Efficiency of Cell Therapy in Liver Cirrhosis.

We studied safety and clinical efficacy of transplantation of autologous bone marrow cell in complex therapy of 158 patients with chronic hepatitis and cirrhosis of the liver. The efficiency of cell therapy was assessed in 12 months after single injection of the cells. The positive response (alleviation of liver cirrhosis or stabilization of the pathological process) was observed in 70% cases. The efficacy of therapy correlated with the severity and etiology of the disease and was maximum in patients with Child-Pugh class A (in 82.5% cases) and class B liver cirrhosis (in 79% cases); in patients with class C liver cirrhosis, the positive response was achieved in 42.5% cases. In 39 patients, ultrasonic examination performed in 3 years after transplantation revealed no focal lesions or ectopic ossification foci.

[Gastrointestinal diseases and abdominal pain in combat veterans].

AIM: To analyze the role of consequences of combat stress in the development of gastrointestinal tract (GIT) diseases. SUBJECTS AND METHODS: One hundred and sixty-one combat veterans aged 24 to 69 years were examined. All underwent a clinical and neurological examination using the McGill pain questionnaire (MPQ), Beck depression inventory, Kotenev trauma stress questionnaire, and visual analogue scale to determine pain intensity. Anxiety, impairments in memory and sleep, and depression were identified. The SF-36 questionnaire was used to estimate quality of life in the patients. Gastric secretory function was investigated; esophagogastroduodenoscopy, X-ray and ultrasound studies, clinical and biochemical blood tests, coprological examinations, fecal tests for dysbiosis, if indicated, occult blood were made. RESULTS: Combat stress and its consequences as posttraumatic stress disorder have been shown to play an important role in the pathogenesis of GIT diseases and in the development of chronic abdominal pain. GIT diseases in combat veterans are in larger measure a sequel of impaired processes of adjustment to combat stress. Chronic abdominal pains were heterogeneous. On the one hand, chronic GIT disease serves as a source of pain syndrome; on the other hand, the central nervous system is of importance in the development of chronic abdominal pain. CONCLUSION: In addition to therapy for GIT and hepatobiliary diseases, the treatment of GIT diseases in this category of patients involves psychotherapy and neuroprotection, aimed at reducing the consequences of combat stress in combat veterans.

[Age-related aspects of the extent of lipid metabolism and post-traumatic stress disorders among veterans of modern warfare].

The peculiarities of violations of lipid metabolism and symptoms of post-traumatic stress disorder (PTSD) in 161 patients of 25-69 years, veterans of the military actions on the territory of Afghanistan and the Northern Caucasus were investigated. The dependence of the formation of dyslipidemia and related changes of atherosclerosis in the young age on neuroendocrine effects, accompanying the effects of combat stress and promoting accelerated aging was determined. On the other hand, with the time, after 15-25 years after participating in hostilities, the intensity of PTSD and its influence on the development of violations of lipid spectrum may decline. The leading role in the pathogenesis of dyslipidemia goes to age-related changes, accompanying a process of accelerated aging of veterans of combat operations, and to pathological disorders of metabolism in liver associated with alcohol abuse and the consequences of infectious diseases.

[Pathology of biliary tract IN elderly patients with the system approach. Principles of therapy].

The biliary tract pathology gains the increasing distribution.So cholelitiasis in different camps is registered from 7.8 to 38%. In Russia the given indicator from 3 to 12%. Special importance cholelitiasis and chronic cholecystitis without cholelitiasis get at persons of the advanced age, connected as with morfofunkcional'nymi changes in an organism of senior citizens, and with a wrong way of life. All it demands the differentiated approach to treatment of this group of patients and includes change of a way of life, a dietotherapy, farmako- and physiotherapeutic treatment.

[Principles of therapy of hepatobiliary and pancreatic pathology in elderly people with chronic opisthorchiasis].

THE PURPOSE OF RESEARCH: studying of features of clinical current, diagnostics, treatment chronic opisthorchiasis at persons of elderly and senile age. 117 patients are surveyed. In bile in 100% of cases, a sladg-syndrome in 66.6%, infringement of motor function of a bilious bubble in 92.3%, macrobiocenosis in 98.3%, an allergic syndrome--microscopic changes are found out in 93%. The diagnostic importance of triad Paltseva at observable patients is confirmed. It is shown, that chronic [Russian characters: see text] is system disease at which leading value the pathology hepatobiliar and pancreatic system has.

[Heart rate variability in migrants to the North with hypertension comorbid with biliary diseases].

AIM: To study heart rate variability (HRV) in patients with biliary problems and hypertension depending on duration of their life in the North. MATERIAL AND METHODS: A standardized screening of 1014 workers living in Mirny (Yakutia) according to the WHO/CINDI Euro regional committee program was performed. CONCLUSION: With an increase of duration of living in the North patients with biliary diseases combined with arterial hypertension develop disorders of humoral-metabolic regulation mechanisms, increased parasympathetic activity, imbalance of the autonomic nervous system.

