[Multiple hepatocellular adenomas and renal cell carcinoma associated with anabolic androgenic steroids]. / Mnozhestvennye gepatotsellyulyarnye adenomy i pochechnokletochnyi rak, assotsiirovannye s priemom bodibilderom anabolicheskikh androgennykh steroidov.

The authors report a rare case of combination of chromophobe renal cell carcinoma Grade 2 pT2aN0 with multiple hepatocellular adenomas in a 31-year-old bodybuilder who received anabolic androgenic steroids at high doses for 8 years. According to MRI data, over 15 liver adenomas and tumor in the lower segment of the right kidney were detected. The patients underwent laparascopic resection of the right kidney and liver segments 2, 3 and 4 with large adenomas. Histological study and immunohistochemistry revealed no malignancy signs in hepatocellular adenomas. Nuclear ß-catenin expression was absent. Kidney tumor had a structure of chromophobe renal cell carcinoma. The patient is currently being followed-up due to residual small liver adenomas. In our opinion, liver adenomatosis and renal cancer have the same cause in this case (chronic toxic effect of androgens).

[Solitary epithelioid hemangioendothelioma concurrent with nodular parenchymal amyloidosis of the lung and Rosai-Dorfman disease]. / Solitarnaia épitelioidnaia gemangioéndotelioma v sochetanii s noduliarnym parenkhimatoznym amiloidozom legkogo i bolezn'iu Rozai-Dorfmana.

The paper describes a case of solitary epithelioid hemangioendothelioma concurrent with nodular parenchymal AL amyloidosis of the lung and Rosai-Dorfman disease in a 70-year-old woman. The core of the tumor was represented by bone tissue with dendriform ossification, as well as by amyloid that showed green apple birefringence at polarized light microscopy. The peripheral portions of the tumor and the myxohyaline stroma exhibited slit-like structures, epithelioid and fusiform cells with small cytoplasmic vacuoles. These cells expressed CD31, CD34, factor VIII, and cytokeratins 7 and 18. The Ki-67 proliferation index was 10%. S100- and CD68-positive histiocytes with the phenomenon of emperipolesis were revealed in the tumor and in the lymph nodes of the mediastinum and lung hilum. There was a positive reaction to immunoglobulin lambda light chains in the lymphocytic infiltration around amyloid clumps. The frequency of epithelioid hemangioendothelioma was less than 1 case per million people annually. We found only one case of its concurrence with pulmonary amyloidosis in the English-language literature. No relationship could be revealed between this tumor and Rosai-Dorfman disease.

[Clinical and morphological signs of viral damage to a kidney transplant]. / Kliniko-morfologicheskie priznaki virusnogo porazheniia pochechnogo transplantata.

AIM: Тo compare morphological changes and results of immunohistochemical (IHC) identification of viruses (polyomaviruses, adenoviruses, and herpesviruses) in the biopsy specimens with their clinical manifestations in recipients of renal transplants. MATERIAL AND METHODS: Morphological and IHC studies were conducted using 71 needle renal transplant biopsy specimens from patients in the study group and 10 renal biopsy specimens from those in the control group. A number of clinical indicators were estimated. RESULTS: IHC examination revealed the expression of adenoviral antigens more commonly in patients with posttransplant nephritis than in recipients without nephritis or in control individuals (p<0.05). The association of patient age and time after kidney transplantation with the severity of viral damage was confirmed: graft loss in children occurred within the first months of surgery (p<0.05). Polyomavirus was detected by PCR in patients with the morphological patterns of polyomavirus nephropathy. Determination of HSV-1 and HSV-2 in the biopsy specimens showed no significant associations with morphological changes. CONCLUSION: By taking into account a variety of factors that influence the development of viral nephritis, morphological and IHC examinations should be combined with evaluation of clinical findings.

[Morphological diagnosis of viral damage to a kidney transplant]. / Morfologicheskaia diagnostika virusnogo porazheniia pochechnogo transplantata.

Due to the development of organ transplantation and its accompanying immunosuppression, recent years have been marked by the higher incidence of opportunistic viral infections that are of considerable importance among posttransplantation complications. A variety of viral infections, the possibility of their concomitant or subtle course, and the ability to cause life-threatening complications in recipients make relevant the description of existing diagnostic methods. The article summarizes the data available in the literature on the etiology, clinical symptoms, and morphological manifestations of viral infections, such as polyomaviruses, adenoviruses, herpesviruses, including HSV-1, HSV-2, cytomegalovirus (CMV), and Epstein-Barr virus. It describes the principles of differential diagnosis of kidney transplant damage caused by these viruses and that with acute cellular and humoral rejection, which plays an important role due to opposite approaches to treating these diseases.

