[Disorders of Vasoregulative Endothelial Function, Echocardiographic Assessment of Myocardial Dysfunction and Hemodynamics of Pulmonary Circulation in Cirrhosis of the Liver].

AIM: to study relationship between parameters of intracardiac hemodynamics assessed by Doppler echocardiography and functional activity of endothelium, hepatic blood flow and severity of portal hypertension in patients with cirrhosis of the liver (CL) of different etiology. RESULTS: We found that changes of structural and functional parameters of the heart in LC depended on the stage of compensation of portal hypertension and were accompanied by rearrangement of parameters of intracardiac hemodynamics. Pulmonary arterial hypertension (PAH) was found in 11.1% of patients with LC. PAH was moderate and was more frequent in patients with end-stage disease (Child-Pugh class C) compared with those with initial stage of LC (21.4% and 6.3%, p<0.05, respectively). CONCLUSION: Disorders of vasoregulating endothelial function in patients with CL were related to parameters of cardiopulmonary hemodynamics and functional state of the right ventricle and were more pronounced in patients with PAH.

[IMMUNOGENETICS AND PROGRESSION OF CHRONIC VIRAL HEPATITES].

AIM OF INVESTIGATION: To estimate the role of polymorphic variants of genes IL4 (C-590T), IL4RA (I50V), TNF (G-308A) and SLC1IAI (D543N) in chronic viral hepatitis progression. MATERIAL AND METHODS: Overall 121 patients with chronic viral hepatitis C and B. RESULTS: Study results have demonstrated, that of all investigated polymorphic variants of genes IL4 (C-590T), IL4RA (150V), TNF (G-308A) and SLC11A1 (D543N) in patients with chronic liver diseases of various etiology the <> IL4RA gene variant (II50Val) is associated with HBV-infection chronization. The allele <> gene TNF-α (G-308A) is protective for chronic viral hepatitis and is associated with a low level of production by mononuclear cells of TNF-α and IL-12, high secretion of IL-4 and low degree of collagenopathy in the liver. Genotype <> of IL4 (C-590T) gene is an adverse marker for progression of chronic viral hepatitis B. There was significant correlation of polymorphic variants TNF (G-308A) and IL4 (C-590T) genes with production of the key interleukins, that determine type of immune response (Th-1, Th-2) and products of collagen metabolism that testifies genetic determination of system immune response and collagen formation processes in the liver at chronic viral hepatitis.

[A case of thoracic actinomycosis].

A case of thoracic actinomycosis manifest as round shadow in the lung is described. Diagnosis was based on the presence of actinomycetes in a transthoracic lung biopsy sample. Treatment for 3 months resulted in recovery. No relapse was documented during 1 year follow-up period.

[Clinical and morphological peculiarities of the clinical course of duodenal ulcer in patients with bronchial asthma].

This work was aimed to study clinical features of H. pylori-associated duodenal ulcer (DU) and elucidate morphological features of gastric mucosa (GM) in patients with bronchial asthma (BA). Simultaneous prospective examination of 118 patients aged 18-64 yr included clinical and endoscopic study of the gastroduodenal region with the assessment of gastroenterological symptoms and morphological analysis of GM and duodenal biopsies by histological, histochemical, and morphometric methods. It was shown that GM inflammation in patients with DU and BA is associated not only with H. pylori infection but also with the phase of BA. Structural changes of GM in the patients with DU and BA, unlike those with DU without BA, were apparent not only in the antrum but also in the fundus. Growing density of eosinophil, neutrophil and mast cell infiltration of fundal and antral GM as well as increased total number of cells in the antrum reflects active immune-mediated inflammation in GM lamina propria. It is concluded that negative effect of uncontrolled BA on the clinical course of DU is not restricted to the association of DU exacerbation with the absence of BA control; it is also responsible for enhanced activity of gastritis. One of the possible factors determining combination of H. pylori-associated duodenal ulcer with BA is chronic hyperergic inflammation and marked structural changes in GM.

[The state of the digestive system in psoriasis].

Many authors emphasize the close relationship between skin lesions and digestive disorders in the patients suffering from psoriasis. The present literature review is focused on the results of investigations carried out in the recent years. The most detailed information concerns lesions in the stomach, small and large intestines, pancreas, and hepatobiliary system of psoriatic patients. The data obtained indicate that the treatment of skin pathology associated with psoriasis should be prescribed with due regard for the state of the digestive system.

