The aim of review. Mammals have complex mechanisms of protection against exogenous pathogenes and internal threats (malignant proliferation). Strategy of protection is based on the presence of two stages of defense: nonspecific (innate immunodefense) and specific (adaptable immunodefense). In the review the basic concepts of innate and adaptable immune responses and their interaction are presented.

State-of-the art. «Operational» components of nonspecific (innate) immune system include macrophages, monocytes, dendritic cells, natural killer cells and neutrophiles which distinguish uniform (conservative) moleculas of pathogenes and moleculas expressed by cells of the host in case of infection or neoplastic transformation. Cells of immune system after exposure to “threat molecules” produce chemokines which recruite inflammatory cells to the focus of damage, and danger is liquidated by joint actions of phagocytic cells, cytotoxic cells, cytokines, proteins of acute phase and complement. Т- and B- lymphocytes acts as instruments of adaptable immune system. T-crates express clonotypical antigenic receptors which distinguish peptide fragments of protein antigens, presenting by molecules of the main histocompatibility complex (MHC) presenting cells (dendritic cells, macrophages). Activation of naive T- cells comes upon after reception of signal from their antigenic receptors (signal 1), and signal of danger from costimultory receptors (signal 2). Activation represents differentiation in effector cells, further capable to carry out the functions in response only to signal 1. Adaptable immune responses to signals of danger (infectious or neoplastic) get either inflammatory nature with involvement of cytotoxic T- cells, Th1-cells and natural killer cells, or antibody-producing nature with participation of Th2-and B-cells. Antibodies neutralize toxins and viruses, opsonize pathogenes for phagocytosis and activate complement. Differentiation of cells in towards Th1/Th2, effectory functions of adaptable immune system and termination of adaptable immune responses are controlled by cytokines produced by T-cells and cells of innate immune system.

Conclusion. Nonspecific (innate) and specific (adaptable) immune systems interreact with each other and adjust each other. Dendritic cells and macrophages play the central role in immune responses of both systems. Т-and B-cells participate mostly in adaptable immune responses though types of T-cells have of nonspecific response functions.

The aim of review. To present analysis of literature data on possible participation of Helicobacter species in pathogenesis of diseases of hepatobiliary system.

Recent literature data. During recent studies, bacteria were revealed in bile, liver tissue, mucosa of the gallbladder and bile ducts that proves ability of Helicobacters to colonize hepatobiliary organs. Multiple investigations with application of molecular, histological, microscopic, bacteriological, immunologic methods, biological models experiments indicate the possible relation of Helicobacter spp. to development of chronic cholecystitis, cholelithiasis, cholangio- and hepatocarcinoma. Decoding of pathogenic mechanisms involving these microorganisms opens prospects for application of antihelicobacter therapy in treatment and prophylaxes of hepatobiliary diseases.

Conclusion. Cumulative data on the role of H. pylori and other species of Helicobacter genus in development of liver, gallbladder and biliary diseases allow to draw initial conclusions on their probable involvement in these processes. Despite equivocal opinions, this new rapidly educing trend may be rather perspective and require further studies in this area.

The aim of review. To carry out analysis of new system of evaluation of clinical signs of gastroesophageal reflux disease (GERD).

Original data. Review presents the characteristic of new system of evaluation of clinical signs of GERD, named ReQuest™ scale which includes 6 groups of clinical signs. Results of testing by this scale in clinical studies, and potentials of its application in combination to Los Angeles endoscopical classification were analysed.

Conclusion. Analysis, that was carried out, testifies that the new system of evaluation of clinical signs of GERD ReQuest ™ enables more detailed characteristic of clinical manifestations and more precise estimation of treatment efficacy.

Aim of investigation. To assess the effect of antisecretory therapy on night attacks of dyspnea in patients with bronchial asthma (BA) in combination to gastroesophageal reflux disease (GERD).

Stuff and methods. 162 BA patients – 59 men (36,4 %) and 103 women (63,6 %), mean age 68,1±10,2 year (32 to 92 years) were investigated. At 86 (53,1%) persons GERD has been diagnosed. In 41 (47,7%) of them night signs of asthma (attacks of difficulty in breathing, stuffiness in breasts, cough) were present. The first group (28 patients) with night signs received along with basic anti-inflammatory therapy for BA antisecretory therapy by proton pump inhibitor ultop (omeprazole, «KRKA», Slovenia) 40 mg per day for 28 days. The second group (13 patients) took no antisecretory therapy and only symptomatic intake of antacids on-demand was allowed. Evaluation of treatment effect on GERD and BA signs was done on 7, 14, 21 and 28 day of the study. Severity of GERD was determined according to five-point Likert’s scale. Effect on the course of BA was estimated by dynamics of daytime and night signs, requirement in bronchodilators per day, change of FEV1 and VC values.