[Von Hippel-Lindau disease type 2-related pancreatic neuroendocrine tumor and adrenal myelolipoma].

The paper describes a case of von Hippel--Lindau-related pancreatic neuroendocrine tumor and adrenal myelolipoma in a 44-year-old woman. The pancreatic tumor and a left retroperitoneal mass were removed in the women in July 2014 and May 2015. Histological examination of the pancreatic tumor revealed that the latter consisted of clear cells forming tubular and tubercular structures showing the expression of chromogranin A, synaptophysin, and cytokeratins 18 and 19 and a negative response to CD10 and RCC. The adrenal medullary mass presented as clear-cell alveolar structures with inclusions of adipose tissue mixed with erythroid, myeloid, and lymphoid cells. The clear-cell component of the adrenal gland expressed neuroendocrine markers with a negative response to cytokeratins, CD10, and RCC. Molecular genetic examination yielded a signal corresponding to two copies of the VHL gene. No deletions or amplifications of the gene were detected. Cases of von Hippel--Lindau disease concurrent with adrenal pheochromocytoma and myelolipoma and simultaneous pancreatic involvement were not found in the literature.

[Resistant cytomegalovirus infection in related donor kidney allograft recipients].

AIM: To clarify whether cytomegalovirus (CMV) infection can affect the results of living related donor kidney transplantation. SUBJECTS AND METHODS: A study group included 17 (7.27%) patients (10 men and 7 women; 8 children and 9 adults) aged 3 to 51 years who had developed resistant CMV infection. For comparative analysis, a control group was formed from 113 patients (61 men and 52 women; 40 children and 73 adults) aged 1 to 61 years, whose CMV polymerase chain reaction (PCR) had always been negative, i.e. CMV DNA was absent. The duration of CMV infection episodes was 44 to 232 days. RESULTS: The patients were given valganciclovir in a dose of 450 mg/day. CMV PCR was negative in all the patients at the end of therapy. None of the patients died; one graft was lost. In the control (negative CMV PCR) group, 6 grafts were lost in 113 patients lost and 4 patients died. Statistical analysis showed that the results of related donor kidney transplantation were virtually equal. CONCLUSION: Suppression of resistant CMV infection can be achieved with the longer use of valganciclovir or its higher dose. CMV infection fails to affect the results of related donor kidney transplantation.

[The effect of gender on the results of related kidney transplantation].

AIM: To define the effect of donor and recipient gender on the results of kidney transplantation from living related donor. MATERIAL AND METHODS: Group of 271 patients who underwent kidney transplantation from living related donor was analyzed. There were 115 women and 156 men. Age varied from 1 to 63 years (mean 21.30±12.32). There were 127 children aged 1-18 years (mean 11.28±4.63) and 144 adults aged 19-63 years (mean 29.81±11.24). Donors included 162 women and 109 men. Overall survival was calculated using Kaplan-Mayer. Mortality and incidence of transplants failure were determined using Fisher's exact test. RESULTS: All patients were divided into 2 groups depending on recipients' gender and then into 4 subgroups depending on gender of donors and recipients. Comparative statistical analysis showed that transplants survival was higher in women vs. men (T=2.7, p=0.007). Survival of patients was similar in both groups. Moreover it was the best in subgroup of recipients-women with kidneys from donors-men. Difference was statistically significant (T=2.16, p=0.03). There was no significant difference in all other cases. CONCLUSION: The results of kidney transplantation are better in recipients-women than in men.

[Kidney allotransplantation from alive related donor in patients with Alport syndrome].

AIM: To evaluate the results of kidney transplantation from alive related donor in patients with Alport syndrome and to compare with those in patients with kidney hypoplasia. MATERIAL AND METHODS: We have analyzed 8 and 27 medical records of patients with Alport syndrome and kidney hypoplasia respectively. Following parameters were used - Kaplan-Meier survival analysis, Wilcox overall risk, percentage of transplants loss and mortality (Fisher's exact test calculation). RESULTS: It is concluded that percentage of transplants loss and mortality rate as well as overall survival and risk were similar in both groups. CONCLUSION: Despite risk of anti-GBM nephritis development in patients with Alport syndrome results are comparable with those after transplatation for chronic renal failure caused by other reasons.

