[The experience of biliary self-expendable nitinol stents for malignant jaundice].

THE AIM: to analyze the effectiveness and possible complications of endoscopic biliary drainage (BD) using self-expanding metal stent (SEMS) in patients with malignant jaundice (MJ). METHODS: From January 2010 to January 2014 in endoscopy department of Pirogov National medical and surgical Center were operated 64 patients with MJ, 38 of them with SEMS. The average patient's age was 65.4 ± 14.5 years. The mean duration of jaundice was 13 ± 5.4 days before drainage. The remaining 6 patients (15.8%) were operated with preliminary PTBD. In all 38 patients were diagnosed unresectable tumors. RESULTS: successful endoscopic BD were achieved in all 38 patients. 35 patients were drained with transpapillary SEMS and 3 patients with EUS-guided choledochoduodenoanastomoses (EUS-CDA). Early postoperative complications were observed in 3 (7.8%) patients with no lethality. CONCLUSION: endoscopic BD with SEMS is an effective method of internal drainage for inoperable pancreatobiliary tumors, providing adequate BD for the entire duration of life expectancy. In case of failed transpapillary drainage EUS-guided biliodigestive anastomoses were performed. The complication rate of endoscopic BD in patients with malignant pancreatobiliary tumors in our study was 7.8% and comparable with complication level due to ERCP/EST for benign pathology.

["Internal runny nose," and gastroesophageal reflux disease: diagnosis, treatment of patients].

The article observes the main up to date questions of pathogenesis, diagnostics and treatment of patients with GERD and postnasal drip syndrome.

[Special medical strategy in patients with decompensated stenosis of the trachea of malignant genesis].

The article presents a generalized experience with treatment of 49 patients with malignant stenosis of the trachea complicated by respiratory insufficiency. Different methods of endoscopic recanalization of the stenosed portion of the trachea are analyzed. Factors are shown influencing the outcome of urgent restoration of patency of the respiratory pathways. Exact indications are proposed on carrying out self-locking stents in patients with malignant damage of the trachea, and the sequence of actions in patients with decompensated stenosis of the trachea of malignant nature.

[Effects of probiotic bifiform on efficacy of Helicobacter pylori infection treatment].

AIM: To study effects of the probiotic bifiform on efficacy of Helicobacter pylori (HP) eradication in patients with chronic gastritis and ulcer disease. MATERIAL AND METHODS: A total of 98 patients with verified HP infection were divided into two groups. The study group received a week three-component anti-HP therapy+a probiotic. The control group received the same treatment without the probiotic. All the patients were tested for HP before the treatment and one month after the end of the treatment. Cell composition of duodenal mucosa (DM), tissue proinflammatory cytokines, secretory immunoglobulin A (sIgA) in coprofiltrates, serum IgA, IgM, IgG, phagocytic parameters and copromicrobiology were studied. RESULTS: HP eradication rate in the study group was higher than in the control group (89.1 vs 63.5, respectively, p < 0.05). After the treatment, patients of the study group had lower rates of side effects, impaired intestinal biocenosis, tissue cytokines levels but higher concentration of plasmatic cells in CO and cIgA in coprofiltrates. CONCLUSION: The addition of probiotic bifiform to the standard three-component antihelicobacter scheme of the treatment raises its efficacy and is promising treatment of HP. Mechanisms of a potentiating action of the probiotic are related to enhancement of antibacterial activity of local immune reactions.

[Methods to optimize the management of Helicobacter pylori infection. The comparative efficacy of the triple and quadruple therapy used as a first line therapy]. / Puti optimizatsii lecheniia Helicobacter pylori-infektsii. Sravnitel'naia éffektivnost' troinoi i kvadroterapii, ispol'zuemykh v kachestve skhem pervoi linii.

The study involved a dynamic comparative efficacy survey of the standard triple and quadruple therapies recommended by the Maastricht Consensus as first line therapies for eradication of Helicobacter pylori infection with the time period of 5 years. The study included 199 Hp-positive patients with stomach ulcer; 101 of them were under examination in 1997 and 98 in 2002. Depending on the therapy type, patients were assigned to one of two groups: the OCM/A group (48 and 53 patients in 1997 and 2002, respectively) was treated with Omeprazole, Clarithromycin and Metronidazole for 7 days and ODTM group (46 and 52 patients in 1997 and 2002, correspondingly) was treated with Omeprazole, De-Nol, Tetracycline and Metronidazole. To discover and confirm Hp eradication, cytological, histological and rapid urease tests were used. Hp eradication was considered as successful when all the tests were negative. The eradication frequency was assessed with the help of ITT and PP analyses. In the OCM/A group Hp was eradicated in 81.3% and 62.3% (p<0.05) of patients when analyzed by the intention-to-treat and in 88.6% and 66.0% (p<0.01) of patients when analyzed by per-protocol in 1997 and 2002, respectively. In the ODTM group Helicobacter pylori was eradicated in 89.1% and 88.5% (p<0.05) of patients when analyzed by intention-to-treat and 95.3% and 93.9% (p<0.05) when analyzed by per-protocol in 1997 and 2002, respectively. The frequency of ulcer cicatrisation and cuticularization of erosions did not depend on the type of the treatment. There was no significant difference between the compliance and side effects of the triple and quadruple therapies. Taking into account the decrease in the efficacy of the triple anti-Hp therapy, the need to use the quadruple therapy as a first line therapy for Hp infection eradication was substantiated.

