[Endovideosurgical interventions for thoracoabdominal wounds].

The authors presented results of examination and treatment of 1347 patients with different injuries of the chest and abdomen. Medico-diagnostic measures used in treatment of such kind of patients with rational application of endovideosurgical techniques such as thoraco- and laparoscopy are described which proved to be the final kind of operative treatment.

[Ways of optimization of standards of treatment of acute cholecystitis].

The article presents an analysis of tactical approaches in patients with acute cholecystitis on the basis of an experience with treatment of acute cholecystitis under conditions of multiprophile hospital in Saint Petersburg and modern ideas of the problem in the world.

[Endoscopic methods of hemostasis in treatment of Mallory-Weiss syndrome].

Results of treatment of Mallory-Weiss syndrome using endoscopic methods of hemostasis in 549 patients were analyzed. The patients were divided into two groups: in 2000-2004 years without endoscopic methods, in 2004-2008 years using the endoscopic methods in the diagnostics and treatment. Considerably decreased operative activity and death rate was established in cases of treatment with endoscopic methods.

[Specific features of medico-diagnostic strategy for cholesterosis of the gallbladder].

The work shows the incidence, criteria of the diagnosis and indications for surgical treatment of patients with cholesterosis of the gallbladder. An analysis of the results of examination and treatment of 3426 patients with diseases of the gallbladder has shown that the ultrasonic method of diagnostics allows detection of the cholesterosis form and determination of treatment strategy.

[Thoracoscopy in verification and treatment of pleural exudate syndrome under conditions of a multifield hospital].

Under an analysis of results of treatment of 186 patients with pleural exudate syndrome there were 139 patients treated by traditional methods, 47 patients treated using the proposed medico-diagnostic program based on using thoracosopy under local anesthesia. Using the proposed medico-diagnostic measures can be used at any multifield hospital where patients with pleural exudate syndrome are admitted although the hospital has neither phthisiatrical nor phthisiothoracic departments.

[Experience with treatment of patients with villous adenoma of the large intestine].

The authors analyzed an experience with treatment of 176 patients. It was shown that increasing colonoscopy allowed clear differentiation of neoplasm in the colon, decision on the strategy of treatment. The effective method is endoscopic resection of intestine mucosa.

[Postulcerorhaphic syndrome: causes of the development and pathogenetic forms].

The article deals with the question of consequences of suturing perforating pyloroduodenal ulcer in late terms in 355 patients. Marking out the postulcerorhaphic syndrome which complicated the course of the ulcer disease in 24.5% of cases and requires the determination of early indications to reoperation was grounded.

[Chronic complicated pancreatitis. Diagnostics and surgical treatment].

The article presents an analysis of surgical treatment of 186 patients with complicated forms of chronic pancreatitis. Potentials of different instrumental techniques of investigations in diagnostics of complications of chronic pancreatitis are analyzed. Performance of retrograde cholangiopancreatography in chronic pancreatitis was shown to be expedient. Potentials of minimally invasive technologies and effectiveness of these interventions in different complicated forms of chronic pancreatitis were studied. Differentiated approach to decision on the kind and volume of operation depending on the complication character was shown. The proposed diagnostic algorithm and medical strategy allowed satisfactory immediate results to be obtained in this difficult group of patients.

[Features of verification of virus B hepatitis in patients with acute cholecystitis].

The article is devoted to studying possibilities of USI in different diagnostics of acute hepatitis B and acute cholecystitis. An analysis of the data of 201 patients has shown high sensitivity and specificity of the method of detection of acute hepatitis and estimation of its severity. Symptoms not described in literature previously are described. The immunohistochemical method allows verification of expression of the hepatitis virus antigen in tissue of the liver and gallbladder even in cases of the absence of data of carriage of virus hepatitis.

[Thoracoscopy in the diagnostics and treatment of chest injury].

The authors have analyzed their experience with treatment of 67 casualties with injuries of the chest of different character. The diagnostic and treatment algorithm was based on the principle of using primary thoracoscopy with local anesthesia during draining the pleural cavity. The proposed algorithm can be used at any hospital rendering emergency to casualties with injuries of the chest independent of the level of available equipment.

[Specific features of strategy of treatment of acute cholecystitis under conditions of multifield hospitals: unsolved problems].

An experience with different approaches to treatment of acute cholecystitis under conditions of multifield hospitals is described. On the basis of comparative data of treatment of 10518 patients the optimal strategy of treatment of acute cholecystitis was determined.

[Use of the multislice spiral computed tomography in planning the treatment of patients with tumors of the biliopancreatoduodenal zone].