[Vaccination in patients with chronic renal failure in the pre- and posttransplantation period].

AIM: To clarify whether vaccination provokes renal graft rejection. SUBJECTS AND METHODS: A total of 131 vaccinations were performed in 92 patients with chronic kidney failure (CKF), including 7 and 85 patients vaccinated before and in different periods after kidney transplantation, respectively. The patients were examined using needle graft biopsy, measurement of proteinuria, and estimation of changes in blood creatinine levels and glomerular filtration rate. RESULTS: Vaccination was not fount to provoke rejection, as suggested by the results of needle biopsy of renal allografts and examination of their function. CONCLUSION: Vaccination is safe for patients with CKF as it causes no rejection episodes.

[THE INFLUENCE OF CYTOMEGALOVIRUS ON THE RESULTS OF KIDNEY TRANSPLANTATION].

To understand whether the presence of cytomegalovirus in blood influences the results of kidney transplantation from live relative donors, we analysed materials from 258 recipients divided into 2 groups. Group 1 included 113 patients with negative results of PCR for cytomegalovirus, group 2 contained 139 patients with positive PCR. We evaluated lethality, the loss of transplanted kidneys, frequency of rejection and infectious complications. Statistical treatment of the data obtained included Kaplan-Meier survival analysis, the Wilcoxon test showing the cumulative hazard risk, and comparative analysis by Fisher's and Student's tests. It was shown that cytomegalovirus present in blood increases lethality and the frequency of infectious complications in recipients of transplanted kidneys but does not influence their rejection. The cumulative survival rate was significantly higher and cumulative risk lower in group 1 than in group 2.

[Predictors of the results of kidney transplantation from living-related donors].

The aim of investigation is analysis of factors forecasting the results of kidney transplantation from living-related donors. This research is based on the analysis of 272 kidneys' transplantation from living-related donors. It was analyzed such parameters as recipients' age, donors' age, donors' sex, degree of relationship between donor and recipient, degree of HLA-compatibility, type of inductive immunosuppression (monoclonal antibodies, corticosteroids, polyclonal antibodies), recipient's sex, presence or absence of rejection episodes for whole postoperative period. We recognized that far not all above-mentioned parameters could predict the results of kidney transplantation from living-related donors.

[IgG4-related chronic periaortitis with retroperitoneal fibrosis].

The paper describes a case of IgG4-related chronic periaortitis in a 56-year-old man. Computed tomography revealed stenosis of the abdominal aorta and both common iliac arteries due to calcified atherosclerotic plaques, in this connection, bifurcation aorta-common femoral bypass surgery was performed. Intraoperatively, a solid retroperitoneal mass intimately connected with the walls of vessels was revealed in the retroperitoneal space around the aorta and iliac arteries. Histological examination ascertained rough fibrous connective tissue growth, a marked lymphoplasmacytic infiltration with an admixture of eosinophils, and formation of lymphoid follicles with germinal centers. Immunohistochemical examination revealed the plasma cell expression of CD20, IgG, IgG4, and kappa and lambda light chains in the inflammatory infiltrate. Because of active immune inflammation, further conservative therapy was recommended.

[Effect of tacrolimus on the results of living related kidney donor transplantation].

AIM: To elucidate whether and how tacrolimus affects the cumulative survival of patients after living related kidney donor transplantation. SUBJECTS AND METHODS: The clinical materials of 246 related kidney transplant recipients, including 108 patients in whom tacrolimus (Prograf and Advagraf) Astellas Pharma US, Inc) was included in the immunodepression protocol (Group 1) and 138 patients who did not receive the agent (Group 2), were analyzed. Comparative analysis used the following tests: the Kaplan Meier test estimating the cumulative survival of recipients and transplants; the Cox test assessing the cumulative risk; and the log-rank test. Allorenal graft losses and mortality rates were also calculated. RESULTS: Mathematical analysis of the above indicators demonstrated that the allograft and survival rates were far higher (p < 0.05) and the cumulative risk was much less in Group 1 (p < 0.02). Graft losses and the recipients' deaths were higher in Group 2. CONCLUSION: The analysis suggests that the incorporation of tacrolimus into the immunodepression therapy protocol positively impacts the results of lung related kidney donor transplantation.

