Biomedical subjects
Publications and source records attributed to Ia S Tsimmerman.
The author believes that eradication of Helicobacter pylori (HP) should be strictly justified and confined to cases with confirmed diagnosis of HP. Ineffective HP eradication leads to acquired resistance of HP to anti-chelicobacter therapy. How to overcome this resistance is shown.
Questionnaire survey has been performed among 100 patients with duodenal ulcer (DU). Character building of these patients when they were children and adolescents was wring in 80 +/- 4 cases (women) and in 88.6 +/- 3.2 cases (men). Most significant negative factors were undercare, hypercare and living in incomplete family. The Leongard's questionnaire distinguishes various accentuations with prevalence of cycloid, epileptoid, emotive and demonstrative; anxiety scale was low. The Gissen personality questionnaire "Ego" confirmed frequent occurrence among DU patients of emotive, hysteroid, epileptoid features with non-flexible type of reaction. By Luscher's test, anxiety was low or moderate. Overall prevalence of personality disorders totalled 29 +/- 4.5 cases, mostly in women. It was proved experimentally that psychosomatic disorders are realized in target organs. In DU these organs were gastrointestinal (36 +/- 5.7 cases). Similar data about involvement of the gastrointestinal tract (GIT) were obtained in stress reactions. However, "ulcer personality" was not documented. Support of preferable realization of psychogenic factors action in GIT was obtained with Gissen somatic questionnaire. Operating psychogenic factors and their dynamics were characterized; emotional deprivation was leading. Among psychopathological manifestations, asthenodepressive symptoms prevailed in 76 +/- 4.3 cases. High efficiency of gestalt-psychotherapy and coaxil in the treatment of DU in patients with psychopathological disorders of the neurotic level were found.
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To test the conception about a pathogenetic role of correlation between gastric comtamination with Helicobacter pylori (Hp) and immune system disorders in duodenal ulcer (DU), immune status and its response to current pharmacotherapy were studied in 84 patients in an acute recurrence phase. The patients were divided into 4 representative groups to receive monotherapy with omeprasol (group 1), combination denol + amoxicillin + tinidasol (group 2), quadrotherapy with drugs of group 1 and 2 (group 3), the above quadrotherapy plus immunomodulating drugs (imunofan + tactivin + oligovit) (group 4). In recurrent DU all the components of the immune system are affected especially cellular immunity. The response to the treatment was highest in group 1 and 4 (90% healing for 3 weeks), the worst in group 2 (68%). The complex of antibacterial drugs produces a moderate immunosuppressive action. The addition of immunomodulating drugs to the quadrotherapy promotes correction of secondary immunodeficiency and secondary Hp resistance to antibacterial drugs. This leads to a rise in eradication effect from 33-55 to 84% and a decrease in the number of early recurrences (during the first 6-12 months) from 42.1-33.6 to 12.5%.
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The review presents 69 references of current literature on the problem of gastroduodenal ulcer physiotherapy which has a good potential of impact on gastroduodenal motility, lipid peroxidation, microcirculation, physiological and reparative regeneration of epithelial and glandular cells. The choice of a physiotherapeutic method depends on the disease stage and to a less extent on location of the ulcer defect.
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Scanner therapy in the treatment of patients having duodenal ulcer relapse combines high pharmacoeconomic efficiency with safety providing for clinical and endoscopic remission of the disease.
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Duodenal ulcer cure, as a systemic gastroenterologic disease, can be achieved in some patients by the addition of the nootropic drug piracetam to current antisecretory and antihelicobacter therapy. Piracetam corrects vegetative and psychoemotional disorders in duodenal ulcer, normalizes gastric motility, has an antioxidant effect and improves cerebral circulation. An optimal effect on clinico-endoscopic manifestations of recurrent duodenal ulcer was achieved in combination of piracetam with current antisecretory (omeprazole) and antihelicobacter (de-nol, amoxicillin, metronidazole) medicines. Such combination improves both short- and long-term outcomes of duodenal ulcer treatment.
A clinical response to and some mechanisms of therapeutic action of extremely high frequency (EHF) therapy were studied in 132 patients with exacerbation of duodenal ulcer vs routine pharmacological treatment. EHF-therapy was used alone and in combination with famotidin (antisecretory drug) and norfloxacine (antibacterial drug). EHF monotherapy proved highly effective in duodenal ulcer exacerbation. It normalizes secretory and motor functions of the stomach, suppresses initially high activity of free radical lipid oxidation, corrects abnormal vegetative and psychoemotional status of the patients, moderately potentiates the antihelicobacter effect of antibacterial drugs. These effects are produced due to specific action of EHF therapy: mobilisation of sanogenesis mechanisms, correction of mechanisms of adaptive regulation and self regulation at different levels. Additional administration of antisecretory and antibacterial drugs improved immediate but deteriorates long-term response to EHF-therapy.
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The etiology of chronic (complete) gastroduodenal erosions is not quite clear and is apparently multifactorial. A total of 100 patients with chronic gastroduodenal erosions were examined and divided into 5 representative groups, 20 pts each. For objective evaluation of the significance of various (probable) etiological and pathogenetic factors in development of chronic erosions, monotherapies with drugs with known pharmacodynamic effects were used (ranitidine, double and triple antihelicobacter protocols, dalargin, trental). Triple antihelicobacter protocol and trental proved to be the most effective in the treatment of chronic erosions (90 and 85%, respectively). Dalargin and double antihelicobacter protocol caused disappearance of complete erosions in 50% patients and ranitidine in only 15%. Analysis of the frequency of erosion epithelialization and Helicobacter pylori eradication under the effect of antibiotics showed a clear-cut positive correlation (r = 0.9) between these parameters, which indicated an important role of Helicobacter pylori in the pathogenesis of chronic gastroduodenal erosions. Moderate antihelicobacter activity of dalargin was revealed for the first time. The results of this study indicate that the majority of complete erosions are an individual nosological entity. Microcirculatory disorders in the antral part of the gastric mucosa and its contamination with Helicobacter pylori play an important role in the disease development; decreased cytoprotection and local immunity in the antral part of the stomach are also. The acidopeptic factor cannot cause complete erosions but is one of conditions for their formation.
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