[Gastroduodenal bleedings in critical illness]. / Gastroduodenal'nye krovotecheniia pri kriticheskikh sostoianiiakh.

Acute erosive lesions of upper parts of gastrointestinal tract with bleeding aggravate severe burn trauma, postoperative period after extensive surgeries and is the often component of polyorganic insufficiency syndrome. Gastric secretion in patients with severe burn trauma and neurotrauma was studied. Decrease of gastric secretory function due to central paresis of gastrointestinal tract and reflux of bile into stomach was seen in majority of patients with neurotrauma and acute gastric ulcers. On the contrary, in patients with burn shock increase of acid-secretory function of stomach was revealed. Schemes of prophylaxis and treatment of acute ulcers were developed. They included antacid therapy (for patients with increased secretion), regulators of motor-evacuatory function of stomach and intestine (for patients with paresis), drugs increased regenerative properties of mucosa, early enteral nutrition with balanced mixtures. This treatment in combination with hemostatic therapy and cure of main disease permitted to reduce number of gastroduodenal bleedings and lethality in these patients.

[Treatment of gastroduodenal ulcer bleedings in a general hospital of emergency care]. / Lechenie gastroduodenal'nykh iazvennykh krovotechenii v usloviiakh mnogoprofil'nogo statsionara neotlozhnoi pomoshchi.

Treatment of patients with gastroduodenal ulcer bleedings in a general hospital of emergency care is a complex of measures including of endoscopic diagnosis and stopping of bleeding, use of effective antisecretory drugs with obligatory laboratory control of acid-producing function of the stomach, surgical treatment and eradication of H. pylori. Up-to-date methods of endoscopic hemostasis - spirituous infiltration, argon-plasma coagulation, clipping of vessels in ulcer and also their combination in difficult cases - provide reliable hemostasis and allow to avoid urgent surgery. Recently we succeeded in reducing the rate of urgent surgeries performed at the height of bleedings from 70 to 40%. These methods can be recommended for clinical practice because they reduce significantly lethality rates in patients with severe conditions.

[Principles of treating stomach and duodenal ulcers complicated by hemorrhage]. / Printsipy lecheniia iazvennoi bolezni zheludka i dvenatsitiperstnoi kishki, oslozhnennoi krovotecheniem.

Ulcerative gastroduodenal bleedings have remained one of the most complicated problems of emergency abdominal surgery up to the present. According to the literature, they make up approximately one half of all gastroduodenal bleedings and are accompanied by high lethality--from 10 to 30%. At that the highest percentage of lethality falls at elderly and old patients.

[Treatment of acute ulcerations of the upper part of the gastrointestinal tract in patient with a neuroreanimation profile]. / Lechenie ostrykh iz''iazvlenii verkhnikh otdelov zheludochno-kishechnogo trakta u bol'nykh neiroreanimatsionnogo profilia.

A success in treatment of acute ulcerations of the upper parts of the gastrointestinal tract in patients with a severe neurosurgical pathology can be achieved only with a complex approach to treatment of the intensive care patients. The application of antiulcerous medicines in combination with pyrokinetics and medicines improving the regeneratory ability of the gastrointestinal tract mucosa allowed to considerably decrease risk of the development of gastroduodenal bleedings against the background of erosive-ulcerous lesion of the mucosa. The endoscopic methods of arresting bleedings in such patients in combination with the correction of homeostasis by infusions and local hemostatic therapy in most cases result in reliable hemostasis of the upper parts of the gastrointestinal tract. The program of active measures is completed with the early enteral feeding with balanced nutritional mixtures.

[Lipid peroxidation and antioxidant system functions in patients with gastroduodenal ulcerous hemorrhages undergoing conservative and surgical treatment]. / Sostoianie perekisnogo okisleniia lipidov i antioksidantnoi sistemy u bol'nykh s gastroduodenal'nymi iazvennymi krovotecheniiami pri konservativnom i operativnom lechenii.

