; RESULTS OF RESECTION METHODS OF TREATMENT IN PATIENTS WITH GIANT PYLORODUODENAL ULCERS COMPLICATED BY PERFORATION AND BLEEDING.

We studied the immediate and long-term results of various methods of gastric resection in 35 patients operated at the S.S. Yudin State Medical Center in Moscow from 2000 to 2019. 20 (57.1%) patients were operated on for perforation, and 15 (42.6%) patients underwent surgery for ulcerative bleeding. There were 27 (77.2%) males and 8 (22.8%) females. The average age of patients was 48.3±2.3 years. The diagnosis of peptic ulcer disease was previously made in 24 (68.6%) patients, the duration of the disease was 7.7±2.7 years. Of the 35 patients, 29 (82.8%) underwent standard gastric resection without vagotomy with Billroth-II anastomosis in various modifications and 6 (17.2%) underwent pylorobulbar resection with Billroth-I anastomosis with bilateral stem vagotomy. According to the analysis of the results of surgical interventions, gastric resection was accompanied by a significant number of early postoperative complications observed in 18 (51.4% of patients): associated with the nature of the operation, 10 and 5 patients had complications from the cardiovascular and respiratory systems. The most frequent complication due to the nature of surgery was a clinically significant violation of the evacuation function of the stomach stump, which developed in 8 of 35 (22.8%) patients. In 4 patients after pylorobulbar resection, the violation of the evacuation function of the stump was due to its parasympathetic denervation. The remaining 4 patients after standard resection of gastric stasis stump occurred due to maintenance of anastomositis of gastrojejunal anastomosis. Post-vagotomic diarrhea: observed in 3 of 6 patients: 1 patient of moderate severity, and 2 patients-mild. Failure of sutures was observed in 2 out of 35 (5.7%) patients after standard gastric resection: one after resection of Hofmeister Finsterer and the other after resection for PY. Complications from the cardiovascular system were observed in 5 (14.3%) patients. After surgery, 5 (22.7%) patients died: 4 after resection of 2/3 of the stomach and 1 patient after pyloroduodenal resection with stem vagotomy. All the deceased were operated on urgently: 2 patients for perforation of giant ulcers and 3 patients for continuing profuse bleeding. The causes of death of patients operated on for bleeding were: myocardial infarction in 1 patient, pulmonary embolism in 2 patients. Another 2 patients with failure of duodenal stump sutures, operated on for perforation of giant ulcers, died from increasing cardiovascular insufficiency. The analysis of long-term results of surgical interventions showed a steady decrease in the number of post gastric resection and post-vagotomic disorders, as well as the absence of ulcer recurrence. It should be noted that the phenomena of dumping syndrome observed in patients after standard gastric resection were not severe and were corrected by a lax diet. After piloroduodenal resection with anastomosis by Billroth-I and stem vagotomy, manifestations of gastrostasis and diarrhea were stopped in the remote postoperative period. When assessing the quality of life, there were no unsatisfactory results, all previously operated patients led their usual lifestyle, maintained their working capacity, and did not require re-hospitalization.

PECULIARITIES OF ACID PRODUCTION AND PATHOGENESIS OF PYLORIC AND PREPYLORIC GASTRIC ULCER COMPLICATIONS.

The purpose of the study was to identify the pathogenesis features of prepiloric and pyloric ulcers and to establish the cause of resistance to conservative therapy and the tendency to complicated course of type III ulcers according to H.D. Johnson. A comparative analysis of acid production was carried out in 150 patents with duodenal ulcer (n-80) and peptic ulcer of type III according to H.D. Johnson classification (n-70). We revealed a definite individual rhythm of daily intragastric acidity with a maximum rise at night in patients with duodenal ulcer. The paper explores the peculiarities of digestive juice secretion depending on ulcerative substratum localization. The pathogenetic validity of the use of antisecretory drugs for duodenal ulcer treatment and the need to further improve the algorithm for pyloric and prepyloric ulcer therapy are shown. For pyloric and prepiloric ulcers characteristic specific morphological changes in the muscle layer of the wall of the antrum, leading to the motor-evacuation disorders and promoting duodenogastric reflux - dystrophy myocytes circular muscle layer vacuolation of the cytoplasm, edema and hypertrophy ganglia intermuscular plexus, hemorrhages in the muscle sheath, violation of muscle bundles.

