[THE EFFICIENCY OF SCHOOL OF COMBINED PATHOLOGY IN THE REHABILITATION OF PATIENTS WITH PEPTIC DUODENAL ULCER ASSOCIATED WITH ARTERIAL HYPERTENSON AFTER ACUTE GASTROINTESTINAL BLEEDING].

Objectives of the investigation was to examine the dynamics of emotional and autonomic disorders in patients with peptic duodenal ulcer (DU) associated with arterial hypertension after acute gastrointestinal bleeding during training at School of Combined Pathology (SCP). Main group included 25 patients. The comparison group consisted of 26 patients with the matched pathology, sex and age, but not trained at SCP. Results. Both groups of patients demonstrated improvement in emotional sphere and autonomic regulation. However, in patients who had training at the SCP the indicators of emotional status improved earlier and got a greater extent. Optimization of autonomic regulation was identified in 3 months, not six months, like in untrained patients. Conclusion. Training hypertensive patients with peptic DU at the SCP improves the efficiency of emotional state and autonomic regulation.

[The spa-and-health resort-based rehabilitation of the patients presenting with frequently recurring erosive and ulcerative lesions in the oesophagus, stomach, and duodenum in the phase of subsiding exacerbation].

OBJECTIVE OF THE STUDY: To develop a new medical technology for the spa-and-health resort-based treatment of the patients presenting with frequently recurring erosive and ulcerative lesions in the oesophagus, stomach, and duodenum in the phase of subsiding exacerbation. MATERIAL AND METHODS: A total of 100 patients presenting with frequently recurring erosive and ulcerative lesions in the oesophagus, stomach, and duodenum in the phase of subsiding exacerbation were available for the examination that included detailed investigations of the clinical picture, characteristics of the immune status, and psychological testing before and after a course of the spa-and-health resort-based treatment. The effectiveness of two therapeutic modalities was evaluated. One of them (control) prescribed to 50 patients consisted of standard antiulcer pharmacotherapy in combination with Essentuki Novaya drinking mineral water and carbon dioxide mineral baths, the other given to 50 patients included radon baths instead of carbon dioxide mineral baths. RESULTS AND DISCUSSION: The combined application of drinking mineral waters, radon baths, and standard antiulcer pharmacotherapy produced the most conspicuous clinical effect in the framework of spa-and-health resort-based rehabilitation of the patients presenting with frequently recurring erosive and ulcerative lesions in the oesophagus, stomach, and duodenum in the phase of subsiding exacerbation as confirmed by positive dynamics of their psychoemotional status in 97.7% of the cases, regression of pain syndrome (91.5%), and improvement of humoral and cellular immunity (94%). An important result of the spa-and-health resort-based rehabilitation is the intensification of the reparative processes in gastroduodenal mucosa responsible for the healing of ulcers and erosions in 94.7% of the patients. CONCLUSION: The spa-and-health resort-based rehabilitation is a pathogenetically sound and efficacious approach to the management of the patients presenting with frequently recurring erosive and ulcerative lesions in the oesophagus, stomach, and duodenum in the phase of subsiding exacerbation.

[Nonpharmacological therapy of duodenal ulcer in elderly patients].

AIM: To validate principles and policy of non-pharmacological treatment of duodenal ulcer (DLU) with onset at old age, to study medico-social efficacy of DU non-pharmacological treatment. MATERIAL AND METHODS: The study was made of 234 cases of DU in patients aged 61-65 years (mean age 63.2 years). DU was diagnosed in them at an old age. RESULTS: Non-pharmacological treatment of old DU patients was performed at three stages: outpatient basic treatment, inpatient rehabilitation with nonpharmacological methods, sanatorium remission and nonspecific resistance consolidation. CONCLUSION: Nonpharmacological measures by 3-stage scheme have higher medico-social efficacy compared to one-stage management.

[Rehabilitation of patients with duodenal ulcer developing in the advanced age].

A rationale is proposed for the principles and strategy of non-medicamentous therapy of duodenal ulcer (DU) developing in the advanced age and assessment of its socio-medical efficiency. Staged treatment was given to 234 patients in whom DU was diagnosed between 61 and 65 (mean 63.2) years of age. Basic therapy and long-term dynamic follow-up were carried out in outpatient settings (basic stage). The aim of the inpatient treatment was to maintain the previously achieved level of physical working capacity and quality of life (maintenance stage). Sanatorium therapy was needed to consolidate remission and strengthen resistance to the illness (consolidation stage). The study demonstrated higher socio-medical efficiency of the three-stage non-medicamentous treatment compared with single-stage therapeutic programs. Its use for physical rehabilitation of patients with DU is substantiated based on modern concepts of neuroimmunoendocrinology.

