[Clinical significance of H. pylori genotyping].

Clinical implications of H. pylori genotyping are analysed. H. pylori usually occurs during exacerbation of duodenal ulcer (91.7%) and lymphocytic gastritis (93.5%). CagA strains of H. pylori most frequently develop resistance to metronidazole (50.5%), furazolidone (15.1%), amxicillin (13.2%), and tetracycline (11.3%).

[Immediate and long-term effects of endoscopic papillosphincterotomy in patients with cholelithiasis].

The subjects of the study were 164 patients, divided into two groups. Group I included 76 patients at the physicochemical stage of cholelithiasis, and 38 patients after cholecystectomy, who underwent endoscopic papillosphincterotomy (EPST). Group II (control) included 30 patients at the physicochemical stage of cholelithiasis, and 20 patients after cholecystectomy, who did not undergo EPST. Endoscopic retrograde pancreatocholangiography revealed type II Oddi's sphincter dysfunction in all the patients. Evaluation of the chemical composition of bile in Group I, performed 6, 12, 18, and 24 months after EPST, revealed its graduate stabilization. In Group II the dynamics of bile composition was negative--in 8 patients bile became more lithogenic. Long-term observations showed that 6 years after EPST bile was lithogenic only in 4 Group I patients, while at the same moment in 25 Group I patients bile lithogenicity did not disappear, but even worsened. Biliferous tract ultrasonography, performed long after EPST, found biliary sludge in 4 Group I patients. 6-year observation of Group Il patients, including ultrasonography, demonstrated that during the 4th year of observation biliary sludge occurred in as many as 28 patients, in 15 of whom small concrements on the bottom of the gall bladder were found during the 5-6th year of observation, and in 3 of whom a solitary concrement of 4 to 5 mm in diameter was found in the choledoch. The results demonstrate that it is appropriate to perform EPST as early as at the physicochemical stage of cholelithiasis, because this procedure results in stabilization of biliary colloid balance and thus prevents biliary sludge and forming of gall bladder concrements. At the same time, 36% of patients with cholelithiasis at various stages who did not undergo EPST, formed gall bladder concrements. EPST is also appropriate in some patients after cholecystectomy, in order to prevent repeating gall bladder concrement formation.

[Insulin resistance in patients with metabolic syndrome and cholelithiasis].

The aim of the study was to determine serum insulin level in patients with metabolic syndrome (MS), pronounced manifestation of cholelithiasis (CL), and abdominal obesity. The measurements were compared with hyperlipidemia and glycemia levels in these patients. The subjects were 55 women with MS, divided into two groups according to 1991 Kh. Kh. Mansurov's classification of CL stages. Insulin level was measured by immune-enzyme assay; carbohydrate and lipid metabolism (lipid levels, lipoprotein and fatty acid spectrums, malonic dialdehyde and catalase levels)--by conventional methods. The study revealed a correlation between high insulin level in patients with hyperglycemia, disorder of tolerance to glucose, and type II diabetes, on the one hand, and lipid peroxidation level and dislipidemia, on the other. The study also found high insulin level at various stages of CL, especially during the period of concrement formation. Insulin is a CL risk factor, i.e. it elevates the risk of nucleation.

[Some parameters of carbohydrate and lipid metabolism in patients with non-alcoholic steatohepatitis].

The pathogenesis of non-alcoholic steatohepatitis (NASH) has not been fully studied yet. At the same time, some key points of its forming are already clear. In this regard, the authors studied disturbances of carbohydrate and lipid metabolism in patients with NASH. This included evaluation of fatty acid (FA) and lipoprotein (LP) spectrum, as well as measurement of triglyceride (TG), malonic aldehyde and glucose blood concentrations. The study found that an important role in the pathogenesis of NASH is played by carbohydrate and lipid dysmetabolism, manifested by hyperglycemia, glucose tolerance disorder, and type II diabetes. Other manifestations include hyperlipoperoxidcholia, high concentrations of chylomicrons, low density lipoproteins, and triglycerides, as well as low concentration of high-density lipoproteins. The spectrum of higher fatty acids is characterized by high concentration of saturated fatty acids and deficit of polyunsaturated fatty acids.

[Lipid peroxidation and anti-oxidative protection in patients with chronic type C hepatitis].

The aim of the work was to study lipid peroxidation (LP) activity and antioxidation protection sufficiency in patients with HCV lesion of the liver. The subjects of the study were 238 such patients, divided into groups according to the degree of the pathological process severity. The results demonstrate a significant increase of malonic dialdehyde (MDA) serum concentration (up to 143.75%) and simultaneous decrease of catalase serum concentration in patients with minimal activity of HCV chronic hepatitis (CH). In patients with moderate and high activity of the pathological process MDA serum concentrations were 150 and 175%, respectively; catalase activity decreased down to 64.8 and 58.47%, respectively. Hepatocirrhosis in HCV patients (HCV-H) was characterized by a more pronounced LP product accumulation and decrease of serum catalase activity. MDA serum concentration in patients with mixed viral CH and hepatocirrhosis was lower than in patients with HCV-H.

[Clinical and morphological features of alcoholic steatohepatitis].

