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V’yuchnova Ye.S., Mayev I.V., Babina S.M.
Efficacy of essential phospholipids in treatment of patients with non-alcoholic steatohepatitis Aim of investigation. To estimate efficacy and tolerability of «Phosphogliv» in treatment of patients with nonalcoholic steatohepatitis (NASH).
Methods. Overall 88 patients (41 men and 47 women) in the age of 8 to 75 years with diagnosis of NASH of various degree of activity were included in original investigation. Comparative analysis of clinical and laboratory data reflecting state of liver function, carbohydrate and lipid metabolism was carried out, ultrasound investigation (US) of the liver was executed. All patients kept a diet, carried out recommended complex of physical exercises. Patients were separated into two groups: the 1st group (main, n=45) additionally received «Phosphogliv» drug, 2nd group (control, n=43) – kept a diet and carried out complex of physical exercises. A control examination was carried on the 15th, 30th and 60th day of treatment.
Results. On a background of intake of «Phosphogliv» relief of asthenic symptoms to the 15th day was noted in 35,6% of patients of the 1st and 16,3% of the 2nd group. In the 1st group the most significant improvement of state of health was observed at the 60th day of treatment – in 95,6% of cases vs 72,5% of patients of the 2nd group (ð <0,001). Dyspepsia and feeling of heaviness in right hypochondrium arrested faster on the 30th day of treatment in the 1st group: in 95,6% of patients vs 48,8% in 2nd group. At 71,9% of patients body weight has decreased (mean – by 6,3 kg). At high number of patients of the 1st group, in comparison to the 2nd (ð <0,05), on the 60th day biochemical scores of blood serum were normalized: activity of alanine transaminase (ALT) was 33,1±5,2 U/L, aspartate aminotransferase (AST) – 31,5±2,5 U/L, gammaglutamyltranspeptidase (GGT) – 44,9±3,1 U/L. At US significant decrease of the liver size to 155,4±7,6 mm was revealed (in the 2nd group – 198±6,4 mm, ð <0,001). The simple undesirable effects which did not demand cessation of agent, were observed in 13,3% (n=8) patients.
Conclusions. Addition of «Phosphogliv» in complex treatment of NASH results in more rapid and significant improvement of the state of health of patients, normalization of biochemical scores, in comparison to application of only nutritional therapy and physical activity.
Skotnikov A.S., Naumov A.V., Vertkin A.L.
Prophylaxis of acute gastroduodenal lesions in therapeutic clinic Aim of investigation. To determine efficacy of prophylaxis of erosive and ulcerative lesions of mucosa of the upper parts of gastrointestinal tract (GIT) by omeprazole (Omez) in patients with decompensation of somatic diseases.
Methods. Original study included 90 patients in the age of 30 to 65 years (mean age was 48,4±4,6 years, 56 men and 34 women), that were admitted to therapeutic departments of versatile hospital for decompensation of basic somatic diseases.
Patients of the 1st group in addition to basic treatment received omeprazole 20 mg bid, patients of the 2nd group in addition to basic treatment received omeprazole dose on 20 mg od, 3rd (control) group received only basic therapy, no proton pump inhibitors were prescribed.
Severity and rate of regression of dyspeptic complaints were estimated. In the beginning and at the end of the 4th week of treatment all patients underwent esophagogastroduodenoscopy (EGDS).
Results. At the end of investigation quantity of erosions of mucosa of the stomach decreased in 1st group by 82%, in the 2nd – by 64%, in the 3rd – by 50%. No stomach ulcers were revealed in the 1st and the 2nd groups, while in the 3rd group their number reduced by 50 %. Frequency of gastroduodenitis, according to EGDS data decreased in 1st group by 79 %, in the 2nd – by 67%, in the 3rd – by 61%. Frequency of esophagites at EGDS at the end of treatment decreased in 1st group by 80 %, in the 2nd – by 69%, in the 3rd by 59%.
