[Surgical treatment of neuromuscular diseases of the esophagus].

Surgical treatment of patients with neuromuscular diseases of the esophagus is a separate issue, and the approach to antireflux surgery they differ from fundoplication for gastroesophageal reflux disease. At the Central Research Institute of Gastroenterology in 2010 yr were 17 patients with neuromuscular diseases of the esophagus laparoscopic fundoplication. Analysis of results showed the effectiveness of laparoscopic fundoplication in patients with severe esophageal motility.

[Primary prevention of reflux esophagitis in achalasia of cardia].

Aim of the study was to compare the incidence of reflux esophagitis in patients with achalasia cardia after successful surgical treatment with balloon dilatation and ezofago-cardio-seromyotomy followed by fundoplication according toToupet type. The study included only those patients with eliminated symptoms of dysphagia. All patients were divided into two groups depending on the method of treatment. In the first group (20 patients) performed balloon dilatation, second group (20 patients)--laparoscopic ezofagocardioseromiotomiya followed by fundoplication according type Toupet. Results evaluated one year after the intervention. Revealed that the incidence of reflux esophagitis were significantly higher in group of patients after balloon dilatation, than in the group of operated patients--40 and 15% respectively (p < 0,05). Received results allow to reconsider approaches to the selection of treatment method of achalasia cardia in favor of laparoscopic ezofagocardioseromitomii with the formation of posterior cuff-type Toupet.

[The diagnostic significance of ultrasound elastometry in evaluation of fibrosis in chronic diffuse liver diseases].

THE PURPOSE OF THE STUDY: Determination of the diagnostic value of ultrasound elastometry of liver (UEL) in the assessment of liver fibrosis in patients with chronic diffuse liver diseases (CDLD). MATERIAL AND METHODS: The study involved 316 patients with various etiologies of the CDLD, with the underwent both liver biopsy, the UEL, and evaluation of fibrosis (F) according to the Metavir classification. RESULTS: The maximum diagnostic accuracy of the UEL was obtained in determining of the 4-th stage of fibrosis according to the Metavir. The accuracy of the method was 91% with a sensitivity of 100%. The lowest sensitivity of the UEL determined in patients with nonalcoholic fatty liver disease (NAFLD): F1 - 25%, F2 - 33%, F3 and F4 - 50%. The High body mass index (BMI = 30,1 +/- 3,8 kg/m2) is a factor which is limiting the use of elastometry for patients NAFLD. The low sensitivity for F1 and F2 - 14,3% and 10%, respectively, 100% for F4, with a BMI = 24,4 +/- 5,1 kg/m2 was obtained in primary biliary cirrhosis (PBC). In the alcoholic liver disease (ALD) obtained high sensitivity (100%) for F2 and F4. In the CDLD of viral etiology the sensitivity of UEL was 33-71,4% in the early stages of fibrosis (F1 and F2) with high specificity - 100% and 93.5% respectively. CONCLUSION: The use of the UEL allows the diagnosis of fibrosis in chronic liver diseases of different etiologies as an alternative to needle biopsy of the liver.

[Characteristics of the fundoplication in patients with shortened esophagus].

Antireflux surgery in recent years become a standard treatment for complicated forms of gastroesophageal reflux disease (GERD). Complicated forms of GERD are usually the result of the availability of hiatal hernia (HH). Acquired shortening of the esophagus is a natural complication of severe reflux esophagitis developing on a background of sliding HH. Among surgeons disagree about the appropriateness of the laparoscopic antireflux interventions for patients with a shortening of the esophagus. On the basis of the Central Research Institute of Gastroenterology 35 patients were performed to laparoscopic surgery by truncation of the esophagus. Analysis of results showed the efficacy and safety of laparoscopic access for treatment of reflux esophagitis in patients with the esophagus truncation.

[Diagnosis of peritoneal adhesions of abdominal cavity organs]. / Diagnostika spaechnoi bolezni organov briushnoi polosti.

The best results produced by objective methods in cases of scheduled examinations of patients with peritoneal commissures of the abdominal cavity organs are observed in a complex study being a combination of X-ray and radionuclide methods of study, ultrasonic method, MRI and laparoscopy.

[Prospects for ultrasonic diagnosis in peritoneal commissures of the abdominal organs]. / Vozmozhnosti ul'trazvukovoi diagnostiki pri spaechnoi bolezni briushnoi polosti.

In the nearest future the ultrasonic method of study will enable clinicians to diagnose quicker and more directly patients with peritoneal commissures of the abdominal cavity and will help to localize more directly the places of the greatest accumulation of commissures, confirm or discover various complications of peritoneal commissures. It will be especially important for the patients who have contraindications to X-ray examinations. It is certain that clinicians should be attracted by the precision of the ultrasonic method and by its non-traumatic nature and safety for a patient.

[Diagnosis of adhesions in abdominal cavity organs]. / Diagnostika spaechnoi bolezni organov briushnoi polosti.

The best results produced by objective methods in cases of scheduled examinations of patients with peritoneal commissures of the abdominal cavity organs are observed in a complex study being a combination of X-ray and radionuclide methods of study, ultrasonic method, MRI and laparoscopy.

[Ultrasound findings in the zone of cholecystectomy and their role in prognosis of paralytic ileus development]. / Rezultaty ultrazvukovogo issledovaniia zony kholetsistéktomii i ikh rol v prognozirovanii razvitiia dinamicheskoi kishechnoi neprokhodimosti.

A comparative analysis of 112 patients' case histories with calculous cholecystitis has revealed that morphological alterations of the gallbladder wall and in the perevesicular area as well as the operative techniques are essential for the wound healing and ultrasound picture in cholecystectomy zone. Ultrasound investigation within postoperative 24 hours enables a significant prognosis of the onset of intestinal paresis, its severity and duration. This is important for conducting early prophylactic measures.