[Orthognathic surgery and contour plasty. Synergism or opposition]. / Ortognaticheskaya khirurgiya i konturnaya plastika. Sinergizm ili protivostoyanie?

The article presents two cases of sisters with malocclusion: distal deep bite with typical skeletal and soft tissue deformation. In the first case classic three-steps orthognatic treatment plan was realized: orthodontic preparation with subsequent orthognatic bi-maxillar surgery with genioplasty. In second one we made contour-plasty with implants. Two different plans follow to two different results. Discussion around all differences of two approaches is the main interest of this overview.

[Surgical-associated expansion of the jaws with asymmetric deformations]. / Khirurgicheski-assotsiirovannoe rasshirenie chelyustei pri asimmetrichnykh deformatsiyakh.

One of the most common abnormalities in the development of the jaw is the narrowing of the alveolar process of the maxilla. In childhood, the elimination of such a deformation is quite common. But with age, the only effective option is the inclusion of a surgical procedure in the rehabilitation plan. The medial and parasagittal osteotomy of the maxilla for the purpose of its expansion by a distraction device has a number of important nuances which can significantly affect the result. These include: localization of sagittal osteotomy of the palate and alveolar process; the direction of cutting the walls of the maxillary sinus; type of fixation of the device (dental-borne or bone-borne). The article summarizes the experience of 74 surgical-associated expansions of the jaws with asymmetric deformations performed over 2 years. A retrospective analysis according to cone beam computed tomography is given. of complex treatment with the inclusion of sparing osteotomy of the maxilla in the rehabilitation plan and a differentiated approach to performing surgical manipulation allow to achieve optimal aesthetic and functional results and to correct the asymmetry to the greatest extent.

[A method of osteoplasty of the mental region of the mandible]. / Metodika kostnoi plastiki podborodochnogo otdela nizhnei chelyusti.

Correction of the lower jaw contours is one of the most popular tasks in aesthetic maxillofacial surgery. There are many reduction operations aimed at changing the shape of the lower jaw. However, augmentation mandible plasty is mainly associated with the use of synthetic implants. In 2013, A. Triaca published a paper «chin wing technique¼ in detail, which we used as a prototype. In this article, we will present the technique and experience of using osteoplastic three-dimensional mandible plasty, which has a number of special features: the increase in the bigonial width is due to the median vertical osteotomy of the free lower edge of the lower jaw, followed by lateralization of the distal parts of the lower fragments, osteosynthesis is performed using the original trapezoidal titanium mini-plate. Since 2018 30 patients have been operated on with different variants of the anatomy of the lower jaw with requirements for increasing the projection of the chin, increasing the width of the lower third of the face and changing the contour of the mandible. The mandible plasty proposed by us allows us to achieve good aesthetic results and can replace the use of synthetic implants.

[THE CLINICAL SIGNIFICANCE OF ENDOSCOPIC MANOMETROGRAPHY OF UPPER GASTROINTESTINAL TRACT IN PATIENTS WITH CHRONIC PANCREATITIS].

THE PURPOSE OF THE RESEARCH: To study the cavitary esophagogastroduodenal pressure in patients with chronic pancreatitis (CP) depending on the dominant clinical symptoms--gastroesophageal reflux (GER) and abdominal pancreatic pain. MATERIAL AND METHODS: By esophagogastroduodenoscopy that included manometrography and acid-perfusion test--were examined 86 patients with CP and 25 healthy individuals. RESULTS: 63% of patients with CP detected changes of the esophagus and the lower esophageal sphincter (LES) based on the endoscopy, or manometrography, or test with 0.1N hydrochloric acid solution. The presence of GER compared with its absence in patients with CP was associated with significantly lower rates LES pressure and pressure gradients between the LES and antral stomach and between the LES and duodenum. Patients with CP with leading pancreatic abdominal pain syndrome compared with patients with GER signs and without GER signs were found the lowest pressure LES and pressure gradients between the LES and the pyloric stomach, LES and the duodenum. The presence of heartburn in patients with CP without erosive esophagitis found correlative connection with positive endoscopic acid-perfusion test and the pressure drop in the LES. CONCLUSION: Integrated upper endoscopy, including endoscopic manometrography and esophageal acid-perfusion test in clinical studies increases the frequency of detection of non-erosive reflux disease and one of its predictors--reduced esophago-gastric pressure gradient.

