[Proinflammatory cytokines in the gastric juice in acid-related diseases before and after standart therapy.]

The aim of research was to evaluate the effectiveness of the effect of eradication therapy on the cytokine status of gastric juice in patients with chronic non-atrophic gastritis (CNG) and duodenal ulcer (DU) associated with Helicobacter pylori. Clinical observations and laboratory-instrumental studies performed in 95 patients aged 20 to 55 years with CNG and duodenal ulcer with determination of cytokine content of IL-1ß, IL-6 and TNF-α in the fasting portion of gastric juice. The most pronounced decrease in the content of proinflammatory cytokines in gastric juice on the background of treatment was found in patients of the 1st group who received combined therapy according to the scheme omeprazole + clarithromycin + amoxicillin. Analysis of the content of proinflammatory cytokines (IL-1ß, IL-6 and TNF-α) in gastric juice in patients with acute exacerbation showed that their concentration in all 8 patients after the course of therapy exceeded the norm (P < 0.05) and was IL -1ß - 30,30 + 1,15 pg/l, IL-6 - 10,4 + 0,83 pg / l and TNF-α - 32,5 + 1,13 pg / l. At the same time, the level of proinflammatory cytokines in gastric juice correlated with the degree of dissemination of H. pylori in the mucosa of the gastroduodenal zone. Helicobacter pylori infection in inflammation and ulceration in the mucous membrane of the stomach and duodenum, possibly in addition to other mechanisms, affects the activation of pro-inflammatory cytokines (IL-1beta, IL-6, TNF-alpha) in gastric juice. Incomplete eradication of H. Pylori after treatment during clinical endoscopic remission in patients with duodenal ulcer in the vast majority of cases is accompanied by the preservation of an increased level of pro-inflammatory cytokines in gastric juice, which may be one of the reasons for the relapse of the disease.

Primary lymphangiectasia of the gastrointestinal tract.

Intestinal lymphangiectasia is a very rare pathology, characterized by the presence of enlarged lymphatic vessels in all layers of the intestinal wall and in the mesentery. As a result, "lymphatic lakes" are formed, through which lymph exudates into the lumen of the intestine. The main manifestation is hypoproteinemic edema. Diagnosis of the disease is based on laboratory-instrumental methods of investigation, including by determining in the stool α-1 antitrypsin as a screening test. Treatment includes: a diet rich in calcium, trace elements, be sure to use medicinal foods enriched with medium chain triglycerides, substitution and symptomatic therapy.

[Zivert-Kartagener's syndrome encountered in the practical work of an otorhionolaryngologist, pulmonologist, obstetrician, and gynecologist]. / Sindrom Ziverta­Kartagenera v praktike LOR-vracha, pul'monologa i akushera-ginekologa.

The objective of the present work was to analyze the current concept of the genetically predetermined condition Zivert-Kartagener's syndrome with special reference to the pathogenetic mechanisms underlying the development of this condition, its clinical picture and methods of treatment. The authors' original observations of the patients presenting with Zivert-Kartagener's syndrome are reported.

[Mucoviscidosis, a challenging medical problem]. / Mukovistsidoz ­ aktual'naya problema meditsiny.

The authors present the currently available data on mucoviscidosis (cystic fibrosis) based on their original experience and the review of the relevant literature. Special attention is given to the pathogenetic mechanisms underlying the development of this condition, its diagnostics, and methods of treatment as exemplified by the clinical case of cystic fibrosis in an adult patient.

[Hepatic tuberculosis with the development of fibrosis and concomitant steatohepatitis].

Tuberculous lesions of the liver frequently occur in autopsy material, even though most of them are clinically unapparent. Pathogenetically, hepatic tuberculosis is a manifestation of general military tuberculosis with the infection brought in through the hematogenous route (through the hepatic artery or the portal system) as a result of intestinal or mesenteric lymph node tuberculosis. We report a case of combination of hepatic tuberculosis and diabetes mellitus in a young woman with reference to the clinical course of the disease, its diagnostics and treatment.

[Dynamics content of nitric oxide in gastric juice before and after treatment helicobacter associated gastroduodenal diseases].

