Multi-detector computer tomography as effective method for Crohn's disease diagnostics

Aim of investigation. Improvement of diagnostics and efficacy of radiological methods of investigation by technique computer-tomography (CT) enterography at inflammatory bowel diseases.Material and methods. Original investigation was based on the data of comprehensive clinical and instrumental investigation of 111 patients with suspected Crohn's disease (CD). The set of tests included colonoscopy, abdominal US, CT-enterography, X-ray investigation of small intestine. Signs of CD were obtained by CT-enterography in 62 patients (55,9%), in all of these cases it was possible to establish localization of process, to estimate its spread and reveal complications.Results. Data of roentgenological and CT investigation comparative analysis were similar. Thus, CT-enterography technique of can be regarded either as alternative to X-ray investigation of the small intestine at CD diagnostics or important addition to diagnostic algorithm for this group of patients

The combined method of rectocele treatment

Aim of investigation. To present experience of monitoring of 17 patients with 3-rd degree rectocele by clinical and instrumental tests in the early and remote postoperative periods. Studied patients underwent transrectal circular proctoplasty with plasty of rectovaginal septum by allotransplant.Key points. Operation was pathogenically proved, accompanied by long-lasting clinical effect, low rate of postoperative morbidity and reduces terms of rehabilitation of operated patients.Conclusion. Surgical technique, discussed in the article is efficient method of treatment of rectocele of the 3-rd degree

Thermodynamic Tree: The Space of Admissible Paths

Is a spontaneous transition from a state x to a state y allowed by thermodynamics? Such a question arises often in chemical thermodynamics and kinetics. We ask the more formal question: is there a continuous path between these states, along which the conservation laws hold, the concentrations remain non-negative and the relevant thermodynamic potential G (Gibbs energy, for example) monotonically decreases? The obvious necessary condition, G(x)\geq G(y), is not sufficient, and we construct the necessary and sufficient conditions. For example, it is impossible to overstep the equilibrium in 1-dimensional (1D) systems (with n components and n-1 conservation laws). The system cannot come from a state x to a state y if they are on the opposite sides of the equilibrium even if G(x) > G(y). We find the general multidimensional analogue of this 1D rule and constructively solve the problem of the thermodynamically admissible transitions. We study dynamical systems, which are given in a positively invariant convex polyhedron D and have a convex Lyapunov function G. An admissible path is a continuous curve along which $G$ does not increase. For x,y from D, x\geq y (x precedes y) if there exists an admissible path from x to y and x \sim y if x\geq y and y\geq x. The tree of G in D is a quotient space D/~. We provide an algorithm for the construction of this tree. In this algorithm, the restriction of G onto the 1-skeleton of $D$ (the union of edges) is used. The problem of existence of admissible paths between states is solved constructively. The regions attainable by the admissible paths are described.Comment: Extended version, 31 page, 9 figures, 69 cited references, many minor correction

Применение магнитно-резонансной томографии у больных хроническим парапроктитом (предварительные результаты)

Aim. Investigation of possibilities of magnetic resonance imaging as a whole, as well as different modes of MR scanning (without intravenous contrast, with intravenous contrast, with the use of diffusion-weighted imaging) in the diagnosis of cryptogenic fistulas of the rectum.Materials and methods. In the study were included 50 patients with cryptogenic fistulas of the rectum (21 women and 29 men). All patients underwent magnetic resonance imaging of the pelvic organs.Results. The sensitivity of MRI in the diagnosis of the primary fistulas was 100%. With regard to secondary fistulas MRI sensitivity was 91.7%, specificity was 94.3%. The sensitivity of MRI in the diagnosis of chronic abscesses paraproctitis was 82.6%, specificity was 95.2%. The sensitivity of the method in the visualization of internal opening was 95.5%, specificity was 80.0%. The sensitivity of the method in the diagnosis of external openings was 91.7% and specificity was 100%. In the analysis of separates MR scanning mode we didn’t find statistically significant differences between them (p < 0.05). Conclusions. Magnetic resonance imaging has a high diagnostic efficacy in the diagnosis of cryptogenic perianal fistulas. We didn’t find statistically significant differences between MR scanning modes.Цель исследования: оценить возможности магнитно-резонансной томографии в целом, а также различных режимов МР-сканирования (без внутривенного контрастирования, с внутривенным контрастированием, с применением диффузионно-взвешенных изображений) в диагностике криптогенных свищей прямой кишки.Материал и методы. В исследование включено 50 пациентов с криптогенными свищами прямой кишки (21 (42,0%) женщина и 29 (58,0%) мужчин). Всем пациентам была выполнена магнитно-резонансная томография органов малого таза.Результаты. Чувствительность магнитно-резонансной томографии в диагностике основного свищевого хода составила 100%. В отношении добавочного свищевого хода чувствительность магнитно-резонансной томографии составила 91,7%, специфичность – 94,3%. Чувстви тельность магнитно-резонансной томографии в диагностике абсцессов при хроническом парапроктите составила 82,6%, специфичность – 95,2%, в визуализации внут реннего свищевого отверстия – 95,5 и 80,0% соответственно, в диагностике наружных свищевых отверстий – 91,7% и 100,0% соответственно. При анализе отдельных МР-режимов сканирования статистически значимых различий между ними выявлено не было (p < 0,05).Выводы. Магнитно-резонансная томография имеет высокую диагностическую эффективность в диагностике криптогенных свищей прямой кишки. Сравнение диагностической информативности отдельных режимов сканирования не выявило между ними статистически значимых различий

