[Case of multiple systemic (extrahepatic) manifestations of chronic HCV infection (analysis of the literature and own observations). Case report].

The article presents a description of a patient with chronic HCV infection and multiple extrahepatic manifestations, which manifested in dynamics and were recorded with a different sequence during 15 years of follow-up. In the patient we observed, the most frequently recorded extrahepatic manifestations were verified: porphyria cutanea tarda, mixed cryoglobulenemia, and utoimmune thyroiditis. Chronic HCV infection is often diagnosed in the presence of psoriasis was assessed as a paraneoplastic disease.

[Porphirin metabolism in non-alcoholic steatohepatitis].

AIM: To study porphirin metabolism in non-alcoholic steatohepatitis (HASH). MATERIAL AND METHODS: The trial enrolled 66 patients with verified diagnosis of HASH. Patients with chronic viral hepatitis and chronic alcohol intoxication were not included in the trial. Aminolevulinic acid (ALA), porphobilinogen (PBG), uroporphirin (UP) and coproporphirin (CP) were assayed in urine, protoporphirin (PP) and CP--in the stool. Total content of porphirins and proportions CP/UP and PP/CP were estimated. RESULTS: 17 patients had normal total porphirin excretion with urine but high levels of ALA, PBG, UP fraction, changed fractions proportion. 21 patients had high content of urinary and fecal porphirin fractions. Biochemical syndromes of high fecal porphirin concentration, secondary coproporphirinuria, chronic latent hepatic porphiria were under development. The above disorders were associated with carbohydrate, lipid and iron disbolism. In porphirin disbolism histological signs of liver fibrosis occurred more frequently. 56 (84.8%) patients had signs of metabolic syndrome. CONCLUSION: Disorders of porphirin metabolism in HASH patients are characterized by many nonspecific abnormalities and metabolic disturbances. Patients with different variants of porphirin disbolism developed hepatic fibrosis more frequently.

[The combination of carbohydrate and porphyrinic exchange disturbances: is it a chance or regularity?].

The subjects of the study were 399 patients with internal diseases and metabolic disturbances. Carbohydrate exchange parameters (fasting level of capillary blood glucose and glucose tolerance test), and porphyrin fractions in urine (uroporphyrin, coproporphyrin), and feces (protoporphyrin, coproporphyrin) were measured. Hepatic type of porphyrinic dysmetabolism was registered in 201 (50.4%) patients. Out of these patients, 38 had disturbances corresponding to the criteria of symptomatic elevation of fecal porphyrin level, 28 had secondary coproporphyrinuria, 40 had latent, and 95 had manifest late cutaneous porphyria. In patients with normal porphyrinic exchange, the frequency of carbohydrate exchange disturbances did not exceed 6%, while in patients with different variants of porphyrinic dysmetabolism it was almost 40%. The results show that patients with hepatic type of porphyrinic dysmetabolism should be considered to have a higher risk of the development of diabetes mellitus and other carbohydrate disorders.

[Porphyrin metabolism in men with metabolic syndrome].

Forty-three patients with metabolic syndrome (MS) were examined. The urinary (uroporphyrin--UP and coproporphyrin--CP) and fecal (CP and protoporphyrin) fractions of porphyrin, as well as the urinary excretion of porphyrin precursors (S-aminolevulinic acid and porphobilinogen) were measured. Porphyrin metabolic disturbances were registered in 33 (76.7%) patients. Nine of these patients displayed such qualitative changes as fraction mismatch (CP/UP < 1; the normal value is 2.1 +/- 0.4), and an increase in the level of porphyrin precursors, while their total urinary porphyrin level was normal. In 24 patients pathological changes in porphyrin exchange were characterized by such quantitative changes as a many-fold increase in urinary and/or fecal porphyrin fraction as well as the development of secondary biochemical coproporphyrinuria syndromes, symptomatic elevation of fecal porphyrin level, and latent late cutaneous porphyria. Changes in porphyrin exchange in patients with metabolic syndrome broaden the scope of disturbances occurring in this syndrome, and allow considering these changes as additional criteria.

[The use of therapeutic plasmapheresis in the combined therapy of a female patient with idiopathic hemochromatosis]. / Ispol'zovanie lechebnogo plazmafereza v kompleksnoi terapii bol'noi s idiopaticheskim gemokhromatozom.

A patient with idiopathic hemochromatosis has been followed-up for a long time. Methods decreasing serum iron content were used in succession. Five courses of plasmapheresis were administered. The level of serum iron normalized after each course consisting of 3-4 sessions, but the effect was but short-termed. Stable remission could be attained by maintenance desferal therapy after a course of therapeutic plasmapheresis, which can be regarded as a stage in basic therapy for idiopathic hemochromatosis.

[Desynchronization of circadian rhythms of the oxygen balance in the tissues and rheological properties of the blood in type I diabetes mellitus]. / Desinkhronizatsiia okolosutochnykh ritmov kislorodnyogo balansa tkanei i reologicheskikh svoistv krovi pri sakharnom diabete I tipa.

Circadian rhythms of tissue oxygen balance and blood rheological properties were investigated in 40 patients with insulin dependent diabetes mellitus. The syndrome of blood hyperviscosity determined by a rise of the level of packed cell volume and blood viscosity developed in decompensation of diabetes mellitus, resulting in desynchronization of packed cell volume. Blood viscosity rhythm was preserved but fluctuation ranges were sharply on an increase. Tissue oxygen balance disorders were manifested in the development of tissue hypoxia leading to rhythm desynchronization. Progression of the above disorders were noted in parallel with growing severity of disease. Compensation of diabetes mellitus was accompanied by moderate hyperviscosity and disappearance of tissue hypoxia in the morning. Fluctuation rhythm of all studied indices returned to normal with the exception of packed cell volume. Preserved blood hyperviscosity and increasing tissue hypoxia at night indicated stable disturbance of hemorheological properties and tissue oxygen balance. These disorders could lead to the development of another decompensation of diabetes mellitus.