[Evolution of diagnostic methods for cicatrical tracheal stenosis and tracheomalacia].

AIM: To analyze the role of ray functional computerized diagnostic technologies in assessment of the state of tracheal wall in cicatricial stenosis. MATERIAL AND METHODS: We examined 45 patients with cicatricial tracheal stenosis during August 2013 -- March 2015. Fibrobronchoscopy, multislice computerized tomography, magnetic resonance imaging and lungs function examination were performed. For the first time dynamic (functional) CT and MRI were included in research algorithm. These techniques have not been used for cicatricial stenosis and tracheomalacia in our country until this moment. Circular resection with anastomosis was made in 38 patients and stage reconstructions were preferred in 7 cases. Last ones had advanced tracheomalacia on the background of cicatrical stenosis that forced to abandon from tracheal resection. So time to treatment and incidence of complications and recurrences were reduced and the results were improved. CONCLUSION: Endoscopy remains the main method of diagnosis of tracheal stenosis despite its invasiveness. Data of cicatrical transformation of tracheal wall per se can be obtained non-invasively using dynamic CT and MRI. These techniques help to identify or exclude tracheomalacia. They potentially complement fibrobronchoscopy and may be preferable to assess perioperative intramural pathological changes of the trachea.

[Possibilities of computed tomography in the diagnosis of primary pulmonary vasculitis].

OBJECTIVE: To study the main computed tomography (CT) signs of primary pulmonary vasculitis at different stages of disease development. MATERIAL AND METHODS: Eighty-nine patients, including those with Wegener's granulomatosis (WG) (n = 60), Churg-Strauss syndrome (CSS) (n = 24), or microscopic polyangiitis (MPA) (n = 5), were examined. Vasculitis was diagnosed on the basis of comprehensive clinical, X-ray, and morphological examination. CT study was performed in 40 (85.1%) patients over time. Radiography encompassed chest X-ray and computed tomography. RESULTS: The CT signs of WG were as follows: parenchymal infiltrates in 41 (68.3%) patients, vast zones of ground glass and consolidation in 16 (21.6%), and bronchial wall thickening in 27 (46.7%). The infiltrates showed aseptic decay cavities in 26 (63.4%) cases. In CSS, the CT changes included ground glass symptom (100%), consolidation symptom (54.2%), bronchial wall thickening concurrent with bronchial dilatation (87.5%), and increased peripheral pulmonary vessel diameter (45.8%). CSS was typified by migratory infiltrates. The pulmonary manifestations of MPA were characterized by the regions of alveolar infiltration of varying intensity and extent. CONCLUSION: The use of CT in pulmonary vasculitis makes it possible to reliably detect and differentiate pathological changes in the lung, to estimate their extent and monitor the efficiency of treatment.

[Complex radiological diagnosis of pulmonary thromboembolism]. / Kompleksnaia luchevaia diagnostika tromboémbolii legochnoi arterii.

Three hundred and twelve patients (210 males and 102 females) aged 47 to 69 years who had suspected pulmonary thromboembolism (PTE) were examined. All the patients received hospital treatment in the clinics of I.M. Sechenov Moscow Medical Academy for different diseases, such as coronary heart disease, chronic venous insufficiency, hypertensive disease, and postoperative condition. PTE was ascertained in 209 patients. The examination used a "Hi Speed CT/i" spiral computer tomograph (General Electric) and an "Aquilion" computer tomograph (Toshiba), a "Millennium" gamma-chamber, and a "Sequoia" high-resolution ultrasound apparatus (Acuson). An algorithm of examination of patients with suspected PTE has been developed.

[Diagnosis and choice of surgery of non-parasitic cysts of the liver]. / Diagnostika i vybor metoda khirurgicheskogo lecheniia neparazitarnykh kist pecheni.

Results of treatment of 342 patients with non-parasitic cysts of the liver (NCL) were analyzed. Based on obtained data diagnostic algorithm was developed. Indications and contraindications for transcutaneous and laparoscopic methods in NCL are clarified and substantiated. Features of laparoscopic operations in different location of cysts are presented. In mini-invasive surgeries postoperative complications rate was minimum, there were no lethal outcomes. The authors believe that conventional surgeries in NCL should be performed in critical states only.

[Prospects of computer tomography in diagnosing adrenal tumors]. / Vozmozhnosit komp'iuternoi tomografii v diagnostiki novoobrazovanii nadpochechnikov.

