A comparative evaluation of methods for detecting duodenogastric reflux in patients with peptic ulcer]

The duodenal contents were examined in 81 patients with gastroduodenal ulcer. Bile acid concentrations, alkaline phosphatase activity, and sodium ion concentration were measured for the detection of duodenogastric reflux. Measurements of sodium ion concentration permitted estimation of the immediate volume of the duodenogastric reflux in the gastric contents. No methods for duodenogastric reflux detection should be given preference in examinations of peptic ulcer patients. Multiple-modality studies appear to be the most effective.     

Unilateral congenital elongation of the cervical part of the internal carotid artery with kinking and looping: two case reports and review of the literature

Unilateral and bilateral variation in the course and elongation of the cervical (extracranial) part of the internal carotid artery (ICA) leading to its tortuosity, kinking and coiling or looping is not a rare condition, which could be caused by both embryological and acquired factors. Patients with such variations may be asymptomatic in some cases; in others, they can develop cerebrovascular symptoms due to carotid stenosis affecting cerebral circulation. The risk of transient ischemic attacks in patients with carotid stenosis is high and its surgical correction is indicated for the prevention of ischemic stroke. Detection of developmental variations of the ICA and evaluation of its stenotic areas is very important for surgical interventions and involves specific diagnostic imaging techniques for vascular lesions including contrast arteriography, duplex ultrasonography and magnetic resonance angiography. Examination of obtained images in cases of unusual and complicated variations of vascular pattern of the ICA may lead to confusion in interpretation of data. Awareness about details and topographic anatomy of variations of the ICA may serve as a useful guide for both radiologists and vascular surgeons. It may help to prevent diagnostic errors, influence surgical tactics and interventional procedures and avoid complications during the head and neck surgery. Our present study was conducted with a purpose of updating data about developmental variations of the ICA. Dissections of the main neurovascular bundle of the head and neck were performed on a total 14 human adult cadavers (10 – Africans: 7 males & 3 females and 4 – East Indians: all males). Two cases of unilateral congenital elongation of the cervical part of the ICA with kinking and looping and carotid stenoses were found only in African males. Here we present their detailed case reports with review of the literature.     

Morphologic features of the chemosensory, visual and vestibular pathways of Helix lucorum

The structure of chemosensory, visual and statocyst pathways of the snail Helix lucorum has been studied by means of five histological methods. The chemoreceptors of the optic tentacle bulb, small and large neurons of tentacle ganglion and bipolar cells of olfactory nerve send their processes to the CNS of the mollusc. In the CNS these processes divide into many clusters of branches. All protocerebral cells and the cluster of neurons of the commissural part of metacerebrum send their processes within the olfactory nerve towards the periphery. The axons of eye cells terminate in the enlargement of optic nerve near the eye; so do the CNS cells and neurons of the optic nerve. In the neuropile of pleural part of metacerebrum a region of ramification of cell axons of the visual pathway is found. Hair cells of statocyst send their axons within the static nerve to the cerebral ganglion (CG). Small cells of metacerebrum send their axons towards the statocyst. In the neuropile of ipsilateral CG some processes of statocyst pathway cells divide into many thin branches; others--cross to the contralateral cerebral neuropile via the commissure joining two CG. In the neuropile of contralateral ganglion these processes give off a spray of many branches just as in the ipsilateral ganglion. The axons of the visual pathway cells and statocyst pathway cells ramify in the same region.     

Plasma HIV-1 RNA decline within the first two weeks of treatment is comparable for nevirapine, efavirenz, or both drugs combined and is not predictive of long-term virologic efficacy: A 2NN substudy

BACKGROUND: The initial rate of plasma HIV-1 RNA (pVL) decline has been proposed as a marker of early efficacy of antiretroviral therapy (ART) and a possible predictor of late efficacy. We compared the rate of pVL decline in patients starting ART with nevirapine (NVP), efavirenz (EFV), or both drugs combined in addition to lamivudine (3TC) and stavudine (d4T). METHODS: Analysis of the viral decay constant (VDc) during the first 2 weeks of treatment in patients enrolled in the 2NN study who remained on allocated treatment. RESULTS: The median VDc (log10 copies per day, [interquartile range]) was similar for NVP (0.30 [0.25-0.36], EFV (0.31 [0.27-0.37]), and NVP + EFV (0.30 [0.27-0.36]). Patients with a baseline pVL >100,000 copies/mL were 8.7 (95% confidence interval [CI]: 6.2-12.3) times more likely to have a VDc >75th percentile. A high VDc was not associated with plasma drug concentration or with a decreased risk of virologic failure at week 48 after the start of therapy (hazard ratio = 0.8, 95% CI: 0.6-1.2). CONCLUSION: NVP, EFV, or NVP + EFV in combination with 3TC and d4T show similar rates of pVL decline during the first 2 weeks of treatment. The VDc with these regimens is not predictive of late virologic efficacy.     

The treatment of coralliform nephrolithiasis

A total of 184 patients with dendritic nephrolithiasis (74.5% females and 25.5% males) were under study. It was established that in more than half of them the disease developed from the infectious inflammation of the urinary tract. Based on the findings, the authors supposed that in these patients the initial instability of cellular membranes was associated with a decrease in nonspecific resistance which was unfavourably complicated by infection of the urinary tracts and the formation of calcium phosphate calculus. As the presence of friable (low-contrast) calculi in the state of growth is accompanied by a severe inflammation, a continuous nonoperative treatment is mandatory. When the growth of the calculus is stopped and confirmed by its high-contrast dense X-ray shadow and the signs of inflammation ceased the authors insisted on the conduction of the 3-4-week inpatient preoperative management. The latter should include the administration of wide-range antibiotics, drugs for potentiation of nonspecific resistance and the complex of vitamins. Subcortical pyelolithotomy with partial nephrotomy is a method of choice in case of a "dry kidney". An average postoperative bedtime comprised 22.3 days.     

Choice of surgical treatment method for peptic ulcer of operated stomach

The analysis of immediate and long-term results of surgical treatment in 98 patients with peptic ulcer of operated stomach is presented. The choice of surgical method was determined by the disease cause. Reconstructive stomach resection by Bilrot-II in Roux modification was operation of choice in peptic ulcer with non-hormonal factors of ulcerogenesis. When hormonal cause of ulcerogenesis was suspected, even in unknown origin of hypergastrinemia, the extirpation of gastric stump is indicated. Trunkal vagotomy can be performed as an additional surgical method only. Favorable surgical outcomes were seen in 90 (91.8%) patients. Long-term results from 2 to 15 years were studied in 74 (82.2%) patients. They were recognized as good in 48 (53.3%) patients, as satisfactory--in 12 (13.3%). The recurrence of the disease was seen in 4 (4.4%) patients. 10 patients died due to causes not associated with stomach diseases.