[Nutricional support in the complex treatment of a patient with esophageal spasm].

In the presented clinical case the theme of the need for an integrated therapeutic intervention has been disclosed, including nutritional support on the various links of the pathogenesis of esophagospasm to the effectiveness of the patient's treatment.

[Alginates in the treatment of postgastroresection reflux esophagitis].

AIM: To evaluate the efficacy of alginates in the treatment of postgastroresection reflux esophagitis. SUBJECTS AND METHODS: Thirty-four post-Billroth II distal gastrectomy patients with reflux esophagitis and without erosive and ulcerative lesions of the gastric stump and anastomosis, who had received geviscon monotherapy for 6 weeks, were examined. Their symptoms and the data of esophagogastroduodenoscopy and impedance pH monitoring were assessed to control treatment results. RESULTS: There was statistically significant relief of the subjective (heartburn and bitter taste in the mouth) and objective symptoms of the disease and the reflux esophagitis in geviscon-treated patients. CONCLUSION: Geviscon is the drug of choice for treating reflux esophagitis in patients after partial distal gastrectomy provided that the acid-forming function of the gastric mucosa is minimally preserved.

[Features of anesthesia in rats at abdominal operations].

Nowadays, in Russia, diethyl ether is the most popular narcosis for rodent and particular rats. We had tested the new methods based on Zoletil 100 + XylaVet (15 mg/kg and 15-10-5 mg/kg) respectively. 6 conventional female rats were treated with this narcosis. The rats, early have narcotized by diethyl ether were investigated as control group. All of 6 treated with new narcosis animals died in early post-operative time. Interestingly enough, that organ toxicity, except neurologic toxicity, was not described in literature and manuals. We assume that this new narcosis is the cause of portal thromboses.

[Dysmotility of the esophagus in patients after stomach resection].

The aim of the work was to evaluate the esophageal motility in patients after distal gastrectomy of different sizes. It was found that in patients after gastrectomy with erosive and ulcerative lesions of the esophagus innofective esophageal motility often registered and this correlates with the reduction clearance indicator of the esophagus according to the pH-impedance monitoring.

[Panum (pantoprazole) effectiveness in the treatment of patients with GERD].

There are demonstrated results of a prospective comparative study on clinical efficacy and tolerability of Panum (INN: pantoprazole) under the sponsorship of"Unique Pharmaceutical Laboratories (India)". Were evaluated the results of a 28-day course of treatment of 30 patients with GERD, including those with severe reflux esophagitis (erosive and ulcerative), who received 40 mg of pantoprazole as monotherapy. Was found an algorithm with an intermediate control efficacy to individualizing the approach to therapy. As a result 16,7% of patients with severe reflux esophagitis required increasing the dose of pantoprazole to 80 mg/day in two divided doses, and the rest (83,3%) patients to achieve clinical and endoscopic remission of GERD was sufficient single dose of 40 mg of the drug. The results of this study indicated the efficacy and safety of the Panum drug in the treatment of GERD, including its complicated forms.

[Study of the esophagus and stomach acidification (according to the interpretation of 24-hour pH monitoring data)].

Is demonstrated current information about the nature and method of computing the 24-hour pH-metria of the esophagus and stomach, as well as the Interpretation acidification (acidification) of the gastrointestinal tract.

[Results of 24-h pH monitoring in patients with gastroesophageal reflux disease before and after fundoplication].

AIM: To study informative value of 24-h pH monitoring in registration of gastroesophageal and duodenogastroesophageal reflux (GER, DGER) in patients with gastroesophageal reflux disease (GERD) before and after surgical treatment. MATERIAL AND METHODS: A total of 39 GERD patients after laparoscopic fundoplication entered the study: 12 (39%) males and 27 (61%) females, mean age 47.6 +/- 3.2 years. pH monitoring was made with domestic device Gastroscan-24 before operation and one year after it. Esophagogastroscopy and polypositional roentgenoscopy of the upper gastroduodenal tract were made also before operation and after 1-year follow-up. RESULTS: Before operation, mean pH in the gastric body was 1.7 +/- 1.28, De Meester index 40.4 +/- 8.91, esophageal acidity index (EAI) 22.3 +/- 1.59, the number of acid GER 59.2 +/- 9.41, number of DGER 14.3 +/- 3.47. After laparoscopic fundoplication--3.3 +/- 1.52, 8.7 +/- 5.71 (p < 0.05), 2.5 +/- 0.62 (p < 0.05), 24.4 +/- 8.6 (p < 0.05), 6.5 +/- 3.63, respectively. Five patients (12.8%) examined before the operation had clinicoendoscopic picture of GERD, but normal values of De Meester index and EAI. CONCLUSION: 24-h pH monitoring can estimate both gastroesophageal and duodenoesophagogastric refluxes, but esophageal and gastric pH monitoring only are not sufficient for decision on treatment policy. Such decision should be taken individually for each patient after the analysis of the results of complete clinical examination, symptoms and the disease history.

