[Morpho-immunological criteria for diagnosis of gastritis associated with Helicobacter pylori].

31 bioptates in the antral mucosa of 24 patients with a chronic gastritis and a body of a stomach for revealing H. pylori were being analysed and for the further studying morpho-immunology communications. The presence of H. pylori in bioptates, gastrits's activity (leukocytic infiltration), gastrits's degree evidence, also eosinophilus's presence and IgE containing plasmocytus had correlated with antibodies titre to H. pylori. After inspection, at the majority of patients serum antibodies to H. pylori correlated with positive respiratory-test. Considering that high sensitivity and specificity of immune-enzyme detection of antibodies to H. pylori in theirs blood serum, this method side by side with respiratory-test can be used at the primary screening H. pylori infections. The Biotates morphological examination is the "golden standard" of H. pylori gastritis' diagnostic by it's informatively and diagnostic's importance.

[Phlebothrombosis and pulmonary thromboembolism in patients with thrombophilia].

A study was made of the course of phlebothrombosis ana pulmonary thromboembolism in 54 patients with thrombophilia. Of these, 23 patients had factor la resistance to protein C, 15 presented with antiphospholipid syndrome, four with protein C deficit, one with protein S deficit, three with antithrombin III deficiency, and three patients with hyperhomocysteinemia. Five patients presented with the following combined forms of thrombophilia: thrombophilia due to protein C deficit and antiphospholipid syndrome; protein C deficit and hyperhomocysteinemia; protein C and antithrombin III deficit; factor Va resistance to protein C and hyperhomocysteinemia; antiphospholipid syndrome and hyperhomocysteinemia. Thrombosis of the inferior vena cava (IVC) was present in 52 and PTE in 27 patients, The recurrence of phlebothrombosis was recorded in 40 (76.9%), that of PTE in 12 (44.4%) patients. The time elapsed between disease exacerbations accounted for one month to nine years, the number of recurrences constituted two to 6. Initially, thrombosis in three patients was located in lower limb saphenous veins, in 18 in the tibial and femoral veins, in 29 in the femoral and iliac veins; two patients presented with femoroiliocaval phlebothrombosis. The recent control examination revealed thrombosis of the saphenous veins in two patients. In ten patients, thrombosis was located in the tibiofemoral segment, in 19 patients, it was discovered in the femoroiliac and in two cases, in the femoroiliocaval segment. During observation period, venous thrombosis in the previously intact lower limb developed in nine (16.7%) patients. Thrombosis of other vessels inclusive of the organ ones was present in 14 (25.9%) patients. Of these, seven patients had thrombosis of the arteries of the upper and lower limbs: in four cases, it was located in the system of the IVC and in two cases, in the mesenterial arteries; ischemic stroke was recorded in two cases, thrombosis of the portal vein in one, and myocardial infarction was also marked in one case. In view of different hemostatic changes underlying the development of venous thromboses and PTE, we carried out differentiated therapy applying anticoagulants, platelet inhibitors, and transfusions of quickfrozed plasma. In acute femoroiliac and caval thromboses and PTE, 40 patients were provided implantation into the IVC of the cava filter <>. After cava filter implantation 16 patients developed tnrombosis of the IVC. Embolism to the cava filter occurred in seven patients. In three cases, it terminated in occlusion of the IVC and in the remaining cases, in its recanalization. Over the period one to six years, occlusive thrombi of the IVC underwent recanalization in 11 patients. Analysis of the course of phiebothrombosis and PTE in patients with thrombophilia made it possible to define situations that require its goal-oriented search. It is demonstrated that it is advisable to implant the cava filter <> to the permanent position in thromboses of the femoral, iliac veins and of the IVC as well as in PTE.

[Methods of surgical and pharmacotherapeutic influence on the celiac plexus in abdominal surgery].

Literature and own experience in surgical, surgical-pharmacological and contact electro-pharmacological influence on the celiac plexus for correction of dysfunctions in the upper abdominal diseases are analyzed. Original surgical procedures on sympathetic nerves in celiac neuro-ischemic syndrome, chronic duodenal obstruction, duodenal ulcer, and also methods of catheterization and electro-pharmacological impact on celiac plexus in celiac ganglioneuritis and surgical trauma of the stomach are described.

[Some features of orthostatic venous hemodynamics of the lower extremities in healthy, subjects and patients with varicose disease according to duplex scanning data]. / Osobennosti ortostaticheskoi venoznoi gemodinamiki nizhnikh konechnostei u zdorovykh i bol'nykh varikoznoi bolezn'iu po dannym dupleksnogo skanirovaniia.

