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Percutaneous interventions for diseases of the kidneys and upper urinary tracts (UUT) were fulfilled in 1254 patients. In renal cysts puncture, evacuation of the content and sclerotherapy were fulfilled. Repeated punctures of the cyst were fulfilled in 20, laparoscopic excision of it was fulfilled in 16 patients. In 499 patients with cholelithiasis 427 percutaneous nephrolitholapaxy and 87 extractions of the stone without its fragmentation were fulfilled. Percutaneous treatment of cholelithiasis by monotherapy was effective in 89.8% of the patients, in 10% of the patients distant lithotripsy was performed for residual stones. Good results of endoscopic correction of UUT strictures were obtained in 85.9% of the patients, unsatisfactory results--in 14.1%. Percutaneous interventions for foreign bodies in UUT and tumors of the pelvis were successful in all observations.

Punctural aspiration of the contents of the pseudocyst cavity caused reduction of the diameter and internal cavity, but failed to result in its full involution. Structural changes in the pseudocyst wall developed from the following phases of the counteraction (first 24 hours), remodeling (from the 1st through 16th day) and stabilization (from the 16th day through the 31st day). Cellular reactions of its wall were characterized by a reduced number of neutrophil leukocytes, increased number of macrophages from the 1st through the 7th day and increased number of fibroblasts and lymphocytes as compared with the control group.

An analysis of results of using the puncture method of treatment of solitary cysts of the liver, kidneys and spleen in 1343 patients has shown that the staged method of treatment makes surgical resection of the cysts considerably less necessary.

Based on their personal experience with treatment of 118 patients the authors consider that sanitation-decompression percutaneous-transhepatic punctures of the gallbladder under US control can be used for arresting the inflammation process. The integral scales SAPS-II and POSSUM allow identification of groups of patients with high operative risk. The strategy of treatment depends on both the state of the patient and results of USI. The detection of an obturating concrement in the gallbladder neck requires punctures for decompression of the gallbladder and attempts to reestablish normal bile passage in addition to conservative therapy at early terms.

The authors analyzed results of treatment of 87 patients with cystic formations of the pancreas. According to an experience with treatment the puncture-catheterization of non-formed and complicated cysts is thought by the authors to be the method of choice. For non-complicated well formed cysts the method of choice is operation of internal drainage using different organs. When the puncture-catheterization intervention is not possible the external drainage of the cyst and complex conservative therapy can be the method of choice for complicated cysts. Radical operations (resection of the pancreas) were used for benign cystic tumors. The greatest number of complications were observed after the external drainage of the cyst, cystogastrostomy, resection for cystadenoma and cystadenocarcinoma. Postoperative lethality was 6.8%.

The authors dealt with 59 children with different variants of polycystic kidney disease. The age of the patients was from 1 month to 19 years. The autosomal dominant type of inheritance was noted in 52 patients, in 24 of them percutaneous ignipuncture, lumbotomy with ignipuncture and dissection of the cysts, endovideosurgical opening and dissection of the cysts transperitoneally and retroperitoneally were performed. Long-term results were followed during the periods from 6 months till 17 years. Good results were obtained in 12 patients, satisfactory--in 2 patients, unsatisfactory--in 7. The most effective methods are traditional lumbotomy and endovideosurgical correction which are not followed by growth of cysts in the operated kidneys at the postoperative period.

Having many-year experience with angiographic interventions, the authors examined the potentialities of ultrasonic angioscanning to monitor the implementation of endovascular interventions (EVI). During the study, they developed an original procedure of different EVI with intraoperative ultrasonic monitoring, refined the ultrasonic semiotics of the procedure, achieved positive results in preventing possible complications. The authors made indications for the procedure and rational ways of its application more concrete. They provide evidence for that the proposed procedure greatly facilitates the performance of different intravascular procedures and reduces the time (or excludes) teleradioscopy, thus lowering the radiation burden on the staff and the patient.

The article describes the method and results of the puncture sclerotherapy of nonparasitic liver cysts in 30 patients. Cooled to -28 degrees C 96% ethyl alcohol was used as a sclerosing agent. The total destructive effect of the agent was obtained due to the combination of its chemical and physical (temperature) factors. Complete recovery was obtained in 86.6% of the patients. The puncture sclerotherapy can be used as a medical alternative for nonparasitic liver cysts.

