[Immediate, early and late results of endoscopic papillosphincterotomy]. / Neposredstvennye, blizhaisie i otdalennye rezul'taty éndoskopicheskoi papillosfinkterotomii.

Clinico-instrumental examination of 226 patients showed that there were no fatal outcomes directly after endoscopic papillosphincterotomy, the number of complications was approximately the same as after transduodenal operations on the major duodenal papilla but they took a much easier course. The high effectiveness of an endoscopic operation was confirmed in the immediate postoperative period (absence of biliary hypertension, jaundice, pancreatitis, cholangitis). In the late-term periods after EPST restenosis was rarely encountered (3.9%); duodeno-biliary reflux caused no serious disorders, while the functional activity of the sphincter Oddi which had been operated on was partly maintained in 84.2% of patients.

[Levels of gastrin and somatostatin in blood and gastroduodenal gastrin and somatostatin cells in the differentiation of treatment of patients with duodenal ulcer]. / Urovni gastrina i somatostatina v krovi, gastroduodenal'nye gastrinovye i somatostatinovye kletki pri differentsirovannom lechenii bol'nykh iazvennoi bolezn'iu dvenadtsatiperstnoi kishki.

Radioimmunoassay and immunomorphological methods were used in the study of pepsinogen 1, basal and food-stimulated gastrin and somatostatin blood levels, the number of gastroduodenal G- and D-cells as well as gastric secretion during routine-dose treatment with gastrozepin and ranisan of 45 gastroduodenal ulcer patients versus 15 controls. The patients were divided into 2 types according to blood gastrin levels and the number of pyloric G-cells: with hypergastrinemia and/or hyperplasia of the G-cells, with normogastrinemia and normal number of G-cells. A course treatment with gastrozepin of type 1 patients brought about normalization of serum gastrin and the number of the G-cells with elevation of blood somatostatin levels. In patients of type 2 the above parameters did not change. The same picture in them remained after ranisan treatment, though they developed hypergastrinemia. In patients of type 1 after ranisan treatment the above parameters did not change. The data obtained demonstrate once more heterogeneity of duodenal ulcer.

[Tactics of management of patients with stomach deformities]. / Taktika vedeniia bol'nykh s deformatsiiami zheludka.

Analysis of gastroscopy in 8781 patients revealed the deformities of the stomach in 1249 (14.2%) patients. Patients younger than 30 had a kink of the stomach and exogastric deformity in 75.5 and 17.7%, respectively. In patients who were older than 70 the respective values were 52.2 and 46.4%. The cause of gastric deformities was stated in 65% of cases (the diseases and specific forms of the adjacent organs). Computed tomography helped to reveal the cause of the deformity in 54% of the cases and ultrasonic investigation in 26% of the cases. The informative value of the used combination of computed tomography and esophagogastroduodenoscopy comprised 75%.

[The diagnosis of cancer of the stomach and large intestine under active dispensary observation]. / Diagnostika raka zheludka i tolstoi kishki v usloviiakh aktivnogo dispansernogo nabliudeniia.

Among patients placed under permanent medical observation carried out for 6-8 years, gastric carcinoma (GC) was revealed in 288 and colonic carcinoma (CC) in 377 cases. In 67 and 60% of the patients, respectively, the diagnosis was established as a result of systematic dispensary examinations. The first and second stage disease was identified in 50 and 43% of the cases, including 67% of GC and 62% of CC patients undergoing active examinations. In 40% of the cases on the average, the disease may run an asymptomatic course, including the late stages of the disease. In half the patients, the clinical manifestations did not last more than 3 months, with their duration being independent of the disease stage. It is assumed that at the initial stage the tumor may, during a short period of time, reach the size corresponding to both early and late stages of the disease, after which the rate of tumor growth is likely to be slower. The authors document the necessity of a comprehensive approach to the diagnosis of GC and CC, using the whole armamentarium of classical and up-to-date methods.

