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The results of surgical treatment of 118 patients with ulcerative disease of the duodenum, complicated by stenosis, were studied. 58 from them (49.2%) underwent selective proximal vagotomy (SPV) with duodenoplasty and 60 (50.8%) patients--SPV with gastroduodenoanastomosis by Zhabuley. In the early and long-term periods lowering of the audio productive function of the stomach was observed both in patients after SPV with duodenoplasty and after SPV with gastroduodenoanastomosis by Zhabuley. According to X-ray examination data in the long-term period after SPV with duodenoplasty the regular evacuation function has been restored in 95.5% of patients, and after SPV with gastroduodenoanastomosis--in 52.2% of patients the acceleration of evacuation was detected. The radionuclear examination after SPV with duodenoplasty manifested evacuation curves characteristic for healthy people in 93.3% of patients, and after SPV with gastroduodenoanastomosis--in 84% of patients the acceleration of the evacuation of various degrees, was revealed. The duodenogastral reflux (DGR) in long-term periods after SPV with duodenoplasty was revealed in 25% of patients, in most cases being periodic (18.8%). After SPV with gastroduodenoanastomosis DGR was registered almost 3 times more frequently (73.3%); permanent DGR was revealed in 46.7% of cases.

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The authors analysed the immediate and late results of selective proximal or truncal vagotomy with excision of the ulcer from the gastric lumen or wedge resection of the stomach in patients with various localization of the gastric ulcers. The best results were produced (Visick I-II) in patients after selective proximal vagotomy with excision of the ulcer from the gastric lumen (in 93%), the results were poorer in selective proximal vagotomy with wedge resection of the stomach and in truncal vagotomy with excision of the ulcer or wedge resection of the stomach (only in 20%, 38%, and 30% of patients, respectively). The results were unsatisfactory (Visick IV) mainly after vagotomy with wedge resection of the stomach due to recurrences and postvagotomy functional disorders. The authors claim only limited use of organ-preserving operations to be admissible.

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An EKC-500 pacemaker was implanted in 16 patients with coronary heart disease (CHD) and 14 idiopathic conduction disturbance for complete atrioventricular block. After surgery, the patients underwent equilibrium radionuclide ventriculography by using a nuclear stethoscope at rest and during exercise at different stimulation rates with the aim of choosing their optimal values. It was established that patients with idiopathic conduction disturbances showed improved left ventricular contractility at all stimulation rates and their optimal values ranged 60-70 per minute. In patients with CHD, the stimulation rate of 60 impulses/min was optimal at rest, and with this, exercise resulted in a significant deterioration of myocardial contractility, but only the stimulation rate of 80 impulses/min led to a slight improvement, which was due to accessory mechanisms of contractility enhancement. The peak ejection rate was the most sensitive to progressive myocardial dysfunction, yet the basic contractility index was the mean ejection rate.

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A EKS-500 pacemaker was implanted in 36 patients with the sick sinus syndrome. Out of them, 18 patients had coronary heart disease, 6, hypertensive disease and myocardial hypertrophy, and 12, idiopathic arrhythmias. After surgery, equilibrium radionuclide ventriculography was performed in the patients at rest in the presence of spontaneous rhythm and pacing, as well as during exercise. In patients with idiopathic arrhythmias, cardiac output and index remained within normal ranges during sinus bradycardia, which was attained by increased stroke volume, whereas in patients with myocardial disease, the normal values of these parameters were recorded only at a rate 60 imp/min. During exercise, the patients with idiopathic arrhythmias showed a noticeable rise in cardiac output not only due to higher heart rate, but due to increased stroke volume, and those with myocardial disease displayed the increase only due to higher heart rate.

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A clinicomorphological analysis was performed of the gastric antrum mucous membrane of 60 patients after selective proximal vagotomy because of stenosing duodenal ulcer. The patients were subdivided into two randomized groups depending on the type of the draining operation. The first group had a gastroduodenoanastomosis for the gastric drainage and the second group underwent duodenum plasty (drainage of the duodenum). Discontinuation of the pylorus function in the gastric drainage operation resulted in higher incidence and intensity of duodenum-gastric reflux and made more severe antrum gastritis; reflux-gastritis developed frequently. Morphological signs of reflux-gastritis in 95% of cases coincided with the results of the radionuclide method. Duodeno-gastric reflux decreased as a rule Helicobacter pylori (HP) contamination of the mucous membrane but did not eliminate it completely in all cases. The combination of these two factors resulted in more severe gastritis than that provoked by each of them separately. The etiology of gastritis and its intensity may be determined only by morphological examination of gastric mucous membrane. The results of endoscopic and histologic methods coincided in 70% of cases. Duodenal-gastric reflux, HP and high acid production play a certain role in ulcer recurrence.

