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Objective: To evaluate the effectiveness and the safety of the spa and resort-based health-promoting treatment of the vehicle drivers (VD) presenting with duodenal ulcer disease., Material and Methods: A total of 67 men suffering from duodenal ulcer disease (DUD) were allocated to two groups. The patients of group 1 (n = 35) were given the courses of balneotherapy that included bromine-iodine mineral baths with a temperature of 36-37 degrees C (8-9 procedures 10-15 min long each every second day) in combination with 8-9 peloid applications to the epigastric region (temperature 38-40 degrees C for 10-15 min every second day). The patients of group 2 (n = 32) were given the similar courses of therapy that included nitric thermal mineral baths with a temperature of 36-37 degrees C (8-9 procedures 10-15 min long each every second day) in combination with 8-9 peloid applications to the epigastric region (38-40 degrees C for 10-15 min every second day). The effectiveness and safety of these balenotherapeutic procedures for the treatment of duodenal ulcer disease in the subjects of the study and control (n = 47) groups were evaluated based on the results of the routine clinical and endoscopic examination, psychological and psychophysiological tests, and the comparative analysis of medical aid appeal-ability and disability cases during twelve months., Results: Dynamics of clinical and instrumental characteristics (subjective, objective, clinical, endoscopic, psychophysiological) suggested the improvement of the health status in 88.6% and 84.4% of the drivers with duodenum ulcer in the two study groups respectively. Some of the patients comprising group 1 showed significant negative dynamics of the operative reaction system while the patients of group 2 demonstrated the marked improvement of the professionally significant functions and properties (PSF&P). The comparative analysis of medical aid appealability, disability cases, frequency of relapses and complications revealed the favorable clinical course of duodenal ulcer disease in both groups of patients who received the spa and resort-based health-promoting treatment., Conclusion: The spa and resort-based health-promoting treatment in the form of nitric thermal and bromine-iodine mineral baths in combination with peloid applications proved to be highly effective and safe for the vehicle drivers with duodenal ulcer disease, its two modalities (bromine-iodine an nitric-thermal baths) being almost similarly beneficial for the patients (88.6% and 84.4% respectively). At the same time, the former modality resulted in the well apparent deterioration of the driving qualityin certain subjects which suggests the necessity of psychophysiological testing for the evaluation of the performance of the operative reaction system. It is concluded that the spa and resort-based health-promoting treatment of the vehicle drivers suffering from duodenal ulcer disease should be considered as an indispensable component of the rational medical-psychological monitoring system providing a basis for the effective health and workability management.

In this paper we compared the efficacy of proton pump inhibitors (PPIs) and H2 receptor antagonists on the morphogenesis of the marginal zone of gastric and duodenal ulcers in 56 patients withacute gastroduodenal bleeding. It is shown that the antisecretory drugs in the treatment of patients with acute ulcerative bleedingnot only affect on the secretory activity of the glands in gastroduodenal zone, but it also modulates inflammatory reparative process and the status of mucous and bicarbonate barrier. A greater anti-inflammatory effect of PPI in comparison with H2-receptor antagonists has been proved. Appointment of PPIs had more pronounced stimulation of angiogenesis and cell proliferation of the surface epithelium.

The article outlines the morphologic evaluation of the gastric mucosa in 159 patients with different types of pyloroduodenal ulcers. The comparative characteristics of the gastric mucosa of 80 patients before and after the gastric resection. The complete restoration of the mucosa within the year after the selective proximal vagotomy was registered. The gastric resection leads to the chronic gastritis with dystrophic changes and intestinal or pseudopyloric metaplasia.

This study included 112 patients presenting with duodenal ulcer disease and 65 ones with chronic duodenitis treated with the use of sinusoidal modulated current (SMC) electrophoresis in combination with peloidotherapy (peat muds of the Uva health resort, Republic of Udmurtia). This treatment was shown to produce positive effect on the proliferative activity of duodenal epithelium.

