[The clinical and pathogenetic types of gastroesophageal reflux disease: risk factors and predictors].

AIM: To study the clinical and pathogenetic types of gastroesophageal reflux disease (GERD) in terms of different types of reflux into the esophagus, their risk factors and predictors. MATERIALS AND METHODS: The clinical, morphological, motor tonic characteristics of the esophagogastroduodenal area, the phenotypic and visceral signs of existing undifferentiated connective tissue dysplasias (UDCTD), and the suprasegmental and segmental autonomic apparatus were studied in detail in 124 patients with GERD. RESULTS: Two clinical and pathogenetic types of GERD associated with the predominance of gastroesophageal or duodenogastroesophageal refluxes (GER and DGER) are identified. The type of the disease running in the predominance of GER develops in subjects with the high rate of visceral stigmas of UDCTD--cardiac failure and hiatal hernias, sympathetic autonomic tone in the digestive system. The feeding preference of piquant and spicy dishes and spices serves to realize the predictors of this type. The DGER-associated type develops in subjects with a concurrence of sympathetic and parasympathetic total autonomic tones in the digestive system in the presence of preexisting biliary tract diseases, including abnormalities in the structure of the gallbladder as visceral signs of UDCTD and it is realized in the feeding preference of high-calorie dishes. CONCLUSION: It is promising to study the autonomic status and the signs of UDCTD as structural and functional predictors of GERD and its types for the prediction of the disease, professional orientation, and the acquisition of eating behavior primarily in young people.

[Clinicofunctional changes of heart in patients with clinically different variants of toxic diphtheria]. / Kliniko-funktsional'nye izmeneniia serdtsa u bol'nykh toksicheskoi difteriei s razlichnymi variantami.

A clinicofunctional examination of 72 patients with toxic diphtheria (mean age 36.8 +/- 7.1 years) has been made to study the course and outcome of diphtheria-related damage to the heart. It is shown that clinical symptoms of myocarditis became more prominent with growing severity of diphtheric infection and evidenced for diffuse affection of the left ventricle. EchoCG detected defective systolic function which in patients with unfavorable prognosis was associated with thickening of the myocardium and dilatation of the left ventricular chamber. 24-h Holter monitoring registered shifts in the end part of the ECG ventricular complex and various abnomalities in the heart rhythm. Focal myocardial lesions manifested with supraventricular and solitary ventricular extrasystoles. In diffuse myocarditis frequent ventricular extrasystoles prevailed. At autopsy, structural myocardial changes in toxic diphtheria were confirmed.

[Pathohistology of costal cartilage and immunomorphologic characteristics of collagen in funnel chest]. / Patogistologiia rebernogo khriashcha i immunomorfologicheskaia kharakteristika kollagena pri voronkoobraznoi grudi.

Biopsy samples from the costal cartilage tissue were studied for 68 children with funnel deformity and from 20 children with normally formed chest. The authors present general morphologic features characteristic of the costal cartilage structure in norm and in case of funnel chest. These features include vast acellular sites, map-like areas, unmasked chondrin fibers and "marrow" cavities. In funnel chest they develop, however, 6-7 years earlier, than normally, and are consequent stages of the accelerated costal cartilage involution. Costal cartilage matrix was found to have an increased content of fibronectin and V collagen type in case of funnel chest. Besides III and IV procollagen types were noted in the chondrocytes. The accelerated growth of costal cartilages is involved in the formation of funnel chest.