[The closed injuries of the lower urinary tract: problems of the X-ray diagnostics].

The closed injuries of the lower urinary tract: problems of the X-ray diagnostics. Results of X-ray investigation were analyzed in 54 patients with urinary bladder trauma and 23 patients with urethral injuries. There were no false conclusions during urography in 23 patients with urethral injuries. In one patient urography was carried out in late terms due to the underestimation of urether trauma by the time of admission to the hospital. Cystography was carried out in 38 out of 54 patients to exclude bladder trauma. Presence of trauma was confirmed in 36 (94,7%) cases. False conclusion about the absence of bladder rupture was given in 2 (5,26%) cases. Type of rupture was misdiagnosed in 5 (13,1%) patients leading to increased extent of operation in 1 case. The reasons for the false conclusions were misconduction of investigation technique and underestimation of the obtained X-ray data.

[The preoperative thoracic X-ray for tactical decisions for the thoracic injuries treatment].

Data of 379 patients with penetrating thoracic wounds were analyzed. The pathologic changes on X-ray of the thoracic cavity were registered 239 (63,1%) patients: the hemothorax was diagnosed in 44,3%, pneumothorax - in 26,8% and hemopneumothorax - in 28,9%. 154 patients had videothoracoscopic surgery and 225 patients were operated on using traditional open methods. Operative findings were compared with X-ray data. The sensitivity of plain chest radiography in diagnostics of hemothorax was 52,1%, the specificity - 92,1%. Mistakes of interpreting X-ray data in diagnosing of low-volume hemo- or pneumothorax were defined. The computed tomography of the thorax proved to be the most precise means of intrapleural injuries diagnostics. The optimal algorithm of preoperative thoracic X-ray was suggested.

[Lung perfusion scanning in the comprehensive diagnosis of pulmonary thromboembolism].

The aim of the study was to define the sensitivity, specificity, and diagnostic accuracy of lung perfusion scanning (LPS) in pulmonary thromboembolism (PTE). PTE diagnostic techniques are comparatively assessed. The data on 108 patients with suspected PTE and lung perfusion defects revealed at pulmonary scintigraphy were analyzed. The diagnostic techniques included electrocardiography (ECG), 150 echocardiography, venous ultrasonography, chest X-ray, and LPS. The significant signs of PTE were singled out of 150 ones (history data, complaints, clinical symptoms, instrumental findings, autopsy data); LPS data were analyzed in detail. The sensitivity, specificity, and accuracy of LPS were 95.2, 20, and 77.7%, respectively. It is shown that lung scans should be interpreted, by taking into account X-ray data, and LPS should follow ECG, venous ultrasonography, and chest X-ray.

[Fistulography in destructive pancreatitis in postoperative period].

Results of different x-ray methods applied in 151 patients early after operations for destructive pancreatitis were analyzed. The technique of fistulography is described. Plain roentgenography of the chest demonstrated changes in 77.4% cases, most often occurred disk-shaped atelectases and pleural effusion. Examination of the abdominal cavity revealed functional disorders in 69.8% cases, direct symptoms of purulent process -- in 52.9%, radiographic signs of aseptic sequestration -- in 47.1% patients. X-ray signs of purulent process in the retroperitoneal fat and aseptic sequestration of the infiltrate or fat are outlined. The value of fistulography for localization and determination of the shape of drained cavities, position of the drainage tubes in the cavity, condition of the adjacent tissue, progression of purulent process, adequacy of drain of the purulent cavities is shown. Based on the results of complex x-ray examination with ultrasound investigation and CT data, the indications to repeated procedure (surgery or additional drainage) were formulated in 82 (54.3%) of 151 patients.

[Prevalence of hereditary pathology in Altai Republic]. / Rasprostranennost' nasledsvennoi patologii u naseleniia respubliki Altai.

Medical genetic study of the population of Altai Republic (Russia) has been performed. The population sample comprises 203 148 subjects, including 59 196 Altaians, 134 972 Russians, and 8980 Kazakhs. For each nosological group, the loads of Mendelian pathology with different modes of inheritance and their prevalence rates in urban and rural populations have been determined. Thirty-six autosomal dominant (AD) diseases have been found in a total of 121 subjects, with hereditary syndromes being the most prevalent. Autosomal recessive (AR) pathology is represented by 24 diseases found in 158 subjects, with metabolic disorders being the most prevalent; and X-linked pathology, by four diseases in nine subjects. The prevalence rate has been calculated for each nosological form in the district where it has been found. The loads of AD, AR, and X-linked pathologies in the urban population were, respectively, 2.98 and 9.62 per 1000 people and 0.56 per 1000 men in Altaians; 0.86 and 0.94 per 1000 people and 0.23 per 1000 men in Russians; 0.34 and 1.16 per 1000 people in Kazakhs. In the rural population, the genetic load has been calculated for each district. The spectrum of hereditary pathology in the populations studied is described.

[Phlegmon of retroperitoneal cellular tissue after endoscopic papillosphincterotomy]. / Flegmona zabriushinnoi kletchatki posle éndoskopicheskoi papillosfinkterotomii.