[Effect of hydrochloric acid on cavernous pressure in the duodenogastroesphageal zone in patients with duodenal ulcer associated with Helicobacter pylori].

Endoscopic manometrografy was performed in 128 patients 40,7 +/- 1,7 years old with duodenal ulcer (DU). In patients with increased basal acid outflow (BAO > 10 MM/per hour vs. BAO < 7 MM/per hour) was increased pressure (mm Hg) in duodenum (11,8 +/- 1,0 vs. 9,2 +/- 0,5) and gastric antrum (11,4 +/- 0,6 vs. 9,3 +/- 0,4), decreased pylorus tone (18,5 +/- 2,4 vs. 30,6 +/- 2,2) and pressure gradient (deltaP) between low esophageal sphincter (LES) and duodenum (3,9 +/- 1,3 vs. 6,4 +/- 0,3). Acid infusion of duodenum with 0.1N HCL in 39 patients with DU was accompanied with the sensation of pain in 87,2% patients with active duodenal ulcers and increased pressure in duodenum (from 9,7 +/- 1,1 to 13,1 +/- 1,2) and gastric antrum (from 8,6 +/- 1,3 to 12,8 +/- 1,4). In 47 Hp-positive patients versus 26 Hp-negative patients was detected increased deltaP duodenum-gastric antrum (2,1 +/- 1,1 vs.- 0,6 +/- 0,43), decreased deltaP LES-duodenum (3,4 +/- 1,5 vs. 8,3 +/- 1,6), deltaP LES-gastric body (9,8 +/- 1,2 vs. 14,3 +/- 1,3) and significantly esophagitis (0,64 +/- 0,09 vs. 0,38 +/- 0,11 score, p < 0,05).

[Blood flow and morphofunctional status of gastroduodenal mucosa in different phases of peptic ulcer].

AIM: To investigate gastric and duodenal mucosal blood flow (MBF) in different phases of gastric ulcer (GU) and duodenal ulcer (DU) and its relation both to Helicobacter pylori (HP) infection and mucosal disorders. MATERIAL AND METHODS: Upper endoscopy and histological examinations (score of inflammation, atrophy, metaplasy) were performed in 407 patients with DU and 103 with GU. Gastric and duodenal MBF were assessed by the hydrogen gas clearance technique in 102 DU and 95 GU patients. HP was detected by histology. Gastric secretion was measured in the interdigestive period and after stimulation by pentagastrin. RESULTS: Lowering of MBF in gastric antrum and duodenum was observed in DU and GU patients only with score 3 of HP infection. DU healing is accompanied with a decrease of HP value and improvement of mucosal histology. At the same time MBF exhibits a significant rise: in the duodenum (by 45%) at the stage of white scar; in gastric antrum (by 26%) and body (by 40%) at healing stage, but a decrease in white scar. During healing of GU gastric MBF reached maximum in active ulcer but in white scar MBF was significantly lower. MBF at ulcer margin and MBF in ulcer crater was the same (30 ml/min/100 g) with MBF in the region of white scar with enhanced inflammation (score 2.1) before GU relapse. CONCLUSION: Changes of MBF in different phases of ulcer are, in part, determined both by HP and by mucosal morphological disorders. The ratio MBF increase in ulcer healing/MBF reduction in ulcer relapse is the same (30% from optimal) and it is restitution entity. The MBF level of 30 ml/min/100 g was assessed as crucial in ulcerogenesis. Lowering MBF in mucosa with remaining inflammation in the scar region may predict GU relapse.

[Impact of hydrochloric acid and HP-invasion on the cavitary pressure in the duodenal and gastroesophageal region in patients with ulcer].

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.

