[Challenges and opportunities for endoscopic ultrasound in the preoperative diagnosis of topical insulin the pancreas].

Insulinoma in most cases is monohormonal orthoendocrine tumor. This fact limits its searching area by a pancreas. However the insulinoma's clinical picture can be caused by other pathology. Therefore the main task of visual the tumor but also to use all the possibilities of each method for defining type of surgery and avoiding such errors and complications, as pancreatorrhage, damage of bile or pancreatic duct, necrosis of duodenal wall, etc. On the basis of our own experience of endoscopic ultrasound for 61 patients with 66 insulinomas, we have allocated the basic variants of insulinoma ultrasound pictures: hypoechoic, heteroechoic, isoechoic tumor, and also foci without a trustworthy contour. On the basis of the analysis of our own errors we have essentially added the technique, having used multiplane pancreas scanning and biplane tumor scanning. Important points in EUS algorithm are also the following items: detecting tumor relationship to pancreatic surface, distance from the tumor to the ducts, gastrointestinal wall and vessels--for definition of possibility of the tumor enucleation; careful scanning of pancreas even after detecting one tumor--for an exception of multiple tumors, especially at MEN-I; careful scanning of a contour of the gland for an exception of parapancreatic insulinomas; estimation of vascularization not only of the detected tumor and suspicious foci, but also of all the gland--for detection of hypervascularized isoechoic tumors; revealing and the description of focal changes, especially more homoechogeneous in comparison with surrounding parenchyma-- for selection patients for examination by other methods; scanning of zones of possible metastasis. Examination of patients with organic hyperinsulinism demands combined application of two or more techniques. Use of all modern possibilities of endosonography can put this technique on one of the first places in the diagnosis of insulinomas.

[Clinico-morphological characteristics of major duodenal papilla benign neoformations of patients with postcholecystectomy syndrome].

The article is devoted to a problem of diagnosis and treatment of postcholecystectomy syndrome caused by benign neoformations of the major duodenal papilla. The material of study was formed by 76 patients; among them 53 ones had isolated benign neoformations of the major duodenal papilla. The medical-diagnostic algorithm applied by authors for the examination of patients with postcholecystectomy syndrome is presented. It's been defined, that benign neoformations of the major duodenal papilla take an essential place in the structure of postcholecystectomy syndrome and make 13.5% of the reasons of its occurrence. Thus, the most widespread morphological substratum of these benign neoformations is the hyperplastic polyp.

[Characteristics of diagnostic of cyst esophagus].

The paper present a clinical diagnosis of cysts of the esophagus surveillance, identified the patient in adulthood, as a review of the literature, reflecting the questions of clinic, diagnosis and the treatment of esophageal cysts.