[Choice of surgical approach to insulin-producing pancreatic tumors]. / Vybor metoda khirurgicheskogo lecheniia insulinprodutsiruiushchikh opukholei podzheludochnoi zhelezy.

AIM: To determine the optimal surgical approach to insulin-producing pancreatic tumors via an analysis of early postoperative results. MATERIAL AND METHODS: There were 134 patients with insulin-producing pancreatic tumors followed by organic hyperinsulinism who have undergone surgery in the faculty-based surgical clinic of the Sechenov First Moscow State Medical University for the period 1990-2017. Patients were divided into three groups depending on type of surgical intervention. Surgical procedure was determined after comprehensive preoperative and intraoperative examination including intraoperative ultrasound. RESULTS: Incidence of postoperative complications was 32.8%. Ten (7.5%) patients required redo surgical interventions. Overall postoperative mortality was 4.5%. The best immediate results were observed in patients undergoing distal pancreatectomy. There was a correlation between incidence of early postoperative complications and tumor location depth in the enucleation group. CONCLUSION: Enucleation is advisable for insulinoma of pancreatic head or uncinated process, as well as superficial tumors of the left half of the pancreas. Distal pancreatectomy is indicated for deep tumors of the left half of the pancreas. Indications for pancreatoduodenectomy are individual.

Mesenchymal cells in the treatment of focal brain injury induced by venous circulation disturbances in rats.

We studied the efficiency of bone marrow multipotent mesenchymal stem cells for correction of neurological deficit in rats with experimental sustained focal brain injury caused by venous outflow disturbances. It was found that neurological deficit in animals with transplantation of multipotent mesenchymal stromal cells decreased by 54-75% (vs. 14-17% in the control group) by day 21. The efficiency of mesenchymal stromal cell transplantation (intravenous or local) on day 1 of postoperation period was significantly higher than on day 7. This manifested in more pronounced decrease in the severity of neurological disorders (according to modified neurological severity score) and more rapid recovery of autonomic feeding. Moreover, transplantation of multipotent mesenchymal stromal cells on day 1 abolished the need in antiedematous therapy, while in animals receiving cell therapy on day 7, administration of glucocorticoids was necessary. Comparison of two regimens of cell administration at early terms revealed no advantages of local transplantation of multipotent mesenchymal stromal cells over intravenous injection.

[Malignant insulinoma].

According to official statistics, malignant insulinomas account for a small fraction of gastroenteropathic endocrine neoplasms, the majority of insulinomas being essentially benign tumours. This paper reports a clinical case of malignant insulin-producing neuroendocrine tumour of the pancreas tail in a 28 year-old woman. She had multiple liver metastases and organic hyperinsulinism. Results of comprehensive examination of the patient at the Endocrinological Research Centre including laboratory diagnostic data and their evaluation are presented. Her surgical treatment was accomplished in N.N. Burdenko Facultative Surgery Clinic, I.M. Sechenov Moscow Medical Academy. Treatment strategy in the post-operative period and follow-up observations are described.