[Pathological changes in the muscular tissue of the colon in diverticular disease]. / Patologicheskie izmeneniya myshechnoi tkani v stenke tolstoi kishki pri divertikulyarnoi bolezni.

The high incidence of colonic diverticular disease (DD) in the general population is a serious public health problem. According to statistics, DD is among the top five most common colorectal diseases. Complicated course of DD is observed in 12-15% of patients, and in 10.7% of cases can lead to death. Algorithms and recommendations for predicting the complicated course of DD for further prevention have not been developed. OBJECTIVE: Comparative analysis of clinical data and structural characteristics of the colonic muscular tissue in patients with different course of DD and without colonic diverticula to identify morphological predictors of a complicated DD. MATERIAL AND METHODS: A comparative analysis of clinical data, pathomorphological and ultrastructural changes of the colonic musculature in the surgical material from 68 patients undergoing left-sided hemicolectomy was carried out. RESULTS: The operative material of 37 patients with complicated course of DD, 19 with uncomplicated course of DD and 12 without diverticula was analyzed. In men, this disease occurs at a younger age than in women (Median age of men 49 (39.5; 61) years, women 66.5 (58; 81) years; U=178, p<0.001). It was shown that the area occupied by connective tissue fibres in the colonic musculature in patients with a complicated DD was 5 times greater (15%) than in observations with an uncomplicated DD (3%) and 50 times greater than in cases without colonic diverticula (0.3%; p<0.001). CONCLUSION: The present study demonstrates age- and sex-specific features of DD, as well as significant differences in the prevalence of fibrosis of the colonic musculature, which can be considered as a potential predictor of a complicated course of DD.

[Ultrasound diagnosis of acute appendicitis]. / Ultrazvukovaia diagnostika ostrogo appenditsita.

The possibilities of ultrasonic examination in the diagnosis of acute appendicitis are analysed. The ultrasonic parameters are systematized on the basis of examination of 76 patients with various forms of acute inflammation of the vermiform process and of 16 healthy individuals. Exosemeiotics of acute appendicitis is presented. The high significance of USE in complex examination of patients with suspected acute inflammation of the vermiform process difficult for diagnosis is shown. This was confirmed by the results of complex examination of 151 patients with various urgent pathological conditions whose clinical symptomatology was similar to that of acute appendicitis. It was found that USE improves the diagnostics in difficult clinical cases and lessens the number of diagnostic and tactical errors. The wide use of ultrasonic examination in the daily practice of surgical clinics is recommended.

[Basic principles of treatment for patients with acute pancreatitis]. / Osnovnye printsipy lecheniia bolnykh ostrym pankreatitom.

The results of treatment of 1,320 patients with acute pancreatitis were analysed, 460 of them had the destructive form of the disease. The high significance of multicomponent etiopathogenetic treatment is demonstrated. The importance of etiotropic treatment with the application of endoscopic interventions, as well as treatment with cytostatics is emphasized. Timely combined use of these methods prevents a progressive uncontrolled course, and reduces the volume of treatment and its duration. The authors also discuss the first experience in nontraditional management of patients with postnecrotic cavitary complications of pancreonecrosis by the aspiration "closed" method with the use of ultrasound.

[Pathologic changes of major duodenal papilla in biliopancreatic diseases]. / Rol izmenenii bolshogo duodenalnogo sosochka pri zabolevaniiakh organov pankreatobiliarnoi oblasti.

The condition of the major duodenal papilla and the periampullary region was studied in 1,113 patients with diseases of the biliary tract and pancreas. In 88.6% of cases complex examination revealed various pathological changes which were considered to be important etiological factors of the development of the diseases. These changes were found to be particularly significant in patients with the postcholecystectomy syndrome. The authors present the modern methods for correction of pathology of the major duodenal papilla, among which endoscopic interventions are most valuable.