[Complex use of ultrasound in the diagnosis and treatment of surgical diseases of the lung and pleura]. / Kompleksnoe primenenie ul'trazvuka dlia diagnostiki i lecheniia khirurgicheskikh zabolevanii legkikh i plevry.

Since 1980 the N.N. Burdenko Faculty Surgical clinic, I.M. Sechenov Moscow Medical Academy, has been using a combination of high- and low-frequency ultrasounds for the diagnosis and treatment of surgical diseases of lung and pleura in 156 patients for the diagnosis of pleuritis of various genesis, in 40 patients for transthoracic aspiration biopsy of lung tumors in the preoperative period, in 156 patients for pleural puncture and drainage, in 40 patients for the intraoperative differential diagnosis of peripheral lung tumors and for the inspection of hematogenic and lymphogenic metastatic areas, in 100 patients for intraoperative prophylaxis, and in 20 patients for the treatment of acute postoperative pleural empyema. Ultrasound was demonstrated to be of high informative value in diagnosing different pleuritis. Transthoracic aspiration biopsy was shown to have some advantages over standard methods: use of needle catheters for pleural puncture permits one to avoid serious complications (pneumothorax, bleeding, etc). Ultrasound was used in intraoperative diagnosis of peripheral lung tumors for the first time. The use of low-frequency ultrasound for the intraoperative prevention of acute postoperative pleural empyemas promotes reliable sanitation of the pleural cavity, as confirmed by bacteriologic control data. Timely rethoracotomies with low-frequency ultrasound treatment of the pleura promote more rapid inflammation elimination in the pleural cavity and prevents irreversible complications.

[Intraoperative ultrasonography in surgery on organs of abdominal cavity and retroperitoneal space]. / Intraoperatsionnoe ul'trazvukovoe issledovanie organov briushnoi polosti i zabriushinnogo prostranstva.

Since 1984 to 1999 intraoperative US examination (IOUSE) was made in 863 patients. 236 of them had diseases of the liver, 137 diseases of the gall bladder and biliary tract, 158 pancreatic disorders, 151 diseases of gastro-intestinal tract, 72 diseases of the adrenal glands, 101 constitutional obesity, 3 splenic disorders and 5 gunshot wounds of the organs of the abdominal cavity and the retroperitoneal soft tissues. In masses of the liver IOUSE showed limits for resection of the liver, location of the diseased area with the vessels and biliary ducts, unpalpablefoci. OUSE allowed to perform US-guided puncture and sclerosizing small metastatic nodes as well as a puncture and antiparasitic treatment of inaccessible echinococcal cysts. In cholelithiasis IOUSE allows to reveal or to rule out the presence of the concrements in bile ducts. In cases of diseases of the pancreas IOUSE helps to localize pathologic area, defines its interrelations with adjacent major vessels and ducts, reveals unpalpable masses and enables US-guided puncture of the major pancreatic duct followed by its further opening. In gastric tumors it is possible under US control to determine precisely the limits of the infiltration of gastric wall which defines the volume for resection. In operation on the adrenals from thoracophrenolumbar approach IOUSE through the diaphragmatic cupula determines the place and the length of phrenotomy and elucidates interrelations of the tumor with adjacent organs. Sensibility of IOUSE made up from 87 to 100%, and specificity--92-100% depending on the disease.

[Adrenal tumors found by chance. Surgical treatment or follow-up?]. / Sluchaino vyiavlennye opukholi nadpochechnikov. Khirurgicheskoe lechenie ili dinamicheskoe nabliudenie?.

206 case records of the patients treated from 1985 to 1998 for various diseases of the adrenal glands were analyzed. In 39 (18.9%) patients tumors were chance finding at ultrasound examination or computer tomography of the abdominal cavity and retroabdominal space. 25 patients from this group were operated on, 14 patients were not operated and were followed up from 1 month to 7 years. All the patients underwent complex examination including analysis of the complaints, anamnesis and physical examination data, hormonal status examination (ACTH, hydrocortisone, 11-oxycorticosteroids, 17-ketosteroids, aldosterone, renin, adrenalin, noradrenalin, vanillyl-mandelic acid), device methods of examination USE, CT, MRT, superselective phlebography with separate catheterization of adrenal veins and blood intake per floor, fine needle aspiration biopsy under ultrasound control. Comparison of the results of complex clinical examination with morphological data of removed adrenal glands was carried out retrospectively. Arteriography and superselective phlebography with separate catheterization of adrenal veins and per floor taking of blood samples, performed in 36 patients, enabled not only to supplement and define more exactly the other methods of topical diagnosis, but also to asses objectively functional actively of the affected and contralateral adrenal. Despite the fact that during the study of hormonal level in peripheral blood of patients it was normal analysis of the data obtained by superselective phlebography of adrenal veins and per floor taking of blood samples showed significant increase in hormones level in blood of all operated patients. Comparison of the data of superselective phlebography with separate catheterization of adrenal veins and per floor taking of blood samples and clinical picture of the disease made it possible to suggest the presence of preclinical (subclinical) Cushing or Conn syndrome. Operative treatment was not indicated in the absence of hormonal activity of the tumor (i.e. preclinical syndromes by Icenko-Cushing, Conn, pheochromocytoma, the virilizing and feminizing tumors), tumors of small size (less than 3 cm), in absence of malignant growth features confirmed by complex instrumental examination (USE, CT, MRT, fine-needle aspiration biopsy under US control, superselective phlebography with per floor taking of blood samples). Such patients were reexamined in 6 months. During the follow up period no changes of tumor size, homogeneity, hormonal status were revealed.

