[Tuberculous abdominal cocoon as a rare variant of peritonitis]. / Osumkovyvayushchii tuberkuleznyi perivistserit kak redkii variant peritonita.

OBJECTIVE: To study and systematize clinical symptoms of tuberculous perivisceritis, to clarify diagnostic value of laboratory and instrumental survey in these patients and to identify the features of surgical treatment. MATERIAL AND METHODS: There were 8 patients with tuberculous perivisceritis. Examination included computed tomography of the abdominal cavity and chest, ultrasound, laparoscopy. All patients underwent surgical treatment with histological, cytological, microbiological and molecular genetic analysis of peritoneal exudate and biopsy of peritoneal specimens. RESULTS: Clinical picture of tuberculous perivisceritis is variable and non-specific. Periods of exacerbation are replaced by periods of prolonged remission. The complex of radiological survey used in verification of perivisceritis does not allow accurate determining the nature of disease. However, peritoneal tuberculosis may be suspected as a rule considering signs of thickening of the peritoneum. Objective confirmation of perivisceritis is possible only during surgical intervention. In this case, etiological factor can be established only after a thorough histological examination of resected fibrous capsule. CONCLUSION: Clinical picture of tuberculous perivisceritis does not have specific symptoms. The disease is characterized by prolonged and undulating course. Acute peritonitis and acute intestinal obstruction may be suspected during exacerbation of the pathological process. Laparotomy followed by complete excision of fibrous capsule and adhesiolysis is preferred.

[Gallstone ileus: diagnosis and treatment]. / Zhelchnokamennaia kishechnaia neprokhodimost': voprosy diagnostiki i lecheniia.

AIM: To analyze informative value of radiological diagnosis of acute gallstone ileus. MATERIAL AND METHODS: There were 7 patients with acute gallstone ileus who underwent diagnostic abdominal X-ray examination, ultrasonography and computed tomography. RESULTS: There was high informative value of CT for acute gallstone ileus if it was applied within the first hours after admission. At the same time other diagnostic approaches were less informative. CONCLUSION: CT within emergency diagnostic algorithm is able to optimize diagnostic process, to clarify the cause of acute ileus and to promptly determine the indications for video-assisted surgery.

[Tuberculous peritonitis. 'Forgotten' disease]. / Tuberkuleznyi peritonit. 'Zabytaia' bolezn'.

AIM: To analyze diagnosis and treatment of patients with tuberculous peritonitis, to develop the algorithms for instrumental examination and differential diagnosis. MATERIAL AND METHODS: There were 48 patients with tuberculous peritonitis. The examination included radiography, abdominal and thoracic computed tomography, ultrasound, and laparoscopy. All patients underwent histological, cytological, microbiological and molecular-genetic analysis of abdominal exudate and peritoneal biopsy. Exclusion criterion was signs of secondary peritonitis. RESULTS: Clinical picture of tuberculous peritonitis was accompanied by nonspecific symptoms. Previously identified pulmonary tuberculosis and HIV-infection were present in 93.8 and 70.8% of patients. Diagnostic laparoscopy of abdominal cavity as the main method of instrumental diagnosis together with cytological, molecular-genetic and microbiological research of peritoneal exudate and tissue specimens were useful to determine diagnosis in 87.2-95.8% of cases. CONCLUSION: Tuberculous peritonitis may be assumed in patients with previous tuberculosis of lungs or other localizations, HIV-infection. Computed tomography is the most informative method to diagnose tuberculous peritonitis. Diagnostic laparoscopy is indicated for suspected tuberculous peritonitis. This procedure is supplemented by peritoneal biopsy, cytological, molecular-genetic and microbiological examination of peritoneal exudate and tissue specimens.

[Diagnosis and treatment of gallstone intestinal obstruction]. / Diagnostika i lechenie zhelchnokamennoi tonkokishechnoi neprokhodimosti (s kommentariem).

AIM: To analyze informative value of radiological examination in diagnosis of acute gallstone intestinal obstruction. MATERIAL AND METHODS: Diagnosis and treatment of 7 patients with acute gallstone intestinal obstruction have been analyzed. Diagnostic protocol included radiography of abdominal cavity, sonography and computed tomography. RESULTS: Computed tomography within the first hours after hospitalization is highly informative to diagnose gallstone intestinal obstruction if other methods are ineffective. CONCLUSION: Inclusion of computed tomography into survey algorithm optimizes diagnostic process, clarifies the cause of acute intestinal obstruction and promptly determines the indications for video-assisted surgery.

