Efficacy and safety of long-term therapy with nucleos(t)ide analogues in chronic hepatitis B.

AIM: To assess the efficacy and safety of long-term treatment with nucleos(t)ide analogues in patients with chronic hepatitis B. MATERIALS AND METHODS: We conducted an observational study in 101 chronic hepatitis B (HBeAg-negative and HBeAg-positive) patients treated (≥3 years) with entecavir, tenofovir or telbivudine. RESULTS: Treatment with entecavir and tenofovir was associated with high rate of virologic and biochemical response (>95%) and HBeAg seroconversion (93% and 67%, respectively). Cumulative rate of virologic resistance was 0; 3.1% and 43.5% for tenofovir, entecavir and telbivudine, respectively. Long-term nucleos(t)ide analogues treatment resulted in a regress of liver fibrosis (from 8.92 to 7.18 kPa, р<0.0001) and reduction in the number of patients with advanced fibrosis (from 48.1% to 13.8%, р<0.0001). Entecavir and tenofovir were safe and well tolerated, while treatment with telbivudine was associated with development of myopathy in 13% of cases. CONCLUSION: Entecavir and tenofovir might be recommended for the treatment of chronic hepatitis B because of having potent antiviral effect, high genetic barriers against resistance and good safety.

[Current concepts of pathogenesis, clinical course and treatment of hepatitis delta (35 years since its discovery)].

Chronic HDV infection is a most serious and rapidly progressing hepatic disease with high risk of liver cirrhosis and hepato cellular carcinoma (HCC). Many aspects of its pathogenesis, virus biology and treatment remain unknown 35 years after the discovery of the disease. HDV is significantly different from HCV and HBV despite common route of infection. HDV as a satellite pathogen realizes its pathological action in an organism with compromised immune system that proved unable to eliminate HBEV. Hepatic lesions induced by HBV create favourable conditions for HDV propagation that causes rapid development of cirrhosis and its complications. The low efficacy of IFN-alpha therapy is due to the properties of HDV that inhibits the immune response. In most cases, decompensation and hepatic insufficiency determine prognosis of and mortality from HDV infection rather than HCC as in HBV and HCV.

[Congenital bile duct hypoplasia (Alagille-Watson syndrome)--a rare cause of biliary cirrhosis in adults].

A case of a rare hereditary disease, Alagille-Watson syndrome, is reported. It most frequently affects liver and cardiovascular system which leads to biliary cirrhosis and cardiovascular catastrophe in young patients. Pathogenesis and clinical variants of the disease are described.

[The interpretation of the data from the ultrasonic examination of patients with acute and chronic suppurative lung and pleural diseases]. / Interpretatsiia dannykh ul'trazvukovogo obsledovaniia bol'nykh s ostrymi i khronicheskimi nagnoitel'nymi zabolevaniiami legkikh i plevry.

Observations were made in 104 patients with acute and chronic lung abscesses and pleural empyema. The endoscopic, bacteriological and ultrasonic methods were used to make full diagnosis and to begin treatment. This article describes the part of the work devoted to the ultrasonic diagnostics. Different forms of lung abscesses were revealed and explained. The method was used to differentiate the collection of pus in the lung and pleural cavity, to reveal the structure of pathologic processes and its development, to learn the character of changes in the lungs and pleural space. The method is rather simple and gives the doctor much information about the condition of the pathologic tissue.