Duplex scanning of the subcutaneous, deep and perforating veins was performed to examine venous return and to establish the diagnosis of valvular venous insufficiency of the lower extremities in 32 clinically healthy subjects (64 extremities) and 38 patients suffering from varicose disease (VD), when the patient was in the horizontal and vertical position. It has been established that in VD patients, the diameter of the deep and subcutaneous veins is greater than that in healthy subjects. When the patient is in the vertical position, the venous lumen expands 1.5-fold on the average (1.6-fold in healthy subjects and 1.4-fold in VD patients) under the influence of orthoshtatic venous pressure (,the sum of hydrodynamic and hydrostatic pressure). The growth of the total venous pressure up to the design values in the distal segments of the lower extremities is removed not only by musculovenous pump (MVP) motion but also by the MVP of free standing (maintenance of body balance) as well as by the action of the arteriovenous pump (AVP). The frequency of recording the retrograde blood runoff at functional exerelse in healthy subjects when they are in the orthostatic position is dramatically reduced. This phenomenon may be related to the orthostatic dilatation of the great veins and tension of the cusps of the unchanged valves, which should be regarded as a functional component of the closing mechanism of the MVP, In YD patients when they are in the orthostatic position, the frequency of revealing the design valvular insufficiency (according to the duration of retrograde runoff) decreases in the deep and rises in the subcutaneous veins. Valvular insufficiency of the perforating veins of the leg was primarily recorded in the veins of Cockett. The data obtained indicate that examination of venous function of the lower extremities is desirable when the patients are in both horizontal and vertical position.

[Evaluation of efficacy of varicose vein surgery]. / Otsenka éffektivnosti metodov khirurgicheskogo lecheniia varikoznogo rasshireniia ven.

A new system of evaluation of efficacy of varicosity surgery is proposed. This system considers regress of chronic venous insufficiency based on it 4-degree classification and recurrences of the disease. Based on these criteria comparative study of efficacy in long-term period (from 6 months to 6 years) of new method of varicosity surgery--ligation of changed subcutaneous major veins and inflows, perforants of Achilles fat window (104 patients) and standard phlebectomy with open ligation of perforants (94 patients) was carried out. Efficacy of new mini-invasive method was demonstrated including in patients with trophic disorders.

[Concealed exclusion of perforant and varicose veins of lower extremities venous insufficiency (communication II)]. / Skrytoe vykliuchenie perforantnykh i varikozno-rasshirennykh ven nizhnikh konechnostei pri khronicheskoi venoznoi nedostatochnosti (soobshchenie II).

The second and the third elements of surgical treatment of a varicose disease and chronic venous insufficiency by concealed exclusion of perforant and varicose subcutaneous veins are outlined. The exclusion of perforant veins of the shin is limited by the zone of Achilles (sub- and retromalleolar) cellular space in muscular channel of the lower extremity. Blunt supra- and infrafascial dissection of cellular tissue with passing there extramuscular perforant veins is performed between two incisions-punctures of the skin of internal surface of the shin at the level of 7 and 20 cm from the sole of the foot using firm ligature and Jigly's hand-saw. Because of disadvantages of Clapp's method, a modified way of putting immersed concealed ligatures on subcutaneous varicose veins is proposed. It includes the usage of the second needle with a blunt end as well as returned conducting of the ligature's end above the vein in a shape of a double loop. After tying a knot with one branch of the loop by pulling another dipping end of the ligature the dissection of the tied vein from the skin and its dislocation within its own bed is carried out. 58 patients were operated on according to this method of treatment for varicose vein disease and recanalized form of the postphlebothrombotic syndrome. Unfavorable outcome was detected in 1 patient with occlusion form of this syndrome and chronic venous insufficiency of III grade in which operative treatment was not strictly indicated.

[Methods of concealed exclusion of lower extremities perforated and varicose veins in chronic venous insufficiency]. / Metody skrytogo vykliucheniia perforantnykh i varikozno-rasshirennykh ven nizhnikh konechnostei pri khronicheskoi venoznoi nedostatochnocti (soobshchenie 1).

A new method of concealed exclusion of major and minor subcutaneous veins by application of subcutaneous ligatures with the use of special instrument--intravenous elevator was described. The application of this method in 53 patients with varicose disease after complex operations resulted in good and excellent follow-up outcomes.

[Initial experience in the diagnosis of thrombophilia due to activated protein C resistance]. / Pervyi opyt diagnostiki trombofilii, obuslovlennoi rezistentnost'iu k aktivirovannomu proteinu C.

