[Ectopic duodenal varices as a cause of difficult diagnosis of bleeding in extrahepatic portal hypertension].

Bleeding from ectopic varicose veins is a rare life-threatening cause of upper gastrointestinal hemorrhage. Alberti first described duodenal varices in 1931. According to the literature, incidence of duodenal varicose veins in patients with portal hypertension is 1-3% of all varicose veins.

[Self-expanding nitinol stents for bleeding from esophageal varices in patients with portal hypertension].

Blakemore probe-obturator was previously preferable for primary hemostasis in patients with bleeding from esophageal varices. Currently, Danis self-expanding nitinol stent became an effective alternative. According to some manufacturers, Danis stent has some advantages over balloon tamponade.

[Expression of plasminogen activator system components in the gastric mucosa in portal hypertensive gastropathy].

Objective: to study the expression of urokinase-type plasminogen activator (uPA) and plasminogen activator inhibitor-1 (PAI-1) in the gastric mucosal (GM) vascular endothelium and epithelial cells of patients with portal hypertensive gastropathy (PHG) and those with portal hypertension (PH) without signs of PHG as compared to a control group.

Material And Methods: GM biopsy specimens from patients with PHG, those with PH without signs of PHG, and controls with the normal gastric mucosa were immunohistochemically examined.

Results: Comparison of the expression of uPA in the GM vascular endothelium and epithelial vessels revealed no significant differences in the patient groups.

[Portal hypertensive gastropathy].

In spite of a great number of publications, as yet there is no agreement that which of the detected morphological changes should be considered pathognomonic in portal hypertensive gastropathy (PHG). The study of the pathogenesis of PHG suggested a diversity of mechanisms involved in varying degrees in the development of this abnormality. The paper summarizes the data available in the literature on the role of endothelial dysfunction, apoptosis, damaging factors, and H.

[Surgical treatment of portal hypertension: the state of art].

The article highlights modern approaches to the treatment of portal hypertension. The differential tactics is based on the type of portal hypertension, functional liver state, urgency of the situation and severity of blood loss, localization and stage of varices, concomitant diseases, etc. The role of miniinvasive methods is stressed.

[Portal gastropathy: diagnosis, classification].

Portal hypertensive gastropathy (PHG) is a complex of secondary macroscopic and microscopic changes in the mucous layer of the stomach, resulting from portal hypertension of any origin. The overall prevalence of PHG ranges from 9.1 to 80%.

[The modification of the M.D. Patsiora's operation by portal hypertension].

The direct transcutaneous transhepatic portography was performed in 85 patients with hystologically confirmed liver cirrhosis, portal hypertension and varices of the esophagus and stomach. It was found out, that the left gastric vein partakes the varicous transformation in 100% of cases. The least had an isolated division in 27% of the studied patients.

[Pathogenesis of esophageal and gastric varicose veins formation in patients with liver cirrhosis].

Research Objective: studying the features of the collateral venous blood flow and the basic ways of the formation of gastroesophageal varices in patients with cirrhosis and portal hypertension.

Methods: The following analysis is based on the interpretation of results from percutaneous transhepatic splenoportography in 85 patients. It has been established that in all 85 patients the left gastric vein plays a key role in the formation of gastroesophageal varices.

[Aneurysm of the thoracic aorta with esophageal perforation].

Aneurysms of a chest department of an aorta with esophageal perforation two cases are presented and a lethal outcome. Difficulties in diagnostics have been caused by rare occurrence of the given pathology, insufficient experience of clinical physicians, and also absence during supervision of characteristic attributes Aortoesophageal Fistula.

[Non-Hodgkin's lymphoma of the stomach. A case report].

Clinical supervision diffuse large B-cell lymphoma of the stomach at the patient of young age is presented. Difficulties of the differential diagnostics of lymphom have been caused by macroscopical polyphormism. With the purpose of verification of disease are used the chromoendoscopy and immunohistochemical research.

[Endoscopy combined hemostasis. Pathogenetic mechanisms of therapeutic action in gastroduodenal ulcers, complicated by severe blood loss and hemorrhagic shock].

On the basis of results of research the pathomorphology severe blood loss and haemorrhagic shock at 38 patients who have died from ulcer gastroduodenal of bleedings, with the purpose of preventive maintains of relapses of bleedings am established by authors necessity of carrying out of the general, and also local metabolic rehabilitation during the endoscopic haemostasis at massive bleedings at the patients with high risk of surgical treatment.

[Conservative treatment of giant gastric ulcer].

Clinical supervision of successful conservative treatment of the patient with a huge stomach ulcer with use in the course of performance endoscopic a metabolic homeostasis of solutions of glucose and ascorbic acid of 5%, and also pH-chromoscopy and capillary gastrointestinal a tube is presented.