Computed tomography (CT) is one of main topical methods of adrenal tumors diagnosis. Medical histories of 68 patients treated from 1995 to 2000 for various adrenal tumors were analyzed. CT was used in all the patients. These data were compared with results of morphological study. It is demonstrated that CT has high sensitivity in diagnosis of adrenal tumors (96.55% cases). It permits to predict the type of tumor with high probability. The degree of tumor size mistake made at CT was estimated. Mean coefficients to assess true sizes of tumors before surgery were calculated. This is important for choice of treatment policy in hormonal-unactive adrenal tumors.

[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.

[Use of regulated silicone bandage in horizontal gastroplasty in patients with morbid obesity]. / Ispol'zovanie reguliruemogo silikonovogo bandazha pri gorizontal'noi gastroplastike u bol'nykh morbidnym ozhireniem.

From 1984 in N.N. Burdenko Surgical clinic of I.M. Sechenov MMA more than 500 horizontal gastroplasties (HGP) were performed for the treatment of patients with extreme degree of alimentary-constitutional obesity. In 1996 for the first time in our country HGP was performed, including laparoscopic method, with use of regulated silicon bandage "Lap-Band" (LB) made by "Bioenterics", USA. Laparoscopic HGP was performed in 29 patients (7 males, 22 females), aged from 23 to 60 years, mean age was 34.2 +/- 10 years. Minimal body weight was 85 kg, maximal--180 kg, mean--131 +/- 27.2 kg. Mean body mass index was 47 +/- 9.9 kg/m2. Open operations were performed in 14 cases, laparoscopic operations--in 15 cases. 11 laparoscopies were performed in initial stages in very stout patients and in the absence of laparoscopic equipment. In 3 cases the conversion from laparoscopic to open operation was necessary: in 1st case because of hemorrhage from lesser omentum's vessels, when hemostasis cannot be performed by laparoscopy; in 2nd case as a result of bronchospasm associated with tense pneumoperitoneum in the patient with bronchial asthma; in 3rd case because of significant enlargement and rigidity of liver left lobe, which didn't permit to create the space for manipulations in cardial portion of the stomach. The mean bed day turnover after traditional HGP with LB and after laparoscopic HGP was 12.2 and 5.4 respectively. Intraoperative complication was observed in one case--hemorrhage from lesser omentum's vessels. One complication was observed in immediate postoperative period, on the 6th day after traditional HGP: the eventration as a result of hard diarrhea due to antibacterial treatment was diagnosed. One more complication was observed in a year after traditional HGP: small stomach evacuatory function disorders as a result of its significant dilatation. These disorders occurred because of gastric mucosa inflammatory edema, decrease of anastomosis diameter and frequent vomiting due to aspirin taking. In this case the repeated operation--bandage's reposition was performed. There were no other complications. The rate of repeated operations was 4% which agrees with literature data.

[Application of ultrasound in differential diagnosis of pleurisy]. / Ul'trazvukovoe issledovanie v differentsial'noi diagnostike plevritov.

According to literature data, pleural exudate is diagnosed approximately in 10% of pulmological patients. The importance of differential diagnosis of pleuriesy is expained by variability of the diseases accompanied by pleural exudate. 146 patients with various diseases accompanied by pleural exudate were examined: 39 from them had pleural empyema, 53--diffuse pleurisy, 42--incapsulated pleurisy, and 12--tumors of the pleura. All the patients underwent ultrasound examination (USE) of the chest together with a routine roentgenography, as well as computed tomography. USE was performed on the. Toshiba and Hitachi egurpment, which work in real time regime with sectorial sensing element (3.5-5.0 mHz). The obtained data show, that USE is most effective diagnostic tool in incapsulated and diffuse liquor accumulations in pleural cavity. In 6 patients the diagnosis of pleuritis was possible only at USE of the pleural cavity. Evaluation of the structure of the liquor and detection of tumor conglomerates on parietal pleura have a substantial diagnostic value. It is noted that echotomographic picture might be insufficiently informative in some situations with a small length of the contact of the lesion with the thoracic wall (less than 3 cm) or thickness of pleural layers up to 4-5 mm, in the presence of artefacts due to pulmonary tissues and osteal structures of the thoracic wall (ribs, scapula, sternum).

[Computed tomography of the pleura]. / Komp'iuternaia tomografiia plevry.

The paper examines CT images of the pleura and interlobar culci in health and in disease. For this, 403 patients were examined (420 CT studies), of whom 218 had pleural lesion and 185 formed a control group. The complex of studies involved computed tomography (CT) as compared with conventional radiation studies. The CT symptomatology of free and sacculated exudates, empyemas of the pleura, pleural depositions and adhesions, tumor lesions of the pleura. Based on the findings, an original scheme of free and sacculated pleural exudates was offered in CT images. The findings have led the authors to the conclusion that computed tomography is a more sensitive method in the evaluation of the pleura than standard X-ray study.