[Toxic effects of cadmium on the human body (literature review)].

A review of the literature about the toxic effects of cadmium on the human body. We describe a patient with clinical and biochemical signs of an attack of acute porphyria imitated or severe lead poisoning. In the patient's blood was revealed a 3-fold, compared to the allowable rate, increase of cadmium in the normal lead content. We discuss the etiologic role of cadmium and the possible pathogenetic mechanisms of this pathological condition.

[Comparative characteristics of porphyrins metabolism in chronic viral diseases of the liver].

AIM: To study porphirin metabolism in chronic viral infections of the liver. MATERIAL AND METHODS: The examination of 101 patients with hepatic viral infections diagnosed chronic HCV-infection in 30 patients, chronic HBV infection in 25 patients and combined infection in 6patients. Patients with chronic alcohol intoxication were not included in the trial. Urinary uroporphirin and coproporphirin (CP), fecal protoporphirin and CP were estimated. Total porphirines were calculated. RESULTS: 29 patients with chronic viral hepatitis had no porphirin disbolism. The latter (elevation of porphirine fractions in the urine and/or feces) was detected in 11 (84.6%) of 13 patients with hepatic cirrhosis (HC). Biochemical syndromes of elevated fecal porphirines, secondary coproporphirinuria, chronic latent hepatic porphiria were developing. The above disorders progressed with aggravation of the disease severity. In manifest late skin porphiria chronic HCV infection was detected in 19 (32.2%) of 59 patients. CONCLUSION: In non-alcoholic patients with chronic diffuse diseases of the liver of viral etiology nonspecific disturbances of porphirine metabolism develop at the stage of arising HC and are registered more frequently in the presence of chronic HBV-infection. Frequent combination of chronic HCV-infection with manifest late skin porphiria suggests a trigger role of HCV initiating specific disbolism of porphirines in this disease.

[Clinical and biochemical syndromes of cadmium-induced acute porphyrinopathy].

AIM: To study the specific features of porphyrin metabolic disturbances in cadmium poisoning. MATERIAL AND METHODS: The paper describes a patient who has developed clinical and biochemical syndromes of acute porphyrinopathy after exposure to cadmium-containing paint the vapors. The levels of delta-aminolevulinic acid, porphobilinogen, coproporphyrin, and uroporphyrin in urine and those of coproporphyrin and protoporphyrin in feces were measured. The concentrations of lead, cadmium, and copper were determined in whole blood and urine; selective screening of amino acids for hereditary metabolic diseases was made. RESULTS: The clinical signs of acute porphyrinopathy developed in the patient mimicked those of acute porphyries known by the current classification. The biochemical syndrome more corresponded to lead poisoning. However, the blood and urinary lead levels were not greater than the normal values, but the blood showed a 4-fold increase in cadmium, which seemed to induce porphyrin dysmetabolism.

[Differentiated diagnosis of specific lung diseases in early syphilis].

To state the diagnosis of early specific pulmonary disease, it is necessary to obtain clinical and/or serological data to reject manifest secondary or early latent syphilis. The most important differential-diagnostic criterion of early syphilis of the lungs is a rapid effect of specific antisyphilis therapy with further verification of complete resolution of pulmonary lesions. Two case reports are presented.

[Differential diagnosis of specific gastric lesions in early syphilis patients with helicobacter infection].

AIM: To evaluate differential-diagnostic significance of different clinical signs, endoscopic and serological studies in making diagnosis of early gastric syphilis (EGS) in patients with helicobacter infection. MATERIAL AND METHODS: Thirty patients were hospitalized with diagnosis of gastric and/or duodenal ulcer. Helicobacter pylori was identified morphologically or with a rapid urease test. Syphilis was rejected when microprecipitation reaction was negative and confirmed with Wassermann reaction. The patients received standard treatment including a course of eradication therapy. RESULTS: Endoscopic examination discovered single and multiple ulcers in 25 and 5 patients, respectively, located in the stomach and duodenum. A rapid test for syphilis produced negative and positive results in 28 and 2 patients, respectively. Twenty two patients tolerated eradication therapy well. Positive results were achieved in 19 (84.6%) patients. Six patients had side effects (pruritus, urticaria, dyspepsia) on eradication treatment day 2-3. Jarisch-Herxheimer reaction (elevated body temperature 38-38.6 degrees C) and roseola eruption were observed in 2 (6.7%) patients with positive serological reactions for syphilis on the first day of eradication therapy. CONCLUSION: Diagnostic criteria of EGS are the following: serologically confirmed manifest or latent syphilis, poor effect of standard antiulcer treatment, rapid elimination of the disease symptoms in antisyphilis therapy and positive changes in pathological alterations in gastric mucosa.

[Alcohol and its effect on porphyrin metabolism]. / Alkogol' i ego vliianie na obmen porfirinov.

