Pub Date : 2020-06-04DOI: 10.25298/2616-5546-2020-4-1-15-19
Dotsenko Ml, M. P. Gorovaya, V. Davydov, L. Anisko, Gutmane Vr, L. Zhmurovskaya, S. V. Krapivina, S. Zhavoronok
Представлен обзор литературных данных по проблеме гепатитов А и Е в группе МСМ (мужчин, имеющих секс с мужчинами), относительно которых вопросы эпидемиологии изучены не до конца, особенно полового пути передачи вирусного гепатита Е, а также частоты инфицирования среди ВИЧ-инфицированных МСМ-пациентов. Проанализированы научные исследования, представленные в базе PubMed. Представлен клинический случай микст-инфекции гепатита А и Е на фоне острой ВИЧ-инфекции. Сделан вывод, что пациенты МСМ должны быть тестированы на маркеры гепатитов А и Е. Ключевые слова: МСМ, гепатит А, гепатит Е, ВИЧ.
{"title":"HEPATITIS A AND E AMONG MEN HAVING SEX WITH MEN - STATE OF THE PROBLEM","authors":"Dotsenko Ml, M. P. Gorovaya, V. Davydov, L. Anisko, Gutmane Vr, L. Zhmurovskaya, S. V. Krapivina, S. Zhavoronok","doi":"10.25298/2616-5546-2020-4-1-15-19","DOIUrl":"https://doi.org/10.25298/2616-5546-2020-4-1-15-19","url":null,"abstract":"Представлен обзор литературных данных по проблеме гепатитов А и Е в группе МСМ (мужчин, имеющих секс с мужчинами), относительно которых вопросы эпидемиологии изучены не до конца, особенно полового пути передачи вирусного гепатита Е, а также частоты инфицирования среди ВИЧ-инфицированных МСМ-пациентов. Проанализированы научные исследования, представленные в базе PubMed. Представлен клинический случай микст-инфекции гепатита А и Е на фоне острой ВИЧ-инфекции. Сделан вывод, что пациенты МСМ должны быть тестированы на маркеры гепатитов А и Е. Ключевые слова: МСМ, гепатит А, гепатит Е, ВИЧ.","PeriodicalId":34878,"journal":{"name":"Gepatologiia i gastroenterologiia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42261949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-06-04DOI: 10.25298/2616-5546-2020-4-1-20-27
E. V. Mahiliavets
Введение. Являясь на сегодняшний день резервными методами, шунтирующие и разобщающие (нешунтирующие) хирургические операции помогают добиться стабильной профилактики рецидивов кровотечений из варикозно расширенных вен пищевода. Хирургические операции азигопортального разобщения более просты в исполнении в сравнении с шунтирующими операциями, ассоциируются с меньшим риском развития энцефалопатии в послеоперационном периоде. Цель исследования – анализ результатов выполнения лапароскопической эзофагогастральной деваскуляризации со степлерной транссекцией пищевода с последующей конверсией в тораколапаротомную резекцию дистальной трети пищевода и проксимальную резекцию желудка. Материал и методы. Лапароскопическая эзофагогастральная деваскуляризация со степлерной транссекцией пищевода с последующей конверсией в тораколапаротомную резекцию дистальной трети пищевода и проксимальную резекцию желудка по поводу обширного дефекта в области аппаратного прошивания в зоне эзофаго-эзофагоанастомоза выполнена в УЗ «Гродненская университетская клиника» в феврале 2019 г. пациенту с циррозом печени, портальной гипертензией и рецидивирующими кровотечениями из варикозно расширенных вен пищевода. Результаты. Пациент выписан на амбулаторное лечение, рецидивов кровотечений из варикозно расширенных вен пищевода за период наблюдения, составляющий 12 месяцев, не было. Лапароскопическая эзофагогастральная деваскуляризация со степлерной транссекцией пищевода, являясь эффективной операцией для лечения и профилактики кровотечений из варикозно расширенных вен пищевода, в ряде случаев сопряжена с осложнениями, связанными с некорректным срабатыванием аппарата циркулярного механического шва. Выводы. Своевременная интраоперационная диагностика данных ситуаций с помощью тщательной ревизии зоны эзофаго-эзофагоанастомоза, проведение тестов на его герметичность, знание оперирующим хирургом техники корригирующих осложнения оперативных вмешательств и готовность к их выполнению позволяют предотвратить фатальные последствия для пациентов. Ключевые слова: цирроз печени, портальная гипертензия, варикозно расширенные вены пищевода, эзофагогастральная деваскуляризация, азигопортальное разобщение, транссекция пищевода, проксимальная резекция желудка, пластика пищевода желудком.
