[Chronorehabilitation of the patients suffering from chronic cholecystitis with concomitant gallbladder dysfunction and opisthorchiasis]. / Khronoreabilitatsiia bol'nykh khronicheskim kholetsistitom s disfunktsiei zhelchnogo puzyria i opistorkhozom.

The importance of the development of the effective rehabilitative measures for the patients suffering from chronic cholecystitis with concomitant gallbladder dysfunction and opisthorchiasis is beyond question. The adequate methods for the rehabilitation of the patients after an intensive de-worming remain to be developed. It is known that de-worming is not infrequently followed by the immediate amplification of the manifestations of the stagnation of bile in the gallbladder that become even more pronounced than before the de-worming procedure. With the purpose of improving the effectiveness of the spa and health resort-based rehabilitation and prevention of the complications, it is recommended to make use of the modern therapeutic physical factors to be prescribed taking into consideration the characteristics of the biological rhythms in the functional activity of the biliary system in the individual patients. The most effective rehabilitation methods for the treatment of the pathology in question include the application of the therapeutic physical factors known to produce the beneficial effect on the functional state of the biliary system and exert the normalizing influence on the structure of the biological rhythms of the functional activity of various organs and systems. We used a range of approaches for the treatment of 123 patients with chronic cholecystitis and concomitant gallbladder dysfunction plus opisthorchiasis including extremely high-frequency electromagnetic irradiation (EHF therapy) in the combination with the oral intake of the choleretic herbal remedies followed by the transverse galvanization of the epigastric region with due regard for the phase of the rhythm of the functional activity of the gallbladder. The results of such treatment gave evidence of the positive dynamics of all the studied indicators of the functional activity of the biliary system and the organism as a whole which suggests the highest therapeutic effect (87.9%) of the proposed treatment that was maintained during 6 to 12 months.

[A case of acute opisthorchiasis concurrent with chronic hereditary hemolytic anemia].

The paper analyzes the clinical and laboratory manifestations of acute Opisthorchis invasion concurrent with chronic hereditary hemolytic anemia before and after antihelminthic therapy. It gives the results of direct clinical observation of a patient in the acute phase of opisthorchiasis in the presence of Minkowsky-Shauffard disease. His examination encompassed conventional laboratory and instrumental studies used in hepatology, such as physical, biochemical, and immunological examinations (tests for viral hepatitismarkers and autoimmune liver diseases), and abdominal ultrasound scanning and magnetic resonance imaging. The patient with acute opisthorchiasis concurrent with hemolytic anemia was found to have a preponderance of clinical and laboratory manifestations of hepatocholangitis in the early stages of the disease and a prevalence of subfebrility with progressive eosinophilia in the presence of regressive symptoms. The clinical and laboratory signs of hereditary microspherocytosis suggest that the process is decompensated. The found clinical and laboratory changes correspond to the natural course of the diseases. The magnitude of changes in laboratory parameters suggests that there is an intercurrent interaction of infectious and somatic diseases, but does not hinder dehelminthization.

[A local case of acute opisthorchiasis in the Moscow Region].

The paper describes a case of acute opisthorchiasis in a 31-year-old female patient after ingestion of dried fish of the family Cyprinidae caught in the Oka River basin on the border of the Moscow and Ryazan Regions. This case could convince of that there was a risk of human Opisthorchis infection despite the zoonotic pattern of circulation of the pathogen in European Russia. The dietary intake of unsterilized fish of the family Cyprinidae caught in the Moscow and neighboring regions may give rise to Opisthorchis invasion and, it a large infectious dose, to acute opisthorchiasis.

[The problem of opisthorchiasis in Ukraine and current approaches to its treatment].

The opisthorchiasis epidemiological situation in Ukraine and the Sumy Region that has the largest natural focus of invasion has been analyzed. Its morbidity rate is 21.6 per 100,000 population, which is more than 20 times greater than that in Ukraine. The clinical course of the disease in the endemic focus, the attribute of which is the high percentage of its latent form, has been examined. Praziquantel is the most effective drug for the etiotropic therapy of opisthorchiasis.

Inflammatory response to liver fluke Opisthorchis viverrini in mice depends on host master coregulator MTA1, a marker for parasite-induced cholangiocarcinoma in humans.

