[Assessment of the quality of life of patients after parathyroidectomy from standard and small access].

BACKGROUND: Primary hyperparathyroidism (PGPT) is an increase in the secretory activity of the parathyroid glands (OSH), due to their tumor or hyperplastic changes. Due to the lack of an effective alternative to the treatment of PGPT, the surgical method is still the only correct tactical solution for the management of patients with an established diagnosis of PGPT. The paper presents the long-term results and assessment of the quality of life of patients who underwent surgical treatment from standard and small access. The results obtained showed the promise of a sparing approach to the treatment of PGPT caused by LV adenoma. AIM: To study the effectiveness of surgical treatment of patients with PGPT based on the assessment of the quality of life of patients who underwent parathyroidectomy from standard and small access. MATERIALS AND METHODS: A retrospective study of the quality of life of patients with PGPT after surgical treatment was conducted using the SF-36 questionnaire and the linear analog scale (LAS). Statistical data processing is performed in the R programming language using the FMSB package. The quantitative parameters were presented as median (Median) and interquartile range (25th (1st Qu) - lower quartile and 75th (3rd Qu ) - upper quartile). As a nonparametric statistical criterion, the Mann-Whitney U-test was used, on the basis of which the p-value was calculated. The calculated data of the research results are presented in graphical form - in the form of bar charts, spider plot and barplot. RESULTS: This study involved 264 patients. The patients were divided into 2 groups: GR1 - patients operated from the Kocher access with mandatory revision of all 4 OSH, GR2 - patients who received surgical treatment from the small access with the removal of the altered OSH, without revision of the remaining OSH. When analyzing the quality of life of patients before surgery, there were no statistically significant differences in the groups in terms of PF (Physical Functioning) and VT (Vitality). Small-access parathyroidectomy (patients with GR 2) significantly improved the quality of life in the GH (General Health) and VT (Vitality) domains. The analysis of LAS before surgery between the groups showed no statistically significant differences, while after surgical treatment, the indicators on the linear analog scale differ in the direction of improvement in GR2. CONCLUSION: The results obtained in the course of the study showed the promise of a gentle approach to the treatment of PGPT caused by LV adenoma, which is reflected in higher quality of life indicators.

[Surgical treatment of ACTH-ectopic syndrome]. / Khirurgicheskoe lechenie AKTG-éktopicheskogo sindroma.

ACTH-ectopic syndrome is a severe, multiple-symptom disease characterized by secretion of adrenocorticotropic hormone (ACTH) by ectopic tumor, increased release of adrenal cortical hormones and clinical picture of hypercorticism. Diagnosis and treatment of ACTH-ectopic syndrome is still difficult problem despite the achievements of modern medicine. There are several unresolved issues including optimal diagnostic algorithm, indications for various surgical procedures and their optimal dates. This review is devoted to these questions.

[Diagnosis and surgical treatment of adrenocortical cancer with invasion into great veins]. / Diagnostika i khirurgicheskoe lechenie adrenokortikal'nogo raka s invaziei v magistral'nye venoznye sosudy.

AIM: To estimate immediate and remote resaults of treatment of adrenocortical cancer with invasion into great veins. MATERIAL AND METHODS: It was analyzed survey and treatment results in 3 patients with adrenocortical cancer and invasion into renal veins and inferior vena cava. RESULTS: Radical surgery with tumoral thrombi removal from great vessels was performed in all cases. There were no complications and deaths in early postoperative period. Life expectancy after surgery was 6, 13 and over 58 months. CONCLUSION: At present time surgical intervention for adrenocortical cancer with invasion into great veins is single method to prolong patients' life.

[Long-term prognostic analysis of surgical treatment of the thymoma-associated myasthenia gravis].

