[Early outcomes of robot-assisted liver resection]. / Robot-assistirovannye rezektsii pecheni. Otsenka blizhaishikh rezul'tatov.

AIM: To assess an experience of robot-assisted liver resection using CUSUM-test. MATERIAL AND METHODS: The results of 46 robot-assisted liver resections were retrospectively analyzed by using of CUSUM-test. RESULTS: There were 3 periods in development of the technology. The 1st period - procedures with the lowest index of difficulty (n=16), the 2nd period - expansion of the indications for difficult resections (n=18) and the 3rd period - stabilization of the results (n=12). The dynamics of difficulty index, intraoperative blood loss, duration of procedure and morbidity (Clavien-Dindo Grade II-V) were evaluated. Five liver resections were needed to decrease blood loss and duration of the procedure. Expansion of indications was feasible after 16 procedures. Stable results were obtained after 34 liver resections.

[Intrahepatic cholangiocarcinoma followed by vascular invasion: is surgical treatment justified?] / Vnutripechenochnaia kholangiokartsinoma s invaziei v sosudy: opravdano li khirurgicheskoe lechenie?

Intrahepatic cholangiocarcinoma (ICC) is one of the most aggressive tumors associated with poor prognosis. Radical surgery is still the main method of treatment in resectable cases. Certain difficulties are observed in case of locally advanced tumors followed by inferior vena cava (IVC) and portal vein (PV) invasion. AIM: To analyze safety of advanced liver resections combined with great vessels repair for locally advanced large and multiple cholangiocellular carcinoma. MATERIAL AND METHODS: Since January 2014 till April 2017 eighty ICC patients have undergone advanced liver resection. There were 62 patients with portal cholangiocarcinoma and 18 with ICC. 4 ICC patients required vascular repair: IVC replacement in 2 cases (i.e. under venous bypass in 1 of them), tangential and circular resection of portal vein bifurcation - in 2 cases. RESULTS: Postoperative complications Clavien-Dindo IIIa developed in all cases. There were no vascular complications. The length of hospital-stay was 14 - 35 days. There were no lethal outcomes. Annual survival was 50%, 2-year - 25%. Adjuvant chemotherapy was used in all patients. CONCLUSION: Advanced liver resection followed by IVC and PV repair for locally advanced ICC may be safely performed and subsequently allows chemotherapeutic treatment.

Diminished electron density in the Vaska-type rhodium(I) complex trans-[Rh(NCBH3)(CO)(PPh3)2].

Vaska-type complexes, i.e. trans-[RhX(CO)(PPh3)2] (X is a halogen or pseudohalogen), undergo a range of reactions and exhibit considerable catalytic activity. The electron density on the Rh(I) atom in these complexes plays an important role in their reactivity. Many cyanotrihydridoborate (BH3CN(-)) complexes of Group 6-8 transition metals have been synthesized and structurally characterized, an exception being the rhodium(I) complex. Carbonyl(cyanotrihydridoborato-κN)bis(triphenylphosphine-κP)rhodium(I), [Rh(NCBH3)(CO)(C18H15P)2], was prepared by the metathesis reaction of sodium cyanotrihydridoborate with trans-[RhCl(CO)(PPh3)2], and was characterized by single-crystal X-ray diffraction analysis and IR, (1)H, (13)C and (11)B NMR spectroscopy. The X-ray diffraction data indicate that the cyanotrihydridoborate ligand coordinates to the Rh(I) atom through the N atom in a trans position with respect to the carbonyl ligand; this was also confirmed by the IR and NMR data. The carbonyl stretching frequency ν(CO) and the carbonyl carbon (1)JC-Rh and (1)JC-P coupling constants of the Cipso atoms of the triphenylphosphine groups reflect the diminished electron density on the central Rh(I) atom compared to the parent trans-[RhCl(CO)(PPh3)2] complex.

[Several hormonal indices during hemofiltration in patients with acute kidney failure]. / Nekotorye gormonal'nye pokazateli pri gemofil'tratsii u bol'nykh s ostroi pochechnoi nedostatochnost'iu.

