[Dilated phase of hypertrophic cardiomyopathy: high-risk reconstructive surgery as an alternative to heart transplantation]. / Dilatatsionnaya faza gipertroficheskoi kardiomiopatii: rekonstruktivnaya khirurgiya bol'shogo riska kak al'ternativa transplantatsii serdtsa.

The authors report the diagnosis and surgical treatment of 5 patients with dilated phase of hypertrophic cardiomyopathy (HCM). Features of these patients are progressive heart failure, double-level blood flow obstruction and the risk of apical aneurysms. Reconstructive remodeling surgery is a reasonable alternative to heart transplantation despite the existing risk.

Recovery of fat following a switch to nucleoside reverse transcriptase inhibitor-sparing therapy in patients with lipoatrophy: results from the 96-week randomized ANRS 108 NoNuke Trial.

OBJECTIVES: To evaluate the impact on peripheral fat tissue of a nucleoside reverse transcriptase inhibitor (NRTI)-sparing regimen in lipoatrophic HIV-1 infected patients. METHODS: This 96-week prospective, randomized study compared lipoatrophic patients switched to an NRTI-sparing regimen with patients remaining on an NRTI-containing regimen. The primary endpoint was the change in thigh subcutaneous fat tissue volume between baseline and week 48, as assessed by computerized tomography. RESULTS: One hundred patients were included, 50 in each arm. At baseline, patients had been on highly active antiretroviral therapy (HAART) for a median time of 6.6 years (4.9-9.7); 71% of the patients had received thymidine analogues [stavudine (37%), zidovudine (34%)]. The mean change in fat volume between baseline and week 48 significantly favoured the NRTI-sparing arm over the NRTI-maintaining arm in the intent-to-treat analysis, with a last-observation-carried-forward approach [+34 cm(3); 95% confidence interval (CI) 5-63 cm(3); P=0.002]. This was confirmed in the intent-to-treat analysis of available data, with a mean difference of +109 cm(3) (95% CI 34-185 cm(3)) at week 96 (n=53; P=0.001). This corresponded to increases of 12 and 30% in fat volume at weeks 48 and 96, respectively, in the NRTI-sparing arm. CONCLUSIONS: Switching from an effective NRTI-containing regimen to an NRTI-sparing regimen preserves immunovirological status and increases subcutaneous fat volume at weeks 48 and 96.

[Laparoscopic surgery in adhesive disease]. / Laparoskopicheskie operatsii pri spaechnoi bolezni.

Experience in 2277 laparoscopic surgeries performed in patients with history of conventional and minimally invasive surgeries is analyzed. Regularities of commissures formation after some surgeries are determined. Viscero-parietal commissures (VPC) which are the main cause of possible intraoperative complications were revealed in 1746 (76,7%) patients. Diagnostic value of special ultrasonic examination was 95,5%, on the average. Laparoscopic adhesiolysis in different types of adhesive disease was attempted in 195 patients, 170 (87,2%) procedures were finished successfully. Application of Interceed (TC-7) on parietal peritoneum was used in 14 patients to prevent repeated formation of commissures.

[Errors in ultrasonic diagnosis of abdominal diseases]. / Oshibki ul'trazvukovoi diagnostiki zabolevanii organov briushnoi polosti.

Errors in the ultrasonic diagnosis of diseases of the abdominal organs in 2,218 patients were analysed in comparison to endoscopic and operative findings. The errors were few in number. A precise diagnosis was established in 99.6% of cases with acute cholecystitis and in 78% of those with a pathological process in the biliary tract. A maximum number of errors (7 per 42 cases) was encountered in carcinoma of the gallbladder. Ultrasonic examination may serve as the basis for choosing the method of rational therapy in diseases of the liver, pancreas, and complications in the postoperative period. Thus, the results of ultrasonic examination may be fully relied on or may be used as a basis for choosing manipulations which are more invasive in character.

[Special methods of examination in the diagnosis of cholelithiasis]. / Spetsial'nye metody issledovaniia v diagnostike kholelitiaza.

Rational combination of special methods of examination yields exact, objective, and detailed information for the diagnosis of cholelithiasis. Ultrasonic examination (USE) is an absolutely noninvasive method and therefore precedes all the other methods. USE suffices for the diagnosis of uncomplicated calculous cholecystitis. USE and intravenous cholegraphy are indicated in complicated cholecystitis without jaundice, USE and percutaneous transhepatic cholegraphy--in the presence of jaundice. These methods of examination are supplemented with endoscopic retrograde cholangiopancreatography in cases which are difficult for differential diagnosis and in those with cicatricial strictures of the bile ducts. Laparoscopy and aspiration biopsy of the liver usually complete the examination. In emergencies diagnostic laparoscopy, despite its definite invasive character, is conducted after USE.