The aim of review. Antigen-specific T lymphocytes act as the main determinants of outcomes of acute and chronic liver diseases as, on one hand, they are involved in the early stage of disease in mechanisms of restriction of antigenic activity, on the other hand, these cells determine degree of immunopathologic responses. It is important to perceive clinical value of these immune mechanisms.

Original positions. Antigen-presenting cell of the liver include dendritic cells, Kupffer’s cells, sinusoidal endothelial cells, stellate cells, epithelial cells (hepatocytes themselves). These antigen-presenting cells are capable to provide immune tolerance of the liver to infectious and non-infectious antigens by various mechanisms. CD8 + T-cells at persistent viral infections change their phenotype, preserving ability of control over a grade of viral load. Antibodies can activate CD8+ T- cells directly, without antigen-presenting cells that is accompanied by cytotoxic damage of the liver directly by CD8 + T- cells, or mediated by Kupffer’s cells activation. The platelet serotonin is involved in immunopathologic response, initiated by virus-induced CD8+ T-lymphocytes.

Conclusion. In practice, at the patient’s bed, constant clinical-immunologic comparisons are essential for development of adequate treatment strategy to restrict the scale of immunopathological reactions. Sinusoids and microcirculation of liver act as springboard and target for immunopathological reactions.

The aim of review. To discover the role of cytokines in pathogenesis of severe alcohol-induced hepatitis and to show directions for therapeutic action.

Original positions. Cytokines is aggregative term including various groups of biologically active substances: interleukins, tumor necrosis factor-α family (TNF-α), interferons, chemokines, growth factors, for example, transforming growth factor-β (TGF-β), colony-stimulating factors, etc. Now the key role of some cytokines in alcoholinduced damage of liver is proved. Such clinical signs of disease, as loss of body weight, cholestasis, fibrosis, hypergammaglobulinemia, production of acute-phase proteins are attributed to cytokines action. Interleukin-6 and TNF-α are involved in development of cholestasis and synthesis of acute-phase proteins. The first pathophysiological event at alcoholic damage of liver is TNF-α production which stimulates synthesis of other cytokines. The latter participate in recruitment of inflammatory cells to damage zone that results in hepatocytes destruction. At the same time reparative processes including fibrogenesis are initiated as well. In patients with progressing damage of the liver the balance between proinflammatory and anti-inflammatory cytokines shifts towards the first, that interferes with natural body control over inflammation and fibrogenesis. The hypothesis of “double impact” in progression of fatty liver disease, including its alcoholic variant is proposed. In treatment of severe alcohol-induced hepatitis glucocorticosteroids, inhibitors of cytokine synthesis and anti-cytokine antibodies, ursodeoxycholic acid are applied to suppress redundant production of proinflammatory cytokines. Clinical case demonstrating efficacy of combined treatment of the patient with severe alcoholic hepatitis is presented.

Conclusion. Alcohol-induced hepatitis with disorders of liver function is related to one of the most severe forms of alcoholic liver disease associated to high intrahospital mortality. The leading part in its pathogenesis belongs to proinflammatory cytokines, first of all – to TNF-α. Treatment of this liver damage assumes influence on basic pathogenic links.

Aim of investigation. To determine morphological markers of hepatotoxic effect of narcotics at drug addiction and effect of some groups of drugs at patients with chronic liver and kidneys diseases at positive markers HCV-and HBV-infections.

Materials and methods. Retrospective analysis of 4 groups of patients with HCV-and the HBV-infection markers with various hepatotoxic injuries: by narcotic drugs, biltricid (antihelminthic) at chronic opisthorchiasis, long programmed polychemotherapy of hemoblastoses, immune suppressive therapy for «chronic renal disease» was carried out.