[The application of the system of «reminder stickers¼ for the rehabilitation programs with the use of behavioural therapy for the patients presenting with anxiety disorders]. / Sistema stikernykh napominanii v programmakh reabilitatsii s primeneniem povedencheskoi terapii u patsientov s trevozhnymi rasstroistvami.

UNLABELLED: This article was designed to report the results of research on the effectiveness of the new original «reminder stickers¼ technique proposed by the authors for the management of the patients undergoing rehabilitation based on behavioral therapy. The essence of this technique consists of providing the patients with systematic reminders of the need to implement skills aimed at coping with maladaptive sensations that accompany anxiety disorders. AIM: The objective of the present study was to evaluate the effectiveness of using the «reminder stickers¼ technique for the formation of stable responses to the correction of the target clinical symptoms. PATIENTS AND METHODS: The study involved 118 patients suffering from anxiety disorders allocated to two groups for comparison. Group 1 was comprised of the patients (n=76) given the reminders while group 2 contained those (n=42) not included in the system of «reminder stickers¼. The difference between the parameters of interest in the two groups was estimated with the use of Mann-Whitney and Kolmogorov-Smirnov tests. RESULTS: The analysis of diary records of the patients was used to evaluate the frequency of occurrence of maladaptive sensations that required the application of the appropriate behavioural skills and the frequency of the missed or delayed responses as well as the level of subjective satisfaction of the patients with the stability of the acquired skills. It was shown that the patients given «reminder stickers¼ significantly more frequently reported situations that required the application of the appropriate skills within the first week after the initiation of monitoring than the patients of group 2 (р<0,0001). The frequency of the missed or delayed responses in these patients was significantly lower than in group 2 (р<0,0001) whereas the degree of subjective satisfaction with the stability of the acquired skills was much higher (р<0,0001). These differences persisted during week 2 after the onset of monitoring when the frequency of maladaptive sensations that required the application of the previously formed behavioural skills of therapeutic significance in the patients given «reminder stickers¼ remained lower than in the patients to whom no such «remainders¼ were provided (р=0,001). The frequency of the missed or delayed responses in these patients decreased significantly in comparison with that in group 2 (р<0,0001),) while the degree of subjective satisfaction of the patients with the stability of the acquired skills further increased (р<0,0001). CONCLUSION: The results of the study indicate that inclusion of «reminder stickers¼ in the structure of cognitive-behavioral therapy at the stages of formation of the skills needed to cope with maladaptive sensations enhances the ability of the patients presenting with anxiety disorders to much more often timely identify situations that require the use of the appropriate behavioural skills and to apply them. It is concluded that the application of the original «reminder stickers¼ technique ensures an adequate response of the patients to maladaptive sensations that accompany anxiety disorders.

[Molecular-genetic methods for diagnostics of tumour growth].

Considerable progress has recently been achieved in understanding molecular medicine in general and vell molecular biology in particular. Molecular medicine is a scientific discipline studying man under normal condition and pathological changes at the cellular-molecular level with reference to gene activity and function of protein mediators responsible for delivery of information to various organs or systems of the body and cell-to-cell interaction.

[Mechanisms of the uncomplicated wound healing in patients with ventral hernia].

84 patients operated on middle ventral hernia with the use of different methots of implantation and types of mesh implants were included in the study. All patients received the thoriugh US-investigation after the operation. The sublay hernia plasty proved to be the best reconstruction method, demonstrating lesser tissue exudation. The onlay plasty should be preserved only for cases of hernioplasty when the use of sublay technique is impossible.

[The ultrasound semiotics of uncomplicated wound healing after inguinal mesh plastics].

Dynamic ultrasound (US) investigation was performed in 89 patients operated on inguinal hernia with the use of meshes of various type. The US scanning proved to be a highly informative means of visualization, allowing the objective postoperative assessment of muscular and aponeurotic structures as well as the implant form and position. The study showed, that the mesh implantation was always accompanied by the exudative tissue reaction, which was determined by the physico-chemical characteristics of the implant.

