Method of treating patients with chronic liver diseases in stage of latency and degree i manifested stage of hepatic encephalopathy

FIELD: medicine.

SUBSTANCE: invention refers to medicine and aims at treating the patients with chronic liver diseases (CLD) in the stage of latency and degree I manifested stage of hepatic encephalopathy. The preparation Essentiale forte N is used. It is combined with prescribing the preparation Mucofalk. The course is 28-30 days.

EFFECT: method enables reducing dyspepsia events and encephalopathy manifestations.

5 ex, 3 tbl, 1 dwg

 

The invention relates to medicine, namely, Hepatology, and can be used in the treatment of patients with chronic liver disease (HSP) with latent stage and I degree clinically severe stage of hepatic encephalopathy.

In modern medical practice up to the present time the problem of correction of hepatic encephalopathy patients HSP is one of the most important, as it is often caused by damage to the persons of working age. It is the Central nervous system has maladaptive impact on patients, determines the clinical picture, the severity of the disease and often leads to disability. In this regard, the restoration of physical, mental and social status of patients with hepatic encephalopathy and improve their quality of life becomes a national level[1, 2, 3, 4, 5].

"Hepatic encephalopathy" (PE) is a potentially reversible disorder of the Central nervous system, caused by metabolic disorders resulting from hepatic cell failure and/or portosystemic shunting of blood [6].

According to the modern classification of portosystemic (liver) encephalopathy - Herber and Schomerus (2000) [7] are two stages: latent (subclinical) and clinically relevant. The importance of the separation of the of latent hepatic encephalopathy (PE-L) can be explained by two reasons: 1. encephalopathy may precede the development of clinically severe hepatic insufficiency; 2. psychomotor disturbances that occur when PE-L, have a negative impact on patient's quality of life, leading to decreased performance.

Stage clinically pronounced Peh, in turn, is divided into 4 stages of development:

I - light (PE-1);

II - moderate;

III - heavy;

IV - coma (loss of consciousness).

Given that the pathogenesis of PE at the present time is likely to be multifactorial and multiorgan process that runs in parallel on 2 levels - the level of the liver and the brain [8, 9], where among neurotoxins main role belongs to the increased formation of ammonia associated with decreased synthesis in the liver to urea and glutamine, as well as with portal systemic shunting of blood. Additional sources increased formation of ammonia is urease - positive microflora of the gastrointestinal tract (decaying urea and protein) [9, 10, 11, 12, 13]. Disorders of the intestinal microflora found in 90% of patients with HSP. Reduced detoxification function of the microflora in the intestinal dysbiosis increases the load on the enzyme system of the liver, which contributes to the appearance in it of metabolic and structural changes [9].

In patients with PE is the intensive growth of proteolytic the Russian flora, which, metabolizer residues of proteins (putrefactive flora), forms a large amount of gaseous ammonia, the end products of protein metabolism, mercaptans, short-chain fatty acids, phenols, etc. coming into the blood stream and can help you increase your symptoms of PE.

With increasing degree of PE observed change microbiocenosis colon: is the reduction in the number of lacto - and bifidobacteria, has experienced steady growth in the number breastreduction and proteolytic bacteria - Clostridium, Enterobacter, bacteroids, etc. Proved that putrefactive and pathogenic bacteria produced in the intestines of toxic products, in particular E. coli and clostridia - ammonia, amines, nitrosamines, phenols, Cresols, indoles, secondary acid, Alikina, bacteroids and streptococci - nitrosamines, secondary bile acids, Proteus - ammonia, amines, indole [14].

Ammonia, in terms of hyperammonia in unionised form (1-3% of the total amount of ammonia in the blood) easily crosses the blood-brain barrier (BBB), breaking amino acid imbalance, leading to a decrease in the content of amino acids with branched side chain (valine, leucine, isoleucine) and facilitating the transport of aromatic amino acids (tyrosine, phenylalanine, tryptophan) in the brain, resulting in increased synthesis false neurotrans is etherow and serotonin, leading to the development of a neurotoxic effect[6, 12, 15, 16]. Also the development of PE contributes to excessive intake of g-aminobutyric acid (GABA) in the brain, which also leads to increased neuro-psychiatric disorders characteristic of PE [16, 17].

At the present time, given the multifactorial nature of the pathogenesis of PE, pathogenetic therapy involves three main groups of activities [9, 13]:

- Search for the causes of the development of PE, treatment of the underlying disease and the elimination of permissive factors encephalopathy.

- A diet with restriction of dietary animal protein replaced by vegetable; ensuring adequate caloric intake to prevent negative nitrogen balance, reducing the degree of hyperammonia.

- Drug therapy with the use of several classes of drugs:

(I) Drugs that reduce the concentration of ammonia in the blood:

1. - Reduce the intake of ammonia from the colon:

A) Newscasino antibiotics (neomycin, rifaximin, paromomycin, ciprofloxacin inhibit "ammoniagenes" microflora in the colon, reduce the risk of developing spontaneous bacterial peritonitis and other infections, as permissive factors PE[18, 19, 20, 21].

B) Osmotic laxatives on the basis of lactulose (duphalac), lactitol (exportall). As fur the isms actions are considered: increase in the number of lactobacilli, growth suppression freezeproofing bacteria, inoculation of bacterial metabolism (increased metabolism of carbohydrates and slow decomposition of protein), reduction glutaminases the formation of ammonia in the ileum and the pH of the colon, the difficulty of absorption of ammonia, facilitating the diffusion of ammonia from the blood vessels of the mucosa into the lumen of the colon, acting as an osmotic laxative nematerializiranih products disaccharides[22, 23, 24, 25, 26] that, in turn, contributes to increased excretion of nitrogen-containing products. The effectiveness of lactulose in PE was evaluated in many studies and ranged from 50% to 95% [27, 28, 29, 30].

2. Binding ammonia in the blood (benzoate, phenylacetate) [31].

3. - Stimulating the ammonia in infinova cycle in the liver and in glutamylcysteine reactions in the liver and muscles (ornithine-aspartate (HEPA-Merz)) [6, 32, 33, 34, 35].

II) Drugs that reduce the inhibitory processes in the Central nervous system:

A) Antagonist of benzodiazepine receptors - fluminese.

B) Amino acids with branched side chain - benefit associated with the inhibition of dissolution of native protein in the liver and muscles, stimulation of protein synthesis, anabolic effect and protect astroglia from damage caused by the action of ammonia. The assignment of amino acids the branched-chain patients with intolerance to the protein can improve the nutritional status of patients without the development of new episodes of PE [36, 37, 38].

III) Drugs with different mechanism of action:

A) Antioxidants slow or prevent oxidative stress (cytoflavin, deepana and others) [39, 40].

B) Zinc, which reduces the activity of lipid peroxidation and himself which is a cofactor of many enzymes, including the synthesis of urea [41].

B) Preparation of a-lipoic acid, a molecule which comprises thiol groups (Berlition) [41, 42].

In each case the choice of regimen depends on the clinical manifestations of the disease, the presence of subclinical, acute or chronic encephalopathy, the nature of the pathologic process.

Yet, despite the experience of use of various drugs for the treatment of PE, currently in the literature there are data only about osmotic laxatives on the basis of lactulose and lactitol for the treatment of PE and no data on other groups of laxatives for the treatment of patients with PE.

As a prototype we have chosen a method of treatment of hepatic encephalopathy, which consists in the use of the drug Duphalac belonging to the group: Laxative preparation with osmotic properties. Giveamanakick tool [43].

DUPHALAC®[43]

Group affiliation: the Purgative preparation with osmotic properties. Giveamanakick the tool.

Description for trade names: DUPHALAC®

Dosage form:

Syrup transparent, viscous, colorless
to light yellow with a brownish tint100 ml
lactulose66,7 g

Excipients: purified water.

15 ml disposable bags (10 - pack carton.

200 ml - polyethylene bottles (1) complete with a measuring Cup.

500 ml plastic bottles (1) complete with a measuring Cup.

1 l polyethylene bottles (1) complete with a measuring Cup.

Pharmacological action.

Laxative preparation with osmotic properties. Has a hyperosmotic laxative effect, stimulates the peristalsis of the intestines, improves the absorption of phosphates and salts of calcium, promotes the excretion of ammonium ions.

Lactulose is cleaved by intestinal flora of the colon on low molecular weight organic acids, which leads to a decrease in pH and increase in osmotic pressure and, consequently, increasing the volume of intestinal contents, which, in turn, leads to increased intestinal motility and changes in consistency with the ula. Constipation disappears and restores the physiological rhythm of the colon.

In hepatic encephalopathy or hepatic precoma or coma effect of the drug is due to suppression of proteolytic bacteria by increasing the number of acidophilic bacteria (such as lactobacilli), transfer of ammonia in ion form by acidification of the contents of the colon, bowel movements due to the decrease of pH in the colon and osmotic effect, and reduction of nitrogen toxic substances by stimulating bacteria that utilize ammonia for bacterial protein synthesis.

Reduces the multiplication of Salmonella.

The pharmacokinetics.

The absorbance is low. Practically not absorbed, reaches the large intestine where it is broken down by intestinal microflora. Completely metabolized when used in doses up to 45-70 ml When used in higher doses partially excreted unchanged.

The dosage.

Dose Duphalac in the treatment of constipation and for softening stool for medical purposes are presented in the table.

Patients:Initial doseMaintenance dose
Adults 15-45 ml10-25 ml
Children 7-14 years old15 ml10 ml
Children 3-6 years5-10 ml5-10 ml
Children up to 3 years5 ml5 ml

Typically, the dose may be reduced after 2 days of admission, depending on the needs of the patient.

