[The specific features of pancreatic incretory dysfunction in chronic pancreatitis].

AIM: To reveal the specific features of pancreatogenic diabetes mellitus (DM) and to discuss the principles of its medical therapy. SUBJECTS AND METHODS: Sixty-six patients (55 men and 11 women) aged 30 to 65 years with chronic pancreatitis (CP) were examined. The disease was accompanied with pancreatic calcification and cyst formation in 22 and 13 patients, respectively; 5 patients were found to have a pseudotumorous form of CP and 10 had clinically and laboratorily verified DM. 14 resections and 11 drainages for complicated CP were performed. Its diagnosis was established on the basis of clinical, instrumental, and laboratory findings. Pancreatic exocrine function was evaluated from the results of the 13C-trioctanain breath test (BT) that is designed for its in vivo diagnosis. The level of C-peptide was studied by an enzyme immunoassay. RESULTS: The findings suggest that pancreatic exocrine function is diminished in CP patients both with and without complications as compared with the normal value in 44% (24.3 +/- 1.7 and 26.6 +/- 1.3%, respectively), as shown by BT. According to the results of BT, a substantial decrease in the total proportion of a released label was noted in patients with CP and pancreatic calcification, diabetes mellitus, after resection operations for complications of CP and there were also significant differences, as compared to a group of CP patients without complications. In these patient groups, the level of C-peptide fell to a larger extent than that in CP patients without complications and in patients with CP and DM it was decreased to 0.11 +/- 0.02 ng/ml, the normal level being 0.7-1.9 ng/ml. There was a direct correlation between C-peptide levels and BT results in the patients with CP after resection operations. Insulin antibodies were absent in all the examined patients with CP, which proves the specific type of DM in CP. These are detectable only in type 1 DM. Seven patients with CP and DM were found to have calcification, 5 underwent resection operations, 3 had calcification and underwent pancreatic resection operations. CONCLUSION: The development of DM may be predicted in CP patients with formation of pancreatic calcification and resections. In these patients, pancreatic exocrine dysfunction achieves a severe degree.

[Peculiarities of diabetes mellitus course in chronic pancreatitis].

In order to identify features of the course pancreatic diabetes and discussion of the principles of conservative therapy were examined 66 patients with CP in age of 30 to 65 years (55 men, 11 women). Among them in 22 cases disease was followed with formation of calcification of pancreas, 13 - pancreatic cysts, and 5 revealed pseudo tumor form of CP, 10 patients had clinical and laboratory evidence of diabetes. Concerning CP complicated course were performed 14 resection and 11 draining operations on the pancreas. Based on clinical, instrumental and laboratory data was made the diagnosis of CP. Exocrine pancreatic function was assessed on the results of the breath test, using 13C-trioktanaine, which is applied for exocrine pancreatic function in vivo test. The content of C-peptide was investigated by enzyme-linked immunosorbent assay (ELISA). The data indicate pancreatic exocrine function decrease in patients with CP with complications and without complications in compare with the norm of 44% (24,3 +/- 1,7, 26,6 +/- 1,3%, respectively) according to the breath test. Significant decrease of the cumulative output tags based on the test data of patients with CP and pancreatic calcification, diabetes mellitus, after resection surgery with CP complications, and there were significant differences in compare with a group of patients with CP without complications (p = 0.5). The level of C-peptide in these groups of patients decreased significantly in compare with a group of patients with CP without complications, and patients with CP and Diabetes was reduced to 0,11 +/- 0,02 ng/ml, at a rate range of 0.7-1.9 ng/ml, ie below the minimum values of norm. Obtained a direct correlation between the level of C-peptide and indicators breath test in patients after resection HP (r = 0,84, p = 0,03). Antibodies to insulin in the whole group of studied patients CPs were negative, which proves the specific type of Diabetes at HP. Antibodies to insulin can be detected only at diabetes type 1. In 7 patients with CP and CD detected calcification, 5 patients performed resection surgery, 3 patients had calcification and conducted the pancreas resection. Thus, we can conclude that in patients with CP and formation of pancreas calcification, pancreas resections may predict the development of diabetes.

[Effect of pancreatic secretory trypsin gene mutations on the development of chronic pancreatitis].

For the first time the relationship between mutations in the pancreatic secretory trypsin inhibitor (SPINK1) in humans and the development of chronic pancreatitis was established in 2000. By mid 2011 the number of studies on the influence of SPINK1 gene mutations on the development of pancreatitis exceeds 250, the results vary greatly. According to modern concepts, mutations in SPINK1 gene are associated with the development of both acute and chronic pancreatitis, and are defined in all etiological forms. Literature review shows the data of the most significant studies about the role of SPINK1 gene mutations in pancreatic diseases.

[Effect of hepatitis C virus genotype on viral load and clinical-laboratory characteristics of liver disease].