102 tissue samples, resected during treatment of the perforated duodenal ulcers. The most pronounced fibroplastic and acute inflammatory tissue changes were registered in the immediate perforation zone and 0,5 sm above. At a distance of 1,0 sm these changes become less evident. Therefore, in patients with the perforated duodenal ulcer and palpable surrounding infiltrate less than 3,0 sm in diameter, the resection line should be no shorter than 1,0 sm away from the perforation.

There is a rise in the rates of acute erosive gastropathies in patients with cardiovascular and other somatic diseases. The role of acute erosive gastropathy-induced hemorrhages in the tanatogenesis of these diseases is underestimated; the problems of their prevention, diagnosis, and treatment remained unsolved. Many factors, mainly acute or chronic ischemia of the gastroduodenal mucosa, as well as its age-related involution, Helicobacter pylori infection, reflux gastritis, multiple organ dysfunction, drug-induced damage, etc., which are implicated in the pathogenesis of acute erosive gastropathies in patients with cardiovascular and other somatic diseases, are summarized.

A total of 4684 autopsies made at Moscow multidisciplinary hospitals in 2002-2008 were studied to reveal the incidence and morphological features of acute gastroduodenal erosions and ulcers in coronary heart disease (CHD), cerebrovascular disease (CVD), and chronic obstructive pulmonary disease (COPD). Cases with combined, background, and concomitant diseases that could be independent causes of gastroduodenal lesions were excluded. Patients older than 60 years with infarctions of the myocardium or brain, a concurrence of CHD, CVD, and COPD, and various diseases with chronic heart failure syndrome, particularly in the presence of arterial hypertension and diabetes mellitus should be referred to as a risk group for acute gastroduodenal erosions and ulcers and their induced hemorrhages.

The purpose of the study was to examine gastric mucosal morphological changes in patients with gastroduodenal pathology after eradication therapy for Helicobacter pylori (H. pylori). A hundred and thirty-eight patients (40 females and 98 males) were examined. Of them, there were 122 patients with duodenal peptic ulcer, 8 with gastric peptic ulcer, 5 with erosive gastritis, 2 with chronic atrophic antral gastritis, and 1 with non-atrophic gastritis. Two months and a year after therapy, manifestations of gastric mucosal atrophy, the degree of inflammation, and its activity significantly diminished in patients with complete H. pylori eradication. Positive changes were observed mainly in the antral portion of the stomach. In patients with partial eradication, chronic inflammation and its activity became less. Two months and a year following therapy, positive changes in the gastric mucosa were absent in patients without H. pylori eradication.

Laser photocoagulation of bleeding ulcer is one of the effective methods of endoscopic hemostasis. Experimental studies were carried out on resected stomach preparation. The preparations were studied histologically. Clinical trial was conducted in 43 patients with gastric and duodenal ulcer for hemostasis and prophylaxis of recurrent bleeding. Initial endoscopic hemostasis was successful in all the patients. Relapse of bleeding was seen in 4 patients. Overall efficacy of laser hemostasis was 90.7%. It is concluded that laser photocoagulation is one of effective and convenient methods of endoscopic hemostasis.

Results of examination of systemic immunity state, microbiocenosis and immunohistological changes of tissues of the esophagus and stomach in 37 adult patients and 69 children with erosive-ulcerous diseases of the gastrointestinal tract were analyzed. Based on these examinations, up-to-date immunomodulator tamerit inhibiting pathologic activity of monocytes/macrophage system with simultaneous activation of neutrophil granulocytes was used in 154 adult patients and 69 children. Positive result was achieved in all the cases when tamerit was used.

Experience and methods of duodenoplasty in duodenal ulcers and pyloric stenosis are presented. Pylorus-saving duodenoplasty in combination with selective proximal vagotomy (SPV) can be performed in the majority of patients with duodenal ulcers. Pyloric sphincter is destroyed by ulcer rarely (7.2%). Removal of ulcerous substrate reduces significantly per cent of postoperative complications, including recurrence of ulcer. Long-term results (from 1 to 20 years) of pylorus-saving duodenoplasty with SPV in 259 patients with duodenal ulcer were analyzed. Low per cent of complications and lethal outcomes have been demonstrated.