The drug should be taken 1 time per day in the morning while eating. Clinical effect occurs within 1-2 days. The dose or the frequency of use increases if within 2 days of taking the drug is not expected to improve the condition of the patient. For softening stool prescribe the same dose as in the lock.

In the treatment of hepatic coma and precoma Duphalac®appoint 30-45 ml of syrup 3 times/day. Then move on to a personalised maintenance dose, in which a soft chair there is a maximum of 2-3 times/day at the rate that the pH of feces was in the range of 5.0-5.5.

In acute cases Duphalac®you can assign in the form of enemas in the ratio of 300 ml syrup Duphalac®and 700 ml of water.

Indications for use of the drug DUPHALAC:®

- constipation: the physiological rhythm of the colon;

- softening of the chair for medical purposes (with hemorrhoids, surgery on the colon and the anus);

- hepatic encephalopathy: treatment and prevention of hepatic precoma and coma.

Side effects.

From the digestive system: in the early days possible flatulence (usually disappears within 2 days); possible nausea, vomiting, abdominal pain; when the drug is taken in high doses, abdominal pain and diarrhea (requires dose adjustment).

From a metabolism: when used in high doses for a long time in the treatment of hepatic encephalopathy due to concomitant diarrhea possible disturbances of electrolyte balance.

Other: electrolyte imbalance due to diarrhea.

Contraindications to the use of the drug DUPHALAC:®

- galactosemia;

intestinal obstruction;

- hypersensitivity to the active substance or fructose, galactose, lactose.

Caution should be prescribed to patients with diabetes.

The use of the drug DUPHALAC®pregnancy and breast-feeding:

Lactulose can be safely used during pregnancy and lactation (breastfeeding).

Special instructions:

In the absence of therapeutic effect within 2 days or when skin is no constipation after treatment the patient should consult a doctor.

The dose commonly used for constipation, should not pose a problem for patients with diabetes. The dose used in the treatment of hepatic precoma or coma, usually much higher and therefore must be specified when assigning patients with diabetes mellitus.

With long-term use of the drug (more than 6 months) in high doses should regularly monitor the level of electrolytes in the blood plasma.

Using the drug in patients with lactase deficiency should be taken into account that in 15 ml of syrup contains up to 1.5 g of galactose and 0.9 g of lactose.

Influence on ability to driving of motor transport and to management of mechanisms:

The use of Duphalac does not have or has a negligible influence on ability to driving and handling machines and mechanisms.

Overdosage.

Cases of overdose have been reported. When using the drug in very high doses, possible abdominal pain, diarrhea.

Treatment: dose reduction or drug discontinuation.

Drug interaction.

Because of the mechanism of action of lactulose, a reduction of pH in the colon, medicines, which are released depending on the pH of the colon (such as drugs 5-aminosalicylic acid), can be inactivated.

Conditions of release apt the K.

The drug is approved for use as a means of prescription.

Terms and conditions of storage.

The preparation should be stored in the dark, inaccessible to children at temperature of 10° to 25°C. storage condition in the original and undamaged packaging, the shelf life is 3 years.

The technical result of the invention is to expand the Arsenal of drugs for the treatment of patients with chronic liver disease with latent stage and I degree clinically severe stage of hepatic encephalopathy drug Mucofalk.

The technical result is achieved by the fact that patients with chronic liver disease with latent stage and I degree clinically severe stage of hepatic encephalopathy against medical exposure, including acceptance of hepatoprotector Essentiale Forte N, the patient is additionally administered the drug Mucofalk within 28-30 days.

Mucofalk: producer - Dr. Falk [43]

The composition and release form

The orange granules for preparation of suspension for receiving inside a light brown color with inclusions of brown particles peel and adjacent cell membranes dried plantain seed (Plantago ovata) - 3.25 g, with aromatic orange smell.

Excipients: sucrose, dextrin, limo is Naya acid, sodium alginate, sodium citrate, sodium chloride, sodium saccharinate, flavor of orange.

Pharmacotherapeutic group.

Laxative herbal remedies

Pharmacological action.

Laxative herbal remedies. The hydrophilic fiber of the shell of the seed plantain keep the liquid in the digestive tract, increased volume and softens the stool consistency. The drug regulates the activity of the intestine, facilitating the passage of intestinal contents [43]. Shell of psyllium seed oval (Plantago ovata), also known as psyllium (psyllium), consists mainly of carbohydrates (>90%) and, in addition, contains a small amount of vegetable proteins (3-4%), mineral and other components (3-4%). 85% psyllium consists of soluble dietary fiber, such as gums (gum Arabic), mucus, some hemicelluloses. The main active component - slideology hydrocolloid, representing arabinoxylan having an extremely high rate of swelling and water retention [3, 44].

Three main fractions shell seeds of Plantago ovata responsible for virtually all carbohydrate composition and make up about 90% of the total weight of psyllium:

- Fraction (15-20%) is insoluble in an alkaline environment and nonfermentable bacteria fraction, is a kind of ballast substance that normalizes the intestinal motility.

The Fraction Of In - active gel-forming, partially parmentiera, provides a laxative effect increasing the volume of intestinal content (due to water retention), provides softening stool, physiological lubrication of the intestinal wall and slide feces, provides lipid-lowering effect, binding bile acids and increasing their excretion with faeces, has a reinforcing effect diarrhea, adsorbs Exo - and endotoxins, transforms the liquid contents of the intestine in a more viscous mass and increases the transit time through the intestines.

The cut - bestrefiratecom fraction slows postprandial evacuation from the stomach and has a pronounced prebiotic properties. Resulting in stimulation of growth of bifido - and lactic acid bacteria and the formation of short-chain fatty acids, which are the main source of energy for the epithelium of the colon[3, 8, 44, 45].

Pharmacokinetics [43].

Data on the pharmacokinetics of the drug Mucofalk not provided.

Indications for use of the drug MUCOFALK [43]

- constipation (including during pregnancy);

- anal fissure, hemorrhoids, postoperative period when interventions in the anorectal region (in order to create a softer stool consistency);

functional diarrhea, irritable bowel syndrome, diverticulosis of the colon, bol is June Krona (normalization of stool).

The dosage regimen

Assign inside adults and children over 12 years : 1 sachet or 1 teaspoon 2-6 times/day.

Before use 1 sachet or 1 teaspoon of granules poured into a glass that slowly fill with cold water (150 ml), stir and immediately drink, then drink another glass of liquid.

Side effect [43]

Possible allergic reactions.

In the early days of treatment may increase bloating and feeling of fullness in the stomach.

Contraindications to the use of the drug MUCOFALK

organic stricture of gastrointestinal tract;

intestinal obstruction;

- decompensated diabetes mellitus;

- children up to 12 years;

- hypersensitivity to the drug.

The use of the drug, MUCOFALK during pregnancy and breastfeeding.

You may use during pregnancy, according to testimony.

Special instructions.

Should not be administered simultaneously with the anti-diarrhoeal drugs and with drugs that inhibit intestinal motility. You should be in intervals of 30-60 minutes between taking Mucofalk and other drugs.

While taking the drug you should drink at least 1.5 liters of fluid per day.

In patients with diabetes mellitus may need to decrease the dose of insulin.

Overdose

Data on overdose pre is Arata, Mucofalk not provided.

Drug interactions

Drug interaction drug Mucofalk not described.

Conditions prescribed.

The drug is approved for use as a means of prescription.

The method is as follows.

On a background of reception of hepatoprotector Essentiale Forte N preparation of Mucofalk take 1 sachet 3 times a day (1 sachet pour into a glass that slowly fill with cold water (150 ml), stir and immediately drink, then drink another glass of liquid (150 ml) for 28-30 days. According to the indications prescribed diuretics and/or beta blockers and/or drugs potassium.

Distinguishing the essential feature of the proposed method is that patients with chronic liver diseases with latency and I degree clinically severe stage of hepatic encephalopathy against medical exposure, including the hepatoprotector Essentiale Forte N, the patient is additionally administered the drug Mucofalk within 28-30 days.

The causal link between the main feature and achieve the result.

First we found a positive effect of the laxative herbal remedies, Mucofalk resolution latent and 1st degree clinically severe stage of hepatic encephalopathy in patients khron the ical liver disease. In the section "Statement of Indications for use of the drug MUCOFALK" [43] there is no information about the use of the drug for the resolution of latent and 1st degree clinically severe stage of hepatic encephalopathy in patients with chronic liver diseases.

Mucofalk helps to normalize the microflora of the colon, increasing the level of members of the normal flora (bifidobacteria and lactobacilli) and reducing the number of representatives of conditionally pathogenic flora, thereby reducing the production of ammonia and endotoxins, and normalizes stools, reducing time promotion contents of the colon, resulting in reduction of time for the formation of ammonia and accelerate its removal. Perhaps this creates hypoimmunity effect, contributing to the resolution of hepatic encephalopathy.

The duration of taking the drug Mucofalk ensure maximum effectiveness in the treatment of patients with chronic liver diseases with latency and I degree clinically severe stage of hepatic encephalopathy.

The laxative herbal remedies, Mucofalk may be an alternative to the use of osmotic laxatives for the treatment of latent and first degree clinically severe stage of hepatic encephalopathy in patients with chronic diseases pécs is I.

Distinctive significant feature of the proposed method is new and expands the Arsenal of laxatives medicines for the treatment of patients with chronic liver diseases with latency and I degree clinically severe stage of hepatic encephalopathy due to taking the drug of Mucofalk affecting microbiocides colon, forming hypoimmunity effect and contributing to the improvement of psychometric indices.