{"title":"SURGICAL TACTICS FOR FAILURE OF STAPLER ESOFAGO-ESOFAGOANASTOMOSIS DURING ESOPHAGASTRIC DEVASCULARIZATION","authors":"E. V. Mahiliavets","doi":"10.25298/2616-5546-2020-4-1-20-27","DOIUrl":"https://doi.org/10.25298/2616-5546-2020-4-1-20-27","url":null,"abstract":"Введение. Являясь на сегодняшний день резервными методами, шунтирующие и разобщающие (нешунтирующие) хирургические операции помогают добиться стабильной профилактики рецидивов кровотечений из варикозно расширенных вен пищевода. Хирургические операции азигопортального разобщения более просты в исполнении в сравнении с шунтирующими операциями, ассоциируются с меньшим риском развития энцефалопатии в послеоперационном периоде. Цель исследования – анализ результатов выполнения лапароскопической эзофагогастральной деваскуляризации со степлерной транссекцией пищевода с последующей конверсией в тораколапаротомную резекцию дистальной трети пищевода и проксимальную резекцию желудка. Материал и методы. Лапароскопическая эзофагогастральная деваскуляризация со степлерной транссекцией пищевода с последующей конверсией в тораколапаротомную резекцию дистальной трети пищевода и проксимальную резекцию желудка по поводу обширного дефекта в области аппаратного прошивания в зоне эзофаго-эзофагоанастомоза выполнена в УЗ «Гродненская университетская клиника» в феврале 2019 г. пациенту с циррозом печени, портальной гипертензией и рецидивирующими кровотечениями из варикозно расширенных вен пищевода. Результаты. Пациент выписан на амбулаторное лечение, рецидивов кровотечений из варикозно расширенных вен пищевода за период наблюдения, составляющий 12 месяцев, не было. Лапароскопическая эзофагогастральная деваскуляризация со степлерной транссекцией пищевода, являясь эффективной операцией для лечения и профилактики кровотечений из варикозно расширенных вен пищевода, в ряде случаев сопряжена с осложнениями, связанными с некорректным срабатыванием аппарата циркулярного механического шва. Выводы. Своевременная интраоперационная диагностика данных ситуаций с помощью тщательной ревизии зоны эзофаго-эзофагоанастомоза, проведение тестов на его герметичность, знание оперирующим хирургом техники корригирующих осложнения оперативных вмешательств и готовность к их выполнению позволяют предотвратить фатальные последствия для пациентов. Ключевые слова: цирроз печени, портальная гипертензия, варикозно расширенные вены пищевода, эзофагогастральная деваскуляризация, азигопортальное разобщение, транссекция пищевода, проксимальная резекция желудка, пластика пищевода желудком.","PeriodicalId":34878,"journal":{"name":"Gepatologiia i gastroenterologiia","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69172385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-06-04DOI: 10.25298/2616-5546-2020-4-1-34-44
V. Tsyrkunov, V. Andreev, R. Kravchuk
Background. cell of hepatocyte apoptosis in chronic hepatitis C (CHC). of hepatitis C. Objective – to present the morphological characteristics of lysosome-dependent hepatocyte cell death. Material and methods. The object of the study was intravital liver biopsy samples of 18 patients with chronic HCV infection, obtained after they had signed informed consent. Liver biopsies were studied in a JEM-1011 electron microscope (JEOL, Japan) at magnifications of 10,000 - 60,000 at accelerating voltage of 80 kW. To obtain images, we used an Olympus Mega View III digital camera with iTEM image processing software (Olympus, Germany). Results. The illustrations and description show the interrelated sequential stages of lysosome-dependent cell death (LDCD) and autophagy-dependent cell death (ADCD) of hepatocytes in chronic hepatitis C. The process of autophagosome formation is presented, three types of autophagy are described (macroautophagy, microautophagy, chaperone-mediated autophagy). One of the main forms of autophagy, mitophagy, is illustrated in detail. The features of autophagy, its proviral and antiviral mechanisms, as well as the role of HCV in apoptosis associated with autophagy, are described.Conclusions. Autophagy-dependent hepatocyte death in chronic hepatitis C is a highly regulated and conservative cellular mechanism for maintaining cell homeostasis and promoting cell survival. HCV-induced autophagy suppresses apoptosis to promote cell survival. The autophagic response caused by HCV reduces the antiviral innate immune response in HCV infected hepatocytes, contributing to the chronicity of the infectious process. Visualization of the autophagy process allows for a more accurate assessment of the mechanisms and ultrastructural components of various types and stages of autophagy. Changes in all structural components of autophagy are not isolated, being characterized by a complex of specific signs associated with each other and united by the apoptosogenic mechanism of the pathogenesis of HCV infection.
