[Chest wall repair after extensive resections]. / Rezul'taty vosstanovleniya karkasa grudnoi stenki posle obshirnykh rezektsii.

OBJECTIVE: To analyze the outcomes after different methods of post-resection chest wall defect reconstruction. MATERIAL AND METHODS: The study included 41 patients aged 22-73 years who underwent chest wall repair with local tissues and synthetic materials. Twelve (29.3±7.1%) patients had sarcoma, 9 (21.9±5.9%) - non-small cell lung cancer (NSCLC) with invasion of the chest, 9 (21.9±5.9%) - metastatic lesions, 8 (19.5±6.2%) - benign tumors, 2 (4.8±3.4%) - breast cancer with invasion of the chest wall, 1 (2.4±2.4%) - desmoid tumor. Seven patients were diagnosed with T3N0M0, 1 - T3N2M0, 1 - T2N0M1b (oss). Among patients with NSCLC with invasion into the chest wall, squamous cell cancer was verified in 4 (44.4±16.6%) patients, adenocarcinoma - in 4 (44.4±16.6%), neuroendocrine tumor - in 1 (11.2±10.5%) patient. Stages of surgeries are presented. RESULTS: We analyzed treatment outcomes in 41 patients. Five (12.2%) patients had seroma, hemothorax, thoracopleural fistula, subcutaneous emphysema and fatal asystole. There were no postoperative complications associated with paradoxical breathing. CONCLUSION: Accurate morphological verification prior to treatment is valuable to determine the stages of combined treatment of chest wall tumors. Chest wall defect closure with own tissues and synthetic materials is necessary after extensive resections. A multidisciplinary approach involving thoracic and plastic surgeons is needed.

[Analysis of fatal outcomes of meningococcal infection in adults].

Clinical characteristics and pathomorphological manifestations in 69 patients aged 18 to 86 years with a fatal outcome of the disease were examined in order to analyze the causes of severe course and high mortality of generalized forms meningococcal infection. It was found that the main clinical form was meningococcemia (90%), in the majority in combination with meningitis (52%). The fulminant course in 77% of patients with meningococcal sepsis manifested itself as a sudden onset, rapid development of typical symptoms. Hemorrhagic exanthema was detected on the first day of meningococcemia. The leading complications and critical conditions were infectious-toxic shock, disseminated intravascular coagulation and acute adrenal insufficiency (Waterhouse-Friederiksen syndrome). The severe course of meningitis (in 10%) led to the development of cerebral coma, the morphological substrate of which was edema - swelling of the brain.

[Efficacy and safety of bulevirtide in patients with chronic hepatitis D and compensated cirrhosis].

AIM: To study the efficacy and safety of bulevirtide, the HBV and HDV entry inhibitor. MATERIALS AND METHODS: Analysis of the results of using bulevirtide in randomized controlled open-label comparative studies MYR202 and MYR203 in 56 patients with chronic hepatitis D and compensated cirrhosis, in monotherapy and combination with pegylated interferon alpha-2a (PEG-IFN). RESULTS: Monotherapy with bulevirtide for 24 weeks in the MYR202 study in 46 patients with compensated liver cirrhosis demonstrated: 1) a high rate of virological (100%) and biochemical response (alanine aminotransferase normalization rate 45.7%), 2) superiority of bulevirtide in efficacy over the control group (tenofovir), 3) comparability of treatment efficacy in patients with and without cirrhosis, 4) no progression of liver fibrosis with elastometry in most patients. Treatment with bulevirtide in monotherapy and combination with PEG-IFN for 48 weeks in 10 patients with compensated liver cirrhosis in the MYR203 study was accompanied by a high rate of virological response (80%) and normalization of alanine aminotransferase (70%). Bulevirtide was well tolerated, there was no deterioration in tolerability compared with patients without cirrhosis, there were no serious adverse events and cases of treatment cancellation due to adverse events. CONCLUSION: Bulevirtide is recommended as the first line of treatment for chronic hepatitis D in patients with compensated cirrhosis in monotherapy and combination with PEG-IFN.

[Efficacy and safety of narlaprevir/ritonavir and daclatasvir non interferon combination in population of Russian patients with chronic hepatitis C].

AIM: Evaluate efficacy and safety of a combination of direct - acting antivirals narlaprevir/ritonavir with daclatasvir in patients with viral hepatitis C. MATERIALS AND METHODS: The study enrolled adult patients with HCV genotype 1b infection without demonstrated NS5A resistance - associated substitutions Y93C/H/N/S and/or L31F/M/V/I. Patients were treated with narlaprevir 200 mg QD, ritonavir 100 mg QD and daclatasvir 60 mg QD. Treatment duration was 12 weeks. Proportion of patients achieving sustained virological response 12 weeks after treatment (SVR12) was the primary efficacy endpoint. RESULTS AND DISCUSSION: In total, 105 (75.0%) patients were treatment with the study combination. Patients' age varied from 21 to 69 years, the mean age being 43.2±10.9 years. There were slightly more women (55.2%), and 69 patients (65.7%) had comorbidities. SVR 12 was 89.5% (95% CI 82.0-94.7%). In 10 of 11 patients with treatment failures NS5A resistance - associated substitutions in residues 31 and/or 93 were found, as well as less clinically relevant substitutions L28M, P58S, R30Q, Q62K. Adverse events (AEs) were found in less than one half of patients (45 patients, or 42.9% in the safety population). Almost all recorded AEs were mild to moderate. CONCLUSION: Efficacy of treatment with a combination of narlaprevir/ritonavir and daclatasvir in treatment - naïve patients with HCV genotype 1b was close to 90%. This combination was found to be safe and well - tolerated.

