[The role of different factors affecting the duodenum in chronic viral hepatitis B].

The aim of the present study was to determine the frequency and the character of duodenal lesions in patients with chronic viral hepatitis B (CVH-B), to elucidate the dependence of these parameters on the activity and duration of hepatitis, virulence, and portal blood flow. A total of 206 patients with CVH-B were examined. It was found that CVH-B was associated with the development of chronic duodenitis in 23.3% of the patients. Endoscopic studies revealed different degree of affection of duodenal mucosa. Superficial focal and moderately severe duodenitis occurred more frequently (in 33.3 and 37.5% of the patients) than manifest duodenitis (12.5%). Erosive duodenitis concomitant with Helicobacter pylori infection was diagnosed in 16.7% of the patients. The main factors contributing to the development of chronic duodenitis included viral infection, its intensity, duration of hepatitis, and disturbed portal circulation. Severity of duodenitis was closely related to the severity of CVH-B.

[Prevalence of the lactase deficiency among the population of the northwestern region of Russia].

The article presents the authors' and literature data on the prevalence of the lactase deficiency among the nations of the Finn-Ugric language group (Finns, Karelians, Vepses, Izhors, Estonians), Eastern Slavs (Russians, Ukrainians, Belorussians) living in the northwestern region of Russia. The lactase deficiency has been established: among Russians--16%, Belorussians--15%, Ukrainians--13%, Finns--22%, Karelians--20%, Vepses--20%, Izhors--20%, Estonians--23%. Confirmations of the cultural and historical hypothesis of the lactase deficiency prevalence have been found. It has been shown that under certain ecological conditions the nature of human nutrition during a continuous period of history can produce significant genetic changes in the population.

[Carbohydrate hydrolysis and absorption in the human small intestine in aging]. / Gidroliz i vsasyvanie uglevodov v tonkoi kishke cheloveka pri starenii.

In old age, a significant increase of the starch hydrolysis and a decrease in the maltose hydrolysis occur, as well as lactose, glucose absorption, fructose and galactose. The starch hydrolysis decreases with further ageing, too, whereas saccharose hydrolysis and pure galactose absorption maintain their levels in old age. In ageing, the enzyme systems maintaining the membrane digestion undergo alterations earlier than the transport systems.

[Use of enzyme substitutes in hypolactasia]. / Primenenie fermentnykh zamestitel'nykh preparatov pri gipolaktazii.

The paper presents the results of clinical and laboratory studies of lactrase, a drug containing lactase. This agent is recommended for splitting lactic sugar in subjects with appreciably decreased production of endogenous lactase (hypolactasia). Twenty-eight patients with this condition were examined. Manifest clinical symptoms of the condition were observed after loading with 50 g of lactose in all examinees. Addition of 250 mg of lactrase to lactose led to complete clinical compensation of the deficit of endogenous lactase in 75% examinees, and if 500 mg of lactrase was administered, hypolactasia was compensated in virtually all patients. A single intake of 50 g of lactose with lactrase causes a statistically reliable increase of glycemia in such patients. Moreover, a reliable effect of lactrase was observed when measuring galactose in the urine following the lactose test with 250 and 500 mg of lactrase. Our results indicate a high efficacy of lactrase in the treatment of patients with hypolactasia.

[The clinico-immunological characteristics of chronic lobular hepatitis]. / Kliniko-immunologicheskie osobennosti khronicheskogo lobuliarnogo gepatita.

A total of 156 patients with chronic hepatitis were examined, among whom 55 had chronic persistant hepatitis, 42 chronic active and 59 lobular hepatitis. It is for the first time that clinicoimmunologic characteristics of chronic lobular hepatitis are fully detailed. The latter was found to take intermidiate place between chronic persistant and chronic active hepatitis in respect of its clinical picture as well as markedness of biochemical and immunological changes. The value of the R-protein titre determination as a sensitive test in the diagnosis of the hepatocellular inflammation in all clinical types of hepatitis was demonstrated.

[The problems of collagen formation in chronic liver diseases]. / Nekotorye voprosy kollagenoobrazovaniia pri khronicheskikh zabolevaniiakh pecheni.

With employment of radioimmunoassay, the level of procollagen-III-peptide was measured in the blood of 71 patients with chronic hepatic diseases versus 20 healthy controls. This level was examined for correlation with characteristics of the etiological factor, the degree of hepatic-cellular inflammation and immune reactions. Procollagen-III-peptide concentrations were directly correlated with transaminases and reversely with activity of antibody formation. Collagenopoiesis gained intensity in the range from chronic persistent hepatitis to hepatic cirrhosis. Virus infection and alcohol are among the most potent etiological factors stimulating collagenopoiesis. The least procollagen levels occurred in hepatic diseases obscure in origin.

[The functional-morphological changes in the duodenum in chronic pancreatitis]. / Funktsional'no-morfologicheskie izmeneniia v dvenadtsatiperstnoi kishke pri khronicheskom pankreatite.

A study of the cavitary and membrane digestion of lipids, carbohydrates, proteins and data of the histological structure of the bioptate of the duodenal mucosa in 34 patients with chronic pancreatitis revealed the morphological picture of chronic duodenitis. This resulted in a reduction of the sorption properties of the intestinal epithelium that was manifested in a reduction of the rate of membranous digestion, mainly of lipids and lactose. Lesser degrees of protein, starch and saccharose hydrolysis were observed. Biopsy specimens of the duodenal mucosa showed a reduced activity of enterokinase and alkaline phosphatase. Antacids (almagel, phosphalugel), mineral waters ("Borzhomi", "Poliana Kvasova"), regeneration stimulators (Metacyl, retalil), agents stimulating the motor function (cerukal, reglan and oth.) are recommended for the complex treatment of concomitant duodenitis.

[The role of immune complexes in chronic liver diseases and their dynamics during treatment]. / Rol' immunnykh kompleksov pri khronicheskikh zabolevaniiakh pecheni i ikh dinamika v protsesse lecheniia.

Chronic liver diseases are marked by a well-defined relationship between the intensity of the cytolytic syndrome and the level of circulating immune complexes (CIC). The highest damaging action on hepatocytes is produced by medium-sized CIC because of their penetrating and complement fixing effects. The level of thrombocytopenia and, to a less measure, of leukopenia also depends on the concentration and size of CIC in CAH and liver cirrhosis (LC), which may provide indirect evidence of the lytic action of CIC on hepatocytes, leading in turn to the impairment of microcirculation and aggravation of hepatocyte hypoxia. The data obtained attest to the role CIC of varying size play in the pathogenesis of CAH and LC. The changes in the properties of immune complexes induced by the derangement of cellular membranes also influence the course of immune responses, favouring an increase of antibody formation. As a result of an appreciable suppression of antibody and medium-sized CIC formation enhancing the cytolytic syndrome, the preference during glucocorticoid treatment should be given to the use of the medium doses of prednisolone which ensure less intensity and less duration of cytolysis as compared to the application of large drug doses.

[Methods of teaching efficient therapy of internal diseases]. / O metodike prepodavaniia ratsional'noi terapii v klinike vnutrennikh boleznei.

An original method of teaching students efficient therapy has been developed basing on the psychological decision theory, conception of stage-by-stage formation of mental actions, method of key signals. The instructor uses the scheme repeatedly when observing the students' clinical activities, at doctor's rounds and conferences.