Results. In the first group decrease of main signs of GERD at the 7th to day of investigation was revealed in 19 (67,8%) patients, and at 14, 21 and 28th days, respectively in 22 (78,5 %), 25 (89,3%) and 26 (92,9%) patients. Four-week antisecretory therapy resulted in relief of clinical symptoms of GERD (first of all — heartburn) in over 90% of patients. Number of daytime attacks of dyspnea has decreased from 3,22±1,29 up to 2,33±0,42, night attacks – from 0,80±0,17 to 0,42±0,15, and average requirement in bronchodilators – from 6,83±2,39 per day up to 5,31±2,35, differences were statistically significant. The most pronounced effect has been obtained for night attacks of difficulty in breathing (decrease of their number by 51,9%), smaller effect was rendered on amount of day attacks – decrease by 24,1%, consumption of bronchodilators was reduced by 20,7 %. Increase in mean FEV1 from 64,08±19,11 to 65,88±21,27%, VC – with 75,0±20,27 up to 79,79±20,23% was observed. Changes of similar scores in the second group of the patients taking antacids on demand, were statistically insignificant.

Conclusion. Results of original study prove the necessity to include antisecretory agents to standart mode of treatment for patients with bronchial asthma, combined to GERD.

Aim of investigation. To compare various methods of H. pylori detection in oral cavity at patients with acidrelated diseases.

Stuff and methods. 52 patients (36 women and 16 men) aged 18 to 65 years were investigated. All of them were distributed into 3 groups: 1st group – 16 patients with non-erosive gastroesophageal reflux disease and concomitant chronic active gastritis (CAG). 2nd group – 17 patients with grade A erosive esophagitis, CAG and duodenal peptic ulcer, 3rd group – 19 patients with reflux-esophagitis of a grade B (10), grade C (9) and gastroduodenitis. Clinical stomatological methods of investigation, morphology, cytology and biochemical methods of investigation of stomach mucosa (SM) and oral mucosa (OM) were applied.

Results. Clinical stomatological signs – erosion of enamel, hypersensitivity of teeth, hemorrhagic gingival diathesis, edema of oral mucosa, desquamation of epithelium, pain or burning sensation of the tongue, dryness in the mouth and lips, development of scales on labial mucosa (exfoliative cheilitis), angular stomatitis, aphthous stomatitis – were found in patients with acid-associated diseases and H. pylori infection. Data of morphological, cytological, biochemical and PCR studies of stomach mucosa have shown high level of H. pylori colonization at all patients. The same methods of investigation for oral cavity revealed presence of H. pylori markers in scrapings from root of the tongue, for the first time in mixed saliva.

Conclusion. Results of cytologic, histological methods, PCR -diagnostics were similar to those at application of rapid urease test which has been carried out for SM and OM that confirms high information value of this rapid test.

Aim of investigation. To study efficacy of prolonged veno-venous hemofiltration (PVVHF) in treatment of patients with liver cirrhosis (LC), complicated by hepatorenal syndrome (HRS) and resistant ascites.

Stuff and methods. Original study was carried out basing on 34 PVVHF procedures in 14 patients with HRS and ascites. Alcohol-induced LC was diagnosed in 7 cases, autoimmune cirrhosis – in 4 and viral etiology – in 4. Duration of PVVHF session was from 8 to 29 hs with an interval of 1,5–3 days according to gain in body weight of the patient, rate of diuresis and severity of uremia. This procedures was combined to paracentesis for patients with resistant ascites.

Results. PVVHF procedures resulted in significant decrease of serum urea and creatinine levels, restitution of hourly diuresis rate. Significant increase in contents of sodium in plasma from 131±5,3 to 140,6±3,8 meq/l and improvement of systemic and intrarenal hemodynamics was obtained. According to US data, signs of overhydration and free fluid in abdominal and pleural cavities considerably decreased. Increase in glomerular filtration rate allowed to decrease a dose of diuretic agents. Procedures were well tolerated by patients. Four of 14 persons (28,5%) were discharged from hospital with normal diuresis, in 6 (43%) the transplantation of liver with complete restoration of renal function in postoperative period was executed, 4 (28,5%) patients have died due to progressive multiorgan failure.

