[Intestinal candidiasis: modern therapeutic tactics].

Bowels candidiasis is an urgent problem not only for gastroenterology but also for other fields of medicine--gynecology, dentistry, phthisiology, surgery, etc. as this disease is directly related with the manifestations of systemic candidiasis in other organs. The diagnostics algorithm includes the detection of a filamentary form (pseudomyceliums) of micromycetes of the Candida genus in the morphological study of a tissue sampling of the bowels mucous coat. The drug of choice for the treatment of bowels candidiasis is Pimafucin (Natamycin) having a local action on the Candida fungi in the intestinal lumen in the absence of any systemic absorption of the drug or any side effects.

[Outpatient treatment of irritable colon syndrome: quality of diagnosis and treatment]. / Otsenka polnotsennosti diagnostiki i éffektivnosti lecheniia bol'nykh s sindromom razdrazhennogo kishechnika v poliklinike.

40 patients with irritable colon syndrome were treated outpatiently: 26 patients by gastroenterologist and 14 ones by therapist. Management of such patients by gastroenterologist significantly lowered frequency of their hospitalizations and sick leave duration as compared to those treated by therapist.

[Sandostatin in the treatment of diarrhea of different origins]. / Sandostatin pri lechenii diarei razlichnogo geneza.

Antidiarrheal action of sandostatin (octreotide) was studied in dumping syndrome, diabetic enteropathy, short-bowel syndrome, Crohn's disease and ulcerative colitis. Sandostatin proved effective in diarrhea of secretory, motor and osmotic origin. Dumping syndrome, diabetic enteropathy, Crohn's disease and short-bowel syndrome responded completely. In ulcerative colitis the effect was paradoxical: intensive diarrhea discontinued, but moderate diarrhea became more intensive. Sandostatin indications in ulcerative colitis should receive further investigations.

[The current pathogenetic aspects of diarrhea in ulcerative colitis]. / Sovremennye aspekty patogeneza diarei pri iazvennom kolite.

The authors consider different mechanisms participating in progression of diarrhea in ulcerative colitis. The involvement of osmotic component was suggested in view of incomplete hydrolysis of carbohydrates by small intestinal glucoamylase under mono- and bisubstrate digestion, whereas diarrhea secretory component develops in participation of cyclic nucleotides. Motor mechanism is also present in diarrhea as evidenced by high concentrations of blood motilin and changes in intestinal evacuation and motility. Polycomponent dysbioses detected in ulcerative colitis patients may also be essential for pathogenesis of diarrhea. Determination of the leading component in each diarrhea case is thought helpful in valid choice of individual therapeutic policy.

[The role of pancreatic polypeptide in the pathogenesis of malabsorption in ulcerative colitis]. / Rol' pankreaticheskogo polipeptida v patogeneze mal'absorbtsii pri iazvennom kolite.

Pancreatic function was evaluated in 16 22-56-year-olds with ulcerative colitis. The diagnosis was verified by coprogram, glycemic curves, blood and urine amylase, ultrasound and endoscopic findings. A basal level of pancreatic polypeptide (PP) was measured in blood serum under glucose tolerance test (50 g) using radioimmunoassay. Intracavitary pH-metry provided data on pH in the upper gastrointestinal tract. The results were processed according to Student's t-criterion. The evidence demonstrated pancreatic involvement with secretory and endocrine insufficiency leading to homeostatic derangement of enteral medium and malabsorption in ulcerative colitis. The addition of pancreatic enzymes and antacids is advisable as pathogenetically valid.

[Role of gastrofluorography in improving detection of pyloroduodenal stenoses]. / Rol' gastrofliuorografii v uluchshenii diagnostiki piloro-duodenal'nykh stenozov.

To improve the diagnosis of pyloroduodenal stenoses (PDS), it is suggested that persons at high risk for gastrointestinal diseases screened among the polyclinic contingents may be examined. With that purpose in view a specialized gastrofluorographic room was set up at a polyclinic. Gastric fluorography was carried out according to a standardized method based on double opacification. Endoscopy was performed on a random basis depending on the gastrofluorography findings. Over 25,000 investigations were made. 155 cases of PDS were revealed. Of these, 107 were of ulcerous etiology, 38 of tumorous. In 10 cases, PDS was caused by primary injury to the organs adjacent to the stomach. Besides, for the suggested diagnostic program to be more significant, roentgenofluoroendoscopic correlations were made in 106 patients with remarkable clinical manifestations of PDS, that demonstrated its high efficacy. In the authors' opinion, the developed diagnostic program based on the use of gastrofluorography combined with endoscopy is to contribute to an appreciable rise of PDS detectability, particularly at the early stages of the disease.

[Gastrofluorography in mass screening of patients with stomach ulcer]. / Gastrofliuorografiia pri dispanserizatsii bol'nykh iazvennoi bolezn'iu zheludka.

The purpose of the paper is to assess the role of present-day fluorography combined with endoscopic investigations in the detection of peptic ulcer. A study of the results of gastrofluorography with videocontrol has shown high potentialities of the method during primary detection of ulcer among persons at high risk for the disease and subsequent control of therapeutic efficacy. The high coverage, low cost and low radiation load proposed by the program make it possible to considerably improve the whole system of prophylactic medical examinations of the patients. The modifications made by the authors in the examination make it possible to raise the accuracy of diagnosis of stomach ulcer recurrences by 28% and to reduce the annual rates of recurrence 1.5-fold.

Cyclic nucleotide concentrations of rectal mucosa in ulcerative colitis.

The concentrations of cyclic nucleotides (CN) were examined in rectal mucosal biopsy specimens from 52 patients with active ulcerative colitis (UC) and 10 healthy controls. The three degrees of inflammation, evaluated macroscopically by endoscopy and by morphometry in the specimens by estimating the cellular infiltration of the lamina propria, corresponded nicely with each other. The proliferative-regenerative morphologic changes in the rectal mucosa were graded qualitatively and quantitatively in three groups in accordance with defined criteria. A significant difference in cAMP concentration was only found between the most severe degree of inflammation (infiltration, 44.6%) in UC and healthy controls. cAMP concentration in rectal mucosal specimens was lower at the highest degree of regeneration than in specimens with lower degrees. Thus cAMP may play a role in the epithelial regeneration of rectal mucosa. The values of CN concentration did not correlate with the degree of inflammation in rectal mucosa from patients with UC.

[Plasma motilin and diarrhea in ulcerative colitis]. / Motilin plazmy i diareia pri iazvennom kolite.

Motilin basal level and that after carbohydrate load were radioimmunoassayed in 26 patients with ulcerative colitis. The results were correlated with the data on motor evacuatory activity of the gastrointestinal tract and clinical manifestations of diarrhea. Basal motilin level was found elevated as against the control (99 rg/ml) in all the patients and surpassed the norm (356-1001 rg/ml) in 6. A significant elevation of motilin content was associated with reduction of the amplitude and number of rhythmic type I contractions, as well as by increased number of type III (propulsive) waves and accelerated transport of the contents via the small intestine. No compensatory rarefying of acid discharge from the stomach, that was observed in reference subjects if transport of contents was accelerated, was detectable in the patients with ulcerative colitis. This resulted in acidification of the enteral medium (pH 5.6 +/- 0.6). Concomitant pancreatitis in 22 patients with reduced production of HCO3- and impaired cavitary hydrolysis of polymer substrate enhanced enteral medium acidification and changed its osmotic pressure. Specific features of enteral medium homeostasis disorders and of impairments of the gastrointestinal tract motor evacuatory function should be borne in mind when planning treatment strategy for diarrhea patients.