Lyophilized samples of human tumor tissue exposed and not exposed to radiation therapy were investigated by magnetic resonance spectroscopy. The measurements were taken in the temperature range of 4-280 K on an X-band electron paramagnetic resonance spectrometer. Two types of ferromagnetic resonance signals were detected. The first type signals (g eff & 2.1 7 2.4) were detected in the spectra of 25% of the samples. The orientational dependence of these signals has been found. The temperature dependences of the first type signals were measured. Specific features were observed near the temperature of 125 K. They are evidently typical for the Verwey phase transition in magnetite. We suppose that the first type signals may belong to arrays or chains of ferritin particles with the crystal core in the form of magnetite. The temperature dependences of magnetic resonance characteristics of ferritin in tumors are differ from those of the same characteristics of ferritin in healthy tissue investigated before. In spectra of irradiated tumors, the second type signals at low fields were detected which may be due to aggregates of different iron particles in cell lysosomes.
We carried out a detailed analysis of rat model of esophageal achalasia previously developed by us. Manifest morphological and functional disorders were observed in experimental achalasia: hyperplasia of the squamous epithelium, reduced number of nerve fibers, excessive growth of fibrous connective tissue in the esophageal wall, high contractile activity of the lower esophageal sphincter, and reduced motility of the longitudinal muscle layer. Changes in rat esophagus observed in experimental achalasia largely correlate with those in esophageal achalasia in humans. Hence, our experimental model can be used for the development of new methods of disease treatment.
Цель. Проанализировать результаты повторных и реконструктивных операций у пациентов с грыжей пищеводного отверстия диафрагмы. Материал и методы. В исследовании представлен опыт выполнения 1032 операций у пациентов с ГПОД. Объем оперативных вмешательств выполнен на базе отделения хирургии пищевода и желудка Республиканского клинического онкологического диспансера (Казань) в 1996-2015 гг. Все операции выполнялись лапароскопическим доступом. Использовались следующие виды фундопликаций: по Ниссену-Розетти-852, по Ниссену-174, по Тупе-6. Эффективность проведенных операций оценивали исходя из жалоб пациентов, данных эндоскопического и рентгенологического обследований. 50 (4,8%) пациентов подверглись повторной операции, показаниями к повторной операции стали кровотечение, стойкая дисфагия, перфорация желудка, рецидив ГЭР, вторичная параэзофагеальная ГПОД, послеоперационная грыжа. Результаты. 50 пациентам выполнены повторные хирургические вмешательства. Кровотечение в раннем послеоперационном периоде наблюдалось у 3 (6,9%) пациентов. В 2 случаях данное осложнение удалось ликвидировать лапароскопическим доступом, а 1 больному выполнена лапаротомия. Источниками кровотечения явились: троакарные проколы у 2 (66%) пациентов, короткие сосуды желудка у 1(34%) больного. По поводу дисфагии 1 (2,5%) больному выполнена рефундопликация по Ниссену, причиной явилось натяжение желудочно-селезеночной связки (вследствие ранее не пересеченных коротких сосудов желудка). У 2 (4,8%) пациентов диагностирована незамеченная во время операции перфорация задней стенки желудка. Обоим больным на 2-е сутки выполнена лапаротомия и ушивание дефекта. Вторичная параэзофагеальная ГПОД возникла у 2 (4,8%) пациентов Выводы. Основными причинами повторной операции явились: деструкция и миграция фундопликационной манжеты-32 (80%) случая, феномен «телескопа»-6 (15%) случаев. Выявлена следующая результативность реконструктивных операций: отличные, хорошие и удовлетворительные результаты после первой реконструкции составляют 55%, неудовлетворительные-45%; после второй-отличных, хороших и удовлетворительных результатов Ч 33%, неудовлетворительных-67%; после третьей реконструкции-100% неудовлетворительный результат. Лапароскопическая фундопликация должна проводиться в специально оборудованных центрах опытными специалистами, владеющими не только лапароскопическими методами, но и имеющими опыт открытых антирефлюксных операций при ГПОД. Пациенты, которым выполнена операция по поводу ГПОД, должны тщательно придерживаться диетических рекомендаций, контролировать вес и соблюдать ограничение физической нагрузки. Ключевые слова: гастроэзофагеальная рефлюксная болезнь, грыжи пищеводного отверстия диафрагмы, осложнения лапароскопических антирефлюксных операций, повторная операция.
Aim. To justify the appropriateness of applying the integrated algorithm of treatment, including the sequential application of conservative antireflux treatment and antireflux surgery, in patients with complicated forms of gastroesophageal reflux disease. Methods. The main group of the study included 554 patients with complicated forms of gastroesophageal reflux disease (erosive esophagitis in 301, peptic stricture in 36, Barrett's esophagus in 90 and a combination of several complications in 127 patients), and the control group included 229 patients with uncomplicated gastroesophageal reflux disease and indications for surgical treatment. At the diagnostic stage, fiberoptic esophagogastroduodenoscopy with chromoendoscopy using a double dye staining technique (Lugol and methylene blue) and biopsies of areas suspicious for metaplasia, as well as a barium contrast multi-positional radiographic examination of the esophagus and gastroesophageal junction were used. At the treatment stage, both groups received conservative antireflux treatment lasting 48 weeks, comprising lifestyle regulation, diet, antisecretory drug therapy (proton pump inhibitors omeprazole or rabeprazole 20 mg orally twice a day, antispasmodic agent domperidone 20 mg orally 3 times a day or itopride 50 mg orally 3 times a day), followed by either laparotomic or laparoscopic antireflux surgery. In the main group, antireflux surgery was supplemented with endoscopic argon plasma coagulation during the postoperative period in the patients with Barrett's esophagus and esophageal bougienage under endoscopic control during the pre- and postoperative period in the patients with a peptic stricture. Results. The frequency of intraoperative [6.3% (95% CI 1.45.8%), p=0.0462] and early postoperative complications [41.5% (95% CI 37.445.7%), p=0.0011] in the main group were statistically significantly higher than in the control group. There was no clinically important difference. Frequency of late postoperative complications in the main group [5.4% (95% CI 3.77.6%)] did not have statistically significant differences from the control (p=0.1239). The integrated algorithm of treatment has proven to be safe with provision for the need to develop measures to reduce the overall incidence of early postoperative complications. Excellent and satisfactory immediate treatment results were achieved in 91.7% (95% CI 89.193.9%), and excellent and satisfactory long-term results were achieved in 91.3% (95% CI 88.793.5%) patients of the main group, and were statistically significantly worse than in the control group, p=0.0008 and p=0.0021 for the immediate and long-term results, respectively. The difference was attributable to the extremely high efficiency of the treatment algorithm in the control group and had no clinical significance. Conclusion. The use of the integrated algorithm of treatment based on the implementation of antireflux surgery is appropriate in all patients with complicated forms of gastroesophageal reflux disease.
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