[Surgical treatment of neuromuscular diseases of the esophagus].

Surgical treatment of patients with neuromuscular diseases of the esophagus is a separate issue, and the approach to antireflux surgery they differ from fundoplication for gastroesophageal reflux disease. At the Central Research Institute of Gastroenterology in 2010 yr were 17 patients with neuromuscular diseases of the esophagus laparoscopic fundoplication. Analysis of results showed the effectiveness of laparoscopic fundoplication in patients with severe esophageal motility.

[Using cycloferon in complex therapy of patients with cutaneous vasculitis (clinical and immunological rationale)].

The immunological status was assessed in a group of patients with superficial and profound cutaneous vasculitis diagnoses. It was established that, in both forms of vasculitis, the same type of immune reactions such as activation of cellular and humoral immunity links took place on the background of leucocytosis and lymphocytosis. The violation of T-helper/T-suppressor (Th/Ts) correlation was accompanied by intense stimulation of the helper lymphocyte subpopulation in both forms of vasculitis. In addition, some differences were observed in pathogenesis of the two forms of vasculitis, which were manifested by (i) a marked increase in the level of Ts cells in patients with superficial and a decrease in this level in patients with profound cutaneous vasculitis. In cases of a more serious profound form of vasculitis, it was found that a more intense stimulation of the humoral and fagocyte links of immune regulation took place. The inclusion of cycloferon into the complex therapy led to expressed immunomodulation effect, increase in the clinical therapeutic effect, reduction of the terms of hospitalization, and prolongation of the periods of disease remission.

[Fundoplication as prophylaxis of reflux-esophagitis in patients with varicose esophageal veins].

AIM: To investigate the condition of esophageal mucosa (EM) before and after surgical and endoscopic treatment of varicose esophageal veins (VEV). MATERIAL AND METHODS: EM was examined in 100 patients (64 males and 36 females aged 33-74 years, mean age 528 +/- 5.7 years) with hepatic cirrhosis (HC). Of them, 80 patients have undergone endoscopic ligation of the esophageal veins, 20 patients--surgical disconnection of the azigoportal blood flow according to the original method with additional fundoplication. All the patients had intrahepatic portal hypertension caused by HC of different etiology. RESULTS: Before operation, 70% patients had inflammation-induced alterations of the EM of different severity. Endoscopic ligation of the esophageal veins did not change the rate of EM inflammation detection. In operated patients reflux-esophagitis was detected significantly less frequently. CONCLUSION: The above results show efficacy of fundoplication as a method of esophagitis prevention. Esophagitis is one of VEV hemorrhage risk factors. Fundoplication is not easy to make and is not indicated for all HC patients, especially in urgent situations. However, in case of decision to operate for prevention of VEV hemorrhage, it is advisable to conduct fundoplication.

[Esophagus lesions after surgical resection].

The article is a an overview of the literature data on pathogenetic aspects of the development of reflux esophagitis, metaplasia, dysplasia, cancer of the esophagus after gastrectomy and partial gastrectomy in the experiment and clinical practice.

[Primary prevention of reflux esophagitis in achalasia of cardia].

Aim of the study was to compare the incidence of reflux esophagitis in patients with achalasia cardia after successful surgical treatment with balloon dilatation and ezofago-cardio-seromyotomy followed by fundoplication according toToupet type. The study included only those patients with eliminated symptoms of dysphagia. All patients were divided into two groups depending on the method of treatment. In the first group (20 patients) performed balloon dilatation, second group (20 patients)--laparoscopic ezofagocardioseromiotomiya followed by fundoplication according type Toupet. Results evaluated one year after the intervention. Revealed that the incidence of reflux esophagitis were significantly higher in group of patients after balloon dilatation, than in the group of operated patients--40 and 15% respectively (p < 0,05). Received results allow to reconsider approaches to the selection of treatment method of achalasia cardia in favor of laparoscopic ezofagocardioseromitomii with the formation of posterior cuff-type Toupet.

[Immunogenic and protective characteristics of surface antigens 6 and d of Burkholderia pseudomallei].

AIM: Extraction of complex of Burkholderia pseudomallei antigens 6+d (Ag6+d) and study of its immunogenic and protective characteristics. MATERIALS AND METHODS: Studied antigens were obtained from acrtone-dried cells of B. pseudomallei 57576. Experiments were performed on white mouse model. Microbiological, immunochemical as well as immunological methods were used in the study. RESULTS: It was shown that antigenic complex 6+d has a glycoprotein nature and corresponds to high-polymeric catode-moving antigen 6 with molecular mass 500 kDa and anode-moving antigen d with molecular mass 40 - 55 kDa. Immunogenic and protective characteristics of surface antigenic complex 6+d was studied. It was noted that Ag6+d caused reliable stimulating effect on cellular arm of immune system of white mice appeared in activation of delayed-type hypersensitivity reactions, enhanced phagocytic activity of polymorphonuclear macrophages as well as increased expression of Fc-receptors on macrophages and neutrophils. CONCLUSION: Observed stimulation of cellular immunity by surface antigens was confirmed during study of their protective characteristics on the model of experimental meloidosis in white mice.

