Vol 78, No 2 (2003)
- Year: 2003
- Articles: 25
- URL: https://bakhtiniada.ru/0040-3660/issue/view/1663
Editorial article
Celiac disease in the XIX, XX and XXI century
Terapevticheskii arkhiv. 2003;78(2):5-7
5-7
Interleukines in chronic gastrointestinal diseases
Abstract
Aim. To characterize quantitatively and functionally interleukines (IL) in chronic gastrointestinal diseases (CGD) depending on the affected organ, etiology, activity and stage of the disease. Material and methods. Levels of IL-lfi, IL-4, IL-6, IL-8, tumor necrosis factor alpha (TNF-a), gamma interferon (lnf-у) in peripheral blood of 300 patients with chronic hepatitis, gastroduodenal ulcer, cholelithiasis, glutenic enteropathy and other CGD were measured by enzyme immunoassay.
Results. CGD are accompanied by cytokine imbalance the severity of which depended on the etiological factor (virus, alcohol, etc.), the disease activity, stage and kind of IL. A maximal IL rise was seen in exacerbations of ulcer, cholelithiasis, chronic viral, autoimmune diseases. At early disease stages higher were the levels of Inf-y, IL-Jfi, IL-S, IL-6; at late stages - of TNF-a, IL-4. In patients with highly and moderately active CGD content of IL reached 250-750pg/ml that is 3-5 times higher than in inactive CGD. In alcohol-induced CGD and metabolic disturbances IL level was under 150 pg/ml. Conclusion. Assessment of the cytokine spectrum in CGD holds prognostic importance as this spectrum allows contusion on the disease activity, its progression.
Terapevticheskii arkhiv. 2003;78(2):7-9
7-9
Ultrastructural changes in the cells of antral gastric mucosa in patients with duodenal ulcer on melatonin treatment
Abstract
Aim. To study ultrastructural condition of the eels in antral gastric mucosa in patients with duodenal ulcer on melatonin treatment.
Material and methods. Electron microscopy was made of biopsy specimens of antral stomach mucosa obtained from 14 patients with duodenal ulcer (DU) in exacerbation and in clinicoendoscopic remission after therapy with proton pump blockers (group I) and after this therapy combined mth melatonin (group 2).
Results. In patients of group 2 there was an increased number of differentiated cover and principal cells, moderately differentiated parietal cells predominated. Conclusion. Melatonin is one of the drugs potentiating trophic processes in gastric mucosa.
Terapevticheskii arkhiv. 2003;78(2):10-14
10-14
Clinicomorphological characteristics of acute gastroduodenal erosions and ulcers in unstable course of ischemic heart disease and contribution of microcirculatory,hemostatic and gastric functional disorders to their development
Abstract
Aim. Determination of clinicomorphological characteristics of acute gastroduodenal erosions and ulcers in unstable course of IHD and the role of disorders in microcirculation, hemostasis, gastric function in development of these erosions.
Material and methods. Clinically and endoscopically were examined 124 patients with unstable IHD. By detected gastroduodenal changes the patients were divided into three groups. The study was also made of local and systemic microcirculation, hemostasis, gastric functions.
Results. Acute gastroduodenal erosions and ulcers in unstable course of ischemic heart disease manifest with mild abdominal pains and gastric dyspepsia for several days. Disorders in the gastroduodenal zone arise because of focal disturbances of terminal circulation in the mucose according to thromboischemic or thrombohemorrhagic types related to generalized changes of microcirculation and hemostasis. High activity of acid-peptic factor, low production of gastromucoproteins and hypomotor dyskinesia of the stomach contribute to development of erosive-ulcerous lesions.
Conclusion. The above information is useful for early diagnosis of acute gastroduodenal erosions and ulcers in unstable course of IHD and upgrading of therapeutic measures.
Terapevticheskii arkhiv. 2003;78(2):14-18
14-18
Duodenogastric reflux in duodenal ulcer and chronic hyperacidic gastritis
Abstract
Aim. To study motor and secretory function of the stomach and duodenum in duodenal ulcer (DU)
and chronic hyperacidic gastritis (CHG).
