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Далеко не каждый выпуск нашего журнала может быть украшен столь радостным и торжественным событием. 1 августа 2017 года исполнилось 95 лет выдающемуся российскому клиницисту, мэтру отечественной терапии и гастроэнтерологии заслуженному деятелю науки РФ профессору Якову Сауловичу Циммерману. Отмечая его огромный авторитет и заслуги в юбилейном поздравлении, мы открываем номер его программной статьей, посвященной постхолецистэктомическому синдрому – одному из самых распространенных явлений современной гастроэнтерологической практики. Патологии печени и желчевыводящих путей посвящены также лекция извеснейшего гепатолога Светланы Дмитриевны Подымовой по хроническому аутоиммунному гепатиту, исследование А. Ю. Горбунова и Д. В. Трониной из Ижевска об изменении сократимости желчного пузыря под воздействием минеральной воды «Увинская», работа И. Л. Кляритской с соавт. Из Республики Крым «Повреждение печени при сочетании инфекций- вируса иммунодефицита человека и туберкулеза» и клиническое наблюдение В. Э. Сагынбаевой и Е. В. Головановой (Москва) «Криоглобулиновый нефрогенный васкулит, ассоциированный с хроическим вирусным гепатитом С…» Несмотря на политематичность номера, четко выделяется его онкологическая направленность, в том числе и по онкогепатологии. Это работы А. В. Белкова и В. А. Дуванского из Москвы «Технология спектрального цветового выделения при эндоскопической диагностике новообразований толстой кишки», группы также московских авторов во главе с С. В. Давыдовой «Стентирование при сочетанной билиарной и пилородуоденальной опухолевой обструкции», а также клинические демонстрации, представленные группой авторов (С. С. Пирогов, В. В. Соколов, А. Д. Каприн и др. из МНИОИ им. П. А. Герцена) «Метастатическое поражение желудка при меланоме кожи: возможности; мультимодальной эндоскопической диагностики» и М. В. Перегудовой, А. Р. Зарецкого с соавт. касательно эффективности таргентной терапии метастатической холангиокациномы. Многообразие «гастроэнтерологических» проблем подчеркивается многообразием поднимаемых авторами данного номера проблем. Это и изменение тканей пародонта при постгастрорезекционных расстройствах (Л. Ю. Островская и Н. В. Булкина из Саратова), и извечная проблема запоров при беременности (С. Г. Бурков, Москва), и обзор по хроническому алкогольному панкреатиту (В. В. Скворцов с соавт. Из Волгограда), и обещающая стать классической классификационная работа московских эндоскопистов Г. В. Беловой и О. С. Руденко «Эндоскопическая анатомия пищеводно-желудочного перехода в норме, при хиатальных грыжах и цилиндроклеточной метаплазии слизистой оболочки пищевода», и обзор А. М. Осадчука с соавт. (Самара) о рефрактерной к ингибиторам протонного насоса гастроэзофагеальной рефлюксной болезни, и очередное экспериментальное подтверждение учеными Московского научного медицинского центра им. А. С. Логинова эффективности мехенхимальных стромальных клеток при язвенном колите (О. В. Князев с соавт.).
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Keywords:cholelithiasis,biliary sludge,postcholecystectomy syndrome,classification,treatment
Abstract:In the overview article discusses: the prevalence of cholelithiasis, the frequency of the related surgical interventions, controversial problems with terminology, the concept of “biliary sludge”. Brief information about the elements of cholelithiasis; etiology and pathogenesis of postcholecystectomy syndrome - PHES and its definition; different approaches to the definition of its nature, the working classification of PHES. Specify modern methods of diagnosis PHES. Discusses in detail the contemporary possibilities of pharmacotherapy and their effectiveness, indications for surgical treatment and basic preventive measures.