Examples of clinical complete method.

Example 1. (Mucofalk)

Patient B., aged 57, And/map No. 19932. 19.12.2008,

Complaints: weakness, lethargy, tremor of the upper extremities, monotonous abdominal pain, feeling of fullness in the abdomen, rumbling; flatulence, the changing nature of the chair - the tendency to constipation. Objective: at the time of inspection - conscious, oriented, the questions are answered correctly. Tremor of the upper extremities, the character of the handwriting changed.

Palpation: the rumbling, increased tension in the region of the sigmoid colon. Liver+7 cm from the edge of the costal arch. Ascites moderate.

From the anamnesis it is known, for 8 years, the abuse of alcohol is about 500 ml per day, from April 2007 appeared yellowness of the skin, dark urine, loss of appetite. Were outpatients from the honey. map - HBsAg negative, HCV negative abdominal ultrasound - hepatosplenomegaly; ASAT u/l, Alt 70 u/l, alkaline phosphatase 168 u/l, GGT 284 e/L. the Condition is regarded as chronic toxic hepatitis, cirrhotic stage. In August 2007 marked nosebleeds, hospitalized at the Mariinsky hospital. (Identified varicose veins (DFDS) of the esophagus) in hospital - course of hepatic and detoxification therapy. After discharge were taken periodically hepatoprotectors (cars, hofitol, zdraveski). Continued to abuse alcohol - 200 ml per day. In October 2008, in outpatient examination: ECG: heart rate 65 sinus, incomplete blockade of the right bundle branch, markers of hepatitis - b and C (HBsAg, HCV) - negative, ambulatory received diuretics (furosemide 40 mg a day, Kars). The condition is considered chronic toxic hepatitis (ASH), cirrhotic stage, portal hypertension (hypersplenism, DFDS esophageal first degree). In the last 2-3 weeks notes tremor of the extremities, weakness, loss of appetite, occasional drowsiness.

Conclusion. On the basis of complaints, physical examination, and clinical and laboratory data of the patient B has chronic toxic hepatitis (ASH), cirrhotic stage Child Pugh A.

Portal hypertension (hypersplenism, DFDS esophagus 1 degree).

Complications: hepatic cell failure, class a, hepatic encephalopathy first degree clinically severe stage.

p> Clinical and laboratory tests during treatment the patient B.

The level of hemoglobin - 163 g/l, erythrocytes - 4,9×1012/l, leukocytes - 8,8×109/l, ESR - 22 mm /h, platelets 85×109/l, Alat - 62 units/l, AST - 74 units/l, alkaline phosphatase - 254 units/l, GGT - 148 u/l, total bilirubin - 34 units/l, total protein - 85 g/l, albumin 35 g/l, Potassium 3.4 mmol/L.

Fibrogastroduodenoscopy: DFDS esophagus 1 degree, chronic gastroduodenitis.

Abdominal ultrasound: hepatosplenomegaly, v porte 15 mm, moderate ascites.

Markers of hepatitis B and C (HBsAg, HCV), RW - negative

Test connection numbers (TSC) - 58 sec.

The test Line (t) - 78 sec.

The number of errors t (COT) - 9.

Consultation of the neurologist. Neurological history is not burdened.

In neurological status - clear consciousness, orientation of all kinds stored, the normal speech rate, in conversation it is not proactive, the questions are answered correctly, sometimes slowly, reluctantly. The elements of emotional lability. The character of the handwriting changed is uneven. Field of view is not changed, easy anisocoria (pupils S=D), the expression is lively, movement of the eyeballs in full, eye - no, the facial muscles are symmetric, bulbar disorders - not, sensitive disorders on the face does not show. The exit point of the trigeminal nerve is painless. Disorders of smell, hearing is not revealed. The sympto is s oral automatism - no. The power of paralysis in the extremities, abnormal stop signs - not detected. Easy mallampally tremor of the upper extremities. Deep reflexes D=S, the average stuffy, superficial abdominal reflexes saved, D=S. asserts hyperesthesia with giperbolicheskim shade type "socks" from the level of the ankle. Vibration sensitivity on the toes and hands are not reduced. Coordinatorsee sample performs satisfactorily. In the Romberg - resistant. Meningeal symptoms are not present.

Conclusion: at the time of inspection data for acute neurological pathology no. Takes place encephalopathy Art. I, more than likely the hepatic origin.

The results of microbiological studies on intestinal dysbiosis:

The levels of lactobacilli - 105, bifidobacteria - 106, Escherichia coli with normal enzymatic activity - 106, Escherichia coli with reduced enzymatic activity - 0, other opportunistic pathogens - 102, Staphylococcus aureus - 104, yeast-like fungi of the genus Candida is 0.

Thus, the subject b, the results of bacteriological research, there are changes characteristic of dysbiosis colon 2 degrees.

For 28 days the patient received therapy with drug Essentiale Forte N 2 capsules 3 times a day, Verospiron 50 megatrom on an empty stomach, Furosemide 40 mg in the morning on an empty stomach, Panangin 1 table 3 times, and Mucofalk 1 sachet 3 times a day.

Clinical and laboratory tests of the patient B. after treatment.

After treatment, weakness, lethargy, tremor of the upper extremities is not concerned about writing is smooth. Chair regular every day.

At the time of inspection - conscious, oriented, the questions are answered correctly.

The hemoglobin level is 164 g/l, erythrocytes - 4,9×1012/l, leukocytes - 8,4×109/l, ESR - 15 mm /hour, platelet - 96×109/l, Alat - 38 units/l, AST - 55 units/l, alkaline phosphatase - 224 units/l, GGT - 116 u/l, total bilirubin - 24 units/l, total protein - 85 g/l, albumin 35 g/l, potassium 4.2 mmol/L.

TSC - 38 sec.

T - 59 sec.

COT- 3.

Consultation of the neurologist. Neurological history is not burdened.

In neurological status - clear consciousness, orientation of all kinds stored, the normal speech rate, in conversation initiative, the questions are answered correctly, sometimes slowly. The elements of emotional lability. The character of the handwriting is not modified. Field of view is not changed, easy anisocoria (pupils S=D), the expression is lively, movement of the eyeballs in full, eye - no, the facial muscles are symmetric, bulbar disorders - not, sensitive disorders on the face does not show. The exit point of the trigeminal nerve is painless. Violations bonani is, hearing loss is not detected. Symptoms of oral automatism is not. The power of paralysis in the extremities, abnormal stop signs - not detected. Tremor of the upper extremities - no. Deep reflexes D=S, the average stuffy, superficial abdominal reflexes saved, D=S. Disorders of surface sensitivity on the trunk and extremities does not show. Vibration sensitivity on the toes and hands are not reduced. Coordinatorsee sample performs satisfactorily. In the Romberg - resistant. Meningeal symptoms - no.

The results of microbiological studies on intestinal dysbiosis: the Levels of lactobacilli - 107, bifidobacteria - 108, Escherichia coli with normal enzymatic activity - 108, Escherichia coli with reduced enzymatic activity - 0, other opportunistic pathogens - 0, Staphylococcus aureus - 102, yeast-like fungi of the genus Candida - 0. The dysbacteriosis of 1 degree.

Given the clinical and biochemical picture, psychometric testing, the patient has hepatic encephalopathy, latent stage.

Example 2. (Mucofalk)

Patient S., 59, map No. 4109.19.03.2010,

Complaints: weakness, change in handwriting, drowsiness in the daytime, discomfort in the right hypochondrium, rumbling; flatulence, the changing nature of the chair's tendency to C the pores.

Objective: at the time of inspection - conscious, oriented, the questions are answered correctly.

Palpation: the rumbling, increased tension in the region of the sigmoid colon. Liver+3 cm from the edge of the costal arch.

From the anamnesis it is known, since the year 2000 drew attention to the reduction of platelets in the clinical analysis of blood, increase of bilirubin to 40.0 u/l, often says nosebleeds. Since August 2009 appeared discomfort in the right hypochondrium. We examined outpatient EGD - DFDS esophagus - grade 2, no blood evidence. HBcor will believe. On abdominal ultrasound - hepatosplenomegaly, HBV PCR neg, serodiagnosis of - the HBeAg negative, anti HBeAgIgG will believe. CEA, AFP rate, diagnostics exchange of copper and iron - N, ECG - HR 75, sinus rhythm, and electrolyte changes. Antiviral therapy is not received, received courses of hepatoprotectors (asslover Forte 1 Cape. 3 times 2 months.) Within 2 weeks - increased weakness, marks the change of handwriting, drowsiness.

Conclusion. On the basis of complaints, physical examination and clinical laboratory findings in a patient with C. occurs:

Chronic viral hepatitis B cirrhotic stage in Child Pugh B.

The syndrome of portal hypertension (DFDS esophageal grade 2, hypersplenism).

Complications: Hepatic cell failure, class b hepatic encephalopathy latent stage.

Clinical laboratory the analyses when handling patient With.: hemoglobin - 138 g/l, erythrocytes - 4,3×1012/l, leukocytes - 6,3×109/l, ESR - 17 mm /h, platelet - 70×109/l, Alat - 59 units/l, AST - 48 units/l, alkaline phosphatase - 134 units/l, GGT - 33 u/l, total bilirubin - 30 units/l, total protein - 83 g/l, albumin - 41 g/l, potassium 4.5 mmol/l

TSC - 34 sec.

T - 44 sec.

COT- 6.

EGD - DFDS esophagus - 2nd degree, chronic gastroduodenit, without exacerbation, no blood evidence.