Material and methods. Autonomic nervous system was studied and esophagogastroduodenoscopy, 24-
h intragastric pH-metry were made in 42 DU and 20 CHG patients.
Results. In comparable secretion, the patients of the above groups differed by severity and frequency of
duodenogastric reflux (DGR). Grave and moderate DGR was typical for CHG and DU in the absence
of complications. Minimal DGR occurred in DU with complications.
Conclusion. DGR severity may be of prognostic significance for DU course.
Terapevticheskii arkhiv. 2003;78(2):18-21
18-21
Psychic characteristics of duodenal ulcer patients at different stages of the disease
Abstract
Mm. To examine patients with duodenal ulcer (DU) at different stages of the disease for psychic alterations. Material and methods. Psychodiagnostic techniques were employed in examination of 192 patients with DU (81 new cases of the disease, 88 cases of recurrent exacerbations, 23 cases with persistent remission for 2 years and longer). Control group consisted of 73 patients without gastrointestinal complaints.
Results. Abnormal psychic adaptation was found in 73.3% patients with DU exacerbation, in 47.8% patients in remission and 41.1% controls. Hypochondriac condition and non-adaptation were diagnosed in new cases of DU and recurrent exacerbations with the same frequency. The former had more frequently mixed attitude to the disease and mixed psychopathological syndromes. Psychic compensation rests on information about DU and its prevention which patients receive from the doctor, so these patients benefit much from communication with the physition. Observation over the patient's behavior during such communication allows the doctor to reveal anxiety and depression. Such patients should be referred to consult psychotherapist or psychiatrist.
Conclusion. Psychic non-adaptation accompanying development of DU manifests with different clinical symptoms at different DU stages. Diagnosis of mental condition of DU patients is important for the choice of individual treatment approach.
Terapevticheskii arkhiv. 2003;78(2):21-23
21-23
Esomeprasol in the treatment of duodenal ulcer under various regimens of antihelicobacter therapy
Abstract
Aim. To assess efficiency of esomeprazole in the treatment of duodenal ulcer (DU) associated with Hpylori in various eradication regimens.
Material and methods. 80 patients with duodenal ulcer at least 0.5 cm in diameter were randomized into three groups. 23 patients of group 1, 28 patients of group 2 received esomeprazole for 7 days in a dose 20 mg twice a day, in a single morning dose 40 mg, respectively. 29 patients of group 3 received omeprazole 20 mg twice a day for 7 days and further 3 weeks 20 mg twice a day. All the patients were also given amoxicillin 1000 mg twice a day and clarithromycin 500 mg twice a day for a week. Results. An antisecretory effect of esomeprazole as shown by 24-h monitoring of gastric secretion was longer and more stable than that of omeprazole: a latent period averaged 1.5 ± 0.6 h in a pharmacological test with 20 mg esomeprazole, 1.2 ± 0.4 h in intake of 40 mg esomeprazole and 2.1 + 0.3 h in intake of 20 mg omeprazole. Overall duration of the antisecretory effect averaged 16.8 ± 1.9, 20.3 ±1.7 and 12.5 ± 1.9 h, respectively. The time of intragastric pH > 4 was 13.1 ± 1.6,
2
± 1.6 and 9.8 ± 1.5 hours, respectively. Eradication of H.pylori in group 1, 2 and 3 was 91.3,
3
and 89.6%, respectively. Complete epithelization of ulcer occurred in 95.6, 92.8 and 93.1% cases, respectively. In 77 patients who finished the treatment according to the protocol the treatment resulted in eradication in 95.6, 92.5 and 92.8%, respectively; in epithelization - in 100, 96.3 and 96.4% patients of groups 1, 2 and 3, respectively. Side effects were mild or moderate but not causing changes of the regimen or treatment discontinuation.
Conclusion. Esomeprazole in three-component treatment was highly effective in eradication of H. pylori and epithelisation of duodenal ulcer defects in various regimens of administration. Esomeprazole in combination with amoxicillin and clarithromycin reduces the time of treatment of DU associated with H. pylori to 1 week without further monotherapy with antisecretory drugs.
