[Lethality after gastroduodenal ulcer bleeding].

The retrospective analysis (2006-2010 yy) of treatment of 895 patients with gastroduodenal ulcer bleeding was conducted. Lethal outcome was registered in 220 (24.6%) patients, of them directly of the ulcer bleeding died 45 (5%). The Rockall score was used as universal prognostic instrument. Of 164 lethal outcomes, did not directly connected to the ulcer bleeding, the etiological distribution was as follows: multiple organ failure - 36% (n=59), cardiovascular diseases - 24.4% (n=40), inveterate oncology - 15.9% (26). Of 45 deaths from bleeding, only 4 patients died of the uncontrolled bleeding, whereas 18 (45%) died after the emergency surgery. Signs of hemorrhagic shock were registered in 60% of died patients (in comparison with 18% among the survived). Bleeding reccurrence was registered in 28.6% of died patients (in comparison with 11% among the survived). The use of the Rockall score confirmed its prognostic value: the mean score was 4.3±2.12 points among the survived patients, whereas among the died patients it was 7.16±2.35 points (p=0.001). Authors conclude, that the leading reasons of death, considering the bleeding itself, were the hemorrhagic shock and recurrent bleeding. Though, about 80% of patients are dying of reasons, do not directly connected to the bleeding episode, but of concomitant diseases (multiple organ failure, cardiovascular and oncologic diseases). The least, nevertheless, leads to the wrong formulation of the final diagnosis and incorrect interpretation of the etiology of death.

[Surgical tactics in gastrointestinal hemorrhages in elderly].

At the present stage the number of operations is reduced at a ulcer gastroenteric bleeding. Occurrence modern antysecretor drags and wide introduction endoscopic and endovascular methods of hemostasis has led to decrease of urgent operative interventions in group of patients with high risk of rebleeding in 4 times. The number of such minimal operations was reduced in 10 times. They do not give expected hemostasis effect and are accompanied high mortality. Change of surgical tactics at elderly patients has led to decrease postoperative mortality from 15.8 up to 5.8% and the general mortality from 15.8 up to 9.6%.

[Therapeutic and diagnostic tactics in complication of ulcer disease in elderly and aged]. / Lechebno-diagnosticheskaia taktika pri oslozhneniiakh iazvennoi bolezni v pozhilom i starcheskom vozraste.

In 78% of cases the ulcerative disease in elderly age proceeds with complications and presents a serious surgical problem. The specificity of elderly patients is the combination of several pathologies, on background of which the ulcerative disease proceeds. The level of an expressiveness of accompanying pathology influences on the prognosis of disease course and on the choice of medical tactics. Therefore for objectivization of state heaviness of the patient group mark systems of an estimation MODS and APACHE III are used. The interventions in gastroduodenal bleedings for the patients of elderly age should be differentiated and depended on a risk degree of bleeding relapse and adequate estimation of MODS heaviness. In 55.4% of the elderly patients the ulcerative perforation occur without antecedent history. Therefore indications to sewing of ulcers, including little-invasive interventions, should be extended in this group of the patients. The size of radical surgical interventions in absence of manifestation of the polyorganic insufficiency for the elderly patients should be the same, as for the younger patients.

[A method of invaginated non-reflux esophago-intestinal anastomosis]. / Sposob invaginatsionnogo arefliuksnogo pishchevodno-kishechnogo anastomoza.

A new method for the formation of an invagination areflux esophago-intestinal anastomosis is suggested. Incompetence of the anastomosis was not encountered in any of the 52 performed operations for gastrectomy. Five patients died, but the cause of death was not connected with the method of anastomosis formation.

[Gastrojejunostomy in proximal resection of the stomach]. / Sposob eiunogastroplastiki pri proksimalnoi rezektsii zheludka.

A new mode of forming an invaginational areflux esophagus-stomach-intestinal anastomosis was proposed. Seven patients were operated on by the proposed procedure. No cases of incompetence of anastomotic sutures were observed. The analysis of long-term outcomes suggests that there were no complications such as reflux-esophagitis and cicatricial strictures, which is accounted for by anatomical and surgical features of this mode of anastomosis.

[Reflux gastritis in duodenal ulcer]. / Refliuks-gastrit pri duodenal'noi iazve.

The results of a comprehensive examination of 44 patients with duodenal ulcer are analyzed. Reflux gastritis was detected in almost 50% of the patients. X-ray method, gastroduodenoscopy, and radiologic method for measuring the duodenal reflux in gastric contents portions were employed to diagnose duodenogastric reflux and reflux gastritis. The radiologic method was found the most informative. Reflux gastritis was finally diagnosed after histologic examination of gastric mucosa biopsy specimens. Increased count of IgE cells in these specimens may be considered as the marker of reflux gastritis. The authors come to a conclusion that reflux gastritis degree should be taken into consideration when choosing a method for conservative and radical treatment of duodenal ulcers.