Vol 80, No 2 (2008)

Articles
Epigastric burning and gastroesophageal reflux disease: problems and solutions
Lazebnik L.B.
Terapevticheskii arkhiv. 2008;80(2):5-11
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Symptoms of gastroesophageal reflux and quality of life: population study
Reshetnikov O.V., Kurilovich S.A., Simonova G.I., Pylenkova E.D., Maliutina S.K., G Gorbunova O., Bogatyrev S.N.
Abstract
Aim. To study prevalence of symptoms of gastroesophageal reflux (GER) in a free living population and to evaluate quality of life (QOL) in this disease. Material and methods. The gastroenterological symptoms and QOL were studied in a representative sample of adult population of 495 males and 548 females aged 45-70 years using a validated questionnaire, SF-36 questionnaire. Results. GER symptoms were seen in 17.0% responders, with the same frequency in men and women, in responders of different age. QOL was worse in responders with GER by 2 scales of SF-36 questionnaire: in males - "general well-being" and "viability", in females - “general well-being" and “physical functioning". In persons who had visited a doctor QOL was lower by all 8 scales than in those who had GER symptoms but had not visited a doctor. GER prevalence in Russia is similar to that in the West Europe and USA. QOL in GER patients is not low but worse in those who seek medical advice.
Terapevticheskii arkhiv. 2008;80(2):11-14
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Potentialities of a serological method in diagnosis of atrophic gastritis
Pimanov S.I., Makarenko E.V.
Abstract
Aim. To analyse diagnostic potential of “serological gastrobiopsy" in patients with various gastroduodenal diseases. Material and methods. A total of 244 patients with gastroduodenal pathology have been examined. The diagnoses made morphologically were compared with those made by the serological method. The diagnosis of duodenal ulcer, gastric ulcer, atrophic gastritis, nonatrophic gastritis was made in 155, 31, 43 and 15 patients, respectively. The type of chronic gastritis was diagnosed by the levels of gastrin-17, pepsinogen I, pepsinogen II and antibodies to Helicobacter pylori in blood serum. The diagnoses made serologically were compared with those made morphologically. Results. The highest accuracy of a serological diagnosis of mucosal atrophy of the antral stomach was observed in gastric ulcer (80.6%) and duodenal ulcer (71.6%) in high sensitivity and low specificity. The accuracy of the diagnosis of gastric body mucosa atrophy in atrophic gastritis was 60.5%, in gastric ulcer - 51.6%, in duodenal ulcer 58.7% in high specificity and low sensitivity. Serological diagnosis of gastric atrophy was accurate in 71.7%. In weak morphological picture of gastric body atrophy false negative serological diagnosis is possible. No false positive results occurred in diagnosis of gastric body mucosal atrophy (specificity 100%). A negative correlation was found between the severity of gastric body atrophy and pepsinogen I serum level (r = -0.380), pepsinogen I to pepsinogen II in blood serum (r = -0.392). No differences were revealed in gastrin-17 levels in the serum in different atrophy severity in the antral mucosa. Conclusion. “Serological gastrobiopsy" provides satisfactory accuracy of atrophic gastritis diagnosis in gastroduodenal diseases.
Terapevticheskii arkhiv. 2008;80(2):15-21
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Dysbacteriosis of mucosal microflora of the gastroduodenal zone in inflammatory and ulcer lesions: diagnosis and classification
Chernin V.V., Bondarenko V.M., Chervinets V.M., Bazlov S.N.
