Search

Ultrasound registration of changes in gallbladder volume by the method of cylinder sum allows reliable means of studying gallbladder contractility in response to pharmacological load. Cerucal increased this activity in chronics with gastroduodenitis and diabetes mellitus, pentagastrin reduced the gallbladder volume. In duodenal ulcer patients a single dose of dalargin dilated the gallbladder for a short time, while in course treatment did not influence it. Gastrocepin inhibited motor activity of gallbladder as well as corinfar.

In patients with chronic pancreatitis (CP) (cholepancreatitis and primary recurrent pancreatitis), a moderate decrease of urocholecystokinin (UCK) excretion as a criterion for incretion of cholecystokinin-pancreozymin (CK) by duodenal endocrine cells was recorded in the presence of concomitant atrophic duodenitis. The beta-adrenoblocker obsidan, the blocker of m-cholinergic receptors gastrozepin, the antagonist of calcium channels finoptin and the synthetic analog of endogenous opiates dalargin reduced excretion of UCK in CP exacerbation. The decrease of CK incretion can be viewed as one of the mechanisms of the therapeutic action of these drugs in CP exacerbations. In the stage of CP remission, calcium gluconate consistently increased basal and intraduodenal oil (as a realizer of CK incretion) infusion-stimulated excretion of UCK. The enhancement of duodenal incretory activity is an essential mediating mechanism by which calcium gluconate stimulates pancreatic enzyme excretion.

In patients suffering from chronic pancreatitis with concomitant atrophic antral gastritis, gastrinemia is less whereas the response of pancreatic enzymic secretion to pentagastrin is more potent than in patients suffering from chronic pancreatitis without atrophic alterations in the gastroduodenal mucosa. The pancreas-stimulating effect of pentagastrin administered in a dose of 6 micrograms/kg is approximately equal to the action of 0.5 U/kg pancreozymine and noticeably yields to the effect of 1.5 U/kg pancreozymine (according to the criteria for output of intraduodenally secreted lipase and trypsin). The same diagnostic dose of pentagastrin used commonly for gastric secretion studies not only stimulates pancreatic enzyme secretion but also enhances the activity of beta-cells of Langerhans' islets of the pancreas in accordance with insulinemia and blood C-peptide determined by RIA.

Toxic hepatitis developed but in one out of 127 peptic ulcer patients treated with cimetidine. In patients (n-142) treated with gastrozepine, no cases of toxic hepatitis were recorded. These anti-ulcer agents did not influence absorptive capacities of the liver or hepatic blood flow. Meanwhile microsomal exidase (antitoxic) function of hepatocytes noticeably declined as a result of cimetidine treatment in every 8th patient with peptic ulcer subjected to the continuous 5-week treatment with the drug and in every 5th patient given the treatment (maintenance included) for a longer time. In patients suffering from liver cirrhosis with secondary gastroduodenal ulcers or multiple erosions, the 5-week treatment either with almagel and platyphylline or gastrozepine provided approximately similar results and promoted ulcer and erosion healing in half the cases. Adjuvant 3-week therapy with sucralfate (venter) having cytoprotective properties led to the disappearance of gastroduodenal ulcers and erosions in 23 out of 26 patients, in whom the previous treatment was ineffective.

As compared to healthy persons and patients with non-atrophic duodenitis, patients with atrophic duodenitis manifest a decrease of gallbladder contractility as shown by the ultrasonography data. In chronic pancreatitis with concomitant atrophic duodenitis, the degree of a decrease in pancreatic enzymic secretion is more considerable than in patients suffering from chronic pancreatitis without duodenitis or from non-atrophic duodenitis. Comparison of the tests for enhancement of the incretion of endogenous cholecystokinin-pancreozymin and with intravenous injection of the hormone formed the basis for regarding incretory duodenal insufficiency as a cause of hypomotor dyskinesia of the gallbladder and deepening of pancreatic enzymic secretion inhibition in cases with atrophic duodenitis. The data obtained may be of importance for estimating the mechanisms of the impairment of gallbladder contractility and pancreatic enzymic secretion in alimentary diseases as well as for prognosis determination and choice of therapeutic modalities.