Terapevticheskii arkhiv. 2003;78(2):23-26
23-26
Primary biliary cirrhosis: 12-year experience of observation
Abstract
Aim. To ascertain initial signs of primary biliary cirrhosis (PBC), criteria of its early diagnosis, variants of the course, clinical picture and life quality of PBC patients.
Material and methods. 128 PBC patients were examined in the Central Research Institute of Gastroenterology from 1991 to 2002. Quality of life was assessed by SF-36 questionnaire adapted for patients with chronic cholestatic diseases of the liver.
Results. The patients complained of skin pruritus (80%), jaundice (66%), fatigue (68.8%), weight loss (24.6%o). The disease manifested with skin pruritis in 75.8%, jaundice - in 12.5% patients. Decompensated hepatic cirrhosis (Child-Pugh C) at first hospitalisation was diagnosed in 11.7% cases. The earlest and most significant biochemical markers of PBS were high activity of gammaglutamiltranspeptidase (GGTP) and alkaline phosphatase (AP). IgM level was high in 70.5% cases. Anfimitochondrial antibodies were detected in 83.6% examinees. Overlapping with autoimmune hepatitis was seen in 9.4%. One-third of the patients had systemic symptoms. Quality of life deteriorated. Conclusion. PBC may be long asymptomatic. The absence of skin pruritus is not a sure sign of the disease absence. To detect PBC early, young and middle-aged women with unexplained weakness or skin pruritus should undergo a comprehensive examination including measurements of GGTP, AP, AM A, IgM, morphological investigation of liver tissue. PBC patients had low quality of life. This should be accounted for when treating patients, in determination of their working ability and for early referral for liver transplantation.
Terapevticheskii arkhiv. 2003;78(2):26-30
26-30
Changes in the liver in glutenic enteropathy
Abstract
Aim. To evaluate frequency of clinical manifestations, biochemical and morphological alterations characteristic of liver affection in patients with glutenic enteropathy (GEP) in correlation with GE duration and severity of malabsorption syndrome (MAS).
Material and methods. 116 GEP patients have undergone clinico-laboratory examination, intestinoscopy with biopsy of jejunal mucosa, puncture biopsy of the liver with morphological examination of the specimens, ultrasonography of the liver. In addition, the immune status was assessed and tests for markers of hepatotropic viruses В and С were made.
Results. Clinical symptoms, typical for hepatic lesion in GEP patients, such as yellowness of the skin and scleras, palmar erythema, vascular Stella and hepatomegaly were found in 7.2% cases. Hyperaminotransferasemia was detected in 48.4% of new cases of celiac disease, in 18.1% of patients on strict aglutenic diet. Aminotransferase hyperactivity detection was associated with severity of MAS. Morphological alterations in the liver in celiac disease are characterized by fat dystrophy, portal and periportal hepatitis, steatohepatitis or fibrosis. Combined therapy of celiac disease including strict aglutenic diet, correction of metabolic disturbances was not always effective in correction of metabolic processes in the liver. In new GEP cases early adequate therapy was most effective. Conclusion. The course of glutenic enteropathy is accompanied with clinicomorphological alterations in the liver. This necessitates use of drugs improving liver function.
Terapevticheskii arkhiv. 2003;78(2):31-34
31-34
Efficiency of ursodesoxycholicacid in cholesterosis of the gallbladder
Abstract
Aim. To study efficacy of ursodesoxycholic acid (UA) drugs in the treatment of polypous and polyporeticular cholesterosis of the gallbladder (CGB), including combination with biliary sludge, with reference to terms of the treatment.
Material and methods. A contraction function of the gallbladder was studied ultrasonically in 74 CGB patients treated with UA drugs. The treatment lasted from 1 month to 1.5 years. A response (complete or partial dilution of cholesterol polyps) was recorded in 71.6% patients. Therapy was less effective if the gallbladder contained biliary sludge, heterogeneous bile and suspension, dense bile. The lytic therapy effect improved with treatment duration. Complete dissolving of cholesterol polyps was achieved after at least 10-month treatment. The treatment also brought about a marked choleretic effect and an increased ejection fraction of the gallbladder. Conclusion. UA drugs can be used in the treatment of CGB.
