[Magnetic resonance imaging in liver function analysis. Modern objective reality]. / Opredelenie funktsii pecheni s pomoshch'yu magnitno-rezonansnoi tomografii. Sovremennaya ob"ektivnaya real'nost'.

Chronic liver disease is a serious worldwide problem because its progression is accompanied by liver fibrosis and cirrhosis at the terminal stages. Primary diagnosis and dynamic assessment of liver fibrosis are essential to determine the prognosis of disease and optimal treatment strategy. Long-term world experience in the use of gadoxetic acid (primovist, eovist) for diagnosis of liver diseases confirms its hepatotropic properties. Thus, magnetic resonance imaging (MRI) in hepatobiliary phase of contrast enhancement is valuable for differential diagnosis of focal liver lesions and assessment of liver structure and fibrotic changes. This review is devoted to the most common methods of contrast-enhanced MRI for assessment of liver function and correlation between severity of diffuse structural liver changes and gadoxetic acid accumulation in liver parenchyma. There is no a single method for MRI-based analysis of liver function that is confirmed by active researches in this direction. It was found that liver biopsy can by unnecessary in some cases if contrast-enhanced MRI with gadoxetic acid is available. The advantage of gadoxetic acid is also elimination properties. Indeed, biliary excretion ensures T1-weighted MR-cholangiography for additional assessment of patency, function and anatomy of the bile ducts. However, there are still several questions in this area that necessitates further research.

[Liver transplantation for hepatoblastoma in children]. / Transplantatsiya pecheni pri gepatoblastome u detei.

OBJECTIVE: To improve the outcomes in children with hepatoblastoma. MATERIAL AND METHODS: There were 160 children with focal liver lesions who underwent surgery at the department of liver transplantation in 2008-2019. Patients with malignant tumors made up 77% (n=123). Hepatoblastoma (HB) prevailed (86%, n=106). Liver transplantation was performed in 19 (18%) patients with HB. Median follow-up after transplantation was 24.3 months by December 2019. Follow-up period did not exceed 4 years in more than 2/3 of patients. RESULTS: Overall and disease-free 10-year survival was 87.1% and 82.7%, respectively. Similar values were observed after resections (91.1% and 86.6%). At the same time, actuarial 4-year survival after liver transplantation for HB was 68%. CONCLUSION: Improvement of treatment outcomes may be achieved through multidisciplinary interaction ensuring timely drug therapy and liver transplantation.

[Postoperative care in patients with DeBakey type I aortic dissection: criteria of aortic remodeling and risk factors of disease progression]. / Osobennosti techeniia posleoperatsionnogo perioda u patsientov s rassloeniem aorty I tipa po DeBakey: kriterii otsenki remodelirovaniia aorty i faktorov riska progressirovaniia zabolevaniia.

AIM: To present current treatment modes for DeBakey type I aortic dissection, to compare their early and mid-term postoperative results, to evaluate predictors of negative aortic remodeling after surgery. MATERIAL AND METHODS: Retrospective cohort analysis included 78 patients with DeBakey type I aortic dissection who underwent surgical treatment in 2009-2017. Patients were divided into 3 groups depending on type of intervention: group I (n=22) - Elephant Trunk procedure, group II (n=29) - hybrid interventions, group III (n=27) - proximal aortic replacement alone. Early postoperative results and aortic remodeling in mid-term postoperative period were compared. RESULTS: There were no significant differences in postoperative morbidity, in-hospital mortality and freedom from aortic death. However, 7 patients were lost for follow-up in group III. Analysis of false lumen patency showed results in favor of more aggressive approach (groups I and II) with significantly higher rate of false lumen thrombosis in segments 1 and 2 (p<0,001 and p=0,004 respectively). Freedom from negative aortic remodeling was also significantly higher in groups I and II. Risk factors of patent false lumen were residual fenestration, large volume of false lumen in segment 2, dissection of supra-aortic vessels and connective tissue disorders. Risk factors of negative aortic remodeling were connective tissue disorders, patent false lumen and dissection of supra-aortic vessels. CONCLUSION: Advanced surgical approach (Elephant Trunk procedure or hybrid interventions) should be preferred for DeBakey type I aortic dissection.

[Solid lesions of heart valves].

