The aim of review. To discuss relation of obesity to phenomena of insulin resistance and lipotoxicity, and to demonstrate main therapeutic directions of their correction.

Original positions. The most serious metabolic disorders related to obesity, include non-alcoholic fatty liver disease (NAFLD), diabetes mellitus, systemic hypertension with gradual development of heart failure, dyslipidemia, night apnea, etc. Recently scientists are more involved into the concept of limitation of fat tissue capacity to increase its volume as a factor associating obesity to metabolic syndrome and NAFLD. According to this hypothesis it is possible to explain phenomenon of severe obesity without development of metabolic complications. Within the same concept the role of differences in sets of nuclear receptors expressed in the liver of healthy persons and patients with NAFLD is taken into account. It is possible to explain lipotoxicity phenomenon as follows: in conditions of insulin resistance glucose stops to be an energy source and is substituted by lipolysis, therefore a plenty of free fatty acids is formed, having potential of toxicity and realizing metabolic disorders in target organs: the liver, the pancreas, muscles. New data on pathogenesis of metabolic disorders at obesity assume changes in comprehension of therapeutic actions. In 2008-2009 data on efficacy in treatment of insulin resistance and NAFLD of such pharmacological compounds, as glitazones, metformin, complex silibinin/phosphatidylcholine, ursodeoxycholic acid were published.

Conclusion. In most cases the significant decrease of body mass is combined to resolution and better control over concomitant diseases. Recent studies demonstrated, that the visceral fat is in the higher degree associated to insulin resistance and the increased cardio-vascular risk while subcutaneous fat is metabolically more inert. In this aspect it is necessary to focus on glitazones (PPARs ligands), metformin among pharmacological substances, which has no influence on insulin secretion, however it has a lot of extrapancreatic effects by which it reduces increased concentrations of glucose in blood, improves tissue sensitivity to insulin and, thus, increases uptake of glucose by liver and muscles cells. In 2009 results of clinical and experimental researches which show significant efficacy of ursodeoxycholic acid at a dose of 30 mg/kg in treatment of non-alcoholic steatohepatitis and major therapeutic potential of silibinin and silibinin/phosphatidylcholine complex at non-alcoholic fatty liver disease were submitted.

The aim of review. Studying of effect of antiviral therapy on regression of fibrosis in chronic hepatitis B.

Original positions. Article presents analysis of the largest investigations estimating effect of interferon α and nucleoside/nucleotide analogues on development of liver fibrosis. Decrease of severity of fibrosis (for prophylaxis of liver cirrhosis and hepatocellular carcinoma development) is one of the basic criteria of efficacy of treatment of chronic liver diseases. Now various strategies of influence on fibrosis are discussed, including elimination of etiological factor, suppression of inflammation and specific antifibrotic therapy.

Conclusion. Successful antiviral therapy at chronic hepatitis B (continuous suppression of replication of virus and activity of inflammation in the liver) results in regression of fibrosis, including cirrhotic stage, and is associated with improvement of patients’ survival rate.

The aim of review. Analysis of literature data on the possible causes of fever at patients with disorders of liver function. Article presents pathophysiological mechanisms of development of fever. The algorithm of assessment of patient with disorder of liver function and fever is submitted.

Original positions. Fever in patients with liver failure can be caused both by infectious and non-infectious causes. Infections are the most frequent causes of fever at disorder of the liver function, that accounts for immunodeficiency state at this category of patients. An important role in development of fever at patients with liver cirrhosis is bacterial overgrowth syndrome, bacterial translocation processes and, as a consequence, endotoxemia. If the site of infection is not detected, it is necessary to keep in mind the option of development of non-infectious fever within acute phase reaction, neoplastic process or reaction to applied pharmaceutical agents.

Conclusion. At development of fever at patients with liver failure carrying out differential diagnostics of the causes of body temperature elevation is necessary that allows more differentiated approaches to treatment.

Aim of the review. To present up-to-date management approach to biliary cysts of the liver and polycystosis.

Original positions. Opinions of surgeons differ in the issue of whom and when to operate, as well as in the choice of intervention procedure. At polycystosis, patients with the II type liver cysts (by J.Gigot classification) are exposed to treatment. At the presence of cysts of the III type, when the massive lesion of parenchyma takes place (>70%), there is no alternative for liver transplantation. At present there is no uniform medical approach in relation to diameter of cysts that results in application of various methods of treatment. Following variants are defined: 1) percutaneous puncture and drainage of cysts with injection of sclerosing agents; 2) laparoscopic erasion of free walls of cysts with impact on remaining epithelium; 3) erasion of cysts by laparotomic access. Laparoscopic resection of cysts is considered to be the optimal method that is low traumatic, with low frequency of relapses (0–4%) and minimum duration of hospital stay.

