[[The Pathogenetic Approaches to the Chronic Liver Diseases Treatment].]

The paper reflects the issues of pathogenesis of the chronic liver diseases (CLD). The role of the cell membrane lipid peroxidation as well as oxidative stress and fibrosis formation in the development and progression of liver lesions of various aetiologies. are represented in details. Particular attention is given to the justification of pathogenetic approaches to the treatment of liver disease. Presented the evidence base of successful application of the standardized silymarin as a part of the drug Legalon in the CLD of different etiology.

A REVIEW OF INTERNATIONAL AND NATIONAL CLINICAL GUIDELINES FOR THE DIAGNOSIS AND TREATMENT-OF NONALCOHOLIC FATTY LIVER DISEASE.

The review presents comparative characteristics of domestic and foreign clinical guidelines for the diagnosis and treatment of nonalcoholic fatty liver disease.

THE HEPATOPROTECTOR ROPREN FOR THE TREATMENT OF PATIENTS WITH NONALCOHOLIC STEATOHEPATITIS: A PROSPECTIVE OBSERVATIONAL STUDY.

OBJECTIVES: New and effective drugs to improve liver function and fibrosis are urgently needed for patients with nonalcoholic steatohepatitis (NASH). This study examines the effectiveness of treatment of patients with NASH with the registered heparoprotector, Ropren~ Methods. This observational study used Ropren? in a post-registration setting to treat 20 females (38-56 years) with chronic NASH unresponsive to standard treatment. Ropren? is a biopolymer made up of polyprenols (analogue of dolichol) isolated from the green verdure of spruce (Picea abies (L) Karst). Ropren? was given orally, three times a day (54 mg/day). Measurements before and after treatment included symptoms and blood biochemistry (triglycerides, high-density lipoproteins, low-density lipoproteins, alanine transaminase, aspartate transaminase, alkaline phosphatase and gamma-glutamyl-transpeptidase). Liver fibrosis was measured with indirect ultrasound elastometry. RESULTS: After 12 weeks of Ropren? treatment, improvements were found for blood lipids and clinical and biochemical signs, including reductions in total cholesterol and triglycerides (p <0.05). Ropren® also significantly decreased the liver fibrosis index (p <0.05). No side effects were observed. CONCLUSIONS: Ropren® treatment increased the elasticity of the liver and might be useful to reduce the risk of cirrhosis. Although the sample size in this study was small, the results demonstrated that a randomised-controlled trial of Ropren? for NASH is warranted.

[SUCCESSFUL ORTHOTOPIC LIVER TRANSPLANTATION IN A PATIENT WITH HEPATOLENTICULAR DISEASE AND FULMINANT HEPATIC FAILURE].

The article presents a clinical case of hepatolenticular disease in young man with rapidly progressive liver disease fulminant hepatic failure and successful emergency orthotopic liver transplantation.

[WILSON'S DISEASE (HEPATOLENTICULAR DEGENERATION, DYSTROPHIA HEPATOCEREBRALIS) DIAGNOSIS, TREATMENT AND DISPENSARY OBSERVATION. GUIDELINES WERE APPROVED BY THE XV GASTROENTEROLOGICAL SCIENTIFIC SOCIETY OF RUSSIA IN 2015].

Wilson's disease (hepatolenticular degeneration, dystrophia hepatocerebralis)--a chronic, progressive disease with a genetically determined autosomal recessive mode of inheritance. The violence in metabolism of copper with its excessive accumulation in visceral organs and central nervous system is the basis of the disease. The guidelines on clinical diagnosis and management of patients based on a Review and analysis of recent publications on this topic in the global and Domestic literature and on the authors' experience in treating patients with Wilson's disease.

[AUTOIMMUNE LIVER DISEASES: CLINICAL FEATURES, DIAGNOSIS, TREATMENT. GUIDELINES WERE APPROVED BY THE XV GASTROENTEROLOGICAL SCIENTIFIC SOCIETY OF RUSSIA IN 2015].

The group of liver autoimmune diseases (LAD) includes autoimmune hepatitis (AIH), Primary biliary cirrhosis (PBC) and Primary sclerosing cholangitis (PSC) The guidelines on clinical diagnosis and management of patients based on a review and analysis of recent publications on this topic in the global and domestic literature and on the authors'experience in treating patients with autoimmune liver disease.

[NONALCOHOLIC FATTY LIVER DISEASE: DIAGNOSTIC, SYMPTOMS, TREATMENT. GUIDELINES WERE APPROVED BY THE XV GASTROENTEROLOGICAL SCIENTIFIC SOCIETY OF RUSSIA IN 2015].

