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The systemic and local immune response was studied in patients with alcoholic liver cirrhosis and the significance of the combined infection with HCV. To investigation were submitted 23 patients (16 males and 7 females) aged between 29 and 61 years with alcoholic liver cirrhosis. Of them 14 were anti-HCV(+) and 9 anti-HCV(-). As controls were used 36 clinically healthy individuals, matched by sex and age to the patients. The flow cytometric analysis of the lymphocyte (Ly) populations from the peripheral venous blood and of cells from liver aspirate obtained by blind liver biopsy according to Menghini, was performed with FacsTAR (Becton Dickinson). In the anti-HCV(-) patients, as compared to the controls (patients/controls) the Ly subpopulations were increased: CD3+/mm3:2010 +/- 738/1440 +/- 388; CD4+/mm3:1350 +/- 441/991 +/- 442; IL-2R+/mm3:133 +/- 78.5/31 +/- 20. In the anti-HVC(+) patients we established increased IL-2R+/mm3: 170 +/- 126 as compared with the controls and anti-HCV(-) patients. The suppressor/cytotoxic (CD8+) Ly with their suppressor (CD8+CD11b+) and cytotoxic (CD8+CD11b-) subpopulations and natural killers (CD16+) had a tendency to diminution in the anti-HCV(+) patients. In both examined groups the B (CD19+) Ly were non-significantly increased. The flow cytometric analysis of the cells from the liver specimen in 9 patients of whom 3 anti-HCV(-) and 6 anti-HCV(+) revealed that CD3+ on the average were 32.8% +/- 20.4% (from 9.2% to 65.1%); CD4+ were 21.1% +/- 7.4% (from 12.0% to 34.5%); CD8+ 22.6% +/- 11.8% (from 4.7% to 39.8%) and their values were higher in the anti-HCV(+) patients; the correlation CD4+/CD8+ = 1/1.09 +/- 0.6; CD16+ were 12.9% +/- 10.1% (from 1.9% to 34.8%); CD19+ varied from 3.2% to 27.8%; monocytes (CD14+) were 7.69% +/- 5.65 (from 2.0% to 15.8%) from the cells of the aspirate and their percentage contents was higher in the anti-HCV(+) patients. The results of out study revealed that in patients with alcoholic liver cirrhosis changes in the cell immune response were also observed and that they were more marked in infection with HCV.

Fifty-six patients presenting choledocholithiasis are covered by the study. They are distributed in groups according to total serum bilirubin values, as follows: with total serum bilirubin < 20 mumol/l--17; 20 to 50 mumol/l--13; 50 to 80 mumol/l--9; and > 80 mumol/l--17 cases. Sixty healthy, sex and age matched individuals serve as controls. The immunocompetent cells are determined flow cytometrically with FACS TAR (BECTON DICKINSON). A panel of monoclonal antibodies (Becton Dickinson) is used, including: Leu4 (anti-CD3+)--T-lymphocytes; Leu3a (anti-CD4+)--helper/inducer lymphocytes; Leu2a (anti-CD8+)--suppressor/cytotoxic cells; Leu11a (anti-CD16+)--cells with a natural killer activity; Leu12 (anti-CD19+)--B-lymphocytes. As shown by the obtained results there are no changes in cell-mediated immune response among choledocholithiasis patients with normal values of total serum bilirubin. Parallel to increasing the degree of cholestatic jaundice (ChJ) severity, the absolute values of lymphocytes and their subpopulations decrease. The deficit is most clearcut in patients presenting the highest degree cholestasis, as compared to healthy individuals ((Ly: 1690 +/- 174/2277 +/- 186; CD3+: 956 +/- 119/1793 +/- 67; CD4+: 607 +/- 83/988 +/- 80; CD8+: 239 +/- 52/639 +/- 85; CD16+: 146 +/- 38/367 +/- 55; CD19+: 181 +/- 33/200 +/- 13. In 11 cases with early restored biliary drainage (by the 21st day of ChJ), total serum bilirubin decreases within 10 days after the operation (choledochoduodenoanastomosis), whereas lymphocytes and their subpopulations show an increase in absolute values. Two months after choledochoduodenoanastomosis, the total serum bilirubin and the lymphocyte subpopulations being examined regain their normal values. In two instances with rather late biliary drainage recovery (30 days after ChJ) the total serum bilirubin and lymphocyte subpopulations under study show no tendency whatsoever towards normalization at 10 days postoperatively. The results of the study demonstrate that the poor prognosis among ChJ patients is also related to inhibition of the cell-mediated immune response. The early biliary drainage recovery (at 21 days of ChJ) exerts a more favourable effect on the immune system, and improves the prognosis of the clinical course run by the pathological process.