AIM: To study hormonal aspects of hemofiltration (HF) in acute renal failure (ARF). MATERIAL AND METHODS: Hydrocortisone (HC), thyroxine (T4), triiodothyronine (T3), TSH, thyrocalcitonine (TC), PTH, insulin (I), C-peptide (CP), STH, beta-endorphine (BE) were examined for plasma content, elimination with filtrate, sifting rate, filtration clearance in 29 patients with oliguric ARF (18 males and 11 females) aged 12-62 years. 19 patients underwent intermittent HF (rate 145.2 +/- 9.2/27-260/ml/min, volume 1.02 +/- 0.20/0.45-1.43/). 10 patients received continuous HF (rate 25.9 +/- 2.3 l/day or 0.36 +/- 0.05/0.17-0.95/). The hormones were measured with radioimmunoassay. The results were processed with variate statistics using Student's criterium. RESULTS: Oliguria was associated with high plasma levels of HC, PTH, TC, I, CP; normal levels of TSH and STH, low ones of T4, T3 and BE. Intermittent HF led to an increased plasma concentrations of HC, T4, I, CP, decreased one of PTH, while TC, TSH, STH and T3 remained unchanged. The filtration rate of the hormones was different. The elimination was greatest for HC, T4, T3, BE. Concentration of the former three in the filtrate surpassed that in blood plasma. CONCLUSION: Besides intensive elimination of the hormones with low molecular mass (HC, T4, T3), HF causes elimination of appreciable quantities of BE, PTH, I, CT and, probably, other peptide hormones. Plasma levels of hormones did not reflect their elimination with filtrate.

[Enzyme clearance in intermittent hemofiltration in patients with acute renal failure]. / Klirens fermentov pri intermittiruiushchei gemofil'tratsii u bol'nykh s ostroi pochechnoi nedostatochnost'iu.

AIM: To characterize elimination of some enzymes in intermittent hemofiltration (HF) in patients with acute renal failure (ARF). MATERIAL AND METHODS: 22 patients with oliguric ARF have undergone 52 procedures of intermittent HF. Before the procedure and after it the activity of enzymes (AA, AP, ACE, LAP, GGT, GDG, AlAT, AsAT, CPG, LDG) was measured in the samples of plasma and filtrate. RESULTS: Besides ACE and AlAT, all the enzymes concentrations were elevated in all the patients. HF did not change significantly the enzymes activity. Most of the enzymes were eliminated from the blood. In some samples the enzymes activity was low or absent. CONCLUSION: Further studies are necessary to answer questions aroused by the findings.

[Metabolic effects of intermittent hemofiltration in patients with acute renal failure]. / Metabolicheskii éffekt intermittiruiushchei gemofil'tratsii u bol'nykh s ostroi pochechnoi nedostatochnost'iu.

AIM: Investigation of postaggressive reaction of metabolism on intermitten hemofiltration (IHF) in patients with acute renal failure (ARF). The speed of generation of urea, creatinine and oligopeptides was estimated in the course of (IHF) and in interval between the procedures. Hormonal stress was evaluated by concentration of hydrocortisone in plasma and and filtrate. MATERIALS AND METHODS: The trial covered 36 patients with oliguric ARF (21 males and 15 females) for whom IHF was the main method of replacement renal therapy. The kinetic modelling accounted for distinctive distribution of markers in body fluids. Statistical processing was made according to Student-Fisher T-criterion. RESULTS: IHF runs with intensive proteinolysis with acceleration of oligopeptides generation by 810%, degradation of large quantities of creatine triphosphate and 770%-accelerated production of creatinine, with protein catabolism and 440%-accelerated production of urea. Hydrocortisone blood levels rise about two-fold despite intensive elimination of the hormone with filtrate. Between speeds of IHF, generation of creatinine and secretion a direct correlation was found. This indicates the importance of the perfusion rate for induction of the stress and catabolism. Background hydrocortisone Irvrl has significant effects only on urea accumulation rates in IHF-free intervals. However, in the course of IHF, generation of urea and oligopeptides is to a great extent independent of hydrocortisone secretion. CONCLUSION: Application of IHF in ARF patients results in rather strong stress with enhanced proteinolysis and protein catabolism. To compensate protein loss associated with only urea generation, additional administration of minimum 60 g of plasma or amino acids is required.

[Plasma myoglobin and continuous hemofiltration in patients with rhabdomyolysis and acute kidney failure]. / Mioglobin plazmy i postoiannaia gemofil'tratsiia u bol'nykh s rabdomiolizom i ostroi pochechnoi nedostatochnost'iu.

Plasma and filtrate levels of myoglobin, specific antibodies and immune complexes were measured by radioimmunoassay or enzyme immunoassay in patients with rhabdomyolysis and acute renal failure on continuous hemofiltration (CHF). 14 of them had crush syndrome, 7 had other forms of rhabdomyolysis. 11 patients died (52%) because of the underlying disease or its complications. Rhabdomyolysis was associated with marked and long-lasting myoglobinemia. Early amputation and restoration of diuresis combined with CHF resulted in a fall in myoglobin content. CHF provided elimination of large amounts of myoglobin with filtrate. In rhabdomyolysis in all cases there appeared specific antibodies and circulating immune complexes.

