[Clinical-functional and morphological changes in the large intestine in patients with chronic abdominal ischemia]. / Kliniko-funktsional'nye i morfologicheskie izmeneninia tolstoi kishki u bol'nykh s khronicheskoi abdominal'noi ishemiei

The article presents a study of clinical variants of ischemic lesions of the large intestine (ILLI) in patients with the chronic abdominal ischemia (CAI) syndrome. There was an examination of 42 patients with putative ILLI, who had a cardiovascular pathology at the background, which led to significant hemodynamic disorders of the blood flow in unpaired visceral branches of the abdominal aorta. The authors performed a complex diagnostics of ILLI including anamnestic and clinical data, laboratory and morphological assessment of the large intestine and vessels providing its blood supply. Based on the data collected, other functional and organic diseases of the large intestine (LI) were excluded. It was revealed that the final result of ILLI differed depending on the ischemia degree--from reversible functional disorders to high-grade organic lesions of the LI. Each clinical variant of ILLI has its own clinical manifestations as well as functional, organic and morphological peculiarities of changes in the LI revealed by a laboratory and histological examination of the LI.

[Functional radiographic anatomy of the terminal sphincter duct of the biliary pancreatic system]. / Funktsional'naia rentgenoanatomiia terminal'nykh sfinkterov protokov binarno-pankreaticheskoi sistemy.

The improvement of techniques of surgical operations on the bile ducts, especially on their terminal portion, as well as on the pancreas generates a need in deeper knowledge of the function of terminal sphincters of ducts--the general bile and main pancreatic ducts, and Oddi's sphincter that regulate the ingress of bile and pancreatic juice in the digestive tract lumen. This knowledge will make it possible to determine the most adequate variant of treatment, which is closest to the physiological one, in each particular case.

[Results of radiotherapy and combined, comprehensive treatment of pancreatic cancer]. / Rezul'taty luchevogo, kombinirovannogo i kompleksnogo lecheniia raka podzheludochnoi zhelezy.

The results of irradiation, combined and complex treatment of pancreatic cancer have been evaluated versus stage, site and extent of surgery. Radiotherapy was carried out in 63 patients (1988-1999): prior to gastropancreaticoduodenectomy (GPDE)--7; after GPDE--12; for local recurrence after GPDE--4, before and after left-sided resection--4, before and after conservative surgery--19, and after diagnostic verification (exploratory laparotomy or ultrasound-controlled fine-needle biopsy)--17. Diagnosis was established on the basis of clinical data and case histories, ultrasonographic, CT, histological, cytological, biopsy, blood serum-marker CA 19-9 and CEA findings. Two months after treatment, complete remission was registered in 5 (13%), partial response--5 (13%), stabilization--13 (33%), tumor progression--16 (41%). Before and after GPDE, tolerance to radiotherapy was sufficient. Median survival in this group was 12.9 months, controls--8.1 months; for conservative surgery--7.3 and 4.1 months, respectively; radiotherapy + exploratory laparotomy alone--16.8 and 4.3 months, respectively. Irradiation of locally-advanced tumors of the body and/or tail of pancreas proved effective: median survival was 7.3 months, control--2.2 months. Hence, radiotherapy made an important contribution to treatment of locally-advanced and resectable pancreatic tumors and longer survival.

[Prognostic factors influencing results of the surgical treatment of pancreatic cancer]. / Prognosticheskie faktory, vliiaiushchie na rezul'taty khirurgicheskogo lecheniia pri rake podzheludochnoi zhelezy.

In patients with carcinoma of the pancreas 128 gastropancreatoduodenal resections (GPDR), 15 distal resections of the pancreas and 3 pancreatectomies were performed. After GPDR 5-year survival was 12%, the survival median was 24.3 months. Only one patient is living 6 years after left-sided resection and pancreatectomy. Long-term results of the operative treatment for carcinoma of the pancreas depended on the amount of regional metastases, degree of differentiation of the tumor, its size and invasion into the vessels. The long-term results were considerably worse if the tumor was localized in the uncinate process, body and tail of the pancreas. The 5-year survival was noted mainly in patients with the 0 and I stages of the disease. It shows the early diagnostics to be necessary.

[Specific features of pancreatoduodenal resection in cancer of the head and unciform process of the pancreas]. / Osobennosti pankreatoduodenal'noi rezektsii pri rake golovki i kriuchkovidnogo otrostka podzheludochnoi zhelezy.

Pancreato-duodenal resections (PDR) were made in 134 patients with cancer of the pancreas, in 31 (23.1%) of them the tumor was localized in the unciform process of the pancreas. In 7 patients the destructive pancreatitis which complicated cancer PDR was completed by the external drainage of the pancreatic duct. Combined PDR were fulfilled in 14 (10.4%) patients including 9 (29.0%) of 31 patients who had cancer of the unciform process. In 48 (35.8%) patients PDR was followed by complications. The most frequent of them were acute pancreatitis of the stump (32.1%) and incompetent pancreatoenteroanastomosis (18.7%). Postoperative lethality after PDR was 6.7%. During the recent six years no lethal outcomes have been observed after 45 PDR. Cancer of the uniform process of the pancreas is the least favorable localization. Combined PDR are followed by a great number of intraoperative, postoperative complications and high lethality rate. If the patients had mechanical jaundice, the use of double step PDR gave better results. If there were intraoperative signs of acute pancreatitis it was necessary to drain the pancreatic duct outside. The using of intraoperative occlusions of the pancreatic ducts is hardly justified because of a high risk of the development of acute pancreatitis.

[Immediate, early and late results of endoscopic papillosphincterotomy]. / Neposredstvennye, blizhaisie i otdalennye rezul'taty éndoskopicheskoi papillosfinkterotomii.

Clinico-instrumental examination of 226 patients showed that there were no fatal outcomes directly after endoscopic papillosphincterotomy, the number of complications was approximately the same as after transduodenal operations on the major duodenal papilla but they took a much easier course. The high effectiveness of an endoscopic operation was confirmed in the immediate postoperative period (absence of biliary hypertension, jaundice, pancreatitis, cholangitis). In the late-term periods after EPST restenosis was rarely encountered (3.9%); duodeno-biliary reflux caused no serious disorders, while the functional activity of the sphincter Oddi which had been operated on was partly maintained in 84.2% of patients.

[The value of ultrasonic and x-ray endoscopic methods in the diagnosis of acute surgical diseases of the abdominal organs]. / Znachenie ul'trazvukovogo i rentgenoéndoskopicheskikh metodov v diagnostike ostrykh khirurgicheskikh zabolevanii organov briushnoi polosti.

The authors discuss experience in the complex use of ultrasonic and radio-endoscopic methods of examination in 820 patients who were admitted to the hospital with acute surgical diseases of the abdominal organs. Instrumental methods of diagnosis were used, which began with ultrasonic examination. The correct diagnosis of the disease was often established by this method, further examination of the patient was planned, and more concrete indications for invasive radio-endoscopic studies were determined by means of which precise data on the identified pathological process were revealed and, sometimes, adequate therapeutic measures were also ensured. Reduction of the duration of the diagnostic period to 2-3 days was the most important result of the use of these methods in the examination of patients with acute diseases of the abdominal organs.