Results. General morphological markers of hepatotoxic damage – macrovesicular lipid infiltration of hepatocytes, intrahepatocellular cholestasis, centrilobular necroses, central (metabolic) and perisinusoidal fibrosis. Endocellular remodeling of hepatocytes includes hyperplasia of agranular cytoplasmic reticulum associated with reduction of protein-synthesizing organellas, as well as destruction and compensatory hyperplasia of mitochondrial compartment. New ultrastructural phenomena of hepatotoxicity were defined which can be related to compensatory and adaptive responses of hepatocytes: interaction of smooth and granular cytoplasmic reticulum aimed on increased metabolism of xenobiotics, «autonomism» of hepatocytes with increase of cytolemma surface, providing parenchymatous – sinusoidal balance in conditions of perisinusoidal fibrosis.

Conclusion. Application of cytotoxic drugs results in the significant lesion of liver starting with centrilobular zone, – dystrophias, hepatocyte necrosis and reactive fibrosis.

Aim of investigation. To compare electrical char- acteristics of erythrocytes to structural changes of their membranes at diffuse liver disease (DLD).

Materials and methods. One hundred and thirty men 35–60 year old with DLD (chronic hepatitis and cirrhosis) and 33 practically healthy persons of compa- rable age were investigated. Parameters of red blood cells were assessed by standard methods, structure of erythrocyte membranes was investigated by thin- layer chromatography method, electrical properties by dielectrophoresis method in heterogeneous variable electrical field in 0,05·106–1·106 Hz frequency range.

Results. In DLD patients electrical conduction of membrane, scores of aggregation, destruction, capac- ity of membranes of erythrocytes is higher, and migra- tion speed of cells to electrodes – is lower, than in control (р < 0,0001–0,05). These disorders grow along with severity of disease and are intimately linked to changes of lipid composition of erythrocyte membranes – increase of cholesterol fraction relative content with decrease of level of total lipids, relative content of phos- pholipids (PL), triglycerides and cholesterol aethers (р < 0,002–0,05). Cholesterol to PL ratio grows due to decrease of total PLs level and increase of PL lysofrac- tions relative content. The score of erythrocyte destruc- tion grows respectively.

Conclusions. Obtained changes of erythrocyte electrical characteristics and structural components of their membranes can be used for evaluation of severity of diffuse liver diseases and assessment of treatment efficacy.

Aim of investigation. To study the effect of trimebutine on electrical activity of organs of gastro-intestinal tract (GIT) in postoperative period at endotoxemia state.

Materials and methods. The study was carried out at 13 nubilous Wistar male rats. Animal had a tube in jejunum and electrodes — in the wall of stomach antrum, duodenum and jejunum — implanted during laparotomy. Solution of lipopolysaccharide of Escherichia coli serotype 055:B5 in a dose of 200 mkg/kg was injected intraoperatively into femoral vein. Two groups of rats were studied: the first had single injection of 0,2 ml normal saline solution intraintestinally for the first 3 days after operation (control group, n=7) while the second — 0,2 ml of trimebutine solution in a dose of 2,86 mg/kg (main group, n=6). Electrical activity of investigated regions of GIT was recorded by electromyography for one hour (background) and for 2 hs after injection of medicine.

Results. In the control group during 3 days after operation significant decrease in score of antroduodenal coordination and absence of phase III of migrating myoelectric complex (MMC) in duodenum and jejunum was observed. On the 2 and 3 day appearance of pathological motility patterns: high-amplitude spastic activity and giant migrating spikes (GMS) in duodenum and jejunum was marked. Normalization of antroduodenal coordination and MMC was noticed only to the 8-th day after surgery. In the main group injection of trimebutine during 3 days after operation cardinally changed dynamics of electrical activity of GIT regions. Already on the 3-rd day in background records the score of antroduodenal coordination did not differ from normal values. On the 4-th day in duodenum and jejunum MMC was recorded. In postoperative period in all terms no episodes of high-amplitude spastic activity or GMS were observed.