[Disturbed absorptive function of small intestines in patients with chronic obstructive pulmonary disease].

The study included 93 patients (mean age 56.8+/-7.2) with COPD; 22 presented with grade 1 COPD, 36 and 35 with grade II and 111 COPD respectively. The latter group displayed reduced absorption of fats, proteins, and carbohydrates in the small intestine, the degree of dysfunction increasing with the severity of the disease, degenerative/dystrophic changes in intestinal mucosa, and deterioration of its regenerative potential. The data obtained are interpreted in the context of the relationship between the functional/structural properties of intestinal mucosa and clinical manifestations. The body mass deficit in COPD patients was shown to positively correlate with the reduction of absorption of fats (r=0.55), proteins (r=0. 71), and carbohydrates (r=0.48) in the small intestine.

[Clinical and functional disorders of the stomach-in patients with psoriasis in the presence of chronic opisthorchiasis].

OBJECTIVE: to study the clinical and functional status of the stompach in patients with psoriasis in the presence of chronic opisthorchiasis (CO). Subjects and methods. Ninety patients with psoriasis concurrent with CO (a study group (Group 1)), 70 with psoriasis (a comparison group (Group 2)), 70 with CO (Group 3), and 30 healthy individuals were examined. All the patients underwent fractional gastric secretory studies and esophagogastroduodenoscopy (EGDS). RESULTS: The study group showed a reduction in stimulated hydrochloric acid output (4.25+/-0.38 mmol/hour), which was significantly less than that in Groups 2 and 3 and healthy individuals [5.87+/-0.51 (p<0.001); 6.86+/-0.59 (p<0.05), and 10.73+/-0.84 mmnol/hour (p<0.001), respectively]. In the study group, stimulated pepsin output (4.87+/-0.49 mmol/hour) was also significantly less than that in the other groups. Reduced basal hydrochloric acid output was found in 65.5% of the study group patients, whose number was significantly larger than that in the comparison group [44.3% (p<0.05)] and its stimulated output was less in 80 and 62.9% in the study and comparison groups, respectively (p < 0.05). A reduction in pepsin output in the basal secretion phase was revealed in 57.8 and 37.1% of the patients in the study and comparison groups, respectively (p<0.05) while that in the stimulated phase was in 63.3 and 34.3% (p<0.001). Thus, gastric secretory function in psoriatic patients is characterized by reduced hydrochloric acid and pepsin outputs and it is more impaired in patients with mixed pathology, which necessitates anthelmintic therapy in this category of patients.

[The clinical and functional state of the liver in patients with psoriasis in the presence of chronic opisthorchiasis].

OBJECTIVE: to study the clinical and functional state of the liver in patients with psoriasis concurrent with chronic opisthorchiasis (CO). SUBJECTS AND METHODS: Twenty-eight patients with psoriasis concurrent with CO, 15 patients with CO, 15 patients with the enlarged liver, and 15 healthy individuals were examined. Serum biochemical study and ultrasonography of the liver and gallbladder were used. RESULTS AND DISCUSSION: The patients with comorbidity were found to have hepatomegaly with syndromes of cytolysis, cholestasis, and mesenchymal inflammation of more degrees than those from Groups 2 and 3. CONCLUSION: The found clinical and functional liver changes in patients with psoriasis concurrent with CO make it necessary to perform anthelmintic therapy in this category of patients.

[Somatopsychic manifestations in patients with chronic viral hepatitis].

The aim of the work was to study somatopsychic manifestations in patients with chronic viral hepatitis (CVH). MMPI profiles, state and trait anxiety were assessed in 110 patients. Boundary psychic problems were evaluated using the Beck scale. It was shown that mean MMPI T-score in patients with CVH was above 50; half of them developed "neurotic triad"; hypochondria occurred in 37.3%, depression in 42.7%, and hysteria in 37.1%. The highest level of state anxiety was documented in patients with HCV infection and isolated HBCor At. The CVH-1b genotype was associated with enhanced occurrence of depression in patients having virus-positive blood for 1-5 years. The level of state and trait anxiety in them was lower than in patients with duration of viremia over 5 years.