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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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A nuclear stethoscope was used to examine central hemodynamic parameters and myocardial contractility in 70 patients with coronary heart disease (CHD). The findings were analyzed according to the degree of cicatricial changes in the myocardium and coronary atherosclerotic lesion. The patients, unlike apparently healthy individuals, were found to show an increase in systolic cardiac output and a decrease in left ventricular ejection fraction in response to transesophageal cardiac pacing. As the cicatricial changes in the myocardium became profound, the maximum left ventricular performance decreased mainly due to the myocardial factor, while there was a reduction in the chronotropic reserve along with relatively slight signs of myocardial dysfunction when coronary atherosclerotic lesion progressed.

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A method for ultrasonic examination of gastric motor evacuatory function, available for clinical practice, has been developed. Results of parallel estimation of the gastric contents half-life period by the ultrasonic and scintigraphic techniques evidence a high accuracy of the suggested method of echographic estimation of gastric function. Accelerated evacuation of the gastric contents was revealed in patients with duodenal ulcer without ++pyloric stenosis++.

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Systemic and intracardiac hemodynamic parameters were examined in 29 patients with arterial hypertension by radionuclide ventriculography. No impairments were found in resting left ventricular pump function in the patients. Left ventricular diastolic function exhibited 24 and 34.5% reductions in left ventricular filling rate and its peak filling rate, respectively, as well as a 44.8% increase in peak filling rate time. To assess the potentialities of myocardial adaptation to a postoperative decrease in blood pressure, artificial hypotension test by using the antihypertensive agent naniprus was performed in 15 patients. This test identified a group of patients with pronounced left ventricular diastolic dysfunctions who required a goal-oriented preoperative preparation. It also defined the principles of this preparation.

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The effect of regulatory peptides on the functional activity of pancreatic cells and phagocytic cells of reticuloendothelial system were determined in intact dogs against the background of acute experimental pancreatitis. Assessment of the efficacy of regulatory peptides was made with the aid of scintigraphic studies in gamma chamber using for this purpose colloid 198Au and 75Se-methionine. It was established that introduction of regulatory peptides to dogs leads to inhibition of capture of labeled methionine by pancreatocytes, practically not influencing the elimination of colloid gold from circulation.

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Affection of the visceral branches of the abdominal aorta was diagnosed in 546 of 783 patients subjected to aorto-femoral reconstructions. The clinical picture of affection of the visceral branches is analysed according to the extent of their involvement and the genesis of the occlusive process. The authors possess experience in 169 cases with revascularization of the visceral branches in aorto-femoral reconstructions. Reconstruction of the inferior mesenteric artery was carried out in 134 cases and reconstruction of the celiac trunk and the superior mesenteric artery--in 35 cases. Retrospective analysis of the frequency and severity of gastrointestinal complications in the immediate and late-term postoperative periods allowed the authors to formulate the indications for and elaborate the optimum extent of reconstruction of the visceral branches depending on the character of their affection and the course of the occlusive process.

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Radionuclide gastroscopy conducted in patients with vast purulent wounds and sepsis disclosed reduced motor-evacuatory function of the stomach and the rate of its fractional emptying, that supports the necessity of continuous administration of nutrient mixtures by a drip method. A significant improvement of the motor evacuatory function and the rate of fractionated emptying of the stomach, 9-12 days after the commencement of the enteral (tube) nutrition, has shown the necessity of its use at the early stages of the course of severe purulent infection. The investigation of the absorptive capacity of the intestine with the use of the D-xylose test has revealed that it is insignificantly decreased in 82.6% of patients with severe purulent infection, and tube nutrition in such patients could be successfully conducted. Only in 17.4% of the patients the adsorptive capacity of the intestine was significantly decreased, and in these cases predominantly parenteral nutrition was recommended.

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Altogether 56 patients with occlusive abdominal aortic lesions and concomitant CHD were examined by radionuclide ventriculography on a nuclear stethoscope. Suppression of left ventricular systolic and diastolic function was noted in the patients with CHD and arterial hypertension. Investigations of cardiohemodynamics using the above method made it possible to identify patients with limited functional cardiac reserve, to predict possible myocardial complications, and to take preventive measures before, during and after reconstructive interventions on the abdominal aorta.

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