[Prevalence of nonalcoholic fatty liver disease in outpatients in Rostov-on-Don: Regional results of the DIREG-2 study]. / Rasprostranennost' nealkogol'noi zhirovoi bolezni pecheni u patsientov ambulatorno-poliklinicheskoi praktiki v Rostove-na-Donu: regional'nye rezul'taty issledovaniya DIREG-2.

AIM: to analyze and summarize the data of the DIREG-2 study of the nonalcoholic fatty liver disease (NAFLD) register in Rostov-on-Don versus those in Russia. MATERIAL AND METHODS: The prospective disease registry study encompasses an epidemiologic, observational, cross-sectional, multicenter study estimating the prevalence of NAFLD in outpatients in Rostov-on-Don. A total of 3200 patients participated in this study. The investigators were 65 outpatient physicians. Epidemiological data were obtained during two patient visits to the research centers. RESULTS: The key result obtained from this study was the significantly higher prevalence of NAFLD in Rostov-on-Don than that in the general population (40.4 and 37.3%). In addition to the higher prevalence of NAFLD, there was also a higher spread of risk factors (RFs), such as abdominal obesity, female age of 45-55 years, and hyperlipidemia. CONCLUSION: The prevalence of NAFLD in the outpatients of Rostov-on-Don was 3.1% greater than that in Russia; this might be due to the significantly higher spread of some RFs (abdominal obesity, female age of 45-55 years, hyperlipidemia). The findings are undoubtedly necessary for the elaboration of measures for the primary and secondary prevention of NAFLD in Rostov-on-Don.

[Non-invasive techniques in diagnosis of steatosis and fibrosis in nonalcoholic fatty liver disease].

UNLABELLED: Diagnosis and treatment of nonalcoholic fatty liver disease (NAFLD) is one of the most actual problems of modern hepatology. Ultrasound elastometry is alternative method to determine the density of the liver tissue. The efficiency of the method was confirmed by a large amount of data in patients with viral hepatitis. However, the diagnostic value of elastometry was not studied enough in patients with NAFLD. THE AIM OF THE RESEARCH: to study the possibility of non-invasive diagnostic methods of examination in a complex assessment of the liver in patients with NAFLD. MATERIALS AND METHODS: We studied 24 patients with signs of NAFLD and a long persistent elevation of liver enzymes. All patients underwent a needle biopsy of the liver. We conducted a comparative analysis of the results of the morphological study of the liver tissue with ultrasound elastometry, computed tomography of the liver, biochemical blood tests. RESULTS AND DISCUSSION: Among biochemical liver enzymes ALT was a marker of NAFLD which characterized the transformation of steatosis to steatohepatitis. The combined ALT and GGT increase reflected the high activity of inflammation in the liver tissue. Elastometry results were comparable to the histological features in all liver fibrosis stages, but the maximum diagnostic accuracy was observed at the late stages. The area under the ROC-curves showed the highest precision in the F2-F3 stages, the lowest value - in the F1 stage. Imprecision of the method in the early stages of fibrosis may be due to the hepatic steatosis in NAFLD and high biochemical activity with cholestasis signs. Patients with early-stage liver fibrosis diagnosed with elastometry need additional examination using other methods of noninvasive diagnostic tools.

[The integrated approach to diagnostics of metabolic syndrome in clinical practice].

Basic criteria of diagnostics and definitions of metabolic syndrome recommended by various international associations and expert groups are discussed. Permanent changes of criteria and usage of various approaches to diagnostics influence prevalence of metabolic syndrome among populations and estimation of its association with unfavorable outcomes. Some definitions of metabolic syndrome are more sensitive in detection of risk groups for cardiovascular diseases, and others in - detection of persons with high risk of type 2 diabetes mellitus. New integrated definition of metabolic syndrome which unites pathophysiological and clinical epidemiological approaches for assessment of metabolic disorders and detection of high risk groups of patients applicable for use in everyday clinical practice is presented.

[Non-alcoholic fatty liver disease as an atherosclerosis risk factor].

