[Radiothermometry in diagnosis of thyroid diseases].

Primary experience (177 patients) of diagnosis of thyroid gland diseases with radiothermography using microwave radiothermometer RTM-01-RES is analyzed. In unaffected thyroid gland there were no temperature differences between symmetric points of right and left lobe. Cancer of thyroid gland and toxic adenoma are characterized by higher internal temperature. High sensitivity of method and its simplicity are the reasons for use of radiothermography as screening method.

[Adenomas of the thyroid gland].

Different methods of diagnosis and treatment of thyroid gland's adenomas are analyzed. Current surgical treatment of euthyroid goiter is reviewed. Basing on long-term studies, the role and place of special diagnostic methods (ultrasonic scanning and fine needle biopsy) and indications for their use and surgical treatment were determined. The proposed treatment and diagnostic algorithm reduces the number of unjustified surgeries. When elective histological examination reveals thyroid cancer, reoperation is not necessary. The groups of patients with confirmed diagnosis "thyroid adenoma" and high cancer risk were distinguished. Optimization of differential diagnosis of thyroid adenoma and cancer based on cytological and immunogenotypic tests will help determine indications to surgical treatment in adequate scope.

[Prophylaxis and treatment of disorders of the vocal cords mobility after surgeries on the thyroid gland].

Own and foreign experience in surgical treatment of thyroid gland (TG) diseases was analyzed. Surgical anatomy of TG, effective methods of surgical techniques, classification of disorders of vocal cords mobility, and treatment policy are described. It is demonstrated that no less than 70-80% patients with respiratory disorders after surgeries on TG can avoid tracheostomy and subsequent complex and sometimes staged plastic surgeries on the larynx. Proposed recommendations permit one to reduce risk of postoperative complications, to improve long-term results of surgical treatment and life quality of operated patients.

[Thyroid cancer with signs of C- and A-cell differentiation]. / Rak shchitovidnoi zhelezy s priznakami C- i A-kletochnoi differentsirovki.

The paper reports a case of thyroid cancer in a female patient aged 56 operated on for nodular euthyroid goiter. The tumor had a mixed histological structure of medullary-follicular cancer and resembled malignant hemangioendothelioma. Electron microscopy detected tumor cells of A- and C-cell type as well as nondifferentiated elements. The tumor contained deposits of amorphous mass deprived of tinctorial properties characteristic of APUD-amyloid and having fine-fibrillar material produced by tumor C-cells.

[Cholecystectomy by mini-approach in the treatment of cholelithiasis]. / Kholetsistéktomiia iz mini-dostupa v lechenii zhelchnokamennoi bolezni.

Along with wide-spread laparoscopic cholecystectomy, cholelithiasis can be treated with another sparing technique--miniaccess cholecystectomy (MACE). Case histories and long-term treatment outcomes were analysed for 168 patients aged 23-77 years subjected to MACE with elements of open laparoscopy for chronic calculous cholecystitis. Surgery was made using a special surgical kit "Mini-assistant" by the team of two surgeons and an instrument nurse. After MACE the patients resume their jobs after a shorter period of inability, suffer from side effects of surgery in rare cases, have higher quality of life than patients after laparoscopic cholecystectomy.

[Surgical interventions in concurrent and concomitant diseases in patients with myasthenia gravis]. / Khirurgicheskie vmeshatel'stva po povodu konkuriruiushchikh i soputstvuiushchikh zabolevanii u bol'nykh miastenii.

The authors analyse the recent 15 years' results of treatment of 51 patients with generalized myasthenia who underwent operation in the clinic for various surgical diseases. Forty-three of them had a history of operation on the thymus. The specific features of preoperative management, anesthesia, and postoperative treatment in this serious category of patients are discussed. It is concluded that it is expedient to hospitalize these patients in special surgical hospitals possessing experience in the treatment of patients with generalized myasthenia and the possibility of conducting long-term ventilation of the lungs and other measures of resuscitation.

[Repeated surgeries on the thyroid gland in nodular euthyroid goiter]. / Povtornye operatsii na shchitovidnoi zheleze pri uzlovom éutireoidnom zobe.

Medical histories of 214 patients hospitalized with diagnosis "recurrent nodular goiter" were studied retrospectively. Complex clinical, laboratory and instrumental examination was carried out in all the patients. Comparative analysis demonstrated that in the structure of recurrent goiter nodular colloid form dominated (84.1%), only in 42.1% cases repeated surgeries were indicated. Other patients (15.9%) were the ones underwent surgery for other thyroid diseases (hypertrophied form of autoimmune thyroiditis, follicular adenoma, thyroid cysts, thyroid cancer). Inadequate surgery and prophylactic therapy with iodine drugs were the main causes of recurrent goiter. Adequate iodine prophylaxis (potassium iodide 100-200 mg per day), complex examination of patients, correct indications for primary surgery and adequate surgical volume, valuable postoperative therapy (iodine drug, LT-4 if it is necessary) permit to reduce the risk of recurrent nodular (multiple-nodular, diffuse-nodular) goiter. Ways of researches for improvement of diagnosis, prophylaxis and treatment results of "recurrence nodular goiter" are projected.

