[Transumbilical cholangiostomy]. / Transumbilika'lnaia kholangiostomiia.

The authors suggest a method for decompression of the biliary system in obstructive jaundice with bile drainage blocked at a high level. The method consists in catheterization of the bile ducts through the lumen of the umbilical vein dilated by bougienage. The efficacy and safety of the method were proved in 15 cases. No complications were encountered.

[Diagnosis and therapy of acute cholecystitis in liver cirrhosis]. / Diagnostika i lechenie ostrogo kholetsistita pri tsirroze pecheni.

The article deals with information on 12 patients with acute cholecystitis and cirrhosis of the liver (class A--with maintained hepatic function in 3, class B--with subcompensated hepatic function in 8, and class C--with decompensated stage of cirrhosis of the liver in one patient). The clinical picture was atypical and the course severe (purulent complications, hepatic insufficiency). Nonoperative management of the attack should be limited to 24 hours. Sparing decompression (laparoscopic or laparocentetic cholecystostomy) is the optimal method of treatment of class B and C patients. The tactics in class A patients does not differ from the commonly accepted tactics. Unfavorable outcomes (3) were linked with performance of emergency cholecystectomy in patients with disturbed hepatic function.

[Iron metabolism in patients with portal hypertension]. / Sostoianie obmena zheleza u bol'nykh s portal'noi gipertenziei.

Ninety-four patients with portal hypertension (48 with cirrhosis of the liver and 46 with pathological changes of the portal vein trunk) were examined. The main parameters of iron metabolism were determined by the radioimmunoassay and the iron deports in the liver and spleen biopsy material were revealed. Tissue iron deficiency was found in all patients. The results of the tests were marked by essential peculiarities. In sharp reduction of the level of serum iron and ferritin the parameters of total and latent iron-binding capacity were decreased.

[Pre- and postoperative correction of hyposiderosis in surgical treatment of portal hypertension]. / Pred- i posleoperatsionnaia korrektsiia giposideroza pri khirurgicheskom lechenii portal'noi gipertenzii.

In order to study iron metabolism disorders in patients with portal hypertension syndrome, to determine clinical significance of hyposiderosis and to work out effective method of its correction, 94 patients with cirrhosis of the liver complicated by portal hypertension were examined. As a result of determination of these disorders of iron metabolism methods for treatment of hypochromal anemia and hyposiderosis have been worked out. Hemotransfusions, administration of iron-containing preparation Ferrum-lec and combination of these methods were used for treatment. It was established that administration of large doses of iron-containing preparation Ferrum-lec substantially contributed to improvement of iron metabolism in patients with cirrhosis of the liver and extrahepatic portal hypertension, to reduction of postoperative complications rate and to upgrading the results of surgical treatment.

[Lesions of the biliary system in primary extrahepatic portal hypertension]. / Porazhenie zhelchevyvodiashchei sistemy pri pervichnoi vnepechenochnoi portal'noi gipertenzii.

The authors describe extensive strictures of the hepaticocholedochus, ranging from 2.5 cm in length to total involvement of the duct, in 15 patients with primary extrahepatic portal hypertension. In 7 patients they were combined with cystic dilatation of the intrahepatic bile ducts. All patients were under 40 year of age, the ages of 10 of them ranged for 18 to 30. There were 9 males. ++Non-operative treatment of the disturbed bile drainage proved ineffective: remittent jaundice was encountered in all cases. The most frequent complications were cholangitis (6 cases), biliary cirrhosis of the liver (3) and the formation of spontaneous biliary fistulas (2).

[Prospects of intraoperative dynamic cholangio-manometry by tensor detectors with graphic recording of pressure function]. / Perspektivy intraoperatsionnoi dinamicheskoi kholangiomanometrii tenzornymi datchikami s graficheskoi registratsiei funktsii davleniia.

Intraoperative cholangio-manometry with a miniature tensor sensor and graphic recording of the results were conducted to study the function of the major duodenal papilla in 53 patients. A periodical activity of the ampulla of the papilla was revealed, which was characterized by certain values of the peak and basal pressure, and duration of contraction and relaxation periods. The numerical values and the pattern of the pressure curve differed in patients with obstructive cholecystitis, biliary pancreatitis, and a concrement incarcerated in the ampulla of the papilla. The informativeness of the study increases with the use of the glucagon test.

[Conservative treatment of complete distal pancreatic fistula]. / Konservativnoe ustranenie polnykh svishcheí podzheludochnoí zhelezy.