UNLABELLED: The aim of the study was to examine dynamics of the content of nitric oxide (NO) in gastric juice in Helicobacter-associated gastroduodenal diseases. MATERIALS AND METHODS: 105 patients were examined: 56 - with chronic non-atrophic (antral) gastritis (CNG) and 49 - duodenal ulcer (DU). 25 healthy individuals were studied as control. RESULTS: It was found that NO concentration increases in gastric juice at the exacerbation of CNG and DU. Moreover, in patients with CNG with the elimination of Helicobacter pylori and inflammatory activity in the gastric mucosa, NO levels decrease to control values, and in DU patients in remission phase the level of it is markedly reducing, but remains higher than normal. The NO content changes, depending not only on a phase, but also character of a course of a disease, are observed at patients with Duodenal ulcer. At recurrent course UD index of NO in the gastric juice was significantly higher than in newly diagnosed destructive process in the mucosa. CONCLUSION: The carried out research show that H. pylori infection stimulates the metabolism of NO in the gastric CO. The Increase in the levels of NO can be regarded as a protective reaction in response to the persistence of HP.

[Gastric juice levels of nitric oxide in relation to gastric acidicity in patients with upper digestive tract diseases].

The purpose of the investigation was to study a correlation between gastric secretory function and the gastric juice levels of nitric oxide (NO) in patients with upper digestive tract diseases. One hundred and seventy-four patients with upper digestive tract diseases were examined to solve the set tasks. Analysis of the correlation between gastric juice NO levels and gastric secretion volume in patients with gastroduodenal diseases indicated that no correlation was found in the level of end products of gastric juice NO metabolism and total acidity as an aggression factor. At the same time, there was a positive correlation between the gastric juice of NO and the volume of basal and stimulated gastric secretion. Since during gastric juice secretion, blood supply of the gastric mucosal is increased due its dilated microvessels, NO is most likely to cause dilatation and accordingly a gastric secretion stimulant. Therefore, by taking into account that provision of sufficient gastric mucosal blood supply is one of the protective means in gastroduodenal diseases, it may be suggested that in this case NO performs a positive role, by participating in gastric protection.

[Time course of changes in the gastric juice levels of nitric oxide in patients with upper digestive tract diseases].

AIM: to study the time course of changes in the gastric juice levels of nitric oxide (NO) in patients with esophagogastroduonenal diseases (EGDD). SUBJECTS AND METHODS: One hundred and seventy-four patients with EGDD were examined. RESULTS: In patients with chronic atrophic gastritis, the level of NO was significantly lower than the normal levels and correlated with the magnitude of mucosal atrophy. Elevated gastric juice NO levels were noted at exacerbations of gastroesophageal reflux disease (GERD), chronic nonatrophic gastritis (CNAG), and duodenal ulcer disease (DUD). At the end of a therapy course, the gastric juice levels of NO did not achieve the control values in patients with GERD, reduced to the normal values in those with CNAG, although became lower, but remained above the normal values in DUD in a remission phase. CONCLUSION: The patients with EGDD were observed to have heterodirectional changes in the content of NO in gastric juice. In the patients with DUD, the remaining gastric juice NO levels above the normal values after ulcerative defect cicatrization are indicative of incomplete reparative processes in the gastric mucosa, i.e., delayed morphological remission. In chronic atrophic gastritis, the gastric juice levels of NO did not achieve normal values after treatment despite the onset of clinical remission which may be caused by a continuous gastric mucosal atrophic process.

[Effect of eradication therapy on nitrogen oxide activity in the gastric juice of patients with chronic gastritis and ulcer disease].

Effect of different ofHelicobacter pylori eradication therapy On nitrogen oxide (NO) levels in the gastric juice was evaluated in 105 patients with chronic non-atrophic gastritis (CNAG) and duodenal ulcer (DU). A rise in NO concentration was associated with exacerbation of CNAG and DU. It decreased to the normal value by the end of therapy in CNAG cases but remained above that in patients with DU. The optimum scheme of eradication therapy included combination of omeprazole (proton pump inhibitoir) and two antibiotics (clarithromycin and amoxicillin).

[Diagnostic value of leukocytic alteration test (in vitro) for drug-induced allergy in a therapist's practice].

