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1.
Ter Arkh ; 93(2): 193-198, 2021 Feb 15.
Article in Russian | MEDLINE | ID: mdl-36286636

ABSTRACT

Primary biliary cholangitis and sarcoidosis are both cholestatic liver diseases. Currently, there are no established specific criteria for distinguishing the diseases from each other; diagnosis is based on the anamnesis, as well as the results of physical, laboratory and instrumental examination. The case report presents a female patient with a rare combination of histologically verified liver sarcoidosis and primary biliary cholangitis. Despite the similar clinical manifestations, the approaches to the treatment of these diseases are completely different, that underlines the importance of the differential diagnosis to exclude combined liver damage.

2.
Ter Arkh ; 92(2): 34-42, 2020 Apr 27.
Article in Russian | MEDLINE | ID: mdl-32598716

ABSTRACT

AIM: To study liver function and portal hypertension, incidence and risk factors of liver-related complications, including hepatocellular carcinoma (HCC), in patients with HCV-related liver cirrhosis achieved sustained virologic response (SVR) after direct-acting antiviral therapy. MATERIALS AND METHODS: Patients with HCV-related liver cirrhosis were followed up after achievement SVR with assessment of liver function parameters, portal hypertension, Model for End-stage Liver Disease (MELD) and Сhild Pugh (CP) scores, complications development, including HCC, every 36 months. The median follow-up duration was 24 [18; 30] months after end of treatment. RESULTS: At last observation, a number of cirrhotic patients with CP class A increased from 72% to 85%, with CP class B reduced from 23.5% to 12.5%, with CP class C from 4.5% to 2.5%. In 89% patients were identified a regress of liver fibrosis (from 23.5 [16.9; 28] to 15.0 [10.2; 21.3] kPa,p0.005), each third patient reduction of fibrosis stage to F2/F3. In 19 (9.5%) patients were occurred liver-related complications, including HCC (in 9 patients). Baseline high total bilirubin level (34 mol/l) (Hazard ratio (HR) 11.5, 95% confidence interval (CI) 2.357.8,р0.005) and ascites (HR=17.6, 95% CI 2.1144.8,p=0.008) were independent risk factors associated with HCC development. CONCLUSION: The risk of HCC development remains in patients with HCV-related liver cirrhosis, despite on eradication of hepatitis C virus. Therefore, these patients should continue to undergo more intensive examination (ultrasound examination and determination of alfa-fetoprotein level each 36 months), including contrast-enhanced methods of imaging, the frequency of which should be determined.


Subject(s)
Antiviral Agents/therapeutic use , Carcinoma, Hepatocellular , Hepatitis C, Chronic/drug therapy , Hepatitis C/drug therapy , Liver Neoplasms , Hepacivirus , Humans , Liver Cirrhosis/drug therapy , Prospective Studies
3.
Ter Arkh ; 92(11): 117-121, 2020 Dec 26.
Article in Russian | MEDLINE | ID: mdl-33720616

ABSTRACT

Leishmaniasis is a vector-born parasitic disease characterized by predominant cutaneous or visceral involvement with fever, hepatosplenomegaly and anemia. Leishmaniasis has relatively high prevalence in tropical and subtropical areas. Several sporadic and mostly imported cases are detected in Russian Federation. Nevertheless, some local incidents are noted in southern areas (Crimea, Dagestan). Lack of epidemiological alertness hampers confirmation of diagnosis and may lead to incorrect treatment. The article summarizes current state of knowledge in epidemiology, diagnostic approach and treatment of leishmaniasis. Particular clinical case is discussed.


Subject(s)
Anemia , Leishmaniasis, Visceral , Humans , Internal Medicine , Leishmaniasis, Visceral/diagnosis , Leishmaniasis, Visceral/drug therapy , Leishmaniasis, Visceral/epidemiology , Russia/epidemiology , Splenomegaly
4.
Ter Arkh ; 91(2): 40-47, 2019 Mar 18.
Article in English | MEDLINE | ID: mdl-31094170

ABSTRACT

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.