Currently, along with cardiovascular disease, changes in lipid and carbohydrate metabolism in the syndrome of insulin resistance seen pathology of the liver. The aim of our study was to determine the prognostic significance of nonalcoholic fatty liver disease (NAFLD) to assess the risk of early manifestations of atherosclerotic disease of carotid arteries. The correlation between the presence of NAFLD and signs of early atherosclerosis in the insulin resistance syndrome. The resulting ranked a number of prognostic factors influencing the degree of change in the walls of the carotid arteries, making it possible to construct estimates of individual risk of atherosclerosis development in clinically healthy patients. The clinical significance of the results is the need for more thorough examination of patients with NAFLD to assess risk factors for progression of pathology not only the liver, and cardiovascular disease.

[Impact of TNF-alpha gene polymorphism, development of atherogenic dyslipidemia and risk of atherosclerosis].

In this 5-year prospective cohort study, 92 clinically healthy subjects (42 men and 50 women) were screened for G-308A polymorphism of the TNF-alpha gene. Fasting serum lipid levels and carotid intima-media thickness (IMT) were measured. Triglyceride levels in the GA+AA group were significantly (more than 3-fold) higher than in GG genotype patients. Patients in the former group had apolipoprotein index above 1 twice more frequently in the latter. The 5-year probability of atherosclerosis in GA+AA male patients was 55.9 +/- 15.4% vs. 9.1 +/- 6.1% in GG men (p < 0.001). The presence of A allele in TNFa gene was associated with a 9 times higher risk of early atherosclerosis estimated using the multivariate stepwise Cox regression model.

[State of the brachial artery wall in patients with and without metabolic syndrome].

The purpose of this study was to investigate the condition of endothelium-dependent vasodilatation of the brachial artery in patients with metabolic syndrome, as well as to determine the clinical and laboratory factors associated with disordered macrovascular reactivity. The study comprised one hundred and thirty-two 35-to-50-year-old somatically healthy men. The diagnosis of metabolic syndrome was made in accordance with the WHO criteria. Insulin resistance was assessed according to the HOMA-IR index. To evaluate the interrelationships between the risk factors of atherosclerosis and the pattern of peripheral vascular reactions, the study was carried out in two groups of patients: one comprising patients with metabolic syndrome, and the control group. The increment of the brachial artery's diameter after decompression in the control group turned out reliably more pronounced as compared with that in the study group patients (averagely 11.9+/-0.44 % for the control group subjects vs. 9.0+/-0.37% for the study group patients, p=0.047). In the group of the patients with metabolic syndrome, the diameter of the brachial artery after the test with reactive hyperaemia varied in inverse proportion with the degree of insulin resistance in accordance with the HOMA index (p=0.04, r=-0.25). Also an inverse correlation was observed with the body mass index (r=-0.43, p<0.001), the duration of arterial hypertension (r=-0.29, p=0.014), and the level of triglycerides and very low density lipoproteins (r=-0.28, p=0.02).

[Predictive significance of insulin resistance and metabolic syndrome for assessment of the degree of endothelium disfunction and early signs of atherosclerotic lesion].

The contribution of the clinical or laboratory risk factors associated with the metabolic syndrome to the changes in peripheral vascular reactions and to the natural history of atherosclerosis has not been established until now. The aim of the work was to study interrelations between the risk factors entering the symptom complex of the metabolic syndrome, to assess their impact on endothelium-dependent vasodilatation and constrictor component of vascular reactivity as well as on the change in the thickness of the intima-media complex (TIMC) of the common carotid artery (CCA). The study accrued 122 practically normal men aged 35 to 50 years. Stepwise multiple regression analysis has established interrelations between the disorder of vasoregulating endothelium function and the intensity of atherosclerotic lesion according to the maximal value of the TIMC of the CCA, glucose concentration 120 min after glucose load, IMT, the signs of arterial hypertension. The data have been obtained that confirmed the hypothesis of the role played by endothelium dysfunction manifesting by the disturbance of vasoregulating function, as an early marker of atherosclerosis. Carbohydrate metabolism, tissue sensitivity to insulin and the presence of arterial hypertension were most significant predictive factors of the TIMC of the CCA and disorder of arterial wall function.

[Breast cancer in Chapayevsk]. / Rak molochnoi zhelezy v Chapaevske.