Conclusion. Addition of PVVHF to HRS complex therapy enables to improve quality of life, increase survival rate and to provide support during search for donor organ for transplantation.

Aim of investigation. Assessment of diagnostic accuracy of non-invasive methods of diagnostics of liver fibrosis (elastometry, fibro-and acti-test) at patients with chronic viral hepatites (HVH).

Stuff and methods. Overall 100 patients with chronic hepatites HCV and HBV underwent investigation including a needle liver biopsy, elastometry, fibro-and acti-test.

Results. Maximal diagnostic accuracy of elastometry was found at HVH patients at F3 stage of fibrosis – 92,5% (AUROC 0,92) and F4 – 96% (AUROC 0,96), that was comparable to results of semiquantitative morphological assessment by METAVIR system. The average index of liver elasticity was 3,5±0,5 kPa for F0 and 6,5±1,5 for F1 stages of fibrosis respectively. Sensitivity (Se) of elastometry for F1 stage of fibrosis was 66%, specificity (Sp) – 83%. The factors influencing diagnostic accuracy of elastometry included: age of the patient ≤ 50 years OR 0,96 (95% CI 0,95–0,97; р<0,0001); BMI ≤25 kg /m2 OR 0,19 (95% CI 0,12–0,29; р<0,0001); absence of steatosis according to liver biopsy OR 1,006 (95% CI 1,002–1,009; р<0,0001). Elastometry appeared non-informative in 6% of patients (BMI ≥28 kg/m2). According to fibro-test data Se was 70%, Sp – 85% for F1; Se – 80%, Sp – 100% for F2; Se – 100%, Sp – 100% for F3; Se – 100%, Sp – 100% for F4 stages of a fibrosis. On data of acti-test Se was 68%, Sp – 75% for А0; Se – 83%, Sp – 82% for А1; Se – 87%, Sp – 88% for А2; Se – 98%, Sp – 97% for А3 stage of histological activity on METAVIR system.

Conclusion. Results of elastometry, fibro-and actitest are highly informative at all stages of liver fibrosis and can be applied for non-invasive diagnostics at patients with chronic viral hepatites.

Aim of investigation. Complex analysis of a spectrum of somatic mutations in TP53, APC, k-Ras and BRAF genes in Russian patients with malignant neoplasms, polyps and inflammatory diseases, evaluation of diagnostic information value of such analysis.

Stuff and methods. Analysis of somatic mutations of APC, k-Ras, TP53 and BRAF genes in biopsy samples or surgical specimens in patients with adenocarcinoma (n=24), adenomatous polyps (n=37), hyperplastic polyps (n=17) and inflammatory bowel diseases (n=69), as well as for patients with irritable bowel syndrome, that formed a control group (n=25) was carried out. DNA sequencing was performed with the ABI Prism BigDye Terminator Cycle Sequencing Ready Reaction Kit on the ABI Prism 3100 Genetic Analyzer («Applied Biosystems», USA; «Hitachi», Japan) according to the manufacture manual as well as with use of original mass-spectrometry minisequencing method.

Results. 50 pathogenic somatic mutations were determined: 31 – in APC gene, 5 – in k-Ras gene and 14 – in TP53 gene. Mutations in BRAF gene were not revea­led. 12 novel somatic mutations of APC gene and one extended deletion in gene TP53 were revealed. General detectability of mutations in adenocarcinoma patients was 66%, in adenomatous and hyperplastic polyps – 49 and 59% respectively. Mutations were not found in patients with inflammatory bowel diseases and control group patients. Potential diagnostic sensitivity of these mutations for diagnostics of colorectal neoplasms was 58% (95%-confidence interval was 47–69%) at 100%- specificity of the method.

Conclusion. Statistically significant difference in TP53 gene mutation frequencies in patients with adenocarcinomas and patients with benign colorectal neoplasms (p=0,02) was demonstrated. Information value of the studied genetical markers for early diagnostics of colorectal cancer and evaluation of clinical and morphological features of disease is discussed.

The aim of review. To present characteristics of antibiotics, applicable for H.pylori eradication.

Recent literature data. Antibiotics, along with antisecretory drugs (proton pump inhibitors – PPI), are obligatory components of eradication modes for H. pylori-associated diseases. High efficacy of the first line algorithms including PPIs, amoxicillin and clarithromycin, is proved by a number of randomized clinical tests, metaanalyses of these tests and established by the international consensus meetings (Maastricht consensus I–III). Components of this mode have synergetic effect: at combined application of clarithromycin and omeprazole blood concentration of the latter and its half-life time increase. At concurrent intake of omeprazole clarithromycin shows similar changes of pharmakokinetics that is liner increase of concentration and active metabolism in stomach mucosa and gastric mucus.

