[Structure of diagnosis in iatrogenic diseases. (Regarding the article by V.D. Fedorov and D.S. Sarkison on "Concept of iatrogenic diseases")].
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Biomedical subjects
Publications and source records attributed to V P Morozov.
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The authors review the role of the gastroduodenal blood flow as a factor ensuring the secretory activity and protective properties of the gastric mucosa. The possibilities of its pharmacoregulation are also reviewed. It has been shown that the decrease of the gastric blood flow in experimental hemorrhagic shock, extravasal celiac artery stenosis, effects of indomethacin, vasopressin, etc. leads to ischemic injuries to the gastric mucosa accompanied by serious morphological and functional disturbances. The pathogenetic aspects of ischemic injuries to the stomach and duodenum are confirmed by the results of clinical examinations of patients with compression celiac artery stenosis and peptic ulcer. It has been noted that in these patients, the tissue blood flow in the mucosa in considerably decreased in the area of ulcerous defect. The lowering of the content of total phospholipids and changes in their composition were also observed both in relapse and after healing. Out of agents that improve peripheral circulation, propranolol, tavegil combined with cimetidine, trimin appeared most potent. These drugs regulate metabolic processes in gastric tissue, normalizing blood flow, reducing the content of histamine, serotonin, lipid peroxidation products, raising the level of total phospholipids and pepsin.
Investigation of 67 patients with peptic ulcer revealed a reliable activation of lipid peroxidation processes both in the blood of the patients and in the mucous membrane in the area of the ulcer location immediately. The activation of lipid peroxidation resulted in a decrease in the contents of phospholipids in the biological membranes of the mucosa cells. The alterations revealed occurred in the presence of inhibition of the antioxidant system of the body. The authors proved the efficacy of the use of antioxidant formulations and ultraviolet irradiation of the blood in the treatment of patients which resulted in acceleration of the ulcer cicatrization and the reduction of the inpatient period as well as the improvement of surgical results.
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Silver plating of nucleoli was used to study the activity of nucleolar organizers (NO) in the cells of one-layer prismatic epithelium of the gastric and duodenal mucosae. The activity of NO was established to be lowered in patients suffering from ulcer disease and in patients with compression stenosis of the celiac trunk, which may point to the impairment of protein synthetic processes in the cells. Factor of ischemia as the most probable cause of the enumerated changes is under discussion.
An examination of 395 patients with ulcer disease of the duodenum was made. The authors have developed a program of examination of patients with ulcer disease. In addition to traditional methods it includes such methods as intragastric pH-metry in the body and antral part of the stomach, measuring tissue blood flow in the wall of the stomach and duodenum, investigation of parameters of local resistance of the mucosa, medicamentous tests. The possibility to predict curative effects of surgical procedures is discussed.
As the practice of perosseous osteosynthesis has demonstrated, it is rather difficult to achieve a high accuracy of reposition using a closed technique. The authors offer the simplest and a biomechanically advisable reposition system of the compression and distraction apparatus. The use of such technique proves its efficacy and advantages. The achievement of a high accuracy of reposition and rational fixation of the fragments has allowed for an abrupt reduction in the treatment terms and costs and to improve its quality.
The contribution made by vascular factors to impairment of blood rheological properties was demonstrated on the basis of examination of 65 apparently healthy persons by using a vascular occlusion test. The vascular endothelium showed a decrease in fibrinolytic, anticoagulant, antiaggregatory activities. The new term "hemorheological tolerance to vascular occlusion" was proposed to use. A number of quantitative and qualitative indices for normal hemorheological tolerance were identified. The paper provides data on the frequency of particular mechanisms responsible for its decrease. It also emphasizes that the knowledge of the mechanisms of vascular impairments makes it possible to choose a combined drug therapy for myocardial infarction in a differential fashion.
By means of a polarographic method, the decrease in the rate of blood flow in the gastric and duodenal mucosa at the period of exacerbation of ulcer disease, and its normalization at the period of ulcer healing were revealed. The role of the impaired blood supply of the mucosa in ulcer formation is discussed.
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Experience with the surgical treatment of 265 patients with a compressive stenosis of the celiac trunk has been analyzed. Stenosis of the celiac trunk is known to be a cause of ischemic abnormalities of the stomach, duodenum, pancreas. Decompression of the celiac trunk is an effective method of treatment of the ischemic disease of digestion organs resulting in better organic blood circulation and involution of the appearing pathologic processes. In a number of patients there appeared symptoms for associated interventions due to complications of ischemic gastroduodenal ulcers or concomitant diseases. Excellent and good remote results were noted in 79,6%, satisfactory--in 16,7%, unsatisfactory--in 3,7%.
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Considerable disturbances of the visceral blood circulation have been found to occur in stenosis of the celiac trunk. Circulatory disorders in the liver, pancreas, stomach and duodenum are dependent on the degree of the celiac trunk narrowing. The collateral vascular bed fails to provide the complete compensation of the reduced organic blood flow. As a result, chronic ischemia of the organs persists.
Experience in the treatment of 218 patients with compression stenosis of the celiac trunk is generalized. The clinical symptoms and the angiographic semiotics of the disease are described in detail. Active surgical tactics is substantiated and the results of operations are studied.
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