[Endoscopic intraluminal treatment of pancreatic fluid collections after pancreas transplantation]. / Endoskopicheskoe vnutriprosvetnoe lechenie pankreaticheskikh zatekov posle transplantatsii podzheludochnoi zhelezy.

OBJECTIVE: To improve the outcomes after pancreas transplantation complicated by pancreatitis using percutaneous drainage and endoscopic stenting of the main pancreatic duct. MATERIAL AND METHODS: There were 64 transplantations of the pancreatoduodenal complex between January 1, 2012 and December 31, 2021 at the Sklifosovsky Research Institute for Emergency Care. In 11 (17.2%) cases, early postoperative period was complicated by acute pancreatitis and parapancreatic fluid accumulations. Of these, 7 patients underwent ultrasound-guided percutaneous drainage of focal destructions. This procedure was effective and did not require additional treatment. In 4 patients, debridement and drainage were ineffective and required additional endoscopic stenting of the main pancreatic duct. RESULTS: All patients underwent percutaneous drainage of peripancreatic fluid collections and subsequent fistulography. All patients had inhomogeneous cavities with irregular shape and volume of 19.6±1.8 cm3. In 3 (75%) out of 4 patients, there was a passage of contrast agent into the main pancreatic duct of the graft and donor duodenal stump. We did not find contrast enhancement of ductal system in 1 (25%) patient since filling of the cavity with a contrast agent was not tight. Sensitivity of this method for detecting pancreatic ductal defects was 75%. Indications for stenting of the main pancreatic duct were established in 22.5±9.6 days after transplantation. Drainage and debridement were ineffective in 2 (50%) patients. In other 2 (50%) patients, peripancreatic fluid collections enlarged. All patients underwent endoscopic stenting of the main pancreatic duct. CONCLUSION: Endoscopic stenting of the main pancreatic duct of the donor pancreas combined with percutaneous drainage of peripancreatic fluid accumulations is a highly effective and minimally invasive approach for fluid collections after transplantation of the pancreatoduodenal complex. This method also minimizes the incidence of postoperative complications. Thanks to this method, we avoided redo open surgeries in all cases.

[Advanced glycation end products and oxidative stress as a basis for metabolic abnormalities in patients with type 1 diabetes after successful simultaneous pancreas-kidney transplantation].

AIM: To compare advanced glycation end-products (AGE, RAGE) and 3-nitrotyrosine (3-HT) in patients with DM 1 after successful simultaneous pancreas-kidney transplantation (SPK) and kidney transplantation alone (KTA). To assess relationship between levels of AGE, RAGE, 3-HT and renal transplant (RT) function, carbohydrate and mineral metabolism. MATERIALS AND METHODS: The study included 58 patients who received kidney transplantation in end-stage renal disease (ESRD). 36 patients received SPK. There were performed routine laboratory, examination of AGE, RAGE, 3-NT, parathyroid hormone (PTH), 25(OH)vitamin D, calcium, phosphorus, FGF23, osteoprotegerin (OPG), and fetuin-A levels. RESULTS: All patients after SPK reached normoglycemia (HbA1c 5.7 [5.3; 6.1] %; C-peptide 3.24 [2.29; 4.40] ng/ml) with the achievement of significant difference vs patients after KTA. Arterial hypertension (AH) was more frequent in recipients of SPK before transplantation than after (p=0.008). AH also persisted in greater number of cases in patients after KTA than after SPK. Patients after SPK had higher AGE (р=0.0003) and lower RAGE (р=0.000003) levels. OPG in patients after SPK was significantly higher (р=0.04). The correlation analysis revealed significant positive correlation between 3-HT and OPG (p0.05; r=0.30), RAGE and eGFR (r=-0.52), HbA1c (r=0.48), duration of AH (r=0.34), AGE with HbA1c (r=0.51). CONCLUSION: The results of the "metabolic memory" markers analysis may indicate their contribution to the persistence of the metabolic consequences of CKD and DM 1 after achievement of normoglycemia and renal function restoration and their possible participation in development of recurrent nephropathy, vascular calcification, and bone disorders.

[Surgical aspects of pancreas transplantation: exocrine drainage. Part 3]. / Khirurgicheskie aspekty transplantatsii podzheludochnoi zhelezy: otvedenie ekzokrinnogo sekreta transplantata. Chast' 3.

Exocrine drainage is an Achilles heel of pancreas transplantation. The author analyzed the outcomes of pancreas transplantations with different types of exocrine drainage in various centers (n=93). The article will ensure insight into evolution of techniques of exocrine drainage within the historical context and current state of this issue.

[Surgical aspects of pancreas transplantation: exocrine drainage. Part 2]. / Khirurgicheskie aspekty transplantatsii podzheludochnoi zhelezy: otvedenie ekzokrinnogo sekreta transplantata. Chast' 2.

