Перекисное окисление липидов и ферментные антиоксиданты при неспецифическом язвенном колите

Increased oxidative stress has been previously demonstrated in patients with inflammatory bowel disease. But this phenomenon has not been analyzed in the course of ulcerative colitis (UC). In this study we evaluated levels of malondialdehyde (the main product of lipid peroxidation), superoxide dismutase and catalase erythrocyte activities in 62 patients with active UC, in 22 patients after achievement of complete, endoscopic remission and in 52 control subjects. Significant increase of malondialdehyde in patients with active disease in comparison with control subjects, demonstrated in this study, suggests the presence of enhanced oxidative stress in active UC. Activation of enzymatic antioxidant system is characteristic of active UC, which is confirmed by an increase in superoxide dismutase and catalase erythrocyte activities in patients with active disease in comparison with control group. There is no significant difference in malondialdehyde and catalase erythrocyte activity between patients in remission of UC and the control subjects. The increase of conditional adaptive index in patients with active UC confirms large adaptive possibilities of enzymatic antioxidant system. The normal levels of malondialdehyde and catalase can be proposed as markers of complete disease remission in UC.В ряде научных исследований доказано наличие оксидативного стресса при неспецифическом язвенном колите (НЯК). Однако, этот феномен не был изучен в динамике заболевания. В настоящей работе оцениваются уровни малонового диальдегида (основного продукта перекисного окисления липидов), супероксиддисмутазной и каталазной активности эритроцитов у 62-х больных в период обострения НЯК, у 22-х больных после достижения полной, эндоскопической ремиссии и у 52-х человек из группы контроля. Существенное увеличение концентрации малонового диальдегида у пациентов в период обострения заболевания по сравнению с контрольной группой, выявленное в данном исследовании, указывает на наличие выраженного оксидативного стресса при активном НЯК. Для обострения НЯК характерна активация ферментной антиоксидантной системы, что подтверждается значительным увеличением супероксиддисмутазной и каталазной активности эритроцитов у пациентов с активными формами заболевания по сравнению с контрольной группой. Статистически значимых различий уровней малонового диальдегида и каталазной активности не было выявлено между группой контроля и пациентами в период ремиссии. В период обострения заболевания установлено увеличение условного адаптационного индекса, что свидетельствует о широких адаптивных возможностях ферментной антиоксидантной системы. Нормальные уровни малонового диальдегида и каталазы могут быть рекомендованы как маркеры полной ремиссии заболевания при НЯК

