[Role of vascular disorders in the pathogenesis of ulcerative colitis and its complications].

Mucous membrane circulatory disorders in ulcerative colitis (UC) are accompanied by significant capillary plethora with endothelial nuclear swelling in the capillaries and minor veins. Some cases show the development of secondary endophlebitis with thrombi occurring in individual veins. Occasionally, there is deep vein thrombosis in the leg with pulmonary embolism. Portal vein thromboembolism is very rarely observed during autopsy. The development of extensive deep mucous membrane ulcers gives rise to destruction of the vessels of the submucous plexis and its recurrent branchlets feeding the circular muscle layer. Impaired microcirculation is confirmed by the presence of myocytic dystrophic or necrotic changes. There are large transmural ischemic necroses in the area of toxic dilatation. Connective tissue foci develop in chronic UC at the site of ischemic necroses. Long longitudinal ulcers seen in nonspecific UC and Crohn's disease are likely to be ischemic, the course of which is long contraction of tenia with vein compression.

[State of the mouth cavity in patients with inflammatory intestinal diseases].

The article presents the results of the dental examination of 75 patients with ulcerative colitis and Crohn's disease with mild and medium-to-severe clinical course. Absolutely all of the patients had intensive dental caries and inflammatory diseases of the paradontium that exceeded the average statistical level for Moscow both in terms of incidence and severity. As many as 20-60% of patients suffering from inflammatory intestinal diseases also had such disorders of the mouth cavity mucous membrane as angular cheilitis, labial fissures, glossitis or aphthous stomatitis. The reduction of the alveolar bony tissue was usually found in cases of gingivitis and paradontosis. It was demonstrated that the treatment of this type of pathologies as well as preventive measures can essentially reduce the mouth cavity disease incidence for this group of patients and improve their life quality.

[Treatment of the irritable bowel syndrome from the point of conclusive medicine].

For many years the irritable bowel syndrome therapy was based only on an empirical approach. A lot of information has appeared for this period, which allows making a judgment about the efficacy of either of the ways of the functional bowel disorders treatment. A part of them was not approved in the course of clinical testing. At the same time, new high-performance ways of treatment appeared. This article presents an analytical survey of the irritable bowel syndrome pharmacotherapy. It also shows the role of diet, spasmolysants, psychotherapy, tricyclic antidepressants, serotonin reuptake inhibitors, HT3 antagonists and HT4 agonists.

[Evaluation of blood loss volume and the degree of activity of nonspecific ulcerative colitis by using Cr51-labeled erythrocytes]. / Otsenka ob"ema krovopoteri i stepeni aktivnosti nespetsificheskogo iazvennogo kolita metkoi éritrotsitov 51Cr.

The volume of daily blood loss was studied in 47 patients with nonspecific ulcerative colitis by labelling red cells with radioactive sodium chromate. The volume of blood loss correlated closely with the activity of the inflammatory process evaluated during colonoscopy. Unlike visual, often erroneous, evaluation of blood loss, radioisotope study in dynamics makes it possible to objectify the appraisal of the activity and severity of the process, choose a rational therapeutic tactics, and determine the efficacy of the antiinflammatory treatment.

[Fat absorption in patients with inflammatory diseases of the large intestine and diffuse polyposis]. / Vsasyvanie zhirov u bol'nykh s vospalitel'nymi zabolevaniiami tolstoi kishki i diffuznym polipozom.

Radioisotope method with oral administration of 131I-trioleate glycerin and 131I-oleic acid was used to study the absorption of neutral fats and fatty acids in 123 patients with ulcerative colitis, diffuse polyposis of the large intestine, and in 7 patients with ileostomy. It was found that fat secretion with feces was insignificantly higher than the normal and fluctuated within the range of 6.6-11.7%. Steatorrhea did not play a role in the development of clinical symptoms of the disease, and it might be caused by concomitant disorders in the bacterial flora. Slight disorders revealed in the fat absorption should not be considered as an obstacle to their normal use in the diet.

[Comparative characteristics of various types of operations performed in treatment of diffuse colonic polyposis]. / Sravnitel'naia kharakteristika razlichnykh vidov operatsii, primeniaemykh pri lechenii diffuznogo polipoza tolstoi kishki.

Diffuse polyposis of the large intestine characterized by the development of multiple polyps in it and their subsequent malignant degeneration is one of the most severe disease of the gastrointestinal tract. That it must be treated by surgery needs no proof. However, the volume and the character of the surgical intervention on the large intestine is still a debatable problem. The article discusses the experience in the follow-up of 445 patients for periods of 12 months to 30 years after operation for diffuse polyposis. In 228 patients various segments of the large intestine which were free from polyps were not resected. During these follow-up periods malignant tumors developed in the preserved parts of the large intestine in 10.1% patients and intensive growth of polyps was encountered in 3.5% of patients. The frequency of carcinoma development depended significantly less on the length of the follow-up period and much more on the character of affection of the preserved parts of the large intestine with the polyps.

[Crohn's disease in children]. / Bolezn' Krona v detskom vozraste.