[Clinico-morphological variants of gastric mucosa atrophic lesions].

AIM: To characterize clinicomorphological manifestations of atrophic process (AP) in gastric mucosa (GM) in chronic atrophic gastritis (CAG) associated and not associated with Helicobacter pylori infection. MATERIAL AND METHODS: Clinicoendoscopic and pathomorphological (light microscopy of gastric biopsies, 6 point scale assessment of dysregeneratory alterations) investigations were made in 98 patients aged 16 to 68 years. H. pylori-negative CAG was diagnosed in 52 of them, H. pylori-positive one in 46 patients (groups 1 and 2, respectively). RESULTS: A comparative clinicomorphological analysis has identified 2 variants of AP morphogenesis in GM. Variant 1 is not associated with H. pylori but associated with a combined action of several endogenic risk factors of chronic gastritis or failure of regeneration, with diffuse or diffuse-focal changes with initial prevalence of dysregeneratory changes in a fundal stomach manifesting as a trend to atrophy of the glands. Clinically, this variant is characterized by longer disease, frequent systemic atrophic lesions of gastrointestinal mucosa, prevalent complaints of dyspeptic pain. Variant 2 is associated with a combined action of endo- and exogenic factors, H. pylori infection in particular, pathogenetic components of "chemical" gastritis (duodenogastric reflux, malnutrition), prevalence of dysregeneratory and sclerotic alterations in the antral stomach. CONCLUSION: GM atrophy is characterized by a significant frequency of concomitant endocrinopathies, undifferentiated connective tissue dysplasia, systemic lesions, structurally--by multidirectional disorders of proliferation and differentiation. First of all, it is the result of impaired regulation of regenerative processes. AP polyetiology and different morphogenetic variants in GM suggest necessity of both individual diagnostic algorithm and pathogenetically sound therapy in each individual case.

[Non-alcoholic fatty liver disease: age peculiarities, breakthrough in pathogenetic therapy].

Non-alcoholic fatty liver disease, including non-alcoholic steatohepatosis (NSH) and non-alcoholic steatohepatitis (NASH) is considered to be a wide spread disease. Such reasons as metabolic, toxic, infections, alimentary and cryptogenic cause this disease. Pathogenesis of the disease is complex. If the necessary medical preventive measures are absent the disease develops as follows, first steatosis, then steatohepatitis, fibrosis, liver cirrhosis, hepatocarcinoma. The aim of the investigation was to study influence of Metadoxil in patients with NSH and NASH. The conducted investigation have shown high efficiency of the drug at combined treatment of a patient.

[Biliary tract in patients with chronic viral hepatitides].

AIM: To characterize motor-kinetic and inflammatory changes in extrahepatic biliary tracts and gallbladder in patients with chronic viral hepatitis (CVH). To ascertain whether there is a pathogenetic correlation between affection of the biliary system and viral infection. MATERIAL AND METHODS: The condition of the biliary tract was examined in 183 patients with CVH using fractionated duodenal tubing with biochemical tests and bacteriological investigation of bile, dynamic ultrasonic investigation. RESULTS: 69.9% patients were diagnosed to have dysfunction of the Oddi's sphyncter caused by its hypertonicity, 4.4% patients had hypotonic sphyncter. Hyper- and hypotonicity of the gallbladder were observed in 45.8 and 20.8% patients, respectively. Biliary dysfunction was associated with the process activity but not with a nosological form of the disease. Chronic acalculous cholecystitis was verified in 21.2% patients. CONCLUSION: Chronic HBV and HCV infections are accompanied with biliary dysfunctions associated with activity of inflammation in the liver. Oddi's sphincter dysfunction in CVH is a risk factor of gallbladder inflammation.

[Clinical picture, diagnosis and treatment of chronic opisthorchiasis]. / Klinika, diagnostika i lechenie khronicheskogo opistorkhoza.

The data on 750 patients with opisthorchiasis aged 16 to 69 years (437 males and 313 females) suggest the conclusion that chronic opisthorchiasis is a systemic disease of man caused by trematoda Opistorchis felimus which parasitizes in the hepatic ducts, gallbladder, pancreas. This parasite provokes allergic, mechanical and neurogenic reactions in the host. Targeted diagnosis should be initiated in existence of the characteristic symptom triad: conjunctival changes (Paltsev's symptom), tremor of the tongue, fissures of the tongue. Chronic opisthorchiasis is treated in three stages: preparation measures, specific chemotherapy, rehabilitation.

[Frequency of occurrence of Hepatitis C virus markers and risk factors among hospital personnel in the Novosibirsk region]. / Chastota vstrechaemosti markerov gepatita C i faktory riska u personala bol'nits Novosibirskoi oblasti.

