CC BY
26
Conclusion. Thus the results of this study suggest that acute ischemic stroke is characterized by high levels of blood C-peptide regardless the presence or absence of diabetes mellitus. Pronounced hormonal-metabolic disorders are interrelated with severity and clinical
outcome of the disease.
References:
1. Dedov I. I., Shestakova M. V. Diabetes Mellitus and Arterial Hypertension. M: MIA, 2006; 344.
2. Badiger Sh., Akkasaligar P. T., Narone U. Hyperglycemia and Stroke. Int. J. Stroke Res. 2013; 1: 1-6.
3. Beckman J. A., Creager M. A., Libby P. Diabetes and Atherosclerosis. Epidemiology, pathophysiology and management. J. Am. Med. Assoc. 2002; 287: 2570-2581.
4. Clark M. E., Payton J. E., Pittiglio LI. Acute Ischemic Stroke and Hyperglycemia. Critical Care Nursing Quarterly 2014; 37: 182-187.
5. Li Y., Meng L., Li Y., Sato Y. Associations of serum C-peptide level with body fat distribution and ever stroke in nondiabetic subjects. J. Stroke Cerebrovasc. Dis. 2014; 23: 163-169.
6. Mavrakanas T., Frachebois C., Soualah A., Aloui F., Julier I., Bastide D. C-peptide and chronic complications in patients with type-2 diabetes and the metabolic syndrome. Presse Medicale 2009; 38: 1399-1403.
7. Rundek T., Gardener H., Xu Q Goldberg RB, Wright CB, Boden-Albala B, Disla N, Paik MC, Elkind MS, Sacco RL. Insulin resistance and risk of ischemic stroke among nondiabetic individuals from the northern Manhattan study. Arch. Neurol. 2010; 67: 1195-1200.
8. Urabe T., Watada H., Okuma Y., Tanaka R., Ueno Y., Miyamoto N., Tanaka Y., Hattori N., Kawamori R. Prevalence of abnormal glucose metabolism and insulin resistance among subtypes of ischemic stroke in Japanese patients. Stroke 2009; 40: 1289-1295.
9. Vasic D, Marx N, Sukhova G, Bach H, Durst R, Grub M, Hausauer A, Hombach V, Rottbauer W, Walcher D. C-peptide promotes lesion development in a mouse model of arteriosclerosis. J. Cell. Mol. Med. 2012; 16: 927-935.
10. Zhang X. D., Chen Y. R., Ge L. Features of stroke in Chinese diabetes patients: a hospital-based study. J. Intern. Med. Res. 2007; 35: 540-546.
Akilov Habibullah Ataullaevich, Vice-rector of the Tashkent Institute of postgraduate training of doctor Primov Farhod Sharifzhanovich, Senior fellow researcher at the Tashkent Institute of postgraduate training of doctor E-mail: evovision@bk.ru
Long-term results of the splenectomy with heterotopic transplantation of splenic tissue in children with injuries of the spleen
Abstract: The main causes of postoperative complications in the late postoperative period in patients operated for injuries of the spleen has been the changes of coagulation hemostasis and rheological properties of blood and immune status. Keywords: splenectomy, heterotopic, splenic tissue.
Actuality: In spite of existing a great amount of methods of treatment after splenectomy (SE), opened possibility of transplant surgery has been promoted medicine and surgery, in general, in a new level of quality.
In certain surgical situations to preserve the spleen is not possible and the only way to maintain the function of the spleen after its removal is autologous transplantation of the spleen tissue [1; 2; 3].
Autotransplantation allows to stabilize the antimicrobial resistance of the organism by stimulating humoral immunity and correction content in the blood the level of taftsin, which leads to normalizing the function of mononuclear phagocyte system [2; 4].
Materials and methods: In the period from 3 months to 3 years after surgery was ambulatory examined 7 patients after conservative surgery (CS), 16 - after SE+HAT (heterotopic au-totrasplantation), 38 after SE. In total, long-term results were analyzed in 61 patients with injuries of the spleen in Republican Research Centre of Emergency Medicine were operated in the period from 2005 to 2015. A survey of patients was carried out in an outpatient setting.
Results and discussion: The study was revealed that late postoperative period in patients operated causing by trauma of spleen the complications directly correlated with the type of the operation.
As can be seen from the table in groups of patients, whom was carried out removal of an organ, a high incidences of various complications in the long period after SE as manifestations of the post-splenectomy syndrome can be established. Compare to the above provided information in the group of patients who was carried out CS clinical manifestations was significantly less as well as occurs in more lightly level than in the group SE group.
In this context, the frequency of clinical manifestations after SE can be seen as manifestations of the late postoperative postsple-nectomy syndrome.
Taking into account the greatest risk of hemostatic disorders and manifestations of immunodeficiency, special attention was paid to the study of relevant indicators.
The results of the study of the coagulation hemostasis obtained in patients after surgery on the spleen in the long term period of time comparing to the control group has been presented in Table 1.
