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Morphological researches of liver at chronic intoxications with drugs and alcohol and their combination
21,2±0.44 ng/mL DHEA-c 1,14±0,09 m.mol/l. Thus, differences in performance between two groups are significant (between Ap1-42-29,0%, ApoE-4-47,6%, DHEA-S — 8,7 times) allows surely include patients with a score 4-7 by scale Khachinsky to a group with symptoms of Alzheimer's disease.
In patients with AD number of patients with the distribution of points in the «gray zone,» i. e. in the range from 4 to 7, have been significant — 52,9 ± 12,1%. Here, the markers have been correlated with those values characteristic of already developed AD: A01-42 above 600 pg/ml, ApoE-4 above 60.0 ng/mL DHEA-S is below 1.0 mmol/L. That is, the use of complex biomarkers not only help the distribution of patients in a particular group whose scores
on a scale Khachinsky not to allow confidently diagnose the cause of a neurodegenerative condition, but also to diagnose a specific pathology under the discriminatory levels of expression of the markers.
Conclusion
In favor of the effectiveness of complex biomarkers with a score on a scale Khachinsky used work says that a significant number of patients who fall into a "gray zone" of the scale (4-7), where it is difficult to determine the cause of neurodegenerative disease. The proportion of these patients in our study was 51.06% in the group diagnosed with early AD and AD. Thus, the use of diagnostic complex biomarkers in patients with neurodegenerative disorders improves the efficiency and diagnostic value of using of scale Khachinsky.
References:
1. Be la Monte S. M. Insulin resistance and Alzheimer's disease, BMB Reports, 42 (8), 2009.
2. Diaz M. C., Rosales R. L. A Case Report on Dyskinesia Following Rivastigmine Patch 13,3mg/24hours for Alzheimer's Disease: Perspective in the Movement Disorders Spectrum Following Use of Cholinesterase Inhibitors, 94 (34), 2015.
3. Schneider J. A., Montine T. J., Sperling R. A., Bennet D. A. Neuropathological Basis of Alzheimer's Disease and Alzheimer's Disease Diagnosis, 28, 2012.
4. Kann O. The interneuron energy hypothesis: implications for brain disease, Neurobiol. Disease, S0969-9961 (15), 2015.
5. Szigeti K. New Genome-Wide Methods for Elucidation of Candidate Copy Number Variations (CNVs) Contributing to Alzheimer's Disease Heritability, Methods Mol. Biol, 1303, 2015.
6. Khachinsky V., Oveisgharan S., Shankle W. R. Atrial fibrillation and the Khachinsky ischemic scale-reply, Arch. Neurol., 69 (8), 2012.
Tursunhojaeva Shoira Utkurovna, senior scientific assistant, applicant to Forensic medicine and medical law department with the course of pathologic anatomy and section course, Tashkent pediatric medical institute
E-mail: mbshakur@mail.ru
Morphological researches of liver at chronic intoxications with drugs and alcohol and their combination
Abstract: The received results help to recommend for differential diagnostics CDI and CAI research of such parameters of a hepatic tissue, as a share of parenchyma, having on fatty vacuoles and on intralobular infiltrates, perimeter and the area of section of a portal tract, extent of the focuses of destruction of a boundary plate along perimeter of a portal tract, average quantity of ductules in a portal tract, shares of a cut of the portal tract, occupied with cells of inflammatory infiltrate and vessels, shares of fibroblasts, macrophages, lymphocytes, neutrophiles and plasmatic cells as a part of inflammatory infiltrate.
Keywords: liver, drugs, alcohol, morphological changes.
One of the most typical diseases of drug-adductors (especially at intervenous injections of drugs) a chronic hepatitis of viral etiology is considered. However the data of the public literature about character and distribution of liver damages at drugs intoxication, as a rule, are not full and extremely contradictory. For instance, a role of drugs in liver damage pathogenesis is still unclear. There are not found the data about liver damages at combined intoxication with drugs and alcohol. There is questionable issue of differences in duration and morphology of viral hepatitis on the background of drug-adduction and at patients, not abusing drugs [1].
