[Problems of the diagnostics of perivascular epithelial cell tumors].

Perivascular epithelioid cell tumors is a group of rare tumors composed of histologically and immunohistochemically distinctive perivascular epithelioid cells. There are no specific imaging sighs. In most cases, the final diagnosis is possible only after the immunihistochemical study. These tumors are extremely rare. We present imaging findings of two cases of perivascular epithelioid cell tumors of the liver.

[Pancreatectomy for the pancreatic tumors].

23 pancreatectomies were made on the reason of various tumors of the pancreas during the period of 2009-2012yy. 15 patients had duct adenocarcinoma, 4 - neuroendocrine neoplasia, 2 - intraductal papillary-mucinous tumor, 1 had metastase of renal-cell carcinoma and 1 was diagnosed with serous cystadenoma. Pancreatectomy was indicated in case of invasion of the whole pancreas or in case of multiple tumor focuses. By adenocarcinoma the pancreatecomy was abstained in case of large vessels (a. mesenterica suoerior, truncus coeliacus and hepatic arteries) invasion or remote metastases presense or impossibility of R0 resection. Metastases and vessel invasion were not considered as contraindication to pancreatectomy in patients with neuroendocrine lesions. 10 (43.5%) patients had postoperative complications; 2 patients died. The survival median was 7 months for the duct adenocarcinoma. Postoperative life duration for patients with other pancreatic tumors was 6-36 months.

[The distal pancreatic stump extirpation on the reason of profuse arrosive intraabdominal bleeding].

11 patients with profuse arrosive intraabdominal bleeding after pancreatic resections were operated on the reason of pancreatic tumor. 9 patients had pancreatoduodenal resections (of the 6 pyloruspreserving), 2 patients had middle pancreatic resections. Bleeding was caused by postoperative pancreonecrosis and suture insufficiency in all cases. The source of bleeding were: vena porta, upper mesenteric and splenic veins, upper mesenteric and common hepatic arteries. 3 patients were relaparotomyzed and the vessel wall was sutured. Nevertheless, they died after bleeding recurrence within 2-3 days. The extirpation of the distal pancreatic stump was performed in 8 patients. Of them 3 patients died of multyorgan failure. The experience permits to consider the distal pancreatic stump the operation of choice by postoperative profuse bleeding.

[Complications after radio-frequency thermoablation of liver tumors].

Results of treatment of 124 patients (228 operations) were analyzed. Complication rate was 19.2%, whereas severe complications were observed in 4.3%. Complications, requiring minimally invasive surgery, on the contrary, conservative treatment , as well as risk actors were defined. Possibilities of radio-frequency thermoablation complications prophylaxis were suggested.

[Arterial celiac-mesenterial aberrations: comparative analysis of intraoperative data and CT-angiography].

137 CT-angiograms of arterial celiac-mesenterial vessels were pro- and retrospectively analyzed in 120 patients. Radiological data was compared with intraoperative anatomy during standard and extended pancreatoduodenal resections. The analysis showed a considerable variability in architecture of celiac and superior mesenteric artery branches: hereby, a classical arterial anatomy was found only on 55% of the analyzed CT-scans. Intraoperative revision confirmed CT-data in all cases. CT-angiography is a prompt and reliable method of celiac-mesenterial arterial anatomy determination, making surgical treatment of patients with liver and pancreas diseases safer.

[Enlarged sinistral hemihepatectomy and prosthetic repair of the inferior vena cava in locally disseminated hepatic alveococcosis].

High risk of surgical management for disseminated forms of alveococcosis appears to be associated with invasive growth of the parasite and the related necessity to perform vast resections of the liver and adjacent organs, as well as resections and prosthetic repair of the major vessels. The only alternative method of treatment could be liver transplantation. The purpose of this study was to demonstrate successful prosthetic reconstruction with the an allograft of the hepatic segment of the inferior vena cava in the course of enlarged hemihepatectomy for locally disseminated hepatic alveococcosis with the involvement of the inferior vena cava. The "Goretex" prosthesis was used as an allograft. The immediate postoperative period was accompanied and followed by mild-degree postresection liver insufficiency. During 6 months of dynamic follow up, the prosthesis was patent, with no relapses of the disease on the background of antiparasitic chemotherapy being noted. The use of allografts in vascular prosthetic repair in hepatic alveococcosis appears justified, requiring, however, further investigation.

[Hilar glissonean access to vascular-secretory elements in anatomical segmental liver resections].

It still remains unclear which patients with hepatic tumors can favour anatomical segmental liver resections instead of major liver resection. Short term results of anatomical segmental liver resection are evaluated and analyzed. Ten patients underwent the anatomical segmental liver resection performed by posterior approach with taping of anterior right hepatic vein. Seven patients had liver metastases of colorectal cancer, one had primary hepatic carcinoma and two had benign lesions, anatomical segmental liver resection were performed without Pringle maneuver. There was no significant difference in blood loss, duration of the procedure, postoperative hospital stay and morbidity in comparison with the segmental liver resection performed by anterior approach. Multiple, large and deep-embedded lesions were removed completely, with tumor-free resection margins. Anatomical segmental liver resection performed by hilar glissonean approach is recommended in patients with compromised liver function "unfavourable" liver anatomy to replace major liver resection provides removal of only affected part of the liver accordingly to its true anatomical borders.