The authors present the data on positive influence of demineralized osteomatrix (DOM) on the osteogenesis in the experimental conditions. On the basis of data received the method of puncture osteoplastic operation with DOM application was developed. Puncture method was applied in 38 children. In 6 months 31 children cyst were liquidated, osteoarchitectonics was reduced, in 7 children rough trabecular picture remains.

The puncture technique for revealing of retroperitoneal hematoma in injured is described. Retroperitoneal hematoma has been revealed in 69 of 315 injured.

The authors introduce a new sparing therapy of pyodestructive lesions of the pararenal fat which comprises subcutaneous puncture drainage controlled by ultrasound with subsequent treatment of the purulent focus with a solution of a new antiseptic, sodium hypochlorite. The advantages of the above method over routine approaches include a 1.5-2-fold decrease in the treatment duration, minor traumatism, simplicity, effectiveness in severe conditions.

Percutaneous puncture sanitation of the gallbladder and microcholecystostomy under ultrasonic control were used in treatment of 62 patients with acute cholecystitis with high operative risk. There were 14 men and 48 women with the average age 78 years. All the patients were admitted to the hospital in critical state. The inflammatory process was completely arrested in 44 of the patients, 9 patients had temporary improvement which was followed by planned operation. In 9 patients no effect was noted. Two patients died. Both interventions can be used in wide clinical practice both as independent procedures and for preoperative treatment.

Under analysis were results of percutaneous cholangiography under the ultrasonic control in 69 patients with jaundice. The investigation in question allowed the cause of the jaundice to be found in 66 of 69 cases. In 3 patients the examination proved to be not informative since only the gallbladder was filled with the contrast. The detection limit of the method was 95.6%. A complication in the form of bile discharge at the site of liver puncture was observed in 2 patients.

In order to prolong the time of spinal anesthesia (SA) and to reduce the doses of local anesthetics a method of catheterization of the subarachnoid space was used in 73 patients. The SA was performed as a fractional infusion of 2% solution of lidokain. Its doses were within the range of 7-11 ml. The prolonged SA is considered to be an adequate method of anesthesia in patients with high risk of the development of neurological, cardiovascular and pulmonary complications.

A method of lateral puncture of the great occipital cistern for descending myelography with water soluble contrast substances was employed. It was used in 150 neurosurgical inpatients aged 4 to 70 with various diseases of the spinal marrow and its coats. A new water soluble drug iopamidol-200 (or 300) (Bracco, Italy) was used for diagnosis of spinal tumors. The drug dosage was worked out for adults as well as for children. A study was made of possible side-effects on a vast clinical material (80 patients). The new contrast substance iopamidol possesses better tolerance by patients and better roentgenocontrast properties than amipack.

The diagnostic puncture of lateral canals of the abdominal cavity in patients with closed trauma of the abdomen was made in 312 patients with associated trauma. Negative results were obtained in 166 patients. Retroperitoneal hematomas were diagnosed in 66 patients, reliable in 98.5%. In 80 patients injuries of the abdominal organs were diagnosed. The volume of intraabdominal blood loss (accurate within 80.7%) was determined before operation in 31 of them with the help of puncture with +/- 200 ml error. The diagnostic significance of lateral canals was 99.7%. Complications were the involvement of the liver in 4 patients not requiring any curative measures.

A modified technique of puncture and catheterization of the femoral vessels in children and a detailed description of the stages of the examination are presented. An analysis of 350 angiographies with the use of the modified puncture and catheterization technique in children aged from 1 month to 15 years was carried out. Technical errors were noted in 16 children (4.3%) and complications in 3 (0.85%). The presented observations prove that the given modification of the catheterization technique is not a very traumatic one and allows to avoid many undesirable complications which may arise especially at the stage of mastering the described method.

On the basis of the experience with 54 transhepatic portographies and 120 super-selective catheterizations of the portal vein branches by various methods the authors give recommendations for choosing the optimum variant of the roentgenological examination of the portal system with individual features of the patients taken into account and with special reference to topographic points.