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Zimmerman J.S. POSTCHOLECYSTECTOMICAL SYNDROME, ITS NATURE, CLINICAL MANIFESTATIONS, DIAGNOSIS AND TREATMENT. Experimental and Clinical Gastroenterology Journal. 2017;144(08):4-11
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Keywords:comorbid diseases,postgastrectomy disturbances,periodontal disease
Abstract:Purpose. Definition of features of a periodontal tissues at patients with postgastrectomy disturbances and predictors of progression periodontal diseases Material and methods. The examination of 42 patients with a disease of the operated stomach and chronic generalized periodontitis at the age of 29-58 years is conducted. Endoscopic, radiological, morphological examination is conducted. Material processed statistically. Results. Clinical features of a periodontal disease against the background of the postgastrectomy disturbances are the expressed inflammatory reaction in periodontal tissues, deep periodontal pockets, suppuration from them, appreciable mobility of teeth, plentiful tooth deposits, erosions of an enamel. Predictors of emergence and advance of a periodontal disease after a resection of a stomach are disturbance of evacuation from a stomach stump, the expression of an enterogastro-ezofageal reflux, general dystrophic changes in an organism caused by malabsorption. Conclusion. Achievement of permanent remission in treatment of patients with comorbid pathology requires joint approach of gastroenterologists and stomatologists.
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Ostrovskaya L.U., Bulkina N.V. CONDITION OF PERIODONTAL TISSUES AT PATIENTS WITH POSTGASTRECTOMY SYNDROM. Experimental and Clinical Gastroenterology Journal. 2017;144(08):12-16
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Abstract:Objective: individualization of therapy in patients with pulmonary tuberculosis and in HIV-coinfected patients who are undergoing antituberculosis and antiretroviral therapy, by studying the risk factors of drug-induced liver disease (polymorphism of NAT2 and cytochrome P450 2E 1). Materials and methods. 200 patients were examined during the study. 120 patients with newly diagnosed pulmonary tuberculosis (TB) who were undergoing anti-tuberculosis therapy according to I or III regimens have been identified among them. Patients with or without drug-induced liver disease on the background of anti-tuberculosis chemotherapy were studied by genotyping of cytochrome P450 2E 1 and NAT2 enzymes by «real time» polymerase chain reaction (PCR) and 13C-metacetin breath test. Results. In the 2 nd group and in the 4 th group (in groups of patients with drug-induced liver disease on the background of antituberculous therapy), slow acetylators and genotype of cytochrome P450 2E 1 c1 / c1 prevailed. Conclusions. It is advisable to recommend patients in the high-risk group for the development of drug-induced liver disease to determine the activity of cytochrome P450 2E 1 and NAT2 enzymes by genotyping and phenotyping in order to select the optimal scheme of anti-tuberculosis therapy, which will lead to increased adherence of patients to therapy and improvement of patients’ quality of life.
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Kliaritskaia I.L., Shelikhova E.O., Maksimova E.V., Stilidi E.I. DAMAGE WHEN TAKING INFECTIONS - HUMAN IMMUNODEFI CIENCY VIRUS AND TUBERCULOSIS. Experimental and Clinical Gastroenterology Journal. 2017;144(08):17-22
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Abstract:On the basis of the endoscopic Department NUZ NCC, Russian Railways conducted a routine colonoscopy which were selected 81 patient for polypectomy. Used video system EPX-4400 Fujifilm, video endoscopes EC-590ZW/L, and EC-530WL. This system has the capability of digital and optical zoom, virtual chromoscopy FICE (spectral color separation). Used two user mode, which we consider to be optimal for routine chromoscopy tumors, FICE-0 (light spectrum 530 of the R, G, 485, 505 B; light amplification R 3, G 4, B 3) and FICE-1 (light spectrum 550 R, G, 500, B 470; light amplification R 2, G 4, B 4). Removal of tumors was performed by polypectomy and mucosal resection, using the electrosurgical unit Erbotom ICC 200, ERBE Elektromedizin company. Presents several applications of spectral color technology selection stages of diagnosis and treatment of tumors of the colon.
