Цель. Повышение эффективности лечения больных распространенным альвеококкозом печени применением современных хирургических технологий, включая трансплантационные. Материал и методы. Проведен анализ хирургического лечения 25 больных с распространенным альвеококкозом печени с 2008 по 2014 г. Операции выполнены 21 больному. Метастазы (отсевы) в легких диагностированы у 2. Длительная механическая желтуха была у 5 пациентов, портальная гипертензия-у 2. У 1 пациентки сопутствующий гепатит В привел к циррозу печени. Результаты. Хирургические вмешательства отличались большим объемом и включали резекцию печени in situ в 16 наблюдениях, ex situ-в 1, ортотопическую трансплантацию печени-в 3. При резекции печени врастание в нижнюю полую вену выявлено в 9 наблюдениях: 6 больным протезировали нижнюю полую вену армированными протезами из политетрафторэтилена, в 1 наблюдении-с пластикой устья левой печеночной вены, в 3с краевой резекцией. Резекция и реконструкция воротной вены выполнены 6 больным. В 9 наблюдениях выполнена резекция внепеченочных желчных протоков. Резекция правого купола диафрагмы выполнена 4 больным. Одному пациенту выполнена диагностическая лапаротомия. Всем больным после операции проводят противопаразитарную терапию. Отмечен 1 летальный исход, наступивший в послеоперационном периоде от полиорганной недостаточности. В течение 7 лет наблюдения рецидива заболевания не выявлено. Противопаразитарная терапия после трансплантации печени не потребовала коррекции иммуносупрессивной терапии. Заключение. Операции при альвеококкозе отличаются большим объемом в сочетании с реконструктивно-пластическими вмешательствами на магистральных сосудах и желчных протоках. Максимальное стремление к резекционной хирургии связано с потенциальной опасностью иммуносупрессивной терапии после трансплантации печени для прогрессирования заболевания, что оправдывает сложные резекции ex situ.
Objective: to study the electrokinetic and aggregation properties, as well as the pro-oxidant and antioxidant processes in red blood cells following kidney transplantation in donors and in recipients in the postoperative period. Materials and methods. Blood from 12 recipients and 5 kidney donors over time – before transplantation, as well as at week 1, months 1, 2, 7, 10 and 12 after surgery, as well as from 8 healthy volunteers who formed the control group. We used microelectrophoresis to measure the electrophoretic mobility of red blood cells, characterizing the electrokinetic properties of cells. Aggregation was calculated microscopically by counting unaggregated red blood cells. Malondialdehyde concentration was measured spectrophotometrically at its absorbance maximum at 530 nm by reaction with thiobarbituric acid. Catalase activity was analyzed by reducing hydrogen peroxide in the sample spectrophotometrically at 240 nm wavelength. The obtained values were compared using the Mann–Whitney U test. Results. Decreased electrophoretic mobility of red blood cells within 2 months after transplantation was associated with increased malondialdehyde concentration and erythrocyte aggregation, decreased catalase activity in kidney recipients, followed by restoration of indicators to the control values. Electrophoretic mobility of red blood cells decreased, while malondialdehyde concentrations increased in donors after surgery. However, the increase was less pronounced than in recipients. The changes indicate that the postoperative period causes changes at the cellular level both in donors and in recipients. This is manifested by decreased stability of erythrocyte membrane structure, which is largely determined by lipid peroxidation processes. At the systemic level, a change in the electrophoretic mobility of red blood cells indicates a stress reaction before and after kidney transplantation in recipients within 2 months after surgery, and in donors in 1–2 months in the postoperative period with gradual increase in the body’s resistance. Conclusion. Kidney transplantation is manifested at the cellular and systemic levels. At the cellular level, there is decreased stability of the membrane structure, which is largely determined by lipid peroxidation processes. At the systemic level, a change in the electrophoretic mobility of red blood cells indicates a stress reaction with gradual increase in the body’s resistance. The data obtained demonstrate changes in the functional properties of red blood cells both in kidney transplant recipients and in donors. These changes need to be taken into account when carrying out therapeutic measures.
The review includes results of retrospective and prospective clinical studies (foreign and national) and guidelines on the use of transplantation technologies for treatment of type 1 diabetes and pancreatogenic diabetes in chronic pancreatitis and pancreatic conditions. Modern data on prevalence of diabetes and modern insulin delivery methods are presented. Results of transplantation of pancreas and islets of Langerhans in primary insulin-dependent conditions are considered. Analysis of the technology for isolation and autotransplantation of islets after pancreatectomy in chronic pancreatitis and benign tumor diseases are given.
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