[Possibilities of laparoscopic decompression of the gallbladder in middle-aged and elderly patients with diseases of the biliary tract]. / Vozmozhnosti laparoskopicheskoi dekompressii zhelchnogo puzyria u bol'nykh pozhilogo i starcheskogo vozrasta s zabolevaniiami biliarnogo trakta.

It is established that laparoscopic cholecystostomy presents the most acceptable method of gall bladder decompression in acute cholecystitis patients of advanced age comprising a high-risk group for surgery. Cholecystostomy efficiency reaches 97.2%. In case the procedure is not feasible in acute cholecystitis patients with intrahepatic position of the gall bladder or perivesicular adhesions the preference should be given to transhepatic drainage of the gall bladder whose effectiveness is 88.5%. An expedient method of laparoscopic decompression of the biliary tracts in mechanical jaundice due to tumor obstruction of the terminal part of the common bile duct is the formation of an external biliary fistula and "continuous" direct drainage of the gall bladder warranting satisfactory results in 93.3 and 100% of cases, respectively. Patients with a 1.5-week history of mechanical jaundice are not recommended transhepatic drainage, in longer duration of the jaundice (more than 1 month) it becomes contraindicated.

[The treatment of erosive-ulcerative lesions of the upper gastrointestinal tract at a polyclinic]. / Lechenie érozivno-iazvennykh porazhenii verkhnikh otdelov zheludochno-kishechnogo trakta v usloviiakh polikliniki.

The data obtained demonstrate the efficacy of the local and oral use of antioxidant dibunol in the treatment of ulcerous lesions of the upper alimentary tract. Besides, dibunol can be used for preventing disease exacerbations. Unlike dibunol, low-energy laser radiation makes it possible to shorten the time of ulcer healing which is particularly manifest in ulcers of the body of the stomach and duodenal ulcers 0.5--0.6 cm in diameter. The times of counteracting the painful and dyspeptic syndromes using dibunol and laser radiation did not differ appreciably. Both the treatment modalities can successfully be applied under outpatient conditions.

[The dynamics of the focal changes in the gastric mucosa of patients with chronic gastritis based on the data from a multiyear endoscopic observation in a polyclinic]. / Dinamika ochagovykh izmenenii slizistoi obolochki zheludka u bol'nykh khronicheskim gastritom po dannym mnogoletnego éndoskopicheskogo nabliudeniia v poliklinike.

Out of 1700 patients suffering from chronic gastritis, a group of 221 patients followed up for 6 to 14 years at an outpatient clinic was distinguished. Endoscopy and biopsy of gastric mucosa areas with focal lesions were carried out annually. 140 patients were discovered to have atrophic hyperplastic gastritis, 81 "complete" erosions". The lesions were of solitary or multiple character and were coupled with the other manifestations of chronic gastritis. Histology revealed different manifestations of chronic atrophic gastritis. 7.2% of the patients showed moderate dysplasia of the epithelium. The follow-up of focal hyperplasias established invariability of those formations or occurrence of the new ones in 89% of cases. In patients with "complete" erosions, such a course was recorded in 47% of cases whereas in the remainder, there was a decrease or complete disappearance of the sign. Dynamics of the histological appearance available in 28% of the patients, lay in atrophy enhancement and in the appearance of foci of intestinal metaplasia. In an equal number of cases, dysplasia of the epithelium was invariable; in some cases, it disappeared or else its intensity changed (within the framework of mild and medium degree).

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.

[Gastroscopy in follow-up studies of patients with chronic atrophic gastritis and diagnosis of early gastric cancer]. / Gastroskopiia v dispansernom nabliudenii za bol'nymi khronicheskim atroficheskim gastritom i diagnostike rannego raka zheludka.