The laboratory diagnostic process of drug intolerance is a clinical challenge. The allergic leukocytic alteration test (ALAT) was used to detect drug intolerance and to estimate its informative value. Three hundred and eighty-seven patients with various manifestations of drug allergy were examined (1227 studies). The test was carried out in vitro using heparinized blood, calculated with reference with 1 ml per drug and incubated at 37 degrees C for 1.5 hours. Smears were prepared, stained by the Romanovsky-Giemsa method, and examined by light microscopy. A hundred cells (neutrophils) were scanned to evaluate allergic alteration. When the affected neutrophils were more than 10%, the test was considered as positive. The findings suggest that ALAT reveals intolerance of different groups of drugs with a high degree of significance and may be proposed for the diagnosis of drug allergy as it is of great informative value, safe to a patient, and allows a large number of drugs to be tested.

[A case of Rossolimo-Melkersson-Rosenthal disease].

The article describes Rossolimo-Melkersson-Rosenthal disease (RMRD); historical background and the modern concept of its pathogenesis are presented in brief. The clinical picture of the disease is described in more detail; the variants of the course of the disease and the manifestations of the monosymptomatic, bisymptomatic, and triadic variants are presented. The article contains a clinical observation of a female patient aged 38, whose first symptoms developed at the age of 18 as facial neuritis and left mimic musculature paresis. With time, the patient developed all the three characteristic components of RMRD.

[Case report of combination of polycystosis of the liver, thyroid and parotid glands]. / Sluchai sochetaniia polikistoza pecheni, shchitovidnoi i okoloyshnoi zhelez.

A case of hepatic polycystosis (HPC), a hereditary diseases inherited by autosomic-dominant type, is reported. This case presents a rare combination of HPC with polycystosis of the thyroid and parotid glands, congenital cryptorchism and rectal prolapse.

[Clinical and morphofunctional characteristics of hydatid liver echinococcosis]. / Klinicheskaia i morfofunktsional;naia kharakteristika gidatidoznogo ékhinokokkoza pecheni.

AIM: To examine the levels of aspartate aminotransferase (AsAT) and alaninaminotransferase (AlAT) in homogenates of hepatic biopsies from patients with echinococcosis. MATERIAL AND METHODS: Clinical, biochemical examinations, ultrasonic examination of the liver were made in 49 patients with hydatid echinococcosis of the liver and 5 control patients operated on for extrahepatic pathology. Morphological picture of the liver was examined with light microscopy. AsAT and AlAT activity in hepatic tissue were estimated with 2,4-dinitrophenilhydrazin method. RESULTS: There were marked cellular and extracellular disorders and significant lowering of transaminases in the pericystic zone of hepatic tissue vs such indices for far from the echynococcal cyst sites of the liver. CONCLUSION: In hepatic echinococcosis hepatic tissue undergoes diffuse alteration associated with severe morphofunctional disorders which require adequate preoperative preparation of the patients, in postoperative period adequate intensive therapy is needed.

[A benign course of histiocytosis X]. / Dobrokachestvennoe techenie histiocytosis X.

A case is reported of an accurate diagnosis of chronic histiocytosis X initiated with lung affection. The disease is characterized by a benign course for 7 years in the absence of treatment in spite of associated viral infection (hepatitis B virus) which is suggested to be one of causative factors of histiocytosis X.

[Clinico-laboratory and morphological parallels in hepatic echinococcosis]. / Kliniko-laboratornye i morfologicheskie paralleli pri ékhinokokkoze pecheni.

The trial included 50 patients with hydatid echinococcosis of the liver and 5 control patients operated urgently for extrahepatic pathology. The patients underwent clinical and biochemical tests, ultrasound investigation of the liver. Structural and functional changes in the liver were analysed with reference to the stage of the echinococcal cyst. Morphological picture of the liver was studied by light microscopy, its functional picture--by activity of AsAT and AlAT in hepatic tissue. Morphological and biochemical tests were made on hepatic biopsies obtained from the pericystic and far from the cyst zones. The most severe histological changes affecting all structures of the liver were registered in the parasite's life cycles II and III. AsAT and AlAT changes in the liver were not related to the biological cycle of the parasite; echinococcal patients' liver contained them in lower concentrations than that of control subjects. Moreover, blood serum levels of AsAT and AlAT are higher than in liver tissue. Thus, growth of the echinococcal cyst in the liver is accompanied with marked morphofunctional disorders. This necessitates early detection and surgical treatment of hepatic echinococcosis. To prevent postoperative complications, adequate preoperative preparation and postoperative intensive treatment must be conducted.