According to the World Health Organization, it is recorded steady growth of the number of chronic liver diseases, including nonalcoholic fatty liver disease (NAFLD), in recent years. As an independent nosological entity, NAFLD is one of the risk factors for cardiovascular diseases, associated with abdominal-visceral obesity, peripheral insulin resistance (IR), and is regarded as the hepatic component of Metabolic syndrome (MS). Nowadays there are no generally accepted national standards for diagnosis and treatment of NAFLD for physicians, gen- eral practitioners, gastroenterologists in Russia. This was the essential reason in their development. The main reason of The guidelines development is the absence of generally accepted national standards for diagnosis and treatment of NAFLD for physicians, general practitioners, gastroenterologists in Russia. These guidelines are based on the global and local data of treatment experience of NAFLD, recently published in reviews, analytical studies in the literature. Guidelines are intended for physicians, general practitioners, gastroenterologists and contain the description of the preferred approaches to the provision of diagnostic, curative and preventive care of patients NAFLD. The quality of recommendations was grading according to the GRADE approach.

[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.

[Case of primary biliary cirrhosis combined with GERD and complicated by peptic strictures of the esophagus].

The clinical case of the two diseases combination such as primary biliary cirrhosis and peptic stricture of the esophagus (complicated GERD) in one patient is presented in the article.

[Treatment of chronic viral hepatitis: achievements and prospects].

The review focuses on the current state of the problem of chronic viral hepatitis (CVH),B and C. Presents an analysis of the effectiveness of schemes of antiviral therapy (AVT) of chronic HCV-infection and current understanding of the treatment tactics of patients with inadequate response to therapy. Particular attention is paid to the nearest perspectives in treatment of chronic hepatitis C (CH C). The questions of the effectiveness of AVT chronic HBV-infection, the results of the comparative effectiveness of interferon (IFN) and nucleoside analogs (AN) in the treatment of chronic hepatitis B (CH B) are observed in the article. Special attention is paid to the treatment of chronic viral infections at the stage of liver cirrhosis (LC).

[Celiac disease is a 33-year-old man with periodic disease].

The article presents a clinical case of a 33-year-old Armenian man, who suffered from two rare diseases: Familial Mediterranean fever and celiac. The diagnosis of Familial Mediterranean fever: abdominal-feverish form, is confirmed by genetic markers. The morphological study of duodenal mucosa's specimens confirms the celiac.

[Diagnosis and treatment of intrahepatic cholestasis in chronic diseases of the liver].

AIM: To improve diagnosis of intrahepatic cholestasis (IHC) basing on clinicobiochemical picture in chronic hepatic diseases (CHD) of different etiology with cholestasis and to develop a differential approach to treatment. MATERIAL AND METHODS: We examined 875 CHD patients with IHC with evaluation of the levels of the enzymes, biliary acids (BA), lipids, characteristics of hemostasis and phosphocalcium metabolism in blood. We also studied correlations and changes of the above parameters in IHC of different etiology. A comparative analysis of efficacy of mono- and combined treatment of CHD patients with IHC was made. RESULTS: We revealed correlations between the levels of the enzymes, bilirubin, lipids and BA concentration in blood serum; unfavourable prognostic value of aggravating cholemia; no correlations between content of serum BA, duration of IHC and intensity of skin itching (SI). We propose to establish "the degree of IHC severity" with 4 degrees of this severity. Characteristics of impairment of hemostasis and phosphocalcium metabolism in IHC of different etiology depending on the degree of IHC severity are presented. Efficacy and universality of combined treatment with ursodeoxicholic acid and ademetionin in moderate and severe IHC of different etiology are shown. CONCLUSION: Introduction of the definition "the degree of IHC severity" allowed us to classify IHC by severity. This enables adequate assessment of the patient's condition, prognosis the risk of complications and their severity, a differential approach to treatment and, finally, improvement of the disease outcome prognosis.

[Clinical significance of intravital morphological investigation of the liver].

AIM: To demonstrate great importance of intravital morphological examination of the liver for differential diagnosis of chronic diffuse diseases (CDD) of the liver. MATERIAL AND METHODS: A complete clinical examination, needle or intraoperative biopsy of the liver were made in 1045 patients with chronic diseases of the liver. Structural features of hepatic tissue were studied histologically. Variational statistics was used for analysis. RESULTS: Viral markers were detected in 373 patients (HCV in 53%, TTV in 10%, HBV in 16%, HGV in 6%, CMV in 3%). Chronic hepatitis (CH) was caused by combined viral infection in 12% cases. CH variants were verified morphologically in 64% patients with provisional diagnosis CH. Objective evaluation of structural changes severity rested on algorithms of semiquantitative determination of the index of histological activity and fibrosis index. Hepatic cirrhosis of viral or alcohol etiology was detected in 4.8%, primary biliary cirrhosis--in 11.2%, non-alcoholic fatty disease of the liver--in 11.2% patients. Impaired glucose tolerance is an essential factor predisposing to non-alcohol fatty disease of the liver. Detection of vacuole-like nuclei in periportal hepatocytes is an early morphological sign of the fatty disease. Three percent of the patients had signs of minimal portal cholangitis. This correlated with TTV detection. CONCLUSION: Life-time morphological examination of the liver specifies activity and stage of the process in chronic hepatitis, confirms or detects abnormalities in hepatic architectonics, identifies clinically significant changes in cellular and intercellular components of hepatic tissue, detects and verifies rare hepatic affection. Such information is of importance for optimization of treatment policy and improvement of prognosis in CDD of the liver.

