[Diagnostic and treatment of the intraductal papillary mucinous tumor of pancreas]. / Diagnostika i lechenie vnutriprotokovoi papilliarnoi mutsinoznoi opukholi podzheludochnoi zhelezy.

OBJECTIVE: Adjustment of diagnostics and management of the surgical treatment of patients with intraductal papillary mucinous tumor of pancreas. MATERIAL AND METHODS: From 2012 to 2018, 45 patients with intraductal papillary mucinous tumor were observed. During the observation the ultrasound examination, contrast-enhanced computed tomography and magnetic resonance tomography with contrast were used. In 29 cases radical surgery was performed, nonradical in 1 case; case follow-up is chosen for 15 patients. RESULTS: Intraductal papillary mucinous tumor was diagnosed and the definition of the type of tumor was made on the base of 2 types of imaging methods. Intraductal papillary mucinous tumor type 1 was founded in 5 (11%), whereas intraductal papillary mucinous tumor type 2 was founded in 20 (44,5%) and intraductal papillary mucinous tumor type 3 was observed in 20 (44,5%) cases. Intraductal papillary mucinous tumor associated with carcinoma was observed in 16 cases. Pancreaticoduodenal resection was performed in 20, distal exsection of pancreas was performed in 4 cases (2 in open manner access, 2 in robot-assisted manner), pancreatic head resection was performed in 3 cases (1 in open manner access, 2 in laparoscopic access) and in 2 cases the duodenopancreatectomy was performed. Explorative laparotomy was performed in case of intraductal papillary mucinous tumor type 2 associated with mucilaginous carcinoma and miliary metastasis in the liver. Early postoperative complications were observed in 5 cases (16, 6%): biliary fistula (n=2), postoperative wound infection (n=2), arrosive hemorrhage type B in ISGPS (n=1, was treated in an X-ray endovascular manner). Case follow-up was chosen in 15 cases of intraductal papillary mucinous tumor over the course of 6 to 74 months and disease progression was not observed. CONCLUSION: Intraductal papillary mucinous tumor is a condition associated with high risk of malignant change and demands early disease detection. The treatment should be provided in medical centers that specialize in the pancreas deceases, where a full patient examination as well as a clear-eyed understanding of diagnostic information with the execution of desirable type of surgical intervention with the guaranty of achievement R0 condition can be offered.

[Wirsungorrhagia in cystic mucinous pancreasic tumor]. / Virsungorragiia pri kistoznoi mutsinoznoi opukholi podzheludochnoi zhelezy.

A rare case of virsungorrhagia in a 65 y/o patient with a mucinous tumor of the tail of the pancreas is presented. Recurrent gastrointestinal bleeding was associated with an arrosis of the splenic artery adjacent to the tumor, which required a two-step treatment - endovascular occlusion of the splenic artery and distal resection of the pancreas.

[The role of 3D-CT in surgery for pancreatic ductal adenocarcinoma: post-processing and tissue volume calculation]. / Trekhmernaia rekonstruktsiia komp'iuternykh tomogramm v vybore operativnogo vmeshatel'stva pri protokovoi adenokartsinome podzheludochnoi zhelezy.

AIM: To define the indications for pancreatoduodenectomy using 3D CT-imaging, to calculate the volume of damaged and intact tissues and to determine type of surgery depending on severity of disease in case of ductal pancreatic adenocarcinoma. MATERIAL AND METHODS: Retrospective analysis of CT-scans of 30 patients with ductal pancreatic adenocarcinoma was performed. In groups 1 and 2 by 15 patients total pancreatectomy and pancreatoduodenectomy were made respectively. All patients underwent contrast-enhanced CT examination (Brilliance iCT, Phillips) followed post-processing on Brilliance Workspace Portal platform. All data were assessed by two reviewers. RESULTS: In group 1 CT volume of the tumor was 24±19 cm3 (32% of total pancreas), in group 2 - 9.8±6 cm3 (16% of total pancreas). CT-volume of celiacomesenteric arteries and portal system was 25.8±10 mm/59.5±18.9 mm and 23.3±6/49.9±14.7 mm in groups 1 and 2 respectively. Greater volume of tumor was significantly associated with increased portal system (p<0.03). Sensitivity, specificity and accuracy of determining of tumor location were increased up to 94%, 50% and 80% respectively in group 1. There were no cases of wrong localization in group 2. Data of both reviewers were similar. CONCLUSION: Total pancreatectomy is advisable for pancreatic adenocarcinoma if its volume is over 31.8% of total pancreas according to 3D CT-scans. 3D-modeling improves preoperative assessment of resectability, accuracy of determining of tumor localization and identifying vascular invasion.

Organic hyperinsulinism: radiological diagnostics and surgical treatment.

AIM: To optimize the diagnosis and surgical treatment of insulinoma and nesidioblastosis. MATERIAL AND METHODS: 42 patients with organic hyperinsulinism (OH) were operated. There were 39 cases of insulinoma including 2 patients with insulinoma combined with nesidioblastosis and 3 cases of nesidioblastosis alone. Preoperative ray imaging consisted of percutaneous, endoscopic and intraoperative sonography, contrast-enhanced computed tomography, magnetic resonance imaging (MRI). Functional test included arterial-stimulated blood sampling (ASBS). Laparotomy and robot-assisted techniques were used in 22 and 20 patients. RESULTS: Sensitivity was 62.0%, 76.9%, 83.3%, 87.5%, 94.8% and 100% in percutaneous sonography, CT, endoscopic sonography, MRI, intraoperative sonography and ASBS respectively. Postoperative complications were observed in 14 and 6 patients after conventional and robot-assisted surgery. 2 patients died. Overall mortality was 4.8%. None patient had recurrent hypoglycemic conditions in long-term postoperative period (mean follow-up 18.7 months). CONCLUSIONS: Comprehensive survey allowed to define the cause of OH. Minimally invasive organ-sparing surgery has satisfactory immediate and remote results in these patients.

