[Gluttony, obesity and the metabolic syndrome in the context of the "seven deadly sins". Historical-theological, literary and art, mass media, political, philosophical, medical-psychological and geriatric aspects of the problem].

In this pape different aspects of problem of obesity are analysed.

[Non-invasive techniques in diagnosis of steatosis and fibrosis in nonalcoholic fatty liver disease].

UNLABELLED: Diagnosis and treatment of nonalcoholic fatty liver disease (NAFLD) is one of the most actual problems of modern hepatology. Ultrasound elastometry is alternative method to determine the density of the liver tissue. The efficiency of the method was confirmed by a large amount of data in patients with viral hepatitis. However, the diagnostic value of elastometry was not studied enough in patients with NAFLD. THE AIM OF THE RESEARCH: to study the possibility of non-invasive diagnostic methods of examination in a complex assessment of the liver in patients with NAFLD. MATERIALS AND METHODS: We studied 24 patients with signs of NAFLD and a long persistent elevation of liver enzymes. All patients underwent a needle biopsy of the liver. We conducted a comparative analysis of the results of the morphological study of the liver tissue with ultrasound elastometry, computed tomography of the liver, biochemical blood tests. RESULTS AND DISCUSSION: Among biochemical liver enzymes ALT was a marker of NAFLD which characterized the transformation of steatosis to steatohepatitis. The combined ALT and GGT increase reflected the high activity of inflammation in the liver tissue. Elastometry results were comparable to the histological features in all liver fibrosis stages, but the maximum diagnostic accuracy was observed at the late stages. The area under the ROC-curves showed the highest precision in the F2-F3 stages, the lowest value - in the F1 stage. Imprecision of the method in the early stages of fibrosis may be due to the hepatic steatosis in NAFLD and high biochemical activity with cholestasis signs. Patients with early-stage liver fibrosis diagnosed with elastometry need additional examination using other methods of noninvasive diagnostic tools.

[Advisability of using probiotics in the treatment of atherogenic dyslipidemia].

One of the main components of the metabolic syndrome is a non-alcoholic fatty liver disease (NAFLD). Currently, NAFLD is recognized as one of the main factors for cardiovascular disease because cholesterol synthesis is carried out mainly in the liver. In connection with this selection of lipid-lowering therapy, which has a known hepatotoxic effect, is a challenge. In the pathogenesis of NAFLD important role played by the violation of the colon microflora and, consequently, elevated levels of metabolic products of microorganisms (short chain fatty acids, endotoxin, nitric oxide), which must also be considered in the treatment of atherogenic dyslipidemia. In patients with NAFLD and atherogenic dyslipidemia appointment of combination therapy of statins and probiotics are more effective in lowering cholesterol and products of metabolism of intestinal microflora compared with monotherapy.

[Gastroenterological aspects of atherosclerosis].

The pathogenesis of atherosclerosis has been studied for over a hundred years, but so far no consensus on this issue doesn't exist. During this time, experts have gone from ideas of atherogenesis as a consequence of excess cholesterol in the diet to complex theories of the pathogenesis of atherosclerosis. Today generally accepted that one of the major risk factor for cardiovascular disease and atherosclerosis is dyslipidemia. When atherogenic dyslipidemia occur expressed disbiotic changes intestine and lead to endotoxemia, bacterial translocation and impaired liver function. The undoubted fact is that the liver plays an important role in the development of atherogenic dyslipidemia, and also is the target organ, which leads to the development of nonalcoholic fatty liver disease (NAFLD). Currently, NAFLD is a major risk factor for cardiovascular disease, it limits the possibility of adequate lipid-lowering therapy, increasing cardiovascular risk. Therefore, in the treatment of atherogenic dyslipidemia with statins and fibrates useful purpose hepatoprotectors. Choosing hepatoprotectors depends on the stage NAFLD.

[Pancreas and metabolic syndrome].

The functional state of the pancreas has a significant share in the development of the basic components of MS (hyperinsulinemia, insulin resistance, impaired glucose tolerance) and, conversely, the existing metabolic changes (obesity, atherogenic dyslipidemia) contribute to the violation of the endocrine and exocrine pancreatic function. It is assumed, on the one hand, the fundamental role of fatty pancreas disease in developing metabolic syndrome, with the formation of insulin resistance, on the other hand, indicates that hyperinsulinemia, hyperglycemia and dyslipidemia, as well as microcirculatory disturbances aggravate the state of the pancreas. Trigger mechanism of progression pancreatic pathology in MS appears inflammation closely accompanied with fatty infiltration of the body against obesity. Changes in pancreas specific to MS, are not only secondary to its background, but also contribute to the progression of the syndrome and the development of complications, closing the pathogenic circle.

[Role of modified lipoprotein in the development of atherogenic dyslipidaemia].

In process and progression of atherosclerosis top-ranked spot belongs to Atherogenic dyslipidemia. This contribution presents analysis of job related to role of lipoproteins in process of dyslipidemia over the past 15 years.

[Obesity is new noninfectious "epidemic"].