[Microhemocirculation and its correction in duodenal ulcer during period of rehabilitation].

The background of this research is to study morphological and functional microcirculatory channel condition with duodenum ulcer in the period of rehabilitation against the background of regular antiulcer therapy (1 group) and further treatment using Vazonit (2 group) in clinical conditions. EDU in animals results in marked microcirculatory disease in duodenum depending on the time of ulcer process development. Hypoxia is to be the significant factor associated with capillary stases, venous congestion. Blood flow impairment in organ results in metabolic damages of tissue structures. The results obtained are evidence of significant correction of microcirculatory channel state, improvement of regeneration and reparation processes. Vazonit improves the disorder of microcirculation and theological blood properties, restoring of macro and microangiopathy changes of hemocirculatory channel.

[Characteristics of outpatient rehabilitation of patients with duodenal ulcer complicated by bleeding].

Now current of a stomach ulcer differs special aggression. Treatment of patients with complicated current gastroduodenal ulcer remains the big problem. The method argon plasma coagulations (APC) now finds primary application for a stop extensive [Russian characters: see text] bleedings. At the same time, the important factor of favorable current of the complicated stomach ulcer is the continuity in treatment of patients and carrying out of adequate therapy from the moment of receipt in a surgical hospital and its continuation at an outpatient stage.

[Clinical variants of hypochondriac state in patients with duodenal ulcer].

AIM: To describe some clinical variants of hypochondriac syndrome in patients with duodenal ulcer (DU). MATERIAL AND METHODS: A hypochondriac trend was studied clinically and was confirmed by changes in the first scale of AMPI in 150 DU patients. If the first scale contained a rise over 70 points, the examinee was stated to be much concerned about his/her health. RESULTS: Hypochondriac syndrome in exacerbation was registered in 59 (39.3%) patients. It was accompanied with anxiety in 28.8% cases. Introversion and original attitude to somatic disorders were observed in 25.4% cases. Demonstrative behavior was seen in 23.8% patients. Depressive trends occurred in 13.5% patients. Conception of the disease was confirmed in 5.1% cases. Hypochondriac state with protest reactions and hyperthymic effect occurred least frequently (1 and 1 case, respectively). CONCLUSION: Hypochondriac states aggravate DU, deteriorate quality of life. Early diagnosis of a variant of hypochondriac syndrome enables a directed individual psychotherapy which improves emotional state of the patient and prevent further development of psychopathological traits.

[The role of the polyclinic in raising the efficacy of rehabilitation with peptic ulcer patients]. / Rol' polikliniki v povyshenii éffektivnosti reabilitatsii bol'nykh iazvennoi bolezn'iu.

The authors provide the results of the treatment and prophylaxis of peptic ulcer (PU) patients followed up by the polyclinic for 14 years. On a large factual material they estimate the efficacy of PU patients treatment with the use of drugs belonging to different groups, including drugs that exert antisecretory, cytoprotective and antibacterial effects. During the follow-up period, the number of patients with medium-grave and grave PU decreased whereas that of patients with mild disease and no relapses rose for 4-5 years and over (from 4.8% in 1972 to 39.6% in 1989). It has been established that the efficacy of rehabilitation measures for PU is determined by a lot of factors, first of all by adequate drug therapy with the use of the novel pharmacological preparations: selective blockers of histamine H2-receptors (ranitidine, famotidine), colloidal bismuth subcitrate (de-nol) that exert a cytoprotective and antibacterial action on Helicobacter pylori. The combination of the indicated remedies with antibacterial drugs (trichopol, oxacillin, furazolidon) for the treatment of PU relapses and their prevention is based.

[Gastric and duodenal mucosal function in peptic ulcer patients exposed to endoscopic laser therapy and sanatorium-health resort factors]. / Sostoianie slizistoi obolochki zheludka i dvenadtsatiperstnoi kishki u bol'nykh iazvennoi bolezn'iu pri vozdeistvii éndoskopicheskoi lazeroterapii i sanatorno-kurortnykh faktorov.

