[Enteral correction of homeostasis in acute pancreatitis]. / Enteral'naia korrektsiia gomeostaza pri ostrom pankreatite.

The experiments showed that heart and liver functional abnormalities will take place even before changes of blood amylase is occurred. It was shown that Dalargin in a dose of 50 micrograms/kg will stimulate the intestinal absorption.

[Possibilities of the use of trypsinogen activation peptide in the pancreatic tissue in the diagnosis of pancreatic necrosis]. / O vozmozhnosti ispol'zovaniia peptida aktivatsii tripsinogena v tkani podzheludochnoi zhelezy v diagnostike pankreonekroza.

The test of peptide of trypsinogen activation (PTA) in various biological media is a principal new diagnostic test for acute pancreatitis. PTA levels in the pancreatic tissue and the plasma of the blood in acute experimental pancreatic necrosis reflects the process of the pathological activation of trypsin in the diseases focus and confirms the source of higher levels of activation peptide in the blood flow. Together with the values of other enzymatic systems of the pancreatic gland the discussed value permits one to make a more precise assessment of the mechanism and stages of autodigestive processes which develop in acute experimental pancreatitis.

Protein proteinase inhibitor therapy in experimental pancreatitis: pharmacological characterization of the inhibitor.

The pharmacodynamical properties of the duck ovomucoid and its effect on the development of experimental pancreatitis in rats have been studied. It has been shown that after intravenous injection the ovomucoid initially accumulated in the liver, kidneys and blood, while after intraperitoneal injection--mainly in the pancreas and kidneys. The inhibitor is removed from circulation by renal filtration, one-half of the injected protein being removed for 4 hr. For the treatment of experimental pancreatitis two modes of ovomucoid administration were used: intravenous and combined (intravenous/intraperitoneal). The ovomucoid intravenous injection in a dose of 16,300 ATU/kg/24 hr resulted in decrease of both the trypsin-like activity and the level of the trypsinogen activation peptide in the blood to the level in intact rats and also in reduction of the primary pancreas destruction. The same effect observed in the case of the ovomucoid combined injection, but with a lower intravenous dose.

Misoprostol and dalargin for the inpatient treatment of duodenal ulcer in the USSR.

In the USSR, uncomplicated duodenal ulcer is usually managed in an inpatient setting. A double-blind, randomized, double-dummy, multiclinic, comparative trial examined the safety and efficacy of oral misoprostol (200 micrograms qid) and intramuscular dalargin (1 mg bid) in duodenal ulcer healing. Dalargin, an enkephalin peptide with gastric antisecretory and cytoprotective properties, is commonly used in the USSR for treating peptic ulcer. The trial characteristics and monitoring were performed in accordance with US standards. Consenting patients of either sex, aged 18 to 70 years, who had a duodenal ulcer of 0.3 to 2.5 cm in diameter were enrolled. Endoscopy, physical examination, and laboratory assessments were performed on entry and after 4 weeks of treatment. The effects of the treatments on complete ulcer healing, dyspeptic symptoms, antacid consumption, adverse drug reactions, and safety were determined. Both treatment groups were well matched for demographic characteristics. The majority of patients were smokers and alcohol users and had a history of recurrent peptic ulcers. Misoprostol was significantly more effective than dalargin in inducing duodenal ulcer healing, both in the intent-to-treat cohort (P = .001) and in the evaluable cohort (P = .0001). Both regimens were well tolerated, and no patients were withdrawn from the study because of adverse reactions. Mild, self-limiting diarrhea was reported more frequently in patients receiving misoprotol (9.4% incidence) than those receiving dalargin (1.9%). The disparity in ulcer healing between the two groups suggests that hospitalization alone is not an optimum treatment in this high-risk patient population.

[The effect of exogenous protein--a proteinase inhibitor--on the development of experimental pancreatitis in dogs]. / Vliianie ékzogennogo belka--ingibitora proteinaz--na razvitie éksperimental'nogo pandreatita u sobak.