Treatment results of 300 patients with myasthenia gravis (MG) were analyzed. 150 patients with MG and thymoma formed the main group, the rest 150 patients with non-thymomatous MG comprised the group of control. Thymomatous myasthenia was more severe and resistant to therapy. 79 (48.7%) patients had thymoma type B, mixed thymoma type AB was found in 45 (30.0%) patients, the rest had medullary tumors type A. I stage of the tumor progression was registered in 62.0% of cases, stage III was the second to find among them (20.0%). Long-term follow-up revealed stable and statistically proved improvement of MG clinic in patients of the main group (p=0.013). Survival rate of patients with thymoma and MG were 91.2, 83.4 and 72.3% after 3-, 5- and 10 years, correspondingly. Survival rates for non-thymomatous MG were significantly higher: 96.0, 91.6 and 87.2% after 3-,5- and 10 years, correspondingly. Tumor characteristics showed no influence on MG course after the operation. As well, as for the patients of the control group, only severity of the disease was the significant factor for the MG prognosis. Oncological prognosis was defined by pathomorphological type of thymoma and its progression stage. Thymomthymectomy allowed not only tumor remission but also myasthenia course stabilization and improvement.

[Corrective plastic surgeries as a conclusive stage of surgical treatment of patients with alimentary-and-constitutional obesity].

The authors performed analysis of Russian and foreign literature (64 items) dedicated to long-term postoperative problems following corrective plastic surgery for morbid obesity. The analysis shows that literature does not contain clear criteria for patient selection and timing of surgery, and does not provide sufficient coverage of plastic surgical techniques. There are no data on the rate of complications and complex preventive measures.

[Intraoperative ultrasound investigation and laser spectroscopy for diagnosis of cancer in patients with lung tumors].

The experience in more than 2000 surgeries on the lungs is analyzed. Recently intraoperative ultrasonic and laser autofluorescent spectroscopic revision of tumors of the lungs and mediastinal organs is successfully used. Intrasurgical ultrasonic examination of the lungs permits to detect the structure and diffusion of primary lung tumor (invasion of vessels) that influences policy of treatment. Optical spectroscopy permits one to carry out intraoperative rapid diagnosis of benign and malignant lung tumors.

[A device for fluorescence diagnosis and photodynamic therapy of eye diseases, by using photosense].

By having a high photodynamic effectiveness and an ability of fluorescence, a Photosense photosensibilizer provides a way of combining photodynamic therapy (PDT) and monitoring its control within a session, which enhances the efficiency of treatment for the subretinal neovascular membrane. A slit lamp-based apparatus complex has been developed to employ the methods of fluorescence diagnosis (FD) and PDT, by applying this photosensitizer. The complex comprises an optical adapter that focusing laser radiation on the fundus of the eye in a range of 100-1000 microm, a video adapter that includes color and high-sensitive monochromic video cameras, as well as a personal computer and software that processes video information from the high-sensitive camera and displays the obtained images in real time. The original system of filters provides an image of the eye fundus in the fluorescent and usual color light at once during a FR procedure. The spatial resolution of the developed apparatus was tested on the test object specially devised for these purposes, which was 10 microm. The sensitivity of the complex is sufficient to record slightly fluorescent objects on the fundus of the eye.

[Ultrasonic technologies in diagnosis and treatment of patients with surgical diseases of lungs and pleura]. / Ul'trazvukovye tekhnologii v diagnostike i lechenii bol'nykh s khirurgicheskimi zabolevaniiami legkikh i plevry.

The results of complex examination and treatment of 376 patients with different diseases of the lungs and pleura were analyzed. High-frequency ultrasound was used in 256 patients for diagnosis of lungs and pleura surgical diseases, 412 ultrasonic examinations were performed. Intraoperative treatment of pleura with low-frequency ultrasound was carried out 134 times for prophylaxis and treatment of acute postoperative pleura empyema in 120 patients operated on for malignant tumors and chronic purulent diseases of the lungs. High efficacy of high-frequency ultrasound for diagnosis of pleura empyema, diffuse and encapsulated pleurisy is demonstrated. Ultrasound-assisted pleural punctures an transthoracic aspiration biopsies permit to avoid complications. Ultrasonic examination of the lungs during surgery in patient suspected of lung cancer permits to study tumor structure. Treatment of pleura with low-frequency ultrasound and combination of this method with photodynamic therapy promote reliable sanation of pleural cavity. Limited rethoracotomy and treatment of pleura with low-frequency ultrasound is the method of choice in the treatment of acute postoperative empyema when there is no effect of conservative treatment.

