[A new view on the problem of nonneoplastic stenosis of the major duodenal papilla. Results of a prospective investigation].

The article contains results of a continuous prospective investigation of the normal course of the major duodenal papilla stenosis in 167 patients. It was revealed that the course of the disease was benign, pain syndrome became inconsiderable in the course of time, the degree of changes in biochemical analysis of blood was not significant. The development of complications (choledocholithiasis, acute pancreatitis, jaundice) was noted in 6-14% of the patients, depending on the presence or absence of GID. The data obtained allow suggestion of an algorithm of managing the patients.

[Gastric carcinoid--modern approaches to diagnosis and treatment].

Gastric carcinoid tumors are rare, but are increasing in incidence. This article reviews what is known about the classification, epidemiology, tumor pathogenesis and management of patients. Additionally we present the results of our own 10-years observation after endoscopic and surgery treatment of this tumors.

[Significance of the operational test parameters in selection of a diagnostic test for Helicobacter infection]. / Znachenie operatsionnykh kharakteristik testa pri vybore metoda diagnostiki infektsii Helicobacter pylori.

The group of 89 patients was examined, 63 of them suffered by a duodenal ulcerative disease, 11--by gastric ulcerative disease and 15--by chronic gastritis. It was conducted the comparison of the following indices: sensitivity, specificity, relationship of probability and diagnostic efficiency of histological, cytological methods, urease and respiratory tests, method of polymerase chain reaction, qualitative and quantitative definition of antibodies of the class IgG in serum blood to H. pylori by a method of enzyme immunoassay and Western-blot for H. pylori infection diagnostics was carried out. The results show that in choice of a diagnostic method of infection H. pylori it is better to use such characteristics as sensitivity and specificity, which more objectively reflect the diagnostic possibilities of each test.

[The use of decompressive endoscopic operations in the complicated course of cholelithiasis]. / Primenenie dekompressivnykh éndoskopicheskikh operatsii pri oslozhnennom techenii zhelchnokamennoi bolezni.

The article is based on an analysis of observation of 853 patients with complicated forms of cholelithiasis. The average age of patients was 73.5 years, two thirds of them had critical coexistent diseases. The system of treatment proposed by the authors allowed achievement of good results (lethality is less than 5%) while the methods of treatment generally accepted in surgical practice is followed by higher lethality achieving 40%. The work analyzes errors and complications of endoscopic decompressing operations and gives recommendations for their prevention.

[Therapeutic tactics in acute obstruction of the terminal part of the common bile duct]. / Lechebnaia taktika pri ostroi blokade terminal'nogo otdela kholedokha.

The authors had 158 patients with acute block of the terminal part of the choledochus under observation. According to the clinical course, a biliary, pancreatic, and mixed forms were distinguished. The emergency diagnostic program was made up of ultrasonic examination, esophagogastroduodenoscopy, ERCP, and laparoscopy. The cause of the block of the terminal choledochus was choledocholithiasis in 104 patients, papillitis and microcholedocholithiasis in 36, and ++choledocholithiasis and stenosis of the major duodenal papilla in 18 patients. Acute block of the major duodenal papilla was found in 76 and acute block of the intramural part of the choledochus in 76 patients. The mixed form prevailed in the first and the biliary form of hypertension in the second. Operations (cholecystectomy, choledocholithotomy with external or internal drainage of the choledochus) were performed on 42 patients, the postoperative fatality rate was 9.7%. Emergency EPST and extraction of concrements was undertaken in 116 patients. Increase in the clinical picture of acute cholecystitis and destructive pancreatitis after EPST called for operative interventions on 21 patients. The lethality rate after EPST performed for acute block of the terminal choledochus was 6.1%.

[Ultrasonic and x-ray parallels in the diagnosis of cholelithiasis]. / Ul'trazvukovye i rentgenologicheskie paralleli v diagnostike kholelitiaza.

The sensitivity and specificity of ultrasound investigation (USI) and x-ray methods of indirect and direct contrast studies of the biliary system in the diagnosis of cholecysto- and choledocholithiasis were compared by a blind control method. USI was shown to be superior over all x-ray contrast methods in the diagnosis of cholecystolithiasis. The diagnosis of choledocholithiasis usually requires the use of x-ray methods among which preference should be given to endoscopic retrograde cholangiography as the most informative method permitting simultaneous intervention on the major duodenal papilla.