[Ultrasonic diagnosis of diseases of the gallbladder and bile ducts]. / Ul'trazvukovaia diagnostika zabolevanii zhelchnogo puzyria i zhelchevyvodiashchikh protokov.

The paper is concerned with analysis of the potentialities of ultrasound introscopy in the diagnosis of various diseases of the gall bladder and biliferous ducts in 174 patients aged 19 to 76. The accuracy of the detection of calcium containing concrements of the gall bladder was 98.8%, that of choledocholithiasis--75%, noncalculous cholecystitis--88.4%, choledochodilatation--71.4%. In the absence of pathological changes in the gall bladder and biliferous ducts the reliability of echography was 27.7 and 93.1%, respectively. Causes of diagnostic errors in ultrasound tomography of the biliary system were discussed, methods of their prevention were proposed. A diagnostic algorithm of the sequence of use of ultrasound introscopy and other diagnostic methods to be employed in clinical practice was devised.

[Ultrasound diagnosis of gallbladder and bile duct diseases]. / Ultrazvukovaia diagnostika zabolevanii zhelchnogo puzyria i zhelchevyvodiashchikh protokov.

The paper is concerned with analysis of the potentialities of ultrasound introscopy in the diagnosis of various diseases of the gall bladder and biliferous ducts in 174 patients aged 19 to 76. The accuracy of the detection of calcium containing concrements of the gall bladder was 98.8%, that of choledocholithiasis--75%, noncalculous cholecystitis--88.4%, choledochodilatation--71.4%. In the absence of pathological changes in the gall bladder and biliferous ducts the reliability of echography was 27.7 and 93.1%, respectively. Causes of diagnostic errors in ultrasound tomography of the biliary system were discussed, methods of their prevention were proposed. A diagnostic algorithm of the sequence of use of ultrasound introscopy and other diagnostic methods to be employed in clinical practice was devised.

[Ultrasound diagnosis of bile ducts after cholecystectomy]. / Ul'trazvukovoe issledovanie zhelchevyvodiashchikh protokov posle kholetsistéktomii.

The paper is concerned with the results of multiprojectional ultrasound investigation of the biliferous system in 68 patients at varying time after cholecystectomy. In most cases (77.9%) signs of dilated biliary ducts were undetectable. Dilatation of the hepaticodoch was most frequently determined by choledolithiasis, stricture or stenosing papillitis, rarely--by pancreatic head cancer. Investigation of the biliary ducts in patients after cholecystectomy should be started with ultrasound tomography; endoscopic retrograde cholangiopancreatography or iv cholangiography and dynamic cholescintigraphy were indicated after the detection of the signs of dilated ducts (the anteroposterior diameter of the common hepatic duct was over 6 mm).

[Ultrasonography of the bile ducts after cholecystectomy]. / Ultrazvukovoe issledovanie zhelchevyvodiashchikh protokov posle kholetsistéktomii.

The paper is concerned with the results of multiprojectional ultrasound investigation of the biliferous system in 68 patients at varying time after cholecystectomy. In most cases (77.9%) signs of dilated biliary ducts were undetectable. Dilatation of the hepaticodoch was most frequently determined by choledolithiasis, stricture or stenosing papillitis, rarely--by pancreatic head cancer. Investigation of the biliary ducts in patients after cholecystectomy should be started with ultrasound tomography; endoscopic retrograde cholangiopancreatography or i.v. cholangiography and dynamic cholescintigraphy were indicated after the detection of the signs of dilated ducts (the anteroposterior diameter of the common hepatic duct was over 6 mm).

[Differential ultrasonic diagnosis of jaundice]. / Ul'trazvukovaia differentsial'naia diagnostika zheltukh.

Multiprojection ultrasound investigation was performed in 87 patients with jaundice. Echography was shown to be an effective method of differential diagnosis of parenchymatous and obstructive jaundice. The accuracy of ultrasound introscopy in the detection of parenchymatous jaundice was 84.3%, that in the detection of mechanical jaundice was 100% (the general accuracy being 85.7%). The authors proposed an algorithm for the use of ultrasound tomography, x-ray and clinico-instrumental methods in differential diagnosis of jaundice of different etiology.

Intra-arterial chemotherapy for advanced bladder cancer.

The results of prolonged intra-arterial chemotherapy in 61 patients with locally advanced bladder cancer (T3-T4) are discussed. Regional internal iliac artery infusion of chemotherapeutic agents was done daily for 5 or 7 days at a rate of 1 to 3 ml/h over an 18-20-h period. The total dosages of each course were 60-120 mg/m2 adriamycin, 2.5-3.5 g/m2 5-fluorouracil (5-FU), 20-40 mg/m2 methotrexate or 30-50 mg/m2 cisplatin. At 3 to 4 weeks after the completion of infusional chemotherapy the results were evaluated, based on data from control cystoscopy and sonography. One patient (1.6%) was free of tumor; an objective response of greater than 50% reduction in tumor size occurred in 26 (42.7%) patients; 34 (55.7%) demonstrated objective responses of less than 50%. No further increase in tumor size during the management was detected. Hematuria, dysuria and urine infection were controlled and pain was relieved. The use of cytostatics and prolonged iliac artery catheterization did not incur any serious complications.

[Multicollector lymphography and phlebography in lower limb edema following radiation and combination therapy]. / Mnogokollektornaia limfografiia i flebografiia pri otekakh nizhnikh konechnostei posle luchevogo i kombinirovannogo lecheniia.

A multimodality x-ray study of the lymphatic and venous vessels was performed in 50 patients with secondary edema of the lower limbs. A complete block of the limb superficial lymphatic collectors was observed in 44% of the patients, a partial block in 26%. In 80% of the cases the level of partial or complete occlusion of the lymphatic vessels was noted in the ilioinguinal region and in 20% on the femur and leg. Distrubed permeability of the deep vessels of the femur and ilioinguinal region in the form of a complete or partial block was noted in 46% of the cases. In disturbed peripheral lymphodynamics different compensatory adaptation mechanisms like the functioning of the collateral tracts, lymphovenous anastomoses, the overflow of a radiographic contrast agent from the superficial vessels into the deep ones were observed in 60% of the patients. Indications for multicollector lymphography were defined. In secondary edema of the lower limbs, combined injuries of the lymphatic and venous systems were marked in 62%, an isolated disorder of the outflow of the peripheral lymph through the collector vessels was marked in 38%.

[Lymphophlebographic studies in arm edema]. / Limfo-flebograficheskie issledovaniia pri oteke verkhnei konechnosti.

Using the results of single and bicollector lymphography noticeable pathological vascular changes of the posterolateral and anteromedial collectors with the prevalence of a complete blocks of the lymph flow were found in 64 patients with the postmastectomy syndrome. The vessels were blocked on the shoulder level in 65%, in the irradiation zone in 22% and on the forearm in 13% of cases. The lymph outflow in secondary edema of the upper limb was compensated for at the expense of the 2nd order vessels (45%), collateral detours (18.4%), junctions between the superficial collectors (30.6%), between the superficial and deep vessels (12.2%) as well as lymphovenous anastomoses (6.1%). In 55% of the patients with the postmastectomy syndrome, edema of the upper limb is caused by combined injuries of the lymphatic and venous outflow, and in 45% by disturbed permeability of the lymphatic collectors only.