[A change in the expression of membrane-associated proteins and cytoplasmic actin isoforms in the progression of human colon tumors]. / Izmenenie ékspressii membranoassotsiirovannykh belkov i tsitoplazmaticheskikh izoform aktina pri progressirovanii opukholei tolstoi kishki cheloveka.

Tumor progression is a complex process that also involves the restructuring of the actin cytoskeleton and the weakening of intercellular adhesive contacts due to the tumor cells that pass through the epithelial-mesenchymal transition (EMT). AIM: Тo identify correlations between clinical features, risk of progression and/or recurrence of human colon adenocarcinomas (CAC), and EMT-related tumor markers. MATERIAL AND METHODS: Descending colon and sigmoid colon adenocarcinoma samples were examined immunohistochemically. Formalin-fixed paraffin-embedded tissue sections were incubated with antigen-specific antibodies, then secondary antibodies labeled with fluorochromes, and the fluorescence intensity of microscopy images was analyzed. RESULTS: The cells of a tumor compared to those of intact colon tissue showed a weak staining of E-cadherin in the cell-cell contact areas. The reduced membrane staining and nuclear localization of ß-catenin were detected in moderately (G2) and poorly (G3) differentiated tumors. There were substantially decreased ß-actin levels in almost all tumor samples and increased γ-actin ones, mainly in the samples belonging to stage IV disease. CONCLUSION: A correlation was found between stage, tumor differentiation grade, risk for relapse or progression of disease, and the impaired expression of different EMT markers: total or partial loss of E-cadherin expression, ß-catenin reorganization in cell-cell contacts, and a change in the ratio of cytoplasmic actin isoforms in the late stages of CAC development. We believe that these molecular markers may have a prognostic potential.

[Multiple endocrine neoplasia type 1 syndrome with three classical components and chiasm glioma: specific features of target organ lesions and a clinical observation].

The article briefly reviews the specific features of target-organ lesions in multiple endocrine neoplasia type 1 (MEN1) syndrome and a clinical case of genetically confirmed MEN1 syndrome in a young female patient. Despite the relative rarity of this disease, timely diagnosis, treatment and screening for its main components are very important for the overall prognosis of patients with MEN1 and their first-degree relatives who are MEN1 gene mutation carriers. The described case is noteworthy for a number of specific features. The authors could find no account of optic chiasm glioma within the framework of MEN1 in the literature. Moreover, therapy-resistant somatoprolactinoma engages attention, which points to its aggressive nature with pituitary adenoma that is not been clearly visualized on magnetic resonance imaging. Of interest is the order of detection of neoplasms, in particular the manifestation of hypoglycemic episodes as a sign of organic hyperinsulinism. which have been initially regarded as epileptic seizures, after the use of sustained-release somatostatin analogues for the treatment of acromegaly.

[Diagnosis of neuroendocrine neoplasms of the pancreas].

The rare clinical case of multiple primary gastrointestinal stromal tumors (GIST) in one patient is presented in the article. The analysis of the available material confirmed that there is the problem of early detection of this type of tumors and their differential diagnosis. The minutes of outpatient radiological methods of research should include methods of identifying GIST in various locations. Early diagnosis of the disease allows you to make a radical mini-invasive intervention in the endoscopic or robotic-assisted version. This tactic is characterized by high efficiency in combination with the chemotherapeutic treatment.

[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.

[Tactics of surgical treatment of chronic pancreatitis].

585 patients were operated on the reason of chronic pancreatitis. 246 patients received various drainig operations: cystojejunostomy with Roux-en-Y anastomosis (n=97), longitudinal pancreatojejunostomy (n=86), external draining of the absceding postnecrotic cysts (n=51), internal draining (n=12). Resections of the pancreas were performed in 327 cases: Frey operation (n=83), Beger operation (n=46), pancreatoduodenal resection (n=61) - of them 55 were suspicious to cancer and 6 had pancreatic dystrophy. Distal resection of the pancreas was performed in 6 cases. 33 patients were operated on pseudoaneurisms, of the 12 patients received endovascular operations. Posoperative complications were registerd in 119 (20.3%) patients. 7 (1.2%) patients died.

[The terminology, classifications and staging of neuroendocrine tumors of the pancreas].

The basic classifications, including the TNM and the WHO's classification of neuroendoctine tumors of the pancreas are highlighted. The WHO's dividing such tumors on G1 and G2 neuroendocrine lesions and G3 neuroendocrine carcinomas is substantiated.

[The intermediate and long-term treatment results of solid-pseudopapillary tumors of pancreas].

15 patients with solid-pseudopapillary tumors of the pancreas (SPTP) were investigated. There were no specific clinical signs of the disease revealed; the major common clinical sign was the upper abdominal pain. Of the diagnostic methods the ultrasound together with endoscopic ultrasound, computed tomography and magnetic resonance imaging were used. Specific diagnostic feature of SPTP is the heterogenous structure and even contours and capsule. Any changes of pancreatic duct are untypical. All 15 patients were operated on. The intraoperative urgent histological analyze together with postoperative immunohystochemical investigation were performed in all cases. 11 patients developed the postoperative pancreatitis. The long-term follow up results were obtained in 15 patients. The disease progression was registered in one case.

