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History and current status of Polish gastroenterological pathology

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The present paper summarizes the contribution of Polish investigators to the development of gastroentrology, and especially pathology of the gastrointestinal tract. We called to mind meritorius scientifists among the 19th-century and modern pathologists. Especially interesting are discoveries of Browicz, being the first, who described thyphus bacilli and shortly after Kupffer - fagocytozing cells in the liver. Noteworthy are detailed description of tumorous lesions being the contribution to oncological pathology of the gastrointestinal tract as well as the reports on congenital malformations (i.e. esophageal fistulas). Moreover we remind the investigators dealing with pathology of gastric ulcer disease, its pathogenesis and mechanisms of healing. Of great importance was also the discovery of regeneration existing also outside the mucosal surfaces. In the paper, besides the above-mentioned Tadeusz Browicz investigations of professors: Lesniowski, Ciechanowski, Kowalczykowa, Stachura, Konturek are called to mind.
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Non-variceal upper gastrointestinal bleeding-guidelines on management

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In gastroenterology non-variceal upper gastrointestinal bleeding is health hazard. Frequency of occurrence accounts for 40-150 cases per 100000 inhabitants with death rate of 7-14%. Researches which goal is to improve treatment effectiveness as well as to establish standardized procedures for managing patients with symptoms of non-variceal upper gastrointestinal bleeding; have been conducted since many years. At the moment of admission, designed standards enable appropriate elaboration of patients’ health state, referral to the right clinic and implementation of the most accurate treatment methods. Increase of suppression of primary bleeding as well as prevention of recurrence is associated with dynamic development of endoscopic treatment methods as well as with optimization of pharmacological treatment. In significant percentage, efficiency of non – variceal bleedings treatment depends on clinic’s character (availability of equipment, experience of personnel) and on cooperation between several specialists (including gastroenterologist, surgeon, anesthetist, operative radiologist). Aim of the work is to present the latest evaluation of the mentioned subject, based on accessible literature. This work includes the basic principles for determination of bleeding intensity and risk of its recurrence as well as directions referring to fluids resuscitation and to monitoring of patients. Information on currently applied endoscopic methods for inhibition of non variceal upper gastrointestinal bleeding (injection, mechanical and thermo-coagulation techniques), comparison of their efficiency and possibility of application is provided in the work. The paper work also presents the newest directives for pharmacological treatment and guidelines for possible surgical treatment.
In 1987 on the occasion of the 50th anniversary of the British Society of Gastroenterology Sir Francis Avery-Jones (1) wrote (perhaps a little exaggerating) in his introductory remarks: “In 1937 the alimentary tract was invisible, impalpable and inaccessible-except the top and the bottom”. Indeed, diagnostics in gastroenterology was very weak and uncertain at the beginning and even in the middle of the last century. Endoscopy and radiology, developing first apart and then together revolutionized the diagnostics and consequently the practice in gastroenterology. Endoscopy brought a new access to operative procedures alleviating the burden of open surgery as well. The method, apart from knowledge, needs personal skills and so new problems of postgraduate education and ethics appeared. Due to the enormous progress in science and in technology it has reached the present level of accuracy. Polish gastroenterology with its early achievements in gastric secretion (Leon Popielski, histamine), abdominal surgery (Ludwik Rydygier, first gastric resection), endoscopy (Jan Mikulicz-Radecki) and later research upon the neuro-hormonal brain-gut axis (Stanis³aw J. Konturek) tried to keep pace with the world-wide progress in this field. The Polish contributions to the growing knowledge and improving practice may be traced from the very beginning of the 20th century.
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The short history of gastroenterology

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In this paper research on the stomach and bowel physiology is presented in a historical perspective. The author tries to show how digestive processes were interpreted by the ancients and how they tried to adjust them to the dominating humoral theory of disease. It is pointed out that the breakthrough which created a new way of understanding of the function of the digestive system was made by Andreas Vesalius and his modern model of anatomy. The meaning of acceptance of chemical processes in digestion by iatrochemics representatives in XVII century is shown. Physiological research in XIX century, which decided about a rapid development of physiology, especially the physiology of the gastrointestinal tract, is discussed. Experiments were performed by all main representatives of this discipline: Claude Bernard, Jan Ewangelista Purkynì, Rudolph Heidenhain and especially Ivan Pavlov, who, thanks to the discoveries in the secretion physiology, explained basic functions of the central nervous system. The XX century was dominated by the research showing the important role of the endocrine system and biological agents in the regulation of secretion and motility of the digestive system. The following discoveries are discussed: Ernest Sterling (secretin), John Edkins (gastrin) and André Latarjet and Lester Dragstedt (acetylcholine). It is underlined that Polish scientists play an important role in the development of the gastroenterological science - among others; Walery Jaworski, who made a historical suggestion about the role of the spiral bacteria in etiopathogenesis of the peptic ulcer, Leon Popielski, who stated the stimulating influence of histamine on the stomach acid secretion, Julian Walawski, who discovered enterogastrons - hormones decreasing secretion. As a supplement, there is the list of achievements in the field of the physiology and pathology of the gastrointestinal tract awarded with Nobel Prize and the list of most important Polish papers in this field.
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Helicobacter pylori and its involvement in gastritis and peptic ulcer formation