The authors elucidate an experience with using multislice spiral computed tomography with the method of multiphase scanning (CT-angiography) in patients with suspected tumors of organs of the biliopancreatoduodenal zone. The proposed method allows getting information on the character of the pathological process, dissemination of the tumor lesion. It helps to decide on the strategy of treatment of the patient, to plan the operative intervention and assess the results of operative treatment.

[Minimal invasive methods of treatment of patients with gastroduodenal ulcerous bleedings].

An analysis of results of treatment of 913 patients has shown that the endoscopic methods of hemostasis allowed reducing the operative activity from 63 to 14%. Impossible implementing endoscopic hemostasis and high risk of bleeding in patients with giant ulcers were considered as indications to operative treatment.

[Video capsule endoscopy in the diagnostics of small intestine diseases].

Video capsule endoscopy is a safe and noninvasive, well-endurable method of the direct visual inspection of the whole of the small intestine. The most frequent indications for video capsule endoscopy are the diagnostics of latent gastro-intestinal bleedings, angiodysplasias, Crohn disease, celiac disease, syndromes of hereditary polyposis and tumors of the small intestine. The authors describe the first experience of using this new method in the domestic clinical practice. Data concerning the diagnostics of lesions of the small intestine by the method of video capsule endoscopy as well as the wide range of lesions of the mucous membrane in different diseases of the small intestine are presented.

[Potentials of computed-tomography colonography with added investigations of the abdominal cavity and small pelvis in the diagnosis of diseases of the colon, assessment of dissemination of the pathological process].

The aim of the investigation was an assessment of potentials of computed-tomography colonography (CTC) in diagnosis of diseases of the colon. CTC was made in 125 patients. The investigation was performed after special preparation of the patients for purgation of the colon. The patient was in the supine and prone position. After introduction of room air in the colon the axial sections were laid from the diaphragm cupola to the pelvic floor. The obtained data were estimated and the reconstructions were fulfilled using special software. Pathological alterations or anatomical specific features of the colon were detected in 86 out of 125 cases (68.8%), in 26 of the cases (28.6%) a conclusion was made of malignant tumors in the colon according to the data of CTC. The data obtained by CTC were compared with the data of fibrocolonoscopy, rectomanoscopy, irrigoscopy and histological investigation. In most cases the coincidence of the findings was noted.

[Transabdominal ultrtasonic investigation of the upper parts of the gastro-intestinal tract in diagnostics of ulcer disease and decision on the strategy before and after surgery].

The authors present an analysis of results of the diagnostics and treatment of 293 patients admitted to the Alexandrovskaya hospital of St. Petersburg in 1995-2005 for gastroduodenal ulcer, including 202 patients after operative treatment. The morpho-functional state of the upper parts of the gastro-intestinal tract was assessed by the method of transabdominal sonography of the stomach and duodenum with a convection transducer 5 MHz in on-line regimen. The informative value of the method corresponds to the reference diagnostics method, sensitivity of the method was 91%, specificity--95%. The ultrasound investigation of the stomach and duodenum is a highly efficient method of diagnostics of the morpho-functional state of the gastro-duodenal system giving a reliable interpretation of the local morphological and functional changes, ulcer disease included, corresponding to the efficiency of the reference diagnostics methods. The sonography allows a dynamic control of the treatment process, assessment of the alterations after surgery on the stomach and duodenum and decision on the exact surgical strategy.

[Transjugular intrahepatic portosystemic shunt (TIPS): an experience with treatment of portal hypertension in patients with cirrhosis of the liver].

TIPS procedures have been successfully performed in 18 of 21 patients aged 34-64 (mean age 40 years) with cirrhosis of the liver with acute gastroesophageal bleedings (5) or history of bleeding episodes from gastroesophageal varices (13). The patients were classified according to Child (1964): A--4; B--8 and C--6. The portal pressure before creation of the shunt measured 17-39 (mean 28.1 +/- 7.6) mm Hg. Dilation of the hepatic tissue was performed by a balloon 10 mm in diameter and 4-6 cm long with placement of metallic endoprostheses 10-12 mm in diameter and 80 mm long. The portal pressure after anastomoses were made dropped to 6-28 (mean 20.3 +/- 5.7) mm Hg. The angiogram showed a rapid flow of the contrast medium through the portocaval anastomosis towards the right heart and no filling of the esophageal veins was seen. TIPS procedure is an effective measure to stop variceal gastroesophageal bleeding in patients with portal hypertension. The necessity of regular surveillance and reinterventions makes this approach a temporary measure to reduce hazardous consequences of gastroesophageal hemorrhages.