[Median resection of pancreas].

Experience of 16 median resections of pancreas due to serous or mucinous benign cystic tumor (13 patients) or small afunctional neuroendocrine tumor (3 patients) is analyzed. In all the cases the pathologic process was located at the zone of pancreas isthmus. The long-term results were followed-up at 13 patients from 2 to 14 years (mean followed-up - 8 ys). There were no recurrences of tumor. It is concluded that median resection of pancreas is effective and safe surgical operation for the patients with localization of benign tumor at the zone of pancreatic istmus.

[Complex ultrasonic diagnosis of large and gigantic non-parasitic cysts of liver].

The results of clinical and complex ultrasonic examination of 95 patients with large and gigantic liver non-parasitic cysts (LNC) are analyzed. The morphological examination was performed in all the cases. The mean diameter of large LNC was 105+/-7 mm, of gigantic cysts -- 149+/-33 mm (p<0,05), cyst volume was respectively 600+/-142 and 1721+/-954 ml (p<0,05). Analysis of clinical, ultrasonic and laboratory data allowed to describe three variants of large and gigantic, complicated and non-complicated cysts with 97,9% accuracy. The 3-D US reconstruction permitted to precise the anatomic structure and trace selection during transcutaneous US-assisted treatment.

[Regional intraarterial chemoimmunotherapy in complex treatment of patients with colon cancer complicated by metastatic lesion of the liver].

Results of combined treatment of 48 colon cancer patients with metastases to the liver are analyzed. Efficacy of regional intraarterial chemoimmunotherapy with recombinant interleukine-2 (ronkoleukine) is evaluated. The results of the treatment demonstrate that regional intraarterial chemoimmunotherapy with recombinant interleukine-2 is a safe and promising method in combined treatment of advanced colon cancer, increases survival and improves quality of life.

[Laparoscopic procedures in focal lesions of the liver].

Seventy-three laparoscopic procedures were performed for the treatment of focal lesions of the liver. Fifty-four patients had operations for non-parasitic cysts of the liver and cystic disease. Polycystic disease of the liver was in 8 patients. Multiple cysts were in 19 patients, solitary - in 27. A total of 139 cysts were treated. Surgery was performed with the standard technique. Atypical marginal resection of the liver was performed in 16 patients for hemangioma (n=8), nodular hyperplasia (n=2), hepatic metastases (n=5), hamartoma (n=1). Atypical marginal resection by type of peritumor resection was conducted in 5 cases, and it was similar to segmentectomy in 11 cases. Laparoscopic cryodestruction of benign tumors and hepatic metastases was performed in 3 patients including in combination with atypical marginal resection in 2 cases. There were no intrasurgical complications which required laparotomies. There were no hemotransfusions. Long-term results were followed-up from 1 to 3 years in 25 patients with hepatic cysts and from 3 months to 3 years in 7 patients after marginal resection for hemangiomas and fibronodular hyperplasia. Ultrasonic examination revealed no recurrences of the disease.

[Adult hepatoblastoma].

A rare case of hepatoblastoma is reported in a female of 47 years of age with literature review of these tumors in the adults. Microscopically the tumor was represented by the cells of embryonal and fetal types. Immunohistochemically expression of low-molecular cytokeratins as well as that of S-100 protein and hepatocyte antigen was observed.

[Analysis of a school timetable, bearing in mind the health status of children]. / Analiz shkol'nogo raspisaniia s uchetom zdorov'ia detei.

A type of medical examination of a school timetable is proposed, by bearing in mind the actual educational price established at a specific educational establishment. The ratio of the physiological and emotional stress in pupils during schooling to their learning progress and physical fitness is the price of schooling. The study has revealed no direct relationship between the level of schooling load and the price of education. There are difficulties in learning within the first days of a week and a need for additional efforts to maintain the pupils' working capacity at the end of a week.

[Clinical characteristics of the depressive development of personality]. / Klinicheskie osobennosti depressivnogo razvitiia lichnosti.

To study manifestations of the depressive personality development, the authors followed up 48 women (of the total number of 143 patients) exposed to long-term objectively unsolvable psychogenically traumatizing situation related to a child's disease. The symptomatology of depressive neurosis had undergone a typical course by the moment of examination: the acuteness, vividness and lability of the affect had disappeared, being replaced by its monotony; depression of the psychic activity in all spheres of life had deepened and strengthened, faith in a favourable resolution of the situation had been fully lost; new traits related to anxiety-dysthymic attitude toward people and events had formed; psychosomatic diseases had developed in the presence of marked vegetative manifestations. Clinical variants of depressive personality development are described. A conclusion is drawn about the typical eventuality of a depressive neurosis in the depressive development of the personality.

