Current methods of early diagnosis of hepatic fibrosis

The article covers the functional and clinical significance of hepatic fibrosis. Contemporary principles of invasive and non-invasive methods of diagnostics of fibrotic alterations are described. The article also covers the main forms of fibrosis, chronic hepatic diseases in which they are found, and the most wide-spread systems of half-quantitative evaluation of morphological signs of the fibrotic process.     

Use of biologically active food additive cardiohels in the treatment of patients with ischemic heart disease

Biologically active food additive (Inrich production) cardiohels was added to the diet of ischemic heart disease patients with hypertension and chronic heart failure stage IIB receiving basic medication with hypotensive, coronarolytic drugs and cardiac glycosides. As shown by control 24-h blood pressure and ECG monitoring, echocardiography, cardiohels has a mild hypotensive effect, improves coronary circulation and microcirculation, myocardial contractility. Mechanism of these positive effects are discussed. Cardiohels is recommended for patients with ischemic heart disease as it allows to reduce the dose of hypotensive and coronarolytic drugs by 35% and cardiac glycosides by 25%, thus lowering the risk of relevand side effects.     

Cytokine regulation of liver inflammation and fibrosis during chronic hepatic diseases

Serum concentrations of antiinflammatory cytokines and growth factors were measured in 30 patients with chronic viral hepatitis (HCV), mainly HCV RNA, and 10 patients with liver cirrhosis (LC), classes B and C according to Child-Pew. Serum concentrations of tumor necrosis factor-alpha (TNF alpha), granulocytic-macrophagal colony-stimulating factor (GM-CSF), and growth-transforming factor-1 beta (TGF1 beta) were increased in 63.86 and 80% patients with HCV and LC, respectively, and differed significantly (p < 0.05) from the control. The level of TNF alpha positively correlated with the concentration of alanine aminotransferase (r = 0.14). A positive correlation between TGF1 beta and histologic activity index was detected (r = 0.16). Increased levels (p < 0.05) of IL-5, TNF alpha, and TGF1 beta were detected in LC patients in comparison with the control. Patients with LC concomitant with anemia had higher (though not significantly) concentrations of TNF alpha in comparison with patients without anemia. Increased levels of proinflammatory cytokines and growth factors in the sera of patients with HCV and LC indicate activation of immunocompetent cells, including mononuclear phagocytes. These data are in line with experimental findings, indicating an important role of the studied cytokines in the development of hepatic inflammation, fibrosis, and cytopenic syndromes.     

The diagnostic significance of laser 13C-urea breath test in various Helicobacter pylori-associated diseases

The authors present the results of laser-based 13C-urea breath test (13C-UBT) application in diagnostics of Helicobacter pylori-associated diseases (chronic gastritis, duodenitis, and peptic ulcer). 13C-UBT data distribution before and after eradication therapy, as well as age distribution, were obtained. Correlations between the nosological forms and the rate of contamination were established.     

Randomized double-blind placebo-controlled study of drugs with anti-ulcer action and their use in associated pathology

The effect of lithium preparations (lithium carbonate, lithium oxybutyrate), calcium channel blocking agents (verapamil, nifedipine), beta 2-adrenoagonist (salbutamol), cromolyn sodium and cimetidine on clinical efficacy and frequency of ulcer cicatrization was assessed in 201 patients (33 women, 168 men) with endoscopically verified stomach ulcer (52 patients) and duodenal ulcer (166 patients) during treatment for 4 weeks as compared to placebo and standard antiulcerative therapy (cholinolytics, antacids and reparents). All the tested drugs (excluding cromolyn sodium) significantly increased as compared to placebo the frequency of ulcer cicatrization (p less than 0.001 in the use of lithium preparations and cimetidine; p less than 0.01 in the use of salbutamol and verapamil; p less than 0.05 in the use of nifedipine). The effect of lithium preparations and cimetidine exceeded that of standard antiulcerative multimodality therapy.     

Change in neoadjuvant chemotherapy could alter the prognosis of patients with pancreatic adenocarcinoma: A case report

BACKGROUNDNeoadjuvant treatment has become a standard of care for borderline or locally advanced pancreatic cancer and is increasingly considered even for up-front resectable disease. The aim of this article is to present the case of a 62-year-old patient with locally advanced pancreatic adenocarcinoma who was successfully treated with gemcitabine plus nab-paclitaxel after the failure of the first line treatment.CASE SUMMARYComputerized tomography scan and magnetic resonance imaging demonstrated a nodular lesion of ill-defined limits in the body of the pancreas, measuring approximately 4.2 cm × 2.7 cm, with an infiltrative aspect. The tumor had contact with the superior mesenteric vein, splenomesenteric junction and the proximal segment of the splenic artery, causing focal reduction of its lumens. Due to vascular involvement, neoadjuvant chemotherapy treatment with eight cycles of “folinic acid, 5-fluorouracil, irinotecan and oxaliplatine” (FOLFIRINOX) were performed. At the end of the cycles, surgery was performed, but the procedure was interrupted due to finding of lesions suspected of metastasis. Gemcitabine plus nab-paclitaxel was then successfully used for neoadjuvant treatment with subsequent R0 surgical resection.CONCLUSIONGemcitabine plus nab-paclitaxel may be effective as an alternative regimen when FOLFIRINOX fails as the first line of treatment, suggesting the need for further studies to identify which patients would benefit from each type of therapeutic approach.