[Vascular shunting for gastrointestinal bleeding in children with portal hypertension]. / Sosudistoe shuntirovanie pri pishchevodno-zheludochnykh krovotecheniiakh u detei s portal'noi gipertenziei.

The urgent porto-system bypass has been used in 26 children with portal hypertension to prevent acute gastro-esophageal bleeding. This method may be used in all types of portal circulation blockade. The bleeding stopped within first two postoperative days and there were no cases of its relapse within 6 years.

[Esophagogastroduodenoscopy in evaluation of the results of portacaval shunt]. / Ezofagogastroduodenoskopiia v otsenke rezul'tatov portokaval'nogo shuntirovaniia.

The article discusses the results of endoscopic examination of 44 children with extrahepatic portal hypertension before and after various types of portocaval shunting. Thirteen children were also examined in the late-term postoperative periods. It was found that decompression of the portal system not only leads to rapid reduction of the esophageal varicosities but also facilitates relief from gastritis and esophagitis. An unfavorable effect of cava-mesenteric shunts on the development of the bulbo-gastric reflux was revealed. It is shown that long-term regular medical observation over these patients and their nonoperative treatment are necessary.

[Conservative treatment of gastroesophageal hemorrhage in portal hypertension syndrome in children]. / Konservativnoe lechenie pishchevodno-zheludochnykh krovotechenii pri sindrome portal'noi gipertenzii u detei.

Intraoperative examinations of 15 patients with extrahepatic portal hypertension carried out to elucidate the effect of pituitrin infusion on the central and portal hemodynamics and analysis of the clinical results of treatment of gastroesophageal hemorrhages with pituitrin infusions in 17 patients showed that infusions of pituitrin solution were sufficiently effective in this patient population. The drug exerted the minimal effect on the central hemodynamics and appreciably improved the portal pressure and bloodflow.

[Risk factors and their correction during shunt operation in children with extrahepatic portal hypertension]. / Faktory riska i ikh korrektsiia v khode shuntiruiushchikh operatsii pri vnepechenochnoi portal'noi gipertenzii u detei.

Central hemodynamics, blood gas composition, portal blood flow, and hepatic function have been studied in 30 children with extrahepatic portal hypertension during various types of intraoperative anesthesia. Neuroleptanalgesia and combined halothane and calypsol anesthesia ensure an adequate patient protection from surgical trauma. Each type of anesthesia has its specific effect on portal blood flow. This type of surgical interventions is characterized by frequent use of blood transfusions. According to the data of histochemical and biochemical studies all types of anesthesia have an equal effect on the liver.

[The immune status of children with extrahepatic portal hypertension following splenectomy]. / Immunnyi status detei s vnepechenochnoi portal'noi gipertenziei posle splenéktomii.

The purpose of the work was to study the immune status and some nonspecific defense factors in children with extrarenal portal hypertension after splenectomy. Seventy-one children were examined. It was found that the T-lymphocyte count before and in the early periods after the operation in children with extrahepatic portal hypertension did not differ from that in the control group. At the same time, the changes in serum immunoglobulins depended on the stage of the examination. Study of other links of immunity also revealed the time course of changes in their values.

[Alpha 1-adrenergic receptors in the liver parenchyma of children: the changes in cirrhosis]. / Al'fa 1-adrenergicheskie retseptory v parenkhime pecheni u detei: izmeneniia pri tsirroze.

In the present study alpha 1-adrenergic receptors have been investigated in liver parenchyma, obtained at the resection of prehepatic portal hypertension children without parenchymal affection (control group, n = 7) and the resection of children in parenchymal affection (group of cirrhosis, n = 8). It has been shown, that the binding of alpha 1-adrenergic antagonist 3H-prasozin (3H-PRZ) in liver parenchyma membranes of both control and cirrhosis groups is saturable and shows a high affinity. The Scatchard analysis of the binding data indicated that the binding site is characterized by Kd and Bmax of 0.6 +/- 0.12 nM, 92.8 +/- 8.0 fmol/mg, respectively, for the control group; and 1.5 +/- 0.4 nM, 254.1 +/- 28.4 fmol/mg, respectively, for the group of cirrhosis; (mean +/- SEM). It has been found that the number of binding sites of 3H-PRZ significantly increases in cirrhosis liver parenchyma in comparison with the control group. The results obtained suggest that alpha 1-adrenergic receptors play an important role in cirrhosis formation in children, showing liver parenchyma affection severity and its regenerative properties.