In the present time the forensic-medical diagnostics of drugs intoxication is based in complex of morphological data and results of these substances presence in the biological fluids and tissues of corpse. The forensic-chemical research helps to find out not only a type of drug, but also the duration, passed from the last time drug injection and an injected dosage according to the drug concentration in tissues, blood and urine. The interpretation of pato-morphogenesis and tanatogenesis at drug-adduction is complicated by variety of effects of psychotropic drugs and impurities, and also
defeat of many systems with disorder of intersystem bonds at various levels of an organism [3; 7].
Under the modern data, replication of hepatitis viruses comes to light at 97,8% of the addicts taking heroin intravenously. Prevalence of an infection of a virus of a hepatitis B among addicts makes actual studying of its specificities in this population [4].
According to forensic-chemical researches and morphological signs it is possible to draw a conclusion on rather frequent combination of a narcotism with abusing alcohol. In the literature there are data that abusing alcohol raises activity of a chronic virus hepatitis C, in particular, due to the strengthening of step necrosis [5]. Accordingly there should be accelerated development of cirrhosis too. Besides, acceleration of fibrosis and a cirrhosis can be somewhat caused in addicts by the raised frequency of mix-hepatitis (B+C) in this population. According to our supervision and the literature data [4], mix-hepatitis is differed from monoetiological by strengthening of necrotic and inflammatory processes that is shown, first of all, by high activity of a portal hepatitis.
At this stage of our researches we used histomorphometric method of research of a liver tissue at a chronic alcoholic intoxica-
Section 6. Medical science
tion (CAI), a chronic intoxication with opiates and their combination [6].
At microscopic research in comparison group (SAI with CAI) were marked a fatty dystrophy of hepatocytes, a sclerosis of walls of the central veins and portal tracts which were combined with acute alcoholic hepatitis, manifestated by infiltration of portal tracts with a considerable impurity of neutrophile leukocytes and formation alcoholic hyaline in hepatocytes [2].
At morphometric research on such parametres as the ratio of hepatocytes area, their nuclei, perisinusoidal spaces and sinusoids to a total area of parenchyma in sight view the significant distinctions are not revealed.
A share of parenchyma area, having on fatty vacuoles, at IODI made 0,01, in group of the CODI — 0,05 (P <0,05), and in comparison group (CAI) — 0,3 (P <0,05).
At measurement of an average thickness of a wall of the central vein statistically authentic distinctions between three groups are not revealed. Some authors think that a sclerosis ofwalls of the central veins, that leading to their consolidation is diagnostic criterion of CAI [3]. According to J. I. Pigolkina (2006) this sign is characteristic as well for CDI, including for IODI in this connection, it can be used only as criterion of chronic exogenic intoxications without specification of its kind. The fibrosis of walls of the central veins at addicts, apparently, is not connected with alcohol intake, and has another explanation [6].
The share of parenchyma occupied with intralobular infiltrates at IODI made 0,0003, and in group of the CODI — 0,0009 (P <0,05). According to the literature data, at CAI, as a result of the expressed fatty dystrophy, are possible necrosis ofhepatocytes with monogran-ulemas formation, however, in our researches such cases were not observed [5; 6].
Portal tracts have been expanded in all investigated groups at the expense of growth of connective tissue, and at addicts also at the expense of inflammatory inflitration and proliferation of bilious canals. The average area of section of a portal tract at IODI equaled 58076±7450,9 mkm 2, at the CODI — 51962,0±6761,4 mkm 2 (distinction is statistically doubtful).
In comparison group (CAI) this size made 31608,7±9156,0 mkm2 (P <0,05). Similar law was found out also at measurement of average perimetre of section ofa portal tract which equaled 1237,5±76,9 mkm2 with IODI, 1353,3±88,6 mkm 2 at CODI and 764,8±131,8 mkm 2 at an alcoholic intoxication (P <0,05).
A share of perimetre of section of the portal tract, having on the focuses of destruction of a boundary plate, at addicts made, on the average, 0,1 at IODI and 0,09 at the CODI (doubtfully). In comparison group (CAI) the boundary plate preserves an integrity in all investigated fields of sight view.
A number of bilious canals on one portal tract was more at IODI, than at the CODI (3,68±0,54 and 2,63±0,6 accordingly, P <0,05). In comparison group (CAI) made 1,2±0,7 (P <0,05). Diameter of canals in the investigated groups had no essential distinctions.
