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Ivashkin V.T., Shifrin O.S.
The role of enzyme preparations in treatment of patients with painful form of chronic pancreatitis Aim of investigation. To study clinical efficacy of tablet and encapsulated microgranulated preparations of pancreatin, comparing results of 4-week treatment of 60 patients with chronic pancreatitis (painful form) with moderate disorders of exocrine function of the pancreas.
Methods. Sixty patients with chronic pancreatitis (CP) of biliary or alcoholic etiology in stage of relapse (painful form) without severe manifestations of exocrine insufficiency were studied.
Activity of inflammatory process estimated by parameters of total blood count, activity of serum and urine amylase, level of С-reactive protein. For evaluation of changes of exocrine function of the pancreas general stool test and fecal elastase activity were studied in all patients. At ultrasound investigation (US) sizes and acoustic structure of pancreas, liver, gallbladder, spleen, state of vessels of portal system, and mesenteric vessels were estimated. Computer tomography (CT) of organs of abdominal cavity was carried out with intravenous injection of "Omnipaque" contrast.
Results. Comparable efficacy of tablet forms of pancreatin with enteric-soluble coating and encapsulated agent, containing microgranules of pancreatin in enteric-soluble coating was revealed at treatment of moderate signs of exocrine insufficiency of the pancreas.
More pronounced severe positive effect of Mezym-forte 10 000 was found in comparison to Creon 10 000, on dynamics of abdominal pain at CP with moderate manifestations of exocrine insufficiency of pancreatic function. Application of Mezym-forte(r) 10 000 extremely rarely causes such complication of enzyme treatment as constipation (р <0,05, for specified differences in comparison to Creon 10 000).
Conclusions. Results of clinical investigation show, that the tablet preparation of pancreatin Mezym-forte(r) 10 000 allows to stop or essentially reduce abdominal pain at CP more frequently (р<0,05), in comparison to encapsulated microgranulated agent of pancreatin. Besides this, Mezym-forte(r) 10 000 provides comparable to that Creon compensation of moderate exocrine insufficiency of pancreatic function. On a background of treatment by Mezym-forte(r) 10 000 complications such as constipations are detected much less often, than at similar treatment by Creon 10000 (р<0,05).
Kuznetsova A.V.
Potential and limitations of US-elastography of hepatic parenchyma at chronic hepatitis C Aim of investigation. To compare results of evaluation of state of hepatic parenchyma at investigation of chronic hepatitis C (CHC) patients with application of needle biopsy and ultrasound elastography (USE) of the liver.
Proceedings and methods. Analysis of morphological pattern of lesions of the liver and USE of hepatic parenchyma at 124 patients with chronic HCV-infection, including at 41 narcotic addicts and 45 HIV coinfected patients was {carried out. Effect of narcotic addiction, HIV coinfection, HCV genotype and viral load on the stage of liver fibrosis was determined.
Results. Sensitivity of USE at liver fibrosis was 89,6%, specificity - 100,0%. The least sensitivity (79,9%) of the method was at stage F1, the highest sensitivity - (100,0%) at the stage F4. Narcotic addiction (р<0,05) and HIV coinfection (р<0,001) significantly influenced grade of fibrosis of hepatic parenchyma.
Conclusions. USE results, in general coincide to results of morphological study of hepatic biopsy specimens that allows to recommend this method for establishment of stage of fibrosis including that in HIV-infected patients with chronic hepatitis C. Katikova O.Yu., Shikh Ye.V.
Disorder of vitamin status and therapeutic options of hepatoprotector phosphontiale at chronic alcohol-induced hepatitis on a background of liver cirrhosis The aim. To estimate hepatoprotector efficacy of the agent "Phosphontiale"(r) and its ability to correct deficiency of bioantioxidants at application within standard complex treatment of patients with chronic alcohol-induced hepatitis (CAH) on a background of alcoholic liver cirrhosis (LC).
Methods. Totally 40 patients with CAH on background of LC of classes A and B (by Child-Pugh classification) without concomitant viral infection were investigated. Eighteen patients received standard detoxication, metabolic, substitution treatment. Twenty-two patients in addition to standard complex treatment received "Phosphontiale"(r). Functional liver tests, parameters of lipid metabolism and hemostasis in dynamics on a background of carried out} treatment were studied. Efficacy of hepatoprotector was estimated by minimum index rating scale of liver function (MIRSLF). Concentration of vitamins in blood plasma was determined by high performance liquid chromatography.
Results. It was found, that at patients with CAH on a background of LC concentration of vitamins В2, В6 and C in blood plasma in comparison to normal for middle-aged patients is reduced by 35-90 D%, vitamins E and В1 - by 25-70 D%. The contents of malonic dialdehyde (MDA) - is increased by 50-180 D%. Application for 25 days within complex treatment of "Phosphontiale"(r) revealed its hepatoprotector activity: MIRSLF scoring parameter decreased by 15,95 D% (in control - by 10,45 D%). Application of "Phosphontiale"(r) promoted increase in blood plasma of concentration of vitamins В1 (on 15,18%), В2 (on 12,5%), В6 (on 21,18%), Е (on 16,13%), and also decrease of severity of lipoperoxydation.
