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Aim. To evaluate the clinical and endoscopic features of diseases of the upper gastrointestinal tract (GIT) in patients with atherosclerosis of the mesenteric arteries (MA). Materials and methods. The study included 48 patients with atherosclerosis of MA and 43 patients without atherosclerosis of MA, who were hospitalized in the department of vascular surgery of the Chelyabinsk Regional Clinical Hospital in the period from 2019 to 2021. All patients underwent multispiral computed tomoangiography of the visceral and lower limb arteries, esophagogastroduodenoscopy. Results. Assessment of lesions of the upper gastrointestinal tract revealed a higher incidence of erosive and ulcerative gastroduodenopathies among patients with atherosclerosis of MA (60.4%), compared with patients without atherosclerosis MA (39.5%); p=0.047. Signs of severe atrophy according to the data of histological examination were statistically significantly more frequent among patients with atherosclerosis of MA (29.2 and 11.6%; p=0.031). According to the results of logistic regression, the following predictors of erosions and ulcers of the upper gastrointestinal tract were revealed: the severity of stenosis of the superior mesenteric artery (SMA) is more than 35%, the body mass index (BMI) is less than 25.9 and the total score on the HADS scale is more than 6.5 points for depression (p=0.008). Conclusion. Erosive-ulcerative gastroduodenopathies and atrophy of the gastric mucosa are significantly more common in the group of patients with MA atherosclerosis. The main risk factors for erosions and ulcers of the upper gastrointestinal tract in patients with MA atherosclerosis are: the severity of SMA stenosis is more than 35%, a decrease in BMI is less than 25.9 and an increase in the HADS score is more than 6.5 points.

Aim: To evaluate the clinical and endoscopic features of diseases of the upper gastrointestinal tract (GIT) in patients with atherosclerosis of the mesenteric arteries (MA)., Materials and Methods: The study included 48 patients with atherosclerosis of MA and 43 patients without atherosclerosis of MA, who were hospitalized in the department of vascular surgery of the Chelyabinsk Regional Clinical Hospital in the period from 2019 to 2021. All patients underwent multispiral computed tomoangiography of the visceral and lower limb arteries, esophagogastroduodenoscopy., Results: Assessment of lesions of the upper gastrointestinal tract revealed a higher incidence of erosive and ulcerative gastroduodenopathies among patients with atherosclerosis of MA (60.4%), compared with patients without atherosclerosis MA (39.5%); p =0.047. Signs of severe atrophy according to the data of histological examination were statistically significantly more frequent among patients with atherosclerosis of MA (29.2 and 11.6%; p =0.031). According to the results of logistic regression, the following predictors of erosions and ulcers of the upper gastrointestinal tract were revealed: the severity of stenosis of the superior mesenteric artery (SMA) is more than 35%, the body mass index (BMI) is less than 25.9 and the total score on the HADS scale is more than 6.5 points for depression ( p =0.008)., Conclusion: Erosive-ulcerative gastroduodenopathies and atrophy of the gastric mucosa are significantly more common in the group of patients with MA atherosclerosis. The main risk factors for erosions and ulcers of the upper gastrointestinal tract in patients with MA atherosclerosis are: the severity of SMA stenosis is more than 35%, a decrease in BMI is less than 25.9 and an increase in the HADS score is more than 6.5 points.

Backgraund: Chronic mesenteric ischemia is more often accompanied by clinical signs characteristic of colitis. Acute mesenteric ischemia, unlike chronic, is accompanied by nonspecific symptoms and is a serious disease that requires urgent diagnosis., Aims: The aim of the study was to evaluate the effectiveness of MSCT in the diagnosis of acute and chronic mesenteric ischemia based on our observations., Materials and Methods: The retrospective study included 135 patients with abdominalgia and suspected mesenteric ischemia who underwent multiphase CT of the abdominal cavity with intravenous bolus contrast enhancement. Group 1 included 105 patients with mesenteric ischemia; group 2 included 30, without confirmed mesenteric ischemia, with the presence of a symptom of mesenteric ischemia in the form of abdominalgia., Results: We studied 135 patients, including 105 patients with mesenteric ischemia, 59 women and 46 men of average age 60±14.9 years. The acute form of ischemia (58%) was determined 1.5 times more often than the chronic one. Occlusive and nonocclusive acute mesenteric ischemia occurred in equal proportions. Mesenteric arterial thrombosis was the cause of acute mesenteric ischemia in 23% of cases. Mesenteric venous thrombosis was the cause of chronic intestinal ischemia in 61%, in 5% - acute form. Mixed arterial-venous genesis of mesenteric ischemia was determined in 4% against the background of strangulation obstruction. Dunbar syndrome as a cause of chronic intestinal ischemia was diagnosed in 16%. Chronic ischemic enterocolitis accounted for 10% of all cases of mesenteric ischemia and 23% of chronic ischemia. Symptoms and symptom complexes characteristic of the studied series of diseases with acute or chronic mesenteric ischemia were delineated. Sensitivity, specificity and prognostic value of CT with intravenous bolus contrast enhancement in diagnostics of diseases accompanied by mesenteric ischemia reached 100%., Conclusions: Multiphase CT of the abdominal cavity with bolus contrast enhancement is highly informative in the diagnosis of acute and chronic forms of mesenteric ischemia. Direct CT signs of impaired blood flow in the arteries or veins of the mesentery were indisputable. Indirect signs of mesenteric ischemia were aimed at a thorough analysis of the condition of mesenteric vessels.

