ABSTRACT
The goal of the study was to examine the cavitary pressure (P) in the duodenal and gastroesophageal region under the impact of acidification of the duodenum (D) and depending on the hydrochloric acid gastric secretion (HCL) and Helicobacter pylori (HP) infection in patients with ulcer. Endoscopic manometrography performed in 205 patients (with duodenal ulcer, gastric ulcer and chronic gastritis) revealed a considerable (p<0.05) increase in P (mmHg) in the D (9.4 +/- 0.4 vs. 11.8 +/- 1.0) and in the antral region of the stomach (ARS) (9.6 +/- 0.3 vs. 11.4 +/- 0.6), decreased pylorus tone (33.9 +/- 4.6 vs. 17.5 +/- 6.0) and pressure gradients (AP) between the low esophageal sphincter (LES) and D (6.6 +/- 0.4 vs. 3.9 +/- 1.3) in patients with increased basal acid secretion (BAS (BAS > 10 mm/hour vs. BAS < 7 mm/per hour). Acid infusion of 0.1N HCL in 39 patients was accompanied by the increase of P in the D (from 9.7 +/- 1.1 to 13.1 +/- 1.2), ARS (from 8.6 +/- 1.3 to 12.8 +/- 1.4) and tendency to the reduction in the P in the pylorus (from 28.2 +/- 2.5 to 20.6 +/- 3.6) as well as feeling of pain in all patients with active duodenal ulcers. The presence of HP in 47 out of 87 patients as compared to its absence was associated with the increased deltaP in the D-ARS (-0.6 +/- 0.43 vs. 2.1 +/- 1.1) and reduced deltaP in the LES-D (8.3 +/- 1.6 vs. 3.4 +/- 1.5) and deltaP LES-ARS (14.3 +/- 1.3 vs. 9.8 +/- 1.2) as well as more marked esophagitis (0.64 +/- 0.09 vs. 0.38 +/- 0.11 conventional units, p < 0.05). HP and hypersecreation of HCL synergistically or additively increase the antroduodenal tonic tension, promote the LES incompetence and further damage of the esophageal mucous coat.
Subject(s)
Duodenum/physiopathology , Esophagus/physiopathology , Gastric Acid/metabolism , Helicobacter Infections/complications , Peptic Ulcer/etiology , Stomach/physiopathology , Abdominal Pain/etiology , Abdominal Pain/microbiology , Adult , Aged , Duodenum/microbiology , Esophagus/microbiology , Female , Helicobacter pylori/isolation & purification , Humans , Hydrogen-Ion Concentration , Male , Manometry , Middle Aged , Peptic Ulcer/microbiology , Pressure , Stomach/microbiologySubject(s)
Cystadenoma, Papillary/diagnosis , Pancreatic Neoplasms/diagnosis , Adult , Cystadenoma, Papillary/pathology , Cystadenoma, Papillary/surgery , Diagnosis, Differential , Female , Humans , Middle Aged , Pancreas/diagnostic imaging , Pancreas/pathology , Pancreatectomy , Pancreatic Neoplasms/pathology , Pancreatic Neoplasms/surgery , Radiography , UltrasonographySubject(s)
Appendicitis/diagnostic imaging , Acute Disease , Adult , Diagnosis, Differential , Female , Humans , Male , UltrasonographyABSTRACT
The article discusses the possibility of ultrasonic examination (USE) in the diagnosis of acute appendicitis and its complications. Forty-five patients were examined, 15 of them had a doubtful clinical picture of acute appendicitis and in 30 destructive acute appendicitis was suspected. During USE the vermiform process was not detected in 5 patients, uncomplicated acute appendicitis was diagnosed in 10 and complicated acute appendicitis (appendicular infiltrate, abscess) in 30 patients. Eight patients underwent laparoscopy, 29 patients were subjected to an operative intervention, 15 patients received a course of nonoperative treatment followed by appendectomy 3-6 months later. As the result of the study the USE signs of acute appendicitis and its complications were specified. USE may be of significant aid to the surgeon in the diagnosis of this disease.