背景。慢性丙型肝炎(CHC)中肝细胞凋亡的研究。目的探讨溶酶体依赖性肝细胞死亡的形态学特征。材料和方法。该研究的对象是18名慢性HCV感染患者的活体肝活检样本，这些样本是在他们签署知情同意书后获得的。肝脏活检在JEM-1011电子显微镜(JEOL, Japan)上进行，放大倍数为10,000 - 60,000，加速电压为80 kW。为了获取图像，我们使用了配备iTEM图像处理软件(Olympus, Germany)的Olympus Mega View III数码相机。结果。图解和描述显示了慢性丙型肝炎肝细胞溶酶体依赖性细胞死亡(LDCD)和自噬依赖性细胞死亡(ADCD)的相关顺序阶段。介绍了自噬体形成的过程，描述了三种类型的自噬(巨噬、微自噬、伴侣介导的自噬)。详细说明了自噬的主要形式之一——有丝自噬。本文综述了自噬的特点、前病毒和抗病毒机制，以及HCV在自噬相关细胞凋亡中的作用。慢性丙型肝炎自噬依赖性肝细胞死亡是一种高度调控和保守的细胞机制，用于维持细胞稳态和促进细胞存活。hcv诱导的自噬抑制细胞凋亡，促进细胞存活。HCV引起的自噬反应降低了HCV感染肝细胞的抗病毒先天免疫反应，导致感染过程的慢性化。可视化自噬过程可以更准确地评估各种类型和阶段的自噬机制和超微结构成分。自噬的所有结构成分的变化都不是孤立的，其特征是相互关联的特定体征的复合体，并通过HCV感染发病机制的凋亡发生机制统一起来。
{"title":"LYSOSOME-DEPENDENT DEATH OF HEPATOCYTES IN CHRONIC HEPATITIS C","authors":"V. Tsyrkunov, V. Andreev, R. Kravchuk","doi":"10.25298/2616-5546-2020-4-1-34-44","DOIUrl":"https://doi.org/10.25298/2616-5546-2020-4-1-34-44","url":null,"abstract":"Background. cell of hepatocyte apoptosis in chronic hepatitis C (CHC). of hepatitis C. Objective – to present the morphological characteristics of lysosome-dependent hepatocyte cell death. Material and methods. The object of the study was intravital liver biopsy samples of 18 patients with chronic HCV infection, obtained after they had signed informed consent. Liver biopsies were studied in a JEM-1011 electron microscope (JEOL, Japan) at magnifications of 10,000 - 60,000 at accelerating voltage of 80 kW. To obtain images, we used an Olympus Mega View III digital camera with iTEM image processing software (Olympus, Germany). Results. The illustrations and description show the interrelated sequential stages of lysosome-dependent cell death (LDCD) and autophagy-dependent cell death (ADCD) of hepatocytes in chronic hepatitis C. The process of autophagosome formation is presented, three types of autophagy are described (macroautophagy, microautophagy, chaperone-mediated autophagy). One of the main forms of autophagy, mitophagy, is illustrated in detail. The features of autophagy, its proviral and antiviral mechanisms, as well as the role of HCV in apoptosis associated with autophagy, are described.Conclusions. Autophagy-dependent hepatocyte death in chronic hepatitis C is a highly regulated and conservative cellular mechanism for maintaining cell homeostasis and promoting cell survival. HCV-induced autophagy suppresses apoptosis to promote cell survival. The autophagic response caused by HCV reduces the antiviral innate immune response in HCV infected hepatocytes, contributing to the chronicity of the infectious process. Visualization of the autophagy process allows for a more accurate assessment of the mechanisms and ultrastructural components of various types and stages of autophagy. Changes in all structural components of autophagy are not isolated, being characterized by a complex of specific signs associated with each other and united by the apoptosogenic mechanism of the pathogenesis of HCV infection.","PeriodicalId":34878,"journal":{"name":"Gepatologiia i gastroenterologiia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45155279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-06-04DOI: 10.25298/2616-5546-2020-4-1-45-54
A. G. Lishnevska, M. Chemych
Введение. Хронический гепатит С (ХГС) – заболевание печени, которое часто приводит к циррозу печени и гепатоцеллюлярной карциноме. Цель исследования – установить корреляционные связи между клиническими, лабораторными, интегративными показателями и неинвазивными методами расчета фиброза печени у пациентов с ХГС. Материал и методы. У 287 пациентов с ХГС, которые были разделены на 5 групп (по степени фиброза (F)), изучали особенности клиники, лабораторных показателей, рассчитывали интегративные показатели, APRI (AST to Platelet Ratio Index) и FIB-4 (Fibrosis-4 Index for Liver Fibrosis). Статистический анализ проводился с использованием программ Microsoft Office Excel 2016, IBM SPSS Statistics с расчетом непараметрических критериев. Результаты. Преобладали пациенты с ХГС мужского пола, с умеренно выраженным фиброзом, 1b генотипом и минимальной активностью. Установлена прямая корреляционная связь между F (METAVIR) и FIB-4 (р<0,05), FIB-4 и APRI (р<0,05) и тенденция к корреляции между F (METAVIR) и APRI. Отмечена прямая связь между F (METAVIR), APRI, FIB-4 и возрастом, индексом массы тела (р<0,05). Установлена обратно пропорциональная корреляция между F (METAVIR), APRI, FIB-4 и уровнем тромбоцитов; F (METAVIR) и активностью АЛТ, АСТ, ГГТП; между APRI, FIB-4 и количеством лейкоцитов, FIB-4 и количеством эритроцитов (р<0,05). Прямые связи наблюдались между тремя показателями фиброза и билирубином; F (METAVIR) и ЩФ; APRI, FIB-4 и СОЭ, активностью АЛТ, АСТ и ГГТП; FIB-4 и коэффициентом де Ритиса (р<0,05). Выводы. Увеличение степени фиброза обратно пропорционально коррелировало с количеством тромбоцитов, лейкоцитов и эритроцитов, прямо пропорционально – с СОЭ и билирубином. Корреляция интегративных показателей с нарастанием степени фиброза указывала на усиление интоксикации, связанной с аутоиммунным процессом, снижение неспецифической иммунореактивности. Ключевые слова: корреляция, фиброз печени, интегративные показатели. Оригинальные исследования