The method of plastic repair of the duodenal stump with an invaginated cone formed from the antral part of resected stomach was developed experimentally on 10 cadavers. Experimental surgeries on 16 mongrel dogs demonstrated primary healing and fast epithelisation of this duodenal stump. The method was used in 2 patients with giant penetrating ulcers of the posterior wall of the duodenum, promising results were seen.

Samples of the stomach, duodenum and pancreas removed from 76 patients obtained during organ-preserving operations for ulcer and chronic pancreatitis were examined morphologically. It is found that the most frequent type of changes in the intraorgan arteries is their wall hypertrophy in combination with hyperelastosis and elastotic fibrosis. This characterizes chronic local arterial hypertension. An additional morphological symptom complex caused by a vegetative vascular crisis is formed in the arteries of the damaged organ in exacerbation of the disease. The complex includes prominent dystonic and alterative changes of small arteries leading to stasis and thrombogenesis in the microvessels. Unknown so far phenomenon of arterial invagination in 18 patients was observed. It leads to a complete block of circulation, acute ischemia followed by tissue necrosis which was most typical for ulcer exacerbation and chronic pancreatitis.

77 patients with chronic Helicobacter gastritis verified endoscopically and exacerbation of duodenal ulcer were examined. H. pylori infection was identified by the rapid ureasa test (CLO-test) and Giemza staining. The patients received 7-day three-component therapy for eradication of H. pylori. Apoptosis and proliferation were studied in 16 patients in serial sections with the use of monoclonal antibodies. Eradication of H. pylori resulted in relief of inflammation and transformation of active gastritis in inactive one. H. pylori-associated gastritis is associated with activation of apoptosis of gastric mucosa epithelial cells and epitheliocytes proliferation. H. pylori eradication alters correlation between apoptosis of epitheliocytes and their proliferation: successful eradication of the infection decreases apoptosis, high proliferative activity of epitheliocytes persists reflecting enhancement of regeneration in gastric mucosa.

To study collagen metabolism in reparative regeneration of duodenal ulcer in response to peat mud electrophoresis of Uva sanatorium using sinusoidal modulated currents (SMC) as monotherapy in a day hospital, 82 duodenal ulcer patients in exacerbation or attenuation were examined. They received SMC-electrophoresis of peat mud diluted by sulfate sodium-calcium mineral water Uvinskaya of moderate mineralization. The dynamics of clinico-endoscopic and morphological picture of the disease was controlled with fibrogastroduodenoscopy with target biopsy of the periulcer zone and antral stomach, investigation of secretory and acid-producing function of the stomach, hormone profile and collagen metabolism. Positive changes were found attributed to favourable shifts in the hormone status and normalization of collagen metabolism in duodenal mucosa.

Some clinicomorphological correlations are made in Helicobacter pylori (H. pylori) associated diseases of the gastroduodenal zone. Genes vacA and cagA in the H. pylori genome were revealed by PCR in stomach biopsies of infected patients and the results were compared with histological changes in the patients' mucous membrane. Specific IgG antibodies to some H. pylori antigens were detected in the serum and a comparative analysis of serological and histological data was performed. The findings suggest that H. pylori associated gastroduodenal pathology is determined by interaction between macro- and microorganisms taking account of genetic characteristics of the infective microorganism, its phenotypic variations and properties of inflammatory and immune response of the host.

The conception of prerecurrence syndrome is suggested. Clinical, endoscopic and laboratory characteristics of prerecurrence syndrome are described. Causes of ulcer bleeding recurrence were examined: continued ulcer alteration, digestion of a thrombus in ulcer, fibrinolysis of a thrombus in an arrosive vessel, hyperdynamic regional circulation. Individual surgical policy was developed. Urgent surgery is indicated in continued hemorrhage and verified prerecurrence syndrome.

