[Whipple's disease in a patient with infantile cerebral palsy and hepatitis B virus cirrhosis].

The paper describes a patient who has developed Whipple's disease in the presence of infantile cerebral palsy and hepatitis B virus cirrhosis. After 5-year treatment with co-trimoxazole (480 mg b.i.d.), the clinical manifestations subsided and PAS-positive macrophages were no longer detectable in the small intestinal mucosal biopsy specimens. Subsequent worsening of the patient's condition was associated with the progression of liver cirrhosis.

[The role of small bowel microflora in the development of secondary lactase deficiency and the possibilities of its treatment with probiotics].

AIM: To estimate the incidence of secondary lactase deficiency (SLD) in patients with postinfectious irritable bowel syndrome (PIBS) and the value of the small bowel microflora in its development and to elaborate treatment options for SLD. SUBJECTS AND METHODS: One hundred and thirty-eight patients with PIBS, including 112 (81.2%) women and 26 (18.8%) men, were examined. The patients' mean age was 33.9 +/- 9.1 years. The duration of the disease was 2.6 +/- 1.4 years. Lactase deficiency (LD) was diagnosed using the color scale to test biopsy specimens from the duodenal retrobulbar region. The bacterial overgrowth syndrome (BOS) was identified by a 2-hour lactulose (20 ml) hydrogen breath test. Sixty patients with moderate SLD were randomized to 2 groups: 1) 41 patients received basic therapy (mesim forte as one tablet t.i.d., no-spa, 40 mg, t.i.d.) and combined probiotic bifiform (Ferrosan) containing Bifidobacterium longum 107, Enterococcus faecium 107 as one capsule t.i.d. for 14 days. Group 2 patients (n = 19) had basic therapy in combination with placebo. RESULTS: SLD was detected in 59.4% of the patients with PIBS, including 43.5 and 15.9% with moderate and severe forms, respectively. In all cases, SLD was accompanied by BOS in the small bowel lumen, as confirmed by the results of a hydrogen breath test [101 +/- 37 ppm (a normal value of < 20 ppm)]. After a 14-day course of therapy with the combined probiotic bifiform, restoration of eubiosis in the small bowel lumen was achieved in 70.8% of the patients, as shown by the lesser degree of BOS (86.9 +/- 40.9 and 17.4 +/- 6.6 ppm before and after treatment, respectively; p < 0.01) and by normalization of the lactase test (p < 0.01). In the comparative placebo group, 68.4% showed no clear positive changes, SLD and BOS remained. CONCLUSION: The changes in the small bowel intraluminal microflora, which developed after prior intestinal infection, played a great role in the development of SLD. Bifiform belongs to the currently available probiotics and may be recommended to correct SLD in patients with PIBS resulting from the impaired microbiota of the small bowel and to prevent BOS.

[Principal characteristics of the endoscopic programmed hemostasis in ulcerative gastroduodenal bleedings in patients with high operational-anesthesiological risk].

Application of the endoscopic programmed hemostasis for patients with ulcer gastroduodenal bleedings and with high operational-anesthetic risk provided metabolic rehabilitation (5% solutions of glucose and ascorbic acid) for the purpose of prevention of recurrence of the bleedings which have arisen after a hemostasis at 5.5% of patients.

[Lactase deficiency in patients with postinfectious irritable bowel syndrome and the role of intestinal microflora in its development].

PURPOSE: to define the frequency of secondary lactase deficiency (SLD) in patients with postinfectious IBS and to develop therapy for the correction of mild SLD in adult patients. METHODS AND MATERIALS: In this study, 138 patients (the mean age - 33.9 +/- 9.09; F/M - 112/26) with postinfectious IBS were analyzed concerning lactase deficiency. All patients underwent intestinal endoscopy with biopsies from the mucosa of the descending duodenum in order to determine lactase deficiency twice before and after therapy. To diagnose small intestinal bacterial overgrowth (SIBO) all patients underwent lactulose breath test during 2 hours. RESULTS: SLD was detected in 59.4% of patients with postinfectious IBS. Mild SLD was determined in 43.5% of patients, and severe SLD - in 15.9% of patients. SLD in all cases was accompanied by SIBO (the mean level of lactulose breath test was 101 +/- 37 ppm, N<20 ppm). In group patients who took the probiotic during 14 days in 70.8% of patients recovering of lactose metabolism in the small intestine and decreasing of the intensity of clinical symptoms were registered. The decrease of the lactulose breath test level (86.9 +/- 40.9 ppm; 17.4 +/- 6.6 ppm; p<0.01) and negative LQT (p<0.01) were registered in the first group. In group patients who took placebo during 14 days there was no positive effect in 68.4% of cases. CONCLUSION: the probiotic Bifiform, composed of Bifidobacterium longum 10(7) and Enterococcus faecium 10(7), demonstrated efficiency in correction of mild SLD in patients with postinfectious IBS and can be used to prevent SIBO.