Altogether 78 patients were examined over time. They had erosive reflux esophagitis that complicated the course of duodenal ulcer (in 42 patients, hypersecretion of hydrochloric acid was the leading mechanism of the disease development) and chronic gastroduodenitis (36 persons manifested failure of the inferior sphincter of the esophagus with or without excess acid output). In patients with peptic ulcer exacerbation, the four-week treatment with cimetidine or gastrozepine compared very favourably with almagel and vicalin as regards the treatment efficacy. In chronic gastroduodenitis, the combination of almagel, vicalin and cerucal produced a therapeutic effect that did not yield to the effect of cimetidine or gastrozepine. In 1/5-2/5 of cases, erosive esophagitis was not amenable by the four-week treatment. In 17 out of 18 such patients, the two-week therapy with sucralfat (venter) resulted in the disappearance of esophagitis with multiple erosions. During 1-2 years, erosive reflux esophagitis recurred in 11 out of 34 patients with peptic ulcer and in 2 out of 17 suffering from chronic gastroduodenitis. In all the cases, the disease recurred in those patients who had not received systematic treatment with antisecretory and cytoprotector agents.

The author analyzes current data on the potentialities of antiviral therapy of patients suffering from chronic viral hepatitides. Provides the data on the short- and long-term therapeutic effects of interferon drugs and other antiviral agents, describes side effects produced by such type drugs. Compares the clinico-enzymatic, pathohistologic characteristics of the liver status with the degree of elimination of serum antigenic markers of virus B hepatitis in patients afflicted with chronic viral hepatitides. Relates the effects of antiviral drugs in patients suffering from chronic virus non-A non-B hepatitis.

Gastroesophageal reflux was established in 12 out of 38 patients with infectious allergic bronchial asthma out of exacerbation. According to intraesophageal pH-metry, it turned out appreciable in half of the cases. Prospective observations conducted for up to 8 years made it possible to recognize bronchial asthma in 9 out of 63 patients having initial reflux without any bronchopulmonary alterations. Diminution of the tone of the inferior sphincter of the esophagus proved by electromanometry should be regarded as the leading mechanism by which gastroesophageal reflux developed in bronchial asthma patients. In patients having gastroesophageal reflux without bronchopulmonary pathology, the tone of the upper sphincter of the esophagus was normal or elevated whereas in bronchial asthma patients with reflux, the tone of the superesophageal sphincter was naturally lowered, causing microaspiration into the bronchi of the gastric contents flown to the esophagus. It is desirable that metoclopramide (cerucal) which increases the initially reduced tone of the esophageal sphincters may be included into a complex of therapeutic measures elaborated for patients with associated bronchial asthma and gastroesophageal reflux.

Basing on the results of long-term studies on 850 patients with different forms of chronic pancreatitis, specific variants of hypo- and hyperdiagnosis of this disease have been considered. Incidence and causes of the nonrecognition of chronic pancreatitis and complicating incretory and excretory pancreatic insufficiency, some secondary clinical pancreatogenic syndromes under out- and in-patient conditions are analysed. Errors in the determination of a type of chronic pancreatitis and the major causes of its development are noted. The practical value of various diagnostic errors in patients with chronic pancreatitis have been specified.

Altogether 259 tests with intravenous injection of pancreozymin (0.5 Units/kg) were made with and without administering the drugs. It was discovered that isadrin, dopamine, complamin, calcium gluconate, euphylline and papaverine stimulated the pancreatic secretion of lipase and trypsin. It was also found that atropine, the beta-adrenoreceptor blocker propranolol and corinfar, a calcium antagonist, consistently inhibited the pancreatic secretion of the enzymes. All those drugs did not favour the escape of the pancreatic enzymes to the blood according to the criterion of trypsinemia. Administration of prednisolone in a single dose or in courses enhanced the pancreatic secretion of the enzymes, while the increased trypsinemia was only noticed in solitary cases. All the data obtained during studies of the pancreotropic properties of the drugs administered in single doses or in courses are discussed from the stand-point of the clinical significance of the findings.

Values of intraesophageal pH, basal fundal pH and hydrochloric acid debit were studied in 73 patients with exacerbation of peptic ulcer on the first days of exacerbation and 2-4 weeks after the initiation of therapy with various drugs. Gastrozepin and cimetidine in parallel with gastric acidity inhibition reduced regularly and considerably a degree of gastroesophageal reflux in the patients. The action of combined vicalin and almagel therapy was manifested later on and was less marked.

The degree of hyperlipidemia, hyperthyrosinemia, hyperserotoninemia and enhanced release of bradykinin from kininogen in patients with chronic recurrent pancreatitis was found to be decreased upon the attainment of a clinical remission. In patients with more considerable and more stable metabolic disorders, the incidence of exacerbations and the rate of progression of pancreatic, enzyme-secretory deficiency appeared, according to the data of a 8-year follow up, greater than in those with lesser degree and resistance of metabolic shifts.

