Неселективные β-блокаторы в первичной профилактике кровотечений у больных с асцитом, включенных в лист ожидания трансплантации печени

Objective: to determine the efficacy of non-selective beta-blockers (NSBBs) in the primary prevention of bleeding esophageal varices and to assess their impact on the survival of patients with ascites enrolled in the liver transplant waiting list (LTWL).Materials and methods. We carried out a retrospective comparative study of cirrhotic patients with severe ascites and esophageal varices without bleeding before enrollment in the LTWL. Primary prophylaxis of variceal bleeding included the use of NSBBs (n = 97, group 1). These drugs were not used in the other patients (n = 91, group 2).Results. There were no significant differences between the groups in terms of clinical, laboratory and demographic parameters, MELD scores and Child-Turcotte-Pugh (CTP) classes for cirrhosis. Patient groups included in the study had no significant differences with respect to incidence of medium- and large-sized varices and incidence of severe ascites. Bleeding incidence was significantly lower in the NSBBs group than in the non-NSBBs group (52.6% and 95.6%, respectively, p = 0.0001).Conclusion. NSBBs constitute an efficacious therapy in primary prophylaxis of esophageal variceal bleeding, thereby saving life and preventing delisting of patients with ascites from the LTWL.Цель: определение эффективности неселективных β-блокаторов в первичной профилактике пищеводных кровотечений и оценка их влияния на выживаемость пациентов с асцитом, включенных в лист ожидания трансплантации печени.Материалы и методы. Проведено ретроспективное сравнительное исследование пациентов с циррозом печени, с выраженными формами асцита и развитием варикозных узлов пищевода, не имевших эпизодов кровотечений до включения в лист ожидания трансплантации печени. Первичная профилактика кровотечений из варикозных узлов пищевода включала использование неселективных Р-блокаторов (n = 97, первая группа), у других пациентов терапия этими препаратами не проводилась (n = 91, вторая группа).Результаты. Не было отмечено значимых различий между группами по клиническим, лабораторным и демографическим параметрам, показателям MELD и классам цирроза Child— Turcotte-Pugh. Группы пациентов, включенных в исследование, не имели значимых различий в частоте варикозных узлов среднего и большого размера и частоте выраженных форм асцита. Частота развития кровотечений была достоверно ниже в группе пациентов, получавших неселективные β-блокаторы, чем в группе больных без проведения этой терапии (52,6 и 95,6% соответственно, р = 0,0001). Выживаемость пациентов была достоверно выше в группе больных, получавших неселективные Р-блокаторы, чем в группе больных без данной терапии (40,2 и 4,4% соответственно, р = 0,0001).Заключение. Использование в терапии неселективных β-блокаторов является эффективным методом первичной профилактики кровотечений из варикозных узлов пищевода, обеспечивая сохранение жизни и предупреждение выбывания пациентов с асцитом из листа ожидания трансплантации печени

Efficacy and safety of the first domestic pegilated interferon alpha-2b «Pegaltevir» at chronic hepatitis C: pilot data of phase III clinical study

Aim of investigation. Comparative assessment of efficacy and safety of Pegaltevir and PegIntron in within pattern of combined antiviral therapy in previously untreated patients with chronic hepatitis C.Material and methods. Overall 140 patients with chronic hepatitis C, who received no antiviral therapy previously were included in original study. Patients were randomized in 4 groups. Groups differed in relation to received drug and hepatitis C virus genotype. All patients received 1,5 mkg per 1 kg body weight per week of Pegaltevir or PegIntron and 800–1400 mg of ribavirin per day. Preliminary estimation of drug efficacy was based on rates of rapid and early virologic response (RVR and EVR) achievement, dynamics of biochemical tests, dynamics of blood level of peginterferon alpha and neopterin. Safety features were estimated as well.Results. Comparative analysis has demonstrated absence of statistically significant distinctions of RVR and РВО rates at application of two peginterferon alpha-2b drugs. There were no differences in frequency of achievement of serologic response, as well as safety in Pegaltevir and PegIntron groups. Dynamics of blood concentration of peginterferon alpha correlated to neopterin concentration both in Pegaltevir group and in PegIntron group.Conclusions. Study results have shown high rates of RVR and РВО achievement, and acceptable safety profile of Pegaltevir, comparable with that of PegIntron at chronic hepatitis C in previously untreated patients

