[Lethality after gastroduodenal ulcer bleeding].

The retrospective analysis (2006-2010 yy) of treatment of 895 patients with gastroduodenal ulcer bleeding was conducted. Lethal outcome was registered in 220 (24.6%) patients, of them directly of the ulcer bleeding died 45 (5%). The Rockall score was used as universal prognostic instrument. Of 164 lethal outcomes, did not directly connected to the ulcer bleeding, the etiological distribution was as follows: multiple organ failure - 36% (n=59), cardiovascular diseases - 24.4% (n=40), inveterate oncology - 15.9% (26). Of 45 deaths from bleeding, only 4 patients died of the uncontrolled bleeding, whereas 18 (45%) died after the emergency surgery. Signs of hemorrhagic shock were registered in 60% of died patients (in comparison with 18% among the survived). Bleeding reccurrence was registered in 28.6% of died patients (in comparison with 11% among the survived). The use of the Rockall score confirmed its prognostic value: the mean score was 4.3±2.12 points among the survived patients, whereas among the died patients it was 7.16±2.35 points (p=0.001). Authors conclude, that the leading reasons of death, considering the bleeding itself, were the hemorrhagic shock and recurrent bleeding. Though, about 80% of patients are dying of reasons, do not directly connected to the bleeding episode, but of concomitant diseases (multiple organ failure, cardiovascular and oncologic diseases). The least, nevertheless, leads to the wrong formulation of the final diagnosis and incorrect interpretation of the etiology of death.

[Free radical processes in patients with the gastro-intestinal bleedings].

The role of the free radical processes (FRP) is shown and objectified in the development of the ulcer gastro-intestinal bleedings (UGIB). It is revealed on the first day of hospitalization already. The greatest imbalance of the FRP is registered in heavy patients with acute UGIB. It appeared like decrease of the oxygen and activation of the lipid FRP disregulation. Unheavy patients have FRP changes refer to the oxygen part of the oxidation process only. Intensification FRP in process of increase of weight disease consists in decrease activity oxygen and increase a lipid disbalance. FRP disbalance has long time proceeds, last till the patient's discharge. Results of the research prove as much as possible early inclusion in a complex of medical actions antoixidant therapy. The high efficiency of the energetic corrector reamberin in a dose of 400-800 ml was shown in patients with UGIB.

[Current approaches to treating acute gastroduodenal ulcer bleedings].

The aim of the work was analysis of treatment of 560 patients with a gastrointestinal bleeding from acute ulcers. For estimation of patients was used universal integrated scale APACHE III. Tactics of treatment depend on secretory functions of a stomach and group of polyorganical difunction. At 428 (76,5%) patients with acute ulcers on the background increase secretion of stomach was treatment antysecretion therapy. At 132 (23,5%) patients with acute ulcers on the background of normal ore decrease secretion of stomach was treatment Cytoflavin - the metabolic preparation possessing antyoxidation, cytoprotection and immunomodulaytion activity. For studying antyoxidation and antihypoxation actions of Cytoflavin estimated of microcirculation mucous of a stomach with the laser Doppler floymetrya before course of treatment, observed increase of index efficiency of microcirculation and increase a blood-groove in a stomach at patients with acute peptic ulcers on a background of treatment of Cytoflavin. After course of treatment of Cytoflavin decrease in points on system APACHE III on 5,5-25% at all patients that has led to decrease mortality on 20% in this group of patients.

[Objective system of evaluating severity of illness in the choice of therapeutic strategy in aged and elderly patients].

Use of mark systems estimation MODS and APACHE II at patients of elderly and senile age with the complicated forms of a stomach ulcer allows objectively to judge weight of a condition of the patient risk of operative treatment and to estimate the probable forecast of disease and mortality.

[Duodenogastric reflux and gastric pathology in the elderly patients].