[Early diagnosis of intra-abdominal complications after surgery on the stomach and the duodenum]. / Ranniaia diagnostika vnutribriushnykh oslozhnenii posle operativnykh vmeshatel'stv na zheludke i dvenadtsatiperstnoi kishke..

Ultrasonic examination early after surgery permits to visualize "zone of surgery", to evaluate stomach, duodenum or their stump, to diagnose motor-evacuatory and purulent-septic complications, to determine policy of their treatment. Dynamic ultrasonic examinations permit to realize daily monitoring of "surgical zone" and timely correction of therapy, to reduce number of x-ray and endoscopic examinations after surgery that leads to improving of treatment results.

[Choice of the policy, terms, and method of surgery in acute cholecystitis]. / Vybor taktiki, srokov i metoda provedeniia operatsii pri ostrom kholetsistite.

Results of treatment of 763 patients with different forms of cholecystitis were analyzed. It was revealed that complex ultrasonic examination with dopplerography identifies the form of acute cholecystitis, allows to, predict technical difficulties in cholecystectomy and define optimum method of surgery. Comparative assessment of time of surgeries, rate of conversion of surgical approach, number of intra- and postoperative complications, lethality demonstrated that early urgent surgeries in acute cholecystitis before formation of inflammatory paravesical infiltrate in patients without high anesthesiological risk were similar to ones in elective surgeries and surpassed results of delayed surgeries. Early urgent surgeries permit to decrease hospital stay of patients with acute cholecystitis and reduce cost of treatment.

[Ultrasonic diagnosis of abdominal foreign bodies]. / Ul'trazvukovaia diagnostika inorodnykh tel briushnoi polosti.

Experience with ultrasonic examination (USE) in diagnosis of foreign abdominal bodies in 23 patients is reviewed. Foreign abdominal bodies have specific echosemiotics. It is demonstrated that USE provides maximal information about sizes, structure, location of foreign abdominal bodies, their depth of location and relationship with abdominal organs. It makes sense to make in some cases a differential diagnosis with inflammatory infiltrates and abdominal abscesses, fetus, gastric bezoar. It is necessary for this to use additional X-ray and endoscopic methods. USE helps to decide on optimal surgical approach and gives information for repeated surgery that permits to reduce the time of relaparotomy.

[The arteriolymphatic administration of antibiotics in treating patients with suppurative-inflammatory diseases of the abdominal cavity organs]. / Arteriolimfaticheskoe vvedenie antibiotikov pri lechenii bol'nykh s gnoino-vospalitel'nymi zabolevaniiami organov briushnoi polosti.

Experimental study of pharmacokinetics of Gentamicin was carried out in 23 dogs. Three different modes of its intralymphatic administration were used: intranodular inguinal, lymphotropic retroperineal and arterio-lymphatic. It has been established, that arterio-lymphatic mode of introduction of antibiotics (as well as regional endolymphatic and lymphotropic) warrants high concentration of antibiotics in venous blood and lymph. The peculiarity of arteriolymphatic administration is regional effect of accumulation of the antibiotic in organs and tissues of abdominal cavity of corresponding arterial region. Arteriolymphatic infusions of antibiotics have been introduced into complex of drug treatment of patients with pyogenic and inflammatory disorders of abdominal organs. The clinical testing has revealed high curative effect of this made of antibiotics administration.

[Ultrasound findings in the zone of cholecystectomy and their role in prognosis of paralytic ileus development]. / Rezultaty ultrazvukovogo issledovaniia zony kholetsistéktomii i ikh rol v prognozirovanii razvitiia dinamicheskoi kishechnoi neprokhodimosti.

A comparative analysis of 112 patients' case histories with calculous cholecystitis has revealed that morphological alterations of the gallbladder wall and in the perevesicular area as well as the operative techniques are essential for the wound healing and ultrasound picture in cholecystectomy zone. Ultrasound investigation within postoperative 24 hours enables a significant prognosis of the onset of intestinal paresis, its severity and duration. This is important for conducting early prophylactic measures.

