[Tuberculous abdominal cocoon as a rare variant of peritonitis]. / Osumkovyvayushchii tuberkuleznyi perivistserit kak redkii variant peritonita.

OBJECTIVE: To study and systematize clinical symptoms of tuberculous perivisceritis, to clarify diagnostic value of laboratory and instrumental survey in these patients and to identify the features of surgical treatment. MATERIAL AND METHODS: There were 8 patients with tuberculous perivisceritis. Examination included computed tomography of the abdominal cavity and chest, ultrasound, laparoscopy. All patients underwent surgical treatment with histological, cytological, microbiological and molecular genetic analysis of peritoneal exudate and biopsy of peritoneal specimens. RESULTS: Clinical picture of tuberculous perivisceritis is variable and non-specific. Periods of exacerbation are replaced by periods of prolonged remission. The complex of radiological survey used in verification of perivisceritis does not allow accurate determining the nature of disease. However, peritoneal tuberculosis may be suspected as a rule considering signs of thickening of the peritoneum. Objective confirmation of perivisceritis is possible only during surgical intervention. In this case, etiological factor can be established only after a thorough histological examination of resected fibrous capsule. CONCLUSION: Clinical picture of tuberculous perivisceritis does not have specific symptoms. The disease is characterized by prolonged and undulating course. Acute peritonitis and acute intestinal obstruction may be suspected during exacerbation of the pathological process. Laparotomy followed by complete excision of fibrous capsule and adhesiolysis is preferred.

[Tuberculous peritonitis. 'Forgotten' disease]. / Tuberkuleznyi peritonit. 'Zabytaia' bolezn'.

AIM: To analyze diagnosis and treatment of patients with tuberculous peritonitis, to develop the algorithms for instrumental examination and differential diagnosis. MATERIAL AND METHODS: There were 48 patients with tuberculous peritonitis. The examination included radiography, abdominal and thoracic computed tomography, ultrasound, and laparoscopy. All patients underwent histological, cytological, microbiological and molecular-genetic analysis of abdominal exudate and peritoneal biopsy. Exclusion criterion was signs of secondary peritonitis. RESULTS: Clinical picture of tuberculous peritonitis was accompanied by nonspecific symptoms. Previously identified pulmonary tuberculosis and HIV-infection were present in 93.8 and 70.8% of patients. Diagnostic laparoscopy of abdominal cavity as the main method of instrumental diagnosis together with cytological, molecular-genetic and microbiological research of peritoneal exudate and tissue specimens were useful to determine diagnosis in 87.2-95.8% of cases. CONCLUSION: Tuberculous peritonitis may be assumed in patients with previous tuberculosis of lungs or other localizations, HIV-infection. Computed tomography is the most informative method to diagnose tuberculous peritonitis. Diagnostic laparoscopy is indicated for suspected tuberculous peritonitis. This procedure is supplemented by peritoneal biopsy, cytological, molecular-genetic and microbiological examination of peritoneal exudate and tissue specimens.

[A case report of central pontine and extrapontine myelinolysis in the combination with spinal cord damage in a patient with tuberculosis in the lung]. / Sluchai tsentral'nogo pontinnogo i ekstrapontinnogo mielinoliza v sochetanii s porazheniem spinnogo mozga u bol'nogo tuberkulezom legkikh.

A case report of central pontine and extrapontine myelinolysis in the combination with spinal cord damage is presented. The authors analyze literature data on this problem and discuss the pathogenesis and diagnostic issues of myelinolysis.

[Possibilities of computed tomography in the diagnosis of primary pulmonary vasculitis].

OBJECTIVE: To study the main computed tomography (CT) signs of primary pulmonary vasculitis at different stages of disease development. MATERIAL AND METHODS: Eighty-nine patients, including those with Wegener's granulomatosis (WG) (n = 60), Churg-Strauss syndrome (CSS) (n = 24), or microscopic polyangiitis (MPA) (n = 5), were examined. Vasculitis was diagnosed on the basis of comprehensive clinical, X-ray, and morphological examination. CT study was performed in 40 (85.1%) patients over time. Radiography encompassed chest X-ray and computed tomography. RESULTS: The CT signs of WG were as follows: parenchymal infiltrates in 41 (68.3%) patients, vast zones of ground glass and consolidation in 16 (21.6%), and bronchial wall thickening in 27 (46.7%). The infiltrates showed aseptic decay cavities in 26 (63.4%) cases. In CSS, the CT changes included ground glass symptom (100%), consolidation symptom (54.2%), bronchial wall thickening concurrent with bronchial dilatation (87.5%), and increased peripheral pulmonary vessel diameter (45.8%). CSS was typified by migratory infiltrates. The pulmonary manifestations of MPA were characterized by the regions of alveolar infiltration of varying intensity and extent. CONCLUSION: The use of CT in pulmonary vasculitis makes it possible to reliably detect and differentiate pathological changes in the lung, to estimate their extent and monitor the efficiency of treatment.

[The clinical and X-ray classification of osteonecrosis of the low jaw].

OBJECTIVE: To elaborate a clinical and X-ray classification of osteonecrosis of the low jaw in people with desomorphine or pervitin addiction. MATERIAL AND METHODS: Ninety-two patients with drug addiction who had undergone orthopantomography, direct frontal X-ray of the skull, and multislice computed tomography, followed by multiplanar and three-dimensional imaging reconstruction were examined. One hundred thirty four X-ray films and 74 computed tomographic images were analyzed. RESULTS: The authors proposed a clinical and X-ray classification of osteonecrosis of the low jaw in people with desomorphine or pervitin addiction and elaborated recommendations for surgical interventions on the basis of the developed classification. CONCLUSION: The developed clinical and X-ray classification and recommendations for surgical interventions may be used to treat osteonecroses of various etiology.

[The treatment of the sponateneous biloma and choledocholithiasis after the liver resection on the reason of the giant hemangioma].

Patient with giant rapidly growing liver hemangioma who carried out right hemihepatectomy is reported. The feature if this case is choledocholithiasis after liver resection followed by its rare complication (spontaneous biloma) in 6 years after surgery. Minimally invasive procedures (percutaneous drainage, endoscopic papillotomy and stenting) eliminated each of bile collection and cause of biliary obstruction without surgical intervention.

[Goodpasture's syndrome as a cause of pulmonary hemorrhages]. / Sindrom Gudpaschera kak prichina legochnykh gemorragii.

Analyzing the case histories of 5 patients with Goodpasture's syndrome who have admitted to an emergency clinic for suspected tuberculosis leads to the conclusion that the onset of the disease appeared as intoxication and lung damage, and evolving general weakness, fever, cough. Hemopoiesis appeared just when overall clinical manifestations appeared, it varied from single sputum blood filaments to more frequent mows of pure red blood sputum for several weeks, but there was never an increasing hourly progressively and this failed to cause a rapid drop of hemoglobin. Anemia is attributable by pulmonary blood imbibition, intoxication, and suppressed hemopoiesis in renal failure rather than by external blood loss as hemoptysis.