[Esophagus defeat in patients with scleroderma].

This article presents clinical case of scleroderma with affection of esophagus.

[Primary prevention of reflux esophagitis in achalasia of cardia].

Aim of the study was to compare the incidence of reflux esophagitis in patients with achalasia cardia after successful surgical treatment with balloon dilatation and ezofago-cardio-seromyotomy followed by fundoplication according toToupet type. The study included only those patients with eliminated symptoms of dysphagia. All patients were divided into two groups depending on the method of treatment. In the first group (20 patients) performed balloon dilatation, second group (20 patients)--laparoscopic ezofagocardioseromiotomiya followed by fundoplication according type Toupet. Results evaluated one year after the intervention. Revealed that the incidence of reflux esophagitis were significantly higher in group of patients after balloon dilatation, than in the group of operated patients--40 and 15% respectively (p < 0,05). Received results allow to reconsider approaches to the selection of treatment method of achalasia cardia in favor of laparoscopic ezofagocardioseromitomii with the formation of posterior cuff-type Toupet.

[Bone mineral density in patients with gluten-sensitivity celiac disease].

AIM: to determine the frequency of development of osteopenia/ostoporosis (OP) vitamin D deficiency, some population risk factors, and the effects of alpha-calcidol and calcitriol on bone mineral density (BMD) in patients with gluten-sensitivity celiac disease (GSCD). SUBJECTS AND METHODS: Densitometry of the lumbar vertebra and femoral neck (FN) was carried out in 47 patients with GSCD. Their sera were tested for 25OHD3, 1,25(OH)2D3, total alkaline phosphatase, calcium, phosphorus, parathyroid hormone (PTH), type 1 collagen type C-telopeptides (CrossLaps) and tumor necrosis factor-a (TNF-alpha), as well as urinary creatinine and calcium. RESULTS: The T score below -1 was found in 37 (78.7%) of the patients. BMD reduced to the level of osteopenia in 51.1% of the patients; OP was detected in 27.7%. Lower BMD was noted in 19 (95%) of the 20 menopausal women and in 15 (68.2%) of the 22 females with preserved menstrual function (p = 0.047). The mean value of 250 HD3 was 47.8 +/- 5.0 in patients with OP patients and 85.6 +/- 7.1 ng/l in those with normal BMD (p < 0.001). The latter had no decreased level of vitamin D, suggesting its deficiency, but 11 (30%) osteopenic patients were found to have vitamin D deficiency (25OHD3 < 30 ng/l). Impaired calcitriol synthesis (69.9 +/- 24.0 ng/l) was observed only in patients with OP; the level of calcitriol was 85.6 +/- 31.2 ng/ml in those with normal BMD. Decreased BMD was accompanied by elevated PTH levels in 25 (67%) patients with GSCD. There were increases in the bone resorption marker CrossLaps and in the level of TNF-alpha in 28 (76%) and 8 (22%) osteopenic patients, respectively. A more significant BMD reduction was seen in the presence of antibodies to gliadin and tissue transglutaminase. A significant correlation was found between the titer of immunoglobulin A antibodies to gliadin and TNF-alpha (rho = -0.57; p = 0.035), CrossLaps (rho = -0.58; p = 0.035), Tscores in the vertebral column and FN (rho = -0.62; p = 0.030) and (rho = -0 37; p = 0.06), respectively. CONCLUSION: The risk for OP in patients with GSCD is affected by menopause and the clinical features of the disease: secondary hyperparathyroidism due to impaired calcium and vitamin D absorption, by the activity of immunological inflammation and the compliance with a gluten-free diet. The immunological activity of inflammation is closely related to the activation of bone resorption and enhances a BMT reduction in patients with celiac disease. The use of vitamin D preparations (alpha-calcidol and calcitriol) in combination with calcium salts lowers BMD in patients with celiac disease just within the first 6 months.

[Bone mineral density in patients with liver cirrhosis].

The article represents BMD (bone mineral density) study of 75 patients with a cirrhosis of liver. Main group of patients under study was represented by alcoholic cirrhosis patients - 45%, and primary biliary cirrhosis - 36%. 72% of patients were established BMD deficit, 25% on osteoporosis level. Influence of disease etiology on osteopenia frequency and/or osteoporosis localization was diagnosed. Dependence of osteopenia frequency and/or osteoporosis from population risk factors, duration of disease, hepatic insufficiency class under Child-Pugh score was analyzed.

[Disorder of mineral density of the bone tissue in patients with chronic pancreatitis].

OMD was examined in 50 patients with chronic pancreatitis. The disturbances of OMD was revealed in 46% of the patients with chronic pancreatitis. Influence of chronic pancreatitis to the reduce of OMD was proved, especially in the patients with prolonged desease, analysis of the osteoporosis and osteopenia localization was performed in the patients with chronic pancreatitis.