[Enteral dysfunction as a factor of protein-energy insufficiency development in elderly persons following gastric surgery].

264 patients within the age group of 61-93 were observed both by the gastroenterologist and surgeon for 3-6 years following gastroduodenal ulcer surgical treatment. 31,8% developed protein-energy insufficiency (PEI) in late terms, i.e. 3-12 months after the operation. Comparative analysis with a control group showed that PEI development in elderly patients occurs under conditions of membrane and cytosol enzyme synthesis decrease in small intestine and transport system disturbance in its mucosa in postoperative period. Risk of PEI development is especially high in elderly patients with the accompanying cardiovascular pathology resulting in membrane digestion depression and absorption inhibition. The importance of membrane small intestinal digestion disorders in elderly patients in postoperative period was suggested to play a significant role in prognosis and detection of PEI in early stages.

[A new system of specialized gastroenterological care to patients with inflammatory bowel diseases in St. Petersburg].

AIM: To substantiate the effectiveness of the set-up center in the early detection of patients with inflammatory bowel diseases (IBD) and in its organization and implementation of current therapeutic programs. MATERIALS AND METHODS: The therapeutic activity of the specialized medical care system set up in St. Petersburg for patients with IBD (ulcerative colitis (UC) and Crohn's disease (CD)), which is based on a multifunctional inflammatory bowel disease center at City Clinical Hospital Thirty-One, was analyzed. RESULTS: The effective work of the center could reduce time for verification of the diagnosis of UC from 6.4 +/- 1.4 to 3.6 +/- 0.8 months and CD from 28.6 +/- 6.7 to 15.3 +/- 4.2 months, respectively; decline the annual number of patients with moderate and severe UC from 73.4 to 53.6 and CD from 66.7 to 47%, and also set up a centralized system for all required types of current therapeutic and diagnostic care for these patients. CONCLUSION: The establishment of the St. Petersburg Center for the diagnosis and treatment of inflammatory bowel diseases could develop and realize in practice a new closed-loop urban system for the early detection and notification of IBD patients, the organization and rendering of individual effective therapeutic-and-prophylactic care.

[Opportunities of nutritional therapy and typical errors in the nutrition of patients with biliary tract diseases].

This lecture intended for doctor describes the possibility to influence by nutrition the main mechanisms of pathogenesis in biliary tract diseases including cholestatic syndrome, disorders of bile physical-chemical properties, inflammation, biliary tract and intestinal disorders of motility. Typical mistakes in nutrition of patients with biliary tract pathology are discussed using clinical case history as an example.

[The clinical immunologic characteristics of different variants of course of ulcer colitis].

The study was carried out to determine clinical and immunologic predictors of unfavorable variant of course of ulcer colitis. The sample included 89 patients (48 females--53.9% and 41 males--46.1%) with ulcer colitis established on the basis of clinical, endoscopic and morphologic data. The age of patients was 18-79 years and mean age--42.49 +/- 1.61 years. The patients were divided on two groups depending on clinical course of disease: group 1 with favorable course and group 2 with unfavorable course. The group 2 included patients with frequently relapsing form of disease, patients with hormone-depended/hormone-resistant form of disease and patients with severe exacerbation ua ulcer colitis at the moment of examination. The groups were compared by gender and age. All patients underwent medical history and complaints acquisition and total clinical examination. The clinical and biochemical analysis of blood was made too. The severity of disease was established using the calculation of Trulove- Witts indicator The anti-neutrophil cytoplasmic antibodies of classes IgG and IgA were analyzed using indirect immunofluorescence (Euroimmun AG, Germany). The diagnostic anti-neutrophil cytoplasmic antibodies titer was established in 58 out of 87 of examined patients (66.6%). The antineutrophil cytoplasmic antibodies of class IgG was revealed in 42 patients and anti-neutrophil cytoplasmic antibodies of class IgA in 27 patients. The combination of both classes of anti-neutrophil cytoplasmic antibodies was established in 11 examined patients. In the group of favorable course of disease the diagnostic titer of anti-neutrophil cytoplasmic antibodies was revealed in 20 patients (51%). At the same time, in the subgroups with frequently relapsing, hormone-depended/hormone-resistant and severe forms of disease these antibodies were revealed with rate of 76, 77 and 86.3% correspondingly. Hence, the anti-neutrophil cytoplasmic antibodies can be used both in diagnostic of ulcer colitis and in prognosis of course of disease.