Terapevticheskii arkhiv. 2003;78(2):35-38
35-38
Causes of biliary sludge
Abstract
Aim. To specify characteristics of biochemical bile composition contributing to destabilization of colloid properties of bile in patients with biliary "sludge".
Material and methods. 37patients with "sludge" in the gallbladder (GB), 10 patients with cholelithiasis and 10 patients with intact GB participating in the study were examined for bile portion В bile acids (BA), cholesterol and phospholipids (PL); lipid and lipoprotein blood composition. Results. Three types of biochemical composition of bile in GB "sludge" patients were identified. 22 patients had elevated levels of cholesterol and PL in subnormal content of BA (group I); 9 patients had normal FA and cholesterol, low content of biliary PL (group 2); 6 patients had normal concentrations of the three components (group 3). Blood lipids were characterized by elevated levels of total cholesterol and LDLP cholesterol in group I; low HDLP cholesterol and triglycerides in group 2 and almost normal values in group 3. Basing on these data, causes of "sludge"formation in the GB are suggested. Conclusion. Biliary "sludge" may form because of excessive cholesterol in bile, low phospholipid levels or in normal proportion of the studied substances.
Terapevticheskii arkhiv. 2003;78(2):38-42
38-42
Morphofunctional condition of gastric mucosa in acalculous diseases of the biliary tract
Abstract
Aim. To study morphofunctional peculiarities of gastric mucosa in native and migrant rural population of North Siberia.
Material and methods. A comprehensive clinicomorphological examination including physical examination, ultrasonic scanning, cholecystography, duodenal intubation, intragastric pH-metry, esophagogastroduodenoscopy, quantitative and qualitative investigations of gastric mucosa was conducted in 148 migrants (Russians, Ukrainians) and 165 evenks living in Evenkia.
Results. In both population groups, more often in the migrants, in cholecystitis vs dyskinesia patients frequency of atrophic changes in gastric mucosa was higher while acid production in the stomach was lower, antral gastritis more active.
Conclusion. Morphofunctional condition of the stomach influences the condition of the bile tract in native and migrant population of North Siberia.
Terapevticheskii arkhiv. 2003;78(2):42-44
42-44
Clinical course of alcoholic pancreatitis
Abstract
Aim. To study a natural course of alcoholic pancreatitis (AP).
Material and methods. Follow-up clinical, laboratory and radiation examinations were made of 170 patients with alcoholic pancreatitis. Exocrine secretion of the pancreas was assessed by secretin-pancreozymin test. Morphological signs of pancreatitis were studied in patients who had died of pancreatic cancer.
Results. In 24% of patients AP manifested with acute attack. In 76% it was preceded with weak clinical symptoms. AP ran with recurrences and complications (93.5 and 38%, respectively). Most frequently AP was complicated with pseudotumorous pancreatitis, calcinosis and pancreatic pseudocysts. Pancreatic secretion was suppressed in 87% patients though clinically it was evident only in 12% cases. Autopsy cases of pancreatic cancer carried morphological markers of chronic pancreatitis.
Conclusion. Various clinical forms of AP represent stages of its development: early symptoms, recurrences, complications and decompensated failure of the pancreatic function. The presence of pancreatitis in patients with pancreatic cancer causes difficulties in differential diagnosis between these diseases.
Terapevticheskii arkhiv. 2003;78(2):45-48
45-48
Changes in exocrine and endocrine secretion of the pancreas in the treatment of chronic pancreatitis of alcoholic etiology with somatostatin analogue
Abstract
Aim. To study somatostatin (SS) content in patients with chronic pancreatitis (CP) and effects ofsandostatin (a synthetic analogue of SS) on endo- and exocrine pancreatic functions in CP patients. Material and methods. SS plasma levels were measured by radioimmunoassay in basal conditions in 32 CP patients. Sandostatin treatment was given to 20 patients with CP of alcohol etiology (twice a day subcutaneously for 5 days). In the course of the treatment the following indices were measured: serum trypsin, amilase, lipase, a2-macroglobulin, general antitryptic activity, blood immunoreactive insulin in basal conditions and after intravenous injection of glucose.