[Hemorrhagic shock. A new concept of endoscopic hemostasis and prospects of the non-surgical treatment of ulcer and gastroduodenal hemorrhages complicated by hemorrhagic shock].

A new direction with the use of endoscopic hemostasis (EH) was offered in the complex program of metabolic rehabilitation of patients with ulcerous gastroduodenal bleedings (UGDB) and hemorrhagic shock (HS). There was a study of the results of treatment of 44 patients (29 men and 15 women at the age from 61 to 77) with severe concurrent diseases and UGDB complicated with HS. Recurrences of UGDB in case of HS are a factor of high operative-anesthetic risk.

[Endovascular embolization of the gastric veins in portal hypertension complicated by esophagogastric hemorrhages].

Through a period from 1981 to 1996 127 roentgen-endovascular embolization of gastric veins were carried out in 95 patients for portal hypertension complicated by esophagogastric bleeding or in its threatening relapse. Group 1 consisted of 73 patients, to whom endovascular treatment was carried out urgently at the background of continuing hemorrhage, in 52 patients--it was delayed and in 21 patients in the nearest posthemorrhagic period. In 73 patients bleeding resulting from embolization was stopped.

[Enteral detoxication in patients with liver cirrhosis and bleeding from the esophageal and gastric varices ].

A new method of enteral detoxication with the use of both well-known medicines ("Normase", "Sorbit") and new medicine-"Rafinosa" is described. Clinical effectiveness (normalization of neurological status) of these medicines correlates with normalization of blood amino acids unbalance, decrease of the catabolic processes and accumulation of toxic products of nitrogenous metabolism. All the above medicines (Italian made "Normase", "Sorbit" and Russian made "Rafinosa") are equally important for clinical practice.

[Role of endoscopy in diagnosing rare sources of small intestinal bleedings due to vascular disorders].

The authors describe two cases of intraoperative endoscopic diagnosis of hemangioma and vasculitis of the small intestine. The examination was conducted during laparotomy by colonoileoscopy and enterotomy. The authors believe this method to be most effective in emergency surgery when the operation cannot be postponed because of the patient's severe condition caused by hemorrhagic shock.

[Management strategy for pregnant women with portal hypertension syndrome].

The authors describe their management policy with pregnant patients suffering from portal hypertension syndrome, based on the results of comprehensive examinations and deliveries in 44 women. Principal indications for abortions in such patients are active liver cirrhosis, third-degree varicosity of esophageal and gastric veins, dilatation of the esophagus. Natural labor is permitted when there are no threatened bleedings.

[Use of a gastrointestinal tube in the treatment of gastric and duodenal ulcer].

The trial of a gastrointestinal tube in gastroduodenal ulcer indicates its high efficiency for enteral tube feeding in serious ulcer cases and as a therapeutic modality in noncomplicated cases. The tube introduction in 55 patients out of 89 promoted the defect healing within 2-3 weeks, in 30 out of 36 cicatrization occurred on week 3-5. The presence of the tube produced no effect on acid production in the stomach, cicatrization of the ulcer took place without basic therapy in remaining hypo-achlorhydria and hyperchlorhydria.

[Orthotopic liver transplantation (first clinical experience)].

The article deals with the results of work conducted according to the orthotopic liver transplantation (OLT) program from January 1990 to January 1992. To select the patients for OLT, 54 persons (24 males and 30 females aged from 12 to 55 years) with diffuse (34) and focal (20) diseases of the liver were examined. OLT was indicated for 19 patients who were registered in the waiting list.

[Several factors in the pathogenesis of hepatic failure in patients with liver cirrhosis and bleeding from esophageal and gastric varicose veins].

Bleeding in patients with liver cirrhosis leads to the activation of catabolic processes, accumulation of end products of nitrogen metabolism and pronounced imbalance of blood plasma amino acids. There is a correlation between the changes observed and disorders in neurological status. The authors hold that increased catabolism, pronounced imbalance of blood plasma amino acids and elevated blood ammonia level are the leading factors affecting the onset of hepatic encephalopathy.

[Re-evaluation of the opinions regarding vascular portacaval anastomosis in the surgical treatment of portal hypertension].

Experience in the establishment of vascular portocaval anastomoses in 66 patients with cirrhosis of the liver and 52 patients with extrahepatic portal hypertension was studied. Selective portocaval anastomoses produced the best immediate and late-term results in cirrhosis of the liver, side-to-side or H-type splenorenal anastomoses were found to be optimal, they were marked by minimal trauma to the pancreas and adequate decompression of the gastroesophageal channel with maximal maintenance of the portohepatic blood flow. Maximal decompression of the portal system is expedient in extrahepatic portal hypertension; this is mostly accomplished by means of H-type mesentericocaval anastomosis with an autograft formed from the internal jugular vein.