Contents N 6, 2009

Kozlova A.V., Andreytseva O.I.,. Syutkin V.Ye, Saliyenko A.A., Chzhao A.V., Khubutia M.Ch.
Transplantation of the liver in patients with liver cirrhosis of HBV­-etiology and prophylaxis of graft HBV-­infection

Aim of investigation. To study various variants of prophylaxis of hepatitis B virus infection of transplanted liver in patients with LC of HBV±HDV­etiology after transplantation of the liver (TL). Methods. In the liver transplantation department of N.V.Sklifosovsky ambulance scientific research institute 20 HbsAg­positive patients with LC underwent transplantation of the liver from the beginning of 2002 to May, 2009. Of them in 5 patients LC developed as an outcome of chronic hepatitis B, in 13 patients at combined infection HBV and HDV, in 2 patients – at three viruses coinfection – HBV, HCV and HDV. Prophylaxis of recurrent HBV infection was carried out in preoperative, intraoperative and postoperative periods. Outcomes of prophylaxis of HBV infection relapse were analyzed for 18 cases. Results. Eleven patients received combined prophylaxis of recurrent HBV infection (HBIg for at least 6 months in combination to nucleoside analogues). From the 2nd postoperative week the level of HBs­Ab >50 U/ml has been detected in 81,8% of cases. Frequency of recurrent HBV infection in this group of patients was 9,1%. Decrease of HBIg dose during intraoperative and early postoperative periods considerably increased the risk of recurrent HBV infection. Two patients operated for LC of HBV±HDV­etiology, in postoperative period received monotherapy by lamivudine. In one of patients in 18 months after TL recurrent infection HBV was detected. At patient, infected by three hepatitis viruses B, C, D and not receiving preventive treatment in postoperative period, recurrent HBV infection was absent for 19 months after TL. Conclusions. Carrying out of combined prophylaxis of recurrent HBV infection in post­transplantation period with application of HBIg for 6 months or more in combination to nucleoside analogues allowed to prevent infection of the transplanted liver for 1–6 years after TL in 90,9% of cases. At reduction of HBIg doses the risk of recurrent HBV infection is considerably increased. In HBsAg­positive patients at lamivudine monotherapy the risk of recurrent HBV infection is much higher, than at patients receiving combined treatment.

Kulyushina Ye.A.
Syndrome approach in radiology of liver cirrhosis

Aim of investigation. Increase of radiology methods efficacy in assessment of patients with liver cirrhosis. Material and methods. Complex clinical investigation of 155 patients with liver cirrhosis was. Echographic techniques, spiral computer tomography, magnetic-resonance tomography, scintigraphy with technetium agents were applied. Ten syndromes, giving the complete description of the structure, dimensions, functions, changes of blood flow in the liver, and reflecting state of neighboring organs were defined. Results. Analysis of obtained data showed, that methods of radiology have various diagnostic efficacy in studying liver and surrounding organs in patients with cirrhosis. Conclusions. Rigorous investigation of patients with cirrhosis requires application of complex inclu­ding several methods of radiology.

Ivashkin V.T., Mayevskaya M.V., Fedos’ina Ye.A.
Application of ursodeoxycholic acid in treatment of patients with hepatitis C

The aim of review. To present literature data, confirming efficacy of ursodeoxycholic acid at chronic hepatitis C, complicated by cholestasis. Original positions. Ursodeoxycholic acid (UDCA) has antiapoptotic, cytoprotective, immunomodulating and anti­oxidative action. These properties of UDCA can establish its prescription in cases where there are contraindications to standard antiviral therapy, and also at presence of aggravating factors (cholestasis syndrome at viral hepatites, alcoholic and viral lesions of the liver, cholestasis in pregnancy etc.). Conclusion. UDCA is a drug with wide spectrum of biochemical and immunologic effects, and good safety profile. Application of UDCA can be recommended for patients with chronic hepatitis C with cholestatic syndrome as addition to antiviral therapy, for pregnant women with intrahepatic cholestasis, for patients with combined lesions of the liver.