{"title":"CORRELATIONS BETWEEN CLINICAL, HEMATOLOGICAL, BIOCHEMICAL AND INTEGRATIVE INDICATORS AND THE DEGREE OF FIBROSIS IN PATIENTS WITH CHRONIC HEPATITIS C","authors":"A. G. Lishnevska, M. Chemych","doi":"10.25298/2616-5546-2020-4-1-45-54","DOIUrl":"https://doi.org/10.25298/2616-5546-2020-4-1-45-54","url":null,"abstract":"Введение. Хронический гепатит С (ХГС) – заболевание печени, которое часто приводит к циррозу печени и гепатоцеллюлярной карциноме. Цель исследования – установить корреляционные связи между клиническими, лабораторными, интегративными показателями и неинвазивными методами расчета фиброза печени у пациентов с ХГС. Материал и методы. У 287 пациентов с ХГС, которые были разделены на 5 групп (по степени фиброза (F)), изучали особенности клиники, лабораторных показателей, рассчитывали интегративные показатели, APRI (AST to Platelet Ratio Index) и FIB-4 (Fibrosis-4 Index for Liver Fibrosis). Статистический анализ проводился с использованием программ Microsoft Office Excel 2016, IBM SPSS Statistics с расчетом непараметрических критериев. Результаты. Преобладали пациенты с ХГС мужского пола, с умеренно выраженным фиброзом, 1b генотипом и минимальной активностью. Установлена прямая корреляционная связь между F (METAVIR) и FIB-4 (р<0,05), FIB-4 и APRI (р<0,05) и тенденция к корреляции между F (METAVIR) и APRI. Отмечена прямая связь между F (METAVIR), APRI, FIB-4 и возрастом, индексом массы тела (р<0,05). Установлена обратно пропорциональная корреляция между F (METAVIR), APRI, FIB-4 и уровнем тромбоцитов; F (METAVIR) и активностью АЛТ, АСТ, ГГТП; между APRI, FIB-4 и количеством лейкоцитов, FIB-4 и количеством эритроцитов (р<0,05). Прямые связи наблюдались между тремя показателями фиброза и билирубином; F (METAVIR) и ЩФ; APRI, FIB-4 и СОЭ, активностью АЛТ, АСТ и ГГТП; FIB-4 и коэффициентом де Ритиса (р<0,05). Выводы. Увеличение степени фиброза обратно пропорционально коррелировало с количеством тромбоцитов, лейкоцитов и эритроцитов, прямо пропорционально – с СОЭ и билирубином. Корреляция интегративных показателей с нарастанием степени фиброза указывала на усиление интоксикации, связанной с аутоиммунным процессом, снижение неспецифической иммунореактивности. Ключевые слова: корреляция, фиброз печени, интегративные показатели. Оригинальные исследования","PeriodicalId":34878,"journal":{"name":"Gepatologiia i gastroenterologiia","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69172400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-06-04DOI: 10.25298/2616-5546-2020-4-1-81-85
M. Shylava, A. V. Abramovich, I. N. Valchuk, M. Dotsenko, G. N. Chistenko, S. Zhavoronok
ЭПИДЕМИОЛОГИЧЕСКАЯ ХАРАКТЕРИСТИКА НАРКОПОТРЕБЛЕНИЯ И ЭФФЕКТИВНОСТИ ПРОВЕДЕНИЯ ЗАМЕСТИТЕЛЬНОЙ ТЕРАПИИ МЕТАДОНОМ У ПОТРЕБИТЕЛЕЙ ИНЪЕКЦИОННЫХ НАРКОТИКОВ С ВИЧ-ПОЗИТИВНЫМ СТАТУСОМ, ИНФИЦИРОВАННЫХ ВИРУСОМ ГЕПАТИТА С, В г. МИНСКЕ 1М. А. Шилова, 2А. В. Абрамович, 1И. Н. Вальчук, 1М. Л. Доценко, 1Г. Н. Чистенко, 1С. В. Жаворонок 1Белорусский государственный медицинский университет, Минск, Беларусь 2Городской клинический наркологический диспансер, Минск, Беларусь
{"title":"EPIDEMIOLOGICAL CHARACTERISTICS OF DRUG USE AND EFFECTIVENESS OF METHADONE SUBSTITUTION THERAPY IN HIV-POSITIVE INJECTING DRUG USERS INFECTED WITH VIRAL HEPATITIS C IN MINSK","authors":"M. Shylava, A. V. Abramovich, I. N. Valchuk, M. Dotsenko, G. N. Chistenko, S. Zhavoronok","doi":"10.25298/2616-5546-2020-4-1-81-85","DOIUrl":"https://doi.org/10.25298/2616-5546-2020-4-1-81-85","url":null,"abstract":"ЭПИДЕМИОЛОГИЧЕСКАЯ ХАРАКТЕРИСТИКА НАРКОПОТРЕБЛЕНИЯ И ЭФФЕКТИВНОСТИ ПРОВЕДЕНИЯ ЗАМЕСТИТЕЛЬНОЙ ТЕРАПИИ МЕТАДОНОМ У ПОТРЕБИТЕЛЕЙ ИНЪЕКЦИОННЫХ НАРКОТИКОВ С ВИЧ-ПОЗИТИВНЫМ СТАТУСОМ, ИНФИЦИРОВАННЫХ ВИРУСОМ ГЕПАТИТА С, В г. МИНСКЕ 1М. А. Шилова, 2А. В. Абрамович, 1И. Н. Вальчук, 1М. Л. Доценко, 1Г. Н. Чистенко, 1С. В. Жаворонок 1Белорусский государственный медицинский университет, Минск, Беларусь 2Городской клинический наркологический диспансер, Минск, Беларусь","PeriodicalId":34878,"journal":{"name":"Gepatologiia i gastroenterologiia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49139398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-01DOI: 10.25298/2616-5546-2020-4-2-207-211
E. V. Мahialevеts, A. Sokolov, A. A. Oganesyan, A. Sobol, M. V. Buchinskiy, A. Kuhta
