[Prognosis for patients with chronic diseases of the liver in formulating indications to orthotopic liver transplantation].

AIM: To analyse a clinical course of hepatic cirrhosis of various etiology in potential recipients of donor liver; to formulate symptom complex which determines life span prognosis in patients with chronic diffuse diseases of the liver (CDDL). MATERIAL AND METHODS: We studied 74 recipients of the liver (73 adults aged 15-58 years and 1 boy aged 13 years, mean age at liver transplantation 27.04 +/- 1.5 years, 41% males, 59% females). Orthotopic transplantation of the liver (OTL) was made from a live relative donor. All the patients have undergone clinical, biochemical, immunological, virological, ultrasonic, x-ray and other examinations. Severity of the patients' condition was assessed according to the Child-Pugh classification. Indications to transplantation of the liver were formulated basing on the syndromal approach. RESULTS: Asthenic syndrome was diagnosed in 34, pruritus--in 25, articular syndrome--in 11, jaundice--in 43, hepatomegaly--in 40, splenomegaly--in 65, ascitis--in 26, peripheral edema-- in 8, esophageal varicose veins--in 66, encephalopathy--in 5 patients. Main syndrome manifestations of CDDL involved in formulating indications for liver transplantation consisted in the syndrome of liver cell insufficiency (diagnosed in 77% cases), syndrome of portal hypertension (detected in 100% cases), edemo-ascitic syndrome (41% cases), cholestasis syndrome (95% cases), autoimmune cytopenia syndrome (77% cases), hepatorenal syndrome (5.4%). Most of potential recipients who had liver transplantation were classified as having class B and C by Child-Pugh (66.3%), but often indications for OTL were considered in terms of a combination of various syndromes significant for life prognosis in each patient and in terms of urgency of OTL performance. CONCLUSION: In determination of indications for OTL syndromal approach seems most adequate. Main syndromes influencing primarily on OTL decision making are portal hypertension with consideration of esophageal varicose veins, syndrome of hepatic cell deficiency, edemoascytic syndrome, hepatorenal syndrome, syndrome of autoimmune cytopenia and cholestasis.

[Indications and optimal terms of liver transplantation in chronic diffuse hepatic disease].

Patients with chronic diffuse hepatic disease (CDHD) take a great part in structure of morbidity of adult population. Problem of treatment of patients with hepatic cirrhosis (HC) is still very important. Main contingent of these patients who need hepar transplantation consists from HC patients with various ethiology, cholestatic diseases, inborn metabolism disturbances and hepatic tumors. At present in the world there is a tendency to early performing of operation while decompensation of other organs and systems still do not exist. When there is diagnosis of inborn metabolism disturbance indication to ortotopic transplantation of hepar (OTH) are put at the same time with verification of diagnosis. In case of HC urgency of OTH depends on stage of disease (system assessment of severity of hepatic insufficiency by 'hild-Pugh, MELD), response of patients on therapy and frequency of hospitalizing. Performance of OTH makes possible to prolongate of patients' life and significantly improve its quality.

[Drug therapy of spastic disorder of urine outflow in patients with spinal injury and spinal cord injury]. / Medikamentoznaia korrektsiia spasticheskogo narusheniia ottoka mochi u bol'nykh s travmoi pozvonochnika i spinnogo mozga.

A study was made of efficiency of medicamentous correction of a spastic disorder of outflow of urine from the bladder in 42 patients with dull trauma of the spinal column and marrow. The use in the above patients of cardura alpha 1-adrenoblocker permits restoring a spastic disorder of urine outflow in a 10-day period after the trauma sustained in 82 percent of patients. Shortening the time of a spastic disorder of urine outflow in patients with trauma of the spinal column and cord we allow the frequency of development of the infectious inflammatory process in organs of the urogenitary system to be substantially reduced.

[The use of the alpha 1-adrenoblocker doxazosin in the pharmacotherapy of disorders of urine outflow of spastic origin]. / Primenenie al'fa 1-adrenoblokatora doksazozina v farmakoterapii narushenii ottoka mochi spasticheskogo geneza.

Our objective in this study was summing up of results of clinical studies on effectiveness of a selective alpha-adrenoblocker doxazosine in the pharmacotherapy of reflex and spastic disorders of outflow of urine. Doxazosine ("Cardura", Pfizer Inc.) was prescribed per os once per day in the morning after meal in a dose of 2-4 mg. The drug can be used not only as a hypotensive agent but also in conservative treatment of patients with prostate hyperplasia. It was found to be very effective in attempts to bring the disordered outflow of urine back to normal in patients presenting with calculi in the lower third of ureters as well as those with prior prostata resection; in affections of and injuries to the brain and spinal cord.