A share of the area of section of the portal tract, having on nuclei of inflammatory infiltrate cells, at the CODI and IODI had no authen-
tic distinctions, but was essentially less at suffering CAI (20,3% of the area of a portal tract at IODI, 22,1% at the CODI, 8,9% at CAI). At CAI blood vessels (10,1% of the area of a portal tract prevailed at IODI, 18,2% at the CODI, 33,4% at CAI). A share occupied with fibres of a connective tissue, in all groups was approximately identical and made 33-40%. The section area of bilious canals at the CODI and at CAI rather is not differed, whereas at IODI it was slightly larger (5,0% of the area of a portal tract at IODI, 3,3% at the CODI, 3,2% at CAI).
At IODI in structure of infiltrate less neutrophiles are found out (P <0,05) and slightly more lymphocytes, than at a poisoning with narcotics (P <0,05), the macrophages and, especially, fibroblasts (P <0,05) prevail.
A share of neutrophiles essentially differs from that at the CODI only in cases of a acute alcoholic hepatitis when it can reach 49,2%. Eosinophiles and plasmatic cells at CAI were absent in portal tract whereas at IODI and their number at CODI was approximately identical.
The received results help to recommend for differential diagnostics CDI and CAI research of such parameters of a hepatic tissue, as a share ofparenchyma, having on fatty vacuoles and on intralobular infiltrates, perimeter and the area of section of a portal tract, extent of the focuses of destruction of a boundary plate along perimeter ofa portal tract, average quantity of ductules in a portal tract, shares of a cut of the portal tract, occupied with cells ofinflammatory infiltrate and vessels, shares of fibroblasts, macrophages, lymphocytes, neutrophiles and plasmatic cells as a part of inflammatory infiltrate.
Our researches have shown that alcohol intake by addicts leads to strengthening damage of hepatocytes that is shown by strengthening of a fatty dystrophy, increase activity oflobular hepatitis, occurrence of neutrophiles impurity in inflammatory infiltrate and strengthening of the sclerous processes leading to increase of perimetre of section of portal tracts at the expense of growth of a connective tissue. The quantitative analysis of these processes can be recommended for use by medicolegal experts (histologists) in need of differential diagnostics IADI, CADI and CAI.
Besides, our researches have shown that markers of a chronic alcoholic intoxication meet at the died from the combined acute alcoholic poisoning and opiates essentially more often, than at the died from the isolated acute intoxication with opiates that it is possible to explain an ethanol role in development of these morphological changes.
Conclusion. Thus, for the combined intoxications with opiates and alcohol strengthening damages of hepatocytes which is shown by a combination of signs of viral-toxic and alcoholic damage of a liver is characteristic. The signs of its alcoholic defeat defined by morphometric indicators help to make the differential diagnosis between isolated and combined opium intoxication.
For the solution of these problems the method of histomorpho-metric researches of a liver for the purpose of revealing of signs of narcogenic pathomorphosis of a chronic virus hepatitis, toxic and alcoholic defeat of a liver which are additional diagnostic criteria of the isolated chronic opium intoxication and its combinations with alcoholic one is suggested.
References:
1. Gorbacheva NA Orlova AM, EM Solomatin On the question of evaluation himikotoksilogicheskoy determination of opiates (heroin, morphine, codeine) in the urine in the forensic practice//The forensic-medical expert. - 2004. - № 3. - C. 46-49.
2. Kriger O. V, Mogutov S. V., Bugovskij D. I. and coauthors. The Forensic medical examination of deadly poisonings with narcotic sub-stances//The forensic-medical expert. - 2001. - № 2. - P. 9-14.
3. Loginov A. S., Sharafanova T. I., Ilchenko L. J., etc. A case of infection by viruses of hepatitises of a TT and G at the sick with alcoholic cirrhosis//Archive materials - 2000. - T. 72, № 2. - P. 58-60.
Clinical course and tactics of treatment of tuberculous lesions of the thoracic spine with spinal disorders
4. Nasibulin B. A, Tkachev V. O., Voino-Jasenetsky O. V., Pyhteev D. M. The feature of structural changes of a brain at a HIV-infection and narcotism combination.//Pathology Archive. - 2002. - № 1. - P. 24-27.
5. Pigolkin J. I., Bogomolov D. V. The morphological of change of internal organs at opium narcotism//pathology archive. - 2002. № 3. -P. 3-5.