Small doses of an exogenous protein inhibitor of proteinases ovomucoid, isolated from duck egg-white, exhibited distinct therapeutic effects in acute pancreatitis of dogs. The inhibitor decreased the lethality rate and exceeded the base Kunitz trypsin inhibitor in its efficiency.

[The morphogenesis of pancreonecrosis]. / Morfogenez pankreonekroza.

Pancreas was studied histologically, histochemically and electron microscopically in 117 autopsy cases and in the experiment (25 dogs and 60 white rats). Morphogenesis of pancreonecrosis proceeds through certain stages. The initial stages of an acute pancreatic edema is characterized by degenerative and necrotic changes of pancreocytes with parapedesis of pancreatic enzymes into the interstitium and a reactive stromal edema. The following stages are distinguished in the progressing phase of pancreonecrosis: hemorrhagic pancreonecrosis when the proteolytic enzymes provoke a colliquation necrosis of the acinar tissue, fibrinoid necrosis of vascular walls and disturbances of the intravascular hemorheology resulting in the enhancement of destructive processes and hemorrhagic inhibition of tissues; fat pancreonecrosis in which lipolytic enzymes lead to the coagulation necrosis of the acinar and fat tissue while a non-completed proteolysis of necrotic tissues stipulates the intensity of the reactive inflammation.

[Comparative evaluation of the effect of kontrikal, 5-fluorouracil and the new Soviet peptide preparation dalargin on the course of experimental pancreonecrosis]. / Sravnitel'naia otsenka vliianiia kontrikala, 5-ftoruratsila i novogo otechestvennogo peptidnogo preparata dalargina na techenie éksperimental'nogo pankreonekroza.

The experiments on 24 dogs with experimental hemorrhagic pancreonecrosis showed that contrykal and 5-fluorouracil insignificantly decrease the area of the damaged parenchyma, fail to cease progression of the pancreas destruction. The peptide drug dalargin in these conditions increased the antitryptic activity and normalized BAEE esterase activity. Dalargin abolished erythrostasis and microthromboses in the vessels of the microcirculation, restored the blood supply throughout the area of the exocrine parenchyma, limited necrotic foci and suspended the development of pancreonecrosis.

[Pathomorphism of experimental pancreatic necrosis after endolymphatic administration of contrical]. / Patomorfoz éksperimental'nogo pankreonekroza posle éndolimfaticheskogo vvedeniia kontrikala.

Histological and electron microscopic studies of canine pancrease were conducted with biochemical control of pancreatic enzyme activity before and after treatment of experimental hemorrhagic pancreatonecrosis. 30-60 minutes after the disease induction microfocal pancreatonecrosis was revealed, while 6-8 hours later subtotal hemorrhagic pancreatonecrosis with changes in microcirculatory vessels of the pancreas manifested in erythrostasis, thrombosis and fibrinoid wall necrosis accompanied by the increase of pancreatic enzyme activity and decrease in blood, lymph and serum antienzyme activity developed. The treatment of experimental pancreatonecrosis with endolymphatic injection of contrical resulted in the morphologically confirmed attenuation of the necrosis intensity, limitation of necrotic zone size, blood circulation recovery in microcirculatory system, marked decrease of proteolytic enzyme activity and increase of blood serum and central lymph antienzyme activity.

[Effect of an analog of endogenous opioids, dalargin, on the structure and function of the exocrine tissue of the pancreas in experimental acute pancreatitis]. / Vliianie analoga endogennykh opioidov dalargina na strukturu i funktsiiu ekzokrinnoi tkani podzheludochnoi zhelezy pri eksperimental'nom ostrom pankreatite.

