[Benign nodular formations of the thyroid gland and changes in cell and humoral immunity before and after surgical treatment].

INTRODUCTION: The main trends concerning the volume of surgery in benign thyroid disease - thyroidectomy or organ - preserved surgery, performed in detected immunological disorders, are not well motivated. The AIM of this study was to analyze changes in humoral and cellular immunity in diseases before and after surgical treatment as well as to assess the effects of surgical procedure and to precise its volume. PATIENTS AND METHODS: Changes in immune reactivity were investigated in 100 patients. They were selected with nodular (adenomatous) hyperplastic parenchymal processes in the thyroid gland, with or without hyperfunction - euthyroid or Basedowificated nodular goitre, solitary toxic adenoma and nodular form of lymphocytic thyroiditis. Serum anti - thyroglobulin and anti - microsomal antibodies were examined in these patients, and in 56 of them immunophenotypic flowcytometric analyses of peripheral lymphocytes was performed. RESULTS: Serum antithyroid antibodies gradually decrease in one year after surgery. Pre-surgical changes in lymphocyte subsets number in peripheral blood recovered to great extent. This tendency is best demonstrated in lymphocytic thyreoiditis. DISCUSSION: Study on immune parameters can help to evaluate the positive effect of organ - preserved and at the same time - radical surgical treatment. CONCLUSION: In immune thyroid disorders the organ - preserved radical resection of thyroid gland leaving normal parenchyma is method of choice compared to thyroidectomy since it allows definite treatment with hormonal compensation.

[Therapeutic and microbiologic aspects of pleural empyema]. / Terapevtichni i mikrobiologichni aspektu na plevralnite empiemi.

The pleural empyema is a severe disease which passes with respiratory insufficiency and general toxic symptoms. The early staged surgical treatment combined with total evacuation of the puss from pleural cavity is important for the successful outcome of the disease. We made retrospective study including 82 patients with pleural (61 with acute and 21 with chronic) empyema. We performed the following operative interventions: thoracocentesis with active aspiration--at 43, VATS--20, decortication and pleurectomy--in 16, thoracoplastic with muscle flap--3. Three patients died. The most common causes for the empyema were Gr (+) coccy. At most of the patients combined operative treatment and antibiotic therapy were the most effective.

[The effect of surgical treatment of benign thyroid disease on serum anti-thyroid antibodies]. / Vliianie na operatsiite pri dobrokachestveni zaboliavaniia na shtitovidna zhleza vurkhu serumnite nati-tiroidni avtoantitela.

The mechanisms of development of benign thyroid disease are still not entirely clarified. Immune disorders are possibly engaged in the thyroid pathological conditions. The aim of this prospective study was to follow up the dynamics of serum levels of anti-thyroid antibodies in patients with benign thyroidal disease as well as the local lymphocytic reaction. The autoantibodies to thyroglobulin and thyroid microsomes were detected prior to the surgery and on the 12th month after it using microhemaglutination test. Thyroid resection was performed depending on changes in patients. Lymphocytic infiltration of the thyroid gland from surgical histological specimens was found in various degree in the patients. Serum titres of anti-thyroid antibodies tended to fall in the majority of the patients a year after the surgical treatment. Anti-thyroglobulin antibodies were found in 60% of the patients prior to the surgery and anti-microsomal--in 31.4%. A year after surgery they were detected in 4.3% and 1.4% of the patients respectively. The described changes show that the dynamics of anti-thyroid antibodies may correlate with the effect of surgical treatment and eventual prognosis of relapse.

[Main lymphocyte populations and their subpopulations in patients with acute pancreatitis studied in the course of disease]. / Osnovni limfotitni populatsii i tekhnite subpopulatsii pri bolii s ostur pankreatit, izsledvani v dinamika na zaboliavaneto.

The aim of the study was to establish the changes in the main lymphocyte populations and their subpopulations in peripheral blood of patients with acute pancreatitis. Seventy-one patients were studied in the course of disease. They were classified on the basis of severity of pancreatitis--mild and severe form. Percentage and absolute numbers of CD19+ (B lymphocytes), CD2+ (total T cells), CD3+ (immunocompetent T cells), CD3+CD4+ (helper T cells), CD3+CD8+ (suppressor/cytotoxic lymphocytes), CD4+CD29+ and CD4+CD45-RA+ (helper/inducer and suppressor/inducer subpopulations of helper lymphocytes). Immunophenotype analysis was performed using a flowcytometer Epics XL-MCL, Coulter, USA and monoclonal antibodies by the same company. In the early stage of disease the fall of total CD2+, immunocompetent CD3+ T lymphocytes and their subpopulations (more expressed in the severe form) is an indicator of determining the severity of pancreatitis. These results along with the elevated CD4+CD29+ subpopulation are a sign of both activation of these links in the local immune reaction and development of secondary infectious complications. The observed fall in CD4+CD45-RA+ suggests increased risk of development of autoimmune process. The recovery of most of the studied parameter after day 3 shows unimpaired host compensatory capabilities for both forms of disease.

Immune profile and thyroid function in patients with rheumatoid arthritis.

Thyroid autoantibodies and thyroid function were studied in 175 patients with rheumatoid arthritis (ARA criteria, 1987). The study included 149 women and 26 men aged (54.7 +/- 13.1) all treated in the Clinic of Rheumatology, Higher Medical Institute, Plovdiv. A control group comprising 72 healthy subjects (aged 51.2 +/- 3.2) was used. Rheumatoid factor (RF) (latex agglutination test and Waaler-Rose test), antithyroglobulin (TAT) and antimicrosomal antibodies (MAT), thyroid stimulating hormone (TSH) and the free fraction of thyroxine (FT4) were measured. 69.7% of all patients tested positive for RF by the latex test and 64.5% by the Waaler-Rose test. TAT was found in 55 (31.4%), MAT in 26 (14.8%) from all the examined, which is significantly greater in comparison with the controls (p < 0.05). The thyroid gland was in a euthyroid state in most of the RA patients although MAT and/or TAT were detected in them. The results suggest existence of two autoimmune diseases - rheumatoid arthritis and Hashimoto's thyroiditis and raise the question of whether they are not manifestations of a single autoimmune disease with different body organ localisation.