Liver transplant – assessment of recipients, in time

Catedra Chirurgie nr.2, Catedra Anesteziologie şi reanimare nr.2, Disciplina de gastroenterologie, Departamentul Medicină Internă, Laboratorul de gastroenterologie, USMF „Nicolae Testemiţanu”, Chişinău, Republica Moldova, Al XII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova cu participare internațională 23-25 septembrie 2015Introducere: Transplantul hepatic (TH) reprezintă tratamentul cirozei hepatice în stadiul terminal. Complicaţiile postoperatorii se atestă oricărui proces chirurgical, fiind precoce în prima lună şi tardive după acest interval. Scopul: Evaluarea recipienţilor post-transplant (2013-2015). Material si metode: Studiul include 35 recipienţi, vîrsta medie 46,74±1,89 ani, 23 (65,71 %) – bărbaţi, 12 (34,29%) – femei. La 9 (25,71%) – realizat TH de la donator viu, la 24 (68,57%) – TH de la donator în moarte cerebrală, la 2 (5,71%) – TH cu ficat împărţit. La 13 (37,14%) – efectuat TH în RM. Etiologia maladiei: virală (VHB – 4; VHC – 7; VHD – 18); VHD/CHC – 2, fibroză hepatică idiopatică – 1, insuficienţă hepatică acută – 2, ciroză biliară primitivă – 1. Tratamentul de imunosupresie: standart, conform protocolului. Rezultate: Complicaţii precoce: a). tromboză de arteră hepatică – 1 (2,86%); b). rejet acut – 3 (8,57%), 1 – tratat prin pulsterapie; c). hemoragie intracerebrală – 1 (2,86%); d). complicaţii medicale: pulmonare – 4 (11,43%), renale – 3 (8,57%), neurologice – 3 (8,57%); e). complicaţii biliare – fistulă tranşă secţiune hepatică – 2 (5,71%), peritonită biliară – 1 (1,86%). Complicaţii tardive: a). biliare prin stenoză anastomotică – 4 (11,43%), 2 rezolvate prin stentare; b). rejet cronic – 2 (5,71%); c). complicaţii medicale – insuficienţă renală – 3 (8,57%), hipertensiune arterială – 2 (5,71%), dislipidemii – 2 (5,71%), obezitate – 1 (1,86%); d). recidivă a afecţiunilor primare post-transplant: VHB – 1, VHC – 5, din care 1 cu răspuns susţinut. Mortalitatea postoperatorie – 3 (8, 57%): hemoragie intracerebrală – 1, rejet acut – 2. Concluzii: Complicaţiile postoperatorii precoce s-au estimat în 61,54%: chirurgicale 23,07%, terapeutice 38,46%; printre complicaţiile tardive predomină cele terapeutice 45,71%, supravieţuirea grefei – 91,43%.Introduction: Liver transplantation (LT) is the treatment of end-stage liver cirrhosis. Postoperative complications are as per any surgical process, observed too early if in first month and too late after this period. Aim: Assessment of post-transplant recipients, across time (2013-2015). Material and methods: The study included 35 recipients, average age 46.74±1.89, 23 (65.71%) – men, 12 (34.29%) – women. 9 (25.71%) transplanted from living donor, 24 (68.57%) – whole liver, brain-dead donor, 2 (5.71%) – split liver. 13 (37.14%) recipients were transplanted in Republic of Moldova. Disease etiology: viral (HBV – 4, HCV – 7, HDV – 18); HDV/CHC – 2, idiopathic hepatic fibrosis – 1, acute liver failure – 2, primary biliary cirrhosis – 1. Immunosuppression treatment: standard, according to protocol. Results: Early complications: a). hepatic artery thrombosis – 1 (2.86%); b). acute rejection – 3 (8.57%), of which 1 (2.86%) treated through pulse-therapy; c). intracerebral hemorrhage – 1 (2.86%); d). medical complications: pulmonary – 4 (11.43%), renal – 3 (8.57%), neurological – 3 (8.57%); e). biliary complications – liver fistula installment section – 2 (5.71%), biliary peritonitis – 1 (1.86%). Late complications: a). biliary anastomotic stenosis – 4 (11.43%), of which 2 (5.71%) resolved through stenting; b). chronic rejection – 2 (5.71%); c). medical complications – kidney failure – 3 (8.57%), hypertension – 2 (5.71%), dyslipidemia – 2 (5.71%), obesity – 1 (1.86%); d). primary disease relapse post-transplant: HBV – 1, HCV – 5, of which 1 sustained response. Postoperative mortality – 3 (8.57%): intracerebral hemorrhage – 1, acute rejection – 2. Conclusions: Early postoperative complications were estimated at 61.54%: 23.07% – surgical, therapeutic – 38.46%; therapeutic complications – 45.71%, prevail among tardive complications, graft survival – 91.43%

