[The distal pancreatic resection with spleen preservation: which collaterals can we rely on?].

The spleen preservation by distal pancreatic resection can be performed either with spleen vessels preservation or with the ligation of the least. The experiment evolved ligation of all gastric arteries but the short gastric arteries in 20 cadaveric organocomplexes, followed by ink perfusion through the left gastric and left gastro-epiploic arteries. The study was amplified with the intraoperative dopplerography of portal arteries of the spleen after crossclamping of the left gastro-epiploic and short gastric arteries. Ten patients after distal pancreatic resection with spleen preservation and splenic vessels ligation had the CT-angiography before and after the surgery. All the conducted studies demonstrated the incapability of short gastric arteries to supply the satisfactory spleen perfusion. The left gastro-epiploic artery proved to be the main source of splenic blood supply after splenic vessels ligation.

[Complex ultrasonic diagnosis of large and gigantic non-parasitic cysts of liver].

The results of clinical and complex ultrasonic examination of 95 patients with large and gigantic liver non-parasitic cysts (LNC) are analyzed. The morphological examination was performed in all the cases. The mean diameter of large LNC was 105+/-7 mm, of gigantic cysts -- 149+/-33 mm (p<0,05), cyst volume was respectively 600+/-142 and 1721+/-954 ml (p<0,05). Analysis of clinical, ultrasonic and laboratory data allowed to describe three variants of large and gigantic, complicated and non-complicated cysts with 97,9% accuracy. The 3-D US reconstruction permitted to precise the anatomic structure and trace selection during transcutaneous US-assisted treatment.

[Ultrasound-assisted puncture method of treatment of hepatic hydatid cysts]. / Punktsionnyi metod lecheniia ékhinokokkovykh kist pecheni pod kontrolem ul'trazvukovogo issledovaniia.

Results of treatment of 31 hepatic hydatid cysts in 28 patients were analyzed. The size of the s ranged from 3 to 25 cm. In 26 cases the cysts contained flive es, in 2 cases they were suppurated after US-assisted intraoperative puncture. Simple hydatid cysts (type I by M. Milcevic) were diagnosed in 24 patients (solitary--in 22, multiple--in 2), solitary cysts of type II--in 2 patients. In 23 cases aspiration-catheter treatment with complete removal of chitin membrane by one-stage (4) or two-stage (19) methods was performed. After removal of chitin membrane in 3 patients lateral fistula between spurious cysts cavities and peripheral branches of intrahepatic bile ducts were revealed which spontaneously. Glue composition "Rabrom" was used in 2 cases for closure of the residual cavity. In 4 patients who had cysts less 6 cm in size puncture irrigation of chitin cavity with 30% NaCl (PAIR technique) without it removal was performed. In one patient transcutaneous catheter (PAIR-PD technique) was used for irrigation of the cyst larger than 6 cm. The duration of two-stage aspiration-catheter treatment with removal of chitin membrane was 25.6 +/- 9.6 days. In moderate calcinosis of the fibrous membrane and bile fistulas period of hospitalization was 34 +/- 8.1 days. Treatment with PAIR and PAIR-PD took 1 and 3 days respectively. Complications of percutaneous methods were regarded as mild: hyperthermia (12), right-sided hydrothorax (6), subcapsular hematoma (1), urticaria (1). All the complications were treated conservatively and with US-assisted punctures. Long-term (from 6 months to 9 years) results of treatment were followed up in 26 patients: there were no recurrences. Suppuration of the residual cavity 6 months after the glue occlusion was eradicated by transcutaneous catheter drainage. One lethal outcome was not associated with complications of aspiration-catheter treatment. Both methods of transcutaneous treatment of hepatic hydatid cysts are effective and safe. A hypertonic solution of NaCl I produces a reliable antiscolecidal and sclerosis effect.