[Thin-needle aspiration biopsy of solitary formations of the thyroid gland]. / Tonkoigol'naia aspiratsionnaia biopsiia solitarnykh obrazovanii shchitovidnoi zhelezy.

The paper analyzes the use of thin-needle aspiration biopsy in 372 patients with thyroid solitary formations. By the results of clinical and instrumental studies and cytological examination of thyroid puncture specimens groups of patients with individual clinical and morphological types of the disease were identified. Differential surgical policy in each group of patients was shown on the basis of the finding. It is concluded that thin-needle aspiration biopsy should be integrated into the compulsory programme of comprehensive examination of patients with thyroid solitary formations. Having a high efficiency, the above method helps in most cases to make an accurate clinical and morphological diagnosis and to choose the optimal treatment policy for each specific patient admitted to a surgical hospital for an aggregate diagnosis of nodal euthyroid goiter. Some patients may avoid unjustifiable surgical intervention and be on conservative therapy under follow-up.

[Informative value of various diagnostic methods in Itsenko-Cushing syndrome]. / Informativnost razlichnykh diagnosticheskikh metodov pri sindrome Itsenko-Kushinga.

The authors discuss the comparative evaluation of different methods of examination applied in 36 patients with the Icenko-Cushing syndrome. The results of the investigation are compared with the intraoperative findings and the data of morphological studies. MR-topography proved to be mist informative. Ultrasonic examination was highly effective in tumors measuring up to 1 cm in diameter. The use of USE during the operation hor locatind the tumor and determining its connection with the surrounding organs allows the operation to be performed in a shorter time and its traumatic character.

[Ultrasound diagnosis of breast nodules]. / Ultrazvukovaia diagnostika uzlovykh obrazovanii molochnoi zhelezy.

The authors show the comparative data on ultrasonic examination and mammography in 204 patients with nodular new growths in the breast: 66 had breast carcinoma and 138 had benign diseases. They suggest 6 ultrasonic criteria characteristic of breast carcinoma and describe the ultrasonic picture of the most commonly encountered benign breast tumors: fibroadenoma, nodular mastopathy, cysts. USE sensitivity was 68.8 +/- 7% in breast carcinoma, 82.6 +/- 8.1% in fibroadenoma, 72.8 +/- 7.2% in nodular mastopathy, and 100% in cysts (the respective values in mammography were 76.7 +/- 6.4%, 69.6 +/- 9.8%, 74.4 +/- 7%, and 60 +/- 11.2%). USE sensitivity and sensitivity of mammography were found to differ for different age categories in early forms of breast carcinoma. It is shown that the histological structure of a malignant tumor may be assumed from the ultrasonic criteria. The authors conclude that USE has a high diagnostic value in nodular new growths of the breast and that differential diagnosis of malignant and benign lesions is possible.

[Comprehensive ultrasound study in surgical diseases of the adrenals]. / Kompleksnoe ul'trazvukovoe issledovanie pri khirurgicheskikh zabolevaniiakh nadpochechnikov.

Combined staged ultrasonic examination of 53 patients with surgical diseases of the adrenals (Icenko--Cushing's disease and hormonally active tumors) included preoperative transcutaneous ultrasonic examination, ultrasound-monitored spot fine needle aspiration biopsy, intraoperative and postoperative ultrasonic examinations. Transcutaneous ultrasonic examination was found to be little informative in Icenko--Cushing's disease, whereas in adrenal tumors it was virtually as sensitive as computer-aided tomography. Ultrasound-monitored spot fine needle aspiration biopsy proved to be a highly informative safe method, which helps morphologically diagnose the disease before surgery. Intraoperative ultrasonic examination helped reduce the surgical trauma in all the cases, and in patients with Icenko--Cushing's disease it gave an idea of the type of morphologic changes in the removed adrenal. Ultrasonic monitoring of tissue status at the site of intervention helped timely detect the postoperative complications.

[Pre- and postoperative ultrasonic study in gunshot wounds of parenchymal organs]. / Do- i posleoperatsionnoe ul'trazvukovoe issledovanie pri ognestrel'nykh raneniiakh parenkhimatoznykh organov.