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Belkov A.V., Duvanskiy V.A. SPECTRAL COLOR SEPARATION TECHNOLOGY WITH ENDOSCOPIC DIAGNOSIS OF COLON TUMORS. Experimental and Clinical Gastroenterology Journal. 2017;144(08):23-25
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Keywords:biliary stenting,duodenal stenting,double stenting,self-expanding metal stents,malignant stenosis
Abstract:Aim: analysis of the results of double stenting in patients with combined biliary and pyloroduodenal malignant obstruction. Material and methods: Double stenting with self-expandable metal stents (SEMS) was performed in 9 patients with biliopancreatoduodenal (8) or gastric tumours. Simultaneous presentation of biliary and pyloroduodenal strictures was observed in 6 patients, while in 3 initial development of biliary obstruction was followed by later onset of duodenal stenosis - 4-14 months after first endoscopic (2) or percutaneous transhepatic (1) biliary stenting. In 6 cases single-stage double stenting was performed and endoscopic pyloroduodenal stent insertion was combined with biliary stenting through endoscopic (initial SEMS insertion [4] or replacement of plastic stent [1]) or percutaneous (1) route, in 3 - stents were implanted in two stages. Results: Stenting was successfully carried out in all patients. Early complications were observed in 3 cases and included acute cholecystitis (1), cholangitis (1) and hydrothorax after percutaneous biliary stent insertion (1) with no in-hospital mortality. All patients were followed up until death without any evidence of recurrent obstruction. The median survival was 91,5 days. Conclusion: According to both literature review and authors’ experience, double stenting is an effective minimally invasive palliation of patients with combined biliary and pyloroduodenal malignant obstruction. Multidisciplinary approach is necessary for best results.
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Davydova S.V., Fedorov A.G., Klimov A.E. STENTING COMBINED WITH BILIARY OBSTRUCTION AND TUMOR PILORODUODENALNOY. Experimental and Clinical Gastroenterology Journal. 2017;144(08):26-32
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Keywords:genetic factors,features of a current,the diagnosis,the forecast,indications to treatment,schemes of treatment
Abstract:The review purpose - despite achievements in a comprehension of a pathogenesis and treatment of autoimmune hepatitis still remain unresolved a number of questions, explaining clinical features, change of diagnostic criteria. New researches and emergence of larger cohorts of patients frame unique opportunities to transfer achievements of science to new methods of treatment which will help to improve quality of life and the forecast of patients with AIG. Along with the antibodies of histocompatability defining predisposition to a serious current the role of the transcription factor designated as the autoimmune regulator of the 1st type is undoubted; it is possible that mutations of this transcription factor cause loss of tolerance to liver autoantigens. As the target for influence of drugs is considered by “interface hepatitis”. At diagnostic observation over 25 patients from 3 to 18 years we noted continuously recurrent course of a disease from the death or transition to cirrhosis that determined terms of dispensary observation from 4 to 14 months. The explanation of diagnostic criteria of autoimmune hepatitis is given in article. At the same time accurately follows that the scheme of treatment of AIG depends on options of disease. The combination therapy of glucocorticosteroid drugs and azatioprin considerably increased life expectancy of these serious patients. Various concrete schemes of treatment are considered and advantages of alternative therapy and transplantation.
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Podymova S.D. SOLVED AND UNSOLVED PROBLEMS IN THE DIAGNOSIS AND TREATMENT OF AUTOIMMUNE HEPATITIS. Experimental and Clinical Gastroenterology Journal. 2017;144(08):33-44
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Keywords:pancreatitis,alcohol,pain syndrome,incretory insufficiency,secretory insufficiency,maldigestion,malabsorbtion,steatorrhea,amylase,enzyme preparations,proton pump inhibitors,H2-histamine blockers
Abstract:This review represents the data on classification of chronic alcoholic pancreatitis; discusses symptoms of this disease; studies diagnostic standards at inspection of patients with alcoholic pancreatitis; acquaints with principles of complex treatment of this pathology.