Abstract
Aim. To study mucous (parietal) gastroduodenal microflora in healthy persons, patients with ulcer and chronic gastritis, to develop diagnostic criteria and classification of gastroduodenal dysbacteriosis. Material and methods. Biopsy specimens were obtained from gastroduodenal mucosa of 134 patients with ulcer, 36 - with chronic gastritis and 28 healthy subjects. The mucous microflora agents were isolated microbiologically from biopsy specimens obtained from different compartments of the stomach and duodenum. The spectrum of their enzymatic activity and cytotoxic properties were determined. Results. Gastroduodenal mucous microflora of healthy subjects was represented with 1-2, less often with 3-4 cultures of 12 species, enzymatic activity spectrum of microorganisms was small, cytotoxicity was absent. In ulcer recurrence and exacerbation of chronic gastritis gastroduodenal zone showed dysbacteriosis characterized by overgrowth of mucous microflora (up to 22 species of microorganisms) with a wide spectrum of enzymatic activity and cytotoxic properties. The criteria of dysbacteriosis diagnosis and classification are proposed. Conclusion. The role of gastroduodenal mucous microflora in ulcer and gastritis course is specified. New approaches to effective treatment of gastroduodenal diseases may be developed with consideration of dysbacteriosis.
Terapevticheskii arkhiv. 2008;80(2):21-25
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Ulcer disease: current features and prognosis for the near future
Vakhrushev I.M., Efremova L.I., Efremova V.A.
Abstract
Aim. To make prognosis of ulcer morbidity and lethality from its complications for the near future basing on the trends in ulcer morbidity and lethality for the last 10 years; to assess ulcer patients' follow-up quality and coverage. Material and methods. Time series statistics of general, primary ulcer morbidity and lethality from ulcer complications in the Udmurt republic for the last 10 years have been analysed as well as expert evaluation of the treatment quality and follow-up of ulcer patients by 156 outpatients' cards and 118 disease histories. Results. General and primary gastrointestinal ulcer incidence in Udmurt republic in 1992-2001 decreased significantly but ulcer morbidity did not change. Lethality from ulcer complications rose 1.8-fold. The predicted lethality rise in 2003-2006 proved valid. Conclusion. If social and economic conditions in the republic do not change and public health service reforms remain low effective, further deterioration of the above lethality is predicted.
Terapevticheskii arkhiv. 2008;80(2):26-29
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Efficacy of different laser treatments in combined therapy of patients with gastroduodenal ulcer
Burduli N.M., Gutnova S.K.
Abstract
Aim. To investigate efficacy of different methods of low-intensity laser treatment (LILT) in therapy of exacerbated gastroduodenal ulcer. Material and methods. A total of 111 gastroduodenal ulcer (GDU) patients were divided into two groups: the study group (81 patients) and control group (30 patients). Patients from the study group received combined treatment with anti-ulcer drugs and LILT performed by three methods: intravenous laser radiation of blood (ILRB), epicutaneous radiation (ER) and combination ILRB+ER. Control patients received medication alone. The efficacy of the treatment was assessed by the time of ulcer defect heeling, duration of hospital stay, clinical symptoms of the disease exacerbation manifesting with three syndromes: pain, dyspepsia, asthenovegetative syndrome. Results. The shortest heeling of ulcer defect was achieved in the patients treated with ILRB+ER combination: 17.8 ± 0.8 and 19.3 ± 3.4 days for gastric and duodenal ulcer, respectively (p < 0.05 and p < 0.01 vs control). Conclusion. Combined treatment of gastric and duodenal ulcer with inclusion of laser radiation (ILRB, ER, ILRB+ER) is effective in therapy of ulcer.
Terapevticheskii arkhiv. 2008;80(2):30-33
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Cholagenic diarrhea
Parfenov A.I., Krums L.M., Lychkova A.É., Poleva N.I.