[Surgical treatment of patients with enteric fistulae].

AIM: To create multidisciplinary diagnostic and curative approach to patients with intestinal fistulae. MATERIAL AND METHODS: Additional nutritive support was applied in all patients preoperatively. 35 patients with intestinal fistulae were operated. Unformed and formed intestinal fistulae were observed in 10 and 25 patients respectively. Radical one-stage surgery was performed in 30 cases, two-stage - in 3 patients. Unformed fistulae opened into granulating wound were not eliminated in 2 patients. RESULTS: Postoperative complications were observed in 10 patients. 2 of them required re-intervention. There were no deaths.

Mixed-field neutrons and gamma photons induce different changes in ileal bacteria and correlated sepsis in mice.

High doses of radiation induce septicaemia, from bacterial translocation, and death in animals. Mice were exposed to either comparable lethal (LD90/30) or sublethal (LD0/30) doses of mixed-field [n/(n + y) = 0.67] or pure 60Co gamma-photon radiation. The relative biological effectiveness of these comparable doses of radiation was 1.82, determined by probit analysis. Mice given a lethal dose of mixed-field radiation developed a significant (p < 0.01), 10(9)-fold increase in Gram-negative facultative bacteria in their ilea over values in control mice. In contrast, mice given a lethal dose of gamma-photon radiation developed a significant (p < 0.01) increase in only Gram-positive bacteria in their ilea, while the number of Gram-negative bacteria remained near values in control mice. Data correlated with bacteria that were isolated and identified from the livers of mice that were given comparable lethal doses (LD99/30) of mixed-field or gamma-photon radiation. In sublethally irradiated mice, fluctuation in the total number of bacteria was detected in their ilea during the first week following irradiation, after which the number approximated the value in control mice. This difference in the predominant facultative bacteria in ilea resulting from different qualities of radiation has important implications for the treatment of septicaemic-irradiated hosts.

Gonococci-human polymorphonuclear leukocyte interactions: metabolic studies associated with attachment and ingestion.

Utilizing monolayers of human polymorphonuclear leukocytes, optimal conditions for attachment and ingestion of Neisseria gonorrhoeae were determined. Both attachment and ingestion were optimal at 36 degrees C when a bacteria-leukocyte ratio of 100:1 was employed. After 30 min of incubation, log-phase viable type 2 gonococci were attached to 90% of leukocytes, whereas log-phase viable type 4 gonococci were ingested by 80 to 90% of cells. Respiratory inhibitors had no effect on attachment or ingestion, whereas glycolytic inhibitors blocked ingestion but did not affect attachment of gonocci to the leukocyte surface. Inhibition was dose dependent and partially reversible. The oxidative metabolism of leukocytes with gonococci attached or ingested was also examined. Attachment of log-phase type 2 gonococci stimulated a minimal increase in glucose oxidation and oxygen consumption by leukocytes in contrast to marked increases by leukocytes that had ingested viable type 4 or heat-killed typed 2 organisms. These results demonstrate that attachment of log-phase type 2 gonococci to the surface membrane does not stimulate significant leukocyte oxidative metabolism nor initiate the phagocytic process.

Viridans streptococcal endocarditis: the role of various species, including pyridoxal-dependent streptococci.

The viridans streptococci are a heterogeneous group of organisms frequently associated with microbial endocarditis. Isolates from consecutive patients with endocarditis due to viridans streptococci who were seen at The New York Hospital from 1944 to 1955 and from 1970 to 1978 were speciated, and the relative frequencies and patterns of sus ceptibility to penicillin were determined. Vitamin B6-dependent streptococci, classified as Streptococcus mitior, accounted for 5%-6% of microbial endocarditis in both time periods. Since these nutritional variants require the active forms of vitamin B6 for growth in routein media, they can be responsible for culture-negative endocarditis. Media must be supplemented with either pyridoxal hydrochloride or pyridoxamine dihydrochloride (the active forms of vitamin B6) for isolation, identification, and subsequent testing of susceptibility to antimirobial agents. Pyridoxine hydrochloride does not support the growth of these organisms in vitro.

The species of viridans streptococci associated with microbial endocarditis: incidence and antimicrobial susceptibility.

Streptococcal endocarditis has been well recognized for decades and over the years investigators at The New York Hospital have defined many of the diagnostic and therapeutic modalities currently employed in patients with this disease. In this study, speciation of the viridans streptococci has provided new insights into the relative frequency and antimicrobial susceptibility patterns of these organisms. Indeed, recent studies also suggest that S. milleri endocarditis is associated with a high incidence of suppurative complications and that patients with S. bovis endocarditis may have a significant incidence of underlying but asymptomatic lower gastrointestinal malignancies. Further studies correlating viridans streptococcal species with other clinical and laboratory parameters of endocarditis should provide additional insights into this disease.