The authors describe the first in Russia cases of thrombophilia caused by factor Va resistance to activated protein C. This abnormality was diagnosed in 6 of 25 patients (24%) with recurrent early thrombosis. The diagnosis was conducted according to a modified method implying the addition of protac (activator of protein C) to normal platelet poor plasma (PPP) free of factor V containing 100% of protein C. Protac dose was adjusted to increase the activated partial thromboplastin time (APTT) 2.4-2.8-fold in mixing PPP of the examinee with plasma containing activated protein C. The indices were estimated indicative of insufficient prolongation of APTT in response to activated protein C. Of 6 patients, 2 had apparent and 4 strong resistance to activated protein C. Treatment policy in this variant of thrombophilia is discussed.

[Intravascular prevention of pulmonary thromboembolism (cava filter volan). 2]. / Endovaskuliarnaia profilaktika tromboémbolii legochnykh arterii (kava-fil'tr "volan") (Soobschchenie 2).

The article describes a cava filter "volan" suggested by the authors and the methods of its implantation through the subclavian or femoral vein for primary or secondary prevention of thromboembolism of the pulmonary arteries. The simplicity of the device, universality in size and character of its use for temporary and permanent percutaneous implantation, and the possibility of its application in peripheral nonspecialized therapeutic institutions are noted. The experience in its use in 93 patients with phlebothrombosis of the lower limbs and thromboembolism of the pulmonary arteries is discussed. In 38 patients with temporary implantation the filter was removed in 2 weeks to 6 months. The high effectiveness of the device and the method of its application is noted and wider indications for its use are recommended.

[Precardial proximal vagotomy with pyloroplasty in surgery of chronic duodenal ulcers]. / Prekardial'naia proksimal'naia vagotomiia s piloplastikoi v khirurgii khronicheskikh duodenal'nykh iazv.

The performance of a new operation, precardial proximal vagotomy, for treatment of chronic duodenal ulcer is substantiated, described, and its results are discussed. It consists in division of the proximal vagal branches, stretching to the gastric acid-producing zones, at the level of the cardia, without cutting the blood vessels and sympathetic fibres. This operation in combination with pyloroplasty and temporary drug blockade of the celiac plexus excels in efficacy all the other methods of surgical management of duodenal ulcer. According to wide indications, it was conducted on 149 patients, in 68 of them in combination with the above-named additional interventions. During a 7-year follow-up period of the late results, a recurrent ulcer was encountered in one patient and group III visick trouble in another one.

[Surgical treatment of chronic disorders of duodenal transit]. / Khirurgicheskoe lechenie khronicheskogo narusheniia duodenal'noi prokhodimosti.

New methods of surgical management of chronic duodenal patency impairments (CDPI)--desympathization of the gastroduodenal artery and a longitudinal-sectional cruciform duodenoenteric anastomosis supplemented by the longitudinal cover of the duodenum are described. The former is intended to create a vagal dominant in the nervous control of duodenal motility and indicated in functional diseases. The latter is designed for alimentary masses and digestive juices to move from the duodenum to the abducting part of the small bowel under force, which allows it to be used in all types of CDPI. Details of surgical techniques and procedures are substantiated on the basis of the author's clinical experience. An analysis of late postoperative outcomes used in the multimodality treatment of 80 patients with associated diseases has shown their high efficiency.

[Intravascular thrombolytic therapy in the treatment of acute thrombophlebitis of the lower extremities and pelvis (Report 1)]. / Vnutrisosudistaia tromboliticheskaia terapiia v lechenii ostrykh flebotrombozov nizhnikh konechnostei i taza (Soobshchenie 1).

A new method of thrombolytic therapy is described and substantiated. It consists in percutaneous catheterization of the popliteal vein with a system of paired catheters with the inner one being advanced during infusion of the thrombolytics in the thickness of the thrombus along the length of the proximal segments of the main vein. Phlebographic control is accomplished through the outer, short catheter. The preparations of streptokinase awelysin and celiase were used. The new method of treatment was applied in 27 cases. Comparison with groups of patients treated by other methods of systemic and regional thrombolytic therapy showed that the efficacy of the suggested method was higher. Good late results were found in 72% of patients of the main group. A necessary condition of the applied method is prevention of thromboembolism of the pulmonary arteries by temporary implantation of a cava-filter into the inferior vena cava.

[Selective proximal vagotomy in combination with prolonged drug blockade of the celiac plexus in the treatment of patients with duodenal ulcers]. / Selektivnaia proksimal'naia vagotomiia v sochetanii s dlitel'noi medikamentoznoi blokady chrevnogo spleteniia v lechenii bol'nykh s duodenal'nymi iazvami.

