[Dagnostics and surgical treatment of Bochdalek hernia in adults]. / Diagnostika i khirurgicheskaya taktika pri gryzhakh Bogdaleka u vzroslykh.

OBJECTIVE: To estimate the incidence, diagnostic possibilities and surgical strategy for Bochdalek hernias in adults. MATERIAL AND METHODS: Bochdalek hernias were diagnosed in 7 (9.2%) out of 76 patients with diaphragmatic hernias (age 49-63 years). The left-sided hernia was diagnosed in 5 patients (71.4%), right-sided - 1 patient, bilateral hernia - 1 patient. RESULTS: The disease was diagnosed during routine X-ray examination in 5 cases. Two patients complained of breathlessness and abdominal pain. Computed tomography revealed displacement of retroperitoneal fat (n=6), kidney (n=3), adrenal gland (n=2), pancreas (n=1) and colon (n=1) towards the diaphragm. In one case, ureter angulation caused kidney dysfunction. Mean dimension of hernial orifice was 7.9±3.1 cm. Two patients without any clinical and functional manifestations did not require surgery. In 1 case, surgery was contraindicated due to cardiac comorbidities. The fourth one refused surgery. Three (42%) patients underwent surgery. In the first case, diaphragm repair was performed through the right-sided thoracic approach in combination with nephrectomy because of kidney dysfunction. In the second case, we performed left-sided thoracotomy, in one case - video-assisted thoracoscopy. One patient died from recurrent mesenteric thrombosis accompanied by bowel necrosis after nephrectomy. CONCLUSION: Bochdalek hernias in adults are most often right-sided and contain fat tissue. Surgical treatment is required in case of displacement of internal organs, clinical manifestations, compression and functional disturbances.

[Delayed complication of surgical treatment of duodenal atresia in neonatal period]. / Pozdnee oslozhnenie khirurgicheskogo lecheniya atrezii dvenadtsatiperstnoi kishki v neonatal'nom periode.

We report a 48-year-old woman who underwent surgery in early neonatal period for duodenal atresia and developed subsequent diseases of the upper gastrointestinal tract. Symptoms of gastric outlet obstruction, gastrointestinal bleeding and malnutrition developed over the past 5 years. Inflammatory and cicatricial lesions of gastrojejunostomy formed for congenital duodenal obstruction following annular pancreas required reconstructive surgery.

[Liver echinococcosis in a non-endemic region]. / Ekhinokokkoz pecheni v neendemichnom regione.

OBJECTIVE: To study clinical manifestations and difficulties in diagnosis of liver echinococcosis in a non-endemic region and to assess the long-term results of surgical treatment and quality of life. MATERIAL AND METHODS: The study included 36 residents of a non-endemic region with liver echinococcosis operated on in the Perm Regional Clinical Hospital over the past 15 years. IgG antibodies to echinococcal antigens were determined using enzyme immunoassay. Topical diagnosis was performed using ultrasound and contrast-enhanced computed tomography. We analyzed various difficulties of preoperative diagnosis. Long-term postoperative outcomes and quality of life were studied using the SF-36 questionnaire. RESULTS: In the non-endemic Perm Region, 36% of patients with liver echinococcosis had complicated forms of disease. Sensitivity of detection of antibodies was 77%, ultrasound - 86.1%, CT - 91.7. Echinococcectomy was performed in 13.9% of cases, pericystecomy - 41.7%, liver resection - 30.6%, minimally invasive interventions - in 13.9% of patients. Long-term recurrence of liver echinococcosis (11.1%) developed after laparoscopic echinococcectomy (n=2) and open surgery for multiple liver echinococcosis (n=2). Median score of physical health in long-term period was slightly higher than mental health (67.51 and 62.75 points, respectively). Physical activity had a weak negative correlation with age (p=0.001, r= -0.251). Concomitant diseases significantly impaired vital activity (p=0.001, r= -0.332), role and emotional functioning (p=0.002, r= -0.494; p=0.003, r= -0.415). CONCLUSION: In a non-endemic region, final diagnosis was established only during therapeutic measures in 8.33% of cases. Surgical treatment ensured favorable quality of life in long-term period.

[Mediastinal pancreatic cysts: review and own clinical observations]. / Mediastinal'nye pankreatogennye kisty.

OBJECTIVE: To present the results of surgical treatment of patients with mediastinalpancreatogeniccysts (MPC). MATERIAL AND METHODS: There were 5 patients with MPC. RESULTS: Laboratory tests revealed increased blood amylase level by 1.5-2 times in 3 cases, urine diastase by 4-5 times - in 2 cases. Pleural effusion with amylase concentration in the fluid from 5680 to 48 640 units was diagnosed in 4 cases. CT data of preudocysts of pancreatic body and tail were obtained in 3 cases, head and body - in 2 patients. These cysts extended to posterior mediastinum through the hiatal orifice for about 3.5-40 cm. Three patients underwent VATS removal of pleural fragments, one - thoracotomy, lung decortication and MPC drainage through pleural cavity. Three patients underwent pancreatic drainage procedures (cystogastrostomy, pancreaticojejunostomy and external drainage of the cyst). A small pseudocyst has been successfully treated by conservative treatment with octreotide. CONCLUSION: MPC is a rare complication of pancreatitis and often associated with pleural effusion. CT and fluid amylase analysis are the main diagnostic measures. Surgical treatment includes VATS, destruction of pleural fragments and pleural drainage, cystogastrostomy, pancreaticojejunostomy or external drainage of pancreatic pseudocyst.

[LIPID PROFILE AND LIVER DISEASES AMONG PATIENTS WITH MORBID OBESITY].

Objectives: The aim of our study was to investigate associations between the lipid profile, liver condition and the level of BMI. Methods: Our sample consisted of 58 patients: 30 - with morbid obesity and BMI - 40-49 (1 group), 28 - with superobesity, BMI - 50-69 (2 group). Lipids and hepatic functional tests were measured just prior to surgery. Ultrasound examination was used to estimate liver condition. Liver biopsy specimens were obtained at the time of surgery, classified according to the nonalcoholic fatty liver disease and steatohepatitis activity score. Results: Lower level of cholesterol has been found in the first group with morbid obesity. Higher level of triglycerides and very low-density lipoprotein has been found in the second group with superobesity (р=0,000 ANOVA). High-density lipoprotein was normal but significantly associated with BMI. The level of low-density lipoprotein was higher in the second group, but the difference between ptoups was not significant. BMI was associated with higher scores of ultrasonographic parameters and severity of steatosis, the increased prevalence of steatohepatitis and it activity. We also realized the positive correlation between ultrasonographic parameters and histological features. Conclusion: BMI has significantly positive correlations with the level of triglycerides and very low-density lipoprotein, ultrasonographic parameters, histological features of steatosis and steatohepatitis. The level of total cholesterol did not reflect all changes of lipid profile.