Long-term results of the splenectomy with heterotopic transplantation of splenic tissue in children with injuries of the spleen
Table 1. - Performance of hemostasis in patients in the remote period after splenectomy
Index Units Control After SE CS SE+HAT
n=21 n=14 n=8
Thrombocytes 109/a 275,5±13,8 431,4±81,3* 287,6±33,1# 296,4±62,7*#
Tolerance of plasma to heparin sec 437,7±45,1 478,2±73,4 442,8±47,9 450,6±49,5
Time of recalcification sec 108,6±6,4 85,6±8,3* 111,5±9,4# 105,0±7,9#
Clotting time sec 268,6±15,3 224,6±37,8* 257,3±42,7# 251,8±40,2
Prothrombin % 95,4±2,5 105,2±3,4* 95,6±4,1# 97,0±3,7
Fibrinogen mg\% 3284,9±287,0 3453,1±249,4 3394,2±301,5 3174,5±266,0
Clot retraction % 30,7±2,1 32,5±3,7 30,2±2,4 31,3±2,6
Fibrinolytic activity % 12,2±1,6 16,8±2,0* 14,4±2,3 15,1±1,9
Note: * — significant difference (P<0,05) from the index in the control group;
# — significant difference (P<0,05) from the index in the group after SE.
As can be seen from table 1 significant changes in terms of coagulation hemostasis in the late postoperative period was reported in patients after SE.
In SE group, in long-term was observed increasing concentration of thrombocytes in more than 1.5 times in comparison with donors and patients with CS. This thrombocytosis in groups of patients with SE shows significantly more severe disoder of platelet hemostasis, than in the group with CS (P<0,05).
In the long period in patients after SE is activated coagulation hemostasis, as there is a statistically significant shortening of the time of plasma recalcification, clotting time and increase the time tolerance plasma to heparin and the percentage of prothrombin.
Simultaneously to this third phase activates ofblood coagulation as increasing fibrinogen level in the blood showed a significant growth of fibrinolytic activity of blood, compared with the control group.
In the long term, in patients with SE+HAT maintained of stable and normal level fibrinogen, while its index and other inTable 2. - The results of the mapping of immunological examination of patients after splenectomy
dicators of blood coagulation system has not been significantly different from those of healthy people. According this, the HAT of the splenic tissue allows to some extent to prevent the development of changes in the hemostatic system, which in our opinion eliminates the occurrence of thromboembolic complications in patients after SE.
The results of studies that characterize the cellular, humoral immune system and protect the organism's non-specific factors in patients after surgery on the spleen in the long term with regard to the control group has been presented in Table 2.
When comparing the groups of patients with SE and CS was estimated the significant differences in terms of the number of leukocytes in the remote period of observation. So the median white blood cells in patients with CS amounted to 6852,6 ± 282,7 mkl and no difference from that in the control group was examined, whereas the results in the group of patients with SE showed a significant reduction in their number.
Index Units Control SE (n=12) CS (n=12) HAT (n=10)
Cellular immunity
Leukocytes mkl 6703,0±224,5 6165,2±394,6 6852,6±282,7 6345,6±342,8
CD 3 % 59,7±2,4 47,8±4,2* 57,7±2,8# 52,7±3,4*#
CD 3+ mkl 1583,6±41,5 756,3±82,6* 1426,5±65,2# 1020,7±76,3*#
CD 4+ % 47,9±1,8 25,4±4,1* 46,2±2,7# 32,4±3,1*#
CD 4+ mkl 1284,3±24,6 286,5±41,9* 1216,4±34,2# 568,3±38,0*#
CD 8+ % 14,2±1,1 27,9±3,2* 13,0±1,0# 12,9±1,1#
CD 8+ mkl 385,6±32,2 704,5±56,9* 292,4±45,8# 635,9±52,3#
Index immunoregulation y. e. 1,6±0,1 1,9±0,2* 1,6±0,1# 1,7±0,1#
CD 16+ % 14,7±1,0 10,6±0,8* 13,9±1,1# 13,1±0,9*#
CD 20+ % 8,4±0,7 18,6±1,2* 9,4±1,1# 9,2±0,8#
CD 20+ mka 318,2±24,5 695,4±45,9* 511,8±21,5# 476,2±25,9#
Humoral immunity
Ig A mg% 122,4±5,9 134,8±6,1 127,4±3,9 131,6±4,1
Ig G mg% 1152,6±39,4 811,5±46,9* 1096,4±40,8# 1026,9±54,7#
Ig M mg% 141,6±4,0 52,9±57,9* 125,6±6,7# 102,3±7,2#
Non-specific protection factors
The complement system y. e. 62,6±2,8 35,8±4,1* 61,5±3,4# 59,4±4,6#
Note: * — significant difference (P <0,05) of the indicator in group after SE.
From the data presented in the table is clear that in patients after SE statistically significant reduction of the concentration of IgG and IgM, the complement system, the number of T-lym-phocytes, T-helper and T-killer cells (compared with the control group) transpired. However, only in the group with an isolated SE was marked increasing number of cytotoxic T-lymphocytes and B-lymphocytes.
control group. Significant difference (P<0,05) on the index in the
This could be the direct evidence of that as traumatic surgical manipulations on the organ, as lower level of activity of the secondary immune response we can observe. Thus, after SE possible manifestation of humoral immune deficiency significantly greater than in patients groups with SE+HAT or CS.