The work deals with the results of SPV in combination with prolonged drug blockade of the celiac plexus in 78 patients with duodenal ulcers. The motor activity of the antral part of the stomach intensified and its blood supply increased after blockade of the celiac plexus. The course of the immediate postoperative period improved after SPV and the number of patients with hypokinesia of the stomach reduced.

[Surgical treatment of chronic duodenal ulcer complicated by extravasal compression of the celiac trunk]. / Khirurgicheskoe lechenie khronicheskoi iazvy dvenadtsatiperstnoi kishki, sochetannoi s ékstravazalnoi kompressiei chrevnogo stvola.

The work analyses the results of examination and operative treatment of 69 patients with chronic duodenal ulcer and concurrent extravasal compression of the celiac trunk. The clinical signs characteristic of this combination are distinguished and it is shown that these patients have low indices of maximal acid production with a high frequency of duodenal reflux. Decrease of the hepatic and gastric blood flow was also found. It is suggested that such patients should be treated by combination of selective proximal vagotomy and decompression of the celiac trunk which is accomplished by exposure of the aorta over the celiac trunk and retrograde division of the median diaphragmatic ligament. The late-term results of the operation were analysed for follow-up periods of up to 10 years. Poor results were recorded in 6.2% of cases.

[Intraarterial thrombolytic therapy in obliterative thromboangiitis of the lower extremities]. / Vnutriarterialnaia tromboliticheskaia terapiia pri obliteriruiushchem trombangiite nizhnykh konechnostei.

The article analyses the immediate and late-term results of treatment of patients suffering from thromboangiitis of the lower limbs with acute forms of thromboses of the main arteries and shunts (13 persons) and chronic arterial insufficiency (60 patients). The treatment consisted in intraarterial drug infusion with the use of fibrinolysis activators (celiasa, awelysin) as well as other pathogenetically aimed agents in the form of microcrystal suspensions (hydrocortisone, oxytetracycline, zinc insulin). Regional thrombolysis in acute thrombosis allowed authentic lysis of fresh thrombi in the main arteries in two patients (15%). Local thrombolysis with subsequent course of arterial infusion made possible effective arrest of the local ischemic syndrome in patients with III-IV degree arterial insufficiency and affection of the distal arterial bed and allowed the limb to be preserved during a follow-up period of 2 years in 92.5% of patients.

[Surgical-drug therapy aspects of the treatment of patients with obliterating thromboangiitis of the lower limbs]. / Operativno-medikamentoznye aspekty lecheniia bol'nykh obliteriruiushchim trombangiitom nizhnykh konechnostei.

Standard operative interventions (thromboendarterectomy, (autovenous shunt) in patients with thromboangiitis obliterans of the lower limbs produce a poor effect. This is explained both by a poor initial condition of the draining channels and by advancement of the primary thromboangitic affection of the vascular wall in the zone of the intervention with its development into a stenotic-occlusive process. The use of some technical (operative) innovations, particularly postoperative arterial infusion of suspended forms of immunosuppresive agents (hydrocortisone, Kenalog), increased essentially the efficacy of restorative operations on the vessels with a high level of limb preservation and patency of the vessels which had been operated on.

[Plastic surgery of the valves of the major veins]. / Plastika klapanov magistral'nykh ven.

Three variants of endovascular autovenous plasty of the valves are suggested for the treatment of patients with chronic venous insufficiency of the lower limbs due to primary or secondary incompetence of the valves of the major veins. All are based on the formation of a one-sided cusp with an inner elastic element. The author suggests criteria for appraising the efficacy of methods for plasty of venous valves. Seventy-six operations were carried out, 33 of them were combined with Linton's phlebectomy. The late-term follow-up periods are up to 10 years. The results are positive in 70 patients and no changes were found in 6 patients. No cases with thrombosis in the zone of plastic surgery were encountered. Complete or marked functioning of the valve was noted in half of the patients. Means for improving the methods of endovascular plasty of the venous valves are considered.

[Status of the celiac plexus in patients with extravasal compression of the celiac trunk and its role in the etiology of pain syndrome]. / Sostoianie chrevnogo spleteniia u bol'nykh s ékstravazal'noi kompressiei chrevnogo stvola i ego rol' v geneze bolevogo sindroma.

The technique and results of surgical treatment of 109 patients with extravasal compression of the celiac trunk (ECCT), which in 77 patients was combined with a duodenal ulcer, are described. In the celiac plexus of the patients with ECCT, the inflammatory-sclerotic changes of a different degree of pronouncement were revealed. It was established that periarterial sympathectomy of the celiac artery and its branches had an essential effect on the state of gastric functions. In patients after isolated transection of a median phrenic ligament, the changes in gastric functions were not sharply pronounced.