[The efficacy and safety of quadruple therapy without bismuth (concomitant therapy) in the treatment of patients with Helicobacter pylori - associated gastric and duodenal peptic ulcer disease].

AIM: Evaluation of the efficacy and safety of quadrupletherapy without bismuth (concomitant therapy) in patients with Helicobacter pylori - associated gastric ulcer and duodenal ulcer in the framework of a comparative research in the population of patients in Russia. MATERIALS AND METHODS: A prospective randomized trial was conducted, which included 210 patients with H. pylori - associated gastric/duodenal ulcer without complications. During the process of randomization, the patients were divided into three equal groups (n=70) depending on the prescribed 10-day scheme of eradication therapy (ET): the first group received the classic triple scheme (Omeprazole 20 mg 2 times a day, Amoxicillin 1000 mg 2 times a day and Clarithromycin 500 mg 2 times a day); the second group received quadruple therapy with bismuth drugs (Omeprazole 20 mg 2 times a day, Tetracycline 500 mg 4 times a day, Metronidazole 500 mg 3 times a day, Bismuth subcitrate potassium 120 mg 4 times a day); the third group received quadruple therapy without bismuth - concomitant therapy (Omeprazole 20 mg 2 times a day, Amoxicillin 1000 mg 2 times a day, Clarithromycin 500 mg 2 times a day and Metronidazole 500 mg 2 times a day). Diagnostics of H. pylori infection during screening and control of eradication was carried out via the fast urease biopsy sample test and urea breath test system. Control of the effectiveness of ET of the microorganism was carried out not earlier than 4 weeks after the end of the treatment. During the course of therapy, the frequency of development of side effects was assessed using a special questionnaire. RESULTS AND DISCUSSION: The effectiveness of triple therapy was 72.8% (ITT; 95% CI of 62.17-83.54) and 78,4% (PP; 95% CI 68.19-88.72); quadruple therapy with the preparation of bismuth - 80.0% (ITT; 95% CI 70.39-89.6) and 84,8% (PP; 95% CI, 75.96-93.73); quadruple therapy without bismuth - concomitant therapy - 84.2% (ITT; 95% CI 75.54-93.02) and 92.1% (PP; 95% CI 85.43-98.94). Quadruple therapy without bismuth was reliably more effective than the classical triple therapy in the PP selection (p=0.044883). Statistical analysis showed a tendency to poorer effectiveness of ET in patients who had previously used antibiotic therapy (OR 0.4317; 95% CI 0.1776-1.049), and in individuals with a rapid metabolism genotype - CYP2C19*1/*1 (OR 0.12; 95% CI 0.005848-2.4624). The frequency of development of side effects during the use of triple therapy was 18.5% (95% CI of 9.23-27.91), when using quadruple therapy with bismuth - 20.0% (95% CI 10.39-29.6), and with the use of quadruple therapy without bismuth - concomitant therapy - 24.2% (95% CI 13.98-34.58). CONCLUSION: This prospective randomized study demonstrated the high efficiency of quadruple therapy without bismuth (concomitant therapy) in the framework of eradication of H. pylori infection in Russia.

[Diagnosis of incompetent communicating veins in contrast medium-sensitive patients]. / K diagnostike nesostoiatel'nykh kommunikatsionnykh ven u kontrastno-chuvstvitel'nykh bol'nykh.

A new functional method of phlebotonometry was used by the authors in 36 contrast--sensitive patient with postthrombophlebitic syndrome and varicosis for the purpose of diagnosing incompetent calf communicants. The determination of venous pressure in the superficial veins in these patients should be carried out between tourniquets three times at rest and against the backgrounds of the Valdman's test with the patient in a horizontal position by means of Valdman apparatus with elongated capillary tubes.

[Complications in surgical treatment of varicose veins of the lower limbs and their prevention]. / Oslozhneniia pri khirurgicheskom lechenii varikoznogo rasshireniia ven nizhnikh konechnostei i ikh profilaktika

To prevent hemorrhage and hematomas in the bed of subcutaneously removed large saphenous vein after Babcock the authors somewhat modified tactically the order of manipulations during the operative procedure. This method was employed while operating 42 patients with primary and secondary venous varices. It was feasible to prevent hemorrhage and hematomas along the vascular bed in every case. The suggested tactical modification of the removal of venous varices wound improve the postoperative course and shorten the terms of patients' stay at the hospital postoperatively.