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Belyakin S.A., A.N. Bobrov, Plusnin S.V.
Alcohol consumption level of population and mortality caused by liver cirrhoses. How they are related?
The aim of review. To present data on relation of death rate caused by liver cirrhosis, from alcohol consumption level in Europe and Russia.
Original positions. Liver cirrhosis as one of the most known consequences of abuse by alcohol, is quite often used as general indicator of a harm related to alcohol. Relation between mortality from liver cirrhosis and level of alcohol consumption per capita has been proved by results of numerous investigations and observed in various time spans and various regions of the world. In Europe relation between changes in population consumption of alcohol and mortality has been comprehensively investigated within the framework of ECAS study (European Comparative Alcohol Study) in 14 European countries in 1950 to 1995. Relation between these parameters is mathematically described by regression equation. Evaluation of mortalities related to liver cirrhoses, and level of alcohol consumption in Russia complicated by the absence of these data in WHO databases and in available official statistical documents. Nevertheless, it is possible to speak about over twofold increase of mortality from liver cirrhoses in Russia in period of 1999 to 2006. On a background of favorable situation for viral hepatites and certain successes in their prophylaxis and treatment can be attributed only to increasing consumption level of alcohol which has recently reached of 18 liters per capita.
Conclusion. Mortality of liver cirrhosis is informative score tightly related to consumption level of alcohol in population. In the majority of economically developed countries there is a decrease as alcohol consumption level, and mortality from liver cirrhosis. The alcohol-related situation in Russia can be regarded as critical, described by progressing increase of consumption of alcohol and mortality from diseases directly related to alcohol abuse. Storozhakov G.I., Merzlikina N.N., I.G. Fedorov, Totolyan G.G., Karabinenko A.A., Kosyura S.D., Ilchenko L.Yu.
Course of infections at liver cirrhosis Aim of investigation. To reveal features of the course of liver cirrhosis (LC) in patients with infections.
Methods. The study included 47 patients with LC in the age of 18 to 79 years. All patients underwent complex clinical, laboratory and instrumental investigation, and bacteriological study of various substrates (blood, ascitic fluid, sputum, urine) with the subsequent assessment of antibiotic sensitivity of etiological agents at suspicion for infectious complication.
Results. According to Child-Pugh criteria in the 1st group included 5 (10,6%) patients with class A LC, the 2nd – 12 (25,6%) patients with class B LC, the 3rd – 30 (63,8%) patients with class C LC. Patients with alcoholic LC (51,1%) and combined alcoholic-viral (23,4%) etiology prevailed. Infectious process was revealed in 49% of cases: chronic pyelohephritis – in 15% of patients, infection of urinary tract – in 15%, spontaneous bacterial peritonitis – in 8,4%, pneumonia – in 6,4%, chronic cholecystitis - in 4,2%.
Conclusions. Risk group for infections should include patients with LC of Child–Pugh class C, with frequent hospital admissions for decompensation of liver disease, bleeding from varicose esophageal veins (in past history), attack of acute alcohol-induced hepatitis on a background of chronic liver disease.
Ivashkin V.T., Buyeverov A.O.
Pathogenic and clinical substantiation of ademetionine application in treatment of intrahepatic cholestasis
The aim of the review. To present proofs of S-adenosyl-L-methionine (ademetionine, HeptralÒ) efficacy in treatment of intrahepatic cholestasis syndrome.
Original positions. Ademetionine (HeptralÒ) plays a key role in reactions of transmethylation, transsulphonation, transamination, being involved in metabolism of nitric oxide and cytokines. Besides pathogenic substantiation, results of multiple clinical studies with various design of ademetionine (HeptralÒ) at patients with intrahepatic cholestasis syndrome allow to ascertain: 1) both parenteral (intravenous or intramuscular), and oral application of ademetionine (Heptral) is highly effective in intrahepatic cholestasis of various origin, including alcohol-induced liver cirrhosis and cholestasis in pregnancy;
2) recommended dosage of the drug is 500–800 mg for parenteral route and 800–1600 mg at oral intake;
3) the effect of parenteral application becomes clinically apparent in 1–2 wks;
4) oral intake is optimal as maintaining therapy for 1–2 months and more;
5) Long treatment by ademetionine leads to improvement of survival rate of patients with alcoholic cirrhosis at compensated and subcompensated stages.