Conclusion. Efficacy of this treatment, confirmed by high, over 80%, H. pylori eradication rate, safety and good tolerability, is caused by synergism between components of the mode, first of all between PPI and clarithromycin.

Aim of investigation. To analyze results of the reconstructive surgery at double-barrel ileo-and colostomas.

Stuff and methods. Overall 161 patient were enrolled to original study. Of them 80 patients surgery was limited to the stoma part of the large intestine (1st group). For 81 patients elimination of the disease resulted in stoma formation was combined to concurrent liquidation of the stoma (2nd group).

Results. Postoperative mortality in the 1st group was 1,25%, and zero in the 2-nd group. The incompetence of interintestinal anastomosis (in 3 patients of the 1st group) has developed only at attempt to preserve the back wall of stoma. The total rate of wound-related complications in the site of stoma was 4,9%.

Conclusions. Simultaneous intervention with elimination of the disease, that caused development of a stoma, with its simultaneous liquidation is safe enough. The method of liquidation of double-barrel stoma with resection of stomated intestine and formation of circular interintestinal anastomosis is more preferable. Simultaneous correction of aponeurotic defect in the site of stoma and formation of postoperative scar with good cosmetic effect is also possible.

The aim of publication. To demonstrate new procedure of stomach and duodenum endoscopy with application of NBI-technology.

Stuff and methods. Potentials of the known endoscopic of chronic gastrites diagnostics described in the literature for revealing a gastric mucosa metaplasia are presented. Subjective quality of duodenal mucosa evaluation is marked.

Results. According to the data of endoscopic investigations involving NBI-technology, that were carried out for 65 patients with chronic inflammatory diseases of the stomach and duodenum, the first results were assessed in comparison with routine methods.

Conclusions. Application of NBI-technology at endoscopy improves visualization of inflammatory changes at mucosa of the stomach and duodenum, provides more precise sampling for further histological study from foci of intestinal metaplasia that increases the rate of detectability.

Aim of investigation. Retrospective evaluation of endoscopic resection of the large intestine mucosa for non-polypoid lesions was carried out with account for histological pattern, technique of resection, complications and relapses.

Stuff and methods. 76 non-polypoid lesions in 58 patients were removed. All patients previously underwent total colonoscopy by EC450 HL5 («Fujinon», Japan) or CF-230I («Olympus», Japan) endoscopes with preparation by fortrans (macrogoal), «Ipsen» company (France). Resection included following stages: guided chromoscopy by 0,5% indigo carmine solution, submucosal injection of fluid (1:10 000 epinephrine solution) by NM-220L needle («Olympus», Japan), erasion by SD-16U-1 or SD-17U-1 loop («Olympus», Japan).

Results. The majority of lesions – 45 (59,2%) were adenomas of 0-IIa type and were localized in right-sided regions of large intestine. Of 15 neoplasms with 0-IIс component in 9 cases dysplasia and in 3 – adenocarcinoma were revealed. At the absence of 0-IIc component (61 tumor) dysplasia was observed in 14 cases and adenocarcinoma – in one case. E n-block erasion was done in 67 (88,2%) cases, resection by several fragments – in 9 cases (11,8 %). All, but 2 tumors that have been removed in parts, were over 20 mm in size.

Conclusions. Endoscopic resection of the large intestine mucosa with pathological lesion is a safe and effective method for non-polypoid neoplasms treatment and is a method of choice for lesions less than 20 mm in size. Presence of 0-IIс focus significantly correlates to the presence of dysplasia or adenocarcinoma.

The aim of the review. To study psychopathologic disorders in patients with irritable bowel syndrome (IBS).

Recent literature data. Evaluation of mental disturbances at IBS patients shows, that this syndrome can be related to psychosomatic pathology as it contains all three characteristic attributes of these diseases. Psychopathologic disorders in patients with IBS, show as three basic syndromes – anxiety, depression (with asthenia) and hypochiondrial changes. Domination in clinical pattern of a certain psychopathologic syndrome can be determined by clinical variant of IBS.

Conclusion. Psychopathologic disorders are frequent at irritable bowel syndrome that makes expedient involvement of psychiatrist in treatment of such patients.