[Potential of tomographic methods of diagnosis and three-dimensional analysis of abdominal aortic aneurysm images]. / Vozmozhnosti tomograficheskikh metodov diagnostiki i trekhmernogo analiza izobrazhenii anevrizm briushnoi aorty.

Between 1998 and 2002, 256 tomographic investigations of the abdominal aorta were performed. Aortic aneurysms were identified in 29 (11.3%) patients. Computed tomographic angiography (CTA) was provided to 16 patients 4 patients were examined by an electron-radiation tomograph, 6 by a spiral tomograph, 6 by a multispiral tomograph, and 13 patients underwent magnetic resonance angiography (MRA), with contrast enforcement. Two- and three-dimensional reconstructions of CT- and MR-angiograms were accomplished using special computerized working stations. Good quality MR- or CT- angiograms were obtained in all the patients examined. Interpretation of the angiograms did not cause noticeable difficulties. None of the patients required conventional contrast angiography. The investigations have demonstrated the benefits of multispiral CTA recognized as the method of choice for the diagnosis of aortic aneurysms. Of the 29 patients with the verified diagnosis of aneurysm of the abdominal aorta, aneurysms in 26 subjects were located in the infrarenal aorta. Of these, 5 patients were identified to have an aneurysm extending to the iliac arteries. In two patients, aneurysms extended to the renal arteries or to the suprarenal segment. A thoracoabdominal aneurysm (type III) was revealed in one patient. Associated aneurysm and occlusive lesions of lower extremity arteries (iliac, femoral) were present in 15 (51.7%) cases. In the majority of cases (89.7%), aneurysms ran an uncomplicated course. The complications encountered by us consisted in incomplete (intramural) rupture (2 patients) and dissection (one patient). 22 patients were operated on. Comparison of the intraoperative revision data with the results of preoperative CT and MR angiography has established that the sensitivity of the tomographic methods for the diagnosis of aneurysms was 95.7% and specificity 99%. With an accuracy of up to 2-3 mm there were determined the size of aneurysms, the distance to the renal arteries, the diameter of the proximal and distal "neck", the extension of aneurysms to the iliac arteries, the presence of occlusive lesions of lower extremity arteries. CT and MR angiography with bolus contrast enforcement are safe and noninvasive methods for the diagnosis of aortic aneurysms. They have the high information content and thus allow to plan surgical (and possibly endovascular) interventions without the use of conventional contrast angiography.

[Diagnostic approach in mechanical jaundice, complicated by purulent cholangitis]. / Diagnosticheskii podkhod pri mekhanicheskoi zheltukhe, oslozhnennoi gnoinym kholangitom.

Up-to-date high-informative non-invasive diagnostic methods were used in 54 patients with obstructive jaundice (OJ) complicated by purulent cholangitis (PC). Treatment-diagnostic algorithm can to improve results of diagnosis. This algorithm is the following: ultrasonic examination as a screening method; if a case of jaundice is unclear and obturation is prolonged magnetic-resonance tomography and magnetic-resonance cholangiopancreaticography are carried out; in block of a distal part of the common bile duct--spiral computed tomography with bolus amplification and duodenoscopy. Invasive diagnostic methods--endoscopic retrograde cholangiopancreatography, percutaneous transhepatic cholangiography (PTCG) are performed in buit indications in possibility to perform lithextraction and effective endoscopic decompression or in the tumor of Vater's papilla in case of low block. PTCG is used in high block and finished by percutaneous transhepatic bile outflow. General diagnostic efficacy of the complex in OJ was 97.8%. Diagnostic algorithm permitted us to make diagnosis and to start treatment in 85% during 1-2 days after hospitalization. Bile ducts decompression as a main stage of PC treatment was performed in the first 2 days after hospitalization. Diagnostic quest was performed at the same time with therapy after detoxication and correction of hemostasis disturbances.

[Dynamic magnetic resonance prostatovesiculography in diagnosing prostatic cancer]. / Dinamicheskaia magnitno-rezonansnaia prostatovezikulografiia v diagnostike raka predstatel'noi zhelezy.

Dynamic MR prostatovesiculography (DMRP) is a new method of prostatic cancer diagnosis based on the ability of cancer tissue to accumulate contrast substance (omniscan) than benign tissue. Urologists from the I.M. Sechenov Moscow Medical Academy have examined 23 patients (5 patients with prostatic cancer and 18 suspects) who have undergone standard investigations (test for PSA, finger rectal examination, transrectal ultrasound investigation) and DMRP. DMRP detected prostatic areas suspected of malignancy. Taking biopsy from such areas verified diagnosis of prostatic cancer in 2 patients.

[Differential diagnosis of renal colic]. / Differentsial'naia diagnostika pochechnoi koliki.

Potential of modern examinations in differential diagnosis of renal colic and other emergency states is considered. Renal ultrasonography permits in the majority of cases to make diagnosis based on dilatation of caliceal-pelvic system, sometimes with detection of obstruction cause. It is necessary to differentiate parapelvical cysts from dilatation of caliceal-pelvic system, therefore pharmacultrasonic examination of the kidneys with lasix is recommended. Color dopplerography of the urinary bladder with detection of urine ejection from ureters ostia is analogue of conventional invasive diagnostic method--chromocystoscopy. Magnetic-resonance urography is updated non-invasive, non-contrast and non-radiation method of diagnosis of urinary tract dilatation.

[Late results of the treatment of patients with the extreme degree of alimentary-constitutional obesity by the method of formation of a small stomach]. / Otdalennye rezul'taty lecheniia bol'nykh s krainymi stepeniami alimentarno-konstitutsional'nogo ozhireniia metodom formirovaniia malogo zheludka.

The work analyses the results of treatment of 311 patients with extreme degrees of alimentary-constitutional obesity by formation of a small stomach. Fatal outcomes (1.9%) were encountered in the period of operative technique mastering. The late-term results were studied in 167 patients in follow-up periods of up to 3 years. The patients' average body weight was 149.4 kg, average height 166.2 cm, average body weight excess as compared to the ideal weight was 125.6%. Study of the late-term results of the operation showed that the postoperative weight loss depends on the initial weight excess and the diameter of the anastomosis formed between the proximal and distal parts of the stomach. The more the initial excess of weight as compared to the ideal value, the more the loss of body weight is. The diameter of the formed anastomosis should be no larger than 15 mm. Besides loss of weight, the activity of vital organs and systems is normalized after the operation, and arterial hypertension, diabetes mellitus, the Pickwickian syndrome, and metabolic polyarthritis take a milder course. The operation for formation of a small stomach made it possible for the patients to resume their customary occupation, freed them of the threat of invalidation, and reduced the duration of the disability period by 4.3 times. After surgical treatment the nature of the patients' life significantly improved; 95.8% of patients appraised the effect of the treatment as excellent and good.