Visual assessment of gastric mucosa and histological findings in biopsies from the lesions were compared for 1806 patients with chronic atrophic gastritis. The spectrum of the focal lesions appeared wide. Morphological examinations determined basic comparable structural elements typical for atrophic gastritis. 85 patients were diagnosed to have early gastric cancer. All the cancer patients suffered from chronic atrophic gastritis and developed in 88% of cases intestinal metaplasia, in 32% severe epithelial dysplasia. Focal changes in the mucosa characteristic for early gastric cancer in 64% of cases could be considered as variants of chronic atrophic gastritis. In 52 patients cancer was identified during the follow-up, new-onset macroscopic alterations emerging in the last year in 62% cancer subjects. The rest of them had long-lasting macroscopic lesions, among them severe dysplasia of the epithelium in 65% of cases, believed to be histological variants of atrophic gastritis. Early cancer is suggested to develop in the presence of previous lesions rapidly and discretely.

[Colonoscopy in the diagnosis and follow-up of colonic polyps]. / Kolonoskopiia v diagnostike i dinamicheskom nabliudenii za polipami tolstoi kishki.

Out of 5000 patients examined endoscopically colon polyps were detected in 64%. The polyps were characterized by: higher incidence in 70-79-year-olds, high percentage of tubular adenomas (79%), large sizes of polyps with complex structure and their prevalence in the left colon, signs of malignancy in 0.64% of the removed polyps. The chance to develop cancer from tubular adenoma was 0.28%, tubular-villous, 1.4%, villous 3%. Recurrent polyps following polypectomy arose in 65% of cases. Tumor relapses emerging mainly within the first postoperative year occurred in 14% of cases. In 4 patients with cancer its onset was registered at the site of the removed large adenomas of complex histological structure. Colonoscopy proved an adequate method of diagnosis and follow-up of colon polyps. Endoscopic polypectomy can be considered as a measure to prevent colon cancer.

[Cellular and humoral immunity in duodenal peptic ulcer with gastrin cell hyperplasia]. / Kletochnyi i gumoral'nyi immunitet pri iazvennoi bolezni dvenadtsatiperstnoi kishki s giperplaziei gastrinovykh kletok.

A total of 61 patients with frequently relapsing duodenal ulcer were examined. Of these, 18 patients were in the acute phase and 43 experienced remission. Using 1 mm2 of the mucosa, measurements were made of the counts of duodenal and pyloric G-cells (by immunomorphologic assay), of the absolute and relative counts of T and B lymphocytes, the content of IgA, IgM and IgG, histamine and serotonin (by fluorometry) in the blood, and of the concentration of uropepsin in the urine. In the stages of exacerbation and remission, the patients suffering from duodenal ulcer with hyperplasia of G-cells manifested, as compared with the analogous patients without hyperplasia, a decrease of the absolute and relative counts of T cells, especially of those of B cells, combined with a rise of the content of IgM and IgG during exacerbation, followed by its returning to normal in the phase of remission. Over one year part of the duodenal ulcer patients with hyperplasia of G-cells received preventive treatment with ranitidine, which resulted in a tendency towards the lowering of the count of pyloric G-cells and the rise of the absolute and relative counts of T cells.

[Gastroduodenal incretory cells in duodenal ulcer with different levels of gastric secretion]. / Gastroduodenal'nye inkretornye kletki pri iazve dvenadtsatiperstnoi kishki s raznym urovnem zheludochnoi sekretsii.

Immunomorphological PAP method was used in 20 patients with duodenum ulcer and in 10 control individuals to study gastrin (G)-, somatostatin (D)- and calcitonin-gene-related peptide (CGRP) cells in biopsies of the stomach and duodenum. The gastrin and pepsinogen level in the blood, basal and acid production stimulated by pentagastrin were also studied. All patients are subdivided into two groups by their acid production: those with hypersecretion and those with normal secretion. The group with hypersecretion was not homogeneous: some patients had deficiency of D-cells (sometimes in combination with G-cell hyperplasia) and others had a relative and absolute decrease of the number of CGRP cells in combination with foci of parietal cells in pylorus. These patients showed a tendency to the hypergastrinemia and significant hyperpepsinogenemia I in the blood. Stomach hyperplasia in the duodenum, multiple duodenal ulcers, erosive gastroduodenitis and ulcers in close relatives occurred more frequently in these patients. G- and CGRP cells are found to be similar in the form and localization. It is not excluded that G-cell contains, apart from gastrin 1-17, calcitonin-gene related peptide.

