Biomedical subjects
Publications and source records attributed to T E Polunina.
The research object was the further improvement of diagnostics and tactics of treatment of patients with iatrogenic lesions of the hepatobiliary zone caused by the use of pharmacotherapeutic agents in curative doses.
Drug-induced hepatitides (DIH) may manifest with a wide range of symptoms from insignificant activation of the enzymes with asthenic syndrome to severe disease with jaundice. The most informative tests for early diagnosis of medicinal lesion of the liver are biochemical tests of blood serum with determination of activity of the enzymes AlAt, AsAT, AP, GGTP. Long-term use of the drug and late diagnosis of DIH endanger drug damage to the liver. Treatment of acute drug hepatitides consists in administration of medication stimulating metabolic ability of hepatic cells. Acute DIH is characterized by the absence of splenomegaly.
Many new high effective preparations, acting on cellular and molecular levels, now have appeared. They have rendered more penetrating influences on the various aspects of the organism activity and causing thus the side effects. They are the following: medicine-induced disorders of stomach and duodenum at treatment by nonsteroid anti-inflammation preparations accompanying by development of erosions, ulcers and bleeding, exacerbations of chronic ulcers and etc. The medicine-induced disorders of the digestive organs recently began to determine as the nosologic forms with possible acute and chronic current. Even lethal cases are observed at using medicines in medical doses. Till now there are no legible criteria of clinical-laboratory and morphological diagnostics of medicine-induced disorders of the digestive organs. The problems of their pathogenesis are studied insufficiently. There is no united classification. In this connection, the purpose of the given article is the study of epidemiology, pathogenesis, features of diagnostics and clinical current of medicinal gastropathies.
AIM: To improve diagnosis and treatment of drug-induced hepatitis: to specify drugs with hepatotoxic effect, clinical variants of drug-induced hepatic diseases, management of drug-induced hepatitis (DIH). MATERIALS AND METHODS: Of 2300 examinees with hepatic lesions, 62 were diagnosed to have DIH. Measurements were made of serum levels of bilirubin and its fractions, total protein, some protein fractions, markers of hepatitis A, B, C, activity of aminotransferases (AlAT and AsAT), alkaline phosphatase (AP), glutamate dehydrogenase (GlDG), sorbitol dehydrogenase (SDG), gamma-glutamate transpeptidase (GGTP), choline esterase (CE). Timolveronal test was made. On demand, tests were made for CEA, AFP; device examinations were made: ultrasound investigation, computed tomography of the abdominal organs, endoscopic retrograde pancreatography, laparoscopy with hepatic biopsy, transcutaneous hepatic biopsy, laparotomy with cholecystocholangiography. RESULTS: A direct relationship of hepatitis with drugs intake was revealed in all the patients. Development of drug-induced intrahepatic cholestasis in patients on long-term treatment with anticancer drugs was accompanied with affection of cellular organellas and progressive destruction of small interlobular ducts provoking intrahepatic cholestasis and depletion of natural glutathione. CONCLUSION: Correction of intrahepatic cholestasis and deficiency of endogenic glutathione is successfully carried out with heptral.
The efficacy and safety of lomefloxacin in the treatment of patients with hepatitis due to the use of routine antituberculosis agents were estimated. The trial group included 20 patients (10 with increased activity of enzymes such as alanine and asparagine transaminases, alkaline phosphatase and gamma-glutamate dehydrogenase) who were treated for various forms of tuberculosis with antitubeculosis drugs. The treatment course with lomefloxacin was 4 weeks (400 mg twice a day at 12-hour intervals). The criteria of the enrolment to the trial group were a more than 2-3 times higher activity of the enzymes and the absence of the markers of the virus hepatitis A, B and C. The therapy efficacy before and after the use of lomefloxacin was estimated clinically and by the findings of the laboratory and instrumental investigations. As a result of the treatment with lomefloxacin normalization of the enzyme activity and a favourable time course of the main disease were observed in the patients with drug hepatitis due to the use of antituberculosis agents requiring continuation of the antituberculosis therapy. An important result of the complex treatment with lomefloxacin and antituberculosis agents was discontinuation of the tubercle bacilli isolation in 70 per cent of the patients. Lomefloxacin proved to be a safe and efficient up-to-date agent for the treatment of tuberculosis in patients with hepatitis due to the use of antituberculosis drugs.
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