Background. A burn of the gastrointestinal tract due to the ingestion of corrosive substances is one of the most common causes leading to the development of persistent pathological changes. Objective. To analyze a clinical case of laparoscopic gastroenteroanastomosis in a patient with gastric outlet obstruction secondary to accidental acid ingestion. Material and methods. The laparoscopic gastroenteroanastomosis was successfully performed on a patient with gastric outlet obstruction secondary to accidental acid ingestion in October, 2019 at Grodno University Hospital. During the postoperative period, the patient was followed up and diagnostic observation was conducted. The patient’s medical record was analyzed as well. Results. The surgery proceeded uneventfully and lasted for 3 hours. Enteral feeding was initiated on the 3rd day after the operation and was delivered via a feeding tube using liquid diet. The postoperative period elapsed without complications. The patient was discharged from the hospital after nutritional status compensation on the 12th day after the operation. Conclusions. Laparoscopic gastroenteroanastomosis is a minimally invasive, easily tolerated and effective operation, and can be considered a good alternative to other modern surgical approaches to the treatment of post-burn pyloric stenosis.
{"title":"LAPAROSCOPIC GASTROENTEROANASTOMOSIS FOR GASTRIC OUTLET OBSTRUCTION SECONDARY TO ACCIDENTAL ACID INGESTION","authors":"E. V. Мahialevеts, A. Sokolov, A. A. Oganesyan, A. Sobol, M. V. Buchinskiy, A. Kuhta","doi":"10.25298/2616-5546-2020-4-2-207-211","DOIUrl":"https://doi.org/10.25298/2616-5546-2020-4-2-207-211","url":null,"abstract":"Background. A burn of the gastrointestinal tract due to the ingestion of corrosive substances is one of the most common causes leading to the development of persistent pathological changes. Objective. To analyze a clinical case of laparoscopic gastroenteroanastomosis in a patient with gastric outlet obstruction secondary to accidental acid ingestion. Material and methods. The laparoscopic gastroenteroanastomosis was successfully performed on a patient with gastric outlet obstruction secondary to accidental acid ingestion in October, 2019 at Grodno University Hospital. During the postoperative period, the patient was followed up and diagnostic observation was conducted. The patient’s medical record was analyzed as well. Results. The surgery proceeded uneventfully and lasted for 3 hours. Enteral feeding was initiated on the 3rd day after the operation and was delivered via a feeding tube using liquid diet. The postoperative period elapsed without complications. The patient was discharged from the hospital after nutritional status compensation on the 12th day after the operation. Conclusions. Laparoscopic gastroenteroanastomosis is a minimally invasive, easily tolerated and effective operation, and can be considered a good alternative to other modern surgical approaches to the treatment of post-burn pyloric stenosis.","PeriodicalId":34878,"journal":{"name":"Gepatologiia i gastroenterologiia","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69173618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-01DOI: 10.25298/2616-5546-2020-4-2-126-142
V. Andreev, V. Tsyrkunov, R. Kravchuk
Background. Changes in the architecture of the hepatocyte nucleus resulting from liver tissue exposure to pathogens have diagnostic and prognostic signifcance. In morphological study of liver tissue in chronic HCV infection there is a diffcult with the viability assessment of hepatocytes and their organelles in the presence of various mechanisms of nonprogrammed and controlled cell death. Objective. To present the data available in literature and the results of our own studies of structural architecture of hepatocyte nuclei and their components in chronic hepatitis C (CHC). Material and methods. The intravital liver bioptates of 18 patients with CHC (who had given a written informed consent) were studied. Some visualization methods were used: light and electron microscopy, including examination of semi-thin sections, various methods of fxation and staining. Results. The results of the authors’ morphological studies are presented, demonstrating some changes in structural and functional characteristics of the nuclear apparatus of hepatocytes and nuclear components with a detailed description and interpretation of the changes (polyploidy, nuclear envelope, nucleoplasm, chromosomes, perichromatin fbrils, interchromatin and perichromatin granules, nucleolus, nucleolar stress and replication others). Conclusion. In chronic HCV infection, changes occur in all components of the nuclear apparatus characterizing structural and functional features of hepatocytes. The assessment of architectural organization of the nuclear apparatus in hepatocytes provides pathomorphologists and clinicians (hepatologists) with valuable additional data indicating the applied signifcance of the changes in the parameters of the nuclear apparatus of hepatocytes in CHC, that in its turn, will contribute to more accurate monitoring of the infectious process and accelerated diagnosis of its transformation into malignant growth.