A comparative study of gastric and duodenal bulb mucosa has been performed in 138 patients with ulcer before and after treatment. The patients were treated with either He-Ne laser or copper steam laser alone vs combination of laser therapy with spa treatment. The most favourable was the complex including green spectrum laser in combination with administration of Shira Lake mineral water and electrophoresis of this water.

[Experience in health resort rehabilitation of patients in the early period after exacerbation of duodenal ulcer]. / Opyt kurortnoi reabilitatsii bol'nykh v rannie sroki posle obostreniia iazvennoi bolezni dvenadtsatisperstnoi kishki.

Forty-eight patients with duodenal ulcer were examined for the psychological status and that of autonomic nervous system before and after combined treatment. The group subjected to personality-oriented psychotherapy showed significantly higher potential of psychological defence and vegetative tonicity.

[The rehabilitation of duodenal peptic ulcer patients who participated in the cleanup of the aftereffects of the accident at the Chernobyl Atomic Electric Power Station]. / Reabilitatsiia bol'nykh iazvennoi bolezn'iu dvenadtsatiperstnoi kishki, uchastvovavshikh v likvidatsii posledstvii avarii na Chernobyl'skoi AES.

These patients require individual rehabilitation after determination of the unspecific reactivity of the body with prodigiosane. Depending on the results of this test the patients were treated with drugs stimulating the immune response in case of hyporeactivity, with adaptogens in normoreactive course of the disease and drugs modulating B-cell immunity in hyperreactivity. This approach allows to reduce hospital time, enhances remission.

[Nondrug methods in the combined treatment of peptic ulcer patients]. / Nemedikamentoznye metody v kompleksnom lechenii bol'nykh iazvennoi bolezn'iu.

Use of treatment complexes including non-drug methods (auricular acupuncture, pathogenetic dietotherapy, ILBR) or reduced doses of modern pharmacopreparations allowed to achieve rapid clinical and endoscopic remission in patients with ulcer disease. Simultaneously occurs normalization of the aggressive and defensive properties of the gastric juice, immunological, microcirculatory changes in the body and gastroduodenal mucosa. The vascular laser blood radiation reduced antacid dose and pathogenetic dietotherapy.

[Experience with the early health resort rehabilitation of patients who have undergone a surgical intervention for peptic ulcer]. / Opyt rannei kurortnoi reabilitatsii bol'nykh, perenesshikh operativnoe vmeshatel'stvo po povodu iazvennoi bolezni.

The present article focuses on the analysis of results of health-resort rehabilitative treatment of 49 patients operated on for gastric and duodenal ulcer, in the early postoperative period (by day 20). The treatments were administered at the health-promotion centre Iuzhnyi [correction of "Yuzhny"] (Mirgorod), the Mirgorod mineral water having been taken as a basis of said treatment. A conclusion was reached to the effect that the optimum term for entering the patients into the rehabilitative project and ensuring their complication-free status is day 20 after the operation. This study addresses the issue of the effects Helicobacter pylori has on the inflammatory processes in the remaining portion of the stomach. The presence of Helicobacter pylori in the above portion of the stomach suggests it has no part in the etiology of its inflammatory processes.

[The use of mountain air therapy for the correction of acid formation in patients with hypo- and hyperacidic syndromes]. / Primenenie terapii gornym vozdukhom dlia korrektsii kislotoobrazovaniia u bol'nykh s gipo- i giperatsidnym sindromom.

Changes were studied in intragastric pH with the aid of micromethods of topo-pH-metry in 46 patients presenting with hypo- and hyperacidic syndrome exposed to artificial mountain air (AMA) therapy. The gas mixture containing 14% oxygen was formed by using molecular sieves. AMA was found out to have a significant sanogenic effect: it makes for acid production in patients with hypoacidic syndrome and reduces the above production in those patients presenting with hyperacidic syndrome AMA therapy administered along with the judicious employment of blockers, Hs-histamine receptors will, we believe, help in alleviating and dispelling the withdrawal syndrome.

[The content of connective tissue carbohydrate-protein components in the blood and the free-radical oxidation indices in peptic ulcer in dynamic rehabilitative treatment]. / Soderzhanie uglevodno-belkovykh komponentov soedinitel'noi tkani v krovi i nekotorye pokazateli svobodnoradikal'nogo okisleniia pri iazvennoi bolezni v dinamike vosstanovitel'nogo lecheniia.