Liver transplant program in the Republica Moldova

Catedra de Chirurgie nr 2, Universitatea de Stat de Medicină și Farmacie „Nicolae Testemițanu”, Chișinău, Republica Moldova, Al XIII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” și al III-lea Congres al Societății de Endoscopie, Chirurgie miniminvazivă și Ultrasonografie ”V.M.Guțu” din Republica MoldovaIntroducere: Din momentul primului transplant hepatic în Republica Moldova în 2013, am efectuat 60 de transplanturi hepatice, printre care 40 de transplanturi au fost realizate cu ficat integru de la donator aflat în moarte cerebrală și 20 vde transplante hepatice de la donator viu. Deficitul critic de organe cadaverice disponibile ne-au impus să debutăm cu transplant hepatic cu hemificat drept de la donator viu. Material și metode: Indicaţiile pentru intervenţie chirugicală în majoritatea cazurilor au fost ciroza hepatică de etiologie virală în faza terminală, 12 cazuri de carcinom hepatocelular, câte un caz de ciroză biliară primară, hepatită toxică medicamentoasă, sindromul Budd-Chiari. Rezultate: Doua cazuri de retransplant hepatic cauzat de tromboza arterei hepatice și tromboză de grefă vasculară. În perioada postoperatorie precoce au decedat 7 primitori. Cauzele decesului au fost: hemoragie intracerebrală în perioada postoperatorie precoce – 1, rejet acut al grefei – 2, tromboză de arteră hepatică – 1, disfuncţie primară a grefei – 2, pneumonie postoperatorie – 1. În perioada postoperatorie tardivă au decedat pacienți. Din complicaţiile survenite în perioada postoperatorie precoce putem remarca rejet acut al grefei, tromboză de arteră hepatică, hemoragie postoperatorie, peritonită biliară, disfuncţie primară a grefei, convulsii, peritonită cauzată de ulcer acut duodenal perforat. Complicaţiile în perioada postoperatorie tardivă: peritonită biliară după extragerea drenului din coledoc, tromboză de anastomoză a venei cava, rejet cronic a grefei. Concluzie: Experienţa acumulată şi utilizarea tehnologiilor moderne ne-au permis să reducem rata mortalităţii postoperatorii, la fel ca şi rata complicaţiilor survenite.Introducere: Since the first liver transplant in the Republic of Moldova in 2013, we performed 60 liver transplants, including 40 transplants with integral liver from the brain death donor and 20 live donor liver transplants. The critical shortage of available cadaveric organs has forced us to begin with liver transplantation from the living donor. Material and Methods: Indications for surgical intervention in most cases were hepatic cirrhosis in the terminal terminal stage of disease, 12 cases of hepatocellular carcinoma, one case of primary biliary cirrhosis, drug toxic hepatitis, Budd-Chiari syndrome. Results: Two cases of hepatic retransplantation caused by hepatic artery thrombosis and vascular graft thrombosis. In the early postoperative period, seven recipients died. The causes of death were: intracerebral hemorrhage in the early postoperative period - 1, acute graft rejection - 2, hepatic artery thrombosis - 1, primary graft dysfunction - 2, postoperative pneumonia - 1. Patients died in the postoperative postoperative period. From complications occurring in the early postoperative period, we can notice acute graft rejection, hepatic artery thrombosis, postoperative haemorrhage, biliary peritonitis, primary graft dysfunction, seizures, peritonitis caused by perforated acute duodenal ulcer. Complications in the post-operative post-operative period: biliary peritonitis after T-Tube drain extraction, thrombosis of the cava vein, chronic graft rejection. Conclusion: The accumulated experience and the use of modern technologies have allowed us to reduce the rate of postoperative mortality, as well as the rate of complications

Liver transplantation from living donor in the Republica Moldova

Catedra de Chirurgie nr 2, Universitatea de Stat de Medicină și Farmacie „Nicolae Testemițanu”, Chișinău, Republica Moldova, Al XIII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” și al III-lea Congres al Societății de Endoscopie, Chirurgie miniminvazivă și Ultrasonografie ”V.M.Guțu” din Republica MoldovaIntroducere: În structura mortalităţii prin bolile aparatului digestiv, Republica Moldova (RM) ocupă primul loc în Europa şi unul dintre primele în lume. TH (transplantul hepatic) de la donator viu reprezintă o opţiune importantă de tratament pentru recipienţii cu boală hepatică terminală. Primul TH, realizat în RM, îincepe în 2013, acesta fiind de la donator viu. Material şi metode: În perioada 2013- 2019, s-au realizat 20 transplanturi hepatice de la donator viu. Principala indicaţie au reprezentat-o cirozele de etiologie virală:VHD (60%), VHB (20%), VHC (20%). Studiul a inclus 40 pacienţi: 20 donatori, virsta medie 34,81±11,59 ani şi 20 recipienti, vârsta medie 44,57± 9,91ani. Toţi pacienţii – evaluaţi clinic, biochimic, instrumental conform protocolului instituţional. Steatoza hepatică (25-30%) confirmată prin puncţie biopsie hepatică la 20% donatori. Scorul MELD a variat între 14-19 puncte. Tratamentul de imunosupresie: standard, conform protocolului. Rezultate: Supraveţuirea postoperatorie imediată estimată la 90% (9). Supraveţuirea pacientului şi a grefei la 1 an – 70%. Morbiditatea postoperatorie – 4, complicată cu rejet acut – 2. Complicaţii precoce: a) tromboză de arteră hepatică, cu retransplant – 1; tromboză de grefă vasculară sintetică –a 1 caz, b) rejet acut – 2 tratat prin pulsterapie; c) complicaţii medicale: pulmonare – 4, neurologice – 2; d) complicaţii biliare – fistulă tranşă secţiune hepatică – 2, peritonită biliară – 1. Complicaţii tardive: a) biliare prin stenoză anastomotică - 2, b) recidiva afecţiunilor primare post-transplant: VHB – 1, VHC – 1, CHC - 1 caz. Concluzii:Transplantul hepatic de la donator viu prioritizează recipienţii din lista de aşteptare, identifică şi micşorează factorii de risc preoperator, oferind o grefă optimală.Introduction: In the structure of mortality from digestive diseases, Republic of Moldova ranks first in Europe and one of the first in the world. LT (liver transplant) from a living donor represents an important treatment option for recipients with terminal liver disease. First LT in Republic of Moldova was conducted in 2013, from a living donor. Material and Methods: Between 2013 – 2019, 20 liver transplants from living donors were performed. The main indication was represented by cirrhosis of viral etiology: VHD (60%), VHB (20%), VHC (20%). The study included 40 patients: 20 donors, average age 34.81 ± 11.59 years and 20 recipients, average age 44.57 ± 9,91ani. All patients - assessed clinically, biochemically, instrumentally according to institutional protocol. Hepatic steatosis (25-30%) confirmed by liver biopsy to 20% donors. MELD score ranged from 14 to 19 points. Immunosuppression treatment: standard, according to protocol. Results: Estimated immediate postoperative survival of 90%. Patient and graft survival after 1 year – 70%. Postoperative morbidity – 2, complicated with acute rejection – 2. Early complications: a) hepatic artery thrombosis, with repetitive transplant -1, vascular graft thrombosis; b) acute rejection - 2; c) medical complications: pulmonary - 4, neurological – 2, e) biliary complications - liver fistula installment section - 2, biliary peritonitis - 1. Late complications: a) biliary through stenosis anastomotic - 1, b) relapse of primary disease post-transplantation: HBV - 1, HCV – 1, CHC case. Conclusions: Liver transplantation from living donor prioritizesrecipients from the waiting list, identifies and reduces preoperative risk factors, providing optimal graft