Numerous epidemiological surveys show the ambiguity of evaluation of stable organic chlorine compounds as a risk factor for breast cancer (BC). This is likely to be, to a certain degree, associated with the specific features of performance of epidemiological surveys. The selection of cases of BC from different areas has provided groups with different levels of exposure that as judged from the content of the above substances in the biological environments. Only few epidemiological surveys have been made in the world to assess stable organic pollutants (SOP) as risk factors of BC mainly in occupational groups. In the local areas highly polluted with dioxins, there is evidence for their role as a risk factor of BS only for women living in Sevezo. These findings are in agreement with the results of the surveys made in Chapayevsk. The analytical epidemiological study using a case-control approach has revealed the significance of biological (BC in relatives, childlessness), occupational (women's work at CVZH) and environmental (pollution, the more frequent ingestion of local pork and fish than in the control group) risk factors of BC. In the 1950-1960s, the largest Russian enterprises of chlorine chemistry worked most actively not only in Chapayevsk, but also in towns with plants of chlorine industry, such as Dzerzhinsk, Novomoskovsk, Sayansk, Usolye-Sibirskoye, and others. Ecological and epidemiological studies should be organized in these towns in order to define the value of SOP as a risk factor of BC for general populational groups.

[The role of insulin resistance in diagnosis of metabolic syndrome]. / Rol' insulinorezistentnosti v diagnostike metabolicheskogo sindroma.

Early diagnosis of metabolic syndrome is based on detection of insulin resistance, hyperinsulinemia, and clinical presentations of this syndrome. Differences in approaches to diagnosis of metabolic syndrome and its multi component nature hamper comparison of results of different studies and elaboration of generalized guidelines for selection of high risk groups and prevention of cardiovascular diseases and type 2 diabetes. Until present there are no common criteria of the syndrome and this makes difficult standardization of methodology of its investigation. Several organizations (WHO, National Cholesterol Education Program, European Group for the Study of Insulin Resistance) issued documents in which diagnostic approaches to detection of metabolic syndrome and its separate components have been formulated. These approaches as well as comparative analysis of direct and calculated methods of assessment of insulin resistance are presented in this review.

[Influence of various diets on lipid exchange in patients with obesity and metabolic syndrome]. / Vliianie razlichnykh lechebnykh diet na obmen lipidov u patsientov s ozhireniem i metabolicheskim sindromom.

The investigation of influence the diets with different rations carbohydrate and lipid components on the status of lipid spectrum of patients, suffering of metabolic syndrome, these were be used during 4 mounts, was the aim of present researches. The 84 male in the age of 30-65 years were examination Effective decrease body mass, atherogenic parameters of lipid metabolism (hypertrigleciridemia, LDL) and also the levels of arterial hypertension were founded in patients? Using low carbohydrate and low fatty diets.

[Effect of different diets on quality of life in patients with metabolic syndrome]. / Vliianie razlichnykh diet na kachestvo zhizni patsientov s metabolicheskim sindromom.

The purpose of the research was to study influence of diets with a various ratio of carbohydrates and fatty components on modification of metabolic risk factors due to decrease of weight and abdominal adiposity, and also on quality of life of the patient. 49 males were included in the study the age 30-65 years with metabolic syndrome X. All patients had increased body mass or obesity. Hypertension of I and II stages was observed in 49.0% of cases. The estimation of results was carried out in three months after assignment of one of investigated diets. Effective reduction of body mass parameters was achieved at use of all diets within three months. Nutritional counseling was based on dietary preferences and habits of the patient to improve quality of life at observance of a diet. Common negative feature of investigated diets was occurrence of feeling of hunger that caused infringement of accuracy of observance of recommendations.

[Clinical manifestations and characteristics of vascular bed involvement in atherosclerosis of lower extremities in patients with type 2 diabetes]. / Klinicheskie proiavleniia i kharakter porazheniia sosudistogo rusla pri ateroskleroze arterii nizhnikh konechnostei u bol'nykh sakharnym diabetom 2-go tipa.