The parodont reaction by both supragingival and subgingival arranging an artificial crown edge

The quantity of gingival liquid and Са, P, Na, К containing in it from 220 almost healthy persons with partly adentia was studied before and after prosthetics with fixed dental bridges (stamped-soldered and whole piece metal-ceramic ones) at the different correlation between the edge of artificial crown and the gum (the crowns had been placed at the level of gum or they had been drowned in the gingival fissure by 0,5 mm). The investigations were conducted in 1 and 5 months respectively. Crowns (stamped, metal-ceramic) were not established to have damaging effect to be placed at the gum level. But on the contrary as stamped as metal-ceramic crowns being drowned in the gingival fissure by 0,5 mm have the damaging effect that has been confirmed by increasing both the quantity of gingival liquid and the content of studied macro- and microelements in it.У 220 пациентов (120 жен. и 100 муж.) в возрасте от 20 до 40 лет практически здоровых с частичной адентией было изучено количество десневой жидкости и содержание в ней Са, Р, Na,K, до и после протезирования несъемными мостовидными протезами (штамповано - паяные и цельнолитые металлокерамические) при различном соотношении края искусственной коронки и десны (коронки располагали на уровне десны и погружали в десневую щель на 0,5 мм). Исследования проводились через 1 месяц и 5 лет после протезирования. Установлено, что коронки (штампованые, металлокерамические) не наносят повреждающего эффекта при расположении на уровне десны, напротив, наносят повреждающий äффект, как штампованые, так и металлокерамические погруженные в десневую щель на 0,5 мм, о чем свидетельствуют увеличения количества десневой жидкости и содержание изучаемых макро - и микроэлементов в ней

Safety and efficacy of telaprevir in treatment of a chronic hepatitis C in patients of the Russian population included in early access program study

Aim of investigation. HEP3002 is the international early access program of efficacy and safety estimation of telaprevir in combination to peginterferon alpha and ribavirin for patients with severe fibrosis or liver cirrhosis caused by hepatitis C virus (HCV) genotype 1. Efficacy and safety of this therapeutic mode were evaluated in intermediate analysis on 16-th week of treatment in 153 patients from Russia who have already reached the 16-th week of treatment or potentially can do so.Material and methods. The study has prospectively included 153 HCV infected patients (genotype 1), with bridging fibrosis or compensated liver cirrhosis who received treatment by telaprevir in combination to peginterferon-alpha and ribavirin for 12 wks with subsequent 12-or 36-week rate of antiviral therapy (AVT) by peginterferon alpha and ribavirin in relation to virologic response and fibrosis severity. Analysis has been carried out for intention to treat (ITT) populations with application of 16-th week AVT data.Results. Total of 153 patients have completed 12-week course of triple therapy and 4-week course of peginterferon-alpha and ribavirin treatment (48% cirrhotic patients, 97% – HCV-1b). The level of HCV RNA was undetectable both at the 4-th week, and at the 12-th week (extended rapid virologic response) in 42 (75%) of 56 previously untreated patients, in 34 (89%) of 38 with relapses after previous treatment, in 4 (57%) of 7 with previous incomplete response, in 22 (52%) of 42 with the previous zero response and in 7 (70%) of 10 with previous virologic breakthrough. Sustained virologic response was achieved in 73 (80%) of patients available for analysis (n=91). Most frequent adverse events of the 2-4 degrees, related to telaprevir, were anemia (63 patients, 41%), thrombocytopenia (15 patients, 10%) and skin rash (7 patients, 5%). For anemia treatment in 50 (33%) patients the doze of ribavirin has been reduced, erythropoietin was prescribed to 12 (8%) to patients and no blood transfusion was required; 10 (7%) patients have ahead of schedule stopped course of treatment by telaprevir in connection with development of anemia (6), thrombocytopenia (2) and occurrence of skin rash (2).Conclusion. In 153 patients with severe liver fibrosis caused by hepatitis C virus (genotype 1), on background of triple AVT with telaprevir high level of immediate virologic response and low level of the preterm treatment discontinuation was marked

The Russian consensus on the diagnosis and treatment of chronic pancreatitis: Enzyme replacement therapy

The Russian consensus on the diagnosis and treatment of chronic pancreatitis has been prepared on the initiative of the Russian Pancreatology Club to clarify and consolidate the opinions of Russian specialists (gastroenterologists, surgeons, and pediatricians) on the most significant problems of diagnosis and treatment of chronic pancreatitis. This article continues a series of publications explaining the most significant interdisciplinary consensus statements and deals with enzyme replacement therapy