[Combined endoscopic treatment of villous adenoma of the stomach and large intestine in middle-aged and elderly patients]. / Kombinirovannoe éndoskopicheskoe lechenie steliushchikhsia adenom zheludka i tolstoi kishki u bol'nykh pozhilogo i starcheskogo vozrasta.

Electroexcision combined with laser photocoagulation was performed in 12 patients with creeping neoplasms of the stomach and in 39 patients with the same condition of the large intestine. One-year follow-up studies showed that 2 patients with a malignant gastric tumour had recurrence 9 months after the combined treatment; I patient has recurrence in the same terms after similar treatment of creeping benign adenoma. Combined treatment proved to be more effective in 39 patients with large-intestinal tumour, including invasive cancer, with no recurrence during a year. It follows that the effectiveness of combined treatment was 94.2 per cent.

[The value of ultrasonic and x-ray endoscopic methods in the diagnosis of acute surgical diseases of the abdominal organs]. / Znachenie ul'trazvukovogo i rentgenoéndoskopicheskikh metodov v diagnostike ostrykh khirurgicheskikh zabolevanii organov briushnoi polosti.

The authors discuss experience in the complex use of ultrasonic and radio-endoscopic methods of examination in 820 patients who were admitted to the hospital with acute surgical diseases of the abdominal organs. Instrumental methods of diagnosis were used, which began with ultrasonic examination. The correct diagnosis of the disease was often established by this method, further examination of the patient was planned, and more concrete indications for invasive radio-endoscopic studies were determined by means of which precise data on the identified pathological process were revealed and, sometimes, adequate therapeutic measures were also ensured. Reduction of the duration of the diagnostic period to 2-3 days was the most important result of the use of these methods in the examination of patients with acute diseases of the abdominal organs.

[Duodenal ulcer with gastrin cell hyperplasia--a special form of peptic ulcer]. / Iazva dvenadtsatiperstnoi kishki s giperplaznei gastrinovykh kletok--osoboia forma iazvennoi bolezni.

Pap test was used to study gastric and duodenal G and D cells, blood gastrin levels, basal and stimulated acid production, clinical manifestations, and morphological characteristics of the mucosa in 39 patients with duodenal ulcer and 13 controls. The findings enable the authors to outline a special form of peptic ulcer that is characterized by gastrin cellular hyperplasia concurrent with relative pyloric D cell deficit, gastric metaplasia in the duodenum and gastric hypersecretion. Such patients have more frequently multiple ulcers, predominantly 0(I) blood group, complication-aggravated course of the disease, and ulcer history in close relatives. Moreover, it has been demonstrated that incidence of gastric metaplasia is due to gastric hypersecretion; hyperplasia of duodenal gastrin cells is associated with incidence of gastric metaplasia in patients with peptic ulcer.

[Antiulcer activity of dibunol in experimental stomach and duodenal ulcers]. / Protivoiazvennaia aktivnost' dibunola pri éksperimental'nykh iazvakh zheludka i dvenadtsatiperstnoi kishki.

The antiulcer effect of two medicinal forms (oil solution, liniment) of dibunol in rats with different models of the stomach and duodenum ulcers was studied. The therapeutic activity of dibunol was evaluated by determining the index of ulcer formation as well as during the morphological and histochemical studies. The two medicinal forms of dibunol possessed equal antiulcer activity by all studied criteria. One should note a characteristic property of dibunol--its ability to produce pronounced epithelialization of ulceroerosive and ulceronecrotic lesions of the mucosa without rough scarring.