UNLABELLED: Based on the recently established role for the master coregulator MTA1 and MTA1-containing nuclear remodeling complexes in oncogenesis and inflammation, we explored the links between parasitism by the carcinogenic liver fluke Opisthorchis viverrini and this coregulator using both an Mta1(-/-) mouse model of infection and a tissue microarray of liver fluke-induced human cholangiocarcinomas (CCAs). Intense foci of inflammation and periductal fibrosis in the liver and kidneys of wild-type Mta1(+/+) mice were evident at 23 days postinfection with O. viverrini. In contrast, little inflammatory response was observed in the same organs of infected Mta1(-/-) mice. Livers of infected Mta1(+/+) mice revealed strong up-regulation of fibrosis-associated markers such as cytokeratins 18 and 19 and annexin 2, as determined both by immunostaining and by reverse-transcription polymerase chain reaction compared with infected Mta1(-/-) mice. CD4 expression was up-regulated by infection in the livers of both experimental groups; however, its levels were several-fold higher in the Mta1(+/+) mice than in infected Mta1(-/-) mice. Mta1(-/-) infected mice also exhibited significantly higher systemic and hepatic levels of host cytokines such as interleukin (IL)-12p70, IL-10, and interferon-γ compared with the levels of these cytokines in the Mta1(+/+) mice, suggesting an essential role of MTA1 in the cross-regulation of the Th1 and Th2 responses, presumably due to chromatin remodeling of the target chromatin genes. Immunohistochemical analysis of ≈ 300 liver tissue cores from confirmed cases of O. viverrini-induced CCA showed that MTA1 expression was elevated in >80% of the specimens. CONCLUSION: These findings suggest that MTA1 status plays an important role in conferring an optimal cytokine response in mice following infection with O. viverrini and is a major player in parasite-induced CCA in humans.

[Gastric secretory function in psoriatic patients with chronic opistorchosis before and after antihelminthic therapy].

The aim of the work was to study secretory function of the stomach in psoriatic patients with chronic opistorchosis (CO) before and after antihelminthic therapy. It included 90 such patients, 70 with psoriasis alone, 70 with CO, and 30 healthy subjects. All patients were examined by oesophagogastroduodenoscopy. Fractional gastric secretion was measured. The secretory function of the stomach was most seriously disturbed in psoriatic patients with CO. It did not further deteriorate after antihelminthic therapy. The disturbance was associated with reduced hydrochloric acid and pepsin levels which confirms the necessity of antihelminthic therapy.

[Continuous blood coagulation in chronic opisthorchiasis].

Animal experiments have shown that chronic Opisthorchis invasion results in accelerated continuous blood coagulation, by inducing hypercoagulation and platelet activation. The state of hemostasis depends on the degree of infection and undergoes the largest changes during maximum invasion. Irrespective of invasion rates, chronic opisthorchiasis is accompanied by hypofibrinogenemia.

[Clinical and functional disorders of the stomach-in patients with psoriasis in the presence of chronic opisthorchiasis].

OBJECTIVE: to study the clinical and functional status of the stompach in patients with psoriasis in the presence of chronic opisthorchiasis (CO). Subjects and methods. Ninety patients with psoriasis concurrent with CO (a study group (Group 1)), 70 with psoriasis (a comparison group (Group 2)), 70 with CO (Group 3), and 30 healthy individuals were examined. All the patients underwent fractional gastric secretory studies and esophagogastroduodenoscopy (EGDS). RESULTS: The study group showed a reduction in stimulated hydrochloric acid output (4.25+/-0.38 mmol/hour), which was significantly less than that in Groups 2 and 3 and healthy individuals [5.87+/-0.51 (p<0.001); 6.86+/-0.59 (p<0.05), and 10.73+/-0.84 mmnol/hour (p<0.001), respectively]. In the study group, stimulated pepsin output (4.87+/-0.49 mmol/hour) was also significantly less than that in the other groups. Reduced basal hydrochloric acid output was found in 65.5% of the study group patients, whose number was significantly larger than that in the comparison group [44.3% (p<0.05)] and its stimulated output was less in 80 and 62.9% in the study and comparison groups, respectively (p < 0.05). A reduction in pepsin output in the basal secretion phase was revealed in 57.8 and 37.1% of the patients in the study and comparison groups, respectively (p<0.05) while that in the stimulated phase was in 63.3 and 34.3% (p<0.001). Thus, gastric secretory function in psoriatic patients is characterized by reduced hydrochloric acid and pepsin outputs and it is more impaired in patients with mixed pathology, which necessitates anthelmintic therapy in this category of patients.

[Complicated forms of superinvasion opisthorchiasis: pathogenetic aspects].

Superinvasion opisthorchiasis is characterized by host growth retardation and weight reduction, which are due to the cleptoeffect of Opisthorchis felineus; metabolic disturbances, proliferative processes, accelerated collagen biosynthesis and biodegradation in the organs reflect parasite-host interactions as components of the system. The productive reactions of visceral pathology are initiated by the parasite's metabolites located in the liver, lung, heart, and testes.