[Characteristics of blood flow in the gastric mucosa in relation to its structure and function in patients with peptic ulcer]. / Osobennosti krovotoka v slizistoi obolochke zheludka v soposta- vlenii s ee strukturoi i funktsiei u bol'nykh iazvennoi bolezn'iu.

Hydrogen clearance was used to assess blood flow in fundal and antral gastric mucosa as well as in the lobule of the auricle in 127 patients with ulcer (99 duodenal and 28 gastric ulcer cases), 34 patients with gastric, duodenal, pancreatic and biliary ++non-ulcer lesions against 20 healthy subjects. The findings underwent analysis in relation to the disease form and phase, baseline characteristics of the mucosa (morphological, functional and bacteriological) and changes in them in response to pentagastrin (6 micrograms/kg), alupent (0.0075 mg/kg), clofelin (0.0015 mg/kg) administration. For ulcer involving the body of the stomach and sutured perforated duodenal ulcer, fundal and antral mucosa blood flow showed a decrease by 1/3, the lowest values presenting in the active disease phase. Diminution in gastric mucosa blood flow correlated with gravity of its gastritic lesion and was not directly related to its Campylobacter contamination. Pentagastrin stimulated blood flow in fundic mucosa and led to its 30% increase whereas the flow intensity remained unaffected in the antral mucosa and skin (lobule of the auricle). Acid production in response to pentagastrin introduction rose 3.5-fold, pepsin 2.1-fold. Alupent and clofelin do not affect blood flow causing a 30-50% increase and decrease in acid and pepsin production, respectively. Separate neurohumoral regulation of gastric mucosa blood flow and secretory activity of the latter permits differential correction of each of the impaired functions.

[The morphofunctional characteristics of the duodenal mucosa in patients with a duodenal ulcer at different phases of the disease]. / Morfofunktsional'naia kharakteristika slizistoi obolochki dvenadtsatiperstnoi kishki u bol'nykh s duodenal'noi iazvoi v raznye fazy zabolevaniia.

Endoscopic, morphological, histochemical and biophysical properties of the duodenal mucosa as well as secretory activity of the stomach and pancreas were studied and compared in 398 patients with duodenal ulcer in different phases (active ulcer, healing ulcer, red and white scars). Sixteen patients were observed over time. Analogous studies were conducted in 88 patients with chronic diseases of the biliary and duodenopancreatic zone (with non-ulcerous duodenitis) and in 32 normal persons. The duodenal mucosa was established to undergo consistent morphofunctional reorganization related to the disease phase. Active duodenal ulcer was marked by duodenitis with thickening of the mucosa, shortening of the villi, reduction of the depth of the cryptae, gastric metaplasia, impairment of histochemical properties of epitheliocytes and decrease of the transmural potential difference, overproduction of acid and pepsin in the basal period, high sensitivity of the chief cells to stimulation, and insufficient output of bicarbonates by the pancreas. Gastric metaplasia of the duodenal epithelium, appreciable histochemical and morphometric alterations may be regarded as relatively specific traits of peptic duodenitis. As ulcer heals, a well-defined tendency may be noted towards normalization of all the parameters mentioned. However, they only correspond to normal in 25% of patients in the phase of a white scar. The conclusion is made that there is also a necessity of correcting morphofunctional abnormalities after duodenal ulcer healing.

[Morphobiophysical features of the duodenal mucosa in patients with duodenal ulcers]. / Morfobiofizicheskie osobennosti slizistoi obolochki dvenadtsatiperstnoi kishki u bol'nykh duodenal'noi iazvoi.

Chronic duodenitis in patients with duodenal ulcer is characterized by substantial morphofunctional changes in the mucosa, decreased transmural potential difference and definite patterns of carbohydrate-containing biopolymer production, the initial changes being manifested as neutral glycoprotein hypersecretion with their subsequent diminished synthesis rates, followed by a more pronounced drop of sialo- and sulfoglycoprotein levels. A correlation was found between the severity of duodenitis, morphometric and histochemical parameters, and gastric pepsin secretion rates (hypersecretion). It is suggested that these changes are etiopathogenetically common.