The effect of pharmacological drugs indicated for specific diseases on the lower esophageal sphincter, was studied in 195 patients. Pentagastrin increased the sphincter tone, secretin when used in peptic ulcer, did not influence the tone. Unlike atropine, a therapeutic course with pirenzepine (gastrozepin) for patients with peptic ulcer did not lower the tone of the lower esophageal sphincter. Diazepam significantly decreased indices of the sphincter tone. In the treatment of CHD patients with corinfar, a calcium antagonist, the sphincter tone was on a moderate but statistically significant decrease. Aminophylline in patients with chronic bronchitis made no effect on this index. The ratio of the sphincter tone stimulated with metoclopramide to its basal values was higher in the patients with initially lowered indices as compared to the patients in whom the initial tone was within normal.

It was established during observation over time (within the period from 10 to 12 years) that the overwhelming majority of patients with chronic cholecystopancreatitis and primary chronic pancreatitis progressed to a different degree to enzyme-secreting pancreatic failure according to the pancreozymine tests. At the same time in 2/5 of all the cases, enzyme-secreting failure turned out substantial by the end of the indicated period. During the years of prospective studies, every tenth patient with chronic pancreatitis developed secondary diabetes mellitus. The degree of pancreatic enzyme secretion and carbohydrate metabolism abnormalities depended on the number of disease exacerbations suffered by the patient. Secondary gastroduodenal ulcers occurred in 27 out of 647 patients observed over time, and all the cases were associated with a considerable reduction of pancreatic bicarbonate secretion (according to the secretin test). Pancreatogenous pleural exudate was recorded in 1.4% of all the cases of chronic pancreatitis. During the observation period, 16 out of the 647 patients died from chronic pancreatitis associated with progressive exocrine pancreatic failure and malabsorption.

In chronic pancreatitis with moderate derangements of carbohydrate tolerance (detected by the double glucose test), the basal concentrations of insulin and C-peptide in blood are normal whereas in patients with secondary diabetes mellitus are lowered. Glucagonemia is increased in patients of both groups. Euphylline (applied as an inhibitor of nucleotide phosphodiesterase), calcium gluconate and the adrenomimetic drug isadrin consistently increased insulinemia and the blood level of C-peptide in patients with chronic pancreatitis both with moderate and appreciable derangements of glucose tolerance. In patients with secondary diabetes that developed in the presence of pancreatitis, these drugs did not influence glucagonemia. The clinical prospects of the making use of the stimulating action of euphylline, calcium gluconate and isadrin on the function of beta-cells of the pancreas in chronic pancreatitis patients are under discussion.

Eighty-one patients with chronic gastritis and 124 patients with peptic ulcer were examined. It was discovered that in chronic gastritis, the concomitant gastritis included, in patients with peptic ulcer, the degree of enhancement of reverse diffusion of hydrogen ions depended on the intensity of atrophy of the fundal and antral mucosa as well as on the extent of gastric lesions. The duodenogastral reflux promoted the increase of reverse diffusion of hydrogen ions. In mediogastral ulcer site, reverse diffusion of hydrogen ions was, at the height of exacerbation, enhanced to a greater degree than in the stage of ulcer healing. In atrophic variants of chronic gastritis and in peptic ulcer patients with an ulcer sited in the stomach, a close positive correlation was noted between reverse diffusion of hydrogen ions and proliferative activity of the gastric mucosa epithelium and a negative correlation between the diffusion and hydrochloric acid secretion. In patients with peptic ulcer of the duodenum without gastritis or the duodenogastral reflux, the characteristics of reverse diffusion of hydrogen ions did not differ from those seen in normal subjects.

In patients suffering from chronic pancreatitis (outside exacerbation) with initial enzyme-secretory pancreatic failure, the two-week intake of pancreatin as a replacement therapy brought about a decrease of the enzyme-secretory activity of the patient's own pancreas paralleled by the lowering of diurnal steatorrhea. This was confirmed by repeated pancreozymine tests. These data confirm the concept of a reverse relation between pancreatic enzymatic secretion and the concentration of the enzymes in the duodenal contents. Combined administration of pancreatin and calcium gluconate led to the preservation of the degree of steatorrhea by the enzymatic preparation. At the same time its inhibitory effect on the activity of the own pancreas was prevented. The effect of calcium gluconate is accounted for from the standpoint of the role Ca2+ plays in the maintenance of the function of the exocrine part of the pancreas. The combination with calcium gluconate is indicated in the clinical use of replacement therapy with preparations of pancreatic enzymes in patients with chronic pancreatitis.