AIM: To analyze clinical-diagnostic and surgical aspects of cardiac valve solid lesions as well as long-term results of surgical treatment. MATERIAL AND METHODS: Clinical, diagnostic and surgical aspects of treatment of 51 patients with tumorous and pseudotumorous lesions of cardiac valves were analyzed. RESULTS AND DISCUSSION: Hospital complications were observed in 17.7% of patients. Mortality rate was 3.9%. 1- and 28-year overall survival was 100% and 94.1% respectively. Quality of life was good, satisfactory and unsatisfactory in 73.5%, 20.4% and 6.1% of cases respectively. CONCLUSION: Timely diagnostics of tumorous and pseudotumorous lesions of cardiac valves is very difficult but possible based on short history, positional dependence of symptoms, embolic events without rhythm disturbances. Additional instrumental methods including TTE, TEE, CT and MRI are necessary to define diagnosis. Intraoperative diagnostics and immediate histological survey are useful to determine volume of surgery in each case. Successful surgical treatment implies urgency, hypothermic perfusion and pharmaco-cold cardioplegia during operation.

[Hybrid technology in repeat operation of a patient with aortic arch aneurysm and type A chronic aortic dissection].

Presented herein is a clinical case report concerning successive use of hybrid technology in secondary surgical treatment of a patient with a progressing aortic arch aneurysm and aortic insufficiency, type A chronic aortic dissection after the primary operation of plasty of the aortic valve with prosthetic repair of the ascending aortic portion for type A acute dissection. The patient underwent hybrid operation: prosthetic repair of the aortic valve with mechanical prosthesis "Carbomedics", prosthetic repair of brachiocephalic branches by means of synthetic prostheses "Vascutek" with their switching to the prosthesis of the ascending aorta, stenting of the arch and descending portion of the aorta. The duration of the postoperative hospital stay amounted to 15 days. The control multispiral computed tomography with intravenous contrasting showed that the reconstruction zone was with no deformities, with the stent graft expanded, and no leaks noted. The conclusion was made that further improvement of hybrid technique can make it a true alternative to classical surgical operations in this severely ill cohort of patients. The presented clinical example demonstrates that simultaneous hybrid surgical intervention is the most correct approach in the given situation decreasing lowering the risk of the development of complications in both immediate and remote postoperative period.

[Features of maxillary and mandibular nerves imaging during stem regional blockades. From paresthesia to 3D-CT guidance].

There are difficulties in procedure of regional block of 2 and 3 brunches of the trigeminal nerve despite availability of many different methods of nerves imaging. The difficulties are connected with complex anatomy structure. Neurostimulation not always effective and as a rule, is accompanied with wrong interpretation of movement response on stimulation. The changing of the tactics on paraesthesia search improves the situation. The use of new methods of nerves imaging (3D-CT) also allows decreasing the frequency of fails during procedure of regional block of the brunches of the trigeminal nerve.

[The thoracic aorta aneurism stenting].

27 patients with thoracic aortic aneurism with dissection type III were operated on and stented. The mean age was 56±11,17 years. Men were 24, women 3. 1 patient developed intraoperative stent-graft leakage type IV, and 1 - type II. Both cases needed no additional manipulations. Minimal invasiveness of the procedure and pain absence allowed early activisation of patients. 2 patients had postoperative paraplegia, which was successfully treated by spinal drainage. There were no lethal cases. The long-term follow-up showed no leakage on CT scans; 11 patients demonstrated complete closure of false canal of the stented segment. The overall survival rate was 92.6% after 60 months of follow-up. Unfavorable results were registered in 29.6%.

[Noncoronary dilated cardiomyopathy after reverse remodeling heart surgery].

We present here analysis of surgical treatment of 24 patients (5 women, 19 men, age 20-75, mean age 50.7 +/- 2.5 years) with dilated cardiomyopathy (DCM) operated during the period from 2008 to 2013. Duration of the disease ranged from 4 months to 12 years (mean 49.4 +/- 7.5 months). According to symptoms and results of 6-minute walk test 3 patients (13%) had heart failure NYHA class III and 21 patients (87%)--NYHA class IV. Average end-diastolic left ventricular size was 7.4 +/- 0.18 cm (6.0-9.2 cm), ejection fraction--26.7 +/- 2.1% (13-47%), mean pulmonary artery pressure 54.9 +/- 2.9 mm Hg (35-80 mmHg). All patients underwent organ-conserving surgery aimed at reverse remodeling of the heart. Surgery was accompanied with implantation of implantable cardioverter defibrillator in 3 patients and/or cardiac resynchronization therapy device in 6 patients. Two patients (8.3%) died during hospitalization of hemodynamically significant ventricular arrhythmias; seven patients (29.2%) died in the late postoperative period. The results of the analysis indicate that reverse-remodeling surgery may be effective in patients with DCM of any age group with preserved reserves of the liver, kidney, and lung function in the absence of active myocarditis. Further observations are needed to determine the place of this operation in the protocol of treatment of patients with DCM.