[Clinical value of fine-needle aspiration biopsy of the thyroid gland]. / Klinicheskaia tsennost' tonkoigol'noi aspiratsionnoi biopsii shchitovidnoi zhelezy.

The work compares the results of fine-needle aspiration biopsy (FAB) of the thyroid gland in nodular and diffuse-nodular euthyroid goiter (63 patients) with the findings of pathomorphological study of the operative material (51 patients). The authors' original device for puncture of the thyroid node is described. The suggested method makes it possible to raise the efficacy of obtaining an adequate amount of aspired material to 92%. On the basis of the results of FAB and ultrasonic examination (USE) unfounded surgical intervention was avoided in 12 of the 63 cases. The results of the study bear evidence of the high diagnostic efficacy of FAB as to obtaining the cytologic material and revealing malignant degeneration (96% specificity). The authors believe that FAB in combination with USE should be an obligatory component of complex clinico-instrumental examination of patients with various diseases of the thyroid, nodular forms of affection in particular.

[Diagnosis and surgical treatment of myasthenia gravis in childhood]. / Diagnostika i khirurgicheskoe lechenie miastenii v detskom vozraste.

Thirty-year experience in surgical treatment of myasthenia in children and adolescents (175 patients) is generalized. It provides evidence of delayed recognition of this disease in many patients and of prolonged, often ineffective nonoperative treatment. Operation for thymectomy should be one of the main methods for the management of myasthenia in children. Operative treatment is indicated in a disease of moderate severity or in a severe course of myasthenia, particularly in patients with the first type of immunomorphological changes. It is important to amend the myasthenic disorders before the operation by means of maximally possible doses of anticholinesterases with addition of corticosteroids, whenever necessary. Whatever the method of treatment chosen, the patients must be kept under skilled dynamic control. Excellent and good late-term results were produced in 84.6% of cases.

[Plasmapheresis in combined treatment of severe generalized myasthenia]. / Plazmaferez v kompleksnom lechenii tiazheloi generalizovannoi miastenii.

Experience in the application of plasmapheresis in various stages of treatment is analysed. It was conducted in 52 patients with severe forms of generalized myasthenia; 12 of them were males and 40 were females. It is noted that plasmapheresis is very effective in the preoperative period for the preparation of patients for operation and is ineffective in medicamentous therapy. In the late-term periods after thymectomy plasmapheresis is mainly recommended for arresting crises and precritical conditions because of the rapid and short effect of the method. In patients who underwent thymectomy and splenectomy the effect of plasmapheresis in the late-term period after the operation was of a longer duration. Research must be continued and clinical experience accumulated to identify exactly the mechanism of the effect of plasmapheresis on the myasthenic status and the immune and neuroendocrine systems and to determine the place of the method in the complex of therapeutic measures.

[Comparative assessment of diagnostic methods in adenomas of the thyroid gland]. / Sravnitel'naia otsenka metodov issledovaniia pri adenomakh shchitovidnoi zhelezy.

The authors carried out comparative assessment of sensitivity and specificity of ultrasonic examination with color dopper mapping (USE with CDM), thin-needle aspiration biopsy--TAB (palpation- and US-assisted), express histologic examination--(EHE), intraoperative laser autofluorescent spectroscopy (IOLAS) with retrospective assessment by results of elective histologic examination in adenomas of thyroid gland (TG). Medical histories of 135 patients hospitalized with adenomas of TG of follicular cells were analyzed. Based on comparison of USE with CDM and morphologic analysis of TG adenomas three types of specific echographic symptomcomplexes were recognized. USE with CDM in combination with US-assisted TAB was the most effective diagnostic complex before operation. Comparative analysis of results of these methods with express histologic examination showed equal efficacy, that permitted to reject routene EHE. For the first time IOLAS was used as "optic instant-biopsy" for selection of optimum scope of surgery when "follicular neoplasia" was suspected. Combined use of USE with CDM and TAB before operation as well as IOLAS enabled correct diagnosis of the nature of TG lesion, it morphologic type, and based on these data adegnatechoice.

[Cholecystectomy from mini-approach with the elements of open laparoscopic technique in surgical treatment of cholelithiasis]. / Kholetsistéktomiia iz mini-dostupa s élementami otkrytoi laparoskopicheskoi tekhniki pri khirurgicheskom lechenii zhelchnokamennoi bolezni.

