The aim of review. To demonstrate features of application of up-to-date methods of evaluation of various functions of the stomach in clinical practice.

Original positions. In the review qualities and faults of tube aspiration method of stomach secretory function investigation at continuous (complete) extraction of gastric juice are discussed as well as advantages of various methods of intragastric pH-metry. Advantages of modern multichannel рН-meters, potential of acquiring of the supplemental information by original methods of intragastric рН-grams analysis with application of various pharmacological and stimulaion tests are analyzed. Methods of studying of gastric juice proteolytic activity are compared. Diagnostic descriptive value of methods of electrogastrography and methods of mathematical analysis of electrogastrograms developed by the author, and potential of radionuclide methods are reviewed. Advantages of transillumination functional hemomotordynamic monitoring of the stomach and intragastric impedance measurement at studying functions of the stomach are shown.

Conclusion. The up-to-date methods of investigation used in clinical practice, allow to receive complete information on functional state of the stomach.

The aim of review. To discuss basic functions of microorganisms colonizing human gastro-intestinal tract (GIT), methods of diagnostics of their qualitative and quantitative composition, state at which imbalance of intestinal microflora is possible and treatment options.

Original positions. The human body is inhabited by approximately 500 species of microorganisms. Microflora of gastro-intestinal tract is most representative both by qualitative and quantitative composition. The density of bacteria steadily grows from quite mobile small intestine to less mobile large intestine. Microbiocenoses are characterized by complex hierarchical structure, various interspecies attitudes and carry out set of functions beyond GIT, i.e. immunomodulating, synthetic, absorptive, detoxifying, anticancerogenic, alimentiry, motor and protective. Now there are essentially two various approaches for assessment of intestinal microflora – direct and indirect. Direct methods are based on revealing of living culture. They include culture of smallintestinal aspirate or biopsy specimen. Indirect methods, like various breath tests are based on revealing of bacteria metabolism products in the exhaled air. In the last years in clinical practice chemical methods, in particular gas chromatography (GC) in combination to mass spectrometry (GC-MS) are actively developed, the method of fluorescent DNA hybridization in situ (FISH) is applied, polymerase chain reaction (PCR-diagnostics) became quite widespread method of microorganisms assessment. The range of diseases accompanying by imbalance of intestinal microflora, is outlined quite presumably. Probiotics can be applied for treatment of disordered intestinal microflora, defoamers — as symptomatic treatment. However the theoretical base explaining action of these agents, remains poor, that requires the further studies in this area.

Conclusion. Intestinal microflora is integral part of each individual. Further studying of its functions, the states interfering qualitative and quantitative composition of microorganisms, colonizing human gastrointestinal tract, as well as the mechanism of action of probiotics and drugs of symptomatic action (defoamers) is necessary.

Aim of investigation. To analyze potentials of transcutaneous US in assessment of local progression of cancer of cervical and upper thoracic regions of the esophagus.

Material and methods. Investigation with application of transcutaneous US of neck and mediastinum was carried out in 432 patients with esophageal cancer. Involvement of cervical and upper thoracic parts was present in 38 patients, 22 of them were operated. Results. US allowed to visualize involvement of cervical and upper thoracic regions of the esophagus in all patients, to detect extent of the lesion, to diagnose correctly depth of invasion, neighboring organs and structures involvement.

Conclusions. Transcutaneous US is effective method of visualization of cancer of cervical and upper thoracic regions of the esophagus, assessment of depth of tumor invasion and involvement of neighboring organs and structures in this group of patients.

Aim of investigation. To study potentials of modern therapeutic and diagnostic methods in patients with bleeding non-epithelial tumors of the gut.

Material and methods. In 52 patients for assessment of localization, structure and character of proliferation of tumor modern radiological and endoscopic methods were applied: balloon and videocapsular endoscopy, selective angiography, computer tomography, endoscopic ultrasonography with fine-needle biopsy.

Results. According to suggested diagnostic algorithm detailed characteristic of patients with bleeding tumor was given, the optimal method of surgical intervention was chosen. In 13 (25%) of patients primary endoscopic hemostasis was carried out. Thirty five patients were operated (67,3%), and in 8 (22,8%) of them endoscopic erasion of bleeding non-epithelial tumor was carried out. In 4 cases (7,7%) intraoperative complications developed, after operation 1 patient (2,9%) died of pulmonary artery thrombembolism, overall mortality was 3,8% (2/52).