The proposed technique of cryomassage in outpatient setting promotes a complete healing of duodenal ulcer (DU) in patients with DU exacerbation. Healing of the ulcer is accompanied by improvement of blood flow in the zones of segmental innervation of the gastroduodenal system and by recovery of impaired cellular and humoral immunity in most of the patients.

In 24 patients with uncomplicated duodenal ulcer and 40 patients with acute bleeding duodenal ulcer morphofunctional status of the local paraendocrine adjusting system of the duodenal mucous membrane in the periulcer, ulcer and remote zones was studied with histochemical and electron-microscopic techniques. It is established, that ECL- and G-apudocytes hyperplasia and hyperfunction and vice versa D-cells reduction of the number and suppression of the secretory activity are reliable prognostic criteria of duodenal ulcer bleeding.

The results of examination of 167 patients suffering from gastric and duodenal ulcers complicated by bleeding and perforation in a rehabilitation period are presented. High contamination by HP bacteria was established in gastroduodenal bleeding especially in duodenal ulcer (94.45%), as well as direct correlation between the contamination range and blood loss degree. The presence of HP infection during a control check-up examination suggests that the course of anti-ulcer therapy should last not less than 4-6 weeks. In treating patients suffering from ulcer bleeding conservative therapy is preferable. Stomach resection is considered as a method of choice. Lethality makes up 0.94 and 6.25%, respectively.

71 stomachs removed because of ulcer were examined. It was confirmed that atrophic changes and intestinal metaplasia of the stomach mucous membrane are more pronounced in the stomach ulcer than in duodenal ulcer. There were no significant quantitative differences in the state of glandular apparatus in the anterior wall and small curvature of the stomach. The mean content of the border enterocytes in stomach ulcer was 78.8%, duodenal ulcer-86.9%: goblet cells-15.3% and 9.9%, Panet cells-2.7 and 1.14%, respectively, enterochromaffin cells-3.2 and 2.06%, respectively.

The incidence of various forms of stomach ulcer, their combination with liver diseases and pathogenetic relationships of these two pathological types have been studied on the material of 6456 autopsy cases for 1983-1992. High incidence of nonspecific reactive hepatitis in both gastric and duodenal ulcer and that of liver cirrhosis and cirrhosis-carcinoma in the pyloro-duodenal ulcer is established. A role of gastrin as a promoter in the development of liver cirrhosis and carcinoma in pyloroduodenal ulcer is suggested. The role of nonspecific reactive hepatitis in chronization of the hepatic pathological process is not excluded.

Antral biopsies of 33 duodenal ulcer patients (15 with hypergastrinemia, group 1 and 18 with normal fasting serum gastrin, group 2) and also 13 healthy volunteers were studied for D- and G-cell density and HP-status. Basal acid output (BAO), maximal acid output (MAO) and serum somatostatin were also evaluated. G- and D-cell density was measured by PAP-immunostaining technique. Serum gastrin and somatostatin levels were studied by radioimmunoassay. HP-status was evaluated histologically with the use of semiquantitative enhanced method. Both groups of patients had decreased D-cell density compared with control (p < 0.05). Patients from group 1 had significantly increased BAO, MAO, G-cell density, index of infective load of HP, index of adherence of HP, comparing with group 2 (p < 0.05), and decreased serum somatostatin level and D-cell density compared with group 2. There were no significant differences found in serum somatostatin level, BAO, G-cell density, serum gastrin level between group 2 and control (p > 0.05). Hyperfunction of G-cells arose from impaired paracrine secretion of somatostatin, that strongly associated with increased index of infective load and increased index of adherence of HP to epitheliocytes of gastric antrum.

Gastric mucosa of obese patients with duodenal ulcer was investigated by means of light and electron microscopy and morphometrically. The comparison of the morphological findings and data on gastric secretion shows that overall volume of functional structures of the parietal and peptic cells providing secretion is smaller in duodenal ulcer patients with obesity than in non-obese patients. Elevated gastric secretion in these patients is maintained by hyperfunction of the corresponding structures.