Прогностические возможности КТ в диагностике хронических воспалительных осложнений дивертикулярной болезни ободочной кишки

Objective: to determine the diagnostic effectiveness of computed tomography (CT) in predicting the course of the disease in patients with chronic inflammatory complications of diverticular disease (DD).Material and methods. The study included 70 patients with a complicated course of colon diverticular disease in the phase of exacerbation of the chronic inflammatory process. All patients underwent CT of the abdominal cavity with intravenous contrast to assess the type and severity of inflammatory changes in the colon and surrounding tissues in the area of localization of diverticula. All patients received conservative treatment and were monitored as part of the ongoing study for 12 months from the moment of initial treatment at the Center. Surgical intervention due to the ineffectiveness of conservative therapy or the recurrence of the inflammatory process during the established follow-up period was considered as an unfavorable outcome of the disease (42/60%). The positive effect of drug therapy without signs of a return of the clinical picture of inflammation within 12 months was considered as a favorable outcome (28/40%). A statistical analysis of CT signs of inflammatory changes in various DD outcomes was performed to identify prognostic CT parameters.Results. Statistically significant differences were revealed between the severity of inflammatory changes according to CT data for different outcomes of the disease. In the favorable outcome group, the main part (23/28.82%) were patients with diverticulitis, in the unfavorable outcome group, 2/3 of patients (29/42.64%) were diagnosed with pericolic infiltrates, including abscesses/cavities, and colon fistulas. It was found that the thickness of the intestinal wall, the extent of inflammatory changes in the intestinal wall, the extent of inflammatory infiltration of pericolic fiber, the symptom of “centipede”, the accumulation of fluid in the pericolic region statistically significantly differed with different outcomes of chronic inflammatory complications of diverticular disease. Мultivariate Cox proportional hazard model revealed two main predictors of the onset of an unfavorable outcome – thickening of the intestinal wall and the presence of fluid in the pericolic region. Thickening of the intestinal wall at values equal to or greater than 0,6 cm increased the risk of an unfavorable outcome by 4.69 times, and the presence of fluid by 4.52 times.Conclusion. The use in clinical practice of the revealed CT predictors of the onset of an unfavorable outcome in chronic inflammatory complications of DB can serve as one of the factors for deciding on elective surgery in this category of patients. Цель исследования: определить диагностическую эффективность компьютерной томографии (КТ) в прогнозировании течения заболевания у больных с хроническими воспалительными осложнениями дивертикулярной болезни (ДБ).Материал и методы. В исследование включено 70 пациентов с осложненным течением ДБ ободочной кишки в фазу обострения хронического воспалительного процесса. Всем пациентам выполнена КТ брюшной полости с внутривенным контрастированием для оценки вида и тяжести воспалительных изменений ободочной кишки и окружающих тканей в области локализации дивертикулов. Все пациенты получили консервативное лечение и находились под наблюдением в рамках проводимого исследования в течении 12 мес с момента первичного обращения в Центр. Оперативное вмешательство в связи с неэффективностью консервативной терапии или рецидивом воспалительного процесса в установленный период наблюдения рассматривалось как неблагоприятный исход заболевания (42/60%). Положительный эффект лекарственной терапии без признаков возврата клинической картины воспаления в течение 12 мес рассматривался как благоприятный исход (28/40%). Проведен статистический анализ КТ-признаков воспалительных изменений при различных исходах ДБ для выявления прогностических КТ-параметров.Результаты. Выявлены статистически значимые различия между выраженностью воспалительных изменений по данным КТ при различных исходах заболевания. В группе благоприятного исхода основную часть (23/28,82%) составили пациенты с дивертикулитом,  в группе неблагоприятного исхода у 2/3 больных (29/42,64%) диагностированы паракишечные инфильтраты, в том числе с абсцессами/полостями, и свищи ободочной кишки. Установлено, что толщина кишечной стенки, протяженность воспалительных изменений кишечной стенки, протяженность воспалительной инфильтрации периколической клетчатки, симптом “сороконожки”, скопление жидкости в периколической области статистически значимо различались при разных исходах хронических воспалительных осложнений ДБ. Многофакторный Кокс-регрессионный анализ выявил два основных предиктора  наступления неблагоприятного исхода – утолщение кишечной стенки и наличие жидкости в периколической области. Утолщение кишечной стенки при значениях, равных или более 0,6 см, в 4,69 раза увеличивало риск наступления неблагоприятного исхода, а наличие жидкости в 4,52 раза.Заключение. Применение в клинической практике выявленных КТ-предикторов наступления неблагоприятного исхода при хронических воспалительных осложнениях ДБ может послужить одним из факторов для принятия решения о плановом хирургическом вмешательстве у этой категории пациентов