[Primary non-Hodgkin lymphoma of the liver in patients with chronic virus].

The article provides a brief overview of recent data on non-Hodgkin's lymphoma. We describe a special case primary isolation non-Hodgkin's lymphoma of the liver in a patient with chronic hepatitis C. Were analyzed medical errors at all stages of inspection and treatment of the patient. This exceptional case supplements small number of publications on a problem of the isolated lymphoma of a liver. We also wanted to pay attention once again to need of lifetime morphological research of a liver.

[Endoscopic programed hemostasis: successful application at hemorrhagic shock patient with gastric adenocarcinoma].

Conception of programmed endoscopic hemostasis, the authors used not only for hemostasis, but also to prevent a recurrence of gastrointestinal bleeding of various etiology in patients with high operative risk, as well as the local treatment of peptic ulcer disease. The method is based on metabolic rehabilitation of patients using 5% solutions of glucose, ascorbic acid and 1% solution of methylene blue.

[Cytoprotective effect of ursodeoxycholic acid on the gastroduodenal zone mucous membrane at elderly patients with a combination of gallstone disease and duodenal ulcer].

Was made a clinical-morphological study of elderly patients with a combination of cholelithiasis and duodenal ulcer. Was shown that prolonged ursoterapiya does not adversely affect the clinical course of duodenal ulcer, does not cause exacerbations of her elderly patients. These histological study of gastroesophageal and duodenobioptatov during treatment showed a positive effect of the ursodeoxycholic acid (UDCA) on the mucous membrane of the stomach and duodenum with the partial restoration of its structure, due to its cytoprotective effect.

[Reproductive disorders in women with celiac disease. Effect of the etiotropic therapy].

UNLABELLED: Violation of reproductive function in patients with celiac disease can manifest as delayed puberty, infertility, amenorrhea, premature menopause, spontaneous abortion, low birth weight. The aim of the study was to establish the frequency and nature of reproductive function violation in patients with CD in the Russian Federation. MATERIALS AND METHODS: The study included 132 women (average age 38,5 +/- 1,17 years) with CD observed in CSRIG in the period from 2000 to 2010. Comparison group consisted 105 women (average age 38,7 +/- 1,6 years) with predominantly functional bowel disorders (irritable bowel syndrome, functional constipation, functional bloating, inert colon). Were took into account information regarding obstetric history, physical and laboratory signs of malabsorption syndrome (MS) study of antibodies to alpha-gliadin immunoglobulin (IG) A class (AGA) and tissue transglutaminase (AtTG). RESULTS: The average age of onset of menses was 14,3 +/- 1,4 years, and in the control group - 13,0 +/- 1,3 years (p > 0.05), half of patients with C (43.9%) had menstruation begun at age 15 years and older, while 7.6% of the women--aged 17 and older. In the comparison group menses beginning after 15 years was only at 13.3% of women. In 61.3% of patients with CD was irregular menstrual cycle while in the comparison group such violations were noted in 13.3% (p < 0.001). Prolonged periods of amenorrhea we observed in women with newly diagnosed GC 3 times more likely than the comparison group: 43.9% and 11.4% respectively (p < 0.01). They also had nearly 3 times more likely to occur spontaneous miscarriage: at 46.9% and 14.3% respectively (p < 0.01). The frequency of dead children birth was about the same: 2.3% and 1.9% respectively (p > 0.05). The frequency of reproductive disorders increased with the growth of the severity of MS. In 43% of women after 6-8 months of strict adherence to a gluten-free diet (GFD) had disappeared amenorrhea and there were regular menses. Three women of childbearing age, strictly abided the GFD and had a history of repeated spontaneous abortion during the year managed to get pregnant and give birth to healthy full-term baby. CONCLUSIONS: Reproductive disorders in women with celiac disease are significantly more likely than at women with functional bowel disease. One of the reasons of reproductive disorders in patients with CD can be malabsorption of necessary nutrients in the small intestine. The presence of reproductive disorders should be considered as a risk factor for celiac disease, so these women should be screened for celiac disease.

