[Use of CR in the detection of present gastric cancer: diagnostic aspects].

The authors describe the state-of-the-art of gastric cancer detection in detail and show the current principles of its radiodiagnosis. They provide a detailed explanation for that radiodiagnosis should be urgently returned into gastroenterology as an equal with endoscopy, which is based on the existing tendency for the major morphological types of gastric cancer to appear. The present-day capacities of radiodiagnosis of gastric cancer are mainly based on the introduction of the digital technologies into traditional radiology, which will replace the analog imaging principle in the foreseeable future. The authors present their data of examining 300 gastric cancer cases diagnosed by the CR system and later verified by a morphological study of resected gastric specimens. They emphasize that intraparietally growing gastric cancer is frequently inaccessible for endoscopy long, which determines the need for two basic procedures (radiodiagnosis and endoscopy) coexisting on a par for the detection of gastric cancer. They are sure that computed radiology (CR) will be the most acceptable way of changing traditional radiology to the digital imaging principle in primary, municipal health care in the near future.

[Roentgen diagnostics with the emphasis on it's traditional roentgenological method is a major sourse to improve gastric cancer diagnosis].

The main idea of the article is presentation of todays problem of gastric cancer diagnosis. Authors, supported by long-term experience of gastric cancer diagnostics, demonstrate the necessity of the return of traditional roentgenological method for it's diagnostics, along with endoscopic technique. In the first place it is determined by the increase of sclerotic and mixed forms. In the second place, it is associated by the change of gastric cancer primary localizations, supporting the need of active use of roentgen diagnostics for it's diagnosis. One of the important parts of the article consists of the author's attempt to change general opinion about insignificancy role of traditional roentgenological method for diagnosis of gastric cancer. Authors demonstrate modern techniques of traditional stomach roentgenology and firstly, it's digital development with CR-systems for the improvement of diagnosis of the intramural forms of carcinomas. In the initial stages it is obligatory to engage classical roentgenology with double contrast study and endoscopy as main equally important methods. The unfavourable situaition in the diagnosis of gastric cancer can be changed only with conjoint use of these two approaches. It is chiefly depends with the difficulties of endoscopic study of diffuse (endophytic) forms of gastric carcinoma. Authors separately underline the necessity of including specialists in roentgen diagnostics in the national project of modernization of roentgenological equipment in medical institutions.

[Radiation diagnosis of tumors at four sites (the lung, breast, stomach, and large bowel) in the organizational and methodological standpoints of practical public health of the Russian Federation].

The basic idea of the paper is to put forth today's vision of detecting tumors at four sites (cancer of the lung, breast, stomach, and large bowel) at the level of municipal and regional public health systems. Based on their many years' experience in "contacting" this pathology, the authors characterize the role and significance of basic radiation techniques applied to each of these four tumors, which should be used in their diagnosis. The authors also underline the need for reasonably certifying radiation diagnostic apparatuses for municipal and regional public health systems, which would efficiently combine their diagnostic and economic profitability, which will be able to avoid materializing the potential of expensive radiation equipment by just 15-20% of its built-in efficiency. By taking into account the present epidemiological situation with each of the tumors in question and scientific-and-technological achievements of current diagnostic equipment, the authors underline the need for correcting diagnostic approaches applied in their detection. The paper also presents the opinion of the authors as to selective screening. They are sure that it is impossible without its use to gain even some moderate improvement of the results of diagnosis and hence those of treatment of tumors at four sites, which are all responsible for 50% of all malignancy. The idea that it is necessary to actively return radiation studies to the diagnosis of cancer of the lung, breast, stomach, and large bowel runs throughout the paper. As applied to tumors at each of these sites, the authors express their opinion as to their radiation diagnosis. Naturally, they could not ignore the fact that the authorities of medical industry in our country should take an active part in the solution of organizational problems touched upon in the paper.

[The modern role of stomach cancer radiodiagnostics].

The authors' main purpose was to assess the role of stomach cancer radiodiagnostics, considering the changes in the morphology of the disease within the last decades of the 20th century. The results of radiodiagnostic and morphological study of 1258 cases of verified stomach cancer were compared. This methodical approach allowed correction of radiodiagnostic methods and stomach cancer semiotics, directed towards detection of endophytic tumors. The radiologic examination included conventional radiologic imaging, ultrasonography, computed tomography, and magnetic resonance imaging of the stomach. The morphologic examination included a method of studying endophytic stomach cancer, specially designed for this research. According to the authors of the article, the prevalence of diffuse and mixed stomach cancer has increased substantially within the last 34 years; the incidence of the stomach upper part involvement has increased 2.4 times. The modem radiodiagnostics and semiotics of stomach cancer are based on the principles of endophytic tumor detection. The authors conclude that modern radiodiagnostics and endoscopy are two main methods of stomach cancer diagnostics.