Status of humoral immunity and nonspecific resistance in patients after SE + HAT of the splenic tissue was better than in the
the
group of patients after an SE only. Thus, in this group of patients compared with the control group has not changed in the content of Ig A, Ig G, Ig M and in complement system.
Study of Ig A content in the blood has not shown any difference compared groups of patients. The exception was a slight increase its concentration in the groups after SE (tabl. 2).
Changes in the immune status of patients after SE, undoubtedly accompanied by clinical symptoms. For instance, by comparing the obtained data and clinical laboratory revealed that in patients with splenectomy was occurred complications, which may be associated with impaired immune status. Such changes have a tendency to frequent respiratory infections, diagnosed in 51% of patients. At the same time 28.5% of patients had involvement in the pathological process of the lungs and bronchus and in 16.3% of the patients was observed a predisposition to pustular skin diseases.
In a clinical study by observing the late postoperative period in the group of patients with SE + HAT we have established a
tendency to frequent respiratory disease in 31.3% of patients as well as a predisposition to pustular skin diseases — in 12.5% of patients. At the same time examined changes of immune status can be explained by the lack of compensatory function of the au-tolientransplantation.
Analyzed clinical data estimated that in patients with CS tendency to respiratory infections was in17.1% of cases and a predisposition to pustular skin diseases detected only in 2.4% of cases.
Conclusion: Identified alterations lead to the development of complications after SE in 81.6% of patients; completing SE by auto-lientransplantatsiey — in 56.2% cases. These complications can be allocated to the specific (postsplenectomy), advancing as a decreasing of the immune reactivity of the organism and aggravation of the "quality oflife". After SE possible manifestation ofhumoral immune deficiency was significantly greater than in patients groups with CS or SE+HAT of the splenic tissue.
References:
1. Григорьев Е. Г., Апарцин К. А. Органосохраняющая хирургия селезенки. - Новосибирск: Наука, 2001. - 400 с.
2. Franke M., Chang D. H. A rare complication: acute ischemic stomach necrosis in non-occlusive mesenteric ischemia. - Rofo, 2015. -Vol.36. № 2. - Р. 127-9.
3. Keramidas D. C., Soutis M. W. The function of the spleen in adults after ligation of the splenic artery of the traumatized spleen in childhood//Surgery. - 2003. - Vol.133. № 5. - Р. 583-5.
4. Li W., Shen S. Q., Wu S. M., Chen Z. B., Hu C., Yan R. C. Simultaneous hepatectomy and splenectomy versus hepatectomy alone for hepatocellular carcinoma complicated by hypersplenism: a meta-analysis//OncoTargetsTher. - 2015. - Vol.19. № 8. - Р. 2129-37.
Akilov Habibullah Ataullaevich, Vice-rector of the Tashkent Institute of postgraduate training of doctor Primov Farhod Sharifzhanovich, Senior fellow researcher at the Tashkent Institute of postgraduate training of doctor E-mail: evovision@bk.ru
Evaluation of the results of immediate postoperative period in children with injuries of spleen after splenectomy
Abstract: In the structure of all the complications in the immediate postoperative period was dominated purulence-in-flammatory complications — in 38 (28.1%) cases.
Keywords: evaluation, injuries of spleen, splenectomy.
Actuality: The most important function of spleen is to maintain immune resistance of the organism [1]. The spleen is produced in 54-70 times more cells, forming the antibody than in lymph nodes. No other immune organ does not produce enough antibodies comparable to the spleen [2, 3].
The spleen generates biologically active substances namely in-terleukins, interferon, leukotriene, taftsin, fibronectin, et al., which enhance the phagocytic ability of neutrophil, lymphocyte enhance the functional activity [4], cytotoxicity of monocytes [5].
Furthermore, lien participates in thrombocytopoiesis, after splenectomy caused by lien injury, occurs thrombocytosis and the number of platelets in the spleen is much greater than in the peripheral blood as well as the removal of the spleen leads to profound hemostatic disorders [3; 6].
Examining the changes of thrombopoietin level in plasma after splenectomy showed that regardless of the primary pathology, splenectomy leads increasing levels of thrombopoietin and other throm-
bopoietic cytokines (interleukin-6 and erythropoietin), which in turn causes thrombocytosis reaching a maximum by day 14 after surgery [6].
Based on the literature review, it can be concluded that the number of questions the treatment of closed abdominal injuries and spleen injuries in children has not been sufficient explored. Above all it concerns the choice of the complex diagnostic and treatment methods; the development of minimally invasive techniques and en-dosurgical interventions; optimization and implementation of organ transplantation techniques and technologies, which determined the purpose of this research.
Material and methods: Depending on the type of operations carried out as well as for the purpose of comparison and clarity, all patients had been divided into three groups. The first group included 62 patients who were over the trauma of the spleen made splenectomy (SE) in Republican Research Centre ofEmergency Medicine. The second group included 19 patients who had surgery after SE