[Difficulties in vivo diagnosis of mucinous adenocarcinoma of vermiform appendix with metastasis in the navel].

The article presents a clinical case of mucinous adenocarcinoma in vivo diagnosis of vermiform appendix with metastasis in the navel. Neoplasms vermiform appendix--an extremely rare tumor pathology: the total share of all malignant tumors are less than 1%. Mucinous carcinoma is a rare tumor, according to various authors the frequency of its occurrence ranges from 3 to 10% of all malignancies. By Localization mucinous carcinoma more frequently is found in the colon and rectum (about 20% of cases), ovary (5-10% of all malignant ovarian tumors), stomach, uterus and also in the pancreas (only about 2%). Metastasis in the navel is a very rare disease and is known as Sister Mary Joseph's Nodule, the primary site often localized in the digestive tract (52%), much less--in the female reproductive organs (28%), unspecified localization is approximately 15-20% of cases. The difficulty of diagnosis in the present case was that, in spite of life conducted during survey of the colon, organic pathology was not identified. The presence of hepatosplenomegaly and ascites at the initial examination gave cause to the erroneous diagnostic conception of the presence of liver cirrhosis. It is also was not paid due attention to the presence of changes in the umbilical ring, which were regarded as an umbilical hernia. To verify the diagnosis allowed the infiltrate biopsy of the umbilical region, followed by histological examination of the preparation and identification of a characteristic picture of mucinous cancers.

[Aneurysm of the thoracic aorta with esophageal perforation].

Aneurysms of a chest department of an aorta with esophageal perforation two cases are presented and a lethal outcome. Difficulties in diagnostics have been caused by rare occurrence of the given pathology, insufficient experience of clinical physicians, and also absence during supervision of characteristic attributes Aortoesophageal Fistula.

[Non-Hodgkin's lymphoma of the stomach. A case report].

Clinical supervision diffuse large B-cell lymphoma of the stomach at the patient of young age is presented. Difficulties of the differential diagnostics of lymphom have been caused by macroscopical polyphormism. With the purpose of verification of disease are used the chromoendoscopy and immunohistochemical research.

[Morphological changes in the structure, regional blood circulation and content of the prostaglandins in the rats intestinal mucosa at different NSAIDS effects].

In the experiment on white rats reproduced the damage to the intestinal mucosa after administration of selective and nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) within 24 hours and for 14 days. After the autopsy was measured the index injury (II), the content of prostaglandins (PGs) and cytokines in extracts of intestinal mucosa. Was established that the reduction of PGs was combined with an increase in II. Long reception of NSAIDs (14 days) causes greater damage to the submucous layer, without visible macroscopic changes.

[The damaging role of endogenous nitric oxide in the development of the experimental DSS-induced colitis in rats].

An experimental study on rats to determine the role of inducible NO production in the pathogenesis of inflammation of the mucous membrane of the colon. The introduction of DSS induces the formation of lesions of the colon mucosa of different severity, which is accompanied by increased synthesis of NO and the stable metabolite of NO - citrulline. Inhibition of NO-synthase reduces the release of NO and the formation of lesions of the colon. The Conduct of experimental research on animals will allow further study of the role of NO in the dynamics of damage development and the medication protective role of inhibition of NO-synthase.

[Endoscopy combined hemostasis. Pathogenetic mechanisms of therapeutic action in gastroduodenal ulcers, complicated by severe blood loss and hemorrhagic shock].

On the basis of results of research the pathomorphology severe blood loss and haemorrhagic shock at 38 patients who have died from ulcer gastroduodenal of bleedings, with the purpose of preventive maintains of relapses of bleedings am established by authors necessity of carrying out of the general, and also local metabolic rehabilitation during the endoscopic haemostasis at massive bleedings at the patients with high risk of surgical treatment.