Abstract
Aim. To characterize cholagenic diarrhea as a nosological entity with its specific features of etiology, pathogenesis, clinical picture and treatment. Material and methods. A total of 167 patients with chronic diarrhea (CD) participated in the trial. Of them, 25 patients have undergone resection of the small intestine, 98 - cholecystectomy for cholelithiasis, 44 had concurrent hypokinesia of the gall bladder caused by celiac disease (n = 30) or biliary dyskinesia (n = 14). The examination included estimation of cholic acid in the duodenal content (40% glucose solution or cholecystokinin were used as stimulators); 24-h fecal mass; fecal mass for 24 hours, fat, potassium and sodium content in the feces; electromotor activity (EM A) of the gall bladder, small intestine and colon. Results. Duodenal intubation with 40% glucose in patients with extensive resection of the small intestine detected a fall in cholic acid content in vesical bile to 408 ± 58.39 mg compared to normal (910 ± 97.29 mg%). In intravenous administration of cholecystokinin cholic acid concentration rose insignificantly (547.0 ± 94.7 mg%) and was accompanied with bile loss with feces, polyfecalia, steatorrhea and high sodium concentration in feces. In celiac disease patients bile with high cholic acid concentration was secreted only in administration of cholecystokinin (1673 ± 175.9 mg/%, normal 1701 ± 140.6 mg/%). In patients after cholecystectomy colon EMA was primarily slow-wave and middle-amplitude, typical for hypermotor dyskinesia. Conclusion. CD develops after extensive resection and in inflammatory ileac diseases, suppression of contractile function of the gall bladder and after cholecystectomy. CD after cholecystectomy can be considered as a variant of postcholecystectomy syndrome. The treatment of CD should include drugs binding excessive bile acids in the colon, in hypokinesia of the gall bladder the treatment should include stimulators of its contractile function.
Terapevticheskii arkhiv. 2008;80(2):33-38
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Prevalence of celiac disease in risk group patients in nizhny novgorod region
Repin A.A., Bogdarin I.A., Sarantsev B.V., Teplov O.V., Desiatnikova N.V., Parfenov A.I.
Abstract
Aim. To estimate prevalence of gluten celiac disease (GCD) in Nizhny Novgorod region by the data of examination of patients from high risk group. Material and methods. Outpatient examination was made in 41245 outpatients. GCD risk groups included patients with chronic diarrhea and other manifestations of enteropathy, iron deficiency anemia of unclear genesis, with autoimmune disorders, skin diseases associated with GD, women with reproductive dysfunction of unclear genesis, persons with low body mass, close relatives of GCD patients. All the patients were examined conventionally. Antiglutenic antibodies (AGA) and/or antibodies to tissue transglutaminase (AB TTG) in IgA and IgG were determined and morphological tests of duodenal mucosa were made in patients at high risk of GC. Results. Out of 41245 examinees 2364 (5.7%) were expected to have CD. Immunological tests were performed in 1045 risk group patients. Of them, 251 patients had elevated titers of AGA and/or AB TTG. Histological examination discovered GCD signs in 210 patients with positive AGA and/or AB TTG and in 101 patients who were not examined immunologically. GCD was detected in 311 (13.1%) patients included in risk groups. Conclusion. Prevalence of CD in adults with risk factors is 1:7.6, in outpatients - 1:133. For active GCD screening in risk groups blood tests for AGA and AB TTG should be made. Those with a high titer of these antibodies and patients with chronic diarrhea and malabsorption should undergo biopsy material taken from the duodenum in esophagogastroduodenoscopy.
Terapevticheskii arkhiv. 2008;80(2):38-44
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Psychological characteristics of adult patients with celiac disease
Oreshko L.S.
Abstract
Aim. To study clinical, psychosomatic disorders and quality of life in adult patients with different clinical variants of celiac disease (CD). Material and methods. Questionnaire survey, psychological examination and estimation of quality of life were conducted in 90 patients with celiac disease aged 16-62 years. Depending on clinical symptoms the patients were divided into 3 groups: patients with prevalent diarrhea (n = 30, 33.3%, group 1), patients with prevalent constipation (n =24, 26.7%, group 2), patients with atypical form (n = 36, 40.0%, group 3). Results. Clinical heterogenicity of the disease was revealed: gastrointestinal, endocrine, skeletal-muscular, respiratory and skin lesions were found. Conclusion. CD patients demonstrate social-psychological maladaptation in the form of situational and personality anxiety, moderate depression depending on a clinical variant of the disease. Quality of life in CD patients is significantly inferior of population norm. Psychic component of health suffers more (viability, social functioning) than physical one (physical performance, scales of pain and general health).
Terapevticheskii arkhiv. 2008;80(2):44-48
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Splenic flexure and irritable colon syndromes: conjugate conditions
Osipenko M.F., Bikbulatova E.A., But-Gusaim V.I.