[To differential diagnosis of esophageal cancer and other diseases with the similar clinical symptoms, by using traditional X-ray study].

The principal purpose of the paper is to assess the role of the X-ray section of current radiation diagnosis in obtaining objective information and interpreting it in esophageal cancer. The study was methodically based on its serial studies, by comparing the data of clinical, radiation, and endoscopic diagnosis with those of morphological studies of the biopsy specimens taken at resection for cancer of the esophagus and the upper stomach, and histologically examined them in diseases running with the similar clinical symptoms. The complex of radiation techniques included traditional X-ray study (compact filling, double contrasting). A specially developed procedure that allowed physicians the opportunity to examine the cardioesophageal area in the fragmentary fashion was used during morphological studies. In cancer of the upper stomach, the lower esophageal segments were also involved in the process in 79.9%. It should be also noted that this number of observations includes some cases that clinical symptomatology and endoscopy strongly suggest cancer of the lower third of the esophagus. The authors have arrived at the conclusion that the present-day X-ray semiotics of esophageal diseases running with the similar clinical symptomatology permits their differential diagnosis just before the use of endoscopy and histology of biopsy specimens and that the unique advantage of radiation diagnosis over endoscopy is to specify the initial site of a tumor, namely, to detect primary gastric damage in cardioesophageal carcinoma.

[Role of computed tomography in every day practice of municipal health care of the Russian Federation]. / Rol' komp'iuternoi tomografii v povsednevnoi praktike munitsipal'nogo zdravookhraneniia Rossiiskoi Federatsii.

The basic idea of the paper is due to its authors' wish to provide a comprehensive objective assessment of the role and place of currently available technologies of radiation diagnosis in municipal health care of the Russian Federation on the basis of the computed tomography (CT) room of the Stupino Central Town Clinical Hospital that performs the function of the leading medical institution of the whole Stupino District, Moscow Region. The paper presents a detailed characterization of the basic lines of CT studies and an analysis of their scope in a great variety of clinical subunits of the multidisciplinary Stupino hospital offering 795 beds. The paper lays a great emphasis on the particularly organizational aspects associated with the CT diagnosis of different diseases at the level of municipal heart care. Moreover, the authors express the idea that the findings may be applied not only to CT, but also to the whole group of new radiation diagnostic technologies. By assessing CT at the level of municipal health care, the authors fix their attention on the technological aspects of this technique. Recommendations are given on the most suitable type of CT units for municipal health care depending on the size of the population under service and on the capacity of health care structures. One of the authors' main conclusions suggests that, in addition to the radiation diagnosis service, the administrators of both regional and municipal organizational entities of practical public health care of the Russian Federation should obligatorily participate in order to obtain the high efficiency of radiation techniques.

[Organizational and methodological approaches to using digital X-ray fluorography in the diagnosis of lung diseases in practical public health care of the Russian Federation]. / Organizatsionno-metodicheskie podkhody k primeneniiu tsifrovoi rentgenofliuorografii v diagnostike legochnoi patologii v prakticheskom zdravookhranenii Rossiiskoi Federatsii.

On the basis of a great body of information, the authors propose the most reasonable and effective organizational and methodological approaches to further actively introducing digital lung fluography into Russia's practical public health care. The paper discusses a diversity of topical problems associated with the practical use of digital X-ray fluorography (DXF), such as the assessment of its use depending on the level (municipal or regional) of public health care, methodological issues of its performance, current relationships of DXF and film fluorography; a place of DXF in the screening and routine clinical diagnosis of lung diseases. Great emphasis is laid on the role of DXF in the diagnosis of tuberculosis and cancer of the lung. The place and role of Russian manufacturers of digital lung fluorographs in the further development of SXF in practical public health care of Russia are also touched upon. The authors emphasize that replacement of film fluorography by digital one will present difficulties if regional and municipal health administrators do not take an active part in this matter.

[Some problems of radiation diagnosis of colon cancer]. / Nekotorye voprosy luchevoi diagnostiki raka tolstoi kishki.