The experience and the technique of cholecystectomy from mini-approach with elements of open laparascopic technique (MSE) in 102 patients with choledocholithiasis and calculous cholecystitis is descubed. In 99 cases the operation was carried out for chronic calculous cholecystitis, in 3 cases--for acute calculous cholecystitis. The patients were aged from 23 to 76 years (mean age 59.3 +/- 3.4 years). The average length of the incision in performing MSE made up 4.1 +/- 0.3 cm. Mean duration of the operation 42.4 +/- 5.3 min. In 5 cases (4.9%) intraoperative cholangiography was performed. The possibility to avoid the use of narcotic analgetics in postoperative period in patients who underwent MSE is demonstrated. Postoperative period made up 3.8 days. Social and cost-effect aspects of different modes of surgical treatment of patients with cholelithiasis are considered. The study of quality of life index makes it possible to come to conclusion about quicker return of the patients who underwent MSE to their habitual social and intellectual activities, practically complete absence of the influence of negative factors of conventional treatment (pains, dyspepsial, cosmetic defects) higher appreciation of their health conditions, well being, which manifests in higher quality of life in operated patients.

[Thin-needle aspiration biopsy of solitary formations of the thyroid gland]. / Tonkoigol'naia aspiratsionnaia biopsiia solitarnykh obrazovanii shchitovidnoi zhelezy.

The paper analyzes the use of thin-needle aspiration biopsy in 372 patients with thyroid solitary formations. By the results of clinical and instrumental studies and cytological examination of thyroid puncture specimens groups of patients with individual clinical and morphological types of the disease were identified. Differential surgical policy in each group of patients was shown on the basis of the finding. It is concluded that thin-needle aspiration biopsy should be integrated into the compulsory programme of comprehensive examination of patients with thyroid solitary formations. Having a high efficiency, the above method helps in most cases to make an accurate clinical and morphological diagnosis and to choose the optimal treatment policy for each specific patient admitted to a surgical hospital for an aggregate diagnosis of nodal euthyroid goiter. Some patients may avoid unjustifiable surgical intervention and be on conservative therapy under follow-up.

[Surgical stress in different cholecystectomies]. / Khirurgicheskii stress pri razlichnykh variantakh kholetsistéktomii.

For determination of surgical stress degree and evaluation of long-term results prospective randomized study was carried out. Three representative groups were compared: patients undergone traditional cholecystectomy (TCE)--95 patients (1 group), laparoscopic cholecystectomy--91 patients (2 group), minimally invasive cholecystectomy--92 patients (3 group). Level of stress hormones (before, during and after surgery), parameters of external respiration (before and after surgery), doses of analgetics (or their combinations) which were necessary for adequate analgesia in early postoperative period depending on surgical method were used as objective criteria of surgical stress. Based on evaluation of patients quality life reliable difference in first three years after surgery between patients undergone TCE and ones undergone minimally-invasive surgery was demonstrated.

[Diagnosis, surgical treatment and prognosis in patients with generalized myasthenia]. / Diagnostika, khirurgicheskoe lechenie i ego prognoz u bolnykh generalizovannoi miasteniei.

The work deals with the clinical analysis of the richest experience in the surgical treatment of patients with generalized myasthenia in the country. The efficacy of various methods for the diagnosis of affection of the thymus is studied comparatively. It is shown that for more effective diagnosis of neoplastic lesions of the thymus wider use of computerized and magneto-resonance tomography is expedient and that they must replace the insufficiently informative and invasive examination methods used today (pneumonodiastinography, phlebography, scintigraphy, etc.) which still form the basis for the system of diagnostic research in patients with myasthenia. The authors determined the indications and contraindications for, the optimum terms for undertaking the surgical intervention and its volume in neoplastic and nonneoplastic diseases of the thymus in adults and children. Comparative evaluation of various means of preoperative management was conducted. It is shown that to improve the patient's condition and stabilize the myasthenic status on the possibly minimal doses of anticholesteremic agents glucocorticoid hormones should be included in the complex of preoperative management. The indications for hormonotherapy were determined. The efficacy of plasmapheresis, radiotherapy, and glomectomy with denervation of the sinocarotid zone was evaluated and their place in the complex treatment of patients was determined. From study of the late-term results of treatment of a large group of patients (children, adults with a thymus) the main causes of unsuccessful surgical treatment of generalized myasthenia were identified and the concrete means of improving the results of treatment were planned. Two types of changes in the clinico-immuno-morphological values were revealed in patients with generalized myasthenia, differing evidently in pathogenesis. New clinico-immuno-morphological correlations and prognostic factors were discovered, and a method for prognosticating the effect of thymectomy was suggested. It is shown that splenectomy has a favorable effect in the most severe category of patients in unsuccessful operative and nonoperative treatment. The tactics of management of patients accepted in the clinic led to a uncomplicated course of the postoperative period in the majority of patients in the last years.