OBJECTIVE: To determine the frequency of duodenogastric reflux (DGR), and to assess the changes in the gastric mucosa in the presence of bile reflux. MATERIALS AND METHODS: Our study includes the results of 1371 gastroduodenoscopies carried out in 2008, for patients between 65 and 92 years old, the study includes both kind of patients who were admitted to hospital and those who were investigated on an outpatient basis. The main group includes 695 patients with various level of DGR severity, and the control group consists of 676 patients without DGR. RESULTS: DGR was diagnosed in 14.8% more in women. In case of the presence of DGR we have found changes in the antrum mucosa as congestion, and minor erosion, hyperplasia, metaplasia of gastric and esophageal mucosa, and stomach polyps. And we have not noticed such changes when DGR was absent. We have found that the high frequency of antral hyperplasia is correlated to the DGR severity. CONCLUSION: DGR is diagnosed in more than 10% of patients who undergo gastroduodenoscopy. DGR is an indicator of conditions often associated with various morphological changes in gastric mucosa; therefore this finding has to be taken in consideration in the further investigations and management of such patients.

[Surgical tactics in gastrointestinal hemorrhages in elderly].

At the present stage the number of operations is reduced at a ulcer gastroenteric bleeding. Occurrence modern antysecretor drags and wide introduction endoscopic and endovascular methods of hemostasis has led to decrease of urgent operative interventions in group of patients with high risk of rebleeding in 4 times. The number of such minimal operations was reduced in 10 times. They do not give expected hemostasis effect and are accompanied high mortality. Change of surgical tactics at elderly patients has led to decrease postoperative mortality from 15.8 up to 5.8% and the general mortality from 15.8 up to 9.6%.

[Prognosis of the course of complicated ulcer disease and mortality in aged and senile patients]. / Prognoz techeniia oslozhnennoi iazvennoibolezni i letal'nosti u bol'nykh pozhilogo i starcheskogo vozrasta.

The developed system for forecasting the course of the disease in elderly and senile patients made it possible to distinguish two variants of the ulcer course: favorable and unfavorable. Its application confirmed that it is possible to use the forecast evaluation system in studies of remote results. In case of an unfavorable forecast, this provides the ground for urgent recommendations for surgical treatment in this group of patients without waiting for life-threatening complications to develop.

[Therapeutic and diagnostic tactics in complication of ulcer disease in elderly and aged]. / Lechebno-diagnosticheskaia taktika pri oslozhneniiakh iazvennoi bolezni v pozhilom i starcheskom vozraste.

In 78% of cases the ulcerative disease in elderly age proceeds with complications and presents a serious surgical problem. The specificity of elderly patients is the combination of several pathologies, on background of which the ulcerative disease proceeds. The level of an expressiveness of accompanying pathology influences on the prognosis of disease course and on the choice of medical tactics. Therefore for objectivization of state heaviness of the patient group mark systems of an estimation MODS and APACHE III are used. The interventions in gastroduodenal bleedings for the patients of elderly age should be differentiated and depended on a risk degree of bleeding relapse and adequate estimation of MODS heaviness. In 55.4% of the elderly patients the ulcerative perforation occur without antecedent history. Therefore indications to sewing of ulcers, including little-invasive interventions, should be extended in this group of the patients. The size of radical surgical interventions in absence of manifestation of the polyorganic insufficiency for the elderly patients should be the same, as for the younger patients.

[Pathophysiological features of duodenal ulcers in elderly and senile patients]. / Patofiziologicheskie osobennosti izvennoi bolezni dvenadtsatiperstnoi kishki u bol'nykh pozhilogo i starcheskogo vozrasta.

The following conclusions can be drawn on the basis of the research results: 1. There is no reliable distinction between central hemodynamics and gastric blood flow indices in patients from different age groups. 2. The blood flow in the stomach wall is in a distinct direct proportion to acid production. 3. The gastric blood flow is doubled in most patients with acid peptic ulcers, as compared with the norm. 4. The role of the ischemic factor in the development of duodenal ulcers is not pronounced in elderly patients.