[Adrenergic receptors in the liver parenchyma in children with chronic hepatitis]. / Izuchenie adrenergicheskikh retseptorov v parenkhime pecheni u detei pri khronicheskom gepatite.

In the present study adrenergic receptors have been investigated in liver parenchyma, obtained at the resection of extrahepatic portal hypertension children without parenchymal affection (control group, n-7) and the resection of children in parenchymal affection (group of chronic hepatitis children, n-6). It has been shown, that the binding of beta-adrenergic radioligand 3H-dihydroalprenolol (3H-DHA) in liver parenchyma membranes of both control and chronic hepatitis groups was saturable and showed high affinity. The Scatchard analysis of the binding data indicated that the binding site was characterized by Kd and Bmax of 1.2 +/- 0.5 nM, 261.2 +/- 50 fmol/mg, respectively, for the control group; and 0.9 +/- 0.15 nM, 68.5 +/- 18.8 fmol/mg, respectively, for the group of chronic hepatitis patients; (mean+SEM). The binding of alpha 1-adrenergic antagonist 3H-prazosin (3H-PRZ) in liver parenchyma was also saturable and showed high affinity. The binding site is characterized by Kd = 0.6 +/- 0.12 nM, Bmax = 92.8 +/- 8.0 fmol/mg, for the control group; and Kd = 0.8 +/- 0.15 nM, Bmax = 195.0 +/- 22.0 fmol/mg, for the group of chronic hepatitis. It has been found that the number of binding sites of 3H-DHA significantly decreased and the number of binding sites of 3H-PRZ did not change in chronic hepatitis liver parenchyma in comparison with the control group. The results obtained suggest the important role of beta-adrenergic receptors in the pathogenesis of chronic hepatitis and in liver regeneration in children.

[The effect of splenectomy on the immune status of children with active liver cirrhosis]. / Vliianie splenéktomii na immunnyi status detei s aktivnym tsirrozom pecheni.

A complex study of parameters of the systemic cell humoral immunity, secretory immune system, functional state and phagocytic activity of neutrophils as well as activity of the complement and its C3, C4 components in 28 children with active cirrhosis of the liver has shown that the disease was accompanied by a generalized disturbance of the immunity mechanisms. Splenectomy in these children was shown to have favorable influence on the immune status, to reduce activity of the immunopathological process in the liver. At the same time, splenectomy results in continuous suppression of neutrophilic phagocytosis which may be a cause of the development of postsplenectomy septic conditions.

[Functional condition of the liver after surgical treatment of cirrhosis in children as revealed by hepatoscintigraphy]. / Funktsional'noe sostoianie pecheni posle khirurgicheskogo lechenia tsirroza pecheni u detei po dannym stsintigepatografii.

Scintigraphy with colloid 99mTc (56 cases) and the radiopharmaceutical preparation 99mTc--HIDA (43 cases) was performed in children with early and developed cirrhosis of the liver to study the functional condition of the hepatic Kupffer's and parenchymal cells in the long-term periods after surgical treatment. Increased activity of the parenchymal cells and inactivation of Kupffer's cells were revealed after splenectomy. The formation of a portocaval shunt and denervation of the hepatic artery promoted activation of hepatocyte functioning in these patients.

[The function of the liver mitochondria in rats with experimental cirrhosis undergoing an organ-preserving operation on the spleen]. / Funktsional'noe sostoianie mitokhondrii pecheni krys s éksperimental'nym tsirrozom pri organosokhraniaiushchei operatsii na selezenke.

The effect of splenectomy and of spleen-preserving operation with suture ligation of the left gastric artery on the functional status of liver mitochondria was studied by using 102 white male-rats of mixed population with experimental cirrhosis. The obtained data made it evident that in the immediate postoperative period (from 1 to 3 weeks after the procedure) in the animals of both the first and the second series, the disorder of energetic regulation of mitochondria hepatocytes respiration and the decrease in phosphorylation efficiency had the same tendency, which were seemingly caused by stress-action of the operative trauma. The data accumulated in the more distant postoperative period (8 weeks after the procedure) indicated that the resection of the lower splenic pole in combination with supplementary liver arterialization improved essentially the functional status of mitochondria hepatocytes and was more beneficial in contradistinction to splenectomy.

[Clinical aspects and surgery of fibrocholangiocytosis in children]. / Klinika i khirurgicheskoe lechenie fibrokholangiokistoza u detei.