[The clinical and functional state of the liver in patients with psoriasis in the presence of chronic opisthorchiasis].

OBJECTIVE: to study the clinical and functional state of the liver in patients with psoriasis concurrent with chronic opisthorchiasis (CO). SUBJECTS AND METHODS: Twenty-eight patients with psoriasis concurrent with CO, 15 patients with CO, 15 patients with the enlarged liver, and 15 healthy individuals were examined. Serum biochemical study and ultrasonography of the liver and gallbladder were used. RESULTS AND DISCUSSION: The patients with comorbidity were found to have hepatomegaly with syndromes of cytolysis, cholestasis, and mesenchymal inflammation of more degrees than those from Groups 2 and 3. CONCLUSION: The found clinical and functional liver changes in patients with psoriasis concurrent with CO make it necessary to perform anthelmintic therapy in this category of patients.

[Myocardial structural and functional changes in patients with chronic viral hepatitis concurrent with chronic opisthorchiasis].

The aim of the investigation was to study the myocardium in patients with chronic viral hepatitis concurrent with chronic opisthorchiasis. Ninety patients with chronic viral hepatitis, including 52 patients with this disease concurrent with chronic opisthorchiasis, were examined. Doppler echocardiography indicated a statistically significant increase in left ventricular mass regardless of the presence of Opisthorchis infestation. Analysis of left ventricular diastolic dysfunction showed its great degree in chronic hepatitis C. Single-photon emission computed tomography with 99mTc-pyrophosphate revealed focal tracer incorporation in the myocardium of most patients with Opisthorchis infestation. A third of patients with chronic viral hepatitis showed moderate diffuse trace accumulation that was significantly more frequently found in chronic hepatitis C. Single photon-emission tomography with labeled leukocytes demonstrated abnormal accumulation in none of the patients; troponin T levels were in the normal allowable range. Myocardial lesion was detected in the chronic course of viral hepatitis C concurrent with chronic opisthorchiasis that was unattended by cardiomyocyte necrosis and that was dystrophic.

[Left ventricular diastolic dysfunction in patients with psoriasis in the presence of chronic opisthorchiasis].

Left ventricular diastolic function was studied in patients with psoriasis concurrent with chronic opisthorchiasis (CO). Seventy-five patients with psoriasis concurrent with CO, 50 patients with CO, and 20 healthy individuals were examined. Echocardiographic study (EchoCG) in the M-, B-, and Doppler modes was made in all the patients, by using the standard methods. All the examinees were found to have impaired active left ventricular relaxation that manifested itself as a longer isovolumic relaxation time, which was more pronounced in patients with psoriasis concurrent with CO. Left ventricular systolic function in these patients was preserved. In the psoriatic patients, diastolic dysfunction was characterized by impaired relaxation and it was more evident in patients with comorbidity.

[The clinical and functional status of the stomach and small intestine in patients with chronic inflammatory bowel diseases concurrent with chronic opisthorchiasis].

To study the impact of Opisthorchis infestation on the upper digestive tract and small bowel in chronic inflammatory bowel diseases, the authors examined 164 patients with inflammatory bowel diseases, including 71 patients with ulcerative colitis and 45 with Crohn's disease without parasitosis and 48 with chronic opisthorchiasis (31 with ulcerative colitis and 17 with Crohn's disease). A control group consisted of 20 healthy individuals and 20 patients with chronic opisthorchiasis. A diagnosis was established by colonofibroscopy and a morphological study of colonic biopsy specimens. Gastric mucosal atrophic changes and motor evacuatory disorders as duodenogastric reflux were significantly more frequently encountered in inflammatory bowel diseases concurrent with chronic opisthorchiasis. The presence of Opisthorchis infestation significantly worsened fat and carbohydrate malabsorption in the small bowel in inflammatory bowel diseases.

[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.

[Clinical and functional changes in the biliary tract in patients with psoriasis concurrent with chronic opisthorchiasis].