The hepatitis C virus (HCV) infection could affect not only the liver, but also other tissues, organs and systems. The number of the reported in the literature extrahepatic lesions by HCV incessantly increases. A reliable association between the infections by HCV and the mixed cryoglobulinaemias, membrano-proliferative glomerulonephritis and porphyria cutanea tarda is confirmed. The participation of HCV in the pathogenesis of some diseases of the thyroid gland, the lymphocytic sialadenitis, lichen planus, diabetes mellitus, thrombocytopenia, antiphospholipid syndrome, etc., is assumed. The extrahepatic lesions by HCV are probably connected with the participation of the immune system, but they may be as well due to the replicating virus in the affected tissues, organs and systems. The pathogenetic mechanisms of the extrahepatic and autoimmune manifestations of the infection with HCV are not elucidated, which poses difficult therapeutic problems regarding the choice of interferon and/or corticosteroid hormones.

The presence and degree of manifestation of Campylobacter (Helicobacter) pylori in gastroduodenal mucosa were studied in 100 patients (56 men, mean age 51.4 years, and 44 women, mean age 46.5 years) with endoscopically proved chronic erosive gastritis (52 patients), erosive duodenitis (36 patients) and erosive gastroduodenitis (12 patients). The examinations revealed the presence of Campylobacter (Helicobacter) pylori in mean 77% of the patients with erosive gastritis, duodenitis and gastroduodenitis. Campylobacter (Helicobacter) pylori was found most often in patients with chronic erosive duodenitis--83.3%, whereas in the patients with erosive gastritis it was found in 73.07%. In 83.33% of the patients with chronic erosive gastritis, duodenitis and gastroduodenitis the campylobacter infection was well manifested--(++) according to Le Bodie et al (1987). The results allow the conclusion that one of the important pathogenetic factors of erosive gastritis, duodenitis and gastroduodenitis is the Campylobacter (Helicobacter) pylori infection of gastroduodenal mucosa.

82 patients-10 p. with uncomplicated cholelithiasis, 8 p. with chronic calculous cholecystitis, 34 p. with choledocholithiasis with stenosing papillo-odditis--and 30 healthy controls were examined, with monoclonal antibodies of the firm "Becton-Dickinson". The following immunocompetent cellular clones and subclones were examined: CD3+, CD16+, CD4+, CD8+, CD19+ CD4/CD8, HLA-DR+, CD3+. The results were read with analyzer for fluorescently marked activated cell clones "FACS-TAR". The serum IgA, IgM, IgG, C3-C4 complement fractions and circulating immune complexes were also examined. The analysis of the results shows that in the complicated cases of cholelithiasis with an inflammatory process in the biliary ducts several humoral and cellular immune factors take part.

The hydrocortisone and ACTH blood levels, 17-hydroxycorticosteroids urine excretion and suprarenal function stimulation with Synacthen were studied in 22 patients with chronic obstructive pulmonary disease and 12 healthy persons as controls. The results show the presence of reliably higher hydrocortisone and 17-hydroxycorticosteroids levels in patients with low partial oxygen pressure as well as a higher ACTH plasma level and a strong Synacthen stimulation. After a comprehensive treatment including oxygen therapy the blood concentrations of hydrocortisone, ACTH, 17-hydroxycorticosteroids fell to levels found in healthy persons. The study shows that hypoxemia stimulates the suprarenal-cortex secretion.

Three cases of Dubin-Johnson syndrome in close relatives--brother, sister and a brother's son--are reported. The clinical characteristics, evolution, diagnostic and differential diagnostic problems as well as the treatment and prognosis of the disease are pointed out.

The basic functional respiratory indices were followed up in 50 patients suffering from various forms of chronic obstructive pulmonary disease before and after treatment. A decrease of the dynamic indices followed up was found: inspiration indices--FEV 1% (forced expiratory volume), FVC% (forced vital capacity), FEV 1/FVC%, FEV 1/VC%; flow indices--MEF 25% (maximal expiratory flow), MEF 50% MEF 75%, PEF% (peak expiratory flow), MEF/FVC%, MMEF 25-70% (maximal mean expiratory flow). A decrease of vital capacity and of diffusion capacity was also found. The ratio RV/TLC% (residual volume/total lung capacity) was increased and a general hyperventilation was established. Moderate hypoxemia and lowered saturation by normocapnia and normal pH were also established. The control examinations after treatment showed improvement of all indices followed up.

49 patients with chronic obstructive pulmonary disease and 40 healthy persons were examined. The hemocoagulation state indices were followed up before and after treatment. The patients with chronic obstructive pulmonary disease were classified into two groups: I gr.--treated without drugs acting on the hemocoagulation factors, II gr.--treated with heparin applied by electrophoresis. Significant changes of some of the basic indices of hemostasis were found. Following electrophoretic application of heparin they were considerably improved compared with the control group of patients treated without heparin. This kind of treatment is well tolerated by the patients and does not lead to untoward reactions.