Timely discovery of the bullet or its fragments in the human body and determination of the character and size of the damage inflicted to the internal organs guarantee adequate treatment of the injured. USE makes it possible to exclude or recognize injury to the parenchymal organs (subscapular and intra-tissue hematomas, complete crushing of the organ), and to reveal free or bounded fluid in the abdominal and pleural cavities and in the retroperitoneal space. Moreover, USE may be applied for identifying the location of the bullet or fragment in he parenchymal organ, the subcutaneous fat or the retroperitoneal fat. Intraoperative USE proves to be of great aid in many cases because it allows complete examination of the structure of the internal organs and the abdominal spaces in all planes and the condition of the retroperitoneal fat. The article describes cases in which USE helped in precise localization of the bullet and in revealing the character of the damage, as the result of which an optimal plan of surgical intervention was chosen.

[The informative value of various diagnostic methods in Itsenko-Cushing's disease]. / Informativnost razlichnykh diagnosticheskikh metodov pri bolezni Itsenko-Kushinga.

The authors studied the informative value of various diagnostic methods: ultrasonic examination (USE), computed tomography (CT), magneto-resonance tomography (MRT), phlebography with separate collection of blood from the inferior vena cava and its hormonal investigation in Itsenko-Cushing's disease (52 cases). All patient underwent operation, and because of this the changes detected in the adrenals by various diagnostic methods of examination were compared with the morphological findings. Three patients were subjected to bilateral adrenalectomy. Morphological study of the adrenals revealed diffuse hyperplasia of the cortex in 17 cases, macro- and microadenomas in hyperplasia of the adrenals in 23, and diffuse-nodular hyperplasia in 15 cases. In macroadenomatosis identification, the informative value of MRT was 77.8%, CT 66.6%, and USE 22.2%. MRT was most informative in detection of microedenomatosis and diffuse-nodular hyperplasia--82.3% of cases; the respective values for CT and USE were 71.4% and 56.5%. The quantitative parameters of the adrenal tissue were studied in MRT: relaxation time (T-2) and the value of relative signal intensity (E). The value of relative signal intensity was lower in micro-macroadenomatosis than in diffuse and diffuse-nodular hyperplasia. The use of the quantitative parameters (T-2 and E) increases the diagnostic possibilities of MRT and provides for a more authentic idea of the character of the pathological changes in the adrenal tissue. Precise verification of the pathological process in the adrenal cortex allows the optimal treatment to be chosen, adrenalectomy to be considered in time, and the side of the operation to be correctly determined.

[Transcutaneous drainage of pancreatic pseudocysts guided by ultrasound and computed tomography]. / Chreskozhnoe drenirovanie psevdokist podzheludochnoi zhelezy pod kontrolem UZI i rentgenotelevideniia.

The method of transcutaneous sanation of pancreatic pseudocysts under control of USE and CT has developed quite widely in the recent years and is applied in clinical practice. In the period from 1987 to May 1993 thirty-three patients underwent transcutaneous drainage (TD) of pancreatic cysts at the Burdenko Facultative Surgical Clinic, MMA; a total of 35 procedures were performed. In all cases TD was conducted under control of USE and roentgeno-television (RTV) by Seldinger's method or with various types of stylet catheters. The transperitoneal approach was preferable in cysts of the head, in cysts of the body of the gland hze transgastric approach was used under control of gastroscopy for later attempt to accomplish transcutaneous cystogastrostomy. Contrast examination of the cyst immediately after puncture revealed its connection with the pancreatic duct (PD). Fistulography was repeated every 5-7 days. In the absence of a cystopancreatic fistula the cyst was sclerosed with 96 degrees ethyl alcohol. Complications were encountered in 11% of cases and a recurrent cyst developed in one patient. The TD method under control of USE and RTV is effective in the treatment of pancreatic cysts attended by a low incidence of complications. A large size of the cyst, its infection or connection with the pancreatic duct are not contraindications for TD.

[Intraoperative ultrasonography in Itsenko-Cushing's disease and syndrome]. / Intraoperatsionnoe ultrazvukovoe issledovanie pri bolezni i sindrome Itsenko-Kushinga.

Ultrasonic study conducted during an operation is finding wider use lately. Surgery is the main method of treatment of most diseases of the adrenals, therefore problems of topical intraoperative diagnosis are very urgent. Twenty-three patients were operated on for Itsenko-Cushing's disease and syndrome and tumors of the retroperitoneal space at the Faculty Surgical Clinic of the Moscow Medical Academy within a period of 12 months. All patients were subjected to complex ultrasonic examination, including pre-intra- and postoperative study. Intraoperative ultrasonic study was conducted in two stages: stage 1--examination after thoracotomy through the diaphragm for choosing the optimal place and length of phrenotomy; stage 2--ultrasonic examination after phrenotomy to localize precisely the adrenal or tumor and reveal their connection with the adjacent organs and vascular structures. Complex ultrasonic examination has advantages over the other examination methods (computed tomography, angiography, scintigraphy) which allows it to come to the forefront in the diagnostic search for adrenal tumors. Intraoperative ultrasonic examination makes it possible for the surgeon to avoid wide phrenotomy and prolonged investigation, reduces the possibility of inflicting injury to the large vessels, which reduces the duration of the operation and anesthesia, and improves the course of the postoperative period.