[Treatment of fatty hepatosis in diabetics]. / Lechenie zhirovogo gepatoza u bol'nykh sakharnym diabetom.

A ten-day course of karsil (silimarin, legalon) or silibor therapy improved the absorption (as indicated by ueviridin test) and oxidative-antitoxic (as shown by antipyrine test) hepatocyte functions in patients with non-insulin-dependent diabetes mellitus with hepatosis. A similar ten-day course of Liv-52 did not change the studied liver parameters. Inducto-thermal exposure of the splenic area (a 20 min session daily for 5 days) improved the absorption and antitoxic functions of the liver in diabetics. A positive effect of splenic inductothermia persisted for at least two weeks. The peak values of ultrasonic amplitude histogram of the liver reflect the time course of liver status in the course of karsil and silibor therapy and splenic inducto-thermal exposure.

[Non-ulcer dyspepsia syndrome]. / Sindrom neiazvennoi dispepsii.

In one thousand of 1500 examinees with nonulcerous dyspepsia the syndrome was due to chronic gastritis, duodenitis and gastroduodenitis, in five hundred of them it was attributed to probable dysfunction of the upper gastrointestinal tract. Morphological evidence of chronic gastritis activity is essential but not the only factor affecting the dyspepsia syndrome. Of importance are also motor dysfunctions: high intragastric and/or intraduodenal pressure, unbalance of intracavitary pressure parameters, gastroesophageal and duodenogastric refluxes. A significant contamination of antral mucosa with Helicobacter pylori aggravated dyspeptic manifestations.

[Drug effects on gallbladder motility (based on dynamic ultrasonic data)]. / O lekarstvennykh vliianiiakh na motoriku zhelchnogo puzyria (po materialam ul'trazvukovoi dinamiki).

Ultrasound registration of changes in gallbladder volume by the method of cylinder sum allows reliable means of studying gallbladder contractility in response to pharmacological load. Cerucal increased this activity in chronics with gastroduodenitis and diabetes mellitus, pentagastrin reduced the gallbladder volume. In duodenal ulcer patients a single dose of dalargin dilated the gallbladder for a short time, while in course treatment did not influence it. Gastrocepin inhibited motor activity of gallbladder as well as corinfar.

[Course and therapy of nonpancreatic complications of chronic pancreatitis]. / Techenie i terapiia vnepankreaticheskikh oslozhnenii khronicheskogo pankreatita.

Out of 647 patients with chronic recurrent pancreatitis followed up for 10-12 years 27 patients (4.2%) developed symptomatic gastroduodenal ulcers, 29 (4.5%) multiple gastroduodenal erosions. Ulcers and erosions emerged in patients with pronounced pancreatic bicarbonate insufficiency. Sucralfate treatment produced the best effect, while almagel plus vicalin were superior to gastrozepin. Relapses of ulcerogenesis were registered in 8 cases, multiple erosions in 11 cases, left pleural exudate in 8 cases in the presence of chronic pancreatitis exacerbation. Pancreatocardiac syndrome with cardialgias, a trend to arterial hypotonia, reduced voltage of ECG waves, occasional extrasystolic arrhythmia occurred in 45 patients (7%). It is shown that metabolic disorders of biogenic amines and lowered blood levels of insulin and C-peptide may underlie pathogenesis of pancreatocardiac syndrome.

[Echostructure of the pancreas. Comparison with exocrine secretory activity of the pancreas in patients with diabetes mellitus]. / Ekho-struktura podzheludochnoi zhelezy. Sopostavlenie ee s vneshnesekretornoi pankreaticheskoi aktivnost'iu u bol'nykh sakharnym diabetom.

Qualitative disorders of an echopancreatogram are noted in half of patients with diabetes mellitus (both insulin dependent and noninsulin dependent). The most significant echopancreatographic quantitative and qualitative disorders were observed in diabetic patients with a maximal decrease in pancreatic enzyme excreting activity (on the basis of lipase and trypsin debit in a pancreozymin test, daily steatorrhea and chymotrypsin amount in daily feces). It has been assumed that a degree of ultrasound changes in the pancreas in diabetes depends on a degree of fibrosis of pancreatic exocrine tissue. Ultrasound investigations with quantitative and qualitative assessment of echopancreatograms is a valuable adjuvant diagnostic method in diabetes mellitus.

[Duodenal ulcers that do not heal for a long time]. / O dolgo nezazhivaiushchikh iazvakh dvenadtsatisperstnoi kishki.