{"title":"CLINICAL LIVER MORPHOLOGY: THE NUCLEAR APPARATUS OF HEPATOCYTES","authors":"V. Andreev, V. Tsyrkunov, R. Kravchuk","doi":"10.25298/2616-5546-2020-4-2-126-142","DOIUrl":"https://doi.org/10.25298/2616-5546-2020-4-2-126-142","url":null,"abstract":"Background. Changes in the architecture of the hepatocyte nucleus resulting from liver tissue exposure to pathogens have diagnostic and prognostic signifcance. In morphological study of liver tissue in chronic HCV infection there is a diffcult with the viability assessment of hepatocytes and their organelles in the presence of various mechanisms of nonprogrammed and controlled cell death. Objective. To present the data available in literature and the results of our own studies of structural architecture of hepatocyte nuclei and their components in chronic hepatitis C (CHC). Material and methods. The intravital liver bioptates of 18 patients with CHC (who had given a written informed consent) were studied. Some visualization methods were used: light and electron microscopy, including examination of semi-thin sections, various methods of fxation and staining. Results. The results of the authors’ morphological studies are presented, demonstrating some changes in structural and functional characteristics of the nuclear apparatus of hepatocytes and nuclear components with a detailed description and interpretation of the changes (polyploidy, nuclear envelope, nucleoplasm, chromosomes, perichromatin fbrils, interchromatin and perichromatin granules, nucleolus, nucleolar stress and replication others). Conclusion. In chronic HCV infection, changes occur in all components of the nuclear apparatus characterizing structural and functional features of hepatocytes. The assessment of architectural organization of the nuclear apparatus in hepatocytes provides pathomorphologists and clinicians (hepatologists) with valuable additional data indicating the applied signifcance of the changes in the parameters of the nuclear apparatus of hepatocytes in CHC, that in its turn, will contribute to more accurate monitoring of the infectious process and accelerated diagnosis of its transformation into malignant growth.","PeriodicalId":34878,"journal":{"name":"Gepatologiia i gastroenterologiia","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69172485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-01DOI: 10.25298/2616-5546-2020-4-2-177-183
S. Korotkov, V. Smolnikova, V. Hrynevich, O. Lebed, M. N. Vasilenka, D. Efimov, A. Fedoruk, A. Shcherba, S. I. Kryvenka, O. Rummo, Minsk Scientifc, Minsk Belarus Hematology, Minsk Belarus City Clinical Pathologoanatomic Bureau
Background. Immune-mediated graft dysfunction with the prevalence of 40% is one of the main problems of modern transplantology. Although percutaneous liver graft biopsy is associated with the development of different complications occurring in 2,2% of cases and can also lead to fatal outcome. Objective – to develop a noninvasive method of graft dysfunction diagnostics in the late post-transplant period using terminally differentiated effector CD8+ T-lymphocytes. Material and methods. There was carried out a single center observational retrospective case-control pilot study, including 45 recipients after orthotopic liver transplantation. According to the postoperative clinical course the patients were stratifed into 2 groups depending on the presence of graft rejection episodes. All patients got immunosuppressive therapy after liver transplantation. Immunophenotypes of the recipients were determined by flow cytometry method. Percutaneous liver graft biopsy was performed in all patients, the results of histological examination were evaluated according to the international Banff schema for grading liver allograft rejection. Results. The results of liver biopsies showed that 14 (31%) out of 45 patients had morphological signs of rejection. The patients with rejection had a reliably higher level of CD8+ Temra cells absolute number (0,23 (0,14;0,38) x 109/l) in comparison to those without rejection (0,09) (0,034;0,16) x 109/l (p=0,034)). The results of ROC-analysis have shown that the most optimal cut-off threshold of CD8+ T-lymphocytes level in immune-mediated graft dysfunction diagnostics in the late post-transplant period is 0,1882x109/l; sensitivity and specifcity in this case being 73,33 (95%; 44,9-92,0) and 96,55 (95%; 82,2-99,4) respectively. Conclusions. The increase of terminally differentiated effector CD8+ T-lymphocytes absolute number has diagnostic importance in patients with immune-mediated graft dysfunction in the late post-transplant period. High sensitivity and specifcity of cut-off threshold of CD8+ Temra lymphocytes absolute number in patients after liver transplantation as well as reliable difference between cell number in patients with normal postoperative period and in patients with immune-mediated graft dysfunction allow considering T-lymphocyte subpopulation as a rejection predictor in the late post-transplant period. The correlation between CD8+ T-lymphocyte absolute number and the results of histological examination makes the former an alternative and, what is more, safe noninvasive method in early diagnostics of liver graft rejection.