HBcor - positive, anti-HCV - negative, RW - negative.

Abdominal ultrasound - hepatosplenomegaly, ascites is not specified, v porte 14 mm

Consultation of the neurologist. Neurological history is not burdened.

In neurological status - consciousness clear, focused in time and space, the normal speech rate, the questions are answered correctly, slowly, with elements of emotional lability. The difficulty of writing, the character of the handwriting changed is uneven. Field of view is not changed, (pupils S=D), the expression is lively, movement of the eyeballs in full, eye - no, the facial muscles are symmetric, bulbar disorders - not, sensitive disorders on the face does not show. The exit point of the trigeminal nerve is painless. Disorders of smell, hearing is not revealed. Symptoms of oral automatism is not. The power of paralysis in the extremities, abnormal stop signs - not detected. Tremor of the upper to which neznosta - no. Deep reflexes D=S, the average stuffy, superficial abdominal reflexes saved, D=S. Disorders of surface sensitivity on the trunk and extremities does not show. Vibration sensitivity on the toes and hands are not reduced. Coordinatorsee sample performs satisfactorily. In the Romberg - resistant. Meningeal symptoms - no.

Conclusion. At the time of inspection data for acute neurological pathology no. There has been latent encephalopathy, probably hepatic dysfunction.

The results of microbiological studies on intestinal dysbacteriosis. The levels of lactobacilli - 107, bifidobacteria - 108, Escherichia coli with normal enzymatic activity - 106, Escherichia coli with reduced enzymatic activity - 0, other opportunistic pathogens - 0, Staphylococcus aureus - 104, yeast-like fungi of the genus Candida - 102.

Thus, the examined C., the results of bacteriological research, there are changes characteristic of dysbiosis colon 2 degrees.

For 28 days the patient received therapy with drug Essentiale Forte N 2 capsules 3 times a day, egilok 6.25 mg 2 times a day, Mucofalk 1 sachet 3 times a day.

Clinical and laboratory tests of the patient C. after treatment.

After treatment, weakness, lethargy - no worries, drowsiness no, the handwriting is not modified.

At the time of inspection - conscious, oriented, the questions are answered correctly. Chair regular every day.

The hemoglobin level is 140 g/l, erythrocytes - 4,4×1012/l, leukocyte count of 6.1×109/l, ESR - 12 mm /h, platelets 86×109/l, Alat - 24 units/l, AST - 28 units/l, alkaline phosphatase - 124 units/l, GGT - 30 u/l, total bilirubin - 26 units/l, total protein - 84 g/l, albumin 42 g/l, potassium 4.3 mmol/L.

TSC - 27 sec.

T - 36 sec.

COT- 0.

Consultation of the neurologist. In neurological status - consciousness clear, focused in time and space, the normal speech rate, the questions are answered correctly, quickly. The character of the handwriting is smooth. Field of view is not changed, (pupils S=D), the expression is lively, movement of the eyeballs in full, eye - no, the facial muscles are symmetric, bulbar disorders - not, sensitive disorders on the face does not show. The exit point of the trigeminal nerve is painless. Disorders of smell, hearing is not revealed. Symptoms of oral automatism is not. The power of paralysis in the extremities, abnormal stop signs - not detected. Tremor of the upper extremities - no. Deep reflexes D=S, the average stuffy, superficial abdominal reflexes saved, D=S. Disorders of surface sensitivity on the body and is onenotch does not show. Vibration sensitivity on the toes and hands are not reduced. Coordinatorsee sample performs satisfactorily. In the Romberg - resistant. Meningeal symptoms - no.

The results of microbiological studies on intestinal dysbacteriosis. The levels of lactobacilli - 108, bifidobacteria - 109, Escherichia coli with normal enzymatic activity - 107, Escherichia coli with reduced enzymatic activity - 0, other opportunistic pathogens - 0, Staphylococcus aureus - 0, yeast-like fungi of the genus Candida - 0. Dysbacteriosis of 0 degrees.

Given the clinical and biochemical picture, psychometric testing - the patient has hepatic encephalopathy is missing.

Example 3. (method prototype Duphalac)

Patient K., 33 years old, map No. 19478. 18.12.2009,

Complaints: change of handwriting, drowsiness, General weakness, pain in the right hypochondrium whining character, abdominal discomfort, heartburn, change in the nature of a chair - the tendency to constipation.

Objective: at the time of inspection - conscious, oriented, the questions are answered correctly.

Palpation: the rumbling, increased tension in the region of the transverse and sigmoid colon. Liver +4 cm from the edge of the costal arch.

From the anamnesis it is known, for 4 years - alcohol - 300-200 ml in 3-5 days. Since July 2008, when it became Tecate decreased appetite, interesest sclera. Continued to work. In October 2008, the clinic by place of residence, for biochemical analysis of blood: Alat - 76 u/l, AST - 139 u/l, total bilirubin 139 mmol/l, direct bilirubin - 139 µmol/l was admitted to the Botkin hospital, where he revealed: GGTP increased to 352 u/l, PETIT to 64%, virological markers of hepatitis C, A, B - negative. According to the ultrasound diffuse rebuilding the liver-type cirrhotic. EGD - DFDS esophagus 2nd degree, portal hypertension. Received infusion therapy: electrolytes, vitamin C, Riboxin, dicinorum. Discharged with improvement. 2008 - alcohol - denies. Ambassadorial August 2009 - EGD: DFDS esophagus 2 degrees, ultrasound diffuse rebuilding the liver-type cirrhotic, Hepatosplenomegaly, v porte 14 mm ECG - heart rate 70 sinus, electrolyte changes, Markers of hepatitis B, C, is negative. Took courses hepatoprotectors (Essentiale, Heptral). Within the last 1 week marks the loss of ability to work, daytime sleepiness, change in handwriting (hard to write).

Conclusion. On the basis of complaints, physical examination, and clinical and laboratory data of the patient It is:

Chronic toxic hepatitis (ASH), cirrhotic stage Child Pugh A. Portal hypertension (DFDS esophagus 2 degrees, hypersplenism).

The complication. Hepatic cell under tecnost And, hepatic encephalopathy first degree clinically severe stage.

Clinical and laboratory tests during treatment the patient.. the Level of hemoglobin - 134 g/l, erythrocytes - 5,4×1012/l, leukocytes - 7,3×109/l, ESR - 22 mm /h, platelet - 134×109/l, Alat - 74 units/l, AST - 80 units/l, alkaline phosphatase - 213 units/l, GGT - 413 u/l, total bilirubin - 27 units/l, total protein - 76 g/l, albumin - 49 g/l, potassium 4.0 mmol/l

TSC - 53 sec.

T - 72 seconds.

COT- 7.

EGD - DFDS esophagus 2 degrees, no signs of bleeding, chronic gastritis, without exacerbation.

Ultrasound diffuse rebuilding the liver-type cirrhotic, hepatosplenomegaly, v porte 14 mm

Markers of hepatitis B and C (HBsAg, HCV), RW - negative

Consultation of the neurologist. Neurological history is not burdened.

In neurological status - consciousness clear, focused in time and space, the normal speech rate, the questions are answered correctly, slowly periodically monosyllables, reluctantly, elements of emotional lability. The character of the handwriting changed is uneven. Field of view is not changed, (pupils S=D), the expression is lively, movement of the eyeballs in full, eye - no, the facial muscles are symmetric, bulbar disorders - not, sensitive disorders on the face does not show. The exit point of the trigeminal nerve is painless. Violations the s smell, hearing loss is not detected. Symptoms of oral automatism is not. The power of paralysis in the extremities, abnormal stop signs - not detected. Tremor of the upper extremities - no. Deep reflexes D=S, the average stuffy, superficial abdominal reflexes saved, D=S. Disorders of surface sensitivity on the trunk and extremities does not show. Vibration sensitivity on the toes and hands are not reduced. Coordinatorsee sample performs satisfactorily. In the Romberg - resistant. Meningeal symptoms - no.

Conclusion: at the time of inspection data for acute neurological pathology no. Takes place encephalopathy 1 tbsp. probably hepatic dysfunction.

The results of microbiological studies on intestinal dysbiosis: the Levels of lactobacilli - 105, bifidobacteria - 107, Escherichia coli with normal enzymatic activity - 106, Escherichia coli with reduced enzymatic activity - 103, lactosamine Escherichia coli - 102other opportunistic pathogens - 103, Staphylococcus aureus - 0, yeast-like fungi of the genus Candida is 0.

Thus, the examined K. the results of bacteriological tests are changes characteristic of dysbiosis colon 2 degrees.

For 28 days the patient received terap the th drug Essentiale Forte N 2 capsules 3 times a day, Verospiron 50 mg in the morning on an empty stomach, and Duphalac at a dose of 30 ml of 1 times/day during morning meal.

Clinical and laboratory tests of the patient K. after treatment.

Within 28 days of weakness, lethargy - not worried about drowsiness is no marked increase efficiency, the character of the handwriting is not modified. Chair regular every day.

At the time of inspection - conscious, oriented, the questions are answered correctly.

The level of hemoglobin - 142 g/l, erythrocytes - 5,5×1012/l, leukocyte count was 7.2×109/l, ESR - 14 mm /h, platelets 137×109/l, Alat - 42 units/l, AST - 51 units/l, alkaline phosphatase - 208 units/l, GGT - 318 u/l, total bilirubin of 20 units/l, total protein - 76 g/l, albumin - 48 g/l, potassium 4.2 mmol/L.

TSC - 35 sec.

TL - 42 sec.

COT- 4.

