[New minimally invasive methods for internal bile outflow in oncology].

A few novel minimally invasive techniques are described for catheter-free repair of internal bile outflow in patients with neoplasms in the biliopancreatoduodenal region complicated by mechanical jaundice and in cases of iatrogenic complications of surgical treatment. The methods based on a combination of modern interventional radiologic and endoscopic technologies allow to improve the outcome of antineoplastic treatment and the quality of life in certain categories of patients. The introduction of these techniques into clinical practice of specialized medical facilities may help to optimize the treatment strategy, reduce the volume of surgery whenever it can be confined to minimally invasive treatment, decrease the employment index, increase the surgical bed turnover rate and other economic characteristics of a surgical clinic.

[Assessment of severity of obstructive jaundice of tumoral genesis for predicting of endoscopic retrograde cholangiopancreatography and endoscopic retrograde biliary decompression complications].

UNLABELLED: Mechanical jaundice is a vital indication for performing biliary decompression. Mechanical jaundice is one of the important reasons of serious and frequent complications after ERCP. It is required to assess patient's conditions, to determinate the potential risk of biliary decompretion with the aim of prognosis possible complications. AIM OF THE INVESTIGATION: Assessment of severity patient's conditions to prognosticate risk of complications and mortality development after ERCP in the group of patients who suffered from mechanical jaundice. TASKS: Preoperative analysis of complications severity and frequency after ERCP in dependence of patients'conditions. METHODS: Before performing ERCP severity of mechanical jaundice was assessed concerning V.D. Fedorov's scale (2000); cholangitis was detected by blood analysis, symptoms and bile investigations; coagulative disorders were revealed by blood checking. Effectiveness and complication's possibilities were controlled after each ERCP. Relations between ERCP and complications, severity of complications and patient's conditions were analyzed. MATERIALS: Prospective nonrandomized study was held, based on the investigation and treatment of 133 patients who have been performed 214 diagnostic and therapeutic ERCP. RESULTS: There were 13 (9.8%) complications of 133, of which fatal--6 (4.5%) and there were 7 cases (6.5%) in a jaundice group. In 11 cases (85%) mechanical jaundice was severe, including 6 fatal cases (100%). Cholangitis was diagnosed in 7 (53%) of 13, including 4 (67%) of 6 in the fatal group. Coagulopathy was diagnosed in 6 (46%) of 13, including 3 (50%) in the fatal group. CONCLUSION: Preoperative assessment of severity patient's condition is a very important element of clinical patient's study. It optimizes the choice of method and its particularities. It is necessary to inform the doctors, the patients or their representatives about possible complications. That is why the informed consent must be obligatory signed.

[Up-to=date view on medical documentation in surgical clinic]. / Sovremennyi vzgliad na oformlenie meditsinski dokumentatsii v khirurgicheskoi klinike.

Computer variants of the fragments of clinical records were developed. They represent the parts: "Title-page", "Examination of surgical patient in the admission department", "Protocol of laparoscopic cholecystectomy". During modelling of the intellectual contents of the modules the principle of the formalized protocol was used, which has been realized with use of a context-depending menu. According to the authors opinion, newly developed programs provide objective and correct reflection of any clinical and surgical situation, use of standardized terminology and classifications, save the surgeons the trouble of "scribbling" and decrease time-consuming registration of medical records, provide specialized information, prevent possible diagnostic and technical errors, and give physicians, legal defence.

[Nephro-urological monitoring technology based on radionuclide functional tests (tasks of an automated workplace)]. / Tekhnologiia nefrourologicheskogo kontrolia na baze radionuklidnykh funktsional'nykh testov (zadachi avtomatizirovannogo rabochego mesta).