[The clinical and functional status of the stomach and small intestine in patients with chronic inflammatory bowel diseases concurrent with chronic opisthorchiasis].

To study the impact of Opisthorchis infestation on the upper digestive tract and small bowel in chronic inflammatory bowel diseases, the authors examined 164 patients with inflammatory bowel diseases, including 71 patients with ulcerative colitis and 45 with Crohn's disease without parasitosis and 48 with chronic opisthorchiasis (31 with ulcerative colitis and 17 with Crohn's disease). A control group consisted of 20 healthy individuals and 20 patients with chronic opisthorchiasis. A diagnosis was established by colonofibroscopy and a morphological study of colonic biopsy specimens. Gastric mucosal atrophic changes and motor evacuatory disorders as duodenogastric reflux were significantly more frequently encountered in inflammatory bowel diseases concurrent with chronic opisthorchiasis. The presence of Opisthorchis infestation significantly worsened fat and carbohydrate malabsorption in the small bowel in inflammatory bowel diseases.

[Myocardial structural and functional changes in patients with chronic viral hepatitis concurrent with chronic opisthorchiasis].

The aim of the investigation was to study the myocardium in patients with chronic viral hepatitis concurrent with chronic opisthorchiasis. Ninety patients with chronic viral hepatitis, including 52 patients with this disease concurrent with chronic opisthorchiasis, were examined. Doppler echocardiography indicated a statistically significant increase in left ventricular mass regardless of the presence of Opisthorchis infestation. Analysis of left ventricular diastolic dysfunction showed its great degree in chronic hepatitis C. Single-photon emission computed tomography with 99mTc-pyrophosphate revealed focal tracer incorporation in the myocardium of most patients with Opisthorchis infestation. A third of patients with chronic viral hepatitis showed moderate diffuse trace accumulation that was significantly more frequently found in chronic hepatitis C. Single photon-emission tomography with labeled leukocytes demonstrated abnormal accumulation in none of the patients; troponin T levels were in the normal allowable range. Myocardial lesion was detected in the chronic course of viral hepatitis C concurrent with chronic opisthorchiasis that was unattended by cardiomyocyte necrosis and that was dystrophic.

[Circulating leptin and the trophological status of patients with chronic obstructive pulmonary disease].

AIM: To study the specific features of the nutritional status of patients with persistent chronic obstructive pulmonary disease (COPD) in relation to the hormone-regulating function of energy exchange in terms of leptin and to concurrently evaluate the functional status of fat and protein digestion and absorption and to measure body fat percentage. To assess the influence of these factors on the regulation of the serum concentration of leptin and its potential role in the development of trophological insufficiency in patients. SUBJECTS AND METHODS: In 93 patients with COPD (Stages I, II, and III in 22, 36, and 35 patients, respectively, the nutritional status was evaluated by somatometric methods. The concentration of leptin was measured by enzyme immunoassay using a test system (DSL, USA). Absorption was estimated by biochemical studies and by using radionuclides. Body fat content was determined, by measuring bioelectric impedance with an OmRon BF-302 apparatus (Japan). RESULTS: Protein and fat absorption was decreased in patients with moderate and mainly severe COPD as compared with that in the control group and correlated with body weight deficit and lower body fat percentage. Decreased leptin levels were detected in Stages II-III COPD and correlated with the degree of the disease and reduced protein (r = 0.68 +/- 0.02) and fat (r = 0.64 +/- 0.18) absorption. CONCLUSION: Protein and fat absorption impairments correlating with body weight deficit in patients with COPD underline the significant role of this mechanism in the development of trophological insufficiency. In COPD patients with trophological insufficiency, the lower circulating leptin levels that correlate with impaired absorption of fatty acids and protein characterize the pathogenetic role of secondary malabsorption syndrome in leptin-mediated impairments of energy exchange mechanisms. Functional insufficiency of the hormone-regulating mechanism responsible for energy exchange in terms of leptin in patients with Stages II-III COPD gives warning of the insufficient stock of adipose tissue and its reduced energy reserve.

[The parameters of collagen proteolytic and metabolic systems in chronic liver diseases of viral and toxic etiologies].