The paper gives the view of the author who is based on his many-year experience in studying a role of radiation diagnosis of colon cancer. It shows it necessary to enhance the significance of radiation diagnosis. More attention should be given to the traditional section on the current radiation study of the large bowel: to irrigoscopy and single double contrasting. By taking into account the labor-consumption of irrigoscopy, the author suggests that the procedure should be simplified without losing its diagnostic capacities. However, he considers single double contrasting of the bowel to be the optimum technique of traditional X-ray study of the bowel in detecting its tumors. Pneumocolonoscopy and iliocecal node study of the ileocecal angle are given in the paper as supplementary techniques of traditional X-ray study of the large bowel. Emphasis is also placed on the role of radiation diagnostic techniques, such as ultrasound diagnosis, X-ray computed tomography, and magnetic resonance imaging. By highly appreciating their significance in the diagnosis of colon cancer, the author believes that they should play a role of important, but additional ways of detecting this pathology. By pointing out the excellent capacities of fibrocolonoscopy, as applied to the problem discussed in the paper, the author does emphasize the certain limitations of this technique, by taking into account that its application can cause some complications. The author's opinion that the obvious increase in the incidence of endophytic carcinomas drastically enhances the role of their radiation diagnosis, but by obligatorily correcting currently available principal methodic and semiotic directives, runs through the entire paper.

[Role of digital X-ray study in the current diagnosis of gastric cancer]. / Rol' tsifrovoi rentgenografii v sovremennoi diagnostike raka zheludka.

The authors attempted to assess and provide evidence for the expedience of using a digital radiography CR system in clinical gastroenterology. The prerequisite for this was the results of large-scale diagnostic studies of different organ and systemic diseases. The authors underline the specific features of application of this digital system: the latter allows several analogue X-ray apparatuses to be transformed to digital ones, provides economic efficiency as compared with apparatuses with the direct digitization of an image, shows telemedical prospects, and has low radiation loads as evidenced by research and experimental studies even in comparison with green systems, which makes the use of these digital systems in X-ray gastroenterology highly tempting. Based on a great body of data from 126 studies, the authors could show the effectiveness of the digital radiography CR system in the diagnosis of gastric cancer, demonstrate a modernized approach to formatting an obtained digital image, the possibility of postprocessor treatment that can enhance the validity of existing X-ray symptoms. This all permitted the authors to recommend using the CR systems in the diagnosis of gastric cancer, by taking into account the current obvious predominance of its morphological diffuse and mixed forms and corresponding difficulties of their endoscopic diagnosis.

[To the ways of the most reasonable implementation of digital radiography into the practical public health of the Russian Federation]. / K voprosu o putiakh naibolee razumnogo vnedreniia tsifrovoi radiografii v prakticheskoe zdravookhranenie RF.

The main idea of the authors' paper is to propose the most reasonable way of actively introducing the digital principle into the traditional roentgenological section of radiation diagnosis. For this, a luminophore digital radiography system has been chosen. The authors of the paper give a full-scale assessment and appropriate recommendations for its use. The paper essentially discusses the entire complex of matters that permit assessment whether its sound use is possible in regional and municipal health care systems. This is both a section devoted to a dose load, by making a comparative assessment of luminophore radiography and "the green system" and a study of different clinical diseases (456 cases). In their study, the authors have applied an original principle in the formation of an image obtained and some other approaches in order to make a comprehensive assessment of this method. In the authors' opinion, luminophore radiography has a variety of advantages. Firstly, this technique can be simultaneously applied to several nondigital apparatuses, including those available in the ward and it shows a rather diagnostic effectiveness and economic profitability, yields a qualitative image of varying density tissues upon single exposure, and has some other capacities of the CR system as a digital technique. All this things considered, the authors consider that luminophore radiography may be one of the main ways of introducing a digital technique into the conventional roentgenological section of radiation diagnosis at the level of regional and municipal heath care systems.

[New capacities of roentgen diagnosis in detecting small intestinal pathology]. / Novye vozmozhnosti luchevoi diagnostiki v vyiavlenii patologii tonkoi kishki.

The paper based on the data of more than 200 studies of the small bowel with the new agent Entero-VU specially designed for X-ray study of the bowel gives an objective evaluation of this agent. The authors of the paper analyze the capacities of Entero-VU in diagnosing 38 cases of Crohn's disease, tuberculosis and tumors of the small bowel. Moreover, as a separate section the paper provides an assessment of the agent in mapping the X-ray standards of the small bowel. In the authors' opinion, the use of this agent as though fills the existing gap in the X-ray study of the small bowel.

