[Can the intra-abdominal hypertension be the cause of poly-organic insufficiency during the destructive pancreatitis?].

The results of measurement and dynamics of intra-abdominal pressure obtained in 129 patients with acute destructive pancreatitis are presented. It was revealed that in 78% cases the pancreatonecrosis is accompanied by increase in intra-abdominal pressure (IAP); the intra-abdominal hypertension have developed in 9,3% patients. The prolonged intra-abdominal hypertension in the patients with progressive pancreatonecrosis requires the performance of laparotomy, which contributes to decrease in intra-abdominal pressure. The dependence between IAP value and dissemination of pancreatogenic inflammatory process in abdominal cavity and retroperitoneal space as well as between IAP level and condition gravity according to APACHE II scale was revealed.

[The outlook for the development and improvement of ambulatory polyclinic care]. / Perspektivy razvitiia i sovershenstvovsaniia ambulatorno-poliklinicheskoi pomoshchi.

Out-patients medical care development represent one of the main tasks of the military medical service reforming. The essential effort focuses on a pre-hospital stage of medical aid, i.e. forming-up of day hospitals, centers of specialist care for out-patients, new personnel policy and medics' training improvement.

[Nonepithelial tumors of the stomach]. / Neépitelial'nye opukholi zheludka.

816 patients were operated on because of gastric tumors; in 55 cases they were nonepithelial. Lymphomas have been found in 18 cases, glomus tumors--in 13 cases, leiomyomas, neurinomas and lipomas--in 11 cases, carcinoid--in 7 cases, aberrant pancreas--in 5 cases, gastric wall cyst--in 1 case. In half of the cases tumors were malignant. The preoperative diagnosis was absolutely correct in 30.9% patients and in 61% of cases with gastric lymphomas. All patients with nonepithelial gastric tumors should be operated on. In gastric lymphoma extirpation of the stomach is the operation of choice. In nonmalignant tumors with infiltrative growth and a size not more than 3 cm a stomach resection should be done, in a smaller size--a wedge resection and in subserous small tumors its enucleation, in submucous variant--endoscopic removal is possible.

[HIV infection in servicemen (the work experience of a specialized hospital department)]. / VICh-infektsiia u voennosluzhashchikh (po opytu raboty spetsializirovannogo otdeleniia gospitalia).

PIP: In 1987, under the aegis of the governmental campaign against AIDS, military hospitals in Moscow established a department for the diagnosis and treatment of HIV-infected and AIDS patients among the military and their families. Clinical and laboratory examinations showed that 96 people out of 130 examined either were positive for HIV or were suffering from symptoms of AIDS. 77 were military from African countries, 15 from Russia, and 4 were their family members. Out of these 15 patients from Russia, 8 had been infected via sexual intercourse: 1 via homosexual and 7 via heterosexual intercourse. In 10 patients, HIV infection had been diagnosed 1-2 years after being infected, in 3 patients 3-6 years later, and in 2 patients more than 10 years afterwards. Every other patient exhibited symptoms of the second stage of AIDS: persistent generalized lymphadenopathy. 4 patients had lost body weight, 8 patients had prolonged fever, 2 had diarrhea, 4 had various dermatological symptoms, 4 had opportunistic infections, 5 had other infections (viral hepatitis, acute pneumonia, and salmonella), and 3 patients had other ailments (paranephritis, salpingoophoritis, endometritis, purulent otitis). The cases of 3 patients are described in detail. 4 out of 5 patients who were transferred to this special department demonstrated severe inflammatory processes as a consequence of their HIV-infection: paranephritis, pneumonia, purulent cholangitis, and salmonella. All patients also evinced damage to their immune system: the reduction of T-lymphocyte count and T-helper cells and the reduction of the index of T-helper/T-suppressor cells (to 0.31 from the norm of 1.1-2.2). The treatment of AIDS patients consisted of the use of azidothimidine, which inhibits the activity of reverse transcriptase; the stimulation of the immune system by means of timalin (10 mg for 5 days im); and treating secondary fungal infections (up to 8 million IU of nystatin/day, up to 4 million IU of levorin, and up to 200 mg of diflucan).^ieng

[The status and trends in the improvement of specialized medical care]. / Sostoianie i puti sovershenstvovaniia spetsializirovannoi meditsinskoi pomoshchi.