AIM: To study a relationship of the plasma activity of elastase-like and collagenase-like proteinases and their inhibitors to hepatic collagen metabolism and to detect the serum markers of fibrosis severity. SUBJECTS AND METHODS: Three hundred and fifty-nine patients with chronic liver diseases (CLD), including 118 patients with chronic viral hepatitis (CVH), 113 with CVH concurrent with alcoholic liver disease (ALD), 109 with ALD, and 19 with CLD in the presence of opiomania were examined. The activities of alpha1-proteinase inhibitor and alpha2-macroglobulin (alpha2-MG) were determined by the unified spectrophometric assay from the inhibition of N-benzoyl-arginine ethyl ester hydrolysis. The activity of elastase-like proteinases was determined by enzymatic assay from the hydrolysis of the synthetic substrate N-butyloxycarbonyl-L-alanine-para-nitrophenyl ester. That of collagenase-like proteinases was determined, by using a collagen type 1 substrate and expressed in terms of micromoles of the resultant hydroxyproline. The content of hydroxyproline was determined by a color reaction with demethylbenzaldehyde, a free, peptide- and protein-bound hydroxyproline; their fraction was obtained under various conditions of plasma protein isolation and hydrolysis. Plasma fibronectin levels were measured by solid-phase immunoassay. Liver biopsy specimens were morphologically studied in the majority of patients to determine the histological hepatitis activity index and the stage of fibrosis. RESULTS: Fibrois formation in the liver in its chronic diseases was attended by a significant reduction in the activity of collagenase-like proteinases hydrolyzing collagen and by the lower activity of alpha2-MG, an inhibitor limiting collagen formation. CONCLUSION: The identified changes make themselves evident just in early fibrosis, which suggests the rapid onset of imbalance in the mechanisms responsible for regulation of connective tissue synthesis and promotes intensified fibrosis formation.

[Exocrine function of the pancreas in patients with ulcerative colitis].

Fecal elastase-1 was measured in 38 patients with ulcerative colitis to evaluate the functional state of pancreas by enzyme immunoassay with the use of monoclonal antibodies. It was shown that absolute and relative fecal elastase-1 levels in patients with chronic inflammatory intestinal disorders significantly decreased with increased severity of the disease.

[Quality of life indices in patients with chronic viral hepatitis].

AIM: to estimate quality of life (QL) indices in patients with chronic viral hepatitis (CVH) and their relationships to the clinical characteristics of the disease. SUBJECTS AND METHODS: One hundred and ten patients with chronic viral hepatitis (CVH), including 58 patients with chronic hepatitis C (CHC), 27 with chronic hepatitis B, and 25 with CHC + HBCor, were examined. The personality psychological profile, reaction and personality anxiety were evaluated; the Beck inventory was used to identify borderline mental disorders. The test developed by the Karelian Research Center, Russian Academy of Medical Sciences, modified by Ya. M. Rutgaizer, and the Nottingham Health Profile were applied to estimate QL indices. RESULTS: Parameters characterizing the social and personality indices of life, such as qualitative performance of paid work, participation in social life, impossibility of adequate rest, and sexual life are most frequently influenced. The main indicators of worse QL were diminished vitality (vital energy), sleep disorders, and emergence of emotional reactions. This was largely seen in patients with active CVH infection and in those who had isolated HBcor antibodies. CONCLUSION: QL is directly related to the duration of viral infection.

[Diastolic dysfunction of left ventricle in psoriatic patients with concomitant opisthorchiasis before and after antihelminthic therapy].

The aim of the study was to evaluate left ventricular diastolic function in psoriatic patients with chronic opisthrochosis (CO) before and after antihelminthic therapy. It included 75 patients with psoriasis and CO, 50 with psoriasis alone, 50 with CO, and 20 healthy subjects. All patients underwent standard echocardiographic examination in the M-, B-, and Doppler mode. The study revealed impaired active relaxation of the left ventricle manifest as increased isovolumic relaxation time more pronounced in patients with concurrent CO and psoriasis than in those with psoriasis alone. Antihelminthic therapy did not cause deterioration of the diastolic function in these patients and should be recommended in case of combined pathology.

[The clinical and endoscopic state of the esophagus in patients with asthma concurrent with chronic opisthorchiasis].