Abstract
Aim. To investigate phenotypical and clinical characteristics in individuals with high fixation of the splenic angle (HFSA). Material and methods. The study group included 82 patients with HFSA, the comparison group - 76 patients with irritable colon syndrome (ICS), control group - 19 patients without colon pathology. The results of the following examinations were analysed: the disease history, detailed intestinal investigation, rectal sensitivity, constitution, connective tissue weakness, vegetative dysfunction and regulation. Results. HFSA is encountered maily in persons with hyperstenic constitution. Some HFSA patients have pain on the left side - splenic flexure syndrome (SFS). The pain corresponds most to clinical criteria of irritable colon syndrome diagnosis and is accompanied with reduced threshold of pain sensitivity to ballon extension. Provoking factors of the symptoms are stress situations in childhood. Conclusion. SFS can be considered as a variant of ICS arising in HFSA. The treatment should be based on the principles of ICS treatment.
Terapevticheskii arkhiv. 2008;80(2):48-52
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Microbial intestinal biocenosis in lingering and complicated course of community pneumonia
Osipov M.I., Bilev A.E., Osipov I.A.
Abstract
Aim. To characterize species and quantitative composition of intestinal microflora in lingering and complicated course of community pneumonia (CP). Material and methods. The trial enrolled 130 CP patients and 30 healthy controls. Severe and moderate CP was diagnosed in 118patients, mild CP - in 12patients. In 36 (27.6%) patients the disease stayed long. Among the complications (47.7%) there were respiratory insufficiency of degree I-II (n = 29), exudative pleurisy (n = 7), toxic shock (n = 6), abscess of the lung (n = 5), acute vascular failure (n = 5), chronic renal failure (n = 5), DIС syndrome (n = 3), myocarditis (n = 2). Intestinal microflora was studied quantitatively and qualitatively using domestic materials. Results. Dysbacteriosis often accompanies CP - 42.3% in acute period, 18.8% in convalescence. Dysbacteriosis was more severe in severe CP. Compared to healthy controls, CP patients' intestine contains low content of bifidobacteria (100-fold), nonpathogenic enterococci and escherichia with normal enzymatic activity (10-fold and more). The number of saprophytic and epidermal staphylococci is very high - a 100-fold rise. In lingering pneumonia 2-3 times more often than in mild acute CP feces contain escherichia with low enzymatic activity, lactose-negative, staphylococci. Patients with pneumonia complications had dysbacteriosis of degree I, II, III and IV in 19.4, 30.4, 8.1 and 6.5% cases, respectively. Conclusion. Long-term administration of antibiotics in patients with lingering and complicated CP destroys balance of intestinal microflora and thus influences the course of CP. This dictates the necessity to conduct fecal microflora analysis in patients with CP irrespective of intestinal diseases.
Terapevticheskii arkhiv. 2008;80(2):52-57
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Features of combined (hbv/hcv-infection) viral lesion of the liver
Maev I.V., Nikushkina I.N., Samsonov A.A., Aksel'rod A.G.
Abstract
Aim. To study clinical, biochemical features, course of combined viral hepatitides, dominant viral activity in combination HBV/HCV infection. Material and methods. A total of 37 patients with HbsAg and anti-HCV, 23 patients with chronic hepatitis С and 48 patients with chronic hepatitis В were examined (the study and comparison groups, respectively). 67 HbsAg carriers with normal hepatic parameters (no clinical symptoms, normal transaminase activity) served controls. Results. In patients with parallel detection of HbsAg and anti-HCV detectability of HBV-DNA was 8.1% while HCV rNA was detected in 84% cases. Half the patients with HbeAg positive HBV had seroconversion 1.5-2 years after HCV infection. Documented HCV infection in HBV patients leads to elimination of one of the viruses (HBV more frequently) in more than 50% cases. HCV infection may induce seroconversion of HbeAg. Biochemical parameters (bilirubin, AlAT, AP, gamma HTP of blood) in patients with mixed infection compared with those with mono-infection were 1.5 times higher. In mixed infection cytokines (TNF-alpha, IL-1beta, IL-6, IL-8, TGF-1beta) levels were also higher, the diameter of the portal vein was larger (16.9 ± 0.5 mm). Conclusion. In mixed viral infection there are marked changes in clinico-biochemical, morphological and hemodynamic indices with a clear trend to early formation of portal hypertension with significant alterations in the esophago-gastroduodenal zone.
