[Diagnostic and curative procedures with ultrasound guidance in patients with mechanic jaundice]. / Diagnosticheskie i lechebnye protsedury pod ul'trazvukovym kontrolem u bol'nykh mekhanicheskoi zheltukhoi.

Transcutaneous procedures have been performed under ultrasound control in 404 patients with mechanical jaundice, caused by tumor of the pancreas, primary liver tumor or its metastatic lesion. Cholecystostomy was performed in 40 patients, in other cases external or external-internal draining of bile with subsequent implantation of endoprosthesis for the life-long biliary duct decompression (108 endoprostheses in 98 patients) has been done. Complication have been observed in 3 (0.7%) patients. The mortality rate was 2.1%. The authors recommend this method for wide use in patients with mechanical jaundice and consider it to be a method of choice in inoperable cancer of hepato-pancreatico-duodenal zone.

[Transcutaneous drainage of pancreatic pseudocysts guided by ultrasound and computed tomography]. / Chreskozhnoe drenirovanie psevdokist podzheludochnoi zhelezy pod kontrolem UZI i rentgenotelevideniia.

The method of transcutaneous sanation of pancreatic pseudocysts under control of USE and CT has developed quite widely in the recent years and is applied in clinical practice. In the period from 1987 to May 1993 thirty-three patients underwent transcutaneous drainage (TD) of pancreatic cysts at the Burdenko Facultative Surgical Clinic, MMA; a total of 35 procedures were performed. In all cases TD was conducted under control of USE and roentgeno-television (RTV) by Seldinger's method or with various types of stylet catheters. The transperitoneal approach was preferable in cysts of the head, in cysts of the body of the gland hze transgastric approach was used under control of gastroscopy for later attempt to accomplish transcutaneous cystogastrostomy. Contrast examination of the cyst immediately after puncture revealed its connection with the pancreatic duct (PD). Fistulography was repeated every 5-7 days. In the absence of a cystopancreatic fistula the cyst was sclerosed with 96 degrees ethyl alcohol. Complications were encountered in 11% of cases and a recurrent cyst developed in one patient. The TD method under control of USE and RTV is effective in the treatment of pancreatic cysts attended by a low incidence of complications. A large size of the cyst, its infection or connection with the pancreatic duct are not contraindications for TD.

[The x-ray endovascular treatment of renin-dependent arterial hypertension with secondary aldosteronism in patients without vasorenal involvement]. / Rentgenoéndovaskuliarnoe lechenie reninzavisimoi arterial'noi gipertenzii s vtorichnym al'dosteronizmom u bol'nykh bez vazorenal'nogo porazheniia.

In 20% of cases, essential hypertension is of high renin pathogenesis which is indifferent of that of renal lesions. In these patients high blood pressure is closely related to high aldosterone generation due to elevated angiotensin II levels. Adrenal blood portalization is a possible way of abolishing secondary aldosteronism and hyperreninemia in this case. With this, 90-98% aldosterone and 20-30% renin are inactivated, which served as the basis for bilateral electrocoagulation of adrenal central veins in 13 patients with permanent and malignant arterial hypertension. The renin-dependent pattern of essential hypertension was confirmed by a positive BP response to a tested captopril dose (25 mg), the vasorenal one was ruled out on the basis of the peripheral captopril test, captopril pharmacorenography. Bilateral electrocoagulation of adrenal central veins was performed during a phlebographic examination. The manipulation proved to be successful on 11 (85%) left and 9 (70%) right adrenals. Blood pressure became lower in the first day and stable on days 4-5. There was a significant decrease in blood pressure at a year follow-up, in increased aldosterone levels, plasma renin activity with unchanged adrenocorticotropic hormone concentrations. After the manipulation, 2 patients refused to take antihypertensive drugs, 11 patients received lower doses of drugs. The method for abolishing secondary aldosteronism is considered to be promising for further clinical studies. A special attention should be given to patients with diseases concomitant with essential hypertension who have no alternative to surgical treatment.

[The sequence of interventions in pancreatic cavities]. / Posledovatel'nost' interventsionnykh vmeshatel'stv pri polostiakh v podzheludochnoi zheleze.

Schemes for the sequence of therapeutic interventions were worked out based on experience in the recognition of 56 pancreatic cavitations (cysts, abscesses), US-assisted diagnostic punctures, 28 external drainages of the cavities (mainly prolonged catheterization), 4 diagnostic and therapeutic transcutaneous wirsungographies. The authors also worked out recommendations for a choice of instruments for prolonged external transcutaneous drainage of pancreatic cysts and abscesses, cleansing of the cavity and its sclerosing, inoperative cystogastrostomy between a cyst and a stomach stent.

[Ultrasonic examination in the diagnosis of closed trauma to the kidney]. / Ul'trazvukovoe issledovanie v diagnostike zakrytoi travmy pochki.

Ultrasonic investigations (USI) were used in the diagnosis of closed renal injuries in 59 patients (51 males and 8 females) aged from 17 to 65 years. The lesion of the right kidney was diagnosed in 35 (59.3 per cent) patients, the left kidney was affected in 24 (40.7 per cent) of examinees. In 2 persons the injury of the kidney was combined with the lesion of the urinary bladder. According to USI results, the patients with suspected closed trauma were enrolled in 4 groups: persons with an intact renal parenchyma, fibrous capsula and pelvicaliceal renal system (the contusion of the kidney); persons with normal ultrasonic picture of the kidney and the presence of intermuscular hematoma; those with subcapsular hepatoma; and those with pararenal hematoma. USI technique turned to be high-informative in the diagnosis of the occult renal injuries and permitted evaluating the structure of the kidney, the character and degree of the lesion and following up the status of the compromised organ during the conservative treatment.

[Veins of the pancreas (in vivo angiographic study)]. / Veny podzheludochnoi zhelezy (prizhiznennoe angiograficheskoe issledovanie).

Vital roentgenocontrast investigation of the pancreatic veins has been performed in 125 selective phlebographies of the portal system performed by means of probing through the skin and hepatic catheterization, as well as by means of blood samples from the pancreatic veins. Standard points of the ostia position of the most constantly revealed veins are demonstrated. Accordance between the veins and the glandular parts they drain is described. This makes it possible to localize with certainty hormonally active neoplasms in the organ.

[Choice of method in percutaneous transhepatic portography]. / Vybor metodiki chreskozhnoi chrespechenochnoi portografii.

On the basis of the experience with 54 transhepatic portographies and 120 super-selective catheterizations of the portal vein branches by various methods the authors give recommendations for choosing the optimum variant of the roentgenological examination of the portal system with individual features of the patients taken into account and with special reference to topographic points.