Conclusions. In early postoperative period in conditions of endotoxemia there are significant disorders in MMC generation with appearance of pathological motility patterns like GMS and spasmodic activity. Injection of trimebutine in these conditions is effective, that is proved by absence of pathological patterns of motility, more rapid normalization of antroduodenal coordination and faster restoration of MMC spread from duodenum to jejunum.

Aim of investigation. To determine the role and potential of radiological methods of investigation in diagnostics of complications of chronic pancreatitis.

Materials and methods. Results of investigation and treatment of 102 patients who were undergoing treatment in A.V. Vishnevsky Institute of surgery with suspected cystic lesion of the pancreas were analyzed. Age of patients ranged from 15 to 75 years. Men (68,6%) prevailed. All patients had complex radiological investigation including: complex ultrasound investigation included B-mode study, duplex scanning of the main visceral vessels, investigation of hemodynamics around the focus and blood flow within the structure, three-dimensional reconstruction of ultrasound plotting; helical computer tomography with bolus contrast enhancement and magnetic-resonance tomography with bolus contrast enhancement were carried out.

Results. Chronic pancreatitis which has become complicated by postnecrotic cyst (or cysts) has been preoperatively diagnosed in 99 cases, in 3 – cystic tumor of pancreas. All patients were operated, lesions have been morphologically verified. At revealing of postnecrotic pancreatic cyst in one case the diagnosis has been put incorrectly, that was caused by atypical pattern of tumor and severe portal hypertension. For 3 patients (age 15 to 34 years) at preoperative stage cystic tumor was diagnosed on a basing on the absence of severe inflammatory changes of parenchyma of the pancreas. However at morphological study resected lesions have been verified as postnecrotic cyst. In 10 cases postnecrotic cyst which has become complicated by arrosive bleeding in its lumen from the adjacent main vessel was diagnosed. In 3 cases postnecrotic cyst was combined with the cystic duodenal dystrophy.

Conclusions. Sensitivity, specificity and accuracy ultrasound, computer tomography and magnetic-resonance investigations in revealing of chronic pancreatitis complicated by postnecrotic cyst, was 95,5, 90,5 and 94,8% respectively.

Aim of investigation. To study molecular-biologic and metabolic properties of agent «Acipol» with account to modern requirements to probiotic drugs.

Materials and methods. To study quality properties of Acipol investigation of strains of the agent by polymerase chain reaction (PCR) of DNA amplification and sequenation of 16S RNA gene of NK1, NK2, NK5, NK12 strains of L. acidophilus was carried out. At ultracentrifugation of bacterial cells with further electrophoretic separation and visualization of extrachromosomal fraction in agarose gel absence of mobile genomic information was found. Metabolic properties of Acipol strains were studied by standard biochemical and microbiologic procedures.

Results. The original study proved specific belonging of NK1, NK2, NK5, NK12 strains of L. acidophilus at genetic level, ability of strains to synthesize exopolysaccharides, to tolerate low pH values and influence of bile. Properties of lactobacilli to produce vitamins, to suppress proliferation of saprophytic microflora, as well as metronidazole-resistance properties were revealed.

Conclusions. The complex assessment of Acipol testifies to its conformity to the up-to-date requirements to biological preparations.

The aim of review. To present clinical pattern, methods of diagnostics and approaches to treatment of systemic manifestations of inflammatory bowel diseases (IBD) in children.

Original positions. Extraintestinal manifestations are present in 25–60% of patients of IBD – over 40% of patients with Crohn’s disease (CD) and is much rare in patients with ulcerative colitis (UC). At comparison of frequency of extraintestinal manifestations of UC and CD at children and adults appeared, that children have less often lesions of joints (13% at CD and 7% at UC vs. 28 and 26% in adults), eyes (less than 1% at CD and UC vs. 4% at UC in adults), skin (7% at CD and 1% at UC vs. 14 and 19% at adults). Clinical case of 10 years-old child with ulcerative colitis in whom disease was manifested by joint lesions that considerably complicated diagnostics is presented.