[A case of primary pulmonary hypertension]. / Sluchai pervichnoi legochnoi gipertenzii.

Primary lung hypertension (PLH) is a rare disease of unknown etiology seen largely in young persons. PLH shows rapid progression with lethal outcome 3-5 years after registration of the first symptoms. Early diagnosis of the disease is difficult. A case described in the article illustrates real difficulties in PLH diagnosis and treatment. The patient several times lost consciousness for a short time at insignificant exercise. This phenomenon has not been described in the literature so far.

[The role of the enzymatic antioxidant system and Helicobacter pylori infection in the pathogenesis of peptic ulcer and their effect on treatment efficacy]. / Rol' fermentnoi antioksidantnoi sistemy i infektsii Helicobacter pylori v patogeneze iazvennoi bolezni i ikh vliianie na éffektivnost' lecheniia.

AIM: To assess activity of superoxide dismutase and catalase in acute ulcer and in the end of its treatment with antisecretory (omeprasole and zaran), anti-Helicobacter (metronidasole) and antioxidant (alpha-tocopherol) drugs in patients with duodenal ulcer. MATERIALS AND METHODS: 126 patients with duodenal ulcer were divided into 6 groups: group 1 patients had Helicobacter pylori (HP+) and were given omeprasole; group 2 patients had HP and were given omeprasole + metronizarole; group 3 patients were free of HP and received metronidasole + alpha-tocopherol; group 4 HP+ patients received zaran; group 5 HP+ patients got zaran = metronidasole; group 6 free of HP received zaran + alpha-tocopherol. The patients were examined using esophagogastroduodenoscopy, roentgenoscopy of the stomach, tests of the gastric juice. RESULTS: An acute phase of ulcer was accompanied with enhanced activity of superoxide dismutase and low activity of catalase in mucosal biopsies from ulcer lesion and periulcer zone. In remission, antioxidant system resumed normal activity depending on the kind of the combined therapy. The combination omeprasole + metronidasole was more effective in HP eradication than zaran + metronidasole. Effect of alpha-tocopherol was poor. CONCLUSION: It is suggested that HP stimulates lipid peroxidation and thus maintains inflammation in gastric and duodenal mucosa.

[The characteristics of the lipid peroxidation and antioxidant activity of the duodenal mucosa in peptic ulcer patients]. / Kharakteristika perekisnogo okisleniia lipidov i antioksidantnoi aktivnosti slizistoi obolochki dvenadtsatiperstnoi kishki u bol'nykh iazvennoi bolezn'iu.

AIM: Lipid peroxidation (LPO) and antioxidant defense (AOD) in ulcer and periulcer zones of duodenal mucosa were studied at different phases of ulcer. MATERIALS AND METHODS: 111 patients with duodenal ulcer exacerbation before treatment and in the course of the treatment were studied versus 23 healthy volunteers. RESULTS: In active ulcer there was high activity of LPO and depressed AOD. LPO may be initiated by Helicobacter pylori. Pathogenetic measures including anti-Helicobacter ones decreased LPO hyperactivity and promoted AOD normalization. CONCLUSION: In ulcer, optimal treatment is supposed to combine antisecretory and antibacterial drugs adjusted to the activity of ulcer and imbalance between LPO and AOD systems in gastric and duodenal mucosa.

[Effects of mono- and combined peptic ulcer therapy on lipid peroxidation and antioxidant defense in ulcerous zone]. / Vliianie mono- i kombinirovannoi terapii iazvennoi bolezni na perekisnoe okislenie lipidov i antioksidantnuiu zashchitu v ul'tseroznoi zone.

Lipid peroxidation and antioxidant activity in the margin and periulcerous zones of duodenal mucosa were investigated in 111 patients with duodenal ulcer before treatment and in periscar zone after chemotherapy allowing for Helicobacter pylori infection. In active ulcer lipid peroxidation was high while antioxidant activity was depressed. Helicobacter pylori was found able to initiate peroxidation. Pathogenetic therapy including antihelicobacter drugs inhibits activity of lipid peroxidation and promotes normalization of antioxidant activity of duodenal mucosa. This gives grounds for combined use of antisecretory and antichelicobacter medicines.