[The role of antiviral therapy in the management of patients with liver cirrhosis associated with chronic HBV and HCV infection].

The formation of the liver cirrhosis (LC) is an unfavorable event of the natural history of chronic liver diseases being accompanied by complications that often cause a fatal outcome. The study of the effectiveness of drugs that affect various etiopathogenetic mechanisms of this condition is an urgent problem of modern hepatology.The aim of the review was to show the role of antiviral therapy (AVT) in the management of patients with LC associated with chronic HBV (hepatitis B virus) and HCV (hepatitis C virus) infection.PubMed database, Google Scholar search engine, Cochrane Systematic Reviews, eLIBRARY.RU electronic scientific library, as well as the reference lists of articles were used to search for scientific articles. The relevant objectives of the review of the publications were identified for the period since 2000 up to 2021 by the search queries as following: «liver cirrhosis¼, «liver fibrosis¼, «chronic HBV infection¼, «chronic HCV infection¼, «portal hypertension¼, «treatment¼. The inclusion criteria were restricted to the management of patients with LC associated with chronic HBV and HCV infection.Current guidelines recommend indefinite treatment of patients with HBV-associated LC with nucleos(t)ide analogues regardless of serum HBV DNA levels, while the modern concept of using direct-acting antiviral drug combinations has become the standard treatment for HCV-associated cirrhosis. Studies have shown the ability of AVT to inhibit and reverse fibrotic processes in LC associated with chronic HBV and HCV infection. It has also been reported that HBV/HCV eradication prior to orthotopic liver transplantation improves long-term overall survival.This, in turn, can reduce the severity of portal hypertension and decrease the risk of associated complications, as well as normalize liver function. Thus, ensuring the availability of drugs for those in need of AVT will not only help prevent the development of LC, but also improve the quality of life and increase its expectancy of patients suffering from this disease.

[A rare case of gerniation and incarceration of the gallbladder]. / Redkii sluchai gerniatsii i ushchemleniya zhelchnogo puzyrya.

The authors report a rare case of herniation and incarceration of the gallbladder at the site of abdominal drainage tube deployment in a patient undergoing treatment for aortic valve disease. An incarcerated postoperative ventral hernia was confirmed by contrast-enhanced CT of the abdomen. Emergency surgery was not indicated due to spontaneous reduction, short duration of incarceration and no peritoneal signs. This case reminds us the possibility of ventral hernias, containing the gallbladder, at the site of abdominal drainage tube deployment. According to the literature, untimely diagnosis of this event can result fatal consequences.

[Aspects of pathogenetc pharmacotherapy for portal hypertension in liver cirrhosis].

The review of literature considers the principles of medical treatment for portal hypertension in liver cirrhosis, which are based on the current views of its development mechanisms. It describes both current pharmacotherapy methods for portal hypertension and drugs, the efficacy of which is being investigated.

The Principles of primary prophylaxis of bleeding from oesophagealvaricies in patients with liver cirrhosis.

The principles of primary prevention of bleeding from esophageal varices in patients with liver cirrhosis are discussed with reference to the stage ofportal hypertension. The information was collectedfrom the PubMed database, Google Scholar retrieval system, Cochrane reviews, and lists of references from relevant publications for 1980-2015 using the key words «bleeding from esophageal varices¼, «prophylaxis¼, «portal hypertension¼. Inclusion criteria were confined to primary prophylaxis of bleeding from esophageal varices in patients with liver cirrhosis. The analysis showed that the drugs of choice for primary prophylaxis of bleeding from esophageal varices in patients with liver cirrhosis are non-selective beta-adrenoblockers, but their application is indicated only in case of clinicallyl significant portal hypertension in patients with large and mediumsize esophageal varices. When the use of these drugs is contraindicated, endoscopic ligation of esophageal varices can be recommended.

[Morphofunctional rearrangement of the hepatic vasculature in the pathogenesis of portal hypertension in liver cirrhosis].

The paper presents an update on the mechanisms for enhanced hepatic vascular resistance to the portal circulation underlying the pathogenesis of portal hypertension in liver cirrhosis. In addition to gross hepatic structural disorders related to diffuse fibrosis and formation of regenerative nodules, the morphofunctional rearrangement of the hepatic vasculature is shown to play an important role in this process. It is characterized by endothelial dysfunction and impaired paracrine interaction between activated stellate hepatocytes and sinusoidal endotheliocytes, sinusoidal remodeling and capillarization, as well as intrahepatic angiogenesis.

