[Current views on the treatment of insulinoma].

RELEVANCE: Insulinoma is the most common hormonally active neuroendocrine tumor (NET) of the pancreas. In recent years, there has been a trend towards an increase in the incidence of NET especially insulinoma. AIM: Summarizing and analyzing current data on various approaches to the treatment of insulinoma. Our review includes a comprehensive assessment of the advantages and disadvantages of currently available insulinoma treatment methods in comparison with past experience, as well as a review of promising methods that are not currently widely used. MATERIALS AND METHODS: Analysis of literature from such databases as scientific electronic library elibrary.ru, Pubmed, Google Scholar, MedLine, Scopus and Web of Science. RESULTS: The most common treatment for insulinoma is surgery. For patients with high operative risk, alternative methods such as alcohol ablation, radiofrequency ablation, and tumor embolization may be used. Medications include the use of somatostatin analogues, diazoxide. The literature describes the potential benefit of the use of beta-blockers, phenytoin, glucagon, however, in clinical trials, these drugs have not demonstrated a significant effect. For the treatment of malignant and metastatically advanced insulinoma, targeted therapy (primarily Everolimus), chemotherapy, as well as embolization (including chemoembolization, radioembolization), radiofrequency ablation (RFA), microwave ablation and cryoablation, ultrasound ablation (HIFU), laser ablation, brachytherapy, irreversible electroporation are used. CONCLUSION: The study of new drugs is an important task for scientists, among medications the most promising are new generations of somatostatin analogues, targeted drugs and chemotherapy drugs. The rare frequency of insulinoma makes it difficult to conduct randomized controlled trials and prospective studies. That is why physicians and scientists need to maintain close contacts with each other and take into account the experience of treating each patient with such disease, which will help develop effective treatment algorithms in the future.

[The use of melatonin in combined therapy of drug-induced hepatitis].

Combined treatment including melatonin resulted in the improvement of general conditions in 81.7% of the patients with drug-induced hepatitis compared with 66.5% after standard therapy including hepatoprotectors. Normalization of biochemical characteristics was more pronounced after treatment with melatonin that caused no side effects as shown by laboratory and instrumental studies.

[Effect of combined therapy with melaxen on lipid peroxidation rate and citrate content in blood serum of patients with drug-induced hepatitis diagnosis].

A combined therapy with melaxen led to a decrease in the activity of gamma-glutamyl transpeptidase and the level of diene conjugates in blood serum of patients with the drug-induced hepatitis developing on the background of administration of antituberculous preparations. These changes are indicative of pronounced antioxidant and hepatoprotective properties of the drug. In addition, there was a decrease in the content of citrate and a change in the activity of aconitate hydratase toward a normal level, which reflects a decrease in the degree of pathologic oxidative stress development and is evidence of the antiradical effect of melaxen.

[Peculiar properties of glutathione system and NADPH-generated enzymes functioning in blood of patients with drug-induced hepatitis under combined treatment with epifamin].

Activity of the glutathione antioxidant system has been studied in patients with drug-induced hepatitis treated with standart base therapy and combined with epifamin therapy. In blood serum of patients before treatment the decrease of reduced glutathione (GSH) level and the increase of glutathione peroxidase (GP) and glutathione reductase (GR) activities versus control were observed. Combined treatment with epifamin changed GSH level to the normal values. Treatment with epifamin was accompanied by pronounced increase in GP and GR activities compared with standard therapy. Activities of the NADPH-generated enzymes, glucose-6-phosphate dehydrogenase and NADP-isocitrate dehydrogenase, which decreased at this pathology, also demonstrated a more significant increase than standart treatment.

[Intensity of free radical oxidation and superoxide dismutase activity in patients with drug hepatitis in combination therapy with melaxen or epifamin].

Intensity of free radical oxidation processes and superoxide dismutase activity at patients with drug-induced hepatitis at the combined therapy with melaxen or epifamin. Free radical homoeostasis state at patients with drug-induced hepatitis being on standard treatment, including hepatoprotectors, and the combined therapy with melaxen or epifamin has been investigated. Biochemiluminescence parameters in blood serum point out to intensification of free radical processes and inhibition of antioxidant defense of organism, at this time superoxide dismutase activity in blood serum increased. After leading of standard therapy a decline of oxidative stress expression was observed. Incorporation to base treatment of melaxen or epifamin accompanied by correction of antioxidant status of organism and provided more expressed antioxidant effect, that confirmed by changing of biochemiluminescence parameters and superoxide dismutase activity. Obviously, it is related to antiradical properties of melatonin the level of which is corrected under the action of these preparations.

[Antioxidant status of patients with thyrotoxicosis syndrome treated with the combined regimen containing epifamin].

