[Extracorporeal lithotripsy with endoscopic removal of fragments in cystic duct occlusion].
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Biomedical subjects
Publications and source records attributed to A S Balalykin.
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Surgical treatment of acute cholecystitis attended by an affection of the extrahepatic bile ducts often leads to severe complications, particularly in elderly and old-aged patients, the mortality rate in such cases reaches 5-12%. The authors developed and introduced into practice a method of endoscopic treatment of acute combined diseases of the gallbladder and bile ducts, which included endoscopic papillotomy, antegrade catheterization of the gallbladder (laparoscopic cholecystostomy, transhepatic gallbladder drainage), antegrade perfusion with antiseptics under pressure, and various types of ante- and retrograde lithotripsy. Endoscopic method of treatment of combined diseases of the gallbladder and bile ducts makes it possible to remove the acute inflammatory process and in some cases may be an alternative to an emergency surgical operation.
Gastroduodenoscopy with target examination of the major duodenal papilla (MDP) and morphological study of the tumor, and endoscopic retrograde pancreatocholangiography were conducted in 104 patients with bening and malignant tumors of the MDP to establish the diagnosis. A precise diagnosis was made. Endoscopic papillotomy alone and in combination with nasobiliary drainage and endoprosthetics of the bile ducts were undertaken for therapeutic purposes in this category of patients. Analysis of the results showed that in cancer of the MDP, these methods can be the tool of treatment or an effective one of preoperative decompression, whereas in bening tumors of the MDP endoscopic papillotmy should be the method of choice.
The level of cyclic nucleotides in biological material undergoes changes due to endoscopic treatment of gastric and duodenal ulcers with the help of helium-neon laser radiation which, in addition to dynamics of the clinical picture and gastroduodenoscopic data, makes it possible to diagnose the disease remission and in certain cases to predict the course of peptic ulcer.
The article analyses the results of using colonoscopy as a method for emergency identification of the causes of acute colonic obstruction and intestinal hemorrhage. The diagnostic informativeness of emergency colonoscopy was 98.7% in colonic obstruction and 97.2% in intestinal hemorrhage. With the use of the results of emergency endoscopy in the choice of the therapeutic tactic for patients with acute colonic obstruction and intestinal bleeding, the percentage of fatal outcomes in the group of patients who underwent operation reduced significantly: to 18.8% in operations for acute colonic obstruction and to 14.8% in operations for intestinal hemorrhage.
The paper is concerned with the results of clinical application of a new method of investigation of microcirculation in the gastric and duodenal wall. The method is based on the administration of a radiopharmaceutical in the submucous layer of the stomach and duodenum through the bioptic channel of a gastroscope with further recording of its rate of discharge on a gamma-chamber. A total of 48 patients with different gastroduodenal diseases were investigated. Good reproducibility of the method and good correlation of its results with clinical findings were confirmed.
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The use of the forceps biopsy has not solved many diagnostic problems of early forms of cancer, and the rate of pseudonegative findings may reach 18 to 60%. The endoscopic biopsy carried out by means of the diathermic loop is free of many drawbacks of the forceps biopsy, as the loop captures a portion of the mucous membrane and submucous layer of the gastrointestinal organs within the diameter of 20--25 mm. Clinical experience with 53 examinations has proved a high diagnostic effectiveness of the method and the necessity of its broad clinical use.
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Polypectomy was performed with a special device (a loop and scissors) inserted via the biopsy canal of a fibroscope. During polypectomy diathermic currents from a commerical electric knife are used. An experience with 67 polypectomies has shown that this operation requirs no special pre- and postoperative measures. Failures of polypectomy were as follows: inadequate polypectomy and development of pseudorecurrences, "a loss" of a polyp during its removal, an impossibility ot loop a polyp. Complications that may appear are described.
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