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Modern gastroenterology started in early 19th century with the identification by W. Prout of the inorganic (hydrochloric) acid in the stomach and continued through 20th century with the discoveries by I.P. Pavlov of neuro-reflex stimulation of gastric secretion for which he was awarded first Nobel Prize in 1904. When concept of nervism or complete neural control of all digestive functions reached apogeum in Eastern Europe, on the other side of Europe (in United Kingdom), E. Edkins discovered in 1906 that a hormone, gastrin, may serve as chemical messenger in stimulation of gastric acid secretion, while L. Popielski revealed in 1916 that histamine is the most potent gastric secretagogue. K. Schwartz, without considering neural or hormonal nature of gastric secretory stimulation, enunciated in 1910 famous dictum; “no acid no ulcer” and suggested gastrectomy as the best medication for excessive gastric acid secretion and peptic ulcer. In early 70s, J.W. Black, basing on earlier L. Popielski’s histamine concept, identified histamine-H2 receptors (H2-R) and obtained their antagonists, which were found very useful in the control of gastric acid secretion and ulcer therapy for which he was awarded in 1972 second Nobel Prize in gastrology. With discovery by G. Sachs in 1973 of proton pumps and their inhibitors (PPI), even more effective in gastric acid inhibition and ulcer therapy than H2-R antagonists, gastric surgery, namely gastrectomy, practiced since first gastric resection in 1881 by L. Rydygier, has been considered obsolete for ulcer treatment. Despite of the progress in gastric pharmacology, the ulcer disease remained essentially “undefeated” and showed periodic exacerbation and relapses. The discovery of spiral bacteria in the stomach in 1983 by B.J. Marshall and R.J. Warren, Australian, clinical researches, awarded in 2005 the Nobel Prize for the third time in gastrology, has been widely considered as a major breakthrough in pathophysiology of gastritis and peptic ulcer, which for the first time can be definitively cured by merely eradication of germ infecting stomach. This overview presents the mechanism of induction of gastritis and peptic ulcer by the H. pylori infection and describes accompanying changes in gastric acid and endocrine secretion as well as the effects of germ eradication on gastric secretory functions and gastroduodenal mucosal integrity
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Therapeutic endoscopy in gastroenterology

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Professor Jerzy Kaulbersz, pioneer of Polish gastroenterology

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Jerzy Kaulbersz was undoubtedly the father of experimental gastroenterological physiology in Poland. He pioneered the neural and endocrine aspects of the mechanisms controlling gastric and pancreatic secretion by assessing the influence on this secretion of vagal nerves and endocrine factors such as gastrin, enterogastrone, urogastrone, pituitary, adrenal, thyroid and sex hormones as well as bile, hypoxia and X-ray irradiation. He introduced various models of peptic ulcerations such as induced by pylorus-ligation (Shay ulcers) or Mann-Williamson ulcers to test the influence of neuro-endocrine factors on the formation and healing of these ulcerations. This review is designed to commemorate the outstanding contribution to experimental gastroenterology of Professor Kaulbersz, who first studied biology in German universities to obtain the title of Doctor of Natural Philosophy (Ph.D.) in Freiburg in 1913 and then completed medical studies at the Medical Faculty of the Jagiellonian University in Cracow receiving the title of Doctor of Universal Medicine (MD) in 1920. He then joined Department of Physiology of Jagiellonian University in Krakow as its assistant and gradually was appointed docent and finally promoted to professor in this Department, working here as chairman from 1934 to 1964 with only 7 years interruption when he spent the time of world war II in USA, working at various departments of experimental gastroenterology and publishing his outstanding papers in most prestigious physiology journals such as American Journal of Physiology. He possessed comprehensive knowledge of physiology and was gifted to create and organize Cracow Department of Physiology. Moreover he became co-founder of the of Polish Physiological Society, the honorary member of American Physiological Association, honorary member of Polish Society of Gastroenterology and Physiology and received the diploma of Doctor Honoris Causa of Medical Academy in Cracow. This ad memoriam note commemorates his achievements at one hundred twenty anniversary of Prof. Kaulbersz birth with intention to bring his fundamental discoveries to younger physiologists and pharmacologists.
Rapid progress in gastroenterological research, during past century, was initiated by the discovery by W. Prout in early 18th century of the presence of inorganic, hydrochloric acid in the stomach and by I.P. Pavlov at the end of 19th century of neuro-reflex stimulation of secretion of this acid that was awarded by Nobel prize in 1904. Then, J. W. Black, who followed L. Popielski's concept of histamine involvement in the stimulation of this secretion, was awarded second Nobel prize in gastrology within the same century for the identification of histamine H2-receptor (H2-R) antagonists, potent gastric acid inhibitors, accelerating ulcer healing. The concept of H2-R interaction with other receptors such as muscarinic receptors (M3-R), mediating the action of acetylocholine released from local cholinergic nerves, and those mediating the action of gastrin (CCK2-R) on parietal cells, has been confirmed both in vivo studies and in vitro isolated parietal cells. The discovery of H2-R antagonists by Black and their usefulness in control of gastric secretion and ulcer healing, were considered as real breakthrough both in elucidation of gastric secretory mechanisms and in ulcer therapy. Discovery of even more powerful gastric acid inhibitors, proton pump inhibitors (PPI), also highly effective in acceleration of ulcer healing was, however, not awarded Nobel prize. Unexpectedly, two Australian clinical researchers, R.J. Warren and B.J. Marshall, who discovered in the stomach spiral bacteria, named Helicobacter pylori, received the third in past century Nobel prize in gastrology for the finding that this bacterium, is related to the pathogenesis of gastritis and peptic ulcer. They documented that eradication of H. pylori from the stomach, using antibiotics and potent gastric inhibitors, not only accelerates healing of ulcer but also prevents its recurrence, the finding considered as greatest discovery in practical gastrology during last century. Thus, the outstanding achievements in gastroenterology during last century have been awarded by three Nobel prizes and appreciated by millions of ulcer patients all over the world.
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