The widespread obesity and its complications is the reason for ongoing research of obesity trigger mechanisms, effective and safe methods of treatment and prevention. In the present paper we use the literature data devoted to the study of the pathogenesis of obesity, its diagnosis and treatment over the past 15 years. Currently, emphasis is placed on finding and developing new integrated programs of treatment and rehabilitation of patients with this pathology.

[The role of hormones and types of food behavior in the pathogenesis and treatment of abdominal obesity].

Hormones and the types of eating behavior play the leading role in the development and progression of abdominal obesity. Based on the evaluation of the dynamics of hormones EB and modification of EB types on background of the treatment can determined the most effective method for correction of body weight, which allows not only to achieve the desired result in the short-term, but also to keep the result for a long time.

[Metabolic syndrome and nonalcoholic fatty liver diseases in children].

The review of literature considers the problem of the metabolic syndrome and nonalcoholic fatty liver disease in children. It provides information about common pathogenesis of the metabolic syndrome and nonalcoholic fatty liver disease, the relationship of diagnosis and treatment.

[The role of hormones and types of food behavior in the development of metabolic syndrome].

THE AIM: To investigate the role of hormones and the types of FB in the development of morbid obesity (MO), to develop a treatment policy for MO to examine the diagnostic predictive value of the FB hormones and FB modifications. MATERIALS AND METHODS: Were investigated 67 patients: 28 (42%) males and 39 (58%) female aged 18 to 60 years under the scheme: medical history, questionnaire on the questionnaire SF-36, score types of FB, the study of the anthropometric data (OT/OB, BMI), the definition of the FB hormones with subsequent control of BMI, OT/OB dynamics, types and FB hormones. RESULTS: In patients older than 50 years were dominated abdominal FB, in patients younger than 50 years - all three types of FB in approximately equal proportions. After the decline in MT was observed pattern between the FB modification and age of the patient. There was an increase of leptin and ghrelin and decrease in serotonin at all three types of FB. After weight correction was a decreased leptin, ghrelin, and increased serotonin, but the achievement of normal numbers are not marked. The paradoxical result is related to a violation of reciprocal relations of hormones. CONCLUSIONS: In patients with MO FB hormone levels (Leptin, Ghrelin) elevated to normal values, reduced levels of serotonin, there is an infringement of their reciprocal correlations. The approach to patients should be lengthy and complex, involving multidisciplinary team aimed at FB correcting the with the rejection of improper food stereotype. In the treatment of MO must used different methods: reducing diet, physiotherapy effects, drug therapy and their combination with the selection of individual programs, taking into contraindications account. For the above techniques inefficiency is necessary to use surgical treatment. Correction of FB in patients older than 50 years is the most difficult task (due to the presence of concomitant diseases). Necessary to draw attention and to start treatment at a young age.

[Hypolipidemic therapy in patients with non-alcoholic fatty liver disease].

To date generally accepted that one of the major risk factors for cardiovascular disease (CVD) and atherosclerosis is dyslipidemia. The undoubted fact is that the liver plays an important role in the development of atherogenic dyslipidemia, and simultaneously being the target organs, which leads to the development of nonalcoholic fatty liver disease (NAFLD). NAFLD is a major risk factor for CVD, it limits the possibilities for adequate lipid-lowering therapy, increasing cardiovascular risk. In this regard, the treatment of atherogenic dyslipidemia with statins and fibrates appropriate to hepatoprotectors disposal. Hepatoprotectors choice depends on the stage of NAFLD. At the steatosis stage of the NAFLD expedient method of statins in combination with essential phospholipids. At the nonalcoholic steatohepatitis (NASH) stage of NAFLD patient should receive statin therapy combined with ursodeoxycholic acid (UDCA). Patients with high levels of hypercholesterolemia in achieving target levels of cholesterol--low lipoprotein density (LDL-cholesterol) and decrease the side effects is the best combination of statins with the cholesterol absorption inhibitor. The complex lipid-lowering therapy in patients with NAFLD should include drugs that normalize the intestinal microflora (intestinal antiseptic, pre- and probiotics).

[Taurine in the treatment of non-alcoholic fatty liver disease].

Non-alcoholic fatty liver disease (NAFLD) has several phases of flow: from simple steatosis, steatohepatitis, and ending with fibrosis and cirrhosis. NAFLD characterized by elevated liver enzymes in blood serum, the morphological changes in biopsies of the liver often associated with metabolic disorders. Metabolic syndrome represents a complex of many linked to pathobiochemical and pathophysiological factors levels influencing the extremely high risk of developing coronary heart disease (CHD), diabetes mellitus type 2 and other diseases associated with atherosclerosis. NAFLD proceeds favorably without significant morphological changes in most of the patients. In connection with this treatment is given only to patients with high risk of progression of this disease or the presence of marked changes in biochemical liver tests. Therefore, prevention and treatment of these conditions should be conducted before the complications and lead to improvement of the liver.

[Diagnostic value of nitric oxide and endotoxins at non-alcoholic fatty liver disease].