РЕЗУЛЬТАТЫ ЛЕЧЕНИЯ БОЛЬНЫХ С МЕСТНЫМИ РЕЦИДИВАМИ РАКА ОБОДОЧНОЙ КИШКИ

Aim: to improve the results of treatment of patients with local recurrence of colon cancer and evaluate effectiveness of the combined treatment.Materials and methods. From 1997 to 2012 in SRCC 71 consecutive patients underwent combined surgery for local recurrence of colon cancer. Of these patients 38 (53.5%) had surgical treatment with intraoperative intraperitoneal chemotherapy. Sixty-five (91.5%) patients had locally advanced recurrent tumor. Localization of local recurrence in patients who underwent combined operations, was as follows: in the area of colonic anastomosis - in 11 (15.5%) patients; in the bed of the removed tumor - in 19 (26.8%); in the area of colostomy - in 10 cases (14.1%); in the stump of distal colon after obstructive procedures - in 31 (43.6%) patients. Mean operative time was 270 ± 45 minutes and mean blood loss - 430 ± 80 ml.Results. Postoperative complications were observed in 6 (9.8%) of 61 patients. There was no mortality. Sixty-four (90.1%) patients were followed-up, 34 (53.1%) patients of which are currently alive with no signs of the relapse of the disease. Effectiveness of intraperitoneal chemotherapy was evaluated. Repeated local recurrence occurred in 5 (14.3%) of the 35 followed-up patients who underwent intraperitoneal chemotherapy, and in 6 (20.7%) of the 29 followed-up patients who received surgery alone (p = 0.2). Distant metastases were found in 9 (25.7%) and in 5 patients (17.2%) patients, respectively (p = 0.17), and peritoneal carcinomatosis in 1 (2.9%) and 4 (13.8%) cases, respectively (p = 0.09). Disease-free 5-year survival rate in patients who received intraperitoneal chemotherapy was 57.1%, and in patients received only surgical treatment - 48.3% (p = 0.15).Цель исследования: улучшение результатов лечения больных с местными рецидивами рака ободочной кишки; оценка эффективности комбинированного лечения. Материалы и методы. С 1997 по 2012 годы включительно в ГНЦК 71 пациенту были выполнены комбинированные операции по поводу местных рецидивов рака ободочной кишки. Из них у 38 (53,5 %) пациентов хирургическое лечение было дополнено интраоперационной внутрибрюшной химиотерапией. У 65 (91,5 %) рецидивная опухоль имела местно-распространенный характер. Локализация местных рецидивов у больных, перенесших комбинированные операции, была следующей: в зоне межкишечного анастомоза — у 11 (15,5 %) пациентов; в ложе удаленной опухоли — у 19 (26,8 %); в области колостомы — у 10 (14,1 %); в культе отключенной кишки — у 31 (43,6 %) больного. Средняя продолжительность операций составила 270 ± 45,0 минут, средняя кровопотеря — 430 ± 80,0 мл. Результаты. Послеоперационные осложнения отмечены у 6 (9,8 %) из 61 пациента. Летальных исходов не было. Прослежена судьба 64 (90,1 %) пациентов, из них в настоящее время живы без признаков возврата заболевания 34 (53,1 %) больных. Проведена оценка эффективности внутрибрюшной химиотерапии. Повторные местные рецидивы развились у 5 (14,3 %) из 35 прослеженных больных, которым проводилась внутрибрюшная химиотерапия, и у 6 (20,7 %) из 29 прослеженных пациентов, получивших только хирургическое лечение (р = 0,2). Отдаленные мета-стазы выявлены у 9 (25,7 %) больных и 5 (17,2 %) пациентов сравниваемых групп (р = 0,17), а канцероматоз брюшины в 1 (2,9 %) и 4 (13,8 %) случаях (р = 0,09). Безрецидивная 5-летняя выживаемость у больных, которым проводилась внутрибрюшная химиотерапия, составила 57,1 %, при изолированном хирургическом лечении — 48,3 % (р = 0,15)