Conclusion. Ademetionine (HeptralÒ) can be successfully applied at patients with intrahepatic cholestasis with no regard to etiology.
Kozhanova T.V.,. Ilchenko L.Yu, Isayeva O.V.
HBV drug resistance at HBV/HIV-coinfected patients Mayev I.V., Kucheryavy Yu.A., Ovlashenko Ye.A.
Cholecystolithiasis as the remote complication after gastrectomy
The aim of review. According to literature data to define main aspects of lesion of biliary tract in remote period after gastrectomy and to prove pathogenic treatment of patients with such disorder.
Original positions. The cholecystolithiasis is one of common complications in remote term after stomach resection and gastrectomy that dictates necessity of development of preventive measures. Risk factors of development of cholecystolithiasis are defined: total gastrectomy, lymphodissection D2–D3, reconstruction of the alimentary conveyor with isolation of duodenum, stem vagotomy. Common mechanisms of cholecystolithiasis development include fallout of neurogenic (vagisection) and humoral (decrease of cholecystokinin and a secretin production by I-and S-cells) stimulations of biliary tract motility. Asynchronous motor function of the upper region of gastro-intestinal tract and extrahepatic bile ducts result in accelerated transit of chyme and disorder of segregation. Accelerated transit of intestinal contents, incompetence of natural antibacterial barriers at the level of stomach and duodenum, secondary bacterial overgrowth syndrome in small intestine promote early bacterial deconjugation of bile acids, disorders of their enterohepatic circulation, increase of free bile acids pool in feces, the increased loss of bile acids with feces, resulting in change of colloid state of bile. Thus, change of colloid balance of bile and hyperkinesia of gallbladder is caused with development of biliary sludge, microlites and cholecystolithiasis in patients after gastrectomy.
Conclusion. The count of pathophysiological features allows to prove theoretically the preventive approach i.e. treatment by ursodeoxycholic acid drugs after gastrectomy.
Kozlova I.V., Myalina Yu.N.
Clinical and laboratory criteria of evaluation of efficacy of rifaximin in combined treatment of diverticular bowel disease
Aim of investigation. To estimate efficacy of Alpha Normix within combined treatment of diverticulitis.
Material and methods. Alpha Normix (rifaximin) was prescribed to seventeen patients with diverticulitis in complex with symptomatic treatment. Antibacterial therapy began in hospital and was propagated for 10 days. Later it was recommended to patients to continue intake of Alpha Normix for 7 days during 3 months at out-patient stage. Group of comparison included 16 patients with diverticulitis, receiving ciprofloxacin under the similar mode in combination to symptomatic treatment.
Results. The dynamic assessment which has been carried out in 3 months, confirmed adequate efficacy of Alpha Normix at diverticular disease of intestine (ÄÁÊ) complicated by diverticulitis. In group of the patients receiving Alpha Normix, frequency of abdominal pain syndrome on a background of moderate intestinal dysfunction decreased. Intake of Alpha Normix was accompanied by decrease of inflammatory changes in intestinal mucosa, improvement of parameters of microbionomics of the large intestine. It was found, that quantitative density of colonocytes, reactive to substance Ð and vasoactive intestinal peptide (VIP), at assessment 3 month after beginning of treatment, did not change essentially. Improvement in number of mast cells as marker of remitting inflammation was significant in group of the patients receiving
rifaximin.
Conclusions. Study results showed high efficacy of application of selective intestinal antibiotic at patients with diverticulitis.
Buyeverov A.O.
Tutorial for clinician VAK
Thesis abstracts: information from the Higher attestation commission
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