[Dynamics of psychogenic depressive disorders occasioned by the birth of a sick child into a family]. / O dinamike psikhogennykh depressivnykh rasstroistv, vyzvannykh rozhdeniem v sem'e bol'nogo rebenka.

In order to study the time-course of depressive neurosis, the author followed up 51 women living under the conditions of a prolonged psychotraumatic situation (the presence in the family of a child with infantile cerebral paralysis). Two variants of depressive disturbances formation closely associated with the premorbid characteristics of the patients' personality have been identified. It was shown that with passing years the neurotic disturbances led to a clinically homogeneous neurotic development of depressive nature. The author outlines the mechanism of the time-course of the given type of borderline disturbances, proceding from neurotic depressive reactions to depressive neurosis and further to a specific development of the personality.

[Healing characteristics of wounds produced by various surgical instruments]. / Osobennosti zazhivleniia ran, nanesennykh raznymi khirurgicheskimi instrumentami.

Healing of liver wounds after marginal resection of the liver by CO2 laser of permanent action, scalpel and electric knife were studied. Considerable differences in the course of wound healing were observed. Wounds produced by laser heal without inflammatory infiltration of the abjacent tissues and within a shorter period of time.

[Depressive disorders in gastroenterology: problems in the treatment of chronic duodenal obstruction]. / Depressivnye rasstroistva v gastroénterologii: problemy lecheniia khronicheskoi duodenal'noi neprokhodimosti.

Among 190 patients suffering from chronic duodenal obstruction (CDO) the authors identified 66 patients whose somatic disturbances were manifestations of mental disease, usually depression. They formed a section "primary functional forms of CDO" in the classification scheme. Additionally some of these cases were complicated by nonspecific lymphadenitis and entered a group of mechanical forms of CDO. The use of psychotropic drugs in both cases considerably improved the prognosis of the disease. Sensthopathic feelings in the abdomen in such cases were attributable to vegetative motor disorders of the upper portions of the gastrointestinal tract ascertained by instrumental examination.

[The morphological changes in liver hemangiomas and in organ tissue after endovascular occlusion of branches of the hepatic artery based on the results of a study of surgical material]. / Morfologicheskie izmeneniia v gemangiomakh pecheni i v tkani organov posle éndovaskuliarnoi okkliuzii vetvei pechenochnoi arterii po rezul'tatam issledovaniia operatsionnogo materiala.

30 haemangiomas and surrounding liver tissues removed surgically are studied histologically. 11 patients underwent endovascular occlusion of the hepatic artery peripheral branches at various intervals before the operations. The lack of reaction of the vascular wall to the X-ray noncontrast emboli and minimal reaction to the X-ray contrast emboli were found. The persistence of the vascular lumen occlusion is proved. The degree of the haemangioma blood filling is reducing, the cavernae recede and the tumour sclerosis occurs after the endovascular occlusion. Aseptic necrosis in the haemangioma and small necrosis of liver tissue are possible.

[Characteristics of the topographic interrelation of the head of the pancreas and the duodenum and pathology of the organs of the pancreatoduodenal area]. / Osobennosti topograficheskogo vazimootnosheniia golovki podzheludochnoi zhelezy i dvenadtsatiperstnoi kishki i patologiia organov pankreatoduodenal'noi zony.

Seventy pancreatoduodenal complexes of 55 patients with chronic pancreatitis and tumours of this zone and 15 patients died from other diseases are studies histotopographically . The pieces of the pancreatic head tissue in the medial wall of the duodenum were found in 12 cases of the first group and in 4 control cases. The pancreatic tissue consisted either of all elements of this organ or cystically dilated ducts and seemed to infiltrate different layers of the duodenum wall. Three variants of the pancreatic head structure are suggested on the basis of anatomo-topographical interrelationships of the pancreatic head and duodenum. In 12 out of 14 cases chronic pancreatitis and carcinoma of organs of this zone were combined with the variants of the pancreatic head structure, in 2 cases there was a true heterotopy . Pathogenetic significance of these variants for the development of chronic pancreatitis is discussed.

[A new method of antibiotic prophylaxis in liver surgery]. / Novyi sposob antibiotikoprofilaktiki v khirurgii pecheni.

Ninety patients with focal affections of the liver were followed up. The patients were operated on the liver and treated therapeutically and prophylactically by means of the target-aimed release of antibiotics in erythrocyte ghosts. The antibiotics used were gentamicin and aztreonam. The results of the clinico-laboratory examinations showed that the target-aimed transport of the antibiotics in erythrocyte ghosts provided a 9-fold increase of the antibiotic level in bile and its 2-fold increase in the liver tissue. The time of the drug retention in the body fluids and tissues increased 2 times as compared to that provided by the routine treatment. The incidence of the postoperative purulent complications decreased 3 times. Such an effect is likely due not only to the target-aimed release of the drugs but also to the possible immunomodulating action of the prophylactic procedure used for preventing the complications that prevented as well the development of severe postoperative immune deficiency. Aztreonam proved to be more efficient in the prophylaxis of the postoperative complications.