[The diagnostics of the obstructive jaundice and possibilities to improve the efficacy of its miniinvasive treatment].

The study, which included data of 226 patients with the obstructive jaundice, proved, that the clinical presentation and laboratory tests have secondary role in diagnosing the level of the biliary block. Among diagnostic means of detecting the etiology of the obstruction were the ultrasound investigation (n=268); the magnetic resonance cholangiopanreatography (n=143); the multispiral computed tomograpth (n=119); the endoscopic retrograde cholangiopanreatography (n=187) and the transcutaneous transhepatic cholangiopanreatography (n=69). Flaws and pros of all the methods were thoroughly analyzed. The endoscopic (n=172) and transcutaneous transhepatic cholangiostomy (n=87) were used for biliary decompression. The comparative analysis of both diagnostic and treatment means allowed the creation of 3-stage algorithm. The efficacy of the last for patients with the obstructive jaundice was 96%.

[The role of radiological methods in complex diagnostics of pancreonecrosis].

The results of treatment of 77 patients with necrotic forms of acute pancreatitis are critically revised. The diagnostic algorithm of pancreonecrosis, consisting of ultrasound, computed scanning, magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography proved to be useful and effective. The Balthazar computed tomography severity index allows to prognose the course of the disease more accurately.

[Diagnostic algorithm in severe acute pancreatitis].

Efficacy of diagnostic algorithm in 164 patients with severe acute pancreatitis based on complex results of ultrasonic examination, esophagogastroduodenoscopy, computed tomography, magnetic resonance pancreatocholangiography and retrograde pancreatocholangiography is analyzed. The results show that this algorithm is highly effective and provides optimal treatment policy, better treatment results and lower lethality in severe acute pancreatitis. Balthazar's score system with calculation of CTSI index in combination with Ranson and Apache II scales raise accuracy of the disease prognosis.

[Surgical tactics in benign nodal lesions of the thyroid]. / Khirurgicheskaia taktika pri dobrokachestvennykh uzlovykh obrazovaniiakh shchitovidnoi zhelezy.

Results of surgical treatment of 2307 patients with different forms of thyroid nodal diseases over 11 years (1989-2000) were analyzed. It is necessary to perform organ-saving operations to reduce postoperative complications rate and save hormone-producing function of the thyroid gland: after thyroid resection the rate of postoperative hypothyrosis was 7.9%, after hemithyreoidectomy and subtotal resection--92.4%. Recurrence was revealed in 10.7% cases in 3.7 years, on the average, that testifies to radical surgery. Resection with removal of node in limits of intact tissue was performed according to the results of morphologic examination of both node and surrounding thyroid tissue: discirculation with fibrosis were seen in 69.7%, dystrophic processes with secondary thyroiditis--in 24.3% cases. Etiology and morphology of the node are the main factors of pathogenesis of recurrence. Organ-saving operations and consideration of endocrinological aspects permitted to cure radically 89.3% patients.

[Early diagnosis and differentiated treatment of thyroid cancer]. / Ranniaia diagnostika i differentsirovannoe lechenie raka shchitovidnoi zhelezy.

Cancer of the thyroid gland is an entity characterised by progressive rise of morbidity. The study is based on the results of surgical treatment of 237 patients with various forms of thyroid cancer for the period of 11 years from 1987 to 1998. Absolute majority of malignant thyroid tumors are differentiated (94%). The study of morphological peculiarities of the tumors has shown the prevalence of an incapsulated type of cancer (84%). Such features of "biological aggression" as growth through the capsule of cancer node, vascular invasion, multicentricity and other high increase probability of regional metastasizing even in the initial forms of cancer and could be considered as a prognostic factor. Long-term result (5-year survival--98.9%, 10-year--96.8%), evidence for feasibility of organ-saving operations in differentiated cancer of the thyroid--e.g. saving of its intact lobe.

[Clinical aspects and therapy of cholelithiasis in elderly patients]. / Klinika i lechenie zhelchnokamennoi bolezni u bolnykh pozhilogo i starcheskogo vozrasta.

The article analyses the results of surgical treatment of 110 patients aged over 70 with acute cholecystitis. All of them underwent cholecystectomy with intraoperative cholangiography: choledocholithiasis was found in 26.4% and stricture of the distal choledochus in 10.0% of cases. Postoperative complications developed in 19% of patients, the mortality rate was 5.45%. Simultaneously, 72 elderly and old-aged patients were operated on for chronic calculous cholecystitis after thorough examination and preoperative management. Postoperative complications occurred in 13.9% of cases, none of the patients died. The authors conclude that in adequate preoperative management, careful choice of the method of anesthesia, and substantiated postoperative management, cholecystectomy is the operation of choice in acute calculous cholecystitis in patients over 70 years of age. Planned operations are very advisable in chronic calculous cholecystitis in patients of this age group for the prevention of severe complications, if adequate treatment of concomitant diseases is applied.