Subject(s)
Antiviral Agents/therapeutic use , Guanine/analogs & derivatives , Hepatitis B, Chronic/drug therapy , Nucleic Acid Synthesis Inhibitors/therapeutic use , Telbivudine/therapeutic use , Tenofovir/therapeutic use , Antiviral Agents/adverse effects , Guanine/adverse effects , Guanine/therapeutic use , Hepatitis B e Antigens , Hepatitis B virus , Humans , Nucleic Acid Synthesis Inhibitors/adverse effects , Telbivudine/adverse effects , Tenofovir/adverse effects , Time Factors , Treatment Outcome
5.
Ter Arkh ; 91(4): 8-16, 2019 May 15.
Article in English | MEDLINE | ID: mdl-31094470

ABSTRACT

Sarcoidosis is a multisystem granulomatous disease of unknown etiology. Liver is frequently involved in the pathological process. Wide range of clinical manifestations can be seen: from asymptomatic lesion with normal liver function tests to cirrhosis with portal hypertension. Biopsy plays the key role in diagnosis of the hepatic sarcoidosis. It is essential for morphological diagnosis to exclude other causes of granulomatous liver disease, most often - primary biliary cholangitis. Nowadays there are no standard treatment protocols for patients with hepatic sarcoidosis.


Subject(s)
Liver Cirrhosis, Biliary , Liver Cirrhosis , Liver Diseases , Sarcoidosis , Biopsy , Humans , Liver Cirrhosis/etiology , Liver Cirrhosis, Biliary/etiology , Liver Diseases/etiology , Sarcoidosis/complications
6.
Ter Arkh ; 91(11): 110-115, 2019 Nov 15.
Article in Russian | MEDLINE | ID: mdl-32598621

ABSTRACT

Exactly 30 years ago, hepatitis C virus was identified. Over the years, tremendous success has been achieved in the treatment of hepatitis C, which is currently considered to be an almost completely curable disease. The review presents the main stages in the development of hepatitis C antiviral therapy, the efficacy of various treatment regimens. The greatest progress in treatment was noted over the past 5 years when drugs with direct antiviral action appeared and began to be widely used, including in Russia, which ensure the elimination of the virus in 90-95% of cases.


Subject(s)
Antiviral Agents/therapeutic use , Hepatitis C, Chronic/drug therapy , Hepatitis C/drug therapy , Drug Therapy, Combination , Hepacivirus , Humans , Polyethylene Glycols/therapeutic use , Recombinant Proteins/therapeutic use , Ribavirin/therapeutic use , Russia
7.
Ter Arkh ; 90(8): 107-112, 2018 Aug 27.
Article in English | MEDLINE | ID: mdl-30701952

ABSTRACT

The primary autoimmune liver diseases conventionally include primary biliary cholangitis, primary sclerosing cholangitis and autoimmune hepatitis. Despite of primary autoimmune affection of different parts of the hepatobiliary system, in the recent decades, a lot of data has emerged indicating the presence of extrahepatic manifestations of these diseases, in particular, lung lesions, such as nodular and interstitial changes with possible progression and development of fibrosis and respiratory failure. In case of lungs disease, both pulmonary parenchyma and lung vessels, pleura, and intrathoracic lymph nodes can be involved. The most sensitive and specific procedure to assess the extent of the lung lesions and their evolution is high-resolution computed tomography. Due to the possibility of long-term asymptomatic course of the pulmonary disease with development of irreversible changes in patients with autoimmune liver diseases, it seems reasonable to conduct screening studies aimed at early detection and treatment of lung lesions in this population.


Subject(s)
Cholangitis, Sclerosing/complications , Hepatitis, Autoimmune/complications , Liver Cirrhosis, Biliary/complications , Lung Diseases, Interstitial/complications , Cholangitis, Sclerosing/immunology , Hepatitis, Autoimmune/immunology , Humans , Liver Cirrhosis, Biliary/immunology , Lung Diseases, Interstitial/diagnostic imaging , Lung Diseases, Interstitial/epidemiology , Tomography, X-Ray Computed
8.
Ter Arkh ; 90(11): 74-78, 2018 Nov 22.
Article in English | MEDLINE | ID: mdl-30701819

ABSTRACT

In the article we present three clinical observations demonstrating that HCV infection in patients with remission of Wilson disease causes an recrudescence of the disease, in one of the observations - decompensation of liver cirrhosis. In this study we first describe on the successful treatment of HCV infection with direct antiviral drugs in patients with Wilson disease. Establishment of all factors of liver damage and successful treatment (elimination of the virus, adequate lifelong medical treatment) allow to expect a favorable prognosis in patients with a combination of Wilson disease and HCV infection.