Conclusion. Correct treatment of extraintestinal signs promotes well-timed establishment of the IBD diagnosis and prescription of adequate treatment at possible atypical variant of disease that allows to achieve sustained remission, to avoid complications and prevents development of treatment resistance.

The aim of review. To present up-to-date approach to prescription of laxatives at treatment of constipation.

Original positions. The laxatives are agents with the various mode of action. At incidentally developing constipation stimulative laxatives are most effective. Presence of рН-dependent coating due to which the active substance is delivered to the large intestine, and also predictive time of the effect onset and safety profile make dulcolax (Bisacodyl) an agent of choice among drugs of this group. At chronic constipation with necessity of prolonged treatment the best results of treatment are obtained at application of osmotic laxatives which in case of resistant constipation are prescribed in combination with stimulative purging.

Conclusion. Laxatives prescription should be differentiated with account of differences in mechanisms of their action.

Aim of investigation. To evaluate efficacy of application of probiotic drug Acipol®, containing acidophilic lactobacilli and kefiric fungi inactivated by warmingup, in prophylaxis of antibiotic-associated diarrhea in adults.

Materials and methods. Prospective, randomized, comparative open study included 225 patients. Patients of the main group (n=150) received Acipol® 1 capsule bid for 2 wks along with antibiotics. Patients of the control group (n=75) took no probiotic drug. At development of diarrhea investigation for ruling out of its contagious origin was carried out. After cessation of antibiotics patients reported cases of diarrhea for the following 4 wks.

Results. Frequency of antibiotic-associated diarrhea at patients of the control group in prospective investigation was 12%, in retrospective study – 2%, i.e. in real practice non-diagnosed cases of antibiotic-associated diarrhea in adult patients at hospital stay, make on average 10%. Of patients of the main group receiving probiotic, mild diarrhea was diagnosed only in 1 patient (0,7%).

Conclusions. Preventive application of the Acipol® in adults concurrently with antibiotics reduces risk of antibiotic-associated diarrhea on the average by 11,3%.

The aim of review. To assess therapeutic potentials of alginate-based drug («Gaviscon») in treatment of various forms of gastroesophageal reflux disease (GERD).

Original positions. Alginic acids and alginates have several properties that allow to use them in patients with GERD: cytoprotective effect for damaged tissues, the high sorption activity, coating and antireflux action. On the literature data, it was found, that elimination of gastroesophagal reflux starts from first day of intake of the drug , and relief of the main clinical symptoms of GERD – within 2–3 days. Positive therapeutic effect was also found in alkaline refluxes. According to original observation, application of suspension «Gaviscon-forte» in a standard dose (10 ml after meal tid and 10 ml at the bedtime) for 14 days in the majority of patients improves scores of 24-hour pH-monitoring and considerably reduces percent of time with intragastric pH <2 at night-time. Frequency of heartburn attacks decreased, up to complete cessation already from the 2-nd day of treatment. At the end of treatment this symptom has completely stopped. Gaviscon has good organoleptic properties and high safety.

Conclusion. Gaviscon shows high performance in elimination of GERD symptoms and can be recommended as monotherapy for some forms of reflux disease and at any variant of GERD in combination to proton pump inhibitors.

The aim of review. The relevance of application of modern antacid agents in treatment of acid-related diseases is discussed.

Original positions. Recent literature data testify high clinical efficacy of the modern combined antacids proved in series of multicenter clinical trials in patients with gastroesophageal reflux disease (GERD). It is revealed, that at non-erosive form of GERD monotherapy by Maalox is accompanied by high level (over 90%) of clinical remission achievement, improvement of scores of quality of life and safety.

Conclusion. Antacid agents, along with antisecretory drugs (proton pump inhibitors), remain the important component of modern modes of treatment of basic acid-related diseases.

V.V.Gorban – Morphofunctional features of gastroduodenal mucosa blood flow in patients with peptic ulcer of the stomach and duodenum.