OBJECTIVE: to study the clinical and functional changes in the biliary tract in patents with psoriasis concurrent with chronic opisthorchiasis (CO). SUBJECTS AND METHODS: 60 patients with psoriasis concurrent with CO, 45 patients with psoriasis without helminthism, 30 with CO, and 15 healthy individuals were examined. Chromatic fractional duodenal intubation, dynamic hepatobiliscintigraphy, and ultrasound study of the liver and gallbladder were used. The concentrations of cholesterol, bile acids, bilirubin, total lipids and phospholipids in bile were measured. A number of relative indices, such as cholate-cholesterol coefficient (CCC), Thomas-Hofmann index, and Rubens index were calculated. RESULTS AND DISCUSSION: The patients with psoriasis with CO were found to have signs of mainly hypermotor dyskinesia of the biliary tract, as well as increased bile lithogenicity (lower CCC, and increases in the Rubens index and Thomas-Hofmann index). CONCLUSIONS: The clinical and functional changes found in the biliary tract of the patients with psoriasis concurrent with CO show it necessary to perform antihelminthic therapy in this group of patients.

Human illnesses caused by Opisthorchis felineus flukes, Italy.

We report 2 outbreaks of Opisthorchis felineus infection caused by the consumption of tench filets (Tinca tinca) from a lake in Italy. Of the 22 infected persons, 10 (45.4%) were asymptomatic. When present, symptoms (fever, nausea, abdominal pain, and myalgias) were mild. Eosinophilia occurred in all infected persons.

[Biorhythms to improve efficiency of the treatment of patients with chronic opisthorchosis].

To make the treatment of bile-excreting dysfunctions more effective still remains an actual problem of clinical medicine. Use of chronobiological approach in the treatment is possible to resolve that problem. For any system including bile-excreting one, its own biorhythms are typical. Lesion of these systems causes changes of the biorhythms. Use of parameters of biorhythms of bile-excreting system activity expects an individual or group chronobiological approach in the treatment of patients with chronic opisthorchosis. The combined treatment of opisthorchosis with the use of such approach makes possible to improve efficiency of the treatment and to maintain received effect up to 6 months. It indicates increase the terms of remission and prevents development of early recidivation.

[Systemic responsiveness and the efficiency of antihomotoxic therapy for chronic opisthorchiasis. 3. Responsiveness].

The authors consider systematic responsiveness in chronic opisthorchiasis and a relationship between acute inflammation and responsiveness. A number of regularities that take place in the patho- and sanogenesis of chronic disease in general and that are important in the evaluation of the severity and prognosis of the disease and the efficiency of therapy are demonstrated on a model of severe opisthorchiasis. The reversion syndrome indicative of recovered responsiveness during therapy is described in detail. Differences in the interpretation of the helminthoovoscopic findings are shown in the context of the priority of clinical data.

[Bile and serum biochemical parameters in chronic opisthorchiasis].

Bile biochemical composition and serum hepatic samples were studied in patients with opisthorchiasis and non-parasitic diseases of the biliary tract. Opisthorchiasis was found to cause a much more significant reduction in the concentration of bile acid in the gallbladder. The specific features of the invasive disease manifested themselves in the maximum blood level of cholesterol with its less considerable increase in the cystic bile and with the least concentration of bilirubin in the gallbladder. Analysis in each group of the patients being examined reveals specific correlations between the values of biochemical composition of bile and blood. The findings suggest that biliary tract dysfunction in the absence of a parasitic burden is insufficient to have a noticeable impact on the state of the pancreas and that the composition of cystic bile is predominately affected by impaired biliary excretion in patients with nonparasitic diseases and by the altered concentration function of the gallbladder in those with chronic opisthorchiasis. Thus, comparison of the biochemical composition of bile and serum permits identification of the specific features of the invasive disease and induces to pay attention to the immunopathogenetic mechanisms responsible for hepatic synthetic dysfunction and to the specific features of gallbladder concentration function in opisthorchiasis.

[Biochemical parameters of hepatobiliary system functions in viral hepatitis or ixodes tick-borne borreliosis concurrent with chronic opisthorchiasis].

The biochemical parameters of hepatobiliary system functions were studied in patients with opisthorchiasis and concomitant diseases, such as chronic viral hepatitis concurrent with chronic opisthorchiasis, as well as Ixodes tick-borne borreliosis in the presence of the same invasion. Although the magnitude ofbiochemical changes is not great in chronic opisthorchiasis or chronic viral hepatitis, the concomitance of these two diseases were ascertained to result in pronounced abnormalities, by demonstrating the exhaustion of spare capacities of the hepatobiliary system in parasitic invasion (or viral infection). When opisthorchiasis was concurrent with Ixodes tickborne borreliosis, some parameters under study differed from those in the groups of patients with monoinfections. Variance analysis showed that chronic opisthorchiasis had a great impact on carbohydrate and lipid metabolisms (glucose and cholesterol levels). The findings suggest that the formation of stable host-parasite relationships in chronic opisthorchiasis alters human metabolic processes and their compensatory capabilities.