[The role of computer tomography in differential diagnosis of benign and malignant tumors of the adrenals cortex].

Possibilities of computer tomography (CT) application for differential diagnosis of tumors of the adrenal cortex (TAC) were studied. CT was conducted in 157 patients with TAC, including 75--with malignant (MTAC), 82--with benign (BTAC), permitting to revealed MTAC in 76% patients. In 17.1% patients with BTAC false-positive results were noted, reducing, thus, the method diagnostic value. While the trustworthy signs of malignancy are absent, it is necessary to conduct morphological verification of the adrenal tumors nature using puncture biopsy and/or intraoperative express-cytological investigation.

[Using magnetic-resonance tomography in differential diagnosis of the adrenal glands malignant tumors].

Possibilities of application of magnet-resonance tomography (MRT) for differential diagnosis of the adrenal glands tumors were studied up. MRT was conducted to 39 patients with adrenal glands tumors, including 22 - with malignant adrenal gland tumor, 17 - with benign tumor of adrenal gland. MRT constitutes the most effective method of topic diagnosis of the adrenal glands tumor, owes multipurpose possibilities, do not deliver radiation load, permits to visualize the vessels without the contrast media usage. The tumor diameter more than 10,1 cm, irregular form, illegible edges, uneven contours, presence of lymphadenopathy, regional or remote metastases constitutes diagnostic criterions of the adrenal glands malignant tumors. The intensity of MRT signal could not be used for differential diagnosis of malignant and benign tumors of adrenal glands.

[Using ultrasound investigation in differential diagnosis of adrenal malignant tumors].

Possibilities of ultrasound investigation (USI) application for differential diagnosis of the suprarenal glands tumors (SGT) were studied. USI was conducted in 169 patients with SGT, including 95 with malignant tumors of suprarenal glands (MTSG) and 64--with benign SGT. USI constitutes the main method of screening, permitting to reveal SGT in 90.5% of patients. Diagnostic criterions of MTSG were: diameter of tumor exceeding 10.1 cm, incorrect form, irregular edges, presence of invasion, lymphadenopathy, regional and remote metastases. In 45.3% of observations it was possible to establish the MTSG diagnosis, using USI.

[Classification of malignant tumors of suprarenal glands]. / Klassifikatsiia zlokachestvennykh opukholei nadpochechnikov.

The extent of diagnostic possibilities of medical technique, permitting to reveal the majority of suprarenal tumors, and the most modem information technologies as well demands creation of the suprarenal tumors applicable classification, well-adopted for physician in practice and also for scientist dealing with analysis of the investigation results in these pathology. Taking into account hormonal activity of majority of tumors, influencing the patients management tactic, the authors propose the insight on suprarenal tumor diagnosis of their own.

[Application of the puncture biopsy in diagnosis of malignant tumors of suprarenal glands]. / Primenenie punktsionnoi biopsii v diagnostike zlokachestvennykh opukholei nadpochechnikov.

Possibilities of application of the fine-needle aspiration puncture biopsy (FNAPB) in diagnosis of suprarenal glands tumors were studied. Of 43 patients, to whom FNAPB was performed, in 27 the suprarenal gland tumor was diagnosed, in 11--renal tumor, in 5--the puncture biopsy material occurred noninformative. Of 27 patients with tumor of suprarenal gland in 15 it was malignant, in 11--benign adenoma and cyst of suprarenal gland were revealed. FNAPB of the suprarenal gland tumor is a safe, informative and in some situations curative method. FNAPB is recommended for diagnosis of primarily revealed tumors of suprarenal glands more than 2 cm in diameter. The procedure should be performed by specially trained physician, who determines technical conditions of its conduction by himself and possesses the method o fultrasonography. Data of cytological investigationspermits to differentiate benign and malignant tumor, to determine the tumor type, what constitutes diagnostic background for the tactic choice of surgical intervention and the disease prognosis.

[Results of treatment of parathyroid gland cancer]. / Rezul'taty lecheniia raka parashchitovidnykh zhelez.

Carcinoma of parathyroid glands is characterized by relatively slow course, frequent recurrence after performance of operation. Authors were observed 8 patients, operated in 1967-2001, what had constituted 6% of all quantity of the primary hyperparathyroidism observations. Early diagnosis and performance of adequate surgical intervention promote the efficacy of treatment raising and the prognosis improvement. Most favourable prognosis was noted after performance of primary radical operation. In most observations the performance of reoperation guarantee long-lasting remission, but rarely constitutes the radical measure.

[Analysis of surgical treatment results of primary hyperparathyroidism]. / Analiz rezul'tatov khirurgicheskogo lecheniia pervichnogo giperparatireoza.