Subject(s)
Antiviral Agents , Hepatitis C , Hepatolenticular Degeneration , Liver Cirrhosis , Adolescent , Antiviral Agents/therapeutic use , Drug Therapy, Combination , Hepatitis C/complications , Hepatitis C/drug therapy , Hepatolenticular Degeneration/complications , Humans , Liver Cirrhosis/complications , Middle Aged
9.
Ter Arkh ; 88(8): 93-98, 2016.
Article in Russian | MEDLINE | ID: mdl-27636933

ABSTRACT

AIM: to estimate the clinical and prognostic value of the carriage of different allele variants of the gene polymorphisms of the coagulation system and platelet receptors in the progression of liver fibrosis (LF) in patient with chronic hepatitis C (CHC). SUBJECTS AND METHODS: The investigation enrolled 177 patients with CHC and liver cirrhosis at its outcome who were divided into 2 groups according to the rate of LF progression: 1) 89 patients with rapid (rapid fibrosis) and 2) 88 patients with slow (slow fibrosis) progression. The polymorphism of the study genes was studied using a real-time polymerase chain reaction and a melting curve analysis. RESULTS: In CHC patients, the FV 1691G/A genotype was more often in the rapid progressors than that in the slow progressors (10.11% vs 1.14%; p=0.011). The A allele of the 1691 G/A FV gene was more common in the rapid fibrosis group than that in the slow fibrosis group (1.7% vs 5.56%, odd ratio 9.787; p=0.139). In our investigation, the polymorphic marker GA in the FII 20210 G/A gene, as well as the 4G allele (5G4G + 4G4G genotypes) and the 4G allele of PAI-I -675 5G/4G were more often seen in the rapid fibrosis group than that in the slow fibrosis group; the detection rate was only at the trend level (p=0.118, p=0.112, and p=0.117 respectively). There were no significant differences between the groups in the spread of variant genotypes and alleles of other study genes. Integral model construction by coding «profibrogenic¼ genotypes (FV 1691 G/A, FII 20210 G/A, PAI-I -675 5G/4G) showed that the fibrosis progression rate expressed as fibrosis units annually also increased with higher total scores (p=0.039), indicating the combined effect of these genes. CONCLUSION: The carriage of mutant genotypes of FV 1691 G/A, FII 20210 G/A, and PAI-I -675 5G/4G genes is a prognostic factor for rapid CHC progression.


Subject(s)
Factor V/genetics , Hepatitis C, Chronic , Liver Cirrhosis , Plasminogen Activator Inhibitor 1/genetics , Prothrombin/genetics , Adult , Disease Progression , Female , Genetic Markers , Hepatitis C, Chronic/complications , Hepatitis C, Chronic/genetics , Hepatitis C, Chronic/physiopathology , Humans , Liver Cirrhosis/etiology , Liver Cirrhosis/genetics , Male , Middle Aged , Polymorphism, Genetic , Prognosis , Time Factors
10.
Klin Med (Mosk) ; 94(1): 70-3, 2016.
Article in Russian | MEDLINE | ID: mdl-27172728

ABSTRACT

Wilson-Konovalov's disease is a rare genetic pathology of copper metabolism that in the first place affects liver and CNS. Due to autosomal-recessive inheritance of this condition, it most frequently occurs in sibs. We report a case of Wilson-Konovalov's disease in two sisters differing in its clinical course: severe abdominal variant in the younger sister and largely neurologic form in the elder one. This observation demonstrates clinical variability of Wilson-Konovalov's disease, the possibility of its late clinical manifestation (at the age 45 years), the necessity of examination of all sibs of a proband regardless of age, and the possibility of radical improvement of prognosis even when the disease is diagnosed at the stage of decompensated liver cirrhosis.


