[Diagnostic and conservative treatment nuances in patients with obstructive jaundice: in the wake of Russian consensus].

The research was performed at the Loginov Moscow Clinical Scientific Center. It is based on Russian obstructive jaundice (OJ) consensus results, considered at the 45th annual Central Research Institute of Gastroenterology Scientific session Oncological issues in the gastroenterologist practice (1 March 2019). The article objective is to note the diagnostic and conservative treatment current issues in patients with OJ. The increase in the number of patients with OJ of different etiology provides problem actuality. In a large number of cases, medical treatment is delayed due to inadequate diagnostic and management, while correct patients routing today can be provided regardless of medical institution level. In this article the examination steps and conservative treatment role in patients with biliary obstruction management are presented.

[Russian consensus on current issues in the diagnosis and treatment of obstructive jaundice syndrome]. / Rossiiskii konsensus po aktual'nym voprosam diagnostiki i lecheniya sindroma mekhanicheskoi zheltukhi.

The Russian consensus document on topical issues of the diagnosis and treatment of obstructive jaundice syndrome was prepared by a group of experts in various fields of surgery, endoscopy, interventional radiology, radiological diagnosis and intensive care. The goal of this document is to clarify and consolidate the opinions of national experts on the following issues: timing of diagnosis of obstructive jaundice, features of diagnostic measures, the need and possibility of conservative measures for obstructive jaundice, and strategy of biliary decompression depending on the cause and level of biliary block.

[Use of stents with bioactive coating in treatment of patients with lesions of the superficial femoral artery]. / Primenenie stentov s bioaktivnym pokrytiem v lechenii bol'nykh s porazheniem poverkhnostnoi bedrennoi arterii.

The authors analysed the immediate outcomes of implanting stents with bioactive coating in treatment of patients presenting with atherosclerotic lesions of the superficial femoral artery. Over the period from January 2014 to December 2015, endovascular interventions on the superficial femoral artery were carried out in a total of 18 patients (mean age 61.3±9.2 years). The implants inserted were stents with bioactive coating based on titanium oxinitride, measuring 6 to 8 mm in diameter and being from 50 to 200 mm long. Prior to operation and 7 days after implantation of the stent, the immunoenzymatic assay was used to determine the level of nitrogen nitric oxide (NO) in blood. The stents' patency was assessed by the findings of ultrasound duplex scanning performed at 30 days, and then 6 and 12 months after the intervention. There were no complications either during the operation or in the early postoperative period. An increase in the ankle-brachial index was observed in all patients: with the average value prior to treatment amounting to 0.4±0.3 and equalling 1.1±0.2 after stenting (p<0.0001). Normalization of the blood NO level was revealed (was noted to normalize): the mean value prior to operation amounted to 18.9±2.3 µmol/L and after operation to 28.9±4.1 µmol/L (p<0.05). Primary patency rate of the stents was 100% at 30 days, 94.5% (1 occlusion) at 6 months and 88.8% (1 restenosis and 1 occlusion) at 12 months. The patients with occlusion or restenosis were subjected to repeat endovascular interventions, with restoration of patency of the construction (with the construction's patency restored). By now all the 18 patients show preserved patency (currently patency was preserved) of lower-limb arteries, with no evidence of restenosis in the zones of operations. It was concluded that using stents with bioactive coating based on titanium oxinitride results in normalization of the level of NO in blood, which may contribute favourably to prolongation of the period of functioning of endovascular constructions. The first data concerning primary patency of stents of this type make it possible to count on betterment of the remote results of treatment of patients presenting with atherosclerotic lesions of the superficial femoral artery.

[Regional chemotherapy in treatment of patients with unresectable liver metastases of uveal melanoma].