For the 1967-2000 period 134 patients with primary hyperparathyroidism (PHPTH) were treated in the clinic. Clinico-morphological characteristics of PHPTH were analyzed. In majority of the patients the mixed form of PHPTH was revealed. In 90% of patients solitary adenoma of parathyroid gland had constituted the morphological substrate of the disease. In 117 (87%) of patients positive result of treatment was noted. In 18 (15%) of patients postoperative permanent hypoparathyroidism occurred. Seven (4.5%) patients died. For the improvement of early diagnosis and effective treatment it is necessary to secure wide screening of the calcium content, peculiarly in patients, constituting the risk group.

[Reoperations in thyroid gland cancer]. / Povtornye operativnye vmeshatel'stva po povodu raka shchitovidnoi zhelezy.

Results of reoperation for the thyroid gland cancer (THGC) were analyzed in 189 patients for 1981-2001 yrs period. Majority of patients were primarily operated in other hospitals of Ukraine. Thorough characteristic of the cancer forms, terms of reoperation performance, results of histological investigation of the tumor are adduced. Large frequency (41.2%) of the operation performance for THGC recurrences in term up to one years after performance of primary intervention trusts the necessity of operative intervention performance on thyroid gland (THG) in specialized centre by experienced surgeons. Absence of malignant growth in the THG stump while performance of definitive thyroidectomy in 60% of observations is not the cause to reject of doing it because the conduction of radioiodine therapy is possible after complete excision of the THG tissue. Examination and ultrasonographic investigation of the THG region and of cervical lymphatic nodes after performance of operation for THGC is recommended to conduct no less than once in 6 months.

[Reflecting the mode of metastasizing of the thyroid gland tumor in TNM classification]. / Otrazhenie v klassifikatsii TNM regionarnogo metastazirovaniia opukholi shchitovidnoi zhelezy.

Essential approaches to the regional metastasizing rubric in TNM system were analyzed. Basing on summary of the results of 466 operations, performed for the thyroid gland cancer including intervention on cervical lymph nodes, the subgroup N alteration in international classification TNM was proposed, permitting to reflect individual clinical situation full to the brim and to achieve significant practical gain in further management of patient. The grading proposed corresponds to general principle, according to which every subsequent rubric must determine more severe affection without combining several types of affection in individual patient.

[Immune state of patients of various age with the thyroid gland tumor]. / Immunnyi status bol'nykh razlichnogo vozrasta s novoobrazovaniem shchitovidnoi zhelezy.

The comparative analysis of immune state of the various age patients with benign and malignant thyroid gland (TG) tumors is presented. In the TG cancer the immunogenesis insufficiency is more pronounced. The data obtained trusts the perspectiveness of the immunocorrecting therapy application in patients with the TG cancer.

Thyroid cancer in children of Ukraine after the Chernobyl accident.

The results of treatment of 330 children (< 14 years) and adolescents (15-18 years) with thyroid cancer who were operated on at the Institute of Endocrinology after the Chernobyl accident in 1986 were analyzed. The number of young patients increased after 1986 (1981-1985, 9 cases; 1986-1990, 37 cases; 1991-1995, 177 cases; 1996-1998, 116 cases). Most of these children and adolescents were younger than 8 years at the time of the accident (84.2%). More than half of the children (58.1%) lived in areas receiving the highest radiation exposure. These thyroid cancers developed after a short latent period, were more aggressive at presentation, and expressed regional (57.3%) or distant (14.5%) metastasis. Solid papillary cancers were present in 93.1%. Coexisting thyroid conditions were common (thyroid hyperplasia, 25.1%; nodular goiter, 18.8%; chronic thyroiditis, 10.2%). Most patients were treated by total thyroidectomy with intraoperative visualization of recurrent laryngeal nerves and parathyroid glands. When lymph node metastases were identified, a modified neck dissection was performed. Such operations were done in 277 (84.1%) patients. Postoperatively, the patients were treated with radioiodine and thyroid-stimulating hormone suppressive therapy. Postoperative complications included recurrent nerve palsy in 12.3% and permanent hypoparathyroidism in 6%. Operations for local recurrence of cancer were performed in 2.8% cases and for regional metastasis in 4%. The general mortality was 1. 8%. We anticipate that there will be more patients with thyroid cancer during the next few years. Therefore this high risk population for thyroid cancer must be carefully monitored and evaluated during the next several decades.

[Prophylaxis and methods of correction of the parathyroid insufficiency in surgical treatment of the thyroid cancer]. / Profilaktika i metody korrektsii nodostatochnosti parashchitovidnykh zhelez pri khirurgicheskom lechenii raka shchitovidnoi zhelezy.

The state of calcium metabolism in 249 patients after performance of thyroidectomy was studied up. It was established that precisional technique of the surgical intervention performance directed on the parathyroid glands vascularization preservation, is the main prophylactic method for the parathyroid insufficiency occurrence. Indications for the parathyroid tissue autotransplantation application during the performance of thyroidectomy are substantiated.

[Surgical treatment of benign tumors of thyroid gland in children and adolescents]. / Khirurgicheskoe lechenie dobrokachestvennykh novoobrazovanii shchitovidnoi zhelezy u detei i podrostkov.