The paper is concerned with the inhibitory effect of dalargia, a new analogue of leu-enkephalin synthesized at the Laboratory of Peptides, All-Union Cardiology Research Center, Academy of Medical Sciences of the USSR. Acute experiments on 22 dogs were performed to examine the effect of parenteral administration of dalargin in the total dose 3 mg on morphological and functional changes in the endocrine tissue of the pancreas. It was shown that intravenous injection of dalargin reduces the basal secretion and inhibits the synthesis of pancreatic enzymes in animals with the intact pancreas. In progressive hemorrhagic pancreonecrosis, intravenous drip of dalargin improves the microhemocirculation and recovers the blood supply of the pancreatic parenchyma, restricts the foci of necrosis, reduces the involvement into the pathological process of unaffected exocrine cells. Comparative analysis of changes in enzymological characteristics in the course of pancreonecrosis development before and after parenteral administration of dalargin has revealed a reduction in the proteolytic and kininogenase activity, normalization of the antitryptic activity of the pancreas.

[Effect of endolymphatic infusions of 5-fluorouracil on the course of acute experimental pancreatitis]. / Vliianie éndolimfaticheskikh infuzii 5-ftoruratsila na techenie ostrogo éksperimental'nogo pankreatita.

Experiments on 12 dogs with experimental acute hemorrhagic pancreatitis were made to assess the effect of endolymphatic therapy with 5-fluorouracil (5-FU) in a dose of 5 mg/kg. The changes in the activity of pancreatic enzymes and kinins in the blood, lymph and urine were studied before and after endolymphatic administration of 5-FU. After the dogs were sacrificed the pieces of endocrine tissue from different parts of the pancreas were exposed to morphological study. Endolymphatic administration of 5-FU for experimental acute pancreatitis reduced the activity of proteo- and lipolytic enzymes. The structural manifestation of the enzymological changes included the delimitation of the areas of necrosis in acinar tissue of the pancreas, improvement of intraorgan blood and lymph circulation.

[Effect of the endolymphatic administration of protease inhibitors on pancreatic morphofunctional activity in acute experimental pancreatitis]. / Vliianie éndolimfaticheskogo vvedeniia ingibitorov proteaz na morfofunktsional'nuiu deiatel'nost' podzheludochnoi zhelezy pri éksperimental'nom ostrom pnakreatite.

Experimental acute pancreatitis was induced in 16 dogs by administering infected bile under pressure. Functional and electron microscopic changes in the pancreas were studied before and after endolymphatic infusions of contrykal in a dose of 10 000 ATpE. It was established that endolymphatic administration of contrykal leads to an appreciable decrease in proteolytic activity of the pancreas and to inactivation of the kallikrein-kinin system. Electron microscopy studies of the exocrine apparatus of the pancreas after the dogs' death have demonstrated that endolymphatic administration of contrykal reduces intracellular processes of the synthesis of pancreatic enzymes.

[Effect of contrical introduced into Wirsung's duct on the morphofunctional response of the pancreas in acute experimental pancreatitis]. / Vliianie kontrikala, vvedennogo v virsungov protok, na morfofunktsional'nye reaktsii podzheludochnoi zhelezy pri ostrom éksperimental'nom pankreatite.

Induction of contrical into Wirsung's duct is shown to lessen the total proteolytic amylolytic and lipolytic action of the pancreatic juice, blood and urine, normalizing by this token the exo- and endosecretion of the pancreas. It is also shown that in acute pancreatitis there is in evidence hyperfunction of the acinar glandular cells, responsible for the synthesis of the secretion, and their focal destruction. Introduction of contrical into Wirsung's duct degrades intracellular processes of the secretion synthesis.

[Surgical treatment of post-thrombophlebitic syndrome]. / Khirurgicheskoe lechenie pri posttromboflebiticheskom sindrome

Under observation were 125 patients with postthrombophlebitic syndrome of the lower extremities. Along with the routine surgical methods of treatment the authors suggested and performed in 30 patients a new operative procedure--communicotomy, that consists in separation of the superficial and profound venous systems in the lower crural third via a separate incision in the upper crural third. To this end a new instrument--a communicotome was devised. Indications to some or other kind of surgery were elaborated by the authors. 76% of patients showed an improvement within the terms from 1 to 6 years postoperatively.