36 patients with external pancreatic fistulas have been analysed. Complete distal fistulas have been demonstrated in 23 patients. Pancreatic fistulas were caused by trauma of the pancreas (8), acute pancreatitis (10), surgical treatment of the pancreatic cancer (5). The study of endocrine and exocrine functions has demonstrated that in 2-3 months a gradual decrease of exocrine function of the distal segment of the pancreas takes place. This segment is drained through the fistula. The processes of fibrosis and atrophia are major factors of such a decrease. The method of "biological" filling based on the results of the study of fistulas' pathogenesis, usage of a rational therapy and capillary drain appeared to be the most effective in treatment of this complication. It provided a gradual formation of a narrow fistula and its closure with granulations.

[Role of endoscopy in diagnosing rare sources of small intestinal bleedings due to vascular disorders]. / Znachenie éndoskopii v diagnostike redkikh istochnikov tonkokishechnykh krovotechenii, obuslovlennykh sosudistymi porazheniiami.

The authors describe two cases of intraoperative endoscopic diagnosis of hemangioma and vasculitis of the small intestine. The examination was conducted during laparotomy by colonoileoscopy and enterotomy. The authors believe this method to be most effective in emergency surgery when the operation cannot be postponed because of the patient's severe condition caused by hemorrhagic shock.

[Surgical treatment of strictures of the hepaticocholedochus in patients with primary extrahepatic portal hypertension]. / Khirurgicheskoe lechenie striktur gepatikokholedokha u bol'nykh pervichnoi vnepechenochnoi portal'noi gipertenziei.

An analysis of their experience with treatment of 14 patients has shown that treatment of prolonged strictures of hepaticocholedochus in patients with extrahepatic portal hypertension by conservative measures is not sufficiently effective. The optimum surgical treatment is operation for reestablishment of the bile outflow. Hepaticojejunostomy is most reliable. The use of the gallbladder for anastomosis is not expedient. The operations are technically difficult and are often followed by complications.

[Perioperative correction of hypochromic anemia and iron metabolic disorders in patients with liver cirrhosis and portal hypertension]. / Perioperatsionnaia korrektsiia gipokhromnoi anemii i narushenii obmena zheleza u bol'nykh tsirrozom pecheni s portal'noi gipertensiei.

Forty eight patients with liver cirrhosis and portal hypertension have been examined, most of them had hypochromic anemia. Serum iron and ferritin levels, total and latent iron binding capacity have been radioimmunoassayed. All the patients developed hyposiderosis, the study of liver and spleen bioptates showed tissue iron deficiency. It has been established that measurement of ferritin, total and latent iron binding capacity were not informative. It is iron concentration that should be determined. Intravenous administration of high doses of the drug Ferrum-lek seems most effective. It recovers red blood count, iron metabolism and iron tissue stores and reduces the incidence of pyogenic and cardiovascular complications.

[Cholelithiasis in patients with primary extrahepatic portal hypertension]. / Zhelchnokamennaia bolezn' u bol'nykh s pervichnoi vnepechenochnoi portal'noi gipertenziei.

The results of treatment of 17 patients who had primary extrahepatic portal hypertension in combination with cholelithiasis are analysed. Of them 13, were operated on. In presence of the extended strictures of the bile ducts, the performance of hepaticojejunostomy is mandatory. In dominating involvement of the extrahepatic bile ducts, the endoscopic papillotomy as a definitive intervention is expedient. In asymptomatic course of cholelithiasis, the operation is not expedient.

[Plasma levels of various gastrointestinal polypeptides in patients with cholelithiasis and different degree of functional disorders of the major duodenal papilla]. / Soderzhanie riada gastrointestinal'nykh polipeptidov v plazme krovi u bol'nykh zhelchekamennoi bolezn'iu s razlichnoi stepen'iu narusheniia funktsii bol'shogo sosochka dvenadtsatiperstno'i kishki.

Findings of dynamic cholangiomanometry with the analysis of the tension curves are overviewed. This technique helped reveal different functional ailments of the bile papilla in major variants of the cholelithiasis course (acute obstructive++ cholecystitis, recurrent pancreatitis, and choledocholythiasis with obstructive jaundice). Parallel radioimmunoassay-based studies of a series of gastrointestinal polypeptides (insulin, glucagon, gastrin, vasoactive peptide, bombesin , and somatostatin) were conducted to determine the importance of these polypeptides in the pathogenesis of cholelithiasis complications. The levels of certain polypeptides were found to be related to the clinical manifestations of the disease. The complex assessment of the bile papilla function and gastrointestinal polypeptide concentrations offers a possibility for elaborating the pathogenetically relevant methods of therapy for this group of diseases.