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[Monofilaments in digestive system surgery].

The most important physical and chemical properties of the new synthetic absorbable suture materials are shown. Particularly this paper make a comparison between multifilament and monofilament suture wire from the point of view of tensile strength, "in vivo" tensile strength retention, reabsorbability, foreseeability of the reabsorption time of the capillarity. On these theoretical basis the AA. think that actually the best suture wire for the gastrointestinal surgery must be a synthetic absorbable monofilament suture material. Clinical and experimental experience of the AA. utilizing in the surgery of the gastrointestinal tract a copolymer monofilament of the glycolic acid and of the trimethylene carbonate (polyglyconate-Maxon), resorbable by not-enzymatic hydrolysis in about 180 days are described. The clinical experience was acquired performing 43 manual gastroenteric anastomosis by polyglyconate suture material and making an endoscopic follow-up in 19 cases (12 oesophago-jejunal anastomoses and 7 colo-rectal anastomoses). The experimental study consist of 30 enteric anastomosis performed on rats. The results evaluation was made from three points of views: bacteriological, optical diffuse light microscopy and electronic transmission microscopy. The conclusions of the clinical and experimental studies are favourable for the use the polyglyconate suture wire in digestive surgery, and confirm also "in vivo" its theoretical properties.

Animals↗

[Nutrition in the pathogenesis, therapy and prevention of digestive system diseases].

The role of nutrition in the pathogenesis, therapy, and prevention of gastrointestinal diseases is discussed. Although nutrition is not a leading cause of most gastrointestinal diseases, the role of nutrition in their pathogenesis is very great. Nutritional monitoring of the Russian Federation's population has revealed a shortage of many essential nutrients to be consumed, which may result in worsening of various gastrointestinal diseases. The most promising way of solving this problem is to supplement their diets with biologically active additives (Nutricevtics) which may be a main source of essential nutrients, such as vitamins B, beta-carotene and omega 3-polyunsaturated fatty acids.

Diet↗

[Immunologic indices in chronic pancreatitis and in its combination with other diseases of the digestive system].

Analysis of the immune system status of 200 patients with chronic pancreatitis has shown more marked immune shifts in the patients with the primary condition, who presented with high levels of immune complexes and autosensitization to pancreatic tissue. When pancreatitis was associated with intestinal abnormalities, T lymphocyte function was depressed, as was nonspecific defense of the body. In cases when chronic pancreatitis resulted from diseases of the bile duct, stomach, or duodenum, the findings evidenced high blood serum levels of immunoglobulins A, G, and M, and significant bacterial sensitization. These results may be useful in choosing immunocorrecting therapy.

Chronic Disease↗

[Tumor markers in cancer of the digestive system].

The first tumor marker (TM) described in Oncology was the Bence-Jones protein in 1847 in patients with multiple myeloma. However, it was not until the early 60s that the first useful TM in gastrointestinal (GI) cancer was recognized, alpha fetoprotein. The development of TM has achieved enormous progress over the last years and its definition includes not only tumor products but elements inherent to the tumor such as oncogenes. A review is presented of the most important TM in GI tumors according to anatomic location. Emphasis is made in colon cancer and the clinical usefulness of carcinoembryonic antigen throughout the different stages in the management of such patients.

Adult↗

[Prenatal ultrasonic diagnosis of developmental abnormalities of the organs of the digestive system].

Analysis is made of the results of ultrasound diagnosis of developmental abnormalities of the alimentary tract. It has been established that the information content of echography is dependent on the anatomic intensity of an abnormality and the period of pregnancy at which the examination was done. It has been shown that the method is not of high diagnostic significance in revealing developmental abnormalities of the upper lip and hard palate, atresia of the esophagus, large intestine and rectum. At the same time atresia of the duodenum, small intestine, omphalocele, gastroschisis, diaphragmatic and inguino-scrotal hernia are detectable in practically 100% of cases. The authors provide echograms of the majority of abnormalities, indicate the minimal times of detection, analyze the causes of diagnostic errors.

Congenital Abnormalities↗

[Gastrin secretion during food stimulation in digestive system diseases].

The effect of food on gastrin secretion was examined in 62 patients with various diseases of the alimentary system (chronic gastritis, chronic cholecystitis, chronic pancreatitis) and in 16 normal subjects. In normal persons, the initial gastrin level in the blood was 55.4 +/- 5.2 ng/ml, while in patients with chronic gastritis and chronic pancreatitis, it was increased and in chronic cholecystitis diminished. Development of atrophic gastritis led to the delay of gastrin secretion irrespective of the food irritant type. The patients suffering from chronic cholecystitis manifested a paradoxical reaction (a decrease in gastrin concentration) to fat intake. The patients with chronic pancreatitis showed a decrease in the gastrin content in response to glucose and absence of substantial changes in response to fat.

Adolescent↗

[The value of laparoscopy in the staging of digestive system cancers].