{"title":"THE OPPORTUNITIES OF NON-INVASIVE LIVER GRAFT REJECTION DIAGNOSTICS BY USING TERMINALLY DIFFERENTIATED EFFECTOR CD8+ T-LYMPHOCYTES","authors":"S. Korotkov, V. Smolnikova, V. Hrynevich, O. Lebed, M. N. Vasilenka, D. Efimov, A. Fedoruk, A. Shcherba, S. I. Kryvenka, O. Rummo, Minsk Scientifc, Minsk Belarus Hematology, Minsk Belarus City Clinical Pathologoanatomic Bureau","doi":"10.25298/2616-5546-2020-4-2-177-183","DOIUrl":"https://doi.org/10.25298/2616-5546-2020-4-2-177-183","url":null,"abstract":"Background. Immune-mediated graft dysfunction with the prevalence of 40% is one of the main problems of modern transplantology. Although percutaneous liver graft biopsy is associated with the development of different complications occurring in 2,2% of cases and can also lead to fatal outcome. Objective – to develop a noninvasive method of graft dysfunction diagnostics in the late post-transplant period using terminally differentiated effector CD8+ T-lymphocytes. Material and methods. There was carried out a single center observational retrospective case-control pilot study, including 45 recipients after orthotopic liver transplantation. According to the postoperative clinical course the patients were stratifed into 2 groups depending on the presence of graft rejection episodes. All patients got immunosuppressive therapy after liver transplantation. Immunophenotypes of the recipients were determined by flow cytometry method. Percutaneous liver graft biopsy was performed in all patients, the results of histological examination were evaluated according to the international Banff schema for grading liver allograft rejection. Results. The results of liver biopsies showed that 14 (31%) out of 45 patients had morphological signs of rejection. The patients with rejection had a reliably higher level of CD8+ Temra cells absolute number (0,23 (0,14;0,38) x 109/l) in comparison to those without rejection (0,09) (0,034;0,16) x 109/l (p=0,034)). The results of ROC-analysis have shown that the most optimal cut-off threshold of CD8+ T-lymphocytes level in immune-mediated graft dysfunction diagnostics in the late post-transplant period is 0,1882x109/l; sensitivity and specifcity in this case being 73,33 (95%; 44,9-92,0) and 96,55 (95%; 82,2-99,4) respectively. Conclusions. The increase of terminally differentiated effector CD8+ T-lymphocytes absolute number has diagnostic importance in patients with immune-mediated graft dysfunction in the late post-transplant period. High sensitivity and specifcity of cut-off threshold of CD8+ Temra lymphocytes absolute number in patients after liver transplantation as well as reliable difference between cell number in patients with normal postoperative period and in patients with immune-mediated graft dysfunction allow considering T-lymphocyte subpopulation as a rejection predictor in the late post-transplant period. The correlation between CD8+ T-lymphocyte absolute number and the results of histological examination makes the former an alternative and, what is more, safe noninvasive method in early diagnostics of liver graft rejection.","PeriodicalId":34878,"journal":{"name":"Gepatologiia i gastroenterologiia","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69173092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-01DOI: 10.25298/2616-5546-2020-4-2-201-206
T. Amvrosieva, N. Paklonskaya, I. Belskaya, Y. Koltunova, Y. Shilova
Background. The monitoring of enteric viruses in wastewater is a new epidemiological approach allowing to detect the intensity of their circulation in humans. The aim of the study is to conduct and analyze parallel monitoring studies of wastewater and biological material from patients with acute viral intestinal infections (AEI) selected from different regions of the Republic of Belarus in terms of their actual pathogens. Material and methods. 403 samples of wastewater and 381 samples of feces from patients with AEI, collected in different regions of Belarus, were examined by real-time PCR. Results. In patients with AEI, rotaviruses A (20,4%) and noroviruses of the genogroup 2 (10,2%) were most often detected, while adenoviruses F (2,2%), enteroviruses (0,8%) and noroviruses 1 (0,3%) were found quite rarely. Adenoviruses F (25,9%), rotaviruses A (18,4%) and enteroviruses (13,4%) dominated in wastewater samples while noroviruses 2 (6,8%) and noroviruses 1 were detected much less frequently (1,5%). Certain differences were revealed in the percentage of viral AСI pathogens present in patients and those found in wastewater, that indicates active hidden circulation of some of them (adenoviruses F and enteroviruses). SARS-CoV-2 coronavirus was detected in one of the wastewater samples. The conducted sequencing and bioinformatic analysis of its nucleotide sequence showed 100% similarity with the sequences of isolates identifed in patients with COVID-19.Conclusions. The obtained data indicate the potential of the studies based on monitoring of intestinal viruses in wastewater in order to increase the effectiveness of epidemiological surveillance of known AEI pathogens circulation and to identify new and emerging ones.
