[Improvement of extracorporeal shockwave cholelithotripsy in the comprehensive treatment of cholelithiasis].

The method of shockwave distant lithotripsy (DL) has been used since 1985. However, many facets of this problem have not been solved yet, because large fragments of the stone remain after its destruction, and focused shock waves (FSW) damage the gallbladder (GB). The aim of this study was to determine possibilities of effective distant destruction of gall stones, to reveal negative consequences of the effects of FSW on the gallbladder (GB) and the surrounding tissues, as well as development and perfection of DL technique. The established parameters of FSW were used to develop the new Lithotriptor Compact. By now, 53 patients with cholelithiasis aged 18 to 55 have been treated by DC. The procedure was performed without general anesthesia. A thousand to 3500 shockwave impulses were applied to each stone. All patients had received litholytic therapy and treatment directed towards metabolic normalization, the functional state of the GB, and prevention of recurrent stone formation, prior to DL. In total, 116 DL sessions (2.2 sessions per a patient) were performed. A positive effect as a result of the complex treatment of cholelithiasis using DL method was achieved in 47 (88.7%) of the patients. There were no complications. In 3 patients (5.7%) recurrence of gallstones was found two years after DL sessions. Correctly selected parameters of FSW and DL technology allow for effective destruction of GB stones, while conservative therapy favors their passage through the biliary tract and fast litholysis of remaining stone fragments.

[Diagnostics, treatment and expert evaluation of air crew members with polypoid growth in the gallbladder].

The article discusses results of diagnosing and treatment of various forms of gallbladder polypoid growth (GBPG) in air crew members in the past 10 yr. period. Growth of polyps was detected in 12.1% of pilots with gallbladder pathologies. Timely and correct diagnostics with the use of radiologic visualization may prevent unwarranted surgery of the hepatobilizry system and thus extend the flying longevity. Ultrasound Doppler investigation is particularly effective in diagnosing early GBPG. High quality of visual differentiation attainable with these techniques made it possible to diagnose the nonneoplastic nature of GBPG in 75% of cases that did not require operational treatment. In most cases the authors' diagnostic and treatment algorithm reduced the amount of surgical activity and prolonged ace careers.

[Organization of the methods of early diagnosis and surgical tactics in treatment of nodular thyroid diseases in flying personnel]. / Optimizatsiia metodov rannei diagnostiki i khirurgicheskoi taktiki pri uzlovykh zabolevaniiakh shchitovidnoi zhelezy u letnogo sostava.

Complex analysis of the methods of early diagnostics and tactics of surgery treatment of 340 professional flyers with various forms of nodal thyroid diseases in the 5-yr period (1996-2002) showed effectiveness of a specialized diagnostic program including USI-controlled biopsy, in reliable estimate of structural changes of nodal thyroid formations already at early phases of disease in the majority of patients (83.2%). Organ-preserving and economical operations for removal of benign thyroid knottings led to recovery and professional rehabilitation of 90.3% of the patient-pilots.

[Experience of the 7th Central Military Clinical Aviation Hospital in early diagnostics, treatment, rehabilitation, and expert evaluation of cholelithiasis in flying personnel]. / Opyt raboty 7 Tsentral'nogo voennogo klinicheskogo aviatsionnogo gospitalia po rannei diagnostike, lecheniiu, reabilitatsii i ékspertnoi otsenke kholelitiaza u letnogo sostava.

The Seventh Central military clinical aviation hospital is experienced in performing laparocholecystectomy (LCE) in pilots afflicted with cholelithiasis (CL). In the period from 1990 to 2001, 92 operations were carried out after which 80 patients (87%) were permitted to fly. Medical discharge of 12 patients (13%) was associated not with CL but with some morphofunctional shifts caused by concomitant diseases. Seven to five-yr. follow-up of the 80 pilots who had returned their flying status after LCE showed their good tolerance for the flight loads.

[Laparoscopic cholecystectomy in the treatment, rehabilitation and clinical health certification of the flying personnel with cholelithiasis]. / Laparoskopicheskaia kholetsistéktomiia v lechenii, reabilitatsii i ékspertize letnogo sostava s zhelchnokamennoi bolezn'iu.

Applicability of laparoscopic cholecystectomy (LSCE), a modern approach to the treatment of cholelithiasis, to rehabilitation, and military medical and military aviation certification was evaluated. Since 1994, 303 LSCE operations, including to 97 patients-aviators, have been performed by way of penetrating the abdominal wall with a standard laporoscopic stand (K-Chtorz, Germany). After introduction of LSCE, only 9 operations (2.9%) were fulfilled with the conventional technique. Immediate results of treatment of aviators were satisfactory and characterized by a good cosmetic effect, more rapid recovery of the motor activity, minimal complications (2.2%), absence of severe post-operational pancreatic/biliary dysfunctions, and expedited course of treatment.