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Unlabelled: THE AIM OF THE RESEARCH: Improving the effectiveness of diagnostics and treatment of viral and drug-induced lesions of the liver (DILL) at a tuberculosis in children by identifying the frequency of their distribution, peculiarities of diagnostics and clinics., Materials and Methods: We examined 242 children in the age from 2 months to 17 years, the patients with different forms of tuberculosis., Results: The prevalence of hepatitis in children with tuberculosis: B - 1,2%, C-0.4%, G - 4,6%, TT - 8,7%. DILL was diagnosed in 67.5% of children - TB patients, in 48% of the children with DILL an asymptomatic course of the disease was noted, however, in 54.4% of the children with DILL cytolitic syndrome was expressed (ALT> standards)., Conclusion: The prevalence of viral hepatitis B and C among children with TB is low. The infection with viruses of hepatitis G and TT is more often, but has no significant impact as on the course of tuberculosis, and on the severity of the liver damage. Drug-induced liver damage is a dominant view of pathology of the liver in children - TB patients and is mostly asymptomatic, but with a pronounced cytolitic syndrome.

Apoptosis plays an important role in the pathogenesis of viral hepatitis (VH), affecting not only hepatocytes but also immune cells. However, the occurrence of apoptosis in peripheral blood lymphocytes (PBL) during the course of VH in children has not been described. The aim of this study was to measure the level of PBL apoptosis during VH in children, and to test its possible correction by ursodeoxycholic acid (UDCA). Apoptosis was determined by flow cytometry using propidium iodide (PI) staining for hypodiploid cells. The apoptosis of PBL is closely correlated with the severity and progression of hepatitis A, B and C in children. Furthermore, the improved course and outcomes of the disease following UDCA treatment are associated with the reduction of PBL apoptosis.

Aim: To assess benefit for children with malignant blood disease (MBD) of the hepatoprotector heptral., Materials and Methods: 67 children with blood malignancy aged 3-14 years were examined (53 of them had acute lymphoblastic leukemia). 39 patients were in the study group (25 of them had hepatitis B or C), 28 were controls. Initially, heptral was injected intravenously (14 days) then orally (16-30 days). Activity of transaminases and number of violations of polychemotherapy protocols because of hepatic toxicity were registered., Results: Heptral administration led to inhibited activity of AlAT and AsAT especially in non-infected patients. Protocol deviations became less frequent., Conclusion: Heptral is a potent hepatoprotector in hepatic lesions of toxic, viral and mixed origin.

Anti-HVA IgM, HBsAg, anti-HBc IgM, anti-HVC were determined in the blood sera and saliva specimens obtained from patients with acute hepatitis A, B, C (HA, HB, HC) and from healthy persons of the control group. 37 HA patients, 27 HB patients and 24 HC patients, observed in the dynamics of the disease (for a period of 1 month and longer from the appearance of manifestations of the disease), as well as 30 practically healthy persons (the control group) were examined. Anti-HVA IgM could be found in saliva specimens taken from the HA patients 100% of cases, but could not be found in saliva specimens from the persons of the control group and HB patients. The presence of HBsAg was established in 92.8% and anti-HBc IgM, in 100% of cases in saliva specimens from patients with acute HB. In no case HB markers were found in saliva samples obtained from HA patients and from the persons of the control group. In HBsAg-positive saliva specimens HB virus DNA was detected by the method of polymerase chain, reaction, which opened new aspects for the modern interpretation of the role of saliva as a factor in the natural transmission of HB. Anti-HVC could be found in all patients both in the blood serum and saliva specimens, but proved to be absent in the persons of the control group, as well as in HA and HB patients. The dynamic study of HA, HB and HC patients for the detection of anti-HVA and anti-HBc IgM, HBsAg and anti-VHC demonstrated the possibility of detecting these markers for 1 month and longer in the blood sera and in saliva specimens. The results of these investigations suggest that saliva specimens may be regarded as an alternative to blood sera in the diagnosis of HA, HB and HC in patients with acute viral hepatitis; these results also open prospects for the use of saliva specimens as an object of study in diagnostic laboratories, the deciphering of viral hepatitis outbreaks, the diagnosis of HA in persons with anicteric forms of HA.

