[Improving the system of introduction of the results of scientific research into the practice of health care in surgery].
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Biomedical subjects
Publications and source records attributed to V P Khokholia.
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In experiments on vagotomized and intact rats with the use of two models of experimental gastric ulceration (injection of serotonin and stress) it was demonstrated that the inhibitory action of vagotomy on haemorrhagic gastric effectiveness was more pronounced in stress than after serotonin application. Vagotomy decreased stress-induced erosive lesions but increased serotonin-induced erosions that may be a result of the increase of gastric tissue sensitivity to this amine which developed simultaneously with significant decrease of its level in gastric wall after vagotomy. Serotonin-antagonist peritol decreased stress-induced gastric disturbances in vagotomized rats more significantly than in intact rats; this suggested the great role of serotonin in anti-ulcerogenic effect of vagotomy.
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The authors studied results of treatment of acute erosions and ulcers of the digestive organs that developed in 43 patients after different operative interventions. Twenty-one patients developed uncomplicated erosions and ulcers, 20--complicated hemorrhages and 2--perforations. Follow-up terms--from 1 to 7 years. Approximately 50% of patients complained of stomach pain, some--of dyspeptic phenomena. Endoscopic findings indicate that these patients suffered of chronic diseases of the digestive organs (gastritis, gastroduodenitis). This evidences the necessity of prophylactic medical treatment of patients with a history of acute erosion and ulcers of the digestive organs.
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The authors have established that after different operations acute erosions and ulcers of digestive organs which are often complicated by bleedings and perforations arise in 67% of the patients. The method of complex prophylactics developed by the authors includes general measures (a rational preparation to the operation, adequate anesthesia, sparing method of operating, active management in the postoperative period) and special ones (the administration of cerucal, anabolic steroids, methyluracil and almagel). This method makes the amount of erosive-ulcerous affections 12-15 times less and practically prevents complications.
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Under analysis were results of the surgical treatment of 32 patients with bleeding acute ulcers and erosions of organs of digestion. The analysis has shown that the most effective procedures for this pathology are devascularization of the stomach and vagotomy in combination with suturing and ligation of sources of the bleeding.
Under analysis was an experience with using fibroesophagogastroduodenoscopy in 114 patients with acute erosions and ulcers of digestive organs, including 33 patients in dynamics from 2 to 4 times. In 13 patients erosions and ulcers were not complicated, 95 patients had bleeding ulcers, 6 patients had perforated ulcers. The authors have shown the diagnostic informative value to be as high as 96.5%. It was stressed that fibroendoscopy allowed to determine the character and localization of the process, complications (bleedings in particular), to follow the development of the process in dynamics, to control the efficacy of the curative and prophylactic measures.
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The method of modelling of acute gastric and small intestinal ulcers by intraperitoneal administration of vincristine at a dose of 0.15-0.30 mg/kg body weight is suggested. The method is based on the property of vincristine to stop mitotic cell division at the stage of metaphase, thus impairing regeneration of the epithelium in the stomach and small intestine. The experiments on 20 dogs have shown that single vincristine administration caused the accumulation of cells with nuclei at the stage of metaphase in the generative areas. Mucosa defects formed at these sites acquired all the features of acute ulcers by the third day. The model demonstrates the pathogenetic role of impaired mucous epithelium regeneration and permits the studies of pathogenesis of acute ulcer formation.
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