Conclusion. Only 5–10% of patients with not parasitic (biliary) cysts of the liver are subject to surgical treatment, the others should be observed either by gastroenterologist, or by surgeon of out-patient department.

Aim of investigation. To study at two models of immune hepatitis (Т-cellular and antibody origin) in mice damage of the liver, activity and destruction of its immunocompetent cells, thymus gland and the spleen, as well as the effect of curcumine — inhibitor of NF-κB activation on development of pathological process.

Material and methods. An immune lesion of the liver in mice of СВА line was invoked by Т-cellular mitogen concanavalin A and xenogenic anti-liver antibodies. Study was carried out with application of histological, cytological and biochemical methods.

Results. In comparative studies features of hepatitis development of cellular and antibody origin were revealed. At Т-cellular hepatitis cytolytic component of liver lesion, primary and secondary cell necrosis, depression of cytophagous activity of macrophages that causes preconditions for enhancement of inflammation were more intensive. At hepatitis of antibody origin, at least at early stages, vascular and immunological reactions are expressed in the liver.

Conclusion. Curcumine, the inhibitor of NF-κB activation reduces preconditions for development of inflammatory response at experimental Т-cellular hepatitis, and has protective action for the liver.

Aim of investigation. To evaluate expediency of testing for carbohydrate-deficient transferrin for diagnostics of alcohol intoxication.

Material and methods. For 1996-2007 overall 978 patients with liver cirrhosis (LC) were investigated, including 531 patients with alcoholic LC, 189 patients with HBV-related LC and 258 patients with HCV-related LC. One hundred and three patients taking alcohol (as two subgroups) were tested for carbohydrate-deficient transferrin – a marker of chronic alcohol intoxication. In 56 patients (54,4%) asialoglycoside transferrin was studied, in 47 (45,6%) – all spectrum of sialoglycoside transferrin deficiency: a-, mono-, bi- and three- sialotransferrin deficiency.

Results. Growth of alcohol consumption by population in the country resulted in increase of number of patients with alcohol-induced LC. It account for 3,5 times more deaths (78,0%), than all viral LC. Results of these investigations demonstrated, that at testing only for asialotransferrin positive result was obtained only in 3 (5,4%) patients admitted to the hospital with severe manifestations of acute alcoholic hepatitis. At assessment of integral deficiency of transferrin, changes have been found in 36 (76,6%) patients. It confirms high diagnostic capacity of this method in testing for chronic alcohol intoxication.

Conclusion. In the last decade the number of patients with alcohol-induced LC with lethal outcome essentially exceeded number of patients, died of viral LC. Assessment of integral deficiency of transferrin is highly informative method of diagnostics of chronic alcohol intoxication.

Aim of investigation. To study parameters of activity of liver tissue enzymes and blood lymphocytes in children with chronic viral hepatitis B (CVH B).

Material and methods. 20 patients with CVH B in the age of 12 to 15 years were investigated: 10 children – with the 2-nd stage of process chronization and 10 – with the 3-rd stage. In liver tissue obtained at guided biopsy, and in lymphocytes discharged from blood activity of metabolic enzymes was determined by bioluminescent method.

Results. Metabolic reactions in liver tissue of children depend on stage of chronization of process, at the 3-rd stage the functional lesion of liver cells it is more profound. Metabolism of lymphocytes in children depend on severity of disease as well, thus at children with the 3-rd stage of chronization more severe functional depression of lymphocytes took place.

Conclusions. Intensity of reactions of metabolism of liver cells and lymphocytes in 12–15 years old children with CVH B, depends on stage of chronization of infectious process. Lesions of liver cells and lymphocytes are more profound at the 3-rd stage, than at the 2-nd. Pattern of interrelation of enzyme scores of the liver and lymphocytes allows to postulate, that the latter reflect specificity and orientation of metabolic changes in liver tissue.

Aim of investigation. To estimate various variants of surgical treatment of acute biliary pancreatitis at patients of over 60 years old, to develop a method of cholecystectomy at the large Hartmann pouch adherent to biliary tracts, to decrease such complications, as bleeding, bile leakage, damage (intersection) of common bile or common hepatic duct.

Material and methods. Patients separated into 3 groups in relation to operative access. The first group – (67 patients) was operated by traditional surgical access. The second group (54 patients) was operated through miniaccess with the help of «Generalpurpose frame wound retractor», of them 34 patients with large Hartmann pouch adherent to biliary tracts, were operated by the proposed method (patent of the Russian Federation #2358663 under application #2008103639, priority 30.01.08; registered on 20.06.2009; bulletin #17). The third group (61 patients) was operated by laparoscopic method. The mean age of patients in groups was 73,1 years. In 100% of cases patients had two and more concomitant diseases. The main type of surgical intervention in groups – was cholecystectomy, drainage of common bile duct by Pikovsky, drainage of abdominal cavity.