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Skvortsov V.V., Ustinova M.N., Khalilova U.A. DIAGNOSIS AND TREATMENT OF CHRONIC ALCOHOLIC PANCREATITIS . Experimental and Clinical Gastroenterology Journal. 2017;144(08):45-51
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Keywords:esophageal-gastric junction,cardia,diaphragmatic constriction,metaplastic mucosa,Barrett’s esophagus,hiatal hernia
Abstract:Endoscopic picture of esophageal-gastric junction in normal and pathological conditions is still a matter of attention of domestic and international medical community: endoscopists, gastroenterologists, morphology, as well as abdominal and thoracic surgeons. Endoscopic semiotics and target biopsy of pathological focus are the basis for the diagnosis and definition of further tactics for the patient. The main issues addressed in the review 1.Anatomical Z-line position relative to the outlet of the cardia and diaphragma 2. Histological features of esophageal-gastric junction in normal 3. Options endoscopic picture in normal and in condition of metaplastic mucosa 4. The endoscopic picture with hiatal hernia
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Belova G.V., Rudenko O.S. ENDOSCOPIC ANATOMY OF ESOPHAGEAL-GASTRIC JUNCTION WAS NORMAL, WHEN CHITALNY HERNIAS AND CYLINDRICITY METAPLASIA OF ESOPHAGEAL MUCOSA. Experimental and Clinical Gastroenterology Journal. 2017;144(08):52-54
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Keywords:Refractory to inhibitors of proton pump gastroesophageal reflux disease,diagnosis,treatment
Abstract:Aim of the review. At a modern scientific level, to illuminate the problem of refractory to proton pump inhibitors (PPI) forms of gastroesophageal reflux disease (RFGERD). It is shown that PPI remain the standard and most effective therapy for gastroesophageal reflux disease (GERD). Patients in whom GERD symptoms are refractory to PPI should be further examined to exclude other diseases. It is possible to use different treatment options: medication, endoscopic or surgical. The response to IPP therapy can be complete (no symptoms), partial or absent. In patients with a full response to treatment with PPI, no other treatment is foreseen. Patients with partial response may require endoscopic or surgical intervention. Currently, new methods of conservative therapy of RFGERD are being actively developed. Special hopes for improvement of the symptoms of RFGERD are currently associated with the means that can provide visceral analgesia.
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Osadchuk A.M., Davydkin I.L., Gricenko T.A., Kurtov I.V. et al. REFRACTORY TO PROTON PUMP INHIBITORS GASTROESOPHAGEAL REFL UX DISEASE. Experimental and Clinical Gastroenterology Journal. 2017;144(08):55-61
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Keywords:mesenchymal stromal cells,reparative processes,inflammatory bowel diseases,model of colitis
Abstract:Transplantation of allogenic mesenchymal stromal cells (MSCs) is used for the stimulation of reparative processes in various organs and tissues. The aim of our work was to assess the reparative potential of MSCs to bone marrow in acute and chronic damage to the intestines of Wistar rats induced by sodium dextran-sulfate (DS). An experiment to study the reparative capacity and safety of transplantation of MSCs bone marrow in acute and chronic intestinal damage induced by sodium DS was carried out on Wistar rats. Transplantation of mesenchymal stromal cells in this experiment showed improvement of the histological picture of the intestinal mucosa. Experience has demonstrated the feasibility of this method in the field of medical use of stem cells the type that is aimed at increasing the effectiveness of therapy of chronic inflammatory bowel diseases.