[Manifesting schizophrenic attacks in female adolescents].

Authors have analyzed pre-manifesting symptoms as well as initial and manifesting stages of the disease on the basis of examination of 70 patients, aged 15-17 years. Schizoid and psychastenic types dominated in the premorbid structure of personality. The following variants of the initial stage were singled out: affective, psychopathic-like, with overvalued disorders, neurotic-like, with the predomination of simplex-syndrome, clinically polymorphic. Manifesting schizophrenic attacks in female adolescents were determined by affective-delusive, hallucinatory-delusive, oneiroid-catatonic and polymorphic syndromes. The attack-like course was found in most of cases. The typological similarity of psychotic states studied with those of adult schizophrenic patients was noted.

[A role of sex in the development of manifesting schizophrenic psychoses in adolescents].

To study an effect of sex on symptoms and course of schizophrenia, we have compared two groups (n=70) of adolescents of both sexes with manifesting schizophrenic psychoses. Between-group differences in the family history of schizophrenia, premorbid functioning, typology and duration of initial and manifesting stages of the attack, dynamics of psychosis, frequency of cognitive disorders have been revealed. These differences may predict a benign course of schizophrenic psychosis in girls as compared to boys.

[Changes of the level of serum antibodies to neuroantigens in patients with schizophrenia during the treatment].

The level of antibodies (AT) to neuroantigens (nerve growth factor and basic myelin protein) has been studied in the serum of 80 patients with schizophrenia, attack-like type, (ICD-10 items F20.01-02) during the treatment with psychotropic drugs. Therapeutic effectiveness has been measured clinically and with the PANSS. It has been shown that the autoimmune component is present during the acute episode of schizophrenia in about 30% of cases. No statistically significant differences have been found in the mean values of AT before and after the treatment however the dynamics of their changes has been closely related with the results of therapy: the decrease of AT level during the therapy is a predictive factor for good therapeutical remission; on the contrary, the increase of this level may be considered as an unfavorable prognostic factor.

[Serum immunological markers as predictors of effectiveness of antipsychotic therapy in patients with schizophrenia].

Serum immunological parameters - activity of leukocyte elastase (LE) and a1-proteinase inhibitor (a1-PI), content of C-reactive protein, von Willebrand factor, interleukin 8 as well as a level of autoantibodies to neuroantigens (nerve growth factor and basic myelin protein) were studied in patients with schizophrenia during their treatment with psychotropic drugs. All parameters studied differed in the groups of patients and controls. However, the pronounced dynamics was found only for LE and a1-PI activity. After the therapeutic course, the reduction of LE activity accompanied by the increase of a1-PI activity was observed. The correlation study between the biological parameters during disease exacerbation and therapeutic effectiveness assessed by the PANSS scores revealed that activity of LE and a1-PI may be considered as a prognostic marker of therapeutic efficacy, i.e. the high enzyme activity at the moment of maximal activity of the process was predictive of good therapeutic response.

Rapid identification of group A streptococcus as the cause of necrotizing fasciitis.

Group A beta-hemolytic Streptococcus pyogenes (GAS) causes a spectrum of highly aggressive, invasive infections. We report two cases of necrotizing fasciitis in which GAS was identified as the presumptive causative organism with the use of the standard rapid streptococcal diagnostic kit. We believe the rapid test kits may be a useful adjunct in the diagnosis and treatment of this catastrophic illness and may play a role in limiting the spread of infection.

[Planning of computerized tomography using an X-ray stereogrammetry method]. / Planirovanie vychislitel'noi tomografii s pomoshch'iu s tereorentgenogrammetricheskogo metoda.

X-ray stereogrammetry is used to derive the geometry of optimum body section. Principles and methodology of a trial-and-error technique for X-ray stereogrammetric survey are analysed. Calculations of the optimum slice for one of the clinical situations are presented along with experimental results obtained with a computed tomograph.