Consultation of the neurologist. Neurological history is not burdened.

In neurological status - consciousness clear, focused in time and space, the normal speech rate, the questions are answered correctly, periodically monosyllables, elements with emotional lability. The character of the handwriting is not changed, even. Field of view is not changed, (pupils S=D), the expression is lively, movement of the eyeballs in full, eye - no, the facial muscles are symmetric, bulbar disorders - not, sensitive disorders on the face does not show. The exit point of the trigeminal nerve is painless. Naru the Affairs of smell, hearing loss is not detected.

Symptoms of oral automatism is not. The power of paralysis in the extremities, abnormal stop signs - not detected. Tremor of the upper extremities - no. Deep reflexes D=S, the average stuffy, superficial abdominal reflexes saved, D=S. Disorders of surface sensitivity on the trunk and extremities does not show. Vibration sensitivity on the toes and hands are not reduced. Coordinatorsee sample performs satisfactorily. In the Romberg - resistant. Meningeal symptoms - no.

The results of microbiological studies on intestinal dysbacteriosis. The levels of lactobacilli - 107, bifidobacteria - 108, Escherichia coli with normal enzymatic activity - 107, Escherichia coli with reduced enzymatic activity - 102, lactosamine Escherichia coli - 0, other opportunistic pathogens - 0, Staphylococcus aureus - 0, yeast-like fungi of the genus Candida - 0. The dysbacteriosis of 1 degree.

Given the clinical and biochemical picture, psychometric testing - the patient has hepatic encephalopathy, latent stage.

Example 4. (hepatotropic drug Essentiale Forte N)

Patient M., aged 57, map No. 16071. 06.11.2009,

Complaints: weakness, irritability, drowsiness in the daytime, poor sleep at night, discomfo the t in the abdomen, which take place after bowel movements; feeling of fullness in the abdomen, increased flatulence, bloating, change in the character of the chair alternating diarrhea and constipation.

Objective: at the time of inspection - conscious, oriented, the questions are answered correctly.

Palpation: the rumbling, increased tension in the region of the transverse and sigmoid colon. Liver +1 cm from the edge of the costal arch.

From the anamnesis it is known, since 2003 after emotional stress began to abuse alcohol 100-200 ml 4-5-6 days. In 2003, notes yellowness of the skin is treated at the city hospital name Spotline with a diagnosis of chronic toxic hepatitis, with the transformation in cirrhosis, portal hypertension. hypersplenism. DFDS esophagus. Received therapy (hepatic, metabolic infusion therapy). After was seen by the infectious diseases specialist at the place of residence, received hepatoprotectors (Heptral, Essentiale, Kars) courses. 2008 - alcohol denies. Outpatient survey August 2009 - abdominal ultrasound: diffuse changes in the liver, by type of cirrhosis, hepatosplenomegaly, v porte 14 mm ECG - sinus rhythm, the syndrome of early ventricular repolarization. Received courses Heptral/No. 10. In the last 2 weeks notes frequent mood swings, irritability, drowsiness,frequent changes of mood.

Conclusion. On the basis of complaints, physical examination, and clinical and laboratory data of the patient M, is:

Chronic toxic hepatitis (ASH), cirrhotic stage Child Pugh A.

Portal hypertension (DFDS esophagus, hypersplenism).

The complication. Hepatic cell failure And hepatic encephalopathy latent stage.

Clinical and laboratory tests during treatment the patient M

The level of hemoglobin - 134 g/l, erythrocytes - 4,4×1012/l, leukocytes - 4,4×109/l, ESR - 24 mm /h, platelets 89×109/l, Alat - 60 u/l, AST - 74 units/l, alkaline phosphatase - 309 units/l, GGT - 269 u/l, total bilirubin - 42 units/l, total protein - 81 g/l, albumin 33 g/l, potassium 4.4 mmol/L.

TSC - 36 sec.

T - 61 sec.

COT- 3.

Fibrogastroduodenoscopy: DFDS of the esophagus, Chronic gastritis,

Abdominal ultrasound: diffuse changes in the liver, by type of cirrhosis, hepatosplenomegaly, v porte 14 mm

Markers of hepatitis B and C (HBsAg, HCV), RW - negative

The neurologist, Neurological history is not burdened.

In neurological status - consciousness clear, focused in time and space, the normal speech rate, the questions are answered correctly, slowly with elements of emotional lability. The character of the handwriting changed is uneven. Field of view is not changed, (pupils S=D), the expression is lively, movement of the eyeballs in full, NIS the ASMA - no, the facial muscles are symmetric, bulbar disorders - not, sensitive disorders on the face does not show. The exit point of the trigeminal nerve is painless. Disorders of smell, hearing is not revealed. Symptoms of oral automatism is not. The power of paralysis in the extremities, abnormal stop signs - not detected. Tremor of the upper extremities - no. Deep reflexes D=S, the average stuffy, superficial abdominal reflexes saved, D=S. Disorders of surface sensitivity on the trunk and extremities does not show. Vibration sensitivity on the toes and hands are not reduced. Coordinatorsee sample performs satisfactorily. In the Romberg - resistant. Meningeal symptoms - no.

Conclusion: at the time of inspection data for acute neurological pathology no. There has been latent encephalopathy, probably hepatic dysfunction.

The results of microbiological studies on intestinal dysbacteriosis. The levels of lactobacilli - 106, bifidobacteria - 107, Escherichia coli with normal enzymatic activity - 107, Escherichia coli with reduced enzymatic activity - 103, lactosamine Escherichia coli - 104other opportunistic pathogens - 0, Staphylococcus aureus - 0, yeast-like fungi of the genus Candida is 0.

Thus the om, the examined Meters, according to the results of bacteriological research, there are changes characteristic of dysbiosis colon 2 degrees.

For 28 days the patient received therapy with drug Essentiale Forte N 2 capsules 3 times a day.

Clinical and laboratory tests of the patient M after treatment.

After treatment - weakness decreased slightly, drowsiness in the daytime, as well as complaints about poor night's sleep is preserved, quick notes irritability.

At the time of inspection - conscious, oriented, the questions are answered correctly. A chair with a frequency of 1 every 1-2 days. Periodically during the day, the feeling of bloating in the abdomen, increased flatulence, flatulence.

The hemoglobin level is 136 g/l, erythrocytes - 4,5×1012/l, leukocytes - 4,5×109/l, ESR - 23 mm /hour, platelet - 89×109/l, Alat - 35 units/l, AST - 62 units/l, alkaline phosphatase - 269 units/l, GGT - 248 u/l, total bilirubin - 40 units/l, total protein 80 g/l, albumin 33 g/l, potassium 4.4 mmol/L.

TSC - 36 sec.

TL - 60 sec.

COT- 3.

Consultation of the neurologist.

In neurological status - consciousness clear, focused in time and space, the normal speech rate, the questions are answered correctly, the elements of emotional lability. The character of the handwriting changed is uneven. Field of view is not changed, (pupils S=D), the expression MS is s, movement of the eyeballs in full, eye - no, the facial muscles are symmetric, bulbar disorders - not, sensitive disorders on the face does not show. The exit point of the trigeminal nerve is painless. Disorders of smell, hearing is not revealed. Symptoms of oral automatism is not. The power of paralysis in the extremities, abnormal stop signs - not detected. Tremor of the upper extremities - no. Deep reflexes D=S, the average stuffy, superficial abdominal reflexes saved, D=S. Disorders of surface sensitivity on the trunk and extremities does not show. Vibration sensitivity on the toes and hands are not reduced. Coordinatorsee sample performs satisfactorily. In the Romberg - resistant. Meningeal symptoms - no.

The results of microbiological studies on intestinal dysbacteriosis. The levels of lactobacilli - 106, bifidobacteria - 106, Escherichia coli with normal enzymatic activity - 106, Escherichia coli with reduced enzymatic activity - 103, lactosamine Escherichia coli - 103other opportunistic pathogens - 0, Staphylococcus aureus - 0, yeast-like fungi of the genus Candida - 104. The dysbacteriosis of 2 degrees.

Given the clinical and biochemical picture, psychometric testing - the patient's hepatic encephalopathy, latent stage.

Example 5. (product comparison - Gutalac)

Patient L., aged 34, map No. 3590. 13.03.2009,

Complaints: weakness, drowsiness, abdominal discomfort, which take place after a bowel movement; increased flatulence, bloating, change in the nature of a chair - the tendency to constipation.

Objective: at the time of inspection - conscious, oriented, the questions are answered correctly.

Palpation: the rumbling, increased tension in the region of the transverse and sigmoid colon. Liver +1 cm from the edge of the costal arch.

From the anamnesis it is known, for 2 years, periodically noted pain in the right hypochondrium whining character. In January 2009, the increase in transaminase, took hepatoprotectors (hofitol, Kars effect) 03.03.09 revealed positive anti-HCV (EP. room 21.000), abdominal ultrasound - hepatomegaly, diffuse changes of a liver porte v 10 mm EGD - DFDS are not identified. ECG sinus rhythm, without deviation from the norm. Within the last 1 week marks the change of handwriting, drowsiness, loss of ability to work.

Conclusion: On the basis of complaints, physical examination and clinical laboratory findings in a patient with L, is:

Chronic viral hepatitis (HCV), minimal activity.

Complications: hepatic encephalopathy latent stage.

Clinical and laboratory tests during treatment the patient L:

the Level of hemoglobin 165 g/l, erythrocytes - 5,3×1012/l, leukocytes - 5,6×109/l, ESR - 23 mm /hour, platelet - 206×109/l, Alat - 119 units/l, AST - 43 units/l, alkaline phosphatase - 129 units/l, GGT - 69 u/l, total bilirubin - 55 units/l, total protein - 82 g/l, albumin - 44 g/l, potassium 4.1 mmol/L.