The investigations of 43 duodenal ulcer cases in the patients whose ulcers failed to cicatrize after a 8-week treatment with almagel and vicalin or cimetidine monotherapy revealed the role of the hereditary load, smoking intensity, initial ulcer dimensions, the presence of antral erosions and a pronounced periulcerous duodenitis in the phenomenon of slow healing duodenal ulcer. There was no statistical difference between the values of the basal and pentagastrin-stimulated levels of hydrochloric acid secretion in the morning, partial alkaline gastric secretion, gastrinemia, the rate of evacuation of the gastric contents into the duodenum, the outcome of pancreatic bicarbonates in the sample with exogenic secretin in those whose ulcers cicatrized after a 6-week therapy and those who failed to be cured after being exposed to the same therapy during 8 weeks. The production of hydrochloric acid in the evening and the incidence of manifest duodenal reflux were significantly higher in the patients with slowly healing ulcer. They also had a decreased sensitivity to the intraduodenal inflow of the hydrochloric acid that resulted in the increase of endogenic secretin (stimulating the production of pancreatic bicarbonates and their transport into the duodenum). In case the combination treatment with almagel and vicalin failed, the therapy with gastrocepin or sucralfate was employed. A supplementary course of sucralfate helped to reach a complete healing of noncomplicated ulcers even in the patients in whom the preceding cimetidine treatment failed.

[Cholecystokinin incretion and the pharmacological effects on it in patients with chronic pancreatitis]. / Inkretsiia kholetsistokinina i farmakologicheskie vliianiia na nee u bol'nykh khronicheskim pankreatitom.

In patients with chronic pancreatitis (CP) (cholepancreatitis and primary recurrent pancreatitis), a moderate decrease of urocholecystokinin (UCK) excretion as a criterion for incretion of cholecystokinin-pancreozymin (CK) by duodenal endocrine cells was recorded in the presence of concomitant atrophic duodenitis. The beta-adrenoblocker obsidan, the blocker of m-cholinergic receptors gastrozepin, the antagonist of calcium channels finoptin and the synthetic analog of endogenous opiates dalargin reduced excretion of UCK in CP exacerbation. The decrease of CK incretion can be viewed as one of the mechanisms of the therapeutic action of these drugs in CP exacerbations. In the stage of CP remission, calcium gluconate consistently increased basal and intraduodenal oil (as a realizer of CK incretion) infusion-stimulated excretion of UCK. The enhancement of duodenal incretory activity is an essential mediating mechanism by which calcium gluconate stimulates pancreatic enzyme excretion.

[Significance of duodenitis and disorders of gall bladder motility in patients with diabetes mellitus]. / Znachenie duodenita v narushenii motoriki zhelchnogo puzyria u bol'nykh sakharnym diabetom.

Contractility of the gall bladder (by ultrasound criteria) and pancreatic enzyme excretion were considerably decreased in patients with diabetes mellitus of noninsulin dependent type in the presence of atrophic duodenitis, confirmed by endoscopy and histology, as compared to diabetic patients without duodenitis or with non-atrophic duodenitis. The data obtained were discussed with relation to a decrease in the excretion in atrophic duodenitis of cholecystokinin-pancreozymin (the main physiological stimulator of motility of the gall bladder and pancreatic enzyme excretion). It turned out that contractility of the gall bladder in patients with diabetic neuropathy was much less than that in diabetic patients without neuropathy provided all other conditions were the same. All the results obtained permitted better understanding of the essence, mechanisms and clinical meaning of gastroenterological disorders in patients with diabetes mellitus.

[The use of ultrasonic amplitude histography in the diagnosis of chronic pancreatitis]. / Primenenie ultrazvukovoi amplitudnoi gistografii v diagnostike khronicheskogo pankreatita.

Ultrasound amplitude histography was used to evaluate structural disorders of the pancreas in patients with chronic pancreatitis. The amplitude histogram peak proved to be higher in chronic pancreatitis that in healthy subjects. The method enables to differentiate patients according to the severity of the disease characterized by the level of pancreatic enzyme-secretory insufficiency.

[The effect of cimetidine and gastrozepin on liver function and the pharmacotherapy of "hepatogenous" gastroduodenal ulcers and erosions]. / Vliianie tsimetidina i gastrotsepina na sostoianie pecheni i farmakoterapiia "gepatogennykh" gastroduodenal'nykh iazv i érozii.