Exocrine drainage is an Achilles heel of pancreas transplantation. The author analyzed the outcomes of pancreas transplantations with different types of exocrine drainage in various centers (n=93). The article will ensure insight into evolution of techniques of exocrine drainage within the historical context and current state of this issue.

[Surgical techniques of pancreas transplantation: exocrine drainage. Part 1]. / Khirurgicheskie aspekty transplantatsii podzheludochnoi zhelezy: otvedenie ekzokrinnogo sekreta transplantata. Chast' 1.

Exocrine drainage is an Achilles heel of pancreas transplantation. The author analyzed the outcomes of pancreas transplantations with different types of exocrine drainage in various centers (n=93). The manuscript ensures insight on the evolution and progress of exocrine drainage techniques in pancreas transplantation within the historical context and current state of the problem.

[Endoscopic treatment of gastroduodenal perforations]. / Endoskopicheskoe lechenie gastroduodenal'nykh perforatsii.

A 93-year-old patient underwent endoscopic treatment of perforated duodenal ulcer after previous laparoscopic suturing complicated by failure of sutured defect. A self-expanding nitinol stent with partial polyurethane coating was used. Positive effect of the treatment was noted. Further study of this method and its clinical introduction in case of favorable results can significantly reduce the incidence of complications and mortality in patients with perforated gastroduodenal ulcers.

[Pancreas transplantation with isolated blood supply through the splenic artery]. / Transplantatsiia podzheludochnoi zhelezy s izolirovannym krovosnabzheniem po selezenochnoi arterii.

In multiple organ procurement, taking into consideration certain peculiarities of the vascular architectonics of the celiac trunk or an iatrogenic injury to the superior mesenteric artery, it is impossible to perform standard arterial reconstruction of a pancreas transplant with the use of a Y-shaped vascular allograft. This results in refusal from transplanting a potentially suitable organ. The purpose of our study was to assess the possibility of transplantation of the pancreatoduodenal complex with isolated blood supply via the splenic artery. Between January 2008 and November 2016, transplantation of the pancreas was carried out in a total of 20 patients (9 men and 11 women aged from 26 to 40 years, mean age 37.2±5.6 years). Depending on the number of the major arteries supplying the pancreas, the patients were divided into 2 groups. No statistically significant between-group differences in the parameters of volumetric blood flow determined by means of CT perfusion, in the majority of laboratory findings or therapeutic outcomes were revealed. Based on assessment of the function and quality of pancreatic blood supply, we proved feasibility of transplantation of the pancreatoduodenal complex with isolated blood supply through the splenic artery.

[Pancreas transplantation followed by stumpless duodenal exocrine drainage]. / Transplantatsiia podzheludochnoi zhelezy s bezkul'tevym duodenal'nym drenirovaniem.

Pancreas transplantation followed by stumpless duodenal exocrine drainage was performed in 2 patients. Primary kidney and pancreas graft function was noted in both cases. Two procedures of pancreas transplantation followed by stumpless duodenal exocrine drainage were carried out for the first time. Perhaps, absent donor duodenal stump has several advantages for the further course of postoperative period that may be confirmed in prospective trials.

[Treatment of postoperative ventral hernias in recipients of solitary organs]. / Lechenie posleoperatsionnykh ventral'nykh gryzh u retsipientov solidnykh organov.

AIM: To perform retrospective analysis of treatment of postoperative ventral hernias (PVH) in kidney and extrarenal organs recipients, to assess its safety and effectiveness. MATERIAL AND METHODS: Hernia repair has been performed in 84 PVH patients for the period from May 2006 to November 2017. The main group consisted of 41 patients (24 males, 17 females, mean age 55 (44; 59)) years with PVH due to previous transplantation. The control group included 43 PVH patients (21 males, 22 females, mean age 51 (50, 56)) years without previous transplantation. RESULTS: Incidence of surgical complications was similar in two groups: 63.4% in group 1 vs. 53.5% in group 2 (p>0.05). There were no significant differences in the incidence of surgical complications depending on immunosuppressive therapy and synthetic endoprosthesis deployment technique. CONCLUSION: Treatment of postoperative ventral hernias using synthetic endoprostheses in recipients of solid organs is effective and safe and should be considered as a preferable in treatment of this pathology.

[Morphological diagnostics of fat embolism].

The present review of the literature concerns the problem of morphological diagnostics of fat embolism, i.e. mechanical obturation of multiple blood vessels with fat globules, that can be detected by a variety of methods including polarization microscopy, staining of native, frozen, and paraffin-embedded histological sections with the use of immunohistochemical techniques, electron microscopy, etc.

[Morphologic and morphogenetic features of stomach ulcer]. / Morfologicheskie i morfogeneticheskie osobennosti iazvennoi bolezni zheludka.

Literature data are reviewed concerning morphological and morphogenetic features of stomach ulcer, vascular alterations in both the ulcer zone and other regions of the stomach. Stages in ulcer formation, its healing and prognostic criteria are described. Further study of ulcerogenesis regarding histotopographic features of different regions of gastro-intestinal tract is recommended.