[Diagnostic approach in mechanical jaundice, complicated by purulent cholangitis]. / Diagnosticheskii podkhod pri mekhanicheskoi zheltukhe, oslozhnennoi gnoinym kholangitom.

Up-to-date high-informative non-invasive diagnostic methods were used in 54 patients with obstructive jaundice (OJ) complicated by purulent cholangitis (PC). Treatment-diagnostic algorithm can to improve results of diagnosis. This algorithm is the following: ultrasonic examination as a screening method; if a case of jaundice is unclear and obturation is prolonged magnetic-resonance tomography and magnetic-resonance cholangiopancreaticography are carried out; in block of a distal part of the common bile duct--spiral computed tomography with bolus amplification and duodenoscopy. Invasive diagnostic methods--endoscopic retrograde cholangiopancreatography, percutaneous transhepatic cholangiography (PTCG) are performed in buit indications in possibility to perform lithextraction and effective endoscopic decompression or in the tumor of Vater's papilla in case of low block. PTCG is used in high block and finished by percutaneous transhepatic bile outflow. General diagnostic efficacy of the complex in OJ was 97.8%. Diagnostic algorithm permitted us to make diagnosis and to start treatment in 85% during 1-2 days after hospitalization. Bile ducts decompression as a main stage of PC treatment was performed in the first 2 days after hospitalization. Diagnostic quest was performed at the same time with therapy after detoxication and correction of hemostasis disturbances.

[Diagnosis and choice of surgery of non-parasitic cysts of the liver]. / Diagnostika i vybor metoda khirurgicheskogo lecheniia neparazitarnykh kist pecheni.

Results of treatment of 342 patients with non-parasitic cysts of the liver (NCL) were analyzed. Based on obtained data diagnostic algorithm was developed. Indications and contraindications for transcutaneous and laparoscopic methods in NCL are clarified and substantiated. Features of laparoscopic operations in different location of cysts are presented. In mini-invasive surgeries postoperative complications rate was minimum, there were no lethal outcomes. The authors believe that conventional surgeries in NCL should be performed in critical states only.

[Combined use of low-frequency ultrasound and photodynamic therapy in the prevention of postoperative pleural empyema]. / Sochetannoe primenenie nizkochastotnogo ul'trazvuka i fotodinamicheskoi terapii dlia profilaktiki ostrykh posleoperatsionnykh émpiem plevry.

Results of surgical treatment of 20 patients with malignant lung tumors operated in N.N. Burdenko faculty surgical clinic were analyzed. The authors have developed the method of prophylaxis of acute postoperative pleural empyemas patented in Russian Federation. This method is: after main stage of operation (lob- or pneumonectomy) pleural cavity in filled with antiseptic solutions (furacillin 1:5000, 0.02% chlorgexidin). 5 ml of photosense (sulfured ftalocyanin of aluminium) were injected in pleural cavity, after it pleural cavity is treated by low-frequency ultrasound. After it the antiseptic is removed and pleural cavity is irradiated by red light with use of KAMIN-VIDEO lamp. In all the 20 operated patients who had undergone sanation of pleural cavity by low-frequency ultrasound and it irradiation by KAMIN-VIDEO lamp the postoperative period was uncomplicated.

[Obliterating arteriosclerosis of lower limb arteries and ischemic heart disease clinico-pathogenetic correlations]. / Obliteriruiushchii ateroskleroz arterii nizhnikh konechnostei i ishemicheskaia bolezn' serdtsa: kliniko-patogeneticheskie sootnosheniia.