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Knyazev O.V., Khomeriki S.G., Trubitsyna I.E., Konoplyannikov A.G. TRANSPLANTATION OF MESENCHYMAL STROMAL CELLS OF BONE MARROW ON THE MODEL OF ULCERATIVE COLITIS. Experimental and Clinical Gastroenterology Journal. 2017;144(08):62-66
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Abstract:Objective: to develop an algorithm for step-by-step differential diagnosis of congenital cholestatic diseases in children based on a multifactorial statistical analysis of the characteristics of the course of diseases for their early detection and determination of the tactics of medical care. Patients and research methods. 81 children aged 1 month to 16 years (average age 5 years 2 months ± ± 6 months), of which 20 children with biliary atresia (BA), 17 children with hereditary tyrosinemia type 1 (HT1), 23 children with progressive familial intrahepatic cholestasis (PFIHC), 21 children with Alagilla syndrome (SA). Were performed retrospective analysis of the history and clinical manifestations of disease in the debute; biochemical blood examination; hepatobiliscintiraphy (HBSH). Results. It was found that the most significant clinical symptoms at the onset of congenital cholestatic disease in infants is prolonged jaundice in the neonatal period, hypocolia or Acholia of the stool, hepatomegaly or hepatosplenomegaly in children born with intrauterine hypotrophy from pregnancy, which was threatened with interruption. Dyspepsia syndrome, fever, and rickets in disease onset is characteristic of hereditary tyrosinemia type 1. It has been proven that using HBSH differentiates the type of intrahepatic cholestasis - intracellular sinusoidal from ductular, as well as differentiation of PFIHC and BA from SA and NT1, for example, metabolic diseases involving liver pathology are considered. It is shown that the most significant laboratory parameters in the differential diagnosis of cholestatic diseases in young children are the levels of gammaglutamyltranspeptidase (GGT), total bilirubin with a predominance of direct fraction and alanine aminotransferase (ALT). A set of indicators of changes in GGT, ALT, and bilirubin allows to differentiate congenital cholestatic disease. An algorithm for step-by-step differential diagnosis of congenital cholestatic diseases in young children has been developed. Conclusions. A timely, step-by-step differential diagnosis of congenital cholestatic diseases in children allow early detection of these diseases and determine the correct patient management tactics, including screening for the necessary surgical treatment. Early differential diagnosis of cholestasis in infants will allow to prevent disability in children, as well as to influence such a significant indicator as infant and child mortality.
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Volynets G.V., Khavkin A.I., Panfilova V.N., Nikitin A.V. DIFF ERENTIAL DIAGNOSIS OF CONGENITAL CHOLESTATIC DISEASES IN CHILDREN. Experimental and Clinical Gastroenterology Journal. 2017;144(08):67-74
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Keywords:cholelithiasis,hormones,mineral water “Uvinskaya”
Abstract:The pathogenesis of diseases of the digestive system, assigned role to the disturbances of hormonal homeostasis now. In non-drug treatment of these diseases, drinking mineral waters take a special place. Relatively new are the studies on the effect of mineral waters (MV) on the level of hormones. The aim of the research. Stadying of hormonal status in the process of non-drug therapy in patients with pre-stagnant stage of cholelithiasis (SCI). Material and methods. 96 patients suffering from the pre-stone stage of LCB were examinated. Perform research clinical observations of gallbladder function during a single dose of MV “Uvinskaya” (Udmurt Republic). During the course of treatment, the level of hormones (cortisol, insulin, C-peptide) in the blood was studied by the method of immunoenzymatic analysis. The results of the study revealed that after a single dose of MV, the gallbladder volume was reliably reduced in patients with pre-stagnant stage of GAD. It is noted that the balance between catabolism (in the form of cortisol reduction) and anabolism (in the form of an increase in the level of insulin and C-peptide) is reached by the end of the course of therapy. Conclusion: Taking MV Uvinskaya at the pre-stone stage of LCB actively affects hormonal homeotas, improving the function of not only the gallbladder and pancreas, but also reducing the stress effect in the form of the formation of a new level of functioning of the digestive system, close to the physiological.
