori serology positive) were assessed by the HpSA test. RESULTS: A total of 36 consecutive patients with PUB (21 male) with a mean age of 69.5 yr were included in the study. Using the gold standard, the sensitivity and specificity of the HpSA test were 100% and 52%, respectively. Citrated blood samples of three H. pylori negative and one H. pylori positive volunteer gave a positive result in the HpSA test, suggesting cross-reaction with blood con stituents. CONCLUSIONS: The HpSA test gave a high number of false- positive results in patients with PUB, probably because of blood constituents cross-reacting in the enzyme immunoassay. The HpSA test is not accurate for testing H. pylori infection in patients with PUB.

[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 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.

[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.

[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.

[Clinical and immunological aspects of surgical treatment of stomach and duodenal ulcer]. / Kliniko-immunologicheskie aspekty khirurgicheskogo lecheniia iazvennoi bolezni zheludka i dvenadtsatiperstnoi kishki.

Of 182 examined patients with the stomach and duodenum ulcer disease (UD) 104 (57.14%) of whom with complications. Antiulcerous antibodies were determined in patients according to results obtained in passive hemagglutination reaction (PHAR) using erythrocytic diagnosticums. In patients with gastric and duodenal UD the antitissue antibodies to corresponding antigens from gastric and duodenal ulcers were determined before the operation. The incidence of antibodies discovery depends on the patients condition. In 18 months after the operation the percentage of PHAR positive results have reduced down to 72.5% on average.

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.

[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.

[HLA system antigens in peptic ulcer patients]. / Antigeny sistemy HLA u bol'nykh iazvennoi bolezn'iu.

A study is presented of 105 Georgian patients (age: 24-69 years) with duodenal ulcer. Typing of HLA-A, B, and C antigens was carried out by a set of sera of the Leningrad Research Institute of Hematology and Blood Transfusion. It was found that finding in patients of Georgian origin with duodenal ulcer differ from similar examinations in other ethnic groups indicating the possibility to judge on the population heterogeneity of association of the HLA system with duodenal ulcer.

[Hemostasis and humoral immunity in patients with peptic ulcer hemorrhage]. / Sostoianie gemostaza i gumoral'nogo immuniteta u bol'nykh s iazvennym zheludochno-kishechnym krovotecheniem.

In ulcerative gastroduodenal bleeding, the high blood coagulability is preserved, and prescription of the hemostatic preparations of general action can lead in elderly and senile patients to the thromboembolic complications. The operative treatment should be performed, depending on immunoreactivity of an organism: at the peak of bleedings--at the first 24 h, in stopped bleeding--at the period of immunologic compensation.

[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.