To determine the present-day specific clinical features of viral hepatitis A (HA) in children, observation on 447 children aged 1 year and 10 months to 14 years with verified HA monoinfection was carried out. At the season of 1993 essential differences were observed in the clinical picture of HA: the disease took a more severe course with the prevalence of medium-severe (59.3%) and severe (3.6%) forms of this infection, a tendency to a prolonged convalescence period and fermentative aggravations, an increase in the occurrence of cholestatic forms. One of the causes of this phenomenon may be attributed to changes in the properties of the infective agent.

A total of 142 children aged 2-15 years with different nephropathies, among them 94 children with glomerulonephritis (GN), 26 children with pyelonephritis and 22 children with oxalate nephropathy, were examined. The diagnosis was histologically confirmed in 36 children. Mesangial proliferative GN was detected in 22 patients and membrane proliferative GN, in 14 children. The presence of the markers of HBV infection (HBsAg, anti-HBs and anti-HBc total immunoglobulins, anti-HBc IgM) was detected in the sera of all patients by the enzyme immunoassay. As the result of this examination, essential changes in the distribution of different markers of HBV infection in children with nephropathies were detected. The combination of HBsAg with anti-HBc IgM proved to be the most characteristic feature of patients with the nephrotic syndrome; this was indicative of active HBV infection, and in patients with the mixed form of GN this combination occurred twice as frequently. The established correlation between the activity of HBV infection and the severity of the course of GN made it possible to suggest the participation of HBV in the pathogenesis of GN. This suggestion was indirectly confirmed by a higher detection rate of HBsAg and anti-HBc IgM in patients with the membrane proliferative form of GN.

A total of 33 families were surveyed with a view to determine the presence of viral hepatitis B markers in persons with diagnosed renal diseases. In all patients markers of hepatitis B virus infection (HBsAg, anti-HBs antibodies, anti-HBc total and IgM antibodies) were determined in the enzyme immunoassay. Those families in which examinees with renal pathology were found to have markers of hepatitis B virus infection exhibited a high level of contamination with hepatitis B virus. A high proportion of examinees with viral hepatitis B was established in the families where mothers were found to have markers of hepatitis B virus infection. These facts indicate that everyday contacts play an important role in the transmission of the virus. The study points out that in the family foci of hepatitis B virus infection non-manifest or slightly manifest forms of this infection are mainly registered.

The authors describe the results of the first experience gained with the use of recombinant alpha 2-interferon in children with acute viral hepatitis B. The drug was administered rectally in combination with antioxidants (tocopherol). The study was carried out by the double blind method with randomization and two control groups (given tocopherol alone or placebo alone). 73 children with acute viral hepatitis B were examined. The therapeutic combination reaferon plus tocopherol was established to favour more rapid elimination of dyspeptic and abdominal phenomena, to shorten the time of the liver and spleen size increase, duration of hyperfermentemia, to provide for an accelerated reduction of HBsAg titers, elimination of HBeAg and seroconversion, to stimulate alpha-interferon production by leukocytes, and to activate the system of mononuclear phagocytes.

The results of the controlled field trial of lyophilized erythrocytic immunoglobulin diagnosticum for the detection of hepatitis A virus antigen in the urine and feces of patients are presented. This diagnosticum was used for the study of urine and fecal samples from 225 patients (of these, 176 had hepatitis A) and 54 healthy persons in the passive hemagglutination (PHA) test. Their blood sera were studied in the PHA test (to detect HBsAg) and the radioimmunoassay (to detect anti-HAV IgM). The immunoglobulin diagnosticum under study was found to be nonspecific and faintly sensitive and, therefore, unsuitable for use in medical practice.

The purpose of the present work was to study the rate of HB viral infection from the standpoint of its pathogenetic importance in children with the nephrotic syndrome (NS). As many as 71 children aged 2 to 15 years with the NS were examined. 23 children with hematuric glomerulonephritic (GN) served as control. HB viral infection markers (HBsAg, anti-HBs, total anti-HBc and IgM anti-HBc) were detected in the blood serum by means of IEA in all the patients. The examinations made it possible to reveal material differences in the distribution of various combinations of VHB markers in children with the NS and hematuric GN. The combination of HBsAg and IgM anti-HBc turned out most characteristic for the NS, pointing to active NB viral infection. In patients with mixed GN, that combination was detectable twice as often. The data obtained attest te a high rate of the association of HB viral infection with GN, particularly with that running its course with the NS. In this case, the rate mentioned was significantly higher than in the population. A definite relationship between the activity of HB viral infection and the gravity of the NS suggests that VHB is implicated in the pathogenesis of GN. This suggestion may be indirectly supported by a far higher rate of HBsAg and IgM anti-HBc demonstration in patients suffering from membranoproliferative GN.