Conclusions. Prescription of omeprazole in complex treatment of patients with relapse of somatic disease promotes decrease of terms of regression of clinical symptoms of gastropathy; faster epithelialisation of gastrointestinal mucosa defects; to prevention of recurrent gastrointestinal bleeding.
Podymova S.D.
Potential of clinical application of ademetionine at patients with liver diseases The aim of review. To present generalized literature data on efficacy of SadenosylLmethionine in the treatment of liver diseases of various etiology.
Original positions. SAdenosylLmethionine (ademetionine, Heptral) modulates such important parts of cholestasis pathogenesis, as the reduced permeability of hepatocyte membranes, inhibition of Nà+, K+ATPase and other membrane transporters, as well as destruction of cytoskeleton of hepatocytes and disorders of vesicular transport. The agent increases synthesis and the contents of thiols, promoting protection of cells from bile acids and free radicals.
Literature data on clinical studies of Heptral and author’s own experience prove efficacy of the drug at chronic liver diseases with intrahepatic cholestasis syndrome. Application of ademetionine for patients with alcoholic liver disease reduces damage of the liver by prevention of endogenous SÀÌ and glutathione decrease. Prescription of ademetionine to patients with compensated and subcompensated cirrhosis and milder forms of alcoholinduced liver disease is optimal. Treatment should last for several months to one year and longer. At prolonged application ademetionine improves prognosis for life of patients with alcoholic liver disease.
Conclusion. Results of original studies and analysis of the experimental and clinical data prove efficacy of ademetionine in treatment of liver diseases of various etiology, first of all – with syndrome of intrahepatic cholestasis, as well as alcoholic liver disease.
Ryazantsev A.A., Mayev I.V., Vyuchnova Ye.S.
Diagnostics of benign strictures of common bile duct by threedimensional reconstruction of ultrasound scan Aim of investigation. To determine information value of threedimensional reconstruction of the ultrasound plotting in diagnostics of benign strictures of common bile duct (CBD).
Methods. Overall 74 case records of patients who have admitted in 2004–2008 to Central clinical hospital N 1 of Open Joint Stock Company «Russian Railways» were investigated. The first (control) group included 30 patients who had no signs of gastrointestinal disease, the second – 44 patients with benign strictures of the common bile duct, not accompanied by choledocholithiasis. Comparative analysis of application of routine ultrasound investigation of organs of hepatobiliary system, threedimensional reconstruction of ultrasound plotting, endoscopic methods of investigation (including endoscopic retrograde cholangiopancreatography), computer tomography was carried out; in 12 cases results of investigation were verified during surgery.
Results. Eight percent of patients developed relapse of disease within first two years after surgical operations for cholelithiasis, one of causes of which was benign strictures of CBD which were not diagnosed at their initial stage and not corrected in time.
Conclusion. Threedimensional ultrasound reconstruction of hepatobiliary system gives essential advantage in early diagnostics of disorders of biliary system, being noninvasive, readily available and inexpensive procedure.
Solonin S.À., Kyuregyan Ê.Ê., Ilchenko L.Yu., Mikhailov Ì.I.
Hepatitis E and Pregnancy(Current state of problem) The aim of the study was to present the importance of hepatitis E virus (HEV) in pregnant women for healthcare. The published data on HEV morbidity and cellular and humoral immunity in pregnant women are analyzed, and current approaches to therapy and prevention of hepatitis E are discussed.
Original positions. The analysis of results published in MEDLINE, during the period from 1980 to 2009 has shown the limited understanding of hepatitis E pathogenesis and factors associated with high mortality rates in pregnant women. In some investigations the rate of HEV associated mortality in pregnant women and comparison groups was identical and did not depend neither on a disease trimester, nor from its reason caused.
The conclusion. Pregnant women are at risk for higher morbidity of HEV infection.
Bueverov A.O.
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Higher attestation commission
Thesis abstracts: information from the Higher attestation commission
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