[Gerontodietology].

Gerontodietology is one of the most important parts of dietetics studying problems of nutrition of elderly and old persons and persons with high risk of early and pathological aging, developing principles of rational nutrition, prophylactic and curative nutrition and methods of its organization. Functional structure of modern gerontodietology, its scientific-methodical bases, terminological features are presented. Composition and features of healthy nutrition of elderly people is described in details, methods of its optimization and individualization are given. Notions of geriatric dietotherapy, its principal difference from curative nutrition of patients of other ages are described. Large section of the article is devoted to the modern problems of prophylactic gerontodietology, intended more for persons with high risk of early aging than for elderly persons. Theoretic basis and methodological contents of prophylactic gerontodietology are presented; practical recommendations on dietetic means to prevent intensive development of involution processes and organic pathology in the body are described.

[Dietary prevention of protein-energy malnutrition during early postoperative period in elderly patients with gastroduodenal diseases].

The modified diet of postoperative rehabilitation program in elderly patients with gastroduodenal ulcers and prognosis of development of protein-energy malnutrition (PEM) is presented. It is shown that early initiated special diet in postoperative period, blocks mechanisms of malnutrition and can significantly improve the functional status of the small intestine and activate, thus, membrane digestion, which leads to normalization of all types of metabolism in elderly patients. In comparison with control group, where 72% of patients in postoperative period had malnutrition, malnutrition in the study group revealed a mild degree in only 17.3% of patients.

[Nutrition mistakes in patients with nonalcoholic fatty liver disease and the ways of correction].

THE AIM OF REVIEW: To verify the role of nutrition in development of Nonalcoholic Fatty Liver Disease in patients with metabolic syndrome. ORIGINAL POSITIONS: The article contains main conceptions of etiology and pathogenesis of Nonalcoholic Fatty Liver Disease. Spesial attention gives to the role of nutrition in development of this case. The are own dates presented, which shows relationship between degree of obesity, factual nutrition and expression of morphological changes in liver in patients with Nonalcoholic Fatty Liver Disease. CONCLUSION: Nutrition mistakes in patients with Nonalcoholic Fatty Liver Disease are: excess of energy, animal proteins and fats, deficit of nutrition fibres, carbohydrates, antioxidants, vitamins B1, B2, PP. The main directions of diet in patients with Nonalcoholic Fatty Liver Disease.

[Principles and perspectives of primary biliary cirrhosis therapy].

A survey of existing methods of pathogenetic and symptomatic treatment of primary biliary cirrhosis has been made and it has reviewed prospective directions of its therapy. Is also presents a retrospective analysis of our own data of S-adenosylmethionine (Heptral) in 27 patients PBC receiving UDCA basic therapy. In its application intravenously of 400 mg 2 times daily for 3 weeks showed a reduction in the severity of pruritus, assessed by visual analogue scale, a subjective decrease fatigability and a decrease level of serum bilirubin.

[Modern dietetics on the new step development of medicine (clinical essay)].

THE AIM OF REVIEW: To discuss some controversy moments in terminology. To show the possibility of modern dietetics in prophylacxis and treatment of deseases. ORIGINAL POSITIONS: Dietetics is an impotent part of modern treatment, that is considered on exemple of endoecology and gerontal diet. The authors offer necessary information to create an individual diet for concrete patient. CONCLUSION: In Russia it is not reasonable to change a term "dietetics" to a term "nutrition" or "clinical nutrition". It is necessary to improve a teaching of dietetics to doctors of different specializations.

[Late diagnosis of autoimmune liver disease: causes and consequences].