Toxic hepatitis developed but in one out of 127 peptic ulcer patients treated with cimetidine. In patients (n-142) treated with gastrozepine, no cases of toxic hepatitis were recorded. These anti-ulcer agents did not influence absorptive capacities of the liver or hepatic blood flow. Meanwhile microsomal exidase (antitoxic) function of hepatocytes noticeably declined as a result of cimetidine treatment in every 8th patient with peptic ulcer subjected to the continuous 5-week treatment with the drug and in every 5th patient given the treatment (maintenance included) for a longer time. In patients suffering from liver cirrhosis with secondary gastroduodenal ulcers or multiple erosions, the 5-week treatment either with almagel and platyphylline or gastrozepine provided approximately similar results and promoted ulcer and erosion healing in half the cases. Adjuvant 3-week therapy with sucralfate (venter) having cytoprotective properties led to the disappearance of gastroduodenal ulcers and erosions in 23 out of 26 patients, in whom the previous treatment was ineffective.

[Gastrin and the exocrine-incretory activity of the pancreas in patients with chronic pancreatitis]. / Gastrin i ékzokrinno-inkretornaia aktivnost' podzheludochnoi zhelezy u bol'nykh khronicheskim pankreatitom.

In patients suffering from chronic pancreatitis with concomitant atrophic antral gastritis, gastrinemia is less whereas the response of pancreatic enzymic secretion to pentagastrin is more potent than in patients suffering from chronic pancreatitis without atrophic alterations in the gastroduodenal mucosa. The pancreas-stimulating effect of pentagastrin administered in a dose of 6 micrograms/kg is approximately equal to the action of 0.5 U/kg pancreozymine and noticeably yields to the effect of 1.5 U/kg pancreozymine (according to the criteria for output of intraduodenally secreted lipase and trypsin). The same diagnostic dose of pentagastrin used commonly for gastric secretion studies not only stimulates pancreatic enzyme secretion but also enhances the activity of beta-cells of Langerhans' islets of the pancreas in accordance with insulinemia and blood C-peptide determined by RIA.

[Erosive reflux-esophagitis and its treatment]. / Erozivnyi refliuks-ézofagit i ego lechenie.

Altogether 78 patients were examined over time. They had erosive reflux esophagitis that complicated the course of duodenal ulcer (in 42 patients, hypersecretion of hydrochloric acid was the leading mechanism of the disease development) and chronic gastroduodenitis (36 persons manifested failure of the inferior sphincter of the esophagus with or without excess acid output). In patients with peptic ulcer exacerbation, the four-week treatment with cimetidine or gastrozepine compared very favourably with almagel and vicalin as regards the treatment efficacy. In chronic gastroduodenitis, the combination of almagel, vicalin and cerucal produced a therapeutic effect that did not yield to the effect of cimetidine or gastrozepine. In 1/5-2/5 of cases, erosive esophagitis was not amenable by the four-week treatment. In 17 out of 18 such patients, the two-week therapy with sucralfat (venter) resulted in the disappearance of esophagitis with multiple erosions. During 1-2 years, erosive reflux esophagitis recurred in 11 out of 34 patients with peptic ulcer and in 2 out of 17 suffering from chronic gastroduodenitis. In all the cases, the disease recurred in those patients who had not received systematic treatment with antisecretory and cytoprotector agents.

[Functional sequelae and clinical importance of atrophic duodenitis]. / Funktsional'nye posledstviia i klinicheskoe znachenie atroficheskogo duodenita.

As compared to healthy persons and patients with non-atrophic duodenitis, patients with atrophic duodenitis manifest a decrease of gallbladder contractility as shown by the ultrasonography data. In chronic pancreatitis with concomitant atrophic duodenitis, the degree of a decrease in pancreatic enzymic secretion is more considerable than in patients suffering from chronic pancreatitis without duodenitis or from non-atrophic duodenitis. Comparison of the tests for enhancement of the incretion of endogenous cholecystokinin-pancreozymin and with intravenous injection of the hormone formed the basis for regarding incretory duodenal insufficiency as a cause of hypomotor dyskinesia of the gallbladder and deepening of pancreatic enzymic secretion inhibition in cases with atrophic duodenitis. The data obtained may be of importance for estimating the mechanisms of the impairment of gallbladder contractility and pancreatic enzymic secretion in alimentary diseases as well as for prognosis determination and choice of therapeutic modalities.

[The differential diagnosis of primary and secondary diabetes mellitus in pancreatitis patients]. / Differentsial'naia diagnostika pervichnogo i vtorichnogo sakharnogo diabeta u bol'nykh pankreatitami.

A prospective study is presented of large groups of patients with primary and secondary (in patients with acute of chronic pancreatitis) diabetes. Clinical actual problems of differential diagnosis of these conditions using clinical and paraclinical methods of diagnosis. The authors describe the most difficult diagnostic situations and orientate the physicians how to manage them.