This rare tumor was found at surgery in a 35-year-old male operated for chronic ulcer of the duodenum complicated by gastrointestinal bleeding. The tumor looked like a pedunalated polyp 6 x 3 x 2 cm in size with an ulcer 0.5 cm in diameter. Histologically, the tumor was formed of large lobules of Brunner's glands, and its surface was lined with intestinal villi. Pascual's argyrophilic test discovered focal hyperplasia of endocrine cells in the intestinal lining. The majority of these cells, according to PAP reactions with antisera to polypeptides, were serotonin-positive. Among tumor cells somatostatine-positive cells were most numerous.

The article deals with the appraisal of the gastric mucosa in various developmental stages of pyloroduodenal stenosis. The characteristics of the mucosa after selective proximal vagotomy (SPV) and after resection of the stomach are compared. It was found that the normal structure of the gastric mucosa is restored 12 month after SPV. Chronic gastritis with signs of dystrophy as well as intestinal and pseudopyloric metaplasia develops after resection of the stomach.

475 patients with stomach ulcer (1984-1993) were studied using various methods: endoscopical, immunological, biochemical, bacteriological and morphological. Morphology of exacerbation and type of reparative processes in normal scarring and torpid course of disease are presented. Under adequate regeneration there is an activation of immune system, first that of T-cell compartment. Torpid course is characterized by a grave regeneration disturbance and depression of the immune system. The interpretation of the so-called "red scar" is given: it reflects different stages of the epithelial regeneration, however in 4.8% of duodenal ulcers and in 11.2% of stomach ulcers it masks a torpid course. Helicobacter pylori has no influence on the reparative processes. Adequately chosen therapy improves and accelerates ulcer scarring.

74 patients with GSU are studied. These ulcers occur more frequently than ordinary ulcers in aged persons against the background of various diseases. "True" GSU are localized mainly in the proximal regions. GSU combined with duodenal ulcers have a course with grave complications requiring urgent surgery. GSU located in the central parts are characterized by chronic ulcer symptoms, and those located at the periphery by the symptoms of acute ulcers (centrifugal progression). Confluence of adjacent ulcers occurs at the centripetal progression. Epithelization is lacking at the edges of the majority of GSU this indicating the predominance of the destructive processes.

The defense properties of the gastroduodenal mucosa (lymphoid system cells secreting immunoglobulins A, M, and G, as well as the secretory component IgA) were studied in 85 patients with duodenal ulcer. The acid-producing function of the stomach was tested at the same time according to the pH value and the basal and maximal acid production. Various types of vagotomy were conducted in 52 patients and resection of the stomach in the remaining patients. The results were followed-up before and after the operation. Peptic ulcer was characterized by secondary immunodeficiency. Selective proximal vagotomy restored the tissue immune defense of the mucosa, gastric resection preserved and even increased immunodeficiency.

Epithelial proliferation in the mucosa of the gastro-intestinal tract was studied autoradiographically with 3H-thymidine under the following conditions: acute gastric ulcers as complication of acute pancreatitis; exacerbation of duodenal ulcer; ulcers and erosions in bacterial dysentery. Mucosa of practically healthy persons as well as mucosa of patients with the same diseases not complicated with ulcers and erosions served as control. Biopsies of mucosa were taken 2 cm from ulcers and erosions. The decrease of DNA-synthesizing nuclei number in the mucosa epithelium at early stages of ulcer formation was observed in all these conditions.

Chief cells were studied ultrastructurally and stereometrically in 93 patients at various intervals (from 2 weeks up to 4 years) after complete vagotomy as well as in 87 patients at the same intervals after selective proximal vagotomy. The chief cell structure indicated their high level of secretory activity in patients with duodenal ulcer regardless of the type of initial secretion (hypo-, normo- or hypersecretion). Vagotomy, apart from the decrease of the chief cell volume in the glands results in the reduction of their intracellular structures. The secretory granule structure was changed indicating the disturbance of cell differentiation, more pronounced after selective proximal vagotomy.