Results. At traditional cholecystectomy postoperative complications develop at 44,8% of patients: eventration – 7,5%, subphrenic abscess – 6%, suppuration of postoperative wound – 11,9%, pneumonias – 8,9%, pancreatonecrosis – 10,4%. After minilaparotomy in postoperative period at 9,3% of patients following complications developed: incompetence of cystic duct stump and bile leakage – 3,7%, suppurations of postoperative wounds – 3,7%, pneumonia – 1,9%. Conversions were registered in the main group at 5,6 % of patients. After videolaparoscopy complication were observed at 14,8 % of patients: damage of common bile duct, postoperative bile leakage – 3,3%, incompetence of stump of cystic duct – 1,6%, residual choledocholithiasis with accompanying obstructive jaundice – 3,3%, pancreatonecrosis – 6,6%.

Conclusions. The proposed method of cholecystectomy at large Hartmann pouch adherent to biliary tracts, allows to decrease such complications as bleeding, bile leakage, excludes damage of common bile duct.

The aim of the publication. The case of abnormal elevation of alpha-fetoprotein (AFP) in a patient with autoimmune hepatitis (AIH) of the 1-st type is submitted.

Features of clinical case. At a 17 years old female patient AIH of 1-st type debuted by jaundice, severe rise of transaminase activity and level of gamma-globulins. Manifestations of AIH, at first glance were typical, accompanied by over 200-fold elevation of serum concentration of AFP that required differential diagnostics with hepatocellular carcinoma. Achievement of immunosuppressor-induced remission resulted in normalization of AFP level.

Conclusion. Derepression of respective gene may serve as the mechanism of serum AFP concentration increase at active hepatitis which, however, in absence of neoplastic proliferation is under control of certain regulatory factors. Over 200-fold elevation of AFP level in presented case, that rapidly decreased up to normal level under the influence of successful immune suppressive treatment, can be hard to explain from traditional point of view. Apparently, it is necessary to take into account specific features of AFP synthesis regulation, manifested at vast destruction of hepatic parenchyma.

The aim of review. To present world literature data on epidemiology, features of course and diagnostics of gastroesophageal reflux disease (GERD) at children at different age.

Original positions. Now the major attention is given by gastroenterologists and pediatrists to GERD at children, probability of its progression and development of complications in advanced age. Manifestations of GERD at children are different in various age-grades. At the first year of life of GERD manifests by regurgitation and vomiting. In most of the cases these symptoms are regarded to be physiological. However frequent regurgitation in this period of life is related to probability of further development of typical symptoms of GERD in these children. Along with growth, symptoms of GERD in children become more specific and similar to manifestations of disease at adults for whom the heartburn and acidic belching are considered as the most typical complaints. Basic methods of instrumental diagnostics of GERD and its complications at children, as well as at adults, include esophagogastroduodenoscopy and 24-hour esophageal and gastric рН-monitoring. However at children, there is no interrelation of clinical, endoscopic and рН-metrical changes severity.

Conclusion. Above mentioned data testifies the absence of clear diagnostic criteria of GERD at children. For more exact diagnostics of GERD at pediatric age complex investigation of the child is required.

Aim of investigation. To estimate efficacy and safety of various variants of sclerosing treatment of hemorrhoids at patients with severe concomitant diseases.

Material and methods. At 13 patients with chronic hemorrhoids of 2–4 stages sclerosing treatment in combination to ultrasound cavitation, at 14 patients – sclerosing treatment without additional procedures was carried out.

Results. Good and satisfactory results of treatment (termination or essential decrease of frequency and intensity of bleedings, decrease of degree of prolapse of hemorrhoids) after a week and month in both groups were identical. In 12 months good result after sclerosing treatment in combination to ultrasound cavitation is ascertained in 58,3% of cases, in the other group – in 15,4% (p<0,05).

Conclusion. The best long-term results were obtained after application of sclerotherapy with ultrasound cavitation, allowing to liquidate completely or considerably decrease severity of basic signs of chronic hemorrhoids.

Aim of investigation. Evaluation of potentials of «dulcolax» for preparation for colonoscopy.

Material and methods. Preparation for colonoscopy at versatile hospital was applied by oral intake of macrogol-based preparation (2–2,5 l of solution) in combination to 20 mg of bisacodyl (dulcolax) in 50 patients. Patients of comparison group received a full dose of macrogol (4 l).

Results. Preparation quality in clearing of intestine appeared to be comparable in the main and control groups. At the same time patients of a basic group less often had unpleasant symptoms and they had no adverse effects related to intake of main laxative.

Conclusion. Dulcolax can be used as additional agent in preparation for colonoscopy to minimize adverse effects related to this procedure, and improvement of its end result.