Terapevticheskii arkhiv. 2008;80(2):57-61
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Immune system reactivity in patients with chronic hepatitis С
Sobchak D.M., Korochkina O.V.
Abstract
Aim. To determine levels of IL-1beta, IL-2, IL-4, IL-6, TNF-alpha, IFN-alpha, IFN-gamma in patients with chronic hepatitis С (CHC). Material and methods. Peripheral blood cytokines were measured with enzyme immunoassay (Protein contur kits, St-Petersburg). Results. Higher content of IL-2, IFNa, IFNg was found in older patients with negative results of examination for HCV RNA, a/HCVcore IgM, a/HCV/ns3,5, genotype 3a, evidencing for higher reactivity of the immune system. High levels of IL-1beta, IL-6, TNFa were detected in young patients with narcotic drug consumption history, with high enxymatic activity, biliary inflammation, genotype lb, high index of histological activity. Conclusion. The above changes characterize the severity of morphological, necrotic-inflammatory changes in the liver.
Terapevticheskii arkhiv. 2008;80(2):61-66
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Biliary calculosis, cholesterosis of the gallbladder, xanthogranulematous cholecystitis: clinical-morphological parallels
Shcherbinina M.B., Zakrevskaia E.V.
Abstract
Aim. The retrospective analysis of prevalence, peculiarities of duration of biliary calculosis without gall bladder cholesterosis, biliary calculosis with gall-bladder cholesterosis and xanthogranulematous cholecystitis among persons who underwent cholecystectomy using clinical, instrumental and morphological data. Material and methods. The data was evaluated obtained from medical cards of 4073 inpatients operated for cholelithiasis in 1999-2005. Preoperative clinical condition, body mass index, the results of abdominal ultrasonography, morphology of removed gall-bladders were evaluated. Statistical processing was made by Student's criterion and correlation analysis. Results. After cholecystectomy the diagnosis of cholelithiasis was confirmed in 4020 patients (98.7%). 1177 patients had concomitant gall-bladder cholesterosis (GBC), 38 patients - xanthogranulematous cholecystitis (XC). GBC and XC were diagnosed morphologically only in the postoperative stage. The patients were divided into three groups: cholelithiasis without GBC (32 patients), cholelithiasis with GBC (68 patients), XC (38 patients). Diseases of the gall-bladder occur more frequent in women and older patients. XC in males occurred 2 times more frequently, cholelithiasis without cholesterosis and ХС ran 2 times less. The above diseases are related with disorders of metabolism and lipid transport. GB dyskinesia has different causes in each of the diseases. Conclusion. The analysis determined peculiarities of duration of cholelithiasis without gall-bladder cholesterosis, cholelithiasis with GBC and XC. This necessitate differential therapy.
Terapevticheskii arkhiv. 2008;80(2):66-71
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Association of fatty acid composition of blood serum with bile lipid composition in cholelithiasis patients
Tsukanov V.V., Kupershteĭn E.I., Tonkikh I.L., Bronnikova E.P.
Abstract
Aim. To examine correlations between bile lipid composition and fatty acid composition of blood serum in cholelithiasis patients. Material and methods. Cholelithiasis prevalence in Khakasia Republic was studied in a clinico-epidemiological trial with participation of 1393 european people and 1060 mongoloid people - khakasians. Bile lipids and serum fatty acids were measured. Results. Europeans had cholelithiasis in 7.3%, khakasians - 3.4% (p < 0.001). Total cholesterol in bile of cholelithiasis patients was higher than in healthy subjects (both in europeans and khakasians). Fatty acids content was higher in cholelithiasis patients of both populations. Conclusion. Cholelithiasis was more prevalent in Europeans because of genetical differences in lipid metabolism. Rise in contents of saturated fatty acids and lowering of the proportion of unsaturated acids in blood is a universal aspect of lipid metabolism disturbance in cholelithiasis patients in genetically different populations.
