[Morphological changes in the ureteral wall in contact ureterolithotripsy].

We studied a harmful action of laser, ultrasound and ballistic energies on intact wall of human ureter in 15 ureters of men and women with renal carcinoma aged 43-55 years (mean age 48 +/- 8 years) before nephrureterectomy in vivo. With growing time of exposure to laser radiation, ureteral mucosa undergoes destructive alterations up to muscular layer. Ureteral wall exposure to ultrasound do not change thickness of the wall considerably, cell elements remain viable. Histological examination of the ureteral wall after exposure to intraureteral ballistic impact suggests that 15 second and longer exposure to this impact may reduce probability of mucosal regeneration because of irreversible changes. The analysis of literature data and original findings shows that now there is no absolutely safe energy for contact ureterolithotripsy.

[Ulcerous gastrointestinal bleedings]. / Iazvennye zheludochno-kishechnye krovotecheniia.

On the basis of the study of 2388 patients with chronic gastric and duodenal ulcers complicated by acute bleeding, the most disputable organizational and tactical issues of ulcer bleeding (UB) treatment are discussed. It is reasonable to divide surgery for UB into urgent, delayed and elective. Indications for different surgeries in UB and basic surgical principles are discussed. Severe blood loss is the main factor of general lethality. Combined conservative therapy must provide correction of posthemorrhagic tissue hypoxia, functional disorders, hemostatic disturbances and immunosuppression. Artificial transmitters of oxygen and infusion of antihypoxants are promising in management of UB. Antisecretory drugs are a necessary component of conservative treatment in UB. Therapeutic endoscopy is important in the treatment of acute UB, but it is not alternative to surgical hemostasis. It may be regarded as a method of temporary hemostasis before delayed for more than 2 hours operation or as a method of final hemostasis in combined conservative treatment, first of all in patients of "surgical risk" group.

[2-Component silicone compounds in the emergency surgery of gastrointestinal hemorrhages]. / Dvukhkomponentnye silikonovye kompozitsii v neotlozhnoi khirurgii zheludochno-kishechnykh krovotechenii.

Based upon their clinico-experimental investigations the authors prove advantages of the two-component silicon compositions over oil preparations for the arrest of gastro-intestinal bleedings. Such compositions are recommended for patients whose treatment by traditional methods of hemostasis proved to be ineffective due to some causes which is often observed in elderly and senile patients.

[Successful surgical treatment of cancer with multiple location]. / Uspeshnoe khirurgicheskoe lechenie raka mnozhestvennoi lokalizatsii.

The lecture deals with the specific characteristics of cell membrane damage caused by in vivo and in vitro irradiation at the dosage commonly used in radiation therapy of malignant tumors. The mechanisms of lymphoid cell loss to ionizing radiation are described. They include metabolic depletion, direct damage to the cell membrane causing loss of its asymmetry and surface receptors expression being altered.

[The role of endoscopy in determining the indications for the surgical treatment of the Mallory-Weiss syndrome and of bleeding acute gastroduodenal ulcers]. / Rol' éndoskopii v opredelenii pokazanii k operativnomu lecheniiu sindroma Mallori--Veisa i krovotochashchikh ostrykh gastroduodenal'nykh iazv.

The frequency of acute sources of bleeding has recently increased (47%) in the general picture of gastrointestinal bleedings which makes the improvement of diagnosing "acute" sources of hemorrhage and the development of more perfect methods of nonoperative hemostasis very actual. The authors believe that "Kaprofer" used in most of patients with bleedings from acute ulcers and ruptures of the gastro-esophageal zone mucosa (95%) allows the hemorrhage to be arrested. The treatment can be continued without operative interventions. Search for new hemostatic drugs must be performed in order to obtain reliable and long-term effects of drugs with a minimum aggressive action upon the mucosa.

[A combination of the Mallory-Weiss syndrome with acute ulceration of the gastric and duodenal mucosa]. / Sochetanie sindroma Mallori--Veissa s ostrym iz''iazvleniem slizistoi obolochki zheludki i dvenadtsatiperstnoi kishki.

The Mallory-Weiss syndrome is often associated with acute ulceration of the gastric and duodenal mucosa, which gives grounds for a supposition of the existence of common mechanisms of pathogenesis of these diseases. Because of bad results of the operative treatment of patients with such combinations, the method of choice should be conservative therapy and curative endoscopy. A pathogenetically substantiated operative intervention--suturing the source of bleeding in combination with vagotomy and pyloroplasty is preferable when operation is inevitable.

[The treatment of acute gastrointestinal hemorrhages at a specialized hospital]. / Lechenie ostrykh zheludochno-kishechnykh krovotechenii v spetsializirovannom statsionare.

A differential approach to surgical interventions corresponding to the system of treatment of patients with gastrointestinal bleedings developed by the authors gave considerably less lethality in patients with bleedings caused by acute gastric and duodenal ulcers and by the Mallory-Weiss syndrome. General lethality among these patients was 3.3% and 5.1% correspondingly. This system was most effective at large specialized centers for treatment of patients with acute gastrointestinal bleedings. However many of its principles are easy for a great number of practical surgeons.

[The hemostatic effect of vagotomy in acute gastroduodenal ulcers complicated by massive hemorrhage]. / Gemostaticheskii éffekt vagotomii pri ostrykh gastroduodenal'nykh iazvakh, oslozhnennykh massivnym krovotecheniem.