Subject(s)
Brain , Copper/metabolism , Hepatolenticular Degeneration , Liver , Penicillamine , Adenosine Triphosphatases/analysis , Adult , Brain/pathology , Brain/physiopathology , Cation Transport Proteins/analysis , Chelating Agents/administration & dosage , Chelating Agents/adverse effects , Copper-Transporting ATPases , Diagnostic Techniques, Ophthalmological , Female , Hepatolenticular Degeneration/diagnosis , Hepatolenticular Degeneration/drug therapy , Hepatolenticular Degeneration/metabolism , Hepatolenticular Degeneration/physiopathology , Humans , Liver/pathology , Liver/physiopathology , Middle Aged , Penicillamine/administration & dosage , Penicillamine/adverse effects , Siblings , Treatment Outcome
11.
Klin Med (Mosk) ; 93(6): 5-13, 2015.
Article in Russian | MEDLINE | ID: mdl-26495520

ABSTRACT

This study is focused on a case of nodular polyarteritis associated with hepatitis B virus successfully treated by immunosuppressive and antiviral agents.


Subject(s)
Hepatitis B/complications , Polyarteritis Nodosa/etiology , Adult , Humans , Male
12.
Ter Arkh ; 86(4): 80-4, 2014.
Article in Russian | MEDLINE | ID: mdl-24864473

ABSTRACT

Wilson-Konovalov disease is a rare autosomal recessive genetic disorder in which copper accumulates in the liver, brain and other target organs. The paper describes a family case of the abdominal form of the disease in three sisters, the eldest of them died from fulminant liver failure at the age of 18 years. The second sister aged 16 years was diagnosed as having the disease at the stage of decompensated liver cirrhosis; her treatment with D-penicillamine resulted in complete disease remission. The youngest sister was diagnosed with the disease at the preclinical stage, which could expect its good prognosis. However, the patient's refusal of treatment led to death from liver failure. This case demonstrates the importance of timely diagnosis and the possibility of dramatic improvement in prognosis even at the stage of decompensated liver cirrhosis.


Subject(s)
Hepatolenticular Degeneration/diagnosis , Liver Cirrhosis/diagnosis , Adult , Early Diagnosis , Fatal Outcome , Female , Hepatolenticular Degeneration/complications , Hepatolenticular Degeneration/drug therapy , Humans , Liver Cirrhosis/drug therapy , Liver Cirrhosis/etiology , Liver Failure, Acute/diagnosis , Liver Failure, Acute/etiology , Pedigree , Prognosis , Siblings , Young Adult
13.
Klin Med (Mosk) ; 90(9): 75-8, 2012.
Article in Russian | MEDLINE | ID: mdl-23214021

ABSTRACT

The presented clinical case gave rise to discussion of the main mechanisms and factors behind the progress of chronic hepatitis C. Special emphasis is laid on the currently available possibilities of antiviral therapy and its future prospects. The efficacy of personalized treatment and approaches to its improvement are considered based on the proper preventive measures and correction of factors responsible for poor responsiveness to the treatment, in the first place metabolic disorders (obesity, hepatic steatosis).


Subject(s)
Antiviral Agents , Hepacivirus , Hepatitis C, Chronic , Liver Function Tests/methods , Liver/pathology , Precision Medicine/methods , Antiviral Agents/administration & dosage , Antiviral Agents/adverse effects , Disease Progression , Drug Resistance, Viral , Fatty Liver/etiology , Fatty Liver/pathology , Female , Hepacivirus/isolation & purification , Hepacivirus/pathogenicity , Hepatitis C, Chronic/complications , Hepatitis C, Chronic/diagnosis , Hepatitis C, Chronic/etiology , Hepatitis C, Chronic/genetics , Hepatitis C, Chronic/physiopathology , Hepatitis C, Chronic/therapy , Humans , Liver Cirrhosis/etiology , Liver Cirrhosis/pathology , Metabolic Syndrome/complications , Metabolic Syndrome/metabolism , Middle Aged , Transfusion Reaction , Treatment Outcome , Viremia/diagnosis , Viremia/drug therapy
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