Resection of the parietal cells, a modification of the generally known Wangensteen's tubular resection, was carried out in 8 patients with duodenal ulcer. The greater curvature of the stomach was removed to the left of the line joining the prepyloric part and the His angle. The operation was not devoid of technical difficulties, especially in well-nourished patients with high position of the cardia. The immediate postoperative course was uneventful. The ulcer was not found in any of the patients by endoscopy conducted in periods of 16 to 36 months, all of them noted subjective improvement after the operation. The results allow the operation to be recommended for the treatment of duodenal ulcer complicated by penetration and hemorrhages, when distal resection is a considerable risk.

It was found that in patients with gastroduodenal hemorrhage the number of serotonin-, histamine-, and melatonin-producing apudocytes in the gastric mucosa increases while the number of cells producing gastrin, adrenaline, and noradrenaline reduces. In timely arrest of hemorrhage, the primarily increased number of melatonin-producing apudocytes diminishes with time from the onset of bleeding and reaches normal values gradually. The essential differences in the content of melatonin- and noradrenaline- producing apudocytes in patients with and without hemorrhage allow this morphological sign to be used as diagnostic and prognostic criteria in gastroduodenal hemorrhages.

Immunomorphological PAP method was used in 20 patients with duodenum ulcer and in 10 control individuals to study gastrin (G)-, somatostatin (D)- and calcitonin-gene-related peptide (CGRP) cells in biopsies of the stomach and duodenum. The gastrin and pepsinogen level in the blood, basal and acid production stimulated by pentagastrin were also studied. All patients are subdivided into two groups by their acid production: those with hypersecretion and those with normal secretion. The group with hypersecretion was not homogeneous: some patients had deficiency of D-cells (sometimes in combination with G-cell hyperplasia) and others had a relative and absolute decrease of the number of CGRP cells in combination with foci of parietal cells in pylorus. These patients showed a tendency to the hypergastrinemia and significant hyperpepsinogenemia I in the blood. Stomach hyperplasia in the duodenum, multiple duodenal ulcers, erosive gastroduodenitis and ulcers in close relatives occurred more frequently in these patients. G- and CGRP cells are found to be similar in the form and localization. It is not excluded that G-cell contains, apart from gastrin 1-17, calcitonin-gene related peptide.

Signet-cell carcinoma of Brunner's glands and two chronic ulcers of the duodenum were revealed in the course of the histologic examination of the autopsy material from a 76-year-old patient. One of the ulcers penetrated into the pancreas. This case is interesting for rare occurrence of Brunner's glands carcinoma and its combination with chronic duodenum ulcers.

The mucous membrane of the fundal and pyloric parts of 26 stomachs resected for peptic ulcer was examined. The edges and bottoms of the ulcers were studied. The cells secreting immunoglobulin (Ig) of A, M, and G classes were detected by indirect immunoperoxidase method. The proportions (in per cent) of lymphocytes, plasma cells and Ig-containing cells were determined stereometrically. The intact mucous membrane of the fundal part contains 2.17% lymphocytes and 7.5% plasma cells. The portions of IgA-, IgM- and IgG-secreting cells were 0.99%, 0.39%, and 0.13%, respectively. In atrophic antral gastritis, plasma cell infiltration of the mucosa increases 2 1/2-fold, the number of lymphocytes remaining unchanged. The number of immunocytes secreting IgA and IgM increases almost 4-fold and that of secreting IgG over 13-fold. In the ulcer edges, plasma cell infiltration of the stroma reached 10.83% whereas the number of Ig-secreting cells was the same as in the pyloric part in the same patients. The activation of the secretory immune system in peptic ulcer is due to significant antigenic stimulation. The most predominant are the IgA-containing cells. A marked increase of IgG synthesis indicates the defect of autoregulation of the local immunity and may be of pathogenetic importance for the development of autoaggression which would facilitate progression and chronicity of the ulcer.