A total of 102 children aged 5 to 14 years with virus hepatitis B were examined for the status of the mononuclear phagocytic system in accordance with the absolute monocyte count in the circulating blood, esterase and acid phosphatase activity in the monocytes, for function of organ macrophages of the liver and spleen using dynamic scintigraphy with TC-colloid and for macrophages of the skin by the "skin window" method. The rise of the absolute count and lowering of the functional and metabolic activity of blood monocytes were directly proportional to the gravity of virus hepatitis B. The changes persisted for a long time, namely up to 1.5 to 3 months since the disease onset. There was a progressive drop of the functional activity of Kupffer cells in the liver with a maximum decrease seen within 4 to 6 weeks since the disease onset, followed by returning to normal in cyclic disease and preservation of the changes in lingering and chronic virus hepatitis B. Spleen macrophages play an active compensatory role, maintaining normal "purifying" function of the mononuclear phagocytic system. That compensatory response tension appeared high in lingering and especially in chronic virus hepatitis and may serve as a criterion for process chronicity. The changes in the mononuclear phagocytic system observed in cyclic course of mild and medium-gravity virus hepatitis B may be regarded as normal adaptive reaction and do not require any drug correction. The latter one may only be indicated in patients with grave, lingering or chronic disease patterns associated with break down or depletion of the adaptive mechanisms of the system in question.

For investigation of the specificity of leukocyte hepatitis virus (LHV) in Botkin's disease, 369 patients with virus hepatitis, 96 donors and 61 patients with acute respiratory diseases were examined. The occurrence of specific antibody to LHV was determined by a micromodification of the conventional CFT. LHV was passaged in leukocyte culture stimulated with phytohemagglutinin. A control antigen was a leukocyte culture from the same donor not infected with LHV. An additional control was Epstein-Barr virus passaged in continuous leukocyte suspension cultures. The complement-fixing antibody to LHV was detected in sera from children and adults with virus hepatitis. The number of sera with antibody to LHV was significantly higher than that in the control groups. A rise of antibody titers in the course of the disease in the experimental groups in contrast to the controls attested to certain specificity of LHV in Botkin's disease. No antigenic relationship between LHV and HB antigen was found in serologic tests. The lack of differences in detection of the complement-fixing antibody to Epstein-Barr virus in the experimental and control groups suggests no role of this virus in the etiopathogenesis of Botkin's virus hepatitis.

The authors demonstrate possibilities of viral hepatitis diagnosis by means of fluorescent antisera labeled phiiTts. The antisera were obtained from the blood of convalescents after infectious hepatitis (with an uncomplicated course) on the 25th--30th day of the disease, and also from the placental gamma-globulin of persons who had had viral hepatitis (in the anamnesis). Both diagnostic preparations proved to be highly specific, although the first of them was somewhat more sensitive. Blood smears were stained with fluorescent antisera. The fluoresence was revealed in the cytoplasm of the white blood formed elements--lymphocytes and neutrophils; the nucleus was dark. Materials of this investigation permit experimental substantiation of a possibility of prolonged antigenemia in the blood leukocytes of patients suffering from viral hepatitis.

Immunofluorescence (IF), indirect hemagglutination test (IHA), latex-agglutination test (LA), and immunofluorescence of activated sepharose particles (IFS) were used for early specific diagnosis of viral hepatitis A (VHA). The antisera used in the tests were those from convalescents after VHA collected at 25-30 days which had no HBs antigen or antibody to it. The IF and IHA tests were found to be most sensitive for examination of VHA patients. In VHA foci, positive IF tests were found in 22%-72% contacts (in relation to the number of manifest forms in a focus of infection) which in 84.6% cases correlated with enlarged liver. In parallel examination of contacts in one of VHA foci by IF and IHA tests similar results were obtained and the infection-rate in the group was 64.3% and 64% respectively.