Conclusions. Patients with CAH on a background of LC have deficiency of vitamins E, C and B. Hepatoprotector activity of phosphontiale is confirmed by significant improvement of integrated score MIRSLF, its positive effect on parameters of impaired biovitamin status, decrease of MDA contents that allows to recommend phosphontiale for treatment of alcohol-induced liver disease.
Agayeva G.Sh.
Effect of liver steatosis on efficacy of antiviral therapy at patients with chronic hepatitis C The aim. To study effect of steatosis of liver on efficacy of antiviral therapy at patients with chronic hepatitis C (CHC).
Methods. Overall 79 patients with CHC (54 - with 1-st CHC genotype, 25 - with 2-nd and 3-rd genotypes), receiving combined antiviral therapy by pegilated interferons and ribavirin were investigated. All patients underwent non-invasive diagnostics of steatosis by US.
Results. In 59 (74,7%) of 79 patients sustained viralogical response (SVR) was achieved: in 37 (68,5%) of 54 patients with the 1-st genotype, in 22 (88%) of 25 patients with 2-and 3-rd genotypes. The number of SVR cases in all three groups irrespective of body mass index (BMI) was much higher among patients without steatosis (р<0,05). Of 3 patients with initial BMI over 30 kg/m2 and absence of steatosis of the liver, none had relapse of disease after termination of antiviral therapy course. Of 19 patients with BMI over 30 kg/m2 and presence of liver steatosis, 14 (73,7%) after termination of treatment had relapse of disease (p <0,05).
Conclusion. At patients of CHC presence of steatosis of liver, irrespective of body mass index, worsens results of antiviral therapy. Loranskaya I.D., Vishnevskaya V.V., Panina N.A.
Efficacy of "Ganaton" in treatment of hypokinetic gallbladder dysfunctions Aim of investigation. To estimate effect of the new generation prokinetic drug - itopride hydrochloride ("Ganaton") - in the treatment of hypokinetic gallbladder dysfunction.
Methods. Overall 18 person with hypokinetic gallbladder dysfunction (6 men and 12 women) 16 to 55 years old were studied. All patients had abdominal pain syndrome of biliary type caused by disorder of gallbladder function. In all patients motor and evacuatory function of the gallbladder was studied by ultrasound method with computation emptying index. Pain intensity was estimated by pain visual analog scale.
Results. Application of "Ganaton" in treatment of patients with functional disorders of biliary tract for 2 wks resulted in relief of pain and dyspeptic syndromes, normalization of gallbladder motor function according to control ultrasound data at the majority of patients (78%).
Conclusions. "Ganaton" is effictive prokinetic, which inclusion to treatment of patients with functional biliary disorders is pathogenicly and clinically based. Yakovlev А.А., Kotlyarova S.I.
Options of significant improvement of therapeutic results in chronic viral hepatites by "Heptral" Aim of investigation. To estimate therapeutic effect of application of the drug "Heptral" in composition of complex pathogenic therapy of chronic viral hepatites.
Methods. Statistical analysis of clinical and laboratory tests in 53 men in the age of 43±5,2 years was carried out. Of them in 21 patients chronic viral hepatitis B (HBsAg+, HBеAg-, FibroTest F2-F3), in 32 - chronic viral hepatitis C (HСVAB+ with moderate activity, FibroTest F2-F3) was diagnosed. In 15 of 32 patients cirrhotic stage of chronic viral hepatitis C (FibroTest F3-F4) was detected.
Results. After 2-week course of parenteral injections of 400 mg per day of "Heptral" relief intoxication syndrome was obtained in 35% of patients, regression of skin itching - in 55%, decrease of ALT activity from initial level for 35-40%, contents of bilirubin by 50%, level of alkaline phosphatase by 36%. Differences between scores prior to treatment and after 2 weeks of therapy were significant. Continuation of treatment by heptral tablets 800 mg per day for the next 2 weeks resulted in the further improvement of clinical parameters and long-lasting decrease of cholestatic markers level. Intoxication syndrome was stopped in 94 % of patients, syndrome of cytolysis - in 76%, cholestatic syndrome - in 88%.
Conclusions. Application of the drug "Heptral" for 4 weeks and longer in complex treatment of chronic viral hepatites allows to receive sustained improvement of clinical manifestations of disease, including cholestatic syndrome. No side effects of intake of the drug were revealed.
Application within a steplike mode is the most expedient: 2-week course of parenteral ademetionine, and further 4-week course of tablet form in a dose of 800 mg in day.
Higher attestation commission
Thesis abstracts: information from the Higher attestation commission Bueverov A.O.
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