Sixty two patients with a gastrointestinal carcinoma were evaluated pre-operatively by ultrasonography, CT scan and laparoscopy to seek liver metastases and/or peritoneal carcinomatosis. Performance levels of laparoscopy, ultrasonography and CT scan were comparable regarding the diagnosis of liver metastases. Laparoscopy was markedly better than CT scan and ultrasonography in the diagnosis of peritoneal carcinomatosis. Thus the investigation of choice for the detection of liver metastases is a single imaging technique. In contrast, if excision surgery is envisaged, all gastrointestinal carcinomas should be assessed by ultrasonography and/or CT scan and laparoscopy to definitely eliminate peritoneal carcinomatosis or small superficial liver metastases, in such a way as to avoid unnecessary laparotomy.

Carcinoma↗

Absorption of the toxins of Lantana camara L. from the digestive system of sheep.

When lantana was given into different regions of the alimentary tract, absorption sufficient to cause intoxication occurred from the stomachs, small intestine and large intestine, but absorption from the small intestine was quantitatively the most important. However, it was shown that the passage of ingesta into the small intestine decreased markedly a few hours after the toxin was given and it is suggested that absorption from all areas of the gastrointestinal tract is important for the progression of the disease. When bile was diverted away from the small intestine, animals were still intoxicated by lantana. This indicates that bile is not important for absorption of lantana toxins. Other experiments indicated that the lantana toxins are transported to the liver mainly in the portal blood.

Animals↗

Alkaline and acid phosphatase in the digestive system of two teleost fishes.

Alkaline and acid phosphatases are distributed in the stomach, intestine, liver and pancreas of Heteropneustes fossilis and Cirrhinus reba. In oesophagus and rectum they are found in traces only. In the stomach of Heteropneustes, the phosphatases are confined to the mucosa and gastric glands. In the omnivorous fish, Heteropneustes the intestine is shorter and the activity of the enzymes is higher where as in the herbivorous form Cirrhinus with long and coiled intestine, the enzymes are comparatively weak and distributed from the intestinal bulb to the posterior portion of the intestine. In Heteropneustes the enzymes are concentrated in the duodenum and anterior region of the intestine only. This regional difference in the distribution pattern may be correlated to the site of absorption of the metabolites.

Acid Phosphatase↗

[Preliminary study on the nutritional status of patients operated on for cancer of the digestive system: reflections apropos of the first 18 cases].

The authors undertook a preliminary study of two categories of patients to link morbidity and mortality to the nutritional condition of patients before and after surgery: the first group of patients were to be operated on for cancer; the second group was to act as a control group. For both groups, a study was made before and after surgery, of the nutritional condition of the patients and of progress, respectively. The findings revealed signs of de-nutrition in both groups and a distinct correlation between post-operation complications and the degree of de-nutrition. Hence, in the case of cancer, it is recommended some nutritional preparation before the operation.

Adolescent↗

[Digestive system metastases from breast cancer. Report of two cases].

We have reviewed two unusual cases of gastrointestinal metastases from a primary breast carcinoma. The first case was an unexpected microscopic discovery of metastases in an inguinal hernia sac, eleven years after the patient had surgery for breast carcinoma. The second case was a rectal localization from a unknown breast carcinoma. The incidence of gastrointestinal metastasis from breast carcinoma is underestimated because they have a long latency and screening is difficult. Histologically they are predominantly of the lobular type and the differential diagnosis from a primary gastrointestinal malignancy can be difficult. A wider knowledge of gastrointestinal metastases from primary breast carcinoma is important because an appropriate management allows a long survival period.

Breast Neoplasms↗

[Application of heat combined with antineoplastic agent administration in the treatment of cancer (with special reference to malignancy of the digestive system)].

Recently, there is a renewed interest in the efficacy of hyperthermia in human cancer therapy. Based on the results of our experimental studies, we treated far-advanced cancer patients with extracorporeally induced total-body hyperthermia (TBHT) or continuous hyperthermic peritoneal perfusion (CHPP). In the TBHT combined with anticancer chemotherapy, a partial remission was observed in 4 (25.0%) of 16 far-advanced cancer patients. However, the improvement of survival time was unsatisfactory. The CHPP combined with anticancer chemotherapy was performed in 23 gastric cancer patients with peritoneal dissemination. In 6 of them, subjective complaints were improved, but the remarkable prolongation of survival time was not obtained. If in the future hyperthermochemotherapy is performed for cancer recurrence in early stage, more favourable results may be expected.

Adult↗

[Endoscopic surgery of the digestive system: state of the art. Opinion of an endoscopic surgeon].

The Authors review the possible applications of surgical endoscopy in oesophageal, gastric, biliary, pancreatic and colic diseases. This critical assessment, performed under the abdominal endoscopic surgeon's point of view, is based on the overall experience of about 20 years of surgery, with particular regard to the sclerosis of oesophageal varices, neoplastic obstructions of oesophagus, biliary tract, colon and localized Laser treatment of neoplasms. Based on the results achieved, thanks to selective indications and monitoring by conventional surgical experience, the Authors conclude by staging a better reliability of the surgeon who performs surgical endoscopy to obtain good results after an accurate selection of those cases which can really benefit from endoscopic management.

