Diagnostic methods for detecting forms and strains of Helicobacter pylori and evaluation of its eradication.

Diagnostic methods for detecting forms and strains of Helicobacter pylori isolated from biopsy specimens of gastric mucosa in 28 patients with duodenal ulcers and evaluation of its eradication were compared. Biopsy specimens from all patients were tested for the presence of H. pylori by the urease test, histological method, and PCR with species-specific primers before and after treatment. H. pylori infection was detected in all patients before treatment, the mean titer of serum IgG being 36.7+/-16.6 U/ml. Biopsy specimens positive for H. pylori in PCR were subjected to restriction analysis of specific PCR-amplified genes or their fragments. The fingerprint analysis gave electrophoregrams of restriction products amplified fragment of flaA gene of H. pylori in 7 patients. Differences in restriction maps indicate the presence of 5 H. pylori strains in the studied samples.

[Interleukins in chronic viral hepatitis]. / Interleikiny pri khronicheskom virusnom gepatite.

AIM: To estimate interleukines levels in chronic hepatitis (CH) in respect to CH etiological factor, activity and stage. MATERIAL AND METHODS: Enzyme immunoassay (kits from proteinovy Kontur, St-Petersburg) determined levels of IL-1 beta, IL-4, IL-6 and TNF-alpha in the peripheral blood of 250 patients with chronic hepatitis C (CHC), B (CHB), D (CHD) and G (CHG). RESULTS: IL concentrations in chronic viral hepatitis depend on etiological factor (CHC, CHB, CHD, CHG), activity (high, moderate, low), stage (chronic hepatitis, cirrhosis). IL occur in high quantities in CHC, in moderate concentrations in CHB and in minimal ones in CHG. Maximal IL levels were observed in high hepatitis activity at the stage of hepatic cirrhosis. TNF-alpha and IL-4 concentrations rose more frequently and higher than IL-6 and IL-1 beta (43 and 34%, up to 315 pg/ml and 256 pg/ml, respectively).

[Virus-specific antibodies and interferon therapy in chronic hepatitis C]. / Virusspetsificheskie antitela i interferonoterapiia pri khronicheskom gepatite C.

AIM: To study the spectrum of antibodies in chronic hepatitis C (CHC) against various antigenic structures of hepatitis C virus (HCV) and changes in their quantity in response to interferon treatment. MATERIAL AND METHODS: Enzyme immunoassays (kits by Diagnostic Systems, N. Novgorod) were used in examination of 144 CHC patients with circulation of HCV antibodies in peripheral blood. RESULTS: IgG antibodies to cor, NS3, NS4 HCV antigens were present in the highest percentage (75-100%) and concentration (2.5-1.9 units). IgM antibodies to cor HCV, IgM and IgG to HS5 HCV were detected in 36-63%, concentration of the antibodies ranged 0.7-1.7 units. Interferon therapy reduced frequency and amount of virus-specific antibodies to various antigenic structures of HCV, primarily IgM to cor, NS5-HCV, anti-IgG NS5-HCV. CONCLUSION: In CHC a wide spectrum of antibodies to HCV antigenic structures are produced. They have different biological properties. Interferon treatment diminished their frequency and amount. This allows to consider changes in the amount of virus-specific antibodies in CHC as a criterion of antiviral treatment effectiveness.

[Chronic abdominal ischemia: clinical manifestations, diagnostic potential and treatment policy]. / Khronicheskaia abdominal'naia ishemia: klinicheskie proiavleniia, diagnosticheskie vozmozhnosti i taktika lecheniia.

AIM: To define variants of clinical course of chronic abdominal ischemia (CAI) and treatment policy depending on functional class of the disease. MATERIALS AND METHODS: The examination of 236 patients with CAI included clinicolaboratory, endoscopic, x-ray and ultrasonic investigations, ultrasonic dopplerography, x-ray contrast aortoarteriography, histological analysis of gastric, duodenal and colon mucosa biopsies. RESULTS: 6 variants of CAI clinical course were distinguished. Most frequent CAI manifestations were erosive-ulcerative gastroduodenal lesions, primarily in men, which combined with ischemic heart disease and atherosclerosis of lower limb vessels. Women often presented with pseudopancreatic variant which was associated with hypertension and dyslipoproteinemia. By severity of clinical symptoms, 3 functional classes of the diseases were recognized. They are decisive for the treatment policy. Biopsy specimens of the mucosa exhibited dystrophy in weak inflammation. CONCLUSION: Today's diagnostic techniques and recognition of functional classes of the disease contribute to correct decision on the treatment policy.

[HGV and TTV - new hepatitis viruses]. / HGV i TTV - novye virusy gepatitov.

