Minimally-invasive technologies in the treatment of choledocholithiasis complicated by biliary pancreatitis

Minimal invasive endoscopic technologies are used in the treatment of patients with biliary pancreatitis with complicated cholangitis and biliary sepsis. 56 patients were treated for the period 2014 - 2018, aged 65.5 ± 15.18 years. ERCP was performed in 31 (55,3%) patients, in 13 (23,2%) - surgical intervention was performed without contrast of extrahepatic bile ducts. Papillotomy in 52 cases (96,4%) was performed by string papilloma and in 4 (7,1%) - by needle. In all cases, subtotal papilloprotectomy was performed [1], supplemented by balloon sphincteroplasty. In the I group, the patients included patients with biliary pancreatitis clinic, in group II patients with clinic of biliary sepsis, in the III group patients with purulent cholangitis clinic, biliary sepsis and septic shock. In the 1st and 2nd groups of patients, mortality was not observed. In the 3rd group, 3 patients died (37,5%). The rest of the patients are discharged from the hospital in a satisfactory condition. A decrease in the level of markers of hepatitis cytolysis (AlAT, AsAT, GGTP, L-FABP) was observed during surgical procedures without ERCP, indicating the toxic effect of contrast on the liver parenchyma. L-FABP is a highly informative marker for hepatocyte cytolysis and can be used as a criterion for hepatic insufficiency and prognosis of biliary sepsis. The high efficiency of transpacillary endoscopic surgical techniques in the treatment of biliary pancreatitis and biliary sepsis was noted

Minimally-invasive technologies in the treatment of choledocholithiasis complicated by purulent cholangitis

Minimal invasive endoscopic technologies are used in the treatment of patients with choledocholithiasis with complicated cholangitis and biliary sepsis. 56 patients were treated for the period 2014 - 2018, aged 65.5 ± 15.18 years. ERCP was performed in 31 (55,3%) patients, in 13 (23,2%) - surgical intervention was performed without contrast of extrahepatic bile ducts. Papillotomy in 52 cases (96,4%) was performed by string papilloma and in 4 (7,1%) - by needle. In all cases, subtotal papilloprotectomy was performed [1], supplemented by balloon sphincteroplasty. In the I group, the patients included patients with acute cholangitis clinic, in group II patients with clinic of biliary sepsis, in the III group patients with purulent cholangitis clinic, biliary sepsis and septic shock. In the 1st and 2nd groups of patients, mortality was not observed. In the 3rd group, 3 patients died (37,5%). The rest of the patients are discharged from the hospital in a satisfactory condition. A decrease in the level of markers of hepatitis cytolysis (AlAT, AsAT, GGTP, L-FABP) was observed during surgical procedures without ERCP, indicating the toxic effect of contrast on the liver parenchyma. L-FABP is a highly informative marker for hepatocyte cytolysis and can be used as a criterion for hepatic insufficiency and prognosis of biliary sepsis. The high efficiency of transpacillary endoscopic surgical techniques in the treatment of cholangitis and biliary sepsis was noted

Risks of unfavourable clinical outcomes in patients with first diagnosed stroke-associated atrial fibrillation

© 2018, Pharmainfo Publications. All rights reserved. Background—Atrial fibrillation (AF) is the most common arrhythmia often associated with cardioembolic stroke. Hypothesis—We investigated cases of AF first diagnosed (fdAF) in the acute phase of stroke.This type of AF might be common, and might suggest poor prognosis for patients. Methods— Following screening (n=1291) 661 patients with AF and a history of stroke were enrolled in this open-label, prospective study; patient average age was 68.0 years. Results—A high level of co-morbidity was observed: hypertension (in 100% of patients), ischemic heart disease (in 61.4% of patients), diabetes mellitus (in 52.3% of patients), and chronic kidney disease (in 32.1% of patients). In 154 (23.3%) patients AF was first diagnosed at the onset of cardioembolic stroke. The HAS-BLED score, age, hypertension and ischemic heart disease rates among these patients were comparable with the rest of the group; however, the percentage of patients with chronic kidney disease, diabetes mellitus or myocardial infarction was significantly higher. The highest one-year death rate was seen in patients with fdAF (death reported in 46 [29.9%] patients). The age of patients with fdAF who died was significantly higher, and their neurological disorders were more severe. Conclusions—The results show a high rate of fdAF and its poor prognosis in patients with cardioembolic stroke. Thus, the term “first diagnosed stroke-associated atrial fibrillation” seems relevant. The described condition has a negative predictive value, and is also associated with high co-morbidity burden in patients with fdAF

Параметры периферической крови как маркеры неспецифического адаптационного ответа при острых инфекционных заболеваниях с синдромом тонзиллита

