Comparison of intravenous pantoprazole with intravenous ranitidine in peptic ulcer bleeding.

Following successful endoscopic therapy in patients with peptic ulcer bleeding, rebleeding occurs in 4% to 30% of cases. Rebleeding remains the most important determinant of poor prognosis. The aim of our study is to compare the efficacy of intravenous pantoprazole and ranitidine for prevention of rebleeding of peptic ulcers following initial endoscopic hemostasis. In our study patients who had gastric or duodenal ulcers with bleeding received combined endoscopy therapy with injection of epinephrine and thermocoagulation. Patients with initial hemostasis were randomly assigned to two groups. One group (45 patients) was treated with intravenous pantoprazole, with an initial dose of 40 mg and subsequently with 40 mg every twelve hours during the first three days, followed by 40 mg a day orally. The other group (44 patients) was treated with intravenous ranitidine, with an initial dose of 50 mg and subsequently every eight hours during the first three days, followed by 150 mg ranitidine every 12 h. In all case of rebleeding repeated endoscopy was performed. One patient (2,2%) had rebleeding in pantoprazole group. Bleeding could not be blocked by repeated endoscopic intervention, thus the patient underwent emergency surgery. 6 patients (13,6%) from ranitidine group had recurrence of bleeding. Repeated endoscopy was performed in all these patients: bleeding was stopped in 3 cases endoscopically, other 3 patients were surgically treated urgently as endoscopic hemostasis was not successful. None of the patients died of uncontrolled rebleeding. The frequency of rebleeding was significantly low in the group of pantoprazole compared to ranitidine group (2,2% vs 13,6% P=0,046). There were no statistically significant differences between the groups with regard to need for emergency surgery (2,2% vs 6,8%), the length of hospital stay (6,7±3,3 vs 7,4±4,3 d) and mortality (0%vs 0%). After endoscopic treatment of bleeding peptic ulcers, intravenous pantoprazole is more effective than ranitidine for the prevention of rebleeding.

[The biliary intestinal obstruction].

The successful experience of treatment of 3 patients with biliary intestinal obstruction is depicted. The most informative means of diagnostics was the multispiral computed tomography. Authors state, that the volume of the operation should include only the liquidation of the intestinal obstruction. The simultaneous biliodigestive fistulae closure should be performed only in rare situations.

[Comparative evaluate of methods of placement of polypropylene meshes in alloplastic of incisional hernias].

Treatment results in 107 patients with incisional hernias were analyzed. All patients undergoing abdominal wall grafting with use of cellular polypropylene implant. Patients were divided into 2 groups. 57 patients operated according alloplastic method sublay formed the first group, 50 patients operated by method onlay formed the second group. Frequency of local wound postoperative complications and hernia relapses were taken into account for comparative evaluation of surgical treatment results. Hernia relapses investigated in 51 patients from the first group and in 44 patients from the second group. Basing on the authors' data method sublay are accompanied by local wound complications (infiltration, suppuration, seroma, haematoma) in 12,3% of observations, method onlay - in 28% (x(2)=4,17, p=0,04). In the first group hernia relapse developed in 1 patient (2%), in the second group - in 3 patients (6,8%) (x(2)=1,43, p=0,23). Authors consider that treating median incisional hernias by using diverse alloplastic methods preference should be given to sublay method.

[Experience in treatment of postoperative ventral hernias].

Treatment results in 193 patients with medium and large postoperative ventral hernias were analyzed. All patients were divided into 2 groups. 66 patients operated according to autoplastic methods formed the control group. 127 patients undergoing abdominal wall grafting with use of cellular polypropylene implant formed the main group. Sublay method was used in 48 patients, onlay--in 38 patients, Rives-Stoppa method--in 41 patients. Frequency of local wound postoperative complications and hernia relapses were taken into account for comparative evaluation of surgical treatment results. Hernia relapses developed in 56 patients from the control group and in 115 patients from the main group. Basing on the authors' data autoplastic methods are accompanied by local wound complications (infiltration, suppuration, seroma, haematoma) in 7.9% of observations, alloplastic methods--in 22.8% (chi2 = 6.36, p<0.05). In the control group hernia relapse developed in 18 patients (32.1%), in the main group--in 6 patients (5.2%) (chi2 = 22.63, p<0.001). Hernia relapse was revealed when using onlay method in 8.6% of observations, Rives-Stoppa--in 5.4%, sublay--in 2.3% of observations (chi2 = 1.53, p>0.05). Authors consider that it is necessary to use diverse alloplasic methods treating median postoperative hernias of medium and big sizes. Preference should be given to sublay method.

[Application of lectin for studying of the erythrocytes membranes changes in an acute mechanical intestinal obstruction].

Osmoresistance and the erythrocytes membranes deformity were studied in 62 patients, suffering an acute mechanical ileus, using lectin LPM. The lowering of indices, comparing with such in normal conditions, was established. While applying lectin, in tumoral ileus, in difference with nontumoral affection, the reduction of the erythrocytes membranes deformity was trustworthy (P < 0.01). In favourable course of postoperative period osmoresistance and deformity had approximated to normal values; in purulent complications occurrence the indices values had become poorer, these changes were strictly revealed using lectin. The method may be used for estimation of the treatment efficacy and the disease course prognosis.

[HLA antigens and the process of operative wound healing].

Association of HLA antigens with wound healing process was investigated in Georgian patients. Based on the peculiarities of the wound healing process dynamics, two groups of patients have been distinguished. The first group included 22 patients with primary intention of the operative wounds, while the second group included 30 patients with complicated course of the wound healing process. Control group was comprised by 492 healthy persons. Our study showed that the distribution of HLA antigens is different in these groups. The genetically determined risk of development of wound complications was significantly higher in individuals with HLA-DR1 having the relative risk 3,56.

[Use of lectin for detection of changes of erythrocytic osmotic resistance and deformity in acute advanced peritonitis]. / Primenenie lektina dlia vyiavleniia izmenenii osmorezistentnosti i stepeni deformatsii éritrotsitov pri ostrom rasprostranennom peritonite.

Thirty-one patients with acute general peritonitis were studied. Lectin (LPM) demonstrated an additional peak on kinetic curves of erythrocytic osmolysis in patients with acute general peritonitis. Deformity of erythrocytes had a tendency to decrease (p > 0.05), but in the presence of LPM this difference increased sharply (p < 0.001). On day 7 after surgery in case of a favorable outcome the peak decreased or disappeared, deformity of erythrocytes also disappeared. It is important for diagnosis and prognosis.