The occurrence of markers, the genotypic variety of isolates and the profile of risk factors with respect to viral hepatitis C among 629 employees of the Regional Clinical Hospital (RCH) in Novosibirsk and 1,020 employees of the Central District Hospital (CDH) in Iskitim were studied in a cross-sectional investigation. The occurrence of hepatitis C virus (HCV) markers was 5.1% in RCH and 2.2% in CDH. Among the risk factors in the population under study were: the medical history of blood transfusions (TF) with 0 TF, anti-HCV = 2.3%; 1 TF, = 5.7% > 1 TF, = 13.5% (p < 0.001); general anesthesia (GA) with < or = 2 GA, anti-HCV = 2.8%; > 2 GA, = 7.8% (p = 0.002); surgical interventions (SU) with 0 SU, = 1.9%; > 0 SU, = 4.3% (p = 0.012); the intravenous use of drugs (OR = 31.8); age (< or = 25 years, anti-HCV IgG = 8.6% > 25 years, = 4.5%); the number of partners of the opposite sex < or = 4 partners, = 2.4%; > 4 partners, = 6.9%; p < 0.001). The probable risk factors at a working place (pricks and cuts, contamination of mucous membranes with blood and other biological fluids, etc.) proved to be faintly related with the status of HBV infection. HBV isolates detected in the examined persons (35 examinees) were distributed by genotypes as follows: 60% of subtype 1b, 28.6% of subtype 2a/2c, 11.4% of subtype 3a. HBV of genotype 1a was not detected in the examined specimens, while the detection rate of genotype 2a/2c was considerably greater than in specimens obtained in the European and Asian parts of Russia (according to the data reported earlier).

[Clinico-laboratory and pathomorphological studies of the liver in patients with chronic opisthorchiasis]. / Kliniko-laboratornoe i patomorfologicheskoe issledovanie pecheni u bol'nykh khronicheskim opistorkhozom.

The paper analyzes the clinical course of hepatitis, laboratory and morphological changes in 312 patients with the disease in the presence of chronic opisthorchiasis, including 277 with chronic persistent hepatitis and 35 with chronic active hepatitis. The intensity of a hepatic inflammatory process depended on the duration and number of infections. The greatest changes were observed in superinfections, then in reinfections. They were less profound in primary infection. A picture of chronic active hepatitis with signs of dystrophy, necrobiosis, and necrosis of cells was revealed in patients with super infections by morphological studies. Sclerotic changes with focal destruction of the organ and abnormal reconstruction of the lobar architecture were most significant in patients with reinvasion. Hepatocytic dystrophy in the absence of inflammation was more common in prolonged opisthorchiasis with low infection rates. The findings suggest that opisthorchiasis-associated hepatitis should be included into the current classification.

[The pathomorphosis of opisthorchiasis]. / Patomorfoz opistorkhoza.

Based on the data available in the literature and their own findings, the authors have come to the conclusion that the clinical picture of opisthorchiasis has undergone profound changes in the past decades, which may be regarded as a manifestation of induced and reduced pathomorphism. Uninduced pathomorphism appears as decreased invasion rates and as acute forms. Induced pathomorphism shows up in reduced invasion or by timely liquidation of invasion. The etiological and pathogenetic role of Helicobacter pylori in the development of the gastroduodenal pathology in patients with opisthorchiasis is considered as a manifestation of false pathomorphism.

[The characteristics of gastroduodenal pathology in patients with chronic opisthorchiasis as a criterion for the clinical diagnosis of the invasion]. / Osobennosti gastroduodenal'noi patologii u bol'nykh khronicheskim opistorkhozom kak kriterii klinicheskoi diagnostiki invazii.

Using a syndrome approach the clinical pattern has been studied in 269 patients with chronic gastritis and duodenitis. 55 of patients had gastric ulcer, 105 patients had duodenal ulcer. In 130 patients chronic opisthorchiasis was diagnosed 8.9 +/- 1.9 years after the disease onset. The following syndromes are believed to be diagnostically valuable, enabling one to suspect chronic opisthorchiasis in patients with gastroduodenal pathology from the endemic foci: "low eosinophilia syndrome", "right hypochondrium" syndrome, "fever and enterocolitic syndrome" with the special consideration of the nature of dysbacteriosis of the small bowel.

[The pathogenesis of stomach and duodenal involvement in chronic opisthorchiasis. 1. The urease test]. / Patogenez porazheniia zheludka i dvenadtsatiperstnoi kishki pri khronicheskom opistorkhoze. 1. Ureaznyi test.

The study using the urease test on mucous biopsies from the antral gastric part and from the duodenum of patients with chronic opisthorchiasis with endoscopic evidence of antral gastritis and gastroduodenitis, and from noninvaded patients with gastritis and duodenitis, some of them with the gastric or duodenal ulcers showed that the test was positive. The test was negative in both groups of patients when the mucosa of the gastric body was examined as well as in those without gastroduodenal pathology. It is supposed that in the both groups of patients gastroduodenal pathology was provoked by the colonization of the gastric and duodenal mucosa by gastric campylobacteria.