[Experimental rationale for the use of intra-arterial lymphostimulation in drug treatment of inflammatory diseases of organs of the peritoneal cavity]. / Eksperimental'noe obosnovanie primeneniia vnutriarterial'noi limfostimuliatsii v medikamentoznom lechenii vospalitel'nykh zabolevanii organov briushnoi polosti.

The functional status of regional lymph drainage was studied in 40 rats with various models of pyoinflammatory abdominal diseases. It was shown that intratissue lymphopoiesis and lymph drainage were suppressed in general fecal peritonitis and hemorrhagic pancreonecrosis, which was evident in 1.59-3.15-fold elimination time of the lymphotropic indicator indigo carmine from the tissue and organ depot of the abdomen. The intravenous lymphostimulation with 10% rheomacrodex solution led to 1.06-1.51-fold increases in lymphopoiesis and lymph drainage. Regional intraaortic lymphogenic stimulation caused the most marked changes in the lymph circulatory bed, producing 1.22-1.56-fold effects on lymph drainage of abdominal organs and tissue.

[Pharmacokinetic validation of intra-arterial lymphotropic antibiotic therapy of pyo-inflammatory diseases of organs of the peritoneal cavity]. / Farmakokineticheskoe obosnovanie vnutriarterial'noi limfotropnoi antibiotikoterapii gnoino-vospalitel'nykh zabolevanii organov briushnoi polosti.

Intraarterial infusion of antibiotics provided a 1.39-2.84-fold regional increase in the antibiotic concentration as compared to that after the intravenous infusion in the organs and tissues of the abdominal cavity affected by an inflammatory process. Regional intraarterial lymphostimulation provided a 1.31-1.64-fold increase in the antibiotic resorption from the affected organs and tissues of the abdominal cavity to the relevant regional lymph nodes. Combined intraarterial administration of the antibiotic and lymphostimulant made it possible to provide high antibiotic concentrations in both the affected organs and tissues of the abdominal cavity and the respective portions of the regional lymphatic system.

[The use of computer technology in a tuberculosis control institution]. / Ispol'zovanie komp'iuternoi tekhnologii v protivotuberkuleznom uchrezhdenii.

Program complexes that are being developed at the laboratory of the Research Institute of Tuberculosis (USSR Ministry of Public Health) are directed to the employment of the IBM-compatible personal computers of a diverse configuration in antituberculosis institutions of a various level. In this respect the routine work of a doctor of an out- and in-patient department supplied by the appropriate modules can be replaced by work on computers which will enable the attending doctor to fill in medical records according to the scheme of the out- and in-patient departments. A program complex was also developed for the employment of computer technology in control over the antituberculosis service. These systems operate in a dialogue regimen. All the data can be put on a display and (or) printers in the form of texts, tables, diagrams and curves.

[The 5-fluorouracil content of the pancreas and parapancreatic tissues when it is administered regionally into the tissue of the round ligament of the liver]. / Soderzhanie 5-ftoruratsila v podzheludochnoi zheleze i parapankreaticheskikh tkaniakh pri regionarnykh sposobakh ego vvedeniia v kletchatku krugloi sviazki pecheni.

In the experiment on 31 dogs there was shown a significant increase of 5-fluorouracil concentrations in the pancreas and parapancreatic tissues with regional methods of its administration in the fat of the round ligament of the liver. A more prolonged preservation of the drug concentrations at the therapeutic level in the blood was observed. The most effective method of the cytostatic therapy is the regional lymphotropic method.

[Intralymphatic antibacterial therapy of acute cholecystitis]. / Endolimfaticheskaia antibakterial'naia terapiia ostrogo kholetsistita.

Clinical examination of 34 patients showed that lymphotropic administration of antibiotics creates concentrations in organs and tissues involved in the inflammatory process in acute cholecystitis which are 1.63-14.95 times higher than those produced by intramuscular injection. Study of the course of the clinical picture of the disease in 122 patients with acute destructive cholecystitis revealed the high efficacy of this method of antibiotic therapy: the laboratory indices of the inflammation became normal within a shorter period of time, the inflammatory process in the gallbladder was arrested more rapidly, the number of postoperative complications fell 2.6 times, and the terms of hospital-stay of the patients reduced by 1.3 times. Lymphotropic antibiotic therapy is more pathogenetic in the management of acute destructive cholecystitis.