[Method of treatment of patients with calculous cholecystitis complicated with mechanical jaundice]. / Taktika lecheniia bolnykh kalkuleznym kholetsistitom, oslozhnennym mekhanicheskoi zheltukhoi.

Data on the treatment of 228 patients with calculous cholecystitis complicated by obstructive jaundice are reported. Two-stage treatment was applied. In the first stage endoscopic and roentgenoendobiliary therapeutic interventions were undertaken to relieve jaundice and remove its causes. In the second stage a planned surgical operation was conducted after elimination of biliary hypertension, which consisted in cholecystectomy in the majority of patients. Such therapeutic tactics reduced mortality by half.

[Transcutaneous transvenous occlusion of patent ductus arteriosus]. / Chreskozhnaia transvenoznaia okkliuziia otkrytogo arterialnogo protoka.

Transvenous closure is described of the patent ductus arteriosus with a conical device that consists of polyurethane foam mounted on a stainless steel flame. Since 1981, the procedure has been performed in 273 patients in Russia. Permanent complete ductus closure was achieved in 258 (95%) patients. In eight cases (3%), the occlusion was incomplete. Complications occurred in 10 patients (4%), seven of whom required emergency surgery. The new technique combines certain advantages of both alternative methods. The conical shape of the occlusion device is well suited for the anatomic structure of the ductus. The possibility of selecting the size of the device permits reduction in the rate of incomplete closure while still taking advantage of transvenous delivery to avoid entryside problems. In the initial 10 years of experience, the described technique proved effective, safe, and applicable in the vast majority of patients older than 2 years.

[Pancreonecrosis. Current views and perspectives]. / Pankreonekroz. Sostoianie i perspektiva.

Generalization of data gained from the case records of patients with pancreonecrosis treated at 14 hospitals of Moscow allowed the authors to mark out typical errors in the diagnosis and therapeutic tactics which caused, to a considerable measure, mortality in 58.1 cases. From their personal experience in the treatment of such patients the authors believe it possible to improve essentially the diagnosis of acute pancreatitis by wide use of laparoscopy, ultrasonic scanning, and angiography of the pancreas for early verification of pancreonecrosis, appraisal of the condition of the extrahepatic bile ducts, and application of mildly injurious methods of treatment. Setting apart only two forms of acute pancreatitis is substantiated from the clinico-anatomical standpoint. The choice of the therapeutic tactics in pancreonecrosis should be based on the severity of the disease and the dynamics of its development during intensive therapy, rather than on the morphological diagnosis. Using the criteria of evaluation of the severity of pancreonecrosis, the authors reduced considerably the frequency of operative interventions in the early stages of the disease. Among the methods of operative treatment of pancreonecrosis, distant pancreatectomy or programmed repeated necroso-sequestrectomies are preferred.

[Endoscopic biliodigestive anastomosis with the use of magnets (experimental and clinical study)]. / Endoskopicheskie biliodigestivnye anastomozy s ispolzovaniem magnitnykh élementov (éksperimentalno-klinicheskoe issledovanie).

A new type of endoscopic operations--cholecystodigestive and choledocho-hepaticoduodenoanastomoses with the use of magnetic elements are suggested as an alternative to the traditional palliative methods of treatment of obstructive jaundice with the level of obstruction below the opening of the cystic duct. Two variants of establishing postponed compression cholecystogastroanastomoses were developed in experiments on a model of obstructive jaundice in 50 unbred dogs, a variant of cholecystoentero- and enteroenteroanastomoses with the use of endoscopic techniques, which may be conducted in clinical practice. To restore internal bile drainage the following operations were carried out on 16 patients: colecystogastroanastomosis (4), cholecystoduodenonastomosis (1), choledochoduodenoanastomosis (10), hapaticoduodenoanastomosis (1). These operations were performed in patients with irresectable obstructions of the terminal part of the choledochus and a high operative risk.