The aim of review. To present results of original studies of the author and his collaborators, conforming to literature data on transport of digestive enzymes to blood, physiological role of this process and signal role of enzymes.

Key points. Digestive glands have dual function mode. Enzymes are transported from glands to blood flow by endosecretion of glandular cells, resorption from ducts and lumen of small intestine. Exosecretions of glands have two pools of enzymes: de novo secreted and recreted from the blood. Enzymes are recreted by nondigestive glands as well. Enzymes of the gastro-intestinal tract lumen and circulating in the blood carry out hydrolytic and signal function. The latter is realized both within digestive system and outside of it. The gland ductal system takes part in adjustable endo- and exosecretory enzyme redistribution.

Conclusion. Endosecreted, exosecreted and resorbed enzymes of digestive glands play role not only as accelerators of nutrient hydrolysis, but also signal molecules in modulation of alimentiry and nondigestive body functions. The ductal system of glands participates in adjustable transformations of enzyme spectrum of exosecretions.

Aim of investigation. To analyze results of diagnostics and treatment of difficult forms of choledocholithiasis.

Material and methods. Difficult forms of choledocholithiasis (large size, atypical improper shape and localization of stones, alteration of anatomy of pancreatobiliary area) were revealed in 275 patients. At admission obstructive jaundice was present in 202 (73,5%) of them, cholangitis – in 67 (24,4%), acute biliary pancreatitis – in 8 (2,9%). Surgical treatment was started with transpapillary operations.

Results. In 12 (4,4%) patients transpapillary procedures appeared to be impossible, all of them have been operated by surgically. Endoscopic operations were carried out for remainder 263 patients (95,6%) that allowed to resolve obstructive jaundice, and only at 65,8% of patients – to sanify bile ducts completely. Complications of endoscopic treatment developed in 22 (8,4%) cases. The surgical choledocholititomy was executed in 57 patients, complications develop in 21 (36,8%). The mortality in group with difficult choledocholithiasis was 5,1%. At analysis of the causes of neglect of disease in difficult choledocholithiasis patients it was revealed, that the majority of them (217 – 78,9%) had a long history of gallstone disease (GSD). Various surgical interventions for biliary tracts were carried out to 27 patients. Part of patients (84) received conservative therapy for biliary colic and complications of GSD, abandoning of operative treatment resulted in, first, development of severe complication – choledocholithiasis, second, development of unfavorable anatomical conditions for its noninvasive resolution.

Conclusion. Complex anatomical conditions in patients with choledocholithiasis basically develop as a result of overdue surgical treatment of gallstone disease. The main cause of delay in cholecystectomy is unjustified long-term and ineffective conservative treatment.

The aim of review. To analyze publications in the world scientific literature on relation between druginduced liver injury and genetic polymorphism of enzymes and transport systems, xenobiotics involved in metabolism.

Key points. Drug-induced liver injury can be accompanied by wide spectrum of clinical symptoms, ranging from asymptomatic elevation of aminotransaminases activity to development of fulminant liver failure. The most cases are related to idiosyncrasy phenomenon which is based on genetic predisposition for production of reactive metabolites at xenobiotic transformation reactions in the liver. Types of genetic polymorphism known for today to be associated with the risk of druginduced liver injury are presented in this article. The perspective trends in diagnostics based on application of molecular genetic methods are taken into account as well.

Conclusion. Studies of genetic polymorphism of enzymes and transporters involved in xenobiotic metabolism in the liver, looks to be perspective. Data of investigations allow to expand the concept of pathogenetic mechanisms of drug-induced liver disease, that, in turn, promotes development of the test systems providing diagnostics at molecular genetic level.

Aim of investigation. To estimate frequency of late relapses and clinical outcomes in patients with chronic hepatitis C (CHC) with sustained virologic response (SVO) achievement at antiviral therapy (AVT).

Material and methods. Overall 208 patients with CHC, including 12 at the stage of liver cirrhosis (LC), who achieved SVO were investigated. Mean duration of the follow-up was 56,1±35,4 months. Standard clinical and laboratory investigation and evaluation of RNA HCV was carried out. In 114 patients RNA HCV and DNA HBV in blood serum and peripheral mononuclear blood cells were studied by polymerase chain reaction (PCR) with fluorescent hybridization detection in «real time» mode (sensitivity of 10 IU/ml for HCV and 5 IU/ml for HBV).

Results. In 3 (1,5%) patients late (i.e. over 6 months after AVT) relapses of HCV-infection were observed. Application of ultraresponsive PCR method allowed to reveal relapse half a year prior to its clinical and laboratory manifestation in 2 cases. No data on latent HCVinfection was obtained not in a single case, including patients with relapse of cryoglobulinemia syndrome. A principal cause of elevation of alanine transaminase activity was non-alcoholic steatohepatitis. In one LC patient development of esophageal varicose veins was detected. There were no cases of decompensation of LC, hepatocellular carcinoma and death due to liver disease.

Conclusion. At patients who have achieved SVO as a result of AVT, late relapses of HCV-infection are rare and in the majority no disease progression was found. Relapses of cryoglobulinemia syndrome were observed, but data on presence of latent HCV-infection were not received. Highly sensitive PCR methods are rational for assessment of SVO.

Aim of investigation. To determine efficacy and safety of budesonide and prednisolone at alcoholinduced hepatitis (AH) of severe course on development of inflammation and results of the functional hepatic tests, to estimate treatment response and short-term survival rate of patients.