Terapevticheskii arkhiv. 2008;80(2):71-75
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The role of neuromediators and cytokines in pathogenesis of chronic pancreatitis of alcohol etiology
Vinokurova L.V., Trubitsyna I.E., Tsaregorodtseva T.M., Iashina N.I., Khatsko I.V., Zhivaeva N.S.
Abstract
Aim. To determine the role of acetylcholine (AC), serotonine (5-HT) and cytokines in progression and complications of chronic alcohol pancreatitis (CAP). Material and methods. 50 CAP patients were examined in the exacerbation, remission and complications of CAP (48 males, 2 females) aged 30-50 years. Control group consisted of 15 healthy subjects. IL-lbeta, IL-6, IL-8, IFN-gamma, TNF-alpha, IL-4 were studied with enzyme immunoassay, 5-HT - with Ch. Sadovanquivad method, AC and activity of cholinesterase (CE) in the blood - by the method of Sh. Hestrin. Pancreatic tissue fibrosis was assessed according to computer tomography findings. Results. Patients with CAP in exacerbation had significant rise of proinflammatory, anti-inflammatory cytokines, AC and 5-HT. In a complicated course of CAP there is a pronounced rise in TNFa in normal level of IL-4. CAP patients with destructive changes in the pancreas showed significant rise in the level of AC and 5-HT and lowering of cytokines. CE activity in complicated course of CAP is low this indicating protein-synthetic insufficiency in CAP patients. Conclusion. In CAP the action of 5-HT and AC aims at maintenance of secretory activity of the pancreas. In inflammation participation of neuromediators decreases. Stimulation of pancreatic secretory activity switched to autonomic regulation which is prognostically unfavourable.
Terapevticheskii arkhiv. 2008;80(2):75-78
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The results of the “Tiromobil" epidemiological trial of pregnant women in the Russian Federation
Troshina E.A., Abdulkhabirova F.M., Fedak I.R., Platonova N.M., Pronina L.O., Kavtaradze S.R., Arbuzova M.I., Il'in A.V.
Abstract
Aim. To study structural and functional changes in the thyroid gland (TG) in pregnant women living in iodine-deficiency regions; to evaluate efficacy of prophylactic measures. Material and methods. Random sample method was used for examination of 1090 pregnant women living in the regions with different iodine provision. All the participants were examined clinically, measurements were made of thyroid size, TTH, free T4, iodinuria. Results. Iodine salt in household was used only by 17% women. Prophylaxis of iodine deficiency was conducted in 51% pregnant women. Thyroid alterations were detected in 27% examinees, diffuse goiter was diagnosed on the average in 17% pregnant women (in some regions 36%), nodular goiter - in 3.1%, focal goiter alterations of the thyroid - in 4.4%, symptoms of autoimmune thyroid disease - in 2.7%. Iodinuria varied with regions from 72.5 to 150 mcg/l. TTH and T4 levels were mainly normal. Isolated fall of T4 in trimester II and III was registered in 70% pregnant women, low TTH - in 4.4%. Conclusion. Most of the pregnant women in the regions studied were at risk of diseases associated with iodine deficiency. Prevention of iodine deficiency is not adequate.
Terapevticheskii arkhiv. 2008;80(2):78-81
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Influence of long-term intake of proton pump inhibitors on gastric mucosa and neuroendocrine system of gastric secretion regulation in patients with acid-dependent diseases
Rapoport S.I., Khutsishvili M.B., Rasulov M.I., Trubitsina I.E., Raĭkhlin I.T.
Terapevticheskii arkhiv. 2008;80(2):86-89
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Epidemiology of opisthorchidoses
Pal'tsev A.I., Iakhina S.V.
Terapevticheskii arkhiv. 2008;80(2):89-92
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