The work purpose was research of degree of free-radical processes intensity and catalase activity in blood serum of patients with a thyreotoxicosis syndrome at traditional treatment and the combined therapy with epifamin. Patients (n=25) have been divided into 2 groups: the first group of patients--12 persons who are on traditional treatment (antithyreoid drugs, beta-adrenoblockers); the second group--13 persons, are padding to basic therapy received epifamin on 1 tablet (10 mg) 3 times a day 10-15 minutes prior to meal within 7 days. Patients with thyreotoxicosis syndrome had an intensification of free-radical oxidation that was traced at measurement of biochemiluminescence parameters in blood serum. At the combined therapy with epifamin less expressed intensity of free-radical processes, and also increasing of the general antioxidant activity of an organism that did not descend at traditional treatment was observed. At carrying out of standard therapy of thyreotoxicosis syndrome, including application of antithyreoid drugs and beta-adrenoblockers, catalase activity decreased, that unfavorable affected antioxidant potential of an organism. At the combined therapy with epifamin level of catalase activity, on the contrary, increased, that could influence positively on antioxidant protection of an organism.

[Influence dietary therapy with use sunflower and amaranth oils on parameters of immine reactivity in patients with diabetes mellitus 2 types].

On the basis of the given own researches the positive influence of press non-rafinated amaranth and sunflower oils, and as, their mix on immune reactivity on the patients with diabetes mellitus types 2 is shown.

[Melatonin influence on free radical homeostasis in rat tissues at thyrotoxicosis].

Experimental thyrotoxicosis in rats is accompanied by the increase of serum alanine aminotransferase (AlA), aspartate aminotransferase (AsA), creatine kinase-MB (CK-MB) activities and content of primary products of lipid peroxidation--conjugated dienes--in liver, heart and blood. This suggests impairments in these organs accompanying free radical processes intensification. Administration of melatonin decreased AlA, AsA and CK-MB activities and CD level decreased. Thyrotoxicosis increased catalase activity in liver, heart and blood. Exogenous melatonin decreased specific activity ofcatalase in blood and in heart in comparison with animals subjected to hyperthyroidism. However, some increase of catalase specific activity (approximately 15%) was observed in liver. alpha-Tocopherol content, raising in rat tissues in thyrotoxicosis development conditions, decreased after melatonin treatment. Thus, exogenous melatonin is capable to reduce lipid peroxidation intensity at thyrotoxicosis and to act as an adoptogen, regulating free radical homeostasis.

[Prognostic significance of typical immune reactions in myocardial infarction].

AIM: To ascertain the role of typical reactions of the immune system in early prognostication of congestive cardiac failure (CCF) in patients with primary transmural anterior myocardial infarction (MI) in the postinfarction period. MATERIAL AND METHODS: Typical immune reactions were studied for a year after the disease onset. A total of 228 males aged 40-60 years (mean age 53.8 +/- 4.1 years) with primary Q-wave MI of anterior location without accompanying diseases or allergy, with comparable volumes of myocardial necrosis were included in the trial. The control group consisted of 35 healthy men aged 40 to 60 years (mean age 52.9 +/- 4.3 years). Morphofunctional characteristics of the heart were studied by Doppler echocardiography within a month since MI onset and a year after MI. Immunological examination performed on MI day 1, 15 and 25 included determination by tests of the first-second level by R. V. Petrov of the count of leukocytes, lymphocytes, T-cells, T-helpers, T-suppressors (CD3+, CD4+, CD9+), zero lymphocytes, immunoglobulins, circulating immune complexes, complement by 50% hemodialysis, phagocyte index and count. Statistical processing included parametrical and non-parametrical criteria, correlation-regression analysis, criterion chi-square. The index of diagnostic significance Kj was calculated. Also, frequency and graphic analyses were made. RESULTS: The analysis of immunological disorders in patients with five variants of primary Q-wave MI (LV aneurism with moderate dilatation of the cavity, aneurism of the heart in combination with L V cavity dilation with CDR >60 mm and development of mitral regurgitation >2 degrees, prevalence of LV diastolic dysfunction, progressive dilatation of the heart cavities with development of mitral of degree 2-3 and tricuspidal of degree 1-2 insufficiency, compensated hemodynamics without essential changes of the LV and LA) has established the same type of immune reactions to the pathological process manifesting with a fall in the count of absolute and relative count of lymphocytes, T-cells, T-helpers, B-lymphocytes, complement, phagocytic index, suppression index. These changes were accompanied with increased count of T-suppressors, zero-lymphocytes, CIC, immunoglobulins, leucointoxication index. The immunological examination of the patients showed that all morphofunctional variants of the myocardium correlated with suppression of immune reaction in the following order: compensated aneurism of the LV (18 parameters), diastolic dysfunction of the LV (11), progressive dilatation of the heart cavities (8), aneurism of the LV (6), marked dilatation of the heart cavities (4). Patients with pronounced dynamics of the regenerative processes had suppression of cellular immunity of the second degree, in positive hemodynamics there were characteristic changes in T-suppressor link of immunity in accumulation of zero lymphocytes. Patients with poor outcome of primary Q-MI had the same formula of immune parameters: reduced count of T-helpers, high values of T-suppressors and CIC. Thus, the data show that low count of T-helpers, common T-cells, high level of T-suppressors or zero-cells during post-MI month 1 are related with compensated regeneration of the cardiac muscle. If the patients have deviation of the regulatory index and accumulation of CIC, they have poor prognosis. Regarding the time since MI (1, 15 or 25 days), the following regulation was seen: patients with compensated hemodynamics have 4 decreased and 1 increased parameters of immune status; patients with pathological myocardial remodeling have stimulation of at least 5-6 parameters of the immune status. CONCLUSION: Myocardial remodeling of the LV proceeds within the first year after development of myocardial necrosis; outcomes of myocardial restoration correlate with severity of immune disorders forming 2-3 weeks after MI, suppression of cell reactions agrees with compensated hemodynamics; accumulation of CIC in blood points to the risk of pathological remodeling of the left ventricle and post-MI cardiac failure.