Clinical manifestations of arterial insufficiency and characteristics of vascular damage were compared in 68 patients (54 men, 14 women, mean age 64.5+/-1.1 years) with atherosclerosis of arteries of lower extremities including 40 patients with type 2 diabetes. Color duplex scanning was used for assessment of severity of vascular wall involvement. Ankle blood pressure was measured by Doppler technique with calculation of ankle-brachial index. Atherosclerosis of arteries of lower extremities in patients with diabetes manifested clinically as neuropathy while intermittent claudication was more characteristic of patients without diabetes. Severity of medial calcinosis and vascular wall rigidity were related to duration of diabetes. Ankle-brachial index in patients with diabetes was 20-30% and 1.5-2 times higher compared with those without diabetes with similar occlusive and nonocclusive changes of arteries of lower extremities, respectively. Color duplex scanning did not reveal differences between patients with and without diabetes in frequency of large multiple atherosclerotic plaques in abdominal aorta, iliac, popliteal arteries.

[Effects of dioxins in the development of malignant tumors and disorders of reproductive health of the population]. / O vliianii dioksinov na vozniknovenie zlokachestvennykh novoobrazovanii i narushenii reproduktivnogo zdorov'ia naseleniia.

The mortality caused by malignant tumors in the town of Chapaevsk, characterized by increased level of dioxins in the environment, is statistically higher than the expected values. For men the relative risk of general morbidity is 1.9 and mortality, 1.8; for lung cancer: morbidity, 3.3 and mortality 3.1; for urogenital cancer: morbidity, 3.6 and mortality, 2.6; for gastric cancer: morbidity 1.9 and mortality, 1.7. In women the morbidity and mortality due to breast cancer (relative risks 1.9 and 2.1, respectively) and cancer of the cervix uteri (relative risks 2.1 and 1.8, respectively) are increased. Changes in the reproductive health of residents of this town are as follows: high incidence of spontaneous abortions, appearance of small-for-date babies, and genital disorders in body (cryptorchidism, phimosis, hypospadia, delayed sexual development).

[Statistics of lung, stomach and esophageal cancer: status of oncological care, morbidity and mortality]. / Statistika raka legkogo, zheludka i pishevoda: sostoianie onkologicheskoé pomoshchi, zabolevaemost' i smertnost'.

Lung cancer is the most common pattern of malignant neoplasms in males, gastric cancer ranks next. In the female pattern of cancer morbidity, gastric cancer is third in the incidence of tumors, pulmonary cancer occupies the 9th place. Esophageal cancer accounts for 3%. In the mortality pattern, lung cancer holds the lead in males and ranks 4th in females, gastric cancer is second in both sexes, esophageal cancer occupies the 7th place in males. In 1999 the standardized incidence rates of cancer of the lung were 64.8 and 6.8 in males and females, respectively. Those of the stomach and esophagus were 33.6 and 7.2 in males and 6.8 and 1.2 in females, respectively. There were tendencies for decreases in the morbidity and mortality of cancer at these sites in 1990 to 1999. The morphological verification of diagnosis of lung cancer does not reached 50%, this is higher for cancer of the stomach (71.6%) and esophagus (67.7%). There has been an increase in the proportion of patients with Stage IV disease in all tumor forms in question. The basic treatment for cancer of the stomach and lung was surgical (82.2 and 38.6%, respectively) and that for esophageal cancer is radiation (47.6%). As little as 10% of patients with gastric and lung cancer survive over 5 years. In esophageal cancer, this figure is much less (5%).

[Effects of cardiovascular therapy on risk of the development of ischemia and myocardial infarction in the postoperative period in cancer patients with ischemic heart diseases]. / Vliianie serdechno-sosudistoi terapii na risk razvitiia ishemii i infarkta miokarda v posleoperatsionnom periode u onkologicheskikh bol'nykh, stradaiushchikh ishemicheskoi bolezn'iu serdtsa.

Analysis of 636 surgical interventions for malignant tumors in 576 chronic coronary patients showed that beta-blockers decreased the relative risk of ischemia and myocardial infarction during the postoperative period. Calcium antagonists verapamil and dihydropyridines also essentially decreased the probability of myocardial infarction and less so of myocardial ischemia. Antiischemic effect of nitrates was insignificant, and they increased the risk of myocardial infarction. Antioxidants did not prevent ischemia but significantly decreased the risk of infarction. Therapy with non-fractionated heparin involved the risk of ischemia and myocardial infarction. The causes of low cardioprotective effects of nitrates and heparin can be explained by the discontinuation syndrome, which increases the risk of exacerbation of coronary disease during the postoperative period.