[Time course of morphological changes in humoral renal allograft rejection in ABO incompatibility between donor and recipient].

One hundred and five biopsy specimens taken in different periods after 34 ABO-incompatible mismatched related kidney transplantations were examined to establish the patterns of humoral activity from the morphological changes and expression of C4d deposits in the peritubular capillaries. Severe reversible forms of acute humoral rejection (AHR) (2 patients) and minimal morphological manifestations (13 patients) were observed in the biopsy specimens taken as long as 2 months later in Group 1 (C4d+). In the early period, the minimal manifestations of AHR did not cause organ dysfunction; but in the late period, 5 of them developed chronic humoral rejection in persistent humoral activity; 4 grafts were removed 531,720, 1019, and 1252 days later. Group 2 (C4d-) (n = 19) showed no graft losses or significant chronic changes; the late minimal manifestations of AHR had no impact on the duration of organ function in 3 recipients. The timely detection of early humoral activity and minimal manifestations of AHR is needed for the measures taken to reduce a risk for late function loss of the grafted organ.

[Noncoronary dilated cardiomyopathy after reverse remodeling heart surgery].

We present here analysis of surgical treatment of 24 patients (5 women, 19 men, age 20-75, mean age 50.7 +/- 2.5 years) with dilated cardiomyopathy (DCM) operated during the period from 2008 to 2013. Duration of the disease ranged from 4 months to 12 years (mean 49.4 +/- 7.5 months). According to symptoms and results of 6-minute walk test 3 patients (13%) had heart failure NYHA class III and 21 patients (87%)--NYHA class IV. Average end-diastolic left ventricular size was 7.4 +/- 0.18 cm (6.0-9.2 cm), ejection fraction--26.7 +/- 2.1% (13-47%), mean pulmonary artery pressure 54.9 +/- 2.9 mm Hg (35-80 mmHg). All patients underwent organ-conserving surgery aimed at reverse remodeling of the heart. Surgery was accompanied with implantation of implantable cardioverter defibrillator in 3 patients and/or cardiac resynchronization therapy device in 6 patients. Two patients (8.3%) died during hospitalization of hemodynamically significant ventricular arrhythmias; seven patients (29.2%) died in the late postoperative period. The results of the analysis indicate that reverse-remodeling surgery may be effective in patients with DCM of any age group with preserved reserves of the liver, kidney, and lung function in the absence of active myocarditis. Further observations are needed to determine the place of this operation in the protocol of treatment of patients with DCM.

[Kidney allotransplantation from the AB0-incompatible donors].

The experience of 28 kidney allotransplantations from the AB0-incompatible donors was analyzed. The comparative group consisted of 38 patients, who received the AB0-compatible organ. The results were assessed using the following parameters: renal function, morphology of the biopsy samples of the transplanted kidney and actuary survival of the recipients with functioning transplants in both groups. The comparative analysis showed no significant difference between the two groups, giving the right to consider the kidney allotransplantation from the AB0-incompatible donors safe and effective.

TIME PATTERN OF RADIONUCLIDE EMISSIONS AND DISCHARGES INTO THE NATURAL ENVIRONMENT OF THE PIVDENNOUKRAINSKA NPP SURVEILLANCE ZONE. / ДИНАМІКА ВИКИДІВ ТА СКИДІВ РАДІОНУКЛІДІВ У ПРИРОДНЕ СЕРЕДОВИЩЕ ЗОНИ СПОСТЕРЕЖЕННЯ ПІВДЕННОУКРАЇНСЬКОЇ АЕС.