P41

The aim of this work was to assess the potential of the optical methods for studying erythrocytes (Er) and blood serum (BS) of patients with colorectal cancer (CC). Methods: A total of 26 persons (52 + 8 years old) with CC (histologically – adenocarcinoma) in the T1–2 stage (the 1st group consisting of 10 patients) and in the terminal stage T3–4 (the 2nd group involving 16 patients) were examined. The metastases (in the liver area) were detected in 6 patients; the remaining patients had no metastases. The degree of lymph node involvement in most patients was not determined, the ten corresponding N1. The control group consisted of 16 healthy people (50 + 6 years old). Electric and viscoelastic Er parameters were investigated by dielectrophoresis, their membrane structure – by TLC and gas chromatography. The optical properties of BS were studied by the methods of ellipsometry. The reaction of the monoclonal antibody CD 24 with BS antigens of CC patients was studied by spectroscopic ellipsometry close to the conditions of surface plasmon resonance (SPR) (ProteOn XPR36 (BioRad). Results: We observed significant differences in Er parameters, associated with the CC stage. Given in the 2nd group (T3–4) summarized rigidity, viscosity, electrical conductivity, the relative polarizability, indexes of aggregation and destruction were significantly higher than those in the 1st (T1–2) and in the control group (p < 0.001–0.05). At the same time the patients of the 2nd group had marked disturbances of Er deformability, leading to the development of microcirculatory disorders and tissue hypoxia with the expressed deficit of intracellular macroergs. We observed high levels of cholesterol fraction, oleic, stearic acids, high index of cholesterol/phospholipids (PHL) and low levels of total lipids, easily oxidable PHL, arachidonic acid, omega-3 index in Er membranes in the 2nd group in comparison with those in the 1st group of patients (p < 0.0001–0.03). Scanning ellipsometry showed marked heterogeneity in thickness and composition, the abundance of discontinuities in thin films of BS of patients in the 2nd group compared to the 1st one (p < 0.001). Increasing the refractive index in combination with the reduction in film thickness as CC stage was weighting has been observed (p < 0.01–0,⧹.05). The concentration of the antigens to the CD24 in the BS of patients (obtained by SPR) in the terminal stages of CC was higher than that in the T1–2 (p < 0.001). We revealed correlations between Er parameters, BS ellipsometry characteristics and biochemical parameters, which reflected the interaction between these components depending on the CC stage. Conclusion: Identified microcirculatory disturbances probably aggravate the course of CC and, therefore, require additional therapeutic effects. Differences in Er and BS parameters associated with the stage of CC, give hope for the development of new diagnostic methods at the early stages of the disease