The paper deals with a diagnostic informational and analytical system (DIAS). The system is based on the current concept of a dynamic model of nephro-urological clearance macroregulation under retention factors at the pre-, intra-, and postrenal levels during drug load tests. DIAS includes a package of dynamic renoscintigraphic techniques, as well as original software support. A system for parameters of renal clearance regulation has been developed, which is effective at nephro-urological screening and monitoring at all treatment stages for cancer patients. A two-detector chamber which permits the mounting of a detector at an angle to the patient's body is the optimum diagnostic apparatus for a cancer clinic. The use of functional tests makes it possible to examine the regulatory reserves for each kidney, followed up by the choice of adequate corrective measures to prevent renal failure during treatment. In some cases, DIAS monitoring frequently shows a higher sensitivity to the signs of latent renal failure than does routine clinical and laboratory monitoring. The effective radiation dose taken by a patient during a study by the DIAS technology aimed at reducing radioopaque doses is 100-150 times higher than that at an X-ray study and is an order less than during routine urinary tests.

Effect of beta-carotene supplementation on the activity of ornithine decarboxylase (ODC) in stomach mucosa of patients with chronic atrophic gastritis.

Increase of ornithine decarboxylase (ODC) activity is known to be associated with cell proliferation and, very likely, with tumour promotion. This prompted us to study the activity of ODC in gastric mucosa of patients with chronic atrophic gastritis that has been considered as a precursor of stomach cancer. Examination of 124 patients with this disease revealed the considerable increase in ODC activity in atrophic mucosa (29.8 +/- 2.9 vs 7.9 +/- 1.8 units in normal mucosa, p = 0.001). Supplementation of the patient's diet with beta-carotene (20 mg daily during 3 weeks) results in a statistically significant decrease in ODC activity in gastric mucosa. The data obtained confirm the possibility of application of ODC determination to the detection of early premalignant lesions and suggest the antipromoter activity of beta-carotene in gastric carcinogenesis.

[The effect of beta-carotene on the dynamics of ornithine decarboxylase activity in atrophic mucous membranes and in stomach polyp tissue]. / Vliianie beta-karotina na dinamiku aktivnosti ornitindekarboksilazy v atroficheskoi slizistoi obolochke i v tkani polipov zheludka.

Activity of ornithine decarboxylase was significantly increased, reaching the maximal values in malignant gastric tissues, in mucosal membrane and polypous tissue of patients with atrophic gastritis as compared with normalcy. Any alterations in the enzymatic activity were not observed in the gastric mucosal membrane of 19 patients with atrophic gastritis within 3 weeks. At the same time, statistically significant decrease of the abnormal high activity of ornithine decarboxylase was detected in atrophic gastric mucosal membrane of 12 patients among 20 patients examined, which were treated with 20 mg of beta-carotene daily within 3 weeks; the enzyme activity was decreased also in polypous tissue of 5 patients in the group of 9 patients studied. Decrease in the ornithine decarboxylase activity after beta-carotene treatment involved improvement of the mucosal membrane state, where hemorrhage disappeared and inflammation reduced. Since the high activity of ornithine decarboxylase is related to promotion of cancerogenesis, beta-carotene appears to exhibit an anticarcinogenic effect as it decreases the enzymatic activity in gastric mucosal membrane.

[Diagnostic and therapeutic tactics in gastric polyps]. / Diagnosticheskaia i lechebnaia taktika pri polipakh zheludka.

During examination and dynamic endoscopic follow-up of 151 patients suffering from polyps of the stomach of various histological structure with various degree of epithelial dysplasia or without it, different types of treatment were undertaken in 61 patients. The results of the treatment are analysed, the efficacy of different methods of biopsy of polypoid structures and alternative methods of treatment of patients with benign and malignant polyps are evaluated, and the recognition of endoscopic polypectomy as a diagnostic and therapeutic intervention is substantiated.

[The formation of carcinogenic nitrosamines from a small amount of precursors in human gastric juice]. / Obrazovanie kantserogennykh nitrozaminov iz malogo kolichestva predshestvennikov v zheludochnom soke cheloveka.

It has been shown in vitro with human acidic gastric juice the nitrosomorpholine (NMOR) formation from small doses of precursors (sodium nitrite and morpholine) with a significant difference relative to the control. The presented data suggest the possibility of the nitrosation reaction in the human gastric juice under hypo- and anacidic conditions. The data obtained are one more experimental confirmation of the epidemiological evidence of the potential role of nitrates (nitrites) in the etiology of stomach and esophageal cancers.

[The probability of malignant degeneration of stomach polyps]. / Veroiatnost' malignizatsii polipov zheludka.