Evaluation of nonspecific adaptive response of the body in children with acute infectious diseases associated with tonsillitis syndrome was the aim of this research. This prospective study included clinical, anamnestic and laboratory examination of children with acute infectious diseases with tonsillitis syndrome. A systemic multiple factor analysis was conducted (significance level р<0.05). The evaluation of peripheral blood parameters (specific gravity of lymphocytes and indices of reactive protective potential (RPP) - specific immune lymphocytic-monocytic parameter (SILMP) and coefficient of phagocytic defense (CPD)) gives the possibility to determine the condition of nonspecific adaptation in children with acute infectious diseases associated with tonsillitis syndrome. Children with tonsillitis syndrome show significant increase of integral RPP parameters, i.e. decrease of RPP, which is more pronounced on discharge (on admission - in 57% of children, on discharge - in 87%). The most unfavourable initial nonspecific adaptative body response (NABR) (according to the percentage of lymphocytes) is the reaction of increased activation, as it is associated with the transition to the overactivation by the time of discharge (37% of children). Systemic multiple factor analysis determined which peripheral blood parameters have more influence on children’s adaptation during the course of infectious disease: RPP indices showed high influence coefficients in all diseases (CPD was the highest in bacterial infection - Рi 198.3; SILMP was the highest in viral infection - Рi 147.81; in mixed infection CPD and SILMP were roughly the same - Рi – 107.25 and Рi - 78.11, respectively), which proves the feasibility of RPP evaluation for prognostic purposes in the treatment of this category of patients.Целью настоящего исследования явилась оценка неспецифической адаптационной реакции организма у детей с острыми инфекционными заболеваниями, ассоциированными с синдромом тонзиллита. Данное проспективное исследование включало клинико-анамнестическое и лабораторное обследование детей с острыми инфекционными заболеваниями с синдромом тонзиллита. Проведен системный многофакторный анализ (уровень значимости р<0,05). Оценка показателей периферической крови (удельного веса лимфоцитов и показателей реактивно-протективный потенциал (РПП) - специфического иммунного лимфоцитарно-моноцитарного параметра (ИЛМП) и коэффициента фагоцитарной защиты (КФЗ) дает возможность определить состояние неспецифической адаптации у детей с острыми инфекционными заболеваниями, ассоциированными с синдромом тонзиллита. У детей с синдромом тонзиллита отмечается достоверное повышение интегральных показателей РПП, т. е. снижение РПП, которое более выражено при выписке (при поступлении - у 57% детей, при выписке - у 87%). Наиболее неблагоприятной исходной неспецифической адаптационной реакцией организма (по проценту лимфоцитов) является реакция повышенной активации, так как она связана с переходом к гиперактивации к моменту выписки (37% детей). Системный многофакторный анализ определил, какие показатели периферической крови оказывают большее влияние на адаптацию детей в течение инфекционного заболевания: показатели РПП показали высокие коэффициенты влияния при всех заболеваниях, что доказывает целесообразность оценки РПП в прогностических целях при лечении данной категории больных

Biochemical markers of vital biodestruction in common oak (Quercus robur)

The wood of the common oak (Quercus robur L.) has high mechanical strength, elasticity and resistance to fracture. However, constitutional stability is not always able to provide the plants with reliable protection from wood-decay fungi, and the initial stages of biodegradation are difficult to determine. Therefore, this study concerns research on appropriate biochemical markers for early diagnostics of wood defects. The total content of phenolic compounds in leaves and wood was determined by a spectrophotometer Optizen Pop using Folin & Ciocalteu’s phenol reagent; the flavonoid content in leaves – by adding solutions of aluminum chloride and sodium acetate to methanolic extracts; catechins content – by the reaction with vanillin reagent; the concentration of phenolic antioxidants – by Brand Williams; chlorophyll and carotenoids’ contents in leaves – by the formula for methanol extracts; the qualitative composition of phenolic compounds – by high performance liquid chromatography and highly effective thin-layer chromatography. During the planned felling of oak trees on the territory of the Boyar Forest Research Station, trees were found with signs of brown streak and biodestruction of wood. Brown streak in wood is caused by a polycondensation of phenolic compounds, which are deposited on the internal surfaces of tracheal elements. In cases of an increase in the total amount of oxidized polyphenols, the cell walls are also stained. Active oxidation processes in wood have a systemic nature for the plants and affect the physiological state of the assimilation apparatus. We determined that in leaves of the trees with signs of brown streak the total phenol content increases in comparison with the control by 1.6 times, as well as flavonoid and catechin content. Our research has shown that the complex of plastid pigments in common oak leaves does not significantly change in the early stages of destructive processes. Increase of brown streak and appearance of rot in wood are associated with slight increase in chlorophyll a to b ratio in leaves. Chromatographic profiling of the leaves showed that the presence of brown streak changes the content of individual phenolic compounds. The trees with brown rot have more substances with UV spectrum characteristic for kaempferol glycosides compared to the control. The results have shown that the biochemical profiles of the trees with signs of brown streak and brown rot differ from the control by the composition of low and medium polar compounds. The absence or presence of some individual phenolic components and their ratio in the leaves are considered as biochemical markers of hidden wood defects