Objective: To evaluate the effect of the preventive course of drinking mineral water enriched with selenium on the processes of resistance to the damaging action of reversible occlusion of the anterior mesenteric artery based on the comparison of intestinal morphological changes in the experiment., Material and Methods: There has been modeled ischemic reperfusion injury of the intestinal wall according to H. Ikeda and co-authors using reversible occlusion of the anterior mesenteric artery with 33 outbred male rats. The rats were divided into four groups by block randomization: the 1 st group - intact animals ( n =7) - without an exposure; the control group - sham operated animals ( n =6); the group of comparison ( n =7) - with a model-operation; the experimental group ( n =11) - animals with a model operation that had courses of intragastric watering of bottled sulfate-chloride-hydrocarbonate-sodium low-mineralized (2.2 g/l) drinking mineral water «Psyzh» enriched with selenium. Biopsies of the small intestine were taken for histological examination., Results: Histological examination of the small intestine of experimental animals determines various degrees of severity of damage: on average, the animals of the experimental group on the scale of C.J. Chiu (1970) had the lowest degree of severity of pathological changes, the animals of the group of comparison - 1.4 times higher ( p =0.02). That is, the effect of a preventive course of mineral water «Psyzh» enriched with selenium was manifested in the formation of resistance to the damaging effect of reversible occlusion of the anterior mesenteric artery; in the presence of ischemic reperfusion damage to the intestinal wall, comparable in severity to changes with the animals without prevention, the most significant positive effect was realized in the containment of reactive changes., Conclusion: The effect of the preventive course of drinking mineral water «Psyzh» enriched with selenium manifested itself in the formation of resistance to the damaging effect of reversible occlusion of the anterior mesenteric artery, which is the basis for introducing this technique into clinical practice in order to prevent the development of reperfusion injuries of the intestine.

A comparative study of changes in the contribution of endothelium-dependent hyperpolarization (EDH) induced by activation of the intermediate-conductance calcium-activated potassium channels (IKса) channels and the contribution of NO in pial arterial vessels dilation to acetylcholine (ACh) in normotensive (WKY) and spontaneously hypertensive (SHR) rats at the age of 4 and 18 months was conducted. It was found that in WKY, the EDH is mainly expressed in the group of small pial arterial vessels. During aging, the contribution of EDH to the dilatation of small (diameter less than 20 microns) and medium (20-40 microns) vessels decreases, while it increases in arteries with a diameter of more than 40 microns. Hypertension (HT) leads to an increase in the contribution of EDH processes to dilation of vessels of small and medium diameters. Aging, accompanied by long-term HT, reduces the contribution of EDH to dilation. In 18-month-old SHR, this mechanism is expressed only in a group of small vessels. Age-dependent changes in the EDH contribution in pial arterial vessels dilation in WKY and SHR rats are based on the NO synthesis system damage and a change in the NO-mediated contribution in endothelium-dependent vasodilation.

An analysis of 199 cases has shown that verification of mesenterial thrombosis in municipal medical institutions is 5.6% at the prehospital period, 23% in the admission rooms of hospitals, 30%--in surgical departments before operation. The index of postoperative lethality remains high reaching 91.3% in municipal hospitals of Leningrad oblast. In order to improve results of treatment of patients with mesenterial thrombosis in municipal medical institutions of small towns and rural area it is necessary to develop technology and organization of medical aid in municipal medical institutions.

A course of acute disturbance of mesenterial circulation (ADMC) in 346 patients (89% of them were over 50 years, mean age 68.4+/-3.6 years) was analyzed. Occlusive forms of ADMC occurred in 88% cases (91% of them were due to affection of intestinal arterial bed). Atherosclerosis of the aorta or/and it unpaired visceral branches was the main cause of ADMC in 96% patients. In 87.6% cases the causes of acute mesenterial ischemia were occlusive disease of intestinal vessels due to thrombosis and embolism of unpaired visceral branches of the abdominal aorta, thrombosis in porto-mesenterial bed. Circulatory disorders on the microcirculation level (non-occlusive ischemia) were among the causes in 7.5% cases.