Russian consensus on exoand endocrine pancreatic insufficiency after surgical treatment

The Russian consensus on exo - and endocrine pancreatic insufficiency after surgical treatment was prepared on the initiative of the Russian "Pancreatic Club" on the Delphi method. His goal was to clarify and consolidate the opinions of specialists on the most relevant issues of diagnosis and treatment of exo - and endocrine insufficiency after surgical interventions on the pancreas. An interdisciplinary approach is provided by the participation of leading gastroenterologists and surgeons

Российский консенсус по профилактике, диагностике и лечению рака желудка

The Russian consensus on prevention, diagnostic and treatment of gastric cancer was prepared on the initiative of the Moscow clinical scientific center named after A. S. Loginov according to the Delphi method. Its aim was to clarify and consolidate the opinions of specialists on the most relevant issues of prevention, diagnosis and treatment of gastric cancer. An interdisciplinary approach was provided by the participation of leading gastroenterologists, oncologists and surgeons.Российский консенсус по профилактике, диагностике и лечению рака желудка подготовлен по инициативе Московского клинического научного центра им А. С. Логинова ДЗМ по Дельфийской системе. Его целью явилась консолидация мнений отечественных специалистов по наиболее актуальным вопросам профилактики, скрининга, диагностики и лечения рака желудка. Междисциплинарный подход обеспечен участием ведущих гастроэнтерологов, онкологов и хирургов.Цель статьи: представить положения Российского консенсуса по профилактике, диагностике и лечению рака желудка

Investigation of gastric motility in patients with the overlap syndrome of the gastroesophageal reflux disease and functional dyspepsia

Rationale:  The phenomenon of overlap  of two disorders, non-erosive gastroesophageal reflux disease (NERD) and functional dyspepsia (FD) is an important clinical problem,  while the  symptoms in such  patients  are  more  severe  and  prevalent than  in those  with non-overlapping NERD or FD. This phenomenon may lead to treatment failure, if therapy  does not take into account  the specific pathophysiological mechanisms  of the NERD and FD overlap.Aim: To study motility of the proximal and  distal parts  of the  stomach  in patients  with the overlap syndrome of NERD with FD.Materials and  methods:  The  study  enrolled  56  patients (34 women and 22 men), aged from 18 to 45 years, who met the diagnostic  criteria for NERD and FD (the Rome criteria III, esophageal endoscopy, 24-hour  pH  measurement  or  24-hour  impedance pH measurement), and  had  both  NERD  and  FD symptoms  simultaneously  (overlap); 46 healthy volunteers. The accommodation of the  proximal (fundal) part  of the  stomach  and  motility of the distal gastric part  was assessed  by ultrasonography (Aixplorer, SuperSonic Imagine, France, with convex probe  1–6 MHz) before  and  after the  intake of the liquid test food. The patients  filled in questionnaires to assess the symptoms  and their severity (scored from 0 to 3). The difference  between their mean ± standard  deviation (SD) values was assessed  by Students  t-test  and  was considered  significant at p < 0.05.Results: After intake of the  liquid test  food, the  patients  with the  FD and NERD overlap syndrome demonstrated an advanced and statistically significant gastric motility abnormality  both  in its proximal and distal parts, compared to healthy control: accommodation disturbances and its reduction, decreased amplitude  (61.4 ± 7.5 vs 90.2 ± 6.9%, p < 0.05), frequency of contractions of the antrum during 3-minute interval (4.3 ± 1.5 vs 9.7 ± 1.4, p < 0.05), antral motility index (4.3 ± 1.4 vs 8.8 ± 1.3%, p < 0.05), and gastric emptying   (37.1 ± 14.5   vs  69.1 ± 19.5%,  p < 0.05). Gastric accommodation abnormalities  were associated with a statistically significant increase in the severity  of the  following  symptoms: abdominal distention, postprandial feeling of fullness, early satiety, eructation, and heartburn (р< 0.05 for all symptoms).Conclusion: Detection  of gastric accommodation and evacuation  abnormalities  that determine the  overlap  syndrome,  indicate  some common  mechanisms  of pathophysiology of FD and NERD, which should be taken into account for therapy optimization