The frequency and pattern of manifestations of gastroesogageal reflux disease were studied in asthma concurrent with chronic opisthorchiasis. One hundred and fifty patients (52 males and 98 females) aged 14 to 60 years (mean age 43.18 +/- 10.6 years) who had atopic asthma of varying severity were examined. Group 1 comprised 74 asthmatic patients without opisthorchiasis; Group 2 included 76 asthmatic patients with opisthorchiasis; Group 3 consisted of 20 healthy individuals. According to the severity of asthma, all the patients from Group 1 and 2 were divided into 4 subgroups: mild, moderate, severe hormone-dependent and severe hormone-independent asthma. The patients with and without concurrent opisthorchiasis did not virtually differ in the severity pattern of asthma and its duration. Those with severe hormone-dependent asthma took systemic glucocorticosteroids in doses of not more than 15 mg/day. The scope of clinicoinstrumental and laboratory studies was determined by the presence of concurrent pathology: asthma and gastroduodenal diseases. Esophageal erosive lesions were encountered in a third of the asthmatic patients with opisthorchiasis and in every four patients in Group 1. In patients with severe asthma with and without opisthorchiasis, esophageal erosive lesions were revealed in 66.7%. The presence of concomitant Opisthorchis invasion in patients with asthma results in a significant increase in the clinical manifestations of gastroesophageal reflux disease and calls for the obligatory performance of therapy with antisecretory agents, prokinetics and necessitates dehelmintization during remitting asthma.

[Activity of systemic inflammatory reaction in patients with chronic obstructive pulmonary disease in regard to small intestinal absorption function].

AIM: To study the effect of systemic inflammatory reaction in patients with chronic obstructive pulmonary disease (COPD) in association with absorption of the small intestine. MATERIAL AND METHODS: Small intestinal absorption was studied in 93 COPD patients (22, 36 and 35 patients at stage I, II and III, respectively) in a clinically stable stage of the disease and in 35 healthy controls. The absorption was investigated biochemically and with application of radionuclide methods, blood concentration of TNF alpha was measured with enzyme immunoassay. RESULTS: The small intestine of patients with moderate and severe COPD showed subnormal absorption of fats, protein, carbohydrates. With the disease progression, this disorder aggravated. The same trend was seen in relation to TNF alpha concentration. A strong direct correlation was found between a high concentration of TNF alpha and a low absorption of 131I-albumin and fatty acids, this high concentration correlated negatively with low absorption of d-xilose. CONCLUSION: Relationships between inflammation severity and small intestinal absorption of fats, protein, carbohydrates in patients with moderate and severe COPD means loss of essential nutrients, primarily protein and fats. This is important in understanding of pathobiological processes of development of extrapulmonary (intestinal) manifestations in COPD patients.

[Trophologic insufficiency and absorptive function of small intestine in patients with chronic obstructive pulmonary disease].

The study included 93 patients with grade 1-3 chronic obstructive pulmonary disease (COPD) in the stable clinical phase. Absorptive function of the small intestine was evaluated by biochemical methods and with the use of radionuclides; plasma tumour necrosis factor-alpha (TNF-alpha) levels were measured by an enzyme immune-assay. Trophologic status in 44% of the patients with COPD was unaltered whereas 14% had an excessive body weight. Trophologic insufficiency (TI) was diagnosed in 42% of the patients. Severe TI or cachexia occurred in 5.4% of the patients and only in severe COPD. Impaired absorptive function of the small intestine documented in moderately-severe and severe phases of COPD correlated with the severity of the disease. There was close relationship between body weight deficit and reduced protein absorption (r = 0.77 +/- 0.09). The presence and progress of TI correlated with the magnitude of increment of plasma TNF-alpha. The level of TNF-alpha in patients with COPD and cachexia was 7.8 times its normal value. Elevated plasma TNF-alpha concentration positively correlated with body weight deficit (r = 0.77 +/- 0.12). Also, significant direct correlation was found between the rise in TNF-alpha concentration in patients with COPD and TI and enhanced excretion of fat measured by the method of Van de Kamer (r = 0.56 +/- 0.12), albumin (r = 0.78 +/- 0.12), and d-xylose (r = 0.46 +/- 0.12). It is concluded that impaired absorption of fats, proteins, and carbohydrates in the small intestine plays an important role in the mechanisms underlying the development of trophologic insufficiency in patients with moderately-severe and severe phases of COPD.