Vol 80, No 2 (2008)

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.

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.

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.

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).

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.

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.

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.

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.