Conclusions. Non-epithelial tumor of gut in 29,1% of patients are complicated by gastro-intestinal bleeding that is indication for surgical treatment. Proposed algorithm of diagnostics and treatment, that includes primary endoscopic hemostasis allows to avoid urgent intervention in 94,3% of patients and to execute it in the late stage, while in 22,8% to carry out noninvasive intraluminal surgery as a final treatment.

The aim of review. To generalize literature and authors own data on clinical and laboratory criteria of primary biliary cirrhosis (PBC) diagnostics and treatment.

Original positions. PBC is organ-specific autoimmune liver disease affecting predominantly women that is characterized by chronic progressing destruction of intrahepatic bile ducts with portal inflammation, resulting in development of liver cirrhosis (LC). АМА-positive (classical) variant of PBC with pruritus, jaundice, biochemical syndrome of cholestasis and revealing of AMA in diagnostic titer (more 1:40) in blood serum is defined; АМА-negative variant of PBC with lower biochemical and immunologic activity, lower frequency of extrahepatic manifestations, that, however, does not influence the prognosis and terms of LC progression; overlap syndrome with autoimmune hepatitis (AIH) – PBC/AIH (9,4%); asymptomatic course of PBC which is characterized by absence of clinical symptoms for a long period and manifestation of disease at the stage of LC complications. Prescription of ursodeoxycholic acid (UDCA) results in significant decrease of intensity or its complete relief of pruritus, improvement or normalization of biochemical parameters and histological pattern of the liver, suppression of liver fibrosis and cirrhosis progression, and to decrease of portal hypertension. Combined treatment of UDCA and budesonide is proposed.

Conclusion. UDCA is pathogenicly proved treatment of PBC.

Aim of investigation. To estimate efficacy and safety of entecavir (ETV) in chronic hepatitis B (CHB) at renal graft recipients (RGR).

Material and methods. Four RGR with CHB on in mean 71,5±36,9 month after kidney transplantation received treatment by entecavir. In 2 patients with CHB biochemical remission on background of previous lamivudine (LAM) treatment, who developed YVDD mutation ETV dose was 1 mg/day. One of them was HBeAgnegative prior to onset of LAM treatment, and the other developed HBeAg seroconversion while being at LAM treatment. The viral load before prescription of entecavir at these patients was 1,6×103 and 3,9×104 copies/ml respectively. Two other «naive» RGR with HBeAg-positive CHB, that were infected by HCV as well, received 0,5 mg/ day of entecavir. Activity of ALT was 98 and 149 IU/l, HBV viral load – 1,6×109 and 1,0×108 copies/ml. In all patients stage 1of fibrosis by METAVIR scale was determined. Calculated glomerular filtration rate was over 60 ml/min.

Results. Duration of ETV treatment in 2 RGR (that previously received LAM) with normal ALT level and low viral load was 13 and 23 months. In 6 months after treatment onset HBV DNA was not determined in blood of these patients. Duration of ETV treatment at «naive» patients was 26 and 24 months. Biochemical remission developed in 10 and 15 months after the start treatment. The viral load steadily dropped and HBV DNA elimination has been achieved in 25 and 23 months respectively. One of these patients had HBeAg seroconversion. During treatment no undesirable effects were marked. Function of renal graft remained stable in 3 patients and decreased in one case patient after development of acute rejection crisis on a background of decrease of dose of immune suppressants.

Conclusion. Entecavir demonstrated high effectiveness and safety at limited number of RGR with CHB in short-term course of treatment.

Aim of investigation. Studying of clinical and laboratory efficacy of dicarbamin as hematoprotector in patients with chronic hepatitis C (CHC) with 1b virus genotype at combined antiviral therapy (AVT) by pegilated interferons in combination to ribavirin.

Material and methods. Overall 110 patients with CHC (genotype 1b) with WBC count from 3,9 to 3,0×109/l and neutrophile count from 2,0 to 1,5×109/l according to TBC were under surveillance. Patients were divided to comparable groups by gender and age in relation to the treatment mode: the 1-st group (n=52) received peginterferon α2b + ribavirin, the 2-nd group (n=58) – peginterferon α2b + ribavirin + dicarbamin 100 mg od for 21 day. Subsequently dicarbamin was prescribed to all patients in the similar mode for 3 months.