Methodological aspects of large intestine CT in coloproctological patients

The aim was to study the features of CT scan of large intestine in coloproctological patients. 738 patients with colorectal neoplasm and inflammatory bowel diseases were included in the study and underwent abdominal CT scan and CT colonography. Retrograde air opacification of large intestine is indicated in cases of colorectal cancer, water-soluble contrast agent opacification — in diverticular disease, water opacification — in ulcerative colitis

Power of 3D Transrectal Ultrasonography and Magnetic Resonance Imaging in Diagnosis of Cryptogenic Rectal Fistulae

Background. The only radical curative treatment for rectal fistulae is surgery. The choice of surgery requires precise characterisation of the fistulous tract. The most common instrumental methods for rectal fistula diagnosis are transrectal ultrasonography (TRUS) and magnetic resonance imaging (MRI).Objectives. Comparative assessment of the diagnostic power of 3D TRUS and MRI techniques in revealing cryptogenic anal fistulae with respect to intraoperative examination.Methods. The study enrolled 92 patients with rectal fistulae aged 27 to 66 years. Fistulous opening was external in 47 (51.1%) and obliterated in 45 (48.9%) patients. The average patient age was 42.7 ± 15.9 years. Surgery for acute paraproctitis 14 to 32 days prior to examination was in history of 58 (63.1%) patients. All patients had preoperative subsequent 3D TRUS and MRI compared with intraoperative examination results.Results. The rate of correct fistulous tract type diagnosis verified with intraoperative revision was 96.7% (89/92) with 3D TRUS and 82.6% (76/92) with MRI (p = 0.0027). The error rate of 3D TRUS estimation of external sphincter involvement was 1.1% (1/92), sensitivity 96.6%, specificity 93.5%, overall accuracy 94.5%. The MRI error rate was 21.7% (20/92), with a statistically significant difference for sensitivity and overall accuracy (p < 0.0001). The rate of correct estimation of internal fistulous localisation in “anorectal clock” was 97.8% (90/92) with 3D TRUS and 90% (81/90) with MRI (p = 0.0342). Internal fistula was not detected with MRI in 2/92 (2.2%) cases, which explains the deviation. Intraoperative revision identified total 113 abscesses. The rate or correct abscess estimation was 97.3% (110/113) with 3D TRUS and 74.7% (71/95) with MRI. MRI failed to detect abscess in 18/113 (15.9%) cases (p < 0.0001).Conclusion. 3D transrectal ultrasonography is statistically superior over magnetic resonance imaging in estimating internal fistula localisation in “anorectal clock”, fistulous type, as well as the fistulous tract location relative to external sphincteric tissue in patients with transsphincteric anal fistulae. Estimation of pararectal and intramural abscesses was also significantly different

Risk factors of postoperative prolonged ileus after colorectal cancer surgery

OBJECTIVE. The authors identified independent risk factors of postoperative prolonged ileus after colorectal cancer surgery. MATERIAL AND METHODS. Multivariate logit regression analysis was made in order to reveal independent risk factors of prolonged ileus. RESULTS. The frequency of prolonged ileus cases consisted of 13 %. The authors detected three independent risk factors such as body mass index higher than 25 kg/m² (p=0,033), taking of opioid analgetics (p=0,022) and left colon flexure mobilization (p=0,047) in multivariate statistical analysis. CONCLUSIONS. Postoperative prolonged ileus was the frequent complication in colorectal cancer surgery. There is a possibility to identify the group of patients who exposed to risk of occurrence of prolonged postoperative ileus due to application of revealed risk factors