Biomedical subjects
Publications and source records attributed to G A Bulgakov.
Choice of treatment of duodenal ulcer in elderly and aged patients is discussed. Literature demonstrate high risk of recurrences even in adequate systemic drug treatment. In patients of this age group early organo-saving operations must be performed before development of complications. Results of selective proximal vagotomy in 62 patients aged from 60 to 82 years confirm efficacy and minimal risk of this surgery.
How to choose treatments for uncomplicated duodenal peptic ulcer is discussed. The data available in the literature suggest that there is a high incidence of recurrent ulcers even after regular. This is evidenced by experience in examining and treating 1414 patients at the Institute of Surgery. A large number. The authors consider a great deal of patients to be unresponsive to drug therapy, in whom the disease is characterized by frequent recurrences and complications. These patients require organ-saving surgical treatment. Selective proximal vagotomy that present the minimum risk is the operation of choice. A five-year follow-up revealed 21.4% of recurrences, which effectively responded to drug therapy. This rate is much less than that observed after drug therapy alone.
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Experience in the treatment of 70 patients with stenotic duodenal ulcer by surgery is generalized. In addition to SPV the patients underwent duodenoplasty as a draining operation. There were 61 (87.1%) males and 9 (12.9%) females. Their ages ranged from 18 to 70 years. The stenosis was compensated in 21 (30%), ++non-compensated in 32 (45.7%), and decompensated in 17 (24.3%) patients. To determine the possibility of performing SPV, the maintenance of the gastric contractile activity was studied by noninvasive methods: computed peripheral electrogastrography and computed gastro-scintigraphy. Involvement of the pylorus into the cicatricial-ulcerous inflammatory infiltration is the main contraindication for duodenoplasty. In view of that, intensive 2-3 week preoperative antiulcer therapy acquires particular significance; it removes or reduces significantly the inflammatory infiltration in most cases and raises the possibility of conducting duodenoplasty. Only intraoperative inspection of the pyloroduodenal segment allows the possibility and type of pylorus -preserving duodenum draining operation to be determined. This operation can be undertaken if the proximal boundary of the stenotic cicatricial-ulcerous deformity is at a distance of at least 1 cm from the pyloric sphincter, whatever the degree and length of the narrowing. A total of 43 operations form the Heineke-Mikulicz Mikulicz duodenoplasty, 17 for Finney's pyloroplasty, and 10 for bulbo-duodenostomy were carried out. The authors consider excision of the duodenal ulcer to be expedient and safe only when it is located on the anterior wall; it was carried out in 9 cases.(ABSTRACT TRUNCATED AT 250 WORDS)
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The authors operated on 20 patients with the Zollinger-Ellison syndrome and on 3 patients with Wermer's syndrome. The clinical picture of the disease and the findings of laboratory tests and special methods of examination allow the Zollinger-Ellison syndrome to be diagnosed in most cases and a niveau diagnosis of gastrinoma to be established in some cases. Intraoperative ultrasonic examination is significant in making the niveau diagnosis. The authors claim that the operation of choice in the Zollinger-Ellison syndrome is total gastrectomy (extirpation of the gastric stump) with esophagojejunoduodenoplasty as well as one-stage removal of the revealed tumor by resection of the pancreas or enucleation of the tumor. The application of the group of H2-receptor blocking agents cannot be a substitute for operative treatment, but is expedient as a measure of preoperative management.
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An analysis of causes of the development of dumping-syndrome after selective proximal vagotomy (SPV) has been made. Dumping-syndrome most frequently developed after SPV with draining operation (12.9%). The dumping-syndrome was rare and of light degree after SPV without drainage. The authors consider that disturbed motor-evacuatory function of the stomach and small intestine is responsible for the development of dumping-syndrome after SPV as well as the width of gastroduodenal anastomosis in draining operation which must be not more than 2-2.5 cm.