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Gorbunov A.Yu., Tronina D.V. CHANGE IN THE HORMONAL STATUS IN CHOLELITHIASIS IN THE PROCESS OF TREATMENT WITH MINERAL WATER "UVINSKAYA". Experimental and Clinical Gastroenterology Journal. 2017;144(08):75-78
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Abstract:Introduction. Melanoma as a specific kind if dermal malignant neoplasms had been first described by Laennec as far back as 1806. On statistical evidence, frequency of a primary skin melanoma in Russia is 1.2-1.9 % among all malignant tumors. In 1820 H. Norris was the first, who discovered “a fungiform stomach disease” in a patient with skin melanoma. According to data of recent papers, metastatic lesions in the gastrointestinal tract in patients with skin melanoma are detected more than in 60 % cases at autopsy, but never diagnosed at treatment stage. Metastatic stomach lesions in patients with skin melanoma are usually asymptomatic, or symptoms are of non-specific. Classification of these lesions at first proposed by Ji Yong Ahn in 2014, and it described three macroscopic forms of melanoma metastases in gastrointestinal tract: nodular, exophytic and flat pigmented. Most of them are usually pigmented, amelanotic metastases are very rare. Objectives. The primary objective of this clinical case descripton is to show the possibilites of multimodal endoscopy, including confocal laser endomicroscopy, in metastatic stomach lesions diagnostics. Methods. Patient K., male, 69 years old, had admitted to the P. A. Herzen Moscow Cancer Research Institute, due to a district oncologist’s referral with a diagnosis “Malignant tumor of hepatopancreatobiliary region with metastases in lungs and dextrocerebral hemisphere. Chronic gastric erosions». Patient had been comprehensively examined in our institution: MRI has confirmed presence of metastatic tumor in dextral temporal region; CT described solitary metastases in the left lung inferior lobe and pancreas cervix. Multimodal upper GI endoscopic examination had been performed, including white-light high-resolution endoscopy (WLI-HD), narrow-band imaging (NBI) with optical magnification 80x (NBI-ME), endoscopic ultrasonography (EUS) and confocal laser endomicroscopy (CLE), using Cellvizio system. Results. At upper GI endoscopic examination, four nodular, eroded on top, lesions sized from 0,5 to 2 cm had been detected in the in the subcardia and in upper, middle and lower thirds of the gastric corpus. Taking in mind, that lesions are multicentric, it was necessary to differentiate primary gastric B-cell lymphoma and metastatic stomach lesions. With NBI examination, it had been discovered, that pit pattern in lesions is regular and there were no signs of surrounding mucosa pathology. Also, no significant changes of intrapapillary capillary loops shape had been detected with NBI-ME. With EUS, it had been revealed, that lesions are hypoechoic, originating from deep part of mucosa, not invading submucosa. We have performed CLE and it had been detected, that in eroded lesions there was absence of glandular or pit structures and presence of chaotically (densely in some areas) located dark irregularly shaped, considerably enlarged, tumor cells nuclei. According to these findings, we have concluded, that lesions are poor-differentiated solid tumors, probably - multiple amelanotic metastatic melanoma. Precise biopsy was performed. Due to presence of considerable neurological disorders a microsurgical resection of the dextral temporal lobe tumor was performed, not waiting for routine pathology or immunohistochemical examination. One week later, pathologists confirmed amelanotic epithelial cell melanoma metastases in gastric mucosa and resected brain tumor mass. Conclusion. Thus, metastases to the stomach mucosa are not so rare events in patients with late stages of neoplastic process at skin melanoma. Multimodal endoscopic examination with CLE provides valuable diagnostic data of stomach tumor morphology, not only carcinoma, but a solid tumors too.
