[Morphological changes in the ureteral wall in contact ureterolithotripsy].

We studied a harmful action of laser, ultrasound and ballistic energies on intact wall of human ureter in 15 ureters of men and women with renal carcinoma aged 43-55 years (mean age 48 +/- 8 years) before nephrureterectomy in vivo. With growing time of exposure to laser radiation, ureteral mucosa undergoes destructive alterations up to muscular layer. Ureteral wall exposure to ultrasound do not change thickness of the wall considerably, cell elements remain viable.

[Ulcerous gastrointestinal bleedings].

On the basis of the study of 2388 patients with chronic gastric and duodenal ulcers complicated by acute bleeding, the most disputable organizational and tactical issues of ulcer bleeding (UB) treatment are discussed. It is reasonable to divide surgery for UB into urgent, delayed and elective. Indications for different surgeries in UB and basic surgical principles are discussed.

[2-Component silicone compounds in the emergency surgery of gastrointestinal hemorrhages].

Based upon their clinico-experimental investigations the authors prove advantages of the two-component silicon compositions over oil preparations for the arrest of gastro-intestinal bleedings. Such compositions are recommended for patients whose treatment by traditional methods of hemostasis proved to be ineffective due to some causes which is often observed in elderly and senile patients.

[The role of endoscopy in determining the indications for the surgical treatment of the Mallory-Weiss syndrome and of bleeding acute gastroduodenal ulcers].

The frequency of acute sources of bleeding has recently increased (47%) in the general picture of gastrointestinal bleedings which makes the improvement of diagnosing "acute" sources of hemorrhage and the development of more perfect methods of nonoperative hemostasis very actual. The authors believe that "Kaprofer" used in most of patients with bleedings from acute ulcers and ruptures of the gastro-esophageal zone mucosa (95%) allows the hemorrhage to be arrested. The treatment can be continued without operative interventions.

[Successful surgical treatment of cancer with multiple location].

The lecture deals with the specific characteristics of cell membrane damage caused by in vivo and in vitro irradiation at the dosage commonly used in radiation therapy of malignant tumors. The mechanisms of lymphoid cell loss to ionizing radiation are described. They include metabolic depletion, direct damage to the cell membrane causing loss of its asymmetry and surface receptors expression being altered.

[A combination of the Mallory-Weiss syndrome with acute ulceration of the gastric and duodenal mucosa].

The Mallory-Weiss syndrome is often associated with acute ulceration of the gastric and duodenal mucosa, which gives grounds for a supposition of the existence of common mechanisms of pathogenesis of these diseases. Because of bad results of the operative treatment of patients with such combinations, the method of choice should be conservative therapy and curative endoscopy. A pathogenetically substantiated operative intervention--suturing the source of bleeding in combination with vagotomy and pyloroplasty is preferable when operation is inevitable.

[The treatment of acute gastrointestinal hemorrhages at a specialized hospital].

A differential approach to surgical interventions corresponding to the system of treatment of patients with gastrointestinal bleedings developed by the authors gave considerably less lethality in patients with bleedings caused by acute gastric and duodenal ulcers and by the Mallory-Weiss syndrome. General lethality among these patients was 3.3% and 5.

[The hemostatic effect of vagotomy in acute gastroduodenal ulcers complicated by massive hemorrhage].

The clinico-experimental investigation has shown high efficiency of the bilateral subdiaphragmatic truncal vagotomy in treatment of patients with acute gastroduodenal ulcers complicated by massive hemorrhage. The haemostatic effect of the operation is related to the inhibited acid gastric secretion, proteolytic activity of the intragastric content as well as to the activation of serotonin-containing cells and increased tonus of the sympathetic nervous system, which is responsible for gastric vessel spasm, shortens time of bleeding, increases the amount of thrombocytes and their aggregation. When vagotomy with interventions draining the stomach is not possible, suturing (dissection) of bleeding acute ulcers is recommended in combination with prolonged novocain blockade of vagus nerves.

[The results of the endoscopic diathermy coagulation of hemorrhaging gastroduodenal ulcers].

The authors analysed the results of endoscopic diathermy coagulation of bleeding acute gastroduodenal ulcers in 83 patients; in 47 of them the follow-up period ranged from 12 months to 9 years. A stable hemostatic effect was achieved in the early periods after coagulation of the acute ulcers in 76% of cases. The frequency of recurrent bleeding was found to be directly dependent on the degree of the blood loss.

[Methods for surgical prophylaxis of the development of acute gastroduodenal ulcers].