{"title":"THE MONITORING OF DOMINANT ENTERIC VIRUSES IN WASTEWATER AS AN OPPORTUNITY TO IMPROVE THE EFFICIENCY OF EPIDEMIOLOGICAL SURVEILLANCE OF ACUTE VIRAL INTESTINAL INFECTIONS","authors":"T. Amvrosieva, N. Paklonskaya, I. Belskaya, Y. Koltunova, Y. Shilova","doi":"10.25298/2616-5546-2020-4-2-201-206","DOIUrl":"https://doi.org/10.25298/2616-5546-2020-4-2-201-206","url":null,"abstract":"Background. The monitoring of enteric viruses in wastewater is a new epidemiological approach allowing to detect the intensity of their circulation in humans. The aim of the study is to conduct and analyze parallel monitoring studies of wastewater and biological material from patients with acute viral intestinal infections (AEI) selected from different regions of the Republic of Belarus in terms of their actual pathogens. Material and methods. 403 samples of wastewater and 381 samples of feces from patients with AEI, collected in different regions of Belarus, were examined by real-time PCR. Results. In patients with AEI, rotaviruses A (20,4%) and noroviruses of the genogroup 2 (10,2%) were most often detected, while adenoviruses F (2,2%), enteroviruses (0,8%) and noroviruses 1 (0,3%) were found quite rarely. Adenoviruses F (25,9%), rotaviruses A (18,4%) and enteroviruses (13,4%) dominated in wastewater samples while noroviruses 2 (6,8%) and noroviruses 1 were detected much less frequently (1,5%). Certain differences were revealed in the percentage of viral AСI pathogens present in patients and those found in wastewater, that indicates active hidden circulation of some of them (adenoviruses F and enteroviruses). SARS-CoV-2 coronavirus was detected in one of the wastewater samples. The conducted sequencing and bioinformatic analysis of its nucleotide sequence showed 100% similarity with the sequences of isolates identifed in patients with COVID-19.Conclusions. The obtained data indicate the potential of the studies based on monitoring of intestinal viruses in wastewater in order to increase the effectiveness of epidemiological surveillance of known AEI pathogens circulation and to identify new and emerging ones.","PeriodicalId":34878,"journal":{"name":"Gepatologiia i gastroenterologiia","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69173274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-01DOI: 10.25298/2616-5546-2020-4-2-184-188
D. Danilau
Background. Worldwide, prior to 1990, a large number of patients with hemophilia were infected with the hepatitis C virus due to substitution therapy. The mortality rate from chronic liver disease and HCC in patients with HCV and hemophilia is signifcantly higher than in general population. Objective. To assess the results of direct-acting antiviral therapy in patients with hemophilia and chronic hepatitis C. Material and methods. The rate of sustained virologic response after DAA treatment and the dynamics of clinical and laboratory parameters during antiviral treatment were evaluated. Results. All 14 patients achieved sustained virological response after 12 / 24 weeks of treatment. During antiviral treatment, some patients showed an increase in blood urea nitrogen, a decrease in leukocyte count, and increase of ALT activity. All these phenomena were reversible and resolved spontaneously. Conclusion. The DAA regimens available in Belarus are highly effective for the treatment of chronic hepatitis C in patients with hemophilia. These regimens do not signifcantly affect hematological parameters, are well tolerated, and have acceptable safety profle.
{"title":"THE USE OF DIRECT-ACTING ANTIVIRALS FOR THE TREATMENT OF CHRONIC HEPATITIS C IN PATIENTS WITH HEMOPHILIA","authors":"D. Danilau","doi":"10.25298/2616-5546-2020-4-2-184-188","DOIUrl":"https://doi.org/10.25298/2616-5546-2020-4-2-184-188","url":null,"abstract":"Background. Worldwide, prior to 1990, a large number of patients with hemophilia were infected with the hepatitis C virus due to substitution therapy. The mortality rate from chronic liver disease and HCC in patients with HCV and hemophilia is signifcantly higher than in general population. Objective. To assess the results of direct-acting antiviral therapy in patients with hemophilia and chronic hepatitis C. Material and methods. The rate of sustained virologic response after DAA treatment and the dynamics of clinical and laboratory parameters during antiviral treatment were evaluated. Results. All 14 patients achieved sustained virological response after 12 / 24 weeks of treatment. During antiviral treatment, some patients showed an increase in blood urea nitrogen, a decrease in leukocyte count, and increase of ALT activity. All these phenomena were reversible and resolved spontaneously. Conclusion. The DAA regimens available in Belarus are highly effective for the treatment of chronic hepatitis C in patients with hemophilia. These regimens do not signifcantly affect hematological parameters, are well tolerated, and have acceptable safety profle.","PeriodicalId":34878,"journal":{"name":"Gepatologiia i gastroenterologiia","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69173134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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