[Sonoelastography in differential diagnosis of thyroid nodes].

The study was aimed to assess the diagnostic possibilities of the new method of sonoelastography. 68 patients with different thyroid nodes were studied. Sonoelastography increased the sensitivity of the routine ultrasound investigation from 89 to 94.8%, the specificity from the 83 to 93%, and the accuracy of the method from 76 to 89%. The method assignes the information of the structural changes of the thyroid, unavailable by the routine ultrasound investigation.

[Comparative analysis of different methods in the treatment of patients with acute calculous cholecystitis and choledocholithiasis].

In the patients with different forms of cholelithiasis 1988 operations were performed, 597 of them - on account of acute calculous cholecystitis. In 118 (19%) patients with acute calculous cholecystitis choledocholithiasis was diagnosed. All the patients were divided into two groups. Group 1 consisted of 52 (44%) patients who have undergone conventional "open" operation with choledocholithotomy. Group 2 consisted of 66 (56%) patients treated with endoscopic techniques. In group 1 complications were seen in 4 (7.6%) patients, lethal outcome -- in 3 (5.7%), residual choledocholithiasis -- in 7 (13.4%). Mean hospital stay was 24.7 days. In group 2 complications were seen in 1 (2%) patient, residual choledocholithiasis -- in 1 (2%), there were no lethal outcomes. Mean hospital stay was 15.1 days. It is concluded that minimally invasive technologies in the treatment of acute calculous cholecystitis and choledocholithiasis improve results of treatment and shorten hospital stay.

[Differential treatment of acute pancreatitis].

Results of examination and treatment of 194 patients with acute pancreatitis were analyzed. It is revealed that the diagnosis of an etiopathogenetic form of acute pancreatitis is a key moment in the choice of the treatment. Patients with acute biliary pancreatitis and alimentary pancreonecrosis with pancreatogenic peritonitis require urgent surgical treatment at early stages of the disease. Laparoscopic cholecystectomy and Haulstad's drainage of the common bile duct are the procedures of choice in acute biliary pancreatitis. Alimentary pancreonecrosis with pancreatogenic peritonitis is the indication for videolaparoscopic drainage procedure and peritoneal dialysis as soon as possible after the disease beginning. This approach decreased lethality, number of complication and hospital stay.

[Ultrasonic technologies in diagnosis and surgery planning in patients with nodular pathologies of the thyroid gland].

Twenty patients of the control group without pathology of the thyroid gland were examined for development of the method of 3D-ultrasonic reconstruction and 3D-angiography. The study group consisted of 74 patients with nodular pathologies of the thyroid gland, 53 of them underwent surgery. Ultrasonic data was compared with results of clinical and laboratory studies, puncture biopsy and intraoperative data. Three-dimensional ultrasonic pictures permitted to detect spatial orientation of the nodes relative to lobes and segments of the thyroid gland, vascular structures, to evaluate character of nodes vascularization, to analyze nature and invasiveness of the tumor. Based on these data optimal variant of surgery was chosen. In 12 cases virtual modeling of surgeries with 3D-echography and ultrasonic angiography was performed. These methods permit to choose optimal variant of surgery and make possible prediction and prevention of complications.

[Reliability of the sterilization of surgical instruments is a key point in prevention of surgical infection]. / Nadezhnost' sterilizatsii izdelii meditsinskogo naznacheniia.

Occurrence of postoperative purulent-inflammative complications (PPIC), their structure and dynamics after improvement of sterilization are studied. For epidemiological analysis 65,246 medical histories of operated patients were studied, in 404 of them PPIC were revealed. The PPIC rate reduced from 3.05% in 1981 to 0.49 in 2000 though surgical activity increased 12 times after this period. Thus developed measures for improvement of sterilization promoted reduction of the PPIC rate.

[Ultrasonic examinations of thyroid newgrowths]. / Ul'trazvukovye metodiki issledovaniia ob''emnykh obrazovanii shchitovidnoi zhelezy.