[New approaches to the treatment of patients with idiopathic mitral valve prolapse]. / Novye podkhody k lecheniiu bol'nykh s idiopaticheskim prolabirovaniem mitral'nogo klapana.

AIM: To assess efficiency of magnerot, magnesium orotate, in patients with idiopathic mitral prolapse (IMP). MATERIAL AND METHODS: 84 patients with IMP were randomized to the study group (43 patients) and control group (41 patients). Patients of the study group received magnerot tablets (Germany) containing 500 mg of magnesium orotate (daily dose 3000 mg) for 6 months. The examination performed before the treatment and 6 months after it included: modified clinical and phenotypic records, echocardiography, 24-h ECG and AP monitoring, spectral analysis of cardiac rhythm variability, evaluation of quality of life according to Visual Analog Scale and Disability Scale and of treatment results according to Clinical Global Impression scales, measurements of magnesium in the hair by plasmic nuclear emission spectrometry, histological and histochemical skin tests. RESULTS: IMP patients appeared to suffer from magnesium deficiency which is responsible for many symptoms in mitral prolapse. 6-month therapy with magnerot completely or partially reduced the symptoms in more than half the patients. Positive changes were registered primarily in clinicofunctional manifestations. Morphological changes in the skin correlating with the disease severity alleviated. CONCLUSION: Good objective and subjective response to magnerot 6-month therapy (3000 mg/day) is demonstrated.

[Experience in long-term use of berodual in the treatment of patients with chronic obstructive bronchitis]. / Opyt dlitel'nogo primeneniia beroduala pri lechenii bol'nykh khronicheskim obstruktivnym bronkhitom.

AIM: To study clinical efficiency of 12-month administration of berodual in chronic obstructive bronchitis (COB). MATERIALS AND METHODS: The trial entered 33 patients with at least 2-year history of COB and forced expiratory volume per 1 sec (FEV1) not less than 45% of normal value. RESULTS: The best response of clinical parameters and external respiration was observed throughout 3 weeks of berodual inhalations. Dyspnea and cough were cured by the end of the treatment in 40 and 26% of the patients, respectively. Exercise tolerance has improved, FEV1 has increased for the year from 71.9 to 79.1%. CONCLUSION: Long-term berodual monotherapy is able to inhibit progression of bronchial obstruction and symptoms of COB.

[Analysis of stage IV stomach cancer diagnostic and treatment results in permanently followed-up group of population]. / Analiz rezul'tatov diagnostiki i lecheniia raka zheludka IV stadii u postoianno nabliudaemoi gruppy naseleniia.

982 case records of the patients with cancer of the stomach (CS) were analyzed for the period from 1980 to 1997. Among them tumor of stage IV made up 21.1% (autopsy data were not taken into account). The main cause of late CS diagnosis was defective system of screening for CS. The survival rate of the patients with CS stage IV did not exceed 2 years. Chemotherapy in inoperable patients allowed a reliable increase of 7% to 26% in corrected survival rate during one year. Palliative operations increase the values of 1 year survival rate of patients with CS from 5% to 60%.

[Renal lesions in elderly patients with diabetes mellitus]. / Porazhenie pochek u bol'nykh sakharnym diabetom pozhilogo vozrasta.

AIM: To elucidate the role of some renal diseases, pyelonephritis in particular, in elderly patients with type 2 diabetes mellitus (DM). MATERIALS AND METHODS: The trial included 150 patients with diabetes mellitus type 2 aged over 60 years with DM duration 16.6 +/- 7.8 years. All the patients underwent general clinical examination, Reberg-Tareev test, urine seeding, renal ultrasonography. RESULTS: The diagnoses associated with renal pathology were made in 75% of patients, the specific renal parenchymal damage (diabetic nephropathy-DN) proper was much less common (73 patients with type 2 DM). 16 of them were found to have chronic renal failure. The concurrent abnormalities included pyelonephritis (21%), urolithiasis (14%), renal cysts (19%), their combination (43%). Concomitant pyelonephritis had the most significant impact on renal function. Essential hypertension occurred in 65% of patients. CONCLUSION: In old age, renal damage specific for DM develops in the presence of pyelonephritis, cystic degeneration of the parenchyma, involutional processes, atherosclerotic and hypertensive arteriolosclerosis.