48 patients with alcoholic steatohepatitis (ASH) were examined and divided into 3 groups according to the degree of fatty liver infiltration. It was minimal in 8 (16. 6%) patients, moderate in 10 (20.8%) and severe in 30 (62.5%) patients. The higher the degree of the fatty infiltration, the more pronounced dystrophic alterations and the more often necrosis, fibrosis and cell infiltration focuses were found in liver biopsy material. Morphologic changes in biopsy samples from ASH patients were much more pronounced in comparison with those in non-alcoholic steatohepatitis (NASH). The latter is characterized mostly by lymphocyte infiltration, while leukocyte infiltration is more typical of ASH. The study found prominent alterations in serum lipoprotein spectrum, triglyceride (TG) and saturated fatty acid concentrations in patients with ASH. High concentrations of chylomicrons, low-density lipoproteins and TG were registered together with low levels of high-density lipoproteins and albumin complex.

[Efficacy of combined use of ursodeoxycholic acid and heptral in the treatment of primary biliary cirrhosis]. / Effektivnost' kombinirovannogo primeneniia ursodeoksikholevoi kisloty i geptrala v lechenii pervichnogo biliarnogo tsirroza.

The efficacy of UDCA (10 mg/kg/day) in combination with SAMe (heptral, 800-1600 mg/day) vs UDCA alone was evaluated in the treatment of 19 patients (age 36-57) with primary biliary cirrhosis. It was found that the combination UDCA + SAMe promoted earlier and steadier disease remission. Normalization of biochemical parameters of cholestase (serum bilirubin, cholesterol, total bile acids, alkaline phosphatase, 5-nucleotidase and jamma-glutamyl transpeptidase) was recorded in 33%, and a significant reduction--in the rest patients. Heptral potentiates cytoprotective and anticholestatic actions of UDCA, but has a weak action on its immunomodulatory and antiapoptotic effects.

[Quamatel application in three-drug eradication therapy of duodenal ulcer and gastroduodenal ulcerations associated with helicobacter pylori infection]. / Opyt primeneniia kvamatela v troinoi éradikatsionnoi terapii iazvennoi bolezni dvenadtsatiperstnoi kishki i gastroduodenal'nykh iz''iazvlenii, assotsiirovannykh s infektsiei helicobacter pylori.

Combination of famotidine, amoxicilline and metronidasole was applied in the treatment of 71 patients with erosive-ulcerative affection of the upper gastrointestinal tract. The combination more rapidly relieved pain (within 5-6 days), dyspepsia (for 7-8 days), enabled healing of the ulcer defect for 2-3 weeks, raised gastric pH to 5.7-5.8 and eradicated Helicobacter pylori in 87.3% of the cases.

[Role of lipoproteins and triglycerides in cholesterol lithogenesis]. / O roli lipoproteidov i triglitseridov v kholesterinovom litogeneze.

Serum lipoprotein spectrum was evaluated in 63 patients with cholelithiasis at various stages versus 10 healthy subjects as control. The patients were found to develop lipoprotein shifts as early as a physicochemical stage of the disease. Abnormal proportions of lipoproteins and triglycerides, changes in the formation of free radical products justify correction of dyslipoproteinemia early in cholelithiasis course.

[A mass study of hepatobiliary system function in workers and collective farmers in southern Tadzhikistan]. / Massovoe issledovanie sostoianiia gepatobiliarnoi sistemy u rabochikh i kolkhoznikov iuga Tadzhikistana.

A total of 4085 persons living in the Parkhar District of Kulyab Province of the Tadzhik SSR underwent examination for the cholelithiasis incidence among 3 large groups (Koreans, Tadzhiks and Uzbeks) populating that territory. It has been established that as compared with Tadzhiks and Uzbeks, cholelithiasis turned out to occur rarely in Korean women. This is likely to be due to the metabolism of bile acids in the liver, the lack of genetic predisposition, noticeable disorders in the kinetics of the gallbladder as well as to the presence in the diet of the Korean community of a large amount of food plant fiber and soybean products which ameliorate to a certain degree the chemical composition of the bile and enhance the kinetics of the gallbladder.

[Comparative study of bile sedimentation rate and pH normally and in cholelithiasis patients]. / Sravnitel'noe izuchenie vremeni poiavleniia osadka i pH zhelchi v norme i u bol'nykh kholelitiazom.

The paper is concerned with the results of a study of the time of appearance of bile sediment and change in pH in patients with cholelithiasis (CL) and in healthy persons. In CL patients the rate of bile sediment in vitro was 3-4 times higher than in healthy persons, bile coagulation took place in a weak alkaline medium. In the course of chenoursotherapy one could control dissolution determining bile pH and the time of sedimentation.

[Immunocorrective therapy of patients with chronic active liver diseases of a viral nature]. / Immunokorrigiruiushchaia terapiia bol'nykh khronicheskimi aktivnymi zabolevaniiami pecheni virusnoi prirody.

A study of the effect of immunocorrective drugs on the clinicobiochemical and immunological indices of patients with chronic active liver diseases of viral nature made it possible to work out criteria for administration of levamisole (the absence of the cytolytic syndrome, the presence of immunodeficiency in the system of cellular immunity and disturbance of immunoregulation), prednisolone, the combination of prednisolone and azathioprine, and d-Penicillamine (severe hepatocellular insufficiency, the presence of autoimmune reactions and disturbance of immunoregulation). The treatment of patients with chronic active diseases with immunocorrective drugs required a strict individual approach taking account of clinicobiochemical, immunological and morphological indices.