[A role and a place of ultrasound diagnosis of acute ileus]. / Rol' i mesto ul'trazvukovoi diagnostiki ostroi kishechnoi neprokhodimosti.

The main purpose of the authors is to present their view of a place of present-day ultrasonography in the diagnosis of acute small and large intestinal obstruction. A comparatively sizable material covering 218 verified cases of acute ileus, including 77 patients with large intestinal obstruction and 141 patients with impaired passage of the intestinal contents along the small bowel was used to outline the aspects of ultrasound techniques and the symptomatology of ileus, by differentiating its some types. Along with the general assessment of the methodological and semiotic aspects of ultrasound diagnosis of acute uleus, the authors emphasizes a role of sonography in the detection of large intestinal obstruction by outlining their modified procedure of ultrasound irrigoscopy. For greater objectivization of their positive assessment of the place of ultrasound in the diagnosis of acute ileus and large intestinal obstruction, the authors comparatively studied X-ray and ultrasound studies to reveal this pathology. In addition to their purely personal assessment of a role of ultrasound in the diagnosis of large intestinal obstruction, the lecture also shows its authors' opinion as to the organizational issues associated with the necessity of correcting the existing diagnostic algorithm to detect large intestinal obstruction.

[A place of digital X-ray fluorography in the detection of lung diseases in the public health facilities of the Russian Federation]. / Mesto tsifrovoi rentgenofliuorografii v vyiavlenii legochnoi patologii v usloviiakh prakticheskogo zdravookhraneniia Rossiiskoi Federatsii.

The paper shows the authors' opinion as to the use of digital X-ray fluorography (DXF) to detect pathology of the lung, primarily its tuberculosis and cancer from organizational-and-methodological and purely diagnostic standpoints. Based on a great body of data pooling 21,295 studies of patients, which comprised two (screening and routine clinical) groups, they authors state their views on the place and role of lung DXF in the work of public health facilities in the Russian Federation (RF). The objectivity of the authors' opinion is confirmed by the different nature of a lung abnormality detected by DXF at both the municipal and regional levels of the RF public health system and by a comparative analysis of the findings with those of film fluorography, routine X-ray study, linear tomography, X-ray computed tomography (XCT), and surgical evidence. The study has allowed the authors to express their opinion by recommending DXF as a method for primary diagnosis of lung diseases instead of film fluorography and routine X-ray study and to appreciate it in screenings. The authors' data indicate that XCT in its simplest variant rather than linear tomography should become the optimum method that specifies the diagnosis of lung diseases detected by DXT.

[A place of outpatient screening in the formation of a current organizational scheme for better radical detection of breast cancer]. / Mesto poliklinicheskogo skrininga v formirovanii sovremennoi organizatsionno-metodicheskoi skhemy kardinal'nogo uluchsheniia vyiavliaemosti raka molochnoi zhelezy.

The authors consider it necessary to revise the current views of breast cancer in women. In their opinion, excessive consideration of mammography as an independent section of radiation diagnosis does not contribute to better detection of breast cancer. The principle of including mammography into the general traditional section of current radiation diagnosis should be regarded as of paramount importance. Mammography should be widely introduced into the general polyclinic network of the practical health care system of the Russian Federation. The so-called mammological dispensaries (centers) that have been or being set up should more clearly define their functions mainly to rendering an organizational and methodological assistance in the diagnosis of breast cancer at a routine outpatient level, to make its specified diagnosis, and to define the tactics of rendering a medical care of detected breast pathology in the polyclinic. The authors consider that the wide introduction of screening for breast cancer into the practice of polyclincs is one of the basic ways of improving of its detection.

[Magnetic-resonance tomography in diagnosis of hepatopancreatoduodenal tumors]. / Vozmozhnosti magnitno-rezonansnoi tomografii v diagnostike opukholei gepatopankreatoduodenal'noi oblasti.

Results of magnetic-resonance tomography (MRT) in 112 patients with diseases of hepatopancreatoduodenal zone were analyzed, 24 of them had tumors of bile ducts and pancreas. New noninvasive diagnostic method--magnetic-resonance cholangiopancreatography (MRCPG)--performed in addition to routine MRT was evaluated. The technique of MRCPG, analysis of results, manetic-resonance semiotics are presented. This method is compared with endoscopic retrograde cholangiopancreatography. It is concluded that combination of consentional MRT with MRCPG increases possibilities in diagnosis of hepatopancreatoduodenal cancers, complicated by obstructive jaundice, as a rule.