The results of complex ultrasonic, histological and cytological examination of 148 patients with newgrowths thyroid were analyzed. Grey-scale mode, colored and energy Doppler scanning, three-dimensional reconstruction of vessels were used. A new classification of nodular vascular pattern types based on 3-D reconstruction is proposed. The majority of malignant formations were characterized by perinodular hypervascularization and internodular hypovascularization (82.4%), adenomas--by peri- and intranodular hypervascularization (88.9%), colloid nodes--by perinodular hypervascularization (85.5%), the blood flow was absent in simple cysts (85.3%). It was established that complex of these methods increases informative value of ultrasonic examination in diagnosis of thyroid nodular diseases: in malignant neoplasms the sensitivity is 92.9%, specificity--86.1%, diagnostic accuracy--86.9%, in adenomas--93.4%, 79.2% and 82%, in colloid nodes--75.7%, 84.1% and 79.8%, respectively. In cystic masses diagnostic value of Doppler methods didn't change: sensitivity was 90.4%, specificity--63%, diagnostic accuracy--80.5%. The combined ultrasonic examination provides a differential approach to treatment of patients with thyroid nodular masses and decreases the number of unjustified surgical interventions.

[Treatment of acute destructive alimentary pancreatitis]. / Lechenie ostrogo destruktivnogo alimentarnogo pankreatita.

The paper reports treatment of 52 patients with acute destructive pancreatitis for the period from 1993 to 1999. Up to 1997 conservative policy for management of such patients was used, operative treatment was carried on only in pyoseptic complications (43 patients, group 1). Later on early video-endoscopic procedures (9 patients) aimed at removal of toxic exudate from the abdominal cavity, its sanation and drainage with the use of not less than 5 drainage tubes were employed. From 43 patients of group 1 10 died. There were no lethal outcomes in group 2. The authors believe that early evacuation of the toxic purulent exudate with lavage and drainage of the abdominal cavity promotes more effective elimination of multiorganic insufficiency and decreases the risk for development of pyoseptic complications.

[Triangular anastomoses in surgery of the stomach]. / Trianguliarnye anastomozy v khirurgii zheludka.

The mode of triangulation in the anastomoses of the stomach and the duodenum (thrice-repeated usage of linear suturing apparatuses in shaping anastomoses) is a perspective way for improvement of the results of surgical treatment of these organs. The results of 216 cases have shown that the use of the triangular anastomoses in gastric surgery allows a decrease in the rate of complications because of anastomosis failure in early postop period more than 3.5 times. The healing of such anastomoses proceeds by primary intention and in short terms and is accompanied by minimal inflammatory reaction. The course of restoration of the motor and evacuation function of the stomach after creation of such anastomoses is characterized by early, partial and timely evacuation. In remote postoperative period mechanical everted anastomoses, made up by linear suturing apparatuses, provide absence of the tendency for cicatricial strictures and stipulation of motor and evacuation functional characteristics of the stomach. The authors believe that beneficial impact of this method on gastric function allows to recommend it for wider use in surgery of the stomach.

[The clinical picture and treatment of destructive pancreatitis]. / Klinika i lechenie destruktivnogo pankreatita.

The results of treatment of 319 patients with acute pancreatitis are analyzed, 48 from them (15.1%)--with pancreanecrosis. Etiologic factors in destructive pancreatitis were alcohol addiction (41.67%), cholelithiasis (37.5%), hyperlipidemia (10.41%), hypercalcemia (4.17%), postoperative (4.17%). Location of the necrosis in parapancreatic fat cellular tissue was detected in 6 patients, in pancreatic head--in 8 and both in pancreatic head and corpus--in 11, in corpus and in tail--in 10; total pancreo-necrosis was observed in 5 patients. Therapeutic measures were conservative and only in cholelithiasis cholecystectomy was performed as well as drainage of the choledochus and abdominal cavity. Intensive care was aimed at blocking pancreatic and gastric secretion, inhibition of pancreatic enzymes ferments and suppressing mediators of inflammation, immunocorrection, prophylaxis of infection in the necrotic tissues. Desintoxication was carried out by combination of infusion therapy with forced diuresis, usage of extracorporeal methods and laparoscopic sanation of the abdominal cavity with subsequent lavage. Surgical interventions were carried out in far-off period only for complications of pancreanecrosis. Mortality rate in pancreanecrosis made up 20.85% and in total number of patients with acute pancreatitis--3.13%.

[Difficulties, errors and complications in laparoscopic cholecystectomy]. / Trudnosti, oshibki i oslozhneniia pri laparoskopicheskoi kholetsistéktomii.