TSC - 35 sec.

T - 52 sec.

COT- 5.

Abdominal ultrasound - hepatomegaly, diffuse changes of a liver porte v 10 mm

EGD - DFDS not identified, gastroduodenitis without exacerbation.

The neurologist, Neurological history is not burdened.

In neurological status - consciousness clear, focused in time and space, the normal speech tempo, answers questions slowly, correctly, sometimes in monosyllables, with elements of emotional lability. The character of the handwriting changed is uneven. Field of view is not changed, (pupils S=D), the expression is lively, movement of the eyeballs in full, eye - no, the facial muscles are symmetric, bulbar disorders - not, sensitive disorders on the face does not show. The exit point of the trigeminal nerve is painless. Disorders of smell, hearing is not revealed. Symptoms of oral automatism is not. The power of paralysis in the extremities, abnormal stop signs - not detected. Tremor of the upper extremities - no. Deep reflexes D=S, the average stuffy, superficial abdominal reflexes saved, D=S. R is straist surface sensitivity on the trunk and extremities does not show. Vibration sensitivity on the toes and hands are not reduced. Coordinatorsee sample performs satisfactorily. In the Romberg - resistant. Meningeal symptoms - no.

Conclusion: at the time of inspection data for acute neurological pathology no. There has been latent encephalopathy, hepatic likely origins.

The results of microbiological studies on intestinal dysbiosis: the Levels of lactobacilli - 106, bifidobacteria - 106, Escherichia coli with normal enzymatic activity - 107, Escherichia coli with reduced enzymatic activity - 103, lactosamine Escherichia coli - 102other opportunistic pathogens - 104, Staphylococcus aureus - 0, yeast-like fungi of the genus Candida - 103.

Thus, the examined L. the results of bacteriological tests are changes characteristic of dysbiosis colon 2 degrees.

For 28 days the patient received therapy with drug Essentiale Forte N 2 capsules 3 times a day and Gottex at a dose of 15 drops 1 time per day.

Clinical and laboratory tests of the patient L. after treatment.

After treatment, weakness reduced. Daytime sleepiness is stored.

At the time of inspection - conscious, oriented, the questions are answered correctly. Chair regular 1 times the each day.

The level of hemoglobin - 167 g/l, erythrocytes - 5,3×1012/l, leukocytes - 5,4×109/l, ESR - 23 mm /hour, platelet - 208×109/l, Alat - 97 units/l, AST - 34 units/l, alkaline phosphatase - 120 units/l, GGT - 65 u/l, total bilirubin - 43 units/l, total protein - 82 g/l, albumin - 44 g/l, potassium 4.2 mmol/L.

TSC - 35 sec.

T - 50 sec.

COT- 5.

Consultation of the neurologist.

In neurological status - consciousness clear, focused in time and space, the normal speech tempo, answers questions slowly, correctly, sometimes in monosyllables, reluctantly, with elements of emotional lability. The character of the handwriting changed is uneven. Field of view is not changed, (pupils S=D), the expression is lively, movement of the eyeballs in full, eye - no, the facial muscles are symmetric, bulbar disorders - not, sensitive disorders on the face does not show. The exit point of the trigeminal nerve is painless. Disorders of smell, hearing is not revealed. Symptoms of oral automatism is not. The power of paralysis in the extremities, abnormal stop signs - not detected. Tremor of the upper extremities - no. Deep reflexes D=S, the average stuffy, superficial abdominal reflexes saved, D=S. Disorders of surface sensitivity on the trunk and extremities does not show. Vibration sensitivity on the toes and hands not with Irena. Coordinatorsee sample performs satisfactorily. In the Romberg - resistant. Meningeal symptoms - no.

The results of microbiological studies on intestinal dysbiosis: the Levels of lactobacilli - 106, bifidobacteria - 107, Escherichia coli with normal enzymatic activity - 107, Escherichia coli with reduced enzymatic activity - 103, lactosamine Escherichia coli - 102other opportunistic pathogens - 104, Staphylococcus aureus - 0, yeast-like fungi of the genus Candida - 103. The dysbacteriosis of 2 degrees.

Given the clinical and biochemical picture, psychometric testing - the patient has hepatic encephalopathy, latent stage.

As the comparison drug was taken laxative drug Gutalac, firm manufacturer: BOEHRINGER INGELHEIM PHARMA GmbH, widely used in gastroenterology, for the treatment of constipation; and hepatoprotector Essentiale, firm manufacturer: Sanofi-Aventis

GOTTEX®Guttalax - sodium picosulfate [43]

The company manufacturer: BOEHRINGER INGELHEIM PHARMA GmbH

Release form, composition and packaging:

- Drops for oral administration in the form of a transparent, slightly
viscous rest the RA from colorless to yellowish
or slightly yellowish-brown color.ml (15 drops)
sodium picosulfate (in the form of a monohydrate)7.5 mg

Excipients: sodium benzoate, sodium citrate dihydrate, sorbitol liquid (recrystallizes), citric acid monohydrate, purified water.

15 ml bottle-dropper plastic (1) - bundles of cardboard.

30 ml bottle-dropper plastic (1) - bundles of cardboard.

Pharmacological action

Laxative drug. Active ingredient : sodium picosulfate is a laxative triarylmethane group. As local laxative, sodium picosulfate after bacterial breakdown in the large intestine has a stimulating effect on the mucous membrane of the colon, increasing peristalsis, contributes to the accumulation of water and electrolytes in the colon. This leads to stimulation of defecation, reduction of the time of the evacuation and the softening of the stool.

Pharmacokinetics

After intake of sodium picosulfate enters the colon. The drug absorption is negligible, which excludes its enterohepatic circulation. In the colon there is a decomposition of sodium picosulfate education sports the metabolite, bis-(p-hydroxyphenyl)-pyridyl-2-methane. The time development of the laxative effect of the drug is determined by the rate of release of the active metabolite and is 6-12 o'clock In the systemic circulation enters a small part of the drug. The relationship between the laxative effect of the active metabolite and its concentration in serum is absent.

Indications for use of the drug GOTTEX®

As a laxative agent in the following cases:

- constipation caused by atony and hypotonia of the colon (including the elderly, bedridden patients, after surgery, after childbirth and during lactation);

- constipation caused by medications;

- to control the chair with hemorrhoids, proctitis, anal fissures (to soften the consistency of faeces);

- gallbladder disease, irritable bowel syndrome with constipation;

- constipation due to intestinal dysbiosis, impaired diet.

The dosage regimen

The drug is prescribed inside.

Adults and children over 10 years are designated 10-20 drops (5-10 mg); children 4-10 years 5-10 drops (2.5-5 mg).

To get the laxative effect in the morning the drug should be taken on the eve of the night.

Side effect

From the digestive system discomfort; nausea, vomiting, cramps and pain in the lives is the one the diarrhea.

Possible hypersensitivity reactions by the immune system, including angioneurotic edema and skin reactions.

Contraindications to the use of the drug GOTTEX®

intestinal obstruction;

- obstructive bowel disease;

acute inflammatory bowel disease;

- severe abdominal pain accompanying nausea and vomiting that may be a symptom of the above-mentioned severe conditions;

severe dehydration;

- children up to 4 years;

- hypersensitivity to sodium picosulfate and other components of the drug.

Patients with rare hereditary disease of fructose intolerance should not take the drug.

The use of the drug GOTTEX®during pregnancy and breastfeeding

Data on reliable and well-controlled studies in pregnant women. Long experience in the application revealed no negative effects of the drug on pregnancy. The drug in the first trimester of pregnancy is contraindicated. In II and III trimesters of pregnancy (as when using other laxatives) the drug available only by prescription.

Active metabolite and its glucuronidase is not excreted in breast milk. Thus, the drug can be used during the GRU is nogo-feeding.

Special instructions

It is not recommended to take daily medication without consulting a doctor more than 10 days. Long-term use of the drug in high doses can lead to dehydration, electrolyte imbalance, hypokalemia.

In 1 ml drops contains 450 mg of sorbitol. The maximum recommended daily dose for the treatment of adults and children 4-10 years contains 600 mg and 300 mg of sorbitol, respectively. The drug has no taste, so it can be added in food for use in children. Children should take the drug only by prescription.

Influence on ability to driving of motor transport and to management of mechanisms

Not marked.

Overdose

Symptoms: when using high doses, possible diarrhea, dehydration, reduction of blood pressure, disruption of water and electrolyte balance, hypokalemia, seizures. In addition, there are reported cases of ischemic muscles of the colon associated with taking doses of Guttulata much higher than recommended for routine treatment of constipation.

Gottex®like other laxatives, chronic overdose can lead to chronic diarrhea, pain in the abdomen, hypokalemia, secondary hyperaldosteronism, urolithiasis. Due to the chronic abuse of laxatives may develop damage the renal tubules, metabolic alkalosis and muscle weakness associated with hypokalemia.

Treatment: to reduce absorption of the drug after ingestion can cause vomiting or perform gastric lavage. You may need fluid replacement and correction of electrolyte, as well as the purpose antispasmodics.

Drug interactions

While applying Guttulata in high doses and diuretics or corticosteroids increases the risk of electrolyte disturbances (hypokalemia).

Simultaneous administration of antibiotics can reduce the laxative effect of Guttulata.

Electrolyte imbalance may increase sensitivity to cardiac glycosides.

Conditions prescribed.