Results. SS levels in peripheral blood were elevated in patients with complicated alcoholic CP. Sandostatin in CP used for 5 days had no significant impact on insulin secretion, levels of pancreatic enzymes, inhibiting system of blood. 90% patients with alcoholic СР experienced relief of pain which may relate to suppression of stimulated secretion of gastrointestinal hormones as well as to a favourable action of sandostatin on stabilization of membranes of acinar cells.
Conclusion. Sandostatin administration in CP patients is justified and is especially recommended in the complicated course.
Terapevticheskii arkhiv. 2003;78(2):48-50
48-50
Clinical and prognostic implications of gastrointestinal tract lesions in systemic vascular purpuras
Abstract
Aim. To evaluate clinical peculiarities and prognostic value of abdominal syndrome in adult patients with systemic vascular purpura (SVP).
Material and methods. Incidence, clinical picture, complications of abdominal syndrome, its relations with principal extraintestinal manifestations of SVP were studied in 125 SVP patients. Absorption and barrier functions of the small intestine, their correlations with clinical activity of the disease were investigated in 32 SVP patients with no clinical signs of intestinal affection. Computer-assisted morphometry of duodenal mucosa biopsies was conducted and the results were compared to those of intestinal permiability and clinical activity of SVP.
Results. Negative correlation was found between the occurrence of abdominal syndrome and the patients' age. The gastrointestinal tract suffered more frequently in men. 21% patients had abdominal complications, association of abdominal syndrome with higher frequency of glomerulonephritis. In the absence of abdominal symptoms, the barrier function of the small intestine for protein macromolecules was impaired. This correlated with exacerbations of skin purpura. Increased intestinal permeability and activity of skin purpura correlated with severity of inflammation in the duodenal mucosa. Conclusion. Abdominal syndrome in SVP is an unfavourable prognostic factor indicating possible severe complications and high risk of glomerulonephritis. Subclinical intestinal involvement presenting as barrier dysfunction may contribute to aggravation of skin vasculitis.
Terapevticheskii arkhiv. 2003;78(2):50-54
50-54
Tumor necrosis factor in blood plasm and morphofunctional parameters of the heart in patients with chronic heart failure complicating the course of ischemic heart disease. Changes in response to treatment
Abstract
Aim. To examine the course of chronic cardiac failure (CCF), morphofunctional parameters of the heart in correlation with activity of cytokine system; to evaluate effectiveness, tolerance and safety of combined CCF treatment including a cardioselective fi-adrenoblocker bisoprolol in patients with CCF FC I-IV having a high plasm level of tumor necrosis factor a (TNF-a).
Material and methods. The concentration of TNF-a in plasm of 40patients with IHD complicated by CCF of FC I-IV and ejection fraction under 45% was measured at enzyme immunoassay. The treatment included combined therapy with diuretics, cardiac glycosides, peripheral vasodilators, ACE inhibitors, bisoprolol (group 1) or no bisoprolol (group II).
Results. CCF patients with TNF-a had a significally reduced IMT, more frequent episodes of CCF decompensation, longer CCF history, lower EF and threshold exercise intensity. In group I patients all these parameters improved.
Conclusion. CCF patients with elevated plasm levels of TNF-a showed a severe course of the disease, low IMT, abnormal myocardial contraction and exercise tolerance. The addition of bisoprolol to combined treatment of the above patients improves their clinical condition, morphological parameters of the heart and exercise tolerance.
Terapevticheskii arkhiv. 2003;78(2):54-58
54-58
Function of circulation system in the course of arterial hypertension treatment in patients with vibration disease
Abstract
Aim. To develop medicinal approaches to correction of hemodynamic disturbances in vibration disease (VD) associated with arterial hypertension.