[Autoimmune reaction component in chronic pancreatitis: clinical and experimental study].

UNLABELLED: The study was undertaken to identify the relationship between inflammatory and autoimmune processes in chronic pancreatitis and to determine the prognostic significance of autoantibodies to antigens of acinar cells and hepatocytes, immunoglobulin G1-4. MATERIALS AND METHODS: In 85 patients with CP (43 men, 42 women) were studied autoantibodies to antigens of acinar and liver cells, IgG1-4. Of these, 43 patients HP was characterized by complications (cysts, calcification, pseudotumoral form), 40 patients--HP without complications, 2 patients were diagnosed chronic autoimmune pancreatitis (CAP), confirmed histologically. 20 people-- the control group. Experimental studies on animals, reproduction of acute and chronic pancreatitis. RESULTS: Maximize the level of autoantibodies--32.4 +/- 5.6 U / ml (control--10.5 +/- 2.5 U / ml) (p < or = 0.01), as well as IgG4--24 mg/ml in normal (0.8 +/- 0.08 mg/ml)--was recorded in patients with autoimmune pancreatitis. The average value of autoantibodies--in patients with CP complications: 24.2 +/- 3.8 U/ml (p < or = 0.01). The minimum value of autoantibodies--in patients with CP without complications: 18.6 +/- 2.6 U/ml (p < or = 0.05). CONCLUSION: The course of autoimmune pancreatitis accompanied by an increase of autoantibodies to antigens of acinar and liver cells, as well as serum IgG1-4, especially IgG4, which reflects the intensity of the autoimmune responses in this disease. In addition, the exacerbation of chronic pancreatitis with complications is clearly defined autoimmune component of disease. Experimental studies with preimmunization of animals allogeneic tissues have convincingly demonstrated that the formation of antibodies is not only to the antigens, reflecting the specific characteristics of these tissues, but also to general cell structures of other tissues.

[Conservative treatment of giant gastric ulcer].

Clinical supervision of successful conservative treatment of the patient with a huge stomach ulcer with use in the course of performance endoscopic a metabolic homeostasis of solutions of glucose and ascorbic acid of 5%, and also pH-chromoscopy and capillary gastrointestinal a tube is presented.

[Postinfection irritable bowel syndrome].

AIM: To characterize pathogenesis, clinicolaboratory criteria and treatment of postinfection irritable bowel syndrome (PICS). MATERIAL AND METHODS: The examination including histological study of the small and large intestine mucosa, polymerase chain reaction (PCR), coagglutination reaction using shigella, salmonella, yersinia, campilobacter jejuni diagnosticums, indirect hemagglutination reaction for identification of antibodies to these agents in the blood serum was conducted in 750 patients with PICS. Fecal seeding on selective media was made as well as the respiratory test for bacterial growth in the small intestine. Immune status was studied with laser cytometry, chemiluminescence, immunodiffusion, immunofluorescence, flow laser cytofluorometry. Personality profile was assessed by MMPI. RESULTS: PICS was diagnosed in 599 (79.9%) of 750 patients. Most of them had diarrhea, abnormal fecal microflora, antigens of acute intestinal infection agents in circulating immune complexes of the serum and coprofiltrates. Immune system was characterized by low phagocytic activity, attenuation of cell and humoral immunity. Etiotropic and pathogenetic treatment including intestinal antiseptics, probiotics and immunomodulators produced persistent remission during a year in 79.3% PICS patients. CONCLUSION: PICS is described which differs from ICS by registration of markers of acute intestinal infections in biological media, bacterial overgrowth in the small intestine and dysbiosis in the large intestine, immunodeficiency. A positive response was observed to treatment with intestinal antiseptic and enterosorbent drugs, probiotics and immunomodulators.

[Specific immune response in diagnosis of celiac disease with chronic diarrhea].

High concentration of Ab Gl, Ab tTG, Ab Em and Ab Rt and increased amount of immunocompetent cells in the SIM in coeliac disease is an index of the developing specific immune response to gliadin and tissue antigens. High specificity and sensitivity of Ab tTG and Ab Em were determined in celiac disease.