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Karimov Shavkat Ibrohimovich, Academician, Rector of the Tashkent Medical Academy, Professor in the department of faculty and hospital surgery of the Tashkent Medical Academy, Republic of Uzbekistan Khakimov Murod Shavkatovich, Professor, Chief of the department of faculty and hospital surgery of the Tashkent Medical Academy, Republic of Uzbekistan
Ashurov Sheroz Ermatovich, Assistant of the department of faculty and hospital surgery of the Tashkent Medical Academy, Republic of Uzbekistan E-mail: [email protected]
Prognosing of perforation of chronic gastroduodenal ulcers
Abstract: We analyzed the results of36 patients who were divided into two groups — basic (20 patients) and control (16 patients). Patients of the main group were investigated during exacerbation of peptic ulcer disease. Patients in the control group
suffered surgery for perforated gastroduodenal ulcers. It proved possible to predict chronic perforation of "uncomplicated"
Prognosing of perforation of chronic gastroduodenal ulcers
ulcers. When comparing biopsies of patients of main and control group revealed significant differences in the microscopic structure of the cells. For the prevention of perforation in patients with peptic ulcer disease is recommended to undergo regular medical examinations with biopsy of the ulcer for morphological studies. Keywords: peptic ulcer, perforation, prediction, Paneth cells.
Actuality
Peptic ulcer (PU), stomach and duodenal ulcers are predominant in the structure of the digestive tract. According to the Institute of Health and Medical Statistics Department of Health of the Republic of Uzbekistan and the overall performance of the primary ulcer incidence it declined significantly in the last 10 years, amounting to 381.2 and 37.9 per 100,000 population, respectively [1; 2; 4]. However, while no tendency to reduce the complications rate. For example, if there is bleeding ulcer in 25 % of cases, the most dangerous complication — perforation occurs before 10 % of the cases [1; 2; 5; 7].
Correlation of peptic ulcer disease in foreign countries is almost the same with our data. For example, if South Korea annually registered about 30-40 patients with primary peptic ulcer per 100,000 population, in the United States are diagnosed each year 500,000 primary cases of peptic ulcer disease, and relapse occur in 4 million [5; 6; 7]. A significant proportion of patients with peptic ulcer disease need surgery, including emergency treatment. This is especially true of complicated forms of the disease. In the CIS countries, diseases of the digestive organs and, above all, peptic ulcer disease is the second most common after diseases of the cardiovascular system [4; 6].
Perforation of the wall with the development of peritonitis ranks second among the complications. This complication occurs in all up to 10 % of cases, however, it belongs to the leading cause of death in patients with ulcer — 2/3 of all cases. Most often pyloro-duodenal perforated ulcer — six times more than the body of the stomach ulcer. Annual frequency of perforation of ulcers in the Republic of Uzbekistan is 7-10 cases per 100,000 population [1; 2; 5].
Identification of structural — functional bases of the stomach, the discovery of the role of Helicobacter pylori (HP) in the etiology and pathogenesis ofpeptic ulcer provided the basis for the revision of the basic principles of the treatment of this pathology [1; 2; 3; 4; 5].
The introduction of new standards of medical treatment of peptic ulcer disease has caused what is now the world many forms of peptic ulcer disease are cured with medication. This has led some authors to suggest that "the ulcer goes down in history". However, this is far from the real situation. First, recent studies show that it is not always peptic ulcer associated with HP [2; 5; 8]. Number of HP negative forms of peptic ulcer disease is 8-12 %. It turns out that HP — negative forms of peptic ulcer disease are up to 30 % of duodenal ulcers and up to 50 % of gastric ulcers [3; 4; 5; 8].
Contrary to expectations, the latest knowledge of structural — physiological bases of functioning of the stomach, the etiology and pathogenesis of peptic ulcer could not deliver the people from this disease of the stomach and duodenum. New standards for the treatment of peptic ulcer disease are based, among other things, the opening B. Marshall and J. Warren, not completely solved the problem of peptic ulcer disease, especially those forms that require surgical treatment.
Despite the widespread introduction into clinical practice of modern antiviral drugs and therapeutic endoscopy, the problem of ulcer complications, requiring emergency surgical intervention is urgent. This is due to the lack of objective criteria for prognostic assessment of the possibility of one or another complication of peptic ulcer disease. The reason for the long persistence of chronic ulcers, the occurrence of complications of peptic ulcer disease, a
perforation, ulcer bleeding, the emergence of the giant ulcer, their malignancy continues to be the subject of discussions [1; 2; 3; 7; 8].
Objective
To study the microscopic structure of the substrate complicated ulcer and "uncomplicated" gastroduodenal ulcers and make a comparative analysis between the results.
Material and methods
For comparison of the results, patients were divided into 2 groups according to the presence or absence of complications of peptic ulcer disease. The main group consisted of 20 patients with chronic ulcers of the stomach and duodenum in the acute stage. Ulcerative history ranged from 5 to 20 years. Among them are dominated by patients with duodenal ulcer (4:1). The patients were of working age, men were three times more than women. This group was subjected to study in an outpatient procedure.
The control group included 16 patients with peptic ulcer complicated by perforation.
All biopsy specimens obtained from patients of both groups were studied in the department of Pathomorphology Republican Center of the Ministry of Health of the Republic of Uzbekistan.