The work deals with the specific features of surgical techniques in laparoscopic cholecystectomy. It discusses in detail the most frequently encountered difficulties, errors, and complications developing at various stages of the operation. From their own experience the authors describe the causes and mechanisms of their occurrence. A greater part of the article is concerned with rational surgical tactics in a complicated course of laparoscopic cholecystectomy. It is emphasized that the indications and contraindications for laparoscopic cholecystectomy must be strictly observed, all stages of the intervention must be technically carried out with great care and scrupulously, the surgeon must evaluate adequately his own possibilities, sufficient technical equipment must be provided.

[Duodenal cancer]. / Rak dvenadtsatiperstnoi kishki.

Primary duodenal carcinoma is a relatively rare oncological disease and accounts for 0.04-0.5% of all tumors of the gastrointestinal tract. The absence of pathognomonic symptoms and insufficient knowledge and watchfulness on the part of doctors in relation to this pathological condition are the main causes of the difficult diagnosis and early detection of the disease. Esophagogastroduodenoscopy with biopsy, radiological duodenography, ultrasonic examination, and computered tomography of the abdominal organs play the main role in timely diagnosis of primary duodenal carcinoma. Pancreatoduodenal resection is the optimal method of treatment.

[Classification of limited hyperkeratoses]. / Klassifikatsiia ogranichennykh giperkeratozov.

A classification of limited hyperkeratoses (LH) was developed for practical use in out-patient surgical practice on the basis of literature data and personal studies and observations over 630 patients. Hyperkeratoses are classified according to the etiological sign (mechanical damage to the skin, diseases and deformities of the locomotor apparatus-neurotrophic, genetic, miscellaneous), clinical course (acute LH-soft corn, uncomplicated and infected and chronic LH-dry corn or callus, uncomplicated and complicated with suppuration, formation of fistula, malignization), according to shape (spherical, ellipsoid, cone-shaped), according to localization (hand and foot, unilateral, bilateral, combined, palm, finger, toe, interdigital), according to size (small, moderate, large), and according to number (solitary, multiple). The cause of the disease in 452 patients was the mechanical effect of poorly fitting shoes and trauma caused by various objects. In 19 patients LH occurred as the result of a pathological condition of the locomotor apparatus (exostosis, flexion contracture of the toes, amputation stump, etc.). In 70 cases LH was a consequence of diseases of the peripheral nervous system. There were rare causes in the remaining patients. Various methods of treatment are suggested, including the use of a laser scalpel, depending on the classification signs of the disease. Removal of the etiological factors is a very significant measure in the treatment and prevention of LH.

[Methods and effectiveness of surgical treatment of limited hyperkeratoses with CO2 laser]. / Metodika i éffektivnost khirurgicheskogo lecheniia CO2-lazerom ogranichennykh giperkeratozov.

A method for surgical treatment of limited hyperkeratoses (LH) with CO2 laser was elaborated. Its essence consists in complete "evaporation" of corns within the boundaries of healthy tissues by means of a CO2 laser. Laser excision of LH was conducted in some patients. The method was applied in the treatment of 502 patients with LH with a favorable clinical effect: the immediate results improved, the reparative processes in the wound developed more rapidly in 96% of cases, the period of inability of the patients reduced to one fourth. No complications occurred. Recurrences were noted in the late-term postoperative periods only in 4% of cases. A good cosmetic result was produced in most patients. The economical effect of the method was 36 thousand roubles.

[Diagnosis and treatment of benign tumors of the gallbladder]. / Diagnostika i lechenie dobrokachestvennykh opukholei zhelchnogo puzyria.

The article generalizes experience in the treatment of 226 patients with benign tumors and preneoplastic diseases of the gallbladder, who underwent cholecystectomy. The increased number of patients with the disease is noted, they accounted for 12.77% of all patients who were operated on for gallbladder diseases. Females 40 to 60 years of age have the disease most frequently. In most cases (n = 190) it is seen with calculi. In the absence of concomitant pathological conditions it is generally asymptomatic. The diagnosis is based on instrumental examination. Ultrasonic examination in combination with cholecystography is preferable. Operation is the recommended method of treatment.

Resection of abdominal hollow organs by laser.

During a ten-year period 642 abdominal hollow organ resections have been performed by means of a new, original technique--that is, CO2 laser irradiation combined with specially designed instrumentation. This resulted in a remarkable decrease in postoperative morbidity and mortality. The article describes the laser procedure.