Attitude of Health Personnel↗

[Neuroendocrine tumors of the digestive system].

Despite their rare occurrence, gastroenteropancreatic neuroendocrine tumors have been in the centre of interest because of the wide scale and variability of clinical signs and symptoms associated with oversecretion of different hormones. In the present review the authors summarize epidemiological data, pathologic findings, clinical symptoms, as well as diagnostic and therapeutic methods presently available for the management of patients with gastroenteropancreatic neuroendocrine tumors. In addition to surgical treatment and receptor-specific radionuclide therapy used in cases with surgically noncurable tumors, the therapeutic use of somatostatin analogues in recent years has resulted an important advance in the management of patients with these tumors. Somatostatin analogues alone or in combination with other pharmacological therapies may be used effectively for elimination of symptoms of hormonal oversection and, in a number of cases, for diminishing tumor progression.

Biomarkers, Tumor↗

[History of mechanical sutures in digestive system surgery].

The attempts to suture wounds with mechanical device are very old, and their history is lost in the night of times. But more recently--that means less than two century ago--already before the true initial beginning of the modern surgery, after the birth of anaesthesiology with the "ether day--16 october 1846" there have been many efforts to develop new methods to join the tissue of the gut avoiding the danger of peritoneal contamination. The primitive tools of these ancient stapler were founded on the principle to compress with mechanical devices the two sides of the tissue to join. Very early in the past century, well before the appearance of the antibiotics, in the heart of the old Europe were developed and perfectionated devices able to join the intestinal tissue with metallic stitches: the primitive staplers. But after the end of the second world war the development has become bursting, with the progress of the Sovietic Institute of experimental research on surgical tools of Moscow and then with the mighty initiatives of the industrial power in the USA. The more important progress in this field was founded on the standardization of tools designed to fix metallic stitches on the gut, but very recently there are new attempts to use the more old principle of compression-suture on new basis. The results of this development, essential for modern surgery, are the standardization of the surgical technique, the shortening of operative times, and an important support to the new mininvasive approach to digestive surgery.

Digestive System Surgical Procedures↗

Carbohydrase activity in the digestive system of some teleost fishes.

The activity of carbohydrases in Puntius sophore (Ham.), Channa gachua (Ham.) and Cirrhinus mrigala (Ham.) has been studied. The carbohydrases have been found in the stomach, intestinal bulb, intestine, pyloric caeca and the hepato-pancreas. The hepatopancreas is the main site of production of these enzymes and it is in this organ and the intestine that their activity is highest. Their pH optimum lies between 5.4 and 6.4. The enzyme equipment in the teleost is adapted to their respective food and feeding habits both qualitatively and quantitatively. In Puntius (omnivorous) and Cirrhinus (herbivorous) all three carbohydrases, namely amylase (EC 3.2.1.1.), sucrase (EC 3.2.1.26.) and raffinase, while in Channa (carnivorous) only amylase and sucrase have been found to be active. In Cirrhinus mrigala, which is predominantly a herbivorous species, the concentration of carbohydrases is higher than those in the other two fishes.

Animals↗

[Is your scalpel correctly adjusted? The correct use of electric scalpels in digestive system endoscopy].

Progress has been made in electric scalpel technology, as applied to endoscopy, over recent years. Lamp or spark gap scalpels have been replaced by more reliable transistor scalpels fitted with a return electrode avoiding any defective circuits. Before using an electric scalpel, it is essential to understand the basic physical laws governing their use with section, coagulation or mixed currents. Any interference with other electrical apparatuses in the surgical endoscopy room must be avoided and precautions must also be taken in patients with cardiac pacemakers. Different settings are required for colonic polypectomy and endoscopic sphincterotomy in order to ensure a clean cut without oedema and with perfect haemostasis. Although monopolar currents are generally used, some haemostatic or tumour destruction electrodes use a bipolar current which avoids deep necrosis. Diathermy is a precise technique in interventional endoscopy, but surgeons must adapt their knowledge to the equipment used.

Electrocoagulation↗

[The plasm welding of the digestive system organs in experiment].

The plasm welding of the gut organs--perspective trend, which permits to increase the surgeon possibilities in performance of operative intervention. The results of operations, performed on large intestine and stomach, trusts, that it is possible to apply the streams of the high temperature gas plasm for the tissues dissection and connection. There are such advantages of the method, as the operation time shortage, simplicity in manipulating "Plasmomed" apparatus, absence of foreign bodies in the connection zone, high degree of hemostasis achieved. After the operation there was observed rapid restoration of the main structure elements in the large intestine and stomach wall, localized in the plasm welding zone. There was elaborated and tested a new method of the living tissues welding, and the processes, occurring in tissues within the plasm welding application zone, were studied up.

Animals↗