Urinary and fecal levels of porphyrins were measured spectrophotometrically for 388 patients. 66 of them suffered from melanodermic skin lesions without hepatic affection, 95 had chronic hepatic diseases and 227 exhibited porphyria cutanea tarda. The results were considered in relation to the lesion and alcohol habits. Alcohol proved to provoke manifestations of porphyrin disbolism. High protoporphyrin fecal concentrations serve early indications of alcohol-induced damage to the liver. Alcohol abuse results in persistent disorders of porphyrin metabolism in subjects with chronic active hepatitis and hepatic cirrhosis. In established clinical and biochemical syndrome of porphyria cutanea tarda alcohol contributes to further progression of fermentopathy specific for relevant porphyria.

[Porphyrin metabolism in chronic liver diseases]. / Sostoianie porfirinovogo obmena pri khronicheskikh zabolevaniiakh pecheni.

Out of 147 patients with chronic hepatic diseases, chronic persistent hepatitis, chronic active hepatitis, hepatic cirrhosis, alcoholic lesions of the liver, biliary hepatic cirrhosis and Gilbert syndrome were registered in 26, 35, 27, 43, 8 and 8 patients, respectively. Urinary and fecal porphyrins were measured spectrophotometrically. Disturbances in porphyrin metabolism were diagnosed in 76 patients (51.7%). Four different biochemical syndromes were identified: 1) a symptomatic rise of fecal porphyrins only, 2) secondary coproporphyrinuria, 3) secondary coproporphyrinuria in combination with high fecal protoporphyrin, 4) biochemical syndrome of chronic latent hepatic porphyria. These syndromes were not strictly specific, but secondary coproporphyrinuria occurred significantly more often in chronic active hepatitis and biliary cirrhosis. High symptomatic fecal porphyrins were characteristic for alcoholic affections, and latent hepatic porphyria was indicative of hepatic cirrhosis. Disturbed porphyrin metabolism arises in more severe hepatic lesions and runs in association with more rapid development of hepatocellular insufficiency. Probable pathochemical mechanism and diagnostic value of the above impairment are discussed.

["Double porphyrias" (a review of the literature and case report)]. / O "dvoinykh porfiriiakh" (obzor literatury i opisanie sobstvennogo nabliudeniia).

The authors review literature data on porphyrias with combining enzymopathies in heme biosynthesis system, report a case of porphyria cutanea tarda and porphyria variegata registered simultaneously in a male patient clinically and confirmed biochemically. The patient's mother had elevated levels of fecal protoporphyrin suggesting latent porphyria variegata. Biochemical criteria of double porphyrias are discussed.

[Porphyrin metabolic disorders in porphyria cutanea tarda]. / Narusheniia obmena porfirinov pri pozdnei kozhnoi porfirii.

Altogether 98 patients have been examined, suffering from latent porphyria (n = 18) and manifest porphyria cutanea tarda (n = 80). 90 (91.8%) examinees abused alcohol. Clinical manifestation of the disease is associated with an essential rise of the blood plasma and urine uroporphyrin. Three types of porphyrinemia have been detected in the patients with manifest porphyria cutanea tarda, these types related to the degree of uroporphyrin level increase in the blood plasma and to the length of the disease: (I) uroporphyrinemia, (II) urocoproporphyrinemia, (III) urocoproprotoporphyrinemia. Porphyrinemia types are estimated as successive stages in the development of porphyrin metabolism disorders and are regarded among the criteria determining the clinical pattern of manifest porphyria cutanea tarda.

[Latent porphyria cutanea tarda]. / Latentnaia pozdniaia kozhnaia porfiriia.

A total of 142 subjects have been examined; of these 49 healthy relatives of patients with manifest porphyria cutanea tarda (PCT) (group 1), 48 subjects with melanodermal skin changes characteristic of PCT abd with anamnesis aggravated for alcoholism (group 2), and 45 patients with chronic liver diseases (group 3). None of the examinees has developed photosensitization symptoms. The findings have been compared to the results of examinations of 24 normal subjects and of 145 patients with manifest PCT. Minimal abnormalities of porphyrin metabolism have been detected in 43 subjects (30.2%). In group 1 subjects these abnormalities presented as increased levels of uroporphyrin and fecal coproporphyrin, in Groups 2 and 3 as secondary coproporphyrinuria and a symptomatic rise of fecal protoporphyrin level. Latent PCT has been diagnosed in 18 patients (12.7%). In latent PCT the total porphyrin excretion with the urine has been 10-fold lower than in manifest PCT, not exceeding 1000 nmol/day; in has been associated with a relative elevation of uroporphyrin level (up to 42-65% of the total porphyrin content). Increased coproporphyrin concentrations have been recorded, with coproporphyrin share making up over 60% of the total amount. It is possible that the minimal shifts of porphyrin metabolism anticipate the development of the biochemical syndrome of latent PCT. The author suggests criteria for the early diagnosis of the latent forms of the disease. He considers that the examinees should be referred to a group at risk of developing manifest PCT.

[Klaforan in the treatment of newly diagnosed gonorrhea in men]. / Klaforan v terapii svezhei gonorei u muzhchin.

Two injections of klaforan, 1 g per injection, with a 12 hrs interval is an effective method for the therapy of male patients with fresh gonorrheal urethritis.