In 2013, we filed an application for the acquisition of a patent entitled "Method for predicting perforation of chronic gastroduodenal ulcers" in the Intellectual Property Agency of the Republic of Uzbekistan.
Biopsies were obtained endoscopically using forceps in patients with uncomplicated ulcers or intraoperatively in patients with perforated duodenal ulcers. Biopsies were examined by electron microscopy after staining with hematoxylin and pre-eosin.
Results and its discussion
There were found following results between of 2 groups: significant differences in the ratios of the relative volume fractions of different cell structures and the respective zones between ulcers complicated by perforation and so called uncomplicated ulcers. The most significant differences are revealed in the content of the relative volume fraction of the lymph vessels (Table 1).
Table 1. - The results of microscopic examination
The cellular structure of the stroma Uncomplicated ulcer Before perforation and perforated ulcer
Vessels Blood 0.9 ± 0.02 1.2 ± 0.3
Lymphatic 0.4 ± 0.03 1.2 ± 0.4
Intercellular sybstance 55.4 92.2 ± 1.0
Paneth cells Found Not found
Thus, the relative volume fraction of the lymph vessels in perforated ulcers in more than 3 times higher than in uncomplicated ulcers (Table 1). This is due, primarily, a significant expansion of the lumen of the lymph capillaries. The differences observed in the relative volume fraction of the intercellular substance, which when perforating substantially more (almost twice) than bleeding ulcers and more than the uncomplicated ulcers.
Distinct differences were found in the contents of the duodenum in the crypts Paneth cells. Back in the late 60's mid 70-ies of the last century, it has been suggested that these cells perform the function that facilitates rapid renewal of the population of the intestinal epithelium, ie, mucosal repair. They contribute to an increase in mitotic activity.
A significant increase when perforated ulcers relative volume fraction of the lymphatic vessels is their main difference from the uncomplicated and bleeding ulcers.
Discussion
Analysis of the research showed, that by microscopic counting of morphological structures ulcerative substrate can predict the development of peptic ulcer perforation. To this end, all patients with ulcer history should undergo medical examinations with biopsy of the ulcer for morphological analysis. By increasing the volume fraction of "unstructured" zones in the submucosa, without Paneth cell mitosis and suggested the possible perforation of the ulcer.
Our studies have shown that the perforated ulcers (such as perforated and ulcer with high risk of perforation) major morphological differences are: 1) an increase in the relative volume fraction of cell-free "structureless" zones; 2) an increase in the relative volume fraction of the lymphatic vessels, and 3) a decrease in the number of Paneth cells, followed by a decrease in the number of mitotic figures. These morphological features can serve as predictors of objective possibility of perforation of gastroduodenal ulcers.
Analyzing the literature, the following facts were found. For example, Elisabete Kawakani examined biopsy for neutrophils and HP infection [9]. However, the white blood cells showed only
the degree of inflammation around the ulcer process, predicting perforation or any complications was not possible. A pathogen of ulcer disease is now possible to diagnose even with the help of numerous non-invasive methods.
American Society of Gastroenterology reports that the giant ulcer KDP are more prone to perforation, bleeding and penetration than small ulcers, 65 % and 12 %, respectively [8]. However, there is no information about a possible ulcer perforation.
Also in the medical journal of Hong Kong noted that the perforation (92 % of cases) is more common than bleeding (55 %) and stenosis (45 %) in patients with Helicobacter pylori positive ulcers [6].
In Japan, the granulocytes were found in periulcerative zone, which contained a large number of matrix-metalloprotein-ase-1 (MMP-1) [7]. Increasing these cells also play a role in ulcer perforation of the stomach and duodenum.
However, the literature is still no consensus on the methodology of forecasting of perforation of gastroduodenal ulcers.
Conclusion
The main morphological risk factors of perforation are the increase in the relative volume fraction of cell-free "structureless" zones; increase in the relative volume fraction of the lymphatic vessels and reducing the number of Paneth cells, followed by a decrease in the number of mitotic figures.
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Kasymova Gulmira Gafurovna, Scientific Research Institute of Hematology and Blood Transfusion
E-mail: [email protected]
Peroxidation of lipids and activity of enzymes of antioxidant protection in microsomal fraction of the liver and kidneys of rats with leucosis
Аbstract: In dynamics of experimental leucosis intensification of the POL (peroxidation of lipids) in microsomal fraction of the liver appears earlier and is more expressed, whereas in kidneys it develops slowly, becoming more active at final terms of experiment. It develops together with activity of antioxidant protection enzymes which progressively decrease in microsomal fraction of the liver, whereas in kidneys that inhibits only during sharp progressing of tumor process. Thus Compensatory capacity ofAOP (antioxidant protection) of microsomal fraction of the liver is sharply oppressed, defining early failure (decompensation), and in kidneys its failure noted after 7 months and aggravated by progressing of pathological process.
Keywords: antioxidant protection, tumor, pathological process.
Leucosis are one of actual problems of hematology due to rate of at persons younger 60 years, and among elderly — the rate high prevalence and high lethality. Optimization of its treatment was 10-12 %. However the lethality remains high due to develop-allowed increasing survival rate of patients. Results of treatment ment of septicinfectious, thrombo-haemorrhagic complications and ofacute myeloblast leucosis (OML) showed 35-50 % 5-year survival development of poly-organ insufficiency. In process of development