The clinico-experimental investigation has shown high efficiency of the bilateral subdiaphragmatic truncal vagotomy in treatment of patients with acute gastroduodenal ulcers complicated by massive hemorrhage. The haemostatic effect of the operation is related to the inhibited acid gastric secretion, proteolytic activity of the intragastric content as well as to the activation of serotonin-containing cells and increased tonus of the sympathetic nervous system, which is responsible for gastric vessel spasm, shortens time of bleeding, increases the amount of thrombocytes and their aggregation. When vagotomy with interventions draining the stomach is not possible, suturing (dissection) of bleeding acute ulcers is recommended in combination with prolonged novocain blockade of vagus nerves.

[The results of the endoscopic diathermy coagulation of hemorrhaging gastroduodenal ulcers]. / Rezul'taty éndoskopicheskoi diatermokoaguliatsii krovotochashchikh gastroduodenal'nykh iazv.

The authors analysed the results of endoscopic diathermy coagulation of bleeding acute gastroduodenal ulcers in 83 patients; in 47 of them the follow-up period ranged from 12 months to 9 years. A stable hemostatic effect was achieved in the early periods after coagulation of the acute ulcers in 76% of cases. The frequency of recurrent bleeding was found to be directly dependent on the degree of the blood loss. Recurrent bleeding from acute ulcerations of the gastric mucosa in the late-term period was discovered authentically in only one patient. It was linked with medication with brufen for a long duration. Thus, endoscopic diathermy coagulation produced good results in arresting bleeding from acute gastroduodenal ulcers, particularly in patients with a very high operative risk.

[Methods for surgical prophylaxis of the development of acute gastroduodenal ulcers]. / Metody khirurgicheskoi profilaktiki obrazovaniia ostrykh gastroduodenalnykh iazv.

The results of the use of prolonged novocaine blockade with the aim of prevention of the development of acute gastroduodenal ulcers in 57 patients are presented. In 21 case, the prolonged blockade of the vagus nerves was used, in 36--that of the ligamentum teres hepatis. After the operation, the proteolytic activity and acidity of gastric juice were studied. All the patients underwent gastroduodenofibroscopy with biopsy and target pH-metry. Under the influence of novocaine blockade, the proteolytic activity decreased, pH increased. At endoscopy, no acute erosive-ulcerous lesion of mucosa was revealed. Thus, a high effectiveness of the use of prolonged novocaine blockade has been proved.

[Gastrointestinal hemorrhage after operations for perforated gastroduodenal ulcers]. / Zheludochno-kishechnye krovotecheniia posle operatsii po povodu perforativnykh gastroduodenal'nykh iazv.

On the basis of clinical observation over 521 patients who underwent operations in the clinic for perforating gastric and duodenal ulcer, the authors determined the frequency of massive gastrointestinal hemorrhage (3.2%) in the early postoperative period and the mortality rate in this complication. It is shown that the performance of radical surgical interventions instead of simple closure of the perforating ulcer with sutures, in the absence of life-threatening concomitant diseases and the terminal phase of peritonitis, may improve the results of operative management of this disease.

[Prevention and treatment of stress-induced ulcers]. / Profilaktika i lechenie stress-iazv.

The data presented show that along with acid-peptic aggression an important role in pathogenesis of stress ulceration in the stomach and duodenum belongs to energy and immune deficiency which makes the correction of these alterations necessary. The timely and valuable conservative therapy including histamine H2-receptor blocking agents in addition to antacids and endoscopic electrocoagulation in case of profuse bleeding from stress ulcers allows to obtain hemostasis and healing of the ulcers more than in 90% of cases. When choosing the surgical method of treatment the preference should be given to atraumatic organ-preserving operations.

[State of blood flow in gastric and small-intestinal mucosa in acute diffuse peritonitis]. / Sostoianie krovotoka slizistoi obolochki zheludka i tonkoi kishki pri ostrom razlitom peritonite.

One of the most severe complications of the postoperative period in patients with diffuse peritonitis is known to be erosive ulcerous injuries of the gastrointestinal tract mucosa (in 29 of 150 patients). The blood flow state of the gastric and intestinal mucosa was studied with the help of contact microfluorimeter under conditions of experimental peritonitis. Disturbances of the intramural blood flow of the gastrointestinal tract have been found which is a cause of the formation of acute ulcers and erosions of the mucosa.

[Pathogenesis of acute ulcers of the digestive tract in post- operative suppurative-septic complications]. / Patogenez ostrykh iazv pishchevaritel'nogo kanala pri posle- operatsionnykh gnoino-septicheskikh oslozhneniiakh.

In studying the pathogenesis of acute gastric and duodenal ulcers arising in operated patients against the background of purulent-septic complications, the specific signs distinguishing them from stress-ulcers, which develop in response to surgical aggression, were revealed. They are: the absence of inflammatory reaction in the gastric mucosa, its ischemia, hypo- and achlorhydria with reduction in the proteolytic activity of gastric juice.

[Status of the acid and pepsin-producing functions of the stomach in patients after abdominal surgery]. / Sostoianie kislotno- i pepsinoobrazuiushchei funktsii zheludka u bo'lnykh posle operatsii na organakh briushnoi polosti.

A combination of methods was used to study gastric secretion and intragastric proteolysis in the early postoperative period after traumatic surgical interventions on the abdominal organs. Activation of the acid-peptic aggression was established in the first three days with its maximal manifestations occurring during night, which is evidence of the predominance of the vagus influence. Acute gastric and duodenal ulcers arise, as a rule, in the presence of hypersecretion even if achlorhydria is indicated in case records.