Diagnostics and treatment of intracranial hemorrhages in newborns, being one of the actual problems of pediatrics, are performed taking into account the parasagittal zone structure. To reveal borders of the parasagittal area in newborns in order to find optimal points for puncture of the superior sagittal sinus and subdural hematomas in this area, the investigation has been undertaken. One hundred mature and 50 premature newborns have been studied, their cerebral veins are injected with contrast mass, x-rayed and then the preparations fixed in 3%, 5% and 10% formalin are made ready. It has been stated that for puncture of the newborn subdural space two points should be used: a) on the coronal cross-line of the anterior fontanel, 20 mm away of its middle line at either side (in mature newborns) and 10 mm (in premature newborns), b) within the limits of the sutura lamboidea 30 mm the sagittal suture (in mature newborns) and 15 mm from the sagittal suture (in premature newborns).

A continuous peridural anesthesia was used in 20 patients with pelvic bones injuries. Puncture of the peridural space was performed in an appropriate patient's posture. During 3--15 days 5--12 ml of 2% trimecain solution were infused via a catheter. For patients being in a shock condition the anesthetic dose was 3-4 ml less. 4-5 minutes following injection of the anesthetic in the peridural space pain at the site of fracture disappeared, there was noted a stabilization of hemodynamic indices, and the ventilatory and cardiac functions were improved. Anesthesia contributes to an early restoration of intestinal peristalsis, diuresis, active management of patients in bed. Strict rules of its conduction being followed, continuous peridural anesthesia is an effective method of analgesia in pelvic bones injuries, associated with a traumatic shock, that enabled to use it in traumatological practice.

On the basis of an analysis of 297 laparoscopic interventions on the stomach fulfilled in 266 patients (laparoscopic puncture gastrostomy, laparoscopic ablation of polyps and foreign bodies of the stomach) it was shown that they can be used as sparing methods of the surgical treatment of some diseases of the esophagus, stomach, pancreas.

In surgical treatment of hepatic amebic abscesses by means of extensive dissection and drainage the postoperative lethality remains high. The literature data and the author's own observations on 30 patients, who underwent puncture of amebic abscess of the liver together with specific and antibacterial therapy, which resulted in their recovery, permit to consider paracentensis as a method of choice, when there are no complications, such as a purulent discharge into the adjoining organs and tissues, which calls for surgical intervention.

Treatment of 76 children aged from 1 month to 14 years with acute destructive pneumonia complicated by intrapulmonary abscesses is described. The treatment was complex, general, antibacterial and local. The authors have elaborated a method of percutaneous prolonged catheterization of lung abscesses in children which was used in 22 patients. The method resulted in sanitation of the blocked intrapulmonary abscesses, prevention of severe complications and shorter treatment of the patients at the hospital.

Based on the study of the literature data and personal author's clinical material (682 punctures) the author was able to reveal the advantages of repeated left-sided puncture of the subclavian vein. An attempt is made to systematize complications relative to this procedure, depending on the side of puncturing in cardiosurgical patients.

Based on 653 ultrasound investigations of patients with chronic prostatitis the author concluded that among various forms of parenchymatous inflammations there were some that could be diagnosed as being cystic lesions. Purulent or seropurulent contents of the cysts were identified. The cyst-affected prostate in the patients with chronic prostatitis was featured by a definite echographic picture confirmed in 38 cases. Scanning revealed either small-sized cysts with occasionally rough inner surface or round-shaped echo-negative formations with fine inner structures. The failure of all therapeutic routines employed inspired the author to seek for newer approaches to the problem. As a result he suggested that the patient should be subjected to transperineal needle (in parallel with a rectal transducer) aspiration of cystic contents under the control of ultrasonic technique, then the cavity of the cyst should be cleansed with antiseptic solution and irrigated with tannins and, at last, the cavity of the cyst should be evacuated. Indications to the method proposed should be carefully considered. If employed, the method would prove its high efficiency. Skilled puncturing is required to avoid any associated complications.

Results of chemical synovectomy of knee joints with 70 per cent ethyl alcohol were analyzed in patients with hemophilia. The chemical synovectomy proved to be effective at early stages of hemophilic arthropathy and may be used in order to prevent progress of hemophilic arthropathy in patients with recurrent hemarthroses.

Questions of the application of paracentetic transhepatic catheterization of the portal vein performed from the lateral access are dealt with. Indications for its application are discussed. Morphological changes and disturbances of hemodynamics of the portal system in certain diseases of the abdominal cavity are analyzed. Possible application of catheterization of the portal vein with curative purposes in order to stop oesophageal hemorrhages in portal hypertension and for continuous antienzymatic therapy of pancreonecrosis is shown.