[The resection of the head of the pancreas with longitudinal pancreatojejunostomy (Frey procedure)].

The indications to Frey operation are severe pain syndrome and pancreatic hypertension, caused by concrements and strictures of the main pancreatic duct and/or postnecrotic pancreatic cysts. The pancreaticojejunoanastomosis is performed on the isolated by Roux intestinal loop. The average operating time was 4.62±1.39 hours. 28,3% of the operated patients developed various postoperative complications. 2 (6.7%) patients had the anastomosis insufficiency; the 2 patients had intraanastomotic bleeding and 1 patient had the arrosive bleeding caused by pancreonecrosis. 2 patients had external pancreatic fistulae. 1 patient died. The average hospital stay after the operation was 12±4 days.

[The postoperative pancreatitis after the pancreatic surgery].

The results of 302 operations on the pancreas were analyzed: of them 107 were pancreatoduodenal resections; 67 were distal resections of the pancreas; 74 were various resections of the head of the pancreas and middle resections and 54 other operations. The postoperative pancreatitis was registered in 178 patients. The preventive use of the octreotide intraoperatively and in early postoperative period showed no influence on the frequency and severity of the postoperative pancreatitis. The ultrasound was the optimal screening diagnostig method, whereas the computed tomography was the best in pancreonecrosis diagnostics and the volume of the pancreatic tissue damaged. Of 178 patients with the postoperative pancreatitis 17 died, the lethality rate was 9.5%.

[The metastatic invasion of pancreas by renal cancer].

4 clinical cases of metastatic invasion of pancreas by renal cancer were analyzed. The main features were the late metastatic revealance and the absence of specific clinical picture. The radiodiagnostics showed signs similar to neuroendocrine tumors of the pancreas, which complicated the diagnosis. All the patients were operated on - the resection of the pancreas was performed.

[Intraductal papillary-mucinous tumor of the pancreas: difficulties and mistakes of diagnostics and treatment].

15 patients with intraductal papillary-mucinous tumors (IPMT) of the pancreas were observed. Clinical manifestation corresponded with chronic pancreatitis. Ultrasound study, including endosonography, contrast-enhanced computer and magnetic resonance tomography were used in complex observation of the patients. Dilation of main or lateral pancreatic ducts, connection of tumor with pancreatic duct system and absence of septal calcinosis are typical signs in radiodiagnostics of IPMT. Visualization of parietal papillary proliferations and their contrast enhancement are undeniable signs f or neoplastic character of pancreatic duct dilation. Sensitivity of CT, MRТ and endoUS amounted accordingly 66, 83 and 88%. All patients were operated. Extent of operation was determined by morphological character, localization and size of the tumor (pylorus-preserving pancreaticoduodenal resection was carried out to 6 patients, distal resection including robot-assisted - to 7 patients, midline resection - to 1 patient, duodenum-preserving resection of head and body of pancreas - to 1 patient). Intraoperative urgent histologic study of pancreatic section was carried out by all means. Tumors with borderline degree of malignancy were detected in 4 cases.

[Surgical treatment of the unformed intestinal fistulae].

Treatment results of 5 patients with unformed intestinal fistulae are represented. High unformed intestinal fistulae are acknowledged to be completely unsuitable for conservative treatment and should be operated on. Complex treatment should include complete parenteral feeding, adequate fecal diversion with the use of aspirational drainage. Surgical treatment must be y the increase of fistula discharge or absence of fistula formation. Low intestinal fistulae should better be surgically dissected after their organization, otherwise urgent surgery is to be performed by complications development, such as purulent leakage into the abdominal cavity or severe wound infection.

[Treatment of patients with chronic pancreatitis complicated by pseudoaneurysms of the celiac trunk basin arteries].

The authors have analyzed results of treatment of 26 patients with chronic pancreatitis complicated by pseudoaneurysms. Hospitalization and treatment of such patients should be performed in specialized hospitals which can fulfill special examination in detail and carry out roentgen-endovascular operations. Intraintestinal bleeding is an absolute indication for emergent surgery for performing hemostasis. Conservative treatment is indicated for intestinal bleedings and after arrest of bleeding the patients should be transported to specialized institutions. Two types of the appearance of pseudoaneurysms were established depending on the pathological mechanism: when there was a relationship of the pseudocyst with the main pancreatic duct (I type) and when there was not (II type). For the I type roentgen-endovascular treatment (RET) followed by operation is indicated, for the II type RET is thought to be enough.

[Single-layer uninterrupted suture at the surgery of chronic pancreatitis].

Single-layer uninterrupted suture is uncommon at the pancreatic surgery. This method has been used at 44 patients during pancreatic resection, cysto-enterostomy, pancreato-enterostomy and pancreato-cysto-enterostomy. Techniques of suture is described and illustrated. There were no cases of anastomosis insufficiency or other anastomosis complications. Method is simple, reliable and may be interesting for surgeons operating on pancreas.