Bilateral subdiaphragmatic truncal vagotomy done either 11 days before or 10 days after induction of an acetic (Okabe's modification) duodenal ulcer in rats results in acceleration of the process of its spontaneous healing. The time of epithelization shortens, reduction of connective tissue growth is accelerated, contraction of tissues around the ulcer intensified, tunica muscularis regenerates almost completely. At the same time there are some alterations in the processes of formation at the site of the ulcer: newly forming villi are smaller than in control rats, they have abnormal configuration; newly forming duodenal glands often undergo cystic extension.

The method of therapeutic endoscopy is a very important component in the complex treatment of chronic gastroduodenal ulcers. In 115 of 116 patients with gastric or duodenal ulcers who were treated by the authors the ulcer epithelialized and a cicatrix formed. When therapeutic endoscopy with the application of hippophae oil was added to the basic therapy, the period of the inpatient treatment reduced 1.5-2 times. The late results of the management of chronic gastroduodenal ulcers by this method were studied and confirmed its sufficiently high therapeutic efficacy (the results were positive in 93.7% of cases).

Experimental and clinical studies convincingly indicate that duodenal-gastric reflux may provoke the development of reflux gastritis with a characteristic clinico-morphological complex. However, the clinical picture of reflux gastritis in patients with stomach ulcer is not always typical, is frequently masked by the underlying disease and therefore is difficult for diagnosis. The necessity of the use of the laboratory and instrumental methods arises, with an obligatory histological examination. Morphological studies indicate the existence of certain characteristic signs of reflux gastritis, the detection of which makes this diagnosis valid.

Biopsy material was used for morphometric study of the fundal glands in 114 patients with duodenal ulcers, 177 patients with various forms of gastroduodenal pathology but with typical signs of duodenal ulcer, and in 21 normal subjects. Three variants of the increase in the amount of secretory elements of the fundal glands were found: owing to an increase in the number of main cells (first variant), main and parietal cells (second variant), and parietal cells (third variant). These changes in the fundal glands are not specific for ulcer and pre-ulcer conditions, they are observed in normal subjects with constitutional hypersecretion of hydrochloric acid and pepsin. The patients with duodenal ulcer and pre-ulcer conditions are characterized by "hyper-pepsinogenic shift" in the epithelial formula of the fundal gland (45% and 31-38%, respectively) owing to an increase in the number of main cells.

The fundic glands of 143 stomachs resected in connection with peptic ulcer, including those localized in the stomach (70 observations) and in the duodenum (73 observations) were studied. The number of epithelial cells in the longitudinal section of the fundic gland in ulcer of the stomach was most often in the range of 100 to 149 (in 37 cases of 70), in duodenal ulcer--150 to 199 (in 36 observations of 73). In patients with duodenal ulcer, as distinct from those with gastric ulcer, the epithelial formula of the fundic gland was characterized by a lower content of non-differentiated and mucous neck cells and by a greater number of chief cells, the hyperpepsinogenic cellular shift (a rise of the content of chief cells up to 50% and more) in them was observed 4-5 times more often. The ratio index of chief and parietal cells in gastric ulcer (in 75.7% of cases) was usually in the range of 1--1.9 (tentative norm) and only in some cases (in 18.6% of observations) it was higher. In duodenal ulcer an elevated index was observed in 54.8% of cases.

An electron-microscopy investigation and morphometric analysis were carried out in 30 specimens of bioptic material of the fundal part of the stomach in patients with duodenal ulcer with the hyperacid syndrome. At all levels of the Major gastric glands parietal cells with morphological signs of intensive secretory activity prevailed, which was one of the causes (apart from the increase in the mass of parietal cells) of considerable intensification of secretion of hydrochloric acid. It was suggested that a considerably increased (as compared with the norm) area of the surface of the crysts of mitochondria with simultaneous reduction of the coefficient of their fragmentation was the morphological substrate of a high functional activity of parietal cells of the gastric mucosa in the hyperacid syndrome.