[Current methods of ulcer therapy and their efficacy and cost]. / Sovremennye metody terapii iazvennoi bolezni, ikh éffektivnost' i stoimost'.

The purpose of this study is to assess the efficiency of the anti-ulcer therapy taking into account the economic aspects of treatment. We have examined 708 HP-positive(+) patients with stomach ulcers (SU) and duodenal ulcers (DU). Various schemes of anti-helicobacter and anti-secretory therapy were administered to them. Positive dynamics of some clinical data (local palpatory tenderness and abdominal wall resistance) and gastritis (gastroduodenitis) activity was discovered in all groups of patients. The cost of the treatment was determined with the help of marketing studies by taking the lowest price of drugs. There were no statistically reliable differences found groups of traditional treatment regimens by both results of HP eradication and the cost of eradicative and anti-secretory therapy. All drugs under study are highly effective for rapid relief of symptoms at an exacerbation of stomach ulcer associated with HP as well as the decrease of gastritis (gastroduodenitis) activity. It is possible to recommend them for both eradicative therapy and prolonged treatment.

[Status of the upper parts of the digestive tract and Helicobacter pylori infections in patients with chronic kidney failure after kidney transplantation]. / Sostoianie verkhnikh otdelov pishchevaritel'nogo trakta i Helicobacter pylori-infektsiia u bol'nykh khronicheskoi pochechnoi nedostatochnost'iu posle transplantatstii pochki.

The purpose of the study was to examine the state of upper parts of the digestive tract, prevalence of Helicobacter pylori infection and its relation to the pathology revealed in patients with chronic renal insufficiency after kidney transplantation.

[Stages in the improvement of drug therapy at a polyclinic]. / Etapy sovershenstvovaniia medikamentoznoi terapii v usloviiakh polikliniki.

Within 1968-1997 the authors studied the steps of introduction of the achievements of the medical science, technology and pharmacology to therapy of exacerbations and complications of peptic ulcer (PU). The scientific and practical value of endoscopic, histological, biochemical and bacteriological examinations in the improvement of the methods of pharmacotherapy of exacerbations and complications of PU was shown. Three phases of the PU development were indicated by the clinical signs and results of esophagogastroduodenoscopy, target biopsy and histological examinations. These data and available scientific achievements were assumed as a basis for the design of optimal drug combinations and their introduction to the medical practice. The use of such combinations made it possible to prevent relapses and life-threatening complications of the disease in the overwhelming majority of the patients. The best results of the pharmacotherapy were recorded in the years (1988-1997) when the drug combinations began to be used. The combinations provided eradication of Helicobacter pylori in the gastroduodenal mucosa and it was proved that in all the patients with PU and the relapsing lesions in the duodenum and in the overwhelming majority of the patients with gastric ulcer the disease developed at the background of chronic active gastroduodenitis associated with H.pylori. The success of the pharmacotherapy in the patients with PU was due to the use of the rational combinations of antibacterial and antisecretory agents.

[The drug prophylaxis of peptic ulcer exacerbations]. / Medikamentoznaia profilaktika obostrenii iazvennoi bolezni.

453 patients with ulcer located in the duodenal bulb and pyloric part of the stomach in the presence of Helicobacter pylori were examined before and followed up after hospital treatment of the ulcer. The authors findings support the importance of maintenance with current antisecretory drugs and on-demand therapy as well as of combined antibacterial therapy against Helicobacter pylori. Adequate chemotherapy in the ulcer exacerbation was able to reduce the number of recurrences and complications.

[Scarring embryonal carcinoma of the testis]. / Rubtsuiushchaiasia émbrional'naia kartsinoma iaichka.

The case of testis embryonal carcinoma in a man of 31 is described. Spontaneous necrosis and scarring of a primary tumour were observed macroscopically as well as widespread metastases. Histologically, the tumour was characterized by the two cell differentiations: somatic one in the primary node and trophoblastic in metastases.