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Storozhakov G.I., Ivkova A.N.
Pathogenic aspects of fibrogenesis at chronic liver diseases The aim of review. Article presents up-to-date concepts on liver fibrosis, features of pathogenesis and mechanisms of its regulation at various chronic liver diseases.
Original positions. Liver fibrosis is a typical response at chronic lesion of the liver, that has several causes, including alcohol and persistent viral infections.
Fibrogenesis is a widespread and universal process. Its is based on excessive accumulation of proteins of exocellular matrix and elevation of tissue collagenases activity, that are produced mostly by stellate cells of the liver. A final stage of fibrosis is the liver cirrhosis, manifested by development of liver failure and accompanying portal hypertension.
Numerous literature data prove reversibility of liver fibrosis. Its spontaneous resolution can develop after the arrest of damaging factors action on the liver and successful treatment of diseases that caused fibrosis.
Conclusion. Results of basic researches in this area are insufficiently applied in clinical practice. Comprehension of molecular mechanisms of fibrogenesis gives the basis for development of simple and safe non-invasive markers of liver fibrosis, efficient antifibrotic agents for treatment of patients with chronic liver diseases. Buyeverov A.O.
Some aspects of apoptosis at chronic viral hepatitis The aim of review. To present literature data and results of original investigations on the role of apoptosis at chronic hepatites B and C.
Original positions. Significant data, allowing to consider apoptosis as the key mechanism of pathogenesis of chronic viral hepatites (CVH) is accumulated. Apoptosis of hepatocytes infected by virus, on one hand, promotes elimination of endocellular pathogene, on another, underlies hepatic tissue damage.
The basic mechanism of destruction of cells at liver diseases is represented by receptor-mediated apoptosis, that is interaction of Fas-ligand and Fas-receptor, as well as TNFa and TNF-receptor. Lymphocytes of inflammatory infiltrate also can be destroyed by infected hepatocytes that represents one of mechanisms of virus surviving. Besides this, apoptosis of both lymphocytes and peripheral blood granulocytes is significantly higher in CVH patients than in controls immediately after sampling as well as after 24-hour incubation.
The intensity of hepatocytes peripheral blood apoptosis significantly correlates to serum TNFa concentration. Potential of flow cyto-fluorimetry method for evaluation of peripheral mononuclear cells apoptosis dynamics as prognostic factor of response to chronic hepatitis C antiviral therapy is demonstrated.
Conclusion. Apoptosis is not only a «fashionable» trend of theoretical biochemistry. Studying of this major biological process has essential practical value, including that for hepatology. Alekseyenko S.A.,. Schupak A.Yu, Lebed'ko O.A.,. Puchkov Yu.B.
Effect of ursosan on clinical symptomatology, liver morphology and oxydative status at hepatotoxic lesions caused by alcohol-containing disinfectants Aim of investigation. To estimate efficacy of ursosan by clinical and laboratory parameters in complex treatment of toxic hepatites caused by alcohol-containing disinfectants.
Materials and methods. Two groups of patients with diagnosis of «Toxic severe hepatopathy caused by alcohol-containing disinfectants» in the age of 23 to 45 years were observed. The first group (12 patients) received the baseline therapy, the second (12 patients) within of complex treatment took 750 mg of ursosan per day. Clinical and biochemical investigation of patients was carried out; chemiluminescence was used for integrated evaluation of free-radical oxidation of homogenised liver biopsy samples.
Results. In patients receiving ursosan, besides clinical improvement, activation of anti-oxidative antiradical protection and depression of free-radical oxidation in liver biopsy samples, as well as decrease of biochemical signs of cytolysis and cholestasis in development of disease and in comparison to patients at baseline therapy were detected.
Conclusion. Received data give pathogenic proof and show high efficacy of ursosan in complex treatment of toxic lesions of caused by alcohol-containing disinfectants. Zhdanov K.V., Gusev D.A., Ryazanov A.N.
Ademetionine in treatment of chronic viral hepatitis C Aim of investigation. To estimate efficacy of ademetionine (S-adenosyl-L-methionine-1,4-butanedisulfonate) application in chronic hepatitis C (CHС) and potential of its application in modern modes of antiviral treatment.
Materials and methods.. Retrospective study of 33 patients with CHC treated by standard interferon a2а and ribavirin in 2006–2008 was carried out. The basic group included 13 patients receiving oral ademetionine 400 mg bid for 8–12 wks within pathogenic treatment by IFN-a and ribavirin. Severe cholestatic, cytolytic and astheno-depressive syndromes, as a rule, were indications for ademetionine prescription. A control group included 20 patients who did not receive ademetionine.
Results. At genotype 1 in the basic group significant increase of frequency of sustained viral response up to 60%, in control group – 15,4% was obtained. Among patients with sustained viral response (SVO) biochemical scores were normalized at 100%, among patients with no SVO, prescription of ademetionine resulted in normalization of activity of hepatic enzymes and bilirubin level significantly more frequently often, than in control group. In patients receiving ademetionine, the signs of astheno-depressive syndrome were observed twice less often in comparison to that in control group.
Conclusion. Application of ademetionine at treatment of patients with chronic hepatitis C at combined antiviral treatment by IFN-a and ribavirin significantly increases frequency of SVO at the 1 HCV genotype.
Prescription of ademetionine also increases frequency and stability of serologic response as regression of bilirubinemia, cytolytic and cholestatic syndromes with no relation to viral response at any genotype. Ademetionine essentially reduces risk of development of side effects of antiviral treatment, in particular astheno-depressive syndrome. Grigor'yeva I.N., Romanova T.I.
Tobacco smoking as pancreatitis risk factor The aim of review. To present modern data on pathogenic mechanisms of tobacco smoking influence on cells of the pancreas.
Original positions. In epidemiologic studies it was proved, that the risk of development of chronic pancreatitis of various etiology in smokers is higher in comparison to that in non-smokers, and the degree of risk grows with increase of cigarettes number per day. Tobacco smoking is an independent risk factor of development of alcoholic and idiopathic pancreatitis. The nicotine is involved in various pathogenic mechanisms and affects the course of disease. The tobacco smoking results in depletion of vitt. C and A stores, and also reduces serum level of other antioxidants that causes damage of pancreatic tissue by free radicals. The nicotine activates protooncogene H-ras, increases level of calcium in cytosol with subsequent development of calcifications and focal pancreatic hypertension that damages cells of the pancreas. Review presents the guidelines on management approach of such patients.
Conclusion. Taking into account high rate of disability of patients with pancreatic diseases, it is necessary to pay attention to modified risk factors of pancreatitis, including tobacco smoking, and to take them into account at treatment choice. Pinchuk T.P., Galankina I.E., Il'yashenko K.K.,. Yermachenkova Ye.I.
Mexidol efficacy at endoscopic treatment of corrosive burn of the stomach Aim of investigation. To study the effect of 5% mexidol solution in treatment of necrotic burns of the stomach at direct injection in the focus of lesion.
Materials and methods. Overall 32 patients with CBS of the IV degree were observed, 16 of them along with pharmaceutical and local laser treatment («Mustang» laser, infra-red range, current strength – 10 мА, frequency – 2500 Hz, exposition – up to 10 mines), received injections of mexidol solution was into the edges of burn ulcer.
Results. Injection of mexidol solution into the edges of burn ulcer in addition to standard treatment provided beneficial effect described by decrease of terms of eschar casting-off by 44%, reduction of integral laser exposure dose by 33%, decrease of terms of burn ulcers reparation.
Conclusions. Proposed medical complex allowed to decrease frequency of the burn-related decompensated gastrostenosis by 31%. VAK
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