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Pirogov S.S., Sokolov V.V., Kaprin A.D., Sokolov D.V. et al. METASTATIC LESION OF THE STOMACH WITH MELANOMA OF THE SKIN: POSSIBILITIES MULTIMODAL ENDOSCOPIC DIAGNOSIS. Experimental and Clinical Gastroenterology Journal. 2017;144(08):79-86
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Keywords:Cholangiocarcinoma,moleculartumortesting,BRAF V600E mutation,targeted therapy,dabrafenib,trametinib
Abstract:We report a case of successful targeted treatment of a patient with metastatic cholangiocarcinoma refractory to chemotherapy and immunotherapy. After detection of BRAF V600Emutationinpatient’stumor, dabrafenib + trametinib combo was started which led to dramatic improvement in patient’s general condition and regression of most of the lesions. Effectisongoingafter6monthsoftargetedtherapy. This case demonstrates potential efficiency of a molecularly targeted approach to treatment of advanced cancers.
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Peregudova M.V., Zaretsky A.R., Breder V.V., Romanova K.A. et al. THE EFF ECTIVENESS OF TARGETED THERAPY IN A PATIENT WITH BRAF-POSITIVE METASTATIC CHOLANGIOCARCINOMA. Experimental and Clinical Gastroenterology Journal. 2017;144(08):87-90
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Keywords:kidney damage,antiviral therapy,monoclonal antibodies to CD 20,rituximab (mabthera),mixed cryoglobulinemia,cryoglobulinemic vasculitis,chronic viral hepatitis C
Abstract:As a clinical case we discuss cryoglobulinemic vasculitis of high activity with predominant kidney damage associated with chronic viral hepatitis C. The result of the treatment by monoclonal antibodies to CD 20 receptors - rituximab (mabthera) - confirms the efficiency of the drug in case of severe cryoglobulinemic vasculitis persistent to the standard treatment, with underlying chronic viral hepatitis C. After the therapy the hemodynamic indexes have stabilized, the hemorrhagic rash did not recur, cryoglobulinemia, proteinuria and hematuria decreased. Unfortunately the immunosuppressive therapy contributed to the increase of transaminase and cholestasis, which leaded to the need of the antiviral therapy for the elimination of the virus and relapse prevention. However, the ways of diagnostics and treatment of the patients with chronic viral hepatitis C with extrahepatic symptoms are not developed, represent serious problem and need to be further studied; the scheme of testing and antiviral therapy should be worked out.
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Sagynbaeva V.E., Golovanova E.V. CRYOGLOBULINEMIC VASCULITIS WITH KIDNEY DAMAGE ASSOCIATED WITH CHRONIC VIRAL HEPATITIS C: ANTI-CD 20 MONOCLONAL ANTIBODIES TREATMENT. Experimental and Clinical Gastroenterology Journal. 2017;144(08):91-96
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Abstract:Provides data for the treatment of constipation in 37 women in various stages of pregnancy. Highlighted that in addition to dietary measures requires taking laxatives, in particular Forlaks, has a mild laxative effect, long persistent effect and aftereffect, not causing side effects.
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Burkov S.G. CONSTIPATION IN PREGNANT WOMEN: A MODERN VIEW ON THE PROBLEM. Experimental and Clinical Gastroenterology Journal. 2017;144(08):97-100
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Abstract:The article is devoted to the 95 years anniverssary of outstanding clinician-gastroenterologist, Honored Scientist of the Russian Federation Yakov Saulovich Zimmerman. Professor Ya. S. Zimmerman is the author of a unique, repeatedly republished book, that has become a reference book for many “Wise thoughts about medicine and healing: sayings, aphorisms, quotes”, as well as memories of the Great Patriotic War of 1941-1945 - “Military fate a purely civilian young man "(1995, 2010), and a collection of poems" Living Life Is Not a Field to Go "(2002). The article is published in Russian.
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Lazebnik L.B., Vologzhanina L.G. ANNIVERSARY YAKOV SAULOVICH TSIMMERMAN. Experimental and Clinical Gastroenterology Journal. 2017;144(08):101-102
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