ABSTRACT
Results of surgical treatment for an acute ulcer gastroduodenal bleeding in 120 patients, ageing 16-75 yrs old, were analyzed. In 20 of them a gastric ulcer was a cause of bleeding, while in 84--a duodenal ulcer, and in 16--a coexistent gastroduodenal ulcer. The bleeding activity was estimated in accordance to J. Forrest classification. In 57 patients (a comparison group) preoperatively and postoperatively a complex of a standard basal conservative therapy without immunocorrection was conducted, and in 63 (the main group)--a systemic cytokinotherapy (SCKTH), using betaleukin, was applied postoperatively additionally in a complex of therapy. A content of CD3+, CD4+, CD8+, CD19+, IgA, IgM, IgG was estimated in dynamics, as well as circulating immune complexes, phagocytic index, phagocytic number. There was established, that a dysbalance depth in the immune status have had depended upon the blood loss severity. The SCKTH application is pathogenetically substantiated, it promotes the immune status normalization, as well as a more favorable course of postoperative period and the results of treatment improvement.
Subject(s)
Gastrointestinal Hemorrhage/drug therapy , Immunologic Factors/therapeutic use , Interleukin-1beta/therapeutic use , Peptic Ulcer/drug therapy , Stomach Ulcer/drug therapy , Adolescent , Adult , Aged , Antigen-Antibody Complex/blood , Antigens, CD/immunology , Case-Control Studies , Female , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/immunology , Gastrointestinal Hemorrhage/surgery , Humans , Immunoglobulin A/blood , Immunoglobulin G/blood , Immunoglobulin M/blood , Immunophenotyping , Lymphocytes/drug effects , Lymphocytes/immunology , Lymphocytes/pathology , Male , Middle Aged , Peptic Ulcer/complications , Peptic Ulcer/immunology , Peptic Ulcer/surgery , Recombinant Proteins/therapeutic use , Severity of Illness Index , Stomach Ulcer/complications , Stomach Ulcer/immunology , Stomach Ulcer/surgery , Treatment OutcomeABSTRACT
AIM: To improve the results of surgical treatment of patients with acute ulcerative gastroduodenal bleeding using immune correction with ß-leukin. MATERIAL AND METHODS: Urgent and elective operations were performed in 120 patients with gastroduodenal ulcers. Patients of the main group (n=63) received systemic cytokine therapy with ß-leukin in addition to conventional treatment. Pre- and postoperative immune correction was absent in the comparison group. RESULTS AND DISCUSSION: There was preoperative imbalance of antiphlogistic and proinflammatory cytokines in comparison group. Severity of this process depended on blood loss. Therapy with interleukin decreased severity of cytokine imbalance.
Subject(s)
Hemostasis, Surgical , Interleukin-1beta , Peptic Ulcer Hemorrhage , Peptic Ulcer/complications , Postoperative Complications , Adolescent , Adult , Aged , Drug Monitoring/methods , Female , Hemostasis, Surgical/adverse effects , Hemostasis, Surgical/methods , Humans , Immunologic Factors/administration & dosage , Immunologic Factors/immunology , Interleukin-1beta/administration & dosage , Interleukin-1beta/immunology , Male , Middle Aged , Peptic Ulcer Hemorrhage/diagnosis , Peptic Ulcer Hemorrhage/etiology , Peptic Ulcer Hemorrhage/immunology , Peptic Ulcer Hemorrhage/surgery , Postoperative Complications/immunology , Postoperative Complications/prevention & control , Postoperative Period , Treatment OutcomeABSTRACT
The results of surgical treatment of 39 patients, suffering an acute gastroduodenal ulcer hemorrhage, were analyzed. Gastric ulcer disease was diagnosed in 9 patients, duodenal ulcer disease--in 29, combined ulcer--in 1. A light degree blood loss was noted in 13 patients, while a middle degree--in 12, and severe--in 14. In accordance to J. Forrest classification in 6 patients an active bleeding was revealed (FIa, FIb), in 11--nonstable hemostasis (FIIa, FIIb, FIIc), and in 22--FIII. Preoperatively in patients on the third, seventh and fourteenth day the contents of CD3+, CD4+, CD8+, CD19, calculation of a CD4+/CD8+ ratio, the level of immunoglobulins (IgA, IgM, IgG) and circulating immune complexes were determined in peripheral blood. Phagocytic activity of neutrophils was estimated, using determination of phagocytic index and phagocytic number. In an acute gastroduodenal ulcer hemorrhage immunosuppression was noted, and severity of disorders in T- and B-chains of immunity have depended upon a blood loss severity. Conduction of a routine basic conservative therapy in postoperative period did not guarantee elimination of immunosuppression.