Sirotin B.Z., Fedorchenko Yu.L., Vit'ko L.G., Marenin S.N.
Diabetes mellitus and diseases of the esophagus

The aim. To determine features of course of gastroesophageal reflux disease (GERD) at patients with diabetes mellitus (DM) of the 1st and 2nd type, to study the state of mucosa of the esophagus in patients with diabetic ketoacidosis. Methods. Totally 180 patients with DM of the 1st and 2nd type were investigated including intraesophageal pH-metry, upper endoscopy with biopsy of esophageal and stomach mucosa. In 304 patients with DM and ketoacidosis the state of mucosa of the esophagus and the stomach was assessed by upper endoscopy. Results. GERD was revealed in 19,6% of patients with DM of the 1st type and in 31,1% of the 2nd type. Endoscopically negative GERD was more frequently diagnosed in patients of DM with 1-st type, in DM of the 2nd type – esophagitis of various stages of severity. GERD proceeded asymptomaticly in 22,7% of patients with DM of the 1st type and at 42,3 % – at DM of 2nd type. At the patients of DM of 2nd type receiving insulin, GERD was more frequent and had more severe course. At ketoacidosis development in patients with DM in 27% of cases erosions of esophagus were found, in 18 % – superficial gastritis, in 54% – no pathological changes in upper regions of gastro-intestinal tract. These changes at ketoacidosis did not depend on DM type. Conclusions. The lesions of the esophagus at patients with DM of the 1st and 2nd types, including ketoacidosis, is the widespread phenomenon. These lesions may cause abdominal pain and dyspeptic syndromes, but can be asymptomatic.

Nikitin A.S., Nikonenko V.A.
Efficacy of various methods of preparation of patients to investigation and surgical interventions of the large intestine

The aim. To compare efficacy of preparation of patients to the study of the large intestine by application of flush enemas, macrogoal (Fortrans) and lactulose (Normase). Methods. Results of preparation for investigation of the large intestine at 168 coloproctological patients were analyzed: for 45 patients (26,8%) flush enemas were applied, for 32 (19%) – Fortrans and for 91 (54,2%) – Normase. Results. Efficacy (adequate preparation for investigations assumes complete absence of fecal masses in the lumen and on walls of the large intestine) was 75% for cleansing enemas, 68% – for Fortrans, 87% – for Normase. Conclusions. Application of Normase for preparation of patients for investigation and surgical interventions of the large intestine has series of advantages over other methods including higher efficacy of the agent, good tolerability and economic availability.

Mayev I.V., Melnikova Ye.V., Kryukova T.V., Kashin S.V., Nadezhin A.S.
New methods of serological and endoscopic diagnostics of chronic atrophic gastritis and early stomach cancer

The aim. To study potentials of serological method with assessment of gastrin17 (G17), pepsinogen 1 (РG1), antiH. pylori IgG as screening diagnostics of atrophic gastritis and early stomach cancer (SC). Material and methods. 77 patients with dyspeptic complaints in the age of 17 to 79 years and 15 patients with early SC were investigated. Concentrations of G17, РG1 and antiH. pylori IgG in blood serum were determined by method of immunoenzyme analysis (ELISA), using panels «GastroPanel» of «Biohit» company (Finland). All patients underwent chromoendoscopic investigation with x115 magnification procedure and NBIendoscopies. Severity of atrophy and metaplasia was estimated by semiquantitative method in stomach biopsies according to visualanalog scale by modified Sydney system. Degree of mucosa dysplasia, defining mild, moderate and severe degree was determined. Results. G17 level was higher in patients with early SC and nonatrophic gastritis in comparison to group of patients with atrophic gastritis of antral region of the stomach. Thus at isolated atrophy only in antral region of the stomach this parameter was lower, than at multifocal atrophic gastritis. In group of patients with nonatrophic gastritis elevation of РG1 level was marked in comparison to patients with early stomach cancer and multifocal atrophic gastritis, and no statistically significant differences in this parameter in patients with superficial gastritis and atrophic antral gastritis has been revealed. At presence of fields of intestinal metaplasia at chronic atrophic gastritis no statistically significant changes of РG1 and G17 were revealed. Positive correlation between degree of stomach mucosa atrophy and development of intestinal metaplasia (moderate Rs=0,29) was found. Conclusions. Results of original study allow to use G17 and РG1 as markers of stomach mucosa atrophy and for evaluation of risk of development of stomach cancer in large population studies.

VAK
Thesis abstracts: information from the Higher attestation commission

Bueverov A.O.
Tutorial for clinician

List of articles published in 2009

List of authors

Содержание номера:

Редколлегия
Правила
для авторов
Как
подписаться