In 1981-1998 years 552 children and juveniles were operated on for benign tumors of thyroid gland (TG). The enhancement of the revelation frequency of solitary and polynodous goiter and lowering of follicular adenoma and cystadenoma was noted. The tactics of children and juvenile patients with benign TG tumors was proposed, which included an early morphological verification of diagnosis, the puncture biopsy performance as well as intraoperative express-histological investigation. While solitary node in TG existence and preoperatively established its benign essence, extrafascial hemithyroidectomy, using original method, is the operative of choice.

Thyroid carcinoma in children and adolescents in Ukraine after the Chernobyl nuclear accident: statistical data and clinicomorphologic characteristics.

BACKGROUND: The increase in the number of childhood thyroid carcinoma cases in Ukraine after the Chernobyl nuclear accident in 1986 prompted the development of a registry of thyroid carcinoma cases at the Institute of Endocrinology and Metabolism in Kiev. In the current study, the authors report the statistical data and clinicomorphologic features of the cases included in this registry. METHODS: To study the incidence, and age and gender distribution of thyroid carcinoma in Ukraine, the authors compiled complete clinical information from cases diagnosed and treated at the Institute of Endocrinology and Metabolism and statistical reports submitted to the registry from 27 regions of Ukraine. Morphologic features of the resected tumors were examined and were included in the database. RESULTS: During the 5 years preceding the Chernobyl nuclear accident, a total of 59 cases of thyroid carcinoma were identified in the birth to 18 years age group (25 in children age < or = 14 years and 34 in adolescents ages 15-18 years). Between 1986 and 1997, the total number of thyroid carcinomas in Ukrainian children and adolescents was 577 (358 children and 219 adolescents). Morphologically, the thyroid tumors overwhelmingly were papillary carcinomas, and the majority of these also showed a follicular and/or solid growth pattern. Lymph node metastases and other extrathyroidal spread were common, thus necessitating total thyroidectomy and lymph node dissections in many patients. CONCLUSIONS: Between 1990 and 1997, a significant increase in the incidence of thyroid carcinoma was noted in children and adolescents in Ukraine; the group most affected was comprised of the individuals who were age < or = 5 years in 1986 (the year of the Chernobyl nuclear accident). The largest number of cases occurred in patients living in areas of thyroid radiation doses of > or =0.50 grays. The morphologic features of those thyroid tumors suggest that they are aggressive tumors with a high frequency of lymph node metastases, venous invasion, and extrathyroidal spread.

[Organ-salvaging surgeries for highly differentiated thyroid cancer in children]. / Vypolnenie organosokhraniaiushchikh operatsii po povodu vysokodifferentsirovannogo raka shchitovidnoi zhelezy u detei.

Retrospective analysis of results of organpreserving operations for the thyroid gland cancer (TGC) in 55 children and juveniles for 1981-1997 yrs period was done. The informativity of preoperative cytological (96.4%) and intraoperative express--histological (95.6%) investigations was determined. In cases of the cytological and express--histological diagnosis complexities the possibility of organpreserving intervention of hemithyroidectomy with the isthmus extirpation was noted. Primary thyroidectomy is operation of choice in the established diagnosis of TGC.

[Classification of thyroid gland operations]. / Klassifikatsiia operatsii na shchitovidnoi zheleze.

Classification of operations on thyroid gland depending on the tissue volume preserved and basing on the analysis of surgical treatment of more than 2000 patients was presented. Substantiation and characteristics of its headings permits to take into account the intervention volume, what is peculiarly important during the automatized processing of large masses of information.

[The first experiment in endoscopic surgery of the adrenal gland]. / Pervyi opyt vypolneniia éndoskopicheskogo vmeshatel'stva na nadpochechnikakh.

Laparoscopic adrenalectomy (LA) using transperitoneal lateral access was conducted in 56 patients from June 1994 to September 1996 yr. Unilateral adrenal gland tumor up to 8 cm in diameter was diagnosed in all the patients. All the patients are alive. LA is the method of choice in the patients with syndromes of Conn, Cushing, pheochromocytoma up to 8 cm in diameter. The LA conduction is not indicated if malignant or large (more than 8 cm in diameter) tumor was revealed.

[Transplantation of organic culture of adrenal grand cortical substance in the treatment of post-adrenalectomy hypocorticoidism]. / Transplantatsiia organnoi kul'tury korkovogo veshchestva nadpochechnikov v lechenii postadrenaléktomicheskogo gipokortitsizma.

The organ culture transplantation of the adrenals cortical substance of a newborn piglets was applied while 94 patients treatment to whom total adrenalectomy for Itsenko--Cushing disease was done. Significant lowering of the substitutional hormonal therapy (steroid preparations) dosage was permitted due to the noted improvement of hypocorticism clinical course and an organism hormonal security indexes. The clinical effect duration is 6-9 months. The methods physiologically substantiated, technically simple, economically advantageous, do not cause the side effects.