The article discusses difficulties in diagnostics of some acute vascular diseases of abdominal organs, associated with abdominal pain. The analysis of the reasons for late diagnosis of mesenterial thrombosis and dissecting aneurysm of the abdominal aorta is based on 2 clinical observations.

Laparoscopic data on 74 patients with jejuno-ileal mesentery acute circulatory disturbance were analysed. Positive (diagnosis is confirmed) and negative (diagnosis is rejected) results of the investigation, reasons of false diagnosis and repeated laparoscopies were examined. Features of the jejuno-ileal mesentery acute circulatory disturbance laparoscopic picture are determined depending on its stage (ischemia, infarct, peritxnitis) and kinds (arterial thrombosis and embolism, venous thrombosis, unocclusive mesenteric ischemia).

The article analyses 303 cases with affection of the visceral branches of the abdominal aorta. In 210 cases it was caused by atherosclerosis, in 67 by nonspecific aorto-arteritis and in 26 by extravasal factors. In 190 cases there were no clinical manifestations of occlusive lesions. The abdominal syndrome was found in 113 patients. The main symptoms were abdominal pain (in 94 patients), intestinal dysfunction (in 84) associated with the intake of food, and in severe stages of ischemia, progressive loss of body weight (in 46 patients). On grounds of the case history, the presence of a murmur in the epigastrium, and symptoms of involvement of other arteries it may be assumed that the abdominal abnormalities are of vascular origin. The principal diagnostic method is angiography which makes it possible to identify and record the affection of visceral branches of the abdominal aorta.

A prolonged infusion of noradrenaline (40 mkg) into the mesenterial artery was carried out in the early postoperative period in 30 patients with diffuse purulent peritonitis in order to arrest the inflammatory reaction of the peritoneum. More rapid decrease of intoxication, prevention of plasmatic losses and less lethality were noted as compared with the control group.

The relationship between the number of vesicles in smooth muscle cells in mesenterial arteries and calcium concentration in incubation medium was studied in experiments on normotensive control rats (NKWR) and spontaneously hypertensive rats (SHR). Extracellular elevation of calcium resulted in an increase in the number of vesicles, which was more demonstrable in SHR than in NKWR. After preliminary adrenalectomy the same high concentration of calcium in incubation medium did not induce any changes in the number of vesicles in both animal groups. The decrease of calcium concentration did not produce any changes in the number of vesicles in SHR or NKWR before and after adrenalectomy. The increase of the number of vesicles in response to high extracellular concentration of calcium is assumed to be a means of raising the active surface of the smooth cells and compensates for membrane deficiency seen under pathology.

The experiments in corpses have shown that there are well developed anastomoses between the branches of the rectal arteries.

Electrical stimulation of the anterior limbic area of the cortex in dogs resulted in increase of the lymph flow from the intestinal lymph duct, in enlargement of the mesenteric lymph nodes, in a fall of arterial pressure in the cranial mesenteric artery, and in decrease of the blood-stream from the homonymous vein and in the tone of the mesenteric veins. Constriction of the mesenteric veins and increase in the intestinal lymph-stream are considered to be a compensatory reaction to restore the arterial pressure to the initial level.

The article concerns different variations of associated lesions of visceral arteries, aorta or its other branches in 125 patients. The variations of such combinations are classified into 5 groups, for each of them different operation accesses and means of reestablishing the blood flow being used.

The examination of 36 patients with postoperative disorders of the circulation in the mesenterial vessels has shown postoperative infarctions of the intestine to be most frequently observed in elderly patients after surgery on the abdominal organs. Inflammatory-purulent diseases of the abdominal organs against the background of cardiovascular diseases are of special importance.

An analysis of 534 patients has shown that laparoscopy is a method of high diagnostic informative value. The correct diagnosis was made in 515 patients (96.4%). Diagnostic errors were noted in 19 patients (3.6%). The greatest problems appeared in diagnosing thrombosis of mesenterial vessels and acute appendicitis in cases with the retrocecal disposition of the vermiform process. Surgical operations under control of a laparoscope were fulfilled by strict indications. Good immediate results were obtained in 81.9% of the patients.

On the basis of observation of 227 patients with the acute disturbance of mesenteric circulation the author considers intestinal infarction to be one of serious complications of atherosclerosis. Early diagnosis and operative treatment (reestablishment of circulation in mesenterial vessels, resection of the gut), postoperative intensive therapy allow improving results of the treatment.

Experiments were conducted on 63 healthy mongrel dogs to study the character of structural changes in the mucous membrane of the stomach in 50% obstruction of the celiac trunk (21), protracted gradual obstruction of the celiac trunk (22), and protracted gradual occlusion of the celiac trunk and cranial mesenteric artery (20). The authors revealed a direct dependence of the structural shifts in the gastric mucosa on the duration and degree of disorders of visceral circulation, which confirms the need for surgical correction; the indications and terms for performing restorative operations are directly dependent on the degree of disorders of the main blood flow.