[Results of dynamic observation of patients with polyps in the stomach].

This work is based on the analysis of data doing 409 patients with polyps in the stomach. Among them 200 men (48.9%) and 209 women (51.1%) aged 18 to 91 years. The average age of men was 67.4 years, and women 66.8 years. All these patients were find 1034 neoplasms of various sizes. At all of this patients polyps were identified on a background of chronic gastritis, as a rule, has the character of atrophic process. Histological research was conducted 775 (74.6%) polyps, of which focal hyperplasia and hyperplastic polyps detected in 49% of cases, and adenomas in 51% (including adenomas with varying degrees of dyspiasia, and prostatic adenocarcinoma cells). Endoscopic polypectomy performed 367 patients, and the remaining 42 was merely the dynamic monitoring of the identified entities. In 79 (28.8%) patients after polypectomy noted relapse formations and in 10 cases (3.65%) diagnosed with cancer in the intervention area. 4 (0.98%) patients from 409 cancer in polyps detected during the initial survey and in 4 patients the cancer originated in the not associated with polyps of stomach. As a result of the research of the dependence of the size of neoplasms on the nature of destruction and histological structure. For most existing polyps characteristic of the stability of their morphological structure and the absence of its transformation.

[Expression of proliferation and apoptosis markers in neoplasms of colon mucosa after cholecystectomy].

The cholecystectomy results in change of cholic acids flow into intestine. Permanent type of the bile flow provokes the increase of proliferation of colic epithelial cells and increases the risk for development of right-sided colorectal tumors. Meanwhile morphological features of colorectal tumors at the patients with cholecystectomy are still remaining to be clarified. The goal of the study was to investigate immunohistochemical markers of proliferation and apoptosis in colorectal adenomas and adenocarcinomas at the patients with cholecystectomy. Fifty patients (40 with retained function of gallbladder and 10 patients with cholecystectomy) histologically diagnosed as proximal colon adenoma or adenocarcinoma were included into the study. Colonoscopic biopsies have been taken from the lesion in cancer patients, and colonoscopic polypectomy has been performed for adenomas. In addition, biopsies have been taken from the adjacent healthy colon mucosa at least 5 cm from the lesion in each patient. 83 tumors and 49 samples of mucosa were immunostained with monoclonal mouse anti-human p53 protein (Dako) and monoclonal mouse anti-human Ki-67 antigen (Novocastra). The index of Ki-67 expression in healthy colon mucosa at the patients with cholecystectomy was 37,5 +/- 1,8% (p < 0,05) as compared to 31,36 +/- 1,9 at the patients without cholecystectomy. No significant difference was detected in the comparison of Ki-67 expression levels between the healthy mucosa and adenomas at the patients with cholecystectomy 43,4 +/- 3,45 (p > 0,05), but more prominent increase was revealed in adenocarcinomas 64,33 +/- 7,67% (p < 0,01). Protein p53 expression in healthy mucosa at the patients with a cholecystectomy was at the same level as at the patients without cholecystectomy (37%). At the patients without cholecystectomy the frequency of revealing p53 in adenomas does not vary, compared with healthy mucosa, however in adenocarcinomas p53 was not revealed at none case. As a contrast, in group of the patients with cholecystectomy the frequency of revealing p53 in adenomas is considerably increased (up to 80%), and even in adenocarcinomas, p53 was revealed in 30,8% of cases. Thus, in benign colorectal tumors at the patients with retained function of gallbladder intensifying of epithelial cells proliferation is not accompanied with intensifying of apoptosis, and in malignant tumors a complete supression of apoptosis is observed. At the patients with a cholecystectomy, the increase of proliferative activity is accompanied by increased apoptosis in adenomas and maintained apoptosis in adenocarcinomas. The retaining of apoptosis in colorectal tumors compensates intensive proliferative activity with expectation of better prognosis.

[Endoscopic examination for diagnosis of cancer of major duodenal papilla].

Endoscopic procedures were used for diagnosis and treatment of cancer of major duodenal papilla (MDP) at 31 patients. Gastroduodenoscopy (with visual assessment) and endoscopic retrograde cholangiopancreatography were performed at all the patients. Morphological study of tissue sampling permitted to confirm preliminary visual diagnosis only in half of patients. Detection of x-ray symptoms and bile passage disorders at retrograde cholangiopancreatography were high informative. All the patients underwent endoscopic papillosphincterotomy which was effective at 26 (83.9%) patients.

[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.

[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).

[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.

[Clinico-endoscopic diagnosis of cancer of the large intestine]. / Kliniko-éndoskopicheskaia diagnostika raka tolstoi kishki.

Appearance of the clinical signs of large-intestinal cancer usually demonstrates advanced stages of the process. Endoscopic polypectomy, along with screening and active follow-up of patients, can be one of the measures for identification and prevention of tumours in early terms.

[Gastric endocrine cells containing endorphin, gastrin and somatostatin in duodenal ulcer]. / Endokrinnye kletki zheludka, soderzhashchie endorfin, gastrin i somatostatin, pri iazvennoi bolezni dvenadtsatiperstnoi.

Three types of endocrine cells (G cells producing gastrin-17, D cells producing somatostatin, and GER cells containing endorphine) in the mucous membrane of the stomach antrum from 14 patients with duodenal ulcer and 10 healthy persons were studied. Biopsies were fixed in a modified Bowen solution and imbedded into paraffin. The slides were stained by Grimelins' method and immunohistochemically with the use of the peroxidase-antiperoxidase method. The number of cells per 1 mm2 of the mucous membrane was counted. Patients with ulcer have shown the increased number of G and GER cells and decreased number of D cells. Besides, pronounced G cell hyperplasia with a relative decrease of GER cells and a marked decrease of Grimelins-positive cells (as compared to other patients with duodenal ulcer) were observed in 3 out of 14 ulcer patients. The authors conclude that the alteration of the balance between antagonistic hormone effects results in the hypersecretory syndrome that plays the main role in the pathogenesis of duodenal ulcer.