[Influence with amaranth and sunflower oils used in dietary therapy of patients with diebetes mellitus 2 types on parameters of carbohydrate and lipid metabolism].

On the basis of the given own researches the positive influence of press non-rafinate amaranth and sunflower oils, and as, their mix on clinical displays of disease, including, on carbohydrates and lipids metabolism an exchange on the patients with diabetes mellitus 2 types is shown. The updating dietary therapy of s diabetes mellitus 2 types by inclusion of press non-rafinate sunflower and amaranth oil is offered.

Oxidative status and citrate concentration in rat tissues during experimental hyperthyroidism and melatonin treatment.

Biochemiluminescence increased, while aconitate hydratase activity and citrate accumulation in tissues of the liver and heart and blood decreased in rats with experimental hyperthyroidism. These changes reflect activation of free radical oxidation, damage to enzyme molecules with reactive oxygen species, and impaired utilization of citrate under pathological conditions. Melatonin treatment during hyperthyroidism normalized aconitate hydratase activity and citrate concentration. Biochemiluminescence study showed that the effect of melatonin is related to antioxidant activity of this hormone, inhibition of free radical oxidation, and suppression of reactive oxygen species generation.

[Problem of specific and nonspecific factors in the induction and regulation of immunological reactions].

The functional unity of the specific and nonspecific mechanisms of immunological reactions has been shown on the basis of our own investigations and the published data. As revealed in this study, during the formation of immune response smooth transition from the nonspecific level to the specific one occurs. First, the factors of nonspecific protection are switched on, then intermediate reactions develop, further antibodies are synthesized, etc. At any level of immune response its regulation by nonspecific immunomodulators is possible, their influence controlled by a complex of reactions of the neuroendocrine system, also carrying the elements of nonspecificity and specificity.

[The characteristics of the clinical manifestations and treatment of chronic obstructive bronchitis in patients with hepatobiliary system diseases and pseudoallergy]. / Osobennosti klinicheskikh proiavlenii i lecheniia khronicheskogo obstruktivnogo bronkhita u bol'nykh s zabolevaniiami gepatobiliarnoi sistemy i psevdoallergiei.

Routine clinical, laboratory, instrumental and immunological examinations in 105 patients have established that hepatobiliary disorders occur 2.2 times more frequently in patients with chronic obstructive bronchitis (COB) and pseudoallergy than in those without pseudoallergy. To correct negative effects of pseudoallergy, conventional therapy was combined with enterosorbent polyphepan, spasmolytic nospa and cholagogic allochol used alone or in different combinations. The highest benefit for COB patients was achieved in using combination of polyphepan + nospa + allochol.

[Available methods of evaluation and correction of immune disorders in patients]. / Dostupnye metody otsenki i korrektsii immunnykh narushenii u bol'nykh.

A three-stage scheme for detecting and correcting immunodeficiency is proposed. The first stage is the interview from which the physician may suspect secondary immunodeficiency, the second is assessment of changes in the leukogram, and the third stage is correction of immune disorders with consideration for the immunodeficiency syndrome(s) detected.

[Treatment with thymogen and myelopid of patients with bronchial asthma]. / Lechenie timogenom i mielopidom bol'nykh bronkhial'noi astmoi.

The authors studied the effect of alpha-tocopherol acetate and nicotinamide on lipid peroxidation and antioxidant enzyme defense (AED) in red cell membranes of 61 patients with new-onset insulin-dependent diabetes mellitus. Lipid peroxidation products were found in excessive quantities, whereas enzymes of the cell antioxidant defense were on the decrease. Combination of tocopherol with nicotinamide as adjuvants to conventional insulin therapy promoted normalization of lipid peroxidation and AED, improving beta-cell function. It is believed justified to introduce antioxidant treatment early in the disease onset to prevent toxic damage to beta-cells and vascular endothelium induced by lipid peroxidation products.