[Cancer of the upper stomach: current problems of its diagnosis]. / Rak verkhnego otdela zheludka: sovremennye problemy ego diagnostiki.

Data on 1248 cases of stomaches radically operated on for cancer at the surgical departments of the Moscow Regional Research Clinical Institute in 1971 to 2000 were used to study a number of problems associated with cancer of the upper stomach, by regarding the present-day role of radiation diagnosis as of paramount importance. The following radiation diagnostic techniques were assessed. Among them there were traditional X-ray studies (in each case), the new radiation diagnostic techniques: ultrasound study and computed tomography (CT) (750 studies), magnetic resonance imaging (MRI) (120 studies). The potentialities of radiation diagnosis and endoscopy performed in all cases are compared. A specially developed procedure for exploring endophytic forms of gastric cancer was employed in the morphological studies of the material. The incidence of cancer of the upper stomach and its association with the esophagus are presented; some aspects of the morphogenesis of cancer of this site are discussed. The relationship of its clinical symptoms and its radiation image has been studied. In the authors' opinion, the past two decades' rise in the incidence of proximal gastric cancer is one of the main problems in diagnosing gastric cancer that continues holding its stand in the general structure of cancer morbidity. The tendency for diffuse and mixed forms to increase in the morphogenesis of gastric cancer provides evidence that radiation techniques should be actively used in its diagnosis. It is necessary to apply classical double-contrasting X-ray study and endoscopy on equal grounds as basic diagnostic methods at early stages. Only their concord use may change the poor situation associated with the diagnosis of cancer at this site. CT and MRI as additional techniques may substantially provide more required diagnostic information. This is first and foremost associated with difficulties in gastric endoscopic study when esophageal cancer is apparently proved.

[Current problems in the diagnosis of gastric cancer]. / Sovremennye problemy diagnostiki raka zheludka.

Based on their own long-term experience in diagnosing gastric cancer and by taking into account the fact that clinicians and diagnosticians analyze this problem insufficiently objectively, the authors of the paper try to convince the reader that it is necessary to revert to the problems of its diagnosis again. They proceed from recent new reports on gastric cancer pertaining to both its morphological forms and diagnostic capacities wherein current radiation diagnosis requires its active return to the problem of its detection. This standpoint of the authors is based on the date of over 6000 comprehensive studies of the stomach, of them 2800 cases have been diagnosed as having tumor lesions. In addition to the assessment of current radiation diagnosis of gastric cancer, which involves both routine X-ray study and ultrasonography, X-ray computed tomography, and magnetic resonance imaging of the stomach, the authors express their opinion on some organizational issues without which the diagnosis of this disease cannot be improved.

[New capacities of X-ray diagnosis in detection of small intestine pathology]. / Novye vozmozhnosti luchevoi diagnostiki v vyiavlenii patologii tonkoi kishki.

The paper based on the data of more than 200 studies of the small bowel with the new agent Entero-VU specially designed for X-ray study of the bowel gives an objective evaluation of this agent. The authors of the paper analyze the capacities of Entero-VU in diagnosing 38 cases of Crohn's disease, tuberculosis and tumors of the small bowel. Moreover, as a separate section the paper provides an assessment of the agent in mapping the X-ray standards of the small bowel. In the authors' opinion, the use of this agent as though fills the existing gap in the X-ray study of the small bowel.

[Current possibilities of X-ray diagnosis of small intestine diseases using the agent Entero-view]. / K voprosu o sovremennykh vozmozhnostiakh rentgenologicheskoi diagnostiki zabolevanii tonkoi kishki s pomoshch'iu preparata "Entero-v'iu",

The paper analyzes the current capacities of routine (classical) X-ray study in the diagnosis of organ diseases of the small bowel. The distinctive feature of the paper is that in addition to routine barium passage through the small bowel, the new barium contrast agent Entero-view specially designed for its exploration is used. Of the 115 examined patients with various gastroenterological diseases, 76 underwent Entero-view examination that revealed different organ pathology of the small bowel in 28 cases (Crohn's disease in 18, tuberculosis in 3, lymphomas in 5, and cancer in 2). A normal X-ray pattern of the small bowel was diagnosed in 48 cases. The authors highly appreciate this agent. In their opinion, it is essentially helpful in solving one of the most difficult problems in X-ray gastroenterology--present-day X-ray diagnosis of small bowel pathology. The paper describes a procedure for using this agent. It gives a normal X-ray pattern of the small bowel, the agent's use has provided a particularly vivid image of both a normal part of the ileum and its different organ pathology-associated changes.