Results. At combined AVT no undesirable effects as decrease of total leukocyte and neutrophile count were revealed. In the 1-st group leukopenia was observed from the 4-th week of treatment in 71%, neutropenia – in 69% of patients, similar parameters kept significantly lower during the whole course of treatment in comparison to the 2-nd group that resulted in dose decline of peginterferon α2b in 26,9% and cancellation of AVT in 9,6% of patients. At patients of the 2-nd group leukopenia was marked in 35%, neutropenia – in 46% of cases. No significant reduction of leukocyte and neutrophile count which could cause correction of dose or cessation of AVT has not been registered in this group.

Conclusions. Application of dicarbamin at combined antiviral therapy of CHC results in elevation of leukocyte and neutrophile count in the blood and allows to carry out treatment without dose decline and cancellation of peginterferon. High tolerability of AVT in CHC patients at application of suggested mode of treatment (peginterferon α2b, ribavirin and dicarbamin) was revealed.

The aim of review. To present modern data of foreign literature on efficacy of preparation of Silybum marianum – silymarinum at patients with alcoholinduced liver disease, non-alcoholic steatohepatosis and primary biliary cirrhosis.

Original positions. Analysis of literary data demonstrated, that silymarinum is a safe pharmaceutical and, despite of a plenty of clinical and experimental publications, its efficacy at alcoholic liver disease and primary biliary cirrhosis requires further studying as series of systematic reviews and metaanalyses are subject for discussion due to the absence of uniform methodological approaches, application of drugs with different pharmakokinetics and because of ignoring of evidencebased medicine requirements.

Conclusion. Application of the uniform silymarinum standard and carrying out of further investigations adhering to requirements of evidence-based medicine, should finally resolve present contradictions in assessment of efficacy of standardized silymarinum in patients with alcoholic liver disease, non-alcoholic steatohepatosis and primary biliary cirrhosis.

The aim of review. To present state-of-the-art and modern approaches to a problem of medical and social rehabilitation of stoma patients and disabled persons with nonspecific inflammatory bowel diseases.

Original positions. All innovational approaches and models in medical and social rehabilitation should be targeted and based first of all on patient’s personality. It is necessary to try actively to restore body functions impaired by disease, as well as his/her social interrelations, to improve quality of life. Expert rehabilitational diagnostics is important component in rehabilitational process for this category of patients and disabled persons.

Conclusion. Individual aftertreatment program should be developed individually for each stoma patient according to his/her rehabilitational potential. Efficacy and quality of medical and social rehabilitation of disabled persons with stoma depends on integrative interaction of team of various experts and introduction of interdisciplinary approaches and technologies in systemic process.

Aim of investigation. To improve of treatment results of patients with rectocele.

Material and methods. Overall 97 patients with rectocele of the 1–3rd degrees after surgery with application of transrectal proctoplasty were investigated.

Results. At rectocele of 1-st and 2-nd degree when the diverticulum-like protrusion of rectal wall according to X-ray data, does not exceed 4 cm, modified transrectal circular resection of mucosal-submucosal layer of low ampullary region of rectum is indicated. At rectocele 4 to 5 cm in size transrectal proctoplasty of the rectum by A. Longo with application of two staplers is recommended. At presence rectocele over 5 cm in size it is rational to apply this procedure with additional strengthening of rectovaginal septum by allotransplant.

Conclusions. Application of transrectal proctoplasty allowed to achieve permanent cure in all patients with no relapses of disease during follow-up from 1 month to 5 years.

The aim of publication. To estimate efficacy of multidisciplinary approach in treatment of patients with rectal cancer together with portal hypertension and liver cirrhosis using the example of clinical case.

Original positions. 71 year-old male patient with diagnosed low rectal cancer and concomitant: decompensated liver cirrhosis, portal hypertension with varicose esophageal and stomach veins and hepatocellular failure of class C by Child-Pugh. Patient was treated by simultaneous abdomino-perineal rectal excision with para-aortic lymphadenectomy and retroperitoneal end colostomy, splenectomy, devascularization of the stomach, gastrotomy with stitching of varicose veins at the lower third of the esophagus and the stomach. On the basis of foreign experience, risks of such surgical interventions were analyzed and, based on current clinical case, optimal surgical concept for patients of this category is proposed.

Conclusion. Multidisciplinary approach in diversified clinic allows to provide adequate treatment of patients with cancer of the rectum combined with portal hypertension and liver cirrhosis.

T.N.Sergeyeva – Polyps of cardioesophageal junction at children: causes, development, treatment approach and prognosis.