The study includes 94 persons: 54 patients with chronic obstructive pulmonary disease and 40 healthy controls. The coagulation indices were followed up dynamically before and after heparin treatment. The patients with chronic obstructive pulmonary disease were classified into 3 groups in relation to the degree of respiratory failure. The results show significant changes in some of the basic hemostatic indices: decreased antithrombin III activity, increased alpha 2-macroglobulin and plasminogen activity, partial thromboplastin time shortening, increased erythrocyte, hemoglobin and hematocrit values. With deterioration of the respiratory failure these changes become more manifested which increases significantly the risk of pulmonary thromboembolism. The values of platelets, fibrinogen, prothrombin time, bleeding time, clotting time, alpha 2-antiplasmin and prekallikrein activity do not show any significant changes and are not reliable indices for hemostatic changes in patients with chronic obstructive pulmonary disease. The administration of heparin improves the changed basic indices. This is best expressed in patients with III degree respiratory failure. The parameters of external respiration and gas exchange improve parallelly with the improvement of the coagulation state.

Diagnostic, clinical and therapeutic studies were carried out, under clinical conditions, on 80 patients with endoscopically confirmed chronic erosive gastritis and gastroduodenitis. The subjects aged between 20 and 59 are most often affected, the males being 2 times more often affected. The histological study on the purposeful biopsy of the mucosa of the stomach and duodenum established, most frequently, the presence of chronic superficial gastritis and duodenitis, followed by initial chronic atrophic gastritis. The clinical symptoms were studied in details--pain (91.20%), dyspeptic syndrome (83.7%), hemorrhagic manifestations (hematemesis or melena)--23.7%. In 40% of the patients with erosive gastritis and gastroduodenitis, the disease was combined with duodenal ulcer and in 7.5%--with gastric ulcer. The etiological factors of importance are: food factors, dietetic errors, alcoholic consumption, drug effects (first of all derivatives of Rauwolfia serpentina, followed by the peroral broad spectrum antibiotics, etc), duodenogastric reflux and toxic effect of the bile acids on the antral mucosa. The endoscopic studies are of decisive importance for the diagnosis and determining the effect of the treatment. The treatment with a dietetic regimen, gastro-protective drugs (almagel, preparations of deglycyrrhized licorice--alcid V, vitamin A, spasmolytics) eliminated the erosive alterations in 75% of the patients after 3-week treatment.

Four cases of acute doxycycline injury of the esophageal mucosa--acute catarrhal doxycycline esophagitis and acute doxycycline ulcer are presented. The pathogenesis, clinical course, endoscopic pattern, prophylaxis and treatment of these complications of doxycycline treatment are discussed in detail. The gastroesophageal and duodenogastric reflux, which are most often the result of functional failure of the lower esophageal sphincter, are pointed out as the basic pathogenetic mechanism of the esophageal mucosa injury in oral doxycycline treatment.

The degree of the filling up and the dilation of the gall bladder, its functional state as well as the passibility of d. cysticus are evaluated by ultrasound examination and computer determination of the surface and dimensions of the gall bladder. 546 patients, 20-78 years of age (484 women and 62 men) were examined by a pharmacodynamic functional test with chologon (acidum dehydrocholicum) in a dose of 10 mg/kg body mass and sorbitol (in 116 patients) in a dose of 20 g in 100 ml of water. The functional test is easily performed in the course of the ultrasound examination and side effects were registered. The test allows the assessment of the functional state of the gall bladder, the passibility of d. cysticus, the degree and mechanism of the filling up of the gall bladder and the bile ducts with bile. The better filling up of the gall bladder with bile after application of chologon (by passable d. cysticus) ensures better conditions for detecting microgallstones in the gall bladder as well as of diseases linked with its wall--cholesterosis, cancer and polypi of the bladder, etc.

A case is presented of a woman with a combined Rheumatic mitral valvular disease with a large mixed thrombus (65 mm) in the left atrium diagnosed post mortem. Such cases are very rare. In the course of the investigation of the patient many difficulties arose in spite of the use of modern instrumental methods. The precise and timely diagnosis of a thrombus in the left atrium allows an early radical treatment.

The presence of Campylobacter pylori was studied in biopsy material from gastric mucosa taken by guided biopsy during fiber gastroduodenoscopy from 101 patients with chronic gastritis (n = 50), peptic gastric ulcer (n = 28), peptic duodenal ulcer (n = 7), gastric cancer (n = 10) and gastric polyposis (n = 6). Campylobacter pylori was found in various quantity--moderate (++) and considerable ( )--in 64% of the patients with chronic gastritis, in 85.7% of the patients with peptic gastric ulcer and in 100% of the patients with peptic duodenal ulcer as well as in half of the patients with gastric cancer and polyposis. The quantity of Campylobacter pylori correlated with the severity of the inflammatory process and the degree of atrophy of the gastric antral mucosa. A tendency toward seasonal incidence of Campylobacter pylori infection of gastric mucosa was established: 78.69% of the patients examined during spring time (April-May) and 60.0% of the patients examined during winter time (January-February) had Campylobacter pylori infection. This explains to a certain extent the seasonal exacerbations of the pathological process in chronic gastritis and peptic ulcer. The development of a well expressed chronic atrophic gastritis is in direct relation with the greater quantity of Campylobacter pylori in the gastric mucosa. The study reveals the pathogenetic relations between the presence and quantity of Campylobacter pylori and the development and evolution of chronic gastritis and peptic gastric and duodenal ulcer.