A retrospective analysis of the endoscopic diagnostic data on 151 cases of gastric polyps of various histological structure was carried out. A relationship between the risk of malignant transformation of gastric polyps, on the one hand, and their histology, presence and degree of dysplasia, on the other, was established. Epithelial dysplasia, in pronounced degree included, was observed in 33.7% of patients with hyperplastic polyps and in all cases of gastric adenoma. Epithelial dysplasia of hyperplastic polyps was mild or moderate in most cases while that of adenomatous polyps was moderate or grave. Gastric cancer as a consequence of malignant transformation of polyps was detected in 15 (9.9%) patients (hyperplastic polyps--2; adenomatous polyps--13). No objective endoscopic criteria for establishing the risk of polyp transformation were developed. Grave epithelial dysplasia, i.e. precancerous lesions in the gastric mucosa, may be suggested as such criterion. Moderate or grave dysplasia of the polyp epithelium should be considered in forming the group at risk first and foremost.

[Epithelial dysplasia and cancer of the stomach]. / Epitelial'naia displaziia i rak zheludka.

Relationships between chronic gastric diseases and gastric cancer are discussed. Mucosal epithelial dysplasia may be regarded as the most reliable sign of increased risk of gastric cancer. Endoscopy with biopsy is the principal method for the assessment of the dysplasia-cancer relationship. A retrospective study of histologic preparations and smear imprints from gastric biopsy specimens and operative samples, obtained from 292 patients with chronic gastritis, gastric ulcers, gastric polyps and polyposis, and conditions following gastric resection for nontumorous diseases and cancer (group 1) and 80 patients with verified gastric cancer (group 2), is reported. In both groups, there was mucosal dysplasia of varying markedness. Endoscopic monitoring revealed gastric cancer in 48 first-group patients. Gastric cancer, combined with dysplasia, was detected in 128 patients from both groups, its early stages, in 37 of those. Convincing evidence in favor of a relationship between dysplasia and cancer is presented.

[The role of endoscopic study in the diagnosis of precancerous gastric pathology and identification of a risk group]. / Rol' éndoskopicheskogo issledovaniia v diagnostike predopukholevoi patologii zheludka i formirovanii gruppy riska.

The results of endoscopic diagnosis and case follow-up of 686 patients with precancerous gastric conditions usually identified as a risk group (chronic gastritis, polyps, peptic ulcer, conditions following distal stomach resections) have shown that in patients with symptoms of epithelial dysplasia of gastric mucosa indices of cancer detectability significantly exceeded those in similar pathological conditions without symptoms of epithelial dysplasia. They were 22.0 +/- 2.5% and 2.5 +/- 0.8%, respectively; indices of stage I stomach cancer detectability were 9.9 +/- 1.8% and 0.2 +/- 0.2%, respectively. Patients with precancerous stomach diseases with moderate and severe epithelial dysplasia found in their gastric biopsies, should be attributed to a risk group, and these changes of gastric mucosa must be regarded as the main criterion for the identification of such a group.

[Possibilities for defining dysplastic changes in the gastric mucosa during cytologic studies of gastric biopsies]. / Vozmozhnosti opredeleniia displasticheskikh izmenenii slizistoi obolochki zheludka pri tsitologicheskom issledovanii materiala gastrobiopsii.

The authors compared the data of cytologic and histologic studies of gastric biopsy material from 95 patients with different degree of epithelial dysplasia revealed histologically. Differentiation impairment and epithelial cell atypia can be revealed in cytologic preparations; basing on these features epithelial dysplasia was diagnosed cytologically in 40 patients (30 of them with adenomas). Cytological and histological diagnosis of epithelial dysplasia did not fully coincide. The most reliable are the cytological features of severe dysplasia, thus the main goal of a morphologic study is achieved. One should not identify the term "dysplasia" in a cytologic study with a term "proliferation". Gastric biopsy material may have the following cytologic characteristics: tegmental-fossa epithelium proliferation, marked proliferation of tegmental-fossa epithelium with atypia, epithelial dysplasia and such epithelial dysplasia when cancer is not ruled out.