RESEARCH IN SENSITIVITY TO ANTIBIOTICS, ANTISEPTICS IN PSEUDOMONAS AERUGINOSA STRAINS ISOLATED FROM PATIENTS WITH INFECTIOUS COMPLICATIONS

Background. Infections caused by Pseudomonas are one of the topical issues of medicine.Objective. The aim of the research was to study sensityvity to antibiotics, antiseptics of P. aeruginosa clinical strains that cause infectious complications in patients with burns.Methods. Microbiological study of biological material, received from 435 patients with burns of the 3rd-4th stages (2011-2015 years). In early terms of burn disease 127 clinical strains of P. aeruginosa were isolated from patients. Standard methods were used to identify clinical isolates of P. aeruginosa by their morphological, tinctirial, culture and biochemical properties. The research of antimicrobial action of antiseptics, antibiotics against Pseudomonas were carried out by means of standard methods according to the Directive of the Ministry of Health of Ukraine (No. 167 from 05.04.2007 р.) and guidelines of National Committee of Clinical and Laboratory Study (NCCLS, 2002).Results. It was established that P. aeruginosa caused infectious complications in 23.9% of patients among other pathogens. Clinical isolates of P. aeruginosa were found to be low sensitive to amoxicillin/clavulanate (30.76%), ceftazidime (25.92%), cefoperazonum/sulbactam (46.15%), aztreonam (51.85%), tobramycin (38.46%), amicacin (70.34%), doxiciclini (26.92%), fluoroquinolones (59.26%). The analitical progistic criteria of decrease of sensitivity to ceftazidime, cefepim, meropenem and gatifloxacin were found in P. aeruginosa. This pathogen was determined to be sensitive to decasan ®, antimicrobial composition of decamethoxine ®, iodine pvidone.Conclusions. Clinical strains of Pseudomonas aeruginosa, being highly resistant to antibiotics, are also very sensitive to antiseptics decasan ®, antimicrobial of decamethoxine®, povidone iodine

Tactics of managing a patient with fatty liver disease coursing in the background of a polyorgan digestive tract: clinical observation

Preparations of glycyrrhizic acid (GA) and ursodeoxycholic acid (UDCA) are effective in the treatment of various forms of non-alcoholic fatty liver disease (NAFLD) and gastroesophageal reflux disease (GERD) occurring against the background of duodeno-gastroesophageal reflux. However, their effectiveness in the treatment of hologenic diarrhea and reflux gastritis has not been sufficiently studied. Currently, there are no clinical guidelines for the diagnosis and treatment of patients with hologenic diarrhea and reflux gastritis, including those with obesity and NAFLD. It is assumed that the combined administration of GA and UDCA can be accompanied by a mutual potentiation of the effect of the drugs. The article presents a clinical case of a patient with NAFLD, obesity, dyslipidemia, GERD, refractory to treatment with proton pump inhibitors, associated with duodenogastroesophageal reflux, reflux gastritis and hologenic diarrhea. It was shown that GERD, reflux gastritis, and hologenic diarrhea developed in the long-term period after cholecystectomy. At the same time, the appointment of a complex preparation containing GA (35 mg) and UDCA (250 mg) made it possible to stop the manifestations of a typical reflux syndrome in patients with a form of GERD refractory to proton pump inhibitors, reflux gastritis, and diarrheal syndrome associated with an excess of bile acids, improve lipid profile parameters. It has been shown that the administration of GA (35 mg) and UDCA (250 mg) can improve the parameters of the intestinal microbiome and lipid metabolism, which can be used in the treatment of patients with atherogenic dyslipidemia. At the same time, patients with comorbid pathology, including NAFLD, GERD, reflux esophagitis, hologenic diarrhea, and dyslipidemia require long-term maintenance therapy with GA (35 mg) and UDCA (250 mg)

Suspicion of genital tuberculosis isolated within the unilateral ovary with the dermoid cyst: A diagnostic dilemma

© 2018, Pharmainfo Publications. All rights reserved. Genital tuberculosis isolated in the same ovary with dermoid cyst is a rare condition. We present a 25-year female with a removed dermoid cyst of the ovary who underwent urgent subsequent laparoscopy within 3 months from the first surgery in order to exclude an ectopic pregnancy. The challenging in the pathology report from the second surgery was raised suspicion of specific infection of the resected ovary. To our best knowledge, only one case of tuberculosis of the dermoid cyst reported in 1958. A multidisciplinary approach involving chest specialist, gynecologists and morphologist have opted