[Diagnosis and differential treatment of acute pancreatitis of biliary etiology].

The experience in examination and treatment of 208 patients with acute pancreatitis of biliary etiology was analyzed. Complex endoscopic treatment was carried out in 88% patients. If there are indications, it is reasonable to perform retrograde pancreatocholangiography (RPCG) and endoscopic papillosphincterotomy (EPST) during surgery in patients with concomitant enzymatic ascites-peritonitis. In the others patients RPCG and EPST must be regarded as the first stage of treatment. Surgical procedure of choice at the second stage of treatment is laparoscopic cholecystectomy.

[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.

[Immediate, early and late results of endoscopic papillosphincterotomy]. / Neposredstvennye, blizhaisie i otdalennye rezul'taty éndoskopicheskoi papillosfinkterotomii.

Clinico-instrumental examination of 226 patients showed that there were no fatal outcomes directly after endoscopic papillosphincterotomy, the number of complications was approximately the same as after transduodenal operations on the major duodenal papilla but they took a much easier course. The high effectiveness of an endoscopic operation was confirmed in the immediate postoperative period (absence of biliary hypertension, jaundice, pancreatitis, cholangitis). In the late-term periods after EPST restenosis was rarely encountered (3.9%); duodeno-biliary reflux caused no serious disorders, while the functional activity of the sphincter Oddi which had been operated on was partly maintained in 84.2% of patients.

[Possibilities of laparoscopic decompression of the gallbladder in middle-aged and elderly patients with diseases of the biliary tract]. / Vozmozhnosti laparoskopicheskoi dekompressii zhelchnogo puzyria u bol'nykh pozhilogo i starcheskogo vozrasta s zabolevaniiami biliarnogo trakta.

It is established that laparoscopic cholecystostomy presents the most acceptable method of gall bladder decompression in acute cholecystitis patients of advanced age comprising a high-risk group for surgery. Cholecystostomy efficiency reaches 97.2%. In case the procedure is not feasible in acute cholecystitis patients with intrahepatic position of the gall bladder or perivesicular adhesions the preference should be given to transhepatic drainage of the gall bladder whose effectiveness is 88.5%. An expedient method of laparoscopic decompression of the biliary tracts in mechanical jaundice due to tumor obstruction of the terminal part of the common bile duct is the formation of an external biliary fistula and "continuous" direct drainage of the gall bladder warranting satisfactory results in 93.3 and 100% of cases, respectively. Patients with a 1.5-week history of mechanical jaundice are not recommended transhepatic drainage, in longer duration of the jaundice (more than 1 month) it becomes contraindicated.

[Diagnosis of lung cancer in the general therapeutic departments of the hospital]. / O diagnostike raka legkogo v obshcheterapevticheskikh otdeleniiakh bol'nitsy.

The authors review the therapeutic aspects of lung carcinoma (LC) diagnosis based on the follow-up of 80 patients with LC referred to the hospital for different nonspecific pulmonary diseases (pneumonia, bronchitis, bronchial asthma). Point to the diagnostic significance of the therapeutic microsymptomatology (inexplicable leukocytosis, fever, alterations in the character of cough and sputum, appearance of asphyxia and so forth), measurement of the level of hormones and biologically active substances with regard to the clinico-roentgenological appearance in identification of LC in the general therapeutic departments of the hospital. Analyze the diagnostic errors in the patients' group under examination.