Репозиторий Университета

© 2018 Publishing House of the Union of Pediatricians. All rights reserved. This lecture for the system of postgraduate medical education analyzes causes, types, key links of pathogenesis, and manifestations of the main typical forms of liver pathology-liver failure, hepatic coma, jaundice, cholemia, acholia, cholelithiasis, and their complications in children. To control the retention of the lecture material, case problems and multiple-choice tests are given.

AIM: To develop predictive model for hepatic insufficiency in obstructive jaundice.MATERIAL AND METHODS: Obstructive jaundice was modeled by the author's method on 48 mini pigs, while morpho-functional features of erythrocytes were studied by using of INTEGRA Aura atomic force microscope (NT-MDT, Zelenograd, Russia). Histological specimens were stained with hematoxylin and eosin. Discriminant analysis was used to create predictive model for hepatic insufficiency.RESULTS: Mathematical model of hepatic insufficiency prediction has been developed. Sensitivity and specificity of this model were 94.1% and 74.2% respectively. Total percentage of correct predictions was 81.3%.CONCLUSION: Severe obstructive jaundice contributes erythrocyte's transformation from biconcave to dome-shaped followed by changes of its physical properties. Erythrocyte's volume and activity of cytolysis enzymes are the most informative to predict hepatic insufficiency. Our model allows us to diagnose this complication at early stages and to correct pre-, intra- and postoperative therapy.

© 2018 GEOTAR Media. All rights reserved. The purpose of the study is to develop an accessible method of dynamic control of patients with mechanical jaundice for a practical doctor. Data from 258 medical histories of patients with mechanical jaundice were studied. To solve this problem we used a method for calculating the severity level using a universal statistical program StatSoft Statistica for OS Windows. A mathematical relationship between a degree of possibility of a fatal outcome and the nine significant parameters was developed. As a result of the calculations, such factors as disease duration (days), blood bilirubin, body temperature, blood leucocytosis, pulse rate, patient age, blood creatinine, blood lymphocytes, respiratory rate appeared to be significant parameters in calculating the severity of mechanical jaundice of a particular patient. At the second stage, a multivariate regression analysis was performed, used to assess the degree of influence of various factors on the resulting indicator. A statistical dependence was found on the basis of which a formula combining 9 significant parameters was developed to determine the severity level of a patient based on the degree of influence of each of these factors on the resulting parameter: G = 0,002 (d×b) + 1,2 (t - 36,6) + 0,001 (p×v) + 0,322 (L/1000 - 5) + + 0,22 (16 - Lim) + 0,0085 (K - 60) + 0,165 (Di - 20). The formula took into account the stochastic dependence of the resulting parameter on the factors influencing it. When calculating a correlation analysis was conducted aimed at establishing a stochastic relationship between the parameters and estimating the tightness of the connection between the factors and the resulting index. This method of calculating the severity level can be applied by any surgeon and can accurately monitor the minimum changes in the patient's condition, as well as the effect of individual elements of treatment on the state of the disease.

© 2018 Vitebsk State Medical University. All rights reserved. Objective: To study the functional activity and cytoarchitectonics of neutrophilic granulocytes by the atomic force microscopy technique in the patients with mechanical jaundice of benign genesis of varying severity. Methods: The subject of the study were 92 patients aged from 47 to 69 years undergoing the in-patient treatment in the surgical departments of medical institutions in Krasnoyarsk with the diagnosis of mechanical jaundice of benign genesis. The control group consisted of 60 donors, comparable in sex and age with the main group. Depending on the severity of mechanical jaundice, luminol-dependent chemiluminescence of neutrophils was investigated and atomic-force microscopy of neurophilic granulocytes was performed to determine the shape, membrane state, geometric dimensions and adhesion forces of the blood neutrophils. Results: In patients with mechanical jaundice, the intensity of spontaneous chemiluminescence depends on the severity of mechanical jaundice. The kinetics of the chemiluminescent response of the peripheral blood neutrophils indicates an increase in the compensatory functional capacity of this cell population in case of mild degree of mechanical jaundice severity with their depletion in parallel with the increase in the severity of mechanical jaundice. Atomic force microscopy revealed violations of the structural organization of the neutrophil granulocyte. With increasing severity of mechanical jaundice, neutrophil became convex in shape, the number of segments of the nucleus increased, the cell membrane became irregular, the neutrophil volume reached 62.20 + 5.94 m3. The magnitude of the adhesion forces of neutrophils decreased by 25% in patients with class B severity of mechanical jaundice and by 31% with class C severity of mechanical jaundice. Conclusions: Based on the analysis of the chemiluminescent activity of neutrophilic granulocytes and their cytoarchitectonics, we concluded that the functional capabilities of neutrophilic granulocytes in mechanical jaundice are depleted in parallel with the increase in the severity of mechanical jaundice. Dysfunctions of neutrophils in mechanical jaundice are caused by the change in its cytoarchitectonics and by the decrease in adhesion forces.