[Effectiveness and safety of antiviral therapy of military personnel suffering from chronic hepatitis C].

In order to evaluate effectiveness and safety of antiviral therapy schemes examined and treated 191 patients with chronic bepatitis C were assigned standard interferon and ribavirin, pegslated interferon and ribavirin, the total duration of the course coput 24-48 weeks. Based on clinical and laboratory parameters evaluated the safety of antiviral therapy. Formation of sustainable viral response, depending on the genotype observed, was given at 58,9-70%.of patients. In case of insufficient. antiviral therapy was prescribed a second course that will improve the effectiveness of treatment to 90-95%. Correction of adverse events was held lower dosages of interferon and/or ribavirin.

[Intestinal dysbiosis in liver cirrhosis].

Intestinal dysbiosis is revealed in 28.5% of patients with liver cirrhosis, mainly in classes B and C by Child-Pugh by the results of hydrogen breath test. It is established that revealed intestinal dysbiosis in patients with liver cirrhosis of viral etiology aggravates the course of the disease.

[Morphological characteristics of HCV cirrhosis of the liver].

Pathomorphological changes were analyzed in the HCV-cirrhotic liver of patients with varying decompensation of the organ 's function. The decompensation of liver function in HCV cirrhosis was shown to be directly related to the infectious process. It is conceivable that it is to a greater degree determined by an autoimmune response, as confirmed by lower blood virus replicative activity, NS3 protein expression in the cells of an inflammatory infiltrate in the portal tract, and reduced detection rates for NS3 protein expression in the hepatocytic cytoplasm as the pathological process progresses.

[Chronic HCV-infection and expression of mRNA of CC-chemokines and their receptors].

The aim of this study was to evaluate some patterns in expression of CC-chemokines (MIP-1alpha, MIP-1beta, MCP-1, RANTES) and their receptors (CCR1, CCR2, CCR3, CCR5) in peripheral blood leukocytes and liver biopsy samples from 21 patients with chronic hepatitis C. 10 healthy subjects were included in the control group. In patients with chronic HCV-infection significant increase of MCP-1 mRNA in liver tissue was observed as the disease progressed. Moreover, content of MCP-1 mRNA was significantly higher in liver as compared with blood. Level of MCP-1 mRNA in liver was directly related with histological changes. Levels of mRNA of CCR1, CCR2, CCR3, and CCR5 in blood of patients with minimal histological manifestations of chronic HCV-infection were significantly lower than in patients with more marked lesions. Expression of CCR1 and CCR5 mRNA in blood was directly correlated with histological activity index and degree of fibrosis. Conducted study demonstrates that progression of chronic hepatitis C is realized through local activation of MCP-1 mRNA synthesis leading to systemic response which manifested by increase of expression of CCR1, CCR2, CCR3, and CCR5 in peripheral blood leukocytes.

[The condition of the stomach, duodenum and bile ducts in patients with chronic hepatitis C].

AIM: To study the status of the stomach, duodenum and biliary tracts in young patients with chronic hepatitis C. MATERIAL AND METHODS: We studied associated pathology of the gastroduodenal zone and biliary tract in 140 patients with CHC aged 16 to 35 years (mean age 25 +/- 0.8 years). We used USI and MRT of the abdominal organs, fibroesophagogastroduodenoscopy with biopsy of gastric mucosa for H. pylori, fractional duodenal tubing. 30 healthy males were controls. RESULTS: Asymtomatic gastroduodenal and biliary defects were found (75.5%). Endoscopic signs of gastroduodenal lesions were frequent (76.3%) in CHC patients, the majority of them were associated with H. Pylori and were not significantly different from those in the controls. Biliary tracts pathology, as shown by USI and MRT, occurred in 50.8%, were primarily functional (74.5%) and combined with high occurrence of bile mixed microflora with predominance of B. Fragilis (81%). Correlation of pathological changes of the gastroduodenal zone and biliary tract was established in CHC patients. How ever, they do not correlate with clinicolaboratory and histological signs of HCV infection. CONCLUSION. Young patients with CHC demonstrated no correlation between pathological changes of the gastroduodenal zone, biliary tracts and clinicolaboratory, histological signs of HCV infection. Therefore, it is recommended not to eradicate HP-infection and not to suppress opportunistic bile microflora in CHC young patients in the absence of clinical symptoms of gastrointestinal changes.

[The immunological effects of perftoran]. / Immunologichesie éffekty perftorana.

The effect of perftocarbonic emulsion-perftoran on the course of experimental lipopolysaccharide intoxication was studied in albino mice. Resistance of the animals to the endotoxin reduced 3 days after administration of 10 ml/kg of the preparation and increased 6 days after its administration. The effect of perftoran on the dynamics of some parameters of immunity and nonspecific resistance in CBA mice and guinea pigs was studied in immunodeficiency states induced by injection of 5-fluorouracil, cyclophosphamide, and irradiation. Activation of the phagocytic system occurred 3 days later, and activation of the parameters of cellular and humoral immunity 6 days later.

[Comorbid gastric and duodenal changes in chronic hepatitis C in young patients]. / Soputstvuiushchie izmeneniia v zheludke i dvenadtsatiperstnoi kishke pri khronicheskom gepatite C u lits molodogo vozrasta.

Characteristics of the gastroduodenal zone, frequency of gastric mucosa contamination with Helicobacter pylori (HP) were studied in young patients with chronic hepatitis C (CHC). Affections of the stomach and the duodenum were encountered in 76.3% of CHC patients. They run, as a rule, latently and in most cases (80%) are associated with HP. Concurrent diseases of the upper gastroduodenal tract seem to have only a minor impact on the course of HCV infection. Therefore, it is better to avoid eradication of HP in young patients with CHC.