The results of examination of 53 patients have shown that greater intensity of lipid peroxidation and less activity of the antioxidant system of blood are more pronounced in the operated patients. The authors recommend to include antioxidants in the complex of medical measures.

[Stress-limiting effect of zantac in duodenal ulcer bleeding]. / Stresslimitiruiushchii éffekt zontaka pri iazvennykh gastroduodenal'nykh krovotecheniiakh.

Two randomized groups of patients with ulcerative gastroduodenal hemorrhage were studied. One group of patients with bleeding-accompanied ulcerative disease of the stomach (n = 11) and the duodenum (n = 22) received the routine therapy, another group, including those of the same diseases (n = 9 and n = 22, respectively) had additionally the histamine H2-receptor blocking agent zontac by the following schedule: intravenously, 50 mg thrice a day within the first 3 days, and orally, 150-mg tablets twice a day within the following 3 weeks. Donors (n = 20) served as a control group for the zontac-treated and untreated patients. The stress-limiting effect of zontac was evaluated by the physicochemical parameters of corticosteroid-binding globulin, serum cortisole and insulin concentrations which were measured on days 1, 3, 7, and 14 following the first hemorrhage. In the zontac-treated group, the association constant of the blood cortisole-corticosteroid-binding globulin increased, while the dissociation constant decreased. At the same time the absolute and relative number of sites for binding of cortisole by means of corticosteroid-binding globulin also dropped to the values seen in the group of donors. Zontac caused a reduction in the cortisole/insulin ratio. This all suggests that zontac produces its stress-limiting effect in patients with ulcerative gastroduodenal hemorrhage. Zontac therapy decreased the need for surgical arrest of bleeding by 50% and the average day/bed.

[Change in glucocorticoid-binding function of transcortin in acute gastroduodenal hemorrhaging]. / Izmenenie gliukokortikoidsviazyvaiushchei funktsii transkortina pri ostrykh gastroduodenal'nykh krovotecheniiakh.

The glucocorticoid-binding function of transcortin was studied in the blood serum of 31 patients with gastroduodenal ulcer complicated by moderate hemorrhage. The patients received a routine multimodality therapy. Sixteen donors serves as a control. Labelled cortisol was used to determine the time course of specific glucocorticoid saturation of transcortin. The Scatchard analysis defined the number of specific transcortin binding sites, the association and dissociation constants of cortisol-transcortin complexes. The blood levels of cortisol and insulin were measured using test kits (France). In patients with hemorrhage-complicated ulcer, the cortisol binding sites to transcortin substantially increased in number on days 7 to 14, and on the contrary, the association constant decreased. The serum content of endogenous cortisol significantly rose, starting from day 1 to day 14 of the onset of hemorrhage. Insulin levels significantly decreased only on days 14 of bleeding. In posthemorrhagic patients, the cortisol/insulin index drastically elevated and remained high within 14 days. A role of serum transcortin functional changes in patients with hemorrhage-complicated ulcerous disease in metabolic and immunogenetic processes.

[Morphological changes in splenic autotransplants following splenectomy: clinical and experimental studies]. / Morfologicheskie izmeneniia autotransplantatov selezenki posle splenéktomii v klinike i éksperimente.

Reports results of clinical, morphologic, and laboratory studies carried out in 18 patients allografted with spleen fragments into the greater omentum following splenectomy for a traumatic injury of the spleen, and in 20 splenectomized dogs allografted with spleen fragments or a spleen cell suspension into various parts of the abdominal cavity. Spleen tissue regeneration in the allografts was found to be nearing completion 6 to 8 weeks after the transplantation. The regeneration took less time to be completed in dogs grafted with spleen fragments than in those grafted with a cell suspension, but occurred at similar rates whatever the site in the abdominal cavity into which the fragments or suspension had been grafted. In the allografted patients, the incidence of posttransplantation suppurations was lower than in a similar group of patients who had undergone splenectomy without allografting.