[Urea and creatinine kinetics during the continuous hemofiltration of patients with acute kidney failure]. / Kinetika mocheviny i kreatinina pri postoiannoi gemofil'tratsii u bol'nykh s ostroi pochechnoi nedostatochnst'iu.

Continuous hemofiltration (CHF) procedures (a total of 33 with overall duration 2495 hours and replacement of 2221 kg of fluid) were conducted in 23 patients (12 males and 11 females) aged 30.5 +/- 2.5 years suffering from severe acute renal failure (ARF). CHF efficacy was judged by the kinetics of urea and creatinine. With parenteral feeding the patients received protein and amino acids 1.2-1.5 g/day/kg b.m. The death of 13 patients resulted from sepsis, hemorrhage, shock, adrenal insufficiency. The filtration speed 15.6 +/- 0.6 (7-34) ml/min allowed replacement of 21.7 +/- 1.3 (8-49) kg or 0.49 +/- 0.03 of body fluid a day. The highest rate of hemofiltration was used on day 1, this reducing plasma urea from 35.7 +/- 2.5 (7.5-55.0) to 27.5 +/- 2.0 mmol/l (p < 0.05) and creatinine from 742 +/- 77 (182-1800 to 539 +/- 44 mumol/l (p < 0.05). Subsequently urea and creatinine were maintained in the plasma at the levels 26.8 +/- 1.0 mmol/l and 539 +/- 73 mumol/l, respectively. Urea eliminated with the filtrate amounted to 591 +/- 53, creatinine 13.5 +/- 4.0 mmol or 0.49 +/- 0.02 and 0.65 +/- 0.07 of the overall pools, respectively. In anuria urea generation reached 525 +/- 35 (108-1071) mmol/day, that of creatinine 9.6 +/- 1.4 (1.2-14.0) mmol/day, being on the average less than filtrate elimination of these substances. It is believed that CHF contributes to balanced treatment of severe ARF in spite of parenteral introduction of large quantities of protein and amino acids.

[Treatment results in urethral strictures]. / Rezul'taty lecheniia striktur uretry.

A total of 231 patients with urethral strictures were treated. The disease resulted from trauma, adenomectomy, chronic urethritis, prostatic sclerosis in 92, 72, 51 and 16 patients, respectively. Fifty-one patients underwent conservative treatment which involved bougienage, resolving and anti-inflammatory agents. 38 of them responded, 13 nonresponders were operated on. 72 patients were subjected to partial urethral tunneling according to an original technique which brought success in 90% of the cases. Out of 92 traumatic urethral strictures 88 were cured after end-to-end plastic reconstruction. It is believed that urethral strictures should be managed individually basing on the stricture cause, location, length, severity, complications.

[The level of neopterin in the plasma of patients with acute kidney failure during treatment with continuous arteriovenous hemofiltration]. / Uroven' neopterina v plazme bol'nykh s ostroi pochechnoi nedostatochnost'iu pri ee lechenii postoiannoi arteriovenoznoi gemofil'tratsiei.

Neopterin is a biochemical marker of cellular mediated immune reactions and may be used in elucidating the cause of acute renal failure. 9 patients (6 males, 3 females) aged 23 to 56 years suffering from a severe form of the disease were examined. A continuous arteriovenous hemofiltration was used as a treatment with exchanging 29.2 +/- 2.0 (14-65) kg of fluid during 24 hours. The patients' diet included protein and amino acids of 1.2-1.5 g/kg of body weight, 35-45 Kcal/kg of body weight per 24 hours with meal and parenteral infusions. 4 patients died. Contents of neopterin in the plasma of the healthy equaled to 6.8 +/- 03 (3.4-11.3) nmol/l (radioimmunoassay; Henning; Berlin, GmbH). In patients with acute renal failure plasma neopterin contents were increased, i.e. 130.0 +/- +/- 9.6 (48.2-200.2) nmol/l and in two thirds of the cases and correlated with creatinine levels (r = + 0.60 +/- 0.17; p less than 0.05; n = 23), thus showing a simultaneous influence of anuria and continuous arteriovenous hemofiltration on a neopterin pool amount at the same time, in patients with tropical malaria and hemotransfusion shocks (2 cases), the neopterin contents were extremely high and did not correlate with the creatinine level. During continuous hemofiltration at a rate of 21.6 +/- 1.3 (15.9-36.9) ml/min neopterine clearance was 17.2 +/- 2.1 (6.7-36.2) ml/min. Neopterin hyperproduction after blood transfusion suggests an immune conflict as a possible cause of acute renal failure.