[3rd place in the competition of scientific work in hepatology in 2010. Treatment of patients with overlap of primary biliary cirrhosis and autoimmune hepatitis].

This paper analyzes the results of different treatments overlap (OS) of primary biliary cirrhosis (PBC) and autoimmune hepatitis (AIH): ursodeoxycholic acid monotherapy (UDCA) monotherapy with prednisolone (PD), the combination of PD with UDCA. Results of treatment of 16 OS patients with glucocorticoid last generation--budesonide (BS) in combination with UDCA. The treatment results were estimated in reducing severity of intrahepatic cholestasis (IHC), proposed by the author, as well as the degree of reduction of the biochemical activity of enzymes. Evaluated the quality of life by SF-36 questionnaire. In addition, the efficacy of budesonide in combination with UDCA was assessed by morphological examination of liver tissue in the dynamics after 6 months of treatment. The paper convincingly demonstrate that combination therapy OS is more effective in monotherapy reducing clinical and biochemical disease activity, as well as positive effects on quality of life. The advantages of the use of budesonide in combination with UDCA prior systemic glucocorticoids: a high efficiency and low risk of side effects.

[Intrahepatic cholestasis in chronic liver diseases].

The syndrome of cholestasis is a common manifestation of chronic liver disease (CLD) of any etiology: alcoholic, viral, drug, metabolic, etc. The basis of the formation of cholestasis is a violation of the synthesis, secretion or bile outflow. Accession intrahepatic cholestasis (field surgery) for chronic liver disease alters its course, aggravates the condition of the patient, reduces the immune system, leads to development of severe septic complications, significantly reduces the quality of life (QoL) and worsens the prognosis. In published data, as well as the results of original research aimed at improving the diagnosis and treatment of syndrome of field surgery. Was given the definition of the severity of field surgery, defined the criteria for severity, identified the severity of field surgery. Clarified the influence of field surgery in the state of the plasma level of coagulation, as well as the phosphorus-calcium metabolism in CLD of various etiologies. The advantages and versatility combined antiholestaticheskoy field surgery therapy for moderate and severe degree of different etiologies. An algorithm for treatment of field surgery, suggesting a differential approach to therapy depending on the severity of field surgery.

[Generalized B-cell lymphoma, marginal zone masked by chronic liver disease].

This article describes a case of diagnosis of generalized B-cell lymphoma of marginal zone cells, which debuted with hepatolienal syndrome. Presented the latest information on etiology, pathogenesis, clinical manifestations, diagnostic methods and treatment of non-Hodgkin's lymphoma.

[The state of the vascular bed of the small intestine in patients with portal hypertension].

AIM: To evaluate the condition of vascular channel of small bowel in patients with portal hypertension. MATERIALS AND METHODS: We examined 60 patients from 17 to 70 years, 30 with cirrhosis of different etiologies and 30 with other gastrointestinal diseases, amounted control group. Patients were divided into 2 groups: the main and control: group 1--primary--patients with cirrhosis and portal hypertension. Group 2--control--patients without liver disease and portal hypertension who underwent videocapsule endoscopy. RESULTS: On the results of research, we can conclude that all patients with liver cirrhosis and portal hypertension have various vascular changes of small bowel. We examined patients in the course of the work revealed the following: 1. Varicose vein expansion and increased vascular pattern in 70% of patients. 2. Arteriovenous malformation in 12% of patients. 3. Angiodisplaziya 11%. 4. Delafua defect in 4%. 5. Bleeding in 3%. The combination of vascular disease in patients with liver disease and portal hypertension syndrome accounted for 70%. In the control group of patients vascular channel pathology dated only in 2% of cases in the form of strengthening of vascular pattern of small bowel. CONCLUSION: Videocapsule endoscopy is a highly informative diagnostic method for assessing the condition of vascular channel of the intestine in patients with portal hypertension. Carrying out videocapsule endoscopy is highly effective and comfortable for patients, which greatly improves their quality of life. Timely detection of vascular disease in patients with portal hypertension using videocapsule endoscopy can prevent such severe complications as gastrointestinal bleeding especially from the deep divisions of bowel which are not available to other research methods.

[Features of the HCV-infection in the elderly patients].

The problem of chronic HCV-infection in the elderly patients is poorly known. During the HCV-infection and progression of fibrosis in chronic liver diseases depends on age of the patient.

[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.

[Various mechanisms of heart failure in liver diseases].

The article is a review of the literature on the problem of heart disease in liver cirrhosis of different etiologies (alcohol, amyloidosis, hemochromatosis, viral lesions of the heart). Examined in detail the pathogenesis of cirrhotic cardiomyopathy and diagnosis, occurring in cirrhosis of any etiology. This article presents a noninvasive methods of diagnosis of myocardial fibrosis using serum markers of fibrosis, myocardial fibrosis degree of calculation on the basis of echocardiography and ECG.