Crohn's disease is a chronic transmural inflammation that can involve any part of the digestive system, from the oral cavity to the anal canal, being combined with many abenteric manifestations. It can appear at any age. The first description of this disease in a teenager was made in 1834 by B.B. Crohn, and 11 years later a series of observations describing 48 children with this disease was published. The concept of the Crohn's disease as a non-children illness underwent a change with the widening of diagnostic possibilities, wide use of the endoscopic method of diagnostics in pediatric practice, and histological studies of biopsy materials. A steady growth of the frequency of Crohn's disease detections has been recorded since the middle of the 1980s. Morbidity in Great Britain and Sweden doubled reaching 3.1 for 100,000 infants, and in 1993 its spread made up 16.6 for 100,000.

[Chronic constipations in elderly people]. / Khronicheskie zapory u pozhilykh.

Chronic constipations in elderly people proved to be an important medical and social problem due to their high prevalence and serious complications caused by the very disease and administration of stimulating laxatives. They include as follows: anorectic incontinence, large intestine obstruction, stercoral ulcers, laxative dependence and bowels toxic affection (Cathartic colon). Morphological and physiological prerequisites of chronic constipation and anorectic incontinence occurrence are examined in this review. Drugs and tactics for monitoring constipations depending on their severity, dominance of transit and evacuation disturbances, occurrence of anorectic incontinence are described. Characteristics of laxatives and intestinal motility regulators, range of side effects as well as experience of their application in elderly patients with functional constipations and irritable bowel syndrome are presented.

[Comparative efficacy of mezakol and sulfasalazine in treating chronic relapsing ulcerative colitis]. / Sravnitel'naia éffektivnost' mezakola i sul'fasalazina v lechenii khronicheskogo retsidiviruiushchego iazvennogo kolita.

This research testifies to the fact that it is more preferable to use mesacol than sulfasalazine in treatment of common forms of ulcerative colitis of light and average severity. Mesacol acts faster in arresting inflammations in proximal parts of the larger intestine. One can assume that the pH-dependent release of 5-aminosalicylic acid in these forms of the disease suffers less than the destruction of the diazo link by the anaerobic microflora, due to which a higher concentration of the preparation is formed in the large intestine. Another alternative explanation can be the dose-dependent effect. Thus, 2.4. g of mesacol correspond to 6 g of sulfasalazine. The dose of sulfasalazine was smaller in our study. Mesacol had no advantages over sulfasalazine in treatment of distal colitis, which can and must be treated with rectal introduction of corticosteroids and 5-aminosalicylic acid preparations. Thus, mesacol must be reserved for treatment of patients with common ulcerative colitis of light and average severity in case of intolerance to sulfasalazine or impossibility to increase the preparation dose over 4 g/day. Its efficiency and price make the preparation available for most patients and patient care institutions.

[Immunosuppressive therapy of inflammatory diseases of the large intestine]. / Immunosupressivnaia terapiia vospalitel'nykh zabolevanii tolstoi kishki

The treatment of ulcerous colitis and Crohn's disease is based on suppression of various components of the immunoinflammatory cascade. In addition to aminosalicylates and glucocorticoids, drugs of primary immunosuppressive action are used for this purpose, which are adopted from clinical oncology and transplantation medicine: azathioprine, 6-mercaptopurine, methotrexate, cyclosporine A, tacrolimus, mycophenolate mofetil, thalidomide. Some of them are used for remission induction in case of hormonal dependence or resistance, while others are applied for its maintenance or at various stages of the inflammatory process course. The presented review discloses problems of clinical pharmacology of immunosuppressive drugs, side effects, results of pilot and clinical studies of ulcerous colitis and Crohn's disease. All this makes it possible to determine their role in the therapy of inflammatory diseases of the bowels.

[Disorders of hemostasis in clinical picture and pathogenesis of inflammatory diseases of the colon (literature review)]. / Narusheniia gemostaza v klinike i patogeneze vospalitel'nykh zabolevanii tolstoi kishki (obzor literatury).

Hemostatic disorders are involved in the pathogenesis of inflammatory large intestine diseases. Both thrombocytes and humoral coagulation factors are involved in this process. An attempt to correct these disorders will allow not only to declare a new approach to the treatment of inflammatory large intestine diseases but also to clarify their role in the occurrence and persistence of an active inflammation during these diseases.

[Clinical-functional and morphological changes in the large intestine in patients with chronic abdominal ischemia]. / Kliniko-funktsional'nye i morfologicheskie izmeneninia tolstoi kishki u bol'nykh s khronicheskoi abdominal'noi ishemiei

The article presents a study of clinical variants of ischemic lesions of the large intestine (ILLI) in patients with the chronic abdominal ischemia (CAI) syndrome. There was an examination of 42 patients with putative ILLI, who had a cardiovascular pathology at the background, which led to significant hemodynamic disorders of the blood flow in unpaired visceral branches of the abdominal aorta. The authors performed a complex diagnostics of ILLI including anamnestic and clinical data, laboratory and morphological assessment of the large intestine and vessels providing its blood supply. Based on the data collected, other functional and organic diseases of the large intestine (LI) were excluded. It was revealed that the final result of ILLI differed depending on the ischemia degree--from reversible functional disorders to high-grade organic lesions of the LI. Each clinical variant of ILLI has its own clinical manifestations as well as functional, organic and morphological peculiarities of changes in the LI revealed by a laboratory and histological examination of the LI.