[Middle-molecule oligopeptide kinetics during intermittent hemofiltration in patients with acute kidney failure]. / Kinetika oligopeptidov srednei molekuliarnoi massy pri intermittiruiushchei gemofil'tratsii u bol'nykh s ostroi pochechnoi nedostatochnost'iu.

Acute renal failure was treated by intermittent hemofiltration in 19 patients (8 males and 11 females), 13 of which survived and 6 died. All of them underwent examinations for kinetics and clearance of middle-mass oligopeptides (MMOP) performed by gel filtration (sephadex G-15) and densitometry in UV light (280 nm) using C phi-24 device. Plasma levels of oligopeptides in acute renal failure were found increased 20-fold. They consisted mainly of MMOP (1000-3000 D) entering the 13th eluate fraction. There appeared a correlation between oligopeptides and creatinine plasma levels. Under hemofiltration lasting for 6.45 hours and replacing approximately total body fluid, nearly all the baseline extracellular oligopeptide pool was removed. The average rate of the filtration reached 127 ml/min, clearance of oligopeptides being 57.9 ml/min or more than 22 1 of fluid per one procedure. Intermittent hemofiltration went in enhanced (8-fold) MMOP generation responsible for residual high levels of them in plasma after the procedure.

[The possible pathways for the formation of a pool of an acid-soluble blood plasma fraction in patients with diffuse suppurative peritonitis]. / Vozmozhnye puti formirovaniia pula kislotorastvorimoi fraktsii plazmy krovi u bol'nykh razlitym gnoinym peritonitom.

In patients with diffuse purulent peritonitis, the total pool of an acid-soluble blood plasma fraction (ABPF) considerably increases as compared to that in normals (donors). The present paper is concerned with the role of proteolytic activity and lysis of bacterial cells and cells of different human tissues in the formation of the ABPF in patients with peritonitis. For this purpose the normals' blood and its separate components were treated with various enzymes (trypsin, pronase, chemotrypsin, papain, elastase, alpha-amylase) to measure the ABPF. The pattern of changes detectable on such a treatment was compared with the tendency of changes seen in patients with peritonitis. Measurements were also made of acid-soluble fractions in suspensions of bacterial cells and cells of the pancreas, liver and heart muscle tissue of man. It has been found that on proteolysis of plasma proteins and membrane proteins of blood cells there form products contained by the ABPF. Such products formed in the greatest amount as a result of treatment with pronase. Products of the lysis of bacterial cells may be also contained by the ABPF of peritonitis patients. The possibility of detecting proteolytic degradation and cellular disintegration according to the spectral characteristics of separate fractions of the ABPF is discussed.

[Blood plasma amino acids and total protein, their elimination and catabolism during the hemofiltration of patients with acute kidney failure]. / Aminokisloty i obshchii belok plazmy krovi, vydelenie i katabolizm ikh pri gemofil'tratsii u bol'nykh s ostroi pochechnoi nedostatochnost'iu.

Intermittent hemofiltration (HF) was applied to the treatment of 8 patients (3 men and 5 women) with the grave pattern of acute renal failure (ARF) of prerenal origin. Altogether 23 sessions (from one to six in every patient) were performed with replacement of 44.3 +/- 2.8 1 liquid on the average. Two patients died. Of these, one female patient died from progressive peritonitis and sepsis and the other one from cisplatinum intoxication, bone marrow aplasia and sepsis. The content of blood plasma amino acids (AA), total protein and its fractions was measured before and after HF. Measurements were also made of excretion of those substances with filtrate. Besides, the amount of protein AA catabolized during the procedure was calculated according to the kinetics of urea. The authors hold that ARF-associated changes in the content of AA are primarily determined by adaptive shifts in metabolism. Differences in AA consumption were revealed to depend on the period and quality of adaptation. On the average HF brought about losses of 7.5 g AA and 73.1 g protein with filtrate. At the same time 37.5 g AA underwent oxidation, while urea generation rose 2-fold, amounting to 0.48 mmol/kg bw per hour. It is concluded that in ARF patients undergoing intermittent HF, it is necessary that anabolizing glucose and insulin therapy be applied together with replacement infusion of AA and (or) protein.