The aim of this examination was investigation of the nitrogen oxide (NO) role for the inflammation forming in the patients with nonalcoholic fat disease of the liver. 90 patients (male--25, women--65) were examined: steatohepatitis (SH)--60 patients, liver steatosis--30 patients). Index of body mass was increased on 40-45%. NO metabolites blood level was examined by Metelskaya V.A. (2005) method. The trustworthy increase of NO production in the SH patients in comparison in patients with steatosis liver and was increasing together with aminotransferases and GGTP. NO as inflammation marker may be real criterion of the liver inflammation in the patients with the early stage transformation of liver steatosis to SH.

[Interval hypoxic-hyperoxic training in the treatment of the metabolic syndrome].

AIM: to investigate the possibility of a new method--interval hypo-hyperoxic training (IHHT)--in the correction of the individual components of metabolic syndrome. MATERIALS AND METHODS: The study included 35 patients with metabolic syndrome (alimentary obesity 1-3rd stage [BMI over 30 kg/m2], violation of carbohydrate tolerance or diabetes mellitus type II, hypertension and dyslipidemia). All patients were random separated into three groups: control (11 pers., basic therapy), trial 1 (13 pers. who have undergone 12 procedures of the IHHT) and trial 2 (11 pers. who have undergone IHHT in parallel with systemic hyperthermia and vibrating massage hardware). Course duration was 21 days average. Prior to the course procedures IHHT and the 3-day 4 upon completion all patients were fully examined. This examination included history taking, assessment of diet, psychometric testing, counseling psychologist to determine the type of feeding behavior, anthropometric measurements; body impendansemetria, biochemical study of blood determining the level of total cholesterol, HDL, LDL, TG, fasting plasma glucose (GP), 6-minute walk test to assess physical performance. Was established that the use of hypo-hyperoxic exercise (alone or in combination with systemic hyperthermia and hardware vibratory) leads to a significant reduction in body weight. It mainly arise by reducing fat mass accompanied by a reduction of total cholesterol, LDL, GPN, optimization of blood pressure, increased hypoxic stability, physical endurance, improved mental status. At individual selection of the course structure, dosing of hypoxic effects, combined with other physiotherapy method has some promise in treatment and rehabilitation of patients with metabolic syndrome.

[Experimental steatosis of the pancreas].

The article deals with steatosis of the pancreas in experimental metabolic syndrome. The possibility of modeling of the metabolic syndrome in rats with the development of liver steatosis and steatosis of the pancreas is demonstrated. Morphological changes in insular apparatus are similar to those with metabolic syndrome in the clinic.

[Metabolic syndrome: a pediatrician view].

The review of literature considers the problem of metabolic syndrome in pediatric practice. The review discusses pathogenesis of metabolic syndrome and diagnosis for the children. A therapeutic algorithm and an approach to the principles of diet the therapy is presented.

[Thyroid dysfunction and soft fatty liver disease].

This review discusses the correlation of thyroid dysfunction and non-alcoholic fatty liver disease.

[Intestinal dysbiosis and atherogenic dyslipidemia].

Numerous studies in recent years had proved pathogenetic correlation of the intestinal ecological community, not only with diseases of the gastrointestinal tract but also with diseases such as atherosclerosis and hypertension, urolithiasis and pyelonephritis, gallstones and hepatitis. In its role in maintaining homeostasis an intestinal microflora isn't inferior to any other vital organs. All this allowed to distinguish it as an independent body. Recently, as one of the most important factors for the development of dyslipidemia scientists consider breaking the functional state of the liver, as well as changes in blood lipid spectrum and disturbance of cholesterol metabolism begins at the level of the hepatocyte. However, in 2001, Carneiro de Moura proposed a theory of violation of the microbial community in the colon as one of the ways to lipid metabolism. By reducing the detoxification function of intestinal microflora associated with Microecological disorders of various origins, the first "hit" is to the host liver--is on one side. On the other--the vast majority of microorganisms are characterized by a pronounced ability of bile acids deconjugation, and therefore the increased reproduction in the ileum of bacteria (especially anaerobic, with enhanced activity against deconjugation activity to related bile acids) and the formation of toxic endogenous bile salts, acids are important prerequisites for the occurrence of violations of all functions of the liver, including the activities of Kupffer cells and the whole system of mononuclear macrophages. In this regard, the formation and progression of dyslipidemia, regardless of the target organ must be closely linked with the digestive tract by micro. Schematically it can be represented as follows: violation of microecology intestine --> accumulation of endotoxin in the gut --> entry of endotoxins in portal vein to the liver --> RES of liver cell damage --> strengthening the pathological effects of toxicants other (non-microbial) origin --> dysfunction of hepatocytes --> dislipoproteidemiya.

[Stubborn nausea and not ease vomiting as a manifestation of glycoside toxicity in a patient with duodenal ulcer and gastric erosions in the background of Ebstein's anomaly].

In this article is presented the case of development of glycoside intoxication at patient of 26 years old, who has congenital heart disease (Ebstein's anomaly). He also has duodenal ulcer and gastric erosions, associated with Helicobacter Pylori, that were diagnosed for the first time. The clinical observation reflects the necessity of differential diagnostics between glycoside intoxication and manifestation of duodenal ulcer.