The drug is approved for use as a means of prescription.

Terms and conditions of storage

The drug should be stored out of the reach of children, protected from light place at temperature not exceeding 30°C; do not freeze. Shelf life - 3 years.

ESSENTIALE®Forte N (ESSENTIALE®FORTE N) Firm manufacturer: Sanofi-Aventis [43]

Release form, composition and packaging.

Capsules hard gelatin, brown
color, opaque, prdolgova is s; content
capsules - oily paste
yellowish-brown color.1 caps.
phospholipids from soybeans containing 76%
(3-sn-phosphatidyl) choline
(synonyms - "essential" phospholipids, EPL®)300 mg

Auxiliary substances: solid fat, soybean oil, castor oil gidrirovannoe, ethanol 96%, ethylvanillin, 4-methoxyacetophenone, α-tocopherol.

The capsule: gelatin, purified water, titanium dioxide (E171), the colorant iron oxide yellow (E172), the colorant iron oxide black (E172), the colorant iron oxide red (E172), sodium laurylsulfate.

10 PCs - blisters (3) - packs of cardboard.

10 PCs - blister (10) - pack carton.

Pharmacotherapeutic group. Hepatoprotector

Pharmacological properties: hepatotropic drug. The active substance of the drug are so-called essential phospholipids (EPL®-substance), which are high-purity fraction of phosphatidylcholine. The main component of this fraction is what I tylenolamoxicillin. EPL®its chemical structure is similar to the endogenous membrane phospholipids, exceeding them by their functional properties due to the high content of polyunsaturated fatty acids, especially linoleic acid. Phospholipids are the main structural elements of cell membranes and organel. They take part in differentiation, reproduction and cell regeneration. Functional significance of phospholipids based on their amphiphilic properties, which allow to regulate the permeability of cell membranes. They improve the function of membranes, in particular ion exchange, the process of cell respiration, biological oxidation, affect the binding of intracellular enzymes of respiration in the mitochondria, and the process of oxidative phosphorylation in the energy metabolism of cells. In physiological conditions the synthesis of phospholipids satisfy the normal needs of hepatocytes, which contain a sufficient amount of phospholipids.

It is known that the structure of cell membranes and function of enzyme systems in liver diseases are violated. Impaired biosynthesis of phospholipids, deficiency of which leads to dysfunction of the cell membrane. These processes are especially pronounced in mitochondria, which are approximately 30% consist of phospholipids and which are carried out in inasia metabolic processes, including oxidative phosphorylation. At deficiency of phospholipids is a violation of fat metabolism, which leads to fatty liver. Due to its pharmacological properties of essential phospholipids eliminate these violations, promote regeneration of cell membranes, reactivit broken membrane-bound enzyme systems and receptors, increase detoxification ability of the liver and thus normalize its function.

When taking Essentiale Forte N inside more than 90% of the drug absorbed in the small intestine. The basic amount under the influence of phospholipase-And up to 1-acyl-lyso-phosphatidylcholine, 50% of which is immediately atriums to polyunsaturated phosphatidylcholine during absorption in the small intestine. Polyunsaturated phosphatidylcholine enters the blood via the lymphatic vessels predominantly in complex with PAP and transported to the liver. The maximum level of phosphatidylcholine in the blood is achieved through 6-24 h after dosing, and an average of 20%.

The half-life for halinowego component 66 is h, saturated fatty acids - 32 hours, About 5% of the drug is excreted in the feces.

Indications:

- chronic hepatitis;

- cirrhosis of the liver;

fatty degeneration of the liver of various etiologies;

- toxic p is Cheney;

- toxemia of pregnancy;

- psoriasis (as adjunctive therapy);

- radiation syndrome

Dosage and administration:

Essentiale®Forte N is prescribed orally 2 capsules 2-3 times/day. during the meal. The course of treatment is not less than 3 months and, if necessary, may be continued or repeated.

Capsules should be swallowed whole with a little water.

Side effects.

Essentiale®Forte N is usually well tolerated.

From the digestive system: rarely - discomfort in the abdomen, breaks a chair.

Other: allergic reactions are possible.

Contraindications to the use of the drug ESSENTIALE®FORTE N

- individual intolerance to the drug.

The drug ESSENTIALE®FORTE N during pregnancy and breastfeeding

The drug use during pregnancy, according to testimony.

Use in impaired liver function.

You can use as evidence.

Overdose

Currently, the cases of drug overdose have been reported.

Drug interactions

Drug interactions of preparation is not described.

Conditions prescribed.

The drug is approved for use as a means of prescription.

Terms and conditions storing the Oia

The preparation should be stored in a place inaccessible to children at temperature not above 21°C. shelf Life - 3 years.

As seen from the above examples, the results of treatment by the present method (examples # 1 and # 2) are not inferior to the results of treatment according to the method prototype (sample No. 3), as evidenced by clinical, laboratory and psychometric data. Example No. 4 (monotherapy Essentiale Forte N) demonstrates the lack of a positive effect on psychometric indicators, which proves the presence of this effect in the present method by the introduction of drug Mucofalk (examples # 1 and # 2)and not hepatotropic drug Essentiale Forte N. Example No. 5 provides for proof of lack of psychometric effect when taking laxatives triarylmethane group.

The inventive method was tested in 85 patients GSP, PE-L or I a degree of clinically severe stage of hepatic encephalopathy. All patients were divided into 4 groups:

group 1 - 30 people HSP with PE-L PE-1. The treatment program included a reception hepatoprotector from the group of essential phospholipids (Essentiale Forte N), 2 caps. 3 times a day, Mucofalk 1 sachet 3 times a day (1 sachet pour into a glass that slowly fill with cold water (150 ml), stir and immediately drink, then drink another glass of liquid (150 ml) is for 28-30 days.

group 2 (comparison 1) was 20 people HSP with PE-L PE-1. The treatment program included a reception hepatoprotector from the group of essential phospholipids (Essentiale Forte N), 2 caps. 3 times a day and Duphalac at a dose of 30 ml of 1 times/day during morning meals for 28-30 days.

group 3 - (comparison 2) - amounted to 20 people HSP with PE-L PE-1. The treatment program included a reception hepatoprotector from the group of essential phospholipids (Essentiale Forte N), 2 caps. 3 times a day for 28 to 30 days.

group 4 - (comparison 3) - 15 people HSP with PE-L PE-1. The treatment program included a reception hepatoprotector from the group of essential phospholipids (Essentiale Forte N), 2 caps. 3 times a day and Gottex at a dose of 15 drops 1 time/day for 28 to 30 days.

Patients with edema was appointed an additional Verospiron 50 mg in the morning on an empty stomach.

The distribution of patients HSP latent stage or first degree clinically severe stage of hepatic encephalopathy and identification with dysbiosis of the colon are presented in table 1.

All 85 patients HSP have dysbiosis, made General complaints: disorders of the chair, characterized by the alternation of diarrhea and constipation; feeling of fullness in the stomach due to excess gas, rumbling; pain in the abdomen, often monotonous, pulling and arching, the sometimes - strong, colicky, feeling of fullness in the stomach; aerophagia, belching, nausea when stored appetite; bloating, difficulty urinating; pain in the abdomen by type of intestinal colic, which takes place after the emptying of the bowels.

The examination included:

1) double bacteriological examination of feces on a dysbacteriosis before treatment and one month after treatment with standard regimens;

2) monitoring of manifestations of hepatic encephalopathy [9, 46]:

- psychometric testing (test connection numbers, the test line);

assessment of cognitive functions was performed using the method of "10 words" Arioli (memory impairment) and tables Schulte (deterioration);

- diagnosis of depression according to the method of the Dung;

- consultation of the neurologist and psychiatrist to exclude other causes of encephalopathy. Evaluated neurological symptoms: tremor of the fingers, paresthesias of the extremities, increased tendon reflexes, change handwriting;

- biochemical and clinical analysis of blood.

Dynamics of clinical manifestations in patients HSP with latent and first degree clinically severe stage of hepatic encephalopathy on the background of therapy

According to the results of observation, it was found that on treatment 1 and 2 of the observed groups decrease asthenic and dispepsicheskimi - on average occurred to 6-7 days of treatment and was observed in 21 (70,0%) patients in the 1st group, in 16 (80%) in the 2nd group. Whereas in group 3 to 6-7 days there was a decrease in diarrhoeal syndrome only 4 (20,0%) patients, and 4-Oh group in 6 (40%) patients. Improving performance through 30 days on a background of treatment was noted 56.6% of patients of the 1st group and 65% of the patients of the 2nd group. In group 3 improving health said only 3 people (15,0%), and group 4 - 4 people (27%). Normalization of cognitive function and fine motor skills through 30 days in the 1st group, 67% of patients in group 2 - 70% of the patients in groups 3 and 4 improve the implementation of cognitive function and fine motor function occurred only of 10.0% and 13.0% of patients.

So, after 28-30 days on the background of therapy in patients of the 1st and 2nd groups comparable marked improvement in clinical symptoms.

The change laboratory data in patients HSP with latent and first degree clinically severe stage of hepatic encephalopathy at the time of treatment (see Tables 2, 3 and 4).

Positive dynamics in the state clinical laboratory test results group 1 corresponded to the results of group 2 are presented in table 2, 3 and 4.

The dynamics of the latent and the I degree clinically severe stage of hepatic encephalopathy in patients with chronic diseases of the liver before and after therapy (see Histogram 1).