[Ectopic varicosis: a rare case of gastrointestinal hemorrhage].

The author discusses causes, diagnostics and treatment of ectopic varicosis of the gastrointestinal tract. Bleeding from these pathologically dilatedprotosystemic collateral veins at sites beyond the gastroesophagealjunction is rare, but the high lethality rate associated with this condition is a serious challenge. The author emphasizes the necessity of multicentre clinical studies yielding important data on epidemiology ofectopic varicosis for the development ofa diagnostic and therapeutic algorithm for the management of accompanying hemorrhage.

[The mechanisms of adaptation of the vascular bed to hemodynamic changes in portal hypertension].

The data of the literature on the mechanisms of restructuring of vascular bed in response to hemodynamic changes due to portal hypertension. Despite the fact that these changes are compensatory-adaptive reaction to the deteriorating conditions of blood circulation, they contribute to its progression, promoting the development of serious complications, one of which was bleeding from esophageal varices.

[Bacterial endotoxinemia and risk of hemorrhage from oesophageal varicose veins in patients with liver cirrhosis].

This work was designed to substantiate the necessity of estimating serum bacterial endotoxin levels in patients with liver cirrhosis (LC) for the prognostication of the risk of bleeding from oesophageal varices. The prospective cohort study included 90 patients with LC and clinical signs of portal hypertension. Total endotoxin of Gram-negative bacteria was measured by the activated particle method. The intensity of endotoxemia was estimated using the end-point turbidimetric test (variant of LAL test). Pronounced endotoxemia was associated with acute bleeding from oesophageal varices. Its severity in the patients with the history of hemorrhage was higher than in the absence of this complication. The endotoxin level in the range from 0 to 4 ng/ml suggested low probability of hemorrhage; its risk increased significantly at the endotoxin level in excess of 4.1 ng/ ml. It is concluded that the severity of endotoxemia in LC patients correlates with the degree of oesophageal vein dilation and hemorrhage, the endotoxin level of 4 ng/ml being a reliable diagnostic criterion for the associated risks.

[The role of intestinal microflora in the development of complications of hepatic cirrhosis-associated portal hypertension].

Intestinal microflora plays an important role in the pathogenesis of hepatic cirrhosis (HC) complications. These patients are at a high risk of bacterial infections, mainly spontaneous ascitis infection or spontaneous bacterial peritonitis, pneumonia, or pleural empyema. Other HC complications, such as varicose vein hemorrhage, gastropathy, hepatorenal and hepatopulmonary syndromes, and portopulmonary hypertension, develop mainly due to portal hypertension. Portal hypertension is primarily caused by increased intrahepatic resistance, while after the forming of collateral circulation high portal pressure is maintained by increased splanchnic blood inflow secondary to vasodilatation. Itraorganic vasodilatation initiates hyperdynamic circulatory status, which exacerbates HC complications. Intestinal microflora plays a role in the development of both infectious complications and hyperdynamic circulatory status in HC. The article contains evidence of the influence of intestinal microflora on the development of HC complications.

[Pharmacotherapy of portal hypertension]. / Farmakoterapiia portal'noi gipertenzii.

A brief information is reviewed on potential mechanisms of portal hypertension pathogenesis. Main groups of medicines used for prevention and treatment of hemorrhages from varicose esophageal veins are described.

[Results of resection of a small intestinal segment in patients with portal hypertension]. / Rezul'taty rezektsii chasti tonkoi kishki u bol'nykh s syndromom portal'noi gipertenzii.

In 4 patients with the portal hypertension syndrome, the forced resection of the small intestine was performed. In all the cases, the stable decrease in pressure in the portal vein system was noted in follow-up of from 1 to 15 years.

[Effects of resection of the small intestine on the pressure in the portal vein system in experimental portal hypertension]. / Vliianie rezektsii tonkoi kishki na davlenie v sisteme vorotnoi veny pri éksperimental'noi portal'noi gipertenzii.

A possibility of the portal venous blood flow reduction by means of resection of 1/3 of the small intestine in animals with the model of portal hypertension has been proved. Such an operation was performed in 2 patients, the long-term results are good.