The article is devoted to the problems of the well-timed diagnosis of autoimmune liver diseases, such as autoimmune hepatitis, primary biliary cirrhosis, primary sclerosing cholangitis and overlap-syndromes. It has been shown that diagnosis verification influences on the course of these conditions and the patient's longevity. The causes of last diagnosis and clinical and laboratory data have been analyzed. The authors based on literature facts, obtained results and their experience have advised the number of recommendations to improve the diagnosis of autoimmune liver disease. The well-timed diagnosis permits to elevate the longevity and to advance the quality of life.

[Neuroendocrinology of the stomach and aging]. / Neiroéndokrinologiia zheludka i starenie.

The survey contains information about basic stomach endocrine cells in normal condition and their changes in chronic atrophic gastritis and ageing. The data of modern research devoted to endocrine cells age-related changes are represented here and analyzed. The reasons that influence on endocrine cells age-related changes and the ways of their possible correction are described.

[Effect of "vilon" on cirrhotically changed rat liver. Liver regeneration, and status of glycogen-forming function of hepatocytes]. / Vliianie preparata "vilon" na tsirroticheski izmenennuiu pecheni krys. Regeneratsiia pecheni i sostoianie glikogenoobrazovatel'noi funktsii gepatotsitov.

Effects of a dipeptide preparation "Vilon" on rehabilitation of functional activity of hepatocytes and regeneration of the cirrhotically altered rat liver were studied. The liver cirrhosis was produced by poisoning of rats for 4 months with carbon tetrachloride (CCl4). On the end of the poisoning with CCl4, one group of animals was not submitted to any further actions, whereas animals of the other group were injected "Vilon" (1.7 micrograms/kg) daily for 5 days. On smears of isolated hepatocytes, contents of total glycogen (TG), and its labile and stable fractions (LF and SF) were determined in addition to cell ploidy levels and the total protein content. In liver homogenates, activities of glucose-6-phosphatase (G6P), glycogen synthase (GS), and glycogen phosphorylase (GP) were measured. In 2 weeks after the drug application, G6P activity being reduced in cirrhosis 1.2 times, elevated under effect of "Vilon". In non-treated rats the contents of TG and its fractions and of G6P activity remained at the level characteristic of the cirrhotic liver prior to "Vilon" administration. In both groups of rats, GP and GS activities in the cirrhotically altered liver did not differ from their control values throughout the entire experiment. "Vilon" has been shown to exert a weak stimulating effect on regeneration of the cirrotically altered rat liver: in hepatocytes of the second group of rats the total protein content and ploidy levels were higher than those in the first group by 4.7 and 11.5%, respectively.

[Importance of determination of the content of lactate dehydrogenase and its isoenzymes in patients with myocardial infarct complicated by rupture of the heart]. / Znachenie opredeleniia soderzhaniia laktatdegidrogenazy i ee izofermentov u bol'nykh infarktom miokarda, oslozhennym razryvom serdtsa

In 18 patients with myocardial infarction. who had died due to the rupture of the heart muscle the activity of lactate-dehydrogenase (LDG) and of its isoenzymes in the blood serum and cardiac tissue was studied. Comparisons were made with the results of investigations in donors, in persons dead as a result of accidents, in patients with uncomplicated transmural myocardial infarction, with aneurysm of the heart, severe cardiogenic shock and with other lethal complications of myocardial infarction. The highest levels of the blood LDG activity were registered in cases involving rupture of the heart. The determination of the LDG and its isoenzymes activity mat be used in assessing the degree of the resorption-necrotic syndrome intensity and of factors indicating the risk of a developing aneurysm and rupture of the heart in patients with myocardial infarction.

[Use of luminescence analysis of biopsies of the gastric mucosa in the prognosis of gastric peptic ulcer]. / Primenenie liuminestsentnogo analiza bioptatov slizistoi obolochki zheludka dlia prognozirovaniia iazvennoi bolezni zheludka.

Luminescence analysis of gastric biopsy specimens reflecting the state of cell respiration of the mucous membrane of the stomach (MMS) was used for endoscopic investigation of 271 patients with gastric ulcer (GU). A degree of decrease of the patients' own luminescence (DDPL) in an ordinary course of GU with a favorable outcome of cicatrization (108 patients) did not exceed 25% at the ulcer edge and 10% in the periulcerative zone. Prognosis of malignant transformation of ulcer and the development of callous gastric ulcer was based on the detection of a sharp decrease in the level of luminescence at the ulcer edge. A conclusion was made of a high prognostic value of luminescence endoscopy in GU.