Phlegmon of retroperitoneal cellular tissue as a complication of endoscopic papillosphincterotomy (PST) was observed in 9 patients. All these patients in the first several hours after PST complained of pains in epigastrium and right hypochondrium. 2 days later the signs of pyogenous intoxication appeared. For diagnosis of complications after PST roentgenological and radionuclide methods as well as US examination and computer tomography were used. For exploration of retroperitoneal phlegmon extraperitoneal approach was employed. The phlegmon cavity was drained by number of tubes TMMK and aspiration-lavage treatment 3 patients died.

[The surgical treatment of retroperitoneal phlegmons]. / Khirurgicheskoe lechenie zabriushinnykh flegmon.

Based on the experience with treatment of 112 patients with retroperitoneal phlegmons of different etiology the authors distinguish and describe the diffuse and complicated forms of the disease. In treatment of phlegmons special importance is attached to the optimal surgical access. The article describes main principles of performing sanitation of the suppurative foci of the retroperitoneal space, variants of the aspiration-irrigation methods of treatment of the suppurative process. The authors believe that their original differentiated surgical method using different variants of the aspiration-irrigation drainage is effective in treatment of patients with retroperitoneal phlegmons. This method of treatment gave 23.2% lethality while after the traditional methods of treatment 90% of the patients died.

[X-ray diagnosis of a phlegmon of the retroperitoneal space tissue]. / Rentgenologicheskaia diagnostika flegmony kletchatki zabriushinnogo prostranstva.

The paper is concerned with the results of a combined x-ray study of 36 patients with phlegmon of retroperitoneal fat (RF). The x-ray procedure was described, potentialities and effectiveness of each method (panoramic polypositional investigation of the chest and peritoneal cavity, a contrast study of the G.I. tract) were shown. X-ray semeiotics of phlegmon of RF of different sites, the main differential and diagnostic signs to distinguish between phlegmon and accumulation of gases of other sites and its causes, were described in detail. The accuracy of phlegmon detection with these methods was 97.2%; phlegmon was detected in 35 of 36 patients.

[Roentgeno-ultrasound diagnosis of acute pancreatitis and its complications]. / Rentgenoul'trazvukovaia diagnostika ostrogo pankreatita i ego oslozhnenii.

A program of combined radio-ultrasound diagnosis of acute pancreatitis was developed. Altogether 1257 patients were investigated over time, of them various complications were found in 303 (24%). The accuracy of detection of acute pancreatitis was 92%, that of purulent complications was 93%, that of false pancreatic cysts was 98.2%. Ultrasound and roentgenological semiotics of various types of complications of pancreatitis was described. Ultrasound investigation was shown to be the most important one in the diagnosis of patients with acute pancreatitis.

[A complex x-ray study of patients with enterocutaneous fistulas]. / Kompleksnoe rentgenologicheskoe issledovanie bol'nykh s naruzhnymi kishechnymi svishchami.

The paper is concerned with analysis of the results of x-ray examination of 78 patients with enterocutaneous fistulas of various etiology and site. The authors have shown the characteristic features of x-ray examination of patients in whom the fistulas were at the acute phase of their development. They have also defined the diagnostic value of the employed methods and their efficacy for the diagnosis not only of fistulas but also of related complications (inflammatory infiltrates and abscesses of the abdominal cavity, fatty phlegmon, purulent "fillings", complicated fistulas, etc.). During combined x-ray investigation accurate diagnosis of fistulas was established in 97.4% of the patients, purulent complications were revealed in 94.6%.

[Characteristics of the diagnosis and surgical treatment of injuries of the duodenum]. / Osobennosti diagnostiki i khirurgicheskogo lecheniia povrezhdenii dvenadtsatiperstnoi kishki.

Specific features of diagnostics and surgical treatment of injuries of the duodenum in 41 patients with open and closed traumas of the abdomen are described. A wide access by means of mobilization of the right colic flexure should be used for the revision of the duodenum. In cases with closed injuries of the duodenum, in addition to maintenance of its reliable decompression, it is necessary to exclude the intestine from the passage of the gastric content. In order to prevent postoperative pancreatitis cholecystostoma should be made.

[Early diagnosis of acute pancreatitis]. / Ranniaia diagnostika ostrogo pankreatita.

The article discusses clinical experience of the Sklifosovsky Emergency Ambulance Service Institute in establishing early diagnosis of acute pancreatitis in the last decade. Over 3,000 patients were examined; they were admitted to the Institute for acute pancreatitis the diagnosis of which was made according to the program of complex diagnosis at the stage of the admission department and during the first three days of the hospital stage. The decisive role in establishing the diagnosis is attached to the clinical manifestations, medical history, amylasuria, and obligatory radiological and ultrasonographic examination (USE). The characteristic radiological and ultrasonic signs of various forms of acute pancreatitis are described. Radiological pleuro-pulmonary signs were found in 15.1% of patients with the edematous and in 42% of those with destructive pancreatitis. Specific indirect signs during radiography of the abdominal organs were registered in almost 80% of cases of acute pancreatitis. Informativeness of USE in acute pancreatitis was 95.4%, and it also made it possible to identify the clinico-morphological form of the disease. It is emphasized that USE must be undertaken in the first hours of the patient's admittance to the clinic. The suggested complex program of early diagnosis may be used in essence in all emergency ambulance service hospitals.