Morphological examination of leukocytes in blood smears from patients with viral hepatitis A and B revealed up to 34% of atypical lymphocytes (AL) in the form of cells of irregular shape with the wide basophilic cytoplasm. Their number reached maximum by the 9th--14th day of the disease and decreased to 8% by 40--50 days. The number of AL was significantly higher during the high activity of the process both in acute and chronic forms of viral hepatitis A and B. In normal subjects as well as in patients with chronic hepatitis of alcoholic etiology the amount of AL did not exceed 6%. Immunofluorescent studies with gammaglobulin from convalescents after viral hepatitis A demonstrated fluorescence of the leukocyte cytoplasm in 86.3% of blood smears from patients with viral hepatitis both early in the disease and at 14--20 days in infectious hepatitis A (in controls no more than 6%). Fluorescence was demonstrated in 70.1% of cases in examinations of blood smears from patients with chronic liver diseases of viral etiology.

During a year an overall serological examination of 1,200 children hospitalized with the diagnosis of viral hepatitis was carried out with a view to establish the presence of hepatitis A and hepatitis B markers (anti-HAV IgM, HBsAg, anti-HBs, anti-HBc and anti-HBe IgM) by means of the enzyme immunoassay and radioimmunoassay. The average annual proportion of cases of hepatitis A (61.4%), hepatitis B (20.4%), hepatitis non A, non B (11.2%) and mixed infection (7.0%) among children, as well as seasonal and age-group fluctuations of this proportion, were established. The etiological structure of viral hepatitides, based on commonly accepted clinico-epidemiological diagnostic criteria, was shown to differ from their true etiological structure as determined in accordance with specific serological markers detected in this investigation.

A total of 231 persons from the families of 62 children hospitalized in connection with viral hepatitis B were examined for the presence of HBsAg in their blood over a period of 3 years. Simultaneously with countercurrent electrophoresis (CIE) and the gel precipitation (GP) test, the passive hemagglutination (PHA) test and the GP test with sandwich treatment were used in this work. The presence of HBs-antigenemia in the members of the families of children with viral hepatitis confirmed by laboratory methods were found to occur 6.7 times more frequently than in the families of children with HBsAg-negative hepatitis. The use of the PHA test and the GP test with sandwich treatment increased the frequency of the detection of HBsAg 2.5 times in comparison with CIE and the GP test. The data indicating the possibility of children being infected through everyday contacts in families with cases of HBs-antigenemia among their members are presented, but further studies are necessary to make the final decision on this problem.

Serological examinations of 1,200 children, hospitalized at the viral hepatitis department over a year, for the presence of hepatitis A (HA) and hepatitis B (HB) markers have revealed a 7% incidence rate of mixed HA and HB infections. Three variants of mixed infection have been established (true mixed infection, HA combined with asymptomatic HBsAg carriership, cross superinfection) and the relative significance of each of them has been determined. Mixed infection took an unfavorable course with a tendency to the prolongation of the pathological process eventuating in chronic hepatitis, especially in cases of true mixed infections (15.9%).

To form a judgement about function of liver and spleen macrophages (MP) in vivo, use was made of dynamic scintigraphy with Tc-colloid. Sixty-seven children aged 5 to 14 years were examined. Of these, 45 children were afflicted with virus hepatitis B (VHB), 16 with virus hepatitis A (VHA), and 6 children had VHA associated with asymptomatic HBsAg carriership. There was an appreciable decrease of the activity of liver MP attended by consistent compensatory activation of spleen MP in all the etiological types of virus hepatitis. The changes seen in patients with VHA and VHB turned out similar, differing in the rate of the recovery of normal correlations, which was more rapid in VHA. The characteristic feature of liver and spleen MP function in patients with VHA associated with HBsAg carriership consisted in the lack of the compensatory reaction on the part of spleen MP, which was likely to be connected with overstrain of long standing and depletion of the MP system due to permanent antigenic stimulation of HBsAg. The relationship was disclosed between the activity of organ MP and the phase of the infectious process, its gravity and course as well as the character of the patient's premorbid status and intercurrent infection.