To study clinical and pathogenetic correlations between different stages of arterial deficiency in obliterating atherosclerosis of lower limbs arteries (OALLA) and various clinical forms of ischemic heart disease (IHD) as well as the influence of different risk factors on OALLA clinical course in different arterial territories. The study included 76 OALLA patients (73 men and 3 women, mean age 56 years). The diagnosis was made on the basis of typical complaints, physical and device examinations. IHD was diagnosed on the basis of typical clinical symptoms and/or findings of the device examinations. OALLA and IHD differ by some risk factors. One of them--chronic alcoholism--is responsible for OALLA progression. This was shown by the analysis of chronic alcoholism prevalence in two groups of patients: with OALLA alone and OALLA in combination with IHD. In the former group alcoholics prevailed (61 vs 24.1%). Chronic alcoholism may be considered as an independent risk factor of OALLA development.

[Resources of intraoperative diagnosis of thyroid gland diseases]. / Vozmozhnosti sovershenstvovaniia intraoperatsionnoi diagnostiki zabolevanii shchitovidnoi zhelezy.

The method of intraoperative laser autofluorescent spectroscopy (IOLAS) has been developed and introduced in clinical practice for improvement of intraoperative diagnosis of thyroid gland diseases. 112 patients (17 men, 95 women, mean age 46.5 +/- 3.8) with various thyroid diseases were examined. Benign diseases were revealed in 96 (85.7%) patients, thyroid cancer--in 16 (14.3%). All the patients were operated. Rapid histologic examination and IOLAS were performed in all the patients. Main spectral characteristics and criteria of differential diagnosis of benign and malignant thyroid diseases were determined. High diagnostic value of this method was demonstrated. Results of IOLAS were compared with USI, thin-needle aspiration biopsy, express histologic examination. Sensitivity of IOLAS in differential diagnosis of malignant thyroid diseases achieves 95.4%, specificity--97.6%. IOLAS permits to clarify the morphology of thyroid lesions and to choice optimal scope of surgery. In accordance to IOLAS the scope of planned surgery was expanded in 18.2% cases that permitted to avoid repeated operations after elective histologic examination. It is concluded that the method may be used for optimisation of intraoperative diagnosis of thyroid diseases.

[Laparoscopic and standard cholecystectomy: comparison of immediate results]. / Laparoskopicheskaia i traditsionnaia kholetsistéktomia: sravnenie neposredstvennykh rezyl'tatov.

The advantages of laparoscopic cholecystectomy (LChE) are undoubtable in comparison with traditional one. However the experience showed, that LChE is not devoid of some shortcomings. It is characterized by the same typical complications as in ChE, besides it may be followed by some specific complications. The literature concerning the rate of complications in LChE are controversial. The comparative analysis has been carried out concerning the rate of complications after ChE (6800 operations) and LchE (900). The mean age of patients with choledocholythiasis--61.4 years. 40% of the patients had severe accompanying diseases coronary artery disease, complicated forms of arrythmia, arterial hypertension, diabetes mellitus, obesity. There were no significant differences between patients who underwent ChE (group 1) and LChE (group 2) by their age and the rate of accompanying diseases. Intraoperative cholangiography was performed in 3.5% of cases of group 1 and in 1.1%--in group 2. The average rate of the operations on extrahepatic bile ducts in group 1 was also lower--choledocholithotomy was carried out in 2.7%, transduodenal papillosphyncterotomy--in 1.7% of cases, drainage of the choledochal duct--in 1.9%. Combined operations were carried out in 10% of patients of group 1 and in 9.1% cases of group 2. The rate of intraoperative bleedings which demanded repeated operations made up in patients of group 1 0.1%, in patients of group 2 0.5%. Intraoperative damage of the choledochal duct in group 1 were detected in 0.14% and in group 2--in 0.11% of cases (the only complication of LChE in a patient was assessed as a endogenous wall clipping).