The results of the use of prolonged novocaine blockade with the aim of prevention of the development of acute gastroduodenal ulcers in 57 patients are presented. In 21 case, the prolonged blockade of the vagus nerves was used, in 36--that of the ligamentum teres hepatis. After the operation, the proteolytic activity and acidity of gastric juice were studied.

[Gastrointestinal hemorrhage after operations for perforated gastroduodenal ulcers].

On the basis of clinical observation over 521 patients who underwent operations in the clinic for perforating gastric and duodenal ulcer, the authors determined the frequency of massive gastrointestinal hemorrhage (3.2%) in the early postoperative period and the mortality rate in this complication. It is shown that the performance of radical surgical interventions instead of simple closure of the perforating ulcer with sutures, in the absence of life-threatening concomitant diseases and the terminal phase of peritonitis, may improve the results of operative management of this disease.

[Prevention and treatment of stress-induced ulcers].

The data presented show that along with acid-peptic aggression an important role in pathogenesis of stress ulceration in the stomach and duodenum belongs to energy and immune deficiency which makes the correction of these alterations necessary. The timely and valuable conservative therapy including histamine H2-receptor blocking agents in addition to antacids and endoscopic electrocoagulation in case of profuse bleeding from stress ulcers allows to obtain hemostasis and healing of the ulcers more than in 90% of cases. When choosing the surgical method of treatment the preference should be given to atraumatic organ-preserving operations.

[State of blood flow in gastric and small-intestinal mucosa in acute diffuse peritonitis].

One of the most severe complications of the postoperative period in patients with diffuse peritonitis is known to be erosive ulcerous injuries of the gastrointestinal tract mucosa (in 29 of 150 patients). The blood flow state of the gastric and intestinal mucosa was studied with the help of contact microfluorimeter under conditions of experimental peritonitis. Disturbances of the intramural blood flow of the gastrointestinal tract have been found which is a cause of the formation of acute ulcers and erosions of the mucosa.

[Pathogenesis of acute ulcers of the digestive tract in post- operative suppurative-septic complications].

In studying the pathogenesis of acute gastric and duodenal ulcers arising in operated patients against the background of purulent-septic complications, the specific signs distinguishing them from stress-ulcers, which develop in response to surgical aggression, were revealed. They are: the absence of inflammatory reaction in the gastric mucosa, its ischemia, hypo- and achlorhydria with reduction in the proteolytic activity of gastric juice.

[Status of the acid and pepsin-producing functions of the stomach in patients after abdominal surgery].

A combination of methods was used to study gastric secretion and intragastric proteolysis in the early postoperative period after traumatic surgical interventions on the abdominal organs. Activation of the acid-peptic aggression was established in the first three days with its maximal manifestations occurring during night, which is evidence of the predominance of the vagus influence. Acute gastric and duodenal ulcers arise, as a rule, in the presence of hypersecretion even if achlorhydria is indicated in case records.

[Acute gastroduodenal ulcers in the early postoperative period].

Clinical observations of 146 surgical patients have confirmed high informative value of fibrogastroduodenoscopy which could reveal ulcerations in 69% of the patients examined and thus choose the adequate treatment. A thorough study of acid-forming function of the stomach as well as determination of activity of lysosomal enzymes of the gastric juice has shown that hyperacidic state of the mucosa and high activity of alcaline phosphatase of the gastric juice may be considered as risk factors of the formation of acute ulcers.

[Results of the complex treatment of acute destructive pancreatitis].

Results of treatment of 4018 patients with acute pancreatitis (including 267 cases of destructive pancreatitis) for the last decade has shown that no promising results were obtained in spite of the introduction of new surgical and nonsurgical methods into clinical practice. High percent of lethal outcomes (70%) among patients with acute pancreatitis who have acute gastric ulcers, and the absence of clear understanding of the mechanisms require further investigation of the problem.

[A titration method of determining the acidity of opaque gastric juice in emergency surgery].

The data presented show great practical significance of titration methods of the investigation of gastric secretion. 220 comparative determinations of acidity of the gastric juice have shown the presence of admixtures of mucus, blood and bile in the gastric content to overstate the indices of the colorimetric titration method without a practical effect on the electrometric one which is known to be more precise.

[Changes in gastric secretion in patients in the early period after surgical interventions on the abdominal organs].

The gastric secretion was systematically examined in 58 patients during the first days after operations on organs of the abdominal cavity, 23 of them having it considerably increased. In three of these patients the operation was followed by gastric bleeding from acute ulcers. Higher gastric secretion was most frequently observed in patients with mechanical jaundice, purulent peritonitis and intestinal obstruction.