OBJECTIVE: assessment of impact of operation of the Pivdennoukrainska Nuclear Power Plant (PUNPP) on the environment of surveillance zone (SZ) based on parameters of radiation monitoring within 2015-2021 period. METHODS: socio-hygienic (analysis of the radiation monitoring parameters), analytical, statistical. RESULTS: The environmental radiation impact associated with emissions and discharges of radioactive substances originated in the production cycle of the PUNPP in everyday conditions was found as insignificant. The gas-aerosol atmospheric emissions of inert radioactive gases, long-lived nuclides, and 131I did not exceed the established permissible levels (PL) and amounted to a hundredth of a percent of the emission limit (EL) for the inert radioactive gases and long-lived nuclides, and a thousandth of a percent for radioactive iodine. Total atmospheric emissions of the 51Cr, 54Mn, 59Fe, 58Co, 60Co, 90Sr, 95Zr, 95Nb, 134Cs, 137Cs, and 3Н radionuclides by the PUNPP power units (actual and % of EL) did not exceed the established PL. Maximum average values of atmospheric air concentration of 137Cs in SZ forthe 2015-2021 period ranged from 2.858 µBq/m3 (PUNPP industrial site) to 1.986 µBq/m3 (Riabokoneve village, 33.5 km distance), and maximum average values of the 90Sr air concentration were from 1.310 µBq/m3 to 0.566 µBq/m3, respectively. According to radionuclide monitoring no significant change of the quality of surface water occurred upon the PUNPP discharges to the Pivdennyi Bug River. Specific activity of the 137Сs in agricultural products in the PUNPP SZ was insignificant and not exceeding the PL of the content in food products. Content of 137Cs in the samples from the PUNPP SZ did not exceed 1.0 % of the total activity. CONCLUSION: Average concentration of radionuclides in atmospheric air of the settlements in the PUNPP SZ was several orders of magnitude lower than that established by regulatory documents. The PUNPP discharges to the Pivdennyi Bug River, according to radionuclide parameters that are monitored, have not significantly changed the quality of surface water. The content of 90Sr and 137Cs was uniform in all observation radii of distance from the NPP, confirming the very low level of 90Sr and 137Cs environmental emission by the PUNPP. The content of 137Cs in agricultural products within the PUNPP SZ was significantly lower than PL.

[The kidney transplantation from the ABO-incompatible donors].

The experience of 28 allotransplantations of ABO-incompatible kidneys was compared with the treatment results of 38 ABO-compatible renal transplantations. The transplanted kidney function, morphological changes of the transplanted kidney and the comparative analysis of actuary survival in both groups showed no significant difference. The results of the study prove the validity of the kidney transplantation from the ABO-incompatible donors.

PRE-WAR STATE OF INFORMATION PROVISION OF THE POPULATION OF SURVEILLANCE ZONES ON THE SAFETY OF NUCLEAR ENERGY FACILITIES. / DOVOIeNNYI STAN INFORMATsIINOGO ZABEZPEChENNIa NASELENNIa ZON SPOSTEREZhENNIa Z PYTAN' BEZPEKY OB'IeKTIV IaDERNOÏ ENERGETYKY.

OBJECTIVE: to assess the state of information needs of the population and its provision by local governments on the safety of nuclear energy facilities and community preparedness for emergencies at nuclear power plants (NNP). MATERIALS AND METHODS: To determine the information needs of the population, a survey of the working population of the surveillance zone (SZ) of the NPP was conducted using unique probability sampling, where the sample was 322 people and the sampling error was 5.4 % with a confidence interval of 95.0 %. The issues of population behavior in case of emergencies at NPPs were studied. The assessment of the quality of the information content of the official websites of the executive authorities and local governments of various levels on radiation safety issues was carried out. RESULTS: The population of the SZ NPP considers the most effective information at the place of work, through neighbors, friends, from State Emergency Service specialists. Among information channels, the first place in terms of efficiency is occupied by Internet resources and social networks; the press and television occupy the second position, but remain convenient for the majority of the population. The most popular information related to NPP activities are: radiation status, environmental impact, benefits and subventions, such as compensation for the risk of living near NPPs, conditions of storage and disposal of radioactive waste. The preparedness of communities and the behavior of the population, in case of an emergency at the nuclear power plant, has been practiced in the satellite city and partially in the cities, but the rural population understands the sequence of actions much worse. CONCLUSION: Information support in NPP satellite cities is significantly better compared to rural areas of SZ. Bodies of executive power and local selfgovernment of the NPP SZ do not perform their function of informing the population on radiation safety and community readiness for emergencies through their official websites. The problem of information support of territorial communities is one of the most important to prevent the consequences of emergencies.

[Anemia after renal transplantation].

The study aimed the estimation of posttransplantant anemia (PTA) frequency between the recepients of allogenic kidneys and testing the influence of different factors on the anemia development. The study was ased on the analysis of 129 patients with ERSD, to whom 129 donor kidneys were grafted. An actuarial survival of patients and allografts were calculated. The analysis demonstrated that a duration of the pretranplant hemodialysis influences the dynamics of hemoglobin level and the red blood cells count. The shorter were the dialysis terms, the easier was the anemia to correct. Shorter terms of the pretransplant dialysis also correlated with the higher rates of the overall survival after the transplantation.