Fifty one children with a diagnosis of fibrocholangiocystosis (FCC) were examined. A degree of circulatory blockade in the portal vein system in FCC was established to be one of the factors conditioning a severity of the course of the disease and its prognosis. With increase in duration of the disease and age of a child, the cirrhotic process in the liver and its complications are aggravating. The esophagogastric bleeding with the incidence as well depending on duration of the disease is the most severe and life-threatening complication. Our experience with operative treatment of FCC is indicative of the necessity to perform early interventions, and of a high effectiveness of creating the vascular anastomosis with preservation of the spleen.

[A 99mTc-colloid study of the intrahepatic blood flow in liver cirrhosis in children]. / Issledovanie vnutripechenochnogo krovotoka s 99mTc-kolloidom pri tsirroze pecheni u detei.

Hepatoscintigraphic investigations were conducted in 63 patients aged 3 to 15 to study the features of intrahepatic blood flow and degrees of its compensation in children with liver cirrhosis of different stages. 99mTc-colloid was employed as a radiopharmaceutical. Disproportions of scintigraphic liver images showed close correlation with clinico-biochemical and morphological signs of the severity of disease. Subcompensation and decompensation of the organ blood flow and reticuloendothelial system in children with developed and terminal stages of liver cirrhosis are characterized by prolonged blood RP inhibition, a decrease in the total clearance of radioactive colloid, a progressively reduced index of liver clearance, and an increase in a colloid uptake by the spleen.

[Effect of splenectomy on the dynamics of allergic symptoms and the level of IgE in the complex treatment of children with liver cirrhosis]. / Vliianie splenektomii na dinamiku allergicheskikh simptomov i uroven' IgE pri kompleksnom lechenii detei s tsirrozom pecheni.

Overall 21 children suffering from active liver cirrhosis were examined for the dynamics of allergic symptoms and IgE before and after splenectomy. The IgE level was measured 2-4 weeks, 3-11 months and 1-5 years after splenectomy. All the children received glucocorticosteroid therapy followed by the administration of maintenance therapy. It has been shown that splenectomy as one of the pathogenetic forms of therapy of active liver cirrhosis produces a decrease in blood IgE and in the incidence of allergic manifestations in addition to the clinical effect and amelioration of liver function.

[Carbohydrate metabolism enzymes in children with extrahepatic portal hypertension]. / Fermenty uglevodnogo obmena pri vnepechenochnoi portal'noi gipertenzii u detei.

Glycogen and protein concentrations and the activities of liver glycogen metabolic enzymes were measured in 22 children aged 4 to 15, suffering from extrahepatic portal hypertension. Glucose-6-phosphatase, amylo-1,6-glucosidase, fructose-1,6-diphosphatase, phosphorylases alpha and beta, phosphoglucomutase, and phosphohexose isomerase levels were analyzed. Liver biopsy specimens obtained by surgical marginal biopsy were used in the study. No or drastic reduction of phosphorylase alpha activity and reduction of glycogen concentration and glucose-phosphatase activity were found characteristic of extrahepatic hypertension. Analysis of correlations of the findings has demonstrated a medium correlation in 4 cases and a strong correlation between the findings in 1 case, the possibility being estimated as 0.95-0.99. The highest number of correlations was observed with phosphorylase alpha and glucose-6-phosphatase (3 correlations). Liver blood stream impairments result in injury to one of its main biochemical functions, i.e., the maintenance of blood glucose homeostasis, this leading to reduction of the adaptation potential of the body; this should be borne in mind when planning therapeutic measures for patients with extrahepatic hypertension.

[Hemodynamic and functional changes in the liver of children with extrahepatic portal hypertension in relation to the method of portacaval shunt]. / Gemodinamicheskie i funktsional'nye izmeneniia pecheni u detei s vnepechenochnoi portal'noi gipertenziei v zavisimosti ot metoda portokaval'nogo shuntirovaniia.

Scintihepatographic investigations with colloid 99mTc before and after operations in 4 groups of children were performed: with cavo- or ileomesenterial anastomosis, with splenorenal anastomosis with splenectomy and cavo- or ileomesenterial anastomoses in children with previously performed splenectomy and in a group of comparison. Perfusion of the liver was found to decrease: in the least degree after splenorenal anastomosis and in the greater degere after cavo- and ileomesenterial one. It was established that all kinds of shunts ensured function of hepatocytes.