[The treatment of the sponateneous biloma and choledocholithiasis after the liver resection on the reason of the giant hemangioma].

Patient with giant rapidly growing liver hemangioma who carried out right hemihepatectomy is reported. The feature if this case is choledocholithiasis after liver resection followed by its rare complication (spontaneous biloma) in 6 years after surgery. Minimally invasive procedures (percutaneous drainage, endoscopic papillotomy and stenting) eliminated each of bile collection and cause of biliary obstruction without surgical intervention.

[Pathogenesis of esophageal and gastric varicose veins formation in patients with liver cirrhosis].

RESEARCH OBJECTIVE: studying the features of the collateral venous blood flow and the basic ways of the formation of gastroesophageal varices in patients with cirrhosis and portal hypertension. METHODS: The following analysis is based on the interpretation of results from percutaneous transhepatic splenoportography in 85 patients. It has been established that in all 85 patients the left gastric vein plays a key role in the formation of gastroesophageal varices. RESULTS: It is established that a leading collector in 100% of observations participating in formation gastroesophageal varices, is the left gastric vein. In work the attention is focused on an insufficient estimation of a role of a back gastric vein in a pathogenesis of varicose transformation. From 85 observations its presence is taped in 58 (68%) cases, and, at 19 (22%) patients its expansion isn'ted in a combination to expansion left gastric vein, and at 39 (46%) patients - in a combination with left gastric vein and short veins of a stomach. CONCLUSION: The obtained data on the formation mechanism of varicose expanded veins of an esophagus and a stomach defines necessity of changes for algorithm of inspection of patients for the purpose of diagnostics of features of a venous blood flow of a stomach and an esophagus and definition of surgical tactics concerning volume pre- or intraoperational blockade of the basic venous collectors.

[Resection and aorta replacement in extended and combined operations for lung cancer].

In spite of the progress in thoracic surgery and oncology, great lethality in lung cancer patient still persists, and so the questions of not only the early diagnostics but also the development of new techniques of surgical treatment remain actual which allow radical ablation of extended tumors. In the Russian Scientific Center of Surgery named after academician B.V. Petrovsky of the Russian Academy of Medical Sciences three patients were subjected to extended combined operations of pneumonectomy with a simultaneous resection and replacement of the thoracic part of the aorta for local dissemination of lung cancer. Extracorporeal circulation was used in one patient and in two patients resection and replacement of the aorta were fulfilled on the cross-clapmed aorta under conditions of ischemia of organs and tissues below the left subclavian artery. There were no ischemic injuries of organs after operation. All the patients were directed to chemio-radiation therapy.

[Radiological diagnosis of liver hemangiomas: look at the problem of surgical clinic].

AIM: To define significance of radiological diagnostics in detection and characterization of hepatic hemangiomas. MATERIALS AND METHODS: Analysis of 176 patients with liver hemangiomas was performed. All patients were investigated or consulted in hepato-pancreato-biliary surgical department. US, CT, MRI, angiography, scintigraphy and liver biopsy were compared. RESULTS: Contemporary noninvasive diagnostics disclose liver hemangiomas with high confidence without need for tumor biopsy. MRI and CT with intravenous enhancement are the most efficient modalities for detection of hepatic hemangiomas.

[Brain cryodestruction in mammals in vivo].

26 animals (13 pigs and 13 rabbits) were involved in the study. Liquid nitrogen cryodestruction experimental  machine was used. The following measurements and investigation were performed: invasive temperature measurement, intraoperative ultrasound, magnetic resonance imaging and pathomorphologic assessment. An ice sphere was hypoechogenic with hyperechogenic  contour by ultrasound.  Postoperative MRI showed signs of local ischemic oedema in cryodestruction zone, no signs of bleeding were detected. Morphologically zones of total necrosis, oedema and minor dystrophic changes were recognized. Cryodestruction proved to be a reliable technique of cold brain necrosis.

[Is local prosthetics of descending thoracic aorta by its distal dissection effective?].

12 patients with distal aortic dissection were included in the study. All had aortic prosthetics and hemodynamic correction. 6 patients (1st group) had hemodynamic correction type I - Cutdown of the false aortic canal and guiding the blood flow to the correct canal. The rest 6 (2nd group) hemodynamic correction type II was performed (guiding blood flow to the both aortic channels). 83,3% of patients of the 1st group demonstrated the false aortic channel thrombosis up to the level of visceral branches, the rest 33,3% of patients had total thrombosis of the false channel. All patients of the 2nd group demonstrated maintenance of the blood flow in both channels, which leaves risk of further aortic dilatation and rupture.