[Difficulties in the diagnosis of diarrhea-associated hemolytic uremic syndrome in adults]. / Trudnosti diagnostiki gemolitiko-uremicheskogo sindroma, assotsiirovannogo s diareei, u vzroslykh.

Hemolytic uremic syndrome (HUS) is a rare, but menacing condition registered mainly in children. The paper gives a detailed description and analysis of a clinical case of HUS with a favorable outcome in an adult woman who developed the syndrome in the presence of bloody diarrhea. It considers an update on the etiology, pathogenesis, and clinical features of HUS associated with diarrheal syndrome and discusses differential diagnostic features, diagnostic problems, and characteristics of management tactics for patients.

[Liver involvement in secondary infections in HIV-infected patients]. / Porazheniia pecheni pri vtorichnykh zabolevaniiakh u bol'nykh s VICh-infektsiei.

AIM: To determine spectrum and frequency of hepatic lesions, clinical, laboratory and morphological characteristics of hepatic pathology in secondary diseases in HIV-infected patients. MATERIAL AND METHODS: In 1991 to 2002 the authors observed 59 HIV-infected patients with hepatic affection caused by opportunistic infections and tumors. The examination included biochemical tests of blood, immunological tests, biopsies and tests of the autopsy material for CMVDNA, T. Gondii, M. Tuberculosis. Polymerase chain reaction, puncture biopsy of the liver, ultrasound investigation of the abdominal organs. 57 lethal outcomes were registered. RESULTS: Hepatic lesion was of tuberculous origin in 42.4%, CMV--in 16.9%, toxoplasmic--in 6.8%. 3 patients had fungal infection. Cancer of the liver was diagnosed in 18.6%. Clinical picture in most of the examinees was not clear and did not correspond to morphological severity of the condition. Ultrasound detected hepatic lesions if they were caused by CMV infection, toxoplasmosis and malignant tumors. Biochemical parameters were changed moderately. Patients with CMV hepatitis showed significant rise in the activity of GGT and AP. CONCLUSION: Apart from virus hepatitis B, C and D, the liver of HIV-infected patients got affected with tuberculosis, CMV-infection, toxoplasmosis, cancer. Hepatitis in HIV-infected subjects unrelated to viruses or medicines indicates a generalized disease, late stage of HIV-infection with a fall of the number of CD4-lymphocytes under 100 cells/microl.

[Viral hepatitis B and C in users of psychotropic preparations parenterally administered]. / Virusnye gepatitidy B i C u potrebitelei psikhotropnykh preparatov, vvodimykh parenteral'no.

The dynamic study of 198 patients having virus hepatitides B and C was carried out. The etiological diagnosis in these patients had been made on the basis of serological investigation and the determination of markers with the use of the polymerase chain reaction. The manifestations of the disease were compared in 98 drug addicts and 100 patients stating they used no drugs. In addicts practicing the parenteral introduction of drugs acute virus hepatitides took, in most cases, the moderate course with the pain syndrome in the liver, abstinence symptoms, hepatomegaly, the elevated level of ALT in the blood. The convalescence period is characterized by the prolonged course with the slow restoration of the liver function.

[The etiological structure and characteristics of liver involvement in patients with HIV infection]. / Etiologicheskaia struktura i osobennosti porazhenii pecheni u bol'nykh s VICh-infektsiei.

Hepatic lesions were analyzed in 33 patients with HIV-infection. The patients were divided into two groups by the disease stage: early (stage IIB, IIIA, n = 12) and late (stage IIIB and IIIC, n = 21). Markers of hepatitis A, B and C were found in 42.4% of patients. Patients of group 1 had acute and chronic viral hepatitides (75%), hepatic alcoholic damage. Patients of group 2 developed combined hepatic lesions resultant from generalized bacterial, fungal and parasitic infections (66.7%), chronic hepatitides and viral cirrhoses (33.3%), alcohol abuse (33.3%). Elevated levels of the enzymes (AsAT, AlAT, LDG) at early stages of HIV-infection were brought about by hepatic involvement while at late stages by polyorganic abnormalities.

[Tuberculosis in patients with HIV infection]. / Tuberkulez u bol'nykh s VICh-infektsiei.

Within 1987-1995 the authors observed 16 cases of tuberculosis in HIV-infected patients which accounted for 26.7% of AIDS patients treated by them. 14 cases were diagnosed intravitally, 2 postmortem. Infiltrative, generalized, cavernous, intrathoracic lymph node, intraabdominal lymph node tuberculosis and tuberculous pleurisy were identified in 5, 6, 2, 1, 1 and 1 patients, respectively. 6 patients from the above are still alive and are receiving treatment (5 of them with infiltrative tuberculosis), 10 died. Tuberculosis course and outcomes in HIV-infected subjects depended on the stage of their immunodeficiency. In moderate immunodeficiency (CD4-lymphocyte > 200/mm3) tuberculosis ran, as a rule, as local and infiltrative, sensitive to specific therapy. In severe damage to immune system (CD4 < 100/mm3) tuberculosis acquired a generalized course, sometimes fulminant, resistant to treatment. It is inferred that HIV-infected subjects with immunodeficiency need tuberculosis prophylaxis with isoniazide or rifampicin.