Material and methods. The study compared hypotensive and hypodynamic efficiency of amlodipin, diltiazem, enalapril, perindopril and indapamide in 74 VD patients with arterial hypertension (SAP 140-179 mm Hg, DAP 90-109 mm Hg; mean age 54.8years, mean exposure to vibration 26.Syears). Before and after the treatment course the patients were examined with ultrasound by the following parameters: left ventricular contractility, left and right ventricular diastolic function, left atrial function. Results. Amlodipin reduced left ventricular volume both in systole and diastole as well as maximal intramyocardial tension without significant change in contractility, raised a contraction reserve of the left atrium, improved ventricular relaxation. Diltiazem potentiates contractility of the left ventricle and atrium without marked impact on relaxation and tension of the myocardium. Enalapril and perindopril cause positive hemodynamic shifts. Perindopril vs enalapril was more effective in easing intramyocardial systolic tension of the left ventricular wall and in improving the diastolic function. Indapamid vs calcium antagonists and ACE inhibitors had a weaker effect on arterial pressure, no significant effect on left ventricular contraction, peripheral hemodynamics. Left atrial function was hyperactive. This was observed also in response to the other drugs.
Conclusion. Amlodipin produced in patients with VD and AH more positive hemodynamic effects, reduced isotonic hyperfunction of the left ventricle, improves diastolic function of the ventricles. Amlodipin and perindopril are more promising prognotically in relation to reduction of left ventricular myocardial mass.
Terapevticheskii arkhiv. 2003;78(2):58-61
58-61
Thyroid autoantibodies in hemoblastoses and cytopenias
Abstract
Aim. To study the level of thyroid antibodies (TAB) in blood diseases.
Material and methods. TAB levels dynamics was studied in 413 patients with hematological diseases. Results. Increased incidence of cases with high Ab titer to thyroid microsomal antigen was found. High and moderate tilers were revealed in 33% of all examinees, including 41%, 22%, 32% and 29% among patients with immune cytopenia, chronic lymphoid leukemia, generalized mature-cell lymphoma and myeloproliferative diseases, respectively. These high and moderate titers were rather stable. In 15% patients Ab were elevated insignificantly, this rise being unstable.
Conclusion. Stable high titers of antibodies to thyroid antigens point to increased incidence rates of concomitant autoimmune hyroiditis in patients with blood diseases.
Terapevticheskii arkhiv. 2003;78(2):62-65
62-65
Quantitative assessment of protein replacement in therapeutic plasmapheresis
Abstract
Aim. To calculate parameters of replacement in which the amount of total protein (TP) in the circulating blood remains above critical level after removal of 17-75% of circulating plasm volume (CPL). Material and methods. Therapeutic plasmapheresis (TPA) was made in 96 patients with rheumatoid arthritis, bronchial asthma, systemic lupus erythematosus and other diseases. The plasm was replaced by 0.9% sodium chloride solution, rheopolyglucine and albumin solutions in isovolemic regime. Albumin was given in quantities equivalent to 50-65% of the removed protein.
Results. Close correlation was observed between the expected and actual concentrations of total protein in 96 patients who have undergone 206 TPA procedures. In removal of up to 35% CPL protein deficiency is compensated by its mobilization from the deposits and due to protein-synthetizing function of the liver. In removal of 75% and more and in initial hypoproteinemia 50% of the protein should be replaced. Conclusion. It is confirmed that rheopolyglucin can be used for plasm replacement in TPA in patients with hyperproteinemia having no contraindications.
Terapevticheskii arkhiv. 2003;78(2):65-68
65-68
A case of generalized tuberculosis in the presence of silicosis
Terapevticheskii arkhiv. 2003;78(2):68-70
68-70
Rehabilitation of patients with gastroduodenal ulcer
Terapevticheskii arkhiv. 2003;78(2):70-72
70-72
Chronic pancreatitis and underlying causes
Terapevticheskii arkhiv. 2003;78(2):73-77
73-77
Policy of pharmacological treatment of ulcerative colitis (a review of foreign literature)
Terapevticheskii arkhiv. 2003;78(2):77-81
77-81
New hypolipidemic drugs from the group of reductase inhibitors GMG-CoA
Terapevticheskii arkhiv. 2003;78(2):81-84
81-84
Albarel (rilmenidin) - a selective agonist of imidazol receptors. II. Pharmacological properties and experience of clinical use
Terapevticheskii arkhiv. 2003;78(2):85-88
85-88