The article analyses the changes which have taken place during the last years in the functioning of the system of specialized medical care in the Armed Forces of Russian Federation. A new definition of this kind of medical care is given in this article, as well as its contents, components, and methods of its further improvement. The authors stress the positive results which were achieved by large multipurpose medical establishments with organic specialized medico-diagnostical units. Trends towards the further development of the system of specialized medical care were created taking into account the regional system of medical support of the Army and Navy. This article has a scientific and practical character and is interesting for the physicians and pharmacists of all specialties.

[The radionuclide diagnosis of post-gastric resection disorders]. / Radionuklidnaia diagnostika postgastrorezektsionnykh rasstroistv.

The article studies the possibilities of radionuclide method in disclosing the basic postgastroresectional syndromes: dumping syndrome, duodenogastric reflux and afferent loop syndrome. After resection of stomach 92 patients were examined throughout a period from 1 to 10 years. During dynamic scintigraphy of liver characteristic changes were disclosed in biliary secretory system which could have diagnostic significance. This method gives the possibility to determine the frequency, duration and volume of duodenogastric reflux. It was found out that Roux's [correction of Rue's] method of resection have resulted in minimal number of duodenogastric refluxes. Dynamic scintigraphy of stomach is useful for studying evacuative function of the resected stomach and for afferent loop syndrome diagnosis, which sometimes is more informative than a wide-spread barium sulfate roentgenological method.

[Operations on the stomach with a Roux anastomosis]. / Operatsii na zheludke s anastomozom po Ru.

In order to prevent complications such as reflux gastritis, reflux esophagitis, erosions, ulcers and tumors of the gastric stump the Roux anastomosis was used in 497 patients. Among them there were 194 patients after distal resection of the stomach, 239--after extirpation of the stomach, 45 after vagotomy, antrumectomy, 19 after reconstructive operations on the stomach. These patients had organic complications much more rarely: 3.7% had reflux esophagitis (after resection of the stomach on the short loop and with Brown anastomosis--in 50.5%), 12.5% (85.4%) had reflux gastritis, 3.66% (23.7%) had erosions and ulcers of the gastric stump, 2.1% (21.5%) had polyps and carcinomas of the gastric stump. Postoperative lethality was 3.09 and 7.12%.

[Indications for and the effectiveness of the Nissen operation]. / Pokazaniia k primeneniiu i éffektivnost' operatsii Nissena.

Fifty six Nissen operations and 42 fundorrhaphies+ were performed in patients with hiatal hernias, insufficiency of the lower esophageal sphincter as well as for prophylactic purposes as an addition to vagotomy. In remote periods under examination there were 78 patients, 36 of them had different disorders, most of them of functional character which can be easily arrested by conservative methods.

[Malignant tumors as cause of death of patients with duodenal ulcer]. / Zlokachestvennye opukholi kak prichina smerti bol'nykh s iazvoi dvenadtsatiperstnoi kishki.

A study of 269 cases of chronic duodenal ulcer showed cancer to be the cause of death in 131 (48.7%). Tumors of the lung, large bowel, prostate and kidney developed most frequently.

[Duodenogastric reflux and the pathomorphological picture of the stomach of patients operated on for duodenal ulcer]. / Duodenogastral'nyi refliuks ipatomorfologichaskaia kartina zheludka u bol'nykh, operirovannykh po povodu iazvennoi bolezni dvenadtsatiperstnoi kishki.

The incidence and degree of gastroduodenal reflux and of pathomorphological alterations in the gastric mucosa were studied in 135 patients within the period from 3 to 25 years after the surgical treatment of ulcer disease of the duodenum.