PURPOSE: Retrospective efficacy analysis of transcatheter arterial treatment for unresectable liver metastases of uveal melanoma. MATERIALS AND METHODS: There were performed 38 courses: hepatic arterial chemoembolization with Lipiodol (HACE, n 9) and combination of HACE with hepatic artery infusion (HAI, n = 29). In 9 patients we used the following chemotherapeutic agents: doxorubicin (10-50mg), carboplatin (150 to 450 mg), dacarbazine (200-400mg), mustophoran (360-624mg) and mitomycinum C (5-10mg). RESULTS: There were no mortality or serious complication. According to mRECIST, partial response, stabilization and progression of liver metastases was seen in 1, 3 and 5 patients, retrospectively. The mean survival after arterial treatment was 9,4 (2-34) mo. The 6-, 12- and 18- mo survival rates were 56%, 22% and 11% respectively. CONCLUSION: Transcatheter therapy in unresectable liver metastases of uveal melanoma is safe and can prolong survival of selected patients up to 34 mo.

ARTERIAL CHEMOINFUSION IN PATIENTS WITH LOCALLY ADVANCED AND METASTATIC PANCREAS CANCER.

The chemoinfusions (310) were carried out in celiac trunk in 167 patients with non-removed pancreas cancer at the period from 2000 to 2015. Locally advanced timorous process (stage III, n=79) was revealed in 79 patients and liver metastases (stage IV, n=88) were noted in 88 cases. The celiac axis infusion by Gemcitabine (1000 mg/m²) was applied for patients and GEMOX (Gemcitabine+Oxaliplatin 75 mg/m²) has been using since 2012. Symptomatic improvement such as decrease of pain, growth of body weight was noted in majority of patients. An average lifetime, median and one-year survival consisted of 7,6 months, 5,8 months and 10%. The patients (133) were treated by 1­2 cycles and after that by course of total body chemotherapeutics. There weren't any serious complications. Toxic manifestations of chemotherapy weren't higher than I­II degree and they were arrested by corrective therapy in 92 patients (55%). The celiac axis infusion is safe in patients with locally advanced and inoperable pancreas cancer. Symptomatic improvement showed the most patients. The objective response to the treatment had 20% patients and performance of repeated cycles led to increase of their survival.

[ENDOVASCULAR ABDOMINAL AORTIC ANEURISM REPAIR].

The authors analyzed the single-center experience of treatment of 72 patients with abdominal aortic aneurisms and severe accompanied pathology. The aneurisms were repaired by stent-grafts. All the patients had abdominal aortic aneurisms with the diameters from 41 to 84 mm against the background of severe somatic pathology. It was a contraindication to planned open surgery. An installation of stent-graft was successful in all 72 follow-ups. It wasn't necessary to use a conversion to open surgery. The follow-up period consisted of 44,6?2,1 months. Control ultrasound and computer tomography studies hadn't revealed an increase of aneurism sack sizes or "eakages". A reduction of abdominal aortic aneurism sizes was noted in 37 patients on 4-5% during first year after operation. The stent-graft implantation extends the possibilities of abdominal aortic aneurism treatment for patients from a high surgical risk group.

[WAYS OF IMPROVEMENT OF LOOP ENDARTERECTOMY RESULTS FROM ILIAC-FEMORAL SEGMENT].

The article presents an analysis of treatment results of 91 patients with iliac-femoral segment artery occlusion at the period from 2008 to 2014. Patients were divided into 2 groups: main group (n=30) consisted of patients who undergoing a half-closed loop endarterectomy with following implantation of stent-grafts in this area and control group (n=61) had patients whom were performed routine half-closed loop endarterectomy. The II degree of ischemia of lower extremities was in 88 (96,7%) patients and III degree had 3 (3,3%) patients. The areas of abnormalities of intravascular pattern were detected in 100% of cases in intraoperative angiography. They were modified using stent-grafts. A primary vascular patency was 100% in the first group and it numbered 65% in the second group during 5 years. The intraoperative angiography control with stent-graft implantation to the area of endarterectomy allowed reliable improvement of treatment results.

[Long-term results of combined x-ray endovascular surgical treatment of patients with ductal adenocarcinoma of the pancreatic head].

On the basis of the results of treatment of 105 patients with locally advanced ductal adenocarcinoma of the pancreatic head the authors present the results of work over a period of time since 1999 to 2009. In the main group the combined treatment was used for 51 patients: the non-adjuvant selective chemoembolization of the pancreatic head adenocarcinoma was performed, than standard gastropancreatoduodenal resection with lymphodesection and 6 cycles of adjuvant chemoinfusion in celiac trunk were completed. In control group standard gastropancreatoduodenal resection was performed. In the group of combined treatment the 1-, 2-, 3-year survival rates consist of 80.4%, 58.8% and 43.1%, respectively. The average life span was 22.3+/-2.1 months. The average life span of 54 patient of control group was 8.4+/-2.1 months and a common 3-year survival consists of 13%. There was no lethality after the performance of X-ray endovascular procedures and gastropancreatoduodenal resection. Postoperative complications reliably didn't differ in both groups.