6. Pigolkin J. I., Gasanov A. B. Features of morphological changes in the lungs of patients with chronic drug addiction.//The forensic-medical expert. - 2006. -№ 4. - P. 6-10.
7. Vaisov A. S., Shamsiev E. S., Iskandarov A. I. Diagnostic criteria for dermatological changes in heroin addiction in forensic prac-tice.//News dermatology. - 2006. - № 3.- C. 25-27.
Usmonov Isomiddin Haydarovich, Republican Specialized Scientific Practical Medical Center of Tuberculosis and Pulmonology, Cenior scientific fellow of bone and joint tuberculosis department, Tashkent,
E-mail: uisamiddin@bk.ru Tillyashayhov Mirzagolib Nigmatovich, Republican Specialized Scientific Practical Medical Center of Tuberculosis and Pulmonology, Director of theRSSPMCT&P Tashkent, E-mail: tmirza58@mail.ru Nazirov Primkul Khudjamovich, Republican Specialized Scientific Practical Medical Center of Tuberculosis and Pulmonology, leading scientific fellow of bone and joint tuberculosis department, Tashkent, E-mail: nazirov.primkul@bk.ru
Clinical course and tactics of treatment of tuberculous lesions of the thoracic spine with spinal disorders
Abstract: It is analyzed case records of 57 patients with tubercular spondylitis which have received hospitalization in branch ofbone-articulate tuberculosis the republican specialized scientifically-practical medical centre of Phthisiology and Pulmonology in 2012-2015 years, from them men was — 31 (54, 4%), and women — 26 (45.6%). At 41 (71,9%) the patient are spent considerably-regenerative operation by an is traditional-classical method with application autograft for spondylodesis, and at 16 (28,1%) by means of titanic mesh cage — Piramesh. At application titanic mesh cage the patient the postoperative period the pastel mode was observed for 27-30 days, 28-31 days to the patient it is authorised to rise, and goes, and is traditional-classical to a technique this period has lasted on the average 55 days.
Keywords: tubercular spondylitis, diagnostics, surgical treatment, spinal infringement, results.
Actuality: The specific tubercular lesions of the spine, spondylitis, has always occupied an important place in the problem of os-teoarticular tuberculosis, attracting the attention of researchers and physicians particular severity of the disease and the difficulty of their treatment. Currently, interest in spinal cord injuries has increased significantly due to the introduction of radical surgical treatment, which radically changed for the better, our therapeutic and preventive capabilities in the fight against these resistant diseases [4]. In most cases, the cause ofpsoas abscess is purulent-destructive defeat thoracic or lumbar spine (spondylitis). Such processes often provide a detailed clinical picture, primarily in the form of a pronounced vertebral pain, pulling pain on the inside of the thigh, mainly from the psoas abscess, the development of gross neurological deficits and expressed radicular pain due to spinal cord compression sequestration of bone and cartilage tissue combined with a relative stenosis of the channel [2; 3; 5]. In tuberculous lesions of the spine is especially important to have data as a process, developing bone (the level of destruction, the number of vertebrae, the nature of the destruction, and others.) And complete understanding of the complicated spondylitis abscesses (their location, extent, relation to other bodies
and tissues). Are very important information about the state of the spinal canal and its contents [6; 7; 8; 9]. Long-term course of the disease increases the risk of postoperative complications. In order to prevent early postoperative complications are shown in the amount of surgery radically reducing operations in the period of 6 months from the onset of the disease [1].
Objective: to study the clinical course and to evaluate the effectiveness of surgical treatment of spinal disorders of tuberculosis of the spine.
Material and methods: analyzed 57 case histories of patients with tuberculous lesions of the thoracic and thoracolumbar spine who received inpatient treatment in the department of osteoarticular tuberculosis RSNPMTsFiP in 2012-2015., Of them were men — 31 (54.4%), and -26 women (45.6%). The age of patients ranged from 19 to 64 years, average 45.3 years. The defeat of the spine was observed in the thoracic region — in 35 (61.4%) and in the thoracolumbar — in 22 (38.6%) patients. Complex diagnostic study: clinical and laboratory (blood count, biochemical blood, coagulation of blood, urinalysis), ECG, respiratory function, ultrasound of internal organs (liver, kidney, pancreas, pelvic, retroperitoneal, psoas
