[Portal hypertension as a clinical manifestation of hepatic lesions in sarcoidosis].

The paper is devoted to differential diagnostics of portal hypertension (PH) in view of frequent diagnostic mistakes (10-15%) associated with this pathology. PH syndrome is usually interpreted by practitioners as a clinical manifestation of liver cirrhosis even if it is not necessarily related to the involvement of this organ. In patients with hepatic pathology, PH is likely to develop not only in case of fibrotic transformation and false lobule formation but also in case of disturbed blood flow in the portal vein, e.g. when granulomatous lesion of parenchyma takes place. Pathophysiological mechanisms and clinical peculiarities of intra-, sub-, suprahepatic and mixed forms of this condition are discussed. Etiological factors leading to the development of PH syndrome are considered. An original observation is presented of a patient with generalized sarcoidosis and histologically confirmed thoracic lymph nodes, spleen, lungs, liver; moderate granulomatous hepatitis, septal fibrosis (Knodel histology activity index 1-1-3-3- (8 scores)), PH, grade 1 oesophageal varicosis, splenomegaly, splenorenal anastomoses. The involvement of liver in the pathological process did not exceed 20%. Clinical, laboratory and instrumental studies rarely reveal manifestations of these changes. The diagnosis is verified histologically (discovery of granulomas formed by epithelial and giant multinuclear cells without signs of caseous necrosis. The reported case is distinctive for the development of PH in association of multiple giant heatic granulomas preventing the normal blood flow.

[Blood levels of HbsAg in patients with different variants of chronic HBV-infection].

AIM: To estimate HbsAg in patients with different variants of chronic HBV infection. MATERIAL AND METHODS: Assay of HbsAg (IU/ml) in blood serum was made in 156 patients with chronic HBV infection (70 males and 86 females, age 19 to 78 years) using the test-system HbsAg Architect Lot 59665LF00 (Abbott) on the automatic analyzer Architect with construction of 4-parameter logistic curve. RESULTS: There are significant differences in the levels of HbsAg depending on the course of chronic HBV-infection: inactive carriers of HBV (12,884.14 +/- 5,512.26 IU/ml) had much lower blood levels of HbsAg than patients with HbeAg-negative (66,992.28 +/- 25,908.74 IU/ml) and HbeAg-positive chronic VHB (135,039.3 +/- 48,127.06 IU/ml) patients with chronic mixed hepatitis (82,783.12 +/- 21,001.34 IU/ml) and cirrhosis of HBV-etiology (67,477.86 +/- 24,081.9 IU/ml). No significant differences were found between two subgroups of pregnant women with or without viremia by HbsAg concentration in the blood. Maximal mean content of blood HbsAg was registered in patients with HbeAg-positive chronic hepatitis B. CONCLUSION: Significant differences in blood serum levels of HbsAg exist between patients with chronic viral hepatitis B and inactive carriers of HBV.

[Frequency of the detection of billiary sludge in ulcerative disease].

Patients with gastric and duodenal ulcer, in who never had the typical complaints, and anamnestic data about pathology of biliary system were examined. More than one third of the biliary sludge was found. Finding dates demonatrate an appearence of hypokinetic biliary dysfunction in patients with gastric and duodenal ulcer. The received results indicate the for necessity of obligatory ultrasonic research for the purpose of revealing biliary dysfunctions in patients with gastric ulcer; subsequent dynamic supervision and preservation of pathological changes to prevente cholelithiasis.

[A rare case of metastases in the diaphragm in a patient with gastric cancer].

In spite of the general affection of the greater curvature of the stomach, there were no dyspeptic manifestations, pains in the upper half of the stomach were not related to meals, 'and the stool remained unchanged. The main characteristic of the clinical picture was the distribution of the tumor process to the diaphragm, which was a reason explaining the complaints about acute pains in the right flank enhancing in the course of movements or deep breaths. No data about any metastatic affection of the skeleton bones, lungs or pleura were received. This case shows the need in the close examination of the diaphragm in the case of the pain syndrome in the right hypochondrium in patients with generalized tumor diseases.

[Diagnostic significance of type IV collagen and hyaluronic acid in the serum of patients with chronic hepatitis C for staging hepatic fibrosis].

AIM: To evaluate diagnostic value of serologic fibrosis markers (hyaluronic acid--HA and type IV collagen C-IV) in patients with chronic hepatitis C (CHC) and hepatic cirrhosis (HC). MATERIAL AND METHODS: HA and C-IV were measured in 88 CHC patients with fibrosis stage 1 (n = 63) and 3 (n = 25), 13 patients with acute hepatitis C (AHC), 28 patients with hepatic cirrhosis (HC), 19 patients with pulmonary fibrosis (PF). The control group consisted of 32 healthy subjects. RESULTS: HA concentrations in the serum of CHC patients with mild to severe inflammation and fibrosis (F1 and F3) were normal (100 ng/ml). For HC diagnosis, HA test proved highly sensitive and specific (in HA 100 ng/ml sensitivity was 100%, specificity 84.6%), but this method cannot stage hepatic fibrosis. HA test was inferior to C-IV test. A mean C-IV concentration in the serum of CHC patients at the stage of marked fibrosis (F3) is significantly higher than in F1, in HC (A) patients higher than in patients with CHC F3. CONCLUSION: It is shown than concentration of C-IV above 196 ng/ml can differentiate fibrosis stage 1 from stage 3 with specificity 58.7 and sensitivity 88%.

[Dental status of patients with chronic diffuse diseases of the liver]. / Stomatologicheskii status bol'nykh s khronicheskimi diffuznymi zabolevaniiami pecheni.

The intensity and prevalence of diseases of hard dental tissues and periodontium, correlation of serum, unstimulated mixed saliva, and gingival fluid biochemistry, and changes in the periodontal microcirculation were studied in 122 patients with chronic diffuse diseases of the liver. Specific changes in the biochemical parameters of unstimulated mixed saliva and gingival fluid in these patients were directly related to the biochemical parameters of the serum and the fact of dental treatment. Microcirculatory disorders in the distal portions of periodontal vessels (attached gingiva and gingival papilla) depended on local factors, while disorders in larger vessels of the buccal mucosa (transitional fold) were related to the severity of the underlying disease.