AIM: To examine clinical, immunological and morphological features of HGV- and TTV-infections in patients with chronic hepatic diseases (CHD) and assess efficiency of treatment of HGV-seropositive patients. MATERIAL AND METHODS: 202 patients with CHD were examined for markers of HBV-, HCV-, HGV- and TTV-infections. Some patients were subjected to puncture biopsy of the liver. Efficiency of interferon-alpha treatment of HGV and HBV/HCV coinfection was studied. RESULTS: HGV RNA and TTV DNA were detected in 19.8 and 11.8% of cases, respectively. Biochemical indices in patients with HGV and TTV monoinfections significantly differed from those in the control group while morphological changes in most of them corresponded to those with hepatitis. INF-alpha was given to 7 patients with HGV + HBV/HCV infections. A response was achieved in 3 months in 2 of them. CONCLUSION: The role of HGV and TTV in hepatic diseases pathology is still unclear. Further studies on detection and examination of patients infected with G and TT viruses are necessary. When choosing therapy, the presence of HGV RNA and TTV DNA in blood serum, virus genome in hepatocytes and histological changes in hepatic tissue should be considered.

[Drug addicts' liver]. / Pechen' narkomanov.

AIM: To assess condition of the liver in drug abusers. MATERIALS AND METHODS: Clinicobiochemical, immunological, virological and morphological hepatic tests were made in 144 patients with different forms of drug addiction. RESULTS: Hepatic diseases are rather common in drug addicts. They have some specific clinical features: weak clinical symptoms and laboratory ++indications, high incidence of viral hepatitides markers, repeated infection, initially absent definite evidence on immunological status disturbance, predominant morphologically inactive forms. Symptoms of hepatic disorders were found both in the period of active abuse and in abstinence. CONCLUSION: Young people with psychopathological behavior should be examined and followed up for detection of drug addiction and concomitant liver diseases.

[Nicotinamide in combined treatment of chronic pancreatitis]. / Primenenie nikotinamida v kompleksnom lechenii bol'nykh khronicheskim pankreatitom.

AIM: To evaluate effects of nicotinamide on insulin secretion in glucose tolerance test and on blood clotting in patients with chronic pancreatitis (CP). MATERIALS AND METHODS: 30 patients with CP of alcoholic etiology received combined treatment with enzyme medicines. In addition, some of them were administered nicotinamide as 2.5% solution for 2 weeks (1 ml twice a day). Before the treatment and during its course, measurements were made of fasting and post glucose test values of insulin secretion and thromboelastogram. RESULTS: Both basal and stimulated insulin secretion in CP patients was low compared to control subjects. Nicotinamide significantly increased basal secretion of insulin and insignificantly aroused its glucose-stimulated secretion. Nicotinamide promoted reduction of hypercoagulation and time to remission. CONCLUSION: Nicotinamide administration is thought valid for correction of endocrine pancreatic function and hemocoagulation in patients with alcoholic CP.

[The possibility of Helicobacter pylori being present in the resting state in the gastric mucosa of peptic acid patients after treatment]. / O vozmozhnosti prebyvaniia Helicobacter pylori v pokoiashchemsia sostoianii v slizistoi obolochke zheludka u bol'nykh iazvennoi bolezn'iu posle lecheniia.

AIM: To develop experimental approaches to detection of inactive forms of Helicobacter pylori (HP) in patients treated for gastroduodenal ulcer, to try the role of such HP forms in emergence of ulcer recurrences. MATERIALS AND METHODS: Examination for HP was made using a fast CLO test, polymerase chain reaction (PCR), histologically. A simple quantitative spectrophotometric test for urease activity in biopsies of gastric mucosa is proposed. RESULTS: Antibacterial and other treatments led to a significant decline in urease activity dependent on the amount of the agents in the biopsies. PCR found HP in 48% of patients after the treatment. In these cases HP may be in dormancy. This state is not safe because of possible HP activation eventuating in ulcer recurrence. CONCLUSION: PCR can be used for prediction of ulcer recurrence as it is sensitive to HP when wide-spread urease test gives negative results.

[The potentials of intestinoscopy and guided biopsy in the diagnosis of diseases of the small intestine]. / Vozmozhnosti intestinoskopii i pritsel'noi biopsii v diagnostike boleznei tonkoi kishki.

AIM: To ascertain the role of intestinoscopy in diagnosis of small intestinal diseases. MATERIALS AND METHODS: Intestinoscopy with multiple topographic biopsies was made with SIF-10 device (Olympus) in 92 patients. RESULTS: Of 60 patients with absorption disorders, the diagnosis of gluten enteropathy (GEP), Whipple's disease (WD), general variable hypogammaglobulinemia (GVHG) and small intestinal diverticulum was established in 38, 3, 5 and 1 patients, respectively. 13 patients with mild malabsorption were free of the pathology. GEP, amyloidosis, intestinal lymphangiectasia were found in 5, 3 and 4 of 15 patients with exudative enteropathy. The rest had lymphoma, lymphangiomatosis, Crohn's disease. 11 patients with focal affections had Crohn's disease, polyps, GVHG or had only motor defects. Repeated intestinal hemorrhages in a few patients were due to adenocarcinoma, aberrant pancreas, intestinal or gastric erosions. CONCLUSION: Patients with malabsorption and exudative enteropathy had similar abnormalities in the small intestine and duodenum. Endoscopic biopsy from the distal duodenum is enough for diagnosis of GEP, Whipple's disease and GVHG. Intestinoscopy as well as x-ray imaging are effective in detection of focal lesions of the small intestine and sources of intestinal bleeding.