Material and methods. Original study included 37 patients with acute AH, that have been selected from 3 medical centers and randomized in two groups. The first group included 17 patients (7 men, 10 women, mean age 46,53±11,01 years). Median of daily alcohol dose was 77 g; 25th and 75th percentiles were 55 and 96 g; duration of intake 13,41±8,55 years. Mean Maddrey index (MI) was 65,22 (37,2 to 145,4). The second group included 20 patients (16 men, 4 women, mean age was 46,5±11,89 years). A median of used alcohol consumption was 70,55 g/day (25th 75th percentiles were 37 and 88 g), duration of intake — 16,85±13,32 years. Mean MI – 58,11 (32,1 to 121,7). Groups were comparable for main clinical and laboratory features. In the first group oral budesonide 9 mg/day per os was applied, in the second – oral prednisolone 40 mg/day. Lille index was used as treatment response criterion. Following statistical criteria were used for data processing: χ2, Wilcoxon, Mann-Whitney, Kaplan – Mayer method.

Results. At comparison of treatment efficacy (р=0,810) and short-term survival rate (р=0,857) no significant differences were obtained. At treatment safety analysis in the first group adverse events (AE) were registered in 23,5% of cases (in 4 of 17 patients), in the second group – in 70% (in 14 of 20 patients, р=0,011). Hepatorenal syndrome was significantly more frequent in the second group (р=0,033).

Conclusions. Short-time survival in budesonide and prednisolone group does not differ significantly. At application of prednisolone frequency of AE is higher as a whole, particularly – hepatorenal syndrome.

Publication is intended for clinicians dealing with patients who have abnormal blood biochemical tests. Nowadays investigation of blood biochemistry scores, which reflect functional state of body organs and systems, deeply settled in medical practice. Correct understanding of these results helps to diagnose, stage the disease, prescribe treatment and control its efficacy. Features of differential diagnosis and medical approach in patients without any clinical symptoms is actual and common issue faced by many general practitioners every day. As a rule, elevation of activity of alanine and-or aspartate aminotransferases (ALT, AST) is considered as highly significant marker of hepatocyte damage. However, it is necessary to remember, that far from all patients with raised level of aminotransferases have serious liver diseases. More often doctor should interpret elevation of level of ALT and-or AST in patients with obesity, diabetes mellitus, disorder of lipid metabolism or in the case of absence of clinical symptoms of any disease. In presented article issues of patient management with asymptomatic elevation of ALT and AST activity are covered both general-theoretical, and practical points of view. Screening markers and specifying diagnostic tests are necessary to diagnose correct the majority of liver diseases – viral hepatites, alcoholic (ALD) and non-alcoholic fatty liver diseases (NAFLD), autoimmune hepatitis (AIH), Wilson diseases, primary hemochromatosis etc. States at which in absence of primary liver disease levels of ALT and AST can raise are described.

The aim of review. To present analysis of data on immunopathogenesis of inflammatory bowel diseases.

Key points. At genetically sensitive animals inflammatory bowel diseases (IBD) develop at various effects on innate and adaptive systems of immune defense (knock-out and transgenic mice), causing changes of expression of significant immunologic factors with distortion of pro- and anti-inflammatory cells and molecules ratio at their contact to microbiota structures. The physiological state of intestine is characterized by balanced interaction of effector (Th1, Th2, Th17) and regulatory (Treg) cells determining presence of immune tolerance to resident microflora antigens. Innate immunity changes revealed in last years, related to mutations of genes of bacterial structures receptors (NOD2, toll-like receptors, autophagy), cause disorder of endocellular signal processes and pathological activation of cells of adaptive immunodefense of intestinal mucosa and conforming profile of cytokines with development of chronic inflammation which will be mediated: at Crohn's disease – by Th1-and Th17-cells, cytokines IL-12, interferon-γ etc., at ulcerative colitis – by Th2-and NKT-cells, cytokines IL-4 and IL-3 in combination to incompetence of suppressor function of regulatory Т-cells and their cytokines TGF-β (transforming growth factor) and IL-10.

Conclusion. Investigations of experimental enterocolites and human IBD confirm immunologic hypothesis of pathogenesis: relation of their development to defects of innate and adaptive immune system.

Aim of investigation. Evaluation of quality of life and studying of long-term results of treatment in patients after rectocele surgery.

Material and methods. Original study included patients (n=41), operated in State Scientific Center of Coloproctology for rectocele in 2007 to 2011. Age of patients was 24 to 64 years (mean —48,95±9,09). The plasty of rectovaginal septum was executed by an implant in 23 patients (56,1%), in 18 (43,9%) Longo's procedure, including combination to plasty of rectovaginal septum by polypropylene implant in 9 cases (21,6%). Results of surgery were estimated in terms of 6 to 60 months after operation. The median follow-up period was 36 months.

Results. Good and satisfactory results of treatment were achieved in 28 (70,7%) patients. improvement rectum function was marked in comparison to preoperative period. Unsatisfactory results were registered in 12 (29,3%) patients which postsurgical state did not improve.

Conclusion. Analysis of results indicated, that evacuatory function of the rectum in the first 2 years after operation improved at 85,4% of patients, however eventually in 46,3% it worsened. It was found also, that results of operation did not depend on the method of rectocele surgery. During the study statistically significant factors influencing results of rectocele treatment were revealed: age of patients, duration of constipation and number of deliveries in past history, as well as the presence of internal rectal intussusception.

Ye.S. Ageyeva – Molecular and cellular bases of Helicobacter pylori-associated disease immunopathogenesis at Khakasia population.

Yu.V. Embutnieks – Bone mineral density in patients with digestive diseases.