[The prognosis of the course and outcome in gastric peptic ulcer]. / Prognoz techeniia i iskhodov iazvennoi bolezni zheludka.

A universal system for forecasting gastric ulcer has been devised. It ensures high reliability of the forecasting of uncomplicated or frequently relapsing disease, development of long non-healing or callous gastric ulcer, occurrence of ulcerous hemorrhage, perforation, penetration, stenosis or malignization. The system is designed for the use in the computer mode or in the form of the tabular prognosis method to be employed in hospitals and in ambulatory-polyclinical practice.

[Prognostic value of studying the cellular immunity in ulcerative lesions of the stomach]. / Prognosticheskaia znachimost' issledovaniia kletochnogo immuniteta pri iazvennykh porazheniiakh zheludka.

Altogether 138 patients with peptic and mediogastral ulcers were examined for cellular immunity. Long before the disease took an unfavourable course marked by frequent relapses and chronic ulcers or the occurrence of ulcer malignancy the patients showed immunodeficiency which correlated with the gravity of the disease clinical manifestations or with the degree of the symptomatology of a complication. At the same time there was a rise of the suppressor activity of T lymphocytes and a reduction in the D lymphocyte count, especially in the patients with gastric ulcer malignancy. It is concluded that the methods of cellular immunity studies should be introduced in medical practice on a broader scale in order to predict the character of the course and complications of gastric ulcers.

[Long-term results of gastric ulcers chemotherapy]. / Otdalennye rezul'taty medikamentoznogo lecheniia iazv zheludka.

AIM: Determination of criteria of choice of gastric ulcer (GU) treatment. MATERIALS AND METHODS: 904 GU patients given conservative drug therapy in 1986-1996 were followed up. RESULTS: Recurrences of GU can be of three types: type 1--rare recurrences (once in 10-11 years), type 2--recurrences occur twice for 10-11 years), type 3--recurrences occur every 1.5 years). CONCLUSION: A simple criterion of assessing effectiveness of conservative treatment of uncomplicated ulcers is proposed. It is duration of remission. If the recurrence occurs within 1.5 years after the treatment, the patient is at risk of frequent recurrence. In such cases surgical treatment is justified.

[Prognostic evaluation of the protective potential of gastric mucosa in stomach ulcer]. / Prognosticheskaia otsenka protektivnoi sposobnosti slizistoi obolochki zheludka pri iazvennykh ee porazheniiakh.

Potentialities of medical iconics in assessment of a protective mucosal barrier in gastric ulcer have been studied. Prognostic criteria have been derived for a common and a torpid course of the disease. Pathogenetic mechanisms of the above forms are specified.

[Prognosis of clinical course in stomach ulcer]. / O prognozirovanii klinicheskogo techeniia iazvennoi bolezni zheludka.

Basing on a complex of significant clinical signs of the disease and mathematical methods, algorithms and methodology of prognosticating a course, outcome and complications of gastric ulcer have been developed. The system may be used in variants of automatic and table processing of clinical data.

[Methodological bases for prognosis in medicine]. / Metodologicheskie osnovy prognozirovaniia v meditsine.

Current status of prognosis in clinical, experimental and prophylactic medicine is delineated with formulation of the purposes and feasibility of therapeutic and preventive realization of the disease onset and run prediction. Literature and first-hand experience provided the basis for grounding medical prognosis theory. Basic points in the theory are the following: utilization in the prognosis of only a complex of the most significant clinical signs of the disease, the patient's record, social and household, ecological and occupational aspects of the patient's life; comparison of the latter with leading pathogenetic mechanisms underlying the emergence and progression of the pathology; consideration of the relationships between dysfunction and morphology of the organs and systems; simultaneous analysis of the aggression factors, systemic reactivity and resistance of tissue; scrutiny of predisposition to pathological reactions. An essential aspect of medical prediction is a valid choice of mathematical methods of analysis and processing of the clinical information.