[Glucocorticoid deficiency of the adrenal cortex in chronic liver diseases]. / Gliukokortikoidnaia nedostatochnost' kory nadpochechnikov pri khronicheskikh zabolevaniiakh pecheni.

AIM: The study of blood levels of hydrocortisone and ACTH in patients with chronic hepatic lesions. MATERIALS AND METHODS: Blood levels of hydrocortisone and ACTH were measured in 198 patients with chronic liver diseases (CLD) of different etiology and severity and in 39 healthy controls. RESULTS: Blood hydrocortisone was subnormal while ACTH elevated in all the patients except those with chronic hepatitis running a favorable course. Changes in the hydrocortisone and ACTH content were the greatest in CLD of viral and autoimmune etiology, the least--of alcoholic etiology. CONCLUSION: Hydrocortisone deficiency was most prominent in severe hepatic lesions.

[Whipple's disease: results of long-term follow-up]. / Bolezn' Uippla: rezul'taty dlitel'nogo nabliudeniia.

AIM: To analyze clinical, diagnostic and therapeutic aspects of Whipple's disease. MATERIALS AND METHODS: Diagnostic and therapeutic data are available for 7 patients registered in 1990-1997. The diagnosis was made using intestinoscope SIF-10L ("Olympus"). Biopsies were obtained from the jejunal, duodenal and gastric mucosa. The patients received tetracycline, erythromycin, biceptol, on demand--prednisolone. RESULTS: Whipple's disease was diagnosed 6 years on the average following the first clinical symptoms. In most patients the intestinal symptoms were preceded or accompanied by such extraintestinal symptoms as enlargement of the lymph nodes, lowering of hemoglobin, hypoproteinemia, ESR increase to 40-60 mm/h. To study biopsies from the distal duodenum is the only measure needed for diagnosis of Whipple's disease. In untreated patients PAS-positive macrophages are detectable also in gastric body mucosa. The immediate treatment outcome is favorable. The recurrence was observed only in one patient who had given up taking tetracycline. CONCLUSION: Long-term antibacterial therapy brings the recovery. Primary disorder of the cellular immunity responsible for the disease onset necessitates long-term follow-up of the patients. Control biopsy should be examined once a year.

The morphology and composition of cholesterol, protein, and bilirubin deposits in dried human bile: cathodoluminescence and backscattered electron imaging.

This work is the first to deal with the application of color cathodoluminescence scanning electron microscopy (CCL SEM) and a novel version of combined imaging with backscattered electrons (CCL + BSE SEM) for the study of the composition of bile and its precipitation mechanisms. The present study demonstrates cholesterol, protein, and bilirubin distribution in deposits of normal and abnormal human bile after solution evaporation to full dryness. Qualitative CCL SEM analysis showed that dried bile remnants include different proportions of the above components. Three types of deposits were observed: Arborescent crystals, typical cholesterol crystals, and amorphous bilirubin particles. The selection of crystalline or amorphous precipitate phases is determined by the dehydration/concentration process. The findings may explain key features in lithogenesis.

[Cholestasis assessment by activity of antioxidant enzymes and composition of plasma lipoproteins in patients with liver diseases]. / Otsenka kholestaza po aktivnosti antioksidantnykh fermentov i sostavu lipoproteidov plazmy krovi bol'nykh s patologiei pecheni.

AIM: Investigation of activity of copper-containing enzymes in plasma superoxide dismutase (SOD) and ceruloplasmin (CP) in comparison with concentrations of lipoproteins (LP) of the main classes in patients with chronic hepatic diseases (CHD). MATERIALS AND METHODS: SOD activity, CP and LP in plasma were measured in 90 patients with CHD. RESULTS: An inverse relationship was found between SOD activity and CP content in CHD. SOD/CP ratio proved informative in cholestasis assessment. An increased ratio beta-LP/alpha-LP was noticed in patients with primary biliary cirrhosis. This value and the disease severity correlated. CONCLUSION: Patients with cholestatic hepatic lesions exhibited inhibition of enzyme utilization of superoxide radicals in plasma in line with enhancement of CP secretion.

[Activities of glutathione enzymes in liver biopsy specimens in chronic lesions of hepatocytes]. / Aktivnost' glutationzavisimykh fermentov v bioptate pecheni pri khronicheskom porazhenii gepatsitov.

The nonenzymatic conjugation of metabolites is decreased in chronic diseases of the liver, which is caused by decreased concentration of glutathione. The activities of glutathione enzymes are increased, this indicating the development of compensatory processes of mobilization of the second phase of detoxication, that is, increased conjugation under conditions of suppression of the cytochrome P-450 system. Measurement of liver glutathione transferase is a highly informative test for assessing the activity of the pathological process, particularly important in patients with chronic active hepatitis and cirrhosis of the liver.