Bone metastases in cholangiocarcinoma are uncommon. We report the case of a patient with disseminated osteolytic lesions who was admitted to the Neurology Department for progressive paraparesis. On the computed tomography examination, specific features for cholangiocarcinoma were described, confirmed later by the histopathological aspect of the bone lesions.
To study the possibility and effectiveness of using succinylated gelatin (SG) for injecting endoscopic hemostasis. Material and methods. 70 albino non-linear rats. 0.5 ml of the solution has been injected into the anterior wall of the stomach with a syringe after laparotomy. A mixture of 0.9 % NaCl solution and epinephrine hydrothartrate (1.8 mg/1 ml) has been used in a ratio of 1:20 for the control group (35 animals). A mixture of a solution of SG (40 mg/1000 ml of injection water) and epinephrine hydrothartrate (1.8 mg/1 ml) in a ratio of 1:20 for the experimental group (35 animals). Right after the injection and in 1, 3, 6, 12 hours, after laparotomy, the stomach wall has been taken for histological examination, during which the thickness of the stomach wall (TSW) has been determined. Results. As soon as the injection has been given, the TSW in animals of both groups hasn`t differed significantly. The TSW has significantly increased in both of the groups, and the parameters of indicators in the experimental group have significantly raised in 1 h after the injection. In 3, 6, and 12 hours, the TSW in both groups has been decreasing. The parameters of indicators in the experimental group of animals have been significantly higher than in the control one all the time during the study. The indicators have barely differed from the initial ones in the control group 12 hours later, whereas in the experimental one they have been significantly higher. Histological studies have shown that the structure of stomach tissues in both groups hasn`t varied. The SG injection has not caused any negative effects on the tissues of the stomach wall. The thickness of the submucosa hasn`t been much modified right after the injection. The thickness (26.95±5.34 microns) has increased in the experimental group 12 hours later than in the control one (15.45±4.38 microns, p<0.01). Most of the vessels of the experimental group have remained compressed 12 hours later, whereas the diameter of the vessels of the control group has been growing. Conclusions. 1. The TSW hasn`t differed right after the injection (a mixture of 0.9 % NaCl and epinephrine solution and a mixture of SG and epinephrine solution) into the stomach wall. 2. 1 h later after the injection, the TSW has increased and its parameters after injection of a mixture with SG have been significantly higher. 3. In 3,6,12 h and later on, the TSW has been gradually reducing and its parameters after injection of a mixture with SG have been significantly higher each time. The thickness of the submucosa and the degree of compression of the vessels have also been considerably higher. 4. No negative changes in the structure of stomach tissues after injection of the mixture with SG have been detected. This allows it to be used for performing endoscopic hemostasis by injection therapy in clinical conditions.
результати дослідження активності редокс-реакцій у 17 хворих на гострі виразкові кровотечі. У 4 хворих виник рецидив кровотечі. Встановлено, що у таких хворих переважає активність окисних реакцій на тлі недостатності системи глутатіону. Внаслідок цього порушуються процеси окисної трансформації білків. Це може бути серед причин дисбалансу системи гемостазу, пригнічення процесів регенерації та сприяти відновленню кровотеч. Показники, які характеризують глутатіонову систему, окисну модифікацію білків, можуть бути використані з прогностичною метою. Ключові слова: виразкові кровотечі, редокс-реакції, прогнозування.
Haemostatic therapy of ulcer bleeding (UB) is based on activation of the coagulation system and depression of the fibrinolytic one. Though not so much attention is paid to the oxidation-reduction system. Aim of the study — To elaborate the recommendations on optimization of hemostatic therapy. Were examined 25 patients with UB. 4 patients were evaluated by Forrest classification, type ІВ, 5 – type ІІА, 6 — type ІІВ, and 10 — type ІІІС. Patients with type ІВ had endoscopic haemostasis procedures. All patients got a standard haemostatic complex. Two patients who were evaluated by Forrest classification type ІІА had bleeding recurrence. The following data was determined in blood plasma: fibrinolytic and proteolytic activity, fibrinase, antithrombin ІІІ, prothrombin index, isolated double bonds, diene conjugates, cetodienes and conjugated trienes, oxidation of neutral and alkaline proteins, malonic aldehyde, renew glutathione, catalase. Patients who were evaluated by Forrest classification type ІІА had both a disorder of redox system and hemostasis system balance, caused by a violation of synthesis of its factors. This contributes to the occurrence of bleeding recurrence. The results of redox system together with the criteria for hemostasis condition can be used to predict the recurrence of ulcer bleeding. Medicinal measures need to be adjusted, and antioxidants together with hepatoprotectors to be prescribed. So, patients with UB recurrence have an excessive activation of lipoperoxidation, low level of basic proteins, decrease in functional capacity of antioxidant mechanisms and hemostasis system imbalance, caused by a violation of synthesis of its factors, it is essential to take into account while predicting UB recurrence, and in case of UB one should add to the medication management those means that inhibit the activity of lipid oxidation and contribute to the restoration of synthesis processes of hemostasis factors. The prospect of further development is the assessment of the effectiveness of an optimized treatment complex.
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