[Lesions of the biliary system in primary extrahepatic portal hypertension]. / Porazhenie zhelchevyvodiashchei sistemy pri pervichnoi vnepechenochnoi portal'noi gipertenzii.

The authors describe extensive strictures of the hepaticocholedochus, ranging from 2.5 cm in length to total involvement of the duct, in 15 patients with primary extrahepatic portal hypertension. In 7 patients they were combined with cystic dilatation of the intrahepatic bile ducts. All patients were under 40 year of age, the ages of 10 of them ranged for 18 to 30. There were 9 males. ++Non-operative treatment of the disturbed bile drainage proved ineffective: remittent jaundice was encountered in all cases. The most frequent complications were cholangitis (6 cases), biliary cirrhosis of the liver (3) and the formation of spontaneous biliary fistulas (2).

[Surgical tactics in the treatment of acute cholecystitis with lesions of the bile ducts]. / Taktika khirurgicheskogo lecheniia bol'nykh ostrym kholetsistitom, sochetaiushchimsia s porazheniem zhelchnykh protokov.

The authors analyse the results of treatment of 185 patients with acute cholecystitis coexisting with affection of the bile ducts. In view of the high risk of operative treatment, endoscopic papillosphincterotomy was undertaken as the first stage in 83 patients and was completed by nasobiliary drainage in 46 of them, in still another 12 patients decompression was accomplished by means of laparoscopic cholecystostomy . Surgical intervention was carried out in the second stage after the patients recovered from a grave condition and obstructive jaundice and intoxication caused by purulent cholangitis were corrected. Another 90 patients underwent surgical operation without preliminary decompression in a postponed order (67 patients) and for emergency and urgent indications (19 patients) in vital conditions due to peritoneal phenomena. The changes in the bile ducts were corrected in them in the second stage, which reduced the risk of the development of postoperative complications. The authors emphasize the importance of two-stage treatment in coexistence of lesions and of a differential approach to the treatment of this contingent of patients according to the character and severity of the inflammatory process and the severity of the patients' condition.

[Cholelithiasis in patients with primary extrahepatic portal hypertension]. / Zhelchnokamennaia bolezn' u bol'nykh s pervichnoi vnepechenochnoi portal'noi gipertenziei.

The results of treatment of 17 patients who had primary extrahepatic portal hypertension in combination with cholelithiasis are analysed. Of them 13, were operated on. In presence of the extended strictures of the bile ducts, the performance of hepaticojejunostomy is mandatory. In dominating involvement of the extrahepatic bile ducts, the endoscopic papillotomy as a definitive intervention is expedient. In asymptomatic course of cholelithiasis, the operation is not expedient.

[Endoscopic placement of a jejunal tube and a method of conducting enteral feeding with special mixtures]. / Endoskopicheskaia ustanovka eiunal'nogo zonda i metodika provedeniia énteral'nogo pitaniia spetsial'nymi smesiami.

The endoscopic placement of a nasoenteral probe for jejunal nutrition can be brought about by four main technical modes: conducting the probe through the biopsy canal of the endoscope, placement along the string, parallel introduction with the endoscope and combination of the above methods. An emulsion product containing 1 kkal/ml, macro-, microelements, vitamins was used for the enteral nutrition. Three main methods of enteral probe nutrition were used depending on specificity of the main disease, character of functional disorders of the intestine and the presence of inflammation in digestive organs.

Two rare cases of endoscopic extraction of foreign bodies from the stomach and duodenum.

This is the report of two cases of successful endoscopic foreign body extraction from the gastrointestinal tract. The first case describes the extraction of 18 objects from the stomach and duodenum of an insane patient done 6 months ago. The second case presents a patient with a prior bile duct operation in whom a transpapillary drain had been left behind 8 years ago. The authors suggest a number of recommendations concerning easier and safer technique of endoscopy. Roentgeno-endoscopic diagnostic localization of foreign bodies and choice of active or temporizing tactics is given special attention. Detailed description of foreign body extraction and further treatment of patients is given. In conclusion the authors suggest that endoscopy should be more often used after operations to reveal and remove possible iatrogenic foreign bodies from the gastrointestinal tract.