[Causes of recurrences of gastrointestinal ulcer bleeding, their prophylaxis and treatment].

The authors have analyzed main causes of recurrences of gastro-intestinal ulcer bleeding which are thought to be the continuing ulcer alteration, lysis of the protective thrombus with gastric juice or the fibrinolysis system. The data obtained allowed determination of laboratory signs of the development of DIC-syndrome and its significance in the appearance of recurrent bleeding and greater lethality. The role of antirecidivation antisecretory therapy and therapeutic endoscopy was studied for prevention of recurrent bleeding depending on the degree of blood loss. The indications were formulated for emergency, postponed and planned surgery for gastro-intestinal ulcer bleedings as well as the content of conservative antirecidivation therapy.

[The hemostasis system state in patients with ulcerous gastrointestinal bleedings].

In patients with gastrointestinal bleedings there occurs activation of the hemostasis system directed to arrest of bleeding. Short-term hypercoagulation directed to arrest of the bleeding gives place to hypocoagulative changes. Their degree and duration depend on the severity and rate of blood loss. The excessive intravascular activation of blood is accompanied by the formation of fibrin deposits not only in the area of the bleeding source but in other regions of the blood channel. There appears disseminated intravascular coagulation of blood deteriorating the reparative processes in the ulcer, initiating and maintaining generalized plasminemia which promotes the thrombus lysis in the ulcer crater and recurrent bleeding.

[Local and individual features of angioarchitectonics of the stomach and their significance in manifestation of bleedings]. / Lokal'nye i individual'nye osobennosti angioarkhitektoniki zheludka i ikh znachenie v proiavlenii krovotechenii.

The investigation has shown that on the lesser curvature in the area of the body and cardial part of the stomach there is a 2.3+/-0.3 cm section where there are no large branches of the left gastric artery and tributaries of the coronary vein. In the antral portion of the stomach such a section is not determined. Here there are terminal branches of the posterior descending and right gastric arteries. However, the diameter of these arteries when introduced into the gastric wall is rarely more than 1 mm. In addition, the arterial loops of the first and second order are formed on the anterior and posterior walls of the antral portion by the arteries of less diameter than in other parts of the stomach. In cases of the bleeding complicating the gastric ulcer it can be observed from any part of blood circulation, but the severity of bleeding is mainly dependent on the erosion of the arterial vessels. Hence, the site of the ulcer in the zone of the invasion of large arterial vessels into the gastric wall and their presence in the crater in the endoscopy picture should incline the surgeon to operative intervention.

[Vagotomy in the treatment of acute ulcerations of the stomach complicated by severe hemorrhage]. / Vagotomiia v lechenii ostrykh iz"iazvlenií zheludka, oslozhnennykh tiazhelym krovotecheniem.

It has been found that the intramural nerve apparatus of the stomach is involved in the mechanism of formation of acute gastroduodenal ulcers. Under stress there occurs simultaneous activation of the sympathetic and parasympathetic parts of the vegetative nervous system. The released acetylcholine and noradrenaline influence the corresponding receptors of the target cells which results in hyperproduction of the hydrochloric acid under conditions of hypoxia of the gastric wall and promotes acute ulceration. Conservative hemostatic therapy allows complete hemostasis to be obtained in 95% of patients with acute gastroduodenal ulcers complicated by bleedings. If it fails, the operation of choice is thought to be suturing the source of bleeding supplemented with truncal vagotomy and pyloroplasty.

[The role of endoscopy in determining the indications for the surgical treatment of the Mallory-Weiss syndrome and of bleeding acute gastroduodenal ulcers]. / Rol' éndoskopii v opredelenii pokazanii k operativnomu lecheniiu sindroma Mallori--Veisa i krovotochashchikh ostrykh gastroduodenal'nykh iazv.

The frequency of acute sources of bleeding has recently increased (47%) in the general picture of gastrointestinal bleedings which makes the improvement of diagnosing "acute" sources of hemorrhage and the development of more perfect methods of nonoperative hemostasis very actual. The authors believe that "Kaprofer" used in most of patients with bleedings from acute ulcers and ruptures of the gastro-esophageal zone mucosa (95%) allows the hemorrhage to be arrested. The treatment can be continued without operative interventions. Search for new hemostatic drugs must be performed in order to obtain reliable and long-term effects of drugs with a minimum aggressive action upon the mucosa.