[Simultaneous operations in patients with cholelithiasis and gastroesophageal reflux disease].

The combination of the cholecystitis with gastro-esophageal reflux disease is registries about 12% of cases. On the basis of the CSRI of gastroenterology we underwent 36 patients with cholecystitis combined with gastro-esophageal reflux disease simultaneous surgeries. An analysis of the operation results has shown effectiveness and safety of using the methods by laparoscopic approach.

[Pharmacokinetics of the proton pump inhibitors and psychological status in patients as factors that influence the efficiency of treatment of GERD with pantoprazole].

Was made an investigation of the effectiveness of pantoprazole (sanpraz, "SanFarma", India) at gastroesophageal reflux disease (GERD). 53 patients with GERD, including 20--with reflux esophagitis, received a daily dose of pantoprazole 40 mg to 28 days. To the 7 day of treatment heartburn was broke in 63.3%, regurgitation--in 65% of patients initially experiencing these symptoms. The 14-th day of treatment heartburn was broke in 83.7%, regurgitation--in 90%. Endoscopic remission in 28-th day of treatment was obtained in 85% of patients with reflux esophagitis. Broking of symptoms was accompanied by significant improvement in well-being and quality of life of patients. Treatment of a standard dose of pantoprazole was ineffective in 16.3% of patients. The reasons for the conservation of heartburn in 4.1% of the cases was an individual characteristics of the pharmacokinetics drug, in 12.2%--non-reflux mechanisms of symptoms in the face of mental status.

[Functional methods of the esophagus examination].

Manometry of the esophagus is the "gold standard" in diagnosing diseases of the esophagus associated with motor disorders. The combination of manometry with impedance gives an indication of violation of bolus transport along the esophagus. High resolution manometry is new method that provides the most accurate information about the functional anatomy of the esophagus and its sphincters, as well as accurately characterizes the esophageal-gastric junction. We can increase the diagnostic value of daily pH-monitoring by analyzing communication with reflux symptoms. The combination of pH and impedance can identify different types of reflux (acid, sour, gas, liquid and mixed) in patients with symptoms of GERD and related Ahil, after gastric resection in children and infants, to evaluate the effectiveness of antireflux therapy.

[Gastroesophageal reflux disease in the elderly patients: epidemiology, clinical features, therapy].

AIM: Was made a multicenter study of the GERD prevalence in Russia--MEGRE--that revealed quantitative criteria for GERD in 13.3% of respondents but in Moscow it was 23.6%. Also was detected an increasing prevalence with age, and respondents noted a higher prevalence of GERD in groups of older age (over 60) compared with persons younger than 60 years--accordingly 26.5% and 20.2%. We studied the course and treatment of elderly patients with GERD and assessed the results of surgical treatment of patients with short esophagus syndrome. METHODS: Was made a prospective study of 500 patients with GERD (241--age 60 years) that were treated with PPI and 95 patients were operated with an axial HH (42 of them with shortening of the esophagus 1-2-th power), mean age 65.7 +/- 17.4 years. We used endoscopic techniques (endoscopy), daily pH monitoring, esophageal manometry. RESULTS: Results of a prospective clinical study in elderly patients allocated two clinical variants of the flow of GERD, predicting a more severe course of disease in patients with a short history (up to 5 years) (the second "adult type") and suggests a differentiated approach to diagnosis and treatment. The expediency of extension to 12 weeks in elderly patients with GERD, the duration of the basic course of PPI therapy in full doses, which increased the effectiveness of therapy in 14.1%. after ending of this protocole, elderly patients with a second type of disease showed maintenance treatment in continuous operation since the regime "on demands from them ineffective. A reasonable approach to therapy in elderly patients, including STIs, can benefit and make a minimal risk of treatment. 24 months after performed fundoplication were observed excellent and good results in 96% of cases. In this case, patients with ineffective esophageal motility observed improvement in esophageal manometry, indicating that nature reflux of these disorders at baseline. CONCLUSIONS: Course and treatment of GERD in the elderly has its own characteristics, which dictate the need for an integrated approach to diagnosis and treatment of these patients. Older patients with esophageal shortening, 1 st degree possible to perform laparoscopic surgery, and shortening of the esophagus, 2 nd degree is the most secure laparotomic access.