[Postoperative ventral hernia in patients, who undergone the liver transplantation operation].

The development of postoperative ventral hernia was observed in 8 patients from 114, who undergone the liver transplantation operation. The patients were followed in terms up to 14.5 years. The authors consider the indications and features of surgical treatment of such postoperative hernias.

[Characteristics of surgical approach using for patients with renal cell carcinoma, complicated by postcava tumor thrombosis].

The postcava tumor thrombosis had about 1/3 of patients with renal cell carcinoma at the initial examination. Reconstructive interventions were performed on the postcava for 38 patients (24 men, 14 women). The postcava thrombectomy was applied in 15 patients. The thrombectomy with postcava resection were carried out in 13 patients and plasty- in 6, prosthetics-in 4. An actuarial 3-year or 5-year survival rate of patients consisted of 59.4% and 42.2%. The performance of reconstructive interventions on postcava with its involvement was justified and provided satisfactory results in patients with renal cell carcinoma.

[An experience with 100 cadaveric transplantations of the liver in the Russian Research Center of Radiology and Surgical Technologies].

The authors made an analysis of their first 100 transplantations of cadaveric liver made at the period from 1998 through 2011. Postoperative complications and long-term results of transplantations at the period to 13 years are described. Cumulative survival up to 12 months was 91%, to 36 months--83%. Retransplantation of the liver was performed on 5 patients, 2 of them being successful.

[The value of intraoperative Doppler-flowmetry in assessment of blood flow after the hepatic artery reconstruction during the orthotopic liver transplantation].

The practical relevance of volumetric blood flow in the hepatic artery during orthotopic liver transplantation was determined. From May 2009 to January 2011 25 patients underwent orthotopic liver transplantation. Volumetric blood flow in the hepatic artery is routinely measured using a Doppler flow meter during the operation. In 15 cases out of 25 (60%) the blood flow rate immediately after the formation of arterial anastomosis was 150 ml/min (190 +/- 40 ml/min) and increased to adequate with repeated measurements. In 2 cases out of 25 (8%) the blood flow rate reduced in repeated measurements, but by the end of operation the blood flow to the hepatic artery was at the satisfactory level. Blood flow less than 150ml/min immediately after the formation of arterial anastomosis was found in 8 cases out of 25 (32%). The cause of inadequate blood flow was identified and corrected. There were no cases of hepatic artery thrombosis at the early postoperative period. The routine use of intraoperative blood flow measurements allows timely determination of insufficient arterial blood supply of the transplant and elimination of its causes.

[Roentgenoendovascular hemostasis of arterial bleeding after major surgery for pancreatic cancer].

The efficacy of angiographic hemostasis in cases of massive arterial bleeding after major pancreatic resection was evaluated. Late life-threatening arterial hemorrhage developed in 3 out of 65 patients (4.6%) within 12, 20 and 42 days after pancreatic carcinoma resection. In all cases emergency roentgenoendovascular procedures were fulfilled for hemostasis. Six therapeutic angiographic procedures (from one to three per a patient) were performed. All of them were clinically and technically successful. Depending on the bleeding localization and the character of vascular lesion, the embolization (n = 5) or stent-grafting (n = 1) were used. The further prognosis was dependent on the success of treatment of complications and the course of the malignant disease. The emergency angiography with endovascular hemostasis appears to be the method of choice in treatment of postoperative visceral bleedings especially in patients with high surgical risk.

[The possibilities of surgical and combined treatment of patients with locally-disseminated renal cell carcinoma].

A comparative analysis of surgical and combined treatment of renal carcinoma in 84 patients has shown that preoperative embolization of the renal arteries failed to reduce blood loss and duration of operation, failed to increase recurrence-free period and 3 to 5 years survival of the patients. Specific features of combined interventions are described.