[Laparoscopic resection of the transplanted kidney for renal cell carcinoma T1N0M0].

Laparoscopic resection of the transplanted kidney has been very rarely reported in the literature. On the one hand, this is due to the extremely low incidence of tumors of renal transplants. On the other hand, these patients are usually managed by open surgery due to difficulties in laparoscopic resection because of the scar tissue in the kidney area. Other options, though rarely performed, are cryosurgery and radiofrequency ablation of the tumor. In this article we report our own experience with a patient who underwent laparoscopic resection of renal transplant for renal cell carcinoma T1aN0M0 19 years after kidney transplantation. The tumor sized 27 cm was found incidentally by routine ultrasound. The operative time was 115 minutes, the renal ischemia time - 28 min. No intra- and postoperative complications were observed. Histological examination revealed renal cell carcinoma, surgical margins were negative. The patient was discharged on the 7th day after the surgery, no graft dysfunction was observed.

[Bilateral nephrectomy in patients with end-stage renal failure and chronic active pyelonephritis].

This study analyzed the results of bilateral nephrectomy in 14 patients with end-stage renal disease (ESRD) and chronic active pyelonephritis. Seven patients had urosepsis, and 10 patients had a purulent form of pyelonephritis, which was one-sided in 7 of them. In the early postoperative period, on average, after 9.3 days, 9 patients died. Statistically significant risk factors for death were: chronic hemodialysis, long-term antibiotic therapy, and existing sepsis. Intraoperative complications and postoperative morbidity were not significantly associated with death. The study results imply the need of differentiated approach to bilateral nephrectomy in patients with ESRD and risk factors for fatal outcome. It must be performed on the strong indications since the intervention does not lead to eradication of sepsis. It is advisable to perform "preventive, sanation" bilateral nephrectomy in the "cold period" in patients at risk for developing urosepsis.

[The first national experience of laparoscopic removal of the transplanted kidney].

As a rule, the excision of a non-functioning renal graft in late (over 12 months) post-transplant period is performed using Fedorov subcapsular technique. This is because the kidney is embedded in scar tissue due to immune response to the allograft. This surgical approach is associated with the two major complications: bleeding during surgery or early postoperative hematoma and infection of hematoma confined in the remaining kidney capsule. To reduce blood loss and the risk of inflammatory complications, we, for the first time, carried out laparoscopic transplantectomy in a 42 year old female patient using the extracapsular technique. The operative time was 245 min, intraoperative blood loss - 350 ml. The patient was discharged to outpatient treatment on the 10th day. For the first time, such a surgery was successfully performed in 2010 in Turkey; in 2014 robotic transplantectomy was reported in the United States. No data on laparoscopic transplantectomy was found in the available national sources.

[BILATERAL NEPHROURETERECTOMY WITH CYSTOPROSTATECTOMY AD BLOC AND LYMPHADENECTOMY IN A PATIENT WITH END-STAGE RENAL FAILURE AND CANCER OF THE URINARY BLADDER T2BN0M0].

The article introduces a clinical example of a patient who was first diagnosed with bladder cancer, which contributed to the development of end-stage renal failure. Initially, given the significant upper urinary tract retention and post renal acute renal failure, the patient underwent bilateral percutaneous nephrostomy. Taking into account periodic gross hematuria, cystoscopy and transurethral electrocoagulation and biopsy of bladder tumor were performed and bladder cancer was identified. Despite adequate functioning of nephrostome drainage and daily urine output up to 3000 ml, kidney failure was not resolved. After creation of an arteriovenous fistula, a hemodialysis program was launched. The patient continued to experience persistent gross hematuria, he had a hectic fever, which was estimated as a symptom of acute pyelonephritis. The patient was scheduled for bilateral nephroureterectomy, cystoprostatectomy as the only option to remove the source of bleeding and infection. The operation was carried out without complications. The patient is currently maintained on chronic hemodialysis and followed by an oncologist at the place of residence; there are no data of bladder

[Replacement renal therapy in complex treatment of severe acute pancreatitis].

The purpose of this study was to retrospectively analyze the efficiency of replacement renal therapy (RRT) in multimodality treatment for severe acute pancreatitis (SAP) concurrent with a systemic inflammatory response and multiple organ failure/dysfunction. The authors analyzed the results of treating 55 patients (14 women and 41 men) aged 22 to 72 years (mean 43.5 +/- 16.4 years) treated at the intensive care units of Moscow City Clinical Hospital Fifty-Two in January 1, 2000, to December 31, 2006. All the patients had multiple organ dysfunctions with the involvement of 2 to 5 organs (median 4 (3; 4) and were on RRT. RRT may be successfully used in multimodality treatment for SAP provided that the dose of dialysis is at least 35 ml/kg/hour. The severe condition rated by the APACHE HII and SAPS II scales and the dialysis dose of less than 35 ml/kg/hour are independent risk factors of death in SAP patients.

[Prophylaxis of purulent complications in operations on large joints by endolymphatic infusion of drugs]. / Profilaktika gnoinykh osloznenii pri operatsiiakh na krupnykh sustavakh s pomoshch'iu éndolimfaticheskogo vvedeniia lekarstvennykh veshchestv.

2 groups of patients operated on knee joints for traumatic injuries were examined. In the study group endolymphatic drug therapy was carried out in postoperative period, in control group of patients conventional way of intramuscular administration of preparations was used. During the treatment, plasmatic cells, macrophages and tissue basophiles in synovial liquor were studied as well as synthesis of nucleic acids (DNA and RNA) in plasmatic cells. It was shown that immune homeostasis of synovial liquor in postoperative period normalized faster in endolymphatic administration. The studies of tissue basophiles have shown that inflammatory process in the knee joint is completed faster when endolymphatic route of drug administration was used. Clinical results evidence of higher effectiveness of endolymphatic therapy in comparison with conventional method of treatment in postoperative period. In the former case the inflammatory process was completed by the 5th day, in the latter--by the 7th-9th day. The endolymphatic therapy in all the patients resulted in healing of operation wounds by primary intention. In the group of patients treated by standard methods, suppuration of the wound was detected in 6 from 27 patients and postoperative synovitis in 7-9 days was observed in 6 patients.

[Primary controlled endolymphatic antibiotic therapy in traumatology and orthopedics]. / Priamaia upravlennaia éndolimfaticheskaia antibiotikoterapiia v travmatologii i ortopedii.

The work analyses 55 cases of traumatic osteomyelitis of the leg bones, open fractures of the leg bones, and medial fractures of the femoral neck. Patients with medial fractures of the neck of the femur were treated by endoprosthesis after Mur-Kaplan. Endolymphatic antibiotic therapy was included in the complex of therapeutic measures in each group of patients. This method allowed suppuration of the postoperative wounds to be avoided and promoted in this manner rehabilitation of the patients.