Levels of gexosamines, free oxiprolin, gexuronic acids, malonic dialdehyd, reduced glutathione and total content of gexosamines in blood as well as spontaneous chemiluminescence of blood serum were studied in 89 patients with duodenal ulcer during rehabilitative treatment and in 35 healthy subjects. Rehabilitative stage-by-stage treatment was demonstrated to ensure normalization of anti-radical protective systems of the body, beneficially influence connective tissue structures of gastric and duodenal mucosa, prevent exacerbation of the disease.

[Ultrastructural changes in gastroduodenal mucosal cells in patients with perforating ulcer and effect of serotonin adipinate on their postoperative rehabilitation]. / Ul'trastrukturnye izmeneniia kletok slizistoi obolochki zheludka i dvenadtsatiperstnoi kishki u bol'nykh s perforativnoi iazvoi i vliianie serotina adipinata na dinamiku ikh reabilitatsii v posleoperatsionnom periode.

Consideration is given in the paper to the state of the mucosal cell ultrastructure in the gastroduodenal zone in patients with perforating ulcer. Apparent inflammatory-degenerative type ultrastructural alterations have been found to be precent in the gastric and duodenal mucous coat in the zone of perforating ulcer. The above alterations are noted to persist by day 10 in these postsurgical patients having been administered conventional treatments. The use of serotonin adipinate promotes earlier restoration of the ultrastructural picture in the mucous coat of the gastroduodenal zone.

[The histochemical and histoenzymological changes in the gastric mucosa and the state of the connective tissue in peptic ulcer patients during dynamic rehabilitative treatment]. / Histokhimichni, histoenzymolohichni zminy slyzovoï obolonky shlunka i stan spoluchnoï tkanyny u khvorykh na vyrazkovu khorobu v dynamitsi vidnovnoho likuvannia.

Combined differentiated rehabilitative and staged treatment of 167 patients with peptic ulcer resulted in stable reduction in cellular membrane permeability, subsiding of catabolic processes in cells, steady normalization of enzymic activity of tissue respiration, as well as activation of reparation processes in connective tissue elements and structures located in the connective tissue (capillaries included). The described mode of treatment appeared to be superior to the conventional one, resulting in a substantial improvement in microcirculation in gastric mucosa. Normalization of protein-synthetic processes in the connective tissue makes for enhancing of the gastric mucosa resistance and prevention of the relapse of the disease.

[The use of physical factors on the neck area in gastric and duodenal peptic ulcer]. / Primenenie fizicheskikh faktorov na vorotnikovuiu oblast' pri iazvennoi bolezni zheludka i dvenadtsatiperstnoi kishki.

Basing on examination of 54 peptic ulcer patients and 62 patients operated on for duodenal ulcer it was shown that collar region is functionally active. In response to physical factors it promotes better regulation of pituitary and thyroid function as shown by radioimmunoassay, thermography and other modern investigating techniques. The findings support administration of physiotherapy on collar region for correction of neurohumoral regulation, trophicity and function of the stomach in ulcer patients.

[The effect of acupuncture on the gastric acid-forming function in patients with duodenal peptic ulcer]. / Vliianie akupunktury na kislotoobrazuiushchuiu funktsiiu zheludka u bol'nykh iazvennoi bolezn'iu dvenadtsatiperstnoi kishki.

Acupuncture of points E36 Zusanli and auricular points is shown to influence acid production in the body of the stomach and alkalinization in the stomach antrum in patients with duodenal ulcer and hyperacidity. 20-min acupuncture on points E36 intensifies acid production while 40-min procedure inhibits acid production. Combination of auricular and corporal acupuncture enhances acid production suppression in gastric body and improves alkalinizing function of the antrum.

[The effect of nitrogen silicide thermal mineral water on stomach function in gastroduodenal pathology]. / Vliianie azotno-kremnistoi ternmal'noi mineral'noi vody na funktsional'noe sostoianie zheludka pri gastroduodenal'noi patologii.

Patients with ulcer, hyperacid and normal acid gastritis were given nitrogen silicate mineral water from Annensk thermal springs. The water was found to inhibit acid-pepsin-forming function and to improve gastric motility and evacuation. Acceptable fluoride concentration and not a single case of the disease aggravation make the above mineral water suitable for rehabilitation of patients with ulcer and gastritis.