UNLABELLED: Aim of the work was to examine the influence of HCV genotype on the clinical features of chronic hepatitis and cirrhosis. MATERIALS AND METHODS: Were examined 9.715 patients under treatment in hospital gastroenterological for the presence of hepatitis C virus. In 365 patients was found HCV RNA. At 210 patients was performed genotyping. Was performed a quantitative analysis of 193 patients. There were determined cytolytic syndrome (ALT, AST), cholestatic (alkaline phosphatase, bilirubin), the activity of GGT in the blood of patients by biochemical markers. RESULTS AND DISCUSSION: The frequency of virus infection, confirmed by PCR analysis of data from this group of patients was 3.7% (95% CI 3.3-4.1). Occurrence of genotypes of hepatitis C was for 1 genotype 61.4% (54.7-68.1, 95% CI) for the 2-th genotype--10.9% (6.7-15.2; 95% CI) and the third genotype--at 27.6% (21.5-33.7, 95% CI). Viral load was significantly higher (p < 0.05) at 3-m type of HCV and was amounted to 8.08 +/- 15.6 million IU, compared with patients with 1st and 2nd genotype: 4.5 +/- 11.3 and 3.7 +/- 10.3 MIU. Also among patients with genotype 3 HCV viral load was (more than 800 thousand IU/ml) significantly more frequent in 50% of patients, whereas among patients with genotype 1 HCV, such patients was 22% and from 2 th HCV genotype--26% (chi2 = 13.0, p = 0.001). Significantly more frequent among patients with viral load more than 2.5 million IU/l at men (Fisher's test p = 0.03), as men often had the third genotype of hepatitis C (p < 0.005). Genotype was not significantly affected the performance of cytolytic and cholestatic syndromes. In patients with low viral load (less than 800 thousand IU/ml) was significantly less pronounced cytolytic syndrome, ALT was significantly lower (p < 0.05), the AST activity of reliable statistical difference was noted. Also significantly under high viral load (more than 800 thousand IU/ml) was higher than the activity of GGT (p < 0.05). CONCLUSIONS: Thus, our data showed that among the patients in our hospital were more prevalent third genotype of hepatitis C virus than among the population of the Russian Federation. Gender particular occurrence of the third genotype require further study to clarify the role of gender or other factors, concomitant increase in its prevalence. The presence of the third genotype of hepatitis C virus was accompanied by a high viral load, and probably an additional toxic effect on hepatocytes.

[Cytomegalovirus infection in patients with ulcerative colitis].

AIM: Adjusting therapy of patients with ulcerative colitis (UC) regarding their cytomegalovirus (CMV)--status. MATERIALS AND METHODS: 40 patients were included, mean age--44.3 +/- 3.2 yo. DNA CMV was detected in mucosal tissue samples from rectum using real-time PCR. RESULTS: 4 (10%) were CMV-positive. CMV-positive status rate was higher among patients on therapy with immunomodulators 3 (23.1%) vs 1 in patients on steroids and/or salicylates. There was significantly higher rate of severe disease and steroid dependence among CMV-positive patients than among CMV-negative: 75% vs 13.9%, 75% vs 8.3% correspondently. CONCLUSION: CMV-infection is associated with severe and steroid-dependent UC.

[Polyvirus hepatitides (prevalence, diagnosis, characteristics of virusological process)].

AIM: To ascertain prevalence of chronic hepatitides (CH) of polyvirus etiology and to characterize a course of such polyvirus CH. MATERIAL AND METHODS: A total of 15000 patients with chronic diseases of the liver (CDL) of different etiology were examined for markers of hepatotropic viruses, 312 patients with CH aged 18-59 years were examined clinically, biochemically, virusologically and morphologically. RESULTS: CH of polyvirus etiology are rather prevalent. A replicative form of HBV has a significant effect on the activity of the pathological process in mixed hepatitis. Incidence of chronic HBV and HCV infection rises with age. Viral hepatitis A in drug addicts runs an atypical course. CONCLUSION: Adequate epidemiological analysis, diagnosis and antiviral treatment, follow-up of CDL of mixed viral etiology, monitoring of drug addiction, healthy life style are able to reduce prevalence of mixed hepatitis.

[Gilbert's syndrome: a clinicogenetic trial].

AIM: To improve diagnosis of Gilbert's syndrome (GS) basing on functional and genetic methods of examination. MATERIAL AND METHODS: GS was diagnosed in 88 patients aged 15-72 years using clinical and genetic tests. RESULTS: Genotyping has detected changes in promotor part of the gene coding uridindiphosphateglucuroniltransferase. In homozygous carriers GS was characterized by a higher baseline level of bilirubin, distinct response to functional tests, frequent combination with essential tremor. In heterozygous patients GS often ran latently. CONCLUSION: Four variants of GS course were established: dispepsic, asthenovegetative, jaundice, latent. Low-caloric diet followed by fenobarbital raised sensitivity and specificity of the test. A clinical classification of GS is proposed. The detected disorders of antipirin pharmacokinetics allow prognosis of the risk of unwanted reactions to the drugs metabolized by monooxigenases of the liver.

[Lactulose in treatment of hepatic encephalopathy in patient with liver cirrhosis]. / Laktuloza v lechenii pechenochnoi éntsefalopatii u bol'nykh tsirrozom pecheni.

Our research demonstrated the high efficiency of using lactulose in patients with the latent and first grades of portal-systemic encephalopathy. Lactulose is an efficient and safe remedy, and its consistent application prevents the development of portal-systemic encephalopathy and makes it possible to control the level of hyperammonemia and improve a patient's quality of life.