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RISS 인기검색어
- 검색키워드
- 저자 : ( Abylaikhan Sharmenov ) (검색결과 2 건)
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( Abylaikhan Sharmenov ),( Gani Kuttymuratov ),( Tokan Sultnaliyev ),( Mukazhanov Adilbek ),( Zheksembayev Asan ),( Yermakhan Assylkhanuly ),( Mels Asykbayev ),( Said Abdugafarov ) 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1
Aims: Viral infection such as HSV, after Living donor liver transplantation (LDLT) is a major cause of morbidity and mortality that result in injury to allograft rejection and opportunistic superinfection. Most patients undergoing liver transplantation are seropositive for HSV. Without antiviral treatments, reactivated HSV infection develops in as many as 40% of these patients. Anogenital lesions are the second most common presentation of HSV disease in LDLT recipients, and are usually due to reactivation of latent HSV-2 in the sacral ganglia. Methods: In our clinical experience, i present a case of a 57-year-old female with hepatocellular carcinoma in the outcome of chronic viral hepatitis C who underwent surgery LDLT. ELISA viral panel before surgery: EBV IgG - positive, IgM - negative, HSV IgG- positive, IgM negative. Her immunosuppressive regimen included - MMF, Tacrolimus, and Prednisone. On the 15th day after the LDLT operation the patient in the pubic region appeared herpes lesion. The level of transaminases in dynamics has increased significantly. Biochemical analysis of blood: ALT - 364 U/l, AST - 98 U/l. GGTP - 159.66 U/l. CRP - 64 ng/ml. Then taken polymerase chain reactions (PCR) analysis for viral infection. PCR for viral panel: HSV DNA 1.2 - detected. CMV DNA - negative. EBV DNA - negative. Given the presence of herpes and PCR data scheduled antiviral therapy - per oral Famvir Famcyklovir) 1500 mg per day and local Acyklovir ointment. Results: After the 2 days on the background of anti-viral therapy transaminase levels started to decline over time. Biochemical analysis of blood: AST - 52.80 U/l, ALT - 204.20 U/l, CRP - 11.04 ng/ml. Post operative day (POD) №22, taken PCR for viral panel: HSV DNA 1.2 - negative. CMV DNA - negative. EBV DNA - negative. Antiviral therapy is continued, the dose of Famvir is reduced to 1000 mg per day. On the background of anti-viral therapy marked regression of herpes lesion, transaminase levels declined. Biochemical analysis of blood: AST - 32.80 U/l, ALT - 104.20 U/l. CRP - 3.96 ng/ml. Conclusions: These Results could help define reasonable indications for transplantation in an era with a shortage of liver grafts related to presented case. Prophylaxis for common infections (HSV and other) in high risk patients improves outcomes in the first year after LDLT. HSV can lead to liver failure after liver transplantation. Antiviral therapy such as Acyclovir, Famcyclavir active against HSV in vitro, and these substances must be used in the treatment of HSV infection after LDLT.
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Surgical Treatment of Liver Alveococcosis
( Dzhussubaliev Yerbol ),( Gani Kuttymuratov ),( Tokan Sultnaliyev ),( Mukazhanov Adilbek ),( Zheksembayev Asan ),( Yermakhan Assylkhanuly ),( Mels Asykbayev ),( Sharmenov Abylaikhan ) 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1
Aims: Alveococcosis - a parasitic disease caused by echinococcus multilocularis larvae and proceeding with the formation of the primary liver tumor. Alveococcosis complications may include festering parasitic tumor, a rupture in the formation of peritoneal or pleural cavity, jaundice, portal hypertension, alveococcus metastasis into brain and lungs. In terms of surgical tactics at liver alveococcosis, the most difficult issues are the choice of the optimal variant of surgical intervention and liver resection volume. Methods: Experience of observation over 36 patients with alveococcosis within 2 years is the basis for this presentation. Radical liver resection is performed on 30 patients, the other 6 patients had the unresectable alveococcosis volume. After radical liver resection alveococcosis relapse was observed on 1 patient. At the impossibility to execute radical surgery, resection - bone removal and palliative interventions remain the only surgery options. Results: During intrasurgical audit, mainly right lobe impairment has been revealed on 28 (93,3%) patients, 5 (17,8%) of them had parasitic knots crossed to segments of the left lobe of a liver. 2 (6,7%) patients had tumor generally localized separately in the left lobe of a liver without spreading to the adjacent organs. Germination in the adjacent organs was observed at 2 (7,1%) patients in the 1st group (to a diaphragm). In the same group one patient had lymph nodes of colon impaired, and 2 (7,1%) patients had the remote metastasises of abdominal cavity settled down in retroperitoneum (in the lower hollow vein and a tail of a pancreas). Often, parasitic impairment of an alveococcosis is massive which in some observations demands non-standard approach to treatment of such patients. Separate attention should be given to some clinical observations. Two-stage surgical treatment carried out for 25 years old patient. First, right-sided hemihepatectomia was performed (first phase), then, 12 months later atypical resection of segments II and III was performed (the second phase). In order to achieve a radical intervention for a 42 year-old patient, the resection of the V-VI liver segments, an atypical resection of the VII segment and a bisegmentectomy of the II-III segments were augmented with a radio-frequency ablation of two small (diameter to 1 cm) centers in the VII liver segment. During 2 years of treatment she had been receiving chemotherapy with albendazole, in 2 years after surgery CT of an abdominal cavity in the VII segment will reveal postablation lesions; no signs of disease recurrence present. Conclusions: Thus, alveococcosis remains surgicai- dependent disease. Radical resection during alveococcosis is abie to heal completely majoriti of patients and brings good results in the further perspective. I wonder alveococcosis liver surgery because I was ill alveococcosis liver and underwent surgical treatment. Now I``m alive and well.
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