Analysis of results of psychometric tests after therapy, confirmed the improvement or recovery of psychomotor function in 70% of patients of the 2nd group, 63% of the patients of the 1st group, 10% of people (2 people) from group 3, and 13% (2 people) - group 4. The results of psychometric testing (TSC and TL) patients HSP presented in the histogram 1. In 1-St and 2-nd groups of COTBefore treatment was 6.2±1,1, and 6.3±1,1 respectively, after therapy COTwas 1.1±0,5 (p<0.05) and 1,2±0,5 (p<0,05), respectively, in the 3-rd and 4-th group of COTbefore treatment was 6.0±1,2, and 6.2±1,3, respectively, after therapy COT5.7±1,1 (p>0,05), and 6.0±1,2, (p>0,05), respectively.

In our study, were also reliable inverse correlation between run time TSC and t and the rate of growth of lactobacilli in patients HTP and PE-L and I degree clinically expressed stage - r=-0,29 and -0,20, p<0,05 and a direct link to the growth of clostridia r=0.20 and r=0,19, p<0,05, Staphylococcus aureus r=0,24 and r=0,23, p<0,05, fungi of the genus Candida r=0.41 and r=0,36, p<0,05 and time performing TSC and growth of hemolytic microorganisms r=0,24, p<0,05.

The above data indicate effective use of laxative herbal remedies, Mucofalk for the treatment of patients with chronic liver disease with latent study the th and the I degree clinically severe stage of hepatic encephalopathy. The data obtained is comparable with the method of the prototype (using osmotic laxative drug Duphalac in the treatment of patients with latent and first degree clinically severe stage of hepatic encephalopathy).

Thus, the inventive method expands the Arsenal of drugs for the treatment of patients with chronic liver disease with latent stage and I degree clinically severe stage of hepatic encephalopathy due to the introduction of drug Mucofalk.

Table 1
The distribution of patients with chronic liver disease and latent I degree clinically severe stage of hepatic encephalopathy and identification of dysbacteriosis colon
Group:Dysbacteriosis, colon cancer, n (%)
grade 1grade 2grade 3
group 1, n=3013 (40%)11 (32%)6 (32%)
group 2, n=207 (22%)9 (26%)4 (21%)
group 3, n=207 (22%)8 (24%)5 (26%)
group 4, n=155 (16%)6 (18%)4 (21%)
Total: 8532 (100%)34 (100%)19 (100%)

Method for the treatment of patients with chronic liver disease with latent stage and I degree clinically severe stage of hepatic encephalopathy, which consists in drug exposure, including hepatoprotector Essentiale Forte N, wherein the patient is additionally administered the drug Mucofalk for 28-30 days.



 

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4 ex, 2 tbl, 2 dwg

FIELD: medicine, pharmaceutics.

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FIELD: medicine, pharmaceutics.

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3 ex, 3 tbl, 3 dwg

FIELD: medicine, pharmaceutics.

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2 cl, 6 dwg, 2 tbl

FIELD: medicine.

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FIELD: medicine.

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25 cl, 10 dwg, 2 ex

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FIELD: medicine.

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17 cl, 2 ex

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5 cl, 2 tbl, 2 dwg

FIELD: medicine, pharmaceutics.

SUBSTANCE: invention relates to cosmetic industry and represents product for hair dyeing, which includes first component, including alkaline agent, second component, including hydrogen peroxide and foam-generating container of non-aerosol type for releasing solution of first and second component mixture in form of foam, where mixture solution includes the following ingredients (A) and (B): (A) from 0.1 to 10% by mass of non-ionic surface-active substance and (B) from 0.1 to 5% by mass of cation surface-active substance and mass ratio of ingredient (A) to ingredient (B) (content of ingredient (A)/content of ingredient (B) constitutes from 1 to 100.

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5 cl, 2 tbl, 2 dwg

FIELD: medicine, pharmaceutics.

SUBSTANCE: invention relates to cosmetic industry and represents product for hair dyeing, which includes first component, including alkaline agent, second component, including hydrogen peroxide and foam-generating container of non-aerosol type for releasing solution of first and second component mixture in form of foam, where mixture solution includes the following ingredients (A) and (B): (A) from 0.1 to 10% by mass of non-ionic surface-active substance and (B) from 0.1 to 5% by mass of cation surface-active substance and mass ratio of ingredient (A) to ingredient (B) (content of ingredient (A)/content of ingredient (B) constitutes from 1 to 100.

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5 cl, 2 tbl, 2 dwg

FIELD: medicine, pharmaceutics.

SUBSTANCE: invention relates to cosmetic industry and represents product for hair dyeing, which includes first component, including alkaline agent, second component, including hydrogen peroxide and foam-generating container of non-aerosol type for releasing solution of first and second component mixture in form of foam, where mixture solution includes the following ingredients (A) and (B): (A) from 0.1 to 10% by mass of non-ionic surface-active substance and (B) from 0.1 to 5% by mass of cation surface-active substance and mass ratio of ingredient (A) to ingredient (B) (content of ingredient (A)/content of ingredient (B) constitutes from 1 to 100.

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5 cl, 2 tbl, 2 dwg

FIELD: medicine, pharmaceutics.

SUBSTANCE: invention relates to coloured aromatizing composition, containing in cosmetically acceptable medium: a) at least 2 wt % of aromatising substance from total composition weight; b) at least one derivative of benzotriazole silicone of formula (1), c) at least one coloring agent, soluble in said medium, said composition does not contain compound β,β'-alkyldiphenylacrylate or α-cyano-β,β'-alkyldiphenylacrylate.

EFFECT: composition ensures stability of colour in time and under impact of light.

10 cl, 2 tbl, 1 ex

FIELD: medicine, pharmaceutics.

SUBSTANCE: invention relates to coloured aromatizing composition, containing in cosmetically acceptable medium: a) at least 2 wt % of aromatising substance from total composition weight; b) at least one derivative of benzotriazole silicone of formula (1), c) at least one coloring agent, soluble in said medium, said composition does not contain compound β,β'-alkyldiphenylacrylate or α-cyano-β,β'-alkyldiphenylacrylate.

EFFECT: composition ensures stability of colour in time and under impact of light.

10 cl, 2 tbl, 1 ex

FIELD: medicine, pharmaceutics.

SUBSTANCE: invention relates to cosmetic field and deals with preparation for changing hair colour, which contains in cosmetic carrier at least one colour-changing component and combination (i) of not less than one corresponding to formula compound in amount from 0.01 to 7 wt % in terms of ready for application preparation, where R1, R2 and R3 are independently on each other represent atom of hydrogen, groups -CH3, -CH2CH3, -CH(CH3)2, -CH2CH2CH3, -CH(CH3)CH2CH3, -CH2CH(CH3)2, -C(CH3)3, n stands for 1 or 2; and (ii) of α-lipoic acid, in amount from 0.01 to 3.0 wt % calculated per weight of ready for application preparation. Invention also relates to method of changing hair colour with application of claimed preparation and application of said combination for changing hair colour which spares head skin.

EFFECT: invention ensures reduction of unpleasant sensations on head skin appearing during hair treatment aimed at changing their colour.

7 cl, 2 tbl

FIELD: medicine, pharmaceutics.

SUBSTANCE: invention relates to cosmetic field and deals with preparation for changing hair colour, which contains in cosmetic carrier at least one colour-changing component and combination (i) of not less than one corresponding to formula compound in amount from 0.01 to 7 wt % in terms of ready for application preparation, where R1, R2 and R3 are independently on each other represent atom of hydrogen, groups -CH3, -CH2CH3, -CH(CH3)2, -CH2CH2CH3, -CH(CH3)CH2CH3, -CH2CH(CH3)2, -C(CH3)3, n stands for 1 or 2; and (ii) of α-lipoic acid, in amount from 0.01 to 3.0 wt % calculated per weight of ready for application preparation. Invention also relates to method of changing hair colour with application of claimed preparation and application of said combination for changing hair colour which spares head skin.

EFFECT: invention ensures reduction of unpleasant sensations on head skin appearing during hair treatment aimed at changing their colour.

7 cl, 2 tbl

FIELD: medicine.

SUBSTANCE: group of inventions relates to field of medicine, namely to dentistry, and deal with varnish compositions for teeth and their application. Composition of teeth varnish includes active component and component which forms adhesive film, including decoloured shellac and shellac wax, shellac wax constituting from approximately 0.5 wt % to approximately 15 wt % of composition weight. Source of fluoride ion, antibacterial preparation, preparation reducing teeth sensitivity, preparation for teeth whitening or their combinations can be used and active component. Also claimed is application of claimed composition as means contributing to prevention and/or treatment of carious teeth decay, remineralisation of tooth surface and in case of teeth hypersensitivity. Inclusion of shellac wax in said amounts ensures improved varnish stability at higher temperature.

EFFECT: varnish possesses better adhesive ability, is applied on teeth more easily, results in lesser colouring of teeth surface after its application on teeth, without losing activity of active component in comparison with teeth varnish which contains ordinary shellac.

16 cl, 2 tbl, 6 ex, 3 dwg

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely surgery, and concerns correction of disturbed structural-functional properties of red cells and immune status in patients with acute pancreatitis. For this purpose a complex pharmacotherapy is added by the single intramuscular introduction of the preparation Longidase 3000 IU on the 3, 6, 9, 12 and 15 days; the intravenous drop infusion of the preparation hypoxene 2.0 g once a day for 7 days, by dissolving the content of ampoule ex tempore in 5% glucose 400 ml, and the intravenous slow introduction of Essentiale H 5.0 ml once a day for 10 days.

EFFECT: method provides clinical effectiveness ensured by intensified repair processes and anti-infectious body resistance.

1 ex, 1 dwg

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